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The use of statistical significance is under discussion. Many statisticians and researchers advocate for its retirement. Conversely, other statisticians and researchers think that its retirement would damage science. There is room for improvement in the use of hypothesis testing and p -values in biochemical sciences and omics. The selection of variables by statistical significance with solid cutoffs drives and may bias the biological interpretation of biochemical data. To obtain robust knowledge by comparing studies, it is essential to report thoroughly all results (both quantitative and categorical variables). Because of the big number of variables, the problems of selecting variables by statistical significance increase for omic studies. Over recent years many statisticians and researchers have highlighted that statistical inference would benefit from a better use and understanding of hypothesis testing, p -values, and statistical significance. We highlight three recommendations in the context of biochemical sciences. First recommendation: to improve the biological interpretation of biochemical data, do not use p -values (or similar test statistics) as thresholded values to select biomolecules. Second recommendation: to improve comparison among studies and to achieve robust knowledge, perform complete reporting of data. Third recommendation: statistical analyses should be reported completely with exact numbers (not as asterisks or inequalities). Owing to the high number of variables, a better use of statistics is of special importance in omic studies. [ABSTRACT FROM AUTHOR]

Reproducibility of research is poor; this may be because many articles report statistically significant findings that are false positives. Two potential solutions are to lower the P -value for statistical significance testing from 0.05 to 0.005 and to report the minimum false-positive risk (minFPR). This study determined these metrics for randomised controlled trials (RCTs) in general anaesthesiology journals. We identified superiority RCTs published between January 1, 2019 and March 15, 2021 from seven leading anaesthesia journals. P -values for primary outcomes were collected, and minFPRs for these outcomes were calculated using a formula assuming a 50% prior probability of an intervention being effective (minFPR 50). The primary outcomes were the percentage of RCTs maintaining statistical significance at P <0.005 and minFPR 50. We included 318 RCTs. P -values below 0.05 were reported in 205/318 (64%) of RCTs. Of these 205 RCTs, 119/205 (58%) maintained statistical significance at the P <0.005 threshold. The mean (standard deviation) minFPR 50 was 22% (20). At P =0.005, the minFPR 50 was approximately 5%. These proposed metrics aimed at mitigating reproducibility concerns would call a significant portion of the anaesthesiology literature into question. We found a minFPR of 22% and determined that 42% of primary outcomes would not maintain statistical significance if the P -value threshold changed from 0.05 to 0.005. These findings could partially explain the lack of reproducibility of research findings. [ABSTRACT FROM AUTHOR]

Causal Decomposition (CD) constitutes a novel and widely accepted method for discovering and quantifying the internal causal relationships inherent to complex systems. This new causality bases not on time nor state. Instead, it relies on instantaneous phase coherence between the corresponding Intrinsic Mode Functions (IMFs) of the signals, obtained via Empirical Mode Decomposition (EMD). In this paper we compare the results obtained with two noise-assisted methods: Ensemble EMD (EEMD) and Noise Assisted Multivariate EMD (NA-MEMD). Given the inherent stochastic nature of noise-assisted methods, CD was treated as a randomized experiment. Hence, we repeated procedures to perform a robust statistical analysis. Confidence intervals, adequate normality conditions and differential causality hypothesis testing were then evaluated. The methodology was adjusted through the paradigmatic case of a forced mechanical oscillator, since the causal implications are known in advance. CD was then applied to a couple of series from the Earth system: insolation and oxygen isotope rate. Differential causality was established in favor of insolation at the frequency corresponding to the obliquity cycle. The apparent causality detected with EEMD on other time scales was discarded and attributed to a mode mixing problem. Therefore, NA-MEMD outperformed EEMD with less mode mixing and sharper mode alignment. • Causal Decomposition was performed with EEMD and NA-MEMD methods. • Causal relationships were firmly established through statistical analysis. • The methodology was adjusted through the case of a forced mechanical oscillator. • Causality was established in favor of insolation related to the obliquity cycle. • NA-MEMD outperformed EEMD with less mode mixing and sharper mode alignment. [ABSTRACT FROM AUTHOR]

Although statistical errors have been shown to be prevalent in the medical literature, there has been a paucity of studies focusing on the prevalence of statistical errors in neurosurgery. We examined the contemporary neurosurgical literature for a common statistical mistake, namely, misinterpretations of null hypothesis significance testing results near the P -value threshold by conveying the idea of a trend. PubMed/Medline was used to identify all articles published in 6 major neurosurgical journals between 2000 and 2020. The abstracts of these articles were extracted and scrutinized to determine when the word "trend" was used to express near statistical significance. This study included a total of 45,244 articles. Of those, 461 (1.02% [95% confidence interval, 0.86%–1.18%]) employed the word "trend" to indicate near statistical significance, for a total of 3.8 (95% confidence interval, 2.93–4.75) errors per issue per year. The error under study occurred more frequently in Journal of Neurosurgery: Spine and less frequently in Acta Neurochirurgica (P = 0.007). On an annual basis, there was no linear correlation between the total number of articles published per journal and the number of such errors in that journal (r = 0.34, P = 0.01). Misinterpretations of null hypothesis significance testing results near the P -value threshold are present in at least 1% of the neurosurgical literature. While we believe that most statistical errors in medicine in general and neurosurgery in particular may be unintentional in nature, additional measures should be put in place to prevent the subsequent adoption of such undesirable methodological practices among future researchers. [ABSTRACT FROM AUTHOR]

Background: In 2016, the American Statistical Association stated that the use of statistical significance leads to distortion of the scientific process. The principal alternative to significance or null hypothesis testing (NHT) is estimation with point estimates and confidence intervals (CIs).Objectives: The aim of this study was to determine the time trend of statistical inference and statistical reporting style in abstracts in major cardiovascular journals.Methods: A total of 84,250 abstracts published from 1975 to 2019 in 9 high-ranking cardiovascular journals (Circulation, Circulation Research, European Heart Journal, European Heart Journal: Cardiovascular Imaging, European Journal of Heart Failure, Journal of the American College of Cardiology, JACC: Cardiovascular Imaging, JACC: Cardiovascular Interventions, and JAMA Cardiology) were reviewed; in particular, proportions of abstracts containing statistical inference and its major variants (NHT, significance testing) were compared over time and among journals.Results: Overall, 49,924 abstracts (59%) contained statistical inference. Among these abstracts, NHT was the most frequent reporting style of statistical inference (79% among all journals). Journals differed considerably in the prevalence of CI reporting (1% to 78% in 2017-2019). With the exception of 2 journals, the proportion of abstracts containing CIs was higher in the more recent period. From 2013-2015 to 2017-2019, the proportion of abstracts containing only CIs increased by 5 (95% CI: 0 to 10), 18 (95% CI: 15 to 21), and 9 (95% CI: 3 to 15) percentage points in the European Heart Journal, the Journal of the American College of Cardiology, and JACC: Cardiovascular Imaging, respectively.Conclusions: NHT is still the prevailing reporting style of statistical inference in major cardiovascular journals. Reporting of CIs in abstracts of major cardiovascular journals appears to be growing more popular. [ABSTRACT FROM AUTHOR]

