Polycyclic aromatic hydrocarbons (PAH) are both man-made and naturally occurring environmental pollutants that may be related to cardiometabolic health risk.
To determine whether PAH is associated ...with obesity in the adult population and to examine whether urinary concentrations of PAH metabolites are associated with differences in how obesity relates to 3 or more risk factors for the metabolic syndrome (3RFMetS), type 2 diabetes (T2D), hypertension, and dyslipidemia.
A total of 4765 adult participants from the 2001-2008 National Health and Nutrition Examination Survey were examined. The association between 8 urinary hydroxylated PAH metabolites, obesity, and health were examined using weighted logistic regressions adjusting for age, sex, ethnicity, PIR, smoking status, and urinary creatinine.
There was a positive dose-dependent association between obesity and 2-phenanthrene quintiles (P trend <0.0001). Contrarily, higher quintiles of 1-naphthalene were associated with lower risk of obesity (P trend = 0.0004). For a given BMI, those in the highest quintile of 2-naphthalene, 2-fluorene, 3-fluorene and 2-phenanthrene had a 66-80% greater likelihood of 3RFMetS (P≤0.05) compared to low levels. Higher quintiles of 1-naphthalene, 2-naphthalene, 2-phenanthrene and 1-pyrene were associated with a 78-124% greater likelihood of T2D (P≤0.05) compared to low levels while high 1-naphthalene, 2-naphthalene, 2-fluorene, 3-fluorene and 2-phenanthrene were associated with a 38-68% greater likelihood of dyslipidemia (P≤0.05) compared to lower levels. Finally, 2-naphthalene and 2-phenanthrene were positively associated with hypertension (P trend = 0.008 and P trend = 0.02 respectively).
PAH is related to obesity and the expression of a number of obesity-related cardiometabolic health risk factors. Future research is needed to bring to light the mechanistic pathways related to these findings.
The incidence of Alzheimer's disease is increasing as the global population ages. Given the limited success of pharmaceuticals in preventing this disease, a greater emphasis on non-pharmaceutical ...approaches is needed. The aim of this study was to quantify the association between Alzheimer's disease and physical activity in older adults over the age of 65 years.
A meta-analytic approach was used to determine if physical activity reduced the risk of Alzheimer's disease in individuals 65 years or older. Some evidence indicates that physical activity may improve cognitive function in older adults, while other evidence is inconclusive. The purpose of this study was to examine if prevention of Alzheimer's disease is possible if started at a later age. The precise brain changes that occur with the onset of Alzheimer's disease are not fully known, and therefore may still be influenced by preventative measures even in advancing age. Determining if physical activity can inhibit the onset of the disease at any age may motivate individuals to adopt an "it's never too late" mentality on preventing the onset of this debilitating disease. Longitudinal studies of participants who were 65 years or older at baseline were included. A total of 20,326 participants from nine studies were included in this analysis.
The fixed effects risk ratio is estimated as 0.61 (95% CI 0.52-0.73) corresponding to a statistically significant overall reduction in risk of Alzheimer's disease in physically active older adults compared to their non-active counterparts.
Physical activity was associated with a reduced risk of Alzheimer's disease in adults over the age of 65 years. Given the limited treatment options, greater emphasis should be paid to primary prevention through physical activity amongst individuals at high-risk of Alzheimer's disease, such as those with strong genetic and family history.
As the health risks of sedentary working environments become more clear, greater emphasis on the implementation of walking interventions to reduce sitting time is needed. In this systematic review ...and meta-analysis, we investigate the role of treadmill-desk interventions on energy expenditure, sitting time, and cardiometabolic health in adults with sedentary occupations.
Relevant studies published in English were identified using CINAHL, EMBASE, MEDLINE, Web of Science, Scopus, and PubMed databases up to December 2020. Random effects meta-analysis models were used to pool study results.
Thirteen relevant studies (six workplaces and seven laboratories) were found with a total of 351 participants. Pooled analysis of laboratory studies showed a significant increase in energy expenditure (105.23 kcal per hour, 95% confidence interval CI: 90.41 to 120.4), as well as metabolic rate (5.0 mL/kg/min, 95% CI: 3.35 to 6.64), among treadmill desk users compared to sitting conditions. No evidence of significant differences in blood pressure were found. In workplace studies, we observed a significant reduction in sitting time over a 24-h period (- 1.73 min per hour, 95% CI: - 3.3 to - 0.17) among users of treadmill desks, compared to a conventional desk. However, there were no evidence of statistically significant changes in other metabolic outcomes.
Treadmill desks offer a feasible and effective intervention to increase energy expenditure and metabolic rate and reduce sitting time while performing work-related tasks. Future studies are needed to increase generalizability to different workplace settings and further evaluate their impact on cardiometabolic health.
Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on ...learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits.
Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment.
Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians.
Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed.
Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.
