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August 23, 2018 - Do you wish you could decrease your waistline? Reducing abdominal obesity can lower health risks - but despite claims you may have seen on the Internet, no trending diet can help you specifically eliminate belly fat, according to an article in
ACSM's Health & Fitness Journal®, an official journal of the Wolters Kluwer.

"There is still no miracle diet, food, nutrient, or bioactive component that will target abdominal fat," writes Kari D. Pilolla, PhD, RDN, of the California Polytechnic State University in San Luis Obispo. But a heart-healthy diet high in fiber and low in saturated fats is a great way to prevent and reduce abdominal obesity, according to the article, part of a special theme issue of ACSM's Health & Fitness Journal, focusing on Nutrition.

What's New in Nutrition? New Updates for Health and Fitness Professionals

Amid the ongoing obesity epidemic, there is increasing attention to the health risks associated with abdominal obesity - excess fat stored around the abdomen. According to the most recent data, 54 percent of Americans have abdominal obesity, while the estimated average waist circumference is growing.

"Independent of body weight, a larger waist circumference increases risk for cardiovascular disease, diabetes, and metabolic syndrome," Dr. Pilolla writes. These risks are mainly related to visceral adipose tissue - fat stored below the abdominal muscles, surrounding the major internal organs. Visceral adipose tissue appears to be more "metabolically active" than subcutaneous fat, stored under the skin but above the abdominal muscles.

While definitions vary, abdominal obesity has been defined as a waist circumference of about 34 inches in women and 40 inches in men. Measuring waist circumference is the most common and convenient method of assessing abdominal obesity, and it corresponds well to other techniques (dual-energy x-ray absorptiometry and CT/MRI scans). Risk of abdominal obesity increases with age, especially in women, and with changes in hormone levels.

Can diet help to fight abdominal obesity? These days, the Internet is full of extravagant claims of "new discoveries" to "cure belly fat." Diets touted as reducing abdominal obesity include intermittent fasting, high-protein diets, the "Paleo" diet, and green tea, among many others. But there's a lack of high-quality evidence on these trending diets, none of which has been shown more effective than other types of energy-restricted (reduced-calorie) diets.

The good news is, some diet characteristics appear helpful in reducing or preventing abdominal obesity - particularly lower intake of trans and saturated fats and higher intake of fiber. "These recommendations are consistent with heart-healthy diets like the NIH-developed Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean-style diet," Dr. Pilolla writes. Her article includes information on these diets - both great options as part of a weight loss program including diet and/or exercise, as recommended by the ACSM.

Dr. Pilolla recommends that health and fitness professionals assess and monitor abdominal obesity in their clients, and to evaluate their cardiometabolic health risks. Clients should be educated about evidence-based, heart-healthy diets; working with a Registered Dietitian Nutritionist can help in achieving healthy weight loss through diet and exercise.

"With the health consequences associated with abdominal obesity, research will not cease in this area," Dr. Pilolla comments. "Health and fitness professionals should continue to stay up-to-date and critical of peer-reviewed, published research evidence. A single study, even if well designed, does not support changing diet or exercise recommendations."

The theme issue addresses a range of nutrition-related topics of interest to health and fitness professionals, including food and fitness for active older adults, sport nutrition to optimize performance, the benefits of a "food first" approach for athletes, potential harmful effects of common diet trends, and diet and exercise steps to a healthier gut. Laura Kruskall, PhD, RDN, CSSD, LD, FACSM, FAND, of University of Nevada, Las Vegas, is Guest Editor of the special issue.

"As a sports dietitian and ACSM-Certified Exercise Physiologist, I certainly understand that nutrition and exercise go hand in hand," Dr. Kruskall comments. "It is important for both exercise and nutrition professions to give consistent information that is accurate, evidence-based, and applicable to our patients and clients. This special issue is full of such information written by experts in the field. I hope readers enjoy this issue and leave with some exciting take-away points that can be used in practice."

DURHAM, N.C. -- Duke University researchers have developed a handheld probe that can image individual photoreceptors in the eyes of infants.

The technology, based on adaptive optics, will make it easier for physicians and scientists to observe these cells to diagnosis eye diseases and make early detection of brain-related diseases and trauma.

Photoreceptors are specialized neurons that comprise the light-sensing cells of the retina, an extension of the central nervous system located at the back of the eye. The retina sends signals to the brain via the optic nerve, which then processes the visual information. Previous studies have shown that neurodegenerative diseases, including Alzheimer's and Parkinson's, as well as traumatic brain injuries, such as concussions, can alter the neuronal structures in the retina.

To study these neuronal structures, researchers commonly use an adaptive optics scanning laser ophthalmoscope (AOSLO), a non-invasive tool that provides a significantly higher image resolution than an MRI.

Although traditional AOSLO allows researchers to visualize individual photoreceptor cells, such systems are as large as a billiard table, costly and extremely complex. Its use has been limited to patients who are able to sit upright fix their gaze for several minutes, which means it is not as useful for young children or for adults with cognitive or mobility issues.

The new system, called HAOSLO for handheld AOSLO, measures just 4 inches by 2 inches by 5.5 inches, and weighs less than half a pound.

The Duke researchers transformed the AOSLO into a handheld probe by improving its optical, signal processing and mechanical designs. This included development of a new algorithm that replaces the traditional AOSLO's large wavefront sensing system, an optical component that can detect light distortion caused by the eye.

The study appears August 23 in the journal Optica.

"Other researchers have shown that the wavefront sensor can be replaced by an algorithm, but previous algorithms haven't been fast or robust enough to be used in a handheld device," said Theodore DuBose, a PhD student in the department of biomedical engineering at Duke and the first author of the paper. "The algorithm we developed is much faster than previous techniques and just as accurate."

The tool was tested in a clinical trial with 12 adults and two children, where the team demonstrated its ability to capture detailed images of photoreceptors close to the fovea--the center of the retina where photoreceptors are smallest and vision is most acute.

