Measures Analysis Of Variance Models Research Articles

Preliminary Data of Neck Muscle Morphology With Head-Supported Mass in Male and Female Volunteers.

This study quantified parameters related to muscle morphology using a group of upright seated female and male volunteers with a head-supported mass. Upright magnetic resonance images (MRIs) were obtained from 23 healthy volunteers after approval from the U.S. DoD. They were asymptomatic for neck pain, with no history of injury. The volunteers were scanned using an upright MRI scanner with a head-supported mass (army combat helmet). T1 and T2 sagittal and axial images were obtained. Measurements were performed by an engineer and a neurosurgeon. The cross-sectional areas of the sternocleidomastoid and multifidus muscles were measured at the inferior endplate in the sub-axial column, and the centroid angle and centroid radius were quantified. Differences in the morphology by gender and spinal level were analyzed using a repeated measures analysis of variance model, adjusted for multiple corrections. For females and males, the cross-sectional area of the sternocleidomastoid muscle ranged from 2.3 to 3.6 cm2 and from 3.4 to 5.4 cm2, the centroid radius ranged from 4.1 to 5.1 cm and from 4.7 to 5.7 cm, and the centroid angle ranged from 75° to 131° and from 4.8° to 131.2°, respectively. For the multifidus muscle, the area ranged from 1.7 to 3.9 cm2 and from 2.4 to 4.2 cm2, the radius ranged from 3.1 to 3.4 cm and from 3.3 to 3.8 cm, the angle ranged from 15° to 24.4° and 16.2° to 24.4°, respectively. Results from all levels for both muscles and male and female spines are given. The cross-sectional area, angulation, and centroid radii data for flexor and extensor muscles of the cervical spine serve as a dataset that may be used to better define morphologies in computational models and obtain segmental motions and loads under external mechanical forces. These data can be used in computational models for injury prevention, mitigation, and readiness.

Abstract 12959: Association of Gender-Affirming Hormone Treatment With Metabolic Syndrome in Transgender Patients Compared With Cis-Gender Patients

Background: The long-term effects of gender-affirming hormone therapy (GAHT) is an area of priority in transgender (TG) health research. Also, there is a great gap in our understanding of sex hormone and sex chromosomes and their role in Metabolic Syndrome (MetS) and therefore atherosclerosis risk. Hypothesis: sex hormones, (estradiol and Testosterone) affect the development of MetS and therefore heart disease. Methods: Using International Classification of Diseases ninth and tenth codes for gender dysphoria from the Veteran Health Affairs national data, we identified 284 transfeminine (TF) and 79 transmasculine (TM) patients with documented received GAHT initiation date (index date=ID) and MetS components data. GAHT consists of estradiol in TF and testosterone in TM individuals.TG individuals were matched to 252 cis-male (CM) and 111 cis-female (CF) referents. MetS z-scores were calculated as: where . In the longitudinal analyses, time (years) was computed from the ID (“Time 0”) with negative and positive values indicating pre- and post ID period, respectively. The mean MetS z-scores were compared among TG and cis-gender groups over time using a repeated measures analysis of variance model. Results: The mean age of cohort was 41, 84% non-Hispanic White and 9% non-Hispanic Black.Table 1 shows MetS z-score significantly changed overtime (p<0.001) and differed across groups (p<0.05). Fig 1 shows the changes in adjusted (year and group) MetS z-scores with locally estimated scatterplot smoothing curves. The data indicate that estrogen and testosterone may have different effects on metabolic status. hormones Conclusion: Sex hormones play an important role in the MetS development sex difference.

Tibiofemoral contact force differences between flat flexible and stable supportive walking shoes in people with varus-malaligned medial knee osteoarthritis: A randomized cross-over study.

