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In this pilot study, the NOC instruments Knowledge of Medication, Caregiver Home Care Readiness, and Health Promoting Behavior were evaluated for use in measuring outcomes of a nurse care manager program with chronically ill veterans. The convenience sample included 10 chronically ill veterans who were diagnosed with at least three of the high priority diagnoses targeted for care management: congestive heart failure, ischemic heart disease, chronic obstructive pulmonary disease hypertension, and diabetes. The typical patient was a 68-year-old married Caucasian male. The Caregiver Home Care Readiness and Health Promotion Behavior instruments demonstrated strong correlations for inter-rater reliability and overall reliability using Cronbach's alpha. The correlation coefficient for inter-rater reliability was below the acceptable .80 for Knowledge of Medications. This instrument had been modified considerably from the original NOC instrument because many of the indicators were in the scope of responsibility of pharmacists rather than nurse care managers in the Veterans Administration Medical Center (VAMC). All of the instruments showed acceptable inter-item reliability of .71 to .87. Use of chart audits to collect data regarding health promotion behavior and knowledge of medications was compared to the procedures of data collection with modified NOC instruments. The results from this pilot study demonstrated that NOC instruments provided more reliable data than the chart audits. [ABSTRACT FROM AUTHOR]

Two cases are presented of closed rapture of the extensor pollicis longus due to rotational trauma to the forearm. Case 1 was successfully managed by indicis proprius transfer and the operative findings are described. The rarity of this injury is stressed by a review of the sparse relevant literature. [ABSTRACT FROM PUBLISHER]

Seating arrangements for cerebral palsy children with total body involvement are often unsatisfactory and can pose considerable problems for the multi-disciplinary team. Hip joints at risk of dislocation must be kept in an abducted position in order to minimize pain. A new wheelchair with a barrel-shaped cylindrical seat has been developed which improves the femoral head location and alleviates pain. [ABSTRACT FROM AUTHOR]

Metabolic bone is highly innervated by both sensory and sympathetic nerves. In addition to skeletal development, neural regulation participates in local bone remodeling, which is important for successful osseointegration of titanium implants. Neurectomy is a model used to investigate the lack of neural function on bone homeostasis, but the relative impacts of direct denervation to bone or denervation-induced muscle paralysis are less well defined. To investigate this difference, we used two nerve intervention models, sciatic and femoral neurectomy (SFN) v. botox-induced muscle paralysis (BTX) and assessed the resulting femoral bone phenotype and Ti implant osseointegration. Male Sprague Dawley rats (19) were randomly divided into three groups: implant control (n = 5), SFN (n = 7), and BTX (n = 7). Ti implants (microrough/hydrophilic [modSLA], Institut Straumann AG) were placed in the distal metaphysis of each femur on day 24 post-SFN or BTX. Bone and muscle were examined on day 28 after implant insertion. Both nerve intervention models impaired osseointegration. MicroCT and histology indicated that both models had reduced trabecular bone formation. Only BTX reduced cortical bone formation and increased cortical bone porosity. BTX resulted in more bone loss characterized by the least trabecular and cortical bone, as well as osseointegration. Osteoblasts isolated from the tibia exhibited a model-specific phenotype when they were grown on Ti substrates in vitro. Neurectomy caused more severe muscle atrophy than botox injection. These results indicate that neural regulation directly modulates bone formation and osseointegration. Muscle paralysis modulated the effects of loss of neural inputs into bone, supporting the hypothesis that mechanical loading of bone is a factor in achieving successful osseointegration. The different effects of botox and neurectomy on bone phenotype indicated that the sensory and sympathetic nerves had a role in the osseointegration process., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: The current study aimed to identify features to include in online grocery stores to support healthful food purchasing by those striving to lose weight., Design: A Value Proposition Design approach was used to gain shopper insights, devise potential online grocery store features and obtain feedback on these features., Setting: Telephone interviews were conducted to gain insight into shoppers' needs and perceptions. Results were used by the research team to identify potential online grocery shopping features that may support healthful purchase decisions, and interviews were conducted with a different sample of shoppers to gather feedback on features., Participants: Insight (n 25) and feedback (n 25) interviews were conducted with convenience samples of adults trying to lose weight., Results: Participants were primarily female, white, college educated and with obesity or overweight. Online grocery features devised by the research team based on findings from the insight interviews included (1) shopping cart nutrition rating tool; (2) healthy meal planning tool; (3) interactive healthy eating inspiration aisle and (4) healthy shopping preference settings option. Findings from the feedback interviews indicated that the healthy meal planning tool, healthy shopping preference settings option and shopping cart nutrition rating tool features were positively rated by most participants., Conclusions: There are multiple features grocers should consider including in their online stores to attract and support customers striving to eat healthy for weight loss.