"Our new tool is fast and lightweight so physicians can take it directly to their patients, and the probe allows us to collect images quickly, even if there is movement," said Sina Farsiu, an associate professor in the departments of biomedical engineering and ophthalmology. "These capabilities allow us to open up the pool of patients who could benefit from this technology."

The tool's new design makes it especially useful for imaging the eyes of young children. For example, premature newborns have a greater risk of developing eye diseases, like retinopathy, which can lead to blindness if not diagnosed quickly. Researchers can also use the tool to track early brain development in children by imaging their retina, which develops along with the central nervous system.

The team is optimistic about the tool's use both inside and outside of the hospital. Because the HAOSLO can be taken into an operating room, physicians will be able to see the photoreceptors at the highest resolution possible during surgery, even when a patient is under anesthesia and in a reclined position. It could also help doctors rapidly assess possible brain trauma in athletes, such as football players coming off the field with head injuries.

Before the researchers prepare for large-scale clinical trials, they plan to incorporate additional imaging modes for detecting other diseases.

They also have made the mechanical designs, computational algorithms and control software freely available online so that other scientists can adapt the new system for their scientific applications.

Philadelphia, August 23, 2018 - Dietary risk factors are among the key contributors to mortality and morbidity in the United States and globally, and there is increasing emphasis on understanding the influence of total diet quality and overall dietary patterns rather than single aspects of what we eat and drink. In order to evaluate the quality of what people eat and drink, researchers often rely on recommendations such as the Dietary Guidelines for Americans (DGA). In the latest issue of the Journal of the Academy of Nutrition and Dietetics, leading nutrition experts describe and evaluate the latest version of the Healthy Eating Index (HEI), which has been issued to correspond to the 2015-2020 Dietary Guidelines for Americans.

The DGA are updated every five years, leading to changes in emphasis and quantification, as the evidence on healthy eating evolves over time. Likewise, a new HEI is issued to correspond to each new edition of the DGA and to reflect these changes. The HEI is a measure of diet quality, independent of quantity, that can be used at various levels of the food stream, including the national food supply, the community food environment (e.g., foods available at a school or a fast food menu), and food intakes among the population.

The HEI score can be used to evaluate how healthy the American diet is in relation to federal dietary guidance. It has been applied by researchers to describe diet quality among the US population, as well as population subgroups such as Mexican Americans, children, and cancer survivors. It has also been used to evaluate the quality of food offerings across the food stream, including the US food supply, restaurant menus, grocery store circulars, and Federal food distribution programs.

"Tracking quality at these different levels is critical since we are increasingly recognizing the power of the food environment on eating behavior. That is, individuals cannot be expected to make healthy choices if those options are not readily available in the home, at work, at school, and in the community," comments Jill Reedy, PhD, MPH, RD, Program Director at the Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA, and co-author of the papers in this issue.

The latest HEI was developed through a collaboration between researchers at the National Cancer Institute (NCI) and the United States Department of Agriculture's (USDA) Center for Nutrition Policy and Promotion (CNPP). A trio of papers in this special issue introduce the new HEI and describe differences compared to the 2010 and 2005 editions, evaluate the properties of the HEI-2015 for assessing dietary quality, and discuss its applications.

Update

The first paper outlines the steps taken to update the most recent version of the HEI and prepare an HEI-2015 scoring system to reflect compliance with the 2015-2020 DGA food and nutrient recommendations. "The Dietary Guidelines for Americans evolve incrementally over time based on scientific evidence, and updates to the HEI are designed to capture that evolution," explains Susan M. Krebs-Smith, PhD, MPH, Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda MD, USA.

The 2015 edition has 13 components, each reflecting an important aspect of diet quality as per the DGA. Dr. Krebs-Smith and colleagues describe each of the HEI-2015's constituent food and nutrient categories, as well as its 100-point scoring system, including referent standards for each component of the total score. Since the 2005 version, the HEI has been based on densities (e.g., amounts per 1000 kcal), rather than absolute amounts, and relies on a common set of standards that are applicable across individuals and settings. Notable differences compared to the previous edition are that saturated fat and added sugars are each separately tracked, and excessive alcohol contribution to energy is not captured separately. This new version also incorporates modifications to the scoring procedures for legumes.

Evaluation

In the second paper, Jill Reedy, PhD, MPH, RD, and colleagues report on testing of the index's validity and reliability. Known high-quality sample menus from a variety of organizations such as the National Heart, Lung, and Blood Institute (Dietary Approaches to Stop Hypertension [DASH] diet), US Department of Agriculture (USDA), Harvard Medical School (Healthy Eating Guide), and the American Heart Association (AHA) (No-Fad Diet) were scored using the HEI standards. These menus all achieved high scores, ranging from 88 to 100 points.

At the next level of testing, data from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES) were used to compare HEI-2015 scores across population subgroups to examine if meaningful differences could be detected. Average HEI-2015 scores and ranges demonstrated reasonable variation across the subgroups examined, including groups differentiated by age, gender, and smoking status. Results suggested that the index reflects the many dimensions of dietary guidance. As a final assessment, datasets from the NIH-AARP Diet and Health Study were examined and showed that individuals in the highest quintiles of HEI-2015 scores had a 13-23 percent decreased risk of all-cause, cancer, and cardiovascular disease mortality.

"These analyses demonstrated evidence supportive of validity and reliability for the HEI-2015, as has been shown in earlier work with the HEI-2005 and HEI-2010," notes Dr. Reedy. "However, limitations in the HEI as well as those inherent to dietary intake data more broadly should be considered in any application of the index."

Applications

The third paper examines potential applications of the HEI-2015 in surveillance, epidemiology, and community intervention research. Lead investigator Sharon I. Kirkpatrick, PhD, MHSc, RD, Associate Professor, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada, and colleagues outline approaches to calculating scores and review their suitability for research questions related to monitoring eating patterns, understanding associations between eating patterns and health/disease, and evaluating dietary interventions.

