From Victor Roggli and colleagues: Diffuse Malignant Mesothelioma in Patients with Hematologic Malignancies

Arch Pathol Lab Med. 2015 Apr 6. [Epub ahead of print]

Malignant (Diffuse) Mesothelioma in Patients With Hematologic Malignancies: A Clinicopathologic Study of 45 Cases.

Li X1, Brownlee NA, Sporn TA, Mahar A, Roggli VL.

Author information

• 1From the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Drs Roggli and Sporn); the Department of Pathology, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, Tianjin, China (Dr Li); the Pathology Associates of Greenville, Greenville, South Carolina (Dr Brownlee); and the Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (Dr Mahar).

Abstract

Context .- Ionizing radiation has a role in the development of malignant mesothelioma, in several epidemiologic studies, including patients with hematologic malignancies. 

Objective .- To study the clinicopathologic characteristics of patients with malignant mesothelioma and hematologic malignancies with and without a history of radiotherapy. 

Design .- From a database of approximately 3600 patients with malignant mesothelioma, we identified 45 patients (1%) who also had hematologic malignancies. We examined clinicopathologic features and noted whether the patient had received radiotherapy for malignancy, comparing those with and those without such exposure. 

Results .- Among the 45 cases, 18 (40%) had Hodgkin lymphoma, 15 (33%) had non-Hodgkin lymphoma, 10 (4%) had chronic lymphocytic leukemia, and 2 (22%) had chronic myelogenous leukemia; 20 patients (44%) had a history of radiotherapy, and 23 (51%) did not. Most patients with Hodgkin lymphoma (16 of 18; 90.0%) received radiation, whereas none of the patients with leukemia (0 of 12) and only 20% (3 of 15) of the patients with non-Hodgkin lymphoma did so. Patients without radiation were older than patients who received radiotherapy (median, 73 versus 54 years, respectively; P < .001), had a shorter interval from diagnosis of hematologic malignancy to that of mesothelioma (median, 2 versus 24 years, respectively; P < .001), and had a shorter survival period (median, 6.0 versus 14.0 months, respectively; P = .02). Epithelial mesotheliomas were proportionately more common in patients with a history of radiotherapy. 

Conclusions .- Patients with mesothelioma and hematologic malignancies with a history of radiation tended to be younger, had a longer interval from diagnosis of hematologic malignancy to that of mesothelioma, had a longer survival period, and were more likely to have the epithelial variant compared with patients without radiotherapy.

Zombie allusions: They just keep on coming™: "address[ing] cultural/historical/mythological perspectives that might alter societal norms..."

J Undergrad Neurosci Educ. 2015 Mar 15;13(2):A81-7. eCollection 2015.

Mad dogs, vampires, and zombie ants: a multidisciplinary approach to teaching neuroscience, behavior, and microbiology.

Esteban DJ1, Holloway KS2.

Author information

• 1Biology Department;
• 2Neuroscience and Behavior Program and Department of Psychology, Vassar College, Poughkeepsie, NY 12604.

Abstract

Viruses, parasites, and some bacteria use host organisms to complete their lifecycle. These infectious agents are able to hijack host processes to replicate and transmit to the next host. While we tend to think of infections as just making us sick, they are also capable of changing host behavior. In fact, many infectious agents are able to mediate host behavior in ways that can enhance transmission of the disease. In this course we explore the process of host behavior mediation by infectious agents, combining aspects of multiple fields including neurobiology, animal behavior, infectious disease microbiology, and epidemiology. The goals for this course are: 1) To explore the neurological and behavioral effects of infectious organisms on their hosts, in particular pathogen mediation of host behavior to the benefit of the pathogen, 2) to introduce students to primary literature in a multidisciplinary field, and 3) when applicable, to address cultural/historical/mythological perspectives that might alter societal norms and pressures and influence the impact of the biological processes of behavior modification by infections.

