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Maternal stress in pregnancy exerts powerful programming effects into the next generation. Yet it remains unclear whether and how adversity from other times in the woman's life influences her prenatal stress and her offspring's stress functioning. In a sample of 217 Black American mother-infant dyads, we examined whether different types of maternal stress were differentially related to her infant's stress functioning within the first few months after birth. We prospectively assessed maternal distress (perceived stress, depression, and anxiety) early and late in pregnancy, infant behavioral adaption in the context of a mild stressor at 2 weeks of age, and infant diurnal cortisol at 3-6 months of age. We additionally collected retrospective reports of maternal experiences of lifetime discrimination and childhood adversity. Maternal distress experienced late, but not early, in pregnancy predicted lower infant attention in the context of a stressor. Moreover, lifetime experiences of discrimination indirectly impacted infant attention by increasing maternal distress late in pregnancy. These effects were specific to infant behavioral adaptation and were not related to infant diurnal cortisol levels. However, infant diurnal cortisol levels were associated with maternal experiences of discrimination from prior to pregnancy and adversity from the mother's childhood even after controlling for prenatal distress. Our results underscore the cascading nature of stress across the mother's life span and across generations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Purpose: Nelfinavir, a PI3K pathway inhibitor, is a radiosensitizer that increases tumor blood flow in preclinical models. We conducted an early-phase study to demonstrate the safety of nelfinavir combined with hypofractionated radiotherapy (RT) and to develop biomarkers of tumor perfusion and radiosensitization for this combinatorial approach.Experimental Design: Ten patients with T3-4 N0-2 M1 rectal cancer received 7 days of oral nelfinavir (1,250 mg b.i.d.) and a further 7 days of nelfinavir during pelvic RT (25 Gy/5 fractions/7 days). Perfusion CT (p-CT) and DCE-MRI scans were performed pretreatment, after 7 days of nelfinavir and prior to the last fraction of RT. Biopsies taken pretreatment and 7 days after the last fraction of RT were analyzed for tumor cell density (TCD).Results: There were 3 drug-related grade 3 adverse events: diarrhea, rash, and lymphopenia. On DCE-MRI, there was a mean 42% increase in median Ktrans, and a corresponding median 30% increase in mean blood flow on p-CT during RT in combination with nelfinavir. Median TCD decreased from 24.3% at baseline to 9.2% in biopsies taken 7 days after RT (P = 0.01). Overall, 5 of 9 evaluable patients exhibited good tumor regression on MRI assessed by tumor regression grade (mrTRG).Conclusions: This is the first study to evaluate nelfinavir in combination with RT without concurrent chemotherapy. It has shown that nelfinavir-RT is well tolerated and is associated with increased blood flow to rectal tumors. The efficacy of nelfinavir-RT versus RT alone merits clinical evaluation, including measurement of tumor blood flow. Clin Cancer Res; 22(8); 1922–31. ©2016 AACR.See related commentary by Meyn et al., p. 1834

Supplementary Table 1: Laboratory values (Liver Function Tests) Supplementary Table 2: Overview of mean pCT parameters for tumour VOI on sequential scans Supplementary Table 3: Overview of median DCE-MRI parameters, Ktrans, Ve and Kep for tumour VOI on sequential scans. Mean across all patients of the median per patient values is shown. Supplementary Table 4: Correlations of baseline characteristics, mutation status & overall mrTRG score with TCD. Supplementary Table 5 Correlations of baseline characteristics, mutation status & overall mrTRG score with median Ktrans. Supplementary Table 6: Correlations of baseline characteristics, mutation status & overall mrTRG score with mean Blood Flow. Supplementary Figure 1: Axial and sagittal images from T2W MRI scans at baseline and 8 weeks after completion of therapy. Supplementary Figure 2: Perfusion parameter maps illustrating an increase in Blood Flow and reduction in MTT between Scans 2 and 3. Supplementary Figure 3: Examples of (a) positive immunohistochemistry staining in pre-treatment rectal tumour biopsies and (b) absent staining in negative control.

PURPOSE Polymer covered stents have demonstrated promising clinical outcomes with improved patency rates compared to traditional bare-metal stents. However, little is known on the mechanical implication of stent covering. This study aims to provide insight into the role of a polymeric cover on the biomechanical performance of self-expanding laser-cut stents through a combined experimental-computational approach. METHODS Experimental bench top tests were conducted on bare and covered versions of a commercial stent to evaluate the radial, axial and bending response. In parallel, a computational framework with a novel covering strategy was developed that accurately predicts stent mechanical performance. Different stent geometries and polymer materials were also considered to further improve understanding on covered stent mechanics. RESULTS Results show that stent covering causes increased initial axial stiffness and up to 60% greater radial resistive force at small crimp diameters as the cover folds and self-contacts. The incorporation of a cover allows stent designs without interconnecting struts, thereby providing improved flexibility without compromising radial force. It was also shown that use of a stiffer PET polymeric covering material caused significant alterations to the radial and axial response, with the initial axial stiffness increasing six-fold and the maximum radial resistive force increasing four-fold compared to a PTFE-PU covered stent. CONCLUSION This study demonstrates that stent covering has a substantial effect on the overall stent mechanical performance and highlights the importance of considering the mechanical properties of the combined cover and stent.

Black American women are disproportionately exposed to adversities that may have an intergenerational impact on mental health. The present study examined whether maternal exposure to adversity and epigenetic age acceleration (EAA; a biomarker of stress exposure) predicts the socioemotional health of her offspring. During pregnancy, 180 Black American women self-reported experiences of childhood adversity and marginalization-related adversity (i.e., racial discrimination and gendered racial stress) and provided a blood sample for epigenetic assessment. At a three-year follow-up visit, women reported their offspring's emotional reactivity (an early indicator of psychopathology) via the CBCL/1.5-5. After adjusting for maternal education and offspring sex, results indicated that greater maternal experiences of childhood trauma (β = 0.21, SE(β) = 0.01; p = 0.01) and racial discrimination (β = 0.14, SE(β) = 0.07; p = 0.049) predicted greater offspring emotional reactivity, as did maternal EAA (β = 0.17, SE(β) = 0.09, p = 0.046). Our findings suggest that maternal EAA could serve as an early biomarker for intergenerational risk conferred by maternal adversity, and that 'maternal adversity' must be defined more broadly to include social marginalization, particularly for Black Americans.

