Comparing preferences to evaluations of barrier self-efficacy for two strength training programs in US older adults.

BACKGROUND/OBJECTIVES: Engagement in regular physical activity is one of the best strategies for older adults to remain healthy. Unfortunately, only 35% of older adults meet guidelines for muscle strengthening activities. Eliciting participant preferences is one possible way to improve physical activity engagement. However, other sources of participant input to improve uptake and maintenance remain uninvestigated. This study compared preferences to self-efficacy ratings for two strength training programs. METHODS: We conducted a national cross-sectional survey of 611 US adults over age 65. We compared two participant evaluations (the preferred program and the program for which they had higher barrier self-efficacy) of two hypothetical strength training programs (45 minutes performed three times per week (traditional) and 5 minutes performed daily (brief)). RESULTS: Most participants (68%) preferred the brief strength training program. The difference in self-efficacy ratings was an average of 1.2 (SD = 0.92). One in five participants preferred a strength training program for which they had less self-efficacy; nearly all of these participants (92%) preferred the traditional strength training program but had more self-efficacy for the brief strength training program. CONCLUSION: Older adults reported preferring and having more self-efficacy for a brief compared to a traditional strength training program. Differences in self-efficacy ratings between the two strength training programs were large. Preferences were often not congruent with ratings of self-efficacy. SIGNIFICANCE/IMPLICATIONS: Preferences for strength training programming may not always reflect the program most likely to be maintained. Future investigations should evaluate differences in behavioral uptake, maintenance, and outcomes from two comparative strength training interventions using preferences and self-efficacy.

Modulation of brain serotonin by benzyl butyl phthalate in Fundulus heteroclitus (mummichog).

Endocrine-disrupting chemicals have been known to alter important animal behaviors by modulating serotonin (5-hydroxytryptamine, 5-HT) and dopamine. F. heteroclitus (mummichog) brain serotonin and dopamine levels were quantified by enzyme-linked immunosorbent assay (ELISA) following a 28-day exposure regimen involving daily doses of either 0.1 mg l-1 benzyl butyl phthalate (BBP) dissolved in acetone or acetone alone (0.1 mg l-1). No differences in mean brain mass or total protein homogenate were induced by exposure to the acetone vehicle or BBP in acetone. The acetone vehicle had no effect on dopamine, serotonin, or tyrosine hydroxylase levels, but acetone did decrease tryptophan hydroxylase levels (p = 0.011). Exposure to BBP in acetone decreased dopamine (p = 0.024), increased serotonin (p < 0.001), reduced tryptophan hydroxylase as compared to the acetone vehicle alone (p < 0.001), and had no significant effect on tyrosine hydroxylase levels. This study is the first to report modulation of F. heteroclitus brain serotonin and its enzyme tryptophan hydroxylase following sub-lethal exposure to BBP in an acetone vehicle. In addition, modulation of brain dopamine in F. heteroclitus, sans simultaneous modulation of tyrosine hydroxylase, was also observed. These findings support the use of F. heteroclitus for assessing sub-lethal BBP exposure.

The Business of Health Physics-Jobs In A Changing Market.

The health physics profession was born abruptly when once rare and precious radioactive materials became commonplace. The technological advancements that triggered an industrial complex and ended World War II demanded radiation safety on an unprecedented scale. Until then, protective measures against radiation were largely absent in laboratories. Over the subsequent decades, health physicists began protecting people and the environment in a wide range of settings including medical, research, and industrial. The use of radioactive materials and radiation-generating devices is prevalent today. Radiation doses occur continuously including during airline flights, in our homes, during medical procedures, and in energy production. Radiation is integral to numerous applications including those in medicine, dentistry, manufacturing, construction, scientific research, nuclear electric power generation, and oil and gas exploration. Activities that were once groundbreaking have now become routine and scripted. At higher doses, health effects are understood and avoided. Instruments for the detection and measurement of radiation are at times smarter than their users. Ironically, the same health physics community that has been successful in demonstrating that exposures to radiation and to radioactive materials can be effectively managed is shrinking at an increasingly rapid rate. This paper highlights the creation of past and current jobs, predicts the future opportunities in the profession, and makes recommendations necessary to protect the disappearing specialties.

Vortex ring refraction at large Froude numbers.

We have experimentally studied the impact of an initially planar axisymmetric vortex ring, incident at an oblique angle, upon a gravity-induced interface separating two fluids of differing densities. After impact, the vortex ring was found to exhibit a variety of subsequent trajectories, which we organize according to both the incidence angle, θ(i), and the interface strength, defined as the ratio of the Atwood and Froude numbers, A/F. For grazing incidence angles (θ(i)≳70°) vortices either penetrate or reflect from the interface, depending on whether the interface is weak or strong. In some cases, reflected vortices execute damped oscillations before finally disintegrating. For smaller incidence angles (θ(i)≲70°) vortices penetrate the interface. When there is a strong interface, these vortices are observed to curve back up toward the interface. When there is a weak interface, these vortices are observed to refract downward, away from the interface. The critical interface strength below which vortex ring refraction is observed is given by log(10)(A/F)=-2.38±0.05.

Off-label and unlicensed medication use and associated adverse drug events in a pediatric emergency department.

