Shared care obesity management in 3-10 year old children: 12 month outcomes of HopSCOTCH randomised trial

Objective: To determine whether general practice surveillance for childhood obesity, followed by obesity management across primary and tertiary care settings using a shared care model, improves body mass index and related outcomes in obese children aged 3-10 years. Design: Randomised controlled trial. Setting: 22 family practices (35 participating general practitioners) and a tertiary weight management service (three paediatricians, two dietitians) in Melbourne, Australia. Participants: Children aged 3-10 years with body mass index above the 95th centile recruited through their general practice between July 2009 and April 2010. Intervention: Children were randomly allocated to one tertiary appointment followed by up to 11 general practice consultations over one year, supported by shared care, web based software (intervention) or “usual care” (control). Researchers collecting outcome measurements, but not participants, were blinded to group assignment. Main outcome measures: Children’s body mass index z score (primary outcome), body fat percentage, waist circumference, physical activity, quality of diet, health related quality of life, self esteem, and body dissatisfaction and parents’ body mass index (all 15 months post-enrolment). Results: 118 (60 intervention, 56 control) children were recruited and 107 (91%) were retained and analysed (56 intervention, 51 control). All retained intervention children attended the tertiary appointment and their general practitioner for at least one (mean 3.5 (SD 2.5, range 1-11)) weight management consultation. At outcome, children in the two trial arms had similar body mass index (adjusted mean difference −0.1 (95% confidence interval −0.7 to 0.5; P=0.7)) and body mass index z score (−0.05 (−0.14 to 0.03); P=0.2). Similarly, no evidence was found of benefit or harm on any secondary outcome. Outcomes varied widely in the combined cohort (mean change in body mass index z score −0.20 (SD 0.25, range −0.97-0.47); 26% of children resolved from obese to overweight and 2% to normal weight. Conclusions: Although feasible, not harmful, and highly rated by both families and general practitioners, the shared care model of primary and tertiary care management did not lead to better body mass index or other outcomes for the intervention group compared with the control group. Improvements in body mass index in both groups highlight the value of untreated controls when determining efficacy.Melissa Wake, Kate Lycett, Susan A Clifford, Matthew A Sabin, Jane Gunn, Kay Gibbons, Cathy Hutton, Zoë McCallum, Sarah J Arnup, Gary Witter

Unknowable bodies, unthinkable sexualities: lesbian and transgender legal invisibility in the Toronto women's bathhouse raid

Although litigation involving sexual orientation and gender identity discrimination claims has generated considerable public attention in recent years, lesbian and transgender bodies and sexualities still remain largely invisible in Anglo-American courts. While such invisibility is generally attributed to social norms that fail to recognize lesbian and transgender experiences, the capacity to 'not see' or 'not know' queer bodies and sexualities also involves wilful acts of ignorance. Drawing from R. v Hornick (2002) a Canadian case involving the police raid of a women's bathhouse, this article explores how lesbian and transgender bodies and sexualities are actively rendered invisible via legal knowledge practices, norms and rationalities. It argues that limited knowledge and limited thinking not only regulate the borders of visibility and belonging, but play an active part in shaping identities, governing conduct and producing subjectivity

Expecting less in hard times:how the state of the economy influences students’ educational expectations

Students’ realistic aspirations about their educational attainment (expectations) are predictive of their efforts, actions, and future outcomes. Limited evidence suggests these expectations are affected by the macroeconomy; however, the direction is ambiguous. We combine seven waves of Programme for International Student Assessment (PISA) data to examine this relationship in 38 OECD countries. Using within-country fixed-effect regressions, we find students have significantly lower educational expectations when GDP growth is low or negative. Assessing the heterogeneity of these relationships, we find that the expectations of students with below-average reading skills or who attend non-metropolitan schools are most strongly affected by the state of the economy. The results also suggest that when GDP growth is weak, students are significantly more likely to complete zero homework and arrive late to school, are less likely to participate in extracurricular academic programs, and expect lower labour market returns to completed education.</p

Real-time classification of multivariate olfaction data using spiking neural networks

