Dispelling a Myth: Reevaluating the Predictive Validity of Rape Myth Acceptance for Likelihood of Engaging in Sexual Violence.

Sexual violence prevention on college campuses has received significant recent attention. A prevalent intervention paradigm has centered around re-educating young people around consent and reduce endorsement of "rape myths," based on the correlation between rape myths and sexual violence incidents. Yet many of these programs have not measurably reduced sexual assaults. We evaluated the predictive value of a rape myth measure, as compared with other predictors (criminal history, childhood victimization, aggressive tendencies, substance use, and empathy), in predicting self-reported acts of forcible and incapacitated sexual assault in college-age men (N = 304) from 45 U.S. states. Across three logistic regression model pairs, rape myths were weakly associated with violence when considered as sole predictors. However, this predictive power dissipated when other predictors were included. Comprehensive models accounted significantly better for variability in outcomes; with criminal history demonstrating consistent predictive effects. Based on these findings, we recommend further research into prevention programming based on other predictors of violence.

Comparison of Short-leg and Long-leg Casts for the Treatment of Distal Third Tibial Shaft Fractures in Children.

BACKGROUND: Long-leg casts (LLCs) are an established treatment for pediatric tibial shaft fractures including fractures involving the distal third. There is a paucity of literature assessing the use of short-leg cast (SLC) for tibial shaft fractures. The purpose of this study was to determine if SLC were as effective as LLC for the treatment of pediatric distal third tibial shaft fractures. METHODS: A retrospective review was conducted on consecutive distal third tibial shaft fractures treated at a tertiary pediatric hospital from 2013 to 2018. Exclusion criteria included midshaft and proximal fractures of the tibia, distal fractures that violated the tibial physis or plafond, and pathologic fractures. We compared primary outcomes of time to weight-bearing, time to union, and final angulation between LLC and SLC groups. RESULTS: Eighty-five patients aged 5 to 17 years (mean age: 9.2±3.2 y) met inclusion criteria, including 50 LLC and 35 SLC patients. Time to weight-bearing for SLC (3.3±0.6 wk) was shorter compared with LLC (6.4±0.7 wk, P<0.0001). Overall, fractures treated with SLC had a shorter time to the union (7.4±0.9 wk) compared with LLC (9.0±0.9 wk, P=0.026) without statistical differences in final angulation at the time of union. There was a higher percentage of cast complications in the LLC treatment group (12%) compared with SLC (6%). CONCLUSIONS: SLC demonstrated earlier time to weight-bearing and shorter time to fracture union when compared with LLC. Surgeons should consider SLC and early weight-bearing for the treatment of distal third tibial shaft fractures in children. LEVEL OF EVIDENCE: Level III-retrospective comparative study.

The Impact of Cast Immobilization on Return to Daycare.

BACKGROUND: Children who are prohibited from returning to daycare (RTD) after treatment with cast immobilization place an increased burden on parents and caregivers. The purpose of this study was to assess the impact of cast immobilization on RTD. Specifically, we sought to determine the prevalence of RTD after orthopaedic immobilization based on daycare facility policy. METHODS: This was a survey study of randomly selected daycare facilities servicing a total of 6662 children within 10 miles of a major metropolitan city center. The 40-question survey included information on daycare policies and experience caring for children treated with orthopaedic immobilization. The survey also included questions about daycare type, enrollment, and geographic location. Photographs of the types of immobilization were embedded in the survey to facilitate understanding. Daycare facilities were randomly selected based on a power analysis to estimate a 50% prevalence of RTD after spica casting within 10% margin of error. RESULTS: Seventy-three daycare facilities completed the survey study. The average child-staff ratio was 5:1 and most daycare facilities (78%) did not have a nurse on staff. Predetermined policies regarding RTD after injury were available at 81% of daycares. Twenty-eight (38.5%) facilities had encountered a child with a cast in the previous year. The rate of RTD for children with upper limb injuries was 90.5% compared with 79% for lower limb injuries (P=0.003). Spica casts showed the lowest RTD rate: single leg (22.5%), 1 and a half leg (18%), and 2 leg (16%) (P<0.0001). Experienced daycare facilities (>5 y) had a higher RTD rate compared with less experienced facilities (P=0.026). CONCLUSIONS: The ability to RTD is dependent on immobilization type. Children with long leg and spica casts are disproportionately restricted when compared with other cast types. At minimum, surgeons should consider the socioeconomic implications of orthopaedic immobilization. There is also a need for orthopaedic involvement in policy formation at the local level to provide standardized guidelines for re-entry into childcare facilities following orthopaedic immobilization. LEVEL OF EVIDENCE: Level IV.

