Videos using different message strategies to promote the interruption of sedentary behavior in university students during online lectures - A pilot study.

Background: Sedentary behavior (SB) is highly prevalent among university students and has increased during COVID-19 pandemic. As SB is associated with negative health outcomes, appropriate prevention measures in the university setting are needed. Objective: This pilot study aimed at investigating the effects of videos using different message strategies to interrupt SB in the collective of university students during online lectures. Methods: During online lectures, university students (N = 96) were shown one of three videos on the interruption of SB. The videos differed in their message strategies with regard to evidence type (statistical vs. narrative) and vividness (static vs. animated images). Demographics, health variables (SB intentions, SB attitudes) and selected media reception variables (identification, homophily, counterarguing) were examined as possible influence factors on the interruption of SB evoked by watching the video. Results: Approximately half of the students interrupted sedentary behavior during watching the videos and students of the older age group (cut-off: median = 22 years) interrupted SB significantly more often (p = 0.046). The interruption of SB was predicted by SB intentions (p < 0.05). Identification with characters significantly predicted the intentions to reduce SB (p < 0.001), with a large effect of the overall regression model (R2corr = 0.47). Conclusion: Considering the increased digitalization in general and restrictions due to COVID-19 pandemic, videos seem to be a useful tool to interrupt SB among university students during online lectures. Narrative formats could facilitate the intention to reduce SB, which in turn could have a positive impact on the interruption of SB. However, further research on effective communication and message strategies is needed.

The Design of Making Pre-K count and High Fives: Two-Stage, Multiyear Random Assignment at Different Levels.

The Making Pre-K Count and High 5s studies represent a recent application of a phased two-stage, multi-level design, which was used to examine the effects of two aligned math programs implemented in early childhood settings. The purpose of this paper is to describe the challenges encountered in implementing this two-stage design and to describe approaches to resolving them. We then present a set of sensitivity analyses the study team used to examine the robustness of the findings. During the pre-K year, pre-K centers were randomly assigned either to receive an evidence-based early math curriculum and associated professional development (Making Pre-K Count) or to a pre-K-as-usual control condition. In the kindergarten year, students who had been in Making Pre-K Count program classrooms in pre-K were then individually randomly assigned within schools to small-group supplemental math clubs that were designed to sustain the gains from the pre-K program, or to a business-as-usual kindergarten experience. Making Pre-K Count took place in 69 pre-K sites, comprising 173 classrooms across New York City. High 5s took place in the 24 sites that were part of the public school treatment arm of the Making Pre-K Count study and included 613 students. The study focuses on the effect of the Making Pre-K Count and High 5s programs on children's math skills at the end of kindergarten as measured by two instruments, the Research-Based Early Math Assessment-Kindergarten (REMA-K) and the Woodcock-Johnson Applied Problems test. The multi-armed design, while logistically and analytically challenging, balanced multiple considerations of power, the number of research questions that could be answered, and efficiency of resources. Robustness checks suggest that the design created groups that were both meaningfully and statistically equivalent. Decisions to use a phased multi-armed design should consider both its strengths and weaknesses. While the design allows for a more flexible, expansive research study, it also introduces complexities that need to be addressed both logistically and analytically.

Combining hierarchical clustering and preference mapping differentiates consumer preference for dry aged mutton.

Dry ageing of mutton may enhance mutton's consumer appeal; however, consumer acceptance of mutton is heterogeneous. To identify which consumers prefer dry aged mutton, dry (DA) and wet aged mutton (WA) loin and topside were rated by consumers (n = 540) for tenderness, juiciness, liking of flavour and overall liking on a 0-100 scale. Two predictive liking models were developed, utilising either consumer clusters (identified by agglomerative hierarchical clustering) which related to mutton liking and ageing method preference, or demographic factors. The cluster based model had the highest explanatory power. Cluster 1 (n = 219) preferred DA (p < 0.001), rating it 5.9 points higher than WA, cluster 2 (n = 235) had no ageing method preference (p > 0.05), and cluster 3 (n = 79) preferred WA (p < 0.001), rating WA liking 8.3 points higher than DA. Cluster characterisation identified some differences between clusters that may relate to consumer ethnicity and familiarity with mutton.

