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There has been an increased in attention placed on the energy consumption of miscellaneous electronic loads in buildings by energy analysts and policymakers in recent years. The share of electricity consumed by consumer electronics in US households has increased in the last decade. Many devices, however, lack robust energy use data, making energy consumption estimates difficult and uncertain. Video game consoles are high-performance machines present in approximately half of all households and can consume a considerable amount of power. The precise usage of game consoles has significant uncertainty, however, leading to a wide range of recent national energy consumption estimates. We present here an analysis based on field-metered usage data, collected as part of a larger field metering study in the USA. This larger study collected data from 880 households in 2012 on a variety of devices, including 113 game consoles (the majority of which are Generation 7 consoles). From our metering, we find that although some consoles are left on nearly 24 h/day, the overall average usage is lower than many other studies have assumed, leading to a US national energy consumption estimate of 7.1 TWh in 2012. Nevertheless, there is an opportunity to reduce energy use with proper game console power management, as a substantial amount of game console usage occurs with the television turned off. The emergence of Generation 8 consoles may increase national energy consumption.

Several studies for outcomes data regarding cardiac arrest use ICD-9 codes to establish study populations; however, the accuracy of this mode of data collection is unclear. This study evaluates institutional data for patients with cardiac arrest to determine precision and accuracy of the cardiac

Motivational interviewing (MI) shows promise for pediatric obesity prevention, but few studies address parental perceptions of MI. The aim of this study was to identify correlates of parental perceptions of helpfulness of and satisfaction with a MI-based pediatric obesity prevention intervention. We studied 253 children 2 to 6 years of age in the intervention arm of High Five for Kids, a primary care–based randomized controlled trial. In multivariable models, parents born outside the United States (odds ratio [OR] = 8.81; 95% confidence interval [CI] = 2.44, 31.8), with lower household income (OR = 3.60; 95% CI = 1.03, 12.55), and with higher BMI (OR = 2.86; 95% CI = 1.07, 7.65) were more likely to perceive MI-based visits as helpful in improving children’s obesity-related behaviors after the first year of the intervention. Parents of female (vs male), black (vs white), and Latino (vs white) children had lower intervention satisfaction. Our findings underscore the importance of tailoring pediatric obesity prevention efforts to target populations.

Women diagnosed with breast cancer experience symptom clusters in addition to existential issues from a life-threatening diagnosis during chemotherapy. A complementary therapy, such as traditional acupuncture (TA) with its whole-person orientation, may help to modify these effects, alongside inducing other patient benefits. Exploring the needs and concerns of women and perceived benefits of TA would add to knowledge about its integrative treatment potential.Methods. A longitudinal qualitative study recruited fourteen women to receive up to ten sessions of TA during chemotherapy. They were interviewed before, during, and after chemotherapy. Two practitioners of TA delivered treatment and were interviewed before and after the study, and kept treatment logs and diaries. Interviews were recorded and transcribed, and the data were analysed using grounded theory.Findings. Both broad and specific benefits were reported by the women; a highly valued outcome was enabling coping through the alleviation of symptoms and increased well-being. Practitioners dealt with the presented symptom clusters facilitating outcome patterns, including and beyond individual symptom changes. Further research on TA as a flexible intervention able to respond to the changing needs and concerns of woman during chemotherapy along with the measure of such outcome patterns is warranted.

Objectives To estimate data loss and bias in studies of Clinical Practice Research Datalink (CPRD) data that restrict analyses to Read codes, omitting anything recorded as text. Design Matched case–control study. Setting Patients contributing data to the CPRD. Participants 4915 bladder and 3635 pancreatic, cancer cases diagnosed between 1 January 2000 and 31 December 2009, matched on age, sex and general practitioner practice to up to 5 controls (bladder: n=21 718; pancreas: n=16 459). The analysis period was the year before cancer diagnosis. Primary and secondary outcome measures Frequency of haematuria, jaundice and abdominal pain, grouped by recording style: Read code or text-only (ie, hidden text). The association between recording style and case–control status (χ2 test). For each feature, the odds ratio (OR; conditional logistic regression) and positive predictive value (PPV; Bayes’ theorem) for cancer, before and after addition of hidden text records. Results Of the 20 958 total records of the features, 7951 (38%) were recorded in hidden text. Hidden text recording was more strongly associated with controls than with cases for haematuria (140/336=42% vs 556/3147=18%) in bladder cancer (χ2 test, p

