Results show that the program produced immediate effects in all the outcome variables, which remained significant after 5 months, except for marital quality and for the strategy of compliance. These outcomes showed effect sizes ranging from low to high levels. The study presents evidence about the ability of the “Living as Partners” program to produce improvements in couple’s conflict indicators, addressing an unexplored field of research and intervention focused on Brazilian cultural specificities.Relationship education programs are strategies that can favor better marital quality and conflict management between spouses. The relationship education program “Living as Partners: Turning Challenges into Opportunities” seeks to promote the couples’ learning of conflict resolution strategies and better quality levels in the relationship. This study evaluates the capacity of this program to produce results regarding marital quality and three dimensions of the couple’s conflict: frequency, intensity, and resolution strategies. Data from 41 couples were analyzed before and after the program, and a follow-up after 5 months (The online version of this article (10.1186/s41155-018-0106-z) contains supplementary material, which is available to authorized users. Couple conflicts are inherent in love relationships. When they happen frequently and intensely, however, and when they are not solved satisfactorily, they can negatively affect the quality of the love relationship  is a curriculum-based skills training approach, delivered in six workshops that are conducted weekly in groups of couples. The total hour load ranges from 9 h for groups with four and five couples to 12 h for groups with six to eight couples. The main focus is on couples conflicts, particularly, how the partners resolve their disagreements. In addition, the workshops work with marital myths and with aspects that promote intimacy, such as the rescue of the couple’s history, sexuality, and couple’s leisure  Participants who completed the program will report, immediately after the end of the workshops, increase in marital quality levels, decrease in the frequency of conflicts, greater use of the conflict resolution strategy named positive resolution, and less use of the three negative strategies evaluated: conflict engagement, withdrawal, and compliance; (2) 5 months after the end of the program, there may be a decrease in the indices of all variables, although they will remain significantly better than they were before the program began.n = 82). These participants signed up to one of the ten groups offered in the couple relationship education program “Living as Partners: Turning Challenges into Opportunities.” They completed the program and answered the pre- and post-test evaluations. Participants had a mean age of 37.93 years (SD = 11.56) for men and 36.54 years (SD = 11.31) for women. The mean relationship time of the couples was 13.32 years (SD = 11.16). Most couples were officially married and had children. A significant part of the sample had finished or was studying higher education and had a paid job, with an average income of up to three times the minimum wage. Sociodemographic information is displayed in Table Forty-one couples participated in the study n = 8. These pn = 11) or were undergraduate students  in psychology, social service, nursing, and public management.Teams of three professionals working in private and public health, social service, and higher education services coordinated the ten groups in the Living as Partners program. A moderator led each group, with the assistance of an auxiliary. An observer accompanied the workshops on the spot without intervening in the process. All the moderators had a university degree. Nine were psychologists and one was a pedagogue. Nine of them held a degree or were taking a post-graduate program. The auxiliaries and observers held a higher education degree  and passive  recruitment techniques . The score is reached by adding the points of the 28 items, resulting in a one-dimensional measure. The higher the scores obtained, the more severe are the problems in the marital relationship. The Cronbach’s alpha coefficient found in this sample was 0.86 in the pre-test, 0.83 in the post-test, and 0.88 in the follow-up.This instrument contains two subscales. In the current study, we used an adaptation of Conflict-Disagreement subscale, which evaluates how frequently the subject disagrees with his/her partner on six conflict themes. Recent studies, however, have indicated a wider range of motives on which couples disagree , conflict engagement , withdrawal (when the spouse refuses to continue discussing a subject), and compliance . The instrument contains 16 items measured on a 5-point Likert scale . The means of the answers to each subscale were calculated. The Cronbach’s alphas calculated for this sample for the three times of measurement varied between 0.72 and 0.74 for positive resolution, between 0.67 and 0.74 for conflict engagement, between 0.63 and 0.75 for withdrawal, and between 0.53 and 0.68 for compliance.It evaluates patterns of relationship conflict resolution in four styles: Before the data analysis, the missing data was verified. Random missing data for each participant did not exceed 5 %; hence, missing values were treated by mean imputation .The analysis was performed in two stages. In each phase, the normality of the data was verified by the Kolmogorov-Smirnov (K-S) test. All variables presented normal distribution , conflict frequency , and positive resolution . Conflict engagement presented positive correlation at the pre-test and the follow-up , and compliance showed positive correlation only at the post-test . Withdrawal was not correlated for husbands and wives at any time . In general, these results point to the need of considering the non-independence. Thus, an analysis was made considering dyad as the unit of analysis.To check the non-independence between husbands and wives data, we used the Spearman Correlation Coefficient , results were interpreted according to the Greenhouse-Geisser correction. The Bonferroni correction was used to identify which groups differ.In the first stage of the analysis, we tried to verify if there were changes in the investigated variables immediately after the end of the program. Therefore, husbands’ and wives’ pre-test and post-test scores were compared with the paired Student’s y et al. , repeatet test, Cohen’s d was calculated, and for the ANOVAs, the partial eta squared (ηp2). The interpretation of the effect sizes was based on Cohen’s classification  were applied to the reliability of the program manual Living as Partners: Turning Challenges into Opportunities according to the moderating teams. All statistical analyses were developed using the software SPSS 21.0 .Effect sizes were calculated for all analyses. For the Student’s fication : d coeffApproval for this study was obtained from the Research Ethics Committee at the Psychology Institute of the Universidade Federal do Rio Grande do Sul, under CAAE number 43881515.6.0000.5334. All participants and the professionals who coordinated the workshops signed an informed consent form.1 represents that the moderator did not perform the expected procedure and 4 that it was performed completely. According to the moderators, assistants, and observers, high fidelity scores to the program manual were found for the development of the workshops  and dyad member (husbands and wives) as within-subjects’ independent variables. Considering the time effect, statistically-significant differences were observed among the three times for the variables p < 0.05), except for men’s marital quality. The decrease in conflict frequency, as well as the increase in the use of the positive resolution observed shortly after the end of the program, did not change from the post-test to the follow-up evaluation, indicating the stability of the results after 5 months. As predicted, there was a statistically significant increase in the conflict involvement and withdrawal strategies between the post-test and the follow-up (p < 0.05), but the comparison between the pre-test and the follow-up showed that these indices remained lower than they were in the pre-test (p < 0.05). The decrease in the use of compliance between pre- and post-test did not remain significant after 5 months. Marital quality did not present statistically significant differences at any time. Figure Comparisons with the Bonferroni adjustment confirmed the differences observed at phase 1 between the pre- and the immediate post-test in all variables  was slightly lower than the indices found on similar programs, in which it ranged from 20 to 34% , it should be emphasized that the use of conflict involvement and withdrawal strategies remained significantly lower and better than they were before the beginning of the “Living as Partners” program. In addition, after 5 months, participants maintained the increase in the use of the positive resolution strategy, characterized by the use of commitment and negotiation ; second, the selection bias was present at the design applied for collecting and analyzing the data. Besides that, the study was placed in South Brazil, and the results cannot be generalized to other geographic regions due to important cultural variations. Third, despite the main analysis made considering the dyad as the unit of analysis, the methodological strategy used did not allow us to understand if and how each member of dyad influence in their partners’ answers. Further research should address this point.positive resolution strategy and to decrease the usage frequency of the conflict resolution strategies conflict engagement and withdrawal. Five months after the end of the program, these results were better than they were before its beginning, with moderate to high effect sizes, indicating their stability along time. The changes observed at the three times were similar for husbands and wives. Despite the limitations, this evidence highlights the ability of the “Living as Partners” program to produce improvements in the couple’s conflict indicators. This is an important result once, as far as we know, the “Living as Partners” program is the pioneer scientific relationship education program in Brazil, addressing an unexplored field of research and intervention focused on Brazilian cultural specificities.The results of this study demonstrate that the “Living as Partners” program has helped to reduce the frequency of couples conflicts, as well as to increase the usage frequency of the Additional file 1:Table S1. Description of the workshops’ objectives and activities. (DOCX 18 kb)


