Perceived Barriers to Weight Management in Primary Care—Perspectives of Patients and Providers

BACKGROUND: Despite the consequences of overweight and obesity, effective weight management is not occurring in primary care. OBJECTIVE: To identify beliefs about obesity that act as barriers to weight management in primary care by surveying both patients and providers and comparing their responses. DESIGN: Anonymous, cross-sectional, self-administered survey of patients and providers of a Veteran’s Administration Primary Care Clinic, distributed at the clinic site. SUBJECTS: Forty-eight Internal Medicine providers and 488 patients. MEASUREMENTS: Beliefs, attitudes, and experiences with weight management as well as demographic characteristics were collected through a questionnaire. RESULTS: Providers and patients differed significantly on many beliefs about weight. Providers were more likely than patients to perceive that patients lack self-control to stay on a diet and that fattening food in society and lack of time for exercise were prime factors in weight gain. They also expressed more interest in helping patients with weight management than patients desiring this. Patients were more likely to state that weight problems should be managed on one’s own, talking to a provider is not helpful, providers blame them for their weight problem, and that appointments contain sufficient time for weight discussion. CONCLUSION: Providers and patients emphasize different barriers to weight management. Providers need to be aware of the beliefs that their patients hold to improve weight management discussions and interventions in primary care

Partners in the Parks: Field Guide to an Experiential Program in the National Parks (1st edition)

When Joan Digby first proposed taking collegiate honors students into our national parks, I jumped at the chance. Within minutes of reading her email, I not only responded with an enthusiastic “Yes!” but went so far as to volunteer the resources of the Southern Utah University Honors Program to get things started. Nestled among 5 national parks in southwestern Utah, I felt our campus would be a natural focal point for the kind of program Joan envisioned. Within weeks we had laid the groundwork for a proof-of-concept pilot project at nearby Bryce Canyon National Park. Little did I know at the time, but I was taking the first steps on a nationwide journey that would introduce me to 11 amazing national parks, some 47 park rangers, and over 100 outstanding college students—with the prospect of these numbers growing annually. The aim of Partners in the Parks (PITP) from its inception has been to introduce, or reintroduce, collegiate honors students to this country: not the transformed environment that we have constructed on its surface but the bedrock world upon which it rests. Like de Toqueville, Jefferson, Thoreau, Emerson, and so many others, we recognized that the unique place that is America cannot be separated from the land upon which it was built. One valuable way to study and understand it, then, is to visit places where the bones of America lie exposed, often without the veneer of civilization, cultivation, or modernization: places protected by the people to preserve for this and future generations, original American landscapes, and important historical landmarks that illustrate and define what America was, is, and can be. PITP takes students deep into America’s national parks. PITP is a see-America-first program. While we recognize the importance of a global perspective in an overall honors education, our goal is to help students see and understand America before or in addition to going abroad. Indeed, for students without the desire or resources to leave the country, PITP offers many of the same kinds of personal development that make study abroad so valuable. In the Field Notes to Chapter 2, “Growing from Within,” Bill Atwill and Kathleen King, share their experience in Acadia National Park, observing how their students demonstrated valuable growth in the same four key areas that researchers of study abroad programs have identified in their alumni: personal discovery, academic commitment, cultural development, and career development. The student writings in this volume, such as Andy Grube’s “soul expanding” talk with Juste Gatari on the rocky coast of Mount Desert Island, aptly illustrate this important facet of the PITP experience. (See the Field Notes to Chapter 5, “Sitting There in Silence.”

Podoconiosis treatment in northern Ethiopia (GoLBet): study protocol for a randomised controlled trial

