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Tattooing is a widespread practice and has increased in popularity over time. Many lesions have been described in relation to tattoos, including malignant tumors.

BackgroundThere is no standardised approach to screening adults for social risk factors. The goal of this study was to develop mortality risk prediction models based on the social determinants of health (SDoH) for clinical risk stratification.MethodsData were used from REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal cohort of black and white Americans aged ≥45 recruited between 2003 and 2007. Analysis was limited to participants with available SDoH and mortality data (n=20 843). All-cause mortality, available through 31 December 2018, was modelled using Cox proportional hazards with baseline individual, area-level and business-level SDoH as predictors. The area-level Social Vulnerability Index (SVI) was included for comparison. All models were adjusted for age, sex and sampling region and underwent internal split-sample validation.ResultsThe baseline prediction model including only age, sex and REGARDS sampling region had a c-statistic of 0.699. An individual-level SDoH model (Model 1) had a higher c-statistic than the SVI (0.723 vs 0.708, p<0.001) in the testing set. Sequentially adding area-level SDoH (c-statistic 0.723) and business-level SDoH (c-statistics 0.723) to Model 1 had minimal improvement in model discrimination. Structural racism variables were associated with all-cause mortality for black participants but did not improve model discrimination compared with Model 1 (p=0.175).ConclusionIn conclusion, SDoH can improve mortality prediction over 10 years relative to a baseline model and have the potential to identify high-risk patients for further evaluation or intervention if validated externally.

Background The purpose of this research is to extend Corporate Social Marketing (CSM) literature and provide practitioners with a framework that can be used in different contexts, as the existing literature lacks an understanding of what factors determine the success of a CSM program and understand the interplay between cross-sector partnerships, CSM, and societal outcomes and impact delivery. Companies are taking a greater interest in addressing social issues, utilizing innovative CSR approaches such as CSM to promote behavior change among their audience while matching their core strengths and attributes (Kotler et al., 2012).Focus of the Article The article evaluates how the CSM program Mein Pragatideveloped lasting behavior change and seeks to develop a conceptual model around its success.Research Question How can the CSM contribute to behavior change programs?Program Design/Approach Importance to the Social Marketing Field The proposed model (Input, Outcome, and Impact Model of Program Development) provides a structured approach to building a CSM program that changes behavior and develops mutual benefit between corporations, government, and nonprofits.Methods Using a case study approach, this paper analyzes a successful financial inclusion program, Mein Pragatiof a global analytics company, CRISIL, and its CSR arm. The three studies (in-depth interviews with eight management members, in-depth interviews with 82 Sakhis (peer educators) and their spouses, and 248 survey interviews with beneficiaries reveal the connection between program development, social outcomes, and societal impact.Results Based on the findings of the three studies, the cross-sector Input, Output, and Outcome Model of the Program Development proposes ways to build effective CSR interventions. Individually, the findings from the in-depth interviews provide a thematic overview of CSM’s success, peer educator interviews identify the impact and outcomes of Mein Pragati, and beneficiary interviews demonstrate program success.Recommendations for Research and Practice Future research can empirically test the Input, Outcome, and Impact Model of Program Development, as further exploration of CSM is needed to understand how the concepts of people, planet, and profits can mutually benefit and provide both behavioral and societal change within program development.

This article introduces the deep background to the interest in Italy and specifically Padua displayed by Shakespeare and his contemporaries by attending to the contrasts between their knowledge and that of English characters from a century earlier. Our guide will be John Tiptoft, Earl of Worcester (d. 1470). He was both well-travelled and much-hated in his homeland: he was accused of bringing home from his time abroad ‘the law Padowe’, that is, ‘the law of Padua’ – a penchant for summary justice and grisly execution. This article considers what Tiptoft's life and afterlife tells us about the changing place of Padua in the English imagination.

ABSTRACTThe Reef 2050 Water Quality Improvement Plan 2017–2022 identified that changes to evaluation practices were an urgent need if ambitious water quality targets were to be realised. To understand if progress had been made, this study synthesised publicly available evidence for ten projects aiming to engage sugarcane growers in practice change. The aims of this study were to identify factors facilitating or preventing practice change in sugarcane growing, drawing on monitoring and evaluation evidence that was publicly available for the ten projects. Twenty-one peer-reviewed articles and government and industry reports were collated and analysed. Thematic analysis identified seven enablers of engagement with practice changes resulting from project participation: government and industry partnerships, effective communication, training and education, grower or community leadership, financial support, return on investment and social factors. This review showed that a lack of enabling factors is a barrier to program adoption and practice change. Additional barriers were lack of availability of alternatives, lack of clear and transparent monitoring and evaluation for projects, lack of trust between stakeholders and competing stakeholder interests.

The capacity of an individual to respond to changes in food intake so that postprandial metabolic perturbations are resolved, and metabolism returns to its pre-prandial state, is called phenotypic flexibility. This ability may be a more important indicator of current health status than metabolic markers in a fasting state.

Background: The majority of Northern Irish uveal melanoma (UM) patients are diagnosed in Sheffield. This study aims to present incidence and survival outcomes for UM patients from Northern Ireland (NI). Methods: Collaborative retrospective study between Sheffield and Northern Ireland Cancer Registry (NICR). For UM cases not on both databases, outcomes and survival rates (via Kaplan-Meier analysis) were compared. Anonymised NICR data were used to calculate whole-population incidence of UM for NI. Results: In total, 161 patients from NI were diagnosed in Sheffield, 90 of which were not registered with NICR at the start of this study. Data-omissions were not consistent across patient groups, leading to significant differences between those patients registered and those not. Registered patients had an all-cause 5-year survival rate of only 68.9% compared to 92.5% of those not registered (p&lt; 0.01) and were >17x more likely to have systemic metastases than those not registered (p&lt; 0·001). Following rectification of data-omissions, the European age-standardised incidence rate of UM for NI was 8·6 per million. Conclusions: This study illustrates the impact of incomplete population-wide data, serving as a real-world lesson in case-identification bias. Rare cancers are at higher risk of omission due to systemic failures as the small numbers involved are not detected by system-wide validation procedures. Following this study, data-transfer agreements between England and NI were actioned, preventing future data-omissions. We present survival and incidence data for UM in NI for the first time, showing the incidence is amongst the highest in Europe, with good survival rates.

