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Objectives: To identify the signs and symptoms that people living with acetabular hip dysplasia (AHD) describe and to provide an aid for translating the findings into practice., Methods: A three-phased mixed methods study. Phase 1 employed an open-question online survey that enabled people with AHD (aged ≥16 years) to describe features associated with their condition. Responses were thematically analysed. A Phase 2 survey used these themes to establish how common those features were. Phase 3 created a mnemonic that prompts clinicians to suspect AHD., Results: Ninety-eight respondents completed Phase 1 and sixty-two completed Phase 2. From the responses, five themes were identified: Demographic and Diagnostic Profile; Characteristics of Posture and Gait; Pain; Childhood Hip and Family History; and Hip Joint Characteristics. Within these themes, 19 common signs and symptoms were reported, represented by the ALPHA mnemonic. ALPHA describes a young age at onset of problems (Age), a limp (Limp), progressing pain (Pain), a history of childhood and family hip anomalies (History) as well as hip joint hypermobility and instability (Articulation)., Conclusion: The findings extend current understanding of AHD indicators. ALPHA alerts clinicians to suspect a diagnosis of AHD. ALPHA may facilitate timelier referral of patients for diagnostic X-Ray and appropriate treatment. Future studies should evaluate its clinical utility., (Copyright © 2024. Published by Elsevier Ltd.)

Increasing interest in measuring key components of the 24 h activity cycle (24-HAC) [sleep, sedentary behavior (SED), light physical activity (LPA), and moderate to vigorous physical activity (MVPA)] has led to a need for better methods. Single wrist-worn accelerometers and different self-report instruments can assess the 24-HAC but may not accurately classify time spent in the different components or be subject to recall errors. Objective . To overcome these limitations, the current study harmonized output from multiple complimentary research grade accelerometers and assessed the feasibility and logistical challenges of this approach. Approach . Participants ( n = 108) wore an: (a) ActiGraph GT9X on the wrist, (b) activPAL3 on the thigh, and (c) ActiGraph GT3X+ on the hip for 7-10 d to capture the 24-HAC. Participant compliance with the measurement protocol was compared across devices and an algorithm was developed to harmonize data from the accelerometers. The resulting 24-HAC estimates were described within and across days. Main results . Usable data for each device was obtained from 94.3% to 96.7% of participants and 89.4% provided usable data from all three devices. Compliance with wear instructions ranged from 70.7% of days for the GT3X+ to 93.2% of days for the activPAL3. Harmonized estimates indicated that, on average, university students spent 34% of the 24 h day sleeping, 41% sedentary, 21% in LPA, and 4% in MVPA. These behaviors varied substantially by time of day and day of the week. Significance . It is feasible to use three accelerometers in combination to derive a harmonized estimate the 24-HAC. The use of multiple accelerometers can minimize gaps in 24-HAC data however, factors such as additional research costs, and higher participant and investigator burden, should also be considered., (Creative Commons Attribution license.)

Background: Families experience financial burden and household material hardship (HMH) after a pediatric cancer diagnosis. This study investigates types of financial assistance and other financial coping strategies (FCS) adopted by families during the first year after diagnosis., Methods: Retrospective survey of caregivers of pediatric patients diagnosed with cancer from 2015 to 2019. The survey collected data on demographics, diagnosis, income, HMH, and private, hospital, and government assistance received and other FCS adopted after diagnosis. Bivariate and multivariable logistic regressions were used to analyze FCS by income. Subgroup analysis of families experiencing HMH was used to identify predictors of receiving government assistance., Results: Of 156 respondents, 52% were low-to-middle income, 29% had public insurance, and 22% had non-English language preference. Low-to-middle-income families were more likely to incur debt (odds ratio [OR] 6.24, p < .001) and reduce consumption (OR 2.16, p = .03) than high-income families, and this association persisted in multivariable analysis. Among families with housing, food, and energy insecurity, 40%, 70%, and 39%, respectively, received hospital or government assistance specific to the experienced hardship. In subgroup analysis of families with HMH, after adjusting for income and other confounders, non-English language preference was associated with lower odds of receiving government assistance., Conclusions: After a pediatric cancer diagnosis, low-to-middle-income families are more likely to incur debt than high-income families. Most families experiencing food insecurity received some food assistance, while housing and energy assistance were less common. Future studies should investigate methods to equitably improve access to financial assistance and minimize long-term financial consequences., (© 2024 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Increased dissemination of the CDC's Diabetes Prevention Program (DPP) is imperative to reduce type 2 diabetes. Due to its nationwide reach and mission to improve health, Cooperative Extension (Extension) is poised to be a sustainable DPP delivery system. However, research evaluating DPP implementation in Extension remains scant. Extension professionals delivered the DPP in a single-arm hybrid type II effectiveness-implementation study. Semi-structured interviews with Extension professionals were conducted at three time points. The Consolidated Framework for Implementation Research (CFIR) guided interview coding and analysis. Constructs were rated for magnitude and valence and evaluated as facilitators or barriers of RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) outcomes. The program reached 119 participants, was adopted by 92% (n = 12/13) of trained Extension professionals and was implemented according to CDC standards: all programs exceeded the minimum 22-session requirement (26 ± 2 sessions). The program was effective in achieving weight loss (5.0 ± 5.2%) and physical activity (179 ± 122 min/week) goals. At post-intervention, eight professionals (67%) had begun or planned to maintain the intervention within the next 6 months. Several facilitators were identified, including Extension leadership structure, organizational compatibility, and technical assistance calls. Limited time to recruit participants was the primary barrier. Positive RE-AIM outcomes, facilitated by contextual factors, indicate Extension is an effective and sustainable DPP delivery system. Extension and other DPP implementers should plan strategies that promote communication, the program's evidence-base, recruitment time, and resource access. Researchers should explore DPP implementation in real-world settings to determine overall and setting-specific best practices, promote intervention uptake, and reduce diabetes., (© 2023. The Author(s).)

