Edmonton Obesity Staging System Prevalence and Association with Weight Loss in a Publicly Funded Referral-Based Obesity Clinic

Objectives. To determine the distribution of EOSS stages and differences in weight loss achieved according to EOSS stage, in patients attending a referral-based publically funded multisite weight management clinic. Subjects/Methods. 5,787 obese patients were categorized using EOSS staging using metabolic risk factors, medication use, and severity of doctor diagnosis of obesity-related physiological, functional, and psychological comorbidities from electronic patient files. Results. The prevalence of EOSS stages 0 (no risk factors or comorbidities), 1 (mild conditions), 2 (moderate conditions), and 3 (severe conditions) was 1.7%, 10.4%, 84.0%, and 3.9%, respectively. Prehypertension (63%), hypertension (76%), and knee replacement (33%) were the most common obesity-related comorbidities for stages 1, 2, and 3, respectively. In the models including age, sex, initial BMI, EOSS stage, and treatment time, lower EOSS stage and longer treatment times were independently associated with greater absolute (kg) and percentage of weight loss relative to initial body weight P<0.05. Conclusions. Patients attending this publicly funded, referral-based weight management clinic were more likely to be classified in the higher stages of EOSS. Patients in higher EOSS stages required longer treatment times to achieve similar weight outcomes as those in lower EOSS stages

Understanding resilience in same-sex parented families: the work, love, play study

Background: While families headed by same-sex couples have achieved greater public visibility in recent years, there are still many challenges for these families in dealing with legal and community contexts that are not supportive of same-sex relationships. The Work, Love, Play study is a large longitudinal study of same-sex parents. It aims to investigate many facets of family life among this sample and examine how they change over time. The study focuses specifically on two key areas missing from the current literature: factors supporting resilience in same-sex parented families; and health and wellbeing outcomes for same-sex couples who undergo separation, including the negotiation of shared parenting arrangements post-separation. The current paper aims to provide a comprehensive overview of the design and methods of this longitudinal study and discuss its significance.Methods/Design: The Work, Love, Play study is a mixed design, three wave, longitudinal cohort study of same-sex attracted parents. The sample includes lesbian, gay, bisexual and transgender parents in Australia and New Zealand (including single parents within these categories) caring for any children under the age of 18 years. The study will be conducted over six years from 2008 to 2014. Quantitative data are to be collected via three on-line surveys in 2008, 2010 and 2012 from the cohort of parents recruited in Wave1. Qualitative data will be collected via interviews with purposively selected subsamples in 2012 and 2013. Data collection began in 2008 and 355 respondents to Wave One of the study have agreed to participate in future surveys. Work is currently underway to increase this sample size. The methods and survey instruments are described.Discussion: This study will make an important contribution to the existing research on same-sex parented families.Strengths of the study design include the longitudinal method, which will allow understanding of changes over time within internal family relationships and social supports. Further, the mixed method design enables triangulation of qualitative and quantitative data. A broad recruitment strategy has already enabled a large sample size with the inclusion of both gay men and lesbians.<br /

Next-Generation Probiotics Targeting \u3ci\u3eClostridium difficile\u3c/i\u3e through Precursor- Directed Antimicrobial Biosynthesis

