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The diets of children in the UK are suboptimal(1), which may influence their immediate and future health and well-being(2). Schools offer convenient and prolonged access to children from diverse backgrounds, thus interventions within this setting have been suggested as a means to promote diet and health outcomes among this population(3). This study explored the effects of Project Daire(4), a school-based food intervention, on children’s diet diversity and diet quality as well as their attitudes towards health behaviours.
A factorial design cluster randomized controlled trial was conducted. Fifteen primary schools in Northern Ireland were randomized into one of four 6-month intervention arms: Nourish, Engage, Nourish and Engage or Control (Delayed). The Nourish intervention modified the school food environment, provided food-related experiences and increased access to local foods. The Engage intervention included educational activities on nutrition, food and agriculture. Data on food consumption at home, school and/or in total over a 24-hour period were collected using ageappropriate food frequency questionnaires at baseline, with follow-up at 6-months. Diet diversity score (DDS) and diet quality score (DQS) were developed based on adherence to the Eatwell Guide. Additionally, a Health Attitudes and Behaviour measure assessed 10-11 year old children’s attitudes towards importance of various health behaviours at both time points. Linear and logistic regression models were used to examine intervention effects and to account for school clustering.
A total of 445 children aged 6-7 and 458 aged 10-11 years old completed the trial. Results indicated that children aged 10-11 year old who received the Nourish intervention demonstrated higher school DDS (adjusted mean difference=2.79, 95% CI 1.40 – 4.19; p = 0.001) and total DDS (adjusted mean difference=1.55, 95% CI 0.66 – 2.43, p = 0.002) compared to their counterparts who did not. Subgroup analyses revealed that the increases in school DDS among 10-11 year old children in the Nourish group were apparent in both boys and girls (Boys: adjusted mean difference=2.4 95% CI 0.1 – 4.7, p = 0.04; Girls: adjusted mean difference=3.1 95% CI 1.6 – 4.6, p = 0.001). However, the increase in total DDS remained statistically significant only among girls, with an adjusted mean difference of 1.9 (95% CI 1.1-2.7, p<0.001). No statistically significant changes in DQS were detected in either age group. High levels of positive attitudes towards health behaviours were observed at baseline, with no clinically significant effects of either the Nourish or Engage interventions detected during the follow-up period.
The multi-component approach of the Nourish intervention, addressing both food provision and environment, showed promise in promoting diet diversity. Further research is warranted to develop sustainable implementation strategies for Daire, to explore additional intervention components to impact other outcomes, including diet quality, and to evaluate long-term effectiveness.
Most of the Ross Sea has been designated a marine protected area (MPA), proposed ‘to protect ecosystem structure and function’. To assess effectiveness, the Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR) selected Adélie (Pygoscelis adeliae) and emperor (Aptenodytes forsteri) penguins, Weddell seals (Leptonychotes weddellii) and Antarctic toothfish (Dissostichus mawsoni) as ecosystem change ‘indicator species’. Stable for decades, penguin and seal populations increased during 1998–2018 to surpass historical levels, indicating that change in ecosystem structure and function is underway. We review historical impacts to population trends, decadal datasets of ocean climate and fishing pressure on toothfish. Statistical modelling for Adélie penguins and Weddell seals indicates that variability in climate factors and cumulative extraction of adult toothfish may explain these trends. These mesopredators, and adult toothfish, all prey heavily on Antarctic silverfish (Pleuragramma antarcticum). Toothfish removal may be altering intraguild predation dynamics, leading to competitive release of silverfish and contributing to penguin and seal population changes. Despite decades of ocean/weather change, increases in indicator species numbers around Ross Island only began once the toothfish fishery commenced. The rational-use, ecosystem-based viewpoint promoted by CCAMLR regarding toothfish management needs re-evaluation, including in the context of the Ross Sea Region MPA.
