Effectiveness of the Healthy Lifestyles Programme (HeLP) to prevent obesity in UK primary-school children: a cluster randomised controlled trial

This is the final version of the article. Available from Elsevier via the DOI in this record.Background Although childhood overweight and obesity prevalence has increased substantially worldwide in the past three decades, scarce evidence exists for effective preventive strategies. We aimed to establish whether a school-based intervention for children aged 9–10 years would prevent excessive weight gain after 24 months. Methods This pragmatic cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP), a school-based obesity prevention intervention, was done in 32 schools in southwest England. All state-run primary and junior schools in Devon and Plymouth (UK) with enough pupils for at least one year-5 class were eligible. Schools were assigned (1:1) using a computer-generated sequence to either intervention or control, stratified by the number of year-5 classes (one vs more than one) and the proportion of children eligible for free school meals ( < 19% [the national average] vs ≥19%). HeLP was delivered to year-5 children (ages 9–10 years) over 1 year, and included dynamic and interactive activities such as physical activity workshops, education sessions delivered by teachers with short homework tasks, drama sessions, and setting goals to modify behaviour (with parental support and one-to-one discussions with HeLP coordinators). The primary outcome was change in body-mass index (BMI) standard deviation score (SDS) between baseline and 24 months, analysed in children with BMI data available for both timepoints. This study is registered with the International Standard Randomised Controlled Trial register, number ISRCTN15811706, and the trial status is complete. Findings Between March 21, 2012, and Sept 30, 2013, 32 eligible schools with 1324 children were recruited, of which 16 schools (676 children) were randomly assigned to the HeLP intervention and 16 schools (648 children) to control. All schools that began the trial completed the intervention, and 1244 children (628 in intervention group and 616 in control group) had BMI data at both baseline and 24 months for the primary outcome analysis. Mean BMI SDS was 0·32 (SD 1·16) at baseline and 0·35 (1·25) at 24 months in the intervention group, and 0·18 (1·14) at baseline and 0·22 (1·22) at 24 months in the control group. With adjustment for school-level clustering, baseline BMI scores, sex, cohort, and number of year-5 classes and socioeconomic status of each school, the mean difference in BMI SDS score (intervention–control) at 24 months was −0·02 (95% CI −0·09 to 0·05), p=0·57. One parent reported an adverse event related to their child's eating and activity behaviours, but agreed for the child to continue trial participation after discussion with the chief investigator. Interpretation Despite a theoretically informed and extensively piloted intervention that achieved high levels of engagement, follow-up, and fidelity of delivery, we found no effect of the intervention on preventing overweight or obesity. Although schools are an ideal setting in which to deliver population-based interventions, school-based interventions might not be sufficiently intense to affect both the school and the family environment, and hence the weight status of children. Future research should focus on more upstream determinants of obesity and use whole-systems approaches. Funding UK National Institute for Health Research, Public Health Research Programme.UK National Institute for Health Research, Public Health Research Programme

A Mid-Infrared Imaging Survey of Proto-Planetary Nebula Candidates

We present the data from a mid-infrared imaging survey of 66 proto-planetary nebula candidates using two mid-IR cameras (MIRAC2 and Berkcam) at the NASA Infrared Telescope Facility and the United Kingdom Infrared Telescope. The goal of this survey is to determine the size, flux, and morphology of the mid-IR emission regions, which sample the inner regions of the circumstellar dust shells of proto-planetary nebulae. We imaged these proto-planetary nebulae with narrow-band filters ($\Delta\lambda / \lambda \sim 10$) at wavelengths of notable dust features. With our typical angular resolution of 1\arcsec, we resolve 17 sources, find 48 objects unresolved, and do not detect 1 source. For several sources, we checked optical and infrared associations and positions of the sources. In table format, we list the size and flux measurements for all the detected objects and show figures of all the resolved sources. Images for all the detected objects are available on line in FITS format from the Astronomy Digital Image Library at the National Center for Supercomputing Application. The proto-planetary nebula candidate sample includes, in addition to the predominant proto-planetary nebulae, extreme asymptotic giant branch stars, young planetary nebulae, a supergiant, and a luminous blue variable. We find that dust shells which are cooler ($\rm T \sim 150$ K) and brighter in the infrared are more easily resolved. Eleven of the seventeen resolved sources are extended and fall into one of two types of mid-IR morphological classes: core/elliptical or toroidal. Core/elliptical structures show unresolved cores with lower surface brightness elliptical nebulae. Toroidal structures show limb-brightened peaks suggesting equatorial density enhancements. We argue that core/ellipticals have denser dust shells than toroidals.Comment: 32 pages, 5 tables, 2 e/ps figures (fig3 is available through ADIL [see text]), to be published in ApJS May 1999 issu

