Service evaluation of weight outcomes as a function of initial BMI in 34,271 adults referred to a primary care/commercial weight management partnership scheme

Peer reviewedPublisher PD

Classification and identification of Pfiesteria and Pfiesteria-like species.

Dinoflagellates can be classified both botanically and zoologically; however, they are typically put in the botanical division Pyrrhophyta. As a group they appear most related to the protistan ciliates and apicomplexans at the ultrastructure level. Within the Pyrrhophyta are both unarmored and armored forms of the dominant, motile flagellated stage. Unarmored dinoflagellates do not have thecal or wall plates arranged in specific series, whereas armored species have plates that vary in thickness but are specific in number and arrangement. In armored dinoflagellates, the plate pattern and tabulation is a diagnostic character at the family, subfamily, and even genus levels. In most cases, the molecular characterization of dinoflagellates confirms the taxonomy on the basis of external morphology; this has been demonstrated for several groups. Together, both genetic and morphological criteria are becoming increasingly important for the characterization, separation, and identification of dinoflagellates species. Pfiesteria and Pfiesteria-like species are thinly armored forms with motile dinospore stages characterized by their distinct plate formulae. Pfiesteria piscicida is the best-known member of the genus; however, there is at least one other species. Other genetically and morphologically related genera, now grouped under the common names of "Lucy," "Shepherd's crook," and cryptoperidiniopsoid, are being studied and described in separate works. All these other heterotrophic dinoflagellate groups, many of which are thought to be benign, co-occur in estuarine waters where Pfiesteria has been found

Heterologous vaccination regimens with self-amplifying RNA and adenoviral COVID vaccines induce robust immune responses in mice

Several vaccines have demonstrated efficacy against SARS-CoV-2 mediated disease, yet there is limited data on the immune response induced by heterologous vaccination regimens using alternate vaccine modalities. Here, we present a detailed description of the immune response, in mice, following vaccination with a self-amplifying RNA (saRNA) vaccine and an adenoviral vectored vaccine (ChAdOx1 nCoV-19/AZD1222) against SARS-CoV-2. We demonstrate that antibody responses are higher in two-dose heterologous vaccination regimens than single-dose regimens. Neutralising titres after heterologous prime-boost were at least comparable or higher than the titres measured after homologous prime boost vaccination with viral vectors. Importantly, the cellular immune response after a heterologous regimen is dominated by cytotoxic T cells and Th1+ CD4 T cells, which is superior to the response induced in homologous vaccination regimens in mice. These results underpin the need for clinical trials to investigate the immunogenicity of heterologous regimens with alternate vaccine technologies

Governing Artificial Intelligence to benefit the UN Sustainable Development Goals

Big Tech's unregulated roll-out out of experimental AI poses risks to the achievement of the UN Sustainable Development Goals (SDGs), with particular vulnerability for developing countries. The goal of financial inclusion is threatened by the imperfect and ungoverned design and implementation of AI decision-making software making important financial decisions affecting customers. Automated decision-making algorithms have displayed evidence of bias, lack ethical governance, and limit transparency in the basis for their decisions, causing unfair outcomes and amplify unequal access to finance. Poverty reduction and sustainable development targets are risked by Big Tech's potential exploitation of developing countries by using AI to harvest data and profits. Stakeholder progress toward preventing financial crime and corruption is further threatened by potential misuse of AI. In the light of such risks, Big Tech's unscrupulous history means it cannot be trusted to operate without regulatory oversight. The article proposes effective pre-emptive regulatory options to minimize scenarios of AI damaging the SDGs. It explores internationally accepted principles of AI governance, and argues for their implementation as regulatory requirements governing AI developers and coders, with compliance verified through algorithmic auditing. Furthermore, it argues that AI governance frameworks must require a benefit to the SDGs. The article argues that proactively predicting such problems can enable continued AI innovation through well-designed regulations adhering to international principles. It highlights risks of unregulated AI causing harm to human interests, where a public and regulatory backlash may result in over-regulation that could damage the otherwise beneficial development of AI.Qatar National Research Fund, Grant/Award Number: NPRP 11S-1119-17001

The Eat Smart Study: A randomised controlled trial of a reduced carbohydrate versus a low fat diet for weight loss in obese adolescents

