Development of an Accelerometer-Linked Online Intervention System to Promote Physical Activity in Adolescents

Most adolescents do not achieve the recommended levels of moderate-to-vigorous physical activity (MVPA), placing them at increased risk for a diverse array of chronic diseases in adulthood. There is a great need for scalable and effective interventions that can increase MVPA in adolescents. Here we report the results of a measurement validation study and a preliminary proof-of-concept experiment testing the impact of Zamzee, an accelerometer-linked online intervention system that combines proximal performance feedback and incentive motivation features to promote MVPA. In a calibration study that parametrically varied levels of physical activity in 31 12-14 year-old children, the Zamzee activity meter was shown to provide a valid measure of MVPA (sensitivity in detecting MVPA = 85.9%, specificity = 97.5%, and r = .94 correspondence with the benchmark RT3 accelerometer system; all p < .0001). In a subsequent randomized controlled multi-site experiment involving 182 middle school-aged children assessed for MVPA over 6 wks, intent-to-treat analyses found that those who received access to the Zamzee intervention had average MVPA levels 54% greater than those of a passive control group (p < 0.0001) and 68% greater than those of an active control group that received access to a commercially available active videogame (p < .0001). Zamzee’s effects on MVPA did not diminish significantly over the course of the 6-wk study period, and were statistically significant in both females and males, and in normal- vs. high-BMI subgroups. These results provide promising initial indications that combining the Zamzee activity meter with online proximal performance feedback and incentive motivation features can positively impact MVPA levels in adolescents.     

Dietary Intervention Causes Redistribution of Zinc in Obese Adolescents

Obese people tend to have low zinc circulation levels; this is not always related to zinc intake but can reflect the distribution of zinc in relation to the proportion of body fat and factors related to the inflammatory processes that cause obesity. The purpose of this study was to assess zinc distribution in 15 obese adolescent girls before and after a nutritional orientation program. Participants ranged from 14 to 18 years old (postpubescent) and had a body fat percent (BF%) of >35 %. Zinc nutritional status and other zinc-dependent parameters, such as superoxide dismutase (SOD) and insulin levels, were assessed by biochemical analysis of plasma and erythrocytes, salivary sediment, and urine. Samples were collected before and after 4 months of dietary intervention. Dual energy X-ray absorptiometry (DXA) was used to verify BF% both at the beginning and at the end of the study. Food consumption was assessed in ten individual food questionnaires throughout the study; food groups were separated on the questionnaires in the same way as suggested by some authors to develop the Healthy Eating Index (HEI) but with the addition of zinc. After 4 months of nutritional orientation, 78 % of the participants showed a decrease in BF%. Intraerythrocytic zinc increased over the study period, while salivary sediment zinc, SOD, insulin, and Zn urinary24 h/creatinine all decreased (p?<?0.05). There was no difference in zinc intake throughout the study but participants did increase their consumption of fruits, dairy, and meats during the study (p?<?0.05). There were inverse and statistically significant correlations between the increased levels of intraerythrocytic zinc and decreased levels of SOD. There was also a statistically significant correlation between BF% and Zn urinary 24h/creatinine, and SOD. All these parameters were diminished at the end of the study. The dietary intervention for obese adolescent girls is effective with decrease of BF that led to the redistribution of zinc in the body as shown by the changes in erythrocytes, plasma, salivary, urine zinc, as well as the complementary parameters of insulin and SOD. These changes were not affected by zinc intake.     

Psychometric Assessment of the Rat Grimace Scale and Development of an Analgesic Intervention Score

