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OBJECTIVES/GOALS: To describe a study to develop, test, and collect implementation data on a youth-led hypertension (HTN) education digital intervention that acts as an electronic tool to guide youth through learning and then teaching adults on how to achieve better HTN control. Adults with uncontrolled HTN are recruited from a New Jersey emergency department (ED). METHODS/STUDY POPULATION: Adults with HTN and youth (15-18 years) participate in a remote user-centered design session focus group to provide input in the development of the youth-led HTN education digital intervention. 100 adult ED patients with uncontrolled HTN (blood pressure (BP) â‰¥130/80 mm Hg) who live with a youth (15-18 years) and the youth themselves are recruited for a randomized control trial (RCT). The adult-youth dyad is randomized to one of two arms, each a 6-week program with youth earning a digital badge: 1) intervention- youth-led HTN education with the adult, or 2) control- youth learn life skills (such as job readiness/resume building). Implementation metrics are collected through a post-intervention survey and qualitative interviews on the digital badge intervention including acceptability, feasibility, and fidelity. RESULTS/ANTICIPATED RESULTS: We completed two youth focus groups (total of 8 participants) and data collection is ongoing. Youth have shown great interest in the intervention prototype and thought their peers would find it acceptable. They suggested additions to nutrition education activities, such as adding a sodium tracker and examples of high sodium foods. For the RCT, the primary study outcome is adult BP change (from baseline to 1 week and 2-months post-intervention), with secondary outcomes of HTN knowledge and youth self-efficacy. We anticipate that intervention arm adults will have a more significant decrease in BP than control arm adults. We also expect that HTN knowledge and youth self-efficacy will be higher for the intervention arm. Implementation data collected will allow for improvements to future renditions of the intervention. DISCUSSION/SIGNIFICANCE: Bringing health education home while simultaneously empowering youth is an innovative technology-driven model for improving BP for patients with uncontrolled HTN who may lack access to care. Outcomes of this project will result in a scalable and easily adoptable model to reach an otherwise difficult to reach adult population.
Cow’s milk is a naturally nutrient-dense foodstuff. A significant source of many essential nutrients, its inclusion as a component of a healthy balanced diet has been long recommended. Beyond milk’s nutritional value, an increasing body of evidence illustrates cow’s milk may confer numerous benefits related to health. Evidence from adult populations suggests that cow’s milk may have a role in overall dietary quality, appetite control, hydration and cognitive function. Although evidence is limited compared with the adult literature, these benefits may be echoed in recent paediatric studies. This article, therefore, reviews the scientific literature to provide an evidence-based evaluation of the associated health benefits of cow’s milk consumption in primary-school-aged children (4–11 years). We focus on seven key areas related to nutrition and health comprising nutritional status, hydration, dental and bone health, physical stature, cognitive function, and appetite control. The evidence consistently demonstrates cow’s milk (plain and flavoured) improves nutritional status in primary-school-aged children. With some confidence, cow’s milk also appears beneficial for hydration, dental and bone health and beneficial to neutral concerning physical stature and appetite. Due to conflicting studies, reaching a conclusion has proven difficult concerning cow’s milk and cognitive function; therefore, a level of caution should be exercised when interpreting these results. All areas, however, would benefit from further robust investigation, especially in free-living school settings, to verify conclusions. Nonetheless, when the nutritional-, physical- and health-related impact of cow’s milk avoidance is considered, the evidence highlights the importance of increasing cow’s milk consumption.
This two-part article examines the global public health (GPH) information system deficits emerging in the coronavirus disease 2019 (COVID-19) pandemic. It surveys past, missed opportunities for public health (PH) information system and operational improvements, examines current megatrend changes to information management, and describes a new multi-disciplinary model for population-based management (PBM) supported by a GPH Database applicable to pandemics and GPH crises.
Disasters can damage the essential public health infrastructure and social protection systems required for vulnerable populations. This contributes to indirect mortality and morbidity as high as 70–90%, primarily due to an exacerbation of life-threatening conditions and chronic diseases. Despite this, the traditional focus of public health systems has been on communicable diseases. To address this challenge, disaster and health planners require access to repeatable and measurable methods to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
Propose a repeatable and measurable method for ranking and prioritizing the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
The research began with identifying the risk disasters pose to people with life-threatening and chronic diseases. The data gathered was then used to develop indicators and explore the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize the needs before, during, and after a disaster.
