Families as a Cornerstone in 21st Century Public Health: Recommendations for Research, Education, Policy, and Practice

Families are vastly overlooked in US initiatives to promote population health and health equity despite being the most proximal context for health across the life course. We urge the public health sector to take the lead in recognizing families as essential for promoting 21st century population health. We highlight ways families influence health by providing context, care, continuity, and connections. The dual private and public aspect of families has contributed to how they have been overlooked in the public health sector. We provide recommendations for better integrating families into population health initiatives through national health goals, research, education, policy, and practice.

Reversion and non-reversion mechanisms of resistance to PARP inhibitor or platinum chemotherapy in BRCA1/2-mutant metastatic breast cancer

BACKGROUND

Little is known about mechanisms of resistance to poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi) and platinum chemotherapy in patients with metastatic breast cancer and BRCA1/2 mutations. Further investigation of resistance in clinical cohorts may point to strategies to prevent or overcome treatment failure.

PATIENTS AND METHODS

We obtained tumor biopsies from metastatic breast cancer patients with BRCA1/2 deficiency before and after acquired resistance to PARPi or platinum chemotherapy. Whole exome sequencing was carried out on each tumor, germline DNA, and circulating tumor DNA. Tumors underwent RNA sequencing, and immunohistochemical staining for RAD51 foci on tumor sections was carried out for functional assessment of intact homologous recombination (HR).

RESULTS

Pre- and post-resistance tumor samples were sequenced from eight patients (four with BRCA1 and four with BRCA2 mutation; four treated with PARPi and four with platinum). Following disease progression on DNA-damaging therapy, four patients (50%) acquired at least one somatic reversion alteration likely to result in functional BRCA1/2 protein detected by tumor or circulating tumor DNA sequencing. Two patients with germline BRCA1 deficiency acquired genomic alterations anticipated to restore HR through increased DNA end resection: loss of TP53BP1 in one patient and amplification of MRE11A in another. RAD51 foci were acquired post-resistance in all patients with genomic reversion, consistent with reconstitution of HR. All patients whose tumors demonstrated RAD51 foci post-resistance were intrinsically resistant to subsequent lines of DNA-damaging therapy.

CONCLUSIONS

Genomic reversion in BRCA1/2 was the most commonly observed mechanism of resistance, occurring in four of eight patients. Novel sequence alterations leading to increased DNA end resection were seen in two patients, and may be targetable for therapeutic benefit. The presence of RAD51 foci by immunohistochemistry was consistent with BRCA1/2 protein functional status from genomic data and predicted response to later DNA-damaging therapy, supporting RAD51 focus formation as a clinically useful biomarker.

Abstract PD9-01: Genomic alterations associated with loss of HR expression in metastatic breast cancer

Background: Discordance in hormone receptor (HR) status between primary (p) tumors and metastatic (m) recurrences has been widely described. Loss of estrogen and progesterone receptor expression occurs in ˜12% of asynchronous recurrences, leading to triple-negative (TN) status in the metastasis. Genomic mechanisms driving HR loss and its prognostic and therapeutic implications have not been fully elucidated.

Methods: Targeted NGS (Oncopanel, OP) at Dana-Farber Cancer Institute using multiplexed copy number variation and mutation (mut) detection across the full coding regions of 300 genes and selected intronic regions of 35 genes was prospectively performed on either archival primary or metastatic samples collected in patients (pts) with metastatic breast cancer (MBC). Receptor status at initial diagnosis and recurrence were reviewed using a 1% cutoff to define HR-positivity and excluding HER2+ cases. Fisher´s exact test was used to compare frequency of alterations. Tumor mut burden (TMB) was computed normalizing the sum of reported exon mut in each pt by the exonic-bait-set size of the panel.

Results: Between 8/2013-9/2016, 929 pts with MBC underwent OP testing. Of 517 pts diagnosed with primary HR+/HER2- breast cancer, at time of recurrence 388 remained HR+/HER2- (pHR+/mHR+), 39 switched to HR-/HER2- (pHR+/mTN, of which 23 (59%) had initial HR expression >10%), 10 switched to HER2+ and 80 had unknown metastatic receptor status. Comparison between primary samples in pHR+/mHR+ (n=245) and pHR+/mTN (n=24) showed that pHR+/mTN was significantly more likely to harbor mut in TP53, STK11 and MSH6, amplifications (amp) in CCNE1 and FGFR2, and less likely to have PIK3CA mut or CCND1 amp. Median TMB in primary pHR+/mHR+ was 6.05 mut/Mb (0-37.5) and 5.68 mut/Mb (1.2-10.9) in pHR+/mTN (p=0.45). Metastatic samples in pHR+/mTN (n=15) were enriched in ARID1A, CRTC2 and CDH1 mut compared to metastases (n=40) in pts who remained TN (pTN/mTN). Deletions in CDKN2A/2B and RB1, and mut in TP53, NOTCH2 and ERCC2 were more prevalent in recurrent tumors of pHR+/mTN than pHR+/mHR+. In metastases, TMB was higher in pHR+/mTN than pTN/mTN or pHR+/mHR+ (10.9 vs. 7.0 vs. 7.3 mut/Mb, respectively; p=0.002). Median OS from initial diagnosis was 9.4 yrs in pHR+/mTN, less than pHR+/mHR+ (15.9 yrs; p=0.009) and greater than pTN/mTN (4.3 yrs; p=0.008). Median OS from MBC diagnosis was 1.8 yrs in pHR+/mTN, less than pHR+/mHR+ (6.4 yrs; p=0.001) but not significantly different than pTN/mTN (1.5 yrs, p=0.3).

 pHR+/mHR+ (n=245)pHR+/mTN (n=24)p value NFreq (%)NFreq (%) MutTP536325.72083.3<0.00001PIK3CA9438.4000GATA33514.3000.053STK1152.0312.50.026MSH641.6312.50.017AmpFGFR20028.30.008CCNE10028.30.008CCND14418.0000.018

Conclusion: Targeted NGS shows that alterations in DNA damage and cell-cycle regulation pathways in primary HR+ tumors are associated with HR loss in the metastatic setting. Primary tumors that lose HR appear more similar to basal-like than luminal tumors, despite >10% baseline HR expression in most pts, and once metastatic, survival is comparable to pTN/mTN. Metastases with HR loss have higher TMB than those that remain HR+ or TN throughout the course of the disease. These findings, if confirmed, may influence treatment and pt selection for clinical trials.

Citation Format: Garrido-Castro AC, Hughes ME, Cherniack A, Barroso-Sousa R, Bychkovsky BL, Di Lascio S, Berger A, Mittendorf EA, Files JL, Guo H, Kumari P, Cerami E, Krop IE, Wagle N, Lindeman NI, MacConaill LE, Dillon DA, Winer EP, Lin NU. Genomic alterations associated with loss of HR expression in metastatic breast cancer [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 PD9-01.

Abstract P4-04-02: Identifying ERBB-2 activating mutations (mts) in HER2 negative tumors for clinical trials – Impact of institute-wide genomic testing and trial matching on trial enrollment in clinical practice

Introduction

Tailored treatment trials with biomarker-driven hypotheses are becoming an important strategy in drug development. Umbrella, basket and enrichment trials with eligibility predicated upon results of tumor sequencing are increasingly common. Several institutional and commercial genomic assays have been developed. However, the value of broad-based testing in recruiting patients (pts) to molecular-based clinical trials designed for small subgroups has not been fully evaluated and has been challenging to assess in a real-world setting. We evaluated the likelihood of trial enrollment based upon an institute-wide genomic test.

Methods

Since 2013, all pts with metastatic breast cancer (MBC) seen at least once at Dana-Farber Cancer Institute have been offered the option of tumor sequencing using multiplexed copy number variation (CNV) and mts detection across the full coding regions of a total of 447 cancer genes and 191 regions across 60 genes for rearrangement detection (Oncopanel; OP). For our primary analysis, we selected the ongoing multi-center phase II trial (NCT01670877) activated at our site on Sep 30, 2013, evaluating neratinib in ERBB-2 mutated pts, as the study provided a clear delineation of eligible mts, and timing of slot availability was retrievable retrospectively over an extended time frame. Our primary aim was to describe the proportion of pts with a qualifying ERBB-2 mt detected by OP who enrolled on the selected trial. Secondary objectives included median time from OP result to trial registration and description of ERBB-2 mts spectrum within each subtype. Associations were calculated by Fisher's test.