The focus of this paper is on the use of the HEI for cases in which dietary intake data are available for characterizing diet quality for groups of individuals sampled from the population. Further development of methods for calculating the HEI for individuals will help advance our knowledge on diet quality. "The use of the most appropriate approach to calculating HEI scores for a given purpose can help build a stronger literature on the influence of dietary quality on health and disease risk, helping to inform future policies and programs to support health," comments Dr. Kirkpatrick.

In an accompanying editorial, Barbara Millen, DrPH, MPH, RD, FADA, Millennium Prevention, Inc., and Boston Nutrition Foundation, Inc., Westwood, MA, USA, and Chairman of the 2015 Dietary Guidelines Advisory Committee, points out the growing use of web and mobile platforms and apps in clinical and community settings for purposes such as diet and exercise behavior monitoring. She forecasts a bright future for integrating new methods of nutritional risk assessment, such as the HEI-2015, with advanced analytics and innovative web and mobile technologies.

According to Dr. Millen, "The evidence base is stronger than ever before linking the 'total diet' - its dietary patterns, nutrient density, and overall quality - to health promotion and disease prevention across the human life span. The work of these investigators will hopefully inspire other researchers and nutrition professionals to utilize the HEI-2015 broadly and establish other evidence-based innovations that fully embrace the 2015-2020 DGA's five cornerstone guidelines, and advance research and practice in clinical, public health and consumer settings."

Take a look at your favorite mug; it probably looks the same as it always has, but your neurons may not think so. Neurons are firing in response to the visual stimuli they see but they don't fire in exactly the same way every time.

Researchers at Baylor College of Medicine wanted to know the significance of that variability and whether portions of that variability might be due to changes in an individual's focus of attention.

"For example, neurons may respond one way when you look at the mug and think of drinking the coffee in it, but another way when you think of the work that coffee is going to help get you through. We don't have a good understanding of how neural activity changes when your attention is focused on an object or when your attention is split," said George Denfield, now a fourth-year medical student in the Medical Scientist Training Program who trained in Dr. Andreas Tolias' lab at Baylor. "One of the main assumptions is that the brain is just kind of noisy and that there are random features to the way neurons respond based on their physiology. So some people kind of chalk this variability up to randomness."

However, in a recent study published in Nature Communications, Denfield, a lead author of the study, and his colleagues found evidence that the variability isn't just noise. It can be attributed to fluctuations in internally generated signals like attention, so that the more one's attention is split, the "noisier" the neuronal responses appear to be from the outside.

The study involved non-human primates trained to engage in simple tasks. They would stare at a monitor that showed two patterns in their peripheral vision and were cued to pay attention to either one pattern at a time or both, akin to comparing a focused brain with a multi-tasking brain.

The patterns would change randomly but the monkeys were trained to seek out one particular image. When they saw that image they would move their eyes to focus on it. The researchers were able to track eye movements while also recording brain activity.

"So rather than noise, the variability reflects important changes in the brain that are relevant to the behavior a person is engaging in, like their changing attention state," Denfield said. "While we were focused on only one area of the brain, in visual cortex, and only on a certain number of neurons, we believe these findings show us that there is an important process happening that we might be able to harness to learn something more about how our brains work and focus."

So what is next? Denfield said this is just the beginning.

"As we continue our work and expand to different areas of the brain, these findings could have implications in tracking attentional states and understanding how neuronal populations are working together across the brain to help us focus on important features in our environment."

Statistical models could one day characterize real-time changes in someone's attention, potentially creating diagnostic tools for those living with neurological issues such as autism or attention deficit disorder.

Every summer, cownose rays stream into Chesapeake Bay to mate and give birth to their pups. When autumn comes, they disappear--presumably to migrate south, but no one knew for certain where they spent the winter. Now, after a three-year tagging study published Aug. 23 and led by the Smithsonian Environmental Research Center (SERC), scientists have solved the mystery. Cownose rays all along the Atlantic winter near Cape Canaveral, Florida, and it is likely they return to the same spots each summer.

Cownose rays are large stingrays native to the Chesapeake, with dark brown or olive-gray backs and white bellies. They reproduce slowly. Most mothers give birth to only one pup a year, and they do not mature until age 7 or 8, making them vulnerable to intense fishing or sudden population declines. And yet cownose rays have been dogged by controversy. In the early 2000s, they were saddled with partial blame for oyster declines because their diet includes shellfish. (Later studies cleared their names. Oysters had been declining years before cownose rays became more abundant.) Later, in 2015, bowfishing tournaments for cownose rays began raising alarm among some Marylanders. In response, the Maryland government voted to become the first state to create a fishery-management plan to conserve the cownose ray.

"Because of the slow birth rate, we know that if we don't manage them, and instead harvest them in a way that heavily impacts the population and causes a population decline, it'll take a long time for them to recover," said Matt Ogburn, SERC marine biologist and lead author of the study. "If we lose something important, we could lose it for decades."

The new study, published in Marine Ecology Progress Series, marks the first time scientists have tracked cownose ray migrations along the Atlantic coast for a full year or more. Knowing where they go every year will help fill in some longstanding knowledge gaps about the rays, as Maryland officials decide how to manage them. It is part of the Smithsonian's new Movement of Life Initiative. Scientists from the Virginia Institute of Marine Science (VIMS) and Savannah State University also joined the effort.

To tag the rays, scientists spent three summer and fall field seasons teaming up with commercial fishers. These fishers were not trying to catch cownose rays, but the animals often appear as accidental bycatch in their pound nets or haul seines. Many of the fishers had worked with the scientists before, partnering with VIMS co-author Robert Fisher or on SERC's crab-tagging studies.

"Collaborative efforts with commercial fishers are built on trust, straight talk and inclusion to investigate common problems and opportunities," said Fisher, who has studied cownose rays for nearly three decades.

