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The implementation of a smart water network (SWN) is viewed as a strategic approach to address many challenges faced by water utilities, such as pipe leak detection and main break prevention. This paper develops a convolutional neural network (CNN)–based model to classify acoustic wave files collected by the South Australian Water Corporation’s (SA Water’s) SWN over the city of Adelaide. The VGGish model (VGG refers to the team who developed the model—Visual Geometry Group) is selected as a suitable transfer learning model to extract features from wave files. The CNN model classifies an acoustic wave file as an anomaly or other background or environmental noise. Identification of a wave file as an anomaly triggers a Siamese CNN model to determine whether it is related to a regular/irregular scheduled event (for example, irrigation system near public parks or water consumption by large buildings). A field investigation is initiated if a wave file is classified as an anomaly and it is not related to a scheduled event. The developed models have been validated using data that is recorded by SWN in Adelaide. This validation data set comprises 1098 wave files, which are recorded by 34 accelerometers and are associated with 32 known leaks. The validation results shown that accuracy of alarms generated by the developed models is 92.44%. The validations confirm the developed models as an effective tool for water pipeline leak and crack detection, which, in turn, enables proactive management of the pipeline assets.

Machine learning is a rapidly evolving field that offers physicians an innovative and comprehensive mechanism to examine various aspects of patient data. Cervical and lumbar degenerative spine disorders are commonly age-related disease processes that can utilize machine learning to improve patient outcomes with careful patient selection and intervention. The aim of this study is to examine the current applications of machine learning in cervical and lumbar degenerative spine disease. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of PubMed, Embase, Medline, and Cochrane was conducted through May 31st, 2020, using the following terms: “artificial intelligence” OR “machine learning” AND “neurosurgery” AND “spine.” Studies were included if original research on machine learning was utilized in patient care for degenerative spine disease, including radiographic machine learning applications. Studies focusing on robotic applications in neurosurgery, navigation, or stereotactic radiosurgery were excluded. The literature search identified 296 papers, with 35 articles meeting inclusion criteria. There were nine studies involving cervical degenerative spine disease and 26 studies on lumbar degenerative spine disease. The majority of studies for both cervical and lumbar spines utilized machine learning for the prediction of postoperative outcomes, with 5 (55.6%) and 15 (61.5%) studies, respectively. Machine learning applications focusing on degenerative lumbar spine greatly outnumber the current volume of cervical spine studies. The current research in lumbar spine also demonstrates more advanced clinical applications of radiographic, diagnostic, and predictive machine learning models.

Background: Among adults, weight stigma is associated with markers of poor cardiometabolic health. Although weight-based teasing (WBT) is common among youth with high body weight, few studies have examined its associations with cardiometabolic markers. Owing to unique stressors (e.g., parental deployment and frequent moves), military-dependent youth may be at particularly high risk for obesity, WBT, and poor cardiometabolic health. We, therefore, assessed associations between WBT and cardiometabolic health markers among adolescent military dependents presenting for a weight gain prevention trial. Methods: Participants underwent fasting phlebotomy; had fasting weight, height, and waist circumference measured; and completed assessments of WBT, anxiety, and loss-of-control eating. Multivariate analysis of covariance, adjusting for relevant covariates including demographics and body composition, was used to examine differences in metabolic syndrome (MetS) components (waist circumference, systolic and diastolic blood pressure, high-density lipoprotein cholesterol, triglycerides, and glucose) between youth reporting WBT and youth reporting no WBT. Bootstrapped models examined whether WBT mediated the relationship between BMIz and MetS components. Results: Data from 142 youth (57.7% female; 14.4 ± 1.6 years; 51.2% non-Hispanic White, 20.9% non-Hispanic Black; BMIz: 1.9 ± 0.4) were analyzed. WBT was not significantly associated with any MetS component. Relationships were observed between BMIz and all MetS components (except systolic blood pressure and glucose), although WBT did not significantly mediate these relationships (p's > 0.05). Conclusions: This study did not find support for a relationship between WBT and MetS components in adolescent military dependents at risk for adult obesity. Prospective research is needed to determine whether associations between WBT and adverse cardiometabolic outcomes emerge primarily in adulthood.

