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AIM: The aim of this study was to examine the existence of a relationship between the grading of reflective journals and student honesty in reflective journal writing. BACKGROUND: Journal writing is often used to gauge skills and knowledge. However, disagreement exists as to whether journals should be graded as studentsmay embellish experiences or write what the instructor wants to read. If students are not engaged in honest reflection, the benefit of reflective practice is reduced. METHOD: Data were collected using an anonymous online survey. The nonprobability sampling technique was used to examine the existence of a relationship between the grading of reflective journals and student honesty in reflective journal writing. RESULTS: Findings indicated a statistically significant positive relationship between grading of reflective journals and student honesty. CONCLUSION: Instead of grading the written component, the process of reflective practice should be assessed, possibly changing to a grade of complete/incomplete. [ABSTRACT FROM AUTHOR]

Background: There is little published about non-traditional and online college students' health and well-being. College health services must evolve to address the needs of this growing population. The purpose of this study was to explore risk factors, perceived well-being, health behaviors, and health education preferences of US college students enrolled in a fully online academic programs compared to a national sample of college students enrolled in campus-based programs. Methods: This cross-sectional study included a volunteer sample of 961 college students enrolled in two large, U.S. accredited online universities. Participants completed an online survey that included questions and sub scales from the National College Health Assessment (NCHA, IIb). Responses on survey items from student learning online were compared to an equal sample of college students enrolled in non-online programs, randomly drawn from the NCHA IIb national data set (n = 961). Frequencies on survey items were calculated and mean scores of subset measures for online students were compared against those from the NCHA data set using twotailed z-test scores and independent sample t-tests with alpha at 0.05. Results: Online students reported significantly (P ≤ 0.05) higher percentages of chronic illnesses, psychiatric conditions, mobility disabilities, deafness/hearing loss, speech/language disorders, cigarette use, obesity, sedentary activity, and depression than the NCHA national sample. Implication for Practice: Health professionals and leaders who work in higher education must consider the shifting landscape and demographics in higher education in order to develop more tailored, innovative digital health promotion approaches that effectively reach the growing population of online, commuter, and older learners. [ABSTRACT FROM AUTHOR]

Background. For health care providers in the United States, the risk for nonfatal violence in the workplace is 16 times greater than that for other workers. Inappropriate patient sexual behavior (IPSB) is directed at clinicians, staff, or other patients and may include leering, sexual remarks, deliberate touching, indecent exposure, and sexual assault. Inappropriate patient sexual behavior may adversely affect clinicians, the organization, or patients themselves. Few IPSB risk factors for physical therapists have been confirmed. The US prevalence was last assessed in the 1990s. Objective. The objectives of this study were to determine career and 12-month exposure to IPSB among US physical therapists, physical therapist assistants, physical therapist students, and physical therapist assistant students and to identify IPSB risk factors. Design. This was a retrospective and observational study. Methods. An electronic survey was developed; content validity and test-retest reliability were established. Participants were recruited through physical therapist and physical therapist assistant academic programs and sections of the American Physical Therapy Association. Inappropriate patient sexual behavior risk models were constructed individually for any, mild, moderate, and severe IPSB events reported over the past 12 months. Open-ended comments were analyzed using qualitative methods. Results. Eight hundred ninety-two physical therapist professionals and students completed the survey. The career prevalence among respondents was 84%, and the 12-month prevalence was 47%. Statistical risk modeling for any IPSB over the past 12 months indicated the following risks: having fewer years of direct patient care, routinely working with patients with cognitive impairments, being a female practitioner, and treating male patients. Qualitative analysis of 187 open-ended comments revealed patient-related characteristics, provider-related characteristics, and abusive actions. Limitations. Self-report, clinician memory, and convenience sampling are limitations of this type of survey research. Conclusions. The extremely high prevalence of IPSB among physical therapist professionals warrants practitioner and student education as well as clear workplace policy and support. [ABSTRACT FROM AUTHOR]

Background: Limited knowledge regarding the reproducibility of biomarkers in 24-h urine samples has hindered the collection and use of the samples in epidemiologic studies. Objective: We aimed to evaluate the reproducibility of various markers in repeat 24-h urine samples. Design: We calculated intraclass correlation coefficients (ICCs) of biomarkers measured in 24-h urine samples that were collected in 3168 participants in the NHS (Nurses' Health Study), NHSII (Nurses' Health Study II), and Health Professionals Follow-Up Study. Results: In 742 women with 4 samples each collected over the course of 1 y, ICCs for sodium were 0.32 in the NHS and 0.34 in the NHSII. In 2439 men and women with 2 samples each collected over 1 wk to =1 mo, the ICCs ranged from 0.33 to 0.68 for sodium at various intervals between collections. The urinary excretion of potassium, calcium, magnesium, phosphate, sulfate, and other urinary markers showed generally higher reproducibility (ICCs >0.4). In 47 women with two 24-h urine samples, ICCs ranged from 0.15 (catechin) to 0.75 (enterolactone) for polyphenol metabolites. For phthalates, ICCs were generally =0.26 except for monobenzyl phthalate (ICC: 0.55), whereas the ICC was 0.39 for bisphenol A (BPA). We further estimated that, for the large majority of the biomarkers, the mean of three 24-h urine samples could provide a correlation of =0.8 with true long-term urinary excretion. Conclusions: These data suggest that the urinary excretion of various biomarkers, such as minerals, electrolytes, most polyphenols, and BPA, is reasonably reproducible in 24-h urine samples that are collected within a few days or =1 y. Our findings show that three 24-h samples are sufficient for the measurement of long-term exposure status in epidemiologic studies. [ABSTRACT FROM AUTHOR]