A person-centered approach to examining trauma has uncovered typologies of polytraumatization that are differentially associated with psychopathology. However, previous research is limited by narrow conceptualizations of trauma, limited distal outcomes, and underrepresentation of racially marginalized groups. To address these gaps, we used latent profile analysis to uncover distinct polytraumatization typologies and examine four symptom-based (posttraumatic stress disorder, depression, aggression, and substance abuse) and two behavior-based (self-harm, jail counts) outcomes in a sample of adults with low socioeconomic resources ( N = 7,426, 94% African American). The models were indicated by 19 traumatic experiences (e.g., accident, sexual assault, witnessing/experiencing violence). The best fitting model uncovered five classes: minimal trauma, physical abuse, violence exposure, sexual abuse, and polytrauma. Classes characterized by significant and varied trauma were higher on both internalizing and externalizing psychopathology, whereas those characterized by specific types of trauma were higher on only one type of psychopathology. Implications for the assessment and treatment of trauma-related disorders are discussed.

Purpose To quantitatively evaluate the effect of computed tomography (CT) reconstruction kernels on various dose calculation algorithms with heterogeneity correction. Methods The gammex electron density (ED) Phantom was scanned with the Siemens PET/CT Biograph20 mCT and reconstructed with twelve different kernel options. Hounsfield unit (HU) vs electron density (ED) curves were generated to compare absolute differences. Scans were repeated under head and pelvis protocols and reconstructed per H40s (head) and B40s (pelvis) kernels. In addition, raw data from a full‐body patient scan were also reconstructed using the four B kernels. Per reconstruction, photon (3D and VMAT), electron (18 and 20 MeV) and proton (single field) treatment plans were generated using Varian Eclipse dose calculation algorithms. Photon and electron plans were also simulated to pass through cortical bone vs liver plugs of the phantom for kernel comparison. Treatment field monitor units (MU) and isodose volumes were compared across all scenarios. Results The twelve kernels resulted in minor differences in HU, except at the extreme ends of the density curve with a maximum absolute difference of 55.2 HU. The head and pelvis scans of the phantom resulted in absolute HU differences of up to 49.1 HU for cortical bone and 45.1 HU for lung 300, which is a relative difference of 4.1% and 6.2%, respectively. MU comparisons across photon and proton calculation algorithms for the patient and phantom scans were within 1–2 MU, with a maximum difference of 5.4 MU found for the 20 MeV electron plan. The 20MeV electron plan also displayed maximum differences in isodose volumes of 20.4 cc for V90%. Conclusion Clinically insignificant differences were found among the various kernel generated plans for photon and proton plans calculated on patient and phantom scan data. However, differences in isodose volumes found for higher energy electron plans amongst the kernels may have clinical implications for prescribing dose to an isodose level.

Recent studies have implicated cellular senescence as a disease-related process linked to progressive forms of multiple sclerosis (MS). Herein, we present an overview of the current pharmacopeia of cellular senescence affecting compounds and evidence for their effects, if known, in murine and cellular models of MS. Consideration is also given to the utility of these compounds for the treatment of progressive MS, with an examination of past and current clinical trials that have tested these agents, often for other purposes, in the MS patient population. Lastly, we discuss the implications and potential utility for targeting cellular senescence as a strategy to fulfil the unmet need of treatment options for the progressive MS population.

Objective Race-related lifetime stress exposure (LSE) including racial discrimination, trauma, and stressful life events have been shown to contribute to racial health disparities. However, little is known about associations between race-related stressors and premature biological aging that confer the risk of adverse health outcomes. Even less is known about the mechanisms through which race-related stressors may be associated with accelerated aging. Early evidence suggests psychological processes such as anger, and particularly the internalization of anger, may play a role. Methods In a community sample of predominantly low-income Black adults (n = 219; age = 45.91 [12.33] years; 64% female), the present study examined the association of race-related LSE (as defined by exposure to racial discrimination, trauma, and stressful life events) and epigenetic age acceleration through anger expression. Results Internalized and externalized anger expression were each significantly associated with LSE and age acceleration. Although LSE was not directly associated with age acceleration (ΔR2 = 0.001, p = .64), we found that greater LSE was indirectly associated with age acceleration through increases in internalized, but not externalized, anger (indirect effect: β = 0.03, standard error = 0.02, 95% confidence interval = 0.003 to 0.08; total effect: β = 0.02, 95% confidence interval = -0.25 to 0.31). Conclusions These results suggest race-related LSE may elicit the internalization of anger, which, along with the externalization of anger, may initiate detrimental epigenetic alterations that confer the risk of adverse health outcomes. These findings lay the groundwork for longitudinal studies of the association between race-related stress and racial health disparities.

Background Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) display a strong male bias. Androgen exposure is profoundly increased in typical male development, but it also varies within the sexes, and previous work has sought to connect morphological proxies of androgen exposure, including digit ratio and facial morphology, to neurodevelopmental outcomes. The results of these studies have been mixed, and the relationships between androgen exposure and behavior remain unclear. Methods Here, we measured both digit ratio masculinity (DRM) and facial landmark masculinity (FLM) in the same neurodevelopmental cohort (N = 763) and compared these proxies of androgen exposure to clinical and parent-reported features as well as polygenic risk scores. Results We found that FLM was significantly associated with NDD diagnosis (ASD, ADHD, ID; all $$p p < 0.05 ), while DRM was not. When testing for association with parent-reported problems, we found that both FLM and DRM were positively associated with concerns about social behavior ($$\rho =0.19$$ ρ = 0.19 , $$p=0.004$$ p = 0.004 ; $$\rho =0.2$$ ρ = 0.2 , $$p=0.004$$ p = 0.004 , respectively). Furthermore, we found evidence via polygenic risk scores (PRS) that DRM indexes masculinity via testosterone levels ($$t=4.0$$ t = 4.0 , $$p=8.8\times 10^{-5}$$ p = 8.8 × 10 - 5 ), while FLM indexes masculinity through a negative relationship with sex hormone binding globulin (SHBG) levels ($$t=-3.3$$ t = - 3.3 , $$p=0.001$$ p = 0.001 ). Finally, using the SPARK cohort (N = 9419) we replicated the observed relationship between polygenic estimates of testosterone, SHBG, and social functioning ($$t=-2.3$$ t = - 2.3 , $$p=0.02$$ p = 0.02 , and $$t=4.2$$ t = 4.2 , $$p={3.2\times 10^{-5}}$$ p = 3.2 × 10 - 5 for testosterone and SHBG, respectively). Remarkably, when considered over the extremes of each variable, these quantitative sex effects on social functioning were comparable to the effect of binary sex itself (binary male: $$-0.22\pm 0.05$$ - 0.22 ± 0.05 ; testosterone: $$-0.35\pm 0.15$$ - 0.35 ± 0.15 from 0.1%-ile to 99.9%-ile; SHBG: $$0.64\pm 0.15$$ 0.64 ± 0.15 from 0.1%-ile to 99.9%-ile). Limitations In the devGenes and SPARK cohorts, our analyses rely on indirect, rather than direct measurement of androgens and related molecules. Conclusions These findings and their replication in the large SPARK cohort lend support to the hypothesis that increasing net androgen exposure diminishes capacity for social functioning in both males and females.