Avoidable disasters are both saddening and baffling. In 2022, 159 people, mostly in their 20s, and 30s were crushed to death in Itaewon’s narrow alleyway amid South Korea’s first pandemic-restrictions-free Halloween celebration. What is particularly sobering about this tragedy is that although many people called police hotlines as crowds became cramped and static, their calls went unheeded for hours. Rather than order independent investigations into the catastrophe (as of January 2024), the President of South Korea at the time focused on superficial issues such as asking the public to refer to the disaster as an “accident” (which it was not, it was an avoidable disaster) and the casualties as “the dead” (who are casualties indeed, instead of victims of a preventable tragedy). In this paper, we examine how officials’ complacency about public health and safety dangers, ineffective disaster prevention, and preparedness systems, as well as the government’s chronic lack of prioritization of public health and safety may have contributed to the disaster. Furthermore, we discuss the importance of creating integrated public health and safety protection systems to prevent similar tragedies from happening.
Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are associated with various social determinants. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address known social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders.
Objectives
To examine the evidence base for interventions that seek to improve mental health through targeting the social determinants of mental disorders.
Methods
We conducted a systematic review of reviews, using a five-domain conceptual framework which aligns with the UN SDGs (PROSPERO registration: CRD42022361534). PubMed, PsycInfo, and Scopus were searched from 01 January 2012 until 05 October 2022. Citation follow-up and expert consultation were used to identify additional studies. Systematic reviews including interventions seeking to change or improve a social determinant of mental disorders were eligible for inclusion. Study screening, selection, data extraction, and quality appraisal were conducted in accordance with PRISMA guidelines. The AMSTAR-2 was used to assess included reviews and results were narratively synthesised.
Results
Over 20,000 records were screened, and 101 eligible reviews were included. Most reviews were of low, or critically low, quality. Reviews included interventions which targeted sociocultural (n = 31), economic (n = 24), environmental (n = 19), demographic (n = 15), and neighbourhood (n = 8) determinants of mental disorders. Interventions demonstrating the greatest promise for improved mental health from high and moderate quality reviews (n = 37) included: digital and brief advocacy interventions for female survivors of intimate partner violence; cash transfers for people in low-middle-income countries; improved work schedules, parenting programs, and job clubs in the work environment; psychosocial support programs for vulnerable individuals following environmental events; and social and emotional learning programs for school students. Few effective neighbourhood-level interventions were identified.
Conclusions
This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health. A range of issues across the literature were identified, including barriers to conducting randomised controlled trials and lack of follow-up limiting the ability to measure long-term mental health outcomes. Interdisciplinary and novel approaches to intervention design, implementation, and evaluation are required to improve the social circumstances and mental health experienced by individuals, communities, and populations.
Type 1 diabetes mellitus (T1DM) patients are treated via insulin which could result in weight gain. Studies have coined a new term, “Diabulimia” which refers to the limitation or skipping of insulin doses, with the objective of weight control. A previous meta-analysis has found that eating disorders (ED) are significantly associated with T1DM (Mannucci, E et al. J Endocrinol Invest 2005; 417-9), while a more recent one, has shown an insignificant association between ED and T1DM on analysis of diabetes-adapted questionnaires only (Young V, et al. Diabet Med. 2013:189-198)
Objectives
We aimed to re-analyze the association between ED and T1DM, whilst taking into account recently published literature and the type of questionnaire utilized.
Methods
A literature search of PubMed, Scopus, and Web of Science was conducted on 17th January 2023, using the key terms “ T1DM”, “Eating Disorders”, and “ Bulimia”. Only Observational controlled studies were included.