High consumer acceptance of mutton and the influence of ageing method on eating quality.

To compare the eating quality (EQ) of wet (WA) and dry aged (DA) mutton longissimus thoracis et lumborum (LTL) and semimembranosus (SM), bone-in leg and loin primals from 81 merino cull ewes were WA or DA for 14, 28, 42 or 56 days. Untrained consumers (n = 540) assessed the excised LTL and SM for EQ (tenderness, juiciness, liking of flavour and overall liking, 0-100), quality grade and respective willingness to pay (WTP). LTL scored higher than SM for EQ, P < 0.001 for all consumer sores. Mean LTL EQ scores were > 70 and mean SM EQ scores >54. Ageing method had no significant effect on LTL or SM EQ (P > 0.05 for all consumer scores). Ageing beyond 14 days improved SM and LTL tenderness. Consumers most often graded LTL and SM quality grades as "better than everyday" and "good everyday" respectively; corresponding WTP was 26.90 $AUD/kg and 18.80 $AUD/kg. Extended ageing periods improved mutton tenderness.

Mental health needs in a large urban school district: Findings from a web-based survey.

OBJECTIVE: To explore the mental health needs of students, and the professional development and support needs of teachers and school health professionals, as a way to foster community engagement and help set priorities for a comprehensive school mental health system in the Detroit Public Schools Community District (DPSCD). SETTING: The study team surveyed all DPSCD staff in June 2019 and all students in grades 8-12 between October and December 2019. STUDY DESIGN: A descriptive study based on anonymous, web-based surveys focused on student trauma exposure and mental health symptoms, student mental health resource utilization, staff burnout, and professional development needs. DATA COLLECTION: All students (grades 8-12) and district staff were eligible to participate; the student survey was made available in six languages. Parents/guardians could opt children out; schools could exclude children unable to complete the survey independently. Student surveys were administered in school; staff surveys were sent via email. PRINCIPAL FINDINGS: Thirty-four percent of DPSCD students reported moderate/severe depression symptoms; 22% had seriously considered suicide in the past year. Rates exceed national averages; 37% of students with severe depression and 34% of those with suicidal ideation had not accessed mental health supports. Staff indicated high levels of burnout and substantial interest in learning about self-care strategies or coping with vicarious trauma. Over 75% of teachers and school mental health professionals expressed interest in learning about best practices for supporting students impacted by trauma or mental illness. CONCLUSIONS: A large number of DPSCD students are experiencing symptoms of depression and anxiety, and many students who need care are not accessing it. Addressing the mental health needs of students is a high priority for staff, but they need more training and support, as well as support for their own vicarious trauma and high levels of burnout.

Association of Serum Ferritin Levels and Methylprednisolone Treatment With Outcomes in Nonintubated Patients With Severe COVID-19 Pneumonia.

Importance: Serum ferritin, an acute phase marker of inflammation, has several physiologic functions, including limiting intracellular oxidative stress. Whether the effectiveness of corticosteroids differs according to serum ferritin level in COVID-19 has not been reported. Objective: To examine the association between admission serum ferritin level and methylprednisolone treatment outcomes in nonintubated patients with severe COVID-19. Design, Setting, and Participants: This retrospective cohort study included patients with severe COVID-19 admitted to an academic referral center in Stony Brook, New York, from March 1 to April 15, 2020, receiving high-flow oxygen therapy (fraction of inspired oxygen, ≥50%). The outcomes of treatment with methylprednisolone were estimated using inverse probability of treatment weights, based on a propensity score comprised of clinical and laboratory variables. Patients were followed up for 28 days. Data were analyzed from December 19, 2020, to July 22, 2021. Exposures: Systemic methylprednisolone administered per the discretion of the treating physician. Main Outcomes and Measures: The primary outcome was mortality, and the secondary outcome was a composite of death or mechanical ventilation at 28 days. Results: Among 380 patients with available ferritin data (median [IQR] age, 60 years [49-72] years; 130 [34.2%] women; 250 [65.8%] men; 310 White patients [81.6%]; 47 Black patients [12.4%]; 23 Asian patients [6.1%]), 142 patients (37.4%) received methylprednisolone (median [IQR] daily dose, 160 [120-240] mg). Ferritin levels were similar in patients who received methylprednisolone vs those who did not (median [IQR], 992 [509-1610] ng/mL vs 893 [474-1467] ng/mL; P = .32). In weighted analyses using tertiles of ferritin values (lower: 29-619 ng/mL; middle: 623-1316 ng/mL; upper: 1322-13 418 ng/mL), methylprednisolone was associated with lower mortality in patients with ferritin in the upper tertile (HR, 0.16; 95% CI, 0.06-0.45) and higher mortality in those with ferritin in the middle (HR, 2.46; 95% CI, 1.15-5.28) and lower (HR, 2.43; 95% CI, 1.13-5.22) tertiles (P for interaction < .001). Composite end point rates were lower with methylprednisolone in patients with ferritin in the upper tertile (HR, 0.45; 95% CI, 0.25-0.80) but not in those with ferritin in the middle (HR, 0.83; 95% CI, 0.50-1.39) and lower (HR, 0.89; 95% CI, 0.51-1.55) tertiles (P for interaction = .11). Conclusions and Relevance: In this cohort study of nonintubated patients with severe COVID-19, methylprednisolone was associated with improved clinical outcomes only among patients with admission ferritin in the upper tertile of values.

