Are Wearable Photoplethysmogram-Based Heart Rate Variability Measures Equivalent to Electrocardiogram? A Simulation Study.

BACKGROUND: Traditional electrocardiography (ECG)-derived heart rate variability (HRV) and photoplethysmography (PPG)-derived "HRV" (termed PRV) have been reported interchangeably. Any potential dissociation between HRV and PRV could be due to the variability in pulse arrival time (PAT; time between heartbeat and peripheral pulse). OBJECTIVE: This study examined if PRV is equivalent to ECG-derived HRV and if PRV's innate error makes it a high-quality measurement separate from HRV. METHODS: ECG data from 1084 subjects were obtained from the PhysioNet Autonomic Aging dataset, and individual PAT dispersions for both the wrist (n = 42) and finger (n = 49) were derived from Mol et al. (Exp Gerontol. 2020; 135: 110938). A Bayesian simulation was constructed whereby the individual arrival times of the PPG wave were calculated by placing a Gaussian prior on the individual QRS-wave timings of each ECG series. The standard deviation (σ) of the prior corresponds to the PAT dispersion from Mol et al. This was simulated 10,000 times for each PAT σ. The root mean square of successive differences (RMSSD) and standard deviation of N-N intervals (SDNN) were calculated for both HRV and PRV. The Region of Practical Equivalence bounds (ROPE) were set a priori at ± 0.2% of true HRV. The highest density interval (HDI) width, encompassing 95% of the posterior distribution, was calculated for each PAT σ. RESULTS: The lowest PAT σ (2.0 SD) corresponded to 88.4% within ROPE for SDNN and 21.4% for RMSSD. As the σ of PAT increases, the equivalence of PRV and HRV decreases for both SDNN and RMSSD. The HDI interval width increases with increasing PAT σ, with the HDI width increasing at a higher rate for RMSSD than SDNN. CONCLUSIONS: For individuals with greater PAT variability, PRV is not a surrogate for HRV. When considering PRV as a unique biometric measure, SDNN may have more favorable measurement properties than RMSSD, though both exhibit a non-uniform measurement error.

Experimental evidence on a "light-touch" personalized email intervention in an online, undergraduate physiology course.

In large physiology classes, there is a demand for low-effort, or "light touch," strategies that faculty can use to connect with students and promote increased academic performance and student engagement. The purpose of this study was to compare personalized versus standardized emails following unit quizzes on student perceptions of faculty engagement, participation in academic resources, and academic performance in a junior-level, online physiology course. Students completed the online unit quiz and received a subsequent feedback email from the course director. Students were randomized into the Control (n = 101) or the Experimental (n = 104) group for general or personalized performance feedback emails, respectively. Students completed start and end of semester surveys capturing demographics, course expectations, self-reported use of resources, and impressions of the faculty. Final exam and course grades were collected. Perceptions of faculty were similar between groups, and receiving professor feedback after quizzes did not make the Experimental group more likely to use any of the available academic support services. There was no difference in final exam grades (Control: 73.9 ± 14.1%; Experimental: 73.4 ± 15.3%) or final course grades between groups (Control: 79.2 ± 13.1%; Experimental: 78.7 ± 13.3; P > 0.05). Personalized performance feedback from light-touch emails did not improve student perceptions of faculty engagement, self-reported participation in academic resources, or academic performance compared with a standardized email in a junior-level, online physiology course. Overall, this study does not support the use of personalized emails regarding quiz performance in an online physiology course.NEW & NOTEWORTHY Personalized performance feedback from light-touch emails did not improve student perceptions of faculty engagement, self-reported participation in academic resources, or academic performance compared with a standardized email in a junior-level, online physiology course.

Peer-supported physical activity intervention for academic probation freshmen in a physiology-related major: a feasibility study.

