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The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase III randomized controlled clinical trial (Clinicaltrials.gov identifier: NCT01072500) that will provide definitive evidence regarding the effect of physical activity (PA) on major mobility disability in older adults (70-89 years old) who have compromised physical function. This paper describes the methods employed in the delivery of the LIFE Study PA intervention, providing insight into how we promoted adherence and monitored the fidelity of treatment. Data are presented on participants' motives and self-perceptions at the onset of the trial along with accelerometry data on patterns of PA during exercise training. Prior to the onset of training, 31.4% of participants noted slight conflict with being able to meet the demands of the program and 6.4% indicated that the degree of conflict would be moderate. Accelerometry data collected during PA training revealed that the average intensity - 1,555 counts/minute for men and 1,237 counts/minute for women - was well below the cutoff point used to classify exercise as being of moderate intensity or higher for adults. Also, a sizable subgroup required one or more rest stops. These data illustrate that it is not feasible to have a single exercise prescription for older adults with compromised function. Moreover, the concept of what constitutes “moderate” exercise or an appropriate volume of work is dictated by the physical capacities of each individual and the level of comfort/stability in actually executing a specific prescription.

A methodological discrepancy exists in the hydration assessment literature regarding the establishment of euhydration, as some investigations utilize a prehydration technique, while others do not (overnight fluid/food fast). However, the degree that plasma osmolality (Posm) dilutes when using the pre-hydration method and how body mass/composition might influence the results is not known. Thirty subjects (22 M, 8 F; 20 ± 2 years (mean ± SD); 1.8 ± 0.1 m; 75.8 ± 13.5 kg) had P osm measured after an 8-h food and fluid fast (overnight fast) and 90 min after a 500-mL (4-9 mL/kg) water bolus (prehydration). From pre- to post-bolus, participants' P osm declined from 297 ± 3.5 to 295 ± 3.8 mmol/kg (p<0.05; Δ -1.7 ± 3.5 mmol/kg). One-third of the sample diluted to more than -3 mmol/kg. The effect of body mass on P osm dilution was investigated by comparing dilution in the ten lightest (62.8 ± 3.4 kg) and heaviest (92.0 ± 9.8 kg) participants; however, the change between the light (Δ -1.9 ± 3.8 mmol/kg) versus heavy groups (Δ -1.1 ± 3.0 mmol/kg) was not different (p>0.05). The correlation between body mass or total body water and change in P osm was weak (p>0.05), as was the correlation between relative fluid intake based on mass and change in P osm (p>0.05). The two methodologies appear to produce similar P osm values when measured in most individuals. However, the potential for significant dilution (>3 mmol/kg) should be considered when choosing the pre-hydration methodology. © Springer-Verlag (outside the USA) 2011.

Purpose To evaluate baroreflex sensitivity and autonomic control in a cohort of normotensive obese (OB) children. Method A cross-sectional investigation, in which, baroreflex sensitivity and autonomic control were evaluated using transfer function and power spectral density analysis (PSDA) of the electrocardiogram and beat-to-beat blood pressures in normotensive OB children and normal weight normotensive controls. All methods used were noninvasive and data were captured while seated and at rest. Results The OB and control subjects non-obese (NO) were of similar age (OB 9.1 ± 1.9 years vs.NO9.2 ± 1.4 years). The OB group was classified as having a BMI greater than the 95th percentile adjusted for age and gender, and a NO group with a BMI at or less than the 95th percentile (BMI percentile OB. 97.5 ± 1.3 vs. NO 58.5 ± 24.1). Both groups had similar normotensive blood pressures. T tests revealed that baroreflex sensitivity and HFRR were significantly reduced in the OB 9.2 ± 2.7 vs. 15.2 ± 4.7 (ms/mmHg) and 6.7 ± 1.1 vs. 8.2 ± 1.1 ms 2, respectively, while LF SBP and LF/HF ratio were significantly increased in the OB 11.9 ± 5.6 vs. 8.2 ± 4.7 mmHg 2 and 1.2 ± 0.7 vs. 0.54 ± 0.3, respectively. Conclusions Normotensive OB children exhibited significantly reduced baroreflex sensitivity, parasympathetic control as well as increased sympathetic control when compared with healthy, NO controls. Findings in this investigation raise the awareness that autonomic dysfunction is present in young OB normotensive children. © Springer-Verlag 2011.

Using eye-tracking methodology, gaze to a speaking face was compared in a group of children with autism spectrum disorders (ASD) and a group with typical development (TD). Patterns of gaze were observed under three conditions: audiovisual (AV) speech in auditory noise, visual only speech and an AV non-face, non-speech control. Children with ASD looked less to the face of the speaker and fixated less on the speakers' mouth than TD controls. No differences in gaze were reported for the non-face, non-speech control task. Since the mouth holds much of the articulatory information available on the face, these findings suggest that children with ASD may have reduced access to critical linguistic information. This reduced access to visible articulatory information could be a contributor to the communication and language problems exhibited by children with ASD.

