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377 Background: Previous randomized controlled trials have demonstrated benefits to patients from remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePROs) including healthcare utilization. However, less is known about the impact of RSM in diverse, real-world populations. Methods: This cross-sectional analysis from a hybrid, type 2 implementation-effectiveness trial evaluated the impact of RSM on healthcare utilization amongst patients with cancer receiving chemotherapy, immunotherapy, monoclonal antibody, or targeted therapy at two academiccancer centers in the Southeastern United States. Modified Poisson regression models with robust standard error and 95% confidence interval (CI) was used to calculate the relative risk (RR) of any hospital or ICU utilization between patients receiving RSM and controls for 3 and 6 months after index date. Models were controlled for age at index, race, sex, cancer type, cancer stage, insurance, prior treatment, comorbidities, RUCA, and follow-up during COVID-19 pandemic. Additional logistic regression models were used to estimate odds ratios (OR) for subset analysis stratified by race (Black or African American, Other, or White), rurality using Rural-Urban Commuting Area Codes, and neighborhood disadvantage using Area Deprivation Index (ADI). Results: From 5/2021-2/2024, 1215 patients were enrolled in RSM; 27% were Black, 16% lived in a rural area, and 25% lived in an area with high neighborhood disadvantage. The populations receiving RSM were similar to the control population (n = 4559); 26% were Black, 22% lived in a rural area, and 28% lived in area with high neighborhood disadvantage. The unadjusted relative risk of hospitalization for patients receiving RSM and control patients were 0.70 (95% CI, 0.63-0.70) and 0.77 (95% CI, 0.71-0.85), respectively. In adjusted analyses, hospitalizations were lower amongst patients receiving RSM compared to control patients with a RR of 0.82 (95% CI 0.73-0.92). Similar patterns were observed for ICU admissions (RR 0.59; 95% CI,0.40-0.88). Analysis by patient subgroup was similar to the overall analysis. A lower odd of hospitalizations and ICU admissions at 6 months was observed across all subset analyses: Black vs. White patients (OR 0.80; OR 0.48); rural vs. urban patients (OR 0.78; OR 0.68); and patients living in areas of high vs. lower neighborhood disadvantage (OR 0.59; OR 0.33). Conclusions: The use of RSM amongst patients receiving treatment for cancer is associated with reductions in hospitalizations and ICU admissions in real-world, diverse settings. Further work to expand this intervention nationally is needed. Clinical trial information: NCT04809740. [ABSTRACT FROM AUTHOR]

328 Background: Disparities in pain management for Black patients with cancer are well-documented, but less is known about other symptom clusters like gastrointestinal (GI), respiratory, and urinary symptoms. This study assessed racial disparities in electronically reported symptom clusters among Black and White patients with cancer enrolled in a Remote Symptom Monitoring (RSM) program. Methods: Patients with cancer at the University of Alabama at Birmingham (UAB) and the Mitchell Cancer Institute (MCI) reported symptoms weekly using the Patient Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAEs). The GI symptom cluster included decreased appetite, nausea, vomiting, constipation, and diarrhea; the respiratory cluster included cough and shortness of breath; the urinary cluster included frequent urinary problems. We assessed the presence of any moderate/severe symptoms or any severe symptoms (triggering a nurse alert) in the clusters. The study evaluated surveys submitted within the first six months after RSM enrollment. Generalized linear mixed effects modeling with random effects adjusting for cancer type, sex, and age were used to calculate the odds of reporting any moderate/severe pain between Black and White patients. Results: Among 1454 patients (31% Black, 69% White), 17,937 surveys were analyzed. The median age for Black patients was 59 (IQR 47-66) and 63 (IQR 54-71) for White patients. Breast cancer was most common in both groups (36% Black, 23% White), followed by gynecological (20% Black, 17% White) and gastrointestinal cancers (19% Black, 18% White). At baseline, both races reported similar proportions of moderate/severe or severe symptom for all clusters (Table). During the first six months in the RSM program, symptom proportions remained similar (Table). These findings were consistent in adjusted analysis for the GI (OR 0.85; 95% CI 0.68-1.07), respiratory (OR 1.18; 95% CI 0.87-1.61), and urinary clusters (OR 0.92; 95% CI 0.61-1.39). Conclusions: Our findings suggest no significant racial disparities in reporting moderate/severe or severe symptoms among Black and White patients with cancer at baseline or within their initial six months in the RSM program across GI, respiratory, and urinary symptom clusters. Survey characteristics. Total Surveys (N=17,937) Baseline Surveys 6 Months Surveys White (n=999) Black (n=455) White (n=11,344) Black (n=5139) Gastrointestinal Symptoms, No. (%) Severe 1376 (8) 121 (12) 59 (13) 783 (7) 413 (8) Moderate/Severe 4701 (26) 300 (30) 130 (29) 2971 (26) 1300 (25) Respiratory Symptoms, No. (%) Severe 438 (2) 28 (3) 29 (6) 241 (2) 140 (3) Moderate/Severe 1612 (9) 90 (9) 62 (14) 996 (8) 464 (9) Urinary Symptoms, No. (%) Severe 333 (2) 31 (3) 13 (3) 184 (2) 105 (2) Moderate/Severe 620 (3) 44 (4) 21 (5) 372 (3) 183 (4) [ABSTRACT FROM AUTHOR]

