Collapsars as a major source of r-process elements.

The production of elements by rapid neutron capture (r-process) in neutron-star mergers is expected theoretically and is supported by multimessenger observations1-3 of gravitational-wave event GW170817: this production route is in principle sufficient to account for most of the r-process elements in the Universe4. Analysis of the kilonova that accompanied GW170817 identified5,6 delayed outflows from a remnant accretion disk formed around the newly born black hole7-10 as the dominant source of heavy r-process material from that event9,11. Similar accretion disks are expected to form in collapsars (the supernova-triggering collapse of rapidly rotating massive stars), which have previously been speculated to produce r-process elements12,13. Recent observations of stars rich in such elements in the dwarf galaxy Reticulum II14, as well as the Galactic chemical enrichment of europium relative to iron over longer timescales15,16, are more consistent with rare supernovae acting at low stellar metallicities than with neutron-star mergers. Here we report simulations that show that collapsar accretion disks yield sufficient r-process elements to explain observed abundances in the Universe. Although these supernovae are rarer than neutron-star mergers, the larger amount of material ejected per event compensates for the lower rate of occurrence. We calculate that collapsars may supply more than 80 per cent of the r-process content of the Universe.

Sotatercept for the Treatment of Pulmonary Arterial Hypertension.

BACKGROUND: Pulmonary arterial hypertension is characterized by pulmonary vascular remodeling, cellular proliferation, and poor long-term outcomes. Dysfunctional bone morphogenetic protein pathway signaling is associated with both hereditary and idiopathic subtypes. Sotatercept, a novel fusion protein, binds activins and growth differentiation factors in the attempt to restore balance between growth-promoting and growth-inhibiting signaling pathways. METHODS: In this 24-week multicenter trial, we randomly assigned 106 adults who were receiving background therapy for pulmonary arterial hypertension to receive subcutaneous sotatercept at a dose of 0.3 mg per kilogram of body weight every 3 weeks or 0.7 mg per kilogram every 3 weeks or placebo. The primary end point was the change from baseline to week 24 in pulmonary vascular resistance. RESULTS: Baseline characteristics were similar among the three groups. The least-squares mean difference between the sotatercept 0.3-mg group and the placebo group in the change from baseline to week 24 in pulmonary vascular resistance was -145.8 dyn · sec · cm-5 (95% confidence interval [CI], -241.0 to -50.6; P = 0.003). The least-squares mean difference between the sotatercept 0.7-mg group and the placebo group was -239.5 dyn · sec · cm-5 (95% CI, -329.3 to -149.7; P<0.001). At 24 weeks, the least-squares mean difference between the sotatercept 0.3-mg group and the placebo group in the change from baseline in 6-minute walk distance was 29.4 m (95% CI, 3.8 to 55.0). The least-squares mean difference between the sotatercept 0.7-mg group and the placebo group was 21.4 m (95% CI, -2.8 to 45.7). Sotatercept was also associated with a decrease in N-terminal pro-B-type natriuretic peptide levels. Thrombocytopenia and an increased hemoglobin level were the most common hematologic adverse events. One patient in the sotatercept 0.7-mg group died from cardiac arrest. CONCLUSIONS: Treatment with sotatercept resulted in a reduction in pulmonary vascular resistance in patients receiving background therapy for pulmonary arterial hypertension. (Funded by Acceleron Pharma; PULSAR ClinicalTrials.gov number, NCT03496207.).

Increasing fire and the decline of fire adapted black spruce in the boreal forest.

