Maternal vitamin D and markers of glycaemia during pregnancy in the Belfast centre of the Hyperglycaemia and Adverse Pregnancy Outcome study.

AIMS: To measure total 25-hydroxyvitamin D levels in women in mid-pregnancy who participated in the Belfast centre of the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) observational study, and to investigate the associations between levels of 25-hydroxyvitamin D and markers of gestational diabetes mellitus and lipid biomarkers. METHODS: A total of 1585 pregnant women had serum samples available for measurement. Participants were recruited from the Royal Jubilee Maternity Hospital, Belfast, Northern Ireland, at 24-32 weeks' gestation, as part of the HAPO study. 25-hydroxyvitamin D concentrations were measured using liquid chromatography tandem mass spectrometry. Glucose, C-peptide and lipid levels were previously analysed in a central laboratory. Statistical analysis was performed. RESULTS: The median (interquartile range) 25-hydroxyvitamin D concentration during pregnancy was 38.6 (24.1-60.7) nmol/l, with 65.8% of women being vitamin D-deficient (≤50 nmol/l). In regression analysis, the association between maternal 25-hydroxyvitamin D and fasting plasma glucose levels approached significance [regression coefficient -0.017 (95% CI -0.034 to 0.001); P=0.06], and a significant positive association was observed between maternal 25-hydroxyvitamin D and ß-cell function [1.013 (95% CI 1.001 to 1.024); P=0.031]. Maternal 25-hydroxyvitamin D level was positively associated with HDL [0.047 (95% CI 0.021 to 0.073) P≤ 0.001] and total cholesterol [0.085 (95% CI 0.002 to 0.167); P=0.044] in regression analysis. CONCLUSIONS: These results indicate a high prevalence of vitamin D deficiency during pregnancy, which requires identification and treatment; however, only weak associations were observed between 25-hydroxyvitamin D level and markers of glucose and insulin metabolism. This would suggest that these are of doubtful clinical significance.

Nutritional and clinical associations of food cravings in pregnancy.

BACKGROUND: Cravings in pregnancy are considered to alter dietary intake; however, the nutritional consequences are unknown. The present study aimed to investigate the prevalence of food cravings in pregnancy, and their contribution, as a potentially modifiable determinant of weight gain and the development of obesity in pregnancy. METHODS: Healthy pregnant women were participants in the Belfast cohort of the Hyperglycaemia and Adverse Pregnancy Outcome study (HAPO), a prospective observational study examining maternal glycaemia and pregnancy outcome. Diet was assessed at an average of 29 weeks of gestation using a self-administered validated food frequency questionnaire over the previous 2 weeks that included questions on food cravings experienced at any time during pregnancy. Clinical measurements collected included, height, weight, blood glucose and neonatal outcomes. Mean daily nutrient intakes were analysed with appropriate software. RESULTS: Food cravings were reported by 39% (n = 635) of women, with sweet foods, fruit and dairy products most frequently consumed. Those who craved foods had a higher mean (SD) energy intake [9721 (3016) kJ] (P = 0.002) even when under-reporters were removed [10131 (2875) kJ] (P = 0.008). However, no differences were found in nutrient or food intake between groups when adjusted for energy. Similarly, no differences were observed between groups and glycaemic control, anthropometric measurements or offspring outcome measures. CONCLUSIONS: Cravings commonly occur in pregnancy and contributed to a small increase in energy intake; however, this did not impact on overall dietary intake, nor was it associated with excessive gestational weight gain, maternal glycaemia or offspring outcome measurements.

The impact of inducing germination of Bacillus anthracis and Bacillus thuringiensis spores on potential secondary decontamination strategies.

