Independent Samples Kruskal-Wallis Test Research Articles

GDF15 Promotes Osteoclast Differentiation and High Serum GDF15 Levels are Associated with Multiple Myeloma Bone Disease

Introduction Growth differentiation factor 15 (GDF15) is a multifunctional growth factor of the transforming growth factor beta (TGFbeta) family that plays a complex role in several types of cancers. In multiple myeloma, GDF15 was recently shown to enhance the tumor-initiating and self-renewal potential of the cancer cells (Tanno et al, Blood 2014). Moreover, blood and bone marrow plasma levels of GDF15 are elevated in myeloma patients compared with healthy persons, and high serum levels are associated with a poor prognosis (Corre et al, Cancer Research 2012). GDF15 seems important for bone remodeling during hypoxia (Hino et al, JBMR 2012), and one study proposed GDF15 to increase osteoclast activation in prostate cancer metastasizing to bone (Wakchoure et al, Prostate 2009). Whether GDF15 plays a role in the bone disease of multiple myeloma is not well characterized. Aim Our aim was to investigate whether high GDF15 serum levels are associated with multiple myeloma bone disease and to characterize the effect of GDF15 on osteoclast differentiation in vitro. Methods GDF15 was measured in serum samples obtained at diagnosis from 138 myeloma patients and 58 age and sex-matched healthy controls. The patient serum samples were collected for the Nordic Myeloma Study Group during a randomized phase 3 clinical trial which compared the effect of two different doses of pamidronate on bone. The bone disease was therefore particularly well-characterized in this study (Gimsing et al, Lancet Oncol 2010). Peripheral blood mononuclear cells (PBMC) isolated from buffy coats were cultured in osteoclast medium (a-MEM with human serum (20%), M-CSF (30ng/ml) and RANKL (50ng/ml)) for up to 14 days with or without GDF15. Purchased pre-osteoclasts (Lonza Inc.) were cultured in purchased bullet kit (OC medium with M-CSF (33ng/ml) and RANKL (66ng/ml)) for 7 days with or without GDF15. Cells positive for tartrate resistant acidic phosphatase (TRAP) staining and with more than two nuclei were counted as osteoclasts. Results GDF15 was significantly higher in serum obtained from myeloma patients (median 1.08 ng/ml, range 27.91) compared with healthy controls (median 0.46 ng/ml, range 1.66, Independent samples Kruskal-Wallis test p In vitro, addition of GDF15 (0-100 ng/ml) to osteoclast precursors or PBMC increased numbers of multi-nucleated TRAP positive cells in a dose dependent manner (n=3, O ng/ml GDF15 mean 25.7, SEM 5.9, 2 ng/ml GDF15 mean 29.7, SEM 4.3, 20 ng/ml GDF15 mean 38.7, SEM 4.9, 50 ng/ml GDF15 mean 53.3, SEM 11.6, 100 ng/ml GDF15 mean 78.7 SEM 7.8). OPG inhibited the pro-osteoclastogenic activity of GDF15 inferring that the effect is mediated by RANKL. Hence, GDF15 increases osteoclast differentiation. Conclusion Serum GDF15 is elevated in myeloma patients with advanced osteolytic bone disease compared to patients with no lesions. GDF15 increases osteoclast differentiation in vitro. Hence, GDF15 could play a role in regulating bone remodeling in myeloma patients. Disclosures No relevant conflicts of interest to declare.

Laser fiber cleaving techniques: effects on tip morphology and power output.

