Making integration foundational in population health intervention research: why we need 'Work Package Zero'.

OBJECTIVES: We aimed to identify when and how integration should take place within evaluations of complex population health interventions (PHIs). STUDY DESIGN: Descriptive analytical approach. METHODS: We draw on conceptual insights that emerged through (1) a working group on integration and (2) a diverse range of literature on case studies, small-n evaluations and mixed methods evaluation studies. RESULTS: We initially sought techniques to integrate analyses at the end of a complex PHI evaluation. However, this conceptualization of integration proved limiting. Instead, we found value in conceptualizing integration as a process that commences at the beginning of an evaluation and continues throughout. Many methods can be used for this type of integration, including process tracing, realist evaluation, congruence analysis, general elimination methodology/modus operandi, pattern matching and contribution analysis. Clearly signposting when integrative methods should commence within an evaluation should be of value to the PHI evaluation community, as well as to funders and related stakeholders. CONCLUSIONS: Rather than being a tool used at the end of an evaluation, we propose that integration is more usefully conceived as a process that commences at the start of an evaluation and continues throughout. To emphasize the importance of this timing, integration can be described as comprising 'Work Package Zero' within evaluations of complex PHIs.

Cellular events of acute, resolving or progressive COVID-19 in SARS-CoV-2 infected non-human primates.

Understanding SARS-CoV-2 associated immune pathology is crucial to develop pan-effective vaccines and treatments. Here we investigate the immune events from the acute state up to four weeks post SARS-CoV-2 infection, in non-human primates (NHP) with heterogeneous pulmonary pathology. We show a robust migration of CD16 expressing monocytes to the lungs occurring during the acute phase, and we describe two subsets of interstitial macrophages (HLA-DR+CD206-): a transitional CD11c+CD16+ cell population directly associated with IL-6 levels in plasma, and a long-lasting CD11b+CD16+ cell population. Trafficking of monocytes is mediated by TARC (CCL17) and associates with viral load measured in bronchial brushes. We also describe associations between disease outcomes and high levels of cell infiltration in lungs including CD11b+CD16hi macrophages and CD11b+ neutrophils. Accumulation of macrophages is long-lasting and detectable even in animals with mild or no signs of disease. Interestingly, animals with anti-inflammatory responses including high IL-10:IL-6 and kynurenine to tryptophan ratios show less severe illness. Our results unravel cellular mechanisms of COVID-19 and suggest that NHP may be appropriate models to test immune therapies.

Changes in consumption of added sugars from age 13 to 30 years: a systematic review and meta-analysis of longitudinal studies.

Added sugar intake during adolescence has been associated with weight gain and cardiometabolic risk factors. Moreover, dietary habits may persist into adulthood, increasing chronic disease risk in later life. This systematic review investigated changes in intake of added sugars between the ages of 13 and 30 years. Literature databases were searched for longitudinal studies of diet during adolescence or early adulthood. Retrieved articles were screened for studies including multiple measures of intake of sugars or sugary foods from cohort participants between the ages of 13 and 30. Data were analysed using random-effects meta-analysis, by the three main nutrient and food group categories identified (PROSPERO: CRD42015030126). Twenty-four papers reported longitudinal data on intake of added sugar or sucrose (n = 6), sugar-sweetened beverages (SSBs) (n = 20) and/or confectionery (n = 9). Meta-analysis showed a non-significant per year of age decrease in added sugar or sucrose intake (-0.15% total energy intake (95%CI -0.41; 0.12)), a decrease in confectionery consumption (-0.20 servings/week (95%CI -0.41; -0.001)) and a non-significant decrease in SSB consumption (-0.15 servings/week (95%CI -0.32; 0.02)). Taken together, the overall decrease in added sugar intake observed from adolescence to early adulthood may suggest opportunities for intervention to further improve dietary choices within this age range.

Knowledge to action for solving complex problems: insights from a review of nine international cases.