To determine the validity and reliability of a nutrition knowledge questionnaire for adolescents. An adult questionnaire was administered to 4 high school student convenience samples with and without known prior nutrition education. Questionnaire refinement was determined by item-total correlation, item discrimination, and item difficulty. Mean percentage of correct answers was calculated, and the group difference was assessed using an independent samples t test. A post hoc regression analyzed the association between mean percentage of correct answers and group while controlling for school. The questionnaire, with 1 question eliminated, had good internal consistency reliability (Cronbach α = 0.83). The nutrition education group (n = 174) demonstrated significantly (P < 0.0001) higher mean percentage of correct answers compared with the no nutrition education group (n = 136). The association between mean percentage of correct answers and the group remained with school controlled. Results suggest that the questionnaire is valid and reliable for measuring nutrition knowledge in high school–aged adolescents. [ABSTRACT FROM AUTHOR]

To develop, implement, and evaluate a patient simulation to assess Nutrition-Focused Physical Exam (NFPE) skills among dietetics students. Three student cohorts (n = 47) in a combined internship and master's program participated. Curricula included: (1) formal instruction with practice resources, (2) baseline NFPE evaluation performed on a classmate, and (3) final NFPE evaluation performed on a standardized patient. Trained observers evaluated students using the NFPE Skills Assessment tool. Self-rated performance was assessed by the 8-item survey completed at baseline and after the final evaluation. Paired t tests analyzed differences in observed NFPE skill, and 1-tailed Wilcoxon signed-rank test analyzed differences in survey responses. Nutrition-Focused Physical Exam skill improvements were observed for each cohort (P <.05). Surveys demonstrated increased comfort touching patients (P <.001), and improved self-rated abilities to assess subcutaneous fat, muscle stores, fluid accumulation, and micronutrient deficiency (P <.001). Simulations were an effective method for increasing observed and perceived NFPE skills among dietetics students. These findings justify the investigation of these methods within a larger sample of students from multiple programs with rigorous study design. [ABSTRACT FROM AUTHOR]

To compare changes in mindful eating habits between students receiving a mindful eating intervention (MEI) vs those who were engaged in usual course work. From 2017 to 2019, 109 nutrition and medical students completed a quasi-experimental study, including usual course work either with or without the addition of a 5-week MEI. The Mindful Eating Questionnaire (MEQ) was completed before and after the MEI. Repeated measures MANOVA was used to detect differences in changes in the overall MEQ score and its 5 subscales between groups. Within the MEI group (n = 64), overall MEQ, disinhibition, and eating with awareness scores increased significantly (P <.001, P <.001, and P =.004, respectively). No significant changes were noted within the comparison group (n = 45). Significant between-group differences were noted for the changes in the overall MEQ (P =.03) and disinhibition scores (P =.01). MEI participation may improve students' overall mindful eating scores. Future research could assess a larger cohort of participants, including health care professionals from other disciplines, assess additional mindfulness measures, and follow students for a longer period to determine the long-term effects on participants' mindful eating. [ABSTRACT FROM AUTHOR]

• The null hypothesis significance test (NHST) approach is flawed and should be avoided where possible. • Estimation with measures of uncertainty e.g. point estimates and confidence intervals is a better and practical alternative. • Effect sizes are important for experimental design and meta-analysis. • The use of effect size measures to assess results in the absence of statistical analysis should be avoided. • Researchers need to understand concepts of experimental design, analysis and new approaches such as Bayesian methods. The Null Hypothesis Significance Testing (NHST) paradigm is increasingly criticized. Estimation approaches such as point estimates and confidence intervals, while having limitations, provide better descriptions of results than P-values and statements about significance levels. Their use is supported by many statisticians. The effect size approach is an important part of power and sample size calculations at the experimental design stage and in meta-analysis and in the interpretation of the biological importance of study results. Care is needed, however, to ensure that such effect sizes are relevant for the endpoint. Effect sizes should not be used to interpret results without accompanying limits, such as confidence intervals. New methods, especially Bayesian approaches, are being developed; however, no single method provides a simple answer. Rather there is a need to improve researchers understanding of the complex issues underlying experimental design, statistical analysis and interpretation of results. [ABSTRACT FROM AUTHOR]

In recent years several authors have documented common problems in the use of statistics in nursing research, including failure to consider the effects of multiple testing, inattention to clinical significance, and under-reporting of effect sizes and confidence intervals. More subtle forms of multiple testing are not as widely recognized, and abuse of researcher degrees of freedom has received little attention in the nursing research literature. These and other unsound practices in applying and interpreting statistics are problematic in themselves, and they arguably reflect an insufficiently clear understanding of statistical inference as a method for dealing with randomness among many researchers. The goal of this educational paper is to improve the understanding and practice of inferential statistics among nursing researchers. An accessible explanation of hypothesis testing is provided, including discussion of the crucial concept of repeated sampling. Several pervasive mistakes and misconceptions in statistical inference are examined in detail, including misinterpretation of "non-significant" p -values as evidence for the null hypothesis, failure to account for forms of multiple testing that arise in model selection, abuse of researcher degrees of freedom, and hypothesis testing for baseline differences between arms in randomized trials. Recommendations for better statistical practice are offered. For the foreseeable future classical methods of statistical inference based on the idea of repeated sampling will be the primary tools for quantifying randomness in nursing research. The hypothesis testing framework, despite its limitations, can be helpful in ruling out chance as an explanation for observed effects. Nursing researchers who use quantitative methods, as well as journal reviewers and editors, should understand this framework well. Those involved in educating nursing researchers and those who teach statistics would do well to ask what changes need to be made to raise the level of statistical practice in nursing research. [ABSTRACT FROM AUTHOR]

The article informs that non-inferiority trials can be shown if the difference between two treatments does not cross a predefined inferiority margin. It mentions that non-inferiority studies need to be carefully planned, as failings in the design of the study may make accepting an inferior treatment more likely.

Introduction: Not enough is known about the epidemiology of opioid poisoning to tailor interventions to help address the growing opioid crisis in the U.S. The objective of this study is to expand the current understanding of opioid poisoning through the use of data analytics to evaluate geographic, temporal, and sociodemographic differences of opioid poisoning- related hospital visits in a region of New York State with high opioid poisoning rates.Methods: This retrospective cohort study utilized patient-level New York State all-payer hospital data (2010-2016) combined with Census data to evaluate geographic, patient, and community factors for 9,714 Long Island residents with an opioid poisoning-related inpatient or outpatient hospital facility discharge. Temporal, 7-year opioid poisoning rates and trends were evaluated, and geographic maps were generated. Overall, significance tests and tests for linear trend were based upon logistic regression. Analyses were completed between 2017 and 2018.Results: Since 2010, Long Island and New York State opioid poisoning hospital visit rates have increased 2.5- to 2.7-fold (p<0.001). Opioid poisoning hospital visit rates decreased for men, white patients, and self-payers (p<0.001) and increased for Medicare payers (p<0.001). Communities with high opioid poisoning rates had lower median home values, higher percentages of high school graduates, were younger, and more often white patients (p<0.01). Maps displayed geographic patterns of communities with high opioid poisoning rates overall and by age group.Conclusions: Findings highlight the changing demographics of the opioid poisoning epidemic and utility of data analytics tools to identify regions and patient populations to focus interventions. These population identification techniques can be applied in other communities and interventions. [ABSTRACT FROM AUTHOR]

Background: The use of secondary data, such as claims or administrative data, in comparative effectiveness research has grown tremendously in recent years.Purpose: We believe that the current review can help investigators relying on secondary data to (1) gain insight into both the methodologies and statistical methods, (2) better understand the necessity of a rigorous planning before initiating a comparative effectiveness investigation, and (3) optimize the quality of their investigations.Main Findings: Specifically, we review concepts of adjusted analyses and confounders, methods of propensity score analyses, and instrumental variable analyses, risk prediction models (logistic and time-to-event), decision-curve analysis, as well as the interpretation of the P value and hypothesis testing.Conclusions: Overall, we hope that the current review article can help research investigators relying on secondary data to perform comparative effectiveness research better understand the necessity of a rigorous planning before study start, and gain better insight in the choice of statistical methods so as to optimize the quality of the research study. [ABSTRACT FROM AUTHOR]

