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Objective: We aimed to evaluate the relationship of a history of strength training with symptomatic and structural outcomes of knee osteoarthritis (OA). Methods: This study was a retrospective, cross‐sectional study within the Osteoarthritis Initiative (OAI), a multicenter prospective longitudinal observational study. Data were collected at four OAI clinical sites: Memorial Hospital of Rhode Island, the Ohio State University, the University of Pittsburgh, and the University of Maryland/Johns Hopkins. The study included 2,607 participants with complete data on strength training, knee pain, and radiographic evidence of knee OA (male, 44.2%; mean ± SD age 64.3 ± 9.0 years; mean ± SD body mass index 28.5 ± 4.9 kg/m2). We used a self‐administered questionnaire at the 96‐month OAI visit to evaluate the exposure of strength training participation during four time periods throughout a participant's lifetime (ages 12–18, 19–34, 35–49, and ≥50 years old). The outcomes (dependent variables) were radiographic OA (ROA), symptomatic radiographic OA (SOA), and frequent knee pain. Results: The fully adjusted odds ratios (95% confidence interval) for frequent knee pain, ROA, and SOA among those who participated in strength training any time in their lives were 0.82 (0.68–0.97), 0.83 (0.70–0.99), and 0.77 (0.63–0.94), respectively. Findings were similar when looking at the specific age ranges. Conclusion: Strength training is beneficial for future knee health, counteracting long‐held assumptions that strength training has adverse effects. [ABSTRACT FROM AUTHOR]

This study examined the 4th-grade National Assessment of Educational Progress (NAEP) assessments (history, geography, and civics) and 3rd- and 4th-grade social studies standards from nine randomly selected states and organized the content around three global concepts (conflict, movement, discovery) and six specific concepts (war, rebellion, immigration, migration, exploration, invention). The extent to which additional related concepts appeared in both documents was recorded, and alignment between the NAEP and standards was determined. Findings revealed that 3rd- and 4th-graders are learning social studies content that represent these global and specific concepts. However, there is variability among states' standard documents and inconsistencies between what is assessed on the NAEP and what is presented in the standards. In addition, much instruction for these concepts takes place during 4th grade, the same year the NAEP is administered. Implications of these findings, including the urgent need for conceptually based social studies instruction to meet students' knowledge and achievement gaps, are discussed.

Discusses a study of global education in 16 Delaware County, Pennsylvania, public high schools. Reports that global education was more widely taught than the written curriculum indicated. Describes factors that promote global education. Offers recommendations for increasing the impact of global education on the curriculum and in the classroom. (SG)

Context: Black patients are more likely than white patients to die in the intensive care unit with life-sustaining treatments. Differences in patient- and/or surrogate-provider communication may contribute to this phenomenon.Objectives: To test whether hospital-based physicians use different verbal and/or nonverbal communication with black and white simulated patients and their surrogates.Methods: We conducted a randomized factorial trial of the relationship between patient race and physician communication using high-fidelity simulation. Using a combination of probabilistic and convenience sampling, we recruited 33 hospital-based physicians in western Pennsylvania who completed two encounters with prognostically similar, critically and terminally ill black and white elders with identical treatment preferences. We then conducted detailed content analysis of audio and video recordings of the encounters, coding verbal emotion-handling and shared decision-making behaviors, and nonverbal behaviors (time interacting with the patient and/or surrogate, with open vs. closed posture, and touching the patient and physical proximity). We used a paired t-test to compare each subjects' summed verbal and nonverbal communication scores with the black patient compared to the white patient.Results: Subject physicians' verbal communication scores did not differ by patient race (black vs. white: 8.4 vs. 8.4, P-value = 0.958). However, their nonverbal communication scores were significantly lower with the black patient than with the white patient (black vs. white: 2.7 vs. 2.9, P-value 0.014).Conclusion: In this small regional sample, hospital-based physicians have similar verbal communication behaviors when discussing end-of-life care for otherwise similar black and white patients but exhibit significantly fewer positive, rapport-building nonverbal cues with black patients. [ABSTRACT FROM AUTHOR]