325 Background: Remote symptom monitoring (RSM) utilizes electronic patient-reported outcomes (ePROs) to facilitate the monitoring and management of treatment-related symptoms outside of traditional healthcare appointment settings. Research suggests benefits surrounding the implementation of RSM; however, there is a literature gap regarding patient and provider perceptions of its implemented use. Methods: This qualitative study included patients and providers from the University of Alabama at Birmingham (UAB) and the Mitchell Cancer Institute (MCI) in Mobile, Alabama, who participated in semi-structured interviews aimed at gaining insight into the experiences of and perceptions surrounding RSM utilization. Interviews occurred over the phone, via digital videoconference, or in person, and were transcribed and inductively coded using NVivo software alongside a constant comparative method to establish a grounded coding schema. Results: Forty patients (20 UAB; 20 MCI) and 30 oncology providers (16 UAB; 14 MCI) identified 25 benefits across 3 overarching themes. Patients and providers found RSM Facilitated Proactive Management enabling early symptom identification and intervention, which helped to reduce symptom burden. Both groups also noticed RSM Improved Therapeutic Alliance, by fostering the relationship between the patient and their care team and enhancing the patient's sense of safety and security through continued and sincere communication. Patients and providers also discussed how RSM Promoted Self-Efficacy and Management among Patients by allowing patients to feel involved and in control of their care, while giving them an inclination to be active members in their care. Providers felt that more active patient involvement in care contributed to a more accurate and thorough reporting of symptoms. Patients and providers also noted drawbacks regarding RSM, including lack of need in cases of no or mild symptoms. Conclusions: Patients and providers recognized the impact RSM had on patient care during cancer treatment. However, given some of the perceived limitations, patient and provider evaluations should continue to ensure successful implementation in future clinical trials. Clinical trial information: NCT04809740. [ABSTRACT FROM AUTHOR]