Background: Statistical analysis plans increase the transparency of decisions made in the analysis of clinical trial results. The purpose of this paper is to detail the planned analyses for the PREVENT trial, a randomized, placebo-controlled trial of patient education for acute low back pain. Results: We report the pre-specified principles, methods, and procedures to be adhered to in the main analysis of the PREVENT trial data. The primary outcome analysis will be based on Mixed Models for Repeated Measures (MMRM), which can test treatment effects at specific time points, and the assumptions of this analysis are outlined. We also outline the treatment of secondary outcomes and planned sensitivity analyses. We provide decisions regarding the treatment of missing data, handling of descriptive and process measure data, and blinded review procedures. Conclusions: Making public the pre-specified statistical analysis plan for the PREVENT trial minimizes the potential for bias in the analysis of trial data, and in the interpretation and reporting of trial results. [ABSTRACT FROM AUTHOR]

Background Recent evidence suggests that nutritional interventions may improve muscle outcomes in malnutrition and sarcopenia. Objectives We evaluated the effects of 2 high-quality oral nutritional supplements (ONS) differing in amount and type of key nutrients in older adult men and women. Design A multicenter, randomized, double-blinded, controlled clinical trial. Participants Malnourished and sarcopenic men and women, 65 years and older (n = 330). Intervention A 24-week intervention period with 2 energy-rich (330 kcal) ONS treatment groups: Control ONS (C ONS , 14 g protein; 147 IU vitamin D 3 ) versus Experimental ONS (E ONS , 20 g protein; 499 IU vitamin D 3 ; 1.5 g CaHMB) taken twice daily. Both ONS also contained other vitamins, minerals, and nutrients in varying amounts. Measurements Isokinetic peak torque (PT, Nm) leg strength, grip strength (kg), and gait speed (m·s −1 ) were assessed at baseline and 12 and 24 weeks. Left and right leg muscle mass (LMM, kg) were assessed by dual-energy x-ray absorptiometry (DXA). Muscle quality (MQ) was leg strength expressed relative to the tested LMM (Nm·kg −1 ). Subgroup analyses were performed: severe sarcopenia (low skeletal mass index, low grip strength [<30 kg men; <20 kg women], low gait speed [<0.8 m·s −1 ]) and mild-moderate sarcopenia (low skeletal mass index, normal gait speed, or normal grip strength). Results Both ONS groups (E ONS and C ONS ) improved PT, MQ, grip strength, and gait speed from baseline with no treatment differences. Those with severe sarcopenia (44%) exhibited lower baseline PT and MQ, with no differences in strength improvements between treatments. However, participants with mild-moderate sarcopenia exhibited higher baseline PT and MQ, with differences in strength improvements at 12 weeks (E ONS > C ONS , P = .032) in those with normal grip strength. There were no treatment differences based on sarcopenic severity for either grip strength or gait speed. Conclusion ONS improved strength outcomes in malnourished older adults with sarcopenia. In those with mild-moderate sarcopenia, but not severe sarcopenia, consumption of the E ONS improved leg muscle strength and quality compared with the standard C ONS . [ABSTRACT FROM AUTHOR]

Background: Ear Acupuncture (EA) is a form of acupuncture in which needles are applied to the external ear and has been used in multiple painful conditions. Low back pain (LBP) is highly prevalent in active individuals and causes high economic burden to health systems worldwide. LBP affects the person's ability to keep balance, especially in challenging conditions. Objective: The aim of the study was to examine the effects of a single session of EA on pain intensity and body sway during postural tasks. Method: Eighty adults with LBP and pain intensity equal to or greater than 4 (0-10 scale) were randomly allocated (1:1) to EA group (EAG) or placebo group (PG). Initially, the level of pain intensity was assessed. Next, participants stood still on a force plate either with feet in parallel or in semi-tandem and with eyes open or closed. Then, the EAG was treated with EA for 20 min and the PG was treated with detuned ultrasound. After the treatment, pain intensity was assessed again and the postural test was repeated. Pain intensity was the primary outcome and center of pressure sway area and speed were the secondary outcomes measured. Results: Results revealed that pain intensity decreased in both groups after treatment, but decreased more in the EAG. For postural control, no effect of treatment and no interaction between treatment and postural condition on body sway were found. Conclusion: Those findings indicate that EA is better than placebo to reduce pain, but neither treatment has any effect on postural control. [ABSTRACT FROM AUTHOR]

Objectives Cholinesterase inhibitors (ChEIs) offer modest benefits in Alzheimer disease (AD), which must be balanced against risks. Relatively few data delineate the benefits and risks of long-term ChEI administration in institutionalized patients with advanced AD. This study investigated the effects of ChEI discontinuation in institutionalized patients with AD. Design Institutionalized patients with moderate to severe AD (standardized Mini- Mental Status Examination ≤15) and treated with a ChEI for ≥2 years were randomized, double-blind, to ChEI continuation or placebo, with a 2-week tapering phase, for 8-weeks. Measurements The primary outcome of this pilot study was change on the Clinician's Global Impression of Change (CGI-C) scale. Secondary outcomes included safety, efficacy, and tolerability. Baseline (BL) predictors of clinical deterioration were also determined. Results Forty patients (mean ± standard deviation age = 89.3 ± 3.5 years, standardized Mini-Mental Status Examination = 8.1 ± 5.2, Neuropsychiatric Inventory–Nursing Home version total score = 21.1 ± 15.9, 80% male) were randomized to ChEI continuation (n = 21) or placebo (n = 19). There was no significant difference in clinical worsening in the ChEI continuation (28.6%) and placebo groups (36.8%) on CGI-C (odds ratio for worsening 1.58, 95% confidence interval .38–6.55, P = .53). The occurrence of adverse events was similar in both groups. There were no significant differences in any of the secondary outcome measures. In the placebo group, BL hallucinations predicted CGI-C worsening [F(1,17) = 6.4, P = .02], and there was a trend for BL delusions to predict CGI-C worsening [F(1,15) = 3.5, P = .08]. Conclusions These results suggest that ChEI discontinuation is safe and well tolerated in the majority of institutionalized patients with moderate to severe AD. When discontinuing ChEI, the presence of hallucinations and delusions may predict clinical deterioration, suggesting the need for increased caution. [ABSTRACT FROM AUTHOR]

Facial soft tissue thicknesses (FSTTs) hold an important role in craniofacial identification, forming the underlying quantitative basis of craniofacial superimposition and facial approximation methods. It is, therefore, important that patterns in FSTTs be correctly described and interpreted. In prior FSTT literature, small statistically significant differences have almost universally been overemphasized and misinterpreted to reflect sex and ancestry effects when they instead largely encode nuisance statistical noise. Here we examine FSTT data and give an overview of why P-values do not mean everything. Scientific inference, not mechanical evaluation of P, should be awarded higher priority and should form the basis of FSTT analysis. This hinges upon tempered consideration of many factors in addition to P, e.g., study design, sampling, measurement errors, repeatability, reproducibility, and effect size. While there are multiple lessons to be had, the underlying message is foundational: know enough statistics to avoid misinterpreting background noise for real biological effects. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of a Health at Every Size general education course on intuitive eating, body esteem (BES), cognitive behavioral dieting scores, and anti-fat attitudes of college students. Methods: Quasi-experimental design with 149 students in intervention (45), comparison (66), or control (46) groups. Analysis of variance and post hoc Tukey adjusted tests were used. Results: Mean scores for total general education course on intuitive eating (P < .001), unconditional permission to eat (P < .001), reliance on hunger (P < .001), cognitive behavioral dieting scores (P < .001), BES appearance (P = .006), BES weight (P < .001), and anti-fat attitudes (P < .001) significantly improved from pre to post in the intervention group compared with control and comparison groups. Conclusion and Implications: Students in the Health at Every Size class improved intuitive eating, body esteem, and anti-fat attitudes and reduced dieting behaviors compared with students in the control and comparison groups. [ABSTRACT FROM AUTHOR]

