Search

BackgroundPeople of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group. ObjectiveThis study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management. MethodsEatSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning; smart food budgeting and shopping; time-saving meal strategies, healthy cooking methods, modifying recipes; and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program’s appeal. ResultsThe EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020. ConclusionsThis study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget. Trial RegistrationAustralian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 International Registered Report Identifier (IRRID)DERR1-10.2196/19488

BackgroundThere is a critical need for weight management programs that are effective, cost efficient, accessible, and acceptable to adults from diverse ethnic and socioeconomic backgrounds. mHealth (delivered via mobile phone and Internet) weight management programs have potential to address this need. To maximize the success and cost-effectiveness of such an mHealth approach it is vital to develop program content based on effective behavior change techniques, proven weight management programs, and closely aligned with participants’ needs. ObjectiveThis study aims to develop an evidence-based mHealth weight management program (Horizon) using formative research and a structured content development process. MethodsThe Horizon mHealth weight management program involved the modification of the group-based UK Weight Action Program (WAP) for delivery via short message service (SMS) and the Internet. We used an iterative development process with mixed methods entailing two phases: (1) expert input on evidence of effective programs and behavior change theory; and (2) target population input via focus group (n=20 participants), one-on-one phone interviews (n=5), and a quantitative online survey (n=120). ResultsExpert review determined that core components of a successful program should include: (1) self-monitoring of behavior; (2) prompting intention formation; (3) promoting specific goal setting; (4) providing feedback on performance; and (5) promoting review of behavioral goals. Subsequent target group input confirmed that participants liked the concept of an mHealth weight management program and expressed preferences for the program to be personalized, with immediate (prompt) and informative text messages, practical and localized physical activity and dietary information, culturally appropriate language and messages, offer social support (group activities or blogs) and weight tracking functions. Most target users expressed a preference for at least one text message per day. We present the prototype mHealth weight management program (Horizon) that aligns with those inputs. ConclusionsThe Horizon prototype described in this paper could be used as a basis for other mHealth weight management programs. The next priority will be to further develop the program and conduct a full randomized controlled trial of effectiveness.

This article presents the results of a small-scale, comparative study on the perceived impact that having students enter Mathematics competitions has on Mathematics teachers in Puerto Rico, Switzerland and the UK and on their classroom practice. The study surveyed a small number of Mathematics teachers in the three countries who teach in both public and private schools and in both rural and urban regions. The perceived advantages and disadvantages to students from taking part in competitions and to teachers who have students taking part in competitions are discussed and the findings compared across the three countries. The effect that Mathematics competitions have on the identification and development of the mathematical talent of students is considered together with the contribution of these activities to the academic environment of the classroom. For the teachers who did have students taking Mathematics competitions, the limitations of entry and the different methods in which teachers prepare or assist students to prepare for the competitions are compared between countries. Since the study is small in scale, no firm conclusions are drawn but suggestions are made as to where future, larger scale, studies might be carried out to see if the classroom experiences of all could be positively influenced by exposure to Mathematics competitions.

The relationship between phytoplankton abundances and wind forcing in upwelling systems involves a number of processes that make the relationship nonlinear in nature. In particular, although upwelling-favorable winds tend to provide nutrients for phytoplankton growth, they can also induce export of both biomass and nutrients to the open ocean through Ekman and eddy-induced transport, or dilution of populations through vertical mixing, which negatively impacts increase in biomass. These processes are essentially nonlinear and can interact antagonistically or synergistically on the overall coastal accumulation of biomass. Consequently, producers and consumers tend to decline above a certain wind threshold despite input of nutrient-enriched water. We have observed this phenomenon in an embayment off Central Chile (30°S), where almost 10 years (2000-2009) of microphytoplankton data were analyzed together with environmental variables and wind phenology. Our findings showed that abundance, species diversity and evenness of diatoms and dinoflagellates all increased post-2005 when the mean of the alongshore surface wind stress reached a maximum threshold value of 0.026 N m-2, observed at the decadal temporal variability scale. The increased abundances of diatoms and dinoflagellates post-2005 was associated with the changing phase of the Pacific Decadal Oscillation (PDO) from positive (warm) to negative (cold) phases, which was also associated with a decrease in the intra-seasonal wind activity. Both abundance and diversity of the microphytoplankton community peaked during the post-2005 period whereas higher abundances and frequency of harmful algal blooms (e.g. Pseudo-nitzschia australis) were observed prior to 2005. We suggest that the low-frequency (decadal) variations of mean wind stress during a transition phase of the PDO combined with the reduction in intra-seasonal (periods shorter than 2 months) wind variability after 2005 provided an "optimal environmental window" for the ecosystem. [ABSTRACT FROM AUTHOR]

Purpose Guidelines are limited for genetic testing for prostate cancer (PCA). The goal of this conference was to develop an expert consensus-driven working framework for comprehensive genetic evaluation of inherited PCA in the multigene testing era addressing genetic counseling, testing, and genetically informed management. Methods An expert consensus conference was convened including key stakeholders to address genetic counseling and testing, PCA screening, and management informed by evidence review. Results Consensus was strong that patients should engage in shared decision making for genetic testing. There was strong consensus to test HOXB13 for suspected hereditary PCA, BRCA1/2 for suspected hereditary breast and ovarian cancer, and DNA mismatch repair genes for suspected Lynch syndrome. There was strong consensus to factor BRCA2 mutations into PCA screening discussions. BRCA2 achieved moderate consensus for factoring into early-stage management discussion, with stronger consensus in high-risk/advanced and metastatic setting. Agreement was moderate to test all men with metastatic castration-resistant PCA, regardless of family history, with stronger agreement to test BRCA1/2 and moderate agreement to test ATM to inform prognosis and targeted therapy. Conclusion To our knowledge, this is the first comprehensive, multidisciplinary consensus statement to address a genetic evaluation framework for inherited PCA in the multigene testing era. Future research should focus on developing a working definition of familial PCA for clinical genetic testing, expanding understanding of genetic contribution to aggressive PCA, exploring clinical use of genetic testing for PCA management, genetic testing of African American males, and addressing the value framework of genetic evaluation and testing men at risk for PCA-a clinically heterogeneous disease.