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BACKGROUND: Vitamin D (vitD) plays a major role in maintenance of bone mineral homeostasis. It is unknown if bone mineral content (BMC) and bone mineral density (BMD) differ between infants who receive direct vitD supplementation and those who receive vitD indirectly via their mother's breast milk, while she received a high dose of vitD. It is hypothesized that there would be no differences in BMC or BMD by treatment group. DESIGN/METHODS: Randomized, double-blind trial to compare BMD and BMC of infants who received direct vitD (400 IU vitD(3)/day) in addition to their mother receiving standard dosage (400 IU vitD(3)/day) versus infants whose mothers were their only source of vitD and were given high-dose supplementation (6,400 IU vitD(3)/day). Participants were exclusively breastfeeding mothers and their infant consuming only human milk. Infant BMC and BMD were measured by dual-energy X-ray absorptiometry (DXA) scans of the infant's total body using Hologic Discovery A Densitometer and analyzed using Hologic Infant software at 1, 4, and 7 months of age. RESULTS: Infant BMC and BMD did not differ significantly at 1, 4, or 7 months of age between direct and indirect supplementation arms. The mean difference in BMC from 1 to 7 months was 1.624 and 1.464 g for the 400 and 6,400 IU groups, respectively, (p = 0.5); the mean difference in BMD over this same period was 0.042 and 0.032 g/cm(2) for the 400 and 6,400 IU groups, respectively (p = 0.2). Although some differences among races were observed, this did not reflect changes in bone growth between the treatment arms. CONCLUSION: High-dose vitD supplementation of mothers during lactation provided an efficacious alternative to direct supplementation of infants, as evidenced by noninferior infant BMD and BMC. Clinical Trial Registration number: NCT00412074.

BACKGROUND: To assess emergency department (ED) clinician perception of patient risk, we measured willingness to discharge patients categorized as increased risk by traditional risk stratification modalities for acute coronary syndrome but low risk by a validated high-sensitivity troponin accelerated diagnostic protocol (HST-ADP). METHODS: This was a cross-sectional descriptive survey study distributed to ED clinicians at an urban academic medical center. Four clinical vignettes classified hypothetical patients as low risk for 30-day acute coronary syndrome according to the 0-/1-hour HST-ADP. Vignettes additionally identified patients with History, Electrocardiogram, Age, Risk factors, and initial Troponin (HEART) scores of 4 or 6 (2 cases each). One patient in each subset had preexisting coronary artery disease (CAD). ED clinicians self-reported willingness to discharge patients from the ED on a 10-point Likert scale. RESULTS: Among 66 eligible participants, 36 (55%) participated in the survey. ED clinicians reported a mean willingness to discharge patients of 6.07 (95% confidence interval, 5.34–6.80). They reported higher mean willingness to discharge patients with HEART scores of 4 compared with those with HEART scores of 6 (mean difference, 3.61; 95% confidence interval, 2.19–5.03). There were no differences in willingness to discharge regarding presence or absence of CAD or between clinician types (attending, resident, advanced practice provider). CONCLUSIONS: ED clinicians accustomed to the HEART Pathway demonstrated limited willingness to discharge patients from the ED categorized as moderate risk by the HEART score despite simultaneous classification as low risk by the 0-/1-hour HST-ADP. Willingness to discharge was higher with lower HEART scores but not affected by the presence of CAD and did not vary between clinician types.

BACKGROUND Premature infants who cannot achieve full oral feeds may need a gastrostomy tube (GT) to be discharged from the neonatal intensive care unit (NICU). We previously developed a model to predict which infants born

ImportanceDisseminated superficial actinic porokeratosis (DSAP) is an inherited or sporadic disorder of keratinization associated with germline variations. There is no effective standard of care therapy for DSAP, but treatment with topical lovastatin combined with cholesterol cream has shown promise.ObjectivesTo evaluate and compare the safety and efficacy of topical lovastatin 2% plus cholesterol 2% cream (lovastatin-cholesterol) and topical lovastatin 2% cream (lovastatin) alone in adults diagnosed with DSAP.Design, Setting, and ParticipantsThis patient- and assessor-blinded, randomized clinical trial was conducted at the Medical University of South Carolina between August 3, 2020, and April 28, 2021. Nonpregnant adults with a previous clinical or histological diagnosis of DSAP were eligible. Data were blindly analyzed after study completion.InterventionsParticipants were randomized to once- or twice-daily application of either lovastatin-cholesterol cream (n = 17) or lovastatin cream (n = 14) to symptomatic regions for 12 weeks.Main Outcomes and MeasuresThe primary efficacy measure was the effect of the treatment on DSAP at the end of treatment (12 weeks) as measured by the DSAP General Assessment Severity Index (DSAP-GASI; scored from 0-4, with 0 indicating clear and 4 indicating severe). Treatment efficacy was based on investigator-standardized photographs provided by the participants because of the need for evaluation via telehealth during the COVID-19 pandemic. Secondary efficacy measures included patient-reported outcomes, application frequency, and adverse events (AEs).ResultsOf the 87 participants screened, 32 were enrolled. One participant randomized to receive lovastatin-cholesterol did not receive the intervention, leaving 17 participants (mean [range] age, 59.2 [40-83] years; 13 females [76.5%]; all White) allocated to receive lovastatin-cholesterol treatment and 14 participants (13 female [92.9%]; mean (range) age, 53.7 [33-71] years; all White) to receive lovastatin treatment. Twelve participants in each treatment group qualified for the analysis. Disease severity decreased from week 1 to week 12 by 50.0% (from 3.08 [95% CI, 2.57-3.60] to 1.54 (95% CI, 1.04-2.05] points on the DSAP-GASI; P < .001) in the lovastatin-cholesterol group and 51.4% (from 2.92 [95% CI, 2.40-3.43] to 1.50 [95% CI, 0.99-2.01] points; P Conclusions and RelevanceThis randomized clinical trial found improvements in DSAP severity in both treatment groups, without serious AEs, indicating a limited benefit with the addition of cholesterol. These results suggest that lovastatin cream may be a new primary treatment option for patients diagnosed with DSAP.Trial RegistrationClinicalTrials.gov Identifier: NCT04359823

The American Academy of Pediatrics recommends premedication for all nonemergent neonatal intubations, yet there remains significant variation in this practice nationally. We aimed to standardize our unit's premedication practices for improved intubation success and reduced adverse events.The study workgroup developed educational material and protocol content. Process measures included premedication use, education, and audit form completion. Primary (success on first intubation attempt and adverse event rates) and secondary (trainee success) study outcomes are displayed using statistical process control charts and pre-post cohort comparisons.Forty-seven percent (97/206) of nurses completed educational intervention before protocol release, with an additional 20% (42/206) following a staff reminder. Two hundred sixteen (216) patients were intubated per protocol with 81% (174/216) audit completion. Compared with baseline (n = 158), intubation attempts decreased from 2 (IQR, 1-2) to 1 (IQR, 1-2) (Standardizing procedural care delivery reduced intubation attempts and increased the attempt success rate. However, this was accompanied by an increase in the rate of nonsevere adverse events.

