Political voting in the United Kingdom 2019 general election and risk of living with obesity in a nationally representative sample.

BACKGROUND: Limited evidence from the United States suggests that county/state rates of people with obesity are positively associated with voting for the Republican Party presidential candidate, although this question has not yet been studied at the individual level, and/or outside of the United States, where the health and political systems are very different in other countries. OBJECTIVES: Using individual level data, assess differences in rates of people with obesity according to political voting in the United Kingdom 2019 general election, and examine whether people living in constituencies won by Members of Parliament (MPs) from the Conservative Party were more likely to be living with obesity than those living in constituencies won by MPs from other parties. METHODS: Data was obtained by the Ipsos KnowledgePanel where panellists are recruited via a random probability unclustered address-based sampling method. 4000/14,016 panellists were randomly invited to provide data on socio-demographics, health outcomes, voting behaviour and height/weight. RESULTS: 2668/4000 (67%) of invitees provided data, 95/2668 (3.5%) were not eligible to vote, with the remaining 2573 (96.5%) included. Conservative Party voters were more likely to be living with obesity than those who voted Labour (OR:1.42 95% CI (1.01-1.99)) or Liberal Democrats (1.54 95% CI (1.00-2.37)). Conservative Party voters on average had significantly higher BMI scores than those voting Labour and Liberal Democrats; BMI mean difference 0.88 points (95% CI: 0.16-1.61) between Conservative and Labour voters, and 1.04 points (95% CI: 0.07-2.02) between Conservatives and Liberal Democrats voters. There was no evidence participants living in constituencies won by Conservative MPs were more likely to be living with obesity than constituencies won by other party MPs. CONCLUSION: Governments and public health agencies may need to focus on the political affiliation of the public when developing strategies to reduce the number of people with obesity.

"Fear of raising the problem without a solution": a qualitative study of patients' and healthcare professionals' views regarding the integration of routine support for physical activity within breast cancer care.

OBJECTIVE: The benefits of physical activity across the cancer continuum for many adult cancers are well established. However, physical activity is yet to be routinely implemented into health services throughout the world. This study aims to explore patients' and healthcare professionals' views about integrating conversations and support for physical activity into routine care during treatment for breast cancer. METHODS: Healthcare professionals and patients from across the UK living with or beyond breast cancer were invited to take part in semi-structured interviews that were conducted online. Recruitment for the study was advertised on social media, in cancer support groups and newsletters. Data were analysed using inductive thematic analysis. RESULTS: Three themes captured perceptions of integrating support for physical activity in routine breast cancer care among 12 health care professionals (who deliver breast cancer care) and 15 patients. Themes between healthcare professionals and patients overlapped, and therefore, combined themes are presented. These were: (1) current practice; (2) implementation in care and (3) training needs. CONCLUSION: Many healthcare professionals who offer cancer care are reluctant to raise the topic of physical activity with patients, yet patients have suggested that they would like additional support to be physically active from their medical team. Providing healthcare professionals with education regarding the benefits of physical activity to reduce the risk of recurrence along with evidence based low-cost, remote interventions would allow them to integrate conversations about physical activity within routine cancer care for all patients.

Views of the public about Snacktivity™: a small changes approach to promoting physical activity and reducing sedentary behaviour.

