1 00:00:05,240 --> 00:00:07,400 >>THANK YOU FOR ATTENDING THE 2 00:00:07,400 --> 00:00:12,200 THIRD OF FOUR MEETINGS FOR THE 3 00:00:12,200 --> 00:00:18,280 BIOMARKERS OF NUTRITION FOR 4 00:00:18,280 --> 00:00:19,040 DEVELOPMENT INDICATING DIETARY 5 00:00:19,040 --> 00:00:21,240 SUFFICIENCY, BOND-KIDS PROJECT. 6 00:00:21,240 --> 00:00:25,400 I'M STILL DREW BREMER. 7 00:00:25,400 --> 00:00:29,760 ON BEHALF OF THE EUNICE KENNEDY 8 00:00:29,760 --> 00:00:32,840 SHRIVER I'D LIKE TO EXTEND A 9 00:00:32,840 --> 00:00:34,120 WELCOME TO THOSE WHO HELPED 10 00:00:34,120 --> 00:00:35,720 SHAPE THE MEETING SERIES AND 11 00:00:35,720 --> 00:00:37,720 AGENDA AND ALL THE WORKING GROUP 12 00:00:37,720 --> 00:00:39,560 CHAIRS AND WORKING GROUP 13 00:00:39,560 --> 00:00:39,800 MEMBERS. 14 00:00:39,800 --> 00:00:41,160 EVERYONE HAS PUT IN COUNTLESS 15 00:00:41,160 --> 00:00:43,800 HOURS OF TIME ON THIS PROJECT 16 00:00:43,800 --> 00:00:46,720 WHICH WE'RE SO APPRECIATIVE FOR. 17 00:00:46,720 --> 00:00:48,000 ALL WHILE CONTINUING YOUR DAY 18 00:00:48,000 --> 00:00:51,160 JOBS AMIDST CHALLENGES OF THE 19 00:00:51,160 --> 00:00:51,400 PANDEMIC. 20 00:00:51,400 --> 00:00:55,120 SECOND, I'D LIKE TO THANK NICHD 21 00:00:55,120 --> 00:01:06,280 COLLEAGUES AND RECOGNIZE DR. 22 00:01:06,280 --> 00:01:08,800 DANIEL REITAN AND ALLISON FOR 23 00:01:08,800 --> 00:01:10,120 THEIR AMAZING SUPPORT AND INPUT. 24 00:01:10,120 --> 00:01:12,640 WITHOUT THEM THIS WOULD NOT BE 25 00:01:12,640 --> 00:01:13,280 HAPPENING. 26 00:01:13,280 --> 00:01:15,400 I'D LIKE TO THANK JENNY WILSON 27 00:01:15,400 --> 00:01:18,080 FOR HELPING US STAY ORGANIZED, 28 00:01:18,080 --> 00:01:20,640 NOT AN EASY FEAT AND THANK OUR 29 00:01:20,640 --> 00:01:22,000 CONTRACT, TECHNICAL AND AV TEAMS 30 00:01:22,000 --> 00:01:23,000 FOR WORKING WITH US BEHIND THE 31 00:01:23,000 --> 00:01:25,400 SCENES TO MAKE THESE DISCUSSIONS 32 00:01:25,400 --> 00:01:26,560 AVAILABLE TO THE PUBLIC. 33 00:01:26,560 --> 00:01:28,760 AS I SAID IN THE PAST TWO WEEKS, 34 00:01:28,760 --> 00:01:30,720 THESE SERIES OF WORKING MEETINGS 35 00:01:30,720 --> 00:01:33,360 ARE THE CULMINATIONS OF HOURS OF 36 00:01:33,360 --> 00:01:34,280 PREPARATION AND DISCUSSIONS, AND 37 00:01:34,280 --> 00:01:36,080 AS DAN WILL EXPLAIN IN A MOMENT 38 00:01:36,080 --> 00:01:37,960 ARE MEANT TO TAKE A DEEP DIVE 39 00:01:37,960 --> 00:01:40,440 INTO EXAMINING THE ISSUES OF 40 00:01:40,440 --> 00:01:42,040 NUTRITIONAL NEEDS AND ASSESSMENT 41 00:01:42,040 --> 00:01:43,280 OF SCHOOL AGE CHILDREN. 42 00:01:43,280 --> 00:01:45,160 THE TWO MEETINGS HAVE BEEN A 43 00:01:45,160 --> 00:01:45,880 SUCCESSI EXPECT ANOTHER 44 00:01:45,880 --> 00:01:48,520 FANTASTIC DAY TODAY. 45 00:01:48,520 --> 00:01:50,880 AGAIN, IT'S AN INCREDIBLE HONOR 46 00:01:50,880 --> 00:02:00,720 TO LAUNCH THESE MEETINGS AND 47 00:02:00,720 --> 00:02:02,080 WELCOME EVERYONE TO THIS. 48 00:02:02,080 --> 00:02:04,160 NOW IT'S MY HONOR TO PASS THE 49 00:02:04,160 --> 00:02:05,080 TORCH TO DAN RAITEN. 50 00:02:05,080 --> 00:02:07,200 >> FOR THOSE THAT ARE JOINING US 51 00:02:07,200 --> 00:02:08,080 AGAIN, WELCOME BACK. 52 00:02:08,080 --> 00:02:13,720 THOSE THAT ARE NEW TO THIS, I'LL 53 00:02:13,720 --> 00:02:15,560 GIVE A BRIEF OVERVIEW OF WHAT 54 00:02:15,560 --> 00:02:17,480 WE'RE TRYING TO ACCOMPLISH WITH 55 00:02:17,480 --> 00:02:20,120 BOND-KIDS, AN EFFORT STARTED 56 00:02:20,120 --> 00:02:22,240 WITH ENGAGEMENT OF SEVERAL 57 00:02:22,240 --> 00:02:25,360 MEMBERS OF THE GLOBAL U.S. AND 58 00:02:25,360 --> 00:02:26,360 INTERNATIONAL COMMUNITY INVOLVED 59 00:02:26,360 --> 00:02:28,280 IN EFFORTS TO PROVIDE 60 00:02:28,280 --> 00:02:28,960 NUTRITIONAL SUPPORT TO 61 00:02:28,960 --> 00:02:29,840 SCHOOL-AGE CHILDREN. 62 00:02:29,840 --> 00:02:31,640 I'M GOING TO BRIEFLY GO THROUGH 63 00:02:31,640 --> 00:02:34,920 THE PROJECT, GOALS AND 64 00:02:34,920 --> 00:02:36,320 OBJECTIVES, STARTING WITH THE 65 00:02:36,320 --> 00:02:38,280 EXPLANATION OF THE TITLE. 66 00:02:38,280 --> 00:02:39,600 SO NEXT SLIDE. 67 00:02:39,600 --> 00:02:43,440 SO, THIS JUST REPRESENTS OUR 68 00:02:43,440 --> 00:02:46,840 GENERAL APPROACH AT NICHD UNDER 69 00:02:46,840 --> 00:02:48,400 DREW'S LEADERSHIP AT THE 70 00:02:48,400 --> 00:02:49,920 PEDIATRIC GROWTH AND NUTRITION 71 00:02:49,920 --> 00:02:51,720 BRANCH, RECOGNIZING OUR JOB IS 72 00:02:51,720 --> 00:02:54,640 TO DEVELOP EVIDENCE AND CONTINUE 73 00:02:54,640 --> 00:02:56,520 AN EVIDENCE-BASED PROGRAM AND 74 00:02:56,520 --> 00:02:59,320 POLICIES WE'RE RESPONSIBLE FOR 75 00:02:59,320 --> 00:03:00,560 SUPPORTING EVIDENCE GENERATORS 76 00:03:00,560 --> 00:03:03,840 THROUGH OUR EFFORTS TO INITIATE 77 00:03:03,840 --> 00:03:04,720 OPPORTUNITIES FOR CONSTITUENT 78 00:03:04,720 --> 00:03:07,600 GROUPS TO DO RESEARCH. 79 00:03:07,600 --> 00:03:08,880 WE ALSO RECOGNIZE THAT RESEARCH 80 00:03:08,880 --> 00:03:11,120 NEEDS TO BE TRANSLATED AND 81 00:03:11,120 --> 00:03:13,640 IMPLEMENTED AND SO WE TRY TO 82 00:03:13,640 --> 00:03:15,080 BUILD A BALANCE IN ALL OF THE 83 00:03:15,080 --> 00:03:18,960 EFFORTS THAT WE DO IN ORDER TO 84 00:03:18,960 --> 00:03:21,520 SUPPORT OUR EFFORTS TO IMPROVE 85 00:03:21,520 --> 00:03:25,200 THE HEALTH AND WELFARE OF 86 00:03:25,200 --> 00:03:28,200 PARENTS AND CHILDREN. 87 00:03:28,200 --> 00:03:32,320 NEXT SLIDE PLEASE. 88 00:03:32,320 --> 00:03:33,640 OUR ASPIRATIONS ARE TO SUPPORT 89 00:03:33,640 --> 00:03:37,480 SUPPORT TO THOSE AGENCIES AND 90 00:03:37,480 --> 00:03:38,120 ORGANIZATIONS DEVELOPING, 91 00:03:38,120 --> 00:03:39,200 IMPLEMENTING, EVALUATING 92 00:03:39,200 --> 00:03:41,760 PROGRAMS TO PROVIDE NUTRITIONAL 93 00:03:41,760 --> 00:03:42,520 SUPPORT TO SCHOOL-AGE CHILDREN, 94 00:03:42,520 --> 00:03:44,280 HOPING TO DO THAT THROUGH 95 00:03:44,280 --> 00:03:46,240 ENGAGEMENT OF THE FULL BREADTH 96 00:03:46,240 --> 00:03:48,520 OF THE CONTINUUM OF PLAYERS 97 00:03:48,520 --> 00:03:50,680 INVOLVED IN THAT ENTERPRISE, 98 00:03:50,680 --> 00:03:55,400 WHETHER BENCH SCIENTIST, 99 00:03:55,400 --> 00:03:57,920 CLINICAL RESEARCHERS, PROGRAM 100 00:03:57,920 --> 00:03:59,760 DEVELOPERS, THOSE THAT DEVELOP 101 00:03:59,760 --> 00:04:01,600 PROGRAM, SURVEILLANCE, ET 102 00:04:01,600 --> 00:04:02,520 CETERA. 103 00:04:02,520 --> 00:04:05,720 THE BOND PROJECT IS GOING TO TRY 104 00:04:05,720 --> 00:04:08,560 AND DEVELOP AN EVIDENCE BASE AND 105 00:04:08,560 --> 00:04:09,320 ALSO IDENTIFY WHERE RESEARCH 106 00:04:09,320 --> 00:04:11,720 GAPS ARE TO SUPPORT OUR EFFORTS 107 00:04:11,720 --> 00:04:13,920 TO EVALUATE THE IMPACT OF THESE 108 00:04:13,920 --> 00:04:25,120 PROGRAMS ON CHILD HEALTH AND 109 00:04:25,120 --> 00:04:25,640 DEVELOPMENT. 110 00:04:25,640 --> 00:04:27,600 WE'RE NOT MAKING RECOMMENDATIONS 111 00:04:27,600 --> 00:04:29,240 OR GUIDELINES BUT ARE HERE TO 112 00:04:29,240 --> 00:04:31,280 SUPPORT AGENCIES THAT DO AS WELL 113 00:04:31,280 --> 00:04:32,000 AS CONSTITUENT GROUPS 114 00:04:32,000 --> 00:04:33,280 RESPONSIBLE FOR DEVELOPING THE 115 00:04:33,280 --> 00:04:35,840 EVIDENCE BASE AND DOING THE 116 00:04:35,840 --> 00:04:36,520 RESEARCH. 117 00:04:36,520 --> 00:04:36,800 NEXT SLIDE. 118 00:04:36,800 --> 00:04:39,320 SO, THE TITLE HAS TWO PARTS, ONE 119 00:04:39,320 --> 00:04:43,520 IS THE BOND PIECE, JUST BRIEFLY 120 00:04:43,520 --> 00:04:46,160 THE BOND PROJECT STARTED IN 2010 121 00:04:46,160 --> 00:04:49,680 AS A COLLABORATION WITH THE BILL 122 00:04:49,680 --> 00:04:50,480 AND MELINDA GATES FOUNDATION, 123 00:04:50,480 --> 00:04:52,720 SEVERAL ENTITIES HERE AT NIH, 124 00:04:52,720 --> 00:04:57,920 BOTH OFFICE OF DIETARY 125 00:04:57,920 --> 00:04:59,520 SUPPLEMENT AND OFFICE OF 126 00:04:59,520 --> 00:05:00,120 NUTRITION RESEARCH. 127 00:05:00,120 --> 00:05:03,720 THE INTENT OF THE BOND PROJECT 128 00:05:03,720 --> 00:05:08,320 IS TO PROVIDE SUPPORT TO THE 129 00:05:08,320 --> 00:05:12,880 GLOBAL NUTRITIONAL ENTERPRISE IN 130 00:05:12,880 --> 00:05:14,640 TERMS OF ASSESSMENT, WHAT DOES 131 00:05:14,640 --> 00:05:21,080 NUTRITIONAL STATUS MEAN, AND 132 00:05:21,080 --> 00:05:24,400 HOPEFULLY HARMONIZE THOSE 133 00:05:24,400 --> 00:05:26,240 EFFORTS AND ASSESSING 134 00:05:26,240 --> 00:05:26,520 METHODOLOGY. 135 00:05:26,520 --> 00:05:29,480 THE ENTERPRISE INCLUDES A NUMBER 136 00:05:29,480 --> 00:05:31,600 OF USER GROUPS, WHETHER BENCH 137 00:05:31,600 --> 00:05:34,640 SCIENTISTS OR CLINICIANS OR 138 00:05:34,640 --> 00:05:35,320 CLINICAL RESEARCHERS, DOING 139 00:05:35,320 --> 00:05:36,440 PROGRAM DEVELOPMENT AND 140 00:05:36,440 --> 00:05:37,480 SURVEILLANCE AND INTERVENTIONS. 141 00:05:37,480 --> 00:05:39,840 AND THOSE PEOPLE THAT ARE MAKING 142 00:05:39,840 --> 00:05:43,280 POLICY AND SORT OF USING THE 143 00:05:43,280 --> 00:05:47,560 DATA THAT WE DEVELOP TO INFORM 144 00:05:47,560 --> 00:05:49,680 DECISIONS. 145 00:05:49,680 --> 00:05:50,600 NEXT SLIDE. 146 00:05:50,600 --> 00:05:51,520 NEXT AGAIN. 147 00:05:51,520 --> 00:05:54,600 SO, THE SECOND PART OF IT IS THE 148 00:05:54,600 --> 00:06:00,240 KIDS PART, ACRONYM, AND WE 149 00:06:00,240 --> 00:06:05,160 WANTED TO BE CLEAR THAT 150 00:06:05,160 --> 00:06:06,160 INFORMATION INDICATING DIETARY 151 00:06:06,160 --> 00:06:08,000 SUFFICIENCY IS DETERMINING MORE 152 00:06:08,000 --> 00:06:09,120 THAN WHAT PEOPLE ARE EATING. 153 00:06:09,120 --> 00:06:10,960 THERE'S AN ECOLOGY THAT NEEDS TO 154 00:06:10,960 --> 00:06:14,040 BE CONSIDERED AND BY ECOLOGY WE 155 00:06:14,040 --> 00:06:16,360 REFER TO THE INTERACTION OF 156 00:06:16,360 --> 00:06:17,760 COMPLEX BIOLOGICAL SYSTEM, IN 157 00:06:17,760 --> 00:06:21,720 THIS CASE THE CHILD, WITH THEIR 158 00:06:21,720 --> 00:06:23,240 INTERNAL BIOLOGY, NUTRITION, 159 00:06:23,240 --> 00:06:24,920 GENETICS, HEALTH CONTEXT, AND 160 00:06:24,920 --> 00:06:28,360 EXTERNAL ENVIRONMENT. 161 00:06:28,360 --> 00:06:29,720 THOSE FACTORS IN THE ENVIRONMENT 162 00:06:29,720 --> 00:06:33,640 THAT SHOW OF THE CHILD LIVES IN, 163 00:06:33,640 --> 00:06:36,840 WHETHER THE HOME, COMMUNITY, 164 00:06:36,840 --> 00:06:41,480 SCHOOLS, A BROADER LEVEL. 165 00:06:41,480 --> 00:06:41,760 NEXT SLIDE. 166 00:06:41,760 --> 00:06:43,920 SO, THIS IS A CARTOON THAT 167 00:06:43,920 --> 00:06:48,840 REPRESENTS OUR VIEW, HOLISTIC 168 00:06:48,840 --> 00:06:50,560 VIEW OF THE ENVIRONMENT, 169 00:06:50,560 --> 00:06:52,480 INCLUDES THE HOME AND COMMUNITY 170 00:06:52,480 --> 00:06:54,640 ENVIRONMENT, HEALTH CONTEXT, ET 171 00:06:54,640 --> 00:06:55,920 CETERA, ALL THESE THINGS 172 00:06:55,920 --> 00:06:56,800 CONSTITUTE THE ENVIRONMENT OF 173 00:06:56,800 --> 00:06:57,760 THE CHILD. 174 00:06:57,760 --> 00:06:58,480 NEXT SLIDE. 175 00:06:58,480 --> 00:07:00,240 A CRITICAL PART OF THAT 176 00:07:00,240 --> 00:07:02,320 ENVIRONMENT PARTICULARLY IN THE 177 00:07:02,320 --> 00:07:04,160 CONTEXT OF HOW WE DEFINE AND HOW 178 00:07:04,160 --> 00:07:07,920 WE TRY AND MEET THE NEEDS OF 179 00:07:07,920 --> 00:07:08,800 CHILDREN GLOBALLY IS 180 00:07:08,800 --> 00:07:10,280 UNDERSTANDING OF THE FOOD 181 00:07:10,280 --> 00:07:11,320 SYSTEM. 182 00:07:11,320 --> 00:07:12,840 THE FOOD SYSTEM OBVIOUSLY IS IN 183 00:07:12,840 --> 00:07:18,040 AND OF ITSELF ITS OWN ECOLOGY 184 00:07:18,040 --> 00:07:19,120 WITH SEVERAL FACTORS WITHIN ITS 185 00:07:19,120 --> 00:07:21,360 ENVIRONMENT THAT NEED TO BE 186 00:07:21,360 --> 00:07:21,680 CONSIDERED. 187 00:07:21,680 --> 00:07:23,400 AND BY FOOD SYSTEMS WE'RE 188 00:07:23,400 --> 00:07:25,080 REPRESENTING, YOU KNOW, ALL 189 00:07:25,080 --> 00:07:26,560 THINGS STARTING FROM THE 190 00:07:26,560 --> 00:07:28,560 PRODUCTION, BUT ALSO INCLUDING 191 00:07:28,560 --> 00:07:31,200 HOW CHOICES ARE MADE, FACTORS 192 00:07:31,200 --> 00:07:32,280 THAT INFLUENCE CHOICES WHAT 193 00:07:32,280 --> 00:07:34,600 FOODS PEOPLE EAT. 194 00:07:34,600 --> 00:07:35,280 NEXT SLIDE. 195 00:07:35,280 --> 00:07:39,400 WHEN YOU PUT THIS TOGETHER, THAT 196 00:07:39,400 --> 00:07:41,880 KNOWLEDGE TO INDICATE DIETARY 197 00:07:41,880 --> 00:07:43,040 SUFFICIENCY CONSTITUTES THIS 198 00:07:43,040 --> 00:07:43,520 ECOLOGY. 199 00:07:43,520 --> 00:07:46,400 AND THIS IS THE REPRESENTATION 200 00:07:46,400 --> 00:07:48,360 OF THAT CHILD NUTRITION ECOLOGY, 201 00:07:48,360 --> 00:07:49,800 ALL THOSE FACTORS WE'RE TRYING 202 00:07:49,800 --> 00:07:51,440 TO ACCOMPLISH. 203 00:07:51,440 --> 00:07:52,160 THAT BEGS THE QUESTION HOW ARE 204 00:07:52,160 --> 00:07:53,720 YOU GOING TO DESIGN SOMETHING TO 205 00:07:53,720 --> 00:07:58,160 ADDRESS ALL THESE THINGS. 206 00:07:58,160 --> 00:07:58,680 NEXT SLIDE. 207 00:07:58,680 --> 00:08:02,440 NEXT. 208 00:08:02,440 --> 00:08:05,480 SO, THE BOND-KIDS PROJECT IS 209 00:08:05,480 --> 00:08:06,520 GOING TO -- IS ATTEMPTING TO 210 00:08:06,520 --> 00:08:09,000 ADDRESS A NUMBER OF REALLY 211 00:08:09,000 --> 00:08:10,120 COMPLICATED ISSUES, WE RECOGNIZE 212 00:08:10,120 --> 00:08:12,000 THAT AND WE'RE GRATEFUL THAT THE 213 00:08:12,000 --> 00:08:14,240 TEAM HAS TAKEN THIS ON. 214 00:08:14,240 --> 00:08:17,200 OBVIOUSLY, WE'RE TALKING ABOUT A 215 00:08:17,200 --> 00:08:18,120 BROAD DEVELOPMENTAL SPECTRUM 216 00:08:18,120 --> 00:08:19,360 THAT HAS TO BE CONSIDERED. 217 00:08:19,360 --> 00:08:23,720 WE'RE TALKING ABOUT THE AGES OF 218 00:08:23,720 --> 00:08:26,080 5-19, RECOGNITION OF THE 219 00:08:26,080 --> 00:08:29,800 PREDISPOSING INFLUENCES OF THAT 220 00:08:29,800 --> 00:08:31,360 FIRST THOUSAND DAYS, THE SECOND 221 00:08:31,360 --> 00:08:33,400 7,000 DAYS IS A CRITICAL PIECE, 222 00:08:33,400 --> 00:08:34,720 THAT'S WHERE WE'RE FOCUSED ON 223 00:08:34,720 --> 00:08:35,280 HERE. 224 00:08:35,280 --> 00:08:36,760 WE NEED TO RECOGNIZE THE 225 00:08:36,760 --> 00:08:39,520 IMPORTANCE OF THE FOOD SYSTEM AS 226 00:08:39,520 --> 00:08:45,160 A DRIVER FOR NEED AND DRIVER FOR 227 00:08:45,160 --> 00:08:50,640 AMELORIATION OF NUTRITION, 228 00:08:50,640 --> 00:08:52,000 DIETARY INSUFFICIENCY. 229 00:08:52,000 --> 00:08:53,320 WE HAVE RECOGNITION OF COVID AS 230 00:08:53,320 --> 00:08:55,320 EXAMPLE OF HOW THE FOOD SYSTEM 231 00:08:55,320 --> 00:08:56,920 CAN BE IMPACTED, HAVE AN IMPACT 232 00:08:56,920 --> 00:08:59,280 ON PROGRAMS AND EFFORTS TO SERVE 233 00:08:59,280 --> 00:09:01,600 THIS POPULATION. 234 00:09:01,600 --> 00:09:02,240 NEXT SLIDE. 235 00:09:02,240 --> 00:09:05,240 SO THE GOALS OF THE BOND PROJECT 236 00:09:05,240 --> 00:09:06,840 ARE ESSENTIALLY TO USE AN 237 00:09:06,840 --> 00:09:08,800 ECOLOGICAL APPROACH TO ADDRESS 238 00:09:08,800 --> 00:09:11,200 THAT ECOLOGY OF SCHOOL AGE 239 00:09:11,200 --> 00:09:12,880 CHILD, BOTH INTERNAL AND 240 00:09:12,880 --> 00:09:14,680 EXTERNAL ECOLOGY. 241 00:09:14,680 --> 00:09:16,520 OUR INTENT IS TO DEVELOP AN 242 00:09:16,520 --> 00:09:19,480 EVIDENCE BASE, YOU HEARD FROM 243 00:09:19,480 --> 00:09:21,640 THE FIRST TWO WORKING GROUPS 244 00:09:21,640 --> 00:09:23,000 PRIOR TWO WEEKS, AND THE NEXT 245 00:09:23,000 --> 00:09:25,920 TWO WORKING GROUPS ARE GOING TO 246 00:09:25,920 --> 00:09:27,200 SORT OF INTEGRATE WHAT WE'VE 247 00:09:27,200 --> 00:09:29,440 HEARD IN THE FIRST TWO WEEKS, 248 00:09:29,440 --> 00:09:31,640 INTO SORT OF A PLAN OF ACTION 249 00:09:31,640 --> 00:09:37,160 THAT CAN BE CONSIDERED FOR 250 00:09:37,160 --> 00:09:38,120 MOVING FORWARD, COVERING PHASE 2 251 00:09:38,120 --> 00:09:40,560 OF THE PROJECT, HOPEFULLY DONE 252 00:09:40,560 --> 00:09:41,200 IN COLLABORATION WITH PARTNERS 253 00:09:41,200 --> 00:09:50,120 ON THE SIGN SCIENTIFIC STEERING 254 00:09:50,120 --> 00:09:51,040 COMMITTEE AND RESEARCH 255 00:09:51,040 --> 00:09:53,880 CONSORTIUM, THE SCHOOL FOR 256 00:09:53,880 --> 00:09:54,640 TOPICAL TROPICAL MEDICINE TO 257 00:09:54,640 --> 00:09:55,720 HELP US TAKE THIS INFORMATION TO 258 00:09:55,720 --> 00:09:58,720 THE NEXT LEVEL IN TERMS OF DOING 259 00:09:58,720 --> 00:10:01,600 RESEARCH, TESTING WHAT WE'VE 260 00:10:01,600 --> 00:10:03,080 COME UP WITH, AND SEEING HOW 261 00:10:03,080 --> 00:10:06,080 THIS INFORMATION MIGHT BE USEFUL 262 00:10:06,080 --> 00:10:07,640 FOR ASSESSING PROGRAMS THAT ARE 263 00:10:07,640 --> 00:10:08,840 CURRENTLY ON THE GROUND. 264 00:10:08,840 --> 00:10:10,880 NEXT SLIDE. 265 00:10:10,880 --> 00:10:14,040 THIS IS JUST THE STRUCTURE OF 266 00:10:14,040 --> 00:10:17,800 THE BOND PROJECT. 267 00:10:17,800 --> 00:10:20,720 WE HAVE THE SECRETARIATE WHO 268 00:10:20,720 --> 00:10:22,400 ACKNOWLEDGED OUR PARTNERS, WE 269 00:10:22,400 --> 00:10:25,720 HAVE OUR TEAM AT NICHD. 270 00:10:25,720 --> 00:10:27,720 THE LEADERSHIP OF THE GROUP OF 271 00:10:27,720 --> 00:10:28,720 THE BOND-KIDS PROJECT COMES 272 00:10:28,720 --> 00:10:31,880 LARGELY FROM THE SCIENTIFIC 273 00:10:31,880 --> 00:10:34,640 STEERING COMMITTEE, YOU HEARD 274 00:10:34,640 --> 00:10:36,520 FROM THE MEMBERS AT OUR FIRST 275 00:10:36,520 --> 00:10:38,560 MEETING, THE PANEL DISCUSSION. 276 00:10:38,560 --> 00:10:41,720 ALL OF THOSE AGENCIES AND 277 00:10:41,720 --> 00:10:42,240 ORGANIZATIONS INVOLVED 278 00:10:42,240 --> 00:10:44,920 DOMESTICALLY AND INTERNATIONALLY 279 00:10:44,920 --> 00:10:47,440 IN PROGRAMS TO SUPPORT CHILD 280 00:10:47,440 --> 00:10:48,920 NUTRITION AND HEALTH ARE 281 00:10:48,920 --> 00:10:49,240 INVOLVED HERE. 282 00:10:49,240 --> 00:10:51,040 AND THEN THE ACTUAL WORK OF THIS 283 00:10:51,040 --> 00:10:53,000 PROJECT IS BEING DONE BY THE 284 00:10:53,000 --> 00:10:54,320 WORK GROUPS, ONE OF WHOM YOU'LL 285 00:10:54,320 --> 00:10:55,800 HEAR FROM TODAY. 286 00:10:55,800 --> 00:10:57,320 NEXT SLIDE. 287 00:10:57,320 --> 00:10:58,960 AND THIS IS JUST SORT OF A 288 00:10:58,960 --> 00:11:02,000 REPRESENTATION OF HOW WE PUT 289 00:11:02,000 --> 00:11:03,120 THIS ECOLOGICAL APPROACH 290 00:11:03,120 --> 00:11:04,560 TOGETHER, PRACTICALLY AND 291 00:11:04,560 --> 00:11:05,720 FUNCTIONALLY, TO ORGANIZE THIS 292 00:11:05,720 --> 00:11:06,200 PROJECT. 293 00:11:06,200 --> 00:11:09,320 YOU'VE HEARD THE FIRST TWO WEEKS 294 00:11:09,320 --> 00:11:11,200 THAT FIRST, YOU KNOW, CARTOON IN 295 00:11:11,200 --> 00:11:14,040 THE MIDDLE REPRESENTING THAT 296 00:11:14,040 --> 00:11:15,320 INTERACTION BETWEEN FUNCTIONAL 297 00:11:15,320 --> 00:11:16,880 DOMAINS, KEY FUNCTIONAL DOMAINS 298 00:11:16,880 --> 00:11:18,720 IN THE CHILD AND NUTRITIONAL 299 00:11:18,720 --> 00:11:23,200 STATUS, EACH OF THOSE DOMAINS IS 300 00:11:23,200 --> 00:11:25,200 IMPACTED BY VARIOUS ASPECTS OF 301 00:11:25,200 --> 00:11:26,600 NUTRITIONAL ASPECT AND ALSO 302 00:11:26,600 --> 00:11:27,600 INTERACT WITH EACH OTHER. 303 00:11:27,600 --> 00:11:28,960 HOW WE PUT THAT TOGETHER IS 304 00:11:28,960 --> 00:11:31,840 GOING TO BE A REAL CHALLENGE OF 305 00:11:31,840 --> 00:11:32,440 THE PROJECT. 306 00:11:32,440 --> 00:11:33,880 OBVIOUSLY, ALL OF THOSE 307 00:11:33,880 --> 00:11:35,720 FUNCTIONS AND NUTRITIONAL STATUS 308 00:11:35,720 --> 00:11:38,200 IS IMPACTED BY THE ENVIRONMENT. 309 00:11:38,200 --> 00:11:40,880 YOU HEARD ABOUT THAT LAST WEEK. 310 00:11:40,880 --> 00:11:43,240 TODAY WE'RE GOING TO FOCUS ON 311 00:11:43,240 --> 00:11:44,720 WORKING GROUP 3, COALESCING OUR 312 00:11:44,720 --> 00:11:47,520 THINKING HOW WE PUT ALL THIS 313 00:11:47,520 --> 00:11:49,920 INFORMATION, THIS VERY COMPLEX 314 00:11:49,920 --> 00:11:51,560 SET OF FACTORS, INTO AN APPROACH 315 00:11:51,560 --> 00:11:53,160 TO ASSESSMENT AND NEXT WEEK 316 00:11:53,160 --> 00:11:56,600 WE'LL HEAR FROM OUR FINAL GROUP 317 00:11:56,600 --> 00:11:57,200 ON TRANSLATION IMPLEMENTATION, 318 00:11:57,200 --> 00:12:00,680 WHAT ARE THOSE FACTORS WE NEED 319 00:12:00,680 --> 00:12:02,880 TO CONSIDER IN PUTTING PROGRAMS, 320 00:12:02,880 --> 00:12:04,440 IMPLEMENTING PROGRAMS, 321 00:12:04,440 --> 00:12:07,360 TRANSLATING NEW EVIDENCE INTO 322 00:12:07,360 --> 00:12:07,920 MEANINGFUL MESSAGING, 323 00:12:07,920 --> 00:12:08,480 COMMUNICATIONS AND PROGRAMS 324 00:12:08,480 --> 00:12:11,240 THAT'S GOING TO BE AN EXCITING 325 00:12:11,240 --> 00:12:11,960 SESSION NEXT WEEK. 326 00:12:11,960 --> 00:12:13,760 I THINK THAT'S IT. 327 00:12:13,760 --> 00:12:14,160 NEXT SLIDE. 328 00:12:14,160 --> 00:12:14,880 SO, THANK YOU. 329 00:12:14,880 --> 00:12:16,240 AND WITH THAT I'M GOING TO TURN 330 00:12:16,240 --> 00:12:22,600 IT OVER TO OUR WORKING GROUP 3 331 00:12:22,600 --> 00:12:24,240 CHAIR, DR. MEHTA FROM CORNELL 332 00:12:24,240 --> 00:12:25,080 UNIVERSITY. 333 00:12:25,080 --> 00:12:27,600 TAKE IT AWAY. 334 00:12:27,600 --> 00:12:31,720 >> THANK YOU, DAN. 335 00:12:31,720 --> 00:12:32,400 WELCOME, EVERYONE. 336 00:12:32,400 --> 00:12:34,640 WE'RE GOING TO TALK ABOUT -- LET 337 00:12:34,640 --> 00:12:39,600 ME START SHARING MY SCREEN. 338 00:12:39,600 --> 00:12:43,320 339 00:12:43,320 --> 00:12:46,960 IS THE RIGHT SCREEN ON? 340 00:12:46,960 --> 00:12:47,720 >> YES. 341 00:12:47,720 --> 00:12:48,560 >> YEP. 342 00:12:48,560 --> 00:12:48,920 >> PERFECT. 343 00:12:48,920 --> 00:12:50,040 GREAT. 344 00:12:50,040 --> 00:12:50,320 THANK YOU. 345 00:12:50,320 --> 00:12:51,120 SO, WELCOME, EVERYONE. 346 00:12:51,120 --> 00:12:52,800 WE'RE GOING TO TALK ABOUT 347 00:12:52,800 --> 00:12:53,840 NUTRITIONAL ASSESSMENT IN THIS 348 00:12:53,840 --> 00:12:55,920 WORKING GROUP AS DAN ALREADY 349 00:12:55,920 --> 00:12:56,200 MENTIONED. 350 00:12:56,200 --> 00:13:00,120 I'LL JUST START WITH A QUICK 351 00:13:00,120 --> 00:13:00,720 POINTER TO MY DISCLOSURES. 352 00:13:00,720 --> 00:13:02,120 I'M ON THE BOARD OF DIRECTORS 353 00:13:02,120 --> 00:13:05,080 FOR A COMPANY THAT'S TRYING TO 354 00:13:05,080 --> 00:13:08,400 COMMERCIALIZE SOME OF MY FACULTY 355 00:13:08,400 --> 00:13:09,000 RESEARCH. 356 00:13:09,000 --> 00:13:10,720 AND I'LL ALLUDE TO THAT MORE 357 00:13:10,720 --> 00:13:14,640 WHEN I TALK ABOUT THAT. 358 00:13:14,640 --> 00:13:16,400 AS DAN ALREADY MENTIONED, OUR 359 00:13:16,400 --> 00:13:21,800 WORKING GROUP IS FOCUSED ON 360 00:13:21,800 --> 00:13:22,840 NUTRITIONAL ASSESSMENT, 361 00:13:22,840 --> 00:13:24,120 NUTRITIONAL ECOLOGY, 362 00:13:24,120 --> 00:13:27,160 TRANSLATION, WE HAVE A CRITICAL 363 00:13:27,160 --> 00:13:29,680 NEED FOR DETERMINING BIOMARKERS 364 00:13:29,680 --> 00:13:32,520 AND METHODS TO MEASURE QUALITY 365 00:13:32,520 --> 00:13:33,400 OF PROGRAMS. 366 00:13:33,400 --> 00:13:35,080 AS DAN MENTIONED, THIS DATA IS 367 00:13:35,080 --> 00:13:36,800 NEEDED TO SUPPORT DEVELOPMENT, 368 00:13:36,800 --> 00:13:38,640 DEPLOYMENT, MONITORING AND 369 00:13:38,640 --> 00:13:40,320 EVALUATION OF SPECIFIC PROGRAMS 370 00:13:40,320 --> 00:13:41,520 AND INTERVENTIONS TO SUPPORT 371 00:13:41,520 --> 00:13:44,200 NUTRITIONAL CARE OF CHILDREN. 372 00:13:44,200 --> 00:13:47,520 OUR FOCUS OR MANDATE IS TO 373 00:13:47,520 --> 00:13:48,480 IDENTIFY THESE KEY FACTORS, 374 00:13:48,480 --> 00:13:50,200 BASED ON DOMAINS THAT WORKING 375 00:13:50,200 --> 00:13:54,560 GROUP 1 AND 2 ALREADY IDENTIFIED 376 00:13:54,560 --> 00:13:55,920 THE KEY DOMAINS IMPORTANT TO 377 00:13:55,920 --> 00:13:57,120 MEASURE AND SO WE WANT TO FIGURE 378 00:13:57,120 --> 00:14:00,480 OUT HOW CAN WE MEASURE THOSE 379 00:14:00,480 --> 00:14:01,000 DOMAINS. 380 00:14:01,000 --> 00:14:02,400 AND HOW THEY MIGHT BE EMPLOYED 381 00:14:02,400 --> 00:14:06,360 TO ASSESS NEED FOR IMPACT OF 382 00:14:06,360 --> 00:14:06,640 PROGRAMS. 383 00:14:06,640 --> 00:14:09,120 AND SPECIFICALLY QUESTIONS WE 384 00:14:09,120 --> 00:14:10,520 WERE CHARGED WITH ARE TO 385 00:14:10,520 --> 00:14:11,600 IDENTIFY CURRENTLY AVAILABLE 386 00:14:11,600 --> 00:14:13,000 METHODOLOGIES FOR FUNCTIONAL 387 00:14:13,000 --> 00:14:14,200 DOMAINS OF INTEREST, WHICH 388 00:14:14,200 --> 00:14:16,520 INDICATORS ARE RESPONSIVE TO 389 00:14:16,520 --> 00:14:17,040 NUTRITIONAL INTERVENTIONS, 390 00:14:17,040 --> 00:14:18,840 WHAT'S RELEVANT TO ASSESS IN 391 00:14:18,840 --> 00:14:20,400 5-19 YEAR OLD AGE GROUP? 392 00:14:20,400 --> 00:14:22,640 HOW DO WE DO THIS? 393 00:14:22,640 --> 00:14:23,320 WHEN AND HOW OFTEN? 394 00:14:23,320 --> 00:14:24,880 WHERE DO WE MEASURE THESE 395 00:14:24,880 --> 00:14:25,120 THINGS? 396 00:14:25,120 --> 00:14:27,240 AND THEN THE DEGREE OF 397 00:14:27,240 --> 00:14:28,760 COMPLEXITY OR FEASIBILITY OF 398 00:14:28,760 --> 00:14:29,560 THESE INDICATORS, OR CAPACITY 399 00:14:29,560 --> 00:14:32,680 THAT MIGHT BE REQUIRED. 400 00:14:32,680 --> 00:14:36,840 AND IS THERE A MINIMAL SET OF 401 00:14:36,840 --> 00:14:37,120 INDICATORS. 402 00:14:37,120 --> 00:14:39,880 AND WE'LL TOUCH UPON NOVEL 403 00:14:39,880 --> 00:14:41,640 TECHNOLOGIES ON THE HORIZON. 404 00:14:41,640 --> 00:14:43,280 THIS IS THE FRAMEWORK WE'VE BEEN 405 00:14:43,280 --> 00:14:45,040 WORKING WITH, AGAIN A WORK IN 406 00:14:45,040 --> 00:14:45,680 PROGRESS. 407 00:14:45,680 --> 00:14:49,320 AND IT'S ONLY FOR ILLUSTRATIVE 408 00:14:49,320 --> 00:14:49,920 PURPOSES. 409 00:14:49,920 --> 00:14:51,640 IF YOU LOOK AT THE X-AXIS, 410 00:14:51,640 --> 00:14:52,920 DEALING WITH COMPLEXITY ON THE 411 00:14:52,920 --> 00:14:57,600 X-AXIS, SIMPLER THINGS ON THE 412 00:14:57,600 --> 00:14:58,200 LEFT, MORE COMPLEX THINGS, 413 00:14:58,200 --> 00:14:59,400 RESOURCE-INTENSIVE THINGS ON THE 414 00:14:59,400 --> 00:15:00,000 RIGHT. 415 00:15:00,000 --> 00:15:02,960 ON THE Y-AXIS TRYING TO FIGURE 416 00:15:02,960 --> 00:15:03,520 OUT RESPONSIVENESS TO 417 00:15:03,520 --> 00:15:05,440 INTERVENTIONS, SO THINGS THAT WE 418 00:15:05,440 --> 00:15:08,560 KNOW RESPOND TO NUTRITIONAL 419 00:15:08,560 --> 00:15:09,680 INTERVENTIONS VERSUS THINGS THAT 420 00:15:09,680 --> 00:15:10,440 ARE GENERAL MARKERS OF HEALTH 421 00:15:10,440 --> 00:15:12,400 AND WE DON'T HAVE ENOUGH 422 00:15:12,400 --> 00:15:13,640 EVIDENCE THAT THEY ARE NUTRITION 423 00:15:13,640 --> 00:15:18,680 SENSITIVE OR SPECIFIC. 424 00:15:18,680 --> 00:15:22,600 425 00:15:22,600 --> 00:15:24,640 WE HAVE A PACKED SCHEDULE, A 426 00:15:24,640 --> 00:15:27,640 WONDERFUL WORKING GROUP AND LIST 427 00:15:27,640 --> 00:15:28,600 OF SPEAKERS. 428 00:15:28,600 --> 00:15:33,440 AND WITHOUT TAKING UP TOO MUCH 429 00:15:33,440 --> 00:15:34,640 TIME SINCE WE HAVE A PACKED 430 00:15:34,640 --> 00:15:38,920 SCHEDULE I'LL INTRODUCE MY 431 00:15:38,920 --> 00:15:44,600 FIRST SET OF SPEAKERS TO TALK 432 00:15:44,600 --> 00:15:46,640 ABOUT NUTRITIONAL ASSESSMENT AND 433 00:15:46,640 --> 00:15:56,040 REGAN BAILEY AND CAROL BOUSHEY. 434 00:15:56,040 --> 00:16:00,640 DR. BAILEY IS A PROFESSOR OF 435 00:16:00,640 --> 00:16:03,400 NUTRITION AND OFFICE OF DIETARY 436 00:16:03,400 --> 00:16:05,920 SUPPLEMENT AND DR. BOUSHEY IN 437 00:16:05,920 --> 00:16:06,760 THE EPIDEMIOLOGY PROGRAM 438 00:16:06,760 --> 00:16:08,960 UNIVERSITY OF HAWAII CANCER 439 00:16:08,960 --> 00:16:10,320 CENTER, DIRECTS NUTRITION 440 00:16:10,320 --> 00:16:11,600 SUPPORT SHARED RESOURCE FOR 441 00:16:11,600 --> 00:16:14,640 CANCER CENTER AND RESEARCH 442 00:16:14,640 --> 00:16:18,680 FOCUSES USING TECHNOLOGY AND 443 00:16:18,680 --> 00:16:19,320 EXAMINING RELATIONSHIP, DIETARY 444 00:16:19,320 --> 00:16:21,400 PATTERNS AS A RISK FOR HEALTH 445 00:16:21,400 --> 00:16:22,440 AND DIETARY DISEASE. 446 00:16:22,440 --> 00:16:25,080 I'LL TURN IT OVER TO DR. BAILEY. 447 00:16:25,080 --> 00:16:26,360 THANK YOU SO MUCH. 448 00:16:26,360 --> 00:16:27,840 >> THANK YOU. 449 00:16:27,840 --> 00:16:30,400 IT'S A PLEASURE TO BE WITH YOU. 450 00:16:30,400 --> 00:16:33,280 I'LL FOCUS ON CURRENT APPROACHES 451 00:16:33,280 --> 00:16:34,040 FOR ASSESSING DIETARY EXPOSURE 452 00:16:34,040 --> 00:16:39,000 AND TURN IT OUR TO DR. BOUSHEY. 453 00:16:39,000 --> 00:16:44,920 I'D LIKE TO START WITH A QUOTE. 454 00:16:44,920 --> 00:16:45,720 PARTICULARLY AS RELATES TO 455 00:16:45,720 --> 00:16:48,800 CHILDREN OF AGES OF INTEREST TO 456 00:16:48,800 --> 00:16:49,600 THIS BOND PROJECT, OFTENTIMES 457 00:16:49,600 --> 00:16:51,520 FOODS ARE CONSUMED AWAY FROM 458 00:16:51,520 --> 00:16:54,560 HOME AND CAREGIVERS, SUCH AS IN 459 00:16:54,560 --> 00:16:54,800 SCHOOLS. 