Intensifying wildfire activity and climate change can drive rapid forest compositional shifts. In boreal North America, black spruce shapes forest flammability and depends on fire for regeneration. This relationship has helped black spruce maintain its dominance through much of the Holocene. However, with climate change and more frequent and severe fires, shifts away from black spruce dominance to broadleaf or pine species are emerging, with implications for ecosystem functions including carbon sequestration, water and energy fluxes, and wildlife habitat. Here, we predict that such reductions in black spruce after fire may already be widespread given current trends in climate and fire. To test this, we synthesize data from 1,538 field sites across boreal North America to evaluate compositional changes in tree species following 58 recent fires (1989 to 2014). While black spruce was resilient following most fires (62%), loss of resilience was common, and spruce regeneration failed completely in 18% of 1,140 black spruce sites. In contrast, postfire regeneration never failed in forests dominated by jack pine, which also possesses an aerial seed bank, or broad-leaved trees. More complete combustion of the soil organic layer, which often occurs in better-drained landscape positions and in dryer duff, promoted compositional changes throughout boreal North America. Forests in western North America, however, were more vulnerable to change due to greater long-term climate moisture deficits. While we find considerable remaining resilience in black spruce forests, predicted increases in climate moisture deficits and fire activity will erode this resilience, pushing the system toward a tipping point that has not been crossed in several thousand years.

Early-Onset Asymptomatic Polypoid Cystitis in Two Adolescent Male Beagle Dogs.

This brief communication describes a rare spontaneous background lesion in the lower urinary tract of two male laboratory beagles. Proliferative lesions comprising a constellation of histological features consistent with polypoid cystitis were observed in the bladder of two adolescent dogs from a routine preclinical toxicology study. Both animals were clinically asymptomatic and had only minor alterations in urinalysis parameters. While chronic polypoid cystitis is well-recognized in adult pet dogs, this is the first reported case in purpose-bred laboratory beagles. An awareness of this uncommon background finding is important for toxicological pathologists to distinguish it from potential test article-related findings.

Origin of the heavy elements in binary neutron-star mergers from a gravitational-wave event.

The cosmic origin of elements heavier than iron has long been uncertain. Theoretical modelling shows that the matter that is expelled in the violent merger of two neutron stars can assemble into heavy elements such as gold and platinum in a process known as rapid neutron capture (r-process) nucleosynthesis. The radioactive decay of isotopes of the heavy elements is predicted to power a distinctive thermal glow (a 'kilonova'). The discovery of an electromagnetic counterpart to the gravitational-wave source GW170817 represents the first opportunity to detect and scrutinize a sample of freshly synthesized r-process elements. Here we report models that predict the electromagnetic emission of kilonovae in detail and enable the mass, velocity and composition of ejecta to be derived from observations. We compare the models to the optical and infrared radiation associated with the GW170817 event to argue that the observed source is a kilonova. We infer the presence of two distinct components of ejecta, one composed primarily of light (atomic mass number less than 140) and one of heavy (atomic mass number greater than 140) r-process elements. The ejected mass and a merger rate inferred from GW170817 imply that such mergers are a dominant mode of r-process production in the Universe.

Method To Visualize the Intratumor Distribution and Impact of Gemcitabine in Pancreatic Ductal Adenocarcinoma by Multimodal Imaging.

Gemcitabine (dFdC) is a common treatment for pancreatic cancer; however, it is thought that treatment may fail because tumor stroma prevents drug distribution to tumor cells. Gemcitabine is a pro-drug with active metabolites generated intracellularly; therefore, visualizing the distribution of parent drug as well as its metabolites is important. A multimodal imaging approach was developed using spatially coregistered mass spectrometry imaging (MSI), imaging mass cytometry (IMC), multiplex immunofluorescence microscopy (mIF), and hematoxylin and eosin (H&E) staining to assess the local distribution and metabolism of gemcitabine in tumors from a genetically engineered mouse model of pancreatic cancer (KPC) allowing for comparisons between effects in the tumor tissue and its microenvironment. Mass spectrometry imaging (MSI) enabled the visualization of the distribution of gemcitabine (100 mg/kg), its phosphorylated metabolites dFdCMP, dFdCDP and dFdCTP, and the inactive metabolite dFdU. Distribution was compared to small-molecule ATR inhibitor AZD6738 (25 mg/kg), which was codosed. Gemcitabine metabolites showed heterogeneous distribution within the tumor, which was different from the parent compound. The highest abundance of dFdCMP, dFdCDP, and dFdCTP correlated with distribution of endogenous AMP, ADP, and ATP in viable tumor cell regions, showing that gemcitabine active metabolites are reaching the tumor cell compartment, while AZD6738 was located to nonviable tumor regions. The method revealed that the generation of active, phosphorylated dFdC metabolites as well as treatment-induced DNA damage primarily correlated with sites of high proliferation in KPC PDAC tumor tissue, rather than sites of high parent drug abundance.