The U.S. federal Every Student Succeeds Act (ESSA) was enacted with goals of closing achievement gaps and providing all students with access to equitable and high-quality instruction. One requirement of ESSA is annual statewide testing of students in grades 3-8 and once in high school. Some students, including many deaf or hard-of-hearing (D/HH) students, are eligible to use test supports, in the form of accommodations and accessibility tools, during state testing. Although technology allows accommodations and accessibility tools to be embedded within a digital assessment system, the success of this approach depends on the ability of test developers to appropriately represent content in accommodated forms. The Guidelines for Accessible Assessment Project (GAAP) sought to develop evidence- and consensus-based guidelines for representing test content in American Sign Language. In this article, we present an overview of GAAP, review of the literature, rationale, qualitative and quantitative research findings, and lessons learned. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether racial/ethnic and income differences in foods and beverages obtained from stores contribute to disparities in caloric intake over time. Objective: We sought to determine whether there are disparities in calories obtained from store-bought consumer packaged goods (CPGs), whether brands (name brands compared with private labels) matter, and if disparities have changed over time. Design: We used NHANES individual dietary intake data among households with children along with the Nielsen Homescan data on CPG purchases among households with children. With NHANES, we compared survey-weighted energy intakes for 2003-2006 and 2009-2012 from store and nonstore sources by race/ethnicity [non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanic Mexican-Americans) and income [≤185% federal poverty line (FPL), 186-400% FPL, and >400% FPL]. With the Nielsen data, we compared 2000-2013 trends in calories purchased from CPGs (obtained from stores) across brands by race/ ethnicity (NHW, NHB, and Hispanic) and income. We conducted random-effect models to derive adjusted trends and differences in calories purchased (708,175 observations from 64,709 unique households) and tested whether trends were heterogeneous by race/ethnicity or income. Results: Store-bought foods and beverages represented the largest component of dietary intake, with greater decreases in energy intakes in nonstore sources for foods and in store sources for beverages. Beverages from stores consistently decreased in all subpopulations. However, in adjusted models, reductions in CPG calories purchased in 2009-2012 were slower for NHB and low-income households than for NHW and high-income households, respectively. The decline in calories from name-brand food purchases was slower among NHB, Hispanic, and lowest-income households. NHW and high-income households had the highest absolute calories purchased in 2000. Conclusions: Across 2 large data sources, we found decreases in intake and purchases of beverages from stores across racial/ethnic and income groups. However, potentially beneficial reductions in calories purchased were more pronounced in some subgroups over others. [ABSTRACT FROM AUTHOR]

Purpose: We examined total activity, light activity, and moderate-to-vigorous physical activity (MVPA) as predictors of mortality in a nationally representative sample of older adults. Then we explored the theoretical consequences of replacing sedentary time with the same duration of light activity or MVPA. Methods: Using accelerometer-measured activity, the associations between total activity, light activity (100-2019 counts per minute), and MVPA (92019 counts per minute) counts and mortality were examined in adults age 50 to 79 yr in the National Health and Nutrition Examination Survey, 2003-2006 (n = 3029), with mortality follow-up through December 2011. Cox proportional hazard models were fitted to estimate mortality risks. An isotemporal substitution model was used to examine the theoretical consequences of replacing sedentary time with light activity or MVPA on mortality. Results: After adjusting for potential confounders, including age, sex, race/ethnicity, education, BMI, and the presence of comorbid conditions, those in the highest tertile of total activity counts had one fifth the risk of death of those in the lowest tertile (hazard ratio [HR] = 0.21, 95% confidence interval [CI] = 0.12-0.38), and those in the middle tertile had one third the risk of death (HR = 0.36, 95% CI = 0.30-0.44). In addition, replacing 30 min of sedentary time with light activity was associated with significant reduction in mortality risk (after 5 yr of follow-up: HR = 0.80, 95% CI = 0.75-0.85). Replacing 30 min of sedentary time with MVPA was also associated with reduction in mortality risk (HR = 0.49, 95% CI = 0.25-0.97). Conclusions: Greater total activity is associated with lower all-cause mortality risk. Replacing sedentary time with light activity or MVPA may reduce mortality risk for older adults. [ABSTRACT FROM AUTHOR]

