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BackgroundThe relationship between intention and behavior has been well researched, but most studies fail to capture dynamic, time-varying contextual factors. Ecological momentary assessment through mobile phone technology is an innovative method for collecting data in real time, including time-use data. However, only a limited number of studies have examined day-level plans to be physically active and subsequent physical activity behavior using real-time time-use data to better understand this relationship. ObjectiveThis study aims to examine whether plans to be physically active (recorded in advance on an electronic calendar) were associated with objectively assessed physical activity (accelerometry), to identify activities that replaced planned periods of physical activity by using the mobile app Life in a Day (LIAD), and to test the feasibility and acceptability of LIAD for collecting real-time time-use data. MethodsThe study included 48 university students who were randomly assigned to 1 of 3 protocols, which were defined by 1, 3, or 5 days of data collection. Participants were asked to record their planned activities on a Google Calendar and were provided with mobile phones with LIAD to complete time-use entries in real time for a set of categories (eg, exercise or sports, eating or cooking, school, or personal care). Participants were instructed to wear an accelerometer on their nondominant wrist during the protocol period. A total of 144 days of protocol data were collected from the 48 participants. ResultsProtocol data for 123 days were eligible for analysis. A Fisher exact test showed a statistically significant association between plans and physical activity behavior (P=.02). The congruence between plans and behavior was fair (Cohen κ=0.220; 95% CI 0.028-0.411). Most participants did not plan to be active, which occurred on 75.6% (93/123) of days. Of these 93 days, no physical activity occurred on 76 (81.7%) days, whereas some physical activity occurred on 17 (18.3%) days. On the remaining 24.4% (30/123) of days, some physical activity was planned. Of these 30 days, no physical activity occurred on 18 (60%) days, whereas some physical activity occurred on 12 (40%) days. LIAD data indicated that activities related to screen time most often replaced planned physical activity, whereas unplanned physical activity was often related to active transport. Feasibility analyses indicated little difficulty in using LIAD, and there were no significant differences in feasibility by protocol length. ConclusionsConsistent with previous literature, physical activity plans and physical activity behaviors were linked, but not strongly linked. LIAD offers insight into the relationship between plans and behavior, highlighting the importance of active transport for physical activity and the influence of screen-related behaviors on insufficient physical activity. LIAD is a feasible and practical method for collecting time-use data in real time.

Purpose To establish a standardized method of reformatting axial images for computed tomography (CT) brain examinations. Methods An anatomic line between the superior orbital rim and the base of the occipital bone (SOR-BS line) was chosen as the standardized reference line. In June 2022, CT technologists at a tertiary care center received an educational presentation and a 1-page reference handout on making standardized CT reformats. This was the quality-of-care intervention. Subsequently, 100 CT brain examinations performed on July 1 to 10, 2020 (preintervention) were analyzed and compared with 100 CT brain examinations performed on July 1 to 10, 2022 (postintervention). Results There were no significant differences in the mean angle differences measured between the preintervention (6.2 ± 5.8°) and the postintervention (5.8 ± 4.7°) groups (P = .67). However, the number of CT brain studies with an angle difference of more than 20° decreased from 4 studies to 1 study. In addition, the number of CT brain studies without reformatted images decreased from 5 to 2 studies. Discussion The cause for the less-than-optimal adoption of the expected change in CT workflow might be complex and multifactorial. However, the institution in this study is a busy tertiary care center with a chronic shortage of CT technologists. The busy workflow might have contributed to lack of significance for the parameters assessed. Conclusion There was a slight but not significant improvement between preintervention and postintervention data. [ABSTRACT FROM AUTHOR]

