What Works in a Pediatric Obesity Treatment Program?

Ms. Savoye will present a brief overview of the research and program model of Yale University\u27s Bright Bodies Weight Management Program for Children. She will discuss the components that make the Program unique and successful and include staffing and other operating strategies that have contributed to the sustainability of the treatment model housed throughout the community and operated by the university

An intervention for multiethnic obese parents and overweight children

The purpose of this pilot study was to determine the effects of the addition of coping skills training for obese multiethnic parents whose overweight children were attending a weight management program. At 6 months, parents in the experimental group had significantly lower body mass index (BMI) and body fat percentage (BFP), and higher numbers of pedometer steps compared to the control group. Parents also demonstrated significant improvement in interpersonal relationships, behavior control, and stress management compared to the control group. Children in the experimental group demonstrated trends toward decreased BMI and BFP and increased pedometer steps

Evolution of Endoscopic Lesions in Steroid-Refractory Acute Severe Ulcerative Colitis Responding to Infliximab or Cyclosporine

BACKGROUND/AIMS: Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort. METHODS: Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0. RESULTS: Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS >= 6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p CONCLUSION: In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.Peer reviewe

Hepatic Fat Accumulation Is Modulated by the Interaction between the rs738409 Variant in the PNPLA3 Gene and the Dietary Omega6/Omega3 PUFA Intake

A single nucleotide polymorphism (SNP), the rs738409, in the patatin like phospholipase 3 gene (PNPLA3) has been recently associated with increased hepatic steatosis and ALT levels in adults and children. Given the potential role of PNPLA3 in fatty liver development, we aimed to explore whether the influence of PNPLA3 genotype on hepatic fat in obese youth might be modulated by dietary factors such as essential omega polyunsaturated fatty acids (PUFA) intake.We studied 127 children and adolescents (56 boys, 71 girls; 58 Caucasians; 30 African Americans and 39 Hispanics; mean age 14.7±3.3; mean BMI 30.7±7.2). The dietary composition was assessed by the Nutrition Data System for Research (NDS-R version 2011). The patients underwent a MRI study to assess the liver fat content (HFF%), ALT measurement and the genotyping of the rs738409 SNP by automatic sequencing.As previously observed, HFF% and ALT levels varied according to the genotype in each ethnicity. ALT levels and HFF% were significantly influenced by the interaction between genotype and omega-6/omega-3 PUFA ratio (n-6/n-3), p = 0.003 and p = 0.002, respectively. HFF% and ALT levels were, in fact, related to the n-6/n-3 consumption only in subjects homozygote for the G allele of the rs738409 (r2 = 0.45, p =  0.001 and r2 = 0.40, p = 0.006, respectively).These findings suggest that the association of a high dietary n-6/n-3 PUFA with fatty liver and liver damage in obese youths may be driven by a predisposing genotype

Islands and Memories, Place and Grief

These two papers comprise an example of the written portion of the English department\u27s colloquium comps option. The theme of the colloquium this year was imitation and revision. The first of these papers looks at the way in which the changes in form alter the revisions in the island memory. It analyzes Daniel Defoe\u27s Robinson Crusoe, Elizabeth Bishop\u27s Crusoe in England, and Nadine Gordimer\u27s Friday\u27s Footprint. The second paper explores the way in which formal elegiac structure compares with the inclusion of physical structures within the narratives as exhibited within Mary Jo Bang\u27s The Role of Elegy, E.M. Forster\u27s Howards End, and Yusef Komunyakaa\u27s Facing I

Which psychological method is most effective for group treatment?

Abstract While outcome studies in pediatric obesity have received considerable attention, research on different components of effective interventions remains limited. Little is known which psychological method (i.e., behavior modification, cognitive behavior therapy and family therapy) is most useful or how the choice of program delivery (group/individual) influences the intervention outcomes. Group treatment is of particular interest for two reasons. First, motivation is important for behavior change; in group settings motivation can be increased in two ways: by the group leader and through the interaction with the group participants. Second, group treatment can be more cost-effective than individual approaches (i.e., it requires fewer staff resources and space). This paper aims to comment on the influence of the method choice and delivery in pediatric obesity interventions through discussion of the existing evidence on current programs. In addition, two examples of useful models will be described in more detail: the Yale Bright Bodies Weight Management Program and the Family Weight School. These are outpatients programs both targeting families with severely obese children but through different methodological approaches. Finally, directions for future research will be explored, particularly regarding how the selection of program delivery and psychological method affect treatment outcomes in various populations

