Mixed Effects Research Articles

Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials.

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity-MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2-19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted.

The Impact of Pedestrian Interactions at Intersections on the Three Levels of Drivers’ Situation Awareness

Evaluating drivers’ situation awareness (SA) is important in the implementation of alert prioritization. This study investigates the relationship between driving performance measures (speed, acceleration and brake usage, steering wheel and lane deviation), pedestrian interaction (location, direction and motion), and driver SA. To achieve this, a controlled study was conducted with 56 participants using a Balanced Incomplete Block Design, where each participant drove 18 out of 48 possible intersections in a driving simulator environment. The Situational Awareness Global Assessment Technique (SAGAT) method was used to assess drivers’ SA. Mixed effects logit models were developed to examine the different SA Levels (perception, comprehension, projection). The driving performance measures were aggregated across three time windows (1, 3, and 5 s). The findings show significant contributions from both driving performance measures and pedestrian interactions in predicting driver SA. More specifically, a one-second time window was useful for predicting pedestrian direction and a three-second time window was best for predicting pedestrian location and intention to cross. The results indicate the importance of considering different time windows for predicting various levels of driver SA responses. These findings offer insights into factors to be considered in driver SA predictive models.

A mixed-method randomised controlled feasibility trial of digital CBT and emotion regulation skills training for employees in the workplace (REST)

Background and aimDigital interventions for depression and anxiety can be as effective as face-to-face therapy. One in six workers experience some form of mental health problems, making the workplace a potential avenue to deliver mental health interventions as part of a stepped care model. This study aimed to assess the acceptability, feasibility, and preliminary efficacy of a digital cognitive behavioural therapy (dCBT) on depression and anxiety for employees in the workplace.MethodsA mixed-methods evaluation of employees allocated to dCBT (n=25), or a waitlist control group (n=27) was used to assess five feasibility objectives related to recruitment of employers and employees, engagement, study procedure and preliminary efficacy of the intervention. Quantitative outcome measures and qualitative interviews at 8 weeks post-randomisation were used. Quantitative outcomes were also assessed within subject at 3-, 6-, and 12-month follow-up. Qualitative data was analysed using thematic and framework analysis in Nvivo, whilst quantitative outcomes were analysed using mixed effect linear models between and within subject in R and SPSS.ResultsThirty-Three businesses agreed to facilitate the delivery of three trials run by the University of Warwick in their workplaces. 52 participants consented into the REST trial. Adherence/usage of participants of the treatment platform was just over 50% across the whole sample. There was a reduction in depression and anxiety symptoms post-intervention and at follow-up timepoints across all participants and over time although there were no statistically significant between group differences. High acceptability and satisfaction of the intervention were reported by participants based on qualitative interview data at post-intervention.ConclusionsResults from this feasibility study suggests that the dCBT programme (REST) was acceptable and shows improvement in depression and anxiety symptoms, albeit not over and above the treatment effects in the control group. Recruitment of participants and engagement with the intervention made the feasibility of the delivery somewhat challenging. With better recruitment promotion and engagement strategies, as well as implementing the learnings from the feasibility trial, a fully powered study can inform the efficacy of the REST intervention.Trial registrationThe study is registered in the BMC Springer Nature ISRCTN registry ISRCTN31161020 (registered on 08/06/2021).

Nonlinear guided wave mixing in weld joints for detection of material nonlinearity

The remarkable sensitivity of ultrasonic waves to detect the early stages of material degradation stems from their inherent nonlinear nature. However, distinguishing the nonlinearity induced by the measurement system from that of the weak materials remains a persistent challenge in second harmonic generation methods. Ultrasonic wave mixing has emerged as a feasible solution for isolating nonlinearities originating from the measurement system. While bulk waves, surface waves, and guided waves have undergone extensive study in wave mixing, the potential of feature-guided wave (FGW) mixing remains largely unexplored. This paper investigates the mutual interaction of FGWs to generate second-order mixed harmonic waves, focusing specifically on weld joints. Acoustic energy trapped along structural features such as weld joints exhibits reduced decay compared to uniform plates, making them ideal for nonlinear characterization. We investigate the effectiveness of FGW mixing for characterizing material nonlinearities in welded joints, utilizing phase velocity matching and resonance criteria to enhance the generation of mixed harmonic components. Through three-dimensional numerical simulations and experimental tests, we showcase the generation of mixed harmonics induced by the mixing of FGWs. Our findings underscore the potential of FGW mixing as a novel approach for enhancing nonlinear-based damage detection techniques in welded joints.

