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Childhood obesity is an “urgent and serious challenge,” with over 340 million children worldwide classified as overweight or obese.1 The World Health Organization has declared war, releasing an implementation plan to end childhood obesity.2 Four of the 6 key actions identified in the plan relate to physical activity and obesity management and are therefore relevant to pediatric physical therapy. Although this article is not all-encompassing, it does highlight 10 key points designed to encourage pediatric physical therapists to seek out more information and become leaders for positive action in childhood overweight/obesity (Figure). Refereed/Peer-reviewed

Children with obesity experience musculoskeletal pain and reduced physical function and wellbeing, which collectively impact their fitness, strength, motor skills and even their ability to undertake simple tasks like walking and climbing stairs. Disrupting obesity-related disability may be critical to increasing children’s physical activity. Thus, barriers to movement should be considered by health practitioners to improve the efficacy of prescribed physical activity. This applied clinical review highlights key subjective and objective findings from a hypothetical case scenario, linking those findings to the research evidence, before exploring strategies to enhance movement and increase physical activity. Refereed/Peer-reviewed

In adults, ratings of perceived exertion (RPE) can be used to predict maximal oxygen uptake, estimate time to exhaustion, assess internal training load and regulate exercise intensity. However, the utility of RPE in children is less researched and therefore, warrants investigation. The purpose of this scoping review is to map out the literature around the application of RPE specifically during aerobic exercise in paediatric populations. Seven bibliographic databases were systematically searched. Grey literature searching and pearling of references were also conducted. To be included for the review, studies were required to comply with the following: (1) participants aged ≤ 18 years asymptomatic of any injuries, disabilities or illnesses; (2) applied RPE in aerobic exercise, testing and/or training; (3) included at least one measure of exercise intensity; and (4) be available in English. The search identified 22 eligible studies that examined the application of RPE in children. These studies involved a total of 718 participants across ten different countries. Nine different types of RPE scales were employed. Overall, the application of RPE in paediatric populations can be classified into three distinct themes: prediction of cardiorespiratory fitness/performance, monitoring internal training loads, and regulation of exercise intensity. The utility of RPE in paediatric populations remains unclear due to the small body of available research and inconsistencies between studies. However, findings from the included studies in this scoping review may show promise. Further research focussing on child-specific RPE scales across various sports, subgroups, and in field-based settings is needed. Refereed/Peer-reviewed

The adverse physical impacts of childhood obesity are increasingly being recognized. The objective of this study is to examine relationships between physical function and adiposity in youth. An umbrella review searched seven databases from inception to May 2019 for systematic reviews examining associations between adiposity and physical function in 0–20‐year‐olds. Findings were synthesized using the International Classification of Functioning, Disability and Health Framework and NHMRC FORM. Seventeen of 21 systematic reviews reported impairments to body function, including cardiorespiratory fitness (CRF), muscle function, balance/coordination, gait biomechanics, pain and injury. Six reviews reported activity restrictions in motor skills, running speed/agility and functional mobility, and two found inverse associations between adiposity and physical health‐related quality of life (p‐HRQOL). Some causal relationships indicated that adiposity inversely predicted p‐HRQOL/CRF and CRF/muscle function inversely predicted adiposity. Assessments of physical function were heterogeneous and impacts on participation in life situations meaningful to the individual were largely unknown. Substantial evidence associates childhood overweight/obesity with reduced physical function. Associations were mainly cross‐sectional, with causative evidence for some outcomes. Comprehensive physical function assessments by qualified health professionals are needed, along with targeted interventions to address deficits. Research should further examine causality of relationships, underlying mechanisms and participation challenges in real‐life contexts. Refereed/Peer-reviewed

This study investigated whether male runners improve running performance, running economy, ankle plantar flexor strength,and alter running bio mechanics and lower limb bone mineral density when gradually transitioning to using minimalist shoes for 100% of weekly running. The study was a planned follow-up of runners (n = 50) who transitioned to minimalist or conventional shoes for 35% of weekly structured training in a previous 6-week randomised controlled trial. In that trial,running performance and economy improved more with minimalist shoes than conventional shoes. Runners in each group were instructed to continue running in their allocated shoe during their own preferred training programme for a further 20 weeks while increasing allocated shoe use to 100% of weekly training. At the 20-week follow-up, minimalist shoes did not affect performance (effect size: 0.19; p = 0.218), running economy (effect size: ≤ 0.24; p ≥ 0.388), stride rate or length(effect size: ≤ 0.12; p ≥ 0.550), foot strike (effect size: ≤ 0.25; p ≥ 0.366), or bone mineral density (effect size: ≤ 0.40; p ≥0.319). Minimalist shoes increased plantar flexor strength more than conventional shoes when runners trained with greater mean weekly training distances (shoe∗distance interaction: p = 0.036). After greater improvements with minimalist shoes during the initial six weeks of a structured training programme, increasing minimalist shoe use from 35% to 100%over 20 weeks, when runners use their own preferred training programme, did not further improve performance, running economy or alter running biomechanics and lower limb bone mineral density. Minimalist shoes improved plantar flexor strength more than conventional shoes in runners with greater weekly training distances. Refereed/Peer-reviewed

Vascular endothelial growth factor-A (VEGF) plays a critical role in stimulating angiogenesis in normal and disease states. Anti-VEGF antibodies have been developed to manage pathological angiogenesis. Bevacizumab, sold under the brand name Avastin, is a humanized mAb that binds VEGF and blocks its binding to its signaling receptor, VEGF receptor 2, and is used to treat patients with a variety of cancers or retinal disorders. The ability of Avastin to modulate other nonreceptor interactions of VEGF has not been fully defined. In this study, we investigated Avastin's capacity to modulate VEGF165 binding to porcine aortic endothelial cells and to heparin and fibronectin (FN) across a range of pH values (pH 5–8). We observed that Avastin slightly enhanced VEGF binding to heparin and that heparin increased VEGF binding to Avastin. In contrast, Avastin inhibited VEGF binding to cells and FN, yet Avastin could still bind to VEGF that was bound to FN, indicating that these binding events are not mutually exclusive. Avastin binding to VEGF was dramatically reduced at acidic pH values (pH 5.0–6.5), whereas VEGF binding to FN and nonreceptor sites on cells was enhanced. Interestingly, the reduced Avastin–VEGF binding at acidic pH was rescued by heparin, as was Avastin's ability to inhibit VEGF binding to cells. These results suggest that heparin might be used to expand the clinical utility of Avastin. Our findings highlight the importance of defining the range of VEGF interactions to fully predict antibody activity within a complex biological setting.

