A survey on perceived medication guide reading and comprehension ease among US adults.

Medication guides (MGs) provide patients with important information about certain prescription drugs to help them take these drugs safely. We surveyed US residents about their perceptions of MG readability and understandability. We randomly sampled 5204 US residents (age 18+) from Ipsos's KnowledgePanel to complete a two-part survey. Only respondents who reported receiving an MG with their prescription drugs (n = 3852) completed part 2, which included two key items: How easy to [(1)read/(2)understand] are the MGs that you have received from a pharmacy along with your prescription medicines? (1 = Very easy, 5 = Very difficult; reverse-coded). Health literacy (HL) and demographic data were also collected. After weighting our data, we found that 85% of respondents who reported receiving an MG perceived this information as 'very easy' (27.3%), 'somewhat easy' (28.3%) or 'about average' (29.3%) to read. Eighty-seven percent of respondents who reported receiving an MG perceived it as 'very easy' (27.6%), 'somewhat easy' (30.2%) or 'about average' (29.5%) to understand. ANOVAs revealed higher average perceived MG reading and comprehension ease scores among respondents presumed to have adequate versus inadequate HL (ps ≤ 0.0006). Younger or less-educated respondents and non-Hispanic Blacks perceived MGs as easier to read and understand, on average, than their counterparts (ps ≤ 0.0001). Many of these relationships remained intact in models predicting perceived MG reading and comprehension ease (ps ≤ 0.001). Adjusted R2 values across models were small, however (≤0.06). Our findings suggest most US residents (18+) who received MGs perceived them to be 'about average' to 'very easy' to read and understand.

Educational attainment, health outcomes and mortality: a within-sibship Mendelian randomization study.

BACKGROUND: Previous Mendelian randomization (MR) studies using population samples (population MR) have provided evidence for beneficial effects of educational attainment on health outcomes in adulthood. However, estimates from these studies may have been susceptible to bias from population stratification, assortative mating and indirect genetic effects due to unadjusted parental genotypes. MR using genetic association estimates derived from within-sibship models (within-sibship MR) can avoid these potential biases because genetic differences between siblings are due to random segregation at meiosis. METHODS: Applying both population and within-sibship MR, we estimated the effects of genetic liability to educational attainment on body mass index (BMI), cigarette smoking, systolic blood pressure (SBP) and all-cause mortality. MR analyses used individual-level data on 72 932 siblings from UK Biobank and the Norwegian HUNT study, and summary-level data from a within-sibship Genome-wide Association Study including >140 000 individuals. RESULTS: Both population and within-sibship MR estimates provided evidence that educational attainment decreased BMI, cigarette smoking and SBP. Genetic variant-outcome associations attenuated in the within-sibship model, but genetic variant-educational attainment associations also attenuated to a similar extent. Thus, within-sibship and population MR estimates were largely consistent. The within-sibship MR estimate of education on mortality was imprecise but consistent with a putative effect. CONCLUSIONS: These results provide evidence of beneficial individual-level effects of education (or liability to education) on adulthood health, independently of potential demographic and family-level confounders.

Biennial Analysis of Medication Guide Length and Estimated Readability for New Molecular Entity Drugs, 2011-2017.

BACKGROUND: A medication guide (MG) is a form of FDA-approved labeling that provides patients with information about certain prescribed drugs so that patients can use these drugs safely and effectively. Given ongoing efforts by FDA and industry to continuously improve MG content and format, we hypothesized that more recently approved MGs for new molecular entities (NMEs) would be shorter and more readable compared to NME MGs approved earlier. METHODS: We analyzed 53 NME MGs that were either approved in 2011 (n = 16), 2013 (n = 9), 2015 (n = 12), or 2017 (n = 16) to determine whether MG page length, word count, and readability scores differed by year. Readability was estimated by Flesch Reading Ease, Flesch-Kincaid Grade Level (FKGL), Fry graph (FRY), and Gunning's Fog Index (FOG) scores. RESULTS: Mean page length was significantly lower in 2017 than in 2011 and 2013 (ps < .0001). Mean FKGL scores reflected sentences and words found in 8th grade textbooks, but mean FOG and FRY scores were consistent with sentences and words found in 10th and 11th grade textbooks. CONCLUSIONS: Although more recent NME MGs were shorter than older NME MGs, additional research is warranted to determine whether shorter MGs lead to improved readability. Developers choosing to estimate MG readability with equations should consider using multiple readability formulas and weigh the strengths and weaknesses of this approach. Using validated tools to more comprehensively assess MG readability should also be considered.