Our limited ability to assess spontaneous pain in rodent models of painful human conditions may be associated with a translational failure of promising analgesic compounds in to clinical use. If measurement of spontaneous pain behaviours can be used to generate an analgesic intervention score their use could expand to guide the use of analgesics, as mandated by regulatory bodies and ethical and welfare obligations. One such measure of spontaneous pain, the Rat Grimace Scale (RGS), has recently been described and shown to exhibit reliability. However, reliability of measurement scores is context and content specific, and further testing required to assess translation to a heterogenous setting (different model, raters, environment). The objectives of this study were to perform reliability testing with the Rat Grimace Scale in a heterogenous setting and generate an analgesic intervention score for its use. In a randomised, blinded study, sixteen adult female rats received one of three analgesia treatments (0.05 mg/kg buprenorphine subcutaneously, 1 mg/kg meloxicam subcutaneously, 0.2 mg/kg oral buprenorphine in jelly) peri-operatively (telemetry unit implantation surgery). Rats were video-recorded (before, 1–6 and 12 hours post-operatively) and images collected for independent scoring by three blinded raters using the RGS, and five experts based on “pain/no pain” assessment. Scores were used to calculate inter- and intra-rater reliability with an intraclass correlation coefficient and generate an analgesic intervention score with receiver operating characteristic curve analysis. The RGS scores showed very good inter- and intra-rater reliability (0.85 [0.78–0.90 95% CI] and 0.83 [0.76–0.89], respectively). An analgesic intervention threshold of greater than 0.67 was determined. These data demonstrate that the RGS is a useful tool which can be successfully employed in a heterogenous setting, and has the potential to guide analgesic intervention.     

Enhancing Causal Assessment of Estuarine Fishkills Using Graphical Models

It is not possible to determine the causal relationship between fishkills and the toxic dinoflagellate Pfiesteria piscicida in the Neuse River Estuary, North Carolina, using observational data on these two variables alone. However, consideration of a third variable, indicating the presence of a broader class of more easily measured Pfiesteria-like organisms (PLOs), leads to causal model structures from which the nature of this relationship can be distinguished. We use reported field data to evaluate alternative models and find that the suggestion that toxic Pfiesteria cause fishkills is inconsistent with observation. The data are more indicative of a model in which PLOs (including potentially toxic Pfiesteria) are stimulated to become actively toxic by the presence of already dead or dying fish. Laboratory experiments performed to date do not provide evidence contradictory to this finding. However, neither can the existence of a common cause of both Pfiesteria toxicity and fishkills be ruled out. The differing implications for ecosystem management suggest that these causal associations should be further investigated through additional modeling and data collection efforts. Graphical methods of model construction and evaluation can assist in this process. Received 22 May 2002; accepted 3 October 2002.     

Human Exposure to Malathion during a Possible Vector-Control Intervention against West Nile Virus. I: Methodological Framework for Exposure Assessment

The arrival of West Nile Virus in North America prompted public health authorities to develop intervention plans in order to prevent the propagation of this mosquito-transmitted pathogen. The last-resort measure proposed by the Government of Quebec (Canada) is the large-scale application of insecticides by aerial or ground Ultra Low Volume (ULV) treatment. This article presents an assessment of the exposure to malathion and its metabolite, malaoxon, for a population where an eventual application of malathion would occur. Each exposure pathway is detailed by describing the equation and every conservative assumption. This methodological framework was then used with the aim of assessing the toxicological risk based on a probabilistic approach (see companion article, this issue). In the current study, a daily absorbed dose of the mixture of malathion and malaoxon was estimated in terms of “malathion equivalent dose.” Each exposure pathway following a single event of ground or aerial ULV spraying of malathion was investigated for the population, classified into five age groups. Dermal exposure to dislodgeable residues on turf, foliage, and hard surfaces was estimated to be the most important source of exposure compared to any other pathways; it accounts for 63% to 98% of the estimated cumulative absorbed doses. The hand-to-mouth behavior of toddlers may also contribute considerably to their “malathion-equivalent” exposure (i.e., approximately 15% of the cumulative dose). Otherwise, the current study shows that ground ULV spraying is the type of treatment that may induce lower exposure, because the predicted concentration of malathion on turf and foliar surfaces is less than the one predicted for aerial ULV spraying.     

Effectiveness of a Randomized School-Based Intervention Involving Families and Teachers to Prevent Excessive Weight Gain among Adolescents in Brazil

Objective

To evaluate the effectiveness of a school-based intervention involving the families and teachers that aimed to promote healthy eating habits in adolescents; the ultimate aim of the intervention was to reduce the increase in body mass index (BMI) of the students.

Design

Paired cluster randomized school-based trial conducted with a sample of fifth graders.

Setting

Twenty classes were randomly assigned into either an intervention group or a control group.

Participants

From a total of 574 eligible students, 559 students participated in the study (intervention: 10 classes with 277 participants; control: 10 classes with 282 participants). The mean age of students was 11 years.