Results
T1DM was associated with increased risk of ED compared to non-diabetic individuals (RR = 2.47, 95% CI = 1.84 to 3.32, p-value < 0.00001), especially bulimia nervosa (RR = 2.80, 95% CI = 1.18 to 6.65, p-value = 0.02) and binge eating (RR = 1.53, 95% CI = 1.18 to 1.98, p-value = 0.001), while no significant association was seen between T1DM and anorexia nervosa. Our sensitivity analysis has shown that increased risk of ED among T1DM persisted regardless of the questionnaire used to diagnose ED; DM-validated questionnaires (RR = 2.80, 95% CI = 1.91 to 4.12, p-value <0.00001) and generic questionnaires (RR = 2.03, 95% CI = 1.27 to 3.23, p-value = 0.003). Furthermore, the Eating Attitudes Test-26 (EAT) showed a significant increase in the dieting subscale (MD = 2.95, 95% CI = 1.84 to 4.06, p-value < 0.00001) and bulimia subscale (MD = 0.78, 95% CI = 0.12 to 1.44, p-value = 0.02) among T1DM patients. Additionally, the Bulimic Investigatory Test, Edinburg (BITE) showed a significant increase in the symptom subscale (MD = 0.31, 95% CI = 0.12 to 0.50, p-value = 0.001), however, no significant difference was detected between T1DM and controls in the severity subscale. Prevalence of insulin omission/misuse was 10.3% (95% CI = 8.1-13); diabetic females demonstrated significantly higher risk of insulin omission (RR = 14.21, 95% CI = 2.66 to 76.04, p-value = 0.002) and insulin misuse (RR = 6.51, 95% CI = 1.14 to 37.31, p-value = 0.04) compared with diabetic males. Analysis of other potentially unhealthy weight control behaviors showed insignificant associations between fasting, excessive exercise, dieting pills misuse, diuretics misuse, and T1DM.
Conclusions
T1DM patients are at higher risk of developing ED according to both generic and diabetes-validated questionnaires. Moreover, female diabetics are at higher risk of insulin misuse/omission. Subsequently, patients should be regularly screened and early psychiatric management is warranted.
Large organisations are designing complex technology-based tools for their staff to use. In busy workplace environments, it can be difficult to get user input about a design. This paper describes the designer and user interactions in one such organisation, gaining insights that could be useful in other similar settings. The findings are based on a set of interviews with designers and researchers within the organisation. The paper identifies the current practices and constraints involved in understanding and capturing users' needs and discusses potential solutions.
If anilinium ions are intercalated into Llano vermiculite, the stacking order of adjacent silicate layers is increased, resulting in a relatively sharp single crystal X-ray diffraction (XRD) pattern. The packing of intercalated organic members forms a superstructure and produces bonding from layer to layer which favors the stacking order. Superlattice reflections occur which, although sharp in the a*b* plane, are streaked along c*. Apparently there is little coherence between adjacent layers of ordered organic units.
A three-dimensional set of XRD reflections for a triclinic sub-cell having the following lattice parameters was measured: a = 5.326(3), b = 9.264(4), c = 14.82(5) Å, α = 90.31(7), β = 96.70(6), and γ = 89.55(5)°. In this unit cell (symmetry Cl), ditrigonal cavities in adjacent silicate layers are approximately opposite. Differential Fourier analyses and least-squares refinements showed that the principal axes of the anilinium ions, i.e., N-C(1)-C(4), are nearly perpendicular to the silicate layers. The planes of the aromatic rings, however, are about ±30° to X, neither parallel nor perpendicular to that direction, as indicated by earlier studies.
Inorganic cations and water molecules are also present in the interlayer; the former and some of the latter occupy sites near the middle of the layer. Anilinium-rich and anilinium-poor domains coexist. In the latter, the cation-water system predominates and apparently conforms to the superstructure. Although the cation-water structure could not be uniquely established from the reflections produced by the sub-cell, possible positional coordinates were obtained. From structural data for the silicate layers, no evidence was found for long-range Si/Al ordering in the tetrahedral sites.