Objective: The effectiveness of the National Diabetes Prevention Program (DPP) in improving diet quality (DQ) in community settings is largely unknown. This study aimed to evaluate the DQ changes of Extension DPP participants., Methods: A single-group, repeated-measures design was used to evaluate an Extension-implemented DPP using the PreventT2 curriculum. Participants were overweight adults with or at high risk for prediabetes (n = 88). Weight and DQ (Healthy Eating Index-2015, Dietary Screener Questionnaire) were evaluated using mixed-effects regression., Results: There was no change in the Healthy Eating Index-2015 total score. Predicted fiber, fruit, and vegetable intake increased (P < 0.05) but remained below recommendations., Conclusions and Implications: Clinically meaningful DQ changes of Extension DPP participants were limited. The effect of the DPP on DQ in Extension and other implementation settings should be evaluated through randomized controlled trials. Diabetes Prevention Program curriculum revisions that include more specific dietary goals and educational tools may promote greater DQ changes in DPP participants., (Copyright © 2023 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: Based on previous reports of disparities in financial burden following a cancer diagnosis, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support., Methods: Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity, and income change., Results: Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH: 57% vs. 21% vs. 19%, p < .001; financial toxicity: 73% vs. 52% vs. 53%, p = .07). Low- and middle-income caregivers were more likely to experience HMH and financial toxicity compared to high-income caregivers (HMH: 68% low vs. 38% middle vs. 8.7% high, p < .001; financial toxicity: 81% vs. 68% vs. 44%, p < .001). All income categories demonstrated significant increases in HMH 1 year after diagnosis. Seventeen percent reported more than 40% income loss, more of whom were low income than high income (27% vs. 12%, p = .20). Work flexibility and social support were associated with income and financial toxicity., Conclusion: HMH, financial toxicity, and income loss are prevalent after a child's cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low-income and Hispanic caregivers. Further research is needed to elucidate the roles of work flexibility and social support, how safety net services are utilized by families, and how best to support families with HMH., (© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Background: Maximizing independence and function post-stroke are two common therapy goals. Rate of torque development in lower-extremity muscles was recently reported to be associated with walking speed; however, trainability and subsequent effect on gait is unknown. This study aimed to determine effect of power training on paretic and non-paretic limb torque parameters, spatiotemporal gait parameters, and walking speed in chronic stroke survivors., Methods: Individuals with chronic stroke (n = 22; 7 females; 62.7 ± 8.8 yrs) completed 24 progressive power-training sessions over 8 weeks with pre and post assessments. Knee extensor strength was assessed via dynamometry with torque parameters measured from maximal voluntary isometric contractions. Gait speed and spatiotemporal gait parameters were assessed via an instrumented gait mat, and a 6-min walk test was performed., Findings: Rate of torque development at 200 ms and peak torque improved 58.6% and 14.1%, respectively, in the quadricep of the paretic limb (p < 0.05); conversely the non-paretic limb was unchanged. On average, self-selected walking speed, fastest-comfortable walking speed, and 6-min walk test improved 21.7%, 21.1%, and 19.5%, respectively (all p < 0.05). Change in torque development at 100 ms in the quadricep of the non-paretic limb was positively associated with improvements in self-selected and fastest-comfortable walking speeds (both r = 0.70, p < 0.05) and 6-min walk (r = 0.78, p < 0.001)., Interpretations: These findings suggest power training may be an effective intervention for improving torque development in the quadricep of the paretic limb in individuals with chronic stroke. Further research to explore utility and mechanistic aspects of force development for gait function in chronic stroke survivors is warranted., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Chris M Gregory reports financial support was provided by National Institutes of Health., (Copyright © 2023. Published by Elsevier Ltd.)

Inadequate physical activity (PA), unhealthy weight status, prevalence of chronic conditions, and psychosocial distress are common in middle-aged women and are linked to reductions in well-being and quality of life. However, their potential interactive effects, specifically on sexual well-being and menopause-specific quality of life (MENQOL), have not been well characterized in postmenopausal women. PURPOSE: To determine if moderate-to-vigorous physical activity (MVPA) and adiposity (%Fat) influence sexual well-being and MENQOL outcomes, controlling for health status (chronic conditions; medications) and psychosocial well-being (depressive symptoms; perceived stress), in postmenopausal women. Postmenopausal women ( n  = 68, 58.6 ± 3.4 yr, 80.9 percent married/partnered, 51.5 percent overweight/obese, nonsmoking) were recruited through e-mail advertisements and flyers placed throughout the community. Participants were scheduled for two laboratory visits 7-10 days apart where they were objectively assessed for MVPA with accelerometers (in the interim), adiposity via dual-energy X-ray absorptiometry (DXA), and self-report questionnaires to determine health status, depressive symptoms, perceived stress, sexual well-being, and MENQOL. Lower MVPA and higher %Fat were associated with lower physical domain MENQOL (both r  = .27, p  < .05); health status and psychosocial well-being were not associated (all p  > .05). Hierarchical regression analyses revealed 1) greater number of chronic conditions and medications, and depressive symptoms scores predicted less favorable sexual well-being, independent of MVPA and %Fat (standardized β range =.22-.56, all p  < .05), 2) depression was most consistently associated with MENQOL (models p  ≤ .001), and 3) greater adiposity augmented the negative influence of depression on the physical domain of MENQOL (β = .40. p  = .002). CONCLUSIONS: PA may influence sexual well-being and MENQOL indirectly through positive impacts on adiposity, chronic conditions, and depressive symptoms in middle-aged postmenopausal women, a sector of the population often afflicted with compromised sexual well-being.

Exercise training (EX) and weight loss (WL) improve lower extremity physical function (LEPF) in older overweight women; however, effects on rate of torque development (RTD) are unknown. This study aimed to determine the effects of WL + EX or WL alone on RTD, and relatedly LEPF, in overweight older women. Leg strength was assessed using isokinetic dynamometry, and RTD was calculated (RTD200 = RTD at 200 ms, RTDPeak = peak RTD, T2P = time to 1st peak). LEPF was determined via clinical functional tasks. Women (n = 44, 69.1 ± 3.6 years, 30.6 ± 4.3 kg/m2) completed a 6-month trial in EX + WL or WL groups with similar weight loss (-9.8 ± 4.2%, p > .95). EX + WL had greater improvements in (a) most LEPF tasks (p < .001) and (b) RTD200, compared with WL (36% vs. -16%, p = .031); no other RTD parameters differed. Changes in RTD parameters and LEPF were not related (all p > .05). RTD is responsive to EX but is not associated with LEPF in older women.

Objective: To identify the sex-specific prevalence of metabolic syndrome (MetS) risk factors and their physiological, psychosocial, and behavioral correlates in a college-aged population. Participants and methods : Cross-sectional assessment of MetS risk factors and potential correlates occurred in 379 first-year students (aged 18.34 ± 0.49 years, 67.3% female). Multivariable linear regression assessed the relationships between potential correlates and continuous MetS risk scores, derived from principal component analysis. Results: MetS risk factors were present in 58.4% of females and 68.5% of males, with 2.4% and 3.2% having defined MetS. In females, percent body fat (β = 0.46, p  < 0.001), stress (β = 0.12, p  = 0.031), % kcal from sugar (β = 0.18, p  = 0.001), and moderate-to-vigorous physical activity (β=-0.12, p  = 0.036) were associated with risk score. Whereas, correlates in males included percent body fat (β = 0.54, p  < 0.001), C-reactive protein (β = 0.15, p  = 0.045), and AUDIT alcohol consumption score (β = 0.15, p  = 0.033). Conclusion: The sex-specific prevalence of MetS risk factors and correlates suggest that primary prevention strategies on college campuses should also follow a sex-specific approach.

Objective To compare physical activity (PA) behaviors and perceived benefits and barriers among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) and non-LGBTQ + college students. Participants : Participants were 406 college students. Methods: Surveys assessed PA behaviors and perceptions of PA among college students. Multivariate ANOVA assessed differences in PA behaviors and perceptions of PA. Results: LGBTQ + students (n = 71) engaged in 17% less aerobic PA and 42% less resistance training than their counterparts (n = 335; both p < .05). LGBTQ + students reported 6.5% lower total Exercise Benefits and Barriers Scale scores and 13.3% higher Barriers Scale scores (both p < .05). Conclusions: LGBTQ + college students are at higher risk of not meeting PA guidelines than non-LGBTQ + students. More perceived barriers and fewer perceived benefits to PA may contribute to this disparity. Identification of LGBTQ+-specific barriers to PA among college students is needed to inform programming to increase PA among this at-risk community.

Objective: To assess whether sex or school year influence physical activity and exercise (PA/EX) behaviors and perceived benefits and barriers of PA/EX among college students. Participants: Participants were 862 (78% female; 20.1 ± 1.4 years) college students. Methods: The International Physical Activity Questionnaire, Exercise Benefits and Barriers Scale, and resistance training (RT) questions were completed online. Results: Factorial ANOVA (sex x year) determined no significant interaction effects of sex and school year in behaviors or perceived benefits and barriers (all p  > .05). Males reported higher levels of PA/EX and RT than females ( p  < .05) with no differences by school year ( p  = .34). Benefits Scale scores and some of its subscales were higher for males and first-year students compared to females and third- and fourth-year students (all p  < .05). Conclusion: PA/EX promotion programs may need to be tailored differently based on sex and school year.

