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BackgroundObesity is a major challenge for people with schizophrenia.AimsWe assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia.MethodIn this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophrenia, schizoaffective disorder or first-episode psychosis from ten mental health organisations in England. Participants were randomly allocated to the STEPWISE intervention or treatment as usual. The 12-month intervention comprised four 2.5 h weekly group sessions, followed by 2-weekly maintenance contact and group sessions at 4, 7 and 10 months. The primary outcome was weight change after 12 months. Key secondary outcomes included diet, physical activity, biomedical measures and patient-related outcome measures. Cost-effectiveness was assessed and a mixed-methods process evaluation was included.ResultsBetween 10 March 2015 and 31 March 2016, we recruited 414 people (intervention 208, usual care 206) with 341 (84.4%) participants completing the trial. At 12 months, weight reduction did not differ between groups (mean difference 0.0 kg, 95% CI −1.6 to 1.7, P = 0.963); physical activity, dietary intake and biochemical measures were unchanged. STEPWISE was well-received by participants and facilitators. The healthcare perspective incremental cost-effectiveness ratio was £246 921 per quality-adjusted life-year gained.ConclusionsParticipants were successfully recruited and retained, indicating a strong interest in weight interventions; however, the STEPWISE intervention was neither clinically nor cost-effective. Further research is needed to determine how to manage overweight and obesity in people with schizophrenia.Declaration of interestR.I.G.H. received fees for lecturing, consultancy work and attendance at conferences from the following: Boehringer Ingelheim, Eli Lilly, Janssen, Lundbeck, Novo Nordisk, Novartis, Otsuka, Sanofi, Sunovion, Takeda, MSD. M.J.D. reports personal fees from Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceuticals International Inc.; and, grants from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, Janssen. K.K. has received fees for consultancy and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Servier and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. K.K. has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk. D.Sh. is expert advisor to the NICE Centre for guidelines; board member of the National Collaborating Centre for Mental Health (NCCMH); clinical advisor (paid consultancy basis) to National Clinical Audit of Psychosis (NCAP); views are personal and not those of NICE, NCCMH or NCAP. J.P. received personal fees for involvement in the study from a National Institute for Health Research (NIHR) grant. M.E.C. and Y.D. report grants from NIHR Health Technology Assessment, during the conduct of the study; and The Leicester Diabetes Centre, an organisation (employer) jointly hosted by an NHS Hospital Trust and the University of Leicester and who is holder (through the University of Leicester) of the copyright of the STEPWISE programme and of the DESMOND suite of programmes, training and intervention fidelity framework that were used in this study. S.R. has received honorarium from Lundbeck for lecturing. F.G. reports personal fees from Otsuka and Lundbeck, personal fees and non-financial support from Sunovion, outside the submitted work; and has a family member with professional links to Lilly and GSK, including shares. F.G. is in part funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme, by the Maudsley Charity and by the Stanley Medical Research Institute and is supported by the by the Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.

A prospective, randomised, 6-month feeding trial was performed in 28 adult cats with International Renal Interest Society (IRIS) stage 1 and 2 chronic kidney disease (CKD). All cats were assigned to either a control food: Royal Canin Renal Support A Feline, dry or a test food: Hill's Prescription Diet k/d Feline with chicken, dry. Food intake was recorded daily; body weight weekly; and serum, urine, dual-energy x-ray absorptiometry (DEXA) and body condition assessments were performed at 0, 1, 3 and 6 months. Twenty cats (9 control, 11 test group) completed the study according to protocol. Cats consuming control food had significant loss of body weight (n=14; mean, -13.0 per cent, P