As the complexity of the pharmaceutical industry increases and with the current disruptive forces affecting it, there is an increasing need for suitably-qualified personnel. Universities must respond to the need for graduates with the appropriate skills and knowledge to enable the transformation and future growth of this industry. Restructuring educational offerings to focus on graduate attributes, such as analytical and critical thinking, collaboration and problem solving, creativity, flexibility and self-direction in the context of the pharmaceutical industry facilitates the changes needed for future growth and viability. This paper discusses the process of program transformation to enable the development of graduates who can respond to these challenges in the pharmaceutical industry. It is said that we now live in a VUCA world: volatile, uncertain, complex and ambiguous; a scenario that can be applied across a number of industries including healthcare and education . Many of1.There is a growing need for qualified personnel to meet the demands of the pharmaceutical industry as therapeutics become more complex, the clinical and regulatory environments become more complicated, pricing environments become more restrictive and demands from patients and healthcare providers for education about therapeutics increase. With increasing pressures on the current operating model for large pharmaceutical companies and an increase in outsourcing critical functions, such as early stage research and development, clinical trials and regulatory affairs in Australia, there is an increased need for higher education institutions to deliver adequately trained employees who can hit the road running and provide immediate value to their employers . In 2017At the same time, higher education is undergoing a transformation in the way education is being delivered worldwide, with an emphasis on digital transformation and skills development to ensure graduates are equipped to meet the significant disruptive forces affecting many industries and societies today and into the future . This trWith this context in mind, it was an opportune time to review the Master of Medical Science in Drug Development program, which had been provided by UNSW Sydney for 20 years. UNSW Sydney is one of Australia’s largest research-intensive universities with a student body of over 50,000 and 6,000 staff. At the same time as this review of the program, the university was implementing an ambitious strategy that includes a commitment to academic excellence by embracing digital innovation, the formation of communities, inspired teaching methodologies, incorporating students as partners in educational reform, and closing the loop with greater feedback and dialogue between all partners in the educational endeavor.The Drug Development program had originally been designed in an era focusing on didactic, instructivist education with an emphasis on knowledge delivery using early models of distance education that relied heavily on large volumes of paper-based notes, individual assignments and summative exam assessments . To faciTo ensure the program remains relevant to the rapidly-changing pharmaceutical environment, a process was developed to systematically review and restructure the program based on sound pedagogical principles and the local pharmaceutical industry requirements . This prThe starting point for the development of the revised program was to articulate the mission of the program, which is to produce graduates with the knowledge and skills to make a meaningful contribution to medicines research, development and access, working across the pharmaceutical industry, academia and government, with the goal of improving the health and wellbeing of the community. Therefore, the program was aimed at people wanting to pursue a range of career possibilities in pharmaceutical drug discovery and development, medical device development, preclinical testing, clinical trials, drug safety and pharmacovigilance, regulatory affairs, medical and scientific communications, medical affairs, product compliance or health technology assessment within industry, regulatory agencies, academia or government health departments. Students enter the program with a variety of prior qualifications and knowledge: healthcare professionals , scientists with undergraduate qualifications, other Masters’ degrees or PhDs  and a small proportion with arts, psychology or law degrees.2), but with the added competences of collaborative team work, development of digital and information literacy skills, an emphasis on development of a personal ethical framework, a global outlook and a thorough understanding of the pricing of new therapies. The emerging importance of the medical affairs role was recognized, and a new course was developed within the restructured program to address this gap in education •A desire to increase self-evaluation and peer-evaluation •The need to equip students with 21st century skills: digital and information literacy, critical and creative thinking, problem-solving, persistence, collaboration and teamwork, flexibility and adaptability, leadership, initiative and self-direction .The Discussion Forums continue to offer great learning opportunities and the chance to bond with other students”. Students now undertake one group-based assessment task in each course throughout the program and this also fosters development of a sense of community, which is essential to the success of online learning programs  between 2013 and 2017, providing evidence that students are seeing the benefit of the new alignment and learning and teaching style. Student grades have increased very slightly over the transition to a fully online program, showing consistency in learning even though student cohorts have changed over the years with slightly more now transitioning from another career. Academic staff teaching into the program have undertaken further postgraduate study in higher education. Industry- and government-based casual lecturers who currently teach on the program have significant experience with over 60% having appointments at director level or above in their own workplace. This greater expertise of all the teachers in the program is reflected by the higher student satisfaction ratings.Finally, graduate employment levels are high for the program, with approximately 87% of graduates working in industry by their graduation (up from between 33 and 50% working in industry on entry to the program). In addition, approximately 80% of those who were working in industry at entry to the program managed to transition roles into the one they wanted or gained a promotion by graduation, including some who have taken promotions to positions based overseas. Further evaluation of the impact of the program transformation is planned and will include long-term follow-up of students after graduation, particularly reviewing transfer of learning to the workplace and career progression . This reIn conclusion, the Master of Pharmaceutical Medicine program at UNSW Sydney is now delivered as a fully online program using the affordances of the digital environment to develop capable graduates ready to take on challenging careers in the pharmaceutical industry. Their capabilities are developed through authentic learning experiences involving active experiential learning using problem-based scenarios focused on real-life situations to develop problem-solving and critical thinking skills. Additionally, students are learning in a connected environment that mirrors many of the interactions and situations they will face in their workplace, as we become more globally connected and work increasingly in digitally connected teams. As the working world changes, so too must the roles of educators and higher education continue to evolve. Thus, the delivery mode of the program is agile and able to be quickly adapted to meet future industry needs for skilled graduates, with Faculty acting not only as knowledge-experts, but as learning facilitators, for our students.The datasets generated for this study are available on request to the corresponding author.OC was responsible for the concept and writing of this paper and takes full accountability for the content.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling Editor DD and reviewers PS and HS declared their involvement as co-editors in the Research Topic, and confirm the absence of any other collaboration.


The Go4Fun program in New South Wales, Australia is a community based weight management program for overweight and obese children aged 7–13 years and their families. This study assessed the impact of the number and type of sessions attended on body mass index (BMI) z-score, fruit and vegetable intake and physical activity and sedentary behaviours to determine the number of sessions required to achieve optimal program outcomes.Secondary analysis was conducted on pre and post participant program data collected over 3.5 years. Relationships between session attendance and program outcomes were assessed using Spearman’s correlation and multivariate analyses of variance and multivariate regression. Number of sessions required to achieve optimal program outcomes was determined using piecewise linear regression.p < 0.01). No relationships were seen between number and type of sessions attended and outcome measures.For 3090 participants (48.5% of registrants) who attended at least five sessions, outcome measures improved significantly at post program compared with pre (p = 0.02) and vegetable intake (P < 0.01) than those children with post-school qualified mothers . Children of mothers without post-school education that attended seven sessions or more achieved significantly better BMI z-score outcomes (p < 0.01) than those who attended fewer sessions.Children of mothers without a post-school qualification  were more likely to achieve lower levels of improvements in BMI z-score  contains supplementary material, which is available to authorized users. Childhood obesity can lead to lifelong overweight and obesity with adverse health effects throughout life. A recent analysis  of worldThe Go4Fun program in New South Wales (NSW), Australia, described elsewhere , 6, is aUnderstanding the level of attendance that is likely to yield optimal participant outcomes would help program staff develop strategies to encourage participants to attend at least the minimum number of sessions that is likely to deliver beneficial lifestyle and health outcomes. The importance of assessing the dose-response relationship between attendance and outcomes for programs targeting childhood obesity has been highlighted previously , but it In this paper, using routinely collected pre and post program data for the Go4Fun program between July 2013 and December 2016, we describe