The Association of Incidental Radiation Dose to the Heart Base with Overall Survival and Cardiac Events after Curative-intent Radiotherapy for Non-small Cell Lung Cancer: Results from the NI-HEART Study.

AIMS: Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer radiotherapy. The dose to the heart base has been associated with poor survival in multiple institutional and clinical trial datasets using unsupervised, voxel-based analysis. Validation has not been undertaken in a cohort with individual patient delineations of the cardiac base or for the endpoint of cardiac events. The purpose of this study was to assess the association of heart base radiation dose with overall survival and the risk of cardiac events with individual heart base contours. MATERIALS AND METHODS: Patients treated between 2015 and 2020 were reviewed for baseline patient, tumour and cardiac details and both cancer and cardiac outcomes as part of the NI-HEART study. Three cardiologists verified cardiac events including atrial fibrillation, heart failure and acute coronary syndrome. Cardiac substructure delineations were completed using a validated deep learning-based autosegmentation tool and a composite cardiac base structure was generated. Cox and Fine-Gray regressions were undertaken for the risk of death and cardiac events. RESULTS: Of 478 eligible patients, most received 55 Gy/20 fractions (96%) without chemotherapy (58%), planned with intensity-modulated radiotherapy (71%). Pre-existing cardiovascular morbidity was common (78% two or more risk factors, 46% one or more established disease). The median follow-up was 21.1 months. Dichotomised at the median, a higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (20.2 months versus 28.3 months; hazard ratio 1.40, 95% confidence interval 1.14-1.75, P = 0.0017) and statistical significance was retained in multivariate analyses. Furthermore, heart base Dmax was associated with pooled cardiac events in a multivariate analysis (hazard ratio 1.75, 95% confidence interval 1.03-2.97, P = 0.04). CONCLUSIONS: Heart base Dmax was associated with the rate of death and cardiac events after adjusting for patient, tumour and cardiovascular factors in the NI-HEART study. This validates the findings from previous unsupervised analytical approaches. The heart base could be considered as a potential sub-organ at risk towards reducing radiation cardiotoxicity.

Implementation of 26 Gy in five fractions over 1 week adjuvant radiotherapy for breast cancer: Prospective report of acute skin toxicity and consideration of resource implications.

PURPOSE: In March 2020, a 1-week adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions, was adopted to reduce the risk of COVID19 for staff and patients. This study quantifies acute toxicity rates and the effect on linac capacity. MATERIALS AND METHODS: This is a report of consecutive patients receiving ultrafractionated breast radiotherapy ( ± sequential boost) Mar-Aug 2020. Virtual consultations assessed acute skin toxicity during treatment and weeks 1, 2, 3 and 4 post treatment using CTCAE V5 scoring criteria. The number of linac minutes saved was estimated accounting for boost and DIBH use. RESULTS: In total, 128/135 (95%) patients, including 31/33 boost patients, completed at least 3/5 assessments. 0/128 (0%) reported moist desquamation not confined to skin folds or minor bleeding (Grade 3), 41/128 (32%) reported brisk erythema, moist desquamation confined to skin folds or breast swelling (Grade 2), 62/128 (48%) reported faint erythema or dry desquamation (Grade 1) as their worst skin toxicity, with the remaining 20% reporting no skin toxicity. The highest prevalence of grade 2 toxicity occurred week 1 following treatment (20%), reducing to 3% by week 4. There was no difference in toxicity between those who received a boost versus not (p = 1.00). Delivering this schedule to 135 patients over six months saved 21,300 linac minutes and 1485 hospital visits compared to a 3-week schedule. CONCLUSION: Rapidly implementing ultrahypofractionated breast radiotherapy is feasible and acute toxicity rates are acceptable even when followed by boost.

Beneath a hairy problem: Phylogeny, morphology, and biogeography circumscribe the new Miconia supersection Discolores (Melastomataceae: Miconieae).

