Are Intervention-Design Characteristics More Predictive than Baseline Participant Characteristics on Participant Attendance to a Paediatric, Community Weight Management Programme?

BACKGROUND: Approximately 50% of participants complete a paediatric weight management programme, yet the predictors of attendance and dropout are inconsistent. This study investigates subject and intervention-design characteristics associated with attendance at a group based, family weight management programme. SETTING AND SUBJECTS: Secondary data analysis of 2948 subjects (Age 10.4±2.8 years, BMI 26.0±5.7kg/m2, Standardised BMI (BMI SDS) 2.48±0.87, White 70.3%) from 244 MoreLife (UK) programmes. Subjects attend weekly for 10-12 weeks, sessions last 2-3 hours. Sessions include lifestyle guidance and physical activity. METHOD: Subject characteristics (demographics, psychological (body satisfaction & self-esteem) and sedentary behaviour) were gathered at first contact and BMI SDS was noted weekly. Intervention-design characteristics were recorded (year, length (weeks), group size, age segregation and day of session). Attendance was calculated as total number of sessions attended (%). Multivariate linear regression examined predictors of attendance and multiple imputation countered missing data. RESULTS: Average attendance was 59.4%±29.3%. Baseline subject characteristics were ‘poor’ predictors of attendance. Intervention year, group size and day of session significantly predicted attendance (Tables 1 & 2). Yet, the most predictive marker of attendance was a change in BMI SDS during the programme (B = -0.38, 95% CI = -0.43 - -0.33). CONCLUSION: A reduction in BMI was seen to predict greater attendance. However, baseline subject characteristics were weakly associated with attendance, refuting past findings. Dominant intervention characteristics (large groups, weekend sessions and recent delivery) predicted lower attendance. Future programmes may be better informed

A qualitative evaluation of healthy weight services in a local authority in England

Objective The purpose of this study was to evaluate the healthy weight services in one local authority in England, where obesity levels have been above the national average since 2006. Design We conducted process and outcome evaluation using a qualitative methodology. Data were generated in focus group discussions and semi-structured interviews with clients, practitioners, healthcare professionals and volunteers. Results Ninety-one individuals from six services participated in the evaluation. Staff competencies and empowerment outcomes were identified as areas of strength. However, despite examples of excellent practice and enthusiastic recommendations from clients, access and referral processes were areas of weakness. Conclusion In England, local authorities have an important role to play in tackling obesity. It is crucial that they are provided with the tools to be able to implement healthy weight interventions effectively. A whole-systems approach presents a real opportunity for staff in local authorities and public health to work collaboratively and innovatively towards the same goal of continuous improvement in obesity management

Engaging Families in Weight Management

Purpose: Approximately 50% of families who initiate a weight management programme (WMP) will not complete. It is fundamental to understand why participants initiate and complete a programme, and to ensure that programmes are effectively designed and delivered. This study examined the reasoning for family (young person and parent) engagement in three different and diverse WMPs. Methods: A multiple instrumental case study approach was employed. Three community-based WMPs participated: MoreLife, SHINE, and Weigh to Go. Clear design and implementation differences existed between WMPs. Multiple WMPs were recruited to examine the generalisability of research findings, and extract key features associated with participant engagement. Thirty families took part (~10 per programme). Data were collected early in the programme (0-2 weeks) and immediately after completion or dropout (within two weeks). Young people took part in a Participatory Action Research (PAR) session (interactive activities to generate meaningful information), and parents completed semi-structured interviews. A deductive line of inquiry was used; questions were based upon participant characteristics, environmental interactions, psychological processes and programme interactions. Interview data was transcribed verbatim and analysed alongside the PAR data using content and thematic analysis (themes presented in italics). Results: Preliminary findings indicate that families often engage in a WMP for non-weight related reasons. Such reasons include: management of mental health, to improve self -esteem, and to create friendships. Families remain in a WMP when: the programme suits their needs, they fit in amongst other participants, strong relationships are fostered with staff, and have strong support networks. Numerous families completing programmes prioritised WMP attendance above other leisure activities, and had plans in place to ensure they could attend each session. Low engagement was due to situational factors (e.g. logistic barriers [transport, timing…]) rather than programme dissatisfaction. Conclusions: Families attend community-based WMPs for reasons beyond weight management. Additionally, the families identified unique WMP features (e.g. maintenance programmes and non-clinical staff) which encourage programme attendance. Such features can be replicated in multiple, diverse settings. Understanding participant engagement is critical to designing and implementing efficacious WMPs

