Evidence-Based Programming Within Cooperative Extension: How Can We Maintain Program Fidelity While Adapting to Meet Local Needs?

In this article, we describe how the recent movement towards evidence-based programming has impacted Extension. We review how the emphasis on implementing such programs with strict fidelity to an underlying program model may be at odds with Extension\u27s strong history of adapting programming to meet the unique needs of children, youth, families, and communities. We describe several techniques that Extension professionals can use to balance program fidelity and adaptability. We suggest that Extension stakeholders may be best served when we tailor certain aspects of interventions without changing the intervention\u27s core components that are responsible for positive outcomes

Ariel - Volume 5 Number 5

Editors Mark Dembert J. D. Kanofsky Entertainment Robert Breckenridge Joe Conti Gary Kaskey Photographer Scot Kastner Overseas Editor Mike Sinason Circulation Jay Amsterdam Humorist Jim McCann Staff Ken Jaffe Bob Sklaroff Janet Welsh Dave Jacoby Phil Nimoityn Frank Chervane

Parent-Focused Childhood Obesity Intervention Improves Family Functioning and Children\u27s Well-Being

An Extension-implemented parent-focused childhood obesity intervention designed to improve family functioning around healthful eating and exercise was evaluated. Thirty-six parents and their children, aged 5–13, were randomized to a 12-week intervention condition or control condition. Intervention parents, compared to control group parents, felt more confident in promoting children\u27s healthful eating and exercise, worried less about their children\u27s weight, and engaged in fewer counterproductive parenting behaviors. The children of these parents, as compared to children of control group parents, lost weight and displayed better social-emotional functioning. These results highlight Extension\u27s important role in disseminating evidence-based childhood obesity interventions

Cultural and Contextual Adaptation of a Childhood Obesity Preventive Intervention Program

This article describes the adaptation of a parent-focused evidence-based childhood obesity intervention program for implementation by county-based Extension educators in coordination with school district personnel in rural Pennsylvania. The Lifestyle Positive Parenting Program was designed and evaluated in Australia in clinical settings. Several minor and more serious adaptations, such as featured recipes and content of follow-up telephone calls, were made so that the program would be more appropriate for and appealing to target families. Conceptual issues regarding the adaptation of evidence-based programs are reviewed

Low-Calorie Sweetened Beverage Consumption Does Not Reduce Total Energy or Sugar Intake among Children

Beverages containing low-calories sweeteners (LCSB) are used as alternatives to sugar-sweetened beverages (SSBs), yet their effects on the overall diet and effectiveness for weight management are unclear. The objective of this analysis was to examine energy and macronutrient intake among children who report LCSB and SSB consumption. The findings of this analysis challenge the utility of LCSB consumption as a strategy for weight management in children

A novel formulation of inhaled sodium cromoglicate (PA101) in idiopathic pulmonary fibrosis and chronic cough: a randomised, double-blind, proof-of-concept, phase 2 trial

Background Cough can be a debilitating symptom of idiopathic pulmonary fibrosis (IPF) and is difficult to treat. PA101 is a novel formulation of sodium cromoglicate delivered via a high-efficiency eFlow nebuliser that achieves significantly higher drug deposition in the lung compared with the existing formulations. We aimed to test the efficacy and safety of inhaled PA101 in patients with IPF and chronic cough and, to explore the antitussive mechanism of PA101, patients with chronic idiopathic cough (CIC) were also studied. Methods This pilot, proof-of-concept study consisted of a randomised, double-blind, placebo-controlled trial in patients with IPF and chronic cough and a parallel study of similar design in patients with CIC. Participants with IPF and chronic cough recruited from seven centres in the UK and the Netherlands were randomly assigned (1:1, using a computer-generated randomisation schedule) by site staff to receive PA101 (40 mg) or matching placebo three times a day via oral inhalation for 2 weeks, followed by a 2 week washout, and then crossed over to the other arm. Study participants, investigators, study staff, and the sponsor were masked to group assignment until all participants had completed the study. The primary efficacy endpoint was change from baseline in objective daytime cough frequency (from 24 h acoustic recording, Leicester Cough Monitor). The primary efficacy analysis included all participants who received at least one dose of study drug and had at least one post-baseline efficacy measurement. Safety analysis included all those who took at least one dose of study drug. In the second cohort, participants with CIC were randomly assigned in a study across four centres with similar design and endpoints. The study was registered with ClinicalTrials.gov (NCT02412020) and the EU Clinical Trials Register (EudraCT Number 2014-004025-40) and both cohorts are closed to new participants. Findings Between Feb 13, 2015, and Feb 2, 2016, 24 participants with IPF were randomly assigned to treatment groups. 28 participants with CIC were enrolled during the same period and 27 received study treatment. In patients with IPF, PA101 reduced daytime cough frequency by 31·1% at day 14 compared with placebo; daytime cough frequency decreased from a mean 55 (SD 55) coughs per h at baseline to 39 (29) coughs per h at day 14 following treatment with PA101, versus 51 (37) coughs per h at baseline to 52 (40) cough per h following placebo treatment (ratio of least-squares [LS] means 0·67, 95% CI 0·48–0·94, p=0·0241). By contrast, no treatment benefit for PA101 was observed in the CIC cohort; mean reduction of daytime cough frequency at day 14 for PA101 adjusted for placebo was 6·2% (ratio of LS means 1·27, 0·78–2·06, p=0·31). PA101 was well tolerated in both cohorts. The incidence of adverse events was similar between PA101 and placebo treatments, most adverse events were mild in severity, and no severe adverse events or serious adverse events were reported. Interpretation This study suggests that the mechanism of cough in IPF might be disease specific. Inhaled PA101 could be a treatment option for chronic cough in patients with IPF and warrants further investigation

