Development and Piloting of a Novel Evaluation Tool for Childhood Obesity Prevention Programs

Childhood obesity remains chronic and high in the U.S., driven by factors including poor dietary habits and lack of physical activity. Interventions that address multiple causal factors may be the most appropriate strategy to address rising childhood obesity rates. The Cooperative Extension Service offers programs across the country to address causal factors of childhood obesity, but few coordinated or concerted efforts have been made to determine overlap, reduce duplication, or identify best practices in programming. To fill this gap, the National Institute of Food and Agriculture Multistate Project W3005 Extension Workgroup sought to develop a novel tool to compare programs with components related to childhood obesity prevention. This manuscript details the iterative process used to develop the Childhood Obesity Prevention Program in Extension Rubric (COPPER), provides findings from the pilot process, and reveals the broad application and potential of this tool within Extension and nutrition education. The newly developed COPPER tool is multi-functional and may be beneficial in program development, implementation, adoption, and/or adaptation of programs in new settings. This tool will be useful for Extension, public health, and other community organizations focused on issues central to childhood obesity targeting children, parents, and/or caregivers

Ovarian cancer symptom awareness and anticipated delayed presentation in a population sample

Background: While ovarian cancer is recognised as having identifiable early symptoms, understanding of the key determinants of symptom awareness and early presentation is limited. A population-based survey of ovarian cancer awareness and anticipated delayed presentation with symptoms was conducted as part of the International Cancer Benchmarking Partnership (ICBP). Methods: Women aged over 50 years were recruited using random probability sampling (n = 1043). Computer-assisted telephone interviews were used to administer measures including ovarian cancer symptom recognition, anticipated time to presentation with ovarian symptoms, health beliefs (perceived risk, perceived benefits/barriers to early presentation, confidence in symptom detection, ovarian cancer worry), and demographic variables. Logistic regression analysis was used to identify the contribution of independent variables to anticipated presentation (categorised as < 3 weeks or ≥ 3 weeks). Results: The most well-recognised symptoms of ovarian cancer were post-menopausal bleeding (87.4%), and persistent pelvic (79.0%) and abdominal (85.0%) pain. Symptoms associated with eating difficulties and changes in bladder/bowel habits were recognised by less than half the sample. Lower symptom awareness was significantly associated with older age (p ≤ 0.001), being single (p ≤ 0.001), lower education (p ≤ 0.01), and lack of personal experience of ovarian cancer (p ≤ 0.01). The odds of anticipating a delay in time to presentation of ≥ 3 weeks were significantly increased in women educated to degree level (OR = 2.64, 95% CI 1.61 – 4.33, p ≤ 0.001), women who reported more practical barriers (OR = 1.60, 95% CI 1.34 – 1.91, p ≤ 0.001) and more emotional barriers (OR = 1.21, 95% CI 1.06 – 1.40, p ≤ 0.01), and those less confident in symptom detection (OR = 0.56, 95% CI 0.42 – 0.73, p ≤ 0.001), but not in those who reported lower symptom awareness (OR = 0.99, 95% CI 0.91 – 1.07, p = 0.74). Conclusions: Many symptoms of ovarian cancer are not well-recognised by women in the general population. Evidence-based interventions are needed not only to improve public awareness but also to overcome the barriers to recognising and acting on ovarian symptoms, if delays in presentation are to be minimised

VEGF regulates local inhibitory complement proteins in the eye and kidney

10.1172/JCI86418Journal of Clinical Investigation1271199-21

Sustainable development goal 2: improved targets and indicators for agriculture and food security

The pursuit of global food security and agricultural sustainability, the dual aim of the second Sustainable Development Goal (SDG-2), requires urgent and concerted action from developing and developed countries. This, in turn, depends on clear and universally applicable targets and indicators which are partially lacking. The novel and complex nature of the SDGs poses further challenges to their implementation on the ground, especially in the face of interlinkages across SDG objectives and scales. Here we review the existing SDG-2 indicators, propose improvements to facilitate their operationalization and illustrate their practical implementation in Nigeria, Brazil and the Netherlands. This exercise provides insights into the concrete actions needed to achieve SDG-2 across contrasting development contexts and highlights the challenges of addressing the links between targets and indicators within and beyond SDG-2. Ultimately, it underscores the need for integrated policies and reveals opportunities to leverage the fulfillment of SDG-2 worldwide

Advances in our understanding of the pathogenesis of glomerular thrombotic microangiopathy

Glomerular thrombotic microangiopathy is a hallmark feature of haemolytic uraemic syndrome, the leading cause of acute renal failure in childhood. This paper is a review of the different mechanistic pathways that lead to this histological picture in the kidney. It will focus on atypical HUS and complement dysregulation, but will also highlight some other recent advances in our understanding of this condition, including the potential role of the molecule vascular endothelial growth factor- A (VEGF-A)

