Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity.

BACKGROUND: Longstanding biases have fostered the erroneous notion that only those of higher socioeconomic status (SES) experience eating disorders (EDs); however, EDs present across all SES strata. Considering the dearth of ED research among those of lower SES, this study examined (1) the overall association between SES and ED prevalence, and (2) ED prevalence in the context of four relevant social identities (i.e. SES, gender identity, sexual orientation, and race/ethnicity) from an intersectional perspective, as unique combinations of multiple social identities may differentially influence risk. METHODS: A sample of 120 891 undergraduate/graduate students from the Healthy Minds Study self-reported family SES with a single-item question, gender identity, sexual orientation, and race/ethnicity, and were screened for ED risk. RESULTS: Participants of lower SES had 1.27 (95% CI 1.25-1.30) times greater prevalence of a positive ED screen than those of higher SES. Substantial heterogeneity was observed across the four social identities beyond the association with SES. For example, positive ED screens were particularly common among lower SES, Latinx, sexual minority cisgender men and women, with 52% of bisexual men and 52% of lesbian women of Latinx ethnicity and lower SES screening positive. CONCLUSIONS: Although positive ED screens were more common among undergraduate/graduate students of lower SES, the particularly high ED risk reported by certain groups of lower SES with multiple minority identities reinforces the importance of investigating multi-layered constructs of identity when identifying groups at disproportionate risk.

Toward inclusivity: A systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades.

OBJECTIVE: Sexual minority (SM) groups (e.g., those who identify as lesbian, gay, bisexual, questioning, queer, asexual, or those who feel their sexual orientation identity cannot be captured with existing terminology [LGBQA+] and those who report same-sex or same-gender attraction and/or behavior) are at elevated risk for eating disorder (ED) symptoms and behaviors. However, the ways in which this risk varies across SM is less clear, and findings are not fully convergent. Evolution in the definition and assessment of SM status may contribute to this divergence. The aim of this study was to systematically review how sexual orientation and SM status have been assessed in the ED literature and how this may relate to patterns of associations between SM status and ED symptoms. METHODS: A systematic review of the literature focused on ED symptoms and behaviors and SM groups was conducted, yielding 182 studies. RESULTS: Five categories were created reflecting SM status assessment: identity only (n = 105), attraction only (n = 8), behavior only (n = 4), combinations of identity, behavior, or attraction (n = 58), and articles with unclear or insufficient information about SM status assessment (n = 7). SM status operationalizations varied across studies, with more inclusive assessments in more recent work. Findings revealed persistent conflicting patterns of disordered eating symptomatology for some SM groups. In addition, decisions to selectively combine SM participants in some studies, most often to increase power, decreased the specificity of their results in relation to differential risk and protective factors within specific LGBQA+ groups. DISCUSSION: Findings highlight the importance of inclusive assessments of sexual orientation in the ED literature and research focused on underrepresented groups with intersecting identities. Identifying modifiable targets for intervention is a critical next step. PUBLIC SIGNIFICANCE: Sexual minority (SM) groups have been identified as presenting elevated risk for eating disorder symptoms and behaviors. Our findings suggest that the level of risk is variable across SM groups and points to the need for multi-dimensional assessments of SM status, and increased focus on the function of disordered eating behaviors and different profiles that might emerge related to efforts to modify physical appearance or to regulate emotion.