FDA Okays First Direct-to-Consumer Genetic Test

Rita Rubin, MA

JAMA. 2015;313(13):1306. doi:10.1001/jama.2015.2809

"The personal genetics company 23andMe made regulatory history recently when the US Food and Drug Administration (FDA) announced that its carrier test for Bloom syndrome could be marketed directly to consumers, a first for a genetic test (http://1.usa.gov/1EgzEy4)."

.

J Law Med Ethics. 2015 Mar;43(1):134-42. doi: 10.1111/jlme.12201.

On the Justifiability of ACMG Recommendations for Reporting of Incidental Findings in Clinical Exome and Genome Sequencing.

May T1.

Author information

• 1Ursula Von der Ruhr Professor of Bioethics at the Medical College of Wisconsin, and Affiliated Faculty at the Institute for Health and Aging, University of California San Francisco.

Abstract

This paper examines three possible justifications for original ACMG recommendations to return incidental findings from whole exome or genome sequencing independent of patient preferences. The first two potential justifications, based on a patient's authentic values, then on harms to others, are founding lacking as a basis of justification for these recommendations. The third, grounded in analogous professional practices, might serve as a potential justification if several controversies can be avoided. However, given the nature of these controversies and the need to instill public trust in this newly emerging science, the paper finds that updated ACMG recommendations that recognize opt-out rights on behalf of patients is the most prudent, and justifiable, approach.

Radiology. 2015 Apr 3:141769. [Epub ahead of print]

Chronic Obstructive Pulmonary Disease: Pulmonary Function and CT Lung Attenuation Do Not Show Linear Correlation.

Paoletti M1, Cestelli L, Bigazzi F, Camiciottoli G, Pistolesi M.

Author information

• 1From the Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy.

Abstract

Purpose 

To determine whether the relationship between pulmonary function and computed tomographic (CT) lung attenuation in chronic obstructive pulmonary disease (COPD), which is traditionally described with single univariate and multivariate statistical models, could be more accurately described with a multiple model estimation approach. 

Materials and Methods 

The study was approved by the local ethics committee. All participants provided written informed consent. The prediction of the percentage area with CT attenuation values less than -950 HU at inspiration (%LAA-950insp) and less than -910 HU at expiration (%LAA-910exp) obtained with single univariate and multivariate models was compared with that obtained with a multiple model estimation approach in 132 patients with COPD. 

Results 

At univariate analysis, %LAA-950insp and %LAA-910exp values higher than the mean value of this cohort (19.1% and 22.0%) showed better correlation with percentage of predicted diffusing capacity of lung for carbon monoxide (Dlco%) than with airflow obstruction (forced expiratory volume in 1 second [FEV1]/vital capacity [VC]). Conversely, %LAA-950insp and %LAA-910exp values lower than the mean value were correlated with FEV1/VC but not with Dlco%. Multiple model estimation performed with two multivariate regressions, each selecting the most appropriate functional variables (FEV1/VC for mild parenchymal destruction, Dlco% and functional residual capacity for severe parenchymal destruction), predicted better than single multivariate regression both %LAA-950insp (R2 = 0.75 vs 0.46) and %LAA-910exp (R2 = 0.83 vs 0.63). 

Conclusion 

The relationship between pulmonary function data and CT densitometric changes in COPD varies with the level of lung attenuation impairment. The nonlinear profile of this relationship is accurately predicted with a multiple model estimation approach. ©RSNA, 2015 Online supplemental material is available for this article.

Pers Soc Psychol Bull. 2015 Apr 3. pii: 0146167215575731. [Epub ahead of print]

Gender Differences in Responses to Moral Dilemmas: A Process Dissociation Analysis.

Friesdorf R1, Conway P2, Gawronski B3.

Author information

• 1Wilfrid Laurier University, Waterloo, Ontario, Canada frie3750@mylaurier.ca.
• 2University of Cologne, Cologne, Germany.
• 3University of Texas at Austin, USA.

