Publications by authors named "Sarah Amin"

25 Publications

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Quality Nutrition Education Materials for Pregnant or Lactating Women and Children Ages 0-24 Months Old.

J Nutr Educ Behav 2021 05;53(5):369

Bradley University, SNEB Nutrition Education for Children Division, Chair-Elect.

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http://dx.doi.org/10.1016/j.jneb.2021.03.009DOI Listing
May 2021

The Fueling Learning Through Exercise Study Cluster RCT: Impact on Children's Moderate-to-Vigorous Physical Activity.

Am J Prev Med 2021 Jun 26;60(6):e239-e249. Epub 2021 Mar 26.

Division of Nutrition Interventions, Communication, and Behavior Change, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.

Introduction: Most children do not meet the recommendations for school-time and daily moderate-to-vigorous physical activity, with significant demographic disparities and declines over the elementary school years. Investigators examined the impact of Fueling Learning through Exercise study school-based physical activity programs on school-time and total daily moderate-to-vigorous physical activity among lower-income school children.

Design, Participants, And Intervention: Urban elementary schools (N=18) were cluster randomized to 100 Mile Club, Just Move, or control. Data collection and analyses occurred from 2015 to 2019 among third- and fourth-grade school children (N=1,008) across 2 academic years.

Main Outcome Measures: Student's moderate-to-vigorous physical activity was measured by 7-day accelerometry (Actigraph GT3X+) at baseline (before intervention), midpoint (6 months), and endpoint (18 months). Mixed-effects linear regression models examined program impact on school-time and daily moderate-to-vigorous physical activity, adjusting for clustering, demographics, weight status, free/reduced-price lunch eligibility, school physical activity environment, wear time, and weather. Program reach by sex, weight status, race/ethnicity, and baseline activity levels was explored.

Results: Of the 979 participants analyzed (aged 8.7 [SD=0.7] years, 44% male, 60% non-White, 40% overweight/obese, 55% eligible for free/reduced-price lunch), 8.4% (18.2 [SD=7.9] minutes per day) and 19.8% (45.6 [SD=19.4] minutes per day) fulfilled the 30-minute school-time and 60-minute daily moderate-to-vigorous physical activity recommendations at baseline, respectively. Overall, daily moderate-to-vigorous physical activity decreased from baseline to 18 months (p<0.001, -5.3 minutes, 95% CI= -8.2, -2.4) with no effect of programming. However, for school-time moderate-to-vigorous physical activity, intervention schools maintained school-time moderate-to-vigorous physical activity across the 2 academic years, whereas school-time moderate-to-vigorous physical activity decreased in control schools (p=0.004, -2.3 minutes, 95% CI= -4.3, -0.4). Program reach on school-time moderate-to-vigorous physical activity appeared equitable by sex and weight status but was different by race/ethnicity (p<0.001).

Conclusions: Two different school-based physical activity programs were effective in preventing the decline in school-time moderate-to-vigorous physical activity that is typical across the elementary years, with similar reach by sex and weight status. Multiple opportunities for physical activity during school are needed to promote meeting school-time moderate-to-vigorous physical activity recommendations among diverse children.

Trial Registration: This study is registered at www.clinicaltrials.gov NCT02810834.
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http://dx.doi.org/10.1016/j.amepre.2021.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154686PMC
June 2021

Effectiveness of mobile produce markets in increasing access and affordability of fruits and vegetables among low-income seniors.

Public Health Nutr 2020 12 4;23(17):3226-3235. Epub 2020 Sep 4.

Rhode Island Public Health Institute, 383 W. Fountain St. Suite 101, Providence, RI02903, USA.

Objective: Mobile produce markets (MPM) offering Supplemental Nutrition Assistance Program (SNAP) incentive programmes have the potential to provide accessible and affordable fruits and vegetables (FV) to populations at risk of food insecurity. The objective of this study is to characterise the customer base of an MPM and describe their participation at twelve market sites serving low-income seniors.

Design: In 2018, customers from an MPM in Rhode Island (RI) participated in a cross-sectional survey (n 330; 68 % response rate), which measured dietary patterns, food security and food shopping behaviours. We compared the shopping habits and market experiences of customers who currently received SNAP benefits with those who did not currently receive SNAP benefits.

Setting: An MPM in RI which offers a 50 % discount for FV purchased with SNAP benefits.

Participants: This study describes current market customers at twelve market sites serving low-income seniors.

Results: Market customers were mostly low-income, female, over the age of 50 years and Hispanic/Latino. Most customers received SNAP benefits, and almost half were food insecure. In addition, three quarters of SNAP customers reported their SNAP benefits last longer since shopping at the markets. Mixed logistic regression models indicated that SNAP customers were more likely to report buying and eating more FV than non-SNAP customers.

Conclusions: MPM are critical resources of affordable produce and have been successful in improving access to FV among individuals of low socio-economic status in RI. This case study can inform policy and programme recommendations for MPM and SNAP incentive programmes.
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http://dx.doi.org/10.1017/S1368980020002931DOI Listing
December 2020

Establishing a Technique for Pectoral II-Block Catheter Insertion with Ultrasound Guidance: A Randomized Controlled Trial.

