Prediction of MET Overexpression in Lung Adenocarcinoma from Hematoxylin and Eosin Images.

Mesenchymal epithelial transition (MET) protein overexpression is a targetable event in non-small cell lung cancer and is the subject of active drug development. Challenges in identifying patients for these therapies include lack of access to validated testing, such as standardized immunohistochemistry assessment, and consumption of valuable tissue for a single gene/protein assay. Development of prescreening algorithms using routinely available digitized hematoxylin and eosin (H&E)-stained slides to predict MET overexpression could promote testing for those who will benefit most. Recent literature reports a positive correlation between MET protein overexpression and RNA expression. In this work, a large database of matched H&E slides and RNA expression data were leveraged to train a weakly supervised model to predict MET RNA overexpression directly from H&E images. This model was evaluated on an independent holdout test set of 300 overexpressed and 289 normal patients, demonstrating a receiver operating characteristic area under curve of 0.70 (95th percentile interval: 0.66 to 0.74) with stable performance characteristics across different patient clinical variables and robust to synthetic noise on the test set. These results suggest that H&E-based predictive models could be useful to prioritize patients for confirmatory testing of MET protein or MET gene expression status.

Colorectal cancer screening in high-risk groups is increasing, although current smokers fall behind.

BACKGROUND: There is limited information about colorectal cancer (CRC) screening trends in high-risk groups, including the black, obese, diabetic, and smoking populations. For this study, the authors evaluated national CRC screening trends in these high-risk groups to provide insights into whether screening resources are being appropriately used. METHODS: This was a nationally representative, population-based study using the Behavioral Risk Factor Surveillance System from the Centers for Disease Control. Data analysis was performed using bivariate analyses with weighted logistic regression. RESULTS: In the general population, CRC screening increased significantly from 59% to 65% during the years 2006 to 2010. The screening prevalence in non-Hispanic blacks was 58% in 2006 and 65% in 2010. Among obese individuals, the prevalence of up-to-date CRC screening increased significantly from 59% in 2006 to 66% in 2010. Screening prevalence in individuals with diabetes was 63% in 2006 and 69% in 2010. The CRC screening prevalence in current smokers was 45% in 2006 and 50% in 2010. The odds of CRC screening in the non-Hispanic black population, the obese population, and the diabetic population were higher than in non-Hispanic whites, normal weight individuals, and the population without diabetes, respectively. Current smokers had significantly lower odds of CRC screening than never-smokers in the years studied (2006: odds ratio [OR], 0.71; 95% confidence interval [CI], 0.66-0.76; 2008: OR, 0.67; 95% CI, 0.63-0.71; 2010: OR, 0.69; 95% CI, 0.66-0.73). CONCLUSIONS: The prevalence of CRC screening in high-risk groups is trending upward. Despite this, current smokers have significantly lower odds of CRC screening compared with the general population.

The Cadet Athlete Physical Training Intervention (CAPTI): A 16-week Periodized Program to Remediate Underdeveloped Tactical Athletes at a Senior Military College.

