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Highlights • Multi-cohort, longitudinal investigation delineated trajectories of youth psychopathy. • Findings revealed substantial malleability in developmental course of psychopathy. • Chronically high trajectory exhibited most deleterious outcomes in later adulthood. • Unique pathways exert considerable influence on future antisocial and criminal behaviors. Abstract This multi-cohort study delineates developmental trajectories of psychopathic features across childhood and adolescence (ages 7–16) and investigates associations with adult outcomes (ages ∼ 23–34). Although most youth demonstrated consistently low levels of psychopathic features, approximately 10–15% followed a chronically high trajectory. A similar number (∼14%) displayed initially high levels that decreased over time, while others (∼10–20%) followed an increasing pattern. Boys in the chronically high trajectory exhibited the most deleterious adult outcomes and some evidence suggested that youth in the decreasing subgroup experienced fewer maladaptive outcomes than those in the increasing and high groups. Findings revealed substantial malleability in the developmental course of psychopathic features and suggest that unique pathways may exert considerable influence on future engagement in antisocial and criminal behaviors. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the effects of a theory-based physical activity and healthy eating intervention aimed at reducing stroke risk factors among overweight/obese and sedentary older adults. Methods: Between 12/2009–1/2011, participants (n=69) were randomly assigned to an 8-week group motivational intervention or biweekly newsletters by mail. Physical activity (blinded pedometer, 7-day recall) body composition, theoretical mediator, and dietary (24-hour recall) variables were measured at pre-test and post-test. The physical activity and dietary outcomes are reported. Results: For outcome measures, the follow-up was 90% for the intervention group (n=29) and 91% for the control group (n=34) for this sample. Statistically significant differences in the 7-day physical activity self-report were noted at post-test in the intervention group. The dietary measures were not statistically significant at post-test; however, the intervention group increased the quantity of vegetable servings. Conclusion: Limited efficacy testing was supported for a combined physical activity-dietary intervention, framed by a wellness-motivation theory, and designed to reduce stroke risk factors in older adults who are sedentary and overweight/obese. Limitations were identified and recommendations for additional research provided. [Copyright &y& Elsevier]

Objective To accurately assess the benefits of tobacco control interventions and to better inform decision makers, knowledge of medical expenditures by age, gender, and smoking status is essential. Method We propose an approach to distribute smoking-attributable expenditures by age, gender, and cigarette smoking status to reflect the known risks of smoking. We distribute hospitalization days for smoking-attributable diseases according to relative risks of smoking-attributable mortality, and use the method to determine national estimates of smoking-attributable expenditures by age, sex, and cigarette smoking status. Sensitivity analyses explored assumptions of the method. Results Both current and former smokers ages 75 and over have about 12 times the smoking-attributable expenditures of their current and former smoker counterparts 35-54 years of age. Within each age group, the expenditures of formers smokers are about 70% lower than current smokers. In sensitivity analysis, these results were not robust to large changes to the relative risks of smoking-attributable mortality which were used in the calculations. Conclusion Sex- and age-group-specific smoking expenditures reflect observed disease risk differences between current and former cigarette smokers and indicate that about 70% of current smokers' excess medical care costs is preventable by quitting. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study is to determine the impact of obesity on surgical and oncologic outcomes after primary debulking surgery (PDS) in advanced epithelial ovarian cancer (EOC). Methods Women with stage IIIC/IV EOC who underwent PDS with curative intent between 1/2/2003 and 12/30/2011 were included. Patient characteristics, intraoperative and postoperative outcomes, recurrence and status were abstracted. Complications were graded according to the 4-point Accordion classification. For analyses, patients were divided into three groups according to body mass index (BMI): group 1-BMI < 25.0 kg/m²; group 2-BMI 25.0-39.9 kg/m²; and group 3-BMI ≥ 40.0 kg/m². Results Of the 620 patients included in the study, 36.6%, 56.9%, and 6.5% were in weight groups 1, 2, and 3, respectively. Weight group 3 was an independent predictor of severe complications after adjusting for confounders (adjusted odds ratio (95% CI): 2.93 (1.38, 6.20) for group 3 vs. group 2). Weight group was not associated with differences in residual disease (p = 0.80). The 90-day mortality rates were 11.9%, 6.7%, and 15.7%, respectively, in weight group 1, 2, and 3 (p = 0.049 unadjusted, p = 0.01 adjusted). There was no difference in OS (p = 0.52) or PFS (p = 0.23) between weight groups. Conclusions BMI ≥ 40.0 kg/m² is an independent predictor of severe 30-day postoperative morbidity and 90-day mortality after PDS for EOC-information useful in preoperative counseling. BMI does not appear to impact long-term oncologic outcomes including residual disease at PDS, although we had limited power at the extremes of BMI. BMI may be an important factor to consider in risk-adjustment models and reimbursement strategies. [ABSTRACT FROM AUTHOR]

