Systematic review and meta-analysis of physical activity interventions to increase elementary children's motor competence: a comprehensive school physical activity program perspective.

BACKGROUND: Regular participation in physical activity (PA) benefits children's health and well-being and protects against the development of unhealthy body weight. A key factor in children's PA participation is their motor competence (MC). The comprehensive school physical activity program (CSPAP) framework offers a way to classify existing PA interventions that have included children's MC development and understand the potential avenues for supporting children's MC. However, there have been no systematic reviews or meta-analyses of PA interventions and their effects on the MC of elementary school children (aged 5-12 years) from a CSPAP perspective. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We searched seven electronic databases (PubMed/Medline, Embase, ERIC, SPORTDiscus, CINAHL, Web of Science, and PsycINFO) for articles on 29 November 2021. The CSPAP framework was used to categorize the different intervention approaches. This review was registered with PROSPERO (CRD42020179866). RESULTS: Twenty-seven studies were included in the review, and twenty-six studies were included in the meta-analysis. A wide range of PA intervention approaches (e.g., single component or multicomponent) within the context of the CSPAP framework appear to be promising pathways in enhancing children's MC. The results of the aggregate meta-analysis presented that effect sizes for the development of MC from pre-and post- intervention ranged from moderate to large (Hedges' g = 0.41-0.79). The analysis revealed that the predicted moderators, including study length, delivery agent, and study design, did not result in statistically significant moderate variations in MC outcomes. There was, however, considerable heterogeneity in study design, instruments, and study context, and studies were implemented in over 11 countries across diverse settings. CONCLUSIONS: This study uniquely contributes to the literature through its primary focus on the effectiveness of PA interventions on elementary children's MC. This review emphasizes the importance of customizing CSPAP to fit the specific characteristics of each school setting, including its environmental, demographic, and resource attributes. The effectiveness of CSPAP, particularly its physical education (PE) component, is significantly enhanced when these programs are adapted to address the unique needs of each school. This adaptation can be effectively achieved through targeted professional teacher training, ensuring that PE programs are not only contextually relevant but also optimized for maximum impact in diverse educational environments. Researchers and practitioners should pursue how to effectively translate the evidence into practice to better conceptualize CSPAPs designed for children's MC development.

Changing trajectory of daily physical activity levels among at-risk adolescents: influences of motivational mechanisms.

BACKGROUND: Guided by Self-Determination Theory (SDT), the purpose of this study was to determine changes in the 16-week moderate-to-vigorous physical activity (MVPA) trajectory of underserved adolescents who participated in the Connect through PLAY afterschool program intervention and the effects of changes in participating adolescents' intrinsic and autonomous extrinsic motivations on their MVPA trajectory over the 16-week intervention. METHODS: A subsample of 113 adolescents (56.64% female; 61.06% African American; average age = 11.29) provided complete data throughout the 16-week intervention were examined. Adolescents' objective daily MVPA was measured using 7- day accelerometer data. Changes in adolescents' intrinsic motivation and autonomous extrinsic motivation were assessed using subscales from the Intrinsic Motivation Inventory [1] and the Treatment Self-Regulation Questionnaire [2] respectively. A hierarchical linear model was built and tested to address the research aims. RESULTS: The results of hierarchical linear models showed that, on average, youth daily MVPA increased 6.36 minutes in each 8-week period. Intrinsic motivation change, but not autonomous extrinsic motivation, was a positive and significant level-2 predictor of daily MVPA changes. CONCLUSION: The findings provide significant evidence suggesting a benefit of integrating SDT-based approaches and further suggest that nurturing intrinsic motivation can be an effective approach to supporting youth daily MVPA in under-resourced afterschool programs. TRIAL REGISTRATION: Connect Through PLAY: A Staff-based Physical Activity Intervention for Middle School Youth (Connect). https://clinicaltrials.gov/ct2/show/NCT03732144 . Registered November 6th, 2018.

The influence of social support, social affiliation and intrinsic motivation for increasing underserved youth's physical activity: A social climate-based intervention study.