Background Despite the recognition of obesity in young people as a key health issue, there is limited evidence to inform health professionals regarding the most appropriate treatment options. The Eat Smart study aims to contribute to the knowledge base of effective dietary strategies for the clinical management of the obese adolescent and examine the cardiometablic effects of a reduced carbohydrate diet versus a low fat diet. Methods and design Eat Smart is a randomised controlled trial and aims to recruit 100 adolescents over a 2½ year period. Families will be invited to participate following referral by their health professional who has recommended weight management. Participants will be overweight as defined by a body mass index (BMI) greater than the 90th percentile, using CDC 2000 growth charts. An accredited 6-week psychological life skills program ‘FRIENDS for Life’, which is designed to provide behaviour change and coping skills will be undertaken prior to volunteers being randomised to group. The intervention arms include a structured reduced carbohydrate or a structured low fat dietary program based on an individualised energy prescription. The intervention will involve a series of dietetic appointments over 24 weeks. The control group will commence the dietary program of their choice after a 12 week period. Outcome measures will be assessed at baseline, week 12 and week 24. The primary outcome measure will be change in BMI z-score. A range of secondary outcome measures including body composition, lipid fractions, inflammatory markers, social and psychological measures will be measured. Discussion The chronic and difficult nature of treating the obese adolescent is increasingly recognised by clinicians and has highlighted the need for research aimed at providing effective intervention strategies, particularly for use in the tertiary setting. A structured reduced carbohydrate approach may provide a dietary pattern that some families will find more sustainable and effective than the conventional low fat dietary approach currently advocated. This study aims to investigate the acceptability and effectiveness of a structured reduced dietary carbohydrate intervention and will compare the outcomes of this approach with a structured low fat eating plan. Trial Registration: The protocol for this study is registered with the International Clinical Trials Registry (ISRCTN49438757)

Lifeworld Inc. : and what to do about it

Can we detect changes in the way that the world turns up as they turn up? This paper makes such an attempt. The first part of the paper argues that a wide-ranging change is occurring in the ontological preconditions of Euro-American cultures, based in reworking what and how an event is produced. Driven by the security – entertainment complex, the aim is to mass produce phenomenological encounter: Lifeworld Inc as I call it. Swimming in a sea of data, such an aim requires the construction of just enough authenticity over and over again. In the second part of the paper, I go on to argue that this new world requires a different kind of social science, one that is experimental in its orientation—just as Lifeworld Inc is—but with a mission to provoke awareness in untoward ways in order to produce new means of association. Only thus, or so I argue, can social science add to the world we are now beginning to live in

A randomised controlled trial to compare a range of commercial or primary care led weight reduction programmes with a minimal intervention control for weight loss in obesity: the Lighten Up trial

<p>Abstract</p> <p>Background</p> <p>Developed countries are facing a huge rise in the prevalence of obesity and its associated chronic medical problems. In the UK Primary Care Trusts are charged with addressing this in the populations they serve, but evidence about the most effective ways of delivering services is not available. The aim of this study is to determine the effectiveness of a range of weight loss programmes for obese patients in primary care and to determine the characteristics of patients who respond to an invitation to a free weight management programme.</p> <p>Methods/Design</p> <p>Lighten Up is a randomised controlled trial comparing a range of 12-week commercial and NHS weight reduction programmes with a comparator group who are provided with 12 vouchers enabling free entrance to a local leisure centre. The weight reduction programmes are: (i) Weight Watchers, (ii) Slimming World, (iii) Rosemary Conley, (iv) a group-based dietetics-led programme (Size Down), (v) general practice one-to-one counselling, (vi) pharmacy-led one-to-one counselling, (vii) choice of any of the 6 programmes. People with obesity or overweight with a co-morbid disorder are invited to take part by a letter from their general practitioner. The sample size is 740 participants.</p> <p>The primary outcome is weight loss at programme-end (3 months). Secondary outcomes are weight-loss at one year, self-reported physical activity at 3 and 12 months follow-up and percentage weight-loss at 3 months and one year.</p> <p>Discussion</p> <p>This trial will provide evidence about the effectiveness of a range of different weight management programmes in a primary care population.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN25072883</p