After transferring the rays to a holding tank, the researchers gave them general and local anesthesia and inserted a small acoustic tag inside them. Once the rays had recovered from surgery, the scientists released them back into the water. As the rays continued their journeys, the tags emitted a series of "pings" unique to each ray. An array of hundreds of receivers lines the Chesapeake and the Atlantic coast, waiting to pick up their signal. These receivers were placed by dozens of scientists from institutions along the East Coast, all sharing data on different species. If a ray passed within half a kilometer of a receiver, the receiver would record data about the ray's location. Then the data were shared through the Atlantic Cooperative Telemetry Network and Florida Atlantic Coast Telemetry Network.

The teams tagged 42 rays total. Most were tagged in Virginia, with five in Maryland and two in Georgia. Of those rays, 28 had their signals detected multiple times over a period longer than 90 days, enough time for scientists to get a sense of their migration behavior.

Regardless of where scientists tagged the rays, every ray they detected in winter went to the same spot: a region just off the coast of Cape Canaveral. The greater challenge was figuring out if cownose rays go back to the same places each summer. While most rays returned to the same regions where scientists tagged them the previous year--some even to the same rivers--many rays were tagged in the fall, when they might have already left their summer homes. Only five rays sent out location signals for both summer 2015 and summer 2016. Four of those rays (three from Virginia and one from Georgia) returned to their original regions. The fifth spent both summers in the Chesapeake, but the first summer in Virginia and the second in Maryland.

This pattern could make conservation even more critical. If cownose rays are returning to the same places each summer, that means the Chesapeake likely has its own distinct population. Intense fishing of rays in the Chesapeake, especially during summer, could wipe out a large slice of the species' genetic diversity.

"If they're really tied to one specific place, then you'll be removing a whole piece, a whole unique segment, from the population," Ogburn said.

While scientists have unraveled one mystery about cownose ray migrations, there are still many unknowns surrounding the animals. Not least, the authors emphasized, is their role in the Chesapeake Bay as a whole. By turning over the sediment, a bit like tilling a garden, they could play a vital role for organisms like shellfish and crabs that live on the bay floor. As Maryland develops the first official management plan for cownose rays, studies like this will offer more guidance on how to manage one of the most enigmatic creatures in the Chesapeake.

Bottom Line: Compared with non-drinkers, men who consumed at least seven drinks per week during adolescence (ages 15-19) had three times the odds of being diagnosed with clinically significant prostate cancer.

Journal in Which the Study was Published: Cancer Prevention Research, a journal of the American Association for Cancer Research

Author: Emma Allott, PhD, assistant professor in the Department of Nutrition at the University of North Carolina at Chapel Hill

Background: "The prostate is an organ that grows rapidly during puberty, so it's potentially more susceptible to carcinogenic exposure during the adolescent years," said Allott. "For this reason, we wanted to investigate if heavy alcohol consumption in early life was associated with the aggressiveness of prostate cancer later."

Previous research in this area often focused on the effect of alcohol intake on overall prostate cancer risk. Because many cases of prostate cancer are indolent, the researchers analyzed whether alcohol consumption during puberty and midlife are associated with high-grade prostate cancer in adulthood.

How the Study Was Conducted: Allott and colleagues evaluated data from 650 men undergoing a prostate biopsy at the Durham Veterans Affairs Medical Center between January 2007 and January 2018. These veterans had no prior history of prostate cancer, and their ages ranged from 49 to 89 years old. The population was racially diverse; 54 percent of patients were non-white. Men completed questionnaires which assessed the average number of alcoholic drinks consumed weekly during each decade of life to determine age-specific and cumulative lifetime alcohol intake.

Results: Following multivariable analysis, the researchers found that heavy alcohol intake at ages 15-19 was not associated with overall prostate cancer; however, consumption of at least seven drinks per week during this age was associated with 3.2 times the odds of high-grade prostate cancer compared with non-drinkers. Similar associations were observed among those who consumed at least seven alcoholic drinks per week at ages 20-29, 30-39, and 40-49, resulting in 3.14, 3.09, and 3.64 times the odds of high-grade prostate cancer, respectively, compared with non-drinkers. However, current alcohol consumption was not significantly associated with high-grade prostate cancer.

The authors also evaluated the association between cumulative lifetime alcohol consumption and prostate cancer diagnosis. Compared with men in the lowest tertile of lifetime alcohol intake, those in the upper tertile had 3.2 times the odds of being diagnosed with high-grade prostate cancer at biopsy.

Author's Comments: "Our results may explain why previous evidence linking alcohol intake and prostate cancer has been somewhat mixed," noted Allott. "It's possible that the effect of alcohol comes from a lifetime intake, or from intake earlier in life rather than alcohol patterns around the time of diagnosis of prostate cancer."

Study Limitations: Limitations of the study include a reliance on self-reported data, which could be subject to recall bias. Furthermore, because heavy drinkers within the study were often heavy smokers, Allott noted that despite adjusting their model for smoking, residual confounding may exist, and that the sample size was not large enough to explore this association further.

Additionally, those who heavily consumed alcohol early in life typically continued to drink heavily throughout their entire life; as such, the researchers could not definitively separate the potential effects of early-life exposure of alcohol from cumulative lifetime exposure.

Funding & Disclosures: This study was sponsored by the American Institute for Cancer Research, the Irish Cancer Society John Fitzpatrick Fellowship, and the National Institutes of Health. Allott declares no conflict of interest.

UNIVERSITY PARK, Pa. -- Parents who positively engage with their children during play time -- and gently steer them to clean up afterward -- may help toddlers with low-self regulation have lower body mass indexes (BMIs) later on as preschoolers.

In a study, researchers found that toddlers who had poor self-regulation skills -- the ability to control their behaviors and emotions -- went on to have lower BMIs as preschoolers if their mothers engaged with them during playtime and then helped direct them during clean up.

Cynthia Stifter, professor of human development and psychology, Penn State, said the results -- recently published in the International Journal of Obesity -- suggest that when parents help their child develop regulatory skills, it may help the child maintain a healthy weight.

