Education for cancer-related fatigue: could talking about it make people more likely to report it?

PURPOSE: Education-based interventions for cancer-related fatigue have shown promise in adults undergoing radiotherapy. Research on the cancer-related fatigue intervention trial (CAN-FIT) programme found that pre-radiotherapy fatigue information and support (pre-RFES) did not improve levels of fatigue, but was associated with improvements in activity-based outcomes. We aimed to measure whether pre-RFES resulted in greater participant self-ratings of their performance of daily living activities, fatigue, quality of life and distress. METHODS: Thirty people undergoing radiotherapy and/or chemotherapy were randomly allocated to either a 1-h RFES session from the CAN-FIT programme (delivered individually to participants and modified where necessary for patients undergoing chemotherapy) or standard care. Measures were taken pre- and post-treatment and 6 weeks after completing treatment. RESULTS: There was no significant difference between groups on performance of daily living activities or ratings of distress. Further analysis found a significant difference between the control and treatment groups for EQ-5D health state visual analogue scale (-9.05 [-18.09; -0.018]; p < 0.05) and physical fatigue (2.86 [0.58; 5.14]; p < 0.02) with the treatment group rating their overall health state worse and their physical fatigue higher than the controls. CONCLUSIONS: Pre-RFES delivered individually did not significantly improve participants' ratings of their performance of daily occupations and was unexpectedly associated with worse overall health state and higher physical fatigue. Future trials, ideally comparing individual and group education to exercise programmes or cognitive-behavioural approaches, are recommended to examine the broader question of whether discussing fatigue might actually make participants feel worse.

Pilot study of an assessment tool for measuring head and neck lymphoedema.

Head and neck lymphoedema (HNL) is a persistent symptom for many patients following head and neck cancer treatment. There is limited research into the benefits of lymphoedema treatment with this population. This pilot study (n=8) employs the Assessment of Lymphoedema of Head and Neck (ALOHA) system to evaluate treatment changes in this clinical population. The ALOHA assessment combines the use of the Princess Alexandra Hospital tape measurement system and the use of Tissue Dielectric Constant (MoistureMeterD) to measure HNL. Baseline measures were taken at the start of treatment and were repeated when the participants had reduced one level on the MD Anderson Cancer Centre HNL rating scale. The MoistureMeterD and three of the four tape measurement points showed a statistically significant change over time. This indicates the ALOHA system was useful in objectively detecting changes associated with clinical improvements.

Maternal Weight Management to Prevent the Developmental Programming of MAFLD in Offspring of Obese Mothers.

The global surge of obesity amongst women of reproductive age has raised concerns surrounding the health consequences for their offspring as there is a formidable link between an obesogenic maternal environment and the developmental programming of metabolic dysfunction in the offspring. Specifically, the offspring of mothers with obesity have a three-fold higher risk of developing metabolic-associated fatty liver disease (MAFLD) compared to the offspring of healthy-weight mothers. Given the burgeoning burden of obesity and its comorbidities, it is essential to focus research efforts on methods to alleviate the intergenerational onset of obesity and MAFLD. This review summarizes the current research surrounding the developmental programming of MAFLD in the offspring of mothers with obesity and examines the potential for weight interventions to prevent such metabolic dysfunction in the offspring. It focuses on the benefits of pre-pregnancy interventional strategies, including dietary and exercise intervention, to ameliorate adverse liver health outcomes in the offspring. The utility and translation of these interventions for humans may be difficult for prospective mothers with obesity, thus the use of pre-pregnancy therapeutic weight loss aids, such as glucagon-like peptide-1 receptor agonists, is also discussed.

Maternal Weight Intervention in the Perinatal Period Improves Liver Health in the Offspring of Mothers with Obesity.

Early-life exposure to maternal obesity predisposes offspring to metabolic-associated fatty liver disease (MAFLD). This study aimed to determine if peripartum weight loss, either through dietary intervention or pharmacological intervention, improved adverse liver health outcomes in the offspring of mothers with obesity. C57Bl/6 dams were fed a chow diet or a high-fat diet (HFD) for 8 weeks. HFD-fed mice either continued HFD, transitioned to a chow diet, or were administered liraglutide for 4 weeks. Pregnancy was induced following a one-week washout of liraglutide during which all animals remained on their respective diets. A proportion of HFD-fed mice transitioned to a chow diet during pregnancy. All offspring were weaned to the HFD. Offspring anthropometric, metabolic, and hepatic outcomes were assessed at postnatal week 12. The offspring of mothers with obesity had phenotypic changes consistent with MAFLD. The offspring of mothers that had weight loss with perinatal dietary intervention had reduced insulin resistance (p < 0.001) and hepatic expression of markers of inflammation (p < 0.001), oxidative stress (p < 0.05), and fibrosis (p < 0.05). A similar phenotype was observed in the offspring of mothers with pre-pregnancy weight loss via liraglutide despite ongoing consumption of the HFD during pregnancy. All methods and timing of maternal weight intervention were effective at ameliorating adverse liver effects in the offspring.

