Assessing the effectiveness of a naturally occurring population-level physical activity intervention for children.

OBJECTIVES: The aim of the study was to assess the impact of a recreation access pass on grade 5 children's physical activity (PA) levels. STUDY DESIGN: This is a pre-post evaluation of a population-level community-based intervention. METHODS: All grade 5 students in (London, Ontario, Canada) were invited to participate in the [ACT-i-Pass] program (G5AP) in May 2014. A total of 643 children completed surveys, that included Physical Activity Questionnaire for Children (PAQ-C), at baseline (October 2014) and 6-month follow-up (April 2015). Difference in the means t-test compared PAQ-C scores between baseline and follow-up for the sample and subgroups. Multiple regression analysis tested associations between change in PAQ-C scores and intrapersonal-, interpersonal-, and physical environment-level variables. RESULTS: PA increased significantly from baseline to 6-month follow-up. Girls, visible minorities, immigrants, and children with low parental support experienced significant increases in PA. Regression found girls benefitted from the G5AP significantly more than boys, and lower parental support is related to increases in PA. CONCLUSION: The findings indicate that collaboratively developed, community-based interventions can significantly increase children's PA levels, particularly among subgroups with traditionally lower PA. The pre-post evaluation of this community-based intervention provides useful evidence for developing policies and programs aimed at making population-level improvements in children's PA levels.

Inequitable health service use in a Canadian paediatric population: A cross-sectional study of individual- and contextual-level factors.

BACKGROUND: Health service use may be influenced by multilevel predisposing, enabling, and need factors but is equitable when driven by need. The study's objectives were as follows: (a) to investigate residential context's effect on child health service use and (b) to examine inequity of child health service use by testing for effect measure modification of need factors. METHODS: The sample of 1,451 children was from a prenatal cohort recruited from London, Ontario, between 2002 and 2004, with follow-up until children were toddler/preschooler-aged. Individual-level data were linked by residential address to neighbourhood contextual-level data sourced from Statistics Canada. Multilevel logistic regression modelled factors associated with child health service use. Interaction terms were included in the model to test for effect measure modification of need factors by predisposing and enabling factors. RESULTS: Contextual-level factors were not associated with child health service use. Maternal parity and nativity to Canada modified the effect of the need factor, paediatric health condition, on health service use. Health condition's effect was lowest in children of Canadian-born mothers with one child only (OR = 1.58, p = .04) and highest in children of Canadian-born mothers with three or more children (OR = 3.52, p < .01). Further, its effect was higher in children of Canadian-born mothers compared to children of mothers who migrated to Canada; however, odds ratios were not statistically significant for the latter. CONCLUSIONS: Results may inform future investigation of the potential inequity of health service use for subgroups of children whose mothers are of lower parity and not Canadian-born. An understanding of these inequities may inform future healthcare policy and care for paediatric populations.

Synthesis of a new element with atomic number Z = 117.

The discovery of a new chemical element with atomic number Z=117 is reported. The isotopes (293)117 and (294)117 were produced in fusion reactions between (48)Ca and (249)Bk. Decay chains involving 11 new nuclei were identified by means of the Dubna gas-filled recoil separator. The measured decay properties show a strong rise of stability for heavier isotopes with Z > or = 111, validating the concept of the long sought island of enhanced stability for superheavy nuclei.

Interfacial interactions between Np(V) and manganese oxide minerals manganite and hausmannite.

Manganese oxides, present as minor phases in the vadose zone, have been previously shown to sequester large quantities of plutonium under environmental conditions. We are now continuing these studies with Np(V). Sorption onto manganite (MnOOH) and hausmannite (Mn3O4) at solid-to-solution ratios of 2.5-3.3 mg/mL has been studied as a function of neptunium concentration and pH. The sorption of Np increased as a function of pH for both minerals, attaining a maximum at neutral pH, and then decreased with increasing alkalinity. X-ray absorption fine structure spectroscopy (XAFS), taken at the Np L(III)-edge, has been used to determine the oxidation state of the sorbed Np. Our experimental results indicate reduction of the Np(V) because of interaction with the X-ray beam. These findings significantly impact the interpretation of results reported elsewhere on Np(V) investigated though the use of high-intensity X-ray beams.

Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model.

OBJECTIVE: In this study, we tested an expanded model of Kanter's structural empowerment, which specified the relationships among structural and psychological empowerment, job strain, and work satisfaction. BACKGROUND: Strategies proposed in Kanter's empowerment theory have the potential to reduce job strain and improve employee work satisfaction and performance in current restructured healthcare settings. The addition to the model of psychological empowerment as an outcome of structural empowerment provides an understanding of the intervening mechanisms between structural work conditions and important organizational outcomes. METHODS: A predictive, nonexperimental design was used to test the model in a random sample of 404 Canadian staff nurses. The Conditions of Work Effectiveness Questionnaire, the Psychological Empowerment Questionnaire, the Job Content Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables. RESULTS: Structural equation modelling analyses revealed a good fit of the hypothesized model to the data based on various fit indices (chi 2 = 1140, df = 545, chi 2/df ratio = 2.09, CFI = 0.986, RMSEA = 0.050). The amount of variance accounted for in the model was 58%. Staff nurses felt that structural empowerment in their workplace resulted in higher levels of psychological empowerment. These heightened feelings of psychological empowerment in turn strongly influenced job strain and work satisfaction. However, job strain did not have a direct effect on work satisfaction. CONCLUSIONS: These results provide initial support for an expanded model of organizational empowerment and offer a broader understanding of the empowerment process.