OBJECTIVES: The study objectives were to (1) determine the types and frequency of off-label (OL) or unlicensed (UL) medications used in a pediatric emergency department (PED) and before admission, (2) describe OL/UL-associated adverse drug events (ADEs) resulting in admission to the PED and those occurring during patient care in PED, and (3) determine the outcomes of these ADEs. METHODS: Medical records of patients 18 years or younger admitted to the PED over a 5-month period were reviewed. Off-label/UL use of medications was determined based on Food and Drug Administration-approved labeling. The Adverse Drug Reaction Probability Scale was used to determine ADE causality. Data were analyzed using descriptive statistics. RESULTS: A total of 2191 patients with 6675 medication orders were evaluated. About 26.2% (n = 1712) of medication orders were considered as OL/ UL use; 70.5% (n = 1208) of these medications were ordered as part of treatment in the PED, and the remaining 29.5% (n = 504) were home medications before their PED evaluation. Inhaled bronchodilators (30.4%), antimicrobials (14.8%), and antihistamines/antiemetics (9.1%) were the most common OL/UL medication classes. The frequency of ADEs among licensed medication use was greater compared with OL/UL use by 2-fold. Reported overall rate of ADEs was 0.6% (n = 40). Of these 40 ADEs, 5 resulted from the use of an OL/UL medication, 3 from home medication use, and 2 from PED-prescribed medications. CONCLUSIONS: The frequency of reported ADEs associated with OL/UL medications was less than the frequency of ADEs from licensed medication use, with overall ADE frequency of less than 1%.

Treatment of allergic rhinitis in infants and children: efficacy and safety of second-generation antihistamines and the leukotriene receptor antagonist montelukast.

Allergic rhinitis (AR) affects a large percentage of paediatric patients. With the wide array of available agents, it has become a challenge to choose the most appropriate treatment for patients. Second-generation antihistamines have become increasingly popular because of their comparable efficacy and lower incidence of adverse effects relative to their first-generation counterparts, and the safety and efficacy of this drug class are established in the adult population. Data on the use of the second-generation antihistamines oral cetirizine, levocetirizine, loratadine, desloratadine and fexofenadine, and the leukotriene receptor antagonist montelukast as well as azelastine nasal spray in infants and children are evaluated in this review. These agents have been found to be relatively safe and effective in reducing symptoms associated with AR in children. Alternative dosage forms such as liquids or oral disintegrating tablets are available for most agents, allowing ease of administration to most young children and infants; however, limited data are available regarding use in infants for most agents, except desloratadine, cetirizine and montelukast. Unlike their predecessors, such as astemizole and terfenadine, the newer second-generation antihistamines and montelukast appear to be well tolerated, with absence of cardiotoxicities. Comparative studies are limited to cetirizine versus ketotifen, oxatomide and/or montelukast. Although second-generation antihistamines and montelukast are deemed relatively safe for use in paediatric patients, there are some noteworthy drug interactions to consider when selecting an agent. Given the wide variety of available agents for treatment of AR in paediatric patients, the safety and efficacy data available for specific age groups, type of AR, dosage form availability and cost should be considered when selecting treatment for AR in infants and children.

The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review.

OBJECTIVES: Irritable bowel syndrome (IBS) is a common disorder and available therapies have limited efficacy. Mucosal inflammation and alterations in gut microflora may contribute to the development of IBS symptoms, and researchers have hypothesized that probiotics might improve these symptoms. The aim of this study was to perform a systematic review of randomized controlled trials (RCTs) evaluating the efficacy, safety, and tolerability of probiotics in the treatment of IBS. METHODS: Comprehensive literature searches of multiple databases were performed. Study selection criteria were as follows: (i) RCTs, (ii) adults with IBS defined by Manning or Rome II criteria, (iii) single or combination probiotic vs. placebo, and (iv) improvement in IBS symptoms and/or decrease in frequency of adverse events reported. Data about study design and results were extracted in duplicate using standardized data extraction forms. Owing to variability in outcome measures, quantitative pooling of data was not feasible. RESULTS: A total of 16 RCTs met selection criteria. Of those, 11 studies showed suboptimal study design with inadequate blinding, inadequate trial length, inadequate sample size, and/or lack of intention-to-treat analysis. None of the studies provided quantifiable data about both tolerability and adverse events. Bifidobacterium infantis 35624 showed significant improvement in the composite score for abdominal pain/discomfort, bloating/distention, and/or bowel movement difficulty compared with placebo (P<0.05) in two appropriately designed studies. No other probiotic showed significant improvement in IBS symptoms in an appropriately designed study. CONCLUSIONS: B. infantis 35624 has shown efficacy for improvement of IBS symptoms. Most RCTs about the utility of probiotics in IBS have not used an appropriate study design and do not adequately report adverse events. Therefore, there is inadequate data to comment on the efficacy of other probiotics. Future probiotic studies should follow Rome II recommendations for appropriate design of an RCT.

The NIOSH Radiation Dose Reconstruction Project: managing technical challenges.

Approximately two years after promulgation of the Energy Employees Occupational Illness Compensation Program Act, the National Institute for Occupational Safety and Health Office of Compensation and Analysis Support selected a contractor team to perform many aspects of the radiation dose reconstruction process. The project scope and schedule necessitated the development of an organization involving a comparatively large number of health physicists. From the initial stages, there were many technical and managerial challenges that required continuous planning, integration, and conflict resolution. This paper identifies those challenges and describes the resolutions and lessons learned. These insights are hopefully useful to managers of similar scientific projects, especially those requiring significant data, technical methods, and calculations. The most complex challenge has been to complete defensible, individualized dose reconstructions that support timely compensation decisions at an acceptable production level. Adherence to applying claimant-favorable and transparent science consistent with the requirements of the Act has been the key to establishing credibility, which is essential to this large and complex project involving tens of thousands of individual stakeholders. The initial challenges included garnering sufficient and capable scientific staff, developing an effective infrastructure, establishing necessary methods and procedures, and integrating activities to ensure consistent, quality products. The continuing challenges include maintaining the project focus on recommending a compensation determination (rather than generating an accurate dose reconstruction), managing the associated very large data and information management challenges, and ensuring quality control and assurance in the presence of an evolving infrastructure. The lessons learned concern project credibility, claimant favorability, project priorities, quality and consistency, and critical path project activities.