Best Outcomes for Indian Children

The Wisconsin Department of Children and Families and the Midwest Child Welfare Implementation Center are collaborating with Wisconsin\u27s tribes and county child welfare agencies to improve outcomes for Indian children by systemically implementing the Wisconsin Indian Child Welfare Act (WICWA).This groundbreaking coUaboration wiU increase practitioners\u27 understanding ofthe requirements of WICWA and the need for those requirements, enhance communication and coordination between all stakeholders responsible for the welfare of Indian children in Wisconsin; it is designed to effect the systemic integration of the philosophical underpinnings of WICWA. In December 2009, Governor James Doyle signed the Wisconsin Indian Child Welfare Act, signaling the end ofa historic collaborative effort to enact the law and marking the beginning ofa new initiative to effectively implement it. Like the work that led to enactment ofthe statute, the work required to effectuate it requires the involvement of stakeholders with very diverse views and interests. However, this group has a common goal to which aU members are committed: to achieve better outcomes for Indian children in Wisconsin. The Midwest Child Welfare Implementation Center, a member of the Training and Technical Assistance network ofthe Children\u27s Bureau, is privileged to assist the 11 tribes, the state of Wisconsin, and its project partners in a four-year implementation project toward the achievement ofthat goal. This article describes the early years ofthat journey and the plan for its current segment, which is in progress

The association between excess weight and COVID-19 outcomes: An umbrella review

\ua9 2024 The Author(s). Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.This umbrella review assessed the association between excess weight and COVID-19 outcomes. MEDLINE, PsycINFO, and CINAHL were systematically searched for reviews that assessed the association between excess weight and COVID-19 outcomes. A second-order meta-analysis was conducted on the available data for intensive care unit admission, invasive mechanical ventilation administration, disease severity, hospitalization, and mortality. The quality of included reviews was assessed using the AMSTAR-2 appraisal tool. In total, 52 systematic reviews were included, 49 of which included meta-analyses. The risk of severe outcomes (OR = 1.86; 95% CI: 1.70 to 2.05), intensive care unit admission (OR = 1.58; 95% CI: 1.45 to 1.72), invasive mechanical ventilation administration (OR = 1.70; 95% CI: 1.57 to 1.83), hospitalization (OR = 1.82; 95% CI: 1.61 to 2.05), and mortality (OR = 1.35; 95% CI: 1.24 to 1.48) following COVID-19 infection was significantly higher in individuals living with excess weight compared with those with a healthy weight. There was limited evidence available in the included reviews regarding the influence of moderating factors such as ethnicity, and the majority of included reviews were of poor quality. Obesity appears to represent an important modifiable pre-infection risk factor for severe COVID-19 outcomes, including death

Statistical methods for body mass index: a selective review

Obesity rates have been increasing over recent decades, causing significant concern among policy makers. Excess body fat, commonly measured by body mass index, is a major risk factor for several common disorders including diabetes and cardiovascular disease, placing a substantial burden on health care systems. To guide effective public health action, we need to understand the complex system of intercorrelated influences on body mass index. This paper, based on all eligible articles searched from Global health, Medline and Web of Science databases, reviews both classical and modern statistical methods for body mass index analysis. We give a description of each of these methods, exploring the classification, links and differences between them and the reasons for choosing one over the others in different settings. We aim to provide a key resource and statistical library for researchers in public health and medicine to deal with obesity and body mass index data analysis.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work has been supported in part by the National Institute for Health Research Method Grant (NIHR RMOFS-2013-03-09) and the National Natural Science Foundation of China (Grant No. 71490725, 11261048, 11371322)

Effectiveness of individual and group programmes to treat obesity and reduce cardiovascular disease risk factors in pre‐pubertal children

Childhood obesity results in premature atherosclerosis and requires early intervention. Compare the effectiveness of 6‐month lifestyle interventions (with choice of either individual or group therapy) with standard care on body mass index (BMI) z‐score and cardiovascular disease (CVD) risks factors in children with obesity. This 6‐month randomized controlled trial with a 6‐month follow‐up included 74 pre‐pubertal children with obesity (7.5‐11.9 years) assigned randomly (2:1) to intervention or control. Families in the intervention arm choose between an individually delivered treatment (3 hours paediatrician + 4 hours dietician) or group treatment (35 hours with a multidisciplinary team). Children participated also to a weekly physical activity programme. We measured BMI, BMI z‐score; waist circumference (WC); total and abdominal fat; blood pressure; common carotid artery intima‐media thickness and incremental elastic modulus (Einc); endothelium‐dependent and independent dilation (nitroglycerin‐mediated dilation [NTGMD]) of the brachial artery; fasting plasma glucose, insulin, lipids; and high‐sensitivity C‐reactive protein (hs‐CRP). Compared to controls, at 6 months, abdominal fat and hs‐CRP were reduced in both interventions. The group intervention was also effective in reducing BMI (−0.55 kg/m2; 95% confidence interval −1.16 to 0.06) and BMI z‐score (−0.08; −0.15 to 0.00) at 6 months and BMI, BMI z‐score, WC, NTGMD, total and abdominal fat at 12 months. Abdominal fat and low‐grade inflammation were significantly decreased in both interventions. High‐intensity group treatment improved early signs of atherosclerosis in children with obesity. These findings are important for the promotion of cardiometabolic health in this population

Development of the MapMe intervention body image scales of known weight status for 4-5 and 10-11 year old children

