Prosthetic device and service satisfaction, quality of life, and functional performance in lower limb prosthesis clients.

OBJECTIVE: The aim of this study was to characterize the relationship between prosthetic device and service satisfaction, health-related quality of life (HRQOL), and functional movement in a diverse population of lower limb prosthesis users. METHODS: An online survey was conducted on individuals with lower limb amputation between September and October 2021. Sample validated questionnaires assessing demographic and clinical features, satisfaction, functional outcomes, and quality of life were analyzed using path analysis. RESULTS: Participants were 1736 individuals with lower limb amputation. Overall, 44% of participants reported dissatisfaction with prosthetic device, whereas 37% were dissatisfied with prosthetic service. Low functional mobility was reported by 58% of participants and 61% reported low HRQOL. Lower extremity functional status (ß = 0.55), HRQOL (ß = 0.08), Activities-specific Balance Scale (ß = 0.22), and modified fall efficacy scale (ß = -0.07) are significantly associated with prosthetic device satisfaction (P < 0.0005, R2 = 0.47). Satisfaction with provider service was significantly associated with lower extremity functional status (ß = 0.44) and balance confidence (ß = 0.18) (P < 0.0005, R2 = 0.34). CONCLUSION AND CLINICAL RELEVANCE: Civilians, veterans, and service members reported low functional mobility, low quality of life, and moderate levels of dissatisfaction with their lower extremity prosthetic device and provider service. Improvements in mobility, balance, quality of life, and fall efficacy may enhance device satisfaction. Functional mobility and balance improvements may increase ratings of provider service. This study provides feedback that may improve clinical decisions on lower limb prosthesis patient care.

Characterization of initial ankle-foot prosthesis prescription patterns in U.S. Service members following unilateral transtibial amputation.

Introduction: The purpose of this study was to explore relationships between patient-specific characteristics and initial ankle-foot prosthesis prescription patterns among U.S. Service members with unilateral transtibial limb loss. Methods: A retrospective review of health records identified 174 individuals with unilateral transtibial limb loss who received care at Walter Reed National Military Medical Center between 2001 and 2019. We examined patient-specific factors such as demographics, participant duty status at injury and amputation, amputation etiology, and timing between injury, amputation, and initial prescription. The type of first prescribed ankle-foot prosthesis was categorized as energy storing and return - nonarticulating, energy storing and return - articulating, or computer controlled. Results: Sex, amputation etiology, time from injury to initial prescription, and time from amputation to initial prescription differed by type of initial ankle-foot prosthesis prescription. Service members with shorter intervals between injury-initial prescription and amputation-initial prescription, and those injured by combat blast, were more likely to receive a non-articulating device. Incorporating sex, time from injury-initial prescription, time from amputation-initial prescription, and amputation etiology as predictors of prosthesis type, we were able to correctly classify 72% of all first prostheses prescribed. Discussion: Patient-specific characteristics such as sex, the time between injury-initial prescription, time from amputation-initial prescription and amputation etiology are essential characteristics that influence initial ankle-foot prosthesis prescription patterns in U.S. Service members.

Single-Leg Squat and Reported Pain in Collegiate Softball Pitchers.

Background: Single-leg squat (SLS) performance is related to altered mechanics related to injury during the windmill softball pitch; however, it is unknown if SLS kinematics differ between softball pitchers with and without upper extremity pain. Purpose/Hypothesis: The purpose of this study was to compare knee valgus, trunk rotation, trunk lateral flexion, and trunk flexion during an SLS in collegiate softball pitchers with and without self-reported upper extremity pain. It was hypothesized that those who reported upper extremity pain would show increased compensatory trunk and knee kinematics compared with those without pain. Study Design: Controlled laboratory study. Methods: A total of 75 collegiate softball players (mean age, 20.4 ± 1.7 years; mean height, 173.3 ± 7.7 cm; mean weight, 79.1 ± 11.6 kg) participated and were placed in pain (n = 20) or no-pain (n = 55) groups. Participants performed an SLS once per side. Kinematic data were collected at 100 Hz using an electromagnetic tracking system. A 2 (pain vs no pain) × 2 (descent vs ascent) × 2 (drive leg vs stride leg) mixed-design multivariate analysis of variance with Wilks lambda distribution was used to determine differences in drive-leg and stride-leg lower body mechanics between the descent and ascent phases of the SLS between the pitchers in the current study with and without pain. Results: There was no significant effect in the 3-way interaction between upper extremity pain, side, and phase (Λ = 0.960; F[4, 70] = 0.726; P = .577; η2 = 0.04). However, there were large effects for the phase × side interaction (Λ = 0.850; P = .021; η2 = 0.150). There was a main effect of phase (Λ = 0.283; P < .001; η2 = 0.717). Conclusion: Study findings indicated that SLS mechanics do not differ between collegiate softball pitchers with and without reported upper extremity pain. Drive-leg mechanics showed more stability in the SLS than stride-leg mechanics. Clinical Relevance: Softball pitchers are at risk of upper extremity injury. It is important to identify mechanisms that may lead to pain in order to mitigate the risk of injury.

