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Intolerance of uncertainty and maladaptive information seeking are linked in many models of wony and clinical anxiety. This study aimed to examine children's use of information to regulate negative arousal associated with uncenainty in an exciting or threatening pretend play context. Children were presented with a positively or negatively valenced imaginary creature in a closed box. They were then given visual, verbal, or no reminder as to the pretend status of the entity. Children in the verbal and no information conditions were significantly more likely to spontaneously check as to the presence or absence of the creature during the game. These results confirm that some children react with more intense wony in situations of uncertainty, and that the type of information provided to children is important in assisting them to regulate that emotional response. The study provides analogue experimental support for the value in clinical contexts of direct experience in order to reduce uncenainty regarding imagined possibilities, and, in turn, worrying. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this investigation was to determine whether whole body composition could be estimated in tall individuals using summed measures from two partial DXA scans. METHODS: Using a pencil-beam DXA, a convenience sample of young individuals (N = 19) were scanned three times. Two partial scans of the upper and lower body were combined to predict bone area, bone mineral content (BMC), bone mineral density (BMD), fat mass (FM), fat-free soft tissue mass (FFST), and percent fat (%Fat), from a complete whole body scan. Two different methods, dividing the body at the hip (HIP) or at the top of the shoulders (NECK), were used to determine optimal method of summing. RESULTS: There were no significant differences in BMC, BMD, FM, FFST, and %Fat comparing the complete scan and summed scans regardless of summing method. There was excellent agreement between complete and summed values of BMC, BMD, FM, FFST, and %Fat values as indicated by regression analysis (r value range: 0.992-1.00) and nonsignificant intercepts. Bland-Altman plot analysis indicated that a small systemic bias occurred in estimates of FM and %Fat using the HIP method and FFST using the NECK method; however, all biases were negligible. CONCLUSIONS: The findings suggest that accurate estimates of whole body composition from a complete scan can be obtained by summing two partial scans. Although both summing methods provide good estimates of body composition, dividing the body at the neck provides more accurate estimates of bone and soft tissue composition than dividing the body at the hip. [ABSTRACT FROM AUTHOR]

Many authors have emphasized the importance of cultural sensitivity in delivering mental health services to immigrants. Self-construal and ethnic identity are important components of the acculturative process, which may be useful in the diagnosis, assessment, and treatment of immigrant clients. This study investigated the self-construal and ethnic identity of male Arabic immigrants in the United States. Based on pilot interview data and existing measures, a Male Arabic Ethnic Identity Measure (MAEIM) was developed using a sample of 115 male Arabic immigrants. Satisfactory reliability is reported for the overall MAEIM as well as its four factor analytically derived scales, including Religious-Family Values, Sense of Belonging/Ethnic Pride, Friendship, and Ethnic Arabic Practices. Arabs reporting a strong Arabic ethnic identity had a more salient interdependent sense of self than those reporting a weaker ethnic identity. Independent self-construal was not significantly correlated with any of the individual MAEIM scales or the total MAEIM scale. The implications of these findings for research and clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Background: Most methods available to clinicians for estimating body-composition changes have been validated against estimates from densitometry, based on a 2-component (fat mass and fat-free mass) model. Objective: Estimates of changes in percentage body fat (%BF) from dual-energy X-ray absorptiometry (DXA), skinfold thicknesses (SFTs), bioelectrical impedance analysis (BIA), and body mass index (BMI; in kg/m2) were compared with estimates from a 4-component (fat, water, mineral, and protein) model (%BFd,w,m), a more accurate method. Design: Determinations of body density from hydrostatic weighing, body water from deuterium dilution, bone mineral and %BF from whole-body DXA, resistance from BIA, and anthropometric measures were made in 27 obese women (BMI: 31.1 +/= 4.9) assigned to 1 of 3 groups: control (C; n = 9), diet only (DO; n = 9), or diet plus aerobic exercise (DE; n = 9). Results: After the 16-wk intervention, changes in body mass (BM) averaged 0.5 +/= 2.0, -7.2 +/= 7.4, and -4.0 +/= 3.3 kg and changes in %BFd,w,m averaged 2.1 +/= 1.0%, -1.2 +/= 1.4%, and -2.4 +/= 1.6% in the C, DO, and DE groups, respectively. Compared with changes in %BFd,w,m, the errors (SD of bias) for estimates of changes in %BF by DXA, BIA, SFTs, and BMI were similar (range: +/= 2.0-2.4% of BM). BIA, SFTs, and BMI provided unbiased estimates of decreases in %BFd,w,m, but DXA overestimated decreases in %BF in the DO and DE groups. Conclusions: DXA, BIA, SFTs, and BMI are comparably accurate for evaluating body-composition changes induced by diet and exercise interventions; however, small changes in %BF may not be accurately detected by these clinical methods. Copyright 1999 American Society for Clinical Nutrition [ABSTRACT FROM AUTHOR]

