Abstract P4-12-02: Age-related distress in 3352 breast cancer patients

Purpose: Age-related biopsychosocial distress in breast cancer patients has been poorly studied and understood. The breast cancer experience may be different based on chronological age, which may be a surrogate marker of biologic, psychological, social, and functional age. This study reports patient-reported biopsychosocial problem-related distress in breast cancer patients.

Methods: All new patients seen at the City of Hope breast cancer clinic undergo a validated comprehensive biopsychosocial screening prior to their first visit with a medical/surgical oncologist. This touchscreen driven technology queries patients on their physical symptoms, psychosocial concerns, informational and resource needs, interests in clinical trials, and other breast cancer specific concerns. This IRB approved study was conducted in 3,352 patients evaluated from 2009 to 2017. Screening occurred immediately prior to meeting with the physician so that the information could be integrated into the clinical encounter.

Results: The age-related groups included 268 Adolescent and young adult (AYA) patients ages 18-39, 2,244 middle aged adults 40-64 years, and 840 older adults ages 65+ years. Regardless of age, four of the top seven highly distressing problems were the same: worry about the future, side effects of treatment, sleep and fatigue. AYA patients and middle aged adults, but not older adults, identified finances and being anxious or fearful among their top five causes of distress. Middle aged adults and older adults, but not AYA patients, identified physical pain among their top seven causes of distress. Interestingly, both AYA and older adults, but not middle aged adults, identified getting information about complementary and alternative practices as a top source of distress. Although a serious problem across all age categories, thoughts of ending one's life and seriously considering taking one's life were the least common problems identified.

Conclusions: In this series with 3,352 patients, biopsychosocial concerns raised with a diagnosis of breast cancer were similar regardless of age. However, patients under the age of 65 may worry more about finances and patients over the age of 40 may worry more about physical symptoms such as pain. Both AYA patients and older adults cited distress learning about complementary and alternative practices, suggesting a need for providers to address this, especially in these patient populations. Thoughts of ending one's own life were uncommon, which is relevant in a state with the End of Life Option Act.

Citation Format: Hill A, Obenchain R, Clark K, Loscalzo M, Mortimer J. Age-related distress in 3352 breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-02.

Constraints on Minute-Scale Transient Astrophysical Neutrino Sources

High-energy neutrino emission has been predicted for several short-lived astrophysical transients including gamma-ray bursts (GRBs), core-collapse supernovae with choked jets, and neutron star mergers. IceCube's optical and x-ray follow-up program searches for such transient sources by looking for two or more muon neutrino candidates in directional coincidence and arriving within 100 s. The measured rate of neutrino alerts is consistent with the expected rate of chance coincidences of atmospheric background events and no likely electromagnetic counterparts have been identified in Swift follow-up observations. Here, we calculate generic bounds on the neutrino flux of short-lived transient sources. Assuming an E^{-2.5} neutrino spectrum, we find that the neutrino flux of rare sources, like long gamma-ray bursts, is constrained to <5% of the detected astrophysical flux and the energy released in neutrinos (100 GeV to 10 PeV) by a median bright GRB-like source is <10^{52.5}  erg. For a harder E^{-2.13} neutrino spectrum up to 30% of the flux could be produced by GRBs and the allowed median source energy is <10^{52}  erg. A hypothetical population of transient sources has to be more common than 10^{-5}  Mpc^{-3}  yr^{-1} (5×10^{-8}  Mpc^{-3}  yr^{-1} for the E^{-2.13} spectrum) to account for the complete astrophysical neutrino flux.

U.S. Survey of Shared Decision Making Use for Treating Pregnant Women Presenting with Opioid Use Disorder