Hormonal replacement therapy is administered to many brain-dead organ donors to improve hemodynamic stability. Previous clinical studies present conflicting results with several randomized studies reporting no benefit.Consecutive adult donors (N = 199) were randomized to receive high-dose levothyroxine, high-dose methylprednisolone, both (Combo), or no hormonal therapy (Control). Vasopressor requirements using the vasoactive-inotropic score (VIS) were assessed at baseline, 4 h, and at procurement. Crossover to the Combo group was sufficient to require separate intention-to-treat and per-protocol analyses.In the intention-to-treat analysis, the mean (±SD) reduction in VIS from baseline to procurement was 1.6 ± 2.6, 14.9 ± 2.6, 10.9 ± 2.6, and 7.1 ± 2.6 for the levothyroxine, methylprednisolone, Combo, and Control groups, respectively. While controlling for the baseline score, the reduction in VIS was significantly greater in the methylprednisolone and Combo groups and significantly less in the levothyroxine group compared with controls. Results were similar in the per-protocol analysis.High-dose methylprednisolone alone or in combination with levothyroxine allowed for significant reduction in vasopressor support in organ donors. Levothyroxine alone offered no advantage in reducing vasopressor support. Organ yield, transplantation rates, and recipient outcomes were not adversely affected.

Background and PurposeThe literature indicates there is a lack of evidence of a standard for diabetes medication adherence (MA) measures. The purpose of this integrative review (IR) was to identify instruments appropriate to measure MA among adults with T2DM.MethodsThe IR was conducted according to Whittemore and Knafl (2005) methodology. The databases CINAHL, OVID, PubMed, and Scopus were searched for manuscripts published between 2006 and 2016 using the keywords “adherence,” “diabetes,” “instrument,” and “measure.” Ten manuscripts reflecting the psychometric properties of twelve published instruments were reviewed.ResultsThe most commonly used instrument was the Morisky Medication Adherence 8 item. Reliability and validity varied among studies.ConclusionThe findings suggest the need for continued psychometric testing of diabetes MA instruments.

Early right heart failure (RHF) remains a major source of morbidity and mortality after left ventricular assist device (LVAD) implantation, yet efforts to predict early RHF have proven only modestly successful. Pharmacologic unloading of the left ventricle may be a risk stratification approach allowing for assessment of right ventricular and hemodynamic reserve.We performed a multicenter, retrospective analysis of patients who had undergone continuous-flow LVAD implantation from October 2011 to April 2020. Only those who underwent vasodilator testing with nitroprusside during their preimplant right heart catheterization were included (n = 70). Multivariable logistic regression was used to determine independent predictors of early RHF as defined by Mechanical Circulatory Support-Academic Research Consortium.Twenty-seven patients experienced post-LVAD early RHF (39%). Baseline clinical characteristics were similar between patients with and without RHF. Patients without RHF, however, achieved higher peak stroke volume index (SVI) (30.1 ± 8.8 vs 21.7 ± 7.4 mL/mPeak SVI with nitroprusside administration was independently associated with post-LVAD early RHF while resting hemodynamics were not. Vasodilator testing may prove to be a strong risk stratification tool when assessing LVAD candidacy though additional prospective validation is needed.

Objective Develop a model to predict gastrostomy tube (GT) for feeding at discharge in infants born < 30 weeks’ (w) gestational age (GA). Study design A single-center retrospective study at academic NICU. Total of 391 (78 GT, 313 non-GT) infants < 30 w GA admitted in 2015–2018 split into test (15–16) and validation (17–18) cohorts. Classification and regression tree analysis was used to identify predictive factors for GT. Results Several factors were associated with GT requirements. Four factors included in the model were postmenstrual age (PMA) at first oral feeding, birth GA, high-frequency ventilation exposure, necrotizing enterocolitis stage II/III. Area under the receiver operator characteristic curve was 0.944 in the test cohort, 0.815 in the validation cohort. Implementation plan based on the model was developed. Conclusions We developed a predictive model to risk-stratify infants born < 30 w GA for failing full oral feeding. We hope implementation at 38 w PMA will result in earlier placement of needed GT and discharge.

BACKGROUND Pacing at sites of late intraventricular activation (QLV) or long interventricular conduction (right ventricle [RV]-left ventricular [LV]) have been associated with improved cardiac resynchronization therapy (CRT) outcomes. Quadripolar leads improve CRT outcomes by allowing for electrical repositioning to optimize pacing sites. However, little is known regarding the effect of such repositioning on electrical delay. OBJECTIVE Determine the relationship between different electrical bipoles from a quadripolar lead and measures of electrical delay. METHODS Forty-six patients underwent CRT with a quadripolar lead. The RV-LV and QLV intervals were measured for both the proximal and distal bipoles and the difference (Δ) between bipoles for each measure were calculated. Multivariate analyses were performed to identify predictors of electrical delays. RESULTS This was a typical CRT population with a mean age of 65 years and ejection fraction of 27%, with left bundle branch block (LBBB) present in 70%. The regression model for ΔQLV was significant (p = .05), with both gender (p = .008) and LBBB status (p = .020) significant predictors. The overall regression model for ΔRV-LV was not significant. ΔQLV and ΔRV-LV were significant among LBBB patients. Among non-LBBB, only ΔRV-LV was significant (mean: 7.2 ms, p = .006). ΔRV-LV versus ΔQLV were strongly correlated in LBBB (R2 = .92) but not non-LBBB (R2 = .06). CONCLUSION In LBBB, ΔRV-LV and ΔQLV are closely correlated suggesting that the proximal bipole and thus basal LV pacing sites should be selected when feasible. Greater variation in activation pattern is present in non-LBBB, so pacing sites should be individualized.

Purpose The aim of this study was to evaluate the use of a lavender aromatherapy skin patch on anxiety and vital sign variability during the preoperative period in female patients scheduled for breast surgery. Design This observational pilot study used a one-group, pretest and post-test design. Methods Participants received an aromatherapy patch in addition to standard preoperative care. Anxiety levels were assessed with a 10-cm visual analog scale at baseline and then every 15 minutes after patch placement. Vital sign measurements were recorded at the same interval. Findings There was a statistically significant decrease (P = .03) in the anxiety visual analog scale measurements from baseline to final scores. Conclusions Findings from this study suggest the use of aromatherapy is beneficial in reducing anxiety experienced by females undergoing breast surgery. Further research is needed to address the experience of preoperative anxiety, aromatherapy use, and the challenges of managing preoperative anxiety.

