Student feedback to improve the United States Department of Agriculture Fresh Fruit and Vegetable Program

BACKGROUND/OBJECTIVES: Fruit and vegetable consumption of children in the United States falls below recommendations. The U.S. Department of Agriculture Fresh Fruit and Vegetable Program (FFVP) is a national free-fruit and vegetable school distribution program designed to address this problem. This permanent, legislated program provides funding to qualified elementary schools for provision of additional fruit and vegetables outside of school meals. The objective of this study was to understand children's perceptions of FFVP after the intervention and formulate recommendations that may improve success of the intervention. SUBJECTS/METHODS: Secondary data were obtained from 5,265 4th-6th graders at 51 randomly-selected FFVP intervention schools in Indiana. Anonymous questionnaires were completed late in the 2011-2012 academic year. Multilevel logistic regressions were used to determine associations between students' perceptions of program effects (4 close-ended items) and their preference toward the program. Content analysis was applied to a single open-ended item for program comments. RESULTS: Over 47% of students reported greater intake of fruit and vegetables due to FFVP, and over 66% reported liking the program. Student-reported program effects were positively associated with preference for the program (P < 0.01). Themes that emerged during analysis of 3,811 comments, included, students liked: the opportunity to try different kinds of fruit and vegetables, types and flavors of fruits served, and benefits of eating fruit. Fewer students liked the types of vegetables and their benefits. A small group disliked the program citing poor flavor of vegetables and quality of fruits. Important suggestions for the program include serving more dipping sauces for vegetables, cooking vegetables, and providing a greater variety of produce. CONCLUSIONS: The degree that students liked FFVP may predict the program's effects on fruit and vegetable intake. FFVP may become more acceptable to students by incorporating their suggestions. Program planners should consider these options for achieving program goals.

Student feedback to improve the United States Department of Agriculture Fresh Fruit and Vegetable Program

BACKGROUND/OBJECTIVES: Fruit and vegetable consumption of children in the United States falls below recommendations. The U.S. Department of Agriculture Fresh Fruit and Vegetable Program (FFVP) is a national free-fruit and vegetable school distribution program designed to address this problem. This permanent, legislated program provides funding to qualified elementary schools for provision of additional fruit and vegetables outside of school meals. The objective of this study was to understand children's perceptions of FFVP after the intervention and formulate recommendations that may improve success of the intervention. SUBJECTS/METHODS: Secondary data were obtained from 5,265 4th-6th graders at 51 randomly-selected FFVP intervention schools in Indiana. Anonymous questionnaires were completed late in the 2011-2012 academic year. Multilevel logistic regressions were used to determine associations between students' perceptions of program effects (4 close-ended items) and their preference toward the program. Content analysis was applied to a single open-ended item for program comments. RESULTS: Over 47% of students reported greater intake of fruit and vegetables due to FFVP, and over 66% reported liking the program. Student-reported program effects were positively associated with preference for the program (P < 0.01). Themes that emerged during analysis of 3,811 comments, included, students liked: the opportunity to try different kinds of fruit and vegetables, types and flavors of fruits served, and benefits of eating fruit. Fewer students liked the types of vegetables and their benefits. A small group disliked the program citing poor flavor of vegetables and quality of fruits. Important suggestions for the program include serving more dipping sauces for vegetables, cooking vegetables, and providing a greater variety of produce. CONCLUSIONS: The degree that students liked FFVP may predict the program's effects on fruit and vegetable intake. FFVP may become more acceptable to students by incorporating their suggestions. Program planners should consider these options for achieving program goals.

