Childhood Obesity: The Role of Health Policy

This first policy report from the CPRC and the NICHQ Childhood Obesity Action Network was released on March 18, 2008 in Miami Florida as part of the Second Childhood Obesity Congress

Protocol for a realist review of complex interventions to prevent adolescents from engaging in multiple risk behaviours

Objectives - Adolescent risk behaviours are a key health concern. The purpose of this research is to gain a deeper understanding of how, why, for whom, and in what circumstances complex adolescent risk behaviour prevention programmes are most successful. Methods and analysis - To understand how adolescent risk behaviour prevention programmes work in a real life context, a realist synthesis will be undertaken, operationalised in four phases. Phase one - Developing a framework to map the theoretical and conceptual landscape of adolescent risk behaviour prevention. Guided by stakeholder consultation. Phase two - Formulating initial programme theories through exploration of the literature, along with primary data from professional stakeholder interviews. Phase three - Refining programme theories through more purposeful, in depth screening of the literature, along with primary qualitative data, from young people and professionals. Data will be collected through semi structured focus groups, to explore specific elements of the emerging programme theories. Phase four - Testing programme theories through interviews with youth workers, following consultation with young people, using vignettes to explore the relationship between specific programme theories. This relatively novel method of primary and secondary data integration within a realist synthesis will provide deeper insight in to young peoples lived experience of risk behaviour prevention programmes, while maintaining transparency in the process of programme theory development. Methods and analysis Data analysis - A realist logic of analysis will be used to align data from each phase with context mechanism outcome configurations or specific elements thereof. Substantive theory will then be sought to understand and explain the findings. Ethics and dissemination - This study has been approved by the Ethics committee at Northumbria University, UK. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations, and formal and informal reports

Operationalisation of realist synthesis as a PhD student; what works, for whom, and in what circumstances?

Introduction: Operationalisation of realist methods can be challenging (Dalkin et al. 2015). Protocols and standards do exist in the literature to guide the process of realist informed research: Rycroft Malone et al (2012), Saul et al (2013), RAMESES (2013), Greenhalgh et al (2014) Blane et al (2015). However Realist methodologies are advocated for the exploration of complex interventions in a variety of subject areas and so are likely to require individually tailored approaches. This heterogeneity of process can affect the progress of novice realists, especially those who find themselves as doctoral students working more alone than is the norm in realist research. Objectives: This poster illustrates the approaches taken by three doctoral students undertaking realist synthesis as part of a PhD. The Projects: Project 1 - The mobile clinical skills and simulation facility was unique in the UK at the time of its launch, and is now the subject of a PhD (realist synthesis and realist evaluation). Published literature was very limited, so the revelation that doing stakeholder interviews was not considered primary data and was indorsed as part of a realist synthesis was a pivotal point in understanding and addressing the way forward in a realist synthesis of an intervention which at first appeared to be theory blind. Project 2 - Saul et al’s (2013) protocol for a rapid realist review (RRR) suggests a composition of essential team members. My RRR was undertaken as part of a PhD, therefore, instead of engaging a local reference group and expert panel throughout the RRR as Saul et al. (2013) suggest, guidance was sought from the PhD supervision team, who have a breadth of knowledge of care planning and realist methodology and thus fulfil the role of the local reference group and expert panel. Project 3 – As a PhD student new to both realist methods, and the subject area, prevention of risk behaviour in adolescents, a large amount of time was spent submerged in the literature. Unfamiliarity with the specifics of the subject impacted on both retroductive theorizing, and application to ethics in order to carry out consultations with key stakeholders. A key issue in this was reaching an agreement on when consultation becomes primary data in relation to research governance. Addressing and resolving methodological issues is an ongoing process. Discussion: Looking for a Realist review recipe is a natural yearning as a PhD student who is unfamiliar or uncertain about using this methodology. Three PhD students have undertaken different approaches to their realist studies modifying the standards, protocols and methods to find a bespoke way to explore their respective unique complex interventions with a realist lens. The acceptance of uncertainty and the importance of theorizing from a plethora of sources is fundamental for realist doctoral students

Constraints on Mars Aphelion Cloud Belt Phase Function and Ice Crystal Geometries