To retain students on academic probation, physiology and physiology-related programs may offer a variety of academic support initiatives. This pilot research study examined the feasibility and perceptions of implementing a success coach-led physical activity (PA) program for freshmen on academic probation in a physiology-related program. Freshman on academic probation [grade point average (GPA) <2.0] worked with a success coach on academic success strategies and PA. Freshmen completed validated surveys (Academic Self-Efficacy, Self-Efficacy of Regulated Learning, Institutional Integration Scale) before and after intervention and semistructured interviews after intervention. Retention rate was determined at longitudinal follow-up in Fall 2022. Six freshmen participated. Average GPA did not improve between Fall 2021 (1.561 ± 0.285) and Spring 2022 (1.606 ± 0.832) (P = 0.89). All felt that the program improved their study skills, but fewer (40%) felt that their grades improved. Most had positive perceptions of the PA program, including self-reported improvements in health/fitness (60%), mood/mental well-being (100%), and stress management (80%). Although most improved attention when studying (80%), this did not translate to improved academic performance (40%). For the Institutional Integration Scales, only the scale for "Faculty Concern for Student Development and Teaching" improved by the end of the semester (pre: 37 ± 7.6, post: 19 ± 3.4, P < 0.001). Retention rate of participants (83%) was higher than the university's overall retention rate for students on academic probation (37%). By fostering social integration, improving mood and mental well-being, and increasing university retention rates this pilot project confirmed the feasibility of using upperclassmen as success coaches for a physical activity intervention for academic probation freshmen.NEW & NOTEWORTHY Using upperclassmen as success coaches for a physical activity intervention for academic probation freshmen fostered social integration, improved mood and mental well-being, and increased university retention rates.

Perceptions of academic preparedness of first-gen freshmen in a physiology major inform recommendations for program-level academic development initiatives.

Many factors contribute to students' academic success, and some, including first-generation (FG) college student status and academic preparation, are especially relevant in physiology programs. The purpose of this qualitative study was to examine FG college students' perceptions of academic preparedness and intended success strategies with the goal of informing program-level strategies to support FG students in similar undergraduate physiology-related programs. FG freshmen completed short surveys and reflections at the start and end of the semester. Qualitative responses from written reflections were compiled, and content was analyzed. Students were high achievers in high school; 98% expected As and Bs in college, but only 53% had achieved this by the end of the first semester. At the start of the semester, FG students reported feeling prepared academically but were hoping to improve their academic readiness skills, and academic success plans focused on organizational strategies. At the end of the semester, some thought they were as prepared as they expected, but most found they were not as academically prepared for college as they had expected. Several minor themes were identified as areas to address with future cohorts. This study proposes several potential avenues by which to support FG freshmen's academic success in similar physiology programs, including early identification of at-risk students, setting realistic expectations, educating students early and often about evidence-based strategies, and developing academic recovery strategies as needed.NEW & NOTEWORTHY A qualitative investigation of first-generation (FG) college freshmen's perceptions of academic preparedness and intended success strategies informs the development of potential avenues by which to support FG freshmen in physiology programs.

American Head and Neck Society position statement on the use of PD-1 inhibitors for treatment of advanced cutaneous squamous cell carcinoma.

BACKGROUND: A position statement put forth by the American Head and Neck Society (AHNS) was constructed to provide evidence-based treatment recommendations for PD-1 inhibitor use in advanced cutaneous squamous cell carcinoma (cSCC). Secondarily, we sought to identify knowledge gaps warranting further investigation. METHODS: A literature search utilizing key terms: cutaneous squamous cell carcinoma, cutaneous cancer, checkpoint inhibitors, systemic therapy, Program Cell Death, PD-1 (PubMed, Cochrane, and Google Scholar) was carried out to generate evidence-based statements. The statements were distributed among the AHNS membership. Delphi methodology was applied to identify statements achieving 70% or greater consensus among the leadership team. RESULTS: Twenty-six position statements achieved consensus. Knowledge gaps for future research included: impact of immunosuppression on cSCC staging and associated treatment; role of PD-1 inhibitors in immunosuppressed patients. CONCLUSION: This comprehensive position statement put forth by the AHNS represents majority consensus by practicing head and neck surgeons throughout the country.

A Randomized Multi-institutional Phase II Trial of Everolimus as Adjuvant Therapy in Patients with Locally Advanced Squamous Cell Cancer of the Head and Neck.