Integration of antibiotic and probiotic therapy has the potential to lessen the public health burden of antimicrobial-associated diseases. Clostridium difficile infection (CDI) represents an important example where the rational design of next-generation probiotics is being actively pursued to prevent disease recurrence. Because intrinsic resistance to clinically relevant antibiotics used to treat CDI (vancomycin, metronidazole, and fidaxomicin) is a desired trait in such probiotic species, we screened several bacteria and identified Lactobacillus reuteri to be a promising candidate for adjunct therapy. Human-derived L. reuteri bacteria convert glycerol to the broad-spectrum antimicrobial compound reuterin. When supplemented with glycerol, strains carrying the pocR gene locus were potent reuterin producers, with L. reuteri 17938 inhibiting C. difficile growth at a level on par with the level of growth inhibition by vancomycin. Targeted pocR mutations and complementation studies identified reuterin to be the precursor-induced antimicrobial agent. Pathophysiological relevance was demonstrated when the codelivery of L. reuteri with glycerol was effective against C. difficile colonization in complex human fecal microbial communities, whereas treatment with either glycerol or L. reuteri alone was ineffective. A global unbiased microbiome and metabolomics analysis independently confirmed that glycerol precursor delivery with L. reuteri elicited changes in the composition and function of the human microbial community that preferentially targets C. difficile outgrowth and toxicity, a finding consistent with glycerol fermentation and reuterin production. Antimicrobial resistance has thus been successfully exploited in the natural design of human microbiome evasion of C. difficile, and this method may provide a prototypic precursor-directed probiotic approach. Antibiotic resistance and substrate bioavailability may therefore represent critical new determinants of probiotic efficacy in clinical trials

Primary Health Care (PHC) Search Filter: Bringing the evidence to shore

Surfing the internet for primary health care (PHC) literature produces waves of information that can lead a researcher to feel as though they are drowning in papers. Sifting through material to find the oysters containing pearls can be a complex task. With the PHC literature and evidence base rapidly increasing, Flinders Filters and the Primary Health Care Research & Information Service collaborated on a project to develop a search filter designed to facilitate easier access to this pool of PHC resources, by enabling efficient and effective retrieval of relevant literature. The PHC Search Filter was developed in the Ovid Medline platform with an extensive methodology comprising five phases including: constructing a gold standard set of PHC-specific articles; identifying relevant index terms and textwords; testing combinations of search terms; assessing the search strategy which performed most effectively; and translating the filter for use in PubMed to enable ‘one click searching’. This presentation will introduce the PHC Search Filter, addressing its development and showcasing the tool through an audiovisual ‘how to’ segment. In addition, the presentation will report on a mixed-methods study used to evaluate the Filter, four months after its launch. This evaluation involved extensive advertising of an online survey with individuals invited to participate regardless of whether they had used the Filter or not. With 90 respondents, the survey provided details about the overarching benefits and positive response to the tool, and directions for further refinement of the Filter. The key findings from the evaluation noted that the PHC Search Filter reduces the burden associated with literature searching, increases the value of the results that are received, and provides a useful resource to improve the likelihood of incorporating evidence into policy and practice

Sources of uncertainty in estimating stream solute export from headwater catchments at three sites

Uncertainty in the estimation of hydrologic export of solutes has never been fully evaluated at the scale of a small-watershed ecosystem. We used data from the Gomadansan Experimental Forest, Japan, Hubbard Brook Experimental Forest, USA, and Coweeta Hydrologic Laboratory, USA, to evaluate many sources of uncertainty, including the precision and accuracy of measurements, selection of models, and spatial and temporal variation. Uncertainty in the analysis of stream chemistry samples was generally small but could be large in relative terms for solutes near detection limits, as is common for ammonium and phosphate in forested catchments. Instantaneous flow deviated from the theoretical curve relating height to discharge by up to 10% at Hubbard Brook, but the resulting corrections to the theoretical curve generally amounted to \u3c0.5% of annual flows. Calibrations were limited to low flows; uncertainties at high flows were not evaluated because of the difficulties in performing calibrations during events. However, high flows likely contribute more uncertainty to annual flows because of the greater volume of water that is exported during these events. Uncertainty in catchment area was as much as 5%, based on a comparison of digital elevation maps with ground surveys. Three different interpolation methods are used at the three sites to combine periodic chemistry samples with streamflow to calculate fluxes. The three methods differed by \u3c5% in annual export calculations for calcium, but up to 12% for nitrate exports, when applied to a stream at Hubbard Brook for 1997–2008; nitrate has higher weekly variation at this site. Natural variation was larger than most other sources of uncertainty. Specifically, coefficients of variation across streams or across years, within site, for runoff and weighted annual concentrations of calcium, magnesium, potassium, sodium, sulphate, chloride, and silicate ranged from 5 to 50% and were even higher for nitrate. Uncertainty analysis can be used to guide efforts to improve confidence in estimated stream fluxes and also to optimize design of monitoring programmes