Background and Objectives: Promotion has historically valued the scholarship of discovery over the scholarship of teaching. The clinician-educator promotion pathway is an attractive option for academic family physicians engaged in significant teaching. However, clinician-educators are less often promoted than peers on other tracks. Family medicine educators face unique challenges in promotion due to clinical requirements and often less guidance on how to meet promotion criteria. Promotion recognizes achievements of faculty and is often tied to higher base salary. We aimed to identify promotion preparation tips for academic family medicine educators. Methods: We surveyed members of the Society of Teachers of Family Medicine (STFM) Medical Student Education Collaborative electronically on promotion preparation lessons learned in (1) curriculum vitae preparation, (2) personal statement preparation, (3) selecting external reviewers, and (4) identifying measurable achievements. This qualitative study used grounded theory and constant comparison. Results: Fourteen individuals from 13 medical institutions responded with tips for success in promotion preparation. The tips identified actionable steps for promotion preparation of academic family medicine educators. Several main themes emerged, including the importance of timely and thorough documentation, detailed planning, and being knowledgeable about institutional-specific criteria early. Conclusions: The tips provided in this study support family medicine educators in preparing for promotion and can be used as a tool for mentors, chairs and faculty development.

Managing pipe breaks in water supply networks has been a challenge for water utilities around the world. In order to transform from reactive to proactive management of pipe breaks, South Australia ...

Strategic pipeline asset management requires accurate and up-to-date information on pipeline condition. As a tool for pipeline condition assessment, inverse transient analysis (ITA - a pipeline model calibration approach) is typically formulated as a deterministic problem, and optimization methods are used for searching a single best solution. The uncertainty associated with the single best solution is rarely assessed. In this paper, the pipeline model calibration problem is formulated as a Bayesian inverse problem, and a Markov Chain Monte Carlo (MCMC) based method is used to construct the estimated posterior probability density function (PDF) of the calibration parameters. The MCMC based method is able to achieve parameter estimation and uncertainty assessment in a single run, which is confirmed by numerical experiments. The proposed technique is also validated using measured hydraulic transient response data from an experimental laboratory pipeline system. Two thinner-walled pipe sections (simulating extended deterioration) are successfully identified with an assessment of the parameter uncertainty. The results also suggest that proper sensor placement can reduce parameter uncertainty and significantly enhance system identifiability.

Smart water networks, created using Internet of Things (IoT) technologies, have been increasingly adopted by water utilities across the world. This research focuses on the use of smart water technologies for detecting newly formed through-wall pipe cracks and leaks in water distribution systems for the purpose of pipe break early warning and prevention. This research develops easy-to-implement algorithms for analysing the hydro-acoustic vibration wave files regularly collected by permanently installed accelerometers in a water network, and for generating alarms when small leaks from developing pipe cracks are detected. Descriptive features of the historical wave files are investigated for five sites where newly-formed pipe cracks were detected nearby. It is found that the median frequency (MF) and the root-mean-square (RMS) values derived from the wave files are useful indicators for detecting new cracks and leaks. The confidence of pipe crack detection in noisy city environments can be significantly increased by windowing each already short-duration wave file into a number of frames with even shorter durations, and analysing the behaviour of the MF and RMS values of all the frames to look for the persistence of the leak feature even when part of the signal is contaminated with interference. The results show that the developed technique can robustly detect new through-wall cracks and leaks in a timely manner, and is tolerant of interference from customer water use and transient environmental noise.

Background and Objectives: Professional identity formation (PIF) is increasingly recognized as a core element of medical education. The use of narrative reflection is traditionally the most common means to explore PIF. We explored the use of mask-making as a process of reflective expression to encourage iterative exploration of professional identity in medical students. This project focused on elements of personal and professional identity in a cohort of entering students. Methods: One hundred fifty entering students at the Pennsylvania State University College of Medicine created a mask to use descriptive words to express their perceptions of an ideal physician (external face of the mask) and their sense of self (internal face of the mask). Responses were compared to established domains of professional identity. Results: Students most commonly listed elements in the domain of personal characteristics to describe both their sense of self and of an ideal physician. Students were more likely to list emotional elements when describing self and more likely to use elements in the domains of relationships, attitudes, and duties/responsibilities when describing an ideal physician. Conclusions: The beginning of medical school is a time of significant transition. Mask making can blend visual and narrative arts to provide a complementary tool to examine professional identity formation.

