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Two studies examined the change in self-efficacy of practitioners after attending Triple P training and the moderators that affect training outcomes. Study 1 used a large multidisciplinary sample of health, education, and welfare practitioners (N = 37,235) came from 30 countries around the world, which all participate in a Triple P professional training course during 2012–2019. This study assessed practitioners’ overall self-efficacy and their consultation skills efficacy prior to training, immediately following training, and at six- to eight-weeks follow-up. Participants reported significant improvements of their overall self-efficacy and their consultation skills self-efficacy. There were significantly small differences based on practitioners’ gender, disciplines, education levels, and country location. Study 2 examined the training outcomes of videoconference-based training (following the COVID-19 pandemic) compared to in-person training (N = 6867). No significant differences were found between videoconference and in-person training on any outcome measure. Implications for the global dissemination of evidence-based parenting programs as part of a comprehensive public health response to COVID-19 was discussed.

Although parents of siblings play a crucial role in the development of both the positive and negative aspects of their children’s relationships, relatively few parenting programs specifically target sibling conflict alongside sibling warmth. To bridge this gap, the current study reports the outcomes of a randomized controlled trial evaluating a brief parenting intervention focusing on improving sibling relationships. A total of 74 parents reporting concerns about sibling conflict were randomized to either the Triple P brief discussion group intervention condition (n = 37) or the waitlist control condition (n = 37). Parents were predominately Caucasian, female, from a middle-income background. Parents completed a range of self-report measures examining the quality of the sibling relationship, parenting practices, family functioning, and child emotional and behavioral problems. Across treatment groups, participants showed improvements on almost all measures of sibling conflict, sibling warmth, child emotional and behavioral problems, parenting practices, and parenting confidence. Participants in the treatment group also experienced a greater reduction in the amount of help they wanted to manage sibling warmth, relative to participants in the control group. These results suggest that a low-intensity parenting intervention may only have a small effect on improving sibling relationships. Additional research is needed to determine how to broaden program efficacy for sibling conflict and parental adjustment, for families from diverse levels of income and family composition. Trial registration: ANZCTR 365567.

In Vietnamese culture, grandparents are significantly involved in the upbringing of grandchildren. This involvement of grandparents entails lots of ambiguities and challenges. Boundaries between parents and grandparents are often unclear, and communication can be restricted due to power differentials, leading to inconsistent discipline. This study seeks to evaluate the efficacy of the Group Triple P-Positive Parenting Program plus Building Coparenting Alliance-a compassion-focused module to promote the parent-grandparents relationship. One hundred Vietnamese parents whose parents or parent in-laws provided care for their children were randomly assigned to either an intervention condition (n = 50) or a waitlist control condition (n = 50). Both groups were assessed at three time-points (pre-intervention, post-intervention, and 6-month follow-up). The short-term intervention effects were found across domains, including co-parenting conflict, parents' self-compassion, dysfunctional parenting, parenting self-efficacy, parental adjustment, child behavioral problems and child prosocial behaviors. Intervention effects on co-parenting conflict, parenting behaviors, and the child's prosocial behaviors were maintained at a 6-month follow-up. This study demonstrates the efficacy of Triple P plus compassion in promoting co-parenting relationships between parents and grandparents, enhancing parenting practice and child outcomes in Vietnamese families.

This study assesses postoperative quality-of-life outcomes via the Glasgow Benefit Inventory (GBI) in patients undergoing transnasal endoscopic pituitary surgery for pituitary adenoma.This was a retrospective cohort study in a UK tertiary referral centre. 145 patients who had undergone transnasal endoscopic pituitary surgery for pituitary adenoma over a 6-year period at one institution completed the GBI with at least 3 months' follow up. Patients with prior radiotherapy were excluded. The GBI is a patient-reported outcome measure that assesses post-intervention outcomes in three domains: 'general' functioning, 'social support' and 'physical' functioning. Pre- and post-operative visual loss scores were additionally assessed via a 1-5 Likert scale. GBI scores were assessed alongside these visual loss scores, clinical and surgical parameters and demographics.Mean age was 59.5 years (range 20-87 years) and mean follow up was 36 months. A total of 46 of 145 (31.7%) patients had secreting tumours. The most common primary symptom was visual loss. Mean total score for all patients was positive (+8.4); with 'general' domain score the most positive (+10.5). All patient groups had overall positive, 'general' and 'social support' domain scores. Patients with Cushing's disease reported significantly higher mean total scores (+29.6) than all other groups. Acromegaly (+7.9) and non-functioning adenoma (NFA) groups (+5.2) reported lower mean total scores. 'Physical' domain mean scores were negative for acromegaly and NFA groups. There was statistical significance between a pre- to post-operative improvement in visual score and mean total GBI score (These findings can aid preoperative counselling of patients undergoing this surgery. Those with NFA and no anticipated improvement to visual loss symptoms may be advised of possible worsened physical outcomes and of the option to delay the surgery until symptoms are present.