460 00:16:54,800 --> 00:16:57,440 WHILE NOT EXCITING, HOW 461 00:16:57,440 --> 00:16:58,360 IMPORTANT FOOD COMPOSITION 462 00:16:58,360 --> 00:17:01,320 DATABASES ARE IN ASSESSING 463 00:17:01,320 --> 00:17:02,120 DIETARY INTAKES. 464 00:17:02,120 --> 00:17:05,160 SO WHY DO WE MEASURE THE DIET? 465 00:17:05,160 --> 00:17:09,680 WHY ARE WE INTERESTED? 466 00:17:09,680 --> 00:17:11,520 IN GENERAL CAPTURING SHORT OR 467 00:17:11,520 --> 00:17:13,880 LONG TERM OF EXPOSURES TO FOOD, 468 00:17:13,880 --> 00:17:15,160 ENERGY OR FOOD GROUPS. 469 00:17:15,160 --> 00:17:18,240 WE ALSO WANT TO MEASURE CHANGE 470 00:17:18,240 --> 00:17:20,640 OVER TIME, CLINICAL APPLICATIONS 471 00:17:20,640 --> 00:17:21,920 ARE OF INTEREST, ULTIMATELY OUR 472 00:17:21,920 --> 00:17:23,880 GOALS ARE TO RELATE DIETARY 473 00:17:23,880 --> 00:17:25,400 EXPOSURES TO HEALTH OUTCOMES. 474 00:17:25,400 --> 00:17:31,520 AND TO EVALUATE PROGRAMS AND 475 00:17:31,520 --> 00:17:32,360 POLICIES. 476 00:17:32,360 --> 00:17:32,880 IN GENERAL SELF-REPORTED 477 00:17:32,880 --> 00:17:34,120 INSTRUMENTS CAN BE BROKEN INTO 478 00:17:34,120 --> 00:17:36,880 SHORT TERM AND LONG TERM TOOLS, 479 00:17:36,880 --> 00:17:38,160 AND I'LL GO THROUGH EACH 480 00:17:38,160 --> 00:17:39,200 BRIEFLY. 481 00:17:39,200 --> 00:17:41,720 AS WE ALL HAVE A BACKGROUND IN 482 00:17:41,720 --> 00:17:41,960 THIS AREA. 483 00:17:41,960 --> 00:17:43,640 THERE ARE OTHER TYPES OF DIETARY 484 00:17:43,640 --> 00:17:45,640 ASSESSMENT THAT I WANTED TO 485 00:17:45,640 --> 00:17:47,200 TOUCH ON. 486 00:17:47,200 --> 00:17:49,280 WE HAVE DIRECT OBSERVATION. 487 00:17:49,280 --> 00:17:52,720 WEIGHING OF PLATES OR TRAYS. 488 00:17:52,720 --> 00:17:55,120 DISAPPEARANCE DATA, DIETARY 489 00:17:55,120 --> 00:17:56,280 DIVERSITY SCORES, SO DIETARY 490 00:17:56,280 --> 00:17:57,960 DIVERSITY, THIS IS DEVELOPED BY 491 00:17:57,960 --> 00:17:59,760 TUFTS, AND I PUT THE LINKS HERE 492 00:17:59,760 --> 00:18:01,200 IN THE CHAT. 493 00:18:01,200 --> 00:18:03,520 IT'S RELATED TO HOUSEHOLD AND 494 00:18:03,520 --> 00:18:05,520 CHILD FOOD ACCESS. 495 00:18:05,520 --> 00:18:07,400 IN GENERAL MORE DIVERSE DIETS 496 00:18:07,400 --> 00:18:11,920 ARE ASSOCIATED WITH CALORIC AND 497 00:18:11,920 --> 00:18:12,720 NUTRIENT ADEQUACY. 498 00:18:12,720 --> 00:18:13,920 FOOD SECURITY STATUS AND OTHER 499 00:18:13,920 --> 00:18:14,800 PROXY METHODS. 500 00:18:14,800 --> 00:18:17,600 I HAVE HIGHLIGHTED HERE A LINK 501 00:18:17,600 --> 00:18:20,720 TO THE FAO GUIDE FOR 502 00:18:20,720 --> 00:18:21,440 LOW-RESOURCE SETTINGS, SO 503 00:18:21,440 --> 00:18:23,680 THERE'S A LOT OF INFORMATION 504 00:18:23,680 --> 00:18:25,920 THAT CAN BE OBTAINED FROM THIS. 505 00:18:25,920 --> 00:18:27,640 SO FIRST STARTING WITH FOOD 506 00:18:27,640 --> 00:18:29,960 RECORDS AND DIARIES, THESE AIM 507 00:18:29,960 --> 00:18:32,360 TO CAPTURE CURRENT DIET, IN 508 00:18:32,360 --> 00:18:34,120 GENERAL RESPONDENTS RECORD ALL 509 00:18:34,120 --> 00:18:35,840 FOODS AND BEVERAGES CONSUMED IN 510 00:18:35,840 --> 00:18:36,560 REAL TIME. 511 00:18:36,560 --> 00:18:39,840 IDEALLY THESE ARE WEIGHED AND 512 00:18:39,840 --> 00:18:41,120 MEASURED WHICH REQUIRES 513 00:18:41,120 --> 00:18:41,720 PARTICIPANT TRAINING AND 514 00:18:41,720 --> 00:18:46,360 MULTIPLE DAYS WHICH CAN BE 515 00:18:46,360 --> 00:18:53,560 BURDEN SOME, IDEALLY DAYS ARE 516 00:18:53,560 --> 00:18:54,640 NOT CONSECUTIVE AND WE'RE 517 00:18:54,640 --> 00:18:56,000 INTERESTED IN USUAL INTAKES. 518 00:18:56,000 --> 00:18:58,280 STRENGTH OF FOODS RECORDS AND 519 00:18:58,280 --> 00:19:01,120 DIARIES TEND TO BE LESS 520 00:19:01,120 --> 00:19:02,800 COGNITIVELY CHALLENGING AND WE 521 00:19:02,800 --> 00:19:05,240 CAN OBTAIN RICH DETAIL. 522 00:19:05,240 --> 00:19:07,600 HOWEVER, IT DOES REQUIRE 523 00:19:07,600 --> 00:19:09,040 LITERACY, REQUIRES CODING AND 524 00:19:09,040 --> 00:19:10,880 ANALYZING THE DATA WHICH CAN 525 00:19:10,880 --> 00:19:14,200 TAKE A LOT OF TIME. 526 00:19:14,200 --> 00:19:16,400 AS I ALLUDED EARLIER WE NEED 527 00:19:16,400 --> 00:19:19,280 MULTIPLE FOOD RECORDS AND 528 00:19:19,280 --> 00:19:21,560 DIARIES, AND RECORDING MAY 529 00:19:21,560 --> 00:19:24,360 AFFECT INTAKE, KNOWN AS 530 00:19:24,360 --> 00:19:24,680 REACTIVITY. 531 00:19:24,680 --> 00:19:27,280 HABITUAL INTAKE MAY CHANGE AS 532 00:19:27,280 --> 00:19:28,920 ARTIFACT OF KEEPING A FOOD 533 00:19:28,920 --> 00:19:29,400 RECORD. 534 00:19:29,400 --> 00:19:30,680 MOVING TO THE 24-HOUR RECALL, 535 00:19:30,680 --> 00:19:32,720 THIS AIMS TO CAPTURE CONSUMPTION 536 00:19:32,720 --> 00:19:34,320 OVER THE PREVIOUS 24 HOURS. 537 00:19:34,320 --> 00:19:36,080 AND AGAIN MULTIPLE DAYS ARE 538 00:19:36,080 --> 00:19:37,920 NEEDED HERE. 539 00:19:37,920 --> 00:19:43,040 THE MODE OF COLLECTION CAN BE 540 00:19:43,040 --> 00:19:46,080 IN PERSON, OVER THE PHONE OR 541 00:19:46,080 --> 00:19:48,720 WEB-BASED METHODS AND THESE CAN 542 00:19:48,720 --> 00:19:50,320 TAKE TIME, 30 TO 60 MINUTES 543 00:19:50,320 --> 00:19:53,760 DEPENDING ON TYPE OF 544 00:19:53,760 --> 00:19:56,280 INFORMATION AND DIVERSITY OF 545 00:19:56,280 --> 00:19:58,320 DIET, STRUCTURED TO HAVE PROBES 546 00:19:58,320 --> 00:20:00,320 TO ENHANCE MEMORY AND RECALL OF 547 00:20:00,320 --> 00:20:01,920 FOODS AND BEVERAGES CONSUMED. 548 00:20:01,920 --> 00:20:03,520 WE CAN CAPTURE RICH DETAIL IN 549 00:20:03,520 --> 00:20:04,680 DOING SO. 550 00:20:04,680 --> 00:20:06,840 TENDS TO BE LESS COGNITIVELY 551 00:20:06,840 --> 00:20:08,320 CHALLENGING THAN OTHER METHODS. 552 00:20:08,320 --> 00:20:13,000 IN GENERAL, IT'S NOT AFFECTED BY 553 00:20:13,000 --> 00:20:15,920 REACTIVITY BUT MULTIPLE DAYS ARE 554 00:20:15,920 --> 00:20:18,320 NEEDED. 555 00:20:18,320 --> 00:20:21,760 AND IF COLLECTED BY INTERVIEWER 556 00:20:21,760 --> 00:20:24,920 CAN BE EXPENSIVE TO COLLECT AND 557 00:20:24,920 --> 00:20:26,640 CODE. 558 00:20:26,640 --> 00:20:27,480 FOOD FREQUENCY QUESTIONNAIRES 559 00:20:27,480 --> 00:20:29,880 CAPTURE INTAKE OVER 30 DAYS OR 560 00:20:29,880 --> 00:20:32,840 OVER A YEAR, GENERALLY 561 00:20:32,840 --> 00:20:34,400 SELF-ADMINISTERED, DEPENDING ON 562 00:20:34,400 --> 00:20:35,520 THE RESEARCH QUESTION MULTIPLE 563 00:20:35,520 --> 00:20:36,840 MAY BE NEEDED. 564 00:20:36,840 --> 00:20:38,280 ONE MAY BE ENOUGH. 565 00:20:38,280 --> 00:20:41,040 THESE ALSO CAN BE QUANTITATEIVE 566 00:20:41,040 --> 00:20:42,880 OR QUALITATIVE. 567 00:20:42,880 --> 00:20:44,120 SO QUANTITATIVE WOULD CAPTURE 568 00:20:44,120 --> 00:20:47,000 PORTION SIZE ALONG WITH 569 00:20:47,000 --> 00:20:48,280 FREQUENCY, QUALITATIVE COULD 570 00:20:48,280 --> 00:20:50,200 CAPTURE FREQUENCY AND ASSUME 571 00:20:50,200 --> 00:20:52,280 PORTION SIZE BASED ON PREVIOUS 572 00:20:52,280 --> 00:20:52,600 DATA. 573 00:20:52,600 --> 00:20:54,560 SO THESE ARE OFTEN USED IN LARGE 574 00:20:54,560 --> 00:20:56,720 RESEARCH STUDIES BECAUSE THEY 575 00:20:56,720 --> 00:20:58,520 ARE INEXPENSIVE TO ADMINISTER 576 00:20:58,520 --> 00:21:00,400 BUT CAN BE COGNITIVELY 577 00:21:00,400 --> 00:21:01,760 CHALLENGING FOR PARTICIPANTS TO 578 00:21:01,760 --> 00:21:02,360 COMPLETE. 579 00:21:02,360 --> 00:21:05,160 WHILE THE TIME FRAME MAY VARY, 580 00:21:05,160 --> 00:21:06,400 IT'S GENERALLY AFFECTED BY 581 00:21:06,400 --> 00:21:08,240 RECENT DIET. 582 00:21:08,240 --> 00:21:10,600 THERE'S ONLY SO MANY QUESTIONS 583 00:21:10,600 --> 00:21:11,240 ONE CAN ASK. 584 00:21:11,240 --> 00:21:13,720 IT MAY OR MAY NOT CAPTURE FOODS 585 00:21:13,720 --> 00:21:15,360 OF INTEREST TO THE POPULATION 586 00:21:15,360 --> 00:21:18,320 THAT IS BEING STUDIED, OR 587 00:21:18,320 --> 00:21:19,520 POLICIES AND PROGRAMS BEING 588 00:21:19,520 --> 00:21:22,200 EVALUATED AND THEREFORE MAY LACK 589 00:21:22,200 --> 00:21:22,520 DETAIL NEEDED. 590 00:21:22,520 --> 00:21:25,360 IN GENERAL THESE ARE NOT 591 00:21:25,360 --> 00:21:26,920 AFFECTED BY REACTIVITY. 592 00:21:26,920 --> 00:21:28,680 SO ALL OF THE METHODS THAT I'VE 593 00:21:28,680 --> 00:21:30,760 TALKED ABOUT UP TILL NOW TEND TO 594 00:21:30,760 --> 00:21:33,920 BE COSTLY AND TIME CONSUMING. 595 00:21:33,920 --> 00:21:34,640 COGNITIVELY DEMANDING, 596 00:21:34,640 --> 00:21:36,040 ESPECIALLY FOR CHILDREN AND 597 00:21:36,040 --> 00:21:36,960 PROXY REPORTERS. 598 00:21:36,960 --> 00:21:38,720 THEY ARE NOT PRACTICAL IN ALL 599 00:21:38,720 --> 00:21:41,840 SETTINGS OR ALL POPULATION 600 00:21:41,840 --> 00:21:42,680 GROUPS. 601 00:21:42,680 --> 00:21:44,400 THEY REQUIRE SOFTWARE AND 602 00:21:44,400 --> 00:21:45,560 PROFESSIONAL PERSONNEL TO 603 00:21:45,560 --> 00:21:46,600 ANALYZE THE DATA. 604 00:21:46,600 --> 00:21:49,920 AND ARE THEREFORE NOT FEASIBLE 605 00:21:49,920 --> 00:21:51,320 FOR BROAD-BASED SCREENING. 606 00:21:51,320 --> 00:21:53,240 SO, SCREENING TOOLS CAN BE IDEAL 607 00:21:53,240 --> 00:21:55,760 IF THERE ARE SPECIFIC BEHAVIORS, 608 00:21:55,760 --> 00:21:58,200 NUTRIENTS OR FOOD GROUPS OR EVEN 609 00:21:58,200 --> 00:22:00,320 NUTRITION RISK THAT'S OF 610 00:22:00,320 --> 00:22:00,720 INTEREST. 611 00:22:00,720 --> 00:22:03,240 SO IDEALLY THESE TOOLS WOULD BE 612 00:22:03,240 --> 00:22:04,280 POPULATION SPECIFIC. 613 00:22:04,280 --> 00:22:05,880 AND SCREENING TOOLS HAVE SIMILAR 614 00:22:05,880 --> 00:22:07,680 STRENGTHS AND WEAKNESSES TO FOOD 615 00:22:07,680 --> 00:22:10,520 FREQUENCY QUESTIONNAIRES. 616 00:22:10,520 --> 00:22:13,720 I'M SHOWING AN EXAMPLE OF ONE 617 00:22:13,720 --> 00:22:14,960 SUCH DEVELOPED FOR THE AGE 618 00:22:14,960 --> 00:22:17,200 GROUPS OF INTEREST. 619 00:22:17,200 --> 00:22:20,320 THIS IS DONE BY DR. BOUSHEY AND 620 00:22:20,320 --> 00:22:21,720 COLLEAGUES, INTERESTED IN 621 00:22:21,720 --> 00:22:22,920 CAPTURING CALCIUM INTAKE. 622 00:22:22,920 --> 00:22:26,760 AND SO IN ADOLESCENT GIRLS. 623 00:22:26,760 --> 00:22:27,960 AND THROUGH MULTIPLE 24-HOUR 624 00:22:27,960 --> 00:22:29,600 RECALLS WERE ABLE TO IDENTIFY 625 00:22:29,600 --> 00:22:32,520 MOST OF THE VARIANTS IN CALCIUM 626 00:22:32,520 --> 00:22:33,960 INTAKE WAS EXPLAINED BY 15 FOOD 627 00:22:33,960 --> 00:22:34,320 GROUPS. 628 00:22:34,320 --> 00:22:36,840 RATHER THAN GOING THROUGH 629 00:22:36,840 --> 00:22:37,720 EXTENSIVE DIETARY ASSESSMENT, 630 00:22:37,720 --> 00:22:39,440 THEY TARGETED QUESTIONS AROUND 631 00:22:39,440 --> 00:22:40,880 THOSE 15 FOOD GROUPS. 632 00:22:40,880 --> 00:22:41,840 SO IF THERE'S SOMETHING THAT'S 633 00:22:41,840 --> 00:22:45,160 VERY SPECIFIC THAT'S OF 634 00:22:45,160 --> 00:22:46,040 INTEREST, THESE 635 00:22:46,040 --> 00:22:49,920 POPULATION-SPECIFIC TOOLS CAN 636 00:22:49,920 --> 00:22:52,640 BE HELPFUL BUT WILL VARY. 637 00:22:52,640 --> 00:22:55,120 15 FOODS WILL NOT BE THE SAME IN 638 00:22:55,120 --> 00:22:57,720 OTHER AGE GROUPS OR OTHER 639 00:22:57,720 --> 00:22:58,280 POPULATIONS. 640 00:22:58,280 --> 00:23:01,040 IT'S IMPORTANT TO NOTE THAT ALL 641 00:23:01,040 --> 00:23:01,920 DIETARY ASSESSMENT METHODS HAVE 642 00:23:01,920 --> 00:23:02,920 MEASUREMENT ERROR. 643 00:23:02,920 --> 00:23:04,720 THERE'S A REFERENCE IF YOU'RE 644 00:23:04,720 --> 00:23:06,200 INTERESTED IN LEARNING MORE 645 00:23:06,200 --> 00:23:08,760 ABOUT MEASUREMENT ERROR AT THE 646 00:23:08,760 --> 00:23:10,720 BOTTOM OF THIS SLIDE. 647 00:23:10,720 --> 00:23:11,520 SO JUST BRIEFLY MEASUREMENT 648 00:23:11,520 --> 00:23:14,280 ERROR IS THE DIFFERENCE BETWEEN 649 00:23:14,280 --> 00:23:15,320 OBSERVED VALUE AND MEASURED 650 00:23:15,320 --> 00:23:16,600 VALUE OR TRUTH. 651 00:23:16,600 --> 00:23:20,640 SO ALL MEASURES HAVE BOTH RANDOM 652 00:23:20,640 --> 00:23:22,640 AND SYSTEMATIC ERROR. 653 00:23:22,640 --> 00:23:25,000 SO RANDOM ERROR, HOW WE KNOW 654 00:23:25,000 --> 00:23:26,480 ABOUT MEASUREMENT ERROR THROUGH 655 00:23:26,480 --> 00:23:28,360 USE OF RECOVERY BIOMARKERS, SO 656 00:23:28,360 --> 00:23:29,760 EVERYTHING THAT'S REPORTED OR 657 00:23:29,760 --> 00:23:32,720 GOES IN, COMES OUT. 658 00:23:32,720 --> 00:23:34,960 UNFORTUNATELY, WE ONLY HAVE THIS 659 00:23:34,960 --> 00:23:36,640 TRUTH FOR ENERGY, PROTEIN, 660 00:23:36,640 --> 00:23:38,360 POTASSIUM AND SODIUM. 661 00:23:38,360 --> 00:23:40,640 AND, AGAIN, WHILE WE HAVE THESE 662 00:23:40,640 --> 00:23:42,720 RECOVERY BIOMARKERS, THEY ARE 663 00:23:42,720 --> 00:23:44,120 GENERALLY IN SMALL SAMPLES, 664 00:23:44,120 --> 00:23:45,600 PRIMARILY IN ADULTS. 665 00:23:45,600 --> 00:23:47,880 WE DON'T HAVE A LOT OF DATA ON 666 00:23:47,880 --> 00:23:51,320 MEASUREMENT ERROR IN CHILDREN. 667 00:23:51,320 --> 00:23:53,240 IDEALLY THE INSTRUMENT OF CHOICE 668 00:23:53,240 --> 00:23:55,400 HAS ONLY RANDOM ERROR BECAUSE 669 00:23:55,400 --> 00:24:01,760 TAKING MULTIPLE ASSESSMENTS WILL 670 00:24:01,760 --> 00:24:03,800 REDUCE RANDOM MEASUREMENT AREA, 671 00:24:03,800 --> 00:24:10,120 NOT THE CASE FOR SYSTEMATIC 672 00:24:10,120 --> 00:24:10,480 ERROR. 673 00:24:10,480 --> 00:24:13,440 FOOD FREQUENCY QUESTIONNAIRES 674 00:24:13,440 --> 00:24:18,520 AND SCREENERS HAVE PRIMARILY 675 00:24:18,520 --> 00:24:20,040 SYSTEMATIC MEASUREMENT ERROR. 676 00:24:20,040 --> 00:24:23,240 THIS IS WRIT LARGE, IN GENERAL 677 00:24:23,240 --> 00:24:26,640 DIFFICULT FOR PARTICIPANTS TO 678 00:24:26,640 --> 00:24:28,760 ACCURATELY REPORT PORTION SIZES, 679 00:24:28,760 --> 00:24:31,680 DEPENDING ON WHICH METHOD IS 680 00:24:31,680 --> 00:24:33,520 CHOSEN MOMENTARY CAN BE AN 681 00:24:33,520 --> 00:24:34,360 ISSUE. 682 00:24:34,360 --> 00:24:34,960 SOCIAL DESIRABILITY, THAT IS 683 00:24:34,960 --> 00:24:39,640 WHEN PEOPLE TEND TO UNDERREPORT 684 00:24:39,640 --> 00:24:41,240 FOODS CONSIDERED UNHEALTHY, 685 00:24:41,240 --> 00:24:42,920 DIFFERS IN CHILDREN. 686 00:24:42,920 --> 00:24:44,080 DATA FROM CHILDREN TEND TO 687 00:24:44,080 --> 00:24:45,400 OVERREPORT FOODS THAT ARE 688 00:24:45,400 --> 00:24:47,520 PERCEIVED AS HEALTHY SUCH AS 689 00:24:47,520 --> 00:24:50,640 FRUITS AND VEGETABLES, IN ADULTS 690 00:24:50,640 --> 00:24:51,880 THERE'S A TENDENCY TO 691 00:24:51,880 --> 00:24:53,760 UNDERREPORT FOODS PERCEIVED AS 692 00:24:53,760 --> 00:24:54,200 UNHEALTHY. 693 00:24:54,200 --> 00:24:55,520 THERE'S ALSO MEASUREMENT ERROR 694 00:24:55,520 --> 00:24:58,640 THAT CAN BE INTRODUCED THROUGH 695 00:24:58,640 --> 00:25:00,960 FOOD AND NUTRIENT DATABASES. 696 00:25:00,960 --> 00:25:04,200 SPECIFIC TO CHILDREN, FOSTER AND 697 00:25:04,200 --> 00:25:06,000 BRADLEY HAVE A NICE PAPER THAT 698 00:25:06,000 --> 00:25:07,040 TALKS ABOUT THESE ISSUES 699 00:25:07,040 --> 00:25:09,360 SPECIFIC TO AGE GROUPS WE'RE 700 00:25:09,360 --> 00:25:10,040 INTERESTED IN. 701 00:25:10,040 --> 00:25:12,640 THE LACK OF ABILITY TO HAVE A 702 00:25:12,640 --> 00:25:14,480 CONCEPT OF TIME TO IDENTIFY AND 703 00:25:14,480 --> 00:25:16,840 DESCRIBE ALL FOODS AND 704 00:25:16,840 --> 00:25:19,720 BEVERAGES, DIFFICULTY WITH 705 00:25:19,720 --> 00:25:20,400 MEMORY AND CONCENTRATION, 706 00:25:20,400 --> 00:25:22,480 LITERACY AND WRITING SKILLS, AND 707 00:25:22,480 --> 00:25:24,000 MOTIVATION SO CHILDREN TEND TO 708 00:25:24,000 --> 00:25:25,880 BE LESS MOTIVATED TO PARTICIPATE 709 00:25:25,880 --> 00:25:26,880 IN HEALTH AND NUTRITION 710 00:25:26,880 --> 00:25:27,440 RESEARCH. 711 00:25:27,440 --> 00:25:29,680 AND THEN AS I ALLUDED TO EARLIER 712 00:25:29,680 --> 00:25:31,440 CONSUMPTION AWAY FROM PROXY AND 713 00:25:31,440 --> 00:25:32,920 CAREGIVERS IS A MAJOR ISSUE IN 714 00:25:32,920 --> 00:25:36,160 THIS AGE GROUP. 715 00:25:36,160 --> 00:25:38,400 THERE IS A SYSTEMATIC REVIEW OF 716 00:25:38,400 --> 00:25:41,480 DIETARY ASSESSMENT METHODS IN 717 00:25:41,480 --> 00:25:43,440 COMPARISON WITH LABELED WATER IN 718 00:25:43,440 --> 00:25:46,840 AGE GROUPS WE'RE INTERESTED IN. 719 00:25:46,840 --> 00:25:47,680 THERE ARE 12 STUDIES. 720 00:25:47,680 --> 00:25:50,720 THIS IS A PAPER BY BURROWS ET 721 00:25:50,720 --> 00:25:51,040 AL. 722 00:25:51,040 --> 00:25:52,920 THEY DETERMINED THAT THE 723 00:25:52,920 --> 00:25:54,800 ACCURACY OF ENERGY REPORTING IS 724 00:25:54,800 --> 00:25:57,040 NOT RELATED TO SEX, AGE, OR 725 00:25:57,040 --> 00:25:57,920 WEIGHT STATUS. 726 00:25:57,920 --> 00:26:00,320 AND THIS DIFFERS FROM SOME PRIOR 727 00:26:00,320 --> 00:26:02,320 WORK WHICH SUGGESTED THAT 728 00:26:02,320 --> 00:26:04,520 OVERWEIGHT AND OBESE CHILDREN 729 00:26:04,520 --> 00:26:06,120 HAD DIFFERENTIAL ENERGY 730 00:26:06,120 --> 00:26:07,520 REPORTING THAN NORMAL OR 731 00:26:07,520 --> 00:26:08,040 UNDERWEIGHT CHILDREN. 732 00:26:08,040 --> 00:26:09,600 THEY ALSO HAD A CALL TO ACTION 733 00:26:09,600 --> 00:26:11,960 THAT THERE'S VERY LIMITED DATA 734 00:26:11,960 --> 00:26:14,000 IN YOUNGER CHILDREN, IN CHILDREN 735 00:26:14,000 --> 00:26:16,560 11 YEARS AND OLDER, AS WELL AS 736 00:26:16,560 --> 00:26:18,840 POPULATIONS THAT ARE DIVERSE BY 737 00:26:18,840 --> 00:26:22,880 RACE AND ETHNICITY, AND 738 00:26:22,880 --> 00:26:24,520 DIFFERENTIAL SOCIOECONOMIC 739 00:26:24,520 --> 00:26:24,840 BACKGROUNDS. 740 00:26:24,840 --> 00:26:28,120 SO IN GENERAL, THIS IS EARLIER 741 00:26:28,120 --> 00:26:29,400 WORK FROM LIVINGSTON ET AL. 742 00:26:29,400 --> 00:26:31,200 SUGGESTING A PROXY IS NEEDED TO 743 00:26:31,200 --> 00:26:32,360 ASSIST CHILDREN YOUNGER THAN THE 744 00:26:32,360 --> 00:26:34,560 AGE OF 8 TO COMPLETE MOST OF THE 745 00:26:34,560 --> 00:26:36,160 METHODS THAT I DESCRIBED 746 00:26:36,160 --> 00:26:36,400 EARLIER. 747 00:26:36,400 --> 00:26:38,600 THERE'S A TRANSITION TO MORE 748 00:26:38,600 --> 00:26:39,200 INDEPENDENT REPORTING AROUND 8 749 00:26:39,200 --> 00:26:42,800 TO 12 YEARS OF AGE WITH IDEAL 750 00:26:42,800 --> 00:26:44,200 AGE OF 10 YEARS. 751 00:26:44,200 --> 00:26:45,720 THERE'S SOME CONFLICTING DATA ON 752 00:26:45,720 --> 00:26:46,640 PROXY ASSIST. 753 00:26:46,640 --> 00:26:49,360 SO SOME STUDIES SUGGEST THAT 754 00:26:49,360 --> 00:26:50,480 PROXIES HELP INCREASE REPORTING, 755 00:26:50,480 --> 00:26:53,920 AND THEN OTHERS THAT THERE'S NO 756 00:26:53,920 --> 00:26:55,200 EFFECT OF PROXY ASSIST. 757 00:26:55,200 --> 00:26:57,880 OLDER CHILDREN TEND TO BE MORE 758 00:26:57,880 --> 00:27:00,480 LIKELY TO UNDERREPORT ENERGY 759 00:27:00,480 --> 00:27:03,320 THAN YOUNGER CHILDREN. 760 00:27:03,320 --> 00:27:04,640 SO, SOME ISSUES WITH THE 761 00:27:04,640 --> 00:27:06,680 ANALYSIS OF THE DIETARY DATA 762 00:27:06,680 --> 00:27:08,720 THAT'S COLLECTED, AS I MENTIONED 763 00:27:08,720 --> 00:27:10,400 WE HAVE ENERGY UNDERREPORTING 764 00:27:10,400 --> 00:27:12,400 AND OVERREPORTING, AND HOW WE 765 00:27:12,400 --> 00:27:14,160 IDENTIFY THOSE IN THE CUT-POINTS 766 00:27:14,160 --> 00:27:17,240 TO APPLY TO THE DATA COLLECTED 767 00:27:17,240 --> 00:27:21,160 IS A SUBJECT OF MUCH DEBATE. 768 00:27:21,160 --> 00:27:22,800 DIETARY DATA ARE NOTORIOUSLY 769 00:27:22,800 --> 00:27:23,800 RIGHT-HAND SKEWED, THERE ARE A 770 00:27:23,800 --> 00:27:28,680 LOT OF OUTLIERS, HOW TO HANDLE 771 00:27:28,680 --> 00:27:32,160 THOSE IS AN ISSUE THAT REMAINS. 772 00:27:32,160 --> 00:27:34,440 MISSING OR INCOMPLETE DATA 773 00:27:34,440 --> 00:27:36,920 SPECIAL FOR THOSE PROXY 774 00:27:36,920 --> 00:27:38,040 ASSISTED, THAT HAPPENS FOR 775 00:27:38,040 --> 00:27:38,880 MULTIPLE REASONS. 776 00:27:38,880 --> 00:27:40,600 OFTENTIMES WE'RE TALKING ABOUT 777 00:27:40,600 --> 00:27:42,200 RELATIVE VALIDITY BECAUSE WE 778 00:27:42,200 --> 00:27:44,200 ONLY HAVE TRUTH FOR THE FOUR 779 00:27:44,200 --> 00:27:44,720 FOOD COMPONENTS. 780 00:27:44,720 --> 00:27:47,960 AND SO ON THE RIGHT-HAND SIDE 781 00:27:47,960 --> 00:27:50,200 ARE JUST SOME KIND OF BEST 782 00:27:50,200 --> 00:27:52,040 PRACTICE IDEAS, WHEN ANALYZING 783 00:27:52,040 --> 00:27:54,400 DIETARY DATA, ALWAYS HAVE TO 784 00:27:54,400 --> 00:27:56,800 CHECK FOR NORMALITY GIVEN THE 785 00:27:56,800 --> 00:27:57,920 SKEW. 786 00:27:57,920 --> 00:27:59,920 WHEN EVALUATING DIETARY 787 00:27:59,920 --> 00:28:03,320 EXPOSURES AND SOME OUTCOME OF 788 00:28:03,320 --> 00:28:07,720 INTEREST CAREFUL PLANNING FOR 789 00:28:07,720 --> 00:28:08,400 CONFOUNDING, COVARIATES, 790 00:28:08,400 --> 00:28:09,240 LIFESTYLE INTERACTIONS. 791 00:28:09,240 --> 00:28:10,720 AND THERE'S A RECENT CONFERENCE 792 00:28:10,720 --> 00:28:13,320 HELD BY THE NATIONAL ACADEMY OF 793 00:28:13,320 --> 00:28:16,600 SCIENCE ENGINEERING AND MEDICINE 794 00:28:16,600 --> 00:28:17,840 AMONG CHILDREN 2 TO 11 YEARS OF 795 00:28:17,840 --> 00:28:18,840 AGE AND THESE ARE THE 796 00:28:18,840 --> 00:28:20,880 RECOMMENDATIONS FROM THE REPORT. 797 00:28:20,880 --> 00:28:21,880 TO MATCH DIETARY ASSESSMENT 798 00:28:21,880 --> 00:28:24,600 METHODS WITH RESEARCH QUESTIONS 799 00:28:24,600 --> 00:28:26,640 OR POLICY NEEDS, TO UTILIZE 800 00:28:26,640 --> 00:28:27,720 METHODS THAT ENHANCE ACCURACY 801 00:28:27,720 --> 00:28:29,320 BASED ON AGE OR OTHER 802 00:28:29,320 --> 00:28:31,320 CHARACTERISTICS, AGAIN GOING 803 00:28:31,320 --> 00:28:32,960 BACK TO THOSE 804 00:28:32,960 --> 00:28:33,560 POPULATION-SPECIFIC METHODS, 805 00:28:33,560 --> 00:28:34,920 MULTIPLE DAYS ARE OFTEN NEEDED 806 00:28:34,920 --> 00:28:37,360 TO GET USUAL OR HABITUAL INTAKE 807 00:28:37,360 --> 00:28:39,520 AND IT MIGHT NOT JUST BE GETTING 808 00:28:39,520 --> 00:28:42,320 PROXY INFORMATION FROM PARENTS 809 00:28:42,320 --> 00:28:43,920 OR CAREGIVERS THAT ALSO 810 00:28:43,920 --> 00:28:45,720 OBTAINING INFORMATION FROM WHERE 811 00:28:45,720 --> 00:28:47,720 OUR CHILD IS IN SCHOOL OR 812 00:28:47,720 --> 00:28:49,480 ANOTHER SETTING MIGHT AID IN 813 00:28:49,480 --> 00:28:51,320 ACCURACY OF REPORTING, AND USE 814 00:28:51,320 --> 00:28:52,840 OF MULTIPLE METHODS, SO 815 00:28:52,840 --> 00:28:55,480 COMBINING SOMETHING LIKE A FOOD 816 00:28:55,480 --> 00:28:56,520 FREQUENCY QUESTIONNAIRE AND 817 00:28:56,520 --> 00:28:59,720 24-HOUR RECALL TO GET USUAL OR 818 00:28:59,720 --> 00:29:00,960 HABITUAL INTAKES. 819 00:29:00,960 --> 00:29:03,400 AND THEN IN THIS SLIDE I PROVIDE 820 00:29:03,400 --> 00:29:06,280 A FEW RESOURCES WITH HYPERLINKS, 821 00:29:06,280 --> 00:29:08,960 AVAILABLE TO EVERYONE. 822 00:29:08,960 --> 00:29:10,680 I MENTIONED FAO RESOURCES. 823 00:29:10,680 --> 00:29:12,520 INTAKE 24 IS BASED OUT OF THE 824 00:29:12,520 --> 00:29:13,160 U.K. 825 00:29:13,160 --> 00:29:15,360 IF YOU'RE INTERESTED IN 826 00:29:15,360 --> 00:29:16,920 MEASUREMENT ERROR, NCI HAS A 827 00:29:16,920 --> 00:29:18,600 WHOLE WEBINAR SERIES ON THIS 828 00:29:18,600 --> 00:29:20,280 TOPIC SPECIFIC TO DIETARY DATA. 829 00:29:20,280 --> 00:29:22,280 AND MUCH MORE BACKGROUND THAN I 830 00:29:22,280 --> 00:29:24,280 COULD PRESENT IN TEN MINUTES IS 831 00:29:24,280 --> 00:29:27,520 AVAILABLE AT THE DIET ASSESSMENT 832 00:29:27,520 --> 00:29:28,360 PRIMER. 833 00:29:28,360 --> 00:29:30,440 SO, WHILE DIETARY DATA ARE 834 00:29:30,440 --> 00:29:32,160 WIDELY USED AND ARE USED TO 835 00:29:32,160 --> 00:29:34,240 PROVIDE GUIDANCE FOR INDIVIDUALS 836 00:29:34,240 --> 00:29:36,080 AND INSTITUTIONS AND INTERPRET 837 00:29:36,080 --> 00:29:36,680 CLINICAL AND LABORATORY DATA, 838 00:29:36,680 --> 00:29:39,560 THEY ARE ALSO USED TO EVALUATE 839 00:29:39,560 --> 00:29:41,440 INTERVENTION OUTCOMES AND 840 00:29:41,440 --> 00:29:42,680 ESTABLISH RECOMMENDATIONS AND 841 00:29:42,680 --> 00:29:42,960 GUIDELINES. 842 00:29:42,960 --> 00:29:45,040 SO THERE ARE LIMITATION ALSO TO 843 00:29:45,040 --> 00:29:47,040 THE DATA BUT THEY ARE STILL 844 00:29:47,040 --> 00:29:47,480 WIDELY USEFUL. 845 00:29:47,480 --> 00:29:49,120 AND SO WHAT I WILL DO NOW IS 846 00:29:49,120 --> 00:29:51,760 TURN IT OVER TO DR. CAROL 847 00:29:51,760 --> 00:29:53,800 BOUSHEY, WHO WILL TALK ABOUT 848 00:29:53,800 --> 00:29:55,240 SOME OF THESE METHODS WITH 849 00:29:55,240 --> 00:29:57,640 TECHNOLOGY. 850 00:29:57,640 --> 00:30:03,680 851 00:30:03,680 --> 00:30:05,760 >> THANK YOU. 852 00:30:05,760 --> 00:30:09,320 THAT WAS GREAT, REGAN. 853 00:30:09,320 --> 00:30:14,680 SO, I MADE THIS SELECTION OF 854 00:30:14,680 --> 00:30:17,680 SOMEONE BRINGING UP SLIDES. 855 00:30:17,680 --> 00:30:23,720 856 00:30:23,720 --> 00:30:30,200 857 00:30:30,200 --> 00:30:30,440 858 00:30:30,440 --> 00:30:30,720 THANK YOU. 859 00:30:30,720 --> 00:30:31,840 REMEMBER, IT'S 4:00 IN THE 860 00:30:31,840 --> 00:30:33,640 MORNING FOR ME SO I DIDN'T WANT 861 00:30:33,640 --> 00:30:40,680 TO HAVE CONTROL OF THE SLIDES. 862 00:30:40,680 --> 00:30:40,880 OKAY. 863 00:30:40,880 --> 00:30:43,760 REGAN, THAT WAS FANTASTIC. 864 00:30:43,760 --> 00:30:47,440 AND HOPEFULLY EVERYONE CAN HEAR 865 00:30:47,440 --> 00:30:47,760 ME. 866 00:30:47,760 --> 00:30:53,320 I'M GOING TO TRANSITION A BIT TO 867 00:30:53,320 --> 00:30:54,560 TECHNOLOGY AND DIETARY 868 00:30:54,560 --> 00:30:57,640 ASSESSMENT. 869 00:30:57,640 --> 00:31:07,480 870 00:31:07,480 --> 00:31:08,920 NEXT SLIDE. 871 00:31:08,920 --> 00:31:10,600 OVER THE PAST 15 YEARS RESEARCH 872 00:31:10,600 --> 00:31:14,320 TEAMS HAVE BEEN DEVELOPING 873 00:31:14,320 --> 00:31:15,640 INSTRUMENTS DESIGNED TO IMPROVE 874 00:31:15,640 --> 00:31:18,600 ACCURACY, AND TO REDUCE 875 00:31:18,600 --> 00:31:20,360 RESPONDENT BURDEN AND RESEARCHER 876 00:31:20,360 --> 00:31:20,880 BURDEN. 877 00:31:20,880 --> 00:31:24,720 AND AUTOMATE THE PROCESSING OF 878 00:31:24,720 --> 00:31:25,080 DATA. 879 00:31:25,080 --> 00:31:27,280 THESE INSTRUMENTS ARE AT VARYING 880 00:31:27,280 --> 00:31:29,000 STAGES OF DEVELOPMENT AND ARE 881 00:31:29,000 --> 00:31:32,280 PART OF A GROWING TECHNOLOGICAL 882 00:31:32,280 --> 00:31:37,520 TOOLBOX THAT IS EVER EVOLVING 883 00:31:37,520 --> 00:31:48,760 AREA OF INVESTIGATION. 884 00:31:48,760 --> 00:31:50,040 NEXT SLIDE. 885 00:31:50,040 --> 00:31:52,560 SO, THESE METHODS, THIS IS -- WE 886 00:31:52,560 --> 00:31:56,600 HAVE TWO DISTINCT METHODS. 887 00:31:56,600 --> 00:31:59,360 THE PASSIVE APPROACH, WHICH 888 00:31:59,360 --> 00:32:01,040 COLLECTS ABOUT, YOU KNOW, 889 00:32:01,040 --> 00:32:02,120 MULTIPLE IMAGES ACROSS A PERIOD 890 00:32:02,120 --> 00:32:03,440 OF TIME. 891 00:32:03,440 --> 00:32:06,000 AND THEN THE ACTIVE APPROACH, 892 00:32:06,000 --> 00:32:10,120 WHICH FOCUSES IN ON A 893 00:32:10,120 --> 00:32:15,680 SPECIFIC -- YOU SEE A SPECIFIC 894 00:32:15,680 --> 00:32:18,280 FOOD OR ACTIVITY. 895 00:32:18,280 --> 00:32:21,480 896 00:32:21,480 --> 00:32:24,080 SO NEXT SLIDE. 897 00:32:24,080 --> 00:32:25,640 SO, FOR THE PASSIVE APPROACH, 898 00:32:25,640 --> 00:32:28,480 THIS IS THE TIME ELAPSED OVER 24 899 00:32:28,480 --> 00:32:30,520 MINUTES, WHAT THIS MIGHT LOOK 900 00:32:30,520 --> 00:32:32,160 LIKE, WHAT THIS LOOKS LIKE. 901 00:32:32,160 --> 00:32:35,960 NEXT SLIDE. 902 00:32:35,960 --> 00:32:37,920 FOR THE ACTIVE APPROACH, THE 903 00:32:37,920 --> 00:32:40,720 TIME ELAPSED IS 24 HOURS, AND 904 00:32:40,720 --> 00:32:42,640 THIS EXAMPLE THERE ARE EIGHT 905 00:32:42,640 --> 00:32:45,160 EATING OCCASIONS, AND I DIDN'T 906 00:32:45,160 --> 00:32:46,920 PUT IN THE AFTER IMAGES. 907 00:32:46,920 --> 00:32:50,360 AS JUST AN INTERESTING NOTE, FOR 908 00:32:50,360 --> 00:32:54,400 MOST OF THE AFTER IMAGES, AMONG 909 00:32:54,400 --> 00:32:57,720 ADULTS AND ADOLESCENT BOYS, ALL 910 00:32:57,720 --> 00:33:00,480 THE FOOD IS EATEN. 911 00:33:00,480 --> 00:33:02,600 NEXT SLIDE. 912 00:33:02,600 --> 00:33:05,240 913 00:33:05,240 --> 00:33:07,520 SO TO THE LEFT FOR THE PASSIVE 914 00:33:07,520 --> 00:33:09,840 METHOD WE CAN SEE THAT THERE ARE 915 00:33:09,840 --> 00:33:13,240 35 IMAGES FOR WHICH THE FOOD 916 00:33:13,240 --> 00:33:15,920 INTAKE CAN BE ENUMERATED, FOR 917 00:33:15,920 --> 00:33:19,240 WHAT IS NOW IDENTIFIED AS A 918 00:33:19,240 --> 00:33:21,160 15-MINUTE EATING OCCASION. 919 00:33:21,160 --> 00:33:23,520 WHERE THE ACTIVE METHOD, IN THIS 920 00:33:23,520 --> 00:33:26,560 CASE A CHILD, CAN BE ENUMERATED 921 00:33:26,560 --> 00:33:30,680 AS AMOUNT SERVED AND AMOUNT 922 00:33:30,680 --> 00:33:31,200 REMAINING. 923 00:33:31,200 --> 00:33:33,640 UNLIKE ADULTS, CHILDREN ARE MORE 924 00:33:33,640 --> 00:33:36,280 LIKELY TO LEAVE FOOD BEHIND. 