Introduction: Professional identity formation is the complex and iterative process by which medical students learn to think, act, and feel like physicians. Methods: Using mask making, we iteratively explored changes in student perceptions of their identity across time during medical school. Results: Themes of impostorism, uncertainty, and identity progression/integration were identified. Conclusion: Mask making represents a unique method to examine fundamental themes in identity formation for medical students.

The patient is a 15-year-old male who sustained injury to his right lower brachial plexus (C8–T1) in a motor vehicle accident. Six months after the injury, the patient still had persistent hand weakness and wished to regain function in his first and second digits. Transfer of the extensor carpi radialis brevis (ECRB) branch of the radial nerve to the anterior interosseous nerve (AIN) was performed to restore motor function. The patient did well after the surgery, although it may take 12–24 months for benefits to fully manifest. Pertinent surgical anatomy and techniques are highlighted in this video demonstration. The video can be found here: https://stream.cadmore.media/rr10.3171/2022.10.FOCVID2287

The performance of a compressor stator airfoil with end-wall injection was studied experimentally and computationally. The geometry was a high-speed, subsonic, linear cascade. The independent variables studied were airfoil incidence angle and mass flow rate of end-wall injection upstream of the stator. The end-wall injection was intended to simulate upstream “leakage” through hardware gaps in the end-walls of gas-turbine engines. The exit of the cascade was interrogated experimentally by a five-hole-probe and a total pressure Kiel probe to provide total pressure measurements, which were used to calculate total pressure loss coefficients at the exit of the test section. Computational studies were completed to examine the end-wall flow physics and entropy generating mechanisms through the stator section. The experimental results showed a distinct decrease in the downstream total pressure field with end-wall injection flow, and the impact of the upstream injection on the stator loss coefficient was not a function of the incidence angle. The computational investigation found that the majority of the end-wall injection’s effect on the downstream total pressure field was observed as an increase in the size of the secondary flows on the suction-side of the stator near the upper end-wall.

Objective Parental military deployment can lead to stress in the family system due to concerns about the deployed service-member's safety and increased responsibilities for those not deployed. Parent-related stress can impact adolescent disordered eating. Given the important role that stress plays in disordered eating and obesity, it is crucial to understand the impacts of unique stressors to which vulnerable populations are exposed. Method We studied 126 adolescent (14.3 ± 1.6 years; 59.5% girls; 44.4% non-Hispanic White; BMI-z, 1.91 ± .39) military dependents prior to entering an obesity and binge-eating disorder prevention trial. The Eating Disorder Examination was used to assess adolescent disordered eating. Parents self-reported their own distress and family deployment history that occurred during the adolescent's lifetime. Results Parental distress interacted with frequency of parental deployments such that for those with high parental distress, more frequent deployment was associated with greater adolescent shape and weight concerns (β = .21, p = .012) and global eating pathology (β = .18, p = .024). Discussion In this hypothesis-generating study, the combination of number of deployments and parental distress may be associated with disordered eating among adolescent military dependents seeking prevention of binge-eating disorder and adult obesity. If these preliminary findings are supported longitudinally, interventions to reduce parental stress related to deployment may be warranted to reduce disordered eating in adolescent dependents.

Background and Objectives: “Forward feeding” is defined as the sharing of information regarding learner behaviors and performance outside of formal institutional committee structures. The purpose of this study was to establish baseline opinions and policies of forward feeding in family medicine residency programs. Methods: Data for this study were obtained as part of the 2015 CERA Program Directors Fall Survey. Program directors indicated whether they felt that faculty should and do engage in forward feeding. Respondents were asked to rate the importance of various types of information about learners (academic performance, clinical performance, professionalism, physical health, and mental health), reasons for promoting, and concerns regarding forward feeding on a 5-point Likert scale. Results: The overall response rate was 49% (227/461). Most agreed that faculty should (87%) and do (83%) engage in forward feeding. Concerns regarding professionalism and clinical performance were reported as most important to share. The most important reason identified for forward feeding was the early identification of struggling residents, followed by the ability to direct teaching to the resident’s specific needs, and improving the quality of feedback. Fear of creating bias was the most commonly cited concern for engaging in forward feeding, followed by fear of violating confidentiality and difficulty maintaining confidentiality. Fear of litigation was the least common concern. Conclusions: Despite concerns, the majority of program directors feel that faculty should and do engage in forward feeding. Our study confirms the importance of clinical performance and professionalism as two important themes of information shared by attendings about residents.