Objectives To assess the impact of frailty as measured by a frailty deficit index (FI) on outcomes in advanced epithelial ovarian cancer (EOC) after primary debulking surgery (PDS). Methods Women with Stage IIIC/IV EOC who underwent PDS between 1/1/2003–12/31/2011 were included. Medical records were reviewed for patient characteristics and outcomes. The FI includes 30 items scored at 0, 0.5 or 1 and is calculated by summing across all the item scores and dividing by the total. Frailty was defined as a FI ≥ 0.15. Associations were assessed using logistic regression and Cox proportional hazards regression. Results Of the 535 studied, 78% had stage IIIC disease and mean (SD) age was 64.3 (11.3) years. Median FI was 0.08, and 131 patients (24.5%) were considered frail with FI ≥ 0.15. Compared to non-frail patients, frail patients were more likely to have an Accordion grade 3 + complication (28.2 vs. 18.8%; odds ratio (OR): 1.70, 95% CI: 1.08–2.68) and more likely to die within 90 days of surgery (16.0 vs. 5.2%; OR: 3.48, 95% CI: 1.83–6.61). After adjusting for known risk factors, these associations remained significant, adjusted OR (aOR): 1.62, 95% CI: 1.00–2.62; aOR: 2.60, 95% CI 1.32–5.10; and aOR: 0.57, 95% CI 0.34–0.97, respectively. Overall survival (OS) for the entire cohort was 39.6 months (m). OS was shorter in the frail versus non-frail (median 26.5 vs 44.9 m, p < 0.001). Frailty was independently associated with death (adjusted hazard ratio: 1.52, 95% CI: 1.21–1.92) after adjusting for known risk factors. Conclusions Frailty is a common finding in patients with EOC and is independently associated with worse surgical outcomes and poorer OS. Routine assessments of frailty can be incorporated into patient counseling and decision-making for the EOC patient beyond simple reliance on single factors such as age. [ABSTRACT FROM AUTHOR]

Objective To examine the influence of diabetes and metformin therapy on overall survival (OS) and progression-free survival (PFS) in patients with endometrial cancer (EC) by using propensity score (PS) matching to account for confounding factors. Methods We retrospectively identified consecutive patients with stage I–IV EC managed surgically from 1999 through 2008 and stratified patients by diabetes status. PS matching was used to adjust for confounding covariates. OS and PFS were compared between diabetic and nondiabetic matched pairs and between matched pairs of diabetic patients with or without metformin therapy. Cox proportional hazards models were fit to estimate the effects on outcomes. Results Among 1303 eligible patients (79% stage I, 28% grade 3), 277 (21.3%) had a history of diabetes. Among diabetic patients, treatment consisted of metformin in 116 (41.9%); 57 (20.6%) had other oral agents, 51 (18.4%) insulin with or without other oral agents, and 53 (19.1%) diet modification only. For PS-matched diabetic and nondiabetic patients with EC, OS (hazard ratio [HR], 1.01; 95% CI, 0.72–1.42) and PFS (HR, 1.01; 95% CI, 0.60–1.69) were similar between matched subsets. No differences in OS and PFS were observed when comparing PS-matched metformin users with nondiabetic patients (OS HR, 1.03; 95% CI, 0.57–1.85; PFS HR, 1.14; 95% CI, 0.49–2.62) or with other diabetic patients (OS HR, 0.61; 95% CI, 0.30–1.23; PFS HR, 1.06; 95% CI, 0.34–3.30). Conclusions When adjusted for confounding covariates, OS and PFS are similar between diabetic and nondiabetic patients with EC and between metformin users and nonusers or nondiabetic patients. [ABSTRACT FROM AUTHOR]