the impact of the number and type of sessions attended on BMI zscore and nutritional behaviours at program completion to determine the number and type of sessions likely to generate optimal program outcomes.Secondary analysis was conducted on routinely collected de-identified Go4Fun program data, which includes anthropometric measurements of the participating child and the attending parent and parent reported nutritional, physical activity and sedentary behaviours. Go4Fun program is delivered over 10 weeks during school terms . Groups typically comprise of 8–12 children. The program is delivered by the local health districts (LHDs), geographical administrative regions for health services in NSW.All program participants for whom pre and post data were available between July 2013 and December 2016 were used for this study, which includes data for 265 children from a pragmatic incentives study  to assesFamilies were enrolled into Go4Fun via the usual enrolment pathways such as self-referral (the majority) or by referral from their health practitioners, and each eligible child was allocated to a local program based on availability and the family’s preferences for day and time. BMI was calculated from the height and weight recorded by the program facilitators who were trained to conduct the measurements using a standardised approach . BMI zscThe Go4Fun program at each site was delivered by LHD allocated facilitators who had undertaken the standardised Go4Fun training as a prerequisite for employment as a facilitator . As partPre and post program measurements were conducted by the trained program facilitators.The attending parents completed a questionnaire on physical activity, sedentary activities and dietary behaviour that had been used previously . Parent The dietary questions included the number of servings of vegetables, fruit and other food types (mostly energy dense nutrient poor food) as well as the number of cups of water and other drinks such as milk and soft drinks the child consumed. For the purpose of this study, the vegetable and fruit intakes were assessed because fruit and vegetable intake has been demonstrated to be a reliable measure of childhood obesity  and therQuestions asked about the total amount of time (hours and minutes) during the week the child walked and participated in moderate to vigorous physical activity during the week for recreation, exercise or to get to or from places, with the response option an open field for the number of times. Questions about sedentary time asked about the usual weekday, and each of the weekend days, how much time the child spent sitting and using a mobile phone, iPad, tablet, computer, gaming console or watching TV/DVDs. Total weekly duration of physical activity was determined by adding the time spent participating in organised sports and non-organised physical activity. Weekly sedentary behaviour questions were on recreational screen time and sedentary travel modes. The pre-program parent questionnaire also included demographic questions including the highest qualification of mother to represent socioeconomic status, adapted from the Australian Census .For health outcomes, physical measurements were height using a height measuring rod  and weight using a digital scale . Height and weight were each measured twice and the average taken. Weight was measured in KG and height in CM. Waist circumference was also measured, but these data was not analysed due to concerns raised recently in Australia  and UK  regardin2 from pre-program similar to the approach used in the routine Go4Fun program reporting as it is highly improbable for a child to achieve a BMI change of ±5 kg/m2 in a 10 week period. Program sessions were categorised into knowledge and application types by LC and face validated by CIH.  and to assess whether the session type had any effect on program outcomes.p-value of p < 0.01 for statistical significance for all analyses), and correlations between the number of sessions attended and the program outcomes  were assessed using a boxplot and Spearman’s correlation coefficient to account for the potential monotonic relationship between the variables. An initial multivariate analysis of variance and a subsequent multivariate regression was conducted for the BMI zscore program outcomes as the dependent variable, and the number of sessions attended and the participant and family characteristics as independent variables.The data were initially analysed descriptively to explore the demographic and other characteristics of participants and their families. Pre and post program date were compared  RCT (comparing once a week with twice a week delivery) we did not find any differences when the analysis was done at the group and Local Health District levels . An initA total of 6366 eligible children registered for the program within the study period of which pre-program data were available for 5389 participants (84.7% of registrants) and post-program data for 3090 participants (57.3% of those with pre-program data). Program delivery occurred at 426 sites, with the number of participants ranging from four to 22. The intracluster coefficient (ICC) for BMI z-scores was found to be 0.13.n = 4327, 72.6%). Children who did not attend the post-program measurement session attended 4.2 (±2.3) sessions on average whereas the children for whom the post program data were available attended 8.8 (±1.4) sessions on average. The children who completed the Go4Fun program were more likely to be from families with post-school qualified mothers and those that lived with more than one parent or carer. There were no differences in the other demographic characteristics and the health and behaviourial measures between the children who attended or did not attend the post program measurements  years, 50.6% of whom were females  were excluded from further analysis as the low numbers did not allow a reliable assessment of the association between attendance and outcomes. For participants who attended at least five sessions, there was a statistically significant change in BMI z-score and other outcome measures at post program compared with pre  (Table Children with post program data who attended fewer than five sessions (s) Table . The nums) Table .Table 2Pp = 0.03) and the subsequent multivariate regression showed that the only variable likely to influence the BMI zscore was highest qualification of mother. (Table p < 0.01) at program completion compared to the children of mothers who were university degree qualified. No effects were seen for number and type of attended sessions, age and gender of child, parent BMI at pre-program and household type.The multivariate analysis of variance . However, there does not appear to be incremental benefits in BMI z-score outcomes of attending more than seven sessions . In comparison, children of mothers with post school qualifications were able to achieve a BMI z-score change of − 1.0 after attending six sessions  or less than seven sessions (− 0.5 ± 0.1) .Our study, using routinely collected data from large scale routine implementation of the Go4Fun program, supports previous reports that participants of the scaled up childhood obesity programs based on the MEND program achieve positive health and behaviourial outcomes at program completion –25. Our An important finding in our study was the association between maternal educational level and program outcomes. Participants that had mothers without university qualifications benefited incrementally from attending more sessions until seven sessions after which the impact of the program plateaued, whilst other participants seem to achieve better BMI z-score outcomes by attending fewer sessions. It has been reported in other areas of health care that families with low level of parental literacy are less likely to fully participate in or adhere to programs like Go4Fun , 28 and There was no distinctive pattern in our study of participants attending either a session which was based on learning information or obtaining knowledge e.g. a session learning about fats and sugars or a session around application of knowledge e.g. supermarket tour. Session type did not influence the program attendance or outcomes for Go4Fun families. This may be because attendance is often determined by factors outside of the program schedule  and material covered in the sessions can be caught up or learned from the program resource material. Interest in program content is one of the main predictors of attrition in paediatric weight management programs , 33 alonIn a broader context, our finding highlights the strengths of routinely collected robust program data in monitoring and evaluating weight management programs delivered at scale to identify program implementation strategies that can be key influencers of program outcomes . ConversGiven the large sample size however, it can be expected that the effect of any measurement errors in the final outcomes is likely to be small. Also, it is not possible from our study to establish cause-effect associations for program outcomes, and we could not ascertain the reasons for families withdrawing from the program. Despite these limitations, we have been able to gain insights into how the program benefits can be optimised for participating children.Our study has been able to show that children from families with mothers without university degree qualifications need to attend more program sessions than those with university degree qualified mothers to achieve similar level of health and behaviourial outcomes in family based weight management programs.Additional file 1:Table S1. Comparison of demographic characteristics and health and behaviourial measures at pre program of children for whom post program data was not and was available. (DOCX 14 kb)


Older adults with dementia face challenges in their outdoor mobility and there are concerns of their not being able to continue going outside for everyday activities and social participation. The focus of this study was to identify patterns of visits to community destinations and activities, and perceptions of risks. Interviews were conducted with 59 adults (aged 54-84) with (n=29) and without (n=30) dementia using the Participation in ACTivities and Places OUTside the Home (ACT-OUT) questionnaire in Vancouver, Canada. Findings indicate that participants with dementia had abandoned visiting a few places over time , whereas there were no change in participation in taking transit to destinations such as supermarkets, entertainment and cultural places. However, in some cases, companions or partners of persons with dementia indicated that they were prone to getting anxious when left alone in public places and were at high risk of getting lost.


