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Objective This study aimed to compare attendance of nutritional counseling, dietary composition, exercise patterns, and socioeconomic factors among obese women with inappropriate gestational weight gain (iGWG) versus appropriate GWG (aGWG). Study Design Medicaid-eligible women receiving prenatal care at a tertiary care center from January 2013 to December 2015 were offered individualized nutritional counseling by a registered dietitian encouraging well-balanced meals and 150 min/wk of exercise. We conducted a prospective case–control study of obese women (body mass index or BMI ≥30) with a singleton gestation with iGWG (20 pounds) versus aGWG (11–20 pounds). Dietary intake, activity level, and socioeconomic factors were compared with Chi-square, Fisher's exact, Student's t-test, and Wilcoxon Rank Sum tests as indicated, and odds ratios with 95% confidence intervals were calculated. Multivariate regression analysis for significant variables was performed. A subgroup analysis of women with BMI ≥40 was planned. Results A total of 401 women were analyzed: 78% (n = 313) with iGWG and 22% (n = 88) with aGWG. Demographics were similar between groups. Women with iGWG less frequently reported physician reinforcement of counseling and reported more physical inactivity and unemployment; there were no differences in caloric intake or macronutrient profile between groups. Multivariate regression identified physician reinforcement and employment as independent predictors of aGWG. Among women with BMI ≥40 (n = 133), those with iGWG (78%) were less likely to attend counseling, report physician reinforcement of counseling, and have adequate caloric and protein intake when compared with those with aGWG (22%). Activity level and socioeconomic factors were not different between groups. Conclusion Physician reinforcement of nutritional counseling, greater activity level, and employment are associated with aGWG in women with BMI ≥30, while individualized professional nutritional counseling and dietary modifications were further associated with aGWG in women with BMI ≥40. Thus, greater focus should be placed on enhancing exposure to counseling and altering nutritional and exercise choices to optimize aGWG. Key Points

Objectives: A nutrition support program for ovarian cancer patients via early consultation with a registered dietician was developed in 2016 at our institution. The initial goal of our nutrition support program was focused on optimizing nutrition counseling for patients receiving NACT, though it has been broadened to include the majority of newly diagnosed ovarian cancer patients. Follow-up visits are patient-initiated. We sought to evaluate outcomes of consultation in these patients to identify how to improve the program and better meet patient needs. Methods: We retrospectively reviewed data from ovarian cancer patients receiving chemotherapy at our institution who ≥1 consult with a registered dietician from 12/2016-5/2020. We reviewed weight at baseline (time of initial consult) and at 6 months and baseline albumin. Patients were categorized using body mass index (BMI) as underweight (BMI Results: 227 patients were included; 216 were actively receiving chemotherapy and 11 were initiating chemotherapy. There were 113 (50%) receiving NACT. Average age was 62 (range 20-92), 44 (19%) patients were BlackBlack, and average baseline BMI was 28 (range 16-55). At initial consultation, 6 (3%) patients were underweight, 73 (32%) were normal weight, 73 (32%) were overweight, and 75 (33%) were obese. Table 1 details weight change data in patients with 6-month weight follow-up. The average weight change from baseline to 6m was -1.67 kg for underweight, -0.27 kg for normal weight, -0.16 kg for overweight, and -1.6 kg for obese patients. Among 116 patients receiving NACT, an initial albumin level was recorded in 83 patients (average 3.8). In 108 patients who underwent primary debulking surgery, initial albumin was obtained in 66 patients (average 3.9). Most patients (180/227, 79%) had a single nutrition consult. Of 47 patients who had at least one follow-up visit, 34 (72%) were receiving NACT. Follow-up visits were problem focused and primarily conducted in-person except for 3 telephone follow-up visits. Review of visit documentation identified several themes, including poor appetite, concerns about weight, and symptom management. Download : Download high-res image (92KB) Download : Download full-size image Conclusions: Given the large proportion of obese patients in our cohort, weight goals (maintain, lose, gain) differ based on patient BMI. Average baseline albumin was similar between patients receiving NACT versus primary debulking surgery and has an unclear role as it was inconsistently followed and can be modified by multiple variables. As more patients who received NACT had patient-initiated follow-up visits, implementing scheduled follow-up for this group of patients would more proactively address a population to improve symptom management.