Background: Patients on maintenance hemodialysis suffer from diminished physical health. Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being. However, nurses seldom include an exercise intervention in the care plan for hemodialysis patients. Objectives: The purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients. Design: The study was a randomized, two-parallel group trial. Settings: Hemodialysis units in two tertiary hospitals in Nanjing, mainland China. Participants: One hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and randomly assigned to either the study group (n = 57) or the control group (n = 56). Methods: Both groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks. The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks. The intervention was to facilitate patients in performing regular exercise at home. Outcome measures, including gait speed, 10-repetition sit-to-stand performance, and quality of life were collected at baseline, and at 6 and 12 weeks into the program. Results: The results revealed that patients in the study group demonstrated greater increases in normal gait speed [F(1,111) = 4.42, p = 0.038] than the control group. For the study group, a mean increase of 12.02 (±3.03) centimeters/second from baseline to week 12 was found. With regard to the fast gait speed, there was a marginally significant between-group effect [F(1,111) = 3.93, p = 0.050]. The study group showed a mean improvement of 11.08 (±3.32) cm/s, from baseline to week 12. Patients from both groups showed improvements in their 10-repetition sit-to-stand performance. The between-group differences approached significance [F(1,111) = 3.92, p = 0.050], with the study group showed greater improvement than the control group. The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (±3.88) s from baseline to week 12. Significant improvements in quality of life across three time points were found only in the study group. Conclusions: Home exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients. [ABSTRACT FROM AUTHOR]

Background: The high recurrence rate of chronic venous leg ulcers has a significant impact on an individual's quality of life and healthcare costs. Objectives: This study aimed to identify risk and protective factors for recurrence of venous leg ulcers using a theoretical approach by applying a framework of self and family management of chronic conditions to underpin the study. Design: Secondary analysis of combined data collected from three previous prospective longitudinal studies. Setting: The contributing studies' participants were recruited from two metropolitan hospital outpatient wound clinics and three community-based wound clinics. Participants: Data were available on a sample of 250 adults, with a leg ulcer of primarily venous aetiology, who were followed after ulcer healing for a median follow-up time of 17 months after healing (range: 3-36 months). Methods: Data from the three studies were combined. The original participant data were collected through medical records and self-reported questionnaires upon healing and every 3 months thereafter. A Cox proportion-hazards regression analysis was undertaken to determine the influential factors on leg ulcer recurrence based on the proposed conceptual framework. Results: The median time to recurrence was 42 weeks (95% CI 31.9-52.0), with an incidence of 22% (54 of 250 participants) recurrence within three months of healing, 39% (91 of 235 participants) for those who were followed for six months, 57% (111 of 193) by 12 months, 73% (53 of 72) by two years and 78% (41 of 52) of those who were followed up for three years. A Cox proportional-hazards regression model revealed that the risk factors for recurrence included a history of deep vein thrombosis (HR 1.7, 95% CI 1.07-2.67, p = 0.024), history of multiple previous leg ulcers (HR 4.4, 95% CI 1.84-10.5, p = 0.001), and longer duration (in weeks) of previous ulcer (HR 1.01, 95% CI 1.003-1.01, p < 0.001); while the protective factors were elevating legs for at least 30 min per day (HR 0.33, 95% CI 0.19-0.56, p < 0.001), higher levels of self-efficacy (HR 0.95, 95% CI 0.92-0.99, p = 0.016), and walking around for at least 3 h/day (HR 0.66, 95% CI 0.44-0.98, p = 0.040). Conclusions: Results from this study provide a comprehensive examination of risk and protective factors associated with leg ulcer recurrence based on the chronic disease self and family management framework. These results in turn provide essential steps towards developing and testing interventions to promote optimal prevention strategies for venous leg ulcer recurrence. [ABSTRACT FROM AUTHOR]

Objective: Examine whether use of a grocery list is associated with healthier diet and weight among food desert residents. Methods: Cross-sectional analysis of in-person interview data from randomly selected household food shoppers in 2 low-income, primarily African American urban neighborhoods in Pittsburgh, PA with limited access to healthy foods. Results: Multivariate ordinary least-square regressions conducted among 1,372 participants and controlling for sociodemographic factors and other potential confounding variables indicated that although most of the sample (78%) was overweight or obese, consistently using a list was associated with lower body mass index (based on measured height and weight) (adjusted multivariant coefficient = 0.095) and higher dietary quality (based on the Healthy Eating Index-2005) (adjusted multivariant coefficient = 0.103) (P < .05). Conclusions and Implications: Shopping with a list may be a useful tool for low-income individuals to improve diet or decrease body mass index. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between Theory of Planned Behavior (TPB) beliefs and eating behavior, explore which beliefs have the greatest association with eating behavior, and explore differences between adults without children and first-time parents. Design: Longitudinal evaluation via questionnaires and food records at baseline and 6 and 12 months. Participants: Couples without children (n = 72) and first-time parents (n = 100). Main Outcome Measures: Dependent variables: fruit and vegetable consumption and fat consumption. Independent variables: TPB beliefs. Analysis: Pearson correlations between TPB beliefs and eating behavior; exploratory data reduction via linear regression. Results: Control beliefs were associated with eating behavior (r = .26--.46; P < .05). After controlling for past behavior, control beliefs were associated with eating behavior for first-time parents only. Control beliefs regarding preparation and time had the strongest associations with fruit and vegetable consumption for mothers (β= .26; P < .05) and fathers (thers (β = .38; P < .01). The absence of a ceiling effect for control beliefs suggests room for improvement via intervention. Conclusions and Implications: Interventions guided by TPB should target control beliefs to enhance healthy eating among new parents. Strategies (eg, individual, environmental, policy) to enhance control beliefs regarding healthy eating despite limited time and opportunity for preparation may be particularly valuable. [ABSTRACT FROM AUTHOR]

Background: Nurse practitioners perform a diagnostic role previously delivered by doctors. Multiple studies demonstrate nurse practitioners are as effective as doctors when managing chronic conditions and minor illnesses and injuries. No studies have focused on how nurse practitioners compare to doctors in their management of complex cases presenting for the first time. Objective: This study assessed how nurse practitioners’ diagnostic reasoning abilities when managing a complex case compared to those of doctors’? Design: A comparative research design. Participants: Purposeful sampling recruited 30 nurse practitioners and 16 doctors working in multiple specialties in New Zealand. All doctors were completing postgraduate specialist training programmes. Specialties included older adults, emergency care, primary health care/general practice, cardiology, respiratory and palliative care. Methods: A complex case scenario assessed by an expert panel and think aloud protocol was used to assess diagnostic reasoning abilities. The ability of 30 nurse practitioners to determine diagnoses, identify the problem, and propose actions was compared to that of 16 doctors. Correct responses were determined by an expert panel. Data gained from the case scenario using think aloud protocol were quantified for analysis. Results: 61.9% of doctors identified the correct diagnoses, 56.3% the problem and 34.4% the actions as determined by the expert panel. This compares to 54.7% of nurse practitioners identifying the correct diagnoses, 53.3% the problem and 35.8% the actions. Analysis revealed no difference between these groups (diagnoses 95% CI: 1.76 to 0.32, p = 0.17, problem χ2 = 0.00, p = 1.0, or actions 95% CI: 1.23 to 1.58, p = 0.80). Conclusion: Nurse practitioners’ diagnostic reasoning abilities compared favourably to those of doctors in terms of diagnoses made, problems identified and action plans proposed from a complex case scenario. In times of global economic restraints this adds further support to alternative models of care. [ABSTRACT FROM AUTHOR]

