In vivo ephaptic coupling allows memory network formation

It is increasingly clear that memories are distributed across multiple brain areas. Such "engram complexes" are important features of memory formation and consolidation. Here, we test the hypothesis that engram complexes are formed in part by bioelectric fields that sculpt and guide the neural activity and tie together the areas that participate in engram complexes. Like the conductor of an orchestra, the fields influence each musician or neuron and orchestrate the output, the symphony. Our results use the theory of synergetics, machine learning, and data from a spatial delayed saccade task and provide evidence for in vivo ephaptic coupling in memory representations.

Coordination challenges and promising practices for pediatric healthcare-community partnerships: A multi-site study

There have been delays integrating universal screening and referral for social needs in pediatric practice. The study investigated two frameworks for clinic-based screen-and-refer practice in eight clinics. The frameworks depict different organizational strategies to bolster family access to community resources. We conducted semi-structured interviews with healthcare and community partners at two timepoints (n = 65) to investigate start-up and ongoing implementation experiences, including continuing challenges. Results highlighted common within-clinic and clinic-community coordination challenges across diverse settings as well as promising practices supported by the two frameworks. In addition, we identified ongoing implementation challenges that face efforts to integrate these approaches and to translate screening results into activities that help children and families. Assessing the existing service referral coordination infrastructure of each clinic and community in early implementation is critical to screen-and-refer practice as this influences the continuum of supports available to meet family needs.

Association of body mass index with health care expenditures in the United States by age and sex

Background

Estimates of health care costs associated with excess weight are needed to inform the development of cost-effective obesity prevention efforts. However, commonly used cost estimates are not sensitive to changes in weight across the entire body mass index (BMI) distribution as they are often based on discrete BMI categories.

Methods

We estimated continuous BMI-related health care expenditures using data from the Medical Expenditure Panel Survey (MEPS) 2011–2016 for 175,726 respondents. We adjusted BMI for self-report bias using data from the National Health and Nutrition Examination Survey (NHANES) 2011–2016, and controlled for potential confounding between BMI and medical expenditures using a two-part model. Costs are reported in $US 2019.

Results

We found a J-shaped curve of medical expenditures by BMI, with higher costs for females and the lowest expenditures occurring at a BMI of 20.5 for adult females and 23.5 for adult males. Over 30 units of BMI, each one-unit BMI increase was associated with an additional cost of $253 (95% CI $167-$347) per person. Among adults, obesity was associated with $1,861 (95% CI $1,656-$2,053) excess annual medical costs per person, accounting for $172.74 billion (95% CI $153.70-$190.61) of annual expenditures. Severe obesity was associated with excess costs of $3,097 (95% CI $2,777-$3,413) per adult. Among children, obesity was associated with $116 (95% CI $14-$201) excess costs per person and $1.32 billion (95% CI $0.16-$2.29) of medical spending, with severe obesity associated with $310 (95% CI $124-$474) excess costs per child.

Conclusions

Higher health care costs are associated with excess body weight across a broad range of ages and BMI levels, and are especially high for people with severe obesity. These findings highlight the importance of promoting a healthy weight for the entire population while also targeting efforts to prevent extreme weight gain over the life course.

Cost-Effectiveness of 2 Support Models for a Healthy School Initiative

BACKGROUND

In school year (SY) 2014-2015, 128 schools in 24 districts and 14 states were randomly assigned to receive either onsite or online support to implement a school-based wellness program. The objective of this study was to assess the cost-effectiveness (CE) of the 2 models of implementation support: onsite and online.

METHODS

We adapted the "ingredients method" for the CE analysis. Using expenditure data, we tabulated the costs of relevant expense categories and allocated the appropriate proportion to determine the total costs of providing each type of support for 4 years (SY 2014-2015 through SY 2017-2018). We divided the average cost per school by the average change in school wellness policies and practices, using assessment data provided by the program provider, to calculate a CE ratio for schools in each group.

RESULTS

Findings indicate that when the program is implemented as intended, online support is, on average, approximately 1.3 times more cost-effective than onsite support at the end of 4 years.

CONCLUSIONS

By demonstrating the relative CE of 2 approaches to supporting the implementation of a school health program, this study provides further insight on more efficient interventions for improving overall school wellness.

Pregnancy Intentions, Contraceptive Knowledge And Educational Aspirations Among Community College Students

CONTEXT

Community college students, representing more than one-third of U.S. undergraduates, are a diverse population of young people motivated to seek higher education who are at elevated risk of unintended pregnancy. However, it is unknown how well prepared they are to prevent pregnancy and what they think about it in terms of their educational aspirations.

METHODS

In-depth interviews were conducted with 57 students aged 18-25, inclusive of all genders, in three community colleges in California in 2015. Content analysis was used to code data and identify themes.

RESULTS

All participants reported strong desires to prevent pregnancy in the next year and perceived their pregnancy risk as low, but many reported unprotected sex with opposite-sex partners. Participants had specific timelines for completing their degrees and believed pregnancy would make that far more challenging, but would not ultimately prevent them from achieving their goals. Female students expressed concern about the risks of exacerbated poverty, housing instability and unachieved career goals. Participants had little knowledge of their pregnancy risks and of the health benefits, side effects or effectiveness of contraceptives. They held negative beliefs about hormonal contraception (including emergency contraception, IUDs and the implant), fearing long-lasting effects and infertility. Gay or bisexual students shared concerns about contraceptives, although several were using methods for noncontraceptive reasons.

CONCLUSION

Many community college students not desiring pregnancy have limited awareness of pregnancy risk and prevention.

A pilot and feasibility study to assess children's consumption in quick-service restaurants using plate waste methodology

BACKGROUND

Children regularly consume foods from quick-service restaurants (QSR), but little is known about the foods that children order, the calories and nutrients consumed, the accuracy of stated calorie information, or the ability to assess food orders and consumption in QSRs. This study evaluated the feasibility of plate waste collection in QSRs and examined children's orders and consumption of meals from the standard and children's menus. Additional aims were to examine if the meals ordered met healthier standards for children's menu items and determine the accuracy of the QSR-stated energy content of foods.

METHODS

Fifteen QSRs, two malls, and 116 eligible parents were approached to participate in the study in 2015. Among the families recruited, children's meal orders and consumption were analyzed using plate waste methodology, and a subsample of foods was analyzed using bomb calorimetry in 2015.

RESULTS

Two individual QSRs and one mall food court with two QSRs agreed to participate, and n = 50 participants (parents with children between the ages of 5-10 years) were recruited. Children consumed on average 519 calories, 5.7 g saturated fat, 957 mg sodium, 3.7 g fiber, and 22.7 g sugar. Children ordered and consumed significantly fewer calories and less sodium and sugar with meals ordered exclusively from the children's menu compared with the standard menu. Overall there were no significant differences between the measured and stated energy contents of the QSR foods.

CONCLUSIONS

Conducting plate waste research in QSRs is feasible and there is concordance with stated calorie information. Consuming foods exclusively from the children's menu may help limit overconsumption in QSRs.