Local Reg Anesth 2020 11;13:85-93. Epub 2020 Aug 11.

Department of Anesthesia, Intensive Care and Pain Management, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.

Purpose: To assess the efficacy and safety of a modified technique for ultrasound-guided pectoral II block for postoperative pain control after mastectomy.

Methods: In this randomized controlled trial, patients were randomly allocated into two groups (40 patients each). Group I patients were subjected to ultrasound-guided pectoral II block with injection of 10 mL lidocaine 1% as a dissecting solution before attempting catheter insertion, while group II patients underwent the standard procedure without a dissecting solution. Measured outcomes included catheter visibility, pain, patient satisfaction, performance time, and complications.

Results: Compared with group II, group I had significantly lower median catheter-visibility scores, shorter block performance time, and fewer insertion attempts. Group I had a nonsignificantly higher rate of complications than group II.

Conclusion: The modified technique facilitated the procedure, shortened the catheter-insertion time, and showed higher patient satisfaction. However, it was associated with lower catheter visibility on ultrasonography. Further studies are required to confirm the present findings and assess the safety of the modified technique.
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http://dx.doi.org/10.2147/LRA.S262138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429189PMC
August 2020

Modified-ramped position: a new position for intubation of obese females: a randomized controlled pilot study.

BMC Anesthesiol 2020 06 17;20(1):151. Epub 2020 Jun 17.

Department of anesthesia and critical care medicine, Cairo university, Giza, Egypt.

Background: Endotracheal intubation requires optimum position of the head and neck. In obese females, the usual ramped position might not provide adequate intubating conditions. We hypothesized that a new position, termed modified-ramped position, during induction of anesthesia would facilitate endotracheal intubation through bringing the breasts away from the laryngoscope and would also improve the laryngeal visualization.

Methods: Sixty obese female patients scheduled for general anesthesia were randomly assigned into either ramped or modified-ramped position during induction of anesthesia. In the ramped position (n = 30), the patient head and shoulders were elevated to achieve alignment of the sternal notch and the external auditory meatus; while in the modified-ramped position (n = 30), the patient shoulders were elevated using a special pillow, and the head was extended to the most possible range. Our primary outcome was the incidence of failed laryngoscopic insertion in the oral cavity (the need for patient repositioning). Other outcomes included time till vocal cord visualization, time till successful endotracheal intubation, difficulty of the mask ventilation, and Cormack-Lehane grade for laryngeal view.

Results: Fourteen patients (47%) in ramped group required repositioning to facilitate introduction of the laryngoscope in the oral cavity in comparison to one patient (3%) in the modified-ramped position (p < 0.001). Modified-ramped position showed lower incidence of difficult mask ventilation, shorter time for glottic visualization, and shorter time for endotracheal tube insertion compared to the ramped position. The Cormack-Lehane grade was better in the modified-ramped position.

Conclusion: Modified-ramped position provided better intubating conditions, improved the laryngeal view, and eliminated the need for repositioning of obese female patients during insertion of the laryngoscope compared to ramped position.

Clinical Trial Registration: Identifier: NCT03640442. Date: August 2018.
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http://dx.doi.org/10.1186/s12871-020-01070-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298754PMC
June 2020

Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial.

BMC Anesthesiol 2020 04 17;20(1):84. Epub 2020 Apr 17.

Department of anesthesia and critical care medicine, 01 elsarayah street, Elmanyal, Cairo, 11559, Egypt.

Background: Data on the best norepinephrine bolus dose for management of hypotension are limited. The aim of this study was to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of maternal hypotension during cesarean delivery.

Methods: This randomized, controlled trial included mothers scheduled for cesarean delivery with spinal anesthesia with a prophylactic norepinephrine infusion. Following spinal anaesthesia administration, a participant was considered hypotensive if systolic blood pressure was ≤80% compared to the baseline reading. Participants were allocated to receive either 6 mcg or 10 mcg norepinephrine bolus for the management of hypotensive episodes. The hemodynamic response after administration of norepinephrine bolus was recorded. The episode was considered successfully managed if systolic blood pressure returned to within 80% from the baseline reading within 2 min after norepinephrine bolus administration, and did not drop again within 6 min after the norepinephrine bolus. The primary outcome was the incidence of successful management of the first hypotensive episode. Other outcomes included systolic blood pressure, heart rate, incidence of maternal bradycardia, and reactive hypertension.

Results: One hundred and ten mothers developed hypotensive episodes and received norepinephrine boluses for management. The number of successfully managed first hypotensive episodes was 50/57 (88%) in the 6 mcg-treated episodes and 45/53 (85%) in the 10 mcg-treated episodes (p = 0.78). Systolic blood pressure was comparable after administration of either bolus dose. Heart rate was lower after administration of 10 mcg bolus compared to 6 mcg bolus, without significant bradycardia requiring atropine administration. The incidence of reactive hypertension was comparable between both groups.

Conclusion: In mothers undergoing elective cesarean delivery under prophylactic norepinephrine infusion at 0.05 mcg/kg/min, there was no advantage to the use of 10 mcg norepinephrine bolus over 6 mcg norepinephrine bolus for the rescue management of first hypotensive episode. Neither of the 2 bolus doses reached a 100% success rate. The incidences of bradycardia and reactive hypertension were comparable between both norepinephrine doses.