State trust in middle childhood: an experimental manipulation of maternal support

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Distance travelled : Outcomes and evidence in flexible learning options

Flexible learning options (FLOs) provide individualised learning pathways for disengaged young people with strong emphasis on inclusivity and wellbeing support. Amidst a rapid expansion of Australia’s flexible learning sector, service providers are under increasing pressure to substantiate participant outcomes. This paper stems from a national study of the value of FLOs to young people and the broader Australian community. The study enumerates the outcomes valued by flexible learning practitioners, as well as the various evidence forms they cite to substantiate participant outcomes. Framing success as ‘distance travelled’ (i.e. an individual’s progress relative to his or her own starting point), practitioners demonstrate critical awareness of the social and structural mechanisms by which young people are marginalised from mainstream schooling. Holistic assessment practices also reveal practitioners’ efforts to expand the terms of reference by which educational outcomes may be validated in alternative education settings

The Mid-IR spatially resolved environment of OH26.5+0.6 at maximum luminosity

We present observations of the famous OH/IR star OH26.5+0.6 obtained using the Mid-Infrared Interferometric Instrument MIDI at the European Southern Observatory (ESO) Very Large Telescope Interferometer VLTI. The emission of the dusty envelope, spectrally dispersed at a resolution of 30 from 8 to 13.5 micron, appears resolved by a single dish UT telescope. In particular the angular diameter increases strongly within the silicate absorption band. Moreover an acquisition image taken at 8.7 micron exhibits, after deconvolution, a strong asymmetry. The axis ratio is 0.75+/-0.07 with the FWHM of the major and minor axis which are 286mas and 214mas respectively. The measured PA angle, 95 degrees +/-6 degrees is reminiscent of the asymmetry in the OH maser emission detected at 1612MHz by Bowers & Johnston (1990) for this star. In interferometric mode the UT1-UT3 102m baseline was employed to detect the presence of the star. No fringes have been found with a detection threshold estimated to be of the order of 1% of the total flux of the source, i.e. 5-8 Jy. These observations were carried out during the phase of maximum luminosity of the star, when the dust shell is more diluted and therefore the chance to detect the central source maximized. We modeled the dusty environment based on the work of Justannont et al. (1996). In particular, the failure to detect fringes provides strong constraints on the opacities in the inner regions of the dust shell or in the close vicinity of the star.Comment: Accepted in A&

Children's unique experience of depression: Using a developmental approach to predict variation in symptomatology

