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Excess weight has the potential to carry a substantial physical and emotional burden. A better understanding of perceived consequences of excess weight may facilitate the development of patient-centered programs and interventions to promote weight management efforts in persons with spinal cord injury (SCI). The study objective was to describe consequences of excess weight from the personal perspectives of individuals with SCI.Descriptive qualitative design using in-depth semi-structured interviews and thematic analysis.Veterans Health Administration (VHA) SCI System of Care.Individuals with SCI (n-33).Key themes from thematic analysis.Participants were male (61%), ranged from 29 to 84 years of age, and about half had tetraplegia (55%). Five themes were identified that demonstrate negative consequences of excess weight experienced by individuals with SCI, including: (1) physical health conditions (including chronic conditions and SCI secondary conditions), (2) physical symptoms (such as pain, discomfort, and fatigue), (3) movement challenges, (4) appearance-related concerns, and (5) emotional impacts.Carrying excess weight is concerning to individuals with SCI and in terms of consequences such onset or exacerbation of chronic conditions, SCI secondary conditions, physical symptoms

International climate goals require over 5 gigatons/year (Gt/year) of CO2 to be removed from the atmosphere by midcentury. Macroalgae mariculture has been proposed as a strategy for such carbon dioxide removal (CDR). However, the global potential for seaweed cultivation has not been assessed in detail. Here, we develop and use a dynamic seaweed growth model, the Global MacroAlgae Cultivation MODeling System (G-MACMODS), to estimate potential yields of four different types of seaweed worldwide, and test the sensitivity of these estimates to uncertain biophysical parameters under two nutrient scenarios (one in which the surface ocean nutrient budget is unaltered by the presence of seaweed farms, and another in which seaweed harvest is limited by nutrients that are resupplied by vertical transport). We find that 1 Gt of seaweed carbon could be harvested in 0.8% of global exclusive economic zones (EEZs; equivalent to ~1 million km2) if farms were located in the most productive areas, but potential harvest estimates are highly uncertain due to ill-constrained seaweed mortality and nitrogen exudation rates. Our results suggest that seaweed farming could produce climate-relevant quantities of biomass carbon and highlight key uncertainties to be resolved by future research.

Background PROS disorders are driven by somatic, gain-of-function mutations in PIK3CA that result in hyperactivation of the phosphatidylinositol-3-kinase (PI3K) signaling pathway. PROS encompasses a broad spectrum of overlapping phenotypes (including overgrowth and vascular malformations) that vary significantly in their severity; every case is unique, leading to different, complex experiences. Here, we aim to describe the PROS experience from the patients’ and caregivers’ points of view, from onset to diagnosis to treatment and support. Results The PROS patient journey was developed using a literature review, an ethnography study, health care professional (HCP) research, and social listening. It was then validated with patients, caregivers, and patient advocates. Physician research included 94 PROS centers and other vascular anomaly centers throughout the United States and Europe. Ethnographic research included 24 patients, caregivers, and/or advocates; selected data from 223 patients were reviewed. Key priority areas of need were identified, along with barriers to and potential enablers of quality care. Visual mapping of the PROS patient and family journey was developed to identify key personal health and system issues, and opportunities for improvements throughout patients’ lifespans. Maps were also developed for 3 specific conditions: Klippel–Trénaunay syndrome (K–T); congenital lipomatous overgrowth, vascular malformations, epidermal nevi, scoliosis/skeletal and spinal anomalies (CLOVES) syndrome; and megalencephaly-capillary malformation syndrome (M-CM). Overall, most patients with PROS conditions and their families struggle with a long path to diagnosis, access to genetic testing, and finding qualified specialists. Following diagnosis, patients and families are frequently challenged with major medical events, comorbidities, unpredictability, frequent hospitalization, impact on school and work, the need for multidisciplinary care, unwanted attention, adverse impact on mental and emotional health, and financial pressures. Lack of effective pain management emerged as a substantial issue. Challenges and barriers to quality care shift throughout patients’ lifespans; transition from pediatric to adult care can be especially difficult. Conclusions This patient journey in PROS was created in collaboration with patients, caregivers, and advocates as key partners. This novel methodology, which could be applied elsewhere, can more accurately identify areas of unmet need, barriers to care, education topics, and assist HCPs to understand the patient and family perspective.

