The relation between subitizable symbolic and non-symbolic number processing over the kindergarten school year.

A long-standing debate in the field of numerical cognition concerns the degree to which symbolic and non-symbolic processing are related over the course of development. Of particular interest is the possibility that this link depends on the range of quantities in question. Behavioral and neuroimaging research with adults suggests that symbolic and non-symbolic quantities may be processed more similarly within, relative to outside of, the subitizing range. However, it remains unclear whether this unique link exists in young children at the outset of formal education. Further, no study has yet taken numerical size into account when investigating the longitudinal influence of these skills. To address these questions, we investigated the relation between symbolic and non-symbolic processing inside versus outside the subitizing range, both cross-sectionally and longitudinally, in 540 kindergarteners. Cross-sectionally, we found a consistently stronger relation between symbolic and non-symbolic number processing within versus outside the subitizing range at both the beginning and end of kindergarten. We also show evidence for a bidirectional relation over the course of kindergarten between formats within the subitizing range, and a unidirectional relation (symbolic â†’ non-symbolic) for quantities outside of the subitizing range. These findings extend current theories on symbolic and non-symbolic magnitude development by suggesting that non-symbolic processing may in fact play a role in the development of symbolic number abilities, but that this influence may be limited to quantities within the subitizing range.

Implementation of clinical research trials using web-based and mobile devices: challenges and solutions.

BACKGROUND: With the increasing implementation of web-based, mobile health interventions in clinical trials, it is crucial for researchers to address the security and privacy concerns of patient information according to high ethical standards. The full process of meeting these standards is often made more complicated due to the use of internet-based technology and smartphones for treatment, telecommunication, and data collection; however, this process is not well-documented in the literature. RESULTS: The Smart Heart Trial is a single-arm feasibility study that is currently assessing the effects of a web-based, mobile lifestyle intervention for overweight and obese children and youth with congenital heart disease in Southwestern Ontario. Participants receive telephone counseling regarding nutrition and fitness; and complete goal-setting activities on a web-based application. This paper provides a detailed overview of the challenges the study faced in meeting the high standards of our Research Ethics Board, specifically regarding patient privacy. CONCLUSION: We outline our solutions, successes, limitations, and lessons learned to inform future similar studies; and model much needed transparency in ensuring high quality security and protection of patient privacy when using web-based and mobile devices for telecommunication and data collection in clinical research.

Exercise to Enhance Smoking Cessation: the Getting Physical on Cigarette Randomized Control Trial.

BACKGROUND: Exercise has been proposed as a useful smoking cessation aid. PURPOSE: The purpose of the present study is to determine the effect of an exercise-aided smoking cessation intervention program, with built-in maintenance components, on post-intervention 14-, 26- and 56-week cessation rates. METHOD: Female cigarette smokers (n = 413) participating in a supervised exercise and nicotine replacement therapy (NRT) smoking cessation program were randomized to one of four conditions: exercise + smoking cessation maintenance, exercise maintenance + contact control, smoking cessation maintenance + contact control or contact control. The primary outcome was continuous smoking abstinence. RESULTS: Abstinence differences were found between the exercise and equal contact non-exercise maintenance groups at weeks 14 (57 vs 43 %), 26 (27 vs 21 %) and 56 (26 vs 23.5 %), respectively. Only the week 14 difference approached significance, p = 0.08. CONCLUSIONS: An exercise-aided NRT smoking cessation program with built-in maintenance components enhances post-intervention cessation rates at week 14 but not at weeks 26 and 56.

The effects of a peer modeling intervention on cardiorespiratory fitness parameters and self-efficacy in obese adolescents.