OBJETIVO: Los grupos de minorías sexuales (SM) tienen un riesgo elevado de síntomas y comportamientos de trastornos de la conducta alimentaria. Sin embargo, las formas en que este riesgo varía entre SM son menos claras. La evolución en la definición y evaluación del estatus de SM puede contribuir a esta divergencia. El objetivo de este estudio fue revisar sistemáticamente cómo se han evaluado la orientación sexual y el estado de SM en la literatura sobre trastornos de la conducta alimentaria y cómo esto puede relacionarse con los patrones de asociaciones entre el estado de SM y los síntomas del trastorno alimentario. MÉTODOS: Se realizó una revisión sistemática de la literatura centrada en los síntomas y comportamientos del trastorno de la conducta alimentaria y los grupos de SM, que arrojó 182 estudios. RESULTADOS: Se crearon cinco categorías que reflejan la evaluación del estado de SM: solo identidad (n = 105), solo atracción (n = 8), solo comportamiento (n = 4), combinaciones de identidad, comportamiento o atracción (n = 58) y artículos con información poco clara o insuficiente sobre la evaluación del estado de SM (n = 7). Las operacionalizaciones del estado de SM variaron entre los estudios, con evaluaciones combinadas más inclusivas en el trabajo más reciente. Los hallazgos revelaron patrones persistentes y conflictivos de sintomatología alimentaria disfuncional para algunos grupos de SM. Además, las decisiones de combinar selectivamente a los participantes de SM en algunos estudios, con mayor frecuencia para aumentar el poder, disminuyeron la especificidad de sus resultados en relación con el riesgo diferencial y los factores de protección dentro de grupos LGBQA+ específicos. DISCUSIÓN: Los hallazgos resaltan la importancia de las evaluaciones inclusivas de la orientación sexual en la literatura sobre trastornos alimentarios y la investigación centrada en grupos subrepresentados con identidades que se cruzan. Identificar objetivos modificables para la intervención como recursos es un siguiente paso crítico.

Gluten-induced Neurocognitive Impairment: Results of a Nationwide Study.

GOALS: This study aimed to understand the neurocognitive symptoms associated with gluten exposure in individuals with self-reported celiac disease (CD) and nonceliac gluten sensitivity (NCGS). BACKGROUND: While gluten-induced neurocognitive impairment (GINI; eg, "celiac fog" or "brain fog") is commonly described by individuals with CD and NCGS, there are little data regarding the prevalence and symptoms associated with these experiences. STUDY: A 9-question online survey was accessed by 1396 individuals (1143 with CD; 253 with NCGS). Forced choice and free-response questions were asked of participants to obtain a description of neurocognitive symptoms experienced after gluten ingestion. Free-response answers were coded using a coding structure developed based on the Health-Related Quality of Life Instrument. RESULTS: The majority of survey participants (89% of CD and 95% of NCGS) reported having GINI symptoms. When describing symptoms, the most common word descriptors for both groups were difficulty concentrating, forgetfulness, and grogginess. Timing of symptoms, including onset and symptom peak, were similar across the 2 groups. Coding of free responses found the most common references were to cognitive, physical, psychological, and overall quality of life impacts. CONCLUSIONS: This survey suggests that GINI is common and may be severe in both individuals with CD and NCGS. Cognitive impairment and decline in physical functioning may be similar to that occurring in other illnesses, such as lupus. Clinical follow-up with both individuals with CD and NCGS should include assessment of GINI symptoms. Further research is warranted, including the development of a patient-reported outcome measure including neurocognitive effects of gluten exposure.

Evaluating the Implementation of the Diabetes Self-Management Program in a Rural Population.

The evidence-based Diabetes Self-Management Program (DSMP) has been shown to improve a variety of health-related outcomes, but the program has been challenging to implement in rural areas, and rural dissemination has been low. The purpose of this project was to evaluate the effect of implementing the DSMP on self-reported outcomes in a rural region. Through a collaboration with multiple partners, the Living Well program delivered 28 DSMP workshops from 2017 to 2019. Data were collected to determine whether there were post-intervention changes in patient-reported outcomes on measures of diabetes distress, self-management, and patient activation. In addition, secondary analysis of A1C was abstracted from the medical records of participants with type 2 diabetes who completed at least four sessions of a DSMP workshop between 2017 and 2019 and whose medical records had an A1C value in the year before the program and at least one A1C value >3 months after the program. Statistically significant improvements were seen for the Diabetes Distress Scale (P = 0.0017), the Diabetes Self-Management Questionnaire (P <0.0001) and the 10-item Patient Activation Measure (P <0.0001). There was no evidence of change in A1C over time in analyses of all participants (P = 0.5875), but a consistent though nonsignificant (P = 0.1087) decline in A1C was seen for a subset of participants with a baseline A1C ≥8%. This evaluation provides preliminary support for implementing the DSMP as part of a comprehensive treatment and self-management plan for people living with diabetes in rural areas.

Wrong drug and wrong dose dispensing errors identified in pharmacist professional liability claims.

