A cluster randomised controlled trial of the efficacy of a brief walking intervention delivered in primary care : study protocol

Background: The aim of the present research is to conduct a fully powered explanatory trial to evaluate the efficacy of a brief self-regulation intervention to increase walking. The intervention will be delivered in primary care by practice nurses (PNs) and Healthcare Assistants (HCAs) to patients for whom increasing physical activity is a particular priority. The intervention has previously demonstrated efficacy with a volunteer population, and subsequently went through an iterative process of refinement in primary care, to maximise acceptability to both providers and recipients. Methods/ Design: This two arm cluster randomised controlled trial set in UK general practices will compare two strategies for increasing walking, assessed by pedometer, over six months. Patients attending practices randomised to the self-regulation intervention arm will receive an intervention consisting of behaviour change techniques designed to increase walking self-efficacy (confidence in ability to perform the behaviour), and to help people translate their “good” intentions into behaviour change by making plans. Patients attending practices randomised to the information provision arm will receive written materials promoting walking, and a short unstructured discussion about increasing their walking. The trial will recruit 20 PN/HCAs (10 per arm), who will be trained by the research team to deliver the selfregulation intervention or information provision control intervention, to 400 patients registered at their practices (20 patients per PN/HCA). This will provide 85% power to detect a mean difference of five minutes/day walking between the self-regulation intervention group and the information provision control group. Secondary outcomes include health services costs, and intervention effects in sub-groups defined by age, ethnicity, gender, socioeconomic status, and clinical condition. A mediation analysis will investigate the extent to which changes in constructs specified by the Theory of Planned Behaviour lead to changes in objectively assessed walking behaviour. Discussion: This trial addresses the current lack of evidence for interventions that are effective at increasing walking and that can be offered to patients in primary care. The intervention being evaluated has demonstrated efficacy, and has been through an extensive process of adaptation to ensure acceptability to both provider and recipient, thus optimising fidelity of intervention delivery and treatment receipt. It therefore provides a strong test of the hypothesis that a self-regulation intervention can help primary care patients increase their walking

Effects of Fuel Reduction Treatments on Surface Fire Behavior in Juniper Woodland Ecosystems

Juniper (Juniperus spp.) woodlands are native but expanding ecological communities that were historically limited by the natural fire return interval of the sagebrush (Artemisia spp.) steppe. These woodlands are often a mix of pinyon pine (Pinus spp.) and juniper that have increased significantly over the last century. This expansion has lengthened the fire return intervals and has resulted in a decrease in understory vegetation, leading to a shift in fuel sources from the surface to the crowns of the trees. This is a concern for sagebrush conservation and the conservation of sagebrush-associated wildlife species. Fuel reduction treatments are being performed throughout the Great Basin in an attempt to limit the expansion of juniper woodlands and potentially reduce fire risk. The treatments focused on in this study are prescribed fire, mechanical (cut and drop of the trees), and untreated control. I used existing field data from a 10 year experiment paired with the Fuel and Fire Tools fire behavior modeling program to determine how treatments impacted potential surface fire behavior in juniper woodlands. Treatments shifted post-treatment surface fuel loads towards increased herbaceous and shrub cover when compared to the pre-treatment data. Prescribed fire and mechanical treatment both significantly impacted modeled fire behavior metrics: rate of spread (ROS; m/min), reaction intensity (RI; kW m-2 min-1), and flame length (FL; m). Prescribed fire increased the rate of spread by 25 fold, tripled the flame length, and increased reaction intensity by 30.5% in fully cured plots from year 0 (pre-treatment) to year 10 following treatment. Rate of spread increased by 15 fold, flame length by 3.8 fold, and reaction intensity roughly doubled in fully cured mechanical treatment plots in year 10 compared to pretreatment and to control. This has important management implications - prescribed fire and mechanical treatments in juniper woodlands are likely to both increase herbaceous vegetation as well as increase fire behavior, indicating potential tradeoffs between desired vegetation and wildfire risk.Key words: Pinyon-juniper woodlands, prescribed fire, fuel treatments, woodland expansion, sagebrush restoration, rangeland managemen