<p>Abstract</p> <p>Background</p> <p>Current clinical knowledge suggests that children can have different types of depressive symptoms (irritability and aggression), but presents no theoretical basis for these differences. Using a developmental approach, the present study sought to test the relationship between developmental level (mental age) and expression of depressive symptoms. The primary hypothesis was that as children's mental age increased, so would the number of internalizing symptoms present.</p> <p>Methods</p> <p>Participants were 252 psychiatric inpatients aged 4 to 16 with a diagnosed depressive disorder. All children were diagnosed by trained clinicians using DSM criteria. Patients were predominantly male (61%) with varied ethnic backgrounds (Caucasian 54%; African American 22%; Hispanic 19%; Other 5%). Children were given an IQ test (KBIT or WISC) while within the hospital. Mental age was calculated by using the child's IQ score and chronological age. Four trained raters reviewed children's records for depressive symptoms as defined by the DSM-IV TR. Additionally, a ratio score was calculated to indicate the number of internalizing symptoms to total symptoms.</p> <p>Results</p> <p>Mental age positively correlated (<it>r </it>= .51) with an internalizing total symptom ratio score and delineated between several individual symptoms. Mental age also predicted comorbidity with anxiety and conduct disorders. Children of a low mental age were more likely to be comorbid with conduct disorders, whereas children with a higher mental age presented more often with anxiety disorders. Gender was independently related to depressive symptoms, but minority status interacted with mental age.</p> <p>Conclusion</p> <p>The results of this study indicate that a developmental approach is useful in understanding children's depressive symptoms and has implications for both diagnosis and treatment of depression. If children experience depression differently, it follows that treatment options may also differ from that which is effective in adults.</p

Mechanical compression attenuates normal human bronchial epithelial wound healing

Background: Airway narrowing associated with chronic asthma results in the transmission of injurious compressive forces to the bronchial epithelium and promotes the release of pro-inflammatory mediators and the denudation of the bronchial epithelium. While the individual effects of compression or denudation are well characterized, there is no data to elucidate how these cells respond to the application of mechanical compression in the presence of a compromised epithelial layer. Methods: Accordingly, differentiated normal human bronchial epithelial cells were exposed to one of four conditions: 1) unperturbed control cells, 2) single scrape wound only, 3) static compression (6 hours of 30 cmH(2)O), and 4) 6 hours of static compression after a scrape wound. Following treatment, wound closure rate was recorded, media was assayed for mediator content and the cytoskeletal network was fluorescently labeled. Results: We found that mechanical compression and scrape injury increase TGF-beta 2 and endothelin-1 secretion, while EGF content in the media is attenuated with both injury modes. The application of compression after a pre-existing scrape wound augmented these observations, and also decreased PGE(2) media content. Compression stimulated depolymerization of the actin cytoskeleton and significantly attenuated wound healing. Closure rate was partially restored with the addition of exogenous PGE(2), but not EGF. Conclusion: Our results suggest that mechanical compression reduces the capacity of the bronchial epithelium to close wounds, and is, in part, mediated by PGE(2) and a compromised cytoskeleton

Release of Severe Acute Respiratory Syndrome Coronavirus Nuclear Import Block Enhances Host Transcription in Human Lung Cells

The severe acute respiratory syndrome coronavirus accessory protein ORF6 antagonizes interferon signaling by blocking karyopherin-mediated nuclear import processes. Viral nuclear import antagonists, expressed by several highly pathogenic RNA viruses, likely mediate pleiotropic effects on host gene expression, presumably interfering with transcription factors, cytokines, hormones, and/or signaling cascades that occur in response to infection. By bioinformatic and systems biology approaches, we evaluated the impact of nuclear import antagonism on host expression networks by using human lung epithelial cells infected with either wild-type virus or a mutant that does not express ORF6 protein. Microarray analysis revealed significant changes in differential gene expression, with approximately twice as many upregulated genes in the mutant virus samples by 48 h postinfection, despite identical viral titers. Our data demonstrated that ORF6 protein expression attenuates the activity of numerous karyopherin-dependent host transcription factors (VDR, CREB1, SMAD4, p53, EpasI, and Oct3/4) that are critical for establishing antiviral responses and regulating key host responses during virus infection. Results were confirmed by proteomic and chromatin immunoprecipitation assay analyses and in parallel microarray studies using infected primary human airway epithelial cell cultures. The data strongly support the hypothesis that viral antagonists of nuclear import actively manipulate host responses in specific hierarchical patterns, contributing to the viral pathogenic potential in vivo. Importantly, these studies and modeling approaches not only provide templates for evaluating virus antagonism of nuclear import processes but also can reveal candidate cellular genes and pathways that may significantly influence disease outcomes following severe acute respiratory syndrome coronavirus infection in vivo