Thinking and Learning in Nested Systems: The Classroom Level.

Teaching and learning in college chemistry classrooms is affected by a variety of structural and psychosocial factors that influence classroom dynamics. In this second part of a two-part perspective [Talanquer et al. J. Chem. Educ.10.1021/acs.jchemed.3c00838], we review and discuss the results from research that has helped us understand the complex social and knowledge dynamics that emerge in interactive learning environments. We use this analysis to make explicit major insights about curriculum, instruction, assessment, teachers, and students gained in the past 25 years and to summarize their implications for chemistry education.

Spectroscopic Monitoring and Modeling Drug Dissolution for Undergraduate Chemistry Curriculum.

The pharmaceutical and medicine manufacturing industry has become the largest industrial sector for the employment of chemists, indicating a need for experiments with a pharmaceutical sciences context in the undergraduate chemistry curriculum. In the pharmaceutical industry, testing drug dissolution is a key analytical task for solid oral dosage forms that is performed in different phases of drug development to test the release behavior of new formulations, ensure consistency between manufacturing lots, and help predict the in vivo absorption of the drug substance after administration. However, there are a limited number of laboratory experiments in dissolution testing developed for the undergraduate chemistry curriculum. To help students obtain hands-on experience in dissolution testing, a protocol has been developed for an undergraduate chemistry laboratory course for students to build a dissolution apparatus, monitor dissolution processes, model the dissolution to extract kinetic parameters, and evaluate the consistency between dissolution curves with FDA regulated methods. Students successfully collected dissolution curves and completed the modeling analysis with nonlinear least-squares fitting. The designed dissolution protocol has been evaluated to have consistency and reproducibility to be implemented in the undergraduate chemistry laboratory curriculum.

Teaching little kids big sentences: A randomized controlled trial showing that children with DLD respond to complex syntax intervention embedded within the context of preschool/kindergarten science instruction.

BACKGROUND: The language of the science curriculum is complex, even in the early grades. To communicate their scientific observations, children must produce complex syntax, particularly complement clauses (e.g., I think it will float; We noticed that it vibrates). Complex syntax is often challenging for children with developmental language disorder (DLD), and thus their learning and communication of science may be compromised. AIMS: We asked whether recast therapy delivered in the context of a science curriculum led to gains in complement clause use and scientific content knowledge. To understand the efficacy of recast therapy, we compared changes in science and language knowledge in children who received treatment for complement clauses embedded in a first-grade science curriculum to two active control conditions (vocabulary + science, phonological awareness + science). METHODS & PROCEDURES: This 2-year single-site three-arm parallel randomized controlled trial was conducted in Delaware, USA. Children with DLD, not yet in first grade and with low accuracy on complement clauses, were eligible. Thirty-three 4-7-year-old children participated in the summers of 2018 and 2019 (2020 was cancelled due to COVID-19). We assigned participants to arms using 1:1:1 pseudo-random allocation (avoiding placing siblings together). The intervention consisted of 39 small-group sessions of recast therapy, robust vocabulary instruction or phonological awareness intervention during eight science units over 4 weeks, followed by two science units (1 week) taught without language intervention. Pre-/post-measures were collected 3 weeks before and after camp by unmasked assessors. OUTCOMES & RESULTS: Primary outcome measures were accuracy on a 20-item probe of complement clause production and performance on ten 10-item unit tests (eight science + language, two science only). Complete data were available for 31 children (10 grammar, 21 active control); two others were lost to follow-up. Both groups made similar gains on science unit tests for science + language content (pre versus post, d = 2.9, p < 0.0001; group, p = 0.24). The grammar group performed significantly better at post-test than the active control group (d = 2.5, p = 0.049) on complement clause probes and marginally better on science-only unit tests (d = 2.5, p = 0.051). CONCLUSIONS & IMPLICATIONS: Children with DLD can benefit from language intervention embedded in curricular content and learn both language and science targets taught simultaneously. Tentative findings suggest that treatment for grammar targets may improve academic outcomes. WHAT THIS PAPER ADDS: What is already known on the subject We know that recast therapy focused on morphology is effective but very time consuming. Treatment for complex syntax in young children has preliminary efficacy data available. Prior research provides mixed evidence as to children's ability to learn language targets in conjunction with other information. What this study adds This study provides additional data supporting the efficacy of intensive complex syntax recast therapy for children ages 4-7 with Developmental Language Disorder. It also provides data that children can learn language targets and science curricular content simultaneously. What are the clinical implications of this work? As SLPs, we have to talk about something to deliver language therapy; we should consider talking about curricular content. Recast therapy focused on syntactic frames is effective with young children.