INTRODUCTION: Solving complex problems such as preventing chronic diseases introduces unique challenges for the creation and application of knowledge, or knowledge to action (KTA). KTA approaches that apply principles of systems thinking are thought to hold promise, but practical strategies for their application are not well understood. In this paper we report the results of a scan of systems approaches to KTA with a goal to identify how to optimize their implementation and impact. METHODS: A 5-person advisory group purposefully selected 9 initiatives to achieve diversity on issues addressed and organizational forms. Information on each case was gathered from documents and through telephone interviews with primary contacts within each organization. Following verification of case descriptions, an inductive analysis was conducted within and across cases. RESULTS: The cases revealed 5 guidelines for moving from conceiving KTA systems to implementing them: (1) establish and nurture relationships, (2) co-produce and curate knowledge, (3) create feedback loops, (4) frame as systems interventions rather than projects, and (5) consider variations across time and place. CONCLUSION: Results from the environmental scan are a modest start to translating systems concepts for KTA into practice. Use of the strategies revealed in the scan may improve KTA for solving complex public health problems. The strategies themselves will benefit from the development of a science that aims to understand adaptation and ongoing learning from policy and practice interventions, strengthens enduring relationships, and fills system gaps in addition to evidence gaps. Systems approaches to KTA will also benefit from robust evaluations.

TITRE: Passer de la connaissance à l'action pour résoudre des problèmes complexes : aperçu de l'examen de neuf cas internationaux. INTRODUCTION: La résolution de problèmes complexes du type de la prévention des maladies chroniques présente des défis particuliers pour la création et le transfert de connaissances, soit le passage de la connaissance à l'action (PCA). Les approches axées sur le PCA respectant les principes de la pensée systémique sont jugées prometteuses, mais les stratégies pour les mettre en place ne sont pas bien comprises. Dans cet article, nous présentons les résultats d'une analyse de plusieurs approches systémiques axées sur le PCA dans le but de déterminer comment optimiser leur mise en oeuvre et leur efficacité. MÉTHODOLOGIE: Un groupe consultatif de cinq personnes a choisi neuf initiatives représentant une diversité d'enjeux et de formes organisationnelles. Pour chaque cas, l'information a été recueillie à partir de documents et par l'entremise d'entrevues téléphoniques avec des personnes-ressources de chaque organisation. Après la vérification des descriptions de cas, une analyse inductive a été effectuée à la fois pour chaque cas et entre les cas. RÉSULTATS: Ces cas ont révélé cinq lignes directrices permettant de passer de la conception de systèmes de PCA à leur mise en oeuvre : 1) établir et entretenir des relations, 2) coproduire et organiser les connaissances, 3) créer des boucles de rétroaction, 4) les encadrer comme des interventions systémiques plutôt que comme des projets et 5) envisager des variations dans le temps et selon les lieux. CONCLUSION: Les résultats de cette analyse contextuelle constituent un départ modeste pour transformer en résultats concrets les concepts systémiques de PCA. L'utilisation des stratégies mises au jour pourrait améliorer le PCA pour la résolution de problèmes complexes en matière de santé publique. Les stratégies elles-mêmes pourront bénéficier de l'évolution d'une science visant à comprendre l'adaptation et l'apprentissage constant des politiques et des interventions pratiques, ce qui renforcera les relations durables et comblera les lacunes des systèmes, et pas simplement celles des données probantes. Les approches systémiques de PCA tireront également des bénéfices d'évaluations rigoureuses.

A spatial analysis of community level overweight and obesity.