Proper cleaving of reusable laser fibers is needed to maintain optimal functionality. This study quantifies the effect of different cleaving tools on power output of the holmium laser fiber and demonstrates morphologic changes using microscopy. The uncleaved tips of new 272 μm reusable laser fibers were used to obtain baseline power transmission values at 3 W (0.6 J, 5 Hz). Power output for each of four cleaving techniques-11-blade scalpel, scribe pen cleaving tool, diamond cleaving wheel, and suture scissors-was measured in a single-blinded fashion. Dispersion of light from the fibers was compared with manufacturer specifications and rated as "ideal," "acceptable," or "unacceptable" by blinded reviewers. The fiber tips were also imaged using confocal and scanning electron microscopy. Independent samples Kruskal-Wallis test and chi square were used for statistical analysis (α<0.05). New uncleaved fiber tips transmitted 3.04 W of power and were used as a reference (100%). The scribe pen cleaving tool produced the next highest output (97.1%), followed by the scalpel (83.4%), diamond cleaving wheel (77.1%), and suture scissors (61.7%), a trend that was highly significant (P<0.001). On pairwise comparison, no difference in power output was seen between the uncleaved fiber tips and those cleaved with the scribe pen (P=1.0). The rating of the light dispersion patterns from the different cleaving methods followed the same trend as the power output results (P<0.001). Microscopy showed that the scribe pen produced small defects along the fiber cladding but maintained a smooth, flat core surface. The other cleaving techniques produced defects on both the core and cladding. Cleaving techniques produce a significant effect on the initial power transmitted by reusable laser fibers. The scribe pen cleaving tool produced the most consistent and highest average power output.

GDF15 Promotes Osteoclast Differentiation and High Serum GDF15 Levels Are Associated with Multiple Myeloma Bone Disease

IntroductionGrowth differentiation factor 15 (GDF15) is a multifunctional growth factor of the transforming growth factor beta (TGFbeta) family that plays a complex role in several types of cancers. In multiple myeloma, GDF15 was recently shown to enhance the tumor-initiating and self-renewal potential of the cancer cells (Tanno et al, Blood 2014). Moreover, blood and bone marrow plasma levels of GDF15 are elevated in myeloma patients compared with healthy persons, and high serum levels are associated with a poor prognosis (Corre et al, Cancer Research 2012). GDF15 seems important for bone remodeling during hypoxia (Hino et al, JBMR 2012), and one study proposed GDF15 to increase osteoclast activation in prostate cancer metastasizing to bone (Wakchoure et al, Prostate 2009). Whether GDF15 plays a role in the bone disease of multiple myeloma is not well characterized.AimOur aim was to investigate whether high GDF15 serum levels are associated with multiple myeloma bone disease and to characterize the effect of GDF15 on osteoclast differentiation in vitro.MethodsGDF15 was measured in serum samples obtained at diagnosis from 138 myeloma patients and 58 age and sex-matched healthy controls. The patient serum samples were collected for the Nordic Myeloma Study Group during a randomized phase 3 clinical trial which compared the effect of two different doses of pamidronate on bone. The bone disease was therefore particularly well-characterized in this study (Gimsing et al, Lancet Oncol 2010). Peripheral blood mononuclear cells (PBMC) isolated from buffy coats were cultured in osteoclast medium (a-MEM with human serum (20%), M-CSF (30ng/ml) and RANKL (50ng/ml)) for up to 14 days with or without GDF15. Purchased pre-osteoclasts (Lonza Inc.) were cultured in purchased bullet kit (OC medium with M-CSF (33ng/ml) and RANKL (66ng/ml)) for 7 days with or without GDF15. Cells positive for tartrate resistant acidic phosphatase (TRAP) staining and with more than two nuclei were counted as osteoclasts.ResultsGDF15 was significantly higher in serum obtained from myeloma patients (median 1.08 ng/ml, range 27.91) compared with healthy controls (median 0.46 ng/ml, range 1.66, Independent samples Kruskal-Wallis test p< 0.0001). Moreover, serum GDF15 was elevated in patients with a more advanced osteolytic bone disease (n= 51, median 1.44 ng/ml, range 6.48) as compared to patients without osteolytic lesions (n= 16, median 0.84 ng/ml, range 10.62) at inclusion (p<0.05). The difference between serum GDF15 in patients with limited bone disease at inclusion (n=51, median 1.07 ng/ml, range 6.84) and patients with no bone disease at baseline was not significantly different.In vitro, addition of GDF15 (0-100 ng/ml) to osteoclast precursors or PBMC increased numbers of multi-nucleated TRAP positive cells in a dose dependent manner (n=3, O ng/ml GDF15 mean 25.7, SEM 5.9, 2 ng/ml GDF15 mean 29.7, SEM 4.3, 20 ng/ml GDF15 mean 38.7, SEM 4.9, 50 ng/ml GDF15 mean 53.3, SEM 11.6, 100 ng/ml GDF15 mean 78.7 SEM 7.8). OPG inhibited the pro-osteoclastogenic activity of GDF15 inferring that the effect is mediated by RANKL. Hence, GDF15 increases osteoclast differentiation.ConclusionSerum GDF15 is elevated in myeloma patients with advanced osteolytic bone disease compared to patients with no lesions. GDF15 increases osteoclast differentiation in vitro. Hence, GDF15 could play a role in regulating bone remodeling in myeloma patients. DisclosuresNo relevant conflicts of interest to declare.