Ucp1 mRNA levels with increased plasma Fgf21 levels. Because Fgf21 and Angptl3 are known to activate and suppress lipolysis in adipose tissues and oxidative tissues, ChREBP appears to regulate plasma TAG levels by modulating Fgf21 and Angptl3 levels. Thus, ChREBP overexpression led to dissociation of hepatic steatosis from hyperlipidemia.Carbohydrate response element-binding protein (ChREBP) has an important role in the carbohydrate-mediated regulation of hepatic de novo lipogenesis, but the mechanism for how it regulates plasma triacylglycerol (TAG) levels has not been established. This study aimed to clarify the role of ChREBP in regulation of plasma TAG levels. We analyzed the metabolic changes in mice infected with an adenovirus expressing ChREBP Δ196 (Ad-ChREBP). Compared with adenovirus harboring green fluorescent protein infected mice, Ad-ChREBP-infected mice had higher plasma free fatty acid levels and paradoxically lower plasma 3-hydroxybutyrate levels through decreased fatty acid oxidation, rather than ketogenesis. Consistent with their hepatomegaly and increased lipogenic gene expression, the liver TAG contents were much higher. Regarding lipid composition, C16:0 was much lower and C18:1n-9 was much higher, compatible with increased stearoyl CoA desaturase-1 and ELOVL fatty acid elongase 6 expression. Furthermore, Ad-ChREBP-infected mice had decreased plasma TAG and very low density lipoprotein (VLDL)-TAG levels, consistent with decreased Angiopoietin-like protein 3 (Angptl3) and increased fibroblast growth factor (Fgf21) mRNA and protein levels. Finally, Ad-ChREBP infection increased white adipose tissue  Excess dietary carbohydrate and fat intakes occasionally cause obesity, glucose intolerance, and dyslipidemia ,2. TheseFasn) and acetyl CoA carboxylase 1 (Acc1), in the liver and consequently, de novo lipogenesis [Elovl6 and Scd1 are also regulated by SREBP1c and ChREBP [De novo lipogenesis plays an important role in the regulation of hepatic lipid contents . In a progenesis . ChREBP ogenesis ,8,9,10. ogenesis ,12. Elovd ChREBP ,14,15,16Fgf21 is a target gene for ChREBP [Hyperlipidemia is controlled by several factors, including hepatic lipid synthesis, plasma lipid secretion, and plasma lipid clearance . For exar ChREBP , we hypoIn the present study, we examined the effect of ChREBP on lipid metabolism with special reference to plasma triglyceride metabolism. Clarification of the role of ChREBP in lipid metabolism will be useful for therapeutic strategies in the treatment of non-alcoholic fatty liver disease (NAFLD) and hyperlipidemia.n = 6 per group) were intravenously infected with an adenovirus harboring ChREBP lacking the N-terminal 196 amino acids (ChREBP Δ196) or enhanced green fluorescent protein (GFP) as a control [Animal experiments were carried out in accordance with the National Institutes of Health Guide for the Care and Use of Laboratory Animals . All animal care was approved by the Animal Care Committee of the University of Gifu . Mice were housed at 23 °C on a 12-h/12-h light/dark cycle. At 8–9 weeks of age, male C57BL/6J mice ( control . ChREBP Liver glucose-6-phosphate (G6P) and glycogen contents were measured as described ,23. LivePol2 expression was evaluated as an internal control.Total RNA isolation, cDNA synthesis, and real-time PCR analysis were performed as described ,29,30,31t-test. Values of p < 0.05 were considered statistically significant.All values are presented as mean ± standard deviation. Data were analyzed by Student’s Chrebp mRNA levels in Ad-ChREBP-infected mice were increased by about four times compared with those in Ad-GFP-infected mice  were increased by ChREBP overexpression. Mttp expression was only modestly increased. Thus, Ad-ChREBP successfully infected the liver of C57BL/6J mice , a fatty acid-elongating enzyme, were increased in Ad-ChREBP-infected mice (Scd1) were increased in Ad-ChREBP-infected mice , specific to brown adipose tissue, and peroxisome proliferator-activating protein gamma (Pparg) were increased , which produce cytosolic NADPH for lipogenesis, were increased in Ad-ChREBP-infected mice. These findings were compatible with previous papers describing findings in ChREBP−/− mice [In Ad-ChREBP-infected mice, hepatomegaly caused by fatty liver was seen. These effects arise through increased gene expression related to lipogenesis. Moreover, pentose phosphate shunt pathway genes , we hypothesized that peripheral lipolysis may be increased by secretory factors that promote lipolysis. Angptl3 is known to increase lipolysis by inhibiting lipoprotein lipase [Angptl3 mRNA and plasma Angptl3 protein levels were decreased, while hepatic Fgf21 mRNA and plasma Fgf21 protein levels were significantly increased. In support of these findings, Fgf21 is known to induce adipose tissue Ucp1 and Pparg mRNA expression [Ucp1 and Pparg mRNA expression were induced in white adipose tissue. Taken together with the finding that Ad-ChREBP was not present in white adipose tissue, these observations suggest that increased plasma Fgf21 levels could modulate adipose tissue function in Ad-ChREBP-infected mice. The findings suggest that decreased Angptl3 and increased Fgf21 may promote peripheral TAG disposal. Angptl8 is known to increase plasma TAG levels by suppressing lipoprotein lipase [Angptl8 is a target gene for ChREBP [Angptl8 mRNA levels were increased, plasma Angptl8 protein levels were not significantly increased. In Ad-ChREBP-infected mice, only Angptl8 mRNA levels were significantly increased. Moreover, in Angptl3−/− mice, Angptl8 administration did not increase plasma triglyceride levels [In Ad-ChREBP-infected mice, plasma TAG, VLDL-TAG, LDL-TAG, and HDL-TAG levels were decreased compared with Ad-GFP-infected mice. Plasma TAG levels are regulated by de novo lipogenesis, plasma lipid secretion, and peripheral lipolysis . As de nn lipase  and Fgf2n lipase . In Ad-Cpression ,44. Inter ChREBP . Althouge levels . These oThe mechanism for how ChREBP regulates Angptl3 expression has not been established and further investigations are needed. Meanwhile, plasma cholesterol levels in Ad-ChREBP infected mice were lower. VLDL-Chol and LDL-Chol levels were higher and HDL-Chol levels were lower. Regarding plasma HDL-Chol levels, lower Angptl3 mRNA levels lead to lower plasma HDL-Chol levels . In partWe clarified that (1) ChREBP negatively regulates plasma ketone levels, and (2) ChREBP differently regulates hepatic and plasma triglyceride levels. Under normal conditions, excess intake of carbohydrates such as fructose or sucrose is converted into triglyceride through glucose-activated ChREBP. ChREBP promotes hepatic de novo lipogenesis by induction of lipogenic gene expression. ChREBP lowers plasma ketone levels by inhibiting fatty acid oxidation. Furthermore, ChREBP lowers plasma TAG levels through TAG disposal in adipose tissue and oxidative tissues by decreasing plasma Angptl3 levels and increasing plasma Fgf21 levels. Therefore, the discrepancies between plasma and liver TAG levels in Ad-ChREBP mice revealed that ChREBP reciprocally regulates hepatic and plasma TAG levels in different manners. With the intake of a high-fructose or high-sucrose diet, Fgf21 and Angptl3, rather than Angptl8, may be better targets for the improvement of hypertriglyceridemia.


In addition to increasing knowledge, research is meant to improve practice and policy. The papers presented in this symposium draw from the experiences and insights of actual participants and their caregivers in major government-sponsored program options for people with disabilities wanting to remain in the community. Many of these programs are administered by our Administration for Community Living. For all, ACL serves as a main source of information for people in the community. These papers give us first-hand knowledge of what participants like and what they want improved. They give us guidance on how consumers define quality; the results can guide efforts to improve program design and the training of support brokers and representatives who assist people who want to manage their own supports and services. I will give a few examples starting with the paper on the Veterans-Directed Care Program and drawing ideas from the other papers.