Intraoperative Burden of Flexible Intramedullary Nailing and Spica Casting for Femur Fractures in Young Children.

BACKGROUND: Spica casting (Spica) remains the widely accepted treatment of closed femoral shaft fractures in young children aged 6 months to 5 years. In some centers, there has been a recent trend towards surgical fixation of these fractures with flexible intramedullary nails (FINs). Despite numerous studies evaluating both Spica and FIN treatment of femoral shaft fractures, there remains a paucity of data regarding patient burden during the intraoperative period. The purpose of this study was to compare the intraoperative burden, defined as anesthetic exposure, fluoroscopic duration, and radiation load, between Spica and FIN treatment of femoral shaft fractures in young children. METHODS: A retrospective chart review was conducted for pediatric femoral shaft fractures presenting to a tertiary pediatric referral hospital from 2012 to 2017. Comparison groups included pediatric femur fractures treated with Spica and those treated with FIN. Outcomes included anesthetic exposure, fluoroscopy duration, and radiation exposure. In addition, length of stay, clinic visits, and complications were recorded. RESULTS: Of 449 consecutive pediatric femur fractures treated at our center, 143 patients ages 2 to 6 years (mean age 3.8±1.4 y) met inclusion criteria. The Spica group contained 91 patients; FIN contained 52 patients. Mean anesthetic exposure was less for Spica compared with FIN [45.1 min, 95% confidence interval (CI): 38.0-52.3 vs. 90.7 min, 95% CI: 80.5-100.8 min; P<0.001]. On average, Spica procedures required less fluoroscopy time compared with FIN (15.4 s, 95% CI: 4.8-26.0 vs. 131.6 s, 95% CI: 117.6-145.6 s; P<0.001). Mean radiation load was less for Spica compared with FIN (1.6 mGy, 95% CI: 0.6-2.6 vs. 6.9 mGy, 95% CI: 5.7-8.1 mGy; P<0.001). There was no difference in length of hospital stay (P=0.831), follow-up visits (P=0.248), or complication rate (P=0.645) between Spica and FIN groups. The most common complication was skin irritation for Spica (18.7%) and symptomatic hardware for FIN (17.3%). CONCLUSIONS: The findings of this study suggest that pediatric patients with femoral shaft fractures experience an increased intraoperative burden when treated with FIN compared with Spica. Treatment with FIN was associated with increased exposure to anesthesia, fluoroscopic duration, and radiation load despite similar complication rates when compared with Spica. LEVEL OF EVIDENCE: Level III.

Comparison of lower limb muscle architecture and geometry in distance runners with rearfoot and forefoot strike pattern.

We examined the association between footfall pattern and characteristics of lower limb muscle function and compared lower limb muscle function between forefoot and rearfoot runners. Fifteen rearfoot and 16 forefoot runners were evaluated using ultrasonography of the gastrocnemii and tibialis anterior while strike index and heel strike angle quantified footfall pattern. Higher strike index was associated with lower medial gastrocnemius echo intensity (p = 0.05), lower lateral gastrocnemius echo intensity (p = 0.04), smaller tibialis anterior pennation angle (p = 0.05), and longer lateral gastrocnemius fascicle length (p = 0.04). Larger heel strike angle was associated with smaller medial gastrocnemius cross-sectional area (p = 0.04), shorter lateral gastrocnemius fascicle length (p < 0.01), and lower plantar flexion moment (p < 0.01). Larger plantar flexion moment was associated with lesser medial gastrocnemius echo intensity (p = 0.04), lesser lateral gastrocnemius echo intensity (p = 0.03), and greater lateral gastrocnemius fascicle length (p = 0.02). A smaller plantar flexion moment, larger heel strike angle, lower tibialis anterior echo intensity, larger tibialis anterior pennation angle, and smaller lateral gastrocnemius pennation angle were observed in rearfoot compared to forefoot runners (p < 0.05). Lower limb muscle architecture is associated with footfall pattern and ankle mechanics during running. Abbreviation: EMG: electromyographic; MG: medial gastrocnemius; LG: lateral gastrocnemius; TA: tibialis anterior; EI: echo intensity; CSA: cross-sectional area; PA: pennation angle; FL: fascicle length; FT: fat thickness.