Maternal stress during pregnancy can cause alterations to the fetal hypothalamus–pituitary–adrenal (HPA) axis, a phenomenon known as fetal programming that may have lasting effects on offspring outcomes, including depression. Evidence suggests that these effects may vary with respect to the offspring's genetic risk. Nonetheless, few studies have examined these effects into adulthood, when risk for depression onset is highest. The present study builds upon the extant literature by examining the interaction of maternal prenatal perceived stress (MPPS) and offspring HPA-axis polygenic risk to predict offspring depression in early adulthood. A total of 381 mother–child dyads participated in a prospective, longitudinal study that spanned from pregnancy until offspring were 20 years of age. Polygenic risk was defined by a multilocus genetic profile score (MGPS) that reflected the additive risk of three HPA-axis candidate genes. The results indicated that the interaction of MPPS and HPA-axis MGPS confers risk for offspring depression at age 20, in line with the differential susceptibility model. This interaction may be specific to prenatal stress, as maternal stress during early childhood did not interact with genetic risk to predict depression. These findings provide the first evidence that genetic variants that are associated with the HPA axis may act in a polygenic, additive fashion to moderate the association between fetal programming and adult depression.

Purpose: Tumor hypoxia fuels an aggressive tumor phenotype and confers resistance to anticancer treatments. We conducted a clinical trial to determine whether the antimalarial drug atovaquone, a known mitochondrial inhibitor, reduces hypoxia in non–small cell lung cancer (NSCLC). Patients and Methods: Patients with NSCLC scheduled for surgery were recruited sequentially into two cohorts: cohort 1 received oral atovaquone at the standard clinical dose of 750 mg twice daily, while cohort 2 did not. Primary imaging endpoint was change in tumor hypoxic volume (HV) measured by hypoxia PET-CT. Intercohort comparison of hypoxia gene expression signatures using RNA sequencing from resected tumors was performed. Results: Thirty patients were evaluable for hypoxia PET-CT analysis, 15 per cohort. Median treatment duration was 12 days. Eleven (73.3%) atovaquone-treated patients had meaningful HV reduction, with median change −28% [95% confidence interval (CI), −58.2 to −4.4]. In contrast, median change in untreated patients was +15.5% (95% CI, −6.5 to 35.5). Linear regression estimated the expected mean HV was 55% (95% CI, 24%–74%) lower in cohort 1 compared with cohort 2 (P = 0.004), adjusting for cohort, tumor volume, and baseline HV. A key pharmacodynamics endpoint was reduction in hypoxia-regulated genes, which were significantly downregulated in atovaquone-treated tumors. Data from multiple additional measures of tumor hypoxia and perfusion are presented. No atovaquone-related adverse events were reported. Conclusions: This is the first clinical evidence that targeting tumor mitochondrial metabolism can reduce hypoxia and produce relevant antitumor effects at the mRNA level. Repurposing atovaquone for this purpose may improve treatment outcomes for NSCLC.

Platinum chemotherapies are highly effective cytotoxic agents but often induce resistance when used as monotherapies. Combinatorial strategies limit this risk and provide effective treatment options for many cancers. Here, we repurpose atovaquone (ATQ), a well-tolerated & FDA-approved anti-malarial agent by demonstrating that it potentiates cancer cell death of a subset of platinums. We show that ATQ in combination with carboplatin or cisplatin induces striking and repeatable concentration- and time-dependent cell death sensitization in vitro across a variety of cancer cell lines. ATQ induces mitochondrial reactive oxygen species (mROS), depleting intracellular glutathione (GSH) pools in a concentration-dependent manner. The superoxide dismutase mimetic MnTBAP rescues ATQ-induced mROS production and pre-loading cells with the GSH prodrug N-acetyl cysteine (NAC) abrogates the sensitization. Together, these findings implicate ATQ-induced oxidative stress as key mediator of the sensitizing effect. At physiologically achievable concentrations, ATQ and carboplatin furthermore synergistically delay the growth of three-dimensional avascular spheroids. Clinically, ATQ is a safe and specific inhibitor of the electron transport chain (ETC) and is concurrently being repurposed as a candidate tumor hypoxia modifier. Together, these findings suggest that ATQ is deserving of further study as a candidate platinum sensitizing agent.

Current rheumatology guidelines recommend exercise as a key component in the management of people with RA, however, what is lacking is evidence on its impact on sleep. Objective is to assess the feasibility of a walking-based intervention on TST, sleep quality, and sleep disturbance and to generate potential effect size estimates for a main trial. Participants were recruited at weekly rheumatology clinics and through social media. Patients with RA were randomized to a walking-based intervention consisting of 28 sessions, spread over 8 weeks (2-5 times/week), with 1 per week being supervised by a physiotherapist, or to a control group who received verbal and written advice on the benefits of exercise. Primary outcomes were recruitment, retention, protocol adherence and participant experience. The study protocol was published and registered in ClinicalTrials.gov NCT03140995. One hundred and one (101) people were identified through clinics, 36 through social media. Of these, 24 met the eligibility criteria, with 20 randomized (18% recruitment; 100% female; mean age 57 (SD 7.3 years). Ten intervention participants (100%) and eight control participants (80%) completed final assessments, with both groups equivalent for all variables at baseline. Participants in the intervention group completed 87.5% of supervised sessions and 93% of unsupervised sessions. No serious adverse events were related to the intervention. Pittsburgh Sleep Quality Index global score showed a significant mean improvement between the exercise group-6.6 (SD 3.3) compared to the control group-0.25 (SD 1.1) (p = 0.012); Intervention was feasible, safe and highly acceptable to study participants, with those participants in the exercise group reporting improvements in sleep duration and sleep quality compared to the control group. Based on these findings, a fully powered randomized trial is recommended. Trial registration number: ClinicalTrials.gov Identifier: NCT03140995 (April 25th, 2017).