Pharmacological and non-pharmacological predictors of the LSD experience in healthy participants

The pharmacodynamic effects of lysergic acid diethylamide (LSD) are diverse and different in different individuals. Effects of other psychoactive substances have been shown to be critically influenced by non-pharmacological factors such as personality traits and mood states. The aim of this study was to determine pharmacological and psychological predictors of the LSD effects in healthy human subjects. This analysis is based on nine double-blind, placebo-controlled, cross-over studies with a total of 213 healthy subjects receiving between 25–200 µg LSD. The influence of sex, age, dose, body weight, pharmacogenetic, drug experience, personality, setting, and mood before drug intake on the peak autonomic and total subjective responses to LSD was investigated using multiple linear mixed effects models and Least Absolute Shrinkage and Selection Operator regression. Results were adjusted for LSD dose and corrected for multiple testing. LSD dose emerged as the most influential predictor, exhibiting a positive correlation with most response variables. Pre-drug mental states such as “Well-Being”, “Emotional Excitability”, and “Anxiety” were also important predictor for a range of subjective effects but also heart rate and body temperature. The trait “Openness to Experiences” was positively correlated with elevated ratings in “Oceanic Boundlessness” and mystical-type effects. Previous experiences with hallucinogens have been negatively associated with the overall altered state of consciousness and particularly with “Anxious Ego Dissolution”. Acute anxiety negatively correlated with the genetically determined functionality of the Cytochrome 2D6 enzyme. In summary, besides the amount of drug consumed, non-pharmacological factors such as personal traits and current mood also significantly predicted the subjective drug experience. Sex and body weight were not significant factors in influencing the drug experience.

Musicians' pursuit of expertise-related goals is characterised by strategic regulation of functional and counterproductive affect.

Emotion regulation is an important part of effective goal pursuit. Functional accounts of emotion regulation suggest that the attainment of challenging goals may be supported by regulating emotions which promote utilitarian over hedonic outcomes. When pursuing the challenging, long-term goal of acquiring expert musical skills and knowledge, musicians may wish to prioritise whichever emotions are most conducive to attaining this goal, even if those emotions are not necessarily positive. Via an online questionnaire, musicians (N = 421) answered questions concerning their musical experience and their expertise-related practice goals. They also reported how strongly they experienced different emotions during practice, and how strongly they desired to either increase or decrease the intensity of those same emotions. Data were analysed using inferential frequentist statistics and Bayesian mixed effects models. Evidence ratios (ER) > 19 were considered strong evidence in favour of an effect. Our analysis showed that musicians experienced and desired strong levels of positive emotions in their practice. In addition, they reported greater desire to intensify positive compared to negative emotions [paired t (420) = 58.13, p < 0.001]. Our Bayesian mixed effects model provided strong evidence that greater desire to intensify anger increased the probability that an observation derived from a musician with stronger expertise-related goals [Est = 0.70; Odds (Est > 0) > 9,999]. In addition to anger, higher levels of expertise-related goals were increasingly predicted by less strong desire to intensify guilt and gloom and greater desire to reduce downheartedness (all ER > 19). Overall, musicians had a strong, general desire to intensify positive emotions during their musical practice. However, musicians with higher levels of expertise-related goals increasingly indicated a nuanced approach regarding how they desired to regulate certain negative emotions. Findings suggest that musicians engage in selective and sophisticated emotion regulation behaviour that aligns with their long-term commitment to develop musical expertise. They may prioritise emotions which may be functionally beneficial, whilst avoiding emotions which may be counterproductive or undermine efforts. Findings from this study contribute to our understanding of expertise-related, domain-specific emotion regulation behaviour and may inform the design of prioritised musical practice strategies.

Minimum acceptable diet use and its associated factors among children aged 6-23 in Ghana: a mixed effect analysis using Ghana Demographic and Health Survey.