Admission NT-proBNP and outcomes in patients without history of heart failure hospitalized with COVID-19.

AIMS: We examined the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients admitted for coronavirus disease 2019 (COVID-19) without prior history of heart failure (HF) or cardiomyopathy. METHODS AND RESULTS: Retrospective cohort of consecutive adults (N = 679; median age 59 years; 38.7% women; 87.5% White; 7.1% Black; 5.4% Asian; 34.3% Hispanic) admitted with documented COVID-19 in an academic centre in Long Island, NY. Admission NT-proBNP was categorized using the European Society of Cardiology Heart Failure Association age-specific criteria for acute presentations. We examined (i) mortality and the composite of death or mechanical ventilation and (ii) out-of-hospital, intensive care unit (ICU)-free, and ventilator-free days at 28 days. Estimates were adjusted for confounders using a lasso selection process. Using age-specific criteria, 417 patients (61.4%) had low, 141 (20.8%) borderline, and 121 (17.8%) high NT-proBNP. Mortality was 5.8%, 20.6%, and 36.4% for patients with low, borderline, and high NT-proBNP, respectively. In lasso-adjusted models, high NT-proBNP was associated with higher mortality [hazard ratio (HR) 2.15; 95% confidence interval (CI) 1.06-4.39; P = 0.034] and composite endpoint rates (HR 1.66; 95%CI 1.04-2.66; P = 0.035). Patients with high NT-proBNP had 32%, 33%, and 33% fewer out-of-hospital, ICU-free, and ventilator-free days compared with low NT-proBNP counterparts. Results were consistent across age, sex, and race, and regardless of coronary artery disease or hypertension, except for stronger mortality signal with high NT-proBNP in women. CONCLUSIONS: In patients with COVID-19 and no HF history, high admission NT-proBNP is associated with higher mortality and healthcare resources utilization. Preventive strategies may be required for these patients.

Consumer Perceptions of Meat Redness Were Strongly Influenced by Storage and Display Times.

Lamb (n = 79) meat colour was scored by 879 untrained consumers using a scale of 0 (brown) to 100 (red). This consumer colour score (CCS) was obtained on m. longissimus lumborum (loin) and m. semimembranosus (topside), stored for short (5-7 days), medium (33-35 days), and long periods (110-112 days) and a retail display time of up to 4 days. Consumers perceived topside to be less red initially and changed from red to brown more rapidly when stored for the long-storage period (p < 0.01). Whereas, the initial CCS of loin samples were similar across the storage periods (p > 0.05). CCS and the instrument measure oxy/met (reflectance of light at wavelengths 630 nm and 580 nm) had a low correlation coefficient of 0.33 (p < 0.01). The propensity for lamb growth and leanness indicated by sire breeding values for lamb weight, eye muscle depth, eye muscle fat depth, and loin intramuscular fat had varied and inconsistent effects on CCS. Therefore, even the selection on CCS.

