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Purpose: To explore the relationship between different amounts of physical exercise and drug craving in individuals with substance-use disorders (SUD), and to reveal the mediating role of internal inhibition between physical activity and drug craving. Method: This study adopted the Physical Activity Rating Scale, Internal Inhibition Scale, and Drug Craving Scale to assess 438 cases of SUD in a compulsory isolation detoxification center in southwest China. Results: (1) The amount of physical exercise individuals with SUD engaged in was positively correlated with internal inhibition and negatively correlated with drug craving, while the amount of physical exercise was negatively correlated with drug craving. (2) The amount of physical exercise was able to negatively predict drug craving in addicts, the amount of physical exercise and internal inhibition were able to jointly predict drug craving, and internal inhibition played a mediating role between the amount of physical exercise and drug craving (the mediating effect was 0.22). (3) There was a dose-effect relationship regarding different amounts of physical exercises and drug craving. Internal inhibition did not mediate between a low amount of physical exercise and drug craving, it played a partial mediating role between a moderate amount of physical exercise and drug craving (the mediating effect was −0.19), and it played a partial mediating role between a high amount of physical exercise and drug craving (the mediating effect was −0.15). Conclusions: Physical activity has a positive effect on reducing drug craving in individuals with SUD. Moreover, in the process of sports rehabilitation for SUD, medium or high amounts of physical activity were required in order to effectively reduce and alleviate drug cravings.

Objectives Deciding when cuspal coverage is needed for posterior teeth is considered a challenge for dentists. The aims were to assess dentists' decision making regarding the need for cuspal coverage for vital teeth (VT) and endodontically treated teeth (ETT) with varying amounts of tooth structure loss and to identify clinical situations of dissimilarity and uncertainty in decision making. Materials and Methods A random sample of 182 dentists were invited to participate in the survey. The survey included photos of 13 posterior teeth: six VT and seven ETT. The clinical situations selected were based on a hypothetical scale of typodont teeth with ascending amounts of tooth structure loss. A brief description of each situation was provided. Each dentist was asked to decide whether cuspal coverage is needed, not needed, or unsure. Descriptive analyses using SPSS were conducted. Seventy‐five percent was chosen as a cutoff point for assessing similarity in decision making. The unsure answer reflected uncertainty. Associations were assessed using chi‐square test. Results One hundred twenty dentists participated (65.9% response rate, 70 females). Median for years of experience was 3.5 (interquartile range 1.1–10.8). Analyses revealed a similarity percentage of

The underlying structure of self-harm behaviors is not well-understood; for example, whether suicidality and nonsuicidal self-injury (NSSI) lie on a single dimension or two separate dimensions is unknown. We used confirmatory factor analyses to examine the factor structure of self-harm items in a clinical/community sample (N = 641). Of three alternative factor structures (one-factor, correlated-factors, bifactor), the bifactor model fit best. The general factor, representing overlap between suicidality and NSSI, captured the majority of model variance and was the strongest predictor of psychosocial correlates. The NSSI-specific factor captured a moderate amount of variance and correlated uniquely with both antagonistic traits and obsessive-compulsive tendencies; this factor was named NSSI. The suicidality-specific factor explained little model variance and was weakly associated with external criteria; this factor was named low attraction to life. Results are interpreted as preliminary evidence for the utility of bifactor modeling in understanding the latent structure of self-harm. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relative to survivors of other traumatic events, survivors of sexual assault have an increased likelihood of meeting criteria for posttraumatic stress disorder (PTSD). They are also comparatively more likely to exhibit higher levels of PTSD symptom severity. Recent research has highlighted the importance of trauma-related disclosure within the context of intimate relationships for posttrauma functioning and recovery, but this phenomenon has yet to be examined specifically in sexual assault survivor samples. Accordingly, this study examines the association of PTSD symptom severity with disclosure about one’s experience of sexual assault to one’s intimate partner, as well as the association of such disclosure with trauma-related shame and perception of partners’ negative and positive responses to trauma-related disclosure. A sample of 104 female participants who had disclosed their experience of sexual assault to their current romantic partner provided survey data. On average, these participants reported a moderate amount of trauma-related disclosure. Counter to hypotheses, level of engagement in trauma-related disclosure was not significantly correlated with PTSD symptom severity, shame, or perceived negative responses to disclosure. Only perceived positive responses to disclosure demonstrated a significant, bivariate association with overall level of engagement in trauma-related disclosure. Similarly, when trauma-related shame, negative responses, and positive responses were accounted for simultaneously, only positive responses were related to level of disclosure. Overall, results suggest that intimate relationships may serve as a unique context for disclosure about one’s history of sexual assault, with perceived positive responses demonstrating particularly strong associations with level of engagement in trauma-related disclosure.

A growing body of work suggests that early motor experience affects development in unexpected domains. In the current study, children’s hand preference for role-differentiated bimanual manipulation (RDBM) was measured at monthly intervals from 18 to 24 months of age (N=90). At 3 years of age, children’s language ability was assessed using the Preschool Language Scales 5th edition (PLS™-5; Zimmerman, Steiner, & Pond, 2011). Three distinct RDBM hand preference trajectories were identified using latent class growth analysis: 1) children with a left hand preference but a moderate amount of right hand use, 2) children with a right hand preference but a moderate amount of left hand use, and 3) children with a right hand preference and only a mild amount of left hand use. Stability over time within all three trajectories indicated that children did not change hand use patterns from 18 to 24 months. Children with the greatest amount of preferred (i.e., right) hand use demonstrated higher expressive language scores compared to children in both trajectories with moderate levels of non-preferred hand use. Children with the greatest amount of right hand use also had higher scores for receptive language compared to children with a right hand preference but moderate left hand use. Results support that consistency in handedness as measured by the amount of preferred hand use is related to distal language outcomes in development.