Inconsistencies exist in the assessment and interpretation of peak VO2 in the pediatric obese population, as cardiorespiratory fitness assessments are effort-dependent and psychological variables prevalent in this population must be addressed. This study examined the effect of a peer modeling intervention on cardiorespiratory fitness performance and task self-efficacy in obese youth completing a maximal treadmill test. Forty-nine obese (BMI ≥ 95th percentile for age and sex) youth were randomized to an experimental (received an intervention) or to a control group. The outcome variables were mean and variability cardiorespiratory fitness (peak VO2, heart rate, duration, respiratory exchange ratio), rating of perceived exertion, and task self-efficacy scores. Irrespective of whether a mean or variability score was used, receiving the intervention was associated with non-significant trends in fitness parameters and task self-efficacy over time, favoring the experimental group. Cardiorespiratory fitness and task self-efficacy were moderately correlated at both time points. To elucidate the aforementioned findings, psychosocial factors affecting obese youth and opportunities to modify the peer modeling intervention should be considered. Addressing these factors has the potential to improve standard of care in a clinical setting regarding pretest patient education.

Extending ideas of numerical order beyond the count-list from kindergarten to first grade.

Ordinal processing plays a fundamental role in both the representation and manipulation of symbolic numbers. As such, it is important to understand how children come to develop a sense of ordinality in the first place. The current study examines the role of the count-list in the development of ordinal knowledge through the investigation of two research questions: (1) Do K-1 children struggle to extend the notion of numerical order beyond the count-list, and if so (2) does this extension develop incrementally or manifest as a qualitative re-organization of how children recognize the ordinality of numerical sequences. Overall, we observed that although young children reliably identified adjacent ordered sequences (i.e., those that match the count-list; '2-3-4') as being in the correct ascending order, they performed significantly below chance on non-adjacent ordered trials (i.e., those that do not match the count-list but are in the correct order; '2-4-6') from the beginning of kindergarten to the end of first grade. Further, both qualitative and quantitative analyses supported the conclusion that the ability to extend notions of ordinality beyond the count-list emerged as a conceptual shift in ordinal understanding rather than through incremental improvements. These findings are the first to suggest that the ability to extend notions of ordinality beyond the count-list to include non-adjacent numbers is non-trivial and reflects a significant developmental hurdle that most children must overcome in order to develop a mature sense of ordinality.

Kindergarteners' symbolic number abilities predict nonsymbolic number abilities and math achievement in grade 1.

Research has shown that two different, though related, ways of representing magnitude play foundational roles in the development of numerical and mathematical skills: a nonverbal approximate number system and an exact symbolic number system. While there have been numerous studies suggesting that the two systems are important predictors of math achievement, there has been substantial debate regarding whether and how these basic numerical competencies may be developmentally interrelated. Specifically, the causal direction of their relation has been the subject of debate: whether children's approximate number abilities predict later symbolic number abilities (the mapping account) or the other way around (the refinement account). Our sample included 622 kindergarten children (mean age = 62 months, SD = 3.5, 279 females, 75 born outside Canada), whose dot comparison, number comparison, and mixed comparison skills were assessed over three time-points and math achievement assessed over four time-points. We contrasted multiple theoretical predictions of the interrelations between the variables of interest posited by these two developmental accounts using longitudinal random intercept cross-lagged models. Results were most consistent with the refinement account, suggesting that earlier symbolic number ability is consistently the strongest predictor of approximate number ability, mixed-comparison ability, and arithmetic skills. Notably, our results demonstrated that, when individual models are examined in isolation, model fit was adequate or near adequate for all models tested. This highlights the need for future research to contrast competing accounts, as our results suggest the examination of any one account in isolation may not reveal the best fitting developmental model. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Improving remote lifestyle intervention studies in children: Participant and caregiver feedback of the smart heart study.

OBJECTIVES: We sought to describe and analyze the quantitative and qualitative feedback obtained from participants and their caregivers of the Smart Heart study, a successful 12-month lifestyle intervention for children with overweight or obesity and congenital heart disease that provided remote lifestyle counseling, to improve future lifestyle interventions in children. METHODS: Thirty-six participants and caregivers were polled using a standard program evaluation questionnaire at the end of the intervention. Feedback was compiled into themes, and facilitators and barriers to program success were identified. RESULTS: There was a high level of satisfaction with the intervention and staff interactions as well as a low perceived burden of participation. There were also specific concerns, including mixed impressions regarding technology usage and a less impressive indication of actual impactful behavior change. CONCLUSIONS: The study identified five themes, and corresponding facilitators and barriers to participant compliance, from the Smart Heart intervention feedback and offered suggestions for improving future lifestyle behavioral intervention study designs in children. PRACTICE IMPLICATIONS: Remote smartphone counseling is effective and efficient. It is recommended that the counseling messages are specific, the counseling schedule is patient-centric, patient burden is limited, methods with immediate patient feedback are used and family is included when feasible.

