Improving molecular testing and personalized medicine in non-small-cell lung cancer in Ontario.

BACKGROUND: Although molecular testing has become standard in managing advanced nonsquamous non-small-cell lung cancer (nsclc), most patients undergo minimally invasive procedures, and the diagnostic tumour specimens available for testing are usually limited. A knowledge translation initiative to educate diagnostic specialists about sampling techniques and laboratory processes was undertaken to improve the uptake and application of molecular testing in advanced lung cancer. METHODS: A multidisciplinary panel of physician experts including pathologists, respirologists, interventional thoracic radiologists, thoracic surgeons, medical oncologists, and radiation oncologists developed a specialty-specific education program, adapting international clinical guidelines to the local Ontario context. Expert recommendations from the program are reported here. RESULTS: Panel experts agreed that specialists procuring samples for lung cancer diagnosis should choose biopsy techniques that maximize tumour cellularity, and that conservation strategies to maximize tissue for molecular testing should be used in tissue processing. The timeliness of molecular reporting can be improved by pathologist-initiated reflex testing upon confirmation of nonsquamous nsclc and by prompt transportation of specimens to designated molecular diagnostic centres. To coordinate timely molecular testing and optimal treatment, collaboration and communication between all clinicians involved in diagnosing patients with advanced lung cancer are mandatory. CONCLUSIONS: Knowledge transfer to diagnostic lung cancer specialists could potentially improve molecular testing and treatment for advanced lung cancer patients.

Total chemical synthesis of lassomycin and lassomycin-amide.

Herein we report a practical synthetic route to the lasso peptide lassomycin () and C-terminal variant lassomycin-amide (). The biological evaluation of peptides and against Mycobacterium tuberculosis revealed that neither had any activity against this bacterium. This lack of biological activity has led us to propose that naturally occurring lassomycin may actually exhibit a standard lasso peptide threaded conformation rather than the previously reported unthreaded structure.

Reducing errors benefits the field-based learning of a fundamental movement skill in children.

Proficient fundamental movement skills (FMS) are believed to form the basis of more complex movement patterns in sports. This study examined the development of the FMS of overhand throwing in children through either an error-reduced (ER) or error-strewn (ES) training program. Students (n = 216), aged 8-12 years (M = 9.16, SD = 0.96), practiced overhand throwing in either a program that reduced errors during practice (ER) or one that was ES. ER program reduced errors by incrementally raising the task difficulty, while the ES program had an incremental lowering of task difficulty. Process-oriented assessment of throwing movement form (Test of Gross Motor Development-2) and product-oriented assessment of throwing accuracy (absolute error) were performed. Changes in performance were examined among children in the upper and lower quartiles of the pretest throwing accuracy scores. ER training participants showed greater gains in movement form and accuracy, and performed throwing more effectively with a concurrent secondary cognitive task. Movement form improved among girls, while throwing accuracy improved among children with low ability. Reduced performance errors in FMS training resulted in greater learning than a program that did not restrict errors. Reduced cognitive processing costs (effective dual-task performance) associated with such approach suggest its potential benefits for children with developmental conditions.

Reduction of errors during practice facilitates fundamental movement skill learning in children with intellectual disabilities.

BACKGROUND: Children with intellectual disabilities (ID) have been found to have inferior motor proficiencies in fundamental movement skills (FMS). This study examined the effects of training the FMS of overhand throwing by manipulating the amount of practice errors. METHODS: Participants included 39 children with ID aged 4-11 years who were allocated into either an error-reduced (ER) training programme or a more typical programme in which errors were frequent (error-strewn, ES). Throwing movement form, throwing accuracy, and throwing frequency during free play were evaluated. RESULTS: The ER programme improved movement form, and increased throwing activity during free play to a greater extent than the ES programme. Furthermore, ER learners were found to be capable of engaging in a secondary cognitive task while manifesting robust throwing accuracy performance. CONCLUSIONS: The findings support the use of movement skills training programmes that constrain practice errors in children with ID, suggesting that such approach results in improved performance and heightened movement engagement in free play.

Physical activity for children in special school environment.