Trial Registration: At clinicaltrial.gov registry system on January 4, 2019 Clinical trial identifier: NCT03792906.
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http://dx.doi.org/10.1186/s12871-020-01004-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164145PMC
April 2020

Accuracy and trending of non-invasive oscillometric blood pressure monitoring at the wrist in obese patients.

Anaesth Crit Care Pain Med 2020 04 14;39(2):221-227. Epub 2020 Feb 14.

Department of anaesthesia and critical care medicine, faculty of medicine, 01 Elsarayah Street, Elmanyal Cairo 11559, Egypt. Electronic address:

Background: In obese patients, non-invasive blood pressure monitoring in the arm is difficult due to the arm size and morphology. We compared the non-invasive oscillometric wrist blood pressure measurement with the arm and forearm in obese patients monitored with invasive radial blood pressure (reference standard).

Methods: This prospective observational study included adult obese patients scheduled for bariatric surgery. Non-invasive blood pressure was measured at the arm, upper forearm and wrist of one upper extremity, while invasive blood pressure was simultaneously measured through a radial arterial catheter in the contralateral upper extremity. The accuracy of non-invasive blood pressure reading at each site was evaluated for absolute and trending values using the Bland-Altman analysis and Spearman's correlation coefficient.

Results: In 40 patients, 262, 259, and 263 pairs of non-invasive blood pressure readings were obtained from the arm, forearm, and wrist sites, respectively. As primary outcome, the correlation coefficient for systolic blood pressure was higher for the wrist (0.92, 95% confidence interval (CI) [0.9-0.94]) than for the arm (0.74, 95% CI [0.68-0.79]) and the forearm (0.71, 95% CI [0.64-0.76]) (P<0.05). The non-invasive systolic wrist blood pressure showed the least mean bias and the narrowest limits of agreement (-0.3±7.6mmHg) when compared with forearm (4.3±16) and arm measurements (14.2±13.6) (P<0.05). For trending values, the correlation coefficient was the highest at the wrist.

Conclusion: In obese patients undergoing bariatric surgery, non-invasive blood pressure measured at the wrist showed the highest accuracy in comparison with the arm and forearm.
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http://dx.doi.org/10.1016/j.accpm.2020.01.006DOI Listing
April 2020

Associations between Food Group Intake, Cognition, and Academic Achievement in Elementary Schoolchildren.

Nutrients 2019 Nov 9;11(11). Epub 2019 Nov 9.

Milken Institute of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC 20052, USA.

Nutrition plays an important role in proper physical and cognitive functioning. However, there is limited evidence on the relationship between overall diet, cognition, and academic success in children, particularly among low-income and diverse groups. The objective of this study was to examine the relationships between healthful versus less healthful food group intake, cognitive performance, and academic achievement in a diverse sample of schoolchildren. 868 urban schoolchildren (age 8 to 10 years) participated in the study. Intake of healthful (fruits, vegetables, unsweetened beverages) and less healthful (sweet and salty snacks, sugar-sweetened beverages) food groups was determined via a food frequency questionnaire. Digit Span and Stroop test scores were used to assess cognitive performance. Academic achievement was assessed via standardized test scores. Multiple Poisson and multiple linear regression were used to test the associations between diet and cognitive scores. Multiple ordered logistic regression was used to assess the associations between diet and academic achievement. Potential confounders (age, sex, body mass index (BMI) z-score, race/ethnicity, English language learner status, individualized education plan enrollment, physical activity, and parent education level) were tested for inclusion in all models. The sample included 868 children (56.7% girls; 33.2% non-Hispanic white, 26.2% Hispanic, 17.1% multiracial/other, 8.3% non-Hispanic black; 40.5% overweight/obese). The most frequently consumed foods were fruits and sweet snacks (1.9 and 1.6 servings per day, respectively). There were no statistically significant associations between diet and cognitive test scores. Greater intake of less healthful food groups (sweet snacks, salty snacks, and sweetened beverages) was associated with lower math (OR = 0.91, CI [0.84, 0.98], = 0.014) and English standardized test scores (OR = 0.87, CI [0.80, 0.94, = 0.001). Greater intake of sweet snacks and fruits was associated with lower English scores (OR = 0.72, 95% CI [0.59, 0.88] = 0.001; and OR = 0.75, 95% CI [0.72, 0.94] = 0.003, respectively). Consumption of less healthful food groups was associated with poorer academic achievement. Further research may shed light on unexpected associations between fruit consumption and achievement. Policies targeting multiple dietary components may positively influence child academic achievement and development.
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http://dx.doi.org/10.3390/nu11112722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893423PMC
November 2019

Variable versus fixed-rate infusion of phenylephrine during cesarean delivery: a randomized controlled trial.

BMC Anesthesiol 2019 11 3;19(1):197. Epub 2019 Nov 3.

Department of anesthesia and critical care medicine, Cairo university, Cairo, Egypt.

Background: Phenylephrine is the most commonly used vasopressor for prophylaxis against maternal hypotension during cesarean delivery; however, the best regimen for its administration is not well established. Although variable infusion protocols had been suggested for phenylephrine infusion, evidence-based evaluation of variable infusion regimens are lacking. The aim of this work is to compare variable infusion, fixed on-and-off infusion, and intermittent boluses of phenylephrine for prophylaxis against maternal hypotension during cesarean delivery.