925 00:33:36,280 --> 00:33:39,760 NEXT SLIDE. 926 00:33:39,760 --> 00:33:43,040 SO, MOVING TO SOME OF THE ACTUAL 927 00:33:43,040 --> 00:33:45,920 IMAGES OF ADOLESCENTS EATING AND 928 00:33:45,920 --> 00:33:49,760 USING AN APP TO ENUMERATE THEIR 929 00:33:49,760 --> 00:33:51,600 EATING OCCASIONS, THE QUESTION 930 00:33:51,600 --> 00:33:54,560 HERE WAS, HOW WILLING ARE 931 00:33:54,560 --> 00:33:56,400 ADOLESCENTS TO RECORD DIETARY 932 00:33:56,400 --> 00:33:57,440 INTAKE? 933 00:33:57,440 --> 00:33:59,560 FOR THE MOST PART, YES. 934 00:33:59,560 --> 00:34:02,960 AND MAJOR THEMES FROM FOCUS 935 00:34:02,960 --> 00:34:06,520 GROUP RESPONSES WERE INTEGRATE 936 00:34:06,520 --> 00:34:08,640 THE TASK WITH GAINS, REWARDS, 937 00:34:08,640 --> 00:34:10,440 AND INTERESTINGLY ENOUGH THEY 938 00:34:10,440 --> 00:34:13,560 NEED TO KNOW MORE ABOUT WHY THEY 939 00:34:13,560 --> 00:34:14,960 ARE USING A PARTICULAR APP OR 940 00:34:14,960 --> 00:34:16,640 METHOD. 941 00:34:16,640 --> 00:34:22,120 NEXT SLIDE. 942 00:34:22,120 --> 00:34:25,200 MANY OF THE MOBILE-BASED APPS 943 00:34:25,200 --> 00:34:27,120 USE A FIDUCIAL MARKER WHICH 944 00:34:27,120 --> 00:34:29,000 ASSISTS WITH FOOD RECOGNITION. 945 00:34:29,000 --> 00:34:31,400 DUE TO THE MOST IMPORTANT 946 00:34:31,400 --> 00:34:34,440 FEATURE TO IDENTIFY FOOD IS 947 00:34:34,440 --> 00:34:34,920 COLOR. 948 00:34:34,920 --> 00:34:41,480 IMAGES FROM MOBILE DEVICES AND 949 00:34:41,480 --> 00:34:43,440 ANY DEVICE HAVE DIFFERENT 950 00:34:43,440 --> 00:34:43,680 COLORS. 951 00:34:43,680 --> 00:34:45,200 YOU COMPARED PICTURES. 952 00:34:45,200 --> 00:34:47,000 OH, YOUR BLUE OCEAN IS BLUER 953 00:34:47,000 --> 00:34:48,880 THAN MY PICTURE. 954 00:34:48,880 --> 00:34:50,880 THUS, THE FIDUCIAL MARKER ALLOWS 955 00:34:50,880 --> 00:34:54,600 FOR COLOR CALIBRATION TO ASSIST 956 00:34:54,600 --> 00:34:55,560 WITH FOOD IDENTIFICATION, AS 957 00:34:55,560 --> 00:35:00,320 SEEN HERE THE MAJORITY OF 958 00:35:00,320 --> 00:35:04,720 CHILDREN, 78%, WITH MINE USING A 959 00:35:04,720 --> 00:35:06,120 CREDIT CARD SIZE FIDUCIAL MARKER 960 00:35:06,120 --> 00:35:09,920 MORE SO THAN USING SOMETHING 961 00:35:09,920 --> 00:35:15,080 SMALLER, A USB-SIZE FIDUCIAL 962 00:35:15,080 --> 00:35:15,680 MARKER. 963 00:35:15,680 --> 00:35:16,960 NEXT SLIDE. 964 00:35:16,960 --> 00:35:19,120 THIS IS ANOTHER EXAMPLE OF 965 00:35:19,120 --> 00:35:21,120 CHILDREN USING THE MOBILE FOOD 966 00:35:21,120 --> 00:35:28,440 RECORD AS PART OF A STUDY 967 00:35:28,440 --> 00:35:33,920 CONDUCTED BY AFLAGUE IN REQUEST 968 00:35:33,920 --> 00:35:34,520 OF GUAM. 969 00:35:34,520 --> 00:35:37,120 THAT'S FAKE FOOD IN THE 970 00:35:37,120 --> 00:35:39,480 BACKGROUND, THE YOUNG BOY IS 971 00:35:39,480 --> 00:35:43,200 SMILING BUT HIS ENTHUSIASM IS 972 00:35:43,200 --> 00:35:44,000 REAL. 973 00:35:44,000 --> 00:35:44,800 NEXT SLIDE. 974 00:35:44,800 --> 00:35:47,920 FOR THIS STUDY USING REAL FOOD, 975 00:35:47,920 --> 00:35:49,560 WHICH TESTED USE OF MOBILE FOOD 976 00:35:49,560 --> 00:35:53,960 RECORD IN THIS CASE AMONG 3-10 977 00:35:53,960 --> 00:35:55,240 YEAR OLDS, TWO GROUPS 978 00:35:55,240 --> 00:35:58,720 PARTICIPATED AS PART OF TWO 979 00:35:58,720 --> 00:36:00,400 SUMMER CAMPS, SAMPLE 1 WAS ASKED 980 00:36:00,400 --> 00:36:01,960 WAS THE MOBILE FOOD RECORD EASY 981 00:36:01,960 --> 00:36:04,600 TO USE AND WOULD YOU USE IT 982 00:36:04,600 --> 00:36:05,000 AGAIN? 983 00:36:05,000 --> 00:36:06,680 THE RESPONSES FROM BOTH THE BOYS 984 00:36:06,680 --> 00:36:08,560 AND GIRLS WOULD SUGGEST THE 985 00:36:08,560 --> 00:36:10,920 MAJORITY WOULD GO THROUGH THE 986 00:36:10,920 --> 00:36:12,320 PROCESS AGAIN. 987 00:36:12,320 --> 00:36:14,680 THE FUNNIEST PART IS THE 988 00:36:14,680 --> 00:36:21,720 RESPONSE TO THE FIDUCIAL MARKER. 989 00:36:21,720 --> 00:36:27,880 CARRY THE FIDUCIAL MARKER 990 00:36:27,880 --> 00:36:29,880 AROUND HAD ONE OF THE HIGHEST 991 00:36:29,880 --> 00:36:30,240 RESPONSES. 992 00:36:30,240 --> 00:36:32,120 WHAT I WANT BEFORE I START THIS 993 00:36:32,120 --> 00:36:35,320 IS FOR YOU TO FIGURE OUT JUST 994 00:36:35,320 --> 00:36:38,680 GUESS HOW OLD THIS CHILD IS; SO 995 00:36:38,680 --> 00:36:41,720 AS YOU CAN SEE, THIS PARTICULAR 996 00:36:41,720 --> 00:36:44,640 CHILD DIDN'T EAT A LOT BUT DID 997 00:36:44,640 --> 00:36:48,160 FINISH OFF THE CAPRI SUN 998 00:36:48,160 --> 00:36:48,400 SUPER-V. 999 00:36:48,400 --> 00:36:52,160 NOW, IN LOOKING AT THAT, I HOPE 1000 00:36:52,160 --> 00:36:53,520 YOU HAVE IN YOUR HEAD HOW THE 1001 00:36:53,520 --> 00:36:55,680 AGE OF THE CHILD AND SEE IF YOU 1002 00:36:55,680 --> 00:37:01,320 CAN CAME CLOSE TO 5 YEARS OLD. 1003 00:37:01,320 --> 00:37:03,720 NEXT SLIDE. 1004 00:37:03,720 --> 00:37:09,640 1005 00:37:09,640 --> 00:37:11,600 1006 00:37:11,600 --> 00:37:13,280 TECHNOLOGY BASED METHODS FOR 1007 00:37:13,280 --> 00:37:16,320 ASSESSING DIET IN THOSE WITH 1008 00:37:16,320 --> 00:37:17,560 DISABILITY REMAINS LARGELY 1009 00:37:17,560 --> 00:37:17,880 UNEXPLORED. 1010 00:37:17,880 --> 00:37:19,800 THE AIM OF THIS STUDY WAS TO 1011 00:37:19,800 --> 00:37:22,320 EXPLORE THE FEASIBILITY OF 1012 00:37:22,320 --> 00:37:25,080 ASSESSING DIET WITH IMAGE-BASED 1013 00:37:25,080 --> 00:37:26,040 MOBILE FOOD RECORD AMONG 51 1014 00:37:26,040 --> 00:37:28,960 ADOLESCENTS AND YOUNG ADULTS 1015 00:37:28,960 --> 00:37:30,400 WITH DOWN SYNDROME. 1016 00:37:30,400 --> 00:37:36,280 THE PAN DS STUDY, RESULTS WERE 1017 00:37:36,280 --> 00:37:40,000 COMPARED WITH SAMPLE OF YOUNG 1018 00:37:40,000 --> 00:37:43,160 ADULTS FROM CHAT STUDY, THE 1019 00:37:43,160 --> 00:37:45,720 PARTICIPANTS REPORTED MORE FRUIT 1020 00:37:45,720 --> 00:37:47,920 AND VEGETABLES, COMPARED TO THE 1021 00:37:47,920 --> 00:37:53,840 CHAT STUDY. 1022 00:37:53,840 --> 00:37:55,520 THE AUTHORS CONCLUDED METHOD 1023 00:37:55,520 --> 00:37:58,960 SHOWED PROMISE FOR ASSESSING 1024 00:37:58,960 --> 00:38:00,520 DIETS IN ADOLESCENTS AND YOUNG 1025 00:38:00,520 --> 00:38:07,080 ADULTS WITH DOWN SYNDROME. 1026 00:38:07,080 --> 00:38:07,720 NEXT SLIDE. 1027 00:38:07,720 --> 00:38:10,720 SO, HOW OLD IS THIS CHILD? 1028 00:38:10,720 --> 00:38:13,200 I'LL LET YOU THINK ABOUT THAT 1029 00:38:13,200 --> 00:38:17,000 ONE A WHILE. 1030 00:38:17,000 --> 00:38:19,680 THIS ONE IS 3 YEARS OLD. 1031 00:38:19,680 --> 00:38:21,600 I HOPE IF WE DO THE NEXT SLIDE 1032 00:38:21,600 --> 00:38:24,040 YOU SHOULD GET THE 3 YEARS OLD 1033 00:38:24,040 --> 00:38:25,920 DOWN THERE. 1034 00:38:25,920 --> 00:38:29,200 IMPORTANT TO KNOW IN SPITE OF 1035 00:38:29,200 --> 00:38:32,120 THIS NICE IMAGE WE ONLY 1036 00:38:32,120 --> 00:38:33,960 RECOMMEND CONTROL OF A MOBILE 1037 00:38:33,960 --> 00:38:37,400 DEVICE STARTING AT 5 YEARS OLD. 1038 00:38:37,400 --> 00:38:40,280 SO, AS GOOD AS THIS LOOKS, EVEN 1039 00:38:40,280 --> 00:38:42,520 FOR A 3-YEAR-OLD, THEY HAVE A 1040 00:38:42,520 --> 00:38:45,120 HARD TIME KEEPING TRACK OF THE 1041 00:38:45,120 --> 00:38:46,920 MOBILE PHONE OR WHATEVER MOBILE 1042 00:38:46,920 --> 00:38:48,520 DEVICE THEY ARE USING. 1043 00:38:48,520 --> 00:38:51,560 WE HAVE BEEN LUCKY TO FIND ALL 1044 00:38:51,560 --> 00:38:54,680 OF THE MISSING PHONES. 1045 00:38:54,680 --> 00:38:57,000 SO, BELOW 5 YEARS OLD, THEY CAN 1046 00:38:57,000 --> 00:38:58,560 TAKE IMAGES, THEY JUST CAN'T 1047 00:38:58,560 --> 00:39:03,560 REMEMBER TO KEEP TRACK OF THE 1048 00:39:03,560 --> 00:39:04,560 PHONE. 1049 00:39:04,560 --> 00:39:05,960 NEXT SLIDE. 1050 00:39:05,960 --> 00:39:07,600 I DO WANT TO COMMUNICATE, THERE 1051 00:39:07,600 --> 00:39:11,920 ARE MULTIPLE GROUPS THAT HAVE 1052 00:39:11,920 --> 00:39:13,600 CREATED APPS BASED DEVICES FOR 1053 00:39:13,600 --> 00:39:15,320 CAPTURING FOOD IMAGES. 1054 00:39:15,320 --> 00:39:18,240 THIS IS AN EXAMPLE OF THE SALK 1055 00:39:18,240 --> 00:39:21,720 METABOLIC APP. 1056 00:39:21,720 --> 00:39:22,640 NEXT SLIDE. 1057 00:39:22,640 --> 00:39:24,960 THESE ARE IMAGES CAPTURED BY THE 1058 00:39:24,960 --> 00:39:27,520 STUDY PARTICIPANTS USING THE 1059 00:39:27,520 --> 00:39:28,400 SALK METABOLIC APP. 1060 00:39:28,400 --> 00:39:31,720 IN THIS CASE THESE WERE NOT 1061 00:39:31,720 --> 00:39:31,960 CHILDREN. 1062 00:39:31,960 --> 00:39:34,640 THEY WERE COLLEGE AGE STUDENTS. 1063 00:39:34,640 --> 00:39:35,920 BUT I HOPE YOU APPRECIATE 1064 00:39:35,920 --> 00:39:39,000 DIVERSITY IN THE FOOD FROM HIGH 1065 00:39:39,000 --> 00:39:41,360 NUTRITIOUS FOODS TO SNACK FOODS 1066 00:39:41,360 --> 00:39:44,640 AND HIGH SUGAR FOODS. 1067 00:39:44,640 --> 00:39:45,880 ALTHOUGH NOT STUDIED, SOMETHING 1068 00:39:45,880 --> 00:39:49,640 WITH REGARD TO IMAGES APPEARS TO 1069 00:39:49,640 --> 00:39:52,040 REDUCE INHIBITION WITH REGARD TO 1070 00:39:52,040 --> 00:39:53,800 IMAGE CAPTURE OF LESS HEALTHFUL 1071 00:39:53,800 --> 00:39:54,240 FOODS. 1072 00:39:54,240 --> 00:39:56,720 SO THIS IS ACTUALLY A BIT OF AN 1073 00:39:56,720 --> 00:39:59,280 OPEN QUESTION AND SOMETHING MORE 1074 00:39:59,280 --> 00:40:00,080 TO EXPLORE. 1075 00:40:00,080 --> 00:40:03,720 NEXT SLIDE. 1076 00:40:03,720 --> 00:40:09,320 1077 00:40:09,320 --> 00:40:09,920 BESIDES BEING ENTERTAINING, 1078 00:40:09,920 --> 00:40:12,600 DISTINCT BEFORE AND AFTER IMAGES 1079 00:40:12,600 --> 00:40:15,440 MAKE IDENTIFICATION OF THE FOODS 1080 00:40:15,440 --> 00:40:18,800 AND LEFTOVERS EASIER FOR MACHINE 1081 00:40:18,800 --> 00:40:27,120 LEARNING AND/OR HUMAN 1082 00:40:27,120 --> 00:40:27,920 ENUMERATION. 1083 00:40:27,920 --> 00:40:28,520 NEXT SLIDE. 1084 00:40:28,520 --> 00:40:34,320 THERE IS A LARGE FOCUS ON 1085 00:40:34,320 --> 00:40:36,440 SPECIFICALLY DESIGNED WEARABLE 1086 00:40:36,440 --> 00:40:37,080 MONITORING ACCESSORIES INTENDED 1087 00:40:37,080 --> 00:40:39,880 TO BE PASSIVE IN USE WHICH SOME 1088 00:40:39,880 --> 00:40:44,240 CONSIDER IDEAL FOR WORK WITH 1089 00:40:44,240 --> 00:40:44,920 CHILDREN. 1090 00:40:44,920 --> 00:40:47,440 THESE USES ARE CONTINUOUS VIDEO 1091 00:40:47,440 --> 00:40:50,360 FEED WHICH USUALLY CAN BE TURNED 1092 00:40:50,360 --> 00:40:50,720 OFF. 1093 00:40:50,720 --> 00:40:53,920 WHICH USUALLY CAN BE TURNED OFF 1094 00:40:53,920 --> 00:40:54,200 IF NEEDED. 1095 00:40:54,200 --> 00:40:57,680 THERE'S SENSORS WHICH DETECT 1096 00:40:57,680 --> 00:40:59,480 CHEWING, SWALLOWING, AND OTHER 1097 00:40:59,480 --> 00:41:00,800 PHYSIOLOGICAL PROCESSES, 1098 00:41:00,800 --> 00:41:01,720 ASSOCIATED WITH EATING. 1099 00:41:01,720 --> 00:41:03,480 OTHER THAN THE VIDEO, MANY OF 1100 00:41:03,480 --> 00:41:06,080 THESE SENSORS DO NOT DIRECTLY 1101 00:41:06,080 --> 00:41:08,560 ASSESS FOODS OR BEVERAGES. 1102 00:41:08,560 --> 00:41:10,240 THIS PARTICULAR APP CALLED AIM 1103 00:41:10,240 --> 00:41:13,360 HAS BEEN USED WITH CHILDREN, 1104 00:41:13,360 --> 00:41:17,120 ADOLESCENTS, AND ADULTS. 1105 00:41:17,120 --> 00:41:17,960 NEXT SLIDE. 1106 00:41:17,960 --> 00:41:19,320 THIS DEVICE WAS CREATED BY A 1107 00:41:19,320 --> 00:41:22,520 GROUP IN THE U.K. AND THE 1108 00:41:22,520 --> 00:41:24,840 RESULTS WOULD SUGGEST THE DEVICE 1109 00:41:24,840 --> 00:41:28,840 HAS PROMISE. 1110 00:41:28,840 --> 00:41:30,000 NEXT SLIDE. 1111 00:41:30,000 --> 00:41:32,960 GEMMING TESTED VALIDITY OF A 1112 00:41:32,960 --> 00:41:34,920 WEARABLE CAMERA ASSISTED 24-HOUR 1113 00:41:34,920 --> 00:41:37,120 DIETARY RECALL. 1114 00:41:37,120 --> 00:41:39,640 THESE RECALLS WERE USED DURING 1115 00:41:39,640 --> 00:41:41,320 THE 15-DAY DOUBLY LABELED WATER 1116 00:41:41,320 --> 00:41:45,200 PROTOCOL, USE OF THE DATA FROM 1117 00:41:45,200 --> 00:41:47,560 THE CAMERA REDUCED MAGNITUDE OF 1118 00:41:47,560 --> 00:41:48,120 UNDERREPORTING. 1119 00:41:48,120 --> 00:41:50,520 ALTHOUGH THIS WAS AN ADULT 1120 00:41:50,520 --> 00:41:52,400 STUDY, SIMILAR APPROACHES HAVE 1121 00:41:52,400 --> 00:41:55,360 BEEN USED WITH 5 TO 19 YEAR OLDS 1122 00:41:55,360 --> 00:41:56,160 USING THE e-BUTTON. 1123 00:41:56,160 --> 00:42:02,680 NEXT SLIDE. 1124 00:42:02,680 --> 00:42:03,840 1125 00:42:03,840 --> 00:42:05,560 1126 00:42:05,560 --> 00:42:06,920 THESE DEVICES MAY UNINTELLIGIBLY 1127 00:42:06,920 --> 00:42:09,120 CAPTURE INDIVIDUALS, SOME APPS 1128 00:42:09,120 --> 00:42:10,280 HAVE AAUTOMATED SELECTIVE 1129 00:42:10,280 --> 00:42:12,200 REMOVAL OF WHAT WOULD BE 1130 00:42:12,200 --> 00:42:13,560 CONSIDERED PROTECTED 1131 00:42:13,560 --> 00:42:14,120 INFORMATION. 1132 00:42:14,120 --> 00:42:17,280 SO THE INDIVIDUALS IN THE 1133 00:42:17,280 --> 00:42:20,360 BACKGROUND ARE NOT RECOGNIZABLE. 1134 00:42:20,360 --> 00:42:22,240 NEXT SLIDE. 1135 00:42:22,240 --> 00:42:25,280 SO WE HAVE IDENTIFIED A 1136 00:42:25,280 --> 00:42:26,520 3-YEAR-OLD, 5-YEAR-OLD, HOW OLD 1137 00:42:26,520 --> 00:42:28,520 IS THIS CHILD? 1138 00:42:28,520 --> 00:42:34,240 SO THINK IN YOUR HEAD AND MOVE 1139 00:42:34,240 --> 00:42:36,720 FORWARD TO THE NEXT SLIDE. 1140 00:42:36,720 --> 00:42:39,080 THANK YOU. 1141 00:42:39,080 --> 00:42:40,120 THE IMPORTANT PART, YOU'VE SEEN 1142 00:42:40,120 --> 00:42:42,000 HOW WELL YOUNG CHILDREN CAN 1143 00:42:42,000 --> 00:42:44,200 CAPTURE IMAGES OF THEIR EATING 1144 00:42:44,200 --> 00:42:44,720 OCCASIONS. 1145 00:42:44,720 --> 00:42:47,280 THIS ONE BEING THE OLDEST THAT 1146 00:42:47,280 --> 00:42:50,360 I'VE SHOWN TO DATE. 1147 00:42:50,360 --> 00:42:54,080 NEXT SLIDE. 1148 00:42:54,080 --> 00:42:56,880 AS A PARTING GIFT TO EXPLORE 1149 00:42:56,880 --> 00:42:58,080 MORE INFORMATION ON THIS TOPIC, 1150 00:42:58,080 --> 00:43:00,760 THERE IS A RECENT REVIEW 1151 00:43:00,760 --> 00:43:02,320 SUMMARIZING IMAGE ASSISTED 1152 00:43:02,320 --> 00:43:05,080 METHODS AND INCLUDES FOUR 1153 00:43:05,080 --> 00:43:06,920 REVIEWS OF METHODS AMONG 5 TO 19 1154 00:43:06,920 --> 00:43:07,360 YEAR OLD CHILDREN. 1155 00:43:07,360 --> 00:43:11,400 THIS WOULD BE A NICE ADDITIONAL 1156 00:43:11,400 --> 00:43:13,360 RESOURCE FOR YOUR WORK GOING 1157 00:43:13,360 --> 00:43:14,000 FORWARD. 1158 00:43:14,000 --> 00:43:15,800 AND THAT IS THE END. 1159 00:43:15,800 --> 00:43:18,360 THANK YOU. 1160 00:43:18,360 --> 00:43:21,880 1161 00:43:21,880 --> 00:43:27,000 >> THANK YOU, DR. BAILEY AND DR. 1162 00:43:27,000 --> 00:43:27,440 BOUSHEY. 1163 00:43:27,440 --> 00:43:30,520 WE'LL SWITCH TO ANOTHER SET OF 1164 00:43:30,520 --> 00:43:34,520 PRESENTATIONS BY DOCTORS ALLEN 1165 00:43:34,520 --> 00:43:36,640 AND ENGLE-STONE FROM U.C. DAVIS, 1166 00:43:36,640 --> 00:43:39,000 DR. ALLEN IS A FORMER DIRECTOR 1167 00:43:39,000 --> 00:43:43,160 OF RESEARCH CENTER, STUDIES 1168 00:43:43,160 --> 00:43:45,880 PREFERENCE CAUSES IN DEVELOPING 1169 00:43:45,880 --> 00:43:47,480 COUNTRIES AND HAS 350 1170 00:43:47,480 --> 00:43:50,280 PUBLICATIONS, CURRENT FOCUS IS 1171 00:43:50,280 --> 00:43:54,080 ON NUTRIENTS AND HUMAN MILK, 1172 00:43:54,080 --> 00:43:55,120 DEVELOPMENT OF REFERENCE VALUES 1173 00:43:55,120 --> 00:43:57,440 AND INTERVENTIONS FOR INCREASING 1174 00:43:57,440 --> 00:43:58,680 LOW MILK CONCENTRATIONS. 1175 00:43:58,680 --> 00:44:00,120 DR. STONE IS ASSISTANT PROFESSOR 1176 00:44:00,120 --> 00:44:01,320 IN DEPARTMENT OF NUTRITION AND 1177 00:44:01,320 --> 00:44:03,280 MEMBER OF THE INSTITUTE FOR 1178 00:44:03,280 --> 00:44:06,120 GLOBAL INTEREST, UNIVERSITY OF 1179 00:44:06,120 --> 00:44:13,760 CALIFORNIA DAVIS, FOCUSING ON 1180 00:44:13,760 --> 00:44:22,640 MICRONUTRITION IN LOW RESOURCE 1181 00:44:22,640 --> 00:44:25,600 CONTEXTS. 1182 00:44:25,600 --> 00:44:30,640 THANK YOU BOTH. 1183 00:44:30,640 --> 00:44:34,320 1184 00:44:34,320 --> 00:44:39,680 1185 00:44:39,680 --> 00:44:42,560 >> GOOD MORNING FROM CALIFORNIA. 1186 00:44:42,560 --> 00:44:47,520 I'M NANCY ALLEN, USDA ARS 1187 00:44:47,520 --> 00:44:48,440 WESTERN HUMAN NUTRITION RESOURCE 1188 00:44:48,440 --> 00:44:52,760 CENTER, AND THIS IS A JOINT 1189 00:44:52,760 --> 00:44:54,760 PRODUCTION, NOVELTY 1190 00:44:54,760 --> 00:44:57,240 PRESENTATION, BY DR. REINA 1191 00:44:57,240 --> 00:44:57,800 ENGLE-STONE, UNIVERSITY OF 1192 00:44:57,800 --> 00:44:59,160 CALIFORNIA DAVIS. 1193 00:44:59,160 --> 00:45:01,720 I HAVE NO CONFLICTS OF INTEREST 1194 00:45:01,720 --> 00:45:06,280 AND FUNDED PRIMARILY BY THE 1195 00:45:06,280 --> 00:45:10,120 GATES FOUNDATION. 1196 00:45:10,120 --> 00:45:10,680 SO, ASSESSING NUTRITIONAL 1197 00:45:10,680 --> 00:45:12,520 STATUS, ON THE FIRST DAY OF THE 1198 00:45:12,520 --> 00:45:14,600 SERIES OF TALKS WE HEARD FROM 1199 00:45:14,600 --> 00:45:17,440 AGENCIES, AND ALMOST ALL OF THEM 1200 00:45:17,440 --> 00:45:22,160 SAID THEY WANT TO ASSESS THE 1201 00:45:22,160 --> 00:45:23,520 NUTRITIONAL STATUS AND KNOW 1202 00:45:23,520 --> 00:45:27,160 WHETHER THEIR INTERVENTIONS ARE 1203 00:45:27,160 --> 00:45:27,800 EFFECTIVE. 1204 00:45:27,800 --> 00:45:29,720 WHAT THEY EXACTLY MEANT BY 1205 00:45:29,720 --> 00:45:30,360 NUTRITIONAL STATUS WAS UNCLEAR, 1206 00:45:30,360 --> 00:45:31,600 AND I THINK IT WAS UNCLEAR TO 1207 00:45:31,600 --> 00:45:33,400 THEM IN SOME CASES AS WELL 1208 00:45:33,400 --> 00:45:36,200 BECAUSE THERE ARE A NUMBER OF 1209 00:45:36,200 --> 00:45:40,400 OPTIONS, QUANTITY AND QUALITY 1210 00:45:40,400 --> 00:45:44,840 OF THE DIET, FUNCTIONAL MEASURES 1211 00:45:44,840 --> 00:45:47,440 SUCH AS NEURAL DEFECTS, PREGNANT 1212 00:45:47,440 --> 00:45:48,520 TEENAGERS, AND BIOMARKERS. 1213 00:45:48,520 --> 00:45:53,200 AND I'M GOING TO TALK TODAY 1214 00:45:53,200 --> 00:45:55,520 ABOUT BIOMARKERS, BIOCHEMICAL 1215 00:45:55,520 --> 00:45:56,400 MARKERS IN THIS CONTEXT. 1216 00:45:56,400 --> 00:46:02,680 I WANT TO MAKE THE POINT THAT 1217 00:46:02,680 --> 00:46:04,120 THIS COMPLEMENTARITY WITH 1218 00:46:04,120 --> 00:46:05,040 BIOCHEMICAL AND DIETARY 1219 00:46:05,040 --> 00:46:06,840 MEASURES, USUALLY NOT ALWAYS BUT 1220 00:46:06,840 --> 00:46:08,920 OFTEN NEED BOTH. 1221 00:46:08,920 --> 00:46:11,360 YOU HAVE TO CHOOSE THE BEST 1222 00:46:11,360 --> 00:46:13,000 BIOCHEMICAL MARKERS, DEPENDING 1223 00:46:13,000 --> 00:46:15,560 ON YOUR PURPOSE, RESEARCH 1224 00:46:15,560 --> 00:46:17,080 SURVEYS, PROGRAMS, AND POLICY. 1225 00:46:17,080 --> 00:46:20,160 WE'RE GOING TO TALK ABOUT COMMON 1226 00:46:20,160 --> 00:46:23,280 PITFALLS AND EXPERIENCES THAT 1227 00:46:23,280 --> 00:46:26,280 HAPPEN UNDER FIELD/PROGRAM 1228 00:46:26,280 --> 00:46:26,560 CONDITIONS. 1229 00:46:26,560 --> 00:46:31,440 AND THEN MENTION INFORMATION 1230 00:46:31,440 --> 00:46:32,920 GAPS THROUGHOUT. 1231 00:46:32,920 --> 00:46:35,960 SO I VERY MUCH BELIEVE IN THE 1232 00:46:35,960 --> 00:46:37,960 COMPLEMENTARITY OF DIETARY AND 1233 00:46:37,960 --> 00:46:39,680 BIOCHEMICAL DATA. 1234 00:46:39,680 --> 00:46:41,240 SO AS THE PREVIOUS SPEAKER SAID, 1235 00:46:41,240 --> 00:46:44,640 FROM THE DIET YOU CAN TRANSLATE 1236 00:46:44,640 --> 00:46:47,520 INTAKE DATA INTO THE PERCENT 1237 00:46:47,520 --> 00:46:48,880 PREFERENCE OF INADEQUATE INTAKES 1238 00:46:48,880 --> 00:46:51,720 FOR EACH NUTRIENT. 1239 00:46:51,720 --> 00:46:54,840 THAT MEANS THE PERCENT BELOW THE 1240 00:46:54,840 --> 00:47:00,560 ESTIMATED AVERAGE REQUIREMENT OR 1241 00:47:00,560 --> 00:47:00,880 EAR. 1242 00:47:00,880 --> 00:47:01,480 SOME PROGRAMS, FORTIFICATION, 1243 00:47:01,480 --> 00:47:03,320 YOU MIGHT ALSO NEED TO KNOW 1244 00:47:03,320 --> 00:47:08,720 PERCENT ABOVE THE UPPER LEVEL OF 1245 00:47:08,720 --> 00:47:10,680 INTAKE, WHEN YOU'RE MODELING THE 1246 00:47:10,680 --> 00:47:10,920 PROGRAM. 1247 00:47:10,920 --> 00:47:14,720 SO, DIETARY DATA HAS A NUMBER OF 1248 00:47:14,720 --> 00:47:16,600 ADVANTAGES OVER BIOCHEMICAL 1249 00:47:16,600 --> 00:47:16,880 MEASURES. 1250 00:47:16,880 --> 00:47:20,000 IT MEASURES BOTH MACRO AND 1251 00:47:20,000 --> 00:47:21,640 MICRONUTRIENTS, AND I'LL SHOW AN 1252 00:47:21,640 --> 00:47:24,120 EXAMPLE OF WHERE MEASURING 1253 00:47:24,120 --> 00:47:27,000 DIETARY QUALITY IN TERMS OF 1254 00:47:27,000 --> 00:47:29,840 HEALTHFULNESS IS PROBABLY BETTER 1255 00:47:29,840 --> 00:47:32,360 THAN DOING BIOCHEMISTRY. 1256 00:47:32,360 --> 00:47:35,520 IT EXAMINES MORE NUTRIENTS, CAN 1257 00:47:35,520 --> 00:47:41,120 ALL ALL THE NUTRIENTS IN FOOD 1258 00:47:41,120 --> 00:47:42,080 COMPOSITION TABLES, IDENTIFIES 1259 00:47:42,080 --> 00:47:45,880 LOCAL FOOD SOURCES, WHICH MIGHT 1260 00:47:45,880 --> 00:47:47,640 BE INCREASED FOR INTAKE AND 1261 00:47:47,640 --> 00:47:49,960 WHICH FOODS WITH ASSOCIATED WITH 1262 00:47:49,960 --> 00:47:54,080 LOW MICRONUTRIENT INTAKE AND 1263 00:47:54,080 --> 00:47:54,720 DEFICIENCIES. 1264 00:47:54,720 --> 00:47:56,720 ANOTHER ISSUE, THERE'S SOME, NOT 1265 00:47:56,720 --> 00:47:59,440 VERY MANY BUT SOME NUTRIENTS 1266 00:47:59,440 --> 00:48:03,560 HAVE NO BIOMARKERS SUCH AS 1267 00:48:03,560 --> 00:48:05,240 CALCIUM, FOR EXAMPLE. 1268 00:48:05,240 --> 00:48:07,280 WE'LL CAN LEARN INFORMATION ON 1269 00:48:07,280 --> 00:48:09,240 LIKELY BIOAVAILABILITY OF IRON 1270 00:48:09,240 --> 00:48:11,000 AND ZINC AND USING SOME OF THE, 1271 00:48:11,000 --> 00:48:12,520 QUOTE, MODERN METHODS YOU'VE 1272 00:48:12,520 --> 00:48:14,320 JUST SEEN OF DATA COLLECTION, 1273 00:48:14,320 --> 00:48:17,160 SOMETIMES I THINK THESE CAN BE 1274 00:48:17,160 --> 00:48:20,280 CHEAPER AND FASTER THAN 1275 00:48:20,280 --> 00:48:21,280 BIOCHEMICAL METHODS. 1276 00:48:21,280 --> 00:48:22,160 BUT THERE'S SOMETIMES 1277 00:48:22,160 --> 00:48:28,120 DISAGREEMENT BETWEEN DIETARY AND 1278 00:48:28,120 --> 00:48:32,720 BIOCHEMICAL VALUES. 1279 00:48:32,720 --> 00:48:33,800 SO, BIOCHEMICAL MARKERS ARE 1280 00:48:33,800 --> 00:48:35,880 USEFUL FOR SURE BECAUSE THEY ARE 1281 00:48:35,880 --> 00:48:38,320 MEASURING THE STATUS OF SPECIFIC 1282 00:48:38,320 --> 00:48:40,400 NUTRIENTS IN THE BODY, WHICH 1283 00:48:40,400 --> 00:48:43,000 DIETARY DATA DON'T DO, DOESN'T 1284 00:48:43,000 --> 00:48:43,160 DO. 1285 00:48:43,160 --> 00:48:45,320 AND SO IT'S USEFUL TO CONFIRM 1286 00:48:45,320 --> 00:48:48,000 THEN YOUR INFORMATION ON THE 1287 00:48:48,000 --> 00:48:49,160 PREVALENCE OF INADEQUATE 1288 00:48:49,160 --> 00:48:51,400 INTAKES, AND THE INADEQUATE 1289 00:48:51,400 --> 00:48:54,080 INTAKE DATA MIGHT BE WRONG IN 1290 00:48:54,080 --> 00:48:56,360 SCHOOLERS OR ANY OTHER GROUP, 1291 00:48:56,360 --> 00:48:59,800 DUE TO POORLY COLLECTED OR DIET 1292 00:48:59,800 --> 00:49:02,240 DATA OR INSUFFICIENT DAYS OF 1293 00:49:02,240 --> 00:49:05,120 DATA, ERRORS IN FOOD COMPOSITION 1294 00:49:05,120 --> 00:49:05,520 TABLES. 1295 00:49:05,520 --> 00:49:07,320 SOMETIMES WE SEE IN SURVEYS THAT 1296 00:49:07,320 --> 00:49:13,640 IT LOOKS LIKE INTAKE OF, SAY, 1297 00:49:13,640 --> 00:49:15,600 FOLATE, ONE STUDY, WILL BE 1298 00:49:15,600 --> 00:49:19,320 DEFICIENCY IN ALMOST EVERYBODY, 1299 00:49:19,320 --> 00:49:20,760 BLOOD VALUES, SERUM FOLATE WAS 1300 00:49:20,760 --> 00:49:23,240 NORMAL SO THERE'S A PROBLEM WITH 1301 00:49:23,240 --> 00:49:27,640 THE FOOD COMPOSITION TABLE. 1302 00:49:27,640 --> 00:49:28,400 YOU CAN GET WRONG ESTIMATES, 1303 00:49:28,400 --> 00:49:33,920 THIS IS A BIT OF A CHALLENGE 1304 00:49:33,920 --> 00:49:35,120 WHEN INTERPRETING. 1305 00:49:35,120 --> 00:49:36,360 VERY IMPORTANTLY YOU MIGHT HAVE 1306 00:49:36,360 --> 00:49:38,320 INADEQUATE INFORMATION ON USUAL 1307 00:49:38,320 --> 00:49:40,720 INTAKE OF SUPPLEMENTS AND 1308 00:49:40,720 --> 00:49:43,600 FORTIFICATION AND THOSE HAVE 1309 00:49:43,600 --> 00:49:44,480 REALLY CHANGED BIOCHEMICAL 1310 00:49:44,480 --> 00:49:48,320 VALUES WHERE YOU DIDN'T CATCH IT 1311 00:49:48,320 --> 00:49:52,160 IN YOUR DIET SURVEYS. 1312 00:49:52,160 --> 00:49:53,520 BIOCHEMICAL MARKERS WILL TELL 1313 00:49:53,520 --> 00:49:55,440 YOU WHICH SPECIFIC NUTRIENTS ARE 1314 00:49:55,440 --> 00:49:56,440 DEFICIENT AND REQUIRE 1315 00:49:56,440 --> 00:49:57,080 INTERVENTION. 1316 00:49:57,080 --> 00:50:00,680 AND CAN BE VERY USEFUL TO 1317 00:50:00,680 --> 00:50:01,760 DOCUMENT EFFECTIVENESS OF 1318 00:50:01,760 --> 00:50:02,040 PROGRAMS. 1319 00:50:02,040 --> 00:50:04,240 ARE YOU GIVING ENOUGH? 1320 00:50:04,240 --> 00:50:06,120 ARE THE SUPPLEMENTS ENOUGH? 1321 00:50:06,120 --> 00:50:08,480 VERY, VERY OFTEN WE SEE AT THE 1322 00:50:08,480 --> 00:50:12,120 END OF AN INTERVENTION STUDY 1323 00:50:12,120 --> 00:50:13,880 THERE'S STILL A HIGH LEVEL OF 1324 00:50:13,880 --> 00:50:17,040 DEFICIENCY LEFT IN THE 1325 00:50:17,040 --> 00:50:17,600 POPULATION. 1326 00:50:17,600 --> 00:50:19,400 SO THIS WILL DEPEND ON WHETHER 1327 00:50:19,400 --> 00:50:23,600 YOU'RE TALKING ABOUT FOOD 1328 00:50:23,600 --> 00:50:24,800 INTERVENTION, SUPPLEMENTATION, 1329 00:50:24,800 --> 00:50:26,640 FORTIFICATION, UNIVERSAL SALT 1330 00:50:26,640 --> 00:50:35,560 IONIZATION OR WHATEVER, WE , IF 1331 00:50:35,560 --> 00:50:38,760 THE PROGRAM IS GIVING ENOUGH 1332 00:50:38,760 --> 00:50:39,000 AMOUNTS. 1333 00:50:39,000 --> 00:50:46,600 MY SLIDES WON'T MOVE. 1334 00:50:46,600 --> 00:50:51,560 I DON'T KNOW AWAY. 1335 00:50:51,560 --> 00:50:53,000 I DON'T KNOW WHY. 1336 00:50:53,000 --> 00:50:54,200 >> TRY CLICKING ON THE SLIDE, 1337 00:50:54,200 --> 00:50:57,640 YOU MIGHT BE ABLE TO MOVE IT 1338 00:50:57,640 --> 00:50:57,880 FORWARD. 1339 00:50:57,880 --> 00:50:58,640 >> YEAH, I DID. 1340 00:50:58,640 --> 00:51:02,000 THINK I'VE GOT IT NOW. 1341 00:51:02,000 --> 00:51:03,160 I THINK THE LASER POINTING IS 1342 00:51:03,160 --> 00:51:04,320 SCREWING UP. 1343 00:51:04,320 --> 00:51:06,640 WHAT IS AN IDEAL BIOMARKER? 1344 00:51:06,640 --> 00:51:08,160 IT FITS THE PURPOSE THAT YOU 1345 00:51:08,160 --> 00:51:09,400 NEED IT FOR. 1346 00:51:09,400 --> 00:51:12,720 DO YOU WANT IT TO EXPLAIN SOME 1347 00:51:12,720 --> 00:51:13,600 CLINICAL SYMPTOMS THAT YOU 1348 00:51:13,600 --> 00:51:15,760 SUSPECT DUE TO A SPECIFIC 1349 00:51:15,760 --> 00:51:17,200 NUTRIENT DEFICIENCY? 1350 00:51:17,200 --> 00:51:19,360 DO YOU WANT TO DO A SURVEY TO 1351 00:51:19,360 --> 00:51:20,880 DESCRIBE A POPULATION GROUP? 1352 00:51:20,880 --> 00:51:23,760 DO YOU WANT TO CONFIRM ADEQUACY 1353 00:51:23,760 --> 00:51:24,600 OF INTAKE? 1354 00:51:24,600 --> 00:51:27,560 DO YOU WANT TO KNOW WHICH 1355 00:51:27,560 --> 00:51:29,440 MICRONUTRIENTS ARE LACKING AND 1356 00:51:29,440 --> 00:51:31,760 WHICH INTERVENTIONS ARE NEEDED? 1357 00:51:31,760 --> 00:51:35,520 DO YOU WANT TO MEASURE RESPONSE 1358 00:51:35,520 --> 00:51:36,280 TO INTERVENTIONS? 1359 00:51:36,280 --> 00:51:39,880 THE BIOMARKERS SHOULD BE 1360 00:51:39,880 --> 00:51:41,520 SENSITIVE TO INTERVENTIONS AND 1361 00:51:41,520 --> 00:51:43,640 SPECIFIC FOR EACH NUTRIENT THAT 1362 00:51:43,640 --> 00:51:48,080 YOU'RE LOOKING AT. 1363 00:51:48,080 --> 00:51:50,600 ARE THE MARKERS FEASIBLE TO 1364 00:51:50,600 --> 00:51:51,160 MEASURE? 1365 00:51:51,160 --> 00:51:53,120 CAN YOU GET THE SAMPLE, CAN YOU 1366 00:51:53,120 --> 00:51:54,560 GET ENOUGH SAMPLE? 1367 00:51:54,560 --> 00:51:57,960 CAN YOU TRANSPORT AND STORE THE 1368 00:51:57,960 --> 00:52:01,720 SAMPLES IN THE FIELD? 1369 00:52:01,720 --> 00:52:02,920 FINALLY, ARE THE MEASURES 1370 00:52:02,920 --> 00:52:03,240 AFFORDABLE? 1371 00:52:03,240 --> 00:52:06,120 IF WE HAVE TO SEND THE SAMPLES 1372 00:52:06,120 --> 00:52:09,160 TO A HOSPITAL COMMERCIAL LAB 1373 00:52:09,160 --> 00:52:10,120 THEY ARE OFTEN UNAFFORDABLE. 1374 00:52:10,120 --> 00:52:12,240 IF YOU CAN INVOLVE A RESEARCH 1375 00:52:12,240 --> 00:52:14,920 LAB OR WORK WITHIN A PROGRAM, 1376 00:52:14,920 --> 00:52:17,880 OFTEN THEY ARE A LOT MORE 1377 00:52:17,880 --> 00:52:21,720 AFFORDABLE. 1378 00:52:21,720 --> 00:52:22,600 1379 00:52:22,600 --> 00:52:25,520 I'M STILL HAVING A PROBLEM WITH 1380 00:52:25,520 --> 00:52:26,320 MOVING SLIDES. 1381 00:52:26,320 --> 00:52:27,320 OKAY. 1382 00:52:27,320 --> 00:52:33,920 THIS IS AN EXAMPLE OF WHERE 1383 00:52:33,920 --> 00:52:35,320 INTAKE AND BIOCHEMICAL DATA 1384 00:52:35,320 --> 00:52:37,880 REALLY GIVE YOU DIFFERENT 1385 00:52:37,880 --> 00:52:38,640 RESULTS. 