Results

We identified a total of 1,046 pts with HER-2 negative MBC and who had OP results between Sep 1, 2013 and Jun 1, 2017. A total of 43 pts (4.1%) were found to have ERBB-2 mts. Of these, 20 (1.9%) had activating eligible mts. The proportion of these pts who enrolled in the trial was 30% (6/20). Of the remaining 14 pts, 5 screen-failed and 2 were enrolled with known ERBB-2 mt through other testing modalities. Seven of 20 (35%) molecularly eligible pts were not approached (3 pts lost to follow-up, 3 enrolled in other clinical trials and 1 pt chose standard treatment). The median time from OP result to trial enrollment was 85 days (34-554). A significantly higher frequency of ERBB2 activating mts was found in ER+ compared to ER- primary tumors (2.5% vs. 0.3%, p =0.036), and in lobular tumors compared with ductal (5.5% vs. 1.25%, p=0.003). Frequency of eligible mts in primary tumors were similar to metastatic site (1.9% and 1.8%, respectively p=1.0)

Discussion

In this cohort, activating ERBB-2 mts were present in 20 of 1046 (1.9%) pts tested. Although over half of pts with eligible mts on OP testing were approached for NCT01670877, only 0.5% of the total tested population were enrolled (6/1046). Our data illustrate the substantial challenges in screening and enrolling to trials of rare subsets, even within a large academic institution, and point to the need for creative and novel approaches to leverage pts and community- and academic-based providers to more effectively support the success of such studies.

Citation Format: Exman P, Garrido-Castro A, Hughes ME, Freedman RA, Ma C, Bose R, Cerami E, Wagle N, Barroso-Sousa R, Fitz CD, Lindeman NI, MacConaill L, Bychkovsky BL, Lloyd MR, Mackichan CR, Kumari P, Tolaney SM, Krop IE, Winer EP, Dillon DA, Lin NU. Identifying ERBB-2 activating mutations (mts) in HER2 negative tumors for clinical trials – Impact of institute-wide genomic testing and trial matching on trial enrollment in clinical practice [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 P4-04-02.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2016

Leaves of wheat infected with the leaf rust fungus Puccinia triticina were obtained from farm fields and breeding plots at experimental stations in the Great Plains, Ohio River Valley, and southeastern states in 2016 in order to identify virulence phenotypes prevalent in the United States in different wheat-growing regions. In total, 496 single uredinial isolates derived from the leaf rust collections were tested for virulence to 20 lines of Thatcher wheat that differ for single leaf rust resistance genes. In total, 71 virulence phenotypes were described in the United States in 2016. The three most common virulence phenotypes across the United States were MBTNB, MBDSD, and TNBJJ. Phenotype MBTNB is virulent to Lr11, and was most common in the soft red winter wheat region of the southeastern states and Ohio Valley. Phenotype MBDSD is virulent to Lr17 and Lr39, and was most common in the hard red winter wheat area of the southern Great Plains. Phenotype TNBJJ is virulent to Lr24 and Lr39, which are present in the hard red winter wheat cultivars. The P. triticina population in the United States was characterized by two major regional groups of virulence phenotypes in the Great Plains region where hard red winter and spring wheat cultivars are grown, and in the southeastern states and Ohio Valley region where soft red winter wheat cultivars are grown. Isolates from New York State differed the most for virulence compared with the other two major regions.

Tidal and diel orchestration of behaviour and gene expression in an intertidal mollusc

Intertidal inhabitants are exposed to the 24-hour solar day, and the 12.4 hour rising and falling of the tides. One or both of these cycles govern intertidal organisms' behaviour and physiology, yet little is known about the molecular clockworks of tidal rhythmicity. Here, we show that the limpet Cellana rota exhibits robust tidally rhythmic behaviour and gene expression. We assembled a de-novo transcriptome, identifying novel tidal, along with known circadian clock genes. Surprisingly, most of the putative circadian clock genes, lack a typical rhythmicity. We identified numerous tidally rhythmic genes and pathways commonly associated with the circadian clock. We show that not only is the behaviour of an intertidal organism in tune with the tides, but so too are many of its genes and pathways. These findings highlight the plasticity of biological timekeeping in nature, strengthening the growing notion that the role of 'canonical' circadian clock genes may be more fluid than previously thought, as exhibited in an organism which has evolved in an environment where tidal oscillations are the dominant driving force.

Abstract P4-10-04: EMBRACE (Ending metastatic breast cancer for everyone): A comprehensive approach to improve the care of patients with metastatic breast cancer

Background: In contrast to early stage breast cancer, the quality of care for patients with metastatic breast cancer (MBC) has been relatively understudied, as have interventions to improve care in the real-world setting. Patients with MBC face a variety of unique needs related to their disease, treatment options, and supportive care. Little attention has been focused on leveraging the strengths of academic and community-based settings to provide optimal care for these patients. To address these critical issues, we have designed and implemented a comprehensive program that combines clinical care, clinical research, physician engagement and patient education to optimize the care of MBC patients.

Methods: We developed a consistent and comprehensive intake process and follow-up approach for MBC patients who were seen at least once in the Breast Oncology Clinic (BOC) at Dana-Farber Cancer Institute (DFCI). A key component of our approach is the EMBRACE coordinator who meets with each MBC patient at the first clinic visit to review the clinical program, available educational and supportive resources, and consents to research studies. Each coordinator supports the DFCI-based oncologist and follows a discrete patient panel longitudinally, for whom they are responsible for facilitating referrals to supportive care resources, identifying potential candidates for trial prescreening, tracking availability of results from molecular testing for clinical trial matching, facilitating communication between DFCI-based providers and referring providers and organizing re-consultation visits when clinically appropriate. The coordinator contacts patients every 3 months to inquire about the patient's overall health and needs and provides updates on upcoming educational and supportive care activities at our institution. Educational offerings have been expanded to include a bi-annual newsletter, quarterly email updates, webcasts and an annual educational patient forum. Results: The program was fully implemented in the BOC across 27 oncologists in August 2016, after the start of a pilot in July 2015. On average, the program enrolls 30 to 40 new MBC patients per month at their initial visit. The EMBRACE coordinators currently support the DFCI-based oncologists in the care of approximately 1500 new and existing MBC patients and facilitate collaborations with 350 referring providers.

Conclusions: The EMBRACE program has made a tangible improvement in the quality of care for patients with MBC in our clinic. We have successfully established the infrastructure of the coordinator role and a robust tracking system to support the patient, DFCI-based provider, and referring provider. While the program has been solely based at DFCI, we believe that our approach has the potential for impact beyond our institution and ultimately serve as a model for enhanced academic-community-patient partnership.

Citation Format: Hughes ME, Frank ES, Merrill MS, Santiago RA, Kuhnly N, Crowley LM, Gupta G, Winer EP, Lin NU. EMBRACE (Ending metastatic breast cancer for everyone): A comprehensive approach to improve the care of patients with metastatic breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-04.

Abstract GS3-07: Genome-wide copy number analysis of chemotherapy-resistant metastatic triple-negative breast cancer from cell-free DNA

Introduction:

Triple-negative breast cancer (TNBC) is a poor prognosis breast cancer subset characterized by relatively few mutations but extensive copy number alterations (CNAs). Cell-free DNA (cfDNA) offers the potential to overcome infrequent tumor biopsies in metastatic TNBC (mTNBC) and interrogate the genomics of chemotherapy resistance.

