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Objectives We examined whether caregivers of children/adolescents enroled in a randomised controlled trial (RCT) of a family-centred intervention indirectly achieved reductions in body mass index (BMI), and if these were associated with changes in their children’s BMI. Methods RCT participants were New Zealand children/adolescents aged 4.8–16.8 years with BMI ≥ 98th percentile or >91st with weight-related comorbidities. Participants and accompanying caregivers were assessed at baseline, 12, and 24 months. Results Overall, caregivers’ BMI was unchanged at 12 or 24 months. Among Māori participants, reductions in caregivers’ BMI at 12 months were associated with reductions in their children’s BMI SDS at 12 (r = 0.30; p = 0.038) and 24 months (r = 0.39; p = 0.009). Further, children identifying as Māori whose caregivers’ BMI decreased at 12 months had greater BMI SDS reductions at 12 months [ −0.30 (95% CI −0.49, −0.10); p = 0.004] and 24 months [ −0.39 (95% CI −0.61, −0.16); p = 0.001] than children of caregivers with increased/unchanged BMI. Conclusions This intervention programme for children/adolescents with obesity did not indirectly reduce caregiver weight status. However, reductions in caregivers’ BMI were key to BMI SDS reductions among Māori participants. Given the intergenerational nature of obesity, our findings highlight the importance of culturally relevant, family-focused programmes to achieve clinically meaningful improvements in weight status across the family.

Obesity as a major risk factor for childhood hypertension necessitates careful blood pressure (BP) monitoring of those affected. This study aimed to compare BP classification in a cohort of children affected by obesity using tables versus digital calculations in two sets of guidelines.This study was a secondary analysis of data collected from a randomised clinical trial of a multidisciplinary life-style assessment and intervention program. Baseline data from 237 children with a body mass index99th percentile or91st percentile with weight-related comorbidities and available BP measurements were analysed. We assessed agreement between tables and algorithms in classification of elevated BP/pre-hypertension and hypertension based on the American Academy of Paediatrics (AAP) clinical practice guidelines (CPG) and the older Fourth Report using Cohen's weighted kappa. The prevalence of hypertensive diagnoses was also compared between the two guidelines.Agreement between BP tables and algorithmic calculation of percentiles was discordant, though improved in the AAP CPG compared to the Fourth Report (Cohen's kappa = 0.70 vs. 0.57, respectively). None (0%) were missed diagnoses, and 59 (24.9%) were false positives for the Fourth Report, and 0 (0%) were missed diagnoses, and 49 (20.9%) were false positives for the AAP CPG. Under the recent guidelines, there was an increase in prevalence of 6.0% (95% confidence interval (CI) 2.5-9.4%; P = 0.0001) for BP ≥90th percentile, and of 3.0% (95% CI 0.4-5.6%; p = 0.016) for hypertension (BP ≥ 95th percentile) in the cohort (18.0% and 6.8%, respectively, increased from 12.0% and 3.8%).Digital calculators over tables in clinical practice are recommended where possible to improve the accuracy of paediatric BP classification. Substantial rates of elevated BP/Hypertension were found in this cohort of children and adolescents with overweight and obesity.

Aim Expert recommendations for child/adolescent obesity include extensive investigation for weight-related comorbidities, based on body mass index (BMI) percentile cut-offs. This study aimed to estimate the cost of initial investigations for weight-related comorbidities in children/adolescents with obesity, according to international expert guidelines. Methods The annual mean cost of investigations for weight-related comorbidities in children/adolescents was calculated from a health-funder perspective using 2019 cost data obtained from three New Zealand District Health Boards. Prevalence data for child/adolescent obesity (aged 2-14 years) were obtained from the New Zealand Health Survey (2017/2018), and prevalence of weight-related comorbidities requiring further investigation were obtained from a previous New Zealand study of a cohort of children with obesity. Results The cost of initial laboratory screening for weight-related comorbidities per child was NZD 28.36. Based on national prevalence data from 2018/2019 for children with BMI greater than the 98th percentile (obesity cut-off), the total annual cost for initial laboratory screening for weight-related comorbidities in children/adolescents aged 2-14 years with obesity was estimated at NZD 2,665,840. The cost of further investigation in the presence of risk factors was estimated at NZD 2,972,934. Conclusions Investigating weight-related comorbidities in New Zealand according to international expert guidelines is resource-intensive. Ways to further determine who warrants investigation with an individualised approach are required.