1386 00:52:38,640 --> 00:52:41,080 AND THIS IS OUR BELOVED U.S. 1387 00:52:41,080 --> 00:52:45,040 NHANES NATIONAL HEALTH AND 1388 00:52:45,040 --> 00:52:47,520 NUTRITION EDUCATION SURVEY, 1389 00:52:47,520 --> 00:52:49,400 2015-58 DATA, FOR MANY GROUPS 1390 00:52:49,400 --> 00:52:52,720 PUBLISHED BUT THIS IS FEMALES 1391 00:52:52,720 --> 00:52:53,720 9-13 YEARS. 1392 00:52:53,720 --> 00:52:57,120 THE BLUE LINES ARE PERCENT OF 1393 00:52:57,120 --> 00:52:59,160 FEMALES WITH USUAL INTAKE BELOW 1394 00:52:59,160 --> 00:53:00,160 THE EAR. 1395 00:53:00,160 --> 00:53:02,280 IN OTHER WORDS, INADEQUATE 1396 00:53:02,280 --> 00:53:02,680 INTAKES. 1397 00:53:02,680 --> 00:53:05,760 SO YOU CAN SEE ON THE LEFT-HAND 1398 00:53:05,760 --> 00:53:09,720 SIDE VITAMIN D IS A MAJOR 1399 00:53:09,720 --> 00:53:09,960 PROBLEM. 1400 00:53:09,960 --> 00:53:11,520 E, MAGNESIUM, CALCIUM, VITAMIN 1401 00:53:11,520 --> 00:53:14,840 A, C, ZINC, AND IRON. 1402 00:53:14,840 --> 00:53:16,840 ARE THEY REALLY MAJOR PROBLEMS? 1403 00:53:16,840 --> 00:53:20,960 SO ON THE RIGHT IN THE BOX I 1404 00:53:20,960 --> 00:53:24,360 HAVE THE PERCENT USING 1405 00:53:24,360 --> 00:53:25,160 BIOMARKERS. 1406 00:53:25,160 --> 00:53:28,560 INDEED 30 TO 50% WERE DEFICIENT. 1407 00:53:28,560 --> 00:53:30,240 NOW, OF COURSE, WE DON'T EXPECT 1408 00:53:30,240 --> 00:53:34,640 DIETS TO PROVIDE ALL THE VITAMIN 1409 00:53:34,640 --> 00:53:36,160 D BECAUSE OF UV LIGHT 1410 00:53:36,160 --> 00:53:36,720 PRODUCTION. 1411 00:53:36,720 --> 00:53:40,960 AT LEAST IN THE SUMMER. 1412 00:53:40,960 --> 00:53:42,680 15% WERE IRON DEFICIENT. 1413 00:53:42,680 --> 00:53:44,120 FOR ALL THE OTHER MICRONUTRIENTS 1414 00:53:44,120 --> 00:53:47,320 LESS THAN 3% WERE DEFICIENT. 1415 00:53:47,320 --> 00:53:50,360 FOR CALCIUM, THERE IS NO 1416 00:53:50,360 --> 00:53:51,280 BIOMARKER. 1417 00:53:51,280 --> 00:53:54,560 AND SO WHAT IS LIKELY HAPPENING 1418 00:53:54,560 --> 00:53:57,560 IN THIS POPULATION IS 1419 00:53:57,560 --> 00:53:58,320 SUPPLEMENTS AND FORTIFIED 1420 00:53:58,320 --> 00:54:01,840 CEREALS, SO ON, HAVE INFLUENCED 1421 00:54:01,840 --> 00:54:03,960 BIOMARKERS SO THERE'S NOT SUCH A 1422 00:54:03,960 --> 00:54:08,240 PROBLEM AS FOOD INTAKE DATA 1423 00:54:08,240 --> 00:54:08,960 MIGHT SUGGEST. 1424 00:54:08,960 --> 00:54:10,920 EVEN SO, EVALUATING THE INTAKE 1425 00:54:10,920 --> 00:54:13,480 OF FOODS AND DIETARY QUALITY IS 1426 00:54:13,480 --> 00:54:15,920 PROBABLY MOST IMPORTANT IN THIS 1427 00:54:15,920 --> 00:54:17,760 GROUP IN SCHOOLERS. 1428 00:54:17,760 --> 00:54:21,800 BECAUSE WE ARE REALLY CONCERNED 1429 00:54:21,800 --> 00:54:25,920 ABOUT THE MICRO NUTRIENTS, 1430 00:54:25,920 --> 00:54:36,040 SUGAR, SATURATED FAT. 1431 00:54:36,040 --> 00:54:39,600 WORK BASED ON INTAKE DATA, NOT 1432 00:54:39,600 --> 00:54:40,400 ON BIOMARKERS. 1433 00:54:40,400 --> 00:54:44,000 AND THE CDC CURRENTLY IS JUST 1434 00:54:44,000 --> 00:54:45,600 MONITORING IRON, FOLATE, IODINE 1435 00:54:45,600 --> 00:54:47,920 AND VITAMIN D IN ADOLESCENTS AND 1436 00:54:47,920 --> 00:54:53,600 NOT ANY OF THESE OTHER 1437 00:54:53,600 --> 00:54:54,240 NUTRIENTS. 1438 00:54:54,240 --> 00:54:58,160 NOW, IT CAN HAPPEN THAT YOU HAVE 1439 00:54:58,160 --> 00:55:00,920 GOOD AGREEMENT BETWEEN 1440 00:55:00,920 --> 00:55:03,320 BIOCHEMICAL AND INTAKE DATA. 1441 00:55:03,320 --> 00:55:05,640 THE GREEN LINES, THIS IS AN OLD 1442 00:55:05,640 --> 00:55:09,320 SLIDE OF MINE FROM THE 1980s, 1443 00:55:09,320 --> 00:55:11,160 AND CHILDREN IN RURAL MEXICO. 1444 00:55:11,160 --> 00:55:13,680 THE GREEN BARS ARE WHAT THE 1445 00:55:13,680 --> 00:55:16,880 PREVALENCE OF DEFICIENCY THAT WE 1446 00:55:16,880 --> 00:55:19,480 PREDICT FROM DIETARY DATA, AND 1447 00:55:19,480 --> 00:55:21,480 THE ORANGE ONES WHAT WERE 1448 00:55:21,480 --> 00:55:22,280 ACTUALLY MEASURED BIOCHEMICALLY 1449 00:55:22,280 --> 00:55:24,280 SO YOU CAN SEE VERY GOOD 1450 00:55:24,280 --> 00:55:25,880 AGREEMENT. 1451 00:55:25,880 --> 00:55:27,920 AND IN THIS CASE, EXCELLENT 1452 00:55:27,920 --> 00:55:31,120 DIETARY DATA, A HIGH PREVALENCE 1453 00:55:31,120 --> 00:55:32,400 OF DEFICIENCIES, GOOD 1454 00:55:32,400 --> 00:55:35,520 SPECIFICITY OF THE MARKERS, AND 1455 00:55:35,520 --> 00:55:38,600 NO SUPPLEMENTS OF FORTIFICATION. 1456 00:55:38,600 --> 00:55:42,640 THIS WAS THE EARLY 1980s. 1457 00:55:42,640 --> 00:55:43,800 WHAT'S THE CURRENT GLOBAL 1458 00:55:43,800 --> 00:55:44,080 SITUATION? 1459 00:55:44,080 --> 00:55:47,120 WE HAVE ALMOST NO DATA ON THE 1460 00:55:47,120 --> 00:55:50,640 PREVALENCE OF INADEQUACY IN 1461 00:55:50,640 --> 00:55:51,720 SCHOOLERS. 1462 00:55:51,720 --> 00:55:56,320 NEW W.H.O. MICRONUTRIENTS 1463 00:55:56,320 --> 00:55:56,800 DATABASE HAS DETAILED 1464 00:55:56,800 --> 00:56:00,320 INFORMATION BY REGION. 1465 00:56:00,320 --> 00:56:02,920 AND THAT'S AVAILABLE. 1466 00:56:02,920 --> 00:56:04,720 PREVALENCE OF ANEMIA, LOW 1467 00:56:04,720 --> 00:56:09,840 FERRITIN, URINARY IODINE AND 1468 00:56:09,840 --> 00:56:10,600 ZINC FOR SCHOOLERS, 1469 00:56:10,600 --> 00:56:11,520 REPRESENTATIVE DATA FROM MANY 1470 00:56:11,520 --> 00:56:14,280 COUNTRIES AND REGIONS BUT ONLY 1471 00:56:14,280 --> 00:56:16,720 FOR THOSE NUTRIENTS. 1472 00:56:16,720 --> 00:56:20,120 THE BOND REPORTS PREVIOUS ONES 1473 00:56:20,120 --> 00:56:21,520 THAT DAN MENTIONED HAVE VERY 1474 00:56:21,520 --> 00:56:24,960 DETAILED INFORMATION ON HOW TO 1475 00:56:24,960 --> 00:56:28,480 ASSESS IRON, A AND B-12 STATUS, 1476 00:56:28,480 --> 00:56:30,680 FOLATE, IODINE AND ZINC. 1477 00:56:30,680 --> 00:56:32,200 FOR METHODS OF ASSESSMENT THAT'S 1478 00:56:32,200 --> 00:56:35,480 WHERE I WOULD REFER YOU, VERY 1479 00:56:35,480 --> 00:56:37,360 LONG AND USEFUL INFORMATION 1480 00:56:37,360 --> 00:56:41,920 ABOUT THE APPLICATION OF 1481 00:56:41,920 --> 00:56:43,560 BIOCHEMICAL METHODS. 1482 00:56:43,560 --> 00:56:47,600 IMPACT AND CDC FOCUS ON ANEMIA, 1483 00:56:47,600 --> 00:56:48,440 IRON, IODINE. 1484 00:56:48,440 --> 00:56:56,400 ALSO VITAMINS A&D, FOLATE AND 1485 00:56:56,400 --> 00:56:58,600 ZINC, DEALING WITH FORTIFICATION 1486 00:56:58,600 --> 00:57:01,960 IN LOW, MIDDLE NOOK COUNTRIES. 1487 00:57:01,960 --> 00:57:05,760 A WHOLE GROUP OF NEGLECTED 1488 00:57:05,760 --> 00:57:08,280 MICRONUTRIENTS, PARTICULARLY B 1489 00:57:08,280 --> 00:57:08,640 VITAMINS. 1490 00:57:08,640 --> 00:57:10,520 AND ALSO AS VITAMIN A IN 1491 00:57:10,520 --> 00:57:13,520 SCHOOLERS, W.H.O. DOESN'T 1492 00:57:13,520 --> 00:57:14,920 RECOMMEND GIVING VITAMIN A IN 1493 00:57:14,920 --> 00:57:17,240 HIGH DOSES UP TO THE AGE OF 5, 1494 00:57:17,240 --> 00:57:19,160 AND SO THERE'S VERY ALSO 1495 00:57:19,160 --> 00:57:20,920 INFORMATION ON ACTUALLY HOW 1496 00:57:20,920 --> 00:57:22,680 SCHOOLERS ARE DOING. 1497 00:57:22,680 --> 00:57:24,680 YOU WOULD EXPECT THOSE 1498 00:57:24,680 --> 00:57:26,000 DEFICIENCIES WHERE ANIMAL SOURCE 1499 00:57:26,000 --> 00:57:29,120 FOOD INTAKE IS LOW. 1500 00:57:29,120 --> 00:57:32,240 YOU WOULD EXPECT FOLATE AND 1501 00:57:32,240 --> 00:57:33,960 CAROTINOID DEFICIENCY, VITAMIN A 1502 00:57:33,960 --> 00:57:35,160 WHERE FRUIT AND VEGETABLE INTAKE 1503 00:57:35,160 --> 00:57:36,240 ARE LOW. 1504 00:57:36,240 --> 00:57:39,360 SPECIAL ISSUES IN SCHOOLERS, 1505 00:57:39,360 --> 00:57:41,160 URINARY IODINE CONCENTRATION, IS 1506 00:57:41,160 --> 00:57:42,880 A POPULATION MARKER OF IODINE 1507 00:57:42,880 --> 00:57:46,360 STATUS FOR THE WHOLE POPULATION. 1508 00:57:46,360 --> 00:57:49,720 VITAMIN D OFTEN DEFICIENT IN LOW 1509 00:57:49,720 --> 00:57:51,120 ULTRAVIOLET LIGHT EXPOSURE 1510 00:57:51,120 --> 00:57:51,920 SITUATIONS. 1511 00:57:51,920 --> 00:57:54,200 AND THEN IRON BECOMES A CRITICAL 1512 00:57:54,200 --> 00:57:56,400 NUTRIENT, A LOT MORE IRON 1513 00:57:56,400 --> 00:58:00,200 DEFICIENCY AFTER THE ONSET OF 1514 00:58:00,200 --> 00:58:00,520 MENSTRUATION. 1515 00:58:00,520 --> 00:58:03,520 IT'S IMPORTANT TO REMEMBER THAT 1516 00:58:03,520 --> 00:58:05,360 MANY OF THESE SCHOOLERS 1517 00:58:05,360 --> 00:58:06,840 ESPECIALLY IN LOW OR MIDDLE 1518 00:58:06,840 --> 00:58:08,760 INCOME COUNTRIES ARE GOING TO 1519 00:58:08,760 --> 00:58:11,560 BECOME PREGNANT AND SO WE HAVE 1520 00:58:11,560 --> 00:58:14,120 TO WORRY ABOUT IRON, FOLIC ACID, 1521 00:58:14,120 --> 00:58:20,160 B-12 STATUS AFTER ONSET OF 1522 00:58:20,160 --> 00:58:20,720 MENSTRUATION. 1523 00:58:20,720 --> 00:58:24,120 A SIMPLE OLD CHART HERE, ALWAYS 1524 00:58:24,120 --> 00:58:25,320 USEFUL REMINDER TO PREDICT WHAT 1525 00:58:25,320 --> 00:58:27,560 YOU'RE LIKELY TO FIND DEFICIENT 1526 00:58:27,560 --> 00:58:28,920 IN A POPULATION. 1527 00:58:28,920 --> 00:58:31,560 AND THE POINT IS THAT ANIMAL AND 1528 00:58:31,560 --> 00:58:33,600 PLANT FOODS PROVIDE VERY 1529 00:58:33,600 --> 00:58:35,720 DIFFERENT NUTRIENTS. 1530 00:58:35,720 --> 00:58:37,080 SO PLANT FOODS HERE IN GREEN, 1531 00:58:37,080 --> 00:58:40,160 THEY ARE VERY GOOD SOURCES OF 1532 00:58:40,160 --> 00:58:41,480 FOLATE. 1533 00:58:41,480 --> 00:58:43,920 AND CAN HAVE QUITE A LOT OF 1534 00:58:43,920 --> 00:58:45,720 VITAMIN A. 1535 00:58:45,720 --> 00:58:48,320 LEGUMES ARE HIGH IN FOLATE. 1536 00:58:48,320 --> 00:58:50,920 SO THAT IS LIKELY TO BE 1537 00:58:50,920 --> 00:58:53,080 DEFICIENCY IN POPULATIONS EATING 1538 00:58:53,080 --> 00:58:56,960 ELECTRIC ALLS, AND OVER TO THE 1539 00:58:56,960 --> 00:58:58,560 ANIMAL SOURCE FOODS AND THEY 1540 00:58:58,560 --> 00:59:00,880 HAVE MUCH MORE NUTRIENT DENSE 1541 00:59:00,880 --> 00:59:05,200 THAN PLANT BASED FOODS, AND IN 1542 00:59:05,200 --> 00:59:09,200 MOST POPULATIONS THE GROUP OF 1543 00:59:09,200 --> 00:59:11,400 MICRONUTRIENTS THAT ARE 1544 00:59:11,400 --> 00:59:12,800 DEFICIENT ARE DEFICIENT BECAUSE 1545 00:59:12,800 --> 00:59:15,440 OF LOW INTAKE OF THESE FOODS IN 1546 00:59:15,440 --> 00:59:17,600 THE ORANGE BARS. 1547 00:59:17,600 --> 00:59:22,640 PRETTY PREDICTABLE, ALWAYS AS A 1548 00:59:22,640 --> 00:59:27,760 GROUP OF NUTRIENTS. 1549 00:59:27,760 --> 00:59:29,560 THIS IS A REVIEW, 2022. 1550 00:59:29,560 --> 00:59:35,720 NUTRITIONAL STATUS OF SCHOOL AGE 1551 00:59:35,720 --> 00:59:37,000 CHILDREN IN LOW- AND 1552 00:59:37,000 --> 00:59:38,360 MIDDLE-INCOME COUNTRIES ACROSS 1553 00:59:38,360 --> 00:59:42,920 SEVEN GLOBAL REGIONS. 1554 00:59:42,920 --> 00:59:44,400 SYNTHESIS OF SCOPING REVIEWS, 1555 00:59:44,400 --> 00:59:46,600 THE POINT TO SHOW THAT THE 1556 00:59:46,600 --> 00:59:48,600 NUMBER OF CHILDREN IS ON THE 1557 00:59:48,600 --> 00:59:57,520 LEFT HERE, THAT MOSTOF THE, 1558 00:59:57,520 --> 00:59:59,400 ANTHROPO METRIC. 1559 00:59:59,400 --> 01:00:03,080 NEXT HIGHEST IS ANEMIA, IODINE 1560 01:00:03,080 --> 01:00:04,320 DEFICIENCY, VERY LOW, AND 1561 01:00:04,320 --> 01:00:09,320 VITAMIN A, D, AND ZINC ALSO 1562 01:00:09,320 --> 01:00:09,520 KNOW. 1563 01:00:09,520 --> 01:00:11,160 NOT VERY INFORMATIVE ON A GLOBAL 1564 01:00:11,160 --> 01:00:11,480 SCALE. 1565 01:00:11,480 --> 01:00:14,880 THIS IS PERCENT OF DEFICIENCY, 1566 01:00:14,880 --> 01:00:16,760 WIDE RANGE IN THESE REGS. 1567 01:00:16,760 --> 01:00:19,160 THE OTHER POINT HERE IS MOST OF 1568 01:00:19,160 --> 01:00:22,840 THESE STUDIES ARE IN EASTERN 1569 01:00:22,840 --> 01:00:24,320 SOUTHERN AFRICA, AND IN AFRICA 1570 01:00:24,320 --> 01:00:28,520 IN GENERAL. 1571 01:00:28,520 --> 01:00:28,920 1572 01:00:28,920 --> 01:00:33,160 FOR GOOD REASON. 1573 01:00:33,160 --> 01:00:41,320 SO, THE SCOPING REVIEW, 990 LOW 1574 01:00:41,320 --> 01:00:44,920 LOW- AND MIDDLE-INCOME 1575 01:00:44,920 --> 01:00:47,000 COUNTRIES, ANTHROPOMETRY, 1576 01:00:47,000 --> 01:00:49,160 ANEMIA, WHERE IODINE, VITAMIN A 1577 01:00:49,160 --> 01:00:50,440 AND D ZINC DEFICIENCY WERE 1578 01:00:50,440 --> 01:00:54,400 MEASURED THERE WAS A LOT OF 1579 01:00:54,400 --> 01:00:54,720 DEFICIENCY. 1580 01:00:54,720 --> 01:00:56,920 STUDIES WERE VARIABLE AGE 1581 01:00:56,920 --> 01:00:59,400 RANGES, CUT-POINTS, METHODS, SO 1582 01:00:59,400 --> 01:00:59,840 ON. 1583 01:00:59,840 --> 01:01:02,720 SO THAT MAKES INTERPRETATION 1584 01:01:02,720 --> 01:01:03,320 DIFFICULT. 1585 01:01:03,320 --> 01:01:07,240 POINT THEY MADE WAS 1586 01:01:07,240 --> 01:01:10,120 MICRONUTRIENT DEFICIENCY EXISTED 1587 01:01:10,120 --> 01:01:12,920 IN OBESOGENIC AND LOWER SES 1588 01:01:12,920 --> 01:01:14,640 ENVIRONMENT, FOOD INSECURE 1589 01:01:14,640 --> 01:01:15,080 ENVIRONMENTS. 1590 01:01:15,080 --> 01:01:17,120 MOST PROGRAM ALSO TARGETED 1591 01:01:17,120 --> 01:01:17,600 ANEMIA. 1592 01:01:17,600 --> 01:01:20,960 BUT THERE WAS LACK OF DETAILS ON 1593 01:01:20,960 --> 01:01:24,120 BASELINE STATUS, DOSE, SO ON. 1594 01:01:24,120 --> 01:01:25,560 AND FINALLY THEY FOUND 1595 01:01:25,560 --> 01:01:27,880 MICRONUTRIENT FORTIFIED FOODS 1596 01:01:27,880 --> 01:01:32,480 AND BEVERAGES HAD MORE IMPACT 1597 01:01:32,480 --> 01:01:34,000 THAN NON-FORTIFIED FOOD-BASED 1598 01:01:34,000 --> 01:01:34,400 STRATEGIES. 1599 01:01:34,400 --> 01:01:39,120 SO THERE'S A WHOLE RANGE OF 1600 01:01:39,120 --> 01:01:41,480 INTERVENTION STRATEGIES, 1601 01:01:41,480 --> 01:01:44,320 AGENCIES CONSIDER AND USE 1602 01:01:44,320 --> 01:01:45,280 INCLUDING MULTIPLE MICRONUTRIENT 1603 01:01:45,280 --> 01:01:48,120 SUPPLEMENTS AND FORTIFICATION OF 1604 01:01:48,120 --> 01:01:49,720 SCHOOL-BASED MEALS. 1605 01:01:49,720 --> 01:01:52,200 NOW, THE TYPE OF INTERVENTION 1606 01:01:52,200 --> 01:01:53,320 THAT YOU CHOOSE WILL AFFECT THE 1607 01:01:53,320 --> 01:01:55,800 AMOUNT OF TIME THAT YOU HAVE TO 1608 01:01:55,800 --> 01:02:02,120 GIVE THE INTERVENTION BEFORE YOU 1609 01:02:02,120 --> 01:02:02,960 DETECT EFFECT. 1610 01:02:02,960 --> 01:02:05,400 FOOD-BASED STRATEGIES ARE SLOW 1611 01:02:05,400 --> 01:02:07,240 TO SHOW EFFECT, ESPECIALLY 1612 01:02:07,240 --> 01:02:08,640 NON-FORTIFIED FOODS. 1613 01:02:08,640 --> 01:02:10,600 SO OFTEN WE SEE AGRICULTURE AND 1614 01:02:10,600 --> 01:02:12,920 FOOD INTERVENTIONS APPEAR TO BE 1615 01:02:12,920 --> 01:02:14,200 INEFFECTIVE BUT IN FACT THEY 1616 01:02:14,200 --> 01:02:18,160 JUST HAVEN'T BEEN DONE FOR LONG 1617 01:02:18,160 --> 01:02:18,720 ENOUGH. 1618 01:02:18,720 --> 01:02:21,040 DAILY SUPPLEMENTS AT THE DRI 1619 01:02:21,040 --> 01:02:22,640 LEVELS CAN AFFECT BIOMARKERS IN 1620 01:02:22,640 --> 01:02:24,760 WEEKS, BUT FOR SOME NUTRIENTS 1621 01:02:24,760 --> 01:02:26,120 FASTER THAN OTHERS. 1622 01:02:26,120 --> 01:02:29,960 SO IF YOU WANT TO SEE IF PEOPLE 1623 01:02:29,960 --> 01:02:32,680 ARE TAKING THEM WATER SOLUBLE 1624 01:02:32,680 --> 01:02:41,480 VITAMINS, IODINE WILL RESPOND 1625 01:02:41,480 --> 01:02:45,920 QUICKLY BUT MONTHS FOR MINERALS. 1626 01:02:45,920 --> 01:02:47,120 FORTIFIED PROVIDE LOWER AMOUNTS 1627 01:02:47,120 --> 01:02:48,480 THAN SUPPLEMENTS BUT DON'T 1628 01:02:48,480 --> 01:02:51,400 FORGET THAT PEOPLE ARE HOPEFULLY 1629 01:02:51,400 --> 01:02:55,800 CONSUMING THEM MULTIPLE TIMES A 1630 01:02:55,800 --> 01:03:00,480 DAY CONSISTENTLY AND FOR LONGER 1631 01:03:00,480 --> 01:03:02,520 TIME AND MAY SHOW MORE RESPONSE 1632 01:03:02,520 --> 01:03:04,120 THAN DAILY SUPPLEMENTS. 1633 01:03:04,120 --> 01:03:09,440 SOME MEASURES ARE STABLE FOR A 1634 01:03:09,440 --> 01:03:11,600 WHILE AFTER INTERVENTION LIKE 1635 01:03:11,600 --> 01:03:13,840 IRON AND FOLATE, SOME CHANGE 1636 01:03:13,840 --> 01:03:17,320 QUICKLY AS SOON AS YOU STOP 1637 01:03:17,320 --> 01:03:18,320 INTERVENTION, SERUM FOLATE AND 1638 01:03:18,320 --> 01:03:20,160 ZINC MIGHT FALL FAST. 1639 01:03:20,160 --> 01:03:22,160 THIS IS A REAL CONSIDERATION IN 1640 01:03:22,160 --> 01:03:23,720 SCHOOL EVALUATIONS BECAUSE YOU 1641 01:03:23,720 --> 01:03:26,400 HAVE TO WORK AROUND SCHOOL 1642 01:03:26,400 --> 01:03:26,640 BREAKS. 1643 01:03:26,640 --> 01:03:28,440 YOU MIGHT HAVE LONGER AND 1644 01:03:28,440 --> 01:03:30,560 SHORTER TIME TO INTERVENE AND 1645 01:03:30,560 --> 01:03:32,520 YOU HAVE TO COLLECT SAMPLES 1646 01:03:32,520 --> 01:03:35,160 BEFORE THE SCHOOL BREAKS. 1647 01:03:35,160 --> 01:03:37,640 COMPLIANCE IS VERY IMPORTANT. 1648 01:03:37,640 --> 01:03:39,520 YOU HAVE TO MONITOR COMPLIANCE 1649 01:03:39,520 --> 01:03:42,520 AND USE THAT AS A VARIABLE IN 1650 01:03:42,520 --> 01:03:44,680 EVALUATING THE EFFICACY AN 1651 01:03:44,680 --> 01:03:45,920 EFFECTIVENESS OF PROGRAMS. 1652 01:03:45,920 --> 01:03:47,720 HERE'S A ANIMAL SOURCE FOOD 1653 01:03:47,720 --> 01:03:52,200 INTERVENTION WE DID IN KENYAN 1654 01:03:52,200 --> 01:03:55,920 SCHOOLERS 7 TO 10 YEARS, FOR TWO 1655 01:03:55,920 --> 01:03:59,440 YEARS WE GAVE EITHER CONTROL 1656 01:03:59,440 --> 01:04:01,800 DIET, NO INTERVENTION, OR MAZE 1657 01:04:01,800 --> 01:04:04,880 AND BEANS WITH 85 GRAMS OF MEAT 1658 01:04:04,880 --> 01:04:11,000 OR 250 MILLILITERS OF MILK, OR 1659 01:04:11,000 --> 01:04:12,400 EQUICALORIC OIL EVERY DAY FOR 1660 01:04:12,400 --> 01:04:14,120 TWO YEARS DURING SCHOOL DAYS. 1661 01:04:14,120 --> 01:04:19,440 WE HAD ALL SORTS OF IMPROVEMENTS 1662 01:04:19,440 --> 01:04:21,480 WITH MEAT, FUNCTIONAL 1663 01:04:21,480 --> 01:04:24,760 IMPROVEMENT AND B-12 STATUS. 1664 01:04:24,760 --> 01:04:25,920 WITH MILK IMPROVED LINEAR GROWTH 1665 01:04:25,920 --> 01:04:28,720 OF STUNTED CHILDREN AND B-12 1666 01:04:28,720 --> 01:04:28,920 STATUS. 1667 01:04:28,920 --> 01:04:29,800 ONLY B-12 STATUS. 1668 01:04:29,800 --> 01:04:32,320 HERE'S A CHANGE IN B-12 STATUS A 1669 01:04:32,320 --> 01:04:36,360 TWO YEARS, ONE YEAR IN ORANGE, 1670 01:04:36,360 --> 01:04:39,640 TWO YEARS -- I'M SORRY, IN 1671 01:04:39,640 --> 01:04:40,800 DARKER ORANGE. 1672 01:04:40,800 --> 01:04:46,480 AND YOU CAN SEE THIS SLOW CHANGE 1673 01:04:46,480 --> 01:04:48,720 OVER TIME. 1674 01:04:48,720 --> 01:04:53,960 NO SIGNIFICANT EFFECTS ON IRON, 1675 01:04:53,960 --> 01:04:55,600 COPPER, ZINC, FOLATE, 50% STILL 1676 01:04:55,600 --> 01:04:58,520 DEFICIENT IN B-12 AT THE END. 1677 01:04:58,520 --> 01:05:00,200 DON'T EXPECT MIRACLES IN TERMS 1678 01:05:00,200 --> 01:05:01,440 OF CHANGES IN BIOCHEMICAL 1679 01:05:01,440 --> 01:05:03,000 MARKERS IF YOU'RE DOING THE 1680 01:05:03,000 --> 01:05:07,320 RIGHT THING GIVING FOODS TO 1681 01:05:07,320 --> 01:05:08,520 ANYBODY. 1682 01:05:08,520 --> 01:05:09,720 THESE WERE SCHOOLERS. 1683 01:05:09,720 --> 01:05:12,120 HOW DID SCHOOL FEEDING 1684 01:05:12,120 --> 01:05:12,480 INTERVENTIONS? 1685 01:05:12,480 --> 01:05:17,920 15 OUT OF 39 STUDIES IN THIS 1686 01:05:17,920 --> 01:05:18,680 REVIEW INCLUDED BIOMARKERS, THEY 1687 01:05:18,680 --> 01:05:21,080 HAD LOTS OF OTHER OUTCOMES. 1688 01:05:21,080 --> 01:05:27,520 THIS IS A RECENT REVIEW, 1689 01:05:27,520 --> 01:05:28,040 ANTHROPOMETRY, ATTENDANCE, 1690 01:05:28,040 --> 01:05:32,200 EDUCATION ACHIEVEMENT, COG 1691 01:05:32,200 --> 01:05:34,080 COGNITIVE FUNCTION. 1692 01:05:34,080 --> 01:05:36,160 HERE ARE THE INTERVENTIONS IN 1693 01:05:36,160 --> 01:05:37,680 DIFFERENT COUNTRIES. 1694 01:05:37,680 --> 01:05:41,760 DURATION WHICH THE INTERVENTION 1695 01:05:41,760 --> 01:05:43,280 WAS DONE AND CHANGES RESPONSE 1696 01:05:43,280 --> 01:05:44,040 WE'RE SEEING. 1697 01:05:44,040 --> 01:05:46,000 SO REALLY THEY WERE ONLY 1698 01:05:46,000 --> 01:05:49,400 MEASURING THE USUAL WHICH WAS 1699 01:05:49,400 --> 01:05:52,480 FERRITIN, IRON, ZINC, COPPER, 1700 01:05:52,480 --> 01:05:54,600 B-12, AND FOLATE. 1701 01:05:54,600 --> 01:05:56,920 AND BY AND LARGE. 1702 01:05:56,920 --> 01:05:58,760 SO BIG GENERALIZATION, IF YOU 1703 01:05:58,760 --> 01:06:02,400 GAVE VITAMIN A YOU DID SEE A 1704 01:06:02,400 --> 01:06:03,640 RESPONSE IN CAROTINOIDS, 1705 01:06:03,640 --> 01:06:05,560 RETINOL, NOT ALWAYS THOUGH. 1706 01:06:05,560 --> 01:06:08,360 HERE YOU DID NOT SEE IT, SERUM 1707 01:06:08,360 --> 01:06:09,680 VITAMIN A CHANGE. 1708 01:06:09,680 --> 01:06:12,920 GAVE ZINC SAW A CHANGE IN ZINC. 1709 01:06:12,920 --> 01:06:16,120 IF YOU GAVE FORTIFIED FOODS WITH 1710 01:06:16,120 --> 01:06:17,400 MULTIPLE MICRONUTRIENTS, THEN 1711 01:06:17,400 --> 01:06:19,760 YOU COULD HOPE TO SEE A CHANGE 1712 01:06:19,760 --> 01:06:22,640 IN ALL OF THOSE MICRONUTRIENTS. 1713 01:06:22,640 --> 01:06:25,360 YOU SEE HOW LONG SOME OF THESE 1714 01:06:25,360 --> 01:06:26,680 PROGRAMS WERE, 12 MONTHS, 18 1715 01:06:26,680 --> 01:06:32,120 MONTHS, SCHOOL YEAR AND SO ON. 1716 01:06:32,120 --> 01:06:35,640 FORTIFICATION HAS GREATER FASTER 1717 01:06:35,640 --> 01:06:42,720 IMPACT ON BIOMARKERS. 1718 01:06:42,720 --> 01:06:44,320 SUPPLEMENTS HIGHLY AVAILABLE, 1719 01:06:44,320 --> 01:06:45,680 CRYSTALLINE FORM, EATEN MULTIPLE 1720 01:06:45,680 --> 01:06:55,440 TIMES A DAY PREPARESES GIRLS. 1721 01:06:55,440 --> 01:06:58,120 YOU ASSESS BIOMARKERS OF 1722 01:06:58,120 --> 01:07:00,560 NUTRIENTS IN FORTIFIED FOODS, 1723 01:07:00,560 --> 01:07:03,920 SEE IF FORTIFICATION CAN IMPROVE 1724 01:07:03,920 --> 01:07:04,880 VALUES FROM BASELINE, CHOOSE 1725 01:07:04,880 --> 01:07:06,360 ONES THAT WILL RESPOND TO THE 1726 01:07:06,360 --> 01:07:08,360 PROGRAM AND ARE IMPORTANT FOR 1727 01:07:08,360 --> 01:07:10,320 FUNCTION AND HEALTH. 1728 01:07:10,320 --> 01:07:13,800 THIS IS AN EXAMPLE OF 1729 01:07:13,800 --> 01:07:14,800 BIOFORTIFIED CROPS. 1730 01:07:14,800 --> 01:07:18,400 AND YOU SEE THE SAME SORT OF 1731 01:07:18,400 --> 01:07:19,720 PATTERN. 1732 01:07:19,720 --> 01:07:21,080 MOSTLY VITAMIN A, ZINC, BETA 1733 01:07:21,080 --> 01:07:22,680 CAROTENE AND IRON HAVE BEEN 1734 01:07:22,680 --> 01:07:24,360 LOOKED AT. 1735 01:07:24,360 --> 01:07:27,160 AND THESE PROGRAMS HAVE BEEN RUN 1736 01:07:27,160 --> 01:07:30,200 BY AND LARGE FOR SIX MONTHS OR 1737 01:07:30,200 --> 01:07:35,560 SO. 1738 01:07:35,560 --> 01:07:35,960 FINALLY PRACTICAL 1739 01:07:35,960 --> 01:07:38,520 CONSIDERATIONS, WHEN YOU WANT TO 1740 01:07:38,520 --> 01:07:40,560 DO A BIOCHEMICAL ASSESSMENT, 1741 01:07:40,560 --> 01:07:42,720 IT'S IMPORTANT TO PREVIOUSLY 1742 01:07:42,720 --> 01:07:46,120 UNDERSTAND THE LOCAL DIETARY 1743 01:07:46,120 --> 01:07:47,240 PATTERN, UNDERSTAND LIKELY 1744 01:07:47,240 --> 01:07:48,600 DEFICIENCIES, ARE THERE CURRENT 1745 01:07:48,600 --> 01:07:50,680 PROGRAMS LIKE VITAMIN A, HIGH 1746 01:07:50,680 --> 01:07:53,720 DOSE VITAMIN A, GOING ON? 1747 01:07:53,720 --> 01:07:55,720 IS THERE SUPPLEMENTATION, IS 1748 01:07:55,720 --> 01:07:57,440 THERE FORTIFICATION OF SOME 1749 01:07:57,440 --> 01:07:59,000 FOODS IN THE COMMUNITY? 1750 01:07:59,000 --> 01:08:04,080 AND IT'S REALLY IMPORTANT TO 1751 01:08:04,080 --> 01:08:06,480 ASSESS BIOMARKERS IN SUBSAMPLE 1752 01:08:06,480 --> 01:08:07,440 TO CONFIRM DEFICIENCIES BEFORE 1753 01:08:07,440 --> 01:08:08,720 YOU DO A LARGE INTERVENTION. 1754 01:08:08,720 --> 01:08:10,920 THERE ARE SO MANY STUDIES THAT 1755 01:08:10,920 --> 01:08:13,240 DON'T SEE IMPACT OF THE 1756 01:08:13,240 --> 01:08:15,240 INTERVENTION BECAUSE THEY DIDN'T 1757 01:08:15,240 --> 01:08:17,800 HAVE DEFICIENCIES IN THE FIRST 1758 01:08:17,800 --> 01:08:19,920 PLACE BUT DIDN'T BOTHER TO LOOK 1759 01:08:19,920 --> 01:08:21,520 AND SEE WHERE THERE WERE 1760 01:08:21,520 --> 01:08:25,800 DEFICIENCY SIRS -- DEFICIENCIES 1761 01:08:25,800 --> 01:08:29,800 IN THE FIRST PLACE. 1762 01:08:29,800 --> 01:08:31,800 THERE ARE CHALLENGES IN 1763 01:08:31,800 --> 01:08:33,800 COMMUNITY SETTINGS IN SCHOOLS, 1764 01:08:33,800 --> 01:08:37,920 YOU NEED SPECIAL PERSONNEL FOR 1765 01:08:37,920 --> 01:08:40,040 VENOUS BLOOD SAMPLES VERSUS 1766 01:08:40,040 --> 01:08:42,960 CATHETER SAMPLE, NEED THE RIGHT 1767 01:08:42,960 --> 01:08:43,760 COLD CHAIN, ENOUGH BLOOD WHICH 1768 01:08:43,760 --> 01:08:46,600 CAN BE A PROBLEM FOR CHILDREN, 1769 01:08:46,600 --> 01:08:48,840 RIGHT STORAGE SPACE, CONSIDER 1770 01:08:48,840 --> 01:08:53,600 SHIPPING COSTS VERY EXPENSIVE. 1771 01:08:53,600 --> 01:08:56,360 AND THERE ARE NEW ASSAYS COMING 1772 01:08:56,360 --> 01:08:58,800 ALONG, FOR EXAMPLE THE PATH KIT, 1773 01:08:58,800 --> 01:09:01,680 YOU CAN MEASURE IRON, IODINE, 1774 01:09:01,680 --> 01:09:04,360 VITAMIN A, CRP FOR INFLAMMATION, 1775 01:09:04,360 --> 01:09:06,000 YOU MUST MEASURE INFLAMMATORY 1776 01:09:06,000 --> 01:09:10,160 MARKERS WHEN YOU DO BIOCHEMICAL 1777 01:09:10,160 --> 01:09:10,800 VALUES BECAUSE INFORMATION 1778 01:09:10,800 --> 01:09:14,520 CHANGES VALUES QUITE A LOT. 1779 01:09:14,520 --> 01:09:17,360 AND ALSO DEFECTS MALARIA. 1780 01:09:17,360 --> 01:09:21,320 AND THIS IS $1.40 PER ANALYTE, 8 1781 01:09:21,320 --> 01:09:22,440 MICRO LITERS OF SAMPLE. 1782 01:09:22,440 --> 01:09:24,320 IF YOU'RE MORE SOPHISTICATED YOU 1783 01:09:24,320 --> 01:09:28,600 CAN MEASURE MULTIPLE B VITAMINS 1784 01:09:28,600 --> 01:09:30,200 SIMULTANEOUSLY WITH MASS 1785 01:09:30,200 --> 01:09:30,760 SPECTROMETRY, FOR EXAMPLE. 1786 01:09:30,760 --> 01:09:35,120 THIS HELPS AS FAR AS METHODOLOGY 1787 01:09:35,120 --> 01:09:35,440 GOES. 1788 01:09:35,440 --> 01:09:37,720 SO FINALLY, DIETARY AND 1789 01:09:37,720 --> 01:09:39,720 BIOCHEMICAL DATA ARE 1790 01:09:39,720 --> 01:09:40,600 COMPLEMENTARY, YOU NEED BOTH. 1791 01:09:40,600 --> 01:09:45,400 THERE ARE FEW DATA ON SCHOOLERS. 1792 01:09:45,400 --> 01:09:50,680 MOSTLY IRON, ZINC, VITAMINS A&D 1793 01:09:50,680 --> 01:09:53,640 DEFICIENCIES SOMETIMES IODINE 1794 01:09:53,640 --> 01:09:55,920 AND FOLATE, DEFICIENCY EXPECTED 1795 01:09:55,920 --> 01:09:56,760 OR ISSUE ON ADOLESCENT PREGNANCY 1796 01:09:56,760 --> 01:09:59,720 FOR EXAMPLE. 1797 01:09:59,720 --> 01:10:01,920 YOU HAVE TO CHOOSE THE PURPOSE, 1798 01:10:01,920 --> 01:10:04,480 LOOK AT THE PURPOSE THAT YOU 1799 01:10:04,480 --> 01:10:06,200 WANT TO USE YOUR BIOMARKER FOR. 1800 01:10:06,200 --> 01:10:08,120 ARE YOU GOING TO DO ANYTHING 1801 01:10:08,120 --> 01:10:09,240 WITH THE DATA? 1802 01:10:09,240 --> 01:10:11,600 YOU HAVE TO WORRY ABOUT HOW LONG 1803 01:10:11,600 --> 01:10:13,320 YOUR INTERVENTION IS. 1804 01:10:13,320 --> 01:10:14,880 USUALLY THE INTERVENTION IS 1805 01:10:14,880 --> 01:10:16,720 DESIGNED FOR OTHER REASONS AND 1806 01:10:16,720 --> 01:10:17,920 THEN YOU MEASURE BIOMARKERS. 1807 01:10:17,920 --> 01:10:20,120 BUT YOU SHOULD DESIGN THE 1808 01:10:20,120 --> 01:10:22,040 INTERVENTION TO BE LONG ENOUGH 1809 01:10:22,040 --> 01:10:25,560 THAT YOU WOULD SEE THE BIOMARKER 1810 01:10:25,560 --> 01:10:26,000 CHANGES. 1811 01:10:26,000 --> 01:10:30,560 LESS LIKELY TO DETECT RESPONSES 1812 01:10:30,560 --> 01:10:31,880 TO FOOD. 1813 01:10:31,880 --> 01:10:33,400 YOU WANT TO CHOOSE MARKERS 1814 01:10:33,400 --> 01:10:36,320 LIKELY TO RESPOND AND HAVE, 1815 01:10:36,320 --> 01:10:38,040 QUOTE, FUNCTIONAL IMPORTANCE. 1816 01:10:38,040 --> 01:10:40,360 I'VE ALWAYS BELIEVED ALL 1817 01:10:40,360 --> 01:10:42,160 NUTRIENTS ARE IMPORTANT AND FOR 1818 01:10:42,160 --> 01:10:46,000 MANY OF THESE HERE WE JUST 1819 01:10:46,000 --> 01:10:48,520 HAVEN'T PROPERLY UNDERSTOOD 1820 01:10:48,520 --> 01:10:51,080 THEIR IMPORTANCE IN POPULATION 1821 01:10:51,080 --> 01:10:51,320 STATUS. 1822 01:10:51,320 --> 01:10:54,720 AND THIS IS AN OLDER VIEW THAN 1823 01:10:54,720 --> 01:10:57,440 DECISIONS YOU WOULD MAKE, WHAT 1824 01:10:57,440 --> 01:10:59,400 IS RISK OF DEFICIENCY, AND USE 1825 01:10:59,400 --> 01:11:01,320 DIETARY DATA AS WELL AS EXISTING 1826 01:11:01,320 --> 01:11:06,120 PROGRAM DATA AND SO ON. 1827 01:11:06,120 --> 01:11:08,080 TYPE OF INTERVENTION, WHAT IS IT 1828 01:11:08,080 --> 01:11:10,320 GOING TO BE, FOODS OR 1829 01:11:10,320 --> 01:11:11,120 SUPPLEMENTS OR FORTIFICATION, 1830 01:11:11,120 --> 01:11:14,320 WHY DO YOU WANT THE DATA? 1831 01:11:14,320 --> 01:11:15,720 WHAT ARE THE CHARACTERISTICS OF 1832 01:11:15,720 --> 01:11:16,320 BIOMARKERS? 1833 01:11:16,320 --> 01:11:17,920 ARE THEY GOING TO RESPOND? 1834 01:11:17,920 --> 01:11:20,280 ARE THEY IMPORTANT FOR FUNCTION? 1835 01:11:20,280 --> 01:11:22,320 AND FINALLY THE LOGISTICS AND 1836 01:11:22,320 --> 01:11:24,920 COST OF COLLECTION AND ANALYSIS. 1837 01:11:24,920 --> 01:11:28,400 I THINK THAT IS THE END OF MY 1838 01:11:28,400 --> 01:11:28,720 PRESENTATION. 