Inappropriate feeding practices are a major contributor to child malnutrition. To monitor the feeding practices of young children, current and frequent studies are required. However, as far as our searches are concerned, there is a scarcity of up-to-date information on attainment of the minimum acceptable diet and its predictors in the study area. Therefore, this study aimed to assess the magnitude of attainment of the minimum acceptable diet and its associated factors among children aged 6-23 in Ghana by using the most recent data. Secondary data analysis was conducted based on the demographic and health survey data conducted in Ghana in 2022. A total weighted sample of 2,621 children aged 6-23 months in the 5 years preceding the survey was included in this study. A multi-level logistic regression model was used to identify the determinants of the minimum acceptable diet. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant. The national prevalence of the attainment of the minimum acceptable diet in Ghana was 26.40% (95% CI: 24.82-28.06). Child from mother with higher education (AOR = 1.96; 95% CI: 1.56-3.31) and father with higher education (AOR = 1.59; 95% CI: 1.04-2.41), Children having postnatal visit (AOR = 1.29; 95% CI: 1.03-1.62), being in the child age of 9-11 months (AOR = 2.09; 95% CI: 1.42-5.03) and 12-23 months (AOR = 3.62; 95% CI: 2.61-5.03), being in a middle (AOR = 1.66; 95% CI: 1.14-3.06), and rich wealth quintile (AOR = 2.06; 95% CI: 1.37-3.10), breastfed children (AOR = 3.30; 95% CI: 2.38-4.56), being in a high-community poverty (AOR = 0.65; 95% CI: 0.44-0.96), and being in the Savannah region (AOR = 0.32; 95% CI: 0.16-0.67) were factors significantly associated with the minimum acceptable diet use. Many children are still far behind in meeting the minimum acceptable diet in Ghana as per 90% of WHO-recommended coverage. Measures should be taken to optimize the minimum acceptable diet attainment in the country. Thus, policymakers, the government, and other relevant authorities should focus on the early initiation of complementary feeding, the Savannah region, further empowering women, and enhancing breast-feeding and household wealth status.

Associations between blood nickel and lung function in young Chinese: An observational study combining epidemiology and metabolomics

Prior research has explored the relationship between occupational exposure to nickel and lung function. Nonetheless, there is limited research examining the correlation between blood nickel levels and lung function among young adults in the general population. The metabolomic changes associated with nickel exposure have not been well elucidated. On August 23, 2019, we enrolled 257 undergraduate participants from the Chinese Undergraduates Cohort to undergo measurements of blood nickel levels and lung function. The follow-up study was conducted in May 2021. A linear mixed-effects model was employed to assess the relationship between blood nickel levels and lung function. We also conducted stratified analyses by home address. In addition, in order to explore the biological mechanism of lung function damage caused by nickel exposure, we performed metabolomic analyses of baseline serum samples (N = 251). Both analysis of variance and mixed linear effect models were utilized to assess the impact of blood nickel exposure on metabolism. Our findings from cross-sectional and cohort analyses revealed a significant association between blood nickel levels and decreased forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) among young adults in the general population. Furthermore, we found stronger associations in urban areas. In metabolomics analysis, a total of nine metabolites were significantly changed under blood nickel exposure. The changed metabolites were mainly enriched in six pathways including carbohydrate, amino acid, and cofactor vitamin metabolism. These metabolic pathways involve inflammation and oxidative stress, indicating that high concentrations of nickel exposure can cause inflammation and oxidative stress by disrupting the above metabolism of the body.

The effects of ambient air pollution exposure on Thoroughbred racehorse performance.