The purpose of this study was to investigate the influences of intrinsic motivation, social affiliation orientations and reciprocal social support for physical activity (PA) on underserved youths' afterschool period moderate-to-vigorous (MVPA) changing trajectories across the 16-week Connect through PLAY intervention, a social-motivational climate intervention. A total of 113 youth (61.06% African American, 56.64% girls) provided full data. Youths' intrinsic motivation, social affiliation orientations and social support were measured by youth responses to a set of surveys at baseline and post-intervention. Youths' afterschool period MVPA was measured using data from 7-day ActiGraph accelerometer wear at baseline, midpoint and post-intervention. Hierarchical linear modelling analysis found that youth daily afterschool period (3pm-6pm) MVPA increased, on average, 37.94 min across the 16-week intervention. Increases in intrinsic motivation, social affiliation orientations and social support were positive predictors of youth afterschool MVPA changing trajectory. The findings clarify the contributions that a social-motivational climate intervention can have on youth afterschool period MVPA through increasing youth intrinsic motivation, social affiliation and reciprocal social support.

Exploring South Korean Elementary School Classroom Teachers' Beliefs and Practices in Physical Education.

Physical education (PE) is beneficial for the development of elementary school-age children through its promotion of different educational learning outcomes, which in turn affects the long-term development of physically active lifestyles. In many countries, PE is taught by classroom teachers (CTs), who are thought to be in a unique position to positively impact students' learning. While a substantial body of studies examines the challenges that CTs encounter when teaching PE, less research has been directed towards gaining a comprehensive understanding of how CTs visualize PE and, in turn, how to promote various types of PE. The purpose of this study, therefore, was to explore elementary school CTs' beliefs about and practices in PE in South Korea. To achieve the research goal, a semi-structured face-to face interview with six CTs was performed to collect the qualitative data source, using the ground theory as an analysis method. Three themes emerged from these interviews concerning the CTs' beliefs in PE: (a) the importance of understanding students' characteristics, (b) the importance of centering internal perceptions in PE method, and (c) the importance of meaningful experiences. The results also identified two themes for teaching practices in PE that corresponded to CTs' beliefs: (a) crafting personalized instructional methods and (b) connecting PE experiences. This study lends important insights to future practices and research recommendations for CTs' PE teaching and teacher education programs.

Health-Related Fitness Levels among Title I Elementary School Students.

Over the past few decades, studies have emphasized improving children's health by increasing health-related fitness levels. Despite the known benefits of health-related fitness in youth, studies have also highlighted a lack of physical activity opportunities for children living in low-income households. The purpose of this study was to investigate the health-related fitness levels of students attending Title I (low-income) elementary schools. A total of 77 elementary students (50.6% female; Mage = 10.0, SD = 0.827) from two Title I elementary schools in the western United States completed the FitnessGram assessments of aerobic capacity, muscular strength and endurance, and flexibility. Descriptive statistics were used to identify the number of students in the Healthy Fitness Zone (HFZ) based upon the FitnessGram HFZ Performance Standards. Less than 17% of students achieved the HFZ for aerobic capacity and only 31.2% achieved the HFZ for upper body strength and endurance. Students performed better for abdominal strength and endurance and flexibility with 55.8% and 68.8% achieving the HFZ, respectively. The results of this study offer insights into the health-related fitness levels of a unique population, students attending Title I schools. School health professionals, including physical education teachers, need to be aware of existing disparities and make efforts to systematically intervene.

Effect of Blending Ratio and Temperature on CO2 Solubility in Blended Aqueous Solution of Monoethanolamine and 2-Amino-2-methyl-propanol: Experimental and Modeling Study Using the Electrolyte Nonrandom Two-Liquid Model.

This paper reports the newly measured experimental data for CO2 solubility in a blended aqueous solution of monoethanolamine (MEA) and 2-amino-2-methyl-propanol (AMP) at different amine mixing ratios (MEA/AMP/H2O = 9:21:70, 15:15:70, and 21:9:70 wt %) and working temperatures (323.15, 373.15, and 383.15 K). The successive substitution method was used for calculating the mole fractions of all molecules (four molecules) and electrolytes (three cations and four anions) from the equilibrium along with the material and charge balance equations (11 equations). The electrolyte nonrandom two-liquid (e-NRTL) model was used to investigate nonideality in the liquid phase. Using the abovementioned thermodynamic models, the partial pressures of CO2 in the gas phase, mole fractions of all components in the liquid phase, pH variations, heats of absorption, and cyclic capacities of CO2 according to the absorption/desorption temperature and the blending ratio of MEA/AMP were estimated.

Effective CO2 and CO Separation Using [M2(DOBDC)] (M = Mg, Co, Ni) with Unsaturated Metal Sites and Excavation of Their Adsorption Sites.