Efficacy of methods for ovulation estimation and their effect on the statistical detection of ovulation-linked behavioral fluctuations.

Contention of the ovulatory shift hypothesis is principally supported by failures to replicate previous findings; e.g., recent meta-analytic work suggests that the effects endorsing the hypothesis may not be robust. Some possible limitations in this and other ovulatory-effects research-that may contribute to such controversy arising-are: (a) use of error-prone methods for assessing target periods of fertility that are thought to be associated with behavioral shifts, and (b) use of between-subjects-as opposed to within-subjects-methods. In the current study we present both simulated and empirical research: (a) comparing the ability of between- and within-subject t-tests to detect cyclical shifts; (b) evaluating the efficacy of correlating estimated fertility overlays with potential behavioral shifts; and (c) testing the accuracy of counting methods for identifying windows of cycle fertility. While this study cannot assess whether the ovulatory shift hypothesis or other ovulatory-based hypotheses are tenable, it demonstrates how low power resulting from typical methods employed in the extant literature may be associated with perceived inconsistencies in findings. We conclude that to fully address this issue greater use of within-subjects methodology is needed.

Applying the precautionary principle to nutrition and cancer.

PRIMARY OBJECTIVE: Research has identified certain foods and dietary patterns that are associated with reduced cancer risk and improved survival after cancer diagnosis. This research has formed the basis for dietary guidance issued by cancer organizations. Unfortunately, gaps within nutrition research have made it difficult to make recommendations in some areas. This review specifies suggested dietary guidance in which evidence of a dietary influence on cancer risk is substantial, even if not conclusive. Evidence summaries within the review are based on the 2007 report of the World Cancer Research Fund/American Institute for Cancer Research. This review also describes advantages and disadvantages of following the suggested dietary guidance and includes putative mechanisms involved in cancer progression. MAIN OUTCOMES AND RESULTS: Suggested dietary guidance where evidence is sufficiently compelling include (1) limiting or avoiding dairy products to reduce the risk of prostate cancer; (2) limiting or avoiding alcohol to reduce the risk of cancers of the mouth, pharynx, larynx, esophagus, colon, rectum, and breast; (3) avoiding red and processed meat to reduce the risk of cancers of the colon and rectum; (4) avoiding grilled, fried, and broiled meats to reduce the risk of cancers of the colon, rectum, breast, prostate, kidney, and pancreas; (5) consumption of soy products during adolescence to reduce the risk of breast cancer in adulthood and to reduce the risk of recurrence and mortality for women previously treated for breast cancer; and (6) emphasizing fruits and vegetables to reduce risk of several common forms of cancer. CONCLUSION: By adopting the precautionary principle for nutrition research, this review aims to serve as a useful tool for practitioners and patients.

Longitudinal models for studying multivariate changes and dynamics.

In this paper, we describe a longitudinal modeling approach for examining multivariate changes and dynamics. This technique is based on latent change scores and is executed using a structural equation modeling framework. We provide an overview of the model, describing desirable features for identifying dynamics among multiple processes. We then illustrate its application using empirical data consisting of longitudinal processes and conclude the paper with some potential steps for advancing the modeling possibilities.

Individual Pooling for Group-Based Modeling Under the Assumption of Ergodicity.

Psychology principally utilizes nomothetic, interindividual approaches to model phenomena of interest. However, it is the case that these approaches do not always capture the processes for each individual in the sample. If the research is focused on individual processes, confining analysis to the idiographic level may be more appropriate. One way to overcome the nomothetic inability to capture idiographic processes is to identify those participants who meet the criteria of ergodicity and restrict analysis to the resulting sample. Under these conditions it is quantitatively justifiable to create a group model without concern that it may fail to represent each member's idiographic process. In this study we explore the utility of such a method by (a) applying an ergodic pooling test to a sample of dyads (N = 128) who provided daily (T = 50) self-reports of affect, (b) applying an ergodic pooling test to samples (N = 4) of simulated ergodic time series data (T = 50, 250, and 1,000),

Nutrition intervention for migraine: a randomized crossover trial.