Author(s): Meyers, Stephen; Williams, Alison; Chan, Peter; Price, Sarah | Abstract: This paper presents estimates of the key impacts of Federal energy and water conservation standards adopted from 1987 through 2015. The standards for consumer products and commercial and industrial equipment include those set by legislation as well as standards adopted by DOE through rulemaking. In 2015, the standards saved an estimated 4.49 quads of primary energy, which is equivalent to 5% of total U.S. energy consumption. The savings in operating costs for households and businesses totaled $63.4 billion. The average household saved $320 in operating costs as a result of residential appliance standards. The estimated reduction in CO2 emissions associated with the standards in 2015 was 238 million metric tons, which is equivalent to 4.3% of total U.S. CO2 emissions. The estimated cumulative energy savings over the period 1990-2090 amount to 216.9 quads. Accounting for the increased upfront costs of more-efficient products and the operating cost (energy and water) savings over the products’ lifetime, the standards have a cumulative net present value (NPV) of consumer benefit of between $1,627 billion and $1,887 billion, using 7 percent and 3 percent discount rates, respectively. The water conservation standards, together with energy conservation standards that also save water, reduced water use by 1.9 trillion gallons in 2015 and estimated cumulative water savings by 2090 amount to 55 trillion gallons. The estimated consumer savings in 2015 from reduced water use amounted to $12 billon.

1,1-Dichloroethane induces a monomer–aggregate equilibrium of common BODIPY dyes in organic solvents at low μM dye concentrations, thus providing an opportunity to study monomeric, aggregate-free forms of BODIPY dyes.

Excessive gestational weight gain (GWG) predicts adverse pregnancy outcomes and later obesity risk for both mother and child. Women who receive GWG advice from their obstetric clinicians are more likely to gain the recommended amount, but many clinicians do not counsel their patients on GWG, pointing to the need for new strategies. Electronic medical records (EMRs) are a useful tool for tracking weight and supporting guideline-concordant care, but their use for care related to GWG has not been evaluated. We performed in-depth interviews with 16 obstetric clinicians from a multi-site group practice in Massachusetts that uses an EMR. We recorded, transcribed, coded, and analyzed the interviews using immersion-crystallization. Many respondents believed that GWG had "a lot" of influence on pregnancy and child health outcomes but that their patients did not consider it important. Most indicated that excessive GWG was a big or moderate problem in their practice, and that inadequate GWG was rarely a problem. All used an EMR feature that calculates total GWG at each visit. Many were enthusiastic about additional EMR-based supports, such as a reference for recommended GWG for each patient based on pre-pregnancy body mass index, a "growth chart" to plot actual and recommended GWG, and an alert to identify out-of-range gains, features which many felt would remind them to counsel patients about excessive weight gain. Additional decision support tools within EMRs would be well received by many clinicians and may help improve the frequency and accuracy of GWG tracking and counseling.

Understanding parents’ perceptions of their young children’s viewing behaviors and environments is critical to the development of effective television reduction interventions. To explore parents’ attitudes, perceptions, and experiences regarding their children’s television viewing and the use of televisions in their children’s bedrooms, we conducted focus groups with 74 racial/ethnic minority parents of children aged birth to 5 years. We analyzed transcripts of the focus group discussions using immersion-crystallization. Over 50 % of parents reported that their children watch more than 2 h of television per day and 64 % reported that their children have a television in their bedrooms. In general, parents were unconcerned about the amount of television their children watched. However, parents did express concern about the content of their children’s viewing. Discussion of potential harmful effects of television viewing focused mainly on the impact television viewing may have on children’s behavior and academic outcomes and only rarely on a concern about weight. Most parents were unaware of adverse consequences associated with children having a television in their bedroom and many reported that having a television in their child’s bedroom helped keep their child occupied. To effectively engage parents of young children, television reduction interventions should include messages that address parents’ key concerns regarding their children’s viewing and should provide parents with alternative activities to keep children occupied.

Human habitations require energy and water, which are increasingly interdependent. Energy systems have changed from using water for mechanical energy to building dams to provide irrigation water for agriculture and hydroelectricity. Large volumes of water are required to cool thermal electricity-generating stations—whether coal, natural gas, nuclear, or solar powered. Changes in cooling technology are reducing water withdrawals while increasing water consumption. Water produced from fossil fuel production represents environmental challenges and supply opportunities. Some renewable energy sources, such as wind turbines and photovoltaics, have far lower water requirements. Increasing development of biofuels creates a direct connection between water and energy systems. Energy, mostly for pumps, is necessary for supplying potable water and treating wastewater. Pumping from deeper underground as well as removing more contaminants (e.g., medicines, agricultural chemicals) and salt requires more energy. Water and wastewater treatment can dominate electricity demand in municipalities. Water reuse requires energy for treatment and pumping. Life cycle assessments and integrated resource planning strive to account for the total impacts.

