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BackgroundMulticomponent family interventions underline current best practice in childhood obesity treatment. Mobile health (mHealth) adjuncts that address eating and physical activity behaviors have shown promise in clinical studies. ObjectiveThis study aimed to describe process methods for applying an mHealth intervention to reduce the rate of eating and monitor physical activity among children with obesity. MethodsThe study protocol was designed to incorporate 2 mHealth apps as an adjunct to usual care treatment for obesity. Children and adolescents (aged 9-16 years) with obesity (BMI ≥98th centile) were recruited in person from a weight management service at a tertiary health care center in the Republic of Ireland. Eligible participants and their parents received information leaflets, and informed consent and assent were signed. Participants completed 2 weeks of baseline testing, including behavioral and quality of life questionnaires, anthropometry, rate of eating by Mandolean, and physical activity level using a smart watch and the myBigO smartphone app. Thereafter, participants were randomized to the (1) intervention (usual clinical care+Mandolean training to reduce the rate of eating) or (2) control (usual clinical care) groups. Gender and age group (9.0-12.9 years and 13.0-16.9 years) stratifications were applied. At the end of a 4-week treatment period, participants repeated the 2-week testing period. Process evaluation measures included recruitment, study retention, fidelity parameters, acceptability, and user satisfaction. ResultsA total of 20 participants were enrolled in the study. A web-based randomization system assigned 8 participants to the intervention group and 12 participants to the control group. Attrition rates were higher among the participants in the intervention group (5/8, 63%) than those in the control group (3/12, 25%). Intervention participants undertook a median of 1.0 training meal using Mandolean (25th centile 0, 75th centile 9.3), which represented 19.2% of planned intervention exposure. Only 50% (9/18) of participants with smart watches logged physical activity data. Significant differences in psychosocial profile were observed at baseline between the groups. The Child Behavior Checklist (CBCL) mean total score was 71.7 (SD 3.1) in the intervention group vs 57.6 (SD 6.6) in the control group, t-test P

Background: Dietetics curricula currently fail to meet the educational needs of the future dietetic workforce to contribute expertise in sustainable, healthy food systems in the settings in which dietitians work. A 'Global Networking Event on Sustainable Food Systems in Nutrition and Dietetics Education' was held in June 2023 with the goals of building relationships among international stakeholders and informing the development of shared curricula. Methods: Plenary lectures, panels and roundtable discussions were held over 2 days, designed to provide the background required to generate informed actions. Topics included recent research from practice and education, competency standards and relevant policy documents, examples from the field, 'big questions' about scope and student perspectives. Key messages were summarised thematically to inform educators and national dietetics associations. Results: Fifty‐five delegates attended from 11 nations representing education, research, dietetic associations, industry and diverse practice backgrounds. Key priorities identified for educators included co‐development of curricular frameworks and pedagogical theory, practical training supports and solutions to limited time and expertise. Key recommendations for national dietetics associations included strategic promotion of sustainable food systems in dietetic roles and practical supports. Conclusions: Outcomes are anticipated to stimulate ongoing discussion, collaboration and actions on sustainable food systems education within the dietetics profession leading to shared curricular models and supports. Highlights: Sustainable food system (SFS) competency requirements and curricular integration are inconsistent globally and lack robust frameworks to support dietetics education.There is a need to define the scope of practice for SFS within dietitians' roles.Current opportunities in education include scaffolding existing topics and activities with signature pedagogies for sustainability, harnessing transferrable knowledge and skills to adapt to future SFS roles, and establishing interdisciplinary food systems teaching and learning activities.National dietetics associations can act to support SFS in the professional role of dietitians. [ABSTRACT FROM AUTHOR]

