Reduction in intake of discretionary foods and drinks among Danish schoolchildren: dietary results from the real-life cluster-randomised controlled trial 'Are You Too Sweet?'

OBJECTIVE: To evaluate the effectiveness of the multicomponent intervention trial 'Are You Too Sweet?' in reducing discretionary foods and drinks intake among young schoolchildren. DESIGN: The study was a 3·5-month two-arm cluster-randomised controlled trial among primary schoolchildren and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilise at home. Dietary intake was assessed using a web-based 7-d dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups. SETTING: Six schools from a Danish municipality were randomised to the intervention group (n 4) or the control group (n 2). PARTICIPANTS: A total of 153 children aged 5-7 years. RESULTS: No significant reduction in the children's intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40·9 % (P = 0·045) was observed compared with control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2·9 E% (P = 0·002). CONCLUSION: The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.

An Evaluation of Gastric Emptying Scintigraphy Protocols in Health Care Institutions When Compared with the Society of Nuclear Medicine and Molecular Imaging Procedure Guidelines.

This study aimed to analyze the compliance of health care institutions with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) procedure guidelines for gastric emptying scintigraphy (GES). Methods: A 19-question survey on demographics and the GES protocol was conducted using a Google form. The demographic questions covered position, number of technologists in the department, location, type of health care institution, and number of GES studies per month. The protocol questions included patient preparation, meal preparation, withholding of scheduled medications, radiopharmaceutical type, and radiopharmaceutical dose. The survey was sent to 7 nuclear medicine Facebook groups and a list of clinical affiliates provided by the Indiana University School of Medicine Nuclear Medicine Program. Descriptive statistics were compiled for most questions. A Fisher exact test with a significance level of 0.05 was used to compare the type of health care institution with compliance with the SNMMI GES protocol regarding radiolabeling time, meal preparation, and meal components, as well as to compare the type of health care institution with the number of GES studies performed per institution. Results: In total, 240 people responded to the survey. Most were nonsupervisory nuclear medicine technologists (72%) in nonacademic institutions (72%) and groups with 4 or more technologists (62%). Of the respondents, 72% followed the SNMMI guideline of adding the radiopharmaceutical before cooking, but only 37% followed the meal component guideline. There was no significant association between the type of institution or the number of GES studies and compliance with radiolabeling time or with meal preparation or components. Most respondents asked patients to withhold medications per SNMMI guidelines and used the recommended radiopharmaceutical (99mTc-sulfur colloid, 95%) at the recommended dose (18.5-37 MBq, 84%). Conclusion: Although most respondents followed most aspects of the SNMMI guidelines for GES, more than half did not use the recommended meal of liquid egg whites. Compliance did not vary between academic and nonacademic institutions or between groups performing a large or a small number of GES studies.

Evaluation of Parental Acceptability and Use of Intervention Components to Reduce Pre-School Children's Intake of Sugar-Rich Food and Drinks.

Knowledge is needed about effective tools that reach public health objectives focused on reducing the intake of sugar-rich foods and drinks. The purpose of this study was to assess the parental acceptability, use and motivational potential of intervention components developed in the randomized family-based trial 'Are you too sweet?' aimed at reducing the intake of sugar-rich foods and drinks among children (5-7 y). Intervention components included guidance on sugar-rich foods and drinks at a school health nurse consultation, a box with home-use materials and a digital platform. The methods used were a questionnaire among intervention families (n = 83) and semi-structured interviews with parents in selected intervention families (n = 24). Results showed the good acceptability and usefulness of the components, with reported frequencies of use of materials ranging from 48% to 94% and a high satisfaction rate with the school health nurse consultation. Personalized feedback and guidance from the school health nurse seemed to be a motivational trigger, and components that were compatible with existing practices were most frequently used. However, the components were not considered engaging by all families. Overall, intervention components were well received and hold the potential for enhancing parental knowledge and parenting practices regarding limiting the intake of sugar-rich foods and drinks.

Comparison of Discretionary Food and Drink Intake Based on a Short Web-Based Sugar-Rich Food Screener and a Validated Web-Based 7-Day Dietary Record.