To compare the effect of stable supportive to flat flexible walking shoes on medial tibiofemoral contact force (MTCF) in people with medial knee osteoarthritis and varus malalignment. This was a randomized cross-over study. Twenty-eight participants aged ≥50 years with medial knee osteoarthritis and varus malalignment were recruited from the community. Three-dimensional full-body motion, ground reaction forces and surface electromyograms from twelve lower-limb muscles were acquired during six speed-matched walking trials for flat flexible and stable supportive shoes, tested in random order. An electromyogram-informed neuromusculoskeletal model with subject-specific geometry estimated bodyweight (BW) normalized MTCF. Waveforms were analyzed using statistical parametric mapping with a repeated measures analysis of variance model. Peak MTCF, MTCF impulse and MTCF loading rates (discrete outcomes) were evaluated using a repeated measures multivariate analysis of variance model. Statistical parametric mapping showed lower MTCF in stable supportive compared to flat flexible shoes during 5-18% of stance phase (p = 0.001). For the discrete outcomes, peak MTCF and MTCF impulse were not different between the shoe styles. However, mean differences [95%CI] in loading impulse (-0.02 BW·s [-0.02, 0.01], p<0.001), mean loading rate (-1.42 BW·s-1 [-2.39, -0.45], p = 0.01) and max loading rate (-3.26 BW·s-1 [-5.94, -0.59], p = 0.02) indicated lower measure of loading in stable supportive shoes compared to flexible shoes. Stable supportive shoes reduced MTCF during loading stance and reduced loading impulse/rates compared to flat flexible shoes and therefore may be more suitable in people with medial knee osteoarthritis and varus malalignment. Australian and New Zealand Clinical Trials Registry (12619000622101).

Patterns of Food Security and Dietary Intake Among Children Across the U.S. Child Tax Credit Expansion

ObjectivesFamilies with lower economic resources are at higher risk for experiencing food insecurity and suboptimal diet quality. During COVID-19, the novel expansion to the U.S. Child Tax Credit (CTC) provided families from lower income backgrounds with unconditional cash assistance ($250–300 per child, each month) from July to December 2021. This additional income has potential to improve food security and diet quality, if spent towards food resources. This study aimed to examine patterns of food insecurity and children’s dietary intake before and during monthly CTC payments. MethodsParents (N = 621) with a child ages 2–10 years who qualified for the full CTC benefit were enrolled. Three online surveys were completed baseline (T0: June 2021) and at two timepoints during (T1: September 2021; T2: December 2021) the CTC expansion. The validated 18-item USDA Food Security Module, NCI Dietary Screening Questionnaire, and Beverage Intake Questionnaire were administered at each timepoint. Repeated measures analysis of variance models will examine changes in dietary intake before and during the CTC expansion. ResultsTo date, data from T0 and T1 have been analyzed. Late-breaking data that include T2 results will be presented at Nutrition 2022. At T1, after receiving 3 monthly payments, 45.9% of parents reported spending CTC funds on foods/beverages. This was the most commonly reported use of CTC funds, particularly for families with very low food security (63.0%). From T0 to T1, families with very low food security decreased (T0: 12.7% vs. T1: 5.6%), while food security increased (T0: 57.4% vs. T1: 66.4%). Children’s consumption of added sugar, sugar-sweetened beverages, and sweetened fruit juice decreased over time (qs < .05). No changes were observed in other dietary components (qs > .05). ConclusionsInitial patterns indicate promise that CTC monthly payments are associated with reduced household food insecurity and lower sugar-sweetened beverage intake among children. This line of research can inform legislative decisions regarding the maintenance of this policy mandate, by enhancing understanding of the CTC expansion’s impact on children’s food security and nutritional intake. Funding SourcesChild Health Research Institute at Virginia Commonwealth University and NIH (2T32CA093423) for ELA effort.

Differing Characteristics of Human-Shaped Visual Stimuli Affect Clinicians’ Dosage of a Spinal Manipulative Thrust on a Low-Fidelity Model: A Cross-Sectional Study

ObjectiveThe purpose of this study was to determine whether chiropractic clinicians modulate spinal manipulation (SM) thrust characteristics based on visual perception of simulated human silhouette attributes. MethodsWe performed a cross-sectional within-participant design with 8 experienced chiropractors. During each trial, participants observed a human-shaped life-sized silhouette of a mock patient and delivered an SM thrust on a low-fidelity thoracic spine model based on their visual perception. Silhouettes varied on the following 3 factors: apparent sex (male or female silhouette), height (short, average, tall), and body mass index (BMI) (underweight, healthy, obese). Each combination was presented 6 times for a total of 108 trials in random order. Outcome measures included peak thrust force, thrust duration, peak preload force, peak acceleration, time to peak acceleration, and rate of force application. A 3-way repeated measures analysis of variance model was used to for each variable, followed by Tukey's honestly significant difference on significant interactions. ResultsPeak thrust force was reduced when apparent sex of the presented silhouette was female (F1,7 = 5.70, P = .048). Thrust duration was largely invariant, except that a BMI by height interaction revealed a longer duration occurred for healthy tall participants than healthy short participants (F4,28 = 4.34, P = .007). Compared to an image depicting obese BMI, an image appearing underweight lead to reduced peak acceleration (F2,5 = 6.756, P = .009). Clinician time to peak acceleration was reduced in short compared to tall silhouettes (t7 = 2.20, P = .032). ConclusionVisual perception of simulated human silhouette attributes, including apparent sex, height, and BMI, influenced SM dose characteristics through both kinetic and kinematic measures. The results suggest that visual information from mock patients affects the decision-making of chiropractic clinicians delivering SM thrusts.

