Window Of Opportunity Research Articles

From symptom onset to ED departure: understanding the acute care chain for patients with undifferentiated complaints: a prospective observational study.

For most acute conditions, the phase prior to emergency department (ED) arrival is largely unexplored. However, this prehospital phase has proven an important part of the acute care chain (ACC) for specific time-sensitive conditions, such as stroke and myocardial infarction. For patients with undifferentiated complaints, exploration of the prehospital phase of the ACC may also offer a window of opportunity for improvement of care. This study aims to explore the ACC of ED patients with undifferentiated complaints, with specific emphasis on time in ACC and patient experience. This Dutch prospective observational study, included all adult (≥ 18 years) ED patients with undifferentiated complaints over a 4-week period. We investigated the patients' journey through the ACC, focusing on time in ACC and patient experience. Additionally, a multivariable linear regression analysis was employed to identify factors independently associated with time in ACC. Among the 286 ED patients with undifferentiated complaints, the median symptom duration prior to ED visit was 6 days (IQR 2-10), during which 58.6% of patients had contact with a healthcare provider before referral. General Practitioners (GPs) referred 80.4% of the patients, with the predominant patient journey (51.7%) involving GP referral followed by self-transportation to the ED. The median time in ACC was 5.5 (IQR 4.0-8.4) hours of which 40% was spent before the ED visit. GP referral and referral to pulmonology were associated with a longer time in ACC, while referral during evenings was associated with a shorter time in ACC. Patients scored both quality and duration of the provided care an 8/10. Dutch ED patients with undifferentiated complaints consulted a healthcare provider in over half of the cases before their ED visit. The median time in ACC is 5.5h of which 40% is spent in the prehospital phase. Those referred by a GP and to pulmonology had a longer, and those in the evening a shorter time in ACC. The acute care journey starts hours before patients arrive at the ED and 6 days of complaints precede this journey. This timeframe could serve as a window of opportunity to optimise care.

Advocacy Coalitions, Policy Entrepreneurs, and Windows of Opportunity: Tobacco Control in South Africa, 1948-2018.

This article examines the political history of tobacco control policy in South Africa from 1948 to 2018 by drawing on available historical documents, media reports, published books and articles, the grey literature, and face-to-face interviews with key policy actors. Tracing the historical evolution of tobacco control policies in South Africa reveals how embedded opposition from vested interest groups at every stage of the policy process complicates responses to the tobacco issue. This case study demonstrates how, despite such embedded difficulties, a confluence of regime change, evidence-based messaging, political will, policy entrepreneurs, and advocacy coalitions have led to the gradual transformation of tobacco control policy in South Africa over time. Understanding the historical evolution of tobacco control policy in South Africa opens up space for an in-depth inquiry that allows researchers to trace the policy-making process over the last seven decades, and to understand how those processes have facilitated a shift in the orientation of policy makers over time.

A case report of successful rescue using veno-arterial extracorporeal membrane oxygenation: managing cerebral-cardiac syndrome

IntroductionThe presence of cerebral-cardiac syndrome, wherein brain diseases coincide with heart dysfunction, significantly impacts patient prognosis. In severe instances, circulatory failure may ensue, posing a life-threatening scenario necessitating immediate life support measures, particularly effective circulatory support methods. The application of extracorporeal membrane oxygenation (ECMO) is extensively employed as a valuable modality for delivering circulatory and respiratory support in the care of individuals experiencing life-threatening circulatory and respiratory failure. This approach facilitates a critical temporal window for subsequent interventions. Consequently, ECMO has emerged as a potentially effective life support modality for patients experiencing severe circulatory failure in the context of cerebral-cardiac syndrome. However, the existing literature on this field of study remains limited.Case descriptionIn this paper, we present a case study of a patient experiencing a critical cerebral-cardiac syndrome. The individual successfully underwent veno-arterial-ECMO (VA-ECMO) therapy, and the patient not only survived, but also received rehabilitation treatment, demonstrating its efficacy as a life support intervention.ConclusionVA-ECMO could potentially serve as an efficacious life support modality for individuals experiencing severe circulatory failure attributable to cerebral-cardiac syndrome.