Bevacizumab (known by the tradename Avastin) is an antibody that binds VEGF and blocks its binding to VEGF receptors on endothelial cells, and is used to treat cancers and other diseases associated with excessive vascular growth. Our previous findings showed enhanced VEGF binding to Avastin in the presence of heparin, indicating that colocalizing heparin with Avastin could enhance VEGF inhibitory activity. Thus, the aim of the present study was to determine if conjugating Avastin and heparin to one another would lead to enhanced anti-VEGF activity. Avastin was conjugated to either biotin or streptavidin, and biotin–heparin was used to bring the two molecules into close proximity via biotin–streptavidin binding. Radioligand binding assays with 125 I-VEGF and cell migration assays using human umbilical vein endothelial cells were used to evaluate the impact of heparin on Avastin binding and activity. We found that bringing Avastin and heparin together, either on a surface or through streptavidin conjugation of Avastin, led to increased VEGF binding compared to that with each molecule alone. The heparin-mediated increase in VEGF binding was also noted at acidic pH where Avastin showed decreased VEGF binding. Conditions where Avastin and heparin showed enhanced VEGF binding also showed reduced VEGF-induced migration of human umbilical vein endothelial cells. These findings suggest design principles for a modified Avastin-based inhibitor of angiogenesis.

Purpose:Stride-to-stride fluctuations in running-stride interval display long-range correlations that break down in the presence of fatigue accumulated during an exhaustive run. The purpose of the study was to investigate whether long-range correlations in running-stride interval were reduced by fatigue accumulated during prolonged exposure to a high training load (functional overreaching) and were associated with decrements in performance caused by functional overreaching.Methods:Ten trained male runners completed 7 d of light training (LT7), 14 d of heavy training (HT14) designed to induce a state of functional overreaching, and 10 d of light training (LT10) in a fixed order. Running-stride intervals and 5-km time-trial (5TT) performance were assessed after each training phase. The strength of long-range correlations in running-stride interval was assessed at 3 speeds (8, 10.5, and 13 km/h) using detrended fluctuation analysis.Results:Relative to performance post-LT7, time to complete the 5TT was increased after HT14 (+18 s; P < .05) and decreased after LT10 (–20 s; P = .03), but stride-interval long-range correlations remained unchanged at HT14 and LT10 (P > .50). Changes in stride-interval long-range correlations measured at a 10.5-km/h running speed were negatively associated with changes in 5TT performance (r –.46; P = .03).Conclusions:Runners who were most affected by the prolonged exposure to high training load (as evidenced by greater reductions in 5TT performance) experienced the greatest reductions in stride-interval long-range correlations. Measurement of stride-interval long-range correlations may be useful for monitoring the effect of high training loads on athlete performance.

Background Nature play is growing in popularity as children’s play spaces are transforming from traditional playgrounds into more nature-based play spaces with considerable financial and resource investment from government bodies. This has resulted in the re-development of children’s play spaces to incorporate more natural elements such as trees, plants and rocks. Despite this, it is unclear whether there is empirical evidence to support claims that play in nature is beneficial for child health and development. Aim To conduct a systematic review examining the impacts of nature play on the health and developmental outcomes of children aged 2–12 years. Methods Seven electronic databases were searched (MEDLINE, ERIC, Embase, PsycINFO, The Cochrane Library, The Joanna Briggs Institute and Emcare) from inception to July/August 2018 (search updated July/August 2019). The Inclusion criteria were children aged 2–12 years with no health/developmental conditions. The exposure/intervention of interest was unstructured, free play in nature. Critical appraisal of included studies was conducted using the McMaster Critical Appraisal Tool. Descriptive synthesis was then undertaken using the NHMRC FORM Framework. Results Out of 2927 articles identified, 16 studies met the inclusion criteria. The nature play exposure/intervention was heterogeneously described, and a plethora of outcome measures were used. Nature play had consistent positive impacts on physical activity outcomes and cognitive play behaviours (imaginative and dramatic play). However, there remain some concerns regarding the quality of the evidence base, heterogeneity in intervention description and parameters in the outcome measures used. Conclusions While the positive impacts of nature play were encouraging in terms of physical activity and cognitive development, nature play stakeholders should focus on producing a universal definition for nature play, the development of standardised outcome measures and the conduct of robust research designs. Implications of these findings suggest the need for the development of standardised guidelines to inform practice and policy in the design of children’s play spaces in different contexts Refereed/Peer-reviewed

The aim of this study was to describe and undertake an initial evaluation of a student-led assessment service for children with possible motor-skill difficulties. A secondary analysis of cross-sectional descriptive clinical data collected from 2015 to 2016 was undertaken. Children (N = 102) were assessed in preschools by physiotherapy students (supervised by qualified physiotherapists). Key outcomes included the following: Children’s Activities Scale, Movement Assessment Battery for Children-2, and demographic/service-usage/onward referral statistics. The results highlighted that for every five children referred/assessed, two were at risk of motor-skill difficulties (∼43%). About 66% of children were subsequently referred on or monitored (40% requiring multidisciplinary follow-up). Conversely 34% of children did not require further services. In conclusion, a student-led assessment service may be a sustainable and feasible option to assist children at risk of motor-skill difficulties, enabling onward referral. Additional evaluation is required to garner stakeholder feedback.

The aim of this study was to characterize the prevalence and seasonal variation of vitamin D (vit D) deficiency/insufficiency in healthy children and adolescents in Greece, and to explore its relationship with the use of sunscreens. The serum level of 25-hydroxy-vitamin D (25(OH)D) was measured in 376 children and adolescents (184 males and 192 females) with a mean age of 7.6 ± 4.9 years, at different time points over a period of 13 months. The prevalence of low serum 25(OH)D level, including deficiency and insufficiency, was 66.2%. The lowest mean 25(OH)D was observed in the month of January (17.9 ± 6.8 ng/mL) and the highest in September, July, August, and October (34.6 ± 8.7, 33.0 ± 9.4, 30.1 ± 8.2, and 30.1 ± 10.6 ng/mL, respectively). Higher levels of serum 25(OH)D were detected in the children to whom sunscreens had been applied on the beach (p = 0.001) or off the beach (p &lt, 0.001). The subjects with deficiency and insufficiency were significantly older than those with normal levels of 25(OH)D, but no significant differences were demonstrated according to gender. This study emphasizes the high prevalence of low serum levels of 25(OH)D and their seasonal variation in children living in a region characterized by many hours of sunshine. Our data suggest that the real-life use of sunscreens during the summer months allows sufficient sunlight to be received to enable production of vit D at a level adequate to maintain normal serum levels. Vit D supplements should be given to children during the months of lower sun exposure.

