Childhood and Adolescent Obesity: Related Comorbidities and Interventions

Background The prevalence of childhood and adolescent obesity in the United States has steadily risen over the years and has become a public health concern. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. Obese children and adolescents are at risk for poor health and poor quality of life. Furthermore, there are numerous comorbidities associated with childhood and adolescent obesity. While some of the associated diseases are acute, others can become chronic and result in lifelong conditions. Objective The purpose of the present thesis is to explore and summarize the currently available literature regarding diseases that relate to childhood and adolescent obesity, factors that can affect obesity, and possibly effective prevention methods. Summary of Findings Children and adolescents who are obese are likely to have various comorbidities. Some of these comorbidities include increased risk for hypertension, obstructive sleep apnea, and other cardiometabolic risk factors. Due to obesity and related comorbidities, children and adolescents have poorer physical and mental health. Some of the mental health deficits seen in obese children include depression, learning disabilities, and attention deficit disorder. Research has shown that food environments and sleep duration can be factors in obesity in children. Proposal The gathered information will then be utilized to formulate a proposal on how nurses across school settings can play a direct role in the prevention of exacerbation of obesity and comorbidities associated with childhood and adolescent obesity

Piloting a workflow for extracting author citations from Samuel Johnson's Dictionary of the English Language

Since the 18th century, English-language dictionaries have used quo- tations from written works to illustrate a word's use in context. These quotations form a link between language authority and literary authority. In this paper we pilot a workflow for identifying, extracting, and counting author citations in Samuel Johnson's Dictionary of the English Language to investigate how au- thors in a defined corpus are represented. We consider how these authors are distributed across the text and compare our results to past studies that used dif- ferent methodologies. We find a consistency that encourages the broader appli- cation of our workflow on other dictionary texts, enabling further study of au- thor citations in dictionaries across time

Addressing Hidden Imperfections in Online Experimentation

Technology companies are increasingly using randomized controlled trials (RCTs) as part of their development process. Despite having fine control over engineering systems and data instrumentation, these RCTs can still be imperfectly executed. In fact, online experimentation suffers from many of the same biases seen in biomedical RCTs including opt-in and user activity bias, selection bias, non-compliance with the treatment, and more generally, challenges in the ability to test the question of interest. The result of these imperfections can lead to a bias in the estimated causal effect, a loss in statistical power, an attenuation of the effect, or even a need to reframe the question that can be answered. This paper aims to make practitioners of experimentation more aware of imperfections in technology-industry RCTs, which can be hidden throughout the engineering stack or in the design process.Comment: Presented at CODE@MIT 202

Success rates of re-excision after positive margins for invasive lobular carcinoma of the breast.

Rates of positive margins after surgical resection of invasive lobular carcinoma (ILC) are high (ranging from 18 to 60%), yet the efficacy of re-excision lumpReceptor subtypeectomy for clearing positive margins is unknown. Concerns about the diffuse nature of ILC may drive increased rates of completion mastectomy to treat positive margins, thus lowering breast conservation rates. We therefore determined the success rate of re-excision lumpectomy in women with ILC and positive margins after surgical resection. We identified 314 cases of stage I-III ILC treated with breast conserving surgery (BCS) at the University of California, San Francisco. Surgical procedures, pathology reports, and outcomes were analyzed using univariate and multivariate statistics and Cox-proportional hazards models. We evaluated outcomes before and after the year 2014, when new margin management consensus guidelines were published. Positive initial margins occurred in 118 (37.6%) cases. Of these, 62 (52.5%) underwent re-excision lumpectomy, which cleared the margin in 74.2%. On multivariate analysis, node negativity was significantly associated with successful re-excision (odds ratio [OR] 3.99, 95% CI 1.15-13.81, p = 0.029). After 2014, we saw fewer initial positive margins (42.7% versus 25.5%, p = 0.009), second surgeries (54.6% versus 20.2%, p < 0.001), and completion mastectomies (27.7% versus 4.5%, p < 0.001). In this large cohort of women with ILC, re-excision lumpectomy was highly successful at clearing positive margins. Additionally, positive margins and completion mastectomy rates significantly decreased over time. These findings highlight improvements in management of ILC, and suggest that completion mastectomy may not be required for those with positive margins after initial BCS

Advancing Accessibility Research in Kinesiology: A Mixed-Methods Case Study of One Survey Website