Methods: A randomized controlled study was conducted, including full-term pregnant women scheduled for elective cesarean delivery. Participants were divided into three groups which received phenylephrine by either intermittent boluses (1.5 mcg/Kg phenylephrine), fixed on-and-off infusion (with a dose of 0.75 mcg/Kg/min), or variable infusion (with a starting dose of 0.75 mcg/Kg/min). The three groups were compared with regard to frequency of: maternal hypotension (primary outcome), second episode hypotension, reactive hypertension, and bradycardia. Other outcomes included heart rate, systolic blood pressure, physician interventions, and neonatal outcomes.

Results: Two-hundred and seventeen mothers were available for final analysis. The 2 infusion groups showed less incidence of maternal hypotension {26/70 (37%), 22/71 (31%), and (51/76 (67%)} and higher incidence of reactive hypertension compared to the intermittent boluses group without significant differences between the two former groups. The number of physician interventions was highest in the variable infusion group compared to the other two groups. The intermittent boluses group showed lower systolic blood pressure and higher heart rate compared to the two infusion groups; whilst the two later groups were comparable.

Conclusion: Both phenylephrine infusion regimens equally prevented maternal hypotension during cesarean delivery compared to intermittent boluses regimen. Due to higher number of physician interventions in the variable infusion regimen, the current recommendations which favor this regimen over fixed infusion regimen might need re-evaluation.
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http://dx.doi.org/10.1186/s12871-019-0879-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827237PMC
November 2019

Robustness of Food Processing Classification Systems.

Nutrients 2019 Jun 14;11(6). Epub 2019 Jun 14.

Milken Institute School of Public Health, The George Washington University, Washington, DC 20037, USA.

Discrepancies exist among food processing classification systems and in the relationship between processed food intake and dietary quality of children. This study compared inter-rater reliability, food processing category, and the relationship between processing category and nutrient concentration among three systems (Nova, International Food Information Council (IFIC), and University of North Carolina at Chapel Hill (UNC)). Processing categories for the top 100 most commonly consumed foods children consume (NHANES 2013-2014) were independently coded and compared using Spearman's rank correlation coefficient. Relative ability of nutrient concentration to predict processing category was investigated using linear discriminant analysis and multinomial logistic regression and compared between systems using Cohen's kappa coefficient. UNC had the highest inter-rater reliability ( = 0.97), followed by IFIC ( = 0.78) and Nova ( = 0.76). UNC and Nova had the highest agreement (80%). Lower potassium was predictive of IFIC's classification of foods as moderately compared to minimally processed ( = 0.01); lower vitamin D was predictive of UNC's classification of foods as highly compared to minimally processed ( = 0.04). Sodium and added sugars were predictive of all systems' classification of highly compared to minimally processed foods ( < 0.05). Current classification systems may not sufficiently identify foods with high nutrient quality commonly consumed by children in the U.S.
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http://dx.doi.org/10.3390/nu11061344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627649PMC
June 2019

Norepinephrine versus phenylephrine infusion for prophylaxis against post-spinal anaesthesia hypotension during elective caesarean delivery: A randomised controlled trial.

Anaesth Crit Care Pain Med 2019 12 30;38(6):601-607. Epub 2019 Mar 30.

Department of obstetrics and gynaecology, Cairo university, Cairo, Egypt. Electronic address:

Background: Prophylactic vasopressors are fundamental during caesarean delivery under spinal anaesthesia. The aim of this work is to compare the efficacy and safety of phenylephrine and norepinephrine when used in variable infusion rate during caesarean delivery.

Methods: A randomised, double-blinded, controlled trial was conducted including mothers scheduled for elective caesarean delivery under spinal anaesthesia. Participants were allocated to two groups norepinephrine group (n = 60), and phenylephrine group (n = 63). Participants received prophylactic vasopressors after spinal block at rate started at 0.05 mcg/kg/min and 0.75 mcg/kg/min respectively. The rate of vasopressor infusion was manually adjusted according to maternal systolic blood pressure. Both groups were compared according to incidence of post-spinal hypotension (the primary outcome), incidence of bradycardia, incidence of reactive hypertension, systolic blood pressure, heart rate, rescue vasopressor consumption, number of physician interventions, and neonatal outcomes.

Results: One hundred and twenty-three mothers were available for final analysis. Both groups were comparable in the incidence of post-spinal hypotension (32% versus 30%, P = 0.8). The number of physician intervention was lower in norepinephrine group. The incidence of bradycardia and the incidence of reactive hypertension were potentially lower in norepinephrine group without reaching statistical significance, (13% vs. 21%, P = 0.3) and (12% vs. 24%, P = 0.1). Rescue vasopressor consumption, and neonatal outcomes were comparable between both groups.

Conclusion: When given in a manually adjusted infusion, norepinephrine effectively maintained maternal SBP during caesarean delivery under spinal anaesthesia with lower number of physician interventions, and likely less incidence of reactive hypertension and bradycardia compared to phenylephrine.
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http://dx.doi.org/10.1016/j.accpm.2019.03.005DOI Listing
December 2019

Development of a Tool for Food Literacy Assessment in Children (TFLAC).