Heatwaves—excessively hot ambient conditions that are considered a serious threat to human health—are often associated with poor air quality. The aim of this study was to examine the impact of an early heatwave episode in an industrialized plain in the eastern Mediterranean region (Thriasio, Greece) on human thermal discomfort and urban air quality. The heatwave occurred in mid (15–20) May 2020, shortly after some of the restrictions that were improsed to halt the spread of coronavirus disease 2019 (COVID-19) in Greece were lifted (on 4 May). The discomfort index (DI) and the daily air quality index (DAQI) were calculated on an hourly basis throughout spring 2020 (March, April, May) using data from two stations that measure meteorological parameters and air pollutant concentrations in the Thriasio Plain. The analysis showed that the air temperature increased during 7–17 May to levels that were more than 10 °C above the monthly average value (25.8 °C). The maximum measured air temperature was 38 °C (on 17 May). The results showed a high level of thermal discomfort. The DI exceeded the threshold of 24 °C for several hours during 13–20 May. Increased air pollution levels were also identified. The average DAQI was estimated as 0.83 ± 0.1 and 1.14 ± 0.2 at two monitoring stations in the region of interest during the heatwave. Particulate matter (diameter < 10 μm) appeared to contribute significantly to the poor air quality. Significant correlations between the air temperature, DI, and AQSI were also identified.

Background: This study examined relationships between adiposity, physical functioning, and physical activity. Methods: Obese (N = 107) and healthy-weight (N = 132) children aged 10-13 years underwent assessments of percent body fat (%BF, dual energy X-ray absorptiometry); knee extensor strength (KE, isokinetic dynamometry); cardiorespiratory fitness (CRF, peak oxygen uptake by cycle ergometry); physical health-related quality of life (HRQOL); and worst pain intensity and walking capacity [six-minute walk (6MWT)]. Structural equation modelling was used to assess relationships between variables. Results: Moderate relationships were observed between %BF and (1) 6MWT, (2) KE strength corrected for mass, and (3) CRF relative to mass (r -0.36 to -0.69, p ≤ 0.007). Weak relationships were found between %BF and physical HRQOL (r -0.27, p = 0.008); CRF relative to mass and physical HRQOL (r -0.24, p = 0.003); physical activity and 6MWT (r 0.17, p = 0.004). Squared multiple correlations showed that 29.6% variance in physical HRQOL was explained by %BF, pain, and CRF relative to mass; while 28.0% variance in 6MWT was explained by %BF and physical activity. Conclusions: It appears that children with a higher body fat percentage have poorer KE strength, CRF, and overall physical functioning. Reducing percent fat appears to be the best target to improve functioning. However, a combined approach to intervention, targeting reductions in body fat percentage, reductions in pain, and improvements in physical activity and CRF may assist physical functioning. Refereed/Peer-reviewed

Genomic profiling of circulating tumor DNA derived from cell-free DNA (cfDNA) in blood can provide a noninvasive method for detecting genomic biomarkers to guide clinical decision making for cancer patients. We developed a hybrid capture–based next-generation sequencing assay for genomic profiling of circulating tumor DNA from blood (FoundationACT). High-sequencing coverage and molecular barcode–based error detection enabled accurate detection of genomic alterations, including short variants (base substitutions, short insertions/deletions) and genomic re-arrangements at low allele frequencies (AFs), and copy number amplifications. Analytical validation was performed on 2666 reference alterations. The assay achieved >99% overall sensitivity (95% CI, 99.1%–99.4%) for short variants at AF >0.5%, >95% sensitivity (95% CI, 94.2%–95.7%) for AF 0.25% to 0.5%, and 70% sensitivity (95% CI, 68.2%–71.5%) for AF 0.125% to 0.25%. No false positives were detected in 62 samples from healthy volunteers. Genomic alterations detected by FoundationACT demonstrated high concordance with orthogonal assays run on the same clinical cfDNA samples. In 860 routine clinical FoundationACT cases, genomic alterations were detected in cfDNA at comparable frequencies to tissue; for the subset of cases with temporally matched tissue and blood samples, 75% of genomic alterations and 83% of short variant mutations detected in tissue were also detected in cfDNA. On the basis of analytical validation results, FoundationACT has been approved for use in our Clinical Laboratory Improvement Amendments–certified/College of American Pathologists–accredited/New York State–approved laboratory.

Objective This study aimed to examine associations between postural control and body composition in 8–10-year-old girls. Methods An observational cross-sectional study was conducted in 47 girls who were healthy-weight/overweight/obese [body mass index (BMI) percentile]. Girls participated in six postural control conditions of varying difficulty (standing with malleoli touching, tandem stance leading with dominant and non-dominant foot, repeated with eyes open and closed). Postural control outcomes included Centre of Pressure (COP) sway area, COP principal and minor axis length and COP maximum velocity. Data were analysed using linear mixed modelling. Results BMI percentile was positively associated with COP sway area ( p = 0.034) and principal axis ( p = 0.030 ) during tandem stance non-dominant foot leading with eyes closed and COP principal axis during tandem stance dominant foot leading with eyes open ( p = 0.045). BMI percentile significantly interacted with postural control conditions of varying difficulty to predict postural control outcomes ( p ≤ 0.035), notable for tandem stance positions [all four COP sway outcomes in tandem stance non-dominant foot leading eyes closed; tandem stance dominant foot leading with eyes open and closed (two COP sway outcomes each)]. Conclusions Girls with greater adiposity may have impairments in postural control, but only during more challenging postural control conditions. In contrast, BMI has little role to play in girls’ postural control in easier postural control conditions (standing with feet together). These findings may suggest potential functional or safety considerations when girls with overweight/obesity are performing demanding postural control tasks (such as during sport or physical activity).

