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MyPlate is a tool designed to educate the general US population on how to eat in alignment with the Dietary Guidelines for Americans; yet, there is a lack of data on who has heard of MyPlate over time. The objective of this analysis was to examine the prevalence of awareness of MyPlate within the US population and if awareness changes differentially over time. This study was a serial, cross-sectional survey. Three survey waves of data (2013-2018) were used from the National Health and Nutrition Examination Survey of adults aged 20 years or older (n = 17,023). Percentage of the US adult population who had heard of MyPlate was measured and stratified by sex, age, citizenship status, education, household food security status, income, receipt of Supplemental Nutrition Assistance Program (SNAP) benefits, and receipt of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits. Global Wald tests were used to assess whether prevalence of awareness of MyPlate differed by sociodemographic characteristics. Tests of homogeneity using likelihood ratio tests of nested logistic regression models were used to assess whether differences in awareness of MyPlate by various sociodemographic characteristics changed over time from 2013 to 2018. Twenty percent (19.5%) (n = 875) of the analytic sample of participants aged 20 years and older had heard of MyPlate in 2013-2014, 24.5% (n = 1,020) in 2015-2016, and 24.6% (n = 1,086) in 2017-2018. Awareness of MyPlate changed differentially over time (P value <.1) from 2013 to 2018 by income, household food security status, and receipt of SNAP benefits, with slower increases in awareness for households with lowest income over time, narrowing of differences in awareness by household food security status over time, and persistent differences in awareness by receipt of SNAP benefits over time. These results highlight the current low awareness of MyPlate, disparities in awareness of MyPlate immediately after implementation by sociodemographic characteristics, and increases in awareness over time at differential rates within levels of income, food security status, and ever receipt of SNAP benefits. Given that the Dietary Guidelines for Americans 2025-2030 are currently in development, new strategies should be considered to disseminate tools that translate the updated Dietary Guidelines in such a way that reach the general population equitably upon implementation within the United States. [ABSTRACT FROM AUTHOR]

Patients with cervical cancer undergoing chemoradiation have high symptom burden. We performed an analysis of prospectively collected data on patient-reported outcomes to determine characteristics predictive of poor treatment experience. Between 2021 and 2023, we prospectively collected data on patient-reported outcomes from patients with cervical cancer undergoing definitive chemoradiation. The European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Question-Core 30 and the EORTC-Quality of Life Question-Cervical Cancer module were completed at baseline (BL) and at the end of treatment (EOT). Poor treatment experience was defined as EOT poor health-related quality of life (HRQOL), low physical function, or significant overall symptom burden. Predictive factors analyzed included demographic, clinical, and disease-specific factors and BL financial toxicity, depression, social function, and emotional function. Receiver operating characteristic analysis provided appropriate predictive cutoff values. Univariable and multivariable (MVA) linear regression analyses were performed. Forty-nine patients completed BL and EOT questionnaires. Median age was 43 years (range, 18-85 years). Most patients (59%) had stage III disease. BL financial toxicity ≥66.7, depression ≥66.7, social function ≤50, and emotional function ≤58 on the EORTC linear transformed scale of 0 to 100 were significant predictors for poor treatment experience (p ≤.04) based on receiver operating characteristic analysis. On MVA, poor BL social function was associated with reduced EOT HRQOL (β, −9.3; 95% CI, −16.1 to −2.6; p <.008), decreased physical function (β, −24.4; 95% CI, −36.3 to −12.6; p <.001), and high symptom burden (β, 26.9; 95% CI, 17.5-36.3; p <.001). Earlier disease stage predicted decreased symptom burden (β, −6.7; 95% CI, −13.1 to −0.3; p =.039). BL financial toxicity was a significant predictor in univariable analysis (p =.001-.044) and showed a significant interaction term on MVA (p =.024-.041) for all 3 domains of poor treatment experience. Demographic and treatment-related factors were not predictive. Patients with cervical cancer with poor BL social function or high financial toxicity were at risk for increased symptom burden and poor HRQOL. Screening for these factors provides an opportunity for early intervention to improve treatment experience. [ABSTRACT FROM AUTHOR]

Cold temperatures have been posited as a key driver of polyploidy (possession of multiple chromosome sets). However, high temperatures associated with fire, and the indirect impact of post-fire environments in polypoid formation and establishment deserve more attention for a comprehensive understanding of polyploid ecology, evolution, and current distributions. [ABSTRACT FROM AUTHOR]