Between December 2005 and October 2009, FDA approved six targeted therapies shown to significantly extend survival for advanced renal cell carcinoma (RCC) patients in clinical trials. This study aimed to examine changes in survival between the pretargeted and targeted therapy periods in advanced RCC patients in a real‐world setting. Utilizing the 2000–2010 SEER Research files, a pre–post study design with a contemporaneous comparison group was employed to examine differences in survival outcomes for patients diagnosed with advanced RCC (study group) or advanced prostate cancer (comparison group, for whom no significant treatment innovations happened during this period) across the pretargeted therapy era (2000–2005) and the targeted therapy era (2006–2010). RCC patients diagnosed in the targeted therapy era (N = 6439) showed improved survival compared to those diagnosed in the pretargeted therapy era (N = 7231, hazard ratio (HR) for all‐cause death: 0.86, P

The purpose of pre-service nursing education programs is to prepare competent graduates who are able to function as safe, professional registered nurses. An extensive element of these programs is the teaching of physical assessment skills, with most programs educating students to perform over 120 such skills. Previous research from North America suggests that the majority of skills taught to nurses in their pre-service programs are not used in practice. As part of a larger study, an online survey was used to explore use of 121 physical assessment skills by Australian nurses. Recruitment occurred via mailed invitation to members of the Australian Nursing Federation. Data were extracted from 1220 completed questionnaires returned by nurses who were mostly employed in New South Wales, were female and experienced nurses. Respondents indicated that they used only 34% of skills routinely. Results reinforce evidence found in the literature that many of the skills taught to nurses are either not used at all (35.5%) or are used rarely (31%). These findings have implications for the teaching of physical assessment skills in pre-service nursing programs, and raise questions about the value of extensive skills teaching in the context of contemporary health care. Further research into barriers to the use of physical assessment skills in nursing and the need for comprehensive skills preparation for the generalist nurse is likely to offer some solutions to these questions.

Objective: The purpose was to assess factors potentially affecting care pharmacists provide to HIV/AIDS patients including comfort level, confidence, education, experience, professional competence, continuity of care and patient-provider relationship between pharmacists and HIV-infected patients. Methods: A 24-item questionnaire assessed the constructs of this study. Surveys were distributed from October 2009 to April 2010 to pharmacists in Alabama with varying levels of experience treating HIV-infected patients. Chi-square tests determined whether relationships existed between responses, consisting of how often respondents reported treating HIV-infected patients, amount of HIV education respondents had, participants' confidence with HIV/AIDS knowledge and comfort level counseling HIV-infected patients about their medications. Results: Thirty-three percent of the pharmacists cared for HIV-infected patients on a monthly basis, yet 86% do not feel very confident with their HIV/AIDS knowledge. Forty-four percent were not comfortable counseling patients on antiretroviral medications, and 77% would feel more comfortable with more education. Significant, positive relationships were revealed concerning how often respondents treat HIV-infected patients and their comfort level counseling them (r=0.208, p