Impacts of LUCC on soil properties in the riparian zones of desert oasis with remote sensing data: A case study of the middle Heihe River basin, China

Large-scale changes in land use and land cover over long timescales can induce significant variations in soil physicochemical properties, particularly in the riparian zones of arid regions. Frequent reclamation of wetlands and grasslands and intensive agricultural activity have induced significant changes in both land use/cover and soil physicochemical properties in the riparian zones of the middle Heihe River basin of China. The present study aims to explore whether land use/land cover change (LUCC) can well explain the variations in soil properties in the riparian zones of the middle Heihe River basin. To achieve this, we mapped LUCC and quantified the type of land use change using remote sensing images, topographic maps, and GIS analysis techniques. Forty-two sites were selected for soil and vegetation sampling. Then, physical and chemical experiments were employed to determine soil moisture, soil bulk density, soil pH, soil organic carbon, total nitrogen, total potassium, total phosphorous, available nitrogen, available potassium, and available phosphorous. The Independent-Samples Kruskal–Wallis Test, principal component analysis, and a scatter matrix were used to analyze the effects of LUCC on soil properties. The results indicate that the majority of the parameters investigated were affected significantly by LUCC. In particular, soil moisture and soil organic carbon can be explained well by land cover change and land use change, respectively. Furthermore, changes in soil moisture could be attributed primarily to land cover changes. Changes in soil organic carbon were correlated closely with the following land use change types: wetlands–arable, forest–grasslands, and grasslands–desert. Other parameters, including pH and total K, were also found to exhibit significant correlations with LUCC. However, changes in soil nutrients were shown to be induced most probably by human agricultural activity (i.e. fertilize, irrigation, tillage, etc.), rather than by simple conversions from one land use/cover types to the others.

Diatom indices in the biological assessment of the water quality based on the example of a small lowland river

Abstract The aim of the study was to compare the biological analyzes of the Linda River (Central Poland), which were based on three diatom indices: IO, GDI and IPS in order to select the best diatom index for the biological assessment of the lotic water quality. Additionally, the summary of the selected results of the biological and chemical analyzes was presented to show how precise the biological analyzes are as a basic tool in the assessment of the ecological status of the lotic waters. The results showed that each of the indices assessed the water in the Linda River to a specific but different quality class. The IO index showed class II of the water quality, while the IPS and GDI — class III. Statistical analysis conducted with the nonparametric Kruskal-Wallis test for independent samples (Kruskal, Wallis 1952) showed that differences in the values of individual indices at different sites were not statistically significant. It should be noticed that the IPS and GDI indices gave values that classify the water in the Linda River at least one class below. The obtained results confirmed that the biological methods are most reliable in the assessment of the water quality. These methods are less sensitive to a single impact of the environmental factors, therefore they permit accurate determination of the ecological status of the water ecosystems.