A high consumption of discretionary foods and drinks has been associated with increased risk of multiple adverse health outcomes, including risk of overweight and dental caries. The family-based cluster randomized intervention study "Are you too sweet?" aimed at reducing the intake of discretionary foods and drinks in a population of children starting pre-school. As part of the intervention a new short web-based sugar-rich food screener (SRFS), was developed to make the parents and the school health nurses aware of the children's intake of discretionary foods and drinks. In addition to the short assessment tool the parents also completed a validated web-based 7-day dietary record for the children. In the present study, estimates for intake of discretionary foods and drinks from the two assessment tools were compared (n = 80). There was significant correlation between estimates from the two assessment tools, but the SRFS provided lower estimates for intake of discretionary foods and drinks compared to the 7-day dietary record. The correlation coefficient between the two assessment tools was 0.49 (p < 0.001) and Kappa coefficient was 0.33. It is concluded that the SRFS can provide a fairly ranking of participants according to their intake of discretionary foods and drinks when compared to a validated 7-day dietary record. The screener may be a useful tool in practical settings, such as school health nurse consultations, in order to gain insight into the child's sweet intake habits.

Diastereoselective Synthesis of P-Stereogenic Secondary Phosphine Oxides (SPOs) Bearing a Chiral Substituent by Ring Opening of (+)-Limonene Oxide with Primary Phosphido Nucleophiles.

Kinetic separation of the commercially available cis/trans-(+)-limonene oxide mixture by ring opening with primary phosphido nucleophiles LiPHR (R = ferrocenyl, Ph, Cy, t-Bu, Mes* (Mes* = 2,4,6-(t-Bu)3C6H2)), followed by treatment with aqueous NH4Cl and H2O2, gave unreacted cis-(+)-limonene oxide and diastereoenriched mixtures of the secondary phosphine oxides (SPOs) PHR(trans-(+)-Lim-OH)(O), which could be separated by chromatography and/or recrystallization. This one-pot synthesis uses a cheap chiral material and commercially available primary phosphines to control the configuration of the new P-stereogenic SPOs, which are potentially useful as ligands for metal complexes in asymmetric catalysis.

Reducing Young Schoolchildren's Intake of Sugar-Rich Food and Drinks: Study Protocol and Intervention Design for "Are You Too Sweet?" A Multicomponent 3.5-Month Cluster Randomised Family-Based Intervention Study.

A high consumption of sugar-rich discretionary food and drinks has several health implications, which have been traced from childhood into adulthood. Parents act as primary mediators shaping children's dietary habits, and interventions that engage parents have shown to result in positive outcomes. Further, collaboration with local school health nurses and dentists provides an effective structural frame to support behaviour change and anchor new initiatives. The multicomponent 3.5-month cluster randomised family-focused intervention "Are you too Sweet?" aims to evaluate the effectiveness of communicating new Danish guidelines for sugar-rich discretionary food and drinks for school starters (5-7 years). This paper describes the development, outcomes and process evaluation of the intervention that includes three main components: extended dialogue during a school health nurse consultation, a box with home-use materials, and a social media platform to facilitate interaction among participants. Children (n = 160) and their parents were scheduled for a baseline interview at six different schools. The intervention was developed to increase self-efficacy, knowledge about guidelines, observational learning and reduce impediments for behavioural change. The desired primary outcome was a reduction in intake of sugar-rich food measured through a 7-day dietary record. The results contribute to the evidence on effective health promotion strategies.

Diastereoselective Coordination of P-Stereogenic Secondary Phosphines in Copper(I) Chiral Bis(phosphine) Complexes: Structure, Dynamics, and Generation of Phosphido Complexes.