The herbicides that inhibit very-long-chain fatty acid (VLCFA) elongases are primarily used for residual weed control in corn, barley, oat, sorghum, soybean, sugarcane, certain vegetable crops, and wheat production fields in the United States. They act primarily by inhibiting shoot development of susceptible species, preventing weed emergence and growth. The objectives of this review were to summarize 1) the chemical family of VLCFA-inhibiting herbicides and their use in the United States, 2) the VLCFA biosynthesis in plants and their site of action, 3) VLCFA-inhibitor resistant weeds and their mechanism of resistance, and 4) the future of VLCFA-inhibiting herbicides. After their reclassification as Group 15 herbicides to include shoot growth-inhibiting herbicides (Group 8), the VLCFA-inhibiting herbicides are currently represented by eight chemical families (benzofurans, thiocarbamates, α-chloroacetamides, α-oxyacetamides, azolyl-carboxamides, isoxazolines, α-thioacetamides, and oxiranes). On average, VLCFA-inhibiting herbicides are applied once a year to both corn and soybean crops in the United States with acetochlor and S-metolachlor being the most used VLCFA-inhibiting herbicides in corn and soybean production, respectively. The site of action of Group 15 herbicides results from inhibition of the VLCFA synthase, which is encoded by several fatty acid elongase (FAE1)-like genes in VLCFA elongase complex in an endoplasmic reticulum. The VLCFA synthase is a condensing enzyme, and relies on a conserved, reactive cysteinyl sulfur in its active site that performs a nucleophilic attack on either the natural substrate (fatty acyl-CoA) or the herbicide. As of August 2023, 13 weed species have been documented to be resistant to VLCFA inhibitors, including 11 monocot weeds and two dicot weeds (Palmer amaranth and waterhemp). The isoxazolines (pyroxasulfone and fenoxasulfone) are the most recently (2014) discovered VLCFA-inhibiting herbicides. Although the intensity of VLCFA-inhibitor-directed discovery efforts has decreased over the past decade, this biochemical pathway remains a viable mechanistic target for the discovery of herbicide premixes and a valuable component of them.
In 2016, the National Center for Advancing Translational Science launched the Trial Innovation Network (TIN) to address barriers to efficient and informative multicenter trials. The TIN provides a national platform, working in partnership with 60+ Clinical and Translational Science Award (CTSA) hubs across the country to support the design and conduct of successful multicenter trials. A dedicated Hub Liaison Team (HLT) was established within each CTSA to facilitate connection between the hubs and the newly launched Trial and Recruitment Innovation Centers. Each HLT serves as an expert intermediary, connecting CTSA Hub investigators with TIN support, and connecting TIN research teams with potential multicenter trial site investigators. The cross-consortium Liaison Team network was developed during the first TIN funding cycle, and it is now a mature national network at the cutting edge of team science in clinical and translational research. The CTSA-based HLT structures and the external network structure have been developed in collaborative and iterative ways, with methods for shared learning and continuous process improvement. In this paper, we review the structure, function, and development of the Liaison Team network, discuss lessons learned during the first TIN funding cycle, and outline a path toward further network maturity.
Improving the quality and conduct of multi-center clinical trials is essential to the generation of generalizable knowledge about the safety and efficacy of healthcare treatments. Despite significant effort and expense, many clinical trials are unsuccessful. The National Center for Advancing Translational Science launched the Trial Innovation Network to address critical roadblocks in multi-center trials by leveraging existing infrastructure and developing operational innovations. We provide an overview of the roadblocks that led to opportunities for operational innovation, our work to develop, define, and map innovations across the network, and how we implemented and disseminated mature innovations.
New technologies and disruptions related to Coronavirus disease-2019 have led to expansion of decentralized approaches to clinical trials. Remote tools and methods hold promise for increasing trial efficiency and reducing burdens and barriers by facilitating participation outside of traditional clinical settings and taking studies directly to participants. The Trial Innovation Network, established in 2016 by the National Center for Advancing Clinical and Translational Science to address critical roadblocks in clinical research and accelerate the translational research process, has consulted on over 400 research study proposals to date. Its recommendations for decentralized approaches have included eConsent, participant-informed study design, remote intervention, study task reminders, social media recruitment, and return of results for participants. Some clinical trial elements have worked well when decentralized, while others, including remote recruitment and patient monitoring, need further refinement and assessment to determine their value. Partially decentralized, or “hybrid” trials, offer a first step to optimizing remote methods. Decentralized processes demonstrate potential to improve urban-rural diversity, but their impact on inclusion of racially and ethnically marginalized populations requires further study. To optimize inclusive participation in decentralized clinical trials, efforts must be made to build trust among marginalized communities, and to ensure access to remote technology.