Purpose of Review: Skin cancer is the most common cancer globally, and the incidence and prevalence of both melanoma and non-melanoma skin cancers has been increasing in recent decades, representing a rising number of disability-adjusted life years. This narrative review explores the interplay between climate change and the development of skin cancer, highlighting potential mechanistic links including increased UV radiation, tumorigenic effects of air pollutants such as phthalates and polycylic aromatic hydrocarbons stemming from anthropogenic practices, and sociobehavioral changes related to increasing ambient temperatures. Recent Findings: International efforts to mitigate ozone layer depletion, greenhouse gas emissions, and rising temperatures are summarized to explore the current state of global collaboration and success regarding climate protective policies. Timely strategies for dermatologists to engage in climate advocacy are compiled and discussed, including community- and practice-level actions, organizational involvement, and opportunities for improving personal and office sustainability. Summary: This review highlights the influence of climate change on cutaneous carcinogenesis given the observed annual increases in skin cancer incidence and the well-established link between UV radiation and skin cancer while presenting practical, easily adoptable strategies for dermatologists to reduce their carbon footprints and become climate advocacy leaders.

Background Segmentation use in social marketing especially in improving the health of young adults is limited, and theory use within segmentation remains infrequent. A generalisable segmentation structure that can be reliably applied across different young adult’s samples may assist social marketers to move beyond one size fits all healthy eating programs.Focus of the Article Segmentation is an essential marketing principle which allows customising marketing activities to the needs of specific segments. Evidence shows that behaviour change is more likely when more principles are used, yet segmentation remains underutilised and a cross-sample validation of segments across different populations remains to be demonstrated.Importance to the Social Marketing Field Delivery of healthy eating programs targeted to group differences and accommodating a broader theory-based socio-ecological viewpoint is needed to engage with a cross section of young adults more effectively along with a cross-sample validation of segments across different populations to identify a valid segmentation structure that can be reliably applied across the Australian young adult population.Methods A replication study was conducted using the same constructs, items and analytical procedures as in the original study. Data was collected online and in person using a paper survey in two military bases to ensure a mix of Australian Defence Force (ADF) trainee types. Psychographic variables informed by the MOA framework were collected and used to segment the sample with two-step cluster analysis along with a demographic measure (education) and behavioural measure (eating behaviour) to repeat the segmentation analysis.Results The ability of the MOA framework to explain eating behaviour was confirmed in the ADF trainee sample, and two-step cluster analysis produced a similar segment structure to the original study with education, opportunity and motivation to eat healthy being the most important variables in segment formation.Recommendations for Research or Practice Segmentation is important for developing understanding that enables social marketers to design social change programs to meet the needs of young adults. This empirical replication study confirmed a similar theory-driven healthy eating segment solution across two young adult populations illustrating the value of using behavioural theories to draw segments and utilising the same theory to cross-validate the constructs in a comparable sample. Future research could use this approach to identify a valid segmentation structure that can be reliably applied across different populations and behavioural contexts.

Introduction: Proton beam therapy has been utilised for the treatment of uveal melanoma in the UK for over 30 years, undertaken under a single centre. In the UK, all ocular tumours are treated at one of four centres. We aimed to understand the variation in referral patterns to the UK proton service, capturing all uveal melanoma patients treated with this modality. Methods: Retrospective analysis of data regarding all patients treated at the Clatterbridge Proton service between January 2004 and December 2014. Results: A total of 1084 patients with uveal melanoma were treated. The mean age was 57 years (range 9–90 years), basal diameter of 11.5 mm (range 2.0–23.4 mm) and tumour thickness of 3.9 mm (range 0.1–15.4 mm). The majority were TNM stage I (39%) or II (36%). The distance to the optic nerve varied from 0 to 24.5 mm with 148 (14%) of patients having ciliary body involvement. There were variations in the phenotypic characteristic of the tumours treated with protons from different centres, with London referring predominantly small tumours at the posterior pole, Glasgow referring large tumours often at the ciliary body and Liverpool sending a mix of these groups. Discussion: In the UK, common indications for the use of proton treatment in uveal melanoma include small tumours in the posterior pole poorly accessible for plaque treatment (adjacent to the disc), tumours at the posterior pole affecting the fovea and large anterior tumours traditionally too large for brachytherapy. This is the first UK-wide audit enabling the capture of all patients treated at the single proton centre.

ABSTRACTThe koala (Phascolarctos cinereus) is an iconic Australian animal. Its recent reclassification to endangered in locations such as South East Queensland, New South Wales and the Australian Capital Territory indicates urgent and further conservation actions are required. This article proposes that a downstream social marketing approach can be applied to encourage South East Queensland residents to take preventative actions to protect koalas in their region. This article reports the results of an online survey that was completed by 2,592 South East Queensland residents. The data was cluster analysed using TwoStep cluster analysis, resulting in three valid segments. Active koala enthusiasts are knowledgeable and active in koala conservation. City residents were aware of koalas’ decline but are unfamiliar with conservation actions. Young dog owners do not know about the decline of koalas and they do not currently perform conservation actions. Respondents agreed that koala conservation is a shared responsibility between residents, organisations and governments and too many are not aware of actions they can take. Tailored approaches should be applied in the future, including citizen science initiatives such as completing online koala sightings to broaden understanding of koala habitats.

ABSTRACTEarly life gut microbiome composition has been correlated with childhood obesity, though microbial functional contributions to disease origins remain unclear. Here, using an infant birth cohort (n = 349) we identify a distinct fecal microbiota composition in 1-month-old infants with the lowest rate of exclusive breastfeeding, that relates with higher relative risk for obesity and overweight phenotypes at two years. Higher-risk infant fecal microbiomes exhibited accelerated taxonomic and functional maturation and broad-ranging metabolic reprogramming, including reduced concentrations of neuro-endocrine signals. In vitro, exposure of enterocytes to fecal extracts from higher-risk infants led to upregulation of genes associated with obesity and with expansion of nutrient sensing enteroendocrine progenitor cells. Fecal extracts from higher-risk infants also promoted enterocyte barrier dysfunction. These data implicate dysregulation of infant microbiome functional development, and more specifically promotion of enteroendocrine signaling and epithelial barrier impairment in the early-life developmental origins of childhood obesity.

ABSTRACTFood waste is a significant environmental, economic, and social issue contributing to global warming. The benefits of theoretically informed programs have been verified in psychology, social science, and education, yet our understanding of theory application in food waste behaviour change is scarce. To understand how food waste can be reduced, we need to understand what works, when, where and why. Assessing the extent of theory use in the context of food waste behaviour is needed to advance progress. Following the approach employed in Willmott et al. (2019) this study sought to assess the extent of theory application in studies aiming to reduce household food waste. A systematic search and review of published studies concerning household food waste behaviour was conducted. Of 3,532 studies, nine studies met the inclusion criteria. Eight studies mentioned a theory, however, the association between program strategies implemented and the theory base reported was lacking. This review concludes there is considerable room for improvement in theory reporting to indicate clearly how theory is applied to reduce household food waste behaviour.