BACKGROUND: Many people do not meet the recommended health guidance of participation in a minimum of 150-300 min of moderate intensity physical activity per week, often promoted as at least 30 min of physical activity on 5 days of the week. This is concerning and highlights the importance of finding innovative ways to help people to be physically active each day. Snacktivity™ is a novel approach that aims to encourage people to do small, 2-5 min bouts of physical activity 'snacks' throughout the whole day, such that they achieve at least 150 min of moderate intensity activity per week. However, before it can be recommended, there is a need to explore whether the concept is acceptable to the public. METHODS: A survey to assess the views of the public about Snacktivity™ was distributed to adult patients registered at six general practices in the West Midlands, UK and to health care employees in the same region. RESULTS: A total of 5989 surveys were sent to patients, of which 558 were returned (9.3%). A further 166 surveys were completed by health care employees. A total of 85% of respondents liked the Snacktivity™ concept. The flexibility of the approach was highly rated. A high proportion of participants (61%) reported that the ability to self-monitor their behaviour would help them to do Snacktivity™ throughout their day. Physically inactive participants perceived that Snacktivity™ would help to increase their physical activity, more than those who were physically active (OR = 0.41, 95% CI: 0.25-0.67). Approximately 90% of respondents perceived that Snacktivity™ was easy to do on a non-working day compared to 60% on a working day. Aerobic activity 'snacks' were preferred to those which were strength based. CONCLUSIONS: The Snacktivity™ approach to promoting physical activity was viewed positively by the public and interventions to test the merits of such an approach now need to be developed and tested in a variety of everyday contexts.

Many-Body Quantum State Diffusion for Non-Markovian Dynamics in Strongly Interacting Systems.

Capturing non-Markovian dynamics of open quantum systems is generally a challenging problem, especially for strongly interacting many-body systems. In this Letter, we combine recently developed non-Markovian quantum state diffusion techniques with tensor network methods to address this challenge. As a first example, we explore a Hubbard-Holstein model with dissipative phonon modes, where this new approach allows us to quantitatively assess how correlations spread in the presence of non-Markovian dissipation in a 1D many-body system. We find regimes where correlation growth can be enhanced by these effects, offering new routes for dissipatively enhancing transport and correlation spreading, relevant for both solid state and cold atom experiments.

Measurement of Identical Particle Entanglement and the Influence of Antisymmetrization.

We explore the relationship between symmetrization and entanglement through measurements on few-particle systems in a multiwell potential. In particular, considering two or three trapped atoms, we measure and distinguish correlations arising from two different physical origins: antisymmetrization of the fermionic wave function and interaction between particles. We quantify this through the entanglement negativity of states, and the introduction of an antisymmetric negativity, which allows us to understand the role that symmetrization plays in the measured entanglement properties. We apply this concept both to pure theoretical states and to experimentally reconstructed density matrices of two or three mobile particles in an array of optical tweezers.

Feasibility and acceptability of a brief routine weight management intervention for postnatal women embedded within the national child immunisation programme in primary care: randomised controlled cluster feasibility trial.

BACKGROUND: The prevalence of obesity in women continues to rise and pregnancy is a high-risk time for excessive weight gain. The period after childbirth represents an opportunity to offer women support to manage their weight. The primary aim here was to investigate the acceptability and feasibility of delivering a self-management intervention to postnatal women to support weight loss, embedded within the national child immunisation programme. METHODS: The research involved a randomised controlled cluster feasibility trial. Data were collected at baseline and 3 months later. Twenty-eight postnatal women living with overweight or obesity were recruited via Birmingham Women Hospital or general practices. Babies are routinely immunised at 2, 3 and 4 months of age; the intervention was embedded within these appointments. The intervention involved brief motivation/support by practice nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme, when they attended their practice to have their child immunised. The role of the nurse was to provide external accountability for weight loss. Participants were asked to weigh themselves weekly and record this on a record card or using the online programme. The weight goal was for participants to lose 0.5 to 1 kg per week. Usual care received a healthy lifestyle leaflet. The primary outcome was the feasibility of a phase III trial to test the subsequent effectiveness of the intervention, as assessed against three stop-go traffic light criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS: The traffic light stop-go criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. DISCUSSION: Whilst participants and nurses followed the trial protocol well and adherence to self-weighing was acceptable, recruitment was challenging and there is scope to improve engagement with the online weight management programme component of the intervention. TRIAL REGISTRATION: ISRCTN 12209332 . Registration date is 04/12/18.

Dynamical Disentangling and Cooling of Atoms in Bilayer Optical Lattices.