The use of commitment techniques to support weight loss maintenance in obese adolescents

Objectives: Obesity is a rising problem in adolescents related to unhealthy behaviours. Commitment devises are one type of behavioural intervention that may help people change their behaviours. The current pilot trial tests whether commitment devices delivered via text message help adolescents maintain their recent weight loss. Methods: During a 12-week pilot trial adolescents who attended a weight loss camp were randomly assigned to either received text messages that contained only information, i.e., advice, about weight loss management (n=13) or asked for them to commit to following the same advise (n=14). Results: The BMI of the adolescents in the commitment group did not change. In contrast, the BMI of adolescents in the information group increased. A linear regression revealed that group was a significant predictor of BMI change. A logistic regression revealed that adolescents in the information group were nearly eight times more likely to regain weight than those in the commitment group. Conclusions: This is the first study with adolescents to show weight maintenance using a commitment device. The results suggest that commitment devices can help adolescents maintain their recent weight loss

Implementation Fidelity of an Online Integrated Healthy Lifestyle Service During COVID-19: A Process Evaluation

Background: It is recommended that process evaluations of implementation fidelity become an integral part of the conduct of all digital health behaviour intervention research. The current study evaluated implementation fidelity of an Integrated Healthy Lifestyle Service (IHLS) during the COVID-19 lockdown. Methods: A pragmatic sample of 167 online surveys were conducted across IHLS staff (n= 44) and clients (n= 123). Results: A positive degree of online implementation fidelity was demonstrated during the COVID-19 lockdown for IHLS staff and clients alike across the key themes of integration, training, support, session delivery and content, and health benefits. Mixed degrees of online implementation fidelity were noted across the key themes of key performance indicators (KPIs), client engagement, and perceived competence. Lessons learned show that incorporating a bottom-up approach to information dissemination and rapid feedback from commissioners through to ground level staff, in particular in relation to KPI targets, is necessary for ensuring that programme targets are fully understood and agreed upon. The majority of IHLS clients were able to access and engage with online IHLS sessions successfully. Conclusion: This process evaluation represents one of the first efforts to document how an ongoing IHLS was adapted as a result of the COVID-19 pandemic. In the context of behavioural health interventions, the ubiquity of digital technologies and their adoption into day-to-day life translates into greater potential reach than traditional interventions, and consequently, greater potential for positive public health impact

Exploring reasons for attrition amongst vulnerable and hard-to-reach sub-groups across an online integrated healthy lifestyles service during COVID-19

Aims: Reported health behavior change intervention attrition rates vary considerably, from 10% to more than 80%, depending on the type and setting of the treatment programme. A better understanding of the determinants of programme adherence are required. Between March and August 2020, a convenience sample of 44 individual telephone interviews, as well as 42 online Qualtrics surveys took place. The aim was to explore perceived barriers, facilitators and opportunities for participation, sustained participation as well as initial non-participation to better understand reasons for attrition in online delivery during the COVID-19 lockdown amongst vulnerable and under-served groups within an Integrated Healthy Lifestyle Service (IHLS). Methods: This resulted in a total of 86 (33 male) individuals comprising intervention clients, including children and young people (CYP) (n=16), manual workers (n=7), Black, Asian or Minority Ethnic (BAME) (n=19), physical disability (n=8), learning disability (n=6), and those from areas of high deprivation (n=19), as well as IHLS practitioners (n=11). Results: The study revealed that more resources and support are needed for BAME, manual worker, learning disability, and high deprivation sub-groups in order to reduce attrition rates. Specifically, a lack of technological equipment and competence of using such equipment was identified as key barriers to initial and sustained attendance among these vulnerable and under-served sub-groups during the COVID-19 lockdown. Conclusion: The pattern of differences in attrition during the COVID-19 lockdown suggests that further research is required to explore how best to ensure online health behavior change offers are scalable and accessible to all. Keywords: Attrition; Behavior Change; Community Intervention; COVID-19; Digital Intervention; Health Promotio

