U.S. Breast Cancer Cases Could Rise 50 Percent by 2030 .


The number of U.S. women diagnosed with breast cancer could rise by as much as 50 percent within the next 15 years, according to new government predictions.

Researchers say there will be an increase in breast tumors that are “ER-positive” — which means they rely on the hormone estrogen to fuel their growth. And because of the aging population, women older than 70 will account for a growing proportion of breast cancer cases.

There is some “good news,” however, said study leader Philip Rosenberg, a senior investigator at the U.S. National Cancer Institute.

The number of ER-negative breast cancers is expected to drop in coming years, and those tumors can be among the most difficult to treat, Rosenberg said.

But that’s not the only reason the decline is encouraging, he added.

“There could be a breast cancer-prevention clue in that decline,” Rosenberg said. “Understanding the ‘why’ behind the trend will be very important.”

Rosenberg is scheduled to present the findings Monday at the annual meeting of the American Association for Cancer Research in Philadelphia. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.

The rate of ER-positive breast cancer has been on the rise for decades, so it’s no surprise that more U.S. women will be diagnosed with the disease in coming years, said Dr. Graham Colditz, of Washington University School of Medicine in St. Louis.

He said the increase in those cancers is thought to be related to certain “Western” lifestyle factors — such as obesity, lack of exercise and exposure to hormones (through birth control pills or hormone replacement therapy, for instance).

But it’s much less clear why ER-negative tumors are on the wane, said Colditz, who was not involved in the study.

“It will be important to figure out the mechanisms,” he said.

For the study, Rosenberg’s team used government data on breast cancer rates, population projections from the Census Bureau, and a mathematical model to estimate the “burden” of breast cancer in the United States over the next couple of decades.

The researchers predict that in 2030, roughly 441,000 U.S. women will be diagnosed with the disease — up from 283,000 in 2011.

When it comes to ER-positive cancer, Rosenberg said, the rate is expected to rise by 0.5 percent each year among women age 70 and up. The increase will be even greater among women ages 50 to 69 — at around 0.9 percent, he said.

But because the elderly population will swell by 2030, those women will account for a growing proportion of breast cancer cases — 35 percent, Rosenberg’s team predicts, versus 24 percent in 2011.

Meanwhile, the proportion of cases among women ages 50 to 69 could decline from 55 percent to 44 percent.

That’s important, Rosenberg said, because elderly women are typically left out of breast cancer treatment trials. Yet in the “real world,” doctors will be seeing more and more patients in that age group, he pointed out.

As for ER-negative tumors, the researchers predict that they will account for only 9 percent of breast cancers in 2030, versus 17 percent in 2011.

There are some theories on the causes, Rosenberg said.

For example, research suggests that women who give birth at a young age, then do not breast-feed, have a relatively increased risk of ER-negative breast cancer. And in more recent years, Rosenberg said, U.S. women have been delaying childbirth and breast-feeding at a higher rate.

The predicted rise in ER-positive cancers includes “in-situ” cancers — small, early tumors that are almost always detected through mammography screening. And while the incidence of breast cancer may be growing, more women are beating the disease, Colditz pointed out.

“We have compelling evidence that death rates from breast cancer are going down,” he said. “That’s because of screening and earlier detection, better treatment, and better access to treatment.”

He suggested that women focus on the modifiable risk factors for developing ER-positive breast cancer — by exercising, eating well, and maintaining a healthy weight.

Salt Pills Do Little for Endurance Athletes.


Taking salt pills does little to boost the performance of endurance athletes, new research shows.

Although the study only involved 11 athletes, the findings challenge the widely held belief that salt pills can help these athletes do better during competitions, said the researchers from Saint Louis University, in St. Louis.

“I recommend that athletes use caution with sodium [salt] supplementation, especially when daily intake already exceeds the upper safe limit of 2,300 [milligrams] mg/day for most Americans,” study author Edward Weiss, an assistant professor of nutrition and dietetics, said in a university news release.

During training and competitions, athletes sometimes consume large quantities of salt or electrolyte supplements containing sodium in the belief that it will help them perform better, but this can lead to excessive salt intake, the researchers explained.