Apoptosis Gene Hunting Using Retroviral Expression Cloning: Identification of Vacuolar ATPase Subunit E

Over the past 10-15 years there has been an explosion of interest in apoptosis. The delayed realisation that cell death is an essential part of life for any multicellular organism has meant that, despite the recent and rapid developments of the last decade, the precise biochemical pathways involved in apoptosis remain incomplete and potentially novel genes may, as yet, remain undiscovered. The hunt is therefore on to bridge the remaining gaps in our knowledge. Our contribution to this research effort utilises a functional cloning approach to isolate important regulatory genes involved in apoptosis. This mini-review focuses on the use and advantages of a retroviral expression cloning strategy and describes the isolation and identification of one such potential apoptosis regulatory gene, namely that encoding vacuolar ATPase subunit E

Recent results in the decoding of Algebraic geometry codes

Objectives: The aim of this study was to examine the relationships between perceived teacher autonomy support versus control and students’ life skills development in PE, and whether students’ basic need satisfaction and frustration mediated these relationships. Design: Cross-sectional study. Method: English and Irish students (N = 407, Mage = 13.71, SD = 1.23) completed measures assessing perceived autonomy-supportive and controlling teaching, basic need satisfaction and frustration (autonomy, competence, and relatedness), and life skills development in PE (teamwork, goal setting, social skills, problem solving and decision making, emotional skills, leadership, time management, and interpersonal communication). Results: On the bright side of Self-Determination Theory (SDT), correlations revealed that perceived teacher autonomy support was positively associated with students’ basic need satisfaction and life skills development in PE. On the dark side of SDT, perceived controlling teaching was positively related to students’ basic need frustration, but not significantly related to their life skills development. Mediational analyses revealed that autonomy and relatedness satisfaction mediated the relationships between perceived teacher autonomy support and students’ development of all eight life skills. Competence satisfaction mediated the relationships between perceived teacher autonomy support and students’ development of teamwork, goal setting, and leadership skills. Conclusions: Our findings indicate that satisfaction of the needs for autonomy, competence, and relatedness are important mechanisms that in part explain the relationships between perceived teacher autonomy support and life skills development in PE. Therefore, teachers may look to promote students’ perceptions of an autonomy-supportive climate that satisfies their three basic needs and helps to develop their life skills

The effects of acute wild blueberry supplementation on the cognition of 7-10 year old schoolchildren

Purpose: Previous evidence suggests consumption of flavonoids, a sub-class of polyphenols, is associated with improved cognitive function across the lifespan. In particular, acute intervention of a flavonoid-rich wild blueberry (WBB) drink has been shown to boost executive function (EF), short-term memory and mood 2-6 h post-consumption in 7-10 yr old children. However, confirmation of the aspects of EF and memory susceptible to WBB ingestion is required, particularly during childhood, a critical period of neurological development. In addition, the child literature on berry-flavonoid supplementation and cognition highlights the potential for such interventions to elicit positive benefits to real world educational scenarios, such as reading; a complex ability which relies upon aspects of cognition already known to improve following WBB. Methods: Here we examined which aspects of EF and memory are susceptible to acute WBB, as well as investigating whether acute WBB could further benefit reading ability. Fifty-four healthy children, aged 7-10 yrs, consumed a 200ml WBB drink (253mg anthocyanins) or a matched placebo according to a randomised, single-blind, parallel groups design. Verbal memory (Auditory Verbal Learning Task; AVLT), EF (Modified Attention Network Task; MANT), and reading efficiency (Test of Word Reading Efficiency-2; TOWRE-2) were assessed at baseline and 2 h post consumption. Results: For the MANT, significantly quicker RTs were observed for WBB participants when compared to placebo participants on 120 ms trials, without cost to accuracy. Furthermore, WBB participants showed enhanced verbal memory performance on the AVLT, recalling more words than placebo participants on short delay and memory acquisition measures post-consumption. Despite these significant improvements in cognitive performance, no significant effects were observed for reading measures. Conclusion: Consumption of WBB was found to significantly improve memory and attentional aspects of EF. This indicates that a flavonoid-rich blueberry product, equivalent to 240 g or 1½ cups of fresh blueberries can provide acute cognitive benefits in children. These findings support accumulating evidence that flavonoid-rich products are beneficial for healthy brain function, particularly during critical developmental periods. However, the lack of findings relating to reading ability suggested acute WBB may not be sufficient to elicit benefits to reading. Chronic supplementation and other more sensitive reading measures should be considered for examining the effects of WBB on such a complex skill in the future