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Rare coding variants in PLCG2, ABI3, and TREM2 implicate microglial-mediated innate immunity in Alzheimer's disease

We identified rare coding variants associated with Alzheimer’s disease (AD) in a 3-stage case-control study of 85,133 subjects. In stage 1, 34,174 samples were genotyped using a whole-exome microarray. In stage 2, we tested associated variants (P<1×10-4) in 35,962 independent samples using de novo genotyping and imputed genotypes. In stage 3, an additional 14,997 samples were used to test the most significant stage 2 associations (P<5×10-8) using imputed genotypes. We observed 3 novel genome-wide significant (GWS) AD associated non-synonymous variants; a protective variant in PLCG2 (rs72824905/p.P522R, P=5.38×10-10, OR=0.68, MAFcases=0.0059, MAFcontrols=0.0093), a risk variant in ABI3 (rs616338/p.S209F, P=4.56×10-10, OR=1.43, MAFcases=0.011, MAFcontrols=0.008), and a novel GWS variant in TREM2 (rs143332484/p.R62H, P=1.55×10-14, OR=1.67, MAFcases=0.0143, MAFcontrols=0.0089), a known AD susceptibility gene. These protein-coding changes are in genes highly expressed in microglia and highlight an immune-related protein-protein interaction network enriched for previously identified AD risk genes. These genetic findings provide additional evidence that the microglia-mediated innate immune response contributes directly to AD development

Quantifying system disturbance and recovery from historical mining-derived metal contamination at Brotherswater, northwest England

The final publication is available at Springer via https://doi.org/10.1007/s10933-016-9907-1Metal ore extraction in historical times has left a legacy of severe contamination in aquatic ecosystems around the world. In the UK, there are ongoing nationwide surveys of present-day pollution discharged from abandoned mines but few assessments of the magnitude of contamination and impacts that arose during historical metal mining have been made. We report one of the first multi-centennial records of lead (Pb), zinc (Zn) and copper (Cu) fluxes into a lake (Brotherswater, northwest England) from point-sources in its catchment (Hartsop Hall Mine and Hogget Gill processing plant) and calculate basin-scale inventories of those metals. The pre-mining baseline for metal contamination has been established using sediment cores spanning the past 1,500 years and contemporary material obtained through sediment trapping. These data enabled the impact of 250 years of local, small-scale mining (1696 – 1942) to be quantified and an assessment of the trajectory towards system recovery to be made. The geochemical stratigraphy displayed in twelve sediment cores show strong correspondence to the documented history of metal mining and processing in the catchment. The initial onset in 1696 was detected, peak Pb concentrations (>10,000 µg g-1) and flux (39.4 g m-2 y-1) corresponded to the most intensive mining episode (1863-1871) and 20th century technological enhancements were reflected as a more muted sedimentary imprint. After careful evaluation, we used these markers to augment a Bayesian age-depth model of the independent geochronology obtained using radioisotope dating (14C, 210Pb, 137Cs and 241Am). Total inventories of Pb, Zn and Cu for the lake basin during the period of active mining were 15,415 kg, 5,897 kg and 363 kg, respectively. The post-mining trajectories for Pb and Zn project a return to pre-mining levels within 54-128 years for Pb and 75-187 years for Zn, although future remobilisation of metal-enriched catchment soils and floodplain sediments could perturb this recovery. We present a transferable paleolimnological approach that highlights flux-based assessments are vital to accurately establish the baseline, impact and trajectory of mining-derived contamination for a lake catchment