Background: Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes., Study Design and Methods: Dual-center, retrospective cohort study conducted over 6 months (March-August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of - 3 to - 5 or Riker Sedation-Agitation Scale of 1-3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days., Results: 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65-7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19., Conclusions: The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach., (© 2022. The Author(s).)

Pressure injuries (PIs) are common and costly complications in long-term care (LTC) residents. Educating and coaching certified nursing assistants (CNAs) to communicate early skin changes is a PI surveillance strategy that may influence PI outcomes. A communication guide related to Skin, Clean, Activity, and Nutrition was developed for CNAs to promote prompt upstream communication to licensed nurses. A pre-/post-intervention design measured PI knowledge and skills in 24 CNAs, and PI incidence was tracked over a 6-week time period. CNAs demonstrated improvement in their PI surveillance role, comfort in identifying and reporting skin changes, keeping skin clean and dry, and resident nutritional status. Baseline PI incidence of 9.6% decreased to 0% by Week 3, and no new PIs occurred over 6 weeks. CNAs developed role awareness and knowledge in primary PI surveillance and were instrumental in a team approach to decrease PIs in a LTC setting. [ Journal of Gerontological Nursing, 47 (8), 21-28.].

Community Health Workers (CHWs) are becoming essential members of the HIV workforce as emerging evidence demonstrates their effectiveness in engaging people with HIV into care and treatment. In 2018, among the estimated 37,000 persons who received an HIV diagnosis, the majority were from racial ethnic minority communities. CHWs serve as a bridge between the community and health care system and have the potential to address structural inequities and reduce the stigma, discrimination and other barriers that prevent people with HIV from seeking and staying in care and treatment. Effective CHW integration into the HIV primary care team requires a training and supervision system that is culturally responsive to the complex social and medical needs of people with HIV. This article describes a comprehensive training approach and curricula for CHWs and supervisors and its impact on the health care team. Grounded in a Popular Education model and using the CHW core consensus competency (C3) framework, a team of experts in HIV, training and supervision, including CHWs working in HIV care and treatment developed an 80-h CHW and 20-h supervisor curricula. The trainings were delivered via in-person and virtual sessions over the course of 2 years. Using a mixed method evaluation, 23 CHWs and 22 supervisors across 10 clinic sites in eight states participated in the training sessions. Measures included knowledge and confidence related to HIV-specific content, supporting clients with managing stigma and discrimination, ability to communicate with other team members and helping clients navigate the services system. CHWs reported improved skills with documentation in the electronic health record, helping clients with treatment adherence challenges and educating on lab results. Supervisors reported learning strategies for assigning clients to CHWs, self-care techniques, providing strengths-based feedback, and mentoring and coaching. The participatory practice-based curricula allowed supervisors and CHWs to share experiences and solicit input from peers for problem resolution and implementation of new policies and practices. This training approach focused on HIV specific content with core competency training could serve as a model for CHWs working in primary care settings and with populations experiencing multiple chronic health conditions and social needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Rajabiun, Baughman, Sullivan, Poteet, Downes, Davich, Phillips, Jackson, Miles, Drainoni, Evans, Bachman and Sprague Martinez.)

A colovesical fistula (CVF) is a pathological connection between the colon and the urinary bladder. Although they are uncommon, consequences can severely affect quality of life and mortality. Diverticula are the most common cause of CVF. This case details a patient's CVF diagnosis in the emergency department with unremitting gastrointestinal and urinary symptoms. A 78-year-old male patient with recent hospitalization for stroke and left carotid endarterectomy complicated by urinary retention treated with a Foley catheter presented to the Emergency Department with a chief complaint of hematuria and unremitting diarrhea. Foley exchange resulted in improved urinary retention and diarrhea during hospitalization. One day following hospital discharge, the patient presented again with a blocked Foley catheter and diarrhea. Foley irrigations resulting in near immediate diarrhea and lack of bladder filling on bladder scan portended to a diagnosis of colovesical fistula despite no history diverticula or colon malignancy. An abdominal/pelvic computed tomography scan and cystogram confirmed a colovesical fistula. This case highlights the need for consideration of colovesical fistula in a seemingly simple ED complaint of urinary retention. It is prudent to closely follow bladder scan volumes when flushing a Foley catheter. Given the significant comorbidities such as urosepsis and health care impact of repeat ED visits and hospitalizations, CVF can and should be entertained and rapidly diagnosed in the emergency department. Our case highlights the need for consideration of a vesico-colic fistula despite the absence of initial relevant risk factors., Competing Interests: Declaration of Competing Interest The authors have no outside support information, conflicts or financial interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Obesity negatively affects lower extremity physical function (LEPF) in older adults. Exercise and a higher protein diet are both known to positively and independently affect body composition, muscle strength, and LEPF during weight loss; however, their potential interactive effects have not been well characterized in older women., Purpose: The aim of this study was to determine the relative efficacy of a higher protein diet with or without exercise to improve body composition, muscle strength, and LEPF in older inactive overweight/obese women after weight loss., Methods: Postmenopausal women (body mass index = 31.1 ± 5.1 kg·m, 69.2 ± 3.6 yr) completed a 6-month weight loss program after randomization to three groups (n = 72 randomized; 15% dropout): 1) higher protein diet (PRO, ~30% energy from protein; n = 20), 2) PRO plus exercise (PRO + EX; n = 19), or 3) a conventional protein control diet plus EX (CON + EX, ~18% energy from protein; n = 22). EX was supervised, multicomponent (aerobic, muscle strengthening, balance, and flexibility), and three sessions per week. Body composition was measured via dual-energy x-ray absorptiometry, leg strength by isokinetic dynamometry, and LEPF via 6-min walk, 8-ft up and go, and 30-s chair stand tests., Results: Changes in weight (-7.5 ± 4.1 kg; -9.2% ± 4.8%), fat mass, and leg lean mass did not differ among groups (all P > 0.50). Despite weight loss, muscle strength improved in the exercise groups (PRO + EX and CON + EX) but it declined in the PRO group (P = 0.008). For all LEPF measures, the PRO group had attenuated improvements compared with both PRO + EX and CON + EX (all P < 0.01)., Conclusion: Exercise during weight loss is critical to preserve strength and enhance LEPF; however, a higher protein diet does not appear to influence body composition, muscle strength, or LEPF changes when combined with multicomponent exercise.