A 30-year-old African female with established acquired immunodeficiency syndrome (AIDS) and no history of diabetes, presented in severe diabetic ketoacidosis (DKA). Blood pH was 6.96, serum bicarbonate 5 mmol/l, plasma glucose (PG) 33.0 mmol/l, and urine heavily positive for ketones. She responded to standard treatment and was established on twice-daily subcutaneous insulin. Four months later her insulin was stopped because of hypoglycaemic attacks on small doses. A glucose tolerance test (GTT) at 6 months postdiagnosis was normal (fasting PG 4.4 mmol/l and 2 h PG 7.5 mmol/l), and at 12 months random PG was 4.1 mmol/l and HbA1c 4.3%. The onset of her apparent Type 1 diabetes coincided with an HIV-associated cytomegalovirus (CMV) infection, and a reversible 'CMV insulitis' may be an explanation. Alternatively, the patient may have had what has recently been described as 'atypical diabetes' in African or Afro-Caribbean diabetic patients. Here resolution of diabetes may occur after presentation, though complete return to normoglycaemia after true DKA is very unusual. [ABSTRACT FROM AUTHOR]

This study examined the relationships among physical activity, glucocorticoid use, body composition, and bone health in ambulatory women with multiple sclerosis (MS). Twenty-nine white women (mean +/- standard deviation: age 45.1 +/- 9.0 yr, Expanded Disability Status Scale 2.9 +/- 1.2) diagnosed with MS were assessed for whole body (WB), proximal femur (PF) and lumbar spine (LS) bone status (bone mineral content [BMC], bone mineral density [BMD], and quantitative ultrasound index [QUI] by calcaneal quantitative ultrasound) and body composition by dual energy X-ray absorptiometry; for physical activity by pedometer and accelerometer; and for glucocorticoid medication exposure by self-report. Accelerometer counts were related to PF BMC (r = 0.50, p = 0.010) when we controlled for age, fat and lean mass, MS disease duration, and glucocorticoid use. Glucocorticoid use was not associated with bone measures. When we controlled for age and fat mass, lean mass was associated with WB BMC (r = 0.41, p = 0.04), PF BMC (r = 0.61, p = 0.001), and speed of sound (SOS) (r = 0.44, p = 0.02), whereas fat mass was associated with SOS and QUI (r =0.43, p = 0.03, and r = 0.44, p = 0.02, respectively). Lean mass was an independent predictor of WB BMC ( p = 0.04) and PF BMC ( p = 0.001), whereas fat mass was an independent predictor of LS BMD (p = 0.05). In conclusion, physical activity and lean mass are associated with femoral bone mass in women with MS who are ambulatory. [ABSTRACT FROM AUTHOR]

Objectives: To identify the signs and symptoms that people living with acetabular hip dysplasia (AHD) describe and to provide an aid for translating the findings into practice., Methods: A three-phased mixed methods study. Phase 1 employed an open-question online survey that enabled people with AHD (aged ≥16 years) to describe features associated with their condition. Responses were thematically analysed. A Phase 2 survey used these themes to establish how common those features were. Phase 3 created a mnemonic that prompts clinicians to suspect AHD., Results: Ninety-eight respondents completed Phase 1 and sixty-two completed Phase 2. From the responses, five themes were identified: Demographic and Diagnostic Profile; Characteristics of Posture and Gait; Pain; Childhood Hip and Family History; and Hip Joint Characteristics. Within these themes, 19 common signs and symptoms were reported, represented by the ALPHA mnemonic. ALPHA describes a young age at onset of problems (Age), a limp (Limp), progressing pain (Pain), a history of childhood and family hip anomalies (History) as well as hip joint hypermobility and instability (Articulation)., Conclusion: The findings extend current understanding of AHD indicators. ALPHA alerts clinicians to suspect a diagnosis of AHD. ALPHA may facilitate timelier referral of patients for diagnostic X-Ray and appropriate treatment. Future studies should evaluate its clinical utility., (Copyright © 2024. Published by Elsevier Ltd.)

