The importance of parents and teachers as stakeholders in school-based healthy eating programs

Schools have a crucial role for promoting and establishing healthy behaviors early in the life-course. In recent years, a substantial effort and resources have been invested in attempts to change the 'food culture' in schools in westernized societies. Large school-based programs which promote healthy eating often utilize an ecological model for instigating behavior change amongst school children. An ecological model is a set of comprehensive intervention strategies that target a multitude of factors which influence the eating practices of children in the school setting. The cultural issues that necessitate these healthy eating programs mean that interventions are not without challenges to their application and effectiveness particularly as they rely on collaboration between stakeholders: teachers, parents, public health practitioners, policy makers and more. The stakeholder input and relations are key parts of planning, implementing and evaluating complex health promotion and education programs in schools. This commentary will outline the importance of considering both teachers and parents as influencing agents or 'enablers' in the process of creating change in this context. Parental perceptions and teachers’ insights are critical for underpinning intervention feasibility, acceptability and performance. Their perceptions and understandings can provide ground-level and highly applicable expertise and importantly motivate children in the school environment. The philosophical principles behind parent and teacher integration into formal program evaluation are discussed, providing a theoretical basis for program evaluation. Recommendations are made for policy makers, researchers and professional evaluation experts’ to consider and integrate these stakeholders in future programs

‘VIOLET’: a fluorescence-based simulation exercise for training healthcare workers in the use of personal protective equipment

Background Healthcare workers caring for patients with high-consequence infectious diseases (HCIDs) require protection from pathogen exposure, for example by wearing personal protective equipment (PPE). Protection is acquired through the inherent safety of the PPE components, but also their safe and correct use, supported by adequate training and user familiarity. However, the evidence base for HCID PPE ensembles and any associated training is lacking, with subsequent variation between healthcare providers. Aim To develop an evidence-based assessment and training tool for evaluating PPE ensembles and doffing protocols, in the assessment of patients with suspected HCIDs. Methods VIOLET (Visualising Infection with Optimised Light for Education and Training) comprises a healthcare mannequin adapted to deliver simulated bodily fluids containing UV-fluorescent tracers. On demand and remotely operated, the mannequin projectile vomits (blue), coughs (red), has diarrhoea (yellow) and is covered in sweat (orange). Wearing PPE, healthcare staff participate in an HCID risk assessment and examination of the ‘patient’, thereby becoming exposed to these bodily fluids. Contamination of PPE is visualized and body-mapped under UV light before and after removal. Observational findings and participant feedback, around its use as a training exercise, is also recorded. Findings Significant contamination from different exposure events was seen, enabling evaluation of PPE and doffing procedures used. Observational data and participant feedback demonstrated its strengths and success as a training technique. Conclusion Simulation exercises using VIOLET provide evidence-based assessment of PPE ensembles, and are a valuable resource for training of healthcare staff in wearing and safe doffing of PPE

Use of ultraviolet-fluorescence-based simulation in evaluation of personal protective equipment worn for first assessment and care of a patient with suspected high-consequence infectious disease

Background: Variations currently exist across the UK in the choice of personal protective equipment (PPE) used by healthcare workers when caring for patients with suspected high-consequence infectious diseases (HCIDs). Aim: To test the protection afforded to healthcare workers by current PPE ensembles during assessment of a suspected HCID case, and to provide an evidence base to justify proposal of a unified PPE ensemble for healthcare workers across the UK. Methods: One ‘basic level’ (enhanced precautions) PPE ensemble and five ‘suspected case’ PPE ensembles were evaluated in volunteer trials using ‘Violet’; an ultraviolet-fluorescence-based simulation exercise to visualize exposure/contamination events. Contamination was photographed and mapped. Findings: There were 147 post-simulation and 31 post-doffing contamination events, from a maximum of 980, when evaluating the basic level of PPE. Therefore, this PPE ensemble did not afford adequate protection, primarily due to direct contamination of exposed areas of the skin. For the five suspected case ensembles, 1584 post-simulation contamination events were recorded, from a maximum of 5110. Twelve post-doffing contamination events were also observed (face, two events; neck, one event; forearm, one event; lower legs, eight events). Conclusion: All suspected case PPE ensembles either had post-doffing contamination events or other significant disadvantages to their use. This identified the need to design a unified PPE ensemble and doffing procedure, incorporating the most protective PPE considered for each body area. This work has been presented to, and reviewed by, key stakeholders to decide on a proposed unified ensemble, subject to further evaluation

Using an Audience Response System Smartphone App to Improve Resident Education in the Pediatric Intensive Care Unit.