Bisphenol A (BPA) is an endocrine disrupting chemical used in a wide range of consumer products including photoactive dyes used in thermal paper. Recent studies have shown that dermal absorption of BPA can occur when handling these papers. Yet, regulatory agencies have largely dismissed thermal paper as a major source of BPA exposure. Exposure estimates provided by agencies such as the European Food Safety Authority (EFSA) are based on assumptions about how humans interact with this material, stating that ‘typical’ exposures for adults involve only one handling per day for short periods of time (30% of individuals hold thermal paper with more than three fingertips, and >60% allow the paper to touch their palm. Only 11% of the participants we observed were consistent with the EFSA model for time of contact and dermal surface area. Mathematical modeling based on handling times we measured and previously published transfer coefficients, concentrations of BPA in paper, and absorption factors indicate the most conservative estimated intake from handling thermal paper in this population is 51.1 ng/kg/day, similar to EFSA’s estimates of 59 ng/kg/day from dermal exposures. Less conservative estimates, using published data on concentrations in thermal paper and transfer rates to skin, indicate that exposures are likely significantly higher. Based on our observational data, we propose that the current models for estimating dermal BPA exposures are not consistent with normal human behavior and should be reevaluated.

In a pilot randomized controlled trial involving overweight or obese participants with type 2 diabetes, we find that smartphone users have sharply higher adherence to self-monitoring of diet, physical activity, blood glucose, and body weight, as compared to paper diary users. By characterizing the pattern of adherence with the probability of continuation of active and inactive sequences of self-monitoring, we find that smartphone users have longer active sequences of self-monitoring of all four behaviors that were being monitored. Smartphone users are also quicker to resume self-monitoring of diet and physical activity after a lapse in self-monitoring, whereas paper diary users have shorter inactive sequences for monitoring blood glucose and body weight. The findings are informative for data collection methodology in this burgeoning area of research.

A risk assessment study of seven phthalates in paper diapers for newborn babies produced in Japan was performed. The diapers were purchased and the contents of the seven phthalates were determined and estimated amounts of exposure were calculated based on the eluted rate into artificial medium of urine or sweat, average weight of infants, and frequency of use. Di-2-ethylhexyl phthalate and di- n -butyl phthalate were detected in the topsheets and determined to be 0.6 μg/g and 0.2 μg/g, respectively. The daily estimated exposure volume was calculated to be in the range of 1.86 × 10 −10 –2.98 × 10 −6 mg/kg/day as follows: content of seven phthalates in the topsheet (0.1–1 μg/g) × eluted rate of phthalates into artificial sweat (0.0006–2.4%) × weight of the topsheet of a diaper (1.5 g) × the number of diapers used per day (12 sheets) × skin absorption rate (0.005–0.1)/average body weight (2.9 kg). For hazard assessment, we used 0.2–300 mg/kg/day for the seven phthalates based on the data available at international agencies. The margin of exposure to the seven phthalates was 6.71 × 10 4 –1.99 × 10 11 , indicating that the risk of exposure to phthalates from the diapers produced in Japan was negligible.

Laboratory facilities use many varieties of contact bedding, including wood chips, paper products, and corncob, each with its own advantages and disadvantages. Corncob bedding, for example, is often used because of its high absorbency, ability to minimize detectable ammonia, and low cost. However, observations that mice eat the corncob lead to concerns that its use can interfere with dietary studies. We evaluated the effect of corncob bedding on feed conversion (change in body weight relative to the apparent number of kcal consumed over 7 d) in mice. Four groups of mice (6 to 12 per group) were housed in an individually ventilated caging system: (1) low-fat diet housed on recycled paper bedding, (2) low-fat diet housed on corncob bedding, (3) high-fat diet housed on recycled paper bedding, and (4) high-fat diet housed on corncob bedding. After 4 wk of the high-fat diet, feed conversion and percentage body weight change both were lower in corncob-bedded mice compared with paper-bedded mice. Low-fat–fed mice on corncob bedding versus paper bedding did not show statistically significant differences in feed conversion or change in percentage body weight. Average apparent daily feed consumption did not differ among the 4 groups. In conclusion, these data suggest that corncob bedding reduces the efficiency of feed conversion in mice fed a high-fat diet and that other bedding choices should be favored in these models.