Youth facing barriers created by social marginalization are at a greater risk of adverse health outcomes, lower educational and occupational attainment, and decreased overall quality of life as adults. The negative psychosocial and physiological consequences of significant barriers to positive development during youth may be mitigated by interventions promoting physical activity, psychosocial development, and healthy behaviours. Sport for Development programming is a possible opportunity for youth facing barriers to engage in activities that foster positive youth development, which may improve socioeconomic outcomes, quality of life and long-term health status in this population. This paper outlines the study protocol measuring impact of an urban Sport for Development facility on positive youth development in youth facing barriers.Participants aged 6–29 will be recruited from programs at an urban Sport for Development facility to a 2-year prospective longitudinal mixed-methods study. Participants will be stratified by age into three cohorts with age-specific outcomes. Age-specific positive youth development outcomes will be assessed quantitatively by self-report and pedometer at baseline and after 6 months, 1-year, and 2-years of program participation. Focus groups will provide data regarding youth experience and the impact of facility and program components on youth outcomes.Our findings will inform best-practice and feasibility of a Sport for Development facility delivering programs in a socially and economically challenged urban setting in a high-income country.ISRCTN67016999. Date of registration: October 22, 2019. Significant barriers to positive development during youth including low socioeconomic status and other social marginalization can have negative consequences persisting into adulthood –4. PhysiA subpopulation of adults who faced significant barriers to positive development during youth develop no measurable negative consequences despite the adversity they have faced during childhood and are said to be “resilient” . The quaPositive Youth Development (PYD) includes the promotion of personal characteristics described as life skills that enable individuals ‘to lead a healthy, satisfying and productive life’ and can be intentionally incorporated into sport programming , 16. TheMeaningful outcomes achieved through intentional sport programming may be mediated by the PYD context, positive relationships, and explicit inclusion of life skills programming within physical activity-centred programming , 20–23. SFD programs have demonstrated a range of benefits to youth facing barriers in a variety of studies conducted internationally, often assessing participation in a single short-term program; long-term longitudinal research is lacking. The programs studied also tend to lack use of a logic model or theory of change to explain the factors expected to lead to the attainment of the program’s objectives, whether PYD, SFD, or otherwise. Similarly, it may be expected that research on PYD through sport as evaluated by the transference of life skills through team or competitive sport participation may promote SFD and PYD outcomes in a different manner or to a different degree than community-based participatory programs. As such, the impact of a sustainable urban SFD facility promoting PYD through recreational sport plus  and plus sport  programming where youth may engage in several ongoing programs in addition to wrap-around services such as counselling, nutrition, and homework programs, is unknown. Further, a thorough understanding of the contextual factors of such a program and its participants is lacking, resulting in a paucity of evidence to inform best-practice for SFD and PYD through sport programs to optimize individual and community impact.A large, long-term longitudinal study investigating PYD outcomes in a SFD facility for urban youth facing barriers that is based on a clear theory of change illustrating program components is therefore needed. This research is important for both theoretical and practical reasons, and addresses several future research directives published in the field including calls for mixed-methods, longitudinal, and evaluative studies that validate the development of life skills through sport and evaluate the impact of program type of PYD outcomes , 30–32. The MLSE LaunchPad trial employs a single-arm, non-randomized within subject quasi-experimental design following a cohort of 350 participants aged 6–29 years old over up to 2-years of self-selected participation in programming at MLSE LaunchPad, a Sport for Development facility in downtown Toronto, ON, Canada. Data collection methods utilize repeated measures of age-specific outcomes according to hypotheses outlined in Table All procedures have been approved by the Community Research Ethics Office and amendments will be reviewed and approved by this same ethics review body for scientific content and compliance with applicable research and human subject regulations. Informed consent will be obtained from participants aged 13 years and older and participant assent and parental consent will be obtained from participants under the age of 13 years prior to data collection. Consent/assent procedures will be conducted by a trained staff member conveying full assurance to prospective participants that their participation will not impact programming availability or access and is entirely voluntary. Additional consent will be obtained for all qualitative data collection processes. Informed consent processes will follow the Community Research Ethics Office guidelines, which adhere to the 2014 Tri-council Policy Statement on Ethical Conduct for Research Involving Humans and will be completed in accordance with the MLSE LaunchPad Privacy and Data Collection Policies .Age 6–29 yearsRegistered member of MLSE LaunchPadAttending programming at MLSE LaunchPadAbility to speak, understand and read EnglishPhysically able to participate in programming with or without the use of assistive devices-Recruited within 8 weeks of commencing program participation.Participants will be eligible for the study given the following criteria upon enrolment for the study:MLSE LaunchPad defines ‘youth facing barriers’ as ‘youth who may need greater supports and services to reach their full potential’, including low income, racialized, Indigenous, new to Canada, LGBTQ2S, and homeless or underhoused youth; youth in care or leaving care; and youth in conflict with the law. Demographic data will be collected in self-report surveys and through member registration and used to define characteristics of the population. No formal process is used to ensure youth accessing MLSE LaunchPad’s programs meet the stated criteria for ‘youth facing barriers’, and no youth are excluded from programming based on these criteria; however, the neighborhood demographics and outreach strategy have to date resulted in program participation by youth who meet the criteria outlined.n = 150 youth ages 6–12, n = 100 youth ages 13–18 years of age, and n = 150 youth ages 18–29. Statistical power calculations were conducted to justify the appropriateness of the proposed study sample sizes for each age group. For youth aged 6 to 12, statistical power for the primary outcome variable, physical literacy, was analyzed using pre-post MLSE LaunchPad member data on the PLAYself Physical Literacy Assessment tool. To achieve a large effect size , the power calculation performed suggests that the proposed sample size of 150 will yield 94.9% post-hoc power. Power calculations were conducted using data previously collected at MLSE LaunchPad for primary outcome variables of interest in the 13 to 18-year-old cohort . To achieve large effect sizes for these variables, the proposed sample size of 100 will yield 99.5–100% post-hoc power. Lastly, for youth aged 19 to 29, to achieve a large effect size in the primary outcome variable, employment status, the proposed sample size of 150 will yield 100% post-hoc power .Based on the number of variables planned for analyses in each cohort  will be given information about the research study and the requirements of research participation. If the participant indicates interest, they (and the parent/guardian where applicable) will be taken through the consent process.All programming and data collection will occur at MLSE LaunchPad, a SFD facility for youth facing barriers in downtown Toronto, Ontario, Canada. The facility includes 3 sport courts, a rock-climbing wall, 3 classrooms, a commercial kitchen, wellness rooms for confidential services, a large atrium, a staff room, and multiple offices and storage spaces. MLSE LaunchPad’s stated focus is on achieving sustainable, wide-ranging social outcomes for youth facing barriers through a SFD approach. All programs are free of charge and the facility offers programs for youth facing barriers aged 6–29.The facility is located on the ground floor of a subsidized housing building. The local area has a high proportion of subsidized housing and the highest density of homeless shelters in Canada , 34, 44.Programs  will be offered in both co-ed and girls-only formats. The priority of this age group will be the Healthy Body program pillar with the intent to develop physical literacy as PYD asset, allowing for continued engagement in physical activity and sport as youth age out of these programs and setting the stage for additional life skills development.Participants aged 13–18 years will be offered sport plus programs emphasizing life skills development, including multi-sport, fitness, rock climbing, dance, volleyball, ball hockey, and basketball. Plus sport programs developed in collaboration with local community organizations with demonstrated histories of positive youth impact relevant to the four program pillars will also be offered, including group mentoring programs, a restorative justice program, a kitchen skills-building program, and a social circus program. School day programs for this age group will involve weekly visits by classes from local public schools, and will focus on physical literacy and nutrition education, and exposure to Science, Technology, Engineering and Math topics on-court in a sport setting. All programs will include program-specific sport and life-skill components to achieve the objectives identified for this cohort. Some programs  will be offered in both co-ed and girls-only programming. The priority for this age group will be the Healthy Mind and Ready for School Pillars, with a secondary emphasis on Healthy Body.Programs for the 6–12 and 13–18 year-old cohorts will be delivered in 8-week cycles with 5 cycles each year. As research participants may participate in multiple recreational programs concurrently, volume  and duration (number of program weeks) of participation will be used as mediating variables in analyses to examine the dose-response on objectives outlined in Table Participants aged 19–29 years will be offered plus sport programming developed in collaboration with local community organizations offering occupational skills training and other employment services. These agencies will demonstrate strong histories of positive youth impact and will work with MLSE LaunchPad’s sport programmers to deliver integrated employment training and sport/physical activity programming. The addition of sport and physical activity is expected to offer a different context for reiteration of in-class themes (i.e. leadership and other key life skills) and to encourage increased long-term physical activity participation. The priority of this age group will be the Ready for Work pillar. Secondary emphasis will be on the Healthy Body and Healthy Mind pillars. Due to the training nature of these programs, the format will differ from the programs offered for youth aged 6–18, and programs will generally be delivered for 4 or more hours per day, 5 days per week for 8–10 weeks, with sport programming delivered in 1-h sessions 2 days/week.In addition to the programs described above, participants will be offered access to mental health counselling services, nutrition programming , and academic assistance provided through a homework club. Structured drop-in style sport