Isostructural [M2(DOBDC)(EG)2] (M = Mg, Co, Ni) frameworks are first synthesized by controlling the pH* in the reaction medium. Coordinated ethylene glycols form a hexagonal OH cluster, which works as a template to grow single crystals with high crystallinity. After the liberation of solvated molecules, [M2(DOBDC)] shows notably higher surface areas than the reported values and completely different CO2 and CO separation properties depending on the kinds of unsaturated metal. Therefore, breakthrough experiments using a CO2/CO mixed gas show that Mg-MOF has a longer breakthrough time for CO2 than for CO, whereas Co/Ni-MOFs have longer breakthrough times for CO than for CO2. Apart from CO2 and CO, other gases such as CH4, H2, and N2 were almost not adsorbed at all in these materials at 298 K. To reveal the role of unsaturated metal sites, CO2 and CO adsorption sites are unequivocally determined by single-crystal X-ray diffraction analysis. One of very interesting discoveries is that there are two CO2 and CO adsorption positions (sites A and B) in the hexagonal channels. Site A is the unsaturated metal center working as Lewis acidic sites, and site B is the secondary adsorption site located between two A sites. A close inspection of crystal structures reveals that unsaturated Co(II) and Ni(II) sites adsorb both CO2 and CO, whereas the unsaturated Mg(II) sites strongly capture only CO2, not CO. Density functional theory calculations elucidate the discrepancy in CO affinity: Co(II) and Ni(II) form strong π-back-donating bonds with CO via electron transfer from the d orbitals of the transition metals to the antibonding molecular orbitals of CO, whereas Mg(II) does not participate in electron transfer or orbital overlap with CO. This observation provides new insight into the synthesis of novel functional materials with high CO2/CO separation performance.

Chabazite-Type Zeolite Membranes for Effective CO2 Separation: The Role of Hydrophobicity and Defect Structure.

Chabazite (CHA)-type zeolites are promising for the separation of CO2 from larger molecules, such as N2 (relevant to postcombustion carbon capture) and CH4 (relevant to natural gas/biogas upgrading). In particular, the pore size of CHA zeolites (0.37 × 0.42 nm2) can recognize slight molecular size differences between CO2 (0.33 nm) and the larger N2 (0.364 nm) or CH4 (0.38 nm) molecules, thus allowing separation in favor of CO2 through CHA membranes. Furthermore, the siliceous constituents in the CHA zeolite can reduce the adsorption capacity toward the smaller H2O molecule (0.265 nm) and, thus, the H2O permeation rate. This is highly desirable for securing good molecular sieving ability with CO2 permselectivity in the presence of H2O vapor. Indeed, a siliceous CHA film obtained with a nominal Si/Al ratio of 100 (CHA_100) showed high CO2/N2 and CO2/CH4 separation performance, especially in the presence of H2O vapor; ∼13.4 CO2/N2 and ∼37 CO2/CH4 separation factors (SFs) at 30 °C. These SFs were higher than the corresponding values (∼5.2 CO2/CH4 SFs and ∼31 CO2/CH4 SFs) under dry conditions; such improvement could be ascribed to defect blocking by physisorbed water molecules. Finally, the contribution of molecular transport through zeolitic and nonzeolitic parts was quantitatively analyzed by combining information extracted from image processing of fluorescence confocal optical microscopy images with a one-dimensional permeation model. It appears that ∼19 and ∼20% of the total CO2 permeance for CHA_100 were reduced due to transport inhibition by the physisorbed water molecules on the membrane surface and defect, respectively.

Predictors of Malignancy in "Pure" Branch-Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas without Enhancing Mural Nodules on CT Imaging: A Nationwide Multicenter Study.