Introduction The current standard to assess chemotherapy tolerability relies on patient self-reporting. However, as the sole mechanism of managing symptom burden, this may be inconsistent and fraught with bias. Mobile wearable health devices have the ability to monitor and aggregate objective activity and sleep data over long periods of time, but have not been systematically used in the oncology clinic. The aim of the study was to assess whether the use of mobile wearable technology establishes patterns of "sleep" and "wake" states in newly diagnosed Multiple Myeloma (NDMM) patients receiving therapy, and whether these patterns differ over time. Methods Patients presenting to the myeloma clinic at Memorial Sloan Kettering Cancer Center (MSKCC) with a new diagnosis of Multiple Myeloma and smart phone or tablet (iOS or Android) compatible with the Garmin Vivofit device were offered to participate in a mobile wearable bio-monitoring study. All eligible participants were required to receive primary chemotherapy treatment at a MSKCC facility. Treatment was determined by physician. NDMM patients were assigned to one of two cohorts (20 in each; Cohort A - patients Results Between February 2017-March 2018, 37 patients (19 males and 18 females) enrolled onto the study, with 20 in cohort A and 17 in cohort B. The mean age was 55 years (range 41-64) for cohort A and 72 years (range 65-82) for cohort B. Treatment regimens included Carfilzomib/Revlimid/Dexamethasone 14(38%), Velcade/Revlimid/Dexamethasone 10(27%), Daratumumab/Carfilzomib Revlimid/Dexamethasone, 7(19%), Cyclophosphamide/Velcade/Dexamethasone 3(8%), Revlimid/Dexamethasone 2(5%), and Velcade/Revlimid/Dexamethasone-Lite 1(3%). Twenty-four patients have completed the trial, and 7 remain active. Six patients came off-study due to the following reasons: lost devices (n=4), intolerable rash during cycle 3 (n=1), and incompletion of baseline activity (n=1). Three patients were excluded for incomplete data sets with no baseline data collection at the time of analysis. Fifteen patients were available for data review including 10 in cohort A and 5 in cohort B. Mean activity for cohort A was 6,437 steps/24 hr period (1,002 - 12,754) versus for cohort B was 3,218.37 steps/24 hr period (387 - 6,155) (p 100% increase, 1 patient had 50-100% increase, and 11 patients had within +/- 50% change in activity from baseline. Conclusion Electronic mobile wearable device monitoring in symptomatic NDMM patients may be a useful tool to assess a patient's overall wellness and health as they are receiving chemotherapy. For three patients, we were able to capture a dramatic increase in activity after initiation of treatment. Overall activity in the elderly NDMM patients is decreased compared to younger patients. Mobile wearable monitoring may be an even more useful strategy for tracking elderly and unfit patients that are more prone to side effects, where the balance of response versus quality of life is paramount. Figure. Figure. Disclosures Mailankody: Physician Education Resource: Honoraria; Janssen: Research Funding; Takeda: Research Funding; Juno: Research Funding. Hassoun:Oncopeptides AB: Research Funding. Lesokhin:Squibb: Consultancy, Honoraria; Serametrix, inc.: Patents & Royalties: Royalties; Janssen: Research Funding; Bristol-Myers Squibb: Consultancy, Honoraria, Research Funding; Genentech: Research Funding; Takeda: Consultancy, Honoraria. Smith:Celgene: Consultancy, Patents & Royalties: CAR T cell therapies for MM, Research Funding. Shah:Amgen: Research Funding; Janssen: Research Funding. Landgren:Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Consultancy, Research Funding; Pfizer: Consultancy; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Research Funding; Merck: Membership on an entity's Board of Directors or advisory committees; Karyopharm: Consultancy. Korde:Amgen: Research Funding.

Study objectives: To investigate whether differing airway interleukin (IL)-18 levels may be implicated in the pathogenesis of asthma and sarcoidosis. Setting: University teaching hospital. Patients and methods: IL-18 levels were measured in BAL fluid and in the supernatant of lipopolysaccharide (LPS)-stimulated alveolar macrophages obtained by BAL from 15 patients with sarcoidosis, 11 patients with asthma, and 13 healthy subjects. We also examined the relationship between IL-18 levels and macrophage and lymphocyte concentrations in BAL fluid. IL-18 was measured using an in-house enzyme-linked immunosorbent assay. Results: IL-18 levels were significantly lower in BAL fluid from patients with asthma (median, 0.0 pg/mL; interquartile range, 0.0 to 0.0 pg/mL) compared to patients with sarcoidosis (median, 222.0 pg/10 6 ; interquartile range, 110 to 340 pg/mL; p 0.009, Mann Whitney rank-sum test) and healthy control subjects (median, 162 pg/mL; interquartile range, 38 to 203 pg/mL; p 0.025, Mann Whitney rank-sum test). Individual analyses comparing IL-18 levels with BAL macrophage counts, and IL-18 with lymphocyte counts in the three groups showed no correlation between these indexes. The mean levels of IL-18 in unstimulated macrophage supernatants were 410 pg/10 6 cells for patients with asthma, 723.4 pg/10 6 cells for patients with sarcoidosis, and 734.8 pg/10 6 cells for healthy control subjects (p > 0.05). Stimulated macrophages from patients with sarcoidosis responded with increasing amounts of IL-18 at lower doses of LPS than macrophages from healthy control subjects or patients with asthma. Conclusion: Our findings suggest that inherently low levels of IL-18 may be associated with the pathogenesis of asthmatic airway inflammation. (CHEST 2002; 121:1421–1426)

This chapter reviews the epidemiological features of the global dissemination of multiresistant Salmonella enterica serovar typhimurium DT104, discusses the possible origins of this clone, hypothesizes about the possible mechanisms by which rapid global dissemination and displacement of other clones may have occurred, and discusses possible means of control. The clonal nature of mr-DT104 is well established by the genetics of antimicrobial resistance and by restriction fragment length polymorphism analyses. Nosocomial salmonellosis associated with nontyphoidal salmonellae occurs in some developing countries. Four hypothetical models are discussed with respect to their ability to explain the ecological characteristics typical of the agent. These models include: model 1: the enlarged niche hypothesis, model 2: the dissemination fitness hypothesis, model 3: the chance dissemination event hypothesis and model 4: the selection focus hypothesis. To date, the discussion of control efforts for mr-DT104 and similar clones has been limited primarily to debates on the use of antimicrobials in livestock, notably subtherapeutic antimicrobials. The epidemiology of multiresistant serovar Typhimurium is not confined by national borders but is global in nature, as well illustrated by mr-DT104. The available evidence indicates that these efforts should center on selection foci, such as calf-raising operations, which serve as reservoirs of serovar Typhimurium and as sites for clonal competition among epidemic multiresistant strains.