Recent studies in bioinspired artificial olfaction, especially those detailing the application of spike-based neuromorphic methods, have led to promising developments towards overcoming the limitations of traditional approaches, such as complexity in handling multivariate data, computational and power requirements, poor accuracy, and substantial delay for processing and classification of odors. Rank-order-based olfactory systems provide an interesting approach for detection of target gases by encoding multi-variate data generated by artificial olfactory systems into temporal signatures. However, the utilization of traditional pattern-matching methods and unpredictable shuffling of spikes in the rank-order impedes the performance of the system. In this paper, we present an SNN-based solution for the classification of rank-order spiking patterns to provide continuous recognition results in real-time. The SNN classifier is deployed on a neuromorphic hardware system that enables massively parallel and low-power processing on incoming rank-order patterns. Offline learning is used to store the reference rank-order patterns, and an inbuilt nearest neighbor classification logic is applied by the neurons to provide recognition results. The proposed system was evaluated using two different datasets including rank-order spiking data from previously established olfactory systems. The continuous classification that was achieved required a maximum of 12.82% of the total pattern frame to provide 96.5% accuracy in identifying corresponding target gases. Recognition results were obtained at a nominal processing latency of 16ms for each incoming spike. In addition to the clear advantages in terms of real-time operation and robustness to inconsistent rank-orders, the SNN classifier can also detect anomalies in rank-order patterns arising due to drift in sensing arrays

Formar bem as mães para criar e educar boas crianças: as revistas portuguesas de educação familiar e a difusão da maternidade científica (1945-1958)

Este artigo tem como principal objetivo contribuir para a compreensão do processo de construção da maternidade científica em Portugal. Neste sentido, foi analisado um conjunto de artigos (n=628), publicados em revistas de educação familiar, entre 1945 e 1958. A análise realizada permitiu compreender que as revistas analisadas contribuem para a difusão da maternidade científica, ou seja, da ideia de que a aquisição de conhecimento científico sobre a criação e educação das crianças é elemento indispensável ao adequado exercício da função maternal. Observou-se, ainda, a existência de diferentes estratégias de educação para a maternidade, às quais está subjacente um elemento de classe, assim como diferentes níveis de adesão, por parte das mulheres, à concepção de maternidade científica

The use of the cluster randomized crossover design in clinical trials: protocol for a systematic review

BACKGROUND: The cluster randomized crossover (CRXO) design is gaining popularity in trial settings where individual randomization or parallel group cluster randomization is not feasible or practical. In a CRXO trial, not only are clusters of individuals rather than individuals themselves randomized to trial arms, but also each cluster participates in each arm of the trial at least once in separate periods of time. We will review publications of clinical trials undertaken in humans that have used the CRXO design. The aim of this systematic review is to summarize, as reported: the motivations for using the CRXO design, the values of the CRXO design parameters, the justification and methodology for the sample size calculations and analyses, and the quality of reporting the CRXO design aspects. METHODS/DESIGN: We will identify reports of CRXO trials by systematically searching MEDLINE, PubMed, Cochrane Methodology Register, EMBASE, and CINAHL Plus. In addition, we will search for methodological articles that describe the CRXO design and conduct citation searches to identify any further CRXO trials. The references of all eligible trials will also be searched. We will screen the identified abstracts, and retrieve and assess for inclusion the full text for any potentially relevant articles. Data will be extracted from the full text independently by two reviewers. Descriptive summary statistics will be presented for the extracted data. DISCUSSION: This systematic review will inform both researchers addressing CRXO methodology and trialists considering implementing the design. The results will allow focused methodological research of the CRXO design, provide practical examples for researchers of how CRXO trials have been conducted, including any shortcomings, and highlight areas where reporting and conduct may be improved

Blinded and unblinded sample size reestimation procedures for stepped-wedge cluster randomized trials.

The ability to accurately estimate the sample size required by a stepped-wedge (SW) cluster randomized trial (CRT) routinely depends upon the specification of several nuisance parameters. If these parameters are misspecified, the trial could be overpowered, leading to increased cost, or underpowered, enhancing the likelihood of a false negative. We address this issue here for cross-sectional SW-CRTs, analyzed with a particular linear-mixed model, by proposing methods for blinded and unblinded sample size reestimation (SSRE). First, blinded estimators for the variance parameters of a SW-CRT analyzed using the Hussey and Hughes model are derived. Following this, procedures for blinded and unblinded SSRE after any time period in a SW-CRT are detailed. The performance of these procedures is then examined and contrasted using two example trial design scenarios. We find that if the two key variance parameters were underspecified by 50%, the SSRE procedures were able to increase power over the conventional SW-CRT design by up to 41%, resulting in an empirical power above the desired level. Thus, though there are practical issues to consider, the performance of the procedures means researchers should consider incorporating SSRE in to future SW-CRTs