Healthy eating and lifestyle in pregnancy (HELP): a cluster randomised trial to evaluate the effectiveness of a weight management intervention for pregnant women with obesity on weight at 12 months postpartum

Objective: To assess whether a weight management intervention for pregnant women with obesity was effective in reducing body mass index (BMI) 12 months after giving birth. Methods: Pragmatic, cluster randomised controlled trial (RCT) with embedded cost-effectiveness analysis. 598 women with a BMI of ≥30 kg/m2 (between 12 and 20 weeks gestation) were recruited from 20 secondary care maternity units in England and Wales. BMI at 12 months postpartum was the primary outcome. A range of clinical and behavioural secondary outcomes were examined. Interventions: Women attending maternity units randomised to intervention were invited to a weekly weight management group, which combined expertise from a commercial weight loss programme with clinical advice from midwives. Both intervention and control participants received usual care and leaflets on diet and physical activity in pregnancy. Results: Mean (SD) BMI at 12 months postpartum was 36.0 kg/m2 (5.2) in the control group, and 37.5 kg/m2 (6.7) in the intervention group. After adjustment for baseline BMI, the intervention effect was −0.02 (95% CI −0.04 to 0.01). The intervention group had an improved healthy eating score (3.08, 95% CI 0.16 to 6.00, p < 0.04), improved fibre score (3.22, 1.07 to 5.37, p < 0.01) and lower levels of risky drinking at 12 months postpartum compared to the control group (OR 0.45, 0.27 to 0.74, p < 0.002). The net incremental monetary benefit was not statistically significantly different between arms, although the probability of the intervention being cost-effective was above 60%, at policy-relevant thresholds. Conclusions: There was no significant difference between groups on the primary outcome of BMI at 12 months. Analyses of secondary outcomes indicated improved healthy eating and lower levels of risky drinking. Trial registration: Current Controlled Trials ISRCTN25260464

Recent Progress and Next Steps for the MATHUSLA LLP Detector

We report on recent progress and next steps in the design of the proposed MATHUSLA Long Lived Particle (LLP) detector for the HL-LHC as part of the Snowmass 2021 process. Our understanding of backgrounds has greatly improved, aided by detailed simulation studies, and significant R&D has been performed on designing the scintillator detectors and understanding their performance. The collaboration is on track to complete a Technical Design Report, and there are many opportunities for interested new members to contribute towards the goal of designing and constructing MATHUSLA in time for HL-LHC collisions, which would increase the sensitivity to a large variety of highly motivated LLP signals by orders of magnitude.Comment: Contribution to Snowmass 2021 (EF09, EF10, IF6, IF9), 18 pages, 12 figures. v2: included additional endorser

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

El juego como facilitador para lograr aprendizajes significativos

Tesis (Educadora de Párvulos, Licenciado en Educación)El juego es una de las actividades más importantes de todo niño, porque además de satisfacer las necesidades lúdicas de los párvulos, favorece su ubicación en el ambiente y su captación de la realidad que lo circunda. Así también, estamos conscientes de que existen muchas formas de aprender, unas más apropiadas que otras, pero sin lugar a dudas el juego debe constituir el principal instrumento de aprendizaje, ya que, por medio de esta los niños experimentan la vida y comparten con otros; por tanto el aprendizaje es más efectivo y duradero cuando parte del mundo y las experiencias de los niños. Sin embargo, a través de las prácticas realizadas a lo largo de nuestra formación universitaria, hemos podido percibir, que a pesar de ser el juego lo que caracteriza a la infancia, generalmente sólo se limita a los momentos de esparcimiento de los niños, excluyéndolo del quehacer pedagógico. Es por ello y considerando todo lo anteriormente planteado, que nace la necesidad de abordar el juego infantil, sus diferentes tipos y características; así como también indagar respecto a la concepción constructivista y su postura respecto al aprendizaje significativo, el cual se caracteriza por ser funcional, ya que se reconocen los conocimientos anteriores y se aplican al enfrentarse y establecer relaciones con conocimientos nuevos. Por tanto será significativo en la medida en que se le asignen significado a todas las experiencias previas que el individuo trae, para que así se produzca una interacción dinámica entre lo que se conoce y lo nuevo por conocer. De esta manera se incentiva que el niño construya su propia red de conocimiento sobre la base de sus propias experiencias y de la interacción con otros. Así se está aprendiendo con sentido de manera pertinente, entre la relación de lo nuevo con lo que ya sabe. Esto y más es lo que abordaremos a continuación, dejamos por tanto la invitación a seguir viendo nuestro seminario