The study was a randomised controlled trial evaluating the effectiveness of the Group Triple P Program for Chinese immigrant parents living in New Zealand. Sixty-seven Chinese immigrant parents of a 5- to 9-year-old child with disruptive behaviour problems were randomly allocated to either an intervention or a waitlist group. Parents completed measures of child adjustment problems, general parenting practices, parenting practices in children's academic lives, parental adjustment, parental teamwork, and family relationships at pre-, post-, and 4-month follow-up. Intervention group ratings of programme satisfaction were collected following programme completion. Significant short-term intervention effects were found for improvements in child behaviour, parenting practices, parental teamwork, and parenting in the child academic context. All intervention effects, except for parental teamwork, were maintained at 4-month follow-up. There were no significant intervention effects for parental adjustment, however, medium effect sizes were found at post-intervention and follow-up. A high level of programme satisfaction was reported.

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Bullying victimisation is a serious risk factor for mental health problems in children and adolescents. School bullying prevention programs have consistently produced small to moderate reductions in victimisation and perpetration. However, these programs do not necessarily help all students affected by bullying. Paradoxically whole-school programs lead to higher levels of depression and poorer self-esteem for students who continue to be victimised after program implementation. This may be because some elements of whole-school programs make victims more visible to their peers, thus further eroding their peer social status. Three main identified risk factors for children and adolescents who continue to be victimised following school bullying prevention programs are peer rejection, internalising problems, and lower quality parent-child relationships. All are potentially modifiable through family interventions. A large body of research demonstrates the influence of families on children's social skills, peer relationships and emotional regulation. This paper describes the theoretical foundations and empirical evidence for reducing the incidence and mental health outcomes of school bullying victimisation through family interventions. Family interventions should be available to complement school efforts to reduce bullying and improve the mental health of young people.

The diffusion and reorganization of phospholipids and membrane-associated proteins are fundamental for cellular function. Fluorescence cross-correlation spectroscopy (FCCS) measures the diffusion and molecular interactions at nanomolar concentration in biological systems. We have developed a novel, economical method to simultaneously monitor diffusion and oligomerization with the use of super-continuum laser and spectral deconvolution from a single detector. Customizable excitation wavelengths were chosen from the wide-band source and spectral fitting of the emitted light revealed the interactions for up to four spectrally overlapping fluorophores simultaneously. This method was applied to perform four-color FCCS, as demonstrated with polystyrene nanoparticles, lipid vesicles, and membrane-bound molecules. Up to four individually customizable excitation channels were selected from the broad-spectrum fiber laser to excite the diffusers within a diffraction-limited spot. The fluorescence emission passed through a cleanup filter and a dispersive prism prior to being collected by a sCMOS or EMCCD camera with up to 10 kHz frame rates. The emission intensity versus time of each fluorophore was extracted through a linear least-square fitting of each camera frame and temporally correlated via custom software. Auto- and cross-correlation functions enabled the measurement of the diffusion rates and binding partners. We have measured the induced aggregation of nanobeads and lipid vesicles in solution upon increasing the buffer salinity. Because of the adaptability of investigating four fluorophores simultaneously with a cost-effective method, this technique will have wide application for examining complex homo- and heterooligomerization in model and living systems.

