Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence

Background: Population monitoring has been introduced in UK primary schools in an effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screening for overweight and obesity in primary school children and highlight areas where evidence is lacking and research should be prioritised. Design: Systematic review with discussion of evidence gaps and future research. Data sources: Published and unpublished studies ( any language) from electronic databases ( inception to July 2005), clinical experts, Primary Care Trusts and Strategic Health Authorities, and reference lists of retrieved studies. Review methods: We included any study that evaluated measures of overweight and obesity as part of a population-level assessment and excluded studies whose primary outcome measure was prevalence. Results: There were no trials assessing the effectiveness of monitoring or screening for overweight and obesity. Studies focussed on the diagnostic accuracy of measurements. Information on the attitudes of children, parents and health professionals to monitoring was extremely sparse. Conclusions: Our review found a lack of data on the potential impact of population monitoring or screening for obesity and more research is indicated. Identification of effective weight reduction strategies for children and clarification of the role of preventative measures are priorities. It is difficult to see how screening to identify individual children can be justified without effective interventions.

A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions

Objectives: To clarify the role of growth monitoring in primary school children, including obesity, and to examine issues that might impact on the effectiveness and cost-effectiveness of such programmes. Data sources: Electronic databases were searched up to July 2005. Experts in the field were also consulted. Review methods: Data extraction and quality assessment were performed on studies meeting the review's inclusion criteria. The performance of growth monitoring to detect disorders of stature and obesity was evaluated against National Screening Committee (NSC) criteria. Results: In the 31 studies that were included in the review, there were no controlled trials of the impact of growth monitoring and no studies of the diagnostic accuracy of different methods for growth monitoring. Analysis of the studies that presented a 'diagnostic yield' of growth monitoring suggested that one-off screening might identify between 1: 545 and 1: 1793 new cases of potentially treatable conditions. Economic modelling suggested that growth monitoring is associated with health improvements [ incremental cost per quality-adjusted life-year (QALY) of pound 9500] and indicated that monitoring was cost-effective 100% of the time over the given probability distributions for a willingness to pay threshold of pound 30,000 per QALY. Studies of obesity focused on the performance of body mass index against measures of body fat. A number of issues relating to human resources required for growth monitoring were identified, but data on attitudes to growth monitoring were extremely sparse. Preliminary findings from economic modelling suggested that primary prevention may be the most cost-effective approach to obesity management, but the model incorporated a great deal of uncertainty. Conclusions: This review has indicated the potential utility and cost-effectiveness of growth monitoring in terms of increased detection of stature-related disorders. It has also pointed strongly to the need for further research. Growth monitoring does not currently meet all NSC criteria. However, it is questionable whether some of these criteria can be meaningfully applied to growth monitoring given that short stature is not a disease in itself, but is used as a marker for a range of pathologies and as an indicator of general health status. Identification of effective interventions for the treatment of obesity is likely to be considered a prerequisite to any move from monitoring to a screening programme designed to identify individual overweight and obese children. Similarly, further long-term studies of the predictors of obesity-related co-morbidities in adulthood are warranted. A cluster randomised trial comparing growth monitoring strategies with no growth monitoring in the general population would most reliably determine the clinical effectiveness of growth monitoring. Studies of diagnostic accuracy, alongside evidence of effective treatment strategies, could provide an alternative approach. In this context, careful consideration would need to be given to target conditions and intervention thresholds. Diagnostic accuracy studies would require long-term follow-up of both short and normal children to determine sensitivity and specificity of growth monitoring.

Fast regridding of large, complex geospatial datasets

In the earth sciences, data are commonly cast on complex grids in order to model irregular domains such as coastlines, or to evenly distribute grid points over the globe. It is common for a scientist to wish to re-cast such data onto a grid that is more amenable to manipulation, visualization, or comparison with other data sources. The complexity of the grids presents a significant technical difficulty to the regridding process. In particular, the regridding of complex grids may suffer from severe performance issues, in the worst case scaling with the product of the sizes of the source and destination grids. We present a mechanism for the fast regridding of such datasets, based upon the construction of a spatial index that allows fast searching of the source grid. We discover that the most efficient spatial index under test (in terms of memory usage and query time) is a simple look-up table. A kd-tree implementation was found to be faster to build and to give similar query performance at the expense of a larger memory footprint. Using our approach, we demonstrate that regridding of complex data may proceed at speeds sufficient to permit regridding on-the-fly in an interactive visualization application, or in a Web Map Service implementation. For large datasets with complex grids the new mechanism is shown to significantly outperform algorithms used in many scientific visualization packages.

