Search

Community Health Workers (CHWs) have shown value in diabetes care. CHWs are often the individuals who provide behavioral lifestyle intervention to underserved communities and are often the first to assist patients in gaining appropriate access to care. As trusted members of their communities, they have the ability to significantly impact psychosocial and biomedical outcomes, making them important members of the behavioral medicine team. However, lack of recognition of CHWs within multidisciplinary teams (MDTs) gives rise to the issue of the underutilization of their services. Therefore, barriers to including CHWs in MDTs including standardized training and strategies to overcome these are discussed.

The SARS-Cov-2 pandemic changed many contemporary experiences, including how healthcare and exercise programming are delivered. As a result of the pandemic, there was an increase in virtual services and programming and there continues to be a demand for virtual options. The results from Desir et al support the use of virtual visits to successfully change lifestyle factors, specifically nutrition and physical activity. The use of individualized dietary and exercise goals were important to the success of the intervention, and should not be disregarded. As virtual healthcare and exercise continues to evolve, to maximize behavior change, we should also consider how to include the social and community aspects of exercise. Regardless, it is encouraging to see that significant advances are being made in virtual programming and that the needed engagement can occur in a virtual setting.

Pregnancy is a unique time when health care providers have more regular contact with women. Using this time to more fully understand the social influences at play can provide physicians an opportunity to leverage networks to improve health and wellbeing while stemming the exposure to health misinformation. Advocating for supportive social networks or exercise groups/programs can provide additional support and behavioral reinforcement which is needed for sustained behavior change. In this manner, fostering these networks is likely more beneficial to supporting healthy exercise behavior during pregnancy than education alone.

Resolving thermodynamic transport in three-dimensional models of stratified coronal loops is a long-standing challenge that limits progress in solving the coronal heating problem.Since three-dimensional thermal conduction in MHD has been computationally too expensive to resolve the steep temperature gradients in the transition region, two simpler approaches have been adopted: one-dimensional, field-aligned models following the thermal response to imposed forms of heating, and three-dimensional MHD models that produce the forms of Ohmic and viscous heating self-consistently but cannot consider the consequent thermodynamic response.Now, using a novel numerical technique, TRAC, we can resolve energetic transport in the transition region in fully three-dimensional MHD models.In a model of a multi-stranded coronal loop in a curved arcade, we investigate the heating produced in an 'avalanche'-like process.In such, a chain reaction of reconnection-induced local events occurs, with each event disturbing wider plasma and triggering other processes, such as shocks, jets, and turbulence, that generate heating, which we analyse with particular attention to the spatio-temporal distribution of nanoflares.At the same time, we treat the thermodynamic response of the plasma self-consistently, and study the evolving temperature profiles.Avalanches successfully propagate in curved arcades and appear capable of maintaining a hot corona with realistic temperatures and densities in heated loops.One novelty of interest lies in `campfire'-like events, with simultaneous reconnection events at disjoint sites along coronal strands, akin to recent results from Solar Orbiter.

Background/objective Maintenance interventions inherently require BMI improvement to maintain. This overlooks individuals initially unresponsive to obesity interventions. Staged pediatric clinical treatment guidelines were adapted to the school setting to develop an escalated treatment option for individuals initially unresponsive. This staged randomized controlled trial examined differences between escalated treatment (Take CHARGE!) and a maintenance program (PE Planners). Take CHARGE was hypothesized to have greater improvements in BMI as a percentage of the 95th BMI Percentile (%BMIp95) than PE Planners. Subjects/methods From 2018 to 2020, 171 middle and high schoolers (BMI Percentile ≥ 85) were recruited from a Houston school district to participate in a staged obesity intervention in their physical education (PE) class. After receiving a semester-long intensive lifestyle intervention (ILI) with established efficacy, all participants were randomized to Take CHARGE (n = 85) or PE Planners (n = 86). Take CHARGE escalated the behavioral treatment of obesity received in ILI with more frequent individual sessions, additional opportunities for parental and school staff involvement, and increased mentorship from trained college students. PE Planners allowed participants to decide how they wanted to be active in PE class. Mixed linear modeling examined %BMIp95 overtime between groups. This trial was registered at ClinicalTrials.gov (#NCT04362280). Results Participants were 13.63 ± 1.32 years old; 59% were female, and 85% were Hispanic. Among those initially unresponsive to ILI, Take CHARGE had significantly greater decreases in %BMIp95 than PE Planners (β = −0.01, p

Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school-based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school-based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school-based setting, weight-based outcomes (e.g., BMI, BMI z-score), weight-based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z-score, decrease in BMI z-score ≥0.10, and decrease in BMI z-score ≥0.20. Few school-based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked.

Funding: JR acknowledges the support of the Carnegie Trust for the Universities of Scotland. JR and AWH acknowledge the financial support of STFC through the Consolidated grant, ST/S000402/1, to the University of St Andrews. AWH acknowledges support from ERC Synergy grant ‘The Whole Sun’ (810218). CDJ acknowledges funding from the European Research Council (ERC) under grant agreement No. 647214. A ‘proof of principle’ is presented, whereby the Ohmic and viscous heating determined by a three-dimensional (3D) MHD model of a coronal avalanche are used as the coronal heating input for a series of field-aligned, one-dimensional (1D) hydrodynamic models. Three-dimensional coronal MHD models require large computational resources. For current numerical parameters, it is difficult to model both the magnetic field evolution and the energy transport along field lines for coronal temperatures much hotter than 1MK⁠, because of severe constraints on the time step from parallel thermal conduction. Using the 3D MHD heating derived from a simulation and evaluated on a single field line, the 1D models give coronal temperatures of 1MK and densities 1014--1015m−3 for a coronal loop length of 80Mm⁠. While the temperatures and densities vary smoothly along the field lines, the heating function leads to strong asymmetries in the plasma flows. The magnitudes of the velocities in the 1D model are comparable with those seen in 3D reconnection jets in our earlier work. Advantages and drawbacks of this approach for coronal modelling are discussed. Publisher PDF

INTRODUCTION The objective of this study was to develop and validate a questionnaire to better understand barriers and facilitators to physical activity among low-income, Hispanic youth. METHODS Low-income Hispanic middle and high school students were recruited to participate in this study from a public charter school district in Houston, TX. Questionnaire development and psychometric validation included scale development and question pretesting, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), construct validity, and test-retest reliability of the scales. RESULTS EFA resulted in three subscales for the Barriers to Youth Physical Activity (BYPA) scale: competing interests, environmental interests, and social barriers. CFA suggested that this three-factor model fit data adequately after removing two items that had high loading on all three factors. The BYPA subscales were internally consistent and stable. All three BYPA subscale scores were negatively correlated with self-reported physical activity. EFA for the facilitators to youth physical activity (FYPA) scale resulted in three subscales: enjoyment, family support, and socialization. CFA suggested that this three-factor model fit data adequately after removing one item that had high loading on all three factors. The FYPA subscales were internally consistent and stable. All three FYPA subscale scores were significantly positively correlated with physical activity. CONCLUSIONS The development and validation of the BYPA and FYPA scales resulted in a total of six valid subscales for assessing barriers and facilitators to physical activity among low-income, Hispanic youth. The developed subscales have the potential to assist future efforts in designing physical activity interventions to better address disparities in physical activity levels among this population.

