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The aim of the study was to assess the impact of different lunchbox messages on parents’ intention to pack a healthy lunchbox.
This study employed an experimental design.
A series of messages were developed to align with the six constructs of the Health Belief Model. Messages were also developed that were (and were not) personalised and varied based on the source of the information provided (university, school, dietitian and health promotion service). During a telephone survey, participants were read the content of each message and asked about their intention to pack a healthy lunchbox.
Parents of primary school-aged children were randomised to receive different messages to encourage the packing of healthy lunchboxes.
The study was completed by 511 parents. Linear mixed regression analyses identified significant differences (P < 0·05) in intention scores between variant messages targeting the same behavioural constructs for ‘susceptibility’, ‘severity’, ‘benefits’ and ‘barriers’ but not ‘cues to action’ or ‘self-efficacy’. The highest mean behavioural intention score was for ‘benefits’, whilst the lowest mean score was for ‘barriers’. There were no significant differences in intention scores of parents receiving messages from a dietitian, university, health promotion team or school (P = 0·37). Intention scores did not differ in which messages were personalised based on child’s name (P = 0·84) or grade level (P = 0·54).
The findings suggest that messages that focus on the benefits of packing healthy lunchboxes may be particularly useful in improving intentions of parents to pack healthy foods for their children to consume at school.
SARS-CoV-2 has been implicated in the largest recorded coronavirus outbreak to date. Initially, most COVID-19 cases were in China, but the virus has spread to more than 184 countries worldwide, and the United States currently has more cases than any other country.
With person-to-person spread expanding in the United States, we describe hospital preparedness for managing suspected and confirmed COVID-19 patients.
Cross-sectional survey focused on various elements of respiratory disease preparedness.
Critical access hospitals (CAHs) and acute-care hospitals (ACHs) in Idaho.
The electronic survey was sent to infection preventionists (IPs) and nurse administrators in 44 hospitals in Idaho.
Overall, 32 (73%) hospitals responded to the survey. Participating facilities reported their preparedness with respect to existing, formalized structures for managing infectious disease incidents—specifically COVID-19—as well as availability of resources, such as isolation rooms and personal protective equipment, for safely managing suspected and confirmed COVID-19 cases.
Hospitals covered by the survey had varying levels of preparedness for managing COVID-19 cases, with differences across the various categories of interest in this study. Although the study reveals strengths, including in application of emergency management and infection control frameworks, it also suggests that other areas, such as consistent implementation of federal guidelines and requirements for infection prevention, are potential areas for strengthening preparedness for SARS-CoV-2 and other respiratory pathogens with pandemic potential.
Polymer solutions are often injected in porous media for applications such as oil recovery and groundwater remediation. As the fluid navigates the tortuous pore space, elastic stresses build up, causing the flow to become unstable at sufficiently large injection rates. However, it is poorly understood how the spatial and temporal characteristics of this unstable flow depend on pore space geometry, which can vary widely between different porous media. We investigate this dependence by systematically varying the spacing between pore constrictions in a one-dimensional ordered array. We find that when the pore spacing is large, unstable eddies form upstream of each constriction, similar to observations of an isolated constriction. By contrast, when the pore spacing is sufficiently small, the flow in the different pores exhibits a surprising bistability, stochastically switching between two distinct unstable flow states. We hypothesize that this unusual behaviour arises from the interplay between elongation and relaxation of polymers as they are advected through the pore space. Consistent with this idea, we find that the flow state in a given pore persists for long times; moreover, flow states are strongly correlated between neighbouring pores. Thus, the characteristics of unstable flow are not determined just by injection conditions and the geometry of the individual pores, but also depend on the spacing between pores. Ultimately, these results help to elucidate the rich array of behaviours that can arise in polymer solution flow through porous media.
Beginning with loose aggregations of dust particles coated with heterogeneous ices under vacuum at Kuiper Belt temperatures, moving to Jupiter/Saturn distances and eventually to low-perihelion orbit, we consider the likely development of the gaseous phase within a cometary nucleus over the course of its lifetime. From the perspective of physical chemistry, we consider limits on the spatial and temporal distribution and composition of this gaseous phase. The implications of the gaseous phase for heat transfer and for the possible spatial and temporal development of liquid phases are calculated. We conclude that the likely temperatures, pressures, and compositions beneath the outer crust of typical cometary nuclei are such that fluidised phases can exist at significant depths and that these reservoirs give a coherent explanation for the high-intensity outbursts observed from cometary nuclei at large distances from perihelion.
