Make Better Choices (MBC): Study design of a randomized controlled trial testing optimal technology-supported change in multiple diet and physical activity risk behaviors

<p>Abstract</p> <p>Background</p> <p>Suboptimal diet and physical inactivity are prevalent, co-occurring chronic disease risk factors, yet little is known about how to maximize multiple risk behavior change. Make Better Choices, a randomized controlled trial, tests competing hypotheses about the optimal way to promote healthy change in four bundled risk behaviors: high saturated fat intake, low fruit and vegetable intake, low physical activity, and high sedentary leisure screen time. The study aim is to determine which combination of two behavior change goals - one dietary, one activity - yields greatest overall healthy lifestyle change.</p> <p>Methods/Design</p> <p>Adults (n = 200) with poor quality diet and sedentary lifestyle will be recruited and screened for study eligibility. Participants will be trained to record their diet and activities onto a personal data assistant, and use it to complete two weeks of baseline. Those who continue to show all four risk behaviors after baseline recording will be randomized to one of four behavior change prescriptions: 1) increase fruits and vegetables and increase physical activity, 2) decrease saturated fat and increase physical activity, 3) increase fruits and vegetable and decrease saturated fat, or 4) decrease saturated fat and decrease sedentary activity. They will use decision support feedback on the personal digital assistant and receive counseling from a coach to alter their diet and activity during a 3-week prescription period when payment is contingent upon meeting behavior change goals. They will continue recording on an intermittent schedule during a 4.5-month maintenance period when payment is not contingent upon goal attainment. The primary outcome is overall healthy lifestyle change, aggregated across all four risk behaviors.</p> <p>Discussion</p> <p>The Make Better Choices trial tests a disseminable lifestyle intervention supported by handheld technology. Findings will fill a gap in knowledge about optimal goal prescription to facilitate simultaneous diet and activity change. Results will shed light on which goal prescription maximizes healthful lifestyle change.</p> <p>Trial Registration</p> <p>Clinical Trials Gov. Identifier NCT00113672</p

An improved estimate for the delta C-13 and delta O-18 signatures of carbon monoxide produced from atmospheric oxidation of volatile organic compounds

Atmospheric carbon monoxide (CO) is a key player in global atmospheric chemistry and a regulated pollutant in urban areas. Oxidation of volatile organic compounds (VOCs) is an important component of the global CO budget and has also been hypothesized to contribute substantially to the summertime urban CO budget. In principle, stable isotopic analysis of CO could constrain the magnitude of this source. However, the isotopic signature of VOC-produced CO has not been well quantified, especially for the oxygen isotopes. We performed measurements of CO stable isotopes on air samples from two sites around Indianapolis, US, over three summers to investigate the isotopic signature of VOC-produced CO. One of the sites is located upwind of the city, allowing us to quantitatively remove the background air signal and isolate the urban CO enhancements. as well as the isotopic signature of these enhancements. In addition, we use measurements of &Delta;14CO2 in combination with the CO:CO2 emission ratio from fossil fuels to constrain the fossil-fuel-derived CO and thereby isolate the VOC-derived component of the CO enhancement. Combining these measurements and analyses, we are able to determine the carbon and oxygen isotopic signatures of CO derived from VOC oxidation as &minus;32.8&permil;&plusmn;0.5&permil; and 3.6&thinsp;&permil;&plusmn;1.2&thinsp;&permil;, respectively. Additionally, we analyzed CO stable isotopes for 1 year at Beech Island, South Carolina, US, a site thought to have large VOC-derived contributions to the summertime CO budget. The Beech Island results are consistent with isotopic signatures of VOC-derived CO determined from the Indianapolis data. This study represents the first direct determination of the isotopic signatures of VOC-derived CO and will allow for improved use of isotopes in constraining the global and regional CO budgets.</p

Humanitarianism, security and the price of compassion : the discursive construction of humanitarian security as an economic, operational and normative imperative for the humanitarian community

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Gender and Racial/Ethnic Disparities in HIV Care and Viral Suppression Before Incarceration

Background: Studies examining the independent influence of gender and race/ethnicity on HIV care engagement among people living with HIV (PLWH) in correctional facilities have found that women and racial/ethnic minorities have a disproportionately low likelihood of accessing HIV treatment and achieving desirable viral load outcomes before incarceration. Few studies have examined the intersection of gender and race/ethnicity in this context, which may mask disparities among some population subsets. Objectives: 1) Jointly assess gender and racial/ethnic disparities in pre-incarceration HIV treatment utilization and viral suppression among jailed PLWH, and 2) evaluate modifiable characteristics accounting for disparities. Methods: The primary exposure was gender by race/ethnicity. Outcomes of interest included linkage to an HIV care provider, ART use, optimal ART adherence, and viral suppression. Potential mediators were classified into conceptual domains according to Andersen’s Behavioral Model of Health Care Utilization. We performed nested multivariable logistic regression analyses to assess differences in the outcomes between each gender-stratified racial/ethnic group and non-Hispanic White men, accounting for potential confounders and mediators. Model 1 accounted for potential confounders, Model 2 accounted for predisposing factors (e.g. homelessness), Model 3 further accounted for enabling resources (e.g. health insurance), and Model 4 further accounted for need factors (e.g. drug abuse severity). We determined whether disparities in the outcome existed based on the results of Model 1. We then assessed the proportion of the disparity explained by potential mediators in Models 2-4. Results: Overall, racial/ethnic minority women had the lowest odds of engaging in care relative to non-Hispanic White men. Non-Hispanic Black women had the greatest odds of lacking an HIV care provider, while Hispanic women had the highest odds of no ART use and the lowest odds of optimal ART adherence. NH Blacks and Hispanic men had the lowest odds of viral suppression. Factors accounting for disparities varied by gender-stratified racial/ethnic group and across outcomes. Conclusions: Study findings offer useful information to plan for the provision of community- and jail-based services for PLWH and the development of more effective, customized HIV interventions. Future research should aim to further clarify modifiable factors accounting for disparities in care utilization and viral suppression

New controls investigated for vine mealybug

The vine mealybug is a newly invasive pest that has spread throughout California's extensive grape-growing regions. Researchers are investigating new control tools to be used in combination with or as an alternative to standard organophosphate insecticide controls. Insect growth regulators and nicotine-based insecticides provide good alternative pesticides for use in some vineyards. Ongoing studies on the augmentative release of natural enemies and mating disruption also show promise, but commercial products are not yet available to growers

Carbon monoxide isotopic measurements in Indianapolis constrain urban source isotopic signatures and support mobile fossil fuel emissions as the dominant wintertime CO source

We present measurements of CO mole fraction and CO stable isotopes (δ13CO and δC18O) in air during the winters of 2013–14 and 2014–15 at tall tower sampling sites in and around Indianapolis, USA. A tower located upwind of the city was used to quantitatively remove the background CO signal, allowing for the first unambiguous isotopic characterization of the urban CO source and yielding 13CO of –27.7 ± 0.5‰ VPDB and C18O of 17.7 ± 1.1‰ VSMOW for this source. We use the tower isotope measurements, results from a limited traffic study, as well as atmospheric reaction rates to examine contributions from different sources to the Indianapolis CO budget. Our results are consistent with earlier findings that traffic emissions are the dominant source, suggesting a contribution of 96% or more to the overall Indianapolis wintertime CO emissions. Our results are also consistent with the hypothesis that emissions from a small fraction of vehicles without functional catalytic systems dominate the Indianapolis CO budget