BACKGROUND Moderate-to-vigorous physical activity (MVPA) declines during adolescence, particularly among girls. In this randomized control trial, we examined MVPA in a physical activity intervention compared to physical education (PE) class as usual (TAU), stratified by sex and weight classification. Standardized BMI (zBMI) overtime was also examined. METHODS Hispanic-American middle school students (N = 193) were recruited from a school district in Houston, Texas. Participants were randomized to either a circuit-based physical activity intervention or TAU (PE class as usual). MVPA was assessed using accelerometry at baseline and 6 months. Repeated measures ANCOVA were conducted to examine changes in MVPA, overall and stratified by sex and weight classification. This procedure was repeated for zBMI. RESULTS Participants were 12.10 ± 0.63 years old and 53% were girls. Overall those in intervention increased weekday MVPA more than TAU (F(1,190) = 7.03, p

Despite considerable evidence that plant-based diets can significantly improve health, medical professionals seldom discuss this with their patients. This issue might occur due to minimal training received in medical education, lack of time, and low self-efficacy for counseling patients about diet. Nutrition and lifestyle change should be considered a core competency for all physicians and health professionals looking for cost-effective ways to improve patient health outcomes and reduce nutrition-related chronic diseases. Strategies for health professionals to acquire nutrition counseling skills in medical training and clinical practices are discussed.

Background: The value of telemedicine has been underscored during the coronavirus pandemic. Utilizing telemedicine could markedly enhance group visit scalability and sustainability. However, there are limited data demonstrating telemedicine use for group visits. Objective: To evaluate the feasibility and acceptability of provider encounters conducted via telemedicine in group visits. Materials and Methods: We conducted a 6-month diabetes group visit program and compared in-person (months 1-3) versus telemedicine (videoconferencing) (months 4-6) patient-provider encounters. Participants completed the Telehealth Usability Questionnaire (TUQ) at 6-months (primary outcome). To ensure telemedicine did not negatively affect clinical outcomes, we compared in-person versus telemedicine differences in HbA1c, blood pressure, body mass index (BMI), and attendance. Results: The TUQ revealed that participants (N=19) found telemedicine useful and easy to use (4.9/5.0, 4.4/5.0, respectively) and with excellent interface (4.3/5.0), interaction (4.6/5.0), reliability (4.2/5.0), and satisfaction (4.4/5.0). There were no significant differences in clinical outcomes between arms: HbA1c (in-person: -0.60%, telemedicine: -0.52%, p=0.86), blood pressure (systolic: p=0.475, diastolic: p=0.683), weight (p=0.982), BMI (p=0.981), attendance (in-person: 75.44%, telemedicine: 70.12%, p=0.551). Conclusion: Provider telemedicine encounters in group visits are feasible and acceptable. This is a promising model to address provider limitations in group visits and increase access to care. Larger studies are needed to further evaluate these findings.

Objective To develop a childhood obesity prevention program, Food, Feeding and Your Family (FFYF), which encourages eating self-regulation in young children. This article describes the research methods for FFYF. Activities that will be used to guide the development of the program are illustrated in a logic model. Design A randomized control trial will be conducted with participant groups randomized into 1 of 3 conditions: (1) in-class delivery of feeding content and nutrition education, (2) online delivery of feeding content and in-class delivery of nutrition education, and (3) nutrition education only. Assessments will be collected at baseline, program completion, and 6 and 12 months after completion of the program. Setting Study will be conducted through the Expanded Food and Nutrition Education Program in Colorado and Washington State. Participants Parents with 2- to 8-year-old children will be recruited from affiliated community agencies, 540 participants across both states. Interventions FFYF derives content from an empirically validated parental feeding program, Strategies for Effective Eating Development, and will be administered with Eating Smart • Being Active, an evidence-based, nutrition education curriculum. Main Outcome Measures Parents will report on feeding practices, child eating behaviors, feeding styles, and acculturation. Analysis Because of the nested nature of the data, multilevel analyses will be used: time points, within parents, and within groups.

Mental health is a critical component of overall well-being and exists on a continuum much like physical health. Although many ways to assess mental health exist outside of either having a disorder or not, practitioners often rely on the presence or absence of symptomatology. The assessment and promotion of emotional regulation in patients is one way to encourage individuals to engage in mental health-promoting behaviors. Specific techniques are discussed that address emotional regulation. Overall, providing patients with the tools to regulate emotional responding will likely have a direct impact on well-being as well as reduce MH symptomology.