Background: Less than 2% of children in the U.S., ages 9-13, meet the minimum dietary recommendations for vegetable intake. The home setting provides potential opportunities to promote dietary behavior change among children, yet limited trials exist with child vegetable intake as a primary outcome. Strategies to increase vegetable intake grounded in behavioral economics are no/low cost and may be easily implemented in the home by parents., Methods: This non-randomized, controlled study tested whether an intervention of parent-led strategies informed by behavioral economics and implemented within a series of 6 weekly parent-child vegetable cooking skills classes, improved dietary outcomes of a diverse sample of low-income children (ages 9-12) more than the vegetable cooking skills classes alone. The primary outcomes were total vegetable intake, dietary quality (HEI scores), total energy intake, vegetable liking, variety of vegetables tried, child BMI-z score, and home availability of vegetables. Outcome measures were collected at baseline, immediate post-treatment, 6 and 12 months follow-up. Mixed model regression analyses with fixed independent effects (treatment condition, time point and treatment condition x time interaction) were used to compare outcomes between treatment conditions., Results: A total of 103 parent/child pairs (intervention = 49, control = 54) were enrolled and 91 (intervention = 44, control = 47) completed the weekly cooking skills program. The intervention did not improve child total vegetable intake. Intervention children increased dark green vegetable intake from immediate post-treatment to 12 months. The number of vegetables children tried increased and mean vegetable liking decreased over time for both control and intervention children., Conclusions: Findings from this study suggest that the strategies and the manner in which they were implemented may not be effective in low-income populations. The burden of implementing a number of strategies with potentially higher food costs may have constrained the ability of families in the current study to use the strategies as intended., Trial Registration: This trial has been retrospectively registered at : # NCT03641521 on August 21, 2018.

Measurement of lower limb strength, power and asymmetries of soccer players is important for monitoring physical development and injury risk. The aim of the present study was to establish the reliability and limits of meaningful change of single and double leg maximal strength, power and bilateral imbalance measures in elite soccer players using a pneumatic resistance based seated leg press. Thirteen participants undertook an incremental resistance leg press test on three separate testing days within a seven day period. Paired t-tests established no significant differences (p > 0.156) between consecutive tests, whilst 'good' reliability (intraclass correlation coefficient-ICC >0.762) and acceptable typical percentage errors (< 6.9%) were observed for maximal resistance, velocity and force pushed as well as average and peak power outputs. Imbalance variables accounting for left and right leg average power output across all repetitions were established as the most reliable imbalance variables, with 'good' reliability (ICC > 0.874) and absolute typical error values of 2.1%. Imbalance variables calculated using peak power output or average power output from the last 4 repetitions resulted in weaker reliability (ICC < 0.657) and significant differences between tests, and therefore were considered less suitable for applied use. Subsequently, to better inform the practitioner, limits of meaningful change were calculated for all strength, power and imbalance variables. The current study shows that lower limb strength, and power output variables and average imbalance measures of soccer players assessed through a seated leg press protocol show acceptable levels of reliability, and provides practitioners with limits of meaningful change around parameters to better evaluate test results.

