Parents understanding of vitamin D requirements, and the use of fortified foods

One in four toddlers are not achieving the recommended vitamin D intake crucial for their healthy development(1, 2). This study explored parents’ acceptability of factors affecting purchasing of foods and drinks fortified with Vitamin D in children aged 0-2 years old. A total of 194 parents completed an online parent questionnaire. Focus groups and interviews were used to explore in depth perceptions of vitamin D fortification. Thirteen participants participated in the 5 focus groups, 5 completed interviews. The majority of participants were female (mothers) and of White-British ethnic background, aged between 25-40 years, with 89% of the sample with a level 3 qualification (e.g. 2 or more A levels, NVQ level 3). Basic descriptive statistics were calculated from the questionnaire data and a thematic analysis methodology was applied to the qualitative data. The findings indicated low purchasing of vitamin D fortified foods/drinks by parents (21% of the sample). The foods/drinks most purchased were cereal, yogurts and alternative milks. Willingness to purchase certain products fortified with vitamin D to increase their child’s vitamin D was however high. After excluding formula milk, parents would be willing to buy yogurt, yogurt drinks, cereals, milk-based drinks, fruit juice and margarine. The table outlines parents’ views on the facilitators and barriers to purchasing vitamin D fortified foods and drinks. There is a potential for fortified foods to play a role in increasing the intake of vitamin D intake. Parents need quality education explaining the need to prevent vitamin D deficiency, though fortified products. Products also need to be suitable for babies and toddlers; better labelled, lower cost; with healthy options available with lower sugar and salt content, tasty, longer shelf life and better availability in local shops and supermarkets. Future research should determine if consumption of fortified foods/drinks alone rather than supplementation is sufficient to meet children’s daily intake of vitamin D(3)

Assessing Ozone-Related Health Impacts under a Changing Climate

Climate change may increase the frequency and intensity of ozone episodes in future summers in the United States. However, only recently have models become available that can assess the impact of climate change on O(3) concentrations and health effects at regional and local scales that are relevant to adaptive planning. We developed and applied an integrated modeling framework to assess potential O(3)-related health impacts in future decades under a changing climate. The National Aeronautics and Space Administration–Goddard Institute for Space Studies global climate model at 4° × 5° resolution was linked to the Penn State/National Center for Atmospheric Research Mesoscale Model 5 and the Community Multiscale Air Quality atmospheric chemistry model at 36 km horizontal grid resolution to simulate hourly regional meteorology and O(3) in five summers of the 2050s decade across the 31-county New York metropolitan region. We assessed changes in O(3)-related impacts on summer mortality resulting from climate change alone and with climate change superimposed on changes in O(3) precursor emissions and population growth. Considering climate change alone, there was a median 4.5% increase in O(3)-related acute mortality across the 31 counties. Incorporating O(3) precursor emission increases along with climate change yielded similar results. When population growth was factored into the projections, absolute impacts increased substantially. Counties with the highest percent increases in projected O(3) mortality spread beyond the urban core into less densely populated suburban counties. This modeling framework provides a potentially useful new tool for assessing the health risks of climate change

Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use Disorders in Title X Facilities: Assessing Barriers, Change of Provider Behavior, and Patient Outcomes

Introduction: Substance use disorders, specifically opioids, are an increasing problem in the US. Screening, brief intervention, and referral to treatment (SBIRT) is a method to identify and treat patients at risk, or currently using illicit substances. Integrating SBIRT into Title X facilities, which provide reproductive healthcare to lower income populations, may allow identification and treatment of individuals that do not seek healthcare elsewhere. Objective: We aim to assess the efficacy of a longitudinal training program in Title X facilities. The program provides a structured approach to implementing new protocols, including an educational session on SBIRT and motivational interviewing (MI). Methods: We conducted a trial of assessments during the first of two cohorts to determine their value as assessments for learner outcomes based on SBIRT/MI training. One assessment measured SBIRT/MI knowledge, while the other measured attitudes about substance users. Data was collected using electronic forms with personalized and de-identified codes. Results: 3 of 35 providers responded, representing 3 of 5 facilities. All respondents thought the assessments were ‘Very relevant’ to their training, the knowledge assessment was ‘Appropriately difficult’ (mean score of 8/10 ± 1), and the training program improved their skills to identify and address patients with concerns of substance use. Conclusion: Despite limitations, results suggest the knowledge and attitude assessments were appropriate for our population. In the second cohort, we will conduct pre- and post-testing. These measures will be used to assess the efficacy of training, as well as compare the attitude outcomes with values in the literature

Comparison of school day eating behaviours of 8–11 year old children from Adelaide, South Australia, and London, England