Konepajakoneiden riskien arviointi

Opinnäytetyön aiheena oli tehdä IS Works Oy:n käytössä oleville koneille riskien arviointi. Koneille on jo tehty riskien arviointi tehtaan toimesta silloin, kun ne ovat olleet uudet. Käyttöasetus (403/2008) vaatii kuitenkin, että työnantaja varmistaa työntekijöidensä koneiden ja työvälineiden riittävän turvallisuuden. Koneiden riskien arvioinnilla saadaan hyvin selville koneiden turvallisuustaso. Työn teoriaosuudessa käydään läpi oleellisimmat asetukset ja standardit, mitkä vaikuttavat koneturvallisuuteen ja riskien arviointiin. Koneturvallisuusosiossa käydään läpi oleellisimmat riskitekijät koneissa. Lisäksi käydään läpi, mitä koneilta vaaditaan, jotta niiden turvallisuustaso olisi hyväksyttävällä tasolla. Teoriaosuuden lopussa perehdytään riskien arvioinnin tekoon ja mitä vaatimuksia siihen liittyy. Käytännön osuudessa kerrotaan konepajan nykytilanne ja esitellään riskiarvioitavat koneet. Riskien arvioinnin tulokset kerrottiin ja esitettiin työnantajalle. Työstä oli hyötyä tilaajayritykselle, koska he saivat tietää koneidensa nykyisen turvallisuustason. Tarvittavat toimenpiteet riskin arvioinnin perusteella jää IS Works Oy:n toimeenpantavaksi.Theme of this thesis was to make the risk assessment of IS Works Ltd machines. The machine risk assessments have already been made by the factory when they were new. Government decree on the safe use and inspection of work equipment (403/2008), however, requires the employer to ensure that employees’ machines and tools are safe. Machinery risk assessment is a good tool to ensure the safety of machines. The theoretical part consists of the most essential regulations and standards which affect machine safety and risk assessment. Safety of machinery section goes through the most relevant risk factors for machines. In addition, section goes through what from machines are required that their safety would be at acceptable level. The end of the theoretical part introduces risk assessment act and the requirements it entails. Practical part describes the current situation and presents the machines to be risk assessed. The risk assessment results were communicated and presented to the employer. The work was bound to benefit local company, as they learned about the current safety of their machines. IS Works Ltd will do the necessary actions based on the risk assesment

Cost-Effectiveness and Long-Term Savings of the Bright Bodies Intervention for Childhood Obesity

OBJECTIVE: To estimate the cost and cost-effectiveness of Bright Bodies, a high-intensity, family-based intervention demonstrated to improve BMI among children with obesity in a randomized controlled trial. METHODS: We developed a microsimulation model to project 10-year BMI trajectories of 8-16 year-old children with obesity using data from National Longitudinal Surveys and Centers for Disease Control and Prevention growth charts and validated the model using data from the Bright Bodies trial and a follow-up study. We used the trial data to estimate the average reduction in BMI per person-year over 10 years and the incremental costs of Bright Bodies, compared with traditional clinical weight management (control), from a health system perspective in 2020 US dollars. Using results from studies of Medical Expenditure Panel Survey data, we projected long-term obesity-related medical expenditure. RESULTS: In the primary analysis, assuming depreciating effects post-intervention, Bright Bodies is expected to achieve an average reduction in BMI of 1.67 kg/m (95% Uncertainty Interval: 1.43-1.94) per person-year over 10 years compared with control. The incremental intervention cost of Bright Bodies was $360 ($292-$421) per person compared with the clinical control. However, savings in obesity-related health care expenditure offset these costs and the expected cost-savings of Bright Bodies is$1,126 ($689-$1,693) per person over 10-years. The projected time to achieving cost savings compared with clinical control was 3.58 (2.63-5.17) years. CONCLUSIONS: While resource-intensive, our findings suggest Bright Bodies is cost-saving compared with clinical control by averting future obesity-related health care costs among children with obesity