We show how experimentally available bilayer lattice systems can be used to prepare quantum many-body states with exceptionally low entropy in one layer, by dynamically disentangling the two layers. This disentangling operation moves one layer-subsystem A-into a regime where excitations in A develop a single-particle gap. As a result, this operation maps directly to cooling for subsystem A, with entropy being shuttled to the other layer. For both bosonic and fermionic atoms, we study the corresponding dynamics showing that disentangling can be realized cleanly in ongoing experiments. The corresponding entanglement entropies are directly measurable with quantum gas microscopes, and, as a tool for producing lower-entropy states, this technique opens a range of applications beginning with simplifying production of magnetically ordered states of bosons and fermions.

Central and peripheral line-associated bloodstream infections in Australian neonatal and paediatric intensive care units: findings from a comprehensive Victorian surveillance network, 2008-2016.

BACKGROUND: Healthcare-associated infections in neonatal and paediatric populations are associated with poorer outcomes and healthcare costs, and surveillance is a necessary component of prevention programmes. AIM: To evaluate burden of illness, aetiology, and time-trends for central and peripheral line-associated bloodstream infection (CLABSI and PLABSI) in Australian neonatal and paediatric intensive care units (ICUs) between July 1st, 2008 and December 31st, 2016. METHODS: Using National Healthcare Safety Network methods, surveillance in neonatal and paediatric units was performed by hospitals participating in the Victorian Healthcare Associated Infection Surveillance System. Mixed effects Poisson regression was used to model infections over time. FINDINGS: Overall, 82 paediatric CLABSI events were reported during 37,125 CVC-days (2.21 per 1000 CVC-days), 203 neonatal CLABSI events were reported during 92,169 CVC-days (2.20 per 1000 CVC-days), and 95 neonatal PLABSI events were reported during 142,240 peripheral line-days (0.67 per 1000 peripheral line-days). Over time, a significant decrease in quarterly risk for neonatal CLABSI events was observed (risk ratio (RR): 0.98; 95% confidence interval: 0.97-0.99; P = 0.023) and this reduction was significant for the 751-1000 g birth weight cohort (RR: 0.97; P = 0.015). Most frequently, coagulase-negative Staphylococcus spp. (24.2%) and Staphylococcus aureus (16.1%) were responsible for CLABSI events. A significant reduction in Gram-negative neonatal infections was observed (annual RR: 0.85; P < 0.001). CONCLUSION: CLABSI rates in neonatal and paediatric ICUs in our region are low, and neonatal infections have significantly diminished over time. Evaluation of infection prevention programmes is required to determine whether specific strategies can be implemented to further reduce infection risk.

What factors influence weight loss in participants of commercial weight loss programmes? Implications for health policy.

BACKGROUND: Finding effective referral policies for weight management services would have important public health implications. AIM: Here we compare percentage weight change by referral methods, BMI categories and participants who have had attended weight loss programmes multiple times. DESIGN AND SETTINGS: A prospective cohort study of 15,621 participants referred to 12-week behavioural weight loss programmes funded by the public health service in Birmingham, UK. METHODS: Comparisons were made between GP versus self-referrals, BMI ≥40kg/m2-<40kg/m2 and multiple referrals compared to only one referral. Linear mixed modelling was used to assess percentage weight change after adjusting for covariates. RESULTS: Participant's mean age was 48.5 years, 78.7% were of white ethnicity, 90.3% female and mean baseline BMI was 36.3kg/m2. There were no significant differences in percentage weight loss, between participants that self-referred and those that were referred by their general practitioner (GP) and no significant differences between baseline BMI categories. Referral to a weight loss programme more than once was associated with less weight loss at subsequent attendances (0.92%, 95% CI 0.70-1.14, p<0.001). CONCLUSION: Allowing self-referral to a weight loss programme widens access without compromising amount of weight lost. These programmes are beneficial for all categories of obesity, including those with a BMI ≥40kg/m2. Attending weight management programmes more than once results in less weight loss and that swapping to a different program may be advisable.

Floquet Engineering of Correlated Tunneling in the Bose-Hubbard Model with Ultracold Atoms.

