Understanding factors associated with successful adherence and maintenance of weight loss interventions is important to potentially increase efficacy. Activity spaces and environmental exposures are two understudied factors that may be associated with intervention adherence and outcomes. Women with overweight or obesity (n = 498) from two weight loss intervention studies, Reach for Health and Metabolic, Exercise, and Nutrition at University of California San Diego, wore accelerometer and Global Positioning System (GPS) devices for 1 week at baseline and at 6-month follow up. Changes in activity spaces and time spent in three life space domains (Home, Neighborhood, and Beyond Neighborhood) were assessed at the two timepoints for total time and the subset of time in physical activity (PA). Relationships between repeated GPS-measured exposure to PA promoting environments (walkability; recreation; and greenness) were assessed with linear mixed effects models with an interaction between intervention and timepoint. There was no significant change in the average total or PA-related activity space size. There was no significant change in the amount of total time spent in life space domains by intervention group. However, for PA time in life spaces, the Intervention group increased percent of PA time in the Neighborhood (1.49 %-1.71 %; p = 0.011) and Beyond Neighborhood domains (from 5.85 %-6.60 %; p < 0.0001), whereas PA time at Home was not significantly different (p = 0.755). For the mixed effects models with PA-related time, being in the Intervention group was associated with (-0.06, 95 % CI: -0.19, -0.07; p < 0.01) less exposure to walkability and this was attenuated at time 2, compared to controls. Results suggest that PA-focused interventions did not increase the size of participants' total and PA-related activity spaces but were associated with a higher percent of PA-related time outside of the home. There were not consistent associations between the Intervention group and increased exposure to PA-supportive environments.

ABSTRACTSensor devices, such as accelerometers, are widely used for measuring physical activity (PA). These devices provide outputs at fine granularity (e.g., 10–100 Hz or minute‐level), which while providing rich data on activity patterns, also pose computational challenges with multilevel densely sampled data, resulting in PA records that are measured continuously across multiple days and visits. On the other hand, a scalar health outcome (e.g., BMI) is usually observed only at the individual or visit level. This leads to a discrepancy in numbers of nested levels between the predictors (PA) and outcomes, raising analytic challenges. To address this issue, we proposed a multilevel longitudinal functional principal component analysis (mLFPCA) model to directly model multilevel functional PA inputs in a longitudinal study, and then implemented a longitudinal functional principal component regression (FPCR) to explore the association between PA and obesity‐related health outcomes. Additionally, we conducted a comprehensive simulation study to examine the impact of imbalanced multilevel data on both mLFPCA and FPCR performance and offer guidelines for selecting optimal methods.

Abstract Background: Intake of polyunsaturated fatty acids (PUFA) may affect mortality following breast cancer; however, epidemiological studies have relied on the self-reported assessment of PUFA intake. Herein, we examined the associations between red blood cell (RBC) PUFAs and mortality. Methods: This nested case–control study included 1,104 women from the Women’s Healthy Eating and Living study, a multistate randomized controlled trial. Cases (n = 290) comprised women who died from 1995 to 2006. Matched controls (n = 814) comprised women who were alive at the end of follow-up. PUFAs were measured in baseline RBC samples and included four ω-3 and seven ω-6 PUFAs. We examined each PUFA individually and principal components factor analysis (PCFA)-derived scores in association with all-cause mortality (ACM) and breast cancer–specific mortality (BCM) using conditional logistic regression to estimate ORs and 95% confidence intervals (CIs). Results: In fully adjusted models, ACM ORs were elevated among women with PUFAs above the median (>median) versus at the median or below (≤median) for α-linolenic acid (ALA; OR = 1.63, 95% CI, 1.18–2.24) and linolenic acid (LA; OR = 1.56, 95% CI, 1.16–2.09). BCM ORs were elevated for ALA (OR = 1.83, 95% CI, 1.27–2.63), LA (OR = 1.70, 95% CI, 1.23–2.37), and γ-linolenic acid (GLA; OR = 1.50, 95% CI, 1.04–2.16). PCFA Factor 1 (arachidonic acid–adrenic acid–docosapentaenoic acid) scores above the median (vs. ≤median) were associated with lower odds of ACM (OR = 0.71, 95% CI, 0.52–0.97) and BCM (OR = 0.69, 95% CI, 0.49–0.97). PCFA Factor 4 (ALA/GLA) scores above the median (vs. ≤median) were associated with increased odds of BCM (OR = 1.47, 95% CI, 1.04–2.09). Conclusions: RBC ALA, LA, and GLA may be prognostic indicators among breast cancer survivors. Impact: These results are important for understanding the associations between a biomarker of PUFA intake and mortality among BC survivors.

