AGO-OVAR 28/ENGOT-ov57. Niraparib alone versus niraparib in combination with bevacizumab in patients with carboplatin-taxane-based chemotherapy in advanced ovarian cancer: a multicenter randomized phase III trial.

BACKGROUND: Phase III trial data have shown a significant benefit by the addition of a maintenance treatment with niraparib, irrespective of BRCA or HRD status, in patients with advanced high-grade ovarian cancers; and, a significant benefit of the combination of olaparib and bevacizumab compared with bevacizumab monotherapy in HRD positive patients. However, it is unclear whether a PARP inhibitor monotherapy is sufficient, or if the addition of bevacizumab is needed. PRIMARY OBJECTIVES: This trial will investigate if the treatment strategy of carboplatin/paclitaxel/bevacizumab/niraparib is superior to the treatment of carboplatin/paclitaxel/niraparib in an all-comer population. STUDY HYPOTHESIS: Adding bevacizumab to chemotherapy followed by niraparib maintenance improves progression-free survival in patients with newly diagnosed advanced ovarian cancer. TRIAL DESIGN: AGO-OVAR 28/ENGOT-ov57 is an international, multicenter, randomized, prospective phase III trial within the the European Network for Gynecological Oncological Trial (ENGOT), led by the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) study group. All patients should have completed the first cycle of chemotherapy (carboplatin and paclitaxel) as part of the Study Run-In-Period. Prior to day 1 of cycle 2, patients with a valid central tumor BRCA (tBRCA) test result were randomized in a 1:1 ratio into either: Arm 1, to receive five additional cycles of carboplatin and paclitaxel q21d, followed by niraparib for up to 3 years; or Arm 2, to receive five additional cycles of carboplatin and paclitaxel plus bevacizumab q21d, followed by bevacizumab q21d (for up to 1 year), and niraparib for up to 3 years. MAJOR INCLUSION/EXCLUSION CRITERIA: The trial population is composed of adult patients with newly diagnosed, advanced high-grade epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer FIGO III/IV (except FIGO IIIA2 without nodal involvement). Patients who are scheduled for neoadjuvant chemotherapy and interval debulking surgery are also eligible for the trial. PRIMARY ENDPOINT: The primary endpoint is progression-free survival. SAMPLE SIZE: The study plans to recruit 970 patients (485 patients in each arm). ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS: The Last-Patient-In is expected to be enrolled in September 2024, with presentation of the primary endpoint in 2028. TRIAL REGISTRATION: NCT05009082; EudraCT Number: 2021-001271-16.

Assessment of the change of antiemetic prophylaxis from double to triple combination in patients with high dose carboplatin chemotherapy.

INTRODUCTION: Chemotherapy-induced nausea and vomiting (CINV) is one of the adverse events that most affects oncologic patients' quality of life. Carboplatin AUC ≥ 4 belongs to agents with high emetic risk (moderate risk in ASCO guidelines). We aimed to compare the effectiveness of netupitant/palonosetron and dexamethasone triple combination (TC) therapy versus ondansetron and dexamethasone double combination (DC) therapy as antiemetic prophylaxis in patients with carboplatin AUC ≥ 4. As a secondary endpoint, in TC group we evaluated the effectiveness of changing NEPA administration timing from 1 h to 15 min before chemotherapy. METHODS: Open-label prospective study conducted in a tertiary-care hospital in patients receiving carboplatin AUC ≥ 4. CINV was evaluated using MASCC antiemetic tool, in acute (<24 h) and delayed phase (24-120 h). Results were analyzed using χ2 test. RESULTS: Two-hundred four completed questionnaires (CQ) were analyzed (76 in DC and 128 in TC). The proportion of patients who remained emesis-free was superior for TC-treated group compared to DC, either in acute (99.2% vs 92.1%, p = 0.0115) and delayed phase (97.6% vs 90.7%, p = 0.043). Likewise, a higher proportion of TC-treated patients compared to DC remained nausea-free for the first 24 h after treatment (90.6% vs 71%, p = 0.0004) and between 24 and 120 h (82.3% vs 62.7%, p = 0.0025). The change of NEPA administration time showed similar effectiveness in terms of CINV control (81.6% vs 74.5%, p = 0.70). CONCLUSIONS: TC showed superiority in early and delayed CINV control in carboplatin AUC ≥ 4 regimens, with no significant differences among cancer types. Change in NEPA administration timing has beneficial implications; it allows NEPA to be administered at hospitals before chemotherapy session.