Joint-specific memory, resident memory T cells and the rolling window of opportunity in arthritis.

In rheumatoid arthritis, juvenile idiopathic arthritis and other forms of inflammatory arthritis, the immune system targets certain joints but not others. The pattern of joints affected varies by disease and by individual, with flares most commonly involving joints that were previously inflamed. This phenomenon, termed joint-specific memory, is difficult to explain by systemic immunity alone. Mechanisms of joint-specific memory include the involvement of synovial resident memory T cells that remain in the joint during remission and initiate localized disease recurrence. In addition, arthritis-induced durable changes in synovial fibroblasts and macrophages can amplify inflammation in a site-specific manner. Together with ongoing systemic processes that promote extension of arthritis to new joints, these local factors set the stage for a stepwise progression in disease severity, a paradigm for arthritis chronicity that we term the joint accumulation model. Although durable drug-free remission through early treatment remains elusive for most forms of arthritis, the joint accumulation paradigm defines new therapeutic targets, emphasizes the importance of sustained treatment to prevent disease extension to new joints, and identifies a rolling window of opportunity for altering the natural history of arthritis that extends well beyond the initiation phase of disease.

Optimizing Weed Control: A Review of Integrated Weed Management in Mustard (Brassica juncea L.)

Mustard (Brassica juncea L.), a species of the cruciferous family, is the world's third most significant oilseed crop, following soybean and palm. Mustard seeds range in oil content from 37 to 49%. India is the fourth-largest producer of mustard and rapeseed in the world. The most significant issue causing mustard's low yield is weed control. Crop yields are significantly reduced by weeds; in the case of mustard, this can mean a complete failure rate of 15–30%. Crop plants compete with weeds for nutrients, sunlight, space, and water. In addition to lowering crop quality, weeds pose a number of nutritional and environmental hazards. In mustard crops, weed competition is particularly important in the early stages since the crop grows slowly in the first 4–8 weeks after sowing. On the other hand, 15–40 days are the critical window for crop–weed competition. Weed control must be carried out appropriately and on time in order to maximize mustard growth and production. During the early stages of crop growth, 25–30 days after sowing, the traditional practice of hand weeding once is insufficient because weeds always reappear after manual weeding, irrigation, or winter rainfall. More importantly, though, is that these weeds drain a large amount of the soil's moisture and nutrients. Though hand weeding mustard is simple, the expense of doing so is significant due to the scarcity of labor at the appropriate time and the uncontrolled growth of various intra row weeds. Weeds may become tolerant of herbicides despite their regular and high dosage application. Therefore, combined approaches could be the best option to control the complex weed flora in mustard.

Abstract CT022: Mutant KRAS peptide-based vaccine in patients at high risk of developing pancreatic cancer: Preliminary analysis from a phase I study