Abstract: Objective: School food intake makes a considerable contribution to children’s overall diet, especially fruit and vegetable intake. Comparing differing school food provision systems can provide novel insights for intervention and improved nutrition policy. This study compared school day food in children from Australia and England. Design: Children completed food frequency questionnaires reporting school day food intake, breakfast intake and family evening meals. Differences in school day food intake consumed between Australia and England were evaluated. Multinomial logistic regressions compared fruit and vegetable intake, family dinner frequency and breakfast in Australian and English children adjusting for confounders: Age, sex, ethnicity and parent education. Setting: 27 Primary schools in Adelaide, Australia and 32 in London, England. Subjects: N = 772 children aged 8–11 years from the Australian REACH study (n = 347) and UK RHS School Gardening Trial in England (n = 425). Results: Considerably more English children reported consuming vegetables at school than Australian children (recess/lunchtime Australian children 3.4/6.1%; English children recess/lunctime 3.6/51.1%). However, Australian children were more likely to consume vegetables daily (OR = 4.1; 1.3, 12.5), and have family evening meals everyday [OR = 4.01; 1.88, 8.55], and were less likely to consume breakfast (OR = 0.26; 0.08, 0.79) than English children. Conclusions: Findings indicate that provision of a school lunch meal, compared to a packed lunch from home, may be more supportive of children’s vegetable intake. However, without a supportive home environment that encourages vegetable intake, children will not be able to consume sufficient amounts of vegetables

Evaluation of the impact of a school gardening intervention on children's fruit and vegetable intake: a randomised controlled trial.

Background: Current academic literature suggests that school gardening programmes can provide an interactive environment with the potential to change children’s fruit and vegetable intake. This is the first cluster randomised controlled trial (RCT) designed to evaluate whether a school gardening programme can have an effect on children’s fruit and vegetable intake. Methods: The trial included children from 23 schools; these schools were randomised into two groups, one to receive the Royal Horticultural Society (RHS)-led intervention and the other to receive the less involved Teacher-led intervention. A 24-hour food diary (CADET) was used to collect baseline and follow-up dietary intake 18 months apart. Questionnaires were also administered to evaluate the intervention implementation. Results: A total of 641 children completed the trial with a mean age of 8.1 years (95% CI: 8.0, 8.4). The unadjusted results from multilevel regression analysis revealed that for combined daily fruit and vegetable intake the Teacher-led group had a higher daily mean change of 8 g (95% CI: −19, 36) compared to the RHS-led group -32 g (95% CI: −60, −3). However, after adjusting for possible confounders this difference was not significant (intervention effect: −40 g, 95% CI: −88, 1; p = 0.06). The adjusted analysis of process measures identified that if schools improved their gardening score by 3 levels (a measure of school gardening involvement - the scale has 6 levels from 0 ‘no garden’ to 5 ‘community involvement’), irrespective of group allocation, children had, on average, a daily increase of 81 g of fruit and vegetable intake (95% CI: 0, 163; p = 0.05) compared to schools that had no change in gardening score. Conclusions: This study is the first cluster randomised controlled trial designed to evaluate a school gardening intervention. The results have found very little evidence to support the claims that school gardening alone can improve children’s daily fruit and vegetable intake. However, when a gardening intervention is implemented at a high level within the school it may improve children’s daily fruit and vegetable intake by a portion. Improving children’s fruit and vegetable intake remains a challenging task

Measures of low food variety and poor dietary quality in a cross-sectional study of London school children.

BACKGROUND/OBJECTIVES: The use of simple screening tools to measure nutritional adequacy in a public health context in developed countries are currently lacking. We explore the relationship between food variety and nutrient intake of London school children using a simple tool with potential use for screening for inadequate diets. SUBJECTS/METHODS: A cross-sectional survey was carried out in 2010. The survey included 2579 children aged 7-10 years in 52 primary schools in East London in the United Kingdom. The analysis included 2392 children (93% of the original sample). Food variety was assessed as the total number of listed foods recorded over 24 h using the validated Child and Diet Assessment Tool (CADET) comprising 115 listed foods divided into 16 food categories. Dietary quality was determined by the proportion of children meeting recommended intakes of individual micronutrients, namely, calcium, iron, zinc, folate, vitamin A and vitamin C. RESULTS: The mean number of CADET-listed foods consumed daily by children was 17.1 (95% CI: 16.8, 17.5). Children who consumed fewer than 11 foods on the collection day had particularly low nutrient intakes. Children consuming three different vegetables and two different fruits on average consumed 19-20 listed foods. It was estimated between 4 and 20% of children did not meet the recommended levels for individual micronutrients during the period of data collection. CONCLUSIONS: A simple method using food counts to assess daily food variety may help public health nutritionists identify groups of children at risk of inadequate diets

Brief for American Association on Mental Retardation, The Arc of the United States, the Judge David L. Bazelon Center for Mental Health Law, The Arc of Georgia, and the Georgia Advocacy Office, Stripling v. Head