"If parents can help their kids learn to self-regulate, that child can then use those skills in many other situations, including eating," Stifter said. "Good self-regulation may help a child stop themselves from throwing a tantrum, but it may also keep them from eating too much. Building those skills is a process that isn't going to develop on its own, so that's where parents can step in."

According to researchers, 17.5 percent of children in the U.S. are obese. The researchers said it's important to identify risk factors for childhood obesity, which is linked to such conditions as high blood pressure, diabetes, and breathing problems like asthma. It also increases the chance of being obese as an adult.

Kameron Moding, a postdoctoral fellow at University of Colorado Denver who received her doctorate in human development and family studies from Penn State, said research on how parenting behaviors -- beyond how parents feed their kids -- affect children's weight has been varied.

"One possible reason for the inconsistent results so far is that child characteristics, such as self-regulation, are not often considered," Moding said. "These studies have mostly focused on the parents. We wanted to know whether associations between general parenting behaviors and children's weight outcomes could depend on the children's self-regulation."

The study's participants included 108 mothers and their 18-month-old toddlers. During their first lab visit, the children were weighed and participated in tasks designed to measure their temperament and regulatory skills.

The mother and child were then allowed to free play for five minutes before a researcher signaled it was time to clean up. The researchers noted how "responsive" the mothers were during free play, defined as when the mothers followed the child's lead during play. They also measured how often the mother guided the child during clean up in a positive or neutral tone, referred to as "gentle control."

When the children were 4.5 years old, the mother and child pairs returned to the lab. The children were weighed again, and the researchers calculated their BMIs.

After analyzing the data, the researchers found that when mothers were more responsive during free play and showed more gentle control during clean-up, their child was more likely to have a lower BMI at 4.5 years of age if that child also had poor regulation skills.

But, they found that children who started the study with good regulation skills were actually more likely to have higher BMIs as preschoolers if their mothers showed high levels of gentle control during clean up.

Stifter said the study demonstrates that while parents have an influence on their child's behavior, the child also affects his own development.

"Children are partners with their parents in their development," Stifter said. "In this case, we found that the level of self-regulation a child possessed at 18 months was a factor in their BMI as a preschooler. So it wasn't just the mother's actions that mattered."

Stifter added that the study underscores the importance of parents being responsive and using gentle control to guide their children when possible.

"It's understandable that parents can't always be positive and gentle when controlling situations," Stifter said. "But in situations where you can, this study implies that this way of parenting will teach the child a skill that they can apply in many situations, including waiting to eat or eating a less desirable food. This skill -- complying when asked to do or not to do something -- is one of the most important developmental tasks of early childhood."

Moding said that in the future, she and the other researchers are hoping to explore whether parent-child interactions and child self-regulation also have implications for children's eating behaviors and weight gain in slightly older children.

PITTSBURGH--One of the oldest, most versatile and inexpensive of materials - paper - seemingly springs to life, bending, folding or flattening itself, by means of a low-cost actuation technology developed at Carnegie Mellon University's Human-Computer Interaction Institute.

A thin layer of conducting thermoplastic, applied to common paper with an inexpensive 3D printer or even painted by hand, serves as a low-cost, reversible actuator. When an electrical current is applied, the thermoplastic heats and expands, causing the paper to bend or fold; when the current is removed, the paper returns to a pre-determined shape.

"We are reinventing this really old material," said Lining Yao, assistant professor in the HCII and director of the Morphing Matter Lab, who developed the method with her team. "Actuation truly turns paper into another medium, one that has both artistic and practical uses."

Post-doctoral researcher Guanyun Wang, former research intern Tingyu Cheng and other members of Yao's Morphing Matter Lab have designed basic types of actuators, including some based on origami and kirigami forms. These enable the creation of structures that can turn themselves into balls or cylinders. Or, they can be used to construct more elaborate objects, such as a lamp shade that changes its shape and the amount of light it emits, or an artificial mimosa plant with leaf petals that sequentially open when one is touched.

In June, more than 50 students in a workshop at Zhejiang University in Hangzhou, China, used the paper actuation technology to create elaborate pop-up books, including interpretations of famous artworks, such as Van Gogh's Starry Night and Sunflowers.

The printed paper actuator will be exhibited Sept. 6-10 at the Ars Electronica Festival in Linz, Austria; Sept. 13-30 at Bozar Centre for the Fine Arts in Brussels, Belgium; and from October through March at Hyundai Motorstudio in Beijing, China. Yao's group presented the technology in April at CHI 2018, the Conference on Human Factors in Computing Systems, in Montreal.

"Most robots -- even those that are made of paper -- require an external motor," said Wang, a CMU Manufacturing Futures Initiative fellow. "Ours do not, which creates new opportunities, not just for robotics, but for interactive art, entertainment and home applications."

Creating a paper actuator is a relatively simple process, Cheng said. It employs the least expensive type of 3D printer, a so-called FDM printer that lays down a continuous filament of melted thermoplastic. The researchers use an off-the-shelf printing filament -- graphene polyactide composite -- that conducts electricity.

The thermoplastic actuator is printed on plain copy paper in a thin layer, just half a millimeter thick. The actuator is then heated in an oven or with a heat gun and the paper is bent or folded into a desired shape and allowed to cool. This will be the default shape of the paper. Electrical leads can then be attached to the actuator; applying electrical current heats the actuator, causing the thermoplastic to expand and thus straighten the paper. When the current is removed, the paper automatically returns to its default shape.

Yao said the researchers are refining this method, changing the printing speed or the width of the line of thermoplastic to achieve different folding or bending effects. They have also developed methods for printing touch sensors, finger sliding sensors and bending angle detectors that can control the paper actuators.

More work remains to be done. Actuation is slow, which Yao and her team hope to address with some material engineering -- using papers that are more heat conductive and developing printing filaments that are customized for use in actuators. The same actuation used for paper might also be used for plastics and fabrics.