This research found people at greatest risk are those with underlying cardiovascular and respiratory diseases, unstable diabetes, renal diseases, and those undergoing cancer treatment. A sustainable method to help address this problem is to expand the use of DisasterAWARE™ (All-hazard Warnings, Analysis, and Risk Evaluation) to rank and prioritize needs at national and sub-national levels.
DisasterAWARE™ has been successfully applied to the assessment and prioritization of disaster risk and humanitarian assistance needs in Southeast Asia (ASEAN, Viet Nam), Central America (Guatemala, El Salvador, Honduras, Nicaragua), South America (Peru), and the Caribbean (Jamaica, Dominican Republic). Using the indicators developed through this research, this proven methodology can be seamlessly and easily translated to rank and prioritize the needs of people with life-threatening and chronic diseases before, during, and after a disaster.
The building blocks of planets in planet-forming (“protoplanetary”) disks are assembled early in the lifetime of a young star. The gas disks are relatively short-lived, with a half-life of about 3 million years, as chemical reactions modify the reservoir of material from the natal molecular cloud. Spitzer Space Telescope Infrared Spectrograph (IRS) spectra of protoplanetary disks around T Tauri stars show emission from H2O and absorption from other gases, sometimes consistent with formaldehyde, H2CO , and other times consistent with formic acid, HCOOH, in the 5-7.5 μm region. SOFIA-EXES spectra of YSOs that follow up on these Spitzer-IRS studies are presented. How the gaseous features observed between 5-7.5 μm relate to those at other wavelengths is discussed. This work suggests that water and organic molecules, which are crucial for life as we know it, are present in the habitable zones of stars at a very early age [of 1-3 million years].
Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research (CSER) Consortium. The authors then negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death.
While the use of formal trauma teams is widely promoted, the literature is not clear that this structure provides improved outcomes over emergency physician delivered trauma care. The goal of this investigation was to examine if a trauma team model with a formalized, specialty-based trauma team, with specific activation criteria and staff composition, performs differently than an emergency physician delivered model. Our primary outcome was survival to discharge or 30 days.
An observational registry-based study using aggregate data from both the New Brunswick and Nova Scotia trauma registries was performed with data from April 1, 2011 to March 31, 2013. Inclusion criteria included patients 16 years-old and older who had an Injury Severity Score greater than 12, who suffered a kinetic injury and arrived with signs of life to a level-1 trauma centre.
266 patients from the trauma team model and 111 from the emergency physician model were compared. No difference was found in the primary outcome of proportion of survival to discharge or 30 days between the two systems (0.88, n=266 vs. 0.89, n=111; p=0.8608).
We were unable to detect any difference in survival between a trauma team and an emergency physician delivered model.
The acute effects of active and seated video gaming on energy intake (EI), blood glucose, plasma glucagon-like peptide-1 (GLP-17–36) and subjective appetite (hunger, prospective food consumption and fullness) were examined in 8–11-year-old boys. In a randomised, crossover manner, twenty-two boys completed one 90-min active and one 90-min seated video gaming trial during which food and drinks were provided ad libitum. EI, plasma GLP-17–36, blood glucose and subjective appetite were measured during and following both trials. Time-averaged AUC blood glucose was increased (P=0·037); however, EI was lower during active video gaming (1·63 (sem 0·26) MJ) compared with seated video gaming (2·65 (sem 0·32) MJ) (P=0·000). In a post-gaming test meal 1 h later, there were no significant differences in EI between the active and seated gaming trials. Although estimated energy expenditure was significantly higher during active video gaming, there was still no compensation for the lower EI. At cessation of the trials, relative EI (REI) was significantly lower following active video gaming (2·06 (sem 0·30) MJ) v. seated video gaming (3·34 (sem 0·35) MJ) (P=0·000). No significant differences were detected in time-averaged AUC GLP-17–36 or subjective appetite. At cessation of the active video gaming trial, EI and REI were significantly less than for seated video gaming. In spite of this, the REI established for active video gaming was a considerable amount when considering the total daily estimated average requirement for 8–11-year-old boys in the UK (7·70 MJ).