Background & Aims: Overall diet quality is a key predictor of disease risk and mortality. Diets higher in animal protein have been associated with increased disease risk and all-cause mortality. However, the source of protein consumed will inevitably influence the intake of other macronutrients and micronutrients which can also play a role in the onset of disease. The aim of the present study was to assess the relationship between animal and plant protein intake and overall diet quality in young adult females and males., Methods: Dietary intake was assessed via 3-day food log (n = 150; 53% females) and data were analyzed using the Nutrition Data Systems for Research (NDSR)., Results: Females and males consuming <70% of their protein from animal sources had higher scores on a modified Healthy Eating Index (HEI) compared those consuming >70% of their protein from animal sources. Males scored lower than females on the modified HEI regardless of protein source intake variation., Conclusions: Our findings suggest that overall diet quality differs with varying protein source consumption and eating <70% of protein from animal sources might lead to a better score on the HEI. Future research investigating protein source and disease risk should examine overall dietary quality as a potential effect modifier., Competing Interests: Conflict of Interest The authors declare no conflict of interest., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Muscle mass is a commonly cited mediator of the relationship between physical activity (PA) and bone, representing the mechanical forces generated during PA. However, neuromuscular properties (eg, peak force) also account for unique portions of variance in skeletal outcomes. We used serial multiple mediation to explore the intermediary role of muscle mass and force in the relationships between cortical bone and moderate-to-vigorous intensity PA (MVPA). In a cross-sectional sample of young adults (n = 147, 19.7 ± 0.7 years old, 52.4% female) cortical diaphyseal bone was assessed via peripheral quantitative computed tomography at the mid-tibia. Peak isokinetic torque in knee extension was assessed via Biodex dynamometer. Thigh fat-free soft tissue (FFST) mass, assessed via dual-energy X-ray absorptiometry, represented the muscular aspect of tibial mechanical forces. Habitual MVPA was assessed objectively over 7 days using Actigraph GT3X+ accelerometers. Participants exceeded MVPA guidelines (89.14 ± 27.29 min/day), with males performing 44.5% more vigorous-intensity activity relative to females (p < 0.05). Males had greater knee extension torque and thigh FFST mass compared to females (55.3%, and 34.2%, respectively, all p < 0.05). In combined-sex models, controlling for tibia length and age, MVPA was associated with strength strain index (pSSI) through two indirect pathways: (i) thigh FFST mass (b = 1.11 ± 0.37; 95% CI, 0.47 to 1.93), and (i) thigh FFST mass and knee extensor torque in sequence (b = 0.30 ± 0.16; 95% CI, 0.09 to 0.73). However, in sex-specific models MVPA was associated with pSSI indirectly through its relationship with knee extensor torque in males (b = 0.78 ± 0.48; 95% CI, 0.04 to 2.02) and thigh FFST mass in females (b = 1.12 ± 0.50; 95% CI, 0.37 to 2.46). Bootstrapped CIs confirmed these mediation pathways. The relationship between MVPA and cortical structure appears to be mediated by muscle in young adults, with potential sex-differences in the muscular pathway. If confirmed, these findings may highlight novel avenues for the promotion of bone strength in young adults. © 2019 American Society for Bone and Mineral Research., (© 2019 American Society for Bone and Mineral Research.)

Background: Fever is common in mechanically ventilated patients and may be uniquely detrimental in those with lung injury because of its injurious effects on pulmonary vascular permeability and alveolar epithelium. We evaluated the association of fever and antipyretic medication with mortality in mechanically ventilated emergency department (ED) patients., Methods: This is a retrospective cohort study of 1,264 patients requiring mechanical ventilation initiated in the ED with subsequent admission to an intensive care unit. Maximum body temperature was recorded for the first 24 h after ED admission and categorized into four categories: <37°C, 37°C to 38.2°C, 38.3°C to 39.4°C, and ≥39.5°C. The primary outcome was 28-day mortality. We conducted a planned subgroup analysis of patients with sepsis at the time of intubation. Multivariable Cox proportional hazard ratios (HRs) were used to assess the relationship between temperature, antipyretics, and mortality., Results: Multivariable Cox proportional HRs demonstrated that a maximum temperature ≥39.5°C was associated with increased mortality (adjusted hazard ratio [aHR] 1.59 [95% confidence interval, CI, 1.05-2.39]). In the subgroup of patients with sepsis, a maximum temperature of 38.3°C to 39.4°C was associated with survival (aHR 0.61 [95% CI, 0.39-0.99]). There was no difference in 28-day mortality between patients who did and did not receive antipyretic medication in either the overall cohort or the septic subgroup., Conclusion: High fever (≥39.5°C) was associated with increased risk for mortality in mechanically ventilated patients. However, in patients with sepsis, moderate fever (38.3°C-39.4°C) was protective. Antipyretic medication was not associated with changes in outcome. This suggests that fever may have different implications in septic versus nonseptic mechanically ventilated patients.

Background: Pediatric firearm-related deaths and injuries are a serious societal problem. Our study's objective was to determine social workers' assessment of child neglect with respect to access or potential access to a loaded firearm., Methods: Study invitations were delivered by e-mail to National Association of Social Workers members designating their practice as "Child/Family Welfare" (N = 4933) in October/November, 2015. Demographics, attitudes regarding child access prevention (CAP) laws, and the ages (4-14 years) at which social workers deemed several scenarios as child neglect were determined. Descriptive (frequencies) and bivariate (chi square) analyses were performed., Results: 485 of 4933 social workers completed the survey (9.8%). Of these, most agreed or strongly agreed (≥92%) there should be laws in place requiring firearms to be stored so unwanted access cannot be obtained by a child, even up to 15 years of age. In a scenario where a child had potential access to a loaded firearm, but never gained access, the presence of a CAP law pertinent to the child in the scenario increased the likelihood respondents would find the situation child neglect for all ages (p < 0.0001 for each age comparison). Moreover, 10.3% felt they could not deem the situation child neglect without the presence of a CAP law, no matter the age of the child. In a scenario where a child gained access to a loaded firearm, the vast majority found this to be child neglect (82-99%, with the percentage varying by the age of the child involved), regardless of the presence or absence of a CAP law and/or an injury being sustained. In addition, when a CAP law was in place, social workers were more likely to find neglect if the child had sustained a firearm-related injury as well (p values ranged from 0.016-0.0081 for age comparisons)., Conclusions: The vast majority of child/family welfare social workers surveyed found it to be child neglect when youth accessed or had potential access to a loaded, unsecured firearm. Results of the study provide support for the passage of universal CAP laws to help protect children equally across states and ensure the safe storage of firearms in homes., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Introduction: Excess sitting is a risk factor for early mortality. This may be resulting, at least in part, from the displacement of physical activity with sedentary behaviors. The purpose of this observational study was to examine the mortality risk reductions associated with replacing 30minutes/day sitting for an equivalent duration of light or moderate to vigorous physical activity (MVPA)., Methods: Participants included 37,924 men and 54,617 women in the Cancer Prevention Study-II Nutrition Cohort, of which 14,415 men and 13,358 women died during follow-up (1999-2014). An isotemporal substitution approach to the Cox proportional hazards regression model was used to estimate adjusted hazard ratios and 95% CIs for mortality associated with the substitution of 30minutes/day self-reported sitting for light physical activity or MVPA. Analyses were conducted in 2018., Results: Among the least active participants (≤17minutes/day MVPA), the replacement of 30minutes/day sitting with light physical activity was associated with a 14% mortality risk reduction (hazard ratio=0.86, 95% CI=0.81, 0.89) and replacement with MVPA was associated with a 45% mortality risk reduction (hazard ratio=0.55, 95% CI=0.47, 0.62). Similar associations were seen among moderately active participants (light physical activity replacement, hazard ratio=0.94, 95% CI=0.91, 0.97; MVPA replacement, hazard ratio=0.83, 95% CI=0.76, 0.88). However, for the most active (MVPA >38 minutes/day), substitution of sitting time with light physical activity or MVPA was not associated with a reduction in mortality risk (hazard ratio=1.00, 95% CI=0.97, 1.03, and hazard ratio=0.99, 95% CI=0.95, 1.02, respectively)., Conclusions: These findings suggest that the replacement of modest amounts of sitting time with even light physical activity may have the potential to reduce the risk of premature death among less active adults., (Copyright © 2019 American Journal of Preventive Medicine. All rights reserved.)

