Publications by authors named "R Y Declan Fleming"

1,043 Publications

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A Mixed-Methods Examination of Referral Processes to Clinic-Community Partnership Programs for the Treatment of Childhood Obesity.

Child Obes 2021 Jul 5. Epub 2021 Jul 5.

Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.

Partnerships with community programs have been used to improve access to obesity care and address clinical barriers to childhood obesity management; however, little is known about the program referral process. The objective of this study was to identify factors that affect the referral from clinics to community-based programs. Active Recreation through Community-Healthcare Engagement Study (ARCHES) is a mixed-method, implementation study designed to test the feasibility of establishing clinic-community partnerships to treat childhood obesity. We collected clinical referral and program attendance data from the six ARCHES clinic-community partnerships and conducted semistructured interviews ( = 19) with key stakeholders. Logistic regression models were used to identify referral characteristics associated with ever attending a community program. We used deductive thematic analysis to examine contextual factors affecting the clinical referral and subsequent attendance at the community programs. Patients referred from individual providers [odds ratio (OR): 3.20, 95% confidence interval (CI): 1.08-9.48], specialty clinics (OR: 2.73, 95% CI: 1.48-5.05), and community wellness clinics (OR: 3.42, 95% CI: 1.05-11.13), had greater odds of ever attending the programs compared with patients from primary care clinics. Patients referred to cohort-based programs compared with open enrollment programs had greater odds of ever attending the programs. Stakeholders emphasized the value of communication within the partnership and with patients in clinical settings. Effective provider communication with patients involved engaging and program endorsing conversations to explain the value of the program. We identified factors that may improve the referral process in clinic-community partnerships to provide resources to primary care providers looking to address childhood obesity. Clinical Trial Registration number: NCT03246763.
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http://dx.doi.org/10.1089/chi.2020.0361DOI Listing
July 2021

Comparative analysis of the morphology, chemistry and structure of the tibiotarsus, humerus and keel bones in laying hens.

Br Poult Sci 2021 Jul 12:1-9. Epub 2021 Jul 12.

The Roslin Institute, University of Edinburgh, Edinburgh, Scotland.

1. Bone properties are adapted to their specific functions in the animal, so various types of bones develop different characteristics depending on their location in the skeleton.2. The aim of this research was to compare the chemical composition, mineral characteristics and structural organisation in tibiotarsus, humerus and keel bones as representatives of hen skeletal mineralisation. Complementary analytical techniques, such as X-ray radiography, optical and electron microscopy, thermogravimetry and 2D X-ray diffraction, were used for characterisation.3. The humerus had a thinner cortex and cortical bone mineral had higher crystallinity and a greater degree of crystal orientation than the tibiotarsus. The humerus generally lacks medullary bone although, when present, it has a higher mineral content than seen in the tibiotarsus. These differences were attributed to the different forces that stimulate bone formation and remodelling.4. The keel cortical bone had a lower degree of mineralisation than the tibiotarsus or humerus. Its degree of mineralisation decreased from the cranial to the distal end of the bone. This gradient may affect keel mechanical properties, making it more prone to deformation and fractures.5. Data from studying different bones in laying hens can help to understand mineralisation as well as finding solutions to prevent osteoporosis-related fractures.
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http://dx.doi.org/10.1080/00071668.2021.1943310DOI Listing
July 2021

Prehabilitation program composed of blood flow restriction training and sports nutrition improves physical functions in abdominal cancer patients awaiting surgery.

Eur J Surg Oncol 2021 Jun 1. Epub 2021 Jun 1.

Department of Kinesiology and Health Education, USA. Electronic address:

Introduction: The impact of prehabilitation remains controversial due to a short presurgical waiting period and the diminished capacity of the patient population. A strategy to augment and optimize the effectiveness of prehabilitations for abdominal cancer patients may be found in the unlikely field of sport science. We investigated the use of blood flow restriction training and sport nutrition supplementation to augment functional capacity and increase muscle strength in twenty-four abdominal cancer patients awaiting surgery.

