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Background: The benefit of regular exercise in improving cancer outcomes is well established. The American Cancer Society (ACS) released a recommendation that cancer survivors should engage in at least 150 minutes of moderate to vigorous physical activity (PA) per week; however, few report meeting this recommendation. This study examined the patterns and correlates of meeting ACS PA recommendations in the Detroit Research on Cancer Survivors (ROCS) cohort of African American cancer survivors., Methods: Detroit ROCS participants completed baseline and yearly follow-up surveys to update their health and health behaviors, including PA. This study examined participation in PA by select characteristics and reported health-related quality of life (HRQOL) as measured with the Functional Assessment of Cancer Therapy and Patient-Reported Outcomes Measurement Information System instruments., Results: Among the first 1500 ROCS participants, 60% reported participating in regular PA, with 24% reporting ≥150 min/wk. Although there were no differences by sex, prostate cancer survivors were the most likely to report participating in regular PA, whereas lung cancer survivors were the least likely (P = .022). Survivors who reported participating in regular PA reported higher HRQOL (P < .001) and lower depression (P = .040)., Conclusions: Just 24% of African American cancer survivors reported meeting the ACS guidelines for PA at the baseline, but it was encouraging to see increases in activity over time. Because of the established benefits of regular exercise observed in this study and others, identifying and reducing barriers to regular PA among African American cancer survivors are critical for improving outcomes and minimizing disparities., (© 2020 American Cancer Society.)

Nontuberculous mycobacteria are human pathogens with increasing incidence and prevalence worldwide. Mycobacterium shimoidei is a rare cause of pulmonary disease, with only 15 cases previously reported. This series documents an additional 23 cases of M. shimoidei from Queensland, Australia, and highlights the pathogenicity and clinical role of this species.

Background: As part of the Collaborative Home Infant Monitoring Evaluation, a home monitor was developed to record breathing, heart rate, other physiologic variables, and the time the monitor was used., Objective: To determine the frequency of monitor use, factors that influence use, and validity of a model developed to predict use., Design: We developed a model to predict monitor use using multiple linear regression analysis; we then tested the validity of this model to predict adherence for the first week of monitoring and for the subsequent 4-week period (weeks 2-5)., Setting: Clinical research centers in Chicago, Ill; Cleveland, Ohio; Honolulu, Hawaii; Los Angeles, Calif; and Toledo, Ohio. Patients Preterm infants, infants younger than 1 month with a history of autopsy-confirmed sudden infant death syndrome in a sibling, and infants with an idiopathic apparent life-threatening event were divided into 2 cohorts based on enrollment date. Main Outcome Measure Mean hours of monitor use per week., Results: In cohort 1, the variables available before monitoring were only weakly associated with total hours of monitor use in weeks 2 to 5 (total model r(2) = 0.08). However, when hours of monitor use in week 1 were included as a variable to predict monitor use in weeks 2 to 5, the r(2) increased to 0.64 for hours of monitor use per week., Conclusions: Our data show that monitor use in the first week was the most important variable for predicting subsequent monitor use. The study suggests that a major focus of home monitoring should be adherence in the first week, although it remains to be tested whether this adherence can be altered.

Unlabelled: Transient episodes of apnea and bradycardia are common in preterm infants. Pronounced asystole or sinus arrest, however, is relatively rare and the clinical significance of such events is unknown., Objective: The purpose of our study was to: (1) evaluate the prevalence of severe bradycardic and asystolic events in infants studied with polygraphic cardiorespiratory monitoring, (2) characterize these events, and (3) correlate the events with other clinical findings., Methods: A total of 583 studies were performed in 454 preterm infants at a post-conceptional age 37.4 +/- 2.5 (range 34-42 weeks). Asystolic pauses were defined as no QRS complex for >or=3 s consistent with a heart rate <20 beats per minute (bpm). Severe bradycardia was defined as no QRS for >or=2 s consistent with a heart rate of 21-30 bpm., Results: Eight infants (29.5 +/- 3.9 weeks' gestational age, birth weight 1,283 +/- 445 g) met the criteria of having had at least 1 asystolic event (heart rate

Apnoea is common in the newborn period and especially in preterm newborns. Bradycardia and desaturation of oxyhaemoglobin typically occur with apnoea. These abnormalities reflect an immature cardiorespiratory system and resolution of this immaturity can be expected within a predictable time frame. Infants who have apnoea in the newborn period are thought not to be at higher risk for sudden infant death syndrome (SIDS). Whether apnoea episodes are associated with a higher incidence of long-term handicap for these infants is not yet clear.