Physical activity (PA) is significantly associated with many health outcomes. The wide usage of wearable accelerometer-based activity trackers in recent years has provided a unique opportunity for in-depth research on PA and its relations with health outcomes and interventions. Past analysis of activity tracker data relies heavily on aggregating minute-level PA records into day-level summary statistics, in which important information of PA temporal/diurnal patterns is lost. In this paper we propose a novel functional data analysis approach based on Riemann manifolds for modeling PA and its longitudinal changes. We model smoothed minute-level PA of a day as one-dimensional Riemann manifolds and longitudinal changes in PA in different visits as deformations between manifolds. The variability in changes of PA among a cohort of subjects is characterized via variability in the deformation. Functional principal component analysis is further adopted to model the deformations and PC scores are used as a proxy in modeling the relation between changes in PA and health outcomes and/or interventions. We conduct comprehensive analyses on data from two clinical trials: Reach for Health (RfH) and Metabolism, Exercise and Nutrition at UCSD (MENU), focusing on the effect of interventions on longitudinal changes in PA patterns and how different modes of changes in PA influence weight loss, respectively. The proposed approach reveals unique modes of changes including overall enhanced PA, boosted morning PA, and shifts of active hours specific to each study cohort. The results bring new insights into the study of longitudinal changes in PA and health and have the potential to facilitate designing of effective health interventions and guidelines.

Accelerometers are widely used for tracking human movement and provide minute-level (or even 30 Hz level) physical activity (PA) records for detailed analysis. Instead of using day-level summary statistics to assess these densely sampled inputs, we implement functional principal component analysis (FPCA) approaches to study the temporal patterns of PA data from 245 overweight/obese women at three visits over a 1-year period. We apply longitudinal FPCA to decompose PA inputs, incorporating subject-specific variability, and then test the association between these patterns and obesity-related health outcomes by multiple mixed effect regression models. With the proposed methods, the longitudinal patterns in both densely sampled inputs and scalar outcomes are investigated and connected. The results show that the health outcomes are strongly associated with PA variation, in both subject and visit-level. In addition, we reveal that timing of PA during the day can impact changes in outcomes, a finding that would not be possible with day-level PA summaries. Thus, our findings imply that the use of longitudinal FPCA can elucidate temporal patterns of multiple levels of PA inputs. Furthermore, the exploration of the relationship between PA patterns and health outcomes can be useful for establishing weight-loss guidelines.

Purpose: To examine the associations between red blood cell (RBC) composition of polyunsaturated fatty acids (PUFAs) and mortality among women with breast cancer. Methods: This nested case-control study included 1,104 women from the Women's Healthy Eating and Living Study, a randomized controlled trial of a plant-based dietary change on breast cancer survival. Cases were women who died from any cause (n = 290) from 1995 to 2006. Controls were women who were alive at the end of follow-up matched to cases on age at diagnosis, years since randomization, intervention group, and stage (n = 814). RBC fatty acid composition was measured in blood samples collected at baseline using gas chromatography and included the proportions of four n-3 and seven n-6 PUFAS. We examined each PUFA individually as well as factor analysis-derived factors in association with all-cause and breast cancer-specific mortality using conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: In fully-adjusted models, all-cause mortality ORs were elevated among women with PUFAs >median (versus ≤ median) for alpha-linolenic acid (ALA, C18:3n3; OR = 1.56; 95% CI = 1.14–2.14) and for linolenic acid (LnA, C18:2n6, OR = 1.54; 95% CI = 1.15–2.07), and breast cancer-specific mortality ORs were elevated for LnA (OR = 1.72, 95% CI = 1.24–2.38) and gamma-linolenic acid (GLA, C18:3n6; OR = 1.40; 95% CI = 0.97–2.00). Factor 1 [arachidonic acid, C20:4n6; adrenic acid, C22:4n6; and docosapentaenoic acid, C22:5n6] scores >median (versus ≤median) were associated with lower odds of all-cause (OR = 0.72; 95% CI = 0.53–0.98) and breast cancer-specific (OR = 0.67; 95% CI = 0.47–0.94) mortality, and Factor 4 [ALA and GLA] scores >median (versus ≤median) were associated with increased odds of breast cancer-specific mortality (OR = 1.42; 95% CI = 1.01–2.01). Additionally, 1-SD increase in Factor 4 scores were associated with ORs of 1.22 (95% CI = 1.04–1.42) for all-cause mortality and 1.24 (95% CI = 1.05–1.47) for breast cancer-specific mortality. Conclusions: RBC PUFA composition profiles are associated with all-cause and breast cancer-specific mortality risk among women with breast cancer.