Extensive research, in Western countries, links parental mood and parenting styles with child outcomes including emotional and behavioural adjustment. However, the effects of cultural differences, particularly between Australia and Indonesia on such linkages have not been adequately addressed in the existing literature. This cross-cultural study aims to examine the relationship between perceived parental mood, parenting styles, and child emotional and behavioural adjustment among both Australian and Indonesian parents. Using an online survey, a total of 436 parents (125 Australian and 311 Indonesian parents) with at least one typically developing child between the age of 3 and 9 years participated in this descriptive, exploratory study. Results indicated that in comparison to Australian parents, Indonesian participants reported greater anxiety symptoms, lower levels of depression, and more use of an authoritarian style in parenting. Similar patterns in the associations of observed variables were found between different cultural groups. High levels of parental stress and less use of authoritative parenting were revealed to be predictors of child emotional and behavioural problems while the authoritative parenting style was the predictor for child competencies within both cultures. This study provides evidence for the inconsistency between cultural preference in parenting style and the predicted factors for child outcomes.

Parent-child relationships influence learning throughout a child’s formal schooling and beyond. The quality of parenting children receive has a major influence on their learning and developmental capabilities. Parental influence is important in the early years of life and extends throughout a child’s schooling. Parenting has a pervasive influence on children’s language and communication, executive functions and self-regulation, social and peer relationships, academic attainment, general behaviour and enjoyment of school. Schools can further enhance educational outcomes for students by developing the resources and expertise needed to engage parents as partners in learning. This can be achieved by delivering and facilitating access to a comprehensive system of high-quality, culturally informed, evidence-based parenting support programs. In this article, recent developments in the Triple P system of parenting support are used to illustrate how schools can develop a low-cost, comprehensive, high-quality parenting support strategy that blends universal components with targeted components for more vulnerable children. We identify potential organisational and logistical barriers to implementing parenting support programs and ways to address these.

Fatty acids are vital for the survival of eukaryotes, but when present in excess can have deleterious consequences. The AMP-activated protein kinase (AMPK) is an important regulator of multiple branches of metabolism. Studies in purified enzyme preparations and cultured cells have shown that AMPK is allosterically activated by small molecules as well as fatty acyl-CoAs through a mechanism involving Ser108 within the regulatory AMPK β1 isoform. However, the in vivo physiological significance of this residue has not been evaluated. In the current study, we generated mice with a targeted germline knock-in (KI) mutation of AMPKβ1 Ser108 to Ala (S108A-KI), which renders the site phospho-deficient. S108A-KI mice had reduced AMPK activity (50 to 75%) in the liver but not in the skeletal muscle. On a chow diet, S108A-KI mice had impairments in exogenous lipid-induced fatty acid oxidation. Studies in mice fed a high-fat diet found that S108A-KI mice had a tendency for greater glucose intolerance and elevated liver triglycerides. Consistent with increased liver triglycerides, livers of S108A-KI mice had reductions in mitochondrial content and respiration that were accompanied by enlarged mitochondria, suggestive of impairments in mitophagy. Subsequent studies in primary hepatocytes found that S108A-KI mice had reductions in palmitate- stimulated Cpt1a and Ppargc1a mRNA, ULK1 phosphorylation and autophagic/mitophagic flux. These data demonstrate an important physiological role of AMPKβ1 Ser108 phosphorylation in promoting fatty acid oxidation, mitochondrial biogenesis and autophagy under conditions of high lipid availability. As both ketogenic diets and intermittent fasting increase circulating free fatty acid levels, AMPK activity, mitochondrial biogenesis, and mitophagy, these data suggest a potential unifying mechanism which may be important in mediating these effects.

Purpose Sustained implementation is required for evidence-based parenting programs to promote children and their families’ wellbeing at the societal level. Previous literature has examined the role of a range of different factors in enhancing sustainability. However, the inter-relationship between, and the relative importance of different factors remain largely unknown. The overall aim of this study is to identify predictors of sustained program use, the relative importance of factors, and potential mediation pathways. Methods We surveyed 1202 practitioners who were trained in at least one variant of the Triple P-Positive Parenting Program, at least one and half years before data collection. The present data were linked with data collected during professional training. We first examined the independent effect of each factor on sustained program use, then, developed and evaluated a structural equation model of sustained program use. Results The structural equation model explained a considerable amount of variance in sustained program use, with seven positive predictors and one negative predictor identified. Organisational support was identified as a key facilitator, which was not only positively linked with other facilitators but also had an independent positive effect. Perceived usefulness of the program was the most important practitioner-level facilitator, which might be contributed by both research-based evidence and practice-based evidence. Practitioners’ self-regulation in program delivery impacted sustained use by influencing other factors such as perceived usefulness of the program. Conclusion The findings provided insight into factors influencing the sustainability of evidence-based parenting programs which could be used to inform future implementation practice.