A new physiologic monitor for use in the home has been developed and used for the Collaborative Home Infant Monitor Evaluation (CHIME). This monitor measures infant breathing by respiratory inductance plethysmography and transthoracic impedance; infant electrocardiogram, heart rate and R-R interval; haemoglobin O2 saturation of arterial blood at the periphery and sleep position. Monitor signals from a representative sample of 24 subjects from the CHIME database were of sufficient quality to be clinically interpreted 91.7% of the time for the respiratory inductance plethysmograph, 100% for the ECG, 99.7% for the heart rate and 87% for the 16 subjects of the 24 who used the pulse oximeter. The monitor detected breaths with a sensitivity of 96% and a specificity of 65% compared to human scorers. It detected all clinically significant bradycardias but identified an additional 737 events where a human scorer did not detect bradycardia. The monitor was considered to be superior to conventional monitors and, therefore, suitable for the successful conduct of the CHIME study.

Limitations in home monitoring technology have precluded longitudinal studies of hemoglobin oxygen saturation during unperturbed sleep. The memory monitor used in the Collaborative Home Infant Monitoring Evaluation addresses these limitations. We studied 64 healthy term infants at 2 to 25 weeks of age. We analyzed hemoglobin oxygen saturation by pulse oximetry (SpO(2)), respiratory inductance plethysmography, heart rate, and sleep position during 35, 127 epochs automatically recorded during the first 3 minutes of each hour. For each epoch baseline SpO(2) was determined during >/=10 s of quiet breathing. Acute decreases of at least 10 saturation points and <90% for >/=5 s were identified, and the lowest SpO(2) was noted. The median baseline SpO(2) was 97.9% and did not change with age or sleep position. The baseline SpO(2) was <90% in at least 1 epoch in 59% of infants and in 0.51% of all epochs. Acute decreases in SpO(2) occurred in 59% of infants; among these, the median number of episodes was 4. The median lowest SpO(2) during an acute decrease was 83% (10th, 90th percentiles 78%, 87%); 79% of acute decreases were associated with periodic breathing, and >/=16% were associated with isolated apnea. With the use of multivariate analyses, the odds of having an acute decrease increased as the number of epochs with periodic breathing increased, and they lessened significantly with age. We conclude that healthy infants generally have baseline SpO(2) levels >95%. The transient acute decreases are correlated with younger age, periodic breathing, and apnea and appear to be part of normal breathing and oxygenation behavior.