Most genes associated with neurodevelopmental disorders (NDDs) were identified with an excess of de novo mutations (DNMs) but the significance in case-control mutation burden analysis is unestablished. Here, we sequence 63 genes in 16,294 NDD cases and an additional 62 genes in 6,211 NDD cases. By combining these with published data, we assess a total of 125 genes in over 16,000 NDD cases and compare the mutation burden to nonpsychiatric controls from ExAC. We identify 48 genes (25 newly reported) showing significant burden of ultra-rare (MAF 0.01%) gene-disruptive mutations (FDR 5%), six of which reach family-wise error rate (FWER) significance (p 1.25E-06). Among these 125 targeted genes, we also reevaluate DNM excess in 17,426 NDD trios with 6,499 new autism trios. We identify 90 genes enriched for DNMs (FDR 5%; e.g., GABRG2 and UIMC1); of which, 61 reach FWER significance (p 3.64E-07; e.g., CASZ1). In addition to doubling the number of patients for many NDD risk genes, we present phenotype-genotype correlations for seven risk genes (CTCF, HNRNPU, KCNQ3, ZBTB18, TCF12, SPEN, and LEO1) based on this large-scale targeted sequencing effort.

We aim to demonstrate the unique use of embedded lead eye shields in an electron wax bolus when treating the nasal dorsum. A patient presented to the clinic with squamous cell carcinoma of the nasal dorsum requiring treatment with en face electrons. A 3D customized wax bolus was designed and imported into the treatment planning system (TPS) to calculate the dose distribution. Due to high lens dose, the bolus was customized further to create 2 milled open slots in the wax, over the lens of eye, to allow lead sheets totaling 4 mm to be slid into the wax. The patient was brought back to the clinic to be scanned with the wax bolus fitting snugly over the nose, eyes, and cheek regions. The 3D milled insert holes were contoured on the CT in the TPS, assigned HU of 2758, to mimic the lead insertion. The lens dose with lead inserts was compared to the plan without lead insert. To further confirm the lens dose, EBT3 films were placed on the right and left eye under the bolus, and nose dorsum on the first day of treatment. The maximum dose of right lens, as calculated in the TPS with the simulated lead shields in place, decreased from 989.5cGy to 457cGy. The maximum dose of left lens decreased from 1085.4cGy to 501cGy. The dose readings from EBT3 films were in good agreement with the TPS, with deviation of 3.32%, 0.26%, and 3.44% for right lens, left lens, and nose, respectively. Daily positioning deviations compared to the plan were 0.65 ± 0.16cm and 0.63 ± 0.29cm for right eye and left eye, respectively. This novel device demonstrated the feasibility, in terms of dose calculation accuracy in the TPS and fabrication, of using customized bolus with lead inserts to conveniently shield the lens of the eyes in an electron treatment for the nose, enabling a streamlined daily setup.

Previous studies suggest epigenetic alterations may contribute to the association between maternal prenatal depression and adverse offspring outcomes. Developmental researchers have recently begun to examine these associations in relation to epigenetic age acceleration/deceleration, a biomarker of developmental risk that reflects the deviation between epigenetic age and chronological age. In the perinatal period, preliminary studies indicate that maternal prenatal depression may lead to epigenetic age deceleration in newborns, which may predict adverse developmental outcomes. The present study examined the relationship between maternal prenatal exposures (i.e., depression, stress, and SSRI use) and offspring epigenetic age deceleration in 303 mother-offspring dyads. Women were recruited in the first trimester of pregnancy and followed longitudinally until delivery. Maternal depression, perceived stress, and SSRI use were assessed at each prenatal visit. Newborn epigenetic age was determined via cord blood samples. Results indicated maternal prenatal stress was not associated with newborn epigenetic age deceleration (ΔR(2) = 0.002; p = 0.37). Maternal prenatal depression was associated with decelerated epigenetic age (ΔR(2) = 0.01, p = 0.04), but this relationship did not hold when accounting for maternal use of SSRIs (ΔR(2) = 0.002, p = 0.43). Conversely, maternal SSRI use significantly predicted newborn epigenetic age deceleration over and above the influence of maternal depression (ΔR(2) = 0.03, p = 0.001). These findings suggest maternal prenatal SSRI use may significantly contribute to the previously documented association between maternal prenatal depression and epigenetic age deceleration. Further studies are needed to examine how these epigenetic differences at birth may contribute to adverse outcomes in later development.

Self-expanding covered braided stents are routinely used across a diverse range of clinical applications, but few computational studies have attempted to replicate their complex behaviour. In this study, a computational framework was developed to predict the functional performance of bare and covered self-expanding wire braided stents, with a systematic evaluation on the effect of various braid and cover parameters presented. Simulated radial force and kink deformation tests show good agreement to experimental data for covered braided stents across a range of braid angles and cover thicknesses. Our results demonstrate that braid angle is a key governing parameter that dictates the radial and kink performance of both bare-metal and covered wire braided stents. It was also demonstrated that addition of a polymeric cover to a wire braided stent causes a stiffer radial response across all braid angles, particularly when thicker and/or stiffer covering systems were considered. This study represents the first experimentally-validated computational model for covered wire braided stent systems and has excellent potential to be used in future design of these devices for a range of applications.

Purpose: Establishing physiotherapists’ management of people with rheumatoid arthritis, in addition to their promotion of physical activity, is important to ascertain if there are educational needs in this area. Materials and methods: Physiotherapists from three Irish Chartered Physiotherapy clinical interest groups (N = 457) were invited to participate in a cross-sectional online questionnaire hosted on SurveyMonkey(R)™. Results: One hundred and sixty-eight (168/457; 37%) responded. Exercise prescription and education were the most frequent treatments, with 84% always/regularly providing same. Physical activity is a component of treatment with 52% always/regularly advising. In addition, 69% agree that physical activity is attainable, 68% safe, and 67% an important goal. However, 62% never recommend the appropriate guidelines, while 14% define physical activity according to frequently used definitions. There was a statistically significant association between longer years qualified and more years working with people with RA, when using guidelines to guide physical activity and exercise prescription. Low-intensity exercises were prescribed by however, 67% never provide high-intensity. Conclusions: Current practice is in line with guidelines in which, exercise therapy and education are considered as the mainstay. Promotion of physical activity is strong; however, two-thirds never recommend the appropriate guidelines, and only a minority defined physical activity correctly. The majority never prescribe high-intensity exercise. There is a need to develop education and training for physiotherapists in the promotion of physical activity in people with rheumatoid arthritis.Implications for rehabilitationExercise therapy and education are considered as the mainstay in the physiotherapy management of people with rheumatoid arthritis.Those physiotherapists’ who are qualified longer and have more experience working with people with rheumatoid arthritis use the relevant physical activity guidelines.Overall there is a need to develop education and training for physiotherapists in the promotion of physical activity in people with rheumatoid arthritis. Exercise therapy and education are considered as the mainstay in the physiotherapy management of people with rheumatoid arthritis. Those physiotherapists’ who are qualified longer and have more experience working with people with rheumatoid arthritis use the relevant physical activity guidelines. Overall there is a need to develop education and training for physiotherapists in the promotion of physical activity in people with rheumatoid arthritis.

