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Eytan Cohen,1,2 Ili Margalit,1,2 Tzippy Shochat,3 Elad Goldberg,1,2 Ilan Krause1,2 1Department of Medicine F - Recanati, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel; 3Statistical Counselling Unit, Rabin Medical Center – Beilinson Hospital, Petach Tikva, IsraelCorrespondence: Eytan CohenDepartment of Medicine F - Recanati, Rabin Medical Center – Beilinson Hospital, Petach Tikva, 4941492, IsraelTel +972-3-9377361Fax +972-3-9244663Email dreytancohen@gmail.comObjective: During the last decade, obesity has become an epidemic. As obesity is now considered a state of low-grade inflammation, the purpose of this study was to assess the prevalence of four common elements of inflammation, in individuals with increased BMI. These findings were compared to those of subjects with normal BMI. The effect of gender was also noted.Methods: Data were collected from medical records of individuals examined at a screening center in Israel between the years 2000– 2014. Cross-sectional analysis was carried out on 7526 men and 3219 women. White blood cell count (WBC); platelet (PLT) count; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were assessed in four BMI categories: normal, overweight, obese and morbidly obese.Results: Mean (SD) age of the study sample was 47.5 (9.7) and 46.7 (9.8) years for men and women, respectively. The prevalence of each inflammatory marker increased significantly when comparing abnormal to normal BMI (p< 0.0001). The odds ratio (OR) of the prevalence of increased inflammatory markers was compared between subjects with overweight, obese and morbid obesity and subjects with normal BMI. This study showed that the higher the BMI, the higher the OR. For those in the morbid obesity group, the OR for the different inflammatory markers adjusting for age, diabetes mellitus hypertension and kidney function were as follows: WBC levels, 5.1 (2.9– 8.7) and 4.7 (2.4– 9.1) for men and women, respectively; PLT levels, 1.7 (0.3– 8.5) and 2.0 (0.6– 7.2) for men and women, respectively; ESR levels, 4.2 (3.2– 5.4) and 4.6 (3.2– 6.6) for men and women, respectively, and CRP levels, 13.4 (10.0– 18.2) and 19.2 (12.9– 28.6) for men and women, respectively.Conclusion: Inflammatory markers are significantly higher in subjects with abnormal compared to normal BMI. This difference was found to be greater in women than in men.Keywords: gender, inflammatory markers, body mass index

Hilary A Marusak,1– 3 Allesandra S Iadipaolo,4 Cindy Cohen,5 Elimelech Goldberg,5,6 Jeffrey W Taub,6,7 Felicity WK Harper,3,7 Martin H Bluth,5,8 Christine A Rabinak1,2,4,9 1Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA; 2Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA; 3Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA; 4Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA; 5Kids Kicking Cancer, Southfield, MI, USA; 6Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA; 7Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA; 8Department of Pathology, School of Medicine, Wayne State University, Detroit, MI, USA; 9Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USACorrespondence: Hilary A Marusak Tel +1 313-577-1278Fax +1 313-577-6188Email hmarusak@med.wayne.eduObjective: Test whether a martial arts-based therapy, Kids Kicking Cancer (KKC), can reduce pain and emotional distress in children with cancer, other chronic health conditions (e.g., sickle cell), and healthy siblings.Methods: This study surveyed children’s pain and distress levels immediately before and after a 1-hr in-person KKC class. Eligible participants were enrolled in standard KKC classes, were diagnosed with a chronic health condition (e.g., cancer, sickle cell) or were the sibling of a child diagnosed and were between the ages of 5– 17 years (inclusive). Children reported on their pain and distress using Likert-style scales (Coloured Analog Scale and modified FACES scale, respectively). Friedman test was used to test for overall changes in pain and distress, and within subgroups. Age and sex effects were evaluated using Spearman’s rank-order correlation. Additional Yes/No questions were administered regarding KKC satisfaction and use of techniques.Results: Fifty-nine youth (19 cancer patients, 17 non-cancer patients, 23 siblings; 5– 17 yrs, 26 females) completed this study. Overall, there was a significant reduction in pain (p = 0.033) and emotional distress (p < 0.001) after a 1-hr class, with 50% and 89% of youth reporting a reduction in pain and distress, respectively. On average, pain levels remained within the mild/moderate range on average (i.e., pre vs. post levels; pre: M = 1.67, post: M = 1.33) and emotional distress went from mild/moderate to none/mild distress, on average (pre: M = 1.92, post: M = 1.08). Youth with higher pre-class pain and distress reported greater reductions (p = 0.001 and p < 0.001, respectively). The reduction in pain appeared to be most pronounced with cancer and non-cancer patients. In contrast, the reduction in distress appeared to be most pronounced among healthy siblings. However, overall, reductions in pain and distress did not significantly differ among subgroups (i.e., cancer patients, non-cancer patients, siblings), and change in pain and distress was not associated with age or sex. Ninety-six percent of youth would recommend KKC to others and 81% reported using KKC techniques (e.g., the Breath BrakeTM or other martial arts techniques) outside of class, such as at home.Conclusion: Results support the more widespread application of KKC as a psychosocial intervention for reducing pain and distress in various pediatric populations.Keywords: meditation, mindfulness, oncology, psychosocial, sickle cell, leukemia

