Improving child weight management uptake through enhanced National Child Measurement Programme parental feedback letters: A randomised controlled trial

This single-blind, pragmatic, cluster randomised controlled trial aims to investigate uptake of children's weight management services in response to enhanced National Child Measurement Programme (NCMP) letters providing weight status feedback to parents in three English counties in 2015. Parents of 2642 overweight or very overweight (obese) children aged 10-11 years received an intervention or control letter informing them of their child's weight status. Intervention letters included (i) a visual tool to help weight status recognition, (ii) a social norms statement, and for very overweight children, (iii) a prepopulated booking form for weight management services. The primary outcome was weight management service enrolment. Additional outcome measures included attendance at and contact made with weight management services, and a number of self-report variables. A small effect was observed, with intervention parents being significantly more likely to enrol their children in weight management services (4.33% of Intervention group) than control parents (2.19% of Control group) in both unadjusted (OR = 2.08, p = .008) and adjusted analyses (AOR = 2.48, p = .001). A similar picture emerged for contact with services (4.80% Intervention vs. 2.41% Control; OR = 2.10, p = .003; AOR = 2.46, p < .001) and attendance at services, although group differences in the latter measure were not significant after corrections for multiple comparisons (1.89% Intervention vs. 1.02% Control; AOR = 2.11, p = .047). No effects were found on self-report variables. Theoretically informed weight status feedback letters appear to be an effective strategy to improve enrolment in paediatric weight management services.

Human TNF-Luc reporter mouse: A new model to quantify inflammatory responses

Tumour necrosis factor (TNF) is a key cytokine during inflammatory responses and its dysregulation is detrimental in many inflammatory diseases, such as rheumatoid arthritis and inflammatory bowel disease. Here, we used a bacterial artificial chromosome (BAC) construct that expresses luciferase under the control of the human TNF locus to generate a novel transgenic mouse, the hTNF.LucBAC strain. In vitro stimulation of hTNF.LucBAC cells of different origin revealed a cell specific response to stimuli demonstrating the integrated construct's ability as a proxy for inflammatory gene response. Lipopolysaccharide was the most potent luciferase inducer in macrophages, while TNF was a strong activator in intestinal organoids. Lipopolysaccharide-induced luciferase activity in macrophages was downregulated by inhibitors of NF-κB pathway, as well as by Interleukin-10, a known anti-inflammatory cytokine. Moreover, the transgene-dependent luciferase activity showed a positive correlation to the endogenous murine soluble TNF secreted to the culture medium. In conclusion, the hTNF.LucBAC strain is a valuable tool for studying and screening molecules that target TNF synthesis and will allow further functional studies of the regulatory elements of the TNF locus.

The intervertebral disc contains intrinsic circadian clocks that are regulated by age and cytokines and linked to degeneration

OBJECTIVES

The circadian clocks are internal timing mechanisms that drive ∼24-hour rhythms in a tissue-specific manner. Many aspects of the physiology of the intervertebral disc (IVD) show clear diurnal rhythms. However, it is unknown whether IVD tissue contains functional circadian clocks and if so, how their dysregulation is implicated in IVD degeneration.

METHODS

Clock gene dynamics in ex vivo IVD explants (from PER2:: luciferase (LUC) reporter mice) and human disc cells (transduced with lentivirus containing Per2::luc reporters) were monitored in real time by bioluminescence photon counting and imaging. Temporal gene expression changes were studied by RNAseq and quantitative reverse transcription (qRT)-PCR. IVD pathology was evaluated by histology in a mouse model with tissue-specific deletion of the core clock gene Bmal1.

RESULTS

Here we show the existence of the circadian rhythm in mouse IVD tissue and human disc cells. This rhythm is dampened with ageing in mice and can be abolished by treatment with interleukin-1β but not tumour necrosis factor α. Time-series RNAseq revealed 607 genes with 24-hour patterns of expression representing several essential pathways in IVD physiology. Mice with conditional knockout of Bmal1 in their disc cells demonstrated age-related degeneration of IVDs.

CONCLUSIONS

We have established autonomous circadian clocks in mouse and human IVD cells which respond to age and cytokines, and control key pathways involved in the homeostasis of IVDs. Genetic disruption to the mouse IVD molecular clock predisposes to IVD degeneration. These results support the concept that disruptions to circadian rhythms may be a risk factor for degenerative IVD disease and low back pain.

Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis

Objective

Haemorrhagic cystitis (HC) is a relatively common complication of chemotherapy and radiotherapy to the pelvic area, but can be a challenging condition to treat, particularly since there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed.

Materials and methods

A comprehensive literature search was undertaken to evaluate the evidence for the diagnosis, prevention and management of cancer treatment-induced HC.

Results

Recommendations and a proposed management algorithm for the diagnosis, prevention and treatment of HC, as well as the management of intractable haematuria, have been developed based on the expert opinion of the multidisciplinary consensus panel following a comprehensive review of the available clinical data.

Conclusion

These guidelines are relevant and applicable to current clinical practice and will help clinicians optimally define and manage this potentially serious condition.

Signal transduction controls heterogeneous NF-κB dynamics and target gene expression through cytokine-specific refractory states

Cells respond dynamically to pulsatile cytokine stimulation. Here we report that single, or well-spaced pulses of TNFα (>100 min apart) give a high probability of NF-κB activation. However, fewer cells respond to shorter pulse intervals (<100 min) suggesting a heterogeneous refractory state. This refractory state is established in the signal transduction network downstream of TNFR and upstream of IKK, and depends on the level of the NF-κB system negative feedback protein A20. If a second pulse within the refractory phase is IL-1β instead of TNFα, all of the cells respond. This suggests a mechanism by which two cytokines can synergistically activate an inflammatory response. Gene expression analyses show strong correlation between the cellular dynamic response and NF-κB-dependent target gene activation. These data suggest that refractory states in the NF-κB system constitute an inherent design motif of the inflammatory response and we suggest that this may avoid harmful homogenous cellular activation.

Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults

BACKGROUND

Obesity levels continue to rise annually. Face-to-face weight loss consultations have previously identified mixed effectiveness and face high demand with limited resources. Therefore, alternative interventions, such as internet-delivered interventions, warrant further investigation. The aim was to assess whether internet-delivered weight loss interventions providing personalized feedback were more effective for weight loss in overweight and obese adults in comparison with control groups receiving no personalized feedback.

METHOD

Nine databases were searched, and 12 studies were identified that met all inclusion criteria.

RESULTS

Meta-analysis, identified participants receiving personalized feedback via internet-delivered interventions, had 2.13 kg mean difference (SMD) greater weight loss (and BMI change, waist circumference change and 5% weight loss) in comparison with control groups providing no personalized feedback. This was also true for results at 3 and 6-month time points but not for studies where interventions lasted ≥12 months.

CONCLUSION

This suggests that personalized feedback may be an important behaviour change technique (BCT) to incorporate within internet-delivered weight loss interventions. However, meta-analysis results revealed no differences between internet-delivered weight loss interventions with personalized feedback and control interventions ≥12 months. Further investigation into longer term internet-delivered interventions is required to examine how weight loss could be maintained. Future research examining which BCTs are most effective for internet-delivered weight loss interventions is suggested.

BCL-3 attenuation of TNFA expression involves an incoherent feed-forward loop regulated by chromatin structure

Induction of genes is rarely an isolated event; more typically occurring as part of a web of parallel interactions, or motifs, which act to refine and control gene expression. Here, we define an Incoherent Feed-forward Loop motif in which TNFα-induced NF-κB signalling activates expression of the TNFA gene itself and also controls synthesis of the negative regulator BCL-3. While sharing a common inductive signal, the two genes have distinct temporal expression profiles. Notably, while the TNFA gene promoter is primed to respond immediately to activated NF-κB in the nucleus, induction of BCL3 expression only occurs after a time delay of about 1h. We show that this time delay is defined by remodelling of the BCL3 gene promoter, which is required to activate gene expression, and characterise the chromatin delayed induction of BCL3 expression using mathematical models. The models show how a delay in inhibitor production effectively uncouples the rate of response to inflammatory cues from the final magnitude of inhibition. Hence, within this regulatory motif, a delayed (incoherent) feed-forward loop together with differential rates of TNFA (fast) and BCL3 (slow) mRNA turnover provide robust, pulsatile expression of TNFα . We propose that the structure of the BCL-3-dependent regulatory motif has a beneficial role in modulating expression dynamics and the inflammatory response while minimising the risk of pathological hyper-inflammation.