Introduction The ‘Raising Healthy Kids (RHK) health target’ recommended that children identified as having obesity [body mass index (BMI) ≥98th centile] through growth screening at the B4 School Check (B4SC) be offered referral for subsequent assessment and intervention. Aim To determine the impact of the ‘RHK health target’ on referral rates for obesity in Aotearoa New Zealand (NZ). Methods A retrospective audit was undertaken of 4-year-olds identified to have obesity in the B4SC programme in Taranaki and nationally in 2015–19. Key outcomes were: ‘RHK health target’ rate [proportion of children with obesity for whom District Health Boards (DHBs) applied the appropriate referral process]; Acknowledged referral rate (proportion of children with a referral for obesity whose referral was acknowledged by DHBs); and Declined referral rate (proportion of children offered a referral for obesity who declined their referral). Results Data were audited on 266 448 children, including 7464 in Taranaki. ‘RHK health target’ rates increased markedly between 2015–16 and 2016–17 following the health target implementation (NZ: 34–87%; P

To examine caregiver perceptions relating to the acceptability of weight screening at New Zealand's B4 School Check (B4SC), and the accessibility and acceptability of a healthy lifestyle programme (Whānau Pakari) for preschool children (Whānau Pakari preschool programme) identified with weight issues.An online survey was designed to assess agreement with statements relating to the B4SC healthy weight check and Whānau Pakari programme. Eligible participants (n=125) were caregivers of preschool children identified with obesity (BMI ≥98th centile), or overweight (BMI91st centile) with weight-related co-morbidities, at the B4SC and referred to Whānau Pakari over the period July 2016 to March 2019.Twenty-nine caregivers responded to the survey (23%). The majority (76%, n=22) were open to discussing their child's weight. However, whilst most caregivers were comfortable receiving a weight referral to a healthy lifestyle programme for their child, some were ambivalent (24%, n=7) or disagreed (21%, n=6) to feeling comfortable about this. Furthermore, only 38% (n=11) of caregivers were concerned about their child's weight.Findings reveal a reasonable level of acceptability by caregivers to aspects of the B4SC healthy weight check. However, caregiver perceptions may not always be in alignment with the support offered by B4SC health professionals. Regular healthy lifestyle messaging by health professionals, and positive referral experiences, are key to subsequent engagement with healthy lifestyle programmes.

Supplemental Digital Content is available in the text., Rationale: The efficient resolution of tissue hemorrhage is an important homeostatic function. In human macrophages in vitro, heme activates an AMPK (AMP-activated protein kinase)/ATF1 (activating transcription factor-1) pathway that directs Mhem macrophages through coregulation of HO-1 (heme oxygenase-1; HMOX1) and lipid homeostasis genes. Objective: We asked whether this pathway had an in vivo role in mice. Methods and Results: Perifemoral hematomas were used as a model of hematoma resolution. In mouse bone marrow–derived macrophages, heme induced HO-1, lipid regulatory genes including LXR (lipid X receptor), the growth factor IGF1 (insulin-like growth factor-1), and the splenic red pulp macrophage gene Spic. This response was lost in bone marrow–derived macrophages from mice deficient in AMPK (Prkab1−/−) or ATF1 (Atf1−/−). In vivo, femoral hematomas resolved completely between days 8 and 9 in littermate control mice (n=12), but were still present at day 9 in mice deficient in either AMPK (Prkab1−/−) or ATF1 (Atf1−/−; n=6 each). Residual hematomas were accompanied by increased macrophage infiltration, inflammatory activation and oxidative stress. We also found that fluorescent lipids and a fluorescent iron-analog were trafficked to lipid-laden and iron-laden macrophages respectively. Moreover erythrocyte iron and lipid abnormally colocalized in the same macrophages in Atf1−/− mice. Therefore, iron-lipid separation was Atf1-dependent. Conclusions: Taken together, these data demonstrate that both AMPK and ATF1 are required for normal hematoma resolution.

Objective To understand facilitators and barriers to engagement in a multidisciplinary assessment and intervention program for children and adolescents with obesity, particularly for Māori, the Indigenous people of New Zealand. Methods Whānau Pakari participants and caregivers (n = 71, 21% response rate) referred to the family-based healthy lifestyles program in Taranaki, New Zealand, were asked to participate in a confidential survey, which collected self-reported attendance levels and agreement with statements around service accessibility and appropriateness and open-text comments identifying barriers and facilitators to attendance. Results Self-reported attendance levels were higher when respondents reported sessions to be conveniently located (P = .03) and lower when respondents considered other priorities as more important for their family (P = .02). Māori more frequently reported that past experiences of health care influenced their decision to attend (P = .03). Facilitators included perceived convenience of the program, parental motivation to improve child health, and ongoing support from the program. Conclusions and Implications Program convenience and parental and/or self-motivation to improve health were facilitators of attendance. Further research is required to understand the relationship between past experiences with health care and subsequent engagement with services.