Integrating nitrogen fluxes at the European scale

Executive summary Nature of the problem • Environmental problems related to nitrogen concern all economic sectors and impact all media: atmosphere, pedosphere, hydrosphere and anthroposphere. • Therefore, the integration of fluxes allows an overall coverage of problems related to reactive nitrogen (Nr) in the environment, which is not accessible from sectoral approaches or by focusing on specific media. Approaches • This chapter presents a set of high resolution maps showing key elements of the N flux budget across Europe, including N2 and Nr fluxes. • Comparative nitrogen budgets are also presented for a range of European countries, highlighting the most efficient strategies for mitigating Nr problems at a national scale. A new European Nitrogen Budget (EU-27) is presented on the basis of state-of-the-art Europe-wide models and databases focusing on different segments of Europe’s society. Key findings • From c. 18 Tg Nr yr −1 input to agriculture in the EU-27, only about 7 Tg Nr yr− 1 find their way to the consumer or are further processed by industry. • Some 3.7 Tg Nr yr−1 is released by the burning of fossil fuels in the EU-27, whereby the contribution of the industry and energy sectors is equal to that of the transport sector. More than 8 Tg Nr yr−1 are disposed of to the hydrosphere, while the EU-27 is a net exporter of reactive nitrogen through atmospheric transport of c. 2.3 Tg Nr yr−1. • The largest single sink for Nr appears to be denitrifi cation to N2 in European coastal shelf regions (potentially as large as the input of mineral fertilizer, about 11 Tg N yr–1 for the EU-27); however, this sink is also the most uncertain, because of the uncertainty of Nr import from the open ocean. Major uncertainties • National nitrogen budgets are diffi cult to compile using a large range of data sources and are currently available only for a limited number of countries. • Modelling approaches have been used to fill in the data gaps in some of these budgets, but it became obvious during this study that further research is needed in order to collect necessary data and make national nitrogen budgets inter-comparable across Europe. • In some countries, due to inconsistent or contradictory information coming from different data sources, closure of the nitrogen budget was not possible. Recommendations • The large variety of problems associated with the excess of Nr in the European environment,including adverse impacts, requires an integrated nitrogen management approach that would allow for creation and closure of N budgets within European environments. • Development of nitrogen budgets nationwide, their assessment and management could become an effective tool to prioritize measures and prevent unwanted side effects.

Putting the S-word back into Sustainability: Can we be more social?

In an era dominated by climate change debate and environmentalism there is a real danger that the important ‘social’ pillar of sustainability drops out of our vocabulary. This can happen at a variety of scales from business level through to building and neighbourhood level regeneration and development. Social sustainability should be at the heart of all housing and mixed-use development but for a variety of reasons tends to be frequently underplayed. The recent English city riots have brought this point back sharply into focus. The relationships between people, places and the local economy all matter and this is as true today as it was in the late 19th century when Patrick Geddes, the great pioneering town planner and ecologist, wrote of ‘place-work-folk’. This paper, commissioned from Tim Dixon, explains what is meant by social sustainability (and how it is linked to concepts such as social capital and social cohesion); why the debate matters during a period when ‘localism’ is dominating political debate; and what is inhibiting its growth and its measurement. The paper reviews best practice in post-occupancy social sustainability metric systems, based on recent research undertaken by the author on Dockside Green in Vancouver, and identifi es some of the key operational issues in mainstreaming the concept within major mixed-use projects. The paper concludes by offering a framework for the key challenges faced in setting strategic corporate goals and objectives; prioritising and selecting the most appropriate investments; and measuring social sustainability performance by identifying the required data sources

Entity-based semantic search on conversational transcripts semantic

This paper describes the implementation of a semantic web search engine on conversation styled transcripts. Our choice of data is Hansard, a publicly available conversation style transcript of parliamentary debates. The current search engine implementation on Hansard is limited to running search queries based on keywords or phrases hence lacks the ability to make semantic inferences from user queries. By making use of knowledge such as the relationship between members of parliament, constituencies, terms of office, as well as topics of debates the search results can be improved in terms of both relevance and coverage. Our contribution is not algorithmic instead we describe how we exploit a collection of external data sources, ontologies, semantic web vocabularies and named entity extraction in the analysis of underlying semantics of user queries as well as the semantic enrichment of the search index thereby improving the quality of results.