1. We assessed children's physical activity (PA) in structured (physical education) and unstructured (recess, lunch, before and after school) periods in special schools and examined its association with modifiable area contextual characteristics. 2. Children with disabilities were not highly active, but were more active during recess and lunch periods than at other times including physical education classes. 3. Areas were often not accessible during unstructured settings. Children were more active in areas when supervision and organised activities were provided. 4. Providing an interactive game during free play did not significantly increase group's PA. 5. Children's PA accrual is influenced by contextual characteristics of the school environment. There is a need to make areas more accessible and to use social marketing and programming to attract more users. School and health professionals should modify contextual characteristics by providing more direct supervision and organised activities during free play.

Effects of built environment on walking among Hong Kong older adults.

1. Reliable and valid interviewer-administered questionnaires were developed to investigate associations of perceived neighbourhood attributes of Hong Kong older adults with their walking for transportation and recreation. 2. Access to and availability of different types of services and destinations, provision of facilities for resting/sitting in the neighbourhood, and easy access to/from residential buildings may help maintain an active lifestyle by facilitating walking for transport in the neighbourhood. 3. Access to services, indoor places for walking, environmental aesthetics, low traffic, and absence of physical barriers may promote recreational walking..

Reliability and validity of the IPAQ-L in a sample of Hong Kong urban older adults: does neighborhood of residence matter?

This study examined reliability and validity of the Chinese version of the International Physical Activity Questionnaire-Long Form (IPAQ-LC) in Chinese seniors, including moderating effects of neighborhood walkability and socioeconomic status (SES) on reliability and validity. The IPAQ-LC was interviewer-administered (n = 96), accelerometer and 7-day walk-diary data were collected (n = 94), and the IPAC-LC was readministered (N = 92). Acceptable reliability was found for all measures of physical activity (PA) overall and across different types of neighborhood. Participants from highly walkable neighborhoods were more reliable at estimating walking for transport. Participants from low-SES areas were less reliable at estimating leisure-time PA and sitting but more reliable at estimating transport-related walking. IPAQ-LC walking was significantly related to light- but not moderate-intensity accelerometry-based PA. It was moderately to strongly related to a 7-day diary of walking. The data imply slow-paced walking, probably due to age, climate, and terrain. The findings suggest that the IPAQ-LC's reliability and validity are acceptable in Chinese seniors.

The ability of post-chemoradiotherapy DWI ADCmean and 18F-FDG SUVmax to predict treatment outcomes in head and neck cancer: impact of human papilloma virus oropharyngeal cancer status.

OBJECTIVES: To evaluate the ability of post-chemo-radiotherapy (CRT) diffusion-weighted-MRI apparent diffusion coefficient (ADCmean) and 18F-FDG PET maximum standardized uptake value (SUVmax) to predict disease-free survival (DFS) in head and neck squamous cell carcinoma (HNSCC), and to determine whether this ability is influenced by human papillomavirus oropharyngeal cancer (HPV-OPC) status. METHODS: This prospective cohort observational study included 65 participants (53 male, mean ± SD age 59.9 ± 7.9 years, 46 HPV-OPC) with stage III or IV HNSCC. Primary tumour and nodal ADCmean (pre-treatment, 6- and 12-weeks post-CRT) and SUVmax (12-weeks post-CRT) were measured. Variables were compared with 2-year DFS (independent t-test/Mann-Whitney test) and overall DFS (Cox regression), before and after accounting for HPV-OPC status. Variables were also compared between HPV-OPC and other HNSCC subgroups after stratifying for DFS. RESULTS: Absolute post-CRT ADCmean values predicted 2-year DFS and overall DFS for all participants (p = 0.03/0.03, 6-week node; p = 0.02/0.03 12-week primary tumour) but not in the HPV-OPC subgroup. In participants with DFS, percentage interval changes in primary tumour ADCmean at 6- and 12-weeks were higher in HPV-OPC than other HNSCC (p = 0.01, 6 weeks; p = 0.005, 12 weeks). The 12-week post-CRT SUVmax did not predict DFS. CONCLUSION: Absolute post-CRT ADCmean values predicted DFS in HNSCC but not in the HPV-OPC subgroup. Amongst participants with DFS, post-CRT percentage interval changes in primary tumour ADCmean were significantly higher in HPV-OPC than in other HNSCC. Knowledge of HPV-OPC status is crucial to the clinical utilisation of post-CRT DWI-MRI for the prediction of outcomes.