Quantitative measurement of single cell dynamics

Over the past 20 years luminescent and fluorescent imaging assays have been developed to report on the dynamics of transcription and protein translocation in single cells. The combination of these measurements with mathematical analysis is having an increasingly significant impact on cell biology. There is an urgent need to translate these assays to the study of cells and tissues in vivo, which requires new tools and technologies. Emergence of these new tools and techniques will further the understanding of the role of signalling and transcriptional dynamics in the generation of cellular heterogeneity and the control of cell fate.

Prevalence of autistic spectrum disorders in Lothian, Scotland: an estimate using the "capture-recapture" technique

AIMS

To determine the prevalence of autistic spectrum disorder in a geographically defined population for children receiving services and compare this to the estimated prevalence based on a two source “capture–recapture” technique previously employed in biological populations to give a “true” prevalence with full ascertainment.

METHODS

Information on gender, age, and postcode sector was determined from nine different datasets maintained for children with autistic spectrum disorder and point prevalence was calculated. Data from the diagnostic services and the Special Needs System were entered into the two source “capture–recapture” calculation.

RESULTS

Of a total population of 134 661 under 15 year olds resident in Lothian in southeast Scotland, 443 were known to autism services, with a point prevalence of 32.9 per 10 000 (95% CI 29.8 to 36.0). The estimated prevalence using a capture–recapture method was 44.2 (95% CI 39.5 to 48.9), which suggests that 74% of affected children were registered with services in some way. The age distribution was similar to that of the background population under the age of 12 years and there was no indication of a rising prevalence. The ratio of boys to girls was 7:1.

CONCLUSIONS

The prevalence of autistic spectrum disorder in a geographically based population employing two source capture–recapture analysis is comparable to that quoted for the best active ascertainment studies. This technique offers a tool for establishing the prevalence of this condition in health service populations to assist in planning clinical services.

A questionnaire assessment of nutrition knowledge--validity and reliability issues

OBJECTIVE

This study describes an evaluation of validity and reliability measures in a questionnaire designed to assess knowledge of applied nutrition in children participating in an after-school care dietary intervention programme being undertaken in an area of high social disadvantage.

DESIGN

Three domains were assessed: Knowledge of Applied Nutrition (KN), Knowledge of Food Preparation (KP) and Perceived Confidence in Cooking Skills (PC). Four pilot studies were undertaken to determine item reliability, test-retest reliability, discrimination and difficulty indices, and content, cognitive and face validity.

SETTING

Primary schools in Dundee, Scotland and Newcastle upon Tyne, England.

SUBJECTS

Ninety-eight children aged 11 years.

RESULTS

The final instrument comprised 36 questions (18 KN items, 9 KP items and 9 PC items) presented on four sides of paper, which could be self-completed in less than 15 minutes. Question formatting included open and closed structures (KP) and multiple choice (KN and PC) items. All knowledge questions could be answered correctly by 5 to 95% of the target population, with discrimination scores ranging from 0.06 to 0.83. Retest reliability scores were significant (KN 0.458, KP 0.577, PC 0.381, ) and internal reliability (Cronbach's alpha) of each component was also significant.

CONCLUSION

The test meets basic psychometric criteria for reliability and validity and forms a suitable instrument for measuring changes associated with intervention work aimed at improving food and dietary knowledge.

When complexity helps: an electrophysiological analysis of multiple feature benefits in object perception

Fournier, L. R., Eriksen, C. W. and Bowd, C. (1998. Multiple feature discrimination faster than single feature discrimination within the same object? Perception & Psychophysics 60, 1384-1405) found that judging the presence of multiple features within an object is faster than judging the presence of the least discriminable of these features alone (multiple feature benefits, MFBs). When an 'absent' response is required, responses are slower when some of the relevant (target) features are present (multiple feature costs, MFCs). The present study utilized psychophysiological measures (of the event-related brain potential and the electromyogram) to determine the contributions of response priming and stimulus evaluation processes (P300 latency) to these effects. P300 latency and reaction time (RT) both showed evidence of MFBs and MFCs. These findings suggest that MFBs and MFCs can be attributed to processing that occurs prior to response selection. No dissociations between P300 latency and RT measures were found for 'present' responses across the single and multiple feature judgements. However, for 'absent' responses, partial dissociations were found between these measures, and partial errors and longer response execution intervals were observed more often when an object contained some target features. These findings suggest that response priming contributes to MFCs, but may not contribute to MFBs.