AIMS: Decontamination and remediation of a site contaminated by the accidental or intentional release of fully virulent Bacillus anthracis spores are difficult, costly and potentially damaging to the environment. Development of novel decontamination strategies that have minimal environmental impacts remains a high priority. Although ungerminated spores are amongst the most resilient organisms known, once exposed to germinants, the germinating spores, in some cases, become susceptible to antimicrobial environments. We evaluated the concept that once germinated, B. anthracis spores would be less hazardous and significantly easier to remediate than ungerminated dormant spores. METHODS AND RESULTS: Through in vitro germination and sensitivity assays, we demonstrated that upon germination, B. anthracis Ames spores and Bacillus thuringiensis Al Hakam spores (serving as a surrogate for B. anthracis) become susceptible to environmental stressors. The majority of these germinated B. anthracis and B. thuringiensis spores were nonviable after exposure to a defined minimal germination-inducing solution for prolonged periods of time. Additionally, we examined the impact of potential secondary disinfectant strategies including bleach, hydrogen peroxide, formaldehyde and artificial UV-A, UV-B and UV-C radiation, employed after a 60-min germination-induction step. Each secondary disinfectant employs a unique mechanism of killing; as a result, germination-induction strategies are better suited for some secondary disinfectants than others. CONCLUSIONS: These results provide evidence that the deployment of an optimal combination strategy of germination-induction/secondary disinfection may be a promising aspect of wide-area decontamination following a B. anthracis contamination event. SIGNIFICANCE AND IMPACT OF THE STUDY: By inducing spores to germinate, our data confirm that the resulting cells exhibit sensitivities that can be leveraged when paired with certain decontamination measures. This increased susceptibility could be exploited to devise more efficient and safe decontamination measures and may obviate the need for more stringent methods that are currently in place.

Two-year outcomes of an adjunctive telephone coaching and electronic contact intervention for adolescent weight-loss maintenance: the Loozit randomized controlled trial.

This paper reports the final 24-month outcomes of a randomized controlled trial evaluating the effect of additional therapeutic contact (ATC) as an adjunct to a community-based weight-management program for overweight and obese 13-16-year-olds. ATC involved telephone coaching or short-message-service and/or email communication once per fortnight. Adolescents were randomized to receive the Loozit group program-a two-phase behavioral lifestyle intervention with (n=73), or without (n=78), ATC in Phase 2. Adolescents/parents separately attended seven weekly group sessions (Phase 1), followed by quarterly adolescent sessions (Phase 2). Assessor-blinded, 24-month changes in anthropometry and metabolic health included primary outcomes body mass index (BMI) z-score and waist:height ratio (WHtR). Secondary outcomes were self-reported psychosocial and lifestyle changes. By 24 months, 17 adolescents had formally withdrawn. Relative to the Loozit program alone, ATC largely had no impact on outcomes. Secondary pre-post assessment of the Loozit group program showed mean (95% CI) reductions in BMI z-score (-0.13 (-0.20, -0.06)) and WHtR (-0.02 (-0.03, -0.01)) in both arms, with several metabolic and psychosocial improvements. Adjunctive ATC did not provide further benefits to the Loozit group program. We recommend that further work is needed to optimize technological support for adolescents in weight-loss maintenance. Australian New Zealand Clinical Trials Registry Number ACTRNO12606000175572.

Tuning microcavities in thermally rearranged polymer membranes for CO2 capture.

Microporous materials have a great importance in catalysis, delivery, storage and separation in terms of their performance and efficiency. Most microporous materials are comprised of inorganic frameworks, while thermally rearranged (TR) polymers are a microporous organic polymer which is tuned to optimize the cavity sizes and distribution for difficult separation applications. The sub-nano sized microcavities are controlled by in situ thermal treatment conditions which have been investigated by positron annihilation lifetime spectroscopy (PALS). The size and relative number of cavities increased from room temperature to 230 °C resulting in improvements in both permeabilities and selectivities for H(2)/CO(2) separation due to the significant increase of gas diffusion and decrease of CO(2) solubility. The highest performance of the well-tuned TR-polymer membrane was 206 Barrer for H(2) permeability and 6.2 of H(2)/CO(2) selectivity, exceeding the polymeric upper bound for gas separation membranes.

