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Introduction: There are limited data available regarding patient outcomes in those who would have been ineligible to receive therapy based on the original clinical trial eligibility criteria. We decided to conduct a retrospective study to evaluate outcomes based on clinical trial eligibility in patients with metastatic non--small cell lung cancer (NSCLC). Methods: A retrospective chart review of all patients with metastatic NSCLC who received first-line systemic therapy at a single academic institution was performed. Each patient's chart was reviewed to determine if they would have qualified for the phase 3 clinical trial that led to the approval of the specific treatment regimen which they received. Data were analyzed to determine if there was a difference in survival time between those who would have been eligible compared with those who were ineligible for the clinical trial of the treatment regimen administered. Results: There were 170 patients with a diagnosis of metastatic NSCLC who received first-line systemic therapy. Of these, 109 received combined chemotherapy, 25 received immunotherapy, and 36 received targeted therapy. There is a statistically significant difference in the restricted mean survival time between the eligible and ineligible groups in those who received combined chemotherapy (19.9 months vs 13.2 months; P = .03), but not in either the immunotherapy group (22.4 months vs 12.9 months; P = .06) or the targeted therapy group (57.7 months vs 39.0 months; P = .14). Conclusion: These data support less restrictive clinical trial eligibility criteria for those with metastatic NSCLC. This is especially true regarding both targeted therapy and immunotherapy treatment regimens. [ABSTRACT FROM AUTHOR]

Objective Nutrition and weight gain significantly contribute to overall health outcomes in children with cystic fibrosis (CF). Strong emphasis is placed on these entities by the CF team, which can cause stress for parents and impact parent and child mealtime behaviors. The current study sought to investigate the relationship between parental feeding style, parenting stress, and parent and child mealtime behaviors in families of children with CF. Methods Forty-five parents of a child with CF between the ages of 2 and 10 years were recruited during a CF clinic appointment. They completed surveys assessing child mealtime behaviors, parental feeding style, and parental stress. Medical data including body mass index (BMI) were collected from the medical record. Results There was a significant difference in behavioral feeding scores based on feeding style (F 3,41 = 13.48, p  <.001), with authoritarian parents reporting significantly greater mealtime behavior problems than all other parents. There was also a significant difference in parenting stress based on parental feeding style (F 3,41=4.11, p  <.05), with authoritarian parents showing more stress than authoritative parents (M diff=23.70, p  <.05). Correlation analyses showed a positive relationship between behavioral feeding problems and parent stress, r (45)=0.403; p  <.01. Conclusions Data suggest parents using an authoritarian feeding style experience more stress and behavioral feeding problems than other parents. More feeding problems were also associated with more stress. Findings help determine how pediatric psychologists can intervene to support positive parenting behaviors that reduce children's mealtime behavior problems and parental stress, thus improving health outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

This study investigated the effects of different visual rotation speeds and types of visual perturbation in virtual reality (VR) on lower extremity muscle activation during incline treadmill walking. Twenty healthy young adults walked on an incline treadmill with six different visual perturbation paradigms in VR (normal VR, 10°/s rotation, 20°/s rotation, 30°/s rotation, 60°/s rotation, and random speed rotation). Muscle activation of the lower extremity was measured by surface electromyography. Results showed an increased visual rotation speed induced higher vastus lateralis and lateral gastrocnemius activation. Females and males had different responses to increased visual rotation speed in vastus lateralis. Random speed rotation induced higher medial hamstring activation than constant speed rotation, in which was more pronounced in females. In conclusion, the amount of visual perturbation should be taken into consideration when developing future VR training for astronauts. Visual perturbation elicited higher muscle activation than normal condition during incline treadmill walking, and this perturbation effect was magnitude dependent and gender specific. These findings suggested that performance training with systematically manipulated visual perturbations might increase specific muscle activations. Gender differences should be considered in developing future performance training in space. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies on cancer risk among agricultural producers have focused on occupational exposures, with only a few studies examining behavioral factors. The aim of this study was to understand cancer risky and preventative behaviors among the large farming population in Nebraska. Methods: A statewide cross‐sectional study of farmers in Nebraska aged 19 and older was conducted in 2019 (n = 782). Multivariable logistic regression was used to examine factors associated with being up to date on cancer screening and with cancer risky and preventive behaviors. Findings: The 93.68% of the Nebraska farmers population do not meet the daily recommended consumption of fruits and vegetables, and 70.14% reported regular alcohol consumption. The proportion of adults up to date on cancer screening was 79.57% for breast, 67.55% for cervical, 85.54% for colorectal, and 46.05% for skin cancers. Compared to women, men had a higher odds of heavy alcohol consumption (aOR 2.96, 95% CI 1.94–4.56) and ever smoking 100 or more cigarettes (aOR 1.66, 95% CI 1.03–2.73). The odds of being current with skin cancer screening was higher among those with higher incomes (aOR 1.77, 95% CI 1.06–3.01). Compared to men aged 50–64, the odds of being current with prostate cancer screening was higher among men aged 65–74 (aOR: 2.65, 95% CI 1.10–7.31) and 75 and older (aOR: 7.73, 95% CI 2.03–51.73). Conclusions: Disparities in cancer screening and risk and preventive behaviors exist among farmers in Nebraska. The study highlights a need for continuing efforts to improve preventive cancer behaviors targeted to the farming population. [ABSTRACT FROM AUTHOR]