Rare Diseases in the Educational Field: Knowledge and Perceptions of Spanish Teachers.

BACKGROUND: Education plays a fundamental role in everyone's wellbeing. That means it is essential to provide quality inclusive activities to ensure equity and equality of opportunity in order to shape a cohesive, democratic, healthy society. METHODS: In this study we focus on how inclusive educational practice addresses students with rare diseases, looking at teachers' knowledge and opinions in this regard. A questionnaire was administered to 574 teachers who taught in various stages of non-university education to determine their knowledge and opinions about different dimensions: conceptualization, legislation, intervention, and diagnosis. RESULTS: The results suggested various ideas for improvement in pursuit of positive, real inclusion, such as the need to improve teachers' knowledge and understanding of these students' characteristics and potential, with widespread specific training being urgently needed. CONCLUSIONS: in summary, students' rights to education without discrimination is a basic premise of an educational system, leading to the need for a complete educational response that allows each student to develop as a person.

El rol de las actividades del tiempo libre en la reserva cognitiva en adultos mayores / The Role of Leisure Activities in the Cognitive Reserve of Seniors / O papel das atividades de lazer na reserva cognitiva em idosos

La participación en actividades de ocio puede prevenir el deterioro cognitivo. El objetivo del presente trabajo es analizar a través de un modelo de ecuaciones estructurales, el peso relativo que tiene la participación en actividades del tiempo libre en cuatro dominios cognitivos: memoria episódica verbal, lenguaje, funciones ejecutivas y funciones atencionales en adultos mayo-res autoválidos. Para ello, se llevó a cabo un análisis de senderos, utilizando el procedimiento de ecuaciones estructurales (sem) en 167 participantes mayores (m= 72.34 años, de= 5.07 años) independientes en actividades de la vida diaria. Todos fueron evaluados con cuestionario de datos sociodemográficos, cuestionario de participación social y una batería neuro-psicológica de pruebas de uso frecuente en el ámbito clínico para memoria, lenguaje, funciones atencionales y funciones ejecutivas. Los resultados obtenidos indican que el factor de actividades muestra efectos significativos sobre el factor de funciones ejecutivas (ß = .45, p < .001, R2 = .20), también sobre el factor de memoria (ß = .38, p < .001, R2 = .14), al igual que con el factor de lenguaje (ß = .45, p < .001, R2 = .20) y el factor funciones atencionales (ß = .44, p = .03, R2 = .20). Estos resultados concuerdan con los de otros estudios que indican que las actividades de ocio podrían desempeñaron papel diferencial e importante en la construcción de la reserva cognitiva a lo largo del ciclo de vida, conformando un posible factor de protección cognitiva en el proceso de envejecimiento

Participation in cognitively demanding leisure activities can prevent cognitive decline. The objective of the present work is to analyze through a structural equation model (sem) the relative weight that partici-pation in leisure time activities has in three cognitive domains: episodic verbal memory, language execu-tive functions, and attentional functions in self-validated seniors. A path analysis was carried out using the semin 167 elderly participants (m=72.34 years, sd=5.07 years), independent in activities of daily living. All the participants were evaluated with a sociodemographic data questionnaire, a social participation questionnaire, and a neuropsychological battery of neuropsycho-logical tests frequently used in the clinical setting for memory, language, attentional functions, and executive functions. The results obtained indicate that the activities factor shows significant effects on the executive functions factor (ß=.45, p<.001, R2=.20), also on the memory factor (ß=.38, p<.001, R2=.14), as well as on the language factor (ß=.45, p<.001, R2=.20) and the attentional functions factor (ß=.44, p=.03, R2=.20). These results coincide with those of other studies that indicate that leisure activities could play a differential and important role in the construction of cognitive reserve throughout the life cycle, forming a possible cognitive protection factor in the aging process.

A participação em atividades de lazer pode prevenir o declínio cognitivo. O objetivo do presente trabalho é analisar, por meio de um modelo de equações estruturais, o peso relativo que a participação em atividades de lazer exerce em quatro domínios cognitivos: memória verbal episódica, linguagem, funções executivas e funções atencionais em idosos autovalidados. Foi realizada uma análise de trilha por meio do procedimento de equações estruturais (sem) em 167 idosos (m= 72.34 anos, dp = 5.07 anos), independentes nas atividades de vida diária. Todos os participantes foram avaliados com: questionário de dados sociodemográficos, questionário de participação social e uma bateria neurop-sicológica de testes neuropsicológicos frequentemente utilizados em âmbito clínico para: memória, linguagem, funções atencionais e funções executivas. Os resultados obtidos indicam que o fator atividade apresenta efeitos significativos sobre o fator funções executivas (ß = 0.45, p < 0.001, R2 = 0.20), também sobre o fator memória (ß = 0.38, p < 0.001, R2 = 0.14), assim como no fator linguagem (ß = 0.45, p < 0.001, R2 = 0.20) e sobre o fator funções atencionais (ß = 0.44, p < 0.03, R2 = 0.20). Estes resultados são corroborados por outros estudos que indicam que as atividades de lazer podem desempenhar um papel diferencial e importante na construção da reserva cognitiva ao longo do ciclo vital, constituindo um possível fator de proteção cognitiva no processo de envelhecimento.