1839 01:11:28,720 --> 01:11:28,920 YEAH. 1840 01:11:28,920 --> 01:11:35,240 THANK YOU VERY MUCH. 1841 01:11:35,240 --> 01:11:36,760 >> THANK YOU, DOCTOR. 1842 01:11:36,760 --> 01:11:39,520 WE'LL MOVE TO THE NEXT 1843 01:11:39,520 --> 01:11:45,640 PRESENTATION, BY DR. CHRISTOPHER 1844 01:11:45,640 --> 01:11:46,680 DUGGAN, BOSTON CHILDREN'S 1845 01:11:46,680 --> 01:11:47,720 HOSPITAL, CENTER FOR NUTRITION, 1846 01:11:47,720 --> 01:11:54,680 EDITOR IN CHIEF OF AMERICAN 1847 01:11:54,680 --> 01:11:56,560 JOURNAL OF CLINICAL NUTRITION. 1848 01:11:56,560 --> 01:11:58,960 OVER TO YOU, CHRIS. 1849 01:11:58,960 --> 01:12:00,800 >> THANKS FOR JOINING THIS 1850 01:12:00,800 --> 01:12:01,320 MORNING. 1851 01:12:01,320 --> 01:12:04,520 WE CAN CONFIRM YOU SEE ONE 1852 01:12:04,520 --> 01:12:05,000 SLIDE? 1853 01:12:05,000 --> 01:12:05,560 >> YES. 1854 01:12:05,560 --> 01:12:06,600 >> EXCELLENT. 1855 01:12:06,600 --> 01:12:08,160 THANKS FOR THE INTRODUCTION. 1856 01:12:08,160 --> 01:12:11,880 WORKING GROUP 2 TOUCHED UPON THE 1857 01:12:11,880 --> 01:12:12,960 METABOLIC NEEDS OF ADOLESCENTS 1858 01:12:12,960 --> 01:12:18,000 BUT THIS VERY IMPACT FINANCIAL 1859 01:12:18,000 --> 01:12:19,320 PAPER PUBLISHED BY HERMAN 1860 01:12:19,320 --> 01:12:21,680 UPONTZER AND COLLEAGUES IS WORTH 1861 01:12:21,680 --> 01:12:23,280 REVIEWING POINTING OUT ADJUSTED 1862 01:12:23,280 --> 01:12:25,040 TOTAL ENERGY INTAKE IS MEASURED 1863 01:12:25,040 --> 01:12:28,360 BY DOUBLY LABELED WATER REALLY 1864 01:12:28,360 --> 01:12:29,240 ADJUSTED FOR BODY COMPOSITION, 1865 01:12:29,240 --> 01:12:30,560 OBVIOUSLY VERY HIGH IN EARLY 1866 01:12:30,560 --> 01:12:33,000 INFANCY BUT IN THE AGE GROUP 1867 01:12:33,000 --> 01:12:34,720 WE'RE TALKING ABOUT REALLY 1868 01:12:34,720 --> 01:12:36,480 BECOMES QUITE VARIABLE, MULTIPLE 1869 01:12:36,480 --> 01:12:38,520 CHANGES OVER TIME, SEX 1870 01:12:38,520 --> 01:12:39,600 DIFFERENCES BECOME APPARENT IN 1871 01:12:39,600 --> 01:12:42,160 OUR AGE GROUP AS WELL. 1872 01:12:42,160 --> 01:12:44,040 SO THIS REALLY CALLS TO MIND AND 1873 01:12:44,040 --> 01:12:46,880 REITERATES IMPORTANCE OF LOOKING 1874 01:12:46,880 --> 01:12:49,440 AT SCHOOL AGED CHILDREN AS BEING 1875 01:12:49,440 --> 01:12:51,800 PERHAPS A UNIQUE BRIDGE AS I 1876 01:12:51,800 --> 01:12:53,040 THINK THE WORKING GROUP 2 1877 01:12:53,040 --> 01:12:55,240 POINTED OUT, A BRIDGE BETWEEN 1878 01:12:55,240 --> 01:12:59,120 THE HIGH METABOLIC NEEDS OF 1879 01:12:59,120 --> 01:13:01,760 INFANCY AND STABLE PATTERN IN 1880 01:13:01,760 --> 01:13:02,320 ADULTHOOD. 1881 01:13:02,320 --> 01:13:04,480 I WAS ASKED TO ADDRESS HOW 1882 01:13:04,480 --> 01:13:06,120 CLINICAL ASSESSMENTS OF 1883 01:13:06,120 --> 01:13:07,400 NUTRITIONAL STATUS COULD 1884 01:13:07,400 --> 01:13:08,880 CONTRIBUTE TO SCIENTIFIC 1885 01:13:08,880 --> 01:13:10,360 MEASURES OF POPULATION 1886 01:13:10,360 --> 01:13:11,400 NUTRITIONAL STATUS IN HEALTH. 1887 01:13:11,400 --> 01:13:13,360 AND INDEED THERE ARE SOME 1888 01:13:13,360 --> 01:13:15,760 ADVANTAGES OF THIS APPROACH. 1889 01:13:15,760 --> 01:13:17,920 THERE ARE VARIOUS WELL-KNOWN 1890 01:13:17,920 --> 01:13:20,160 WELL-TAUGHT MEDICAL SCHOOL SIGNS 1891 01:13:20,160 --> 01:13:22,400 AND SYMPTOMS OF NUTRIENT 1892 01:13:22,400 --> 01:13:22,720 DEFICIENCIES. 1893 01:13:22,720 --> 01:13:26,440 AND INDEED THEY TEND TO BE 1894 01:13:26,440 --> 01:13:27,040 NON-INVASIVE MEASURES OF 1895 01:13:27,040 --> 01:13:29,160 NUTRITIONAL STATUS BECAUSE OFTEN 1896 01:13:29,160 --> 01:13:31,120 IT'S JUST PHYSICAL EXAMINATION 1897 01:13:31,120 --> 01:13:32,920 OR DIRECT OBSERVATION OF 1898 01:13:32,920 --> 01:13:37,120 PATIENTS OR GROUPS OF CHILDREN. 1899 01:13:37,120 --> 01:13:39,040 AND AS A RESULT THERE TEND TO BE 1900 01:13:39,040 --> 01:13:43,400 LOWER COSTS THAN BIOCHEMICAL OR 1901 01:13:43,400 --> 01:13:44,880 FANCY GLASSES THAT MEASURE 1902 01:13:44,880 --> 01:13:46,840 DIETARY INTAKE BUT THEY ARE NOT 1903 01:13:46,840 --> 01:13:49,400 ZERO COST BECAUSE WE NEED 1904 01:13:49,400 --> 01:13:51,920 TRAINED OBSERVERS TO CARRY THEM 1905 01:13:51,920 --> 01:13:53,760 OUT. 1906 01:13:53,760 --> 01:13:59,240 AND AS I WAS SAYING THERE'S SOME 1907 01:13:59,240 --> 01:14:05,240 PRIMA FACIE VALIDITY, YOU ARE 1908 01:14:05,240 --> 01:14:07,360 CLEARLY IDENTIFYING PEOPLE WHO 1909 01:14:07,360 --> 01:14:08,720 ARE AFFECTED IN A 1910 01:14:08,720 --> 01:14:10,200 PATHOPHYSIOLOGIC WAY BY THIS 1911 01:14:10,200 --> 01:14:12,160 NUTRITIONAL DEFICIENCY. 1912 01:14:12,160 --> 01:14:13,160 THERE'S NO DISCUSSION OF 1913 01:14:13,160 --> 01:14:14,680 SUBCLINICAL DEFICIENCIES. 1914 01:14:14,680 --> 01:14:16,640 SO YOU CAN CONFIRM THAT YOU'RE 1915 01:14:16,640 --> 01:14:18,200 NOT JUST TREATING THE LAB RESULT 1916 01:14:18,200 --> 01:14:25,320 OR A LOW BLOOD LEVEL BUT YOU ARE 1917 01:14:25,320 --> 01:14:27,160 IMPACTING A CLINICAL ENTITY. 1918 01:14:27,160 --> 01:14:29,000 I'VE INCLUDED A NUMBER OF 1919 01:14:29,000 --> 01:14:31,720 CLINICAL SIGNS THAT ARE APPARENT 1920 01:14:31,720 --> 01:14:33,200 BY THE PHYSICAL EXAMINATION. 1921 01:14:33,200 --> 01:14:35,360 THIRD COLUMN POINTED OUT WHAT 1922 01:14:35,360 --> 01:14:37,040 NUTRIENT DEFICIENCIES THOSE HAVE 1923 01:14:37,040 --> 01:14:39,280 BEEN ATTRIBUTABLE TO BUT AS YOU 1924 01:14:39,280 --> 01:14:42,240 CAN QUICKLY POINT OUT YOU CAN 1925 01:14:42,240 --> 01:14:46,920 SEE THAT MULTIPLE NUTRIENT 1926 01:14:46,920 --> 01:14:49,440 DEFICIENCIES, B VITAMINS HAVE 1927 01:14:49,440 --> 01:14:58,360 BEEN ATTRIBUTED TO CAUSE NASAL 1928 01:14:58,360 --> 01:15:04,960 SEBORHEA, AND THE LIST GOES ON. 1929 01:15:04,960 --> 01:15:06,000 AND CERTAINLY PROTEIN ENERGY 1930 01:15:06,000 --> 01:15:09,560 MALNUTRITION CAN SHOW PHYSICAL 1931 01:15:09,560 --> 01:15:12,920 SIGNS AND SYMPTOMS AS WELL. 1932 01:15:12,920 --> 01:15:15,480 SO THERE ARE MANY LIMITATIONS 1933 01:15:15,480 --> 01:15:17,720 ABOUT THE PHYSICAL EXAMINATION 1934 01:15:17,720 --> 01:15:19,080 AND CLINICAL PRESENTATION. 1935 01:15:19,080 --> 01:15:22,360 CERTAINLY IF YOU RELY ONLY ON 1936 01:15:22,360 --> 01:15:23,720 CLINICALLY APPARENT NUTRITIONAL 1937 01:15:23,720 --> 01:15:24,680 DEFICIENCIES YOU'RE DEFINING THE 1938 01:15:24,680 --> 01:15:26,120 FIELD BASED ON THE TIP OF THE 1939 01:15:26,120 --> 01:15:28,720 ICEBERG, IF YOU WILL. 1940 01:15:28,720 --> 01:15:30,200 NEGLECTING AND NOT KNOWING THE 1941 01:15:30,200 --> 01:15:32,920 SIZE OF THE NUTRIENT PROBLEM 1942 01:15:32,920 --> 01:15:34,320 THAT'S UNDERWATER, IF YOU WILL. 1943 01:15:34,320 --> 01:15:35,480 AND I THINK THERE'S REASONABLE 1944 01:15:35,480 --> 01:15:38,120 AND GOOD DATA TO SUGGEST THAT 1945 01:15:38,120 --> 01:15:41,080 MANY FUNCTIONAL CHANGES OCCUR IN 1946 01:15:41,080 --> 01:15:42,960 THE BODY THAT PRECEDE CLINICAL 1947 01:15:42,960 --> 01:15:45,360 SOMETIMES OR SYMPTOMS, NOT ONLY 1948 01:15:45,360 --> 01:15:47,640 ARE YOU SEEING MORE SEVERE 1949 01:15:47,640 --> 01:15:49,400 DEFICIENCIES THAT ARE CLINICALLY 1950 01:15:49,400 --> 01:15:52,760 APPARENT BUT HAVING TO WAIT 1951 01:15:52,760 --> 01:15:56,720 DEPENDING ON AGE AND NUTRIENT 1952 01:15:56,720 --> 01:16:01,960 METABOLISM WEEKS TO MONTHS TO 1953 01:16:01,960 --> 01:16:03,840 YEARS OF BEING CLINICALLY 1954 01:16:03,840 --> 01:16:06,640 APPARENT, OBVIOUSLY YOU DON'T 1955 01:16:06,640 --> 01:16:08,320 WANT TO WAIT THAT LONG FOR 1956 01:16:08,320 --> 01:16:10,120 SOMEONE TO BE CLINICALLY 1957 01:16:10,120 --> 01:16:10,360 DEFICIENT. 1958 01:16:10,360 --> 01:16:11,600 OTHER LIMITATION ALSO I ALLUDED 1959 01:16:11,600 --> 01:16:13,280 TO EARLIER, THE FACT THAT MANY 1960 01:16:13,280 --> 01:16:16,280 OF THE SIGNS AND SYMPTOMS ARE 1961 01:16:16,280 --> 01:16:19,440 NOT SPECIFIC FOR A SPECIFIC 1962 01:16:19,440 --> 01:16:21,480 VITAMIN, MINERAL OR 1963 01:16:21,480 --> 01:16:24,480 MACRONUTRIENT DEFICIENCY AND 1964 01:16:24,480 --> 01:16:26,720 THERE'S THE TRICKY ISSUE OF 1965 01:16:26,720 --> 01:16:28,680 ENTER-OBSERVER VARIABILITY. 1966 01:16:28,680 --> 01:16:32,400 MANY PEOPLE HAVE DIFFERENT WAYS 1967 01:16:32,400 --> 01:16:33,320 OF ASSESSING CHILDREN, 1968 01:16:33,320 --> 01:16:35,880 SCHOOL-AGE CHILDREN FROM A 1969 01:16:35,880 --> 01:16:37,000 CLINICAL PERSPECTIVE. 1970 01:16:37,000 --> 01:16:41,360 AND SO I THOUGHT THE CASE 1971 01:16:41,360 --> 01:16:43,840 EXAMPLE OF THE EYE SIGNS OF 1972 01:16:43,840 --> 01:16:45,000 VITAMIN A DEFICIENCY MIGHT BE 1973 01:16:45,000 --> 01:17:02,640 VERY HELP FINANCIAL IN -- 1974 01:17:02,640 --> 01:17:03,920 HELPFUL. 1975 01:17:03,920 --> 01:17:05,160 THIS GETS ESTABLISHED OFTEN ON 1976 01:17:05,160 --> 01:17:08,040 THE SIDE OF THE CONJUNCTIVA NEXT 1977 01:17:08,040 --> 01:17:11,000 TO THE CORNEA THERE, AND THE 1978 01:17:11,000 --> 01:17:13,120 SPOTS ARE QUITE DRAMATIC 1979 01:17:13,120 --> 01:17:14,960 PRESENTATION AND INTERESTINGLY 1980 01:17:14,960 --> 01:17:16,640 VERY SPECIFIC PRESENTATION OF 1981 01:17:16,640 --> 01:17:17,280 VITAMIN A DEFICIENCY. 1982 01:17:17,280 --> 01:17:18,920 AND SO I THOUGHT IN REVIEWING 1983 01:17:18,920 --> 01:17:21,520 LITERATURE I WOULD BE ABLE TO 1984 01:17:21,520 --> 01:17:24,440 FIND DATA TO SUGGEST THAT INDEED 1985 01:17:24,440 --> 01:17:26,280 PEOPLE COULD BE TRAINED TO 1986 01:17:26,280 --> 01:17:27,320 IDENTIFY BETO SPOTS. 1987 01:17:27,320 --> 01:17:28,520 AS A YOUNG STUDENT MANY YEARS 1988 01:17:28,520 --> 01:17:30,680 AGO I WAS INVOLVED IN A VITAMIN 1989 01:17:30,680 --> 01:17:33,040 A SURVEY WITH KEITH WEST AND AL 1990 01:17:33,040 --> 01:17:36,080 SUMNER AND COLLEAGUES AT HOPKINS 1991 01:17:36,080 --> 01:17:37,680 THAT HAD DISTINCT FORMATIVE 1992 01:17:37,680 --> 01:17:39,720 IMPACT ON MY CAREER. 1993 01:17:39,720 --> 01:17:41,360 AND I THOUGHT, WELL, THERE MUST 1994 01:17:41,360 --> 01:17:42,480 BE GOOD LITERATURE BUT I WASN'T 1995 01:17:42,480 --> 01:17:43,920 ABLE TO FIND IT. 1996 01:17:43,920 --> 01:17:47,120 I FOUND THE OPPOSITE. 1997 01:17:47,120 --> 01:17:54,560 THIS IS A PAPER BY A 1998 01:17:54,560 --> 01:17:56,920 GASTROENTEROLOGIST I THINK AS 1999 01:17:56,920 --> 01:18:01,880 TEXAS, EVALUATING CHILDREN WITH 2000 01:18:01,880 --> 01:18:07,120 B.A., BILIARY ATRESION, SEVERE 2001 01:18:07,120 --> 01:18:09,160 ELEVATION IN SERUM BILIRUBIN 2002 01:18:09,160 --> 01:18:11,480 DESPITE THEM RECEIVING VITAMIN A 2003 01:18:11,480 --> 01:18:13,320 SUPPLEMENTATION, TEN CHILDREN 2004 01:18:13,320 --> 01:18:14,880 BASED ON THE RETINAL GOES 2005 01:18:14,880 --> 01:18:17,440 RESPONSE CONVINCING EVIDENCE OF 2006 01:18:17,440 --> 01:18:18,920 BIOCHEMICAL VITAMIN A 2007 01:18:18,920 --> 01:18:19,360 DEFICIENCY. 2008 01:18:19,360 --> 01:18:21,040 AND THEY COMPARED THE CLINICAL 2009 01:18:21,040 --> 01:18:23,920 SIGNS AND SYMPTOMS OF VITAMIN A 2010 01:18:23,920 --> 01:18:25,560 DEFICIENCY WITH 23 CHILDREN 2011 01:18:25,560 --> 01:18:29,520 HEALTHY WITH NO EVIDENCE OF 2012 01:18:29,520 --> 01:18:30,760 BIOCHEMICAL EVIDENCE OF VITAMIN 2013 01:18:30,760 --> 01:18:32,000 A DEFICIENCY. 2014 01:18:32,000 --> 01:18:34,360 PHYSICAL SIGNS AND SYMPTOMS WERE 2015 01:18:34,360 --> 01:18:36,800 A VARIETY OF OCULAR TESTS. 2016 01:18:36,800 --> 01:18:39,520 THESE ARE LISTED HERE. 2017 01:18:39,520 --> 01:18:41,040 THIS IS THE CONJUNCTIVAL 2018 01:18:41,040 --> 01:18:42,960 IMPRESSION PSYCHOLOGY, A MEASURE 2019 01:18:42,960 --> 01:18:44,240 OF THE EPITHELIAL CHANGES THAT 2020 01:18:44,240 --> 01:18:50,320 HAPPEN IN THE CON JUNG 2021 01:18:50,320 --> 01:18:54,520 CONJUNCTIVA, SLIT LAMP EXAM IS 2022 01:18:54,520 --> 01:18:56,920 DETAILED EXAMINATION OF THE 2023 01:18:56,920 --> 01:18:58,920 INNER CHAMBER OF THE EYE, THIS 2024 01:18:58,920 --> 01:19:05,400 IS HOW READILY YOUR EYES PRODUCE 2025 01:19:05,400 --> 01:19:09,480 TEARS AND THE CHERMER TEST 2026 01:19:09,480 --> 01:19:10,280 MEASURES MOISTNESS OF 2027 01:19:10,280 --> 01:19:11,000 CONJUNCTIVA. 2028 01:19:11,000 --> 01:19:14,800 IN THESE TEN PATIENTS WITH 2029 01:19:14,800 --> 01:19:16,440 CONFIRMED BIOCHEMICAL AND REALLY 2030 01:19:16,440 --> 01:19:19,080 VARIETY OF WAYS THEY ARE VITAMIN 2031 01:19:19,080 --> 01:19:22,320 A DEFICIENT YOU CAN SEE A LARGE 2032 01:19:22,320 --> 01:19:24,520 NUMBER OF 50 TO 80% OF THE 2033 01:19:24,520 --> 01:19:26,240 ADMITTEDLY SMALL NUMBER OF 2034 01:19:26,240 --> 01:19:29,600 CHILDREN HAD NORMAL MEASURES OF 2035 01:19:29,600 --> 01:19:30,200 CLINICAL EXAMINATIONS THAT 2036 01:19:30,200 --> 01:19:32,040 PURPORT TO BE SPECIFIC FOR 2037 01:19:32,040 --> 01:19:35,120 VITAMIN A DEFICIENCY AND 2038 01:19:35,120 --> 01:19:35,800 CONCURRENTLY 23 HEALTHY 2039 01:19:35,800 --> 01:19:38,520 CONTROLS, YOU KNOW, IN SOME 2040 01:19:38,520 --> 01:19:41,600 CASES MORE HAD ABNORMAL 2041 01:19:41,600 --> 01:19:42,680 CONJUNCTIVAL OR CLINICAL 2042 01:19:42,680 --> 01:19:44,680 MEASURES OF VITAMIN A DEFICIENCY 2043 01:19:44,680 --> 01:19:47,120 THAN WERE FOUND TO BE NORMAL. 2044 01:19:47,120 --> 01:19:50,360 SO TO MY MIND, THAT WAS TRULY 2045 01:19:50,360 --> 01:19:52,240 DAMNING EVIDENCE THAT AT LEAST 2046 01:19:52,240 --> 01:19:55,840 IN THIS SPECIFIC NUTRIENT 2047 01:19:55,840 --> 01:19:56,440 DEFICIENCY, CLINICAL SIGNS AND 2048 01:19:56,440 --> 01:19:59,200 SYMPTOMS MAY NOT BE AS HELPFUL 2049 01:19:59,200 --> 01:20:01,680 AS ONE WOULD THINK. 2050 01:20:01,680 --> 01:20:07,200 SO, THAT REALLY LED ME TO 2051 01:20:07,200 --> 01:20:16,160 APPROACH THE IDEA WHETHER OTHER 2052 01:20:16,160 --> 01:20:18,160 TOOLS WERE CLINICALLY BASED, AND 2053 01:20:18,160 --> 01:20:20,320 THAT HAS LED ME TO INVESTIGATE 2054 01:20:20,320 --> 01:20:21,840 THESE VARIOUS SCREENING TOOLS 2055 01:20:21,840 --> 01:20:23,640 WHICH HAVE A VARIETY OF 2056 01:20:23,640 --> 01:20:24,080 ACRONYMS. 2057 01:20:24,080 --> 01:20:26,760 I'VE ONLY PICKED THE TWO PERHAPS 2058 01:20:26,760 --> 01:20:29,040 MOST COMMONLY USED ONES, THE 2059 01:20:29,040 --> 01:20:34,520 SCREENING TOOL FOR ASSESSMENT OF 2060 01:20:34,520 --> 01:20:37,480 MALNUTRITION, SCAMP TOOL, AND 2061 01:20:37,480 --> 01:20:39,480 SCREENING TOOL, BOTH OF THESE 2062 01:20:39,480 --> 01:20:44,280 TOOLS HAVE BEEN VALIDATED IN A 2063 01:20:44,280 --> 01:20:46,160 WIDE RANGE OF CHILDREN. 2064 01:20:46,160 --> 01:20:48,840 HERE'S THE STRONG KIDS TOOL 2065 01:20:48,840 --> 01:20:50,840 BETWEEN AGE ALSO 6 MONTHS AND 18 2066 01:20:50,840 --> 01:20:55,520 YEARS ON ADMISSION TO HOSPITAL. 2067 01:20:55,520 --> 01:20:57,720 IT'S A ZERO TO 5 SCALING SYSTEM 2068 01:20:57,720 --> 01:21:01,840 IN WHICH CHILDREN WHO SCORE 4 TO 2069 01:21:01,840 --> 01:21:04,880 5 HIGH RISK OF NUTRITIONAL 2070 01:21:04,880 --> 01:21:09,120 DEFICIENCY VERSUS LOW VERSUS 2071 01:21:09,120 --> 01:21:09,600 MEDIUM RISK. 2072 01:21:09,600 --> 01:21:11,120 INDEED THE FOUR QUESTIONS, IF 2073 01:21:11,120 --> 01:21:13,040 YOU WILL, ARE BASED ON WHETHER 2074 01:21:13,040 --> 01:21:16,040 THERE'S AN UNDERLYING ILLNESS AT 2075 01:21:16,040 --> 01:21:17,400 RISK FOR MALNUTRITION, SO-CALLED 2076 01:21:17,400 --> 01:21:18,920 HIGH RISK DISEASES ARE NOTED IN 2077 01:21:18,920 --> 01:21:21,120 THE BOX ON THE RIGHT. 2078 01:21:21,120 --> 01:21:23,080 WHETHER THERE'S A SUBJECTIVE 2079 01:21:23,080 --> 01:21:25,520 CLINICAL ASSESSMENT OF LOSS OF 2080 01:21:25,520 --> 01:21:27,120 CUTANEOUS FAT OR MUSCLE MASS, 2081 01:21:27,120 --> 01:21:30,600 THAT GETS YOU ANOTHER POINT. 2082 01:21:30,600 --> 01:21:33,160 AND WHETHER A CHILD HAS 2083 01:21:33,160 --> 01:21:35,240 DIARRHEA, ANOREXIA, OR OTHER 2084 01:21:35,240 --> 01:21:36,440 REQUIREMENTS FOR PREVIOUS 2085 01:21:36,440 --> 01:21:37,080 NUTRITIONAL INTERVENTIONS GIVES 2086 01:21:37,080 --> 01:21:38,400 YOU ANOTHER SCORE, ET CETERA. 2087 01:21:38,400 --> 01:21:41,640 SO THAT IS A KIND OF QUICK AND 2088 01:21:41,640 --> 01:21:44,320 EASY MEASURE OF NUTRITIONAL 2089 01:21:44,320 --> 01:21:44,520 STATUS. 2090 01:21:44,520 --> 01:21:45,680 AND AS I MENTIONED, THEY HAVE 2091 01:21:45,680 --> 01:21:47,440 BEEN STUDIED IN A VARIETY OF 2092 01:21:47,440 --> 01:21:49,760 DIFFERENT POPULATIONS. 2093 01:21:49,760 --> 01:21:54,120 THIS IS A PUBLICATION WHICH 2094 01:21:54,120 --> 01:21:54,800 LOOKED AT CONTINUOUS 2095 01:21:54,800 --> 01:21:55,680 CORRELATION, BETWEEN THE SCORE 2096 01:21:55,680 --> 01:21:59,080 ON STRONG AND WEIGHT FOR HEIGHT 2097 01:21:59,080 --> 01:22:02,680 Z SCORES, YOU CAN SEE A POOR 2098 01:22:02,680 --> 01:22:04,720 CORRELATION IN SETTING OF 2099 01:22:04,720 --> 01:22:07,080 STUNTING, MODERATE IN WASTING, 2100 01:22:07,080 --> 01:22:10,920 AND SENSITIVE AND SPECIFIC 2101 01:22:10,920 --> 01:22:12,040 SPECIFICITY, ET CETERA. 2102 01:22:12,040 --> 01:22:15,280 THE STAMP SCREENING TOOL IS VERY 2103 01:22:15,280 --> 01:22:18,040 ANALOGOUS, AGAIN A SCALE OF ZERO 2104 01:22:18,040 --> 01:22:20,680 TO 3 OR 4, ITS SEEMS HIGH RISK 2105 01:22:20,680 --> 01:22:22,880 IS GREATER THAN OR EQUAL TO 4, 2106 01:22:22,880 --> 01:22:25,920 MEDIUM 2 TO 3, LOW 0 TO 1, 2107 01:22:25,920 --> 01:22:28,080 SIMILARLY A LONG LIST OF 2108 01:22:28,080 --> 01:22:30,880 DIAGNOSES THAT HAVE DEFINITIVE 2109 01:22:30,880 --> 01:22:32,160 OR POSSIBLE NUTRITIONAL 2110 01:22:32,160 --> 01:22:33,840 IMPLICATIONS THAT ARE SCORED. 2111 01:22:33,840 --> 01:22:37,040 WHETHER THE CHILD IS HAVING NO 2112 01:22:37,040 --> 01:22:37,760 NUTRITIONAL INTAKE, RECENTLY 2113 01:22:37,760 --> 01:22:40,600 DECREASED OR POOR NUTRITIONAL 2114 01:22:40,600 --> 01:22:42,040 INTAKE OR NO CHANGE, THEY GET 2115 01:22:42,040 --> 01:22:43,840 SCORED THAT WAY. 2116 01:22:43,840 --> 01:22:45,760 THERE'S A ROUGH MEASURE OF 2117 01:22:45,760 --> 01:22:49,640 WHETHER THE CHILD IS AT OR BELOW 2118 01:22:49,640 --> 01:22:52,760 VARIOUS SEX AND AGE-SPECIFIC 2119 01:22:52,760 --> 01:22:53,840 PERCENTILES. 2120 01:22:53,840 --> 01:22:55,440 SO I THINK THE STAMP SCORE IS A 2121 01:22:55,440 --> 01:22:56,160 NICE ONE. 2122 01:22:56,160 --> 01:22:59,360 THIS IS A VERY NICE VALIDATION 2123 01:22:59,360 --> 01:23:03,000 PAPER OF A LARGE NUMBER OF 2124 01:23:03,000 --> 01:23:05,840 CHILDREN OF ALL AGES, 2500 2125 01:23:05,840 --> 01:23:07,200 CHILDREN AT 14 HOSPITALS, 12 2126 01:23:07,200 --> 01:23:08,000 EUROPEAN COUNTRIES. 2127 01:23:08,000 --> 01:23:11,320 I FORGET, THIS IS A THIRD 2128 01:23:11,320 --> 01:23:14,240 SCREENING TOOL THAT PEDIATRIC 2129 01:23:14,240 --> 01:23:17,400 MALNUTRITION SCORE. 2130 01:23:17,400 --> 01:23:19,880 OF THE TWO I REVIEWED THERE WAS 2131 01:23:19,880 --> 01:23:20,840 LINEAR AND SIGNIFICANT 2132 01:23:20,840 --> 01:23:21,880 RELATIONSHIP BETWEEN SCORING 2133 01:23:21,880 --> 01:23:23,920 LOW, MEDIUM OR HIGH, LOW BEING 2134 01:23:23,920 --> 01:23:25,640 REFERENCE GROUP, CHILDREN WHO 2135 01:23:25,640 --> 01:23:27,760 SCORED MEDIUM OR HIGH HAD ON 2136 01:23:27,760 --> 01:23:30,480 AVERAGE A DAY OR TWO DAYS 2137 01:23:30,480 --> 01:23:33,000 ADDITIONAL LENGTH OF STAY IN THE 2138 01:23:33,000 --> 01:23:33,760 HOSPITAL. 2139 01:23:33,760 --> 01:23:35,520 LENDING CREDENCE TO THE FACT 2140 01:23:35,520 --> 01:23:37,960 SCREENING TOOLS DO MEASURE A 2141 01:23:37,960 --> 01:23:39,720 CLINICALLY IMPORTANT FEATURE OF 2142 01:23:39,720 --> 01:23:41,360 THEIR NUTRITIONAL STATUS. 2143 01:23:41,360 --> 01:23:45,480 AND THEN MORE RECENTLY A PAPER 2144 01:23:45,480 --> 01:23:46,440 THAT EVALUATED INTERRATER 2145 01:23:46,440 --> 01:23:48,800 RELIABILITY OF SCREENING TOOLS 2146 01:23:48,800 --> 01:23:50,880 AND THERE WAS A VERY HIGH DEGREE 2147 01:23:50,880 --> 01:23:52,400 OF OBSERVE THE AGREEMENT BETWEEN 2148 01:23:52,400 --> 01:23:53,680 SO CALLED EXPERT AND NON-EXPERT 2149 01:23:53,680 --> 01:23:56,600 STAFF AS WELL AS HIGH DEGREE OF 2150 01:23:56,600 --> 01:24:02,080 AGREEMENT ON THE KAPPA RATIO. 2151 01:24:02,080 --> 01:24:02,760 2152 01:24:02,760 --> 01:24:04,880 SO, THIS IS MY LAST SLIDE. 2153 01:24:04,880 --> 01:24:07,320 I CAME AWAY FROM THIS LITERATURE 2154 01:24:07,320 --> 01:24:12,200 REVIEW ON MY OWN CLINICAL 2155 01:24:12,200 --> 01:24:13,400 EXPERIENCE, WONDERING WHETHER 2156 01:24:13,400 --> 01:24:15,640 IT'S TIME TO REDEFINE A CLINICAL 2157 01:24:15,640 --> 01:24:17,120 METRIC WHERE PHYSICIANS ARE USED 2158 01:24:17,120 --> 01:24:18,760 TO EXAMINING PATIENTS WITH HANDS 2159 01:24:18,760 --> 01:24:21,320 AND EARS AND EYES AND 2160 01:24:21,320 --> 01:24:24,400 STETHOSCOPES, BUT PERHAPS WE'RE 2161 01:24:24,400 --> 01:24:26,160 BEYOND IN A IN THE CENTURY OF 2162 01:24:26,160 --> 01:24:29,200 MEDICINE AND MAYBE CAN THINK OF 2163 01:24:29,200 --> 01:24:30,520 OF THE ANSWER FOR METRIC 2164 01:24:30,520 --> 01:24:31,560 MEASURES, BEDSIDE MEASURES AND 2165 01:24:31,560 --> 01:24:32,960 OTHERS OF BODY COMPOSITION TESTS 2166 01:24:32,960 --> 01:24:35,120 AND WE'LL HEAR ABOUT LATER POINT 2167 01:24:35,120 --> 01:24:36,520 OF CARE TESTS. 2168 01:24:36,520 --> 01:24:38,600 AS A CLINICIAN I WOULD INCLUDE 2169 01:24:38,600 --> 01:24:42,080 ALL OF THEM AS ALL MY 2170 01:24:42,080 --> 01:24:44,040 ARMAMENTARIUM, AND SO I THANK 2171 01:24:44,040 --> 01:24:45,760 YOU FOR LISTENING TO, IF YOU 2172 01:24:45,760 --> 01:24:54,560 WILL, A TRIP DOWN MEMORY LANE. 2173 01:24:54,560 --> 01:24:57,760 >> THANK YOU, CHRIS. 2174 01:24:57,760 --> 01:25:07,520 COMPLETELY AGREE ABOUT THE 2175 01:25:07,520 --> 01:25:08,520 CONTINUUM. 2176 01:25:08,520 --> 01:25:13,440 WE'LL MOVE TO DR. ADDO, FROM THE 2177 01:25:13,440 --> 01:25:15,120 CDC, ATLANTA, GEORGIA, FACULTY 2178 01:25:15,120 --> 01:25:16,800 APPOINTMENT AT EMORY, RESEARCH 2179 01:25:16,800 --> 01:25:21,760 INTERESTS IN CHILD GROWTH AND 2180 01:25:21,760 --> 01:25:23,120 DEVELOPMENT, MATERNAL/CHILD 2181 01:25:23,120 --> 01:25:24,720 HEALTH, PUBLIC HELD PROGRAM, 2182 01:25:24,720 --> 01:25:26,720 LIFE COURSE EPIDEMIOLOGY, U.S. 2183 01:25:26,720 --> 01:25:27,760 AND INTERNATIONAL POPULATIONS 2184 01:25:27,760 --> 01:25:29,360 TALKING ABOUT LINEAR GROWTH. 2185 01:25:29,360 --> 01:25:29,640 THANK YOU. 2186 01:25:29,640 --> 01:25:30,920 OVER TO YOU. 2187 01:25:30,920 --> 01:25:32,120 >> THANK UP. 2188 01:25:32,120 --> 01:25:35,560 CAN YOU HEAR ME PLEASE? 2189 01:25:35,560 --> 01:25:35,840 >> YES. 2190 01:25:35,840 --> 01:25:36,520 >> OKAY. 2191 01:25:36,520 --> 01:25:38,840 THERE'S A STORM PASSING THROUGH 2192 01:25:38,840 --> 01:25:40,720 HERE IN ATLANTA, SO HOPEFULLY 2193 01:25:40,720 --> 01:25:45,800 THERE'S NO POWER OUTAGE OR 2194 01:25:45,800 --> 01:25:46,120 ANYTHING. 2195 01:25:46,120 --> 01:25:48,840 I WILL SHARE MY SCREEN. 2196 01:25:48,840 --> 01:25:49,520 GREETINGS, EVERYONE. 2197 01:25:49,520 --> 01:25:52,680 I WOULD LIKE TO THANK THE 2198 01:25:52,680 --> 01:25:53,760 BOND-KIDS SECRETARIAT FOR THE 2199 01:25:53,760 --> 01:25:56,000 OPPORTUNITY TO SPEAK AT THIS 2200 01:25:56,000 --> 01:25:58,520 WORKSHOP AND CONTRIBUTE TO THIS 2201 01:25:58,520 --> 01:25:59,400 IMPORTANT EFFORT. 2202 01:25:59,400 --> 01:26:03,120 I'VE BEEN ASKED TO SPEAK ABOUT 2203 01:26:03,120 --> 01:26:05,600 ASSESSMENT MUCH LINEAR GROWTH 2204 01:26:05,600 --> 01:26:08,360 INTERPRETATION FOR DEVELOPMENT 2205 01:26:08,360 --> 01:26:10,960 OF STAGES IN CHILDREN 5-19 2206 01:26:10,960 --> 01:26:13,320 YEARS. 2207 01:26:13,320 --> 01:26:16,920 I HAVE NO DISCLOSURES. 2208 01:26:16,920 --> 01:26:21,720 SO I WOULD LIKE TO KIND -- GROUP 2209 01:26:21,720 --> 01:26:25,360 1 TALKED ABOUT BIOLOGY. 2210 01:26:25,360 --> 01:26:27,480 I WANT TO BUILD ON THAT. 2211 01:26:27,480 --> 01:26:28,880 GROWTH CAN BE DEFINED AND 2212 01:26:28,880 --> 01:26:33,400 INCREASE IN SIZE OR MASS THAT 2213 01:26:33,400 --> 01:26:35,480 RESULTS IN CELLULAR HYPERTROPHY 2214 01:26:35,480 --> 01:26:36,360 AND HYPERPLASIA, THERE IS 2215 01:26:36,360 --> 01:26:39,520 ACCRETION OF MASS THAT CAN OCCUR 2216 01:26:39,520 --> 01:26:42,120 AT INTERSTITIAL LEVEL, ORGAN 2217 01:26:42,120 --> 01:26:45,440 LEVEL, ORGANISM LEVEL. 2218 01:26:45,440 --> 01:26:47,800 SO LINEAR GROWTH OCCURS AT 2219 01:26:47,800 --> 01:26:49,800 ORGANISM LEVEL, WHOLE CHILD 2220 01:26:49,800 --> 01:26:50,160 LEVEL. 2221 01:26:50,160 --> 01:26:55,120 SO IT IS BIOINDICATOR, PERHAPS 2222 01:26:55,120 --> 01:26:57,120 EXPLAIN WHY IT'S COMPLEX TO 2223 01:26:57,120 --> 01:27:00,080 INTERPRET AND ALSO TO ASSESS 2224 01:27:00,080 --> 01:27:06,680 CHANGE. 2225 01:27:06,680 --> 01:27:09,000 THIS IS BECAUSE ATTAINED HEIGHT 2226 01:27:09,000 --> 01:27:10,680 IS A CUMULATIVE INDICATOR OVER 2227 01:27:10,680 --> 01:27:12,320 THE GROWING PERIOD. 2228 01:27:12,320 --> 01:27:14,320 WHILE LINEAR GROWTH USUALLY 2229 01:27:14,320 --> 01:27:16,120 FOLLOWS A TRAJECTORY, THERE ARE 2230 01:27:16,120 --> 01:27:20,600 PERIODS OF HIGH PLASTICITY IN 2231 01:27:20,600 --> 01:27:22,920 EARLY LIFE AND ADOLESCENCE. 2232 01:27:22,920 --> 01:27:27,520 AND ALSO DOCUMENTED EVIDENCE OF 2233 01:27:27,520 --> 01:27:28,120 INTERGENERATIONAL INFLUENCES ON 2234 01:27:28,120 --> 01:27:30,720 ATTAINED HEIGHT AT A GIVEN TIME, 2235 01:27:30,720 --> 01:27:34,680 SUCH THAT MATERNAL AND PATERNAL 2236 01:27:34,680 --> 01:27:36,520 HEIGHTS ASSOCIATED WITH 2237 01:27:36,520 --> 01:27:38,760 OFFSPRING LINEAR GROWTH AND 2238 01:27:38,760 --> 01:27:41,080 DEMONSTRATED IN BIRTH COHORT 2239 01:27:41,080 --> 01:27:41,400 STUDIES. 2240 01:27:41,400 --> 01:27:43,200 AND FOR IN PARTICULAR IN AMONG 2241 01:27:43,200 --> 01:27:47,520 OUR AGE GROUP OF INTEREST, 2242 01:27:47,520 --> 01:27:49,120 ATTAINED HATE REFLECTS NOT ONLY 2243 01:27:49,120 --> 01:27:54,680 NUTRITION BUT INFLUENCE OF 2244 01:27:54,680 --> 01:27:59,280 ENVIRONMENT, INFECTION, INSULTS, 2245 01:27:59,280 --> 01:28:01,760 INTOXICANTS, TIMING OF 2246 01:28:01,760 --> 01:28:02,600 MATURATION, HORMONALALLY 2247 01:28:02,600 --> 01:28:05,400 REGULATED SUCH AS PUBERTY AND 2248 01:28:05,400 --> 01:28:14,680 PREGNANCY. 2249 01:28:14,680 --> 01:28:15,760 2250 01:28:15,760 --> 01:28:20,640 THERE'S SOMATIC GROWTH AND 2251 01:28:20,640 --> 01:28:22,680 FUTURE GONAD TO PROMOTE LINEAR 2252 01:28:22,680 --> 01:28:27,640 GROWTH SPURT AND STOP LINEAR 2253 01:28:27,640 --> 01:28:31,480 GROWTH WHEN GROWTH PLATE FUSES. 2254 01:28:31,480 --> 01:28:35,840 I THINK ONE THING ANTHROPOMETRY 2255 01:28:35,840 --> 01:28:41,920 IS ONE OF THE EASIEST TOOLS TO 2256 01:28:41,920 --> 01:28:42,960 ASSESS NUTRITIONAL STATUS, NOT 2257 01:28:42,960 --> 01:28:45,840 THE EASIEST TO MEASURE BECAUSE 2258 01:28:45,840 --> 01:28:49,400 IT REQUIRES AGE AND SEX OF THE 2259 01:28:49,400 --> 01:28:55,280 CHILD, MEASUREMENT IS TO OFFER 2260 01:28:55,280 --> 01:28:56,480 MEANINGFUL INTERPRETATION. 2261 01:28:56,480 --> 01:28:58,320 I WOULD SAY THIS MEANINGFUL 2262 01:28:58,320 --> 01:29:00,920 INTERPRETATION IS NEEDED TO MAKE 2263 01:29:00,920 --> 01:29:02,200 PROGRAM DECISIONS. 2264 01:29:02,200 --> 01:29:05,680 AND I THINK THAT THE EASE OF 2265 01:29:05,680 --> 01:29:07,080 MEASUREMENT OF HEIGHT EXPLAINS 2266 01:29:07,080 --> 01:29:10,520 WHY IT'S MEASURED A LOT IN 2267 01:29:10,520 --> 01:29:12,160 SCHOOL NUTRITION PROGRAMS. 2268 01:29:12,160 --> 01:29:16,640 SO ON THIS SLIDE I'M SHOWING YOU 2269 01:29:16,640 --> 01:29:17,520 ONE COMPREHENSIVE META-ANALYSIS 2270 01:29:17,520 --> 01:29:21,120 OF SCHOOL FEEDING PROGRAMS 2271 01:29:21,120 --> 01:29:22,480 AROUND THE WORLD. 2272 01:29:22,480 --> 01:29:27,960 AND EXAMINE DATA FOR SIX 2273 01:29:27,960 --> 01:29:31,840 DECADES, AND FROM 1962 THROUGH 2274 01:29:31,840 --> 01:29:32,480 2019. 2275 01:29:32,480 --> 01:29:34,200 17 DATA STUDIES MEASURED HEIGHT, 2276 01:29:34,200 --> 01:29:37,080 MOST FOUND NO IMPACT ON LINEAR 2277 01:29:37,080 --> 01:29:39,320 GROWTH OR HEIGHT. 2278 01:29:39,320 --> 01:29:41,640 SEVEN STUDIES MEASURED HIGH GAIN 2279 01:29:41,640 --> 01:29:45,160 OVER UNIQUE TIME. 2280 01:29:45,160 --> 01:29:47,440 AND IN THIS META-ANALYSIS THOSE 2281 01:29:47,440 --> 01:29:50,680 SEVEN STUDIES FOUND POSITIVE 2282 01:29:50,680 --> 01:29:54,560 IMPACT OF .32 CENTIMETERS PER 2283 01:29:54,560 --> 01:29:55,040 YEAR. 2284 01:29:55,040 --> 01:30:01,320 WHEN THE SAME IMPACT WAS 2285 01:30:01,320 --> 01:30:02,560 EXAMINED USING HAZ SCORE THERE 2286 01:30:02,560 --> 01:30:03,440 WAS NO IMPACT. 