Clinical significance of different antiphospholipid antibody isotypes in systemic lupus erythematosus

Objective To investigate the prevalence and clinical significance of different subtypes (IgG, IgM and IgA) of anticardiolipin antibodies (aCL) and anti-β2-glycoprotein I antibodies (aβ 2GP1), as well as lupus anticoagulant (LA) in systemic lupus erythematosus (SLE). Methods IgG/IgM/IgA, IgG, IgM, IgA aCL and anti-β2GP1 were tested by enzyme-linked immunosorbent assay (ELISA) in 100 patients with SLE (42 patients were diagnosed as secondary antiphospholipid syndrome), 44 healthy controls and 32 patients with other connective tissue diseases excluding SLE and antiphospholipid syndrome (APS). Meanwhile, LA was tested by modified Dilute Russell′s viper venom time (dRVVT). The correlation between antiphospholipid antibodies and clinical manifestation was analyzed by Spearman correlation analysis.The postiverate of antiphospholipid antibodies in SLE patients, health controls and patients with other connective tissue diseases were compared by chi square test. The concentrations of antiphospholipid antibodies in different groups were compared using independent sample Kruskal Wallis test. The diagnostic efficacy of antiphospholipid antibodies in SLE patients was analyzed by crosstable using clinical diagnosis of APS as gold standard. P<0.05 was considered statistically significant. Results The prevalence of IgG aCL(χ2=15.031 ,P<0.001), IgA/G/M (χ2=11.678, P=0.003) and IgA (χ2=6.17, P=0.036) anti-β2GP1 were significantly higher in patients with SLE than in the other two groups. IgA/G/M (r=0.207, P=0.039), IgG (r=0.230, P=0.021) and IgA (r=0.217, P=0.030) aCL, IgA/G/M (r=0.218, P=0.029) and IgA (r=0.255, P=0.01) anti-β2GP1, as well as LA (r=0.233, P=0.02) were associated with thrombotic events. IgA/G/M anti-β2GP1 (r=0.22, P=0.029) and LA (r=0.254, P=0.011) were associated with pathological pregnancy. 23.1% (6/26) aCL positive SLE patients were IgM and/or IgA aCL positive. 53.6% (15/28) anti-β2GP1 positive SLE patients were IgM and/or IgA anti-β2GP1 positive. In SLE patients, the specificity and sensitivity of IgA/G/M aCL for APS were 98.3% and 26.2%, respectively. The specificity and sensitivity of IgA/G/M anti-β2GP1 were 84.5% and 40.5%, respectively. The specificity of at least two isotypes positive for APS (both aCL and anti-β2GP1 were 98.3%), was higher than IgG aCL (94.8%) or anti-β2GP1 (93.1%). The sensitivity of at least one isotype of aCL (47.6%) or anti-β2GP1 (42.9%) positive for APS were higher than IgG aCL (40.5%) and anti-β2GP1 (21.4%). Conclusions IgG and IgM aCL together would be better than IgA/G/M aCL for APS screening. IgA/G/M anti-β2GP1 would be better for APS screen due to higher sensitivity and strong association with thromboembolic events and pathologic pregnance. IgA aCL or anti-β2GP1 was associated with thromboembolic events. IgA aCL or anti-β2GP1 would be useful for APS diagnosis in IgG and IgM aCL or anti-β2GP1 negative patients. （Chin J Lab Med,2014,37:597-602） Key words: Lupus erythematosus, systemic; Antiphospholipid syndrome; Immunoglobulins; Antibodies, anticardiolipin; beta 2-Glycoprotein I; Lupus coagulation inhibitor

Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury–induced bradycardia

Cervical spinal cord injury (CSCI) is often complicated by autonomic instability and life-threatening bradycardia. β-adrenergic receptors offer a potential target for modulating cardiac vagal activity and heart rate. Enteral albuterol may mitigate symptomatic bradycardia in CSCI patients. The purpose of this study was to examine the effect of enteral albuterol on the frequency of symptomatic bradycardia and the need for rescue therapy in CSCI patients. The charts of CSCI patients admitted to a Level I trauma center from February 2008 through March 2012 were reviewed for demographics, episodes of symptomatic bradycardia (defined as heart rate < 60 beats per minute and systolic blood pressure < 90 mm Hg), use of enteral albuterol, hospital days requiring chronotropic use, and total atropine administered. In the albuterol group, patients received scheduled enteral albuterol after experiencing symptomatic bradycardia, with chronotropic agents used as needed for rescue treatment. In the no-albuterol group, only chronotropic agents were used as needed for rescue treatment. The albuterol and no-albuterol groups were compared using independent-samples Kruskal-Wallis test for total number of bradycardic episodes, hospital days requiring chronotropic use, and total atropine administered. Eighteen patients with CSCI-induced bradycardia were identified. Eight patients received treatment with enteral albuterol, and 10 patients did not. The median age did not differ significantly between the two groups. However, the median Injury Severity Score (ISS) was higher in the albuterol group (median ISS, 36.5; interquartile range, 35-66.5 vs. median ISS 26; interquartile range, 27-37.25 in no-albuterol group). Patients receiving albuterol experienced 1.8 symptomatic bradycardic episodes versus 4.3 episodes in those patients not receiving albuterol (p = 0.08). Hospital days on chronotropic agents were significantly less in the albuterol group (1.8 vs. 8.6, p = 0.01). One patient, in the no-albuterol group, required pacemaker placement. Enteral albuterol may reduce the frequency of symptomatic bradycardia in patients with CSCI, resulting in less rescue therapy using chronotropic agents. Therapeutic study, level IV.

Role of α-blockers in the Treatment of Stent-related Symptoms: A Prospective Randomized Control Study

To properly use the Ureteric Symptom Score Questionnaire (USSQ) to evaluate, in a randomized control study, the effect of 2 different α-blockers in improving symptoms and quality of life in patients with indwelling ureteral stents. After institutional review board approval, 150 consecutive patients with a double-J ureteral stent inserted after extracorporeal shockwave lithotripsy (ESWL) or ureteroscopic stone treatment were randomly assigned to receive tamsulosin 0.4 mg, alfuzosin 10 mg, or placebo. The validated USSQ was completed 1 and 4 weeks after stent insertion and 4 weeks after stent removal. The Kruskal-Wallis test for independent samples for non-normally distributed ordinal variables, chi-square to compare proportions or differences, and 1-way analysis of variance (ANOVA) for independent samples to compare for differences in case of continuous variables were used for statistical analysis of the results. Patients receiving α-blockers expressed an overall statistically significant lower urinary (P<.001), pain (P<.001 with stent in situ), and general health index (P<.002) scores. Sexual life and quality of life were also positively influenced. Quality of work was not influenced. No patients had to discontinue medication because of side effects or underwent stent removal before the due date. There was no difference in various outcomes between the 2 α-blockers. Stent-related morbidity is a reality in the majority of patients. Simple medication, such as α-blockers, reduce stent-related symptoms and the negative impact on quality of life. It seems that stent-related symptom improvement is independent to the type of α-blocker.