Introduction: Work-related musculoskeletal disease (MSD) is the second leading cause of disability globally. Ophthalmologists widely report MSDs in the neck (70%) and back pain (40– 80%). Our study intended to identify the prevalence of MSDs among pediatric ophthalmologists. Methods: Pediatric ophthalmologists self-reported chronic pain, instrumentation used, years practiced, surgeries performed, work schedule/environment modifications due to MSD, and treatment for MSD via an anonymous online survey. Statistical analysis of responses included odds ratios, Pearson chi-square testing, and Spearman correlations. Results: This study had 101 respondents, with 66% reporting chronic pain. Chronic neck pain (41%) and lower back pain (31%) followed by shoulder pain (30%) were the leading MSD complaints and significantly correlated with years of experience (p< 0.05). Participants often had multiple types of pain, including 13% of the sample who experienced all three types of pain. Those reporting shoulder and back pain also reported a greater incidence in work modification (68– 83%). Those suffering from chronic neck, shoulder, and lower back pain have sought treatment for their MSD (p< 0.05). Discussion: With such wide reporting of chronic neck, back, and shoulder pain, the development of MSDs likely leads to disability. Ergonomic innovations in the workplace may reduce the healthcare burden and prolong pediatric ophthalmologists' ability to provide services. Conclusion: In our study, the reported prevalence of chronic neck and back pain was comparable to previous studies and published literature, with 2/3 of participants reporting pain. There is a tremendous need for ongoing innovations, especially surgical loupes, operating microscopes, and slit-lamp modifications to prevent musculoskeletal disease. [ABSTRACT FROM AUTHOR]

Purpose Glaucoma patients with peripheral vision loss have in the past subjectively described their field loss as ‘blurred’ or ‘no vision compromise’. We developed an iPad app for patients to self-characterise perception within areas of glaucomatous visual field loss. Methods Twelve glaucoma patients with visual acuity ≥20/40 in each eye, stable and reliable Humphrey Visual Field (HVF) over 2 years were enrolled. An iPad app (held at 33 cm) allowed subjects to modify ‘blur’ or ‘dimness’ to match their perception of a 2×2 m wall-mounted poster at 1 m distance. Subjects fixated at the centre of the poster (spanning 45° of field from centre). The output was degree of blur/dim: normal, mild and severe noted on the iPad image at the 54 retinal loci tested by the HVF 24-2 and was compared to threshold sensitivity values at these loci. Monocular (Right eye (OD), left eye (OS)) HVF responses were used to calculate an integrated binocular (OU) visual field index (VFI). All three data sets were analysed separately. Results 36 HVF and iPad responses from 12 subjects (mean age 71±8.2y) were analysed. The mean VFI was 77% OD, 76% OS, 83% OU. The most common iPad response reported was normal followed by blur. No subject reported dim response. The mean HVF sensitivity threshold was significantly associated with the iPad response at the corresponding retinal loci (For OD, OS and OU, respectively (dB): normal: 23, 25, 27; mild blur: 18, 16, 22; severe blur: 9, 9, 11). On receiver operative characteristic (ROC) curve analysis, the HVF retinal sensitivity cut-off at which subjects reported blur was 23.4 OD, 23 OS and 23.3 OU (dB). Conclusions Glaucoma subjects self-pictorialised their field defects as blur; never dim or black. Our innovation allows translation of HVF data to quantitatively characterise visual perception in patients with glaucomatous field defects. [ABSTRACT FROM AUTHOR]