Effects of meditation compared to music listening on biomarkers in breast cancer survivors with cognitive complaints: secondary outcomes of a pilot randomized control trial

ContextWe previously reported positive behavioral effects of both daily mantra meditation and classical music listening interventions in breast cancer survivors with cancer related cognitive complaints. ObjectiveThe objective of this pilot study was to compare the effects of the meditation intervention to a music listening intervention on biomarkers of inflammation and cellular aging (secondary outcomes) in breast cancer survivors. DesignRandomized control trial, baseline data collection (time 1), post intervention data collection (time 2) SettingCommunity-based, Central Texas Participants25 breast cancer survivors (BCS) who were 3 months to 6 years post chemotherapy completion and reported cognitive changes. Intervention(s)Kirtan Kriya meditation (KK) or classical music listening (ML), 8 weeks, 12 min a day Main OutcomeTelomerase activity [TA], c-reactive protein [CRP], soluble IL-2 receptor alpha [sIL-2Rα], soluble IL-4 receptor [sIL-4R], soluble IL-6 receptor [sIL-6R], soluble tumor necrosis factor receptor II [sTNF-RII], VEGF receptor 2 [sVEGF-R2], and VEGF receptor 3 [sVEGF-R3] ResultsRepeated measures analysis of variance models were analyzed from time 1 to time 2 by group for each biomarker. A pattern of greater telomerase activity across time in both groups (F (1,15) = 3.98, p = .06, ω2 = 0.04); significant decreases in sIL-4R across time for both groups (F (1,22) = 6.28, p = .02, ω2 = .003); group*time effect was nominally different but not statistically different for sIL-4R (F(1,22) = 3.82, p = .06, ω2 = .001); and a pattern for a group*time effect with ML group showing higher levels of sVEGF-R3 at time 2 (F (1,20) = 2.59, p = .12, ω2 = .009). No significant effects were found for CRP, sIL-2Rα, sIL-6R, sTNF-RII, or sVEGF-R2.

Sustained effects of mantra meditation compared to music listening on neurocognitive outcomes of breast cancer survivors: A brief report of a randomized control trial

ObjectiveCancer-related cognitive impairment is common following the end of adjuvant treatment and there are limited treatment options for it. We compared the sustained cognitive (primary) and psychological (secondary) effects of mantra meditation to classical music listening 8 weeks after interventions ended (Time 3) compared to baseline (Time 1). MethodsA two-group parallel random assignment experimental design was used in a community setting. Thirty one breast cancer survivors (ages 21 to 75, received chemotherapy, and reported cognitive complaints) were randomly assigned to practice mantra meditation (n = 16) or listen to classical music (n = 15) 12 min a day for 8 weeks. No blinding was used. Repeated measures analysis of variance models were used to compare Time 1 and Time 3 data for the 26 survivors (13 per group) who completed the interventions and Time 3 data collection. ResultsVerbal fluency (p < .001, ηp2 = 0.58), attention (p = .002, ηp2 = 0.33), immediate memory recall (p < .001, ηp2 = 0.38), perceived cognitive impairment (p < .001, ηp2 = 0.39), and quality of life (p = .001, ηp2 = 0.35) improved significantly across time for both groups. The two conditions did not differ significantly in changes across time. There were no adverse effects. ConclusionDaily mantra meditation or classical music listening may be beneficial for cognitive outcomes and quality of life of breast cancer survivors with cancer-related cognitive impairment. The cognitive benefits appear to be sustained beyond the initial intervention period.Clinical Trials Registration number: NCT03696056, recruitment status completed.The study details can be accessed at: https://clinicaltrials.gov/ct2/show/NCT03696056 Key messageThere are limited treatment options for managing cancer-related cognitive impairments. Daily mantra meditation or classical music listening for 12 min a day may improve cognitive outcomes and quality of life for cancer survivors, with no negative side effects.

Internet-Based Cognitive-Behavioral Therapy for College Students With Anxiety, Depression, Social Anxiety, or Insomnia: Four Single-Group Longitudinal Studies of Archival Commercial Data and Replication of Employee User Study.