Patients with gynecologic malignancies have high psychosocial and symptom burden. We report data from a prospective trial evaluating patient-reported outcome (PRO) metrics in women undergoing definitive chemoradiation with brachytherapy (BT). A single-institution prospective trial evaluating outcomes of gynecologic cancer patients undergoing BT. Questionnaires to assess PROs at baseline, post-BT, and 60-day follow-up were collected, using European Organization for Research and Treatment of Cancer-Quality of Life Question-Core 30 and European Organization for Research and Treatment of Cancer-Quality of Life Question-Cervical Cancer Module validated metrics. Higher scores for functional scales/global health and lower scores for symptom items are favorable. European Organization for Research and Treatment of Cancer-Quality of Life Question-Core 30 mean scores were compared with a reference population. When comparing the study population between time points, medians, interquartile range, and nonparametric testing were used. Thirty-three patients were enrolled, and 29 (88%) completed baseline PRO metrics. Mean global health score was worse than the reference population of women with any cancer diagnosis at baseline (41 vs 59, P <.001) and decreased further at follow-up (42 vs 33, P =.005). Compared with the cervical cancer reference, our patients had significantly worse social function (62 vs 83, P =.03), financial toxicity (49 vs 10, P <.001), fatigue (49 vs 34, P =.04), nausea/vomiting (26 vs 9, P =.001), and appetite loss (36 vs 16, P =.004).The majority of patients described depression (53%), feeling less attractive (64%), life interference (66%), and/or worry (69%). At baseline, higher global health scores were associated with improved physical functioning (R20.58, P <.001), social functioning (R20.56, P <.001), and body image (R20.40, P <.001); lower scores with more symptom burden (R20.71, P <.001), financial toxicity (R20.50, P <.001), and/or sexual worry (R20.25, P =.001). Patients with cervical cancer have significant symptom burden and psychosocial toxicity, contributing to decreased quality of life. These data highlight the need for improved support throughout treatment for this high-risk population. [ABSTRACT FROM AUTHOR]

Syringeless power injectors obviate the need for reloading iodinated contrast media (ICM) and plastic consumable pistons between exams. This study evaluates the potential time and material waste (ICM, plastic, saline, and total) saved using a multi-use syringeless injector (MUSI) compared to a single-use syringe-based injector (SUSI). Two observers recorded technologist time spent using a SUSI and a MUSI over three clinical workdays. CT technologists (n = 15) were polled on their experience between the systems using a 5-point Likert scale survey. ICM, plastic, and saline waste data from each system were collected. A mathematical model was created to estimate total and categorical waste from each injector system over a 16-week period. On average, CT technologists spent 40.5 seconds less per exam with MUSI compared to SUSI (p <.001). Technologists rated MUSI work efficiency, user-friendliness, and overall satisfaction (strongly or somewhat improved) higher relative to SUSI (p <.05). Iodine waste was 31.3 L and 0.0 L for SUSI and MUSI, respectively. Plastic waste was 467.7 kg and 71.9 kg for SUSI and MUSI, respectively. Saline waste was 43.3 L and 52.5 L for SUSI and MUSI, respectively. Total waste was 555.0 kg and 124.4 kg for SUSI and MUSI respectively. Switching from SUSI to MUSI resulted in a 100%, 84.6%, and 77.6% reduction in ICM, plastic, and total waste. This system may fortify institutional endeavors toward green radiology initiatives. The potential time saved administering contrast using MUSI may improve CT technologist efficiency. [ABSTRACT FROM AUTHOR]

Growing evidence has demonstrated significant, persistent, and widespread disparities in cancer clinical trial enrollment across myriad disease sites and target populations. Although mechanisms underlying such disparities are complex and multifactorial, clinical trial eligibility criteria may serve as a key structural barrier to equitable and diverse trial enrollment. In this review, we provide an overview of the data describing historical and current disparities in cancer clinical trial enrollment and subsequently describe several patient-, institution-, and trial-related factors which appear to be key drivers of enrollment inequity, with specific discussion regarding the impact of eligibility criteria. We further describe the landscape of ongoing professional efforts aimed at eliminating clinical trial disparities through various medical, professional, and advocacy groups. The review concludes with a practical discussion of how modernization of eligibility criteria in clinical trials may decrease or eliminate trial disparities, including specific actionable recommendations aimed at improving the quality of future eligibility criteria. [ABSTRACT FROM AUTHOR]