Methods:

506 archival or fresh plasma samples were identified from 164 patients with mTNBC who had previously received chemotherapy. We performed low coverage whole genome sequencing to determine genome-wide copy number and estimate 'tumor fraction' of cfDNA (TFx) using our recently-developed approach, ichorCNA. In patient samples with TFx >10%, we identified regions that were significantly gained or lost using GISTIC2.0. We compared CNAs of 20 paired primary-metastatic samples and also mTNBCs from cfDNA versus primary TNBCs from TCGA and METABRIC.

Results:

We successfully obtained high quality, low coverage whole genome sequencing data for 478 (94.5%) plasma samples from 158 patients, with 1 to 14 samples per patient. TFx and copy number profiles were highly concordant with paired metastatic biopsy (n=10, range 0-7 days from biopsy to blood draw) with sensitivity of 0.86 and specificity of 0.90 and reproducible in independently-processed blood draws (TFx intraclass correlation coefficient 0.984). Median overall survival from time of first blood draw was 8 months, and TFx was highly correlated independent of primary stage, primary receptor status, age at primary diagnosis, BRCA status, and metastatic line of therapy: adjusted hazard ratio between 4th and 1st quartiles = 2.14 (95% CI 1.40-3.28; p=0.00049). 101/158 patients (63.9%) had at least one sample with TFx >10%, our threshold for high confidence CNA calls. Copy number profiles and percent genome altered were remarkably similar between mTNBCs and primary TNBCs in TCGA and METABRIC (n=433), suggesting that large-scale chromosomal events are infrequent in TNBC metastatic progression. We identified chromosomal gains that demonstrated significant enrichment in mTNBCs relative to paired primary TNBCs (n=20) and also TCGA/METABRIC, including driver genes (NOTCH2, AKT2, AKT3) and putative antibody-drug conjugate targets. Finally, we identify a novel association of gains of 18q11 and/or 19p13 with poor metastatic prognosis, independent of clinicopathologic factors and TFx.

Conclusions:

Here, we present the first large-scale genomic characterization of metastatic TNBC to our knowledge, derived exclusively from cfDNA. 'Tumor fraction' of cfDNA is an independent prognostic marker in mTNBC. Primary and metastatic TNBC have remarkably similar copy number profiles yet we identify alterations enriched and prognostic in mTNBC. Collectively, these data have potential implications in the understanding of metastasis, therapeutic resistance, and novel therapeutic targets.

Citation Format: Stover DG, Parsons HA, Ha G, Freeman S, Barry B, Guo H, Choudhury A, Gydush G, Reed S, Rhoades J, Rotem D, Hughes ME, Dillon DA, Partridge AH, Wagle N, Krop IE, Getz G, Golub TA, Love JC, Winer EP, Tolaney SM, Lin NU, Adalsteinsson VA. Genome-wide copy number analysis of chemotherapy-resistant metastatic triple-negative breast cancer from cell-free DNA [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS3-07.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2015

Leaves of wheat infected with the leaf rust fungus, Puccinia triticina, were obtained from farm fields and breeding plots at experimental stations in the Great Plains, Ohio River Valley, and southeastern states in 2015 in order to identify virulence phenotypes prevalent in the United States in different wheat growing regions. A total of 526 single uredinial isolates derived from the leaf rust collections were tested for virulence to 20 lines of Thatcher wheat that differ for single leaf rust resistance genes. A total of 60 virulence phenotypes were described in the United States in 2015. The three most common virulence phenotypes across the United States were MBDSD, MBTNB, and TBBGS. Phenotype MBDSD is virulent to Lr17, Lr37, and Lr39, and was most common in the hard red winter wheat area of the southern Great Plains. Phenotype MBTNB is virulent to Lr11, and was most common in the soft red winter wheat region of the southeastern states and Ohio Valley. Phenotype TBBGS is virulent to Lr39, which is present in the hard red winter wheat cultivars, and Lr21, which is present in the hard red spring wheat cultivars. The P. triticina population in the United States was characterized by two major regional groups of virulence phenotypes in the Great Plains region where hard red winter and spring wheat cultivars are grown, and in the southeastern states and Ohio Valley region where soft red winter wheat cultivars are grown.

Abstract P1-12-08: The incidence and outcomes of brain metastases in HER2-positive metastatic breast cancer with the advent of modern anti-HER2 therapies

Background: Human epidermal growth factor receptor 2 (HER2) is over-expressed in approximately 20 - 30% of breast cancers. HER2-positive breast cancers frequently metastasize to the brain. In recent years, many new drugs have been approved for HER2-positive metastatic breast cancer (MBC). In the metastatic setting, trastuzumab was approved in 2000, lapatinib 2007, and pertuzumab and ado-trastuzumab emtansine in 2012. We sought to describe the incidence, time course, and prognostic factors of BM in patients (pts) with HER2+ MBC during the time when dramatic changes in systemic therapy occurred.

Patients/methods: The study included pts with HER2-positive MBC treated at two academic hospitals: Dana Farber Cancer Institute (DFCI) (2000-2007 [DFCI-T1], 2008-2011 [DFCI-T2]) and University of North Carolina (UNC) (2012-2014). We examined the incidence of BM (at diagnosis [dx] and within 1-2 years of MBC dx). We combined the two cohorts to examine outcomes – time to BM, survival following MBC, and survival following BM – using the Kaplan Meier method and Cox regression modeling.

Results: We identified 185 (DFCI n=128, 97 diagnosed 2000-2007 and 31 diagnosed 2008-2011; UNC n=57, all diagnosed 2012-2014) pts with HER2-positive MBC. Through a median of 4 years follow-up after the MBC dx (min 2, max 11), 118 had died and 67 were censored. The median age at MBC dx was 52 (min 25, max 88), 149 (82%) were Caucasian, 88 (48%) had hormone receptor (HR) positive BC, and 67 (37%) had de-novo (i.e., non-recurrent) MBC. BM was present at the MBC dx for 8% of pts in DFCI-T1, 16 % of pts in DFCI-T2, and 16% of pts at UNC. Within 1 year of the MBC dx, BM was present in 21% of DFCI-T1, 29% in DFCI-T2, 23% of UNC pts. Within 2 years of the MBC dx, 67 (36%) pts had developed BM, of which one third (22) were diagnosed at initial MBC presentation. In unadjusted analyses, there were no differences in time to BM dx by age (p=0.2), race (p=0.1) or HR status (p=0.1). The median survival following the development of BM for all pts was 1.5 years. A multivariable model predicting survival after the MBC dx, found factors associated with shorter survival included having (vs. not having) BM at the initial MBC dx, having received (vs. not having received) adjuvant HER2-directed therapy prior to the MBC dx, and having recurrent (vs. de novo) MBC (P≤0.02 for all). Age, HR status, race and time period of MBC dx were not significant in the multivariable model.

Conclusions: Among pts diagnosed in the modern era, after new therapies became available, BM remains a common problem for pts with HER2-positive MBC. While no obvious trends in the incidence of HER2-positive MBC are suggested, conclusions regarding incidence trends should be considered hypothesis-generating until larger, population-based data become available. Nevertheless, a dx of BM early in the course of MBC treatment and prior receipt of adjuvant trastuzumab appeared to confer a more aggressive disease course. Coordinated, prospective collection of the incidence and outcomes of BM among pts with HER2-positive MBC, studies of pts who develop BM >2 years after their MBC dx, and clinical trials of treatment strategies for pts with trastuzumab-resistant BM are needed.

Citation Format: Strulov Shachar S, Deal AM, Vaz-Luis I, Dees EC, Carey LA, Hassett MJ, Garrett AL, Benbow JM, Hughes ME, Mounsey L, Lin N, Anders CK. The incidence and outcomes of brain metastases in HER2-positive metastatic breast cancer with the advent of modern anti-HER2 therapies [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-12-08.