Objective: To investigate the reliability of a simple, efficient technique for measuring bone mineral density (BMD) in the metatarsals using dual-energy X-ray absorptiometry (DXA). Materials and methods: BMD of the right foot of 32 trained male distance runners was measured using a DXA scanner with the foot in the plantar position. Separate regions of interest (ROI) were used to assess the BMD of each metatarsal shaft (1st–5th) for each participant. ROI analysis was repeated by the same investigator to determine within-scan intra-rater reliability and by a different investigator to determine within-scan inter-rater reliability. Repeat DXA scans were undertaken for ten participants to assess between-scan intra-rater reliability. Results: Assessment of BMD was consistently most reliable for the first metatarsal across all domains of reliability assessed (intra-class correlation coefficient [ICC] ≥0.97; coefficient of variation [CV] ≤1.5 %; limits of agreement [LOA] ≤4.2 %). Reasonable levels of intra-rater reliability were also achieved for the second and fifth metatarsals (ICC ≥0.90; CV ≤4.2 %; LOA ≤11.9 %). Poorer levels of reliability were demonstrated for the third (ICC ≥0.64; CV ≤8.2 %; LOA ≤23.6 %) and fourth metatarsals (ICC ≥0.67; CV ≤9.6 %; LOA ≤27.5 %). BMD was greatest in the first and second metatarsals (P < 0.01). Conclusion: Reliable measurements of BMD were achieved for the first, second and fifth metatarsals. Refereed/Peer-reviewed

This study assessed vitamin D status in asymptomatic children and adolescents in Greece, with and without atopy, and possible changes during the coronavirus disease 2019 (COVID-19) pandemic. Serum levels of 25-hydroxy-vitamin D (25(OH)D) and total immunoglobulin E (IgE), and eosinophil count were measured in 340 asymptomatic children and adolescents (155 males, 185 females), mean age 8.6 ± 4.6 years, recruited over a period of 24 months (February 2019–January 2021). Atopy, defined by high level of IgE for age, was associated with vitamin D deficient status (p = 0.041). Subjects with and without atopy showed similar rates of insufficient and normal levels of 25(OH)D. The median level of 25(OH)D was significantly higher in subjects recruited during the pandemic, when home confinement rules were observed, than before the pandemic, and significantly more children had normal levels of 25(OH)D (p &lt, 0.001), but no differences were noticed for IgE levels or eosinophil count. These results support a link between vitamin D and allergic and infectious inflammations, and specifically the association of vitamin D deficiency with asymptomatic atopy, defined as increased IgE level for age.

Triple Negative Breast Cancer (TNBC) continues to present a challenge in the clinic, as there is still no approved targeted therapy. TNBC is the worst sub-type of breast cancer in terms of prognosis and exhibits a deficiency in estrogen, progesterone, and human epidermal growth factor 2 (HER2) receptors. One possible option for the treatment of TNBC is chemotherapy. The issue with many chemotherapy drugs is that their effectiveness is diminished due to poor water solubility, and the method of administration directly or with a co-solvent intravenously can lead to an increase in toxicity. The issues of drug solubility can be avoided by using liposomes as a drug delivery carrier. Liposomes are engineered, biological nanoconstructs that possess the ability to encapsulate both hydrophobic and hydrophilic drugs and have been clinically approved to treat cancer. Specific targeting of cancer cell receptors through the use of ligands conjugated to the surface of drug-loaded liposomes could lessen damage to normal, healthy tissue. This study focuses on polyethylene glycol (PEG)-coated, folate conjugated, benzoporphyrin derivative (BPD)-loaded liposomes for treatment via photodynamic therapy (PDT). The folate receptor is over expressed on TNBC cells so these liposomes are targeted for greater uptake into cancer cells. PDT involves remotely irradiating light at 690 nm to trigger BPD, a hydrophobic photosensitive drug, to form reactive oxygen species that cause tumor cell death. BPD also displays a fluorescence signal when excited by light making it possible to image the fluorescence prior to PDT and for theranostics. In this study, free BPD, non-targeted and folate-targeted PEGylated BPD-loaded liposomes were introduced to a metastatic breast cancer cell line (MDA-MB-231) in vitro. The liposomes were reproducibly synthesized and characterized for size, polydispersity index (PDI), zeta potential, stability, and BPD release kinetics. Folate competition tests, fluorescence confocal imaging, and MTT assay were used to observe and quantify targeting effectiveness. The toxicity of BPD before and after PDT in monolayer and 3D in vitro cultures with TNBC cells was observed. This study may contribute to a novel nanoparticle-mediated approach to target TNBC using PDT.

In the Mediterranean area, rural abandonment and the rapid urbanisation after the 1950's led to complex environmental problems, such as the exploitation of natural resources, the environmental pollution, whilst the unstrained urban growth caused excessive pressure on the existing infrastructure, which affects buildings, public transportation, water quality and public health. Various studies demonstrate that the implementation of green roof technology can moderate environmental problems, through the reduction of heat flux and solar reflectivity, the minimisation of buildings’ energy consumption, the air pollution removal, the storm water runoff reduction, the air cooling and the effective management of the urban heat island effect. In this framework, the aim of this study is to assess the green roof potential and the quantification of its benefits over Thessaloniki, Greece's second largest city. In order to do so, very high spatial resolution satellite image and natural colour orthoimagery were used along with a geographical object-based image analysis approach. Carbon sequestration potential, rainwater retention and energy conservation were estimated based on coefficients adopted after a comprehensive literature review and actual dynamic energy simulations.

In the Mediterranean area, rural abandonment and the rapid urbanisation after the 1950׳s have led to complex environmental problems, such as the exploitation of natural resources, the environmental pollution and the rapid increase of greenhouse gas emissions. Especially the unrestrained urban growth caused excessive pressure on the existing infrastructure, which affects buildings, public transportation, road networks, water quality, waste collection and public health. Green roofs are emerging building technologies that can help communities mitigate some of the above mentioned problems. Various studies have demonstrated that the implementation of green roof technology can moderate some of these environmental problems, through the reduction of heat flux and solar reflectivity, the minimisation of heat losses through the building׳s envelope, the air pollution removal, the storm water runoff reduction, the air cooling as well as the effective management of the urban heat island effect. In this line of thought, the aim of this study is to assess the green roof potential and the quantification of its benefits over Thessaloniki, Greece׳s second largest city. To delineate the available green roof areas, very high spatial resolution satellite image and natural colour orthoimagery were used along with a geographical object-based image analysis approach. Potential green roof extent was extracted with a mean error of 8.78 m 2 , and discriminated from staircases, penthouse setbacks and terracotta tiles. Subsequently GIS were used to extrapolate the results from the building to the city scale. Carbon sequestration potential, rainwater retention and energy conservation were estimated based on coefficients adopted after a comprehensive literature review and actual dynamic energy simulations. The green roof potential in Thessaloniki approximated 17% of the gross built areas of the city, which means that there is a strong potential for green roof retrofit. Depending on the vegetation type installed in an extensive green roof, C stocks in Thessaloniki can increase by 2.5 times, while the dynamic energy simulations suggested that in certain city blocks reduced heating and cooling consumptions up to 5% and 16% respectively could be achieved. In regard to rainwater retention, implementation of green roofs in Thessaloniki is estimated to contribute in rainwater retention by almost 45%, allowing more than half of the rainwater precipitation to be reserved at the 50% of the city blocks.

