DEveloping a Complex Intervention for DEteriorating Patients using Theoretical Modelling (DECIDE study): study protocol

AIM: To develop a theory-based complex intervention (targeting nursing staff), to enhance enablers and overcome barriers to enacting expected behaviour when monitoring patients and responding to abnormal vital signs that signal deterioration. DESIGN: A mixed method design including structured observations on hospital wards, field notes, brief, un-recorded interviews and semi-structured interviews to inform the development of an intervention to enhance practice. METHODS: Semi-structured interviews will be conducted with nursing staff using a topic guide informed by the Theoretical Domains Framework. Semi-structured interviews will be transcribed verbatim and coded deductively into the 14 Theoretical Domains Framework domains and then inductively into 'belief statements'. Priority domains will be identified and mapped to appropriate behaviour change techniques. Intervention content and mode of delivery (how behaviour change techniques are operationalised) will be developed using nominal groups, during which participants (clinicians) will rank behaviour change techniques /mode of delivery combinations according to acceptability and feasibility. Findings will be synthesised to develop an intervention manual. DISCUSSION: Despite being a priority for clinicians, researchers and policymakers for two decades, 'sub-optimal care' of the deteriorating ward patient persists. Existing interventions have been largely educational (i.e., targeting assumed knowledge deficits) with limited evidence that they change staff behaviour. Staff behaviour when monitoring and responding to abnormal vital signs is likely influenced by a range of mediators that includes barriers and enablers. IMPACT: Systematically applying theory and evidence-based methods, will result in the specification of an intervention which is more likely to result in behaviour change and can be tested empirically in future research. This article is protected by copyright. All rights reserved

Benefits of a snacking intervention as part of a school-based obesity intervention for Mexican American children

Objective: To examine the impact of adherence to a healthy snacking component of a 6 month school-based intervention program for overweight and obese children. Design: Randomized controlled intervention trial Methods: Mexican American children who were ≥ 85th percentile for body mass index (BMI) were recruited between 2005-2012 from three Houston schools. Children participated in a 12-week instructor led intensive intervention program that included nutrition education, physical activity, and a snacking component which consisted of a daily choice of peanuts and/or peanut butter snacks. Children (12±0.6 years) (n= 257) were divided into either low or high snacking adherence groups based on their responses on a peanut food frequency questionnaire. The low adherence group reported consuming peanuts or peanut butter ≤ once per week and the high adherence group \u3e once per week over 6 months. Change of BMI, standardized BMI (zBMI), triceps skinfold, and weight were compared at six months of children reporting high and low levels of adherence to the snacking component. Analysis: T-tests were performed with SPSS version 22 with level of significance set at P \u3c0.05. Results: Children in the high snacking adherence group demonstrated significantly greater decreases in BMI (P= 0.021) and zBMI (P = 0.005) at six months compared to the children in the low snacking adherence group. Although triceps skinfold did not significantly decrease, anthropometric measures trended towards significance. Conclusions and Implications: Peanuts provided an acceptable, healthy snack for children. Although peanuts were relatively high in fat, the weight loss intervention of replacing energy-dense and unhealthy snacks with peanuts and peanut butter helped children maintain a healthy body weight

Prevalence of Overweight and Obesity in Asian American Students Using Asian Specific Criteria to Determine Weight Classification

Individuals of Asian descent have been found to be at greater risk of developing conditions associated with obesity at lower BMI levels compared to other ethnic groups. As a result, new criteria have been developed to identify overweight and obesity in Asian populations. The purpose of the current study was to assess the percentage of Asian children who may be at risk for health conditions associated with obesity, but are currently overlooked when standard criteria are used to determine weight classification. Data from a larger study examining the weight status of elementary students were analyzed. Participants included 585 Asian (47% female) kindergarten and 437 5th grade (46% female) students. Using standard criteria, 15.6% of kindergarteners and 29.3% of 5th graders were considered to be overweight or obese. Chi square analyses revealed that an additional 10.2% of kindergarten and 11.7% of 5th grade Asian students were identified as being at increased risk of developing conditions associated with obesity when using Asian specific criteria compared to standard criteria (χ2=309.7, p\u3c.001 and χ2=260.9, p\u3c.001, respectively). These findings suggest that when using the standard criteria to identify at risk children, a significant number of Asian students who would potentially benefit from intervention may be overlooked

Chandra X-ray Sources in the Collapsed-Core Globular Cluster M30 (NGC 7099)