Limitations of molecular and antigen test performance for SARS-CoV-2 in symptomatic and asymptomatic COVID-19 contacts.

OBJECTIVES: COVID-19 has brought unprecedented attention to the crucial role of diagnostics in pandemic control. We compared SARS-CoV-2 test performance by sample type and modality in close contacts of SARS-CoV-2 cases. METHODS: Close contacts of SARS-CoV-2 positive individuals were enrolled after informed consent. Clinician-collected nasopharyngeal (NP) swabs in viral transport media (VTM) were tested with a nucleic acid test (NAT). NP VTM and self-collected passive drool were tested using the PerkinElmer real-time reverse transcription PCR (RT-PCR) assay. For the first 4 months of study, mid-turbinate swabs were tested using the BD Veritor rapid antigen test. NAT positive NP samples were tested for infectivity using a VeroE6TMPRSS2 cell culture model. RESULTS: Between November 17, 2020, and October 1, 2021, 235 close contacts of SARS-CoV-2 cases were recruited, including 95 with symptoms (82% symptomatic for < 5 days) and 140 asymptomatic individuals. NP swab reference tests were positive for 53 (22.6%) participants; 24/50 (48%) were culture positive. PerkinElmer testing of NP and saliva samples identified an additional 28 (11.9%) SARS-CoV-2 cases who tested negative by clinical NAT. Antigen tests performed for 99 close contacts showed 83% positive percent agreement (PPA) with reference NAT among early symptomatic persons, but 18% PPA in others; antigen tests in 8 of 11 (72.7%) culture-positive participants were positive. CONCLUSIONS: Contacts of SARS-CoV-2 cases may be falsely negative early after contact, which more sensitive platforms may identify. Repeat or serial SARS-CoV-2 testing with both antigen and molecular assays may be warranted for individuals with high pretest probability for infection.

Estimation of cognitive reserve and its impact on cognitive performance in older adults.

OBJECTIVES: Cognitive reserve provides evidence in the search for answers regarding the role that lifestyle has in the protection of cognition in old age. Through a structural equations model, different things were analyzed: the relative weight of education, occupational complexity, free time activities and the intelligence quotient in cognitive reserve; and its impact on three cognitive domains: memory, language and executive functions. DESIGN: A trail analysis was executed, using structural equations procedure. PARTICIPANTS: 167 older participants (mean = 76.74 years, standard deviation = 6.8 years). MEASUREMENTS: Participants were assessed with: Sociodemographic Questionnaire, Occupational Activity Agency Questionnaire, Social Participation Questionnaire and Neuropsychological Evaluation Battery for: memory, language and executive functions. RESULTS: The cognitive reserve factor is well represented by the measures included, with values ​​between .43 and .86, and shows a direct effect on language (ß = .52, p < .001), executive functions (ß = .77, p <.001), and memory (ß = .36, p = .003). CONCLUSIONS: In conclusion, lifestyle factors, such as education, occupational complexity, leisure time activities and intelligence quotient have an impact on the conformation of cognitive reserve and performance in some psychological processes.

Combining collective and artificial intelligence for global health diseases diagnosis using crowdsourced annotated medical images.

Visual inspection of microscopic samples is still the gold standard diagnostic methodology for many global health diseases. Soil-transmitted helminth infection affects 1.5 billion people worldwide, and is the most prevalent disease among the Neglected Tropical Diseases. It is diagnosed by manual examination of stool samples by microscopy, which is a time-consuming task and requires trained personnel and high specialization. Artificial intelligence could automate this task making the diagnosis more accessible. Still, it needs a large amount of annotated training data coming from experts.In this work, we proposed the use of crowdsourced annotated medical images to train AI models (neural networks) for the detection of soil-transmitted helminthiasis in microscopy images from stool samples leveraging non-expert knowledge collected through playing a video game. We collected annotations made by both school-age children and adults, and we showed that, although the quality of crowdsourced annotations made by school-age children are sightly inferior than the ones made by adults, AI models trained on these crowdsourced annotations perform similarly (AUC of 0.928 and 0.939 respectively), and reach similar performance to the AI model trained on expert annotations (AUC of 0.932). We also showed the impact of the training sample size and continuous training on the performance of the AI models.In conclusion, the workflow proposed in this work combined collective and artificial intelligence for detecting soil-transmitted helminthiasis. Embedded within a digital health platform can be applied to any other medical image analysis task and contribute to reduce the burden of disease.

