Factors Associated With Weight Management Counseling During Primary Care Clerkships

Background: The United States Preventive Services Task Force guidelines support screening and provision of intensive multi-component behavioral counseling for adults who have obesity. One barrier to providing such counseling is lack of training in medical school. Not much is known about factors associated with medical students’ perceived weight management counseling (WMC) skills or whether preceptors model or teach WMC during primary care clerkships. Methods: A mixed methods approach addressed factors affecting WMC training during primary care clerkships. A secondary analysis of 3rd year medical students (n=730) described students’ perceived WMC skills, attitudes and frequency of engagement in 5As educational experiences. Linear mixed models were used to determine associations between educational experiences and perceived skills. Semi-structured interviews (n=12) and a survey were administered to primary care preceptors (n=77). Interviews described individual, inter-personal and institutional factors associated with preceptors’ WMC. The survey described preceptors’ frequency of modeling WMC behaviors, perceived WMC skills, and attitudes. Results: Students perceived themselves to be moderately skilled (M=2.6, SD=0.05, range 1-4). Direct patient experiences and specific instruction were associated with higher perceived skill. Preceptors support WMC curricula but do not perceive themselves to be experts in WMC. Preceptors perceive themselves to be moderately skilled (M=2.8, SD=0.06, range 1-4) but only sometimes model WMC (M=3.3, SD=0.05, range 1-5) to students during clerkships. Conclusion: Preceptor modeling WMC may not be feasible or necessary during primary care clerkships. Providing specific WMC instruction and working with patients may provide more benefit as they were more strongly associated with students’ perceived skills

The probable larva of an undescribed species of Edrabius (Coleoptera: Staphylinidae) and its implications for the systematics of the tribe Amblyopinini.

Larval staphylinids collected from the nest of the Chilean tuco-tuco, Ctenomys maulinus brunneus, are presumed to be those of an undescribed species of Edrabius, adults of which are known to occur on this host. These larvae are described and illustrations are provided for their identification. The larvae are characteristic of the subfamily Staphylininae; however, they do not have a combination of characteristics which allows unambiguous placement into one of the described tribes of this subfamily. Edrabius larvae share the greatest number of characteristics with larvae of the tribe Staphylinini, and, among these, with members of the subtribe Xanthopygina. Importantly, they differ from larvae of the tribe Quediini, to which the amblyopinines were believed to be related, in a number of significant ways. However, Edrabius may not be a part of a monophyletic lineage with the remainder of the South American amblyopinines

Towards a dignified food security? Discourses of dignity, development and culture in New York City and Bogotá

In light of a severe, changing and globally implicative New Food Equation marked perhaps above all else by the dynamics of a new, bimodal food insecurity and the simultaneous rising importance of cities, new approaches to address food security at urban scales suggest promise. But as such efforts are relatively new, the discourses and activities of urban actors are understood to only a limited extent. Moreover, while attention to food security per se is robust and growing, attention to the discursive and narrative dimensions that ultimately construct both the real nutritional achievements and the real experiential implications of such policy is not. In this research, I apply analytical methods informed by the interpretive, critical and ethnographic traditions to understand (some of) the cultural, ideological and philosophical particularities of these new dynamics and contexts, examining the cases of two large cities in the North and South, New York City and Bogotá. Tandem to the empirical work, I explore the philosophical tenets that ground food security efforts in the two studied cities and more generally, and I finally settle upon the purposefully normative appeal for motion towards a new concept: dignified food security

Pathology of chronic achilles-tendon injuries in athletes

Overuse tendon conditions have traditionally been considered to result from an inflammatory process and were treated as such. Microscopic examination of abnormal Achilles-tendon tissues, however, reveals a non-inflammatory degenerative process. The histopathology found in surgical specimens in patients with chronic overuse Achilles tendinopathy and those with Achilles-tendon rupture are reviewed. Seminal studies suggest that so-called tendinitis is a rare condition that might occur occasionally in the Achilles tendon in association with a primary tendinosis. These data have clinical implications and require a review of the traditional classification of pathologies seen in tendon conditions, The authors recommend that nomenclature be based on histopathological findings rather than traditional hypothesis. <br /

Sex differences in the influence of body mass index on anatomical architecture of brain networks.

Background/objectivesThe brain has a central role in regulating ingestive behavior in obesity. Analogous to addiction behaviors, an imbalance in the processing of rewarding and salient stimuli results in maladaptive eating behaviors that override homeostatic needs. We performed network analysis based on graph theory to examine the association between body mass index (BMI) and network measures of integrity, information flow and global communication (centrality) in reward, salience and sensorimotor regions and to identify sex-related differences in these parameters.Subjects/methodsStructural and diffusion tensor imaging were obtained in a sample of 124 individuals (61 males and 63 females). Graph theory was applied to calculate anatomical network properties (centrality) for regions of the reward, salience and sensorimotor networks. General linear models with linear contrasts were performed to test for BMI and sex-related differences in measures of centrality, while controlling for age.ResultsIn both males and females, individuals with high BMI (obese and overweight) had greater anatomical centrality (greater connectivity) of reward (putamen) and salience (anterior insula) network regions. Sex differences were observed both in individuals with normal and elevated BMI. In individuals with high BMI, females compared to males showed greater centrality in reward (amygdala, hippocampus and nucleus accumbens) and salience (anterior mid-cingulate cortex) regions, while males compared to females had greater centrality in reward (putamen) and sensorimotor (posterior insula) regions.ConclusionsIn individuals with increased BMI, reward, salience and sensorimotor network regions are susceptible to topological restructuring in a sex-related manner. These findings highlight the influence of these regions on integrative processing of food-related stimuli and increased ingestive behavior in obesity, or in the influence of hedonic ingestion on brain topological restructuring. The observed sex differences emphasize the importance of considering sex differences in obesity pathophysiology