Oceanographic habitat and the coral microbiomes of urban-impacted reefs.

Coral reefs are in decline worldwide. In response to this habitat loss, there are efforts to grow, outplant, and restore corals in many regions. The physical oceanographic habitat of corals-such as sea temperature, waves, ocean currents, and available light-is spatially heterogeneous. We therefore hypothesize that outplant location may affect microbiomes, and ultimately, coral health and restoration success. We evaluated the influence of the physical oceanographic habitat on microbes in wild Porites astreoides and Siderastrea siderea. Tissue samples were collected at four Florida reefs in March, June, and September of 2015. We estimated oceanographic conditions from moored instruments, diver observations, remote sensing data, and numerical models. We analyzed microbiomes using amplicon 16S rRNA high-throughput sequencing data. We found microbial alpha-diversity negatively correlated with in situ sea temperature (which represented both the annual cycle and upwelling), as well as modeled alongshore currents, in situ sea-level, and modeled tide. Microbial beta-diversity correlated positively with significant wave height and alongshore currents from models, remotely-sensed relative turbidity, and in situ temperature. We found that archaea from the order Marine Group II decrease with increases in significant wave height, suggesting that this taxon may be influenced by waves. Also, during times of high wave activity, the relative abundance of bacteria from the order Flavobacteriales increases, which may be due to resuspension and cross-shelf transport of sediments. We also found that bacteria from the order SAR86 increase in relative abundance with increased temperature, which suggests that this taxon may play a role in the coral microbiome during periods of higher temperature. Overall, we find that physical oceanographic variability correlates with the structure of these coral microbiomes in ways that could be significant to coral health.

High-speed X-ray imaging of the Leidenfrost collapse.

The Leidenfrost layer is characterized by an insulating vapor film between a heated surface and an ambient liquid. The collapse of this film has been canonically theorized to occur from an interfacial instability between the liquid and vapor phases. The interfacial instability alone, however, is insufficient to explain the known influence of the surface on the film collapse process. In this work, we provide visual evidence for two key mechanisms governing the film collapse: the interfacial instability, and the nucleation of vapor upon multiple non-terminal liquid-solid contacts. These results were obtained by implementing high-speed X-ray imaging of the film collapse on a heated sphere submerged in liquid-water. The X-ray images were synchronized with a second high-speed visible light camera and two thermocouples to provide insight into the film formation and film collapse processes. Lastly, the dynamic film thickness was quantified by analysis of the X-ray images. This helped assess the influence of surface roughness on the disruption of the film. The results of this work encourage further investigation into non-linear stability theory to consolidate the role of the surface on the liquid-vapor interface during the film collapse process.

Thermodynamics of sustaining liquid water within rough icephobic surfaces to achieve ultra-low ice adhesion.

The build-up of ice on aircraft, bridges, oil rigs, wind turbines, electrical lines, and other surfaces exposed to cold environments diminishes their safe and effective operation. To engineer robust surfaces that reduce ice adhesion, it is necessary to understand the physics of what makes a surface icephobic ("ice-hating") as well as the relationship between icephobicity and ice adhesion. Here we elucidate the molecular origin of icephobicity based on ice-surface interactions and characterize the correlation between material icephobicity and liquid wettability. This fundamental understanding of icephobic characteristics enables us to propose a robust design for topologically textured, icephobic surfaces. The design identifies the critical confinement length scale to sustain liquid water (as opposed to ice) in between roughness features and can reduce the strength of ice adhesion by over a factor of twenty-seven compared to traditional hydrophobic surfaces. The reduction in ice adhesion is due to the metastability of liquid water; as ambient ice cleaves from the textured surface, liquid water leaves confinement and freezes - a process which takes the system from a local energy minimum to a global energy minimum. This phase transition generates a detachment force that actively propels ambient ice from the surface.

Differential Impacts of Land-Based Sources of Pollution on the Microbiota of Southeast Florida Coral Reefs.