Abstract

The principle of deontology states that the morality of an action depends on its consistency with moral norms; the principle of utilitarianism implies that the morality of an action depends on its consequences. Previous research suggests that deontological judgments are shaped by affective processes, whereas utilitarian judgments are guided by cognitive processes. The current research used process dissociation (PD) to independently assess deontological and utilitarian inclinations in women and men. A meta-analytic re-analysis of 40 studies with 6,100 participants indicated that men showed a stronger preference for utilitarian over deontological judgments than women when the two principles implied conflicting decisions (d = 0.52). PD further revealed that women exhibited stronger deontological inclinations than men (d = 0.57), while men exhibited only slightly stronger utilitarian inclinations than women (d = 0.10). The findings suggest that gender differences in moral dilemma judgments are due to differences in affective responses to harm rather than cognitive evaluations of outcomes.

"s-word"

Am Psychol. 2015 Apr;70(3):282-3. doi: 10.1037/a0039070.

Comment on the January 2015 cover of the American Psychologist.

Peters WM1, Cavalieri CE2.

Author information

• 1The NETT, Ltd.
• 2University of St. Thomas.

Abstract

This article comments on the January 2015 cover of the American Psychologist (Vol. 70, Issue 1). The caption linked to a picture of a wintry mountain scene said "Squaw Valley Meadow." Although a seemingly innocuous word to most people, a majority of Society of Indian Psychologists (SIP) members wanted to share what the term squaw , hereinafter deemed "s-word," invokes for many Native individuals as well as in the collective cultural memories of American Indian peoples. As a voice representative of Native peoples, the members of SIP are acutely aware of the many issues that need to be redressed, both within our own communities and in our relations with non-Native society. In the case of the cover art caption and the ire provoked by the use of the s-word, the members of SIP opted to take an opportunity to educate versus confront, and to inform versus chastise or accuse amid this polarized political climate of interracial tensions.

Int J Health Policy Manag. 2015 Mar 16;4(4):199-201. doi: 10.15171/ijhpm.2015.66. eCollection 2015.

Why and how is compassion necessary to provide good quality healthcare?

Fotaki M1.

Author information

• 1Warwick Business School, University of Warwick, Coventry, UK.

Abstract

Recent disclosures of failures of care in the National Health Service (NHS) in England have led to debates about compassion deficits disallowing health professionals to provide high quality responsive care. While the link between high quality care and compassion is often taken for granted, it is less obvious how compassion - often originating in the individual's emotional response - can become a moral sentiment and lead to developing a system of norms and values underpinning ethics of care. In this editorial, I argue why and how compassion might become a foundation of ethics guiding health professionals and a basis for ethics of care in health service organisations. I conclude by discussing a recent case of prominent healthcare failure in the NHS to highlight the relationship between compassion as an aspect of professional ethics on the one hand, and values and norms that institutions and specific policies promote on the other hand.

Sci Context. 2015 Mar;28(1):99-129.

The Surgical Elimination of Violence? Conflicting Attitudes towards Technology and Science during the Psychosurgery Controversy of the 1970s.

Casey BP1.

Author information

• 1School of Social Service Administration,University of ChicagoE-mail:bcasey1@uchicago.edu.

Abstract

Argument 

In the 1970s a public controversy erupted over the proposed use of brain operations to curtail violent behavior. Civil libertarians, civil rights and community activists, leaders of the anti-psychiatry movement, and some U.S. Congressmen charged psychosurgeons and the National Institute of Mental Health, with furthering a political project: the suppression of dissent. Several government-sponsored investigations into psychosurgery rebutted this charge and led to an official qualified endorsement of the practice while calling attention to the need for more "scientific" understanding and better ethical safeguards. This paper argues that the psychosurgery debate of the 1970s was more than a power struggle between members of the public and the psychiatric establishment. The debate represented a clash between a postmodern skepticism about science and renewed focus on ultimate ends, on the one hand, and a modern faith in standards and procedures, a preoccupation with means, on the other. These diverging commitments made the dispute ultimately irresolvable.

"Only a small number of styles in popular music manage to sustain a high level of instrumentational complexity over an extended period of time."

PLoS One. 2014 Dec 31;9(12):e115255. doi: 10.1371/journal.pone.0115255. eCollection 2014.

Instrumentational complexity of music genres and why simplicity sells.

Percino G1, Klimek P1, Thurner S2.