For many adolescents in developed countries mobile apps can be the easy way for learning and teaching. This paper examines its role in secondary education focusing in mobile applications that support autistic students. The results of a research revealed the educators ` views that high school students with autism may use mobile apps in a variety of supportive educational ways.

Mutations in titin are responsible for many cardiac and muscle diseases, yet the underlying mechanisms remain largely unexplained. Numerous studies have established roles for titin in muscle function, and Ca2+-dependent interactions between titin and actin have been suggested to play a role in muscle contraction. The present study used co-sedimentation assays, dynamic force spectroscopy (DFS), and in vitro motility (IVM) assays to determine whether the N2A region of titin, overlooked in previous studies, interacts with actin in the presence of Ca2+. Co-sedimentation demonstrated that N2A – F-actin binding increases with increasing protein and Ca2+ concentration, DFS demonstrated increased rupture forces and decreased koff in the presence of Ca2+, and IVM demonstrated a Ca2+-dependent reduction in motility of F-actin and reconstituted thin filaments in the presence of N2A. These results indicate that Ca2+ increases the strength and stability of N2A – actin interactions, supporting the hypothesis that titin plays a regulatory role in muscle contraction. The results further support a model in which N2A – actin binding in active muscle increases titin stiffness, and that impairment of this mechanism contributes to the phenotype in muscular dystrophy with myositis. Future studies are required to determine whether titin – actin binding occurs in skeletal muscle sarcomeres in vivo.

Background: Obese children are typically less physically active than their normal-weight peers and are often assumed to be 'unfit'. Objective Investigate the relationships between adiposity, physical activity levels and cardiorespiratory fitness (CRF) in obese and normal-weight children. A secondary aim was to examine obese/normal-weight differences in CRF. Methods Obese (N = 107) and normal-weight (N = 132) 10-13-year-olds participated. Fat-free mass (FFM), percent fat, physical activity and peak oxygen uptake (VO2peak) were assessed. Analyses were adjusted for socioeconomic status (SES). Results Higher percent fat was inversely associated with VO2peak normalized for mass (r = -0.780, P < 0.001) even after controlling for physical activity (r = -0.673, P < 0.001). While higher percent fat was also inversely associated with VO2peak normalized for FFM, this was only significant in males (r = -0.247, P = 0.004) and did not persist after controlling for physical activity (r = -0.059 P = 0.526). Compared with normal-weight children, obese children had higher absolute VO2peak, lower VO2peak corrected for mass (P ≤ 0.009) and lower VO2peak corrected for FFM (P = 0.041) that did not persist after controlling for SES (P = 0.086). Conclusion Obesity-related inefficiencies in CRF were evident. Higher adiposity was associated with poorer CRF relative to mass, irrespective of physical activity levels. However, low physical activity levels may be responsible for associations between adiposity and CRF relative to FFM seen in boys, indicating the importance of encouraging physical activity.

Background: Minimalist shoes have been popularized as a safe alternative to conventional running shoes. However, a paucity of research is available investigating the longer-term safety of minimalist shoes. Purpose: To compare running-related pain and injury between minimalist and conventional shoes in trained runners and to investigate interactions between shoe type, body mass, and weekly training distance. Study Design: Randomized clinical trial; Level of evidence, 2. Methods: Sixty-one trained, habitual rearfoot footfall runners (mean ± SD: body mass, 74.6 ± 9.3 kg; weekly training distance, 25 ± 14 km) were randomly allocated to either minimalist or conventional shoes. Runners gradually increased the time spent running in their allocated shoes over 26 weeks. Running-related pain intensity was measured weekly by use of 100-mm visual analog scales. Time to first running-related injury was also assessed. Results: Interactions were found between shoe type and weekly training distance for weekly running-related pain; greater pain was experienced with minimalist shoes ( P < .05), and clinically meaningful increases (>10 mm) were noted when the weekly training distance was more than 35 km/wk. Eleven of 30 runners sustained an injury in conventional shoes compared with 16 of 31 runners in minimalist shoes (hazard ratio, 1.64; 95% confidence interval, 0.63-4.27; P = .31). A shoe × body mass interaction was found for time to first running-related injury ( P = .01). For runners using minimalist shoes, relative to runners using conventional shoes, the risk of sustaining an injury became more likely with increasing body mass above 71.4 kg, and the risk was moderately increased (hazard ratio, 2.00; 95% confidence interval, 1.10-3.66; P = .02) for runners using minimalist shoes who had a body mass of 85.7 kg. Conclusions: Runners should limit weekly training distance in minimalist shoes to avoid running-related pain. Heavier runners are at greater risk of injury when running in minimalist shoes. Registration: Australian New Zealand Clinical Trials Registry (ACTRN12613000642785).

Purpose: To investigate associations between aspects of time use and health-related quality of life (HRQoL) in youth. Methods: 239 obese and healthy-weight 10- to 13-year-old Australian children completed the Pediatric Quality of Life Inventory (PedsQL™) quantifying their health-related quality of life. Time use was evaluated over four days using the Multimedia Activity Recall for Children and Adolescents (MARCA), a validated 24 h recall tool. The average number of minutes/day spent in physical activity (divided into sport, active transport and play), screen time (divided into television, videogames and computer use), and sleep were calculated. Percent fat was measured using dual-energy X-ray absorptiometry, Tanner stage by self-report, and household income by parental report. Sex-stratified analysis was conducted using Partial Least Squares regression, with percent fat, Tanner stage, household income, and use-of-time as the independent variables, and PedsQL™ total, physical and psychosocial subscale scores as the dependent variables. Results: For boys, the most important predictors of HRQoL were percent fat (negative), videogames (negative), sport (positive), and Tanner stage (negative). For girls, the significant predictors were percent fat (negative), television (negative), sport (positive), active transport (negative), and household income (positive). Conclusion: While body fat was the most significant correlate of HRQoL, sport was independently associated with better HRQoL, and television and videogames with poorer HRQoL. Thus, parents and clinicians should be mindful that not all physical activity and screen-based behaviours have equivocal relationships with children’s HRQoL. Prospective research is needed to confirm causation and to inform current activity guidelines. Refereed/Peer-reviewed