A parallel quantum histogram architecture

A parallel formulation of an algorithm for the histogram computation of n data items using an on-the-fly data decomposition and a novel quantum-like representation (QR) is developed. The QR transformation separates multiple data read operations from multiple bin update operations thereby making it easier to bind data items into their corresponding histogram bins. Under this model the steps required to compute the histogram is n/s + t steps, where s is a speedup factor and t is associated with pipeline latency. Here, we show that an overall speedup factor, s, is available for up to an eightfold acceleration. Our evaluation also shows that each one of these cells requires less area/time complexity compared to similar proposals found in the literature.

The prevalence and nature of prescribing and monitoring errors in English general practice – a retrospective case note review

Objective To determine the prevalence and nature of prescribing and monitoring errors in general practices in England. Design Retrospective case note review of unique medication items prescribed over a 12 month period to a 2% random sample of patients. Mixed effects logistic regression was used to analyse the data. Setting Fifteen general practices across three primary care trusts in England. Data sources Examination of 6048 unique prescription items prescribed over the previous 12 months for 1777 patients. Main outcome measures Prevalence of prescribing and monitoring errors, and severity of errors, using validated definitions. Results Prescribing and/or monitoring errors were detected in 4.9% (296/6048) of all prescription items (95% confidence interval 4.4 - 5.5%). The vast majority of errors were of mild to moderate severity, with 0.2% (11/6048) of items having a severe error. After adjusting for covariates, patient-related factors associated with an increased risk of prescribing and/or monitoring errors were: age less than 15 (Odds Ratio (OR) 1.87, 1.19 to 2.94, p=0.006) or greater than 64 years (OR 1.68, 1.04 to 2.73, p=0.035), and higher numbers of unique medication items prescribed (OR 1.16, 1.12 to 1.19, p<0.001). Conclusion Prescribing and monitoring errors are common in English general practice, although severe errors are unusual. Many factors increase the risk of error. Having identified the most common and important errors, and the factors associated with these, strategies to prevent future errors should be developed based on the study findings.

Reading the world through words: cultural themes in heritage Chinese language textbooks

This paper explores the social and cultural knowledge embedded in the textbooks for language and literacy education in a Chinese heritage language school, the Zhonguo School, in Montreal, Quebec, Canada. It examines how Chinese language arts textbooks introduce the child reader to cultural knowledge considered legitimate and valued in China as well as in Chinese diasporan communities. Furthermore, it looks at the construction of cultural knowledge in Chinese language textbooks in relation to the mainstream ideology to which immigrant children are exposed in and out of mainstream school classrooms. It looks at how the power relationship between legitimate cultural knowledge in majority and minority contexts is established and to what extent it affects language minority students' literacy practices in mainstream school and heritage language school contexts. Data sources are the Chinese textbooks used from kindergarten to Grade 5 in a Chinese heritage language school.

Updated empirical model of genetically-modified maize grain production practices to achieve European Union labeling thresholds

An updated empirical approach is proposed for specifying coexistence requirements for genetically modified (GM) maize (Zea mays L.) production to ensure compliance with the 0.9% labeling threshold for food and feed in the European Union. The model improves on a previously published (Gustafson et al., 2006) empirical model by adding recent data sources to supplement the original database and including the following additional cases: (i) more than one GM maize source field adjacent to the conventional or organic field, (ii) the possibility of so-called “stacked” varieties with more than one GM trait, and (iii) lower pollen shed in the non-GM receptor field. These additional factors lead to the possibility for somewhat wider combinations of isolation distance and border rows than required in the original version of the empirical model. For instance, in the very conservative case of a 1-ha square non-GM maize field surrounded on all four sides by homozygous GM maize with 12 m isolation (the effective isolation distance for a single GM field), non-GM border rows of 12 m are required to be 95% confident of gene flow less than 0.9% in the non-GM field (with adventitious presence of 0.3%). Stacked traits of higher GM mass fraction and receptor fields of lower pollen shed would require a greater number of border rows to comply with the 0.9% threshold, and an updated extension to the model is provided to quantify these effects.