Tactical vests worn by law enforcement: is this improving stability for optimal job performance?

Objectives. The purpose of this study was to determine whether equipped tactical vests would improve postural stability of law enforcement officers (LEOs) versus a duty belt or without either condition. Methods. Volunteers were police officers (n = 25, 22 males, three females; age 42.4 ± 3.2 years; weight 101.65 ± 19.4 kg; height 178.92 ± 8.2 cm). The Institutional Review Board approved the investigation. A Bertec posturography plate (Bertec Inc., USA) determined four center of pressure (CoP) scores - eyes open stable surface (EOSS), eyes closed stable surface (ECSS), eyes open perturbed surface (EOPS), eyes closed perturbed surface (ECPS) - and four limit of stability (LoS) scores - frontal plane (LoSF), posterior plane (LoSP), left sagittal plane (LoSL), right sagittal plane (LoSR). Results. A repeated-measures multivariate analysis of variance (MANOVA) demonstrated no statistical difference within subject group CoP scores EOSS (p = 0.723), ECSS (p = 0.252), EOPS (p = 0.079) and ECPS (p = 0.137). Comparing between groups, the tactical vest demonstrated significance over the other CoP group conditions with ECPS (p = 0.001). The duty belt group showed significance with ECSS (p = 0.001). LoS variables indicated no significant results between groups. Conclusion. Tactical vests demonstrated improvements in ECPS scores (p = 0.001) compared to either group.

Impact on social capital and learning engagement due to social media usage among the international students in the U.S.

International students who pursue their academic goals in United States are prone to difficulties when attempting to build social resources and adjust to the new culture. Social media is a practical means of connection due to its ease of use and accessibility. Previous research has indicated contradictory effects of social media use on academic engagement. In addition to the direct effect, this research examined social media use influences on international students' learning engagement by mediating social capital and cultural adjustment. A total of 209 international students completed a web-based survey distributed via e-mail and social media between November 2021 and May 2022. Data were analyzed using Structural Equation Model. Results showed that only purposely using social media to collaborate with learning counterparts or materials directly improves international students' learning engagement. Other uses of social media (e.g., expanding new resources, solidifying close relationships) have no significant direct effects. Nonetheless, they are essential to improving levels of learning engagement via the mediation of bridging capital (social resources attributed to expanding relationships) and students' cultural adjustment in the U.S. International students' bonding capital (social resources available through trustworthy relationships) and home cultural retention showed little direct or indirect effects on learning engagement. This study recognizes the importance of social resources and cultural adjustment for international students. Also, this study provides valuable information to educators and administrators, as there is a need to identify the underlying mechanisms to contribute feasible learning intervention approaches and alleviate negative effects for international students.

Single-Leg Squat Compensations Are Associated With Softball Pitching Pathomechanics in Adolescent Softball Pitchers.