Intervention

Students attended 9 nutritional education sessions during the 2010 academic year. Parents/guardians and teachers received information on the same subjects.

Main Outcome Measurement

Changes in BMI and percentage of body fat.

Results

Intention-to-treat analysis showed that changes in BMI were not significantly different between the 2 groups (β = 0.003; p = 0.75). There was a major reduction in the consumption of sugar-sweetened beverages and cookies in the intervention group; students in this group also consumed more fruits.

Conclusion

Encouraging the adoption of healthy eating habits promoted important changes in the adolescent diet, but this did not lead to a reduction in BMI gain. Strategies based exclusively on the quality of diet may not reduce weight gain among adolescents.

Trial Registration

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01046474","term_id":"NCT01046474"}}NCT01046474.     

Adapting to an Uncertain World: Cognitive Capacity and Causal Reasoning with Ambiguous Observations

Ambiguous causal evidence in which the covariance of the cause and effect is partially known is pervasive in real life situations. Little is known about how people reason about causal associations with ambiguous information and the underlying cognitive mechanisms. This paper presents three experiments exploring the cognitive mechanisms of causal reasoning with ambiguous observations. Results revealed that the influence of ambiguous observations manifested by missing information on causal reasoning depended on the availability of cognitive resources, suggesting that processing ambiguous information may involve deliberative cognitive processes. Experiment 1 demonstrated that subjects did not ignore the ambiguous observations in causal reasoning. They also had a general tendency to treat the ambiguous observations as negative evidence against the causal association. Experiment 2 and Experiment 3 included a causal learning task requiring a high cognitive demand in which paired stimuli were presented to subjects sequentially. Both experiments revealed that processing ambiguous or missing observations can depend on the availability of cognitive resources. Experiment 2 suggested that the contribution of working memory capacity to the comprehensiveness of evidence retention was reduced when there were ambiguous or missing observations. Experiment 3 demonstrated that an increase in cognitive demand due to a change in the task format reduced subjects’ tendency to treat ambiguous-missing observations as negative cues.     

The Wagon Wheel Illusions and models of orientation selection

We present an analysis of the Wagon Wheel Illusions—classic psychophysical phenomena—in the context of a neural network model of orientation selectivity in the visual system. We find that both the continuous Wagon Wheel Illusion (c-WWI) and the standard, stroboscopic Wagon Wheel Illusion (WWI) can be explained by a recurrent model in which the cortex provides both excitatory and inhibitory feedback to a weakly tuned input from the lateral geniculate nucleus. Comparison of data from recent psychophysics experiments with theoretical predictions derived from the network dynamics leads to excellent agreement. Conversely, this agreement confirms the validity of the model and highlights the fact that the Wagon Wheel Illusion can serve as a useful probe of the human striate cortex. We find that the WWI results from phase-locking in the visual system and that a circle map determines the dynamics of the illusion. Furthermore, our results suggest that the c-WWI is a consequence of continuous processing and cannot be used to support claims of discrete processing by the visual system.     

Assessment of a DNA vaccine encoding an anchored-glycosylphosphatidylinositol tegumental antigen complexed to protamine sulphate on immunoprotection against murine schistosomiasis

Protamine sulphate/DNA complexes have been shown to protect DNA from DNase digestion in a lipid system for gene transfer. A DNA-based vaccine complexed to protamine sulphate was used to induce an immune response against Schistosoma mansoni anchored-glycosylphosphatidylinositol tegumental antigen in BALB/c mice. The protection elicited ranged from 33 to 44%. The spectrum of the elicited immune response induced by the vaccine formulation without protamine was characterized by a high level of IgG (IgG1> IgG2a). Protamine sulphate added to the DNA vaccine formulation retained the green fluorescent protein encoding-plasmid longer in muscle and spleen. The experiments in vivo showed that under protamine sulphate effect, the scope of protection remained unchanged, but a modulation in antibody production (IgG1= IgG2a) was observed.     