Smoking behaviour and sensations during the pre-quit period of an exercise-aided smoking cessation intervention.

INTRODUCTION: Previous research has shown reductions in cigarette consumption during the pre-quit period of exercise-aided smoking cessation interventions. Smoking topography and sensation patterns during this period is unknown and may provide valuable insight into compensation and cessation readiness. METHODS: Female smokers (N = 236, M age = 43, M cigarettes/day = 17.0) enrolled in an exercise-aided smoking cessation intervention self-reported daily cigarette use and cigarette sensory experiences. Breath carbon monoxide and smoking topography data were collected during the period leading up to the targeted quit date (i.e., baseline, week 1, and week 3), which was set for week 4. RESULTS: Repeated measures ANOVAs revealed that cigarette consumption (p < 0.001, eta = 0.32), carbon monoxide (p < 0.001, eta = 0.14), puff duration (p = 0.01, eta = 0.05), smoking satisfaction (p < 0.001, eta = 0.34), psychological reward (p < 0.001, eta = 0.43), enjoyment of respiratory tract sensations (p < 0.001, eta = 0.29), and craving (p < 0.001, eta = 0.39) decreased, whereas average puff flow (p = 0.01, eta = 0.05) increased. CONCLUSIONS: This is the first study to establish that regular exercise during the pre-quit period served as a conduit for facilitating behavioral and sensory harm reduction with cigarettes. Furthermore, the pattern of change observed between cigarette consumption and smoking topography does not support compensation. These findings imply that female smokers who exercise prior to a quit attempt are in a favourable state to achieve cessation.

Affect and cortisol mechanisms through which acute exercise attenuates cigarette cravings during a temporary quit attempt.

INTRODUCTION: A number of mechanisms have been proposed to explain how exercise attenuates cravings among temporarily abstinent smokers; however, research has presented mixed findings. The aim of this study was to further investigate the mechanistic role of positive and negative affect and cortisol in the exercise-craving reduction relationship. METHODS: Adult smokers (N=110, male=56, M age=33.1, M cigarettes/day=15.4) provided baseline affective and cortisol data (T1). After an 18-h period of abstinence, participants were randomized to a passive sitting (PSG) or moderate exercise group (MEG; 40-68% of heart rate reserve) for 10min. Affect and cortisol data were also collected immediately before (T2) and after (T3) the condition. RESULTS: The smoking abstinence manipulation increased cravings (p<0.001, eta=0.40) and negative affect (p<0.001, eta=0.17), as well as decreased positive affect (p<0.001, eta=0.08) and cortisol (trending, p=0.07, η2=0.04). As expected, a significant reduction in cravings from T2 to T3 was found for MEG but not PSG (p<0.001, eta=0.25). Mediation was tested using Sobel and bootstrapping tests with residual change scores of mediators and cravings. Findings showed that both positive and negative affect, but not cortisol, mediated the relationship between exercise and cravings. CONCLUSIONS: Understanding the mechanisms by which exercise induces craving reductions will better allow researchers and healthcare professionals to infer causality and implement interventions guided by the processes that yield such desirable outcomes.

Anthropometric and body composition changes in smokers vs abstainers following an exercise-aided pharmacotherapy smoking cessation trial for women.