Synthetic Lethal Interactions for Kinase Deficiencies to DNA Damage Chemotherapeutics.

Kinases are signaling enzymes that regulate diverse cellular processes. As such, they are frequently mutated in cancer and therefore represent important targets for drug discovery. However, until recently, systematic approaches to identify vulnerabilities and resistances of kinases to DNA-damaging chemotherapeutics have not been possible, partially due to the lack of appropriate technologies. With the advent of CRISPR-Cas9, a comprehensive study has investigated the cellular survival of more than 300 kinase-deficient isogenic cell lines to a diverse panel of DNA-damaging agents, enriched for chemotherapeutics. Here, we discuss how this approach has allowed for the rational development of combination therapies that are aimed at using synthetic lethal interactions between kinase deficiencies and DNA-damaging agents that are used as chemotherapeutics.

Efficacy and safety results from GEICO 1205, a randomized phase II trial of neoadjuvant chemotherapy with or without bevacizumab for advanced epithelial ovarian cancer.

BACKGROUND: Bevacizumab is an approved treatment after primary debulking surgery for ovarian cancer. However, there is limited information on bevacizumab added to neoadjuvant chemotherapy before interval debulking surgery. OBJECTIVE: To evaluate neoadjuvant bevacizumab in a randomized phase II trial. METHODS: Patients with newly diagnosed stage III/IV high-grade serous/endometrioid ovarian cancer were randomized to receive four cycles of neoadjuvant chemotherapy with or without ≥3 cycles of bevacizumab 15 mg/kg every 3 weeks. After interval debulking surgery, all patients received post-operative chemotherapy (three cycles) and bevacizumab for 15 months. The primary end point was complete macroscopic response rate at interval debulking surgery. RESULTS: Of 68 patients randomized, 64 completed four neoadjuvant cycles; 22 of 33 (67%) in the chemotherapy-alone arm and 31 of 35 (89%) in the bevacizumab arm (p=0.029) underwent surgery. The complete macroscopic response rate did not differ between treatment arms in either the intention-to-treat population of 68 patients (6.1% vs 5.7%, respectively; p=0.25) or the 55 patients who underwent surgery (8.3% vs 6.5%; p=1.00). There was no difference in complete cytoreduction rate or progression-free survival between the treatment arms. During neoadjuvant therapy, grade ≥3 adverse events were more common with chemotherapy alone than with bevacizumab (61% vs 29%, respectively; p=0.008). Intestinal (sub)occlusion, fatigue/asthenia, abdominal infection, and thrombocytopenia were less frequent with bevacizumab. The incidence of grade ≥3 adverse events was 9% in the control arm versus 16% in the experimental arm in the month after surgery. CONCLUSIONS: Adding three to four pre-operative cycles of bevacizumab to neoadjuvant chemotherapy for unresectable disease did not improve the complete macroscopic response rate or surgical outcome, but improved surgical operability without increasing toxicity. These results support the early integration of bevacizumab in carefully selected high-risk patients requiring neoadjuvant chemotherapy for initially unresectable ovarian cancer.

[Muscle in critically ill patients]. / Papel del músculo en el paciente crítico.

INTRODUCTION: Polyneuropathy in the critically ill patient was defined as a generalized weakness, acquired during Intensive Care Unit (ICU) admittance and attributed to lesion of the peripheral nerve. Research in this field progressed over time, revealing the crucial role of muscle injury in this disease, to the point of re-naming the disorder as ICU adquired weakness (ICUAW). Muscle damage is common in severe illness, and may be classified in qualitative (weakness) or quantitative (decrease in mass) muscle loss. The most frequent scenario in these patients, is simultaneous change in quality and quantity of muscle; resulting in a challenging and delayed recovery during hospital admittance and after discharge. Multiple causes have been identified in the pathogenesis of this disorder, such as: prolonged bed rest, inadequate intake of nutrients and exposure to drugs that affect muscle structure and contraction. The assessment of muscle mass using images provided by ultrasound or computerized tomography may guide follow up. The prevention and treatment of ICUAW requires a multimodal approach: early mobilization and exercise, appropriate nutritional prescription and, occasionally, muscle protein synthesis stimulants. Further studies will clarify more aspects regarding critically ill patients suffering from muscle injury, in order to better address prevention and treatment of ICUAW.