Ice-Cream Substitute for Patients With Kidney Failure.

OBJECTIVE: Quality of life for patients with kidney failure is less than similar-aged, general population counterparts. A large part of the decrease in quality of life is from the change of diet and nutritional restrictions. One way to combat this decrease in quality of life is through oral nutrition supplements. METHODS: An ice-cream substitute product was developed for patients with kidney failure on peritoneal dialysis. The product consisted of an ice-cream-like base of rice milk, egg whites, evaporated coconut milk, sugar, and vanilla bean paste. Two flavors were then created: cinnamon and lemon. Both flavors were tested subjectively and objectively. Sensory taste testing was with peritoneal dialysis patients using a Likert scale ballot with a comment section. Texture analysis was completed using a CT3 Brookfield texture analyzer. The results from the sensory testing (taste, texture, overall acceptability) and the texture analysis were analyzed using paired-samples t-tests. Nutritional analysis for the product was calculated. RESULTS: The sensory test of taste, texture, and overall acceptability between the two flavors was not found to be statistically different between the cinnamon and lemon. Similarly, the objective results were also not statistically significant between the two flavors. CONCLUSION: Based on the nutritional analysis, both the lemon and the cinnamon flavors were found to be "good" sources of protein when compared with the Food and Drug Administration's definition of a "good" source of protein. In addition, patients found the sensory aspects of both flavors to be slightly to moderately likable.

Vitamin D status is associated with muscular strength in a nationally representative sample of US youth.

AIM: To evaluate the association between serum 25-hydroxyvitamin D (25OHD) and muscular strength in a nationally representative sample of US youth. METHODS: Participants (n = 3350) were 6- to 18-y-olds from 2011 to 2014 National Health and Nutrition Examination Survey. Relative handgrip strength was quantified using age- and sex-specific z-scores. Poor strength was defined as those <25th percentile. Multivariate general linear and logistic models were used to compare strength and poor strength status by clinically relevant groupings of 25OHD. RESULTS: Approximately 20.2% of youth had 25OHD <50 nmol/L. Mean relative strength was highest for those at ≥75 nmol/L of 25OHD. The percentage of boys/girls with poor strength in the <50 nmol/L, 50-74.9 nmol/L and ≥75 nmol/L groups was 34.9%/32.3%, 25.8%/28.2% and 14.0%/15.8%, respectively. The odds of boys and girls with <50 nmol/L 25OHD having poor strength were 2.8 (95% CI: 1.4, 5.5) and 3.4 (1.7, 6.8) times higher compared to those with ≥75 nmol/L, respectively. CONCLUSION: Higher levels of circulating vitamin D were associated with higher relative strength, and poor strength was more prevalent when 25OHD was <75 nmol/L. These findings highlight the value of vitamin D for the muscle-bone unit and potential extraskeletal ramifications.

Problem-solving therapy reduces subjective burden levels in caregivers of family members with mild cognitive impairment or early-stage dementia: Secondary analysis of a randomized clinical trial.

OBJECTIVES: Interventions addressing burden have limited impact among long-term family caregivers. We examined whether problem-solving therapy (PST) would reduce burden levels of caregivers of individuals diagnosed with mild cognitive impairment (MCI) or early-stage dementia (AD). METHODS: Caregivers (N = 73) randomly received PST or nutritional training (NT). Burden measures were assessed over 1-year post-intervention. RESULTS: Relative to NT, caregivers receiving PST endorsed improved perceived burden levels over time, regardless of the type of caregiver. Distress over the care recipient's dementia-related behaviors remained low over time among MCI caregivers receiving PST, while these burden levels among MCI caregivers receiving NT rose over time. AD caregivers receiving PST endorsed reductions in these burden levels over time, while AD caregivers in the NT group endorsed higher burden levels over time. CONCLUSION: PST, taught early in the caregiving trajectory, improves subjective burden levels among caregivers of family members with relatively mild cognitive deficits.

