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Abstract Traditional measurements of gait are typically performed in clinical or laboratory settings where functional assessments are used to collect episodic data, which may not reflect naturalistic gait and activity patterns. The emergence of digital health technologies has enabled reliable and continuous representation of gait and activity in free-living environments. To provide further evidence for naturalistic gait characterization, we designed a master protocol to validate and evaluate the performance of a method for measuring gait derived from a single lumbar-worn accelerometer with respect to reference methods. This evaluation included distinguishing between participants’ self-perceived different gait speed levels, and effects of different floor surfaces such as carpet and tile on walking performance, and performance under different bouts, speed, and duration of walking during a wide range of simulated daily activities. Using data from 20 healthy adult participants, we found different self-paced walking speeds and floor surface effects can be accurately characterized. Furthermore, we showed accurate representation of gait and activity during simulated daily living activities and longer bouts of outside walking. Participants in general found that the devices were comfortable. These results extend our previous validation of the method to more naturalistic setting and increases confidence of implementation at-home.

Short, intensive education programs provide an under-utilized avenue for public health professionals to learn and apply the latest methods and technologies. We report on the creation and implementation of the Skills for Health and Research Professionals (SHARP) program at the Columbia University Mailman School of Public Health. The self-sustaining, concise, intense educational format equips participants with concrete skills, better enabling them to respond to complex public health challenges.

Debates on intellectual property rights and open source frequently stem from the business sector and higher education, where goals are typically oriented toward profit, academic status, credit, and/or reputation. What happens if we reconsider the ethics of intellectual property rights and open source when our driving motivation is advancing women's health and rights? How does this prioritization complicate our assumptions of copyright and open access? How can we embark on a journey that validates the complex realities of multiple stakeholders who have good intent, but do not always consider the unintended impacts and the broader power dynamics at play? This paper explores the tensions and nuances of sharing methodologies that aim to transform harmful gender norms in an ecosystem that does not always consider the complex challenges behind intellectual property and open-source material. As a thought-collective dedicated to using a feminist approach to unpack and promote the principles of ethical, effective, and sustainable scale, we hope to underscore how the current research and debates on intellectual property rights and open-source material have good aims but may also fall short in encompassing the realities of gendered social norms change in and with communities around the world. We conclude with key recommendations for donors, researchers, International Development Corporations, International Non-Governmental Organizations, and those interested in using or adapting dynamic, gender transformative materials created by others.

Abstract Digital health technologies (DHTs) are increasingly being adopted in clinical trials, as they enable objective evaluations of health parameters in free-living environments. Although lumbar accelerometers notably provide reliable gait parameters, embedding accelerometers in chest devices, already used for vital signs monitoring, could capture a more comprehensive picture of participants’ wellbeing, while reducing the burden of multiple devices. Here we assess the validity of gait parameters measured from a chest accelerometer. Twenty healthy adults (13 females, mean ± sd age: 33.9 ± 9.1 years) instrumented with lumbar and chest accelerometers underwent in-lab and outside-lab walking tasks, while monitored with reference devices (an instrumented mat, and a 6-accelerometers set). Gait parameters were extracted from chest and lumbar accelerometers using our open-source Scikit Digital Health gait (SKDH-gait) algorithm, and compared against reference values via Bland–Altman plots, Pearson’s correlation, and intraclass correlation coefficient. Mixed effects regression models were performed to investigate the effect of device, task, and their interaction. Gait parameters derived from chest and lumbar accelerometers showed no significant difference and excellent agreement across all tasks, as well as good-to-excellent agreement and strong correlation against reference values, thus supporting the deployment of a single multimodal chest device in clinical trials, to simultaneously measure gait and vital signs. Trial Registration: The study was reviewed and approved by the Advarra IRB (protocol number: Pro00043100).