J Nutr Educ Behav 2019 03;51(3):364-369

Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC.

Objective: Food literacy provides a framework for food-related knowledge, skills, and behaviors. The aim of this study was to develop a Tool for Food Literacy Assessment in Children (TFLAC), grades 4-5.

Methods: Development of the TFLAC consisted of 3 phases: (1) content validity using a 2-round modified Delphi panel (n = 16) and content validity ratios (CVR); (2) pilot-testing (n = 38); and (3) assessment of internal consistency and test-retest reliability (n = 706) using Cronbach α and intraclass correlation coefficients, respectively. Statistical significance was set at P < .05.

Results: Round 1 (CVR = 0.40) and 2 (CVR = 0.70) Delphi panel feedback and the pilot test informed modifications to the TFLAC question format, wording, and difficulty. Food literacy domain-specific Cronbach α values were acceptable (range, .80-.98) except for cooking knowledge (.63), and intraclass correlation coefficients were 0.64-0.70 (P < .001).

Conclusions And Implications: The TFLAC meets basic psychometric standards and may serve as a foundation for nutrition education intervention design and evaluation. Further testing with a broader geographic audience may be warranted.
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http://dx.doi.org/10.1016/j.jneb.2018.12.006DOI Listing
March 2019

The FLEX study school-based physical activity programs - measurement and evaluation of implementation.

BMC Public Health 2019 Jan 16;19(1):73. Epub 2019 Jan 16.

Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, USA.

Background: Increasing children's physical activity (PA) at school is critical to obesity prevention and health promotion. Implementing novel, low-cost PA programs offers potential to contribute to children's in-school PA, particularly in resource-constrained schools. This evaluation describes implementation fidelity, reach, and dose of two PA programs in the Fueling Learning through Exercise (FLEX) Study.

Methods: Thirteen diverse, low-income Massachusetts elementary schools were recruited and randomized to the 100 Mile Club walking/running program (n = 7) or CHALK/Just Move classroom activity break PA program (n = 6). Intervention programs were delivered across two school years. Surveys with program champions/teachers and children, in-session measurement of children's PA by accelerometry (Actigraph GT3X) in a subset of schools, and key informant interviews were used to collect information on implementation, including fidelity, dose, reach, and sustainability, and to calculate an implementation score.

Results: Six CHALK/Just Move schools implemented the program in both years. Two schools randomized to 100 Mile Club did not implement at all, and only three schools implemented both years. Implementing schools had similar implementation scores (range = 0-3; 100 Mile Club = 2.0 vs. CHALK/Just Move = 1.9) but fidelity to core and enhanced elements differed between programs. In 100 Mile Club schools, dose of program delivered was greater than in CHALK/Just Move schools (34.9 vs. 19.7 min per week). Dose of PA received per session was also greater in 100 Mile Club schools (n = 55, 2 schools) compared with CHALK/Just Move schools (n = 160, 2 schools) (13.6 min vs. 2.7 min per session). A slightly higher proportion of eligible children participated in CHALK/Just Move compared to 100 Mile Club (54.0% vs. 31.2%). Both programs were well received by champions/teachers and students.

Conclusions: Program implementation varied across programs and schools, and erosion in delivery was seen over the two years. However, among implementing schools, additional PA was delivered and received, and the programs were generally well-received. Although school resource issues remain barriers to implemention, this evaluation demonstrates that low-cost programs may enhance PA opportunities. Future research should evaluate how multiple programs can be implemented to increase children's PA at school.

Trial Registration: ClinicalTrials.gov Identifier: NCT02810834 . Registered May 11, 2015.
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http://dx.doi.org/10.1186/s12889-018-6335-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335723PMC
January 2019

Norepinephrine Infusion for Preventing Postspinal Anesthesia Hypotension during Cesarean Delivery: A Randomized Dose-finding Trial.

Anesthesiology 2019 01;130(1):55-62

From the Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt (A.M.H., S.M.A., N.A.A., M.K.E., S.R., T.I.R., M.A., M.E.E., K.A.E., A.R.) the Department of Anesthesia and Critical Care Medicine, Beni-Suef University, Beni-Suef, Egypt (H.A.H.).

Background: Norepinephrine has been recently introduced for prophylaxis against postspinal hypotension during cesarean delivery; however, no data are available regarding its optimum dose. The objective of this study is to compare three infusion rates of norepinephrine for prophylaxis against postspinal hypotension during cesarean delivery.

Methods: The authors conducted a double-blinded, randomized, controlled study including full-term pregnant women scheduled for cesarean delivery. Norepinephrine infusion was commenced after subarachnoid block. Patients were randomized into three groups, which received norepinephrine with starting infusion rates of 0.025 μg · kg(-1) · min(-1), 0.050 μg · kg(-1) · min(-1), and 0.075 μg · kg(-1) · min(-1). Infusion was stopped when intraoperative hypertension occurred. The primary outcome was the frequency of postspinal hypotension (defined as decreased systolic blood pressure less than 80% of the baseline reading). The three groups were compared according to the following: systolic blood pressure, heart rate, frequency of intraoperative hypertension, frequency of bradycardia, and neonatal outcomes.