Background: Controversy exists over the disparate circulating 25-hydroxyvitamin D [25(OH)D] concentrations between black and white Americans. Objective: We sought to determine whether there are differences in total and directly measured free 25(OH)D concentrations between black and white American adults and how daily supplementation with cholecalciferol changes these concentrations. Design: Cross-sectional and longitudinal analyses were conducted with the use of data from 2 placebo-controlled, randomized trials at 2 academic medical centers in the United States: CaDDM (Calcium and Vitamin D in Type 2 Diabetes) and DDM2 (Vitamin D for Established Type 2 Diabetes). A total of 208 subjects with pre- or well-controlled diabetes with a mean age of 59.1 y and mean body mass index (BMI; in kg/m²) of 31.6 were randomly assigned to receive daily cholecalciferol supplementation at 1 of 2 doses (2000 or 4000 IU) or a matching placebo for 16 wk. We measured serum total 25(OH)D, vitamin D-binding protein (DBP) by 2 different immunoassays (with the use of monoclonal or polyclonal antibodies), parathyroid hormone, and albumin. Free 25(OH)D concentration was directly measured and calculated. Results: Blacks had lower total 25(OH)D concentrations than whites [adjusted median: 20.3 ng/mL (95% CI: 16.2, 24.5 ng/mL) compared with 26.7 ng/mL (95% CI: 25.2, 28.1 ng/mL), respectively; P = 0.026)], and a higher proportion of blacks had total 25(OH)D concentrations < 20 ng/mL (46% compared with 19%, respectively; P, 0.001). Directly measured free 25(OH)D concentrations were lower in blacks than in whites [adjusted median: 4.5 ng/mL (95% CI: 3.7, 5.4 ng/mL) compared with 5.7 ng/mL (95% CI: 5.4, 5.9 ng/mL), respectively; P = 0.044] and were strongly correlated with total 25(OH)D without an effect of race. DBP was lower in blacks when measured by the monoclonal but not the polyclonal antibody immunoassay. Cholecalciferol supplementation increased total and measured free 25(OH)D concentrations proportionally to the dose and without a difference between races. Conclusions: The relation between free and total 25(OH)D did not vary systematically by race in this multiracial population with pre- or well-controlled diabetes. The results need to be replicated in additional cohorts before concluding that the clinical assessment of vitamin D status in blacks and whites should follow a single standard. The CaDDM and DDM2 trials were registered at clinicaltrials.gov as NCT00436475 and NCT01736865, respectively. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections (UTIs) are among the most common bacterial infections and are often treated with antibiotics. Concerns about multidrug-resistant uropathogens have pointed to the need for safe and effective UTI-prevention strategies such as cranberry consumption. Objective: We assessed the effects of the consumption of a cranberry beverage on episodes of clinical UTIs. Design: In this randomized, double-blind, placebo-controlled, multicenter clinical trial, women with a history of a recent UTI were assigned to consume one 240-mL serving of cranberry beverage/ d (n = 185) or a placebo (n = 188) beverage for 24 wk. The primary outcome was the clinical UTI incidence density, which was defined as the total number of clinical UTI events (including multiple events per subject when applicable) per unit of observation time. Results: The dates of the random assignment of the first subject and the last subject's final visit were February 2013 and March 2015, respectively. The mean age was 40.9 y, and characteristics were similar in both groups. Compliance with study product consumption was 98%, and 86% of subjects completed the treatment period in both groups. There were 39 investigator-diagnosed episodes of clinical UTI in the cranberry group compared with 67 episodes in the placebo group (antibiotic use-adjusted incidence rate ratio: 0.61; 95% CI: 0.41, 0.91; P = 0.016). Clinical UTI with pyuria was also significantly reduced (incidence rate ratio: 0.63; 95% CI: 0.40, 0.97; P = 0.037). One clinical UTI event was prevented for every 3.2 woman-years (95% CI: 2.0, 13.1 woman-years) of the cranberry intervention. The time to UTI with culture positivity did not differ significantly between groups (HR: 0.97; 95% CI: 0.56, 1.67; P = 0.914). Conclusion: The consumption of a cranberry juice beverage lowered the number of clinical UTI episodes in women with a recent history of UTI. This study was registered at clinicaltrials.gov as NCT01776021. [ABSTRACT FROM AUTHOR]

Background: Lipid biomarkers, such as HDL-cholesterol concentrations, have been shown to have positive, inverse, and null associations with total, breast, and colorectal cancer risks. Studies of novel lipid biomarkers, such as apolipoprotein A-I (apo A-I) and apolipoprotein B- 100 (apo B-100), and cancer risk have been sparse, to our knowledge. Objectives: We evaluated the prospective association of total, breast, colorectal, and lung cancers and cancer mortality with circulating lipid biomarkers in 15,602 female health professionals in the Women's Health Study (aged ≥45 y, free of cardiovascular disease and cancer, and without hormone replacement therapy or lipid-lowering medications at baseline). Design: Cox regression models estimated HRs of cancer endpoints (19 y median follow-up) across quartiles 1 (reference) to 4 of each lipid biomarker after adjustment for cancer risk factors. Results: Confirmed cases included 2163 incident cancer cases (864 breast, 198 colorectal, and 190 lung cancers) and 647 cancer deaths. Total cancer risk was significantly lower in the highest quartile of apo A-I (adjusted HR: 0.79; 95% CI: 0.70, 0.90; P-trend = 0.0008) and HDL cholesterol (HR: 0.85; 95% CI: 0.75, 0.97; P-trend = 0.01). For site-specific cancers, significant associations included colorectal cancer risk with HDL cholesterol (HR: 0.63; 95% CI; 0.41, 0.98; P-trend = 0.03), triglycerides (HR: 1.86; 95% CI: 1.17, 2.97; P-trend = 0.02), and apo B-100 (HR: 1.60; 95% CI: 1.03, 2.49; P-trend = 0.006) and lung cancer risk with HDL cholesterol (HR: 0.59; 95% CI: 0.38, 0.93; P-trend = 0.01). LDL cholesterol was not significantly associated with risk of total cancer or any site-specific cancers. In time-dependent models that were adjusted for the use of a lipid-lowering medication after baseline, these associations remained. Conclusions: Lipids were associated with total, lung, and colorectal cancer risks in women. Lifestyle interventions for heart-disease prevention, which reduce apo B-100 or raise HDL cholesterol, may be associated with reduced cancer risk. The Women's Health Study was registered at clinicaltrials.gov as NCT00000479. [ABSTRACT FROM AUTHOR]