Background: There is currently a nationwide effort to bring parks and green spaces within a 10-minute walk of the home. We examined the association between park area within 1 km of a child's residence and self-reported park-specific physical activity (PA) along with accelerometer-derived moderate to vigorous physical activity (MVPA). Methods: A subsample of K through eighth-grade youth (n = 493) from the Healthy Communities Study reported whether they engaged in park-specific PA during the last 24 hours and wore an accelerometer for up to 7 days. Park area was defined as the percentage of park land in a 1 km Euclidean buffer around the participant's residence, categorized into quintiles. Analysis consisted of logistic and linear regression modeling with interaction effects that controlled for clustering within communities. Results: Regression models estimated greater park-specific PA for participants in the fourth and fifth quintiles of park land. Age, sex, race ethnicity, and family income were unrelated to park-specific PA. Accelerometer analysis indicated that total MVPA was unrelated to park area. Older children (β = −8.73, P <.001) and girls (β = −13.44, P <.001) engaged in less MVPA. Seasonality significantly predicted both park-specific PA and total MVPA. Conclusion: Increasing park area is likely to improve youth PA patterns, lending support for the 10-minute walk initiative. [ABSTRACT FROM AUTHOR]

Introduction: Oral cavity squamous cell carcinoma (OSCC) occurs most frequently in patients >60 years old with a history of tobacco and alcohol use. Epidemiological studies describe increased incidence of OSCC in younger adults (<45 years). Despite its poor prognosis, knowledge of OSCC tumor microenvironment (TME) characteristics in younger adults is scarce and could help inform possible resistance to emerging treatment options. Methods: Patients with OSCC were evaluated using TCGA-HNSC (n=121) and a stage and subsite-matched institutional cohort (n=8) to identify differential gene expression focusing on the extracellular matrix (ECM) and epithelialmesenchymal transition (EMT) processes in younger (=45 years) vs. older adults (=60 years). NanoString nCounter analysis was performed using isolated total RNA from formalin-fixed paraffin-embedded (FFPE) tumor samples. Stained tumor slides from young and old OSCC patients were evaluated for CD8+ Tcell counts using immunohistochemistry. Results: Younger OSCC patients demonstrated significantly increased expression of ECM remodeling and EMT process genes, as well as TME immunosuppression. Gene set enrichment analyses demonstrated increased ECM pathways and concurrent decreased immune pathways in young relative to old patients. Transcripts per million of genetic markers involved in ECM remodeling including LAMB3, VCAN, S100A9, COL5A1, and ITGB2 were significantly increased in tumors of younger vs. older patients (adjusted p-value < 0.10). Young patient TMEs demonstrated a 2.5-fold reduction in CD8+ T-cells as compared to older patients (p < 0.05). Conclusion: Differential gene expression impacting ECM remodeling and TME immunosuppression may contribute to disease progression in younger adult OSCC and has implications on response to evolving treatment modalities, such as immune checkpoint inhibitor therapy. [ABSTRACT FROM AUTHOR]

Author(s): Matthew Stewart [sup.1] Author Affiliations: (1) grid.189504.1, 0000 0004 1936 7558, Humanities and Rhetoric, Boston University, , Boston, USA Derangement is one of Douglas Murray's keywords in his study [...]

A hearing aid or a contralateral routing of signal device are options for unilateral cochlear implant listeners with limited hearing in the unimplanted ear; however, it is uncertain which device provides greater benefit beyond unilateral listening alone. Eighteen unilateral cochlear implant listeners participated in this prospective, within-participants, repeated measures study. Participants were tested with the cochlear implant alone, cochlear implant + hearing aid, and cochlear implant + contralateral routing of signal device configurations with a one-month take-home period between each in-person visit. Audiograms, speech perception in noise, and lateralization were evaluated. Subjective feedback was obtained via questionnaires. Marked improvement in speech in noise and non-implanted ear lateralization accuracy were observed with the addition of a contralateral hearing aid. There were no significant differences in speech recognition between listening configurations. However, the chronic device use questionnaires and the final device selection showed a clear preference for the hearing aid in spatial awareness and communication domains. Individuals with limited hearing in their unimplanted ears demonstrate significant improvement with the addition of a contralateral device. Subjective questionnaires somewhat contrast with clinic-based outcome measures, highlighting the delicate decision-making process involved in clinically advising one device or another to maximize communication benefits. [ABSTRACT FROM AUTHOR]