This work was supported by the National Prevention Research Initiative [grant number MR/J00054X/1] (incorporating funding from Alzheimer’s Research UK; Alzheimer’s Society; Biotechnology and Biological Sciences Research Council; British Heart Foundation; Cancer Research UK; Chief Scientist Office, Scottish Government Health Directorate; Department of Health; Diabetes UK; Economic and Social Research Council; Engineering and Physical Sciences Research Council; Health and Social Care Research Division, Public Health Agency, Northern Ireland; Medical Research Council; Stroke Association; Wellcome Trust and World Cancer Research Fund).Background: Parents tend to visually assess children to determine their weight status and typically underestimate child body size. A visual tool may aid parents to more accurately assess child weight status and so support strategies to reduce childhood overweight. Body image scales (BIS) are visual images of people ranging from underweight to overweight but none exist for children based on UK criteria. Our aim was to develop sex- and age-specific BIS for children, based on British growth reference (UK90) criteria. Methods: BIS were developed using 3D surface body scans of children, their associated weight status using UK90 criteria from height and weight measurements, and qualitative work with parents and health professionals. Results: Height, weight and 3D body scans were collected (211 4-5 years; 177 10-11 years). 12 qualitative sessions were held with 37 participants. Four BIS (4-5 year old girls and boys, 10-11 year old girls and boys) were developed. Conclusions: This study has created the first sex- and age-specific BIS, based on UK90 criteria. The BIS have potential for use in child overweight prevention and management strategies, and in future research. This study also provides a protocol for the development of further BIS appropriate to other age groups and ethnicities.Publisher PDFPeer reviewe

Improving Practice in Supported Decision-Making and Mental Capacity Assessment

Current models of evidence-based practice are predicated on the inclusion of patients / service users in decisions about their healthcare. In the United Kingdom (UK), healthcare policy and legislation requires practitioners to provide support with decision-making and, if necessary, complete mental capacity assessments to identify if service users can make informed decisions. People with communication disabilities may have difficulties understanding, thinking and talking about decisions and may require communication support. In this paper, I discuss the current challenges associated with mental capacity assessment and supported decision-making. I propose that healthcare professionals should look beyond legal and policy imperatives to consider the ethical foundations for their practice, when they face such challenges. I compare two conceptual approaches to ethical reasoning. I describe a practical solution to the clinical challenge – the development of the MCAST, a toolkit to support multidisciplinary staff to assess mental capacity and provide support to service users with communication disabilities during the decision-making proces

The PNL high-transmission three-stage mass spectrometer

We have constructed a three-stage isotope-ratio mass spectrometer of unique ion-optical design that achieves high ion transmission efficiency and high abundance sensitivity. The spectrometer has tandem 90[degrees] -deflection magnets with boundaries 18[degrees] off normal. The magnet drift lengths are 1.48 times the 27-cm radius of deflection. This extended geometry gives mass dispersion equivalent to a 40-cm-radius magnet with normal boundaries. The first magnet renders the ion beam parallel in the vertical plane and provides a focus in the horizontal plane of mass dispersion. The second magnet brings the beam to a stigmatic focus. This novel ion-optical design gives 100% transmission without the need for intermediate focusing lenses. It also provides a 16% increase in mass resolution over the traditional tandem geometry with normal magnet boundaries. Complete transmission of ions is maintained through a third-stage cylindrical electric sector of 38-cm radius, which provides increased isotope-abundance sensitivity. The isotope-abundance sensitivity of the new mass spectrometer is an order of magnitude better than similar instruments with normal magnet boundaries. This is because the vertical focusing of the ion beam prevents ion scattering from the top and bottom of the flight tube. The measured values of the isotope-abundance sensitivity one-half mass unit away from the rhenium ion peaks at masses 185 and 187 are M [minus] 1/2 = (6.5 [plus minus] 0.5)[times] 0[sup [minus]10] M + 1/2 = (3.1 [plus minus] 0.8) [times] 10[sup [minus]10]. By extrapolation, the uranium isotope-abundance sensitivity is m [minus] 1 = 1 [times] 10[sup [minus]10]. Construction of the instrument was facilitated by using standard commercial mass spectrometer components

A Layman's guide to SUSY GUTs

The determination of the most straightforward evidence for the existence of the Superworld requires a guide for non-experts (especially experimental physicists) for them to make their own judgement on the value of such predictions. For this purpose we review the most basic results of Super-Grand unification in a simple and clear way. We focus the attention on two specific models and their predictions. These two models represent an example of a direct comparison between a traditional unified-theory and a string-inspired approach to the solution of the many open problems of the Standard Model. We emphasize that viable models must satisfy {\em all} available experimental constraints and be as simple as theoretically possible. The two well defined supergravity models, $SU(5)$ and $SU(5)\times U(1)$, can be described in terms of only a few parameters (five and three respectively) instead of the more than twenty needed in the MSSM model, \ie, the Minimal Supersymmetric extension of the Standard Model. A case of special interest is the strict no-scale $SU(5)\times U(1)$ supergravity where all predictions depend on only one parameter (plus the top-quark mass). A general consequence of these analyses is that supersymmetric particles can be at the verge of discovery, lurking around the corner at present and near future facilities. This review should help anyone distinguish between well motivated predictions and predictions based on arbitrary choices of parameters in undefined models.Comment: 25 pages, Latex, 11 figures (not included), CERN-TH.7077/93, CTP-TAMU-65/93. A complete ps file (1.31MB) with embedded figures is available by request from [email protected]