Background: Mexican immigrants are disproportionally affected by diet-related risk of metabolic dysfunction. Whether adhering to a traditional Mexican diet or adopting a US diet contributes to metabolic changes associated with future risk of type 2 diabetes and other chronic diseases has not been investigated. Objective: The purpose of this study was to test in a randomized crossover feeding trial the metabolic responses to a Mexican diet compared with a commonly consumed US diet. Design: First- and second-generation healthy women of Mexican descent (n = 53) were randomly assigned in a crossover design to consume a Mexican or US diet for 24 d each, separated by a 28-d washout period. Diets were eucaloric and similar in macronutrient composition. The metabolic responses to diets were assessed by measuring fasting serum concentrations of glucose, insulin, insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3), adiponectin, C-reactive protein (CRP), and in-terleukin 6 (IL-6), as well as the homeostasis model assessment of insulin resistance (HOMA-IR) at the beginning and end of each period. Linear mixed models tested the intervention effect on the bio-markers, while adjusting for diet sequence, feeding period, baseline and washout biomarker concentrations, age, acculturation, and BMI. Results: Compared with the US diet, the Mexican diet reduced insulin by 14% [geometric means (95% CIs): 9.3 (8.3, 10.3) compared with 8.0 (7.2, 8.9)µU/mL; P = 0.02], HOMA-IR by 15% [2.0 (1.8, 2.3) compared with 1.7 (1.6, 2.0); P = 0.02], and IGFBP-3 by 6% (mean ± SEM: 2420 6 29 compared with 2299 ± 29 ng/mL; P, 0.01) and tended to reduce circulating concentrations of IGF-1 by 4% (149 ± 2.6 compared with 144 ± 2.5 ng/mL; P = 0.06). There was no significant intervention effect on serum concentrations of glucose, adiponectin, CRP, or IL-6 in the US compared with the Mexican diet. Conclusion: Compared with the commonly consumed US diet, the traditional Mexican diet modestly improved insulin sensitivity under conditions of weight stability in healthy women of Mexican descent, while having no impact on biomarkers of inflammation. This trial was registered at clinicaltrials.gov as NCT01369173. [ABSTRACT FROM AUTHOR]

Integrating the perspectives of psychological contract and sex differences, this study examines how organizational decision to reduce labour costs influences employees' perceived psychological contract breach and their commitment to their organizations. Using two experiments, we found three-way interaction effects among the decision to reduce labour costs, employee sex, and the managerial control over the decision. The decision of labour costs reduction leads to stronger feelings of psychological contract breach for females when the decision is in low than in high levels of managerial control, but the same decision leads to stronger psychological contract breach for males when the decision is in high than in low levels of managerial control. Furthermore, the indirect effect of labour costs reduction on employees' organizational commitment through psychological contract breach is also contingent upon the interaction between employee sex and managerial control. Our findings expand the literature of psychological contract and shed light on timely practical issues of management's decisions regarding labour costs reduction. Practitioner points Labour costs reductions in economic downturns lead to different responses from employees, and managers are advised to plan their actions bearing in mind such differences., Management in crisis or difficulties calls for more delicate considerations of employees' psychological feelings towards the organization., Nuanced empirical evidence informs us about the different needs and responses of a diverse group of employees and how their responses contradict. [ABSTRACT FROM AUTHOR]

AIM The aim of this research was to replicate Dreifuerst's 2012 findings of enhanced clinical reasoning scores using a structured debriefing: Debriefing for Meaningful Learning© (DML). BACKGROUND The direct effect of debriefing on clinical reasoning is not well studied. The nursing education literature supports debriefing as a reflective dialogue necessary to enhance clinical reasoning. METHOD A quasi-experimental, pretest-posttest, repeated measure research design was used to evaluate nursing students' clinical reasoning using the Health Sciences Reasoning Test (HSRT). RESULTS The change in HSRT mean scores was determined to be significant for the intervention group at the .05 level and insignificant for the control group. The change in HSRT mean scores between the intervention and control groups was determined to be significant at the .10 level. CONCLUSION Nursing students who had the DML debriefing scored significantly higher in their clinical reasoning than nursing students who had usual and customary debriefing. [ABSTRACT FROM AUTHOR]

Research suggests that community reintegration (CR) after injury and rehabilitation is difficult for many servicemembers. However, little is known about the influence of the contextual factors, both personal and environmental, on CR. Framed within the International Classification of Functioning, Disability and Health and social cognitive theory, the quantitative portion of a larger mixed-methods study of 51 injured, community-dwelling servicemembers compared the relative contribution of contextual factors between groups of servicemembers with different levels of CR. Cluster analysis indicated three groups of servicemembers showing low, moderate, and high levels of CR. Statistical analyses identified contextual factors that significantly discriminated between CR clusters. Multivariate analysis of variance and discriminant analysis indicated significant contributions of general selfefficacy, services and assistance barriers, physical and structural barriers, attitudes and support barriers, perceived level of disability and/or handicap, work and school barriers, and policy barriers to CR scores. Overall, analyses indicated that injured servicemembers with lower CR scores had lower general self-efficacy scores, reported more difficulty with environmental barriers, and reported their injuries as more disabling. [ABSTRACT FROM AUTHOR]