INTRODUCCIÓN: La "polineuropatía del paciente crítico", un cuadro que cursa con debilidad generalizada durante la estancia de los pacientes en la UCI, fue inicialmente atribuida a una afectación de los nervios periféricos. No obstante, a medida que ha progresado la investigación en este campo ha podido describirse el papel fundamental de la alteración muscular en este cuadro de "debilidad muscular adquirida en la UCI" (DMA-UCI). La afectación muscular es frecuente en pacientes críticos. Puede ser cualitativa (debilidad muscular), cuantitativa (disminución de la masa muscular) o, con frecuencia, de ambos tipos. Los efectos de la afectación muscular comprometen la recuperación de los pacientes tanto en la UCI como en el hospital y se extienden hasta después del alta hospitalaria durante un periodo que puede ser prolongado. El origen de la alteración muscular suele ser multifactorial, estando implicados factores como el reposo prolongado, la inadecuada ingesta de nutrientes o la exposición a fármacos que pueden afectar a la estructura muscular y a la función contráctil. La valoración de la masa muscular mediante técnicas de imagen como la ecografía o la tomografía computarizada puede servir de ayuda para el seguimiento de los pacientes. La prevención y el tratamiento de la DMA-UCI requiere un abordaje multimodal recurriendo al empleo de movilización y ejercicio precoces, tratamiento nutricional adecuado y, ocasionalmente, fármacos con efecto estimulante sobre la síntesis proteica muscular. Estudios en marcha permitirán una mejor definición de las alteraciones musculares durante la enfermedad crítica y la mejor forma de abordar su prevención y tratamiento.

Papel del músculo en el paciente crítico / Muscle in critically ill patients

La "polineuropatía del paciente crítico", un cuadro que cursa con debilidad generalizada durante la estancia de los pacientes en la UCI, fue inicialmente atribuida a una afectación de los nervios periféricos. No obstante, a medida que ha progresado la investigación en este campo ha podido describirse el papel fundamental de la alteración muscular en este cuadro de "debilidad muscular adquirida en la UCI" (DMA-UCI). La afectación muscular es frecuente en pacientes críticos. Puede ser cualitativa (debilidad muscular), cuantitativa (disminución de la masa muscular) o, con frecuencia, de ambos tipos. Los efectos de la afectación muscular comprometen la recuperación de los pacientes tanto en la UCI como en el hospital y se extienden hasta después del alta hospitalaria durante un periodo que puede ser prolongado. El origen de la alteración muscular suele ser multifactorial, estando implicados factores como el reposo prolongado, la inadecuada ingesta de nutrientes o la exposición a fármacos que pueden afectar a la estructura muscular y a la función contráctil. La valoración de la masa muscular mediante técnicas de imagen como la ecografía o la tomografía computarizada puede servir de ayuda para el seguimiento de los pacientes. La prevención y el tratamiento de la DMA-UCI requiere un abordaje multimodal recurriendo al empleo de movilización y ejercicio precoces, tratamiento nutricional adecuado y, ocasionalmente, fármacos con efecto estimulante sobre la síntesis proteica muscular. Estudios en marcha permitirán una mejor definición de las alteraciones musculares durante la enfermedad crítica y la mejor forma de abordar su prevención y tratamiento

Polyneuropathy in the critically ill patient was defined as a generalized weakness, acquired during Intensive Care Unit (ICU) admittance and attributed to lesion of the peripheral nerve. Research in this field progressed over time, revealing the crucial role of muscle injury in this disease, to the point of re-naming the disorder as ICU adquired weakness (ICUAW). Muscle damage is common in severe illness, and may be classified in qualitative (weakness) or quantitative (decrease in mass) muscle loss. The most frequent scenario in these patients, is simultaneous change in quality and quantity of muscle; resulting in a challenging and delayed recovery during hospital admittance and after discharge. Multiple causes have been identified in the pathogenesis of this disorder, such as: prolonged bed rest, inadequate intake of nutrients and exposure to drugs that affect muscle structure and contraction. The assessment of muscle mass using images provided by ultrasound or computerized tomography may guide follow up. The prevention and treatment of ICUAW requires a multimodal approach: early mobilization and exercise, appropriate nutritional prescription and, occasionally, muscle protein synthesis stimulants. Further studies will clarify more aspects regarding critically ill patients suffering from muscle injury, in order to better address prevention and treatment of ICUAW

Map of synthetic rescue interactions for the Fanconi anemia DNA repair pathway identifies USP48.