Unlocking Data to Inform Public Health Policy and Practice: The Report

Background In England, many services that are paid for using taxpayers’ money are decided on and funded by local commissioners such as Local Authorities (LAs) and Clinical Commissioning Groups (CCGs); although, CCGs are set to be replaced by Integrated Care Systems (ICSs) within 2022. LAs are responsible for publicly funded social care (e.g. home-based services) and some public health services (e.g. sexual health services). CCGs are responsible for funding most healthcare services in local areas. All local decision makers aim to fund services for public benefit; for example, promoting and protecting health and preventing ill-health, while ensuring ‘value for money’ for taxpayers. Such services and local decision makers often collect data to inform their processes. This data is used to support the services provided for individuals, but also for administrative reasons. This data could be used more often to help inform improvements to current services and funding of new services, but also to support research by universities. However, as this data could include potentially personal and sensitive information, it is important that it is protected and only shared in circumstances when there is a clear and legal reason that would benefit the public. What did we aim to achieve? We set out to understand: (1) what data is available to local decision makers; (2) how they currently use it; (3) how data can be used and potentially shared with parties who want to use it for public benefit. Furthermore, we aimed to explain how to best use and share data legally with clear reasons for its use. An example would be helping local decision makers calculate which services are considered ‘value for money’ or not, to allow local decision makers to best use money available to them. How did we do it? We first identified examples of when data has been used and legally shared to inform local decision making. We then produced a detailed list of what data these local decision makers have available. These examples and data were discussed with people who work within two LAs and a CCG, within three universities, and members of the public. This allowed us to further explore what is important to consider when using such data to inform local decision making or research purposes, and how the use of such information could be made more transparent and understandable for the public. Patient and the public involvement in the project A lay co-applicant (KS) helped with every aspect of the research project. We additionally set up a public advisory group to advise on the public workshops, interpretation of the findings, and co-design study outputs. What did we discover? Local commissioners are using and sharing data in various ways to benefit the public, such as identifying if certain people may be at-risk of a bad event; for example, older people at-risk of falling who would then require hospital and perhaps social care. However, local commissioners are not always clear in how they report the use of such data, who has control or is using such data, and if any public benefit was ever achieved from recording this data. We attempted to develop an understanding of what data was available for adult social care services. However, we were unable to achieve this aim because of issues to do with the amount of time, effort, and types of staff available within the relevant local commissioners to understand the data available. By discussing the need and use of data with LA and CCG staff, and members of the public, we identified a variety of areas to improve the responsible use of data. One thing discussed was the need for trust and understanding between everyone involved about how and when data is being used, what data is used (for example, if it reflects an individual or group), but also the public benefit of using such data. When analysing data, researchers and local commissioners need to communicate better and come to a joint understanding of how such data can be accessed and used for public benefit. This includes information about what services are considered value for money and who may be paying for what aspects associated with the services across CCGs and LAs, and if there is any chance spending may not remain within budget. Overall, there are ways to responsibly use data which protects the public and could provide public benefit such as treating or avoiding ill-health; however, clearer communication and building trust is needed. How will this research change health and social care? We believe our research could start to change and improve how researchers and local decision makers use locally available data to decide which services to fund to benefit communities. This includes suggested information to be made clearer to the public.</p

The views of young children in the UK about obesity, body size, shape and weight: a systematic review

BACKGROUND: There are high levels of concern about childhood obesity, with obese children being at higher risk of poorer health both in the short and longer terms. Children's attitudes to, and beliefs about, their bodies have also raised concern. Children themselves have a stake in this debate; their perspectives on this issue can inform the ways in which interventions aim to work.This systematic review of qualitative and quantitative research aimed to explore the views of UK children about the meanings of obesity and body size, shape or weight and their own experiences of these issues. METHODS: We conducted sensitive searches of electronic databases and specialist websites, and contacted experts. We included studies published from the start of 1997 which reported the perspectives of UK children aged 4-11 about obesity or body size, shape or weight, and which described key aspects of their methods. Included studies were coded and quality-assessed by two reviewers independently.Findings were synthesised in two analyses: i) an interpretive synthesis of findings from open-ended questions; and ii) an aggregative synthesis of findings from closed questions. We juxtaposed the findings from the two syntheses. The effect of excluding the lowest quality studies was explored. We also consulted young people to explore the credibility of a subset of findings. RESULTS: We included 28 studies. Instead of a focus on health, children emphasised the social impact of body size, describing experiences and awareness of abuse and isolation for children with a greater weight. Body size was seen as under the individual's control and children attributed negative characteristics to overweight people. Children actively assessed their own size; many wished their bodies were different and some were anxious about their shape.Reviewers judged that children's engagement and participation in discussion had only rarely been supported in the included studies, and few study findings had depth or breadth. CONCLUSIONS: Initiatives need to consider the social aspects of obesity, in particular unhelpful beliefs, attitudes and discriminatory behaviours around body size. Researchers and policy-makers should involve children actively and seek their views on appropriate forms of support around this issue