Purpose: This study examined the 1-yr test-retest reliability and criterion validity of sedentary time survey items in a subset of participants from a large, nationwide prospective cohort., Methods: Participants included 423 women and 290 men age 31 to 72 yr in the Cancer Prevention Study-3. Reliability was assessed by computing Spearman correlation coefficients between responses from prestudy and poststudy surveys. Validity was assessed by comparing survey-estimated sedentary time with a latent variable representing true sedentary time estimated from the 7-d diaries, accelerometry, and surveys through the method of triads. Sensitivity analyses were restricted to 566 participants with an average of 14+ h of diary and accelerometer data per day for 7 d per quarter., Results: Reliability estimates for total sitting time were moderate or strong across all demographic strata (Spearman ρ ≥ 0.6), with significant differences by race (P = 0.01). Reliability estimates were strongest for the TV-related sedentary time item (Spearman ρ, 0.74; 95% confidence interval, 0.70-0.77). The overall validity coefficient (VC) for survey-assessed total sedentary time was 0.62 (95% confidence interval, 0.55-0.69), although VC varied by age group and activity level (P < 0.05). However, VC were similar across groups (P < 0.05) when restricting to highly compliant participants in a sensitivity analysis., Conclusions: The Cancer Prevention Study-3 sedentary behavior questionnaire has acceptable reliability and validity for ranking or categorizing participants according to sedentary time. Acceptable reliability and validity estimates persist across various demographic subgroups.

We investigated children's (n = 120; 3- to 11-year-olds) and adults' (n = 18) reasoning about life-cycle changes in biological organisms by examining their endorsements of four different patterns of life-span changes. Participants were presented with two separate tasks: (a) judging possible adult versions of a juvenile animal and (b) judging possible juvenile versions of an adult animal. The stimuli enabled us to examine the endorsement of four different patterns of change: identical growth, natural growth, dramatic change, and speciation. The results suggest that endorsement of the different patterns is influenced by age and familiarity. Young children and individuals confronted with unfamiliar organisms often endorsed an identical growth that emphasizes the stability of features over the life span and between parents and offspring. The results are interpreted as supporting the idea that cognitive constraints influence individuals' reasoning about biological change and that the influence of these constraints is most notable when individuals are young or are presented with unfamiliar biological organisms., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The purpose of this study was to examine the relative contributions of changes in muscle quality and body composition to changes in lower-extremity physical function (LEPF) following a 6-month exercise and weight loss intervention in overweight and obese older women. Thirty-eight overweight and obese (BMI = 30.0 ± 4.4 kg/m 2 ) older (age = 69.3 ± 4.1 y) women completed 6 months of multicomponent exercise (cardiorespiratory, resistance, balance and flexibility training) and weight loss (hypocaloric diet that reduced energy intake by ~500 kcal/d). Body composition was measured via dual-energy X-ray absorptiometry and muscle quality (N-m/kg) was defined as maximal concentric isokinetic knee torque divided by upper-leg lean mass. The standardized scores of four objective measures of physical function were summed to yield a composite LEPF Z-score. At 6 months, there were significant reductions in body weight (-9.6 ± 3.5%, p < 0.01), absolute fat mass (-6.8 ± 2.4 kg, p < 0.01) and relative adiposity (-4.9 ± 2.1%, p < 0.01). There were also improvements in both muscle quality (+1.6 ± 1.8 N-m/kg, p < 0.01) and individual measures of LEPF (11-57%, p < 0.01). Multivariate linear regression indicated that increased muscle quality was the strongest independent predictor of an improvement in LEPF Z-score (standardized β = 0.64, p < 0.01) and explained 34% of the variance. A reduction in body weight also predicted an improvement in LEPF, independent of the change in muscle quality. In conclusion, muscle quality can be increased in the presence of clinically meaningful weight loss, and is the primary determinant of improved physical function in overweight/obese older women., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: Muscle cross-sectional area (MCSA) is often used as a surrogate for the forces applied to bones during physical activity. Although MCSA is a strong predictor of cortical bone status, its use makes assumptions about the relationship between muscle size and force that are inaccurate. Furthermore, to measure MCSA and other muscle force surrogates typically requires expensive and/or radiative laboratory equipment. Thus, this study aimed to determine whether clinical laboratory- and field-based methodologies for measuring muscular force capacity accounted for similar variance in diaphyseal cortical bone status as a commonly used muscular force surrogate, MCSA, at the midtibia in young men and women., Methods: Healthy young adults (n = 142, 19.7 ± 0.7 yr old, 52.8% female) were assessed via peripheral quantitative computed tomography at the midtibia for cortical bone status and MCSA. Muscle force capacity was measured via Biodex dynamometer, Nottingham leg extensor power rig, and Vertec vertical jump. Regression analysis compared the independent variance predicted by each muscle force measure with that of MCSA, accounting for relevant confounders., Results: MCSA, knee extension peak torque, and peak anaerobic power from vertical jump were independent predictors of select cortical structural outcomes (cortical thickness and area, periosteal and endosteal circumference, and estimated strength) accounting for up to 78.4% of the variance explained (all P < 0.05). However, cortical volumetric bone mineral density was unrelated to any measure or surrogate of muscle force capacity., Conclusions: MCSA is a strong independent predictor of cortical bone structure; however, both laboratory- and field-based measures of peak torque and/or peak anaerobic power are promising alternatives, explaining similar and sometimes greater variance than MCSA.

Background: Vaccination rates against Human Papillomavirus (HPV) in the US remain alarmingly low. Physicians can significantly influence a parent's decision to vaccinate their children. However, medical education often lacks training on specific strategies for communicating with vaccine hesitant parents., Methods: We created an innovative curriculum designed to teach medical students how to address HPV vaccine hesitancy. The curriculum consisted of (1) a presentation on the epidemiology, biology, and disease morbidity associated with HPV, (2) a video that teaches specific communication strategies and (3) role-playing simulations. This curriculum was delivered to medical students at two separate sites. Medical students were surveyed before and after completing the educational curriculum. The surveys assessed student comfort talking to HPV vaccine hesitant parents and their likelihood to recommend the HPV vaccine., Results: Pre- and post-intervention surveys were completed by 101 of the 132 participants (77% response rate). After the intervention, student awareness of the benefits of the HPV vaccine increased by a mean of 0.82 points (Likert scale 1-5, p < 0.01) and student comfort talking to vaccine hesitant parents increased by a mean of 1.37 points (p < 0.01). Prior to the intervention, students more strongly recommended the HPV vaccine to females compared to males, but this gender disparity was eliminated after the intervention (p < 0.01). Personal vaccination status was independately associated with a higher likelihood of recommending the HPV vaccine both before and after the intervention., Conclusion: Our innovative curriculum improved medical student comfort level discussing HPV vaccination with hesitant parents and increased the perceived likelihood of recommending HPV vaccination. The intervention is easy to implement, scalable, and requires minimal resources. Educating future providers on this important topic has the potential to improve vaccination rates nationwide and thus should be considered for all medical students., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Sprint interval cycle training is a contemporary popular mode of training but its relative efficacy, under conditions of matched energy expenditure, to reduce risk factors for cardiometabolic disease is incompletely characterised, especially in young women. The purpose of this investigation was to determine the relative efficacy of six weeks of moderate-intensity cycling (MOD-C) and vigorous sprint-interval cycling (VIG-SIC) on lipid profile, insulin (INS) and insulin resistance using the homeostatic model assessment (HOMA-IR) and C-reactive protein (CRP) in inactive, overweight/obese (OW/OB) young women., Methods: Participants (BMI ≥25 kg/m 2 , waist circumference ≥88 cm) were randomly assigned to MOD-C (20-30 min at 60-70% of heart rate reserve(HRR)) or VIG-SIC (5-7 repeated bouts 30-second maximal effort sprints, followed by four minutes of active recovery) supervised training three days/week for six weeks, with each group matched on energy expenditure. Adiposity (%Fat) was measured using dual x-ray absorptiometry., Results: Forty-four participants (20.4 ± 1.6 years, 65.9% Caucasian, 29.8 ± 4.1 kg/m 2 ) were included in the analysis. The improvement in CRP observed in the MOD-C group was larger than the VIG-C group (p = .034). Overall, high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) levels improved following training (p < .05); however, total cholesterol, triglyceride, INS and HOMA-IR did not improve (p > .05)., Conclusion: These results indicate MOD-C training may be more effective in reducing CRP than VIG-SIC.