Background: The relationship between leadership and employee distress is well established, however, the processes involved in this relationship remain largely unclear. For a stretched nursing workforce, understanding in what ways leadership may influence employee distress is particularly important. Objectives: To examine possible mediating effects of the work environment factors demand and control in the relationship between leadership behaviour in change, production, and employee orientation and employee distress. Design: Cross-sectional study design. Settings: The study was conducted at a large county council in Sweden providing both institutional and non-institutional care. Participants: A random sample of 1249 employees (primarily nurses, but also a wide range of other healthcare professionals and administrative staff), who had a healthcare manager that was about to enter a leadership development programme (n = 171), responded to a web-based questionnaire. The response rate was 62%. Methods: The employees rated their healthcare managers' behaviour in change, production, and employee orientation, as well as their own perceptions of level of demand, control (subdivided into decision authority and skill discretion), and five distress outcomes. Multilevel analysis was performed. Results: The mediators demand, decision authority, and skill discretion were significant predictors of all five distress outcomes for all three leadership orientations. In eight of 15 regressions, the mediators fully explained the relationships between leadership orientations and outcomes. Four of five relationships with distress outcomes were fully mediated for change-oriented leadership, whereas two of five outcomes were fully mediated for production- and employee-oriented leadership. In all three leadership orientations, the relationship between the mediator skill discretion and the distress measure disengagement were particularly strong, with B-coefficients (.44, p < .001) twice as high as for any of the other relationships. Conclusions: It seems that the way that employees perceive healthcare managers' change- oriented behaviour, and how that aspect is related to employee distress, is primarily explained by perception of demand and control. Furthermore, regardless of leadership behaviour orientation, how employees perceive their opportunity to use specific job skills plays an important role in the interplay between perception of healthcare managers' behaviour and disengagement. [ABSTRACT FROM AUTHOR]

Background: Successful management of atopic dermatitis poses a significant and ongoing challenge to parents of affected children. Despite frequent reports of child behaviour problems and parenting difficulties, there is a paucity of literature examining relationships between child behaviour and parents' confidence and competence with treatment. Objectives: To examine relationships between child, parent, and family variables, parents' self-efficacy for managing atopic dermatitis, self-reported performance of management tasks, observed competence with providing treatment, and atopic dermatitis severity. Design: Cross-sectional study design. Participants A sample of 64 parent-child dyads was recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Methods: Parents completed self-report questionnaires examining child behaviour, parents' adjustment, parenting conflict, parents' relationship satisfaction, and parents' self-efficacy and self-reported performance of key management tasks. Severity of atopic dermatitis was assessed using the Scoring Atopic Dermatitis index. A routine home treatment session was observed, and parents' competence in carrying out the child's treatment assessed. Results: Pearson's and Spearman's correlations identified significant relationships (p < .05) between parents' self-efficacy and disease severity, child behaviour difficulties, parent depression and stress, parenting conflict, and relationship satisfaction. There were also significant relationships between each of these variables and parents' self-reported performance of management tasks. More profound child behaviour difficulties were associated with more severe atopic dermatitis and greater parent stress. Using multiple linear regressions, significant proportions of variation in parents' self-efficacy and self-reported task performance were explained by child behaviour difficulties and parents' formal education. Self-efficacy emerged as a likely mediator for relationships between both child behaviour and parents' education, and self-reported task performance. Direct observation of treatment sessions revealed strong relationships between parents' treatment competence and parents' self-efficacy, outcome expectations, and self-reported task performance. Less competent task performance was also associated with greater parent-reported child behaviour difficulties, parent depression and stress, parenting conflict, and relationship dissatisfaction. Conclusion: This study revealed the importance of child behaviour to parents' confidence and practices in the context of atopic dermatitis management. Children with more severe atopic dermatitis are at risk of presenting with challenging behaviour problems and their parents struggle to manage the condition successfully. [ABSTRACT FROM AUTHOR]

Highlights: [•] A platform to search for data driven flow experiences in patients is introduced. [•] Traumatic Brain Injury patients rehabilitation plans based on empirical clinical data. [•] Zone of rehabilitation potential modeled using NeuroRehabilitation Range (NRR). [•] Analytical and visual tools are introduced and validated to search data driven NRR. [•] Obtained results lead to actual clinical NRR hypothesis reconsideration. [Copyright &y& Elsevier]

Objective: To assess the effectiveness of Wisconsin Farm to School (F2S) programs in increasing students’ fruit and vegetable (FV) intake. Design: Quasi-experimental baseline and follow-up assessments: knowledge and attitudes survey, food frequency questionnaire (FFQ), and lunch tray photo observation. Setting: Wisconsin elementary schools: 1 urban and 8 rural. Participants: Children, grades 3-5 (n = 1,117; 53% male, 19% non-Caucasian). Intervention(s): Farm to School programming ranging from Harvest of the Month alone to comprehensive, including school garden, locally sourced produce in school meals, and classroom lessons. Main Outcome Measures: Knowledge, attitudes, exposure, liking, willingness; FFQ-derived (total), and photo-derived school lunch FV intake. Analysis: t tests and mixed modeling to assess baseline differences and academic-year change. Results: Higher willingness to try FV (+1%; P < .001) and knowledge of nutrition/agriculture (+1%; P < .001) (n = 888), and lunch FV availability (+6% to 17%; P < .001) (n = 4,451 trays), both with increasing prior F2S program exposure and across the year. There was no effect on overall dietary patterns (FFQ; n = 305) but FV consumption increased among those with the lowest intakes (FFQ, baseline very low fruit intake, +135%, P < .001; photos; percentage of trays with no FV consumption for continuing programs decreased 3% to 10%, P ≤ .05). Conclusions and Implications: Farm to School programming improved mediators of FV consumption and decreased the proportion of children with unfavorable FV behaviors at school lunch. Longer-term data are needed to further assess F2S programs. [ABSTRACT FROM AUTHOR]

Background: Confidence is required for effective engagement in interprofessional collaboration. New graduate nurses often lack confidence in interprofessional interactions, and this may compromise the delivery of safe and effective healthcare. Objectives: The overall objective of this study was to explore new graduate nurse confidence in interprofessional collaboration. Design: An explanatory sequential mixed methods design was used. Methods: New graduate nurses from Ontario, Canada (N = 514) completed a crosssectional descriptive survey in 2012. The survey measured perceived confidence in interprofessional collaboration, and it included items that were proposed to have a relationship with new graduate nurse confidence in interprofessional collaboration. Follow-up qualitative telephone interviews were conducted with 16 new graduate nurses. Results: The quantitative findings suggested that several factors have a positive relationship with new graduate nurse confidence in interprofessional collaboration: availability and accessibility of manager, availability and accessibility of educator, number of different disciplines worked with daily, number of team strategies, and satisfaction with team. The qualitative phase supported the quantitative findings and also provided new information about factors that facilitated and challenged new graduate nurse confidence when engaging in interprofessional collaboration. The facilitators were: experience, knowledge, respect, supportive relationships, and opportunities to collaborate. Challenges included: lack of experience, lack of knowledge, communication challenges, and balancing practice expectations. The overall findings relate to team and organizational support, and new graduate nurse development. Conclusion: Interventions that provide support for interprofessional collaboration at the team and organizational levels, and develop new graduate nurse knowledge and experiences regarding collaborative practice, are essential for enhancing new graduate nurse confidence in interprofessional collaboration. [ABSTRACT FROM AUTHOR]

