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Smartphone mHealth apps can help children with obesity modify their rate of eating(1) and monitor physical activity(2). However, owing to issues with adherence, mHealth interventions require rigorous feasibility testing(3).
To evaluate, using a randomised design, the feasibility and acceptability of a mHealth intervention to reduce rate of eating and track physical activity among children in treatment for obesity.
Children (9–16 years) with obesity (BMI ≥ 98th centile) were recruited at a tertiary healthcare centre. The Research Ethics Committee at Temple St. Children's University Hospital granted ethical approval. Upon completing informed consent and assent, participants completed 2-week baseline testing including anthropometry, rate of eating by Mandometer® and physical activity using myBigO app. Thereafter participants were randomised to:(1)Treatment: Usual clinical care + Mandometer® training or (2)Control: Usual clinical care. Gender and age (9.0–12.9 years and 13.0–16.9 years) stratifications were applied. After a 4-week treatment period, participants repeated the 2-week testing period. Feasibility measures included fidelity with planned recruitment, randomisation, and intervention delivery and attrition. Acceptability measures included objective clinical portal engagement data and feedback from participants.
Of 20 recruited, eight were randomised to intervention and 12 to control, with no significant age, gender or BMI SDS differences between groups. At baseline, 7 intervention (87.5%) and 8 control (66.7%) participants recorded rate of eating. Eighteen participants (90%) registered with myBigO app, with 16 recording data successfully. Two had smartphones incompatible with myBigO (n = 1 intervention;n = 1 control) and two did not engage with myBigO app (n = 1 intervention;n = 1 control). Among 4 participants who completed Mandometer® intervention, dose received ranged from 7%-92% of planned meals. 37.5% intervention and 58.3% control participants completed post-intervention measures. Attrition was higher in the intervention (n = 5;62.5%) than control (n = 3;25%) group. Reasons cited for withdrawing included loss of interest (n = 3 intervention), child felt overwhelmed or self-conscious (n = 2 control), lack of time (n = 1 intervention), behavioural issue with child (n = 1 control), and family illness (n = 1 intervention). No significant age, gender or BMI SDS differences were observed between non-completers and completers. Participant engagement and feedback indicated mixed acceptability among this cohort.
Based on results, the current protocol for study design and intervention should be improved, if engagement is to be maximised.
The study is part of EU H2020 BigO Study (Big Data Against Childhood Obesity, Grant No. 727688.https://bigoprogram.eu/).
Prenatal adversity shapes child neurodevelopment and risk for later mental health problems. The quality of the early care environment can buffer some of the negative effects of prenatal adversity on child development. Retrospective studies, in adult samples, highlight epigenetic modifications as sentinel markers of the quality of the early care environment; however, comparable data from pediatric cohorts are lacking. Participants were drawn from the Maternal Adversity Vulnerability and Neurodevelopment (MAVAN) study, a longitudinal cohort with measures of infant attachment, infant development, and child mental health. Children provided buccal epithelial samples (mean age = 6.99, SD = 1.33 years, n = 226), which were used for analyses of genome-wide DNA methylation and genetic variation. We used a series of linear models to describe the association between infant attachment and (a) measures of child outcome and (b) DNA methylation across the genome. Paired genetic data was used to determine the genetic contribution to DNA methylation at attachment-associated sites. Infant attachment style was associated with infant cognitive development (Mental Development Index) and behavior (Behavior Rating Scale) assessed with the Bayley Scales of Infant Development at 36 months. Infant attachment style moderated the effects of prenatal adversity on Behavior Rating Scale scores at 36 months. Infant attachment was also significantly associated with a principal component that accounted for 11.9% of the variation in genome-wide DNA methylation. These effects were most apparent when comparing children with a secure versus a disorganized attachment style and most pronounced in females. The availability of paired genetic data revealed that DNA methylation at approximately half of all infant attachment-associated sites was best explained by considering both infant attachment and child genetic variation. This study provides further evidence that infant attachment can buffer some of the negative effects of early adversity on measures of infant behavior. We also highlight the interplay between infant attachment and child genotype in shaping variation in DNA methylation. Such findings provide preliminary evidence for a molecular signature of infant attachment and may help inform attachment-focused early intervention programs.
The placement of angiosperms and Gnetales in seed plant phylogeny remains one of the most enigmatic problems in plant evolution, with morphological analyses (which have usually included fossils) and molecular analyses pointing to very distinct topologies. Almost all morphology-based phylogenies group angiosperms with Gnetales and certain extinct seed plant lineages, while most molecular phylogenies link Gnetales with conifers. In this study, we investigate the phylogenetic signal present in published seed plant morphological data sets. We use parsimony, Bayesian inference, and maximum-likelihood approaches, combined with a number of experiments with the data, to address the morphological–molecular conflict. First, we ask whether the lack of association of Gnetales with conifers in morphological analyses is due to an absence of signal or to the presence of competing signals, and second, we compare the performance of parsimony and model-based approaches with morphological data sets. Our results imply that the grouping of Gnetales and angiosperms is largely the result of long-branch attraction (LBA), consistent across a range of methodological approaches. Thus, there is a signal for the grouping of Gnetales with conifers in morphological matrices, but it was swamped by convergence between angiosperms and Gnetales, both situated on long branches. However, this effect becomes weaker in more recent analyses, as a result of addition and critical reassessment of characters. Even when a clade including angiosperms and Gnetales is still weakly supported by parsimony, model-based approaches favor a clade of Gnetales and conifers, presumably because they are more resistant to LBA. Inclusion of fossil taxa weakens rather than strengthens support for a relationship of angiosperms and Gnetales. Our analyses finally reconcile morphology with molecules in favoring a relationship of Gnetales to conifers, and show that morphology may therefore be useful in reconstructing other aspects of the phylogenetic history of the seed plants.
Architecture and the Origins of Preclassic Maya Politics highlights the dramatic changes in the relationship of ancient Maya peoples to the landscape and to each other in the Preclassical period (ca. 2000 BC–250 AD). Offering a comprehensive history of Preclassic Maya society, James Doyle focuses on recent discoveries of early writing, mural painting, stone monuments, and evidence of divine kingship that have reshaped our understanding of cultural developments in the first millennium BC. He also addresses one of the crucial concerns of contemporary archaeology: the emergence of political authorities and their subjects in early complex polities. Doyle shows how architectural trends in the Maya Lowlands in the Preclassic period exhibit the widespread cross-cultural link between monumental architecture of imposing intent, human collaboration, and urbanism.