Background: Experimental evidence suggests that hepatic de novo lipogenesis (DNL) affects insulin homeostasis via synthesis of saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs). Few prospective studies have used fatty acid biomarkers to assess associations with type 2 diabetes. Objectives: We investigated associations of major circulating SFAs [palmitic acid (16:0) and stearic acid (18:0)] and MUFA [oleic acid (18:1n-9)] in the DNL pathway with metabolic risk factors and incident diabetes in community-based older U.S. adults in the Cardiovascular Health Study. We secondarily assessed other DNL fatty acid biomarkers [myristic acid (14:0), palmitoleic acid (16:1n-7), 7-hexadecenoic acid (16:1n-9), and vaccenic acid (18:1n-7)] and estimated dietary SFAs and MUFAs. Design: In 3004 participants free of diabetes, plasma phospholipid fatty acids were measured in 1992, and incident diabetes was identified by medication use and blood glucose. Usual diets were assessed by using repeated food-frequency questionnaires. Multivariable linear and Cox regression were used to assess associations with metabolic risk factors and incident diabetes, respectively. Results: At baseline, circulating palmitic acid and stearic acid were positively associated with adiposity, triglycerides, inflammation biomarkers, and insulin resistance (P-trend < 0.01 each), whereas oleic acid showed generally beneficial associations (P-trend < 0.001 each). During 30,763 person-years, 297 incident diabetes cases occurred. With adjustment for demographics and lifestyle, palmitic acid (ex-treme-quintile HR: 1.89; 95% CI: 1.27, 2.83; P-trend = 0.001) and stearic acid (HR: 1.62; 95% CI: 1.09, 2.41; P-trend = 0.006) were associated with higher diabetes risk, whereas oleic acid was not significantly associated. In secondary analyses, vaccenic acid was inversely associated with diabetes (HR: 0.56; 95% CI: 0.38, 0.83; P-trend = 0.005). Other fatty acid biomarkers and estimated dietary SFAs or MUFAs were not significantly associated with incident diabetes. Conclusions: In this large prospective cohort, circulating palmitic acid and stearic acid were associated with higher diabetes risk, and vaccenic acid was associated with lower diabetes risk. These results indicate a need for additional investigation of biological mechanisms linking specific fatty acids in the DNL pathway to the pathogenesis of diabetes. This trial was registered at clinicaltrials.gov as NCT00005133. [ABSTRACT FROM AUTHOR]

Mental health disorders (MHDs), mild traumatic brain injury (mTBI), and alcohol use disorder (AUD) are endemic among recent Veterans, resulting in a population with heterogeneous, co-occurring conditions. While alcohol craving negatively affects rehabilitation and leads to relapse, no studies have examined alcohol craving among Veterans with co-occurring MHDs and mTBI. The purpose of this preliminary cohort study is to describe alcohol craving in a convenience sample of Iraq and Afghanistan Veterans (n = 48), including those exposed to traumatic events and experiencing active symptoms. Veterans completed weekly telephone interviews that included the Alcohol Use Disorder Identification Test, consumption questions (AUDIT-C) (week 1) and the Penn Alcohol Craving Scale (PACS) (weeks 1-6). Sixty percent of the sample screened positive on the AUDIT-C for probable AUD. Using Rasch analysis, the person separation reliability of the PACS was strong (0.87) among AUDIT-C positive Veterans. Higher PACS scores were reported among AUDITC positive versus AUDIT-C negative Veterans (mixed effects analysis, p < 0.001). PACS scores were higher among AUDIT-C positive Veterans with MHDs with and without mTBI versus AUDIT-C positive combat comparison Veterans (pairwise comparison, p < 0.001). Rates of hazardous alcohol use are high among Iraq and Afghanistan conflict Veterans and suggest that alcohol craving is elevated among those with MHDs with and without mTBI. [ABSTRACT FROM AUTHOR]

Background: Prior research suggests that vitamin D protects against lung cancer only among certain subgroups. objectives: We investigated whether vitamin D intake was associated with lung cancer and explored whether vitamin A intake modified the association. Design: Prospective cohort data from 128,779 postmenopausal women, including 1771 incident lung cancers in the Women's Health Initiative (Clinical Trials and Observational Study) 1993-2010, were analyzed. Twelve percent of women received active intervention (1 g C a+4 00 IU vitamin D3/d) in the Calcium/Vitamin D Trial. Baseline total intake included both dietary intake (from food-frequency questionnaires) and supplement intake (from bottle labels). HRs were estimated by Cox proportional hazard models. Results: No significant association was observed overall. Among never smokers, a total vitamin D intake ≥400 IU/d was significantly associated with lower risks of lung cancer (HR: 0.37; 95% CI: 0.18, 0.77 for ≥ compared with,100 IU/d; P-trend = 0.01). No significant effect modification of total vitamin A intake on the association between total vitamin D intake and lung cancer was found. However, the Calcium/Vitamin D Trial active intervention was significantly associated with a lower lung cancer risk only among women with a vitamin A intake < 1000 μg/d retinol activity equivalents (HR: 0.69; 95% CI: 0.50, 0.96; P-interaction = 0.09). Conclusions: Vitamin D intake was associated with a lower lung cancer risk in never-smoking, postmenopausal women. Lower vitamin A intake may be important for a beneficial association of 1 g Ca + 400 IU vitamin D3 supplementation with lung cancer. This trial was registered at clinicaltrials.gov as NCT00000611. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported beneficial effects of a Mediterranean diet rich in monounsaturated fatty acids (MUFAs) on coronary artery disease (CAD) risk. However, these findings remain inconsistent because some experimental studies have suggested atherogenic and lipotoxicity effects of long-chain and very-long-chain MUFAs on cardiomyocytes. Objective: We examined whether red blood cell (RBC) long-chain and very-long-chain MUFAs are associated with risk of CAD in the Physicians' Health Study. Design: The ancillary study used a prospective nested case-control design to select 1000 cases of incident CAD and 1000 control subjects matched for age, year of birth, and time of blood collection. RBC MUFAs were measured by using gas chromatography, and CAD was validated by an endpoint committee. Conditional logistic regression was used to estimate RRs. Results: The mean (±SD) age was 68.7 ± 8.7 y. In a multivariable model that was controlled for matching factors and established CAD risk factors and RBC saturated and omega-3 (n-3) fatty acids, ORs for CAD associated with each SD increase of 20:1n-9 and log 22:1n-9 were 0.89 (95% CI: 0.80, 1.00; P = 0.0441) and 0.83 (95% CI: 0.72, 0.95; P = 0.0086). However, only the 22:1n-9-CAD relation remained statistically significant after Bonferroni correction (P < 0.0125). RBC cis 18:1n-9 and 24:1n-9 were not associated with CAD risk. Conclusion: Our data suggest an inverse association of RBC 22:1n-9 but not 20:1n-9, 18:1n-9, or 24:1n-9 with CAD risk after Bonferroni correction in the Physicians' Health Study. [ABSTRACT FROM AUTHOR]