A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies

Most studies of social relationships in later life focus on the amount of social contact, not on individuals' perceptions of social isolation. However, loneliness is likely to be an important aspect of aging. A major limiting factor in studying loneliness has been the lack of a measure suitable for large-scale social surveys. This article describes a short loneliness scale developed specifically for use on a telephone survey. The scale has three items and a simplified set of response categories but appears to measure overall loneliness quite well. The authors also document the relationship between loneliness and several commonly used measures of objective social isolation. As expected, they find that objective and subjective isolation are related. However, the relationship is relatively modest, indicating that the quantitative and qualitative aspects of social relationships are distinct. This result suggests the importance of studying both dimensions of social relationships in the aging process.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2014

Collections of Puccinia triticina obtained from wheat fields and breeding plots in the Great Plains, Ohio River Valley, and southeastern states, were tested for virulence in 2014 in order to determine the virulence of the wheat leaf rust pathogen population in the United States. Single uredinial isolates (380 total) were derived from the collections and tested for virulence phenotype on 20 lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes. In 2014, 55 virulence phenotypes were described in the United States. Virulence phenotypes MBTNB, TBBGS, and TCRKG were the three most common phenotypes. Phenotypes MBTNB and TCRKG are both virulent to Lr11, and TCRKG is also virulent to Lr18 and Lr26. MBTNB and TCRKG were most common in the soft red winter wheat region of the southeastern states and the Ohio Valley. Phenotype TBBGS is virulent to Lr39, which is present in the hard red winter wheat cultivars, and Lr21, which is present in the hard red spring wheat cultivars. Isolates with virulence to Lr11, Lr18, and Lr26 were most common in the southeastern states and Ohio Valley region. Isolates with virulence to Lr21 and Lr39 were most common in the hard red wheat region of the southern and northern Great Plains.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2013

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from wheat fields and breeding plots by USDA-ARS personnel and cooperators in the Great Plains, Ohio River Valley, and southeastern states in order to determine the virulence of the wheat leaf rust population in 2013. Single uredinial isolates (490 total) were derived from the collections and tested for virulence phenotype on 20 lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes. In 2013, 79 virulence phenotypes were described in the United States. Virulence phenotypes MBTNB, TNBGJ, and MCTNB were the three most common phenotypes. Phenotypes MBTNB and MCTNB are both virulent to Lr11, and MCTNB is virulent to Lr26. MBTNB and MCTNB were most common in the soft red winter wheat region of the southeastern states and Ohio Valley. Phenotype TNBGJ is virulent to Lr39/41 and was widely distributed throughout the hard red winter wheat region of the Great Plains. Isolates with virulence to Lr11, Lr18, and Lr26 were common in the southeastern states and Ohio Valley region. Isolates with virulence to Lr21, Lr24, and Lr39/41 were frequent in the hard red wheat region of the southern and northern Great Plains.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2012

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from wheat fields and breeding plots by United States Department of Agriculture-Agricultural Research Service personnel and cooperators in the Great Plains, Ohio River Valley, southeastern states, and Washington State and Idaho in order to determine the virulence of the wheat leaf rust population in 2012. Single uredinial isolates (501 in total) were derived from the collections and tested for virulence phenotype on 20 lines of 'Thatcher' wheat that are near-isogenic for leaf rust resistance genes. In 2012, 74 virulence phenotypes were described in the United States. Virulence phenotypes TNBGJ, TCRKG, and MBTNB were the three most common phenotypes. Phenotype TNBGJ is virulent to Lr39/41 and was widely distributed throughout the hard red winter wheat region of the Great Plains. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and was found mostly in the soft red winter wheat region in the eastern United States. Phenotype MBTNB is virulent to Lr11 and was also found mostly in the soft red winter wheat region. The frequency of isolates with virulence to Lr39/41, which is present in many hard red winter wheat cultivars in the Great Plains region, continued to increase. Isolates with virulence to Lr21, which is present in many hard red spring wheat cultivars, also continued to increase in frequency in the northern Great Plains region.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2011

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from wheat fields and breeding plots by USDA-ARS personnel and cooperators in the Great Plains, Ohio River Valley, southeastern states, Oregon, and Washington State in order to determine the virulence of the wheat leaf rust population in 2011. Single uredinial isolates (440 total) were derived from the collections and tested for virulence phenotype on 18 lines of Thatcher wheat and a winter wheat line that are near-isogenic for 19 leaf rust resistance genes. In 2011, 87 virulence phenotypes were described in the United States. Virulence phenotypes TBBGJ, MLDSD, and TCRKG were the three most common phenotypes. Phenotype TBBGJ is virulent to Lr39/41 and was widely distributed throughout the hard red winter wheat region of the Great Plains. Phenotype MLDSD is virulent to Lr17 and Lr39/41 and was widely distributed throughout the United States. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and was found mostly in the soft red winter wheat region in the eastern United States. Isolates with virulence to Lr39/41 and avirulence to Lr9 were prevalent in the Great Plains region for the first time. Virulence to Lr21 was present in five virulence phenotypes mostly from the spring wheat region of the northern Great Plains.

Grandparents Providing Care to Grandchildren: A Population-Based Study of Continuity and Change

This study examines transitions in grandchild care and the characteristics of grandparents making these transitions, using longitudinal data from a nationally representative sample of 13,626 grandparents in the 1998-2008 Health and Retirement Study. More than 60% of grandparents provided grandchild care over the 10-year period; more than 70% of those did it for 2 years or more. Grandparents with fewer functional limitations and more economic resources were more likely to start or continue nonresidential care, whereas relatively disadvantaged grandparents were more likely to start and continue coresidential care. Grandparents who were African American, younger, married, living with fewer minor children of their own, or had more grandchildren were more likely to start care, particularly nonresidential care. African Americans and Hispanics were more likely than Whites to start and continue coresidential care. These findings demonstrate the heterogeneity of caregiving and point to the lack of resources among those who provide coresidential care.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2010

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from wheat fields and breeding plots by United States Department of Agriculture-Agricultural Research Service personnel and cooperators in the Great Plains, Ohio River Valley, southeastern states, Oregon, and Washington State in order to determine the virulence of the wheat leaf rust population in 2010. Single uredinial isolates (537 total) were derived from the collections and tested for virulence phenotype on 19 lines of 'Thatcher' wheat and a winter wheat line that are near-isogenic for 20 leaf rust resistance genes. In 2010, 38 virulence phenotypes were described in the United States. Virulence phenotypes MLDSD, TDBJG, and TCRKG were the three most common phenotypes. Phenotype MLDSD is virulent to Lr17 and Lr39/Lr41 and was widely distributed throughout the United States. Phenotype TDBJG is virulent to Lr24 and was found in both the soft red winter wheat and hard red winter wheat regions. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and was found mostly in the soft red winter wheat region in the eastern United States. Virulence to Lr21 was found for the first time in North America in isolates collected from spring wheat cultivars in North Dakota and Minnesota.

P1-11-02: Racial/Ethnic Differences in Adjuvant Trastuzumab Receipt for Women with Breast Cancer within the National Comprehensive Cancer Network

Background Racial/ethnic disparities in breast cancer care are well documented. Although adjuvant trastuzumab has been shown to improve disease outcomes for women with Human Epidermal Growth Factor Receptor 2 (HER2)-positive cancers, the ‘real world’ utilization and toxicity of adjuvant trastuzumab are unknown. Because therapy involves one year of treatment and the costs of treatment are high, a risk for treatment disparity exists. We examined differences in receipt and completion of adjuvant trastuzumab by race/ethnicity, education, employment, and insurance for women diagnosed with HER2−positive breast cancer.

Methods Using the National Comprehensive Cancer Network (NCCN) Breast Cancer Outcomes Database, we identified 1,146 women with stage I-III HER-2 positive breast cancer who presented to participating NCCN institutions during 2005–2008. In multivariable logistic analyses, we assessed the effect of race/ethnicity on the likelihood of trastuzumab therapy, and among women who initiated trastuzumab, the likelihood of completing ≥ 270 days of therapy, adjusting for center, diagnosis year, age, insurance, comorbidity, education, employment, and tumor characteristics. We also examined reasons for discontinuation of therapy among those who stopped treatment prematurely.