Clinically integrated networks of community pharmacies are expanding partnerships with health care payers for sustainable provision of patient care services. The Pennsylvania Pharmacists Care Network (PPCN), a part of CPESN USA, launched its first payer program in 2017 with a Medicaid managed care organization for comprehensive medication management (CMM). Some PPCN pharmacy teams have participated in Flip the Pharmacy, a national practice transformation initiative. This study aimed to determine whether pharmacy participation in Flip the Pharmacy was associated with a greater rate of CMM encounters than in nonparticipating pharmacies within a statewide clinically integrated network. This project was a retrospective quantitative study. CMM encounter data including total number of encounters and total number of eligible members were extracted from monthly reports. Generalized estimating equations were used to assess the association between Flip the Pharmacy participation and CMM encounter rates. Of 103 pharmacies that participated in the CMM program in 2019 and 2020, 77.7% of pharmacies (n = 80) were included in analyses. Of these, 31.3% (n = 25) participated in Flip the Pharmacy. Overall, 80 pharmacies documented 8460 patient encounters through the CMM program. On average, pharmacies participating in Flip the Pharmacy recorded 1.67 times the rate of encounters compared with non-Flip the Pharmacy pharmacies (95% CI 1.10–2.54), controlling for single versus multiple pharmacy sites and weekend hours. On average, pharmacies participating in Flip the Pharmacy recorded 1.18 times the rate of initial encounters (95% CI 0.84–1.59) and 2.06 times the rate of follow-up encounters (95% CI 1.22–3.48) compared with non-Flip the Pharmacy pharmacies. Participation in Flip the Pharmacy in Pennsylvania was associated with greater engagement and completion of encounters within a payer program for CMM. Continued practice transformation efforts are needed to ensure the sustainability of community pharmacy practice as it continues to expand into payment for patient care services. [ABSTRACT FROM AUTHOR]

More than 250,000 patients die from Hodgkin or non-Hodgkin lymphoma each year. Currently, molecular imaging with 18F-FDG-PET/CT is the standard of care for lymphoma staging and therapy response assessment. In this review, we will briefly summarize the role of molecular imaging for lymphoma diagnosis, staging, outcome prediction, and prognostication. We discuss future directions in response assessment and surveillance with quantitative PET parameters, the utility of interim assessment, and the differences with response assessment to immunomodulatory therapy. Lastly, we will cover innovations in the field regarding novel tracers and artificial intelligence. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore a systemwide process for assessing components of low back pain (LBP) care quality in Veterans Health Administration (VHA) chiropractic visits using electronic health record (EHR) data. We performed a cross-sectional quality improvement project. We randomly sampled 1000 on-station VHA chiropractic initial visits occurring from October 1, 2017, to September 30, 2018, for patients with no such visits within the prior 12 months. Characteristics of LBP visits were extracted from VHA national EHR data via structured data queries and manual chart review. We developed quality indicators for history and/or examination and treatment procedures using previously published literature and calculated frequencies of visits meeting these indicators. Visits meeting our history and/or examination and treatment indicators were classified as "high-quality" visits. We performed a regression analysis to assess associations between demographic/clinical characteristics and visits meeting our quality criteria. There were 592 LBP visits identified. Medical history, physical examination, and neurologic examination were documented in 76%, 77%, and 63% of all LBP visits, respectively. Recommended treatments, such as any manipulation, disease-specific education/advice, and therapeutic exercise, occurred in 75%, 69%, and 40% of chronic visits (n = 383), respectively. In acute/subacute visits (n = 37), any manipulation (92%), manual soft tissue therapy (57%), and disease-specific advice/education (54%) occurred most frequently. Female patients and those with a neck pain comorbid diagnosis were significantly less likely to have a "high-quality" visit, while other regression associations were non-significant. This study explored a systemwide process for assessing components of care quality in VHA chiropractic visits for LBP. These results produced a potential framework for uniform assessment of care quality in VHA chiropractic visits for LBP and highlight potential areas for improvements in LBP care quality assessments. [ABSTRACT FROM AUTHOR]