Diastereoselective coordination of racemic secondary phosphines (PHRR') to Cu(I) precursors containing chiral bis(phosphines) (diphos*) was explored as a potential route to P-stereogenic phosphido complexes. Reaction of [Cu(NCMe)4][PF6] with chiral bis(phospholanes) gave [Cu(diphos*)2][PF6] (diphos* = ( R, R)-Me-DuPhos (1), ( R, R)-Et-DuPhos (2), or ( R, R)-Me-FerroLANE) (3)) or the mono(chelates) [Cu(diphos*)(NCMe) n][PF6] (diphos* = ( R, R)- i-Pr-DuPhos, n = 2 (4); diphos* = ( R, R)-Me-FerroLANE, n = 1 (5)). Treatment of [Cu(NCMe)4][PF6] with diphos* and PHMe(Is) (Is = 2,4,6-( i-Pr)3C6H2) gave mixtures of diastereomers of [Cu(( R, R)- i-Pr-DuPhos)(PHMe(Is))(NCMe)][PF6] (6) and [Cu(( R, R)-Me-FerroLANE)(PHMe(Is))][PF6] (7); two of the three expected isomers of the bis(secondary phosphine) complexes [Cu(( R, R)- i-Pr-DuPhos)(PhHP(CH2) nPHPh)][PF6] ( n = 2 (8); n = 3 (9)) were formed preferentially in related reactions. Reaction of the halide-bridged dimers [Cu(( R, R)- i-Pr-DuPhos)(X)]2 or [Cu(( R, R)-Me-FerroLANE)(I)]2 with PHMe(Is) gave the labile adducts Cu(( R, R)- i-Pr-DuPhos)(PHMe(Is))(X) (X = Cl (10), Br (11), I (12)) and Cu(( R, R)-Me-FerroLANE)(PHMe(Is))(I) (13). Complexes 1, 6, and 8-11 were structurally characterized by X-ray crystallography. Variable temperature NMR studies of 6 and 8 showed that the secondary phosphine ligands underwent reversible dissociation. Deprotonation of 6 or 7 generated the P-stereogenic phosphido complexes Cu(diphos*)(PMeIs) (diphos* = ( R, R)- i-Pr-DuPhos (14) or ( R, R)-Me-FerroLANE) (17)), observed by 31P NMR spectroscopy, but decomposition also occurred. Density functional theory calculations were used to characterize the diastereomers of thermally unstable 17 and the inversion barrier in a model copper-phosphido complex. These observations provided structure-property relationships which may be useful in developing catalytic asymmetric reactions involving secondary phosphines and P-stereogenic copper phosphido intermediates.

Synthesis, Structure, and Luminescence of Copper(I) Halide Complexes of Chiral Bis(phosphines).

For investigation of structure-property relationships in copper phosphine halide complexes, treatment of copper(I) halides with chiral bis(phosphines) gave dinuclear [Cu((R,R)-i-Pr-DuPhos)(µ-X)]2 [X = I (1), Br (2), Cl (3)], [Cu(µ-((R,R)-Me-FerroLANE)(µ-I)]2 (5), and [Cu((S,S)-Et-FerroTANE)(I)]2 (6), pentanuclear cluster Cu5I5((S,S)-Et-FerroTANE)3 (7), and the monomeric Josiphos complexes Cu((R,S)-CyPF-t-Bu)(I) (8) and Cu((R,S)-PPF-t-Bu)(I) (9); 1-3, 5, and 7-9 were structurally characterized by X-ray crystallography. Treatment of iodide 1 with AgF gave [Cu((R,R)-i-Pr-DuPhos)(µ-F)]2 (4). DuPhos complexes 1-4 emitted yellow-green light upon UV irradiation at room temperature in the solid state. This process was studied by low-temperature emission spectroscopy and density functional theory (DFT) calculations, which assigned the luminescence to (M + X)LCT (Cu2X2 to DuPhos aryl) excited states. Including Grimme's dispersion corrections in the DFT calculations (B3LYP-D3) gave significantly shorter Cu-Cu distances than those obtained using B3LYP, with the nondispersion-corrected calculations better matching the crystallographic data; other intramolecular metrics are better reproduced using B3LYP-D3. A discussion of the factors leading to this unusual observation is presented.

Elucidation of the Fe(III) Gallate Structure in Historical Iron Gall Ink.

Synthetic, structural, spectroscopic and aging studies conclusively show that the main colorant of historical iron gall ink (IGI) is an amorphous form of Fe(III) gallate·xH2O (x = ∼1.5-3.2). Comparisons between experimental samples and historical documents, including an 18th century hand-written manuscript by George Washington, by IR and Raman spectroscopy, XRD, X-ray photoelectron spectroscopy, and Mössbauer spectroscopy confirm the relationship between the model and authentic samples. These studies settle controversy in the cultural heritage field, where an alternative structure for Fe(III) gallate has been commonly cited.

IAPT and Long Term Medical Conditions: What Can We Offer?