The lamina cribrosa (LC) is a layer of fenestrated connective tissue tethered to the posterior sclera across the scleral canal in the optic nerve head (ONH). It is located at the interface of intracranial and intraocular compartments and is exposed to intraocular pressure (IOP) anteriorly and intracranial pressure (ICP) or Cerebrospinal fluid (CSF) pressure (CSFP) posteriorly. We hypothesize that the pressure difference across LC will determine LC position and meridional diameter of scleral canal (also called Bruch's membrane opening diameter; BMOD). We enrolled 19 human subjects undergoing a medically necessary lumbar puncture (LP) to lower CSFP and 6 anesthetized pigs, whose ICP was increased in 5 mm Hg increments using a lumbar catheter. We imaged ONH using optical coherence tomography and measured IOP and CSFP/ICP at baseline and after each intervention. Radial tomographic ONH scans were analyzed by two independent graders using ImageJ, an open-source software. The following ONH morphological parameters were obtained: BMOD, anterior LC depth and retinal thickness. We modeled effects of acute CSFP/ICP changes on ONH morphological parameters using ANOVA (human study) and generalized linear model (pig study). For 19 human subjects, CSFP ranged from 5 to 42 mm Hg before LP and 2 to 19.4 mm Hg after LP. For the six pigs, baseline ICP ranged from 1.5 to 9 mm Hg and maximum stable ICP ranged from 18 to 40 mm Hg. Our models showed that acute CSFP/ICP changes had no significant effect on ONH morphological parameters in both humans and pigs. We conclude that ONH does not show measurable morphological changes in response to acute changes of CSFP/ICP. Proposed mechanisms include compensatory and opposing changes in IOP and CSFP/ICP and nonlinear or nonmonotonic effects of IOP and CSFP/ICP across LC. [ABSTRACT FROM AUTHOR]

Background: Bathing intensive care unit (ICU) patients with chlorhexidine gluconate (CHG) decreases healthcare-associated infections (HAIs). The optimal method of CHG bathing remains undefined., Methods: Prospective crossover study comparing CHG daily bathing with 2% CHG-impregnated cloths versus 4% CHG solution. In phase 1, from January 2020 through March 2020, 1 ICU utilized 2% cloths, while the other ICU utilized 4% solution. After an interruption caused by the coronavirus disease 2019 pandemic, in phase 2, from July 2020 through September 2020, the unit CHG bathing assignments were reversed. Swabs were performed 3 times weekly from patients' arms and legs to measure skin microbial colonization and CHG concentration. Other outcomes included HAIs, adverse reactions, and skin tolerability., Results: 411 assessments occurred after baths with 2% cloth, and 425 assessments occurred after baths with 4% solution. Average microbial colonization was 691 (interquartile range 0, 30) colony-forming units per square centimeter (CFU/cm 2 ) for patients bathed with 2% cloths, 1,627 (0, 265) CFUs/cm 2 for 4% solution, and 8,519 (10, 1130) CFUs/cm 2 for patients who did not have a CHG bath ( P < .001). Average CHG skin concentration (parts per million) was 1300.4 (100, 2000) for 2% cloths, 307.2 (30, 200) for 4% solution, and 32.8 (0, 20) for patients without a recorded CHG bath. Both CHG bathing methods were well tolerated. Although underpowered, no difference in HAI was noted between groups., Conclusions: Either CHG bathing method resulted in a significant decrease in microbial skin colonization with a greater CHG concentration and fewer organisms associated with 2% CHG cloths.