Contact high: Mania proneness and positive perception of emotional touches.

How do extreme degrees of positive emotion-such as those characteristic of mania-influence emotion perception? The present study investigated how mania proneness, assessed using the Hypomanic Personality Scale, influences the perception of emotion via touch. Using a validated dyadic interaction paradigm for communicating emotion through touch (Hertenstein, Keltner, App, Bulleit, & Jaskolka, 2006), participants (N=53) received eight different touches to their forearm from a stranger and then identified the emotion via forced-choice methodology. Mania proneness predicted increased overall accuracy in touch perception, particularly for positive emotion touches, as well as the over-attribution of positive and under-attribution of negative emotions across all touches. These findings highlight the effects of positive emotion extremes on the perception of emotion in social interactions.

Methicillin-Resistant Staphylococcus aureus Spinal Epidural Abscess: Local and Systemic Case Management.

Spinal epidural abscess (SEA) is a rare condition with complex pathophysiology and highly variable clinical presentation. While it is known to cause focal peripheral nerve symptoms such as muscle weakness, paresthesia, or pain, these are typically accompanied by complaints of back or spine pain and systemic symptoms indicative of infection. In our case, a 53-year-old male initially presented with unilateral pain and swelling in his right hand, with no fever at presentation and no complaints of back pain. Blood culture confirmed methicillin-resistant Staphylococcus aureus (MRSA)for which he was given vancomycin. The patient later endorsed back pain and diagnostic imaging revealed a spinal epidural abscess spanning the T5-T9 vertebrae. The abscess was drained, and vancomycin was placed in the subfascial and epifascial compartments. The hand was debrided in the same operation and showed no gross purulence. Two days after the procedure, intraoperative cultures remained negative, and the patient was subsequently managed with daptomycin.

Identification and Characterization of Small RNA Markers of Age in the Blow Fly Cochliomyia macellaria (Fabricius) (Diptera: Calliphoridae).

Blow fly development is important in decomposition ecology, agriculture, and forensics. Much of the impact of these species is from immature samples, thus knowledge of their development is important to enhance or ameliorate their effects. One application of this information is the estimation of immature insect age to provide temporal information for death investigations. While traditional markers of age such as stage and size are generally accurate, they lack precision in later developmental stages. We used miRNA sequencing to measure miRNA expression, throughout development, of the secondary screwworm, Cochliomyia macellaria (Fabricius) (Diptera: Calliphoridae) and identified 217 miRNAs present across the samples. Ten were identified to be significantly differentially expressed in larval samples and seventeen were found to be significantly differentially expressed in intrapuparial samples. Twenty-eight miRNAs were identified to be differentially expressed between sexes. Expression patterns of two miRNAs, miR-92b and bantam, were qPCR-validated in intrapuparial samples; these and likely food-derived miRNAs appear to be stable markers of age in C. macellaria. Our results support the use of miRNAs for developmental markers of age and suggest further investigations across species and under a range of abiotic and biotic conditions.

Is education an effective management strategy for reducing cancer-related fatigue?

PURPOSE: The use of education is recommended to teach patients self-care behaviours to reduce cancer-related fatigue, however, there is little evidence of its effectiveness or optimal timing. This educationally based cancer-related fatigue intervention trial, CAN-FIT, aimed to reduced severity of fatigue in radiotherapy patients. METHODS: One hundred and ten participants aged≥18 years undergoing curative radiotherapy were randomly assigned to receive (1) pre- and post-radiotherapy fatigue education and support (RFES); (2) pre-RFES only; (3) post-RFES only; or (4) no RFES (standard care). Data collection occurred at pre- and post- radiotherapy and at 6-weeks follow-up. RESULTS: The intervention was not associated with reduction in fatigue levels at any assessment point. Significant changes were seen with secondary activity-based outcomes: Physical activity participation: Pre-RFES was associated with significantly greater increase in vigorous [Assessment (Ax)1-Ax2: 1.05 (0.24, 1.86) p<0.01: Ax2-Ax3: 1.24, (0.44, 2.03) p<0.01] and moderate physical activity participation [Ax1-Ax2: 1.4 (0.53, 2.26) p<0.01]. Post-RFES was associated with significant improvements in walking levels [Ax1-Ax3: 5.82 (0.07, 11.56) p<0.05] compared with no pre-RFES. Paid and unpaid employment: Pre-RFES was associated with slower return to pre-treatment levels of paid work [Ax2-Ax3: -0.72 (-1.41, -0.04) p<0.05] than no pre-RFES. Post-RFES was associated with decreased levels of unpaid work [Ax1-Ax3: 561.79 (51.21, 1,072.37) p<0.05] compared with no post-RFES. CONCLUSION: The CAN-FIT programme did not significantly improve the primary outcome, level of fatigue, regardless of when it was delivered, however, significant changes were observed in activity-based outcomes. Further investigations into educationally based programmes should target activity participation rather than changes in underlying fatigue to improve overall patient health.