Fear of falling is a critical component in fall prevention approaches; however, it is often overlooked in the majority of fall prevention exercises. Alternative fall prevention approaches that take fear of falling into account are necessary. This article discusses fall prevention activities that are feasible for individuals with limited mobility who have an increased fear of falling. Health care providers should consider the degree to which a patient has a fear of falling and recommend activities that fit most to their patient’s comfort level.

Background Indices of multimorbidity and deficit accumulation (ie, frailty indices) have been proposed as markers of biological aging. If true, changes in these indices over time should predict downstream changes in cognition and physical function, and mortality. Methods We examined associations that 8-year changes in (i) a multimorbidity index comprised of 9 chronic diseases and (ii) a frailty index (FI) based on deficit accumulation in functional, behavioral, and clinical characteristics had with subsequent measures of cognitive and physical function over 10 years. We drew data from 3 842 participants in the Action for Health in Diabetes clinical trial. They were aged 45–76 years at baseline and at risk for accelerated biological aging due to overweight/obesity and type 2 diabetes mellitus. Results A total of 1 501 (39%) of the cohort had 8-year increases of 1 among the 9 diseases tracked in the multimorbidity index and 868 (23%) had increases of ≥2. Those with greatest increases in multimorbidity tended to be older individuals, males, and non-Hispanic Whites. Greater FI increases tended to occur among individuals who were older, non-Hispanic White, heavier, and who had more baseline morbidities. Changes in multimorbidity and FI were moderately correlated (r = 0.26; p < .001). Increases in both multimorbidity and FI were associated with subsequently poorer composite cognitive function and 400-m walk speed and increased risk for death (all p < .001). Conclusions Accelerated biological aging, as captured by multimorbidity and frailty indices, predicts subsequent reduced function and mortality. Whether intensive lifestyle interventions generally targeting multimorbidity and FI reduce risks for downstream outcomes remains to be seen. Clinical Trials Registration Number: NCT00017953

Background: While children have been shown to have increased BMI during the summer compared to the school year, it is not known if this may be due to seasonal variations in height or weight separately.Methods: Trained nurses measured heights (cm) and weights (kg) in a cohort of Kindergarteners (n = 7648) twice per year from the beginning of kindergarten through 5th grade. Variation in height and weight by season (school year vs. summer) was examined using separate mixed-effects models. Season, sex, and BMI trajectory group were tested as fixed effects. Random effects included repeated measurements of time, students nested within a school, intercept, and slope for growth over time. Similar models using BMIz as the outcome examined the interaction of height or weight with season.Results: The rate of height gain was greater during the school year (∼Sept to April) compared to summer (∼April to Sept) (β = -0.05, SE = 0.013, p < 0.0001). The rate of weight gain did not differ seasonally. Height gain was more strongly associated with increased BMIz during summer compared to the school year (β =.02, SE = 0.005, p p < 0.0001) and those who transitioned to a healthier weight status (β = 0.026, SE = 0.008, p = 0.004). We found a similar seasonal effect for the association between weight with BMIz among children who maintained a healthy weight status (β = 0.014, SE = 0.014, p < 0.0001).Conclusion: This study indicates seasonality in children’s height gain, gaining height at a faster rate during the school year compared to the summer, while weight gain remained relatively more consistent throughout the year. Seasonality in height and weight gain had the greatest impact on BMIz among children with a healthy weight status. Future research with more frequent measurements is needed to better understand the seasonal regulation of children’s growth and weight gain.