Deduction and Verification of Optimal Factors for Stent Structure and Mechanical Reaction Using Finite Element Analysis / 의학물리

Recently, along with technology development of endoscopic equipment, a stent has been developed for the convenience of operation, shortening of recovery times, and reduction of patient's pain. To this end, optimal factors are simulated for the stent structure and mechanical reaction and verified using finite element analysis. In order to compare to present commercialized product such as Zilver (Cook, Bloomington, Indiana, USA) and S.M.A.R.T (Cordis, Bridgewater Towsnhip, New Jersey, USA), mechanical impact factors were determined through Taguchi factor analysis, and flexibility and expandability of all the products including ours were tested using finite element analysis. Also, important factors were sought that fulfill the optimal condition using central composition method of response surface analysis, and optimal design were carried out based on the important factors. From the centra composition method of Response surface analysis, it is found that importat factors for flexibility is stent thickness (T) and unit area (W) and those for expandability is stent thickness (T). In results, important factors for optimum condition are 0.17 mm for stent thickness (T) and 0.09 mm2 for unit area (W). Determined and verified by finite element analysis in out research institute, a stent was manufactured and tested with the results of better flexibility and expandability in optimal condition compared to other products. Recently, As Finite element analysis stent mechanical property assessment for research much proceed. But time and reduce expenses research rarely stent of optimum coditions. In this research, Important factor as mechanical impact factor stent Taguchi factor analysis arrangement to find flexibility with expansibility as Finite element analysis. Also, Using to Center composition method of Response surface method appropriate optimized condition searching for important factor, these considering had design optimized. Production stent time and reduce expenses was able to do the more coincide with optimum conditions. These kind of things as application plan industry of stent development period of time and reduce expenses etc. be of help to many economic development.

Comparison of the Complications and Urodynamic Parameters for Orthotopic Bladder Substitution with using Ileocolic or Ileal Segments after Radical Cystectomy / 대한비뇨기과학회지

PURPOSE: The objective of this study was to compare the complications and urodynamic parameters of the patients who underwent orthotopic bladder substitution with using ileocolic or ileal segments after radical cystectomy for treating invasive bladder cancer. MATERIALS AND METHODS: Between January 1990 and April 2006, 260 patients with invasive bladder cancer underwent radical cystectomy and construction of the urinary diversion; ileal conduit, indiana pouch, ileocolic neobladder, ileal neobladder were all done at St. Mary's Hospital. The mean age of the patient was 61.8 years (range: 46-86). The ratio of male and female was 88%/12%. Forty nine patients received an orthotopic ileocolic neobladder and 45 patients received an orthotopic ileal neobladder. The complications and urodynamic parameters were compared in both groups. RESULTS: The orthotopic ileocolic neobladder after radical cystectomy for treating invasive bladder cancer has been performed between 1990 and 1996 and the orthotopic ileal neobladder has been performed between 1996 and 2006. Ileocolic neobladder related complications developed in 10 patients; neobladder leakage in 1 (2%), neobladder rupture in 1 (2%), stricture of the ureteroenteric anastomosis site in 4 (8.2%), and stricture of the urethral anastomosis site in 4 (8.2%). Ileal neobladder related complications developed in 11 patients; ureteroenteric stricture in 7 (15.5%), stricture of the urethral anastomosis site in 3 (6.6%) and acute pyelonephritis in 1 (2.2%). The results of the mean maximal flow rate and mean postvoid residual volume were better in the ileal neobladder group than those in the ileocolic neobladder group. CONCLUSIONS: There were no significant differences in complications between ileocolic neobladder and ileal neobladder. The maximal uroflow and residual urine volume of the ileal neobladder were superior to those of the ileocolic neobladder on urodynamic study.

Cyclopamine Inhibits Cancer Cell Proliferation in Thyroid Cancer Cell Lines / 대한내분비외과학회지

