Free healthy breakfasts in primary schools: A cluster randomised controlled trial of a policy intervention in Wales, UK

Objective: The present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK. Design: A cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour. Setting: Primary schools in nine local education authority areas. Subjects: A total of 4350 students (aged 9–11 years) at baseline and 4472 at follow-up in 111 schools. Results: Students in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other significant differences were found. Conclusions: The intervention did not reduce breakfast skipping; rather, pupils substituted breakfast at home for breakfast at school. However, there were improvements in children’s nutritional intake at breakfast time, if not the rest of the day, and more positive attitudes to breakfast, which may have implications for life-course dietary behaviours. There was no impact on episodic memory or classroom behaviour, which may require targeting breakfast skippers

Optimizing medication management for patients with cirrhosis: Evidence‐based strategies and their outcomes

Cirrhosis is a morbid condition associated with frequent hospitalizations and high mortality. Management of cirrhosis requires complex medication regimens to treat underlying liver disease, complications of cirrhosis and comorbid conditions. This review examines the complexities of medication management in cirrhosis, barriers to optimal medication use, and potential interventions to streamline medication regimens and avoid medication errors. A literature review was performed by searching PUBMED through December 2017 and article reference lists to identify articles relevant to medication management, complications, adherence, and interventions to improve medication use in cirrhosis. The structural barriers in cirrhosis include sheer medication complexity related to the number of medications and potential for cognitive impairment in this population, faulty medication reconciliation and limited adherence. Tested interventions have included patient self‐education, provider driven patient education, intensive case management including medication blister packs and smartphone applications. Initiatives are needed to improve patient, caregiver and provider education on appropriate use of medications in patients with cirrhosis. A multidisciplinary team should be established to coordinate care with close monitoring, address patient and caregiver concerns, and to provide timely access to outpatient evaluation of urgent/complex issues. Future studies evaluating the clinical outcomes and cost effectiveness of interventions are needed.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146454/1/liv13892_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146454/2/liv13892.pd

Frailty, Psychoactive Medications, and Cognitive Dysfunction Are Associated With Poor Patient‐Reported Outcomes in Cirrhosis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148384/1/hep30336-sup-0001-Supinfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148384/2/hep30336_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148384/3/hep30336.pd

Acceptance and use of a smartphone application in cirrhosis

Background and AimsThe development of cirrhosis‐related smartphone applications for remote monitoring is increasing. Whether patients with cirrhosis will welcome such new technology, however, is uncertain.MethodsWe prospectively enrolled patients with cirrhosis (N = 102) to determine predictors of acceptance and utilization of a smartphone application for cirrhosis management using a 12‐item Technology Acceptance Model (TAM) survey. Patients were then shown the EncephalApp© and evaluated for their willingness to download and use the application.ResultsPatients had a median age of 61.3 years and 63.7% had a history of hepatic decompensation. Intention to use the hypothetical application was associated with perceived usefulness (β: 0.4, 95% CI: 0.3‐0.5) and the presence of a caregiver (β: 1.1, 95% CI: 0.2‐2.0). Of the eligible participants, 71% agreed to download the EncephalApp© and the decision was influenced by computer anxiety, behavioural intent, caregiver presence and disease state factors. Actual usage was 32% and not associated with baseline characteristics or the technology acceptance model.ConclusionsPatient acceptance of smartphone applications for the management of cirrhosis is high and related to their attitudes towards technology and the presence of a caregiver. However, usage was low. Future research must employ behavioural interventions to optimize uptake and utilization of remote monitoring technology.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155977/1/liv14494_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155977/2/liv14494.pd

As old as the hills: Pliocene palaeogeographical processes influence patterns of genetic structure in the widespread, common shrub Banksia sessilis

The impact of Quaternary glaciation on the development of phylogeographic structure in plant species is well documented. In unglaciated landscapes, phylogeographic patterns tend to reflect processes relating to persistence and stochasticity, yet other factors, associated with the palaeogeographical history of the landscape, including geomorphological events, can also have a significant influence. The unglaciated landscape of south‐western Western Australia is an ideal location to observe these ancient drivers of lineage diversification, with tectonic activity associated with the Darling Fault in the late Pliocene attributed to patterns of deep phylogeographic divergence in a widespread tree from this region. Interestingly, other species within this region have not shown this pattern and this palaeogeographical boundary therefore presents an opportunity to examine age and historical distribution of plant species endemic to this region. In this study, we assess patterns of genetic diversity and structure across 28 populations of the widespread shrub Banksia sessilis using three cpDNA markers and nine nuclear microsatellite markers. Sixteen cpDNA haplotypes were identified, comprising two major chloroplast DNA lineages that are estimated to have diverged in the Pliocene, approximately 3.3 million years ago. This timing coincides with major geomorphological processes in the landscape, including the separation of the Darling Plateau from the adjacent Swan Coastal Plain, as well as eustatic changes on the Swan Coastal Plain that are likely to have resulted in the physical isolation of historical plant lineages. Chloroplast lineages were broadly aligned with populations associated with older lateritic soils of the Darling Plateau and Geraldton sandplains or the younger sandy soils associated with the Swan Coastal Plain and Southern Coastline. This structural pattern of lateritic versus non‐lateritic division was not observed in the nuclear microsatellite data that identified three genetic clades that roughly corresponded to populations in the North, South, and Central portions of the distributions

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Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142921/1/hep29806_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142921/2/hep29806.pd

Restraint, disinhibition and food-related processing bias

This study examined associations between restraint, disinhibition and food-related processing bias (FPB, assessed by the emotional Stroop task) in males and females in the UK, Greece and Iran. Results showed high restraint was associated with higher FPB. However, high restrained current dieters showed lower FPB that high restrained non-dieters. There was no significant difference in FPB for those showing high versus low disinhibition. Results are discussed in relation to theories of incentive salience and current concerns

Data Acquisition and Presentation in Scanning Nuclear Microprobe Analysis

The data acquisition is a very important part of the scanning nuclear microprobe instrument. To make full use of the potential of the technique an adequate system for acquiring, storing, processing and presenting the data is a prerequisite. Various principles applied are presented including the list mode approach, which facilitates flexible off-line data processing. As in the case of the electron probe the beam-induced effects in the sample may be substantial and the list mode acquisition can then also be used to monitor and correct for any such effects. A comprehensive system for scanning nuclear microprobe control and data acquisition, based on a combination of a VMEbus computer system and a μVax-II computer, is described in some detail