Results: Two hundred eighty-four mothers were included in the analysis. The frequency of postspinal hypotension was lower for both the 0.050-μg · kg(-1) · min(-1) dose group (23/93 [24.7%], odds ratio: 0.45 [95% CI: 0.24 to 0.82], P = 0.014) and the 0.075-μg · kg(-1) · min(-1) dose group (25/96 [26.0%], odds ratio: 0.48 [95% CI:0.26 to 0.89], P = 0.022) compared with the 0.025-μg · kg(-1) · min(-1) dose group (40/95 [42.1%]). The two higher-dose groups (the 0.050-μg · kg(-1) · min(-1) group and the 0.075-μg · kg(-1) · min(-1) group) had higher systolic blood pressure and lower heart rate compared with the 0.025 μg · kg(-1) · min(-1) group. The three groups were comparable in the frequency of intraoperative hypertension, incidence of bradycardia, and neonatal outcomes.

Conclusions: Both the 0.050-μg · kg(-1) · min(-1) and 0.075-μg · kg(-1) · min(-1) norepinephrine infusion rates effectively reduced postspinal hypotension during cesarean delivery compared with the 0.025-μg · kg(-1) · min(-1) infusion rate.
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http://dx.doi.org/10.1097/ALN.0000000000002483DOI Listing
January 2019

Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.

BMC Anesthesiol 2018 08 14;18(1):104. Epub 2018 Aug 14.

Department of anesthesia and critical care medicine, Cairo university, 01 elsarayah street, Elmanyal, Cairo, 11559, Egypt.

Background: Dexmedetomidine infusion improves oxygenation and lung mechanics in patients with chronic obstructive lung disease; however, its effect in patients with restrictive lung disease has not been thoroughly investigated yet. The aim of this work was to evaluate the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.

Methods: Forty-two morbidly obese patients scheduled for bariatric surgery were included in the study. Patients were randomized to receive either dexmedetomidine infusion at a bolus dose of 1mcg/Kg followed by infusion at 1 mcg/Kg/hour for 90 min (Dexmedetomidine group), or normal saline infusion (Control group). Both groups were compared with regard to: oxygenation {P/F ratio: PaO/fraction of inspired oxygen (FiO)}, lung compliance, dead space, plateau pressure, blood pressure, and heart rate.

Results: Dexmedetomidine group showed significant improvement of the PaO/FiO ratio, and higher lung compliance compared to control group by the end of drug infusion. Dexmedetomidine group demonstrated decreased dead space, plateau pressure, blood pressure, and heart rate compared to control group by the end of drug infusion.

Conclusion: A 90-min dexmedetomidine infusion resulted in moderate improvement in oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.

Trial Registration: clinicaltrials.gov : NCT02843698 on 20 July 2016.
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http://dx.doi.org/10.1186/s12871-018-0572-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090793PMC
August 2018

Identifying Food Literacy Educational Opportunities for Youth.

Health Educ Behav 2018 12 30;45(6):918-925. Epub 2018 May 30.

1 Tufts University, Boston, MA, USA.

Background: Recent efforts supporting children's dietary behaviors suggest the importance of food literacy (FL), which is a multidimensional concept that encompasses food-related knowledge, skills, and behaviors. To date, FL has been largely informed by adult and adolescent research.

Aims: To assess the FL experiences, perceived skills, and knowledge of school-age children to inform FL educational opportunities.

Method: Six focus groups were conducted with children (age 9-12 years) from three Massachusetts elementary schools. Two team members independently reviewed and coded a portion of the transcripts to assess interrater reliability. Predominant themes connected to children's perceived FL skills and knowledge were identified using an inductive and deductive content analysis approach.

Results: There were five central FL themes identified during the focus groups ( n = 31 children), including (1) food systems concepts; (2) food safety and food freshness; (3) gardening environment, perceived skills, and knowledge; (4) cooking environment, perceived skills, and safety; and (5) autonomy of meal preparation.

Discussion: The themes that emerged in these focus groups with children provided new information surrounding children's perceived FL skills and knowledge as well as important context regarding the food environment (school vs. home). These findings captured important concepts across the "farm to plate" spectrum and highlight potential school-based opportunities where FL topics could be expanded upon most successfully.

Conclusion: This formative research informed educational opportunities for a FL curriculum, which holds promise for improving food-based education and programs, designing more effective interventions, and developing measurement tools.
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http://dx.doi.org/10.1177/1090198118775485DOI Listing
December 2018

The Association Between Perceived Athletic Competence and Physical Activity: Implications for Low-Income Schoolchildren.

Pediatr Exerc Sci 2018 08 15;30(3):433-440. Epub 2018 Mar 15.

3 The George Washington University.

Purpose: Socioeconomic status (SES) may impact children's physical activity (PA) behaviors and confidence to participate in PA. We examined how SES modifies the relationship between children's perceived athletic competence (PAC) and moderate to vigorous PA (MVPA).