OBJECTIVE: This study aimed to identify pharmacist professional liability patterns and trends associated with 2 of the most common allegations in legal claims: wrong drug dispensing errors and wrong dose dispensing errors. METHODS: This study used pharmacist professional liability claim data from the Healthcare Providers Service Organization professional liability insurance program, underwritten by CNA. The final 2018 claims dataset consisted of pharmacist professional liability (i.e., malpractice) claims that closed between 2012 and 2016 and incurred a payment of at least $1 from the Healthcare Providers Service Organization program. Using malpractice claim data, the claims were classified by clinical license (pharmacist or pharmacy technician), primary allegation type, and total payment amount. These claims were then analyzed to determine the risk factors that most often led to wrong drug and wrong dose dispensing errors and the factors that led to claims with higher-than-average total payments. Then, the results were compared with the 2013 claims dataset to identify patterns and trends. RESULTS: Inclusion criteria, applied to 1264 reported adverse incidents and claims, created the 2018 claim dataset consisting of 184 closed claims over the 5 years available for review. The average total payment was $124,407 for closed claims with a payment of at least $1. Wrong drug dispensing errors represented 36.8% of claims in the 2018 dataset, and wrong dose dispensing errors represented 15.3% of claims. Comparisons with the 2013 dataset revealed that the percentage of claims associated with wrong drug dispensing errors decreased from 43.8% in the 2013 dataset to 36.8% in the 2018 dataset. The percentage of wrong dose claims also decreased since the 2013 dataset from 31.5% to 15.3%. CONCLUSION: Although technology and automation have contributed to improvements in the area of medication error prevention, wrong drug and wrong dose dispensing errors continue to occur because of system and human factor errors.

BreakPoint Surveyor: a pipeline for structural variant visualization.

SUMMARY: BreakPoint Surveyor (BPS) is a computational pipeline for the discovery, characterization, and visualization of complex genomic rearrangements, such as viral genome integration, in paired-end sequence data. BPS facilitates interpretation of structural variants by merging structural variant breakpoint predictions, gene exon structure, read depth, and RNA-sequencing expression into a single comprehensive figure. AVAILABILITY AND IMPLEMENTATION: Source code and sample data freely available for download at https://github.com/ding-lab/BreakPointSurveyor, distributed under the GNU GPLv3 license, implemented in R, Python and BASH scripts, and supported on Unix/Linux/OS X operating systems. CONTACT: lding@wustl.edu. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

A biopsychosocial model of body image, disordered eating, and breastfeeding among postpartum women.

BACKGROUND: The aim of the current study was to test a biopsychosocial model of body image, eating, and feeding attitudes among postpartum women. Specifically, the model predicted that desired weight-loss, depressive symptoms, and body surveillance would predict body dissatisfaction and appearance-related barriers to breastfeeding, which in turn would predict maternal disordered eating and breastfeeding self-efficacy. METHODS: Data from 151 women, mean age = 32.77 (4.47) years, who provided complete data in response to an online survey were analyzed. RESULTS: Path analysis revealed that after minor modifications, the biopsychosocial model was a good fit to the data. Desired weight-loss, depressive symptoms, and body surveillance were associated with higher levels of disordered eating and lower levels of breastfeeding self-efficacy directly, as well as indirectly through body dissatisfaction and appearance-related barriers to breastfeeding. CONCLUSION: Findings provide support for an integrated biopsychosocial model of body image concerns, and eating and feeding attitudes among postpartum women as well as highlighting the need for additional support around body image, eating, and breastfeeding following childbirth. Our study has clinical implications for healthcare providers working with new mothers and can be used to inform postpartum psychoeducation efforts addressing breastfeeding, weight loss expectations and body image concerns.

Uncovering the transcriptomic and epigenomic landscape of nicotinic receptor genes in non-neuronal tissues.