Patients with premenopausal breast cancer (PMBC) have been historically excluded from some clinical trials because of the limitations of using endocrine therapy (ET) in this population. We analyzed breast cancer randomized clinical trials (RCTs) to determine the rates of and factors associated with inclusion of PMBC patients to provide a benchmark for PMBC inclusion in RCTs moving forward. Using ClinicalTrials.Gov , we identified breast cancer phase III RCTs and extracted inclusion criteria and patient enrollment information. Multiple binary logistic regression modeling was used to assess trial-related factors that were associated with PMBC patient inclusion. Of 170 breast cancer RCTs identified, 131 (77.1%) included PMBC patients. Sixty-five (38.2%) trials analyzed patients with hormone-receptor-positive (HR+) and HER2-negative (HER2-) breast cancer, of which 31 (47.7%) allowed for enrollment of PMBC patients. Lower rates of PMBC inclusion were seen in trials that studied HR+/HER2-patients (47.7% PMBC inclusion in HR+/HER2-trials vs. 94.3% in non-HR+/HER2-trials, aOR 0.07 [95% CI: 0.02–0.19], p < 0.001) and in trials that randomized or mandated ET (44.4% in ET trials vs. 83.2% in non-ET trials, aOR 0.21 [95% CI: 0.10–0.83], p = 0.02). Trials studying chemotherapy (CT) were associated with inclusion of PMBC patients (100% in CT trials vs. 70.5% in non-CT trials, a OR 14.02 [95% CI: 1.54–127.91], p = 0.01). All surgical and radiation therapy clinical trials allowed for the inclusion of PMBC patients in their eligibility criteria. Breast cancer clinical trials should carefully select their enrollment criteria and consider inclusion of premenopausal patients when appropriate. • We investigated the inclusion of premenopausal breast cancer (PMBC) patients in clinical trials. • There was lower inclusion of PMBC in trials studying HR+/HER2-patients. • There was lower inclusion of PMBC in trials studying endocrine therapy. • Trials should carefully select their enrollment criteria and include PMBC patients when appropriate. [ABSTRACT FROM AUTHOR]

• The interaction of behavioral and psychological factors may influence glucose. • More physical activity and higher perceived stress than usual predicted lower glucose. • Biopsychosocial paradigms should be explored for chronic disease prevention. • Combining multiple ambulatory methods in free-living settings is feasible in youth. Less moderate to vigorous physical activity (MVPA), more sedentary time (ST), and higher perceived stress are related to type 2 diabetes mellitus (T2DM) occurrence, but observational evidence addressing the interaction of these factors is lacking in youth. This pilot study investigated momentary stress as a moderator in the acute associations of MVPA and ST with subsequent glucose in healthy adolescents. Participants (N=15, M age=13.1±1.0 years, 10 girls, 5 with overweight/obesity) simultaneously wore a continuous glucose monitor (CGM), thigh-mounted accelerometer, and reported momentary stress via random ecological momentary assessments (EMA; Time T) for 7–14 days. MVPA and ST (min) were calculated for 60- and 120-minute time windows before each EMA prompt (Time T-1). Mean CGM-measured interstitial glucose (mg/dL) was calculated after each prompt (M min=120.0±25.4; Time T+1). Multilevel models assessed whether within-subject MVPA and ST (Time T-1) predicted mean glucose (Time T+1), with momentary stress as a moderator (Time T). There were 513 time-matched EMA reports of stress, accelerometer, and CGM data. Momentary stress moderated the effects of MVPA 60 (β=-0.22, p=.001) and 120 min (β=-0.08, p=.02) before the prompt on subsequent glucose levels. When youth spent more time in MVPA than their average and when momentary stress was higher than their average, subsequent glucose was lower. Stress did not moderate associations of ST with glucose (p>.05). Higher momentary stress may interact with higher MVPA to lower subsequent glucose in youth. Accelerometers, EMA, and CGMs can be integrated in future studies to further understand these associations in free-living environments. [ABSTRACT FROM AUTHOR]

Taylor Swift is arguably one of the most popular and influential celebrities. Of particular interest is her power as a role model for millions of fans across the world. Swift has spoken openly about different cultural issues, including her struggles with disordered eating and diet culture. Thus, the purpose of this paper was to explore whether Swift's disclosures of her own eating and body image struggles influenced her fans. Over 200 TikTok and Reddit posts related to Swift and eating disorders or body image, as well as their associated comments, were qualitatively coded to examine relevant themes. Key themes included: 1) Swift as a role model for disordered eating recovery; 2) use of or identification with specific Swift songs to illustrate struggles with eating or body image; 3) continued objectification of Swift's body; and 4) conflicted reaction to a scene in Swift's video for 'Anti-Hero' that depicted the word 'fat' on a scale. Overall, Swift's disclosures of her own eating/body image struggles positively influenced her fans' relationships with their eating behaviors and body image. This analysis illustrates the positive influence celebrities can have while also highlighting the limitations of personal disclosures to impact understanding of systemic issues like anti-fat bias. • Taylor Swift is a positive role model for users. • Swift content positively impacted fans' disordered relationships to food and body. • Swift content can reduce stigma of eating disorders and contribute to recovery. • In contrast, themes of objectification and anti-fat bias were present. [ABSTRACT FROM AUTHOR]