Design and Implementation of Website Information Disclosure Assessment System

Internet application technologies, such as cloud computing and cloud storage, have increasingly changed people’s lives. Websites contain vast amounts of personal privacy information. In order to protect this information, network security technologies, such as database protection and data encryption, attract many researchers. The most serious problems concerning web vulnerability are e-mail address and network database leakages. These leakages have many causes. For example, malicious users can steal database contents, taking advantage of mistakes made by programmers and administrators. In order to mitigate this type of abuse, a website information disclosure assessment system is proposed in this study. This system utilizes a series of technologies, such as web crawler algorithms, SQL injection attack detection, and web vulnerability mining, to assess a website’s information disclosure. Thirty websites, randomly sampled from the top 50 world colleges, were used to collect leakage information. This testing showed the importance of increasing the security and privacy of website information for academic websites.     

Serological Evidence of an Early Seroconversion to Simian Virus 40 in Healthy Children and Adolescents

At present Simian virus 40 (SV40) infection in humans appears to be transmitted independently from early contaminated vaccines. In order to test the spread of SV40 infection in children, an immunologic assay employing specific SV40 synthetic peptides corresponding to its viral protein (VP) antigens was employed to estimate the seroprevalence of this polyomavirus in Italian infants and adolescents. Serum samples from 328 children and adolescents, up to 17 years, were investigated. Serum antibodies against SV40 VPs were detected by indirect enzyme-linked immunosorbent assays. The seroprevalence of this polyomavirus was calculated after stratifying the subjects by age. Anti-viral capsid protein 1-2-3 SV40 IgG antibodies were detected in 16% of the study participants. The prevalence of antibodies against SV40 VPs tended to increase with age in children, up to 10 year old (21%). Then, in the cohort of individuals aged 11–17 years, the prevalence decreased (16%). A higher prevalence rate (23%) of SV40 VP antibodies was detected in the cohorts of 1–3 year and 7–10 year old children, than in children and adolescents of the other age groups. This age corresponds to children starting nursery and primary school, respectively, in Italy. IgM antibodies against SV40 VP mimotopes were detected in 6–8 month old children suggesting that SV40 seroconversion can occur early in life. SV40 VP antibodies are present at low prevalence in Italian children (16%), suggesting that SV40 infection, although acquired early in life, probably through different routes, is not widespread. The low SV40 seroprevalence suggests that SV40 is less transmissible than other common polyomaviruses, such as BKV and JCV. Alternatively, our immunologic data could be due to another, as yet undiscovered, human polyomavirus closely related to SV40.     

Cost-Effectiveness of an Intervention to Reduce Emergency Re-Admissions to Hospital among Older Patients

Background

The objective is to estimate the cost-effectiveness of an intervention that reduces hospital re-admission among older people at high risk. A cost-effectiveness model to estimate the costs and health benefits of the intervention was implemented.

Methodology/Principal Findings

The model used data from a randomised controlled trial conducted in an Australian tertiary metropolitan hospital. Participants were acute medical admissions aged >65 years with at least one risk factor for re-admission: multiple comorbidities, impaired functionality, aged >75 years, recent multiple admissions, poor social support, history of depression. The intervention was a comprehensive nursing and physiotherapy assessment and an individually tailored program of exercise strategies and nurse home visits with telephone follow-up; commencing in hospital and continuing following discharge for 24 weeks. The change to cost outcomes, including the costs of implementing the intervention and all subsequent use of health care services, and, the change to health benefits, represented by quality adjusted life years, were estimated for the intervention as compared to existing practice. The mean change to total costs and quality adjusted life years for an average individual over 24 weeks participating in the intervention were: cost savings of $333 (95% Bayesian credible interval $ -1,932∶1,282) and 0.118 extra quality adjusted life years (95% Bayesian credible interval 0.1∶0.136). The mean net-monetary-benefit per individual for the intervention group compared to the usual care condition was $7,907 (95% Bayesian credible interval $5,959∶$9,995) for the 24 week period.

Conclusions/Significance

The estimation model that describes this intervention predicts cost savings and improved health outcomes. A decision to remain with existing practices causes unnecessary costs and reduced health. Decision makers should consider adopting this program for elderly hospitalised patients.     