Miconia is among the largest plant genera in the Neotropics and a taxonomically complex lineage. Indeed, molecular phylogenetic data shows that none of its traditionally accepted sections are monophyletic, preventing taxonomic advances within the genus. Miconia is the largest plant genus in the Brazilian Atlantic Forest, including three main lineages, the Leandra s.s. clade (ca. 215 spp.), the Miconia sect. Chaenanthera (24 spp.), and the Miconia discolor clade (estimated 77 spp.). Out of these lineages, the Miconia discolor clade is the only currently lacking phylogenetic data, complicating its taxonomy. In this study, we reconstruct the phylogeny of the Miconia discolor clade, using three plastid (atpF-H, psbK-I, and psaI-accD) and two nuclear (ETS and ITS) markers. We sampled 60 out of the 77 species of the group, representing 78% of its diversity. Taxa were selected considering their distribution, morphology, and previous phylogenetic knowledge. We used the newly reconstructed phylogeny to better understand phylogenetic relationships among Atlantic Forest species and morphologically similar taxa, and to propose a new infrageneric classification for the Miconia discolor clade: the Miconia supersection Discolores. We further studied the evolution of seven morphological characters using a Maximum Likelihood approach, and estimated the ancestral range distribution of various lineages in order to understand the biogeographic history of this clade. We found that dichasial inflorescences represent the ancestral condition within Miconia, subsequently giving rise to scorpioid and glomerulate inflorescences in the studied group. We describe Miconia supersect. Discolores, originated in the Amazon region, which is recognized by a dense layer of branched tricomes covering young branches and non-dichasial inflorescences, including three main lineages: (i) Miconia sect. Albicantes, characterized by persistent bracts and arachnoid indument on the abaxial surface of leaves, mainly distributed in the Amazon basin; (ii) Miconia sect. Discolores, characterized by caducous calyx lobes and glomerulate inflorescences, centered in the Atlantic Forest; and (iii) Miconia sect. Multispicatae, characterized by leaves not completely covered with indument, and capitate stigma, mainly distributed in the Atlantic Forest. All three sections and the supersection originated in the Neogene, between the Late Miocene and the Early Pliocene.

Floristic survey of vascular plants of a poorly known area in the Brazilian Atlantic Forest (Flona do Rio Preto, Espírito Santo).

BACKGROUND: The Atlantic Forest is one of the most threatened biomes in the world. Despite that, this biome still includes many areas that are poorly known floristically, including several protected areas, such as the "Floresta Nacional do Rio Preto" ("Flona do Rio Preto"), located in the Brazilian State of Espírito Santo. This study used a published vascular plant species list for this protected area from the "Catálogo de Plantas das Unidades de Conservação do Brasil" as the basis to synthesise the species richness, endemism, conservation and new species occurrences found in the "Flona do Rio Preto". NEW INFORMATION: The published list of vascular plants was based on field expeditions conducted between 2018 and 2020 and data obtained from herbarium collections available in online databases. Overall, 722 species were documented for the "Flona do Rio Preto", 711 of which are native to Brazil and 349 are endemic to the Atlantic Forest. In addition, 60 species are geographically disjunct between the Atlantic and the Amazon Forests. Most of the documented species are woody and more than 50% of these are trees. Twenty-three species are threatened (CR, EN and VU), while five are Data Deficient (DD). Thirty-two species are new records for the State of Espírito Santo. Our results expand the knowledge of the flora of the Atlantic Forest and provide support for the development of new conservation policies for this protected area.

Two Consecutive Invasive Surgeries Utilizing Zymogen Protein C (ZPC) That Enhanced Patient Safety and Reduced Costs.

This case report describes a major surgical procedure for a protein C-deficient, hypercoagulable patient who underwent two back-to-back invasive surgeries, hip replacement, and spinal stenosis correction. The patient, an 84-year-old male with a history of deep vein thromboses (DVT) and pulmonary emboli (PE), was treated pre-, peri-, and postoperatively with zymogen protein C (ZPC-Baxter, International) and recovered without clotting or increased bleeding. During the procedure, the patient was not administered any other anticoagulants. There have now been several case reports on different patients with unrelated teams in various locations worldwide using zymogen protein C during surgical procedures. Thus, this procedure is becoming a viable choice for patients with a high probability of clotting during and after invasive surgery. This case focuses on accomplishing safer surgery and reducing costs, by using less ZPC while accomplishing two surgeries in one procedure. As a result, this procedure might be useful for many medical situations where acquired protein C deficiency could be a problem (e.g., sepsis, pregnancy, etc.). This approach may have greater application to medical conditions other than protein C deficiency, where clotting and inflammation can become issues.

Phenological responses to climate change based on a hundred years of herbarium collections of tropical Melastomataceae.