PDF - 94K, Detailed mixed models analysis of self-reported and biomarker data.

Supplementary Table 1 from Low to Moderate Alcohol Intake Is Not Associated with Increased Mortality after Breast Cancer

BACKGROUND:Little is known about the impact of environmental exposure change on metabolic biomarkers associated with cancer risk. Furthermore, this limited epidemiological evidence on metabolic biomarkers focused on residential exposure, without considering the activity space which can be done by modelling dynamic exposures. In this longitudinal study, we aimed to investigate the impact of environmental exposures change on metabolic biomarkers using GPS-GIS based measurements. METHODS:Among two weight loss interventions, the Reach for Health and the MENU studies, which included ∼460 women at risk of breast cancer or breast cancer survivors residing in Southern California, three metabolic biomarkers (insulin resistance, fasting glucose, and C-reactive protein) were assessed. Dynamic GPS-GIS based exposure to green spaces, recreation, walkability, NO2, and PM2.5 were calculated at baseline and 6 months follow-up using time-weighted spatial averaging. Generalized estimating equations models were used to examine the relationship between changes in environmental exposures and biomarker levels over time. RESULTS:Overall, six-month environmental exposure change was not associated with metabolic biomarkers change. Stratified analyses by level of environmental exposures at baseline revealed that reduced NO2 and PM2.5 exposure was associated with reduced fasting glucose concentration among women living in a healthier environment at baseline (β -0.010, 95%CI -0.025, 0.005; β -0.019, 95%CI -0.034, -0.003, respectively). Women living in poor environmental conditions at baseline and exposed to greener environments had decreased C-reactive protein concentrations (β -1.001, 95%CI -1.888, -0.131). CONCLUSIONS:The impact of environmental exposure changes on metabolic biomarkers over time may be modified by baseline exposure conditions.

Background Modifying the environment to promote healthy foods is a population-based approach for improving diet. This study evaluated the outcome effectiveness of a food store intervention that used structural and social change strategies to promote fruits and vegetables. It was hypothesized that intervention versus control store customers would improve their consumption of fruits and vegetables at 6 months. Trial design Clustered randomized controlled trial Methods Sixteen pair-matched stores were randomized to an intervention or wait-list control condition. With the research team’s support, intervention stores modified the availability, accessibility, and promotion of fruits and vegetables, including augmenting produce displays within the store and building employees’ capacity to place and promote fruits and vegetables throughout the store (Phase 1), followed by the delivery of a customer-directed marketing campaign for 6 months (Phase 2). From months 7 to 12, stores were encouraged to maintain strategies on their own (Phase 3). Customer-reported daily fruit and vegetable consumption (cups/day) were collected by blinded research assistants at three time-points (baseline, 6 months and 12 months post-baseline) from 369 participating customers (an average of 23/store). Secondary outcomes included customer-reported fruit and vegetable purchasing and other behaviors. Results The study retained the 16 stores and most customers at 6 (91%) and 12 (89%) months. Although significant differences were not observed in the overall sample for vegetable consumption, male customers of intervention versus control stores consumed significantly more fruit daily at 6 months [mean (standard deviation) cups at baseline and six months; intervention: 1.6 (1.5) to 1.6 (1.5) vs. control: 1.4 (1.2) to 1.1 (0.8)]. However, this difference was not observed at 12 months, or among females. There was an overall increase in dollars spent at the targeted store in the intervention versus control condition among male versus female customers at 6 months; however, no change was observed in the percent of dollars spent on fruits and vegetables at the targeted store. Frequency of shopping at the targeted store did not modify intervention effects. Conclusions Structural and social change interventions can modify customers’ behavior in the short-term. Future research should consider methods for achieving longer-term changes, and potential generalizability to other products (e.g., energy-dense sweet and savory products). Trial registration NCT01475526