Results Among patients eligible for this analysis, 75% women were Caucasian, 9% were African-American, and 9% were Hispanic. Most women had managed care insurance (71%) and were employed/student (52%). About one-third (36%) had a college degree and 39% had a high school education or less. Overall, most women (82%) received neo/adjuvant trastuzumab and there were no racial/ethnic differences in receipt of therapy (adjusted odds ratio [OR] 1.11, 95% confidence interval [CI] .72-1.71 for African-American and OR 1.39, 95% CI .76-2.54 for Hispanic, versus Caucasian women). Among the 769 women who initiated neo/adjuvant trastuzumab and had ≥ 365 days of follow-up, 84% completed ≥ 270 days of trastuzumab. Rates of completion were lower for African-American (72%) and Hispanic (82%) women than Caucasian women (85%). In adjusted analyses, African-American women but not Hispanic women had lower odds of completing therapy compared with Caucasian women (OR .45, 95% CI .29-.70, p=0.0003). Indemnity insurance (versus managed care) was associated with lower odds of trastuzumab completion, as was having a high school education or less (versus college education). Among the 123 women who did not complete trastuzumab, 26% stopped early for toxicity, and this occurred more frequently for African-American women than Caucasian women (50% vs. 21%), but small sample precluded a meaningful test for statistical significance.

Conclusion: Compared with Caucasian women, African-American women had similar rates of initiation of adjuvant trastuzumab but much lower rates of completion that were not explained by differences in education, employment, or insurance. Because of the significant benefits conferred by adjuvant trastuzumab therapy for HER2−positive breast cancer, interventions to assure completion of therapy could lead to improved outcomes. Further exploration of racial differences in toxicity and tolerance of therapy are also warranted.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-02.

P1-08-05: Age and Survival in Women with Early Stage Breast Cancer: An Analysis Controlling for Tumor Subtype

Background: Previous research has suggested that young age at diagnosis is an independent risk factor for breast cancer recurrence and death in women with early stage breast cancer. However, young women are more likely to have aggressive subtypes of breast cancer. No prior studies have adequately controlled for tumor phenotype, including HER-2/neu (HER2) status, in particular. Recent evidence has suggested that the prognostic effect of young age varies by tumor subtype.

Methods: We examined data from women with newly diagnosed Stage 1–3 breast cancer presenting to one of 8 NCCN centers between January 2000 and December 2007. Multivariate Cox proportional hazards models were used to assess the relationship between age and breast cancer specific survival, controlling for known prognostic factors and treatment. In addition, we conducted stratified analyses by estrogen receptor (ER) and HER2 status.

Results: 19,633 women with Stage 1–3 breast cancer eligible for analysis including 2,177 (11%) who were age 40 years or younger at diagnosis. Younger women were more likely to be non-white or Hispanic, more educated, employed, and to have higher stage, high grade, ER-negative, progesterone receptor (PR) negative, and HER2−positive disease, and treated with chemotherapy and trastuzumab (all variables P< 0.0001 by Chi-Square test). 5-year survival among younger women was 94.1 (95% Confidence Interval [CI] 92.9−95.3) and 96.3 (95% CI 95.9−96.6) for older women. In a multivariate Cox proportional hazards model controlling for sociodemographic, disease, and treatment characteristics, women age < 40 or younger at diagnosis had increased mortality compared to older women (Hazard Ratio [HR] 1.26, 95% CI 1.02−1.56). In stratified analyses, age 40 or less was associated with increased mortality among women with ER-positive disease (HR 1.44, 95% CI 1.01−2.05), but was not among those with ER-negative disease (HR 1.15, 95% CI 0.85−1.55). Younger age was associated with a statistically significant increase in mortality among women with HER2−negative disease (HR 1.29, 95% CI 1.00−1.68), but this difference did not reach statistical significance among those with HER2−positive disease (HR 1.30, 95% CI 0.82−2.09). Conclusions: The effect of age on short-term survival of women with early breast cancer appears to vary by breast cancer subtype, particularly ER status. Further research to elucidate differences in breast cancer biology and efficacy of therapy within tumor types by age is warranted.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-05.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2009

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from surveys of wheat (Triticum aestivum) fields and wheat breeding plots by United States Department of Agriculture-Agricultural Research Service personnel in the Great Plains, Ohio River Valley, southeast, California, and Washington State in order to determine the virulence of the wheat leaf rust population in 2009. Single uredinial isolates (591 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, and Lr28 and a winter wheat line with Lr39/41. Forty-one virulence phenotypes were described. Virulence phenotypes MLDSD, TCRKG, and TDBGG were the three most common phenotypes. Phenotype MLDSD is virulent to Lr17 and Lr39/Lr41 and was widely distributed throughout the United States. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and is found mostly in the soft red winter wheat region in the eastern United States. TDBGG is virulent to Lr24 and was found in both the soft red winter wheat and hard red winter wheat regions. Virulence to Lr21 was not found in any of the tested isolates. Virulence to Lr11, Lr18, and Lr26 increased in 2009 in the soft red winter wheat regions. Virulence to Lr17 and Lr39/Lr41 increased in the Great Plains region. Two separate epidemiological zones of P. triticina in the soft red winter wheat region of the southern and eastern states and in the hard red wheat region of the Great Plains were described.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2008

Collections of Puccinia triticina were obtained from rust-infected wheat (Triticum aestivum) leaves provided by cooperators throughout the United States and from surveys of wheat fields and wheat breeding plots by USDA-ARS personnel in the Great Plains, Ohio River Valley, Southeast, and Washington State in order to determine the virulence of the wheat leaf rust population in 2008. Single uredinial isolates (730 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, Lr28, and a winter wheat line with Lr41. Forty-eight virulence phenotypes were described. Virulence phenotypes TDBGG, TCRKG, and MLDSD were the three most common phenotypes. TDBGG is virulent to Lr24 and was found in both the soft red winter wheat and hard red winter wheat regions. Phenotype TCRKG is virulent to Lr11, Lr18, and Lr26 and is found mostly in the soft red winter wheat region in the eastern United States. Phenotype MLDSD is virulent to Lr17 and Lr41 and was widely distributed in the Great Plains. Virulence to Lr21 was not found in any of the tested isolates. Virulence to Lr11 and Lr18 increased in 2008 in the soft red winter wheat regions. Two separate epidemiological zones of P. triticina in the soft red winter wheat region of the southern and eastern states and in the hard red wheat region of the Great Plains were described.

Marital biography and health at mid-life

This article develops a series of hypotheses about the long-term effects of one's history of marriage, divorce, and widowhood on health, and it tests those hypotheses using data from the Health and Retirement Study. We examine four dimensions of health at mid-life: chronic conditions, mobility limitations, self-rated health, and depressive symptoms. We find that the experience of marital disruption damages health, with the effects still evident years later; among the currently married, those who have ever been divorced show worse health on all dimensions. Both the divorced and widowed who do not remarry show worse health than the currently married on all dimensions. Dimensions of health that seem to develop slowly, such as chronic conditions and mobility limitations, show strong effects of past marital disruption, whereas others, such as depressive symptoms, seem more sensitive to current marital status. Those who spent more years divorced or widowed show more chronic conditions and mobility limitations.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2007

In 2007, leaf rust of wheat was severe throughout the Great Plains region of North America. Yield losses in wheat due to leaf rust were estimated to be 14% in Kansas. Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio River Valley, southeast, California, and Washington State in order to determine the virulence of the wheat leaf rust population in 2007. Single uredinial isolates (868 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, and Lr28, and on winter wheat lines with genes Lr41 and Lr42. Fifty-two virulence phenotypes were found. Virulence phenotypes TDBJG, MFPSC, and TDBJH were among the four most common phenotypes and were all virulent to resistance gene Lr24. These phenotypes were found throughout the Great Plains region. Phenotype MLDSD, with virulence to Lr9, Lr17, and Lr41, was also widely distributed in the Great Plains. In the soft red winter wheat region of the southeastern states, phenotypes TCRKG, with virulence to genes Lr11, Lr26, and Lr18, and MFGJH, with virulence to Lr24, Lr26, and Lr11, were among the common phenotypes. Virulence phenotypes with virulence to Lr16 were most frequent in the spring wheat region of the northern Great Plains. Virulence phenotypes with virulence to Lr11, Lr18, and Lr26 were most common in the soft red winter areas of the southeastern states and Ohio Valley. Virulence to Lr21 was not found in any of the tested isolates.

