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Building on earlier work identifying Biologically Important Areas (BIAs) for cetaceans in U.S. waters (BIA I), we describe the methodology and structured expert elicitation principles used in the “BIA II” effort to update existing BIAs, identify and delineate new BIAs, and score BIAs for 25 cetacean species, stocks, or populations in seven U.S. regions. BIAs represent areas and times in which cetaceans are known to concentrate for activities related to reproduction, feeding, and migration, as well as known ranges of small and resident populations. In this BIA II effort, regional cetacean experts identified the full extent of any BIAs in or adjacent to U.S. waters, based on scientific research, Indigenous knowledge, local knowledge, and community science. The new BIA scoring and labeling system improves the utility and interpretability of the BIAs by designating an overall Importance Score that considers both (1) the intensity and characteristics underlying an area’s identification as a BIA; and (2) the quantity, quality, and type of information, and associated uncertainties upon which the BIA delineation and scoring depend. Each BIA is also scored for boundary uncertainty and spatiotemporal variability (dynamic, ephemeral, or static). BIAs are region-, species-, and time-specific, and may be hierarchically structured where detailed information is available to support different scores across a BIA. BIAs are compilations of the best available science and have no inherent regulatory authority. BIAs may be used by international, federal, state, local, or Tribal entities and the public to support planning and marine mammal impact assessments, and to inform the development of conservation and mitigation measures, where appropriate under existing authorities. Information provided online for each BIA includes: (1) a BIA map; (2) BIA scores and label; (3) a metadata table detailing the data, assumptions, and logic used to delineate, score, and label the BIA; and (4) a list of references used in the assessment. Regional manuscripts present maps and scores for the BIAs, by region, and narratives summarizing the rationale and information upon which several representative BIAs are based. We conclude with a comparison of BIA II to similar international efforts and recommendations for improving future BIA assessments.

The lymphatic vasculature of the liver is vital for liver function as it maintains fluid and protein homeostasis and is important for immune cell transport to the lymph node. Chronic liver disease is associated with increased expression of inflammatory mediators including oxidized low-density lipoprotein (oxLDL). Intrahepatic levels of oxLDL are elevated in nonalcoholic fatty liver disease (NAFLD), chronic hepatitis C infection (HCV), alcohol-associated liver disease (ALD), and cholestatic liver diseases. To determine if liver lymphatic function is impaired in chronic liver diseases, in which increased oxLDL has been documented, we measured liver lymphatic function in murine models of NAFLD, ALD and primary sclerosing cholangitis (PSC). We found that Mdr2−/− (PSC), Lieber-DeCarli ethanol fed (ALD) and high fat and high cholesterol diet fed (NAFLD) mice all had a significant impairment in the ability to traffic FITC labeled dextran from the liver parenchyma to the liver draining lymph nodes. Utilizing an in vitro permeability assay, we found that oxLDL decreased the permeability of lymphatic endothelial cells (LEC)s, but not liver sinusoidal endothelial cells (LSEC)s. Here we demonstrate that LECs and LSECs differentially regulate SRC-family kinases, MAPK kinase and VE-Cadherin in response to oxLDL. Furthermore, Vascular Endothelial Growth Factor (VEGF)C or D (VEGFR-3 ligands) appear to regulate VE-Cadherin expression as well as decrease cellular permeability of LECs in vitro and in vivo after oxLDL treatment. These findings suggest that oxLDL acts to impede protein transport through the lymphatics through tightening of the cell-cell junctions. Importantly, engagement of VEGFR-3 by its ligands prevents VE-Cadherin upregulation and improves lymphatic permeability. These studies provide a potential therapeutic target to restore liver lymphatic function and improve liver function.

This scoping review will examine ways in which regulatory measures have been used to create healthier food retail environments. It aims to identify the types of regulatory measures described in the literature as being used to create healthier food retail environments, including policy, taxes, acts and ordinances to more informal regulatory measures, including local council interventions or negotiated arrangements between health actors and food retail outlets with the aim of creating healthier food retail. This scoping review will focus on regulatory measures that have been embedded in policy or formal documentation and will exclude those that have been implemented as part of a research trial.

A collection of methodology questions, with answers, frequently asked by density surface modelers during marine mammal modeling projects

NOAA Technical Memorandum NMFS-AFSC ; 393

Summary Background Evidence is mounting that price discounts can be effective in improving diet. This study examined the effectiveness of a 20% price discount on food and drink purchases with and without consumer education in remote Indigenous Australia. Methods A 20% discount on fruit, vegetables, water, and artificially sweetened soft drinks was applied for 24 weeks in 20 communities in remote Indigenous Australia where the community store was managed by the Arnhem Land Progress Aboriginal Corporation (ALPA) or Outback Stores (OBS) in a stepped-wedge randomised trial. Communities were randomly allocated to a fixed framework of five sets of four stratified by store association; ten stores (two in each set) were randomly assigned to receive consumer education. A store from each of the ALPA and OBS store groups (contained in separate opaque envelopes) was selected, and stores in turn continued to be consecutively allocated to the fixed store set framework, starting with the first store slot in the first store set, until all stores had been allocated. The effect of the discount on the weight of fruit and vegetables purchased (the primary endpoint) was assessed using weekly store sales data and mixed models per protocol. We did sensitivity analyses by repeating the analyses with the outliers included and repeating the analyses for the primary outcome measure removing each store one at a time. This trial was registered with Australian New Zealand Clinical Trials Registry, number ACTRN12613000694718. Findings Weekly store sales data on all food and drink products sold in 20 stores were collected from July 1, 2012, to Dec 28, 2014. Price discount alone was associated with a 12·7% (95% CI 4·1–22·1) increase in purchases in grams of fruit and vegetables combined (primary outcome), and a 19·8% (6·2–35·1) increase post discount (after vs before); an effect of 12 g and 18 g per capita per day. Sensitivity analyses did not modify the results for the primary outcome measure. Interpretation A 20% discount can only increase fruit and vegetable purchases to help protect against obesity and diet related disease to a certain extent. Large discounts might have a greater impact than small discounts. Creative merchandising approaches to consumer education could also be considered alongside fiscal interventions to achieve marked improvements in diet. Funding Australian National Health and Medical Research Council.