Objective. This study aimed to identify socioeconomic correlates of computer/Internet use among parents of overweight preschool-aged children. Methods. A total of 470 baseline participants in a trial to prevent obesity in children 2 to 6.9 years old with body mass index ≥95th percentile or 85th to 95th percentile with one overweight parent were studied. Interviews with parents used Health Information National Trends Survey questions. Results/conclusions. Overall, 94% of the participants had home computers and 93% reported Internet usage. In adjusted models, parents with ≤college degree (odds ratio = 4.8; 95% confidence interval = 1.2-18.3) or with household income ≤$50 000 (odds ratio = 7.6; 95% confidence interval = 2.2-26.8) had decreased likelihood of computer ownership. Of parents who reported going online, 63% used Internet to look for health/medical information for themselves and 42% for their children. Parents with ≤a college degree or with body mass index 2were less likely to use Internet. Results support using the Internet for early childhood obesity prevention with enhanced outreach efforts for low socioeconomic status families.

Detection of angry, happy and sad faces among neutral backgrounds was investigated in three single emotion tasks and an emotion comparison task using schematic (Experiment 1) and photographic faces (Experiment 2). Both experiments provided evidence for the preferential detection of anger displays over displays of other negative or positive emotions in tasks that employed all three target emotions. Evidence for preferential detection of negative emotion in general was found only with schematic faces. The present results are consistent with the notion that the detection of displays of anger, and to some extent sadness, does not reflect on a pre-attentive mechanism, but is the result of a more efficient visual search than is the detection of positive emotion.

An infectious disease is a disease which is spread by micro-organisms. These diseases can be caused by bacteria, viruses, fungi or protozoa.

The term ectoparasite commonly refers to an organism that lives on another organism. Ectoparasites are of growing importance in the veterinary world and this article looks at the main ones affecting the domestic dog and cat. Ectoparasites include the arthropod species and certain species of fungus. Most ectoparasite arthropods belong to either the insect group, such as lice and fleas, or the acari, which is a subgroup of arachnids, such as mites and ticks.

National Science Foundation grant (NSF DEB0128810 to H.M.A, and REU supplement for S. P.); University of Kansas General Research Fund Grant (2301547-003); Educational Opportunity Award from University of Kansas Student Senate for S.P.

The obesity epidemic has spared no age group, even young infants. Most childhood obesity is incident by the age of 5 years, making prevention in preschool years a priority.To examine 2-year changes in age- and sex-specific BMI z-scores and obesity-related behaviours among 441 of the 475 originally recruited participants in High Five for Kids, a cluster randomized controlled trial in 10 paediatric practices.The intervention included a more intensive 1-year intervention period (four in-person visits and two phone calls) followed by a less intensive 1-year maintenance period (two in-person visits) among children who were overweight or obese and age 2-6 years at enrolment. The five intervention practices restructured care to manage these children including motivational interviewing and educational modules targeting television viewing and intakes of fast food and sugar-sweetened beverages.After 2 years, compared with usual care, intervention participants had similar changes in BMI z-scores (-0.04 units; 95% CI -0.14, 0.06), television viewing (-0.20 h/d; -0.49 to 0.09) and intakes of fast food (-0.09 servings/week; -0.34 to 0.17) and sugar-sweetened beverages (-0.26 servings/day; -0.67 to 0.14).High Five for Kids, a primarily clinical-based intervention, did not affect BMI z-scores or obesity-related behaviours after 2 years.

Background The Connect for Health study is designed to assess whether a novel approach to care delivery that leverages clinical and community resources and addresses socio-contextual factors will improve body mass index (BMI) and family-centered, obesity-related outcomes of interest to parents and children. The intervention is informed by clinical, community, parent, and youth stakeholders and incorporates successful strategies and best practices learned from ‘positive outlier' families, i.e., those who have succeeded in changing their health behaviors and improve their BMI in the context of adverse built and social environments. Design Two-arm, randomized controlled trial with measures at baseline and 12 months after randomization. Participants 2–12 year old children with overweight or obesity (BMI ≥ 85th percentile) and their parents/guardians recruited from 6 pediatric practices in eastern Massachusetts. Intervention Children randomized to the intervention arm receive a contextually-tailored intervention delivered by trained health coaches who use advanced geographic information system tools to characterize children's environments and neighborhood resources. Health coaches link families to community-level resources and use multiple support modalities including text messages and virtual visits to support families over a one-year intervention period. The control group receives enhanced pediatric care plus non-tailored health coaching. Main outcome measures Lower age-associated increase in BMI over a 1-year period. The main parent- and child-reported outcome is improved health-related quality of life. Conclusions The Connect for Health study seeks to support families in leveraging clinical and community resources to improve obesity-related outcomes that are most important to parents and children.