The Simons Foundation Autism Research Initiative (SFARI) has launched SPARKForAutism.org, a dynamic platform that is engaging thousands of individuals with autism spectrum disorder (ASD) and connecting them to researchers. By making all data accessible, SPARK seeks to increase our understanding of ASD and accelerate new supports and treatments for ASD.

To address questions on the activity that led to the deposition of biological traces in a particular case, general information on the probabilities of transfer, persistence and recovery of cellular material in relevant scenarios is necessary. These figures may be derived from experimental data described in forensic literature when conditions relevant to the case were included. The experimental methodology regarding sampling, DNA extraction, DNA typing and profile interpretation that were used to generate these published data may differ from those applied in the case and thus the applicability of the literature data may be questioned. To assess the level of variability that different laboratories obtain when similar exhibits are analysed, we performed an inter-laboratory study between four partner laboratories. Five sets of 20 cable ties bound by different volunteers were distributed to the participating laboratories and sampled and processed according to the in-house protocols. Differences were found for the amount of retrieved DNA, as well as for the reportability and composition of the DNA profiles. These differences also resulted in different probabilities of transfer, persistence and recovery for each laboratory. Nevertheless, when applied to a case example, these differences resulted in similar assignments of weight of evidence given activity-level propositions.

Background: In LAPC, additional benefit of CRT over chemotherapy is uncertain. Optimising local therapy for a subset that never develops distant disease may prolong survival. Nelfinavir is thought to enhance radiosensitivity through hypoxia reduction by increasing tumour blood flow. Methods: A non-randomised, single centre phase II study, in FDG-PET-selectedpatients withhistologically proven LAPC. CRT consisted of: nelfinavir 1250 mg bd (days -3 to 45); gemcitabine 300 mg/m2 & cisplatin 30 mg/m2 (days 2, 9, 23 & 30); concurrent radiotherapy: 59.4 Gy/33# to primary tumour, 50.4 Gy/28# to regional nodes. Adjuvant gemcitabine was given for 6 months. Primary endpoint: 1 year overall survival (OS); secondary endpoints included: toxicity, response rate, resectability, median progression free survival (PFS), OS and local PFS. 6 patients had sequential dynamic 18fluoromisonidazole PET (FMISO-PET) and perfusion CT (pCT) before and after 6-7 days of nelfinavir (given from day -8). Results: 23 patients entered between Feb 2010-July2014. The trial was stopped because of unavailability of nelfinavir in Europe. 3 patients did not complete treatment (1 each of PE, biliary sepsis, stroke). Common G3/4 toxicities: thrombocytopenia/leukopenia (both 35%), diarrhoea (17%), nausea/vomiting (17%), fatigue (13%). 1 yr and median OS: 76.7% (95% CI 52.8-89.6) and 17.4 months (95% CI 12.7-22.8) respectively. 1 yr PFS and Local PFS: 36.8% (16.5-57.5) and 52.9% (95% CI 25.2-74.4) respectively. Mean FDG SUVmax reduction was 39% (p < 0.001) and was ≥60% in 29% of patients. 2 patients became resectable. 4/6 patients had reduced FMISO retention and increased pCT derived blood flow (BF) post-nelfinavir. Mean change in FMISO-k3 (2 tissue compartmental model) -50.3% vs 6% and BF 20.1 vs -7.1% in responders vs non-responders. 8/13 demonstrated a reduction in pAKT in peripheral blood mononuclear cells. Conclusions: Nelfinavir with CRT is well tolerated with promising outcomes, as these patients were not pre-selected through induction chemotherapy. Modulation of hypoxia & BF by nelfinavir was demonstrated. A randomised phase II study, SCALOP2, opens in 2015. Clinical trial information: 2008-006302-42.

Among the various items recovered from crime scenes or persons involved in a crime event, clothing items are commonly encountered and submitted for forensic DNA sampling. Depending on the case circumstances and the activity-of-interest, sampling of the garment may concentrate on collecting DNA from the wearer, or from one or more offenders who have allegedly contacted the item and/or wearer. Relative to the targeted DNA, background DNA already residing on the item from previous contacts, or transferred during or after the crime event, may also be collected during sampling and observed in the resultant DNA profile. Given our limited understanding of how, and from where, background DNA is derived on clothing, research on the transfer, persistence, prevalence, and recovery (TPPR) of DNA traces from upper garments was conducted by four laboratories. Samples were collected from several areas of two garments, each worn on separate working or non-working days and individually owned by four individuals from each of the four laboratories, and processed from DNA extraction through to profiling. Questionnaires documented activities relating to the garment prior to and during wearing, and reference profiles were obtained from the wearer and their close associates identified in the questionnaire. Among the 448 profiles generated, variation in the DNA quantity, composition of the profiles, and inclusion/exclusion of the wearer and their close associates was observed among the collaborating laboratories, participants, garments worn on different occasions, and garment areas sampled.

Available literature on the detection of transferred DNA does not address the interpretation issues in relation to who wore rather than touched the garment. To acquire a greater knowledge of the rate of detectable wearer, toucher and background DNA, 63 males wore their own underpants for 12h. The inside-waistband was handled by one of 11 female volunteers for 15s. The waist-band was mini-taped and subjected to DNA profiling with the AMPFlSTR(®) NGM SElect™ kit. The findings show that on worn garments the probability of observing reportable DNA profiles is 61.9%. The wearer was detected as a single profile or part of a mixed profile in 50.8% of samples. When the wearer was present in a mixture, he was always observed as the major contributor. The toucher was detected on 11.1% of underpants. Reportable background DNA (non-wearer and non-toucher) occurs in 14.3% of samples and may affect the assessment of who wore the garment. Greater knowledge of the frequency of detection of reportable wearer DNA and/or toucher allows scientists to evaluate the likelihood of observing a matching profile if an individual wore a garment rather than touched it in disputed case scenarios.