BACKGROUND: A lack of lumbopelvic-hip complex (LPHC) stability is often associated with altered pitching mechanics, thus increasing pain and injury susceptibility. The single-leg squat (SLS) is a simple diagnostic tool used to examine LPHC stability. PURPOSE: To examine the relationship between trunk compensatory kinematics during the SLS and kinematics at foot contact during the windmill pitch. STUDY DESIGN: Descriptive laboratory study. METHODS: Participants included 55 youth and high school softball pitchers (mean age, 12.6 ± 2.2 years; height, 160.0 ± 11.0 cm; weight, 60.8 ± 15.5 kg). Kinematic data were collected at 100 Hz using an electromagnetic tracking device. Participants were asked to complete an SLS on each leg, then throw 3 fastballs at maximal effort. Values of trunk flexion, trunk lateral flexion, and trunk rotation at peak depth of the SLS were used as the dependent variables in 3 separate backward-elimination regression analyses. Independent variables examined at foot contact of the pitch were as follows: trunk flexion, trunk lateral flexion, trunk rotation, center of mass, stride length, and stride knee valgus. RESULTS: The SLS trunk rotation regression (F(1,56) = 4.980, P = .030) revealed that trunk flexion predicted SLS trunk rotation (SE = 0.068, t = 2.232, P = .030) and explained approximately 7% of the variance in SLS trunk rotation (R 2 = 0.083, adjusted R 2 = 0.066). The SLS trunk flexion regression (F(1,56) = 5.755, P = 0.020) revealed that stride knee valgus significantly predicted SLS trunk flexion (SE = 0.256, t = 2.399, P = .020) and explained approximately 8% of variance in SLS trunk flexion (R 2 = 0.095, adjusted R 2 = 0.078). CONCLUSION: Additional trunk rotation and trunk flexion at peak depth of the SLS showed increased knee valgus and trunk flexion at foot contact of the pitch, both of which indicate poor LPHC stability during the softball pitch and may increase the potential for injury. CLINICAL RELEVANCE: Players and coaches should implement SLS analyses to determine their players' risk for injury and compensation due to poor core stability.

Trends in alcohol intoxication among native and immigrant youth in Sweden, 1999-2017: A comparison across family structure and parental employment status.

BACKGROUND: Developing a better understanding of drinking patterns across immigrant generations and how these change over time is important for the development of effective alcohol polices. This study investigates the direction and rate of change in youth alcohol intoxication over time, based on immigrant status, and by family structure and parental employment status. METHOD: The study is based on eight nationally representative school surveys conducted by the Swedish National Council for Crime Prevention between 1999 and 2017, with a combined sample of 50,657 adolescents. Group by time interactions were examined to compare rates of change of alcohol intoxication over time across immigrant generations. RESULTS: The results show a decreasing trend in alcohol intoxication among both first and second generation immigrant youth, and also among immigrant youth across different family structures and parental employment statuses. The results also show that the decrease in alcohol intoxication over time is greater for youths born abroad and for youths with two immigrant parents than for native Swedes, and that the decrease over time is greater for youths from intact families than for native Swedish youths from non-intact families and youths with one immigrant parent. CONCLUSION: Native and first- and second-generation immigrant youth may differ substantially from one another in many ways, and may therefore manifest different patterns of drinking behaviours. From a policy and prevention perspective, the data in this study imply that native youths and youths with one immigrant parent should be a central target group for alcohol prevention policy in Sweden.

Kinematic Differences Exist Between the Fastball, Changeup, Curveball, and Dropball Pitch Types in Collegiate Softball Pitchers.

BACKGROUND: A majority of softball literature focuses on the mechanics associated with pain and injury within a single pitch type per study; however, the generalizability of these findings is unknown since a kinematic comparison has yet to be performed between pitch types. Understanding kinematic differences between pitch types can be used to identify risk factors for injury, improve safety guidelines, and improve performance by linking specific mechanics with desired pitch outcomes. HYPOTHESIS/PURPOSE: The purpose of this study was to compare kinematics between the fastball, changeup, curveball, and dropball pitch types in collegiate softball pitchers. It was hypothesized that there would be significant kinematic differences between pitch types. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 28 female collegiate softball pitchers pitched 3 trials of each pitch type to a catcher at regulation distance. Pitch speed, stride length, trunk extension, trunk rotation, trunk lateral flexion, elbow flexion, and center of mass for each trial were calculated using an electromagnetic motion capture system and were averaged for analysis. A 1-way analysis of variance (ANOVA) was used to investigate pitch speed differences between the 4 pitch types. A 4 (pitch type) × 5 (event) within-athlete multivariate ANOVA was also used to determine kinematic differences. RESULTS: The results revealed a significant difference in pitch speed between pitch types; a pitch type main effect for trunk extension, trunk rotation, trunk lateral flexion, and center of mass; and an event main effect for all variables except stride length. The results also revealed a pitch type by event interaction for trunk flexion, trunk lateral flexion, and center of mass. Specifically, the dropball type had less trunk extension than the fastball at all pitching events. Similarly, the curveball type had a more posteriorly shifted center of mass than the dropball at the last 3 pitching events of foot contact, ball release and follow-through. CONCLUSION: Significant kinematic differences exist between pitch types, but these differences may be necessary to execute desired pitch outcomes. CLINICAL RELEVANCE: This is the first study to analyze kinematic differences between pitch types in softball pitchers. Understanding the effects of different pitch types on kinematic parameters may enhance injury prevention and performance strategies for softball pitchers.