PURPOSE: Investigate whether adjuvant everolimus, an mTOR inhibitor, improves progression-free survival (PFS) in advanced-stage head and neck squamous cell carcinoma (HNSCC) and provide outcomes related to correlative biological factors associated with disease control. PATIENTS AND METHODS: This was a prospective, randomized, double-blind phase II trial of patients with advanced-stage HNSCC from 13 institutions who were confirmed disease-free post-definitive therapy and enrolled between December 2010 and March 2015. Patients received adjuvant everolimus or placebo daily (10 mg, oral) for a maximum of 1 year. p16 IHC as a surrogate marker for human papillomavirus infection and whole-exome sequencing were performed. Cox proportional hazard models estimated hazard rates. Log-rank tests evaluated differences in survival. The primary endpoint was PFS. Secondary endpoints and objectives included overall survival (OS) and toxicity assessment. RESULTS: 52 patients [median (range) age, 58 (37-76) years; 43 men (83%), 9 women (17%)] were randomized to placebo (n = 24) or everolimus (n = 28). PFS favored everolimus, but was not significant [log-rank P = 0.093; HR = 0.44; 95% confidence interval (CI), 0.17-1.17]. There was no difference in OS (P = 0.29; HR = 0.57; 95% CI, 0.20-16.2). Everolimus resulted in significant improvement in PFS for p16-negative patients (n = 31; P = 0.031; HR = 0.26; 95% CI, 0.07-0.97), although subgroup analysis showed no difference for p16-positive patients (n = 21; P = 0.93). Further, PFS was significantly higher in TP53-mutated (TP53mut) patients treated with everolimus compared with placebo (log-rank P = 0.027; HR = 0.24; 95% CI, 0.06-0.95). No treatment difference was seen in patients with TP53 wild-type tumors (P = 0.79). CONCLUSIONS: p16-negative and TP53mut patients may benefit from adjuvant treatment with everolimus.

Applicant Perspectives on Virtual Otolaryngology Residency Interviews.

OBJECTIVE: Residency interviews serve as an opportunity for prospective applicants to evaluate programs and to determine their potential fit within them. The 2019 SARS-CoV2 pandemic mandated programs conduct interviews virtually for the first time. The purpose of this study was to assess applicant perspectives on the virtual interview. METHODS: A Qualtrics survey assessing applicant characteristics and attitudes toward the virtual interview was designed and disseminated to otorhinolaryngology applicants from 3 large academic institutions in the 2020 to 2021 application cycle. RESULTS: A total of 33% of survey applicants responded. Most applicants were satisfied with the virtual interview process. Applicants reported relatively poor quality of interactions with residents and an inability to assess the "feel" of a geographic area. Most applicants received at least 11 interviews with over a third of applicants receiving >16 interviews. Only 5% of applicants completed >20 interviews. Most applicants believed interviews should be capped between 15 and 20 interviews. Most applicants reported saving >$5000, with over a quarter of applicants saving >$8000, and roughly one-third of applicants saving at least 2 weeks of time with virtual versus in-person interviews. CONCLUSIONS: While virtual interviews have limitations, applicants are generally satisfied with the experience. Advantages include cost and time savings for both applicants and programs, as well as easy use of technology. Continuation of the virtual interview format could be considered in future application cycles; geographical limitations may be overcome with in-person second looks, and increased emphasis should be placed on resident interactions during and prior to interview day.

An exploratory study of freshman attrition from an Appalachian physiology program.

Appalachia has low rates of college attendance and graduation, but relevant data investigating student attrition from physiology majors in this region are lacking. This exploratory study examined freshman attrition from an undergraduate exercise physiology program in Appalachia with the goal of identifying potential strategies for improving retention across similar programs in this underserved region. Questionnaires were administered at the beginning and end of the fall semester to freshman (n = 247) and students transferring out of the major [Transferred group (T); n = 50] by the end of their first semester were compared against those that remained [Retained group (R); n = 190]. The Transferred group was invited to participate in qualitative interviews. Fewer Transferred students reported feeling underprepared in academic preparedness skills, but more reported feeling underprepared in math. At the end of the semester, more in the Transferred group reported doing worse than expected in math and in getting good grades and had a lower grade point average (R: 3.27 ± 0.05; T: 2.62 ± 0.15; P < 0.01). More in the Transferred group were first-generation (FG) college students (R: 17%; T: 30%). Transferred FG had lower academic preparation and performance and more financial need than Retained FG. In interviews (n = 35), most students expressed a change in career goals and many noted the academic rigor of the program, while academic advising, faculty, and the major received generally positive praise. This study identified several factors that would allow for early identification of incoming freshmen at risk for attrition and proposes strategies for improving retention within Appalachian physiology programs.