Rationale: A major abnormality that characterizes the red cell "storage lesion" is increased hemolysis and reduced red cell lifespan after infusion. Low levels of intravascular hemolysis after transfusion of aged stored red cells disrupt nitric oxide (NO) bioavailabity, via accelerated NO scavenging reaction with cell-free plasma hemoglobin. The degree of intravascular hemolysis post-transfusion and effects on endothelial-dependent vasodilation responses to acetylcholine have not been fully characterized in humans.Objectives: To evaluate the effects of blood aged to the limits of Food and Drug Administration-approved storage time on the human microcirculation and endothelial function.Methods: Eighteen healthy individuals donated 1 U of leukopheresed red cells, divided and autologously transfused into the forearm brachial artery 5 and 42 days after blood donation. Blood samples were obtained from stored blood bag supernatants and the antecubital vein of the infusion arm. Forearm blood flow measurements were performed using strain-gauge plethysmography during transfusion, followed by testing of endothelium-dependent blood flow with increasing doses of intraarterial acetylcholine.Measurements and Main Results: We demonstrate that aged stored blood has higher levels of arginase-1 and cell-free plasma hemoglobin. Compared with 5-day blood, the transfusion of 42-day packed red cells decreases acetylcholine-dependent forearm blood flows. Intravascular venous levels of arginase-1 and cell-free plasma hemoglobin increase immediately after red cell transfusion, with more significant increases observed after infusion of 42-day-old blood.Conclusions: We demonstrate that the transfusion of blood at the limits of Food and Drug Administration-approved storage has a significant effect on the forearm circulation and impairs endothelial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01137656). [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives MEDLINE offers the Core Clinical Journals filter to limit to clinically useful journals. To determine its effectiveness for searching and patient-centric decision making, this study compared literature used for Morning Report in Internal Medicine with journals in the filter. Method An End Note library with references answering 327 patient-related questions during Morning Report from 2007 to 2012 was exported to a file listing variables including designated Core Clinical Journal, Impact Factor, date used and medical subject. Bradford's law of scattering was applied ranking the journals and reflecting their clinical utility. Recall (sensitivity) and precision of the Core Morning Report journals and non- Core set was calculated. This study applied bibliometrics to compare the 628 articles used against these criteria to determine journals impacting decision making. Results Analysis shows 30% of clinically used articles are from the Core Clinical Journals filter and 16% of the journals represented are Core titles. When Bradford-ranked, 55% of the top 20 journals are Core. Articles <5 years old furnish 63% of sources used. Among the 63 Morning Report subjects, 55 have <50% precision and 41 have <50% recall including 37 subjects with 0% precision and 0% recall. Conclusions Low usage of publications within the Core Clinical Journals filter indicates less relevance for hospital-based care. The divergence from high-impact medicine titles suggests clinically valuable journals differ from academically important titles. With few subjects demonstrating high recall or precision, the MEDLINE Core Clinical Journals filter may require a review and update to better align with current clinical needs. [ABSTRACT FROM AUTHOR]

Background: Evidence indicates that men and African Americans may be more susceptible to weight gain resulting from sleep loss than women and whites, respectively. Increased daily caloric intake is a major behavioral mechanism that underlies the relation between sleep loss and weight gain. Objective: We sought to assess sex and race differences in caloric intake, macronutrient intake, and meal timing during sleep restriction. Design: Forty-four healthy adults aged 21-50 y (mean ± SD: 32.7 ± 8.7 y; n = 21 women, n = 16 whites) completed an in-laboratory protocol that included 2 consecutive baseline nights [10 or 12 h time in bed (TIB)/night; 2200-0800 or 2200-1000] followed by 5 consecutive sleep-restriction nights (4 h TIB/night; 0400-0800). Caloric intake and meal-timing data were collected during the 2 d after baseline sleep and the first 3 d after sleep restriction. Results: During sleep restriction, subjects increased daily caloric intake (P < 0.001) and fat intake (P = 0.024), including obtaining more calories from condiments, desserts, and salty snacks (Ps < 0.05) and consumed 532.6 ± 295.6 cal during late-night hours (2200-0359). Relative to women, men consumed more daily calories during baseline and sleep restriction, exhibited a greater increase in caloric intake during sleep restriction (d = 0.62), and consumed a higher percentage of daily calories during late-night hours (d = 0.78, Ps < 0.05). African Americans and whites did not significantly differ in daily caloric intake, increased caloric intake during sleep restriction, or meal timing. However, African Americans consumed more carbohydrates, less protein, and more caffeine-free soda and juice than whites did during the study (Ps < 0.05). Conclusions: Men may be more susceptible to weight gain during sleep loss than women due to a larger increase in daily caloric intake, particularly during late-night hours. These findings are relevant to the promotion of public health awareness by highlighting nutritional risk factors and modifiable behaviors for weight gain related to sleep-wake timing. This trial was registered at clinicaltrials.gov as NCT02128737 and NCT02130791. [ABSTRACT FROM AUTHOR]