Increasing interest in measuring key components of the 24 h activity cycle (24-HAC) [sleep, sedentary behavior (SED), light physical activity (LPA), and moderate to vigorous physical activity (MVPA)] has led to a need for better methods. Single wrist-worn accelerometers and different self-report instruments can assess the 24-HAC but may not accurately classify time spent in the different components or be subject to recall errors. Objective . To overcome these limitations, the current study harmonized output from multiple complimentary research grade accelerometers and assessed the feasibility and logistical challenges of this approach. Approach . Participants ( n = 108) wore an: (a) ActiGraph GT9X on the wrist, (b) activPAL3 on the thigh, and (c) ActiGraph GT3X+ on the hip for 7-10 d to capture the 24-HAC. Participant compliance with the measurement protocol was compared across devices and an algorithm was developed to harmonize data from the accelerometers. The resulting 24-HAC estimates were described within and across days. Main results . Usable data for each device was obtained from 94.3% to 96.7% of participants and 89.4% provided usable data from all three devices. Compliance with wear instructions ranged from 70.7% of days for the GT3X+ to 93.2% of days for the activPAL3. Harmonized estimates indicated that, on average, university students spent 34% of the 24 h day sleeping, 41% sedentary, 21% in LPA, and 4% in MVPA. These behaviors varied substantially by time of day and day of the week. Significance . It is feasible to use three accelerometers in combination to derive a harmonized estimate the 24-HAC. The use of multiple accelerometers can minimize gaps in 24-HAC data however, factors such as additional research costs, and higher participant and investigator burden, should also be considered., (Creative Commons Attribution license.)

Background: Families experience financial burden and household material hardship (HMH) after a pediatric cancer diagnosis. This study investigates types of financial assistance and other financial coping strategies (FCS) adopted by families during the first year after diagnosis., Methods: Retrospective survey of caregivers of pediatric patients diagnosed with cancer from 2015 to 2019. The survey collected data on demographics, diagnosis, income, HMH, and private, hospital, and government assistance received and other FCS adopted after diagnosis. Bivariate and multivariable logistic regressions were used to analyze FCS by income. Subgroup analysis of families experiencing HMH was used to identify predictors of receiving government assistance., Results: Of 156 respondents, 52% were low-to-middle income, 29% had public insurance, and 22% had non-English language preference. Low-to-middle-income families were more likely to incur debt (odds ratio [OR] 6.24, p < .001) and reduce consumption (OR 2.16, p = .03) than high-income families, and this association persisted in multivariable analysis. Among families with housing, food, and energy insecurity, 40%, 70%, and 39%, respectively, received hospital or government assistance specific to the experienced hardship. In subgroup analysis of families with HMH, after adjusting for income and other confounders, non-English language preference was associated with lower odds of receiving government assistance., Conclusions: After a pediatric cancer diagnosis, low-to-middle-income families are more likely to incur debt than high-income families. Most families experiencing food insecurity received some food assistance, while housing and energy assistance were less common. Future studies should investigate methods to equitably improve access to financial assistance and minimize long-term financial consequences., (© 2024 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Increased dissemination of the CDC's Diabetes Prevention Program (DPP) is imperative to reduce type 2 diabetes. Due to its nationwide reach and mission to improve health, Cooperative Extension (Extension) is poised to be a sustainable DPP delivery system. However, research evaluating DPP implementation in Extension remains scant. Extension professionals delivered the DPP in a single-arm hybrid type II effectiveness-implementation study. Semi-structured interviews with Extension professionals were conducted at three time points. The Consolidated Framework for Implementation Research (CFIR) guided interview coding and analysis. Constructs were rated for magnitude and valence and evaluated as facilitators or barriers of RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) outcomes. The program reached 119 participants, was adopted by 92% (n = 12/13) of trained Extension professionals and was implemented according to CDC standards: all programs exceeded the minimum 22-session requirement (26 ± 2 sessions). The program was effective in achieving weight loss (5.0 ± 5.2%) and physical activity (179 ± 122 min/week) goals. At post-intervention, eight professionals (67%) had begun or planned to maintain the intervention within the next 6 months. Several facilitators were identified, including Extension leadership structure, organizational compatibility, and technical assistance calls. Limited time to recruit participants was the primary barrier. Positive RE-AIM outcomes, facilitated by contextual factors, indicate Extension is an effective and sustainable DPP delivery system. Extension and other DPP implementers should plan strategies that promote communication, the program's evidence-base, recruitment time, and resource access. Researchers should explore DPP implementation in real-world settings to determine overall and setting-specific best practices, promote intervention uptake, and reduce diabetes., (© 2023. The Author(s).)

