Text messaging and brief phone calls for weight loss in overweight and obese English- and Spanish-speaking adults: A 1-year, parallel-group, randomized controlled trial.

BACKGROUND:Weight loss interventions based solely on text messaging (short message service [SMS]) have been shown to be modestly effective for short periods of time and in some populations, but limited evidence is available for positive longer-term outcomes and for efficacy in Hispanic populations. Also, little is known about the comparative efficacy of weight loss interventions that use SMS coupled with brief, technology-mediated contact with health coaches, an important issue when considering the scalability and cost of interventions. We examined the efficacy of a 1-year intervention designed to reduce weight among overweight and obese English- and Spanish-speaking adults via SMS alone (ConTxt) or in combination with brief, monthly health-coaching calls. ConTxt offered 2-4 SMS/day that were personalized, tailored, and interactive. Content was theory- and evidence-based and focused on reducing energy intake and increasing energy expenditure. Monthly health-coaching calls (5-10 minutes' duration) focused on goal-setting, identifying barriers to achieving goals, and self-monitoring. METHODS AND FINDINGS:English- and Spanish-speaking adults were recruited from October 2011 to March 2013. A total of 298 overweight (body mass index [BMI] 27.0 to 39.9 kg/m2) adults (aged 21-60 years; 77% female; 41% Hispanic; 21% primarily Spanish speaking; 44% college graduates or higher; 22% unemployed) were randomly assigned (1:1) to receive either ConTxt only (n = 101), ConTxt plus health-coaching calls (n = 96), or standard print materials on weight reduction (control group, n = 101). We used computer-based permuted-block randomization with block sizes of three or six, stratified by sex and Spanish-speaking status. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured percent of weight loss from baseline at 12 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. A total of 261 (87.2%) and 253 (84.9%) participants completed 6- and 12-month visits, respectively. Loss to follow-up did not differ by study group. Mean (95% confidence intervals [CIs]) percent weight loss at 12 months was -0.61 (-1.99 to 0.77) in the control group, -1.68 (-3.08 to -0.27) in ConTxt only, and -3.63 (-5.05 to -2.81) in ConTxt plus health-coaching calls. At 12 months, mean (95% CI) percent weight loss, adjusted for baseline BMI, was significantly different between ConTxt plus health-coaching calls and the control group (-3.0 [-4.99 to -1.04], p = 0.003) but not between the ConTxt-only and the control group (-1.07 [-3.05 to 0.92], p = 0.291). Differences between ConTxt plus health-coaching calls and ConTxt only were not significant (-1.95 [-3.96 to 0.06], p = 0.057). These findings were consistent across other weight-related secondary outcomes, including changes in absolute weight, BMI, and percent body fat at 12 months. Exploratory subgroup analyses suggested that Spanish speakers responded more favorably to ConTxt plus health-coaching calls than English speakers (Spanish contrast: -7.90 [-11.94 to -3.86], p < 0.001; English contrast: -1.82 [-4.03 to 0.39], p = 0.107). Limitations include the unblinded delivery of the intervention and recruitment of a predominantly female sample from a single site. CONCLUSIONS:A 1-year intervention that delivered theory- and evidence-based weight loss content via daily personalized, tailored, and interactive SMS was most effective when combined with brief, monthly phone calls. TRIAL REGISTRATION:ClinicalTrials.gov NCT01171586

Thermal Remote Sensing for Global Volcano Monitoring: Experiences From the MIROVA System