Juvenile female rainbow trout was exposed for 4.5 months (June to October) to two dilutions of untreated and activated sludge treated whole mill effluent from a pulp mill producing bleached ECF pulp. Two controls were used, on fed ad libitum and a second receiving 0.5% feed of the body weight. All effluent exposed groups were fed ad libitum. Mean weight of the fish was measured monthly. At the end of the experiment a number of physiological and biochemical parameters were analyzed in order to establish the physiological status of the exposed fish in comparison with unexposed fish that obtained ad libitum or restricted amount of feed. The fish exposed to treated effluent grew significantly more than ad libitum control fish until August, whereupon growth retarded in fish exposed to the lower effluent dilution (400 v/v). The growth of fish exposed to untreated effluent did not deviate significantly from the control fed ad libitum. The results from the hematological analysis clearly showed that fish fed restricted amount of feed deviated significantly in most parameters compared with the control fed ad libitum. Fish exposed to treated effluent showed a response pattern similar to that of the control fed restricted amount of feed, whereas the fish exposed to untreated effluent showed a response pattern that did not deviate from that of the ad libitum control. The metabolic parameters suggested that fish exposed to treated effluent had a higher metabolic demand than ad libitum control and that the energy allocation at the end of the experiment was directed to processes other than growth. The responses on hematology were mainly a consequence of the increased energy demand and were not primary effects. The implications of using feed related parameters at field studies are discussed.

The impact of utilizing chopped computer and bond paper as a litter material on growth performance of broilers reared to market age was evaluated. In the first experiment, broilers were placed in pens at 10 birds per square meter, and four different litter treatments were used; 1) 100% chopped computer and bond paper (CCP); 2) a mix of 75% CCP and 25% wood shavings (WS); 3) 50% CCP and 50% WS; 4) 100% WS. Experiment 2 evaluated the same treatments, but with densities of 14 birds per square meter. Litter treatments had no effect on body weight gain, feed consumption, conversion, or mortality for either of the two experiments. No differences were found for percentage litter moisture among treatments. Chopped computer and bond paper alone or mixed in different percentages with WS can be used as an alternate litter material for rearing broilers as long as there is good waterer management, especially with open watering systems. These systems may have the tendency to increase the incidence of litter caking.

Objectives: This study examined the levels of genetic knowledge, health literacy and beliefs about causation of health conditions among individuals in different age groups. Methods: Individuals (n = 971) recruited through 8 community health centers in Suffolk County, New York, completed a one-time survey. Results: Levels of genetic knowledge were lower among individuals in older age groups (26–35, p = 0.011; 36–49, p = 0.002; 50 years and older, pConclusions: Providing additional information that compensates for their lower genetic knowledge may help individuals in older age groups benefit from rapidly emerging genetic health information more fully. Increasing the levels of genetic knowledge about common complex diseases may help motivate individuals to engage in health promoting behaviors to maintain healthy weight through increases in behavioral causal attributions.

Aims To evaluate the usefulness of a quantification method using filter paper for analyzing minute voided urine of the mouse. Methods Voided stain on paper (VSOP) method; the correlation between area of stained spot on a filter paper and amount of applied liquid was calculated. Voiding behavior of the mice was analyzed by placing the animal above the same filter paper and recording voided time and area over 2 hr. The usefulness of the VSOP method was tested in analysis of the voiding behavior of five female 7-week-old ddY mice treated with cyclophosphamide (CPM, 150 mg/kg, intraperitoneally) and five control ones, in comparison with the histology of CPM-induced cystitis. Further, the voided volume of male and female ddY mouse ranging from 2 to 13 weeks was assessed. Results There was a linear correlation between liquid volume and stained area on the filter paper (y = 16.472x − 22.411, R2 = 0.9981). Between control mice and those with histologically proven CPM cystitis, there was a significant difference in voided volume (362.7 ± 51.9 and 127.8 ± 100.0 µl

Background and purpose: Thrombolysis of acute ischaemic stroke is based strictly on body weight to ensure efficacy and to prevent bleeding complications. Many candidate stroke patients are unable to communicate their body weight, and there is often neither the means nor the time to weigh the patient. Instead, weight is estimated visually by the attending physician, but this is known to be inaccurate. Methods: Based on a large general population sample of nearly 7000 subjects, we constructed approximation formulae for estimating body weight from simple anthropometric measurements (body height, and waist and hip circumference). These formulae were validated in a sample of 178 consecutive inpatients admitted to our stroke unit, and their accuracy was compared with the best visual estimation of two experienced physicians. Results: The simplest formula gave the most accurate approximation (mean absolute difference 3.1 (2.6) kg), which was considerably better than the best visual estimation (physician 1: 6.5 (5.2) kg; physician 2: 7.4 (5.7) kg). It reduced the proportion of weight approximations mismatched by >10% from 31.5% and 40.4% (physicians 1 and 2, respectively) to 6.2% (anthropometric approximation). Only the patient’s own estimation was more accurate (mean absolute difference 2.7 (2.4) kg). Conclusions: By using an approximation formula based on simple anthropometric measurements (body height, and waist and hip circumference), it is possible to obtain a quick and accurate approximation of body weight. In situations where the exact weight of unresponsive patients cannot be ascertained quickly, we recommend using this approximation method rather than visual estimation.