Product Design to Enhance Consumer Liking of Cull Ewe Meat.

The global sheepmeat industry aspires to increase consumer liking for cull ewe meat and thereby increase its value; dry ageing application can increase the consumer appeal of this meat. In order to develop novel consumer-liked dry aged sheepmeat products, an innovation process aligned with design thinking principles was initiated. The objective was to understand optimal dry aged sheepmeat product formats from chef, butcher, producer and consumer perspectives, and use these findings to develop "highly liked" and "premium" dry aged cull ewe meat dishes. The methodology used and the results of stakeholder engagement, perceptual mapping, and quantitative consumer assessments are reported. Stakeholder engagement showed the importance of how novel products are introduced to the consumer and to the chef. Perceptual mapping highlighted that chef-perceived product "premiumness" was driven by eating quality and complexity of the dish. Consumer assessment validated these findings with increases in dish liking associated with increased premiumness and complexity in dish presentation. Overall, the described approach was successful; eight highly liked dry aged cull ewe meat dishes were developed (all scored > 7.69 on a 9-point hedonic scale for liking), and four of the eight dishes were rated "at the level of a very premium food".

Comprehensive Review of Complete Versus Culprit-only Revascularization for Multivessel Disease in ST-segment Elevation Myocardial Infarction.

Several organizations have developed guidelines for the management of ST-segment elevation myocardial infarction (STEMI). However, the optimal strategy regarding revascularization in the setting of multivessel disease, specifically with regards to culprit vessel versus complete revascularization, continues to evolve. While previous observational studies promoted culprit vessel-only intervention in patients with STEMI, recent randomized controlled trials suggest potential benefits with multivessel revascularization, either at the time of the index event or in a staged fashion, in patients without cardiogenic shock. This may be due to the known instability of non-culprit lesions in the setting of acute coronary syndrome, and the diffuse coronary processes involved. As additional literature examines culprit vessel versus multivessel revascularization strategies, clinicians continue to be tasked with determining optimal treatment plans for their patients and understanding the factors that promote selected revascularization strategies. This review summarizes and discusses observational studies, randomized control trials and current guidelines in order to evaluate optimal reperfusion strategies for patients presenting with STEMI in the setting of multivessel disease.

Energy Drink Effects on Hemodynamics and Endothelial Function in Young Adults.

INTRODUCTION: Cardiovascular side effects associated with energy drink consumption may be related to effects on vascular endothelial function, heart rate, blood pressure, and electrocardiogram parameters. We sought to measure them following energy drink consumption. METHODS: Forty-four healthy non-smoking young volunteer medical students, at an average age of 24.7 years (range 23-27 years, 34 males), with an average BMI of 23.4, received electrocardiograms and had their heart rates and blood pressures taken. Subjects then underwent baseline testing of endothelial function using the technique of endothelium-dependent flow-mediated dilatation (FMD) with high-resolution ultrasound. The subjects then drank an energy drink (24 oz Monster Energy Drink®). Hemodynamic measurements were repeated 15 and 90 min later. FMD and the electrocardiogram were repeated 90 min later. The FMD was calculated as the ratio of the post-cuff release and the baseline diameter. RESULTS: Energy drink consumption resulted in a significantly attenuated peak FMD response (mean ± SD): baseline 5.1 ± 4.1% versus post-energy drink (2.8 ± 3.8%; p = 0.004). In addition, systolic and diastolic blood pressures and heart rate increased after 15 min. Diastolic blood pressure and heart rate remained increased 90 min following energy drink consumption. There were no significant changes in electrocardiogram parameters. CONCLUSION: Energy drink consumption was associated with an acute significant impairment in endothelial function in young healthy adults as well as with significant hemodynamic changes. As energy drinks are becoming more popular, it is important to study their effects to better determine safe consumption patterns.

High-dose methylprednisolone in nonintubated patients with severe COVID-19 pneumonia.