IMPORTANCE: Dermatologists, pulmonologists, and rheumatologists study and treat patients with sarcoidosis with cutaneous manifestations. The validity of cutaneous sarcoidosis outcome instruments for use across medical specialties remains unknown.\ud \ud OBJECTIVE: To assess the reliability and validity of cutaneous sarcoidosis outcome instruments for use by dermatologists and nondermatologists treating sarcoidosis.\ud \ud DESIGN, SETTING, AND PARTICIPANTS: We performed a cross-sectional study evaluating the use of the Cutaneous Sarcoidosis Activity and Morphology Instrument (CSAMI) and Sarcoidosis Activity and Severity Index (SASI) to assess cutaneous sarcoidosis disease severity and the Physician's Global Assessment (PGA) as a reference instrument. Four dermatologists, 3 pulmonologists, and 4 rheumatologists evaluated facial cutaneous sarcoidosis in 13 patients treated at a cutaneous sarcoidosis clinic in a 1-day study on October 24, 2014; data analysis was performed from November through December 2014.\ud \ud MAIN OUTCOMES AND MEASURES: Interrater and intrarater reliability and convergent validity, with correlation with quality-of-life measures as the secondary outcome.\ud \ud RESULTS: All instruments demonstrated excellent intrarater reliability. Interrater reliability (reported as intraclass correlation coefficient [95% CI]) was good for the CSAMI Activity scale (0.69 [0.51-0.87]) and PGA (0.66 [0.47-0.85]), weak for the CSAMI Damage scale (0.26 [0.11-0.52]), and excellent for the modified Facial SASI (0.78 [0.63-0.91]). The CSAMI Activity scale and modified Facial SASI showed moderate correlations (95% CI) with the PGA (0.67 [0.57-0.75] and 0.57 [0.45-0.66], respectively). The CSAMI Activity scale but not the modified Facial SASI showed significant correlations (95% CI) with quality-of-life instruments, such as the Dermatology Life Quality Index (Spearman rank correlation, 0.70 [0.25-0.90]) and the Skin Stigma raw score of the Sarcoidosis Assessment Tool (Pearson product moment correlation, 0.56 [0.01-0.85]).\ud \ud CONCLUSIONS AND RELEVANCE: The CSAMI and SASI were reliable and valid in assessing cutaneous sarcoidosis among our diverse group of specialists. The CSAMI Activity score also correlated with quality-of-life measures and suggested construct validity. These results lend credibility to expand the use of the CSAMI and SASI by dermatologists and nondermatologists in assessing cutaneous sarcoidosis disease activity.

Pain, atrophy and dysfunction of thelongissimus dorsiin the equine back can lead to poor performance and altered biomechanics. Back problems are often treated by manipulative therapy to this muscle. The purpose of this study was to identify if manipulative therapy resulted in changes to muscle tone or electromyographic (EMG) activity immediately after treatment. We measured the muscle tone during standing using a mechanical tissue indenter and the EMG activity (both at the T16 level in thelongissimus dorsi) during walking around a figure-of-eight course in 26 horses. The horses were randomly assigned into three groups that received: (a) spinal (McTimoney) manipulations, (b) reflex inhibition therapy or (c) a control group that was not manipulated. The muscle tone and activity were measured immediately after treatment. Both the McTimoney and the reflex inhibition groups showed significant decreases in muscle tone (c.12%) and walking EMG activity (c.19%). The control group showed no significant change in tone or EMG activity. These results document how thelongissimus dorsimuscle responds immediately after manipulative therapy. Further studies would be needed to identify how long such changes persist or if such changes caused a reduction in pain or an increase in performance.

As many regions of the United States experience rising temperatures, consumers have come to rely increasingly on cooling appliances (including portable air conditioners) to provide a comfortable indoor temperature. Home occupants sometimes use a portable air conditioner (PAC) to maintain a desired indoor temperature in a single room or enclosed space. Although PACs in residential use are few compared to centrally installed and room air conditioning (AC) units, the past few years have witnessed an increase of PACs use throughout the United States. There is, however, little information and few research projects focused on the energy consumption and performance of PACs, particularly studies that collect information from field applications of PACs. The operation and energy consumption of PACs may differ among geographic locations and households, because of variations in cooling load, frequency, duration of use, and other user-selected settings. In addition, the performance of building envelope (thermal mass and air leakage) as well as inter-zonal mixing within the building would substantially influence the ability to control and maintain desirable indoor thermal conditions. Lawrence Berkeley National Laboratory (LBNL) conducted an initial field-metering study aimed at increasing the knowledge and data related to PAC operation and energy consumption in the United States.