Abstract Background: The development of pancreatic ductal adenocarcinoma (PDAC) from the first driver event takes >10 years, providing a unique window of opportunity for early interception. As a frequent alteration identified in both PDAC and pancreatic premalignancy, mutant KRAS (mKRAS) has emerged as a potential target for immune-based interception strategies in individuals at high risk of developing pancreatic cancer. Methods: This is a single-arm, open-label, second-in-human phase I study of a pooled synthetic long peptide (SLP) vaccine with poly-ICLC adjuvant targeting up to six mKRAS subtypes (G12D, G12R, G12V, G12A, G12C, G13D) in patients with hereditary predisposition to developing PDAC (NCT05013216). Key inclusion: radiographic evidence of a pancreatic abnormality and eligibility under at least one of three high-risk groups based on family history of PDAC and/or germline mutation status. Vaccination schema: mKRAS vaccine given on weeks 1, 3, 5, and 13. Peripheral blood collected at baseline and weeks 5, 13, and 17 for analysis of immunogenicity by IFN-gamma ELISpot. Co-primary endpoints: safety and mKRAS-specific T cell response. Results: At the time of data cutoff (November 15, 2023), 15 out of 20 planned patients were vaccinated on study and evaluable for immunogenicity. All 15 patients achieved a mKRAS-specific T cell response, defined by the maximal fold change in the pooled average IFN-gamma-producing mKRAS-specific T cell density within 17 weeks post-vaccination (median: 12.3, range: 3.1-167). Differential immunogenicity elicited by individual mKRAS epitopes was noted in this cohort. Specifically, the mKRAS G12V peptide induced the highest fold change increase in antigen-specific T cell expansion (median: 32.6, range: 2.9-243) while the mKRAS G12D peptide was the least immunogenic (median: 7.6, range: 0.4-104). Regarding safety, all adverse events were grade 1 or grade 2 in severity per NCI CTCAE v5.0. The most frequent vaccine-related adverse events were injection site reactions (93.8%), fatigue (62.5%), chills (43.8%), and headache (37.5%). No safety signals were observed. Conclusions: For the first time, we demonstrate mKRAS-specific T cell responses induced by vaccination in a cohort of high-risk individuals with inherited predisposition to PDAC. These findings directly serve as proof-of-concept to advance vaccine strategies focused on intercepting the development of pancreatic cancer in high-risk populations. Support: Stand Up To Cancer, Lustgarten Foundation, and NIH/NCI. Citation Format: Saurav D. Haldar, Amanda Huff, Elizabeth Abou Diwan, Anna Ferguson, Carol Judkins, Jiayun Lu, Hao Wang, Hassan Sinan, Christopher Thoburn, Katherine M. Bever, Mark Yarchoan, Amy M. Thomas, Julie M. Nauroth, Daniel A. Laheru, Michael G. Goggins, Elizabeth M. Jaffee, Nilofer S. Azad, Neeha Zaidi. Mutant KRAS peptide-based vaccine in patients at high risk of developing pancreatic cancer: Preliminary analysis from a phase I study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT022.

SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis

Nearly 150 million cases of urinary tract infections (UTIs) are reported each year, of which uncomplicated cystitis triggers > 25% of outpatient prescriptions of oral antimicrobial treatment (OAT). OAT aids immune cells infiltrating the urothelium in eliminating uropathogens capable of invading the urothelium and surviving hyperosmotic urine. This self-evident adaptability of uropathogens and the short interval between the introduction of Penicillin and the first report of antimicrobial resistance (AMR) implicate AMR as an evolutionary conserved heritable trait of mutant strains selected by the Darwinian principle to survive environmental threats through exponential proliferation. Therefore, AMR can only be countered by antimicrobial stewardship (AMS) following the principle of the five Ds—drug, dose, duration, drug route, and de-escalation. While convenient to administer, the onset of the minimum inhibitory concentration (MIC) for OAT in urine leaves a window of opportunity for uropathogens to survive the first contact with an antimicrobial and arm their descendant colonies with AMR for surviving subsequent higher urine antimicrobial levels. Meanwhile, the initial dose of intravesical antimicrobial treatment (IAT) may be well above the MIC. Therefore, the widespread clinical use of OAT for cystitis warrants an analysis of the strengths, weaknesses, opportunity, and threats (SWOTs) and a root cause analysis of the AMR associated with OAT and IAT.

Emerging Storylines in the Context of the Pandemic for the Mainstreaming of Bicycles in the Transport System

Using Metropolitan Manila in the Philippines as a case study, we investigate how the Covid pandemic has opened up a window of opportunity for the de-legitimization of dominant storylines marginalizing cycling and the legitimization of alternative storylines favoring the mainstreaming of bicycles in urban transport systems. Storylines are condensed summaries of complex narratives deployed as convenient shorthand in discussions. Through a content analysis of posts from ten Facebook groups by cycling advocates, we identify six pairs of contending storylines and their key narratives. Furthermore, through semi-formal interviews and an online survey, we determine the level of agreement and the consensus around agreement with the content of the storylines among a limited sample of respondents representing various backgrounds. Our results suggest that pre-pandemic, delegitimizing storylines resonate more strongly among the respondents. Peri-pandemic, a positive shift has occurred in the social representation of bicycles in Metropolitan Manila, as indicated by the emergence of legitimizing storylines. This does not mean, however, that this positive shift is complete and not challenged anymore. Though a rapid legitimization of pro-cycling storylines has been observed, there is an ongoing contestation against such legitimization. Whether the peri-pandemic cycling gains can be sustained post-pandemic is an open question.