Let Students Work: Analysis of the Role of Differing Facilitation on Student Engagement in a Large Stadium-Style Lecture Hall.

The classroom environment is shaped by factors such as facilitation style, curricular design, and classroom layout. These factors are all inputs into student framing of the classroom environment and affect a student's comfort interacting within it. Promoting student discourse in active learning environments provides students the opportunity to explain their thinking and develop their understanding of natural phenomena. However, successfully implementing these practices in large lecture environments is often difficult. Undergraduate introductory chemistry lectures were investigated to identify the effects that instructional practices had on student engagement. Instructor facilitation, question level, and student interactions were analyzed and compared to provide insights into what instructional practices may promote or hinder student engagement in a large enrollment course. Overall instructors were positioning themselves as an authority on knowledge in the classroom by leading questions authoritatively like instructor-focused didactic lecturing that led to a decrease in student engagement. These results highlight the complexity of the classroom ecosystem related to student interactions and the role that facilitation plays in social and cognitive engagement.

Representation in Online Prostate Cancer Content Lacks Racial and Ethnic Diversity: Implications for Black and Latinx Men.

PURPOSE: Black men have the highest incidence and mortality from prostate cancer (PCa) and lower quality of life compared to other U.S. racial groups. Additionally, more Latinx men are diagnosed with advanced disease and fewer receive guideline-concordant care. As many men seek medical information online, high-quality information targeting diverse populations may mitigate disparities. We examined racial/ethnic representation and information quality in online PCa content. MATERIALS AND METHODS: We retrieved 150 websites and 150 videos about "prostate cancer" using the most widely used search engine (Google) and social network (YouTube). We assessed quality of health information, reading level, perceived race/ethnicity of people featured in the content and discussion of racial/ethnic disparities. RESULTS: Among 81 websites and 127 videos featuring people, 37% and 24% had perceived Black representation, and racial/ethnic disparities were discussed in 27% and 17%, respectively. Among 1,526 people featured, 9% and 1% were perceived as Black and Latinx, respectively. No content with Black or Latinx representation was high quality, understandable, actionable and at the recommended reading level. CONCLUSIONS: Black and Latinx adults are underrepresented in online PCa content. Online media have significant potential for public education and combating health disparities. However, most PCa content lacks diversity and is not readily understandable.

Weight management behaviours mediate the relationship between weight cycling, BMI and diet quality among US Army Soldiers.

Weight cycling is prevalent in sports/professions with body composition standards, and has been associated with weight management behaviours that may contribute to suboptimal diet quality and weight gain. US Army Soldiers may be at increased risk of weight cycling relative to civilians due to mandated body composition standards. However, the relationship between weight cycling, weight management behaviours, BMI and diet quality among Soldiers is unknown. In this cross-sectional study, 575 Soldiers (89 % enlisted, 90 % male, 23 ± 4 years) at Army installations at Joint Base Elmendorf-Richardson, AK, Joint-Base Lewis McChord, WA, and Fort Campbell, KY completed questionnaires on food frequency, health-related behaviours and history of weight cycling (≥ 3 weight fluctuations ≥ 5 % body weight). Weight cycling was reported by 33 % of Soldiers. Those who reported weight cycling reported higher BMI (27 ± 4 v. 25 ± 3 kg/m2, P < 0·001) and higher prevalence of engaging in weight management behaviours prior to body weight screening but did not report lower dietary quality (Healthy Eating Index-2015 (HEI) scores 59 ± 10 v 59 ± 11, P = 0·46) relative to those who did not report weight cycling. Results of mediation analyses suggested that weight cycling may affect BMI both directly (c' = 1·19, 95 % CI: 0·62, 1·75) and indirectly (ab = 0·45, 95 % CI: 0·19, 0·75), and HEI scores indirectly (ab = 0·69, 95 % CI: 0·20, 1·35) through the adoption of weight management behaviours. Weight cycling is common in Soldiers and is associated with higher BMI and higher prevalence of engaging in weight management behaviours that mediate associations between weight cycling, BMI and diet quality.