Background: Little is known about adults’ experience of living with cystic fibrosis (CF) specifically in relation to the gut. However, their unique perspectives may be meaningful to children with CF and inform the understanding and practice of dietitians. The present study aimed to explore adults’ lived experience of the CF gut and how they learnt to manage the gut as they were growing up. Methods: Semi‐structured interviews were conducted with adult inpatients (n = 10). Interviews were audio‐recorded, transcribed verbatim and accounts analysed using interpretative phenomenological analysis. Results: Three super‐ordinate themes were identified: taking Creon, the learning process and this much I (now) know. Participants accounts of how CF affects the gut predominantly focused on taking Creon (pancreatin, Mylan). Various strategies were employed for coping with peer responses to taking Creon at school. Several participants reached adulthood before they understood and/or accepted that taking Creon consistently needed to be normal for them. Knowledge and understanding developed over time, with ‘CF experience’ and was shaped by family, CF care teams and other children with CF. All had unmet information needs when growing up. Having key explanations earlier, to make connections between eating, taking Creon, gaining weight and growth, did or would have helped most participants. Participants urged children to be assertive, ask questions and not only be involved in managing their diet and gut, but also begin to take control of this aspect of their CF. Conclusions: Supporting development of knowledge, skills and confidence to manage diet and the gut needs to be integral to care throughout childhood.

A flora and fauna survey was conducted at the east coast Tasmanian property Wind Song in 2017 as part of the Tasmanian Museum and Art Gallery’s ongoing research, collection-building and nature-discovery program. The survey recorded 885 taxa, primarily from the targeted groups of vascular plants, bryophytes, lichens, butterflies, moths, beetles, snails and slugs. Several of the taxa recorded, chiefly lichens and invertebrates, are new to science or new records for Tasmania. The survey provides a benchmark for further work and serves as an indicator of the biodiversity of a former farming property on Tasmania’s east coast.

We examined whether caregivers of children/adolescents enroled in a randomised controlled trial (RCT) of a family-centred intervention indirectly achieved reductions in body mass index (BMI), and if these were associated with changes in their children's BMI.RCT participants were New Zealand children/adolescents aged 4.8-16.8 years with BMI ≥ 98th percentile or91st with weight-related comorbidities. Participants and accompanying caregivers were assessed at baseline, 12, and 24 months.Overall, caregivers' BMI was unchanged at 12 or 24 months. Among Māori participants, reductions in caregivers' BMI at 12 months were associated with reductions in their children's BMI SDS at 12 (r = 0.30; p = 0.038) and 24 months (r = 0.39; p = 0.009). Further, children identifying as Māori whose caregivers' BMI decreased at 12 months had greater BMI SDS reductions at 12 months [ -0.30 (95% CI -0.49, -0.10); p = 0.004] and 24 months [ -0.39 (95% CI -0.61, -0.16); p = 0.001] than children of caregivers with increased/unchanged BMI.This intervention programme for children/adolescents with obesity did not indirectly reduce caregiver weight status. However, reductions in caregivers' BMI were key to BMI SDS reductions among Māori participants. Given the intergenerational nature of obesity, our findings highlight the importance of culturally relevant, family-focused programmes to achieve clinically meaningful improvements in weight status across the family.

Aims To explore the perceptions and experiences of caregivers of preschool children with weight issues referred from New Zealand’s preschool check (the B4 School Check) to a healthy lifestyle programme. Second, to understand determinants of engagement with the programme for families post referral. Methods Semi-structured focus groups and interviews were conducted with caregivers of preschool children referred from the national preschool check (the B4 School Check) to the Whānau Pakari healthy lifestyle programme. A purposeful sampling approach ensured the opinions of Māori (New Zealand’s indigenous population) and non-Māori caregivers were included. Those who engaged and did not engage with the programme were included from across Taranaki (a semi-rural region of New Zealand). Focus groups and interviews were run separately for Māori and non-Māori participants. Results Thematic analysis yielded one sub-theme related to caregiver perceptions of weight: societal beliefs about childhood weight, and three sub-themes related to determinants of engagement: referral experience, competing life demands, and caregiver resistance to and motivation for accepting external support. A negative referral experience to Whānau Pakari often resulted in caregivers declining to engage with the programme. Themes were similar across both Māori and non-Māori caregivers. Conclusions This study confirmed that caregiver perceptions influence their acceptance and management of their child’s weight issues. The experience of the referral to a healthy lifestyle programme is important for determining future engagement, and is likely to be facilitated by providing improved training and support to health professionals around discussing childhood weight issues with caregivers of young children.

Objective To determine whether 12-month BMI SDS reductions persisted at 24 months in a multi-disciplinary assessment and intervention program for children and adolescents with obesity, and whether secondary outcomes improved. Methods This was a community-based 12-month RCT in Aotearoa/New Zealand. Eligible participants were aged 5 to 16 years with BMI ≥98th centile or BMI >91st centile with weight-related comorbidities. The low-intensity control received comprehensive home-based baseline assessments and advice, and 6-monthly follow-up. The high-intensity intervention received the same assessments and advice, but also weekly multidisciplinary sessions. Primary outcome was BMI SDS at 12 months. Secondary outcomes included cardiovascular and metabolic markers. Results 121 participants (60% of participants at baseline) were assessed at 24 months. BMI SDS reduction at 12 months was lost at 24 months in the modified intention-to-treat analysis [Control -0.03 (95%CI -0.14, 0.09) and Intervention -0.02 (-0.12, 0.08); P = .93]. However, sweet drink intake was reduced, water intake increased, and there were improvements in cardiovascular fitness in the high-intensity intervention. ≥70% attendance in the high-intensity intervention resulted in a persistent BMI SDS reduction of -0.22 after 24 months (95%CI -0.38, -0.06). Conclusions This trial was negative in terms of primary outcome at 24 months. However, high engagement led to sustained treatment effect, and there were multiple improvements in health measures.