The effect of carbohydrate and protein co-ingestion on energy substrate metabolism, sense of effort, and affective responses during prolonged strenuous endurance exercise.

This study examined the effect of carbohydrate (CHO) and protein (PRO) co-ingestion on energy substrate metabolism, sense of effort, and affective responses during prolonged strenuous endurance exercise. In a four-stage randomized cross-over design, 10 male endurance runners (age: 27.3±1.4yrs; height: 172.9±1.1cm, weight: 63.5±1.6kg; body fat: 9.0±1.4%; V̇O2max: 62.9±1.8ml/kg/min) ran on a treadmill at 70% of their individual V̇O2max for 90min. There were two CHO and PRO treatments (CA: CHO+alpha-lactalbumin and CW: CHO+whey PRO isolate), one CHO treatment (CC: CHO+CHO), and a placebo control (CON). On each occasion, subjects consumed 5ml/kg according to their body weight (kg) immediately before and 2ml/kg every 15min during exercise. Blood samples were collected at 0min, 30min, 60min and 90min of exercise to measure glucose, lactate, insulin, and cortisol levels. The extent of physical sensation (abdominal discomfort, leg muscle pain), the sense of effort (rating of perceive exertion, RPE), and affective responses (pleasure-displeasure, arousal) were evaluated by numeric scales before, during, and immediately after exercise. Blood glucose and insulin concentrations in the CA, CW, and CC treatments were higher than in the CON at 90min (P<0.05). Muscle pain (evaluated by a single item, 0 to 10 pain intensity scale from "no pain at all" to "extremely unbearable") was lower following CA ingestion than CON and CW ingestion, at 75min (vs. CON and CW, 1.95±0.61 vs. 3.70±1.00 and 3.60±1.02, P<0.05) and 90min (vs. CON & CW: 2.40±0.76 vs. 4.20±0.99 and 4.05±1.1, P<0.05). RPE (evaluated by a 15-point, 6 to 20 rating scale ranging from "very, very light" to "very, very hard") following treatment with CA was lower than with CON and CW at 90min (vs. CON and CW: 11.30±1.14 vs. 14.20±1.30 and 13.30±1.24, P<0.05). Compared with CON and CW, CA enhanced the feeling of pleasure (evaluated by feeling scale from -5, "very bad" to +5, "very good") at 90min (vs. CON and CW, 2.20±0.67 vs. -0.30±0.94 and 0.20±0.91, P<0.05). Co-ingestion of CHO and alpha-lactalbumin protein attenuates muscle pain, and therefore alleviates the sense of effort and enhances affective responses during 90min of strenuous running at 70% V̇O2max.

Growth of infants and children in China.

Growth of China s infants and children has improved since the introduction of economic reforms. After 1979, secular increases in both weight and length have been observed. In certain industrial centers, infant lengths have caught up to international standards. Overall prevalence of underweight and stunting have declined. However, the health benefits from economic growth have not been shared equally among the Chinese population. There remain large disparities in the standard of health delivered to different sectors of the Chinese population. Rural children and children of minority nationalities continue to suffer from malnutrition and thus lower growth as compared to urban children. Economic reform has also changed the Chinese diet. Infant and child obesity is rising. Therefore, although economic reform has stimulated improvements in the growth of China s children, continued development and attention is needed in disadvantaged areas and populations. Public education is also necessary for China s children to avoid the diet-related diseases frequently seen in the west.

Cost-benefit analysis of a computerized medical record system.

This paper describes the cost-benefit analysis of a computerized medical record system for use in physicians' offices. Actual data for savings in physician time in paper work was collected. The qualitative benefits of the system were evaluated using a questionnaire. The cost-benefit ratios demonstrated that the use of a computerized medical system is justified.