Changes in phenological events have been vastly documented in face of recent global climate change. These studies are concentrated on temperate plants, and the responses of tropical species are still little understood, likely due to the lack of long-term phenological records in the tropics. In this case, the use of herbarium specimens to gather phenological data over long periods and wide geographic areas has emerged as a powerful tool. Here, we used four Melastomataceae species endemic to the Brazilian Atlantic Forest to evaluate phenological patterns and alterations as responses to recent climate changes. Phenological data were gathered from Reflora Virtual Herbarium specimens collected between 1920 and 2018, and analyzed with circular statistics applied to the intervals 1920-1979, 1980-1999, and 2000-2018. The effects of temperature range, average temperature, precipitation, and photoperiod on flowering and fruiting of each species were tested using multiple linear regressions. Through circular statistics, we detected changes, mostly delays, in the flowering of Miconia quinquedentata, Pleroma clavatum and P. trichopodum, and in the fruiting of M. acutiflora, P. clavatum and P. trichopodum. We also found that flowering and fruiting occurrence were related to local climatic conditions from months prior to the collections. We found marked phenological variations over the decades and also that these variations are associated to global climate change, adding up to the large body of evidence from higher latitudes. Our results also support herbarium collections as an important source for long-term tropical phenological studies. The lack of consistent patterns of responses among the four species (e.g. fruiting delayed two months in P. clavatum and advanced one month in M. acutiflora) suggests that climate change has unequal effects across tropical forests. This highlights the urgent need for further research to understand and forecast the ecological implications of these changes in global ecosystems processes.

Phylogeny and biogeography of Myrcia sect. Aguava (Myrtaceae, Myrteae) based on phylogenomic and Sanger data provide evidence for a Cerrado origin and geographically structured clades.

Myrcia is one of the largest exclusively Neotropical angiosperm genera, including ca. 800 species divided into nine sections. Myrcia sect. Aguava is one of most complex sections of Myrcia due to high morphological variation and wide distribution range of some species, including M. guianensis, with distribution throughout South America and a complex taxonomic history. We used complete plastid DNA sequences data generated using next-generation sequencing of 45 terminals, mostly from Myrcia sect. Aguava. These data were combined with five target DNA regions (ITS, psbA-trnH, trnL-trnF, trnQ-rps16, ndhF) of additional terminals to increase taxonomic coverage. Phylogenetic analyses were conducted using a maximum likelihood approach, and divergence times and ancestral range distributions were estimated. Myrcia sect. Aguava is monophyletic and exclusively comprises species with trilocular ovaries but has no relationship with other groups within Myrcia that possess trilocular ovaries. Three main lineages that correspond to geographical distribution are recognized within Myrcia sect. Aguava. Multiple accessions reveal a non-monophyletic Myrcia guianensis and stress the biogeographical structure inside the group. Myrcia sect. Aguava had a probable mid-Miocene origin in the Cerrado, but lineages that persisted there diversified only more recently, when the present-day vegetation started to stabilize. Posterior migrations to Atlantic Forest, Amazon and Caribbean occurred at the end of Miocene, evidencing transitions from open and dry to forested and more humid areas that are less frequent in the Neotropics. Overall, it is observed that related lineages remained in ecologically similar environments. Future perspectives on Myrcia and Myrteae in the phylogenomic era are also discussed.

Can Web-based preenrollment alcohol brief interventions be effective screening tools? Precollege drinking behavior predicts college retention and alcohol violations.

Objective: To test if precollege drinking data gathered during an online brief intervention are associated with problems and could inform screening for campus alcohol prevention efforts. Participants: Two cohorts of incoming students (N = 5300). Method: Precollege alcohol drinking was gathered through an online preenrollment alcohol brief intervention. Drop out was obtained from university records. On-campus alcohol violations were obtained from university judicial affairs, and off-campus alcohol citations were obtained from the city police. The 2011 cohort was tracked for 4 years, the 2012 cohort for 3 years. Results: Precollege abstaining and heavy drinking were significantly associated with retention and alcohol violations, even with ethnicity, residency, and gender controlled. Association of precollege drinking with later college problems extended beyond the first year and affected retention up to four years of enrollment. Conclusions: The findings support using data from preenrollment alcohol brief interventions as screening tools to customize further campus alcohol interventions.

International Variation in Criteria for Internal Mammary Chain Radiotherapy.