> Different therapists have said different things [contradictory advice on pain with exercise]…and it makes you wonder which therapist to believe. Exercise is a proven treatment for managing at least some persistent pain, including musculoskeletal-related pain.1 2 But an area often overlooked is what type of pain and what intensity of pain should be associated with exercise. What would achieve the best results? No pain? A little pain? A moderate amount of pain? How does the patient judge what is ‘a little’ or ‘moderate’? How much pain is too much? Is there ‘good pain’ as patients often tell us when stretching or massaging a muscle, as well as ‘bad pain’ (presumably thought to be harmful)? Qualitative research tells us that many individuals with persistent pain are uncertain when it comes to pain and exercise.3 4 This is closely linked to pain-related fear and questions as to whether exercise is helpful or harmful. As one patient framed it, ‘Are you making it worse? And that’s the crux of it really…if this is hurting should I really be doing this?’.3 There are few …

User-guided deformable image registration (DIR) has allowed users to actively participate in the DIR process and is expected to improve DIR accuracy. The purpose of this study was to evaluate the time required for and effect of user-guided DIR on registration accuracy for thoracic images among users. In this study, 4-dimensional computed tomographic images of 10 thoracic cancer patients were used. The dataset for these patients was provided by DIR-Lab (www.dir-lab.com) and included a coordinate list of anatomical landmarks (300 bronchial bifurcations). Four medical physicists from different institutions performed DIR between peak-inhale and peak-exhale images with/without the user-guided DIR tool, Reg Refine, implemented in MIM Maestro (MIM software, Cleveland, OH). DIR accuracy was quantified by using target registration errors (TREs) for 300 anatomical landmarks in each patient. The average TREs with user-guided DIR in the 10 images by the 4 medical physicists were 1.48, 1.80, 3.46, and 3.55 mm, respectively, whereas the TREs without user-guided DIR were 3.28, 3.45, 3.56, and 3.28 mm, respectively. The average times taken by the 4 physicists to use the user-guided DIR were 10.0, 6.7, 7.1, and 8.0 min, respectively. This study demonstrated that user-guided DIR can improve DIR accuracy and requires only a moderate amount of time (

OBJECTIVE The purpose of this study was to obtain data on interrater repeatability of the motor nerve conduction velocity (NCV) of the ulnar nerve of different segments, ulnar distal motor latency (DML), and compound muscle action potential (CMAP) amplitudes. DESIGN Twenty-four healthy volunteers were examined in consecutive order. Ulnar motor NCV of different segments, ulnar DML, and CMAP amplitudes were determined. Based on a randomization list of various combinations and sequences, 1 of 3 examiners performed the first measurement. A second examiner repeated the evaluation within half an hour. RESULTS There were no significant differences between the first and second measurements for all parameters. For the ulnar motor NCV of the different segments, the intraclass correlation coefficient (ICC) ranged from 0.38 to 0.51, and the coefficient of repeatability (CR) ranged from 8.0 to 11.6 m/s. For the ulnar DML, the ICC was 0.44, and the CR was 0.49 millisecond. For the CMAP amplitudes at the different stimulation sites, the ICC ranged from 0.53 to 0.76, and the CR ranged from 1.5 to 2.3 mV. CONCLUSIONS A moderate amount of interrater variability of the ulnar motor NCV must be taken into account. Compared with the CMAP amplitudes, the interrater repeatability of the ulnar motor NCV is poorer.

Introduction The effects of training content consisting of examples and/or non-examples was studied on the acquisition of safety-related skills. Method Participants (N = 160) were randomly assigned to first receive computer-based training on office ergonomics that included either no examples of safe or at-risk postures, safe examples only, at-risk examples only, or both safe and at-risk examples. Participants then attempted to classify as safe or at-risk various postures depicted in short video clips and demonstrate with their own posture the range of safe postures. Results Groups that were trained with both safe and at-risk examples showed greater classification accuracy and less error in their demonstration of safe postures. Training with only safe or at-risk examples resulted in a moderate amount of error and a consistent underestimation of risk. Conclusion Training content consisting of both examples and non-examples improved acquisition of safety-related skills. Practical applications The strategic selection of training content may improve identification of risks and safe work practices.

Social support studies often focus on psychological outcomes for the support recipient and also presume potential support providers who will attempt to provide support in the first place. Therefore, the negative relational outcomes associated with not receiving emotional support when support is expected (nonsupport) are an understudied topic. Instances of nonsupport were compared to various emotional support messages on relational and psychological outcomes to understand how nonsupport compares against support messages of varying quality. Two hundred twenty-four women with breast cancer were asked to think of a person expected to provide emotional support if they disclosed their diagnosis on social media. Participants were given either a hypothetical support message from this person or told the person provided no message even though a message was expected. Dunnett's t tests were used to analyze the nonsupport condition against low, moderate, and highly person-centered support messages. Providing no emotional support message (nonsupport) creates low levels of emotional improvement and high levels of negative relational ramifications similar to low person-centered messages. Moreover, only participants receiving the low person-centered message agreed on average they would rather have received no message at all instead. Because low person-centered messages and saying nothing whatsoever both create negative relational ramifications, support providers should strive to communicate emotional support messages with at least a moderate amount of person-centeredness. These findings further suggest those who are expected to provide emotional support cannot dodge this obligation since nonsupport is shown to have negative relational outcomes to low person-centered support messages.

Human mercaptoalbumin (HMA) is a reduced form of albumin that is associated with cardiovascular disease in dialysis patients. Albumin-leaky hemodialysis (HD) is increasingly recognized as a gold standard therapy because it is correlated with better prognosis compared to conventional HD. However, albumin-leaky HD induces low serum albumin concentration because of albumin leakage, which is a classical risk factor for mortality. The aim of this study was to explain the preferable prognosis in patients undergoing albumin-leaky HD with low serum albumin concentration. Ten HD patients were enrolled. They were preconditioned with albumin-non-leaky HD (mean albumin leakage: 1.0 g) for 2 months. Subsequently, albumin-leaky HD (9.1 g) was performed for 6 months, followed by relatively non-leaky HD (within 3.0 g). The ratio and level of HMA were evaluated. The amount of albumin leakage was related to the ratio of HMA, and inversely correlated with serum albumin concentration. The level of HMA was maintained regardless of albumin leakage. Regarding HMA level, a moderate amount of albumin leakage was acceptable. A stably maintained HMA level in albumin-leaky HD patients can contribute to preferable prognosis even if they have low serum albumin concentration.