Causal Assessment of Biological Impairment in the Little Floyd River,Iowa, USA

An assessment of biological impairment in the Little Floyd River (Iowa, USA) was based on evidence of three characteristics of causation: co-occurrence, preceding causation, and sufficiency. Evidence of the physical interaction of the probable causes and the biota, resulting alterations to the biota, as well as the time order of the cause and the effect were consistent within the assessment, but the evidence for these causal characteristics did not discriminate among probable causes or other causes. Deposited sediment, low dissolved oxygen, heat stress, and ammonia toxicity are the probable causes of impaired biological condition in the Little Floyd River compared with other rivers in the ecoregion. Less likely causes are suspended sediment, altered basal food resources, and flow alteration. Very unlikely causes are pH shifts, total dissolved solids, Cyprinus carpio (an invasive species), metal toxicity, and pesticides. Data were insufficient to assess salinity or other toxicants. The assessment was used to develop a recovery plan for the stream. This assessment demonstrates that, even when there are many candidate causes and uncertainties are substantial, the probable causes of biological impairments can be determined with enough certainty to inform decision-making to address environmental problems.     

Evidence for a Causal Link between Exposure to an Insecticide Formulation and Declines in Catch of Atlantic Salmon

We report a case study showing relationships between historical insecticide applications (1973 to 1990) of an aminocarb formulation (Matacil® 1.8D ) containing 4-nonylphenol (4-NP) and catch data for Atlantic salmon (Salmo salar) populations. To address the hypothesis that Matacil® 1.8D caused reductions in Atlantic salmon catch, seven epidemiological criteria are used to evaluate causality between the stressor and effect. These criteria include: strength of association; consistency of association; specificity of association; time order; biological gradient; experimental support; and biological plausibility. We conclude that the general weight-of-evidence supporting the seven epidemiological criteria is consistent with a causal relationship between declines in salmon catch and Matacil® 1.8D exposure during parr-smolt transformation (PST). If the effects exerted by 4-NP are due to its activity as a weak estrogen, then hormonal activity stemming from other sources (e.g., domestic sewage, agricultural, industrial) might influence present day salmon populations.     

Illusions and realities of the ecosystem approach to the study and management of marine and oceanic biological resources

The scientific and applied problem of the ecosystem approach to the management of marine biological resources arose during the last quarter of the 20th century as a component of the Rational Nature Use Concept. This occurred mostly because the existing fishery rules and concepts of the optimum yield theory, which were introduced in the practice of fishery regulations, have proven to be insufficiently effective to conserve biological resources and provide stability of the fishery resource base. The ecosystem approach to biological-resource management implies a change of the autecological studies of commercial stock units (populations) and the managerial single-species models for the sustainable-sized management, taking the impacts of the fishery on marine ecosystems into account, as well as those of marine ecosystems on the fishery. At present, the ecosystem-based biological-resource management includes a complex of ecological topics and issues, such as biodiversity conservation, effect of climate changes, sustainability of stocks and communities, interspecies relationships, multi-species fishery, conservation of rare species, protection of especially important water bodies and landscapes, biotope degradation, anti-pollution measures, invasive species, ranching aquaculture, genetic diversity, etc. The main current problem, besides insufficient knowledge of many of these issues, is how to practically integrate such a large number of parameters into the management system. Thus, the complicated and long-term problem of ecosystem management of marine biological resources should be solved step-by-step, following the progress in the technical capabilities and concepts of natural processes. As well, certain better-studied elements of the ecosystem approach should be implemented first in the practice of management, while taking the regional specifics into account.     

Treatment and Follow-up of Adolescents Addicted to Heroin

A survey of the first year''s referral of heroin-addicted adolescents was undertaken exactly two years after the opening of a special treatment unit. Out of 130 patients presenting 78 were selected for treatment and were followed up. The drug-taking pattern of this group is reported. At the time of the survey 27% were assessed as off all addictive drugs.     