Context: Minimalist shoes have been suggested as a way to alter running biomechanics to improve running performance and reduce injuries. However, to date, researchers have only considered the effect of minimalist shoes at slow running speeds. Objective: To determine if runners change foot-strike pattern and alter the distribution of mechanical work at the knee and ankle joints when running at a fast speed in minimalist shoes compared with conventional running shoes. Design: Crossover study. Setting: Research laboratory. Patients or Other Participants: Twenty-six trained runners (age = 30.0 ± 7.9 years [age range, 18−40 years], height = 1.79 ± 0.06 m, mass = 75.3 ± 8.2 kg, weekly training distance = 27 ± 15 km) who ran with a habitual rearfoot foot-strike pattern and had no experience running in minimalist shoes. Intervention(s): Participants completed overground running trials at 18 km/h in minimalist and conventional shoes. Main Outcome Measure(s): Sagittal-plane kinematics and joint work at the knee and ankle joints were computed using 3-dimensional kinematic and ground reaction force data. Foot-strike pattern was classified as rearfoot, midfoot, or forefoot strike based on strike index and ankle angle at initial contact. Results: We observed no difference in foot-strike classification between shoes (χ21 = 2.29, P = .13). Ankle angle at initial contact was less (2.46° versus 7.43°; t25 = 3.34, P = .003) and strike index was greater (35.97% versus 29.04%; t25 = 2.38, P = .03) when running in minimalist shoes compared with conventional shoes. We observed greater negative (52.87 J versus 42.46 J; t24 = 2.29, P = .03) and positive work (68.91 J versus 59.08 J; t24 = 2.65, P = .01) at the ankle but less negative (59.01 J versus 67.02 J; t24 = 2.25, P = .03) and positive work (40.37 J versus 47.09 J; t24 = 2.11, P = .046) at the knee with minimalist shoes compared with conventional shoes. Conclusions: Running in minimalist shoes at a fast speed caused a redistribution of work from the knee to the ankle joint. This finding suggests that runners changing from conventional to minimalist shoes for short-distance races could be at an increased risk of ankle and calf injuries but a reduced risk of knee injuries.

The purpose of this study was to determine if minimalist shoes improve time trial performance of trained distance runners and if changes in running economy, shoe mass, stride length, stride rate and footfall pattern were related to any difference in performance. Twenty-six trained runners performed three 6-min sub-maximal treadmill runs at 11, 13 and 15 km·h−1 in minimalist and conventional shoes while running economy, stride length, stride rate and footfall pattern were assessed. They then performed a 5-km time trial. In the minimalist shoe, runners completed the trial in less time (effect size 0.20 ± 0.12), were more economical during sub-maximal running (effect size 0.33 ± 0.14) and decreased stride length (effect size 0.22 ± 0.10) and increased stride rate (effect size 0.22 ± 0.11). All but one runner ran with a rearfoot footfall in the minimalist shoe. Improvements in time trial performance were associated with improvements in running economy at 15 km·h−1 (r = 0.58), with 79% of the improved economy accounted for by reduced shoe mass (P

Parenting styles have been associated with health-related behaviours in children and adolescents. We present a series of studies. Study 1 investigated parenting styles and parent-child communication styles as cross-sectional predictors of dietary patterns in children, and study 2 as cross-sectional predictors of weight status in adolescents. Data were collected from parents of 382 children aged 2-12 in study 1, and from parents of 72 adolescent children aged 12-18 in study 2. Controlling for confounders, laxness and over-reactivity predicted lower fruit/vegetable and higher non-core food consumption in study 1. Incendiary parent-adolescent communication predicted higher adolescent body mass index in study 2. These findings suggest that different parent-child parenting styles are associated with diet and weight in children and adolescents. Improving ways in which parents communicate with their children may be an important consideration in the development of effective parent-targeted treatment programmes for child diet quality and subsequent adolescent overweight/obesity. Refereed/Peer-reviewed

Karagouniko and Chios sheep breeds present a lot of advantages on the implementation of sheep farming in Greece, a country with diverse relief resulting in a microclimatic variety, but nothing is known about the impact of season, as the outcome of important meteorological variables, on the fibre length growth (FLG) of the aforementioned breeds. Thus, the effect of season (Winter, Spring, Summer, Autumn) on the FLG of these breeds (by using analysis of variance) was studied in the Artificial Insemination Center of Karditsa (39021΄18΄΄N, 21054΄19΄΄E), Periphery of Thessaly, Greece, combined with a correlation analysis between FLG of each examined sheep breed and each of the studied meteorological variables, air temperature (AIRT), relative humidity (RH), sunshine (SUNS) and rainfall (R) for a two-year period. It was found that the FLG of Karagouniko sheep was significantly higher than the respective growth of Chios sheep, for each examined season, while the descending order of seasonal FLG for both breeds was Winter>Spring>Autumn>Summer. Fibre length growth of Karagouniko and Chios breeds correlated negatively with AIRT and SUNS and positively with RH, implying a better FLG in cooler, more overcast and wetter time periods. Our study adds new knowledge concerning the effect of season, and particularly, the effect of the aforementioned meteorological variables on the wool growth of two considerable sheep breeds in Greece, Karagouniko and Chios, opening up new horizons for their exploitation.

Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns ( i.e. breaks and bouts ) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases ( EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus ) were searched ( up to 12 November 2015 ) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes ( adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes ). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.

Objective: The aim of this study was to investigate whether obesity is related to impaired day-to-day physical functioning and disability in children. Methods: An observational case-control study was conducted in three Australian states. Obese (n = 107) and healthy-weight (n = 132) 10- to 13-year-olds (132 male, 107 female) were recruited via media advertisements. Assessment of body composition (dual energy X-ray absorptiometry), locomotor capacity (six-minute walk test [6MWT], timed up and down stairs test [TUDS] and timed up and go [TUG]) and child-reported physical health-related quality of life (HRQoL) were undertaken. Participants wore an accelerometer for 8 days and completed two use-of-time telephone interviews to assess participation in key life areas. Results: Compared with their healthy-weight counterparts, obese children had lower physical HRQoL scores (P < 0.01) and reduced locomotor capacity (TUDS z-score, TUG and 6MWT; P < 0.01). Higher percent body fat was significantly related to lower physical HRQoL scores (r = -0.48, P < 0.01), slower performance times for the TUDS and TUG (r = 0.59 and 0.26 respectively, P < 0.01), shorter 6MWT distances (r = -0.51, P < 0.01) and reduced time spent in community participation activities (r = -0.23, P < 0.01). Conclusions: As anticipated, obesity appears to undermine physical functioning in children, including the capacity to perform basic locomotor skills yet, unexpectedly, participation in key life areas related to physical functioning appeared largely unaffected.