In the noncereal-producing areas, there is not enough straw to supply the amount required for animal bedding. However, pulp and paper mills produce tons of wood fiber wastes, including de-inking paper sludge (DPS), in which most toxic compounds are at their detection limit. Among the detected compounds in DPS, aluminum, copper, and polycyclic aromatic hydrocarbons (PAHs) are present and were selected as model molecules. In this context, broilers were submitted to a diet containing 0, 5, and 10% of their ration as DPS. In addition, broilers and pigs were grown on de-inking paper sludge and wood shavings beddings. The presence of aluminum and copper were evaluated in blood and bones, whereas the presence of PAHs was evaluated in fat, liver, meat, and urine or blood of broilers and pigs. Animal performances were also investigated. DPS bedding did not increase aluminum or copper contents of blood or bones or PAHs in animal tissues. Animal performances and health were similar on DPS and wood shaving beddings. Using DPS as bedding material provides an integrated source of disposal of DPS and animal manure.

Perch (Perca fluviatilis L.) and roach (Rutilus rutilus L.) populations in a state of late vitellogenesis were studied downstream of two pulp and paper mills and at upstream references in southern Lake Saimaa, Finland. The mills used elemental chlorine-free bleaching and activated sludge effluent treatment technologies. The exposure of fish to pulp mill effluents, as measured by concentrations of chlorophenolics in the bile and liver ethoxyresorufin-O-deethylase (EROD) activity, was low and almost similar to the references. Nevertheless, bile resin acid concentrations in exposed perch and roach (260-320 micrograms/ml) and bile beta-sitosterol concentrations in exposed roach (1.5-3.5 micrograms/ml) were, respectively, 10 to 30 times and 2 to 5 times higher compared with the references. Reproductive parameters like plasma 17 beta-estradiol and testosterone levels were lower in exposed male and female perch but the same in roach. Vitellogenin concentrations in plasma and liver cytosol of roach were similar. Gonad weight and fecundity were lower in exposed female perch but similar in roach. The relative liver weight was higher in exposed roach but not in perch. The body condition and immunologic parameters in fish were the same. The growth and age at maturity of exposed perch and roach were similar to the references. The size and age distribution of perch in the recipient of one of the mills was shifted toward smaller and younger fish. Our results show that several reproductive variables were altered in late vitellogenic perch in the vicinity of the mills, but they were not altered in roach.

Two different materials-aspen wood-wool and paper towel-were compared as nesting material for three inbred mouse strains (BALB/c, C57BL/6J and DBA/2) housed in barrier conditions. In addition, the effect of varying the number of females per cage (one to three per cage) of these three strains and with NIH/S outbred mouse stock was studied. The number of litters, litter size and neonatal mortality were determined, as well as age, sex and weight of weanlings. The type of nesting material did not affect the characteristics monitored. In all strains, the number of weanlings per female was greatest in singly-housed females. In terms of the number of weanlings per cage, two females per cage gave the best result. In DBA/2 mice, neonatal mortality increased when several females were caged together.