Low-resource communities that rely on the environment face challenges in the forms of climate change and the overuse of natural resources. Behaviour science offers methods and strategies to mitigate behaviours that contribute to environmental degradation, as well as promote the adoption of desirable behaviours. We investigated the attitudes and beliefs of vulnerable communities. We conducted surveys across five villages on Selayar Island, a small island in Sulawesi Indonesia. Our results suggest a willingness to participate in behaviour-based programmes and concern for families. When offering development programmes to communities, the needs of the community should inform the design and implementation process.

Parenting strategies such as communicating clear expectations, providing calm directions, and teaching specific skills can strengthen young children’s social-emotional development. Parenting programs for children with disruptive behavior often emphasize gaining compliance via effective directives, and less on how to facilitate child skill acquisition or on effective parenting for differing situations and task demands. We aimed to study how parenting strategies and associated child behavior vary by situational contexts. Specifically, we focused on the differential use of directives and guidance during different tasks. This observation study utilized a microsocial coding system, the Parent–Child Play Task Observation System (PCPTOS), to closely examine parent and child interactions in multiple analogue task situations. The study drew on pre-intervention data for 224 parent–child dyads who participated in a parenting-focused intervention trial for children ages 3–7 who presented elevated levels of disruptive behaviors. Interrater reliabilities were very good to excellent. Parents used directives more frequently during the clean-up task and guidance more frequently during the teaching task compared to the other tasks. Associations of parent use of directives and guidance with child behavior and affect differed by task. Observed parent directives were associated with child disruptive behavior during each task, whereas parent guidance was negatively associated with child disruptive behavior and positively associated with child positive affect during the teaching task. Parenting strategies that are well matched to the situational context and proactively consider task demands are more likely to facilitate children’s social-emotional development.

Individuals with cystic fibrosis (CF) are at high risk of clinically significant anxiety, which can be related to lower treatment adherence and poorer health outcomes. Additionally, up to half of the parents/caregivers of children with CF experience clinically significant anxiety. Research has focussed on CF youth aged 13 years and older, leaving anxiety among school-aged children (aged 6-12 years) largely unstudied. This review aimed to synthesize research on anxiety among children with CF and their parents, examining prevalence, risk factors, and relationships between parent and child factors. Four electronic databases were searched, and publications were included if participants were children (or parents of children) with CF with a mean age between 6 and 12 years, and a standardized anxiety measure was used. Data from fourteen studies were extracted for descriptive synthesis; however, no studies focussed exclusively on the age range of 6-12 years. Results generally indicated that anxiety is highly prevalent in both child and parent populations; anxiety was the most prevalent mental health condition among children with CF, and anxiety was higher among CF populations than control populations among both children and parents. However, there were disparities, with some papers finding low rates of anxiety, and results on the relationship between anxiety and health outcomes varying greatly. Several risk factors were identified, but few were corroborated. There is an overall deficiency of research in this area, particularly examining the relationships between parent and child anxiety, and anxiety and health outcomes. Further research on suitable screening and intervention practices is also required.

Background Parents of children with developmental or intellectual disabilities tend to report greater use of coercive parenting practices relative to parents of typically developing children, increasing the risk of adverse child outcomes. However, to date, there is limited research exploring the role and relative contribution of modifiable and nonmodifiable risk factors in parents of children with a disability. The present study aimed to explore the role of various modifiable and nonmodifiable parenting, family and sociodemographic factors associated with the use of coercive parenting practices in parents of children with a disability. Methods Caregivers (N = 1392) enrolled in the Mental Health of Young People with Developmental Disabilities (MHYPeDD) programme in Australia completed a cross-sectional survey about their parenting and their child aged 2-12 years with a disability. Measures covered a range of domains including relevant demographic and family background, use of coercive parenting practices, intensity of child behavioural difficulties and questions relating to parent and family functioning such as parental self-efficacy, adjustment difficulties and quality of family relationships. Results Parents of older children, those who were younger at the birth of their child, and parents who were co-parenting or working reported more use of coercive parenting practices. Greater intensity of child difficulties, poorer parental self-efficacy and parent-child relationships, and more parental adjustment difficulties were also significantly associated with more use of coercive parenting. Examination of the relative contribution of variables revealed parent-child relationship was a key contributing factor, followed by intensity of child behaviour problems, parent adjustment and parent confidence. Conclusions These findings highlight a range of factors that should be targeted and modified through upstream prevention programmes and further inform our understanding of how coercive practices may be influenced through targeted parenting interventions.