AIMS: Evidence has emerged that internal mammary chain (IMC) radiotherapy reduces breast cancer mortality, leading to changes in treatment guidelines. This study investigated current IMC radiotherapy criteria and the percentages of patients irradiated for breast cancer in England who fulfilled them. MATERIALS AND METHODS: A systematic search was undertaken for national guidelines published in English during 2013-2018 presenting criteria for 'consideration of' or 'recommendation for' IMC radiotherapy. Patient and tumour variables were collected for patients who received breast cancer radiotherapy in England during 2012-2016. The percentages of patients fulfilling criteria stipulated in each set of guidelines were calculated. RESULTS: In total, 111 729 women were recorded as receiving adjuvant breast cancer radiotherapy in England during 2012-2016 and full data were available on 48 095 of them. Percentages of patients fulfilling IMC radiotherapy criteria in various national guidelines were: UK Royal College of Radiologists 13% (6035/48 095), UK National Institute for Health and Care Excellence 18% (8816/48 095), Germany 32% (15 646/48 095), Ireland 56% (26 846/48 095) and USA 59% (28 373/48 095). Differences between countries occurred because in Ireland and the USA, treatment may be considered in some node-negative patients, whereas in the UK, treatment is considered if at least four axillary nodes are involved or for high-risk patients with one to three positive nodes. In Germany, treatment may be considered for all node-positive patients. CONCLUSIONS: There is substantial variability between countries in criteria for consideration of IMC radiotherapy, despite guidelines being based on the same evidence. This will probably lead to large variations in practice and resource needs worldwide.

Effects of a comprehensive nutrition education programme to change grade 4 primary-school students' eating behaviours in China.

OBJECTIVE: As part of a national initiative to reduce child obesity, a comprehensive school-based nutrition education intervention to change eating behaviours among grade 4 primary-school students was developed, implemented and evaluated. DESIGN: The intervention was developed by school staff, with technical assistance from outside health education specialists. The programme included school facility upgrades, school teacher/staff training, curriculum changes and activities for parents. Student scores on nine key eating behaviours were assessed prior to and after the programme. The quality of programme implementation in the schools was monitored by technical assistance teams. SETTING: Shandong Province (high household income) and Qinghai Province (low household income), China. Three programme schools and three control schools in each province.ParticipantsStudents in grade 4 (age 8-9 years). RESULTS: There were significant positive changes in self-reported eating behaviour scores from pre- to post-assessment in programme schools. At post-test students in programme schools had significantly higher scores than students in control schools after controlling for other variables. The programme was more effective in the high-income province. Observations by the technical assistance teams suggested the programme was implemented more completely in Shandong. The teams noted the challenges for implementing and evaluating programmes like these. CONCLUSIONS: This intervention increased healthy eating behaviours among 4th graders in both provinces and had more effect in the more affluent province. Results suggest that a scaled-up initiative using existing school and public health resources could change eating practices in a large population over time. The intervention also provided lessons for implementing and evaluating similar nutrition programmes.

Effects of a web-based pre-enrollment alcohol brief motivational intervention on college student retention and alcohol-related violations.

OBJECTIVE: To determine whether completing a pre-enrollment Web-based alcohol brief motivational intervention (BMI) increased student retention and reduced student alcohol-related violations. PARTICIPANTS: Fall 2011 (3,364) and Fall 2012 (3,111) entering cohorts of all first-year students at a midwestern state university. METHOD: Students completing the brief intervention (BI) were compared to students not completing the BI. Retention was tracked for four years for the 2011 cohort and three years for the 2012 cohort. Campus and community alcohol violations were tracked for two academic years following enrollment. Kaplan-Meier survival analysis and Cox regression were used to test retention survival. Logistic regression was used to test campus and community violations. RESULTS: Students in both cohorts who completed the BI had significantly higher retention and significantly fewer alcohol-related violations than noncompleters. CONCLUSIONS: Population-level Web-based BIs help prevent student dropout and decrease alcohol-related violations, with impacts extending multiple years. Web-based BI is an efficacious population-level prevention tool.

Pilot Study of a Brief WeChat Intervention in China to Increase Students' Willingness to Assist a Flushing Student to Reduce Alcohol Use.