BACKGROUND: Nicotinic acetylcholine receptors (nAChRs) play an important role in cellular physiology and human nicotine dependence, and are closely associated with many human diseases including cancer. For example, previous studies suggest that nAChRs can re-wire gene regulatory networks in lung cancer cell lines. However, the tissue specificity of nAChRs genes and their regulation remain unexplored. RESULT: In this study, we integrated data from multiple large genomic consortiums, including ENCODE, Roadmap Epigenomics, GTEx, and FANTOM, to define the transcriptomic and epigenomic landscape of all nicotinic receptor genes across many different human tissues and cell types. We found that many important nAChRs, including CHRNA3, CHRNA4, CHRNA5, and CHRNB4, exhibited strong non-neuronal tissue-specific expression patterns. CHRNA3, CHRNA5, and CHRNB4 were highly expressed in human colon and small intestine, and CHRNA4 was highly expressed in human liver. By comparing the epigenetic marks of CHRNA4 in human liver and hippocampus, we identified a novel liver-specific transcription start site (TSS) of CHRNA4. We further demonstrated that CHRNA4 was specifically transcribed in hepatocytes but not transcribed in hepatic sinusoids and stellate cells, and that transcription factors HNF4A and RXRA were likely upstream regulators of CHRNA4. Our findings suggest that CHRNA4 has distinct transcriptional regulatory mechanisms in human liver and brain, and that this tissue-specific expression pattern is evolutionarily conserved in mouse. Finally, we found that liver-specific CHRNA4 transcription was highly correlated with genes involved in the nicotine metabolism, including CYP2A6, UGT2B7, and FMO3. These genes were significantly down-regulated in liver cancer patients, whereas CHRNA4 is also significantly down-regulated in cancer-matched normal livers. CONCLUSIONS: Our results suggest important non-neuronally expressed nicotinic acetylcholine receptors in the human body. These non-neuronal expression patterns are highly tissue-specific, and are epigenetically conserved during evolution in the context of non-conserved DNA sequence.

What is really causing the obesity epidemic? A review of reviews in children and adults.

Obesity prevention is a public health priority and intervention strategies have focused primarily on healthy eating and physical activity in children and adults. To date, no review has systematically compiled and synthesised the scientific evidence from published review articles to determine whether there is clear consensus on the causes of obesity. A systematic review of the literature was conducted searching PubMed/Medline for narrative and systematic review articles published between January 1990 and October 2014 that examined the causes of obesity. In total, 12 of 65 articles met the inclusion criteria; 7 reviews focused on adults (1 systematic, 6 narrative) and 5 reviews on children (2 systematic, 3 narrative). The most popular cause of obesity identified in reviews of adult studies was "combined physical activity and diet" (3 of 7 studies), whereas the most popular cause specified in reviews of child studies was deemed "inconclusive" (2 of 5 studies). While a number of reviews have examined the causes of obesity, the methodology and conclusions varied widely, and few were conducted systematically. Currently, no consensus exists across published literature reviews regarding the primary cause of the obesity epidemic, and more research, particularly prospective studies using state-of-the-art measures, is warranted.

Policies for promotion of physical activity and prevention of obesity in adolescence.

Obesity rates among children and adolescents in developed countries have increased dramatically since the 1970s. During that same period, numerous secular changes have combined to reduce the demand for physical activity in day-to-day life, and many barriers to physical activity are now evident. As a consequence, most children and adolescents do not meet the accepted public health guidelines for physical activity. Accordingly, public health interventions are needed to increase physical activity in adolescence. Such interventions, if successfully implemented, can be expected to improve fitness and health as well as reduce the prevalence of overweight and obesity in young people. Promotion of physical activity in populations of children and adolescents will require comprehensive strategic planning and adoption of new policies in multiple societal sectors. This paper highlights nine initiatives that can address the problem of physical activity in children. The initiatives are to: establish comprehensive school physical activity programming; demand high quality physical education; require physical activity in early child care and education; require physical activity in afterschool programs; create equity in community resources; activate youth sports programs; re-normalize active transport to school; institutionalize clinic-based physical activity assessment and counseling; and build activity-friendly homes. A case will be made for comprehensive national and international strategic planning aimed at effective and large-scale implementation of these initiatives and tactics.

Triage in times of drug shortage.

This paper addresses the current drug shortage, and examines the ethics framework for dealing with drug shortages developed by our organization. That three-step allocation process and framework was published previously in this journal. Specifically, this paper offers a rationale and justification for the framework's second step, which involves a triage process aimed to ensure that the available drug supply is utilized effectively and ethically.

Osteoporosis and treatments in Japan: management for preventing subsequent fractures.