Patients with mutations of the recombination-activating genes (RAG) present with diverse clinical phenotypes, including severe combined immune deficiency (SCID), autoimmunity, and inflammation. However, the incidence and extent of immune dysregulation in RAG-dependent immunodeficiency have not been studied in detail. Here, we have demonstrated that patients with hypomorphic RAG mutations, especially those with delayed-onset combined immune deficiency and granulomatous/autoimmune manifestations (CID-G/AI), produce a broad spectrum of autoantibodies. Neutralizing anti-IFN-α or anti-IFN-ω antibodies were present at detectable levels in patients with CID-G/AI who had a history of severe viral infections. As this autoantibody profile is not observed in a wide range of other primary immunodeficiencies, we hypothesized that recurrent or chronic viral infections may precipitate or aggravate immune dysregulation in RAG-deficient hosts. We repeatedly challenged Rag1S723C/S723C mice, which serve as a model of leaky SCID, with agonists of the virus-recognizing receptors TLR3/MDA5, TLR7/-8, and TLR9 and found that this treatment elicits autoantibody production. Altogether, our data demonstrate that immune dysregulation is an integral aspect of RAG-associated immunodeficiency and indicate that environmental triggers may modulate the phenotypic expression of autoimmune manifestations.

For each odd integer n \geq 3, we construct a rank-3 graph \Lambda _n with involution \gamma _n whose real C^*-algebra C^*_{\scriptscriptstyle \mathbb {R}}(\Lambda _n, \gamma _n) is stably isomorphic to the exotic Cuntz algebra \mathcal E_n. This construction is optimal, as we prove that a rank-2 graph with involution (\Lambda,\gamma) can never satisfy C^*_{\scriptscriptstyle \mathbb {R}}(\Lambda, \gamma)\sim _{ME} \mathcal E_n, and Boersema reached the same conclusion for rank-1 graphs (directed graphs) in [Münster J. Math. 10 (2017), pp. 485–521, Corollary 4.3]. Our construction relies on a rank-1 graph with involution (\Lambda, \gamma) whose real C^*-algebra C^*_{\scriptscriptstyle \mathbb {R}}(\Lambda, \gamma) is stably isomorphic to the suspension S \mathbb {R}. In the Appendix, we show that the i-fold suspension S^i \mathbb {R} is stably isomorphic to a graph algebra iff -2 \leq i \leq 1. [ABSTRACT FROM AUTHOR]

Autoantibodies against cytokines, chemokines, and growth factors inhibit normal immunity and are implicated in inflammatory autoimmune disease and diseases of immune deficiency. In an effort to evaluate serum from autoimmune and immunodeficient patients for Abs against cytokines, chemokines, and growth factors in a high-throughput and unbiased manner, we constructed a multiplex protein microarray for detection of serum factor-binding Abs and used the microarray to detect autoantibody targets in SLE. We designed a nitrocellulose-surface microarray containing human cytokines, chemokines, and other circulating proteins and demonstrated that the array permitted specific detection of serum factor-binding probes. We used the arrays to detect previously described autoantibodies against cytokines in samples from individuals with autoimmune polyendocrine syndrome type 1 and chronic mycobacterial infection. Serum profiling from individuals with SLE revealed that among several targets, elevated IgG autoantibody reactivity to B cell-activating factor (BAFF) was associated with SLE compared with control samples. BAFF reactivity correlated with the severity of disease-associated features, including IFN-α-driven SLE pathology. Our results showed that serum factor protein microarrays facilitate detection of autoantibody reactivity to serum factors in human samples and that BAFF-reactive autoantibodies may be associated with an elevated inflammatory disease state within the spectrum of SLE.