Objective: The effectiveness of the National Diabetes Prevention Program (DPP) in improving diet quality (DQ) in community settings is largely unknown. This study aimed to evaluate the DQ changes of Extension DPP participants., Methods: A single-group, repeated-measures design was used to evaluate an Extension-implemented DPP using the PreventT2 curriculum. Participants were overweight adults with or at high risk for prediabetes (n = 88). Weight and DQ (Healthy Eating Index-2015, Dietary Screener Questionnaire) were evaluated using mixed-effects regression., Results: There was no change in the Healthy Eating Index-2015 total score. Predicted fiber, fruit, and vegetable intake increased (P < 0.05) but remained below recommendations., Conclusions and Implications: Clinically meaningful DQ changes of Extension DPP participants were limited. The effect of the DPP on DQ in Extension and other implementation settings should be evaluated through randomized controlled trials. Diabetes Prevention Program curriculum revisions that include more specific dietary goals and educational tools may promote greater DQ changes in DPP participants., (Copyright © 2023 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: Based on previous reports of disparities in financial burden following a cancer diagnosis, this study aims to characterize mechanisms of disparities experienced by caregivers of children with cancer, including the impact of work flexibility and social support., Methods: Cross-sectional survey (in English or Spanish) of caregivers of children with cancer that assessed household material hardship (HMH), financial toxicity, and income change., Results: Of 156 caregivers surveyed, 32% were Hispanic and 32% were low income. Hispanic caregivers were more likely to report HMH and financial toxicity compared to non-Hispanic White and Asian (HMH: 57% vs. 21% vs. 19%, p < .001; financial toxicity: 73% vs. 52% vs. 53%, p = .07). Low- and middle-income caregivers were more likely to experience HMH and financial toxicity compared to high-income caregivers (HMH: 68% low vs. 38% middle vs. 8.7% high, p < .001; financial toxicity: 81% vs. 68% vs. 44%, p < .001). All income categories demonstrated significant increases in HMH 1 year after diagnosis. Seventeen percent reported more than 40% income loss, more of whom were low income than high income (27% vs. 12%, p = .20). Work flexibility and social support were associated with income and financial toxicity., Conclusion: HMH, financial toxicity, and income loss are prevalent after a child's cancer diagnosis, suggesting that screening should be incorporated into routine care. This financial burden disproportionately affects low-income and Hispanic caregivers. Further research is needed to elucidate the roles of work flexibility and social support, how safety net services are utilized by families, and how best to support families with HMH., (© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)

Background: Maximizing independence and function post-stroke are two common therapy goals. Rate of torque development in lower-extremity muscles was recently reported to be associated with walking speed; however, trainability and subsequent effect on gait is unknown. This study aimed to determine effect of power training on paretic and non-paretic limb torque parameters, spatiotemporal gait parameters, and walking speed in chronic stroke survivors., Methods: Individuals with chronic stroke (n = 22; 7 females; 62.7 ± 8.8 yrs) completed 24 progressive power-training sessions over 8 weeks with pre and post assessments. Knee extensor strength was assessed via dynamometry with torque parameters measured from maximal voluntary isometric contractions. Gait speed and spatiotemporal gait parameters were assessed via an instrumented gait mat, and a 6-min walk test was performed., Findings: Rate of torque development at 200 ms and peak torque improved 58.6% and 14.1%, respectively, in the quadricep of the paretic limb (p < 0.05); conversely the non-paretic limb was unchanged. On average, self-selected walking speed, fastest-comfortable walking speed, and 6-min walk test improved 21.7%, 21.1%, and 19.5%, respectively (all p < 0.05). Change in torque development at 100 ms in the quadricep of the non-paretic limb was positively associated with improvements in self-selected and fastest-comfortable walking speeds (both r = 0.70, p < 0.05) and 6-min walk (r = 0.78, p < 0.001)., Interpretations: These findings suggest power training may be an effective intervention for improving torque development in the quadricep of the paretic limb in individuals with chronic stroke. Further research to explore utility and mechanistic aspects of force development for gait function in chronic stroke survivors is warranted., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Chris M Gregory reports financial support was provided by National Institutes of Health., (Copyright © 2023. Published by Elsevier Ltd.)