The older age groups comprise an increasing proportion of the population. The large cohort of "baby boomers," individuals born between 1946 and 1964, are now on the threshold of entering the older age groups, and they bring unique characteristics and lifestyle patterns to their older years when compared with those of preceding generations. Knowledge of the nutritional requirements of older adults in general has been notably limited, and the levels for the Recommended Dietary Allowances (RDA) in even the most recent edition5 are based on an age division at 51 years as a rather arbitrary point to distinguish older from younger adults. Aging is associated with distinct changes in body composition, some of which may be modified by activity and exercise patterns in the older adult. A reduction in the amount of skeletal muscle is the major determinant of reduced lean body mass, which has also been observed in association with aging.

The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.

IMPORTANCE Behavioral weight loss (BWL) programs result in weight loss for some, but most individuals regain the weight. The behavioral susceptibility theory proposes that genetically determined appetitive traits, such as food responsiveness (FR) and satiety responsiveness (SR), interact with the environment and lead to overeating and weight gain; the regulation of cues (ROC) intervention was developed specifically to target FR and SR. OBJECTIVE To evaluate the efficacy of ROC, ROC combined with BWL (ROC+), BWL, and an active comparator (AC) over 12 months of treatment and 12 months of follow-up. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from December 2015 to December 2019 in a university clinic. A total of 1488 volunteers from the community inquired about the study; 1217 were excluded or declined to participate. Eligibility criteria included body mass index (BMI) of 25 to 45, age 18 to 65 years, and lack of comorbidities or other exclusionary criteria that would interfere with participation. Data were analyzed from September 2021 to January 2022. INTERVENTIONS ROC uniquely targeted FR and SR. BWL included energy restriction, increasing physical activity, and behavior therapy techniques. ROC+ combined ROC with BWL. AC included mindfulness, social support, and nutrition education. MAIN OUTCOMES AND MEASURES Change in body weight as measured by BMI. RESULTS A total of 271 adults (mean [SD] age, 46.97 [11.80] years; 81.6% female [221 participants]; mean [SD] BMI, 34.59 [5.28]; 61.9% White [167 participants]) were assessed at baseline, midtreatment, posttreatment, and 6-month and 12-month follow-up. Sixty-six participants were randomized to AC, 69 to ROC. 67 to ROC+. and 69 to BWL. Results showed that ROC. ROC+, and BWL interventions resulted in significantly lower BMI at the end of treatment (BMI ROC, -1.18; 95% CI, -2.10 to -0.35; BMI ROC+, -1.56; 95% CI. -2.43 to -0.67; BMI BWL, -1.58; 95% Cl. -2.45 to -0.71). Compared with BWL. BMI at the end of treatment was not significantly different from ROC or ROC+ (BMI ROC, 0.40; 95% CI. -0.55 to 1.36; BMI ROC+. 0.03; 95% CI, -0.88 to 0.93); however, the BMI of the AC group was substantially higher (BMI AC, 1.58; 95% CI, 0.72 to 2.45). BMI reductions at 24 months after randomization were similar for ROC, ROC+, and BWL. Importantly, FR was a moderator of treatment effects with more weight loss for participants who scored higher in FR in the ROC and ROC+ groups. CONCLUSIONS AND RELEVANCE These findings suggest that ROC and ROC+ provide alternative weight loss approaches for adults. These models could be particularly effective for individuals who struggle with FR and could be used as a precision approach for weight loss.