Reproductive effects have been recorded in wild fish in waters receiving pulp mill effluent (PME) since the mid to late 1980s. Laboratory assays with fathead minnow (FHM; Pimephales promelas) have been developed to better understand fish responses to PME. However, observations from laboratory studies have been variable, making it difficult to establish cause/effect relationships. A lack of environmental relevance in these laboratory studies may have contributed to the variability observed. The objectives of the present study were, first, to determine the effects of bleached kraft PME (BKME) on FHM under environmentally realistic conditions (i.e., ambient water and effluent quality) and, second, to determine the suitability of pair-breeding FHM to better link BKME-induced changes in indicators at the biochemical, individual, and population levels. A mobile bioassay trailer was situated on-site at a bleached kraft mill for 60 d, allowing supply of both ambient water (Lake Superior, Canada) and final BKME. The reproductive output of FHM was initially assessed for 21 d to obtain baseline data pre-exposure. At the end of the pre-exposure period, selected breeding pairs were exposed to final BKME (100% v/v and 1% v/v) for 21 d. Results demonstrated a stimulatory response pattern at 1% BKME (e.g., increased egg production) compared to control. In the 100% treatment, spawning events were reduced and fewer eggs were produced during the first two weeks of exposure. Exposure to 100% (v/v) BKME also resulted in ovipositor development in males and development of male secondary sex characteristics in females. Obtaining pre-exposure data and use of pair-breeding FHM in this assay gave a sensitive indication of effluent effects and allowed accurate comparisons of endpoints to be made.

Several different culture media were tested for their effect on weight and viability of earthworms ( Lumbricus terrestris). A medium containing pulverized newspaper, pelletted rabbit food, walnut meal, peanut oil, topsoil and coffee grounds supported life and growth for 62 weeks, and improved the condition of degenerated worms.

Interview or questionnaire response as a measure of health or medical status has usually been validated by tests of agreement with physicians' evaluations of the same subjects at a point in time. The self-reporting of symptoms has been used and tested as a screening-type index of the medical diagnoses which would have been obtained, given the more expensive and definitive set of procedures of professional history, physical examination, and laboratory tests. In survey circumstances, symptoms have been found to be of poor validity as surrogate measures of disease.

Paper containing colored inks from magazines and newspapers was fed as 23% of their ration to sheep for 175 days. A similar ration containing oat hulls in place of the paper was fed to control animals. The paper-fed animals consumed 29% more feed than the controls but the feed efficiency (kg animal weight gained/kg ration consumed) of the two rations was approximately equivalent. Lead contained in the paper accumulated in animal tissues. Hepatic microsomal mixed function oxidase activity was several fold higher in the paper-fed animals than the controls. Histopathologic examination of liver and kidney using light and electron microscopy revealed no lesions attributable to diet.

To reduce the number of false-positives in our screening program for neonatal hypothyroidism, we investigated the effect of age, body weight, and interval between sampling and analysis on results for filter paper spot thyroxine determination. The statistical analysis included an analysis of covariance. The age of the infant did not influence the results, the interval influenced them minimally, but weight did require a correction factor of about 0.16 ng/kg below the mean weight. This correction factor should reduce our false-positives from 0.75% to 0.60%. Furthermore, because all hypothyroid infants had results that fell more than 2.8 SD below the geometric mean, we intend to measure thyrotropin concentrations in the blood eluate of all the spots with a thyroxine concentration below that cut-off point.

Aplysia californica when prefed a partial meal of nonnutritional bulk eat significantly less food compared to control animals. The total mass of material consumed by animals fed bulk and then fed to satiation with seaweed was not significantly different from the mass consumed by animals fed to satiation with seaweed alone. In a second experiment, animals were fed daily, alternating weekly periods of feeding animals 50% diluted food with periods of feeding animals nutritionally normal meals. The nutritional content of diluted meals was significantly less than the nutritional content of undiluted meals. The mass of material consumed was not significantly different for diluted compared to nondiluted meals. These experiments indicate that the bulk properties of food play an important role in producing satiation in Aplysia.

Serial determinations of progesterone in the peripheral plasma of each of 13 pregnant women before, during, and after labor have been performed with a modification of the method of van der Molen and Groen. The reliability of the method has been tested by a series of repeated determinations. From the thirty-fourth week of pregnancy up to the beginning of labor, there is no definite increase in the plasma progesterone level until term. During labor a drop in the plasma progesterone concentration takes place in the majority of cases. There is a marked drop in the plasma progesterone concentration from the removal of the placenta until 2 hours post partum. Within 24 hours after childbirth the progesterone concentration falls to levels similar to those found in the luteal phase of the menstrual cycle.