In addition to Yao, Wang and Cheng, authors of the CHI research paper are Youngwook Do and Byoungkwon An, HCII research affiliates; Jianzhe Gu, a Ph.D. student in HCII; Humphrey Yang, a master's student in the CMU School of Architecture, and Ye Tao, a visiting scholar from Zhejiang University. More information is available on the project's web page, http://morphingmatter.cs.cmu.edu/paper-actuator/.

Nanoparticle manufacturing, the production of material units less than 100 nanometers in size (100,000 times smaller than a marble), is proving the adage that "good things come in small packages." Today's engineered nanoparticles are integral components of everything from the quantum dot nanocrystals coloring the brilliant displays of state-of-the-art televisions to the miniscule bits of silver helping bandages protect against infection. However, commercial ventures seeking to profit from these tiny building blocks face quality control issues that, if unaddressed, can reduce efficiency, increase production costs and limit commercial impact of the products that incorporate them.

To help overcome these obstacles, the National Institute of Standards and Technology (NIST) and the nonprofit World Technology Evaluation Center (WTEC) advocate that nanoparticle researchers, manufacturers and administrators "connect the dots" by considering their shared challenges broadly and tackling them collectively rather than individually. This includes transferring knowledge across disciplines, coordinating actions between organizations and sharing resources to facilitate solutions.

The recommendations are presented in a new paper in the journal ACS Applied Nano Materials.

"We looked at the big picture of nanoparticle manufacturing to identify problems that are common for different materials, processes and applications," said NIST physical scientist Samuel Stavis, lead author of the paper. "Solving these problems could advance the entire enterprise."

The new paper provides a framework to better understand these issues. It is the culmination of a study initiated by a workshop organized by NIST that focused on the fundamental challenge of reducing or mitigating heterogeneity, the inadvertent variations in nanoparticle size, shape and other characteristics that occur during their manufacture.

"Heterogeneity can have significant consequences in nanoparticle manufacturing," said NIST chemical engineer and co-author Jeffrey Fagan.

In their paper, the authors noted that the most profitable innovations in nanoparticle manufacturing minimize heterogeneity during the early stages of the operation, reducing the need for subsequent processing. This decreases waste, simplifies characterization and improves the integration of nanoparticles into products, all of which save money.

The authors illustrated the point by comparing the production of gold nanoparticles and carbon nanotubes. For gold, they stated, the initial synthesis costs can be high, but the similarity of the nanoparticles produced requires less purification and characterization. Therefore, they can be made into a variety of products, such as sensors, at relatively low costs.

In contrast, the more heterogeneous carbon nanotubes are less expensive to synthesize but require more processing to yield those with desired properties. The added costs during manufacturing currently make nanotubes only practical for high-value applications such as digital logic devices.

"Although these nanoparticles and their end products are very different, the stakeholders in their manufacture can learn much from each other's best practices," said NIST materials scientist and co-author J. Alexander Liddle. "By sharing knowledge, they might be able to improve both seemingly disparate operations."

Finding ways like this to connect the dots, the authors said, is critically important for new ventures seeking to transfer nanoparticle technologies from laboratory to market.

"Nanoparticle manufacturing can become so costly that funding expires before the end product can be commercialized," said WTEC nanotechnology consultant and co-author Michael Stopa. "In our paper, we outlined several opportunities for improving the odds that new ventures will survive their journeys through this technology transfer 'valley of death.'"

Finally, the authors considered how manufacturing challenges and innovations are affecting the ever-growing number of applications for nanoparticles, including those in the areas of electronics, energy, health care and materials.

Turning up the thermostat may help manage hypertension, finds a new UCL study into the link between indoor temperatures and high blood pressure.

Comparing blood pressure readings of people in their own homes with temperature readings, the researchers found that lower indoor temperatures were associated with higher blood pressure, according to the new study in the Journal of Hypertension.

"Our research has helped to explain the higher rates of hypertension, as well as potential increases in deaths from stroke and heart disease, in the winter months, suggesting indoor temperatures should be taken more seriously in diagnosis and treatment decisions, and in public health messages," said senior author Dr Stephen Jivraj (UCL Institute of Epidemiology & Health Care).

"Among other diet and lifestyle changes people can make to reduce high blood pressure, our findings suggest that keeping homes a bit warmer could also be beneficial," he added.

The researchers found that every 1°C decrease in indoor temperature was associated with rises of 0.48 mmHg in systolic blood pressure and 0.45 mmHg in diastolic blood pressure.

Ideal blood pressure is considered to be between 90/60 mmHg and 120/80 mmHg, as per NHS guidelines. Blood pressure readings consist of two figures given together: systolic pressure, the force of the heart's contraction, and diastolic pressure, the resistance in the blood vessels.

The research team identified study subjects using Health Survey for England data, initially interviewing them with a questionnaire covering general health and lifestyle factors. Afterwards, nurses followed up by visiting 4,659 participants in their homes, to measure their blood pressure and to take an indoor temperature reading in their living room.

The researchers accounted for potential confounding factors such as social deprivation and outdoor temperature to identify an independent association with indoor temperature. They found that average systolic and diastolic blood pressure were 126.64 mmHg and 74.52 mmHg, respectively, for people in the coolest homes in the study, compared with 121.12 mmHg and 70.51 mmHg, respectively, in the warmest homes.

The research team found the effect of indoor temperature on blood pressure was stronger among people who do not exercise regularly, suggesting that physical activity could mitigate the risk of living in a cool environment, and that people who do not exercise need to keep warmer to manage their blood pressure.

Previous research had suggested that indoor temperature is associated with blood pressure, but researchers lacked evidence on strength of the association because there are so few studies using nationally representative data, which the team saw as an important factor given that people in cooler climates such as the UK spend most of their time indoors.

"We would suggest that clinicians take indoor temperature into consideration, as it could affect a diagnosis if someone has borderline hypertension, and people with cooler homes may also need higher doses of medications," said co-author Hongde Zhao (UCL Institute of Epidemiology & Health Care).