Background: The rates of annual visits for adult Medicaid enrollees to the emergency department (ED) are increasing. Many programs throughout the country are focused on engaging patients in the use of their primary care providers (PCP) rather than the ED for low acuity conditions. It is unclear, however, the proportion of patients who are willing to use primary care services rather than the ED if they are given the choice. Methods: Cross-sectional study of adult Medicaid enrollees (18 y and older) presenting to a large, urban, academic ED from June to August 2012 with a low acuity condition was performed. We excluded patients who did not have a PCP or active Medicaid insurance. Our primary goal was to determine the proportion of patients who prefer to use the ED, rather than their PCP clinic, if an appointment was immediately available. Our second goal was to understand why patients would prefer ED over PCP care. Results: A total of 150 patients agreed to complete the survey, and 95 (63.3%) met our inclusion criteria. Forty-three patients (45.3%) stated preferring to use their PCPs rather than the ED if an appointment was available at that time. Thirteen (48.1%) cited that the ED had more technology or specialty care services available when compared with their PCP's clinic, 8 (15.4%) were in significant pain, and 6 (11.5%) felt the care they received in the ED was better than what they would receive in their PCP clinic. Conclusions: Our study shows that a little less than half of adult Medicaid enrollees presenting to the ED with low acuity conditions would have preferred to use their PCP rather than the ED, if an appointment had been immediately available.

Despite prevention efforts of colleges and universities across the nation, there have been no substantial decreases in heavy episodic drinking among undergraduates over the past 2 decades.This study provides an update on correlates of heavy episodic drinking for a recent cohort of undergraduate college students.A cross-sectional survey design was utilized. Participants were randomly selected undergraduate students from a public 4-year university located in the Northeast.Heavy episodic drinking was associated with male gender, white race, having a family history of drug or alcohol abuse, smoking cigarettes, and using marijuana. Age, athlete status, completion of an alcohol education program, condom use, depression, anxiety, and financial stress were not associated. After controlling for gender and race, marijuana use and smoking cigarettes were found to increase predictability of heavy episodic drinking.Rates of heavy episodic drinking remain high but correlates may be shifting for this cohort of college students. Opportunities to address heavy episodic drinking concurrently with cigarette smoking and marijuana use should be explored.Qualitative research methods are needed to gain insight into reasons for heavy episodic drinking; information that could inform the creation of more effective programming. © 2014 Copyright © SHAPE America.

Empirical data support the benefits of physical activity for women who have been diagnosed with breast cancer. However, the experience of exercising during or after breast cancer treatment has not been fully documented. The purpose of the researchers in this study was to provide an in-depth description of women's experiences with exercising during or after their breast cancer treatments, specifically, their perceptions of the benefits they experienced as a result of participation in an individualized exercise program that included cardiovascular and resistance activities. Forty-five women who had been diagnosed with breast cancer within the previous two years were recruited from two oncology practices after electing to enroll in an exercise program. Data were collected between September 2006 and August 2007 through in-depth interviews at various stages in the exercise program and analyzed simultaneously using thematic analysis methods. Whether in treatment or post-treatment, women attributed psychological, physical, and social benefits to their participation in the exercise program. Participants credited the program with helping them to feel better, regain control over their bodies and their lives, manage their emotions, and prepare them to live healthfully going forward. These results provide insight into the specific ways women experience exercise during and after their breast cancer treatments.

Objective: To explore the psychosocial effects of living with polycystic ovary syndrome (PCOS) through the experiences of young women diagnosed with this endocrine disorder. Design: A qualitative, phenomenological methodology was used. Data were obtained through personal, semistructured interviews. Setting: College campuses in New England. Participants: A purposive sample of 12 young women with PCOS age 18 to 23 years. Results: The following themes emerged from analysis of participants' responses: concerns for older self, feeling physically inferior, coping with symptoms, patient-provider relationship, seeking useable information and support, and coming to terms with a chronic condition. Conclusions: Participants in this study faced numerous physical, social, and emotional challenges on a daily basis. As these young women gathered information relevant to their needs, sought and received social support, and maintained their daily routines to improve their health and appearance, they came to terms with this chronic condition. Based on participants' relayed experiences, it became evident that a need exists for health care practitioners to include psychosocial support in a comprehensive holistic plan for the treatment of PCOS in adolescents and young women in their early twenties. JOGNN, 40, 709-718; 2011. DOI: 10.1111/j.1552-6909.2011.01299.x