2287 01:30:03,440 --> 01:30:10,680 IT'S FAIR TO SAY LINEAR GROWTH 2288 01:30:10,680 --> 01:30:13,160 NUTRITION OUTCOMES THAT EITHER 2289 01:30:13,160 --> 01:30:15,440 ATTRACTS LOW GRANT SCORE OR 2290 01:30:15,440 --> 01:30:18,120 KEEPS DONORS A LITTLE BIT ON 2291 01:30:18,120 --> 01:30:20,760 THEIR SHY SIDE BUT I THINK WE 2292 01:30:20,760 --> 01:30:22,080 SHOULD CONTINUE MEASURING LINEAR 2293 01:30:22,080 --> 01:30:24,880 GROWTH BECAUSE IT'S A MARKER OF 2294 01:30:24,880 --> 01:30:27,840 THE INTERNAL AND EXTERNAL SYSTEM 2295 01:30:27,840 --> 01:30:30,120 OF THE CHILD. 2296 01:30:30,120 --> 01:30:31,440 I THINK LOOKING AT THIS RESULTS 2297 01:30:31,440 --> 01:30:37,120 ALSO IT'S ON THE SCREEN A FEW 2298 01:30:37,120 --> 01:30:45,280 QUESTIONS WILL COME UP, IS .32 2299 01:30:45,280 --> 01:30:45,760 CENTIMETERS MEANINGFUL? 2300 01:30:45,760 --> 01:30:47,320 I THINK IT IS. 2301 01:30:47,320 --> 01:30:49,560 SOME THINGS WE ALSO NEED TO 2302 01:30:49,560 --> 01:30:54,400 CONSIDER THAT THE AGE GROUP ALSO 2303 01:30:54,400 --> 01:30:56,080 OVERLAPS WITH AGE OF GROWTH 2304 01:30:56,080 --> 01:30:58,920 SPURT SO COULD IT BE DUE TO 2305 01:30:58,920 --> 01:30:59,200 THAT? 2306 01:30:59,200 --> 01:31:01,080 THOSE ARE SOME THINGS I FEEL 2307 01:31:01,080 --> 01:31:05,040 THIS BRINGS IN THE IMPORTANCE OF 2308 01:31:05,040 --> 01:31:09,080 MATURATION IN THIS AGE GROUP. 2309 01:31:09,080 --> 01:31:09,920 MATURATION-BASED SOMATIC GROWTH 2310 01:31:09,920 --> 01:31:13,600 MAY DIFFER A LOT FROM 2311 01:31:13,600 --> 01:31:15,560 CHRONOLOGIC AGE CONDITION GROWTH 2312 01:31:15,560 --> 01:31:16,720 TRAJECTORY SHOWN IN MANY 2313 01:31:16,720 --> 01:31:20,080 COUNTRIES AROUND THE WORLD. 2314 01:31:20,080 --> 01:31:29,680 AND HIGH VELOCITY AND TEMPO 2315 01:31:29,680 --> 01:31:31,680 DIRECTS HUMAN GROWTH, LINEAR 2316 01:31:31,680 --> 01:31:34,600 GROWTH IS OFTEN CONSIDERED A 2317 01:31:34,600 --> 01:31:35,120 TARGET-SEEKING FUNCTION 2318 01:31:35,120 --> 01:31:36,320 ESPECIALLY IN UNCONSTRAINED 2319 01:31:36,320 --> 01:31:37,360 ENVIRONMENT. 2320 01:31:37,360 --> 01:31:40,760 SO THE TIMING DIFFERENCES CAN 2321 01:31:40,760 --> 01:31:43,040 AFFECT ATTAINED HEIGHT AND 2322 01:31:43,040 --> 01:31:45,680 INTERPRETATION OF RESULTS FOR 2323 01:31:45,680 --> 01:31:45,920 EXAMPLE. 2324 01:31:45,920 --> 01:31:51,280 FOR EXAMPLE, JOHNSTON ET AL. 2325 01:31:51,280 --> 01:31:54,040 REPORTED THIS IN GUATEMALA, 2326 01:31:54,040 --> 01:31:57,120 TEMPO DIFFERENCE IN GROWTH OF 2327 01:31:57,120 --> 01:31:58,360 GUATEMALAN CHILDREN COMPARED TO 2328 01:31:58,360 --> 01:32:03,040 PEERS FROM EUROPE AND AMERICA. 2329 01:32:03,040 --> 01:32:10,960 AND IN U.S. SUN, ET AL., 2330 01:32:10,960 --> 01:32:11,840 DEMONSTRATED DIFFERENCE USING 2331 01:32:11,840 --> 01:32:13,640 NHANES DATA AND MY COLLEAGUES 2332 01:32:13,640 --> 01:32:15,800 AND I FOUND CLASSIFICATION OF 2333 01:32:15,800 --> 01:32:17,960 SHORT STATURE WAS HIGHLY 2334 01:32:17,960 --> 01:32:20,720 IMPACTED BY MATURATION STATE IN 2335 01:32:20,720 --> 01:32:22,920 U.S. YOUTH. 2336 01:32:22,920 --> 01:32:27,360 SO ON THIS SLIDE I WANT TO SHOW 2337 01:32:27,360 --> 01:32:30,320 YOU THAT SOME EXAMINATION OF 2338 01:32:30,320 --> 01:32:33,120 MATURATION OR LINEAR TRENDS OF 2339 01:32:33,120 --> 01:32:35,920 CHILDREN GO THROUGH PUBERTY. 2340 01:32:35,920 --> 01:32:37,440 ACTIVELY GROWING SCHOOLERS HAVE 2341 01:32:37,440 --> 01:32:39,040 DIFFERENT LINEAR GROWTH 2342 01:32:39,040 --> 01:32:41,520 PATTERNS, GUIDED BY THEIR OWN 2343 01:32:41,520 --> 01:32:43,680 MATURATION STATUS. 2344 01:32:43,680 --> 01:32:47,000 ON THIS SLIDE, BLACK ON THE 2345 01:32:47,000 --> 01:32:49,240 RIGHT PANEL, BLACK SOLID LINE IS 2346 01:32:49,240 --> 01:32:54,280 THE CDC HEIGHT FOR AGE 50th 2347 01:32:54,280 --> 01:32:55,160 PERCENTILE, COLORED LINE 2348 01:32:55,160 --> 01:32:58,640 DEMONSTRATED CHANNELS FOR HEIGHT 2349 01:32:58,640 --> 01:32:59,720 FOR AGE. 2350 01:32:59,720 --> 01:33:02,440 ORANGE MEANING ONE, GREEN 2351 01:33:02,440 --> 01:33:03,520 MEANING FIVE. 2352 01:33:03,520 --> 01:33:06,680 AT EACH PARTICULAR AGE SAME 2353 01:33:06,680 --> 01:33:08,880 CHILDREN, SAME AGE, THEY WERE 2354 01:33:08,880 --> 01:33:10,440 ALL FOLLOWING DIFFERENT 2355 01:33:10,440 --> 01:33:10,920 TRAJECTORIES BECAUSE OF 2356 01:33:10,920 --> 01:33:12,520 MATURATION STATE. 2357 01:33:12,520 --> 01:33:14,480 THIS IS PARTICULARLY IMPORTANT 2358 01:33:14,480 --> 01:33:17,920 WHEN ASSESSING CHANGE AS RELATED 2359 01:33:17,920 --> 01:33:19,440 TO PROGRAMS IN NUTRITION AND 2360 01:33:19,440 --> 01:33:19,720 SCHOOLS. 2361 01:33:19,720 --> 01:33:24,440 AND WE ARE ABLE TO EXAMINE THIS 2362 01:33:24,440 --> 01:33:28,040 EFFECT ON LINEAR GROWTH BECAUSE 2363 01:33:28,040 --> 01:33:30,560 WE USE NHANES DATA. 2364 01:33:30,560 --> 01:33:33,600 BUT I SHOULD RECOGNIZE THAT THIS 2365 01:33:33,600 --> 01:33:37,480 OBTAINING IN PUBLIC HEALTH 2366 01:33:37,480 --> 01:33:40,760 SETTINGS MAY NOT BE FEASIBLE. 2367 01:33:40,760 --> 01:33:43,120 ONE PUT OUT ONE OF THE PROGRAMS, 2368 01:33:43,120 --> 01:33:45,560 CDC HAS BEEN PROVIDING TECHNICAL 2369 01:33:45,560 --> 01:33:46,120 ASSISTANCE IN ADOLESCENT 2370 01:33:46,120 --> 01:33:51,640 PROGRAMS, WE HAVE BEEN ABLE TO 2371 01:33:51,640 --> 01:33:53,400 SUCCESSFUL COLLECT AGE AT 2372 01:33:53,400 --> 01:33:55,320 MENARCHE IF IT HAS STARTED OR 2373 01:33:55,320 --> 01:33:57,200 NOT, WE DIDN'T GET A LOT OF 2374 01:33:57,200 --> 01:34:00,320 REFUSALS BUT THERE WASN'T ANY 2375 01:34:00,320 --> 01:34:03,680 CORRESPONDING MARKER FOR BOYS IN 2376 01:34:03,680 --> 01:34:06,640 THOSE KIND OF WORK. 2377 01:34:06,640 --> 01:34:10,880 PREVIOUS SLIDE SHOWED YOU 2378 01:34:10,880 --> 01:34:12,080 MATURATION TRAJECTORIES, AS 2379 01:34:12,080 --> 01:34:13,720 LINEAR GROWTH TRAJECTORY DUE TO 2380 01:34:13,720 --> 01:34:14,680 MATURATION. 2381 01:34:14,680 --> 01:34:18,240 HERE I'M GOING TO ALSO EXAMINE 2382 01:34:18,240 --> 01:34:21,800 HEIGHT GAIN PER UNIT TIME. 2383 01:34:21,800 --> 01:34:23,520 WE'RE LUCKY TO HAVE LONGITUDINAL 2384 01:34:23,520 --> 01:34:25,920 STUDY FROM ONE OF OUR PROGRAMS 2385 01:34:25,920 --> 01:34:27,200 WHERE HEIGHT WAS COLLECTED AT 2386 01:34:27,200 --> 01:34:28,720 THE BEGINNING OF THE SCHOOL YEAR 2387 01:34:28,720 --> 01:34:30,640 AND END OF THE SCHOOL YEAR. 2388 01:34:30,640 --> 01:34:35,680 AND AT THE END OF SCHOOL YEAR 2389 01:34:35,680 --> 01:34:41,600 10% OF PRE-MENARCHE ADOLESCENT 2390 01:34:41,600 --> 01:34:48,680 GIRLS WERE CONSIDERED TO HAVE 2391 01:34:48,680 --> 01:34:49,960 LESS THAN (INDISCERNIBLE) 2392 01:34:49,960 --> 01:34:50,640 STANDARD DEVIATION. 2393 01:34:50,640 --> 01:34:53,040 WHEN YOU SEE VELOCITY CURVE IT'S 2394 01:34:53,040 --> 01:34:55,520 SHOWING GROWTH IS QUITE 2395 01:34:55,520 --> 01:34:58,040 REMARKABLE, GAINING AROUND 5 TO 2396 01:34:58,040 --> 01:35:02,560 6 CENTIMETERS MEDIAN OF THAT PER 2397 01:35:02,560 --> 01:35:06,240 SCHOOL YEAR BUT HEIGHT CHART WE 2398 01:35:06,240 --> 01:35:08,400 USE CLASSIFIED THEM AS PERHAPS 2399 01:35:08,400 --> 01:35:09,280 STUNTED. 2400 01:35:09,280 --> 01:35:11,520 SO THIS KIND OF DEMONSTRATE ONE 2401 01:35:11,520 --> 01:35:14,680 OF THE CHALLENGES OF 2402 01:35:14,680 --> 01:35:16,560 INTERPRETING LINEAR GROWTH FOR 2403 01:35:16,560 --> 01:35:19,520 SCHOOLERS TRYING TO TRANSITION 2404 01:35:19,520 --> 01:35:20,280 THROUGH PUBERTY RAPIDLY OVER THE 2405 01:35:20,280 --> 01:35:23,280 COURSE OF THE SCHOOL YEAR, FOR 2406 01:35:23,280 --> 01:35:23,720 EXAMPLE. 2407 01:35:23,720 --> 01:35:27,000 SO HOW DO THE VELOCITY COMPARE 2408 01:35:27,000 --> 01:35:33,120 WITH ADOLESCENTS FROM OTHER 2409 01:35:33,120 --> 01:35:33,520 COUNTRIES? 2410 01:35:33,520 --> 01:35:36,000 VELOCITY IS COMPARABLE. 2411 01:35:36,000 --> 01:35:39,960 THIS ONE, IT'S ANOTHER ANALYZED 2412 01:35:39,960 --> 01:35:44,000 VELOCITY USING PUBLISHED CHARTS, 2413 01:35:44,000 --> 01:35:47,520 OVERLAID ADOLESCENCE FROM GHANA, 2414 01:35:47,520 --> 01:35:49,320 SHOWS GROWTH IS NOT ANY 2415 01:35:49,320 --> 01:35:54,040 DIFFERENT FROM THE OTHERS. 2416 01:35:54,040 --> 01:35:55,600 SO IT APPEARS THAT HIGH VELOCITY 2417 01:35:55,600 --> 01:35:57,480 APPEARS TO BE A BETTER MARKER OF 2418 01:35:57,480 --> 01:35:58,800 ASSESSING CHANGE IN THIS AGE 2419 01:35:58,800 --> 01:36:02,680 GROUP AND I SHOULD NOTE THE 2420 01:36:02,680 --> 01:36:06,320 CHART SHOWS FROM 10 THROUGH 16, 2421 01:36:06,320 --> 01:36:09,360 BUT 5 TO 10 ALSO WE HAVE GROWTH 2422 01:36:09,360 --> 01:36:11,840 VELOCITY THEY MIGHT BE SLIGHTLY 2423 01:36:11,840 --> 01:36:16,680 BIT SLOWER COMPARED TO PEERS 2424 01:36:16,680 --> 01:36:19,400 BECAUSE THEY ARE RAPIDLY GROWING 2425 01:36:19,400 --> 01:36:22,960 AT THIS AGE. 2426 01:36:22,960 --> 01:36:25,000 SO, ONE THING I WANT TO PUT 2427 01:36:25,000 --> 01:36:30,320 ACROSS IS THAT LINEAR GROWTH 2428 01:36:30,320 --> 01:36:31,480 DEVIATES FROM STANDARD AFTER 2429 01:36:31,480 --> 01:36:32,120 EARLY LIFE. 2430 01:36:32,120 --> 01:36:36,760 AFTER FIVE YEARS UP ON, HEIGHT 2431 01:36:36,760 --> 01:36:37,840 REFERENCE USING INTERPRETING, 2432 01:36:37,840 --> 01:36:41,320 YOUR PROGRAM REALLY HAS AN 2433 01:36:41,320 --> 01:36:42,160 IMPACT. 2434 01:36:42,160 --> 01:36:44,480 FOR EXAMPLE, THE CURRENT W.H.O. 2435 01:36:44,480 --> 01:36:50,600 HEIGHT BASED ON 1977 DATA, 2436 01:36:50,600 --> 01:36:56,280 ESSENTIALLY BASED ON U.S. DATA, 2437 01:36:56,280 --> 01:37:09,240 INTERPRETATION CAN BE 2438 01:37:09,240 --> 01:37:09,960 PROGRAMMATIC. 2439 01:37:09,960 --> 01:37:10,760 HIGH VELOCITY IS SENSITIVE 2440 01:37:10,760 --> 01:37:12,440 PARAMETER FOR ASSESSING GROWTH 2441 01:37:12,440 --> 01:37:14,880 IN RESPONSE TO CLINICAL GROWTH 2442 01:37:14,880 --> 01:37:15,880 INTERVENTIONS SUCH AS GROWTH 2443 01:37:15,880 --> 01:37:16,840 HORMONE TREATMENT. 2444 01:37:16,840 --> 01:37:20,600 I THINK WE CAN POOL SOME VALUE 2445 01:37:20,600 --> 01:37:26,520 FROM THAT AND PUBLIC HEALTH. 2446 01:37:26,520 --> 01:37:30,080 HIGH VELOCITY QUITE MEANINGFUL 2447 01:37:30,080 --> 01:37:32,400 SO MANY WAYS BECAUSE IT'S 2448 01:37:32,400 --> 01:37:34,880 ANCHORED ON THE CHILD'S OWN 2449 01:37:34,880 --> 01:37:37,120 PRIOR HEIGHT SO IT'S REFLECTIVE 2450 01:37:37,120 --> 01:37:39,800 OF ITS OWN BIOLOGY AND RESPONSE 2451 01:37:39,800 --> 01:37:42,480 TO EXTERNAL STIMULI SUCH AS 2452 01:37:42,480 --> 01:37:44,200 NUTRITION, AND ANY OTHER INSULT, 2453 01:37:44,200 --> 01:37:47,440 SO I WOULD SAY IT'S A GOOD 2454 01:37:47,440 --> 01:37:50,520 INDICATOR TO CAPTURE IMPACT. 2455 01:37:50,520 --> 01:37:53,320 SO HOW DO WE MEASURE MATURATION? 2456 01:37:53,320 --> 01:37:55,920 I THINK THERE ARE SEVERAL TOOLS 2457 01:37:55,920 --> 01:38:01,080 OUT THERE, I'LL LIST A FEW HERE, 2458 01:38:01,080 --> 01:38:04,440 TANNER SEXUAL MATURATION STAGES, 2459 01:38:04,440 --> 01:38:06,680 CULTURAL SENSITIVITY RELATED AND 2460 01:38:06,680 --> 01:38:07,560 VALIDATED QUESTIONNAIRES CAN 2461 01:38:07,560 --> 01:38:09,200 ALSO HELP THERE. 2462 01:38:09,200 --> 01:38:11,600 BUT ONE POINT STICKS OUT A 2463 01:38:11,600 --> 01:38:13,520 LITTLE BIT IS BIOCHEMICAL 2464 01:38:13,520 --> 01:38:16,360 INDICATORS IN THIS FIELD OF 2465 01:38:16,360 --> 01:38:18,680 ASSESSING MATURATION CAN ADVANCE 2466 01:38:18,680 --> 01:38:19,960 THE FIELD. 2467 01:38:19,960 --> 01:38:23,120 THERE ARE TWO, BONE AIM, DENTAL 2468 01:38:23,120 --> 01:38:26,440 AGE, HEIGHT AGE, HAVE PROS AND 2469 01:38:26,440 --> 01:38:28,480 CONS BUT I THINK CONSIDERING 2470 01:38:28,480 --> 01:38:31,320 THEM IN YOUR INTERPRETATION OF 2471 01:38:31,320 --> 01:38:34,240 LINEAR GROWTH WILL HELP CAPTURE 2472 01:38:34,240 --> 01:38:37,560 POTENTIAL PROGRAM IMPACT. 2473 01:38:37,560 --> 01:38:40,520 SO WE'RE ASKED TO GIVE SOME 2474 01:38:40,520 --> 01:38:42,000 THOUGHT ON PRACTICAL 2475 01:38:42,000 --> 01:38:42,960 CONSIDERATIONS, ON SOME 2476 01:38:42,960 --> 01:38:43,920 INDICATORS. 2477 01:38:43,920 --> 01:38:47,720 I'LL LIST A FEW YEAR BUT THEY 2478 01:38:47,720 --> 01:38:51,600 ARE NOT EXHAUSTIVE AND THERE WAS 2479 01:38:51,600 --> 01:38:53,000 ALSO ANOTHER PART ON HOW OFTEN 2480 01:38:53,000 --> 01:38:55,640 SHOULD HEIGHT BE MEASURED. 2481 01:38:55,640 --> 01:39:00,560 I WOULD SAY A MINIMUM OF AT 2482 01:39:00,560 --> 01:39:01,920 LEAST YEARLY INCREMENTS, 2483 01:39:01,920 --> 01:39:03,320 ANYTHING ABOVE SIX MONTHS WOULD 2484 01:39:03,320 --> 01:39:05,920 BE SUFFICIENT. 2485 01:39:05,920 --> 01:39:11,280 HOWEVER, IT HAS TO BE BALANCED 2486 01:39:11,280 --> 01:39:19,320 WITH EXPOSURE AND MONITORING 2487 01:39:19,320 --> 01:39:20,000 TIME. 2488 01:39:20,000 --> 01:39:21,000 IN SUMMARY, HEIGHTS OF GROWING 2489 01:39:21,000 --> 01:39:24,880 CHILDREN IS A MARKER OF 2490 01:39:24,880 --> 01:39:26,880 NUTRITION AND ENVIRONMENTAL 2491 01:39:26,880 --> 01:39:28,040 HISTORY. 2492 01:39:28,040 --> 01:39:30,920 IT REFLECTS ECOLOGY AND IS 2493 01:39:30,920 --> 01:39:34,920 RELATIVELY EASY TO MEASURE, WITH 2494 01:39:34,920 --> 01:39:36,920 TRAINING, LINEAR GROWTH IT 2495 01:39:36,920 --> 01:39:38,400 CONNOTES IS COMPLEX. 2496 01:39:38,400 --> 01:39:42,560 EARLY LIFE HAS AN IMPACT AND 2497 01:39:42,560 --> 01:39:46,320 INCREMENTAL GROWTH LIKE HEIGHT 2498 01:39:46,320 --> 01:39:48,520 GAINS PER UNIT TIME, HEIGHT 2499 01:39:48,520 --> 01:39:50,080 VELOCITY OFFER GOOD METRICS. 2500 01:39:50,080 --> 01:39:52,440 SCHOOL PLATFORM IS WELL SUITED 2501 01:39:52,440 --> 01:39:54,400 FOR THIS. 2502 01:39:54,400 --> 01:39:57,080 AND TOOLS LIKE GLOBAL 2503 01:39:57,080 --> 01:39:58,640 INCREMENTAL CHARTS WILL HELP. 2504 01:39:58,640 --> 01:39:59,520 MEASUREMENT ERRORS, QUANTIFYING 2505 01:39:59,520 --> 01:40:04,120 THEM WILL ALSO HELP IN 2506 01:40:04,120 --> 01:40:05,920 INTERPRETING LINEAR GROWTH 2507 01:40:05,920 --> 01:40:06,640 RESULTS. 2508 01:40:06,640 --> 01:40:08,560 APPROPRIATE QUESTIONNAIRES 2509 01:40:08,560 --> 01:40:09,760 RELATED TO ASSESSING MATURATION 2510 01:40:09,760 --> 01:40:17,520 STATUS WILL ADVANCE THE FIELD. 2511 01:40:17,520 --> 01:40:19,160 BIOMARKERS OF PUBERTY AND THEN 2512 01:40:19,160 --> 01:40:23,040 PORTABLE BONE ASSESSMENT COULD 2513 01:40:23,040 --> 01:40:26,120 ALSO BE HELPFUL IN HELPING 2514 01:40:26,120 --> 01:40:27,000 EXPLAIN INTERPRETING LINEAR 2515 01:40:27,000 --> 01:40:27,360 GROWTH DATA. 2516 01:40:27,360 --> 01:40:31,000 AND I THANK YOU FOR YOUR TIME. 2517 01:40:31,000 --> 01:40:33,800 THANK YOU. 2518 01:40:33,800 --> 01:40:41,520 >> THANK YOU SO MUCH, AND FOR 2519 01:40:41,520 --> 01:40:43,960 TAKING 15 MINUTES. 2520 01:40:43,960 --> 01:40:45,400 WE'RE RUNNING BEHIND SCHEDULE SO 2521 01:40:45,400 --> 01:40:47,320 WE'LL SKIP THE BREAK TO PRESERVE 2522 01:40:47,320 --> 01:40:49,240 A FEW MINUTES FOR DISCUSSION AT 2523 01:40:49,240 --> 01:40:51,120 THE END. 2524 01:40:51,120 --> 01:40:54,560 NEXT SPEAKER IS DR. VICTOR 2525 01:40:54,560 --> 01:40:59,320 OWINO, INTERNATIONAL ATOMIC 2526 01:40:59,320 --> 01:41:01,680 ENERGY AGENCY. 2527 01:41:01,680 --> 01:41:04,080 WORK FOCUSING ON DESIGNING AND 2528 01:41:04,080 --> 01:41:04,720 EVALUATING NUTRITION 2529 01:41:04,720 --> 01:41:06,400 INTERVENTIONS THAT TARGET ALL 2530 01:41:06,400 --> 01:41:08,400 FORMS OF MALNUTRITION. 2531 01:41:08,400 --> 01:41:09,920 HE WILL DISCUSS BODY COMPOSITION 2532 01:41:09,920 --> 01:41:11,640 AND OVER TO YOU, VICTOR. 2533 01:41:11,640 --> 01:41:12,920 THANK YOU. 2534 01:41:12,920 --> 01:41:16,200 >> CAN YOU SEE MY SLIDES? 2535 01:41:16,200 --> 01:41:16,480 >> YES. 2536 01:41:16,480 --> 01:41:18,320 >> YEAH, THANK YOU. 2537 01:41:18,320 --> 01:41:21,000 SO, THANKS TO THE TEAM FOR 2538 01:41:21,000 --> 01:41:25,400 HAVING ME TO GIVE THIS 2539 01:41:25,400 --> 01:41:26,520 PRESENTATION TODAY. 2540 01:41:26,520 --> 01:41:33,600 SO, I'LL BE TALKING ABOUT BODY 2541 01:41:33,600 --> 01:41:33,960 COMPOSITION. 2542 01:41:33,960 --> 01:41:35,080 ANSWERING QUESTIONS WHY BODY 2543 01:41:35,080 --> 01:41:36,720 COMPOSITION IS IMPORTANT. 2544 01:41:36,720 --> 01:41:38,600 BASICALLY BODY COMPOSITION IS 2545 01:41:38,600 --> 01:41:41,920 WHAT MAKES UP OUR BODY WEIGHT. 2546 01:41:41,920 --> 01:41:48,000 AND IN THIS SCHEMA YOU CAN SEE 2547 01:41:48,000 --> 01:41:49,040 MAINLY FAT, WATER, OTHER 2548 01:41:49,040 --> 01:41:51,480 NUTRIENTS, BUT IN A MORE SIMPLER 2549 01:41:51,480 --> 01:41:53,800 WAY WE TALK ABOUT BODY 2550 01:41:53,800 --> 01:41:57,920 COMPOSITION AS FAT OR FAT-FREE 2551 01:41:57,920 --> 01:41:58,600 MASS. 2552 01:41:58,600 --> 01:42:02,040 AND IF WE LOOK AT BODY 2553 01:42:02,040 --> 01:42:03,800 COMPOSITION, IT IS CRITICAL 2554 01:42:03,800 --> 01:42:08,920 MARKER BECAUSE IT IS RELATED TO 2555 01:42:08,920 --> 01:42:09,200 EXPOSURES. 2556 01:42:09,200 --> 01:42:12,040 IT CAN BE FOOD INTAKE OR LACK OF 2557 01:42:12,040 --> 01:42:16,160 IT, IT CAN BE ACUTE 2558 01:42:16,160 --> 01:42:17,760 MALNUTRITION, IT COULD ALSO BE 2559 01:42:17,760 --> 01:42:19,720 OVERINTAKE OF FOOD BUT ALSO IT 2560 01:42:19,720 --> 01:42:22,680 COULD BE RELATED TO 2561 01:42:22,680 --> 01:42:24,960 INTERVENTIONS TO ADDRESS THOSE 2562 01:42:24,960 --> 01:42:25,320 PROBLEMS. 2563 01:42:25,320 --> 01:42:26,920 AND SO YOU SEE AT THE CENTER 2564 01:42:26,920 --> 01:42:31,120 HERE BODY COMPOSITION IS RELATED 2565 01:42:31,120 --> 01:42:38,920 TO ALL ANTHROPO METRIC 2566 01:42:38,920 --> 01:42:39,680 INDICATORS, HEIGHT, 2567 01:42:39,680 --> 01:42:42,520 CIRCUMFERENCE, WEIGHT GAIN. 2568 01:42:42,520 --> 01:42:44,040 MORE DEEPLY, IT'S ASSOCIATED CAN 2569 01:42:44,040 --> 01:42:49,000 INDICATORS OF HEALTH AND 2570 01:42:49,000 --> 01:42:51,480 DEVELOPMENT LIKE BRAIN GROWTH, 2571 01:42:51,480 --> 01:42:54,840 COGNITIVE, EDUCATIONAL AND 2572 01:42:54,840 --> 01:42:57,320 SOCIAL PERFORMANCE, IMMUNITY AND 2573 01:42:57,320 --> 01:42:59,320 WORK CAPACITY, METABOLIC 2574 01:42:59,320 --> 01:42:59,960 PROGRAM, CARBOHYDRATES, LIPIDS, 2575 01:42:59,960 --> 01:43:04,880 AMINO ACIDS AND SO FORTH, AND 2576 01:43:04,880 --> 01:43:07,920 RELATES TO RISK OF 2577 01:43:07,920 --> 01:43:09,200 NON-COMMUNICABLE DISEASES. 2578 01:43:09,200 --> 01:43:12,880 SO, I THOUGHT THAT BODY 2579 01:43:12,880 --> 01:43:14,040 COMPOSITION IS A FUNCTIONAL 2580 01:43:14,040 --> 01:43:19,920 INDICATOR THAT RESPONDS TO 2581 01:43:19,920 --> 01:43:23,240 SUBTLE BEFORE INDICATORS DO. 2582 01:43:23,240 --> 01:43:27,280 AND RESPONDS TO INSULTS LIKE 2583 01:43:27,280 --> 01:43:32,680 ACUTE MALNUTRITION, STUNTING, 2584 01:43:32,680 --> 01:43:39,400 EXCESS ADIPOSITY, AND EXCESS 2585 01:43:39,400 --> 01:43:53,720 ADIPOSITY IS A RISK FOR DISEASE 2586 01:43:53,720 --> 01:43:59,160 AND SARCOPENIA IS A RISK. 2587 01:43:59,160 --> 01:44:02,600 IT SEEMS INTERVENTIONS LIKE FOOD 2588 01:44:02,600 --> 01:44:04,840 SUPPLEMENTATION IMPACT BODY 2589 01:44:04,840 --> 01:44:05,600 COMPOSITION FAST. 2590 01:44:05,600 --> 01:44:07,800 SO, I JUST WANTED TO ANSWER A 2591 01:44:07,800 --> 01:44:10,680 FEW QUESTIONS HERE. 2592 01:44:10,680 --> 01:44:13,240 HOW DOES BODY COMPOSITION RELATE 2593 01:44:13,240 --> 01:44:14,800 TO LINEAR GROWTH? 2594 01:44:14,800 --> 01:44:21,000 USE THIS EXAMPLE FROM ETHIOPIA, 2595 01:44:21,000 --> 01:44:22,520 FOLLOWING A COHORT OF CHILDREN 2596 01:44:22,520 --> 01:44:31,240 FROM BIRTH THROUGH 5 YEARS. 2597 01:44:31,240 --> 01:44:34,360 MEASURED BODY COMPOSITION AND 2598 01:44:34,360 --> 01:44:41,560 OBSERVED FAT-FREE MASS' 2599 01:44:41,560 --> 01:44:44,080 ACCRETION WAS ASSOCIATED WITH 2600 01:44:44,080 --> 01:44:45,200 LINEAR GROWTH 1-5 YEARS, 2601 01:44:45,200 --> 01:44:46,160 ASSOCIATION BETWEEN BODY 2602 01:44:46,160 --> 01:44:47,640 COMPOSITION AND LINEAR GROWTH 2603 01:44:47,640 --> 01:44:54,040 WAS STRONGER FOR THE FIRST YEAR 2604 01:44:54,040 --> 01:44:56,040 OF LIFE. 2605 01:44:56,040 --> 01:45:00,400 SO, THE OTHER QUESTION, HOW DOES 2606 01:45:00,400 --> 01:45:02,400 EXPOSURE LIKE ACUTE WASTING 2607 01:45:02,400 --> 01:45:05,720 DURING CHILDHOOD IMPACT BODY 2608 01:45:05,720 --> 01:45:07,640 COMPOSITION IN SHORT, MEDIUM, 2609 01:45:07,640 --> 01:45:13,400 LONG TERM, SO THIS IS A STUDY 2610 01:45:13,400 --> 01:45:15,120 SUPPORTED IN NINE AFRICAN 2611 01:45:15,120 --> 01:45:18,920 COUNTRIES, SO STARTING WITH THIS 2612 01:45:18,920 --> 01:45:22,240 STUDY IN ZAMBIA, WHERE THEY 2613 01:45:22,240 --> 01:45:26,120 FOLLOWED UP CHILDREN NOW 7-12 2614 01:45:26,120 --> 01:45:28,960 YEARS MALNOURISHED BELOW THE AGE 2615 01:45:28,960 --> 01:45:30,720 OF 2. 2616 01:45:30,720 --> 01:45:33,520 AND THEY COMPARED THEM TO 2617 01:45:33,520 --> 01:45:36,760 NEIGHBORHOOD CONTROLS WHO HAD 2618 01:45:36,760 --> 01:45:38,400 NEVER EXPERIENCED SEVERE 2619 01:45:38,400 --> 01:45:40,080 MALNUTRITION AND FOUND CHILDREN 2620 01:45:40,080 --> 01:45:44,680 WITH PRIOR SAM WERE SLIGHTLY 2621 01:45:44,680 --> 01:45:47,520 SMALLER THAN CONTROLS, AND BUT 2622 01:45:47,520 --> 01:45:51,960 DIFFERENCES WERE NOT THAT MUCH 2623 01:45:51,960 --> 01:45:57,680 EXCEPT THEY OBSERVED DIFFERENCES 2624 01:45:57,680 --> 01:46:00,760 IN HIP CIRCUMFERENCE, SUPRA 2625 01:46:00,760 --> 01:46:02,640 ILIAC SKINFOLD AND FAT-FREE MASS 2626 01:46:02,640 --> 01:46:02,920 INDEX. 2627 01:46:02,920 --> 01:46:05,600 UNDER THE SAME PROJECT 2628 01:46:05,600 --> 01:46:07,120 COLLEAGUES IN CONGO FOLLOWED UP 2629 01:46:07,120 --> 01:46:12,320 PEOPLE WHO ARE NOW ADULTS, WHO 2630 01:46:12,320 --> 01:46:15,680 HAD BEEN MALNOURISHED EITHER 2631 01:46:15,680 --> 01:46:21,760 WITH SEVERE ACUTE MALNUTRITION 2632 01:46:21,760 --> 01:46:22,560 OR MODERATE. 2633 01:46:22,560 --> 01:46:28,920 SINCE 1988, AND ALSO COMPARED 2634 01:46:28,920 --> 01:46:30,080 THEM WITH SEX-MATCHED CONTROL 2635 01:46:30,080 --> 01:46:31,680 ADULTS IN THE SAME COMMUNITY. 2636 01:46:31,680 --> 01:46:34,440 MESSAGE IS THE SAME, THOSE 2637 01:46:34,440 --> 01:46:38,640 EXPOSED TO SAM HAD REDUCED 2638 01:46:38,640 --> 01:46:41,480 FAT-FREE MASS IN ADULTHOOD 2639 01:46:41,480 --> 01:46:45,360 ESPECIALLY MORE CLONALITY IN MEN 2640 01:46:45,360 --> 01:46:46,520 PARTICIPANTS. 2641 01:46:46,520 --> 01:46:50,520 AND SO THERE IS ALWAYS A 2642 01:46:50,520 --> 01:46:55,080 QUESTION ON IF WE GIVE 2643 01:46:55,080 --> 01:46:58,080 INDIVIDUALS, FEED THEM WITH HIGH 2644 01:46:58,080 --> 01:47:01,960 ENERGY, HIGH LIPID BASED FOOD 2645 01:47:01,960 --> 01:47:04,440 SUPPLEMENTS HOW DOES THAT IMPACT 2646 01:47:04,440 --> 01:47:05,520 BODY COMPOSITION? 2647 01:47:05,520 --> 01:47:07,360 THE ASSUMPTION IS ALWAYS THAT 2648 01:47:07,360 --> 01:47:09,440 THIS WILL LEAD TO FAT GAIN AND 2649 01:47:09,440 --> 01:47:13,800 WILL EXPOSE PEOPLE TO THE RISK 2650 01:47:13,800 --> 01:47:21,120 OF LATER NCD. 2651 01:47:21,120 --> 01:47:24,680 SO FABIANSEN AND COLLEAGUES GAVE 2652 01:47:24,680 --> 01:47:26,640 BURKINA CHILDREN SUPPLEMENT WITH 2653 01:47:26,640 --> 01:47:30,680 DIFFERENT VARIATION, THE MAIN 2654 01:47:30,680 --> 01:47:34,600 COMPARISON WAS LNS COMPARED TO 2655 01:47:34,600 --> 01:47:36,600 BLEND, EACH CHILD GETTING 500 2656 01:47:36,600 --> 01:47:42,560 KILOCALORIES PER DAY FOR 12 2657 01:47:42,560 --> 01:47:44,320 WEEKS, AND SUPPLEMENT CONTAINS 2658 01:47:44,320 --> 01:47:48,120 SOY ISOLATE, DRY SKIM MILK, OR 2659 01:47:48,120 --> 01:47:49,920 PROTEIN FROM MILK. 2660 01:47:49,920 --> 01:47:53,920 AND THEY OBSERVED THAT CHILDREN 2661 01:47:53,920 --> 01:47:56,680 WITH MODERATE ACUTE MALNUTRITION 2662 01:47:56,680 --> 01:47:59,920 MAINLY GAINED FAT-FREE MASS WHEN 2663 01:47:59,920 --> 01:48:02,080 REHABILITATED USE BE LIPID-BASED 2664 01:48:02,080 --> 01:48:03,200 NUTRITION SUPPLEMENT. 2665 01:48:03,200 --> 01:48:05,000 SO I THINK THERE IS MORE WORK TO 2666 01:48:05,000 --> 01:48:08,280 BE DONE HERE SO THIS MAY BE ONE 2667 01:48:08,280 --> 01:48:10,680 OF THE VERY FIRST STUDIES TRYING 2668 01:48:10,680 --> 01:48:14,680 TO ADDRESS THIS QUESTION SO MORE 2669 01:48:14,680 --> 01:48:15,440 IS NEEDED. 2670 01:48:15,440 --> 01:48:19,200 SO HOW DO WE MEASURE BODY 2671 01:48:19,200 --> 01:48:19,520 COMPOSITION? 2672 01:48:19,520 --> 01:48:23,400 I NEED TO PUT A CAVEAT HERE THAT 2673 01:48:23,400 --> 01:48:31,560 I RECOGNIZE THAT THERE ARE MANY 2674 01:48:31,560 --> 01:48:33,360 NEW TECHNOLOGIES MEASURING, SO 2675 01:48:33,360 --> 01:48:35,320 MY TALK DOESN'T COVER THAT. 2676 01:48:35,320 --> 01:48:38,560 I START WITH BIOCHEMICAL 2677 01:48:38,560 --> 01:48:41,720 MARKERS, FOR EXAMPLE BLOOD 2678 01:48:41,720 --> 01:48:44,840 NUTRIENTS, FOR EXAMPLE, THIS 2679 01:48:44,840 --> 01:48:53,880 STUDY BY KONZ LOOKED AT BLOOD 2680 01:48:53,880 --> 01:48:57,680 NUTRIENTS INCLUDING LYSINE, AND 2681 01:48:57,680 --> 01:49:00,960 ALBUMIN, CRP, FOLATE, AND 2682 01:49:00,960 --> 01:49:01,600 PROLINE. 2683 01:49:01,600 --> 01:49:04,040 AND WHAT YOU CAN SEE THROUGHOUT 2684 01:49:04,040 --> 01:49:06,320 THE SLIDES THAT THESE ARE VERY 2685 01:49:06,320 --> 01:49:10,640 USEFUL MARKERS STRONGLY 2686 01:49:10,640 --> 01:49:12,960 INFLUENCED BY SEX. 2687 01:49:12,960 --> 01:49:14,360 I LOOKED AT ANALYTICAL PLATFORMS 2688 01:49:14,360 --> 01:49:16,840 USED, I THINK IF YOU ARE GOING 2689 01:49:16,840 --> 01:49:20,120 TO USE MASS SPECTROMETRY THEN 2690 01:49:20,120 --> 01:49:23,520 THESE ARE ASSESSMENTS THAT MAY 2691 01:49:23,520 --> 01:49:25,520 BE MORE APPROPRIATE FOR WELL 2692 01:49:25,520 --> 01:49:32,440 EQUIPPED SETTINGS WHERE YOU HAVE 2693 01:49:32,440 --> 01:49:36,800 SUCH KIND OF EQUIPMENT. 2694 01:49:36,800 --> 01:49:38,200 WE'VE ALWAYS MEASURED WEIGHT AND 2695 01:49:38,200 --> 01:49:50,760 ALWAYS MEASURED HEIGHT, AND CAL 2696 01:49:50,760 --> 01:49:53,000 CLIENT-- CALCULATED BODY MASS 2697 01:49:53,000 --> 01:49:54,600 INDEX, A GOOD MARKER FOR 2698 01:49:54,600 --> 01:50:00,920 MALNUTRITION OR RISK OF 2699 01:50:00,920 --> 01:50:02,640 OVERWEIGHT AND OBESITY. 2700 01:50:02,640 --> 01:50:04,560 IN FACT THIS STUDY SHOWED PEOPLE 2701 01:50:04,560 --> 01:50:09,040 THE SAME BMI DO NOT NECESSARILY 2702 01:50:09,040 --> 01:50:11,280 HAVE THE SAME BODY COMPOSITION 2703 01:50:11,280 --> 01:50:14,080 IN TERMS OF BODY FAT. 2704 01:50:14,080 --> 01:50:15,720 AND IT SEEMS THAT THE 2705 01:50:15,720 --> 01:50:19,600 ASSOCIATION BETWEEN BODY MASS 2706 01:50:19,600 --> 01:50:23,280 INDEX AND BODY FAT IS NOT THAT 2707 01:50:23,280 --> 01:50:23,520 STRONG. 2708 01:50:23,520 --> 01:50:25,200 AND THIS IS BECAUSE BODY 2709 01:50:25,200 --> 01:50:28,600 COMPOSITION IS INFLUENCED BY SO 2710 01:50:28,600 --> 01:50:30,920 MANY FACTORS, GENTICS AND MANY 2711 01:50:30,920 --> 01:50:31,800 OTHERS. 2712 01:50:31,800 --> 01:50:34,520 AND SO THESE ARE THE KIND OF 2713 01:50:34,520 --> 01:50:37,400 INFORMATION WE GENERATE, SO WE 2714 01:50:37,400 --> 01:50:40,960 CAN PLOT HEIGHT OVER TIME. 2715 01:50:40,960 --> 01:50:42,880 WE CAN PLOT BMI, BUT REALLY THEY 2716 01:50:42,880 --> 01:50:44,920 DON'T TELL US WHAT COMPONENT OF 2717 01:50:44,920 --> 01:50:51,080 THE BODY WEIGHT IS CHANGING. 2718 01:50:51,080 --> 01:50:57,800 ANOTHER INDICATOR THAT'S BEEN 2719 01:50:57,800 --> 01:50:59,400 USED IS CIRCUMFERENCE, LOW COST, 2720 01:50:59,400 --> 01:51:01,000 LOW LEVEL TRAINING IS REQUIRED 2721 01:51:01,000 --> 01:51:03,800 BUT HOW DOES IT COMPARE WITH 2722 01:51:03,800 --> 01:51:04,520 BODY COMPOSITION? 2723 01:51:04,520 --> 01:51:12,840 SO AGAIN FROM WITH BURKINA FASO 2724 01:51:12,840 --> 01:51:19,000 THEY ADMITTED CHILDREN, EITHER 2725 01:51:19,000 --> 01:51:26,120 USING WEIGHT FOR LENGTH Z SCORE 2726 01:51:26,120 --> 01:51:29,960 OR MUAC, AND THAT WAS CORRECTED 2727 01:51:29,960 --> 01:51:32,360 FOR HEIGHT SO THEY REPORTED IT 2728 01:51:32,360 --> 01:51:34,240 AS FAT-FREE MASS INDEX OR FAT 2729 01:51:34,240 --> 01:51:35,680 MASS INDEX. 2730 01:51:35,680 --> 01:51:38,600 SO WHAT THEY OBSERVED IS 2731 01:51:38,600 --> 01:51:42,520 CHILDREN IDENTIFIED BY MUAC HAD 2732 01:51:42,520 --> 01:51:44,200 HIGHER RATES OF STUNTING, NEAR 2733 01:51:44,200 --> 01:51:46,000 DOUBLE RATES OF SEVERE STUNTING 2734 01:51:46,000 --> 01:51:52,920 COMPARED TO THOSE IDENTIFIED BY 2735 01:51:52,920 --> 01:51:56,040 WEIGHT FOLLOWING Z SCORE. 