Background and Situation Analysis The United Nations has announced serious global water crises at the beginning of the 21st century. In the United Arab Emirates (UAE), the problem of water shortage is more significant than in other parts of the world, due to lack of the natural freshwater resources and extremely harsh weather. All of this compounded with the highest individual water consumption in the world; the average consumption per capita is 500 L a day, around 82% above the global average.Focus of the Article The main objectives of this study were to gain insights about factors that might impact residents water consumption behavior and open more avenues for using social marketing to influence residents’ behaviors.Research question The research questions are: RQ1: What beliefs are held about the UAEs current water situation? RQ2: What are the current water consumption behaviors of UoS residents? RQ3: What would facilitate lower water consumption?Importance to the Social Marketing Field The importance of this study is to develop a model which may be employed to change individual water consumption behavior using social marketing principlesMethod A case study methodology was applied to collect data from the University of Sharjah for this study, using the focus groups method. A convenience sample of six focus groups with a total of 39 participants of students, faculty members, administrative staff, and other stakeholders formed the basis of the current study.Results This study revealed that the residents lacked accurate knowledge about the water situation inside the country. In addition, consumers showed mismatch between their religious beliefs and actual consumption behaviors.Recommendations for research/or practice More studies and research should take place in this field, especially in connection with personal behavior issues where individuals need encouragement and incentives to change underlying habits, such as over-consumption of water, obesity, and road accidents.

Tin sulfide (SnS) and tin selenide (SnSe) are attractive materials for thermoelectric conversion applications. Favorable small band gap, high carrier mobility, large Seebeck coefficient, and remarkably low lattice thermal conductivity are a consequence of their anisotropic crystal structure of symmetry Pnma, made of corrugated, black phosphorus-like layers. Their internal lattice dynamics combined with chemical bond softening in going from SnS to SnSe make for subtle effects on lattice thermal conductivity. Reliable prediction of phonon transport for these materials must therefore include many-body effects. Using first principles methods and a transferable tight-binding potential for frozen phonon calculations, here, we investigate the evolution of thermal lattice conductivity and thermoelectric figure of merit in Pnma-SnS and -SnSe, also including the high-temperature Cmcm-SnS phase. We show how thermal conductivity lowering in SnS at higher temperatures is largely due to dynamic phonon softening ahead of the Pnma–Cmcmstructural phase transition. SnS becomes more similar to SnSe in its lifetime and mean free path profiles as it approaches its high-temperature Cmcmphase. The latter nonetheless intrinsically constraints phonon group velocity modules, preventing SnS to overtake SnSe. Our analysis provides important insights and computational benchmarks for optimization of thermoelectric materials via a more efficient computational strategy compared to previous ab initio attempts, one that can be easily transferred to larger systems for further thermoelectric materials nanoengineering. The good description of anharmonicity at higher temperatures inherent to the tight-binding potential yields calculated lattice conductivity values that are in very good agreement with experiments.

ABSTRACTAs part of a national survey on social workers’ attitudes toward immigrants and immigration (N=4,499), we collected information on respondents’ perceptions of immigrants as threats and respondents’ views on structural inequality as it pertains to immigrants’ opportunities for success. Contrary to the Council on Social Work Education’s Educational Policy and Accreditation Standards stating the need for social workers to understand the existence and functioning of structural forces of inequality, nearly a third of our respondents denied that immigrants are disadvantaged compared to U.S.-born citizens, and more than a third denied that disadvantage is related to race, ethnicity, or national origin. Those who denied disadvantage were more likely than those who did not to see immigrants as threats. We provide interpretations for these findings and offer some recommendations for social work research and education geared toward deepening practitioners’ knowledge of the structural barriers faced by immigrants.

Purpose of Review: We explore the utility of social media platforms as educational tools in dermatology, providing a summary of how these sites are used by the public and dermatologists alike, and demonstrating ways these findings may be applied for educational purposes. Recent Findings: Over half of the world’s population utilizes social media platforms. More recently, these platforms have increasingly been used for educational purposes. In the field of dermatology, a large portion of the educational content is coming from users with no formal medical or dermatologic training. Summary: Each of the top five social media platforms in the world (Twitter, Instagram, TikTok, YouTube, and Facebook) has unique qualities which people may utilize to educate fellow users. As more of the population seeks online health information and education, it is important that dermatologists, while taking ethical considerations into account, become more comfortable facilitating educational content on social media.

Purpose: Participatory design involves users and other key stakeholders in processes that aim to ensure solutions generated meet their needs. This paper compares the processes and outcomes of two participatory design approaches (design thinking and co-design) to examine their utility in co-creating innovative service solutions for reducing household energy demand. Design/methodology/approach: Design thinking and co-design were implemented in two independent convenience samples of household energy users in Queensland, Australia. Workshops were conducted online using Zoom and Padlet technology. Informed by the capability-practice-ability (CPA) portfolio, a critical analysis based on the research team's experiences with implementing the two participatory design approaches is presented. Findings: The key distinguishing features that set design thinking apart from co-design is extent of user involvement, solution diversity and resource requirements. With a shorter duration and less intensive user involvement, co-design offers a more resource efficient means of solution generation. In contrast, design thinking expands the solution space by allowing for human-centred problem framing and in so doing gives rise to greater diversity in solutions generated. Research limitations/implications: Mapping the six constellations of service design outlined in the CPA portfolio to the research team's experiences implementing two different participatory design approaches within the same context reconciles theoretical understanding of how capabilities, practices and abilities may differ or converge in an applied setting. Practical implications: Understanding the benefits and expected outcomes across the two participatory design approaches will guide practitioners and funding agencies in the selection of an appropriate method to achieve desired outcomes. Originality/value: This paper compares two forms of participatory design (design thinking and co-design) for service innovation in the context of household energy demand offering theoretical and practical insights into the utility of each as categorised within the CPA portfolio.

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The last 12 months have provided further evidence of the potential for cascading ecological and socio-political crises that were warned of 12 months ago. Then a consensus statement from the Regional Action on Climate Change Symposium warned: “the Earth’s climatic, ecological, and human systems are converging towards a crisis that threatens to engulf global civilization within the lifetimes of children now living.” Since then, the consequences of a broad set of extreme climate events (notably droughts, floods, and fires) have been compounded by interaction with impacts from multiple pandemics (including COVID-19 and cholera) and the Russia–Ukraine war. As a result, new connections are becoming visible between climate change and human health, large vulnerable populations are experiencing food crises, climate refugees are on the move, and the risks of water, food, and climate disruption have been visibly converging and compounding. Many vulnerable populations now face serious challenges to adapt. In light of these trends, this year, RACC identifies a range of measures to be taken at global and regional levels to bolster the resilience of these populations in the face of such emerging crises. In particular, at all scales, there is a need for globally available local data, reliable analytic techniques, community capacity to plan adaptation strategies, and the resources (scientific, technical, cultural, and economic) to implement them. To date, the rate of growth of the support for climate change resilience lags behind the rapid growth of cascading and converging risks. As an urgent message to COP27, it is proposed that the time is now right to devote much greater emphasis, global funding, and support to the increasing adaptation needs of vulnerable populations.