BACKGROUND Podoconiosis is one of the forgotten types of leg swelling (elephantiasis) in the tropics. Unlike the other, better-known types of leg swelling, podoconiosis is not caused by any parasite, virus or bacterium, but by an abnormal reaction to minerals found in the clay soils of some tropical highland areas. Non-governmental Organizations (NGOs) have been responsible for the development of simple treatment methods without systematic evaluation of its effectiveness. It is essential that a large scale, fully controlled, pragmatic trial of the intervention is conducted. We aim to test the hypothesis that community-based treatment of podoconiosis lymphoedema reduces the frequency of acute dermatolymphangioadenitis episodes ('acute attacks') and improves other clinical, social and economic outcomes. METHODS/DESIGN This is a pragmatic, individually randomised controlled trial. We plan to randomly allocate 680 podoconiosis patients from the East Gojjam Zone in northern Ethiopia to one of two groups: 'Standard Treatment' or 'Delayed Treatment'. Those randomised to standard treatment will receive the hygiene and foot-care intervention from May 2015 for one year, whereas those in the control arm will be followed through 2015 and be offered the intervention in 2016. The trial will be preceded by an economic context survey and a Rapid Ethical Assessment to identify optimal methods of conveying information about the trial and the approaches to obtaining informed consent preferred by the community. The primary outcome will be measured by recording patient recall and using a simple, patient-held diary that will be developed to record episodes of acute attacks. Adherence to treatment, clinical stage of disease, quality of life, disability and stigma will be considered secondary outcome measures. Other outcomes will include adverse events and economic productivity. Assessments will be made at baseline and at 3, 6, 9 and 12 months thereafter. DISCUSSION The evidence is highly likely to inform implementation of the new master plan for integrated control of Neglected Tropical Diseases (NTDs), in which podoconiosis is identified as one of eight NTDs prioritised for control. Potentially, an estimated 3 million patients in Ethiopia will therefore benefit from the results of this trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number. REGISTRATION NUMBER ISRCTN67805210 . Date of registration: 24 January 2013

JWST UNCOVER: Discovery of z>9z>9 Galaxy Candidates Behind the Lensing Cluster Abell 2744

We present the results of a search for high-redshift ($z>9$) galaxy candidates in the JWST UNCOVER survey, using deep NIRCam and NIRISS imaging in 7 bands over $\sim45$ arcmin$^2$ and ancillary HST observations. The NIRCam observations reach a $5-\sigma$ limiting magnitude of $\sim 29.2$ AB. The identification of high$-z$ candidates relies on a combination of a dropout selection and photometric redshifts. We find 16 candidates at $9<z<12$ and 3 candidates at $12<z<13$, eight candidates are deemed very robust. Their lensing amplification ranges from $\mu=1.2$ to 11.5. Candidates have a wide range of (lensing-corrected) luminosities and young ages, with low stellar masses ($6.8<$ log(M$_{\star}$/M$_{\odot}$) $<9.5$) and low star formation rates (SFR=0.2-7 M$_{\odot}$ yr$^{-1}$), confirming previous findings in early JWST observations of $z>9$. A few galaxies at $z\sim9-10$ appear to show a clear Balmer break between the F356W and F444W/F410M bands, which helps constrain their stellar mass. We estimate blue UV continuum slopes between $\beta=-1.8$ and $-2.3$, typical for early galaxies at $z>9$ but not as extreme as the bluest recently discovered sources. We also find evidence for a rapid redshift-evolution of the mass-luminosity relation and a redshift-evolution of the UV continuum slope for a given range of intrinsic magnitude, in line with theoretical predictions. These findings suggest that deeper JWST observations are needed to reach the fainter galaxy population at those early epochs, and follow-up spectroscopy will help better constrain the physical properties and star formation histories of a larger sample of galaxies.Comment: Submitted to MNRA

UNCOVER: Illuminating the Early Universe -- JWST/NIRSpec Confirmation of z>12z > 12 Galaxies

Observations of high-redshift galaxies provide a critical direct test to the theories of early galaxy formation, yet to date, only four have been spectroscopically confirmed at $z>12$. Due to strong gravitational lensing over a wide area, the galaxy cluster field Abell~2744 is ideal for searching for the earliest galaxies. Here we present JWST/NIRSpec observations of two galaxies: a robust detection at $z_{\rm spec} = 12.393^{+0.004}_{-0.001}$, and a plausible candidate at $z_{\rm spec} = 13.079^{+0.013}_{-0.001}$. The galaxies are discovered in JWST/NIRCam imaging and their distances are inferred with JWST/NIRSpec spectroscopy, all from the JWST Cycle 1 UNCOVER Treasury survey. Detailed stellar population modeling using JWST NIRCam and NIRSpec data corroborates the primeval characteristics of these galaxies: low mass ($\sim 10^8~{\rm M_\odot}$), young, rapidly-assembling, metal-poor, and star-forming. Interestingly, both galaxies are spatially resolved, having lensing-corrected rest-UV effective radii on the order of 300-400 pc, which are notably larger than other spectroscopically confirmed $z \gtrsim 12$ systems. The observed dynamic range of $z \gtrsim 12$ size spans over an order of magnitude, implying a significant scatter in the size-mass relation at early times. Deep into the epoch of reionization, these discoveries elucidate the emergence of the first galaxies.Comment: submitted to ApJL; 13 pages, 4 figures, 2 table

