Neuromorphic one-shot learning utilizing a phase-transition material.

Design of hardware based on biological principles of neuronal computation and plasticity in the brain is a leading approach to realizing energy- and sample-efficient AI and learning machines. An important factor in selection of the hardware building blocks is the identification of candidate materials with physical properties suitable to emulate the large dynamic ranges and varied timescales of neuronal signaling. Previous work has shown that the all-or-none spiking behavior of neurons can be mimicked by threshold switches utilizing material phase transitions. Here, we demonstrate that devices based on a prototypical metal-insulator-transition material, vanadium dioxide (VO2), can be dynamically controlled to access a continuum of intermediate resistance states. Furthermore, the timescale of their intrinsic relaxation can be configured to match a range of biologically relevant timescales from milliseconds to seconds. We exploit these device properties to emulate three aspects of neuronal analog computation: fast (~1 ms) spiking in a neuronal soma compartment, slow (~100 ms) spiking in a dendritic compartment, and ultraslow (~1 s) biochemical signaling involved in temporal credit assignment for a recently discovered biological mechanism of one-shot learning. Simulations show that an artificial neural network using properties of VO2 devices to control an agent navigating a spatial environment can learn an efficient path to a reward in up to fourfold fewer trials than standard methods. The phase relaxations described in our study may be engineered in a variety of materials and can be controlled by thermal, electrical, or optical stimuli, suggesting further opportunities to emulate biological learning in neuromorphic hardware.

Reproducibility and Relative Validity of a Short Food Frequency Questionnaire for Chinese Older Adults in Hong Kong.

Changes in an individual's digestive system, hormones, senses of smell and taste, and energy requirement accompanying aging could lead to impaired appetite, but older adults may not notice their risk of nutrient deficiency. When assessing the dietary intake of older adults, it was found that they had more difficulties with short-term recall and open-ended recall and would experience greater fatigue and frustration when compared to younger individuals when completing a lengthy questionnaire. There is a need to develop a brief dietary assessment tool to examine the nutritional needs of older adults. In this study, we aimed to assess the diet of Hong Kong older adults using the short FFQ and examine its reproducibility and relative validity as a dietary assessment tool. Dietary data of 198 older adults were collected via FFQs and three-day dietary records. Correlation analyses, cross-tabulation, one-sample t-tests, and linear regression analyses were used to evaluate the relative validity of the short FFQ. In general, the short FFQ was accurate in assessing the intake of phosphorus, water, grains, and wine, as shown by a significant correlation (>0.7) between values reported in the FFQs and dietary records; good agreement (more than 50% of observations belonged to the same quartile) and insignificant differences detected with the one-sample t-tests and linear regression analyses were observed for the above four variables. Additionally, the intake of proteins, carbohydrates, total fat, magnesium, and eggs in terms of the values reported in the FFQs and dietary records showed good agreement.

Exerkines and cardiometabolic benefits of exercise: from bench to clinic.

Regular exercise has both immediate and long-lasting benefits on cardiometabolic health, and has been recommended as a cornerstone of treatment in the management of diabetes and cardiovascular conditions. Exerkines, which are defined as humoral factors responsive to acute or chronic exercise, have emerged as important players conferring some of the multiple cardiometabolic benefits of exercise. Over the past decades, hundreds of exerkines released from skeletal muscle, heart, liver, adipose tissue, brain, and gut have been identified, and several exerkines (such as FGF21, IL-6, and adiponectin) have been exploited therapeutically as exercise mimetics for the treatment of various metabolic and cardiovascular diseases. Recent advances in metagenomics have led to the identification of gut microbiota, a so-called "hidden" metabolic organ, as an additional class of exerkines determining the efficacy of exercise in diabetes prevention, cardiac protection, and exercise performance. Furthermore, multiomics-based studies have shown the feasibility of using baseline exerkine signatures to predict individual responses to exercise with respect to metabolic and cardiorespiratory health. This review aims to explore the molecular pathways whereby exerkine networks mediate the cardiometabolic adaptations to exercise by fine-tuning inter-organ crosstalk, and discuss the roadmaps for translating exerkine-based discovery into the therapeutic application and personalized medicine in the management of the cardiometabolic disease.

Programming nonreciprocity and harmonic beam steering via a digitally space-time-coded metamaterial antenna.