A survey was designed to determine how willingly patients reveal personal health information on dental health history forms. After giving informed consent, 107 patients at a university dental hygiene program completed a 10-item survey privately and anonymously. The results suggest that a significant number of patients provide inaccurate or incomplete information to questions routinely asked on the dental health history form.

Excerpt: In March 2009 the SoTL Commons Conference at Georgia Southern University in Statesboro, Georgia (USA) was attended by many faculty members from across the globe. Three faculty members were invited to share both professional and personal perspectives about the conference. In this essay, we will talk about our experiences, the role and meaning of the scholarship of teaching and learning (SoTL), and final impressions from the conference.

An oxidant/antioxidant imbalance has been proposed in patients with idiopathic pulmonary fibrosis (IPF). We tested this hypothesis by measuring various parameters of the oxidant/antioxidant balance in the plasma of 12 patients with IPF (7 nonsmokers and 5 smokers); in the bronchoalveolar lavage fluid (BALF) of 24 patients with IPF (17 nonsmokers and 7 smokers) and 31 healthy subjects (23 nonsmokers and 8 smokers). The trolox equivalent antioxidant capacity (TEAC) in plasma and BALF was lower in nonsmoking patients with IPF (plasma 0.55+/-0.1 mM, p

The purpose of this investigation was to determine if listeners were capable of speaker height and weight identifications from recorded speech samples. A standard prose passage was recorded by 30 speakers, 15 females and 15 males. A master tape containing the randomly arranged recorded readings of all speakers was played to a group of 30 subjects for speaker height and weight identification purposes. All subjects participated in two experimental sessions. In one session they were asked to determine the height of each of the speakers on the tape, and in another session weight judgments were made. The order of presentation of the height and weight tasks was randomized so that 15 subjects made height judgments first while 15 subjects made weight judgments first. A multiple‐choice response sheet containing four choices for the judgment of height and weight for each speaker was provided. Results indicate that the subjects were capable, with slightly better than chance guessing accuracy, of identifying the heig...

The cases of 76 patients with chronic radiation dermatitis resulting from low-dose ionizing radiation for benign disease were reviewed retrospectively for risk factors leading to the development of neoplasia. The patients were studied with respect to original hair color, eye color, sun reactive skin type, benign disease treated, area treated, age at treatment, and age at development of first skin cancer. Analysis of data showed 37% of patients had sun-reactive skin type I, 27% had type II, and 36% had type III. Types IV through VI were not represented. There appeared to be an overrepresentation of types I and II. Increased melanin pigmentation may therefore be either directly or indirectly protective against the development of skin cancers in patients who have received low-dose superficial ionizing radiation for benign disease. The sun-reactive skin type of patients with chronic radiation dermatitis may be used as a predictor of skin cancer risk when the total dose of ionizing radiation is not known.

The purpose of this investigation was to determine if listeners were capable of speaker height and weight identification from recorded speech samples of speakers' voices. A standard prose passage was recorded by 30 speakers, 15 females and 15 males. A master tape containing the randomly arranged recorded readings of all speakers was played to a group of 30 subjects. All subjects participated in two experimental sessions. In one session they were asked to determine the height of each speaker and in another session weight judgments were made. The order of presentation of the two experimental tasks was randomized so that 15 subjects made height judgments first and 15 subjects made weight judgments first. A multiple‐choice response sheet containing four choices for height and weight judgments for each speaker was provided. In addition, subjects were also asked to indicate the confidence of their decisions on a seven‐point rating scale, and to describe the criteria upon which they based their decisions. Results indicate that (1) for both order groups, subjects were capable, with better than chance‐guessing accuracy, of correctly identifying the heights and weights of speakers when presented with only recorded speech samples and (2) subjects exhibited slightly greater accuracy in identifying speaker weights than heights, regardless of the order in which they were exposed to the two kinds of identification tasks. Implications of these findings and suggestions for future research are discussed.