Planetary Protection (PP) is the practice of safeguarding solar system bodies from terrestrial biological contamination and screening the Earth against potentially harmful extraterrestrial biological contamination. On Earth, cleanrooms and spacecraft surfaces are assayed using swabs and wipes that are then heat shocked for 15 min at 80°C to select for spores. The samples are further processed using the pour-plate method and Petri plates (TSA plates), with trypticase soy agar (TSA) serving as the growth medium. This sampling and processing procedure, called the NASA Standard Assay (NSA), is used by PP engineers around the world. Recent years have seen an increase in the incorporation of state-of-the-art technology, such as membrane filtration, into the NSA, with a push for implementing environmentally friendly technology into day-to-day activities. Dehydrated thin film media, such as Petrifilm Rapid Aerobic Count (RAC) plates, suit these goals as an alternative method to TSA plates. RAC plates show bacterial growth (and distinguish colonies from foreign particles such as bubbles) faster than TSA plates due to the incorporation of chromogenic colour indicators in the media. RAC plates also possess a much smaller environmental footprint than TSA plates, and are designed to evaluate even some of the challenging-to-detect environmental organisms, including spreaders that fill over 25% of the plate area in only a few hours. With these benefits in mind the PP Group at the NASA Jet Propulsion Laboratory took on the task of comparing RAC plates directly to TSA plates within the context of the NSA. Not only were the RAC plates able to detect surface environmental samples and in vitro spiked samples equivalent to NSA-processed TSA plates, but spreader organisms were countable on RAC plates at culture densities 10- to 100-fold greater than on TSA plates. In addition, RAC plates showed a robust, linear detection capability when challenged with membrane filter incorporation and organisms were easily acquired from RAC plates for archiving or post-processing experiments including MALDI-TOF bacterial identification. With their ease of use, small footprint, and both rapid and accurate bioburden measurements, RAC plates have the potential to overcome limitations posed by current PP culturing protocols.
One challenge for multisite clinical trials is ensuring that the conditions of an informative trial are incorporated into all aspects of trial planning and execution. The multicenter model can provide the potential for a more informative environment, but it can also place a trial at risk of becoming uninformative due to lack of rigor, quality control, or effective recruitment, resulting in premature discontinuation and/or non-publication. Key factors that support informativeness are having the right team and resources during study planning and implementation and adequate funding to support performance activities. This communication draws on the experience of the National Center for Advancing Translational Science (NCATS) Trial Innovation Network (TIN) to develop approaches for enhancing the informativeness of clinical trials. We distilled this information into three principles: (1) assemble a diverse team, (2) leverage existing processes and systems, and (3) carefully consider budgets and contracts. The TIN, comprised of NCATS, three Trial Innovation Centers, a Recruitment Innovation Center, and 60+ CTSA Program hubs, provides resources to investigators who are proposing multicenter collaborations. In addition to sharing principles that support the informativeness of clinical trials, we highlight TIN-developed resources relevant for multicenter trial initiation and conduct.
Deciding whether or not eradication of an invasive species has been successful is one of the main dilemmas facing managers of eradication programmes. When the species is no longer being detected, a decision must be made about when to stop the eradication programme and declare success. In practice, this decision is usually based on ad hoc rules, which may be inefficient. Since surveillance undertaken to confirm species absence is imperfect, any declaration of eradication success must consider the risk and the consequences of being wrong. If surveillance is insufficient, then eradication may be falsely declared (a Type I error), whereas continuation of surveillance when eradication has already occurred wastes resources (a Type II error). We review the various methods that have been developed for quantifying these errors and incorporating them into the decision-making process. We conclude with an overview of future developments likely to improve the practice of determining invasive species eradication success.