Objective To reexamine the tenet that advanced age independently impacts progression-free and cause-specific survival in patients with endometrial cancer (EC). Methods Patients undergoing surgery for stages I-IIIC EC between 1999 and 2008 were stratified by age (< 70 vs ≥ 70 years). Three propensity score (PS) methods were utilized to adjust for confounding risk factors. The PS, or conditional probability of being ≥ 70 years old, given a patient's baseline covariates, was derived using logistic regression. The Cox proportional hazards models were fit to estimate the effect of age ≥ 70 years on outcomes. Results Of 1182 eligible patients, 822 (69.5%) were < 70 and 360 (30.5%) were ≥ 70. Patients ≥ 70 were more likely to have multiple adverse risk factors. The total standardized difference of these factors was reduced by 74% and 81%, respectively, using PS-stratification and PS-matching analyses. The nonsignificant trend toward an association between progression-free survival and age ≥ 70 in an unadjusted analysis (hazard ratio [HR], 1.40; 95% CI, 0.95-2.04) was further attenuated in the 3 PS analyses. The unadjusted HR for the association between age ≥ 70 and cause-specific survival was 2.03 (95% CI, 1.32-3.13). HRs were attenuated in PS analyses but retained significance (except for PS matching), potentially reflecting differences in salvage therapies (P < .001), including a 3-fold greater use of chemotherapy in those < 70. Conclusion When risk-adjusted for the higher prevalence of adverse prognostic factors in elderly EC patients, progression-free survival after primary therapy is not age dependent but the less favorable cause-specific survival in this cohort may reflect age-related postrecurrence treatment differences. [ABSTRACT FROM AUTHOR]

Live-attenuated influenza virus (LAIV) prime-boost vaccination previously conferred protection against heterologous H3N2 swine influenza challenge, including in piglets with maternally derived antibodies (MDA). Conversely, a whole-inactivated virus (WIV) vaccine was associated with enhanced disease. This study was aimed at identifying immune correlates of cross-protection. Piglets with and without MDA received intramuscular adjuvanted WIV or intranasal LAIV, and were challenged with heterologous H3N2. WIV induced cross-reactive IgG, inhibited by MDA, and a moderate T cell response. LAIV elicited mucosal antibodies and T cells cross-reactive to the heterologous challenge strain. The presence of MDA at LAIV vaccination blocked lung and nasal antibody production, but did not interfere with T cell priming. Even without mucosal antibodies, MDA-positive LAIV vaccinates were protected, indicating a likely role for T cells. Based on the data, one LAIV dose can induce cell-mediated immunity against antigenically divergent H3N2 influenza virus despite passive antibody interference with humoral immune responses. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Identify risk factors of anastomotic leak (AL) after large bowel resection (LBR) for ovarian cancer (OC) and compare outcomes between AL and no AL. Methods: All cases of AL after LBR for OC between 01/01/1994 and 05/20/2011 were identified and matched 1:2 with controls for age (±5years), sub-stage (IIIA/IIIB; IIIC; IV), and date of surgery (±4years). Patient-specific and intraoperative risk factors, use of protective stomas, and outcomes were abstracted. A stratified conditional logistic regression model was fit to determine the association between each factor and AL. Results: 42 AL cases were evaluable and matched with 84 controls. Two-thirds of the AL had stage IIIC disease and >90% of both cases and controls were cytoreduced to <1cm residual disease. No patient-specific risk factors were associated with AL (pre-operative albumin was not available for most patients). Rectosigmoid resection coupled with additional LBR was associated with AL (OR=2.73, 95% CI 1.13–6.59, P =0.025), and protective stomas were associated with decreased risk of AL (0% vs. 10.7%, P =0.024). AL patients had longer length of stay (P <0.001), were less likely to start chemotherapy (P =0.020), and had longer time to chemotherapy (P =0.007). Cases tended to have higher 90-day mortality (P =0.061) and were more likely to have poorer overall survival (HR=2.05, 95% CI 1.18–3.57, P =0.011). Conclusions: Multiple LBRs appear to be associated with increased risk of AL and protective stomas with decreased risk. Since AL after OC cytoreduction significantly delays chemotherapy and negatively impacts survival, surgeons should strongly consider temporary diversion in selected patients (poor nutritional status, multiple LBRs, previous pelvic radiation, very low anterior resection, steroid use). [Copyright &y& Elsevier]