Volcanic activity is always accompanied by the transfer of heat from the Earth's crust to the atmosphere. This heat can be measured from space and its measurement is a very useful tool for detecting volcanic activity on a global scale. MIROVA (Middle Infrared Observation of Volcanic Activity) is an automatic volcano hot spot detection system, based on the analysis of MODIS data (Moderate Resolution Imaging Spectroradiometer). The system is able to detect, locate and quantify thermal anomalies in near real-time, by providing, on a dedicated website (www.mirovaweb.it), infrared images and thermal flux time-series on over 200 volcanoes worldwide. Thanks to its simple interface and intuitive representation of the data, MIROVA is currently used by several volcano observatories for daily monitoring activities and reporting. In this paper, we present the architecture of the system and we provide a state of the art on satellite thermal data usage for operational volcano monitoring and research. In particular, we describe the contribution that the thermal data have provided in order to detect volcanic unrest, to forecast eruptions and to depict trends and patterns during eruptive crisis. The current limits and requirements to improve the quality of the data, their distribution and interpretation are also discussed, in the light of the experience gained in recent years within the volcanological community. The results presented clearly demonstrate how the open access of satellite thermal data and the sharing of derived products allow a better understanding of ongoing volcanic phenomena, and therefore constitute an essential requirement for the assessment of volcanic hazards. Peer reviewe

Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.

Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,†,§ To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence

Identification of additional risk loci for stroke and small vessel disease: a meta-analysis of genome-wide association studies

BACKGROUND: Genetic determinants of stroke, the leading neurological cause of death and disability, are poorly understood and have seldom been explored in the general population. Our aim was to identify additional loci for stroke by doing a meta-analysis of genome-wide association studies. METHODS: For the discovery sample, we did a genome-wide analysis of common genetic variants associated with incident stroke risk in 18 population-based cohorts comprising 84 961 participants, of whom 4348 had stroke. Stroke diagnosis was ascertained and validated by the study investigators. Mean age at stroke ranged from 45·8 years to 76·4 years, and data collection in the studies took place between 1948 and 2013. We did validation analyses for variants yielding a significant association (at p<5 × 10(-6)) with all-stroke, ischaemic stroke, cardioembolic ischaemic stroke, or non-cardioembolic ischaemic stroke in the largest available cross-sectional studies (70 804 participants, of whom 19 816 had stroke). Summary-level results of discovery and follow-up stages were combined using inverse-variance weighted fixed-effects meta-analysis, and in-silico lookups were done in stroke subtypes. For genome-wide significant findings (at p<5 × 10(-8)), we explored associations with additional cerebrovascular phenotypes and did functional experiments using conditional (inducible) deletion of the probable causal gene in mice. We also studied the expression of orthologs of this probable causal gene and its effects on cerebral vasculature in zebrafish mutants. FINDINGS: We replicated seven of eight known loci associated with risk for ischaemic stroke, and identified a novel locus at chromosome 6p25 (rs12204590, near FOXF2) associated with risk of all-stroke (odds ratio [OR] 1·08, 95% CI 1·05-1·12, p=1·48 × 10(-8); minor allele frequency 21%). The rs12204590 stroke risk allele was also associated with increased MRI-defined burden of white matter hyperintensity-a marker of cerebral small vessel disease-in stroke-free adults (n=21 079; p=0·0025). Consistently, young patients (aged 2-32 years) with segmental deletions of FOXF2 showed an extensive burden of white matter hyperintensity. Deletion of Foxf2 in adult mice resulted in cerebral infarction, reactive gliosis, and microhaemorrhage. The orthologs of FOXF2 in zebrafish (foxf2b and foxf2a) are expressed in brain pericytes and mutant foxf2b(-/-) cerebral vessels show decreased smooth muscle cell and pericyte coverage. INTERPRETATION: We identified common variants near FOXF2 that are associated with increased stroke susceptibility. Epidemiological and experimental data suggest that FOXF2 mediates this association, potentially via differentiation defects of cerebral vascular mural cells. Further expression studies in appropriate human tissues, and further functional experiments with long follow-up periods are needed to fully understand the underlying mechanisms

Genetic and lifestyle risk factors for MRI-defined brain infarcts in a population-based setting.