Objectives To quantify the economic investment required to increase bariatric surgery (BaS) capacity in National Health Service (NHS) England considering the growing obesity prevalence and low provision of BaS in England despite its high clinical effectiveness.Design Data were included for the patients with obesity who were eligible for BaS. We used a decision-tree approach including four distinct steps of the patient pathway to capture all associated resource use. We estimated total costs according to the current capacity (current scenario) and three BaS scaling up strategies over a time horizon of 20 years (projected scenario): maximising NHS capacity (strategy 1), maximising NHS and private sector capacity (strategy 2) and adding infrastructure to NHS capacity to cover the entire prevalent and incident obesity populations (strategy 3).Setting BaS centres based in NHS and private sector hospitals in England.Main outcome measures Number of BaS procedures (including revision surgery), cost (GBP) and resource utilisation over 20 years.Results At current capacity, the number of BaS procedures and the total cost over 20 years were estimated to be 140 220 and £1.4 billion, respectively. For strategy 1, these values were projected to increase to 157 760 and £1.7 billion, respectively. For strategy 2, the values were projected to increase to 232 760 and £2.5 billion, respectively. Strategy 3 showed the highest increase to 564 784 and £6.4 billion, respectively, with an additional 4081 personnel and 49 facilities required over 20 years.Conclusions The expansion of BaS capacity in England beyond a small proportion of the eligible population will likely be challenging given the significant upfront economic investment and additional requirement of personnel and infrastructure.

Due to the COVID-19 pandemic, university professors are challenged to re-envision mathematics learning environments for virtual delivery. Those of us teaching in elementary teacher preparation programs are exploring different learning environments that not only promote meaningful learning but also foster positive attitudes about mathematics teaching. One learning environment that has been shown to be effective for introducing preservice teachers to the creative side of mathematics--the mathematics makerspace--promotes computational thinking and pedagogical understandings about teaching mathematics, but the collaborative, hands-on nature of such a learning environment is difficult to simulate in virtual delivery. This article describes the research-based design decisions for the re-envisioned virtual mathematics makerspace.

Objectives Bariatric surgery is an effective treatment for severe obesity that leads to significant physical health improvements. Few studies have prospectively described the short-term impact of surgery on mental health using standardised case-finding measures for anxiety or depressive disorders. This study describes the prevalence and short-term course of these conditions following surgery.Design Prospective observational cohort study.Setting 12 National Health Service centres in England.Participants Participants studied took part in the By-Band-Sleeve study, a multicentre randomised controlled trial evaluating the surgical management of severe obesity. We included participants who had undergone surgery (gastric bypass, gastric band or sleeve gastrectomy) within 6 months of randomisation.Primary and secondary outcome measures Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at baseline and 12 months post-randomisation. Sociodemographic variables collected at prerandomisation included body mass index, age, sex, ethnicity, marital status, tobacco use, employment status and income band.Results In our sample of 758 participants, 94.5% (n 716) and 93.9% (n 712) had completed baseline anxiety (HADS-A) and depression (HADS-D) subscales. At pre-randomisation 46.1% (n 330/716, 95% CI 42.4% to 49.7%) met clinical case criteria for anxiety and 48.2% (n 343/712, 95% CI 44.5% to 51.8%) for depression. Among participants returning completed 12 months post-randomisation questionnaires (HADS-A n 503/716, HADS-D n 498/712), there was a significant reduction in the proportion of clinical cases with anxiety (−9.5%, 95% CI −14.3% to -4.8% p

A protective HIV-1 vaccine has been hampered by a limited understanding of how B cells acquire neutralizing activity. Our previous vaccines expressing two different HIV-1 envelopes elicited robust antigen specific serum IgG titers in 20 rhesus macaques; yet serum from only two animals neutralized the autologous virus. Here, we used high throughput immunoglobulin receptor and single cell RNA sequencing to characterize the overall expansion, recall, and maturation of antigen specific B cells longitudinally over 90 weeks. Diversification and expansion of many B cell clonotypes occurred broadly in the absence of serum neutralization. However, in one animal that developed neutralization, two neutralizing B cell clonotypes arose from the same immunoglobulin germline and were tracked longitudinally. Early antibody variants with high identity to germline neutralized the autologous virus while later variants acquired somatic hypermutation and increased neutralization potency. The early engagement of precursors capable of neutralization with little to no SHM followed by prolonged affinity maturation allowed the two neutralizing lineages to successfully persist despite many other antigen specific B cells. The findings provide new insight into B cells responding to HIV-1 envelope during heterologous prime and boost immunization in rhesus macaques and the development of selected autologous neutralizing antibody lineages.