Objective: To evaluate the impact of a vegetable-focused cooking skills and nutrition program on parent and child psychosocial measures, vegetable liking, variety, and home availability., Design: Baseline and postcourse surveys collected 1-week after the course., Setting: Low-income communities in Minneapolis-St Paul., Participants: Parent-child dyads (n = 89; one third each Hispanic, African American, and white) with complete pre-post course data; flyer and e-mail recruitment., Intervention(s): Six 2-hour-weekly sessions including demonstration, food preparation, nutrition education lessons, and a meal., Main Outcome Measures: Parental cooking confidence and barriers, food preparation/resource management, child self-efficacy and cooking attitudes, vegetable liking, vegetable variety, and vegetable home availability., Analysis: Pre-post changes analyzed with paired t test or Wilcoxon signed-rank tests. Results were significant at P < .05., Results: Increased parental cooking confidence (4.0 to 4.4/5.0), healthy food preparation (3.6 to 3.9/5.0), child self-efficacy (14.8 to 12.4; lower score = greater self-efficacy), vegetable variety (30 to 32/37 for parent, 22 to 24/37 for child), and home vegetable availability (16 to 18/35) (all P < .05)., Conclusions and Implications: A short-term evaluation of a vegetable-focused cooking and nutrition program for parents and children showed improvements in psychosocial factors, variety, and home availability., (Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Vegetable consumption in the United States is low despite the wealth of evidence that vegetables play an important role in reducing risk of various chronic diseases. Because eating patterns developed in childhood continue through adulthood, we need to form healthy eating habits in children. The objective of this study was to determine if offering vegetables before other meal components would increase the overall consumption of vegetables at school lunch. We served kindergarten through fifth-grade students a small portion (26-33 g) of a raw vegetable (red and yellow bell peppers) while they waited in line to receive the rest of their lunch meal. They then had the options to take more of the bell peppers, a different vegetable, or no vegetable from the lunch line. We measured the amount of each vegetable consumed by each child. Serving vegetables first greatly increased the number of students eating vegetables. On intervention days most of the vegetables consumed came from the vegetables-first portions. Total vegetable intake per student eating lunch was low because most students chose to not eat vegetables, but the intervention significantly increased this value. Serving vegetables first is a viable strategy to increase vegetable consumption in elementary schools. Long-term implementation of this strategy may have an important impact on healthy eating habits, vegetable consumption, and the health consequences of vegetable intake., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Heart failure (HF), despite continuing progress, remains a leading cause of mortality and morbidity. P2X4 receptors (P2X4R) have emerged as potentially important molecules in regulating cardiac function and as potential targets for HF therapy. Transgenic P2X4R overexpression can protect against HF, but this does not explain the role of native cardiac P2X4R. Our goal is to define the physiological role of endogenous cardiac myocyte P2X4R under basal conditions and during HF induced by myocardial infarction or pressure overload., Methods and Results: Mice established with conditional cardiac-specific P2X4R knockout were subjected to left anterior descending coronary artery ligation-induced postinfarct or transverse aorta constriction-induced pressure overload HF. Knockout cardiac myocytes did not show P2X4R by immunoblotting or by any response to the P2X4R-specific allosteric enhancer ivermectin. Knockout hearts showed normal basal cardiac function but depressed contractile performance in postinfarct and pressure overload models of HF by in vivo echocardiography and ex vivo isolated working heart parameters. P2X4R coimmunoprecipitated and colocalized with nitric oxide synthase 3 (eNOS) in wild-type cardiac myocytes. Mice with cardiac-specific P2X4R overexpression had increased S-nitrosylation, cyclic GMP, NO formation, and were protected from postinfarct and pressure overload HF. Inhibitor of eNOS, L-N(5)-(1-iminoethyl)ornithine hydrochloride, blocked the salutary effect of cardiac P2X4R overexpression in postinfarct and pressure overload HF as did eNOS knockout., Conclusions: This study establishes a new protective role for endogenous cardiac myocyte P2X4R in HF and is the first to demonstrate a physical interaction between the myocyte receptor and eNOS, a mediator of HF protection., (© 2014 American Heart Association, Inc.)

The purpose of this study was to investigate the correlations between biomechanical outcome measures and weightlifting performance. Joint kinematics and kinetics of the hip, knee, and ankle were calculated while 10 subjects performed a clean at 85% of 1 repetition maximum (1RM). Kinematic and kinetic time-series patterns were extracted with principal components analysis. Discrete scores for each time-series pattern were calculated and used to determine how each pattern was related to body mass-normalized 1RM. Two hip kinematic and 2 knee kinetic patterns were significantly correlated with relative 1RM. The kinematic patterns captured hip and trunk motions during the first pull and hip joint motion during the movement transition between the first and second pulls. The first kinetic pattern captured a peak in the knee extension moment during the second pull. The second kinetic pattern captured a spatiotemporal shift in the timing and amplitude of the peak knee extension moment. The kinematic results suggest that greater lift mass was associated with steady trunk position during the first pull and less hip extension motion during the second-knee bend transition. Further, the kinetic results suggest that greater lift mass was associated with a smaller knee extensor moments during the first pull, but greater knee extension moments during the second pull, and an earlier temporal transition between knee flexion-extension moments at the beginning of the second pull. Collectively, these results highlight the importance of controlled trunk and hip motions during the first pull and rapid employment of the knee extensor muscles during the second pull in relation to weightlifting performance.

The purpose of this study was to identify multijoint lower extremity kinematic and kinetic synergies in weightlifting and compare these synergies between joints and across different external loads. Subjects completed sets of the clean exercise at loads equal to 65, 75, and 85% of their estimated 1-RM. Functional data analysis was used to extract principal component functions (PCF's) for hip, knee, and ankle joint angles and moments of force during the pull phase of the clean at all loads. The PCF scores were then compared between joints and across loads to determine how much of each PCF was present at each joint and how it differed across loads. The analyses extracted two kinematic and four kinetic PCF's. The statistical comparisons indicated that all kinematic and two of the four kinetic PCF's did not differ across load, but scaled according to joint function. The PCF's captured a set of joint- and load-specific synergies that quantified biomechanical function of the lower extremity during Olympic weightlifting and revealed important technical characteristics that should be considered in sports training and future research.

Healthcare providers should look both outside and inside their organizations to prepare for Recovery Audit Contractor (RAC) program challenges. Organizations should have the right team in place to focus on their RAC audit response. Preparation for RAC audits should include mining data to identify potential risk, automating claim filing, educating staff and physicians, and communicating to key stakeholders.