2736 01:51:56,040 --> 01:52:00,880 IF YOU DON'T USE WEIGHT, YOU MAY 2737 01:52:00,880 --> 01:52:02,680 MISS SOME CHILDREN. 2738 01:52:02,680 --> 01:52:04,680 ESPECIALLY THOSE WITH LOW 2739 01:52:04,680 --> 01:52:07,560 FAT-FREE MASS INDEX. 2740 01:52:07,560 --> 01:52:09,320 OKAY. 2741 01:52:09,320 --> 01:52:11,120 SO THEN THERE ARE SKINFOLDS, SO 2742 01:52:11,120 --> 01:52:13,320 THEY ARE USEFUL MEASUREMENTS BUT 2743 01:52:13,320 --> 01:52:16,280 THERE IS HIGH INTRA AND 2744 01:52:16,280 --> 01:52:17,040 INTERMEASUREMENT VARIABILITY, 2745 01:52:17,040 --> 01:52:20,800 AND THEY ARE BASED ON EQUATIONS 2746 01:52:20,800 --> 01:52:22,640 DEVELOPED FOR OTHER CONTEXTS. 2747 01:52:22,640 --> 01:52:26,600 SO, THIS IS, AGAIN, FROM THE 2748 01:52:26,600 --> 01:52:32,040 PAPER BY GHARIB AND RASHEED, 2749 01:52:32,040 --> 01:52:32,880 PLOTTING DIFFERENT SKINFOLD 2750 01:52:32,880 --> 01:52:34,160 INFORMATION AND THE THING HERE 2751 01:52:34,160 --> 01:52:38,920 IS THERE IS IT A LOT OF 2752 01:52:38,920 --> 01:52:39,760 VARIATION. 2753 01:52:39,760 --> 01:52:42,520 SO THERE ARE OTHER TECHNIQUES 2754 01:52:42,520 --> 01:52:46,280 THAT CAN BE USED BY ELECTRICAL 2755 01:52:46,280 --> 01:52:48,280 IMPEDANCE IS ONE, THEY ARE EASY 2756 01:52:48,280 --> 01:52:50,960 TO USE, LESS COST, LESS INVASIVE 2757 01:52:50,960 --> 01:52:53,720 AND HAVE POTENTIAL FOR USE IN 2758 01:52:53,720 --> 01:52:54,760 LARGER SURVEYS BUT VARIABILITY 2759 01:52:54,760 --> 01:52:59,920 DUE TO THE TYPE OF INSTRUMENT 2760 01:52:59,920 --> 01:53:03,760 SUBJECT AND THERE IS A NEED 2761 01:53:03,760 --> 01:53:04,880 ALWAYS TO DEVELOP 2762 01:53:04,880 --> 01:53:06,360 CONTEXT-SPECIFIC EQUATIONS, AND 2763 01:53:06,360 --> 01:53:10,160 THIS SHOULD KEEP IN MIND SEX AND 2764 01:53:10,160 --> 01:53:13,960 ETHNICITY DIFFERENCES. 2765 01:53:13,960 --> 01:53:16,680 AND JUST TO MANSION AGAIN THE 2766 01:53:16,680 --> 01:53:21,920 VERY COMPLEX BUT EASY TO USE 2767 01:53:21,920 --> 01:53:32,920 PROCEDURES LIKE AIR DISPLACEMENT 2768 01:53:32,920 --> 01:53:39,720 AND DUAL ENERGY X-RAY 2769 01:53:39,720 --> 01:53:40,320 ABSORPTIOMETY. 2770 01:53:40,320 --> 01:53:51,320 I COME TO STABILIZE ISOTOPE 2771 01:53:51,320 --> 01:53:54,560 TECHNIQUES, MEMBER STATES 2772 01:53:54,560 --> 01:53:56,120 MEASURE BODY COMPOSITION USING 2773 01:53:56,120 --> 01:54:02,080 DILUTION AND YOU COULD GET 2774 01:54:02,080 --> 01:54:02,680 RESULTS. 2775 01:54:02,680 --> 01:54:11,280 SO WHY STABLE ISOTOPES? 2776 01:54:11,280 --> 01:54:18,640 TECHNIQUES HAVE POTENTIAL FOR 2777 01:54:18,640 --> 01:54:21,600 USE IN OTHER AREAS, AND LOOK AT 2778 01:54:21,600 --> 01:54:24,160 BREASTFEEDING PROMOTION, HOW 2779 01:54:24,160 --> 01:54:28,040 THAT INFLUENCES GROWTH BUT ALSO 2780 01:54:28,040 --> 01:54:29,120 BODY COMPOSITION, FOR EXAMPLE, 2781 01:54:29,120 --> 01:54:31,640 STUDY IN SOUTH AFRICA SHOWING 2782 01:54:31,640 --> 01:54:34,760 THE MORE EXCLUSIVELY CHILDREN 2783 01:54:34,760 --> 01:54:36,160 WERE BREASTFED HIGHER FAT-FREE 2784 01:54:36,160 --> 01:54:38,880 MASS THEY HAD. 2785 01:54:38,880 --> 01:54:43,120 AND THEN THIS STUDY HERE 2786 01:54:43,120 --> 01:54:45,520 PROFILED BODY COMPOSITION IN 2787 01:54:45,520 --> 01:54:48,200 SCHOOL AGE CHILDREN IN THESE 2788 01:54:48,200 --> 01:54:49,920 AFRICAN COUNTRIES COMPARED TO 2789 01:54:49,920 --> 01:54:52,720 BMI. 2790 01:54:52,720 --> 01:55:00,480 AND SO THE MOST COMMON TECHNIQUE 2791 01:55:00,480 --> 01:55:04,760 IS DEUTERIUM DILUTION, ONE 2792 01:55:04,760 --> 01:55:06,640 COLLECTS BASELINE SAMPLE, SALIVA 2793 01:55:06,640 --> 01:55:12,920 OR URINE, GIVE A DOSE OF 2794 01:55:12,920 --> 01:55:17,760 DEUTERIUM AND THE ASSUMPTION IS 2795 01:55:17,760 --> 01:55:19,480 IT HAS CALIBRATED WITH BODY 2796 01:55:19,480 --> 01:55:22,800 WATER, CAN YOU MEASURE ABUNDANCE 2797 01:55:22,800 --> 01:55:26,000 IN THE SALIVA OR URINE, AND YOU 2798 01:55:26,000 --> 01:55:30,880 CAN CONFLATE BODY WATER AND 2799 01:55:30,880 --> 01:55:35,720 BASED ON STANDARD FAT-FREE MASS 2800 01:55:35,720 --> 01:55:37,720 HYDRATION THEN YOU CAN CALCULATE 2801 01:55:37,720 --> 01:55:39,120 FAT-FREE MASS AND BODY FAT BY 2802 01:55:39,120 --> 01:55:42,400 DIFFERENCE OF BODY WEIGHT AND 2803 01:55:42,400 --> 01:55:44,040 FAT-FREE MASS. 2804 01:55:44,040 --> 01:55:54,520 THIS IS A PRACTICAL EXAMPLE , 2805 01:55:54,520 --> 01:55:57,640 PREVALENCE OF OVERWEIGHT AND 2806 01:55:57,640 --> 01:55:59,200 OBESITY IN SCHOOL CHILDREN, 2807 01:55:59,200 --> 01:56:00,680 ANTHROPO METRIC BASED PREVALENCE 2808 01:56:00,680 --> 01:56:05,400 OF OBESITY WAS REPORTED AT 28, 2809 01:56:05,400 --> 01:56:08,600 BUT THEN THE DEUTERIUM DILUTION 2810 01:56:08,600 --> 01:56:10,840 TECHNIQUE SHOWED ALMOST DOUBLE 2811 01:56:10,840 --> 01:56:13,600 THAT NUMBER. 2812 01:56:13,600 --> 01:56:17,160 AND THESE ARE MEDIA REPORTS FROM 2813 01:56:17,160 --> 01:56:18,640 LOCAL MEDIA STATIONS. 2814 01:56:18,640 --> 01:56:20,880 SO THESE ARE THE 2815 01:56:20,880 --> 01:56:22,880 INSTRUMENTATIONS FOR MEASURING 2816 01:56:22,880 --> 01:56:36,640 BODY COMPOSITION WITH STABILIZE 2817 01:56:36,640 --> 01:56:38,840 ISOTOPES, DESKTOP OR PORTABLE 2818 01:56:38,840 --> 01:56:39,360 FTR. 2819 01:56:39,360 --> 01:56:41,040 THE QUESTION THAT ARISES IS WHAT 2820 01:56:41,040 --> 01:56:48,720 IS THE SAFETY OF STABLE 2821 01:56:48,720 --> 01:56:49,160 ISOTOPES? 2822 01:56:49,160 --> 01:56:50,280 THEY ARE VERY SAFE AT THE LEVEL 2823 01:56:50,280 --> 01:56:56,080 THEY ARE USED IN HUMAN STUDIES. 2824 01:56:56,080 --> 01:56:58,160 AS I CLOSE I THOUGHT I WOULD 2825 01:56:58,160 --> 01:57:00,960 SAY, OKAY, WHERE COULD WE APPLY 2826 01:57:00,960 --> 01:57:01,840 THESE TECHNIQUES? 2827 01:57:01,840 --> 01:57:06,400 WE COULD LOOK AT 2828 01:57:06,400 --> 01:57:07,680 LABORATORY-BASED OR MAYBE FIELD 2829 01:57:07,680 --> 01:57:10,320 OR EVEN LARGE REAL LIFE SURVEYS 2830 01:57:10,320 --> 01:57:12,520 AND I THINK ALL THE TECHNIQUES 2831 01:57:12,520 --> 01:57:14,800 MENTIONED CAN BE USED AT 2832 01:57:14,800 --> 01:57:16,880 LABORATORY LEVEL BUT THERE ARE A 2833 01:57:16,880 --> 01:57:20,720 FEW ONES THAT MAY BE USED IN 2834 01:57:20,720 --> 01:57:24,120 REAL LIFE SURVEYS WITH 2835 01:57:24,120 --> 01:57:29,280 LIMITATIONS, AND THEN I THINK 2836 01:57:29,280 --> 01:57:29,920 ABOUT. 2837 01:57:29,920 --> 01:57:32,520 IA, ANTHROPOMETRY MAY BE APPLIED 2838 01:57:32,520 --> 01:57:36,840 BUT PRIOR VALIDATION WITH 2839 01:57:36,840 --> 01:57:39,960 METHODS LIKE STABLE ISOTOPES ARE 2840 01:57:39,960 --> 01:57:40,160 NEED. 2841 01:57:40,160 --> 01:57:43,320 BODY COMPOSITION IS CENTRAL TO 2842 01:57:43,320 --> 01:57:44,440 UNDERSTANDING, AND BODY 2843 01:57:44,440 --> 01:57:52,040 COMPOSITION IS IMPORTANT 2844 01:57:52,040 --> 01:57:52,600 FUNCTIONAL OUTCOMES, THERE'S 2845 01:57:52,600 --> 01:57:54,760 MANY WAYS TO MEASURE BUT THE 2846 01:57:54,760 --> 01:57:57,640 CHOICE OF METHODOLOGY DEPEND ON 2847 01:57:57,640 --> 01:58:02,760 COST LEVEL, INVASIVENESS AND 2848 01:58:02,760 --> 01:58:03,920 ACCURACY. 2849 01:58:03,920 --> 01:58:05,200 AND ANTHROPOMETRY ESTIMATES WEEK 2850 01:58:05,200 --> 01:58:07,360 WEAKLY ASSOCIATED WITH BODY 2851 01:58:07,360 --> 01:58:08,960 COMPOSITION, AND IT SEEMS THAT 2852 01:58:08,960 --> 01:58:10,560 THERE IS A STRONG ASSOCIATION 2853 01:58:10,560 --> 01:58:12,760 BETWEEN BODY COMPOSITION AND 2854 01:58:12,760 --> 01:58:15,920 LINEAR GROWTH AND STUNTING FOR 2855 01:58:15,920 --> 01:58:18,440 THAT MATTER. 2856 01:58:18,440 --> 01:58:20,360 REFERENCE METHODS CAN BE USED TO 2857 01:58:20,360 --> 01:58:22,160 VALIDATE SIMPLER TECHNIQUES FOR 2858 01:58:22,160 --> 01:58:22,560 WIDER APPLICATION. 2859 01:58:22,560 --> 01:58:25,960 I THANK YOU VERY MUCH. 2860 01:58:25,960 --> 01:58:32,680 2861 01:58:32,680 --> 01:58:37,920 2862 01:58:37,920 --> 01:58:45,120 >> NEXT IS DR. SCOTT CROUTER, 2863 01:58:45,120 --> 01:58:45,720 UNIVERSITY OF TENNESSEE 2864 01:58:45,720 --> 01:58:46,120 KNOXVILLE. 2865 01:58:46,120 --> 01:58:48,600 RESEARCH IN AREA OF MEASURING 2866 01:58:48,600 --> 01:58:50,640 PHYSICAL ACTIVITY IN ADULTS AND 2867 01:58:50,640 --> 01:58:53,520 YOUTH USING WEARABLE PHYSICAL 2868 01:58:53,520 --> 01:58:55,120 ACTIVITY MONITORS AND HAS SERVED 2869 01:58:55,120 --> 01:58:57,720 ON COMMITTEES RELATED TO THIS 2870 01:58:57,720 --> 01:59:10,320 WORK SUCH AS CENTERS FOR DISEASE 2871 01:59:10,320 --> 01:59:10,720 PREVENTION. 2872 01:59:10,720 --> 01:59:14,000 OVER TO YOU. 2873 01:59:14,000 --> 01:59:14,360 >> THANK YOU. 2874 01:59:14,360 --> 01:59:16,560 THE SAME STORMS ARE GOING 2875 01:59:16,560 --> 01:59:18,520 THROUGH ATLANTA ARE COMING 2876 01:59:18,520 --> 01:59:19,800 THROUGH KNOXVILLE ALSO. 2877 01:59:19,800 --> 01:59:21,640 HOPEFULLY I'VE HEARD SOME 2878 01:59:21,640 --> 01:59:23,520 RUMBLES OF THUNDER, HOPEFULLY I 2879 01:59:23,520 --> 01:59:29,320 DON'T GET DISCONNECTED HERE. 2880 01:59:29,320 --> 01:59:32,040 SO I'VE BEEN TASKED WITH TALKING 2881 01:59:32,040 --> 01:59:35,520 ABOUT WAYS TO ASSESS PHYSICAL 2882 01:59:35,520 --> 01:59:36,560 ACTIVITY AND PERFORMANCE AND 2883 01:59:36,560 --> 01:59:36,920 FITNESS. 2884 01:59:36,920 --> 01:59:39,640 THIS IS A BROAD TOPIC. 2885 01:59:39,640 --> 01:59:42,360 MY GOAL HERE IS TO JUST 2886 01:59:42,360 --> 01:59:44,640 HIGHLIGHT SOME DIFFERENT WAYS 2887 01:59:44,640 --> 01:59:46,680 THAT WE CAN MEASURE THEM AND 2888 01:59:46,680 --> 01:59:47,520 PRACTICAL WAYS THAT THEY HAVE 2889 01:59:47,520 --> 01:59:51,760 BEEN USED IN THE FIELDS 2890 01:59:51,760 --> 01:59:52,400 PREVIOUSLY. 2891 01:59:52,400 --> 01:59:54,960 AND MOVE THROUGH IN THAT 2892 01:59:54,960 --> 01:59:56,520 DIRECTION HERE. 2893 01:59:56,520 --> 02:00:00,080 SO, BEFORE I START, I THINK IT'S 2894 02:00:00,080 --> 02:00:01,360 IMPORTANT TO UNDERSTAND WHAT 2895 02:00:01,360 --> 02:00:03,280 WE'RE TRYING TO MEASURE WITH 2896 02:00:03,280 --> 02:00:04,160 PHYSICAL ACTIVITY. 2897 02:00:04,160 --> 02:00:08,320 AND ON THE ONE SIDE WITH HEALTH 2898 02:00:08,320 --> 02:00:09,400 ENHANCING PHYSICAL ACTIVITY, WE 2899 02:00:09,400 --> 02:00:13,120 CAN LOOK AT THINGS LIKE 2900 02:00:13,120 --> 02:00:14,120 INTENSITY, DURATION, FREQUENCY, 2901 02:00:14,120 --> 02:00:16,160 YOU CAN LOOK AT QUESTIONS TO 2902 02:00:16,160 --> 02:00:18,640 ASSESS ARE WE MEETING THE 2903 02:00:18,640 --> 02:00:20,120 PHYSICAL ACTIVITY RECOMMENDATION 2904 02:00:20,120 --> 02:00:21,480 AND SO FORTH. 2905 02:00:21,480 --> 02:00:24,320 ON THE FITNESS SIDE WE'RE 2906 02:00:24,320 --> 02:00:26,840 GETTING INTO THINGS LIKE VO2 2907 02:00:26,840 --> 02:00:34,360 MAX, ECONOMY, MUSCULAR STRENGTH, 2908 02:00:34,360 --> 02:00:35,120 ENDURANCE. 2909 02:00:35,120 --> 02:00:35,920 SO IT'S IMPORTANT TO FOCUS ON 2910 02:00:35,920 --> 02:00:38,280 THE QUESTION THAT NEEDS TO BE 2911 02:00:38,280 --> 02:00:41,720 ADDRESSED, AND THEN USE THE BEST 2912 02:00:41,720 --> 02:00:48,760 MEASURE TO ASSESS THOSE 2913 02:00:48,760 --> 02:00:49,160 QUESTIONS. 2914 02:00:49,160 --> 02:00:51,480 IT'S IMPORTANT TO LOOK AT WHAT 2915 02:00:51,480 --> 02:00:53,840 OTHERS ARE DOING AND LEVERAGE 2916 02:00:53,840 --> 02:00:57,000 THE WORK OF OTHERS WITH THIS. 2917 02:00:57,000 --> 02:00:59,000 SO I THINK WE DON'T HAVE TIME TO 2918 02:00:59,000 --> 02:01:01,880 GO INTO IT TODAY BUT THERE'S A 2919 02:01:01,880 --> 02:01:02,760 PHYSICAL ACTIVITY REPORT CARD 2920 02:01:02,760 --> 02:01:07,360 AND THIS IS GOING ON SINCE ABOUT 2921 02:01:07,360 --> 02:01:09,920 2014 AND THERE'S A GLOBAL 2922 02:01:09,920 --> 02:01:10,200 ALLIANCE. 2923 02:01:10,200 --> 02:01:12,520 WHEN IT STARTED THERE WERE 15 2924 02:01:12,520 --> 02:01:14,120 COUNTRIES INVOLVED, NOW IT'S 2925 02:01:14,120 --> 02:01:15,040 OVER 60 COUNTRIES. 2926 02:01:15,040 --> 02:01:16,720 AND SO I THINK THE IMPORTANCE OF 2927 02:01:16,720 --> 02:01:19,120 THIS IS A LOT OF THINGS THAT 2928 02:01:19,120 --> 02:01:22,520 WE'RE ASSESSING IN THERE ARE 2929 02:01:22,520 --> 02:01:25,360 PHYSICAL ACTIVITY, SEDENTARY 2930 02:01:25,360 --> 02:01:30,320 BEHAVIOR, SCHOOL ENVIRONMENT, 2931 02:01:30,320 --> 02:01:30,680 FITNESS LEVELS. 2932 02:01:30,680 --> 02:01:32,360 THERE'S SOME PREFERENCE FOR WHAT 2933 02:01:32,360 --> 02:01:35,000 TYPE OF MEASUREMENTS ARE USED IN 2934 02:01:35,000 --> 02:01:37,040 EACH OF THOSE SETTINGS. 2935 02:01:37,040 --> 02:01:42,640 AND I THINK LOOKING AT WHAT 2936 02:01:42,640 --> 02:01:45,640 THOSE DO CAN HELP LEVERAGE HOW 2937 02:01:45,640 --> 02:01:46,760 CAN WE COMBINE SOME OF THESE 2938 02:01:46,760 --> 02:01:47,240 EFFORTS. 2939 02:01:47,240 --> 02:01:50,320 ALL RIGHT, SO IN TALKING ABOUT 2940 02:01:50,320 --> 02:01:52,720 PHYSICAL PERFORMANCE AND FITNESS 2941 02:01:52,720 --> 02:01:56,720 LEVELS, WE CAN ALWAYS HAVE THIS 2942 02:01:56,720 --> 02:01:58,880 ASSESSMENT CASCADE, WHERE AT THE 2943 02:01:58,880 --> 02:02:00,120 BOTTOM WE HAVE PREDICTION 2944 02:02:00,120 --> 02:02:03,320 EQUATIONS, AND THEN AS WE MOVE 2945 02:02:03,320 --> 02:02:04,920 UP TOWARDS THE LAB-BASED 2946 02:02:04,920 --> 02:02:06,200 MEASURES WE'RE INCREASING 2947 02:02:06,200 --> 02:02:08,000 PRECISION BUT THE DIFFICULTY IN 2948 02:02:08,000 --> 02:02:10,320 COST IS ALSO INCREASING WITH IT. 2949 02:02:10,320 --> 02:02:13,320 SO, REALLY THE GOAL IS TO 2950 02:02:13,320 --> 02:02:14,720 MAXIMIZE THE BENEFIT OF THESE 2951 02:02:14,720 --> 02:02:14,920 TESTS. 2952 02:02:14,920 --> 02:02:17,240 SO IT'S GOING TO BE SOMEWHERE IN 2953 02:02:17,240 --> 02:02:21,080 THE MIDDLE HERE FOR THESE LARGE 2954 02:02:21,080 --> 02:02:21,640 SCALE STUDIES. 2955 02:02:21,640 --> 02:02:24,240 AND SO THE KIND OF GOLD STANDARD 2956 02:02:24,240 --> 02:02:27,960 IS DOING VO2 MAX TEST OR MAXIMAL 2957 02:02:27,960 --> 02:02:30,080 OXYGEN CONSUMPTION. 2958 02:02:30,080 --> 02:02:33,520 BUT IN REALITY, THIS IS REALLY A 2959 02:02:33,520 --> 02:02:35,840 TEST FOR CARDIO RESPIRATORY 2960 02:02:35,840 --> 02:02:36,360 FITNESS. 2961 02:02:36,360 --> 02:02:37,680 IN TERMS OF NUTRITION 2962 02:02:37,680 --> 02:02:39,720 INTERVENTION, IT'S PROBABLY 2963 02:02:39,720 --> 02:02:42,520 GOING TO HAVE LESS APPLICATION. 2964 02:02:42,520 --> 02:02:43,720 THIS IS JUST ONE STUDY 2965 02:02:43,720 --> 02:02:47,440 HIGHLIGHTED IN THE TABLE BELOW, 2966 02:02:47,440 --> 02:02:49,600 AND REALLY NORMALLY YOU DON'T 2967 02:02:49,600 --> 02:02:51,560 SEE LARGE DIFFERENCES IN VO2 MAX 2968 02:02:51,560 --> 02:02:53,720 WHEN WE LOOK AT IRON STATUS 2969 02:02:53,720 --> 02:02:55,680 LEVELS, FOR EXAMPLE. 2970 02:02:55,680 --> 02:02:56,360 AND THERE'S NUMEROUS STUDIES 2971 02:02:56,360 --> 02:02:59,680 THAT SHOW THE SAME THING. 2972 02:02:59,680 --> 02:03:01,120 AND SO GOING FOR GOLD STANDARD 2973 02:03:01,120 --> 02:03:05,360 IN THIS SITUATION IS PROBABLY 2974 02:03:05,360 --> 02:03:07,080 NOT AS RELEVANT FOR SOME OTHER 2975 02:03:07,080 --> 02:03:12,400 TYPE OF STUDY THAT WE WOULD LOOK 2976 02:03:12,400 --> 02:03:12,720 AT. 2977 02:03:12,720 --> 02:03:16,240 WHEN WE GET INTO FIELD TESTS FOR 2978 02:03:16,240 --> 02:03:17,520 CARDIO RESPIRATORY FITNESS, THE 2979 02:03:17,520 --> 02:03:20,320 THING TO KEEP IN MIND HERE 2980 02:03:20,320 --> 02:03:24,560 THERE'S A LOT OUT THERE. 2981 02:03:24,560 --> 02:03:26,360 AND PACER IS POPULAR, TREADMILL 2982 02:03:26,360 --> 02:03:30,400 TESTS, CYCLE TESTS ARE POPULAR. 2983 02:03:30,400 --> 02:03:32,400 ONE-MILE WALK IS POPULAR. 2984 02:03:32,400 --> 02:03:35,520 IT'S NOT NECESSARILY ABOUT CAN 2985 02:03:35,520 --> 02:03:37,440 WE PREDICTS VO2 MAX, WHEN YOU'RE 2986 02:03:37,440 --> 02:03:38,720 LOOKING AT CHANGE OVER A PERIOD 2987 02:03:38,720 --> 02:03:40,800 OF TIME IT'S REALLY ABOUT 2988 02:03:40,800 --> 02:03:43,520 LOOKING AT THE ACTUAL OUTCOME. 2989 02:03:43,520 --> 02:03:44,200 WITH THE PACER TEST, LOOKING 2990 02:03:44,200 --> 02:03:47,560 IT'S A HOW MANY LAPS DID THEY 2991 02:03:47,560 --> 02:03:49,560 COMPLETE, ON TARGET. 2992 02:03:49,560 --> 02:03:54,560 USE THAT AS OUTCOME RATHER THAN 2993 02:03:54,560 --> 02:03:56,640 REALLY FOCUSING ON PREDICTED VO2 2994 02:03:56,640 --> 02:03:59,240 MAX. 2995 02:03:59,240 --> 02:04:00,520 THERE'S SOME BIG ASSUMPTIONS, 2996 02:04:00,520 --> 02:04:08,040 ONE IS KIND OF THIS LINEARITY 2997 02:04:08,040 --> 02:04:11,320 BETWEEN HEART RATE AND VO2 OR 2998 02:04:11,320 --> 02:04:12,800 WORK RATE. 2999 02:04:12,800 --> 02:04:14,120 THEY MEASURE AT VARIOUS POWER 3000 02:04:14,120 --> 02:04:19,920 LEVELS LIKE HERE AND THEN YOU 3001 02:04:19,920 --> 02:04:20,920 EXTRAPOLATE TO HEART RATE MAX 3002 02:04:20,920 --> 02:04:24,440 AND FIGURE OUT WHAT VO2 MAX IS. 3003 02:04:24,440 --> 02:04:26,680 WHEN YOU DO THAT, IT WORKS 3004 02:04:26,680 --> 02:04:28,800 FAIRLY WELL BUT THESE PREDICTION 3005 02:04:28,800 --> 02:04:30,240 EQUATIONS FOR HEART RATE MAX 3006 02:04:30,240 --> 02:04:34,680 HAVE ROUGHLY A PLUS OR MINUS 20 3007 02:04:34,680 --> 02:04:35,560 BEAT PER MINUTE STANDARD 3008 02:04:35,560 --> 02:04:35,840 DEVIATION. 3009 02:04:35,840 --> 02:04:37,320 YOU CAN GET A GREAT AMOUNT OF 3010 02:04:37,320 --> 02:04:38,920 ERROR IN THERE. 3011 02:04:38,920 --> 02:04:42,160 AND SO JUST FOCUSING ON WHAT WAS 3012 02:04:42,160 --> 02:04:51,560 THE FINAL OUTCOME IN TERMS OF 3013 02:04:51,560 --> 02:04:52,520 VALID MEASUREMENT FOR CARDIO 3014 02:04:52,520 --> 02:04:53,720 RESPIRATORY VALUES. 3015 02:04:53,720 --> 02:04:55,320 HEART RATE IS A VALUABLE 3016 02:04:55,320 --> 02:05:10,640 TECHNIQUE WHEN LOOKING AT 3017 02:05:10,640 --> 02:05:12,520 PHYSIOLOGICAL ASSESSMENTS. 3018 02:05:12,520 --> 02:05:14,160 HEART RACE WILL DECREASEK AT 3019 02:05:14,160 --> 02:05:16,080 SAME INTENSITY LOWER HEART RATE, 3020 02:05:16,080 --> 02:05:18,440 MAKING IT A VALUABLE ASSESSMENT 3021 02:05:18,440 --> 02:05:20,640 TOMB FOR TRACKING CHANGE. 3022 02:05:20,640 --> 02:05:23,400 THIS HAS BEEN USED IN NUMEROUS 3023 02:05:23,400 --> 02:05:24,360 DIFFERENT STUDIES. 3024 02:05:24,360 --> 02:05:28,360 I HIGHLIGHT A COUPLE HERE ON THE 3025 02:05:28,360 --> 02:05:28,560 LEFT. 3026 02:05:28,560 --> 02:05:30,600 THIS WAS LOOKING -- THEY DID A 3027 02:05:30,600 --> 02:05:32,800 PEAK EXERCISE HEART RATE, CYCLE 3028 02:05:32,800 --> 02:05:42,720 TEST, LOOKING AT MAXIMAL HEART 3029 02:05:42,720 --> 02:05:44,160 RATE DURING ENDURANCE TEST. 3030 02:05:44,160 --> 02:05:45,520 NORMAL, IRON DEFICIENT, AMERICAN 3031 02:05:45,520 --> 02:05:47,240 AND WOMEN, ONE A PLACEBO, ONE 3032 02:05:47,240 --> 02:05:48,520 IRON TREATMENT. 3033 02:05:48,520 --> 02:05:51,240 IMPORTANT OUTCOME HERE TO FOCUS 3034 02:05:51,240 --> 02:05:54,360 ON IS WITH THOSE THAT GOT IRON 3035 02:05:54,360 --> 02:05:56,160 TREATMENT, THIS MIDDLE BOX, YOU 3036 02:05:56,160 --> 02:06:00,240 SEE THE PEAK HEART RATE 3037 02:06:00,240 --> 02:06:01,320 DECREASED PRE-TO POST TREATMENT 3038 02:06:01,320 --> 02:06:04,200 AND IT'S A FUNCTION OF THE IRON 3039 02:06:04,200 --> 02:06:08,360 BEING VERY IMPORTANT FOR OXYGEN 3040 02:06:08,360 --> 02:06:09,880 TRANSPORT. 3041 02:06:09,880 --> 02:06:11,520 DOESN'T AFFECT MAXIMAL VO2 TO 3042 02:06:11,520 --> 02:06:16,200 THE SAME EXTENT BUT IN TERMS OF 3043 02:06:16,200 --> 02:06:17,440 SOME MAXIMAL INTENSITY YOU SEE 3044 02:06:17,440 --> 02:06:18,280 NICE CHANGES. 3045 02:06:18,280 --> 02:06:23,280 ON THE RIGHT A STUDY IN YOUTH, 3046 02:06:23,280 --> 02:06:27,720 OVERWEIGHT AND OBESE YOUTH, 3047 02:06:27,720 --> 02:06:29,320 SIMPLE TREADMILL TEST, STAGE 1 3048 02:06:29,320 --> 02:06:31,440 WAS 3 MILES AN HOUR. 3049 02:06:31,440 --> 02:06:34,800 WHAT WE SAW THERE WAS BASELINE 3050 02:06:34,800 --> 02:06:36,920 ACROSS 16 WEEKS TO TIME 2, WE 3051 02:06:36,920 --> 02:06:49,120 GOT A 10 BEAT PER MINUTE 3052 02:06:49,120 --> 02:06:50,360 DECREASE. 3053 02:06:50,360 --> 02:06:51,680 MUSCULAR STRENGTH AND ENDURANCE 3054 02:06:51,680 --> 02:06:54,480 ALSO IMPORTANT TO EVALUATE BUT 3055 02:06:54,480 --> 02:06:55,920 CAN BE TRICKIER. 3056 02:06:55,920 --> 02:07:01,800 THE GOLD STANDARDS ARE THINGS 3057 02:07:01,800 --> 02:07:05,920 LIKE 1RM, DOING PERCENTAGE OF 3058 02:07:05,920 --> 02:07:07,080 MAXIMAL EFFORT, ENDURANCE TEST. 3059 02:07:07,080 --> 02:07:11,720 YOU CAN GET NICE CHANGES BUT 3060 02:07:11,720 --> 02:07:13,600 THEY AREN'T PRACTICAL IN LARGE 3061 02:07:13,600 --> 02:07:15,880 GROUP SETTINGS. 3062 02:07:15,880 --> 02:07:17,120 SO COMING BACK TO LEVERAGING 3063 02:07:17,120 --> 02:07:21,760 WHAT OTHERS DO, SO THIS IS A 3064 02:07:21,760 --> 02:07:22,800 SNAPSHOT OF A FITNESS GRAM 3065 02:07:22,800 --> 02:07:26,480 REPORT FROM TEXAS. 3066 02:07:26,480 --> 02:07:28,720 IN TEXAS, THEY DO THE TESTING IN 3067 02:07:28,720 --> 02:07:30,320 ALL THEIR SCHOOLS, SEVERAL 3068 02:07:30,320 --> 02:07:32,280 STATES HAVE TAKEN THIS APPROACH. 3069 02:07:32,280 --> 02:07:33,840 AND WHAT YOU SEE OVER ON THE 3070 02:07:33,840 --> 02:07:42,120 RIGHT SIDE OF THE SCREEN HERE IS 3071 02:07:42,120 --> 02:07:46,400 WITHIN THE FITNESS GRAM THEY DO 3072 02:07:46,400 --> 02:07:49,320 ALSO A SIT-UP AND PUSHUP TEST 3073 02:07:49,320 --> 02:07:54,160 FOR MUSCULAR STRENGTH AND 3074 02:07:54,160 --> 02:07:54,600 ENDURANCE. 3075 02:07:54,600 --> 02:07:58,120 WHAT YOU GET IS A STRUCTURED SET 3076 02:07:58,120 --> 02:08:00,920 OF CRITERIA BUT YOU ALSO GET 3077 02:08:00,920 --> 02:08:03,440 NORM REFERENCE VALUES TO COMPARE 3078 02:08:03,440 --> 02:08:05,160 THE GROUPS TO, ALONG WITH YOU 3079 02:08:05,160 --> 02:08:06,520 GET SOME NICE CHANGES. 3080 02:08:06,520 --> 02:08:09,840 THEY ARE EASY TO DETECT WITH 3081 02:08:09,840 --> 02:08:10,640 THESE TESTS. 3082 02:08:10,640 --> 02:08:12,160 ALL RIGHT. 3083 02:08:12,160 --> 02:08:14,400 SO, MOVING ON TO PHYSICAL 3084 02:08:14,400 --> 02:08:16,720 ACTIVITY ASSESSMENT, WE HAVE THE 3085 02:08:16,720 --> 02:08:18,520 SAME TYPE OF CASCADE CHART HERE, 3086 02:08:18,520 --> 02:08:21,120 GOING LEFT TO RIGHT ON IT, 3087 02:08:21,120 --> 02:08:22,920 LOWEST COST ON THE LEFT, HIGHEST 3088 02:08:22,920 --> 02:08:25,080 COST ON THE RIGHT. 3089 02:08:25,080 --> 02:08:26,720 ALSO HIGHEST BURDEN. 3090 02:08:26,720 --> 02:08:27,840 BOTTOM TO TOP. 3091 02:08:27,840 --> 02:08:30,120 AS WE MOVE UP THE MEASURES 3092 02:08:30,120 --> 02:08:32,000 BECOME LESS PRACTICAL BUT THEY 3093 02:08:32,000 --> 02:08:33,720 ARE MORE VALID. 3094 02:08:33,720 --> 02:08:35,720 WE HEARD ABOUT DOUBLY LABELED 3095 02:08:35,720 --> 02:08:41,720 WATER, ALSO A CRITERION, HOWEVER 3096 02:08:41,720 --> 02:08:44,120 THE LIMITATION OF DOUBLY LABELED 3097 02:08:44,120 --> 02:08:45,640 WATER WITH PHYSICAL ACTIVITY 3098 02:08:45,640 --> 02:08:48,080 ONLY GIVES YOU TOTAL ENERGY 3099 02:08:48,080 --> 02:08:50,640 EXPENDITURES, DOESN'T GIVE 3100 02:08:50,640 --> 02:08:52,080 INTENSITY LEVELS. 3101 02:08:52,080 --> 02:08:54,120 SO THAT'S WHERE INDIRECT 3102 02:08:54,120 --> 02:08:55,720 TELEMETRY IS IMPORTANT AND 3103 02:08:55,720 --> 02:08:58,280 DIRECT OBSERVATION WHICH IS 3104 02:08:58,280 --> 02:09:06,520 REALLY USEFUL FOR IING SPECIFIC 3105 02:09:06,520 --> 02:09:07,120 ACTIVITIES -- INDIRECT 3106 02:09:07,120 --> 02:09:07,840 CALORIEMETRY. 3107 02:09:07,840 --> 02:09:08,920 THEY AREN'T PRACTICAL FOR LARGE 3108 02:09:08,920 --> 02:09:10,440 GROUP SETTINGS FOR THE MOST 3109 02:09:10,440 --> 02:09:11,800 PART, AREN'T GOING TO GIVE A LOT 3110 02:09:11,800 --> 02:09:14,640 OF WHAT YOU NEED. 3111 02:09:14,640 --> 02:09:17,440 I'LL TALK ABOUT SELF-REPORT BASE 3112 02:09:17,440 --> 02:09:18,200 MEASURES HERE. 3113 02:09:18,200 --> 02:09:20,960 BUT IN GENERAL THEY AREN'T GOING 3114 02:09:20,960 --> 02:09:24,760 TO BE AS USEFUL IN YOUNG 3115 02:09:24,760 --> 02:09:26,680 CHILDREN, AND IN YOUTH, AS WE 3116 02:09:26,680 --> 02:09:31,920 SAW EARLIER FROM DR. BAILEY'S 3117 02:09:31,920 --> 02:09:32,520 PRESENTATION SELF-REPORT 3118 02:09:32,520 --> 02:09:34,120 MEASURES HAVE A LOT OF 3119 02:09:34,120 --> 02:09:35,800 SYSTEMATIC AND RANDOM ERRORS IN 3120 02:09:35,800 --> 02:09:36,000 THEM. 3121 02:09:36,000 --> 02:09:39,040 IT'S NO DIFFERENT IN PHYSICAL 3122 02:09:39,040 --> 02:09:39,320 ACTIVITY. 3123 02:09:39,320 --> 02:09:41,880 AND SO REALLY THIS IS GOING TO 3124 02:09:41,880 --> 02:09:43,080 BE THE DEVICE-BASED MEASURES ARE 3125 02:09:43,080 --> 02:09:45,720 GOING TO BE KIND OF THE SWEET 3126 02:09:45,720 --> 02:09:50,680 SPOT THAT WE WANT TO FOCUS ON. 3127 02:09:50,680 --> 02:09:52,920 THERE'S A LOT OF DIFFERENT 3128 02:09:52,920 --> 02:09:55,720 DECISION MATRIX GUIDES. 3129 02:09:55,720 --> 02:09:57,480 THIS IS ONE EXAMPLE THAT I 3130 02:09:57,480 --> 02:10:00,120 PULLED UP THAT ALLOWS YOU TO GO 3131 02:10:00,120 --> 02:10:01,280 THROUGH AND ANSWER VARIOUS 3132 02:10:01,280 --> 02:10:02,720 QUESTIONS AND AT THE END GIVES 3133 02:10:02,720 --> 02:10:04,600 YOU KIND OF A GENERAL IDEA ON 3134 02:10:04,600 --> 02:10:08,800 WHAT YOU SHOULD BE USING TO 3135 02:10:08,800 --> 02:10:10,440 ANSWER YOUR QUESTION. 3136 02:10:10,440 --> 02:10:13,200 SO, WHEN WE LOOK AT DIFFERENT 3137 02:10:13,200 --> 02:10:14,600 PHYSICAL ACTIVITY MEASURES, IT'S 3138 02:10:14,600 --> 02:10:16,560 REALLY IMPORTANT TO UNDERSTAND 3139 02:10:16,560 --> 02:10:18,560 THE DIFFERENCES BETWEEN THEM. 3140 02:10:18,560 --> 02:10:25,240 AND THERE'S A LOT OF WORK THAT 3141 02:10:25,240 --> 02:10:29,920 GOES INTO COMPARING THINGS LIKE 3142 02:10:29,920 --> 02:10:31,160 IPAC, MINUTES TO ACCELEROMETERS 3143 02:10:31,160 --> 02:10:32,760 DEVICES, NOT THAT ONE IS RIGHT 3144 02:10:32,760 --> 02:10:35,120 AND WRONG, THEY ARE GIVING YOU 3145 02:10:35,120 --> 02:10:35,640 APPLES AND ORANGES. 3146 02:10:35,640 --> 02:10:37,480 AND SO ON THE SUBJECTIVE MEASURE 3147 02:10:37,480 --> 02:10:40,840 SIDE SO THIS IS GOING TO BE THE 3148 02:10:40,840 --> 02:10:42,040 QUESTIONNAIRES, RECALLS AND SO 3149 02:10:42,040 --> 02:10:43,960 FORTH, THESE ARE GOING TO 3150 02:10:43,960 --> 02:10:46,000 CAPTURE THE BEHAVIOR THAT AN 3151 02:10:46,000 --> 02:10:46,920 INDIVIDUAL DOES. 3152 02:10:46,920 --> 02:10:52,280 IT DOESN'T DO A GOOD JOB AT 3153 02:10:52,280 --> 02:10:52,840 NECESSARILY CAPTURING TOTAL 3154 02:10:52,840 --> 02:10:53,120 MOVEMENT. 3155 02:10:53,120 --> 02:10:57,360 BUT THEY DO A GOOD JOB OF 3156 02:10:57,360 --> 02:11:00,720 CAPTURING GENERAL BEHAVIOR THAT 3157 02:11:00,720 --> 02:11:01,280 SOMEONE DOES. 3158 02:11:01,280 --> 02:11:03,560 WITH PEDOMETERS IN THE MIDDLE 3159 02:11:03,560 --> 02:11:06,120 AND TO A DEGREE 3160 02:11:06,120 --> 02:11:06,680 ACCELEROMETER-BASED DEVICES 3161 02:11:06,680 --> 02:11:08,480 WE'RE GETTING TOTAL VOLUME OF 3162 02:11:08,480 --> 02:11:08,720 ACTIVITY. 3163 02:11:08,720 --> 02:11:12,280 SO, YOU CAN GET TOTAL STEPS PER 3164 02:11:12,280 --> 02:11:15,120 DAY OR FROM THE 3165 02:11:15,120 --> 02:11:16,560 ACCELEROMETER-BASED DEVICES 3166 02:11:16,560 --> 02:11:18,680 TOTAL COUNTS PER DAY, USEFUL BUT 3167 02:11:18,680 --> 02:11:20,320 THEY DO HAVE LIMITATIONS I'LL 3168 02:11:20,320 --> 02:11:24,120 BRING UP. 3169 02:11:24,120 --> 02:11:24,520 AND THEN WITH 3170 02:11:24,520 --> 02:11:25,920 ACCELEROMETERS-BASED DEVICES 3171 02:11:25,920 --> 02:11:29,080 MORE AT INTENSITY FREQUENCY, 3172 02:11:29,080 --> 02:11:30,240 DURATION AND SO FORTH. 3173 02:11:30,240 --> 02:11:32,440 BUT THEY ALL HAVE STRENGTHS AND 3174 02:11:32,440 --> 02:11:34,280 ALL HAVE LIMITATIONS, AND IT'S 3175 02:11:34,280 --> 02:11:35,800 NOT -- IT'S REALLY ABOUT THE 3176 02:11:35,800 --> 02:11:37,720 RESEARCH QUESTION YOU'RE TRYING 3177 02:11:37,720 --> 02:11:39,360 TO ADDRESS WHEN DECIDING WHAT 3178 02:11:39,360 --> 02:11:43,720 THE BEST MEASUREMENT WILL BE. 3179 02:11:43,720 --> 02:11:46,680 SO WITH SELF-REPORT, WE SAW SOME 3180 02:11:46,680 --> 02:11:48,640 OF THIS WITH DIETARY 3181 02:11:48,640 --> 02:11:51,480 MEASUREMENTS EARLIER, IT'S THE 3182 02:11:51,480 --> 02:11:53,000 SAME KIND OF RELIABILITY ISSUES 3183 02:11:53,000 --> 02:11:56,200 IN YOUTH THAT WE SAW EARLIER FOR 3184 02:11:56,200 --> 02:11:57,760 THE -- WITH THIS ON THE FIRST 3185 02:11:57,760 --> 02:11:59,440 ACTIVITY SIDE. 3186 02:11:59,440 --> 02:12:01,680 AND THE YOUNGER THEY ARE, THE 3187 02:12:01,680 --> 02:12:03,640 WORSE KIND OF IT GETS, 3188 02:12:03,640 --> 02:12:05,280 ESPECIALLY WHEN IT COMES TO 3189 02:12:05,280 --> 02:12:07,680 RECALL WHAT THEY ARE DOING. 