Severe negative energy balance during 21 d at high altitude decreases fat-free mass regardless of dietary protein intake: a randomized controlled trial.

In this 2-phase randomized controlled study, we examined whether consuming a higher-protein (HP) diet would attenuate fat-free mass (FFM) loss during energy deficit (ED) at high altitude (HA) in 17 healthy males (mean ± sd: 23 ± 6 yr; 82 ± 14 kg). During phase 1 at sea level (SL, 55 m), participants consumed a eucaloric diet providing standard protein (SP; 1.0 g protein/kg,) for 21 d. During phase 2, participants resided at HA (4300 m) for 22 d and were randomly assigned to either an SP or HP (2.0 g protein/kg) diet designed to elicit a 40% ED. Body composition, substrate oxidation, and postabsorptive whole-body protein kinetics were measured. Participants were weight stable during SL and lost 7.9 ± 1.9 kg ( P < 0.01) during HA, regardless of dietary protein intake. Decrements in whole-body FFM (3.6 ± 2.4 kg) and fat mass (3.6 ± 1.3 kg) were not different between SP and HP. HP oxidized 0.95 ± 0.32 g protein/kg per day more than SP and whole-body net protein balance was more negative for HP than for SP ( P < 0.01). Based on changes in body energy stores, the overall ED was 70% (-1849 ± 511 kcal/d, no group differences). Consuming an HP diet did not protect FFM during severe ED at HA.-Berryman, C. E., Young, A. J., Karl, J. P., Kenefick, R. W., Margolis, L. M., Cole, R. E., Carbone, J. W., Lieberman, H. R., Kim, I.-Y., Ferrando, A. A., Pasiakos, S. M. Severe negative energy balance during 21 d at high altitude decreases fat-free mass regardless of dietary protein intake: a randomized controlled trial.

Self-reported eating behaviors of military recruits are associated with body mass index at military accession and change during initial military training.

Eating behaviors such as eating fast and ignoring internal satiety cues are associated with overweight/obesity, and may be influenced by environmental factors. This study examined changes in those behaviors, and associations between those behaviors and BMI, cardiometabolic biomarkers, and diet quality in military recruits before and during initial military training (IMT), an environment wherein access to food is restricted. Eating rate and reliance on internal satiety cues were self-reported, and BMI, body fat, cardiometabolic biomarkers, and diet quality were measured in 1389 Army, Air Force and Marine recruits (45% female, mean ±â€¯SEM BMI = 24.1 ±â€¯0.1 kg/m2) before and after IMT. Pre-IMT, habitually eating fast relative to slowly was associated with a 1.1 ±â€¯0.3 kg/m2 higher BMI (P < 0.001), but not with other outcomes; whereas, habitually eating until no food is left (i.e., ignoring internal satiety cues) was associated with lower diet quality (P < 0.001) and, in men, 1.6 ±â€¯0.6% lower body fat (P = 0.03) relative to those that habitually stopped eating before feeling full. More recruits reported eating fast (82% vs 39%) and a reduced reliance on internal satiety cues (55% vs 16%) during IMT relative to pre-IMT (P < 0.001). Findings suggest that eating behaviors correlate with body composition and/or diet quality in young, predominantly normal-weight recruits entering the military, and that IMT is associated with potentially unfavorable changes in these eating behaviors.

Epididymectomy Is an Effective Treatment for Chronic Epididymal Pain.