Expected Performance of the ATLAS Experiment - Detector, Trigger and Physics

A detailed study is presented of the expected performance of the ATLAS detector. The reconstruction of tracks, leptons, photons, missing energy and jets is investigated, together with the performance of b-tagging and the trigger. The physics potential for a variety of interesting physics processes, within the Standard Model and beyond, is examined. The study comprises a series of notes based on simulations of the detector and physics processes, with particular emphasis given to the data expected from the first years of operation of the LHC at CERN

Cognitive behaviour therapy (CBT) for anxiety and depression in adults with mild intellectual disabilities (ID): a pilot randomised controlled trial

Background: Several studies have showed that people with intellectual disabilities (ID) have suitable skills to undergo cognitive behavioural therapy (CBT). Case studies have reported successful use of cognitive behavioural therapy techniques (with adaptations) in people with ID. Modified cognitive behavioural therapy may be a feasible and effective approach for the treatment of depression, anxiety, and other mood disorders in ID. To date, two studies have reported group-based manaulised cognitive behavioural treatment programs for depression in people with mild ID. However, there is no individual manualised programme for anxiety or depression in people with intellectual disabilities. The aims of the study are to determine the feasibility of conducting a randomised controlled trial for CBT in people with ID. The data will inform the power calculation and other aspects of carrying out a definitive randomised controlled trial.Methods: Thirty participants with mild ID will be allocated randomly to either CBT or treatment as usual (TAU). The CBT group will receive up to 20 hourly individual CBT over a period of 4 months. TAU is the standard treatment which is available to any adult with an intellectual disability who is referred to the intellectual disability service (including care management, community support, medical, nursing or social support). Beck Youth Inventories (Beck Anxiety Inventory & Beck Depression Inventory) will be administered at baseline; end of treatment (4 months) and at six months to evaluate the changes in depression and anxiety. Client satisfaction, quality of life and the health economics will be secondary outcomes.Discussion: The broad outcome of the study will be to produce clear guidance for therapists to apply an established psychological intervention and identify how and whether it works with people with intellectual disabilities

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

The adaptive capacity of maize-based conservation agriculture systems to climate stress in tropical and subtropical environments: A meta-regression of yields

Conservation agriculture is widely promoted across sub-Saharan Africa as a sustainable farming practice that enhances adaptive capacity to climate change. The interactions between climate stress, management, and soil are critical to understanding the adaptive capacity of conservation agriculture. Yet conservation agriculture syntheses to date have largely neglected climate, especially the effects of extreme heat. For the sub-tropics and tropics, we use meta-regression, in combination with global soil and climate datasets, to test four hypotheses: (1) that relative yield performance of conservation agriculture improves with increasing drought and temperature stress; (2) that the effects of moisture and temperature stress exposure interact; (3) that the effects of moisture and temperature stress are modified by soil texture; and (4) that crop diversification, fertilizer application rate, or the time since no-till implementation will enhance conservation agriculture performance under climate stress. Our results support the hypothesis that the relative maize yield performance of conservation agriculture improves with increasing drought severity or exposure to high temperatures. Further, there is an interaction of moisture and heat stress on conservation agriculture performance and their combined effect is both non-additive and modified by soil clay content, supporting our second and third hypotheses. Finally, we found only limited support for our fourth hypothesis as (1) increasing nitrogen application rates did not improve the relative performance of conservation agriculture under high heat stress; (2) crop diversification did not notably improve conservation agriculture performance, but did increase its stability with heat stress; and (3) a statistically robust effect of the time since no-till implementation was not evident. Our meta-regression supports the narrative that conservation agriculture enhances the adaptive capacity of maize production in sub-Saharan Africa under drought and/or heat stress. However, in very wet seasons and on clay-rich soils, conservation agriculture yields less compared to conventional practices

An exploratory analysis of planning characteristics in Australian visitor attractions

This paper provides an exploratory analysis of the planning practices of 408 Australian attraction operators. The results indicate that attraction managers can be divided into four categories: those that do not engage in any formal planning, those that adopt a short-term planning approach, those that develop long-term plans, and those that use both short-term and long-term planning approaches. An evaluation of the sophistication of attraction planning showed a bipolar distribution. Attraction managers favored a planning horizon of three or five years, and were inclined to involve their employees in the planning process. Managers relied strongly on their own research and tourism industry intelligence when formulating business plans. The content of plans tended to focus on operational activities, financial planning and marketing. The study provides a benchmark for the comparison of attraction planning efforts in various contexts. © 2006 Asia Pacific Tourism Association