The prevalence of chronic kidney disease in rheumatology outpatients.

BACKGROUND: The introduction of routine reporting of estimated glomerular filtration rate coupled with a new definition of chronic kidney disease (CKD) has led to an unprecedented focus on kidney disease in many patient groups. In light of this, we performed an audit of patients attending the rheumatology clinics to assess the prevalence of CKD in this population. METHODS: Over a four week period, we reviewed the renal function of all patients attending the rheumatology clinics and day ward at our hospital (n=351). Renal function was assessed using the 4-variable MDRD formula. We then interviewed those patients with estimated glomerular filtration rate (eGFR) of 59 ml/min or lower. RESULTS: We found a prevalence rate of 18% for stage 3 CKD or lower in our audit population. Surprisingly, 60.3% of patients in this category were not aware of any problems with their kidneys (n=38). CONCLUSIONS: The prevalence rate of 18% for stage 3 CKD or lower is significantly higher than the five per cent reported within the general population. As a result of this audit, we now plan to ensure that these patients undergo measurement of blood pressure, eGFR, and urinalysis on a six to twelve monthly basis.

The bigger picture: young children's perception of fatness in the context of other physical differences.

BACKGROUND: Negative obesity stereotypes and anti-fat attitudes have been observed in children from age three. It is uncertain whether this is specific to fatness or generalizable to other visible differences. OBJECTIVES: To determine whether young children base decisions about qualities in others and friendship choices more on fatness than other visible differences between people. METHODS: Using a personal construct theory approach, 85 children (mean age 5.7, 42 girls) completed a simple repertory grid. The children were asked about differences (constructs) between four illustrations (elements) that showed children as healthy weight, fat, the opposite gender and in a wheelchair. Children were also asked about friendship with the illustrated children and self-image preferences. Their answers were grouped using thematic analysis. RESULTS: The fat, opposite gender and wheelchair-bound characters were equally chosen by children as different to the standard character. When identifying differences, fatness or body shape was referred to significantly less than gender or being in a wheelchair. Children were more likely to reject an opposite gender character as a friend, or as someone they would like to be, than to reject the fat character. Only one child, themselves overweight, voiced strong anti-fat attitudes. CONCLUSIONS: Apparent negativity towards fatness is fostered by failure to consider other visible differences and by children's 'like me' peer preferences. It was less desirable in the eyes of most 5-year old girls to be a boy than to be fat. This offers some reassurance to those working to improve children's health literacy in obesity.

'Say no': a feasibility trial of a brief intervention to reduce instances of indulgent energy-intake episodes.

The aim of this study is to examine the feasibility of a brief intervention to reduce instances of indulgent energy intake. Forty-five participants with a body mass index (BMI) ≥25 kg m-2 were randomized to one of three groups for 8 weeks. The control group was asked to complete a questionnaire every 4 days, the self-monitoring group was given the same instructions but also asked to 'say no' to indulgences. The self-monitoring and feedback group was asked to do the same but in addition to send a photograph or description of that to which they had 'said no' and were then provided with feedback. All participants reported on indulgences for 7 days prospectively at baseline and 8-week follow-up. The follow-up rate was 80%; completion of questionnaires was 63% and 87 text messages were sent. The control group reduced their indulgences by 4.1 (SD 10.0), the self-monitoring group by 13.8 (SD 16.8) and self-monitoring and feedback group by 9.0 (SD 11.7) per week. All bar one, feasibility progression criteria were met and this was the return of the indulgence diaries during the intervention period. The study demonstrates the feasibility of a brief intervention to reduce the number of indulgences people ate. The progression criteria were met and areas of improvement are highlighted.

Guided self-help to manage binge eating in a dietetic-led community weight management service.