OBJECTIVES: This pilot study tested the effectiveness of a brief alcohol-related intervention delivered by the social media app WeChat to teach about ethanol-induced facial flushing and increase the willingness of students who see another student flushing to suggest that he or she should reduce or stop drinking. In the context of Chinese drinking culture, it is sometimes socially difficult to refuse a drink, even when experiencing physical discomfort, such as flushing. METHODS: Classrooms of students in a medical university in China were randomly assigned to the intervention or control group. Students in the intervention group were invited to view 3 alcohol education lessons on WeChat during a 2-week period. A pretest and posttest before and after the 2-week period assessed changes in students' willingness to intervene if they saw someone flush while drinking. Data were collected about students' alcohol use and their ratings of the lessons. RESULTS: Mixed-design analysis of variance yielded a significant time-by-treatment interaction effect on the variable of willingness to suggest that a flushing person stop or slow down their drinking, and the change was significant between the intervention and control groups. One-way analysis of covariance yielded a significant treatment effect at the posttest, after controlling for the pretest score. Students rated the lessons above the midpoint of the scale for being informative, interesting, and useful. CONCLUSIONS: The pilot study showed that a brief alcohol-related intervention delivered by WeChat could produce a measurable positive change in the willingness of university students to suggest that a student who flushes should stop drinking. This pilot study also suggested improvements for future lessons and evaluation design.

Variables Associated with Alcohol Consumption and Abstinence among Young Adults in Central China.

This paper presents a descriptive analysis of data gathered by personal interviews from a multistage random sample of 1640 residents aged 18⁻34 years in Wuhan, China. First, alcohol drinkers and abstainers were compared based on demographic, attitude, and belief variables. Next, the drinkers from the sample were classified into four groups based on frequency-quantity of alcohol use, and the frequency-quantity groups were compared on the same variables. For Abstainers versus Drinkers, we found no difference by age or gender in this sample. Married people and people with children were more likely to be abstainers. University-educated, currently-employed individuals in mid-level jobs were more likely to abstain from alcohol. Vocational/Technical graduates, people who were currently attending college, currently unemployed and never-employed individuals were more likely to be drinkers. Abstainers also responded with less-positive attitudes and beliefs about drinking and attached more importance to reasons for not drinking compared to drinkers. When the drinking frequency-quantity groups were compared, gender differences became significant: more high-quantity drinkers were women; however the guideline for quantity for women was >1 drink at a time compared to >2 drinks at a time for men. Quantity and frequency of drinking was significantly associated with having children, educational level, employment status, and type of occupation. Age, marital status, and being in college did not relate significantly with quantity and frequency of drinking alcohol. Attitudes and beliefs about drinking tended to be more positive among high-frequency and high-quantity drinkers. Drinkers in all frequency-quantity groups attached greater importance to social reasons for drinking compared to personal/psychological reasons for drinking. Drinkers in the lowest frequency-quantity group attached the most importance to reasons for not drinking. These findings confirmed that in China drinking plays an important role in socializing and celebrating, and that there are important differences between alcohol drinkers and abstainers and between frequency/quantity groups of drinkers. Western models of individualized motivation of behaviors may not accurately explain alcohol use in China. We believe the findings from this study suggest the need for more detailed studies of alcohol drinking and abstaining.

University Students' Willingness to Assist Fellow Students Who Experience Alcohol-Related Facial Flushing to Reduce Their Drinking.

This study explored bystanders’ willingness to help a friend who flushes when drinking to reduce his/her drinking. Alcohol-related facial flushing is an indicator of an inherited variant enzyme, aldehyde dehydrogenase (ALDH), that impairs alcohol metabolism and increases drinkers’ lifetime risk of certain aerodigestive cancers. Individuals who flush should reduce their alcohol exposure, but they may continue to drink if social pressures and rules of etiquette make not drinking socially risky. The analysis used data from 2912 undergraduate students from 13 universities in southwestern, central and northeastern China from a survey asking how they respond to someone’s flushing in various scenarios. Latent class analysis grouped students by similar responses to flushing. A multinomial logistic regression explored how class membership was associated with knowledge, drinking status, and reactions to one’s own flushing. Five classes were derived from the latent class analysis, ranging from always intervene to mostly hesitate to help; in between were classes of students who were willing to help in some scenarios and hesitant in other scenarios. Only 11.6% students knew the connection between facial flushing and impaired alcohol metabolism, and knowledgeable students were somewhat more likely to assist when they saw someone flushing. In the absence of knowledge, other factors—such as drinking status, the gender of the bystander, the gender of the person who flushed, and degree of friendship with the person who flushed—determined how willing a person was to help someone reduce or stop drinking. Class membership was predicted by knowledge, gender, drinking status, and reactions to one’s own flushing. Of these 4 factors, knowledge and reactions to one’s own flushing could be influenced through alcohol education programs. It will take some time for alcohol education to catch up to and change social and cultural patterns of drinking. Meanwhile, motivational strategies should be developed to increase the willingness of bystanders to assist friends and to create a social expectation that flushers should stop or reduce their drinking.