Maternal depression and infant attachment security: A meta-analysis.

The purpose of this study is to clarify the magnitude of the association between maternal depression and infant attachment nonsecurity, and to identify possible moderators of this relationship. An extensive literature search was conducted using multiple databases of both published and unpublished studies. A meta-analysis was conducted to determine the relationship between maternal depression and infant attachment security and to establish the effect size. The main findings from this meta-analysis, which included 42 studies, indicate that there is a small, yet significant, relationship between maternal depression and infant attachment nonsecurity. The rate of nonsecurity in infants of mothers with depression was approximately 20% higher than expected rates in a nonclinical population, and the association between depressive symptoms and nonsecurity was small, but significant. Infants of mothers with depression were nearly twice as likely to have a nonsecure attachment than were infants of healthy mothers. Depression measure and maternal sample source were identified as significant moderators of the odds ratio effect size. Results of this study demonstrate that there is a significant relationship between maternal depression and infant attachment nonsecurity, and suggest that interventions that focus on both maternal mental health and the attachment relationship are warranted.

Propósito: Clarificar la magnitud de las asociaciones entre la depresión materna y la falta de seguridad en la afectividad del infante, así como identificar posibles moderadores de esta relación. Métodos: Se llevó a cabo una extensa búsqueda de la literatura existente usando múltiples bancos de información tanto de estudios publicados como de los no publicados. Se realizó un meta-análisis para determinar la relación entre la depresión materna y la seguridad de la afectividad del infante y establecer la dimensión del efecto. Resultados: Los principales resultados de este meta-análisis, el cual incluyó 42 estudios, indicaron que existe una pequeña pero significativa relación entre la depresión materna y la falta de seguridad en la afectividad del infante. La tasa de falta de seguridad en infantes de madres con depresión fue aproximadamente 20% más alta que la tasa esperada en una población no clínica, y la asociación entre los síntomas depresivos y la falta de seguridad fue pequeña pero significativa. Los infantes de madres con depresión estuvieron casi dos veces más propensos a tener una afectividad no segura que los infantes de madres saludables. Se identificó la medida de depresión y la fuente del grupo muestra materno como moderadores significativos de la dimensión del efecto en las posibilidades promedio. Conclusiones: Los resultados de este estudio demuestran que existe una significativa relación entre la depresión materna y la falta de seguridad en la afectividad del infante, y sugieren que las intervenciones que se enfocan tanto en la salud mental materna como en la relación de afectividad están garantizadas.

But: Clarifier la magnitude du lien entre la dépression maternelle et l'insécurité de l'attachement du nourrisson, et identifier des facteurs de modération possibles de cette relation. Méthodes: Une importante recherche sur les recherches a été faite en utilisant plusieurs bases de données comprenant à la fois des études publiées et des études non publiées. Une méta-analyse a été faite afin de déterminer la relation entre la dépression maternelle et la sécurité de l'attachement du nourrisson et afin d'établir la taille de l'effet. Résultats: Les principaux résultats de cette méta-analyse, qui a porté sur 42 études, ont indiqué qu'il existe une relation petite et cependant importante entre la dépression maternelle et l'insécurité de l'attachement du nourrisson. Le taux d'insécurité chez les nourrissons de mère avec une dépression était lié à des taux environ 20% plus élevés que les taux attendus chez une population non-clinique, et le lien entre les symptômes dépressifs et la non-sécurité était limité mais important. Les nourrissons de mères avec une dépression étaient presque deux fois plus à même d'avoir un attachement insécure que les nourrissons de mères en bonne santé. La mesure de dépression et la source de l'échantillon maternel ont été identifiées comme étant des facteurs de modération importants de l'ampleur des effets des rapports de cote. Conclusions: Les résultats de cette étude démontrent qu'il existe une relation importante entre la dépression maternelle et l'insécurité de l'attachement du nourrisson, et suggèrent que les interventions qui mettent l'accent à la fois sur la santé mentale maternelle et la relation d'attachement sont justifiées.