The electricity consumption of miscellaneous electronic loads (MELs) in the home has grown in recent years, and is expected to continue rising. Consumer electronics, in particular, are characterized by swift technological innovation, with varying impacts on energy use. Desktop and laptop computers make up a significant share of MELs electricity consumption, but their national energy use is difficult to estimate, given uncertainties around shifting user behavior. This report analyzes usage data from 64 computers (45 desktop, 11 laptop, and 8 unknown) collected in 2012 as part of a larger field monitoring effort of 880 households in the San Francisco Bay Area, and compares our results to recent values from the literature. We find that desktop computers are used for an average of 7.3 hours per day (median = 4.2 h/d), while laptops are used for a mean 4.8 hours per day (median = 2.1 h/d). The results for laptops are likely underestimated since they can be charged in other, unmetered outlets. Average unit annual energy consumption (AEC) for desktops is estimated to be 194 kWh/yr (median = 125 kWh/yr), and for laptops 75 kWh/yr (median = 31 kWh/yr). We estimate national annual energy consumption for desktop computers to be 20more » TWh. National annual energy use for laptops is estimated to be 11 TWh, markedly higher than previous estimates, likely reflective of laptops drawing more power in On mode in addition to greater market penetration. This result for laptops, however, carries relatively higher uncertainty compared to desktops. Different study methodologies and definitions, changing usage patterns, and uncertainty about how consumers use computers must be considered when interpreting our results with respect to existing analyses. Finally, as energy consumption in On mode is predominant, we outline several energy savings opportunities: improved power management (defaulting to low-power modes after periods of inactivity as well as power scaling), matching the rated power of power supplies to computing needs, and improving the efficiency of individual components.« less

BACKGROUND Patients' ability to understand information about medication is crucial for safety and effectiveness. Rates of illiteracy worldwide indicate that written information alone cannot meet many patients' needs. Medication pictograms are an alternative, but may be culturally sensitive. Previous testing has used large pictograms, which are impractical for conventional drug information formats. OBJECTIVE To compare 2 sets of pictograms for instructions or warnings (from the US and South Africa) for understandability by adults in the UK and examine the effects of pictogram size and repeat presentation on understandability among older adults. METHODS In the first part of the study, 160 adults (aged 17–83 y) reviewed and interpreted 10 pictograms. In the second, 67 older adults (aged 65–96 y) were randomly assigned to review 10 small or large pictograms. After giving their interpretation, they were informed of the correct meaning. One week later, they were shown the same pictograms and gave their interpretation. RESULTS The pictograms for the 10 different instructions and warnings showed great variation in interpretation rates (7.5–90%), with few significant differences between the US and South African versions. Only 3 were understood by ≥85% of the population. Pictograms performed significantly better if they were larger and at the second presentation. CONCLUSIONS Pictograms have the potential to help patients understand information on drug therapy. This study shows that some existing pictograms are not easily interpreted and that testing is needed before their implementation. A reduction in their size to allow incorporation into conventional written formats may cause additional problems for patients.

The ‘malnutrition universal screening tool’ (‘MUST’) for adults has been developed for all health care settings and patient groups, but ease of use and agreement with other published tools when screening to identify malnutrition requires investigation. The present study assessed the agreement and the prevalence of malnutrition risk between ‘MUST’ and a variety of other tools in the same patients and compared the ease of using these tools. Groups of patients were consecutively screened using ‘MUST’ and: (1) MEREC Bulletin (MEREC) and Hickson and Hill (HH) tools (fifty gastroenterology outpatients); (2) nutrition risk score (NRS) and malnutrition screening tool (MST; seventy-five medical inpatients); (3) short-form mini nutritional assessment (MNA-tool; eighty-six elderly and eighty-five surgical inpatients); (4) subjective global assessment (SGA; fifty medical inpatients); (5) Doyle undernutrition risk score (URS; fifty-two surgical inpatients). Using ‘MUST’, the prevalence of malnutrition risk ranged from 19–60% in inpatients and 30% in outpatients. ‘MUST’ had ‘excellent’ agreement (κ 0.775–0.893) with MEREC, NRS and SGA tools, ‘fair–good’ agreement (κ 0.551–0.711) with HH, MST and MNA-tool tools and ‘poor’ agreement with the URS tool (κ 0.255). When categorisation of malnutrition risk differed between tools, it did not do so systematically, except between ‘MUST’ and MNA-tool (P=0.0005) and URS (P=0.039). ‘MUST’ and MST were the easiest, quickest tools to complete (3–5 min). The present investigation suggested a high prevalence of malnutrition in hospital inpatients and outpatients (19–60% with ‘MUST’) and ‘fair–good’ to ‘excellent’ agreement beyond chance between ‘MUST’ and most other tools studied. ‘MUST’ was quick and easy to use in these patient groups.