Determining the minimal clinically important difference criteria for the Multidimensional Fatigue Inventory in a radiotherapy population.

PURPOSE: The Multidimensional Fatigue Inventory (MFI) is a commonly used cancer-related fatigue assessment tool. Unlike other fatigue assessments, there are no published minimal clinically important difference (MCID) criteria for the MFI in cancer populations. MCID criteria determine the smallest change in scores that can be regarded as important, allowing clinicians and researchers to interpret the meaning of changes in patient's fatigue scores. This research aims to improve the clinical utility of the MFI by establishing MCID criteria for the MFI sub-scales in a radiotherapy population. MATERIALS AND METHODS: Two hundred ten patients undergoing radiotherapy were recruited to a single-centre prospective cohort study. Patients were assessed at three time points, at the start of radiotherapy, the end of radiotherapy and 6 weeks after radiotherapy completion. Assessment consisted of four clinically relevant constructs: (1) treatment impact on fatigue, (2) health-related quality of life, (3) performance status and (4) occupational productivity. These constructs were used as external or anchor-based measures to determine MCIDs for each sub-scale of the MFI. RESULTS: Multiple MCIDs were identified, each from a different perspective based on the constructs cited. Researchers seeking to use a generic MCID may wish to use a two-point reference for each MFI sub-scale as it was consistent across the pre- and post-radiotherapy comparison and occupational productivity anchors. CONCLUSIONS: MCIDs validated in this study allow better interpretation of changes in MFI sub-scale scores and allow effect size calculations for determining sample size in future studies.

A Unique Case of Extra-articular Extravasation of Metal Into the Lower Leg Resulting From Oxidized Zirconium Wear Particles From Total Knee Arthroplasty.

With an increasing number of joint replacements and the evolution of orthopaedic implants and hardware, there is increased occurrence and awareness of metal-related sensitivity. This has resulted in the development of devices using a variety of different materials to coat the implant. One popular option is to cover the metallic surface with a ceramic. One commercially available ceramic-coated prosthesis is coated with oxidized zirconium, with the trade name Oxinium. Although pseudotumor and metallosis resulting from ceramic joint arthroplasty implants have been documented, there is limited information on the occurrence of metallosis resulting from ceramic-coated knee implants. The purpose of this case report is to discuss a potential differential diagnosis for lower leg mass after total knee arthroplasty and to present a novel case of catastrophic failure of an Oxinium-coated total knee prosthesis (Smith and Nephew) that resulted in metallosis with extra-articular extravasation along the extensor digitorum longus tendon.

Zone V Extensor Tendon Repair with a Palmaris Longus Tendon Autograft and Human Umbilical Membrane.

Extensor tendon repairs, although common, can be difficult injuries to treat. Their treatment is tailored to the zone of the hand that is affected since varying biomechanical forces are applied to the tendon at each zone. Prompt treatment is necessary to prevent potential complications associated with these injuries. This is particularly true of Zone V extensor tendon injuries, as their mechanism is commonly a highly infectious human bite. We present the case of a human fight bite resulting in a Zone V extensor tendon injury. The delayed presentation of this case resulted in an untreated infection that caused an abscess with associated extensor tendon necrosis and rupture. Given the large gap length between the ends of the tendons, tendon repair was performed using a palmaris longus autograft. Even when these are done in a controlled setting, adhesions are common. The compromised wound bed caused irritation, erosion, and subsequent rupture of the extensor tendon of the hand. In an effort to avoid common complications such as adhesion, the repair was then wrapped with human umbilical membrane (AVIVE® Soft Tissue Membrane, AxoGen Inc., Alachua, FL) to separate adjacent tissue and reduce inflammation. Even without access to formal physical therapy, our patient had excellent functional outcomes at his final follow-up visit. The patient was able to make a loose composite fist, had no extensor lag at the MCP joints, and had extensor lag of 15 degrees at the PIP joints of digits 4-5.