Morbidity and mortality from coronavirus disease 2019 (COVID-19) have been significant among elderly residents of residential aged-care services (RACS). To prevent incursions of COVID-19 in RACS in Australia, visitors were banned and aged-care workers were encouraged to work at a single site. We conducted a review of case notes and a social network analysis to understand how workplace and social networks enabled the spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) among RACS.
Design:
Retrospective outbreak review.
Setting and participants:
Staff involved in COVID-19 outbreaks in RACS in Victoria, Australia, May–October 2020.
Methods:
The Victorian Department of Health COVID-19 case and contact data were reviewed to construct 2 social networks: (1) a work network connecting RACS through workers and (2) a household network connecting to RACS through households. Probable index cases were reviewed to estimate the number and size (number of resident cases and deaths) of outbreaks likely initiated by multisite work versus transmission via households.
Results:
Among 2,033 cases linked to an outbreak as staff, 91 (4.5%) were multisite staff cases. Forty-three outbreaks were attributed to multisite work and 35 were deemed potentially preventable had staff worked at a single site. In addition, 99 staff cases were linked to another RACS outbreak through their household contacts, and 21 outbreaks were attributed to staff–household transmission.
Conclusions:
Limiting worker mobility through single-site policies could reduce the chances of SARS-CoV-2 spreading from one RACS to another. However, initiatives that reduce the chance of transmission via household networks would also be needed.
Globally, adolescent self-harm rates remain high, while help-seeking behaviour remains low. School staff are in a position to facilitate access to appropriate care for young people who self-harm (YPS-H), but little is known about gatekeepers’ attributions of self-harm or whether these attributions influence the support they provide. This study investigates the perceived functions of self-harm reported by potential gatekeepers and examines how these compare to the self-reported functions of self-harm in young people; 386 students from postgraduate teaching (n = 111), school counselling (n = 37), and undergraduate psychology (n = 238) programs completed a survey regarding their beliefs about YPS-H, which included the Inventory of Statements about Self-Harm. Responses were compared to those of 281 young people attending treatment at a suicide prevention program who completed the same measure. Preservice teachers, school counsellors and psychology students endorsed all functions of self-harm at a higher rate than treatment-seeking young people themselves. In particular, they endorsed interpersonal functions to a greater extent than the clinical reference group. The potential effect of greater endorsement of interpersonal influence as a function of self-harm gatekeeper’s responding to YPS-H is discussed.
Many mental disorders, including depression, bipolar disorder and schizophrenia, are associated with poor dietary quality and nutrient intake. There is, however, a deficit of research looking at the relationship between obsessive–compulsive disorder (OCD) severity, nutrient intake and dietary quality.
Aims
This study aims to explore the relationship between OCD severity, nutrient intake and dietary quality.
Method
A post hoc regression analysis was conducted with data combined from two separate clinical trials that included 85 adults with diagnosed OCD, using the Structured Clinical Interview for DSM-5. Nutrient intakes were calculated from the Dietary Questionnaire for Epidemiological Studies version 3.2, and dietary quality was scored with the Healthy Eating Index for Australian Adults – 2013.
Results
Nutrient intake in the sample largely aligned with Australian dietary guidelines. Linear regression models adjusted for gender, age and total energy intake showed no significant associations between OCD severity, nutrient intake and dietary quality (all P > 0.05). However, OCD severity was inversely associated with caffeine (β = −15.50, 95% CI −28.88 to −2.11, P = 0.024) and magnesium (β = −6.63, 95% CI −12.72 to −0.53, P = 0.034) intake after adjusting for OCD treatment resistance.
Conclusions
This study showed OCD severity had little effect on nutrient intake and dietary quality. Dietary quality scores were higher than prior studies with healthy samples, but limitations must be noted regarding comparability. Future studies employing larger sample sizes, control groups and more accurate dietary intake measures will further elucidate the relationship between nutrient intake and dietary quality in patients with OCD.