Circadian rhythm of the ventricular fibrillation threshold in female Wistar rats.

The circadian rhythm of ventricular fibrillation threshold (VFT) and its relation to the heart rate (HR) and the rectal temperature (RT) was studied in female Wistar rats. The animals were exposed to daily light-dark cycles of 12 h of light alternating with 12 h of darkness and were under pentobarbital anaesthesia (40 mg/kg i.p.). The experiments were performed on open chest animals and VFT was measured by direct stimulation of the myocardium. VFT in female rats showed a circadian rhythm with the acrophase -338 degrees (at 22.53 h), with the mesor 2.58 mA and the amplitude 0.33 mA. HR was not significantly changed during the experiments and no dependence was found between VFT and HR during the whole 24-hour period (r = 0.08). The acrophase of the circadian rhythm of HR (on -47 degrees, i.e. at 03.08 h) was shifted to the acrophase of VFT. The circadian rhythms of RT before the application of the anaesthetic agent and under general anaesthesia before the operative interventions had a very similar course with the nearly corresponding acrophases as the circadian rhythm of VFT. It is concluded that the electrical stability of the rat heart measured by VFT shows the significant circadian rhythm in a parallel with the circadian rhythm of RT and probably without dependence on the changes of HR.

The present status of biliary tract surgery.

The techniques now routinely available for modern biliary tract diagnosis and treatment have allowed today's biliary surgeon to make a diagnosis more rapidly and with greater delineation of the pathology than a decade ago. As well, the extension of these diagnostic techniques has allowed interventional procedures to be carried out by both the radiologist and the endoscopist such that certain palliative procedures may now be done without laparotomy, and reoperations may be avoided by percutaneous or endoscopic approaches. Operative surgery in this area has not had the same spectacular advances. Rather there have been refinements and additions to previously used techniques that have standardized the procedures. Moreover, surgery has benefited from the technologies that have allowed the better preparation of the patient by the percutaneous or endoscopic relief of jaundice before an operation, the disimpaction of stones in cholangitis, and papillotomy in acute pancreatitis. The availability to the surgeon of the extremely slim flexible endoscope has made biliary endoscopy at operation simpler as well as providing a tool for percutaneous biliary endoscopy and stone extraction. In the same era, tests that were among the most common for diagnoses such as the oral cholecystogram and intravenous cholangiogram have become infrequent and perhaps obsolete. It has become obvious that the complete biliary surgeon must now have available isotopic, sonographic, and radiologic imaging, endoscopy, and other equipment not even imagined by those who pioneered biliary surgery.

Acute acalculous cholecystitis.

Sixty-eight patients with acute acalculous cholecystitis were reviewed. The results of history and physical examinations were usually nondiagnostic. IDA cholescintigraphy (93 per cent accuracy rate) was the only reliable diagnostic modality. The results of oral cholecystography, intravenous cholangiography and ultrasonography were considerably less reliable. One-half of the patients had gangrenous cholecystitis. Cholecystectomy was the preferred operation with an over-all mortality of 9 per cent. IDA cholescintigraphy is an important new modality for the diagnosis of acute acalculous cholecystitis which, in the past, has often been difficult to diagnose.

Changes in the vulnerable period of the rat myocardium during hypoxia, hyperventilation and heart failure.

Changes in the duration and size of the vulnerable period of the myocardium in the presence of respiratory changes were studied in acute experiments on rats. The limits of the vulnerable period were determined by directly stimulating the heart during ventilation via the enlarged respiratory dead space, during hyperventilation and during heart failure. In the control group (normal ventilation without enlargement of the dead space), the vulnerable period lasted 5.7 +/- 0.76 ms. During ventilation via the enlarged dead space, hypercapnic hypoxaemia developed and the vulnerable period was markedly prolonged (18.55 +/- 5.29 ms) by a shift of its inner limit to the left. Hyperventilation caused normoxic to hyperoxic hypocapnia and markedly reduced the duration of the vulnerable period (8.17 +/- 2.21 and 9.31 +/- 2.38 ms respectively). The vulnerable period lengthened the most in heart failure (25.46 +/- 3.93), mainly as a result of a shift of its outer limit. In all the experimental groups there was a shift of the vulnerable period to the right, which was fastest in hypercapnic hypoxaemia and slowest in hyperoxic hypocapnia. The administration of Inderal (3 mg/kg i.p.) or Arfonad (50 mg/kg i.p.) markedly shortened the vulnerable period during hypercapnic hypoxaemia (9.87 +/- 2.78 and 9.32 +/- 2.16 ms respectively), but did not block the shift. Lengthening of the vulnerable period during hypercapnic hypoxaemia was probably due to activation of sympathetic nerves via beta-adrenergic receptors.