Recent advancement in digital coding metasurfaces incorporating spatial and temporal modulation has enabled simultaneous control of electromagnetic (EM) waves in both space and frequency domains by manipulating incident EM waves in a transmissive or reflective fashion, resulting in time-reversal asymmetry. Here we show in theory and experiment that a digitally space-time-coded metamaterial (MTM) antenna with spatiotemporal modulation at its unit cell level can be regarded as a radiating counterpart of such digital metasurface, which will enable nonreciprocal EM wave transmission and reception via surface-to-leaky-wave transformation and harmonic frequency generation. Operating in the fast wave (radiation) region, the space-time-coded MTM antenna is tailored in a way such that the propagation constant of each programmable unit cell embedded with varactor diodes can toggle between positive and negative phases, which is done through providing digital sequences by using a field-programmable gate array (FPGA). Owing to the time-varying coding sequence, harmonic frequencies are generated with different main beam directions. Furthermore, the space time modulation of the digitally coded MTM antenna allows for nonreciprocal transmission and reception of EM waves by breaking the time-reversal symmetry, which may enable many applications, such as simultaneous transmitting and receiving, unidirectional transmission, radar sensing, and multiple-input and multiple-output (MIMO) beamformer.

A prospective randomised controlled trial evaluating prophylactic Floseal, a gelatin and thrombin-based haemostatic matrix, in postoperative drain output and blood transfusion in transforaminal lumbar interbody fusion surgery.

PURPOSE: To evaluate the prophylactic use of Floseal in reducing postoperative blood loss in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). TLIF is a lumbar spine decompression and fusion procedure with potential for postoperative blood loss. Prophylactic application of Floseal, a gelatin and thrombin-based haemostatic matrix to the surgical wound before closure was shown to be effective in reducing postoperative drain output in anterior cervical discectomy and fusion. This study postulated that prophylactic use of Floseal before wound closure would reduce postoperative blood loss in patients who underwent TLIF. METHODS: Randomised controlled trial comparing prophylactic use of Floseal and control in patients undergoing single level or two-level TLIF. Primary outcomes included postoperative drain output within 24 h and postoperative transfusion rate. Secondary outcomes included days of drain placement, length of stay and haemoglobin level. RESULTS: A total of 50 patients was recruited. Twenty six patients were allocated to the Floseal group and 24 were allocated to the control group. There were no baseline characteristic differences between the groups. There were no statistically significant differences in primary outcomes which included postoperative drain output within 24 h and postoperative transfusion rate between patients who received prophylactic Floseal and control. There were no statistically significant differences in secondary outcomes which included haemoglobin level, days of drain placement and length of stay between the two groups. CONCLUSION: Prophylactic use of Floseal was not shown to reduce postoperative bleeding in single level or two-level TLIF.

A machine-learning algorithm integrating baseline serum proteomic signatures predicts exercise responsiveness in overweight males with prediabetes.

The molecular transducers conferring the benefits of chronic exercise in diabetes prevention remain to be comprehensively investigated. Herein, serum proteomic profiling of 688 inflammatory and metabolic biomarkers in 36 medication-naive overweight and obese men with prediabetes reveals hundreds of exercise-responsive proteins modulated by 12-week high-intensity interval exercise training, including regulators of metabolism, cardiovascular system, inflammation, and apoptosis. Strong associations are found between proteins involved in gastro-intestinal mucosal immunity and metabolic outcomes. Exercise-induced changes in trefoil factor 2 (TFF2) are associated with changes in insulin resistance and fasting insulin, whereas baseline levels of the pancreatic secretory granule membrane major glycoprotein GP2 are related to changes in fasting glucose and glucose tolerance. A hybrid set of 23 proteins including TFF2 are differentially altered in exercise responders and non-responders. Furthermore, a machine-learning algorithm integrating baseline proteomic signatures accurately predicts individualized metabolic responsiveness to exercise training.

Recent Development of Non-Contact Multi-Target Vital Sign Detection and Location Tracking Based on Metamaterial Leaky Wave Antennas.

Microwave radar sensors have been developed for non-contact monitoring of the health condition and location of targets, which will cause minimal discomfort and eliminate sanitation issues, especially in a pandemic situation. To this end, several radar sensor architectures and algorithms have been proposed to detect multiple targets at different locations. Traditionally, beamforming techniques incorporating phase shifters or mechanical rotors are utilized, which is relatively complex and costly. On the other hand, metamaterial (MTM) leaky wave antennas (LWAs) have a unique property of launching waves of different spectral components in different directions. This feature can be utilized to detect multiple targets at different locations to obtain their healthcare and location information accurately, without complex structure and high cost. To this end, this paper reviews the recent development of MTM LWA-based radar sensor architectures for vital sign detection and location tracking. The experimental results demonstrate the effectiveness of MTM vital sign radar compared with different radar sensor architectures.