Importance Novel approaches to care delivery that leverage clinical and community resources could improve body mass index (BMI) and family-centered outcomes. Objective To examine the extent to which 2 clinical-community interventions improved child BMI z score and health-related quality of life, as well as parental resource empowerment in the Connect for Health Trial. Design, Setting, and Participants This 2-arm, blinded, randomized clinical trial was conducted from June 2014 through March 2016, with measures at baseline and 1 year after randomization. This intent-to-treat analysis included 721 children ages 2 to 12 years with BMI in the 85th or greater percentile from 6 primary care practices in Massachusetts. Interventions Children were randomized to 1 of 2 arms: (1) enhanced primary care (eg, flagging of children with BMI ≥ 85th percentile, clinical decision support tools for pediatric weight management, parent educational materials, a Neighborhood Resource Guide, and monthly text messages) or (2) enhanced primary care plus contextually tailored, individual health coaching (twice-weekly text messages and telephone or video contacts every other month) to support behavior change and linkage of families to neighborhood resources. Main Outcomes and Measures One-year changes in age- and sex-specific BMI z score, child health-related quality of life measured by the Pediatric Quality of Life 4.0, and parental resource empowerment. Results At 1 year, we obtained BMI z scores from 664 children (92%) and family-centered outcomes from 657 parents (91%). The baseline mean (SD) age was 8.0 (3.0) years; 35% were white (n = 252), 33.3% were black (n = 240), 21.8% were Hispanic (n = 157), and 9.9% were of another race/ethnicity (n = 71). In the enhanced primary care group, adjusted mean (SD) BMI z score was 1.91 (0.56) at baseline and 1.85 (0.58) at 1 year, an improvement of −0.06 BMI z score units (95% CI, −0.10 to −0.02) from baseline to 1 year. In the enhanced primary care plus coaching group, the adjusted mean (SD) BMI z score was 1.87 (0.56) at baseline and 1.79 (0.58) at 1 year, an improvement of −0.09 BMI z score units (95% CI, −0.13 to −0.05). However, there was no significant difference between the 2 intervention arms (difference, −0.02; 95% CI, −0.08 to 0.03; P = .39). Both intervention arms led to improved parental resource empowerment: 0.29 units (95% CI, 0.22 to 0.35) higher in the enhanced primary care group and 0.22 units (95% CI, 0.15 to 0.28) higher in the enhanced primary care plus coaching group. Parents in the enhanced primary care plus coaching group, but not in the enhanced care alone group, reported improvements in their child’s health-related quality of life (1.53 units; 95% CI, 0.51 to 2.56). However, there were no significant differences between the intervention arms in either parental resource empowerment (0.07 units; 95% CI, −0.02 to 0.16) or child health-related quality of life (0.89 units; 95% CI, −0.56 to 2.33). Conclusions and Relevance Two interventions that included a package of high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child BMI. Trial Registration clinicaltrials.gov Identifier:NCT02124460

Diagnosis of bladder cancer relies on investigation of symptoms presented to primary care, notably visible haematuria. The importance of non-visible haematuria has never been estimated.To estimate the risk of bladder cancer with non-visible haematuria.A case-control study using UK electronic primary care medical records, including uncoded data to supplement coded records.A total of 4915 patients (aged ≥40 years) diagnosed with bladder cancer between January 2000 and December 2009 were selected from the Clinical Practice Research Datalink and matched to 21 718 controls for age, sex, and practice. Variables for visible and non-visible haematuria were derived from coded and uncoded data. Analyses used multivariable conditional logistic regression, followed by estimation of positive predictive values (PPVs) for bladder cancer using Bayes' theorem.Non-visible haematuria (coded/uncoded data) was independently associated with bladder cancer: odds ratio (OR) 20 (95% confidence interval [CI] =12 to 33). The PPV of non-visible haematuria was 1.6% (95% CI = 1.2 to 2.1) in those aged ≥60 years and 0.8% (95% CI = 0.1 to 5.6) in 40-59-year-olds. The PPV of visible haematuria was 2.8% (95% CI = 2.5 to 3.1) and 1.2% (95% CI = 0.6 to 2.3) for the same age groups respectively, lower than those calculated using coded data alone. The proportion of records of visible haematuria in coded, rather than uncoded, format was higher in cases than in controls (P0.002, χ(2) test). There was no evidence for such differential recording of non-visible haematuria by case/control status (P = 0.78), although, overall, the uncoded format was preferred (P0.001).Both non-visible and visible haematuria are associated with bladder cancer, although the visible form confers nearly twice the risk of cancer compared with the non-visible form. GPs' style of record keeping varies by symptom and possible diagnosis.

Energy and Economic Impacts of U.S. Federal Energy and Water Conservation Standards Adopted From 1987 Through 2013 Principal Authors Stephen Meyers, Alison Williams and Peter Chan Environmental Energy Technologies Division Project Contributors Greg Rosenquist, Helcio Blum, Barbara Atkinson, Sanaee Iyama, Jie Gu, Maithili Iyer, Sarah Price Environmental Energy Technologies Division One Cyclotron Road Berkeley, CA 94720 June 2014 The work described in this report was funded by the U.S. Department of Energy’s Office of Energy Efficiency and Renewable Energy, Building Technologies Program under Contract No. DE-AC02- 05CH11231.