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Introduction: The Cockcroft-Gault equation (CG) has been validated for estimation of creatinine clearance (CrCl) in patients with stable renal function. Nonetheless, it is used in the intensive care unit (ICU) where acute kidney injury (AKI) is common. Hypothesis: Compared to measured CrCl from 24-hour urine collection (24-CrCl), the CG-CrCl overestimates renal function in patients with AKI. Methods: A retrospective analysis of consecutive admissions to five ICUs at a tertiary care, referral center was conducted between 2006 and 2012. Patients with a 24-CrCl, daily serum creatinine and recorded daily urine output were included. AKI was defined using AKI Network (AKIN) and RIFLE classifications, and was assessed on ICU days prior to urine collection. Continuous variables were analyzed with the Wilcoxon Rank Sum test and the Mann-Whitney U test. The independent samples Kruskal-Wallis test was used to analyze the effect of AKI severity on the discrepancy between 24-CrCl and CG-CrCl. Results: Included patients (n=291) had a median age of 61 years and were 64% male, 47% white, and 48% admitted to coronary care unit. CG-CrCl overestimated 24-CrCl by a median 9.3 ml/min (61.3 [IQR 38.8 to 90.4] vs. 52 [IQR 27 to 85], P < 0.001). Per AKIN criteria, 165 (57%) patients had AKI as either stage 1 (n=50, 17%), stage 2 (n=60, 21%), or stage 3 (n=55, 19%). The CG-CrCl overestimated 24-CrCl in patients with AKI per AKIN criteria, which increased with severity (ml/min; stage 0=3.8 [IQR -11.1 to 24.7], stage 1=3.0 [IQR 2.5 to 12.8], stage 2=6.4 [IQR -4.2 to 25.6], and stage 3=12.7 [IQR 0.5 to 28.8], P=0.037). Per RIFLE criteria, 147 (51%) patients had AKI classified as either Risk (n=29, 10%), Injury (n=65, 22%), or Failure (n=53, 18%). The CG-CrCl overestimated 24-CrCl in patients with AKI per RIFLE criteria, which increased with severity (ml/min, normal=3.0 [IQR -10.7 to 20.3], Risk=5.9 [IQR -7.4 to 15.2], Injury=6.2 [IQR-3.4 to 25.5], Failure=14.5 [IQR 0.8 to 33.3], P=0.023). Conclusions: The CG-CrCl overestimates 24-CrCl in patients with AKI, especially AKIN stage 3 and RIFLE Failure classification patients. Use of CG estimations should be used with caution in these patient populations.

Longitudinal Changes in Iron Overload Parameters and Iron Chelation Therapy in Young Patients with Thalassemia Major,

Abstract 3202 Background:New modalities for the assessment of iron overload and the availability of new oral chelators have led to important changes in the iron load status and its treatment for patients with thalassemia major (TM). The goals of this retrospective analysis were to evaluate the changes that occurred in regards to the degree of iron overload, as well as to the therapeutic regimen of iron chelation over the last decade in young patients with TM. Methods:All patients with TM followed in our unit, who were <18 years at certain time points, were included in this study. Group A included all patients who were younger than 18 years old on 1/1/2001, while group B, C, D, E and F on 1/1/2003, 1/1/2005, 1/1/2007, 1/1/2009, and 1/1/2011, respectively. Liver iron concentration (LIC) and cardiac siderosis (T2*) were evaluated by MRI. Cardiac iron concentration (CIC) was calculated based on the recently prescribed formula CIC= 45 × (T2*Heart)−1.22.The closest MRI, which was <12 months from the time point, was recorded for each patient at each group. The therapeutic regimen for iron chelation, being deferoxamine (DFO), deferiprone (DFP), combination therapy of DFO and DFP (DFO+DFP) and deferasirox (DFX), used at the different time points were also recorded. Results:The results of the analysis are shown in the following table:GroupABCDEFN1109282725648Mean age (SD) in years12.24 (4.8)11.93 (5.2)11.36 (5.3)11.87 (5.2)11.29 (4.4)11.74 (4.3)Mean ferritin (SD) (μg/L)1981 (1364)1767 (1346)1720 (1402)1909 (1422)1567 (1670)1740 (1502)MRI (N)011221177Mean LIC (SD) (mgFe/g.d.w.)7.4510.57 (8.33)3.68 (4.55)2.30 (4.53)3.9 (3.06)Mean CardiacT2* (SD) (msec)28.130.4 (4.53)29.9 (7.15)34.5 (5.73)33.3 (1.63)Mean CIC (SD) (mgFe/g.d.w.)0.770.74 (0.42)0.71 (0.37)0.63 (0.25)0.63 (1.54)DFO (%)10089.1354.7616.278.823.57DFP (%)02.1711.9011.6235.2921.42DFO+DFP (%)08.697.149.3007.14DFX (%)0026.1862.7955.8867.85N= numberFerritin levels did not change significantly over the last decade (p>0.05). There was a trend for decreasing values of LIC (Independent Samples Kruskal-Wallis test, p=0.075) with the mean LIC of group E and F being significantly lower than group C (Mann-Whitney test, p<0.05). Similarly, there was a trend for improvement in the indexes of cardiac iron load. Of note is, that cardiac overload was not documented in this group of patients. None of the patients has significant (T2*<10 msec), and only 3 patients had moderate cardiac siderosis (T2*>10 <20 msec). Conclusions:A steady decrease in the number of young patient with thalassemia has been observed, reflecting the efficacy of the thalassemia prevention program. As expected, the utilization of MRI to evaluate iron overload has increased significantly especially in the second part of the last decade, but it remains limited mainly to older children and teenagers. Oral chelation has become the preferable mode of treatment of hemosiderosis in young patients with TM. While DFX is, currently, the most used iron chelator, the use of DFO is becoming limited as an additive therapy to DFP. Despite presumed better compliance with oral chelation therapy, the iron overload indexes have not improved dramatically. This may reflect the short period of using the oral chelators or/and the need for further treatment intensification. Disclosures:Kattamis:Novartis Oncology: Honoraria, Research Funding, Speakers Bureau; Apopharma: Honoraria.