An estimated 30% of patients accessing community weight management services experience symptoms of binge eating disorder (BED). Guided self-help (GSH) is the recommended first line of treatment for BED. This study is a preliminary investigation into the effectiveness of GSH delivered by dietitians for patients with binge eating within a weight management service and a consideration of the association between wellbeing, therapeutic relationship and outcomes. The study was conducted as a single group, pre- and post-intervention study with 24 patients reporting symptoms of binge eating who completed the self-help manual with guidance from a trained community dietitian. Primary outcomes were eating disorder psychopathology and behaviours (Eating Disorder Evaluation Questionnaire), depression and anxiety. Principle results showed a significant reduction on all subscales of eating disorder psychopathology, anxiety and depression. There was a reduction in loss of control over eating but the 40% reduction in binge episodes was not statistically significant. Mid-treatment sessional ratings were positively associated with outcome. In conclusion, the GSH intervention was appropriate for dietitian delivery to patients with obesity and binge eating behaviour. This research indicates potential for other dietetic-led weight management services to deliver such interventions and support patients with binge eating accessing their service.

Evaluation of two dental identification computer systems: DAVID and WinID3.

Human identification, by comparing dental characteristics, is considered to be one of the most reliable, accurate and rapid methods of resolving the identity of visually un-identifiable deceased persons. In recent decades computer programs have evolved to aid odontologists by suggesting records that have similar dental features. The aim of the present study was to compare two of those programs; Disaster And Victim IDentification (DAVID) and WinID3 in terms of effectiveness, accuracy and speed of data entry and to further compare them with the efficiency of the classical method of manually matching postmortem and antemortem dental records. An open disaster was simulated whereby 52 fragmented remains made of acrylic replicas and 77 provisional victims were represented on Interpol F2 postmortem and antemortem forms. The results assessed were the first seven possible matches made by each program. Manual matching of dental characteristics performed better than both programs (P<0.001) yielding 29 identifications. Eleven and six positive matches were the result of the DAVID and the WinID3 programs respectively (P=0.185). Data entry was quicker for WinID3. It was concluded that both programs are still not as accurate as the time-consuming manual matching method. The difference in performance between the DAVID and the WinID3 programs was attributed to the inclusion of more comparable dental characteristics, the inclusion of the type of dentition (deciduous or permanent) and the weighting of those characteristics by the DAVID program.

It is not how much you crave but what you do with it that counts: behavioural responses to food craving during weight management.

BACKGROUND/OBJECTIVES: The relationship between food craving and dieting is mixed and uncertain, with little evidence during active weight management. Accordingly, the frequency and nature of food cravings were investigated in people attending a commercial weight management programme. SUBJECTS/METHODS: An online survey was completed by 2932 participants (97% female, mean age=43.0 years, mean body mass index=31.6 kg/m2). Assessments included the Control of Eating Questionnaire, measuring the frequency, intensity, specificity and behaviour following food cravings. Others included body weight, dietary restraint, perceived success of dieting and mood. Forty-two per cent of the sample completed a second survey 7 weeks later. RESULTS: Cross-sectional analysis showed those currently dieting to lose weight (55% of sample) had significantly fewer, less intense and more resisted food cravings than those watching what they ate so as not to gain weight (35% of sample). Cravings were fewer for chocolate and other sweet foods. Longitudinally, food cravings decreased over the period of weight loss (2.0 kg). Fewer foods were craved and the cravings were less intense, easier to resist and to control. Eating in response to food cravings was a significant predictor of weight change. CONCLUSIONS: People with obesity and recent experience of resisting eating in response to food cravings lost more weight over the next 7 weeks. Feeling in control of eating was also associated with greater weight loss. This suggests it is the behaviour that follows food cravings rather than simply their frequency or intensity that contributes to successful weight management. This has implications for interventions to help address food cravings.

New software for computer-assisted dental-data matching in Disaster Victim Identification and long-term missing persons investigations: "DAVID Web".