Background:OMERACT has identified sleep quality as one of the key outcomes for people with RA [1]. Poor sleep and reduced total sleep time (TST) are common complaints among people with RA. Poor sleep can in turn lead to deterioration in function, reduce activity levels and also impact mental health. Although sleep and mental health outcomes have been identified as important, they are frequently not measured in clinical trials. Involving key stakeholders, like people with RA, is important when designing exercise interventions as it allows consideration of particular issues that may influence future intervention delivery. This study involved people with RA who participated in a pilot RCT group exercise class to improve sleep quality.Objectives:To explore participants experiences of an exercise intervention in improving sleep quality and TST, to capture their reality.Methods:A descriptive qualitative study design of face-to-face semi-structured interviews was employed. The interview schedule explored a number of areas: experience of the intervention; outcome measures used; views regarding the intervention; perceptions regarding exercise and sleep and the impact on sleep. Interviews were transcribed verbatim by a professional transcriber. Inductive thematic analysis was used as an analytical approach. Interview transcripts were read, notes made, and ideas formulated to facilitate coding. The research team searched for patterns, analysed and coded the data, and generated themes and sub-themes. Themes were reviewed by the research team to check if they worked in relation to the coded extracts and the entire data set. The COREQ checklist provided guidance.Results:Twelve females participated with a mean age of 58 (SD 7.4); mean RA diagnosis of 9.9 (SD 7.4) years; moderate to severe disability (HAQ-DI: 1.5 (SD 0.60). Four main themes were generated: 1) Positive impact of exercise on sleep -“I really didn’t think any type of exercise would help me sleep better if I’m honest.”;2) Positive experiences of exercise intervention to improve sleep-“I learnt so much regarding walking that I didn’t even think about.”;3) Clear mental health benefits –“If you don’t sleep well then it will have a knock-on effect to your mental health”; 4) Achieving empowerment and ownership when exercising -“I feel empowered now and confident that I’m not doing harm to myself”.The findings demonstrated that participants were clearly surprised that exercise could improve sleep.Conclusion:In a variety of inflammatory conditions exercise is recommended as an effective intervention for the treatment of sleeping disorders. Although there is a growing consensus that exercise will benefit sleep, research is severely lacking in those with RA. This study demonstrates that participants were clearly surprised that exercise could improve their sleep. Due to the multifactorial nature of RA, engaging in exercise may not only improve sleep quality but also mitigate some of its symptoms.References:[1]Kirwan JR, Boonen A, Harrison MJ, Hewlett SE, et al (2011) OMERACT 10 Patient Perspective Virtual Campus: Valuing health; measuring outcomes in rheumatoid arthritis fatigue, RA sleep, arthroplasty, and systemic sclerosis; and clinical significance of changes in health. The Journal of Rheumatology;38:1728–34.Disclosure of Interests:None declared

Cellular material derived from contact traces can be transferred via many direct and indirect routes, with the manner of contact and the time of transfer (in relation to the alleged crime-event) having an impact on whether DNA is recovered from the surface and a reportable profile generated. In an effort to acquire information on the transfer and recovery of DNA traces from clothing items worn during scenarios commonly encountered in casework, upper garments were worn during a normal working day before individuals were paired to embrace one another (‘contact’), go on an outing together (‘close proximity’), or individually asked to spend a day in another person’s environment (‘physical absence’). Each prescribed activity was repeated by sixteen individuals across four countries, and was the last activity performed before the garment was removed. Samples were collected from several areas of the upper garments and processed from DNA extraction through to profiling within the laboratory of the country in which the individual resided. Activities relating to the garment prior to and during wearing, including the prescribed activity, were recorded by the participant and considered during the interpretation of results. In addition to obtaining reference profiles from the wearer and their activity partner, DNA profiles from the wearers’ close associates identified in the questionnaire were obtained to assess the impact of background DNA transferred prior to the prescribed activity. The wearer was typically, but not always, observed as the major contributor to the profiles obtained. DNA from the activity partner was observed on several areas of the garment following the embrace and after temporarily occupying another person’s space. Particular areas of the garment were more prone to acquiring the hugging partner or office owner’s DNA than others, and whether they were observed as the major or minor component was activity dependent. For each of the pairs, no DNA from the activity partner was acquired by the garments during the outing, even though both participants were in close proximity. This study provides empirical data on the transfer, persistence, prevalence and recovery of DNA from clothing items, and enables a better understanding of the mechanisms which lead to the transfer and detectability of DNA traces in different scenarios.

Sharing data between forensic scientists on DNA transfer, persistence, prevalence and recovery (TPPR) is crucial to advance the understanding of these issues in the criminal justice community. We present the results of a collaborative exercise on reporting forensic genetics findings given activity level propositions. This exercise outlined differences in the methodology that was applied by the participating laboratories, as well as limitations to the use of published data on DNA TPPR. We demonstrate how publication of experimental results in scientific journals can be further improved to allow for an adequate use of these data. Steps that can be taken to share and use these data for research and casework purposes are outlined, and the prospects for future sharing of data through publicly accessible databases are discussed. This paper also explores potential avenues to proceed with implementation and is intended to fuel the discussion on sharing data pertaining to DNA TPPR issues. It is further suggested that international standardization and harmonization on these topics will benefit the forensic DNA community as it has been achieved in the past with the harmonization of STR typing systems.