Ice jams that occurred on the Pemigewasset River in central New Hampshire resulted in significant localized flooding on 26 February 2017 and 13 January 2018. Analyses of these two case studies shows that both ice jam events occurred in association with enhanced moisture transport characteristic of atmospheric rivers (ARs) that resulted in rain-on-snow, snowpack ablation, and rapid increases in streamflow across central New Hampshire. However, while the ice jams and ARs that preceded them were similar, the antecedent hydrometeorological characteristics of the region were different. The February 2017 event featured a “long melting period with low precipitation” scenario, with several days of warm (~5°–20°C) maximum surface temperatures that resulted in extensive snowmelt followed by short-duration, weak AR that produced ~10–15 mm of precipitation during a 6-h period prior to the formation of the ice jam. Alternatively, the January 2018 event featured a “short melting period with high precipitation” scenario with snowmelt that occurred primarily during a more intense and long-duration AR that produced >50 mm of rainfall during a 30-h period prior to the formation of the ice jam. Composite analysis of 20 ice jam events during 1981–2019 illustrates that 19 of 20 events were preceded by environments characterized by ARs along the U.S. East Coast and occur in association with a composite corridor of enhanced integrated water vapor > 25 mm collocated with integrated water vapor transport magnitudes > 600 kg m−1 s−1. Additional analyses suggest that most ice jams on the Pemigewasset River share many common synoptic-scale antecedent meteorological characteristics that may provide situational awareness for future events.

The purpose of this review is to describe the standard procedures used to treat venous leg ulcers (VLUs), including endovenous laser ablation (EVLA), sclerotherapy, radiofrequency ablation, or other surgical modalities, and discuss the associated literature. Results of relevant studies, including clinical trials, prospective studies, and retrospective chart reviews, will be critically analyzed and integrated with the authors’ clinical experience. We aim to compare the different methods to help guiding clinical decision-making. It is important to consider each patient’s medical comorbidities, age, and preference in considering a surgical intervention. Studies show that EVLA and ultrasound-guided foam sclerotherapy (UGFS) enable ulcers to heal faster and lower the rates of recurrence. Minimally invasive procedures have replaced open surgical techniques as a means of treating VLUs. EVLA and UGFS appear to be safe and effective treatment options for most patients.

Among the many Callinectes spp. across the western Atlantic, the blue crab C. sapidus has the broadest latitudinal distribution, encompassing both tropical and temperate climates. Its life history varies latitudinally, from extended overwintering at high latitudes to year-round activity in tropical locations. Callinectes sapidus reovirus 1 (CsRV1) is a pathogenic virus first described in North Atlantic C. sapidus and has recently been detected in southern Brazil. Little information exists about CsRV1 prevalence at intervening latitudes or in overwintering blue crabs. Using a quantitative reverse transcription PCR (RT-qPCR) method, this study investigated CsRV1 prevalence in C. sapidus across latitudinal differences in temperature and crab life history, as well as in additional Callinectes spp. and within overwintering C. sapidus. CsRV1 prevalence in C. sapidus was significantly correlated with high water temperature and blue crab winter dormancy. Prevalence of CsRV1 in C. sapidus on the mid-Atlantic coast was significantly lower in winter than in summer. CsRV1 infections were not detected in other Callinectes spp. These findings revealed that CsRV1 is present in C. sapidus across their range, but not in other Callinectes species, with prevalence associated with temperature and host life history. Such information helps us to better understand the underlying mechanisms that drive marine virus dynamics under changing environmental conditions.