BackgroundThe growing behavioral health needs of college students have resulted in counseling centers reporting difficulties in meeting student demand.ObjectiveThis study aims to test the real-world voluntary use by college students of 4 digital, self-directed mental health modules based on a cognitive behavioral therapy clinical model. The findings were also compared with those of employee users.MethodsArchival operational data from Learn to Live were extracted for student users at 4 colleges and universities in the Midwest region of the United States (N=951). The inclusion criteria were having clinical symptoms at established levels of moderate or higher severity and the use of 2 or more of the 8 lessons of a program within a 6-month period. Unique users in each program included 347 for depression; 325 for stress, anxiety, and worry; 203 for social anxiety; and 76 for insomnia. Paired t tests (two-tailed) compared the average level of change over time on a standardized measure of clinical symptoms appropriate to each program. Cohen d statistical effect sizes were calculated for each program. Potential moderator factors (age, gender, preliminary comprehensive assessment, number of lessons, duration, live coach support, and live teammate support) were tested together in repeated measures analysis of variance models with covariates in the full sample. Follow-up survey data (n=136) were also collected to explore user satisfaction and outcomes. Select data from another study of the same 4 programs by employee users meeting the same criteria (N=707) were examined for comparison.ResultsThe percentage of users who improved to a clinical status of no longer being at risk after program use was as follows: stress, anxiety, and worry program (149/325, 45.8%); insomnia program (33/76, 43.4%), depression program (124/347, 35.7%); and social anxiety program (45/203, 22.2%). Significant improvements (all P<.001) over time were found in the mean scores for the clinical measures for each program: stress, anxiety, and worry (t324=16.21; d=1.25); insomnia (t75=6.85; d=1.10); depression (t346=12.71; d=0.91); and social anxiety (t202=8.33; d=0.80). Tests of the moderating factors across programs indicated that greater improvement was strongly associated with the use of more lessons and it also differed by program, by gender (males demonstrated more improvement than females), and by the use of live support (particularly coaching). Analyses of survey data found high satisfaction, improved academic outcomes, and successful integration into the university counseling ecosystem. The operational profile and outcomes of the college students were also similar to those of employee users of the same programs from our other study of employee users. Thus, this study provides a replication.ConclusionsSelf-directed internet-based cognitive behavioral therapy mental health modules are promising as a supplement to traditional in-person counseling services provided by college counseling centers.

Changes in Acoustic Aspects of Vocal Function in Children After Adenotonsillectomy

Adenotonsillectomy is one of the most common pediatric surgical procedures. Postoperative voice changes are a very common concern among patient's parents. Therefore, the aim of this study is to analyze acoustic voice parameters after adenotonsillectomy, tonsillectomy, and adenoidectomy in pediatric patients in a tertiary referral academic center. All pediatric patients undergoing an adenotonsillectomy, tonsillectomy or adenoidectomy in a single center from 2002 to 2018 were included in the study. Change of fundamental frequency, jitter, shimmer, and harmonic-noise ratio at first, seventh and 30th postoperative day compared to preoperative values were the primary outcome parameters. Statistical analysis was performed using repeated measures analysis of variance model. A total of 1258 patients were included in the study. The mean age of patients at the time of surgery was 8.3 years (range 3.0-18.0 years). Around 698 were male (55.5%) and 560 female (44.5%). The values of fundamental frequency increased significantly after the first and seventh postoperative day (P=0.001 both) but normalized 1 month after surgery (P=0.962). At the first postoperative month, values of jitter and shimmer decreased significantly (P=0.005 and P=0.002, respectively). Measurements of harmonic-noise ratio revealed a significant increase 30 days after surgery (P=0.004). Statistically significant differences in objective voice parameters within the first postoperative month after tonsillectomy, adenoidectomy, and adenotonsillectomy were observed. The fundamental frequency returned to normal 1 month after surgery. These findings can contribute in soothing the concerns of parents regarding postoperative voice changes.

The comparison between repeated measures ANOVA and multilevel modeling to investigate the effectiveness of language instruction

The purpose of the current study is to compare two different statistical analyses—repeated measures analysis of variance (ANOVA) and multilevel modeling (MLM)—with regard to international second language (L2) students’ lexico-grammatical writing gains in the interventions. Fifty college students’ lexico-grammatical writing gains in the pre-test, immediate and delayed post-tests were collected from three groups—one control and two intervention groups. Research questions include: (1) Is there a change in the dependent variable over time through repeated measures ANOVA?; (2) How much on average do the individuals change over time through MLM?; and (3) What are the differences of the results between repeated measures ANOVA and MLM? Repeated measures ANOVA and MLM were conducted separately to answer the research questions. Both analyses revealed that there was no difference of the interventions over time. In terms of methodological considerations, however, the two analyses exhibited the results in a different manner. Repeated measures ANOVA requires several assumptions (e.g., homoschedasticity and sphericity) while MLM does not need the requirement of the data as long as it contains different periodic datasets. Furthermore, MLM enables researchers to investigate the rate of individual growth. This paper offers methodological insight into adequate quantitative analyses to investigate the effectiveness of language acquisition and learning.