Background Excess weight gain in young adulthood is associated with future weight gain and increased risk of chronic disease. Although multimodal, technology-based weight-loss interventions have the potential to promote weight loss among young adults, many interventions have limited personalization, and few have been deployed and evaluated for longer than a year. We aim to assess the effects of a highly personalized, 2-year intervention that uses popular mobile and social technologies to promote weight loss among young adults. Methods The Social Mobile Approaches to Reducing Weight (SMART) 2.0 Study is a 24-month parallel-group randomized controlled trial that will include 642 overweight or obese participants, aged 18–35 years, from universities and community colleges in San Diego, CA. All participants receive a wearable activity tracker, connected scale, and corresponding app. Participants randomized to one intervention group receive evidence-based information about weight loss and behavior change techniques via personalized daily text messaging (i.e., SMS/MMS), posts on social media platforms, and online groups. Participants in a second intervention group receive the aforementioned elements in addition to brief, technology-mediated health coaching. Participants in the control group receive a wearable activity tracker, connected scale, and corresponding app alone. The primary outcome is objectively measured weight in kilograms over 24 months. Secondary outcomes include anthropometric measurements; physiological measures; physical activity, diet, sleep, and psychosocial measures; and engagement with intervention modalities. Outcomes are assessed at baseline and 6, 12, 18, and 24 months. Differences between the randomized groups will be analyzed using a mixed model of repeated measures and will be based on the intent-to-treat principle. Discussion We hypothesize that both SMART 2.0 intervention groups will significantly improve weight loss compared to the control group, and the group receiving health coaching will experience the greatest improvement. We further hypothesize that differences in secondary outcomes will favor the intervention groups. There is a critical need to advance understanding of the effectiveness of multimodal, technology-based weight-loss interventions that have the potential for long-term effects and widespread dissemination among young adults. Our findings should inform the implementation of low-cost and scalable interventions for weight loss and risk-reducing health behaviors. Trial registration ClinicalTrials.gov NCT03907462 . Registered on April 9, 2019

Background: Health-related quality of life (HRQoL) among patients with localized prostate cancer (PC) on active surveillance (AS) and whether it may be improved through lifestyle-focused interventions remain underdefined. Objective: To assess longitudinal changes in HRQoL in patients who received and those who did not receive a behavioral intervention that increased vegetable intake. Design, setting, and participants: A secondary analysis of participants in the Men's Eating and Living (MEAL) study (Cancer and Leukemia Group 70807 [Alliance]), a randomized trial of vegetable consumption in patients on AS, was conducted. Outcome measurements and statistical analysis: Patient-reported outcomes (PROs) included the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), the Expanded Prostate Cancer Index Composite 26 (EPIC-26), and the Functional Assessment of Cancer Therapy Scale-Prostate (FACT-P). Areas under the curves (AUCs) were used to summarize serial HRQoL. Results and limitations: PROs were completed in 87% (n = 387) of the intention-tocollect population. Baseline characteristics of patients completing HRQoL measures did not differ significantly from the entire study population or between groups. Baseline scores were high for all PROs and remained stable over 24 mo, with no significant differences from baseline at any time point. In adjusted analyses, there were no significant differences in summary AUC measures comparing control with intervention for the total MAX-PC score (p = 0.173); EPIC-26 domains of urinary incontinence (p = 0.210), urinary obstruction (p = 0.062), bowel health (p = 0.607), sexual health (p = 0.398), and vitality (p = 0.363); and total FACT-P scores (p = 0.471). Conclusions: Among men with localized PC on AS enrolled in a randomized trial, HRQoL was high across multiple domains at baseline, remained high during follow-up, and did not change in response to a behavioral intervention that increased vegetable intake. Patient summary: Patients with localized prostate cancer enrolled on active surveillance experience minimal cancer-associated anxiety, suffer low levels of cancer-associated symptoms, and perceive high physical and emotional well-being. (C) 2022 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Purpose/Objective(s)The feasibility and safety of re-irradiation for ultracentrally located thoracic tumors has been reported, however there is very little information detailing outcomes, toxicity and cumulative dosimetry data to define the maximal tolerant dose of radiation to organs at risk (OAR). This study presents detailed dosimetry summary data of re-irradiation with an attempt to enrich the literature in this regard.Materials/MethodsFifteen individuals undergoing 10-fraction hypofractionated stereotactic body re-irradiation (re-hfSBRT) for the management of ultracentrally located thoracic tumors between 2009 and 2020 at a single institution were retrospectively reviewed. Cumulative dosimetric variables were generated from the construction of the cumulative plan sum, initial and re-irradiation treatment plans, using oncology imaging informatics system planning software. Treatment outcomes, toxicity and detailed dosimetry of OARs were analyzed.ResultsAt a median follow up of 10 months, one- and three-year overall survival (OS), progression free survival (PFS) and local control (LC) were 52% and 28%, 33% and 28%, and 76% and 61%, respectively. Treatment related adverse events were low with 5 individuals (33%) developing ≥ grade 2 pneumonitis (Grade 2 = 4, Grade 3 = 1). Dosimetric parameters were not associated with the development of clinically relevant pneumonitis. No adverse events involving central OARs (esophagus, great vessels, primary bronchial tree) were documented. Median cumulative mean lung dose (MLD) was 24 Gy (range: 10-33 Gy), with a V20 of 33% (range: 11-51%). Median esophageal, primary bronchial tree, and great vessel maximum doses (Dmax) were 93.2 Gy (range: 50-148 Gy), 163 Gy (range: 77-204 Gy), and 191 Gy (range: 129-262 Gy), respectively.ConclusionThe current study is the first to provide detailed cumulative dosimetric data from a cohort of patients treated with re-irradiation with ultracentrally located thoracic tumors. Despite unfavorable anatomic tumor location given an intimate association to critical OARs, delivering an ablative dose with a 10-fraction hfSBRT course can serve as a feasible option for these challenging cases.