The study was published recently in The Journal of Sports Science and Medicine.

In the study, the athletes went through two exercise sessions, one in which they were given either an 1,800-mg salt pill or an inactive placebo. It was a “double-blind” study, where neither participants nor the researchers knew which person was getting the salt pill.

In each session, the athletes performed endurance exercise for two hours, and then were given an exercise performance test. The researchers found no significant differences in performance in either session.

When the results are combined with health concerns about high levels of salt in people’s diets, guidelines that call for salt replenishment in athletes should be interpreted conservatively, Weiss added.

“While moderate sodium consumption is perfectly reasonable and should be encouraged, high sodium intake is associated with health concerns, like hypertension [high blood pressure]. Many Americans already consume too much salt on a daily basis,” he said.

Resistance to antibiotics found in isolated Amazonian tribe .


When scientists first made contact with an isolated village of Yanomami hunter-gatherers in the remote mountains of the Amazon jungle of Venezuela in 2009, they marveled at the chance to study the health of people who had never been exposed to Western medicine or diets. But much to their surprise, these Yanomami’s gut bacteria have already evolved a diverse array of antibiotic-resistance genes, according to a new study, even though these mountain people had never ingested antibiotics or animals raised with drugs. The find suggests that microbes have long evolved the capability to fight toxins, including antibiotics, and that preventing drug resistance may be harder than scientists thought.

Hunter-gatherers host more diverse bacteria than humans in industrialized nations.

The human gut harbors trillions of bacteria, collectively known as the microbiome. Several recent studies have found that people in industrialized nations host far fewer types of microbes than hunter-gatherers in Africa, Peru, and Papua New Guinea, for example. This is intriguing as the absence of diverse bacteria has been linked to obesity, diabetes, and many autoimmune disorders, such as allergies, Crohn’s disease, celiac disease, and colitis.

So, when microbiologist Maria Dominguez-Bello of the New York University School of Medicine in New York City learned that army personnel aboard a helicopter had spotted Yanomami living in an uncharted village in the mountains of southern Venezuela in 2008, she immediately requested permission to study these uncontacted people before they were exposed to Western medicines and diets and would, therefore, lose diverse microbes. “This information is important; because it will give us some light on what are the bacteria we are missing, what bacteria are we losing,” she says. “We need to get a better understanding of the microbiota in this community of hunter-gatherers before they are lost.”

The Yanomami health care workers who were the first to contact the remote villagers in a medical expedition in 2009 collected bacteria from the mouths, skin, and feces of 34 of the 54 Yanomami for the researchers. They prescribed medicines to some children with respiratory ailments but have not published the name of the village to protect these people from further contact. After 2 years of getting the proper permits and an 11-month delay when Dominguez-Bello’s lab in New York was closed by damage from Hurricane Sandy, she and her colleagues eventually sequenced the Yanomami gut bacteria RNA in their labs to compare it with samples from industrialized Americans and rural Guahibo Amerindians of Colombia and farmers from Malawi. When they compared the genetic sequences, they found that the Yanomami harbor “significantly higher diversity than other populations,” including high amounts of Prevotella, Helicobacter, Oxalobacter, and Spirochaeta, for example, that are absent or significantly reduced in industrialized humans. The medical workers also documented that although these Yanomami had high levels of parasites, they were healthy and did not suffer from autoimmune disorders, diabetes, high blood pressure, or heart disease, the team reports today in Science Advances.

Meanwhile, microbiologist Gautam Dantas of Washington University in St. Louis interrogated the Yanomami gut and oral samples for the presence of antibiotic-resistance genes. Dantas’s graduate student Erica Pehrsson cloned bacterial DNA from these samples and tested whether any of their genes could inactivate natural and synthetic antibiotics. They found that the Yanomami gut bacteria had nearly 60 unique genes that could turn on and rally to fend off antibiotics, including a half-dozen genes that could protect the bacteria from synthetic antibiotics. This is particularly troubling, Dantas says, because researchers have thought that it would take bacteria longer to evolve resistance to humanmade antibiotics not found naturally in the soil.