This article adds to current research by examining treatment fidelity of an evidence-based parenting program (namely Triple P) as part of a large clinical trial which included a range of procedures for promoting fidelity including both expert and peer supervision. Procedures for monitoring and promoting fidelity are described, and two major aspects of fidelity, namely content adherence and process fidelity, were evaluated. All treatment sessions for 166 families participating in the Standard Triple P-Positive Parenting Program were video-recorded and then sampled for evaluation without advanced knowledge by delivery practitioners. Independent coders at an external site assessed content adherence and rated delivery process. Fidelity promotion included high-quality training of practitioners on a standardized protocol, ongoing clinical supervision by peers and supervisors, and fidelity feedback sessions. Average content fidelity was consistently high (i.e., over 80%). Process fidelity scores were similarly high across sessions. A brief survey indicated practitioners found that the fidelity and implementation model was useful and contributed to increasing self-efficacy over the course of the initiative.

Psychology and the social sciences have an important role to play in developing innovative solutions to pressing global mental health and social problems. Programs developed by psychologists and other social scientists have immense potential to alleviate suffering and to promote healthy human development across the lifespan. In order to realise this potential program developers must manage the research and development challenges involved in testing an intervention, evaluating, and then preparing it for wider dissemination and scaling. Particular challenges and conflicts can occur in managing the joint roles of being a program developer and a researcher evaluating an intervention or innovation. This article examines the management of various forms of conflicts of interest that have the potential to produce bias and decrease the confidence of policy makers, funders, practitioners, fellow researchers, and the public in the value of psychological interventions. We argue that best practice guidelines are needed to assist developers negotiate the predictable, sometime unavoidable but challenging conflicts of interest that arise in the research process.

Lumbar decompression (LD) surgery, with or without discectomy, is a commonly performed surgical procedure. Despite the concept of day-case LD being reported as early as the 1980s, day-case LD is yet to become routine clinical practice.This systematic review aimed to examine the published literature on the safety and complication rates of day-case LD. Secondary outcome measures, including the economic impact and patient satisfaction of day-case LD, were also examined.A systematic electronic search was carried out on PubMed, EMBASE and the Cochrane Library between 1999 and January 2022. Studies were screened against predefined inclusion/exclusion criteria with the quality of included studies subsequently being assessed.In total, 15 studies were included in this review. The majority of studies were undertaken in the USA (n ​= ​8, 53%) and were of a case series design (n ​= ​9, 60%). Reported complication rates ranged from 0% to 7.8%, with nine studies reporting a complication rate of4%. Readmission rates ranged from 0% to 7.7%. Seven studies quoted a readmission rate of 0%. Five studies found cost saving benefits of day-case LD in comparison to inpatient LD of up to $27,984 (USD). Patient acceptability of day-case LD was consistently high across the six studies that assessed it.Day-case LD surgery is a safe and economically efficient surgical option in appropriately selected patients.

The importance of champions in the implementation of evidence-based public health programs has been well established. Champions perform a range of behaviors which can have significant influence on the adoption and sustainability of interventions. This study investigates champion behaviors in parenting practitioners with the aim to provide insight into the range and extent that practitioners engage in champion behaviors and to examine predictors of practitioners' champion behaviors using structural equation modeling. Data were collected during a large international implementation survey of 1606 practitioners trained to deliver an evidence-based parenting program, the triple P-Positive Parenting Program. We developed a 13-item Champion Behaviors Scale which was administered alongside other measures of predictors of implementation outcomes. Perceived usefulness of the program was the most important facilitator of both public and personal champion behaviors. Certain desirable features of the program tended to not only be positively associated with the perceived usefulness of the program, but also had a unique impact on practitioners' personal champion behaviors. Higher positions within organizations were linked with more public champion behaviors. Although organizational support was found to be unrelated to champion behaviors in the structural model, it facilitated other predictors of champion behaviors.