BACKGROUND: Rates of overweight and obesity are now considered to be epidemic. Few studies have examined the spatial distribution of overweight and obesity at the community level, an area of geography recommended for prevention and intervention. Therefore, the present study aimed to examine the spatial variation of overweight and obesity using community geographic boundaries. METHODS: A cross-sectional secondary spatial data analysis was conducted using three combined cycles of Canadian Community Health Survey data for the province of Nova Scotia with community level boundaries. Descriptive rates were calculated using standardised incidence ratio values and spatial analysis was carried out using Global and Local Moran's I and the GetisOrdGi* statistic for cluster identification. RESULTS: Maps illustrating local cluster analysis showed a significant degree of similarity between neighbouring communities in urban areas more so than rural communities. Hot spot analysis maps showed communities clustering together in the urban centre tended to have lower incidence of overweight and obesity ('cool spots'), whereas clustered communities in a more rural area had a higher incidence of overweight and obesity ('hot spots). CONCLUSIONS: The present study showed that there was geographical variation in overweight and obesity between urban and rural communities, and also there was a tendency for communities to cluster based on the incidence of overweight and obesity. This highlights the importance of understanding community level obesity rates and associated behavioural determinants, such as diet and physical activity, as well as the role that urbanisation or rurality may play in intervention initiatives for these behavioural determinants. Specifically, public health nutrition efforts for community level food environments in rural areas should ensure an individualised approach is used, whereas urban areas may be amenable to more general approaches aiming to support healthy weight status among the broader population.

Effective weight management practice: a review of the lifestyle intervention evidence.

OBJECTIVES: Despite the existence of guidelines for obesity management, uncertainty remains as to what interventions comprise effective practice. This uncertainty could act as a barrier to busy health care professionals, who may lack the time and expertize to fully appraise the huge amount of literature that is published each year on obesity management. Therefore, the objectives of this review were to synthesize the available evidence, determine most effective and most promising practices for obesity management in adults, using an established methodology, and present this information according to its quality. EVIDENCE ACQUISITION: This synthesis review was conducted from January 2009. A detailed search of relevant databases was conducted to September 2010. Most effective and promising practices were defined using the Canadian Best Practice Initiative Methodology Background Paper, with systematic reviews (with/without meta analysis) as the most rigorous methodology for developing recommendations that were deemed most effective (level 1), and non-systematic reviews for developing recommendations deemed as most promising (level 2). Literature was reviewed and classified across these two levels of rigor, and supplemented with primary studies to further refine recommendations. RESULTS: Evidence from systematic reviews and meta-analyses was classified into three intervention themes or areas of context, in which more specific most effective and/or promising practice recommendations could be nested. These intervention themes were (1) targeted multi-component interventions for weight management, (2) dietary manipulation strategies and (3) delivery of weight management interventions, including health professional roles and method of delivery. Specific recommendations accompanied each theme. CONCLUSIONS: This review highlights the value of multi-component interventions that are delivered over the longer term, and reinforces the role of health care professionals. The findings will help to inform evidence-based practice for health care practitioners involved in obesity management and prevention.

Characterizing the obesogenic environment: the state of the evidence with directions for future research.

Despite the explosion of obesogenic environment research within the last decade, consensus on what constitutes the very environment we are trying to measure has not yet been reached. This presents a major challenge towards our understanding of environmental research for obesity, and the development of a desperately needed contextualized evidence base to support action and policies for curbing this epidemic. Specifically, we lack the application of a cohesive definition or framework, which creates the potential for confusion regarding the role of the environment, misinterpretation of research findings and missed opportunities with respect to possible avenues for environmentally based interventions. This scoping review identified primary studies and relevant reviews examining factors related to body mass index, diet and/or physical activity with respect to the obesogenic environment. Using a comprehensive framework for conceptualizing the obesogenic environment, the Analysis Grid for Environments Linked to Obesity (ANGELO), we identified 146 primary studies, published between January 1985 and January 2008, that could be characterized according to the dimensions of ANGELO. Gaps in the literature were clearly identified at the level of the macro-environment, and the political and economic micro-environments, highlighting key areas where further research is warranted if we are to more fully understand the role of the obesogenic environment.

Repetition related ERP effects in a visual object target detection task.

ERP responses to initial and repeated presentations of possible and impossible objects were recorded from 61 recording sites in a simple target detection task. In Experiment 1, the non-target objects were line drawings of possible and impossible 3-D geometric figures and the targets were line drawings of familiar everyday objects or combinations of parts of everyday objects. In Experiment 2, the non-target objects were everyday objects and the targets were possible and impossible 3-D geometric figures. In both experiments, at frontal sites, the repeated possible and impossible non-target items elicited less negative ERP waveforms relative to first presentations between 250 and 350-400 ms. At parieto-occipital sites, in both experiments, the repeated possible and impossible non-target items elicited less positive ERP waveforms than did first presentations beginning at about 300 ms. The briefly reduced frontal negativity to repeated items is consistent with familiarity arising from a facilitation of access to conceptual, semantic and visuo-spatial representations during object categorization. The polarity of the parieto-occipital effect was the reverse of what is usually found in stimulus repetition tasks, although it is consistent with earlier work using similar visual stimuli. It is interpreted as reflecting the availability of a newly formed representation (i.e., token) of the object just experienced.