Coral reefs are dynamic ecosystems known for decades to be endangered due, in large part, to anthropogenic impacts from land-based sources of pollution (LBSP). In this study, we utilized an Illumina-based next-generation sequencing approach to characterize prokaryotic and fungal communities from samples collected off the southeast coast of Florida. Water samples from coastal inlet discharges, oceanic outfalls of municipal wastewater treatment plants, treated wastewater effluent before discharge, open ocean samples, and coral tissue samples (mucus and polyps) were characterized to determine the relationships between microbial communities in these matrices and those in reef water and coral tissues. Significant differences in microbial communities were noted among all sample types but varied between sampling areas. Contamination from outfalls was found to be the greatest potential source of LBSP influencing native microbial community structure among all reef samples, although pollution from inlets was also noted. Notably, reef water and coral tissue communities were found to be more greatly impacted by LBSP at southern reefs, which also experienced the most degradation during the course of the study. The results of this study provide new insights into how microbial communities from LBSP can impact coral reefs in southeast Florida and suggest that wastewater outfalls may have a greater influence on the microbial diversity and structure of these reef communities than do contaminants carried in runoff, although the influences of runoff and coastal inlet discharge on coral reefs are still substantial.IMPORTANCE Coral reefs are known to be endangered due to sewage discharge and to runoff of nutrients, pesticides, and other substances associated with anthropogenic activity. Here, we used next-generation sequencing to characterize the microbial communities of potential contaminant sources in order to determine how environmental discharges of microbiota and their genetic material may influence the microbiomes of coral reef communities and coastal receiving waters. Runoff delivered through inlet discharges impacted coral microbial communities, but impacts from oceanic outfalls carrying treated wastewater were greater. Geographic differences in the degree of impact suggest that coral microbiomes may be influenced by the microbiological quality of treated wastewater.

The Thermodynamics of Restoring Underwater Superhydrophobicity.

Superhydrophobic surfaces submerged in liquids are susceptible to permanently becoming wet. This is especially true when the ambient liquid is pressurized or undersaturated with air. To gain insight into the thermodynamics of restoring underwater superhydrophobicity, nucleation theory is applied to the design of spontaneously dewetting conical pores. It is found that, for intrinsically hydrophobic materials, there is a geometric constraint for which reversible superhydrophobic behavior may occur. Molecular dynamics simulations are implemented to support the theory, and steered molecular dynamics simulations are used to investigate the energy landscape of the dewetting process. The results of this work have implications for the efficacy of underwater superhydrophobicity and enhanced nucleation sites for boiling heat transfer.

Sustaining Superheated Liquid within Hydrophilic Surface Texture.

During pool boiling of water, it is advantageous to keep liquid touching the surface in order to delay the onset of filmwise boiling. This allows water to remain in the nucleate boiling regime, leading to increased heat transfer. In this work, we propose a mechanism to sustain superheated liquid within hydrophilic pores. This mechanism for the design of superwetting hydrophilic surfaces does not rely on the transport of vapor and offers an additional pathway for wetting via the condensation of vapor within the surface texture. We adapt nucleation theory to design the surface geometry and implement molecular dynamics simulations to verify this concept. Simulation results are consistent with theory and demonstrate superheated liquid residing within the surface texture.

"I'm Not Telling": The Effects of Racial Disparities Communications on Task Persistence Among Blacks.

Research suggests that communications about racial health disparities may adversely affect Blacks. In this study, we varied the message content (Black-White cardiovascular-related disparities + neutral health topics vs. neutral health topics only) embedded in public service announcements given to Black and White participants (N = 86) and had them complete a purported health self-assessment. We used the number of items completed as a measure of task persistence. Our results showed that participants in the disparities condition completed fewer items on average than participants in the neutral condition (p < .01). Planned contrasts revealed that this effect was driven by the responses of Blacks who completed fewer items in the disparities condition (p < .01), though Whites evinced a comparable condition-based trend (p = .12). We found no Black-White differences in the number of items completed in either of our experimental conditions (ps ≥ .53). Although preliminary, our findings suggest that Blacks and Whites exposed to comparative racial disparities messaging about cardiovascular diseases could experience reduced task persistence. Research implications and study limitations are also discussed.

Sustaining dry surfaces under water.