IntroductionCommunity clinics often face pragmatic barriers, hindering program initiation and replication of controlled research trial results. Mentoring is a potential strategy to overcome these barriers. We piloted an in-person and telehealth mentoring strategy to implement the Telehealth-supported, Integrated Community Health Workers (CHWs), Medication-access, group visit Education (TIME) program in a community clinic.Research design and methodsParticipants (n=55) were low-income Latino(a)s with type 2 diabetes. The study occurred in two, 6-month phases. Phase I provided proof-of-concept and an observational experience for the clinic team; participants (n=37) were randomized to the intervention (TIME) or control (usual care), and the research team conducted TIME while the clinic team observed. Phase II provided mentorship to implement TIME, and the research team mentored the clinic team as they conducted TIME for a new single-arm cohort of participants (n=18) with no previous exposure to the program. Analyses included baseline to 6-month comparisons of diabetes outcomes (primary outcome: hemoglobin A1c (HbA1c)): phase I intervention versus control, phase II (within group), and research-run (phase I intervention) versus clinic-run (phase II) arms. We also evaluated baseline to 6-month CHW knowledge changes.ResultsPhase I: compared with the control, intervention participants had superior baseline to 6-month improvements for HbA1c (mean change: intervention: −0.73% vs control: 0.08%, p=0.016), weight (p=0.044), target HbA1c (p=0.035), hypoglycemia (p=0.021), medication non-adherence (p=0.0003), and five of six American Diabetes Association (ADA) measures (pConclusionsA novel, mentored approach to implement TIME into a community clinic resulted in improved diabetes outcomes. Larger studies of longer duration are needed to fully evaluate the potential of mentoring community clinics.

We thank EPSRC (UK) for a DTA studentship for C.A.J. The bioactive natural product perophoramidine has proved a challenging synthetic target. An alternative route to its indolo[2,3-b]quinolone core structure involving an N-chlorosuccinimde mediated intramolecular cylization reaction is reported. Attempts to progress towards the natural product are also discussed with an unexpected deep-seated rearrangement of the core structure occurring during an attempted iodoetherification reaction. X-ray crystallographic analysis provides important analytical confirmation of assigned structures. Publisher PDF

This study evaluated the feasibility and effects of the Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup on toddler (12–36-month-old) diet and activity behaviors. Parent–toddler dyads were recruited from disadvantaged communities and randomly assigned to receive 10-weekly sessions of the FUNPALs Playgroup (n = 24) or dose-matched health education control group (n = 26). FUNPALs Playgroups involved physical and snack activities, delivery of health information, and positive parenting coaching. The control group involved group health education for parents only. Process outcomes (e.g., retention rate, fidelity) and focus groups determined feasibility and perceived effects. To evaluate preliminary effects, validated measures of toddler diet (food frequency questionnaire and a carotenoid biomarker), physical activity (PA, accelerometers), general and feeding parenting (self-report surveys), and home environment (phone interview) were collected pre and post. The sample comprised parents (84% female) who self-identified as Hispanic/Latino (38%) and/or African American (32%). Retention was high (78%). Parents from both groups enjoyed the program and perceived improvements in their children’s health behaviors. Objective measures demonstrated improvement with large effects (η2 = 0.29) in toddler diet (p &lt, 0.001) but not PA (p = 0.099). In conclusion, the FUNPALs Playgroup is feasible and may improve toddler eating behaviors.

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

Carbon prices are used to induce forest managers to adopt longer rotation periods, leading to higher carbon sequestration in the ecosystem and storage in harvested wood products. However, national ...

The use of screen media has significantly increased and several lifestyle consequences have occurred following this change. Screen media exposure is more common among younger age children. Multiple factors may be the reason for this; however, their use is likely reinforced. Parents seek support from screen media devices, which can help calm and occupy their children in a matter of minutes. However, resorting to electronic devices for instant relief is likely to persist due to both negative and positive reinforcement. Reinforcing screen media in this way will make the use of screen devices inextricable for parents and their children. Explaining the issue clearly and coming up with feasible solutions will help minimize the negative health effects of prolonged screen use, the general desirability of screen media devices, and also improve (and increase) healthy screen time habits in children.