The article discusses the court case Bayada Nurses Inc. v. Commonwealth, Department of Labor and Industry in which the term domestic services cited in the Pennsylvania Minimum Wage Act of 1968 was examined by the Commonwealth Court of Pennsylvania. The interpretation of such term by the Department of Labor was found to be justifiable by the U.S. Supreme Court, which indicates that the act could be imposed against the defendant. It is said that the values of the state and federal courts were affirmed by the ruling.

Background: The biventricular implantable cardioverter-defibrillator (ICD) is an important therapy for select patients with severe heart failure. Given reported risk factors for elevated defibrillation thresholds (DFTs), patients undergoing biventricular ICD placement would be suspected of having a higher incidence of elevated DFT.Objectives: The purpose of this study was to examine the clinical predictors and mortality risk of elevated DFTs in patients receiving a biventricular ICD.Methods: Characteristics of patients undergoing biventricular ICD placement with an elevated DFT were compared to those without an elevated DFT.Results: An elevated DFT was found in 14 (12%) of 121 patients. Mean QRS duration was 210 +/- 50 ms in the elevated DFT group and 171 +/- 36 ms in the normal DFT group (P = .01). Patients with a QRS duration >or=200 ms were more likely to have an elevated DFT than those with a duration <200 ms (odds ratio 13.4, 95% confidence interval 3.1-66.7, P <.01). No other clinical characteristics were associated with an elevated DFT. More than 90% of patients with an elevated DFT achieved an adequate safety margin through system modification or manipulation of their drug regimen. An elevated DFT did not have an impact on 2-year mortality.Conclusion: Patients with a biventricular ICD had a 12% incidence of elevated DFT in our sequential patient cohort. QRS duration prior to biventricular ICD placement is the most powerful predictor of patients at risk for an elevated DFT. An elevated DFT does not have an impact on mortality, perhaps because of successful implementation of system modifications to ensure an adequate defibrillation safety margin. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with research which measured physical activity in dementia patients using accelerometry.

Abstract: Studies have shown racial disparities in neighborhood access to healthy food in the United States. We used a mixed methods approach employing geographic information systems, focus groups, and a survey to examine African Americans’ perceptions of the neighborhood nutrition environment in Pittsburgh. We found that African Americans perceive that supermarkets serving their community offer produce and meats of poorer quality than branches of the same supermarket serving White neighborhoods (p<0.001). Unofficial taxis or jitneys, on which many African Americans are reliant, provide access from only certain stores; people are therefore forced to patronize these stores even though they are perceived to be of poorer quality. Community-generated ideas to tackle the situation include ongoing monitoring of supermarkets serving the Black community. We conclude that stores should make every effort to be responsive to the perceptions and needs of their clients and provide an environment that enables healthy eating. [Copyright &y& Elsevier]