Defects in DNA repair can cause various genetic diseases with severe pathological phenotypes. Fanconi anemia (FA) is a rare disease characterized by bone marrow failure, developmental abnormalities, and increased cancer risk that is caused by defective repair of DNA interstrand crosslinks (ICLs). Here, we identify the deubiquitylating enzyme USP48 as synthetic viable for FA-gene deficiencies by performing genome-wide loss-of-function screens across a panel of human haploid isogenic FA-defective cells (FANCA, FANCC, FANCG, FANCI, FANCD2). Thus, as compared to FA-defective cells alone, FA-deficient cells additionally lacking USP48 are less sensitive to genotoxic stress induced by ICL agents and display enhanced, BRCA1-dependent, clearance of DNA damage. Consequently, USP48 inactivation reduces chromosomal instability of FA-defective cells. Our results highlight a role for USP48 in controlling DNA repair and suggest it as a potential target that could be therapeutically exploited for FA.

Parallel genome-wide screens identify synthetic viable interactions between the BLM helicase complex and Fanconi anemia.

Maintenance of genome integrity via repair of DNA damage is a key biological process required to suppress diseases, including Fanconi anemia (FA). We generated loss-of-function human haploid cells for FA complementation group C (FANCC), a gene encoding a component of the FA core complex, and used genome-wide CRISPR libraries as well as insertional mutagenesis to identify synthetic viable (genetic suppressor) interactions for FA. Here we show that loss of the BLM helicase complex suppresses FANCC phenotypes and we confirm this interaction in cells deficient for FA complementation group I and D2 (FANCI and FANCD2) that function as part of the FA I-D2 complex, indicating that this interaction is not limited to the FA core complex, hence demonstrating that systematic genome-wide screening approaches can be used to reveal genetic viable interactions for DNA repair defects.

Monitoring of carbon monoxide in residences with bulk wood pellet storage in the Northeast United States.

The interest in biomass fuel is continuing to expand globally and in the northeastern United States as wood pellets are becoming a primary source of fuel for residential and small commercial systems. Wood pellets for boilers are often stored in basement storage rooms or large bag-type containers. Due to the enclosed nature of these storage areas, the atmosphere may exhibit increased levels of carbon monoxide. Serious accidents in Europe have been reported over the last decade in which high concentrations of carbon monoxide (CO) have been found in or near bulk pellet storage containers. The aim of this study was to characterize the CO concentrations in areas with indoor storage of bulk wood pellets. Data was obtained over approximately 7 months (December 2013 to June 2014) at 25 sites in New Hampshire and Massachusetts: 16 homes using wood pellet boilers with indoor pellet storage containers greater than or equal to 3 ton capacity; 4 homes with wood pellet heating systems with outdoor pellet storage; 4 homes using other heating fuels; and a university laboratory site. CO monitors were set up in homes to collect concentrations of CO in the immediate vicinity of wood pellet storage containers, and data were then compared to those of homes using fossil fuel systems. The homes monitored in this study provided a diverse set of housing stock spanning two and a half centuries of construction, with homes built from 1774 to 2013, representing a range of air exchange rates. The CO concentration data from each home was averaged hourly and then compared to a threshold of 9 ppm. While concentrations of CO were generally low for the homes studied, the need to properly design storage locations for pellets is and will remain a necessary component of wood pellet heating systems to minimize the risk of CO exposure. IMPLICATIONS: This paper is an assessment of carbon monoxide (CO) exposure from bulk wood pellet storage in homes in New Hampshire and Massachusetts. Understanding the CO concentrations in homes allows for better designs for storage bins and ventilation for storage areas. Hence, uniform policies for stored wood pellets in homes, schools, and businesses can be framed to ensure occupant safety. Currently in New York State rebates for the installation of wood pellet boilers are only provided if the bulk pellet storage is outside of the home, yet states such as New Hampshire, Vermont, and Maine currently do not have these restrictions.

Factors in Placement and Enrollment of Primary Care Patients in YMCA's Diabetes Prevention Program, Bronx, New York, 2010-2015.