250 Background: Electronic patient reported outcomes (ePROs) enable patients to report symptoms from treatment in real time using their mobile device. This analysis sought to better understand the trajectory of reported symptoms via remote symptom monitoring (RSM) during treatment for patients with lung cancer. Methods: We approached patients with lung cancer initiating treatment at the Mitchell Cancer Institute (MCI) between March 2022-October 2023 to participate in an RSM program. Patients were eligible if they were initiating treatment (chemotherapy, targeted therapy, or immunotherapy) for the first time at MCI. Patients seeking a second opinion were excluded. Enrolled patients received a symptom survey (PRO-CTCAE questions) once a week via text or email. Alerts were forwarded to the clinical care team for symptom management. Patients completed symptom assessments for 24 weeks or until withdrawal. At 24 weeks, patients were given the ability to continue symptom assessments if they were continuing treatment. Patient demographics including age at enrollment, race, sex, cancer type, cancer stage, and PRO data were collected from electronic health records and the PRO platform (Carevive). Descriptive statistics were calculated using frequencies and percentages for categorical variables and median and interquartile ranges (IQR) for continuous variables. Results: Of 80 patients approached, a total of 57 (71%) patients with lung cancer were enrolled in RSM; 20% were Black or African American and 80% were White; median age was 66 (IQR 61-73). Over 24 weeks, 732 symptom alerts were reported; 75% considered moderate and 25% considered severe. Overall, the most frequently reported symptom was pain (29%), followed by dyspnea/cough (25%) and constipation (13%). At baseline (week 0), 78 moderate symptoms and 39 severe symptoms alerts were reported. At week 24, 10 moderate symptoms and 4 severe symptoms alerts were reported. Overall, there was a decrease in symptom alerts over time for both moderate and severe alerts. Specific symptom trajectories followed similar patterns. Conclusions: In our sample, most symptoms were reported during the initial three months of treatment with a subsequent decrease in symptom alerts over time, indicating effective monitoring and management by clinical teams engaged in RSM. Future research is needed to understand if symptom improvement correlates with enhanced quality of life, reduced hospitalizations, and prolonged survival, as well as a lessened burden of call volume on the clinical team. Future analyses should also be done to compare similar results of different disease types. [ABSTRACT FROM AUTHOR]

205 Background: The American Cancer Society (ACS) CARES (Community Access to Resources, Education, and Support) is a novel nationwide non-clinical navigation program for people with cancer and caregivers. ACS CARES includes a multi-channel approach providing direct, individualized, non-clinical assistance through a native app, telephonic, and in-person support. This study examines the feasibility of leveraging non-clinical virtual and in-person volunteers to expand navigation capacity. Methods: This pragmatic study evaluates the implementation of volunteer navigation of patients and caregivers accessing virtual navigation via the ACS CARES app and in-person/telephonic navigation for patients at 3 pilot cancer centers. Virtual and in-person volunteers aim to deliver timely information and support for health-related social needs (HRSNs) identified using a HRSN assessment, which was adapted from the NCCN distress thermometer and problem list. Initial process measures include number and demographics of patients served, HRSNs, and time spent by volunteers. Results: In the first year, 4,673 individuals utilized the ACS CARES app (54% people with cancer, 31% caregivers, 15% supporters). Since launching the virtual connection feature on 11/30/2023, we have trained 122 virtual volunteers (20% Black, 78% female, 8% Hispanic) who have made 182 connections with app users. App users prioritized matches based on shared cancer experience (47.7%), caregiving for an adult with cancer (28.8%), need for help finding information (12.4%), desire for a Spanish-speaking volunteer (3%), other (8.1%, geographic location, caring for a child with cancer volunteers averaged). Community volunteers averaged 11 messages per connection over 35 days. From 10/23/2023 to 4/30/2024, 31 volunteers at 3 cancer centers navigated 195 patients who were 55% female, 22% Black, with an average age of 53.02. The most common HRSNs were finances and transportation. Volunteers spent an average of 105 min per patient per in-person meeting, 35 min per patient per follow-up call, 38 min per patient coordinating care and sending encrypted messages, and 75 min per patient identifying and providing resources to address barriers to care. Conclusions: Preliminary data indicates feasibility of leveraging the multi-channel approach of CARES to address gaps in access to navigation. App utilization data analysis is ongoing. In-person support will be expanded to 9 additional cancer centers in September. [ABSTRACT FROM AUTHOR]