This review addresses the impact of obesity on paediatric physical functioning utilizing the World Health Organization International Classification of Functioning, Disability and Health Framework (ICF). The ICF encompasses functioning (as it relates to all body functions and structures), activities (undertaking a particular task) and participation (in a life situation) with disability referring to impairments in body functions/structures, activity restrictions or participation limitations. Electronic databases were searched for peer-reviewed studies published in English prior to May 2009 that examined aspects of physical functioning in children (≤18 years). Eligible studies (N = 104) were ranked by design and synthesized descriptively. Childhood obesity was found to be associated with deficits in function, including impaired cardiorespiratory fitness and performance of motor tasks; and there was some limited evidence of increased musculoskeletal pain and decrements in muscle strength, gait and balance. Health-related quality of life and the subset of physical functioning was inversely related to weight status. However, studies investigating impacts of obesity on wider activity and participation were lacking. Further research utilizing the ICF is required to identify and better characterize the effects of paediatric obesity on physical function, activity and participation, thereby improving targets for intervention to reduce disability in this population.

Purpose: There is high interest in longitudinal analysis of plasma ctDNA as an early predictor of response and long-term outcomes. We report a retrospective longitudinal analysis of ctDNA in the double-blind placebo (PBO)-controlled randomized phase 2 LOTUS (NCT02162719) trial of the oral Akt inhibitor IPAT + PAC for mTNBC. Methods: Pre-treatment plasma samples were analyzed to identify and quantify genomic alterations in ctDNA using a hybrid-capture-based NGS assay that interrogates 62 genes (FoundationACT). A narrow ctDNA panel quantified the same mutations in on-treatment samples collected at 8 wks (d1, cycle 3). The ctDNA fraction (CTF) was defined as the highest mutant allele frequency in each sample. The ratio of CTF in on-treatment vs pre-treatment samples was compared with objective response (RECIST v1.1) and progression-free survival (PFS) in the experimental (IPAT + PAC) and control (PBO + PAC) arms. Results: Paired on-treatment samples were evaluable from 66 of 88 patients with evaluable pre-treatment samples. The most common reason for no on-treatment sample was disease progression (PD) before cycle 3. In 81 baseline samples, 149 mutations were identified. Calculated CTF ratios ranged from 0% (not detected in on-treatment sample) to 648% (increase in on-treatment sample). In both arms and the pooled population, a greater CTF decrease was associated with objective response and longer PFS (Table). Conclusions: On-treatment change in CTF shows a meaningful association with objective response and PFS in LOTUS. This effect was seen in the experimental and control arms, suggesting independence from the specific mechanism of therapy. Evaluation of samples from the time of PD is ongoing. Inclusion of additional timepoints will likely improve the predictive ability of CTF, possibly allowing its use as an early surrogate trial endpoint. IPAT + PAC (n=32)PBO + PAC (n=34)Pooled arms (n=66)Median CTF ratio, % (IQR)Confirmed complete/partial response(n=14)(n=14)(n=28)0.4 (0-14.3)0.2 (0-46.9)0.3 (0-17.8)Stable/progressive disease(n=18)(n=20)(n=38)8.2 (4.4-45.9)26.9 (8.4-91.4)20.7 (4.9-67.9)Median PFS, months (95% CI)CTF ratio ≤5%(n=15)(n=14)(n=29)7.2 (3.7-NE)6.3 (3.6-NE)7.2 (5.1-12.9)CTF ratio >5%(n=17)(n=20)(n=37)3.7 (3.5-5.3)3.7 (2.8-5.4)3.7 (3.6-5.0)PFS hazard ratio (95% CI)0.46 (0.19-1.09)0.43 (0.17-0.97)0.43 (0.23-0.78)CI = confidence interval; IQR = interquartile range; NE = not estimable. Citation Format: Matthew J. Wongchenko, Doron Lipson, Travis Clark, Mark Kennedy, Mandy Greene, Virginia Breese, Alyssa Tsiros, Sung-Bae Kim, Cristina Saura, Mafalda Oliveira, Jose Baselga, Amy V. Kapp, Wai Y. Chan, Stina M. Singel, Steven Gendreau, Rebecca Dent. On-treatment changes in circulating tumor DNA (ctDNA) level as an early predictor of clinical outcome in the LOTUS randomized phase 2 trial of 1st-line ipatasertib (IPAT) + paclitaxel (PAC) for metastatic triple-negative breast cancer (mTNBC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2964.

Background: The effect of footwear on running economy has been investigated in numerous studies. However, no systematic review and meta-analysis has synthesised the available literature and the effect of footwear on running performance is not known. Conclusions: Certain models of footwear and footwear characteristics can improve running economy. Future research in footwear performance should include measures of running performance. Methods: The Web of Science, Scopus, MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials), EMBASE, AMED (Allied and Complementary Medicine), CINAHL and SPORTDiscus databases were searched from inception up until April 2014. Included articles reported on controlled trials that examined the effects of footwear or footwear characteristics (including shoe mass, cushioning, motion control, longitudinal bending stiffness, midsole viscoelasticity, drop height and comfort) on running performance or running economy and were published in a peer-reviewed journal. Objective: The aim of this systematic review and meta-analysis was to investigate the effect of footwear on running performance and running economy in distance runners, by reviewing controlled trials that compare different footwear conditions or compare footwear with barefoot. Results: Of the 1,044 records retrieved, 19 studies were included in the systematic review and 14 studies were included in the meta-analysis. No studies were identified that reported effects on running performance. Individual studies reported significant, but trivial, beneficial effects on running economy for comfortable and stiff-soled shoes [standardised mean difference (SMD)

The use of the kidneys in secular and spiritual practices according to ancient Greek and Byzantine texts. The use of kidneys in secular and spiritual practices was very common for centuries. In this article we present some references on their employment as sacrificial offers, as plain food or as a source for medicaments. Our material derives from Greek texts of the Classical, Hellenistic, Roman, and Byzantine eras. Relevant extracts from the Old Testament are also included, as they have become part of a common cultural heritage in that period of syncretism, when Jews were Hellenized and Greeks orientized. From the fragments cited in this article, it is obvious that the practical use of kidneys by priests, doctors, and lay persons in the periods under discussion was widespread. The sacrificial offering was based on the religious significance of the organ. The dietary consumption of the kidneys was limited by their function as urine producers. Their medicinal use was dictated first, by the abundance of the adipose tissue surrounding them, which was an ideal warming and binding substance. Second, it may be explained by the deeply rooted conviction that eating a particular organ led to the incorporation of its strength, thus protecting the corresponding eater's organs. Those practices should not surprise us in view of their corresponding modern use. Currently, kidney donors offer their organs in a sacrificial gesture, kidneys are consumed as a delicacy worldwide, and renal tissue is therapeutically used in transplantations and, until very recently, as a source for hormonal substances.