BackgroundMutations in signal transducer and activator of transcription (STAT) 1 cause a broad spectrum of disease, ranging from severe viral and bacterial infections (amorphic alleles) to mild disseminated mycobacterial disease (hypomorphic alleles) to chronic mucocutaneous candidiasis (CMC; hypermorphic alleles). The hypermorphic mutations are also associated with arterial aneurysms, autoimmunity, and squamous cell cancers.ObjectiveWe sought to investigate the role of STAT1 gain-of-function mutations in phenotypes other than CMC.MethodsWe initially screened patients with CMC and autoimmunity for STAT1 mutations. We functionally characterized mutations in vitro and studied immune profiles and regulatory T (Treg) cells. After our initial case identifications, we explored 2 large cohorts of patients with wild-type forkhead box protein 3 and an immune dysregulation-polyendocrinopathy-enteropathy-X-linked (IPEX)-like phenotype for STAT1 mutations.ResultsWe identified 5 children with polyendocrinopathy, enteropathy, and dermatitis reminiscent of IPEX syndrome; all but 1 had a variety of mucosal and disseminated fungal infections. All patients lacked forkhead box protein 3 mutations but had uniallelic STAT1 mutations (c.629 G>T, p.R210I; c.1073 T>G, p.L358W, c.796G>A; p.V266I; c.1154C>T, T385M [2 patients]). STAT1 phosphorylation in response to IFN-γ, IL-6, and IL-21 was increased and prolonged. CD4(+) IL-17-producing T-cell numbers were diminished. All patients had normal Treg cell percentages in the CD4(+) T-cell compartment, and their function was intact in the 2 patients tested. Patients with cells available for study had normal levels of IL-2-induced STAT5 phosphorylation.ConclusionsGain-of-function mutations in STAT1 can cause an IPEX-like phenotype with normal frequency and function of Treg cells.

Background: School is an important setting for creating healthy and sustainable food environments. Using participatory methods, this pilot study examined food and packaging waste and nutrition quality within the school food system. Methods: One secondary school in Ireland participated in a waste audit. Eleven male students (15–17 years) participated as citizen scientists. Students collected waste over 1 day and documented data on waste categories. Nutrition labels were photographed for analysis. Students created a video and participated in a focus group. Quantitative data were summarised using descriptive frequencies. A Nutrient Profile Model was applied to summarise nutrition quality. The focus group discussion was analysed using content analysis. Results: Highest weights of waste were organic waste (14.2 kg), paper and cardboard (5.0 kg), and hard plastics (4.1 kg). Materials banned by the European Union Single Use Plastics Directive were found. Recycling bins were contaminated with food waste. Nutrition labels from 132 food packages were analysed, of which 115 items (87%) were low‐nutrient, energy dense foods. Confectionary, energy bars and desserts and savoury snacks were the most common packaged food groups. Students were not surprised by the unhealthy food choices; however, they were shocked and saddened at the waste practices. Their proposed solutions mapped across individual, community and organisational levels. Conclusions: The methodologies allowed successful engagement with students on this topic. The use of unnecessary plastics to serve food, poor waste separation practices, and the production of avoidable waste from low‐nutrient, energy‐dense products were key issues identified. Students proposed solutions that are achievable in the short‐term. Key highlights: Eleven 15–17‐year‐old secondary school students successfully participated as citizen scientists in a waste audit at their school that characterised the quantity, type and nutrition quality of waste associated with the food system.Organic waste, paper and cardboard, and hard plastics represented the most frequent waste. Recycling bins were contaminated with organic waste.Confectionary, energy bars and desserts and savoury snacks were the most common packaged food groups.The researchers conduced a focus group with students when they expressed shock and sadness at the waste practices. Their proposed solutions mapped across individual, community and organisational levels. [ABSTRACT FROM AUTHOR]

UK National Autism Strategy (Department of Health, 2010 and National Institute for Health and Care Excellence guidance (NICE, 2012) states that frontline staff should have a good understanding of Autism. Fifty-six clinical and administrative staff from a multidisciplinary community Learning Disability service completed an electronic questionnaire to evaluate levels of Autism knowledge. The results showed that, compared with clinical staff, administrative staff were more limited in their understanding of Autism and less able to access relevant Autism training. Autism training was provided for administrative staff. Focus group feedback about the training sessions and subsequent changes to practice concluded that the outcome of the training was positive. "Autism-friendly" changes to administrative practice included alterations to waiting environments, adapted communication for people with Autism and increased communication between clinical and administrative staff about the needs of people with Autism. Future Autism training for all frontline staff and ongoing evaluation of health professionals' Autism knowledge are discussed.