We report on the experimental implementation of tunable occupation-dependent tunneling in a Bose-Hubbard system of ultracold atoms via time-periodic modulation of the on-site interaction energy. The tunneling rate is inferred from a time-resolved measurement of the lattice site occupation after a quantum quench. We demonstrate coherent control of the tunneling dynamics in the correlated many-body system, including full suppression of tunneling as predicted within the framework of Floquet theory. We find that the tunneling rate explicitly depends on the atom number difference in neighboring lattice sites. Our results may open up ways to realize artificial gauge fields that feature density dependence with ultracold atoms.

Feasibility and acceptability of regular weighing, setting weight gain limits and providing feedback by community midwives to prevent excess weight gain during pregnancy: randomised controlled trial and qualitative study.

BACKGROUND: Regular weighing in pregnant women is not currently recommended in many countries but has been suggested to prevent excessive gestational weight gain. This study aimed to establish the feasibility and acceptability of incorporating regular weighing, setting maximum weight gain targets and feedback by community midwives. METHODS: Low risk pregnant women cared for by eight community midwives were randomised to usual care or usual care plus the intervention at 10-14 weeks of pregnancy. The intervention involved community midwives weighing and plotting weight on a weight gain chart, setting weight gain limit targets, giving brief feedback at each antenatal appointment and encouraging women to weigh themselves weekly between antenatal appointments. Women and midwives were interviewed about their views of the intervention. The focus of the study was on process evaluation. RESULTS: Community midwives referred 123 women and 115 were scheduled for their dating scan within the study period. Of these, 84/115 were approached at their dating scan and 76/84 (90.5 %) randomised. Data showed a modest difference favouring the intervention group in the percentage of women gaining excessive gestational weight (23.5 % versus 29.4 %). The intervention group consistently reported smaller increases in depression and anxiety scores throughout pregnancy compared with usual care. Most women commented the intervention was useful in encouraging them to think about their weight and believed it should be part of routine antenatal care. Community midwives felt the intervention could be implemented within routine care without adding substantially to consultation length, thus not perceived as adding substantially to their workload. CONCLUSIONS: The intervention was feasible and acceptable to pregnant women and community midwives and was readily implemented in routine care. TRIAL REGISTRATION: ISRCTN81605162.

Cluster analysis of behavioural weight management strategies and associations with weight change in young women: a longitudinal analysis.

BACKGROUND/OBJECTIVES: Maintaining a healthy weight is important for the prevention of many chronic diseases. Little is known about the strategies used by young women to manage their weight, or the effectiveness of these in preventing weight gain. We aimed to identify clusters of weight control strategies used by women and to determine the average annual weight change among women in each cluster from 2000 to 2009. METHODS: Latent cluster analysis of weight control strategies reported by 8125 participants in the Australian Longitudinal Study of Women's Health. Analyses were performed in March-November 2014. RESULTS: Weight control strategies were used by 79% of the women, and four unique clusters were found. The largest cluster group (39.7%) was named dieters as 90% had been on a diet in the past year, and half of these women had lost 5 kg on purpose. Women cut down on size of meals, fats and sugars and took part in vigorous physical activity. Additionally 20% had used a commercial programme. The next largest cluster (30.2%) was the healthy living group who followed the public health messages of 'eat less and move more'. The do nothing group (20%) did not actively control their weight whereas the perpetual dieters group (10.7%) used all strategies, including unhealthy behaviours. On average women gained 700 g per year (over 9 years); however, the perpetual dieters group gained significantly more weight (210 g) than the do nothing group (P<0.001). CONCLUSIONS: Most women are actively trying to control their weight. The most successful approach was to follow the public health guidelines on health eating and physical activity.

A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial.