Appropriate decision-making is essential for ensuring survival; one such decision is whether to eat. Overall metabolic state and the safety of food are the two factors we examined using C. elegans to ask whether the metabolic state regulates neuronal activities and corresponding feeding behavior. We monitored the activity of sensory neurons that are activated by nutritious (or appetitive) stimuli (ASI) and aversive stimuli (ASH) in starved vs. well-fed worms during stimuli presentation. Starvation reduces ASH activity to aversive stimuli while increasing ASI activity to nutritious stimuli, showing the responsiveness of each neuron is modulated by overall metabolic state. When we monitored satiety quiescence behavior that reflects the overall metabolic state, ablation of ASI and ASH produce the opposite behavior, showing the two neurons interact to control the decision to eat or not. This circuit provides a simple approach to how neurons handle sensory conflict and reach a decision that is translated to behavior.

In recent years, user experience research (particularly usability testing) has become increasingly widespread. One reason for the increased popularity is the scrutiny many highly-publicized websites receive as a result of a poor user experience. Organizations are now focusing more on user experience and are seeking researchers to conduct usability testing, perhaps without fully appreciating the type of data this research can provide and how that data should be interpreted. We will identify and discuss best practices for researchers who are collecting, analyzing, and presenting usability test data to help them provide clear, actionable findings and recommendations that clients can understand. We discuss what types of data can be collected depending on the product being evaluated, what conclusions can be gleaned from different types of data, and which tools can be used to make the analysis more efficient.

The NIHSeniorHealth.gov website has provided information about healthcare topics thought to be of particular interest to older adults for over ten years. The site was designed with the needs and constraints of older adult users in mind. However, realizing that the interests, expectations, and Internet proficiency of older adults continue to evolve, the National Institute on Aging (NIA), which manages the site content, and the National Library of Medicine (NLM), which implements and maintains the site, embarked on an extensive refresh of NIHSeniorHealth.gov over the last several years. An important focus of this update was the user experience (UX) of the site. The authors of this poster presentation were part of a team that supported this refresh effort by conducting a series of usability tests with representative users and offering design recommendations based on the test results as well as best practices in web user interface design. The refresh effort focused on matching the UX to needs, skills, and preferences of older adults. Since this update, the site has experienced a major resurgence of use as measured by web analytics and customer satisfaction ratings.

Owing to efficacy and tolerability, abiraterone acetate (AA) is a leading treatment for men with metastatic castration-resistant prostate cancer. Increased serum concentrations of AA, such as by taking AA with food, may lead to the inhibition of additional enzymes in the androgen synthesis pathway implicated in castration-resistant prostate cancer progression.Medical records of men with metastatic castration-resistant prostate cancer (mCRPC) who received AA between 1 April 2011 and 31 December 2013 were retrospectively reviewed. The primary outcome was the percent of men with a rising PSA on AA who experienced any PSA decline within 3 months after changing the administration of AA from without food to with food. Secondary outcomes were median time on AA therapy in men who received AA therapy without food versus those that switched administration from without food to with food at PSA progression, and the percent of men who experienced any decline in serum testosterone concentration, and the rate of adverse events observed while taking AA with food.Nineteen men who switched AA administration from without food to with food and 41 patients who administered AA without food only were included in the study. Of those patients who took AA with food at PSA progression, a PSA decline was observed in 3 of the 19 (16%) men, including 3 of the 14 men who had an initial response to AA (21%). Testosterone declined in five out of seven patients from pre-food levels. The median time on AA therapy was increased by nearly 100 days in patients who switched AA administration from without food to with food. No increases in toxicity were observed.Some men with mCRPC may benefit from taking AA with food. Further prospective comparative studies are needed to determine if changing AA administration is beneficial.

Background and Purpose.Clinical experiences are essential for a physical therapist (PT) student to develop practical knowledge and critical thinking in the context of the uncertainty and unpredictability of clinical practice. The written narrative provides a method to reflect on experiences and deve

We often eat more than our body needs. We live in an environment where high calorie food is abundant and physical activities are limited. Living in this environment, maintaining healthy bodyweight becomes challenging and obesity becomes a social burden. Why do we continue to eat even after the metabolic needs are satisfied? Feeding is an ancient behavior essential to survive. Thus the mechanisms to regulate appetite, energy expenditure, and energy storage are well conserved throughout animals. Based on this conservation, we study why we fail to control appetite using a simple genetic model system C. elegans. We have discovered certain genetic components that when misregulated have animals eat more and store more fat. In this review we discuss how these genes work in the appetite control circuit to ultimately understand overall appetite control behavior. We will also briefly discuss how social influence affects feeding regardless of the metabolic status of an animal.