Background/Aims: Presence of enhanced mural nodules, which can be visualized using computed tomography (CT), is one of high-risk stigmata in branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs). Conversely, the absence of enhanced mural nodules on preoperative imaging does not exclude malignant risk. The present study aimed to investigate other morphological features as predictors of malignancy in "pure" BD-IPMNs without enhanced mural nodules on CT. Methods: This retrospective study included 180 patients with surgically confirmed "pure" BD-IPMNs of the pancreas and no enhanced mural nodules on preoperative CT. The study was conducted at 15 tertiary referral centers throughout South Korea. Univariate and multivariate analyses were used to identify significant predictors of malignancy. Results: BD-IPMNs with low-grade (n=84) or moderate-grade (n=76) dysplasia were classified as benign; those with high-grade dysplasia (n=8) or invasive carcinoma (n=12) were classified as malignant. The multivariate analysis revealed that cyst size ≥30 mm (odds ratio, 8.6; p=0.001) and main pancreatic duct diameter ≥5 mm (odds ratio, 4.1; p=0.01) were independent risk factors for malignancy in "pure" BD-IPMNs without enhanced mural nodules on CT. Endoscopic ultrasound detected enhanced mural nodules (6/82) that had been missed on CT, and two IPMNs with enhanced mural nodules were malignant. Conclusions: In patients with "pure" BD-IPMNs who have no enhanced mural nodules on CT, cyst size ≥30 mm and main pancreatic duct diameter ≥5 mm may be associated with malignancy.

CuY zeolite catalysts prepared by ultrasonication-assisted ion-exchange for oxidative carbonylation of methanol to dimethyl carbonate.

The influence of ultrasonication treatment on the catalytic performance of CuY zeolite catalysts was investigated for the liquid-phase oxidative carbonylation of methanol to dimethyl carbonate (DMC). The deammoniation method of NH4Y into HY zeolites was optimized and characterized by elemental analyzer, derivative thermogravimetry, Brunauer-Emmett-Teller (BET) analyzer, and powder X-ray diffractometry, revealing that the HY zeolite deammoniated at 400 °C presented the highest surface area, complete ammonium/proton ion exchange, and no structure collapse, rendering it the best support from all the prepared zeolites. CuY zeolites were prepared via aqueous phase ion exchange with the aid of ultrasonication. Upon ultrasonication, the Cu+ active centers were uniformly dispersed in the Y zeolites, penetrating the core of the zeolite particles in a very short time. In addition to enhancing the Cu dispersity, the ultrasonication treatment influenced the BET surface area, acid amount, Cu+/Cu2+ ratio, and also had a relatively small impact on the Cu loading. Consequently, adequate exposure to ultrasonication was able to increase the conversion rate of methanol into dimethyl carbonate up to 11.4% with a comparable DMC selectivity of 23.7%. This methanol conversion is 2.65 times higher than that obtained without the ultrasonication treatment.

An improved anonymous authentication scheme for roaming in ubiquitous networks.

With the evolution of communication technology and the exponential increase of mobile devices, the ubiquitous networking allows people to use our data and computing resources anytime and everywhere. However, numerous security concerns and complicated requirements arise as these ubiquitous networks are deployed throughout people's lives. To meet the challenge, the user authentication schemes in ubiquitous networks should ensure the essential security properties for the preservation of the privacy with low computational cost. In 2017, Chaudhry et al. proposed a password-based authentication scheme for the roaming in ubiquitous networks to enhance the security. Unfortunately, we found that their scheme remains insecure in its protection of the user privacy. In this paper, we prove that Chaudhry et al.'s scheme is vulnerable to the stolen-mobile device and user impersonation attacks, and its drawbacks comprise the absence of the incorrect login-input detection, the incorrectness of the password change phase, and the absence of the revocation provision. Moreover, we suggest a possible way to fix the security flaw in Chaudhry et al's scheme by using the biometric-based authentication for which the bio-hash is applied in the implementation of a three-factor authentication. We prove the security of the proposed scheme with the random oracle model and formally verify its security properties using a tool named ProVerif, and analyze it in terms of the computational and communication cost. The analysis result shows that the proposed scheme is suitable for resource-constrained ubiquitous environments.

Defect-Free Mixed-Matrix Membranes with Hydrophilic Metal-Organic Polyhedra for Efficient Carbon Dioxide Separation.

Defect-free mixed-matrix membranes (MMMs) were prepared by incorporating hydrophilic metal-organic polyhedra (MOPs) into cross-linked polyethylene oxide (XLPEO) for efficient CO2 separation. Hydrophilic MOPs with triethylene glycol pendant groups, which were assembled by 5-tri(ethylene glycol) monomethyl ether isophthalic acid and CuII ions, were uniformly dispersed in XLPEO without particle agglomeration. Compared to conventional neat XLPEO, the homogenous dispersion of EG3 -MOPs in XLPEO enhanced CO2 permeability of MMMs. Upon increasing the amount of EG3 -MOPs, the membrane performance such as CO2 /N2 selectivity was steadily improved because of unsaturated CuII sites at paddle-wheel units, which was confirmed by Cu K-edge XANES and TPD analysis. Therefore, such defect-free MMMs with unsaturated metal sites would contribute to enhance CO2 separation performance.