Survival and prognostic factors of salivary gland malignant mixed tumor-not otherwise specified: A population-based analysis.

OBJECTIVE: Malignant mixed tumors of the salivary gland are a group of neoplasms comprised of carcinoma-ex-pleomorphic adenoma, carcinosarcoma, and metastasizing pleomorphic adenoma. An alternative classification, malignant mixed tumor-not otherwise (MMT-NOS), is a diagnosis of exclusion for neoplasms that do not fit the previous histologically profiled subtypes. The objective was to provide a comprehensive assessment of MMT-NOS and determine prognostic factors. METHODS: This retrospective cohort study queried the Surveillance, Epidemiology, and End Results database for patient and tumor characteristics of US patients with MMT-NOS of the major salivary glands from 1973 to 2016. Kaplan-Meier and Cox regression analysis were performed to determine 5-year survival and prognostic factors. RESULTS: 434 patients were identified with a mean age at diagnosis of 61.5 years. The majority of neoplasms were high grade and stage (70.8% grade III/IV; 63.8% stage III/IV). Extraparenchymal extension (40.6%) and lymph node involvement (28.5%) were common; distant metastases (2.4%) were rare. Treatment included surgery (93.0%), radiation (51.6%), and chemotherapy (10.4%). Facial nerve sacrifice was common (50.8%). Median survival was 66.5 months. 5-year overall and disease-specific survival were 65.7% and 83.0%, respectively. In multivariate analysis, nodal involvement (HR 7.0; P < 0.001), surgery-radiation-chemotherapy (HR 6.1; P = 0.02), extraparenchymal extension (HR 2.50; P = 0.04), and tumor size >4 cm (HR 1.3; P = 0.03) were prognostic factors. CONCLUSION: Despite high stage and grade at diagnosis, MMT-NOS portends a good 5-year prognosis and low rate of distant metastasis. Prognostic factors were nodal involvement, tumor size, and extraparenchymal extension.

Epidemiology and Prevention of Cutaneous Cancer.

Cutaneous malignancy is becoming an increasing public health burden in terms of morbidity and cost, associated with changing environmental exposures and increased longevity of the general and the immunosuppressed population. Yet the understanding of the scope of this problem is hindered by lack of robust registries for nonmelanoma skin cancer. The risk factor responsible for most of these cancers, exposure to ultraviolet radiation, can be mitigated. However, greater consensus is necessary to enact effective prevention and screening programs. New developments, including identification of biomarkers and use of artificial intelligence, show promise for targeting screening efforts.

Influence of smoking history on the perception of radiation-induced dysgeusia/hypogeusia in patients with head and neck cancer.

OBJECTIVES: This investigation aimed to assess the effect of smoking on the onset and resolution of dysgeusia/hypogeusia in head and neck cancer (HNC) patients receiving radiotherapy (XRT). MATERIALS AND METHODS: This is a retrospective cohort investigation of HNC patients treated with XRT. Data collected from the patients' medical records included demographics, primary cancer diagnoses, HNC therapeutic modalities, smoking status, and dates of onset/resolution of dysgeusia/hypogeusia. RESULTS: A 103 met inclusion criteria, of which 61.8% developed dysgeusia/hypogeusia. Mean age was 58.3 ± 12.9 and 66% were either former or current smokers. Never smokers seemed to be at higher, but statistically insignificant, the risk for developing dysgeusia/hypogeusia than former or current smokers [HR 1.05 and 1.66; 95% CI (0.60, 1.84) and (0.85, 3.24)]. They were also less likely to recover when compared to former smokers [HR 0.74; 95% CI (0.39, 1.39)]. Although statistically insignificant, never smokers showed rapid dysgeusia/hypogeusia onset after XRT compared to former or current smokers (median 14 days versus 22 and 9 days, respectively; p = 0.25). Never smokers showed quicker but statistically insignificant, recovery time compared to former or current smokers (median 113 days versus 149 and 238 days, respectively; p = 0.57). CONCLUSION: Although results lacked statistical significance, never smokers receiving XRT were prone to higher risk and faster onset of dysgeusia/hypogeusia than former and current smokers.