In vivo isotopic labeling empowers proteomic and metabolomic analyses to resolve relationships between the molecular composition, environment, and phenotype of an organism. Carbon-13 is particularly useful for plant labeling as it can be introduced via 13 CO 2 gas and readily assimilated into plant metabolic systems through natural carbon fixation. While short-term labeling experiments can be performed within a simple sealed enclosure, long-term growth in an isolated environment raises many challenges beyond nutrient availability and buildup of metabolic waste. Viable growth conditions must be maintained by means that do not compromise the integrity of the carbon-13 enrichment. To address these issues, an automated growth chamber equipped with countermeasures to neutralize stresses and ensure high isotopic enrichment throughout the life cycle of the plant has been developed. The following describes this growth chamber and its use in an example 130-day growth of ten soybean plants to full maturity, achieving 100% carbon-13 enrichment of new seed tissue. © 2018 by John Wiley & Sons, Inc., (Copyright © 2018 John Wiley & Sons, Inc.)

In this study we describe a [ 15 N] stable isotopic labeling study of amino acids in Spirodela polyrhiza (common duckweed) grown under three different light and carbon input conditions which represent unique potential metabolic modes. Plants were grown with a light cycle, either with supplemental sucrose (mixotrophic) or without supplemental sucrose (photoautotrophic) and in the dark with supplemental sucrose (heterotrophic). Labeling patterns, pool sizes (both metabolically active and inactive), and kinetics/turnover rates were estimated for 17 of the proteinogenic amino acids. Estimation of these parameters followed several overall trends. First, most amino acids showed plateaus in labeling patterns of <100% [ 15 N]-labeling, indicating the possibility of a large proportion of amino acids residing in metabolically inactive metabolite pools. Second, total pool sizes appear largest in the dark (heterotrophic) condition, whereas active pool sizes appeared to be largest in the light with sucrose (mixotrophic) growth condition. In contrast turnover measurements based on pool size were highest overall in the light with sucrose experiment, with the exception of leucine/isoleucine, lysine, and arginine, which all showed higher turnover in the dark. K-means clustering analysis also revealed more rapid turnover in the light treatments with many amino acids clustering in lower-turnover groups. Emerging insights from other research were also supported, such as the prevalence of alternate pathways for serine metabolism in non-photosynthetic cells. These data provide extensive novel information on amino acid pool size and kinetics in S. polyrhiza and can serve as groundwork for future metabolic studies.

Oral contraceptives (OCs) are the most frequently used type of birth control among young women. OC-users have higher C-reactive protein (CRP) values, an indicator of systemic inflammation, than do non-OC-users. In addition, adiposity (percent fat) is positively associated with CRP, and physical activity (PA) is inversely associated with CRP. The present study determined the interactive associations of PA, percent fat, and OC-use with CRP. Data were collected during 2012-2015 at the University of Georgia. Objective PA was measured via pedometers. Percent fat was measured via dual X-ray absorptiometry. The current OC-use was self-reported. High-sensitivity (hs) CRP was determined using venipuncture. Multivariate linear regression determined the interactive associations of percent fat, OC-use, and PA with hs-CRP. Participants (n = 247; mean age 18.9 ± 1.4 years, 60.7 percent white) accumulated a mean of 10,075.7 ± 3,593.4 steps/day. One-third of participants were categorized as overweight/obese by BMI (mean = 24.5 ± 4.8 kg/m 2 , mean percent fat = 35.2 ± 6.8). The current OC-use was reported by 26.2 percent of the sample (n = 61). A significant three-way interaction (β = 0.01, p = .03) indicated that higher PA was associated with lower hs-CRP in non-OC-users with higher percent fat, but not among OC-users with higher percent fat. These results highlight the need to measure and account for the current OC-use in studies examining the relationship between PA and CRP.

Eating behaviors (cognitive restraint, flexible and rigid restraint, disinhibition, hunger) have been associated with obesity and weight loss success in middle-aged individuals, but little is known about these relationships in older adults. This study examined relationships between eating behaviors and weight loss in overweight/obese older women (n = 61; 69 ± 3.6 years; body mass index = 31.1 ± 5.0 kg/m 2 ) completed a 6-month behavioral weight loss intervention. Baseline, postintervention, and change measures of eating behaviors (51-items Three-Factor Eating Questionnaire) were assessed for relationships with weight loss. In the final regression model, an increase in flexible restraint accompanied by a decrease in rigid restraint predicted greater weight loss (adjusted R 2  = 0.21, Model F (4, 56) = 4.97, P < 0.01). No associations were found with disinhibition or hunger and degree of weight loss (all P > 0.05). Results suggest encouraging a flexible approach to eating behavior and discouraging rigid adherence to a diet may lead to better intentional weight loss for overweight and obese older women.

Background: Pediatric deaths and injuries from access to firearms are a significant public health problem. No studies have examined how experts determine child neglect regarding firearm access in the home. Our study objectives were to identify factors that influenced pediatric experts' finding of firearm-related child neglect and to assess their attitudes toward child access prevention (CAP) laws., Methods: A survey was distributed to the American Academy of Pediatrics Section on Child Abuse and Neglect members. Demographics, attitudes regarding CAP laws, and ages (up to 14 years old) at which experts deemed several scenarios as child neglect were determined. Scenarios tested potential versus actual loaded firearm access, presence or absence of a CAP law, and injury versus no injury when the firearm was accessed., Results: One hundred ninety-three surveys were completed. Experts agreed (>95%) that CAP laws were important, even for children up to age 15 years. Although a high percentage considered potential access to a loaded firearm as child neglect, a CAP law significantly increased the percentage for each age. In addition, higher percentages of respondents from states with CAP laws than those without deemed potential access as child neglect for 12- and 14-year-olds. In contrast, if the child had accessed a loaded firearm, there were no significant differences in the high percentages that deemed the scenario as child neglect under any conditions, including with and without a CAP law., Conclusions: Although almost all child neglect experts considered potential and actual access to loaded firearms as child neglect, CAP laws increased the percentage for cases of potential access. Universal CAP laws may help ensure that determinations of child neglect are more consistent across states. The deterrent effect of potential child neglect findings may increase the number of parents securing firearms in ways that prevent child access and reduce firearm-related deaths and injuries., Level of Evidence: Epidemiologic study, level III.

Current trends, including an aging population; the impact of the Affordable Care Act; increased complexity and acuity of patient needs; shorter hospital stays; and higher patient expectations have resulted in a significant demand for reconfiguration of the bedside nursing model. The health care system is further complicated by a shortage of highly trained nurses, challenging financial incentive models, and inefficient traditional staffing models. These challenges have increased the urgency for designing a more efficient, cost-effective care delivery model. One large national system is redefining how it cares for patients in the acute care setting in preparation for the Next Era. Catholic Health Initiatives is developing a new integrated model of care that combines advances in technology with a restructuring of nursing roles for significantly more efficient and effective care. The model is person-centered and allows team members to practice to the full extent of their education and training. The model emphasizes care from the right skill level, for the right patient need, at the right time. This article begins to describe the planning and implementation of the Virtually Integrated Care Team (VIC) pilot project on 2 medical-surgical units within the Catholic Health Initiatives system.

