Oregon Urology Institute

ABSTRACTSocial and Emotional Skills (SES) are key to students' academic and personal development. This study explores the effectiveness of a technology‐supported Cooperative Learning (CL) intervention in promoting SES among primary and middle school students in Italy. A quasi‐experimental design was used, involving 36 classes randomly assigned to either the intervention or a waitlist control group. Teachers in the intervention received training on CL and SES instruction, delivering structured lessons within cooperative activities. SES development—measured through emotional knowledge, social awareness, and relationship skills—was assessed at the beginning and end of the school year using a validated self‐report tool. Results from linear mixed‐effects models indicated greater SES improvement in the intervention group. The findings suggest that integrating SES instruction within technology‐supported CL environments enhances SES outcomes and offers a scalable model for schools. This approach holds promise for educators and policymakers aiming to embed social–emotional learning into everyday classroom practice.

ABSTRACT Background The unique training of clinical exercise physiologists (CEPs) positions them to be an integral part of multidisciplinary teams in phase 2 cardiac rehabilitation (CR). However, the roles and responsibilities of CEPs vary widely between institutions. In addition, job tasks of CEPs at some institutions might not fully leverage their knowledge and skills. The purpose of this study was to describe the roles and responsibilities of CEPs working in CR and noninvasive clinical exercise testing at select institutions in the United States. Methods This was a descriptive study of the job tasks performed by CEPs in CR and noninvasive clinical exercise testing at select institutions. Job tasks that are common to CR and noninvasive clinical exercise testing were identified by a working group of the Clinical Exercise Physiology Association. Results The 6 CR programs in this report are predominately staffed by CEPs with no other health care professional present during exercise classes. In 5 of these programs CEPs perform all tasks required of phase 2 CR, from patient screening to program discharge. At 3 of the 4 programs that also performed noninvasive exercise testing, CEPs performed all the necessary tasks with no other health care professional present in the room during testing. Conclusion CEPs play an integral role in the conduct of phase 2 CR and noninvasive cardiology exercise testing. Granting privileges to CEPs that allow them to work at the top of their knowledge and skills will allow other health care professionals to better use their skills in other high demand areas.

Purpose:To report efficacy and safety of samotolisib (LY3023414; PI3K/mTOR dual kinase and DNA-dependent protein kinase inhibitor) plus enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) following cancer progression on abiraterone.Patients and Methods:In this double-blind, placebo-controlled phase Ib/II study (NCT02407054), following a lead-in segment for evaluating safety and pharmacokinetics of samotolisib and enzalutamide combination, patients with advanced castration-resistant prostate cancer with progression on prior abiraterone were randomized to receive enzalutamide (160 mg daily)/samotolisib (200 mg twice daily) or placebo. Primary endpoint was progression-free survival (PFS) assessed by Prostate Cancer Clinical Trials Working Group criteria (PCWG2). Secondary and exploratory endpoints included radiographic PFS (rPFS) and biomarkers, respectively. Log-rank tests assessed treatment group differences.Results:Overall, 13 and 129 patients were enrolled in phase Ib and II, respectively. Dose-limiting toxicity was not reported in patients during phase Ib and mean samotolisib exposures remained in the targeted range despite a 35% decrease when administered with enzalutamide. In phase II, median PCWG2-PFS and rPFS was significantly longer in the samotolisib/enzalutamide versus placebo/enzalutamide arm (3.8 vs. 2.8 months; P = 0.003 and 10.2 vs. 5.5 months; P = 0.03), respectively. Patients without androgen receptor splice variant 7 showed a significant and clinically meaningful rPFS benefit in the samotolisib/enzalutamide versus placebo/enzalutamide arm (13.2 months vs. 5.3 months; P = 0.03).Conclusions:Samotolisib/enzalutamide has tolerable side effects and significantly improved PFS in patients with mCRPC with cancer progression on abiraterone, and this may be enriched in patients with PTEN intact and no androgen receptor splice variant 7.

To evaluate the feasibility of integrating a hereditary cancer risk assessment (HCRA) process in the community urology practice setting for patients with prostate cancer (PCa). In this prospective intervention, an HCRA process was implemented across six different community urology clinics between May 2019 and April 2020. The intervention included a process integration during which the workflow at each site was refined, a post-integration period during which HCRA was conducted in all patients with PCa, and a follow-up period during which healthcare providers and patients reported their satisfaction with the HCRA and genetic testing process. Among patients who completed a family history assessment during the post-integration period, 23.6% met guideline criteria for genetic testing. Of all patients seen at the clinic during the post-integration period, 8.7% completed genetic testing; this was a twofold increase over the period immediately preceding process integration (4.2%), and a sevenfold increase over the same period 1 year prior (1.2%). The majority of providers reported that the HCRA was as important as other regularly performed assessments (61.0%) and planned to continue using the process in their practice (68.3%). Most patients believed that the genetic test results were important for their future cancer care (84.7%) and had already shared their test results with at least one family member (63.2%). This study demonstrated that implementing an HCRA process in the community urology practice setting was feasible, generally favored by providers and patients, and resulted in an increase in the number of patients with PCa who completed genetic testing.