Circadian rhythms are physical, mental and behavioural changes that follow a daily cycle. Sleep in an essential aspect in maintaining the body’s circadian rhythm and maintain health-related quality of life (HQoL) therfore, sleep disturbances can have a detrimental impact on same. The Outcome Measures in Rheumatology (OMERACT) has identified sleep as one of the key outcomes important to RMD patients.1 Patients with various immune-mediated inflammatory diseases, including rheumatoid arthritis, have reported disturbed sleep and reduced sleep duration, further adding to their disease burden.2, 3 It has been well established that being physically active and taking regular exercise are important for those who have been diagnosed with RMD’s.4 Exercise has been identified as an important part of the nonpharmacological management of poor sleep duration and in improving sleep quality however, in a 2013 Cochrane review that examined exercise and fatigue in RA, it was noted by the authors that sleep quality was yet to be examined in this population.6 Moreover, it is known that in general exercise improves mood state, which can also be an additional factor in improving sleep duration and sleep quality.5 Exercise offers a potentially attractive alternative or adjuvant treatment for those people with RMD who have sleep issues. The position stand from the American College of Sports Medicine (ACSM) regarding exercise for those with chronic conditions is categorised by cardio-respiratory exercise, resistance exercise, flexibility exercise and neuro-motor exercise.7 This presentation will consider the evidence regarding the effect exercise has on sleep in general and how the examination of a participants exercise habits prior to any study might be important, as it may have an impact on its effectiveness. A key message from the talk will be the presentation of evidence of exercise programmes in people with RMD, according to the Frequency, Intensity, Time and Type (FITT) principle will be presented.8 References [1] Kirwan JR, Boonen A, Harrison MJ, Hewlett SE, Wells GA, Singh JA, Furst DE, Dworkin RH. OMERACT 10 Patient Perspective Virtual Campus: Valuing health; measuring outcomes in rheumatoid arthritis fatigue, RA sleep, arthroplasty, and systemic sclerosis; and clinical significance of changes in health. The Journal of Rheumatology2011;38:1728–34. [2] Graff LA, Walker JR, Russell AS, Bissonnette R, Bernstein CN. Fatigue and quality of sleep in patients with immune-mediated inflammatory disease. The Journal of Rheumatology Supplement2011;88:36–42. [3] McKenna S, Donnelly A, Fraser A, Kennedy N. Sleep and physical activity: a survey of people with inflammatory arthritis and their engagement by health professionals in rheumatology in Ireland. Disability and Rehabilitation2017:1–7. [4] Hurkmans E, van der Giesen FJ, Vliet Vlieland TPM, Schoones J, Van den Ende ECHM. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. The Cochrane Library2009. [5] Nicassio PM, Ormseth SR, Kay M, Custodio M, Irwin MR, Olmstead R, Weisman MH. The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis. Pain2012;153:107–12. [6] Cramp F, Hewlett S, Almeida C, Kirwan JR, Choy EHS, Chalder T, Pollock J, Christensen R. Non-pharmacological interventions for fatigue in rheumatoid arthritis. The Cochrane Library2013. [7] Moore G, Durstine JL, Painter P, American College of Sports M. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities, 4E. Human Kinetics2016. [8] McKenna S, Donnelly A, Fraser A, Comber L, Kennedy N. Does exercise impact on sleep for people who have rheumatoid arthritis? A systematic review. Rheumatology International2017;37:963–74. Disclosure of Interest None declared

Background Reduced sleep duration and poor sleep quality are prevalent complaints in rheumatoid arthritis (RA). These in turn may further deteriorate functional ability and reduce the person’s exercise levels. Current rheumatology guidelines recommend exercise as a key component in the management of RA however, what is lacking is its impact on sleep. Objectives To obtain reliable estimates regarding recruitment rates; retention; protocol adherence; adverse events, in addition to producing estimates of the potential effect sizes of the intervention on changes in outcomes of sleep duration; sleep quality and disturbances; RA related pain; depression; anxiety; functional limitation; disease activity and fatigue. Methods Participants were recruited in person at weekly rheumatology clinics at a University Hospital and through self-selected social networking. They were randomised to either a walking based exercise intervention consisting of 28 walking sessions, with 1 per week being supervised by a trained physiotherapist, spread over 8 weeks (2–5 times/week), or a control group who received advice on the benefits of exercise for people with RA. Ethical approval was received. Descriptive statistics and t-tests were used to analyse the data with SPSS v22. Results One hundred and one (101) people were identified through the rheumatology clinics, with 36 contacting the primary investigator through social networking. Of these, 24 met the eligibility criteria, with 20 being randomised (18% recruitment; 100% female; mean age 57 (SD 7.3 years). Ten exercise participants (100%) and 8 controls (80%) completed final assessments, with both groups being equivalent for all variables at baseline. Exercise participants completed 87.5% of supervised sessions and 93% of unsupervised sessions. No serious adverse events were recorded and through semi-structured interviews the intervention was highly acceptable to exercise participants. Pittsburgh Sleep Quality Index (PSQI) global score showed a significant mean improvement between the exercise group −6.6 (SD 3.3) compared to control −0.25 (SD 1.1) (p=0.012); PSQI subcomponent sleep duration showed a significant improvement in mean hours between the exercise group 1.65 (SD 0.39) and control 0.56 (SD 0.46) (p=0.021); PSQI subcomponent sleep quality indicated those in the exercise group improved their sleep quality from fairly bad/poor to fairly good/very good, while those in control reported no change at fairly bad/poor. Global rating of change indicated exercise participants reporting their sleep was minimally/much improved, while control participants reported no change/minimally worse, post intervention. Conclusions The walking based exercise intervention designed to improve sleep was feasible, safe and highly acceptable to study participants, with those participants in the exercise group reporting improvements in sleep duration and sleep quality compared to the control group. Adverse events were predominantly mild. This pilot provides a framework for larger intervention studies and based on these findings a fully powered trial of walking as an exercise based intervention is recommended, preceded by focus groups to investigate methods to improve recruitment of males. Disclosure of Interest None declared

Background: Regular physical activity (PA) is associated with improvements in health outcomes, such as quality of life, aerobic fitness, pain, stiffness and inflammation in people with inflammatory joint disease (IJD) (1,2). Current practice in the management of patients with inflammatory arthritis emphasises the importance of health professionals (HP’s) in assessing PA and aerobic capacity. Objectives: The objectives of this study were to identify how HPs working with IJDs measure PA and aerobic capacity. Methods: Rheumatology HPs in Denmark, Sweden, Ireland and Belgium participated in an online survey. Descriptive statistics was undertaken (SPSS v21and SASv9.4) to describe data aggregates and range and to identify sub-classes of groups with respect to use of PA measures. Results: Three hundred and twenty two (n=322, 75% female) HPs responded from Denmark (n=50, 15.5%), Sweden (n=66, 20.5%), Ireland (n=28, 8.7%), and Belgium (n=178, 55.3%). The majority of respondents (n=286, 92%) reported it was important to measure PA in people with IJDs. The mean number of years qualified was 20.08 (SD 9.37) and years working in Rheumatology was 12.29 (SD 8.27), with 32.3% reporting half of their workload coming from people who have inflammatory arthritis. Only 28.2% of HPs used simple body worn sensors to measure PA levels in their patients. Moderate levels of confidence were reported in using a simple body-worn sensor (mean 6.15/10; SD 3.63) and paper questionnaire (6.85/10; SD 3.62) to measure PA, with lower levels of confidence in using a complex body-worn sensor (3.80/10; SD 3.55) and digital diary (4.22/10; SD 3.67). When assessing aerobic capacity 58% were very familiar/somewhat familiar using a bicycle ergometer, 44% a treadmill and 56% other aerobic capacity tests. Low levels of confidence were reported in instructing their patients in performing aerobic capacity tests (4.54/10; SD 3.74) and in interpreting the results (4.79/10; SD 3.58). A large majority were interested in further education around measuring PA (83%) and aerobic capacity measurement (74%), with an online module favoured for both. Conclusions: The majority of respondents reported that they considered measuring PA as important in people with IJDs; however, the majority lacked confidence in how to measure it. There is strong interest in further education around measuring PA. References 1. Stavropoulos-Kalinoglou A, Metsios GS, Veldhuijzen van Zanten JJ, et al. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis2013;72(11):1819–25. doi:10.1136/annrheumdis-2012-202075 2. Hurkmans E, van der Giesen FJ, Vliet Vlieland TP, et al. Dynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis. Cochrane Database Syst Rev2009;(4):CD006853. doi:10.1002/14651858.CD006853.pub2 Acknowledgements: This study was funded by the EULAR Health Professionals Research Grant 2015 Disclosure of Interest: None declared