Stressors unique to military families may place dependents of military service members of both sexes at high-risk for disordered-eating. Yet, there are no data examining sex-related differences in eating pathology and distress among this population. Therefore, we examined disordered-eating attitudes and associated psychosocial characteristics in adolescent military dependents at high-risk for both eating disorders and adult obesity (i.e., BMI ≥ 85th percentile and elevated anxiety symptoms and/or loss-of-control eating). One-hundred-twenty-five (55.2% female) adolescent (12–17 y) military dependents were studied prior to entry in an eating disorder and obesity prevention trial. Youth were administered the Eating Disorder Examination interview to determine disordered-eating attitudes, and completed questionnaires to assess self-esteem, social functioning, and depression. Girls and boys did not differ in BMIz (p = .66) or race/ethnicity (p = .997/p = .55). Adjusting for relevant covariates, girls and boys did not differ significantly with regard to disordered-eating global scores (p = .38), self-esteem (p = .23), or social functioning (p = .19). By contrast, girls reported significantly more symptoms of depression (p = .001). Adolescent male and female dependents at high-risk for eating disorders and adult obesity reported comparable levels of eating-related and psychosocial stress. Data are needed to elucidate how adolescent military dependents respond to intervention and whether sex moderates outcome.

Perceived weight stigma is associated with adverse health indices, such as elevated cortisol, lipid/glucose dysregulation, and poorer self-rated health. This relationship may be particularly relevant for military personnel, given the cultural emphasis on fitness and weight/shape. Therefore, we investigated the relationship between weight stigma and physical health in 117 active duty personnel (66.7% male; 56.4% non-Hispanic White; age: 30.8 ± 7.4 years; BMI: 29.5 ± 2.5 kg/m2). Participants reported weight stigma (general and military-specific), weight bias internalization, and the presence (≥1; n = 55) or absence (n = 62) of medical conditions. Logistic regressions were conducted examining the ability of weight stigma (general or military-specific) and weight bias internalization to predict the presence or absence of medical conditions. General weight stigma was not significantly associated with the presence of a medical condition (p > .05). However, individuals with military-specific weight stigma scores twice that of their peers were over three times more likely (p = .04) to report a medical condition. Weight bias internalization was not significant in any model (ps > .20). Longitudinal studies should prospectively examine the relationship between weight stigma in the military setting and health among service members.

Introduction Recent focus from accrediting bodies emphasizes learning objectives as a means of mapping and standardizing content coverage. While most educational training centers on faculty-derived learning objectives that are geared towards didactic lectures, student-centered teaching modalities like problem-based learning continue to gain popularity. One opportunity is the integration of student-generated learning goals in curriculum development. The educational philosophy at the Penn State College of Medicine University Park Regional Campus centers on discussion-based Inquiry Groups that focus on students’ experiential case learning which leads to student-generated learning objectives. This study examined a student-centered approach to learning objectives. Methods Our quantitative analysis explored student-generated learning objectives during the first-year curriculum. Primary outcome measures included process variables investigating the growth and change of objectives across the year that include Bloom’s taxonomy-based verb scores, verb numbers per session, and learning objective word lengths. Knowledge-based content coverage variables were compared with existing curricular models. Results Student-derived learning objectives changed substantially over the year. Taxonomy scores decreased while the learning objective verb number, word length, and calculated value per session increased significant. Content and comparator analyses showed that coverage and verb quality met or exceeded existing curricular models. Discussion Student-generated learning objectives are not only plausible and achievable, they also provide distinct pacing and engagement benefits. Our findings serve as a model for student-centered educational innovations.