Abstract: Objective: Technological advances in surgical management of endometrial cancer (EC) may allow for novel risk modification in surgical site infection (SSI). Methods: Perioperative variables were abstracted from EC cases surgically staged between January 1, 1999, and December 31, 2008. Primary outcome was SSI, as defined by American College of Surgeons National Surgical Quality Improvement Program. Counseling and global models were built to assess perioperative predictors of superficial incisional SSI and organ/space SSI. Thirty-day cost of SSI was calculated. Results: Among 1369 EC patients, 136 (9.9%) had SSI. In the counseling model, significant predictors of superficial incisional SSI were obesity, American Society of Anesthesiologists (ASA) score >2, preoperative anemia (hematocrit <36%), and laparotomy. In the global model, significant predictors of superficial incisional SSI were obesity, ASA score >2, smoking, laparotomy, and intraoperative transfusion. Counseling model predictors of organ/space SSI were older age, smoking, preoperative glucose >110mg/dL, and prior methicillin-resistant Staphylococcus aureus (MRSA) infection. Global predictors of organ/space SSI were older age, smoking, vascular disease, prior MRSA infection, greater estimated blood loss, and lymphadenectomy or bowel resection. SSI resulted in a $5447 median increase in 30-day cost. Conclusions: Our findings are useful to individualize preoperative risk counseling. Hyperglycemia and smoking are modifiable, and minimally invasive surgical approaches should be the preferred surgical route because they decrease SSI events. Judicious use of lymphadenectomy may decrease SSI. Thirty-day postoperative costs are considerably increased when SSI occurs. [Copyright &y& Elsevier]

Abstract: Background: Despite increasing use of intraperitoneal chemotherapy the optimal delivery strategy and regimen remain undetermined. Catheter-related complications have been reported in 3–34% of cases across a number of platforms and port styles, but few data compare different catheters directly. We sought to evaluate the complication rate of two separate intraperitoneal chemotherapy port delivery systems used within a single practice. Methods: We reviewed the medical records of all patients who underwent port placement in our practice (two surgical centers) from January, 2006 through October, 2008. Data extracted included: demographics, medical co-morbidities, port type, timing of placement, intraoperative procedures, reasons for discontinuation of IP chemotherapy, and number of completed cycles. Results: We identified 85 patients who had intraperitoneal ports placed. Four patients were excluded from this analysis: 2 declined chemotherapy and 2 were treated at other institutions and follow-up data was insufficient. Fifty-two (64%) of the 81 patients analyzed had a fenestrated port placed, and 29 (36%) had single lumen ports. In 67 cases (83%) the port was placed at the time of initial cytoreductive surgery. In 14 patients (17%) it was placed as a secondary event. The groups were well matched for age, stage, BMI, and medical co-morbidities though the group with single lumen catheters had more antecedent surgeries. We observed no significant difference between patients with single lumen or fenestrated ports with regard to: number of intraperitoneal treatments, catheter-related complications, hematologic outcomes, and rates of discontinuation. Conclusions: A low rate of catheter-related complications is observed with both systems. The majority of discontinuations were due to hematologic complications and did not appear to be intrinsic to catheter choice. [Copyright &y& Elsevier]