INTRODUCTION: The reach of the New York State YMCA's Diabetes Prevention Program (DPP) to at-risk populations may be increased through integration with primary care settings. Although considerable effort has been made in the referral and retention of patients, little is known about the factors associated with the placement of potential participants into YMCA's DPP. METHODS: Among Montefiore Health System (MHS) patients referred to YMCA's DPP (n = 1,249) from July 10, 2010, through November 11, 2015, we identified demographic factors (eg, age, preferred language) and primary care practice-level factors (eg, time between referral and start of session, session season) associated with placement into a session and subsequent drop-out. We also evaluated factors associated with weight loss. RESULTS: Patients were predominantly female (71%) and aged 45 years or older (71%). Patients preferring sessions in Spanish were less often placed in sessions. Patients aged 18 to 44 years were less often placed (P = .01) and enrolled (P = .001) than patients aged 60 years or older. Sessions conducted in the summer and spring had higher enrollment than fall and winter months. Patients who started the YMCA's DPP within 2 months of their referral date were more often enrolled (54.4%) than patients who waited 4 or more months (21.6%) to start their sessions. Patients aged 45 to 59 years lost marginally less weight than those aged 60 years or older (-3.1% vs -3.8%; P = .07). CONCLUSION: Although this evaluation gives some insight into the barriers to placement and enrollment in YMCA's DPP, challenges remain. Efforts are under way to increase referral of patients to community-based DPPs.

Mechanisms of change in self-care in adults with heart failure receiving a tailored, motivational interviewing intervention.

Self-care is challenging but we previously demonstrated that motivational interviewing (MI) was effective in improving heart failure (HF) self-care. OBJECTIVE: To identify the mechanisms of intervention effectiveness by elucidating the MI techniques used and the relationship between the techniques and changes in self-care. METHODS: Audiotaped sessions (first and subsequent sessions) from 8 participants were transcribed verbatim and coded to evaluate changes in self-care. Using a sequential mixed method design, quantitative and qualitative self-care data were triangulated; congruence was 97%. The MI techniques used and mechanisms of intervention effectiveness were identified from the qualitative data. RESULTS: Three MI techniques used were related to improved self-care: 1) reflection and reframing, 2) genuine empathy, affirmation, and humor, and 2) individualized problem solving. These techniques stimulated openness to goal setting, positive self-talk, perceived ability to overcome barriers, and change talk. The mechanisms by which the techniques achieved the desired outcomes were the development of discrepancy and self-efficacy, which are consistent with the principles of MI. CONCLUSION: This study contributes to clarifying the mechanism by which MI facilitates behavioral change. PRACTICE IMPLICATIONS: Using MI to discuss self-care can help to overcome barriers and engage HF patients in goal setting for behavior change.

A Comparison of Water-Related Perceptions and Practices Among West Texas and South New Mexico Colonia Residents Using Hauled-Stored and Private Well Water.

In Texas, Arizona, and New Mexico, colonias refer to unincorporated rural settlements along the U.S.­Mexico border. Colonias lack governance and public services normally provided by local government (Ward, 1999). Residents typically rely on well water or hauled water stored in above-ground containers. This study attempted to quantify and compare water-related perceptions and practices of colonia residents. No significant differences were observed between colonia residents using well water versus hauled-stored water for water quality perceptions and water use practices. Most, however, had negative perceptions of their water supply; a majority perceived daily water supplies as not potable. Significant paradoxical discrepancies between perceptions and practice were identified. This study adds to a small but growing literature on subjective dimensions of quality of life indicators for colonia residents. Additional studies are needed to quantify the type and level of health risks posed by compromised water supplies for this vulnerable population. Understanding differences in perceptions and practices associated with water sources could help to identify which subpopulations of colonia residents are in greatest need of water infrastructure or remediation.

VOCs Emissions from Multiple Wood Pellet Types and Concentrations in Indoor Air.