In the Pediatric Intensive Care Unit (PICU), most teaching occurs during bedside rounds, but technology now provides new opportunities to enhance education. Specifically, smartphone apps allow rapid communication between instructor and student. We hypothesized that using an audience response system (ARS) app can identify resident knowledge gaps, guide teaching, and enhance education in the PICU. Third-year pediatric residents rotating through the PICU participated in ARS-based education or received traditional teaching. Before rounds, experimental subjects completed an ARS quiz using the Socrative app. Concomitantly, the fellow leading rounds predicted quiz performance. Then, discussion points based on the incorrect answers were used to guide instruction. Scores on the pre-rotation test were similar between groups. On the post-rotation examination, ARS participants did not increase their scores more than controls. The fellow's prediction of performance was poor. Residents felt that the method enhanced their education whereas fellows reported that it improved their teaching efficiency. Although there was no measurable increase in knowledge using the ARS app, it may still be a useful tool to rapidly assess learners and help instructors provide learner-centered education

Phantom of the Opera: ETF Shorting and Shareholder Voting

The short-selling of exchange-traded funds (ETFs) creates "phantom" ETF shares, trading at ETF market prices, with cash flows rights but no associated voting rights. Unlike regular ETF shares backed by the underlying securities of the ETF and voted as directed by the sponsor, phantom ETF shares are backed by collateral that is not voted. Introducing a novel measure of phantom shares both of the ETF and corresponding underlying securities, we find that increases in phantom shares are associated with decreases in number of proxy votes cast (for and against), and increases in broker non-votes, the vote premium, and value-reducing acquisitions

Rigorous results on spontaneous symmetry breaking in a one-dimensional driven particle system

We study spontaneous symmetry breaking in a one-dimensional driven two-species stochastic cellular automaton with parallel sublattice update and open boundaries. The dynamics are symmetric with respect to interchange of particles. Starting from an empty initial lattice, the system enters a symmetry broken state after some time T_1 through an amplification loop of initial fluctuations. It remains in the symmetry broken state for a time T_2 through a traffic jam effect. Applying a simple martingale argument, we obtain rigorous asymptotic estimates for the expected times ~ L ln(L) and ln() ~ L, where L is the system size. The actual value of T_1 depends strongly on the initial fluctuation in the amplification loop. Numerical simulations suggest that T_2 is exponentially distributed with a mean that grows exponentially in system size. For the phase transition line we argue and confirm by simulations that the flipping time between sign changes of the difference of particle numbers approaches an algebraic distribution as the system size tends to infinity.Comment: 23 pages, 7 figure

Failure Is an Option: Impediments to Short Selling and Options Prices

Regulations allow market makers to short sell without borrowing stock, and the transactions of a major options market maker show that in most hard-to-borrow situations, it chooses not to borrow and instead fails to deliver stock to its buyers. A part of the value of failing passes through to options prices: when failing is cheaper than borrowing, the relation between borrowing costs and options prices is significantly weaker. The remaining value is profit to the market maker, and its ability to profit despite competition between market makers appears to result from the cost advantage of larger market makers

Catechin or quercetin guests in an intrinsically microporous polyamine (PIM-EA-TB) host: accumulation, reactivity, and release

Microporous polymer materials based on molecularly "stiff"structures provide intrinsic microporosity, typical micropore sizes of 0.5 nm to 1.5 nm, and the ability to bind guest species. The polyamine PIM-EA-TB contains abundant tertiary amine sites to interact via hydrogen bonding to guest species in micropores. Here, quercetin and catechin are demonstrated to bind and accumulate into PIM-EA-TB. Voltammetric data suggest apparent Langmuirian binding constants for catechin of 550 (±50) × 103 M-1 in acidic solution at pH 2 (PIM-EA-TB is protonated) and 130 (±13) × 103 M-1 in neutral solution at pH 6 (PIM-EA-TB is not protonated). The binding capacity is typically 1 : 1 (guest : host polymer repeat unit), but higher loadings are readily achieved by host/guest co-deposition from tetrahydrofuran solution. In the rigid polymer environment, bound ortho-quinol guest species exhibit 2-electron 2-proton redox transformation to the corresponding quinones, but only in a thin mono-layer film close to the electrode surface. Release of guest molecules occurs depending on the level of loading and on the type of guest either spontaneously or with electrochemical stimuli

Report of the panel on the land surface: Process of change, section 5

The panel defined three main areas of study that are central to the Solid Earth Science (SES) program: climate interactions with the Earth's surface, tectonism as it affects the Earth's surface and climate, and human activities that modify the Earth's surface. Four foci of research are envisioned: process studies with an emphasis on modern processes in transitional areas; integrated studies with an emphasis on long term continental climate change; climate-tectonic interactions; and studies of human activities that modify the Earth's surface, with an emphasis on soil degradation. The panel concluded that there is a clear requirement for global coverage by high resolution stereoscopic images and a pressing need for global topographic data in support of studies of the land surface