INTRODUCTION: Chronic scrotal pain is difficult to manage, and epididymectomy is a treatment option for a subset of men with pain localized to the epididymis. We sought to evaluate the efficacy of epididymectomy at our institution. METHODS: Between 2000 and 2020, 225 men underwent epididymectomy at our institution for pain localized to the epididymis and not part of a greater constellation of pelvic pain or urinary symptoms. Our primary outcome measure was change in pain after epididymectomy, categorized as cured/improved or no change/worsened. Multivariable logistic regression compared the impact of pain duration, and surgical and psychiatric histories on postoperative pain. RESULTS: Patients in both outcome categories-cured/improved and no change/worsened-were similar in age and BMI. Overall, 162 patients (72%) reported cured/improved pain at the last documented follow-up visit. Median follow-up time was 12 (IQR 1-364) weeks. About half of the cohort (n = 117, 52%) had a prior vasectomy, and there was no difference in outcome based on vasectomy history on multivariate analysis (OR 0.625, P = .3). Men with pain duration > 1 year (OR 0.46, P = .03), diagnosed psychiatric conditions (OR 0.44, P = .04), or prior scrotal/inguinal/abdominal surgeries other than vasectomy (OR 0.47, P = .03) had decreased odds of pain relief after epididymectomy. CONCLUSIONS: This 20-year analysis is the largest review of postepididymectomy outcomes reported. Among carefully screened men, 72% had resolution or improvement of scrotal pain. Epididymectomy is most effective for men with < 1 year of focal epididymal pain, with no history of psychiatric conditions or scrotal/inguinal/abdominal surgery other than vasectomy.

Nutrition Knowledge Is Associated With Diet Quality Among US Army Soldiers.

OBJECTIVE: Examine the relationship between nutrition knowledge, diet quality, and eating behavior among active-duty US Army Soldiers. METHODS: Cross-sectional study with data collection in February 2018 via paper surveys during the validation of the Military Eating Behavior Survey. RESULTS: Among 440 US Army Soldiers, nutrition knowledge was positively and significantly associated with diet quality (b = 0.29, P < 0.001). For every 1-point increase in nutrition knowledge, the Healthy Eating Index-2015 score was expected to increase by 0.29 points. Nutrition knowledge was not significantly associated with skipping breakfast (odds ratio, 1.01; 95% confidence interval, 0.98-1.04) or dining out (odds ratio, 1.01; 95% confidence interval, 0.98-1.03). CONCLUSIONS AND IMPLICATIONS: The outcomes of this study warrant further investigation to determine what interventions provide the strongest outcomes for improving nutrition knowledge and diet quality, as well as create and support an environment that enhances healthy behaviors regarding nutrition that lead to improved diet quality among active-duty Soldiers.

Air Quality Implications of Using Ammonia as a Renewable Fuel: How Low Can NOx Emissions Go?

In addition to their lifecycle carbon emissions, another important issue with decarbonized energy pathways is their air quality, water, or land use implications. This paper considers the air quality issue for ammonia combustion. When directly combusting ammonia, reactions of its N atom with atmospheric oxygen lead to NOx emissions that are O(103) ppm, 2 orders of magnitude higher than EPA limits or the amount emitted by current natural-gas-fired technologies. In order to provide guidance to policymakers and technologists on what is fundamentally possible, this Perspective analyzes the fundamental minimum NOx emissions that can be produced from ammonia combustion. The analysis shows that it is possible to achieve quite low NOx emission levels of O(10) ppm, but these designs differ markedly from those used in today's lean, premixed combustion systems.

Adjusting body weight for edema in severely burned patients.

Weight loss is difficult to quantify in critically ill burn patients, as the presence of edema can mask changes in dry body weight. We sought to estimate dry body weight using measured weights adjusted for reported extremity edema. We evaluated patients with at least 20% total body surface area (TBSA) burns admitted to our intensive care unit over a 3½-year period. Body weights were collected for this analysis from admission to the time of a recorded dry weight after wound healing. Extremity edema was collected at the time of each weight measurement and was categorized into three groups: (1) no edema, (2) 1 + pitting edema, (3) 2 + or 3 + pitting edema. Logistic regression yielded the following formula for estimating dry weight (in kg): 0.66 x measured body weight + 25 - (3 for 1 + pitting edema or 4 for 2 + or 3 + pitting edema of either upper extremity) - (4 for any pitting edema to either lower extremity) (p < 0.01, R2 = 0.81). These results may allow us to better estimate dry body weight changes in our edematous patients with severe burns. Nutrition goals can be adjusted earlier, when appropriate, based on these estimated dry body weight changes.

Go for Green® Nutrition Program: Translating Evidence Into Practice.