Higher BMI, lower rates of physical activity (PA), and hormone receptor-negative breast cancer (BC) subtype are associated with poorer BC treatment outcomes. We evaluated the prevalence of high BMI, low PA level, and BC subtype among survivors with white/European American (EA) and African American (AA) ancestry, as well as a distinct subset of AAs with Sea Island/Gullah ancestry (SI). We used the South Carolina Central Cancer Registry to identify 137 (42 EAs, 66 AAs, and 29 SIs) women diagnosed with BC and who were within 6–21 months of diagnosis. We employed linear and logistic regression to investigate associations between BMI, PA, and age at diagnosis by racial/ethnic group. Most participants (82%) were overweight/obese (P = 0.46). BMI was highest in younger AAs (P = 0.02). CDC PA guidelines (≥150 min/week) were met by only 28% of participants. The frequency of estrogen receptor (ER)-negative BC subtype was lower in EAs and SIs than in AAs (P < 0.05). This is the first study to identify differences in obesity and PA rates, and BC subtype in EAs, AAs, and SIs. BMI was higher, PA rates were lower, and frequency of ER-negative BC was higher in AAs as compared to EAs and SIs. This study highlights the need to promote lifestyle interventions among BC survivors, with the goal of reducing the likelihood of a BC recurrence. Integrating dietary and PA interventions into ongoing survivorship care is essential. Future research could evaluate potential differential immune responses linked to the frequency of triple negative BC in AAs.

Purpose Lifestyle factors associated with personal behavior can alter tumor-associated biological pathways and thereby increase cancer risk, growth, and disease recurrence. Advanced glycation end products (AGEs) are reactive metabolites produced endogenously as a by-product of normal metabolism. A Western lifestyle also promotes AGE accumulation in the body which is associated with disease phenotypes through modification of the genome, protein crosslinking/dysfunction, and aberrant cell signaling. Given the links between lifestyle, AGEs, and disease, we examined the association between dietary-AGEs and breast cancer. Methods We evaluated AGE levels in bio-specimens from estrogen receptor-positive (ER+) and estrogen receptor-negative (ER−) breast cancer patients, examined their role in therapy resistance, and assessed the ability of lifestyle intervention to reduce circulating AGE levels in ER+ breast cancer survivors. Results An association between ER status and AGE levels was observed in tumor and serum samples. AGE treatment of ER+ breast cancer cells altered ERα phosphorylation and promoted resistance to tamoxifen therapy. In a proof of concept study, physical activity and dietary intervention was shown to be viable options for reducing circulating AGE levels in breast cancer survivors. Conclusions There is a potential prognostic and therapeutic role for lifestyle derived AGEs in breast cancer. Given the potential benefits of lifestyle intervention on incidence and mortality, opportunities exist for the development of community health and nutritional programs aimed at reducing AGE exposure in order to improve breast cancer prevention and treatment outcomes. Electronic supplementary material The online version of this article (10.1007/s10549-018-4992-7) contains supplementary material, which is available to authorized users.

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), first identified in Wuhan, China, was declared a pandemic by WHO in March 2020 due to its high transmission rate. Due to the diffuse vasculo-endothelial damage, individuals with Sickle Cell Disease (SCD) are at risk to develop severe clinical complications, if infected with coronavirus 19 (COVID-19).[1] Given this risk, a systematic evaluation of individuals with SCD presenting with COVID19 infection is paramount to identify the variable clinical manifestations and complications encountered in children and adults with SCD. Methods: A retrospective chart review was conducted from January to June 2020 at the Medical University of South Carolina. We included individuals with sickle cell disease of all genotypes, from 0 to 65 years of age found to be positive for COVID19 by polymerase chain reaction (PCR). Patients' past medical history, clinical presentations, admissions, treatment, complications, and mortality data were reviewed. The data was collected with REDCap@ and descriptive data analysis was conducted per SPSS@. Results: Of the identified 23 patients with SCD who tested positive for COVID during the time specified, 19 (82.6%) had Hgb SS genotype, two had Hgb SC (9%) and two Hgb Sβ+ thalassemia (9%) with similar incidence in both genders (47.8% male and 52.2 % female). All patients were African American. The mean age was 26.13+/-11.53 years. In the last three years they had admissions for pain at a mean of 4.29 +/- 5 and admissions for acute chest syndrome 1+/- 2.2. Six participants (26.1%) had history of mild asthma. Two (8.7%) had pulmonary hypertension. No participants had a history of silent stroke. One participant had history of ischemic stroke, three (13%) had history of pulmonary embolism, and six (26.1%) had deep vein thrombosis (DVT). A variable clinical presentation was noted in our population (Table 1). Of the 23, only nine (39%) required admission of which only one met criteria for intensive care (4.3%) requiring respiratory support with high flow nasal canula. All participants recovered well with the mean length of admission 4.36+/- 3.8 days. Treatment included supportive care including transfusion support, two (8.7%) needed simple transfusion, two (8.7%) needed exchange transfusion. Regarding the laboratory values, coagulations studies were noted to be elevated among all those obtained, but overall limited values were obtained. (Table 2) Thus far no complications of stroke, thrombosis, or pulmonary emboli are noted in the patients positive for COVID in sickle cell disease at our institution. No deaths were reported. Conclusion: Our population reflects what has been described thus far in other cohorts regarding patient demographics, clinical presentation and evolution of disease. Missing laboratory results is most likely due to the mild severity which did not require further clinical evaluation. The absence of VTE/PE may be explained by the low rate of ICU admissions. A similar ICU admission rate of 13% in the same age group as our population was described in a study conducted in France with 83 patients. [2] Compared to a study conducted in Detroit, Michigan, our population underwent comparable rates of transfusions with 3 patients compared to 4 in our population, again most likely due to the mild severity. [3] Our results reflect only MUSC's testing sites and we are dependent on patient's self-report which may not represent our entire population. To address this issue, as part of the Sickle Cell South Carolina network, we are partnering with two other institutions to assess SARS-Cov-2 infection in South Carolina. SARS-CoV-2 pandemic has brought to light many disparities encountered in the American health care system. It is premature to evaluate the immediate and long-term ramifications of COVID19 in individuals with sickle cell disease, due to which we plan to continue to monitor for the next 2 years. References 1. Hussain, F.A., et al.,COVID-19 Infection in Patients with Sickle Cell Disease.Br J Haematol, 2020. 2. Arlet, J.B., et al.,Prognosis of patients with sickle cell disease and COVID-19: a French experience.Lancet Haematol, 2020. 3. Balanchivadze, N., et al.,Impact of COVID-19 Infection on 24 Patients with Sickle Cell Disease. One Center Urban Experience, Detroit, MI, USA.Hemoglobin, 2020: p. 1-6. Disclosures Gregoski: National Institutes of Health under Grant Number UL1 TR001450:Current Employment.