Approximately half of military recruits fail the Army Physical Fitness Test (APFT), and 70% of all injuries in the US military are musculoskeletal in nature. The purpose of this study was to investigate whether underdeveloped musculoskeletal and cardiovascular fitness levels and subsequent APFT scores of senior military college cadets could be improved by a novel, evidence-based Cadet Athlete Physical Training Intervention (CAPTI) compared to the current Remedial Physical Training program (RPT). Cadets failing the APFT (total score < 180, or < 60 in scored sit-ups, pushups or run time, respectively) participated in a 16-week remedial training program including either CAPTI (periodized full body calisthenic and varied-technique cardiovascular training, along with mobility training and mental health and wellbeing sessions), or a traditional, event-specific remedial training program (RPT). CAPTI was randomly assigned to one of three battalions, while the others received RPT. One hundred and thirty-eight cadets (n = 70 CAPTI, n = 68 RPT) participated in the study. After training, 82.9% (n = 58) of CAPTI passed the APFT compared to 27.9% (n = 19) of RPT. Paired t-tests demonstrated significant improvement (p < 0.01) for CAPTI in total APFT scores (42 ± 31.5 points), sit-ups (13.8 ± 9.4) pushups (6.5 ± 11) and run time (83 ± 123s). In RPT, significant improvements (p < 0.01) were noted in total APFT scores (16 ± 27.8), sit-ups (3.3 ± 6.7) pushups (3.69 ± 8.0) and run time (43 ± 127s). Between-group analyses demonstrated CAPTI had significantly higher improvements compared to RPT in APFT total score (p < 0.01) and sit-ups (p < 0.01). Higher perceived program enjoyment was also demonstrated for CAPTI when compared to RPT (P < 0.01). The CAPTI program could help address the military's physical readiness and musculoskeletal injury problem by incorporating evidence-based, wellness-focused, periodized training as part of a remedial physical training model.

Psychological correlates of physical activity among adults living in rural and urban settings.

Middle-aged and older adults living in rural settings have been consistently less likely to report regular physical activity (PA) than those living in urban settings. While past literature has identified sociodemographic and environmental correlates of PA that may contribute to these differences, consideration of psychological correlates has been limited. A total of 95 rural and urban adults ≥50 years old provided self-reported sociodemographic information, PA level, and psychological correlates of PA including measures assessing motivation, self-efficacy, social support, and attitudes related to PA. The average participant age was 68.6 years, and most were female (62.1%) and married (70.5%). While PA level did not differ significantly between the rural and urban groups, different psychological correlates contributed significantly to separate rural and urban linear regression models considering PA status. Among rural adults, more positive attitudes toward PA, and greater PA self-efficacy and social support were associated with greater amounts of PA while for urban adults, no psychological correlates were significantly associated with PA. Psychosocial factors may be key considerations in developing more effective PA interventions in middle-aged and older adults living in rural areas.

Do 'mind over muscle' strategies work? Examining the effects of attentional association and dissociation on exertional, affective and physiological responses to exercise.

Despite the well established physical and psychological benefits derived from leading a physically active life, rates of sedentary behaviour remain high. Dropout and non-compliance are major contributors to the problem of physical inactivity. Perceptions of exertion, affective responses (e.g. displeasure or discomfort), and physiological stress could make the exercise experience aversive, particularly for beginners. Shifting one's attentional focus towards environmental stimuli (dissociation) instead of one's body (association) has been theorized to enhance psychological responses and attenuate physiological stress. Research evidence on the effectiveness of attentional focus strategies, however, has been perplexing, covering the entire gamut of possible outcomes (association and dissociation having been shown to be both effective and ineffective). This article examines the effects of manipulations of attentional focus on exertional and affective responses, as well as on exercise economy and tolerance. The possible roles of the characteristics of the exercise stimulus (intensity, duration) and the exercise participants, methodological issues, and limitations of experimental designs are discussed. In particular, the critical role of exercise intensity is emphasized. Dissociative strategies may be more effective in reducing perceptions of exertion and enhancing affective responses at low to moderate exercise intensities, but their effectiveness may be diminished at higher and near-maximal levels, at which physiological cues dominate. Conversely, associative strategies could enable the exerciser to regulate intensity to avoid injury or overexertion. Thus, depending on intensity, both strategies have a place in the 'toolbox' of the public health or exercise practitioner as methods of enhancing the exercise experience and promoting long-term compliance.

Transformational and transactional leadership and exercise-related self-efficacy: an exploratory study.

The purpose of this study was to examine the relationships between transformational and transactional leadership behaviors and the self-efficacy ofparticipants involved in a structured 10-week exercise program. Three weeksinto their exercise classes 174 females (M age = 25.36 years, SD = 8.48) provided ratings of their exercise instructor's leadership behaviors as well as their personal efficacy related to scheduling, over-coming barriers and within-class capabilities. Results revealed that for exercise initiates, contingent rewards behaviors were able to explain unique variation in scheduling self-efficacy and barrier self-efficacy, but not within-class self-efficacy. For experienced exercisers, none of the leadership behaviors assessed in this study were associated with participant self-efficacy.