Background: Despite the increasing popularity of acupuncture, there remains uncertainty as to its effectiveness and how it brings about change. Particular questions are posed over whether acupuncture research has sufficient model validity and reflects acupuncture as practised. Exploring traditional acupuncture (TA) in practice should help to expose processes essential to the theory of TA. The aim of this study was to examine what TA practitioners aim to achieve, their rationale and how they follow this through in their practice. Methods: A longitudinal study of TA for women with early breast cancer (EBC) was performed. Study participants comprised 14 women with EBC and two experienced TA practitioners, all taking part in in-depth interviews, conducted before and after receipt of up to 10 treatment sessions, and analysed using grounded theory methods. Additional data came from practitioner treatment logs and diaries. Results: Practitioners sought long-term goals of increasing strength and enabling coping as well as immediate relief of symptoms. They achieved this through a continuous process of treatment, following through the recursive and individualized nature of TA and adjusted, via differential diagnosis, to the rapidly fluctuating circumstances of individual women. Establishing trust and good rapport with the women aided disclosure which was seen as essential in order to clarify goals during chemotherapy. This process was carefully managed by the practitioners and the resultant therapeutic relationship was highly valued by the women. Conclusion: This study provided insight into the interdependent components of TA helping to demonstrate the multiple causal pathways to change through the continuous process of new information, insights and treatment changes. A good therapeutic relationship was not simply something valued by patients but explicitly used by practitioners to aid disclosure which in turn affected details of the treatment. The therapeutic relationship was therefore a vital and integral part of the treatment process.

To evaluate the High Five for Kids intervention effect on television within subgroups, examine participant characteristics associated with process measures and assess perceived helpfulness of television intervention components.High Five (randomized controlled trial of 445 overweight/obese 2-7 year-olds in Massachusetts [2006-2008]) reduced television by 0.36 h/day. 1-year effects on television viewing, stratified by subgroup, were assessed using linear regression. Among intervention participants (n=253), associations of intervention component helpfulness with television reduction were examined using linear regression and associations of participant characteristics with processes linked to television reduction (choosing television and completing intervention visits) were examined using logistic regression.High Five reduced television across subgroups. Parents of Latino (versus white) children had lower odds of completing ≥2 study visits (Odds Ratio: 0.39 [95% Confidence Interval: 0.18, 0.84]). Parents of black (versus white) children had higher odds of choosing television (Odds Ratio: 2.23 [95% Confidence Interval: 1.08, 4.59]), as did parents of obese (versus overweight) children and children watching ≥2 h/day (versus2) at baseline. Greater perceived helpfulness was associated with greater television reduction.Clinic-based motivational interviewing reduces television viewing in children. Low cost education approaches (e.g., printed materials) may be well-received. Parents of children at higher obesity risk could be more motivated to reduce television.

Community structures and dynamics played a large part in determining the success of radical movements in certain localities in the early I9th century. Taking the case of Oldham, a textile town in south-east Lancashire, this article argues that to understand fully how radicalism worked it is necessary to look in detail at how local community processes, particularly the bodies of local government, worked in practice and over time.

BackgroundText messaging (short message service, SMS) is a widely accessible and potentially cost-effective medium for encouraging behavior change. Few studies have examined text messaging interventions to influence child health behaviors or explored parental perceptions of mobile technologies to support behavior change among children. ObjectiveOur aim was to examine parental acceptability and preferences for text messaging to support pediatric obesity-related behavior change. MethodsWe conducted focus groups and follow-up interviews with parents of overweight and obese children, aged 6-12 years, seen for “well-child” care in eastern Massachusetts. A professional moderator used a semistructured discussion guide and sample text messages to catalyze group discussions. Seven participants then received 3 weeks of text messages before a follow-up one-on-one telephone interview. All focus groups and interviews were recorded and transcribed verbatim. Using a framework analysis approach, we systematically coded and analyzed group and interview data to identify salient and convergent themes. ResultsWe reached thematic saturation after five focus groups and seven follow-up interviews with a total of 31 parents of diverse race/ethnicity and education levels. Parents were generally enthusiastic about receiving text messages to support healthy behaviors for their children and preferred them to paper or email communication because they are brief and difficult to ignore. Participants anticipated high responsiveness to messaging endorsed by their child’s doctor and indicated they would appreciate messages 2-3 times/week or more as long as content remains relevant. Suggestions for maintaining message relevance included providing specific strategies for implementation and personalizing information. Most felt the negative features of text messaging (eg, limited message size) could be overcome by providing links within messages to other media including email or websites. ConclusionsText messaging is a promising medium for supporting pediatric obesity-related behavior change. Parent perspectives could assist in the design of text-based interventions. Trial RegistrationClinicaltrials.gov NCT01565161; http://clinicaltrials.gov/show/NCT01565161 (Archived by WebCite at http://www.webcitation.org/6LSaqFyPP).