Background Worksite wellness programs offer an ideal setting to target high-risk sedentary workers to improve health status. Lack of physical activity is associated with increased risk for coronary heart disease and mortality. Despite the risks, the number of sedentary workers is increasing. Objective This study examined the perceived barriers and motivators for physical activity among employees at high-risk for coronary heart disease. Methods A purposive sample of 24 high-risk workers participating in a wellness program in rural South Carolina were enrolled in the study. Qualitative data was obtained through semi-structured face-to-face interviews. Grounded theory was used to analyze qualitative data, and identify overarching themes. Results Physical limitations due to pain and weakness, lack of motivation, and lack of time emerged as the main barriers to physical activity. Family relationships were reported as the strongest motivator along with social support and potential health benefits. Conclusion Findings highlight the unique experience of high-risk workers with physical activity. The findingsunderscore the need to design and implement effective interventions specifically designed to meet the needs of high-risk employees.

Acute situational anxiety is a subjective fearful feeling of emotion that is influenced by an immediate situation. It can vary in intensity and duration among patients in the preoperative period of hospitalization. In adults, the incidence of preoperative acute situational anxiety ranges from 11% to 80%. Untreated anxiety in the perioperative period can lead to multiple deleterious effects for patients. Previous reviews on instruments to measure anxiety have not focused on the preoperative period of hospitalization for surgical patients. The objective of this integrative review was to synthesize and describe the instruments used over the last decade to measure preoperative anxiety in the surgical setting. A systematic search strategy of the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases was used to review the literature. A total of 370 articles were identified, but only 5 met the inclusion criteria for this review. In the 5 articles, varying levels of reliability, validity, and feasibility of the instruments were reported as well as context considerations. Reliability and validity are not consistently reported among instruments that measure preoperational anxiety, making it difficult for providers to measure preoperational anxiety and provide treatment based on the instrument results.

Measurement of recessive carrier screening attitudes related to conception and pregnancy is necessary to determine current acceptance, and whether behavioral intervention strategies are needed in clinical practice. To evaluate quantitative survey instruments to measure patient attitudes regarding genetic carrier testing prior to conception and pregnancy databases examining patient attitudes regarding genetic screening prior to conception and pregnancy from 2003–2013 were searched yielding 344 articles; eight studies with eight instruments met criteria for inclusion. Data abstraction on theoretical framework, subjects, instrument description, scoring, method of measurement, reliability, validity, feasibility, level of evidence, and outcomes was completed. Reliability information was provided in five studies with an internal consistency of Cronbach’s α >0.70. Information pertaining to validity was presented in three studies and included construct validity via factor analysis. Despite limited psychometric information, these questionnaires are self-administered and can be briefly completed, making them a feasible method of evaluation.

Background and Purpose: Obesity is a modifiable risk factor associated with multiple disease states. The purpose of this integrative review is to synthesize instruments measuring participants' readiness to lose weight. Methods: The CINAHL, MEDLINE, and PsycINFO databases were searched; 1,048 manuscripts were initially retrieved. Results: There were 11 studies retained. Eight reported moderate to strong validity; however, reliability was not reported in two studies. Overall, sample heterogeneity was limited, reducing generalizability across more diverse populations. In conjunction with readiness to lose weight, some instruments focused on additional attributes. Conclusions: An overview of instruments for assessing or monitoring readiness to lose weight is provided. Gaps in the literature included a lack of scales focusing on overweight, but not obese individuals, and male participants.

Lifestyle factors associated with personal behavior can alter tumor-associated biologic pathways and thereby increase cancer risk, growth and disease recurrence. Advanced glycation end products (AGEs) are reactive metabolites produced endogenously as a byproduct of normal metabolism. A Western lifestyle consisting of high-fat, high-sugar and processed foods as well as little exercise can lead to a significant increase in AGE accumulation in the body and is also associated with driving cancer disparity. Increased AGE accumulation promotes disease phenotypes through modification of the genome, protein crosslinking and dysfunction, and aberrant cell signaling. We evaluated AGE levels in biospecimens from ER+ and ER- breast cancer patients, examined their role in therapy resistance, and assessed the ability of a lifestyle intervention to reduce circulating AGE levels in ER+ breast cancer survivors. A correlation between ER status and AGE levels was observed in tumor and serum samples. AGE treatment of ER+ breast cancer cells impacted pathways associated with ER regulation. We observed a significant increase in phosphorylation of ERalpha following AGE treatment when compared to untreated control with no change in total ERalpha levels. We also observed a significant increase in both AKT and ERK phosphorylation in ER+ cell lines in response to AGE treatment in a time-dependent manner. Inhibition of AKT with Ly294002 and inhibition of ERK with the MEK inhibitor U0126 significantly reduced ERalpha phosphorylation in the presence of AGE. Significantly, ER+ cells treated with AGEs no longer responded to hormonal therapy with tamoxifen. In a proof-of-concept study we examined the ability of a defined exercise and dietary intervention (i.e., cardiac rehabilitation) to reduce circulatory AGE levels in ER+ breast cancer survivors. A significant increase in average very active minutes and average calories burned was observed as a result of the intervention. This was accompanied by a significant reduction in dietary-AGE intake and also showed significant reductions in circulating AGE levels when fasting serum samples were analyzed by ELISA. An analysis of IL6 and CRP levels by ELISA in the same AGE assessed samples revealed no significant differences at any time point. There is a potential prognostic and therapeutic role for lifestyle-derived AGEs in cancer disparity. Given the potential benefits of lifestyle intervention on cancer incidence and mortality, opportunities exist for the development of community health and nutritional programs aimed at reducing AGE exposure in order to improve cancer prevention and treatment outcomes. Lifestyle interventions that lower AGE levels may then be utilized to reduce breast cancer incidence and improve prognosis in cancer disparity populations. Citation Format: Katherine R. Walter, Ford E. Ford, Mathew J. Gregoski, Rita M. Kramer, Kendrea D. Knight, Laura Spruill, Lourdes M. Nogueira, Bradley A. Krisanits, Marian H. Taylor, Amanda C. La Rue, Michael B. Lilly, Stefan Ambs, King Chan, Tonya F. Turner, Heidi Varner, Shweta Singh, Jaime Uribarri, Elizabeth Garrett-Mayer, Kent E. Armeson, Ebony J. Hilton, Mark Clair, Victoria J. Findlay, Lindsay L. Peterson, Gayenell Magwood, David P. Turner. Lifestyle-associated advanced glycation end products are elevated in ER+ positive breast cancer patients, alter response to therapy, and can be targeted by lifestyle intervention [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C024.