The present study describes the energy content of primary-school children’s lunchboxes and the proportion of lunchbox foods considered discretionary. Subgroup analyses by sex, socio-economic status, age and weight status were undertaken.
A cross-sectional study was conducted. Mean kilojoule content, number of items and categorisation of foods and drinks in lunchboxes as ‘everyday’ (healthy) or discretionary (sometimes) foods were assessed via a valid and reliable lunchbox observational audit.
Twelve Catholic primary schools (Kindergarten–Grade 6) located in the Hunter region of New South Wales, Australia.
Kindergarten to Grade 6 primary-school students.
In total, 2143 children (57 %) had parental consent to have their lunchboxes observed. School lunchboxes contained a mean of 2748 kJ, of which 61·2 % of energy was from foods consistent with the Australian Dietary Guidelines and 38·8 % of energy was discretionary foods. The proportion of lunchboxes containing only healthy foods was 12 %. Children in Kindergarten–Grade 2 packed more servings of ‘everyday’ foods (3·32 v. 2·98, P < 0·01) compared with children in Grades 3–6. Children in Grades 3–6 had a higher percentage of energy from discretionary foods (39·1 v. 33·8 %, P < 0·01) compared with children in Kindergarten–Grade 2 and children from the most socio-economically disadvantaged areas had significantly higher total kilojoules in the school lunchbox compared with the least disadvantaged students (2842 v. 2544 kJ, P = 0·03).
Foods packed within school lunchboxes may contribute to energy imbalance. The development of school policies and population-based strategies to support parents overcome barriers to packing healthy lunchboxes are warranted.
The historical question of the personal and theological relationship between Martin Luther and John Calvin has long been freighted with larger questions of Evangelical identity. Calvin, in his published and epistolary rhetoric, deliberately constructed the image of a positive but critical attitude toward Luther, which he used to establish his own place in the Reformation. Luther’s own positive but qualified opinion of Calvin, however, came to be distorted by transmission by different parties in the theological disputes of the succeeding generation.1
In June 1498, the Florentine government publicly punished and exiled the Piagnona, the lone bell of the church of San Marco, for its role in defending Girolamo Savonarola during the April siege that led to the preacher's execution. Drawing on new evidence, this essay offers the most complete account of this still poorly understood chapter in Renaissance history, examining its complex and conflicting motives. At the same time, the punishment of the Piagnona, and struggle for its return, affords uncommon insight into the culture's deepest structures of thinking about what bells were, and who had the legal authority to adjudicate their fate.
Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
OBJECTIVES/SPECIFIC AIMS: To establish an effective team of researchers working towards developing and validating prognostic models employing use of image analyses and other numerical metadata to better understand pediatric undernutrition, and to learn how different approaches can be brought together collaboratively and efficiently. METHODS/STUDY POPULATION: Over the past 18 months we have established a transdisciplinary team spanning three countries and the Schools of Medicine, Engineering, Data Science and Global Health. We first identified two team leaders specifically a pediatric physician scientist (SS) and a data scientist/engineer (DB). The leaders worked together to recruit team members, with the understanding that different ideas are encouraged and will be used collaboratively to tackle the problem of pediatric undernutrition. The final data analytic and interpretative core team consisted of four data science students, two PhD students, an undergraduate biology major, a recent medical graduate, and a PhD research scientist. Additional collaborative members included faculty from Biomedical Engineering, the School of Medicine (Pediatrics and Pathology) along with international Global Health faculty from Pakistan and Zambia. We learned early on that it was important to understand what each of the member’s motivation for contributing to the project was along with aligning that motivation with the overall goals of the team. This made us help prioritize team member tasks and streamline ideas. We also incorporated a mechanism of weekly (monthly/bimonthly for global partners) meetings with informal oral presentations which consisted of each member’s current progress, thoughts and concerns, and next experimental goals. This method enabled team leaders to have a 3600 mechanism of feedback. Overall, we assessed the effectiveness of our team by two mechanisms: 1) ongoing team member feedback, including team leaders, and 2) progress of the research project. RESULTS/ANTICIPATED RESULTS: Our feedback has shown that on initial development of the team there was hesitance in communication due to the background diversity of our various member along with different cultural/social expectations. We used ice-breaking methods such as dedicated time for brief introductions, career directions, and life goals for each team member. We subsequently found that with the exception of one, all other team members noted our