Measuring head and neck lymphedema: The "ALOHA" trial.

BACKGROUND: There is no clinical assessment available to measure head and neck lymphedema. This study proposes the use of a tape measurement system and the MoistureMeterD (MMD) to evaluate head and neck lymphedema. METHODS: The reliability and validity of these assessments was examined in 20 patients with head and neck lymphedema and 20 matched healthy controls. RESULTS: Interrater reliability for the MMD and 3 of the 4 tape measurements was excellent (intraclass correlation coefficients [ICCs] >0.90). Intrarater reliability of the MMD was 0.97. The MMD discriminated between patients with head and neck lymphedema and healthy controls, t(19) = 8.97, p < .001, whereas the tape measurements did not. Correlation between MMD score and head and neck lymphedema level ratings was significant (rho = 0.59) indicating convergent validity. Three of the tape measurements were significantly correlated with MMD scores (rho = 0.37-0.38) but not with ratings of head and neck lymphedema. CONCLUSION: The tape measurement system and MMD show potential as objective measurements of head and neck lymphedema with the exception of 1 tape measurement point.

Unseen positive and negative affective information influences social perception in bipolar I disorder and healthy adults.

Bipolar disorder is fundamentally a disorder of emotion regulation, and associated with explicit processing biases for socially relevant emotional information in human faces. Less is known, however, about whether implicit processing of this type of emotional information directly influences social perception. We thus investigated group-related differences in the influence of unconscious emotional processing on conscious person perception judgments using a continuous flash suppression task among 22 individuals with remitted bipolar I disorder (BD; AgeM=30.82, AgeSD=7.04; 68.2% female) compared with 22 healthy adults (CTL; AgeM=20.86, AgeSD=9.91; 72.2% female). Across both groups, participants rated neutral faces as more trustworthy, warm, and competent when paired with unseen happy faces as compared to unseen angry and neutral faces; participants rated neutral faces as less trustworthy, warm, and competent when paired with unseen angry as compared to neutral faces. These findings suggest that emotion-related disturbances are not explained by early automatic processing stages, and that activity in the dorsal visual stream underlying implicit emotion processing is intact in bipolar disorder. Implications for understanding the etiology of emotion disturbance in BD are discussed.

Compression use during an exercise intervention and associated changes in breast cancer-related lymphedema.

AIM: This study assessed the association between compression use and changes in lymphedema observed in women with breast cancer-related lymphedema who completed a 12-week exercise intervention. METHODS: This work uses data collected from a 12 week exercise trial, whereby women were randomly allocated into either aerobic-based only (n = 21) or resistance-based only (n = 20) exercise. Compression use during the trial was at the participants discretion. Differences in lymphedema (measured by lymphedema index [L-Dex] score and interlimb circumference difference [%]) and associated symptoms between those who wore, and did not wear compression during the 12-week intervention were assessed. We also explored participants' reasons surrounding compression during exercise. RESULTS: No significant interaction effect between time and compression use for lymphedema was observed. There was no difference between groups over time in the number or severity of lymphedema symptoms. Irrespective of compression use, there were trends for reductions in the proportion of women reporting severe symptoms, but lymphedema status did not change. Individual reasons for the use of compression, or lack thereof, varied markedly. CONCLUSION: Our findings demonstrated an absence of a positive or negative effect from compression use during exercise on lymphedema. Current and previous findings suggest the clinical recommendation that garments must be worn during exercise is questionable, and its application requires an individualized approach.

Heart rate variability as a potential indicator of positive valence system disturbance: A proof of concept investigation.

One promising avenue toward a better understanding of the pathophysiology of positive emotional disturbances is to examine high-frequency heart rate variability (HRV-HF), which has been implicated as a potential physiological index of disturbances in positive emotional functioning. To date, only a few psychopathology relevant studies have systematically quantified HRV-HF profiles using more ecologically valid methods in everyday life. Using an experience-sampling approach, the present study examined both mean levels and intra-individual variability of HRV-HF - as well as comparison measures of cardiovascular arousal, sympathetic activity, and gross somatic movement - in everyday life, using ambulatory psychophysiological measurement across a six-day consecutive period among a spectrum of community adult participants with varying degrees of positive valence system disturbance, including adults with bipolar I disorder (BD; n=21), major depressive disorder (MDD; n=17), and healthy non-psychiatric controls (CTL; n=28). Groups did not differ in mean HRV-HF, but greater HRV-HF instability (i.e., intra-individual variation in HRV-HF) was found in the BD compared to both MDD and CTL groups. Subsequent analyses suggested that group differences in HRV-HF variability were largely accounted for by variations in clinician-rated manic symptoms. However, no association was found between HRV-HF variability and dimensional measures of positive affectivity. This work provides evidence consistent with a quadratic relationship between HRV-HF and positive emotional disturbance and represents a valuable step toward developing a more ecologically valid model of positive valence system disturbances and their underlying psychophysiological mechanisms within an RDoC framework.

