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Cheryl A Gibson,1 Keith J August,2 Jerry L Greene,3 Stephen D Herrmann,4 Jaehoon Lee,5 Susan P Harvey,6 Kate Lambourne,3 Debra K Sullivan7 1Department of Internal Medicine, Division of General and Geriatric Medicine, University of Kansas Medical Center, KS, USA; 2Children's Mercy Hospital, MO, USA; 3Department of Health, Sport, and Exercise Sciences, University of Kansas, KS, USA; 4Children's Health Research Center, Sanford Research, SD, USA; 5Institute for Measurement, Methodology, Analysis and Policy, Texas Tech University, TX, USA; 6Center for Research on Learning, University of Kansas, KS, USA; 7Department of Dietetics and Nutrition, University of Kansas Medical Center, KS, USA Abstract: Changes in nutrient intake and decreased exercise resulting from cancer therapies as well as their side effects may be contributing factors in the increased body weight and differences in physical fitness observed in survivors of childhood acute lymphoblastic leukemia (ALL). This article will describe the study protocol for an intervention program designed to improve the physical activity and nutrition behaviors of ALL survivors. Twenty-four children aged between 4 years and 12 years with ALL will be randomized to a 6-month technology-based exercise and nutrition program (TLC4ALLKids) or to enhanced usual care (eUC). The participants randomized to the TLC4ALLKids will participate in weekly, 1-hour coaching sessions on nutrition and physical activity and 1-hour physical activity classes delivered by group video conferencing. Participants will be provided with iPad tablets loaded with video conferencing software and the Healthy Lifestyle Tracking calendar to track daily nutrition and physical activity goals and weight. Both groups will be provided with Fitbit™ Zip to monitor physical activity. To assess feasibility, participant recruitment (achievement of proposed sample size), attendance (per weekly online sessions/assessment sessions), and adherence (number of families at 3 and 6 months) will be evaluated. Outcome measures to assess the intervention will include anthropometrics (weight, height, and waist circumference), physical activity (accelerometry), energy and macronutrient intake (food records), sleep habits (Children's Sleep Habits Questionnaire), and quality of life (Pediatric Quality of Life Inventory) will be obtained at baseline, 3 months, and 6 months. Semi-structured interviews will be used to gather information about ways to improve the program and overcome barriers to participation. If successful, the TLC4ALLKids intervention will provide a means to educate and improve the health behaviors of ALL survivors that can be delivered remotely and conveniently to participants. Keywords: acute lymphoblastic leukemia, enhanced usual care, social cognitive theory

The discovery and subsequent investigations of atmospheric oxygen on Mars are reviewed. Free oxygen is a biomarker produced by photosynthesizing organisms. Oxygen is reactive and on Mars may be destroyed in 10 years and is continually replenished. Diurnal and spring/summer increases in oxygen have been documented, and these variations parallel biologically induced fluctuations on Earth. Data from the Viking biological experiments also support active biology, though these results have been disputed. Although there is no conclusive proof of current or past life on Mars, organic matter has been detected and specimens resembling green algae / cyanobacteria, lichens, stromatolites, and open apertures and fenestrae for the venting of oxygen produced via photosynthesis have been observed. These life-like specimens include thousands of lichen-mushroom-shaped structures with thin stems, attached to rocks, topped by bulbous caps, and oriented skyward similar to photosynthesizing organisms. If these specimens are living, fossilized or abiogenic is unknown. If biological, they may be producing and replenishing atmospheric oxygen. Abiogenic processes might also contribute to oxygenation via sublimation and seasonal melting of subglacial water-ice deposits coupled with UV splitting of water molecules; a process of abiogenic photosynthesis that could have significantly depleted oceans of water and subsurface ice over the last 4.5 billion years.

In the space of the entire universe, the only conclusive evidence of life, is found on Earth. Although the ultimate source of all life is unknown, many investigators believe Earth, Mars, and Venus may have been seeded with life when these planets, and the sun, were forming in a galactic cluster of thousands of stars and protoplanets. Yet others hypothesize that while and after becoming established members of this solar system, these worlds became contaminated with life during the heavy bombardment phase when struck by millions of life-bearing meteors, asteroids, comets and oceans of ice. Because bolide impacts may eject tons of life-bearing debris into space, and as powerful solar winds may blow upper atmospheric organisms into space, these three planets may have repeatedly exchanged living organisms for billions of years. In support of these hypotheses is evidence suggestive of stromatolites, algae, and lichens on Mars, fungi on Mars and Venus, and formations resembling fossilized acritarchs and metazoans on Mars, and fossilized impressions resembling microbial organisms on the lunar surface, and dormant microbes recovered from the interior of a lunar camera. The evidence reviewed in this report supports the interplanetary transfer hypothesis and that Earth may be seeding this solar system with life.

OBJECTIVES: This study examined tobacco use prevalence, types of tobacco used, interest in quitting, and prior quit attempts among persons in methadone maintenance treatment. METHODS: Counselors collected surveys from 84% (550 of 655) of all clients in a 4-county metropolitan area. RESULTS: Most clients (77%) smoked cigarettes. Of the 59 former tobacco users, only 6 reported using a cessation pharmacotherapy to quit. Three quarters of the current smokers had attempted to quit at least once, with an average of 5 attempts. Most smokers (80%) were 'somewhat' or 'very' interested in quitting. CONCLUSIONS: The quit ratio among methadone maintenance treatment clients was 12%, compared with 50% nationwide. To reduce morbidity and mortality, cessation interventions must be developed and disseminated. © 2002 by the United States Cancer Pain Relief Committee. [ABSTRACT FROM AUTHOR]

Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is a proinflammatory participant in atherosclerosis and a potential biomarker for coronary heart disease. The effects of low-density lipoprotein (LDL) apheresis on Lp-PLA(2) levels were evaluated in 8 patients with cardiovascular disease. Each patient received 5 LDL apheresis treatments over a 3-month period. The mean direct LDL cholesterol level reduction was 60% (252 to 100 mg/dl). LDL apheresis acutely reduced Lp-PLA(2) by 21.4%. Over the course of treatment, Lp-PLA(2) levels were reduced by 29%. Chronic LDL apheresis significantly reduces Lp-PLA(2) independent of LDL cholesterol, which may be a potential mechanism by which LDL apheresis diminishes coronary heart disease risk. [ABSTRACT FROM AUTHOR]

Traumatic brain injuries (TBIs) present with symptoms ranging from a mildly altered level of consciousness to irreversible coma and death. The most severe stage of TBIs is diffuse axonal injury and swelling affecting the whole brain. Management strategies are based on the classification of TBIs by severity and type and range from cognitive therapy sessions to complex surgeries. Neuroimaging modalities, predominantly magnetic resonance imaging, and the clinical Glasgow Coma Scale are principal indicators to diagnose and assess a patient's condition and neurological status and decide optimal treatment modality. In this review, we have summarized the indications and patient outcomes based on neurological and functional status, post-surgical complications, and mortality rates for various life-saving interventional procedures including surgery for brain contusions, intracranial hematomas and penetrating injuries, and craniectomy and ventriculostomy for elevated intracranial pressure and hydrocephalus. Cranioplasty performed for aesthetic purposes has also been explored. Overall quality evidence presented advocates surgery as needed for improved patient outcomes resulting in early recovery and decreased mortality, especially with the emergence of minimally invasive techniques. However, there is still an increased risk of certain complications like infections and bleeding and severe disabilities leading to a vegetative state with surgery. Some guidelines have been formed to provide indications for optimal management of TBI patients including surgeries, although their effectiveness in each individual case is debatable. It is imperative to explore certain key areas like the timing of the surgery and the role of intensive patient monitoring pre- and post-procedure in future studies and lay down guidelines also applicable to resource-limited areas. Also, a deeper understanding of physiological and pathological mechanisms of functional outcomes post-surgery will help clinicians predict the patient's course of recovery., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yathindra et al.)