Purpose: Definitive radiation therapy with concurrent chemotherapy is curative for nonmetastatic squamous cell carcinoma of the anus (SCCA). However, the true effect of chemoradiation on long-term functional outcomes is poorly understood owing to limited follow-up and patient-reported outcomes (PROs).Methods and Materials: We conducted a cross-sectional survey of 248 patients with SCCA treated with definitive intensity modulated radiation and concurrent chemotherapy from 2010 to 2018 who were alive and without recurrence. PRO measures were collected, including Functional Assessment of Cancer Therapy-General (FACT-G7), Fecal Incontinence Quality of Life (FIQoL), Low Anterior Resection Syndrome (LARS), and International Consultation on Incontinence Questionnaires (ICIQ). Models were used to determine the association between demographic, tumor, treatment, and dosimetric data with PROs.Results: One hundred twelve (45%) patients completed PROs. Median [interquartile range (IQR)] time from radiation completion to survey was 51 [37-85] months. The median scores [IQR] for FACT-G7, FIQoL, and LARS were 21 [15-24], 14 [11-16], and 32 [25-37], respectively. For men, median subscores [IQR] for ICIQ voiding and incontinence subscores were 5 [2-6] and 1 [1-3], respectively. For women, median subscores [IQR] for ICIQ voiding, incontinence, and filling were 1 [1-3], 5 [3-8], and 4 [2-5], respectively. Higher (better) FIQoL scores were associated with higher (better) FACT-G7 scores (β = 0.83; 95% confidence interval, 0.58-1.09; P < .001), and higher (worse) LARS scores were associated with lower (worse) FACT-G7 scores (β = -0.22; 95% confidence interval, -0.31 to -0.13; P < .001). A separate multivariable analysis revealed higher bowel bag D1% was associated with lower (worse) FIQoL (P = .001) and higher (worse) LARS (P = .003) scores. Higher bladder V40 Gy was associated with increased (worse) ICIQ voiding subscore (P = .001).Conclusions: Patients treated with modern chemoradiation for SCCA experience significant long-term bowel toxic effects with considerable effect on quality of life. Minimizing bowel hotspots and bladder V40 Gy may improve bowel and urinary function. Other interventions to reduce long-term toxic effects and improve quality of life are needed. [ABSTRACT FROM AUTHOR]

Pelvic chemoradiation can have a profound effect on sexual function. Few data exist describing long-term sexual function patient-reported outcomes (PROs) for patients treated with intensity modulated radiation and concurrent chemotherapy (CRT) for squamous cell carcinoma of the anus (SCCA). We identified 248 patients with SCCA treated with CRT from 2010 to 2018 who were alive and without recurrence. We sent a PRO survey to 148 patients who agreed to participate. The survey was comprised of the PROMIS sexual function and satisfaction questionnaire, the international index of erectile function 5-item questionnaire for men, and the female sexual function index questionnaire for women. Clinical and dosimetric data were collected for each patient. We used multiple regression models to identify factors associated with sexual function PROs. One-hundred twelve patients (45.2% of all eligible patients, 75.7% of administered surveys) completed the survey; 90 (80.4%) were women, 107 (95.5%) were white. The median (interquartile range [IQR]) age was 61.5 (53.8-66.0) years. The median (IQR) interval since CRT was 51 (37-85) months. Twelve men (54.5%) and 52 women (57.1%) were sexually active. The median (IQR) age of sexually active patients was 58.2 (50.1-64) years compared with 64.8 (59.1-68.8) years for sexually inactive patients (P <.001). The median (IQR) female sexual function index score for sexually active women was 20.2 (13.6-25.1). The median (IQR) international index of erectile function 5-item questionnaire score was 14 (6.5-19). Patients treated with modern CRT for SCCA experience significant long-term sexual dysfunction as reported using validated PROs. Interventions to reduce sexual toxicities and improve patient support are needed. [ABSTRACT FROM AUTHOR]

To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP. The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG. Research facility. Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37). Not applicable. IMP, LOI, UEMS, FIST-SCI. UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P <.001), 0.480 (P =.003), 0.467 (P =.004), 0.527 (P =.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001,.008,.002, respectively, and ITG vs. ATG P values=<.001,.032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P <.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]). The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB. [ABSTRACT FROM AUTHOR]