This study constrains the lower bound of the scattering phase function of Martian water ice clouds (WICs) through the implementation of a new observation aboard the Mars Science Laboratory (MSL). The Phase Function Sky Survey (PFSS) was a multiple pointing all-sky observation taken with the navigation cameras (Navcam) aboard MSL. The PFSS was executed 35 times during the Aphelion Cloud Belt (ACB) season of Mars Year 34 over a solar longitude range of L_s=61.4{\deg}-156.5{\deg}. Twenty observations occurred in the morning hours between 06:00 and 09:30 LTST, and 15 runs occurred in the evening hours between 14:30 and 18:00 LTST, with an operationally required 2.5 hour gap on either side of local noon due the sun being located near zenith. The resultant WIC phase function was derived over an observed scattering angle range of 18.3{\deg} to 152.61{\deg}, normalized, and compared with 9 modeled phase functions: seven ice crystal habits and two Martian WIC phase functions currently being implemented in models. Through statistical chi-squared probability tests, the five most probable ice crystal geometries observed in the ACB WICs were aggregates, hexagonal solid columns, hollow columns, plates, and bullet rosettes with p-values greater than or equal to 0.60, 0.57,0.56,0.56, and 0.55, respectively. Droxtals and spheres had p-values of 0.35, and 0.2, making them less probable components of Martian WICs, but still statistically possible ones. Having a better understanding of the ice crystal habit and phase function of Martian water ice clouds directly benefits Martian climate models which currently assume spherical and cylindrical particles.Comment: Accepted Manuscript by Planetary and Space Scienc

Complex interventions to prevent adolescents from engaging in multiple risk behaviours; a realist enquiry

Background: Adolescent health risk behaviours are a key contributing factor to adolescent morbidity and mortality. Evidence suggests that many risk behaviours begun in adolescence impact significantly on longer term health and well-being. While many prevention programmes have been found to be moderately effective, they tend to have little success when replicated at scale. Current literature fails to address underlying causality, or broader contextual factors which may contribute to this failure. The purpose of this research is to gain a deeper understanding of how, why, for whom, and in what circumstances complex multiple risk behaviour prevention programmes are most successful in reducing or preventing health risk behaviours in adolescents. Methods and analysis: A novel realist approach was used, combining realist synthesis of the existing literature with aspects of realist evaluation, and qualitative analysis of primary data from stakeholders, to explore causal mechanisms and contextual factors which contribute to programme success or failure. Data collection and analysis was conducted across four phases: Phase One: Building the framework. Mapping the theoretical and conceptual landscape of adolescent risk behaviour prevention in the literature. Phase Two: Formulating initial programme theories through broad literature searching, and screening, to identify patterns or ‘demi-regularities’, guided by data from professional stakeholders. Phase Three: Refining programme theories through purposeful, in depth screening of the literature, along with collection and analysis of primary qualitative data, from young people and school nurses. Phase Four: Testing programme theories through interviews with youth workers, informed by young people, based on a series of vignettes, to explore the relationships within and between specific programme theories. Data Analysis: A realist logic of analysis was used to align data from each phase with context mechanism outcome configurations. Substantive theory was then sought to further understand, and explain these findings. Results: The results of this study are complex and multifaceted. A broad range of context mechanism outcome configurations were formulated and tested, exploring key constructs such as implementation, leadership and support, programme deliverer and ethos, and sociocultural and interpersonal factors. Three overarching programme theories were identified, suggesting that complex multiple risk behaviour prevention programmes are most successful in reducing or preventing risk behaviour in adolescents when strongly grounded in theory, paying close attention to relationships, and wider contextual factors, such as family, community, culture, socioeconomic status, intersectionality, and health inequalities. Discussion: Programme theories developed as part of this study provide key areas of focus for future adolescent risk behaviour prevention programmes, and the development of policy designed to guide practice. Furthermore, it is argued that future research could build upon these findings, and that findings can be generalised to other related issues, such as adolescent mental health, and the health and wellbeing of school staff

Effectiveness of Group Kickboxing as a Means to Improve Gait and Balance in Individuals with MS