Inadequate physical activity (PA), unhealthy weight status, prevalence of chronic conditions, and psychosocial distress are common in middle-aged women and are linked to reductions in well-being and quality of life. However, their potential interactive effects, specifically on sexual well-being and menopause-specific quality of life (MENQOL), have not been well characterized in postmenopausal women. PURPOSE: To determine if moderate-to-vigorous physical activity (MVPA) and adiposity (%Fat) influence sexual well-being and MENQOL outcomes, controlling for health status (chronic conditions; medications) and psychosocial well-being (depressive symptoms; perceived stress), in postmenopausal women. Postmenopausal women ( n  = 68, 58.6 ± 3.4 yr, 80.9 percent married/partnered, 51.5 percent overweight/obese, nonsmoking) were recruited through e-mail advertisements and flyers placed throughout the community. Participants were scheduled for two laboratory visits 7-10 days apart where they were objectively assessed for MVPA with accelerometers (in the interim), adiposity via dual-energy X-ray absorptiometry (DXA), and self-report questionnaires to determine health status, depressive symptoms, perceived stress, sexual well-being, and MENQOL. Lower MVPA and higher %Fat were associated with lower physical domain MENQOL (both r  = .27, p  < .05); health status and psychosocial well-being were not associated (all p  > .05). Hierarchical regression analyses revealed 1) greater number of chronic conditions and medications, and depressive symptoms scores predicted less favorable sexual well-being, independent of MVPA and %Fat (standardized β range =.22-.56, all p  < .05), 2) depression was most consistently associated with MENQOL (models p  ≤ .001), and 3) greater adiposity augmented the negative influence of depression on the physical domain of MENQOL (β = .40. p  = .002). CONCLUSIONS: PA may influence sexual well-being and MENQOL indirectly through positive impacts on adiposity, chronic conditions, and depressive symptoms in middle-aged postmenopausal women, a sector of the population often afflicted with compromised sexual well-being.

Exercise training (EX) and weight loss (WL) improve lower extremity physical function (LEPF) in older overweight women; however, effects on rate of torque development (RTD) are unknown. This study aimed to determine the effects of WL + EX or WL alone on RTD, and relatedly LEPF, in overweight older women. Leg strength was assessed using isokinetic dynamometry, and RTD was calculated (RTD200 = RTD at 200 ms, RTDPeak = peak RTD, T2P = time to 1st peak). LEPF was determined via clinical functional tasks. Women (n = 44, 69.1 ± 3.6 years, 30.6 ± 4.3 kg/m2) completed a 6-month trial in EX + WL or WL groups with similar weight loss (-9.8 ± 4.2%, p > .95). EX + WL had greater improvements in (a) most LEPF tasks (p < .001) and (b) RTD200, compared with WL (36% vs. -16%, p = .031); no other RTD parameters differed. Changes in RTD parameters and LEPF were not related (all p > .05). RTD is responsive to EX but is not associated with LEPF in older women.

Objective: To identify the sex-specific prevalence of metabolic syndrome (MetS) risk factors and their physiological, psychosocial, and behavioral correlates in a college-aged population. Participants and methods : Cross-sectional assessment of MetS risk factors and potential correlates occurred in 379 first-year students (aged 18.34 ± 0.49 years, 67.3% female). Multivariable linear regression assessed the relationships between potential correlates and continuous MetS risk scores, derived from principal component analysis. Results: MetS risk factors were present in 58.4% of females and 68.5% of males, with 2.4% and 3.2% having defined MetS. In females, percent body fat (β = 0.46, p  < 0.001), stress (β = 0.12, p  = 0.031), % kcal from sugar (β = 0.18, p  = 0.001), and moderate-to-vigorous physical activity (β=-0.12, p  = 0.036) were associated with risk score. Whereas, correlates in males included percent body fat (β = 0.54, p  < 0.001), C-reactive protein (β = 0.15, p  = 0.045), and AUDIT alcohol consumption score (β = 0.15, p  = 0.033). Conclusion: The sex-specific prevalence of MetS risk factors and correlates suggest that primary prevention strategies on college campuses should also follow a sex-specific approach.