A 17-year-old girl was referred to our hospital with an inability to belch, while experiencing chest gurgling noises, and severe abdominal bloating. She reported having these symptoms all her life. A timed barium esophagogram revealed a moderate amount of bubbles in the esophagus and gastric fundus, which significantly increased after the examination. High resolution manometry revealed that the basal upper esophageal sphincter pressure increased with a rise in the cervical esophageal pressure. A pathological inability to belch is rare; at present, no specific name exists to describe the disorder. Further research is needed in this unexplored field.

Adversities refer to events that are characterized by perceived or actual threat to human functioning. Often considered deleterious for health and well-being, recent work supports an alternative picture of the effects of adversity on human functioning, such that a moderate amount of adversity - when compared with none or high levels - can be beneficial. We extend this body of work in the current study by considering the breadth or type of adversities experienced simultaneously (referred to as polyadversity), with a focus on individual profiles of lifetime adversities. Latent class analysis was employed to explore different configurations of lifetime adversity experiences in two independent samples and examine how these latent classes differed with regard to resilience resources (i.e., optimism, hope, self-efficacy, and bounce-back ability). University students (N = 348) and members from the broader community (N = 1,506) completed measures of lifetime adversity exposure and resilience resources. Three polyadversity classes were revealed in each sample, with both producing a high and a low polyadversity class. The third class differed between samples; in the student sample, this class represented experiences of vicarious adversity, whereas in the community sample, it represented moderate levels of exposure to adversity. Support for the adaptive nature of a moderate amount of adversity exposure was found in the community sample but not in the student sample. This study produces initial evidence of how lifetime adversity experiences group together and how class membership is related to resilience resources.

This research explores the effect of consuming a moderate amount of commercially available caffeinated coffee on an individual’s self-evaluated participation in a group activity and subsequent evaluations of the experience. Across two studies, results show that consuming a moderate amount of caffeinated coffee prior to indulging in a group activity enhances an individual’s task-relevant participation in the group activity. In addition, subjective evaluations of the participation of other group members and oneself are also positively influenced. Finally, the positive impact of consuming a moderate amount of caffeinated coffee on the evaluation of participation of other group members and oneself is moderated by a sense of an increased level of alertness.

A light to moderate consumption of certain types of alcoholic beverages may exert a favorable effect on cardiovascular risk, but no conclusive information is available on the putative relationship between alcohol intake and the risk of venous thromboembolism (VTE). We performed an electronic search on Medline and Scopus, using the keywords "venous thromboembolism", "venous thrombosis" and "alcohol", to identify clinical studies linking alcohol intake and VTE risk. The literature search generated 16 studies, 4 of which are case-control, 1 cross-sectional and 11 prospective. Significant reduction of VTE associated with alcohol intake is observed in only 4/16 studies, and in all these the association is only meaningful for a moderate amount of alcohol (i.e., 2-4 glasses). Unlike these trials, two other studies observe that alcohol intake is associated with an increased risk of VTE, whereas the association is insignificant in the remainder. Binge drinking increases the VTE risk in one study but not in another. The consumption of beer is associated with a decreased VTE risk in one study but not in two others. We hence conclude that the relationship between intake of alcoholic beverages and increased or decreased risk of VTE is largely elusive.

Preventing cancer has much to offer. Aside from plummeting health care costs, we might enjoy a healthier life free of cancer and chronic disease. Prevention requires the adoption of healthier choices and a moderate amount of exercise. The supporting evidence is observational, clinical, and partly common sense. Further investigations reveal several substances in a whole-food plant-based diet that have protective effects and an inhibitory effect on tumor development. For pancreatic cancer, the basis of cure remains a century old operation that rarely cures. With little to lose, prevention deserves center stage and additional studies.

AIM A DSM-5 diagnosis of attention deficit/hyperactive disorder (ADHD) requires that symptoms be present in two settings. We wanted to see how teachers and parents compare on their assessments. METHODS We evaluated how well Child Symptom Inventory-4 (CSI-4) reports from 871 parents and 634 teachers of 10-year-old children born before the 28th week of gestation provided information about indicators of school dysfunction. RESULTS Kappa values for parent and teacher agreement of any ADHD were at best fair to poor (

OBJECTIVE This study was designed to explore characteristics of chronic wounds that present with wound-related itch. BACKGROUND Although wound-related itch is recognized clinically, little is known about the phenomenon. Recent scientific advances have enabled the study of itch physiology, yet the clinical problem is not well described in the literature. DESIGN The study was observational, descriptive. METHOD Persons (N = 200) with wounds being followed up at a hospital-affiliated wound care center were interviewed and assessed. Instruments included a health history tool, Paul-Pieper Itching Questionnaire, Bates-Jensen Wound Assessment Tool, and 10-g monofilament for assessment of sensation in the area of the wound. RESULTS Participants were aged 21 to 98 years (mean, 66.82 [SD, 14.02] years); 56% of the participants were men, and 85% were white. One-fourth (56/200) of the participants reported wound-related itch. Wounds that itched were generally larger (t77.74 = -3.27; P = .002; d = 0.63; 95% confidence interval [CI], -1.01 to -0.25), had more tissue edema (t88.38 = -2.19; P = .031; 95% CI, -0.93 to -0.47), and demonstrated more granulation tissue in the wound base (t98.71 = 2.03; P = .045; 95% CI, 0.01-0.87), compared with wounds without itch. Greater itch was associated with wounds that had a moderate amount of exudate (P = .02) or necrotic tissue in the base. CONCLUSIONS Wound itch was present in more severe wounds as evidenced by larger size, more tissue edema, and necrotic tissue. Understanding wound itch could promote wound healing and improve quality of life for persons with chronic wounds.