The relationship between insomnia symptoms and frailty in community-dwelling older persons: a path analysis.

BACKGROUND: The relationship between sleep and frailty in older age is complex. Most previous studies focused on sleep duration, while insomnia, a common sleep problem in older adults, has not been adequately examined and the factors implicated in its association with frailty were under-explored. METHODS: A community-based sample of 345 prefrail and frail older adults were recruited and completed the measures on insomnia symptoms (Pittsburgh Sleep Quality Index) and frailty status (FRAIL Scale). The relationship between insomnia symptoms and frailty, with potential mediators including physical performance (Short Physical Performance Battery), depression (Patient Health Questionnaire-9), and level of physical activity (Physical Activity Scale for the Elderly), were tested in path analysis adjusting for age, gender, body mass index and sleep medications. RESULTS: The prevalence of sleep-onset insomnia was higher in frail participants than their prefrail counterparts (48% vs. 34%, aOR = 1.73; 95% CI 1.09, 2.76; p = 0.02), but there was no significant difference in the prevalence of sleep-maintenance insomnia (61% vs. 54%). The association between sleep-onset insomnia and frailty was explained by reduced physical performance (standardized coefficient = 0.11; 95% BCa CI [0.002, 0.233]), but not depression and level of physical activity. Sleep-maintenance insomnia was not associated with frailty. CONCLUSIONS: Insomnia symptoms are prevalent in frail and prefrail older adults. Sleep-onset insomnia is associated with poorer physical performance, which is further linked to a higher risk for frailty in older persons. The findings highlight the importance of timely assessing and managing insomnia among older adults at risk of frailty.

Unusual case of locked trigger thumb due to tophaceous infiltration of the flexor tendon over the wrist: a lesson learned.

We report a rare case in which intratendinous gouty tophi were found within the flexor pollicis longus tendon at the wrist, causing locked thumb, which was misdiagnosed as trigger thumb.

The Contribution of Sense of Community to the Association Between Age-Friendly Built Environment and Health in a High-Density City: A Cross-Sectional Study of Middle-Aged and Older Adults in Hong Kong.

Sense of community may be shaped by the quality of the physical environment and has potential health implications. Based on a survey of 2,247 community-dwelling middle-aged and older adults living in Hong Kong, we tested the mediation effect of sense of community on the relationship between the quality of the built environment and physical and mental health using path analysis. The quality of the built environment was indicated by the age-friendliness of outdoor spaces and buildings. No direct association was found between the built environment and health outcomes, although age-friendly outdoor spaces were associated with better mental health. Sense of community mediated 14% of the total effect between outdoor spaces and mental health and 44.8% of the total effect between buildings and physical health, underscoring the importance of accommodating the social needs of middle-aged and older people in urban development in high-density cities.

Spatial Cleaning Action of Ultrasonic Irrigation on Enterococcus faecalis Biofilm.

This study aimed to examine the spatial cleaning effect of ultrasonic irrigation in simulated root canal with oblong cross section in the absence of antimicrobial agent. A 7-day E. faecalis biofilm was cultivated in a rectangular, simulated canal model and subjected to passive ultrasonic irrigation (PUI) with sterile saline for 5 minutes. After that, the biofilm was examined by confocal microscopy after bacterial viability staining at 58 sites around and beyond the endosonic file. Results showed that, at the vicinity of the file, the amount of viable bacteria ranged from 13.1% (2.75 mm from the tip) to 40.5% (4.5 mm level). Lesser amounts of live bacteria were observed within 1 mm from the vibrating file, which amount increased for sites farther away. At 3 mm distance, the amount of bacteria (35.5 to 64.4%) was significantly greater than areas situated close to the vibrating file (P < 0.01). Sites next to the anti-nodes of file had less bacteria remaining than sites near the nodes (P = 0.050). Apically (0.5 mm or more), the amount of bacteria was significantly greater than that at the file tip (16.4%) (P < 0.05). It was concluded that PUI is able to dislodge a single-species biofilm, provided that they are situated in close vicinity to the vibrating file.

Gut Microbiome Fermentation Determines the Efficacy of Exercise for Diabetes Prevention.