Stapling in intestinal surgery.

Although stapling technology was introduced to surgical procedures early in this century, its accelerated use has taken place since 1968. Several methods of restoring interrupted continuity of the large and small bowel are available to the surgeon. The method used is influenced by the level involved, especially as it relates to the availability of the two ends to be joined. The degree of cleansing of the bowel lumen also affects the method chosen, especially in colorectal anastomosis. The surgeon should avail himself of the appropriate training in the operation and use of stapling instruments because the principles of stapling technology differ from those of conventional suturing technics.

Evaluation of the postoperative patient with 99mTc-IDA cholescintigraphy.

In order to assess the role of 99mTc-iminodiacetic acid (IDA) cholescintigraphy in evaluating postoperative patients, a total of 213 studies were performed in 189 patients over a 3-year time period. Of these, 130 studies were obtained in 125 cases with signs and/or symptoms suggesting postcholecystectomy syndrome. A normal sized duct that emptied within an hour ruled out significant pathology with a high degree of accuracy (97%). A less reliable finding of normalcy was the combination of ductal dilatation with functional patency in that three of 20 patients (15%) who exhibited this pattern were proven to have nonobstructing calculi in their common bile duct. AZ spectrum of abnormal findings was encountered. Ductal dilatation was a most significant indicator of partial or intermittent ductal obstruction when it was associated with altered time-activity dynamics in the ducts and secondarily, delayed biliary-to-bowel transit time of the radiotracer. Patterns indicating complete common duct obstruction, cystic duct remnants, and bile leaks also proved to be very sensitive. Seventy-three studies in 56 patients very accurately evaluated the integrity of biliary-enteric bypass anastomosis. Complete and partial obstructive patterns were similar in appearance to those encountered in postcholecystectomy syndrome. Several leaks were also detected in this patient population. Ten studies were performed in eight patients who underwent Billroth II gastroenterostomies primarily to see if afferent loop obstruction was present. Three of these patients did demonstrate dilated A-loops with stasis, thereby making a positive diagnosis possible.

Total fecal diversion by the temporary skin-level loop transverse colostomy.

The temporary skin-level loop transverse colostomy has been described. Proof of its ability to divert the fecal stream totally is illustrated by complete diversion in 25 patients ingesting a postcolostomy barium meal. There was no postoperative complication.

The dilemma of Crohn's disease: ileosigmoidal fistula complicating Crohn's disease.

Between 1965 and 1975, 27 patients underwent surgical treatment for ileosigmoidal fistulas complicating Crohn's disease at the Cleveland Clinic. There was no death and no anastomotic leak. The preferred procedure is resection of the ileocecal area involved by Crohn's disease with ileocolic anastomosis and a separate segmental resection of the sigmoid colon with colocolic anastomosis. A covering temporary loop ileostomy is used when there is associated pelvic sepsis or small-bowel obstruction.

The dilemma of Crohn's disease: ileoduodenal fistula complicating Crohn's disease.

Nine cases of duodenal fistula complicating Crohn's disease are reported. All nine patients were male. Four patients had Crohn's disease of the ileum and five had ileocolitis. No patient had primary duodenal Crohn's disease. Because attempt at primary closure of the duodenal defect may fail, our treatment of choice has been formal cross cut two-layered duodenojejunal anastomostis with extensive drainage of the area postoperatively. This treatment has been associated with no mortality and little morbidity, and no late recurrence of duodenal fistula.

Internal bile diversion--a new model for the study of cholesterol metabolism.

Biliary diversion in different ways has been studied as a prevention against induced hypercholesterolemia in experimental animals. A new model for the study of cholesterol metabolism is described in dogs in this paper. The technique consists in ligation and division of the common bile duct and interposition of an isoperistaltic loop of jejunum between the gallbladder and urinary bladder. This technique is free of complications such as diarrhea, infection, and peptic ulceration that are seen in other biliary diversion models, and it is tolerated well by the animals. This requires further study for its effectiveness in the prevention of experimental hypercholesterolemia and subsequent development of arteriosclerosis.

The role of the peritoneum in the healing of abdominal incisions.

These results support the assumption that careful approximation of the gascial edges is one key in the repair of abdominal incisions. It is difficult to say how pertinent these observations are to the clinical situation in which nonabsorbable sutures are generally used. However, we believe that some of these factors are germane in both situations and that concentration on maintaining a meticulous, accurate and strong fascial approximation will result in a safer, faster and equally strong and less frustrating closure of the abdominal incision.