Demographic and Clinical Features and Factors Affecting the Quality of Life of Patients With Hidradenitis Suppurativa: A Cross-sectional Study.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with well-known adverse effects on quality of life (QoL). Improving patients' QoL has become an important objective of treatment. The purpose of this study was to evaluate the demographic and clinical characteristics and factors affecting the QoL of patients with HS. One hundred seventy-six patients with HS aged between 18 and 65 years were included in the study. The patients' demographic and clinical characteristics, treatments, and comorbidities were recorded. The disease stage was determined based on the Hurley staging system. The Dermatology Life Quality Index (DLQI) was used to evaluate QoL. Mean DLQI scores were significantly higher in patients with advanced Hurley stages, lesions in the gluteal region and legs, and with more than 2 affected areas (p < .001). Correlations between patient-reported treatment outcomes and clinical characteristics of the patients were assessed. Findings of this study indicate the existence of a potential "window of opportunity" for laser epilation and wide local surgical excision, similar to anti-tumor necrosis factor therapy. Timely and appropriate treatment can only be provided for patients with HS by evaluating objective disease severity measures and subjective patient data in combination.

Estimating the dynamic early life exposure to PFOA and PFOS of the HELIX children: Emerging profiles via prenatal exposure, breastfeeding, and diet

In utero and children’s exposure to per- and polyfluoroalkyl substances (PFAS) is a major concern in health risk assessment as early life exposures are suspected to induce adverse health effects. Our work aims to estimate children’s exposure (from birth to 12 years old) to PFOA and PFOS, using a Physiologically-Based Pharmacokinetic (PBPK) modelling approach.A model for PFAS was updated to simulate the internal PFAS exposures during the in utero life and childhood, and including individual characteristics and exposure scenarios (e.g., duration of breastfeeding, weight at birth, etc.). Our approach was applied to the HELIX cohort, involving 1,239 mother–child pairs with measured PFOA and PFOS plasma concentrations at two sampling times: maternal and child plasma concentrations (6 to 12 y.o).Our model predicted an increase in plasma concentrations during fetal development and childhood until 2 y.o when the maximum concentrations were reached. Higher plasma concentrations of PFOA than PFOS were predicted until 2 y.o, and then PFOS concentrations gradually became higher than PFOA concentrations. From 2 to 8 y.o, mean concentrations decreased from 3.1 to 1.88 µg/L or ng/mL (PFOA) and from 4.77 to 3.56 µg/L (PFOS). The concentration–time profiles vary with the age and were mostly influenced by in utero exposure (on the first 4 months after birth), breastfeeding (from 5 months to 2 (PFOA) or 5 (PFOS) y.o of the children), and food intake (after 3 (PFOA) or 6 (PFOS) y.o of the children). Similar measured biomarker levels can correspond to large differences in the simulated internal exposures, highlighting the importance to investigate the children’s exposure over the early life to improve exposure classification.Our approach demonstrates the possibility to simulate individual internal exposures using PBPK models when measured biomarkers are scarce, helping risk assessors in gaining insight into internal exposure during critical windows, such as early life.

Establishing trust and distrust when states leave international organisations: the case of Brexit

ABSTRACT Although EU and UK participants in Brexit negotiations emphasise the role that trust and distrust played for them, existing Brexit research has largely disregarded this factor. From a trust perspective, withdrawals from international organisations are highly significant events. When states leave a common institution and their relationship with each other is deprived of previous institutional certainties, trust becomes both necessary and precarious. Building on insights from trust research in International Relations, we argue that the former partners gauge whether the other side can be trusted based on two types of signals: signals of benevolence and of integrity. Our analysis shows that during Boris Johnson’s premiership, the EU lost trust in the UK government’s benevolence and integrity, mainly because the UK repeatedly failed to honour previous commitments. Rishi Sunak’s government countered the signals sent by its predecessor. By demonstrating its integrity and benevolence, it succeeded in rebuilding trust and facilitated the conclusion of the ‘Windsor Framework’. This not only sheds light on an under-researched dimension of the Brexit process. It also contributes to trust research, which has yet to fully acknowledge both the significance of signals of trustworthiness and leadership transitions in creating windows of opportunity for changes in trust dynamics.