The medical team’s interviews with these Yanomami villagers found they were never given drugs or exposed to food or water with antibiotics. Instead, Dantas suggests that the Yanomami gut bacteria have evolved an armory of methods to fight a wide range of toxins that threaten them—just as our ancestors and other primates have done to fight dangerous microbes. For example, the Yanomami bacteria may already have encountered toxins that occur naturally in their environment that are similar in molecular structure to modern antibiotics, but have yet to be discovered by scientists. Or, gut bacteria in humans have evolved a generalized mechanism for detecting certain features shared by all antibiotics—including the synthetic ones designed by scientists—and so can mount a defense against new threats.

The discovery is troubling because it suggests that “antibiotic resistance is ancient, diverse, and astonishingly widespread in nature—including within our own bodies,” says anthropologist Christina Warinner of the University of Oklahoma in Norman, who is not a co-author. “Such findings and their implications explain why antibiotic resistance was so quick to develop after the introduction of therapeutic antibiotics, and why we today should be very concerned about the proper use and management of antibiotics in both clinical and agricultural contexts.”

Other researchers are also interested in exploring the function of the diverse bacteria found in the Yanomami, to see if these microbes train their children’s immune systems early and if they are protective against autoimmune diseases on the rise in industrialized populations. One type of gut bacteria, Oxalobacter, found in the Yanomami is already known to protect humans from the formation of kidney stones. “I think these missing microbes are at the root of many Western diseases,” says microbiologist Justin Sonnenburg of Stanford University in Palo Alto, California, co-author of the forthcoming book The Good Gut: Taking Control of Your Weight, Your Mood, and Your Long-term Health. “The big message is we in the Western world have lost the diversity in our microbiota. We have to study these groups to figure out what we lost, what these microbes do, and how we get back to a healthy microbiota.”

How octopuses coordinate their arms


Octopus (c) Science Photo Library
The study is the first to examine how octopuses co-ordinate their eight, flexible limbs as they crawl

With the aid of high-speed cameras, scientists have revealed how octopuses co-ordinate their arms to crawl.

Researchers from the Hebrew University of Jerusalem filmed crawling octopuses to work out exactly how the animals used their almost limitlessly flexible arms when they move.

This revealed the surprising simplicity of their motion; they just choose which arm to use to push themselves along.

The findings are published in the journal Current Biology.

 The study is the first detailed analysis of exactly how octopuses manages to move without a rigid skeleton.

How octopuses control and move their soft bodies is of interest to engineers who aim to design biologically inspired robots.

“People want to build soft robots for medical purposes and rescue operations,” said Dr Guy Levy, one of the researchers involved in the project.

Such soft-bodied, octopus-inspired arms would not be limited by fixed joints, he explained. This could be useful to access narrow, difficult to reach spaces – perhaps getting help to people trapped at the scene of a collapsed building.

Pick a leg

To find out the secrets of the octopus’s remarkably efficient movement, Dr Levy and his colleague Prof Benny Hochner videoed the animals from underneath as they crawled, and analysed their motion frame by frame.

This detailed study showed that, by shortening and lengthening, each arm pushed the body in only one direction.

“So the octopus only has to decide which arm to use for the pushing – it doesn’t need to decide which direction this arm will push,” explained Dr Levy.

“[It has] found a very simple solution to a potentially complicated problem – it just has to pick which arm to recruit.”

And because the creatures are able to push off any of their eight legs, they are able to crawl in any direction – no matter which way their body is facing. And, uniquely, there is no rhythm or pattern to their undulating limb movements

The scientists’ next step is to delve into the internal circuitry of the octopus nervous system, to find out exactly how this co-ordinated crawling is controlled.

Dr Levy added: “Every time we try to understand something new about the octopus, there are new surprises.”

Athlete’s foot drug may be MS therapy


 

athletes foot

Two common drugs – one used for treating athlete’s foot and another for alleviating eczema – may be useful therapies for multiple sclerosis, scientists believe.