Developing an effective population-level system of evidence-based parenting support capable of shifting (at a population level) rates of child maltreatment and social, emotional, and behavioral problems in children requires an integrated theory of change. This paper presents a systems-contextual model of change and identifies modifiable mechanisms that can potentially explain population-level changes in parenting and child outcomes.Using the Triple P-Positive Parenting Program as an exemplar of a tiered, multi-level system of evidence-based parenting interventions, we discuss the putative mechanisms of change necessary to produce change in child behavior, parenting, practitioner behavior, and organizational changes to support the sustained implementation of an intervention.A model of change is proposed that blends theoretical perspectives derived from social learning theory, self-regulation theory, applied behavior analysis, cognitive behavior principles, developmental theory, and principles derived from the fields of public health, implementation science, and economics to explain change in the behavior at the community wide level. Different types of interventions targeting different populations and mechanisms are used to illustrate how sustainable change in child and parent outcomes can be achieved.Evidence supporting specific mechanisms and moderators of intervention effects are discussed as well as directions for future research on mechanisms.

AMP-activated protein kinase (AMPK) is a central energy sensor that coordinates the response to energy challenges to maintain cellular ATP levels. AMPK is a potential therapeutic target for treating metabolic disorders, and several direct synthetic activators of AMPK have been developed that show promise in preclinical models of type 2 diabetes. These compounds have been shown to regulate AMPK through binding to a novel allosteric drug and metabolite (ADaM)–binding site on AMPK, and it is possible that other molecules might similarly bind this site. Here, we performed a high-throughput screen with natural plant compounds to identify such direct allosteric activators of AMPK. We identified a natural plant dihydrophenathrene, Lusianthridin, which allosterically activates and protects AMPK from dephosphorylation by binding to the ADaM site. Similar to other ADaM site activators, Lusianthridin showed preferential activation of AMPKβ1-containing complexes in intact cells and was unable to activate an AMPKβ1 S108A mutant. Lusianthridin dose-dependently increased phosphorylation of acetyl-CoA carboxylase in mouse primary hepatocytes, which led to a corresponding decrease in de novo lipogenesis. This ability of Lusianthridin to inhibit lipogenesis was impaired in hepatocytes from β1 S108A knock-in mice and mice bearing a mutation at the AMPK phosphorylation site of acetyl-CoA carboxylase 1/2. Finally, we show that activation of AMPK by natural compounds extends to several analogs of Lusianthridin and the related chemical series, phenanthrenes. The emergence of natural plant compounds that regulate AMPK through the ADaM site raises the distinct possibility that other natural compounds share a common mechanism of regulation.

AMP-activated protein kinase (AMPK) is a master regulator of cellular energy homeostasis and a therapeutic target for metabolic diseases. Co/post-translational N-myristoylation of glycine-2 (Gly2) of the AMPK β subunit has been suggested to regulate the distribution of the kinase between the cytosol and membranes through a “myristoyl switch” mechanism. However, the relevance of AMPK myristoylation for metabolic signaling in cells and in vivo is unclear. Here, we generated knockin mice with a Gly2-to-alanine point mutation of AMPKβ1 (β1-G2A). We demonstrate that non-myristoylated AMPKβ1 has reduced stability but is associated with increased kinase activity and phosphorylation of the Thr172 activation site in the AMPK α subunit. Using proximity ligation assays, we show that loss of β1 myristoylation impedes colocalization of the phosphatase PPM1A/B with AMPK in cells. Mice carrying the β1-G2A mutation have improved metabolic health with reduced adiposity, hepatic lipid accumulation, and insulin resistance under conditions of high-fat diet-induced obesity.

Parents can be essential change-agents in their children’s lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.

This mixed methods study describes attributions for improvement following reductions in victimization for children who were bullied at school. It also tests hypotheses from attribution theory about...

A general approach to prepare unsymmetrical sulfamides is described. This method relies on the activation of sulfamic acid salts with triphenylphosphine ditriflate, and subsequent trapping by a nucleophilic amine. This strategy improves access to N-octadecyl-N′-propylsulfamide, a feeding suppressant.