plus programs incorporating life skills teaching will also be offered year-round as an additional engagement opportunity for youth who participate in registered programs, and as an alternative for youth who are unable to commit to regular registered programming.Participants will complete a baseline assessment within 2 weeks of recruitment. Follow-up research assessments will take place at 6 months, 12 months, and 24 months from the baseline assessment with data collection concluding March 31, 2020. Outcomes have been identified based on the program theory illustrated in the MLSE LaunchPad Theory of Change  provided by MLSE LaunchPad. Participants under the age of 8 or requiring assistance will be assisted by an adult. Participants aged 8 and over may complete questionnaires independently, but staff assistance will be offered.Pedometer data will be collected using PiezoRx pedometers for 1 week at each research assessment time-point according to manufacturer’s instructions. Participants will be instructed on how to attach the pedometer to the waist line of clothing, to not open or tamper with the case, and to wear the device at all times unless sleeping or in water. When the pedometer is returned after 7 days, the data will be uploaded to an electronic database using minutes of activity in the Moderate to Vigorous range based on the criterion of 100 steps per minute outlined by PiezoRx.Focus groups will be conducted annually with participants to gather personal perspectives regarding experience of programs and facility processes and impact of program involvement. Discussions will focus on: the impact of participation on health behaviours, life skills, academic engagement, job readiness and employment, and other impacts not explicitly expected or defined; the trajectory of involvement and access to programs, and wrap-around services offered in the facility.As attendance in programs is expected to mediate anticipated outcomes of participation in programs, strategies will be used to increase youth engagement and facilitate ongoing, regular participation in registered programs. The use of a gamified digital infrastructure to incentivise target behaviours such as attendance and provide external motivation to complete research requirements will be used. A customized mobile website will centralize incentivization of program participation and research-related activities and points will be allocated for various behaviours such as attendance, early registration, completion of research questionnaires, and demonstration of positive health behaviours and key life skills. The points earned can be exchanged for prizes of the participant’s choosing from a selection of sporting goods, apparel and school supplies.This method will allow the research team to communicate with participants remotely, collect relevant participation data centrally (i.e. program hours and attendance), and provide participants with a consistent means of accessing information and reminders for participation in both programs and research activities. We expect this strategy will engage participants through competition and goal setting and will also allow the research team to reinforce positive health behaviours and life skills included in program curricula remotely to support development and retainment of PYD assets. Further, we expect the electronic collection of data will improve protocol adherence, data accuracy, user acceptability, and adherence to timelines. Given the potential barrier regarding internet and device access, tablet kiosks will be available in the facility’s atrium to ensure all participants have access to the digital infrastructure and incentive strategy.Standardized electronic capture forms will be used for all data collection to ensure clarity and ease of entry. All data will be entered electronically and exported into an SPSS  database on a secure server at MLSE LaunchPad. Participant data will be delinked and accessed only by research staff. All data will be hosted on a secure server that is routinely serviced and backed up by MLSE IT staff. Informed consent forms will be scanned and stored on the server and hard copy documents will be destroyed upon conversion to electronic formatting. The data will be retained indefinitely. Peer audit will be conducted by research staff including research analyst, coordinator, manager, and director who will audit procedures and existing data on a cyclical basis.R. Missingness in data will be evaluated for amount of missing data and patterns in missingness. Based on the results of this evaluation, a single mean value imputation method will be applied as needed.Preliminary analyses will be conducted after 6, 12, and 24 months of recruitment. All statistical analyses will be completed using either SPSS versions 24/25 (IBM) or Ages 6–12: Repeated measures ANOVAs will be used to examine the main effect of time on physical literacy scores, self-reported physical activity and rates of continued participation in physical activity, controlling for demographic variables such as age and gender. Moderation analyses will be used to explore the effect of program dosage in terms of the number of programs attended over the course of participation in this study on the relationship between time and change in physical literacy. A similar moderation effect will be explored in the relationship between time and the change in self-reported physical activity levels. Pearson’s product-moment correlation coefficients will also be used to explore the relationship between physical literacy and physical activity levels. A standard multiple regression controlling for age, gender, household income and housing status will be used to identify predictive variables for each of the three primary outcomes. Potential predictors for the change in physical literacy include program dosage, type of program involvement (Sport Plus or Plus Sport), physical literacy score at baseline and physical activity level. Potential predictors for the change in physical activity level and rate of continued participation in sport or physical activity include program dosage, type of program involvement, physical activity level at baseline and physical literacy score.Ages 13–18: Repeated measures ANOVAs will be used to examine the main effect of time on positive health behaviours and each of the six life skills, controlling for demographic variables such as age, gender, household income and race. Moderation analyses will be used to explore the impact of program dosage on the relationship between time and each of the six life skills. Pearson’s product-moment correlation coefficients will also be used to explore the relationship between each of the life skills, positive health behaviors and academic outcomes. Logistic regression will be used to identify predictors of high school graduation for the subset of this age group that would be expected to graduate during the study with possible predictors including scores for each life skill at 2-year follow-up, program dosage and program type, while controlling for gender, household income, housing status and baseline life skills score. The same variables will also be used in a standard multiple regression to identify predictors of continued participation in sport and physical activity in this age group.Ages 19–29: Repeated measures ANOVAs will be used to examine the main effect of time on rate of employment, apprenticeship, or continued training, personal income, and rate of continued participation in physical activity, controlling for demographic variables such as age, education level, household income at baseline and housing status at baseline. Logistic regression will be used to identify predictors of employment status at 2-year follow-up, which may include program type and program dosage (number of programming hours), while controlling for similar demographic variables as identified above for the Repeated Measures ANOVA.Qualitative: Focus groups will be recorded digitally for review and transcription. The transcripts will be coded manually and analyzed using a hermeneutic approach, a cyclical process in which the researcher moves between working with the entire text and smaller parts of the text. This approach educes understanding of the transcribed material by bringing forth existing suppositions and recognizes that the interpreter’s own thoughts play a role in re-awakening the texts’ meaning. Using this approach, the perspectives of MLSE LaunchPad members and staff will be understood and contextualized with reference to PYD and SFD theory through repeated reading of the text and interpretation of the phenomena described. Regular research team meetings will be held to confer on analysis and discuss emergent qualitative findings. Analyzed quantitative and qualitative data will be integrated in reporting and presentation of findings.Adverse events including physical injuries will be monitored by MLSE LaunchPad’s staff team and documented through the facility’s incident reporting process.The paper reviews the rationale and methodology for a 2-year longitudinal study of a community-based Sport For Development facility in an urban setting using blended PYD and SFD program theory and outcomes with a unifying Theory of Change. Mixed methods of quantitative and qualitative data collection including validated questionnaires, pedometers and focus groups will be used to measure the impact of a community-based SFD program. Age-specific outcomes related to PYD including personal, social, and physical domains , 23, 48 Youth facing barriers to positive development have a higher risk of experiencing physical, mental, behavioural, and psychosocial challenges that may persist into adulthood. As such the adversely affected development of these critical life domains can inhibit academic, occupational, and social attainment, physical and mental health, and overall quality of life –53. SFD The SFD programs described herein will incorporate these necessary elements of a successful SFD program offering intentional programming with high quality coaching, equipment, facilities and support staff that this population would otherwise not have access to. Beyond providing more numerous, varied, and quality sport opportunities for socially marginalized youth, barriers to participation are addressed through the use of youth voice and a novel digital infrastructure to incentivize continued and engaged participation that emphasizes process-oriented goal pursuit to enhance personal investment in the program and opportunities for supplementary PYD and life-skill development through mobile access of program information and research activities. Intentional programming emphasizing age-specific life skills transference in a sport context with wrap-around support services will be used to prioritise physical literacy and activity in youth aged 6–12, academic engagement and positive health behaviours including physical activity in youth aged 13–18, and occupational readiness and physical activity habits in youth aged 19–29. The age-specific prioritization of objectives is designed to provide participants with the necessary life skills to reach their potential socially, physically, and psychologically in order to engage in academic, occupational, and civic pursuits, ultimately improving broader social and economic outcomes in this currently marginalized urban community in Toronto, Ontario, Canada.To the authors’ knowledge, this is the first long-term longitudinal study of SFD programming in an urban setting using both quantitative and qualitative methods of data collection and analysis. We believe that this program is uniquely positioned to deliver best in class SFD and PYD through sport programming given the collaborative development of evidence-based programming and embedded measurement and evaluation bridging the gap between research and practice. Further, the inclusion of community partners, a digital gamified delivery of participation incentivization, and branding affiliation with a local professional sports organization may help overcome several existing barriers to participation and optimize the acquisition of age-specific PYD outcomes that will lead to larger scale community impacts.