138 Background: Black patients with cancer report higher pain intensity for both consistent and breakthrough pain. Remote symptom monitoring (RSM) using electronic patient-reported outcomes (ePROs) allows patients with cancer to communicate symptoms between visits. This study evaluated whether there were racial disparities in pain severity reporting among Black and White patients with cancer utilizing RSM with ePROs. Methods: This retrospective study analyzed data from 1453 patients with cancer undergoing treatment who utilized an RSM platform for the completion of weekly PRO-CTCAEs surveys to report pain intensity. Survey data from patients during the initial 6 months following RSM enrollment at the University of Alabama at Birmingham (UAB) and the Mitchell Cancer Institute (MCI) were included. Descriptive statistics were compared using frequencies, percentages, and Cramer's V for categorical variables. Regression models were adjusted for age, sex, cancer type, and rurality. Results: Data from 1453 patients and 17,722 surveys were analyzed. 454 (31.2%) patients were Black and 999 (68.8%) patients were White. Among 454 baseline surveys completed by Black patients, no pain was reported in 68%, mild pain in 4%, moderate in 12%, and severe in 16%. In comparison, among 999 baseline surveys completed by White patients, no pain was reported in 71%, mild pain in 3%, moderate in 12% and severe in 14% (V=0.03). Among all post-baseline surveys completed by Black patients, no pain was reported in 69% (n=5081), mild pain in 5%, moderate in 13% and severe in 13%. In comparison, among all post-baseline surveys completed by White patients, no pain was reported in 72% (n=11188), mild pain in 4%, moderate in 14% and severe in 10% (V=0.05). In adjusted analysis, severe pain at follow-up was higher amongst Black patients than White patients (OR 1.17; 95% CI 0.87-1.56). Conclusions: Although modestly increased prevalence (3%) in any pain at baseline and severe pain during their 6 months after enrollment in RSM was observed for Black participants compared to Whites, this finding was not significant in adjusted models. This analysis suggests similar pain levels for Black and White patients within RSM programs. RSM can promote proactive reporting and early intervention for pain, which may help to mitigate previously reported disparities in long-term pain for Black individuals. [ABSTRACT FROM AUTHOR]

The use of standardized I.Q. tests for Blacks has been banned in California State schools. This court settlement culminated 15 years of legal action on a class action suit filed by Black parents for their children who had been disproportionately assigned to classes for the mentally retarded. (VM)

A court order banned the use of standardized I.Q. tests in California because they disproportionately assigned Black and other minority children to special education programs. Nonbiased assessments of cognitive behavior were implemented. They emphasize processes rather than products of learning. The number of minorities in special education has decreased. (VM)

Insane Clown Posse is a musical duo whose fans are known as Juggalos. Many homeless youths (HY) identify as Juggalos, most likely because the group's music embraces poverty and being an outsider in mainstream society. Juggalos are stereotyped as being violent, undereducated, poor, racist, crime-committing youth, and in 2011 the FBI officially labeled Juggalos as a gang. However, little is known about the intersection of HY and Juggalos. A convenience sample of Los Angeles-area, drop-in service-seeking HY completed a self-administered questionnaire (N = 495). In the sample, 15 % of HY identified as Juggalos. Juggalo-identifying youth were more likely to have experienced childhood trauma, including physical and sexual abuse and witnessing community violence. Multivariable models revealed that identifying as a Juggalo was associated with increased odds of recent methamphetamine use, ecstasy use, chronic marijuana use, and prescription drug misuse. Juggalos were also more likely to experience suicidal ideation, attempt suicide, recently engage in interpersonal violence, become injured during a fight, and have unprotected sex. In conclusion, Juggalos constitute a unique subpopulation of HY. Implications for Juggalo-specific trauma-informed services, rather than punitive, are discussed as well as the potential for future research regarding resiliency associated with Juggalo identification. [ABSTRACT FROM AUTHOR]

The federally endangered tidewater goby, Eucyclogobius newberryi, is the most locally differentiated vertebrate with marine dispersal on the California Coast. It inhabits seasonally closed estuaries along the California coast; a habitat heavily impacted by anthropogenic filling and artificial opening, and exhibits varied metapopulation behavior as a consequence of hydrologic variation and anthropogenic impact. We describe 19 taxon-specific microsatellite loci, and assess genetic variation across the taxon range relative to genetic subdivision. A highly divergent southern clade, with reduced genetic variation, now confined to Northern San Diego County, appears to merit status as a separate species. The mid-coast is subdivided into regional groups with overall similarity to, and minor differences from previous mitochondrial sequence based clades. The northernmost region, although locally differentiated, forms a star phylogeny with limited geographic structure which we attribute to dispersal during Pleistocene/Holocene sea-level rise followed by increasing isolation during the Holocene. Bottleneck/founder events are evident in some habitats thought to have experienced (anthropogenic) extirpation. Further work with more, and larger, samples will be required to assess local and regional differences. Analytical methods employed include Analysis of Molecular Variance (AMOVA), Neighbor-Joining, Bayesian/STRUCTURE analysis and Principle Components Analysis (PCA). [ABSTRACT FROM AUTHOR]