Background: The incidence of pregnant women with an opioid use disorder (PWOUD) at delivery has quadrupled since 1999. State-specific statutes regarding PWOUD often pose punitive measures to the mother-infant dyad, involving the child welfare and criminal justice systems. Shared decision making (SDM) assists individuals through complex health and recovery processes. Objectives: To determine use of SDM in treating PWOUD and associated factors and to quantify physicians' review and discussion of child welfare statutes. Methods: The American College of Obstetricians and Gynecologists (ACOG) e-mailed the survey to a random sample of members, with 568 responding. Bivariate analyses to identify factors associated with each outcome were performed using Wilcoxon Rank Sum tests or Fisher's Exact tests. Variables yielding p values < .20 were included in initial logistic regression models; the final model included only significant (<.05) variables. Results: Sixty-one percent used SDM most of the time. Logistic regression indicated that those using SDM were more likely to have had training in substance use disorder and felt prepared for caring for PWOUD; 39% reviewed statutes, and 54% discussed them with PWOUDs. Conclusion: Survey results provide evidence for patient-centered care approaches that support PWOUD involvement in treatment decision making. The SDM model provides an empowerment framework for women to be involved in the process during their pregnancies and opioid use disorder treatments. Future studies might assess the effectiveness of SDM dialogs with PWOUD and evaluate CME training and medical curricula regarding the SDM model.

Search for neutrinos from decaying dark matter with IceCube: IceCube Collaboration

With the observation of high-energy astrophysical neutrinos by the IceCube Neutrino Observatory, interest has risen in models of PeV-mass decaying dark matter particles to explain the observed flux. We present two dedicated experimental analyses to test this hypothesis. One analysis uses 6 years of IceCube data focusing on muon neutrino 'track' events from the Northern Hemisphere, while the second analysis uses 2 years of 'cascade' events from the full sky. Known background components and the hypothetical flux from unstable dark matter are fitted to the experimental data. Since no significant excess is observed in either analysis, lower limits on the lifetime of dark matter particles are derived: we obtain the strongest constraint to date, excluding lifetimes shorter than10 28 s at 90% CL for dark matter masses above 10 TeV .

Measurement of the ν μ energy spectrum with IceCube-79: IceCube Collaboration

IceCube is a neutrino observatory deployed in the glacial ice at the geographic South Pole. The ν μ energy unfolding described in this paper is based on data taken with IceCube in its 79-string configuration. A sample of muon neutrino charged-current interactions with a purity of 99.5% was selected by means of a multivariate classification process based on machine learning. The subsequent unfolding was performed using the software Truee. The resulting spectrum covers an E ν -range of more than four orders of magnitude from 125 GeV to 3.2 PeV. Compared to the Honda atmospheric neutrino flux model, the energy spectrum shows an excess of more than 1.9 σ in four adjacent bins for neutrino energies E ν ≥ 177.8 TeV . The obtained spectrum is fully compatible with previous measurements of the atmospheric neutrino flux and recent IceCube measurements of a flux of high-energy astrophysical neutrinos.

Light intensity of 5 or 20 lux on broiler behavior, welfare and productivity

Light intensity can influence broiler behavior, but discrepancies in the scientific literature remain. Furthermore, few studies have investigated the welfare implications induced by varying light intensity. We investigated the effects of providing 5 or 20 lux light intensity on broiler behavior, welfare and productivity. A total of 1,872 Ross 308 broilers of mixed sex were studied across 2 replicates. Treatments began on d 8 with one of 2 light intensity levels: 5 lux or 20 lux, using LED lights on a 16L:8D photoperiod with 30 min sunrise and sunset periods. Production data, behavioral activity, and plasma samples for corticosterone concentration analysis were collected weekly from 8 to 46 d of age. Eye weight was collected at 42 d of age. Leg strength was assessed at 35, 42 and 45 d of age using the latency to lie test and leg and foot conditions (foot pad dermatitis, hock burn, leg straightness) were assessed at 46 d. Live weight differed between light treatments, with broilers kept at 20 lux being lighter than broilers kept at 5 lux at 46 d of age (males: -5.1%, females: -2.8%, P < 0.0001), despite no significant differences in feed intake. However, broilers kept at 20 lux were more active during the photophase than broilers kept at 5 lux throughout the rearing period (P < 0.0001). Eye weight was also on average 5% lighter for broilers kept at 20 lux compared to 5 lux (P = 0.001). Nonetheless, there was no significant effect of light intensity on other measures of broiler welfare: mortality and culls, plasma corticosterone concentrations, or latency to lie reflective of leg strength. Hence, broilers kept at 20 lux compared to 5 lux were found to be more active, had slower growth, and had lighter eye weight, but other welfare measures reflective of biological functioning or leg health did not show significant changes.