The management of chronic illnesses should continue during hospitalization. Some chronic conditions require immediate intervention, whereas intensification of therapy for other conditions may be delayed until after discharge. Factors such as pain, anxiety, poor sleep hygiene, and concurrent illness can result in a transient elevation of blood pressure. Acute lowering of blood pressure in hospitalized patients who do not have target-organ damage is not recommended and may lead to harm. If treatment is needed, intravenous antihypertensive agents should be avoided. Patients with diabetes mellitus require continued management of their blood glucose while hospitalized. Noninsulin agents are typically discontinued. Blood glucose levels should be managed using basal, prandial, and/or correction insulin. During hospitalization, conservative blood glucose targets (140 to 180 mg per dL) are preferred vs. lower targets to reduce length of stay, mortality, and the risk of hypoglycemic events in critically ill patients. Alcohol use disorder is common and hospitalization for other conditions necessitates identification and management of alcohol withdrawal syndrome. The mainstay of therapy for alcohol withdrawal syndrome is benzodiazepines; however, phenobarbital is an alternative treatment option. The risk of venous thromboembolic disease is significantly increased for hospitalized patients. Venous thromboprophylaxis is recommended for all but low-risk patients. Pharmacologic prophylaxis with subcutaneous low-molecular-weight heparin is preferred; mechanical prophylaxis is an alternative for patients who are at high risk of bleeding or have contraindications to anticoagulation. (Am Fam Physician. 2024; 109(2): 134–142. Copyright © 2024 American Academy of Family Physicians.) The management of chronic illnesses should continue during hospitalization. Some chronic conditions require immediate intervention, whereas intensification of therapy for other conditions may be delayed until after discharge. Factors such as pain, anxiety, poor sleep hygiene, and concurrent illness can result in a transient elevation of blood pressure. Acute lowering of blood pressure in hospitalized patients who do not have target-organ damage is not recommended and may lead to harm. If treatment is needed, intravenous antihypertensive agents should be avoided. Patients with diabetes mellitus require continued management of their blood glucose while hospitalized. Noninsulin agents are typically discontinued. Blood glucose levels should be managed using basal, prandial, and/or correction insulin. During hospitalization, conservative blood glucose targets (140 to 180 mg per dL) are preferred vs. lower targets to reduce length of stay, mortality, and the risk of hypoglycemic events in critically ill patients. Alcohol use disorder is common and hospitalization for other conditions necessitates identification and management of alcohol withdrawal syndrome. The mainstay of therapy for alcohol withdrawal syndrome is benzodiazepines; however, phenobarbital is an alternative treatment option. The risk of venous thromboembolic disease is significantly increased for hospitalized patients. Venous thromboprophylaxis is recommended for all but low-risk patients. Pharmacologic prophylaxis with subcutaneous low-molecular-weight heparin is preferred; mechanical prophylaxis is an alternative for patients who are at high risk of bleeding or have contraindications to anticoagulation. [ABSTRACT FROM AUTHOR]

Postoperative pain associated with abdominal surgeries impairs physical function, delays recovery, and decreases quality of life. Regional anesthetic techniques such as transversus abdominis plane (TAP) block and erector spinae plane (ESP) block are used to improve patients' postoperative pain experiences. PubMed, CINAHL, Google Scholar, Cochrane Library, and gray literature were searched. Mean difference (MD) and risk ratio were used to estimate continuous and dichotomous variables. Quality of evidence was analyzed using Risk of Bias and GRADE. Sixteen studies involving 934 patients were analyzed. Compared with TAP block, ESP reduced resting (MD, -0.83; 95% confidence interval [CI], -1.02 to -0.64; P < .00001) and dynamic pain intensity (MD, -0.71; 95% CI, -0.93 to -0.50; P < .00001) in the first 24 hours lowered postoperative opioid consumption (MD, -4.52; 95% CI, -5.99 to -3.04; P < .00001) and prolonged the time to first rescue analgesic (MD, 3.18; 95% CI, 2.43 to 3.93; P < .00001). However, ESP was similar to TAP block for intraoperative opioid consumption, and the incidence of nausea or vomiting. Although the ESP block provided statistical superiority over the TAP block for acute pain management, the clinical relevance of the differences was small. [ABSTRACT FROM AUTHOR]

Author(s): Matthew Stewart [sup.1] Author Affiliations: (1) Boston University, 0000 0004 1936 7558, grid.189504.1, , 02215, Boston, MA, USA Three books authored or edited by British writers-'I Find That Offensive!' [...]