The purpose of this qualitative study was to describe the lived experience of African-American informal caregivers of family members with Alzheimer's Disease and Related Dementias (ADRD) in a home environment. Using a qualitative, phenomenological approach, a purposive sample of 16 African-American informal caregivers completed an in-depth interview that lasted from 30 to 60 minutes. Four themes emerged: (a) a sense of obligation, (b) an arduous journey, (c) sentinel events, and (d) faith in God. Findings indicated that caregivers needed to be well-informed concerning the demands of caregiving and needed more assistance with the task of delivering care. Informal caregivers lacked support, knowledge, and guidance. Implications for the discipline of nursing include emphasis on family assessment, teaching, awareness of resources, and collaboration with healthcare teams.

Physical inactivity can have major implications for cardiovascular disease and diabetes, which are leading causes of morbidity among African-American women. Recruiting in rural populations can present challenges and strategies that work in one community but may not be successful in another community. This study examined the feasibility, acceptability, and implementation of community-based screening using an abbreviated Racial and Ethnic Approaches to Community Health (REACH) Risk Factor self-report survey in a geographic region where these data were previously unavailable. Participants (N = 32) included African-American/Black women, 21 years of age or older, who attended health screening events in a rural county in South Carolina. Findings from this study demonstrated the feasibility of community-based cardiometabolic risk screenings using an abbreviated REACH Risk Factor survey and linking participants to follow-up primary care. Findings also provide insight into recruitment strategies in this geographic region.

Lack of physical activity is associated with increased risk for coronary heart disease, the main cause of death in African American women. This integrative review aims to evaluate self-report instruments to assess physical activity in African American women, within the context of coronary heart disease. A systematic literature search was conducted using PubMed, CINAHL, PsycINFO, and PubMed Central databases. Only peer-reviewed studies (a) that included African American women and (b) that assessed the psychometric properties of physical activity instruments in the context of heart disease were included in the search. Initial search located 691 articles but only 7 studies were included in the final review. Of the 7 studies, 6 utilized a combination of self-report and objective measures. While most self-report instruments yielded modest validity and reliability, results were inconsistent and modest at best for African American women. Further studies are needed to identify psychometrically and culturally competent instruments for African American women.

The significantly higher breast cancer (BCa) mortality rates of African-American (AA) women compared to non-Hispanic (NHW) white women constitute a major US health disparity. Investigations have primarily focused on biological differences in tumors to explain more aggressive forms of BCa in AA women. The biology of tumors cannot be modified, yet lifestyle changes can mitigate their progression and recurrence. AA communities have higher percentages of obesity than NHWs and exhibit inefficient access to care, low socioeconomic status, and reduced education levels. Such factors are associated with limited healthy food options and sedentary activity. AA women have the highest prevalence of obesity than any other racial/ethnic/gender group in the United States. The social ecological model (SEM) is a conceptual framework on which interventions could be developed to reduce obesity. The SEM includes intrapersonal factors, interpersonal factors, organizational relationships, and community/institutional policies that are more effective in behavior modification than isolation from the participants' environmental context. Implementation of SEM-based interventions in AA communities could positively modify lifestyle behaviors, which could also serve as a powerful tool in reducing risk of BCa, BCa progression, and BCa recurrence in populations of AA women.

Evidence is accumulating, predominantly among clinical trials in adults, that yoga improves blood pressure (BP) control, with downregulation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS) projected as underlying mechanisms. This pilot study assessed whether Hatha yoga has the potential to reduce BP among youth and whether dampening of the SNS and/or HPA activity is a likely pathway of change.Thirty-one seventh graders were randomly assigned to a Hatha yoga program (HYP) or attention control (AC) music or art class. Baseline and 3-month evaluations included resting BP; overnight urine samples; and saliva collected at bedtime, upon awakening, and at 30 and 60 minutes after awakening for α-amylase and cortisol assays.Twenty-eight (14 in the HYP group and 14 in the AC group) students were assessed both before and after the intervention. BP changes from pre- to post-intervention were -3.0/-2.0 mmHg for the HYP group and -0.07/-0.79 mmHg for the AC group (p=0.30 and 0.57, respectively). Changes in systolic BP (SBP)/diastolic BP (DBP) for the prehypertensive (75th-94th percentiles for SBP) subgroup analyses were -10.75/-8.25 mmHg for the HYP group (n=4) versus 1.8/1.0 mmHg for the AC group (n=5) (p for SBP=0.02; p for DBP=0.09). Although no statistically significant group differences were observed with changes in SNS or HPA awakening curves (area under curve for α-amylase and cortisol, respectively), a small to moderate effect size was seen favoring a reduction of α-amylase activation for the HYP group (Cohen d=0.34; prehypertensive d=0.20).A school-based Hatha yoga program demonstrated potential to decrease resting BP, particularly among prehypertensive youth. Reduced SNS drive may be an underlying neurohormonal pathway beneficially affected by the program. A large-scale efficacy/effectiveness randomized clinical trial is warranted.

Everyday discrimination scale scores are associated with increased ambulatory blood pressure (BP) and reduced nocturnal dipping, and the endothelin-1 (ET-1)/Lys198Asn polymorphism is associated with increased resting BP and exaggerated BP reactivity among African Americans compared to European Americans. Combined influences of these factors on BP control are unknown.This study tested the hypothesis of a three-way interaction between ethnicity, ET-1 carrier status, and everyday discrimination upon ambulatory BP and nocturnal dipping.Baseline laboratory anthropometrics and the everyday discrimination scale were completed by 352 (175 African American) young adult normotensives, followed by 24-h ambulatory BP monitoring.For nocturnal dipping, multiple regression models controlling for age, sex, ethnicity, and body mass index revealed significant three-way ET-1 × everyday discrimination × ethnicity interactions. Specifically, among African American ET-1 T-allele carriers, increases in everyday discrimination led to reduced nocturnal dipping.African Americans that carry the ET-1/Lys198Asn T-allele and report higher everyday discrimination scores may be at particular risk for reduced nocturnal dipping.

Physical activity is critical to improve the condition of patients with chronic leg and foot ulcers, especially those who are obese and experienced multiple co-morbid conditions. Unfortunately, these individuals are unable to engage in guideline based physical activity (PA) programs. A prototype of BluetoothTM enabled acceleration tracking (BEAT) mHealth system was developed and manufactured for remote monitoring and stimulation of adherence to PA in deconditioned patients. The system consists of a miniature accelerometer-based sensor, smartphone application, and a network service. Validation testing showed high reliability and reproducibility of the BEAT sensors. Pilot study with human subjects demonstrated high accuracy of the BEAT system in recognition of different exercises and calculating overall outcomes of PA. Taken together, these results indicate that BEAT system could become a valuable tool for realtime monitoring of PA in deconditioned patients.