PURPOSE: The Hedgehog (HH) signaling pathway is important in development. Recently,ectopic activation of this pathway has been implicated in several forms of solid cancer including basal cell carcinoma, pancreatic cancer, colon cancer, and prostate cancer. There are three HH proteins involved in the pathway: Sonic HH, Indiana HH, and Desert HH. Cyclopamine disrupts Sonic HH signaling by inhibition of the seven-transmembrane receptor Smoothened (SMO). Whereas cyclopamine is cytotoxic to several human cancer cells, its effect on thyroid cancer cellsis unknown. We therefore investigated the effect of cyclopamine on cell proliferation in human thyroid cancer cell lines. METHODS: We used fivethyroid cancer cell lines: TPC-1 (papillary), FTC-133, FTC-236, FTC-238 (follicular), and XTC-1 (Hurthle cell). The MTT assay and cell cycle analysis were used to evaluate anti-proliferative effects. Tomatidine, a structural analogue of cyclopamine, was used as a control agent. Statistical significance was tested by ANOVA. RESULTS: After 4 days of treatment, the percent inhibition of growth with a concentration of 5, 10, and 20 M cyclopamine in the cell lines were 23.6±4.9%, 66.4±4.7% and 69.3±1.3% in TPC-1 7.5±2.8%, 10.7±3.2% and 49.6±6.4% in FTC-133, 19.2±9.5%, 50.4±4.8% and 60.4±2.0% in FTC- 236 22.8±4.2%, 53.4±5.5% and 63.7±4.8% in FTC- 238 7.6±5.8%, 16.6±2.2%, 24.0±4.3% in XTC-1. Treatment with tomatidine at the same concentrations did not significantly affect cell growth. Exposure to cyclopamine, however, did not affect the cell cycle significantly CONCLUSION: Cyclopamine inhibits cancer cell proliferation in a dose dependent manner in thyroid cancer cell lines. The Hh signaling pathway might be a useful therapeutic target for thyroid cancer.

Cementless Bipolar Hemiarthroplasty for Femoral Neck Fracture in Patients More than Eighty Years Old / 대한정형외과학회잡지

PURPOSE: This study evaluated the minimum 3 year follow-up results of cementless bipolar hemiarthroplasty in elderly patients more than 80 years of age with a femoral neck fracture. MATERIALS AND METHODS: 57 cementless bipolar hemiarthroplasties for femoral neck fractures were performed in elderly patients more than 80 years of age between January 1996 and December 2000. The clinical, radiological results and bone mineral density of 38 hips in 35 patients who could be followed up for at least 3 years were analyzed. The mean age of the patients was 82.5 years (80 to 100 years). 29 patients were women and 6 were men. For all cases, an identical prosthesis (VerSys(R) fiber metal midcoat collarless stem, Zimmer, Warsaw, Indiana, USA) was implanted. RESULTS: The average follow-up period was 41 months (36 to 62 months). The average Harris Hip Score was 76.4+/-14.1 points at the time of the most recent follow-up. An excellent score (90-100 points) was recorded in 2 hips (5%), good (80-89 points) in 10 hips (26%), fair (70-79 points) in 21 hips (55%) and poor (60-69) in 5 hips (13%). The radiological assessment showed that all stems were biological stable, with 20 stems (53%) showing bony ingrowth and 18 stems (47%) having stable fibrous fixation. No cup migration, osteolysis, vertical subsidence, pedestal reaction and varus deposition of the stem etc. were observed. The mean T value of the bone mineral density (BMD) was -3.75+/-0.75 and was not related to the clinical and radiological results. CONCLUSION: Cementless bipolar hemiarthroplasty for elderly patients more than 80 years of age with a femoral neck fracture showed satisfactory short-term results with no relationship to the severity of osteoporosis.

Tibial Plateau Coverage in Total Knee Replacement Arthroplasty: Coverage on 12 quadrants / 대한정형외과학회잡지

PURPOSE: We investigated proximal tibial cutting surface in total knee replacement arthroplasty to improve its coverage and get basic data for developing more adequate tibial components for Koreans. MATERIALS AND METHODS: Of cases of total knee replacement arthroplasty performed by one surgeon between September 1995 and October 1996, we chose 100 cases with no bony defect on resected tibial surface. We traced the outline of tibial resection margin manually and then, decided the most adequate size for each tibial tray from 5 companies, AGC (Biomet, Warsaw, USA), Advantim (Wright medical technology, Arlington, USA), AMK (DePuy, Warsaw, USA), MGII (Zimmer, Indiana, USA), and Series 7000 (Osteonics, New Jersey, USA). We divided the tibial cutting surface with 12 quadrants by 30 degree radian. Then, we overlaped both images (traced tibial surface margin and tibial tray) on the computer and fixed the position when we got the largest coverage of area. From this position we calculated the coverage, underhang and overhang ratios by pixel counts. During this process, we discarded 20 cases because of inadequate overlapping. RESULTS: The overall average ratio of coverage was 82.3%, underhang 17.3%, and overhang 6.0%. The consequence of good coverage and minimal underhang were posterolateral, posteromedial, anterolateral, anteromedial and posterior aspects sequentially. But the posterior side was more overhanged by tibial component than anterior side. CONCLUSION: We feel that improving coverage on posterior and anteromedial portion is key to increasing the coverage ratio of proximal tibia in total knee replacement arthroplasty.