“everything in one place”

Purpose: To describe older adults’ perspectives on a new patient education manual for the recovery process after hip fracture. Materials and methods: The Fracture Recovery for Seniors at Home (FReSH) Start manual is an evidence- based manual for older adults with fall-related hip fracture. The manual aims to support the transition from hospital to home by facilitating self- management of the recovery process. We enrolled 31 community-dwelling older adults with previous fall-related hip fracture and one family member. We collected data using a telephone-based questionnaire with eight five-point Likert items and four semi-structured open-ended questions to explore participants’ perceptions on the structure, content, and illustration of the manual. The questionnaire also asked participants to rate the overall utility (out of 10 points) and length of the manual. We used content analysis to describe main themes from responses to the open-ended interview questions. Results: Participants’ ratings for structure, content, and illustrations ranged from 4 to 5 (agree to highly agree), and the median usefulness rating was 9 (10th percentile: 7, 90th percentile: 10). Main themes from the content analysis included: ease of use and presentation; health literacy; illustration utility; health care team delivery; general impression, information support from hospital to home; emotional and decision-making support; and the novelty of the manual. Conclusion: The FReSH Start manual was perceived as comprehensive in content and acceptable for use with older adults post-fall- related hip fracture. Participants expressed a need for delivery and explanation of the manual by a health care team member

Polarimetric imaging for air accident investigation

We report a trial wherein a simple 4 CCD visible-band Polarimetric Imaging (PI) camera was fielded against aircraft debris distributed across an arid terrain, a littoral region and a small number of maritime debris targets A debris field realistically simulating an aircrash and a debris grid of aircraft remains were observed from an air platform flying in dry and sunny conditions. We report PI utility in support of air accident investigation by an enhanced ability to successfully locate small targets within the scene via the use of colour enhanced and decorrelated intensity PI products. Our results indicate that handheld PI capability may represent an effective low cost, upgrade and augmentation option for existing and future imaging systems that would support air accident investigators and assist in the cueing of more sophisticated assets and/or analyst attention

At the crossroads: new paradigms of food security, public health nutrition and school food

Public health nutrition sits at the nexus of a global crisis in food, environmental and health systems that has generated – along with numerous other problems – an urgent and changing problem of food insecurity. The ‘new’ food insecurity, however, is different from the old: it is bimodal, encompassing issues of both under- and over-consumption, hunger and obesity, quantity and quality; it has assumed a decidedly urban dimension; and it implicates rich and poor countries alike. The complexity of the expressions of this challenge requires new approaches to public health nutrition and food policy that privilege systemic, structural and environmental factors over individual and mechanistic ones. In this context, the current paper argues that school food systems rise with buoyant potential as promising intervention sites: they are poised to address both modes of the food security crisis; integrate systemic, structural and environmental with behavioural approaches; and comprise far-reaching, system-wide efforts that influence the wider functioning of the food system. Based on a discussion of Bogota´ and other pioneering policies that explicitly aim to create a broader food system with longterm foundations for good public health and food security, the paper suggests a new research and action agenda that gives special attention to school food in urban contexts

Could the Last Interglacial Constrain Projections of Future Antarctic Ice Mass Loss and Sea‐Level Rise?

Previous studies have interpreted Last Interglacial (LIG; ∼129–116 ka) sea-level estimates in multiple different ways to calibrate projections of future Antarctic ice-sheet (AIS) mass loss and associated sea-level rise. This study systematically explores the extent to which LIG constraints could inform future Antarctic contributions to sea-level rise. We develop a Gaussian process emulator of an ice-sheet model to produce continuous probabilistic projections of Antarctic sea-level contributions over the LIG and a future high-emissions scenario. We use a Bayesian approach conditioning emulator projections on a set of LIG constraints to find associated likelihoods of model parameterizations. LIG estimates inform both the probability of past and future ice-sheet instabilities and projections of future sea-level rise through 2150. Although best-available LIG estimates do not meaningfully constrain Antarctic mass loss projections or physical processes until 2060, they become increasingly informative over the next 130 years. Uncertainties of up to 50 cm remain in future projections even if LIG Antarctic mass loss is precisely known (±5 cm), indicating that there is a limit to how informative the LIG could be for ice-sheet model future projections. The efficacy of LIG constraints on Antarctic mass loss also depends on assumptions about the Greenland ice sheet and LIG sea-level chronology. However, improved field measurements and understanding of LIG sea levels still have potential to improve future sea-level projections, highlighting the importance of continued observational efforts