Time spent sitting is positively correlated with endothelial dysfunction and cardiovascular disease risk. The underlying molecular mechanisms are unknown. MicroRNAs contained in extracellular vesicles (EVs) reflect cell/tissue status and mediate intercellular communication. We explored the association between sitting patterns and microRNAs isolated from endothelial cell (EC)-derived EVs. Using extant actigraphy based sitting behavior data on a cohort of 518 postmenopausal overweight/obese women, we grouped the woman as Interrupted Sitters (IS; N = 18) or Super Sitters (SS; N = 53) if they were in the shortest or longest sitting pattern quartile, respectively. The cargo microRNA in EC-EVs from the IS and SS women were compared. MicroRNA data were weighted by age, physical functioning, MVPA, device wear days, device wear time, waist circumference, and body mass index. Screening of CVD-related microRNAs demonstrated that miR-199a-5p, let-7d-5p, miR-140-5p, miR-142-3p, miR-133b level were significantly elevated in SS compared to IS groups. Group differences in let-7d-5p, miR-133b, and miR-142-3p were validated in expanded groups. Pathway enrichment analyses show that mucin-type O-glycan biosynthesis and cardiomyocyte adrenergic signaling ( P < 0.001) are downstream of the three validated microRNAs. This proof-of-concept study supports the possibility that CVD-related microRNAs in EC-EVs may be molecular transducers of sitting pattern-associated CVD risk in overweight postmenopausal women.

In March 2020, the pandemic brought significant changes to higher education modalities. This paper examines how family and consumer sciences (FCS) instructors in a comprehensive, multi-disciplinary department at a large 4-year university modified instruction and related activities as a response to the pandemic. Using the Family and Consumer Sciences Body of Knowledge as a framework, we illustrate approaches to meet students' basic needs and support their individual well-being during the crisis, and we provide a detailed description of changes in instructional strategies across different disciplines within the department. We highlight the lessons learned by instructors during the transition to fully online instruction and provide suggestions for other FCS programs moving forward.

ObjectiveModels such as family‐based treatment (FBT), delivered to both the parent and child, are considered the most efficacious intervention for children with obesity. However, recent research suggests that parent‐based treatment (PBT; or parent‐only treatment) is noninferior to FBT. The aim of this study was to evaluate the comparative costs of the FBT and PBT models.MethodsA total of 150 children with overweight and obesity and their parents were randomized to one of two 6‐month treatment programs (FBT or PBT). Data was collected at baseline, during treatment, and following treatment, and and trial‐based analyses of the costs were conducted from a health care sector perspective and a limited societal perspective.ResultsResults suggest that PBT, compared with FBT, had lower costs per parent‐child dyad from the health care sector perspective (PBT = $2,886; FBT = $3,899) and from a limited societal perspective (PBT = $3,231; FBT = $4,279).ConclusionsThese findings suggest that a PBT intervention has lower costs and is noninferior to an FBT intervention for both child and parent weight loss.

Our results demonstrate that 10-fraction ultra-central thoracic SBRT can be effectively administered with high rates of LC, favorable dosimetry, and acceptable rates of toxicity. Caution with re-treatment of ultracentral disease must be taken as this may be associated with increased toxicity, and inferior tumor control.