Introduction The optimal length of Family Medicine Residency is unknown. As part of the American Board of Family Medicine 4-year Length of Training (LoT) pilot project, Naval Hospital Jacksonville (NHJ) maintained a dual-track 3- and 4-year Family Medicine Residency, graduating seven 4-year residents over consecutive 4 years of the LoT program. One measure of success regarding the impact of 4-year residents on program outcomes is scholarly output during residency. Materials and Methods Cumulative scholarly activity points are tracked for all NHJ residents. Cumulative scholarly activity points, points per year per, and raw percentile USMLE/COMLEX scores from academic years 2016–17 to 2019–20 were compared between PGY3 and PGY4 graduates using one-way ANOVA to 95% confidence with post hoc Tukey honestly significant difference pairwise comparison to evaluate pairwise significance between groups where multi-group differences were found. Results During the 2016–17 through 2019–20 academic years, NHJ had 28 residents complete 3 years of training without interruption (3 Years), 11 residents complete 3 years of training interrupted by general medical officer tours (Resiterns), and 7 residents complete 4 years of training without interruption (4 Years). There were no significant differences in average raw USMLE and COMLEX scores between 3 Year (71%), Resitern (68%), and 4 Year (76%) residents (P = .335). 4-Year residents had significantly more cumulative scholarly points (103) than 3-Year residents (32.6, P Conclusions An observed benefit of a 4-year Family Medicine Residency was a marked increase in scholarly output at this program.

The HEADSS approach is one way to begin discussing key clinical and social topics and to guide further screening or intervention.

Introduction Adolescent military-dependents face unique psychosocial stressors due to their parents’ careers, suggesting they may be particularly vulnerable to excess weight gain and symptoms of depression and anxiety. Despite these risk factors, there is a lack of tested preventative interventions for these youths. Given the transient nature of military family deployments, research may be hindered due to difficulty in collecting long-term prospective outcome data, particularly measured height and weight. The primary aim of this study was to examine the feasibility and acceptability of collecting body mass index (BMI, kg/m2) outcome data up to 2 years following a randomized controlled pilot trial of an adapted interpersonal psychotherapy (IPT) program aimed at preventing excess weight gain and improving psychological functioning for adolescent military-dependents. In exploratory analyses, patterns in body composition over time were examined. Materials and Methods Twenty-seven adolescent military-dependent girls (baseline: Mage: 14.4 ± 1.6 years; MBMI: 30.7 ± 4.9 kg/m2; MBMI-z: 1.9 ± 0.4) participated in this study. After a baseline assessment, utilizing a computerized program to create a randomization string, girls were assigned to either an IPT or a health education (HE) program. Participants completed three follow-up visits (posttreatment, 1-year follow-up, and 2-year follow-up). Girls completed a Treatment Acceptability Questionnaire at posttreatment; at all time points, height and fasting weight were collected. For the primary aim, Fisher’s exact tests examined the rate of obtained follow-up data and lost to follow-up status between the two groups, Mann-Whitney U tests examined the session attendance between groups, and treatment acceptability ratings were compared between the two groups at posttreatment using an independent samples t-test. For the exploratory aim, one-way analyses of covariance (ANCOVAs) examined the group differences in BMI at each time point, adjusting for baseline values, and paired samples t-tests examined the within-group differences at each time point relative to baseline. Using imputed data in the full intent-to-treat sample, mixed model ANCOVAs were conducted to examine the group differences over time. Results Across both groups, girls attended an average of 72.0% of sessions. At least partial data were collected at posttreatment, 1-year follow-up, and 2-year follow-up for 96.3%, 85.2%, and 74.1% of the participants, respectively. There were no significant group differences in follow-up data collection rates, follow-up status, number of sessions attended, or treatment acceptability. BMI-z stabilized across groups, and there were no group differences in BMI-z. In adjusted ANCOVA models with imputed data, no significant group-by-time effects emerged. Conclusions For this randomized controlled prevention trial, long-term outcome data collection of measured BMI was possible in adolescent military-dependents and IPT was an acceptable and feasible intervention. An adequately powered trial is required to assess the efficacy of this intervention among military-dependents for obesity prevention and improvements in BMI.