In early animal studies, the medicines repaired some of the cell damage and paralysis seen in MS.

The drugs encouraged new growth of myelin to coat and protect the nerves.

Experts say although the results in Nature journal are promising, people should not be tempted to self-medicate.

Much more work is needed to check that the treatments will work in people.

Lab tests on human cells already hint that they might.

The two drugs in question – an antifungal called miconazole and a steroid called clobetasol – are currently topical medicines that are applied as creams to the skin.

They already have a good safety history for treating these conditions, says lead researcher Dr Paul Tesar, from Case Western Reserve School of Medicine in the US.

He says the formulation of the drugs would need to be changed so that they could be better targeted to the nervous system where MS strikes.

Myelin

brain scan of MS

In MS, the body’s immune system mistakes myelin for a foreign body and attacks it.

This leads to progressive disability.

Current medications for MS can help slow or prevent this attack, but they cannot replace myelin.

A number of researchers are looking at existing drugs to see if they can be reclaimed for treating MS.

Dr Tesar’s team screened a library of more than 700 existing drugs to find any that would promote new myelin production by the individual’s own cells.

Dr Tesar said they were working tirelessly to get a safe and effective drug for clinical use.

“We appreciate that some patients or their families feel they cannot wait for the development of specific approved medications.

“But off-label use of the current forms of these drugs is more likely to increase other health concerns than alleviate multiple sclerosis symptoms.”

Prof Daniel Altmann, an expert in immunology at Imperial College London, said: “There has been tremendous progress in recent years in development, clinical trials and licensing of new drugs that aim to block the immune attack and thus ameliorate progress of disease.

“The problem that has been much harder to crack is what to do about the fact that this still leaves patients with irreversible disability through the damage to the myelin sheaths in the central nervous system that has been sustained.”

He said the fruits of this approach to treating MS were still “a little way off”.

Dr Sorrel Bickley of the MS Society said: “More than 100,000 people in the UK live with MS, which is why there is a huge unmet need for new therapies that can repair the damage to myelin that occurs in the condition.

“While this is an early study, it’s exciting to think that there is now a growing list of potential myelin repair therapies that have been identified in laboratory and animal model studies. The next step will be to test these treatments in clinical trials to establish whether they can bring real benefits in slowing or stopping the progression of MS.”

Portuguese researchers discover the secret of Mind Control .


Mind control is the stuff of pure science fiction, but today reading data from your brain has never been more accurate, and that opens the way to, for example, controlling machines.

A recent drone flight from an airfield outside Lisbon may prove to be historic. Its flight was remotely controlled by the pilot’s mind. It’s an impressive result delivered by a European research project to develop technology to transform the lives of disabled people.

“It’s the first time we’ve done a public demonstration of a real flight, that’s completely unprecedented,” says the Tekever Brainflight project’s co-ordinator Ricardo Mendes

Like most drones, the unmanned plane receives radio commands from the ground. But instead of using a joystick and buttons, the pilot just thinks of the direction the plane should take.

“We’re switching from normal control to the “brain flight”. From this moment, it will be flown by the brainwaves of the pilot,” says Mendes.

The researcher at the controls focuses his attention on the screen with the parameters of the flight. It takes some mental effort to steer the drone in the required direction, keeping it within the designated area.

“Ideally, this shouldn’t be too difficult. With more training, we’ll be able to do more, and the piloting should become more intuitive,” says Nuno Loureiro, researcher at the BMI Champalimaud Foundation.

This technology is based on a brain-machine interface – a system that uses a set of electrodes applied to the scalp. Using specially-written software, the researchers can basically read the subject’s mind.

So how does the brain-machine interface actually work?

“We use a cap that captures from the skin surface the electrical activity that goes on inside the brain. We take those signals and transmit them into the computer which converts them into visible cursor movements that you can see on the screen,” says the Foundation’s Rui Costa.

As the pilot observes the screen, his brain learns electrical patterns that control the movements of the objects. Scientists say with more training, this can become as intuitive as driving a car.

“In principle, anyone can learn to do this,” continues Costa, “but it will ultimately depend on the person’s learning capabilities. Not everyone can be a pianist!”