From Source to Sink: Past Changes and Model Projections of Carbon Sequestration in the Global Forest Sector

Developing Detailed Shared Socioeconomic Pathway (SSP) Narratives for the Global Forest Sector

This study examines how natural disturbance can adversely affect the carbon sequestration potential of the forest, and the potential contribution that genomics might make towards offsetting these impacts when carbon is priced. A stochastic dynamic programming model of the BC interior, which includes a detailed carbon accounting module, shows that harvests are delayed as carbon prices rise, with less carbon stored in harvested wood products and more in the forest ecosystem, but an increase in the risk of natural disturbance causes the landowner to harvest sooner. As natural disturbance increases in prevalence and severity, this will somewhat offset the lengthening of rotation age that occurs when carbon is priced. With disturbance, the total amount of carbon sequestered falls significantly, but some of this can be recovered through proactive planting of genetically modified (GM) stems that are more productive and less susceptible to disturbance. To make such an investment worthwhile, however, the costs of planting GM stock should not exceed $120–$150/ha. Finally, this study suggests that a modest price of carbon (somewhat less than $25/tCO2) can be an effective incentive to encourage land owners to reduce the rotation age brought about by disturbance, and generate additional carbon offsets.

Carbon stored in harvested wood products (HWPs) can affect national greenhouse gas (GHG) inventories, in which the production and end use of HWPs play a key role. The Intergovernmental Panel on Climate Change (IPCC) provides guidance on HWP carbon accounting, which is sensitive to future developments of socioeconomic factors including population, income, and trade. We estimated the carbon stored within HWPs from 1961 to 2065 for 180 countries following IPCC carbon-accounting guidelines, consistent with Food and Agriculture Organization of the United Nations (FAOSTAT) historical data and plausible futures outlined by the shared socioeconomic pathways. We found that the global HWP pool was a net annual sink of 335 Mt of CO(2) equivalent (CO(2)e)⋅y(−1) in 2015, offsetting substantial amounts of industrial processes within some countries, and as much as 441 Mt of CO(2)e⋅y(−1) by 2030 under certain socioeconomic developments. Furthermore, there is a considerable sequestration gap (71 Mt of CO(2)e⋅y(−1) of unaccounted carbon storage in 2015 and 120 Mt of CO(2)e⋅y(−1) by 2065) under current IPCC Good Practice Guidance, as traded feedstock is ineligible for national GHG inventories. However, even under favorable socioeconomic conditions, and when accounting for the sequestration gap, carbon stored annually in HWPs is

We previously found that a 6-month multidimensional diabetes program, TIME (Telehealth-Supported, Integrated Community Health Workers, Medication-Access) resulted in improved clinical outcomes.To follow TIME participant clinical outcomes for 24 months PARTICIPANTS: Low-income Latino(a)s with type 2 diabetes DESIGN AND INTERVENTION: We collected post-intervention clinical data for five cohorts (n = 101, mean n = 20/cohort) who participated in TIME programs from 2018 to 2020 in Houston, Texas.We gathered HbA1c (primary outcome), weight, body mass index (BMI), and blood pressure data at baseline, 6 months (intervention end), and semiannually thereafter until 24 months after baseline to assess sustainability. We also evaluated participant loss to follow-up until 24 months.Participants decreased HbA1c levels during the intervention (p0.0001) and maintained these improvements at each timepoint from baseline to 24 months (p range:0.0001 to 0.015). Participants reduced blood pressure levels during TIME and maintained these changes at each timepoint from baseline until 18 months (systolic p range0.0001 to 0.0005, diastolic p range:0.0001 to 0.008) but not at 24 months (systolic: p = 0.065; diastolic: p = 0.85). There were no significant weight changes during TIME or post-intervention: weight (p range = 0.07 to 0.77), BMI (p range = 0.11 to 0.71). Attrition rates (loss to follow-up during the post-intervention period) were 5.9% (6 months), 24.8% (12 months), 35.6% (18 months), and 41.8% (24 months).It is possible for vulnerable populations to maintain long-term glycemic and blood pressure improvements using a multiple dimensional intervention. Attrition rates rose over time but show promise given the majority of post-intervention timepoints occurred during the COVID-19 pandemic when low-income populations were most susceptible to suboptimal healthcare access. Future studies are needed to evaluate longitudinal outcomes of diabetes interventions conducted by local clinics rather than research teams.