Implementation of an experimental and computational tool set to study protein-mAb interactions

This work focused on the development of a combined experimental and computational tool set to study protein-mAb interactions. A model protein library was first screened using cross interaction chromatography to identify proteins with the strongest retention. Fluorescence polarization was then employed to study the interactions and thermodynamics of the selected proteins—lactoferrin, pyruvate kinase, and ribonuclease B with the mAb. Binding affinities of lactoferrin and pyruvate kinase to the mAb were seen to be relatively salt insensitive in the range examined. Further, a strong entropic contribution was observed, suggesting the importance of hydrophobic interactions. On the other hand, ribonuclease B-mAb binding was seen to be enthalpically driven and salt sensitive, indicating the importance of electrostatic interactions. Protein–protein docking was then carried out and the results identified the CDR region on the mAb as an important binding site for all three proteins. The binding interfaces identified for the mAb-lactoferrin and mAb-pyruvate kinase systems were found to contain complementary hydrophobic and oppositely charged clusters on the interacting regions which were indicative of both hydrophobic and electrostatic interactions. On the other hand, the binding site on ribonuclease B was predominantly positively charged with minimal hydrophobicity. This resulted in an alignment with negatively charged clusters on the mAb, supporting the contention that these interactions were primarily electrostatic in nature. Importantly, these computational results were found to be consistent with the fluorescence polarization data and this combined approach may have utility in examining mAb-HCP interactions which can often complicate the downstream processing of biologics. © 2019 American Institute of Chemical Engineers     

Two‐year Follow‐up in 21,784 Overweight Children and Adolescents With Lifestyle Intervention

Although randomized controlled trials demonstrated the long‐term efficacy of lifestyle interventions in overweight children, the effects of these interventions in clinical practice under real‐life conditions are largely unknown. One hundred twenty‐nine centers specialized in outpatient pediatric obesity care participated in this quality assessment. All patients presenting before the year 2006 for lifestyle intervention of at least 6 months duration in these institutions were analyzed in a 2‐year follow‐up. A total of 21,784 (45% male) overweight children and adolescents aged 2–20 years (mean BMI 30.4 kg/m², mean SDS‐BMI 2.51, mean age 12.6 years) were included in the analysis. Based on an intention‐to‐treat analysis with variables set back to baseline in lost of follow‐up, 22% of the children reduced their SDS‐BMI after 6 months, 15% after 12 months, and 7% after 24 months, but only in 24, 17, and 8% of children, respectively, complete data were available. In the five treatment centers with the best outcome (518 patients), 83% of the children reduced their overweight after 6 months, 67% after 12 months, and 51% after 24 months. Under real‐life conditions, most treatment centers cannot prove the long‐term efficacy of their interventions due to high drop‐out rate or lack of documentation. Conversely, some institutions achieved a reduction of overweight in nearly the half of their patients 24 months after baseline demonstrating the great heterogeneity in outcome. To improve the effectiveness of lifestyle interventions in real‐life studying, the process and structure quality as well as their long‐term results is urgently needed.     

Evolving Strategies, Opportunistic Implementation: HIV Risk Reduction in Tanzania in the Context of an Incentive-Based HIV Prevention Intervention

Background

Behavior change communication (BCC) interventions, while still a necessary component of HIV prevention, have not on their own been shown to be sufficient to stem the tide of the epidemic. The shortcomings of BCC interventions are partly due to barriers arising from structural or economic constraints. Arguments are being made for combination prevention packages that include behavior change, biomedical, and structural interventions to address the complex set of risk factors that may lead to HIV infection.

Methods

In 2009/2010 we conducted 216 in-depth interviews with a subset of study participants enrolled in the RESPECT study - an HIV prevention trial in Tanzania that used cash awards to incentivize safer sexual behaviors. We analyzed community diaries to understand how the study was perceived in the community. We drew on these data to enhance our understanding of how the intervention influenced strategies for risk reduction.

Results

We found that certain situations provide increased leverage for sexual negotiation, and these situations facilitated opportunistic implementation of risk reduction strategies. Opportunities enabled by the RESPECT intervention included leveraging conditional cash awards, but participants also emphasized the importance of exploiting new health status knowledge from regular STI testing. Risk reduction strategies included condom use within partnerships and/or with other partners, and an unexpected emphasis on temporary abstinence.

Conclusions

Our results highlight the importance of increasing opportunities for implementing risk reduction strategies. We found that an incentive-based intervention could be effective in part by creating such opportunities, particularly among groups such as women with limited sexual agency. The results provide new evidence that expanding regular testing of STIs is another important mechanism for providing opportunities for negotiating behavior change, beyond the direct benefits of testing. Exploiting the latent demand for STI testing should receive renewed attention as part of innovative new combination interventions for HIV prevention.