Glenohumeral and Hip Range of Motion in Youth Softball Athletes.

The purpose of this study was to compare measures of bilateral shoulder and hip range of motion (ROM) between youth softball pitchers and position players. Fifty-two youth softball athletes (12.7±2.1 yrs.; 160.28±10.98 cm; 59.31±15.07 kg) participated. Bilateral hip and shoulder ROM were measured among pitchers (n=29) and position players (n=23). A 2 (pitcher/position player) × 2 (dominant/non-dominant) ANOVA was performed for both internal and external rotation ROM for the shoulder and hip. Paired sample t-tests were also conducted to examine side-to-side differences in total ROM. Data revealed a significant interaction between position and side dominance. Specifically, position players have significantly more non-dominant shoulder external rotation ROM (106.92°± 9.14°) than pitchers (100.12°± 11.21°). There were no significant differences between throwing and non-throwing sides. It is important that coaches and clinicians are aware of these adaptations between overhand and underhand throwing in order to properly develop conditioning and rehabilitation programs to alleviate injury susceptibility and cater to position-specific demands. Additionally, the current data suggest many of the functional adaptations seen within older populations are not fully developed until after youth.

Predicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions.

BACKGROUND: Pharmacies have much to contribute to the health of people who inject drugs (PWID) and to community efforts in HIV and hepatitis C (HCV) prevention through syringe access. However, little is known about what predicts pharmacy syringe sales without a prescription. OBJECTIVE: To identify factors predicting pharmacy syringes sales to PWID. METHODS: A hybrid staggered online survey of 298 Indiana community pharmacists occurred from July-September 2016 measuring pharmacy policy, practice, and pharmacist perceptions about syringe sales to PWID. Separate bivariate logistical regressions were followed by multivariable logistic regression to predict pharmacy syringe sales and pharmacist comfort dispensing syringes to PWID. RESULTS: Half (50.5%) of Indiana pharmacies sold syringes without a prescription to PWID. Pharmacy syringe sales was strongly associated with pharmacist supportive beliefs about syringe access by PWID and their comfort level selling syringes to PWID. Notably, pharmacies located in communities with high rates of opioid overdose mortality were 56% less likely to sell syringes without a prescription than those in communities with lower rates. Pharmacist comfort dispensing syringes was associated with being male, working at a pharmacy that sold syringes to PWID and one that stocked naloxone, having been asked about syringe access by medical providers, and agreement that PWID should be able to buy syringes without a prescription. CONCLUSIONS: As communities with high rates of opioid overdose mortality were less likely to have pharmacies that dispensed syringes to PWID, a concerted effort with these communities and their pharmacies should be made to understand opportunities to increase syringe access. Future studies should explore nuances between theoretical support for syringe access by PWID without a prescription and actual dispensing behaviors. Addressing potential policy conflicts and offering continuing education on non-prescription syringe distribution for pharmacists may improve comfort distributing syringes to PWID, and therefore increase pharmacy syringe sales.

Motivational Interviewing Skills in Health Care Encounters (MISHCE): Development and psychometric testing of an assessment tool.