PIM kinase inhibition: co-targeted therapeutic approaches in prostate cancer

PIM kinases have been shown to play a role in prostate cancer development and progression, as well as in some of the hallmarks of cancer, especially proliferation and apoptosis. Their upregulation in prostate cancer has been correlated with decreased patient overall survival and therapy resistance. Initial efforts to inhibit PIM with monotherapies have been hampered by compensatory upregulation of other pathways and drug toxicity, and as such, it has been suggested that co-targeting PIM with other treatment approaches may permit lower doses and be a more viable option in the clinic. Here, we present the rationale and basis for co-targeting PIM with inhibitors of PI3K/mTOR/AKT, JAK/STAT, MYC, stemness, and RNA Polymerase I transcription, along with other therapies, including androgen deprivation, radiotherapy, chemotherapy, and immunotherapy. Such combined approaches could potentially be used as neoadjuvant therapies, limiting the development of resistance to treatments or sensitizing cells to other therapeutics. To determine which drugs should be combined with PIM inhibitors for each patient, it will be key to develop companion diagnostics that predict response to each co-targeted option, hopefully providing a personalized medicine pathway for subsets of prostate cancer patients in the future

Assessing urban methane emissions using column-observing portable Fourier transform infrared (FTIR) spectrometers and a novel Bayesian inversion framework

Cities represent a large and concentrated portion of global greenhouse gas emissions, including methane. Quantifying methane emissions from urban areas is difficult, and inventories made using bottom-up accounting methods often differ greatly from top-down estimates generated from atmospheric observations. Emissions from leaks in natural gas infrastructure are difficult to predict and are therefore poorly constrained in bottom-up inventories. Natural gas infrastructure leaks and emissions from end uses can be spread throughout the city, and this diffuse source can represent a significant fraction of a city\u27s total emissions. We investigated diffuse methane emissions of the city of Indianapolis, USA, during a field campaign in May 2016. A network of five portable solar-tracking Fourier transform infrared (FTIR) spectrometers was deployed throughout the city. These instruments measure the mole fraction of methane in a total column of air, giving them sensitivity to larger areas of the city than in situ sensors at the surface. We present an innovative inversion method to link these total column concentrations to surface fluxes. This method combines a Lagrangian transport model with a Bayesian inversion framework to estimate surface emissions and their uncertainties, together with determining the concentrations of methane in the air flowing into the city. Variations exceeding 10 ppb were observed in the inflowing air on a typical day, which is somewhat larger than the enhancements due to urban emissions (<5 ppb downwind of the city). We found diffuse methane emissions of 73(±22) mol s−1, which is about 50 % of the urban total and 68 % higher than estimated from bottom-up methods, although it is somewhat smaller than estimates from studies using tower and aircraft observations. The measurement and model techniques developed here address many of the challenges present when quantifying urban greenhouse gas emissions and will help in the design of future measurement schemes in other cities

A Pilot Trial Of Pioglitazone Hcl And Tretinoin In Als: Cerebrospinal Fluid Biomarkers To Monitor Drug Efficacy And Predict Rate Of Disease Progression

Objectives. To determine if therapy with pioglitazone HCl and tretinoin could slow disease progression in patients with ALS. Levels of tau and pNFH in the cerebrospinal fluid were measured to see if they could serve as prognostic indicators. Methods. 27 subjects on stable doses of riluzole were enrolled. Subjects were randomized to receive pioglitazone 30 mg/d and tretinoin 10 mg/BID for six months or two matching placebos. ALSFRS-R scores were followed monthly. At baseline and at the final visit, lumbar punctures (LPs) were performed to measure cerebrospinal fluid (CSF) biomarker levels. Results. Subjects treated with tretinoin, pioglitazone, and riluzole had an average rate of decline on the ALSFRS-R scale of -1.02 points per month; subjects treated with placebo and riluzole had a rate of decline of -. 86 (P =. 18). Over six months of therapy, CSF tau levels decreased in subjects randomized to active treatment and increased in subjects on placebo. Further higher levels of pNF-H at baseline correlated with a faster rate of progression. Conclusion. ALS patients who were treated with tretinoin and pioglitazone demonstrated no slowing on their disease progression. Interestingly, the rate of disease progression was strongly correlated with levels of pNFH in the CSF at baseline. © 2012 Todd D. Levine et al

2-[3-(Methyl­diphenyl­silyl)prop­yl]isoindoline-1,3-dione

In the title compound, C24H23NO2Si, the dihedral angle between the planes of the phenyl rings attached to the Si atom is 80.78 (10)°. In the crystal, the mol­ecules form sheets lying perpendicular to [101] via C—H⋯O inter­actions. These sheets are stacked and linked in a three-dimensional framework by additional C—H⋯O inter­actions in the [10] direction