INTRODUCTION: Go for Green® (G4G) is an evidence-based, multi-component nutrition program for military dining facilities (DFAC) to improve nutritional fitness among Service Members. The program evolved from supporting "fueling" during initial Army training into a robust intervention across all U.S. Military branches. The current G4G program consists of eight program requirements to optimize the nutrition environment, including traffic light labeling, nutritious menus, choice architecture, food promotion, marketing, and staff training. The evolution of the G4G program, development of standardized program requirements, and lessons learned are described. MATERIALS AND METHODS: The latest scientific evidence, best practices in health promotion and nutrition education, results and data from G4G implementation in the military community support the current version of G4G. Feedback and observations from program developers, military branch foodservice headquarters, installation leadership, and local G4G DFAC teams provided insight into implementation challenges, successes, facilitators, and barriers. RESULTS: The G4G program has evolved and expanded from its initial inception over 10 years ago to its current version. Research studies, nutrition science, and feedback from military community stakeholders have informed programmatic changes and improvements. CONCLUSIONS: G4G 2.0 is a robust, innovative, multi-component, performance nutrition program with clear program element requirements. Value was added to elevate the G4G program by setting program requirements, expanding program components, and establishing a centralized resource hub. Performance nutrition initiatives in local military DFAC for dining facilities, such as G4G 2.0, has great potential to impact the health and well-being of Service Members.

Multidisciplinary intervention with sibutramine: assessing successful weight loss predictors in military adolescent dependents.

OBJECTIVES: Assess body mass index (BMI) reduction through a multidisciplinary intervention with sibutramine in adolescents of military parents and examine characteristics and behavioral traits as predictors of successful weight loss. METHODS: A prospective study where participants received sibutramine daily for 6 months. Adolescents ages 12 to 18 with BMI-for-age and sex greater than 95 percentile and good health were enrolled. Outcome variables are BMI, biochemical indices, and clinical measurements. Predictor variables are participant demographics, family history, lifestyle changes, and behavioral traits assessed with behavioral assessment for children. RESULTS: One hundred participants were recruited with 81% completion. In those participants who completed the 6-month intervention, a mean participant BMI reduction of 3.1 kg/m2 (-9.3%) (p < 0.001; 95% CI: -10.5% to -7.9%) was obtained with 79% successfully meeting the weight loss goal. Sibutramine dose was increased from 10 to 15 mg at 3 months for participant with <2.5% BMI reduction from baseline. Sibutramine dose at 3 months (p < 0.001) and participants perception of relationship with parents (p = 0.05) were statistically significant predictors of successful weight loss (> or =10% reduction in BMI). CONCLUSIONS: Sibutramine was effective at promoting minimum beneficial BMI reduction of 5% in adolescents with service-connected parents; however, increasing dosage at 3 months did not improve the likelihood of being successful.

Systematic review of sleep and sleep disorders among prostate cancer patients and caregivers: a call to action for using validated sleep assessments during prostate cancer care.

OBJECTIVE/BACKGROUND: To examine the impact of prostate cancer (PCa) on sleep health for patients and caregivers. We hypothesized that sleep disturbances and poor sleep quality would be prevalent among patients with PCa and their caregivers. PATIENTS/METHODS: A systematic literature search was conducted according to the Preferred Reporting Items for a Systematic Review and Meta-analysis guidelines. To be eligible for this systematic review, studies had to include: (1) patients diagnosed with PCa and/or their caregivers; and (2) objective or subjective data on sleep. 2431 articles were identified from the search. After duplicates were removed, 1577 abstracts were screened for eligibility, and 315 underwent full-text review. RESULTS AND CONCLUSIONS: Overall, 83 articles met inclusion criteria and were included in the qualitative synthesis. The majority of papers included patients with PCa (98%), who varied widely in their treatment stage. Only 3 studies reported on sleep among caregivers of patients with PCa. Most studies were designed to address a different issue and examined sleep as a secondary endpoint. Commonly used instruments included the Insomnia Severity Index and European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaires (EORTC-QLQ). Overall, patients with PCa reported a variety of sleep issues, including insomnia and general sleep difficulties. Both physical and psychological barriers to sleep are reported in this population. There was common use of hypnotic medications, yet few studies of behavioral interventions to improve sleep for patients with PCa or their caregivers. Many different sleep issues are reported by patients with PCa and caregivers with diverse sleep measurement methods and surveys. Future research may develop consensus on validated sleep assessment tools for use in PCa clinical care and research to promote facilitate comparison of sleep across PCa treatment stages. Also, future research is needed on behavioral interventions to improve sleep among this population.