Author information

• 1Section for Science of Complex Systems, CEMSIIS, Medical University of Vienna, Austria.
• 2Section for Science of Complex Systems, CEMSIIS, Medical University of Vienna, Austria; Santa Fe Institute, Santa Fe, New Mexico, United States of America; IIASA, Laxenburg, Austria.

Abstract

Listening habits are strongly influenced by two opposing aspects, the desire for variety and the demand for uniformity in music. In this work we quantify these two notions in terms of instrumentation and production technologies that are typically involved in crafting popular music. We assign an 'instrumentational complexity value' to each music style. Styles of low instrumentational complexity tend to have generic instrumentations that can also be found in many other styles. Styles of high complexity, on the other hand, are characterized by a large variety of instruments that can only be found in a small number of other styles. To model these results we propose a simple stochastic model that explicitly takes the capabilities of artists into account. We find empirical evidence that individual styles show dramatic changes in their instrumentational complexity over the last fifty years. 'New wave' or 'disco' quickly climbed towards higher complexity in the 70s and fell back to low complexity levels shortly afterwards, whereas styles like 'folk rock' remained at constant high instrumentational complexity levels. We show that changes in the instrumentational complexity of a style are related to its number of sales and to the number of artists contributing to that style. As a style attracts a growing number of artists, its instrumentational variety usually increases. At the same time the instrumentational uniformity of a style decreases, i.e. a unique stylistic and increasingly complex expression pattern emerges. In contrast, album sales of a given style typically increase with decreasing instrumentational complexity. This can be interpreted as music becoming increasingly formulaic in terms of instrumentation once commercial or mainstream success sets in.

Economics 101

ROUND ONE

ROUND TWO

Good Friday: Jackie Fox's excellent "The 10 Commandments of Breast [or any] Cancer"

The 10 Commandments of Breast Cancer

Early to bed, early to rise: Night Owls At Greater Risk of Developing Diabetes

Night Owls At Greater Risk of Developing Diabetes

"This might be explained in terms of the sleep quality of the night owls. They
might be having poorer sleep quality than morning people who prefer to sleep early and wake up early. Also, they might be indulging in activities like smoking and eating late."

"...45 percent of all non-alcoholic beverages sold today have zero calories."

Regulating restaurants won't solve the problem of childhood obesity



"The industry has shipped 90 percent fewer beverage calories to schools across the country since 2004. It's also labeled all its products with the number of calories on the front of bottles or cans so consumers can make the choice that's right for them.

The industry is offering consumers more low- and zero-calorie options than ever before. In fact, 45 percent of all non-alcoholic beverages sold today have zero calories.

And it is supporting physical activity programs in Maryland communities. The American Beverage Association recently launched an integrated consumer awareness and engagement program that talks to teens and their parents about the importance of balancing physical activity with what they drink and eat."

Zombie allusions: They just keep on coming™: turning junk DNA into garbage DNA

Genome Biol Evol. 2015 Jan 28;7(3):642-645.

An Evolutionary Classification of Genomic Function.

Graur D1, Zheng Y2, Azevedo RB2.

Author information

• 1Department of Biology and Biochemistry, University of Houston dgraur@uh.edu.
• 2Department of Biology and Biochemistry, University of Houston.

Abstract

The pronouncements of the ENCODE Project Consortium regarding "junk DNA" exposed the need for an evolutionary classification of genomic elements according to their selected-effect function. In the classification scheme presented here, we divide the genome into "functional DNA," that is, DNA sequences that have a selected-effect function, and "rubbish DNA," that is, sequences that do not. Functional DNA is further subdivided into "literal DNA" and "indifferent DNA." In literal DNA, the order of nucleotides is under selection; in indifferent DNA, only the presence or absence of the sequence is under selection. Rubbish DNA is further subdivided into "junk DNA" and "garbage DNA." Junk DNA neither contributes to nor detracts from the fitness of the organism and, hence, evolves under selective neutrality. Garbage DNA, on the other hand, decreases the fitness of its carriers. Garbage DNA exists in the genome only because natural selection is neither omnipotent nor instantaneous. Each of these four functional categories can be 1) transcribed and translated, 2) transcribed but not translated, or 3) not transcribed. The affiliation of a DNA segment to a particular functional category may change during evolution: Functional DNA may become junk DNA, junk DNA may become garbage DNA, rubbish DNA may become functional DNA, and so on; however, determining the functionality or nonfunctionality of a genomic sequence must be based on its present status rather than on its potential to change (or not to change) in the future. Changes in functional affiliation are divided into pseudogenes, Lazarus DNA, zombie DNA, and Jekyll-to-Hyde DNA.

