This study assessed factors associated with the perceived dose of intervention received and with the participant satisfaction in a school-based obesity prevention intervention. It also explored the variance in the dose of intervention received that was at the school level. Process evaluation data from a school-based intervention study conducted in Oslo in 2007-2009 were used. A total of 542 11-year-olds from 12 intervention schools were included. A web-based questionnaire was used to collect data. Descriptive analyses and multilevel regression analyses were conducted. Females and those with medium (vs. low) parental education had higher odds of reporting a high vs. low dose of intervention received at mid-way (8 months after baseline). Perceived social capital and perceived social support for physical activity from friends at baseline were positively associated with the dose of intervention received at mid-way. Perceived social capital at mid-way was positively associated with the dose of intervention reported post-intervention (20 months after baseline). Around 20% of the variance in the perceived dose of intervention received was at the school level. Satisfaction with the intervention was high overall and higher for females for several intervention components at mid-way and at post-intervention. The factors identified in this study should be taken into consideration when planning future obesity prevention interventions among youth.
Guidelines to evaluate patients for coronary artery disease (CAD) during preoperative evaluation for orthotopic liver transplantation (OLT) are conflicting. Cardiac catheterization is not without risk in patients with end-stage liver disease. No study to date has looked at the utility of non-electrocardiogram-gated chest computed tomography (CT) in the preliver transplant population. Our hypothesis was that coronary artery calcium scores (CACSs) from chest CT scans ordered during the liver transplant workup can identify patients who would benefit from invasive angiography. Nine hundred and fifty-three patients who underwent coronary angiography as part of their OLT workup were considered. Charts were randomly selected and reviewed for the presence of a chest CT performed before coronary angiography during the OLT workup. Agatston and Weston scores were calculated. CACS results were compared with coronary angiography findings. Nine of 54 patients were found to have obstructive CAD by angiography. Receiver-operating characteristic analysis demonstrated that an Agatston score of 251 and a Weston score of 6 maximized sensitivity and specificity for detection of obstructive coronary disease. An Agatston score <4 or Weston score <2 excluded the presence of obstructive CAD; using these thresholds, 13 patients (24%) or 15 patients (28%), respectively, could have theoretically avoided catheterization without missing significant CAD. In conclusion, our data identify the strength of CACS in ruling out coronary disease in patients being evaluated for OLT. Calcium scoring from non-electrocardiogram-gated CT studies may be integrated into preoperative algorithms to rule out obstructive CAD and help avoid invasive angiography in this high-risk population.
This volume was produced in collaboration with the San Fernando Valley Refugee Children Center, an organization committed to supporting unaccompanied minors who are seeking asylum after making the dangerous journey from Central America to the United States. Looking across the U.S. southern border, this book draws together vivid first-person accounts from children at the SFVRCC with current research and testimonials from immigration attorneys, trauma therapists, and case workers to form a kind of children’s book for adults–that is, for the children to narrate and for adults to listen to. This collaborative book thus challenges the current discourse surrounding refugee experience and immigration policy by documenting and sharing the untold stories of the families involved. Together with our partners at the SFVRCC, we hope to educate and mobilize readers by providing a more holistic understanding of the refugee experience through the voices of those who have been excluded from the very discussions and structures that shape their lives.
Aging is associated with an increased prevalence of both cancer and heart disease. The progression of aortic valve calcification to aortic stenosis may be accelerated by both cardiovascular risk factors and cancer treatments, such as radiotherapy with mediastinal involvement. Symptomatic aortic stenosis is occasionally diagnosed in cancer patients undergoing cardiovascular evaluation; likewise, cancer is often recognized during assessment preceding aortic valve interventions. In these complex cases, physicians face difficult treatment decisions. Due to a myriad of clinical presentations of cancer and valve disease, specific guidelines for this patient population are not currently in place. Management is currently based on clinical judgment, on an individual basis.
Patients with cancer in remission or with a favorable prognosis should be treated according to current cardiovascular guidelines. In these patients, aortic valve replacement can be performed either by surgery or transcatheter. Significant challenges arise in patients with active cancer, especially those receiving anti-cancer treatment. Recent data suggests that these patients can be offered aortic valve replacement, with a trend of favoring the transcatheter route in order to minimize perioperative risk and complications associated with major surgery. Patients with advanced cancer and severe aortic stenosis should be offered palliative care and can benefit from aortic balloon valvuloplasty if indicated. Modern cancer treatments associated with improved long-term prognosis may allow the appropriate cure of aortic stenosis. We discuss the protocol, outcomes, and evolving recommendations of aortic valve replacement in cancer patients with aortic stenosis.
In physical rehabilitation, exoskeleton assistive devices aim to restore lost motor functions of a patient suffering from neuromuscular or musculoskeletal disorders. These assistive devices are classified as operating in one of two modes: (1) passive mode, in which the exoskeleton passively moves its joints through the full range (or a subset) of the patient's motion during engagement, or (2) assist-as-needed (AAN) mode, in which the exoskeleton provides assistance to the joints of the patient, either by initiating the movements or assisting the patient's movements to complete the task at hand. Achieving high physical human-robot interaction (pHRI) transparency is an open problem for multiple degrees-of-freedom (DOFs) redundant exoskeletons. Using the EXO-UL8 exoskeleton, this study compares two multi-joint admittance control schemes (hyper parameter- based, and Kalman Filter-based) with comfort optimization to improve human-exoskeleton transparency. The control schemes were tested by three healthy subjects who completed reaching tasks while assisted by the exoskeleton. Kinematic information in both joint and task space, as well as force- and torque-based power exchange between the human arm and exoskeleton, are collected and analyzed. The results show that the preliminary Kalman Filter-based control scheme matches the performance of the existing hyper parameter-based scheme, highlighting the potential of the Kalman Filter-based approach for additional performance.