BACKGROUND: Recent trials with dexamethasone and hydrocortisone have demonstrated benefit in patients with coronavirus disease 2019 (COVID-19). Data on methylprednisolone are limited. METHODS: Retrospective cohort of consecutive adults with severe COVID-19 pneumonia on high-flow oxygen (FiO2  ≥ 50%) admitted to an academic centre in New York, from 1 March to 15 April 2020. We used inverse probability of treatment weights to estimate the effect of methylprednisolone on clinical outcomes and intensive care resource utilization. RESULTS: Of 447 patients, 153 (34.2%) received methylprednisolone and 294 (65.8%) received no corticosteroids. At 28 days, 102 patients (22.8%) had died and 115 (25.7%) received mechanical ventilation. In weighted analyses, risk for death or mechanical ventilation was 37% lower with methylprednisolone (hazard ratio 0.63; 95% CI 0.47-0.86; P = .003), driven by less frequent mechanical ventilation (subhazard ratio 0.56; 95% CI 0.40-0.79; P = .001); mortality did not differ between groups. The methylprednisolone group had 2.8 more ventilator-free days (95% CI 0.5-5.1; P = .017) and 2.6 more intensive care-free days (95% CI 0.2-4.9; P = .033) during the first 28 days. Complication rates were not higher with methylprednisolone. CONCLUSIONS: In nonintubated patients with severe COVID-19 pneumonia, methylprednisolone was associated with reduced need for mechanical ventilation and less-intensive care resource utilization without excess complications.

Proliferative potential and response to nivolumab in clear cell renal cell carcinoma patients.

Background: Biomarkers predicting immunotherapy response in metastatic renal cell cancer (mRCC) are lacking. PD-L1 immunohistochemistry is a complementary diagnostic for immune checkpoint inhibitors (ICIs) in mRCC, but has shown minimal clinical utility and is not used in routine clinical practice. Methods: Tumor specimens from 56 patients with mRCC who received nivolumab were evaluated for PD-L1, cell proliferation (targeted RNA-seq), and outcome. Results: For 56 patients treated with nivolumab as a standard of care, there were 2 complete responses and 8 partial responses for a response rate of 17.9%. Dividing cell proliferation into tertiles, derived from the mean expression of 10 proliferation-associated genes in a reference set of tumors, poorly proliferative tumors (62.5%) were more common than moderately (30.4%) or highly proliferative (8.9%) counterparts. Moderately proliferative tumors were enriched for PD-L1 positive (41.2%), compared to poorly proliferative counterparts (11.4%). Objective response for moderately proliferative (29.4%) tumors was higher than that of poorly (11.4%) proliferative counterparts, but not statistically significant (p = .11). When cell proliferation and negative PD-L1 tumor proportion scores were combined statistically significant results were achieved (p = .048), showing that patients with poorly proliferative and PD-L1 negative tumors have a very low response rate (6.5%) compared to moderately proliferative PD-L1 negative tumors (30%). Conclusions: Cell proliferation has value in predicting response to nivolumab in clear cell mRCC patients, especially when combined with PD-L1 expression. Further studies which include the addition of progression-free survival (PFS) along with sufficiently powered subgroups are required to further support these findings.

Outcomes of Patients Undergoing Transcatheter Aortic Valve Implantation With Incidentally Discovered Masses on Computed Tomography.

Routine preprocedural chest and abdomen computed tomography is done prior to transcatheter aortic valve implantation (TAVI), which, in turn, have led to the discovery of radiographic potentially malignant incidental masses (pMIM). It is largely unknown whether pMIM impact the outcomes of patients undergoing TAVI. In this retrospective cohort study from a single center, 1,081 patients underwent TAVI from 2012 to 2016, who had available computed tomographies, survived the index hospitalization, and also had 1 year follow-up data for review. Machine learning (backward propagation neural network)-augmented multivariable regression for mortality by pMIM was conducted. In this cohort of 1,081 patients, the mean age was 79.1 (± 9.0), 48.8% were females, 16.8% had a history of prior malignancy, and 21.1% had pMIM. One-year mortality for the entire cohort was 12.6%. The most common prior malignancies were prostate, breast, and lymphoma and the most common pMIM were present in the lung, kidneys, and thyroid. In a fully adjusted regression analysis, neither prior malignancy nor pMIM increased mortality odds. However, having both was associated with a higher 1-year mortality (odds ratio 4.02, 95% confidence interval 1.50 to 10.73, p = 0.006). In conclusion, presence of pMIM alone was not associated with an increased 1-year mortality among patients undergoing TAVI. However, the presence of pMIM and a history of prior malignancy was associated with a significant increase in 1-year mortality.