Introduction: Sexually transmitted infections (STIs) are a common reason for emergency department (ED) visits. The objective of this study was to determine if there were gender differences in adherence to Centers for Disease Control and Prevention (CDC) STI diagnosis and treatment guidelines, as documented by emergency providers., Methods: We performed a retrospective chart review to identify patients treated for urethritis, cervicitis, and pelvic inflammatory disease (PID) in the EDs of three hospitals in a Pennsylvania network during a calendar year. Cases were reviewed to assess for compliance with CDC guidelines. We used descriptive statistics to assess the distributions of study variables by patient sex. In the analysis we used Student's t-tests, chi-square tests, and logistic regression. Statistical significance was set at p ≤ 0.05., Results: We identified 286 patient records. Of these, we excluded 39 for the following reasons: incorrect disease coding; the patient was admitted and treated as an inpatient for his/her disease; or the patient left the ED after refusing care. Of the 247 participants, 159 (64.4%) were female. Females were significantly younger (26.6 years, SD=8.0) than males (31.2, SD=11.5%), (95% confidence interval [CI] [2.0- 7.0], p=0.0003). All of the males (n=88) in the cohort presented with urethritis; 25.8% of females presented with cervicitis, and 74.2% with PID. Physician compliance for the five CDC criteria ranged from 68.8% for patient history to 93.5% for patient diagnostic testing, including urine pregnancy and gonorrhea/chlamydia cultures. We observed significant differences by patient sex. Fifty-four percent of the charts had symptoms recorded for female patients that were consistent with CDC characteristics for diagnostic criteria compared to over 95% for males, OR=16.9; 95% CI [5.9-48.4], p<0.001. Similar results were observed for patient discharge instructions, with physicians completely documenting delivery of discharge instructions to 51.6% of females compared to 97.7% of complete documentation in males, OR=42.3; 95% CI [10.0-178.6] p<0.001). We observed no significant sex differences in physician documentation for physical exam or for therapeutic antibiotic treatment., Conclusion: This retrospective study found patient gender differences in how emergency providers complied with documenting with regard to the 2010 CDC guidelines for the diagnosis and treatment of urethritis, cervicitis, and PID. Specifically medical records of men were more likely to have complete documentation of symptoms recorded (95% CI 5.9-48.4) and to have discharge instruction documentation (95% CI 10.0-178.6) than records of women., Competing Interests: Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Skeletal muscle power is a salient determinant of physical function in older adults, but its relationship with habitual physical activity has not been well-characterized. The aim of this study was to examine the association between moderate-intensity physical activity and lower-extremity muscle power in community-dwelling older women. Older women (n = 96, mean age = 73.9 ± 5.6 years, mean body mass index = 26.5 ± 4.7 kg/m(2)) underwent assessments for body composition via dual-energy X-ray absorptiometry and lower-extremity muscle power (watts) using the Nottingham power rig. The Community Health Activities Model Program for Seniors questionnaire was used to estimate weekly caloric expenditure in moderate-intensity physical activity (kcals/wk). Linear regression indicated that moderate-intensity physical activity was independently related to muscle power (standardized β = 0.20, p = .03), and this relationship remained following adjustment for covariates. Analysis of covariance revealed that women in the highest tertile of volume of physical activity had significantly greater muscle power than those with the lowest volume (199.0 vs. 170.7 watts, p < .05). Moderate-intensity physical activity was independently associated with lower-extremity muscle power in older women. Future intervention trials should determine if increasing habitual physical activity is associated with improvements in lower-extremity muscle power in older women.

The purpose of the study was to examine the effects of sprint interval training (SIT) and moderate-intensity continuous cycle training (MICT), with equal estimated energy expenditure during training on body composition and aerobic capacity. Body composition measured via dual-energy X-ray absorptiometry and aerobic capacity were assessed following 6 weeks of training in previously inactive overweight/obese young women (n = 52; age, 20.4 ± 1.5 years; body mass index, 30.3 ± 4.5 kg·m -2 , 67.3% white). Training was performed in a group-exercise format that mimicked cycling classes offered by commercial fitness facilities, and included 3 weekly sessions of either 30-s "all-out" sprints followed by 4 min of active recovery (SIT), or continuous cycling at 60%-70% heart rate reserve to expend a similar amount of energy. Participants were randomized to SIT or MICT, attended a similar number of sessions (15.0 ± 1.5 sessions vs. 15.8 ± 1.9 sessions, P = 0.097) and expended a similar amount of energy (541.8 ± 104.6 kJ·session -1 vs. 553.5 ± 138.1 kJ·session -1 , P = 0.250). Without significant changes in body mass (P > 0.05), greater relative reductions occurred in SIT than in MICT in total fat mass (3.6% ± 5.6% vs. 0.6% ± 3.9%, P = 0.007), and android fat mass (6.6% ± 6.9% vs. 0.7% ± 6.5%, P = 0.002). Aerobic capacity (mL·kg -1 ·min -1 ) increased significantly following both interventions (P < 0.05), but the relative increase was 2-fold greater in SIT than in MICT (14.09% ± 10.31% vs. 7.06% ± 7.81%, P < 0.001). In conclusion, sprint-interval cycling reduces adiposity and increases aerobic capacity more than continuous moderate-intensity cycling of equal estimated energy expenditure in overweight/obese young women.

Objective: The aim of this study was to examine the association between asymmetry in leg extension power (LP) and lower-extremity physical function (LEF) in community-dwelling older women., Methods: Older women (n = 94, 74.0 ± 5.5 y) were assessed for unilateral LP (watts) using the Nottingham power rig, and absolute and relative (%ASYM) differences in LP between the dominant and nondominant legs were calculated. LEF was assessed via the 6-minute walk, 8-foot up-and-go and 30-second chair stand, and a composite measure of LEF was calculated by summing z scores of each test. In addition, body composition was measured via dual-energy x-ray absorptiometry and moderate-intensity physical activity was assessed via questionnaire., Results: The absolute difference in LP between the dominant and nondominant legs was 10.2 ± 9.0 watts, which translated to a %ASYM of 11.3% ± 10.5% (P < 0.01). %ASYM had bivariate associations with all individual measures of LEF (r range = -0.22 to -0.34, all P < 0.05). Using multivariate linear regression, %ASYM was an independent predictor of a composite LEF z score (standardized β= -0.18, P < 0.05) after adjustment for age, comorbidities, physical activity, relative adiposity, and total leg power. Analysis of covariance indicated that women with low asymmetry had a significantly better LEF z score than those with high asymmetry (0.60 vs -0.13, P = 0.04)., Conclusions: These findings indicate that a greater magnitude of asymmetry in LP is associated with poorer LEF in older women. Research is needed to determine whether interventions that correct asymmetries in lower-body muscle power confer functional benefits in older women.

Background: Resistance training (RT) has been investigated as a potential intervention strategy for improving muscle function, but the effects on lower-extremity muscle power in middle-aged and older adults have not been systematically reviewed., Objective: The aim of this meta-analysis is to provide a quantitative estimate of the effect of RT on lower-extremity muscle power in middle-aged and older adults and to examine independent moderators of this relationship., Methods: Randomized controlled trials that examined the effects of RT on either leg press (LP) or knee extension (KE) muscle power in adults aged ≥50 years were included. Data were aggregated with meta-analytic techniques, and multi-level modeling was used to adjust for nesting effects. A total of 52 effects from 12 randomized controlled trials were analyzed with a random-effects model to estimate the effect of RT on lower-extremity muscle power. A multiple-regression analysis was conducted to examine independent moderators of the mean effect., Results: The adjusted aggregated results from all studies indicate that RT has a small-to-moderate effect on lower-extremity muscle power (Hedges' d = 0.34, 95% confidence interval [CI] 0.25-0.43), which translated to 54.90 watts (95 % CI 40.37-69.43). Meta-regression analyses indicated that high-velocity RT was superior to traditional RT (Δ = 0.62 vs. 0.20, respectively) for increasing lower-extremity muscle power. In addition, training volume significantly moderated the effect of RT on muscle power., Conclusion: The findings from this meta-analysis indicate that RT is an efficacious intervention strategy for improving LP and KE muscle power in adults aged ≥50 years. Training mode and volume independently moderate the effect of RT on lower-extremity muscle power, and should be considered when prescribing RT exercise for middle-aged and older adults.