Comparison of Patterns of Use of Unrecorded and Recorded Spirits: Survey of Adult Drinkers in Rural Central China.

About 70% of the beverage alcohol consumed in China annually is spirits. Recorded spirits make up most spirit consumption, but about 25% of total alcohol consumption (1.7 L pure alcohol per capita annually) is unrecorded spirits (bai jiu), either homemade or made in unregulated distilleries. In some parts of China, the consumption of unrecorded spirits is higher than average. This paper compares the patterns of use of unrecorded distilled spirits and recorded distilled spirits among rural residents in Central China. Interviews were conducted with 3298 individuals in 21 towns/villages in 10 counties in the Hubei, Anhui, and Hebei provinces in the People's Republic of China. Unrecorded bai jiu drinkers chose it because of its taste and its low price. It was consumed mostly by older men, mostly at home with family, more regularly and at higher alcohol by volume (ABV) compared to recorded alcohol. Recorded bai jiu drinkers were more likely to drink away from their homes, consumed more bai jiu at memorable drinking occasions, and reported feeling sick after drinking more often than unrecorded bai jiu drinkers. This comparison of patterns of use of unrecorded bai jiu and recorded bai jiu does not suggest that unrecorded bai jiu is more problematic for drinkers.

Exploring the SDSS Dataset with Linked Scatter Plots: I. EMP, CEMP, and CV Stars.

We present the results of a search for EMP, CEMP, and cataclysmic variable stars using a new exploration tool based on linked scatter plots (LSPs). Our approach is especially designed to work with very large spectrum data sets such as the SDSS, LAMOST, RAVE, and Gaia data sets and can be applied to stellar, galaxy, and quasar spectra. As a demonstration, we conduct a search for EMP, CEMP, and cataclysmic variable stars in the SDSS DR10 data set. We first created a 3326-dimensional phase space containing nearly 2 billion measures of the strengths of over 1600 spectral features in 569,738 SDSS stars. These measures capture essentially all the stellar atomic and molecular species visible at the resolution of SDSS spectra. We show how LSPs can be used to quickly isolate and examine interesting portions of this phase space. To illustrate, we use LSPs coupled with cuts in selected portions of phase space to extract EMP stars, C-rich EMP stars, and CV stars. We present identifications for 59 previously unrecognized candidate EMP stars and 11 previously unrecognized candidate CEMP stars. We also call attention to 2 candidate He II emission CV stars found by the LSP approach that have not yet been discussed in the literature.

Effects of selected socio-demographic characteristics on nutrition knowledge and eating behavior of elementary students in two provinces in China.

BACKGROUND: National and international child health surveys have indicated an increase in childhood obesity in China. The increase has been attributed to a rising standard of living, increasing availability of unhealthy foods, and a lack of knowledge about healthy diet. The objective of this study was to assess the effect of selected socio-demographic characteristics on the BMI, nutrition knowledge, and eating behavior of elementary school children. METHODS: Multistage stratified cluster sampling was used. Information on demographics, nutrition knowledge, and eating behavior was gathered by means of questionnaires. The schools' doctors provided the height and weight data. The study was set in one economically advantaged and one economically disadvantaged province in China. The participants were Grade 3 students, ages 8-10 years (N = 3922). RESULTS: A cluster analysis identified four socio-demographic variables distinguished by parental education and family living arrangement. A one-way ANOVA compared differences among the clusters in BMI, child nutrition knowledge, and child eating behavior. Students in the cluster with lowest parent education level had the lowest nutrition knowledge scores and eating behavior scores. There was no significant benefit from college education versus high school education of parents in the other three clusters. BMI was not affected by parent education level. CONCLUSION: The nutrition status of elementary school age children will benefit most by increasing the general level of education for those adults who are presently least educated.