Objective To report 12-month outcomes from a multidisciplinary child obesity intervention program, targeting high-risk groups. Methods In this unblinded randomized controlled trial, participants (recruited January 2012-August 2014) were aged 5 to 16 years, resided in Taranaki, Aotearoa/New Zealand, and had BMI ≥ 98th percentile or BMI > 91st percentile with weight-related comorbidities. Randomization was by minimization (age and ethnicity), with participants assigned to an intense intervention group (home-based assessments at 6-month intervals and a 12-month multidisciplinary program with weekly group sessions) or to a minimal-intensity control group with home-based assessments and advice at each 6-month follow-up. The primary outcome was the change in BMI standard deviation score (SDS) at 12 months from baseline. A mixed model analysis was undertaken, incorporating all 6- and 12-month data. Results Two hundred and three children were randomly assigned (47% Māori, 43% New Zealand European, 53% female, 28% from the most deprived quintile, mean age 10.7 years, mean BMI SDS 3.12). Both groups displayed a change in BMI SDS at 12 months from baseline (−0.12 control, −0.10 intervention), improvements in cardiovascular fitness (P

Objective/designIt remains unclear as to the efficacy of readiness for change measurements in child and adolescent obesity intervention programmes. This observational study aimed to determine whether the caregiver’s stage of change could predict outcome and adherence to treatment in an intensive intervention programme for children and adolescents with obesity.SettingParticipants were from the Whānau Pakari randomised clinical trial, a community based multi-disciplinary intervention programme for obesity in Taranaki, New Zealand.ParticipantsEligible participants (recruited January 2012 to August 2014) were aged 5–16 years and had a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities.InterventionsThis study only assessed participants randomised to the high-intensity intervention programme (6-month assessments with weekly group sessions for 12 months) given attendance data were required (n=96).Primary and secondary outcome measuresPrimary trial outcome was BMI SD score (SDS). Secondary outcome measures included indices such as fruit and vegetable intake, 550-m run/walk time and quality of life scores. At baseline assessment, participants (if >11 years old) and their accompanying adult were assessed for readiness to make healthy lifestyle change.ResultsA quantitative measure of stage of change in caregivers was not a predictor of primary or secondary outcomes (change in BMI SDS pre-contemplation/contemplation −0.08, 95% CI −0.18 to 0.03, action −0.16, 95% CI −0.27 to –0.05, p=0.27), or overall attendance in the weekly activity sessions (40.0% vs 37.1%, respectively, p=0.54) in the child or adolescent.ConclusionsCaregiver’s stage of change was not a predictor of success in this multi-disciplinary assessment and intervention programme for children and adolescents with obesity. Future research needs to determine participants’ factors for success.Trial registration numberANZCTR12611000862943; Post-results.

Aim The aim of this study was to describe the characteristics at enrolment of children and adolescents referred to an obesity programme and to determine how the prevalence of comorbidities differed in Indigenous versus non-Indigenous children. Methods Participants were residents of a semi-rural region of New Zealand (NZ). Eligibility was defined by a body mass index (BMI) of ≥98th percentile or >91st centile with weight-related comorbidities. Fasting blood, medical and physical assessments were obtained. Results During the recruitment period from January 2012 to August 2014, 239 participants, aged 4.8–16.8 years, undertook assessment. Average BMI standard deviation score was 3.09 (standard deviation (SD) = 0.60, range 1.52–5.34 SD). The majority of participants were of either Maori (NZ’s indigenous people (45%)) or NZ European (45%) ethnicity; 29% of participants were from the most deprived quintile of household deprivation. Maori participants were more likely than NZ Europeans to have a mother who smoked during pregnancy (52% vs. 28%, P = 0.001), a family history of type 2 diabetes (66% vs. 53%, P = 0.04), acanthosis nigricans on examination (58% vs. 20%, P