BACKGROUND: Limited evidence suggests that dietary interventions may offer a promising approach for migraine. The purpose of this study was to determine the effects of a low-fat plant-based diet intervention on migraine severity and frequency. METHODS: Forty-two adult migraine sufferers were recruited from the general community in Washington, DC, and divided randomly into two groups. This 36-week crossover study included two treatments: dietary instruction and placebo supplement. Each treatment period was 16 weeks, with a 4-week washout between. During the diet period, a low-fat vegan diet was prescribed for 4 weeks, after which an elimination diet was used. Participants were assessed at the beginning, midpoint, and end of each period. Significance was determined using student's t-tests. RESULTS: Worst headache pain in last 2 weeks, as measured by visual analog scale, was initially 6.4/10 cm (SD 2.1 cm), and declined 2.1 cm during the diet period and 0.7 cm during the supplement period (p=0.03). Average headache intensity (0-10 scale) was initially 4.2 (SD 1.4) per week, and this declined by 1.0 during the diet period and by 0.5 during the supplement period (p=0.20). Average headache frequency was initially 2.3 (SD 1.8) per week, and this declined by 0.3 during the diet period and by 0.4 during the supplement period (p=0.61). The Patient's Global Impression of Change showed greater improvement in pain during the diet period (p<0.001). CONCLUSIONS: These results suggest that a nutritional approach may be a useful part of migraine treatment, but that methodologic issues necessitate further research. TRIAL REGISTRATION: Clinicaltrials.gov, NCT01699009 and NCT01547494.

Probability of Occult Ankle Fracture Based on Radiograph-Measured Swelling.

INTRODUCTION: Pediatric ankle injuries are a common presentation in the emergency department (ED). A quarter of pediatric ankle fractures show no radiographic evidence of a fracture. Physicians often correlate non-weight bearing and tenderness with an occult fracture. We present this study to predict the probability of an occult fracture using radiographic soft-tissue swelling on initial ED radiographs. METHODS: This is a retrospective study at a Level 1 pediatric trauma center from 2021 to 22. Soft-tissue swelling between the lateral malleolus and skin was measured on radiographs, and weight-bearing status was documented. Statistical analysis was conducted using Stata software. DISCUSSION: The study period involved 32 patients with an occult fracture, with 8 (25%) diagnosed with a fracture on follow-up radiographs. The probability of an occult fracture was calculated as a function of the ankle swelling in millimeters (mm) using a computer-generated predictive model. False-negative and false-positive rates were plotted as a function of the degree of ankle swelling. CONCLUSION: Magnitude of ankle soft-tissue swelling as measured on initial ED radiographs is predictive of an occult fracture. Although weight-bearing status was not a sign of occult fracture, it improves the predictive accuracy of soft-tissue swelling.

Discernment of Children's True and False Memory Reports: Police Officers and Laypersons.

Adults' ability to accurately evaluate children's statements can have far-reaching consequences within the legal system. This study examined the evaluations of police officers ("experts") and laypersons ("nonexperts") when presented with videotaped interviews of children aged 3 and 5 years who provided either true or false reports or denials. Participants were drawn from several counties in the eastern United States. Children's interview statements fell within four statement types: accurate reports, false reports, accurate denials, and false denials. Both groups of participants displayed overbelief in false denials. Several control variables predicted accuracy, including children's age and children's race. A significant interaction emerged: Experts (vs. nonexperts) had greater odds of being accurate when judging false reports (vs. false denials). These findings highlight the challenges adults face when distinguishing between various types of children's statements. The results have important implications for legal contexts, emphasizing that fact finders need to be mindful of the risks associated with both overaccepting false denials and accepting false reports.

Predictors of non-offending caregiver support in cases of child sexual abuse.