Role of Fluid Milk in Attenuating Postprandial Hyperglycemia and Hypertriglyceridemia.

Postprandial plasma glucose and triglyceride concentrations are predictive of relative cardiovascular disease (CVD) risk, and the pathogenesis of both insulin resistance and atherosclerosis has been attributed to acute states of hyperglycemia and hypertriglyceridemia. Postprandial lipemia and hyperglycemia suppress vascular reactivity and induce endothelial dysfunction. Epidemiological studies suggest that chronically-high consumption of milk and milk products is associated with a reduced risk of type 2 diabetes, metabolic syndrome, and CVD. The addition of dairy products to meals high in carbohydrates and fat may lessen these risks through reductions in postprandial glucose and triglyceride responses. Purported mechanisms include dairy proteins and bioactive compounds, which may explain the inverse relationship between dairy consumption and cardiometabolic diseases. The current review evaluates the available literature describing the relationships between metabolic dysfunction, postprandial metabolism, and vascular dysfunction and discusses the potential role of milk and dairy products in attenuating these impairments.

Evaluation of an Occupational Exercise Training Program for Firefighters: Mixed Methods Pilot Study.

BACKGROUND: Occupational exercise training programs can improve overall health and fitness in firefighters, but evidence beyond clinical and performance outcomes is needed before fire departments invest in and successfully adopt health promotion programs. OBJECTIVE: This mixed methods pilot study sought to pair clinical and performance outcomes with participants' qualitative feedback (eg, participants' enjoyment, lifestyle behavior changes, and team structure) with the goal of informing recommendations for future programs. METHODS: Professional firefighters participated in a 14-week occupational exercise training program with assessments conducted pre- and posttraining. Clinical outcomes included weight, BMI, body fat percentage, resting heart rate, systolic blood pressure, and diastolic blood pressure. Performance outcomes included the sharpened Romberg balance test, 1-repetition maximum leg press and bench press, graded exercise test (estimated VO2max), knee range of motion, shoulder flexibility, and hamstring flexibility. Self-administered surveys (Short Form-36, International Physical Activity Questionnaire, Barriers Self-Efficacy Scale, and Barriers to Being Active Quiz) were completed. In 3 private focus groups of 3 to 4 participants, firefighters' experiences in the training program and their health behaviors were explored. RESULTS: Male firefighters (n=14; age: mean 36.4, SD 2.6 years) completed 20 training sessions. There were no significant changes to weight (P=.20), BMI (P=.15), body fat percentage (P=.16), systolic blood pressure (P=.12), estimated VO2max (P=.34), balance (P=.24), knee range of motion (left: P=.35; right: P=.31), or hamstring flexibility (P=.14). There was a significant decrease in diastolic blood pressure (P=.04) and significant increases in shoulder flexibility (P<.001) and leg press 1-repetition maximum volume (P=.04). Participants reported improvements in overall health, endurance, flexibility, and mood as well as improvements to team environment and health behaviors around the station; however, there was a decline in overcoming barriers to physical activity. CONCLUSIONS: A 14-week program of exercise training in firefighters elicited improvements in clinical, performance, and self-reported physical activity outcomes. This occupational exercise training program for firefighters increased time spent exercising, improved team building, and led to physical and mental health benefits. Results from this pilot study set a broad, informed, and meaningful foundation for future efforts to increase firefighter participation in occupational fitness programs.

Breast Cancer Metastases to the Paranasal Sinuses Mimicking Inflammatory Sinus Disease.