Exercise is an effective strategy for diabetes management but is limited by the phenomenon of exercise resistance (i.e., the lack of or the adverse response to exercise on metabolic health). Here, in 39 medication-naive men with prediabetes, we found that exercise-induced alterations in the gut microbiota correlated closely with improvements in glucose homeostasis and insulin sensitivity (clinicaltrials.gov entry NCT03240978). The microbiome of responders exhibited an enhanced capacity for biosynthesis of short-chain fatty acids and catabolism of branched-chain amino acids, whereas those of non-responders were characterized by increased production of metabolically detrimental compounds. Fecal microbial transplantation from responders, but not non-responders, mimicked the effects of exercise on alleviation of insulin resistance in obese mice. Furthermore, a machine-learning algorithm integrating baseline microbial signatures accurately predicted personalized glycemic response to exercise in an additional 30 subjects. These findings raise the possibility of maximizing the benefits of exercise by targeting the gut microbiota.

Motivating Diabetic and Hypertensive Patients to Engage in Regular Physical Activity: A Multi-Component Intervention Derived from the Concept of Photovoice.

Aims: A community-based multi-component intervention (increasing awareness of the importance of physical activity in chronic illness management through reading comic books, training regarding warm-up stretching exercises, identifying facilitators and barriers to exercise through photosharing, supporting self-reflection and development of action plans) was developed to promote physical activity (PA) among patients with diabetes and hypertension. This study aimed to evaluate the efficacy of this intervention on health behaviour (walking) and health outcomes. Design: A non-randomized controlled trial with waitlisted control and pre- and post-measures. Setting: Community centres for the elderly. Participants: A total of 204 older adults with diabetes and/or hypertension were recruited. They were assigned to either the intervention group (IG) or waitlisted to the control group (CG). Intervention: Under the supervision of a nurse, six weekly group meetings were arranged in community centres for the elderly in which the participants freely exchanged their views regarding the barriers and facilitators of regular physical activity. Participants were encouraged to take photos in their neighbourhood or at home and brought these photos to share at the group meetings. The photos showed both the barriers and the facilitators to PA. In the last meeting, each participant worked out a plan to perform PA in the coming four weeks. Measures: PA referred to the number of steps taken per day and it was measured by a Garmin Accelerometer at baseline, Week 6 and Week 10. Other measures included the nine-item Self-Efficacy Scale for Exercise⁻Chinese version (SEE-C), and the 23-item Chinese Barriers to Exercise Scale and Senior Fitness Tests. Generalised estimating equations (GEE) models compared the outcomes over time between IG and CG. Results: A statistically significant difference in the changes in the average number of steps taken daily between the two groups at Week 10 (mean difference = 965.4; 95% confidence interval: 92.2, 1838.6, p = 0.030) was observed, although the difference at Week 6 was non-significant (mean difference = 777.6; 95% confidence interval: -35.3, 1590.5, p = 0.061). IG participants also showed significant improvements in lower body strength (mean difference = 0.967; 95% confidence interval: 0.029, 1.904, p = 0.043) and lower limb flexibility (mean difference = 2.068; 95% confidence interval: 0.404, 3.731, p = 0.015) at Week 10 compared to CG participants. Conclusion: This multi-component intervention improved the participants' physical activity level and physical fitness, particularly in lower limb flexibility and body strength.

Older Adults' Perceptions of Age-friendliness in Hong Kong.

BACKGROUND AND OBJECTIVES: There is little understanding about how rapid urban development has affected the extent to which communities are able to optimize health and participation opportunities for older adults in Hong Kong. Our objective was to examine what older residents perceive to be the shortcomings of their communities in meeting their psychosocial and physical needs as they age. RESEARCH DESIGN AND METHODS: In reference to the WHO Age-Friendly Cities Project Methodology: Vancouver Protocol, we conducted nine focus groups comprising 65 participants for an Age-Friendly City baseline assessment in two districts in Hong Kong, China. Participants were asked to share their views on their respective district of residence, and identify aspects of the city they found unfriendly. Data generated from interviews were analyzed using thematic analysis. RESULTS: Five of the following key themes were identified: the failure of public transportation to cater to the needs of older adults; a lack of public space for recreation and socializing; diminishing human interactions in welfare services; physical and financial challenges relating to housing; and workplace discrimination against older adults. DISCUSSION AND IMPLICATIONS: These findings underscore the importance of prioritizing the social welfare of older adults in building a more inclusive and age-friendly city. They also highlight the difficulties in fostering an inclusive environment while ensuring efficiency and profit maximization.