Longitudinal study on the use of dried blood spots for home monitoring in children after kidney transplantation

The use of DBSs for home monitoring has been limited due to unsatisfactory blood sampling and analytical difficulties. The aim of this longitudinal feasibility trial was to assess the utility of DBS to monitor TAC and Cr at home in transplant recipients. A total of 30 participants (2-21 years, mean±SD, 13.6±5.4 year) were enrolled over 12 months. Eighteen were males. Monthly DBS samples were obtained at home and mailed to the central laboratory for analysis of TAC and Cr. Nineteen patients completed the study, and 216 cards were received in the laboratory from a total of 279 cards expected, with 416/519 (80%) blood spots being suitable for analysis. We found a high correlation between blood TAC and Cr levels by DBS and the clinical laboratory, R² =.81 and .95, respectively. Fifteen parents and 15 youth completed measures of satisfaction with and preference for DBS testing. All but one parent/caregiver and youth reported satisfaction and preference for this method of testing over laboratory blood draws. We conclude that home DBS monitoring is a feasible method to monitor TAC and Cr in pediatric transplant recipients.

Abstract 3732: Analytical performance of TruSight® Tumor 170 on small nucleotide variations and gene amplifications using DNA from formalin-fixed, paraffin-embedded (FFPE) solid tumor samples

Expanding the paradigm of solid tumor profiling from single-gene testing to comprehensive panels presents many challenges. One such challenges is the ability of these panels to detect genetic alterations from FFPE samples, where the DNA is of low abundance and often heavily compromised. Despite these challenges, next-generation sequencing (NGS) offers the ability to assess multiple variants simultaneously in an ever-expanding list of relevant tumor genes. To that end, Illumina developed a comprehensive, hybrid capture-based NGS assay targeting 170 key cancer genes that is FFPE optimized. The assay consists of a DNA workflow for the identification of single and multiple nucleotide variants (SNVs, MNVs), small insertions and deletions (indels), gene amplifications, as well as a RNA workflow for the identification of splice variants and gene fusions. Following sequencing on the NextSeq® or HiSeq® instruments, the analytical pipeline initiates variant calling. The DNA aligner and variant callers were first optimized against the simulated read data from &gt;40,000 COSMIC[1] mutations reported in the exons of the 170 genes. To reduce false positive variant calling due to systematic errors, each variant call was evaluated against its locus specific background error distribution. This distribution was compiled from a panel of FFPE normal samples and was also used to normalize against systematic bias in read coverage to increase the accuracy of amplification calling. Furthermore, gene amplification calling was improved by the addition of enhancer probes to the hybrid capture pool. The analytical sensitivity and specificity of TruSight® Tumor 170* was assessed on a large collection of FFPE samples and reference material. A panel of 72 cancer samples, including multiple tissue types, reference standards, and cell line and FFPE mixes were used to evaluate the limit of detection. The samples contained 533 SNVs, 80 indels including deletions up to 30 base pairs and insertions up to 31 base pairs, 4 MNVs, and 31 gene amplifications, characterized by orthogonal testing methods. Using 40 ng DNA input, detection sensitivity of the &gt;1000 variants (including replicates) tested at variant allele frequencies down to ~5% was at 99.6%, while detection sensitivity of gene amplifications as low as 1.45x to 2.2x was at 98%. For limit of blank samples, a panel of 24 normal samples was used. Again using 40 ng DNA input, we show &gt;99% specificity for small variant calling and &gt;95% specificity for gene amplification calling. These data demonstrates the TruSight® Tumor 170 is able to detect multiple variant types within a single sample at low nucleic acid input, while exhibiting high analytical sensitivity and specificity for low allele fraction detection.

[1] Forbes, et al. (2015) *For Research Use Only. Not for use in diagnostic procedures.