Background: Disturbed sleep pattern is a common symptom after head trauma and its prevalence in acute traumatic brain injury (TBI) is less discussed. Sleep has a profound impact on cognitive function recovery and the mediating effect of disturbed sleep on cognitive function recovery has not been examined after acute TBI. Objectives: To identify the prevalence of disturbed sleep in mild, moderate, and severe acute TBI patients, and to determine the mediating effects of sleep on the relationship between brain injury severity and the recovery of cognitive function. Design: A prospective study design. Setting: Neurosurgical wards in a medical center in northern Taiwan. Participants: Fifty-two acute TBI patients between the ages of 18 and 65 years who had received a diagnosis of TBI for the first time, and were admitted to the neurosurgical ward. Method: The severity of brain injury was initially determined using the Glasgow Coma Scale. Each patient wore an actigraphy instrument on a non-paralytic or non-dominated limb for 7 consecutive days. A 7-day sleep diary was used to facilitate data analysis. Cognitive function was assessed on the first and seventh day after admission based on the Rancho Los Amigos Levels of Cognitive Functioning. Results: The mild (n = 35), moderate (n = 7) and severe (n = 10) TBI patients exhibited poorer sleep efficiency, and longer total sleep time (TST) and waking time after sleep onset, compared with the normative values for the sleep-related variables (P < .05 for all). The severe and moderate TBI patients had longer daytime TST than the mild TBI patients (P < .001), and the severe TBI patients had longer 24-h TST than the mild TBI patients (P = .001). The relationship between the severity of brain injury and the recovery of cognition function was mediated by daytime TST (t = -2.65, P = .004). Conclusions: Poor sleep efficiency, prolonged periods of daytime sleep, and a high prevalence of hypersomnia are common symptoms in acute TBI patients. The duration of daytime sleep mediates the relationship between the severity of brain injury and the recovery of cognition function. [ABSTRACT FROM AUTHOR]

Background: There is increasing interest in using complementary and alternative treatments to manage behavioural and psychological symptoms of dementia such as agitation, aggression and depressed mood. Objective: To compare the effect of foot massage (intervention) and quiet presence (control) on agitation and mood in people with dementia. Design: A randomised controlled trial using a within-subjects, crossover design. Settings: Five long-term care facilities in Brisbane, Australia. The primary outcome was the Cohen-Mansfield Agitation Inventory (CMAI) and the secondary outcome was the Observed Emotion Rating Scale (OERS). The screening and data collection research assistants, families, and care staff were blinded to participant allocation. Participants: Participants of the study were 55 long-term care residents aged 74-103 years (mean age 86.5), with moderate to severe dementia and a history of agitated behaviour according to the Pittsburgh Agitation Scale. A computer-program randomised participants to 10-min foot massage (intervention) or quiet presence (control), every weekday for 3 weeks. Results: A carry-over effect was identified in the data, and so the data was treated as a parallel groups RCT. The mean total CMAI increased in both groups (reflecting an increase in agitation) with this increase greater in the quiet presence group than the foot massage group (p = 0.03). There was a trend towards a difference on OERS General Alertness, with a positive change in alertness for participants in the foot massage group (indicating reduced alertness) and a negative change for participants in the quiet presence group (indicating increased alertness) (F(1,51) = 3.88, p = 0.05, partial ...² = 0.07). Conclusions: The findings highlight the need for further research on the specific conditions under which massage might promote relaxation and improve mood for people with dementia. The unfamiliar research assistants and variations in usual activity may have contributed to the increase in agitation and this needs further research. [ABSTRACT FROM AUTHOR]

Objectives: To (a) assess the statistical power of nursing research to detect small, medium, and large effect sizes; (b) estimate the experiment-wise Type I error rate in these studies; and (c) assess the extent to which (i) a priori power analyses, (ii) effect sizes (and interpretations thereof), and (iii) confidence intervals were reported. Design: Statistical review. Data sources: Papers published in the 2011 volumes of the 10 highest ranked nursing journals, based on their 5-year impact factors. Review methods: Papers were assessed for statistical power, control of experiment-wise Type I error, reporting of a priori power analyses, reporting and interpretation of effect sizes, and reporting of confidence intervals. The analyses were based on 333 papers, from which 10,337 inferential statistics were identified. Results: The median power to detect small, medium, and large effect sizes was .40 (interquartile range [IQR] = .24-.71), .98 (IQR = .85-1.00), and 1.00 (IQR = 1.00-1.00), respectively. The median experiment-wise Type I error rate was .54 (IQR = .26-.80). A priori power analyses were reported in 28% of papers. Effect sizes were routinely reported for Spearman's rank correlations (100% of papers in which this test was used), Poisson regressions (100%), odds ratios (100%), Kendall's tau correlations (100%), Pearson's correlations (99%), logistic regressions (98%), structural equation modelling/confirmatory factor analyses/path analyses (97%), and linear regressions (83%), but were reported less often for two-proportion z tests (50%), analyses of variance/analyses of covariance/multivariate analyses of variance (18%), t tests (8%), Wilcoxon's tests (8%), Chi-squared tests (8%), and Fisher's exact tests (7%), and not reported for sign tests, Friedman's tests, McNemar's tests, multi-level models, and Kruskal-Wallis tests. Effect sizes were infrequently interpreted. Confidence intervals were reported in 28% of papers. Conclusion: The use, reporting, and interpretation of inferential statistics in nursing research need substantial improvement. Most importantly, researchers should abandon the misleading practice of interpreting the results from inferential tests based solely on whether they are statistically significant (or not) and, instead, focus on reporting and interpreting effect sizes, confidence intervals, and significance levels. Nursing researchers also need to conduct and report a priori power analyses, and to address the issue of Type I experiment-wise error inflation in their studies. [ABSTRACT FROM AUTHOR]

Abstract: The goal of this work is to describe some connections between cryptology and statistics. Starting from basic frequency analysis, throughout history, statistical ideas have been employed to attack cryptographic systems and continue to be important in modern day cryptanalysis. Brief descriptions of hypothesis testing based distinguishing attacks, differential cryptanalysis and statistical ideas used in side channel attacks are provided. From the designer's point of view, we consider three connections. A brief description is provided of the cryptographic ideas that have been suggested to strengthen the technique of randomised response. In recent times, a new notion of privacy of statistical databases has arisen and has been called differential privacy. We provide a brief description of this idea and mention some of its applications. Lastly, we consider the problem of defining and proving security of public key encryption schemes and provide a simple example of this method. It is hoped that the topics outlined here will motivate researchers to further investigate the connection between these two subjects. [Copyright &y& Elsevier]

The article offers information on a study in which parents' perspectives about nutrition and physical activity (PA) during out-of-school time (OST). It mentions that 600 parents with a school-aged child participated in programs from selected OST organizations. It adds that about two thirds of parents agreed that OST programs should promote healthy environments for children, whereas one third agreed that parents alone should be responsible for children's nutrition and PA.