Risk of cardiovascular disease measured by carotid intima-media thickness at age 49-51: lifecourse study

OBJECTIVE

To quantify the direct and indirect effects of fetal life, childhood, and adult life on risk of cardiovascular disease at age 49-51 years.

DESIGN

Follow up study of the "Newcastle thousand families" birth cohort established in 1947.

PARTICIPANTS

154 men and 193 women who completed a health and lifestyle questionnaire and attended for clinical examination between October 1996 and December 1998.

MAIN OUTCOME MEASURES

Correlations between mean intima-media thickness of the carotid artery (carotid intima-media thickness) and family history, birth weight, and socioeconomic position around birth; socioeconomic position, growth, illness, and adverse life events in childhood; and adult socioeconomic position, lifestyle, and biological risk markers. Proportions of variance in carotid intima-media thickness that were accounted for by each stage of the lifecourse.

RESULTS

Socioeconomic position at birth and birth weight were negatively associated with carotid intima-media thickness, although only social class at birth in women was a statistically significant covariate independent of adult lifestyle. These early life variables accounted directly for 2.2% of total variance in men and 2.0% in women. More variation in carotid intima-media thickness was explained by adult socioeconomic position and lifestyle, which accounted directly and indirectly for 3.4% of variance in men (95% confidence interval 0.5% to 6.2%) and 7.6% in women (2.1% to 13.0%). Biological risk markers measured in adulthood independently accounted for a further 9.5% of variance in men (2.4% to 14.2%) and 4.9% in women (1.6% to 7.4%).

CONCLUSIONS

Adult lifestyle and biological risk markers were the most important determinants of the cardiovascular health of the study members of the Newcastle thousand families cohort at age 49-51 years. The limited overall effect of early life factors may reflect the postwar birth year of this cohort.

Development of a System to Provide Full, Real-time Remote Control of a Scanning Electron Microscope across the Second Generation Internet: The Teaching SEM

The development and makeup of a real-time full remote control system for the University of Michigan, Department of Materials Science and Engineering Teaching SEM is described. The instrument was initially controlled via the campus local area Ethernet network and cable TV network. The latest implementation employs Fast Ethernet, Asynchronous Transfer Mode (ATM) networks, and moving picture experts group (MPEG) video encoding to effect the remote control via the computer network alone. Remote control demonstrations from Washington, DC, Dearborn, MI, and Emerson School, Ann Arbor, MI are described.

Proliferation, C-myc, and cyclin D1 expression in diffuse alveolar damage: potential roles in pathogenesis and implications for prognosis

In this study we compared expression of DNA topoisomerase IIalpha, a marker of cellular proliferation, c-myc, and cyclin D1 in lung biopsy specimens showing diffuse alveolar damage (DAD) with control lung tissues. We subsequently correlated DNA topoisomerase IIalpha, c-myc, and cyclin D1 expression with survival. We hypothesized that poor outcome may correlate with a higher proliferation index, and that c-myc and cyclin D1 activation are potentially important regulators of both proliferation and apoptosis in DAD. Immnuohistochemical stains for c-myc, cyclin D1, and DNA topoisomerase IIalpha were performed on 10 cases of DAD (15 cases for DNA topoisomerase IIalpha) and 10 control lungs. A proliferation index for each case was calculated by dividing the number of nuclei expressing DNA topoisomerase IIalpha by the total number of nuclei counted. The percentages of alveolar pneumocytes and interstitial cells staining positively for c-myc and cyclin D1 were estimated. The average proliferation index (DNA topoisomerase IIalpha index) in DAD (0.16 +/- 0.06, n = 15) was significantly greater than in control lungs (0.00 +/- 0.01, n = 10) (P < .0001). The average proliferation index of patients with DAD who died of respiratory failure (0.18 +/- 0.05, n = 9) was significantly greater than the average proliferation index of patients whose respiratory disease resolved or stabilized (0.11 +/- 0.05, n = 5) (P < .03). Expression of c-myc in alveolar pneumocytes and interstitial cells was more intense and slightly more widespread in cases of DAD compared with control lungs. In 9 of 10 cases of DAD, cyclin D1 expression was present in up to 30% of alveolar pneumocytes and up to 10% of interstitial cells. No staining for cyclin D1 was present in control lungs. These results show that the proliferation index in DAD potentially correlates with patient survival. Furthermore, enhanced expression of c-myc and cyclin D1 may contribute to dysregulation of cellular proliferation and apoptosis observed in DAD.