ObjectiveTo describe health-related quality of life (HRQOL) and psychological well-being of children and adolescents at enrolment in a multidisciplinary community-based obesity programme and to determine association with ethnicity. This programme targeted indigenous people and those from most deprived households. Further, this cohort was compared with other populations/normative data.MethodsThis study examines baseline demographic data of an unblinded randomised controlled clinical trial. Participants (recruited from January 2012-August 2014) resided in Taranaki, New Zealand, and for this study we only included those with a body mass index (BMI) ≥98th percentile (obese). HRQOL and psychological well-being were assessed using the Pediatric Quality of Life Inventory (PedsQL V.4.0TM) (parent and child reports), and Achenbach’s Child Behavior Checklist (CBCL)/Youth Self Report (YSR).ResultsAssessments were undertaken for 233 participants (45% Māori, 45% New Zealand European, 10% other ethnicities, 52% female, 30% from the most deprived household quintile), mean age 10.6 years. The mean BMI SD score (SDS) was 3.12 (range 2.01–5.34). Total PedsQL generic scaled score (parent) was lower (mean=63.4, SD 14.0) than an age-matched group of Australian children without obesity from the Health of Young Victorians study (mean=83.1, SD 12.5). In multivariable models, child and parental generic scaled scores decreased in older children (β=−0.70 and p=0.031, β=−0.64 and p=0.047, respectively). Behavioural difficulties (CBCL/YSR total score) were reported in 43.5% of participants, with the rate of emotional/behavioural difficulties six times higher than reported norms (pConclusionsIn this cohort, children and adolescents with obesity had a low HRQOL, and a concerning level of psychological difficulties, irrespective of ethnicity. Obesity itself rather than ethnicity or deprivation appeared to contribute to lower HRQOL scores. This study highlights the importance of psychologist involvement in obesity intervention programmes.Trial registration numberAustralian NZ Clinical Trials Registry ANZCTR 12611000862943; Pre-results.

To report 12-month outcomes from a multidisciplinary child obesity intervention program, targeting high-risk groups.In this unblinded randomized controlled trial, participants (recruited January 2012-August 2014) were aged 5 to 16 years, resided in Taranaki, Aotearoa/New Zealand, and had BMI ≥ 98th percentile or BMI 91st percentile with weight-related comorbidities. Randomization was by minimization (age and ethnicity), with participants assigned to an intense intervention group (home-based assessments at 6-month intervals and a 12-month multidisciplinary program with weekly group sessions) or to a minimal-intensity control group with home-based assessments and advice at each 6-month follow-up. The primary outcome was the change in BMI standard deviation score (SDS) at 12 months from baseline. A mixed model analysis was undertaken, incorporating all 6- and 12-month data.Two hundred and three children were randomly assigned (47% Māori, 43% New Zealand European, 53% female, 28% from the most deprived quintile, mean age 10.7 years, mean BMI SDS 3.12). Both groups displayed a change in BMI SDS at 12 months from baseline (-0.12 control, -0.10 intervention), improvements in cardiovascular fitness (P 0.0001), and improvements in quality of life (P 0.001). Achieving ≥ 70% attendance in the intense intervention group resulted in a change in BMI SDS of -0.22.This program achieved a high recruitment of target groups and a high rate of BMI SDS reduction, irrespective of intervention intensity. If retention is optimized, the intensive program doubles its effect.

We aimed to describe physical activity and sedentary behaviour of obese children and adolescents in Taranaki, New Zealand, and to determine how these differ in Māori (indigenous) versus non-indigenous children. Participants (n = 239; 45% Māori, 45% New Zealand European [NZE], 10% other ethnicities) aged 4.8–16.8 years enrolled in a community-based obesity programme from January 2012 to August 2014 who had a body mass index (BMI) ≥ 98th percentile (n = 233) or >91st–98th percentile with weight-related comorbidities (n = 6) were assessed. Baseline activity levels were assessed using the children’s physical activity questionnaire (C-PAQ), a fitness test, and ≥3 days of accelerometer wear. Average BMI standard deviation score was 3.09 (SD = 0.60, range 1.52–5.34 SDS). Reported median daily activity was 80 minutes (IQR = 88). Although 44% of the cohort met the national recommended screen time of

ObjectivesIt is unclear whether an association exists between obesity in children/adolescents and cognitive function, and whether the latter can be altered by body mass index (BMI) standard deviation score (SDS) reductions. We aimed to determine whether an association exists between BMI SDS and cognitive function in children/adolescents with obesity engaged in an obesity intervention. Second, we sought to determine if BMI SDS reduction at 12 months was associated with improved cognitive function.DesignSecondary analysis of a clinical trial.ParticipantsParticipants (n=69) were recruited from an obesity intervention. Eligible participants (recruited June 2013 to June 2015) were aged 6–16 years, with a BMI ≥98th centile or BMI >91st centile with weight-related comorbidities.Outcome measuresPrimary outcome measure was change in BMI SDS from baseline at 12 months. Dependent variables of cognitive functioning and school achievement were assessed at baseline and 12 months, using dependent variables of cognitive functioning (elements of Ravens Standard Progressive Matrices, Wide Range Achievement Test-fourth edition and Wechsler Intelligence Scale for Children-fourth edition).ResultsAt baseline, BMI SDS was not associated with all aspects of cognitive function tested (n=69). Reductions in BMI SDS over time did not alter cognitive function overall. However, there was a greater reduction in comprehension standard scores in participants who increased their BMI SDS (adjusted estimated difference −6.1, 95% CI −11.6 to −0.6; p=0.03).ConclusionsThere were no observed associations between BMI SDS and cognitive function in participants, apart from comprehension in the exploratory analyses, which may have been a random finding. Further studies need to include larger longitudinal cohorts incorporating a wider BMI range at entry to determine whether our findings persist.Trial registration numberANZCTR12611000862943; Pre-results.