Background: Dairy consumption is linked to a lower risk of type 2 diabetes, but constituents responsible for this relation are not established. Emerging evidence suggests that trans-palmitoleate (trans 16:1n-7), a fatty acid in dairy and also partially hydrogenated oils, may be associated with a more favorable metabolic profile and less incident diabetes. Objective: We investigated the association of trans-palmitoleate with metabolic risk and incident diabetes in a multiethnic US cohort. Design: Phospholipid fatty acids and metabolic risk factors were measured in 2000-2002 among 2617 adults in the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort of white, black, Hispanic, and Chinese Americans. In 2281 participants free of baseline diabetes, we also prospectively assessed the risk of new-onset diabetes (205 cases) from baseline to 2005-2007. Results: trans-Palmitoleate concentrations correlated positively with self-reported consumption of whole-fat dairy, butter, margarine, and baked desserts and with other circulating biomarkers of both dairy fat and partially hydrogenated oil consumption, which suggested mixed dietary sources. After multivariable adjustment, trans-palmitoleate concentrations were associated with higher LDL cholesterol (quintile 5 compared with quintile 1: +6.4%; P-trend = 0.005), lower triglycerides (-19.1%; P-trend < 0.001), lower fasting insulin (-9.1%; P-trend = 0.002), and lower systolic blood pressure (-2.4 mm Hg; P-trend = 0.01). In prospective analyses, trans-palmitoleate was independently associated with lower incident diabetes (P-trend = 0.02), including a 48% lower risk in quintile 5 compared with quintile 1 (HR: 0.52; 95% CI: 0.32, 0.85). All findings were similar between men and women and between different race-ethnic subgroups. Conclusions: Circulating trans-palmitoleate is associated with higher LDL cholesterol but also with lower triglycerides, fasting insulin, blood pressure, and incident diabetes in a multiethnic US cohort. Our findings support the need for further experimental and dietary intervention studies that target circulating trans-palmitoleate. [ABSTRACT FROM AUTHOR]

Background: Although trans fatty acids (TFAs) may increase the risk of dyslipidemia and coronary artery disease (CAD), limited data are available on their association with heart failure (HF). Objective: Our goal was to assess associations of plasma and dietary TFAs with HF and CAD. Design: We used a prospective, nested case-control design to select 788 incident HF cases and 788 matched controls from the Physicians' Health Study for biomarker analyses and a prospective cohort for the dietary analyses. Plasma fatty acids were assessed by using gas chromatography, and dietary intake was estimated by using a food-frequency questionnaire. Self-reported HF was ascertained by using annual follow-up questionnaires with validation in a subsample. We used conditional logistic (or Cox) regression to estimate multivariable-adjusted ORs (or HRs) for HF and CAD. Results: Multivariable-adjusted ORs (95% CIs) for HF across consecutive quintiles of plasma trans 18:2 (linoleic acid) fatty acids were 1.0 (reference), 1.10 (0.79, 1.54), 0.88 (0.62, 1.25), 0.71 (0.49, 1.02), and 0.67 (0.45, 0.98) (P-trend = 0.01). Each SD of plasma trans 18:2 was associated with a 22% lower risk of HF (95% CI: 6%, 36%). Plasma trans 16:1 and 18:1 were not associated with risk of HF (P > 0.05). Dietary trans fats were not associated with incident HF or CAD. Conclusions: Our data are consistent with a lower risk of HF with higher concentrations of plasma trans 18:2 but not with trans 16:1 or trans 18:1 fatty acids in male physicians. Dietary TFAs were not related to incident HF or CAD. [ABSTRACT FROM AUTHOR]

Hookah tobacco smoking is increasing among US college students, including those who would not otherwise use tobacco. Part of hookah’s appeal is attributed to the perception that hookah is less harmful than cigarettes. The aims of this study were to assess knowledge of harmful exposures associated with hookah smoking relative to cigarette smoking and to determine associations between this knowledge and hookah smoking outcomes. Students (N = 852) at the University of Florida were randomly sampled via e-mail to obtain information on demographics, hookah smoking behavior and knowledge of five exposures (e.g. tar and nicotine). Multivariable logistic regression models assessed independent associations between knowledge and hookah smoking outcomes. Of the five factual knowledge items asked, 475 (55.8%) of the respondents answered none correctly. In multivariable models, correct responses to any knowledge items were not associated with lower odds of hookah smoking or susceptibility to hookah smoking in the future. Although college students are largely unaware of the toxicant exposures associated with hookah smoking, there is little association between knowledge and hookah smoking behavior. [ABSTRACT FROM PUBLISHER]