Objective To compare physical activity (PA) behaviors and perceived benefits and barriers among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) and non-LGBTQ + college students. Participants : Participants were 406 college students. Methods: Surveys assessed PA behaviors and perceptions of PA among college students. Multivariate ANOVA assessed differences in PA behaviors and perceptions of PA. Results: LGBTQ + students (n = 71) engaged in 17% less aerobic PA and 42% less resistance training than their counterparts (n = 335; both p < .05). LGBTQ + students reported 6.5% lower total Exercise Benefits and Barriers Scale scores and 13.3% higher Barriers Scale scores (both p < .05). Conclusions: LGBTQ + college students are at higher risk of not meeting PA guidelines than non-LGBTQ + students. More perceived barriers and fewer perceived benefits to PA may contribute to this disparity. Identification of LGBTQ+-specific barriers to PA among college students is needed to inform programming to increase PA among this at-risk community.

Objective: To assess whether sex or school year influence physical activity and exercise (PA/EX) behaviors and perceived benefits and barriers of PA/EX among college students. Participants: Participants were 862 (78% female; 20.1 ± 1.4 years) college students. Methods: The International Physical Activity Questionnaire, Exercise Benefits and Barriers Scale, and resistance training (RT) questions were completed online. Results: Factorial ANOVA (sex x year) determined no significant interaction effects of sex and school year in behaviors or perceived benefits and barriers (all p  > .05). Males reported higher levels of PA/EX and RT than females ( p  < .05) with no differences by school year ( p  = .34). Benefits Scale scores and some of its subscales were higher for males and first-year students compared to females and third- and fourth-year students (all p  < .05). Conclusion: PA/EX promotion programs may need to be tailored differently based on sex and school year.

Background: Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes., Study Design and Methods: Dual-center, retrospective cohort study conducted over 6 months (March-August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of - 3 to - 5 or Riker Sedation-Agitation Scale of 1-3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days., Results: 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65-7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19., Conclusions: The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach., (© 2022. The Author(s).)

Pressure injuries (PIs) are common and costly complications in long-term care (LTC) residents. Educating and coaching certified nursing assistants (CNAs) to communicate early skin changes is a PI surveillance strategy that may influence PI outcomes. A communication guide related to Skin, Clean, Activity, and Nutrition was developed for CNAs to promote prompt upstream communication to licensed nurses. A pre-/post-intervention design measured PI knowledge and skills in 24 CNAs, and PI incidence was tracked over a 6-week time period. CNAs demonstrated improvement in their PI surveillance role, comfort in identifying and reporting skin changes, keeping skin clean and dry, and resident nutritional status. Baseline PI incidence of 9.6% decreased to 0% by Week 3, and no new PIs occurred over 6 weeks. CNAs developed role awareness and knowledge in primary PI surveillance and were instrumental in a team approach to decrease PIs in a LTC setting. [ Journal of Gerontological Nursing, 47 (8), 21-28.].

Community Health Workers (CHWs) are becoming essential members of the HIV workforce as emerging evidence demonstrates their effectiveness in engaging people with HIV into care and treatment. In 2018, among the estimated 37,000 persons who received an HIV diagnosis, the majority were from racial ethnic minority communities. CHWs serve as a bridge between the community and health care system and have the potential to address structural inequities and reduce the stigma, discrimination and other barriers that prevent people with HIV from seeking and staying in care and treatment. Effective CHW integration into the HIV primary care team requires a training and supervision system that is culturally responsive to the complex social and medical needs of people with HIV. This article describes a comprehensive training approach and curricula for CHWs and supervisors and its impact on the health care team. Grounded in a Popular Education model and using the CHW core consensus competency (C3) framework, a team of experts in HIV, training and supervision, including CHWs working in HIV care and treatment developed an 80-h CHW and 20-h supervisor curricula. The trainings were delivered via in-person and virtual sessions over the course of 2 years. Using a mixed method evaluation, 23 CHWs and 22 supervisors across 10 clinic sites in eight states participated in the training sessions. Measures included knowledge and confidence related to HIV-specific content, supporting clients with managing stigma and discrimination, ability to communicate with other team members and helping clients navigate the services system. CHWs reported improved skills with documentation in the electronic health record, helping clients with treatment adherence challenges and educating on lab results. Supervisors reported learning strategies for assigning clients to CHWs, self-care techniques, providing strengths-based feedback, and mentoring and coaching. The participatory practice-based curricula allowed supervisors and CHWs to share experiences and solicit input from peers for problem resolution and implementation of new policies and practices. This training approach focused on HIV specific content with core competency training could serve as a model for CHWs working in primary care settings and with populations experiencing multiple chronic health conditions and social needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Rajabiun, Baughman, Sullivan, Poteet, Downes, Davich, Phillips, Jackson, Miles, Drainoni, Evans, Bachman and Sprague Martinez.)