Independent of Cirrhosis, Hepatocellular Carcinoma Risk Is Increased with Diabetes and Metabolic Syndrome.

BACKGROUND: Hepatocellular carcinoma is the most common primary liver malignancy, commonly a sequelae of hepatitis C infection, but can complicate cirrhosis of any cause. Whether metabolic syndrome and its components, type II diabetes, hypertension, and hyperlipidemia increase the risk of hepatocellular carcinoma independent of cirrhosis is unknown. METHODS: A retrospective cohort study was conducted using the MarketScan insurance claims database from 2008-2012. Individuals with hepatocellular carcinoma aged 19-64 years and age and sex-matched controls were included. Multivariate analysis of hepatocellular carcinoma risk factors was performed. RESULTS: Hepatitis C (odds ratio [OR] 2.102) was the largest risk factor for hepatocellular carcinoma. Other independent risk factors were type II diabetes (OR 1.353) and hypertension (OR 1.229). Hyperlipidemia was protective against hepatocellular carcinoma (OR 0.885). The largest risk increase occurred with hypertension with type II diabetes and hepatitis C (OR 4.580), although hypertension and type II diabetes without hepatitis C still incurred additional risk (OR 3.399). Type II diabetes and hyperlipidemia had a similar risk if hepatitis C was present (OR 2.319) or not (OR 2.395). Metformin (OR 0.706) and cholesterol medications (OR 0.645) were protective in diabetics. Insulin (OR 1.640) increased the risk of hepatocellular carcinoma compared with the general type II diabetes population. CONCLUSION: In the absence of cirrhosis, type II diabetes and hypertension were independent risk factors for hepatocellular carcinoma. Hyperlipidemia and medical management of type II diabetes with metformin and cholesterol medication appeared to reduce the incidence of hepatocellular carcinoma. In contrast, insulin was associated with a higher risk of hepatocellular carcinoma.

Walking versus biofeedback: a comparison of acute interventions for stressed students.

BACKGROUND: High rates of stress-related problems in college students and low utilization of treatment options demonstrate the need for effective stress-reducing interventions that can be self-regulated. This study compared the effect of brief paced-breathing with biofeedback and exercise interventions on heart rate variability, state anxiety and affect. METHODS: Students (n = 32) with high levels of perceived stress completed three 10-min interventions on separate days: paced-breathing with biofeedback (Biofeedback), a self-paced walk (Exercise), and an attention control condition of quiet studying (Quiet Study). Anxiety and affect were measured before (Pre), immediately after (Post0) and 15 mins after (Post15) the intervention. Heart rate variability was measured pre- and post-intervention using electrocardiogram. RESULTS: Biofeedback reduced anxiety more than the exercise condition (Pre to Post0: Biofeedback d = -0.48, Exercise d = -0.13). Secondly, Exercise temporarily increased energy (Pre to Post0: d = 0.67), whereas Biofeedback temporarily increased calmness (Pre to Post0: d = 0.51). All conditions significantly increased total heart rate variability (p < .05). CONCLUSIONS: Biofeedback and Exercise interventions improved emotional states in high-stress college students, but the type of change observed (i.e. energizing, calming or anxiety reducing) depended upon the condition.

Web-Based Behavioral Intervention Increases Maternal Exercise but Does Not Prevent Excessive Gestational Weight Gain in Previously Sedentary Women.