Ripple Effect Mapping (REM) is an evaluation approach that has traditionally been used in community settings to visually map the impact of programming and community interventions. This manuscript utilizes the Community Capitals Framework (CCF) to inform REM and to better highlight the changes and impact between various levels of a community, following a childhood obesity prevention intervention. The addition of in-depth qualitative analyses makes this approach particularly useful for the evaluation of interventions with a research–community partnership focus. The objective of this study was to describe a CCF-informed REM approach with detailed protocol, training, and application to the community-based, childhood obesity prevention intervention, iCook 4-H, which targeted youth and adult pairs. This protocol includes the steps required to prepare for REM sessions of, ideally, six youth and adult pairs, one facilitator, and one or two evaluators/note takers. REM sessions typically begin with an icebreaker and appreciative inquiry activities that inform the REM mapping process that follows. In-depth qualitative analysis of the notes and map images captured during REM sessions ensure the rigor required for research-related interventions. Researchers, community members, and participants can use CCF-informed REM collectively as a robust evaluation tool to demonstrate, through visual mapping, the positive effects of community-partnered research programs. Research to examine effective implementation and dissemination of community programming has increased within the last 25 years ,2. SubseImpact evaluation is a process that enables researchers, participants, and community members to understand the efficacy and reach of programming on its targeted population. Furthermore, this evaluation information can improve future programming . Ripple Although REM with CCF is a proposed impact evaluation method, it has not been widely adopted within the research sector for health promotion programming. REM has been used in Extension programming to evaluate projects including the Horizons leadership program , the “TiSpecifically, because of increasing rates of obesity in children, many prevention programs have been developed in the past decade to alleviate this trend . ChildhoFollowing the two-year iCook 4-H obesity prevention program , REM sesThe REM process takes approximately 90–120 min to complete and includes a structured group activity (similar to a focus group) with sequential questioning designed to elicit reflection and feedback from participants. A map, a visual picture of responses, is created by a trained facilitator as the discussion ensues. The facilitator should be familiar with the research program and participants, preferably the individual who led the community intervention and with whom the participants are familiar. Trained note taker(s) record session discussions and input data into a report template. These note-takers can be researchers or other community members trained in the process. The following sections detail the stepwise components necessary for completing a REM session in a community-based research program.Training videos on the REM process were developed and are available online . SpecifiParticipants that completed the research program should be invited to participate in REM session. Focus groups include both youth and adult participants together and should contain a minimum of 3 youth and 3 adult participants and no more than 6 of each per session , to stay within recommended limits for focus group data collection . Having For the REM session, the following materials are required. A whiteboard for constructing the map, which could also be a variation of a whiteboard . Next, four different colored markers are needed, as each “ripple” of the map will be indicated by a different color. For participants, pens and paper can be provided to allow for note taking. A short demographic survey  is needed as well to capture sample population characteristics. Additionally, a laptop and audio recorder are highly encouraged, but not required to capture data. The laptop will be used by the note-taker during the REM session with the audio recorder capturing any responses the note-taker might have missed, particularly connecting comments to youth and adults. Further, for data capturing, a camera  is required to take a photo of the map at the end of the REM session, ideally with all participants and facilitators around it  and especially of the map alone with a close up to be able to read the notes. Lastly, participant handouts and printouts of the community capitals are necessary. Depending on the organization/institution, consent forms and media releases may be required by institutional review boards (IRB) or governing bodies and should be considered. Additionally, incentivizing can be used for participation and should be reviewed with the appropriate organization/institution oversight committee. A sample of posted mapping components is seen in The layout of the room used for REM activity is very important for creating an effective facilitator-led discussion. A horseshoe or half-circle seating arrangement is recommended to optimize participant interaction. Begin REM sessions with introductions by the facilitator and the note-taker, describe REM session participants by having them complete a brief demographic survey. Guidelines for group discussions should be reviewed to ensure a respectful environment during REM sessions. Basic guidelines include being polite when other participants are speaking, allowing youth participants to speak before adults, and respecting other participants’ privacy once the session is over. Group dynamics, such as participant placement around the sitting area, should be recorded by the note-taker.The facilitator leads an icebreaker activity to allow participants to become comfortable with the group and stimulate open communication. It is recommended that the ice breaker activity be associated with the research program in which the subjects participated. For example, an activity could consist of a question and answer matching game based on information included in the program. Following the icebreaker activity, the facilitator leads an appreciative inquiry activity using a separate paper on one side of the map for the purpose of participants identifying the most beneficial program aspects. Appreciative Inquiry is a method used to help enterprises become more effective by adopting an overall way of thinking that focuses on solutions and positives, with the belief being that focusing on positives will in turn create more solutions and positives ,34. In g“This session will give us a better understanding of your experience with the [insert research program here] and how it impacted you individually and as a group and/or community. This map will be a tool for us to understand the effects this program has had on your families and in the community through a ‘rippling effect.’ This ‘ripple effect’ is like a pebble being dropped into a pond; one small pebble can make a large impact of ripples throughout a pond. Similarly, a singular program can make small and large impacts within a family and community by individuals passing on their new experiences and knowledge learned from the program to others.”Prior to beginning the REM mapping, the facilitator should explain why the session is being conducted and what participants can expect within the 90–120-min session. A sample explanation isNext, the facilitator should provide an explanation of the community capitals that will be used throughout the session. Descriptions of each capital can be found in The mapping process is completed in accordance with the “Ripple Effect Mapping Field Guide ” and proThe facilitator, through discussion with participants, should apply three to four broad themes from the appreciative inquiry activity around the research title in the middle of the map. For example, if participants completed a culinary program, they might state their favorite memories were “developing cooking skills”, “eating healthy foods”, and “family time physical activity”, as in the iCook 4-H program ,36. Thes[insert research program action statement here]? Allow time for each participant to comment and each note taker to capture responses. Both the facilitator and note taker should document whether the response was a youth or adult with a marked “Y” or “A” following the comment. Allow participants time to correct, clarify, or add to what the facilitator writes on the map to ensure credibility of the data. Repeat the question for each of the 3–4 important themes reported. Once every participant has had the opportunity to comment, the facilitator should then ask the group what capital is related to each comment. A line will be drawn to each capital and comment in the same color marker. Each comment should have a square next to it with the letter of the capital inside as well .The first question is “What are people doing differently as a result of [insert research program here] and how?”, and the third question is “Are there changes in the way community groups and institutions do things as a result of [insert research program here]? Remember to continue to document whether an adult or youth made the comment and what capital is related to which comment within the square for each. Through this process, the facilitator documents the participants’ thoughts on how one event or outcome affected another; this is termed mapping the “ripples” that have taken place [Following the same guidelines, the next two questions can be asked and a different colored marker can be used to indicate responses for each question. The second question is “Who has benefited from en place ,20.Following the questions and community capitals discussion, the facilitator should discuss with participants the most important or significant idea, most bridging among new people, and most bonding among the group/participants that emerged from the mapping process. Participants can discuss among themselves, noting the most accepted response. If there is a discrepancy between the participants, the note-taker should note the other ideas brought up during discussion. To represent the most important or significant impact on the map, the facilitator should label beside the comment with a star. Following the same process, a circle is placed on the map to represent the most bonding for bringing the group or family together, and a square represents the most bridging to new people. This activity reflects the importance of social capital within a community, giving participants additional time to reflect on program events that lead to positive community cohesion. A sample, finished map is represented in The facilitator or note-taker should capture a photographic image of the REM map following the session. The photograph can be taken with REM participants if they choose, but a participant-free photo should also be captured for reference in analysis. Facilitators and note-takers should converse immediately following the REM session to document any additional limitations perceived to have occurred during the sessions and what the facilitator perceived as having worked best during the process. Further, member checking, otherwise termed as expert reviewer debriefing, should occur to ensure an accurate depiction of participant perceptions from the REM session. The data should be entered into a data report template  for data analysis, with use of the map picture to transcribe all data.Inductive content analysis is recommended since a dyad approach in a research setting is weakly discussed in the literature . This prAdopting a framework to evaluate the effect of interventions and translation of sustainable action is needed to deploy with interventions addressing preventive measures for widespread chronic disease within the community setting ,44. FramAlthough REM has been used in various settings , includiIn context, REM is only one of many evaluation tools and techniques available to assess the impact of community research ,10,46,47While REM provides opportunity for program evaluation, it is not without limitations. First, REM largely focuses on positive outcomes, with participants’ reports of program failures, or program harms, less likely to be stated. Therefore, it is important that program failures are acknowledged and addressed before disseminating a program into the community. Next, with little researcher control over the data collected and the complexity of qualitative research, it is hard to distinguish causality . While RThis REM methodology has been presented in a way that had not been previously reported as a comprehensive, qualitative tool that could be used for robust evaluation following community-based programs. To understand program effects and outcomes, evaluation tools, such as REM, can be used to benefit participants, community members, and researchers by providing visual imaging or story boards through the ripple mapping of program impacts. Furthermore, using REM as a qualitative research evaluation tool gives a more telling and deeper story compared to quantitative findings only . Therefo