Background: Goal-directed fluid therapy (GDFT) has been shown to reduce complications and hospital length of stay following major surgery. However, there has been no assessment regarding its use in clinical practice. Methods: An electronic survey was administered to randomly selected anaesthetists from the United Kingdom (UK, n = 2000) and the United States of America (USA, n = 2000), and 500 anaesthetists from Australia/New Zealand (AUS/NZ). Preferences, clinical use and attitudes towards GDFT were investigated. Results were collated to examine regional differences. Results: The response rates from the UK (n = 708) and AUS/NZ (n = 180) were 35%, and 36% respectively. The response rate from the USA was very low (n = 178; 9%). GDFT use was significantly more common in the UK than in AUS/NZ (p < 0.01). The Oesophageal Doppler Monitor was the most preferred instrument in the UK (n = 362; h76%) with no clear preferences in other regions. GDFT was most commonly utilised in major abdominal surgery and for patients with significant comorbidities. The commonest reasons stated for not using GDFT were either lack of availability of monitoring tools (AUS/NZ: 57 (70%); UK: 94 (64%)) or a lack of experience with instruments (AUS/NZ: 43 (53%); UK: 51 (35%)). A subset of respondents (AUS/NZ: 22(27%); UK: 45 (30%)) felt GDFT provided no perceived benefit. Enthusiasm towards the use of GDFT in the absence of existing barriers was high. Conclusion: Several hypotheses were generated regarding important differences in the use of GDFT between anaesthetists from the UK and AUS/NZ. There is significant interest in utilising GDFT in clinical practice and existing barriers should be addressed. [ABSTRACT FROM AUTHOR]

Aim. The aim of this exploratory research was to examine the cultural competence of practicing nurses entering an RN to BSN program. Background. As nonwhite populations increase in the United States, the cultural competence of nurses increases in importance. With 38 percent of baccalaureate nursing students in RN-BSN programs, it is important to examine the cultural competence of this population. Method. Fifty-three RN-BSN students completed the Inventory for Assessing the Process of Cultural Competency Among Healthcare Professionals-Revised (IAPCC-R) upon program entry; 50.9 percent were culturally competent as determined by the tool. Results. A strong correlation existed between IAPCC-R scores and student age, with students 20 to 30 years old scoring significantly higher than those in the age range of 41 to 50. Conclusion. The findings suggest and invite more extensive research on the success of the systematic nursing education initiatives of current associate degree programs and adherence to NLNAC standards for cultural competence, particularly in the cultural skill construct. [ABSTRACT FROM AUTHOR]

Aim. Using Kanter's theory of structural power, this study explored whether the degree of structural empowerment as perceived by nurse educators influences the degree of their innovative behavior. Background. Faculty are challenged to reform nursing education via innovation and a departure from traditional pedagogies. Little research on innovative behavior of nurse educators exists in the literature. Method. Nurse educators randomly selected from 150 accredited baccalaureate nursing programs were invited to complete an online survey. Results. The nurse educators perceived themselves as moderately empowered. Significant and positive correlations between structural empowerment and innovative behavior were found. Significant differences in the degree of perceived innovative behavior were associated with age, academic rank, employment status, and tenure status. Nurse educators employed in private institutions perceived greater structural empowerment than those employed in public institutions. Conclusion. The findings support Kanter's belief that workplace environment structures can positively influence workers' behavior and attitudes. [ABSTRACT FROM AUTHOR]

Background. Early discontinuation of adjuvant endocrine therapy may affect the outcome of treatment in breast cancer patients. The aim of this study was to assess age-specific persistence and age-specific survival outcome based on persistence status. Methods. Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational trial were included. Nonpersistence was defined as discontinuing the assigned endocrine treatment within 1 year of follow-up because of adverse events, intercurrent illness, patient refusal, or other reasons. Endpoints were the breast cancer-specific and overall survival times. Analyses were stratified by age at diagnosis (<65 years, 65-74 years, ≥75 years). Results. Overall, 3,142 postmenopausal breast cancer patients were included: 1,682 were aged <65 years, 951 were aged 65-74 years, and 509 were aged ≥75 years. Older age was associated with a higher proportion of nonpersistence within 1 year of follow-up. In patients aged<65 years, nonpersistent patients had lower breast cancer- specific and overall survival probabilities. In patients aged 65-74 years and patients aged ≥75 years, the survival times of persistent and nonpersistent patients were similar. Conclusion. Nonpersistence within 1 year of follow-up was associated with lower breast cancer-specific and overall survival probabilities in patients aged <65 years, but it was not associated with survival outcomes in patients aged 65-74 years or in patients aged>75 years. These results suggest that extrapolation of outcomes from a young to an elderly breast cancer population may be insufficient and urge age-specific breast cancer studies. [ABSTRACT FROM AUTHOR]