Rough surfaces immersed under water remain practically dry if the liquid-solid contact is on roughness peaks, while the roughness valleys are filled with gas. Mechanisms that prevent water from invading the valleys are well studied. However, to remain practically dry under water, additional mechanisms need consideration. This is because trapped gas (e.g. air) in the roughness valleys can dissolve into the water pool, leading to invasion. Additionally, water vapor can also occupy the roughness valleys of immersed surfaces. If water vapor condenses, that too leads to invasion. These effects have not been investigated, and are critically important to maintain surfaces dry under water. In this work, we identify the critical roughness scale, below which it is possible to sustain the vapor phase of water and/or trapped gases in roughness valleys - thus keeping the immersed surface dry. Theoretical predictions are consistent with molecular dynamics simulations and experiments.

Health-Related Stereotype Threat Predicts Health Services Delays Among Blacks.

To our knowledge, no published research has developed an individual difference measure of health-related stereotype threat (HRST). We adapted existing measures of academic stereotype threat to the health domain on a sample of black college students (N = 280). The resulting health-related stereotype threat scale-24 (HRST-24) was assessed for internal consistency, construct and incremental validity, and whether it explains variance in self-reported delays among four preventive health behaviors-blood pressure and cholesterol assays, physical exams, and routine checkups. After adjusting for several control variables, the HRST-24's (full scale α = 0.96) perceived black health inferiority (18 items; α = 0.96) and perceived physician racial bias (6 items; α = 0.85) sub-scales explained unique variance in delays among two of the four behaviors including a blood cholesterol check (p < .01) and routine checkup-albeit at marginal levels (p = .063) in the case of the latter. Overall, these data provide preliminary evidence of construct and incremental validity for the HRST-24 among blacks. Recommendations for administering the scale are provided and future directions for HRST research are discussed.

Realising the potential for an Olympic legacy; teaching medical students about sport and exercise medicine and exercise prescribing.

BACKGROUND: Physicians are increasingly being called upon to promote physical activity (PA) among patients. However, a paucity of exercise medicine teaching in the UK undergraduate medical curricula prevents students from acquiring the necessary knowledge and skills to do so. To address this issue, King's College London School of Medicine introduced an exercise medicine strand of teaching. This study evaluated the acceptability of exercise promotion behaviour change lectures and explored the knowledge and attitudes of the students who received it. METHODS: Students were invited to complete a 6-item online questionnaire prior to and after exercise medicine lectures. The questionnaire assessed beliefs regarding the importance of PA in disease prevention and management, in addition to their confidence in advising patients on PA recommendations. A focus group (n=7) explored students' attitudes towards and knowledge of PA promotion and exercise prescribing. RESULTS: In total, 121 (15%) first-year and second-year MBBS students completed the questionnaire. Students' beliefs regarding the importance of PA in managing disease and their confidence in PA promotion among patients increased after the teaching (p<0.001). More students were able to correctly identify the Chief Medical Officer recommended adult PA guidelines (p<0.05). Students were enthusiastic about the exercise medicine teaching, strongly supportive of its continued inclusion in the curriculum and advocated its importance for patients and themselves as future doctors. CONCLUSIONS: Behaviour change teaching successfully improved students' knowledge of and confidence regarding PA promotion. These improvements are a step forward and may increase the rates and success of physician PA counselling in the future.

Pre-cooling for endurance exercise performance in the heat: a systematic review.

BACKGROUND: Endurance exercise capacity diminishes under hot environmental conditions. Time to exhaustion can be increased by lowering body temperature prior to exercise (pre-cooling). This systematic literature review synthesizes the current findings of the effects of pre-cooling on endurance exercise performance, providing guidance for clinical practice and further research. METHODS: The MEDLINE, EMBASE, CINAHL, Web of Science and SPORTDiscus databases were searched in May 2012 for studies evaluating the effectiveness of pre-cooling to enhance endurance exercise performance in hot environmental conditions (≥ 28°C). Studies involving participants with increased susceptibility to heat strain, cooling during or between bouts of exercise, and protocols where aerobic endurance was not the principle performance outcome were excluded. Potential publications were assessed by two independent reviewers for inclusion and quality. Means and standard deviations of exercise performance variables were extracted or sought from original authors to enable effect size calculations. RESULTS: In all, 13 studies were identified. The majority of studies contained low participant numbers and/or absence of sample size calculations. Six studies used cold water immersion, four crushed ice ingestion and three cooling garments. The remaining study utilized mixed methods. Large heterogeneity in methodological design and exercise protocols was identified. Effect size calculations indicated moderate evidence that cold water immersion effectively improved endurance performance, and limited evidence that ice slurry ingestion improved performance. Cooling garments were ineffective. Most studies failed to document or report adverse events. Low participant numbers in each study limited the statistical power of certain reported trends and lack of blinding could potentially have introduced either participant or researcher bias in some studies. CONCLUSIONS: Current evidence indicates cold water immersion may be the most effective method of pre-cooling to improve endurance performance in hot conditions, although practicality must be considered. Ice slurry ingestion appears to be the most promising practical alternative. Interestingly, cooling garments appear of limited efficacy, despite their frequent use. Mechanisms behind effective pre-cooling remain uncertain, and optimal protocols have yet to be established. Future research should focus on standardizing exercise performance protocols, recruiting larger participant numbers to enable direct comparisons of effectiveness and practicality for each method, and ensuring potential adverse events are evaluated.