INTRODUCTION: Post-cessation weight gain contributes to smoking relapse, especially for women. Furthermore, excess weight in the form of android or visceral fat is associated with metabolic health problems. For this study, a secondary analysis was conducted in 2015 to determine whether quitting status, achieved through a 14 week supervised exercise-aided nicotine replacement therapy (NRT) cessation program [Getting Physical on Cigarette Trial-2009 to 2013; Prapavessis, et al., 2016], affects anthropometric and body composition parameters in female smokers (N = 413, M age = 42.39 years). METHODS: Anthropometric (weight and BMI) and body composition (% total body fat, % android fat, lean mass and visceral fat) indices were assessed at baseline and end of treatment. Smoking status was confirmed weekly from expired breath carbon monoxide. Adherence to exercise and NRT patch was calculated from the number of exercise sessions attended and patches worn to the number of exercise sessions offered and patches supplied, respectively. RESULTS: Factorial (smoking status) ANCOVAs controlling for baseline anthropometric and body composition parameters as well as adherence to exercise and NRT revealed significant differences in weight (p = .033; ɳp2 = 0.017) and BMI (p = .020; ɳp2 = 0.020) at week 14. This equated to abstainers weighing 1.26 kg more and having a 0.52 higher BMI than smokers. No significant differences were found for any of the body composition parameters at week 14 (ɳp2 range from 0.001-0.007). CONCLUSIONS: Abstainers gain modest weight compared to smokers. This weight gain is related to increases in lean mass and not total, android, or visceral fat.

Symbolic number skills predict growth in nonsymbolic number skills in kindergarteners.

There is currently considerable discussion about the relative influences of evolutionary and cultural factors in the development of early numerical skills. In particular, there has been substantial debate and study of the relationship between approximate, nonverbal (approximate magnitude system [AMS]) and exact, symbolic (symbolic number system [SNS]) representations of number. Here we examined several hypotheses concerning whether, in the earliest stages of formal education, AMS abilities predict growth in SNS abilities, or the other way around. In addition to tasks involving symbolic (Arabic numerals) and nonsymbolic (dot arrays) number comparisons, we also tested children's ability to translate between the 2 systems (i.e., mixed-format comparison). Our data included a sample of 539 kindergarten children (M = 5.17 years, SD = .29), with AMS, SNS, and mixed-comparison skills assessed at the beginning and end of the academic year. In this way, we provide, to the best of our knowledge, the most comprehensive test to date of the direction of influence between the AMS and SNS in early formal schooling. Results were more consistent with the view that SNS abilities at the beginning of kindergarten lay the foundation for improvement in both AMS abilities and the ability to translate between the 2 systems. It is important to note that we found no evidence to support the reverse. We conclude that, once one acquires a basic grasp of exact number symbols, it is this understanding of exact number (and perhaps repeated practice therewith) that facilitates growth in the AMS. Though the precise mechanism remains to be understood, these data challenge the widely held view that the AMS scaffolds the acquisition of the SNS. (PsycINFO Database Record

Feasibility of an exercise intervention for fatigued breast cancer patients at a community-based cardiac rehabilitation program.

PURPOSE: Exercise is beneficial to quality of life after cancer treatment, yet few cancer survivors meet exercise guidelines. Our study sought to determine the feasibility of an oncology rehabilitation exercise program embedded within a cardiac rehabilitation program. METHODS: Patients who rated their fatigue >4/10 after completion of adjuvant chemotherapy for breast cancer were screened for eligibility and the outcomes were assessed (Piper Fatigue Scale, Functional Assessment of Cancer Therapy-Breast [FACT-B], Edmonton Symptom Assessment System, body composition, stress test, and physical activity measurement [accelerometer]). Participants received individualized exercise prescription. Following the 16-week program, repeat assessment plus patient acceptance and satisfaction survey was completed. The primary end point was the composite of accrual rate >25%, program adherence >80%, and mean compliance with accelerometer use >80%. RESULTS: Twenty of 24 screened patients consented to the study and completed the baseline assessment. Adherence was 30.3%. Mean accelerometer use was 3.88/7 days (78%). Fatigue at baseline was rated at 4.82/10, and at 3.59 (p = 0.09) after the intervention. Overall well-being (FACT-B) score changed from 92.7 to 98.3 (p = 0.05). There were no significant changes in body composition (except for bone mineral content), aerobic exercise capacity, or activity patterns. CONCLUSION: Although the primary outcome was not met, our study indicates that an oncology exercise rehabilitation program can be incorporated into an existing cardiac rehabilitation program. Based on feedback received, we propose that in order to achieve exercise goals, frequent, encouraging, and tailored feedback and group sessions to foster a sense of community may additionally be needed to strengthen adherence to a prescribed exercise program.