Stand-Alone Cervical Cages in 2-Level Anterior Interbody Fusion in Cervical Spondylotic Myelopathy: Results from a Minimum 2-Year Follow-up.

STUDY DESIGN: A retrospective review of patients who underwent 2-level anterior cervical discectomy and fusion (ACDF) with standalone polyetheretherketone (PEEK) cages for cervical spondylotic myelopathy (CSM). PURPOSE: To evaluate the efficacy of stand-alone PEEK cage in 2-level cervical interbody fusion for CSM. OVERVIEW OF LITERATURE: ACDF is a standard surgical procedure to treat degenerative disc disease. However, the use of additional anterior plating for 2-level ACDF remains controversial. METHODS: We reviewed outcomes of patients who underwent 2-level ACDF with stand-alone PEEK cages for CSM over a 7-year period (2007-2015) in a regional hospital. Japanese Orthopaedic Association (JOA) score, fusion rate, subsidence rate, cage migration, and cervical alignment by the C2-7 angle as well as the local segmental angle (LSA) of the cervical spine were assessed. RESULTS: In total, 31 patients (mean age, 59 years; range, 36-87 years) underwent 2-level ACDF with a cage-only construct procedure between 2007 and 2015. The minimum follow-up was 24 months; mean follow-up was 51 months. C3-5 fusion was performed in 45%, C4-6 fusion in 32%, and C5-7 fusion in 23%. Mean JOA score improved from 10.1±2.2 to 13.9±2.1 (p<0.01) at the 24-month follow-up. Fusion was achieved in all patients. Subsidence occurred in 22.5% of the cages but was not associated with differences in JOA scores, age, sex, or levels fused. Lordosis of the C2-7 angle and LSA increased after surgery, which were maintained for up to 1 year but subsequently disappeared after 2 years, yet the difference was not statistically significant. No cage migration was noted; two patients developed adjacent segment disease requiring posterior laminoplasty 3 years after ACDF. CONCLUSIONS: The use of a stand-alone PEEK cage in a 2-level cervical interbody fusion achieves satisfactory improvements in both clinical outcomes and fusion.

The Inaccuracy of Surface Landmarks for the Anterior Approach to the Cervical Spine in Southern Chinese Patients.

STUDY DESIGN: Observational study. PURPOSE: To assess the correlational accuracy between the traditional anatomic landmarks of the neck and their corresponding vertebral levels in Southern Chinese patients. OVERVIEW OF LITERATURE: Recent studies have demonstrated discrepancies between traditional anatomic landmarks of the neck and their corresponding cervical vertebra. METHODS: The center of the body of the hyoid bone, the upper limit of the lamina of the thyroid cartilage, and the lower limit of the cricoid cartilage were selected as representative surface landmarks for this investigation. The corresponding vertebral levels in 78 patients were assessed using computed tomography. RESULTS: In both male and female patients, almost none of the anatomical landmarks demonstrated greater than 50% correlation with any vertebral level. The most commonly corresponding vertebra of the hyoid bone, the lamina of the thyroid cartilage, and the cricoid cartilage were the C4 (47.5%), C5 (35.9%), and C7 (42.3%), respectively, which were all different from the classic descriptions in textbooks. The vertebral levels corresponding with the thyroid and cricoid cartilage were significantly different between genders. CONCLUSIONS: The surface landmarks of the neck were not accurate enough to be used as the sole determinant of vertebral levels or incision sites. Intra-operative fluoroscopy is necessary to accurately locate each of the cervical vertebral levels.

Psychometric Assessment of the Chinese Version of the Abbreviated Expanded Prostate Cancer Index Composite (EPIC-26) and the Clinical Practice Version (EPIC-CP) in Chinese Men With Prostate Cancer.

PURPOSE: The Expanded Prostate Cancer Index Composite (EPIC) instrument was designed to assess a range of health-related quality-of-life issues specifically relevant to patients with prostate cancer. This study examined the validity and reliability of Chinese versions of the 26-item EPIC and of the 16-item EPIC for Clinical Practice (EPIC-CP) in Chinese patients with prostate cancer. MATERIALS AND METHODS: A Chinese version of the 26-item EPIC and the 16-item EPIC-CP were self-completed by 252 Chinese patients with prostate cancer who were recruited from three community-based cancer service centers. Confirmatory factors analysis assessed the factor structures of the EPIC and the EPIC-CP. Internal consistency and construct and clinical validities of the factor structures were assessed. RESULTS: Confirmatory factor analysis revealed that the original factor structure of both EPIC-26 and EPIC-CP showed good fit to this sample. A correlated model was superior to a hierarchical model in both EPIC-26 and EPIC-CP supporting the utility of the domain scores over the total scores. Cronbach α ranged from 0.55 to 0.91 for EPIC-26 and 0.44 to 0.67 for EPIC-CP. Construct validity was supported by correlations between EPIC-26/EPIC-CP and psychological distress measures. Clinical validity was supported by differentiation between patients with and without prostatectomy. CONCLUSIONS: These Chinese versions of the five-factor EPIC-26 and the EPIC-CP are valid and practical measures for assessing a range of health-related quality-of-life issues related to the diagnosis and treatment of prostate cancer, highlighting their utility in assessing health-related quality of life for patients diagnosed with prostate cancer.