Objective To investigate vicarious posttraumatic growth in labor and delivery nurses who cared for women during traumatic births. Design A convergent parallel mixed-methods design was used. Participants The sample consisted of 467 labor and delivery nurses who completed the quantitative portion and 295 (63%) who completed the qualitative portion of this mixed-methods study via the Internet. Methods The Association of Women's Health, Obstetric and Neonatal Nurses sent out e-mails to members who were labor and delivery nurses with a link to the electronic survey. Labor and delivery nurses completed the Posttraumatic Growth Inventory and the Core Beliefs Inventory in the quantitative portion. For the qualitative portion, the nurses were asked to describe their experiences of any positive changes in their beliefs or life as a result of their care for women during traumatic births. Results Labor and delivery nurses who cared for women during traumatic births reported a moderate amount of vicarious posttraumatic growth as indicated by their Posttraumatic Growth Inventory scores. Appreciation of Life was the dimension of the Posttraumatic Growth Inventory that reflected the highest growth, followed by Relating to Others, Personal Strength, Spiritual Change, and New Possibilities. In the qualitative findings, Relating to Others was also the dimension of posttraumatic growth most frequently described. Conclusion We compared our results with those of previous studies in which researchers assessed vicarious posttraumatic growth in clinicians, and we found that labor and delivery nurses who cared for women during traumatic births experienced growth levels that were scored between the lowest and highest reported levels of therapists and social workers. Nurses need to be aware of the potential to experience this growth despite the significant stress and unpredictability of the labor and delivery environment, which could decrease burnout and improve retention rates.

Aims: Animal experiments have shown that the endocannabinoid system (ECS) plays an important role in the regulation of ethanol intake. We investigated these effects in healthy volunteers who consumed a moderate amount of ethanol (red wine) and measured plasma levels of the endocannabinoids (ECs) anandamide (AEA) and 2-arachidonoylglycerol (2-AG) to test whether alcohol consumption influences the ECS in humans. Grape juice or plain non-sparkling water served as non-alcoholic control liquids. Methods: In total, 55 adults were enrolled in this study and assigned to one of three groups drinking either 250 ml of red wine (28.0 g of ethanol

Background Jaundiced infants are uncommon in most emergency departments (EDs). Biliary rupture remains one of the more rare and less described causes of this condition. Case Report A 5-month-old male presented to our ED with scleral icterus, increasing abdominal distention, and increased irritability. A bedside ultrasound revealed a moderate amount of ascites and further imaging suggested he had a rupture of his common bile duct. Surgical exploration confirmed this and revealed the presence of choledocholithiasis, which was the likely cause of the rupture. Why Should an Emergency Physician Be Aware of This? Biliary rupture remains a rare but serious condition in very young patients. Emergency physicians should consider bedside ultrasound as an adjunct in undifferentiated abdominal distention or jaundice in this patient population.

OBJECTIVE Examine overall level of and variation in local health department (LHD) use and perceived impact of the County Health Rankings report (Rankings) in Florida (2010, 2011) and North Carolina (2010-2012, 2013). DESIGN Two cross-sectional surveys among LHDs. PARTICIPANTS Local health directors and relevant staff. MAIN OUTCOME MEASURES Use of the Rankings was measured by asking respondents if their LHD had used the Rankings in any of 10 ways and through assessment of community engagement. Perceived impact was measured by amount of attention the Rankings received from various stakeholders and whether they had already produced or would likely produce any of 7 possible results. RESULTS Overall, LHDs used the Rankings most often to educate staff in Florida (78%) and North Carolina (56%). Engagement with community groups around the Rankings was variable. Media engagement, through press releases (41%; 40%) or interviews (51%; 36%) in Florida and North Carolina, was moderate. Florida LHDs used the Rankings in more ways and significantly more frequently than North Carolina LHDs. There were few significant differences in perceived impact by state. At least a moderate amount of attention was received from media in Florida (52%) and North Carolina (46%). Twenty-percent of LHDs reported the Rankings received at least moderate attention from the general public in both states and 38% (Florida) and 33% (North Carolina) from policy makers. Tangible benefits to communities from the Rankings, such as having already influenced adoption of new policies, were modest in Florida (3%) and North Carolina (11%). CONCLUSIONS Results suggest that tangible benefits to communities from use of the Rankings have yet to be fully realized but are encouraging. More effective media engagement could produce the community awareness necessary to maximize the Rankings' potential to mobilize communities for health improvement. State variation in Rankings use suggests that more support to LHDs may be helpful.

The Internet is increasingly being viewed as a health promotion tool with enormous potential. However, this potential cannot be realized if Web sites do not utilize the features that make the Internet a "hybrid" mass and interpersonal communication medium. The purpose of this study was to examine interactive safer sex Web sites on a number of dimensions. A comprehensive search that included Internet search engines, links from well-known sites, and previously published reviews yielded 21 Web sites that met criteria. Web sites were coded on dimensions including targeting of the Web sites, safer sex messages presented, theoretical strategies utilized, interactivity, and other characteristics. Results indicate that a moderate amount of targeting of Web sites exists, especially on age group (e.g., teenagers); the most prevalent safer sex messages were to "use condoms" and "be sexually abstinent"; raising the perceived threat of sexually transmitted diseases and HIV was the most prevalent theoretical strategy used to motivate safer sex; and finally, a moderate amount of interactivity was found on the Web sites, with most Web sites containing 4 or 5 features out of 15 features examined. Evidence that Web sites were tailoring information or messages to individuals was not found. Implications of these results for improving safer sex Web sites and developing interventions online are discussed.