How Social Reactions to Alcohol-Related Facial Flushing Are Affected by Gender, Relationship, and Drinking Purposes: Implications for Education to Reduce Aerodigestive Cancer Risks.

Alcohol-related facial flushing is a sign of compromised alcohol metabolism and increased risk of certain cancers. This project examined how facial flushing might be used to reduce alcohol use to lower cancer risks. Interviews with Chinese university students identified gender, friendship, and drinking purpose as important variables related to whether someone would encourage a person who flushes when drinking alcohol to stop or reduce their drinking. A questionnaire was developed that incorporated these variables into 24 drinking scenarios in which someone flushed while drinking. Students responded whether they would (a) encourage the flusher to stop or drink less; (b) do nothing while wishing they could; or (c) do nothing because there was no need. Analysis of survey responses from 2912 university students showed a three-way interaction of the variables and implied that the probability students will intervene when a drinker flushes was highest when the flusher was a female, a close friend, and the drinking purpose was for fun and lowest if the flusher was a male, the friendship was general, and the drinking purpose was risky. The results provide important details about the social factors affecting how other people respond to a person who flushes when drinking alcohol. This information is useful for those considering ways to reduce and prevent aerodigestive cancers through education and information programs.

Children's Sense of Control as a Determinant of Adult Health: Causation, Mediation, and Spuriousness.

Previous research suggests higher levels of education instill a greater sense of internal control that promotes health in adulthood. We propose that the sense of control has its origins in early childhood and that prior research has possibly misattributed a mediational role to sense of control in adulthood. Using a conceptual framework that includes these early influences, we employ data from the 1970 British Cohort Study ( N = 9,855), examining the extent to which the association between education and adult health is spurious due to these early childhood factors. We find that the internal sense of control as assessed in childhood and adolescence has profound influences on both education and health in early adulthood and that a substantial portion of the latter association is spurious. We conclude that the sense of control is an important health-related factor originating early in life, influencing both health and education later in adulthood.

Myrteae phylogeny, calibration, biogeography and diversification patterns: Increased understanding in the most species rich tribe of Myrtaceae.

Myrteae (c. 2500 species; 51 genera) is the largest tribe of Myrtaceae and an ecologically important groups of angiosperms in the Neotropics. Systematic relationships in Myrteae are complex, hindering conservation initiatives and jeopardizing evolutionary modelling. A well-supported and robust phylogenetic hypothesis was here targeted towards a comprehensive understanding of the relationships within the tribe. The resultant topology was used as a base for key evolutionary analyses such as age estimation, historical biogeography and diversification rate patterns. One nuclear (ITS) and seven chloroplast (psbA-trnH, matK, ndhF, trnl-trnF, trnQ-rps16, rpl16 and rpl32-trnL) DNA regions for 115 taxa representing 46 out of the 51 genera in the tribe were accessed and analysed using maximum likelihood and Bayesian inference tools for phylogenetic reconstruction. Dates of diversification events were estimated and contrasted using two distinct fossil sets (macro and pollen) in BEAST. The subsequent dated phylogenies were compared and analysed for biogeographical patterns using BioGeoBEARS and diversification rates using BAMM. Myrteae phylogeny presents strong statistical support for three major clades within the tribe: Australasian group, Myrtus group and Main Neotropical Lineage. Dating results from calibration using macrofossil are an average of 20 million years older and show an early Paleocene origin of Myrteae, against a mid-Eocene one from the pollen fossil calibration. Biogeographic analysis shows the origin of Myrteae in Zealandia in both calibration approaches, followed by a widespread distribution throughout the still-linked Gondwana continents and diversification of Neotropical endemic lineages by later vicariance. Best configuration shift indicates three points of acceleration in diversification rates, all of them occurring in the Main Neotropical Lineage. Based on the reconstructed topology, several new taxonomic placements were recovered, including: the relative position of Myrtus communis, the placement of the Blepharocalyx group, the absence of generic endemism in the Caribbean, and the paraphyletism of the former Pimenta group. Distinct calibration approaches affect biogeography interpretation, increasing the number of necessary long distance dispersal events in the topology with older nodes. It is hypothesised that biological intrinsic factors such as modifications of embryo type and polyploidy might have played a role in accelerating shifts of diversification rates in Neotropical lineages. Future perspectives include formal subtribal classification, standardization of fossil calibration approaches and better links between diversification shifts and trait evolution.