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Surfactants, many of which are used as detergents, can be found in many common household items, such as shampoos, conditioners, soaps, and cosmetics. One should recognize the multitude of surfactants that are used in today's products to identify any potential allergic contact dermatitis (ACD) or irritant contact dermatitis (ICD). Given their abundance in everyday products, it is understandable that many cases of occupational contact dermatitis that arise can be attributed to surfactants. The products most connected with ACD are cocamidopropyl betaine, oleamidopropyl dimethylamine, decyl glucoside, 3-dimethylaminopropylamine, amidoamine, and cocamide diethanolamine. Similarly, the most common surfactant-related causes of ICD are sodium lauryl sulfate and benzalkonium chloride. It is important for dermatologists to identify the causes and differentiate between the two, to adjust treatments and products accordingly. Here, the most frequently used surfactants, as well as their correlation between ACD and ICD, will be reviewed.

Background: This paper aims to extend the application of social marketing to social and environmentally beneficial behavior change providing a three-step process—Co-create-Build-Engage (CBE). The key strength social marketing brings to the social change space is the development of something of value that moves and motivates people to voluntarily change their behavior; in turn benefitting themselves, the planet and society at large.Method: Using a case study method, this paper identifies how up to eight marketing principles, initially penned to distinguish social marketing from public health, are applied in the three step CBE process, using first time program development and implementation examples. First, programs are co-created (C) with people at the heart of the problem and built (B) to create and embed lasting solutions and finally communities are engaged (E) to partake in these programs. This linear process is applied in first time program development and stages blur following first time implementation as CBE steps become continuous when programs are embedded into communities. This paper outlines four cases demonstrating when and where key marketing activities were applied to co-create, build and implement social marketing programs that achieved behavioral change.Results: Included is a roadmap of the activities that occurred in first time program development and implementation across each stage of the three step CBE process. During co-creation competition is assessed and groups are identified (segmentation). Formative research programs are theoretically underpinned and human centred (customer orientation) and solely aimed at identifying insights to guide program build and engagement. Elements of the marketing mix focus program build ensuring that a valued exchange offering is built. Engagement represents the initial implementation phase and encompasses the set of activities that focus on ensuring people are aware of and can adopt the program.Recommendations for Research or Practice: Many of the foundational techniques that distinguish social marketing from other behavioral science approaches are not widely adopted. This paper offers a roadmap to demonstrate how and when core social marketing activities can be applied to effect voluntary behavior change. Volitional change avoids stigmatization, alienation, reactance and community divides, which occur when behaviors are mandated or when people are told what to do. The CBE process provides a process, outlining social marketing’s key principles and the set of activities that are applied to build more effective marketing programs.

ABSTRACTKoalas are an Australian icon, and their existence is under threat. Environmental protection efforts that centre on people are needed, ensuring the human dimension is considered in conservation efforts aiming to protect wildlife. This article reports process and outcome evaluation results for a social marketing program that aimed to reduce dog and koala interactions. This project aimed to leverage pilot study outcomes. Specifically, the program sought to embed koala aversion (the ability for a dog to avoid koalas) skills within one local government area. A total of 2013 dog owners were surveyed to assess program outcomes, with improved dog abilities observed following city-wide program implementation. Further evidence of program success was indicated in the process evaluation. Dog trainers and dog owners were satisfied, willing to recommend the program to other people, and they were willing to attend events in future. Lessons learned, implications, limitations of the current study and future directions are outlined.

AbstractHistorically, prosecutors and judges relied almost exclusively on punitive measures, most notably jail or prison sentences, to address and deter criminal activity. However, the traditional punitive approach to justice is unduly expensive, does not work as well as it should, and has unnecessary and devastating consequences for lower level offenders and their families. While more and more district attorneys have begun to experiment with what some call “progressive” solutions, strategic remedial measures that reduce crime, improve lives, and save money are a matter of tradition for Miami-Dade County prosecutors. This paper outlines the results of a new strategy in Miami-Dade County, Florida, “Miami-Style Smart Justice” which focuses on a mixture of rehabilitation and incapacitation depending on the circumstances of the offenders as individuals and employs an evidence-based outcome-oriented approach that maximizes public safety, makes judicious use of jail space, minimizes unintended collateral consequences, and reduces costs. Using this approach Miami-Dade County as seen an almost 70% drop in the crime rate since 1993, while dramatically reducing its reliance on incarceration.

Cerebrovascular reactivity mapping performed with resting-state blood oxygen level–dependent functional MRI provided a task-free method for measuring cerebrovascular reserve in both healthy adults and patients with Moyamoya disease and is sensitive to revascularization surgery.

An experiment was conducted to test the hypothesis that inclusion of hybrid rye in diets fed to growing-finishing pigs would not affect growth performance. A total of 1,177 pigs (initial body weight: 25.75 ± 0.04 kg) were randomly allotted to one of four dietary treatments with 40 experimental pens, 30 pigs per pen, sex split evenly within pen, and pen as the experimental unit. There were 2 experimental phases with a control diet containing corn (CON) and three diets containing increasing levels of hybrid rye replacing corn (LOW, MOD, or HIGH) formulated within each phase: 10%, 20%, or 30% in phase 1 and 20%, 40% or 50% in phase 2, respectively. Prediction equations were used to calculate net energy values of hybrid rye and diets were formulated to be isocaloric, with the addition of choice white grease (CWG) as hybrid rye was increased in the diet to compensate for predicted energy values. Pigs were provided ad libitum access to feed and water. Pig body weights and feed consumption were recorded on d 14, 28, 42, 56, 70, 84, 90, 100, and 118. Average daily gain, average daily feed intake, and gain:feed were calculated. Data were analyzed with R using linear and quadratic contrast statements to evaluate effects of increasing levels of hybrid rye in the diet, and another contrast statement to compare the control diet with the combined rye dietary treatments. Average daily feed intake was linearly reduced (P≤ 0.05) if hybrid rye was added to the diet on d 56, 70, 84 and 90, and in the overall experimental period. Average daily gain linearly increased (P≤ 0.05, d 90, d 100; P≤ 0.10, d 28) or was not affected by dietary treatment throughout the experiment. Consequently, addition of hybrid rye resulted in a linear increase (P≤ 0.05) in gain:feed on d 28 and d 90, with a tendency for a linear increase (P≤ 0.10) also observed on d 70 and d 100. The hybrid rye treatment groups had a greater (P≤ 0.05; overall; P≤ 0.10; d 56) gain:feed compared with the corn-based control group, indicating improved efficiency. There were also no differences (P≥ 0.21) among treatments in the average selling body weight on d 90, d 100, or d 118. However, it is possible that the energy value of hybrid rye was greater than predicted, and that the inclusion of CWG in the diet resulted in improvements in growth performance due to the greater energy content. Therefore, it may be concluded that hybrid rye is a suitable ingredient in swine rations with or without the addition of CWG to improve or maintain feed efficiency and market weight during the growing-finishing phase of production.