The researchers say their findings suggest that adequately heating homes during the winter months could help reduce the winter increases in hypertension and associated cardiovascular risks, particularly among those at heightened risk of high blood pressure such as older adults or people with a family history of hypertension.

While the study did not identify a threshold for a warm enough home, the researchers suggest that keeping living rooms to at least 21°C could be advisable for general health.

"The findings demonstrate support for universal benefit schemes such as the Winter Fuel Payment, which could be extended to enable everyone to heat their homes without worrying about the financial cost," added Dr Jivraj.

If you're about to run headfirst into something, your reflex might be to tense your neck and stabilize your noggin. But according to new research from Stanford University that may not be the best way to stave off a concussion. Instead, the findings suggest that your head's position is more important than whether you are tensing your neck.

It all comes down to how your head accelerates backward after impact, which some think is the major factor controlling concussion risk. The work was published Aug. 20 in IEEE Transactions on Biomedical Engineering.

"We found it really interesting that your soft tissue - muscles, ligaments and tendons - isn't doing much to dictate how your head is rotating immediately after an impact," said Michael Fanton, lead author on the paper and graduate student in the lab of David Camarillo, assistant professor of bioengineering. "Whereas even a few degrees of change in your head-neck angle can really alter how much your head is rotated and therefore, probably, your risk of concussion."

The researchers made their discovery in a model of the human head and neck, but confirmed what they found in a similar model of a woodpecker, which can endure extreme accelerations when pecking holes. It turns out they too may be protected in part by the angle of their pecking.

A big surprise

In a previous study led by Calvin Kuo, who is a co-author on the new paper and graduated with his PhD this spring, the group tied miniature weights to people's heads to tilt them backward. They then monitored how the head moved after participants either relaxed or tensed their necks. From this, the group constructed a simple computer model that recreated the way the head tilts forward and backward.

The researchers ran simulations with this model that replicated low-impact forces and found tense neck muscles slightly reduced head acceleration. But they also extended those simulations to include higher-force impacts - the kinds that could lead to concussion, such as what someone might experience falling off a bike - with much different results. When looking at fast, hard impacts, it does not seem to matter whether the neck muscles are tensed or relaxed.

"Originally, we thought your neck muscles could affect head acceleration and we wanted to figure out if that offered another strategy for reducing brain injury," Fanton said. "It was surprising that in these shorter-duration impacts, the neck muscles are not doing a whole lot."

The importance of positioning

The researchers were also curious whether head and neck positioning could alter front-to-back acceleration after a hard, fast hit. They ran their simulations with the head positioned at a wide variety of angles and found that small variations in position could mean the difference between high and low concussion risk. Their results showed that both the angle of the head and where it is hit affect the subsequent rotation of the head.

All this raised the question of how woodpeckers are able to withstand so much pounding - thought to produce head-on accelerations 10 times greater than those that cause severe concussions in athletes. So, the researchers created a simplified head and neck model of a woodpecker and ran it through the same positioning tests they had run in the human simulations. What they found is that small changes in position could substantially change the head acceleration the bird experienced. When the researchers aligned their model in the way real woodpeckers hold themselves as they peck, they noticed very low rotational acceleration.

However, the group cautioned that position alone likely doesn't explain the woodpecker's ability to withstand these forces. Scientists have suggested the size of their brains and features of their beak may be mitigating factors.

Focusing on prevention

Although the Camarillo lab and others in the field are finding that the neck muscles and ligaments might not prevent the kinds of head movement that lead to concussions, neck positioning is not a simple solution. Positions that could prevent concussions might make people more susceptible to other injuries, such as paralysis, and what protects one person could potentially raise the injury risk of another person involved in the same impact.

"Discovering how sensitive the head is to slight changes in positioning has implications on design of helmets and other protective equipment," Camarillo said. "For example, could the facemask in football be offering a lever arm that adds to the rotation of the head and therefore risk of concussion? Are downhill mountain bike helmets protecting the chin at the cost of the brain? We hope to use this model we have developed to determine better design geometry of helmets and potentially for input to coaching on how to brace for impact."

Ultimately, Camarillo is hoping this kind of modeling work can aid in developing better ways of preventing head injuries.

New research published in the August edition of the Journal of the American College of Cardiology's Heart Failure issue found significant correlations between blood levels of EPA plus DHA omega-3s in "cognitive" (as opposed to "somatic") depression among heart failure subjects. (Cognitive depression would include symptoms like sadness and pessimism, whereas somatic would include manifestations such as fatigue and sleep disturbances.)

This randomized controlled pilot study was designed to investigate the effects of supplemental omega-3s (EPA and DHA) on depressive and psychomotor symptoms in people with chronic heart failure and depression.

The study included 108 subjects who were assigned to one of three groups each taking 2 grams per day of either 1) a 2:1 mg EPA/DHA supplement; 2) a high EPA product; or 3) a placebo. The study lasted 12 weeks with blood testing (i.e., Omega-3 Index, RBC levels of EPA and DHA) completed pre- and post-supplementation.

The Omega-3 Index reached 6.79% in the 2:1 EPA/DHA group, 6.32% in the EPA only group, and 4.61% in the placebo group. In those who were determined to have taken at least 70% of their capsules and finish all testing (n=80), these values were 7.32%, 7.11%, and 4.42%, respectively. This indicates that the dose (and compliance) were both adequate to significantly improve the Omega-3 Index in only three months.

The social functioning sub-score of the SF-36, a short general health survey, was significantly improved on the 2:1 EPA/DHA supplement and tended to improve with the high EPA supplement.

Significant correlations between the Omega-3 Index and measures of cognitive depression where also found. More specifically, a higher Omega-3 Index was related to lower cognitive depression scores on the Beck Depression Inventory-II (BDI-II), which is the most widely used instrument for detecting depression.

While these findings are of interest, there are a few caveats. First, this was a pilot study, so the p-values weren't adjusted for multiple comparisons, meaning that there is a higher likelihood that these were chance findings, (i.e. 1 of 19 outcomes was different between intervention and placebo arms).