A colovesical fistula (CVF) is a pathological connection between the colon and the urinary bladder. Although they are uncommon, consequences can severely affect quality of life and mortality. Diverticula are the most common cause of CVF. This case details a patient's CVF diagnosis in the emergency department with unremitting gastrointestinal and urinary symptoms. A 78-year-old male patient with recent hospitalization for stroke and left carotid endarterectomy complicated by urinary retention treated with a Foley catheter presented to the Emergency Department with a chief complaint of hematuria and unremitting diarrhea. Foley exchange resulted in improved urinary retention and diarrhea during hospitalization. One day following hospital discharge, the patient presented again with a blocked Foley catheter and diarrhea. Foley irrigations resulting in near immediate diarrhea and lack of bladder filling on bladder scan portended to a diagnosis of colovesical fistula despite no history diverticula or colon malignancy. An abdominal/pelvic computed tomography scan and cystogram confirmed a colovesical fistula. This case highlights the need for consideration of colovesical fistula in a seemingly simple ED complaint of urinary retention. It is prudent to closely follow bladder scan volumes when flushing a Foley catheter. Given the significant comorbidities such as urosepsis and health care impact of repeat ED visits and hospitalizations, CVF can and should be entertained and rapidly diagnosed in the emergency department. Our case highlights the need for consideration of a vesico-colic fistula despite the absence of initial relevant risk factors., Competing Interests: Declaration of Competing Interest The authors have no outside support information, conflicts or financial interest to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Obesity negatively affects lower extremity physical function (LEPF) in older adults. Exercise and a higher protein diet are both known to positively and independently affect body composition, muscle strength, and LEPF during weight loss; however, their potential interactive effects have not been well characterized in older women., Purpose: The aim of this study was to determine the relative efficacy of a higher protein diet with or without exercise to improve body composition, muscle strength, and LEPF in older inactive overweight/obese women after weight loss., Methods: Postmenopausal women (body mass index = 31.1 ± 5.1 kg·m, 69.2 ± 3.6 yr) completed a 6-month weight loss program after randomization to three groups (n = 72 randomized; 15% dropout): 1) higher protein diet (PRO, ~30% energy from protein; n = 20), 2) PRO plus exercise (PRO + EX; n = 19), or 3) a conventional protein control diet plus EX (CON + EX, ~18% energy from protein; n = 22). EX was supervised, multicomponent (aerobic, muscle strengthening, balance, and flexibility), and three sessions per week. Body composition was measured via dual-energy x-ray absorptiometry, leg strength by isokinetic dynamometry, and LEPF via 6-min walk, 8-ft up and go, and 30-s chair stand tests., Results: Changes in weight (-7.5 ± 4.1 kg; -9.2% ± 4.8%), fat mass, and leg lean mass did not differ among groups (all P > 0.50). Despite weight loss, muscle strength improved in the exercise groups (PRO + EX and CON + EX) but it declined in the PRO group (P = 0.008). For all LEPF measures, the PRO group had attenuated improvements compared with both PRO + EX and CON + EX (all P < 0.01)., Conclusion: Exercise during weight loss is critical to preserve strength and enhance LEPF; however, a higher protein diet does not appear to influence body composition, muscle strength, or LEPF changes when combined with multicomponent exercise.