OOI Coastal Arrays Community Workshop; Washington, D. C., 5–7 January 2016

Animals change feeding behavior depending on their metabolic status; starved animals are eager to eat and satiated animals stop eating. C. elegans exhibits satiety quiescence under certain conditions that mimics many aspects of post-prandial sleep in mammals. Here we show that this feeding behavior depends on fat metabolism mediated by the SREBP-SCD pathway, an acetyl-CoA carboxylase (ACC) and certain nuclear hormone receptors (NRs). Mutations of the genes in the SREBP-SCD pathway reduce satiety quiescence. An RNA interference (RNAi) screen of the genes that regulate glucose and fatty acid metabolism identified an ACC necessary for satiety quiescence in C. elegans. ACC catalyzes the first step in de novo fatty acid biosynthesis known to be downstream of the SREBP pathway in mammals. We identified 28 NRs by microarray whose expression changes during refeeding after being starved. When individually knocked down by RNAi, 11 NRs among 28 affect both fat storage and satiety behavior. Our results show that the major fat metabolism pathway regulates feeding behavior and NRs could be the mediators to link the feeding behavior to the metabolic changes.

It is a well-known psychological phenomenon that one’s perceptions are influenced by one’s expectations and biases. This is manifest in behavioral situations ranging from detecting signals in noise to more complex cognitive situations like recounting eyewitness accounts of observed events. Such dynamics also affect our thought processes as we observe usability test participants. Yet the approach to observing user behavior, determining what to look for and what to consider important, seems highly individualized and not often explicated. Even how-to texts on usability testing give relatively little guidance on the process of observing test participants and taking notes on their performance and comments. Consequently, one suspects that some of the variability in usability test results that has plagued the field may be due to a lack of consensus about how to observe user behavior or how to prepare for observation. This alternative format presentation will use collective viewing of video clips from sample usability tests as a stimulant for audience discussion about these issues. We see this as a consensus building exercise, exploring the extent to which the audience can, as a group, agree on what is noteworthy in the clips we present. In doing so we hope to offer some tips and lessons learned that may point towards defining best practices for observing user behavior and comments during usability testing.

BACKGROUND Sipuleucel-T, an autologous cellular immunotherapy, is approved for the treatment of certain patients with metastatic castration-resistant prostate cancer (mCRPC). Sipuleucel-T is the first personalized treatment for prostate cancer to be manufactured using the immune system of each individual patient. Patient preparation and compliance are critical because patients undergo serial leukapheresis and reinfusion procedures within a relatively short time period, which may result in transient reactions. OBJECTIVES The study aims to identify patients best suited for sipuleucel-T treatment, provide an overview of treatment, and encourage infusion sites to consider a primary contact model for the efficient coordination of care. METHODS Treatment experiences were evaluated from 124 patients with mCRPC who received sipuleucel-T from January 2010 to August 2013 according to current best practices. Feedback was collected from reflective interdisciplinary discussion within the sipuleucel-T delivery team (nurses, advanced practice providers, urologists, and medical oncologists). FINDINGS Early patient identification and education on treatment rationale, delivery, and expectations help ensure a successful sipuleucel-T treatment experience. A multidisciplinary coordinated-care process can facilitate proficient sipuleucel-T delivery, and the selection of a primary contact for care coordination offers benefits, such as clear and efficient education.

Utilities: in this paper, we decided to take the theme ‘Ute Culture’ very literally. The first ute that came to our minds was the white 4-wheel-drive ute, complete with custom-made canvas canopy, that Joanne Lees had described to investigators following the disappearance of her boyfriend Peter Falconio off the Stuart Highway on 14 July 2001. Not only did the ute strike us as such a quintessentially Australian vehicle for which the police were searching, but so too was the ‘mystery’ man sought in connection with the case. He was reported to be tall and stocky, to have shoulder length hair and a droopy moustache, to be wearing a flannel shirt, and to have a kelpie dog in the back of the ute. As people joked at the time, half the men travelling around the Northern Territory fit that description!