Objective: To determine whether an evidence-based, behavioral lifestyle intervention program delivered at a worksite setting is effective in improving type 2 diabetes and cardiovascular disease risk factors. Methods: A ran domized 6-month delayed control design was utilized, with two thirds of the participants assigned to begin intervention immediately, and one third beginning 6 months later. The year-long program (weekly for 3 months transitioning to monthly) focused on weight loss and increasing physical activity. Results: The immediate intervention group had greater mean weight loss (-10.4 lb, 5.1%, vs —2.3 lb, 1%; P = 0.0001) than the delayed control group at 6 months and relatively greater improvements in activity, HbAlc, and other risk factors. The delayed group experienced similar improvements after completing the intervention program. Conclusions: A worksite behavioral lifestyle intervention is feasible and effective in significantly improving risk factors for type 2 diabetes and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: The combination of exposure to multiple stressors and psychological distress may contribute to the disproportionate burden of dementia risk among Black Americans. This study estimates the effect of an index of stress and psychological distress (ie, "stress burden") on cognitive function and clinically adjudicated cognitive outcomes among older Black American adults, and examines sleep as a mediator., Methods: The sample included 204 Black adults (79% female; mean age = 64 years) from Pittsburgh, PA, USA. Stress burden comprised 3 self-reported stress and distress measures assessed in 2016: discrimination, psychological distress, and posttraumatic stress. Potential mediators included actigraphy-assessed sleep duration and efficiency from 2018. Cognitive battery and clinical adjudication in 2019 assessed cognitive function and clinically adjudicated outcomes. Causal mediation analysis estimated the direct effect between stress burden and cognitive outcomes, and indirect effects through sleep, after adjusting for sociodemographics and hypertension., Results: Higher stress burden had a significant direct effect on lower executive functioning and visuospatial performance. However, there were no significant indirect effects (ie, mediation) by sleep disturbances on any domain of cognitive function assessed. Also, there were no significant direct or indirect effects on clinically adjudicated outcomes., Conclusions: Multiple stressors often co-occur and may contribute to racial disparities in cognitive health. Findings suggest that higher stress burden had negative effects on functioning in executive and visuospatial domains in this community-based sample of older Black American adults. However, there was no evidence of mediation by sleep. Findings highlight the importance of continued work to identify modifiable pathways between stress burden and cognitive health disparities., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Aims/hypothesis: Type 1 diabetes increases CHD risk. We examined the use of the American Heart Association's cardiovascular health metrics (blood pressure, total cholesterol, glucose/HbA 1c , BMI, physical activity, diet, smoking) to predict incidence of CHD among individuals with type 1 diabetes, with the hypothesis that a better American Heart Association health metric profile would be associated with lower incident CHD., Methods: Prevalence of the seven cardiovascular health metrics was determined using first and second visits from adult participants (mean age 28.6 years) in the Epidemiology of Diabetes Complications prospective cohort study of childhood-onset type 1 diabetes. An ideal metric score (0-7) was defined as the sum of all metrics within the ideal range, and a total metric score (0-14) was calculated based on poor, intermediate and ideal categories for each metric. Incident CHD development (medical record-confirmed CHD death, myocardial infarction, revascularisation, ischaemic electrocardiogram changes or Epidemiology of Diabetes Complications physician-determined angina) over 25 years of follow-up was examined by metric scores., Results: Among 435 participants, BMI, blood pressure, total cholesterol and smoking demonstrated the highest prevalence within the ideal range, while diet and HbA 1c demonstrated the lowest. During 25 years of follow-up, 177 participants developed CHD. In Cox models, each additional metric within the ideal range was associated with a 19% lower risk (p = 0.01), and each unit increase in total metric score was associated with a 17% lower risk (p < 0.01) of CHD, adjusting for diabetes duration, estimated glomerular filtration rate, albumin excretion rate, triacylglycerols, depression and white blood cell count., Conclusions/interpretation: Among individuals with type 1 diabetes, higher cardiovascular health metric scores were associated with lower risk of incident CHD. The American Heart Association-defined cardiovascular health metrics provide straightforward goals for health promotion that may reduce CHD risk in the type 1 diabetes population. Graphical abstract.

Objective: This prospective, longitudinal study explored the impact of a continuing education class on librarians' knowledge levels about and professional involvement with systematic reviews. Barriers to systematic review participation and the presence of formal systematic review services in libraries were also measured., Methods: Participants completed web-based surveys at three points in time: pre-class, post-class, and six-months' follow-up. Descriptive statistics were calculated for demographics and survey questions. Linear mixed effects models assessed knowledge score changes over time., Results: Of 160 class attendees, 140 (88%) completed the pre-class survey. Of those 140, 123 (88%) completed the post-class survey, and 103 (74%) completed the follow-up survey. There was a significant increase ( p <0.00001) from pre-class to post-class in knowledge test scores, and this increase was maintained at follow-up. At post-class, 69% or more of participants intended to promote peer review of searches, seek peer review of their searches, search for grey literature, read or follow published guidelines on conduct and documentation of systematic reviews, and ask for authorship on a systematic review. Among librarians who completed a systematic review between post-class and follow-up, 73% consulted published guidelines, 52% searched grey literature, 48% sought peer review, 57% asked for authorship, and 70% received authorship., Conclusions: Attendance at this continuing education class was associated with positive changes in knowledge about systematic reviews and in librarians' systematic review-related professional practices. This suggests that in-depth professional development classes can help librarians develop skills that are needed to meet library patrons' changing service needs., (Copyright: © 2020, Authors.)