We report an investigation into processes of change in a randomized controlled trial of Stepping Stones Triple P (SSTP) and acceptance and commitment therapy (ACT) for families of children with cerebral palsy (CP). In comparison with the control group, the SSTP-only group showed improvements in child behavior problems and emotional symptoms and the SSTP-plus-ACT group showed benefits in child behavior problems, child hyperactivity, dysfunctional parenting styles, child functional performance in the mobility domain, child quality of life, and parental adjustment. Sixty-seven parents of children with CP were randomly allocated to one of three groups: waitlist control, SSTP-only and SSTP-plus-ACT groups. We investigated three potential processes of change: parenting style, parental attitude to child emotion, and parental psychological flexibility. We used bootstrapping to perform the mediation analysis. Contrary to the existing literature, we find that neither dysfunctional parenting styles nor parental attitude to child emotion were significant mediators of the intervention effect on child behavior and adjustment. Consistent with existing literature, we find that psychological flexibility mediates the intervention effect on dysfunctional parenting styles (overreactivity confidence interval [CI] = −0.4750 to −0.115) and parental adjustment (depressive symptoms CI = −6.5641 to −0.5922; stress CI = −6.0546 to −0.4195). Overall, our findings support the conclusion that ACT makes a unique contribution to parenting intervention. Australian New Zealand Clinical Trials Registry (00336291).

Background High-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality. Objective This study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the same content. This objective, pursued in the context of a randomized trial, made use of cost data collected from parents and service providers. Methods A cost-minimization analysis (CMA) was conducted comparing the online and staff-delivered parenting interventions. Families (N=334) with children 3-7 years old, who exhibited clinically elevated disruptive behavior problems, were randomly assigned to the two parenting interventions. Participants, delivery staff, and administrators provided data for the CMA concerning family participation time and expenses, program delivery time (direct and nondirect), and nonpersonnel resources (eg, space, materials, and access fee). The CMA was conducted using both intent-to-treat and per-protocol analytic approaches. Results For the intent-to-treat analyses, the online parenting intervention reflected significantly lower program costs (t168=23.2; P Conclusions The online-delivered parenting intervention in this randomized study produced substantial cost minimization compared with the staff-delivered intervention providing the same content. Cost minimization was driven primarily by personnel time and, to a lesser extent, by facilities costs and family travel time. The CMA was accomplished with three critical conditions in place: (1) the two intervention delivery modalities (ie, online and staff) held intervention content constant; (2) families were randomized to the two parenting interventions; and (3) the online-delivered intervention was previously confirmed to be non-inferior to the staff-delivered intervention in significantly reducing the primary outcome, child disruptive behavior problems. Given those conditions, cost minimization for the online parenting intervention was unequivocal. Trial Registration ClinicalTrials.gov NCT02121431; https://clinicaltrials.gov/ct2/show/NCT02121431

BACKGROUND High-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality. OBJECTIVE This study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the same content. This objective, pursued in the context of a randomized trial, made use of cost data collected from parents and service providers. METHODS A cost-minimization analysis (CMA) was conducted comparing the online and staff-delivered parenting interventions. Families (N=334) with children 3-7 years old, who exhibited clinically elevated disruptive behavior problems, were randomly assigned to the two parenting interventions. Participants, delivery staff, and administrators provided data for the CMA concerning family participation time and expenses, program delivery time (direct and nondirect), and nonpersonnel resources (eg, space, materials, and access fee). The CMA was conducted using both intent-to-treat and per-protocol analytic approaches. RESULTS For the intent-to-treat analyses, the online parenting intervention reflected significantly lower program costs (t168=23.2; P<.001), family costs (t185=9.2; P<.001), and total costs (t171=19.1; P<.001) compared to the staff-delivered intervention. The mean incremental cost difference between the interventions was $1164 total costs per case. The same pattern of significant differences was confirmed in the per-protocol analysis based on the families who completed their respective intervention, with a mean incremental cost difference of $1483 per case. All costs were valued or adjusted in 2017 US dollars. CONCLUSIONS The online-delivered parenting intervention in this randomized study produced substantial cost minimization compared with the staff-delivered intervention providing the same content. Cost minimization was driven primarily by personnel time and, to a lesser extent, by facilities costs and family travel time. The CMA was accomplished with three critical conditions in place: (1) the two intervention delivery modalities (ie, online and staff) held intervention content constant; (2) families were randomized to the two parenting interventions; and (3) the online-delivered intervention was previously confirmed to be non-inferior to the staff-delivered intervention in significantly reducing the primary outcome, child disruptive behavior problems. Given those conditions, cost minimization for the online parenting intervention was unequivocal. CLINICALTRIAL ClinicalTrials.gov NCT02121431; https://clinicaltrials.gov/ct2/show/NCT02121431