tudy Objective To compare the effect of medication therapy management by a clinical pharmacy specialist who used the Care Coordination Home Telehealth (CCHT) program with the effect of medication therapy management by a clinical pharmacy specialist who did not use the CCHT program in a cohort of patients with poorly controlled type 2 diabetes mellitus. Design Nonrandomized, parallel, control group study. Setting Four outpatient primary care clinics within a Veterans Affairs health care system in which diabetes management services were provided by three clinical pharmacy specialists. Patients One hundred three patients with type 2 diabetes and a hemoglobin A1c (A1C) of greater than 7% who were receiving insulin therapy between October 1, 2008, and April 1, 2010; 36 patients were enrolled in the CCHT group, and 67 patients were in the non-CCHT group. Patients enrolled in the CCHT group were initially seen by a clinical pharmacy specialist and had two follow-up visits within a 6-month period. The CCHT program predominantly used a messaging device as a means of communication between providers and clinical pharmacy specialists and patients in the time intervals between their face-to-face visits. The clinical pharmacy specialist evaluated the transmitted data and made clinical decisions with respect to medication therapy management and diabetes management; a registered nurse communicated this information to the patients by telephone. Measurements and Main Results Data from medical records were reviewed for both groups. Baseline demographics were similar between the groups, with an initial A1C of 9% and 9.1% in the CCHT and non-CCHT groups, respectively (p=0.6201). The primary outcome was the change in A1C from baseline to 6 months. Secondary outcomes included the percentage of patients meeting American Diabetes Association (ADA) treatment goals for A1C, total amount of time spent/patient, and number of antidiabetic drug changes. A statistically significant difference in mean A1C was noted in the CCHT versus the non-CCHT group at 3 months (7.2% vs 8.0%, p=0.0002) and 6 months (6.9% vs 7.5%, p=0.0066); however, the mean reduction in A1C from baseline to 6 months was not significant between groups (p=0.1987). Sixty-nine percent of the CCHT group versus 36% in the non-CCHT group achieved the ADA A1C goal of less than 7% (p=0.0011). More time was spent (p

35 Background: In men with high grade PC and rapid PSA progression after RP, failure rates are unacceptably high despite salvage RT. Androgen deprivation therapy (ADT) is not curative in this setting and we thus evaluated a novel multi-modality approach of systemic chemotherapy and anti-angiogenic therapy prior to prostate bed salvage RT in a multicenter trial. Methods: Eligible men had a rising PSA of 0.1-3.0 ng/ml within 4 years of RP, no metastatic disease except resected positive nodes, no prior ADT, and Gleason 7-10. Men received 4 cycles of docetaxel 70 mg/m2 q3w with prednisone 5 mg bid and sunitinib 37.5 mg qd for 14/21 days each cycle. Salvage RT (66Gy/33fx) to the prostate bed started at day 100. The primary endpoint was progression-free survival at 2 years (PFS2), defined as a confirmed PSA rise above the post-RT nadir or baseline if no nadir occurred, clinical/radiographic progression, or death from date of enrollment. Safety and dose-limiting toxicities were evaluated. This was a single arm prospective open-label phase 2 trial. Results: Thirty-four men accrued in this multisite Dept. of Defense Prostate Cancer Clinical Trials Consortium trial (median age 62, 85% Caucasian, 9% African American); 24% were node positive at surgery, 47% had Gleason 8-10. Median PSA at entry was 0.54 (range 0.2-2.8) and median time since RP was 11 months. The trial was terminated prematurely due to excess dose-limiting toxicity (9 DLT events) including grade 3 events of hand-foot syndrome (n=4), neutropenic fever (n=2), AST increase (n=1), fatigue (n=1), and vomiting with diarrhea (n=1). PFS at 2 years was 48.9% (95% CI: 32.8%, 67.2%) with a median PFS of 26.2 mo (95% CI: 12.5, -). Six men (17.6%) had an undetectable PSA at 2 years. Conclusions: Sunitinib and docetaxel/prednisone followed by salvage RT resulted in excess pre-specified DLTs. However, efficacy data suggests that some men achieved durable long-term disease control with this aggressive approach. Longer-term follow-up and comparative data with salvage XRT and ADT is needed to fully understand the risks/benefits of this combined modality approach in high risk PSA-recurrent PC. Clinical trial information: NCT00734851.

This article examines the impact of trace items through their evocation and elevation to the status of the sublime object. The authors focus on the impact that things left behind by the dead or missing have on those whose loved them, arguing that such traces provide a glimmer of materiality that those left behind can desperately crave.