School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analyzing 5926 students (mean age 11.5 years) from five randomized school-based interventions. These studies focused on encouraging students to change their drinking, eating habits and physical activities over the one-school year, with monthly 1-h sessions in the classroom, culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI (body mass index) after one school year of positive changes in behaviors associated with obesity. Estimated mean BMI changed from 19.02 to 19.22 in the control group and from 19.08 to 19.32 in the intervention group (p-value of change over time= 0.09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared to intervention (p-value= 0.05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviors associated with obesity.

In 1857, Henry Box Brown starred in Edward Gascoigne Burton's The Fugitive Free and The Nubian Captive, two “slave dramas” based on his life. His performance inevitably infused both with an antislavery message: in a radical departure from conventional black abolitionist strategies of resistance in the British Isles, the plays change our understanding of British anti-slavery, of Brown, and of black British performance in general. Despite his short acting career, Brown should be placed alongside fellow African American actors like Ira Aldridge for his integral role in challenging the white racial schema on the Victorian stage.

Year-round monitoring of Erebus volcano (Ross Island) has proved challenging due to the difficulties of maintaining continuous power for scientific instruments, especially through the Antarctic winter. We sought a potential solution involving the harvesting of thermal energy dissipated close to the summit crater of the volcano in a zone of diffuse hot gas emissions. We designed, constructed and tested a power generator based on the Seebeck effect, converting thermal energy to electrical power, which could, in principle, be used to run monitoring devices year round. We report here on the design of the generator and the results of an 11 day trial deployment on Erebus volcano in December 2014. The generator produced a mean output power of 270 mW, although we identified some technical issues that had impaired its efficiency. Nevertheless, this is already sufficient power for some monitoring equipment and, with design improvements, such a generator could provide a viable solution to powering a larger suite of instrumentation.

Higher consumption of ‘ultra-processed’ (UP) foods has been linked to adverse health outcomes. The present paper aims to characterise percentage energy from UP foods by participant socio-economic status (SES), diet quality, self-reported food expenditure and energy-adjusted diet cost. Participants in the population-based Seattle Obesity Study III (n 755) conducted in WA in 2016–2017 completed socio-demographic and food expenditure surveys and the FFQ. Education and residential property values were measures of SES. Retail prices of FFQ component foods (n 378) were used to estimate individual-level diet cost. Healthy Eating Index (HEI-2015) and Nutrient Rich Food Index 9.3 (NRF9.3) were measures of diet quality. UP foods were identified following NOVA classification. Multivariable linear regressions were used to test associations between UP foods energy, socio-demographics, two estimates of food spending and diet quality measures. Higher percentage energy from UP foods was associated with higher energy density, lower HEI-2015 and NRF9.3 scores. The bottom decile of diet cost ($216·4/month) was associated with 67·5 % energy from UP foods; the top decile ($369·9/month) was associated with only 48·7 % energy from UP foods. Percentage energy from UP foods was inversely linked to lower food expenditures and diet cost. In multivariate analysis, percentage energy from UP foods was predicted by lower food expenditures, diet cost and education, adjusting for covariates. Percentage energy from UP foods was linked to lower food spending and lower SES. Efforts to reduce UP foods consumption, an increasingly common policy measure, need to take affordability, food expenditures and diet costs into account.

Accurate diagnosis and appropriate treatment of tardive dyskinesia (TD) are imperative, as its symptoms can be highly disruptive to both patients and their caregivers. Misdiagnosis can lead to incorrect interventions with suboptimal or even deleterious results. To aid in the identification and differentiation of TD in the psychiatric practice setting, we review its clinical features and movement phenomenology, as well as those of other antipsychotic-induced movement disorders, with accompanying links to illustrative videos. Exposure to dopamine receptor blocking agents (DRBAs) such as antipsychotics or antiemetics is associated with a spectrum of movement disorders including TD. The differential diagnosis of TD is based on history of DRBA exposure, recent discontinuation or dose reduction of a DRBA, and movement phenomenology. Common diagnostic challenges are the abnormal behaviors and dyskinesias associated with advanced age or chronic mental illness, and other movement disorders associated with DRBA therapy, such as akathisia, parkinsonian tremor, and tremor related to use of mood stabilizing agents (eg, lithium, divalproex). Duration of exposure may help rule out acute drug-induced syndromes such as acute dystonia or acute/subacute akathisia. Another important consideration is the potential for TD to present together with other drug-induced movement disorders (eg, parkinsonism, parkinsonian tremor, and postural tremor from mood stabilizers) in the same patient, which can complicate both diagnosis and management. After documentation of the phenomenology, severity, and distribution of TD movements, treatment options should be reviewed with the patient and caregivers.

The ongoing impact on global mental health of the COVID-19 pandemic and the isolation measures used to combat its spread is increasingly acknowledged. This reflection focuses on the effect the pandemic has had specifically on the mental health of women in the peripartum period, using recent case examples from a busy and diverse south London community perinatal psychiatry service.