BACKGROUND: Postnatal depression affects about 10-15% of women in the year after giving birth. Many women and healthcare professionals would like an effective and accessible non-pharmacological treatment for postnatal depression. METHOD: Women who fulfilled the International Classification of Diseases (ICD)-10 criteria for major depression in the first 6 months postnatally were randomized to receive usual care plus a facilitated exercise intervention or usual care only. The intervention involved two face-to-face consultations and two telephone support calls with a physical activity facilitator over 6 months to support participants to engage in regular exercise. The primary outcome was symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) at 6 months post-randomization. Secondary outcomes included EPDS score as a binary variable (recovered and improved) at 6 and 12 months post-randomization. RESULTS: A total of 146 women were potentially eligible and 94 were randomized. Of these, 34% reported thoughts of self-harming at baseline. After adjusting for baseline EPDS, analyses revealed a -2.04 mean difference in EPDS score, favouring the exercise group [95% confidence interval (CI) -4.11 to 0.03, p = 0.05]. When also adjusting for pre-specified demographic variables the effect was larger and statistically significant (mean difference = -2.26, 95% CI -4.36 to -0.16, p = 0.03). Based on EPDS score a larger proportion of the intervention group was recovered (46.5% v. 23.8%, p = 0.03) compared with usual care at 6 months follow-up. CONCLUSIONS: This trial shows that an exercise intervention that involved encouragement to exercise and to seek out social support to exercise may be an effective treatment for women with postnatal depression, including those with thoughts of self-harming.

The effectiveness of exercise as treatment for vasomotor menopausal symptoms: randomised controlled trial.

OBJECTIVE: To investigate the effectiveness of exercise as treatment for vasomotor menopausal symptoms. DESIGN: Three-group randomised controlled trial, two exercise interventions and a control group. SETTING: Primary Care, West Midlands UK. POPULATION: Perimenopausal and postmenopausal women experiencing at least five hot flushes/night sweats per day and not taken MHT in previous 3 months were recruited from 23 general practices. METHODS: Participants in both exercise interventions groups were offered two face-to-face consultations with a physical activity facilitator to support engagement in regular exercise. In addition, one exercise group received a menopause-specific information DVD and written materials to encourage regular exercise and the other exercise group was offered the opportunity to attend exercise social support groups in their communities. Interventions lasted 6 months. MAIN OUTCOME MEASURE: The primary outcome was frequency of hot flushes/night sweats at 6-month up. RESULTS: Two hundred and sixty-one women were randomised (n = 87 per group). Neither of the exercise intervention groups reported significantly less frequent hot flushes/night sweats per week than controls (exercise-DVD versus control: -8.9, 95% CI -20.0 to 2.2; exercise-social support versus control: -5.2, 95% CI -16.7 to 6.3). CONCLUSIONS: This trial indicates that exercise is not an effective treatment for hot flushes/night sweats. Contrary to current clinical guidance, women should not be advised that exercise will relieve their vasomotor menopausal symptoms.

The effectiveness of exercise for the prevention and treatment of antenatal depression: systematic review with meta-analysis.

BACKGROUND: Antenatal depression can have harmful consequences for the mother and fetus. Exercise may be a useful intervention to prevent and treat antenatal depression. OBJECTIVES: This systematic review aims to establish whether there is sufficient evidence to conclude that exercise is an effective intervention for preventing and treating antenatal depression. SEARCH STRATEGY: Searches using electronic databases from MEDLINE, Cochrane Library, CINAHL, EMBASE, AMED and PsycINFO were performed. SELECTION CRITERIA: Randomised controlled trials (RCT) that compared any type of exercise intervention with any comparator in pregnant women were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Meta-analysis was performed calculating standardised mean differences (SMD). MAIN RESULTS: Six trials (seven comparisons) were eligible for inclusion. Meta-analysis showed a significant reduction in depression scores (SMD -0.46, 95% CI -0.87 to -0.05, P = 0.03, I(2) = 68%) for exercise interventions relative to comparator groups. The test for subgroup differences in women who were non-depressed (one trial) (SMD -0.74, 95%CI -1.22 to -0.27, P = 0.002) and depressed (five trials) (SMD -0.41, 95% CI -0.88 to 0.07, P = 0.09) at baseline was not significant (P = 0.32). The test for subgroup differences between aerobic (one trial) and non-aerobic exercise (five trials) was also nonsignificant (P = 0.32). AUTHORS' CONCLUSIONS: We found some evidence that exercise may be effective in treating depression during pregnancy but this conclusion is based on a small number of low-moderate quality trials with significant heterogeneity and wide confidence intervals.