BACKGROUND: Innovative methods are warranted to optimize prenatal outcomes. This study's objective was to determine if a web-based behavioral intervention (BI) can prevent excessive gestational weight gain (GWG) by increasing physical activity (PA). METHODS: Participants were randomized to usual care (UC; n = 21) or BI (n = 24) between 10 to 14 weeks gestation. GWG, PA, and diet were assessed at baseline, mid-, and late pregnancy. RESULTS: No differences in GWG or adherence to GWG recommendations presented between groups. Total UC MET-minutes significantly decreased from baseline to late-pregnancy (1,234 ± 372 MET-minutes, P = .013). Mid-pregnancy sustained PA was greater for BI than UC (20-minute PA bouts: 122 ± 106 vs. 46 ± 48 minutes/week, P = .005; 30-minute PA bouts: 74 ± 70 vs. 14 ± 24 minutes/week, P < .001), and greater for BI at mid-pregnancy compared with baseline (20-minute PA bouts: 61.3 ± 21.9; 30-minute PA bouts: 39.6 ± 14.8, both P < .05). BI energy intake at mid-pregnancy significantly increased from baseline (336 ± 127 kcals, P = .04) and was significantly greater than UC (2,503 ± 703 vs. 1,894 ± 594, P = .005). CONCLUSIONS: Sedentary pregnant women should increase PA but may need additional dietary counseling to prevent excessive GWG.

Self-reported musculoskeletal pain in Latino vineyard workers.

The agricultural economy in the United States is dependent on millions of Latino migratory workers. Despite the health risks associated with this line of work, many agricultural workers lack health insurance or access to health care services. The purpose of this study was to collect demographic data and investigate the musculoskeletal health of Latino migratory vineyard workers. A physical therapy team collected demographic data at health clinics held at vineyards in Oregon. Nearly half (48.4%) of all vineyard workers reported experiencing musculoskeletal symptoms (MSS) in at least one region of the body. The primary region of reported MSS was the back (32% of all men and 43.7% of all women). In most cases, those who reported MSS were significantly older than those who did not report MSS. Future research is necessary to identify personal and work related injury risk factors in order to develop prevention programs.

Affect and self-efficacy responses during moderate-intensity exercise among low-active women: the effect of cognitive appraisal.

To investigate the relationship between cognitive and affective responses during acute exercise, 24 low-active females completed two 30-min bouts of cycle ergometer exercise at 90% of the ventilatory threshold. In one condition participants had full knowledge of the exercise duration (KD); in the other, exercise duration was unknown (UD). Affect and self-efficacy were measured before and every 3 min during exercise, and affect was also measured postexercise. Affect declined throughout the first half of both conditions, and continued its decline until the end of the UD condition, when a rebound effect was observed. Self-efficacy during exercise displayed a similar pattern. Hierarchical regression analyses demonstrated that during-exercise self-efficacy was a stronger predictor of during-exercise affect than preexercise self-efficacy, and that this relationship was strongest at the end of exercise when duration was unknown. These results indicate that repetitive cognitive appraisal of self and the task could impact the exercise experiences of low-active women during the adoption phase of an exercise program.

The effects of 15 min and 30 min of exercise on affective responses both during and after exercise.

Although much research has examined the relationship between exercise and affect, few studies have considered the effects of exercise bouts of different durations and few researchers have questioned the longer term effects that might be associated with acute exercise. The aim of this study was to compare the effects of the standard health recommended exercise duration of 30 min with a shorter (15 min) bout of exercise upon individuals' affect scores both during and after exercise. Twenty-three (mean age 22.4 years) physically active participants engaged in two counterbalanced cycle ergometer exercise conditions for 15 min (short bout) and 30 min (moderate bout). The participants completed the Subjective Exercise Experience Scale before, during, 5 min, 30 mins, 1 h and 2 h after both exercise conditions. A series of 2 x 6 within-participant repeated-measures analyses of variance for positive well-being (P <0.01), psychological distress (P <0.01) and fatigue (P <0.01) scores revealed significant time main effects, with improved scores over time. No significant differences were noted between the 15-min and 30-min exercise bouts. These results indicate that positive affective responses are experienced by exercisers after relatively short bouts of acute exercise and these effects can still be evident some time later.