The impact of humanistic coach training on youth athletes’ development through sport

The purpose of this study was to evaluate the impact of humanistic coach training on athletes’ developmental outcomes. A sample of 148 high school student-athletes between 12 and 17 years old from low socio-economic communities completed questionnaires during their season. The student-athletes were divided into an experimental group composed of student-athletes of 11 head coaches who participated in a humanistic coach training session, and a comparison group composed of student-athletes of 8 untrained coaches. Four questionnaires were used to assess competence, confidence, connection to the coach, and character (prosocial and antisocial behaviours) of the participants. The effects of the humanistic coach training program were assessed using repeated measures analysis of variance models. Results showed that connection to the coach worsened for athletes of untrained coaches. Also, participants from both groups reported an increase in antisocial behaviours at the end of the season, but the athletes of trained coaches reported engaging less frequently in antisocial behaviours compared to athletes of untrained coaches. These findings suggest that teaching humanistic coaching may help practitioners foster positive developmental outcomes in youth sport participants and build positive coach-athlete relationships, while also raising awareness to the use of sport as a tool to promote personal growth and development.

Use of Novaluron-Based Autocidal Gravid Ovitraps to Control Aedes Dengue Vector Mosquitoes in the District of Gampaha, Sri Lanka.

Dengue is the most important mosquito-borne viral infection in Sri Lanka causing an enormous social and economic burden in the country. In the absence of therapeutic drugs and the developed vaccines are under investigation, vector control is the best strategy to reduce the disease transmission. Therefore, the development of novel tools to control dengue vector mosquitoes has become the need of the hour. Novaluron is a recently developed Insect Growth Regulator (IGR) which inhibits chitin synthesis in immature stages of insects. The aim of the study was to identify the efficacy of a simple and cost-effective Autocidal Gravid Ovitrap (AGO) developed using Novaluron to control dengue outbreaks in the District of Gampaha, Sri Lanka. Laboratory and semifield experiments were performed to identify the activity range, optimum field dosage, and residual effects of Novaluron following the World Health Organization guidelines, and field experiments were performed in the Ragama Medical Officer of Health (MOH) area. Two study areas 800 m apart were selected and assigned as treated and control areas randomly. In each study area, 30 households were selected randomly. Each household was given two ovitraps, one placed indoors and the other placed outdoors. Mortality and survival counts were recorded separately for one-year time period and data were analyzed using a two-way repeated measures analysis of variance model. During the laboratory experiments, the adult emerging inhibition was 100% in all tested concentrations. The optimum field dosage was 2 ppm and the residual effect was 28 days. In the field experiments, significantly higher mortality counts were recorded in treated areas both indoor- and outdoor-placed AGOs. Two-factor repeated measures ANOVA followed by Tukey's test confirmed that the mean mortality count is high for the developed AGOs both indoor and outdoor settings. The developed AGO can be deployed to control both indoor and outdoor dengue vector mosquito populations, and in dengue-risk areas, the ovitrap will be supportive to local health authorities to enhance the efficiency of future vector control programs.

The Biomechanical Demands on the Hip During Progressive Stepping Tasks.