UNCOVER: Candidate Red Active Galactic Nuclei at 3<z<7 with JWST and ALMA

The James Webb Space Telescope (JWST) is revolutionizing our knowledge of $z>5$ galaxies and their actively accreting black holes. Using the JWST Cycle 1 Treasury program Ultradeep NIRSpec and NIRCam ObserVations before the Epoch of Reionization (UNCOVER) in the lensing field Abell 2744, we report the identification of a sample of little red dots at $3 < z_{\rm{phot}} < 7$ that likely contain highly-reddened accreting supermassive black holes. Using a NIRCam-only selection to F444W$<27.7$ mag, we find 26 sources over the $\sim45$ arcmin$^{2}$ field that are blue in F115W$-$F200W$\sim0$ (or $\beta_{\rm UV}\sim-2.0$ for $f_{\lambda} \propto \lambda^\beta$), red in F200W$-$F444W = $1-4$ ($\beta_{\rm opt} \sim +2.0$), and are dominated by a point-source like central component. Of the 20 sources with deep ALMA 1.2-mm coverage, none are detected individually or in a stack. For the majority of the sample, SED fits to the JWST+ALMA observations prefer models with hot dust rather than obscured star-formation to reproduce the red NIRCam colors and ALMA 1.2-mm non-detections. While compact dusty star formation can not be ruled out, the combination of extremely small sizes ($\langle r_e \rangle\approx50$ pc after correction for magnification), red rest-frame optical slopes, and hot dust can by explained by reddened broad-line active galactic nuclei (AGNs). Our targets have faint $M_{\rm 1450} \approx -14\ \, {\rm to} -18$ mag but inferred bolometric luminosities of $L_{\rm bol} = 10^{43}-10^{46}$ erg/s, reflecting their obscured nature. If the candidates are confirmed as AGNs with upcoming UNCOVER spectroscopy, then we have found an abundant population of reddened luminous AGN that are at least ten times more numerous than UV-luminous AGN at the same intrinsic bolometric luminosity.Comment: submitted to Ap

UNCOVER: A NIRSpec Identification of a Broad Line AGN at z = 8.50

Deep observations with JWST have revealed an emerging population of red point-like sources that could provide a link between the postulated supermassive black hole seeds and observed quasars. In this work we present a JWST/NIRSpec spectrum from the JWST Cycle 1 UNCOVER Treasury survey, of a massive accreting black hole at $z=8.50$, displaying a clear broad-line component as inferred from the H$\beta$ line with FWHM = $3439\pm413$ km s$^{-1}$, typical of the broad line region of an active galactic nucleus (AGN). The AGN nature of this object is further supported by high ionization, as inferred from emission lines, and a point-source morphology. We compute the black hole mass of log$_{10}(M_{\rm BH}/M_\odot)=8.17\pm0.42$, and a bolometric luminosity of $L_{\rm bol}\sim6.6\times10^{45}$ erg s$^{-1}$. These values imply that our object is accreting at $\sim 40\%$ of the Eddington limit. Detailed modeling of the spectral energy distribution in the optical and near-infrared, together with constraints from ALMA, indicate an upper limit on the stellar mass of log$_{10}(M_{\rm *}/M_\odot)<8.7$, which would lead to an unprecedented ratio of black hole to host mass of at least $\sim 30 \%$. This is orders of magnitude higher compared to the local QSOs, but is consistent with recent AGN studies at high redshift with JWST. This finding suggests that a non-negligible fraction of supermassive black holes either started out from massive seeds and/or grew at a super-Eddington rate at high redshift. Given the predicted number densities of high-$z$ faint AGN, future NIRSpec observations of larger samples will allow us to further investigate the galaxy-black hole co-evolution in the early Universe.Comment: 14 pages, 6 figures, 2 tables. Submitted to ApJ