BACKGROUND: Motivational interviewing (MI) has demonstrated a significant impact as an intervention strategy for addiction management, change in lifestyle behaviors, and adherence to prescribed medication and other treatments. Key elements to studying MI include training in MI of professionals who will use it, assessment of skills acquisition in trainees, and the use of a validated skills assessment tool. OBJECTIVES: The purpose of this research project was to develop a psychometrically valid and reliable tool that has been designed to assess MI skills competence in health care provider trainees. The goal was to develop an assessment tool that would evaluate the acquisition and use of specific MI skills and principles, as well as the quality of the patient-provider therapeutic alliance in brief health care encounters. METHODS: To address this purpose, specific steps were followed, beginning with a literature review. This review contributed to the development of relevant conceptual and operational definitions, selecting a scaling technique and response format, and methods for analyzing validity and reliability. Internal consistency reliability was established on 88 video recorded interactions. The inter-rater and test-retest reliability were established using randomly selected 18 from the 88 interactions. The assessment tool Motivational Interviewing Skills for Health Care Encounters (MISHCE) and a manual for use of the tool were developed. RESULTS: Validity and reliability of MISHCE were examined. Face and content validity were supported with well-defined conceptual and operational definitions and feedback from an expert panel. Reliability was established through internal consistency, inter-rater reliability, and test-retest reliability. The overall internal consistency reliability (Cronbach's alpha) for all fifteen items was 0.75. MISHCE demonstrated good inter-rater reliability and good to excellent test-retest reliability. CONCLUSION: MISHCE assesses the health provider's level of knowledge and skills in brief disease management encounters. MISHCE also evaluates quality of the patient-provider therapeutic alliance, i.e., the "flow" of the interaction.

Pharmacist self-reported antidepressant medication counseling.

OBJECTIVES: To identify the extent of pharmacists' self-reported antidepressant counseling (SRAC) and to identify factors that may affect pharmacists' decisions to provide antidepressant counseling. DESIGN: Cross-sectional study. SETTING: Alabama community pharmacies in 2011. PARTICIPANTS: Full-time pharmacists from 600 community pharmacies. INTERVENTION: Self-administered survey; three mail contacts with alternate electronic surveys were used. MAIN OUTCOME MEASURES: Pharmacists' SRAC behavior and its relationship with pharmacists' illness perceptions of depression, self-efficacy, and organizational and environmental influences. RESULTS: 600 surveys were sent; 22 were undeliverable, 1 was partially completed (<80% questions answered), and 118 were completed (20.6% overall response rate). Pharmacists reported low rates of involvement in antidepressant counseling; 61% reported assessing patient knowledge and understanding of depression, and 36% discussed options for managing adverse effects with no more than a few patients. More than one-quarter (28.6%) never asked patients whether they had barriers to taking antidepressants. Pharmacists' perceptions regarding consequences, control/cure, and the episodic nature of depression, as well as their self-efficacy, had significant relationships ( P < 0.05) with pharmacists' involvement in antidepressant counseling. CONCLUSION: Low rates of pharmacists' involvement in antidepressant counseling were reported. Pharmacists must become more involved in counseling patients about their antidepressant medications and overcoming barriers preventing greater involvement.

Examining impulse-variability in overarm throwing.

The purpose of this study was to examine variability in overarm throwing velocity and spatial output error at various percentages of maximum to test the prediction of an inverted-U function as predicted by impulse-variability theory and a speed-accuracy trade-off as predicted by Fitts' Law Thirty subjects (16 skilled, 14 unskilled) were instructed to throw a tennis ball at seven percentages of their maximum velocity (40-100%) in random order (9 trials per condition) at a target 30 feet away. Throwing velocity was measured with a radar gun and interpreted as an index of overall systemic power output. Within-subject throwing velocity variability was examined using within-subjects repeated-measures ANOVAs (7 repeated conditions) with built-in polynomial contrasts. Spatial error was analyzed using mixed model regression. Results indicated a quadratic fit with variability in throwing velocity increasing from 40% up to 60%, where it peaked, and then decreasing at each subsequent interval to maximum (p < .001, η2 = .555). There was no linear relationship between speed and accuracy. Overall, these data support the notion of an inverted-U function in overarm throwing velocity variability as both skilled and unskilled subjects approach maximum effort. However, these data do not support the notion of a speed-accuracy trade-off. The consistent demonstration of an inverted-U function associated with systemic power output variability indicates an enhanced capability to regulate aspects of force production and relative timing between segments as individuals approach maximum effort, even in a complex ballistic skill.