Prevalent fractures are major contributors to an increased risk of subsequent fractures, particularly in people with osteoporosis. While many studies have been conducted to assess the incidence of fracture in Japanese people with osteoporosis, far fewer have been conducted to assess the risk of subsequent fractures. This article reviews the morbidity, mortality, and risk of fracture in patients who are at high risk of subsequent fracture in Japan and the current treatment options available for these patients. Osteoporotic fractures in Japan are associated with high morbidity and mortality that result in significant financial and social costs. The rise in the proportion of elderly women in the Japanese population is contributing to a greater proportion of people with osteoporotic fractures and the high cost of osteoporosis. Although hip fractures have a significant effect on costs, a greater proportion of the Japanese population experience vertebral fractures. An increase in the incidence of vertebral fractures is concerning because preexisting vertebral fractures in older patients are associated with an increased risk of subsequent fractures. Hence, there is a clear rationale for pharmacological treatment of patients with prevalent vertebral fractures, or for those who are hospitalized or undergo surgery for osteoporotic fractures. Several pharmacological therapies are now available in Japan for the treatment of patients with osteoporosis. Understanding the consequences of subsequent fractures and the treatment options available for patients at high risk of subsequent fractures may contribute to clinical decision-making and improved outcomes for patients with osteoporosis.

From framework to the frontline: designing a structure and process for drug supply shortage planning.

Drug shortages are not new; they have been managed through conservation, procurement of alternatives, and redistribution of stock The Sandoz shortage in 2012 has caused a radical reduction of generic injectables. In Newfoundland and Labrador, our response has led to the development of the framework, structure, and process outlined in this paper. The efforts have eased the concerns of clinicians and leaders, as they are aware of the decision-making resource for situations of drug and technology shortage.

Artificial intelligence-driven approach for patient-focused drug development.

Patients' increasing digital participation provides an opportunity to pursue patient-centric research and drug development by understanding their needs. Social media has proven to be one of the most useful data sources when it comes to understanding a company's potential audience to drive more targeted impact. Navigating through an ocean of information is a tedious task where techniques such as artificial intelligence and text analytics have proven effective in identifying relevant posts for healthcare business questions. Here, we present an enterprise-ready, scalable solution demonstrating the feasibility and utility of social media-based patient experience data for use in research and development through capturing and assessing patient experiences and expectations on disease, treatment options, and unmet needs while creating a playbook for roll-out to other indications and therapeutic areas.

Healthcare professional perspectives on medication challenges in the post-stroke patient.

Background: Medications play an essential role in the management of patients who have experienced a stroke. Despite the recognised importance and widespread availability of secondary prevention guidelines, Irish research has shown a continuous failure to meet secondary prevention targets upon discharge. While complex interventions involving healthcare professionals (HCPs) such as Speech and Language Therapists (SLT), Occupational Therapists (OTs) and Pharmacists have been effective in combatting medication non-adherence, community multidisciplinary teams (MDTs) are not as well defined as in the acute setting, leading to wide variation in patient care. Therefore, this study aims to investigate the knowledge, attitudes, beliefs, and challenges faced by HCPs in the continuity of care post-discharge from a hospital stroke ward, and its impact on medication adherence. Methods: Semi-structured interviews and one focus group with HCPs were conducted, and data were analysed using Braun & Clarke's reflexive Thematic Analysis. Results: Fourteen HCPs (6 Pharmacy, 4 SLT, 4 OTs) participated in this study. Participants discussed their views under two main themes 1) continuity of care and 2) medication adherence. Sub-themes observed regarding continuity of care include management and organisation, interpersonal continuity, and informational continuity. Themes generated which impact medication adherence post-discharge include condition-related factors, medication-related factors, systemic and HCP factors, and patient-related factors. Discussion: Additional resources are required to bring community healthcare in line with the standard of acute care. Increased channels of communication must be established across contexts and disciplines, and may be achieved using interprofessional training through continuous professional development or third-level education, a more clearly defined community team structure, and discharge summaries completed to relevant quality standards. While suboptimal continuity of care was reported as contributing to medication non-adherence, HCPs also acknowledged the complexities of medication management post-stroke.

Social instability stress in adolescent male rats alters hippocampal neurogenesis and produces deficits in spatial location memory in adulthood.