Hatfield, GL, Charlton, JM, Cochrane, CK, Hammond, CA, Napier, C, Takacs, J, Krowchuk, NM, and Hunt, MA. The biomechanical demands on the hip during progressive stepping tasks. J Strength Cond Res 31(12): 3444-3453, 2017-Functional hip strengthening exercises are important components of lower extremity (LE) rehabilitation and include single-leg squats (SLS), step-downs (SD), and step-ups (SU). The biomechanical demand of these tasks is unclear. This repeated-measures study determined hip biomechanical demands in a healthy population. Twenty individuals (10 men, 26.6 ± 5.1 years, 22.1 ± 2.3 kg·m) participated. Three-dimensional motion, ground reaction force data, and surface electromyograms (EMG) were recorded during 4 randomly ordered tasks. Outcomes included frontal and sagittal plane hip moment impulses and muscle activity for each task. Repeated measures analysis of variance models (alpha = 0.05) determined between-task differences. Step-down and SLS were most biomechanically demanding, with significantly higher hip flexion and adduction moment impulses, and gluteus medius (GM) and quadriceps activity compared with half step-down (HSD) and SU. No significant difference was found between SD and SLS, indicating minimal difference in demand between the 2 tasks, likely due to kinematic similarities in performance; there were no significant differences in knee or hip sagittal plane angle excursion, or peak pelvic obliquity angle between the 2 tasks. Step-up was least demanding, with the lowest hip flexion and adduction moment impulses and GM, quadriceps, and hamstrings activity. Step-up was least demanding on the hip and would be a good starting task for hip strengthening protocols. Step-down and SLS were most demanding, requiring higher hip moments and muscle activity. These results provide evidence, which may be used in planning of progressive rehabilitation programs for patients with LE pathologies.

Cross-Sex Hormones and Metabolic Parameters in Adolescents With Gender Dysphoria.

The Endocrine Society states that adolescents with gender dysphoria may start cross-sex hormones. The goal of this study was to identify patterns in metabolic parameters in transgender adolescents receiving cross-sex hormones. Data from adolescents aged 14 to 25 years seen in 1 of 4 clinical sites between 2008 and 2014 were retrospectively analyzed. Subjects were divided into affirmed male (female-to-male) patients taking testosterone and affirmed female (male-to-female) patients taking estrogen. Previously recorded measurements of blood pressure, BMI, testosterone, estradiol, prolactin, lipids, electrolytes, liver function tests, hemoglobin/hematocrit, and hemoglobin A1c were reviewed. These values were obtained from before the start of therapy, at 1 to 3 months after initiation, at 4 to 6 months, and at 6 months and beyond. Repeated measures analysis of variance models were used to evaluate changes over time. One hunderd and sixteen adolescents were included (72 female-to-male subjects and 44 male-to-female subjects). Of the 72 subjects taking testosterone, a significant increase in hemoglobin/hematocrit levels and BMI, as well as a decrease in high-density lipoprotein level, was recorded at each visit. No significant changes in any other parameter tested were found. Of the 44 subjects taking estrogen, no statistically significant changes were noted in the measured metabolic parameters. Testosterone use was associated with increased hemoglobin and hematocrit, increased BMI, and lowered high-density lipoprotein levels; estrogen was associated with lower testosterone and alanine aminotransferase levels. Otherwise, cross-sex hormone administration in adolescents was not associated with significant differences in the selected metabolic parameters over time.

Ulnar Collateral Ligament Strain of the Thumb Metacarpophalangeal Joint: Biomechanical Comparison of Two Postoperative Immobilization Techniques

The aim of this study was to compare postoperative immobilization techniques of the thumb metacarpophalangeal (MP) ulnar collateral ligament (UCL) in a cadaver model of a noncompliant patient. A cadaveric model with fresh-frozen forearms was used to simulate pinch under two immobilization conditions: (1) forearm-based thumb spica splint alone and (2) forearm-based thumb spica splint with supplemental transarticular MP Kirschner wire fixation. Pinch was simulated by thumb valgus loading and flexor pollicis longus (FPL) loading. Ulnar collateral ligament displacements were measured and strain values calculated. Statistical analysis was performed using a repeated measures analysis of variance model. With valgus thumb loading, we noted a significantly lower UCL strain in the splint and pin group compared to splint immobilization alone. Increased load was associated with a statistically significant increase in UCL strain within each immobilization condition. FPL loading resulted in negative displacement, or paradoxical shortening, of the UCL in both immobilization groups. While immobilized, valgus thumb force, as opposed to MP flexion, is a likely contributor to UCL strain during simulated pinch representing noncompliance during the postoperative period. Supplemental thumb MP pin fixation more effectively protects the UCL from valgus strain. UCL shortening with FPL loading likely represents paradoxical MP extension due to flexion of the distal phalanx against the distal splint, suggesting attempted thumb flexion with splint immobilization alone does not jeopardize UCL repair. This study provides a foundation to aid clinical decision-making after UCL repair. It reinforces the practice of surgeons who routinely pin their MP joints, but also brings to attention that the use of temporary MP pin fixation may be considered in difficult cases, such as those with potential noncompliance or tenuous repair.

The effect of oral care on intracranial pressure in critically ill adults.