Deep Vein Thrombosis after Cementless Total Hip Replacement Arthroplasty Using Doppler Ultrasound / 대한정형외과학회잡지

Venous thromboembolic disease is a frequent complication after total hip arthroplasty. However, in Korea, the low incidence of deep vein thrombosis after total hip arthroplasty was reported. In this study, we present the results of 82 consecutive patients(90 hips) who had a cementless total hip replacement with a Anatomic Medullary Locking Component(AML: Depuy, Warsaw, Indiana, USA) between August 1995 and September 1996 at Inha University Hospital, Korea. Postoperatively, none of the patients were treated with any known prophylatic method for deep vein thrombosis except elastic stockings. Both preoperatively and six weeks after surgery, all patients were studied by an radiologist using a portable Doppler ultrasonic velocity detector with a transmission frequency of 5 megahertz. Contrast phlebography was also done in all patients at the same time as the Doppler ultrasound. In addition, coagulation assays, a complete blood count, blood typing, and serum chemical-profile tests were done for all patients. In comparing the results of these laboratory tests from the DVT group and from the non-DVT group, we found that only eight patients(9.8%) out of eighty-two patients had DVT after total hip arthroplasty. Thrombi were found in the superficial femoral vein in five cases and in the common femoral vein in three cases. Though two(2.4%) patients showed suspicious symptoms of pulmonary embolim, their perfusion lung scans were negative. The DVT group show a significantly shorter activated partial thromboplastin time than did the non-DVT group(P<0.05). In addition, the DVT group showed significantly higher serum total protein than the total protein level of the non-DVT group(P<0.01). In this two groups, there was no difference between the results of Doppler ultrasound and the results of contrast phlebography. Consequently, the incidence of deep vein thrombosis after total hip replacement arthroplasty in Korean patients is significantly lower than incidence in patients from countries other than Korea. Doppler ultrasound was a non-invasive and the most reliable diagnostic technique for deep vein thrombosis.

Tibial Plateau Coverage in total knee Replacement arthroplasty

Maximizing tibial coverage is an important consideration in total knee replacement arthroplasty to provide stability and even load transfer and to improve long term survival rate of the implants. We evaluated the coverage, underhang and overhang ratio for the proximal tibial resection surface during total knee replacement arthroplasty in Koreans. After cutting the proximal tibia, the outline of tibial resection surface was traced manually. We compared 5 tibial tray designs, AGC(Biomet, Warsaw, U.S.A.), Advantim(Wright medical technology, Arlington, U.S.A.), AMK(DePuy, Warsaw, U.S.A), MG II(Zimmer, Indiana, U.S.A.), Series 7000(Osteonics, New Jersey, U.S.A.), which have been commercially used in Korea for total knee replacement arthroplasty. The average percentage of coverage area were 83.3% in AGC, 81.6% in AMK, 80.3% in MG II, 80.2% in Advantim and 76.9% in Series 7000. The average percentage of underhang were 16.7% in AGC, 18.4% in AMK, 19.6% in MG II, 19.8% in Advantim and 23,1% in Series 7000. The average percentage of overhang were measured 7.97% in AGC, 7.86% in AMK, 8.01% in MG II, 8.77% in Advantim and 10.14% in Series 7000. So average coverage percentage of tibial cutting surface was 80.5% in Koreans. The factors which affect the optimal coverage, were the shape, dimensional interval of tibial trays and the number of practically useful tibial trays for Koreans.