Validation of scoring system predicting permanent pacemaker implantation after transcatheter aortic valve replacement.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with severe aortic stenosis. Despite newer generation valves, atrioventricular (AV) conduction disturbance is a common complication, necessitating permanent pacemaker (PPM) implantation in about 10% of patients. Hence, it is imperative to improve periprocedural risk stratification to predict PPM implantation after TAVR. The objective of this study was to externally validate a novel risk-stratification model derived from the National Inpatient Sample (NIS) database that predicts risk of PPM from TAVR. METHODS: Components of the score included pre-TAVR left and right bundle branch block, sinus bradycardia, second-degree AV block, and transfemoral approach. The scoring system was applied to 917 patients undergoing TAVR at our institution from November 2011 to February 2017. We assessed its predictive accuracy by looking at two components: discrimination using the C-statistic and calibration using the Hosmer-Lemeshow goodness of fit test. RESULTS: Ninety patients (9.8%) required PPM. The scoring system showed good discrimination with C-statistic score of 0.6743 (95% CI: 0.618-0.729). Higher scores suggested increased PPM risk, that is, 7.3% with score ⩽3, 19.23% with score 4-6, and 37.50% with score ≥7. Patients requiring PPM were older (81.4 versus 78.7 years, P = .002). Length of stay and in-hospital mortality was significantly higher in PPM group. CONCLUSIONS: The NIS database derived PPM risk prediction model was successfully validated in our database with acceptable discriminative and gradation capacity. It is a simple but valuable tool for patient counseling pre-TAVR and in identifying high-risk patients.

Alternative cutting methods and dry aging reduce the shear force of hot boned beef striploin in Bos indicus cattle.

Hot boning (HB) is an economical processing technique often resulting in poorer meat quality and tenderness. This study tested a method of partial HB, where the short loin section was removed from the hot carcass and chilled, with the striploin remained in the skeletal system. Thirty six yearling Bos indicus steers carcasses were subjected to either low, high or no electrical stimulation and each side allocated to a cutting treatment of HB, partial HB and conventional (Achillies hung). Striploins were divided into 3 and aged for 5, 14 and 28 days. Warner Bratzler Shear force (WBSF) and sarcomere length were tested. Partial HB resulted in greater tenderization without aging compared to HB. However, optimized electrical stimulation was a requirement. Treatment did not influence sarcomere length. The study also tested the impact of Dry aging of HB striploins, which resulted in further increases in tenderness at 28 days of aging compared to wet aged product, reducing WBSF by 9 N.

Implications of the variation in bloom properties of red meat: A review.

This review aimed to examine the literature about blooming to determine any practical implications for meat colour and colour stability. Blooming is critical to surface colour in addition to pigment and achromatic factors and causes meat to become lighter (higher L*) and redder (higher a*) due to the formation of oxymyoglobin (OMb). Bloom depth of red meat varies in the range of about 1-12 mm due to a range of extrinsic factors notably oxygen partial pressure, temperature and time post slicing. A range of intrinsic factors also affect bloom acting via the oxygen consumption rate of mitochondria and metmyoglobin (MMb) reductase activity post mortem, such as post mortem age, muscle type, rigor temperature, ultimate pH (pHu), genotype and vitamin E status. These sources of variation have implications for measurement protocols and commercial applications for colour and colour stability. Development of a rapid method to measure bloom depth would enable assessment of bloom independently of surface colour.

Lenalidomide-Induced Myocarditis, Rare But Possibly Fatal Toxicity of a Commonly Used Immunotherapy.

A 66-year-old woman with follicular lymphoma on lenalidomide and rituximab presented with chest pain. High-sensitivity troponin T peaked at 7,566 ng/l. Cardiac biopsy revealed extensive inflammation consistent with medication-induced myocarditis. Lenalidomide was stopped with improvement in troponins and patient was initiated on high-dose corticosteroid therapy. (Level of Difficulty: Intermediate.).