While some studies in kinesiology have investigated the accessibility of educational material and electronic applications used to promote physical activity (eg, ease to perceive/navigate content resources), few studies report on the accessibility of survey tools before their use in research. PURPOSE: The purpose of this study was to measure the accessibility of one survey website to a study directly investigating comprehension of mock physical activity promotion material created by Thomas et al. (2023). METHODS: The website was for study participants to complete an online version of a cloze form (for a visual, see Nielsen, 2011; eg, see Cardinal et al., 1995). The accessibility check, done before the research website launched, had two phases: (1) a valid and reliable quantitative accessibility rating form was administered by the research team (Jul - Aug 2022, Wu et al. 2022a & 2022b) and (2) after edits were made based on the rating form findings, a pilot test of the website survey instruments was done with mock end users (Feb - Mar 2023). Mock end users (n = 12) were volunteers from the first author’s research lab and were invited to give qualitative feedback on the site’s usability before leaving the website (eg, on webpage/site navigation, on instruction clarity). Ten gave website feedback. The analytic plan was to (1) identify descriptive trends in the mock end user feedback (2) relate feedback trends to rating form criteria scores with unanimous consensus, as a measure of similarity between the two study findings (ie, Phase 1 vs 2). RESULTS: Phase 1 data analysis suggested each webpage fully met accessibility standards in 7 subareas (eg, plain language use, clear navigation). Phase 2 analysis supported most conclusions derived from rating form results (eg, clear instructions & layout), but challenged others (eg, cloze form was somewhat accessible because website platform, Canvas, required scrolling once finished, not due to missing frequently asked questions page). Pilot test showed text at a lower reading level (before edits) had lower comprehension, but text at a higher level had good validity. CONCLUSION: Our results evidenced the rating form could ensure websites have adequate accessibility. Findings also underscored significance of pilot testing research instruments with mock end users outside the research team

Teaching Current and Future Professionals Techniques for Lay Communication: Validation Study of Published Training Material

Thomas et al. (2023), developed two mock physical activity promotion (PAP) material, which university students (and others) could practice critiquing and revising using the suitability assessment of materials (SAM) protocol. Their objective, however, was to produce mock material at two reading grade levels (11th & 8th RGL), meaning they did not compute suitability scores for other sub/main areas (eg, font size, literacy demand, respectively). PURPOSE: The purpose of the present study was to (1) establish trustworthy baseline data in other SAM sub/main areas for students to compare their own scores to (2) compare mock material SAM scores to one another and published research trends (3) interpret the results using our pilot research directly investigating lay adult comprehension of the mock material, using the cloze procedure (Cardinal et al., 1995). METHODS: An expert coder (JDT) rated the mock material to establish valid scores, using an adapted SAM protocol (Thomas et al., 2020). Intra-rater reliability (JDT) was assessed using a three-day grace period, test-retest method (statistical test: Krippendorff’s alpha, k-α). Suitability scores were compared to contemporary trend data (Thomas et al., 2022). RESULTS: Rater reliability was almost perfect (11th RGL, k-α = .889; 8th RGL, k-α = .907). The mock material suitability was overall adequate (11th RGL = 55.88%, 8th RGL = 67.60%). The materials differed in three main areas (eg, literacy demand & learning stimulation), with suitability greater for the 8th RGL material. Both material had three main areas with the same suitability judgments as the published trend data. The 8th RGL material had more subareas with scores equal to, or greater than, the trend data. CONCLUSION: Findings suggest the 8th RGL material had greater suitability than the 11th RGL, and better mirrored PAP material trend data. This suggests PAP material in circulation may be adequately understood by lay adults in non-stressful situations. Our pilot test showed the reverse, however. The 11th RGL material had greater comprehension before the 8th RGL material was revised using the cloze procedure (SAM scores were equivalent for the original & revised draft). We produced valid/reliable SAM scores for the mock material, and further evidenced the need to directly investigate PAP material comprehension

Accessibility Rating Form for Websites and Other Online Platforms

Background. This file provides a coding form developed to judge how accessible websites and other online platforms are to users. Accessibility may be defined as the ease to which a person can perceive content and navigate material (Ross & Ross, 2021). Users are encouraged to adapt this form for their use. Purpose. The rating form can be used to judge the pages of online media, using 14 criteria under two areas: Accessible Media and Accessible Design. One of three grades could be assigned to each criterion: Not Accessible (0 point), Somewhat Accessible (1 point), Accessible (2 points), adapted from published research by Wallace et al. (2010). Initially, this form was developed to rate the website created using the Learning Management System platform, Canvas (Instructure, n.d.), which was adapted as a research survey website. Form validity and reliability. This form was based on guidelines for accessible websites, provided from the World Wide Web Consortium (Zahra, 2019). This form was found to have excellent rater agreement within a preliminary study, which was presented at the 2022 Southwest Chapter Conference Meeting of the American College of Sports Medicine (October 28-29, Costa Mesa, California). The intraclass coefficient statistic was used (four raters, M = .91, LL = .82, UL = .94; Landers, 2015). Results were interpreted using Cicchetti’s (1994) interpretive cut-points. Further detail is reported in the published abstract to the study’s presentation (Wu et al., in press)