INTRODUCTION: Breast cancer is one of the most common cancers in women. Metastatic disease is a leading cause of morbidity and mortality. It frequently metastasizes to bone, lungs, regional lymph nodes, liver and brain. Metastasis to the orbit and paranasal sinuses is uncommon. Patients presenting with sinus pain, nasal congestion, or visual disturbance can be misdiagnosed with an infectious process. METHODS: The authors describe 2 patients with metastatic breast cancer to the paranasal sinuses presenting with signs and symptoms of sinusitis and orbit pathology unresponsive to antibiotics. The authors discuss diagnostic strategy and perform a literature review. Both patients had biopsy-proven metastatic breast adenocarcinoma lesions, and subsequently underwent various treatment options. RESULTS: A literature review reveals that metastatic breast adenocarcinoma lesions to the paranasal sinuses are a rare entity that commonly denotes a very poor prognosis. These lesions can significantly affect one's quality of life, and can cause blurry vision, diplopia, proptosis, sinus pressure and pain, nasal congestion, mandibular misalignment or difficulty with mastication. However, early diagnosis and treatment of these lesions can lead to prolonged survival and improved quality of life. If the lesion is surgically resectable, endoscopic sinus surgery is generally considered to be the optimal treatment. However, radiotherapy, chemotherapy, and immunotherapy can potentially play a role in controlling the symptomatology. CONCLUSION: Metastatic lesions to the paranasal sinuses are a rare entity that should be considered in the appropriate clinical setting in order to expedite the proper treatment modality for improved morbidity and mortality.

A controlled intervention to improve freshman retention in a STEM-based physiology major.

Using a Scholarship of Teaching and Learning lens, this study systematically examined if a targeted intervention in at-risk students within a science, technology, engineering, and mathematics (STEM)-based physiology program would elicit positive student perceptions and higher retention rates into the second year. Those students who were considered at risk for attrition (retention; n = 82) were compared against a control group (non-retention; n = 165), and outcomes were evaluated with an End-of-Semester Survey and university enrollment data. Students in the retention group reported more favorable responses to questions pertaining to a first-year seminar course and academic advising. By the start of the following (spring 2019) semester, 48 students transferred out of the program (20%) with little difference between groups (non-retention 19%; retention 22%). At the start of fall 2019 term, 55% of the 2018 freshman class were retained within the program (non-retention 66%; retention 39%), and 85% were retained within the university (non-retention 91%, retention 74%). The intervention was successful in eliciting positive student perceptions of the major, but did not improve retention of at-risk students within the physiology major.

The "Motor of the Day": Parent and School-Age Children's Cognitions, Barriers, and Supports for Breakfast.

Despite the many benefits of regular breakfast consumption few parents and children consume this meal every day and research examining the determinants of breakfast consumption is limited. Thus, the purpose of this study was to examine breakfast-related cognitions (i.e., beliefs, attitudes, facilitators, barriers) of parents and school-age children (ages 6-11 years) using the constructs of Social Cognitive Theory as a guide. Parents (n = 37) and children (n = 41) participated in focus group discussions held in community settings in 3 states (FL, NJ, WV). Data were qualitatively content analyzed to detect trends. Parents felt breakfast was important for numerous reasons. Parents expressed concern about the healthfulness of some traditional breakfast options, preferring breakfasts containing mostly fruits, vegetables, and protein and fewer carbohydrates. Parents identified lack of time as the greatest barrier to breakfast consumption. To overcome this barrier, they utilized grab-and-go foods, prepared breakfast ahead of time, and got up earlier. Utilizing the school breakfast program was another strategy mentioned, however some were concerned about the nutritional quality of this option. Children recognized the importance of breakfast and cited several benefits. The greatest barrier to breakfast identified by children was feeling rushed in the morning. To overcome barriers, children suggested having a morning routine, selecting or preparing breakfast foods ahead, and relying on parents to encourage breakfast consumption. The effectiveness of interventions aiming to improve breakfast intake may be improved by addressing parent and child breakfast-related cognitions and tailoring interventions to address their needs.

Recovery from Strenuous Downhill Running in Young and Older Physically Active Adults.

There is a well-conceived notion that rate of recovery from strenuous exercise gets slower with age. However, it is unclear whether older adults who exercise habitually demonstrate slower rates of recovery. We determined whether older adults who are physically active demonstrate slower rates of recovery from unaccustomed strenuous exercise compared with younger peers. Healthy young sedentary (n=10, 28±2 years), young endurance-trained (n=15, 27±2 years), and older endurance-trained (n=14, 58±2 years) men and women were studied. Participants performed 45 min of downhill running at 65% of their maximal oxygen consumption. Visual analog pain scores of muscle groups increased at 24, 48, and 72 h in all three groups (p<0.05), and changes in the muscular pain scale of the legs was smaller in the older trained group than in the young trained group. Maximum isometric strengths at 90° decreased in all groups at 24 h, but the recovery rates were not different at 72 h among the groups. Plasma creatine kinase activity and myoglobin concentration increased at 24 h following downhill running and returned to baseline at 48 h in both the young and older trained groups. The present findings are not consistent with the prevailing notion that older trained adults have a slower rate of recovery from strenuous exercise.