Murine calvariae pre-osteoblasts (MC3T3-E1), grown in a novel bioreactor, proliferate into a mineralizing 3D osteoblastic tissue that undergoes progressive phenotypic maturation into osteocyte-like cells. Initially, the cells are closely packed (high cell/matrix ratio), but transform into a more mature phenotype (low cell/matrix ratio) after about 5 mo, a process that recapitulates stages of bone development observed in vivo. The cell morphology concomitantly evolves from spindle-shaped pre-osteoblasts through cobblestone-shaped osteoblasts to stellate-shaped osteocyte-like cells interconnected by many intercellular processes. Gene-expression profiles parallel cell morphological changes, up-to-and-including increased expression of osteocyte-associated genes such as E11, DMP1, and sclerostin. X-ray scattering and infrared spectroscopy of contiguous, square centimeter-scale macroscopic mineral deposits are consistent with bone hydroxyapatite, showing that bioreactor conditions can lead to ossification reminiscent of bone formation. Thus, extended-term osteoblast culture (< or =10 mo) in a bioreactor based on the concept of simultaneous growth and dialysis captures the full continuum of bone development otherwise inaccessible with conventional cell culture, resulting in an in vitro model of osteogenesis and a source of terminally differentiated osteocytes that does not require demineralization of fully formed bone.

Introduction: Cardiac resynchronization therapy (CRT) or biventricular pacing (BVP) is becoming an important treatment option in patients with severe congestive heart failure (CHF) and electrical dyssynchrony. When combined with implantable cardioverter-defibrillator (ICD) therapy, cardiac resynchronization therapy with a defibrillator (CRT-D) has been shown to improve quality of life, functional class, and, most recently, survival. However, left ventricular (LV) stimulation in the form of BVP in patients at high risk of developing ventricular tachyarrhythmias has raised concerns that BVP may be proarrhythmic. We describe the incidence, clinical characteristics, and management in a series of patients who developed ventricular tachycardia storm (VTS) after initiation of BVP., Methods and Results: Clinical data on all patients undergoing CRT-D were collected prospectively. VTS occurred in eight of 191 (4%) patients and was characterized by recurrent sustained monomorphic ventricular tachycardia (MMVT) with a single morphology. All patients with VTS were men (seven with ischemic heart disease, one with nonischemic cardiomyopathy) with a remote (5 +/- 2 years) history of MMVT. VTS developed a mean of 16 +/- 12.5 days after initiation of BVP. All patients presented with palpitations and/or decompensated CHF. VTS was refractory to intravenous antiarrhythmic medication and was managed by turning off LV pacing and/or radiofrequency catheter ablation and long-term oral antiarrhythmic therapy. Despite elimination of VT, presenting with VTS carried a poor prognosis in that all eight patients subsequently developed refractory CHF., Conclusions: VTS with recurrent MMVT can occur after initiation of BVP. Patients present with decompensated CHF and are best managed by either turning off LV pacing or radiofrequency catheter ablation (RFA) in combination with long-term antiarrhythmic medication. Despite eliminating MMVT, most patients have poor outcomes.

Purpose: After menopause, leisure physical activity (PA) levels seem to decline for reasons that are not completely understood. This study examines the associations between PA, lapses in PA, and psychosocial factors in early postmenopausal women., Methods: This cross-sectional analysis included 497 women from the Women on the Move through Activity and Nutrition study. PA was assessed with a past-year, interviewer-administered Modifiable Activity Questionnaire. Measures of activity lapses of >or= 2 wk in the past 6 months, exercise decision making, processes of change, and self-efficacy were collected along with Beck Depression Inventory, State-Trait Anxiety Inventory, Cohen Perceived Stress Scale, and Short Form-36., Results: Mean age of participants was 56.9 yr. Compared with less active women, women with significantly higher activity levels reported greater exercise self-efficacy (r = 0.31), more frequent use of behavioral exercise processes of change (r = 0.31), greater perceived benefits for PA (r = 0.22), and better physical quality of life (r = 0.16) (all P < 0.001). Women reporting no activity lapses had higher reported activity levels than regularly active women with lapses or occasionally active women with lapses (P < 0.0001 for trend). Of the women who reported lapses, 24% reported low self-confidence, 43% reported difficulty controlling their weight, and 55% reported difficulty maintaining their diet when they lapsed from PA. Thirty-nine percent of women reporting lapses did not resume PA (i.e., relapsed to inactivity). Higher anxiety and depressive symptoms, and less frequent use of behavioral exercise processes of change, were associated with relapse to inactivity., Conclusions: Future interventions for early postmenopausal women should consider psychosocial factors when attempting to encourage and maintain higher levels of PA. Addressing and preventing PA lapses may help to achieve PA goals in this population.