California school board members' perceptions of factors influencing school nutrition policy.

Enactment and enforcement of school nutrition policies represent key components in adolescent overweight and obesity prevention. This study determined: 1) California school board members' attitudes, perceptions, and motivations related to enactment of policies that support healthy eating in schools; and 2) barriers to adopting school policies that support healthy eating. To understand board members' decision-making process, key informant interviews were conducted and a survey was administered to 404 school board members. Though school board members care about the well-being of pupils, competing priorities limit the extent to which nutrition issues get addressed at board meetings. Members' decisions center primarily around academic achievement issues, yet they are interested in nutrition's overall impact on children's health and academic achievement.

In your eyes: does theory of mind predict impaired life functioning in bipolar disorder?

BACKGROUND: Deficits in emotion perception and social functioning are strongly implicated in bipolar disorder (BD). Examining theory of mind (ToM) may provide one potential mechanism to explain observed socio-emotional impairments in this disorder. The present study prospectively investigated the relationship between theory of mind performance and life functioning in individuals diagnosed with BD compared to unipolar depression and healthy control groups. METHODS: Theory of mind (ToM) performance was examined in 26 individuals with remitted bipolar I disorder (BD), 29 individuals with remitted unipolar depression (UD), and 28 healthy controls (CTL) using a well-validated advanced theory of mind task. Accuracy and response latency scores were calculated from the task. Life functioning was measured during a 12 month follow-up session. RESULTS: No group differences for ToM accuracy emerged. However, the BD group exhibited significantly shorter response times than the UD and CTL groups. Importantly, quicker response times in the BD group predicted greater life functioning impairment at a 12-month follow-up, even after controlling for baseline symptoms. LIMITATIONS: The stimuli were static representations of emotional states and do not allow for evaluating the appropriateness of context during emotional communication; due to sample size, neither specific comorbidities nor medication effects were analyzed for the BD and UD groups; preliminary status of theory of mind as a construct. CONCLUSIONS: Results suggest that quickened socio-emotional decision making may represent a risk factor for future functional impairment in BD.

Letting go of the bad: deficit in maintaining negative, but not positive, emotion in bipolar disorder.

Bipolar disorder is a disorder of emotion regulation. Less is known, however, about the specific processes that foster the maintenance of such prolonged and intense emotions-particularly positive-over time in this disorder. We investigated group-related differences in the ability to maintain positive and negative emotion representations over time using a previously validated emotion working memory task (Mikels et al., 2005, 2008) among individuals with bipolar I disorder (BD; n = 29) compared with both major depressive disorder (MDD; n = 29) and healthy control (n = 30) groups. Results revealed that the BD group exhibited a selective deficit in maintaining negative-but not positive-emotions compared to both the MDD and the control groups. The MDD and control groups did not differ significantly. These findings suggest that the heightened magnitude and duration of positive emotion observed in BD may, in part, be accounted for by difficulties maintaining negative emotions.

What goes up can come down? A preliminary investigation of emotion reactivity and emotion recovery in bipolar disorder.

BACKGROUND: How is emotion disrupted in bipolar disorder? Two studies are presented that adopt a multi-method approach to investigate emotion reactivity and emotion recovery in bipolar I disorder. METHODS: Across both studies, individuals with inter-episode bipolar disorder and healthy controls were shown three emotion-eliciting films (neutral, happy, and sad) and experiential and physiological responses were measured. In Study 1, bipolar (BD; n=23) and non-clinical control (NC; n=24) participants' emotional reactivity during film clips was assessed. In Study 2, a separate sample of BD (n=23) and NC (n=25) participants' emotion recovery was assessed after the film clips were assessed. RESULTS: Results indicated that the BD group exhibited increased self-reported positive emotion and respiratory sinus arrhythmia across all films compared to the NC group. There were no group differences in emotion recovery. DISCUSSION: Taken together, these results suggest that bipolar disorder is associated with increased positive emotion reactivity, but not emotion recovery, across contexts.