Background & Aims: Overall diet quality is a key predictor of disease risk and mortality. Diets higher in animal protein have been associated with increased disease risk and all-cause mortality. However, the source of protein consumed will inevitably influence the intake of other macronutrients and micronutrients which can also play a role in the onset of disease. The aim of the present study was to assess the relationship between animal and plant protein intake and overall diet quality in young adult females and males., Methods: Dietary intake was assessed via 3-day food log (n = 150; 53% females) and data were analyzed using the Nutrition Data Systems for Research (NDSR)., Results: Females and males consuming <70% of their protein from animal sources had higher scores on a modified Healthy Eating Index (HEI) compared those consuming >70% of their protein from animal sources. Males scored lower than females on the modified HEI regardless of protein source intake variation., Conclusions: Our findings suggest that overall diet quality differs with varying protein source consumption and eating <70% of protein from animal sources might lead to a better score on the HEI. Future research investigating protein source and disease risk should examine overall dietary quality as a potential effect modifier., Competing Interests: Conflict of Interest The authors declare no conflict of interest., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Muscle mass is a commonly cited mediator of the relationship between physical activity (PA) and bone, representing the mechanical forces generated during PA. However, neuromuscular properties (eg, peak force) also account for unique portions of variance in skeletal outcomes. We used serial multiple mediation to explore the intermediary role of muscle mass and force in the relationships between cortical bone and moderate-to-vigorous intensity PA (MVPA). In a cross-sectional sample of young adults (n = 147, 19.7 ± 0.7 years old, 52.4% female) cortical diaphyseal bone was assessed via peripheral quantitative computed tomography at the mid-tibia. Peak isokinetic torque in knee extension was assessed via Biodex dynamometer. Thigh fat-free soft tissue (FFST) mass, assessed via dual-energy X-ray absorptiometry, represented the muscular aspect of tibial mechanical forces. Habitual MVPA was assessed objectively over 7 days using Actigraph GT3X+ accelerometers. Participants exceeded MVPA guidelines (89.14 ± 27.29 min/day), with males performing 44.5% more vigorous-intensity activity relative to females (p < 0.05). Males had greater knee extension torque and thigh FFST mass compared to females (55.3%, and 34.2%, respectively, all p < 0.05). In combined-sex models, controlling for tibia length and age, MVPA was associated with strength strain index (pSSI) through two indirect pathways: (i) thigh FFST mass (b = 1.11 ± 0.37; 95% CI, 0.47 to 1.93), and (i) thigh FFST mass and knee extensor torque in sequence (b = 0.30 ± 0.16; 95% CI, 0.09 to 0.73). However, in sex-specific models MVPA was associated with pSSI indirectly through its relationship with knee extensor torque in males (b = 0.78 ± 0.48; 95% CI, 0.04 to 2.02) and thigh FFST mass in females (b = 1.12 ± 0.50; 95% CI, 0.37 to 2.46). Bootstrapped CIs confirmed these mediation pathways. The relationship between MVPA and cortical structure appears to be mediated by muscle in young adults, with potential sex-differences in the muscular pathway. If confirmed, these findings may highlight novel avenues for the promotion of bone strength in young adults. © 2019 American Society for Bone and Mineral Research., (© 2019 American Society for Bone and Mineral Research.)

Background: Fever is common in mechanically ventilated patients and may be uniquely detrimental in those with lung injury because of its injurious effects on pulmonary vascular permeability and alveolar epithelium. We evaluated the association of fever and antipyretic medication with mortality in mechanically ventilated emergency department (ED) patients., Methods: This is a retrospective cohort study of 1,264 patients requiring mechanical ventilation initiated in the ED with subsequent admission to an intensive care unit. Maximum body temperature was recorded for the first 24 h after ED admission and categorized into four categories: <37°C, 37°C to 38.2°C, 38.3°C to 39.4°C, and ≥39.5°C. The primary outcome was 28-day mortality. We conducted a planned subgroup analysis of patients with sepsis at the time of intubation. Multivariable Cox proportional hazard ratios (HRs) were used to assess the relationship between temperature, antipyretics, and mortality., Results: Multivariable Cox proportional HRs demonstrated that a maximum temperature ≥39.5°C was associated with increased mortality (adjusted hazard ratio [aHR] 1.59 [95% confidence interval, CI, 1.05-2.39]). In the subgroup of patients with sepsis, a maximum temperature of 38.3°C to 39.4°C was associated with survival (aHR 0.61 [95% CI, 0.39-0.99]). There was no difference in 28-day mortality between patients who did and did not receive antipyretic medication in either the overall cohort or the septic subgroup., Conclusion: High fever (≥39.5°C) was associated with increased risk for mortality in mechanically ventilated patients. However, in patients with sepsis, moderate fever (38.3°C-39.4°C) was protective. Antipyretic medication was not associated with changes in outcome. This suggests that fever may have different implications in septic versus nonseptic mechanically ventilated patients.