This study analyzed quantitative data on tobacco use and dependency for 3,589 high-school students, qualitative data for 448 students, and outcome data for a randomized trial comparing the efficacy of two cessation interventions and a control condition for 337 students. Data were collected from 1988 through 1992 in California and Illinois as part of a larger longitudinal study. Smokeless tobacco users, but not smokers, were more likely than controls to maintain cessation for 4 months: biochemically validated cessation at 4 months was 6.5% versus 3.2% for smokers and 14.3% versus 0.0% for smokeless tobacco users. Implications and limitations are discussed. [ABSTRACT FROM AUTHOR]

There is renewed interest in the use of nitrate to treat the profundal zone of lakes to inhibit anaerobic biogeochemical processes that result in the degradation of bottom water quality (e.g., sediment phosphorus release, mercury methylation). In this study we used experimental sediment–water interface chambers to quantify the rate of sediment nitrate uptake (SNU) in profundal sediments from Lake Perris, a eutrophic raw water reservoir in Southern California. Deoxygenated chamber water was spiked with nitrate, and nitrate concentration was monitored over time under quiescent conditions, followed by mixed conditions with average water velocities of 1 cm/s. Key findings included: (1) SNU decreased with decreasing nitrate concentration, (2) SNU was higher under mixed versus quiescent conditions by nearly 50%, and (3) nitrate uptake as a function of nitrate concentration followed a conventional sediment oxygen demand model in which nitrate uptake was proportional to the square root of nitrate concentration. The probable mechanism for elevated SNU under mixed conditions was an increased diffusional concentration gradient combined with a decrease in the diffusional boundary layer at the sediment–water interface, both of which enhanced the flux of nitrate from overlaying water into sediment. Managers planning to implement lake nitrate addition should account for induced nitrate demand when determining dosing rates. For example, based on our modeling efforts from this data set, SNU in Lake Perris could range by an order of magnitude, from around 12 mg N/m2/d under quiescent, low nitrate conditions (0.1 mg N/l) to around 120 mg N/m2/d under mixed, high nitrate conditions (5 mg N/l). [ABSTRACT FROM AUTHOR]

Abstract: This paper provides a 5-year replication-extension of a previous 1-year follow-up study of the same sample of southern California alternative high school youth. Demographic, behavioral, psychosocial, and emerging adult function predictors of adolescent self-initiated smoking cessation were investigated. Based on the first (1-year) prospective study and this follow-up, one may speculate that smoking cessation programs for adolescents should include counteraction of problem-prone attitudes, assistance with job aspirations and information about drug-free workplaces, motivation to quit strategies, and assistance with overcoming withdrawal symptoms. [Copyright &y& Elsevier]

Focuses on the submission of the proposed dance concept called "Falling" to the University of California Riverside's Dance Under Construction Conference in Riverside, California. Implementation of falling as a subversive tool for asserting resistance; Description of the concept "Falling": Different meanings of the concept "Falling".