This study was conducted to provide descriptive data of accelerometer-determined ambulatory physical activity in a sample of free-living college students and to examine college students' ambulatory physical activity patterns.All participants (245 females, age = 19.9 +/- 1.6 yr, body mass index (BMI) = 22.9 +/- 3.3 kg x m(-2); 209 males, age = 20.2 +/- 2.0 yr, BMI = 25.2 +/- 4.0 kg x m(-2)) wore an accelerometer for seven consecutive days. Accumulated physical activity (ct.d, ct x min(-1) x d(-1), and min x d(-1) spent at different intensities) and minutes per day spent in moderate or vigorous physical activity in sessions of at least 10 min were analyzed to describe the physical activity of the sample and examine physical activity patterns.The entire sample accumulated 362,750.1 +/- 112,824.1 ct x d(-1) (males = 383,787.2 +/- 112,001.3 vs females = 344,804.1 +/- 110,619.5 ct x d(-1), P0.01) and 46.7 +/- 18.9 min x d(-1) in moderate physical activity (males = 51.7 +/- 19.8 vs females = 42.5 +/- 17.0 min x d(-1), P0.01). They were more active on weekdays than weekend days (P0.05), and they spent 13.6 +/- 12.7 min x d(-1) (males = 13.2 +/- 12.0 vs females = 13.8 +/- 13.3, P0.05) in moderate or vigorous physical activity sessions of at least 10 min.Participants in this study accumulated a moderate amount of physical activity on most weekdays. Most participants, however, were not meeting the current moderate physical activity recommendation when moderate or vigorous physical activity sessions of at least 10 min were examined.

Recently, a number of commentators have suggested that growth in use of the Internet may be slowing, and its impact may have been exaggerated. However, a disproportionate number of the nonusers tend to be those over the age of 50, and the young are most likely to go online eventually. Therefore, the most appropriate people to survey with regard to Internet use are adolescents and young adults who are likely to be the Internet users or nonusers of the future. This survey was conducted to find out more about the activities and opinions of secondary-school aged children who do, and do not, use the Internet. Mobile phone use was also examined in this survey as this has also shown a meteoric rise in adults and more particularly in young people. Generally, the survey revealed that children aged between 11 and 16 years old are quite comfortable with the Internet, use it a moderate amount and for a variety of purposes. However, boys were more likely to use the Internet than girls and sometimes for slightly different purposes. Reasons for not using the Internet generally revolved around a lack of access to equipment. Furthermore, a higher percentage of adolescents have mobile phones than adults and girls are more likely to own a mobile phone than boys. Mobile phones were also used for a variety of purposes, most notably making and receiving calls and text-messaging. The most common reasons for children not owning a mobile phone was because they had no need for one. Finally, a significant positive relationship between the use of emails and text messaging suggests that the mobile phone may supplement some of the previous functions of the Internet.

The aim of this study was to review the evidence in the literature for organised cancer screening programmes. A Medline search for publications related to organised cancer screening programmes and their components was done. While there is a broad descriptive literature on various cancer screening programmes, there are few published studies that evaluate the impact of organised cancer screening. Most of the evidence to date is from Scandinavian cervical and breast cancer screening programmes. There is a moderate amount of literature that evaluates specific components of cancer screening programmes (such as quality control and recruitment). There is a substantial body of literature on organised cancer screening programmes. However, the studies tend to describe organised screening programmes rather than evaluate their effectiveness relative to opportunistic screening. Furthermore, most studies focus on individual components of organised screening programmes, rather than on the programmes as a whole. More research is needed that directly compares organised with opportunistic cancer screening.

Background Exposure to PCDD/PCDF (dioxin and furan) through consumption of fish and shellfish is closely related to the occurrence of skin diseases, such as chloracne and hyperpigmentation. This study aimed to determine the exposure of PCDD/PCDF and its congeners in fish and shellfish obtained from different regions of the Straits of Malacca among the fishing community. Methods The risk of fish and shellfish consumption and exposure to PCDD/PCDF among fishermen living in coastal areas of the Straits were evaluated based on a cross-sectional study involving face to face interviews, blood pressure and anthropometric measurements, and administration of food frequency questionnaires (FFQ). Skin examination was done by a dermatologist after the interview session. Determination of 17 congeners of PCDD/PCDF in 48 composite samples of fish and shellfish was performed based on HRGC/HRMS analysis. Results The total PCDD/PCDF in the seafood samples ranged from 0.12 to 1.24 pg WHO-TEQ/g fresh weight (4.6-21.8 pg WHO-TEQ/g fat). No significant difference found for the concentrations of PCDD/PCDF between the same types of seafood samples obtained from the three different regions. The concentrations of the most potent congener, 2,3,7,8-TCDD in the seafood samples ranged from 0.01 to 0.11 pg WHO-TEQ/g FW (1.9 pg WHO-TEQ/g fat). A positive moderate correlation was found between the fat contents and concentrations of PCDD/PCDF determined in the seafood samples. The total PCDD/PCDF in all seafood samples were below the 1 pg WHO-TEQ/g fresh weight, with the exception of grey eel-catfish. The respondents had consumed fish and shellfish with the amounts ranging between 2.02 g and 44.06 g per person per day. The total PCDD/PCDF exposures through consumption of fish and shellfish among the respondents were between 0.01 and 0.16 pg WHO-TEQ/kg BW/day. With regard to the two PCDD/PCDF-related skin diseases, no chloracne case was found among the respondents, but 2.2 % of the respondents were diagnosed to have hyperpigmentation. Conclusion Intake of a moderate amount of fish and shellfish from the area is safe and does not pose a risk for skin diseases. An over-consumption of seafood from the potentially polluted area of the Straits should be monitored in future.

Importance Every year, Ramadan fasting is practiced by many Muslim individuals. In cases of chronic disease, religious texts allow fasting to be broken. However, many believers still want to fast even at the risk of damaging their health. To our knowledge, there are no published recommendations on the medical management of Parkinson disease (PD) during Ramadan. Effective treatments exist in PD and usually require several daily drug intakes. Apart from worsening symptoms, interrupting PD treatment might lead to a severe withdrawal syndrome. Observations Although no specific studies on this topic have led to formal recommendations, we suggest some options for adapting the treatment for patients who fast during Ramadan. The general principle is based on switching the patient’s treatment to an equivalent dosage of a dopamine agonist that can be administered once daily or by transdermal patch. However, such an option is only feasible for patients who require a moderate amount of PD treatment and can tolerate dopamine agonist therapy. Conclusions and Relevance Because many patients with PD require regular multiple daily administration of dopamine-replacement medication, the management of Ramadan fasting is not easy. Switching the patient’s treatment to an equivalent dosage of a dopamine agonist that can be administered once daily or by transdermal patch seems to be a reasonable option to consider for patients treated with a low-to-moderate amount of PD medication.