OBJECTIVE: To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. METHODS: We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n = 20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. RESULTS: The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10-8; and LINC00539/ZDHHC20, p = 5.82 × 10-9. Both have been associated with blood pressure (BP)-related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p [BI] = 9.38 × 10-25; p [SSBI] = 5.23 × 10-14 for hypertension), smoking (p [BI] = 4.4 × 10-10; p [SSBI] = 1.2 × 10-4), diabetes (p [BI] = 1.7 × 10-8; p [SSBI] = 2.8 × 10-3), previous cardiovascular disease (p [BI] = 1.0 × 10-18; p [SSBI] = 2.3 × 10-7), stroke (p [BI] = 3.9 × 10-69; p [SSBI] = 3.2 × 10-24), and MRI-defined white matter hyperintensity burden (p [BI] = 1.43 × 10-157; p [SSBI] = 3.16 × 10-106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p ≤ 0.0022), without indication of directional pleiotropy. CONCLUSION: In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significant modifiable, causal risk factor for BI

Academic Content of Goals and Objectives Included in AAC User\u27s IEPs

Typically, students who require augmentative and alternative communication (AAC) systems do not demonstrate commensurate academic standards as their typically developing peers. According to IDEA, students with disabilities should have individual education plans (IEPs) that address academic standards. The purpose of this study is to (a) determine whether the IEP goals and objectives included in AAC user’s IEPs pertain to academics; (b) determine which subjects are most frequently targeted; (c) identify the most frequent educational diagnoses received among AAC users; and (d) determine the amount of time students who use AAC spend in the general education setting. IEPs of 21 students who require AAC, ages 5-18, were blindly and independently reviewed and coded with respect to educational diagnoses and academic needs, percentage of goals specifically addressing academics and academic areas targeted. It was determined that 29% of goals and 33% of objectives in the IEPS included curricular content with math and reading being the most frequently targeted subjects. Additionally, 15 students who use AAC spent less than 40% of the time in the general education setting. Non-academic areas observed within the IEPs will be discussed as well as implications with the Common Core State Standards. A future direction of research includes conducting a multi-centered study with an increased sample size

Experiences of Racism and Breastfeeding Initiation and Duration Among First-Time Mothers of the Black Women\u27s Health Study

BACKGROUND: Breastfeeding rates are lower for black women in the USA compared with other groups. Breastfeeding and lactation are sensitive time points in the life course, centering breastfeeding as a health equity issue. In the USA, experiences of racism have been linked to poor health outcomes but racism relative to breastfeeding has not been extensively investigated. AIMS: This study aims to investigate the association between experiences of racism, neighborhood segregation, and nativity with breastfeeding initiation and duration. METHODS: This is a prospective secondary analysis of the Black Women\u27s Health Study, based on data collected from 1995 through 2005. Daily and institutional (job, housing, police) racism, nativity, and neighborhood segregation in relation to breastfeeding were examined. Odds ratios and 95% confidence intervals were calculated using binomial logistic regression for the initiation outcomes (N = 2705) and multinomial logistic regression for the duration outcomes (N = 2172). RESULTS: Racism in the job setting was associated with lower odds of breastfeeding duration at 3-5 months. Racism with the police was associated with higher odds of breastfeeding initiation and duration at 3-5 and 6 months. Being born in the USA or having a parent born in the USA predicted lower odds of breastfeeding initiation and duration. Living in a segregated neighborhood (primarily black residents) as a child was associated with decreased breastfeeding initiation and duration relative to growing up in a predominantly white neighborhood. CONCLUSION: Experiences of institutionalized racism influenced breastfeeding initiation and duration. Structural-level interventions are critical to close the gap of racial inequity in breastfeeding rates in the USA

Text messaging and brief phone calls for weight loss in overweight and obese English- and Spanish-speaking adults: A 1-year, parallel-group, randomized controlled trial.