A major goal in the care of patients with neurological problems is to prevent or minimize episodes of increased intracranial pressure (ICP). Elevations in ICP in response to nursing interventions have been acknowledged since the 1960s when ICP monitoring was first introduced in the clinical setting. Until recently, few studies have specifically examined the effect of oral care on ICP, and oral care and other hygiene measures were combined or not specified, prohibiting a direct interpretation of the influence of oral care alone on ICP. The purpose of this study was to describe the relationship between routine oral care interventions and the changes in ICP specifically focusing on the effect of intensity and duration of this intervention. Twenty-three patients with a clinical condition requiring ICP monitoring were enrolled over a 12-month period. Oral care provided by neuroscience intensive care nurses was observed and videotaped. Characteristics of the intervention were documented including products used, patient positioning, and duration of the intervention. A 1-5 subjective scale was used to score intensity of oral care. Wrist actigraphy data were collected from the nurses to provide an objective measure of intensity. Patient physiologic data were collected at 12-second epochs 5 minutes before, during, and 5 minutes after oral care. The mixed-effect repeated measures analysis of variance model indicated that there was a statistically significant increase in ICP in response to oral care (p = .0031). There was, however, no clinically significant effect on ICP. This study provides evidence that oral care is safe to perform in patients in the absence of preexisting elevated ICP.

Dietary Intake and Weight Gain Among Adolescents on Depot Medroxyprogesterone Acetate

Study ObjectiveTo examine the relationship between dietary intake and weight gain among adolescent females initiating depot medroxyprogesterone acetate (DMPA). DesignProspective observational study. SettingTwo urban Adolescent Medicine clinics. Participants45 postmenarchal females, age 12 to 21, enrolled after self-selecting to initiate DMPA. InterventionParticipants received 150 mg DMPA intramuscularly every 12 weeks. Height, weight, and 24-hour dietary recall were collected at baseline, 3, 6, and 12 months. Main Outcome MeasureBody mass index (BMI) over time calculated as weight (kg)/height (m2). Associations between dietary variables and BMI were evaluated with repeated measures analysis of variance modeling. ResultsMean chronological and gynecologic ages were 16.2 ± 1.5 and 4.2 ± 1.8 years, respectively. Mean BMI increased from 23.7 ± 5.3 to 25.3 ± 5.7 over 12 months. Average dietary intake included: 1781.4 ± 554.1 total kilocalories, 228.5 g ± 69.8 carbohydrates, 71.0 g ± 27.3 fat, and 61.0 g ± 20.2 protein. These diet measures were not associated with BMI over time. Dietary fiber, magnesium, and linoleic acid were inversely associated with increased BMI over time (P < .05) ConclusionWe found no evidence that general measures of diet (energy, carbohydrates, fat, and protein), as assessed by 24-hour recall, were predictive of weight gain on DMPA. Several nutrients abundant in foods that benefit overall health were inversely associated with increased BMI over time, suggesting that diet quality, rather than quantity, is a more important predictor of DMPA-associated weight gain.

Effects of Resistance Training and Whey Protein Supplementation on Body Composition, Strength, Endurance, and Muscle Cross-Sectional Area