FAMOUS, faster: using parallel computing techniques to accelerate the FAMOUS/HadCM3 climate model with a focus on the radiative transfer algorithm

We have optimised the atmospheric radiation algorithm of the FAMOUS climate model on several hardware platforms. The optimisation involved translating the Fortran code to C and restructuring the algorithm around the computation of a single air column. Instead of the existing MPI-based domain decomposition, we used a task queue and a thread pool to schedule the computation of individual columns on the available processors. Finally, four air columns are packed together in a single data structure and computed simultaneously using Single Instruction Multiple Data operations. The modified algorithm runs more than 50 times faster on the CELL’s Synergistic Processing Elements than on its main PowerPC processing element. On Intel-compatible processors, the new radiation code runs 4 times faster. On the tested graphics processor, using OpenCL, we find a speed-up of more than 2.5 times as compared to the original code on the main CPU. Because the radiation code takes more than 60% of the total CPU time, FAMOUS executes more than twice as fast. Our version of the algorithm returns bit-wise identical results, which demonstrates the robustness of our approach. We estimate that this project required around two and a half man-years of work.

Ubiquitous grid resource monitoring

In any wide-area distributed system there is a need to communicate and interact with a range of networked devices and services ranging from computer-based ones (CPU, memory and disk), to network components (hubs, routers, gateways) and specialised data sources (embedded devices, sensors, data-feeds). In order for the ensemble of underlying technologies to provide an environment suitable for virtual organisations to flourish, the resources that comprise the fabric of the Grid must be monitored in a seamless manner that abstracts away from the underlying complexity. Furthermore, as various competing Grid middleware offerings are released and evolve, an independent overarching monitoring service should act as a corner stone that ties these systems together. GridRM is a standards-based approach that is independent of any given middleware and that can utilise legacy and emerging resource-monitoring technologies. The main objective of the project is to produce a standardised and extensible architecture that provides seamless mechanisms to interact with native monitoring agents across heterogeneous resources.

GridRM: an extensible resource monitoring system

GridRM is an open and extensible resource monitoring system, based on the Global Grid Forum's Grid Monitoring Architecture (GMA). GridRM is not intended to interact with applications; rather it is designed to monitor the resources that an application may use. This paper focuses on the dynamic driver infrastructure used by GridRM to interact with heterogeneous data sources, such as SNMP or Ganglia agents, and how it provides a homogeneous view of the underlying heterogeneous data. This paper discusses the local infrastructure and details work implementing and deploying a number of drivers.

Network optimization for enhanced resilience of urban heat island measurements

The urban heat island is a well-known phenomenon that impacts a wide variety of city operations. With greater availability of cheap meteorological sensors, it is possible to measure the spatial patterns of urban atmospheric characteristics with greater resolution. To develop robust and resilient networks, recognizing sensors may malfunction, it is important to know when measurement points are providing additional information and also the minimum number of sensors needed to provide spatial information for particular applications. Here we consider the example of temperature data, and the urban heat island, through analysis of a network of sensors in the Tokyo metropolitan area (Extended METROS). The effect of reducing observation points from an existing meteorological measurement network is considered, using random sampling and sampling with clustering. The results indicated the sampling with hierarchical clustering can yield similar temperature patterns with up to a 30% reduction in measurement sites in Tokyo. The methods presented have broader utility in evaluating the robustness and resilience of existing urban temperature networks and in how networks can be enhanced by new mobile and open data sources.

A variational approach to retrieve rain rate by combining information from rain gauges, radars, and microwave links

Accurate and reliable rain rate estimates are important for various hydrometeorological applications. Consequently, rain sensors of different types have been deployed in many regions. In this work, measurements from different instruments, namely, rain gauge, weather radar, and microwave link, are combined for the first time to estimate with greater accuracy the spatial distribution and intensity of rainfall. The objective is to retrieve the rain rate that is consistent with all these measurements while incorporating the uncertainty associated with the different sources of information. Assuming the problem is not strongly nonlinear, a variational approach is implemented and the Gauss–Newton method is used to minimize the cost function containing proper error estimates from all sensors. Furthermore, the method can be flexibly adapted to additional data sources. The proposed approach is tested using data from 14 rain gauges and 14 operational microwave links located in the Zürich area (Switzerland) to correct the prior rain rate provided by the operational radar rain product from the Swiss meteorological service (MeteoSwiss). A cross-validation approach demonstrates the improvement of rain rate estimates when assimilating rain gauge and microwave link information.