Limited research exists on impacts of air pollution on non-human mammals, particularly animal athletes such as Thoroughbred racehorses. Athletes have a greater risk of exposure as heightened exertion and increased airflow carry more pollutants deeper into the respiratory tract. To provide insights into the impact of ambient air pollution, particularly fine particulate matter (PM2.5), on race speed. Retrospective observational study. Data were obtained from The Jockey Club Information Systems, covering 31 407 winning races by Thoroughbred horses in California spanning 10 years (2011-2020) and evaluated the association between air pollution and winning race speeds. For race days, we collected PM2.5 data from the nearest U.S. Environmental Protection Agency (EPA) monitoring site within 100 km of each racetrack (n = 12). We assessed the associations between daily average PM2.5 concentrations and speed of winning horses with linear mixed effects regression. We adjusted for horse characteristics, race-related covariates, temporal indicators (e.g., year), other air pollutants and temperature. We conducted sensitivity analyses by adjusting extreme air pollution days by reassigning values to the 95th percentile value and conducting linear mixed effects regression on series of datasets with incremental cutpoints of PM2.5. In the cutpoint analysis, we found that for PM2.5 between 4 and 23.6 μg/m3, speed decreased 0.0008 m/s (95% CI: -0.0014562 to -0.00018) for every 1 μg/m3 increase of PM2.5. Limitations include the use of offsite monitors leading to imprecise exposure measurements, not using training practice data, and generalisability as the study focuses on California racetracks. This study highlights the need to create advisories to safeguard the performance of horses during periods of poor air quality. Further research is recommended to explore additional factors influencing the relationship between air pollution and equine welfare.

Exploring the relationship between child temperament, maternal psychiatric symptoms, family environment and infant feeding.

Infant temperament is assumed to be primarily innate. However, newer research suggests that maternal affection impacts ratings of temperament and environmental factors, including feeding method, can also influence infant temperament. This study investigates child temperament and its relationships with maternal psychiatric symptoms, environmental variables and feeding method longitudinally in a cohort of children followed from 6 to 72 months. Differences in temperament by feeding group are also investigated. We hypothesized that maternal psychiatric symptoms, environmental stressors, and impaired family dynamics would have negative impact on child temperament, whereas breastfeeding would have a positive impact on child temperament. Mothers' ratings of child's temperament, own psychiatric symptomatology, environmental stresses and family cohesion were obtained in 504 mother-infant dyads via rating scales completed by mothers. Infants were breastfeed (BF), fed soy-based infant formula (SF) or dairy-based infant formula (MF). Linear mixed effect models investigated the relationship of variables on child's temperament while controlling for significant covariates and repeated measurements. Mothers in this study did not endorse clinical-level psychiatric symptomatology; however, when adjusted for significant covariates, higher psychiatric symptomatology significantly correlated with environmental stressors, impaired family dynamics and elevations in temperament ratings of infants' adaptability and mood. There were no lasting differences for temperament between feeding groups. However, some significant transient increases in rhythmicity and adaptability were found between SF and BF children. Positive relationships between family environment stressors and maternal psychiatric ratings were found. Transient differences were found in child temperament based upon feeding method.

Trajectory of associative memory impairment during electroconvulsive therapy in depression

Memory impairment is a serious cognitive side effect of electroconvulsive therapy (ECT) in the treatment of major depressive episodes (MDEs) and has garnered widespread attention in clinical practice, but its underlying evolution pattern during the course of ECT remains rarely understood in detail. Associative memory (AM) is a core indicator that reflects memory impairment in ECT. This study aimed to identify the dynamic trajectory of AM impairment and explore associated predictive factors. 405 intensive longitudinal AM data from 81 patients with MDE were collected at the baseline, after the first, third, fifth, and eighth ECT using five sets of face-cued word memory paradigms. Changes in AM score over time were analyzed using a linear mixed effects model. Trajectory subgroups and predictive factors were investigated using growth mixture model and logistic regression. AM score during ECT were significantly lower than at baseline, with the lowest scores observed after the eighth ECT session. Two trajectories of rapid (N = 56, 69.14%) and slow (N = 25, 30.86%) AM impairment were differentiated. Older female with lower education level were significant predictors contributing to more rapid memory impairment for ECT. The evolving pattern of associative memory impairment during ECT appears to occur early and worsen with subsequent treatment. This study may provide the important evidence understanding of the number effect of ECT sessions on memory impairment and suggest individual factors for predicting ECT memory outcome.

The influence of therapy quality on outcomes from behavioural activation and guided self-help treatments for depression in adults with intellectual disabilities.