This study's objective is to assess differences in dietary intakes in breast cancer survivors (n = 13) and women without a history of breast cancer (controls, n = 71). In a cross-sectional design, intake of foods, food groups, nutrients, and non-nutritive sweeteners was assessed using participant-completed three-day food records. All women were postmenopausal (mean age (SD) 58.5 (±3.8) y, 95% White, 2.4% Asian Pacific, and 2.4% Black). The two groups did not differ in age, energy intake, or body mass index (p > 0.05). Compared to controls, survivors consumed less dairy products, animal protein, total protein, and calcium, but more legumes, noncitrus fruit, and carbohydrates (p ≤ 0.05). Calcium intakes were of particular concern in survivors who consumed an average of 686 mg calcium/d, which is <60% of the recommended 1200 mg/d. Given the important role of calcium in bone health and protein in muscle function among aging women, breast cancer survivors may benefit from consultation with a Registered Dietitian or other health professional knowledgeable in nutritional recommendations for postmenopausal breast cancer survivors.

Background: A positive association between physical activity and mental health is well established, particularly for lower symptoms of depression and anxiety among active adults. However, it is unclear whether the association is influenced by personality, which might moderate or otherwise explain the association. In addition, past studies have not confirmed the association using an objective measure of physical activity., Objective: Our objective was to examine whether Extraversion and Neuroticism influence the association between mental health and physical activity measured by convergent self-reports and an accelerometer., Methods: Structural equation modeling was used to test competing models of the relationships between personality, physical activity, and mental health in a sample of female undergraduates., Results: In bivariate analysis, mental health was negatively related to Neuroticism and positively related to Extraversion, self-reported physical activity (which was related only to Extraversion, positively), and objective physical activity (which was related only to Neuroticism, negatively). In structural equation modeling, a 3-way interaction indicated that objective physical activity and mental health were unrelated in extraverts, but related positively in neurotic-introverts and negatively in stable-introverts., Conclusions: Higher levels of physical activity were associated with better mental health only in neurotic-introverts, who are at higher risk for mental health problems.

We examine how understandings of ordinary and extraordinary communication develop. Three- to 10-year-old children and adults (N = 183) were given scenarios in which a protagonist wanted help from a human (their parent) or from God. Scenarios varied in whether protagonists expressed their desires aloud (by asking) or silently (by hoping), whether (for human scenarios) parents were nearby or far away, and whether (for God scenarios) protagonists expressed desires through ordinary means (asking or hoping) or more extraordinary means (praying). Following each scenario, participants were asked whether the recipient (either the parent or God) was aware of the protagonist's desire. Children as young as 3 to 4 years old understood that both loudness and distance limit the effectiveness of human communication, reporting that humans would most likely be aware of desires when they were expressed both aloud and nearby. As well, by this age children reported that God would more often be aware of desires than would humans, but children of all ages often reported that God (like humans) would be more aware of desires expressed aloud (rather than silently). These concepts of ordinary and extraordinary communication continued to be refined through middle childhood. Children's performance on standard theory-of-mind tasks and participants' religious background predicted whether they attributed awareness to God. (PsycINFO Database Record, ((c) 2015 APA, all rights reserved).)

Objective: Greater muscle strength and power are associated with better physical function in middle-aged and older women. The aim of the present study was to determine whether accelerometer-measured physical activity was associated with muscle strength and power in middle-aged postmenopausal women., Methods: Postmenopausal women (N = 60; mean [SD] age, 58.9 [3.9] y) were assessed for physical activity (step count and moderate to vigorous physical activity [MVPA]) via accelerometer, for body composition via dual-energy x-ray absorptiometry, for concentric isokinetic knee torque at 60°/s and 180°/s using isokinetic dynamometry, and for leg extensor power with the Nottingham power rig., Results: In linear regression analysis, daily step count was independently associated with isokinetic knee torque at 60°/s (standardized β = 0.32, P = 0.01), isokinetic knee torque at 180°/s (standardized β = 0.32, P = 0.01), and total leg extensor power (β = 0.36, P = 0.01) after adjustment for covariates. Daily MVPA had similar associations with isokinetic knee torque at 60°/s (β = 0.38, P < 0.01), isokinetic knee torque at 180°/s (β = 0.41, P < 0.01), and leg power (β = 0.31, P = 0.02). Analysis of covariance indicated that women who engaged in MVPA for 30 minutes or more per day produced significantly greater isokinetic knee torque (60°/s and 180°/s) and leg extensor power compared with women not meeting this guideline (all P < 0.05)., Conclusions: These findings suggest that daily step count and MVPA are independently associated with muscle strength and power in middle-aged postmenopausal women. Future studies should determine whether interventions that increase habitual physical activity in middle-aged women are associated with concomitant improvements in muscle capacity.

Unlabelled: Commonly reported relationships of the broad personality traits of extraversion and neuroticism with self-reports of physical activity (PA) have not been elaborated within motivational theory that posits how functioning of the behavioral inhibition (BIS) and activation (BAS) systems can explain or modify the influence of personality on PA. Whether personality predicts physical activity when it is measured objectively has not been established., Purpose: The study was aimed to test direct, indirect, and interactive relations between extraversion, neuroticism, BIS and BAS, and PA measured by validated self-report and accelerometry., Methods: Two samples of female undergraduates completed personality questionnaires. Sample 2 also completed three PA self-reports and wore an accelerometer for 7 d. Factor structure and measurement equivalence of personality measures, structural equivalence of relationships between personality factors, and multivariate prediction of self-reported and objectively measured PA by personality were tested using structural equation modeling., Results: Equivalence between samples for personality models was confirmed. Behavioral activation system predicted self-reported PA. Neuroticism and BIS predicted objectively measured PA., Conclusions: The relationship between personality and PA may differ according to method used to measure PA. Behavioral inhibition system seems to protect against inactivity among young women high in neuroticism.

Objective: Postmenopausal women (PMW) are at high risk for disabling pain and physical inactivity. This study sought to enhance the understanding of relationships between physical activity (PA) and pain among PMW using heat pain sensitivity test and conditioned pain modulation test. We hypothesized that, compared with active women, (i) inactive women would report higher pain intensity and pain unpleasantness ratings; (ii) inactive women in disabling pain would report higher pain intensity and pain unpleasantness at high, but not low, stimulus intensities; and (iii) inactive women would have less modulation., Methods: Sixty-eight PMW rated the pain intensity and pain unpleasantness of hot stimuli presented to the thenar eminence of the hand. A subset of 31 women rated the pain intensity of a test stimulus (noxious heat) and a conditioning stimulus (cold water) as part of the conditioned pain modulation task. PA was assessed objectively with accelerometry., Results: Mixed-model analysis of variance (2 × 4 × 2; PA × Temperature × Pain Status) showed that inactive women in disabling pain rated pain unpleasantness higher than active women in disabling pain (F3,192 = 3.526, ∂η = 0.052, P = 0.016). Significantly lower pain unpleasantness ratings were found at the highest stimulus intensity (49°C) only for active women in disabling pain compared with inactive women in disabling pain (t11 = 2.523, P = 0.028). The other hypotheses were not supported., Conclusions: PA is associated with a reduced sensitivity to the unpleasantness of painful high-intensity heat stimuli among women in disabling pain.