Flow alteration-ecology relationships in Ozark Highland streams: Consequences for fish, crayfish and macroinvertebrate assemblages

We examined flowalteration-ecology relationships in benthic macroinvertebrate, fish, and crayfish assemblages in Ozark Highland streams, USA, over two years with contrasting environmental conditions, a drought year (2012) and a flood year (2013). We hypothesized that: 1) there would be temporal variation in flow alteration-ecology relationships between the two years, 2) flow alteration-ecology relationshipswould be stronger during the drought year vs the flood year, and 3) fish assemblages would show the strongest relationships with flow alteration. We used a quantitative richest-targeted habitat (RTH) method and a qualitative multihabitat (QMH) method to collect macroinvertebrates at 16 USGS gaged sites during both years. We used backpack electrofishing to sample fish and crayfish at 17 sites in 2012 and 11 sites in 2013.Weused redundancy analysis to relate biological response metrics, including richness, diversity, density, and community-based metrics, to flow alteration.We found temporal variation in flow alteration-ecology relationships for all taxa, and that relationships differed greatly between assemblages. We found relationships were stronger for macroinvertebrates during the drought year but not for other assemblages, and that fish assemblage relationships were not stronger than the invertebrate taxa. Magnitude of average flow, frequency of high flow, magnitude of high flow, and duration of high flow were the most important categories of flow alteration metrics across taxa. Alteration of high and average flows was more important than alteration of low flows. Of 32 important flow alteration metrics across years and assemblages, 19 were significantly altered relative to expected values. Ecological responses differed substantially between drought and flood years, and this is likely to be exacerbated with predicted climate change scenarios. Differences in flow alteration-ecology relationships among taxonomic groups and temporal variation in relationships illustrate that a complex suite of variables should be considered for effective conservation of stream communities related to flow alteration

Hydrology-Biology Response Relationships in the Ozark Highlands

I examined flow-ecology relationships among stream communities in the Ozark Highlands, USA. I sampled fish, crayfish, and benthic macroinvertebrates during two consecutive summers, including a drought year (2012) and a flood year (2013). Biological response variables related to community structure were assessed via two different statistical methods: an Information Theoretic approach relating response variables to a priori selected predictor variables incorporating hydrology, habitat, geomorphology, and water quality, and canonical ordination using forward selection to relate these same response variables to a large assortment of hydrologic metrics. In addition to assessing metrics related to predicted natural flow, flow alteration at gaged sites was also quantified and community metrics were assessed with respect to flow alteration. Additionally, I conducted a manipulative laboratory greenhouse experiment to examine the effects of stream drying, one of the major components of the natural hydrologic disturbance regime in the region, on stream fishes as well as benthic community structure. Hydrologic variation was often less important than other environmental variables and substantial temporal variation existed in flow-ecology relationships. Stream flow magnitude was the most important category of hydrologic metric overall, but there were key differences in which metrics were important for each assemblage and how those assemblages responded to those metrics. Flow alteration has a strong effect on Ozark riverine communities, and the most important categories of flow alteration affecting these communities are magnitude of average flows, and frequency, magnitude, and duration of high flows. The large number of important high flow metrics suggests that flood events may play a particularly crucial role in structuring aquatic assemblages in the region. I found that seasonal stream drying had strong species-specific effects on organisms in pool refuges, and that type of drying specifically affected periphyton growth. Overall, I found that the elucidation of flow-ecology relationships and management decisions that are based on those relationships face a variety of challenges: the complex interaction of hydrology with other kinds of environmental variables, temporal variation in the aquatic community, and the differential effects of flow metrics on different assemblages

Blood Sugar, Your Pancreas, and Unicorns: The Development of Health Education Materials for Youth With Prediabetes