Impact of prostate biopsy technique on outcomes of the precision prostatectomy procedure.

Objective: To assess the impact of iterative changes in preoperative and postoperative biopsy techniques on the outcomes of men undergoing the precision prostatectomy procedure. Precision prostatectomy is a novel surgical treatment for prostate cancer that aims to maximally preserve erectogenic nerves via partial preservation of the prostate capsule. Design: Retrospective. Setting: Single tertiary care center. Participants: This study included 120 patients who consented to undergo prostate cancer treatment with the precision prostatectomy procedure. Patients were originally enrolled in one of two separate prospective protocols studying precision prostatectomy. Interventions: Preoperatively, 60 patients were screened with transrectal (TR) biopsy and 60 were screened by transperineal (TP) biopsy. Ultimately, 117 patients underwent precision prostatectomy. Of the 43 postoperative biopsies, 19 were TR; 17 were TP with ultrasound; and 7 were TP with microultrasound (mUS). Main outcome measures: Preoperatively, we evaluated whether the transition to TP biopsy was associated with differences in postoperative treatment failure defined as a neoplasm-positive postoperative biopsy. Postoperative biopsies were compared with respect to their ability to sample the remnant tissue, specifically percentage of cores positive for prostate tissue. Results: Preoperatively, 9/60 (15%) positive postoperative biopsies occurred in the TR group and 6/60 (10%) in the TP group; Kaplan-Meier survival estimates did not differ between groups (p=0.69 by log rank). Postoperatively, the numbers of cores positive for prostate tissue were 99/160 (62%), 63/107 (59%), and 36/39 (92%) in the TR biopsy, TP with ultrasound, and TP with mUS groups, respectively; this difference was statistically significant versus the rate in the TR and standard TP groups (p=0.0003 and 0.0002). Conclusion: We found no significant improvement in patient screening, preoperatively-though limited by small sample size and relatively short follow-up. The incorporation of high-frequency mUS for postoperative biopsies improved the ability to sample the remnant tissue with a higher efficiency.

Healthy Eating Score-7 as a Measure of Diet Quality in a Military Population.

OBJECTIVE: Identify potential revisions to the Healthy Eating Score (HES-5) that improve associations with the Healthy Eating Index (HEI) -2015 total and component scores. METHODS: Pearson r correlations were determined from soldiers' (n = 433) survey data, including the HES, proposed additional questions, and the Block Food Frequency Questionnaire. RESULTS: Adding sugar-sweetened beverages and energy drink questions (HES-7) strengthened the HES and HEI-2015 correlation (HES-5; r = 0.42, n = 433, r2 = 0.18, P < 0.001) (HES-7; r = 0.52, r2 = 0.27, P < 0.001). The HES components and Block Food Frequency Questionnaire consumption correlations were as follows: quantity of fruit (r = 0.37, r2 = 0.14, P < 0.001), vegetables (r = 0.41, r2 = 0.17, P < 0.001), whole grains (r = 0.35, r2 = 0.12 P < 0.001), dairy (r = 0.34, r2 = 0.12, P < 0.001), fish (r = 0.31, r2 = 0.10, P < 0.001), and energy drink (r = 0.59, r2 = 0.35, P < 0.001). CONCLUSIONS AND IMPLICATIONS: HES-7 had the strongest correlation with HEI-2015. Future studies can explore if including consumption quantity in the HES improves its representation of diet quality.

The Challenge of Rich Vocabulary Instruction for Children With Developmental Language Disorder.