Introduction: Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non-physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6-month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team., Methods: Rural living adults with overweight/obesity ( n  = 187, age ∼ 50 years 82% female, body mass index ∼35 kg/m 2 ) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly ∼ 45 min sessions with 7-14 participants ( n  = 71), IP, which included weekly ∼ 15 min individual sessions ( n  = 80), or EUC, which included one-45 min in-person session at baseline., Results: Weight loss at 6 months was clinically relevant, that is, ≥5% in the GP (-11.4 kg, 11.7%) and the IP arms (-9.1 kg, 9.2%) but not in the EUC arm (-2.6%, -2.5% kg). Specifically, 6 month weight loss was significantly greater in the IP versus EUC arms (-6.5 kg. p  ≤ 0.025) but did not differ between the GP and IP arms (-2.4 kg, p  > 0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and $60 for the IP and GP arms, respectively., Conclusions: Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6 months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost-effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748)., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

Langya virus (LayV) is a recently discovered henipavirus (HNV), isolated from febrile patients in China. HNV entry into host cells is mediated by the attachment (G) and fusion (F) glycoproteins which are the main targets of neutralizing antibodies. We show here that the LayV F and G glycoproteins promote membrane fusion with human, mouse, and hamster target cells using a different, yet unknown, receptor than Nipah virus (NiV) and Hendra virus (HeV) and that NiV- and HeV-elicited monoclonal and polyclonal antibodies do not cross-react with LayV F and G. We determined cryoelectron microscopy structures of LayV F, in the prefusion and postfusion states, and of LayV G, revealing their conformational landscape and distinct antigenicity relative to NiV and HeV. We computationally designed stabilized LayV G constructs and demonstrate the generalizability of an HNV F prefusion-stabilization strategy. Our data will support the development of vaccines and therapeutics against LayV and closely related HNVs., Competing Interests: Competing interests statement:M.M. and D.V. are inventors on patent applications submitted by the University of Washington related to LayV G stabilization. The remaining 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.

Background and Aims: Cachexia is a metabolic syndrome defined by a loss of more than 5% of body weight in patients with chronic diseases. The goal of this study was to investigate the link between cirrhotic cachexia and hospital mortality and the 30-day risk of all-cause readmission., Methods: The study utilized Nationwide Readmission Database for the years 2016-2019 in which all patients older than 18 year old with a primary diagnosis of cirrhosis were included. We excluded patients with a concurrent diagnosis of Human Immunodeficiency Virus, chronic lung disease, end-stage renal disease, malignancy, heart failure, and certain neurological diseases. We compared baseline characteristics and outcomes between those who were cachectic and those who were not. Survey multivariate logistic regression was used to analyze the independent impact of cachexia on categorical outcomes., Results: The study cohort was 342,030 cases. Cachexia was identified in approximately 17% of the study population (58,509 discharges). The mean age was 56 years. Slightly more female patients noted in cachexia group (41% vs 38%). Inpatient mortality during index hospitalization were higher in patients with cirrhotic cachexia (6.7% vs 3%, P < .01). Inpatient mortality during first all-cause readmission within 30 days of index discharge was also higher in cachexia group (8.6% vs 6.5%, P  < .01)., Conclusion: Cachexia is an adverse prognosticator for inpatient outcomes in patients with cirrhosis. It is associated with greater readmission rates, inpatient mortality, and prolonged hospital admissions., (© 2024 The Authors.)

Purpose: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in women, yet it remains underdiagnosed, undertreated, and understudied in women compared with men. Although estrogen has provided observational evidence of cardioprotection, randomized controlled trials using hormone replacement therapy have generally produced unfavorable results., Methods: For this narrative review, a literature search was performed using the key words cardiovascular disease, women, and dyslipidemia in PubMed and Google Scholar with no date limitations. References within each article were also reviewed for additional relevant articles., Findings: Sex-specific risk factors and underrecognized conditions more predominant in women elevate ASCVD risk, creating further clinical challenges, such as the need for accurate risk stratification, compared with in men. Dyslipidemia frequently manifests or worsens during the menopausal transition. Therefore, identification during midlife and implementing lipid-lowering strategies to reduce ASCVD risk is imperative. Women have historically been poorly represented in cardiovascular (CV) outcome trials. However, more recent studies and meta-analyses have indicated that lipid-lowering therapies are equally effective in women and produce similar reductions in CV events and total mortality. Major cholesterol guidelines address many of the challenges that clinicians face when assessing ASCVD risk in women. Key points specific to women include obtaining a detailed history of pregnancy-related conditions, identification of common autoimmune disorders associated with systemic inflammation, and use of 10-year ASCVD risk calculators and imaging modalities (coronary artery calcium) to optimize ASCVD assessment. In terms of treatment, similar to men, women with existing ASCVD or high-risk primary prevention patients should be treated aggressively to achieve ≥50% LDL-C reductions and/or LDL-C goals as low as <55 mg/dL. Appropriate lipid-lowering therapies include high-intensity statins with or without ezetimibe and proprotein convertase subtilisin kexin/type 9 inhibitors. Women with lower ASCVD risk may be considered for low- to moderate-intensity statin therapy (approximately 30%-50% LDL-C reduction). All women, regardless of ASCVD risk category, should implement therapeutic lifestyle changes, which improve many common age-related cardiometabolic conditions., Implications: Although ASCVD and current risk factor trends in women are concerning, numerous evidence-based approaches are available to protect women with ASCVD risk from life-changing CV events., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Many kidney transplant recipients experience weight gain in the first year after transplantation., Research Question: The objective of this research study was to assess the desires of recent kidney transplant patients about the design features of a healthy lifestyle program to counter unnecessary weight gain., Design: In this descriptive study, recent recipients at 2 transplant centers were invited to participate in an online survey. Survey items included sociodemographic information, current medications, health conditions, weight change posttransplant, diet behaviors, physical activity participation, and desired features of a lifestyle program., Results: Fifty-three participants, mean age 60.5 (11.2) years, primarily males, completed surveys. Forty percent gained weight posttransplantation with many indicating struggling with their diet. Physical activity levels stayed the same (17%) or decreased (40%) posttransplantation. Eighty-seven percent of participants indicated they would participate in an online lifestyle program and 76% wanted online physical activity and nutrition sessions to meet at least once weekly. Suggestions about the type of information and activities, included eating strategies (eg, how to eat healthfully at restaurants, grocery shopping tips, and recipes), resources for at-home physical activities, access to cooking classes, and apps to track both activity and food intake., Conclusion: Recent kidney transplant recipients would benefit from and desired to join a lifestyle program featuring tailored nutrition education and physical activity coaching. Gathered information will be used to inform and tailor a lifestyle program. Identifying features for the prevention of unnecessary weight gain with patients' input is essential for promoting and sustaining healthy behaviors.