The use of smartphones to influence lifestyle changes in overweight and obese youth with congenital heart disease: a single-arm study: Pilot and feasibility study protocol: Smart Heart Trial.

BACKGROUND: Both obesity and congenital heart disease (CHD) are risk factors for the long-term cardiovascular health of children and adolescents. The addition of smart mobile technology to conventional lifestyle counseling for weight management offers great potential to appeal to technologically literate youth and can address a large geographical area with minimal burden to participants. This pilot study seeks to examine the influence of a 1-year lifestyle intervention on nutrition and physical activity-related health outcomes in overweight or obese children and adolescents with CHD. METHODS: This is a pilot and feasibility study which utilizes a single-arm, prospective design with a goal to recruit 40 overweight and obese patients. The feasibility metrics will evaluate the integrity of the study protocol, data collection and questionnaires, recruitment and consent, and acceptability of the intervention protocol and primary outcome measures. The primary clinical outcome metrics are anthropometry, body composition, and cardiorespiratory exercise capacity. The secondary clinical metrics include quality of life, nutrition and physical activity behavior, lung and muscle function, and cardio-metabolic risk factors. Outcomes are assessed at baseline, 6 months, and 1 year. To date, a total of 36 children and youth (11 girls), aged 7-17 years (mean = 14.4 years), have commenced the intervention. Recruitment for the study was initiated in June 2012 and is currently ongoing. DISCUSSION: The information provided in this paper is intended to help researchers and health professionals with the development and evaluation of similar lifestyle intervention programs. Since the application of smartphones to pediatric cardiac health and obesity management is a novel approach, and continued research in this area is warranted, this paper may serve as a foundation for further exploration of this health frontier and inform the development of a broader strategy for obesity management in pediatric cardiology. TRIAL REGISTRATION: This pilot study was retrospectively registered at the www.ClinicalTrials.gov registry as NCT02980393 in November 2016, with the study commencing in May 2012. Study protocol version 15OCT2014.

Remote Lifestyle Counseling Influences Cardiovascular Health Outcomes in Youth with Overweight or Obesity and Congenital Heart Disease.

BACKGROUND: Children with overweight/obesity and congenital heart disease (CHD) are at increased cardiovascular risk. A lifestyle intervention may help reduce these risks. We sought to determine the feasibility of a smartphone-based lifestyle intervention to improve cardiovascular health outcomes in children with overweight/obesity and CHD. METHODS: We examined the effect of bi-weekly nutrition and fitness counseling delivered via smartphone over 12 months. Thirty-four youth, previously diagnosed with CHD and with overweight or obesity, participated in the intervention. They were divided into two groups depending on whether the heart disease required surgical correction (operated, n = 19) or not (non-operated, n = 15). Anthropometry, body composition cardiorespiratory exercise capacity, and cardio-metabolic risk factors were assessed at baseline, 6 months, and 12 months. RESULTS: Statistically significant decreases in waist circumference (WC), body mass index z-score, WC z-score, and waist to height ratio z-score were observed at 6 and 12 months in the operated group. A significant linear increase in lean body mass was observed in both groups. The study also had a high retention rate and a low attrition rate. CONCLUSION: The observed changes in anthropometry were positive with significant improvement to some cardiovascular and metabolic risk indicators. However, this was only observed in the operated group suggesting that other factors, such as perception of condition and self-efficacy, may influence lifestyle behaviors. The results from this pilot study clearly demonstrate the feasibility to perform a larger controlled study on remote lifestyle intervention in children with congenital heart defects and overweight or obesity.

Effect of exercise on cigarette cravings and ad libitum smoking following concurrent stressors.