Objective: To evaluate the effect of weekly telephone contact with families in enhancing the use of home apnea monitors., Study Design: This was a prospective, randomized, single-blinded study of 65 infants who were prescribed home apnea monitoring at the time of initial discharge from the hospital. Exclusion criteria included participation in any other study involving home monitoring or nonavailability of home telephone. Infants were randomized either to the "standard" or "telephone" group by a stratified balanced block technique. All families were instructed to use the monitor during the first 4-week period at all times except during bathing and during the second 4-week period at all unattended times and at night. The families in the telephone group were contacted weekly for 8 weeks. The telephone interview reviewed the events of the previous week but did not include specific encouragement to use the monitor. Both groups received routine pediatric care and follow-up at our high-risk premature clinic. The primary outcome measure was compliance measured as the percentage of time as well as the hours per day that the infant spent on the monitor as recorded by the documented monitor., Results: The telephone (n = 30) and standard (n = 32) groups were similar (p > 0.10) with respect to birth weight (1567 +/- 778 versus 1710 +/- 777 gm), gestational age (30.9 +/- 4.2 versus 31.1 +/- 4.6 weeks), maternal age (24.9 +/- 6.0 versus 25.3 +/- 5.4 years), and commercial insurance (46.7% versus 46.9%), a marker of higher socioeconomic status. Compliance of the telephone versus the standard group was similar during the first 4-week period (74.7 +/- 24.9 versus 75 +/- 27.8%, p = 0.85) (17.9 +/- 5.9 versus 18.2 +/- 6.6 hours/day), the second 4 week period (63.4 +/- 29.1 versus 58.9 +/- 30.9%, p = 0.59) (15.2 +/- 7.0 versus 14.1 +/- 7.4 hours/day) and the entire 8-week period (69.3 +/- 24.7 versus 67.7 +/- 26.2%, p = 0.82, Mann-Whitney U-test) (16.7 +/- 6.0 versus 16.1 +/- 6.5 hours/day), respectively. An abnormal pneumocardiogram at the time of discharge was the only identified factor that improved the compliance for the entire 8-week period (73.1 +/- 22 versus 52.1 +/- 28.5%, p = 0.02) (17.5 +/- 5.2 versus 12.5 +/- 6.8 hours/day) and the first 4-week period of monitoring (81.7 +/- 22.9 versus 59.5 +/- 31.3%, p = 0.01) (19.6 +/- 5.5 versus 14.2 +/- 7.5 hours/day)., Conclusion: Weekly telephone contact, without specific encouragement to use the monitor, did not improve compliance. Compliance was greater in subjects who had abnormal pneumocardiogram results at the time of discharge from hospital regardless of their telephone/standard group assignment. We speculate that in this already compliant population, more targeted advice is necessary to increase compliance.

Continuous monitoring of breathing in infants is commonly performed using transthoracic impedance. This method employs skin surface electrodes measuring changes in electrical impedance and relates these changes to respiratory events. Typically, two electrodes on the infant's chest monitor both the ECG and breathing. We have attempted to identify separate electrode locations that give the best signal for breathing and ECG, and a single location that optimizes both of these signals. Thirty-seven infants were studied by placing 12 electrodes on the infant's chest and abdomen, and serially sampling pairwise combinations of electrodes. The optimal signal for breathing was obtained when electrodes spanned the diaphragm. Optimal ECG signal was seen with one electrode at the right mid-clavicle and one at the xyphoid. Clinicians should be aware of these locations in order to provide the best signal available.

To evaluate the effect of body position on oxygenation and ventilation in neonates over a prolonged period, infants with respiratory disease were followed by transcutaneous (tc) monitoring for alterations in tcPO2 and tcPCO2 with position changes. In 14 studies of seven patients, prone positioning was compared with supine positioning over a 6-hour interval. All patients were premature, were receiving supplemental oxygen, and had respiratory disease secondary to prematurity. The median gestational age was 29 weeks; all infants were 2 months old or less at the time of the study. Prone positioning resulted in a significantly higher tcPO2; mean (+/- SD) tcPO2 increased from 63 (+/- 11.6) mm Hg to 71 (+/- 14.6) mm Hg, and decreased to 65 (+/- 11.2) mm Hg when the infant was returned to supine (P less than .05). This increase in tcPO2 was stable throughout 2 hours in the prone position. No significant change in tcPCO2 was detected. Infants were also found to spend a greater proportion of time sleeping when prone (75% +/- 13% vs 33% +/- 14%; P less than .05). These finding suggest that improvement in oxygenation with the prone position is stable over an extended period in the sick preterm infant.

Continuous monitoring of respiration by transthoracic electrical impedance gives a signal that has certain not well understood irregularities. Among them is a change in the amplitude of the signal when there is no apparent change in the infant's tidal respiration. One factor that could hypothetically account for alterations of the impedance signal is a change in current path through the thorax secondary to a change in body position. To test this hypothesis we have studied the relationships between breath amplitude measured by transthoracic impedance, one strain gauge on the chest and one on the abdomen, and tidal volume by integrated flow in four body positions. Median breath amplitude was found to vary significantly with body position according to the measuring device. The median impedance breath amplitude increased by 27% in the supine position compared with the prone position, with no associated change in tidal volume. Differences in the strain gauge signal amplitude for these positions were not statistically significant. Correlation between breath amplitude measured by impedance changes and tidal volume was minimal (r = 0.114). These results indicate that infant position affects impedance breath amplitude independently of changes in tidal volume.