The present study examined the acute effects of active gaming on energy intake (EI) and appetite responses in 8–11-year-old boys in a school-based setting. Using a randomised cross-over design, twenty-one boys completed four individual 90-min gaming bouts, each separated by 1 week. The gaming bouts were (1) seated gaming, no food or drink; (2) active gaming, no food or drink; (3) seated gaming with food and drink offered ad libitum; and (4) active gaming with food and drink offered ad libitum. In the two gaming bouts during which foods and drinks were offered, EI was measured. Appetite sensations – hunger, prospective food consumption and fullness – were recorded using visual analogue scales during all gaming bouts at 30-min intervals and at two 15-min intervals post gaming. In the two bouts with food and drink, no significant differences were found in acute EI (MJ) (P=0·238). Significant differences were detected in appetite sensations for hunger, prospective food consumption and fullness between the four gaming bouts at various time points. The relative EI calculated for the two gaming bouts with food and drink (active gaming 1·42 (sem 0·28) MJ; seated gaming 2·12 (sem 0·25) MJ) was not statistically different. Acute EI in response to active gaming was no different from seated gaming, and appetite sensations were influenced by whether food was made available during the 90-min gaming bouts.
Should children ever have genetic testing for adultonset conditions? For the last two decades, there have been general recommendations from professional organizations that discourage such testing. Until recently, such testing was only plausible in the context of a family history of a Mendelian condition that might prompt the parents (or an adolescent) to request testing for the adult-onset condition present within the family. In this context there has been a gradual shift in the direction of suggesting parents should have greater discretion to obtain such testing after careful consideration of risks and benefits by the family and the health care provider.
The debate about how to manage individual research results and incidental findings in genetic and genomic research has focused primarily on what information, if any, to offer back to research participants. However, increasing controversy surrounds the question of whether researchers have any responsibility to offer a participant’s results (defined here to include both individual research results and incidental findings) to the participant’s relatives, including after the participant’s death. This question arises in multiple contexts, including when researchers discover a result with potentially important health implications for genetic relatives, when a participant’s relatives ask a researcher whether any research results about the participant have implications for their own health or reproductive planning, when a participant’s relative asks whether any of the participant’s results have implications for a child’s health, and when the participant is deceased and the participant’s relatives seek information about the participant’s genetic results in order to address their own health or reproductive concerns.
In May 2013 the Democratic Republic of the Congo (DRC) announced that construction of the world’s largest hydroelectric project will begin in October 2015. Upon completion, according to the DRC, the project will bring electricity to half the African continent. With funding from South Africa, the World Bank, the African Development Bank, and others, the U.S.$80 billion Grand Inga Hydroelectric project will construct a 44,000 megawatt (MW) dam anchored to a new transmission network able to distribute electricity to all four of sub-Saharan Africa’s regional electricity power pools. While the dam promises to bring electricity to many millions of Africans who currently lack access, the project also poses risks to the citizens and environment of the DRC. To assess the complex tradeoffs, this article evaluates four dimensions that are part of an energy security framework: availability, affordability, efficiency, and stewardship. In doing so, it explores some of the governance challenges that arise in managing such a “mega-project.” The analysis also reveals tensions between national and regional energy security. It presents evidence that, under certain assumptions, the pursuit of enhanced security at the regional level may result in a net security loss for the DRC. Finally, the article provides suggestions for enhancing the decision-making process of those designing related national and regional energy strategies.
We report the results of a field experiment conducted in New York City during the 2013 election cycle, examining the impact of nonpartisan messages on donations from small contributors. Using information from voter registration and campaign finance records, we built a forecasting model to identify voters with an above-average probability of donating. A random sample of these voters received one of four messages asking them to donate to a candidate of their choice. Half of these treatments reminded voters that New York City's campaign finance program matches small donations with public funds. Candidates’ financial disclosures to the city's Campaign Finance Board reveal that only the message mentioning policy (in generic terms) increased donations. Surprisingly, reminding voters that matching funds multiplied the value of their contribution had no effect. Our experiment sheds light on the motivations of donors and represents the first attempt to assess nonpartisan appeals to contribute.