Objective Suicide prevention is a high priority. Scalable and sustainable interventions for suicide prevention are needed to set the stage for population-level impact. This systematic review explores how technology-enhanced interventions target suicide risk and protective factors, using the Centers for Disease Control and Prevention (CDC, 2015) Risk and Protective Factors Ecological Model. Methods Information databases (PsycINFO, PubMed and CINAHL) were systematically searched and records including technology-enhanced interventions for suicide prevention ( n = 3764) were reviewed. Records with varying technologies and diverse methodologies were integrated into the search. Results Review of the records resulted in the inclusion of 16 studies that utilized technology-enhanced interventions to address determinants of suicidal behaviour. This includes the use of standalone or, in most cases, adjunct technology-enhanced interventions for suicide prevention delivered by mobile phone application, text message, telephone, computer, web, CD-ROM and video. Conclusion Intervention effectiveness was variable, but several technology-enhanced interventions have demonstrated effectiveness in reducing suicidal ideation and mental health co-morbidities. Large-scale research and evaluation initiatives are needed to evaluate the costs and long-term population-level impact of these interventions.

BACKGROUND/OBJECTIVE: This pilot study investigated the effectiveness of a distance-based e-health program delivered across multiple rural Federal Credit Union worksites that focused on physical activity and dietary education. Program design and implementation were based on the premises of Social Impact Theory (SIT). METHODS: A sample of fifty-four participants (47 white. 7 black) aged 24 to 58 across different worksite locations completed 10 weeks of e-health delivered physical activity and dietary intervention. Pre to post weight changes were examined as a primary outcome. RESULTS: The findings showed that regardless of worksite location, participants on average reduced their weight by 10.13 lbs if they completed both the exercise and lunch and learn components of the study compared to a decrease of 2.73 lbs for participants who chose not to engage in the exercise related activities. Participant dropout from either group was less than four percent. CONCLUSIONS: The results of this study show the beneficial influence of physical activity integration using SIT upon distance programs targeting weight loss. In addition, the high adherence and weight loss success show promise and demonstrates the potential for e-health delivered exercise and lifestyle interventions. Further replication of results via additional randomized controlled trials is needed.

Objective. Current generation smartphones' video camera technologies enable photoplethysmographic (PPG) acquisition and heart rate (HR) measurement. The study objective was to develop an Android application and compare HRs derived from a Motorola Droid to electrocardiograph (ECG) and Nonin 9560BT pulse oximeter readings during various movement-free tasks.Materials and Methods. HRs were collected simultaneously from 14 subjects, ages 20 to 58, healthy or with clinical conditions, using the 3 devices during 5-minute periods while at rest, reading aloud under observation, and playing a video game. Correlation between the 3 devices was determined, and Bland-Altman plots for all possible pairs of devices across all conditions assessed agreement.Results. Across conditions, all device pairs showed high correlations. Bland-Altman plots further revealed the Droid as a valid measure for HR acquisition. Across all conditions, the Droid compared to ECG, 95% of the data points (differences between devices) fell within the limits of agreement.Conclusion. The Android application provides valid HRs at varying levels of movement free mental/perceptual motor exertion. Lack of electrode patches or wireless sensor telemetric straps make it advantageous for use in mobile-cell-phone-delivered health promotion and wellness programs. Further validation is needed to determine its applicability while engaging in physical movement-related activities.

Background Physical inactivity significantly impacts mortality worldwide. Physical inactivity is a modifiable risk factor for obesity, diabetes, cardiovascular disease, and other chronic conditions. African American women in the United States have the highest rates of physical inactivity when compared with other gender/ethnic groups. A paucity of research promoting physical activity (PA) in African American women has been previously identified. The purpose of this review was to identify intervention strategies and outcomes in studies designed to promote PA in African American women. Methods Interventions that promoted PA in African American women published between 2000 and May 2015 were included. A comprehensive search of the literature was performed in Health Source: Nursing/Academic Edition, PsycINFO, CINAHL Complete, and MEDLINE Complete databases. Data were abstracted and synthesized to examine interventions, study designs, theoretical frameworks, and measures of PA. Results Mixed findings (both significant and nonsignificant) were identified. Interventions included faith-based, group-based, and individually focused programs. All studies (n = 32) included measures of PA; among the studies, self-report was the predominant method for obtaining information. Half of the 32 studies focused on PA, and the remaining studies focused on PA and nutrition. Most studies reported an increase in PA or adherence to PA. This review reveals promising strategies for promoting PA. Conclusions Future studies should include long-term follow-up, larger sample sizes, and objective measures of PA. Additional research promoting PA in African American women is warranted, particularly in studies that focus on increasing PA in older African American women.

High rates of overweight/obesity are commonly seen in breast cancer (BC) survivors. Observational data show an association between post-treatment increased weight and lack of physical activity (PA) and risk of BC recurrence and death. Increases in prognostic inflammatory associated biomarkers (BM) such as interleukin-6 (IL6) and C-reactive protein (CRP), and their downstream effects, are linked to overweight/obesity and provide a potential mechanistic explanation for this increase in recurrence risk, but studies are mixed regarding the effect of lifestyle interventions on these BM. In addition, better BM may exist. The Getting on Board with an Active Lifestyle (GOAL) study tested the feasibility of a PA and dietary counseling (DC) intervention in BC survivors and included known BM (IL6 , CRP) as well as a novel BM (advanced glycation end-products [AGEs]). AGEs are reactive metabolites produced by an uncontrolled reaction between sugars and proteins and were selected because they are seen in chronic diseases including: diabetes, neuro-degenerative disorders, stroke, heart disease and more recently, BC. Further, dietary AGEs are consumed in high fat and highly processed foods that contribute to overweight/obesity. Methods: Ten overweight/obese women (BMI≥25) within 36 months of BC diagnosis (stage I-III) participated in a 12-week supervised PA and DC intervention consisting of two supervised PA sessions per week and weekly DC sessions. Body mass index (BMI), resting heart rate (HR) and blood pressure (BP) and blood samples were collected at baseline, week 4, 8, 12, 24, 36, 52. IL-6, CRP and AGEs were assessed in serum using commercially available 96-well format ELISAs. Data through week 12 is presented here. Results: Ten participants (four African American) completed the 12-week intervention. The age range of participants was 50-68 years (mean 56 years). The average number of daily active minutes increased significantly between baseline (45) and week 11 (71). There was a drop off at week 12 due to right-censoring of the data. Dietary AGE intake decreased in 8 of 10 participants from baseline to week 12 (average reduction 53%). Significant reductions in mean serum AGEs were seen (baseline=53 ug/ml, week 12=38ug/ml, p Conclusions: The GOAL intervention has the potential to improve PA and dietary AGE intake among overweight/obese BC patients. Participants improved weight, resting HR, BP, and number of daily active minutes; which are important metrics for overall health. There were no changes in IL6 and CRP, but reductions in AGEs correlated with reductions in dietary AGE levels, indicating that serum AGEs may be reduced through diet and PA. Serum AGEs may represent a better BM than IL6 and CRP in BC survivors. Further investigation of AGEs in BC survivors is warranted. Citation Format: Peterson LL, Ford ME, Gregoski MJ, Knight KD, Hilton EJ, Magwood G, Turner DP. A physical activity and dietary counseling intervention in breast cancer survivors and changes in known and novel prognostic biomarkers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-07-12.