Supplemental Material for “Window of Opportunity”: Clients’ Experiences of Crying in Psychotherapy and Their Relationship With Change, the Alliance, and Attachment

Supplemental Material for “Window of Opportunity”: Clients’ Experiences of Crying in Psychotherapy and Their Relationship With Change, the Alliance, and Attachment

57 Utilizing a Digital Phenotype for Metabolic Syndrome to Elucidate Risk Profiles for Neurocognitive Disease: An Electronic Medical Record Study

OBJECTIVES/GOALS: Metabolic syndrome (MetS), defined as a cluster of cardiometabolic disease risk factors, is seldom coded using the ICD-10 system in electronic medical records (EMR). The goal of this study was to use EMR to construct MetS with a digital phenotype to amplify the pool of patients available to assess risk for neurocognitive disease in this population. METHODS/STUDY POPULATION: A digital phenotype using the EMR platform TriNetX (n=38 million patients between age 50 and 80) was created by clustering codes for the individual components of MetS (insulin resistance, hypertension, dyslipidemia, and central adiposity). The research network database on TriNetX was utilized to elucidate risk ratios for neurocognitive decline, Alzheimer’s disease and related dementias (ADRDs), and cerebrovascular disease between a preclinical sample of older adults with and without MetS. Propensity score matching was used to match cohorts on demographic variables, medication use, and relevant comorbidities. Risk ratios (RR) and confidence intervals (95% CI) were presented for all outcomes. RESULTS/ANTICIPATED RESULTS: The digital phenotype for MetS expanded the sample from 29,830 to 274,703, a 10-fold increase. Sensitivity to the standard MetS ICD-10 code was 95.1%, showing strong agreement between coding schema. Older adults with MetS had higher risk of cognitive decline (RR: 1.30, 95% CI: 1.15–1.48, p &lt;0.001), ADRDs (RR: 1.48, 95% CI: 1.25–1.75, p &lt;0.001), and cerebrovascular issues (RR: 1.62, 95% CI: 1.55–1.70, p &lt;0.001) when controlling for demographics, medication, and comorbidities. MetS individuals with cerebrovascular dysfunction had even greater risks for neurocognitive decline (RR: 1.70, 95% CI: 1.38–2.08, p &lt; 0.001) and ADRDs (RR: 2.09, 95% CI: 1.56–2.80, p &lt; 0.001) than those with only MetS. DISCUSSION/SIGNIFICANCE: Implementing a digital MetS phenotype in EMR effectively increased sample size and power for analyses. Older adults with MetS have higher risk for neurocognitive decline, especially among those with cerebrovascular dysfunction, highlighting a critical intervention window prior to overt cardiometabolic disease.

Disentangling the association of PAH molecules with star formation

Context. Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous complex molecules in the interstellar medium and are used as an indirect indicator of star formation. On the other hand, the ultraviolet (UV) emission from young massive stars directly traces the star formation activity in a galaxy. The James Webb Space Telescope (JWST), along with the UltraViolet Imaging Telescope (UVIT), opened up a new window of opportunity to better understand the properties of PAH molecules that are associated with star-forming regions. Aims. We investigate how the resolved scale properties of PAH molecules in nearby galaxies are affected by star formation. Methods. We analyzed the PAH features observed at 3.3, 7.7, and 11.3 μm using F335M, F770W, and F1130W images obtained from the JWST. These images helped us identify and quantify the PAH molecules. Additionally, we used UVIT images to assess the star formation associated with these PAH-emitting regions. Our study focused on three galaxies, namely NGC 628, NGC 1365, and NGC 7496, which were selected based on the availability of both JWST and UVIT images. Bright PAH emission regions were identified in the JWST images, and their corresponding UV emission was estimated using the UVIT images. We quantified the star formation properties of these PAH emitting regions using the UVIT images. Furthermore, we investigated the relation between the star formation surface density (ΣSFR) and the PAH ratios to better understand the impact of star formation on the properties of PAH molecules. Results. Based on the resolved scale study of the PAH-bright regions using JWST images, we found that the fraction of ionized PAH molecules is high in the star-forming regions with high ΣSFR. We observed that emission from smaller PAH molecules is higher in star-forming regions with higher ΣSFR. Conclusions. Our study suggests that the PAH molecules excited by the photons from star-forming regions with higher ΣSFR are dominantly smaller and ionized molecules. UV photons from the star-forming regions could be the reason for the higher fraction of the ionized PAHs. We suggest that the effect of the high temperature in the star-forming regions and the formation of smaller PAH molecules in the star-forming regions might also result in the higher emission in the F335MPAH band.