Pursuant to Rule 37.2(b) of the Rules of this Court, The Arc of the United States, el al., move the Court for leave to file a Brief Amici Curiae in support of the petition in the above-entitled case. Counsel for Petitioner has granted his consent to the filing of this brief. Counsel for Respondent, however, has notified counsel for amici that Respondent does not consent. Amici include national and state professional and voluntary associations concerned with criminA1 proceedings affecting people with mental disabilities. Amici thus have expertise concerning criminal defendants with mental disabilities and the impediments to fair judicial processes which will result if those defendants are required to prove their mental retardation beyond a reasonable doubt. Amici wish to offer the Court relevant information on the historical development of the beyond a reasonable doubt standard, and why it cannot be applied to a defendant\u27s effort to invoke the constitutional protection of Atkins v. Virginia, 536 U.S. 304 (2002). Amici also wish to present information on contemporary practices and standards when the State imposes a burden of persuasion on defendants with mental retardation who may face execution. Amici believe that the Georgia statute, providing that crimi1:!a1 defendants must prove their mental retardation beyond a reasonable doubt to invoke the protections of Atkins, impermissibly obstructs the fair adjudication of such constitutional claims. For the above-stated reasons, we respectfully urge the Court to grant this motion for leave to file the accompanying brief in the present case in support of the petition for certiorari

Measuring diet in primary school children aged 8-11 years: validation of the Child and Diet Evaluation Tool (CADET) with an emphasis on fruit and vegetable intake.

Background/Objectives:The Child And Diet Evaluation Tool (CADET) is a 24-h food diary that measures the nutrition intake of children aged 3-7 years, with a focus on fruit and vegetable consumption. Until now CADET has not been used to measure nutrient intake of children aged 8-11 years. To ensure that newly assigned portion sizes for this older age group were valid, participants were asked to complete the CADET diary (the school and home food diary) concurrently with a 1-day weighed record. Subjects/Methods:A total of 67 children with a mean age of 9.3 years (s.d.: ± 1.4, 51% girls) participated in the study. Total fruit and vegetable intake in grams and other nutrients were extracted to compare the mean intakes from the CADET diary and Weighed record using t-tests and Pearson's r correlations. Bland-Altman analysis was also conducted to assess the agreement between the two methods. Results: Correlations comparing the CADET diary to the weighed record were high for fruit, vegetables and combined fruit and vegetables (r=0.7). The results from the Bland-Altman plots revealed a mean difference of 54 g (95% confidence interval: -88, 152) for combined fruit and vegetables intake. CADET is the only tool recommended by the National Obesity Observatory that has been validated in a UK population and provides nutrient level data on children's diets. Conclusions:The results from this study conclude that CADET can provide high-quality nutrient data suitable for evaluating intervention studies now for children aged 3-11 years with a focus on fruit and vegetable intake

The Leeway of Shipping Containers at Different Immersion Levels

The leeway of 20-foot containers in typical distress conditions is established through field experiments in a Norwegian fjord and in open-ocean conditions off the coast of France with wind speed ranging from calm to 14 m/s. The experimental setup is described in detail and certain recommendations given for experiments on objects of this size. The results are compared with the leeway of a scaled-down container before the full set of measured leeway characteristics are compared with a semi-analytical model of immersed containers. Our results are broadly consistent with the semi-analytical model, but the model is found to be sensitive to choice of drag coefficient and makes no estimate of the cross-wind leeway of containers. We extend the results from the semi-analytical immersion model by extrapolating the observed leeway divergence and estimates of the experimental uncertainty to various realistic immersion levels. The sensitivity of these leeway estimates at different immersion levels are tested using a stochastic trajectory model. Search areas are found to be sensitive to the exact immersion levels, the choice of drag coefficient and somewhat less sensitive to the inclusion of leeway divergence. We further compare the search areas thus found with a range of trajectories estimated using the semi-analytical model with only perturbations to the immersion level. We find that the search areas calculated without estimates of crosswind leeway and its uncertainty will grossly underestimate the rate of expansion of the search areas. We recommend that stochastic trajectory models of container drift should account for these uncertainties by generating search areas for different immersion levels and with the uncertainties in crosswind and downwind leeway reported from our field experiments.Comment: 25 pages, 11 figures and 5 tables; Ocean Dynamics, Special Issue on Advances in Search and Rescue at Sea (2012

Avoid, Delay, Shorten. Results of Radiation Oncology’s COVID19 Patient Exposure Risk Mitigation Guidelines

We implemented evidence-based COVID19 guidelines on 3/16/20 to minimize patient exposure risks by avoiding, delaying, and shortening patient treatments when possible. We analyzed the effectiveness of our COVID guidelines by comparing the number of new patient starts and number of treatments before and after implementation. Our department successfully decreased patient exposure risk by reducing new prescription starts, rates of longer treatment courses, and overall number of treatment encounters in an evidence-based approach