Hyperemesis Gravidarum (HG) is a rare condition of pregnancy that exerts a profound effect on a woman's physical and psychological health, but limited research regarding women's perceptions of healthcare for this condition exists. The aim of this study was to gain insight into the personal and healthcare experiences of women with HG. Eligible participants included women who had experienced HG in a current or recent pregnancy and were referred to the dietitian at the National Maternity Hospital, Dublin, Ireland. Suitable women were invited to participate by letter, with a follow-up phone call to confirm eligibility. Four semi-structured focus groups were conducted (n = 11). Audio recordings were transcribed and data was thematically analyzed using an inductive, data-driven approach. Participants emphasized the psychological hardship of HG, which manifested in many different ways, and unveiled the far-reaching burden of HG. Women advocated for a dedicated service for HG and the need for increased knowledge, understanding and support for HG, in order to ensure optimal HG management and woman-centered care. Women also highlighted the need for obvious clinical leadership of HG and a continuum of care throughout pregnancy and post-partum. Improvements to the day ward setting and access to HG-specific mental health support would be welcomed. At a government level, timely resolution of the financial assistance for first-line anti-emetics is needed. Overall, greater awareness and understanding of the condition is needed to improve support from family, friends and colleagues. Further research is warranted to determine whether these recommendations would result in improved pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Malnutrition is underdiagnosed in primary care. GPs are key healthcare contacts for older adults at risk of protein-energy malnutrition; however, lack of knowledge and confidence in its diagnosis and treatment is often reported. Aim: To evaluate the impact of a bespoke online education module on GP malnutrition knowledge and management. Design & setting: A prospective pre—post pilot study with 23 GPs and eight GP trainees in the Republic of Ireland. Method: The module included units on the following: ‘malnutrition definition, prevalence, and latest evidence’; ‘identifying malnutrition in clinical practice’; ‘food-first advice’; ‘reviewing malnutrition’; and ‘oral nutritional supplements’. Participant knowledge was measured using a multiple choice questionnaire (MCQ) before and after the module (n = 31), and 6 weeks following completion (n = 11). Case studies assessing identification and management of malnutrition were evaluated by a clinical specialist dietitian with expertise in managing malnutrition. Changes in assessment performance were calculated using paired t-tests. Acceptability was evaluated using a questionnaire. Results: Post-training, 97% of GPs increased MCQ scores from baseline (+25%, P<0.001), with the greatest improvement in ‘identifying malnutrition in clinical practice’ (mean increase 47%, P<0.001). Eleven GPs completed the 6-week MCQ with scores remaining significantly higher than baseline (mean increase 15%, P = 0.005); ‘identifying malnutrition in clinical practice’ remained the most highly scored (mean increase 40%, P<0.001). Seventeen GPs completed the case studies; 76% at baseline and 88% post-module correctly calculated malnutrition risk scores. Appropriate malnutrition management improved for 47% of GPs after module completion. Conclusion: This e-learning module improved malnutrition knowledge, with good short-term retention in a small cohort. Development of online evidence-based nutrition education may improve GP nutrition care. [ABSTRACT FROM AUTHOR]

'Prepping' – the storing of food, water and weapons as well as the development of self-sufficiency skills for the purpose of independently surviving disasters – is an emerging market as well as an expression of generalised anxiety about existential threats (e.g. technological collapse and catastrophic climate change). Whilst accounts of eccentric prepping are common in mainstream media, there is little empirical investigation into how consumers imagine and prepare for a temporary or permanent halt to functioning market systems, and with it, a consumer society. A netnography of European preppers reveals prepping to be an anticipatory mode of practicing for a post-market, post-consumer society before it becomes a reality. We find that preparation is a struggle for cognitive legitimacy through four different modes: vulnerabilising the market, common-sensing market signals, othering civilian consumers and unblackboxing objects. [ABSTRACT FROM AUTHOR]

Background: This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. Summary: It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. Key Messages: People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay. [ABSTRACT FROM AUTHOR]