Objective: Determine how very-remote Indigenous community (RIC) food and beverage (F&B) turnover quantities and associated dietary intake estimates derived from only stores, compare with values derived from all community F&B providers. Methods: F&B turnover quantity and associated dietary intake estimates (energy, micro/macronutrients and major contributing food types) were derived from 12-months transaction data of all F&B providers in three RICs (NT, Australia). F&B turnover quantities and dietary intake estimates from only stores (plus only the primary store in multiple-store communities) were expressed as a proportion of complete F&B provider turnover values. Food types and macronutrient distribution (%E) estimates were quantitatively compared. Results: Combined stores F&B turnover accounted for the majority of F&B quantity (98.1%) and absolute dietary intake estimates (energy [97.8%], macronutrients [≥96.7%] and micronutrients [≥83.8%]). Macronutrient distribution estimates from combined stores and only the primary store closely aligned complete provider estimates (≤0.9% absolute). Food types were similar using combined stores, primary store or complete provider turnover. Conclusions and implications: Evaluating combined stores F&B turnover represents an efficient method to estimate total F&B turnover quantity and associated dietary intake in RICs. In multiple-store communities, evaluating only primary store F&B turnover provides an efficient estimate of macronutrient distribution and major food types. Refereed/Peer-reviewed

ObjectiveTo consider the plausible nutritional impacts of fluctuations in money availability within an income cycle for remote Indigenous Australians.DesignCommunity-level dietary intake (energy, micro/macronutrients) and expenditure on foods and beverages (F&B) were estimated over one year for three remote Indigenous Australian communities (Northern Territory, Australia) using monthly F&B transaction data. F&B that were likely to be consumed during a period within an income cycle when money was relatively limited (low money period (LMP) foods) were identified by panel consensus and scenario modelling was conducted to simulate the nutritional outcomes of a range of F&B selection responses to having an LMP.ResultsAll scenarios resulted in reduced diet quality during the LMP relative to overall average diet values. Protein and fat energy percentages were reduced and carbohydrate energy percentage increased. Despite reduced expenditure, declines in energy intake were typically buffered due to the reduced energy cost ($AU/MJ) of the LMP diet. The micronutrient profile of the LMP diet was substantially poorer, such that additional key micronutrients dropped below population-weighted Estimated Average Requirements/Adequate Intakes.ConclusionsThe modelling undertaken herein suggests that even a short period of low money within an income cycle may noticeably contribute to the reduced diet quality of remote Indigenous Australians and exacerbate lifestyle disease risk. Dietary strategies that are designed to respond to diets and expenditure during different income cycle periods, rather than the overall average diet and expenditure, should be considered for improving diet quality and reducing cardiometabolic disease risk in remote Indigenous Australians.

Objective: Retrospectively evaluate food price discounts in remote Aboriginal community stores. Methods: Four price discount strategies of 10% were designed in 2010, aiming to influence grocery, fruit, vegetables and diet soft-drink sales. This natural experiment across a group of stores was evaluated using an explanatory, sequential mixed method design through analysis of store point-of-sale, document, observation and interview data. The outcome was measured by change in: 1) percentage of grocery sales to total food and beverage; 2) fruit and vegetable sales; and 3) diet soft-drink sales. Qualitative data enabled the interpretation of outcomes through understanding perceived success and benefits, and enablers and barriers to implementation. Results: Eighteen community stores and 54 informants participated. While targeted price discounts were considered important to improving health, no discernible effect was evident, due to inadequate design and communication of discount promotion, and probably inadequate magnitude of discount. Conclusions: Strategy impact on food and beverage sales was limited by promotion and magnitude of discount. Implication for Public Health: This study demonstrates key factors and commitment required to design, communicate, implement and monitor strategies to improve health in this challenging remote retail context. Evaluation of natural experiments can contribute evidence to policy-making. Refereed/Peer-reviewed

Objective: To estimate the cost-effectiveness of fiscal measures applied in remote community food stores for Aboriginal Australians. Methods: Six price discount strategies on fruit, vegetables, diet drinks and water were modelled. Baseline diet was measured as 12 months' actual food sales data in three remote Aboriginal communities. Discount-induced changes in food purchases were based on published price elasticity data while the weight of the daily diet was assumed constant. Dietary change was converted to change in sodium and energy intake, and body mass index (BMI) over a 12-month period. Improved lifetime health outcomes, modelled for the remote population of Aboriginal and Torres Strait Islanders, were converted to disability adjusted life years (DALYs) saved using a proportional multistate lifetable model populated with diet-related disease risks and Aboriginal and Torres Strait Islander rates of disease. Results: While dietary change was small, five of the six price discount strategies were estimated as cost-effective, below a $50,000/DALY threshold. Conclusion: Stakeholders are committed to finding ways to reduce important inequalities in health status between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. Price discounts offer potential to improve Aboriginal and Torres Strait Islander health. Verification of these results by trial-based research coupled with consideration of factors important to all stakeholders is needed. Refereed/Peer-reviewed

Background Indigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts – much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions. This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities. Methods/Design We will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed. Discussion This study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613000694718