This study examined the impact of breathing awareness meditation (BAM), life skills (LS) training, and health education (HE) interventions on self-reported hostility and 24-hour ambulatory blood pressure (ABP) in 121 African American (AA) ninth graders at increased risk for development of essential hypertension. They were randomly assigned to BAM, LS, or HE and engaged in intervention sessions during health class for 3 months. Before, after, and 3 months following intervention cessation, self-reported hostility and 24-hour ABP were measured. Results indicated that between pre- and postintervention, BAM participants displayed significant reductions in self-reported hostility and 24-hour systolic ABP. Reductions in hostility were significantly related to reductions in 24-hour systolic ABP. Between postintervention and follow-up, participants receiving LS showed a significant reduction in hostility but not in 24-hour ABP. Significant changes were not found for the HE group in 24-hour ABP or self-reported hostility, but these change scores were significantly correlated. The implications of the findings are discussed with regard to behavioral stress reduction programs for the physical and emotional health of AAs.

The study tested the effect of aerobic exercise training on executive function in overweight children. Ninety-four sedentary, overweight but otherwise healthy children (mean age = 9.2 years, body mass index 85th percentile) were randomized to a low-dose (20 min/day exercise), high-dose (40 min/day exercise), or control condition. Exercise sessions met 5 days/week for 15 weeks. The Cognitive Assessment System (CAS), a standardized test of cognitive processes, was administered individually before and following intervention. Analysis of covariance on posttest scores revealed effects on executive function. Group differences emerged for the CAS Planning scale (p = .03). Planning scores for the high-dose group were significantly greater than those of the control group. Exercise may prove to be a simple, yet important, method of enhancing aspects of children's mental functioning that are central to cognitive and social development.

Objective: To determine whether regular aerobic exercise improves symptoms of sleep-disordered breathing in overweight children, as has been shown in adults. Research Methods and Procedures: Healthy but overweight (BMI ≥85th percentile) 7- to 11-year-old children were recruited from public schools for a randomized controlled trial of exercise effects on diabetes risk. One hundred children (53% black, 41% male) were randomly assigned to a control group (n = 27), a low-dose exercise group (n = 36), or a high-dose exercise group (n = 37). Exercise groups underwent a 13 ± 1.5 week after-school program that provided 20 or 40 minutes per day of aerobic exercise (average heart rate = 164 beats per minute). Group changes were compared on BMI z-score and four Pediatric Sleep Questionnaire scales: Snoring, Sleepiness, Behavior, and a summary scale, Sleep-Related Breathing Disorders. Analyses were adjusted for age. Results: Both the high-dose and low-dose exercise groups improved more than the control group on the Snoring scale. The high-dose exercise group improved more than the low-dose exercise and control groups on the summary scale. No group differences were found for changes on Sleepiness, Behavior, or BMI z-score. At baseline, 25% screened positive for sleep-disordered breathing; half improved to a negative screen after intervention. Discussion: Regular vigorous exercise can improve snoring, a symptom of sleep-disordered breathing, in overweight children. Aerobic exercise programs may be valuable for prevention and treatment of sleep-disordered breathing in overweight children.

John C Sieverdes,1 Mathew Gregoski,1 Sachin Patel,1 Deborah Williamson,1 Brenda Brunner-Jackson,1 Judith Rundbaken,1 Eveline Treiber,1 Lydia Davidson,1 Frank A Treiber1,21Technology Applications Center for Healthful Lifestyles, College of Nursing, 2College of Medicine, Medical University of South Carolina, Charleston, SC, USAAbstract: Patient nonadherence to medication regimens and provider therapeutic inertia (failure to respond in timely manner to clinical data) are two primary contributors to ineffective chronic disease management. This 3-month proof of concept trial used an iterative design approach guided by self-determination theory and the technology acceptance model to develop a culturally sensitive, patient-centered, and provider-centered mobile health medication and blood pressure self-management program. Cellular connected electronic medication trays provided reminder signals for patients to take medications and smartphone messaging reminded patients to take at-home blood pressures using a Bluetooth-enabled monitor. Providers were given bimonthly feedback. Motivational and reinforcement text and audio messages were sent based upon medication adherence rates and blood pressure levels. Ten Hispanics with uncontrolled essential hypertension were randomized to standard care and Smartphone Medication Adherence Stops Hypertension (SMASH) intervention groups. Primary outcomes of provider and patient acceptability of the program were found to be high. Retention rates for the 3-month program were 100%, with mean ± standard deviation overall medication adherence for the SMASH group at 97.2% ± 2.8%, with all strongly believing the program helped them remember to take their medication. SMASH participants measured their blood pressure every 3 days 83.2% ± 6.0% of the time and completed 89.2% ± 19.06% of the expected readings. Nonparametric tests showed statistical significance for resting blood pressure changes between groups at months 2 (P = 0.016) and 3 (P = 0.008), with a pre-intervention to 3-month mean systolic blood pressure reduction of 47.2 mmHg for the SMASH group compared with a reduction of 12 mmHg for the standard care group. Change in scores between pre-intervention and months 1, 2, and 3 for ambulatory blood pressure values found that the SMASH group exhibited consistently greater reductions for 24-hour, wake, and sleep categories compared with little change in the standard care group, although statistical significance was not reached. Principles of patient-centered care highlight partnering with intended users and implementers are important when developing a culturally sensitive intervention that is meaningful and effective.Keywords: medication adherence, clinical inertia, self-determination theory, mHealth, blood pressure control, essential hypertension, Hispanics