From social structural factors to perceptions of relationship quality and loneliness: the Chicago health, aging, and social relations study

OBJECTIVE

The objective of this study was to test a conceptual model of loneliness in which social structural factors are posited to operate through proximal factors to influence perceptions of relationship quality and loneliness.

METHODS

We used a population-based sample of 225 White, Black, and Hispanic men and women aged 50 through 68 from the Chicago Health, Aging, and Social Relations Study to examine the extent to which associations between sociodemographic factors and loneliness were explained by socioeconomic status, physical health, social roles, stress exposure, and, ultimately, by network size and subjective relationship quality.

RESULT

Education and income were negatively associated with loneliness and explained racial/ethnic differences in loneliness. Being married largely explained the association between income and loneliness, with positive marital relationships offering the greatest degree of protection against loneliness. Independent risk factors for loneliness included male gender, physical health symptoms, chronic work and/or social stress, small social network, lack of a spousal confidant, and poor-quality social relationships.

DISCUSSION

Longitudinal research is needed to evaluate the causal role of social structural and proximal factors in explaining changes in loneliness.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2006

Collections of Puccinia triticina were obtained from rust-infected leaves provided by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio River Valley, southeast, California, and Washington State in order to determine the virulence of the wheat leaf rust population in 2006. Single uredinial isolates (718 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr2, and Lr28 and winter wheat lines with genes Lr41 and Lr42. In the United States in 2006, 56 virulence phenotypes were found. Virulence phenotypes TDBJG, TDBGG, and TDBJH were among the four most common phenotypes and were all virulent to resistance gene Lr24. These phenotypes were found throughout the Great Plains region. Phenotype MLDSD with virulence to Lr9, Lr17, and Lr41 was also widely distributed in the Great Plains. In the soft red winter wheat region of the southeastern states, phenotypes TCRKG and MBRKG with virulence to genes Lr11, Lr26, and Lr18 were among the common phenotypes. Virulence phenotypes with virulence to Lr16 were most frequent in the spring wheat region of the northern Great Plains. Virulence to Lr21 was not found in any of the tested isolates.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2005

Collections of Puccinia triticina were obtained from rust-infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio River Valley, southeast, California, and Washington State, in order to determine the virulence of the wheat leaf rust population in 2005. Single uredinial isolates (797 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, Lr28, and winter wheat lines with genes Lr41 and Lr42. In the United States in 2005, 72 virulence phenotypes of P. triticina were found. Virulence phenotype TDBGH, selected by virulence to resistance gene Lr24, was the most common phenotype in the United States, and was found throughout the Great Plains region. Virulence phenotype MCDSB with virulence to Lr17a and Lr26 was the second most common phenotype and was found widely in the wheat growing regions of the United States. Virulence phenotype MFPSC, which has virulence to Lr17a, Lr24, and Lr26, was the third most common phenotype, and was found in the Ohio Valley region, the Great Plains, and California. The highly diverse population of P. triticina in the United States will continue to present a challenge for the development of wheat cultivars with effective durable resistance to leaf rust.

All in the family: the impact of caring for grandchildren on grandparents' health

OBJECTIVES

The purpose of this study was to examine the effects of caring for grandchildren on health behaviors and mental and physical health among older adults.

METHODS

Using a sample of 12,872 grandparents aged 50 through 80 from the Health and Retirement Study, we examined the relationship between stability and change in various types of grandchild care and subsequent health, controlling for covariates and earlier health.

RESULTS

We found no evidence to suggest that caring for grandchildren has dramatic and widespread negative effects on grandparents' health and health behavior. We found limited evidence that grandmothers caring for grandchildren in skipped-generation households are more likely to experience negative changes in health behavior, depression, and self-rated health. We also found some evidence of benefits to grandmothers who babysit.

DISCUSSION

Our findings suggest that the health disadvantages found previously among grandparent caregivers arise from grandparents' prior characteristics, not as a consequence of providing care. Health declines as a consequence of grandchild care appear to be the exception rather than the rule. These findings are important given continuing reliance on grandparents for day care and increasing reliance on grandparents for custodial care. However, the findings should be tempered by the recognition that for a minority of grandparents, coresidential grandchild care may compromise health.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2004

Collections of Puccinia triticina were obtained from rust-infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, southeast, California, and Pacific Northwest, in order to determine the virulence of the wheat leaf rust population in 2004. Single uredinial isolates (757 in total) were derived from the collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3a, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17a, Lr30, LrB, Lr10, Lr14a, Lr18, Lr21, and Lr28, and winter wheat lines with genes Lr41 and Lr42. In the United States in 2004, 52 virulence phenotypes of P. triticina were found. Virulence phenotype MCDSB, selected by virulence to resistance genes Lr17a and Lr26, was the most common phenotype in the United States and was found in all wheat growing areas. Virulence phenotype TBBGG, with virulence to Lr2a, was the second most common phenotype and was found primarily in the spring wheat region of the north-central states. Virulence phenotype MBDSB, which has virulence to Lr17a, was the third most common phenotype and was found in all wheat growing areas except California. Phenotype TNRJJ, with virulence to genes Lr9, Lr24, and Lr41, was the fourth most common phenotype and occurred in the southeastern states and throughout the Great Plains region. Virulence phenotypes avirulent to a second gene in the Thatcher differential line with Lr1 increased in frequency in the United States in 2004. The highly diverse population of P. triticina in the United States will continue to present a challenge for the development of wheat cultivars with effective durable resistance.

Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses

The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2003

Collections of Puccinia triticina were obtained from rust infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Southeast, California, and the Pacific Northwest, in order to determine the virulence of the wheat leaf rust fungus in 2003. Single uredinial isolates (580 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17, Lr30, LrB, Lr10, Lr14a, and Lr18. In the United States in 2003, 52 virulence phenotypes of P. triticina were found. Virulence phenotype MBDS, which has been selected by virulence to resistance gene Lr17, was the most common phenotype in the United States. MBDS was found in the Southeast, Great Plains, the Ohio Valley, and California. Virulence phenotype THBJ, which has been selected by virulence to genes Lr16 and Lr26, was the second most common phenotype, and was found in the southern and northern central Great Plains region. Phenotype MCDS, which has been selected by virulence to genes Lr17 and Lr26, was the third most common phenotype and occurred in the same regions as MBDS. The use of wheat cultivars with leaf rust seedling resistance genes has selected leaf rust phenotypes with virulence to genes Lr9, Lr16, Lr17, Lr24, and Lr26. The population of P. triticina in the United States is highly diverse for virulence phenotypes, which will continue to present a challenge for the development of wheat cultivars with effective durable resistance.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2002

Collections of Puccinia triticina were obtained from rust-infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Southeast, California, and the Pacific Northwest, in order to determine the virulence of the wheat leaf rust fungus in 2002. Single uredinial isolates (785 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17, Lr30, LrB, Lr10, Lr14a, and Lr18. In the United States in 2002, 52 virulence phenotypes of P. triticina were found. Virulence phenotype MBDS, which is virulent to resistance gene Lr17, was the most common phenotype in the United States. MBDS was found in the Southeast, Great Plains, and the Ohio Valley regions, and also in California. Phenotype MCDS, virulent to Lr17 and Lr26, was the second most common phenotype and occurred in the same regions as MBDS. Virulence phenotype THBJ, which is virulent to Lr16 and Lr26, was the third most common phenotype, and was found in the southern and northern central Great Plains region. Phenotype TLGJ, with virulence to Lr2a, Lr9, and Lr11, was the fourth most common phenotype and was found primarily in the Southeast and Ohio Valley regions. The Southeast and Ohio Valley regions differed from the Great Plains regions for predominant virulence phenotypes, which indicate that populations of P. triticina in those areas are not closely connected. The northern and southern areas of the Great Plains were similar for frequencies of predominant phenotypes, indicating a strong south to north migration of urediniospores.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2001