Obsessive Compulsive Behaviors in Children with Developmental Disabilities: A Function-based Conceptual Framework and Single-case Application

Repetitive behaviors are prevalent in a number of neurodevelopmental disorders including autism spectrum disorder (ASD) and intellectual disability (ID). A subset of repetitive behaviors found in ASD and ID can be topographically similar to symptoms in obsessive compulsive disorder (OCD). Through two manuscripts in preparation (Chapters 2 and 4), this project aims to discuss a function-based approach to conceptualizing, assessing, and treating obsessive compulsive behaviors (OCBs) in ASD and ID. The first manuscript is a conceptual paper responding to the variety of approaches researchers use to categorize the behaviors (i.e., assigning a comorbid diagnosis or acknowledging overlapping symptoms of ASD). To date, a clear consensus has not yet been reached amongst the researchers in this field. This paper builds on the differential diagnosis guidelines of the DSM-5 and clinical experts in the field by providing a multidisciplinary, function-based approach to conceptualizing, assessing, and treating individual OCBs in ASD using clinical case examples. Obsessive compulsive behaviors can serve a variety of functions beyond the reduction of anxiety including automatic positive reinforcement or socially mediated reinforcement. The strengths of function-based treatment combined with cognitive behavioral therapy for working with complex obsessive compulsive behaviors in ASD are presented. A second manuscript demonstrates the applicability of this framework in a single case study of four-year-old boy with mild ID and obsessive compulsive behaviors. An intensive, adapted version of function-based cognitive behavioral therapy was administered in the boy’s preschool. The treatment successfully eliminated two OCBs while concomitantly teaching joint engagement with peers on work-related tasks. Results were maintained at a three-week follow- up. The implications of the treatment protocol, in addition to the broader importance of working from a multidisciplinary perspective for children with obsessive compulsive behaviors, are discussed

Naming Names: The Impact of Supreme Court Opinion Attribution on Citizen Assessment of Policy Outcomes

The manner in which political institutions convey their policy outcomes can have important implications for how the public views institutions\u27 policy decisions. This paper explores whether the way in which the U.S. Supreme Court communicates its policy decrees affects how favorably members of the public assess its decisions. Specifically, we investigate whether attributing a decision to the nation\u27s High Court or to an individual justice influences the public\u27s agreement with the Court\u27s rulings. Using an experimental design, we find that when a Supreme Court outcome is ascribed to the institution as a whole, rather than to a particular justice, people are more apt to agree with the policy decision. We also find that identifying the gender of the opinion author affects public agreement under certain conditions. Our findings have important implications for how public support for institutional policymaking operates, as well as the dynamics of how the Supreme Court manages to accumulate and maintain public goodwill

Argumentum ad misericordiam - the critical intimacies of victimhood

This article discusses the widespread use of victim tropes in contemporary Anglo-American culture by using cultural theory to analyse key social media memes circulating on Facebook in 2015. Since the growth of social media, victim stories have been proliferating, and each demands a response. Victim narratives are rhetorical, they are designed to elicit pity and shame the perpetrator. They are deployed to stimulate political debate and activism, as well as to appeal to an all-purpose humanitarianism. Victimology has its origins in Law and Criminology, but this paper opens up the field more broadly to think about the cultural politics of victimhood, to consider how the victim-figure can be appropriated by/for different purposes, particularly racial and gender politics, including in the case of Rachel Dolezal, and racial passing. In formulating an ethical response to the lived experience of victims, we need to think about the different kinds of critical intimacies elicited by such media