Proc Biol Sci. 2015 May 7;282(1806). pii: 20150347.

Avoidable errors in the modelling of outbreaks of emerging pathogens, with special reference to Ebola.

King AA1, Domenech de Cellès M2, Magpantay FM2, Rohani P3.

Author information

• 1Department of Ecology & Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI 48109, USA Department of Mathematics, University of Michigan, Ann Arbor, MI 48109, USA Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA kingaa@umich.edu.
• 2Department of Ecology & Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA.
• 3Department of Ecology & Evolutionary Biology, University of Michigan, Ann Arbor, MI 48109, USA Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI 48109, USA Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA.

Abstract

As an emergent infectious disease outbreak unfolds, public health response is reliant on information on key epidemiological quantities, such as transmission potential and serial interval. Increasingly, transmission models fit to incidence data are used to estimate these parameters and guidepolicy. Some widely used modelling practices lead to potentially large errors in parameter estimates and, consequently, errors in model-based forecasts. Even more worryingly, in such situations, confidence in parameter estimates and forecasts can itself be far overestimated, leading to the potential for large errors that mask their own presence. Fortunately, straightforward and computationally inexpensive alternatives exist that avoid these problems. Here, we first use a simulation study to demonstrate potential pitfalls of the standard practice of fitting deterministic models to cumulative incidence data. Next, we demonstrate an alternative based on stochastic models fit to raw data from an early phase of 2014 West Africa Ebola virus disease outbreak. We show not only that bias is thereby reduced, but that uncertainty in estimates and forecasts is better quantified and that, critically, lack of model fit is more readily diagnosed. We conclude with a short list of principles to guide the modelling response to future infectious disease outbreaks.

"I’m not saying we’ll ever want to get rid of doctors, but we must overcome fear that stops us from making progress."

Bill Gates Is Wrong

John Thuma

"If I can come up with a computer doctor better than your current doctor, would you as a patient consider it? Would you as a doctor use it? For example, if we do an analysis of common genes between diseases such as obesity and asthma, we can construct a virtual dictionary that defines those genes. We can then take the human genome and check it against that dictionary to see who’s got those genes and use a proven data source to see who’s afflicted with either of the diseases. With that information we can predict who’s obese and who’s asthmatic, and vice versa. If we can do that across a collection of diseases, we would have a tool for being proactive with healthcare and promoting wellness.

I’m not saying we’ll ever want to get rid of doctors, but we must overcome fear that stops us from making progress. Right now, humans are on the front line of fields like healthcare and machine intelligence is in the background. In the future we’ll see machines move closer to the front under the governance of doctors."

Wow. "...13.5% had used Google to research a patient..."

West J Emerg Med. 2015 Mar;16(2):234-239. Epub 2015 Feb 25.

Do Emergency Physicians and Medical Students Find It Unethical to 'Look up' Their Patients on Facebook or Google?

Ben-Yakov M1, Kayssi A2, Bernardo JD1, Hicks CM1, Devon K2.

Author information

• 1University of Toronto, Department of Emergency Medicine, Toronto, Ontario.
• 2University of Toronto, Department of Surgery, Toronto, Ontario.

Abstract

INTRODUCTION:

The use of search engines and online social media (OSM) websites by healthcare providers is increasing and may even be used to search for patient information. This raises several ethical issues. The objective of this study is to evaluate the prevalence of OSM and web-searching for patient information and to explore attitudes towards the ethical appropriateness of these practices by physicians and trainees in the emergency department (ED).