Reducing the Impact of Stereotype Threat on Women's Math Performance: Are Two Strategies Better Than One?

INTRODUCTION: Two studies examined whether stereotype threat impairs women's math performance and whether concurrent threat reduction strategies can be used to offset this effect. METHOD: In Study 1, collegiate men and women (N = 100) watched a video purporting that males and females performed equally well (gender-fair) or males outperformed females (gender differences) on an imminent math test. In Study 2, (N = 44) women viewed the gender differences video, followed by misattribution (cue present, absent) and self-affirmation (present, absent) manipulations, before taking the aforesaid test. RESULTS: In the initial study, women underperformed men on the test after receiving the gender differences video, whereas no gender differences emerged in the gender-fair condition. In Study 2, affirming the self led to better performance than not doing so. Planned contrasts indicated, however, that only women receiving a misattribution cue and self-affirmation opportunity outperformed their counterparts not given these reduction strategies. DISCUSSION: These findings are discussed relative to Stereotype Threat Theory and educational implications are provided.

Estimating alcohol and drug involvement in hospitalized adolescents with assault injuries.

PURPOSE: Adolescents using alcohol and drugs are at higher risk for assaultive behaviors. We examined adolescents aged 10 to 20 years who were hospitalized for assault injuries between July 1995 and December 1998 in Maryland to determine the demographic and injury-related predictors of the presence of drug/alcohol use among adolescents, and to estimate the presence of drug/alcohol use among adolescents with undetermined drug and/or alcohol use. METHODS: Patient records for adolescents were selected from 2189 discharges from the Maryland Trauma Registry and 1625 discharges from the Maryland Hospital Discharge data system. Three discrete groups of adolescents were identified: (1) those on the Trauma Registry and in the Hospital Discharge data system (N = 1197), (2) only those on the Trauma Registry (N = 992), or (3) only those in the Hospital Discharge data system (N = 428). Multiple logistic regression was performed to determine the predictors of the presence of drug/alcohol use among adolescents in the Trauma Registry. These models were then used to estimate the presence of drug/alcohol use among adolescents with undetermined drug and/or alcohol use. RESULTS: Age, sex, mechanism of injury, day of hospital admittance, and time of day were significant predictors of alcohol/drug use. The proportion of predicted alcohol/drug involved hospitalized cases varied from 54% to 66%. CONCLUSION: Our methodology and findings contribute to the understanding of the epidemiology of assaultive behaviors and the role of alcohol/drug use in injury among adolescents.

Bacterial community structure of biofilms on artificial surfaces in an estuary.

This study examined bacterial community structure of biofilms on stainless steel and polycarbonate in seawater from the Delaware Bay. Free-living bacteria in the surrounding seawater were compared to the attached bacteria during the first few weeks of biofilm growth. Surfaces exposed to seawater were analyzed by using 16S rDNA libraries, fluorescence in situ hybridization (FISH), and denaturing gradient gel electrophoresis (DGGE). Community structure of the free-living bacterial community was different from that of the attached bacteria according to FISH and DGGE. In particular, alpha-proteobacteria dominated the attached communities. Libraries of 16S rRNA genes revealed that representatives of the Rhodobacterales clade were the most abundant members of biofilm communities. Changes in community structure during biofilm growth were also examined by DGGE analysis. We hypothesized that bacterial communities on dissimilar surfaces would initially differ and become more similar over time. In contrast, the compositions of stainless steel and polycarbonate biofilms were initially the same, but differed after about 1 week of biofilm growth. These data suggest that the relationship between surface properties and biofilm community structure changes as biofilms grow on surfaces such as stainless steel and polycarbonate in estuarine water.