Parent and School-Age Children's Food Preparation Cognitions and Behaviors Guide Recommendations for Future Interventions.

OBJECTIVE: To investigate parent and child food preparation cognitions and behaviors qualitatively to create recommendations for nutrition programs targeting these audiences. DESIGN: Focus groups were conducted in community settings with school-age children (n = 37) and parents (n = 38) in Florida, West Virginia, and New Jersey. SETTING: Community settings in Florida, West Virginia, and New Jersey. PARTICIPANTS: School-age children (n = 37) and parents (n = 38). PHENOMENON OF INTEREST: Factors influencing food preparation of school-aged children and their parents to inform Social Cognitive Theory-based recommendations. ANALYSIS: Content analysis. RESULTS: Parents believed that child involvement in meal preparation was important for developing cooking skills, responsibility, and self-esteem, but noted that involvement was limited by time scarcity and concern regarding child safety in the kitchen. Parents recommended having children engage in age-appropriate food preparation activities, such as packing their own snacks. Children echoed parents' beliefs, stating they would need to know how to cook later in life. Many children acknowledged being a part of meal preparation by setting the table and helping grocery shop. Food preparation's link to improving diet quality was not mentioned by parents or children. To increase involvement, children suggested that parents demonstrate skills, select age-appropriate tasks for them, and reward them for helping. CONCLUSIONS AND IMPLICATIONS: This research provides insight into parents' and children's food preparation cognitions (eg, beliefs, attitudes) and behaviors and assembles results into recommendations that may guide decisions during nutrition intervention development and potentially improve nutrition intervention.

Consumption of Health-Related Content on Social Media Among Adolescent Girls: Mixed-Methods Pilot Study.

BACKGROUND: Consumption of health- and fitness-related social media content is a predominant behavior among teenage girls, which puts them at risk for consuming unreliable health-related information. OBJECTIVE: This mixed-methods study (qualitative and quantitative) assessed health behavior attitudes and practices as well as social media use among adolescent girls. Additionally, similar practices and behaviors of adults who regularly interact with this population were studied. METHODS: Girls aged 12-18 years were recruited to complete a 28-item survey and participate in a 45- to 60-minute focus group. Adults who regularly interact with adolescent girls, including parents, teachers, and healthcare professionals, were recruited from the local community and given a link to provide online consent and complete a survey. RESULTS: A total of 27 adolescent girls participated in one of nine focus groups. Participants included 18 high school (age: mean 16.1 years; SD 1.3 years) and 9 middle school (age: mean 12.4 years; SD 0.7 years) girls. Eleven adults completed the online survey. Adolescents used social media to communicate and connect with friends, rather than as a source of health information. Although adolescents may see health-related content, most do not follow health-related pages or share such pages themselves, and fewer are actively searching for this information. Adolescents tend to trust information from familiar sources, and the participants reported that they do not follow official news accounts. Adults considered modeling and discussing healthy behaviors important and reportedly expected adolescents to see some level of health-related, especially fitness-related, content on social media. CONCLUSIONS: Education interventions are warranted for both adolescents and adults with whom adolescent girls regularly interact, in the areas of sedentary behavior to guide them to access reliable online health-related information and be judicious consumers of online health information.

Schwannoma Formation in Childhood Cancer Survivors Exposed to Total Body Irradiation: Case Series.

Childhood cancer survivors are at risk for ongoing health risks related to their initial treatment. One potential long-term complication following radiation is the development of secondary tumors, including peripheral nerve tumors, such as schwannomas. We present three adolescent and young adult (AYA)-aged survivors of pediatric cancer (22-40 years), followed in our AYA survivorship clinic. Each was found to have a schwannoma many years following total body irradiation for a childhood primary malignancy. We highlight a late effect of low-dose total body irradiation as well as the importance of long-term monitoring in this population.