Issue: Medical education traditionally focuses on basic science during the first two years of medical school. To “flip” this model, the Penn State College of Medicine has introduced and inquiry-based educational strategy that introduces students to the challenges of patient care immediately upon their arrival. To engage students in a process to promote clinical reasoning, we have modified an Analytic Decision Game (ADG) called “EpiCentre” to address a notional public health crisis facing Centre County, Pennsylvania. Methods: In phase 1 of the activity, students are provided with materials describing the ethnography and infrastructure of Centre County. Students are divided into three communities (teams) to create a strength, weakness, threat, opportunity (SWOT) analysis of local healthcare capabilities. In phase 2 of the activity, students meet with a standardized patient presenting with a targeted medical complaint. They are pushed to think about their approach to taking a medical history and asked to generate a differential diagnosis. In phases 3 and 4, students are faced with the challenge of triaging a number of patients with similar medical complaints and create a plan to deal with a likely outbreak scenario. Findings: Students have found the EpiCentre activity to be worthwhile in multiple contexts. They have been able to develop an initial approach to medical history taking and creating a differential diagnosis. They have formulated an approach to the recognition and control of a potential public health crisis. An additional benefit of the exercise has been the overarching theme of teamwork. Students begin the activity (occurring in the first few weeks after arrival to medical school) as relative strangers and quickly develop a sense of camaraderie and mission focus. Conclusions: The EpiCentre ADG has been a successful activity to introduce medical students to Centre County in the context of healthcare infrastructure, an approach to medical history taking, disaster planning, clinical reasoning and team-building. Implications: EpiCentre derives from an interprofessional collaboration between the College of Medicine and the College of Information Sciences and Technology. It represents one of potentially limitless opportunities to engage students and faculty from multiple disciplines to address challenges of public health within the academic setting.

In addition to providing medical students with the knowledge, skills, and attitudes necessary to gather and synthesize information to accurately diagnose and treat disease, medical education must also help students develop a healthy professional identity. The process of professional identity formation (PIF) is less formal and typically not part of the published curriculum. Despite the importance of PIF, it is difficult to analyze and has typically been done so through narrative means. We propose the artistic process of mask making as an alternative, where medical students visually express their perception of an ideal physician (external face of the mask) and their sense of self (internal face of the mask). Mask making allows students to use descriptions and illustrations on the inside and outside of the masks to express their sense of developing professional identity. A cohort of 148 masks from the Class of 2022 at the Penn State University College of Medicine is being analyzed to compile a list of these illustrations and descriptions. This qualitative data is being sorted according to domains modified from the original Transformation in Medical Education (TIME) initiative PIF framework. Specifically, the TIME framework was edited to include the subdomains, abilities and emotional traits, to the personal characteristic’s domain due to the frequency of qualitative data that aligned with these distinct subdomains. This modified framework has been used to create a codebook using the qualitative coding software, NVivo. After using a subsample of masks to achieve sufficient interrater reliability, we will code the sample cohort to define thematic elements consistent across ideal and self images. We plan to use this method to assess PIF longitudinally in this class of medical students. Our findings should inform opportunities for intervention to alleviate some of the obstacles medical students face as they integrate personal and professional identities.

Clinical educators are continually seeking innovative methods and settings for teaching. As such, they have increasingly begun to use art museums as a new educational space in which to build clinically-relevant skills and promote learners’ professional identity formation. Art museum-based pedagogy can be understood through the framework of transformative learning theory, which provides an account of how adults learn through experience. In this article, the authors apply this theory to art museum-based teaching and offer a practical overview of art museum-based activities, highlighting three exemplars: visual thinking strategies, personal responses tour, and group poems. This toolbox of art museum-based teaching methods provides a launching pad for educators and learners to explore this innovative educational strategy.