Medical professionals’ healthy eating and physical activity behaviors are likely to wane as other life events and everyday pressures increase. This is vital because as health behaviors decrease, the likelihood that this topic is addressed with patients also decreases. Increased training to improve health care providers’ knowledge about lifestyle behaviors may be inadequate to actually bring about a healthier lifestyle. The area of personal identity and value formation may shed light on a significant barrier in this area. Developing health care professionals who have values consistent with a healthy diet and physical activity, instead of just being informed about it, would increase the likelihood that healthy behavior changes are discussed with patients. Strategies to encourage value formation around healthy lifestyles among medical professionals are discussed.

Objective: This study examined the differential impact of Hurricane Harvey on adolescent standardized Body Mass Index (zBMI), physical activity, diet, and perceived stress. Methods: Prior to Hurricane Harvey, 175 ethnic minority adolescents were recruited from an independent school district in Houston. Height and weight were directly measured. The School Physical Activity and Nutrition Questionnaire assessed diet and physical activity. Stress was assessed with the Perceived Stress Scale. High hurricane impact was classified as at least 1 affirmative response to house damage, rescue, displacement, or going without food, water, or medicine. Repeated measures such as ANCOVA models were developed to assess differences in zBMI, physical activity, diet, and stress between the hurricane impact groups. Regression models were used to assess stress as a mediator of the hurricane impact and zBMI change relationship. Results: Students who were highly impacted by the hurricane had a greater decrease in zBMI than those less impacted from pre-hurricane to 15 weeks post-hurricane (95% CI 0.02 to 0.25, p Conclusion: The decrease in zBMI among highly impacted students warrants further monitoring. Perceived stress, immediately following the hurricane, impacted student growth months later.

Background: Diabetes is a major contributor to morbidity and mortality. Community Health Workers (CHWs) have been instrumental in improving patient outcomes. However, CHW training largely focuses on general diabetes concepts rather than medications. Providing accessible, diabetes medication training for CHWs has the potential to increase patient understanding, personalized care, and adherence, thereby improving outcomes. Objective: To evaluate the impact of a telehealth-based diabetes medication training for CHWs on patient outcomes as measured by HbA1c changes. Methods: We provided a 12-month weekly, telehealth (videoconference) medication training for CHWs who led 6-month diabetes programs for low-income Latino(a)s in community clinics. We measured participant HbA1c (primary outcome), blood pressure, and body mass index (BMI) changes. We evaluated CHW knowledge via two pre/post-tests: medication adverse events/side effects (TEST-1, months 1&ndash, 6) and dosing, titration, and emergencies (TEST-2, months 7&ndash, 12). We assessed CHW training application by their ability to identify patient, provider, and healthcare system medication barriers. Results: Participants&rsquo, (n = 55) HbA1c improved (9.0% (75 mmol/mol) to 7.8% (62 mmol/mol) (p = 0.001)). Blood pressure and BMI changes were not significant. CHWs improved their knowledge: TEST-1: 10.5-18.2/20.0 (p = 0.002), TEST-2: 10.3&ndash, 17.3/19.0 (p = 0.0019). CHWs identified 984 patients (n = 610), providers (n = 151), and healthcare systems (n = 223) medication barriers during the 12-month training. Conclusions: Providing a telehealth-based, diabetes medication training program for CHWs allowed a personalized approach to identify barriers to care at several levels, which was associated with significant participant HbA1c reductions and improved CHW knowledge. This is a promising cost-effective, culturally sensitive strategy to improve diabetes care. Larger longitudinal evaluations are needed to fully understand the impact of CHW medication training.