Background: Concern about the potential risks associated with hormone replacement therapy (HRT) has left post-menopausal women and healthcare providers searching for safe and effective means for cardiovascular disease (CVD) risk factor reduction., Methods: The Woman On the Move through Activity and Nutrition study is a 5-year clinical trial (2002-2006) designed to test whether a lifestyle intervention will reduce measures of subclinical CVD. Participants were randomized at baseline to a health education or lifestyle change group. The impact of lifestyle intervention on CVD risk factors was examined in 240 women who were initially on HRT at baseline and either continued (n = 110) or discontinued (n = 130) by 18 months., Results: The lifestyle-change group significantly decreased weight, body mass index, waist circumference (all p<0.0001), total cholesterol (p=0.02), and LDL cholesterol (LDL-C) (p= 0.01), improved fat intake (p<0.0001), and increased leisure physical activity (p=0.005) when compared with the health education group. HRT discontinuation resulted in increased total cholesterol (p=0.04) and LDL-C (p=0.009). CVD risk factor changes were further explored by the HRT group, stratified by randomized group assignment. Within the health education arm, HRT discontinuers averaged over a 22-mg/dL increase in total cholesterol and LDL-C, while HRT continuers averaged less than 4 mg/dL (p=0.004 and 0.002, respectively). No such differences were noted in the lifestyle-change group (p=0.78 and 0.90, respectively)., Conclusions: Lifestyle modification was effective for CVD risk factor reduction in post-menopausal women. HRT discontinuation resulted in increased total cholesterol and LDL-C, which were successfully attenuated by a lifestyle intervention incorporating weight loss, physical activity, and dietary modification.

We assessed the predictive validity of attention-deficit/hyperactivity disorder (ADHD) in 20 girls and 98 boys who met the Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for ADHD at 4 to 6 years of age compared to 24 female and 102 male comparison children. Over the next 8 years, both girls and boys who met criteria for ADHD in Year 1 exhibited more ADHD symptoms and impairment than same-sex comparison children. Effect sizes were consistently large, indicating that the diagnosis of ADHD at 4 to 6 years of age has predictive validity for both sexes. Both girls and boys with ADHD in Year 1 also exhibited higher levels of symptoms of conduct disorder, major depression, and anxiety disorders in early adolescence than same-sex comparison children, controlling levels of the same symptoms in Year 1. This indicates both substantial homotypic and heterotypic continuity for ADHD in both sexes, but significant interactions with time indicated that childhood ADHD predicts more steeply rising symptoms of anxiety and depression during early adolescence in girls than in boys.

Introduction: Radiofrequency catheter ablation can effectively treat patients with refractory atrial fibrillation (AF). Very late AF recurrence (> or = 12 months post-ablation) is uncommon and may represent a unique patient cohort., Methods and Results: A nested case-control study was performed in the cohort who underwent AF ablation at the University of Pennsylvania to characterize patients who develop very late AF recurrence after ablation. The procedure consisted of isolation of pulmonary veins (PVs) demonstrating triggers and elimination of non-PV triggers initiating AF. Twenty-seven (7.9%) patients with very late recurrence were compared to 219 patients without recurrence and > or = 12 months of follow-up. The mean age was 54.6 +/- 11.3 years and 79% were men. Very late recurrence patients more likely weighed >200 lbs (70% vs 55%, P = 0.01); during initial ablation had fewer PVs isolated (2.8 +/- 1.1 vs 3.3 +/- 1.0, P = 0.03); and were less likely to have right inferior PV isolation (37% vs 61%, P = 0.02), less likely to have isolation of all PVs (30% vs 56%, P = 0.01), and more likely to have non-PV triggers (30% vs 11% OR 3.4(95% CI, 1.3-8.7), P = 0.01). PV reconnectivity and new triggers were found in the majority of patients with very late recurrence of AF who underwent repeat ablation., Conclusion: Very late recurrence of AF more likely occurred in patients >200 lbs who demonstrated non-PV triggers and did not undergo right inferior PV isolation. The majority of patients undergoing repeat ablation for very late recurrence demonstrated PV reconnectivity and new non-PV and PV triggers not observed during the initial ablation.