Background: Fast food establishments are available on many college campuses and, as a result, many students consume foods that are high in calories and contribute to unhealthy weight gain. Purpose: This study measured college students' knowledge of the calorie content for fast food items and whether the provision of calorie information for those foods influenced their future purchasing intentions. Method: Randomly selected undergraduate college students (N = 201) completed an online survey that measured baseline knowledge of calorie content for a fast food item and intention to purchase that item in the future. After provision of accurate calorie information, students were posttested for intention to purchase that item in the future. Results: The majority of students underestimated calorie content for fast food items. After receiving accurate calorie information, those who initially underestimated calorie content were significantly more likely to change their intention to purchase that food item in the future. Discussion: Many college students are interested in avoiding high-calorie fast food items but are uninformed about calorie content. Translation to Health Education Practice: Colleges should provide calorie information for fast food items at the point of purchase so that students can make informed decisions that will promote their health. © 2015, Copyright © SHAPE America.

Community-based participatory research (CBPR) is a collaborative methodology that uniquely involves stakeholders in all stages of the research process. CBPR has been widely utilized in the field of public health, but not widely employed with college populations. This study utilized CBPR methods within a college community to gain insight into excessive alcohol consumption. Six student researchers planned and carried out a rigorous qualitative study at a public university in the Northeast region of the United States. A total of 48 undergraduate participants were recruited for focus groups that were facilitated by two student researchers, and transcribed and analyzed using thematic analysis methods. Students' reasons for drinking alcohol were focused within the themes of inclusion, habitual default, and the student development process. Social media, strict policy/enforcement, and student's desire to avoid responsibility led to increased risk and consequences related to drinking. Students recommended late night transportation and a Good Samaritan policy as strategies to improve student safety. This study led to student advocacy and policy change directed at improving student's health and safety and demonstrated that CBPR methods show promise for engaging students and producing meaningful data.

The observation that “(d)rugs don’t work in patients who don’t take them” seems obvious; however, for older people living with HIV and cardiovascular disease (CVD), the potential for taking large numbers of medications on a regular basis may present as an overwhelming task, particularly as HIV and CVD progress and worsen over time. The extent to which older people living with HIV and CVD follow medication schedules for the treatment of these chronic health conditions is not understood well, and myriad questions exist with regard to medication adherence and older people living with HIV and CVD. For instance, do older people living with HIV and CVD take all medications as prescribed? Does this group prioritize which medications to take, perhaps demonstrating a preference for taking antiretroviral medications for the treatment of HIV as opposed to statins for the treatment of CVD? In the process of answering these and other questions, recognizing the individual and his or her attitudes and behaviors within the context of the dyadic relationship shared between patient and physician is paramount. Developing a more thorough understanding of this dyadic relationship allows for a better grasp of the context within which medication adherence occurs for older people living with HIV and CVD. That said, because of the ability to lend itself to an understanding of human behavior, human development, and psychology, the Andersen and Newman Behavioral Model of Health Service Use provides a worthwhile conceptual basis for beginning to answer these questions. © 2015 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

This study uses a multifactor REIT-specific model to estimate and compare REIT idiosyncratic volatility vis-A-vis the same from the Fama-French three-factor model. Estimates of conditional idiosyncratic volatility and conditional betas obtained from a multifactor REIT-returns model and a bivariate EGARCH model respectively are found to be positively and significantly related with REIT returns. Consistent with Merton's (1987) predictions, we observe that larger REITs post higher average returns when idiosyncratic risk is introduced in cross-sectional regressions. Persistence of past market-risk does not appear to be short-lived and seems to have a lasting impact on future idiosyncratic volatility. We also observe mild evidence of persistence of past idiosyncratic risk, albeit short-lived, thereby suggesting that past idiosyncratic risk has a short-term impact on future idiosyncratic risk. Published by Elsevier Inc.

Purpose – This paper aims to examine the link between financing patterns, information asymmetry and legal traditions in 37 countries during the 1990-2004 period. Design/methodology/approach – The analysis is based on three theories: the trade-off theory, pecking order hypothesis and market timing hypothesis. The authors test the predictions of these theories/hypotheses using regression analysis. The econometric method used is panel data with firm and country fixed effects. The authors develop a modified pecking order model which controls for short- and long-term debt level changes and simultaneously test the predictions of all theories. Findings – Consistent with studies for US firms, the results show that firms across all countries adjust toward the target leverage, but with significantly different rate. The long-term debt contribution in the rate of adjustment is 64 percent in common law countries and 51 percent in civil law countries. The ability of the model to explain changes in leverage ratios is higher in common law countries. The authors find support for market timing hypothesis but no support for pecking order of financing. These results support their conjecture that stronger investor protection, higher transparency and well-developed financial markets in common law countries reduce the cost of recapitalization. Research limitations/implications – The limitation of this study comes from lack of data availability to measure contract enforcement, transparency, and corporate governance variables. Future research can incorporate these variables to explain the differences in capital structure decisions across countries with different legal systems. Practical implications – The findings show that firms' capital structure decisions are not only a function of their own characteristics but also the result of legal and financial market development in which they operate. Originality/value – This is the first study that sheds light about rate of adjustment to optimal capital structure and pecking order of financing in 37 countries with different legal traditions and financial market developments. The authors are not aware of any other study that uses a modified pecking order model in an international context. © 2011, © Emerald Group Publishing Limited.