Phase 1 study combining elotuzumab with autologous stem cell transplant and lenalidomide for multiple myeloma

BackgroundAutologous stem cell transplantation (ASCT) after induction therapy improves disease-free survival for patients with multiple myeloma (MM). While the goal of ASCT is to render a minimal disease state, it...

Maternal exposure to tributyltin alters the breast milk, hormonal profile, and thyroid morphology of dams and induces sex-specific changes in neonate rat offspring.

Tributyltin (TBT) is the chemical substance commonly used worldwide to prevent biofouling of vessels. Due to its ability to bioaccumulate and biomagnify, even after being banned, significant concentrations of TBT can be detected in sediment, affecting marine and human life. Although studies have shown that direct exposure to TBT alters physiological parameters in mammals, the relationship between exposure to TBT during pregnancy and lactation, considered critical windows for metabolic programming, has not been fully elucidated. Our hypothesis is that offspring whose mothers were exposed to TBT during critical stages of development may exhibit dysfunctions in endocrine-metabolic parameters. We used pregnant Wistar rats that were divided into groups and received the following treatments from gestational day 7 until the end of lactation by intragastric gavage: vehicle (ethanol 0.01%; Control), low TBT dose (100 ng/kg of body weight (bw)/day; TBT100ng) and high TBT dose (1000 ng/kg bw/day; TBT1000ng). Dams and offspring at birth and weaning (21 days old) were studied. Maternal exposure to TBT promoted dose-dependent changes in dams. The findings for adiposity, milk composition and lipid profile were more pronounced in TBT100ng dams; however, thyroid morphology was altered in TBT1000ng dams. Female offspring were differentially affected by the dose of exposure. At birth, females in the TBT100ng group had low body weight, lower naso-anal length (NAL), and higher plasma T4, and at weaning, females in the TBT100ng group had lower insulin and leptin levels. Females in the TBT1000ng group had lower NAL at birth and lower leptinemia and weight of white adipose tissue at weaning. Male offspring from TBT groups showed high T3 at birth, without biometric alterations at birth or weaning. Despite these findings, both sexes exhibited dose-dependent morphological changes in the thyroid gland. Thus, maternal exposure to TBT constitutes an important route of contamination for both dams and offspring.

Physical Activity and Knowledge about Nutrition Among Adolescents at Madrasah Aliyah Negeri (MAN) Surabaya City

Background: Adolescents are a window of opportunity for future development, so it is necessary to invest in the health and welfare of adolescents in accordance with the Adolescent Nutrition Program launched by the Indonesian government to adjust the Sustainable Development Goal at the UN meeting with a communication strategy for social change and adolescent behavior. Methods: This study used a quantitative design with 196 respondents whose samples were taken with probability sampling techniques in the form of simple random sampling. Physical activity data was taken from the International Physical Activity Questionnaire (IPAQ), data on knowledge of nutrients obtained from the Self Administere Qustionnaire (QuesCa) and intensity of fast food consumption obtained from the Food Frequency Questionnaire while nutritional intake through 24-hour food recall form. Data analysis used multiple linear regression with SPSS 25 statistical tools. Results: Based on the t test, it was concluded that there was an effect of physical activity and knowledge of nutrients with a significance value of 0.000 for each of the two variables. While the intensity of fast food consumption has a significance value of 0.968 (more than 0.05) which concludes that there is no effect of the intensity of fast food consumption on nutritional intake. Nutrient knowledge is the factor that most influences nutrient intake with a t-statistic of 5.941. Conclusions: In this study, it was concluded that there was an effect of physical activity and nutritional knowledge on nutritional intake, while the intensity of fast food consumption did not affect nutritional intake. The dominant factor affecting nutritional intake in this study was nutritional knowledge.