Sexual enhancement medication presents a large market for counterfeit versions. We report here a case of hypoglycemia caused by an illicit sexual enhancement medication containing an extremely large amount of the sulfonylurea drug glibenclamide together with a moderate amount sildenafil citrate.

This study investigated discovery learning pedagogy and its effects on students’ achievement and attitudes toward instruction in a lower-division biology course, entitled Structure and Function of Organisms. Instruction was primarily lecture-based but included four discovery learning activities. Results indicate that students had greater achievement on content learned through discovery methods than lecture-based instruction. Findings regarding students’ attitudes toward discovery-based instruction suggest that students enjoyed active, discovery-based problems, believed that discovery helped them gain an understanding of the material and helped them to develop skills that could be used in other courses. The study presented here shows that a moderate amount of discovery learning used in combination with traditional methods of instruction may be an effective means for promoting students’ achievement.

For skill advancement, motor variability must be optimized based on target information during practice sessions. This study investigated structural changes in kinematic variability by characterizing submovement dynamics and muscular oscillations after practice with visuomotor tracking under different target conditions. Thirty-six participants were randomly assigned to one of three groups (simple, complex, and random). Each group practiced tracking visual targets with trajectories of varying complexity. The velocity trajectory of tracking was decomposed into 1) a primary contraction spectrally identical to the target rate and 2) an intermittent submovement profile. The learning benefits and submovement dynamics were conditional upon experimental manipulation of the target information. Only the simple and complex groups improved their skills with practice. The size of the submovements was most greatly reduced by practice with the least target information (simple > complex > random). Submovement complexity changed in parallel with learning benefits, with the most remarkable increase in practice under a moderate amount of target information (complex > simple > random). In the simple and complex protocols, skill improvements were associated with a significant decline in alpha (8–12 Hz) muscular oscillation but a potentiation of gamma (35–50 Hz) muscular oscillation. However, the random group showed no significant change in tracking skill or submovement dynamics, except that alpha muscular oscillation was reduced. In conclusion, submovement and gamma muscular oscillation are biological markers of learning benefits. Effective learning with an appropriate amount of target information reduces the size of submovements. In accordance with the challenge point hypothesis, changes in submovement complexity in response to target information had an inverted-U function, pertaining to an abundant trajectory-tuning strategy with target exactness.

Objective To examine the relationship between amount of treatment failure and personal and marital distress. Design In this cross-sectional design, three groups of women (n = 91) with varying amounts of treatment failure experience were compared on measures of general and infertility-related distress and marital and sexual distress. Results The relationship between treatment failure experience and personal and marital distress was found to be curvilinear. The group that had a moderate amount of treatment failure experienced the most distress whereas the distress level of those without or with a high amount of treatment failure experience was comparable. The results also showed that the relationship between amount of treatment failure and distress was independent of age, years infertile, or years in treatment. Conclusion The findings of this study provide support for infertility theories that suggest that infertility is a process rather than a series of independent emotional events and suggest that the distress women experience during infertility is a necessary part of their evolution toward acceptance of their infertility.

The purpose of this study was to investigate if a low mixed carbohydrate (CHO) plus moderate protein (PRO) supplement, provided during endurance exercise, would improve time to exhaustion (TTE) in comparison to a traditional 6% CHO supplement. Fourteen (n = 14) trained female cyclists and triathletes cycled on 2 separate occasions for 3 hours at intensities varying between 45 and 70% VO2max, followed by a ride to exhaustion at an intensity approximating the individual's ventilatory threshold average 75.06% VO2max. Supplements (275 mL) were provided every 20 minutes during exercise and were composed of a CHO mixture (1% each of dextrose, fructose, and maltodextrin) + 1.2% PRO (CHO + PRO) or 6% dextrose only (CHO). The TTE was significantly greater with CHO + PRO in comparison to with CHO (49.94 ± 7.01 vs. 42.36 ± 6.21 minutes, respectively, p < 0.05). Blood glucose was significantly lower during the CHO + PRO trial (4.07 ± 0.12 mmol · L(-1)) compared to during the CHO trial (4.47 ± 0.12 mmol · L(-1)), with treatment × time interactions occurring from 118 minutes of exercise until exhaustion (p < 0.05). Results from the present study suggest that the addition of a moderate amount of PRO to a low mixed CHO supplement improves endurance performance in women above that of a traditional 6% CHO supplement. Improvement in performance occurred despite CHO + PRO containing a lower CHO and caloric content. It is likely that the greater performance seen with CHO + PRO was a result of the CHO-PRO combination and the use of a mixture of CHO sources.

The carcinogenic effects of solar activity with different intensities on embryos were studied epidemiologically. The study reveals that receiving a moderate amount of low level cosmic radiation at embryonic stage may reduce cancer occurrence later. This paper analyses and discusses the mechanisms of this hormetic effect.

There is a moderate amount of evidence to suggest that St John's wort is better than placebo in the short-term management of mild to moderate depressive illness, but there is increasing concern over reports of drug interactions. This article examines the scientific evidence and discusses relevant clinical issues.