The ongoing development of the hippocampus in adolescence may be vulnerable to stressors. The effects of social instability stress (SS) in adolescence (daily 1 h isolation and change of cage partner postnatal days 30-45) on cell proliferation in the dentate gyrus (DG) in adolescence (on days 33 and 46, experiment 1) and in adulthood (experiment 2) was examined in Long Evans male rats and compared to nonstressed controls (CTL). Additionally, in experiment 2, a separate group of SS and CTL rats was tested on either a spatial (hippocampal-dependent) or nonspatial (nonhippocampal dependent) version of an object memory test and also were used to investigate hippocampal expression of markers of synaptic plasticity. No memory impairment was evident until the SS rats were adults, and the impairment was only on the spatial test. SS rats initially (postnatal day 33) had increased cell proliferation based on counts of Ki67 immunoreactive (ir) cells and greater survival of immature neurons based on counts of doublecortin ir cells on day 46 and in adulthood, irrespective of behavioral testing. Counts of microglia in the DG did not differ by stress group, but behavioral testing was associated with reduced microglia counts compared to nontested rats. As adults, SS and CTL rats did not differ in hippocampal expression of synaptophysin, but compared to CTL rats, SS rats had higher expression of basal calcium/calmodulin-dependent kinase II (CamKII), and lower expression of the phosphorylated CamKII subunit threonine 286, signaling molecules related to synaptic plasticity. The results are contrasted with those from previous reports of chronic stress in adult rats, and we conclude that adolescent stress alters the ongoing development of the hippocampus leading to impaired spatial memory in adulthood, highlighting the heightened vulnerability to stressors in adolescence.

The role of elbow positioning on arthroscopic assessment of the long head of biceps tendon in the beach chair position.

BACKGROUND: Tendinopathy of the long head of biceps (LHB) tendon is a common cause of anterior shoulder pain and dysfunction. The extra-articular portion within the bicipital groove undergoes frequent load and friction during shoulder movements and pathology within this area is frequently missed during arthroscopic assessment. METHODS: We quantified the arthroscopically assessable length of tendon within the shoulder in 14 consecutive patients undergoing subpectoral biceps tenodesis. After biceps tenotomy at the superior labrum, the tagged tendon was maximally tensioned and marked at the biceps outlet with the elbow in extension and flexion. The distance in distance between the two were measured. RESULTS: Mean distance from the superior labral insertion of the biceps to the outlet was 16.4 ± 4.1 mm (range, 11-25). With tension on the biceps with elbow extension, the mean measurable distance was 31.3 ± 6.7 mm (range, 19-45). With elbow flexion, this increased to 39.5 ± 5.9 mm (range, 25-52). Mean increase in visible tendon length was 8.2 ± 4.3 mm (range, 5-21) (p = 0.002). CONCLUSION: Elbow flexion results in an average increase of 26.2% more extra-articular tendon visualized at arthroscopy. Therefore, we believe that elbow flexion is a useful adjunct, especially when performed in conjunction with techniques that pull the tendon into the joint, thus allowing for more complete arthroscopic assessment of the LHB, increasing detection of symptomatic biceps tendonitis. LEVEL OF EVIDENCE: Level IV.

Body image and associated factors among sexual minority men: A systematic review.

Research suggests that the risk of body image concerns among sexual minority men is high. Recent work has increasingly examined body image in relation to psychological, interpersonal, and behavioral constructs, but these findings have yet to be consolidated and critically examined to identify potential risk and protective factors. The present study sought to systematically review and synthesize published findings on body image among sexual minority men. A total of 136 articles published between January 2011 and March 2022 were included. Sexual minority men were generally reported to have more negative body image compared to heterosexual men, yet findings varied across body image constructs. In correlational work, body image was often examined in relation to disordered eating, mental health, internalization of appearance ideals, objectification, sexual behavior and relationships, gay community identification and discrimination, and health concerns (e.g., HIV, AIDS). Robust relationships emerged among body image and stigma variables, including internalized homophobia and harassment related to LGBTQ+ presentation and intersecting minority identities. Sociocultural, objectification, and minority stress theories were employed to interpret findings and to delineate future directions grounded in intersectional approaches. Additional work focused on the role of stigma and discrimination in the development of these concerns across the lifespan is needed.

Interproton distance determinations by NOE--surprising accuracy and precision in a rigid organic molecule.

The accuracy inherent in the measurement of interproton distances in small molecules by nuclear Overhauser enhancement (NOE) and rotational Overhauser enhancement (ROE) methods is investigated with the rigid model compound strychnine. The results suggest that interproton distances can be established with a remarkable level of accuracy, within a few percent of their true values, using a straight-forward data analysis method if experiments are conducted under conditions that support the initial rate approximation. Dealing with deviations from these conditions and other practical issues regarding these measurements are discussed.