We report the effect of quality of therapy delivery on outcomes in a randomized, controlled trial of behavioural activation (BA) and guided self-help (GSH) for depression in adults with intellectual disabilities. A study specific measure of quality was used in a linear mixed effect model to determine the effects therapy and therapy quality on therapy outcome. There was a significant interaction between quality and treatment type, with lower quality therapy associated with better outcome for GSH but poorer outcome for BA, with little difference in outcomes at higher levels of therapy quality. Factors suggesting high quality in individualized BA may indicate problematic engagement for GSH. More research into processes in therapy for people with intellectual disabilities is required.

Eccentricity Dependency of Retinal Electrophysiological Deficits in People With Episodic Migraine.

During the non-attack period, people with migraine may show retinal dysfunction. This study builds on previous work by exploring the possibility of foveal and non-foveal visual field and electroretinographic deficits and determining the overlap in eccentricity of such localized visual deficits in people with migraine. Visual fields and multifocal electroretinography (mf-ERG) were tested in 27 people with migraine (aged 19-45 years) and 18 non-headache controls (aged 20-46 years). Data were averaged according to 5 concentric rings at < 1.5 degrees (foveal) and 5 degrees, 10 degrees, 15.5 degrees, and 22 degrees eccentricities (non-foveal). Linear mixed effects modelling was used to predict mf-ERG amplitude, mf-ERG peak time, and visual field sensitivity with fixed effects of eye, group, and eccentricity. Foveal mf-ERG responses, and visual field sensitivity across all eccentricities (foveal and non-foveal) were similar between the migraine and control groups (P>0.05). In contrast, the non-foveal mf-ERG was reduced in amplitude in people with migraine relative to controls (P<0.001), and this group difference depended on eccentricity (P<0.001) - most prominently, in the parafoveal region (ring 2, P=0.001). Retinal electrophysiological deficits were observed in people with migraine in the parafoveal region (between 1.5 degrees and 5 degrees eccentricity), without corresponding visual field deficits. This suggests a spatially localized area of retinal neuronal dysfunction in people with migraine that is insufficient to manifest as a visual field sensitivity loss using standard perimetric methods. Our study highlights the added confound of migraine when conducting standard clinical retinal electrophysiological tests for conditions such as glaucoma, particularly non-foveally.

Lived Poverty and the Fate of African Democracies

In comparative politics, economic development is a requisite to democracy (Lipset, 1959). Democracy is deemed to fail in less developed countries as poverty has proven to be detrimental to democratic performance. This study offers a perspective on the effects of poverty on the fate of democracy in Africa. Models are estimated for the Poverty-Democracy linkages using variables derived from merged Afrobarometer survey data (2002-2018). The results indicate that poverty in Africa has a mixed effect on democracy more generally. In particular, the analysis indicates that the experience of poverty, which we have termed ‘lived poverty’, has a negative effect on demand and supply of democracy as well as on a number of attributes of political participation. The fact that the poor demand democracy less than the well-to-do while at the same time perceiving limited supply of democracy, in our view explains why more African regimes are consolidating as hybrid regimes instead of moving towards democratic consolidation

Mixing screw design and high density polyethylene toughening modification for recycled polypropylene based on screw 3D printing

AbstractThe recycling of waste plastics primarily involves physical modification and the addition of modifiers, often utilizing equipment such as twin‐screw extruders for miscible modification. Considering the widespread use of single‐screw 3D printing, improving the mixing efficiency of the single‐screw is crucial to achieve a “one‐stop” recycling modification that is suitable for 3D printing. This paper introduces a 3D printer equipped with a mixing screw (MS) and compares it with a conventional screw (CS). We conduct numerical simulations to investigate the pressure build‐up capacity, velocity streamline distribution, and the mixing effect of the MS. The mechanical properties, thermal characteristics, and molecular orientation of the recycled Polypropylene (rPP) and high density polyethylene (HDPE) mixture are investigated through experiments. The results show that the MS provides more effective elongational flows compared to the CS by breaking down the reinforcing materials into smaller particles. Additionally, toughening and modification experiments are performed on rPP and HDPE. The composites treated with the MS showed improved elongation at break (increased by ~111%), a stable melt crystallization temperature, and an enhanced mixing effect. This study on single‐screw 3D printers lays the groundwork for streamlining the plastic recycling process and increasing the reuse rate of recycled plastics.