Background Exercise reduces depressive and anxiety symptoms among the general population, and those with a chronic illness. Elevated depressive and anxiety symptoms are prevalent co-morbidities in Rheumatoid Arthritis (RA) therefore, addressing same through exercise may have an important impact on their health related quality of life (HQoL). Evidence does support the effect of exercise on these outcomes however, quantitative synthesis of evidence from randomised controlled trials (RCTs) of exercise effects, on these critically important symptoms in RA, has yet to been conducted. Objectives To quantify the overall population effect of exercise on depressive and anxiety symptoms, fatigue, and pain, derived from available RCT’s, and to explore the extent to which participant and trial characteristics moderated the mean effect. Methods Articles published before September 2017 were located by two independent reviewers using Google Scholar, PsycINFO, PubMed, and Web of Science. Trials included both randomization to exercise and non-exercise control using validated measures of depression and anxiety, assessed at baseline and post-intervention. Hedges’d effect sizes (95% CI) were computed and random effects models were used for all analyses. Sources of bias were also assessed independently by two reviewers using the Cochrane bias assessment tool for RCTs and Newcastle–Ottawa Quality Assessment Scale for non-RCTs. Results Seventeen studies were included, with 1214 participants, of which 12 RCT’s contributed to the meta-regression analysis. Participants were aged 49±9 years and 83%±14% female. Exercise training consisted on average of 3±1 weekly sessions, 60±17 min per session, and 11±5 weeks in duration. Interventions were diverse with a mix of aerobic and/or resistance training including, 4 different types of Yoga, 2 dance based and 1 Tai-chi. Mean reported adherence was 87%±11%. For depression, 18 of 20 effects (90%) were >0. The mean effect size Δ was 0.20 (0.10–0.31; p 0. The mean effect size Δ was 0.50 (0.27–0.74; p 0.69). Six of 11 effects (54.5%) did not reduce fatigue with the mean effect delta being −0.01 (95% CI: −0.20 to 0.19; z=-0.09; p>0.93). Depressive or anxiety symptoms were not the primary outcome in any of the included trials. Conclusions Pharmacologic interventions have improved the management of RA however, research indicates that exercise remains an important part of the overall treatment. This quantitative synthesis of evidence from RCTs of the effects of exercise shows significant small-to-moderate reductions in depressive and anxiety symptoms. It has been reported that the degree of depression and anxiety in people with RA is a preceding sign of physical disability that may appear later in life therefore, aiming to target both through exercise may help to improve HQoL. Future trials should focus on depression and/or anxiety as the primary outcome. Exercise prescription is a core skill for physiotherapists therefore, they should be confident in prescribing exercise to people with RA, who have depression and anxiety, as it significantly reduces their symptoms. Disclosure of Interest None declared

Poor sleep is an issue for people with rheumatoid arthritis (RA), which may curtail their ability to function appropriately and reduce their activity levels. This paper describes a protocol for a pilot randomised controlled trial of an aerobic exercise intervention compared with exercise advice designed to improve sleep in people with RA. Objectives are to obtain reliable estimates regarding recruitment rates, participant retention and protocol adherence and to generate potential effect size estimates for a main trial. Participants will be identified from an existing database held at a University Hospital and in person at weekly rheumatology clinics. Participants meeting the inclusion criteria will be randomised into an intervention or control group. Those in the intervention group will participate in an 8-week walking-based exercise intervention consisting of 28 walking sessions, with 1 session per week being supervised by a trained physiotherapist, spread over a maximum of 8 weeks (2–5 times/week), while those in the control group will receive advice on the benefits of exercise for people with RA. Results will provide data for efficient recruitment and data collection, to determine if a larger, statistically powered main trial could be generalised to a multi-centre rheumatoid arthritis population. Given recent information that sleep is commonly reduced in people with RA and that physical activity and exercise profiles are lower, this study will contribute data to the field of exercise and sleep that is currently lacking and importantly will include people with RA in the study process prior to any fully powered trial. Trial registration number: ClinicalTrials.gov Identifier: NCT03140995 (April 25th, 2017).

peer-reviewed Objectives The objectives of this study were to determine rheumatology health professionals' (HPs)' awareness of and confidence in using physical activity (PA) measures in people with inflammatory joint diseases (IJDs), their own self-reported PA levels and to identify HP-related educational needs. Methods Rheumatology HPs in Denmark, Sweden, Ireland and Belgium participated in an on-line survey. Descriptive statistics and latent class analysis (LCA) were undertaken SPSS (v21and SASv9.4) to describe data aggregates and range and to identify subclasses of groups with respect to use of PA measures. Results 322 (n=322, 75.5% women) HPs responded from Denmark (n=50, 15.5%), Sweden (n=66, 20.5%), Ireland (n=28, 8.7%) and Belgium (n=178, 55.3%) and the majority of respondents (n=286, 91.7%) reported it was important to measure PA in people with IJDs. Only 28.2% of HPs used simple body worn sensors to measure PA levels in their patients. The majority were interested in on-line education on measuring PA (82.9%). LCA, used to generate classes of PA measures employed by HPs, revealed three distinct classes reflecting differences in self-reported PA levels, awareness of PA measures, further education requirements and professional background. Conclusions The majority of respondents reported that they considered measuring PA as important in people with IJDs; however, the majority lacked confidence in how to measure it. There was strong interest in further education around measuring PA. Three distinct respondent classes were identified to inform targeted education on how to measure PA.