Use of Gastrointestinal Segment in Urinary Diversion / 대한비뇨기과학회지

We have studied general patient characteristics, the early and late postoperative complications associated with each procedure and the results of urodynamic studies in 29 patients who had received various kinds of urinary diversion at the Dept. of Urology, Dong-A University Hospital from May 1990 to May l994. The results are as follows. 1. Of 29 urinary diversions, ileal conduit was performed in 18 patients, appendicoureterocutaneostomy in 2, Indiana pouch in 8 and rectal pouch in l. The surgical indications were bladder tumor in 28 and pelvic actinomycosis in 1 2. Sex ratio between male and female was 22:7. Average age according to each procedure was 67,4 years old in ileal conduit group, 62.5 years old in appendicoureterocutaneostomy, 54.3 years old in lndiana pouch, and 33.0 years old in rectal pouch. Average operative time ranged from 275.5 to 647.5 minutes. with lndiana pouch group taking maximum time and appendicoureterocutaneostomy group taking the least time. 3. There was no change in postoperative renal function and serum electrolytes. Concerning the period of hospital stay, ileal conduit in 21.3 days, Indiana pouch group was 28.7 and appendicoureterocutaneostomy in 20.5 days being the shortest of all. 4. Wound infection was most common early postoperative complication occurring in 5 out of 29 patients. Anastomotic leakage was seen in 2 out of 18 ileal conduits, 2 paralytic ileus in ilea1 conduit and lndiana pouch each. 5. Six months postoperative cystometric studies show the average volume and average reservoir pressure of 533.3ml and 22.7cmH2O in lndiana pouch and 38.0cmH2O in rectal pouch which is greater than the maximum intraluminal pressure. In conclusion, the author believes that the urologic surgeon should be familiar with several procedures, because these procedures should be tailored to the patient's anatomy, prior surgery, renal function and preference.

Ureteroappendicocutaneostomy(Appendix conduit): 4 Cases / 대한비뇨기과학회지

Cutaneous urinary diversion with intestinal conduits after cystectomy in bladder cancer has been popular. However, because of loss of continence and storage capacity of the lower urinary tract, the situation of patients with an ileal conduit was far from satisfactory with respect to quality of life. Recently, continent urinary diversion has begun to achieve worldwide popularity as Kock, Mainz, or Indiana pouch techniques have been more feasible and accessible, but these techniques have been known as time consuming procedures. In high risk patients with bladder carcinoma more simple techniques of urinary diversion is needed. Herein, we report the outcome of ureteroappendicocutaneostomy (appendix conduit) with radical cystectomy performed in 4 bladder carcinoma patients in whom unilateral nephroureterectomy was necessary or previously done.

Urinary diversion in conjunction with radical cystectomy in bladder cancer patient / 대한비뇨기과학회지

Several different methods of urinary diversion currently are available in conjunction with radical cystectomy. We reviewed our last 30 months of experience with diversion in 56 patients with bladder cancer undergoing surgery from May, 1990 through October. 1992 and focused on the decision- making process used to select the type of diversion. The results obtained were as follows. 1. Of the 56 patients. 27 patients had a diversion with an external appliance (26 via an ileal conduit and 1 via a cutaneous ureterostomy), 15 patients had a diversion with a continent urinary reservoir(Indiana pouch) and 14 patients had a diversion with an internal reservoir anastomosed to the urethra( 13 via an ileocolic neobladder and 1 via a Camey procedure). 2. The ileal conduit was evenly performed during the period. But the Indiana pouch was more performed between May 1990 and April 1991 and the ileocolic neobladder was mainly per formed since May 1991. 3. There were 50 men and 6 women. The majority of female patients (83%) underwent the Indiana pouch. The ileocolic neobladder was performed in patients who were relatively young and in good medical condition. 4. Urodynamic studies of the Indiana pouch and ileocolic neobladder performed at 6 months postoperatively showed low pressure, large capacity reservoir and high outlet (plicated ileum or urethra) resistance. All patients achieved satisfactory continence during the day. However.1 or 13 patients who underwent the ileocolic neobladder was incontinent at night. In conclusion. there are inherent advantages and disadvantages to each form of urinary diversion. Our general policy is the ileal conduit remains the most wise diversion in most patients but the alternative methods may be reasonable in certain circumstances and patients selection will be important to identify the most appropriate method of diversion for individual. Though the follow-up period is not long enough. Indiana pouch and ileocolic neobladder met the demands for ideal form of urinary diversion. With improvement in the technical aspects or the continent and internal functional reservoir, the number of patients having these reservoirs will increase.