Accounting for black carbon refractive index in atmospheric radiation

AbstractBecause of the fractal aggregated structure of black carbon (BC), black carbon refractive index measurements are difficult. There are substantial differences among the over 40 existing measurement schemes and no two schemes are the same. Three typical BC refractive index schemes are chosen to explore the difference in black carbon optical properties and the consequences of the radiative effect. Two schemes are widely used in climate models, and the third is from a newer measurement in 2016. It is shown that black carbon optical properties are sensitive to different refractive indices. The relative differences in extinction coefficient and single scattering albedo can be over 100%. In addition, by using Maxwell–Garnett and Bruggeman mixing rules, it has been found that the effect of internal mixing on aerosol optical properties depends strongly on the choice of refractive index. Using a one‐dimensional radiative transfer model under clear‐sky conditions, we demonstrate that the choice of black carbon refractive index influences the inferred radiative effect. Using the more recent (2016) scheme for pure black carbon can increase the top‐of‐atmosphere radiative effect by 20% relative to the currently widely used lowest‐absorbing scheme. For internally mixed aerosol, the sign of the radiative effect can change depending on which refractive index is used.

Cruciferous vegetables lower blood pressure in adults with mildly elevated blood pressure in a randomized, controlled, crossover trial: the VEgetableS for vaScular hEaLth (VESSEL) study

BackgroundHigher cruciferous vegetable intake is associated with lower cardiovascular disease risk in observational studies. The pathways involved remain uncertain. We aimed to determine whether cruciferous vegetable intake (active) lowers 24-h brachial systolic blood pressure (SBP; primary outcome) compared to root and squash vegetables (control) in Australian adults with mildly elevated BP (SBP 120–160 mmHg inclusive).MethodsIn this randomized, controlled, crossover trial, participants completed two 2-week dietary interventions separated by a 2-week washout. Cruciferous vegetables were compared to root and squash vegetables (~ 300 g/day) consumed with lunch and dinner meals. Participants were blinded to which interventions were the active and control. Adherence was assessed using food diaries and biomarkers (S-methyl cysteine sulfoxide (SMCSO, active) and carotenoids (control)). Twenty-four-hour brachial ambulatory SBP and secondary outcomes were assessed pre- and post each intervention. Differences were tested using linear mixed effects regression.ResultsEighteen participants were recruited (median (IQR) age: 68 (66–70); female: n = 16/18; mean ± SD clinic SBP: 135.9 ± 10.0 mmHg). For both interventions, 72% participants had 100% adherence (IQR: 96.4–100%). SMCSO and carotenoids were significantly different between interventions (mean difference active vs. control SMCSO: 22.93 mg/mL, 95%CI 15.62, 30.23, P < 0.0001; carotenoids: − 0.974 mg/mL, 95%CI − 1.525, − 0.423, P = 0.001). Twenty-four-hour brachial SBP was significantly reduced following the active vs. control (mean difference − 2.5 mmHg, 95%CI − 4.2, − 0.9, P = 0.002; active pre: 126.8 ± 12.6 mmHg, post: 124.4 ± 11.8 mmHg; control pre: 125.5 ± 12.1 mmHg, post: 124.8 ± 13.1 mmHg, n = 17), driven by daytime SBP (mean difference − 3.6 mmHg, 95%CI − 5.4, − 1.7, P < 0.001). Serum triglycerides were significantly lower following the active vs. control (mean difference − 0.2 mmol/L, 95%CI − 0.4, − 0.0, P = 0.047).ConclusionsIncreased intake of cruciferous vegetables resulted in reduced SBP compared to root and squash vegetables. Future research is needed to determine whether targeted recommendations for increasing cruciferous vegetable intake benefits population health.Trial registrationClinical trial registry ACTRN12619001294145. https://www.anzctr.org.au

No Money No Time Culinary Nutrition Website eHealth Challenge: A Pre-Post Evaluation of Impact on Diet Quality, Food Expenditure, and Engagement.