Highlights: [•] New ages are presented for both the Deccan Traps and the KPgB. [•] Utilize strict adherence to statistical requirements for plateau/isochron ages. [•] Use initial 36Ar contents to detect altered samples. [•] Eliminate all (lowered) ages for altered samples caused by partial loss of 40Ar*. [•] The age of reversed polarity lavas in the CWGS overlap that of the KPgB. [ABSTRACT FROM AUTHOR]

Abstract: Due to the uncertainty and variability involved in ground conditions and analytical methods, the calculated factor of safety (FS) of a slope may not be exact. To know whether the calculated FS is unbiased and also the magnitude of its variability, this paper re-analyzes 43 real cases of undrained slope failure reported in the literature. The FS is re-calculated using two-dimensional (2-D) limit equilibrium methods (LEM) (i.e., the simplified Bishop's method and the Spencer's method) to minimize the human factor in FS calculation. Since all cases failed, the conditions (such as geometries) right before failures were adopted to simulate the nearly failure condition in the LEM. Based on the statistical results of the calculated FS obtained from hypothesis testing, it can be concluded that (a) the 2-D LEM seems to give unbiased FS estimates; (b) the FS variability for natural slopes is significantly larger than that for man-made slopes; (c) the conversion of the undrained shear strength (su) to its field value is the most crucial, and the modeling of su spatial variability is also crucial; and (d) the standard deviation of the human error in the logarithm of the calculated FS is about 0.25, and the human error appears to be uncorrelated to the logarithm of the calculated FS. Finally, the relationship between the failure probability of a man-made undrained clay slope and its calculated FS is developed to facilitate reliability analysis and reliability-based design. [Copyright &y& Elsevier]

Objectives: To investigate the reasons for refusal of human papillomavirus (HPV) vaccination, and to explore participants' perceptions and attitudes about Health Belief Model (HBM) constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy) among a sample of female university students. Study design: Cross-sectional. A self-administered questionnaire based on the HBM was used. Methods: Confirmatory factor analysis was applied to the data to examine the construct validity of the six factor models extracted from the HBM. The predictors of non-HPV vaccination were determined by logistic regression models, using non-HPV vaccination as the dependent variable. Results: The sample included 2007 students. The participation rate was 88.9% and the percentage of non-vaccination was 71.65%. Participants who had high scores for 'general perceived barriers', 'perceived barriers to vaccination', 'no perceived general benefits', 'no perceived specific benefits' and 'no general benefits' were more likely to report being unvaccinated. Conclusions: The findings demonstrated the utility of HBM constructs in understanding vaccination intention and uptake. There is an urgent need to improve health promotion and information campaigns to enhance the benefits and reduce the barriers to HPV vaccination. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of 2 post-bariatric support interventions on depressive symptoms of Hispanic Americans treated with gastric bypass for morbid or severe obesity. Design/Setting: Prospective randomized, controlled trial conducted in a laparoscopic institution. Participants/Interventions: During the Phase 1 clinical trial (from preoperative evaluation to 6 months after surgery), all participants received standard care. During Phase 2 (6-12 months after surgery), participants were randomly assigned to receive either standard care (n = 72) or comprehensive support (n = 72). Comprehensive group participants received 6 educational sessions focused on behavior change strategies and motivation with nutrition counseling. Main Outcome Measures: Depression scores and weight change over time. Analysis: Independent samples t tests and regression analysis assessed relationships among depression scores and excess weight loss. Results: Participants receiving behavioral-motivational intervention scored significantly lower on Beck's Depression Inventory questionnaire scores than those receiving standard care. For those with depressive symptoms at randomization, 24% of participants who received the comprehensive intervention reported no depressive symptoms at 12 months after surgery, compared with 6% of those who received standard care (P < .001). Patients' depressive mood improvement was significantly and positively associated with excess weight loss and attendance at educational sessions (P < .001). Conclusions and Implications: Findings support the importance of post-bariatric comprehensive behavioral-motivational nutrition education for decreasing risk for depression and improving weight loss. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of a pilot comprehensive school nutrition program modeled on Social Cognitive Theory on knowledge, intentions, self-efficacy, and intake of milk and milk alternatives (MMA) in First Nations youth. Methods: A pilot school nutrition program was implemented at Peetabeck Academy in Fort Albany, Ontario in May, 2010. The Knowledge, Self-Efficacy, and Intentions Questionnaire (KSIQ) and Waterloo Web-based Eating Behavior Questionnaire (WEB-Q) were used to assess change in attitudes and behavior from pre- to postprogram. Results: The KSIQ preprogram (n = 26), postprogram (n = 19); WEB-Q preprogram (n = 30), postprogram (n = 10). Improved knowledge (6.0±1.5vs6.9±1.5,P= .05) and intention scores (9.6 ± 4.4 vs 11.3 ± 4.1, P = .01) were observed. Conclusions and Implications: A comprehensive school nutrition program can improve knowledge and intentions for intake of MMA in First Nations youth. Environmental constraints beyond the school environment need to be addressed. [ABSTRACT FROM AUTHOR]

Objective: To examine gender differences in unhealthy weight-control behaviors (UWCB) and identify key psychosocial and demographic correlates of UWCB among sixth-graders. Methods: A cross-sectional survey was completed by 146 boys and 153 girls at a middle school. Secondary data analyses included bivariate tests and multivariable logistic regression. Results: Forty-seven percent of participants reported 1 or more UWCB, -with no differences by gender (P - .75). Factors common to boys and girls included: lower global self-esteem; lower body-esteem; and greater negative parental modeling among participants who engaged in UWCB compared to those who did not. However, multivariable models revealed gender differences. Among boys, body mass index, negative parental modeling, and global self-esteem retained statistically significant associations with UWCB after controlling for other variables in the model, whereas race and weight-related body-esteem remained significant for girls. Conclusions and Implications: This research highlights the need for gender-specific UWCB prevention programs implemented in late childhood and early adolescence. [ABSTRACT FROM AUTHOR]

Objective: To compare the difference between self-reported and calculated daily energy requirements of adults within different body mass index (BMI) categories. Methods: Adults (n = 978) self-reported daily energy requirements, demographic information, and height, weight, age, and physical activity level (PAL) to calculate total energy expenditure. Results: The main effects of BMI, gender, PAL, and dieting status on the difference between self- reported and calculated energy requirements for weight maintenance were significant (P < .05); age, race/ethnicity, level of education, and being in a health-related field had no effect. Individuals across all BMI categories underestimated their energy requirements, but obese individuals underestimated to the greatest degree. Males, current dieters, and those who reported a low-active or active PAL underestimated to the greatest extent in each category. Conclusions and Implications: There is a lack of basic nutrition knowledge about personal energy needs in individuals across all BMI categories regardless of age, race/ethnicity, level of education, or work/training in a health-related field. [ABSTRACT FROM AUTHOR]