Collections of Puccinia triticina were obtained from rust-infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Gulf Coast, California, Pacific Northwest, and Atlantic Coast States in order to determine the virulence of the wheat leaf rust fungus in 2001. Single uredinial isolates (477 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes Lr1, Lr2a, Lr2c, Lr3, Lr9, Lr16, Lr24, Lr26, Lr3ka, Lr11, Lr17, Lr30, LrB, Lr10, Lr14a, and Lr18. The isolates also were tested for virulence on adult plants with leaf rust resistance genes Lr12, Lr13, Lr22a, Lr22b, Lr34, Lr35, and Lr37. In the United States in 2001, 44 virulence phenotypes of P. triticina were found. Virulence phenotype MBDS, which is virulent to resistance gene Lr17, was the most common phenotype in the United States. MBDS was found in the Southeast, Great Plains, and Ohio Valley regions. Virulence phenotype THBJ, which is virulent to Lr16 and Lr26, was the second most common phenotype, and occurred almost exclusively in the north-central Great Plains region. Phenotype MCDS, which is virulent to Lr17 and Lr26, was the third most common phenotype and was found primarily in the Southeast, Ohio Valley, and Great Plains regions. The Southeast and Ohio Valley regions differed from the Great Plains region for predominant virulence phenotypes, which indicate that populations of P. triticina in those areas are not closely connected. The northern and southern areas of the Great Plains region differed for phenotypes with virulence to Lr16; however, the two areas had other phenotypes in common. Virulence to the adult plant resistance genes Lr35 and Lr37 was detected for the first time in North America in the MBDS, MCJS, and MCDS phenotypes.

Profile and activity of the bacterial biota of ground beef held from freshness to spoilage at 5-7 degrees C

Four samples of fresh ground beef were stored aerobically and held at 5-7 degrees C for up to 28 days. Although one sample initially yielded 21 different genera of bacteria while two others yielded only seven, all four spoiled essentially in the same way as assessed by aerobic, psychrotrophic, and Gram-negative counts, and by extract-release volume (ERV) and pH values. Pseudomonas spp. was dominant in the spoilage of all samples. As to why this group is so consistently associated with the low-temperature aerobic spoilage of fresh meats, it is hypothesized that they possess the capacity to form a biofilm and that quorum sensing is involved in the overall biofilm forming and functioning processes.

Effect of chronic intermittent immobilization stress on Fos-like immunoreactivity in rat brain and adrenal medulla

The present study examined the influence of short- and long-term chronic intermittent immobilization stress throughout the brain and on the adrenal medulla of intact rats using Fos-like immunoreactivity (Fos-LI) as a marker of cellular activation. The effect of adreno-medullectomy on the central nervous system (CNS) response to chronic immobilization stress was also examined. It was found that control unoperated, unstressed rats had no Fos-LI cells in the brain or in the adrenal medulla. In intact rats, neither short term (1 week) nor long term (4 weeks) chronic intermittent immobilization stress produced significant increases in Fos-LI in the CNS compared with control animals. However, marked increase in the number of Fos-LI cells was observed in the adrenal medulla of animals stressed for 4 weeks compared with control, unstressed animals or those stressed for 1 or 2 weeks. In adreno-medullectomised rats, 4 weeks, but not 1 week, chronic immobilization stress produced significant increases in numbers of Fos-LI neurons in the paraventricular hypothalamic and supraoptic nuclei and the medial amygdala compared with intact animals stressed for a similar period of time. It is concluded that long term stress produces chronic Fos-LI in the adrenal medulla and that adreno-medullectomy increases the Fos response of the PVN, supraoptic nucleus and medial amygdala to long term stress.

Physiologic Specialization of Puccinia triticina on Wheat in the United States in 2000

Collections of Puccinia triticina were obtained from rust infected wheat leaves by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, Gulf Coast, and Atlantic Coast States in order to determine the virulence of the wheat leaf rust fungus in 2000. Single uredinial isolates (1,120 in total) were derived from the wheat leaf rust collections and tested for virulence phenotype on 16 lines of Thatcher wheat that are near-isogenic for leaf rust resistance genes. In the United States in 2000, 54 virulence phenotypes of P. triticina were found. Virulence phenotypes MBDS and MCDS, which are virulent to resistance gene Lr17, were the first and third most common phenotypes in the United States and were found in the Great Plains and the Ohio Valley regions. MCRK, which is virulent to Lr26, was the second most common phenotype and was found primarily in the Southeast, Ohio Valley, and Northeast regions. In the northern area of the Great Plains, phenotypes with virulence to Lr16 increased in frequency from 1998 and 1999. The Southeast and Great Plains regions had different predominant virulence phenotypes, which indicates that populations of P. triticina in those areas are not closely connected. The northern and southern areas of the Great Plains region had the same predominant virulence phenotypes, indicating movement of virulence phenotypes of P. triticina within this region.

Health in household context: living arrangements and health in late middle age

People living in some arrangements show better health than persons in other living arrangements. Recent prospective studies document higher mortality among persons living in particular types of households. We extend this research by examining the influence of household structure on health using longitudinal data. We theorize that individuals experience role-based household relations as sets of resources and demands. In certain household structures, individuals are more likely to perceive that the demands made on them outweigh the resources available to them. This perceived imbalance poses a risk to individual health. We test our expectations by analyzing the relationship between living arrangements and health using data from waves 1 and 2 of the Health and Retirement Study. We focus on persons ages 51-61 and explore gender differences. We find prospective links between household structure and self-rated health, mobility limitation, and depressive symptoms. Married couples living alone or with children only are the most advantaged; single women living with children appear disadvantaged on all health outcomes. Men and women in other household types are disadvantaged on some health outcomes. Our results suggest that the social context formed by the household may be important to the social etiology of health. In addition, they qualify the well-known link between marital status and health: The effect of marital status on health depends on household context.

Virulence of Puccinia triticina on Wheat in the United States in 1999

Isolates of Puccinia triticina were obtained from wheat leaf collections made by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, and Gulf Coast states in 1999. Pathogenic races were determined from virulence/avirulence phenotypes on 14 host lines that are near-isogenic for leaf rust resistance. We found 58 races among 1,180 isolates in 1999. As in previous surveys, regional race distribution patterns showed that the central United States is a single epidemiological unit distinct from the eastern United States. The distinctive racial composition of collections from the Southeast, Northeast, and Ohio Valley indicates that populations of P. triticina in those areas are not closely connected, suggesting epidemics originate from localized overwintering sources.

Virulence of Puccinia triticina on Wheat in the United States from 1996 to 1998

Isolates of Puccinia triticina were obtained from wheat leaf collections made by cooperators throughout the United States and from surveys of wheat fields and nurseries in the Great Plains, Ohio Valley, and Gulf Coast states in 1996, 1997, and 1998. Virulence-avirulence phenotypes were determined on 14 host lines that are near-isogenic for leaf rust resistance. We found 31 phenotypes among 277 single uredinial isolates in 1996, 56 phenotypes among 989 isolates in 1997, and 43 phenotypes among 989 isolates in 1998. As in previous surveys, regional race distribution patterns showed that the central United States is a single epidemiological unit distinct from the eastern United States. The distinctive racial composition of collections from the southeast, northeast, and Ohio Valley indicate that populations of P. triticina in those areas are not closely connected, suggesting that epidemics originate from localized overwintering sources.

Interacting effects of multiple roles on women's health

Our study tests several hypotheses concerning the effects of employment, marriage, and motherhood on women's general physical health. These hypotheses predict how the health effect of each role varies, depending on specific role characteristics and the other roles a woman holds. Our analyses utilize longitudinal panel data for 3,331 women from the National Longitudinal Surveys of Young Women (follow-up intervals: 1978-83 and 1983-88). The Role Substitution Hypothesis proposes that employment and marriage provide similar resources (e.g., income and social support), and consequently, employment and marriage can substitute for each other in their beneficial effects on health. As predicted, we found that employment had beneficial effects on health for unmarried women, but little or no effect for married women. Similarly, marriage had beneficial effects on health only for women who were not employed. The Role Combination Strain Hypothesis proposes that employed mothers experience role strain, resulting in harmful effects on health. However, we found very little evidence that the combination of employment and motherhood resulted in harmful health effects. Contrary to the predictions of the Quantitative Demands Role Strain Hypothesis, it appears that neither longer hours of employment nor having more children resulted in harmful effects on health. As predicted by the Age-Related Parental Role Strain Hypothesis, younger age at first birth, particularly a teenage birth, appeared to result in more harmful health effects.