The Reproducibility of Blood Acid Base Responses in Male Collegiate Athletes Following Individualised Doses of Sodium Bicarbonate: A Randomised Controlled Crossover Study

Background: Current evidence suggests sodium bicarbonate (NaHCO3) should be ingested based upon the individualised alkalotic peak of either blood pH or bicarbonate (HCO3−) because of large inter-individual variations (10–180 min). If such a strategy is to be practical, the blood analyte response needs to be reproducible. Objective: This study aimed to evaluate the degree of reproducibility of both time to peak (TTP) and absolute change in blood pH, HCO3− and sodium (Na+) following acute NaHCO3 ingestion. Methods: Male participants (n = 15) with backgrounds in rugby, football or sprinting completed six randomised treatments entailing ingestion of two doses of 0.2 g·kg−1 body mass (BM) NaHCO3 (SBC2a and b), two doses of 0.3 g·kg−1 BM NaHCO3 (SBC3a and b) or two control treatments (CON1a and b) on separate days. Blood analysis included pH, HCO3− and Na+ prior to and at regular time points following NaHCO3 ingestion over a 3-h period. Results: HCO3− displayed greater reproducibility than pH in intraclass correlation coefficient (ICC) analysis for both TTP (HCO3− SBC2 r = 0.77, P = 0.003; SBC3 r = 0.94, P < 0.001; pH SBC2 r = 0.62, P = 0.044; SBC3 r = 0.71, P = 0.016) and absolute change (HCO3− SBC2 r = 0.89, P < 0.001; SBC3 r = 0.76, P = 0.008; pH SBC2 r = 0.84, P = 0.001; SBC3 r = 0.62, P = 0.041). Conclusion: Our results indicate that both TTP and absolute change in HCO3− is more reliable than pH. As such, these data provide support for an individualised NaHCO3 ingestion strategy to consistently elicit peak alkalosis before exercise. Future work should utilise an individualised NaHCO3 ingestion strategy based on HCO3− responses and evaluate effects on exercise performance

Interaction of convective organisation with monsoon precipitation, atmosphere, surface and sea: the 2016 INCOMPASS field campaign in India

The INCOMPASS field campaign combines airborne and ground measurements of the 2016 Indian monsoon, towards the ultimate goal of better predicting monsoon rainfall. The monsoon supplies the majority of water in South Asia, but forecasting from days to the season ahead is limited by large, rapidly developing errors in model parametrizations. The lack of detailed observations prevents thorough understanding of the monsoon circulation and its interaction with the land surface: a process governed by boundary-layer and convective-cloud dynamics. INCOMPASS used the UK Facility for Airborne Atmospheric Measurements (FAAM) BAe-146 aircraft for the first project of this scale in India, to accrue almost 100 hours of observations in June and July 2016. Flights from Lucknow in the northern plains sampled the dramatic contrast in surface and boundary layer structures between dry desert air in the west and the humid environment over the northern Bay of Bengal. These flights were repeated in pre-monsoon and monsoon conditions. Flights from a second base at Bengaluru in southern India measured atmospheric contrasts from the Arabian Sea, over the Western Ghats mountains, to the rain shadow of southeast India and the south Bay of Bengal. Flight planning was aided by forecasts from bespoke 4km convection-permitting limited-area models at the Met Office and India's NCMRWF. On the ground, INCOMPASS installed eddy-covariance flux towers on a range of surface types, to provide detailed measurements of surface fluxes and their modulation by diurnal and seasonal cycles. These data will be used to better quantify the impacts of the atmosphere on the land surface, and vice versa. INCOMPASS also installed ground instrumentation supersites at Kanpur and Bhubaneswar. Here we motivate and describe the INCOMPASS field campaign. We use examples from two flights to illustrate contrasts in atmospheric structure, in particular the retreating mid-level dry intrusion during the monsoon onset