Psychometric Analysis of the JSPE Nursing Student Version R: Comparison of Senior BSN Students and Medical Students Attitudes toward Empathy in Patient Care.

Background. Empathic communication skills are critical to providing high-quality nursing care to holistically understand the patient's perspective. A survey research design was used to address the research questions discussed in this study. Data consisted of responses from nursing students attending accredited programs in the southeastern United Sates using the Jefferson Scale of Physician Empathy Nursing Student Version R (JSPE-R). Findings. Comparisons of the total scores from JSPE Versions S and R yielded similar means and standard deviations with 115 and 114.57, respectively, and standard deviations of 10 and 10.94, respectively. The results of a one-sample t-test failed to render statistical significance (t = -1.22, P = .224), indicating that the overall attitudes of nursing students and medical students are similar. The 25th, 50th, and 75th percentiles and overall instrument reliability were also comparable. Conclusions. This paper supports the emergence of alternative factor analysis structures as applied to nursing students through statistical progression from exploratory factor analysis to confirmatory structures. Implications for practice explore the utility of empathy instruments in nurse education, such as empathy progression through curriculum. As nursing educators, the utility of development of instruments to measure effectiveness of teaching strategies and pedagogy for empathy enhancement in practice is important.

Program evaluation of nursing school instruction in measuring students' perceived competence to empathetically communicate with patients.

The purpose of this survey study was to examine the relationship between senior baccalaureate nursing students' perceptions of their nursing program effectiveness in teaching them to empathetically communicate with patients and family members and perceived competence in empathetic communication. Nursing program components and students' perceived competence were divided into five areas: academic exposure to patient care situations, curricular emphasis during the nursing program, perceived program effectiveness, academic sources, and perceived competence. Outcomes of the regression analysis showed that the primary factors related to perceived competence were academic exposure, curricular emphasis, and program effectiveness. Data from this study reinforce the need for greater attention to be focused on clinical instruction, maximization of faculty input and feedback, and reinforcement of theoretical tenets that are taught academically.

The influence of habitual exercise training and meal form on diet-induced thermogenesis in college-age men.

This study compared type of habitual exercise and meal form on diet-induced thermogenesis (DIT) in 29 men age 19-28 yr. Resting metabolic rate (RMR) and DIT response to solid-meal (bar) vs. liquid-meal (shake) ingestion were measured via indirect calorimetry; classifications were sedentary (n = 9), endurance trained (n = 11), or resistance trained (n = 9). Height, weight, and body composition (using bioelectrical impedance) were measured for each subject. Energy expenditure was determined before and every 30 min after meal consumption for 210 min. RMR was significantly (p = .045) higher in the endurance- and resistance-trained groups. However, when expressed per kilogram fat-free mass (FFM; relative RMR), differences were not significant. Both DIT (kcal/min) and relative DIT (kcal · min-1 · kg FFM-1) significantly increased with time (p < .0001) from RMR for each meal form. There was no significant exercise-group effect on DIT or relative DIT. There was a significant (p = .012) effect of meal form on DIT; shakes elicited a higher DIT. This significant difference was not found for relative DIT. There was a significant interaction between group and meal form for DIT (p = .008) and relative DIT (p < .0001). Shakes elicited a significantly greater DIT (p = .0002) and relative DIT (p = .0001) in the resistance-trained group. In the sedentary group, relative DIT from shakes was significantly lower than from bars (p = .019). In conclusion, habitual exercise appears to increase RMR, and meal form may impart changes in relative DIT depending on exercise status.

The relationship between resting heart rate variability and heart rate recovery.