A Qualitative Exploration of Weight Bias and Quality of Health Care Among Health Care Professionals Using Hypothetical Patient Scenarios.

The purpose of this study was to determine whether weight bias exhibited by health care professionals (HCPs) impacts quality of health care provided to individuals with obesity. HCPs (n = 220; 88% female, 87% nurses) in the Midwest region of the United States were recruited to complete an online survey. In this within-subjects study design, participants completed the Attitudes Towards Obese Persons (ATOP) scale to assess weight bias and responded to 2 (1 person with obesity and 1 person without obesity) hypothetical patient scenarios to evaluate quality of care. A median split was calculated for ATOP scores to divide participants into high or low weight bias groups. Within these groups, thematic analysis was used to uncover themes in quality of care based on participants' responses to each scenario. The analysis revealed that HCPs in the high weight bias group gave specific diet and exercise recommendations, offered health advice regarding weight loss, and used less teaching discourse when responding to the patient with obesity. In addition, in both weight bias groups, patients with obesity were started on pharmaceutical therapies sooner. The findings of this study suggest a need to educate HCPs on the importance of empathy and compassion when providing treatment to all patients, regardless of weight, to increase quality of care and ultimately improve patient outcomes.

Two-Phase and Graph-Based Clustering Methods for Accurate and Efficient Segmentation of Large Mass Spectrometry Images.

Clustering is widely used in MSI to segment anatomical features and differentiate tissue types, but existing approaches are both CPU and memory-intensive, limiting their application to small, single data sets. We propose a new approach that uses a graph-based algorithm with a two-phase sampling method that overcomes this limitation. We demonstrate the algorithm on a range of sample types and show that it can segment anatomical features that are not identified using commonly employed algorithms in MSI, and we validate our results on synthetic MSI data. We show that the algorithm is robust to fluctuations in data quality by successfully clustering data with a designed-in variance using data acquired with varying laser fluence. Finally, we show that this method is capable of generating accurate segmentations of large MSI data sets acquired on the newest generation of MSI instruments and evaluate these results by comparison with histopathology.

CXCL9 Regulates TGF-ß1-Induced Epithelial to Mesenchymal Transition in Human Alveolar Epithelial Cells.

Epithelial to mesenchymal cell transition (EMT), whereby fully differentiated epithelial cells transition to a mesenchymal phenotype, has been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF). CXCR3 and its ligands are recognized to play a protective role in pulmonary fibrosis. In this study, we investigated the presence and extent of EMT and CXCR3 expression in human IPF surgical lung biopsies and assessed whether CXCR3 and its ligand CXCL9 modulate EMT in alveolar epithelial cells. Coexpression of the epithelial marker thyroid transcription factor-1 and the mesenchymal marker α-smooth muscle actin and CXCR3 expression was examined by immunohistochemical staining of IPF surgical lung biopsies. Epithelial and mesenchymal marker expression was examined by quantitative real-time PCR, Western blotting, and immunofluorescence in human alveolar epithelial (A549) cells treated with TGF-ß1 and CXCL9, with Smad2, Smad3, and Smad7 expression and cellular localization examined by Western blotting. We found that significantly more cells were undergoing EMT in fibrotic versus normal areas of lung in IPF surgical lung biopsy samples. CXCR3 was expressed by type II pneumocytes and fibroblasts in fibrotic areas in close proximity to cells undergoing EMT. In vitro, CXCL9 abrogated TGF-ß1-induced EMT. A decrease in TGF-ß1-induced phosphorylation of Smad2 and Smad3 occurred with CXCL9 treatment. This was associated with increased shuttling of Smad7 from the nucleus to the cytoplasm where it inhibits Smad phosphorylation. This suggests a role for EMT in the pathogenesis of IPF and provides a novel mechanism for the inhibitory effects of CXCL9 on TGF-ß1-induced EMT.

Modified Nutritional Recommendations to Improve Dietary Patterns and Outcomes in Hemodialysis Patients.