The rise of English as a global language has led scholars to call for a paradigm shift in the field of English language teaching (ELT) to match the new sociolinguistic landscape of the twenty-first century. In recent years a considerable amount of classroom-based research and language teacher education (LTE) research has emerged to investigate these proposals in practice. This paper outlines key proposals for change in language teaching from the related fields of World Englishes (WE), English as a lingua franca (ELF), English as an international language (EIL), and Global Englishes, and critically reviews the growing body of pedagogical research conducted within these domains. Adopting the methodology of a systematic review, 58 empirical articles published between 2010 and 2020 were shortlisted, of which 38 were given an in-depth critical review and contextualized within a wider body of literature. Synthesis of classroom research suggests a current lack of longitudinal designs, an underuse of direct measures to explore the effects of classroom interventions, and under-representation of contexts outside of university language classrooms. Synthesis of teacher education research suggests future studies need to adopt more robust methodological designs which measure the effects of Global Englishes content on teacher beliefs and pedagogical practices both before and throughout the programme, and after teachers return to the classroom.

President Donald Trump’s COVID-19 illness, and the treatments he received, raise serious concerns about the adequacy of the Twenty-Fifth Amendment to handle cases of transient presidential incapacity. This is particularly challenging when the president refuses to acknowledge any impairment and resists any attempt to constrain his powers, even temporarily.

Cleaning mutualisms are important interactions on coral reefs. Intraspecific variation in cleaning rate and behaviour occurs geographically and is often attributed to local processes. However, our understanding of fine-scale variation is limited, but would allow us to control for geography and region-specific behavioural patterns. Here, we compare the cleaning activity of Pederson's cleaner shrimp (Ancylomenes pedersoni) on two neighbouring, yet ecologically dissimilar, reef systems in Honduras: Banco Capiro, an offshore bank close to significant land runoff with high coral cover but a depleted fish population, and an oligotrophic fringing reef around the island of Utila, with lower coral cover but high fish abundance and diversity. The proportion of realized to potential fish clientele was <60% at both sites, and the composition of clientele was neither reflective of the demographics of the resident assemblages at each site nor similar between sites. Parrotfishes represented 13–15% of total fish abundance at both sites yet accounted for >50% (Banco Capiro) and 10% (Utila) of all cleans. Conversely, the schoolmaster snapper (Lutjanus apodus) represented ~1% of total fish abundance at both sites yet accounted for 40% (Utila) and 1% (Banco Capiro) of all cleans. After standardizing our cleaning rate data by clientele abundance, we find that clientele at Banco Capiro engage in over four times as many cleaning encounters per hour with A. pedersoni than at Utila. Our study highlights the variable nature of coral reef cleaning interactions and the need to better understand the ecological and environmental drivers of this biogeographic variation.

Background: In spring of 2019, 2 positive sputum cases of Pseudomonas aeruginosa in the cardiac critical care unit (CCU) were reported to the UFHJ infection prevention (IP) department. The initial 2 cases, detected within 3 days of each other, were followed shortly by a third case. Epidemiological evidence was initially consistent with a hospital-acquired infection (HAI): 2 of the 3 patients roomed next to each other, and all 3 patients were ventilated, 2 of whom shared the same respiratory therapist. However, no other changes in routine or equipment were noted. The samples were cultured and processed using Illumina NGS technology, generating 1–2 million short (ie, 250-bp) reads across the P. aeruginosa genome. As an additional positive control, 8 P. aeruginosa NGS data sets, previously shown to be from a single outbreak in a UK facility, were included. Reads were mapped back to a reference sequence, and single-nucleotide polymorphisms (SNPs) between each sample and the reference were extracted. Genetic distances (ie, the number of unshared SNPs) between all UFHJ and UK samples were calculated. Genetic linkage was determined using hierarchical clustering, based on a commonly used threshold of 40 SNPs. All UFHJ patient samples were separated by >18,000 SNPs, indicating genetically distinct samples from separate sources. In contrast, UK samples were separated from each other by <16 SNPs, consistent with genetic linkage and a single outbreak. Furthermore, the UFHJ samples were separated from the UK samples by >17,000 SNPs, indicating a lack of geographical distinction of the UFHJ samples (Fig. 1). These results demonstrated that while the initial epidemiological evidence pointed towards a single HAI, the high-precision and relatively inexpensive (<US$1500) NGS analysis conclusively demonstrated that all 3 CCU P. aeruginosa cases derived from separate origins. The hospital avoided costly and invasive infection prevention interventions in an attempt to track down a single nonexistent source on the CCU, and no further cases were found. This finding supports the conclusion reached from the NGS that this represented a pseudo-outbreak. Furthermore, these genomes serve as an ongoing record of P. aeruginosa infection, providing even higher resolution for future cases. Our study supports the use of NGS technology to develop rational and data-driven strategies. Furthermore, the ability of NGS to discriminate between single-source and multiple-source outbreaks can prevent inaccurate classification and reporting of HAIs, avoiding unnecessary costs and damage to hospital reputations.

Funding: None

Disclosures: Susanna L. Lamers reports salary from BioInfoExperts and contract research for the NIH, the University of California - San Francisco, and UMASS Medical School.