The flipped classroom (FC) inverts the traditional classroom by having students participate in passive aspects of learning at home and active aspects of learning in class with the guide of an ...instructor. The introductory statistics course for nonmath majors may be especially suited to the FC model given its unique challenges as a required course for students with varying mathematical skills and background. For example, these students often have low interest and high statistics-related anxiety. Recent studies suggest the FC for introductory statistics courses leads to increased performance relative to a traditional lecture-based classroom (LC). This meta-analysis compared the academic performance of students in introductory statistics courses for nonmath majors who were taught in a FC versus those taught in a LC. Results indicate that students in the FC had statistically discernibly higher final performance outcomes compared to the LC delivery with an average difference of 6.9% in performance (Hedge's g = 0.43), though there was evidence of moderation by the presence of weekly in-class quizzes. These findings suggest that implementing the FC within the introductory statistics classroom at the undergraduate level may improve learning achievement, but more research is needed to explore the role of regular class quizzes.
Supplementary materials
for this article are available online.
The impending public health impact of Alzheimer's disease is tremendous. Physical activity is a promising intervention for preventing and managing Alzheimer's disease. However, there is a lack of ...evidence-based public health messaging to support this position. This paper describes the application of the Appraisal of Guidelines Research and Evaluation II (AGREE-II) principles to formulate an evidence-based message to promote physical activity for the purposes of preventing and managing Alzheimer's disease.
A messaging statement was developed using the AGREE-II instrument as guidance. Methods included (a) conducting a systematic review of reviews summarizing research on physical activity to prevent and manage Alzheimer's disease, and (b) engaging stakeholders to deliberate the evidence and formulate the messaging statement.
The evidence base consisted of seven systematic reviews focused on Alzheimer's disease prevention and 20 reviews focused on symptom management. Virtually all of the reviews of symptom management conflated patients with Alzheimer's disease and patients with other dementias, and this limitation was reflected in the second part of the messaging statement. After deliberating the evidence base, an expert panel achieved consensus on the following statement: "Regular participation in physical activity is associated with a reduced risk of developing Alzheimer's disease. Among older adults with Alzheimer's disease and other dementias, regular physical activity can improve performance of activities of daily living and mobility, and may improve general cognition and balance." The statement was rated favourably by a sample of older adults and physicians who treat Alzheimer's disease patients in terms of its appropriateness, utility, and clarity.
Public health and other organizations that promote physical activity, health and well-being to older adults are encouraged to use the evidence-based statement in their programs and resources. Researchers, clinicians, people with Alzheimer's disease and caregivers are encouraged to adopt the messaging statement and the recommendations in the companion informational resource.
We consider the evaluation of lateral spread distributions of charged particle beams at therapeutic energies, due to an absorber in the form of a homogeneous slab or of a stack. We show that the ...Molière theory has the same degree of flexibility as the Fermi-Eyges, but is much more accurate and does not present particular computing difficulties with the energy loss formula we have employed. It is also shown that the non-Gaussian shape of the projected one dimensional (1D) distributions is not a complication for passing from the projected to the spatial two-dimensional (2D) distribution, if one assumes circular symmetry. All the calculations are compared with the results of the FLUKA code. The nuclear interaction is not considered here, because it is outside of the scope of this work.
The aim of this study is to investigate the differences between select on-ice measures using inertial movement sensors based on match outcome, and to determine changes in player movements across ...three periods of play. Data were collected during one season of competition in elite female ice hockey players (N = 20). Two-factor mixed effects ANOVAs for each skating position were performed to investigate the differences in match outcome, as well as differences in external load measures during the course of a match. For match outcome, there was a small difference for forwards in explosive ratio (
= 0.02, ES = 0.26) and percentage high force strides (
= 0.04, ES = 0.50). When viewed across three periods of a match, moderate differences were found in skating load (
= 0.01, ES = 0.75), explosive efforts (
= 0.04, ES = 0.63), and explosive ratio (
= 0.002, ES = 0.87) for forwards, and in PlayerLoad (
= 0.01, ES = 0.70), explosive efforts (
= 0.04, ES = 0.63), and explosive ratio (
= 0.01, ES = 0.70) for defense. When examining the relevance to match outcome, external load measures associated with intensity appear to be an important factor among forwards. These results may be helpful for coaches and sport scientists when making decisions pertaining to training and competition strategies.
Abstract Objective Studies measuring interobserver agreement (reliability) are common in clinical practice, yet discussion of appropriate sample size estimation techniques is minimal as compared with ...clinical trials. The authors propose a sample size estimation technique to achieve a prespecified lower and upper limit for a confidence interval for the κ coefficient in studies of interobserver agreement. Study Design and Setting The proposed technique can be used to design a study measuring interobserver agreement with any number of outcomes and any number of raters. Potential application areas include: pathology, psychiatry, dentistry, and physical therapy. Results This technique is illustrated using two examples. The first considers a pilot study in oral radiology, whose authors studied the reliability of the mandibular cortical index as measured by three dental professionals. The second example examines the level of interobserver agreement among four nurses with respect to five triage levels used in the Canadian Triage and Acuity Scale. Conclusion This method should be useful in the planning stages of an interobserver agreement study in which the investigator would like to obtain a prespecified level of precision in the estimation of κ . An R software package (R Foundation for Statistical Computing, Vienna, Austria), kappaSize is also provided that implements this method.
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