Quantum quench in an atomic one-dimensional Ising chain.

We study nonequilibrium dynamics for an ensemble of tilted one-dimensional atomic Bose-Hubbard chains after a sudden quench to the vicinity of the transition point of the Ising paramagnetic to antiferromagnetic quantum phase transition. The quench results in coherent oscillations for the orientation of effective Ising spins, detected via oscillations in the number of doubly occupied lattice sites. We characterize the quench by varying the system parameters. We report significant modification of the tunneling rate induced by interactions and show clear evidence for collective effects in the oscillatory response.

Pragmatic exercise intervention for people with multiple sclerosis (ExIMS trial): study protocol for a randomised controlled trial.

Exercise is an effective intervention for improving function, mobility and health-related quality of life in people with multiple sclerosis (PwMS). Questions remain however, regarding the effectiveness of pragmatic exercise interventions for evoking tangible and sustained increases in physical activity and long-term impact on important health outcomes in PwMS. Furthermore, dose-response relationships between exercise and health outcomes have not previously been reported in PwMS. These issues, and improved knowledge of cost effectiveness, are likely to influence key decisions of health policy makers regarding the implementation of exercise therapy as part of the patient care pathway for PwMS. Hence, the primary aim of this study is to investigate whether a 12-week tapered programme of supervised exercise, incorporating cognitive-behavioural techniques to facilitate sustained behaviour change, is effective for evoking improvements in physical activity and key health outcomes in PwMS over 9 months of follow-up. A total of 120 PwMS will be randomised (1:1) to either a 12-week pragmatic exercise therapy intervention or usual care control group. Participants will be included on the basis of a clinical diagnosis of MS, with an expanded disability status score (EDSS) between 1 and 6.5. Outcome measures, to be assessed before and after the intervention and 6 months later, will include physical activity, clinical and functional measures and health-related quality of life. In addition, the cost effectiveness of the intervention will be evaluated and dose-response relationships between physical activity and the primary/secondary outcomes in those with mild and more severe disease will be explored.

Effects of an exercise and hypocaloric healthy eating program on biomarkers associated with long-term prognosis after early-stage breast cancer: a randomized controlled trial.

Excess body weight at diagnosis and weight gain after breast cancer are associated with poorer long-term prognosis. This study investigated the effects of a lifestyle intervention on body weight and other health outcomes influencing long-term prognosis in overweight women (BMI > 25.0 kg/m(2)) recovering from early-stage (stage I-III) breast cancer. A total of 90 women treated 3-18 months previously were randomly allocated to a 6-month exercise and hypocaloric healthy eating program (n = 47, aged 55.6 ± 10.2 year) or control group (n = 43, aged 55.9 ± 8.9 year). Women in the intervention group received three supervised exercise sessions per week and individualized dietary advice, supplemented by weekly nutrition seminars. Body weight, waist circumference, waist/hip ratio [WHR], cardiorespiratory fitness, blood biomarkers associated with breast cancer recurrence and cardiovascular disease risk, and quality of life (FACT-B) were assessed at baseline and 6 months. Three-day diet diaries were used to assess macronutrient and energy intakes. A moderate reduction in body weight in the intervention group (median difference from baseline of -1.09 kg; IQR -0.15 to -2.90 kg; p = 0.07) was accompanied by significant reductions in waist circumference (p < 0.001), WHR (p = 0.005), total (p = 0.021) and saturated fat (p = 0.006) intakes, leptin (p = 0.005), total cholesterol (p = 0.046), and resting diastolic blood pressure (p = 0.03). Cardiopulmonary fitness (p < 0.001) and FACT-B quality of life (p = 0.004) also showed significant improvements in the intervention group. These findings suggest that an individualized exercise and a hypocaloric healthy eating program can positively impact upon health outcomes influencing long-term prognosis in overweight women recovering from early-stage breast cancer.