In recent years, there has been a particular emphasis on identifying and delivering appropriate therapeutic interventions that address the significant balance and gait impairments that affect individuals with multiple sclerosis (MS). Group interventions implemented in community settings have been especially of interest, including tai chi classes. Recently, the authors conducted a preliminary study to examine whether group kick-boxing, which requires more vigorous movements, might be a feasible intervention. Initial findings showed promise and led the authors to pursue a more rigorous follow-up study, with the objective of determining whether a 5-week group kickboxing class improved clinical measures of balance and gait in individuals with MS. Eleven individuals completed the 5-week kickboxing program, which met three times a week for an hour each session. Clinical measures, including the Mini Balance Evaluation Systems Test (BESTest), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Dynamic Gait Index (DGI) outcomes, were collected at baseline, before the intervention, and after the intervention. Quiet-standing balance was also measured, and self-reported survey data were collected. Data were analyzed using a Friedman ANOVA-by-ranks test with a Wilcoxon signed rank test as the post hoc comparison. Statistically significant improvements were seen after the intervention in the Mini BESTest, TUG, DGI, and Activities of Balance Confidence. The largest improvements were observed on the Mini BESTest, with a mean of 21.9% improvement between pre- and post-test scores. Participants showed the majority of improvement on tasks that required reactive postural control movements. These movements were similar to skills that were practiced during kickboxing (ie, rapid change of base of support upon kicking). This supports the concept of task-specific transfer, and may indicate why more static-type measures like quiet standing did not indicate similar improvement. Overall, though improvements were not necessarily clinically significant, they did demonstrate the potential and feasibility of the kickboxing concept

Assessing the Impact of the Vision Valley Outdoor Education Pilot Initiative at Pymble Ladies' College

This research project was undertaken by the Centre for Educational Research, School of Education at Western Sydney University (WSU) on behalf of Pymble Ladies College. The study commenced during 2022 and investigated the impact of the recently implemented Vision Valley Outdoor Education program upon student learning beyond the traditional classroom setting. The research parameters were co-designed by Pymble Ladies College in consultation with the Sydney research team. The research project set out to identify if levels of courage, stress and resilience changed as a result of engagement in the Vision Valley outdoor education program. These factors were crucial well-being indicators underpinning the school's desire to develop courage and resilience and to decrease or mitigate stress in their students. Participating in the program had a profound impact on students in several key areas. Firstly, their sense of belonging significantly improved as they engaged in activities and actively participated in the program. Making friends from different friendship groups and building social capacity played a crucial role in this development. Secondly, students displayed increased bravery, demonstrating a willingness to take risks and face their fears. They embraced the unknown, embarked on new experiences, and exhibited courage throughout the program. Thirdly, the outdoor education experience fostered personal growth in students. Notably, their resilience showed the most significant growth, alongside the development of leadership skills, adaptability, tolerance, self-confidence, and self-reliance. Correspondingly, the program was instrumental in enhancing students' gratitude and appreciation for their privileges, such as their family, home, and the natural world. They recognised and valued these privileges upon returning from the experience. Lastly, the theme of transitions emerged, encompassing both positive and negative experiences for the students. While some concerns were raised about academic studies, overall, the benefits of disconnecting from technology and reintegrating into the real world were evident for all involved. Overall, the program fostered a sense of belonging, bravery, personal growth, gratitude, and successful transitions for the students

Reduction of cytochrome C oxidase during vasovagal hypoxia-ischemia in human adult brain: a case study

Near-infrared spectroscopy (NIRS)-derived measurement of oxidized cytochrome c oxidase concentration ([oxCCO]) has been used as an assessment of the adequacy of cerebral oxygen delivery. We report a case in which a reduction in conscious level was associated with a reduction in [oxCCO]. Hypoxaemia was induced in a 31-year-old, healthy male subject as part of an ongoing clinical study. Midway through the hypoxaemic challenge, the subject experienced an unexpected vasovagal event with bradycardia, hypotension and reduced cerebral blood flow (middle cerebral artery blood flow velocity decrease from 70 to 30 cm s(-1)) that induced a brief reduction in conscious level. An associated decrease in [oxCCO] was observed at 35 mm (-1.6 μM) but only minimal change (-0.1 μM) at 20-mm source-detector separation. A change in optical scattering was observed, but path length remained unchanged. This unexpected physiological event provides an unusual example of a severe reduction in cerebral oxygen delivery and is the first report correlating change in clinical status with changes in [oxCCO]