Background: Cachexia has been associated with chronic lung disease (pulmonary cachexia syndrome), which is associated with increased mortality. However, studies that looked into this association was relatively small, and national level data are lacking. Herein, we aim to study the association between chronic obstructive lung disease (COPD) and cachexia., Research Question: Do patients with COPD and cachexia has worse inpatient outcomes in comparison to those with no cachexia?, Study Design and Methods: We used the Nationwide Readmissions Database from 2016 to 2019, extracting adult patients with a primary diagnosis of COPD who were admitted between January and November of each year studied. We excluded patients with missing data on event time or length of stay. Furthermore, we excluded all cases with cormobidities associated with cachexia. We used SAS 9.4 for data exploration and analysis., Results: We included 1,446,431 COPD-related weighted hospitalizations for which 115,276 cases (7.9%) had a concurrent diagnosis of cachexia (or cachexia-related diagnoses). Overall, patients with cachexia (COPD-C), compared to patients with COPD and no cachexia (COPD-NC), were older (mean age 69 vs. 66 years, respectively, P < 0.001) with similar gender distribution (58%). COPD-C patients had more inpatient complications including cardiac arrest, and use of mechanical ventilation ( P < 0.001). Furthermore, they had longer mean lengths of stay (5.2 days vs. 3.8 days, P < 0.001). In-hospital mortality during index, admission was significantly higher in these patients at 2.2% compared to 0.5% for COPD-NC ( P < 0.001)., Conclusion: COPD-related cachexia is associated with increased inpatient mortality, resource utilization, and prolonged hospitalization., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Annals of Thoracic Medicine.)

Background: Adolescents and young adults with intellectual and developmental disabilities are at risk of obesity. Parents influence their diet and physical activity behaviours and therefore, can play important roles in weight management. The aims of this qualitative study were to explore parents' experiences assisting their son or daughter to participate in a weight management study., Methods: Interviews were completed at 6 months with 27 parents whose adolescent or young adult had completed the weight loss portion of an 18-month weight management study. Interviews were recorded, transcribed and thematic analysis performed., Results: Parents shared insights about how well program components worked with their family, and what strategies worked best to adopt healthier dietary choices and become more physically active. The importance of meeting regularly with someone outside the family to encourage healthier habits was stressed., Conclusions: Future weight management studies should involve parents and their adolescents to help tailor strategies and adapt intervention approaches., (© 2022 John Wiley & Sons Ltd.)

Cachexia is often seen in patients with heart failure (HF). This study aimed to examine the association between cachexia and clinical outcomes in patients hospitalized for HF. We extracted all adult cases with a primary diagnosis of HF that were discharged between January and November, identified in the Nationwide Readmissions Database for 2016 through 2019. Exclusion criteria included cases with missing data or a diagnosis of acquired immunodeficiency syndrome, advanced liver disease, end-stage renal disease, chronic lung disease, or malignancy. Appropriate weighting was used to obtain national estimates. Primary outcomes were inpatient mortality, length of stay, and 30-day readmission in patients with HF with cachexia compared with patients with no cachexia. Multivariable logistic regression was used to estimate the association between cachexia and clinical outcomes. Survey procedures were applied using Statistical Analysis Software 9.4. The final analysis included 2,360,307 HF-related hospitalizations. Cachexia was present in about 7% of the study population. A greater percentage of patients with cachexia were female and older than patients without cachexia (52% vs 47% female, the mean age of 77 vs 72 years, respectively). However, after adjusting for demographics and co-morbidities, including coronary artery disease and atrial fibrillation, patients with cardiac cachexia had higher inpatient mortality (odds ratio 3.01, 95% confidence interval 2.88 to 3.15, p <0.001), prolonged hospital stays (9 vs 5 days, p <0.0001), and greater all-cause 30-day readmissions (23% vs 21%, p <0.0001). HF-related cachexia is associated with increased inpatient mortality, greater resource use, and additional healthcare costs., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The literature evaluating multi-component interventions for long-term weight loss in adolescents with intellectual disabilities (ID) is extremely limited., Objectives: To compare the effectiveness of two delivery strategies, face-to-face (FTF) or remote delivery (RD), and two diets, enhanced Stop Light diet (eSLD) or conventional diet (CD) on weight change across 12 and 18 months. in response to an 18 months. weight management intervention (6 months Weight loss/12 months. Weight maintenance) in adolescents with ID., Methods: Adolescents with ID were randomized to one of three arms: FTF /CD, RD/CD, RD/eSLD and asked to attend individual education sessions with a health educator which were delivered during FTF home visits or remotely using video conferencing. The CD followed the US dietary guidelines. The eSLD utilized the Stop Light guide and was enhanced with portion-controlled meals. Participants were also asked to increase their physical activity (PA) and to self-monitor diet, PA and body weight across the 18-month., Results: Weight was obtained from 92(84%) and 89(81%) randomized adolescents at 12 and 18 months, respectively. Weight change across 12 months. Differed significantly by diet (RD/eSLD: -7.0% vs. RD/CD: -1.1%, p = 0.002) but not by delivery strategy (FTF/CD: +1.1% vs. RD/CD: -1.1%, p = 0.21). Weight change across 18 months. Was minimal in all intervention arms and did not differ by diet (RD/eSLD: -2.6% vs. RD/CD: -0.5%; p = 0.28) or delivery strategy (FTF/CD: +1.6% vs. RD/CD: -0.5%; p = 0.47)., Conclusions: Additional research is required to identify effective strategies to improve long-term weight loss in adolescents with ID., (© 2022 World Obesity Federation.)

Introduction: According to the 2020 U.S. Census, a Silver Tsunami is looming, with more than 75.4 million persons aged 57 to 75 expected to need more costly medical care. However, a larger wave of 83.1 million Millennials nearing adulthood is approaching rapidly. Therefore, it is important to understand how this population finds their physician and what may influence this decision., Methods: Paper-based surveys were administered to adult patients at primary care and geriatric clinics located at the University of Kansas Medical Center in Kansas City, Kansas. Questions included demographic information, utilization and influence of online reviews, and the effects negative and positive reviews have on a patient's choice of physician. Descriptive statistics were calculated for respondent characteristics and survey responses. Chi-square and McNemar's tests were performed to evaluate differences between age and gender groups, and to determine how influential review ratings are in choosing a physician for medical care. Statistical significance was determined at the 0.05 level., Results: A sample of 284 patients completed the survey (44.35 ± 17.54 years old [range = 18-90], 60.6% female, 57.4% white). Of Millennials, 67.2% read online reviews before choosing a physician. Millennials were significantly more likely to read online reviews before choosing a physician (p = 0.004) and utilize online resources to search for a new physician (p < 0.001) than older patients., Conclusions: Millennials were more likely to research online reviews before choosing a physician. Therefore, an online review presence will be beneficial to one's practice to acquire this new wave of patients., (© 2022 The University of Kansas Medical Center.)