BACKGROUND: In cases of child sexual abuse (CSA), a supportive non-offending caregiver (NOC) is important for the child's overall well-being and adjustment. NOC support is also predictive of CSA cases moving forward to prosecution. Limited research has studied CSA case factors in relation to NOC supportive behaviors across numerous support dimensions. OBJECTIVE: We investigated what case details predicted four different dimensions of caregiver support. PARTICIPANTS AND SETTINGS: In this secondary analysis, a sample of 500 CSA cases from four prosecutors' offices in one New England state from 2009 to 2013 were randomly selected and reviewed. METHOD: This study used regression analysis to test 13 case characteristics (e.g., disclosure of abuse, NOC's relationship to perpetrator) as predictors of NOC support dimensions: belief of victim, support of prosecution, protection of victim, and whether a child protective services neglect report was filed against the caregiver. RESULTS: When the perpetrator was their romantic partner, the NOC was less likely to protect and believe the child victim, yet more likely to support prosecution. NOCs were more likely to demonstrate belief when the child disclosed to them first. CONCLUSION: Our findings reveal the importance of the key case factors that are predictive of NOC support. This is the first study to examine these many case factors in relation to these four dimensions of support. Knowledge of these predictors can play an important role in better understanding the complexity of NOC support predictors and facilitating interventions designed to enhance such support.

Biomechanics associated with tibial stress fracture in runners: A systematic review and meta-analysis.

BACKGROUND: Tibial stress fracture (TSF) is an overuse running injury with a long recovery period. While many running studies refer to biomechanical risk factors for TSF, only a few have compared biomechanics in runners with TSF to controls. The aim of this systematic review and meta-analysis was to evaluate biomechanics in runners with TSF compared to controls. METHODS: Electronic databases PubMed, Web of Science, SPORTDiscus, Scopus, Cochrane, and CINAHL were searched. Risk of bias was assessed and meta-analysis conducted for variables reported in 3 or more studies. RESULTS: The search retrieved 359 unique records, but only the 14 that compared runners with TSF to controls were included in the review. Most studies were retrospective, 2 were prospective, and most had a small sample size (5-30 per group). Many variables were not significantly different between groups. Meta-analysis of peak impact, active, and braking ground reaction forces found no significant differences between groups. Individual studies found larger tibial peak anterior tensile stress, peak posterior compressive stress, peak axial acceleration, peak rearfoot eversion, and hip adduction in the TSF group. CONCLUSION: Meta-analysis indicated that discrete ground reaction force variables were not statistically significantly different in runners with TSF compared to controls. In individual included studies, many biomechanical variables were not statistically significantly different between groups. However, many were reported by only a single study, and sample sizes were small. We encourage additional studies with larger sample sizes of runners with TSF and controls and adequate statistical power to confirm or refute these findings.

Compassion Fatigue and Family Caregivers Caring in End-Stage Heart Failure.

Background: Compassion fatigue is a negative consequence impacting caregivers of chronic illness, such as heart failure. Reliance on family caregivers is expected to rise, placing importance on recognizing family caregiver characteristics that contribute to compassion fatigue. Purpose: This study specifically examined the associations of characteristics of family caregivers caring for end-stage heart failure, compassion satisfaction, social desirability, and the family caregiver-nursing provider relationship on compassion fatigue. Methods: An adapted interaction model of client health behavior guided this cross-sectional survey, which comprised a demographic questionnaire, the Professional Quality-of-Life Scale, the caregiver-provider relationship assessment, the Marlowe-Crowne Social Desirability Scale Short Form (Form C), and the Bakas Caregiving Outcomes Scale. Results: There were 127 family caregivers (FCGs), primarily those who have been a caregiver for longer than 1 year (78.4%), who completed the entire survey. Increased compassion satisfaction and positive caregiving effects were associated with decreased compassion fatigue (p < .001), while increased social desirability was associated with increased compassion fatigue (p < .001). A positive family caregiver-nursing provider relationship was related to decreased compassion fatigue (p < .001). More compassion fatigue was seen with lower spiritual status (p < .001). Implications: The chronic progression of heart failure presents opportunities for nursing providers to assess caregivers and offer frequent interventions. Family caregivers may not ask for help. Nursing providers must foster relationships with family caregivers to prevent negative consequences and mitigate compassion fatigue. Future research on the nursing provider relationship and FCGs is needed.

Why is subjective stress severity a stronger predictor of health than stressor exposure? A preregistered two-study test of two hypotheses.