Wood pellet storage safety is an important aspect for implementing woody biomass as a renewable energy source. When wood pellets are stored indoors in large quantities (tons) in poorly ventilated spaces in buildings, such as in basements, off-gassing of volatile organic compounds (VOCs) can significantly affect indoor air quality. To determine the emission rates and potential impact of VOC emissions, a series of laboratory and field measurements were conducted using softwood, hardwood, and blended wood pellets manufactured in New York. Evacuated canisters were used to collect air samples from the headspace of drums containing pellets and then in basements and pellet storage areas of homes and small businesses. Multiple peaks were identified during GC/MS and GC/FID analysis, and four primary VOCs were characterized and quantified: methanol, pentane, pentanal, and hexanal. Laboratory results show that total VOCs (TVOCs) concentrations for softwood (SW) were statistically (p < 0.02) higher than blended or hardwood (HW) (SW: 412 ± 25; blended: 203 ± 4; HW: 99 ± 8, ppb). The emission rate from HW was the fastest, followed by blended and SW, respectively. Emissions rates were found to range from 10-1 to 10-5 units, depending upon environmental factors. Field measurements resulted in airborne concentrations ranging from 67 ± 8 to 5000 ± 3000 ppb of TVOCs and 12 to 1500 ppb of aldehydes, with higher concentrations found in a basement with a large fabric bag storage unit after fresh pellet delivery and lower concentrations for aged pellets. These results suggest that large fabric bag storage units resulted in a substantial release of VOCs into the building air. Occupants of the buildings tested discussed concerns about odor and sensory irritation when new pellets were delivered. The sensory response was likely due to the aldehydes.

Professional development through policy advocacy: communicating and advocating for health and health equity.

Communicating and advocating for evidence-based public health policy is a key component of health promotion practice, but public health professionals often lack experience in policy advocacy. This article provides perspectives from public health professionals who participated in successful public health policy advocacy efforts in their community. Their experiences using evidence-based research to advocate for policies that promote health equity contributed significantly to their career development, and also contributed to community capacity to reduce tobacco-related disparities. This article builds on previous work emphasizing the value of career development opportunities that enhance and diversify the public health workforce, and provides practical tips and "lessons learned" that are relevant to a wide range of public health professionals.

Tratamiento de la alveolitis dental con tintura de propóleos al 5 por ciento / Treatment of dental alveolitis with 5 por ciento propolis tincture

Objetivo: comparar la efectividad entre el tratamiento con tintura de propóleos al 5 por ciento y el tratamiento farmacológico convencional en pacientes diagnosticados con alveolitis dental. Métodos: se realizó un estudio descriptivo, prospectivo, de corte longitudinal de casos y controles en la Clínica Estomatológica José Martí del municipio Consolación del Sur, durante el 2009. El universo estuvo constituido por 90 pacientes, los cuales se dividieron en dos grupos de tratamiento diferentes de manera aleatoria, teniendo en cuenta un grupo de casos (grupo I) conformado por 30 pacientes a los que se les aplicó tratamiento con tintura de propóleos al 5 por ciento, y otro grupo de controles (grupo II) con 60 pacientes tratados con la terapéutica medicamentosa convencional. Para el procesamiento de los datos se utilizaron métodos de estadística descriptiva e inferencial. Resultados: en ambos grupos de tratamiento prevaleció el sexo femenino y hubo un predominio de la alveolitis en el grupo de edad entre los 46 y 60 años. El grupo I logró la remisión de los síntomas entre el segundo (36,6 por ciento) y el tercer días de tratamiento (60 por ciento) y solo un paciente requirió tratamiento por 5 días; mientras el grupo II requirió de un mayor período para la evolución del cuadro, entre 5 y 7 días de tratamiento para un 61,3 por ciento (27 pacientes) y 23,3 por ciento (14 pacientes). Conclusiones: el tratamiento con tintura de propóleos al 5 por ciento resultó altamente efectivo, pues aportó una remisión más notoria de los síntomas, ya que se observó una disminución de estos, así como la disminución del número de sesiones necesarias, lo que permite recomendarlo como una opción terapéutica adecuada.

Objective: to compare the effectiveness of 5 percent propolis tincture and of the conventional pharmacological treatment in patients diagnosed with dental alveolitis. Methods: a longitudinal, descriptive and prospective case-control study was carried out in Jose Martí dental clinic located in Consolación del Sur municipality, Pinar del Río province in 2009. The universe of study was 90 patients who were divided into two groups randomly and differently treated, that is, one group of cases (group 1) made up of 30 patients who were treated with 5 percent propolis tincture and the other of controls with 60 patients (group II) that followed conventional drug therapy The data processing was based on summary and inference statistics Results: Females prevailed in both groups and dental alveolitis was predominant in 46-60 y age group. The Group I exhibited remission of symptoms after the second(36.6 percent) and the third day (60 percent) of treatment and just one patient required treatment for 5 days, whereas Group II needed a longer treatment, from 5 to 7 days for 61,3 percent(27 patients) and 23,3 percent (14 patients) respectively. Conclusions: the 5 percent propolis tincture treatment proved to be highly effective since it attained remarkable remission of symptoms as well as the reduction of the number of therapeutic sessions required, all of which supports the recommendation of this product as an adequate therapeutic alternative