ABSTRACTThis article contributes to an emerging body of research on the role of assessment design in the prevention and detection of contract cheating. Drawing on the largest contract cheating dataset gathered to date (see cheatingandassessment.edu.au), this article examines the types of assignments and exams in which students self-reported having engaged in some form of third-party cheating, and compares this with the types of assignments and exams in which staff self-reported detectionof third-party cheating. The article outlines three key findings. Firstly, students most commonly reported cheating in the context of exams (particularly multiple-choice exams), yet staff reported the detection of cheating in exams relatively rarely. Secondly, students reported cheating in traditional written assignments, such as reports and essays, at slightly lower rates than exams, however staff detection rates for these assignments were far higher than for exams. So third-party cheating was reported by students as occurring most commonly in exams, yet it was detected most commonly by staff in assignments. And thirdly, staff detection rates relative to student cheating rates were typically highest for text-rich assessments – regardless of whether they were invigilated (e.g., essay under exam conditions) or not (e.g., essay). These findings challenge simplistic advice in the literature and public debate that universities should move away from text-based assignments and towards invigilated exams as a means to prevent contract cheating. While text-rich forms of assessment are not immune to contract cheating, exams are not inherently secure. While staff appear to be practised at detecting cheating in the context of student writing, greater awareness is needed to improve the detection of cheating in exams.

ABSTRACTWith construction waste accounting for 40% of all waste produced in Australia, this paper evaluates front-end strategies to minimize physical site waste on Australian projects. Front-end strategies are those practices at the initial phase of the material logistics chain that will reduce or totally remove site waste, rather than simply treat the residual waste product.Following a global literature review, a qualitative methods approach using a pragmatic research framework was developed. The respondent sample for this research was from across the spectrum of Australian building and construction industry, varying from industry company directors to general superintendents.The paper observes that the historically rapid increase in construction waste will be exacerbated by the very real increasing risk of waste due to recovery from disaster damage (bush fire, flood and storm surge coupled with climate change). Increasingly intelligent front-end strategies that minimize waste have therefore become a high priority for action.It is concluded that the most effective way to reduce construction waste in Australia is via regulatory change, requiring policies and procedures that focus on front-end strategies. This paper explores some opportunities for action in the areas of management, design and procurement in line with the themes identified in the surveys

This article considers one element within the long tradition of the church’s self-identification as a city. It focuses on England, c. 1450 to c. 1510, and considers how the civic rhetoric developed by Italian humanists, pre-eminently Leonardo Bruni, was refracted through an ecclesiastical lens and so appropriated for English clerical use. It describes how two useful elements were quarried from recent writings imported from Italy: the first was the emphasis on the city and its buildings as a locus of virtue; the second was that, because of its virtue, that city was under attack. The discussion begins with the time of social unrest in the mid-fifteenth century,in the wake of which Thomas Chaundler wrote his praise of Thomas Bekynton, bishop of Bath and Wells, and his building works in his episcopal city. It ends in the first years of the sixteenth century with the relations between Christopher Urswick, dean of Windsor, and Thomas Goldstone, prior of Christ Church, Canterbury. Their re-use of older texts, specifically the Speculum regis Edwardi III, which they assumed to be by Archbishop Simon Islip, and more recent humanist ones, by Celso Maffei and Goldstone’s predecessor as prior, William Sellyng, identified other enemies who attacked the church: invoking the name of Thomas Becket, they saw those oppressing them to be not rebels against authority but those in authority. This allows us to reflect on how a few English readers of humanist civic rhetoric found in it potentially radical force.

BackgroundRidesharing services (eg, Uber, Lyft) have facilitated over 11 billion trips worldwide since operations began in 2010, but the impacts of ridesharing on motor vehicle injury crashes are largely unknown.—MethodsThis spatial ecological case-cross over used highly spatially and temporally resolved trip-level rideshare data and incident-level injury crash data for New York City (NYC) for 2017 and 2018. The space-time units of analysis were NYC taxi zone polygons partitioned into hours. For each taxi zone-hour we calculated counts of rideshare trip origins and rideshare trip destinations. Case units were taxi zone-hours in which any motor vehicle injury crash occurred, and matched control units were the same taxi zone from 1 week before (−168 hours) and 1 week after (+168 hours) the case unit. Conditional logistic regression models estimated the odds of observing a crash (separated into all injury crashes, motorist injury crashes, pedestrian injury crashes, cyclist injury crashes) relative to rideshare trip counts. Models controlled for taxi trips and other theoretically relevant covariates (eg, precipitation, holidays).ResultsEach additional 100 rideshare trips originating within a taxi zone-hour was associated with 4.6% increased odds of observing any injury crash compared with the control taxi zone-hours (OR=1.046; 95% CI 1.032 to 1.060). Associations were detected for motorist injury and pedestrian injury crashes, but not cyclist injury crashes. Findings were substantively similar for analyses conducted using trip destinations as the exposure of interest.ConclusionsRidesharing contributes to increased injury burden due to motor vehicle crashes, particularly for motorist and pedestrian injury crashes at trip nodes.

AimsTo investigate the success and recurrence rates and visual outcomes in a large case series of amelanotic posterior choroidal melanomas treated by means of primary photodynamic therapy (PDT) with verteporfin.MethodsRetrospective case series from a single specialist ocular oncology centre. All patients had a clinical diagnosis of choroidal melanoma and were selected for PDT based on tumour characteristics. Included patients had at least 24 months of follow-up from initiation of treatment and all but one had not received treatment prior to PDT.Results69 patients were included. Mean tumour thickness was 1.9 mm (range 0.5–4.4), while the mean basal diameter was 6.9 mm (range 2.4–11.0). Included lesions were stage cT1a (n=66) or cT2a (n=3). The mean duration of follow-up from treatment initiation was 57 months (range 24–116 months). Seven lesions (10%) failed to respond to PDT. 10 patients (16%) experienced recurrence during follow-up. Overall success rate in this series was 75% (n=52). 83% of successfully treated patients (n=43) maintained or gained vision by final follow-up. Visual outcomes were significantly better in those patients who received PDT therapy alone in comparison to those who needed other treatments for their melanoma (Fisher’s exact test, p=0.004). Unfortunately, one patient (1.4%) in the series developed systemic metastases and died.ConclusionSelected amelanotic posterior uveal melanomas may be successfully treated with PDT with retention of good vision in the majority of cases, maintained with a mean of 57 months (minimum of 24 months) of follow-up.