We report the detection of six discrete, low-luminosity (Lx < 10^33 erg/s) X-ray sources, located within 12 arcsec of the center of the collapsed-core globular cluster M30 (NGC 7099), and a total of 13 sources within the half-mass radius, from a 50 ksec Chandra ACIS-S exposure. Three sources lie within the very small upper limit of 1.9 arcsec on the core radius. The brightest of the three core sources has a luminosity of Lx (0.5-6 keV) = 6x10^32 erg/s and a blackbody-like soft X-ray spectrum, which are both consistent with it being a quiescent low-mass X-ray binary (qLMXB). We have identified optical counterparts to four of the six central sources and a number of the outlying sources, using deep Hubble Space Telescope and ground-based imaging. While the two proposed counterparts that lie within the core may represent chance superpositions, the two identified central sources that lie outside of the core have X-ray and optical properties consistent with being CVs. Two additional sources outside of the core have possible active binary counterparts. We discuss the X-ray source population of M30 in light of its collapsed-core status.Comment: 18 pages, 13 figures (8 color), resubmitted to ApJ after incorporating referee comment

No impact of CMV or EBV seropositivity on the frequency of highly differentiated T-cells in Mexican-American adolescents

Recurring activations of the prevalent latent herpes viruses Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) induces immune cell division leading to the premature terminal differentiation of T-cells. Terminally differentiated T-cells are known to accumulate with age causing a reduction in the naïve T-cell repertoire, which compromises the ability of the adaptive immune system to respond to novel pathogens. Although CMV and EBV seropositivity are hallmarks of the “immune risk profile” and are known to influence the frequency of terminally differentiated T-cells and increase infection risk in adults, it is not known if CMV or EBV impacts on the frequency of these cells in a young subject cohort. PURPOSE: To examine the impact of CMV and EBV seropositivity on the frequency of highly differentiated blood T-cells in Mexican-American adolescents. METHODS: Fasted resting blood samples were obtained from 77 adolescents consisting of both males and females. The presence of antibodies against CMV and EBV was determined in serum by ELISA. Lymphocytes isolated from peripheral blood were assessed for a combination of cell surface markers to determine their stage of differentiation. Monoclonal antibodies and four-color flow cytometry were used to identify senescent (CD27-, CD28-, CD57+), naïve (CCR7+, CD45RA+), memory (CCR7-, CD45RA-) and effector memory (CCD7-, CD45RA+) T-cell markers on pan CD3+ T-cells, CD4+ T-cells and CD8+ T-cells. Differences in T-cell phenotype between the CMV/EBV seropositive and seronegative participants were compared using independent Student t-tests. RESULTS: The prevalence of latent CMV and EBV infection among the subject cohort was 16% and 44% respectively, while 7% of all participants were carrying a latent infection for both. No differences in senescent and memory phenotypes were found between the CMV or EBV seropositive and seronegative groups. CONCLUSION: Despite the known influence of latent CMV and EBV infection on the frequency of senescent T-cells in adults, these preliminary data indicate that CMV and EBV seropositivity has no impact on the frequency of senescent T-cells in adolescents. These data suggest that the increased frequency of terminally differentiated T-cells that are associated with CMV and EBV seropositivity in adults is probably due to long-term infections. Future studies will assess the impact of CMV and EBV seropositivity on immunosenescence in association with other factors known to have an effect on T-cells differentiation, such as BMI and physical activity status

Impact of Pediatric Obesity on Grades in Elementary School

Objective: The current study examines the relationship between obesity and academic performance among second grade students. We hypothesized that students who were overweight or obese would have poorer grades than students who were normal weight. Design: Cross-sectional. Setting: Seven elementary schools from a southeast Texas Independent School District. Participants: The sample was composed of 798 ethnically and racially diverse elementary school children. Students were classified as normal weight, overweight, and obese. Main Outcome Measures: Differences in cumulative grades (math, science, and reading) across weight classifications were examined using sex, race/ethnicity, and school socioeconomic level as covariates. Additionally, all subject areas were analyzed independently. Analysis: Linear mixed models and follow-up pairwise comparisons. Results:The linear mixed model revealed significant differences in grades across weight classifications (p\u3c.05). Conclusions and Implications: This study suggests that weight status is an important marker of scholastic success. Addressing overweight may bolster efforts to improve academic performance

Influenza A Virus Host Shutoff Disables Antiviral Stress-Induced Translation Arrest