Objectives The aim of this study was to describe dietary intake and eating behaviours of obese children and adolescents, and also to determine how these differ in Indigenous versus non-Indigenous children at enrolment in an obesity programme. Methods Baseline dietary intake and eating behaviour records were assessed from those enrolled in a clinical unblinded randomised controlled trial of a multi-disciplinary intervention. The setting was a community-based obesity programme in Taranaki, New Zealand. Children or adolescents who were enrolled from January 2012 to August 2014, with a BMI ≥98th percentile or >91st centile with weight-related comorbidities were eligible. Results 239 participants (45% Māori, 45% NZ Europeans, 10% other ethnicities), aged 5–17 years were assessed. Two-thirds of participants experienced hyperphagia and half were not satiated after a meal. Comfort eating was reported by 62% of participants, and daily energy intake was above the recommended guidelines for 54%. Fruit and vegetable intake was suboptimal compared with the recommended 5 servings per day (mean 3.5 [SD = 1.9] servings per day), and the mean weekly breakfasts were less than the national average (5.9 vs 6.5; p

The study goal was to test the equivalence of ten dimensions of psychotic behavior across two measuring media. The data consisted of ratings of 814 newly admitted schizophrenics made in the interview and on the ward. The factored. A least squares solution of a hypothesis matrix yielded ten clear factors of which eight were defined both by ward and interview measures.

A battery of tests was given to 447 studenits in the secondary schools of Alcoa, Tennessee. The tests were composed of the Lorge-Thorndike Intelligence Tests, and five selected creativity tests. The combined battery of tests was factor analyzed and rotated to an oblique simple structure, and then to a hierachical solution. Three factors were found: the verbal intelligence and reasoning factors identified in many previous studies, and a creativity faotor. The structure was very oblique. The second order factor, g, was found to count for 77% of the variance of the verbal facbor, 89% of the reasoning factor and 48% of the creativity factor. These results were compared with those of previous studies of creativity and intelligence.

Nearly one-third of Canadian children can be categorized as overweight or obese. There is a growing interest in applying e-health approaches to prevent unhealthy weight gain in children, especially in settings that families access regularly. Our objective was to develop and refine an e-health screening, brief intervention, and referral to treatment (SBIRT) for parents to help prevent childhood obesity in primary care.Our SBIRT, titled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), was developed by our research team and an e-health intervention development company. RIPPLE was based on existing SBIRT models and contemporary literature on children's lifestyle behaviors. Refinements to RIPPLE were guided by feedback from five focus groups (6-10 participants per group) that documented perceptions of the SBIRT by participants (healthcare professionals [n = 20], parents [n = 10], and researchers and graduate trainees [n = 8]). Focus group commentaries were transcribed in real time using a court reporter. Data were analyzed thematically.Participants viewed RIPPLE as a practical, well-designed, and novel tool to facilitate the prevention of childhood obesity in primary care. However, they also perceived that RIPPLE may elicit negative reactions from some parents and suggested improvements to specific elements (e.g., weight-related terms).RIPPLE may enhance parents' awareness of children's weight status and motivation to change their children's lifestyle behaviors but should be improved prior to implementation. Findings from this research directly informed revisions to our SBIRT, which will undergo preliminary testing in a randomized controlled trial.

The aim of this study was to describe the characteristics at enrolment of children and adolescents referred to an obesity programme and to determine how the prevalence of comorbidities differed in Indigenous versus non-Indigenous children.Participants were residents of a semi-rural region of New Zealand (NZ). Eligibility was defined by a body mass index (BMI) of ≥98th percentile or91st centile with weight-related comorbidities. Fasting blood, medical and physical assessments were obtained.During the recruitment period from January 2012 to August 2014, 239 participants, aged 4.8-16.8 years, undertook assessment. Average BMI standard deviation score was 3.09 (standard deviation (SD) = 0.60, range 1.52-5.34 SD). The majority of participants were of either Maori (NZ's indigenous people (45%)) or NZ European (45%) ethnicity; 29% of participants were from the most deprived quintile of household deprivation. Maori participants were more likely than NZ Europeans to have a mother who smoked during pregnancy (52% vs. 28%, P = 0.001), a family history of type 2 diabetes (66% vs. 53%, P = 0.04), acanthosis nigricans on examination (58% vs. 20%, P0.0001), a low serum high-density lipoprotein cholesterol (27% vs. 14%, P = 0.03) or high serum triglyceride (38% vs. 24%, P = 0.03) concentration.The unique aspect of this study was the ability to recruit high levels of Maori participants and those from most deprived areas, indicating a high level of acceptability for these target groups. Comorbidities were prevalent in this cohort of overweight/obese school-aged children. While there were some differences in comorbidity prevalence between Maori and NZ Europeans, the overall clinical picture in our cohort, irrespective of ethnicity, was of concern.