Event related brain potentials and illusory memories: the effects of differential encoding.

This study investigates event related potentials (ERP) elicited by true and false recognition using words from different semantic categories. In Experiment 1, ERPs for true and false recognition were more positive than for correctly rejected NEW words starting around 300 ms after test word presentation (old/new ERP effects). ERP waveforms for true and false recognition revealed equal early (300-500 ms) fronto-medial old/new ERP effects, reflecting similar familiarity processes, but smaller parietal old/new ERP effects (500-700 ms) for false relative to true recognition, suggesting less active recollection. Interestingly, a subsequent performance based group comparison showed equivalent old/new ERP effects for true and false recognition for participants with high rates of false recognition. In contrast, false recognition failed to elicit an old/new ERP effect in a group with low false recognition rates. To examine whether this between group difference was driven by the differential use of information that studied words and semantically related non studied test words (LURE) have in common (conceptual similarity), we manipulated encoding strategy in Experiment 2. When encoding focused on conceptual similarity, comparable ERP-effects for true and false recognition were obtained, suggesting that both forms of recognition were equally based on familiarity and recollection processes. Conversely, when encoding was focused on item specific features, differences in brain activity for true and false recognition were obtained. The ERP data indicate that, in addition to the false recognition rate, strategic processes during encoding, such as processing conceptual features, are an important factor in determining electrophysiological differences between true and false recognition.

Differential effects of auditory and visual signals on clock speed and temporal memory.

The effects of signal modality on duration classification in college students were studied with the duration bisection task. When auditory and visual signals were presented in the same test session and shared common anchor durations, visual signals were classified as shorter than equivalent duration auditory signals. This occurred when auditory and visual signals were presented sequentially in the same test session and when presented simultaneously but asynchronously. Presentation of a single modality signal within a test session, or both modalities but with different anchor durations did not result in classification differences. The authors posit a model in which auditory and visual signals drive an internal clock at different rates. The clock rate difference is due to an attentional effect on the mode switch and is revealed only when the memories for the short and long anchor durations consist of a mix of contributions from accumulations generated by both the fast auditory and slower visual clock rates. When this occurs auditory signals seem longer than visual signals relative to the composite memory representation.

Scalar expectancy theory and peak-interval timing in humans.

The properties of the internal clock, temporal memory, and decision processes used to time short durations were investigated. The peak-interval procedure was used to evaluate the timing of 8-, 12-, and 21-s intervals, and analyses were conducted on the mean response functions and on individual trials. A distractor task prevented counting, and visual feedback on accuracy and precision was provided after each trial. Mean response distributions were (a) centered at the appropriate real-time criteria, (b) highly symmetrical, and (c) scalar in their variability. Analysis of individual trials indicated more memory variability relative to response threshold variability. Taken together, these results demonstrate that humans show the same qualitative timing properties that other animals do, but with some quantitative differences.

A single emm gene-specific oligonucleotide probe does not recognise all members of the Streptococcus pyogenes M type 1.

Serological typing of the streptococcal M protein has recently been challenged by a number of unique molecular methodologies based on oligonucleotide recognition of allelic variations within the M protein (emm) gene. In these methods, stringent hybridization of an oligonucleotide probe to a polymerase chain reaction amplified emm gene is used as confirmation of specific M type identity. A sample of 17 isolates from 7 previously defined distinct genotypes were tested using a single M1 oligonucleotide probe. Isolates from only three of the genotypes hybridized with the probe. The results demonstrate that a single emm-specific oligonucleotide probe can not identify all members of M type 1, as defined by conventional serotyping using polyclonal antisera.