BACKGROUND:Weight loss interventions based solely on text messaging (short message service [SMS]) have been shown to be modestly effective for short periods of time and in some populations, but limited evidence is available for positive longer-term outcomes and for efficacy in Hispanic populations. Also, little is known about the comparative efficacy of weight loss interventions that use SMS coupled with brief, technology-mediated contact with health coaches, an important issue when considering the scalability and cost of interventions. We examined the efficacy of a 1-year intervention designed to reduce weight among overweight and obese English- and Spanish-speaking adults via SMS alone (ConTxt) or in combination with brief, monthly health-coaching calls. ConTxt offered 2-4 SMS/day that were personalized, tailored, and interactive. Content was theory- and evidence-based and focused on reducing energy intake and increasing energy expenditure. Monthly health-coaching calls (5-10 minutes' duration) focused on goal-setting, identifying barriers to achieving goals, and self-monitoring. METHODS AND FINDINGS:English- and Spanish-speaking adults were recruited from October 2011 to March 2013. A total of 298 overweight (body mass index [BMI] 27.0 to 39.9 kg/m2) adults (aged 21-60 years; 77% female; 41% Hispanic; 21% primarily Spanish speaking; 44% college graduates or higher; 22% unemployed) were randomly assigned (1:1) to receive either ConTxt only (n = 101), ConTxt plus health-coaching calls (n = 96), or standard print materials on weight reduction (control group, n = 101). We used computer-based permuted-block randomization with block sizes of three or six, stratified by sex and Spanish-speaking status. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured percent of weight loss from baseline at 12 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. A total of 261 (87.2%) and 253 (84.9%) participants completed 6- and 12-month visits, respectively. Loss to follow-up did not differ by study group. Mean (95% confidence intervals [CIs]) percent weight loss at 12 months was -0.61 (-1.99 to 0.77) in the control group, -1.68 (-3.08 to -0.27) in ConTxt only, and -3.63 (-5.05 to -2.81) in ConTxt plus health-coaching calls. At 12 months, mean (95% CI) percent weight loss, adjusted for baseline BMI, was significantly different between ConTxt plus health-coaching calls and the control group (-3.0 [-4.99 to -1.04], p = 0.003) but not between the ConTxt-only and the control group (-1.07 [-3.05 to 0.92], p = 0.291). Differences between ConTxt plus health-coaching calls and ConTxt only were not significant (-1.95 [-3.96 to 0.06], p = 0.057). These findings were consistent across other weight-related secondary outcomes, including changes in absolute weight, BMI, and percent body fat at 12 months. Exploratory subgroup analyses suggested that Spanish speakers responded more favorably to ConTxt plus health-coaching calls than English speakers (Spanish contrast: -7.90 [-11.94 to -3.86], p < 0.001; English contrast: -1.82 [-4.03 to 0.39], p = 0.107). Limitations include the unblinded delivery of the intervention and recruitment of a predominantly female sample from a single site. CONCLUSIONS:A 1-year intervention that delivered theory- and evidence-based weight loss content via daily personalized, tailored, and interactive SMS was most effective when combined with brief, monthly phone calls. TRIAL REGISTRATION:ClinicalTrials.gov NCT01171586

Experts et expertise dans les mandats de la société des nations : figures, champs, outils