This technology has already been tried in a full-size plane simulator. Researchers suggest that in the future, brain-machine interfaces may help to simplify control panels, shorten pilots’ training time and one day allow paraplegic people to fly planes.

“Besides aeronautics, we’re looking to apply this technology in many different areas: you can imagine right away applying this to wheelchairs, how you control a wheelchair with your mind. Or you can use it to control your everyday appliances at home,” suggests Ricardo Mendes.

From turning the lights on and off to typing emails or controlling prosthetic limbs with brain signals – all that and more can be made possible with further development of the brain-machine technology, which is still in its infancy and surely has more surprises to come.

 

Advances in neuroscience and neuroengineering have made it possible to envisage and work towards something as complex as controlling an aircraft through a brain–computer interface (BCI). A few years back this would have been unthinkable, but now EU-funded scientists are working to make this happen.
Brain-controlled aircraft

The ‘Brain controlled aircraft flight using multiple feedback mechanisms’ (BRAINFLIGHT) project will adapt recently developed medical technology that allows neural signals from the brain to control a device.

The advantages of this would be decreased pilot workload and less physical fitness requirements for a pilot, thus not excluding people with certain physical disabilities.

For aeronautical application, the design requirements, technical specifications and other requirements are being assessed for five aviation scenarios.

These include general, acrobatic and commercial flights as well as unmanned aerial vehicles.

Pilots were interviewed for these application scenarios to obtain invaluable insight about requirements.

Researchers are working on developing a BCI that can automatically control or guide an aircraft using brain activity, whether the response is active, reactive or passive.

The requirements, functionalities and interfaces between various sub-systems in the system architecture were successfully defined along with appropriate validation scenarios.

Validation would ensure that signals do not contain misleading information such as artefacts from muscular activity.

Scientists have started work on signal acquisition and on optimising the processing of decoder brain signals with promising results.

They have successfully developed a dry electrode and adapted the Ground Control System obtained from one of the consortium members.

In parallel, researchers designed a tactile suit with a control module that was tested in a flight simulator for better tactile feedback and design optimisation.

Based on relevant aviation safety regulations, the flight control system specifications were characterised to ensure safety with brain control.

As a result, preliminary designs for two controllers have been completed to enable both brain and manual control.

Project activities were published in two scientific papers and also presented at a conference.

BRAINFLIGHT technology would be a breakthrough in aviation and permit people with certain physical disabilities to fly an aircraft after undergoing the requisite training.

Using neural signals to control an aircraft by developing ‘sub-conscious’ capability would also free the pilot to focus on other important functions while reducing workload.

This would be like a gift for pilots in the current scenario of increasing air traffic and aircraft complexity.

 

Doctors hail melanoma breakthrough with new drug that allows patients to live longer .


Doctors are hailing the results of a new study that shows more patients with advanced melanoma lived longer and had fewer side effects when given a new drug than those on the standard treatment.

More than 70 per cent of patients given the newer drug, Keytruda, lived for one year, whereas only 58 per cent of those on Yervoy lived an extra year.

Associate Professor Georgina Long from the Melanoma Institute of Australia said it was a groundbreaking development for melanoma patients and all cancer patients.

“The results are world-first, where two effective immunotherapies are directly compared, and we significantly improve outcomes for patients even further,” she said.

“This really is important as this new drug works much better. To show such a large improvement is outstanding.”

Australia has the highest incidence of melanoma in the world, with an Australian dying from the disease every six hours.

The results have just been published in the New England Journal of Medicine.

The study, comparing two immune checkpoint inhibitors, demonstrated that pembrolizumab (Keytruda) significantly prolonged progression-free and overall survival.

Keytruda works by boosting the patient’s own immune system so it can kill the cancer cells.

But the trial showed the new drug did not work in 30 per cent of patients.

“This is not a panacea and for everyone,” Professor Long said. “We are now looking at why those patients don’t respond.”

Study results one of the biggest breakthroughs: expert

The results are one of the biggest breakthroughs in treating melanoma, according to cancer expert Professor Rick Kefford, from Macquarie University.