The purpose of this study was to investigate if obese children have reduced knee extensor (KE) strength and to explore the relationship between adiposity and KE strength. An observational case-control study was conducted in three Australian states, recruiting obese [N = 107 (51 female, 56 male)] and healthy-weight [N = 132 (56 female, 76 male)] 10- to 13-year-old children. Body mass index, body composition (dual energy X-ray absorptiometry), isokinetic/isometric peak KE torques (dynamometry) and physical activity (accelerometry) were assessed. Results revealed that compared with their healthy-weight peers, obese children had higher absolute KE torques (P ≤ 0.005), equivocal KE torques when allometrically normalized for fat-free mass (FFM) (P ≥ 0.448) but lower relative KE torques when allometrically normalized for body mass (P ≤ 0.008). Adjustments for maternal education, income and accelerometry had little impact on group differences, except for isometric KE torques relative to body mass which were no longer significantly lower in obese children (P ≥ 0.013, not significant after controlling for multiple comparisons). Percent body fat was inversely related to KE torques relative to body mass (r = −0.22 to −0.35, P ≤ 0.002), irrespective of maternal education, income or accelerometry. In conclusion, while obese children have higher absolute KE strength and FFM, they have less functional KE strength (relative to mass) available for weight-bearing activities than healthy-weight children. The finding that FFM-normalized KE torques did not differ suggests that the intrinsic contractile properties of the KE muscles are unaffected by obesity. Future research is needed to see if deficits in KE strength relative to mass translate into functional limitations in weight-bearing activities. Refereed/Peer-reviewed

Objective: To critically appraise the Biodex System 4 isokinetic dynamometer for strength assessment of children. Methods: Appraisal was based on experiences from two independent laboratories involving testing of 213 children. Issues were recorded and the manufacturer was consulted regarding appropriate solutions. Results: The dynamometer had insufficient height adjustment for alignment of the knee for some children, requiring the construction of padding to better fit the child within the dynamometer. Potential for entrapment of the non-testing leg was evident in the passive and eccentric modes and a leg bracket restraint was constructed. Automated gravity correction did not operate when protocols were linked or data was exported to an external device. Conclusions: Limitations were noted, some of which were applicable to knee strength testing in general and others which were specific to use with children. However, most of these obstacles could be overcome, making the Biodex System 4 suitable for assessment of knee strength in children. Refereed/Peer-reviewed

Aim: To examine if obesity is related to impaired physical functioning and disability in children. Refereed/Peer-reviewed

The abilities of a screening-level model to predict variations in elemental mercury (Hg0) air emissions from soils in terrestrial landscapes are examined by comparing simulation results to published observational data and by performing sensitivity analyses. Despite uncertainties and simplifications, the model results obtained offer some degree of confidence in the model's joint ability to relate readily available environmental parameters to airborne emissions of Hg predicted by coupling simple atmospheric and soil parameters with Hg cycling and transport algorithms. The model reasonably predicted the observational data in the considered data sets except for one site for which significant uncertainty was associated with model input data. Predictions are consistent with many trends observed in the field studies; better predictions were obtained for nonvegetated systems (relative errors between 0.4 and 9.7%) than for shaded-soil landscapes (relative errors between 2.3 and 27%). The model reflected field data showing that daily average emission rates of Hg0, formed by the reduction of Hg(II), are primarily controlled by changes in solar radiation, soil moisture, temperature, and, to a lesser extent, wind conditions. The model may have potential use in several preliminary studies to characterize trends of airborne Hg emitted from terrestrial sources to the atmosphere.

Objective: This review addresses the effect of overweight and obese weight status on pediatric health-related quality of life (HRQOL). Method: Web of Science, Medline, CINAHL, Cochrane Library, EMBASE, AMED and PubMed were searched for peer-reviewed studies in English reporting HRQOL and weight status in youth (

Adolescence is a vulnerable period for the development of obesity, and adolescent weight tracks strongly into adulthood. Previous reviews of treatment strategies have failed to discriminate between adolescents and children, thereby, disregarding the uniqueness of this population. Hence, this review aims to summarise the evidence for treatment approaches for adolescent obesity. Pubmed, OVID, EBSCOhost and Google Scholar were searched for randomised controlled trials, meta-analyses and systematic reviews testing treatments for overweight/obese adolescents (aged 12-19 years), published from 1982-2006 in English. Eligible studies had to assess either weight, percentage overweight, body mass index (BMI) or body fat. Thirty-four randomised controlled trials were eligible. The results of this review indicate that the safety and efficacy of surgical and pharmacotherapy treatments for adolescent obesity is uncertain. Diet and physical activity approaches may improve obese status in the short term. However, obesity interventions appear more effective when strategies are combined, rather than when used in isolation. Psychological interventions, such as behavioural and cognitive behavioural therapy, show promise in achieving the necessary lifestyle changes for obesity reduction; however, long-term follow-up studies are needed. There were multiple limitations in appraising the literature. Inconsistent definitions of overweight/obesity make comparisons between studies difficult. Many studies have not used direct adiposity measures, have failed to assess pubertal status or have not used an exclusive adolescent sample. We conclude that, despite these limitations, current evidence indicates that behavioural and cognitive behavioural strategies combined with diet and physical activity approaches may assist in reducing adolescent obesity,although long-term follow-up studies are needed. Refereed/Peer-reviewed

Introduction The outcome of the effects of transitioning to minimalist running shoes is a topic of interest for runners and scientists. However, few studies have investigated the longer term effects of running in minimalist shoes. The purpose of this randomised controlled trial (RCT) is to investigate the effects of a 26 week transition to minimalist shoes on running performance and injury risk in trained runners unaccustomed to minimalist footwear. Methods and analysis A randomised parallel intervention design will be used. Seventy-six trained male runners will be recruited. To be eligible, runners must be aged 18–40 years, run with a habitual rearfoot footfall pattern, train with conventional shoes and have no prior experience with minimalist shoes. Runners will complete a standardised transition to either minimalist or control shoes and undergo assessments at baseline, 6 and 26 weeks. 5 km time-trial performance (5TT), running economy, running biomechanics, triceps surae muscle strength and lower limb bone mineral density will be assessed at each time point. Pain and injury will be recorded weekly. Training will be standardised during the first 6 weeks. Primary statistical analysis will compare 5TT between shoe groups at the 6-week time point and injury incidence across the entire 26-week study period. Ethics and dissemination This RCT has been approved by the Human Research Ethics Committee of the University of South Australia. Participants will be required to provide their written informed consent prior to participation in the study. Study findings will be disseminated in the form of journal publications and conference presentations after completion of planned data analysis. Trial registration number This RCT has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000642785).