PURPOSE: To examine the effects of different types of whey protein supplementation and moderate-volume resistance training on lean mass (LM), fat mass (FM), bench press strength (BPMAX) and endurance (BPREPS), leg press strength (LPMAX) and endurance (LPREPS), and thigh muscle cross-sectional area (mCSA) in trained and untrained men. METHODS: Sixty-three healthy men (mean ± SD age: 21.0 ± 2 yrs; height: 178.8 ± 6.8 cm; weight: 77.9 ± 12.8 kg; body fat: 16.8 ± 6.1%) volunteered for testing before and after an 8-week resistance training intervention. BPMAX, BPREPS, LPMAX and LPREPS were determined using a standard one-repetition maximum (1-RM) protocol and repetitions performed to failure on a standard Olympic bench and 45° hip sled, respectively. mCSA at mid-thigh was assessed using a peripheral quantitative computed tomography scanner. Participants were randomly assigned to either a bio-enhanced whey protein (BWP: 20g polyethylene glycosylated whey protein concentrate, 7g leucine, and 200mg proteases; n = 20), standard whey protein (SWP: 20g whey protein concentrate; n = 22) or placebo (PLA: 27g maltodextrin; n = 21) group. The treatment groups were further dichotomized into trained and untrained. All groups consumed a chocolate-flavored shake (BWP, SWP, or PLA) 30 minutes before and immediately after each training session and lifted 3 times per week at 80% of their BPMAX or LPMAX for 8 weeks. RESULTS: Seven separate three-way repeated measures analysis of variance models (time [pre vs. post] × treatment [BWP vs. SWP vs. PLA] × training status [trained vs. untrained]) resulted in no three-way interactions (p>0.05) and no two-way interactions for time × treatment (p>0.05) or treatment × training status (p>0.05) for any variable. However, there were time × training status interactions for BPMAX (p = 0.008) and BPREPS (p = 0.003), but no other significant interactions for any other variable (p>0.05). Post hoc analyses indicated that BPMAX and BPREPS increased (p<0.001) from pre- to post-training in both the trained and untrained. Furthermore, the trained group performed more reps than the untrained group at pre- and post-training (p = 0.001 and p = 0.023, respectively). There were main effects for time for LM (p<0.001), LPMAX (p<0.001), LPREPS (p<0.001), and mCSA (p<0.001). Finally, there were also main effects for training status for LM (p = 0.005), LPMAX (p = 014), and mCSA (p = 0.025). CONCLUSIONS: The resistance training improved all parameters, except FM, for all supplement groups, including the placebo. Furthermore, the initial training status did not influence the outcome, since both trained and untrained men improved from pre- to post-training, despite the trained group having more lean mass, higher BPMAX, LPMAX and mCSA at pre- and post-training than the untrained men. The untrained men performed better at post-training only for BPREPS. PRACTICAL APPLICATIONS: Practitioners and strength coaches can use moderate-volume training to increase lean mass, strength, muscular endurance, and hypertrophy for athletes or the general population, regardless of their initial training status or protein supplementation. ACKNOWLEGMENTS: This study was funded by a grant from the General Nutrition Corporation, Pittsburgh, PA.

Birth characteristics and female sex hormone concentrations during adolescence: results from the Dietary Intervention Study in Children

Birth characteristics and adult hormone concentrations influence breast cancer risk, but little is known about the influence of birth characteristics on hormone concentrations, particularly during adolescence. We evaluated the association of birth characteristics (birth weight, birth length, and gestational age) with serum sex hormone concentrations during late childhood and adolescence in 278 female participants of the Dietary Intervention Study in Children. Repeated measures analysis of variance models were used to assess the relationships of birth characteristics and serum estrogens and androgens at five different time points over a mean period of 7 years. In analyses that did not take into account time from blood draw until menarche, birth weight was inversely associated with pre-menarche concentrations of estradiol, estrone sulfate, androstenedione, testosterone, and dehydroepiandrosterone sulfate (DHEAS). In the post-menarche analyses, birth weight was not significantly associated with concentration of any of the hormones under investigation. Birth length and gestational age were not associated with hormone concentrations before or after menarche. Birth weight is inversely associated with sex hormone concentrations before menarche in the model unadjusted for time from blood draw until menarche. The in utero environment has long-term influences on the hormonal milieu, which could potentially contribute to breast cancer risk.

Posterior reconstruction and anterior suspension with single anastomotic suture in robot-assisted laparoscopic radical prostatectomy: a simple method to improve early return of continence

Post-prostatectomy urinary incontinence is a major cause of morbidity from radical prostatectomy. Efforts have been made to develop techniques to hasten return of urinary control. Several authors have demonstrated improved early continence with anterior, posterior, or combined reconstruction of the urethral–pelvic attachments. In this study, we compare three-month urinary function and continence data for patients who underwent RALP with posterior reconstruction and anterior suspension with single anastomotic suture (PRASS). A prospective cohort of 50 patients underwent RALP with PRASS reconstruction and were compared to 50 control patients who underwent standard RALP. Continence was defined as use of 0–1 urinary pads and was evaluated at each follow-up visit using the EPIC-26 questionnaire. A weighted summary score was created and group differences were compared using a repeated measures analysis of variance model. After adjusting for age, baseline AUA symptom score, and SHIM scores, which were found to correlate with continence, patients who underwent the PRASS reconstruction had significantly improved urinary control at three months compared with the control group; 90.9% of the patients in the PRASS group wore 0–1 pads per day versus 48.2% in the control group (P = 0.014). Of the patients undergoing the standard prostatectomy 20.6% were totally pad-free compared with 42% of the patients undergoing the PRASS procedure (P = 0.042). In conclusion, the PRASS technique resulted in statistically significant improvement in urinary control three months post-operation. The PRASS reconstruction is technically straightforward, requires no additional sutures, and is a simple technique that is easily learned and adaptable to other robotic surgery.