Methods: Children (N = 1157; 45% male; grades 3-4) were recruited for the Fueling Learning through Exercise study. Free/reduced price lunch eligibility was used as an indicator of SES. Seven-day accelerometry (ActiGraph GT3X+) was used to measure daily MVPA, out-of-school MVPA (O-MVPA), and school-time MVPA. PAC was assessed using the Harter's Self-Perception Profile for Children (6 items, scored 1-4; median split: high and low PAC).

Results: MVPA and PAC differed between low-SES [n = 556; 41.6 (17.1) min/d; high PAC = 45%] and middle-SES children [n = 412; 49.6 (22.7) min/d; high PAC = 62%]. There was an interaction between SES and PAC for MVPA (P < .001) and O-MVPA (P < .001), but not for school-time MVPA (P > .05). Middle-SES children with high PAC were more likely to engage in MVPA (β = 6.6 min/d; 95% confidence interval, 3.9 to 9.3; P < .001) and O-MVPA (β = 4.8 min/d; 95% confidence interval, 2.8 to 6.8; P < .001), associations that did not exist for low-SES children (P > .05).

Conclusions: PAC was positively associated with daily MVPA and O-MVPA, but not among low-SES children. Research is needed to elucidate the factors that shape the relationship between PAC and MVPA.
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http://dx.doi.org/10.1123/pes.2017-0242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6862770PMC
August 2018

Cardiorespiratory Fitness in Children and Youth: A Call for Surveillance, But Now How Do We Do It?

Exerc Sport Sci Rev 2018 04;46(2):65

Tufts University Friedman School of Nutrition Science and Policy, Boston, MA.

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http://dx.doi.org/10.1249/JES.0000000000000145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856616PMC
April 2018

The Physical Activity Environment and Academic Achievement in Massachusetts Schoolchildren.

J Sch Health 2017 12;87(12):932-940

Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, 75 Kneeland Street, 8th Floor, Boston, MA 02111.

Background: A supportive school-based physical activity environment (PAE) is integral to children's physical activity behaviors, but less understood is its association with academic achievement. We aimed to assess the association between PAE and academic performance and whether a stronger relationship exists in lower-income schools (LIS) compared to middle-income schools (MIS).

Methods: Schoolchildren (grades 3rd to 5th) were recruited from 17 Massachusetts public schools. Schools were classified based on geographic characteristics and free/reduced-price lunch (FRPL) eligibility (LIS = 7, Median FRPL = 86%; MIS = 10, Median FRPL = 20%). PAE was measured using a 10-item survey. Mixed-effects logistic regression models were used to examine associations between PAE and scoring Advanced/Proficient on standardized Math and English Language Arts (ELA) tests.

Results: Demographic characteristics differed between LIS (N = 278, 5% non-Hispanic white) and MIS (N = 297, 73% non-Hispanic white). In LIS, PAE was associated with Math (odds ratio = 5.40, 95% CI = 2.52-11.54 p < .001), but not ELA test scores (p > .05). There was no relationship between PAE and MIS test scores (p > .05). Schooltime moderate-to-vigorous physical activity was not associated with test scores (p > .05).

Conclusions: A beneficial relationship exists between a high-PAE and test scores among LIS children, suggesting that the PAE may be associated with a more supportive environment and may be more fundamentally important for lower-income students.
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http://dx.doi.org/10.1111/josh.12569DOI Listing
December 2017

Digital workflow in full-arch implant rehabilitation with segmented minimally veneered monolithic zirconia fixed dental prostheses: 2-year clinical follow-up.

J Esthet Restor Dent 2018 01 9;30(1):5-13. Epub 2017 Aug 9.

Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts.

Objective: To illustrate a digital workflow in full-arch implant rehabilitation with minimally veneered monolithic zirconia and to report the outcomes including technical complications.

Clinical Considerations: Three patients (5 edentulous arches) received full-arch fixed implant rehabilitation with monolithic zirconia and mild facial porcelain veneering involving a digital workflow. The incisal edges and occluding surface areas were milled out of monolithic zirconia to reduce the possibility of chipping. Porcelain veneering was applied on the facial aspect to improve the esthetic result. Outcomes and technical complications are reported after 2 years of clinical and radiographic follow-up.

Conclusion: Implant and prosthesis survival rates were 100% after a short-term follow-up of 2 years. Technical complications were encountered in one patient. They did not adversely affect prosthesis survival or patient satisfaction and were easily addressed. A digital workflow for the design and fabrication of full-arch monolithic zirconia implant fixed implant prostheses has benefits, but caution is necessary during CAD planning of the prosthesis to ensure a successful outcome. Long-term clinical studies are needed to corroborate the findings discussed in this report.

Clinical Significance: This article presents an integrated digital workflow that was implemented for the implant-prosthodontic rehabilitation of three edentulous patients with monolithic zirconia prostheses. Monolithic zirconia has been successfully incorporated in implant prosthodontics in an effort to reduce the technical complications associated with bilayered ceramics. This workflow simplifies design and fabrication of the zirconia prostheses. However, caution should be taken during CAD planning of the prosthesis to make sure the zirconia cylinder is sufficiently thick at the interface with the titanium insert. Additionally, when cutback is planned for facial porcelain veneering, the functional occluding cusps and incisal edges should be fabricated in monolithic zirconia to avoid chipping.
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http://dx.doi.org/10.1111/jerd.12323DOI Listing
January 2018

Full-Mouth Implant Rehabilitation With Monolithic Zirconia: Benefits and Limitations.

