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Symptoms, which often cluster together, are a significant problem in heart failure (HF). There is considerable heterogeneity in symptom burden, particularly in the vulnerable transition period after a hospitalization for HF, and the biological underpinnings of symptoms during transitions are unclear. The purpose of this article is to describe the background and design of a study that addresses these knowledge gaps, entitled Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF).BIOMES-HF is a prospective gender- and age-balanced longitudinal study of 240 adults during the 6-month transition period after a HF hospitalization. The aims are to (1) identify clusters of change in physical symptoms, (2) quantify longitudinal associations between biomarkers and physical symptoms, and (3) quantify longitudinal associations between physical frailty and physical symptoms among adults with HF. We will measure multiple symptoms, biomarkers, and physical frailty at discharge and then at 1 week and 1, 3, and 6 months after hospitalization. We will use growth mixture modeling and longitudinal mediation modeling to examine changes in symptoms, biomarkers, and physical frailty after HF hospitalization and associations therein.This innovative study will advance HF symptom science by using a multibiomarker panel and the physical frailty phenotype to capture the multifaceted nature of HF. Using advanced quantitative modeling, we will characterize heterogeneity and identify potential mechanisms of symptoms in HF. As a result, this research will pinpoint amenable targets for intervention to provide better, individualized treatment to improve symptom burden in HF.Adults with heart failure may have significant symptom burden. This study is designed to shed light on our understanding of the role of biological and physiological mechanisms in explaining heart failure symptoms, particularly groups of co-occurring symptoms, over time. We explore how symptoms, biomarkers, and physical frailty change after a heart failure hospitalization. The knowledge generated from this study will be used to guide the management and self-care for adults with heart failure.

Introduction. Estimates of prevalence and comorbidity of ADHD in the United States require additional national, multi-informant data. Further, it is unclear whether the polygenic, neurodevelopmental model of ADHD in DSM-5 is best modeled with a broad or restrictive phenotype definition. Method: In the Adolescent Behavior Cognition Development (ABCD) study baseline data on 9-10 year old children, ADHD prevalence, comorbidity, and association with cognitive functioning and polygenic risk were calculated at four thresholds of definition of ADHD phenotype restrictiveness using multiple measures and informants. Multi-indicator latent variable and composite scores were created and cross validated for ADHD symptoms and for irritability. Missing data, sample nesting, and sampling bias were corrected statistically. Results: Multi-informant estimate of ADHD prevalence by the most restrictive definition was 3.53% when restricted to children in which parent ratings and teacher ratings both converged with KSAD report of current ADHD. As stringency of the phenotype was increased, total comorbidity increased slightly, and associations with cognitive functioning and polygenic risk strengthened. Inclusion of children with past ADHD but now treated increased prevalence estimate without weakening detection of polygenic risk. Irritability and ADHD dimensional composite scores and latent variables achieved satisfactory model fit and expected external correlations. Conclusion: The present report strengthens estimates of ADHD prevalence and comorbidity. Research on polygenic and other correlates of ADHD as a clinical category in the ABCD sample may benefit from using a restrictive, multi-informant operational definition.

TPS193 Background: Many prostate cancer survivors are treated with androgen deprivation therapy (ADT), but these therapies may increase frailty, worsen physical functioning, and increase fall risk. While exercise may counter functional declines associated with ADT, no studies have tested whether and which type of exercise may reduce falls and frailty. The purpose of this trial is to compare the relative efficacy of strength training versus tai ji quan training against each other and to a stretching control group on falls, frailty and physical functioning in men expose to ADT for prostate cancer. Methods: Prostate cancer survivors treated with ADT (n = 360) will be recruited to participate in this single-blind, parallel group, randomized trial. To be eligible men must meet the following criteria: 1) histologically confirmed prostate cancer, 2) received at least 6 months of ADT within the past 10 years, 3) report >1 fall in the past year OR have a score on one of two physical performance tests that is associated with increased fall risk (i.e. ≥ 12.0 seconds to complete the 3 meter timed up and go (TUG), or ≥ 10.0 seconds to complete 5 chair stands), 4) completed any other treatment at least 6 weeks prior to enrollment and not be on any concurrent prostate cancer therapy besides ADT, 5) not currently participating in moderate-vigorous intensity lower-body strength training or tai ji quan training ≥ 2 times/week for ≥ 30 minutes per session, 6) no cognitive difficulties that limit ability to answer survey questions or participate in exercise classes and performance tests, 7) no medical condition, disorder, or take medication that contraindicates participation in moderate intensity exercise, and 8) are able to communicate in English. Participants will be randomized to one of three supervised, group training programs: i) strength training, ii) tai ji quan training, or iii) stretching (control), that train 3x/week for 6 months. Outcomes are assessed at baseline, 3 (mid-intervention), 6 (immediately post-intervention) and 12 (follow-up) months. The primary outcome is falls assessed by monthly self-report. Secondary outcomes include the following: Frailty (low lean body mass (by bioelectrical impedance analysis), exhaustion (by SF-36 vitality scale), low activity (by CHAMPS physical activity survey), slowness (by 4m usual walk speed), and weakness (by chair stand time)); Objective and subjective measures of physical function will also be collected. Negative binomial regression models will be used to assess differences in falls between groups, while mixed-effects modeling will be used to compare the relative efficacy of training group on secondary outcomes. Registered November 18, 2018. Clinical trial information: NCT03741335.

Many environmental and risk management decisions are made jointly by technical experts and members of the public. Frequently, their task is to select from among management alternatives whose outcomes are subject to varying degrees of uncertainty. Although it is recognized that how this uncertainty is interpreted can significantly affect decision-making processes and choices, little research has examined similarities and differences between expert and public understandings of uncertainty. We present results from a web-based survey that directly compares expert and lay interpretations and understandings of different expressions of uncertainty in the context of evaluating the consequences of proposed environmental management actions. Participants responded to two hypothetical but realistic scenarios involving trade-offs between environmental and other objectives and were asked a series of questions about their comprehension of the uncertainty information, their preferred choice among the alternatives, and the associated difficulty and amount of effort. Results demonstrate that experts and laypersons tend to use presentations of numerical ranges and evaluative labels differently; interestingly, the observed differences between the two groups were not explained by differences in numeracy or concerns for the predicted environmental losses. These findings question many of the usual presumptions about how uncertainty should be presented as part of deliberative risk- and environmental-management processes.