Improving Understanding In Preventing Stunting In The First 1,000 Days Of Life

The World Health Organization (WHO) defines stunting as a state of very short stature that exceeds a deficit of 2 SD below the median length or population height which is an international reference (Trihono, et al., 2015). Stunting is closely related to the first 1000 days of life (HPK) period. . The 1000 HPK period is an important period or a golden period for growth and development. 1000 HPK starts from pregnancy until the child is 2 years old. 1000 HPK is called the Window of Opportunity because during this period organ systems experience a very rapid increase in growth and development. Based on data from Basic Health Research (Riskesdas), the prevalence of stunting in Indonesia fluctuated, namely in 2007 it was 36.8%, 35.6% (2010), 37.2% (2013), and 30.8% (2018). Based on Riskesdas, the prevalence of stunting in West Sumatra fluctuated, namely in 2007 it was 36.5%, 32.7% (2010), 39.2% (2013), and 29.9% (2018). This community service activity is carried out in Kelurahan Andalas Padang by providing counseling to mothers who have toddlers. This activity was carried out on June 30, 2022.1000 First Day

The effects of obesity in childhood and adolescence: The role of physiotherapy: Review of reviews

Introduction: Obesity remains a growing global issue with its prevalence in the developed world increasing fourfold in recent decades. Childhood may represent a critical window of opportunity for intervention and prevention of long-term consequences. While physiotherapy has the practical potential to contribute to the treatment of childhood obesity, its role remains unclear due to a lack of specific guidelines. Aim: The aim of this review is to explore the existing literature to delineate, identify and evaluate the role of physiotherapy in the management of childhood obesity Method: A review was conducted of existing literature in 4 databases, Pubmed. Embase, Cinahl, Medline. Results: Of the original 273 articles collected based on title and abstracts, 36 were included which were reviews. Of these, 23 were systematic reviews and 13 were literature reviews. The interventions involved quality-oriented physical activity and quantity-oriented physical activity as well as combined interventions involving different disciplines. The physical therapy interventions for children with obesity that appear to be significantly effective are: First, multi-component interventions involving environmental modification and family involvement and second, quantity-based physical activity interventions Conclusion: Physical therapy in the treatment of children with obesity can play an important role as part of a multidisciplinary team (doctors, psychologists, teachers, trainers and others), evaluating and developing exercise programs with the ultimate goal of increasing quantitative physical activity, a practice that seems to yield the best results. Future studies should examine the impact of different rehabilitation programs depending on the individual characteristics of the children (profile, size of the problem, presence of comorbidities).

After nudging: the ethical challenge of post-pandemic policymaking in the UK

This article explores the interplay between crises, opportunities and democratic change in the United Kingdom. A vast body of scholarship underlines that crises open ‘windows of opportunity’ that can occasionally lead to radical shifts in the role of the state and the design of public policy. Even when a radical shift occurs, however, it has often proved temporary, with relationships and processes quickly reverting to pre-crisis modes once the immediacy of the crisis abates. This may not be true of our present period of crisis following the COVID-19 pandemic. The consequences of decades of underinvestment in infrastructure and increasing concentration of resources in a small minority of individuals and organisations are being exacerbated by climate change, geopolitical conflict and new waves of disease. The challenge for policymakers in the UK now is heightened by evidence that suggests that nudging, a libertarian paternalist means of promoting certain ends, is ineffective. Policymakers who have long used state neutrality between conceptions of the good as the justification for not promoting certain ends now have to confront a real ethical dilemma: coerce to achieve specific outcomes or invest in addressing the social determinants that actually affect behaviour. This article suggests that contrary to decades of opposition to redistribution among UK policymakers, only the latter is consistent with libertarian paternalism.