Three neighborhoods in Lexington, Kentucky, share a common flood history, including property acquisitions, as a means to mitigate against flooding; yet, the interactions of residents with the buyout landscapes vary significantly among the neighborhoods. Although the same institutions and structural controls implemented flood buyout programs in all three neighborhoods, semi-structured interviews illustrate that differing perspectives, personalities, and neighborhood politics shaped unique identities and land uses for the acquired properties in each neighborhood. Varying levels of resident engagement with the buyout landscape resulted in a range of attitudes towards hazard preparation, management, and mitigation, thus leaving some neighborhoods more resilient to future flooding than others. This study explores key residents, termed magnetic agents, who drove neighborhood civic action and land uses on the open space created through floodplain property acquisition. This research indicates magnetic agents can serve as important partners for local governments and non-governmental organizations (NGOs) in building community-based projects aimed at reducing vulnerability to flood events and instituting high utility land uses on floodplain buyout open space.(C) 2016 Elsevier Ltd. All rights reserved.

The Modifiable Areal Unit Problem (MAUP) is a famous issue in spatial analysis that states the output of a spatial analysis is influenced by the spatial extent of the units used in the analysis. This study demonstrates that the MAUP is accompanied with another intractable spatial issue in spatial modeling; the Modifiable Conceptual Unit Problem (MCUP). The MCUP states that the conceptualization of spatial processes impacts the output of spatial analysis and occurs when a model with one spatial dimension is applied to a spatial model with more than one spatial dimension. This study demonstrates the MCUP by developing three conceptual models of dispersal and showing how they produce different results even when given the same initial dispersal curves and areal units. Three conceptual models of dispersal (sum of curve points model, area of distance range model, and the volume of distance range model) are described and applied to a grid landscape with a single point of dispersal and a grid landscape with multiple points of dispersal. A Geographic Information System (GIS) is used to evaluate how the models differ in their distribution of pollen or seeds across the landscapes. The three models of dispersal are each valid conceptualizations of the dispersal process, but when given the same dispersal curve parameters, they produce different distributions of dispersed items across grid landscapes. The sum of curve points model is the least complicated model because it only uses a few points from the defined dispersal curve. The area of distance range model uses the entire dispersal curve, but is based on a single dimension of space and thus conceptually abstracted from the grid landscape. The volume of distance range model uses the two spatial dimensions present in the grid landscape and thus is the most conceptually sound model of the three. The underlying conceptualization of the dispersal process can impact the results of dispersal models. Applying dispersal curves with one spatial dimension to grids with two spatial dimensions makes inherent assumptions about the conceptualization of dispersal. This study highlights the necessity of researchers to declare their conceptual models of dispersal when applying modeled dispersal curves to grid landscapes. © 2016 The Author.

Purpose - The Federal Emergency Management Agency provides guidelines for the management of open space created through property acquisition (buyouts); however, land use decisions are primarily left to local governments manifesting in a variety of uses. The purpose of this paper is to provide a land use assessment of buyout sites, to describe the changes in those uses that have occurred during a ten-year period from 1990 to 2000, and to offer an assessment of management approaches employed across these sites. Design/methodology/approach - Using a mixed-methods approach consisting of a land use classification survey and a semi-structured questionnaire of floodplain managers, this study explores the land use trends at buyout sites, diverse approaches local governments take in managing the open spaces created through floodplain buyout programs, and the successes and challenges communities face in open space management. Findings - Results indicate strong support from floodplain managers for property acquisition and several cases emerged where communities put their newly acquired public land to creative uses. However, the opportunity to leverage these properties for greater public values is largely being missed, primarily because of limited funding. Practical implications - The analysis indicates strong support among floodplain managers for the buyout approach; however, additional resource-sharing and funding opportunities are needed to increase the utility of buyout properties. Originality/value - By evaluating the long-term management strategies floodplain managers utilize on buyout sites, this study adds to an underrepresented area of scholarship and is of value to practitioners, government officials, and academics.

Human societies are known for their resilience and ability to adapt to short- and long-term environmental change. Despite their pragmatism and adaptability, humans could be forced to move and/or seek better conditions for survival, especially when climate change and water availability are at issue. This chapter provides case studies on easy-to-adopt rainwater harvesting applications as effective climate change adaptation strategies in rural and urban settings to increase human resiliency.