BackgroundEfforts to reduce socioeconomic inequities in cardiovascular disease include interventions to change the built environment. We aimed to explore whether socioeconomic inequities in coronary heart disease (CHD) incidence are ameliorated or exacerbated in environments supportive of physical activity (PA).MethodsWe used data from the Reasons for Geographic and Racial Differences in Stroke study, which recruited US residents aged 45 or older between 2003 and 2007. Our analyses included participants at risk for incident CHD (n=20 808), followed until 31 December 2014. We categorised household income and treated it as ordinal: (1) US$75 000+, (2) US$35 000–US$74 000, (3) US$20 000–US$34 000 and (4)

Background: Indoor environments contain a broad diversity of non-pathogenic Basidiomycota yeasts, but their role in exacerbating adverse health effects has remained unclear. Objective: To understand the role of Vishniacozyma victoriaeexposure and its impact on human health. Methods: A qPCR assay was developed to detect and quantify an abundant indoor yeast species, Vishniacozyma victoriae(syn. Cryptococcus victoriae), from homes participating in the New York City Neighborhood Asthma and Allergy Study (NAAS). We evaluated the associations between V. victoriae, housing characteristics, and asthma relevant health endpoints. Results: V. victoriaewas quantified in 236 of the 256 bedroom floor dust samples ranging from less than 300–45,918 cell equivalents/mg of dust. Higher concentrations of V. victoriaewere significantly associated with carpeted bedroom floors (P= 0.044), mean specific humidity (P= 0.004), winter (P&lt; 0.0001) and spring (P= 0.001) seasons, and the presence of dog (P= 0.010) and dog allergen Can f 1 (P= 0.027). V. victoriaeconcentrations were lower in homes of children with asthma vs. without asthma (P= 0.027), an association observed only among the non-seroatopic children.

Purpose of Review: The immense growth of social media has afforded new opportunities in dermatology clinical research. This review serves to outline how social media has impacted clinical research and to explore future avenues for which social media can make a significant impact in dermatology clinical research. Recent Findings: Recent clinical trials augmented by social media have demonstrated increased participant enrollment, shortened recruitment timelines, and decreased recruitment cost. The incorporation of social media into clinical research has also afforded greater access to teledermatology and the initiation of virtual clinical trials. Summary: Clinical research serves as a primary source of evidence for refining healthcare practices by expanding the understanding of patient demographics, methods for improving patient care, and new therapeutic discoveries. Since its initiation, social media has played an integral and ever-expanding role in clinical research.

Background/objectives: The association between mode of delivery and childhood obesity remains inconclusive. Because few studies have separated C-section types (planned or unplanned C-section), our objective was to assess how these subtypes relate to preadolescent obesity. Subjects/methods: The study consisted of 570 maternal–child pairs drawn from the WHEALS birth cohort based in Detroit, Michigan. Children were followed-up at 10 years of age where a variety of anthropometric measurements were collected. Obesity was defined based on BMI percentile (≥95th percentile), as well as through Gaussian finite mixture modeling on the anthropometric measurements. Risk ratios (RRs) and 95% confidence intervals (CIs) for obesity comparing planned and unplanned C-sections to vaginal deliveries were computed, which utilized inverse probability weights to account for loss to follow-up and multiple imputation for covariate missingness. Mediation models were fit to examine the mediation role of breastfeeding. Results: After adjusting for marital status, maternal race, prenatal tobacco smoke exposure, maternal age, maternal BMI, any hypertensive disorders during pregnancy, gestational diabetes, prenatal antibiotic use, child sex, parity, and birthweight z-score, children born via planned C-section had 1.77 times higher risk of obesity (≥95th percentile), relative to those delivered vaginally ((95% CI) = (1.16, 2.72); p= 0.009). No association was found comparing unplanned C-section to vaginal delivery (RR (95% CI) = 0.75 (0.45, 1.23); p= 0.25). The results were similar but slightly stronger when obesity was defined by anthropometric class (RR (95% CI) = 2.78 (1.47, 5.26); p= 0.002). Breastfeeding did not mediate the association between mode of delivery and obesity. Conclusions: These findings indicate that children delivered via planned C-section—but not unplanned C-section—have a higher risk of preadolescent obesity, suggesting that partial labor or membrane rupture (typically experienced during unplanned C-section delivery) may offer protection. Additional research is needed to understand the biological mechanisms behind this effect, including whether microbiological differences fully or partially account for the association.

Background: Eating behaviors are complex and have particular significance for military personnel who require sound nutrition to support health and physical fitness for job performance. Policies and guidelines for the provision of nutritionally appropriate food/drink on base and in the field do exist; however, many military personnel have poor dietary habits, and these habits are evident early in their career. Social marketing could assist in changing unhealthy eating behaviors of personnel through implementation of feasible interventions co-created with stakeholders that are valued by Australian Defence Force (ADF) personnel.Focus of the article: The article reports the first phase of a systemic co-inquiry into unhealthy eating behaviors of military personnel. This study aimed to gain an initial framing of the problem situation and thus hypothesize a “system of interest” in which to conduct future work.Research questions What components (e.g., ideas, objects, attributes, activities) are perceived to be relevant for eating behaviors in military personnel?Do interrelationships and interconnections among components suggest how unhealthy eating behaviors may emerge?Are there places that suggest viable leverage points as opportunities for changing unhealthy eating behaviors through delivery of offerings that ADF personnel value?Program Design/Approach: This study was part of a systemic inquiry approach.Methods: Data for the study included document analysis and 14 semi-structured depth interviews with ADF stakeholders. Data were thematically analyzed to construct a system of interest in which to explore how eating behaviors emerge among personnel and ADF-controlled leverage points that can be used to increase healthy eating for ADF personnel through social marketing intervention.Results: The data analysis identified alternative systems of interest in which to explore how eating behaviors emerge among personnel. Demand and supply side leverage points were identified. On the supplyside, the encouragement of patronage through menu innovation, investment in facilities, cooking skills training, and auditing provision were opportunities for social marketing intervention. On the demandside, education and training coupled with communications that challenge cultural and regulatory norms and link to military values were areas that programs seeking to increase healthy eating in ADF personnel could focus on.Importance to the Social Marketing Field: As an approach for addressing “wicked” problems, the application of systems thinking in social marketing has privileged an ontological concept of system as a metaphor for reality. This approach assists in expanding the focus of change beyond the individual to include factors in social, economic, and policy environments. By using systems thinking as an epistemological device, this article offers an approach that may be applied to overcome practical and philosophical limitations in the application of systems thinking.Recommendations for Research or Practice: Research on alternative methods for applying systems thinking is recommended to strengthen the potential of system approaches in the field of social marketing.Limitations: This study is part of a broader program, and its findings on the problem of unhealthy eating behaviors in ADF are preliminary. Limitations specific to the study include the possibility of “reductionism” in stakeholder identification and self-selection bias in participation.