The renal diet has traditionally been regarded as one of the most complex medical nutrition therapies to teach, understand, and implement. Specifically, patients are instructed to limit fruits, vegetables, nuts, legumes, dairy, and whole grains because of both phosphorus and potassium concerns. Furthermore, hemodialysis patients are often encouraged to decrease fluid intake to control interdialytic weight gain. These restrictions can result in frustration, lack of autonomy, and the perception that there is nothing left to eat. It is possible that the traditional renal diet may be liberalized, with a focus on whole foods low in sodium and phosphorus additives, to afford patients greater choices and ultimately improved outcomes. Therefore, the objective of this review is to concisely assess the evidence in support of a renal diet focused primarily on reducing the intake of sodium and inorganic phosphorus. Finally, the limited evidence for restrictions on dietary potassium intake is summarized.

CXCR3 Requirement for the Interleukin-13-Mediated Up-Regulation of Interleukin-13Rα2 in Pulmonary Fibroblasts.

Idiopathic pulmonary fibrosis (IPF) is a progressive disease characterized by fibrosis and abnormal vascularity. IL-13, a profibrotic cytokine that plays a role in IPF, functions through the Jak/STAT pathway after binding to the IL-13 receptor α1 (IL-13Rα1)/IL-4Rα complex. IL-13 also binds to IL-13Rα2, which has been thought to function as a nonsignaling decoy receptor, although possible signaling roles of this receptor have been proposed. CXCR3 and its IFN-inducible ligands-CXCL9, CXCL10, and CXCL11-have been implicated in vascular remodeling and fibroblast motility during the development of IPF. In this study, CXCR3 expression was demonstrated in cultured pulmonary fibroblasts from wild-type BALB/c mice and was found to be necessary for the IL-13-mediated gene and protein up-regulation of IL-13Rα2. In fibroblasts from CXCR3-deficient mice, STAT6 activation was prolonged. This study is the first to demonstrate the expression of CXCR3 in fibroblasts and its association with the expression of IL-13Rα2. Taken together, the results from this study point strongly to a requirement for CXCR3 for IL-13-mediated IL-13Rα2 gene expression. Understanding the function of CXCR3 in IL-13-mediated lung injury may lead to novel approaches to combat the development of pulmonary fibrosis, whether by limiting the effects of IL-13 or by manipulation of angiostatic pathways. The elucidation of the complex relationship between these antifibrotic receptors and manipulation of the CXCR3-mediated regulation of IL-13Rα2 may represent a novel therapeutic modality in cases of acute lung injury or chronic inflammation that may progress to fibrosis.

JWST detection of a supernova associated with GRB 221009A without an r-process signature.

Identifying the sites of r-process nucleosynthesis, a primary mechanism of heavy element production, is a key goal of astrophysics. The discovery of the brightest gamma-ray burst (GRB) to date, GRB 221009A, presented an opportunity to spectroscopically test the idea that r-process elements are produced following the collapse of rapidly rotating massive stars. Here we present James Webb Space Telescope observations of GRB 221009A obtained +168 and +170 rest-frame days after the gamma-ray trigger, and demonstrate that they are well described by a SN 1998bw-like supernova (SN) and power-law afterglow, with no evidence for a component from r-process emission. The SN, with a nickel mass of approximately 0.09 M ⊙, is only slightly fainter than the brightness of SN 1998bw at this phase, which indicates that the SN is not an unusual GRB-SN. This demonstrates that the GRB and SN mechanisms are decoupled and that highly energetic GRBs are not likely to produce significant quantities of r-process material, which leaves open the question of whether explosions of massive stars are key sources of r-process elements. Moreover, the host galaxy of GRB 221009A has a very low metallicity of approximately 0.12 Z ⊙ and strong H2 emission at the explosion site, which is consistent with recent star formation, hinting that environmental factors are responsible for its extreme energetics.

The five most significant barriers to healthy eating in collegiate student-athletes.

The objective of the present study was to elucidate what student-athletes believe are the most significant barriers to consuming a healthy diet. 418 student-athletes at an NCAA Division 1 university were invited to complete a survey on their nutritional habits and barriers to healthy eating. The survey was designed utilizing the current literature in student-athletes and young adults and underwent a professional review and pilot study before use in data collection. 169 student-athletes (40%) fully completed the survey. Responses indicate the five most significant barriers are lack of time, easy access to unhealthy foods, cost of healthy foods, lack of knowledge about what foods are healthy, and lack of knowledge and skills to cook healthy foods, respectively. Further, data show significant relationships between several variables and the rate of selection of various barriers. Overall, these findings lay the groundwork for future interventions while also presenting initial, usable information for professionals.

The measurement of college athletes' knowledge and behavior on pre- and post-workout nutrition utilizing a text message intervention.

Objective: The purpose of this study was to measure college student athletes' nutrition knowledge and behavior before and after a text message-based educational intervention. Participants: Athletes (n = 35) participated by completing a pre- and post-intervention survey. Methods: This survey gathered information on ability to identify carbohydrate and protein food sources, pre-and post-workout intake, and behavior. Text messages were sent during the 4-week intervention and included information regarding the importance of carbohydrate consumption before training, and a carbohydrate-protein mixture for recovery. Results: Dependent t-tests revealed a lack of statistically significant increases in total knowledge (p = 0.156) or behavior (p = 0.177), but an increase in the behavior questions regarding efficacy of carbohydrate before training (p = 0.026) and carbohydrate and protein after training (p = 0.016). Conclusion: This suggests the text message educational intervention did influence behavioral outcomes. Future research should focus on the effectiveness, length, and frequency of the text message intervention, and investigate the athletes' willingness to change dietary behaviors.

Treadmill-based system for postural studies: Design and validation.

Computer-controlled treadmills are common in many gait labs and offer great potential for conducting perturbation-based postural studies. However, the time-course of these disturbances can be too brief to be controlled manually through product software. Here we present a system that combines a Bertec® split-belt treadmill with custom hardware and software to deliver postural disturbances during standing and record data from multiple sources simultaneously. We used this system to administer to 15 healthy participants an 8-session perturbation-based training protocol in which they learned to respond without stepping to progressively larger perturbations. Kinematic, electromyographic, and force data were collected throughout. Motion capture was used to characterize the accuracy and repeatability of the treadmill-delivered perturbations with respect to duration, displacement, and peak velocity. These (observed) data were compared to that expected based on software commands and the known constraints of the treadmill (i.e., 10 Hz operating speed). We found perturbation durations to be as expected. Peak velocities and displacements were slightly higher than expected (average increases were 0.59 cm/s and 1.76 cm, respectively). Because this increase in magnitude was consistent, it did not impede training or affect data analysis. Treadmill behavior was repeatable across 95 % of trials.

Development of the Drug Adherence Work-up (DRAW) tool.

OBJECTIVE: To develop and conduct an initial field test of the Drug Adherence Work-up (DRAW) tool, which was developed to guide pharmacists when addressing nonadherence during medication therapy management (MTM) visits. METHODS: The field test was a prospective cohort study, in which seven trained pharmacists used DRAW to evaluate patients by asking about possible reasons for nonadherence during an MTM visit. Pharmacists were notified of potentially nonadherent patients identified through drug claims data analyzed by Outcomes Pharmaceutical Health Care. The pharmacists reported on use of DRAW in an MTM claim and provided opinions about DRAW via an online survey. RESULTS: According to the online survey, pharmacists reported that DRAW helped them to improve the focus of their MTM services and address more adherence problems than their usual approach. They thought the tool was easy to use and well organized. Some commented that DRAW could be a useful tool for teaching pharmacists. The most common reasons reported for nonadherence were the presence of adverse effects (59.1%) or forgetting to take the medication (54.5%). More than three-fourths of patients (77.3%) indicated more than one reason for nonadherence. CONCLUSION: A brief, comprehensive tool to evaluate medication nonadherence, such as DRAW, may help pharmacists address various reasons for medication nonadherence. Often nonadherence is multifaceted, which makes an inclusive tool like DRAW a useful approach; however further research is needed.