Aim: The aims of this study were to explore factors that influence initiation and continuation of statin therapy. Patients & methods: Mixed-method design employed with 73 patients completing surveys and 14 patients participating in semi-structured interviews. Results: When lower total cholesterol is achieved, patients' views are favorable while views of statin therapy diminish among those with higher total cholesterol values. All patients are concerned with adverse events including the potential for developing diabetes. However, overall patients believe the benefits of statins outweigh the risk of diabetes. Conclusion: Barriers remain that prevent patients from achieving cholesterol goals and maintaining or initiating statin therapy. Effective strategies to provide accurate information about the risks and benefits of statin therapy, and implementation of shared decision-making to improve medication adherence and persistence are needed.

Introduction: Effective communication during the patient handoff process is critical for ensuring patient safety. At our academic medical center, first-year interns complete hand-off training before starting clinical rotations. The purpose of this study was to evaluate a virtual handoff training for residents as an alternative to in-person sessions due to limitations imposed by COVID-19., Methods: Fifty residents were administered pre/post surveys to gauge the helpfulness of the training for clinical practice, familiarity and confidence in providing a hand-off, and whether they would recommend the virtual format for incoming interns. Additionally, faculty rated the virtual form of the hand-off activity, made comparisons to in-person sessions, and assessed the helpfulness of the session for residents in clinical practice., Results: Forty-four residents (88%) and 11 faculty (85%) completed surveys. After the training session, residents who received instruction and feedback reported significant improvements in familiarity with the hand-off tool and confidence in their hand-off abilities (both p < 0.001). Both residents and faculty were satisfied with the virtual format of hand-off training. Most faculty felt the virtual platform was comparable to in-person sessions and would recommend ongoing use of the virtual platform when in-person sessions were not possible., Conclusions: Teaching hospitals mandate resident training to include strategies for a uniform hand-off method to avoid medical errors. Adaptation to a virtual platform can be a successful instruction strategy, allowing for didactic and interactive sessions with direct faculty observation and feedback., (© 2022 The University of Kansas Medical Center.)

Objectives: In this randomized trial, we compared the effectiveness of 2 diets (enhanced stop light diet [eSLD] versus conventional meal plan diet [CD]) and 2 delivery strategies (face-to-face [FTF] versus remote delivery [RD]) on weight loss across 6 months in adolescents with intellectual and developmental disabilities who were overweight or obese., Methods: Participants were randomly assigned to 1 of 3 arms (FTF/CD, RD/CD, or RD/eSLD) and asked to attend one-on-one sessions with a health educator every 2 weeks to aid in maintaining compliance with recommendations for a reduced-energy diet and increased physical activity. The CD followed the US dietary guidelines. The eSLD used the stop light guide and was enhanced with portion-controlled meals. The FTF arm was delivered during in-person home visits. The RD arms were delivered by using video conferencing., Results: A total of 110 adolescents with intellectual and developmental disabilities (aged ∼16 years, 53% female, BMI 33) were randomly assigned to the FTF/CD ( n = 36), RD/CD ( n = 39), or RD/eSLD ( n = 35) group. Body weight at 6 months was obtained from 97%, 100%, and 86% of participants in the FTF/CD, RD/CD, and RD/eSLD arms, respectively. The eSLD elicited significantly greater weight loss than the CD: RD/eSLD (-5.0 ± 5.9 kg; -6.4%) versus RD/CD (-1.8 ± 4.0 kg; -2.4%) ( P = .01). However, weight loss did not differ by delivery strategy: FTF/CD (-0.3 ± 5.0 kg; -0.2%) versus RD/CD (-1.8 ± 4.0 kg; -2.4%) ( P = .20)., Conclusions: The eSLD elicited significantly greater 6-month weight loss compared with a CD when both interventions were delivered remotely. Minimal 6-month weight loss, which did not differ significantly between FTF delivery and RD, was observed with a CD., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Recreational hiking in the mountains is a common activity, whether for a single day or for several days in a row. We sought to measure blood pressure (BP) response during a 10-day trek at moderate-altitude elevation (6500-13,000 feet) and observe for uncontrolled hypertension and/or adverse cardiovascular outcomes. A total of 1279 adult participants completed an observational study of resting BP during a 10-day trek in the Sangre de Cristo mountains. Following initial recruitment, participants were issued a trail data card to record BP measurements at day 0 (basecamp), day 3, day 6 and day 9. BP was measured using a sphygmomanometer and auscultation. Demographic data, height, weight, home altitude, daily water and sports drink intake, existence of pre-arrival hypertension and BP medication class were also recorded. We observed a rise in mean blood pressure for the cohort during all exposures to moderate altitudes. The increases were greatest for individuals with pre-existing hypertension and/or obesity. There were no observed life-threatening cardiovascular events for participants. We conclude that for individuals with a modestly controlled blood pressure of 160/95 mmHg, hiking at a moderate altitude is a safe activity.

Background: Post-transplant weight gain affects 50-90% of kidney transplant recipients adversely affecting survival, quality of life, and risk for diabetes and cardiovascular disease. Diet modification and physical activity may help prevent post-transplant weight gain. Methods for effective implementation of these lifestyle modifications are needed. The objective of this study is to assess the feasibility and acceptability of a remotely delivered nutrition and physical activity intervention among kidney transplant recipients. Secondary aims were to estimate the effectiveness of the intervention in producing changes in physical activity, qualify of life, fruit and vegetable intake, and consumption of whole grains and water from baseline to 6 months., Methods: A randomized controlled study for stable kidney transplant recipients between 6 and 12 months post-transplantation was conducted. Participants were randomly assigned 1:1 to a technology-based, lifestyle modification program (intervention) or to enhanced usual care (control)., Results: The first 10 kidney transplant recipients screened were eligible and randomized into the intervention and control groups with no significant between-group differences at baseline. Health coaching attendance (78%) and adherence to reporting healthy behaviors (86%) were high. All participants returned for final assessments. The weight in controls remained stable, while the intervention arm showed weight gain at 3 and 6 months. Improvements were found for physical activity, quality of life, and fruit and vegetable intake in both groups. All participants would recommend the program to other transplant recipients., Conclusions: Our data suggest that a remotely delivered televideo nutrition and physical activity intervention is feasible and valued by patients. These findings will aid in the development of a larger, more prescriptive, randomized trial to address weight gain prevention., Trial Registration: Clinicaltrials.gov Identifier NCT03697317. Retrospectively registered on October 5, 2018., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

The Nutrition Literacy Assessment Instrument (NLit) measures nutrition literacy, including a subscale for ability to interpret nutrition fact panels (NFP). Recent redesign of the NFP in the US was issued to improve usability. This study aimed to determine reliability of the NLit subscale using two NFP versions. A 35-item survey was administered to 48 attendees with very low incomes. Surveys included previously validated NLit numeracy questions referencing the Current NFP (C-NFP), demographic and financial literacy questions, and the same NLit numeracy questions referencing the New NFP (N-NFP). NLit numeracy between the C-NFP and N-NFP were related ( r  = 0.842, p  < .001), and N-NFP showed excellent reliability (Cronbach- α  = 0.815). Mean NLit numeracy scores for the C-NFP and N-NFP were 53.5% and 55.5%, respectively ( p  = .437). Exchanging the N-NFP for the C-NFP in the NLit maintains strong reliability. Similar numeracy scores between C-NFP and N-NFP suggest the redesign may not be easier to read.

Systematic evaluation and redesign of a substance use disorder treatment program resulted in elimination of wait times, same-day treatment, and increased pharmacotherapy for patients with alcohol and opioid use disorders., Competing Interests: Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.

Objectives: Healthcare professionals are at higher risk for workplace violence (WPV) than workers in other sectors. This elevated risk exists despite the vast underreporting of WPV in the medical setting. The challenge of responding to this risk is compounded by limited empirical research on medical training environments. Understanding trainees' experience and educating them on workplace safety, WPV reporting, and awareness of resources are shared goals of educational and institutional leadership. In our setting, clear understanding and education were urgent after the enactment of a statewide "constitutional carry" law affording individuals a right to carry concealed firearms in all state-owned universities and hospitals, beginning in July 2017. We sought to examine the incidence of WPV affecting Internal Medicine trainees to understand the types of violence encountered, reporting rates, and the factors that influence reporting., Methods: We conducted a cross-sectional online survey of Internal Medicine residents and fellows in practice for the previous 12 months. Survey items included both forced choice and open-ended questions. Descriptive statistics were calculated and used to summarize the study variables. χ 2 tests were performed to examine whether sex differences existed for each of the survey questions. Qualitative responses were content analyzed and organized thematically., Results: Of 186 trainees, 88 completed the survey. Forty-seven percent of respondents experienced WPV, with >90% of cases involving a patient, a patient's family member, or a patient's friend. Verbal assault was the most common type of incident encountered. Trainees formally reported fewer than half of the violent incidents disclosed in the survey. Major factors that influenced reporting included the severity of the incident, condition of the patient, and clarity of the reporting mechanism., Conclusions: Previous research indicates similar amounts and types of WPV. Likewise, a large percentage of the incidents are not reported. Addressing the key factors related to why physicians underreport can inform institutions on how to make systematic changes to reduce WPV and its negative impact. Future research is needed to examine whether specific interventions can be implemented to improve reporting and reduce the incidence of WPV.

The purpose of this trial was to test whether right prefrontal cortex 1 Hz versus 10 Hz rTMS provides a significantly greater improvement in PTSD symptoms and/or function. Veterans 18 to 50 years of age suffering from PTSD were randomized to right prefrontal 1 Hz rTMS [2400 pulses/session] versus right prefrontal 10 Hz rTMS [2400 pulses/session]. The treatments were performed 5 days a week for 6 weeks with a 3-week taper using the NeuroStar system. There were one month and three months post treatment follow-up evaluations. Forty-four participants were enrolled with 17 being randomized to 1 Hz rTMS and 18 to 10 Hz rTMS. Both groups had significant improvement in PTSD and depression scores from baseline to the end of acute treatment. The 10 Hz group but not the 1 Hz group demonstrated significant improvement in function. Although both groups demonstrated significant improvement in PTSD and depression symptoms, a significant advantage for either the 1 Hz or 10 Hz frequency group on any of the scales acquired was not demonstrated. Further work is required with larger samples sizes to test whether low or high frequency is superior or if individual differences would indicate the more effective frequency., (Published by Elsevier B.V.)

Background: Previous research indicates that individuals with intellectual and developmental disabilities (IDDs) are at risk for poor diet quality., Objective: The purpose of this secondary analysis was to determine whether two different weight-loss diets affect energy intake, macronutrient intake, and diet quality as measured by the Healthy Eating Index-2010 (HEI-2010) during a 6-month weight-loss period and 12-month weight-management period, and to examine differences in energy intake, macronutrient intake, and HEI-2010 between groups., Design: Overweight/obese adults with IDDs took part in an 18-month randomized controlled trial and were assigned to either an enhanced Stop Light Diet utilizing portion-controlled meals or a conventional diet consisting of reducing energy intake and following the 2010 Dietary Guidelines for Americans. Proxy-assisted 3-day food records were collected at baseline, 6 months, and 18 months, and were analyzed using Nutrition Data System for Research software. HEI-2010 was calculated using the data from Nutrition Data System for Research., Participants/setting: The study took place from June 2011 through May 2014 in the greater Kansas City metropolitan area., Main Outcome Measures: This was a secondary analysis of a weight-management intervention for adults with IDDs randomized to an enhanced Stop Light Diet or conventional diet, to examine differences in energy intake, macronutrient intake, and HEI-2010 across time and between groups., Statistical Analyses Performed: Independent- and paired-samples t tests and general mixed modeling for repeated measures were performed to examine group differences and changes at baseline, 6 months, and 18 months between the enhanced Stop Light Diet and conventional diet groups., Results: One hundred and forty six participants (57% female, mean±standard deviation age=36.2±12.0 years) were randomized to either the enhanced Stop Light Diet or conventional diet group (77 enhanced Stop Light Diet, 69 conventional diet) and provided data for analysis at baseline, 124 completed the 6-month weight-loss period, and 101 completed the 18-month study. Participants on the enhanced Stop Light Diet diet significantly reduced energy intake at 6 and 18 months (both P<0.001), but those on the conventional diet did not (both P=0.13). However, when accounting for age, sex, race, education level, and support level (mild vs moderate IDD), there was a significant decrease during the 18-month intervention in energy intake for the enhanced Stop Light Diet and conventional diet groups combined (P<0.01 for time effect), but no significant group difference in this change (P=0.39 for group-by-time interaction). There was no significant change in total HEI-2010 score at 6 and 18 months (P=0.05 and P=0.38 for the enhanced Stop Light Diet group; P=0.22 and P=0.17 for the conventional diet group), and no significant group difference at 6 and 18 months (P=0.08 and P=0.42). However, when participants' age, sex, race, education level, and support level were accounted for, mixed modeling indicated a significant increase in total HEI-2010 scores for the enhanced Stop Light Diet and conventional diet groups combined during the 18-month intervention (P=0.01 for time effect)., Conclusions: The results of this study found that after controlling for demographic factors, individuals with IDDs can decrease their energy intake and increase their diet quality, with no significant differences between the enhanced Stop Light Diet and conventional diet groups., (Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is a complex health problem affecting more than one-third of school-aged youth. The increasing obesity rates in Kansas and Missouri has been particularly concerning, with efforts being made to improve student health through the implementation of school wellness policies (SWPs). The primary purpose of this study was to conduct a rigorous assessment of SWPs in the bi-state region., Methods: SWPs were collected from 46 school districts. The Wellness School Assessment Tool (WellSAT) was used to assess comprehensiveness and strength. Additionally, focus group discussions and an online survey were conducted with school personnel to identify barriers and supports needed., Results: Assessment of the SWPs indicated that most school districts failed to provide strong and specific language. Due to these deficiencies, districts reported lack of enforcement of policies. Several barriers to implementing the policies were reported by school personnel; supports needed for effective implementation were identified., Conclusions: To promote a healthful school environment, significant improvements are warranted in the strength and comprehensiveness of the SWPs. The focus group discussions provided insight as to where we need to bridge the gap between the current state of policies and the desired beneficial practices to support a healthy school environment., (© 2018, American School Health Association.)

Obesity prevalence is higher in rural compared to urban residents. Rural health clinics offer a potential venue for delivery of weight management. However, traditional programs require travel to attend on-site meetings which is impractical or inconvenient for rural residents. Clinic staff in most rural settings are unlikely to be trained to provide effective weight management. Remote delivery using group phone conferences (GP) or individual phone calls (IP), by staff associated with rural clinics eliminates the need for travel to attend on-site meetings. The effectiveness of these approaches will be the focus of this trial. Staff at five primary care clinics, serving primarily rural residents, will be trained to deliver GP and IP interventions and an enhanced usual care (EUC), (i.e., individual face-to-face meetings (~45 min) at clinic site, four times across 18 mos.). Two hundred overweight/obese adults (BMI ≥ 25.0-45.0 kg/m 2 , age ≥ 21 yrs.) will be recruited through each clinic and randomized to GP (n = 80), IP (n = 80), or EUC (n = 40) to compare weight loss (0-6 mos.), weight maintenance (7-18 mos.), and weight change during a 6 mo. no contact follow-up (19-24 mos.) between intervention arms. The GP and IP interventions will be identical in lesson plan content, diet, and physical activity. The only difference between groups will be the delivery format (group vs. individual) and session duration (GP ~45 min/session; IP ~15 min/session). Primary (body weight) and secondary outcomes (waist circumference, energy/macronutrient intake, physical activity) will be assessed at baseline, 6, 12, 18 and 24 mos. Cost and contingent valuation analyses will also be completed., Nct Registration: NCT02932748., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: The prevalence of obesity among individuals with intellectual and developmental disabilities (IDD) is equal to or greater than the general population., Methods: Overweight/obese adults (BMI ≥25 kg/m 2 ) with mild-to-moderate intellectual and developmental disabilities were randomized to an enhanced stop light diet (eSLD = SLD + portion-controlled meals, n = 78) or a conventional diet (CD, n = 72) for an 18 months trial (6 months weight loss, 12 months maintenance). Participants were asked to increase physical activity (150 min/week), self-monitor diet and physical activity and attend counselling/educational sessions during monthly home visits., Results: Weight loss (6 months) was significantly greater in the eSLD (-7.0% ± 5.0%) compared with the CD group (-3.8% ± 5.1%, p < .001). However, at 18 months, weight loss between groups did not differ significantly (eSLD = -6.7% ± 8.3%; CD = 6.4% ± 8.6%; p = .82)., Conclusion: The eSLD and CD provided clinically meaningful weight loss over 18 months in adults with intellectual and developmental disabilities., (© 2017 John Wiley & Sons Ltd.)

Research in education and developmental psychology indicates that behavioral engagement in learning is a critical predictor of children's academic success. In an effort to improve academic achievement, school administrators are continually in search of methods to increase behavioral engagement. Previous research has indicated that classroom-based physical activity (PA) lessons have a positive impact on academic achievement. However, little research has been done in assessing the impact of such interventions on the behavioral engagement of students with learning behavior difficulties. This study assesses the impact of classroom-based PA on teacher-rated classroom behaviors of students with identified learning behavior difficulties. Two schools (one intervention, one control) participating in a larger, cluster-randomized trial provided scores on a teacher-administered classroom behavior scale. This scale was used to collect information on 15 characteristics identified as being essential to behavioral engagement. Participants included male and female students in second and third grade classrooms who were identified by their classroom teacher and school counselor as having difficulties with learning behaviors. Mixed linear modeling for repeated measures was used to examine the changes over time in the classroom behavior scores. The intervention group showed significant improvement over time in classroom behavior while the control group showed no change or a slight degradation over time (i.e., group × time interaction, F [2132] = 4.52, p  = 0.01). Schools must meet the diverse needs of students today, including those who exhibit less than optimal learning behaviors. Combined with the evidence that PA is linked to several health and cognitive-behavior benefits, providing classroom-based PA that is incorporated within the curriculum provides common ground for all students to participate. It is a potential solution to increasing behavioral engagement, and in turn stimulating and enhancing learning., Competing Interests: This study was approved by the University of Kansas Institutional Review Board, HSC #19732. All parents provided voluntary consent for their children to participate.The authors declare that they have no competing interests.

Introduction: Caregivers of adults with IDD often play a large role in the ability of adults with IDD to lose weight., Objective: The purpose of this study was to determine to examine the effects of the caregivers' perceived burdens and self-efficacy and their relationship to an individual (family member or paid staff) on weight changes across a weight management intervention for adults with IDD., Methods: Overweight/obese adults with mild to moderate IDD, along with assigned caregivers who served as their study partner, were randomized to an 18-month weight management intervention. The living environment and caregiver relationship were assessed at baseline. Caregivers completed questionnaires regarding perceived hassles, uplifts, and self-efficacy in helping the participant follow a weight management intervention., Results: 147 adults with IDD (∼57% women and ∼16% minorities) were included in data analysis. After 18 months, there were no differences in weight loss between participants who had a family member as their study partner and those who had a paid assistant as their study partner (-5.5 ± 5.2% vs. -5.6± 5.3% p = 0.16). However, paid assistants reported more hassles with following the diet intervention at 6 months (p < 0.05). Participants who had a paid assistant as their study partner were more likely to have multiple study partners during the study, which was correlated with smaller weight loss., Conclusion: While caregivers are important for weight management of adults with IDD, the caregiver's relationship to the participant does not affect weight change in an intervention., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To explore inpatient pediatric nurses' current experiences and perspectives on medication teaching., Design and Methods: A descriptive qualitative study was conducted at a Midwest pediatric hospital. Using convenience sampling, 26 nurses participated in six focus groups. Data were analyzed in an iterative group coding process., Results: Three themes emerged. 1) Medication teaching is an opportunity. 2) Medication teaching is challenging. Nurses experienced structural and process challenges to deliver medication teaching. Structural challenges included the physical hospital environment, electronic health record, and institutional discharge workflow while process challenges included knowledge, relationships and interactions with caregivers, and available resources. 3) Medication teaching is amenable to improvement., Conclusion: Effective medication teaching with caregivers is critical to ensure safe, quality care for children after discharge. Nursing teaching practices have not changed, despite advances in technology and major changes in hospital care. Nurses face many challenges to conduct effective medication teaching. Improving current teaching practices is imperative in order to provide the best and safest care., Practice Implications: This study generated knowledge regarding pediatric nurses' teaching practices, values and beliefs that influence teaching, barriers, and ideas for how to improve medication teaching. Results will guide the development of targeted interventions to promote successful medication teaching practices., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Improving physical activity in adults with intellectual and developmental disabilities (IDDs) is recommended to improve weight loss and general health. However, in order to determine the success of physical activity interventions, identification of feasible methods for assessment of physical activities is necessary. The purpose of this study is to assess the feasibility of adults with IDD to track daily steps and wear an accelerometer., Methods: Overweight/obese adults with mild to moderate IDD followed a diet and physical activity program for 18 months. All participants were asked to wear a pedometer and track steps daily by using a pedometer and to provide accelerometer data for 7 days at baseline, 6, 12 and 18 months. Adherence to the pedometer protocol and plausibility of the number of recorded steps were assessed, and these measures along with average wear time of the accelerometer were recorded., Results: Data were collected from 149 participants (36.5 ± 12.2 years of age, 57% female). Participants recorded a step value on 81.5% of days across the 18-month study, with 40.9% of written days classified as plausible. When wearing the accelerometer, 26.8% of participants met the recommended 4-day/10-h wear time criterion at baseline, and 22.6, 24.8 and 18.8% met the criterion at 6, 12 and 18 months, respectively., Conclusions: Adults with IDD will adhere reasonably well to wearing a pedometer long term, but may be unable to record the step data accurately. Furthermore, adults with IDD have poor compliance with accelerometer protocols, and future studies should determine if a shorter wear time protocol would produce valid data in this population., (© 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

We compared changes in academic achievement across 3years between children in elementary schools receiving the Academic Achievement and Physical Activity Across the Curriculum intervention (A+PAAC), in which classroom teachers were trained to deliver academic lessons using moderate-to-vigorous physical activity (MVPA) compared to a non-intervention control. Elementary schools in eastern Kansas (n=17) were cluster randomized to A+PAAC (N=9, target ≥100min/week) or control (N=8). Academic achievement (math, reading, spelling) was assessed using the Wechsler Individual Achievement Test-Third Edition (WIAT-III) in a sample of children (A+PAAC=316, Control=268) in grades 2 and 3 at baseline (Fall 2011) and repeated each spring across 3years. On average 55min/week of A+PACC lessons were delivered each week across the intervention. Baseline WIAT-III scores (math, reading, spelling) were significantly higher in students in A+PAAC compared with control schools and improved in both groups across 3years. However, linear mixed modeling, accounting for baseline between group differences in WIAT-III scores, ethnicity, family income, and cardiovascular fitness, found no significant impact of A+PAAC on any of the academic achievement outcomes as determined by non-significant group by time interactions. A+PAAC neither diminished or improved academic achievement across 3-years in elementary school children compared with controls. Our target of 100min/week of active lessons was not achieved; however, students attending A+PAAC schools received an additional 55min/week of MVPA which may be associated with both physical and mental health benefits, without a reduction in time devoted to academic instruction., (Copyright © 2017. Published by Elsevier Inc.)

Background & Aims: Dietary sodium, protein, acid precursors, and water have been linked to cyst growth in polycystic kidney disease; yet, no studies in patients have examined the feasibility of using a dietary intervention that controls all of these factors. The aim of this study was to determine if a diet, appropriate for persons of most ages, reduces the excretion of sodium, urea, acid, and decreases mean urine osmolality while gaining acceptance by patients with autosomal dominant polycystic kidney disease (ADPKD)., Methods: Twelve adults with ADPKD enrolled in a pre-post pilot feasibility study and served as their own controls. Individuals consumed their usual diet for one week then for four weeks followed an isocaloric diet lower in sodium and protein and higher in fruits, vegetables, and water. Three-day diet records and two 24-h urine samples were collected at baseline, week 2, and week 4 visits; blood pressure, weight, and serum were obtained at all three visits. A modified nutrition hassles questionnaire was completed on the last visit., Results: During the dietary intervention, subjects (n = 11) consumed less sodium, protein, and dietary acid precursors 36%, 28%, and 99%, respectively, and increased fluid intake by 42%. Urinary sodium, urea, net acid excretion, osmoles, and osmolality decreased 20%, 28%, 20%, 37%, and 15%, respectively; volume increased 35%. Urine changes were in accord with the diet record. Ninety-one percent of participants reported that none of the hassles were worse than "somewhat severe", and most participants felt "somewhat confident" or "very confident" that they could manage the new diet., Conclusions: A majority of adult patients with ADPKD successfully prepared and followed a composite diet prescription with decreased sodium, protein, acid precursors, and increased fluid intake. This trail was registered at ClinicalTrials.gov (NCT01810614)., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Musculoskeletal symptoms are the most commonly reported adverse effects associated with statin therapy. Yet, certain data indicate that these symptoms often present in populations with underlying musculoskeletal complaints and are not likely statin related. Switching statins or using lower doses resolves muscle complaints in most patients. However, there is a growing population of individuals who experience intolerable musculoskeletal symptoms with multiple statins, regardless of the individual agent or prescribed dose. Recent randomized, placebo-controlled trials enrolling highly intolerant subjects provide significant insight regarding statin-associated muscle symptoms (SAMS). Notable findings include the inconsistency with reproducing muscle complaints, as approximately 40% of subjects report SAMS when taking a statin but not while receiving placebo, but a substantial cohort reports intolerable muscle symptoms with placebo but none when on a statin. These data validate SAMS for those likely experiencing true intolerance, but for others, suggest a psychosomatic component or misattribution of the source of pain and highlights the importance of differentiating from the musculoskeletal symptoms caused by concomitant factors. Managing the highly intolerant requires candid patient counseling, shared decision-making, eliminating contributing factors, careful clinical assessment and the use of a myalgia index score, and isolating potential muscle-related adverse events by gradually reintroducing drug therapy with the utilization of intermittent dosing of lipid-altering agents. We provide a review of recent data and therapeutic guidance involving a focused step-by-step approach for managing SAMS among the highly intolerant. Such strategies usually allow for clinically meaningful reductions in low-density lipoprotein cholesterol and an overall lowering of cardiovascular risk., (Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.)

Adolescents with intellectual and developmental disabilities (IDD) are an underserved group in need of weight management. However, information regarding effective weight management for this group is limited, and is based primarily on results from small, non-powered, non-randomized trials that were not conducted in accordance with current weight management guidelines. Additionally, the comparative effectiveness of emerging dietary approaches, such as portion-controlled meals (PCMs) or program delivery strategies such as video chat using tablet computers have not been evaluated. Therefore, we will conduct an 18month trial to compare weight loss (6months) and maintenance (7-18months) in 123 overweight/obese adolescents with mild to moderate IDD, and a parent, randomized to a weight management intervention delivered remotely using FaceTime™ on an iPad using either a conventional meal plan diet (RD/CD) or a Stop Light diet enhanced with PCMs (RD/eSLD), or conventional diet delivered during face-to-face home visits (FTF/CD). This design will provide an adequately powered comparison of both diet (CD vs. eSLD) and delivery strategy (FTF vs. RD). Exploratory analyses will examine the influence of behavioral session attendance, compliance with recommendations for diet (energy intake), physical activity (min/day), self-monitoring of diet and physical activity, medications, and parental variables including diet quality, physical activity, baseline weight, weight change, and beliefs and attitudes regarding diet and physical activity on both weight loss and maintenance. We will also complete a cost and contingent valuation analysis to compare costs between RD and FTF delivery., (Copyright © 2016. Published by Elsevier Inc.)

Background: Salt, protein, acid precursors, and fluid intake have been identified as factors that influence cyst growth in ADPKD. Unfortunately, the feasibility of following these dietary restrictions/enhancements from a patient's point-of-view has yet to be studied. The purpose of this study is to understand better the experiences of patients following a relatively complex dietary prescription targeting these factors., Methods: Twelve adults with ADPKD and kidney function >30ml/min/1.73m2 were recruited from the University of Kansas Medical Center Polycystic Kidney Disease clinic. In a qualitative design, semi-structured interviews of participants were conducted following a four week dietary intervention (experimental diet lower in sodium, protein, and acid precursors, and supplemented with water) either face-to-face or by telephone. All interviews were recorded, transcribed verbatim, and checked for accuracy. Transcripts were analyzed thematically for emerging themes., Results: Participants reported that eating less meat and more fruits and vegetables were the easiest components of the diet, whereas reaching the daily goal amount of fruits and vegetables and tracking the diet constantly were the most difficult components. Participants had little difficulty with fluid intake and reported the prescribed fluid goal as achievable. The tracking system for fruits and vegetables and protein was reported to be both helpful and intuitive, but tracking their intake on paper was tedious. Eating out was the most significant barrier to following the diet with some individuals avoiding restaurants in order to comply with the dietary prescription., Conclusion: Participants on the experimental diet heightened their awareness of the consumption of dietary salt, protein, acid precursors, and fluid intake. Additionally, most participants believed adherence to the prescribed diet was feasible. However, participants wanted less cumbersome ways to track and monitor the diet, especially given that the prescribed diet is designed for lifelong adherence. Future studies should focus on targeting these specific dietary factors in larger groups of more ethnically and culturally diverse populations to help inform clinicians and how best to help diverse populations adhere to the dietary intervention., Trial Registration: ClinicalTrials.gov NCT01810614.

Bed sediment samples from 79 coastal New York and New Jersey, USA sites were analyzed for 75 compounds including wastewater associated contaminants, PAHs, and other organic compounds to assess the post-Hurricane Sandy distribution of organic contaminants among six regions. These results provide the first assessment of wastewater compounds, hormones, and PAHs in bed sediment for this region. Concentrations of most wastewater contaminants and PAHs were highest in the most developed region (Upper Harbor/Newark Bay, UHNB) and reflected the wastewater inputs to this area. Although the lack of pre-Hurricane Sandy data for most of these compounds make it impossible to assess the effect of the storm on wastewater contaminant concentrations, PAH concentrations in the UHNB region reflect pre-Hurricane Sandy conditions in this region. Lower hormone concentrations than predicted by the total organic carbon relation occurred in UHNB samples, suggesting that hormones are being degraded in the UHNB region., (Published by Elsevier Ltd.)

A small but significant link between new-onset diabetes mellitus (NOD) and statin therapy was noted with rosuvastatin users in the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin study. Since then multiple analyses have further confirmed this association, with most studies demonstrating a modest increase in NOD with statin therapy, especially among individuals with risk factors for developing diabetes mellitus. More recent observational analyses suggest a stronger correlation between statin use and NOD, however. A definitive mechanism confirming causation between statins and glucose impairment remains elusive, but many have been proposed. Although considered a class effect by the US Food and Drug Administration, most data indicate NOD is dependent upon the dose and potency of the statin, with certain agents appearing to be less diabetogenic. The consensus is that the benefits of statin therapy far outweigh the risk of NOD, especially among patients with high cardiovascular risk. Nonetheless, more studies are needed to better understand this association and long-term clinical implications. In the meantime, we provide clinicians with a practical guide to assist with clinical decision making when prescribing statin therapy. Overall, this article serves to provide the primary care physician with a timely review of the most clinically relevant data regarding statins and NOD, with hopes to ultimately optimize statin prescribing and limit any potential drug-induced glucose impairment.

Despite the plethora of weight loss programs available in the US, the prevalence of overweight and obesity (BMI≥25kg/m(2)) among US adults continues to rise at least, in part, due to the high probability of weight regain following weight loss. Thus, the development and evaluation of novel interventions designed to improve weight maintenance are clearly needed. Virtual reality environments offer a promising platform for delivering weight maintenance interventions as they provide rapid feedback, learner experimentation, real-time personalized task selection and exploration. Utilizing virtual reality during weight maintenance allows individuals to engage in repeated experiential learning, practice skills, and participate in real-life scenarios without real-life repercussions, which may diminish weight regain. We will conduct an 18-month effectiveness trial (6 months weight loss, 12 months weight maintenance) in 202 overweight/obese adults (BMI 25-44.9kg/m(2)). Participants who achieve ≥5% weight loss following a 6month weight loss intervention delivered by phone conference call will be randomized to weight maintenance interventions delivered by conference call or conducted in a virtual environment (Second Life®). The primary aim of the study is to compare weight change during maintenance between the phone conference call and virtual groups. Secondarily, potential mediators of weight change including energy and macronutrient intake, physical activity, consumption of fruits and vegetables, self-efficacy for both physical activity and diet, and attendance and completion of experiential learning assignments will also be assessed., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Adolescents with intellectual and developmental disabilities (IDD) have high rates of obesity. However, little research has been conducted demonstrating effective strategies and barriers for weight loss or weight management in adolescents with IDD. Furthermore, parents play a large role in terms of weight management in children and adolescents with IDD, and their views should be taken into consideration when designing a diet and PA intervention for weight management., Objective: The aims of this study are to better understand the parents' perspectives on the strategies and barriers for helping children and adolescents with IDD be successful in a weight management program and to identify how this information to guide future approaches., Methods: Semi-structured interviews were conducted in 18 parents whose children had just finished a diet and PA intervention. Interviews were transcribed verbatim, and thematic analysis was performed., Results: Parents reported a positive attitude toward the program, liked the convenience of the program, and felt that they learned beneficial strategies to encourage healthy habits in the home. Parents found time to be a major barrier to supporting their child with a diet and PA intervention. Parents were willing to change their own dietary behaviors to help their children successfully follow a weight loss intervention; however, no parent reported changing their own PA levels., Conclusion: Future diet and PA studies should aim to reduce parental time commitment and increase importance of PA., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Dietary supplementation with almonds has demonstrated dose-dependent decreases in low-density lipoprotein cholesterol (LDL-C), likely because of their composition of beneficial nutrients including mono- and polyunsaturated fatty acids, fiber, and protein., Objective: The primary objective of this study was to determine the changes in the lipid profile (LDL-C, high-density lipoprotein cholesterol [HDL-C], triglycerides, total cholesterol, non-HDL-C), LDL-C particle size, and lipoprotein (a) when 100 g of almonds daily were added to background statin therapy for 4 weeks., Methods: Subjects (N = 48) receiving a consistent statin dose were randomized to 100 g of almonds daily and to The National Cholesterol Education Program Adult Treatment Panel's third report Therapeutic Lifestyle Changes Diet counseling (almond group; n = 22) or solely Adult Treatment Panel's third report Therapeutic Lifestyle Changes Diet counseling (non-almond group; n = 26), for 4 weeks., Results: No significant changes in weight and weekly physical activity were noted between the 2 groups from baseline. However, the almond group consumed significantly more calories at 4 weeks compared with controls. The almond group experienced a 4.9% reduction in non-HDL-C compared with a 3.5% increase for the non-almond group (P = .02). Additionally, notable improvements were observed in LDL-C and triglycerides, but did not achieve statistical significance (P = .068 for both parameters). There was also a shift from LDL pattern A to pattern B particles (P = .003) in the almond group. No significant differences in total cholesterol (P = .1), HDL-C (P = .3), or lipoprotein (a) (P = .1) were observed., Conclusion: Adding 100 g of almonds daily to chronic statin therapy for 4 weeks significantly reduced non-HDL-C., Trial Registration: clinicaltrials.gov Identifier: NCT00603876., (Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.)