Citation Format: Danny Chou, Xiao Chen, Austin Purdy, Li Teng, Byron Luo, Chen Zhao, Laurel Ball, Allan Castaneda, Katie Clark, Brian Crain, Anthony Daulo, Manh Do, Tingting Du, Sarah Dumm, Yonmee Han, Michael Havern, Chia-Ling Hsieh, Tingting Jiang, Suzanne Johansen, Scott Lang, Rachel Liang, Jennifer S. LoCoco, Jaime McLean, Yousef Nassiri, Jason Rostron, Jennifer Silhavy, June Snedecor, Natasha Talago, Kevin Wu, Clare Zlatkov, Ali Kuraishy, Karen Gutekunst, Sohela De Rozieres, Matthew Friedenberg, Han-Yu Chuang, Anne C. Jager. Analytical performance of TruSight® Tumor 170 on small nucleotide variations and gene amplifications using DNA from formalin-fixed, paraffin-embedded (FFPE) solid tumor samples [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3732. doi:10.1158/1538-7445.AM2017-3732

Dark Matter Search Results from the PICO-60 C_{3}F_{8} Bubble Chamber

New results are reported from the operation of the PICO-60 dark matter detector, a bubble chamber filled with 52 kg of C_{3}F_{8} located in the SNOLAB underground laboratory. As in previous PICO bubble chambers, PICO-60 C_{3}F_{8} exhibits excellent electron recoil and alpha decay rejection, and the observed multiple-scattering neutron rate indicates a single-scatter neutron background of less than one event per month. A blind analysis of an efficiency-corrected 1167-kg day exposure at a 3.3-keV thermodynamic threshold reveals no single-scattering nuclear recoil candidates, consistent with the predicted background. These results set the most stringent direct-detection constraint to date on the weakly interacting massive particle (WIMP)-proton spin-dependent cross section at 3.4×10^{-41}  cm^{2} for a 30-GeV c^{-2} WIMP, more than 1 order of magnitude improvement from previous PICO results.

Longitudinal maternal hemodynamics in pregnancies affected by fetal growth restriction

OBJECTIVE

Fetal growth restriction (FGR) is a powerful determinant of poor perinatal outcome. From our previous work in pregnancies at high risk of development of hypertension we found impaired cardiovascular adaptation early in gestation in those destined to deliver growth-restricted infants. In this study, we monitored serially maternal hemodynamics from the first to third trimester in a similar high-risk cohort, in order to determine whether this distinct hemodynamic profile found at presentation persisted throughout pregnancy in those complicated by FGR.

METHODS

This was a prospective observational study based at a specialist antenatal hypertension clinic at a tertiary hospital in London. Maternal hemodynamics were evaluated serially using a non-invasive bioreactance method in pregnant women referred to the clinic with a history of chronic hypertension or a history of hypertensive disorder in a previous pregnancy. Differences in maternal hemodynamic parameters were compared between women who delivered a baby with a birth weight ≥ 10^th vs < 10^th percentile and ≥ 5^th vs < 5^th percentile.

RESULTS

Eighty-four pregnant women were included in the study. Mean gestational age at presentation was 14.3 weeks. Sixteen women delivered babies with a birth weight < 10^th percentile and 11 with a birth weight < 5^th percentile. In pregnancies with a birth weight ≥ 10^th percentile, longitudinal maternal hemodynamics showed a pattern consistent with well-established physiological changes in pregnancy, i.e. a reduction in vascular resistance and an increase in cardiac output with advancing gestation until mid-pregnancy. However, women who delivered babies with a birth weight < 10^th percentile showed a static pattern with no change during gestation and lower cardiac output and higher peripheral vascular resistance. Similar differences were seen when the 5^th percentile was used to discriminate between appropriately-grown and growth-restricted babies.

CONCLUSION

Serial assessment of maternal hemodynamics in high-risk women identifies distinctive trends associated with pregnancies destined to deliver babies with birth weights < 10^th and < 5^th percentiles. These pregnancies have a suppressed and static maternal cardiac output and stroke volume, and have consistently raised peripheral vascular resistance. This suggests that, in women with chronic hypertension or a history of hypertensive disorder in a previous pregnancy, FGR is associated with a primary and persistent failure of maternal cardiovascular adaptation in pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Serial hemodynamic monitoring to guide treatment of maternal hypertension leads to reduction in severe hypertension

OBJECTIVES

To examine whether treatment for hypertension in pregnancy that is guided by serial monitoring of maternal central hemodynamics leads to a reduction in the rate of severe hypertension, defined as blood pressure ≥ 160/110 mmHg; and to assess the distinct longitudinal hemodynamic profiles associated with beta-blocker monotherapy, vasodilator monotherapy and dual agent therapy, and their relationships with outcomes, including fetal growth restriction.

