Personalized Nutrition as a Key Contributor to Improving Radiation Response in Breast Cancer.

Understanding metabolic and immune regulation inherent to patient populations is key to improving the radiation response for our patients. To date, radiation therapy regimens are prescribed based on tumor type and stage. Patient populations who are noted to have a poor response to radiation such as those of African American descent, those who have obesity or metabolic syndrome, or senior adult oncology patients, should be considered for concurrent therapies with radiation that will improve response. Here, we explore these populations of breast cancer patients, who frequently display radiation resistance and increased mortality rates, and identify the molecular underpinnings that are, in part, responsible for the radiation response and that result in an immune-suppressive tumor microenvironment. The resulting immune phenotype is discussed to understand how antitumor immunity could be improved. Correcting nutrient deficiencies observed in these populations should be considered as a means to improve the therapeutic index of radiation therapy.

Hydrological and Seasonal Controls of Phosphorus in Northern Great Plains Agricultural Streams.

Controls on nutrient transport in cold, low-relief agricultural regions vary dramatically among seasons. The spring snowmelt is often the dominant runoff and nutrient loading event of the year. However, climate change may increase the proportion of runoff occurring with rainfall, and there is an urgent need to understand seasonal controls on nutrient transport to understand how patterns may change in the future. In this study, we assess patterns and drivers of total P (TP) dynamics in eight streams draining agriculturally dominated watersheds, located in southern Manitoba, Canada. Data from three years of monitoring revealed highly coherent patterns of TP concentrations in streams, with pronounced peaks in the spring and midsummer across the region. This coherent pattern was in spite of considerable interannual variability in the magnitude and timing of discharge; in particular, a major storm event occurred in summer 2014, which resulted in more discharge than the preceding spring melt. Concentration-discharge model fits were generally poor or not significant, suggesting that runoff generation is not the primary driver of TP dynamics in the majority of streams. Seasonal patterns of conductivity and stream temperature suggest that mechanisms controlling TP vary by season; a spring TP concentration maximum may be related to surface runoff over frozen soils, whereas the summer TP maximum may be related to temperature-driven biogeochemical processes, which are not well represented in current conceptual or predictive models. These findings suggest that controls on stream TP concentrations are dynamic through the year, and responses to increases in dormant and nondormant season temperatures may depend on seasonally variable processes.

Instrumental Activities of Daily Living, Neuropsychiatric Symptoms, and Neuropsychological Impairment in Mild Cognitive Impairment.

BACKGROUND: Neuropsychological deficits, neuropsychiatric symptoms, and problems with instrumental activities of daily living are common in participants with mild cognitive impairment (MCI). OBJECTIVES: To assess how subtle to mildly impaired instrumental activities of daily living (IADLs) might be related to neuropsychological abilities (including executive control and episodic memory) and neuropsychiatric symptoms (including apathy and depression) among participants with a diagnosis of MCI. METHODS: Participants were evaluated for MCI and possible dementia at an outpatient memory clinic on the basis of a comprehensive neuropsychological evaluation, a geriatric psychiatry evaluation, a magnetic resonance image of the brain, and serum studies to evaluate for a possible reversible cause of cognitive decline. A series of stepwise regression analyses were conducted whereby IADL ability was the dependent variable and neuropsychological abilities, such as executive control and episodic memory, or neuropsychiatric symptoms, including apathy and depression, were the independent or predictor variables. The presence and severity of neuropsychiatric symptoms was assessed using a modified version of the Neuropsychiatric Inventory (mNPI). Participants were grouped by MCI diagnosis status (amnestic MCI, combined dysexecutive/mixed MCI, and no MCI). RESULTS: Twenty-six participants were in the amnestic MCI group, 19 in the combined dysexecutive/mixed MCI group, and 36 participants did not meet criteria for MCI (non-MCI group). Groups did not differ in age, education, Mini-Mental State Examination performance, IADL abilities, estimated premorbid general intellectual abilities, or mNPI ratings for apathy and depression. Stepwise regression analyses found a robust relationship between mild IADL impairment and greater apathy (R=0.497, r21,69=0.247, P<.001; ß=-0.497, P<.001). Depression did not enter the final model. A weaker-but statistically significant-relationship was found between mild IADL impairment and worse executive control test performance (R=0.271, r21,68=0.073, P<.023; ß=0.271, P<.23). Episodic memory did not enter the final model. When both apathy and executive control were assessed as related to IADL impairment, only apathy entered the final model (R=0.497, R21,69=0.247, P<.001; ß=-0.497, P<.001). CONCLUSION: Mildly impaired IADL functioning can negatively affect quality of life. Moreover, apathy may be amenable to treatment. In a primary geriatric care setting, neuropsychiatric symptoms and neuropsychological abilities should be routinely assessed.

Pharmacy claims data versus patient self-report to measure contraceptive method continuation.

OBJECTIVE: To compare self-reported 12-month continuation of oral contraceptive pills (OCPs), patch, and ring versus continuation by pharmacy claims data. STUDY DESIGN: Women in the Contraceptive CHOICE Project who chose OCPs, the patch, or the ring as their initial method were included. Continuation was assessed by periodic telephone survey and by obtaining prescription claims data. Continuation was defined as no gap of more than 30 days. Kaplan-Meier survival functions were used to estimate continuation rates and cumulative unintended pregnancy rates. Kappa statistic assessed the level of agreement between self-report and claims data. RESULTS: We analyzed 1510 women who initiated use by 3 months and provided information on discontinuation. Of OCP users, 59% continued their method at 12 months by self-report versus 38% by pharmacy claims. Patch and ring users had self-reported/pharmacy continuation of 45%/28% and 57%/37%, respectively. Kappa coefficients and their 95% confidence intervals between the two measurements were 0.46 (0.40, 0.52), 0.54 (0.39, 0.68), and 0.54 (0.47, 0.61) for OCP, patch, and ring, respectively. Among women who self-reported continuation, unintended pregnancy rates were 0.4% in those who continued by pharmacy claims versus 4.9% in those who discontinued according to claims data. CONCLUSION: Contraceptive continuation rates differ by self-report versus pharmacy claims with women overestimating their continuation by self-report. IMPLICATIONS: This article directly compares contraception continuation rates by self-report and by pharmacy claims data. The study suggests that previously reported continuation rates from survey data overestimate specific method use.