Martin H Bluth,1,2 Ronald Thomas,3,4 Cindy Cohen,2 Amanda C Bluth,5 Elimelech Goldberg,2,4 1Department of Pathology, Wayne State University School of Medicine, Detroit, MI, 2Kids Kicking Cancer, Southfield, MI, 3Children’s Research Center of Michigan at Children’s Hospital of Michigan, Detroit MI, 4Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, 5Wayne State University, Detroit, MI, USA Background: Martial arts intervention in disease has been mostly limited to adult inflammatory, musculoskeletal, or motor diseases, where a mechanical intervention effects positive change. However, the application and benefit to pain management in childhood malignancy are not well described. Here, we assess the effects of defined martial arts intervention in children with cancer with respect to their pain perception and management. Methods: Sixty-four children with childhood malignancies were enrolled in a martial arts program, which encompassed both meditation and movement modalities. Pain scores (0–10) were recorded pre- and post- 1-hour session intervention. Pain scores were crossed by total visits and tabulated by whether participant pain reduced at least 1 unit, stayed the same, or increased in intensity immediately after (post) participation session. Differences in pain scores were further compared by age and sex. Results: Prepain and postpain scale data were measured for 64 participants, 43 males (67.2%) and 21 females (32.8%), ranging from 3 years to 19 years. Preintervention and postintervention data were obtained for 223 individual session visits. Mean number of patient participation visits was 1.8±1.6 (range one to nine visits). Of 116 individual measured sessions where the participants began with a pain score of at least 1, pain intensity reduced ≥1 unit in 85.3% (99/116) of visits, remained the same in 7.8% (9/116), and increased in 6.9% (8/116). For the majority (96.3%; 77/80) of sessions, participants began with a prepain intensity score of at least 5–10 with reduction in pain intensity following the session. The overall mean pain score presession visit was reduced by ~40% (pre: 5.95±2.64 and post: 3.03±2.45 [95% CI: 2.34–3.50]; P≤0.001). Median pain intensity scores had greater reductions with increased age of participants (3–6 years [-1], 7–10 years [-2], 11–14 years [-3], and 15–19 years [-4]). Conclusion: Martial arts intervention can provide a useful modality to decrease pain in childhood cancer, with greater effect achieved with higher baseline pain scores and patient age. Martial arts intervention may improve patient compliance with respect to medical and surgical management, thus reducing disease morbidity and health care costs. Keywords: martial arts, karate, cancer, pain, intervention, therapy

Setting: Four in-patient health facilities in western Uganda. Objective: To determine the impact of an innovative multi-modal quality improvement program on human immunodeficiency virus (HIV) status assessment and the impact of HIV status on severe illness conditions and mortality. Design: This was a staggered, pre-post quasi-experimental study designed to assess a multi-modal intervention (collaborative improvement meetings, audit and feedback, clinical mentoring) for improving quality of care following formal training in the management of severe illness in low-income settings. Results: From August 2014 to May 2015, 5759 patients were hospitalized, of whom 2451 (42.6%) had their HIV status assessed; 395 (16.1%) were HIV-infected. HIV-infected patients were significantly more likely to meet criteria for shock (27.5% vs. 15.1%, risk ratio [RR] 1.8, 95% confidence interval [CI] 1.7-1.9, P < 0.001) and severe respiratory distress (6.7% vs. 4.3%, RR 1.5, 95%CI 1.2-2.0, P < 0.001), and were significantly more likely to die in hospital (12.0% vs. 2.9%, RR 4.1, 95%CI 3.2-5.4, P < 0.001). There was no evidence of improved HIV status assessment during the intervention period (36.5% vs. 44.8%, +8.3%, 95%CI -8.3 to 24.8, P = 0.33). Conclusions: Hospitalized HIV-infected patients in western Uganda are at high risk for severe illness and death. Novel quality improvement strategies are needed to enhance hospital-based HIV testing in high-burden settings.