Objectives. This study sought to determine the effects of the California Tobacco Control Program on tobacco-related attitudes and behaviors. Methods. In 1996 and 1998, a telephone survey was conducted among adults in randomly selected households in 18 California counties. Tenth-grade youths in 84 randomly selected high schools completed a written survey. In analyses conducted at the county level, differences in outcomes were regressed on an index of program exposure. Results. Among adults, program exposure was associated with decreased smoking prevalence rates, increased no-smoking policies in homes, and decreased violations of workplace no-smoking policies. Among youths, there was no effect of program exposure on outcomes. Conclusions. These results suggest that the California Tobacco Control Program may have reduced adult smoking prevalence rates and exposure to environmental tobacco smoke. (Am J Public Health. 2002;92:975-983) [ABSTRACT FROM AUTHOR]

Background: The Los Angeles classification of reflux oesophagitis includes sharply demarcated areas of erythema without any associated slough within the definition of reflux-induced mucosal breaks, though there is uncertainty as to whether these “red streaks" actually represent such a mucosal lesion. This study evaluates the histopathology of these red streaks. Methods: Forty patients with one or more red streaks on the tops of the mucosal folds in the distal oesophagus were included in a multinational, multicentre prospective study. All patients were referred for upper gastrointestinal endoscopy to investigate chronic heartburn and acid regurgitation. Biopsies were taken from the red streaks and from control biopsies from more normal appearing mucosa 1 cm lateral to the red streaks. A two-sided probability test using normal approximation assessed differences in the histological findings at the two biopsy locations. Results: Compared to control biopsies, biopsies of red streaks had a significantly thicker basal cell layer (mean ± s 41% ± 32% versus 18% ± 23% of mucosal thickness, P = 0.001) and longer papillae (mean ± s 71% ± 19% versus 49% ± 24% of mucosal thickness, P = 0.001). Of the red streak biopsies, 25% had either newly re-epithelized lesions or granulation tissue beneath squamous epithelium. Only 10% of the control biopsies had moderate or more marked regenerative changes (based on elongation of papillae and basal cell hyperplasia), compared to 65.1% of red streak biopsies. Of the biopsies from the red streak itself, 7% showed no abnormality and 27.9% only slight changes. In comparison, 25% of the biopsies from control biopsies showed no regenerative changes and 62.5% only slight change due to gastrooesophageal reflux disease. Conclusion: The histomorphological counterpart to the endoscopically visible red streaks of the distal oesophagus is marked regenerative changes of the squamous epithelium and/or capillary rich granulation tissue beneath the squamous epithelium. Red streaks are validated as being indicative of acid/peptic mucosal injury, but they do not satisfy a strict definition of a mucosal break. [ABSTRACT FROM AUTHOR]

Presents a study which provides the first longitudinal comparison of the frequency and content characteristics of tobacco advertisement that appeared along thoroughfares running through four types of Los Angeles ethnic neighborhoods. Limitations in the antismoking study and other related studies; Methodology; Findings and analysis of results.

Recently, applied social researchers have shown an increased interest using focus groups as a method of generating ideas and solutions pertaining to various social problems. However, caution in the use of this methodology is warranted because focus groups may induce certain group effects which might bias responses. The present study investigated whether an extended focus group procedure resulted in a polarization of attitudes (a group influence bias effect) or a greater pool of ideas than those generated by its members at pretest (brainstorming, a favorable group effect). Southern California and Illinois high school students involved in a total of 31 focus groups were administered pretest and posttest questionnaires. These groups addressed the perceived utility of self-generated strategies designed to recruit adolescent tobacco users into a high school based tobacco use cessation clinic Support was obtained for a group polarization effect, which was replicated across grades, regions, tobacco use status, and specific strategy type. Specifically, after participating in a focus group, the students rated all self-generated cessation clinic recruitment strategies as being more likely to be successful. Moreover, they reported that it was more likely that these strategies would lead them to join a program themselves, if they were tobacco users. However, little support was obtained for the brainstorming effect. In the present context, focus groups do not appear to elicit reporting of new types of strategies but do instill more favorable attitudes regarding self-generated solutions to a problem. Practical implications of these data are discussed. [ABSTRACT FROM AUTHOR]

An abstract to the article "Establishing a hybrid system for cardiac patients -developments and safety issues," by Melanie Jones, Juliet Semple, Tim Dent, Alex Pitcher, Malenka M. Bissell, Elizabeth M. Tunnicliffe, Hayley Harvey, Paul Leeson, Rajesh Kharbanda, and colleagues is presented.