Macroeconomic effects of the minimum wage in Colombia

Utilizando enfoques de equilibrio parcial y equilibrio general, se estudian a fondo los efectos del salario mínimo en la macroeconomía colombiana. Con el primer enfoque, se analizan efectos en variables del mercado laboral, distribución de ingresos, desigualdad, pobreza monetaria de las familias, precios e inflación. Con el enfoque de equilibrio general se estudian los efectos en consumo, bienestar, producción, inversión, inflación y cuentas fiscales del gobierno. Según la evidencia, el salario mínimo tiene efectos negativos en casi todas las variables estudiadas, no permite un funcionamiento fluido del mercado laboral y no está cumpliendo con sus objetivos de contribuir a reducir la desigualdad y la pobreza. Se sugiere el rediseño de la implementación del salario mínimo en Colombia y de la forma como estamos capacitando nuestra mano de obra para elevar su productividad, de suerte que podamos llevar el salario mínimo en relación con el salario mediano de la economía, hoy en el 90%, a un nivel similar al de los países de la OECD, cercano al 50%.Using partial equilibrium and general equilibrium approaches, the effects of the minimum wage on the Colombian macroeconomy are thoroughly studied. With the first approach, the article analyzes the effects on variables of the labor market, income distribution, inequality, monetary poverty of families, prices, and inflation. With the general equilibrium approach, we study the effects on consumption, welfare, production, investment, inflation, and government fiscal accounts. According to the evidence, the minimum wage has negative effects on almost all the variables studied, it does not allow a fluid functioning of the labor market, and it is not fulfilling its objectives of contributing to reducing inequality and poverty. The redesign of the implementation of the minimum wage in Colombia and the way in which we are training our workforce to raise its productivity is suggested, so that we can bring the minimum wage in relation to the median wage of the economy, nowadays about 90 %, at a level similar to that of the OECD countries, close to 50%."Enfoque Al finalizar cada año, el país sigue un protocolo de negociación que conduce, por la vía del acuerdo entre las partes o, a falta de este, por decisión gubernamental, al aumento del salario mínimo. Pese a que se tiene evidencia de sus efectos adversos en el mercado laboral (empleo formal, desempleo e informalidad laboral), los incrementos suelen ser altos, con los argumentos de que un salario mínimo alto estimula la demanda agregada y tiene efectos redistributivos, sobre lo cual no se tiene mucha evidencia. Este documento estudia a fondo los efectos macroeconómicos del salario mínimo en Colombia. Utiliza enfoques de equilibrio parcial –y microdatos– para establecer su efecto en los flujos del mercado laboral (creación y destrucción de puestos de trabajo; contratación y separación de trabajadores) y el empleo formal, en la distribución de ingresos de los trabajadores y las familias, en desigualdad y pobreza monetaria de los hogares. Con este enfoque, también se provee evidencia sobre el efecto en los precios de bienes y servicios, en la inflación básica y en la inflación total.

Early Risks of Death, Stroke/Systemic Embolism, and Major Bleeding in Patients With Newly Diagnosed Atrial Fibrillation Results From the GARFIELD-AF Registry

BACKGROUND: Atrial fibrillation is associated with increased risks of death, stroke/systemic embolism, and bleeding (incurred by antithrombotic therapy), which may occur early after diagnosis