The mechanism of CF2 transfer from TMSCF3 ( 1 ), mediated by TBAT (2–12 mol %) or by NaI (5–20 mol %), has been investigated by in situ/stopped-flow 19F NMR spectroscopic analysis of the kinetics of alkene difluorocyclopropanation and competing TFE/c-C3F6/homologous perfluoroanion generation, 13C/2H KIEs, LFERs, CF2 transfer efficiency and selectivity, the effect of inhibitors, and density functional theory (DFT) calculations. The reactions evolve with profoundly different kinetics, undergoing autoinhibition (TBAT) or quasi-stochastic autoacceleration (NaI) and cogenerating perfluoroalkene side products. An overarching mechanism involving direct and indirect fluoride transfer from a CF3 anionoid to TMSCF3 ( 1 ) has been elucidated. It allows rationalization of why the NaI-mediated process is more effective for less-reactive alkenes and alkynes, why a large excess of TMSCF3 ( 1 ) is required in all cases, and why slow-addition protocols can be of benefit. Issues relating to exothermicity, toxicity, and scale-up are also noted. Postprint

The mechanism of CF

OBJECTIVE Early response to obesity intervention consistently predicts long-term BMI reductions. However, little is known about how changes in weight at other times in an intervention may impact long-term outcomes. This study examined the relationship between weight-related changes that occurred early and later during an intervention and the association between these changes with overall outcomes. METHODS A secondary analysis of a school-based obesity intervention with replicated efficacy among Hispanic middle school students was conducted (n = 174). Linear regression models were developed in which first and second semester changes in BMI represented as a percentage of the 95th BMI percentile (%BMIp95) were separately used to predict overall %BMIp95 outcomes. First semester changes in %BMIp95 were used to predict subsequent %BMIp95 change (i.e., second semester). RESULTS Changes in %BMIp95 during both the first and second semesters were independently associated with overall changes from baseline (e.g., at 24 months: first semester, β = 0.59, P

The increase of the prevalence of type-2 diabetes as a consequence of overweight and obesity has stimulated public health authorities worldwide to develop strategies for its risk management and prevention. Among them, a reduction on the content of sugar in sugar-sweetened foods and beverages has been suggested, which led the food industry to replace partially sucrose with food additives, such as low- and no-calorie sweeteners (LNCS). As a consequence, there has been an increase of their consumption, which has made regulatory agencies to evaluate their exposure and possible consequences. At the same time, speculations about adverse effects, such as carcinogenicity, preterm delivery and metabolic changes involving appetite, weight increase and glucose intolerance, have been published. This scenario led ILSI Brasil to organize a meeting to update scientific knowledge on the safety of LNCS and to promote discussions among academia, regulatory bodies and food industries to clarify currently controversial information. The results of this initiative are presented in this review. It is suggested that LNCS, when used according to recommendations provided by scientific committees and regulatory authorities are considered safe. Further studies are required to evaluate the current level of exposure in general population and specific ones as children.

In much of lifestyle medicine, health-related quality of life (HRQoL) is a primary focus with the assumption that symptom reduction increases quality of life (QoL) in a more global sense. Lifestyle medicine research has shown that reducing symptoms increases the likelihood that QoL is improved. However, little information is available as to the impact of interventions when they are not effective in creating the desired healthy outcomes. It is possible that some lifestyle interventions have a negative impact on QoL, especially when a patient is not “successful” in reducing their symptomatology. Considering QoL from a broader perspective as an outcome in combination with traditional health outcomes may improve provider-patient rapport and empower patients to provide feedback on treatment, which, in turn, may improve overall treatment.

Increasing physical activity (PA) is a critical issue in improving overall health. Prior attempts by public health campaigns to promote PA through health-focused messaging have faced challenges. As PA and sedentary behaviors are developed during the early childhood period (ages 0 to 5 years), this stage represents a unique opportunity for clinicians to encourage activity at the family level. Clinicians should discuss the holistic benefits of PA, including the development of social skills and relationships, motor skills that could be applicable to sports later in life, and cognitive skills that could translate to academic achievements in school. For PA to occur in children, parents should also be engaged in and model the PA behaviors, increasing the likelihood of young children learning to be physically active.