In 1997 an internally supported but unfunded pilot project at the Victorian Institute of Forensic Medicine (VIFM) Australia led to the development of a computer system which closely mimicked Interpol paperwork for the storage, later retrieval and tentative matching of the many AM and PM dental records that are often needed for rapid Disaster Victim Identification. The program was called "DAVID" (Disaster And Victim IDentification). It combined the skills of the VIFM Information Technology systems manager (VW), an experienced odontologist (JGC) and an expert database designer (JC); all current authors on this paper. Students did much of the writing of software to prescription from Monash University. The student group involved won an Australian Information Industry Award in recognition of the contribution the new software could have made to the DVI process. Unfortunately, the potential of the software was never realized because paradoxically the federal nature of Australia frequently thwarts uniformity of systems across the entire country. As a consequence, the final development of DAVID never took place. Given the recent problems encountered post-tsunami by the odontologists who were obliged to use the Plass Data system (Plass Data Software, Holbaek, Denmark) and with the impending risks imposed upon Victoria by the decision to host the Commonwealth Games in Melbourne during March 2006, funding was sought and obtained from the state government to update counter disaster preparedness at the VIFM. Some of these funds have been made available to upgrade and complete the DAVID project. In the wake of discussions between leading expert odontologists from around the world held in Geneva during July 2003 at the invitation of the International Committee of the Red Cross significant alterations to the initial design parameters of DAVID were proposed. This was part of broader discussions directed towards developing instruments which could be used by the ICRC's "The Missing" project that seeks to identify the victims of civil unrest and other atrocities. The most significant of these recommendations was that the next version of DAVID should be web-based allowing it to be used anywhere in the world and on any computer platform. The original intention that the software should be made available as freeware was strongly reiterated and endorsed. During 2005 these recommendations have been realized. This paper will describe the design parameters of the new software "DAVID web" and compare its features and performance with alternative packages.

Self-esteem outcomes over a summer camp for obese youth.

BACKGROUND AND OBJECTIVES: Variation in the existing literature on the psychosocial benefits of weight loss in obese youth results, in part, from methodological limitations and modest weight loss. Accordingly, this research assessed perceived self-competence and low self-esteem during an intensive weight loss programme in a large sample of obese youth and related these to starting weight, gender and weight loss. METHODS: Over 4 years, 303 obese male and female adolescents (body mass index [BMI] 34.3 kg m-2 , BMI standard deviation score 2.99; 14.7 years) attended a residential weight loss camp for a mean duration of 31 d. Outcome variables included dimensional self-esteem (Harter) and weight change over the camp. RESULTS: At the start of camp, obese youth scored highest on social acceptance and lowest on physical appearance and athletic competence. Global self-worth and most domains of self-competence improved significantly over the intervention. The proportion with low global self-worth reduced from 35% to 16%, but there was little change in the proportion reporting high self-competence (23%). Mean weight loss was -5.5 kg (BMI standard deviation scores -0.25) with boys and those heaviest at the start losing most. Weight loss was significantly correlated with improved physical appearance (r = 0.13) and athletic competence (r = 0.19), but not global self-worth. CONCLUSIONS: This intensive weight loss intervention yielded significant psychological benefit, especially in self-competence and among individuals achieving most weight loss. The weak association with weight loss suggests the influence of other contributing environmental or social features that should be the focus of further research.

'Thin people they're healthy': young children's understanding of body weight change.

BACKGROUND: While research has investigated negative stereotyping of fat body shapes, little has focused on young children's understanding of the mechanisms, motivations and consequences of weight change. OBJECTIVES: To investigate children's understanding of how weight change is achieved, people's motivation for weight change, and the consequences of weight loss or weight gain. METHODS: One hundred children (mean age 5.2, 38 girls) read a book in which one of the main characters (male/female according to the child's sex) was either healthy weight or overweight. Afterwards, this character was described as gaining or losing weight, and drawings which depicted the child in the story as either healthy weight or overweight were presented to the child and discussed. An audio-recorded semi-structured interview followed and transcripts were analysed using thematic analysis. RESULTS: Nearly all children described the weight/shape change and attributed this to food more frequently than exercise. Weight loss was viewed positively and both motivations and consequences grouped under two master themes (physical and social reasons). No clear gender differences were observed in these responses. CONCLUSIONS: Talking with 5-year-olds showed them to be observant and knowledgeable, especially about motivations for and consequences of weight change. For those working to improve children's health literacy, this suggests receptiveness to early and fact-based education.