Security enhanced multi-factor biometric authentication scheme using bio-hash function.

With the rapid development of personal information and wireless communication technology, user authentication schemes have been crucial to ensure that wireless communications are secure. As such, various authentication schemes with multi-factor authentication have been proposed to improve the security of electronic communications. Multi-factor authentication involves the use of passwords, smart cards, and various biometrics to provide users with the utmost privacy and data protection. Cao and Ge analyzed various authentication schemes and found that Younghwa An's scheme was susceptible to a replay attack where an adversary masquerades as a legal server and a user masquerading attack where user anonymity is not provided, allowing an adversary to execute a password change process by intercepting the user's ID during login. Cao and Ge improved upon Younghwa An's scheme, but various security problems remained. This study demonstrates that Cao and Ge's scheme is susceptible to a biometric recognition error, slow wrong password detection, off-line password attack, user impersonation attack, ID guessing attack, a DoS attack, and that their scheme cannot provide session key agreement. Then, to address all weaknesses identified in Cao and Ge's scheme, this study proposes a security enhanced multi-factor biometric authentication scheme and provides a security analysis and formal analysis using Burrows-Abadi-Needham logic. Finally, the efficiency analysis reveals that the proposed scheme can protect against several possible types of attacks with only a slightly high computational cost.

Improving Biometric-Based Authentication Schemes with Smart Card Revocation/Reissue for Wireless Sensor Networks.

User authentication in wireless sensor networks is more difficult than in traditional networks owing to sensor network characteristics such as unreliable communication, limited resources, and unattended operation. For these reasons, various authentication schemes have been proposed to provide secure and efficient communication. In 2016, Park et al. proposed a secure biometric-based authentication scheme with smart card revocation/reissue for wireless sensor networks. However, we found that their scheme was still insecure against impersonation attack, and had a problem in the smart card revocation/reissue phase. In this paper, we show how an adversary can impersonate a legitimate user or sensor node, illegal smart card revocation/reissue and prove that Park et al.'s scheme fails to provide revocation/reissue. In addition, we propose an enhanced scheme that provides efficiency, as well as anonymity and security. Finally, we provide security and performance analysis between previous schemes and the proposed scheme, and provide formal analysis based on the random oracle model. The results prove that the proposed scheme can solve the weaknesses of impersonation attack and other security flaws in the security analysis section. Furthermore, performance analysis shows that the computational cost is lower than the previous scheme.

Efficient and Security Enhanced Anonymous Authentication with Key Agreement Scheme in Wireless Sensor Networks.

At present, users can utilize an authenticated key agreement protocol in a Wireless Sensor Network (WSN) to securely obtain desired information, and numerous studies have investigated authentication techniques to construct efficient, robust WSNs. Chang et al. recently presented an authenticated key agreement mechanism for WSNs and claimed that their authentication mechanism can both prevent various types of attacks, as well as preserve security properties. However, we have discovered that Chang et al's method possesses some security weaknesses. First, their mechanism cannot guarantee protection against a password guessing attack, user impersonation attack or session key compromise. Second, the mechanism results in a high load on the gateway node because the gateway node should always maintain the verifier tables. Third, there is no session key verification process in the authentication phase. To this end, we describe how the previously-stated weaknesses occur and propose a security-enhanced version for WSNs. We present a detailed analysis of the security and performance of our authenticated key agreement mechanism, which not only enhances security compared to that of related schemes, but also takes efficiency into consideration.

Development of an in vivo swine model of biliary dilatation-based direct peroral cholangioscopy.