BACKGROUND: The proposal of a 4-year plan to integrate treatment of people with long term medical conditions (LTCs) into the IAPT service (Department of Health, 2011) seeks for research to understand the effectiveness of IAPT interventions for this patient group. AIM: The aim of this service development pilot work was to develop an intervention that is effective for people with Type 2 Diabetes Mellitus (T2DM). It was hypothesized that the standard IAPT intervention would not be effective, but that it can be adapted so that it is effective both in terms of mood and self-management of T2DM. METHOD: Clients (n = 95) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM opted to attend. The intervention was adapted over a series of cohorts from a standard Step 2 intervention. A team of Psychological Wellbeing Practitioners (PWPs), a Clinical Health Psychologist and a General Practitioner worked in collaboration, using outcomes measures and feedback from service users and facilitators. RESULTS: The standard IAPT Step 2 intervention met with challenges when specifically targeting this client group. Using paired t-tests, the modified Step 2 intervention demonstrated significant improvements from pre- to postintervention measures both in terms of psychological (n = 17) and physical (n = 9) outcomes. CONCLUSION: It is concluded that it may be possible to modify a generic Step 2 IAPT intervention to demonstrate improvements both in terms of psychological wellbeing and self-management of T2DM. The main adaptations were related to more targeted recruitment and linking of diabetes specifically into the CBT model.

Synthesis, antimicrobial evaluation, and structure-activity relationship of α-pinene derivatives.

Several (+)- and (-)-α-pinene derivatives were synthesized and evaluated for their antimicrobial activity toward Gram-positive bacteria Micrococcus luteus and Staphylococcus aureus, Gram-negative bacterium Escherichia coli, and the unicellular fungus Candida albicans using bioautographic assays. (+)-α-Pinene 1a showed modest activity against the test organisms, whereas (-)-α-pinene 1b showed no activity at the tested concentration. Of all the α-pinene derivatives evaluated, the ß-lactam derivatives (10a and 10b) were the most antimicrobial. The increase in the antimicrobial activity of 10a compared to 1a ranged from nearly 3.5-fold (C. albicans) to 43-fold (S. aureus). The mean ± standard deviation for the zone of inhibition (mm) for 10a (C. albicans) was 31.9 ± 4.3 and that for S. aureus was 51.1 ± 2.9. Although (-)-α-pinene 1b was not active toward the test microorganisms, the corresponding ß-lactam 10b, amino ester 13b, and amino alcohol 14b showed antimicrobial activity toward the test microorganisms. The increase in the antimicrobial activity of 10b compared to 1b ranged from 32-fold (S. aureus) to 73-fold (M. luteus). The mean ± standard deviation for the zone of inhibition (mm) for 10b (S. aureus) was 32.0 ± 0.60 and that for M. luteus was 73.2 ± 0.30.

Fluorinated acid amplifiers for EUV lithography.

Five new compounds were synthesized for use as acid amplifiers in EUV (13.5 nm) photoresists. Four compounds act as acid amplifiers and decompose by autocatalytic kinetics to generate fluorinated sulfonic acids, essential for the simultaneous improvement of resolution, sensitivity, and line edge roughness (LER) in EUV photoresists. The decomposition rates were studied using (19)F NMR in the presence and absence of 1.2 equiv of tri-tert-butylpyridine. Three acid amplifiers decomposed 490, 1360, and 1430 times faster without base than with base. Preliminary lithographic evaluations show that cis-1-methyl-2-(4-(trifluoromethyl)phenylsulfonyloxy)cyclohexyl acetate simultaneously improves the resolution, LER, and sensitivity of an EUV photoresist.

Antiprotozoal activity of 1-phenethyl-4-aminopiperidine derivatives.

A series of 44 4-aminopiperidine derivatives was screened in vitro against four protozoan parasites (Trypanosoma brucei rhodesiense, Trypanosoma cruzi, Leishmania donovani, and Plasmodium falciparum). This screening identified 29 molecules selectively active against bloodstream-form T. b. rhodesiense trypomastigotes, with 50% inhibitory concentrations (IC50) ranging from 0.12 to 10 microM, and 33 compounds active against the chloroquine- and pyrimethamine-resistant K1 strain of P. falciparum (IC50 range, 0.17 to 5 microM). In addition, seven compounds displayed activity against intracellular T. cruzi amastigotes in the same range as the reference drug benznidazole (IC50, 1.97 microM) but were also cytotoxic to L-6 cells, showing little selectivity for T. cruzi. None of the molecules tested showed interesting antileishmanial activity against axenic amastigotes of L. donovani. To our knowledge, this is the first report of the antitrypanosomal activity of molecules bearing the 4-aminopiperidine skeleton.

Synthesis and pharmacological studies of new hybrid derivatives of fentanyl active at the mu-opioid receptor and I2-imidazoline binding sites.