Background and purpose: The inter-relation between the size of patent foramen ovale (PFO) by transesophageal echocardiography (TEE) and the amount of microembolic signals (MES) on transcranial doppler (TCD) is still not determined. Methods: The study group comprised of 104 patients with first-ever ischaemic stroke or transient ischemic attack (TIA). Three groups were formed according to the amount of MES on TCD: a small amount of MES (0–10 MES); a moderate amount of MES (countable MES higher than 10); and multiple MES. Results: According to TEE, there were 52 patients (50%) with a small PFO, 37 patients (35.6%) with a moderate PFO, and 15 patients (14.4%) with a large PFO. There were 48 patients (46.1%) with a small amount of MES, 34 patients (32.7%) with a moderate amount of MES, and 22 patients (21.1%) with multiple MES on TCD. A strong relationship between the size of the PFO on TEE and the amount of MES on contrast transcranial Doppler was found (P

Objective We sought to determine analytically the potassium content of different varieties of raw potatoes, and to estimate the amount of potassium that can be extracted or leached from raw potatoes by cooking. Design and Methods Six different varieties of fresh potatoes were obtained from the Whole Foods Market in Manhasset, New York. Two different cooking methods (normal cooking [NC] and double cooking [DC]) were applied to each potato. Potassium was extracted from the ash of dried samples. The potassium content of aqueous extractions was ascertained by atomic absorption spectrophotometry. Results Mean potassium content was highest in the purple Viking potato (448.1 ± 60.5 mg [11.5 ± 1.6 mEq]/100 g [values are mean ± SD unless otherwise noted]), and lowest in the Idaho potato (295 ± 15.7 mg [7.6 ± 0.4 mEq]/100 g). All raw potatoes had a mean potassium content of about 300 mg (7.7 mEq)/100 g or greater. The DC method resulted in a greater reduction in potassium from raw potatoes than the NC method. All potatoes retained a mean potassium content greater than 200 mg (5.1 mEq)/100 g, using the NC versus the DC method. Conclusion The potassium content of the raw potatoes studied varied considerably, with most tubers retaining a moderate amount of potassium after leaching. This study showed that the DC method appears to be more effective than the NC method in leaching potassium from the potatoes studied. Our findings provide useful information for dietitians involved in menu planning for people on potassium-restricted diets.

While eating disorders are a prevalent psychiatric issue for women, only a moderate amount of literature discussing the implications for pregnancy exists and even less explores how to identify and manage eating disorders in this patient population. This is despite known risks for adverse fetal, birth, and maternal outcomes because of these disorders. To enhance standard assessment practice and facilitate early intervention for the eating disordered patient, a general obstetrics role need not dramatically change to improve outcomes for mother and child.

This paper describes a successful hepatitis B vaccination program which expanded from one school vaccinating 475 students to 68 schools vaccinating 3,400 students. Issues associated with success include acquiring resources, organizing program logistics, developing an advisor board, determining eligibility for free vaccine, obtaining vaccine for those not eligible for publicly supplied vaccine, methods of consenting, and managing data. The process of obtaining support can increase public awareness and assist further program expansion. The program demonstrates that the time and energy expended in start-up activities for the first two or three years will evolve into a program with a life of its own, requiring only a moderate amount of attention while generating strong positive community support.

Szrmmary.482 rugby referees from Wales, Scodand, and England rated their stress associated with refereeing on a 3-item scale. Mean ratings for the total sample and each group were benveen "very little" and "a moderate amount." Results support earlier studies, suggesting that most sport officials do not experience much stress while officiating. Several studies have examined stress experienced by sport officials. Kaissils and Anshel (1993) measured the intensity of 15 sources of stress among Australian basketball referees, who rated their over-all stress as moderate. Rainey (1994) measured stress among baseball and softball umpires using a rating scale. The umpires' mean rating of their stress was between "very little" and "a moderate amount." Using the same scale, Rainey and Winterich (1995) examined stress among American basketball referees, who rated their stress in the same range. FinaUy, Stewart and Ellery (1996) reported that high school volleyball officials rated their mean stress between "very little" and "a moderate amount " Data from four sports suggest that officials do not experience much stress. However, one limitation of the studies reported by Rainey (1994), Rainey and Winterich (1995), and Stewart and Ellery (1996) is that the officials were questioned after their seasons were over. It is possible that memories of stressful experiences fade with time, and officials surveyed while their sport is still in season may report higher stress. The purpose of the present study was to examine ratings of stress by rugby referees during their season. It was hypothesized that, because their officiating experiences would be more recent, the rugby referees would rate their stress higher than officials in prior studes, between "a moderate amount" and "quite a bit." METHOD Participants Participants were 682 rugby referees from the Rugby Unions of Wales (n = 126), Scotland (n= 140), and England (n=416). Mean age of participants was 41 yr. (SD=7.8 yr.). There were no significant differences among the three groups in mean age (F,,m< 1.00). Mean number of years of refer

A 42-year-old male was admitted to our coronary care unit complaining of chest pain. He had been at a bar the previous night and had consumed a moderate amount of alcohol. The next morning he woke up with a headache and took a dose of an effervescent cold remedy. Approximately 20 min after ingestion of the solution, he began to feel unwell with chest discomfort. His wife called an ambulance and a …

Christmas and alcohol are inextricably linked. But the evidence based party goer has to weigh up a complex body of research. Like smoking, heavy drinking increases the risk of death from many causes. However, as Sir Richard Doll points out on page 1664, there is now convincing evidence that one can reduce one's risk of heart disease by drinking a moderate amount each day in middle and old age.1 For many people the emphasis on cardioprotective effects may bring reassurance, and for some this will be justified. For most people, however, the relevant comparison is not with non-drinkers but with “safe” drinkers.2 From this viewpoint the excess of coronary heart disease deaths in non-drinkers is likely to be smaller than the excess of deaths from other causes in heavy drinkers. Furthermore, media euphoria over the cardioprotective effect obscures …

All volleyball officials registered with a state high school activities association in a midwestern state were surveyed at the end of the volleyball season to assess their self-reported, psychological stress. Of 470 officials contacted, 353 (75%) responded by filling out a simple 5-point rating scale. The mean rating of stress was 2.3 ( SD=.6) (between “very little” and “a moderate amount”) which is similar to past findings for certified, amateur baseball and Softball umpires.