Background. The obesity epidemic has led to an increase in prediabetes in youth, causing a serious public health concern. Education on diabetes risk and initiation of lifestyle change are the primary treatment modalities. There are few existing age-appropriate health education tools to address diabetes prevention for high-risk youth. Aim. To develop an age-appropriate health education tool(s) to help youth better understand type 2 diabetes risk factors and the reversibility of risk. Method. Health education tool development took place in five phases: exploration, design, analysis, refinement, and process evaluation. Results. The project resulted in (1) booklet designed to increase knowledge of risk, (2) meme generator that mirrors the booklet graphics and allows youth to create their own meme based on their pancreas’ current mood, (3) environmental posters for clinic, and (4) brief self-assessment that acts as a conversation starter for the health educators. Conclusion. Patients reported high likability and satisfaction with the health education tools, with the majority of patients giving the materials an “A” rating. The process evaluation indicated a high level of fidelity and related measures regarding how the health education tools were intended to be used and how they were actually used in the clinic setting

Creation of a Decision Support Tool for Expectant Parents Facing Threatened Periviable Delivery: Application of a User-Centered Design Approach

Background Shared decision-making (SDM) is optimal in the context of periviable delivery, where the decision to pursue life-support measures or palliation is both preference sensitive and value laden. We sought to develop a decision support tool (DST) prototype to facilitate SDM by utilizing a user-centered design research approach. Methods We convened four patient and provider advisory boards with women and their partners who had experienced a surviving or non-surviving periviable delivery, pregnant women who had not experienced a prior preterm birth, and obstetric providers. Each 2-h session involved design research activities to generate ideas and facilitate sharing of values, goals, and attitudes. Participant feedback shaped the design of three prototypes (a tablet application, family story videos, and a virtual reality experience) to be tested in a final session. Results Ninety-five individuals (48 mothers/partners; 47 providers) from two hospitals participated. Most participants agreed that the prototypes should include factual, unbiased outcomes and probabilities. Mothers and support partners also desired comprehensive explanations of delivery and care options, while providers wanted a tool to ease communication, help elicit values, and share patient experiences. Participants ultimately favored the tablet application and suggested that it include family testimonial videos. Conclusion Our results suggest that a DST that combines unbiased information and understandable outcomes with family testimonials would be meaningful for periviable SDM. User-centered design was found to be a useful method for creating a DST prototype that may lead to improved effectiveness, usability, uptake, and dissemination in the future, by leveraging the expertise of a wide range of stakeholders

Effects of a Short Term, Short Duration, High Intensity Exercise Intervention on Body Composition and Intra-Abdominal Fat

Short-term high intensity interval training (HIIT) has been shown to significantly improve body composition and intraabdominal fat stores. Studies have shown Tabata, a protocol using repeated rounds of 20-sec of work and 10-sec of rest, to be a valid protocol for HIIT. The purpose of this study was to determine the effectiveness of a short term, short duration, HIIT intervention using a Tabata protocol, on intra-abdominal fat and body composition. Fourteen participants performed eight rounds of Tabata body weight jump squats, at maximal effort each Monday, Wednesday, and Friday for three weeks. There were no significant differences in body composition. The amount of intra-abdominal fat did significantly decrease, p ≤ 0.05. The decrease in intra-abdominal fat suggest that short term, short duration, HIIT can reduce health risks associated with high amounts of intra-abdominal fat, such as cardiovascular disease and the metabolic syndrome. Future research should utilize lower impact body weight exercises, control for outside physical activity, and include a larger population size

Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test

Background: Adolescents with type 1 diabetes mellitus have difficulty achieving optimal glycemic control, partly due to competing priorities that interfere with diabetes self-care. Often, significant diabetes-related family conflict occurs, and adolescents’ thoughts and feelings about diabetes management may be disregarded. Patient-centered diabetes outcomes may be better when adolescents feel engaged in the decision-making process. Objective: The objective of our study was to codesign a clinic intervention using shared decision making for addressing diabetes self-care with an adolescent patient and parent advisory board. Methods: The patient and parent advisory board consisted of 6 adolescents (teens) between the ages 12 and 18 years with type 1 diabetes mellitus and their parents recruited through our institution’s Pediatric Diabetes Program. Teens and parents provided informed consent and participated in 1 or both of 2 patient and parent advisory board sessions, lasting 3 to 4 hours each. Session 1 topics were (1) patient-centered outcomes related to quality of life, parent-teen shared diabetes management, and shared family experiences; and (2) implementation and acceptability of a patient-centered diabetes care plan intervention where shared decision making was used. We analyzed audio recordings, notes, and other materials to identify and extract ideas relevant to the development of a patient-centered diabetes management plan. These data were visually coded into similar themes. We used the information to develop a prototype for a diabetes management plan tool that we pilot tested during session 2. Results: Session 1 identified 6 principal patient-centered quality-of-life measurement domains: stress, fear and worry, mealtime struggles, assumptions and judgments, feeling abnormal, and conflict. We determined 2 objectives to be principally important for a diabetes management plan intervention: (1) focusing the intervention on diabetes distress and conflict resolution strategies, and (2) working toward a verbalized common goal. In session 2, we created the diabetes management plan tool according to these findings and will use it in a clinical trial with the aim of assisting with patient-centered goal setting. Conclusions: Patients with type 1 diabetes mellitus can be effectively engaged and involved in patient-centered research design. Teens with type 1 diabetes mellitus prioritize reducing family conflict and fitting into their social milieu over health outcomes at this time in their lives. It is important to acknowledge this when designing interventions to improve health outcomes in teens with type 1 diabetes mellitus

The Art of Diabetes Prevention Education in Youth

poster abstractBackground: The obesity epidemic has led to an increase in type 2 diabetes as well as the precursor condition “prediabetes.” Prediabetes is defined as blood glucose or hemoglobin A1c levels higher than normal, but not high enough for diabetes. Approximately 30% of obese adolescents in the U.S. have prediabetes. Youth with prediabetes have significantly increased risk for developing type 2 diabetes. Literature demonstrates the significant impact of modest weight loss and physical activity on the prevention or delay of type 2 diabetes. Education on diabetes risk and initiation of lifestyle change is the primary treatment modality. Materials are needed to more effectively educate youth on diabetes progression and risk reduction while using consistent information from evidence-based behavior change methods. Objective: The Youth Diabetes Prevention Clinic is collaborating with the Herron School of Art and Design and a professional design firm to develop an effective tool for communicating the importance of preventing type 2 diabetes while using adolescent-friendly language, visually exciting graphics and relevant messaging. Methods: The team consists of physicians who specialize in adolescent diabetes, a registered dietician, health educators, and graphic design professionals. The project is being completed in four phases: exploration, design, analysis, and refinement. Results: Exploration: The design professionals conducted key personnel interviews and a clinic site visit to determine the appropriate product design. Design: A 16-page booklet was created to incorporate the use of age-appropriate graphics, medical language in lay terms, and cohesive messaging in one package. Analysis: Usability will be measured through user-group testing, key personnel interviews, pre and post knowledge assessments and readiness to change scales. Refinement: Messaging will be revised based on analytical findings. Conclusions: This collaboration exemplifies the benefit of a multidisciplinary approach in the development of patient-centered education materials and provides a framework for others when developing age-specific health communication strategies