BackgroundMobile phone based programs for kidney transplant recipients are promising tools for improving long-term graft outcomes and better managing comorbidities (eg, hypertension, diabetes). These tools provide an easy to use self-management framework allowing optimal medication adherence that is guided by the patients’ physiological data. This technology is also relatively inexpensive, has an intuitive interface, and provides the capability for real-time personalized feedback to help motivate patient self-efficacy. Automated summary reports of patients’ adherence and blood pressure can easily be uploaded to providers’ networks helping reduce clinical inertia by reducing regimen alteration time. ObjectiveThe aim of this study was to assess the feasibility, acceptability, and preliminary outcomes of a prototype mobile health (mHealth) medication and blood pressure (BP) self-management system for kidney transplant patients with uncontrolled hypertension. MethodsA smartphone enabled medication adherence and BP self-management system was developed using a patient and provider centered design. The development framework utilized self-determination theory with iterative stages that were guided and refined based on patient/provider feedback. A 3-month proof-of-concept randomized controlled trial was conducted in 20 hypertensive kidney transplant patients identified as non-adherent to their current medication regimen based on a month long screening using an electronic medication tray. Participants randomized to the mHealth intervention had the reminder functions of their electronic medication tray enabled and received a bluetooth capable BP monitor and a smartphone that received and transmitted encrypted physiological data and delivered reminders to measure BP using text messaging. Controls received standard of care and their adherence continued to be monitored with the medication tray reminders turned off. Providers received weekly summary reports of patient medication adherence and BP readings. ResultsParticipation and retention rates were 41/55 (75%) and 31/34 (91%), respectively. The prototype system appears to be safe, highly acceptable, and useful to patients and providers. Compared to the standard care control group (SC), the mHealth intervention group exhibited significant improvements in medication adherence and significant reductions in clinic-measured systolic blood pressures across the monthly evaluations. Physicians made more anti-hypertensive medication adjustments in the mHealth group versus the standard care group (7 adjustments in 5 patients versus 3 adjustments in 3 patients) during the 3-month trial based on the information provided in the weekly reports. ConclusionsThese data support the acceptability and feasibility of the prototype mHealth system. Further trials with larger sample sizes and additional biomarkers (eg, whole blood medication levels) are needed to examine efficacy and effectiveness of the system for improving medication adherence and blood pressure control after kidney transplantation over longer time periods. Trial RegistrationClinicaltrials.gov NCT01859273; http://clinicaltrials.gov/ct2/show/NCT01859273 (Archived by WebCite at http://www.webcitation.org/6IqfCa3A3).

BackgroundMobile phone–based interventions present a means of providing high quality health care to hard-to-reach underserved populations. Migrant farm workers (MFWs) are among the most underserved populations in the United States due to a high prevalence of chronic diseases yet limited access to health care. However, it is unknown if MFWs have access to mobile phone devices used in mobile health (mHealth) interventions, or if they are willing to use such technologies. ObjectiveDetermine rates of ownership of mobile devices and willingness to use mHealth strategies in MFWs. MethodsA demonstration of mHealth devices and a survey were individually administered to 80 Hispanic MFWs to evaluate use of mobile phones and mHealth devices and willingness to use such technologies. ResultsOf the 80 participants, 81% (65/80) owned cell phones capable of sending and receiving health-related messages. Most participants (65/80, 81%) were receptive to using mHealth technology and felt it would be helpful in enhancing medication adherence, self-monitoring health conditions, and receiving quicker medication changes from their doctors (median scores ≥4 on 5-point Likert scales). Relations between age and attitudes toward using mHealth were not statistically significant. ConclusionsHispanic MFWs have access to mobile phones and are willing to use mHealth devices. Future work is needed to comprehensively evaluate the degree to which these devices could be used.

Objectives: This brief report demonstrates the proof of concept of the Tension Tamer (TT) smartphone application, which integrates photoplethysmograph capabilities with breathing awareness meditation (BAM), to reduce stress and measure heart rate and adherence. Design: Methods for objectively measuring heart rate and adherence to BAM were developed as part of a future randomized controlled trial. Setting/Location: The study was conducted at Jerry Zucker Middle School of Science and the Medical University of South Carolina, Charleston. Subjects: The subjects were three prehypertensive male teachers. Intervention: The method used was smartphone delivered BAM. Outcome measures: Objective measures included heart rate, adherence, and ambulatory blood pressure (BP). Results: Adherence data was successfully collected by the TT application. Increased adherence to TT coincided with increased improvements in ambulatory BP over a 3-month period. Conclusions: TT shows promise as a simple inexpensive program ...

Breast cancer (BCa) is the 2nd leading cause of cancer death in women in the US. African American (AA) women have higher BCa mortality rates and higher obesity rates compared to other women. It is well known that exercise and a healthier diet can improve prognosis among BCa survivors but little is known about their positive effects on common biological pathways involved in BCa recurrence. The RCAM Study is a 1-year study designed to identify bio-behavioral pathways that may impact BCa recurrence. The study evaluates the effect of the intervention on a novel biomarker associated with cancer recurrence advanced glycation end products (AGEs). The intervention, adapted from the highly successful Diabetes Prevention Program (DPP), consists of a 12-week physical activity and dietary counseling program. The supervised physical activity component is conducted twice a week at a local health system's cardiopulmonary rehabilitation center; the individualized dietary counseling component is conducted weekly at the health system's weight management center. The study participants consist of overweight or obese women who received surgery for invasive BCa and who are within 36 months of diagnosis. In addition, adjuvant therapy must have been received at least four weeks prior to study enrollment. To date, 10 participants have completed the 12-week intervention and will be followed for 1 year. Preliminary ELISA data from blood samples collected pre- and post-12 week intervention show significant post-intervention reductions in inflammatory biomarker levels. Commensurate decreases in body mass, resting heart rate, and blood pressure were also seen. The average pre-/post-intervention decrease in AGE levels was not as dramatic for the AA participants, most of whom were morbidly obese at enrollment, as for the European American (EA) women, most of whom were overweight at enrollment. These data demonstrate the high potential of the RCAM intervention in improving prognosis among BCa survivors and show the need to tailor the intervention to meet the specific needs of AA women. Citation Format: Marvella E. Ford, David P. Turner, Mathew J. Gregoski, Lindsay L. Peterson, Kendrea D. Knight, Ebony J. Hilton, Gayenell Magwood. Design and preliminary outcomes of a study to reduce cancer-associated reactive metabolite levels in breast cancer survivors – The RCAM Study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B07.

Effective and efficient management of chronic illness remains a significant clinical problem. To improve chronic illness management, two obstacles that must be overcome are patient non-adherence to medication regimens and provider therapeutic inertia (failure to respond in timely manner to clinical data). Using an iterative approach, behavioral theory was used to develop a mobile health (mHealth) medication and blood pressure self-management system that was patient and provider centered. Electronic medication trays provided reminder signals and smart phone text messages reminded patients to measure blood pressures using a Bluetooth-enabled monitor. Patients received mobile phone-delivered personalized motivational and reinforcement messages based upon adherence levels to these regimens. Two 3-month proof of concept randomized control trials were conducted with 2 patient groups; 1) Hispanics with uncontrolled essential hypertension (n=6), and 2) patients with hypertension after kidney transplantation. (n=6). Hispanic patients who received the mHealth intervention all exhibited significant improvements in both medication adherence and reductions in resting and 24-hour blood pressures during the trial and at 3-month follow-up, as compared to the control group.The still ongoing kidney transplant trial has shown that recipients randomized to the mHealth intervention have demonstrated significant improvements in medication adherence and reduced blood pressure two months into the trial. Following completion of both studies, patient and provider focus groups will allow further iterative refinement of the mHealth system and a feasibility trial of larger scale and longer duration.