No Money No Time (NMNT) is a culinary nutrition website designed to optimize diet quality. The primary aim was to evaluate the impact of an online targeted nutrition challenge email campaign that encouraged engagement with NMNT and goal setting to improve diet quality and weekly food expenditure. A secondary aim was to assess NMNT engagement. Australian adults ≥18 years were recruited to the eHealth nutrition challenge delivered via weekly emails. Diet quality was assessed using the Healthy Eating Quiz (HEQ) diet quality tool. Engagement was assessed using email open and click-through rates. Intention-to-treat (ITT) analysis was conducted using mixed effects linear regression. Of 481 adults (49.7 ± 13.9 years, 84% female) who enrolled 79 (16%) completed the challenge. ITT results indicated statistically significant 6-week increases in diet quality score (+3.8 points p ≤ 0.001, d = 0.58) with sub-scale improvements in vegetables (+0.9 points, p = 0.01, d = 0.32), fruit (+1.2 points, p ≤ 0.001, d = 0.55), and dairy (+0.9 points, p ≤ 0.001, d = 0.58). There were significant post-challenge reductions in household spending on takeaway/snacks/coffee of AUD 8.9 per week (p = 0.01, d = 0.29), body weight reduction (-0.6 kg, p = 0.03, d = 0.26), and BMI (-0.2 kg/m2p = 0.02, d = 0.28). The email open rate remained constant at around 67% (56% to 75%), with an average click-through rate of 18% (7.1% to 37.9%). The eHealth nutrition challenge significantly improved diet quality while reducing BMI and money spent on discretionary foods. Strategies to scale the challenge should be tested as an innovative population strategy for improving diet quality, health indicators, and managing household food budgets.

A 2-stage model of heterogenous treatment effects for brain atrophy in multiple sclerosis utilizing the MS PATHS research network

BackgroundTwo-stage models of heterogenous treatment effects (HTE) may advance personalized medicine in multiple sclerosis (MS). Brain atrophy is a relatively objective outcome measure that has strong relationships to MS prognosis and treatment effects and is enabled by standardized MRI. ObjectivesTo predict brain atrophy outcomes for patients initiating disease-modifying therapies (DMT) with different efficacies, considering the patients’ baseline brain atrophy risk measured via brain parenchymal fraction (BPF). MethodsAnalyses included patients enrolled in the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) network who started DMT and had complete baseline data and ≥ 6-month brain MRI follow-up. All brain MRIs were acquired using standardized acquisition sequences on Siemens 3T scanners. BPF change risk was derived by linear mixed effects models using baseline covariates. Model performance was assessed by predicted versus actual BPF change R2. Propensity score (PS) weighting was used to balance covariates between groups defined by DMT efficacy (high: natalizumab, alemtuzumab, ocrelizumab, and rituximab; moderate: dimethyl fumarate, fingolimod, and cladribine; low: teriflunomide, interferons, and glatiramer acetate). HTE models predicting 1 year change in BPF were built using a weighted linear mixed effects model with low-efficacy DMT as the reference. ResultsAnalyses included 581 high-, 183 moderate-, and 106 low-efficacy DMT-treated patients. The mean and median number of brain MRI observations per treatment period were 2.9 and 3.0, respectively. Risk model performance R2=0.55. After PS weighting, covariate standardized mean differences were <10 %, indicating excellent balance across measured variables. Changes in BPF between baseline and follow-up were found to be statistically significant (p < 0.001), suggesting a pathological change. Patients with low brain atrophy risk had a similar outcome regardless of DMT selection. In patients with high brain atrophy risk, high- and moderate-efficacy DMTs performed similarly, while a 2-fold worse BPF change was predicted for patients selecting low-efficacy DMTs (p < 0.001). Similar results were observed in a sensitivity analysis adjusting for pseudoatrophy effects in a sub-population of patients treated with natalizumab. ConclusionsThe relative benefit of selecting higher efficacy treatments may vary depending on patients’ baseline brain atrophy risk. Poor outcomes are predicted in individuals with high baseline risk who are treated with low-efficacy DMTs.

The effect of mixing between gliding exercises and visual vision on some visual abilities and feet movements for basketball juniors .

The effect of mixing between gliding exercises and visual vision on some visual abilities and feet movements for basketball juniors .