Implementation of a Journal Prototype for Pregnant and Parenting Adolescents

Teenage pregnancy and childbearing remain pressing public health issues that have garnered attention from public health officials and social services agencies. This paper reports on the initial implementation and formative evaluation of a journaling program used as a means of communicating health information to pregnant and parenting adolescents (young women age 15-19) while also providing participants with a means of self-expression. The journaling prototype was implemented in a community-based agency in the Midwest by Family Support Specialists (FSSs) who made home visits on a monthly basis to assist pregnant and parenting adolescents (n = 52) with successful family planning and public health education. A mixed method approach of qualitative (analysis of journals, field notes, and responses of semi-structured interviews with FSSs) and quantitative (questionnaires from pregnant and parenting adolescent respondents) data with purposive sampling was employed to evaluate the implementation of the journaling intervention. Twenty of the 52 study participants were pregnant when the journaling intervention was implemented, while 32 were not pregnant, but recently had a child and were currently parenting. Two core themes emerged from analysis of the data after the implementation of the journals: (1) usefulness of the journal and responsiveness to participants' information needs and (2) functionality challenges. The results offer practical starting points to tailor the implementation of journaling in other contexts. Further, areas for improvement emerged regarding the distribution timeline for the journal and the content of the journal itself. As such, we discuss the lessons learned through this collaborative project and suggest opportunities for future phases of the journal intervention

Islet Adaptations in Fetal Sheep Persist Following Chronic Exposure to High Norepinephrine

Complications in pregnancy elevate fetal norepinephrine (NE) concentrations. Previous studies in NE-infused sheep fetuses revealed that sustained exposure to high NE resulted in lower expression of α2-adrenergic receptors in islets and increased insulin secretion responsiveness after acutely terminating the NE infusion. In this study, we determined if the compensatory increase in insulin secretion following chronic elevation of NE is independent of hyperglycemia in sheep fetuses and whether it is persistent in conjunction with islet desensitization to NE. Following an initial assessment of glucose-stimulated insulin secretion (GSIS) at 129±1 days of gestation, fetuses were continuously infused for seven days with NE and maintained at euglycemia with a maternal insulin infusion. Fetal GSIS studies were again performed on days 8 and 12. Adrenergic sensitivity was determined in pancreatic islets collected at day 12. NE infusion increased (P\u3c0.01) fetal plasma NE concentrations and lowered (P\u3c0.01) basal insulin concentrations compared to vehicle-infused controls. GSIS was 1.8-fold greater (P\u3c0.05) in NE-infused fetuses compared to controls at both one and five days after discontinuing the infusion. Glucose-potentiated arginine-induced insulin secretion was also enhanced (P\u3c0.01) in NE-infused fetuses. Maximum GSIS in islets isolated from NE-infused fetuses was 1.6-fold greater (P\u3c0.05) than controls, but islet insulin content and intracellular calcium signaling were not different between treatments. The half-maximal inhibitory concentration for NE was 2.6-fold greater (P\u3c0.05) in NE-infused islets compared to controls. These findings show that chronic NE exposure and not hyperglycemia produce persistent adaptations in pancreatic islets that augment β-cell responsiveness in part through decreased adrenergic sensitivity

Phase I of the Detecting and Evaluating Childhood Anxiety and Depression Effectively in Subspecialties (DECADES) Study: Development of an Integrated Mental Health Care Model for Pediatric Gastroenterology

Background: Children with gastrointestinal symptoms have a very high rate of anxiety and depression. Rapid identification of comorbid anxiety and depression is essential for effective treatment of a wide variety of functional gastrointestinal disorders. Objective: The objective of our study was to determine patient and parent attitudes toward depression, anxiety, and mental health screening during gastroenterology (GI) visits and to determine patient and parent preferences for communication of results and referral to mental health providers after a positive screen. Methods: We augmented standard qualitative group session methods with patient-centered design methods to assess patient and parent preferences. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. Results: Overall, 11 families (11 patients and 14 parents) participated in 2 group sessions. Overall, patients and their parents found integrated mental health care to be acceptable in the subspecialty setting. Patients’ primary concerns were for the privacy and confidentiality of their screening results. Patients and their parents emphasized the importance of mental health services not interfering with the GI visit and collaboration between the GI physician, psychologist, and primary care provider. Conclusions: Patients and their families are open to integrated mental health care in the pediatric subspecialty clinic. The next phase of the DECADES study will translate patient and parent preferences into an integrated mental health care system and test its efficacy in the pediatric GI office. [J Participat Med 2018;10(3):e10655