Diagnostic criteria and symptom grading for delayed gastric conduit emptying after esophagectomy for cancer: international expert consensus based on a modified Delphi process

Delayed gastric conduit emptying (DGCE) after esophagectomy for cancer is associated with adverse outcomes and troubling symptoms. Widely accepted diagnostic criteria and a symptom grading tool for DGCE are missing. This hampers the interpretation and comparison of studies. A modified Delphi process, using repeated web-based questionnaires, combined with live interim group discussions was conducted by 33 experts within the field, from Europe, North America, and Asia. DGCE was divided into early DGCE if present within 14 days of surgery and late if present later than 14 days after surgery. The final criteria for early DGCE, accepted by 25 of 27 (93%) experts, were as follows: >500 mL diurnal nasogastric tube output measured on the morning of postoperative day 5 or later or >100% increased gastric tube width on frontal chest x-ray projection together with the presence of an air-fluid level. The final criteria for late DGCE accepted by 89% of the experts were as follows: the patient should have 'quite a bit' or 'very much' of at least two of the following symptoms; early satiety/fullness, vomiting, nausea, regurgitation or inability to meet caloric need by oral intake and delayed contrast passage on upper gastrointestinal water-soluble contrast radiogram or on timed barium swallow. A symptom grading tool for late DGCE was constructed grading each symptom as: 'not at all', 'a little', 'quite a bit', or 'very much', generating 0, 1, 2, or 3 points, respectively. For the five symptoms retained in the diagnostic criteria for late DGCE, the minimum score would be 0, and the maximum score would be 15. The final symptom grading tool for late DGCE was accepted by 27 of 31 (87%) experts. For the first time, diagnostic criteria for early and late DGCE and a symptom grading tool for late DGCE are available, based on an international expert consensus process

Seasonal acclimatization to temperature in cardueline finches

1. Seasonal variation in body constituents and utilization of lipid, protein, and carbohydrate during cold stress in American goldfinches were studied to determine relations of these functions to the pronounced seasonal shift in thermogenic capacity documented in a previous study (Dawson and Carey, 1976).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47119/1/360_2004_Article_BF00686746.pd

Social learning correlates of exercise self-efficacy: Early experiences with physical activity

Self-efficacy, the degree of confidence an individual has for performing a given behavior, is a central concept in social learning theory. Self-efficacy is a strong correlate of current exercise and a consistent predictor of future exercise behavior. This study was designed to explore the correlates of exercise self-efficacy in order to determine whether early experiences with exercise and sports fosters exercise self-efficacy in adulthood. This study explored historical and contemporaneous correlates of exercise self-efficacy using a path analytic approach and a randomly selected sample of adults. Historical experiences with exercise and sports were classified as more or less organized and as proximal or distal in time. The activities studied included those reported during elementary (ages 6-14), high school (15-18), and the period after high school. The historical activities, scaled using factor analysis, were found to have no significant direct association with self-efficacy and only marginal indirect associations with self-efficacy mediated by contemporaneous social learning variables. Contemporaneous variables drawn from social learning theory were found to have the largest direct and indirect associations with self-efficacy specifically related to vigorous exercise. Directions for experimental analysis and health promotion policy implications are discussed.self-efficacy exercise early experiences school exercise exercise correlates

Smoking, exposure to secondhand smoke, and smoking restrictions in Tijuana, Mexico

Objective. To estimate the prevalence of tobacco use, exposure to secondhand smoke, and smoking restrictions in the home and workplace among residents of Tijuana, one of Mexico's largest cities. Methods. This cross-sectional household survey was conducted in Tijuana, Baja California, Mexico, during 2003 and 2004. A population-based sample of 400 Tijuana adult residents responded to a tobacco survey, and 397 of the surveys were analyzed. Results. About 22.9% (95% confidence interval (CI): 18.7%-27.1%) of Tijuana adults reported current smoking, and 53.9% (95% CI: 48.8%-58.9%) reported chronic exposure to secondhand smoke. Approximately 44.4% (95% CI: 37.9%-50.9%) of Tijuana adults had a nonsmoking policy in their workplace, while 65.8% (95% CI: 61.0%-70.6%) of Tijuana households were smoke-free. Conclusions. The results underline the need for increased tobacco control efforts, particularly stricter enforcement of existing passive smoking regulations, in order to expand protection from secondhand smoke from private settings to public ones and to curb the tobacco epidemic in Tijuana and elsewhere in Mexico