Compend Contin Educ Dent 2017 Jan;38(1):e1-e4

Assistant Professor, Division of Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts.

As increased chipping rates have been reported with porcelain-fused-to-zirconia fixed dental prostheses, monolithic zirconia has been introduced in an effort to reduce the technical complications associated with bilayered ceramics. This clinical report illustrates the steps for achieving full-mouth implant rehabilitation with monolithic zirconia prostheses and minimal facial porcelain veneering. The benefits and limitations of this technique are also discussed. The incisal edges and occluding surface areas comprised monolithic zirconia to reduce the possibility of breakage and improve the esthetic outcome. Up to 1 year in function, no porcelain fracture was found.
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January 2017

Digital vs. conventional full-arch implant impressions: a comparative study.

Clin Oral Implants Res 2017 Nov 31;28(11):1360-1367. Epub 2016 Dec 31.

Division of Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, MA, USA.

Purpose: To test whether or not digital full-arch implant impressions with two different intra-oral scanners (CEREC Omnicam and True Definition) have the same accuracy as conventional ones. The hypothesis was that the splinted open-tray impressions would be more accurate than digital full-arch impressions.

Material And Methods: A stone master cast representing an edentulous mandible using five internal connection implant analogs (Straumann Bone Level RC, Basel, Switzerland) was fabricated. The three median implants were parallel to each other, the far left implant had 10°, and the far right had 15° distal angulation. A splinted open-tray technique was used for the conventional polyether impressions (n = 10) for Group 1. Digital impressions (n = 10) were taken with two intra-oral optical scanners (CEREC Omnicam and 3M True Definition) after connecting polymer scan bodies to the master cast for groups 2 and 3. Master cast and conventional impression test casts were digitized with a high-resolution reference scanner (Activity 880 scanner; Smart Optics, Bochum, Germany) to obtain digital files. Standard tessellation language (STL) datasets from the three test groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to assess the 3D deviations. Deviations were recorded as root-mean-square error. To compare the master cast with conventional and digital impressions at the implant level, Welch's F-test was used together with Games-Howell post hoc test.

Results: Group I had a mean value of 167.93 μm (SD 50.37); Group II (Omnicam) had a mean value of 46.41 μm (SD 7.34); Group III (True Definition) had a mean value of 19.32 μm (SD 2.77). Welch's F-test was used together with the Games-Howell test for post hoc comparisons. Welch's F-test showed a significant difference between the groups (P < 0.001). The Games-Howell test showed statistically significant 3D deviations for all three groups (P < 0.001).

Conclusion: Full-arch digital implant impressions using True Definition scanner and Omnicam were significantly more accurate than the conventional impressions with the splinted open-tray technique. Additionally, the digital impressions with the True Definition scanner had significantly less 3D deviations when compared with the Omnicam.
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http://dx.doi.org/10.1111/clr.12994DOI Listing
November 2017

Technique to Match Gingival Shade when Using Pink Ceramics for Anterior Fixed Implant Prostheses.

J Prosthodont 2018 Mar 1;27(3):311-313. Epub 2016 Apr 1.

Division of Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, MA.

Use of pink gingival ceramics can reduce the necessity for extensive surgical procedures attempting to restore missing soft and hard tissues in the maxillary esthetic zone. Selecting the appropriate shade for pink porcelain poses a challenge, especially when the patient presents with a high smile line. This paper describes a simple and effective technique to facilitate shade selection for gingival ceramics to match the patient's existing gingival shade.
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http://dx.doi.org/10.1111/jopr.12483DOI Listing
March 2018

Amin et al. Respond.

Public Health Rep 2016 Mar-Apr;131(2):227-8

University of Vermont, Department of Nutrition and Food Sciences, Burlington, VT.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765968PMC
http://dx.doi.org/10.1177/003335491613100204DOI Listing
July 2016

Impact of the National School Lunch Program on Fruit and Vegetable Selection in Northeastern Elementary Schoolchildren, 2012-2013.

Public Health Rep 2015 Sep-Oct;130(5):453-7

University of Vermont Burlington, Department of Nutrition and Food Sciences, Burlington, VT.

Increasing children's fruit and vegetable (FV) consumption is an important goal of the U.S. Department of Agriculture's (USDA's) National School Lunch Program. Since 2012, the USDA's requirement that children select FVs at lunch as part of the reimbursable school meal has been met with concern and evidence of food waste. We compared elementary schoolchildren's FV selection, consumption, and waste before (10 school visits, 498 tray observations) and after (11 school visits, 944 tray observations) implementation of this requirement using validated dietary assessment measures. More children selected FVs in higher amounts when FVs were required compared with when they were optional (0.69 cups vs. 0.89 cups, p<0.001); however, consumption decreased slightly (0.51 cups vs. 0.45 cups, p=0.01) and waste increased (0.25 cups vs. 0.39 cups, p<0.001) when FVs were required compared with when they were optional. More exposure to FVs in schools through programmatic efforts and in the home environment may help familiarize children with FV offerings and encourage consumption.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529829PMC
http://dx.doi.org/10.1177/003335491513000508DOI Listing
December 2015