METHODS

This was a prospective observational study at a dedicated antenatal hypertension clinic in a tertiary UK hospital. Fifty-two untreated women presenting with hypertension were recruited consecutively and started on treatment, either with a beta-blocker or a vasodilator. The choice of initial antihypertensive agent was determined according to a model constructed previously to predict the response to the beta-blocker labetalol in pregnant women needing antihypertensive treatment. At presentation, the demographic and maternal hemodynamic variables associated with a therapeutic response to labetalol, defined as blood pressure control < 140/90 mmHg with labetalol monotherapy throughout pregnancy, were ascertained and analyzed with logistic regression to create a model to predict sustained blood pressure control as described above. The women were reviewed regularly until delivery and underwent serial hemodynamic monitoring throughout pregnancy. If their blood pressure was elevated, the prediction model was referred to again to determine if alternative antihypertensive therapy, either with additional beta-blocker or a vasodilator, should be added.

RESULTS

Treatment by referring to results of serial hemodynamic monitoring reduced the rate of severe antenatal hypertension from 18% to 3.8%. Seventy-seven percent of women were initially prescribed a beta-blocker and 23% a vasodilator. The group that maintained good blood pressure control with beta-blocker monotherapy had the best fetal and maternal outcomes. They had lower blood pressures at presentation and throughout gestation, demonstrated well-maintained cardiac output and had the lowest rates of fetal growth restriction. The groups that required dual therapy to control their blood pressure had persistently higher blood pressure and rate of fetal growth restriction. The groups that required vasodilator therapy due to high levels of peripheral vascular resistance, either at presentation or later in pregnancy, accounted for 81% of cases with fetal growth restriction.

CONCLUSION

Using serial hemodynamic monitoring in pregnancy to guide treatment of hypertension significantly reduces the rate of severe hypertension and allows identification of high-resistance, low-output hypertensive pregnancies that are associated with an increased rate of fetal growth restriction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

RESUMEN OBJETIVOS

Examinar si el tratamiento para la hipertensión en el embarazo guiado por un seguimiento en serie de las principales constantes hemodinámicas de la madre conduce a una reducción en la tasa de hipertensión grave, definida como presión arterial ≥ 160/110 mmHg; y evaluar los diferentes perfiles hemodinámicos longitudinales asociados a la monoterapia con beta-bloqueantes, la monoterapia con vasodilatadores y la terapia dual, y su relación con los resultados, como la restricción del crecimiento fetal. MÉTODOS: Se realizó un estudio observacional prospectivo en una clínica especializada en hipertensión prenatal de un hospital de atención terciaria del Reino Unido. Se reclutaron consecutivamente a cincuenta y dos mujeres no tratadas que presentaban hipertensión y se comenzó a tratarlas, bien con un beta-bloqueante o bien con un vasodilatador. La elección del agente antihipertensivo inicial se determinó de acuerdo con un modelo elaborado previamente para predecir la respuesta al beta-bloqueante labetalol en mujeres embarazadas que necesitaban tratamiento antihipertensivo. Al inicio se registraron las características demográficas y las variables hemodinámicas maternas asociadas con una respuesta terapéutica al labetalol, definida como un control de la presión arterial < 140/90 mmHg con monoterapia de labetalol durante todo el embarazo que se analizó mediante regresión logística para crear un modelo con el que pronosticar un control sostenido de la presión arterial, como se describe arriba. Las mujeres fueron sometidas a revisiones regulares hasta el momento del parto y se les hizo un seguimiento hemodinámico en serie durante todo el embarazo. Si la presión arterial era elevada, se empleó de nuevo el modelo de predicción para determinar si se debería añadir un tratamiento antihipertensivo alternativo, ya sea con un beta-bloqueante adicional o con un vasodilatador.