Field-Monitoring of Whole-Home Dehumidifiers: Initial Results of a Pilot Study Henry Willem, Camilla Dunham Whitehead, Chun Chun Ni, Venessa Tavares, Thomas Alan Burke, Moya Melody, and Sarah Price Energy Analysis and Environmental Impacts Department Environmental Energy Technologies Division Lawrence Berkeley National Laboratory Berkeley, CA 94720 November 2013 This work was supported by the Assistant Secretary for Energy Efficiency and Renewable Energy, Office of Building Technology, State, and Community Programs, of the U.S. Department of Energy under Contract No. DE-AC02-05CH11231 .

LBNL-6469E Using Field-Metered Data to Quantify Annual Energy Use of Residential Portable Unit Dehumidifiers Henry Willem, Thomas Alan Burke, Camilla Dunham Whitehead, Bereket Beraki, Jim Lutz, Moya Melody, Mythri Nagaraju, Chun Chun Ni, Stacy Pratt, Sarah Price, and Venessa Tavares Energy Analysis and Environmental Impacts Department Environmental Energy Technologies Division Lawrence Berkeley National Laboratory Berkeley, CA 94720 November 2013 T his work was supported by the Assistant Secretary for Energy Efficiency and Renewable Energy, Office of Building Technology, State, and Community Programs, of the U.S. Department of Energy under Contract No. DE-AC02-05CH11231.

This study aimed to investigate the influence of an attribution training program for learners who attribute their sport performance to dysfunctional attributions. Participants were 35 college beginner tennis players who were oriented to attribute their performance in a tennis skill task to controllable, unstable factors; uncontrollable, stable factors; or no specific factors. Participants received fictitious failure feedback over 10 trial blocks administered during four sessions. Dependent variables included attributions, expectations, emotions, persistence, and performance. MANOVA analyses revealed that it is possible to modify attributions in regard to a tennis performance task. More importantly, the new attributions were consistent up to 3 weeks postintervention and were generalized to a different tennis task. In addition, participants who changed their attributions to more functional ones had higher expectations for future success and experienced positive emotions.

The Cost of Enforcing Building Energy Codes: Phase 1 Alison Williams, Ed Vine, Sarah Price, Andrew Sturges, Greg Rosenquist Energy Analysis and Environmental Impacts Department Environmental Energy Technologies Division Lawrence Berkeley National Laboratory Berkeley, CA 94720 April 2013 This work was supported by the Assistant Secretary for Energy Efficiency and Renewable Energy, Office of Building Technology, State and Community Programs, of the U.S. Department of Energy under Contract No. DE-AC03-76SF00098.

Objective To examine the extent to which an intervention using electronic decision support delivered to pediatricians at the point-of-care of obese children, with or without direct-to-parent outreach, improved health care quality measures for child obesity. Design and Methods Process outcomes from a three-arm, cluster-randomized trial from 14 pediatric practices in Massachusetts were reported. Participants were 549 children aged 6-12 years with body mass index (BMI) ≥ 95th percentile. In five practices (Intervention-1), pediatricians receive electronic decision support at the point-of-care. In five other practices (Intervention-2), pediatricians receive point-of-care decision support and parents receive information about their child's prior BMI before their scheduled visit. Four practices receive usual care. The main outcomes were Healthcare Effectiveness Data and Information Set (HEDIS) performance measures for child obesity: documentation of BMI percentile and use of counseling codes for nutrition or physical activity. Results Compared to the usual care condition, participants in Intervention-2, but not Intervention-1, had substantially higher odds of use of HEDIS codes for BMI percentile documentation (adjusted OR: 3.97; 95% CI: 1.92, 8.23) and higher prevalence of use of HEDIS codes for counseling for nutrition or physical activity (adjusted predicted prevalence 20.3% [95% CI 8.5, 41.2] for Intervention −2 vs. 0.0% [0.0, 2.0] for usual care). Conclusion An intervention that included both decision support for clinicians and outreach to parents resulted in improved health care quality measures for child obesity.

The authors, representing community practitioners, faculty, students, and administration, collaborated to produce guidelines for university-community partnerships that reflect social work’s commitment to social justice in practice, education, and research. The respective experiences and voices of the authors contribute to a wider perspective on the explicit social justice implications of partnership formation for community-based participatory research, which is a vision shared by many disciplines. These guidelines introduce a communication outline that may augment the creation and maintenance of thriving university-community partnerships across multiple disciplines that promote social justice.