Introduction: Professional identity formation (PIF) is a sociocultural process through which medical students adopt the professional role of physician. This process is often unscripted and influenced by informal curricular elements. PIF is as important as the acquisition of knowledge and clinical skill in the continuum of medical education. Methods: Using the ancient art of mask making, we created a process of reflective expression to explicitly examine and formally promote PIF. Students created individual masks to express elements of self in the context of their medical education experiences. Coupled with a narrative reflection describing the mask and the process of mask making, students were challenged to examine and give shape to their evolving sense of professional identity. Using a retrospective pre/post design, we used the mask-making process to examine identity across 4 years of medical school in a cohort of graduating students. Results: The masks and accompanying narratives showed themes of moving from anxiety and uncertainty at matriculation to a more calm and focused state at the time of graduation. Other themes included the ability to organize complex material and the accumulation of a broad fund of knowledge. Students found the mask-making experience to be introspective and enjoyable. Discussion: Mask making is both a product (mask) and process (creation). As such, mask making is an innovative strategy to examine PIF within individuals and across time. Organization, focus, and self-understanding were common themes of professional growth.

Water main breaks in city areas can cause significant economic loss, interrupt traffic, and result in negative publicity for utilities. The South Australian Water Corporation (SA Water) has...

The topics of creation and new creation are central to the persuasive strategy of Revelation. Addressing itself to a context in which cosmology was often deployed to buttress Roman hegemony, Revelation constructs a “counter-cosmos” to undermine Rome’s pretentious claims to sovereignty. Within this narrative world God is worshipped because he is both the maker of all things and the one who makes all things new. Revelation’s frequent portrayals of cosmic turmoil and catastrophe function to undermine Rome’s claim to secure existence, but the ultimate hope is that creation will be renewed by means of a transference of sovereignty, where the divine reign displaces the corrupted rule of Babylon. Such hopes ultimately serve John’s wider pastoral goals, in which he is seeking for Asian Christians to foster critical distance from their surrounding culture, and so form them for prophetic witness to the nations.

Big data could help identify potential clues about the immediate (and future) impact of coronavirus disease 2019, but it is in short supply.

Background Metabolic syndrome in adolescence has been associated with adverse cardiometabolic outcomes in adulthood. Preliminary data suggest that boys may have worsened metabolic syndrome components compared to girls. Yet, little is known about the physical health of military dependents, a potentially at-risk population. Objective Examine sex differences in metabolic syndrome components in a sample of adolescent military dependents. Methods Participants were adolescents (N = 139; 14.4 ± 1.6 years; 45.3% male; 41.0% non-Hispanic White, 19.4% non-Hispanic Black; BMI-z: 1.9 ± 0.4) at-risk for adult obesity and binge-eating disorder due to an age- and sex-adjusted BMI ≥85th percentile and loss-of-control eating and/or elevated anxiety. A multivariate analysis of covariance was conducted to compare objectively measured metabolic syndrome components across boys and girls. Covariates were age, race, loss-of-control eating status, anxiety symptoms, and BMI-z. Results Metabolic syndrome components differed by sex (P = .01). Boys had higher systolic blood pressure (P = .049), lower high-density lipoprotein cholesterol (P = .01), and higher glucose (P = .001) than girls. Waist circumference, diastolic blood pressure, and triglycerides did not differ between boys and girls (P > .05). Conclusions Future research should prospectively examine these relationships into adulthood. If the current findings are supported, prevention programs should consider targeting cardiometabolic health particularly among male adolescent military dependents.

OBJECTIVE: Adolescent military-dependents may be at higher risk for psychosocial stressors and disordered-eating compared to civilian youths, but the mechanisms underlying these relationships are unclear. Interpersonal theory of disordered-eating proposes that difficult relationships lead to negative affect thereby promoting emotionally-induced eating. Given the unique stressors related to their parents’ careers, the interpersonal model may be particularly relevant to adolescent military-dependents. Therefore, this study examined the prediction of the interpersonal model (that negative emotions mediate the link between multiple aspects of social functioning and emotional-eating) among a cohort of adolescent military-dependents. METHODS: One-hundred-thirty-six military-dependents at high-risk for both adult obesity and binge-eating disorder due to reports of loss-of-control eating and/or anxiety symptoms (56% female, age=14±2y, BMIz=2.0±.4) were studied prior to participation in an excess weight-gain prevention study. Bootstrapping mediation models were conducted to examine depressive symptoms as a potential mediator of the relationship between social functioning and emotional-eating. Analyses were adjusted for age, sex, race, BMIz, the presence of reported loss-of-control eating, and anxiety. RESULTS: Depressive symptoms were a significant mediator of the relationship between multiple domains of social functioning, including general social loneliness, social adjustment related to family and friends, and attachment to father and peers, and emotional-eating (ps < .05). CONCLUSIONS: The interpersonal model of disordered-eating may be important for understanding the development of excess weight-gain and binge-eating disorder among adolescent military-dependents. Prospective data are needed to determine the utility of interpersonal theory in predicting response to intervention and outcomes.