METHODS:

We conducted an online survey study of Canadian emergency physicians and trainees listed under then Canadian Association of Emergency Physicians (CAEP) and senior medical students at the University of Toronto.

RESULTS:

We received 530 responses (response rate 49.1%): 34.9% medical students, 15.5% residents, 49.6% staff physicians. Most had an active Facebook account (74%). Sixty-four participants (13.5%) had used Google to research a patient and 10 (2.1%) had searched for patients on Facebook. There were no differences in these results based on level of training, and 25% of physicians considered using Facebook to learn about a patient "very unethical." The most frequent ethical concerns were with violation of patient confidentiality, dignity, and consent. The practice was usually not disclosed to patients (14%), but often disclosed to senior colleagues (83%).

CONCLUSION:

This is the first study examining the prevalence of and attitudes towards online searching for obtaining patient information in the ED. This practice occurs among staff physicians and trainees despite ethical concerns. Future work should explore the utility and desirability of searching for patient information online.

"Suicide is the worst acute outcome in psychiatry, in part because it is preventable."

J Clin Psychiatry. 2015 Mar;76(3):e383-e384.

Suicidology meets "Big Data".

Grunebaum MF1.

Author information

• 1Columbia University Medical Center and New York State Psychiatric Institute, Department of Psychiatry, Box 42, 1051 Riverside Dr, New York, NY 10032 mgruneb@nyspi.columbia.edu.

Abstract

Globally, nearly a million people die yearly by suicide, yet despite research and prevention efforts, global suicide rates have increased in the past half century, and the World Health Organization projects they will rise more in the years ahead. Suicide is overwhelmingly associated with mental illness, mostly depressive disorders, though substance use and psychotic disorders are also significant risks.

J Health Commun. 2015 Mar 6:1-13. [Epub ahead of print]

Parsing Susceptibility and Severity Dimensions of Health Risk Perceptions.

El-Toukhy S1.

Author information

• 1a Gillings School of Global Public Health , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.

Abstract

Risk perceptions, an important determinant of positive behavioral change, are often conceptualized as an additive or multiplicative index of two concepts: susceptibility to and severity of a health risk. Susceptibility is the possibility of experiencing a health risk, whereas severity is itsseriousness or harmfulness. This article challenged the current theorization of risk perceptions. To demonstrate the differential perceptions of susceptibility and severity, two self-report studies (N = 70, each) and one reaction time study (N = 476) provided data on 50 health conditions that varied on several risk characteristics (e.g., prevalence, personal experience). Results showed that susceptibility and severity were two distinct, inversely related concepts. Perceived susceptibility and severity varied by risk characteristics, mainly prevalence (i.e., how common a health risk was perceived to be). Self-report data showed that a progressive increase in perceptions of a health risk prevalence rates was associated with an increase in susceptibility and a decrease in severity (and vice versa). Reaction-time data mirrored this pattern and showed these differential perceptions of susceptibility and severity were highly accessible, as evident by fast reaction times. Several individual differences (e.g., optimism) emerged as significant predictors of risk perceptions and their accessibility. Theoretical and practical implications are discussed.

JMIR Res Protoc. 2015 Mar 25;4(1):e35.

Working With Parents to Prevent Childhood Obesity: Protocol for a Primary Care-Based eHealth Study.

Avis JL1, Cave AL, Donaldson S, Ellendt C, Holt NL, Jelinski S, Martz P, Maximova K, Padwal R, Wild TC, Ball GD.

Author information

• 1Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.

Abstract

BACKGROUND:

Parents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents' motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention.

OBJECTIVE:

(1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents' concern for, and motivation to, support children's healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial.

METHODS:

This is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III). Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company. Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT. Phase III: Parents (n=200) of children-boys and girls, 5 to 17 years old-will be recruited from a primary care pediatric clinic while they await their children's clinical appointment. Parents will be randomly assigned to one of five groups-four intervention groups and one control group-as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children's dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome).

RESULTS:

This research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016.

CONCLUSIONS:

The proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children's healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or "nudge" individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings.