Incremental Rise Research Articles

Does size matter? Perineometer and digital examination of a model levator hiatus.

Evaluation of the female pelvic floor muscles is commonly carried out with digital examination and assigning a modified Oxford scale score or vaginal manometry. Racial differences can influence the size of the levator hiatus (LH) with "black" or African nulliparous women having a significantly larger LH compared to Caucasian women. The aim of this study was to assess the impact of LH size on manometry readings of simulated pelvic floor muscle contractions (PFMCs) using a small and large model LH. Small and large LH models were created using published data for size. Inflation of a pressure cuff placed circumferentially in the LH model represented a simulated PFMC. The models were examined in a supine position by three examiners and a perineometer twice each at varying simulated PFMC strength. Positive correlation was found between increasing simulated PFMC strength with a higher Oxford score following digital examination and manometry readings for both the small (rs = .87, rs = .98) and large (rs = .95, rs = .87) models. There was good to excellent inter and intraobserver correlation for digital assessment of both models. The manometry measurements showed a much larger incremental rise from baseline in the small model compared with the large model (P < .05). This study demonstrates that perineometer readings are affected by natural variations in LH size and PFMC strength. Therefore improvement to pelvic floor strength cannot be interpreted and measurements cannot be compared with others unless the LH size is known or digital examination is carried out.

Management of subsequent pregnancies following fourth-degree obstetric anal sphincter injuries (OASIS)

ObjectivesThe management of subsequent pregnancy in women who sustained OASIS remains an enigma. Nearly all studies include all grades of OASIS including fourth-degree tears. In addition, most protocols require endoanal ultrasound and anal manometric assessment to provide advice regarding mode of delivery. In reality, most women who sustain an OASI do not undergo these investigations. The aims of our study were firstly to evaluate outcomes of fourth-degree OASIS in terms of sphincter defects, anal manometry and anal incontinence symptoms. Secondly, we wished to review recommendations made regarding subsequent mode of delivery after fourth-degree OASIS according to different published protocols. Study designAn observational study of all women who had undergone a primary repair of a fourth-degree tear and seen in the perineal clinic of a tertiary urogynaecology unit between January 2006 and December 2017. Three-dimensional endoanal ultrasound and anal manometry were performed on all women, and symptoms assessed using the validated modified St Mark’s Score for anal incontinence. Diagnostic test accuracy analysis was performed for use of symptoms in predicting abnormal investigations. Results74 fourth-degree tears were identified (mean follow-up 5.9 months; SD 11.5). Endoanal scan showed an internal anal sphincter defect in 77 % and an external anal sphincter defect in 49 %. Only 18 % had no defect. The mean incremental pressure rise was 12.6 mmHg (SD 15.5). 61 % were asymptomatic with a mean St Mark’s Score of 3.8 (SD 5.4). The presence of symptoms alone had poor accuracy in predicting abnormal investigations. Based on Royal College of Obstetricians and Gynaecologists guidance, only 7% would not be offered a caesarean section as they are asymptomatic women with normal scan and manometry findings and would be counselled for a vaginal delivery. ConclusionsGiven that only a few units offer these specialist investigations to their OASI population, it would be reasonable to offer caesarean section to all women who have sustained a fourth-degree tear. However, in centres where endoanal ultrasound and anal manometry are available, individualised counselling can be offered.

Association of high sensitivity C-reactive protein and metabolic syndrome components in middle-aged subjects without overt cardiovascular disease in LitHiR primary prevention programme

Summary Objectives: Circulating levels of inflammatory markers such as high sensitivity C-reactive protein (hs-CRP) have been reported to be associated with increased risk of cardiovascular disease (CVD), as well as with metabolic syndrome (MetS). Therefore, our objectives were to investigate the associations between hs-CRP levels and individual MetS components as well as to analyse if hs-CRP levels are linked with the number of MetS components present in middle-aged subjects. Design and methods: A cross-sectional study included 4628 middle-aged MetS subjects from the Lithuanian High Cardiovascular Risk primary prevention programme (LitHiR) from 2011 to 2020. MetS was diagnosed according to the National Cholesterol Education Program ATP III modified criteria. CRP was measured by a validated high-sensitivity assay. A hs-CRP cutpoint of 5 mg/l was used to differentiate high and low hs-CRP groups. Results: The mean value of hs-CRP was 3.23 ± 4.04 mg/l, and significantly increased as the number of components of MetS increased (p &lt; 0.001). The concentration of serum hs-CRP was significantly associated with waist circumference, systolic and diastolic blood pressure, and fasting blood glucose (all p &lt; 0.001). However, no statistically significant associations were found between hs-CRP and serum triglycerides (p = 0.340) or serum high-density lipoprotein cholesterol (p = 0.148). Conclusions: Serum hs-CRP increased progressively with increased waist circumference, blood pressure, fasting blood glucose in middle-aged subjects with MetS. The higher values of hs-CRP were more often present in obese subjects and women. The incremental rise in mean serum hs-CRP level was found with an increasing number of MetS components.

Molecular Processes Underpinning Seasonal Regulation of Flowering in Bread Wheat ( &lt;i&gt;Triticum Aestivum L.&lt;/i&gt;)

Plants integrate seasonal progression in daylength and temperature to determine the optimal time to flower and produce seed. In cereals, genes that regulate responses to changing daylengths and temperature have been well-studied using controlled conditions; however, the molecular processes underpinning flowering in nature are poorly understood. Here, we investigate the molecular pathways that coordinate flowering and inflorescence development in wheat as daylengths extend naturally in the field. We find that discrete photoperiods contribute to the initiation of flowering and control of yield-related traits as days becomes longer from winter into spring. This process involves step-wise increases in the expression of FLOWERING LOCUS T1 (FT1). Photoperiod-1 (Ppd-1) partially regulates the seasonal induction of FT1, which responds dynamically to changes in daylength to influence the rate of inflorescence development. The incremental rise in FT1 expression is overridden in plants that contain a photoperiod-insensitive allele of Ppd-1, which hastens the completion of spikelet development and accelerates flowering time. The completion of spikelet formation is promoted by FLOWERING LOCUS T2, which influences spikelet number and is activated by Ppd-1. This research advances our understanding of the seasonal regulation of flowering in wheat and provides a strong foundation to improve yield potential by fine-tuning the photoperiod-dependent control of inflorescence development.

Infections with yeast and yeast like fungi in cancer patients with special emphasis on non- neoformans cryptococcal infections: Retrospective study

Infections with yeast and yeast like fungi in cancer patients with special emphasis on non- neoformans cryptococcal infections: Retrospective study - IJMR- Print ISSN No: - 2394-546X Online ISSN No:- 2394-5478 Article DOI No:- 10.18231/j.ijmr.2019.047, Indian Journal of Microbiology Research-Indian J Microbiol Res

Platelet Refractoriness in a Pediatric ECMO Patient: A Case Report

Thrombocytopenia is a life-threatening condition, the severity of which is exacerbated further if the patient requires anticoagulation and is refractory to platelet transfusion. This is the first report of an infant undergoing extracorporeal support with immune-mediated platelet refractoriness. A 19-month-old girl, with a complex cardiac history, required extracorporeal support because of deterioration 8 days post-cardiac surgery. The child suffered from ongoing thrombocytopenia, unresponsive to multiple platelet transfusions. An incremental rise in the platelet count was achieved following transfusion of human leukocyte antigen–matched platelets, although this was unsuccessful with subsequent transfusions of matched platelets. Following 7 days on extracorporeal membrane oxygenation (ECMO), without cardiac improvement and likely poor prognosis, treatment was withdrawn and the patient died. The management of immune-mediated platelet refractoriness, in an anticoagulated patient on ECMO, requires early diagnosis and timely intervention to achieve a good outcome for the child. An understanding of the condition and a multidisciplinary approach to its treatment will assist in effective direction of medical therapy.

Seasonal and Long-Term Changes to Pavement Life Caused by Rising Temperatures from Climate Change

Pavements are vulnerable to reduced life with climate-change-induced temperature rise. Greenhouse gas emissions have caused an increase in global temperatures since the mid-20th century and the warming is projected to accelerate. Many studies have characterized this risk with a top-down approach in which climate-change scenarios are chosen and applied to predict pavement-life reduction. This approach is useful in identifying possible pavement futures but may miss short-term or seasonal pavement-response trends that are essential for adaptation planning. A bottom-up approach focuses on a pavement’s response to incremental temperature change resulting in a more complete understanding of temperature-induced pavement damage. In this study, a hybrid bottom-up/top-down approach was used to quantify the impact of changing pavement seasons and temperatures on pavement life with incremental temperature rise from 0 to 5°C at a site in coastal New Hampshire. Changes in season length, seasonal average temperatures, and temperature-dependent resilient modulus were used in layered-elastic analysis to simulate the pavement’s response to temperature rise. Projected temperature rise from downscaled global climate models was then superimposed on the results to determine the timing of the effects. The winter pavement season is projected to end by mid-century, replaced by a lengthening fall season. Seasonal pavement damage, currently dominated by the late spring and summer seasons, is projected to be distributed more evenly throughout the year as temperatures rise. A 7% to 32% increase in the asphalt-layer thickness is recommended to protect the base and subgrade with rising temperatures from early century to late-mid-century.

Multi-species test and calibration of an improved transient thermal dissipation system of sap flow measurement with a single probe.

Transient thermal dissipation (TTD) systems provide a simple way to measure xylem sap flow with dual or single Granier-type probe, which gives lower energy consumption and higher accuracy due to its lessor sensitivity to thermal interferences. A new system, TTD heat within 5 min (TTD5), proposed on the reduction of the heating duration. This evolution captured interest through decreased energy consumption and increased temporal resolution. Within our study, the first objective was to test and calibrate this new system with a single probe for young rubber tree - Hevea brasiliensis. The second objective was to explore the sources of variability in calibration such as species, individual cut-stems and probe-wood contact. The complementary species consisted of two diffuse-porous species (mango tree - Mangifera indica, eucalyptus tree - Eucalyptus camaldulensis) and one ring-porous species (teak tree - Tectonia grandis). Twenty-eight response curves were assessed over a large range of flux densities from 0.5 to 10 l dm-2 h-1. The incremental rise of temperature from 30 to 300 s (T300-30) after commencement of heating was sensitive to flux density over the complete range. Compared with the full signal at 300 s, the incremental signal markedly reduced the variability between response curves within species and between species. Moreover, a new index K2, defined as (T0 - Tu)/T0, normalized the responses between 0 and 1. However, the responses had a non-linear trend above 5 l dm-2 h-1. Within diffuse-porous wood type, the species did not differ in calibration, whereas the ring-porous species was markedly different. A sigmoid function provided the best fit for the diffuse-porous species. Individual stems were identified as the main source of within-species variability in calibration. The normalizing K2 index removed the influence of probe-wood contacts, controlled through drilling difference; however, there was still an effect of individual stems interacting with flux density (P = 0.019). Replications of cut-stems and response curves are necessary to assess a reliable averaged calibration. In conclusion, the applicability of the TTD5 system with a single probe has been confirmed and several sources of variability in calibration have been evaluated.

Composition, richness and floristic diversity along an elevational gradient in a semi-disturbed treeline ecotone, Bhaderwah, Jammu and Kashmir

The paper deals with plant species richness - diversity relationship along the rising elevation in a semi-disturbed tree line ecotone in upper Bhaderwah, a part of lesser Himalaya. 253 plant species distributed over 170 genera and 62 families were recorded during the intensive field surveys carried during May 2014 to September 2016. These included 11 trees, 29 shrubs and 213 herb species with 247 angiosperms and 6 gymnosperms. Family Asteraceae with 37 species dominated the study area. Maximum richness (179) was observed at sub-alpine zone (Site IV) while the trees (H'=1.74) and shrubs (H'=2.48) revealed maximum diversity at Site III and herbs at Site IV (H'=4.60). The maximum evenness for trees, shrubs and herbs was exhibited by sites III (J'=0.79), V (J'=0.87) and VI (J'=0.94), respectively. The diversity and evenness showed an incremental rise along the rising elevation reaching maxima at the mid elevation with Site-IV being the species rich and Site-VII species deficit, which implies that sub-alpine and alpine forests need effective monitoring and conservation.

Differential rates of group B streptococcus (GBS) colonisation in pregnant women in a racially diverse area of London, UK: a cross-sectional study.

To describe the epidemiology of maternal group B streptococcus (GBS) colonisation by racial group. Cross-sectional study. Antenatal clinics in London North West University Healthcare NHS Trust. Pregnant women. Group B streptococcus (GBS) colonisation status was recorded during a screening programme for the prevention of invasive early-onset GBS infection. Information regarding age, address, ethnicity, parity, mode of delivery, body mass index (BMI), and diabetes was routinely collected. Data were analysed by multivariable analysis. Association between GBS colonisation and putative risk factors. Overall, 29.1% (1836/6309) of the women were colonized with GBS. Multivariable analysis showed significantly higher colonisation among women of black African origin (39.5%; OR=1.57) compared with white British women (27.4%), and lowest colonisation in women of South Asian origin (23.3%; OR=0.8). Higher parity (≥2) was associated with higher colonisation (35.3%), with the odds of colonisation over 40% higher than for nulliparous women. Increasing BMI was associated with an incremental rise in colonisation from 23 to 35%. Colonisation was not associated with age, season or mode of testing. This study identified high maternal GBS colonisation rates in a racially and socially diverse population. The highest rates were seen in women of black African origin and also with higher parity and BMI. Further research is needed to understand the relationship between these factors and rectovaginal colonisation. Study of group B streptococcus colonisation in pregnant women in London shows highest rates in black African women and those with high BMI and parity.

Microstructure and Mechanical Properties of Cement Mortar Containing Phase Change Materials

This paper presents an investigation of the characterization of cement mortar containing phase change materials (PCMs) in order to control the development of hydration heat. The study examined microstructural characteristics and properties of cement mortar with PCMs such as flow, compressive strength, and flexural strength. This research involved two types of PCM and up to 15% cement added to cement mortar mixtures. The two types of PCM used in this study are PCM with barium (PCM-Ba) and PCM with strontium (PCM-Sr). The experimental results indicate that both the incremental temperature rise and the maximum temperature release time of PCM up to 5% addition are delayed. Both PCM-Ba and PCM-Sr are effective in reducing the development of hydration heat. The microstructural analysis results show that the crystalloid content of cement mortar without PCMs is about 3% more from cement mortar with PCMs, regardless of the type of PCMs used, and that no significant difference is evident in the formation of crystals between cement mortar with and without PCMs.

Addressing Asymmetries in the Eurozone

Asymmetries in the Eurozone are high and the whole undertaking is at the crossroads. On one hand, one of its countries, namely Germany, seems to enjoy current account and budget surpluses, mainly as a result of a strong global demand for high quality German exports, an undervalued single currency, low interest rates, domestic wage restraint and a high domestic saving rate. On the other hand, persistent German surpluses associated with the not-as-good performance of the other economies make it harder for the Eurozone as a whole to recover. The European Union (EU) has tried to create a proper economic and banking union after the crisis. This attempt seems to have not been fully successful for some of the countries. At the same time, the attempts to impose austerity measures caused to a large extent an incremental rise inskepticismin Europe. The purpose of this paper is to record the prevailing asymmetries in the Eurozone, to estimate the priorities and the different maximization functions of the member countries and investigate alternative scenarios that can be followed. It is also to understand and possibly interpret the dilemmas of the German economic policy in depth, as it is the strongest economy in the Eurozone and hence anticipation was created that it would play the role of the steam engine—not necessarily within Europe only. The set of decisions that could have been taken is in the spotlight again especially due to the fear that at least the financial markets—if not the economies as a whole—are entering into a declining pattern again.

Unscrambling the relations of egg and meat consumption with type 2 diabetes risk

ABSTRACTBackgroundMeat intake is associated with increased risk of type 2 diabetes (T2D). It is not clear if egg intake is associated with T2D risk because purported associations may be due to concurrent consumption of eggs with meat.ObjectiveOur aim was to differentiate any associations between meat and egg consumption and the risk of T2D.DesignIn this longitudinal study, 55,851 participants of the Adventist Health Study 2 who were free of diabetes provided demographic, anthropometric, and dietary data at baseline. Meat and egg intakes were assessed with a validated quantitative food-frequency questionnaire. Responses to 2 follow-up questionnaires determined incident T2D cases. Multivariate-adjusted logistic regression was used to determine relations between meat and egg intake and incident T2D.ResultsT2D cases identified during a mean 5.3 y of follow-up totaled 2772. Meat intake of >0 to <25 g/d, ≥25 to <70 g/d, and ≥70 g/d significantly increased the risk of T2D compared with no meat intake (OR: 1.29; 95% CI: 1.16, 1.44; OR: 1.42; 95% CI: 1.25, 1.61; and OR: 1.65; 95% CI: 1.39, 1.96, respectively; P-trend < 0.0001). Egg intake compared with no egg intake was not associated with T2D risk. A significant meat-egg interaction (P = 0.019) showed that within every category of egg intake, there was an incremental rise in T2D risk as meat intake increased. However, within categories of meat intake, increasing egg intake did not increase the risk of T2D except among nonmeat-eaters consuming ≥5 eggs/wk (OR: 1.52; 95% CI: 1.09, 2.12).ConclusionsMeat consumption, but not egg consumption, is independently associated with T2D risk. Egg intake seems not to increase T2D risk further with meat intake. Our findings suggest that the purported egg-T2D risk relation in US populations may be biased due to failure to investigate egg-meat interactions. Further investigations are needed to ascertain T2D risk among nonmeat-eaters with high egg intakes.

Responses to pup vocalizations in subordinate naked mole-rats are induced by estradiol ingested through coprophagy of queen’s feces

Naked mole-rats form eusocial colonies consisting of a single breeding female (the queen), several breeding males, and sexually immature adults (subordinates). Subordinates are cooperative and provide alloparental care by huddling and retrieving pups to the nest. However, the physiological mechanism(s) underlying alloparental behavior of nonbreeders remains undetermined. Here, we examined the response of subordinates to pup voice and the fecal estradiol concentrations of subordinates during the three reproductive periods of the queen, including gestation, postpartum, and nonlactating. Subordinate response to pup voice was observed only during the queen's postpartum and was preceded by an incremental rise in subordinates' fecal estradiol concentrations during the queen's gestation period, which coincided with physiological changes in the queen. We hypothesized that the increased estradiol in the queen's feces was disseminated to subordinates through coprophagy, which stimulated subordinates' responses to pup vocalizations. To test this hypothesis, we fed subordinates either fecal pellets from pregnant queens or pellets from nonpregnant queens amended with estradiol for 9 days and examined their response to recorded pup voice. In both treatments, the subordinates exhibited a constant level of response to pup voice during the feeding period but became more responsive 4 days after the feeding period. Thus, we believe that we have identified a previously unknown system of communication in naked mole-rats, in which a hormone released by one individual controls the behavior of another individual and influences the level of responsiveness among subordinate adults to pup vocal signals, thereby contributing to the alloparental pup care by subordinates.

Interaction and Phase Formation in the WC–Fe2O3–NiO–C System Heated in Vacuum and Argon

The interaction and phase formation in the WC–33 wt.% (80% Fe2O3 + 20% NiO) system with and without free carbon when heated in vacuum and in an argon atmosphere have been studied. Superfine soot and sucrose were used as free carbon. The powders pressed as pellets were heated by incremental temperature rise. In the absence of free carbon, the carbon contained in tungsten carbide and the oxygen contained in iron and nickel oxides actively interact in the carbide–oxide system, leading to weight loss of the samples. The intermetallic (Fe, Ni)7W6 phase, (Fe, Ni)WO4 oxide, and tungsten form as a result. The addition of free carbon allows tungsten carbide to be retained partially or completely and iron and nickel to be reduced from oxides. If there is a lack of free carbon, some part of the carbon contained in tungsten carbide begins to interact with oxygen to form complex Me6C carbide in the system, the metal phase having fcc and bcc lattices. When heating proceeds in vacuum, more carbon is spent to remove the same amount of oxygen than in heating in an argon atmosphere, but temperature of active interaction between carbon and oxygen decreases.

Variables affecting hospital length of stay: a scoping review

PurposeTertiary hospitals have registered an incremental rise in expenditure mostly because of the increasing demands by ageing populations. Reducing the length of stay (LOS) of patients within tertiary hospitals is one of the strategies, which has been used in the last decades to ensure health care systems’ sustainability. Furthermore, LOS is one of the key performance indicators, which is widely used to assess hospital efficiency. Hence, it is crucial that policy makers use evidence-based practices in health care to aim for optimal LOS. The purpose of this paper is to identify and summarize empirical research that brings together studies on the various variables that directly or indirectly impact on LOS within tertiary hospitals so as to develop a LOS causal systems model.Design/methodology/approachThis scoping review was guided by the following research question: “What is affecting the LOS of patients within tertiary-level health care?” and by the guidelines specified by Arksey and O’Malley (2005), and by Armstrong et al. (2011). Relevant current literature was retrieved by searching various electronic databases. The PRISMA model provided the process guidelines to identify and select eligible studies.FindingsAn extensive literature search yielded a total of 30,350 references of which 46 were included in the final analysis. These articles yielded variables, which directly/indirectly are linked to LOS. These were then organized according to the Donabedian model – structure, processes and outcomes. The resultant LOS causal model reflects its complexity and confirms the consideration by scholars in the field that hospitals are complex adaptive systems, and that hospital managers must respond to LOS challenges holistically.Originality/valueThis paper illustrates a complex LOS causal model that emerged from the scoping review and may be of value for future research. It also highlighted the complexity of the construct under study.

Comparison study of indoor/outdoor experiments of a photovoltaic thermal PV/T system containing SiC nanofluid as a coolant

Solar energy technology has been evolving for the better part of the last decade. Worldwide innovation and support have created an alternative energy source that is helping to battle climate change. Photovoltaic thermal (PV/T) converters use various working fluids. Silicon carbide (SiC) nanofluid is employed in this study in the cooling application of a PV/T system. The aim of this study is to assess and evaluate the performance of PV/T collectors when running a SiC nanoparticle dispersed in water as the base fluid for both indoor and outdoor systems. The performance assessment includes thermal, electrical and combined PV/T efficiencies. Indoor and outdoor experimentation is done to accurately assess the performance enhancement hypothesized by the authors. Furthermore, a comparison is made between the indoor and outdoor results to validate each experiment and draw conclusions. The indoor system results were close to the outdoor experiment, suggesting a performance enhancement with an incremental efficiency rise.

Abstract 154: Three-Month Modified Rankin Scale Score Predicts 5-Year Post-Stroke Dementia And Institutionalization Outcomes: A Population-Based Prospective Cohort Study

Background: Dementia and institutionalization are known long-term complications of stroke, but the extent to which post-stroke disability – as captured by the modified Rankin Scale (mRS) in trials – predicts these outcomes remains unclear. Quantifying this relationship can inform prognostication and cost-effectiveness analyses. Methods: In consecutive 3-month survivors of ischaemic stroke in a population-based prospective cohort (Oxford Vascular Study;2002-2014), we established post-stroke dementia (excluding pre-stroke dementia) and tracked institutionalization (admission to nursing or residential care home) through overlapping methods of cognitive testing and interview-based assessments of patients and carers, and ongoing searches of primary care and hospital records. We related 3-month mRS to 5-year dementia and institutionalization using age/sex-adjusted Cox and logistic regressions (repeated excluding premorbid mRS&gt;2), and compared the area under the receiver operating characteristics curves (AUC) for logistic models versus age/sex alone. Results: Among 1,425 survivors, 3-month mRS independently predicted 5-year dementia and institutionalization whether or not those with premorbid disability were excluded, with mRS of 3-5 carrying higher hazards of each outcome than mRS 0-2; aHR(dementia)=3.37, 95%CI 2.63-4.32, aHR(institutionalization)=6.33, 4.53-8.85, p&lt;0.0001. However, each step up the mRS ladder was associated with a jump in hazard for each outcome; e.g. aHR(dementia) vs mRS=0 for mRS=1: 0.91, 95%CI 0.48-1.75, p=0.78; mRS=2: 1.56, 0.84-2.92, p=0.16; mRS=3: 2.86, 1.54-5.30, p=0.001; mRS=4: 4.61, 2.46-8.63, p&lt;0.0001; mRS=5: 9.79, 5.13-18.7, p&lt;0.0001. Logistic models including the mRS, particularly in its ordinal form, predicted 5-year dementia or institutionalization better than age/sex alone (e.g. AUC for dementia with only age/sex: 0.72, 95%CI 0.69-0.75; with 3-month mRS: 0.79, 0.76-0.82, p&lt;0.0001). Conclusions: 3-month mRS strongly predicts post-stroke dementia and institutionalization, both of which should be considered in cost-effectiveness analyses of acute treatments. The incremental rise in hazard with each step up the mRS ladder further supports using ordinal analysis of the mRS in trials.

Web-Based Alcohol Intervention in First-Year College Students: Efficacy of Full-Program Administration Prior to Second Semester

ABSTRACTBackground: Commercially available, web-based interventions for the prevention of alcohol use are being adopted for universal use with first-year college students, yet few have received empirical evaluation. Objectives: This randomized controlled trial investigated the effectiveness of a novel, commercially available, personalized web-based alcohol intervention, Alcohol-Wise (version 4.0, 3rd Millennium Classrooms), on multiple measures of alcohol consumption, alcohol consequences, alcohol expectancies, academic achievement, and adaptation to college in first-year students. Method: Participants received Alcohol-Wise either prior to first semester or were waitlisted and received the intervention second semester. As longitudinal effectiveness was of interest, follow-up surveys were conducted 10 weeks (n = 76) and 24 weeks (n = 64) following the web-based alcohol intervention. Results: Completion of Alcohol-Wise had effects on academic achievement. Specifically, at the 24 week follow-up, academic achievement was higher in participants who received the intervention first semester of their freshman year as compared to the waitlist control. The incremental rise in heavy episodic drinking during the first semester of college was also reduced in waitlisted participants by Alcohol-Wise administration prior to second semester. Conclusion/Importance: Implications for the timing of web-based alcohol interventions to include administration prior to both first and second semesters of the freshman year are discussed.

Does Cardiorespiratory Fitness Attenuate the Adverse Effects of Severe/Morbid Obesity on Cardiometabolic Risk and Insulin Resistance in Children? A Pooled Analysis

To investigate 1) differences in cardiometabolic risk and HOMA of insulin resistance (HOMA-IR) across BMI categories (underweight to morbid obesity), 2) whether fit children have lower cardiometabolic risk/HOMA-IR than unfit children in each BMI category, and 3) differences in cardiometabolic risk/HOMA-IR in normal-weight unfit children and obese fit children. A pooled study including cross-sectional data from three projects (n = 1,247 children aged 8-11 years). Cardiometabolic risk was assessed using the sum of the sex- and age-specific z scores for triglycerides, HDL cholesterol, glucose, and the average of systolic and diastolic blood pressure and HOMA-IR. A significant linear association was observed between the risk score and BMI categories (P trend ≤0.001), with every incremental rise in BMI category being associated with a 0.5 SD higher risk score (standardized β = 0.474, P < 0.001). A trend was found showing that as BMI categories rose, cardiorespiratory fitness (CRF) attenuated the risk score, with the biggest differences observed in the most obese children (-0.8 SD); however, this attenuation was significant only in mild obesity (-0.2 SD, P = 0.048). Normal-weight unfit children had a significantly lower risk score than obese fit children (P < 0.001); however, a significant reduction in the risk score was found in obese fit compared with unfit children (-0.4 SD, P = 0.027). Similar results were obtained for HOMA-IR. As BMI categories rose so did cardiometabolic risk and HOMA-IR, which highlights the need for obesity prevention/treatment programs in childhood. Furthermore, CRF may play an important role in lowering the risk of cardiometabolic diseases in obese children.