Second, possibly because the study was relatively small with limited power, there was no significant effect of either omega-3 formulation on a variety of psychological measurements, in particular on the Hamilton Depression Score (HAM-D). So the primary findings related to correlations between changes in the Omega-3 Index and the BDI-II cognitive depression metric.

Commenting on the treatment vs. prevention dilemma frequently faced by nutritionals like omega-3s was Dr. Bill Harris, one of the study's authors and the co-inventor of the Omega-3 Index test. "This was a study in already depressed individuals, which meant the researchers are looking to high-dose (although it could have been higher) omega-3 supplements to improve depressive symptoms, like a drug," he said.

"Generally, we think of the function of omega-3s as preventative rather than as treatment. If used as treatment, the dose must be fairly high (4 grams is a typical 'drug' dose) and blood levels must be measured," Dr. Harris continued. "In their larger follow-up study, I would recommend they choose just one of the supplements (probably the pure EPA product) and increase the dose and duration of the study."

The authors were also exploring a few different supplement options, focusing on recent evidence that EPA might be more effective for treating depression while DHA may be better for general cognition. "From this study, it's not clear to me that one supplement type was better than the other," Dr. Harris said, adding, "However, linking higher blood levels of omega-3s to improved depression symptoms in people with both depression and heart failure is encouraging and hopefully leads to better treatment for their conditions."

Few studies have explored health professionals' understanding of racism in healthcare, and how they manage it in practice. A new Journal of Advanced Nursing study examined the issue through five focus group discussions with 31 maternal, child, and family health nurses working across metropolitan South Australia. These clinicians represent the core professional group working with infants and families in the first years of life.

The study explored how nurses make sense of racism in practice and contribute to ensuring that children from diverse racial and ethnic backgrounds do not accumulate further disadvantage in their lives through culturally unsafe healthcare practice.

The investigators found mixed understandings and misunderstandings about the nature of racism in practice. Also, where structural racism was identified, participants did not feel capable to challenge it. The findings suggest an urgent need for the introduction of anti-discriminatory education and training in the nursing workforce.

"Child health nurses work extremely hard to partner with the families with whom they work, but their practice is sometimes compromised because the frameworks used in their primary education is outdated. These results show that we urgently need interactive and sustained anti-racist education in pre-service, graduate, and workplace education," said author Dr. Julian Grant, of Flinders University, in Adelaide, South Australia. "Most importantly we need further research to find out what anti-racist approaches work best for Australian children and families."

In the Respirology study, investigators identified strong associations between several measures of OSA severity and higher total cholesterol, higher LDL-cholesterol, elevated triglycerides, and lower HDL-cholesterol. Lipid status was influenced by geographical location with the highest total cholesterol concentration recorded in Northern Europe.

The analysis included 8592 adults across Europe who were not diagnosed with hyperlipidaemia and were not taking lipid-lowering drugs.

"Our data clearly suggest that sleep apnoea may have a negative impact on lipid levels, which may in part explain the association between sleep apnoea and increased risk for cardiovascular disease," said senior author Dr. Ludger Grote, of Gothenburg University, in Sweden. "Patients with sleep apnoea therefore need careful management of all cardiovascular risk factors including hyperlipidaema."

BLOOMINGTON, Ind. -- Results of a new behavioral study into what influences the decision to recall a defective product found that medical device firm managers may rely on their physician-customers to screen out detectable defects, in lieu of issuing a recall.

The study also found that some managers appear to hesitate to recall a product until the root cause of the defect is clearly understood, because this can reduce recall costs to the firm.

The study, performed by professors at the Indiana University Kelley School of Business and the University of Minnesota's Carlson School of Management, has led to changes at the medical device firms that participated in the study and has attracted interest from leadership at the Food and Drug Administration. The FDA expressed interest in using this research to improve how they oversee medical device product quality.

Their research, published in the Journal of Operations Management, is the first behavioral study using actual industry managers to study what influences voluntary product recall decisions, an important new field of study considering the prevalence and customer safety impact of product recalls across multiple industries.

"The decision to recall a product can significantly affect an operations manager's career, the credibility and financial performance of the firm, and the safety of customers," the authors wrote. "Surprisingly, the FDA does not clearly specify how a manager should integrate the multiple, and potentially conflicting, criteria influencing whether or not to recall a product. Consequently, managers use individual judgment in arriving at recall decisions."

George Ball, the lead author and an assistant professor of operations and decision technologies at the Kelley School of Business, and his two co-authors performed a randomized behavioral experiment with medical device industry managers who make recall decisions in practice.

A key finding of the study is that "medical device industry managers appear to trust physicians to screen out defects on behalf of the firm, meaning that when the defect is detectable to the physician, managers are less likely to recall," Ball said. "This is because of a perception of increased patient safety when defects are detectable."

Ball and his colleagues -- Rachna Shah, associate professor of supply chain and operations; and Karen Donohue, Board of Overseers Professor of supply chain and operations, both at the Carlson School -- also found that managers often hesitated to recall until they first understand the root cause of the product defect.

After working closely with these managers, Shah said they observed that, "most of these managers are very technically oriented, and they want to know 'why' before they take an action that could be very costly both in direct financial consequences and in reputational harm. Waiting to understand root cause before choosing to recall, however, is not required by the FDA."

The researchers also found a relationship between a manager's cognition and their recall decision. In particular, managers with high cognitive reflection issued fewer recalls. The ability to first reflect, before making a quick, intuitive decision, may lead to fewer recalls because such reflective individuals have a tendency to seek out more information before reaching a decision. Non-reflective, intuitive managers, conversely, were influenced by relational factors such as their gender, work experience and perception of their firm's relationship with the FDA.

While the paper focuses on operations at medical device manufacturers, the authors believe that the findings have broader applications. "Any industry in which the supply chain has multiple stages where quality can be observed and controlled may be susceptible to the study's conclusions," said Donohue. "For example, auto firms may trust their dealers to catch their mistakes before selling their cars to the final customer."