Purpose: The purpose of these analyses was to describe the levels and types of activity in relationship to current marital status among older adults and determine if the physical activity level of the husband was related to the physical activity level of his wife., Methods: Participants included 3075 well-functioning white and black men and women aged 70-79 yr with further examination of 345 spousal pairs. Marital status was self-reported and participants were grouped as married versus not married. Based on responses to a leisure-time questionnaire, total physical activity was calculated and participants were classified as low or high active. Descriptive statistics were used to describe level and proportions of type of activity by marital status. Logistic regression was used to determine if marital status was an important determinant of physical activity participation. Regression models were adjusted for demographics, body mass index (BMI), and chronic disease conditions., Results: When compared with their single counterparts, married men reported higher median levels of exercise participation (P = 0.008) and married women reported higher levels of total (P < 0.0001) and nonexercise activity (P < 0.0001) with a trend toward higher exercise participation (P = 0.05). In spousal pairs, compared with men in the low active group, highly active men were almost three times as likely (OR = 2.97; 95% CI = 1.73, 5.10) to have a similarly active spouse. The model only modestly attenuated when adjusted for age, BMI, and health status of the husband [OR = 2.49 (1.41, 4.42)]., Conclusions: Marital status and spousal physical activity (PA) levels are important determinants for PA participation among older adults.

Background: Regular physical activity is known to help prevent chronic disease and promote healthy aging. Yet, most older women are not regularly active. This study attempts to identify objectively measured attributes of the neighborhood environment that may be associated with physical activity levels in older women., Methods: Sociodemographics and physical activity level, as measured by pedometer, were assessed in 158 overweight Caucasian and African-American postmenopausal women from southwestern Pennsylvania at the baseline evaluation of a randomized clinical trial in 2002-2003. Geographic information systems technology was used to obtain neighborhood-level data, including neighborhood socioeconomic status (SES) indicators, the median year that homes were built (as a proxy measure for urban form), and proximity to businesses and facilities. Multiple linear regression was used to test associations between individuals' physical activity level and neighborhood characteristics., Results: After controlling for individual age, race/ethnicity, education, smoking status, and body mass index, indicators of low neighborhood SES, living in a neighborhood with homes built between 1950 and 1969 (representing an urban form that is more pedestrian-friendly than after 1969), and living within walking distance (1500 m) of specific types of businesses and facilities were positively associated with individuals' physical activity level measured by pedometer (p <0.05)., Conclusions: Results suggest that certain aspects of the neighborhood environment may have an important influence on the physical activity levels of postmenopausal women. Results warrant future research to clarify the role of these environmental attributes in other populations.

Purpose: To examine the relationship between physical activity and (1) convenience of destinations, measured by whether destinations (such as a park, trail, businesses, and services) are within walking distance of the home, and (2) participants' perception of the quality of their neighborhood surroundings for walking, captured with a global neighborhood "walkability" rating., Design: Cross-sectional analysis of data obtained in 1999., Setting: Community in southwest Pennsylvania., Subjects: Older Caucasian women (n = 149, mean age = 74.2 years). Response rate = 79%., Measures: Walking levels, leisure-time physical activity, and features of the neighborhood environment were measured with interviewer-administered questionnaires. Physical activity was also measured objectively with a pedometer., Results: Living within walking distance (defined as within a 20-minute walk of home) of a park; biking or walking trail; or department, discount, or hardware store was related to higher pedometer readings (p < .01). In addition, there was a positive trend between the sum of destinations within walking distance of home and activity levels measured by pedometer and questionnaire (p < .01). There was also a positive trend between participants' neighborhood "walkability" rating and activity levels measured by pedometer and questionnaire (p < .01)., Conclusion: These findings suggest that the ability to make utilitarian walking trips from home and the perception of having favorable neighborhood surroundings for walking are associated with increased physical activity levels in older women.