There were fluctuations in the pH during the NMP degradation, starting with the acidification of the culture media and finishing with a pH close to 8.5. The most abundant species in the consortium, at the moment of maximum degradation activity, were Aneurinibacillus migulanus, Paenibacillus macerans, Bacillus coagulans, Microbacterium sp. LCT-H2, and Bacillus thuringiensis. The diversity of PM-06 provided metabolic abilities that in combination helped to produce an efficient process. The consortium PM-06 generated a set of different tools that worked coordinated to increase the substrate availability through the solubilization of components and elimination of structural diffusion barriers. This is the first report about the degradation of NMP using a microbial consortium.The nixtamalized maize pericarp (NMP) is a plentiful by-product of the tortilla industry and an important source of fermentable sugars. The aim of this study was to describe the degradation profile of NMP by the action of a consortium (PM-06) obtained from the native microbial community of this residue. The degradation was analyzed in terms of the changes in the community dynamics, production of enzymes (endo-xylanase and endo-cellulase), physicochemical parameters, and substrate chemical and microstructural characteristics, to understand the mechanisms behind the process. The consortium PM-06 degraded 86.8 ± 3.3% of NMP after 192 h of growth. Scanning electron microscopy images, and the composition and weight of the residual solids, showed that degradation was sequential starting with the consumption of hemicellulose. Xylanase was the highest enzyme activity produced, with a maximum value of 12.45 ± 0.03 U mLThe online version of this article (10.1186/s13568-019-0812-7) contains supplementary material, which is available to authorized users. Agro-industrial residues are important sources of fermentable sugars useful for the production of biofuels, biomaterials and biocatalysts   and 5 g yeast extract L−1, and incubated at 37 °C and 125 rpm for 7 days. After the incubation time, 2 mL of these cultures were used to inoculate fresh media. This procedure was repeated until the functional stability was maintained. The functional stability was determined measuring the amount of residual NMP present in the culture after 168 h. All experiments were conducted in triplicate. The composition of the NMP lot used was: 15.3% cellulose, 23.7% xylan, 12.6% arabinose substituents, 33% starch, 4.4% lignin, and 11% of others components .Consortium PM-06 was enriched from the endogenous microbiota in NMP by the dilution-to-stimulation approach  to measure the weight of the residual NMP, cell protein content, enzymatic activities, pH (Thermo Orion 0420A1 pH meter), and the concentration of reducing and total sugars in the culture broth. Negative controls consisted of culture media without inoculum. All experiments were conducted in triplicate.The microbial consortium PM-06 was cultivated in 25 mL of media containing 40 g dried NMP LWt is total NMP weight before microbial growth; and Wi is the residual substrate weight after microbial growth. The degradation rates were calculated dividing the NMP degradation percentage by the time (h after inoculation).Cultures were harvested by filtration through filter paper (11 µm pore size) under vacuum. Retained solids were dried at 60 °C in a convection oven for 24 h after which the weight of the residual NMP was measured. The NMP degradation (%) was calculated with the following formula:g and 4 °C for 5 min. The resulting cell pellets were disrupted by incubation with 1 mL of NaOH 500 mM, at 75 °C for 10 min. Cellular lysates were centrifuged at 16,000×g and 10 °C for 10 min, and then the supernatant was collected. Cellular lysate protein concentrations were determined using a modified version of the Lowry protein assay  were centrifuged at 11,000×Peterson  using BSDuring microbial growth, the concentration of reducing sugars in the supernatant was measured using the 3,5-dinitrosalicylic acid (DNS) method Miller , while tThe activities of these hydrolytic enzymes were evaluated in the culture supernatants measuring the amount of reducing sugars released upon substrate hydrolysis by the DNS method. The endo-xylanase activity was assayed at pH 6.5 and 60 °C for 15 min in reactions containing 1.8% (wt/v) xylan from beechwood (Sigma) in phosphate buffer 100 mM. The endo-cellulase activity was measured at pH 4 and 40 °C for 15 min in reactions containing 0.5% (wt/v) carboxymethylcellulose (CMC) (Sigma) in citrate buffer 500 mM. One unit of endo-xylanase or endo-cellulase activity was defined as the amount of enzyme that catalyzed the production of 1 µmol of reducing sugars (xylose or glucose) per minute under the described conditions.−1 flow rate.Structural carbohydrates and Klason lignin content in the residual NMP were measured by quantitative acid hydrolysis using sulfuric acid (TAPPI T13M method). The monosaccharides obtained from the residual NMP, were quantified by high performance liquid chromatography with refractive index detection . Separations were carried out over a Phenomenex RPM-Monosaccharide column (00H-0135-K0) at 80 °C, using water as the mobile phase, at 0.6 mL minThe supramolecular morphology of residual NMP particles was determined using a scanning electron microscope (Jeol JSM-6360 LV). For this purpose, samples were coated with gold using a Denton Vacuum Desk II sample metallizer. The images were acquired at 20 kV accelerating voltage.g for 10 min at room temperature. The cell pellets obtained were washed (twice) with TEN buffer , to eliminate culture medium residues. The mgDNA was extracted using the methodology reported by Rojas-Herrera et al.  of the degradation kinetics was extracted. Cultures were filtered through filter paper to eliminate the residual NMP. Cells were recovered after centrifugation of filtrates, at 11,000×a et al. . The isoa et al. . Convent−5) for taxonomic classification.The sequencing of the extracted mgDNA (8 h samples), was carried out at Admera Health Inc. , using the Illumina NextSeq platform. Output files were processed by Trimmomatic  were obtained. It is important to note that culture media contains yeast extract and starch derived from the nixtamalization process; however, results indicate that the consumption of NMP was the main metabolic activity.The solubilization of NMP into the medium was determined through the quantification of the total and reducing sugars Fig. a. Total The consortium PM-06 is a prolific endo-xylanase producer, the activities measured were within the interval reported for consortia with high xylanase titles ; and lignin, was determined and presented in Fig. Structurally, NMP consists of three zones with a different morphology: zone I is associated with the pedicel; zone II with the embryo; and the zone III covers the endosperm  along the batch of culture Fig. . The numAneurinibacillus migulanus (29%), Paenibacillus macerans (26%), Bacillus coagulans (15.6%), Microbacterium sp. LCT-H2 (11%), and Bacillus thuringiensis (4.7%).Samples representing the time with the highest degradative activity and OTUs richness (8 h), were analyzed by metagenomics. The assembled metagenome statistics are detailed in Additional file Nixtamalization is an ancient procedure created by early Mesoamerican cultures for the transformation of maize into products with high nutritional content and more palatability  , likely as consequence of the NMP structure (Zhang et al. NMP components were consumed at lower rates in stages II and III. Interestingly, in these periods of time the pH of the media was alkalinized. Alkalinization has been related to different metabolic events like organic acids consumption, and the secretion and accumulation of aminoacid catabolic products, between others (Pometto and Crawford There is an apparent relationship between the diversity and the capacity of a consortium to degrade lignocellulose (Evans et al. Bacillus, Aneurinibacillus, Paenibacillus, and Microbacterium. Several species of Bacillus and Paenibacillus are recognized as great plant biomass degraders (Ghio et al. Aneurinibacillus is part of the ruminal microbiota able to synthesize enzymes that work on lignocellulose (Asem et al. Microbacterium species contain few genes encoding for lignocellulolytic enzymes; however, possess a great metabolic potential to degrade arabinoxylans (Yeager et al. Microbacterium together with Bacillales such as Paenibacillus or Bacillus have demonstrated to be the key bacteria of synthetic lignocellulose-degrading minimal consortia (Jiménez et al. Microorganisms present in PM-06 are part of the Bacteria domain and members of the Bacillales and Actinomycetales orders. The most abundant genera were Aneurinibacillus, Bacillus, Paenibacillus, and Microbacterium genera, whose presence and ecological relationships would be important to preserve the consortium viability and degradation capacity (De Lima Brossi et al. The microbial population of PM-06 presented a cyclical behaviour with the existence of a minimum set of bacterial species possibly conformed by the Consortium PM-06 is an efficient NMP degrader and a prolific endo-xylanase producer. The mechanism utilized for NMP degradation was sequential where the substrate structure, microbial growth, pH, synergistic relation between enzymes, ecological relationships, and microbial dynamics were intimate related. All the tools generated by the consortium worked coordinated to increase the substrate availability through the solubilization of components and elimination of structural diffusion barriers. More studies are necessary to analyze the whole set of enzymes produced, the effect of pH on the enzyme activity and stability, gene regulation strategies, and changes in NMP permeation along time, to obtain specific information of the mechanism. This is the first report about the degradation of NMP using a microbial consortium.Additional file 1: Table S1. Metrics of assembled metagenome. Figure S1. SEM Micrograph of nixtamalized maize pericarp surface morphology after sterilization by autoclaving at 121 °C for 15 min.