OBJECTIVE: There is limited research available regarding a possible relationship between resting heart rate variability (HRV) and post-exercise heart rate recovery (HRR). The aim of this study was to examine the relationship between resting HRV and HRR after maximal exercise. METHODS: Sixty-six college age men participated in this study. HRV was measured in a supine position before and for 30 min after a maximal exercise test on a treadmill. HRV was assessed in the time (i.e., SDNN) and frequency (i.e., normalized HF power [HFnu] and normalized LF:HF ratio [LFnu:HFnu]) domains. Heart rate was recorded at maximal exercise (MHR), and at 1- (HR1) and 2- (HR2) min of the cool-down recovery period. HRR was determined from the difference between MHR and HR1 (HRR1) and the difference between MHR and HR2 (HRR2). RESULTS: No significant relationship was found between resting HRV and HRR1 or HRR2. However, SDNN was significantly inversely correlated to MHR (P < 0.05), and HFnu was significantly inversely correlated to MHR (P < 0.01), HR1 (P < 0.01), and HR2 (P < 0.05). Furthermore, MHR accounted for the greatest variation in both SDNN and HFnu (P < 0.05). INTERPRETATION: Therefore, the HRV may not be related to the recovery of HR expressed as a slope (i.e., HRR) within 2 min following a maximal exercise test. This is possibly due to a significant inverse relationship between HRV and MHR, HR1 and HR2 post-maximal exercise.

Synthetic routes to pyrrolizine-1,5-dione derivatives by flash vacuum pyrolysis of amidomethylene derivatives of Meldrum's acid.

Methoxymethylene Meldrum's acid 1 reacts with 5- and 6-membered lactams in refluxing acetonitrile to give the N-substituted products 9-15. If the reactions are continued for extended times, the Meldrum's acid derivatives decompose to provide enamidoesters e.g. 22-24. Flash vacuum pyrolysis of the 5-membered ring products 9-13 provides reasonable yields of the fused pyrrolones 31-35. The constitution of the products is supported by X-ray crystal structures of 10, 12, 19, 32 and 34.

School gardens: an experiential learning approach for a nutrition education program to increase fruit and vegetable knowledge, preference, and consumption among second-grade students.

OBJECTIVE: To examine the effects of a school garden on children's fruit and vegetable knowledge, preference, and consumption. DESIGN: Self-report questionnaires, interview-style taste and rate items, lunchroom observations. SETTING: An elementary school. PARTICIPANTS: Second-grade students (n = 115). INTERVENTION: Participants were assigned to one of 3 groups: (1) nutrition education and gardening (NE+G) treatment group, (2) nutrition education only (NE) treatment group, or (3) control group (CG). Both treatment groups received classroom instruction, and the NE+G group also received a school gardening experience. MAIN OUTCOME MEASURES: Fruit and vegetable knowledge, preference, and consumption. ANALYSIS: Analyses of variance (alpha = .05). RESULTS: Participants in the NE+G and NE treatment groups exhibited significantly greater improvements in nutrition knowledge and taste ratings than did participants in the CG. Moreover, the NE+G group was more likely to choose and consume vegetables in a lunchroom setting at post-assessment than either the NE or CG groups. CONCLUSIONS AND IMPLICATIONS: School gardens as a component of nutrition education can increase fruit and vegetable knowledge and cause behavior change among children. These findings suggest that school administrators, classroom teachers, and nutrition educators should implement school gardens as a way to positively influence dietary habits at an early age.

Physicians' expectations of pharmacists.

Physicians' current and future expectations of and current experiences with pharmacists were studied. A three-part questionnaire was mailed to 2600 practicing physicians in California, including office-based practitioners, hospital-employed (nonhouse staff) physicians, and medical residents. A 5-point Likert scale was used to measure respondents' level of agreement with statements in each part; part 1 dealt with current expectations, part 2 with current experiences, and part 3 with future expectations. Respondents were asked to confirm their practice setting (office-based, hospital-based, medical resident, or other) and to indicate the number of years since graduation from medical school. The mean values of physician agreement with each statement were reported. There was neither strong agreement nor strong disagreement with any statement regarding physicians' current and future expectations of and current experiences with pharmacists. There was no correlation between practice setting and level of agreement with statements in any part of the questionnaire. There was a correlation between the number of years since graduation from medical school and the level of agreement with statements about current and future expectations; in both cases, those physicians who graduated from medical school less than 10 years ago had higher expectations of pharmacists than those who graduated 10 or more years ago. Overall, physicians do not know what to expect of pharmacists. Physicians' expectations of pharmacists were most strongly correlated with the number of years since graduation from medical school and least strongly correlated with physicians' practice setting.