Subjective stress severity appraisals have consistently emerged as better predictors of poor health than stressor exposure, but the reason for this is unclear. Subjective stress may better predict poor health for one of at least two reasons. First, because stressor exposure measures consider all stressors as equal, stress severity measures-which "weight" stressors by self-reported severity-might better predict poor health simply by not treating all stressors as being equally impactful. Second, subjective stress appraisals may index important individual differences in stress vulnerability. We tested these two possibilities in this preregistered, two-study manuscript. Across these two different studies, subjective stress severity was a better predictor of poor health than independently weighted stress severity or stressor exposure. These results demonstrate that, beyond weighting of stressful experiences, subjective stress severity indexes health-relevant individual differences. Moreover, the results suggest that subjective stress severity may be the preferred stress summary metric even when derived from imprecise stress assessment instruments.

Identifying Obstetric Mistreatment Experiences in U.S. Birth Narratives: Application of Internationally Informed Mistreatment Typologies.

BACKGROUND: Traumatic births are those resulting in feelings of distress that persist after the birth experience. Health care providers may play a role in these experiences through various forms of mistreatment. Analyses of global birth experiences have generated several domains of mistreatment. This study applies these evidence-based domains of mistreatment as an a priori coding scheme for analysis of 96 oral narratives of U.S.-based births to describe the nature of perceived mistreatment using participants' own descriptions of experiences. METHOD: Ninety-six transcripts of oral birth stories from 61 participants were coded using the domains of mistreatment experiences described by the Bohren et al.'s (2015) systematic review of obstetric mistreatment. RESULTS: N = 131 individual experiences of perceived obstetric mistreatment were identified in 41 out of 96 narratives (42.7%). The most frequent types of experiences were Poor Rapport (90 incidences) and Failure to Meet Professional Standards of Care (29). CLINICAL IMPLICATIONS: Although most women in our study did not perceive any instances of obstetric mistreatment during their childbirth, over 40% of participants noted at least one event that fit one of the typologies we used as a framework for analysis. Visibility and review of the types of perceived mistreatment experiences that occur during birth enables health system leaders to implement prevention and accountability strategies. Most instances of perceived mistreatment during birth may be prevented through intentional implementation of individualized, respectful, supportive care during labor and birth.

The Impact of COVID-19 on Family Caregivers of Individuals With End-Stage Heart Failure.

Before the COVID-19 pandemic, family caregivers were providing a tremendous amount of care for family members with heart failure with the prevalence of caregiver reliance in heart failure expected to increase in the United States. Social distancing and other restrictions during the COVID-19 pandemic may have added further challenges to caregiving routines. The purpose of this study was to examine the family caregiver perception of the effect of COVID-19 on caregiving routines. To determine caregiver perception of COVID-19's impact, 1 Likert question and 1 open-ended response were asked. Braun and Clark's method guided open-ended response thematic analysis. The 113 replies to the open-response question yielded themes such as social isolation, added fear, anxiety, or worry, changed appointments, wearing masks, and living status change. Social isolation (41.6%) was the most common theme; the most significant theme was living status change ( P = .003), and family caregivers reported that the pandemic affected their routines either negatively or somewhat negatively (62.1%). Family caregivers are affected during times of crisis. Research and policies that recognize the residual effects of COVID-19 on caregiving practices and support care transitions for family caregivers in the heart failure population are needed.

Avoidant authority: The effect of organizational power on decision-making in high-uncertainty situations.

Individuals in positions of power are often required to make high-stakes decisions. The approach-inhibition theory of social power holds that elevated power activates approach-related tendencies, leading to decisiveness and action orientation. However, naturalistic decision-making research has often reported that increased power often has the opposite effect and causes more avoidant decision-making. To investigate the potential activation of avoidance-related tendencies in response to elevated power, this study employed an immersive scenario-based battery of least-worst decisions (the Least-Worst Uncertain Choice Inventory for Emergency Responses; LUCIFER) with members of the United States Armed Forces. In line with previous naturalistic decision-making research on the effect of power, this research found that in conditions of higher power, individuals found decisions more difficult and were more likely to make an avoidant choice. Furthermore, this effect was more pronounced in domain-specific decisions for which the individual had experience. These findings expand our understanding of when, and in what contexts, power leads to approach vs. avoidant tendencies, as well as demonstrate the benefits of bridging methodological divides that exist between "in the lab" and "in the field" when studying high-uncertainty decision-making.