BackgroundAdults living with overweight/obesity are eligible for publicly funded weight management (WM) programmes according to national guidance. People with the most severe and complex obesity are eligible for bariatric surgery. Primary care plays a key role in identifying overweight/obesity and referring to WM interventions. This study aimed to (1) describe the primary care population in England who (a) are referred for WM interventions and (b) undergo bariatric surgery and (2) determine the patient and GP practice characteristics associated with both.Methods and findingsAn observational cohort study was undertaken using routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. During the study period (January 2007 to June 2020), 1,811,587 adults met the inclusion criteria of a recording of overweight/obesity in primary care, of which 54.62% were female and 20.10% aged 45 to 54. Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09% of those with severe and complex obesity) underwent bariatric surgery. Multivariable Poisson regression examined the associations of demographic, clinical, and regional characteristics on the likelihood of WM referral and bariatric surgery. Higher body mass index (BMI) and practice region had the strongest associations with both outcomes. People with BMI ≥40 kg/m2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m2 (1.34%) (rate ratio (RR) 6.19, 95% confidence interval (CI) [5.99,6.40], p < 0.001). They were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m2 with a comorbidity (0.53%) (RR 5.52, 95% CI [5.07,6.02], p < 0.001). Patients from practices in the West Midlands were the most likely to have a WM referral (5.40%) (RR 2.17, 95% CI [2.10,2.24], p < 0.001, compared with the North West, 2.89%), and practices from the East of England least likely (1.04%) (RR 0.43, 95% CI [0.41,0.46], p < 0.001, compared with North West). Patients from practices in London were the most likely to undergo bariatric surgery (2.15%), and practices in the North West the least likely (0.68%) (RR 3.29, 95% CI [2.88,3.76], p < 0.001, London compared with North West). Longer duration since diagnosis with severe and complex obesity (e.g., 1.67% of individuals diagnosed in 2007 versus 0.34% in 2015, RR 0.20, 95% CI [0.12,0.32], p < 0.001), and increasing comorbidities (e.g., 2.26% of individuals with 6+ comorbidities versus 1.39% with none (RR 8.79, 95% CI [7.16,10.79], p < 0.001) were also strongly associated with bariatric surgery. The main limitation is the reliance on overweight/obesity being recorded within primary care records to identify the study population.ConclusionsBetween 2007 and 2020, a very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either. Higher BMI and GP practice region had the strongest associations with both. Regional inequalities may reflect differences in commissioning and provision of WM services across the country. Multi-stakeholder qualitative research is ongoing to understand the barriers to accessing WM services and potential solutions. Together with population-wide prevention strategies, improved access to WM interventions is needed to reduce obesity levels.

Abstract The effect of electron‐beam patterning on the water uptake and ionic conductivity of Nafion films using a combination of X‐ray photoelectron spectroscopy, quartz crystal microbalance studies, neutron reflectometry, and impedance spectroscopy is reported. The aim is to further characterize the nanoscale patterned Nafion structures recently used as a key element in novel ion‐to‐electron transducers by Gluschke et al. To enable this, the electron beam patterning process is developed for large areas, achieving patterning speeds approaching 1 cm2 h−1, and patterned areas as large as 7 cm2 for the neutron reflectometry studies. It is ultimately shown that electron‐beam patterning affects both the water uptake and the ionic conductivity, depending on film thickness. Type‐II adsorption isotherm behavior is seen for all films. For thick films (≈230 nm), a strong reduction in water uptake with electron‐beam patterning is found. In contrast, for thin films (≈30 nm), electron‐beam patterning enhances water uptake. Notably, for either thickness, the reduction in ionic conductivity arising from electron‐beam patterning is kept to less than an order of magnitude. Mechanisms are proposed for the observed behavior based on the known complex morphology of Nafion films to motivate future studies of electron‐beam processed Nafion.

Macroscelidid afrotherians and canid carnivorans possess four premolar loci, the first of which is not replaced. Previous work suggests that the first premolar in macroscelidids is a retained deciduous tooth, but in Canis it is a successional tooth with no milk precursor. We tested this contrasting interpretation of first premolar homology with data from ontogenetic anatomy and with area predictions from the inhibitory cascade (IC) model. Our results based on anatomy support previous interpretations that the functional first premolar is a retained deciduous tooth (dp1) with no successor in macroscelidids, and a successional tooth (p1) with no precursor in Canis. Hyracoids are among the few placental mammals that show replacement at the first premolar locus and show less deviation than other taxa of actual from predicted areas across the deciduous and molar toothrow. However, predicted vs. actual tooth areas can depart substantially from one another. At least without a better means of representing tooth size, the inhibitory cascade does not help to distinguish the deciduous from successional first premolar. This observation does not rule out the possibility that factors such as a size-shift within the toothrow (e.g., carnivoran carnassials) help to explain deviations from the inhibitory cascade model.