The health consequences of smoking are well documented, yet quit rates are modest. While exercise has supported decreased cravings and withdrawal symptoms in temporarily abstinent smokers, it has yet to be applied when smokers are experiencing concurrent stressors. This study examined the effect of an acute bout of moderate intensity exercise on cravings (primary outcome) and ad libitum smoking (secondary outcome) following concurrent stressors (i.e., temporary abstinence and environmental manipulation-Stroop cognitive task+cue-elicited smoking stimuli). Twenty-five smokers (>10cig/day; Mean age=37.4years) were randomized into either exercise (n=12) or passive sitting conditions. A repeated measure (RM) ANOVA showed that psychological withdrawal symptoms (a measure of distress) were significantly exacerbated after temporary abstinence and then again after the environmental manipulation for all participants (p<.0001, η(2)=.50). Furthermore, a treatment by time RM ANOVA revealed decreases in psychological withdrawal symptoms for only the exercise condition (p<.001, η(2)=.42). A treatment by time RM ANOVA also revealed craving reductions for only the exercise condition (p<.0001, η(2)=.82). Exercise had no effect on ad libitum smoking. This is the first study to use a lab-based scenario with high ecological validity to show that an acute bout of exercise can reduce cravings following concurrent stressors. Future work is now needed where momentary assessment is used in people's natural environment to examine changes in cigarette cravings following acute bouts of exercise.

The effects of acute exercise on tobacco cravings and withdrawal symptoms in temporary abstinent pregnant smokers.

INTRODUCTION: Smoking during pregnancy is common, and quitting at any point during pregnancy can yield benefits to both the fetus and mother. Smoking cessation is typically followed by withdrawal symptoms and a strong desire to smoke, both of which are likely to contribute to relapse. Research has shown that a bout of exercise minimizes cravings and tobacco withdrawal symptoms (TWS) after temporary abstinence in smokers, but these findings have not been replicated in pregnant smokers. This study examined the effect of 20min of exercise on cravings (primary outcome) and TWS (secondary outcomes) among temporary abstinent, inactive pregnant smokers. METHODS: Thirty female smokers (Mean(M) age=25.7years, Standard Deviation(SD)=5.5; M weeks pregnant=18.2, SD=5.3; Fagerstrom Test for Cigarette Dependence=3.3, SD=2.2; M 9.3 cigarettes/day, SD=4.7; M hours abstained=17.2, SD=2.8) were randomized to 20 min of mild-to-moderate intensity exercise (EC; n=14) or passive (PC; n=16) condition. Cravings and TWS were assessed immediately before, during (at 10 min), immediately post, and at 10, 20, and 30 min post-condition. RESULTS: A 2 (condition)×6 (time) repeated measures ANOVA revealed that the EC significantly (p<0.05) reduced cravings (ή(2)=0.46) compared with the PC, across time. Non-significant, but nevertheless, large effects were evident favouring the EC over time for TWS restlessness (ή(2)=0.34), stress (ή(2)=0.24), irritability (ή(2)=0.21), tension (ή(2)=0.15), and depression (ή(2)=0.14). CONCLUSIONS: Consistent with previous research, this study reveals that in pregnant smokers, a bout of exercise is associated with a reduction in cravings and similar patterns exist for TWS. Therefore, exercise may have the potential to assist in the initial stages of smoking cessation attempts during pregnancy.

Effects of a Comprehensive, Intensive Lifestyle Intervention Combined with Metformin Extended Release in Obese Adolescents.

Objective. To assess a comprehensive, intensive lifestyle intervention in combination with metformin extended release (MXR) or placebo on body mass index (BMI) and risk factors for type 2 diabetes and cardiovascular disease in obese adolescents. Study Design. Sixty-nineobese adolescents (mean BMI 32.5) received a comprehensive lifestyle intervention with structured dietary, physical activity, and behavioral components for 24 months. Subjects were randomized to 1 of 4 groups: MXR (33) 2,000 mg daily or placebo, with either moderate or vigorous intensity exercise for the first 3 months. Subsequently the exercise intervention was the same for all 4 groups. Results. Anthropometry measurements did not differ with initial exercise intensity at any time. At 3 months % body fat decreased in all 4 groups (P < 0.006). BMI and % body fat decreased in the MXR groups, but not the placebo groups, at 6 (-0.88, -3.16) and 12 months (-0.56, -2.34) (P < 0.05). Insulin resistance, fasting blood glucose, and leptin improved in all groups at 6 and 12 months. A high subject attrition rate (58%) occurred by 24 months. Conclusion. A comprehensive, intensive lifestyle intervention combined with MXR led to a decline in BMI and % body fat at 1 year independent of initial exercise intensity. This trial is registered with ClinicalTrials.gov NCT00934570 .