Quantitative Anatomy of C7 Vertebra in Southern Chinese for Insertion of Lateral Mass Screws and Pedicle Screws.

STUDY DESIGN: Retrospective study. PURPOSE: To analyze the quantitative anatomy of C7 vertebra for insertion of lateral mass screws and pedicle screws in Southern Chinese patients. OVERVIEW OF LITERATURE: C7 lateral mass is smaller when compared to other subaxial cervical levels, which limits the length of lateral mass screws that can be used. Some studies have suggested pedicle screws for better fixation. But, this option is limited by the narrow pedicle width. METHODS: We have obtained computed tomography (CT) cervical spine data in 0.625 mm slices from our radiology department. The patients were adults. CTs were from May to August, 2015. The lateral mass screw length was measured using Margerl's technique and pedicle width and pedicle screw trajectory were determined in three-dimensional reformated images. RESULTS: CT scans of cervical spines of 94 patients were obtained and 188 lateral masses and pedicles of C7 vertebrae were measured. The mean lateral mass screw length was 13.2 mm (standard deviation [SD] 1.6 mm), mean outer pedicle width was 5.9 mm (SD 1.0 mm) and mean pedicle screw trajectory was 29.4 degrees (SD 3.6 degrees). Most (91.0%) of the pedicles had an outer diameter ≥4.5 mm. CONCLUSIONS: The mean lateral mass screw length was longer when compared with other similar studies, while the mean outer pedicle width was narrower. Nearly 10% of the pedicles were unable to accommodate 3.5 mm screws. These findings favor the use of lateral mass screws to provide a safe and stable fixation for C7 vertebrae in Southern Chinese patients, while the final choice of fixation method should only be confirmed after careful preoperative planning with CT scan.

A randomized controlled trial for families with preschool children - promoting healthy eating and active playtime by connecting to nature.

BACKGROUND: Promotion of healthy lifestyles in children focuses predominantly on proper nutrition and physical activity, elements now widely recognised as essential for a healthy life. Systematic reviews have shown that nature-related activities also enhance general well-being as reflected in increased physical activity, a healthier diet, reduced stress and better sleep. Recent research suggests that many young children in Hong Kong between the ages of two and four in Hong Kong are more sedentary than recommended and seldom participate in active play, placing them at risk of becoming overweight or obese. The proposed project aims to investigate whether connecting families to nature positively influences physical activity (i.e., active playtime) and healthy eating routines in children aged 2 to 4. METHODS: We recently conducted a pilot study in Hong Kong to develop a programme, Play & Grow, based on the most successful evidence-based international preschool interventions. In addition to adopting the healthy eating and physical activity elements of these interventions, this project will additionally include a third novel element of Connectedness to nature: discovering nature through games and awareness of sounds, touch, smells, and temperature. To test the effectiveness of this modified intervention, a randomised controlled trial (RCT) involving 240 families with children aged 2 to 4 will be conducted. Families and children will take part in weekly one-hour activity sessions for 10-weeks. Lifestyle-related habits will be assessed before and immediately after the 10-week intervention, with follow up testing at 6 and 12 months' post intervention. DISCUSSION: A novel measuring tool created specifically for assessing Connectedness to nature, Nature Relatedness Scale (NRS), will be validated and tested for reliability prior to the RCT. The results of the RCT are intended to be used to understand which components of the intervention are most effective. The objectives of this project will be achieved over a 30-month period and will contribute to the research that examines key components of successful healthy lifestyle promotion programmes during early childhood. We predict that the inclusion of Connectedness to nature will significantly improve recognised preschool interventions. Finally, the aim of targeting family involvement will hopefully increase the sustainability of longer-term lifestyle modifications in children. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02715544 . Registered 22 March 2016.