To determine the effectiveness of current interventions in New Zealand in obese children and adolescents accessing either a standard model of care (medical input alone or with the addition of dietitian and physical activity input), or one of the country's long-standing multi-disciplinary intervention programmes.Data were recorded over approximately 2.1 years of intervention from 290 patients across four centres in New Zealand, who manage obese and overweight children and adolescents aged 3-16 years in paediatric clinics.There was a small but significant annual reduction in BMI SDS irrespective of the nature of intervention (-0.15 overall). There was no significant difference in BMI SDS between interventions. The extent of BMI SDS reduction decreased with increasing age at first outpatient attendance (p=0.0006). BMI SDS reduction was unaffected by ethnicity or gender.Mild reductions in BMI SDS are achievable in children being referred to and managed for obesity by a range of models. It is important that paediatricians are proactive in identifying and addressing obesity with families. Further research is required to evaluate multi-disciplinary intervention programmes, and how their effectiveness can be increased, given their recognised benefits in improving cardiovascular and metabolic profile, as well as BMI SDS.

With increasing life expectancy patients with CF are encountering medical complications that historically have never been an issue. Over the last 10 years three patients with CF have been diagnosed with skin malignancy at the Leeds Adult CF unit. Specific risk factors in CF include photosensitive medication, such as ciprofloxacin and anti-fungals, as well as immune suppression post-transplant. In view of this we undertook a questionnaire based survey of our adult patients’ behaviours regarding sun health. The questionnaire was handed out to patients at routine outpatient appointments. Results to date indicate that two thirds of our patients have been sunburnt in the last 12 months. Over half of patients never use any form of sun protection when going out in the sun and only 17% use sun cream most or all of the time. Over 40% of patients had used tanning beds in the past with a third of these using them regularly over the past 12 months. These high risk behaviours were also seen in patients post-lung transplant. In terms of medications almost 60% were able to name medications that increased the risk of sunburn; however, 20% did not know that medications increased the risk. Once the study is completed we plan to implement an educational programme for patients. Particular attention will be paid to high risk groups such as post-transplant patients, patients who have had skin cancer, and patients who have a family history of cancer.

Fig 1. Prebypass midesophageal atrioventricular long-axis view showing a severe aortic insufficiency, an aortic root abscess, and vegetations casting shadowing in the far field. (Color version of figure is available online.)

 Premise of the study : The Sphagnopsida, an early-diverging lineage of mosses (phylum Bryophyta), are morphologically and ecologically unique and have profound impacts on global climate. The Sphagnopsida are currently classifi ed in two genera, Sphagnum (peat mosses) with some 350 – 500 species and Ambuchanania with one species. An analysis of phylogenetic relationships among species and genera in the Sphagnopsida were conducted to resolve major lineages and relationships among species within the Sphagnopsida.  Methods : Phylogenetic analyses of nucleotide sequences from the nuclear, plastid, and mitochondrial genomes (11 704 nucleotides total) were conducted and analyzed using maximum likelihood and Bayesian inference employing seven different substitution models of varying complexity.  Key results : Phylogenetic analyses resolved three lineages within the Sphagnopsida: (1) Sphagnum sericeum , (2) S. inretortum plus Ambuchanania leucobryoides , and (3) all remaining species of Sphagnum . Sister group relationships among these three clades could not be resolved, but the phylogenetic results indicate that the highly divergent morphology of A. leucobryoides is derived within the Sphagnopsida rather than plesiomorphic. A new classifi cation is proposed for class Sphagnopsida, with one order (Sphagnales), three families, and four genera.  Conclusions : The Sphagnopsida are an old lineage within the phylum Bryophyta, but the extant species of Sphagnum represent a relatively recent radiation. It is likely that additional species critical to understanding the evolution of peat mosses await discovery, especially in the southern hemisphere.

The effect of a stern flap on the powering performance and annual fuel consumption of an FFG-7 Oliver Hazard Perry Class Guided Missile Frigate is presented. Analytical analysis using free surface potential flow theory was conducted to evaluate the flow on the afterbody of the ship. Model tests were conducted to determine the optimum geometrical characteristics of the stern flap. Based on the analytical and model test results, a stern flap was retrofitted to an FFG-7 Class frigate, and full-scale results on powering performance were collected. Results of model powering experiments showed that the flap, set at 10 deg trailing edge down, decreased the delivered power by 8.4 percent at 26 knots, and provided for a 3.8 percent decrease in annual fuel consumption. This decrease in annual fuel consumption places the payback period on the cost of the flap installation at only 10 months. The full-scale comparison of the flap's effectiveness was marred by adverse weather conditions and differences in the pre-and post-flap ship configurations. However, observations of the full-scale stern wave system, before and after the installation of the stern flap, lead the authors to conclude that the flap will produce a larger decrease in delivered power at full scale than shown by the model experiments.