Purpose The aims of the study were to explore responses of children with developmental language disorder (DLD) to rich vocabulary instruction and to identify potential factors that contribute to outcomes. Method Children with DLD participated in a language intervention embedded within a science camp. Using parent and clinician reports, standardized tests, probes, notes, and video, we derived descriptions of seven of the campers who received a vocabulary intervention that incorporated principles of rich instruction. We present them here as a case series. Results Five cases responded to the intervention with modest gains in Tier 2 science vocabulary and science knowledge. One case demonstrated no response, and another was unable to complete the intervention. The latter two cases presented with triple risks: DLD, executive function deficits, and stressors associated with poverty. In comparison, the best responder also lived in poverty and had DLD, but he had intact executive function, strengths in extant vocabulary, stronger knowledge of science, better engagement in the science and language intervention activities, and was older. Other factors that seemed to contribute to outcomes included the complexity of the word forms and dosage. Conclusions Translating research on rich instruction to clinical practice is challenging. This case series motivated hypotheses about the nature of the challenge and what to do about it, the primary one being that the modest success of rich vocabulary instruction for children with DLD is not a limitation of the approach itself but rather a reflection of the difficulty of delivering the intervention while tailoring the targets, approach, and dosage to the needs of individual children with DLD. Supplemental Material https://doi.org/10.23641/asha.13667699.

Barriers to Nutrition Interventions in Army Dining Facilities: A Qualitative Study.

INTRODUCTION: Interventions that encourage good nutrition-related behaviors in the dining environment can potentially influence the health of large numbers of military personnel. Thus, the Army has studied the effectiveness of implementing nutrition education and dining facility (DFAC) changes that included healthier recipes, revised menus, and population-specific point-of-choice labeling, but successful intervention implementation largely depends on the foodservice employees' understanding, knowledge, and desire to sustain changes. This phenomenological, qualitative study aimed to better understand common barriers to the implementation and sustainment of DFAC-based nutrition interventions at two U.S. Army DFACs. MATERIALS AND METHODS: Focus group sessions (n = 168 participants) ranging from 60 to 90 minutes in length were conducted at two large DFACs on three separate occasions every 4 months from May 2015 to January 2016 among the foodservice staff during intervention implementation. Focus group transcripts were analyzed using NVivo 11 software. Researchers conducted multiple rounds of coding following an iterative process until four principal themes emerged. RESULTS: Principal themes related to the foodservice employees' experience during the nutrition intervention revealed barriers to a successful implementation related to (1) nutrition knowledge deficits, (2) inadequate culinary training, (3) poor management practices, and (4) low staff morale. CONCLUSION: A lack of foodservice staff training and education is a significant contributor to implementation barriers. Future interventions should increase engagement with foodservice employees during intervention planning and implementation phases with a structured and tailored nutrition education and culinary skill training program. Addressing these barriers may enhance staff morale and promote intervention adherence.

Development and Validation of the Military Eating Behavior Survey.

OBJECTIVE: To describe the Military Eating Behavior Survey (MEBS), developed, and validated for use in military populations. DESIGN: Questionnaire development using a 6-phase approach that included item generation, subject matter expert review, cognitive interviewing, factor analysis, test-retest reliability testing, and parallel forms testing. SETTING: US Army soldiers were surveyed at 8 military bases from 2016 to 2019 (n = 1,561). MAIN OUTCOME MEASURE: Content, face, and construct validity and reliability of the MEBS. ANALYSIS: Item variability, internal consistency, and exploratory factor analysis using principal coordinates analysis, orthogonal varimax rotation, and scree test (correlation coefficient and Cronbach alpha), as well as consistency and agreement (intraclass correlation coefficient) of test-retest reliability and parallel forms reliability. RESULTS: Over 6 phases of testing, a comprehensive tool to examine military eating habits and mediators of eating behavior was developed. Questionnaire length was reduced from 277 items to 133 items (43 eating habits; 90 mediating behaviors). Factor analysis identified 14 eating habit scales (hunger, satiety, food craving, meal pattern, restraint, diet rigidity, emotional eating, fast/slow eating rate, environmental triggers, situational eating, supplement use, and food choice) and 8 mediating factor scales (body composition strategy, perceived stress, food access, sleep habits, military fitness, physical activity, military body image, and nutrition knowledge). CONCLUSIONS AND IMPLICATIONS: The MEBS provides a new approach for assessing eating behavior in military personnel and may be used to inform and evaluate health promotion interventions related to weight management, performance optimization, and military readiness and resiliency.