Porosity in metal-organic framework glasses.

The porosity of a glass formed by melt-quenching a metal-organic framework, has been characterized by positron annihilation lifetime spectroscopy. The results reveal porosity intermediate between the related open and dense crystalline frameworks ZIF-4 and ZIF-zni. A structural model for the glass was constructed using an amorphous polymerization algorithm, providing additional insight into the gas-inaccessible nature of porosity and the possible applications of hybrid glasses.

Multimodality imaging and clinical features in Castleman disease: single institute experience in 30 patients.

OBJECTIVE: To analyse imaging features of subtypes of Castleman disease (CD), emphasizing differentiating features from lymphoma. METHODS: Institutional review board-approved, Health Insurance Portability and Accountability Act compliant, retrospective study examined 30 patients with CD. 30 patients (females, 20; mean age, 46 years; range, 22-87 years) with histopathologically confirmed CD and pre-treatment imaging formed the analytic cohort. Imaging at presentation in all patients [CT, 30; positron emission tomography (PET)/CT, 5; MR, 4; ultrasound, 3] and subsequent imaging in three cases that developed lymphoma was reviewed by two radiologists in consensus. RESULTS: Subtypes: hyaline-vascular (n = 18); multicentric not otherwise specified (NOS) (n = 6); human herpesvirus 8 associated (n = 2); mixed unicentric (n = 2); pure plasma-cell variant (n = 1); and unicentric NOS (n = 1). Distribution: unicentric (n = 17); and multicentric (n = 13). Nodal sites-unicentric: 13 thoracic, 3 abdominal and 1 cervical; multicentric: 9 abdominal, 8 thoracic, 6 cervical, 5 inguinal, 4 axillary and 4 supraclavicular. On CT, differentiating features from lymphoma were calcification (n = 8; 26.7%) and heterogeneous enhancement (n = 5; 19.2%). No association between CD subtype, degree or enhancement pattern, or calcification was noted. On PET/CT (n = 5), nodes were typically fluorine-18 fludeoxyglucose avid (n = 4). On ultrasound (n = 3), nodes were hypoechoic, homogeneous with posterior acoustic enhancement. On MR (n = 4), nodes were hypointense (n = 2) to isointense (n = 2) on T1 weighted images and isointense (n = 1) to hyperintense (n = 3) on T2 weighted images. All (n = 4) demonstrated homogeneous enhancement. Three cases developed non-Hodgkin's lymphoma, two of the three had larger spleens, and these cases had effusions/ascites. CONCLUSION: CD can be unicentric or multicentric and involve nodes above and below the diaphragm. Patients with CD can develop lymphoma. ADVANCES IN KNOWLEDGE: Assessing individual risk of developing lymphoma in patients with CD is difficult, although the findings of splenomegaly, pleural effusion and ascites may be suggestive.

Across-the-day monitoring of mood and energy intake before, during, and after a very-low-calorie diet.

Mood, hunger, and energy intake were monitored in eight obese women before, during, and after 2 wk on a very-low-calorie diet (VLCD). Energy intake was significantly lower by approximately 30% in the week after the VLCD compared with the prediet week, both from food diaries and at a controlled ad libitum test meal. There was a gradual reduction in hunger, irritability, and urge to eat after 1 wk on the VLCD, which persisted through the postdiet week. Hunger and discontent were greatest in the evening during the first few days of the VLCD but diminished as the duration of the VLCD increased.