working environment professional and conducive to productivity. We also learnt from our method of ongoing constant feedback that at times, due to the complexity of different disciplines, some information was lost due to the difference in educational backgrounds. We have now employed new methods to relay information more effectively, with the use of not just sharing literature but also by explaining the content. The progress of our research project has varied over the past 4-6 months. There was a steep learning curve for almost every member, for example all the data science students had never studied anything related to medicine during their education, including minimal if none exposure to the ethics of medical research. Conversely, team members with medical/biology backgrounds had minimal prior exposure to computational modeling, computer engineering and the verbage of communicating mathematical algorithms. While this may have slowed our progress we learned that by asking questions and engaging every member it was easier to delegate tasks effectively. Once our team reached an overall understanding of each member’s goals there was a steady progress in the project, with new results and new methods of analysis being tested every week. DISCUSSION/SIGNIFICANCE OF IMPACT: We expect that our on-going collaboration will result in the development of new and novel modalities to understand and diagnose pediatric undernutrition, and can be used as a model to tackle several other problems. As with many team science projects, credit and authorship are challenges that we are outlining creative strategies for as suggested by International Committee of Medical Journal Editors (ICMJE) and other literature.
This study investigated the characteristics of subjective memory complaints (SMCs) and their association with current and future cognitive functions.
A cohort of 209 community-dwelling individuals without dementia aged 47–90 years old was recruited for this 3-year study. Participants underwent neuropsychological and clinical assessments annually. Participants were divided into SMCs and non-memory complainers (NMCs) using a single question at baseline and a memory complaints questionnaire following baseline, to evaluate differential patterns of complaints. In addition, comprehensive assessment of memory complaints was undertaken to evaluate whether severity and consistency of complaints differentially predicted cognitive function.
SMC and NMC individuals were significantly different on various features of SMCs. Greater overall severity (but not consistency) of complaints was significantly associated with current and future cognitive functioning.
SMC individuals present distinctive features of memory complaints as compared to NMCs. Further, the severity of complaints was a significant predictor of future cognition. However, SMC did not significantly predict change over time in this sample. These findings warrant further research into the specific features of SMCs that may portend subsequent neuropathological and cognitive changes when screening individuals at increased future risk of dementia.
As health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes prehospital personnel in the community as an extension of the traditional health care system. These programs have been labeled as Community Paramedicine (CP) and Mobile Integrated Health (MIH). While variation exists amongst these programs, generally efforts are targeted at individuals with high rates of health care utilization. By assisting with chronic disease management and addressing the social determinants of health care, these programs have been effective in decreasing Emergency Medical Services (EMS) utilization, emergency department visits, and hospital admissions for enrolled patients.
The actual training, roles, and structure of these programs vary according to state oversight and community needs, and while numerous reports describe the novel role these teams play in population health, their utilization during a disaster response has not been previously described. This report describes a major flooding event in October 2015 in Columbia, South Carolina (USA). While typical disaster mitigation and response efforts were employed, it became clear during the response that the MIH providers were well-equipped to assist with unique patient and public health needs. Given their already well-established connections with various community health providers and social assistance resources, the MIH team was able to reconnect patients with lost medications and durable medical equipment, connect patients with alternative housing options, and arrange access to outpatient resources for management of chronic illness.
Mobile integrated health teams are a potentially effective resource in a disaster response, given their connections with a variety of community resources along with a unique combination of training in both disease management and social determinants of health. As roles for these providers are more clearly defined and training curricula become more developed, there appears to be a unique role for these providers in mitigating morbidity and decreasing costs in the post-disaster response. Training in basic disaster response needs should be incorporated into the curricula and community disaster planning should identify how these providers may be able to benefit their local communities.