A behavioral intervention for improving verbal behaviors of heroin addicts in a treatment clinic

Positively reinforcing appropriate behaviors improved verbal behaviors of opioid-dependent patients in a buprenorphine treatment clinic. During B phases of an ABAB design, clients received stickers for engaging in appropriate verbal or nonverbal behaviors. Each sticker provided a chance of winning $25. No reinforcement was provided during the A phases. Appropriate verbal behaviors increased during reinforcement periods, and inappropriate verbal behaviors decreased.

Marital status effects on health: are there differences between never married women and divorced and separated women?

To test whether the effects of marital status on health differ between never married women and divorced and separated women, this study utilizes prospective panel data for a large national sample of non-institutionalized young women in the U.S. (the National Longitudinal Surveys of Young Women). The women were aged 24-34 at the beginning of two successive five-year follow-up intervals (1978-1983 and 1983-1988). The health effects of marital status were evaluated in regressions which assessed the relationships between initial marital status and subsequent health trends in each follow-up interval. In the first follow-up interval, never married women tended to have worse health trends than divorced and separated women for physical impairments and for overall health problems. However, there were no differences between never married women and divorced and separated women in health trends for psychosomatic symptoms in either follow-up interval or for any health measure in the second follow-up interval. Our analyses of cross-sectional data showed few significant differences in health between never married women and divorced and separated women. Taken together, the evidence from our study and previous studies suggests that differences between never married women and divorced and separated women may vary by age and/or cohort. Evidence for the 1970s and 1980s suggests that, among older women, divorced and separated women may have experienced more harmful health effects than never married women; however, among younger women, this difference may have been absent or possibly reversed.

Marriage protection and marriage selection--prospective evidence for reciprocal effects of marital status and health

Married adults are generally healthier than unmarried adults. It has been hypothesized that marriage is associated with good health because marriage has beneficial effects on health (marriage protection effects) and/or because healthier individuals are more likely to marry and to stay married (marriage selection effects). To investigate these hypotheses, this study analyzes prospective panel data for a large national sample of women in the U.S. (the National Longitudinal Surveys of Young Women). The women were aged 24-34 yr at the beginning of two successive five-year follow-up intervals. Analyses of the prospective data indicate that there were significant marriage protection effects, but only among women who were not employed. Specifically, for women who were not employed, married women had better health trends than unmarried women in each follow-up interval. It appears that marriage had beneficial effects on health for women who did not have a job which could provide an alternative source of financial resources and social support. In addition, analyses of the prospective data provide limited evidence for marriage selection effects. Specifically, women who had better health initially were more likely to marry and less likely to experience marital dissolution, but only for women who were not employed full-time and only during the first follow-up interval. Thus, the prospective evidence suggests that, for women who were not employed, both marriage protection and marriage selection effects contributed to the marital status differential in health observed in cross-sectional data. In contrast, neither marriage protection nor marriage selection effects were observed for women who were employed full-time. As would be expected, the cross-sectional data show that marital status differentials in health were large and highly significant for women who were not employed, whereas marital status differentials in health were much smaller and often not significant for employed women. Women who were neither married nor employed had particularly poor health. Additional evidence indicates that the women who were neither married nor employed suffered from multiple interacting disadvantages, including poor health, low incomes, and sociodemographic characteristics which contributed to difficulty in obtaining employment.

Interleukin-1 receptor antagonist allele (IL1RN*2) associated with nephropathy in diabetes mellitus

We have previously found association between an allele of the interleukin-1 (IL-1) receptor antagonist gene (IL1RN) and several inflammatory diseases, where IL-1 has been implicated in the inflammatory mechanism. We have now, therefore, tested the association of this specific allele (IL1RN*2) with complications of diabetes which have an inflammatory tissue component. We have tested the allele frequency of IL1RN*2 in 128 patients with insulin-dependent and 125 with non-insulin-dependent diabetes mellitus (NIDDM). There was a significant association between carriage of IL1RN*2 and diabetic nephropathy (P<0.001, Pcorrected<0.0012). The association was significant in both types of diabetes, but the observed increase was highest in NIDDM, rising to double the control levels. It appears that IL1RN*2 is a novel genetic marker of severity of inflammatory complications of diseases rather than a marker of disease susceptibility. If the DNA polymorphism is associated with altered gene function, new therapeutic interventions may be possible.

The impact of an increase in family planning services on the teenage population of Philadelphia

In an assessment conducted 30 months after a Philadelphia-area project increased the resources that community family planning agencies devoted to teenage services, teenagers in targeted communities showed no generalized improvement in rates of pregnancy and childbearing, in knowledge or use of clinic services, or in attitudes toward contraception compared with those of teenagers in the entire city. Samples of adolescents aged 14-18 from the clinics' catchment areas and from the entire city were interviewed in mid-1988, when the project's activities began, and 2.5 years later. The results suggest that while community family planning clinics may provide effective services to the teenagers who seek them out, they may not be the most effective strategy for decreasing rates of pregnancy and childbearing in the overall teenage population.

Fine structural ribonucleoprotein components of the cell nucleus visualized after spreading and high resolution autoradiography

The fine structure of the nuclear components was studied following mild lysis of mouse or Drosophila tissue culture cells and spreading of nuclear material. Particular attention was paid to nuclear ribonucleoprotein (RNP) constituents, which were analysed by high resolution autoradiography after [3H]uridine pulse labelling of cells. Comparison with the labelling kinetics of various in situ nuclear RNP constituents described previously suggests strong similarities between in situ constituents and structures observed within spread nuclear components. The present observations suggest that the nucleolar dense fibrillar component, shown previously in ultrathin sections of [3H]uridine-labelled intact cells as carrying rapidly labelled pre-rRNA, in fact consists of highly compacted transcribing ribosomal genes. The growing RNP fibrils appearing in transcription complexes of extranucleolar active genes and the in situ observed perichromatin fibrils also show the same labelling properties. This confirms that the two structures indeed represent the same nucleoplasmic constituents. As for the nuclear structures involved in post-transcriptional events, our observations demonstrate the occurrence of a rapidly labelled RNP fibro-granular network. Its granular elements correspond, in size and perichromatin location, to the perichromatin granules seen in the situ preparations and suggest similarities between the two constituents. The results are discussed in the light of other data providing information on the role of various nuclear structural constituents.

An easy guide to electronystagmography interpretations

Although there are numerous text books and long articles written on electronystagmography, there are few comprehensive summary tables to assist in teaching ENG interpretation. The use of such a device, however, is particularly helpful for medical students, residents, audiologists, nurses, and medical specialists who do not interpret electronystagmograms regularly.

Visualization of Transcription in early mouse embryos

Transcriptional activity during early mammalian embryogenesis was examined in 2 cell, 4--8 cell and late morula/early blastocyst mouse embryos. Zona pellucida-free embryos were obtained after pronase digestion followed by a PMSF wash to inhibit proteolytic activity. The embryos were then lysed with NP40 detergent and spread for electron microscopy according to Miller and Bakken (1972). pre-mRNA transcription was observed at all stages. Comparison of growing RNP chain lengths revealed statistically significant differences in the distribution of shorter fibrils between the successive developmental stages examined. The number of shorter fibrils was lower in the 4--8 cell stage than in either of the two other stages. Transcription complexes of ribosomal type were detected only in 4--8 cell and morula/blastocyst embryos. Structures resembling replication loops were observed within chromatin from all stages. Similar loop-like structures as well as individually transcribed RNP fibrils were also occasionally found on fibres emerging from mitotic chromosomes. The results are discussed in the context of recent findings concerning genetic expression in early mouse embryos.