BackgroundParents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents’ motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention. Objective(1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents’ concern for, and motivation to, support children’s healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial. MethodsThis is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III). Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company. Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT. Phase III: Parents (n=200) of children—boys and girls, 5 to 17 years old—will be recruited from a primary care pediatric clinic while they await their children’s clinical appointment. Parents will be randomly assigned to one of five groups—four intervention groups and one control group—as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children’s dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome). ResultsThis research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016. ConclusionsThe proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children’s healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or “nudge” individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings. Trial RegistrationClinicalTrials.gov NCT02330588; http://clinicaltrials.gov/ct2/show/NCT02330588 (Archived by WebCite at http://www.webcitation.org/6WyUOeRlr).

We report the consistent distribution of a population of pigmented trp-1-positive cells in several important septal and valvular structures of the normal mouse (C57BL/6) heart. The pigmented cell population was first apparent by E16.5 p.c. in the right atrial wall and extended into the atrium along the interatrial septum. By E17.5, these cells were found along the apical membranous interventricular septum near or below the surface of the endocardium. The most striking distribution of dark pigmented cells was found in the tricuspid and mitral valvular leaflets and chordae tendineae. The normal distribution of pigmented cells in the valvuloseptal apparatus of C57BL/6 adult heart suggests that a premelanocytic lineage may participate in the earlier morphogenesis of the valve leaflets and chordae tendineae. The origin of the premelanocyte lineage is currently unknown. The most likely candidate populations include the neural crest and the epicardially derived cells. The only cell type in the heart previously shown to form melanocytes is the neural crest. The presence of neural crest cells, but not melanocytes, in some of the regions we describe has been reported by others. However, previous reports have not shown a contribution of melanocytes or neural crest derivatives to the atrioventricular valve leaflets or chordae tendineae in mouse hearts. If these cells are of neural crest origin, it would suggest a possibly greater contribution and persistence of neural crest cells to the valvuloseptal apparatus than has been previously understood.

Yvonne C. Anderson1,2,∗, Tami L. Cave1,2, Vicki J. Cunningham3, Nicola M. Pereira4, Donna M. Woolerton5, Cameron C. Grant6, Wayne S. Cutfield1, Jose G.B. Derraik 1, Paul L. Hofman1 1 Liggins Institute, The University of Auckland, Auckland, New Zealand 2 Taranaki Base Hospital, New Plymouth, New Zealand 3 Child Health Centre, Northland District Health Board, Whangarei, New Zealand 4 Child Health Service, Midcentral District Health Board, Palmerston North, New Zealand 5Waikids, Waikato District Health Board, Waikato, New Zealand 6 Department of Paediatrics, The University of Auckland, Auckland, New Zealand

help evaluate the nature of the ‘healthiness’ of the food environment in these neighbourhoods. 24 different food outlet types were identified from an observational audit of Australian suburbs’ food environments. A purpose-designed questionnaire was developed to obtain expert opinion on the relative healthiness of food outlet types using Delphi method with two survey rounds. At the beginning of the Delphi survey, original scores were proposed for each food outlet type based on available literature, classifying them into 5 categories of ‘healthiness’. Median scores for food outlet types from Rounds 1 and 2 were highly correlated with the originally proposed scores (0.97 and 0.96 respectively, p = 0.01). A ‘healthiness’ score is proposed using the median scores of round 2 of this survey to compare food environment across Australian suburbs; and further studies can explore relationships between the suburbs ‘healthiness’ score and diet habits of the suburbs population.

Tami L. Cave1,2,∗, Michelle S. Butler 1, Kris R. Moller 3, Katharine F. Treves1, Cervantee E.K. Wild1,2, Lisa E. Wynter1, Cameron C. Grant4, Paul L. Hofman2, Yvonne C. Anderson1,2 1 Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand 2 Liggins Institute, The University of Auckland, Auckland, New Zealand 3Whanau Pakari, Sport Taranaki, New Plymouth, New Zealand 4 Department of Paediatrics, The University of Auckland, Auckland, New Zealand

nutrition and diet. Grants with a primary focus on adults and health conditions directly associated with obesity (e.g. key modifiable risk factor) were included (i.e. CVD, diabetes). Grants related to infants/children/adolescents or animals or that did not clearly stipulate adults were excluded. Major findings: For NHMRC it was found that 24 projects/development grants and 12 fellowships ($41,179,720) were funded, equating to 1% of total available NHMRC funding. For ARC there was inadequate information for ARC fellowships available to permit classification for this project. For ARC discovery projects with the included FOR codes a total of three projects were identified, accounting for approximately 9% ($760,540) of total available funding that was allocated. Conclusion: Only a small proportion of federal funds were allocated to obesity research from 2009 to 2014 despite this major public health concern being specifically aligned to National Research Priorities.