Materials And Methods: The sport science-based program was comprised of blood flow restriction exercise 5 to 6 times per week and a daily sports nutrition supplement containing l-citrulline, creatine monohydrate, and whey protein.

Results: After 4 weeks of prehabilitation, 6-min walk test, timed up and go, short physical performance battery, 5-chair stand test and physical component score of quality of life were significantly improved (all p < 0.05). Total body and appendicular lean mass as assessed by dual energy X-ray absorptiometry increased by 0.73 ± 1.04 kg (p = 0.004) and 0.42 ± 0.64 kg (p = 0.006), respectively. Total body fat mass and trunk fat mass decreased (p = 0.004 and p = 0.021). There were no significant changes in hand grip strength, fear of falling, the mental component summary of quality of life, or fasting serum concentrations of myostatin, follistatin, and growth hormone.

Conclusion: A multimodal prehabilitation program, which encompasses blood flow restriction training and sports nutrition supplements, is both feasible and effective in improving lean mass and physical function in abdominal cancer patients prior to surgery.
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http://dx.doi.org/10.1016/j.ejso.2021.05.038DOI Listing
June 2021

A family-based weight loss randomized controlled trial for youth with intellectual disabilities.

Pediatr Obes 2021 Jun 1:e12816. Epub 2021 Jun 1.

Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA.

Background: Scant data exist on weight loss interventions for youth with intellectual disabilities (ID).

Objective: To compare weight loss among youth with ID randomized to a 6-month, family-based behavioural intervention (FBBI) or a waitlist and to compare weight loss among youth who completed a 6-month maintenance (FBBI-M) intervention to a control group (FBBI-C).

Methods: Youth with ID and overweight/obesity, aged 14-22 years, were randomized to the FBBI or to a waitlist and subsequently randomized to a maintenance intervention or a control group. Sessions were held weekly during the FBBI and biweekly during the FBBI-M. Using an intention-to-treat approach, we used linear mixed models to test differences in the change in weight and in BMI from the start of FBBI.

Results: The 24 participants who received the FBBI lost, on average (SE), 5.1 (1.1) kg (P < .001) over 6 months. The 13 participants who were waitlisted gained, on average (SE), 1.2 (1.6) kg over the 6-month waiting period. At 12 months, those who received FBBI-M lost, on average (SE), 4.4 (1.7) kg more than those who received FBBI-C (-7.6 vs -3.2 kg, P-value = .008).

Conclusion: Participation in an intensive FBBI for weight loss with ID was efficacious, and continued participation in a maintenance intervention yielded additional weight loss.
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http://dx.doi.org/10.1111/ijpo.12816DOI Listing
June 2021

An image-computable model of human visual shape similarity.

PLoS Comput Biol 2021 Jun 1;17(6):e1008981. Epub 2021 Jun 1.

Department of Experimental Psychology, Justus-Liebig University Giessen, Giessen, Germany.

Shape is a defining feature of objects, and human observers can effortlessly compare shapes to determine how similar they are. Yet, to date, no image-computable model can predict how visually similar or different shapes appear. Such a model would be an invaluable tool for neuroscientists and could provide insights into computations underlying human shape perception. To address this need, we developed a model ('ShapeComp'), based on over 100 shape features (e.g., area, compactness, Fourier descriptors). When trained to capture the variance in a database of >25,000 animal silhouettes, ShapeComp accurately predicts human shape similarity judgments between pairs of shapes without fitting any parameters to human data. To test the model, we created carefully selected arrays of complex novel shapes using a Generative Adversarial Network trained on the animal silhouettes, which we presented to observers in a wide range of tasks. Our findings show that incorporating multiple ShapeComp dimensions facilitates the prediction of human shape similarity across a small number of shapes, and also captures much of the variance in the multiple arrangements of many shapes. ShapeComp outperforms both conventional pixel-based metrics and state-of-the-art convolutional neural networks, and can also be used to generate perceptually uniform stimulus sets, making it a powerful tool for investigating shape and object representations in the human brain.
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http://dx.doi.org/10.1371/journal.pcbi.1008981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8195351PMC
June 2021
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