ACADEMIC EMERGENCY MEDICINE 2010; 17:940–950 © 2010 by the Society for Academic Emergency Medicine Objectives: The objectives of this study were to determine concordance of emergency department (ED) management of acute myocardial infarction (AMI) with guideline recommendations and to identify ED and patient characteristics predictive of higher guideline concordance. Methods: The authors conducted a chart review study of ED AMI care as part of the National Emergency Department Safety Study (NEDSS). Using a primary hospital discharge diagnosis of AMI (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], codes 410.XX), a random sample of ED visits for AMI in 58 urban EDs across 20 U.S. states between 2003 and 2006 were identified. Concordance with American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations was evaluated using five individual quality measures and a composite concordance score. Concordance scores were calculated as the percentage of eligible patients who received guidelines-recommended care. These percentage scores were rescaled from 0 to 100, with 100 indicating perfect concordance. Results: The cohort consisted of 3,819 subjects; their median age was 65 years, and 62% were men. The mean (± standard deviation [SD]) ED composite concordance score was 61 ± 8), with a broad range of values (42 to 84). Except for aspirin use (mean concordance, 82), ED concordance scores were low (beta-blocker use, 56; timely electrocardiogram [ECG], 41; timely fibrinolytic therapy, 26; timely ED disposition for primary percutaneous coronary intervention [PCI] candidates, 43). In multivariable analyses, older age (beta-coefficient per 10-year increase, −1.5; 95% confidence interval [CI] = −2.4 to −0.5) and southern EDs (beta-coefficient, −5.2; 95% CI = −9.6 to −0.9) were associated with lower guideline concordance, whereas ST-segment elevation on initial ED ECG was associated with higher guideline concordance (beta-coefficient, 3.6; 95% CI = 1.5 to 5.7). Conclusions: Overall ED concordance with guideline-recommended processes of care was low to moderate. Emergency physicians should continue to work with other stakeholders in AMI care, such as emergency medical services (EMS) and cardiologists, to develop strategies to improve care processes. [ABSTRACT FROM AUTHOR]

Virtually all quantitative microdata used by social scientists derive from samples that incorporate clustering, stratification, and weighting adjustments (Kish 1965, 1992). Such data can yield standard error estimates that differ dramatically from those derived from a simple random sample of the same size. Researchers using historical U.S. census microdata, however, usually apply methods designed for simple random samples. The resulting p values and confidence intervals could be inaccurate and could lead to erroneous research conclusions. Because U.S. census microdata samples are among the most widely used sources for social science and policy research, the need for reliable standard error estimation is critical. We evaluate the historical microdata samples of the Integrated Public Use Microdata Series (IPUMS) project from 1850 to 1950 in order to determine (1) the impact of sample design on standard error estimates, and (2) how to apply modern standard error estimation software to historical census samples. We exploit a unique new data source from the 1880 census to validate our methods for standard error estimation, and then we apply this approach to the 1850-1870 and 1900-1950 decennial censuses. We conclude that Taylor series estimation can be used effectively with the historical decennial census microdata samples and should be applied in research analyses that have the potential for substantial clustering effects. [ABSTRACT FROM AUTHOR]

In this article we show how to predict small-area means and obtain valid mean squared error estimators and confidence intervals when the areas represented in the sample are sampled with unequal probabilities possibly related to the true (unknown) area means and the sampling of units within the selected areas is with probabilities possibly related to the outcome values. Ignoring the effects of the sampling process on the distribution of the observed outcomes in such cases may bias the inference very severely. Classical design-based inference that uses the randomization distribution of probability-weighted estimators cannot be applied for predicting the means of nonsampled areas. We propose simple test statistics for testing the informativeness of the selection of areas and sampling of units within the selected areas. We illustrate the proposed procedures by a simulation study and a real application of estimating mean body mass index in U.S. counties, using data from the Third National Health and Nutrition Examination Survey. [ABSTRACT FROM AUTHOR]

The article focuses on the statistical tools or methods used in the assessment of epidemiologic data in the U.S. Different researchers have pointed out various tools or criteria for data interpretation such as the overinterpretation of data, benefits of confidence intervals and replication and refutation interaction and multiple comparisons. Other tools suggested by the author includes used of confidence intervals, p-values, exclusion versus nonexclusion relationship and the exercise of interpretation of interactions.

A diverse set of congressional studies portrays members of standing committees as more or less homogeneous "high demanders" or "preference outliers" relative to members of the larger legislature. Using interest group ratings of members of the Ninety-sixth to Ninety-ninth Congresses, I conduct conventional statistical hypothesis tests to discern whether standing committees are more extreme and more homogeneous than the legislature as a whole. With only a few exceptions, the tests do not allow confident rejection of null hypotheses of identical committee and chamber preferences. The absence of convincing evidence of preference outliers is broadly consistent with emerging incomplete information game-theoretic legislative research and difficult to reconcile with many previous formal theories of legislative politics. [ABSTRACT FROM AUTHOR]

The article focuses on a study undertaken to know about the career mobility processes involving officers in the U.S. Army. Different issues are discussed in the article like, whether the officers at service academies have higher rate of mobility than officers commissioned from other sources, and also the factors that might affect the career mobility process apart from academy education are addressed. Techniques with several variables were used to value the hypothesis test with a sample of the on active duty Army officers of the U.S. during the period 1950-1974.

In this article the authors described a method of testing relative merits of area and quota sampling by drawing various samples from a known universe, which is made up of records based on a house-to-house survey in Iowa City. Stratification simply means dividing the universe into groups which are presumed to be more homogeneous than the entire universe. This is merely a technique for the reduction of the variance of a sample estimate. The differentiation between quota and area samples is made by the way the respondents are selected within strata, not through the presence of strata or their choice. A statistical method, chi-square test was developed by Karl Pearson to test the hypothesis that an observed distribution is a random sample from a proposed universe. The hypothesis is rejected when the probability of securing a value of chi-square as large as, or larger than, the value obtained is small, usually less than 5 percent. It can be seen from the given formula that chi-square is defined in absolute frequencies, not relative frequencies.