Abstract: Background: Several studies have reported increased resting energy expenditure (REE) in people with human immunodeficiency virus (HIV). However, limited data exist on REE in HIV-infected women and the effect of antiretroviral therapy (ART) on REE in this population. Objective: The purpose of this study was to compare REE in healthy controls to adult HIV-infected women classified in three groups: naïve to ART, on ART with virologic suppression, and on ART with an HIV-1 RNA level >5,000 copies/mL. Design: After a fast, body composition by bioelectrical impedance analysis and REE by indirect calorimetry were determined. Anthropometric measures were also taken. Statistical analysis: Distributionally appropriate two-sample tests were used for between-group analyses and analysis of covariance was used for confounding adjustment. Results: Eighty-seven women were enrolled and the HIV-infected and control women were matched for age and body mass index. Log-transformed REE was significantly higher in HIV-infected women naïve to ART compared to controls (7.26±0.22 vs 7.14±0.19; P=0.04, respectively) and the difference remained significant after adjustment for body cell mass (P=0.008). Log-transformed REE was not different in HIV-infected women on ART compared to HIV-infected women naïve to ART (7.25±0.25 vs 7.26±0.23; P=0.81, respectively). Adjusting for body cell mass did not change the results (P=0.56). Similarly, REE was not different between women naïve to ART and those on ART with undetectable HIV-1 RNA, regardless of adjustment for body cell mass. REE correlated to current and nadir CD4 count and trended toward a negative correlation with HIV-1 RNA levels. Conclusions: We showed that REE is elevated in ART-naïve, HIV-infected women and continues to be elevated when on ART, regardless of virologic suppression, compared to age and body mass index−matched healthy women. This suggests an effect of HIV infection itself and not ART on REE in these HIV-infected women, and should be considered during nutrition assessment and counseling of HIV-infected adult women. [Copyright &y& Elsevier]

Objective: To develop a measure of person-centered communication (PCC) and demonstrate feasibility for use in primary care child obesity interventions. Methods: Helping Healthy Activity and Nutrition Directions was a primary care intervention for families of overweight or obese 5- to 8-year-old children. The PCC Coding System (PCCCS) was based on theory and a validated motivational interviewing instrument. The PCCCS provided global scores, and total, positive, and negative PCC utterance frequencies. Three trained coders tested reliability of the PCCCS on audio recordings of sessions with 30 families. Potential uses of the PCCCS were demonstrated. Results: The PCCCS demonstrated good inter-rater reliability for utterance frequencies but not for global scores. Conclusions and Implications: The PCCCS is a reliable and feasible measure of PCC utterances. More research is needed to improve inter-rater reliability of the PCC global scale. The PCCCS may be used in the future to test fidelity of PCC interventions. [ABSTRACT FROM AUTHOR]

Background: A growing body of literature examines the association of postnatal secondhand smoke exposure with attention deficit hyperactivity disorder (ADHD) in children, but the findings are mixed. Objective: We compare prevalence of ADHD in children aged 4-15 years who were exposed to postnatal secondhand smoke with prevalence in those who were not exposed, and examine the association of postnatal secondhand smoke exposure with ADHD using both reported and cotinine-measured secondhand smoke exposure. Design and setting: We analyze secondary data from the 1999-2004 U.S. National Health and Nutrition Examination Surveys. Participants: Analyses using reported secondhand smoke exposure and cotininemeasured exposure included 6283 and 6033 children aged 4-15 respectively, including 419 and 404 children who either had a reported physician diagnosis of ADHD or were taking stimulant medications. Methods: The association of secondhand smoke exposure with ADHD was examined by two multiple logistic regression models that differ in the secondhand smoke measurement used. Results: After controlling for maternal smoking during pregnancy, gender, age, race/ ethnicity, preschool attendance, health insurance coverage, and exposure to lead, children with reported secondhand smoke exposure at home were more likely to have ADHD (adjusted odds ratio = 1.5, 95% confidence interval: 1.1-2.0) than those who were not exposed. After controlling for these covariates, children with detectable cotinine levels were more likely to have ADHD (adjusted odds ratio = 1.8, 95% confidence interval: 1.3- 2.5) than those with non-detectable levels. Conclusions: Our findings suggest that secondhand smoke exposure in children is strongly associated with ADHD independent of other risk factors and this association is robust using both measurements of secondhand smoke exposure. Further research is needed to understand the mechanism underlying this association. Nurses and other healthcare professionals can play an important role in encouraging parents to quit smoking to reduce children's exposure to secondhand smoke and their risk of ADHD. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Hydroalcoholic solutions of propolis, a resinous product produced by bees, have been currently employed in improving the cicatricial repair. Biological activity of propolis might be related to its antimicrobial, anti-inflammatory and immunomudalatory properties. Aim of this study: Investigate the suitability of the collagen-based films containing hydroalcoholic extracts of two different varieties of Brazilian propolis (green and red ones) on the dermal burn healing in rodent model. Materials and methods: The hydroalcoholic extracts of red propolis (RP) or Green propolis (GP) were incorporated into collagen-based dressing films (COL). Burn wounds were performed in the dorsum of Wistar rats and dressing with COL, COL+GPa (0.5%), COL+GPb (1,0%) or COL+RP (0.5%). A control group (CTR) was performed keeping the wound undressed. The histological analyses were carried out after 3, 7, 14, 21 and 30 days for histological assessment of the inflammatory response, epithelization rates (ER), myofibroblastic count (MC) and collagenization pattern. Results: GPa, GPb and RP provided significant decrease of the inflammatory severity, improved the ER in GPa in 7 (p=0.000), 14 (p=0.000), 21 (p=0.005) and 30 days (p=0.015), and induced earlier replacement of type-III for type-I collagen (p<0.05) than COL and CTR. In all the groups, the MC increased progressively from 3 to 14 days, and then started to decrease slowly until 21 days. Although no significant difference was observed among the groups in 3, 7 and 30 days, the MC was significantly increased in RP in 14 (p=0.0001) and 21 days (p=0.04), as well as grosser interlacement of the collagen bundles compared with the other groups. Conclusion: The incorporation of hydroalcoholic extracts of Brazilian propolis improved the biological events associated to burn healing without toxic effects, but the red variety provided the best results. Therefore, these collagen-based containing natural apicultural products films may be considered a promising new dressing for wound occlusion and tissue repairing. [Copyright &y& Elsevier]

Abstract: Ethnopharmacological relevance: Modified Dingchuan decoction (MDD) is used in traditional Chinese medicine for the treatment of cough, chronic bronchitis, asthma and viral pneumonia. Aim of the study: To investigate antiviral potentials of MDD in respiratory syncytial virus (RSV) infected mice. Materials and methods: MDD and each component were evaluated for antiviral efficacy against RSV in vitro in cell culture. Mice were were treated with cyclophosphamide and infected with RSV. Then, treatments with MDD at doses of 1.75g/kg, 3.5g/kg and 7.0g/kg, respectively, were oral administrated daily for 5 days after challenge. The levels of Eotaxin, IL-4 and IFN-γ in serum and lung tissue were detected by ELISA, viral loads in lung tissues were detected by RFQ-PCR while expressions of NF-κB and TLR4 mRNA were also detected by RFQ-PCR. Results: A selective index of >36.8 (2.5 times greater than that observed for ribavirin) was determined in the in vitro studies for this herbal medicine. MDD exhibited significant antiviral and anti-inflammatory effects on decreasing levels of Eotaxin, IL-4 and IFN-γ in serum and lung tissue, inhibiting pneumonia, decreasing lung viral loads and reversaling RSV-induced inflammation through down-regulation of TLR4 and NF-κB mRNA expression in the lung tissue of RSV-infected mice. Conclusions: MDD could exhibit antiviral and anti-inflammatory effects on RSV-infected mice as a suppressor of Eotaxin, IL-4 and IFN-γ. These effects appeared to be mediated by inhibitions of TLR4 and NF-κB activation. Therefore, MDD could provide an effective therapeutic approach for RSV and its subsequent viral bronchitis. [Copyright &y& Elsevier]