IMPORTANCE: Skin and subcutaneous diseases affect the health of millions of individuals in the US. Data are needed that highlight the geographic trends and variations of skin disease burden across the country to guide health care decision-making. OBJECTIVE: To characterize trends and variations in the burden of skin and subcutaneous tissue diseases across the US from 1990 to 2017. DESIGN, SETTING, AND PARTICIPANTS: For this cohort study, data were obtained from the Global Burden of Disease (GBD), a study with an online database that incorporates current and previous epidemiological studies of disease burden, and from GBD 2017, which includes more than 90 000 data sources such as systematic reviews, surveys, population-based disease registries, hospital inpatient and outpatient data, cohort studies, and autopsy data. The GBD separated skin conditions into 15 subcategories according to incidence, prevalence, adequacy of data, and standardized disease definitions. GBD 2017 also estimated the burden from melanoma of the skin and keratinocyte carcinoma. Data analysis for the present study was conducted from September 9, 2019, to March 31, 2020. MAIN OUTCOMES AND MEASURES: Primary study outcomes included age-standardized disability-adjusted life-years (DALYs), incidence, and prevalence. The data were stratified by US states with the highest and lowest age-standardized DALY rate per 100 000 people, incidence, and prevalence of each skin condition. The percentage change in DALY rates in each state was calculated from 1990 to 2017. RESULTS: Overall, age-standardized DALY rates for skin and subcutaneous diseases increased from 1990 (821.6; 95% uncertainty interval [UI], 570.3-1124.9) to 2017 (884.2; 95% UI, 614.0-1207.9) in all 50 states and the District of Columbia. The degree of increase varied according to geographic location, with the largest percentage change of 0.12% (95% UI, 0.09%-0.15%) in New York and the smallest percentage change of 0.04% (95% UI, 0.02%-0.07%) in Colorado, 0.04% (95% UI, 0.01%-0.06%) in Nevada, 0.04% (95% UI, 0.02%-0.07%) in New Mexico, and 0.04% (95% UI, 0.02%-0.07%) in Utah. The age-standardized DALY rate, incidence, and prevalence of specific skin conditions differed among the states. New York had the highest age-standardized DALY rate for skin and subcutaneous disease in 2017 (1097.0 [95% UI, 764.9-1496.1]), whereas Wyoming had the lowest age-standardized DALY rate (672.9 [95% UI, 465.6-922.3]). In all 50 states and the District of Columbia, women had higher age-standardized DALY rates for overall skin and subcutaneous diseases than men (women: 971.20 [95% UI, 676.76-1334.59] vs men: 799.23 [95% UI, 559.62-1091.50]). However, men had higher DALY rates than women for malignant melanoma (men: 80.82 [95% UI, 51.68-123.18] vs women: 42.74 [95% UI, 34.05-70.66]) and keratinocyte carcinomas (men: 37.56 [95% UI, 29.35-49.52] vs women: 14.42 [95% UI, 10.01-20.66]). CONCLUSIONS AND RELEVANCE: Data from the GBD suggest that the burden of skin and subcutaneous disease was large and that DALY rate trends varied across the US; the age-standardized DALY rate for keratinocyte carcinoma appeared greater in men. These findings can be used by states to target interventions and meet the needs of their population.

In 2018, the consensus meeting for the WHO Classification of Tumours of the Eye decided that conjunctival mucoepidermoid carcinoma should be reclassified as adenosquamous carcinoma, as this represented a better morphological fit. To examine the applicability of this terminology, we studied the clinical, histopathological, immunohistochemical and molecular pathology of 14 cases that were originally diagnosed as conjunctival mucoepidermoid carcinoma. There were 7 (50%) females and 7 (50%) males. The median age was 64 years. The left eye was affected in 8 and the right eye in 6 patients. In-situ carcinoma was present in 11/14 (79%) cases and comprised in-situ squamous cell carcinoma (SCC) and conjunctival intraepithelial neoplasia with mucinous differentiation (CIN-Muc). Invasive carcinoma was present in 11/14 (79%) cases. Group 1 (1/11 cases, 9%) comprised invasive SCC only. Group 2 (6/11 cases, 55%) comprised SCC with mucinous differentiation, manifesting as scattered intracellular mucin, occasionally together with intercellular mucin, with no evidence of true glandular differentiation. Group 3 (3/11 cases. 27%) comprised true adenosquamous carcinoma. Group 4 (1/11 cases, 9%) comprised pure adenocarcinoma. Thirteen of 14 cases (93%) underwent FISH for MAML2 translocation and none were rearranged. Two cases harboured high-risk HPV (type 16 and 18). The combined findings confirm that all lesions in our study were not mucoepidermoid carcinoma, but represented predominantly SCC with mucinous differentiation and adenosquamous carcinoma. We, therefore, recommend future revision of the WHO classification to include SCC with mucinous differentiation alongside adenosquamous carcinoma.

In 2018, the consensus meeting for the WHO Classification of Tumours of the Eye decided that conjunctival mucoepidermoid carcinoma should be reclassified as adenosquamous carcinoma, as this represented a better morphological fit. To examine the applicability of this terminology, we studied the clinical, histopathological, immunohistochemical and molecular pathology of 14 cases that were originally diagnosed as conjunctival mucoepidermoid carcinoma. There were 7 (50%) females and 7 (50%) males. The median age was 64 years. The left eye was affected in 8 and the right eye in 6 patients. In-situ carcinoma was present in 11/14 (79%) cases and comprised in-situ squamous cell carcinoma (SCC) and conjunctival intraepithelial neoplasia with mucinous differentiation (CIN-Muc). Invasive carcinoma was present in 11/14 (79%) cases. Group 1 (1/11 cases, 9%) comprised invasive SCC only. Group 2 (6/11 cases, 55%) comprised SCC with mucinous differentiation, manifesting as scattered intracellular mucin, occasionally together with intercellular mucin, with no evidence of true glandular differentiation. Group 3 (3/11 cases. 27%) comprised true adenosquamous carcinoma. Group 4 (1/11 cases, 9%) comprised pure adenocarcinoma. Thirteen of 14 cases (93%) underwent FISH for MAML2 translocation and none were rearranged. Two cases harboured high-risk HPV (type 16 and 18). The combined findings confirm that all lesions in our study were not mucoepidermoid carcinoma, but represented predominantly SCC with mucinous differentiation and adenosquamous carcinoma. We, therefore, recommend future revision of the WHO classification to include SCC with mucinous differentiation alongside adenosquamous carcinoma.