Two series of fentanyl-derived hybrid molecules bearing potent I2-imidazoline binding site (IBS) ligands (i.e., guanidine and BU224 moieties) linked with an aliphatic (m=2, 3, 4, 6, 7, 8, 9 and 12 methylene units) or aromatic spacer were prepared. Their affinities for the mu-opioid receptors and for the I2-IBS were determined through competition binding studies on human postmortem brain membranes. Whereas the BU224 hybrid molecules bound to the mu-opioid receptor and the I2-IBS in the micromolar to low micromolar range, the alkaneguanidine series exhibited remarkable affinities in the nanomolar range for both receptors. [35S]GTPgammaS functional assays were performed on human postmortem brain membranes with selected ligands from each series (4f and 8g) showing the highest dual affinity for the mu-opioid receptor and I2-IBS affinities. Both compounds displayed agonist properties: at the mu-opioid receptor for the alkaneguanidine derivative 4f (spacer: six methylene units) and at a G-protein coupled receptor (GPCR) which remains to be determined for 8g. The lack of analgesic properties of 4f in vivo (i.e., hot plate and writhing tests in mice), discordant with the good in vitro binding data (Ki mu=1.04+/-0.28 nM, Ki I2=409+/-238 nM), may possibly be due to the low intrinsic efficacy of the compound. Alternatively, a low access to the central nervous system for this kind of hybrid molecules cannot be ruled out. Two new compounds reported here (9f and 13), which were not dual acting, are worth mentioning for their outstanding binding affinities; 9f bound to the mu-opioid receptor with a picomolar affinity (Ki=0.0098+/-0.0033 nM), whereas 13 presented an I2-IBS affinity (Ki=18+/-11 nM) similar to the reference compound BU224.

Lopinavir/ritonavir combined with twice-daily 400 mg indinavir: pharmacokinetics and pharmacodynamics in blood, CSF and semen.

OBJECTIVES: To evaluate the steady-state blood plasma (BP), CSF and seminal plasma (SP) pharmacokinetics (PK) of twice-daily indinavir 400 mg and lopinavir/ritonavir. METHODS: Ten HIV-1-positive men on lopinavir/ritonavir participated in a PK study. PK sampling was performed before and 2 weeks after adding indinavir to lopinavir/ritonavir-containing regimens. BP, CSF and SP RNA levels, CD4 counts and blood chemistry were checked at baseline and 2 weeks after indinavir. RESULTS: At baseline: lopinavir parameters (n=10) in BP were within expected levels. Median lopinavir trough concentrations (n=5) in CSF and SP were below the limit of detection (BLD) (i.e. <10 ng/mL) and 248 ng/mL (range 96-2777), respectively. After indinavir: lopinavir C(max), C(min) and AUC(0-12) increased by 9%, 46% and 20%, respectively (P<0.32, P<0.32 and P<0.20). In two of four men lopinavir concentrations in CSF were detectable at 27 and 29 ng/mL. Median SP lopinavir concentration was 655 ng/mL (20-2734). Median indinavir PK parameters were C(max) 3365 ng/mL (range 2130-5194), C(min) 293 ng/mL (14-766), T(max) 2.25 h (1-3), AUC(0-12) 22452 ng/mL.h (11243-33661), and t(1/2) 2.8 h (1.4-3.7). Median indinavir concentrations in CSF and SP were 39 ng/mL (21-86) and 592 ng/mL (96-983). Two of eight men who initially had detectable BP viral load (VL) became BLD (<50 copies/mL) after the addition of indinavir, and in 2/4 men with low-level viraemia in SP (BPVL BLD) their SPVL became BLD after addition of indinavir. CONCLUSIONS: Adding indinavir 400 mg twice daily to lopinavir/ritonavir-containing regimens did not significantly alter the median lopinavir PK parameters. However, wide interpatient variability in lopinavir concentrations was seen. In contrast plasma indinavir levels were >80 ng/mL in seven of eight plasma samples, and all CSF and semen samples collected.

Dose escalation or immediate full dose when switching from efavirenz to nevirapine-based highly active antiretroviral therapy in HIV-1-infected individuals?

Efavirenz induces the metabolism of co-administered drugs through the induction of CYP A4. It is often necessary to switch fron efavirenz to nevirapine because of intolerance or toxicity. In a pharmacokinetic study we determined whether to dose-escalate nevirapine or start the full dose when switching from efavirenz. It was found that when changing from efavirenz to nevirapine individuals should commence on 200 mg twice a day, as this dose is associated with therapeutic plasma drug levels.