Weight-based teasing (WBT) by family members is commonly reported among youth and is associated with eating and mood-related psychopathology. Military dependents may be particularly vulnerable to family WBT and its sequelae due to factors associated with their parents&rsquo, careers, such as weight and fitness standards and an emphasis on maintaining one&rsquo, s military appearance, however, no studies to date have examined family WBT and its associations within this population. Therefore, adolescent military dependents at-risk for adult obesity and binge-eating disorder were studied prior to entry in a weight gain prevention trial. Youth completed items from the Weight-Based Victimization Scale (to assess WBT by parents and/or siblings) and measures of psychosocial functioning, including the Beck Depression Inventory-II, The Rosenberg Self-Esteem Scale, and the Social Adjustment Scale. Eating pathology was assessed via the Eating Disorder Examination interview, and height and fasting weight were measured to calculate BMIz. Analyses of covariance, adjusting for relevant covariates including BMIz, were conducted to assess relationships between family WBT, eating pathology, and psychosocial functioning. Participants were 128 adolescent military dependents (mean age: 14.35 years old, 54% female, 42% non-Hispanic White, mean BMIz: 1.95). Nearly half the sample (47.7%) reported family WBT. Adjusting for covariates, including BMIz, family WBT was associated with greater eating pathology, poorer social functioning and self-esteem, and more depressive symptoms (ps &le, 0.02). Among military dependents with overweight and obesity, family WBT is prevalent and may be linked with eating pathology and impaired psychosocial functioning, prospective research is needed to elucidate the temporal nature of these associations.

The need for honour, meaning publicly acknowledged worth, has been a feature of social life across the ages. From the ancient world of Greece and Rome, through to the honour codes of contemporary celebrity culture, the quest for honour is often framed in agonistic terms, in that honour is a limited good that demands competitive behaviour. This article examines the way early Christianity responded to ancient honour codes, with a view to its potential relevance in contemporary culture. It demonstrates the way early Christianity retained something of the language of honour in its ecclesial communities, but redefined honour in light of its conception of grace.

OBJECTIVE Interpersonal psychotherapy (IPT) prevents weight gain in adults with obesity and binge-eating-disorder, and is especially effective among those with increased psychosocial problems. However, IPT was not superior to health education (HE) to prevent excess weight gain at 1-year follow-up in 113 adolescent girls at high-risk for excess weight gain because of loss-of-control eating and high body mass index (BMI; kg/m2; Tanofsky-Kraff et al., 2014). METHOD Participants from the original trial were recontacted 3 years later for assessment. At baseline, adolescent- and parent-reported social-adjustment problems and trait anxiety were evaluated. At baseline and follow-ups, BMIz and adiposity by dual-energy x-ray absorptiometry were obtained. RESULTS Nearly 60% were reassessed at 3 years, with no group differences in participation (ps ≥ .70). Consistent with 1 year, there was no main effect of group on change in BMIz/adiposity (ps ≥ .18). In exploratory analyses, baseline social-adjustment problems and trait-anxiety moderated outcome (ps < .01). Among girls with high self-reported baseline social-adjustment problems or anxiety, IPT, compared to HE, was associated with the steepest declines in BMIz (p < .001). For adiposity, girls with high or low anxiety in HE and girls with low anxiety in IPT experienced gains (ps ≤ .03), while girls in IPT with high anxiety stabilized. Parent-reports yielded complementary findings. CONCLUSION In obesity-prone adolescent girls, IPT was not superior to HE in preventing excess weight gain at 3 years. Consistent with theory, exploratory analyses suggested that IPT was associated with improvements in BMIz over 3 years among youth with high social-adjustment problems or trait anxiety. Future studies should test the efficacy of IPT for obesity prevention among at-risk girls with social-adjustment problems and/or anxiety. (PsycINFO Database Record