Aconselhamento em alimentação infantil: um estudo de intervenção

To evaluate the effectiveness of an integrated infant and young child feeding counseling course for transforming the knowledge, attitudes and practices of pediatricians and nutritionists working for the municipal health system of São Paulo, Brazil.A randomized intervention study enrolling 29 professionals in the intervention group and 27 in the control group. Interviewers were trained in advance to collect data on the professionals working at health centers, before and 2 months after the intervention. Three research instruments were used, the first was to assess the profile of each professional, the second assessed their knowledge and the third was a clinical observation protocol. Analysis was performed using the Kruskal-Wallis test for independent samples and the Tukey method.The results for the knowledge questionnaire showed improvements in the intervention group (p < 0.001) for the whole questionnaire and for questions on breastfeeding (p = 0.004); HIV and infant and young child feeding (p = 0.049); complementary feeding (p = 0.012); and counseling in infant and young child feeding (p = 0.004). In terms of performance, it was observed that the intervention group had significantly improved their dietary anamnesis after the intervention (p < 0.001).This course effectively promoted an increase in knowledge and improvements in dietary anamnesis performance, but the same was not true of counseling skills.

Infant and young child feeding counseling: an intervention study

To evaluate the effectiveness of an integrated infant and young child feeding counseling course for transforming the knowledge, attitudes and practices of pediatricians and nutritionists working for the municipal health system of São Paulo, Brazil. A randomized intervention study enrolling 29 professionals in the intervention group and 27 in the control group. Interviewers were trained in advance to collect data on the professionals working at health centers, before and 2 months after the intervention. Three research instruments were used, the first was to assess the profile of each professional, the second assessed their knowledge and the third was a clinical observation protocol. Analysis was performed using the Kruskal-Wallis test for independent samples and the Tukey method. The results for the knowledge questionnaire showed improvements in the intervention group (p < 0.001) for the whole questionnaire and for questions on breastfeeding (p = 0.004); HIV and infant and young child feeding (p = 0.049); complementary feeding (p = 0.012); and counseling in infant and young child feeding (p = 0.004). In terms of performance, it was observed that the intervention group had significantly improved their dietary anamnesis after the intervention (p < 0.001). This course effectively promoted an increase in knowledge and improvements in dietary anamnesis performance, but the same was not true of counseling skills.

Music Courses for Elementary Education Majors: An Investigation of Course Content and Purpose

We prepared a survey instrument to determine the purpose, format, and content of courses available to undergraduate elementary education majors at institutions accredited by the National Association of Schools of Music (NASM). We examined the types of music courses offered to elementary classroom teachers, the content of the courses, the instructor's purpose for each course, and factors that influenced curricular decisions. We mailed the questionnaire to 530 schools listed in the NASM directory. An initial and two follow-up mailings yielded 316 responses (60%). The Kruskal-Wallis test for independent samples revealed statistical significance beyond the .01 level for the fundamentals course, F (2, 27) = 17.17. The study's results show there was stronger agreement among respondents who taught fundamentals courses than among respondents who taught methods or combined courses.