Gainey CE, Brown HA, Gerard WC. Utilization of mobile integrated health providers during a flood disaster in South Carolina (USA). Prehosp Disaster Med. 2018;33(4):432–435
In the original publication of this article, the title was printed as “Four Preceramic Points Newly Discovered in Belize: A Comment on Stemp et al. (1996:279–299).” The article has been updated to the correct title. The authors apologize for this error.
Stemp et al. (2016) published data on 81 preceramic (Archaic) points from Belize, Central America. In this comment, we report four more chipped chert bifaces recently recovered in Belize (Figure 1). Based on metrics (Table 1), technology, and style, three are classified as Lowe and one as a Sawmill point (Kelly 1993; Lohse et al. 2006; Stemp et al. 2016).
Luther's student Johann Mathesius, longtime pastor in the Bohemian mining town of Joachimsthal, provides a lens for seeing early modern art and artists through Lutheran eyes, challenging modern interpretations of the dire consequences of the Reformation for the visual arts.1 For Mathesius, pre-Reformation art provided not only evidence of old idolatry but also testimony to the preservation of Evangelical faith under the papacy. After the Reformation, Joachimsthal's Lutherans were active in commissioning new works of art to fill the first newly built Protestant church, including an altarpiece from Lucas Cranach's workshop. Mathesius's appreciation of this art includes not only its biblical and doctrinal content but also its aesthetic quality. In an extended sermon on the construction of the Tabernacle in Exodus 31, Mathesius draws on Luther's theology of the special inspiration of the “great men” of world history to develop a Lutheran theology of artistic inspiration, in which artists are endowed by the Holy Spirit with extraordinary skills and special creative gifts, intended to be used in service of the neighbor by adorning the divinely appointed estates of government, church, and household.
Archaeological fieldwork preceding housing development revealed a Mesolithic site in a primary context. A central hearth was evident from a cluster of calcined flint and bone, the latter producing a modelled date for the start of occupation at 8220–7840 cal bc and ending at 7960–7530 cal bc (95% probability). The principal activity was the knapping of bladelets, the blanks for microlith production. Impact-damaged microliths indicated the re-tooling of hunting weaponry, while microwear analysis of other tools demonstrated hide working and butchery activity at the site. The lithics can be classified as a Honey Hill assemblage type on the basis of distinctive leaf-shaped microlithic points with inverse basal retouch.
Such assemblages have a known concentration in central England and are thought to be temporally intermediate between the conventional British Early and Late Mesolithic periods. The lithic assemblage is compared to other Honey Hill type and related Horsham type assemblages from south-eastern England. Both assemblage types are termed Middle Mesolithic and may be seen as part of wider developments in the late Preboreal and Boreal periods of north-west Europe. Rapid climatic warming at this time saw the northward expansion of deciduous woodland into north-west Europe. Emerging new ecosystems presented changes in resource patterns and the Middle Mesolithic lithic typo-technological developments reflect novel foraging strategies as adaptations to the new opportunities of Boreal forest conditions. While Honey Hill-type assemblages are seen as part of such wider processes their distinctive typological signature attests to autochthonous, regional developments of human groups infilling the landscape. Such cultural insularity may reflect changing social boundaries with reduction in mobility range and physical isolation caused by rising sea level and the creation of the British archipelago.
I examine the origin and development of institutions that assign and enforce rights to hard rock minerals located on federal lands in the United States. Hard rock mining gives a prime example of the ‘artificial selection’ of settled customs or working rules by jurists and legislators. The evolving structure of the industry, conditioned by technological and market factors, produced a parallel shift in the locus and control of sovereignty. In the early days sovereignty vested in the mining clubs. The enlarging scale and complexity of mining catalysed a change in both the uses and location of sovereignty. With the transition from prospecting to large-scale industrial mining, the ‘right to use’ mineral deposits obtained through patents became contingent on the cooperation of labour. At this stage, the capture of the state's monopoly on legitimate violence to protect the right to use became a crucial dimension of property. Mining companies have also enjoyed liberties with respect to the externalization of environmental costs. The emergent structure of rights, duties, capacities and exposures was instrumental in bringing forth a quantum increase in the mining of hard rock minerals necessary for industrial expansion. There is, however, an urgent need for reform of the mineral patent system.