Respiratory system cooling occurs via convective and evaporative heat loss, so right-to-left shunted blood flow through a patent foramen ovale (PFO) would not be cooled. Accordingly, we hypothesized that PFO+ subjects would have a higher core temperature than PFO- subjects due, in part, to absence of respiratory system cooling of the shunted blood and that this effect would be dependent upon the estimated PFO size and inspired air temperature. Subjects were screened for the presence and size of a PFO using saline contrast echocardiography. Thirty well-matched males (15 PFO-, 8 large PFO+, 7 small PFO+) completed cycle ergometer exercise trials on three separate days. During Trial 1, subjects completed a V̇(O2max) test. For Trials 2 and 3, randomized, subjects completed four 2.5 min stages at 25, 50, 75 and 90% of the maximum workload achieved during Trial 1, breathing either ambient air (20.6 ± 1.0°C) or cold air (1.9 ± 3.5°C). PFO+ subjects had a higher oesophageal temperature (T(oesoph)) (P < 0.05) than PFO- subjects on Trial 1. During exercise breathing cold and dry air, PFO+ subjects achieved a higher T(oesoph) than PFO- subjects (P < 0.05). Subjects with a large PFO, but not those with a small PFO, had a higher T(oesoph) than PFO- subjects (P < 0.05) during Trial 1 and increased T(oesoph) breathing cold and dry air. These data suggest that the presence and size of a PFO are associated with T(oesoph) in healthy humans but this is explained only partially by absence of respiratory system cooling of shunted blood.

A patent foramen ovale (PFO), present in ∼40% of the general population, is a potential source of right-to-left shunt that can impair pulmonary gas exchange efficiency [i.e., increase the alveolar-to-arterial Po2 difference (A-aDO2)]. Prior studies investigating human acclimatization to high-altitude with A-aDO2 as a key parameter have not investigated differences between subjects with (PFO+) or without a PFO (PFO-). We hypothesized that in PFO+ subjects A-aDO2 would not improve (i.e., decrease) after acclimatization to high altitude compared with PFO- subjects. Twenty-one (11 PFO+) healthy sea-level residents were studied at rest and during cycle ergometer exercise at the highest iso-workload achieved at sea level (SL), after acute transport to 5,260 m (ALT1), and again at 5,260 m after 16 days of high-altitude acclimatization (ALT16). In contrast to PFO- subjects, PFO+ subjects had 1) no improvement in A-aDO2 at rest and during exercise at ALT16 compared with ALT1, 2) no significant increase in resting alveolar ventilation, or alveolar Po2, at ALT16 compared with ALT1, and consequently had 3) an increased arterial Pco2 and decreased arterial Po2 and arterial O2 saturation at rest at ALT16. Furthermore, PFO+ subjects had an increased incidence of acute mountain sickness (AMS) at ALT1 concomitant with significantly lower peripheral O2 saturation (SpO2). These data suggest that PFO+ subjects have increased susceptibility to AMS when not taking prophylactic treatments, that right-to-left shunt through a PFO impairs pulmonary gas exchange efficiency even after acclimatization to high altitude, and that PFO+ subjects have blunted ventilatory acclimatization after 16 days at altitude compared with PFO- subjects.

Advances in perinatal care in the post surfactant era have increased survivability of infants born extremely preterm (&lt;32 weeks gestation), yet long‐term cardiopulmonary consequences of prematurity in adulthood remain largely unexplored. We studied adults who developed new bronchopulmonary dysplasia (BPD, 22.7 yrs), preterm subjects who did not develop BPD (PRE, 21.1 yrs), and fullterm controls (CONT, 22.7 yrs) at rest and during cycle ergometer exercise in the forward leaning aerobar position. Subjects exercised for 3 min at 25%, 50% and 75% of their maximum workload attained at VO2max from a separate visit. We measured metabolic rate, and pulmonary artery systolic pressure (PASP) with ultrasonography, at rest and during exercise. There were no differences in PASP between the groups at rest. At 50% and 75% VO2max, PASP was higher in PRE subjects than in BPD and CONT subjects, which were not significantly different from each other at any exercise intensity. The slope of the PASP to VO2 relationship was significantly greater in PRE subjects compared to BPD and CONT. These data suggest PRE subjects have a reduced ability for the pulmonary vasculature to accommodate increases in cardiac output during exercise compared to CONT and BPD subjects. Further research is needed to determine if this augmented pressure response during exercise may predispose PRE subjects to developing pulmonary arterial hypertension.Grant Funding Source: Supported by: AHA Scientist Development Grant