RESULTADOS

El tratamiento que tuvo en cuenta los resultados del seguimiento hemodinámico en serie redujo la tasa de hipertensión prenatal grave del 18% al 3,8%. Al 77% de las mujeres se les recetó inicialmente un y al 23% un vasodilatador. El grupo que mantuvo un buen control de la presión arterial con monoterapia de beta-bloqueantes logró mejores resultados fetales y maternos. Este grupo tuvo menor presión arterial al inicio y durante toda la gestación, mostró un gasto cardíaco en buen estado y tuvo las tasas más bajas de restricción del crecimiento fetal. Los grupos que requirieron terapia dual para controlar su presión arterial mostraron persistentemente una mayor presión arterial y un mayor ritmo de restricción del crecimiento fetal. Los grupos que requirieron tratamiento vasodilatador debido a los altos niveles de resistencia vascular periférica, tanto al inicio como durante el embarazo, representaron el 81% de los casos con restricción del crecimiento fetal. CONCLUSIÓN: El uso de un seguimiento hemodinámico en serie en el embarazo como guía para el tratamiento de la hipertensión reduce significativamente la tasa de hipertensión severa y permite la identificación de embarazos con hipertensión de alta resistencia y malos resultados, asociados con una mayor tasa de restricción del crecimiento fetal. : (≥ 160/110 mmHg);β、,()。 : 。52、,β。β。,(<140/90 mmHg),logistic,。,。,(β)。 : ,18%3.8%。77%β,23%。β。,,。,。,81%。 : ,,、。.

Constraints on Ultrahigh-Energy Cosmic-Ray Sources from a Search for Neutrinos above 10 PeV with IceCube

We report constraints on the sources of ultrahigh-energy cosmic rays (UHECRs) above 10^{9}  GeV, based on an analysis of seven years of IceCube data. This analysis efficiently selects very high- energy neutrino-induced events which have deposited energies from 5×10^{5}  GeV to above 10^{11}  GeV. Two neutrino-induced events with an estimated deposited energy of (2.6±0.3)×10^{6}  GeV, the highest neutrino energy observed so far, and (7.7±2.0)×10^{5}  GeV were detected. The atmospheric background-only hypothesis of detecting these events is rejected at 3.6σ. The hypothesis that the observed events are of cosmogenic origin is also rejected at >99% CL because of the limited deposited energy and the nonobservation of events at higher energy, while their observation is consistent with an astrophysical origin. Our limits on cosmogenic neutrino fluxes disfavor the UHECR sources having a cosmological evolution stronger than the star formation rate, e.g., active galactic nuclei and γ-ray bursts, assuming proton-dominated UHECRs. Constraints on UHECR sources including mixed and heavy UHECR compositions are obtained for models of neutrino production within UHECR sources. Our limit disfavors a significant part of parameter space for active galactic nuclei and new-born pulsar models. These limits on the ultrahigh-energy neutrino flux models are the most stringent to date.

The impact on hospital resource utilisation of treatment of hepatic encephalopathy with rifaximin-α

BACKGROUND & AIMS

Rifaximin-α reduces the risk of recurrence of overt hepatic encephalopathy. However, there remain concerns regarding the financial cost of the drug. We aimed to study the impact of treatment with rifaximin-α on healthcare resource utilisation using data from seven UK liver treatment centres.

METHODS

All seven centres agreed a standardised data set and data characterising clinical, demographic and emergency hospital admissions were collected retrospectively for the time periods 3, 6 and 12 months before and following initiation of rifaximin-α. Admission rates and hospital length of stay before and during therapy were compared. Costs of admissions and drug acquisition were estimated using published sources. Multivariate analyses were carried out to assess the relative impact of various factors on hospital length of stay.

RESULTS

Data were available from 326 patients. Following the commencement of rifaximin, the total hospital length of stay reduced by an estimated 31-53%, equating to a reduction in inpatient costs of between £4858 and £6607 per year. Taking into account drug costs of £3379 for 1-year treatment with rifaximin-α, there was an estimated annual mean saving of £1480-£3228 per patient.

CONCLUSIONS

Initiation of treatment with rifaximin-α was associated with a marked reduction in the number of hospital admissions and hospital length of stay. These data suggest that treatment of patients with rifaximin-α for hepatic encephalopathy was generally cost saving.