Debates on intellectual property rights and open source frequently stem from the business sector and higher education, where goals are typically oriented toward profit, academic status, credit, and/or reputation. What happens if we reconsider the ethics of intellectual property rights and open source when our driving motivation is advancing women's health and rights? How does this prioritization complicate our assumptions of copyright and open access? How can we embark on a journey that validates the complex realities of multiple stakeholders who have good intent, but do not always consider the unintended impacts and the broader power dynamics at play? This paper explores the tensions and nuances of sharing methodologies that aim to transform harmful gender norms in an ecosystem that does not always consider the complex challenges behind intellectual property and open-source material. As a thought-collective dedicated to using a feminist approach to unpack and promote the principles of ethical, effective, and sustainable scale, we hope to underscore how the current research and debates on intellectual property rights and open-source material have good aims but may also fall short in encompassing the realities of gendered social norms change in and with communities around the world. We conclude with key recommendations for donors, researchers, International Development Corporations, International Non-Governmental Organizations, and those interested in using or adapting dynamic, gender transformative materials created by others. [ABSTRACT FROM AUTHOR]

Background Adults living with overweight/obesity are eligible for publicly funded weight management (WM) programmes according to national guidance. People with the most severe and complex obesity are eligible for bariatric surgery. Primary care plays a key role in identifying overweight/obesity and referring to WM interventions. This study aimed to (1) describe the primary care population in England who (a) are referred for WM interventions and (b) undergo bariatric surgery and (2) determine the patient and GP practice characteristics associated with both. Methods and findings An observational cohort study was undertaken using routinely collected primary care data in England from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. During the study period (January 2007 to June 2020), 1,811,587 adults met the inclusion criteria of a recording of overweight/obesity in primary care, of which 54.62% were female and 20.10% aged 45 to 54. Only 56,783 (3.13%) were referred to WM, and 3,701 (1.09% of those with severe and complex obesity) underwent bariatric surgery. Multivariable Poisson regression examined the associations of demographic, clinical, and regional characteristics on the likelihood of WM referral and bariatric surgery. Higher body mass index (BMI) and practice region had the strongest associations with both outcomes. People with BMI [greater than or equal to]40 kg/m.sup.2 were more than 6 times as likely to be referred for WM (10.05% of individuals) than BMI 25.0 to 29.9 kg/m.sup.2 (1.34%) (rate ratio (RR) 6.19, 95% confidence interval (CI) [5.99,6.40], p < 0.001). They were more than 5 times as likely to undergo bariatric surgery (3.98%) than BMI 35.0 to 40.0 kg/m.sup.2 with a comorbidity (0.53%) (RR 5.52, 95% CI [5.07,6.02], p < 0.001). Patients from practices in the West Midlands were the most likely to have a WM referral (5.40%) (RR 2.17, 95% CI [2.10,2.24], p < 0.001, compared with the North West, 2.89%), and practices from the East of England least likely (1.04%) (RR 0.43, 95% CI [0.41,0.46], p < 0.001, compared with North West). Patients from practices in London were the most likely to undergo bariatric surgery (2.15%), and practices in the North West the least likely (0.68%) (RR 3.29, 95% CI [2.88,3.76], p < 0.001, London compared with North West). Longer duration since diagnosis with severe and complex obesity (e.g., 1.67% of individuals diagnosed in 2007 versus 0.34% in 2015, RR 0.20, 95% CI [0.12,0.32], p < 0.001), and increasing comorbidities (e.g., 2.26% of individuals with 6+ comorbidities versus 1.39% with none (RR 8.79, 95% CI [7.16,10.79], p < 0.001) were also strongly associated with bariatric surgery. The main limitation is the reliance on overweight/obesity being recorded within primary care records to identify the study population. Conclusions Between 2007 and 2020, a very small percentage of the primary care population eligible for WM referral or bariatric surgery according to national guidance received either. Higher BMI and GP practice region had the strongest associations with both. Regional inequalities may reflect differences in commissioning and provision of WM services across the country. Multi-stakeholder qualitative research is ongoing to understand the barriers to accessing WM services and potential solutions. Together with population-wide prevention strategies, improved access to WM interventions is needed to reduce obesity levels., Author(s): Karen D. Coulman 1,2,3,*, Ruta Margelyte 4,5, Tim Jones 1,4,5, Jane M. Blazeby 2, John Macleod 2,3,4, Amanda Owen-Smith 1, Helen Parretti 6, Richard Welbourn 7, Maria Theresa Redaniel [...]