Influenza A virus (IAV) polymerase complexes function in the nucleus of infected cells, generating mRNAs that bear 5′ caps and poly(A) tails, and which are exported to the cytoplasm and translated by host machinery. Host antiviral defences include mechanisms that detect the stress of virus infection and arrest cap-dependent mRNA translation, which normally results in the formation of cytoplasmic aggregates of translationally stalled mRNA-protein complexes known as stress granules (SGs). It remains unclear how IAV ensures preferential translation of viral gene products while evading stress-induced translation arrest. Here, we demonstrate that at early stages of infection both viral and host mRNAs are sensitive to drug-induced translation arrest and SG formation. By contrast, at later stages of infection, IAV becomes partially resistant to stress-induced translation arrest, thereby maintaining ongoing translation of viral gene products. To this end, the virus deploys multiple proteins that block stress-induced SG formation: 1) non-structural protein 1 (NS1) inactivates the antiviral double-stranded RNA (dsRNA)-activated kinase PKR, thereby preventing eIF2α phosphorylation and SG formation; 2) nucleoprotein (NP) inhibits SG formation without affecting eIF2α phosphorylation; 3) host-shutoff protein polymerase-acidic protein-X (PA-X) strongly inhibits SG formation concomitant with dramatic depletion of cytoplasmic poly(A) RNA and nuclear accumulation of poly(A)-binding protein. Recombinant viruses with disrupted PA-X host shutoff function fail to effectively inhibit stress-induced SG formation. The existence of three distinct mechanisms of IAV-mediated SG blockade reveals the magnitude of the threat of stress-induced translation arrest during viral replication

ROSAT HRI X-ray Observations of the Open Globular Cluster NGC 288

A ROSAT HRI X-ray image was obtained of the open globular cluster NGC 288, which is located near the South Galactic Pole. This is the first deep X-ray image of this system. We detect a Low Luminosity Globular Cluster X-ray source (LLGCX) RXJ005245.0-263449 with an X-ray luminosity of (5.5+-1.4)x10^32 ergs/s (0.1-2.0 keV), which is located very close to the cluster center. There is evidence for X-ray variability on a time scale of <~ 1 day. The presence of this LLGCX in such an open cluster suggests that dense stellar systems with high interaction rates are not needed to form LLGCXs. We also searched for diffuse X-ray emission from NGC 288. Upper limits on the X-ray luminosities are L_X^h < 9.5x10^32 ergs/s (0.52-2.02 keV) and L_X^s < 9.3x10^32 ergs/s (0.11-0.41 keV). These imply upper limits to the diffuse X-ray to optical light ratios in NGC 288 which are lower than the values observed for X-ray faint early-type galaxies. This indicates that the soft X-ray emission in these galaxies is due either to a component which is not present in globular clusters (e.g., interstellar gas, or a stellar component which is not found in low metallicity Population II systems), or to a relatively small number of bright Low Mass X-ray Binaries (LMXBs).Comment: The Astrophysical Journal in press. Minor revisions to improve presentation. 6 pages with 3 embedded Postscript figures in emulateapj.st

Elevated MCP-1, TNF-α, Monocyte Concentration, and Dyslipidemia in Obese Mexican-American Children

Background: Obesity is an independent risk factor for chronic disease. The prevalence of obesity is especially high among Mexican-American children. Peripheral blood monocytes contribute to systemic inflammation and may mediate the relationship between obesity and chronic disease. Obesity affects monocytes and the circulating levels of cytokines/chemokines that influence monocyte behavior. Purpose: investigate alterations in blood monocytes and plasma cytokines/chemokine levels among healthy weight (zBMI ≤ 85th percentile; N=66), overweight (zBMI=85th-95th percentile; N=23), and obese (zBMI ≥ 95th percentile; N=39) Mexican-American children. Methods: Blood samples were analyzed for total monocyte concentration, pro-inflammatory monocyte concentration, and classic monocyte concentration via flow cytometry. Serum MCP-1, Fractalkine, IL-8, and TNF-α were measured using a Milliplex MagPix assay. Serum cholesterol, HDL, triglycerides, and glucose were measured using an enzymatic reagent kit. Results: Total monocyte concentration (P=0.012), classic monocyte concentration (P=0.045), MCP-1 (P=0.015), and TNF- α (P=0.002) were significantly greater in obese children compared to heathly weight children. Also, overweight and obese children had elevated triglycerides (P=0.001) and reduced HDL (P=0.033) compared to healthy weight children. Conclusion: Elevations in circulating monocytes, MCP-1, and TNF-α have been implicated in the development of obesity-related chronic disease in adults. Childhood obesity alters monocytes and circulating chemokines, putting children at a greater risk of developing obesity-related chronic diseases in adulthood. Further characterization of early immune alterations in childhood obesity may provide additional clinical insight into the assessment of obesity-related disease risk

Participation in physical play and leisure : developing a theory- and evidence-based intervention for children with motor impairments

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