Institués au sortir de la Première Guerre mondiale, les mandats de la Société des Nations illustrent les implications de l’arrivée des experts dans les Suds dès les années 1920. Ils constituent pour cette raison un angle d’attaque privilégié pour réfléchir aux liens entre expertise et colonisation comme aux dynamiques qui accompagnent les experts. S’ils ont été l’objet de discussions intenses, les mandats ne peuvent guère être considérés comme l’objet d’un champ d’expertise bien délimité avec ses méthodes uniformisées, son corps de savoirs systématisés et ses procédures formalisées de certification. Les discours institutionnels d’experts sur les mandats, divers et dénués de cohérence, dissimulaient souvent les modalités habituelles du gouvernement colonial. Cependant, les temps changeaient. La pluralité des cadres institutionnels où l’on discutait des mandats (Commission permanente des mandats, autres organes de la SDN) sapait le monopole supposé des États coloniaux sur la prise de décision informée. L’intérêt des organisations privées et caritatives était également d’importance, dans la mesure où certaines investirent massivement dans des projets exploratoires de développement à fort coefficient d’expertise. Ajoutées les unes aux autres, ces circonstances institutionnelles attiraient des experts potentiels vers les mandats, d’où l’on peut observer et les tensions d’empire qui marquaient l’ère coloniale finissante et les prémisses de politiques publiques fortement consommatrices d’expertise qui se diffusent dans les Suds après 1945.Expertise in the colonial world can be characterized, more perhaps than in any other context, by the tension between abstract knowledge and acquaintance with the field as inspirations for decision making. The League of Nations mandates instituted after World War I should not be understood as a laboratory of expertise in the colonial world, but as an early instance of the implications of bringing experts to the global South. Not only does colonial expertise combine the distance of the expert to their objects and the overbearing position inherent to the colonizer’s gaze: the international organizations of the League of Nations system created further institution distance to colonial realities. Yet is the point of involving expertise in the administration of the mandates not to counter the discredited image of brutal colonial, counter-insurrectional rule, by inserting skilled and knowledgeable actors in the decision process? Intensely discussed though they were, the mandates can hardly be said to have become the object of a well-defined field of expertise, complete with unified methods, systematized bodies of knowledge and formalized procedures of certification for its experts. Institutional expert discourses on the mandates, diverse and lacking cohesion as they were, were often smokescreen for colonial rule as usual. Yet the times were changing, and because international organizations relied on the formalization (through comparison and quantification) and publicity of information, it opened a space where would‑be experts coming from different corners could present alternative views on colonial rule.من حقبة الاستعمار مرورا بعصر السياسات العامة الدولية في الجنوب، لعب مفهوم الخبرة دورا متنامياً في النظام الدولي خلال القرن العشرين. يشمل هذا المفهوم المتناقض والمعروف كوسيلة للأخبار وتحسين الفعل العام، حيزا من الوسائط المتناقضة للمعرفة وطرق التعبير والافصاح. بتموضعها بين المعرفة التجريبية والمعرفة التجريدية الشاملة من جهة وبين البحث والسلطة من جهة أخرى، تثير الخبرة الاهتمام لدراستها في إطار النظام الأول للمنظمات الدولية والأزمة المصاحبة للإمبراطوريات الاستعمارية. لقد أصبحت المناطق الخاضعة للانتداب إحدى النقاط الرئيسية لتقارب المسائل المتعلقة بالانتشار العالمي للمعايير من خلال الهيئات الدولية. يتم قراءة الخبرة باعتبارها واحدة من علامات الاستعمار المتأخر، المشفّر والواقع تحت النظرات المتقاربة بين العلماء والدول والرأي العام. من خلال وصاية عصبة الأمم (NDS) ، يدرس هذا الكتاب بروز الحيز الدولي كإطار لصنع القرار بين الدول، وكإطار مفتوح وإجرائي يشمل عالم من العلاقات والتدفقات والبنى المتداخلة على عدة مستويات. يعمل الكتاب على رسم شخصيات الخبراء ويوضح اللعبة المعقدة التي تنشأ بين هؤلاء الخبراء والمؤسسات الانتدابية من أجل تعريف المعايير والخبرة. يلقي الكتاب أخيرا الضوء على التحديات الناتجة من الجدلية غير المتكافئة بين الخبراء والخبراء المناوئين، وبين السكان المحليين وسلطات الانتداب.De l’ère coloniale à celle des politiques publiques internationales dans les Suds, l’expertise a joué un rôle croissant dans l’ordre international au vingtième siècle. Notion paradoxale, réputée instrumentale en vue de l’information et de l’amélioration de l’action publique, elle englobe tout un champ de modalités opposées du savoir et de son énonciation. L’expertise se situe entre le savoir d’expérience et le savoir nomothétique abstrait, la recherche et l’autorité, elle est intéressante à étudier dans le cadre du premier système d’organisations internationales et de la crise concomitante des empires coloniaux. Les mandats sont récemment devenus un des principaux points de convergence des questionnements sur la diffusion globale des normes à travers les instances internationales. L’expertise est lue comme l’un des signes d’un colonialisme tardif, codifié, et placé sous les regards convergents des savants, des États et des opinions publiques. À travers les mandats de la Société des Nations, cet ouvrage scrute l’émergence de l’international comme cadre de prise de décision inter-étatique, ouverte et procédurale encadrant un monde de connexions, de flux et de structures enchevêtrés à diverses échelles. Il dépeint des figures d’experts et éclaire le jeu complexe qui s’institue entre ces experts et les institutions mandataires pour définir les normes de l’expertise. Il met en lumière leur contestation dans une dialectique asymétrique qui oppose experts et contre-experts, populations locales et autorités mandataires