“It’s the most important development in treating this disease,” he said.

Patients tolerated the drug very well, with few serious side effects.

“We found those patients where there was deep shrinkage of the tumour did really well and were alive many years later,” Professor Long said.

The study was funded by the drug manufacturer Merck, Sharp and Dohme, and is likely to be used by the company to argue the drug should be listed on the Pharmaceutical Benefits Scheme (PBS).

Eight-hundred-and-thirty-four patients took part in the study from 16 countries, including Australia.

Doctors said the new drug was appropriate to use in patients with advanced melanoma, where cancer has spread or where it cannot be removed by surgery.

The tumour also needs to have an abnormal “BRAF” gene.

Pancreatic cancer breakthrough: Scientists turn cancer cells into normal cells


A new research study has shown that pancreatic cancer cells can be coaxed to revert back toward normal cells by introducing a protein called E47. E47 binds to specific DNA sequences and controls genes involved in growth and differentiation. The research provides hope for a new treatment approach for the more than 40,000 people who die from the disease each year in the United States.

“For the first time, we have shown that overexpression of a single gene can reduce the tumor-promoting potential of pancreatic adenocarcinoma cells and reprogram them toward their original cell type. Thus, cells retain a genetic memory which we hope to exploit,” said Pamela Itkin-Ansari, Ph.D., adjunct professor in the Development, Aging, and Regeneration Program at Sanford-Burnham and lead author of the study published today in the journal Pancreas.

E47 turns the clock back

The study, a collaborative effort between Sanford-Burnham, UC San Diego, where Itkin-Ansari holds a joint appointment, and Purdue University, generated human cell lines to make higher than normal levels of E47. The increased amount of E47 caused cells to stall in the G0/G1 growth phase, and differentiate back toward an acinar cell phenotype.

In vivo studies showed that when the reprogrammed cancer cells were introduced into mice, their ability to form tumors was greatly diminished compared to untreated adenocarcinoma cells.

“Presently, is treated with cytotoxic agents, yet the average survival for patients post-diagnosis is merely six months, and the improvements in therapies are measured in days,” said Andrew M. Lowy, M.D., professor of surgery at the UC San Diego Moores Cancer Center and co-chair of the National Cancer Institute’s Pancreatic Cancer Task Force. “The finding that we can differentiate these back to a non-threatening phenotype is encouraging. Indeed, there is a precedent for cell differentiation therapy in that the approach has been used to treat acute promyelocytic leukemia (APL) and some neuroblastomas successfully.”

“Our next step is to test primary patient-derived tumor tissue to determine whether E47 can produce similar results, potentially providing a novel therapeutic approach to combat this highly lethal disease,” said Itkin-Ansari. “Additionally, we are screening for molecules—potential drugs—that can induce overexpression of E47.”

Pancreatic adenocarcinoma

Pancreatic adenocarcinoma is the most common form of pancreatic cancer. It’s primarily caused by a mutation in the oncogene called Kras that causes the digestive enzyme-secreting cells () to differentiate into a destabilized duct-like cell type, which is cancerous. The disease is often called a “silent” cancer because it rarely shows early symptoms—it tends to be diagnosed at advanced stages when it causes weight loss, abdominal pain, and jaundice.

A Targeted Agent for Triple-Negative Breast Cancer


Glycoprotein NMB (gpNMB) is a transmembrane protein and tumor-associated antigen that is expressed at higher levels in certain malignancies than in normal tissues. Glembatumumab vedotin (CDX-011) is an antibody-drug conjugate consisting of a fully human IgG2 monoclonal antibody against gpNMB linked to the microtubule inhibitor monomethyl auristatin E (MMAE). By targeting and binding to cells overexpressing gpNMB, the antibody is internalized, allowing for intracellular release of the cytotoxic MMAE.