BACKGROUND AND AIM: A reproducible in vivo swine model of bile duct dilation (BDD) was recently established and reported for preclinical testing of newly developed biliary devices or endoscopic techniques. The aim of the present study was to develop a more advanced large animal model in which it is possible to direct examination of the biliary tree. Methods Six mini pigs were prepared for the study. BDD models were first made by closure of the Vater's ampulla in all swine. Then endoscopic papillary balloon dilation (EPBD) was done in the animals. Feasibility of single-operator peroral cholangioscopy without assistance of accessories was evaluated using an ultra-slim upper endoscope in the animals. Results EPBD could be implemented using a dilation balloon catheter (10~13.5 mm) in all BDD models (6/6, 100%). Success rate of freehand direct insertion of an ultra-slim endoscope into the common bile duct was 100% (6/6), and access to the common hepatic duct with examination was possible using direct peroral cholangioscopy in five animals (5/6, 83.3%). None of the animals died. In the cholangioscopic examination, a bile duct polyp and a benign biliary stricture occurred naturally, respectively, in two of the six swine. Conclusion An in vivo swine model of biliary dilatation-based direct peroral cholangioscopy was established. This novel animal model may be useful for preclinical research of new materials or devices because direct visualization of the biliary tree is feasible.

An Improvement of Robust and Efficient Biometrics Based Password Authentication Scheme for Telecare Medicine Information Systems Using Extended Chaotic Maps.

Recently, numerous extended chaotic map-based password authentication schemes that employ smart card technology were proposed for Telecare Medical Information Systems (TMISs). In 2015, Lu et al. used Li et al.'s scheme as a basis to propose a password authentication scheme for TMISs that is based on biometrics and smart card technology and employs extended chaotic maps. Lu et al. demonstrated that Li et al.'s scheme comprises some weaknesses such as those regarding a violation of the session-key security, a vulnerability to the user impersonation attack, and a lack of local verification. In this paper, however, we show that Lu et al.'s scheme is still insecure with respect to issues such as a violation of the session-key security, and that it is vulnerable to both the outsider attack and the impersonation attack. To overcome these drawbacks, we retain the useful properties of Lu et al.'s scheme to propose a new password authentication scheme that is based on smart card technology and requires the use of chaotic maps. Then, we show that our proposed scheme is more secure and efficient and supports security properties.

An Improvement of Robust Biometrics-Based Authentication and Key Agreement Scheme for Multi-Server Environments Using Smart Cards.

In multi-server environments, user authentication is a very important issue because it provides the authorization that enables users to access their data and services; furthermore, remote user authentication schemes for multi-server environments have solved the problem that has arisen from user's management of different identities and passwords. For this reason, numerous user authentication schemes that are designed for multi-server environments have been proposed over recent years. In 2015, Lu et al. improved upon Mishra et al.'s scheme, claiming that their remote user authentication scheme is more secure and practical; however, we found that Lu et al.'s scheme is still insecure and incorrect. In this paper, we demonstrate that Lu et al.'s scheme is vulnerable to outsider attack and user impersonation attack, and we propose a new biometrics-based scheme for authentication and key agreement that can be used in multi-server environments; then, we show that our proposed scheme is more secure and supports the required security properties.

Predictors of malignancy in pure branch duct type intraductal papillary mucinous neoplasm of the pancreas: A nationwide multicenter study.

BACKGROUND/OBJECTIVES: Prediction of malignancy in patients with BD-IPMNs is critical for the management. The aim of this study was to elucidate predictors of malignancy in patients with 'pure' BD-IPMNs who had a main pancreatic duct (MPD) diameter of ≤5 mm according to the most recent international consensus criteria and in whom MPD involvement was excluded on postoperative histology. METHODS: We identified 177 patients with 'pure' BD-IPMNs based on preoperative imaging and postoperative histology from 15 tertiary referral centers in Korea. BD-IPMNs with low-grade (n = 72) and moderate-grade (n = 66) dysplasia were grouped as benign and BD-IPMNs with high-grade dysplasia (n = 10) and invasive carcinoma (n = 29) were grouped as malignancy. RESULTS: On univariate analysis, particular symptoms (jaundice and clinical pancreatitis), CT findings (cyst size > 3 cm, the presence of enhancing mural nodules) and EUS features (the presence of mural nodules, the mural nodule size > 5 mm) were significant risk factors predicting malignant BD-IPMNs. Multivariate analysis revealed that the cyst size > 3 cm (odds ratio = 9.9), the presence of enhancing mural nodules on CT (odds ratio = 19.3) and the mural nodule size > 5 mm on EUS (odds ratio = 14.9) were the independent risk factors for the presence of malignancy in BD-IPMNs (p < 0.001). CONCLUSIONS: The cyst size > 3 cm, the presence of enhancing mural nodules on CT, the mural nodule size > 5 mm on EUS are three independent predictors of malignancy in patients with 'pure' BD-IPMNs.