The relationship between heart rate variability and level of illness was examined. Fifteen patients (10 male and 5 female), gestational ages 25 to 42 weeks, postnatal ages 1 to 42 days, birthweights 545 to 4375 g receiving care in the neonatal intensive care nursery were randomly selected. Data from each infant was transferred from the bedside physiologic monitor to a microcomputer for analysis. A severity of illness index (the Children's Hospital Illness Score [CHILLS]) correlated with heart rate variability. Four patterns of heart rate variability were identified: (1) infants whose CHILLS score indicated that they were cardiovascularly normal demonstrated a modest amount of variability; (2) infants with a CHILLS score indicating a moderate amount of illness had heart rates and heart rate variability greater than the normal infants; (3) three infants exhibited bimodality (period doubling) in their heart rates; each of these infants had a CH ILLS score that indicated that they were less ill than the most critically ill patients, but sicker than those moderately ill infants without period doubling; and (4) heart rate decreased in the most critically ill infants identified by the CHILLS, but it remained above the heart rate of a healthy newborn; heart rate variability collapsed below that of a healthy newborn. Our data suggest that the variability of heart rate may increase as an infant becomes sicker. When the infant becomes critically ill and unstable, heart rate variability is less than the normal infant. Nonlinear dynamics theory may be a potential model for fitting the data

This study surveyed 782 certified baseball and Softball umpires from randomly chosen umpire associations in one state to assess how much stress they experienced while officiating. The mean stress score was between “very little” and “a moderate amount,” although 4.5% of the respondents reported “quite a bit” or “a great deal” of stress. The mean stress score may have been attenuated by the umpires' reluctance to admit stressful experiences or by collection of data after the season was over.

We describe a suture technique helpful in the repair ofwounds under a moderate amount of tension. It is most beneficial when the surgeon is working without an assistant. The standard repair of a full-thickness elliptical surgical wound involves a layered closure. Absorbable buried dermal sutures are used to close the defect with minimal epidermal surface tension.' Nonabsorbable superficial sutures are then used to secure gentle epidermal approximation and eversion. Special maneuvers are required to close a gaping surgical wound under a moderate amount of tension. Under these circumstances, an assistant pushes the wound edges together while the surgeon is securing the dermal suture knot. Although awkward, this maneuver is sufficient to reduce tension and allow knot placement. Another maneuver involves closing the wound inward from the poles where there is a more manageable amount of tension. Subsequent sutures are placed toward the middle of the defect where greater tension exists.? This, too, can be awkward and often requires an assistant to push skin edges together until the knots are secured. Several suture techniques have been described that can generate a mechanical advantage to close gaping wounds under tension. The "near-far-farnear" suture as developed by ophthalmologic surgeons' and further described by Bennet" and Snow et al.5 is of particular value in thin skin. A variant of the "near-far-far-near" suture is the pulley suture recently described by Hitzig and Sadick'' and is of great assistance in closing tight scalp-reduction defects. The disadvantage of both of these techniques is that they place significant tension on the epidermis and raise appropriate concerns about surface scarring and cosmesis. We offer the buried dermal pulley suture as an alternate suture technique that can significantly assist in closure of large gaping wounds. Because it is

Two studies using separate samples sought to explore differences among male and female elders on their knowledge, attitudes, and sexual behaviour using a nonexperimental approach. Two different samples from separate health and wellness groups were surveyed using the Aging Sexual Knowledge and Attitude Scale (White 1982). Additional data were collected on sexual satisfaction, sexual activity, and demographic variables. In the first study, questionnaires were mailed to the homes of 759 members of the wellness group. The second study was conducted in a similar manner, but with random selection of 400 males and 400 females. Both groups showed a moderate amount of knowledge and permissive attitudes with no significant differences observed between males and females. Reported sexual satisfaction was variable. Subjects were sexually active with activity varying from 0 to 30 times per month, with a mean of 4 times per month. Findings suggest that males and females are comparable on their knowledge and attitudes about sexuality in ageing and most are sexually active. Many are seeking further information on the impact of chronic illness and medications on sexuality.

The author discusses gender differences in the psychosocial correlates of cardiovascular risk. A moderate amount of overtime work was associated with a decreased risk of myocardial infarction in men but a corresponding increased risk in women. The reason for this difference may be the double role (home and paid work) of women. Emotional states in diaries differed between men and women in the same occupations, and these differences seemed to some extent to be occupation specific.

The effects of clear liquids on gastric volume and pH were examined in 30 healthy ASA physical status I volunteers. After overnight fasting, a Salem-sump nasogastric tube was inserted and gastric contents were removed for measurement of volume and pH. Gastric contents were then reinserted through the nasogastric tube into the stomach. The volunteers were randomly divided into three groups: group 1 (n = 10) received 240 mL water, group 2 (n = 10) received 240 mL coffee, and group 3 (n = 10) received 240 mL pulp-free orange juice. All liquids were administered orally. Gastric contents were then again aspirated, measured for volume and pH, and reinserted through the nasogastric tube every half hour until gastric volume was less than 25 mL. All volunteers had gastric volumes less than 25 mL with a slight decrease in pH within 2 h of orally taking one of the three 240-mL liquids. These data suggest that if patients have ingested a moderate amount of clear liquids it is safe to conduct general anesthesia after a 2-h fast in healthy surgical patients.

Additional medical manpower will be required to meet the growth in the elderly segment of the United States population over the next 50 years. This paper provides estimates of the needs for medical geriatric manpower under four different models: continuation of the status quo; academic geriatricians only; provision of care by academic and consultant geriatricians; and provision of care by academic, consultant, and primary-care geriatric practitioners. Each option is further analyzed in terms of three levels of delegation to nonphysician clinicians. We project the implications of these 12 patterns through the year 2030, assuming present usage levels and allowing for improved care of the elderly. The need for geropsychiatric care is explored separately. We think that geriatricians should provide improved care, including both consultant and primary care, to people aged 75 years and older, and that they should delegate a moderate amount of responsibility to nurse practitioners, physician assistants, and social workers. On the basis of these assumptions, and allowing for an academic role as well, we estimate that the United States will require between 7000 and 10,300 geriatricians by the year 1990; the best intermediate figure is about 8000.