A prior phase I/II trial of CDX-011 for refractory advanced breast cancer demonstrated an acceptable toxicity profile and an objective response rate (ORR) of 12% (NEJM JW Oncol Hematol Nov 2014 and J Clin Oncol 2014; 32:3619). In the subset of patients with triple-negative breast cancer (TNBC), the ORR was 20%, and progression-free survival (PFS) was 4.1 months; in TNBC patients with gpNMB-expressing tumors the ORR was 25%, and the PFS was 5.1 months. Now, investigators have conducted an industry-supported, randomized phase II trial (EMERGE) of CDX-011 versus investigator choice of chemotherapy (IC) in 124 refractory breast cancer patients with tumors overexpressing gpNMB (defined as ≥5% of malignant epithelial or stromal cells with any expression).

ORR was similar overall for patients receiving CDX-011 or IC (6% and 7%, respectively) and for those with gpNMB-expressing tumors (12% for both). ORR was higher with CDX-011 versus IC in patients with ≥25% of tumor cells expressing gpNMB (30% vs. 9%) as well as in TNBC patients (18% vs. 0%) and TNBC patients with overexpression of gpNMB (40% vs. 0%). Dose reduction occurred in 25% of patients in both treatment arms. The most common CDX-011 toxicities were rash, fatigue, nausea, neutropenia, and neuropathy.

Comment

The attraction of targeted therapy with an antibody delivery system is that it directs the cytotoxic agent preferentially to the malignant cell population, potentially enhancing efficacy and minimizing systemic toxicity. The use of ado-trastuzumab emtansine for HER2-positive breast cancer demonstrates the success of this approach (NEJM JW Oncol Hematol Sep 2014 and J Clin Oncol2014; 32:2750). The signal that CDX-011 is active in TNBC is exciting, but the observations from this study are based on very small numbers of patients. A larger, pivotal phase II trial (METRIC) is under way to more fully investigate this compound in TNBC.

New questionnaire for measuring cognitive behavioral components of weight management appears valid, reliable


The Body Knowledge Questionnaire, a tool for measuring the cognitive behavioral components of weight management integration, appears to be valid and reliable, according to recent findings.

In the initial development and pilot testing study, David A. Hernandez, EdD, PhD, of Walden University in Minneapolis, and Cheri Ann Hernandez, RN, PhD, CDE, of the University of Windsor in Ontario, developed a questionnaire addressing the attitudes, preferences and behaviors related to weight management and obesity. The 27-item Body Knowledge Questionnaire (BKQ) was created through a review of literature on integration. The researchers describe the theory of integration as a process that occurs in diabetes in which individuals reconcile the existence of “two selves,” the personal (self that always existed) and the diabetic self (self that emerged upon diabetes diagnosis). This concept was applied to weight management based on quantitative studies that have affirmed the value of integration in the experience of those seeking to lose weight.

The BKQ was pilot tested on 37 individuals. Six of the participants were normal weight with type 2 diabetes, 10 had obesity with type 2 diabetes, 11 were normal weight without diabetes and six had obesity without diabetes. The researchers assessed the psychometric properties of the BKQ as follows: determination of content validity, determination of construct validity through factor analysis and establishment of criterion-related validity through discriminant function analysis and logistic regression. Additionally, scale reliability analysis was used to evaluate the internal consistency reliability of the total BKQ and its two subscales, Food Centricity and Psychosomatic Awareness.

Through exploratory factor analysis, the researchers arrived at a 2-factor solution, with factor loading ranging from fair to excellent (0.45 to 0.81). Discriminant function analysis revealed that the BKQ subscales were accurate in predicting the categorization of study participants into normal-weight and obese groups. Logistic regression analysis revealed the BKQ’s reliability in differentiating between normal-weight participants and those with obesity.

Overall the BKQ was found to have an internal consistency of 0.87. The Food Centricity subscale had an internal consistency of 0.89 and the Psychosomatic Awareness subscale had an internal consistency of 0.73.

“With additional psychometric testing, the BKQ instrument has great potential for use in weight management practice areas, such as diabetes education, dietetics, nursing and psychology,” the researchers wrote. “Practitioners can use the instrument to get an assessment of an individual’s attitudes, preferences and behaviors related to weight management.” – by Jennifer Byrne