Changes of Serum Glucose according to Sensory Block Level and Intrathecal Epinephrine , Morphine during Spinal Anesthesia / 대한마취과학회지

The purpose of this study was to observe the effect of spinal anesthesia on serum glucose which is still controversial and to observe the changes of serum glucose according to the blocked level and intrathecal morphine and epinephrine mixed with local anesthetic(tetracaine). 67 patients(age; 16-83, ASA. ps. 1-3) for lower abdominal or lower extremity operation, had no disease affecting serum glucose level and were not contraindicated for spinal anesthesia, were selected randomly and divided them into each 3 group depending on the sensory block level and with or without intrathecal morphine and epinephrine mixed with local anesthetic (tetracaine) as fo11ows; Ggroup l (N =8); high spinal anesthesia(above T4) Group 2(N=23); middle spinal anesthesia(T5~T9) Group 3(N=26); low spinal anesthesia(below T10) Group A(N=18): tetracaine only Group B(N=17); tetracaine+epinephrine(0.2 mg) Group C(N = 32); tetracaine+ epinephrine(0.2 mg)+ morphine(0.2 mg) All patients except emergency cases were premedicated with nalbuphine(5 mg) and droperidol(2.5mg) or hydroxyzine(1 mg/kg) and were kept NPO 6-12hr. Hartman's solution were used for the maintenance fluid. Serum glucose were measured before operation, just immediate before and after spinal anesthesia and at 30 min. after starting operation with Glucometer-2(Miles inc, Indiana, USA). The results were as follows; 1) The values of serum glucose after spinal anesthesia were not changed significantly compared with those of the immediate before anesthesia(P> 0.05). 2) The values of serum glucose according to sensory block level were not changed significanly compared with each group(P>0.05). 3) The values of serum glucose when using mixed epinephrine and morphine with tetracaine intrathecally were not changed significantly compared with using tetracaine only(P>0.05). These results suggested that spinal anesthesia itself did not affect serum glucose level, and neither the sensory block level nor iatrathecal epinephrine and morphine affect serum glucose level. Increased serum glucose caused by surgical stress might be attenuated by spinal anesthesis when lower extremity and lower abdominal operation.

Indiana continent ileocecal reservoir: early followup of 10 cases / 대한비뇨기과학회지

From May 1990 to July 1991. 11 bladder tumor patients were treated with Indiana continent ileocecal reservoir after radical cystectomy with pelvic lymphadnectomy and l0 were followed up. The average operation time for making pouch was 5 hours 22 minutes. The reservoir was created with reconfiguration of disrupted cecum and ileal patch and its average maximal capacity was 527. 8cc. The average interval of catheterization was 5 hours 36 minutes and the average catheterized urine volume was 357cc. The average intrareservoiral maximal pressure was 29.4cmH2O and the average intraluminal maximal pressure of plicated terminal ileal segment along with ilececal valve was 48cmH2O. All of 10 patients(100%) had successful daytime continence and 5 were able to sleep all night without catheteritation. Tunneled ureteral implantations along the tenia of the cecum were revealed no reflux on reservoirogram. The complications were 2 cases of temporary urine leakage From stoma site. 1 wound infection and 1 stomal bleeding. From the above results, although duration of followup is short, we can anticipate a superb outcome after experience further cases with this procedure, since successful continence and antireflux are achieved at this time.

A clinical experience of urinary diversion: postoperative complications of diversion / 대한비뇨기과학회지

124 cases of urinary diversion were reviewed from September, 1974 to March. 1990. Studies were underwent mainly concerning the indications and the postoperative complications in several diversion procedures such as ileal conduit. ileocecal conduit, tubeless cutaneous ureterostomy. Kock pouch and Indiana pouch. Although ileal conduit and ileocecal conduit are one of reliable method with broad applications, the early and late complications are often troublesome. Also continent diversion such as Kock pouch and Indiana pouch need the long operative time with technical difficulties. Tubeless cutaneous ureterostomy have high incidence of stomal stenosis especially in normal sized ureter. Because there are no ideal urinary diversion today, the careful and thorough evaluation and consideration should be given in selecting appropriate urinary diversion method in each different cases.