Evaluating Research Survey Websites in Kinesiology: A Case Study Using An Accessibility Rating Form

Advancing equity in the research and educational practice of kinesiology requires intentional efforts to ensure access divides do not widen nor persist (Ross et al., in press, JOPERD). PURPOSE: Given knowledge of suitability assessment of materials (SAM) principles supports the equitable design of lay print and online material, we evaluated the extent they would also support developing a research survey website consistent with accessibility guidelines for digital technology. METHODS: The study website was adapted from the Canvas learning management system. A cross-sectional formative assessment was performed. Using their knowledge of SAM principles (eg, clear layout, text ≤ 8th grade reading level), the second and third author (JDT, RFH) constructed the website webpages (eg, site welcome page, online questionnaire; Jun.-Jul. 2022). The first author (YSW), using guidelines from two reputable sources (ie, a Canvas tutorial and W3C website), developed a 14-item accessibility rating form to critically appraise the website’s 10 webpages (ie, 1 = Not Accessible, 2 = Somewhat Accessible, 3 = Accessible; Wallace et al., 2010, JPAH). Authors 1-4 then performed a formative assessment of the adapted Canvas websites’ accessibility independently (Jul.-Aug. 2022). Form reliability was assessed using the intraclass correlation coefficient and its interpretive cut-points for average absolute-rater agreement (Cicchetti, 1994, Psych Assess; Landers, 2015, Winnower). RESULTS: Average rater agreement was excellent per webpage (M = .91, LL = .82, UL = .94). Mean webpage score ranged between 2.55 (±0.78) to 2.77 (±0.58). Informational pages (eg, welcome page) had greater accessibility than interactive pages (eg, forms). Five discrepant items were systematic, resulting in redundant rater differences (eg, keyboard navigation was hard to notice). All discrepancies were resolved with 100% consensus. CONCLUSION: The findings of the present study suggest knowledge of SAM principles ensures developers can design lay friendly and accessible research survey websites. They further suggest rating forms inclusive of digital accessibility guidelines should be used as a supplement to further meet accessibility and equity goals. We will share our form, then discuss our results using the universal design for learning framework

Developing an Asthma Self-management Intervention Through a Web-Based Design Workshop for People With Limited Health Literacy:User-Centered Design Approach

BACKGROUND: Technology, including mobile apps, has the potential to support self-management of long-term conditions and can be tailored to enhance adoption. We developed an app to support asthma self-management among people with limited health literacy in a web-based workshop (to ensure physical distancing during the COVID-19 pandemic). OBJECTIVE: The aim of this study is to develop and test a prototype asthma self-management mobile app tailored to the needs of people with limited health literacy through a web-based workshop. METHODS: We recruited participants from a primary care center in Malaysia. We adapted a design sprint methodology to a web-based workshop in five stages over 1 week. Patients with asthma and limited health literacy provided insights into real-life self-management issues in stage 1, which informed mobile app development in stages 2-4. We recruited additional patients to test the prototype in stage 5 using a qualitative research design. Participants gave feedback through a concurrent thinking-aloud process moderated by a researcher. Each interview lasted approximately 1 hour. Screen recordings of app browsing activities were performed. Interviews were audio-recorded and analyzed using a thematic approach to identify utility and usability issues. RESULTS: The stakeholder discussion identified four themes: individual, family, friends, and society and system levels. Five patients tested the prototype. Participants described 4 ways in which the app influenced or supported self-management (utility): offering information, providing access to an asthma action plan, motivating control of asthma through support for medication adherence, and supporting behavior change through a reward system. Specific usability issues addressed navigation, comprehension, and layout. CONCLUSIONS: This study proved that it was possible to adapt the design sprint workshop to a web-based format with the added advantage that it allowed the development and the testing process to be done efficiently through various programs. The resultant app incorporated advice from stakeholders, including sources for information about asthma, medication and appointment reminders, accessible asthma action plans, and sources for social support. The app is now ready to move to feasibility testing