Transdermal Blood Sampling for C-peptide Is a Minimally Invasive, Reliable Alternative to Venous Sampling in Children and Adults With Type 1 Diabetes

OBJECTIVE:C-peptide and islet autoantibodies are key type 1 diabetes biomarkers, typically requiring venous sampling, which limits their utility. We assessed transdermal capillary blood (TCB) collection as a practical alternative.RESEARCH DESIGN AND METHODS:Ninety-one individuals (71 with type 1 diabetes, 20 controls; individuals with type 1 diabetes: aged median 14.8 years [interquartile range (IQR) 9.1–17.1], diabetes duration 4.0 years [1.5–7.7]; controls: 42.2 years [38.0–52.1]) underwent contemporaneous venous and TCB sampling for measurement of plasma C-peptide. Participants with type 1 diabetes also provided venous serum and plasma, and TCB plasma for measurement of autoantibodies to glutamate decarboxylase, islet antigen-2, and zinc transporter 8. The ability of TCB plasma to detect significant endogenous insulin secretion (venous C-peptide ≥200 pmol/L) was compared along with agreement in levels, using Bland-Altman. Venous serum was compared with venous and TCB plasma for detection of autoantibodies, using established thresholds. Acceptability was assessed by age-appropriate questionnaire.RESULTS:Transdermal sampling took a mean of 2.35 min (SD 1.49). Median sample volume was 50 µL (IQR 40–50) with 3 of 91 (3.3%) failures, and 13 of 88 (14.7%) <35 µL. TCB C-peptide showed good agreement with venous plasma (mean venous ln[C-peptide] – TCB ln[C-peptide] = 0.008, 95% CI [−0.23, 0.29], with 100% [36 of 36] sensitivity/100% [50 of 50] specificity to detect venous C-peptide ≥200 pmol/L). Where venous serum in multiple autoantibody positive TCB plasma agreed in 22 of 32 (sensitivity 69%), comparative specificity was 35 of 36 (97%). TCB was preferred to venous sampling (type 1 diabetes: 63% vs. 7%; 30% undecided).CONCLUSIONS:Transdermal capillary testing for C-peptide is a sensitive, specific, and acceptable alternative to venous sampling; TCB sampling for islet autoantibodies needs further assessment

Autoantibodies to truncated GAD(96-585) antigen stratify risk of early insulin requirement in adult-onset diabetes

We investigated whether characterisation of full-length (f-)GADA responses could identify early insulin requirement in adult-onset diabetes. In 179 f-GADA positive participants diagnosed with type 2 diabetes, we assessed associations of truncated (t-)GADA positivity, f-GADA IgG subclasses, and f-GADA affinity with early insulin requirement (<5 years), type 1 diabetes genetic risk score (T1D GRS), and C-peptide. t-GADA positivity was lower in f-GADA positive without early insulin in comparison to f-GADA positive type 2 diabetes requiring insulin within 5 years, and type 1 diabetes (75% vs. 91% and 95% respectively, p<0.0001). t-GADA positivity (in those f-GADA positive) identified a group with a higher type 1 diabetes genetic susceptibility (mean T1D GRS 0.248 vs. 0.225, p=0.003), lower C-peptide (1156 pmol/L vs. 4289 pmol/L, p=1x10-7), and increased IA-2A positivity (23% vs. 6%, p=0.03). In survival analysis, t-GADA positivity was associated with early insulin requirement compared with those only positive for f-GADA, independently from age of diagnosis, f-GADA titre and duration of diabetes [adjusted HR 5.7 (95% CI 1.4, 23.5), p=0.017]. The testing of t-GADA in f-GADA positive individuals with type 2 diabetes identifies those who have genetic and clinical characteristics comparable to type 1 diabetes and stratifies those at higher risk of early insulin requirement