Background: Evidence indicates behavior change is more likely when more social marketing benchmark principles are applied. Yet, transparent and clear reporting of the application of benchmarks to change behavior is rare.Focus of the Article: The aims of this study were (1) to verify the efficacy of social marketing in reducing food waste and (2) to enumerate and critique the practicality of applying social marketing benchmark criteria.Research Question: To address the research aims, two research questions were proposed: (1) Can a social marketing program designed with consumers reduce household food waste behavior? and (2) How are social marketing benchmarks applied to reduce food waste?Program Design/Approach: A consumer-insight driven social marketing program Waste Not Want Not(WNWN) was designed following the social marketing process and delivered to local Redland City Council residents located within the pilot area. This article reports a process and outcome evaluation for the pilot study and a critical evaluation of benchmark criteria application.Importance to the Social Marketing Field: This article demonstrates social marketing’s efficacy to reduce food waste behavior in households, and it critically evaluates application of benchmark criteria to assist future research and practice.Methods: In total, 314 local council area residents were randomly allocated into either a program (n= 110) or control group (n= 204). The program group received intervention materials and invitations to attend the 2-week program activities held in a local shopping center. Control group participants received nothing. The extent of social marketing benchmark application was examined for the WNWN program.Results: Outcome evaluation indicated that the pilot study reduced self-reported household food waste and increased perceived level of self-efficacy in cooking for the program group, but not the control group. WNWN successfully applied five of the eight social marketing benchmark criteria, namely, consumer orientation, insight, competition, marketing mix, and behavior change.Recommendations for Research or Practice: Given that use of more benchmarks increases the likelihood of behavior change, future research must advocate for complete application of the eight major social marketing benchmark criteria in program design. Clear operational definitions are required to improve practice and behavioral change outcomes.Limitations: Study 1 focused on individual feedback and self-reported data minimizing the possibility of generalization. Future research could employ observational methods and involve a wider array of stakeholders to increase generalizability.

Segmenting target audiences can deliver increases in audiences attending events. An examination of segmentation research progress in the field is needed to assess the extent that researchers are capitalizing on available opportunities. Following the Tkaczynski and Rundle-Thiele framework, this article reviews 90 segmentation articles published from 2010 onwards to examine attendee profiling practices and to assess research practice change over time. Nine research issues have been proposed, which are subsequently discussed. Findings indicate an increase in geographic reach (e. g., Africa and Europe) and a continued dominant focus on on-site self-administered surveys as the data collection method. Both sample sizes and application of multivariate data analysis techniques have increased, and studies are largely employing the same segmentation bases and variables across the two research reviews. Recommendations for future research such as a need for larger sample sizes to warrant segmentation and a greater focus on external validation of segments are outlined.

Background:Obesity is present in 17% of US youth, age 2–19 years, but the extent to which obesity in childhood is associated with higher BMI and fat mass in middle age is unclear. In this study, links between childhood body size and BMI and body composition at age ∼50 were assessed.Methods:Child Health and Development Studies participants, born between 1960 and 1963 in Alameda County, and still living in California, from whom anthropometric data were collected at age 5, 9–11, and/or 15–17 years were followed-up at age ∼50 for anthropometric outcomes (251 women; 249 men). Linear regression analyses assessed whether overweight (85th to <95th BMI percentile) or obesity (≥95th BMI percentile) at age 5 were associated with BMI, fat mass index (FMI), and lean mass index (LMI) at age ∼50.Results:At age 50, participants with obesity at age 5 had BMI scores that were 6.51 units higher [95% confidence interval (CI) = 3.67–9.35] than participants who were normal weight at age 5; FMI and LMI scores were 4.15 (95% CI = 1.98–6.32) and 2.36 (95% CI = 1.45–3.26) units higher, respectively. However, obesity experienced at age 5 had only a modest positive predictive value for predicting the presence of obesity at age 50 (67%), whereas obesity present at age 15–17 had a higher positive predictive value (86%).Conclusions:The experience of obesity at age 5 for members of this birth cohort was associated with significantly higher BMI, FMI, and LMI at age ∼50.

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AbstractWhether maternal obesity and gestational weight gain (GWG) are associated with early-childhood development in low-income, urban, minority populations, and whether effects differ by child sex remain unknown. This study examined the impact of prepregnancy BMI and GWG on early childhood neurodevelopment in the Columbia Center for Children’s Environmental Health Mothers and Newborns study. Maternal prepregnancy weight was obtained by self-report, and GWG was assessed from participant medical charts. At child age 3 years, the Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Intelligence were completed. Sex-stratified linear regression models assessed associations between prepregnancy BMI and pregnancy weight gain z-scores with child PDI and MDI scores, adjusting for covariates. Of 382 women, 48.2% were normal weight before pregnancy, 24.1% overweight, 23.0% obese, and 4.7% underweight. At 3 years, mean scores on the PDI and MDI were higher among girls compared to boys (PDI: 102.3 vs. 97.2, P= 0.0002; MDI: 92.8 vs. 88.3, P= 0.0001). In covariate-adjusted models, maternal obesity was markedly associated with lower PDI scores in boys [b= −7.81, 95% CI: (−13.08, −2.55), P= 0.004], but not girls. Maternal BMI was not associated with MDI in girls or boys, and GWG was not associated with PDI or MDI among either sex (all-P> 0.05). We found that prepregnancy obesity was associated with lower PDI scores at 3 years in boys, but not girls. The mechanisms underlying this sex-specific association remain unclear, but due to elevated obesity exposure in urban populations, further investigation is warranted.

ObjectiveThe epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD.MethodsA three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40–74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention.ResultsAt 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI −288.00 to 147.90 and mean difference=7.24 steps, 95% CI −224.01 to 238.50, respectively), reducing weight (mean difference=−0.03 kg, 95% CI −0.49 to 0.44 and mean difference=−0.42 kg, 95% CI −0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds.ConclusionsEnhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk.

Squamous cell carcinoma of the conjunctiva is associated with a number of risk factors, including HIV infection, iatrogenic immunosuppression and atopy. In addition, several studies have suggested an involvement of HPV, based on the presence of viral DNA, but did not establish whether there was active infection or evidence of causal disease association. In this manuscript, 31 cases of conjunctival in situ squamous cell carcinoma were classified as HPV DNA-positive or -negative, before being analysed by immunohistochemistry to establish the distribution of viral and cellular biomarkers of HPV gene expression. Our panel included p16INK4a, TP53 and MCM, but also the virally encoded E4 gene product, which is abundantly expressed during productive infection. Subsequent in situ detection of HPV mRNA using an RNAscope approach confirmed that early HPV gene expression was occurring in the majority of cases of HPV DNA-positive conjunctival in situ squamous cell carcinoma, with all of these cases occurring in the atopic group. Viral gene expression correlated with TP53 loss, p16INK4aelevation, and extensive MCM expression, in line with our general understanding of E6 and E7's role during transforming infection at other epithelial sites. A characteristic E4 expression pattern was detected in only one case. HPV mRNA was not detected in lower grades of dysplasia, and was not observed in cases that were HPV DNA-negative. Our study demonstrates an active involvement of HPV in the development of a subset of conjunctival in situ squamous cell carcinoma. No high-risk HPV types were detected other than HPV16. It appears that the conjunctiva is a vulnerable epithelial site for HPV-associated transformation. These cancers are defined by their pattern of viral gene expression, and by the distribution of surrogate markers of HPV infection.