3190 02:12:07,680 --> 02:12:10,520 ON THE RIGHT THESE ARE JUST TWO 3191 02:12:10,520 --> 02:12:14,160 EXAMPLES OF DIFFERENT TYPES OF 3192 02:12:14,160 --> 02:12:17,080 QUESTIONNAIRES, THESE ARE BOTH 3193 02:12:17,080 --> 02:12:21,080 DESIGNED TO GET AT OUR -- 3194 02:12:21,080 --> 02:12:22,400 PARTICIPANTS MEETING PHYSICAL 3195 02:12:22,400 --> 02:12:23,680 ACTIVITY RECOMMENDATION. 3196 02:12:23,680 --> 02:12:27,920 AND THESE ARE GREAT ON A GROUP 3197 02:12:27,920 --> 02:12:29,120 LEVEL TO CLASSIFY VOLUME OF 3198 02:12:29,120 --> 02:12:30,200 ACTIVITY AND WHAT PEOPLE ARE 3199 02:12:30,200 --> 02:12:32,040 DOING BUT YOU CAN SEE BASED ON 3200 02:12:32,040 --> 02:12:33,800 THE ANSWERS THESE ARE NOT REALLY 3201 02:12:33,800 --> 02:12:36,800 GOING TO BE GREAT FOR DETECTING 3202 02:12:36,800 --> 02:12:38,640 CHANGE. 3203 02:12:38,640 --> 02:12:40,440 AND SO QUESTIONNAIRES HAVE THEIR 3204 02:12:40,440 --> 02:12:43,120 PURPOSE, UNLESS YOU GET INTO 3205 02:12:43,120 --> 02:12:44,200 HAVING THEM RECALL SPECIFIC 3206 02:12:44,200 --> 02:12:46,040 ACTIVITIES THROUGHOUT THE DAY 3207 02:12:46,040 --> 02:12:48,080 WHICH REALLY DECREASES THE 3208 02:12:48,080 --> 02:12:52,280 VALIDITY OF A LOT OF 3209 02:12:52,280 --> 02:12:52,960 QUESTIONNAIRES IN YOUNGER 3210 02:12:52,960 --> 02:12:56,880 CHILDREN, YOU'RE STUCK AT THIS 3211 02:12:56,880 --> 02:12:57,920 HIGHER LEVEL INFORMATION AND SO 3212 02:12:57,920 --> 02:13:02,560 YOU HAVE TO BE CAREFUL ON GOING 3213 02:13:02,560 --> 02:13:04,600 DOWN THAT ROUTE. 3214 02:13:04,600 --> 02:13:11,720 SO, WHEN WE LOOK AT PEDOMETERS, 3215 02:13:11,720 --> 02:13:14,360 WHAT WE'RE LOOKING AT HERE WE 3216 02:13:14,360 --> 02:13:16,760 GET A LACK OF INTENSITY 3217 02:13:16,760 --> 02:13:22,200 MEASURES, AND THEN WE ALSO GET 3218 02:13:22,200 --> 02:13:24,520 POTENTIALLY SOME ISSUES WITH 3219 02:13:24,520 --> 02:13:26,520 DECREASED INACCURACY, WHEN YOU 3220 02:13:26,520 --> 02:13:30,920 LOOK AT USING PEDOMETERS ACROSS 3221 02:13:30,920 --> 02:13:40,240 DIFFERENT WAIST CIRCUMFERENCE, 3222 02:13:40,240 --> 02:13:41,480 ABDOMINAL ADIPOSITY CAN AFFECT 3223 02:13:41,480 --> 02:13:47,080 HOW WELL A PEDOMETER WORKS. 3224 02:13:47,080 --> 02:13:51,600 WHEN WE GO TO RESEARCH GREAT OF 3225 02:13:51,600 --> 02:13:53,280 GRADE AND CONSUMER DEVICES LIKE 3226 02:13:53,280 --> 02:13:55,760 APPLE WATCHES AND SO FORTH THIS 3227 02:13:55,760 --> 02:13:58,920 IS WHERE MOST RESEARCH IS GOING 3228 02:13:58,920 --> 02:14:00,320 AT THIS POINT. 3229 02:14:00,320 --> 02:14:02,040 AND ALL THESE DEVICES ARE KIND 3230 02:14:02,040 --> 02:14:04,640 OF WORKING OFF OF THE GENERAL 3231 02:14:04,640 --> 02:14:06,480 IDEA THAT AS YOU INCREASE 3232 02:14:06,480 --> 02:14:18,120 INTENSITY, HERE WE HAVE 3233 02:14:18,120 --> 02:14:20,120 ACTIGRAPH COUNTS, DEPENDING ON 3234 02:14:20,120 --> 02:14:21,360 ACTIVITY THE RELATIONSHIP WILL 3235 02:14:21,360 --> 02:14:22,120 BE DIFFERENT. 3236 02:14:22,120 --> 02:14:23,920 THERE'S A LOT OF DIFFERENT 3237 02:14:23,920 --> 02:14:26,000 ALGORITHMS OUT THERE. 3238 02:14:26,000 --> 02:14:27,640 ONE IMPORTANT QUESTION IS ALWAYS 3239 02:14:27,640 --> 02:14:30,200 WHAT ALGORITHM DO YOU USE. 3240 02:14:30,200 --> 02:14:32,840 AND IF YOU'RE TRYING TO GET 3241 02:14:32,840 --> 02:14:33,800 GROUP LEVEL ESTIMATES, THERE'S 3242 02:14:33,800 --> 02:14:38,640 GOING TO BE LARGE VARIABILITY. 3243 02:14:38,640 --> 02:14:39,880 IF YOU'RE FOCUSED ON CHANGE, 3244 02:14:39,880 --> 02:14:40,960 REALLY ANY OF THESE ALGORITHMS 3245 02:14:40,960 --> 02:14:43,720 ARE GOING TO WORK. 3246 02:14:43,720 --> 02:14:45,920 HERE IS ONE EXAMPLE, THIRD TO 3247 02:14:45,920 --> 02:14:50,960 FIFTH GRADE STUDENTS, WE DID A 3248 02:14:50,960 --> 02:14:51,960 NUTRITION ONLY EDUCATION, AND 3249 02:14:51,960 --> 02:14:54,320 NUTRITION PLUS P.A. PROGRAM. 3250 02:14:54,320 --> 02:15:01,720 AND YOU CAN SEE WE GOT SOME NICE 3251 02:15:01,720 --> 02:15:02,320 CHANGES, NUTRITION DECREASED, 3252 02:15:02,320 --> 02:15:04,080 AND THAT'S WHAT WE EXPECTED. 3253 02:15:04,080 --> 02:15:06,640 WHEN WE ADDED IN PHYSICAL 3254 02:15:06,640 --> 02:15:09,280 ACTIVITY, WE GOT INCREASES IN 3255 02:15:09,280 --> 02:15:11,200 BOTH MVPA AND LIGHT, SEDENTARY 3256 02:15:11,200 --> 02:15:13,320 ACTIVITY WENT DOWN. 3257 02:15:13,320 --> 02:15:14,680 SO EVERYTHING CHANGED IN THE 3258 02:15:14,680 --> 02:15:17,000 DIRECTION WE EXPECTED. 3259 02:15:17,000 --> 02:15:18,440 WHAT THESE VALUES MEAN IS LESS 3260 02:15:18,440 --> 02:15:20,480 IMPORTANT, IT'S REALLY ABOUT 3261 02:15:20,480 --> 02:15:21,680 CHANGE. 3262 02:15:21,680 --> 02:15:22,320 AND THESE DEVICE-BASED MEASURES 3263 02:15:22,320 --> 02:15:30,280 WILL WORK FOR THAT REALLY WELL. 3264 02:15:30,280 --> 02:15:31,680 HERE'S ANOTHER EXAMPLE, INDIAIAN 3265 02:15:31,680 --> 02:15:32,760 SCHOOL CHILDREN, GIVING PEARL 3266 02:15:32,760 --> 02:15:34,600 MILLET TO LOOK AT IRON 3267 02:15:34,600 --> 02:15:36,280 FORTIFICATION AND THEY GOT 3268 02:15:36,280 --> 02:15:37,320 CHANGES IN LPA BETWEEN THOSE 3269 02:15:37,320 --> 02:15:39,240 THAT TOOK THE IRON AND THOSE 3270 02:15:39,240 --> 02:15:40,440 THAT DIDN'T. 3271 02:15:40,440 --> 02:15:43,520 AND THEY ALSO SAW THAT AS YOU 3272 02:15:43,520 --> 02:15:49,440 CAN CONSUME MORE IRON YOUR LIGHT 3273 02:15:49,440 --> 02:15:50,640 ACTIVITY WAS HIGHER, SEDENTARY 3274 02:15:50,640 --> 02:15:52,320 ACTIVITY WENT DOWN. 3275 02:15:52,320 --> 02:15:54,840 TO WRAP UP HERE, AS WE GO 3276 02:15:54,840 --> 02:15:58,240 FORWARD THE PATTERN RECOGNITION 3277 02:15:58,240 --> 02:16:00,080 IS ON THE HORIZON. 3278 02:16:00,080 --> 02:16:02,440 AIM DEVICE CAME UP EARLIER, 3279 02:16:02,440 --> 02:16:06,240 THAT'S WORN ON THE EYEGLASSES. 3280 02:16:06,240 --> 02:16:09,120 IT'S BEEN USED IN DIETARY INTAKE 3281 02:16:09,120 --> 02:16:09,360 STUDIES. 3282 02:16:09,360 --> 02:16:11,240 WE WORKED WITH SOME COLLEAGUES 3283 02:16:11,240 --> 02:16:14,440 AT ALABAMA TO START DOING 3284 02:16:14,440 --> 02:16:17,960 PATTERN RECOGNITION. 3285 02:16:17,960 --> 02:16:20,360 SENSORS ARE ACCELEROMETERS AND 3286 02:16:20,360 --> 02:16:21,400 GYROSCOPES WE USE, WORKING WITH 3287 02:16:21,400 --> 02:16:25,160 THEM TO LOOK AT SINGLE DEVICE TO 3288 02:16:25,160 --> 02:16:26,800 CAPTURE DIETARY INTAKE AND THEN 3289 02:16:26,800 --> 02:16:27,600 PHYSICAL ACTIVITY. 3290 02:16:27,600 --> 02:16:29,000 SO I THINK THERE'S SOME EXCITING 3291 02:16:29,000 --> 02:16:34,640 THINGS ON THE HORIZON. 3292 02:16:34,640 --> 02:16:35,920 AND THEN SOME OTHER FACTORS THAT 3293 02:16:35,920 --> 02:16:38,760 NEED TO BE TAKEN INTO ACCOUNT 3294 02:16:38,760 --> 02:16:41,520 ARE THINGS LIKE PLACEMENT SITE, 3295 02:16:41,520 --> 02:16:47,560 HOW MANY DAYS OF COLLECTION, 3296 02:16:47,560 --> 02:16:50,040 FREQUENCY OF THE RAW 3297 02:16:50,040 --> 02:16:51,600 ACCELERATION, WHAT YOUR OUTCOME 3298 02:16:51,600 --> 02:16:53,040 IS, SEDENTARY VERSUS PHYSICAL 3299 02:16:53,040 --> 02:16:54,360 ACTIVITY, HOW YOU ANALYZE IT. 3300 02:16:54,360 --> 02:16:56,520 WITH THAT I'M GOING TO WRAP UP 3301 02:16:56,520 --> 02:17:01,840 AND THANK YOU FOR YOUR TIME. 3302 02:17:01,840 --> 02:17:03,720 >> THANK YOU SO MUCH. 3303 02:17:03,720 --> 02:17:08,600 WITH THAT WE HAVE ANOTHER SET OF 3304 02:17:08,600 --> 02:17:13,600 PRESENTATIONS, LED BY DR. 3305 02:17:13,600 --> 02:17:20,000 ELIZABETH PRADO AND DR. JENNIFER 3306 02:17:20,000 --> 02:17:22,680 SAVAGE WILLIAMS. 3307 02:17:22,680 --> 02:17:28,320 3308 02:17:28,320 --> 02:17:41,920 3309 02:17:41,920 --> 02:17:42,040 3310 02:17:42,040 --> 02:17:43,920 THANK YOU BOTH. 3311 02:17:43,920 --> 02:17:46,000 OVER TO YOU, DR. PRADO. 3312 02:17:46,000 --> 02:17:47,720 >> I'M FROM THE INSTITUTE FOR 3313 02:17:47,720 --> 02:17:49,400 GLOBAL NUTRITION AND DEPARTMENT 3314 02:17:49,400 --> 02:17:51,160 OF NUTRITION AT UC-DAVIS. 3315 02:17:51,160 --> 02:17:54,320 I DON'T HAVE ANY CONFLICTS TO 3316 02:17:54,320 --> 02:17:54,600 DISCLOSE. 3317 02:17:54,600 --> 02:17:56,560 MOST OF WHAT I'LL BE TALKING 3318 02:17:56,560 --> 02:17:58,520 ABOUT TODAY IS BASED ON WORLD 3319 02:17:58,520 --> 02:18:00,920 BANK TOOL KIT FOR MEASURING 3320 02:18:00,920 --> 02:18:02,120 EARLY CHILDHOOD DEVELOPMENT 3321 02:18:02,120 --> 02:18:07,680 WHICH I CO-AUTHORED. 3322 02:18:07,680 --> 02:18:08,680 THE TOOLKIT IS FOCUSED ON 3323 02:18:08,680 --> 02:18:14,520 CHILDREN 0 TO 5 YEARS, ON LOW- 3324 02:18:14,520 --> 02:18:18,680 AND MIDDLE-INCOME COUNTRIES, 3325 02:18:18,680 --> 02:18:22,280 MANY PRINCIPLES ARE THE SAME. 3326 02:18:22,280 --> 02:18:25,720 SO THERE ARE SEVERAL POSSIBLE 3327 02:18:25,720 --> 02:18:32,000 GOALS FOR COG COGNITIVE 3328 02:18:32,000 --> 02:18:32,640 ASSESSMENT. 3329 02:18:32,640 --> 02:18:36,280 ONE GOAL IS GLOBAL OR NATIONAL 3330 02:18:36,280 --> 02:18:37,560 POPULATION MONITORING TO DETECT 3331 02:18:37,560 --> 02:18:41,960 BROAD TRENDS TO INFORM POLICY. 3332 02:18:41,960 --> 02:18:43,880 FOR THIS PURPOSE QUICK AND EASY 3333 02:18:43,880 --> 02:18:45,120 TO ADMINISTER BY PERSONNEL WHO 3334 02:18:45,120 --> 02:18:46,640 MIGHT NOT BE HIGHLY TRAINED. 3335 02:18:46,640 --> 02:18:48,520 A TOOL THAT FITS THIS PURPOSE 3336 02:18:48,520 --> 02:18:50,000 MIGHT NOT BE SUFFICIENTLY 3337 02:18:50,000 --> 02:18:52,920 DETAILED TO BE SENSITIVE TO 3338 02:18:52,920 --> 02:18:53,320 INTERVENTIONS. 3339 02:18:53,320 --> 02:18:54,720 SO FOR PROGRAM EVALUATION THE 3340 02:18:54,720 --> 02:18:56,840 GOAL IS TO DEMONSTRATE IMPACTS 3341 02:18:56,840 --> 02:18:58,600 OF SPECIFIC POLICIES OR 3342 02:18:58,600 --> 02:19:01,160 PROGRAMS, AND WE ALSO WANT A 3343 02:19:01,160 --> 02:19:03,120 TOOL RELATIVELY QUICK AND EASY 3344 02:19:03,120 --> 02:19:04,920 TO ADMINISTER BUT IT MUST ALSO 3345 02:19:04,920 --> 02:19:09,320 BE DETAILED ENOUGH TO QUANTIFY 3346 02:19:09,320 --> 02:19:12,440 IMPACT ON CHILD DEVELOPMENT OR 3347 02:19:12,440 --> 02:19:14,000 CHILD COGNITION. 3348 02:19:14,000 --> 02:19:15,800 SO EXPLORATORY RESEARCH THE GOAL 3349 02:19:15,800 --> 02:19:18,320 IS EXPLORING RANGE OF IMPACTS ON 3350 02:19:18,320 --> 02:19:20,560 CHILD COGNITION IN LINE WITH 3351 02:19:20,560 --> 02:19:23,000 THEORY AND NEURAL MECHANISMS. 3352 02:19:23,000 --> 02:19:25,320 SO THIS REALLY ENABLES NEW 3353 02:19:25,320 --> 02:19:27,160 DISCOVERY AND MAY USE NEW 3354 02:19:27,160 --> 02:19:32,520 TECHNOLOGIES TO ADVANCE THE 3355 02:19:32,520 --> 02:19:33,880 FIELD. 3356 02:19:33,880 --> 02:19:38,120 CHILDREN DEVELOP A WIDE RANGE OF 3357 02:19:38,120 --> 02:19:40,120 SCHOOLS, COGNITIVE SKILLS AND 3358 02:19:40,120 --> 02:19:43,560 ANALYTICAL SKILLS, LANGUAGE AND 3359 02:19:43,560 --> 02:19:45,040 MOTOR SKILLS, EXECUTIVE 3360 02:19:45,040 --> 02:19:46,720 FUNCTION, RELATED TO 3361 02:19:46,720 --> 02:19:47,520 SELF-REGULATION AND EFFORTFUL 3362 02:19:47,520 --> 02:19:49,320 CONTROL, AND THIS INVOLVES 3363 02:19:49,320 --> 02:19:50,880 LEARNING TO EXERT INTENTIONAL 3364 02:19:50,880 --> 02:19:52,440 CONTROL OVER THEIR BEHAVIOR. 3365 02:19:52,440 --> 02:19:54,960 IN TERMS OF REGULATING EMOTIONS 3366 02:19:54,960 --> 02:19:57,240 AND ALSO REGULATING COGNITIVE 3367 02:19:57,240 --> 02:20:01,840 PROCESSES LIKE ATTENTION. 3368 02:20:01,840 --> 02:20:02,480 TEMPERAMENT AND SOCIAL-EMOTIONAL 3369 02:20:02,480 --> 02:20:03,200 SKILLS CAN BE MEASURED. 3370 02:20:03,200 --> 02:20:05,520 AS THEY GO TO SCHOOL THEY LEARN 3371 02:20:05,520 --> 02:20:08,720 ACADEMIC SCHOOLS LIKE READING 3372 02:20:08,720 --> 02:20:09,040 AND MATH. 3373 02:20:09,040 --> 02:20:10,200 APPROACHES TO LEARNING IS 3374 02:20:10,200 --> 02:20:12,920 RELATED TO HOW CHILDREN BECOME 3375 02:20:12,920 --> 02:20:14,600 ENGAGED IN LEARNING EXPERIENCES. 3376 02:20:14,600 --> 02:20:17,960 SUCH AS ABILITY TO STAY FOCUSED, 3377 02:20:17,960 --> 02:20:19,320 INTERESTED, ENGAGED IN 3378 02:20:19,320 --> 02:20:19,800 ACTIVITIES. 3379 02:20:19,800 --> 02:20:22,120 AND THIS IS A FIGURE 3380 02:20:22,120 --> 02:20:23,800 ILLUSTRATING THESE DIFFERENT 3381 02:20:23,800 --> 02:20:28,560 BEHAVIORAL DOMAINS ARE ROOTED IN 3382 02:20:28,560 --> 02:20:30,240 DIFFERENT NEURAL STRUCTURES. 3383 02:20:30,240 --> 02:20:32,640 FOR METHODS OF ASSESSMENT WE CAN 3384 02:20:32,640 --> 02:20:33,960 DIVIDE INTO TWO CATEGORIES, 3385 02:20:33,960 --> 02:20:35,240 PHYSIOLOGY AND BEHAVIOR. 3386 02:20:35,240 --> 02:20:36,120 PHYSIOLOGY IS PROBABLY MORE 3387 02:20:36,120 --> 02:20:38,760 LIKELY TO BE ASSESSED IN 3388 02:20:38,760 --> 02:20:40,560 HYPOTHESIS DRIVEN OR EXPLORATORY 3389 02:20:40,560 --> 02:20:41,320 RESEARCH. 3390 02:20:41,320 --> 02:20:42,120 THOUGHTS GENERALLY HIGHER COST 3391 02:20:42,120 --> 02:20:44,640 AND REQUIRE HIGHER DEGREE OF 3392 02:20:44,640 --> 02:20:45,320 TECHNICAL EXPERTISE. 3393 02:20:45,320 --> 02:20:47,280 BUT THEY HAVE GREAT POTENTIAL TO 3394 02:20:47,280 --> 02:20:49,000 IDENTIFY THE BIOLOGICAL 3395 02:20:49,000 --> 02:20:51,040 MECHANISM ALSO OF ENVIRONMENTAL 3396 02:20:51,040 --> 02:20:52,800 INFLUENCES ON BRAIN DEVELOPMENT 3397 02:20:52,800 --> 02:20:57,920 AND BEHAVIOR TO INFORM MORE 3398 02:20:57,920 --> 02:21:00,680 EFFECTIVE INTERVENTIONS. 3399 02:21:00,680 --> 02:21:01,840 THE OTHER OPTION IS ASSESS 3400 02:21:01,840 --> 02:21:03,480 BEHAVIOR LINKING TO FUNCTION AND 3401 02:21:03,480 --> 02:21:05,920 BEHAVIOR CAN BE ASSESSED THROUGH 3402 02:21:05,920 --> 02:21:09,720 DIRECT ASSESSMENT OF THE CHILD, 3403 02:21:09,720 --> 02:21:11,440 THIS METHOD TESTER INTERACTS 3404 02:21:11,440 --> 02:21:13,280 WITH A CHILD AND OBSERVES AND 3405 02:21:13,280 --> 02:21:14,640 RECORDS WHAT THE CHILD IS ABLE 3406 02:21:14,640 --> 02:21:15,520 TO DO. 3407 02:21:15,520 --> 02:21:17,120 ANOTHER IS PARENT OR TEACHER 3408 02:21:17,120 --> 02:21:18,640 REPORT WHERE PARENT IS 3409 02:21:18,640 --> 02:21:19,560 INTERVIEWED OR TEACHER IS 3410 02:21:19,560 --> 02:21:21,320 INTERVIEWED ABOUT THE CHILD'S 3411 02:21:21,320 --> 02:21:23,720 ABILITIES AND BEHAVIOR. 3412 02:21:23,720 --> 02:21:25,920 AND ANOTHER METHOD IS 3413 02:21:25,920 --> 02:21:27,440 NATURALISTIC OR STRUCTURED 3414 02:21:27,440 --> 02:21:32,200 OBSERVATION WITH DEFINED CODING 3415 02:21:32,200 --> 02:21:33,640 SYSTEM TO QUANTIFY BEHAVIORS. 3416 02:21:33,640 --> 02:21:36,800 HERE ARE SOME SPECIFIC EXAMPLES 3417 02:21:36,800 --> 02:21:38,760 OF ASSESSMENTS IN EACH CATEGORY. 3418 02:21:38,760 --> 02:21:40,880 IT LOOKS LIKE AN ALPHABET SOUP, 3419 02:21:40,880 --> 02:21:43,160 I DON'T HAVE TIME TO GO INTO 3420 02:21:43,160 --> 02:21:47,040 DETAILS BUT A FEW EXAMPLES LATER 3421 02:21:47,040 --> 02:21:48,200 ON IN THE PRESENTATION. 3422 02:21:48,200 --> 02:21:51,680 WE CAN ALSO DISTINGUISH BETWEEN 3423 02:21:51,680 --> 02:21:53,000 SCREENING AND ABILITY TEST. 3424 02:21:53,000 --> 02:21:54,760 SCREENING TESTS ARE DESIGNED TO 3425 02:21:54,760 --> 02:21:57,160 IDENTIFY WHETHER A CHILD IS AT 3426 02:21:57,160 --> 02:21:57,840 RISK. 3427 02:21:57,840 --> 02:22:00,480 THEY RESULT IN A BINARY SCORE, 3428 02:22:00,480 --> 02:22:03,520 CHILD IDENTIFIED AS AT RISK 3429 02:22:03,520 --> 02:22:04,800 CATEGORY OR TYPICALLY DEVELOPING 3430 02:22:04,800 --> 02:22:05,760 CATEGORY. 3431 02:22:05,760 --> 02:22:08,480 BUT WE AREN'T ABLE TO 3432 02:22:08,480 --> 02:22:09,800 DISTINGUISH AMONG TYPICALLY 3433 02:22:09,800 --> 02:22:11,680 DEVELOPING CHILDREN. 3434 02:22:11,680 --> 02:22:14,320 SO ABILITY TESTS RESULT IN 3435 02:22:14,320 --> 02:22:19,320 CONTINUOUS SCORE ACROSS THE FULL 3436 02:22:19,320 --> 02:22:20,640 RANGE OF ABILITY LEVEL. 3437 02:22:20,640 --> 02:22:24,120 SO SOME ADVANTAGES IN MEASURING 3438 02:22:24,120 --> 02:22:25,000 PHYSIOLOGY ARE THESE ADVANTAGES 3439 02:22:25,000 --> 02:22:29,600 TEND TO BE LESS EFFECTIVE TO 3440 02:22:29,600 --> 02:22:32,360 CULTURAL BIAS, MAY BE MORE 3441 02:22:32,360 --> 02:22:33,600 SENSITIVE THAN BEHAVIORAL 3442 02:22:33,600 --> 02:22:36,120 ASSESSMENT ESPECIALLY IN EARLY 3443 02:22:36,120 --> 02:22:38,880 INFANCY, THEY HAVE THE POTENTIAL 3444 02:22:38,880 --> 02:22:43,520 TO IDENTIFY BIOLOGICAL 3445 02:22:43,520 --> 02:22:45,760 MECHANISMS AND HAVE GREAT 3446 02:22:45,760 --> 02:22:50,600 POTENTIAL FOR NEW DISCOVERY. 3447 02:22:50,600 --> 02:22:57,160 DISADVANTAGES ARE HIGHER COST, 3448 02:22:57,160 --> 02:23:00,960 HIGHER LEVELS OF TECHNICAL 3449 02:23:00,960 --> 02:23:05,160 EXPERTISE, HIGHER RISK, HARD TO 3450 02:23:05,160 --> 02:23:06,480 TRANSLATE TO POLICYMAKERS. 3451 02:23:06,480 --> 02:23:09,080 SO IF YOU FIND DIFFERENCES, FOR 3452 02:23:09,080 --> 02:23:10,560 EXAMPLE, IN YOUR PROGRAM 3453 02:23:10,560 --> 02:23:13,760 EVALUATION, IF CHILDREN WHO 3454 02:23:13,760 --> 02:23:17,800 RECEIVED THE NUTRITIONAL PROGRAM 3455 02:23:17,800 --> 02:23:19,240 HAD HIGHER AMPLITUDE, IT CAN BE 3456 02:23:19,240 --> 02:23:21,520 HARD TO TRANSLATE THAT TO 3457 02:23:21,520 --> 02:23:23,840 POLICYMAKERS, WHAT DOES THAT 3458 02:23:23,840 --> 02:23:28,280 MEAN FOR THE CHILD'S DAILY LIFE 3459 02:23:28,280 --> 02:23:29,080 AND FUNCTION? 3460 02:23:29,080 --> 02:23:30,840 MEASURING BEHAVIOR IS WELL 3461 02:23:30,840 --> 02:23:33,160 ESTABLISHED AND WIDELY USED TO 3462 02:23:33,160 --> 02:23:34,640 ASSESS OUTCOMES OF NUTRITION 3463 02:23:34,640 --> 02:23:35,120 INTERVENTIONS. 3464 02:23:35,120 --> 02:23:37,160 THERE'S A RANGE OF COST FOR 3465 02:23:37,160 --> 02:23:38,480 VARIOUS TOOLS BUT BEHAVIORAL 3466 02:23:38,480 --> 02:23:41,880 ASSESSMENTS ARE LESS COSTLY THAN 3467 02:23:41,880 --> 02:23:43,640 PHYSIOLOGICAL ASSESSMENTS. 3468 02:23:43,640 --> 02:23:46,320 THERE'S A RANGE OF EXPERTISE BUT 3469 02:23:46,320 --> 02:23:48,240 SOME REQUIRE MINIMAL PREVIOUS 3470 02:23:48,240 --> 02:23:49,320 EXPERIENCE WITH COGNITIVE 3471 02:23:49,320 --> 02:23:50,680 ASSESSMENT FOR TESTERS, DATA 3472 02:23:50,680 --> 02:23:51,160 COLLECTORS. 3473 02:23:51,160 --> 02:23:52,760 AND THEY ARE MORE OBVIOUSLY 3474 02:23:52,760 --> 02:23:55,160 RELEVANT TO A CHILD'S DAILY LIFE 3475 02:23:55,160 --> 02:23:56,560 AND FUNCTION. 3476 02:23:56,560 --> 02:23:58,680 HOWEVER, THEY CAN BE HIGHLY 3477 02:23:58,680 --> 02:24:00,600 SUSCEPTIBILITY OF SPECIAL TO 3478 02:24:00,600 --> 02:24:02,120 BIAS, STRONGLY INFLUENCED BY 3479 02:24:02,120 --> 02:24:03,640 MOOD DURING ASSESSMENT AND MAY 3480 02:24:03,640 --> 02:24:08,840 NOT BE VERY SENSITIVE ESPECIALLY 3481 02:24:08,840 --> 02:24:10,600 IN EARLY INFANCY. 3482 02:24:10,600 --> 02:24:13,520 COMPUTERIZED TESTS ARE BECOMING 3483 02:24:13,520 --> 02:24:14,080 MORE WIDELY AVAILABLE, SOME 3484 02:24:14,080 --> 02:24:18,440 ADVANTAGES ARE THEY ARE QUICK TO 3485 02:24:18,440 --> 02:24:19,160 ADMINISTER, REQUIRE MINIMAL 3486 02:24:19,160 --> 02:24:21,800 TRANSLATION BECAUSE THEY HAVE 3487 02:24:21,800 --> 02:24:23,320 BUILT-IN PRACTICE TRIALS, REPEAT 3488 02:24:23,320 --> 02:24:24,920 UNTIL THE CHILD UNDERSTANDS THE 3489 02:24:24,920 --> 02:24:25,160 TASK. 3490 02:24:25,160 --> 02:24:29,680 THERE'S ALSO MINIMAL INFLUENCE 3491 02:24:29,680 --> 02:24:32,000 OF DATA COLLECTION, AND THEY 3492 02:24:32,000 --> 02:24:33,520 CAPTURE NOT ONLY ACCURACY BUT 3493 02:24:33,520 --> 02:24:34,480 ALSO FIND DIFFERENCES IN 3494 02:24:34,480 --> 02:24:36,360 RESPONSE TIME WHICH MAY MAKE 3495 02:24:36,360 --> 02:24:39,840 THEM MORE SENSITIVE THAN PAPER 3496 02:24:39,840 --> 02:24:40,880 AND PENCIL-BASED ASSESSMENTS. 3497 02:24:40,880 --> 02:24:41,840 DISADVANTAGES THEY CANNOT BE 3498 02:24:41,840 --> 02:24:43,680 USED FOR VERY YOUNG CHILDREN, 3499 02:24:43,680 --> 02:24:46,640 CAN REQUIRE MORE TECHNICAL AND 3500 02:24:46,640 --> 02:24:48,080 ANALYTICAL EXPERTISE, CAN BE 3501 02:24:48,080 --> 02:24:49,640 HIGHER COST AND MAY REQUIRE MORE 3502 02:24:49,640 --> 02:24:54,760 PRACTICE FOR CHILDREN WHO HAVE 3503 02:24:54,760 --> 02:24:56,120 NEVER USED A TABLET. 3504 02:24:56,120 --> 02:24:59,920 IN THE WORLD BANK TOOL KIT WE 3505 02:24:59,920 --> 02:25:05,560 LISTED TEN TRAITS. 3506 02:25:05,560 --> 02:25:06,680 MANY WERE ALREADY MENTIONED BY 3507 02:25:06,680 --> 02:25:07,200 LINDSAY. 3508 02:25:07,200 --> 02:25:13,920 I WON'T GO THROUGH THEM ALL. 3509 02:25:13,920 --> 02:25:15,560 WE DON'T HAVE ONE IDEAL TEST 3510 02:25:15,560 --> 02:25:17,440 THAT MEETS ALL OF THESE 3511 02:25:17,440 --> 02:25:19,320 CRITERIA. 3512 02:25:19,320 --> 02:25:22,240 AS WE'VE ALREADY SEEN, THEY ARE 3513 02:25:22,240 --> 02:25:24,360 TRADEOFFS, ANY METHOD THERE'S 3514 02:25:24,360 --> 02:25:25,600 TRADEOFFS BETWEEN DIFFERENT 3515 02:25:25,600 --> 02:25:25,840 ADEALS. 3516 02:25:25,840 --> 02:25:28,400 WHAT'S REALLY NEEDED IS TO 3517 02:25:28,400 --> 02:25:29,720 PRIORITIZE THE MOST IMPORTANT 3518 02:25:29,720 --> 02:25:31,160 CRITERIA FOR YOUR PURPOSES AND 3519 02:25:31,160 --> 02:25:35,680 THEN SELECT A TEST THAT MEETS 3520 02:25:35,680 --> 02:25:37,040 THOSE CRITERIA. 3521 02:25:37,040 --> 02:25:41,520 SO TO RECAP THE STEPS FOR 3522 02:25:41,520 --> 02:25:44,280 SELECTING ASSESSMENTS, DEFINE 3523 02:25:44,280 --> 02:25:47,840 GOALS, CHOOSE DOUGH METHODS, 3524 02:25:47,840 --> 02:25:50,440 CHOOSE PRIORITIES, AND EVALUATE 3525 02:25:50,440 --> 02:25:52,440 OPTIONS AND SELECT AN ASSESSMENT 3526 02:25:52,440 --> 02:25:54,160 THAT MEETS YOUR PRIORITIES. 3527 02:25:54,160 --> 02:25:56,280 SOME USEFUL TOOLS FOR TEST 3528 02:25:56,280 --> 02:25:58,120 SELECTION ARE LISTED HERE. 3529 02:25:58,120 --> 02:26:02,720 NIH TOOLBOX IS A SET OF OVER 100 3530 02:26:02,720 --> 02:26:03,640 IPAD-BASED ASSESSMENTS, A GREAT 3531 02:26:03,640 --> 02:26:06,400 RESOURCE IF YOU'RE WORKING IN 3532 02:26:06,400 --> 02:26:07,960 ENGLISH OR PAN ISSUE. 3533 02:26:07,960 --> 02:26:09,160 THEY WERE DEVELOPED BY TOP 3534 02:26:09,160 --> 02:26:12,720 EXPERTS IN THE FIELD FOR THE 3535 02:26:12,720 --> 02:26:15,040 VARIOUS BEHAVIORS DOMAINS, WELL 3536 02:26:15,040 --> 02:26:16,400 VALIDATED, BECOMING MORE WIDELY 3537 02:26:16,400 --> 02:26:16,600 USED. 3538 02:26:16,600 --> 02:26:18,040 IN MY EXPERIENCE IT'S NOT BEEN 3539 02:26:18,040 --> 02:26:21,480 FEASIBLE TO USE THESE IN OTHER 3540 02:26:21,480 --> 02:26:21,840 LANGUAGES. 3541 02:26:21,840 --> 02:26:23,760 I WORK IN AFRICA AND ASIA AND 3542 02:26:23,760 --> 02:26:28,520 THE TIMELINE AND COST TO GET THE 3543 02:26:28,520 --> 02:26:30,680 TRANSLATIONS INTO THE APP HAS 3544 02:26:30,680 --> 02:26:32,440 NOT BEEN POSSIBLE IN THE TIME 3545 02:26:32,440 --> 02:26:33,840 LINE FOR THE PROJECTS I'VE 3546 02:26:33,840 --> 02:26:34,640 WORKED ON. 3547 02:26:34,640 --> 02:26:36,840 THAT'S BEEN A BARRIER IN THE 3548 02:26:36,840 --> 02:26:39,800 PAST BUT COULD BE OVERCOME WITH 3549 02:26:39,800 --> 02:26:40,920 MORE TIME AND RESOURCES. 3550 02:26:40,920 --> 02:26:46,440 FOR THE WORLD BANK TOOLKIT WE 3551 02:26:46,440 --> 02:26:48,120 DEVELOPED INVENTORY OF 148 TOOLS 3552 02:26:48,120 --> 02:26:50,200 FOCUSING ON 0 TO 8. 3553 02:26:50,200 --> 02:26:53,720 BUT MANY ARE ALSO APPLICABLE TO 3554 02:26:53,720 --> 02:26:56,920 OLDER CHILDREN. 3555 02:26:56,920 --> 02:26:59,040 A QUICK DEMONSTRATION USING THIS 3556 02:26:59,040 --> 02:26:59,640 SPREADSHEET, AVAILABLE ONLINE, 3557 02:26:59,640 --> 02:27:01,520 THIS IS WHAT IT LOOKS LIKE. 3558 02:27:01,520 --> 02:27:05,280 SO THERE'S A THAT BE THAT HAS 3559 02:27:05,280 --> 02:27:05,880 INSTRUCTIONS, DEFINITIONS, AND 3560 02:27:05,880 --> 02:27:09,280 THEN THIS IS THE ACTUAL 3561 02:27:09,280 --> 02:27:09,880 INVENTORY. 3562 02:27:09,880 --> 02:27:11,400 I'LL JUST SHOW AN EXAMPLE OF A 3563 02:27:11,400 --> 02:27:13,440 PROJECT THAT WANTS TO ASSESS 3564 02:27:13,440 --> 02:27:17,720 ACADEMIC SKILLS IN CHILDREN AGE 3565 02:27:17,720 --> 02:27:19,680 5 TO 18. 3566 02:27:19,680 --> 02:27:21,400 YOU CAN FILTER BAILED ON THAT 3567 02:27:21,400 --> 02:27:23,400 TYPE OF CRITERIA, SO HERE THIS 3568 02:27:23,400 --> 02:27:26,040 COLUMN, THERE'S A YES, IF THE 3569 02:27:26,040 --> 02:27:28,000 TEST ASSESSES ACADEMIC OR 3570 02:27:28,000 --> 02:27:29,600 PRE-ACADEMIC SKILLS, THESE ARE 3571 02:27:29,600 --> 02:27:31,360 ALL -- FIRST IS DIFFERENT 3572 02:27:31,360 --> 02:27:32,880 DOMAINS, SO IF WE CHOOSE YES 3573 02:27:32,880 --> 02:27:35,600 HERE THAT WILL NARROW IT DOWN TO 3574 02:27:35,600 --> 02:27:36,920 TOOLS THAT ASSESS ACADEMIC 3575 02:27:36,920 --> 02:27:38,520 SKILLS, THIS IS THE MINIMUM AGE, 3576 02:27:38,520 --> 02:27:43,840 SO IF WE WANT MINIMUM AGE OF 5, 3577 02:27:43,840 --> 02:27:47,440 CHOOSE 5, CHOOSE EVERYTHING 3578 02:27:47,440 --> 02:27:49,320 LOWER THAN 5 BECAUSE THE MINIMUM 3579 02:27:49,320 --> 02:27:50,920 AGE WOULD BE 5 OR ANYTHING 3580 02:27:50,920 --> 02:27:51,680 LOWER. 3581 02:27:51,680 --> 02:27:53,520 AND THEN FOR THE MAXIMUM AGE WE 3582 02:27:53,520 --> 02:27:58,000 WOULD CHOOSE 18 AND ABOVE TO GET 3583 02:27:58,000 --> 02:27:59,320 ALL TOOLS APPROPRIATE FOR 5 TO 3584 02:27:59,320 --> 02:28:00,440 18 YEARS. 3585 02:28:00,440 --> 02:28:03,520 YOU CAN SEE NOW YOU HAVE A MUCH 3586 02:28:03,520 --> 02:28:04,720 MORE MANAGEABLE LIST OF TOOLS 3587 02:28:04,720 --> 02:28:06,720 THAT YOU CAN CHOOSE FROM. 3588 02:28:06,720 --> 02:28:09,000 AND THE OTHER INFORMATION YOU 3589 02:28:09,000 --> 02:28:12,400 CAN SEE IS WHETHER IT'S ASSESSED 3590 02:28:12,400 --> 02:28:14,720 BY CHILD ASSESSMENT, CAREGIVER 3591 02:28:14,720 --> 02:28:15,560 REPORT, COMPUTER ADMINISTERED, 3592 02:28:15,560 --> 02:28:18,200 WHETHER SCREENING OR ABILITY 3593 02:28:18,200 --> 02:28:21,880 TEST, COUNTRY OF ORIGIN, YOU CAN 3594 02:28:21,880 --> 02:28:23,280 ALSO SEE THE COPYRIGHT 3595 02:28:23,280 --> 02:28:26,960 INFORMATION, HOW MUCH TRAINING 3596 02:28:26,960 --> 02:28:28,240 IS REQUIRED, ADMINISTRATION 3597 02:28:28,240 --> 02:28:29,920 TIME, AND THIS IS REALLY 3598 02:28:29,920 --> 02:28:30,360 IMPORTANT. 3599 02:28:30,360 --> 02:28:33,280 SO THIS CAN BE A BIG BARRIER TO 3600 02:28:33,280 --> 02:28:35,560 USING THESE ASSESSMENTS ON A 3601 02:28:35,560 --> 02:28:38,680 LARGE SCALE BECAUSE SOME OF THE 3602 02:28:38,680 --> 02:28:40,240 PUBLISHERS LIKE PEARSON WHO OWNS 3603 02:28:40,240 --> 02:28:41,760 A LOT OF TESTS REQUIRE YOU TO 3604 02:28:41,760 --> 02:28:44,360 PAY FOR EVERY CHILD THAT YOU 3605 02:28:44,360 --> 02:28:45,120 ASSESS. 3606 02:28:45,120 --> 02:28:47,840 THIS IS ALSO REALLY IMPORTANT 3607 02:28:47,840 --> 02:28:51,960 INFORMATION WHEN YOU'RE 3608 02:28:51,960 --> 02:28:54,520 SELECTING AN ASSESSMENT. 3609 02:28:54,520 --> 02:28:56,760 NYU GLOBAL TEAM DEVELOPED 3610 02:28:56,760 --> 02:28:58,680 INVENTORY OF 257 TOOLS AND IT'S 3611 02:28:58,680 --> 02:29:03,520 VERY SIMILAR TO TOOL KIT, 3612 02:29:03,520 --> 02:29:04,320 SIMILAR INFORMATION, IT'S 3613 02:29:04,320 --> 02:29:06,640 FILTERABLE, TOOLS USED IN THE 3614 02:29:06,640 --> 02:29:16,120 MIDDLE EAST AND NORTH AFRICA 3615 02:29:16,120 --> 02:29:21,200 REGION, MORE WIDELY APPLICABLE. 3616 02:29:21,200 --> 02:29:28,680 OECD IS ADMINISTERED ON VERY 3617 02:29:28,680 --> 02:30:02,040 LARGE GLOBAL SCALE. 3618 02:30:02,040 --> 02:30:03,560 SUMMIT TRIAL IN INDONESIA, WE 3619 02:30:03,560 --> 02:30:10,920 FOLLOWED UP THE CHILDREN AT 9 TO 3620 02:30:10,920 --> 02:30:26,240 12 YEARS OF AGE. 3621 02:30:26,240 --> 02:30:38,560 WE USED THE WEXLER SCALE, 3622 02:30:38,560 --> 02:30:40,800 ACADEMIC ACHIEVEMENT, FINE MOTOR 3623 02:30:40,800 --> 02:30:42,640 ABILITY AND SOCIAL EMOTIONAL 3624 02:30:42,640 --> 02:30:44,240 DEVELOPMENT. 3625 02:30:44,240 --> 02:30:50,280 3626 02:30:50,280 --> 02:31:04,920 3627 02:31:04,920 --> 02:31:06,920 YOU CAN SEE OUR TESTING 3628 02:31:06,920 --> 02:31:09,920 STATIONS, CHILDREN WOULD WORK 3629 02:31:09,920 --> 02:31:11,360 AROUND TO EACH STATION. 3630 02:31:11,360 --> 02:31:12,760 THIS IS THE PEGBOARD TEST WHERE 3631 02:31:12,760 --> 02:31:15,720 THE CHILD IS PUTTING THE PEGS IN 3632 02:31:15,720 --> 02:31:17,920 THE BOARD, FINE MOTOR 3633 02:31:17,920 --> 02:31:18,200 ASSESSMENT. 3634 02:31:18,200 --> 02:31:35,480 HERE COUNTING, PART OF THE 3635 02:31:35,480 --> 02:31:36,920 ARITHMETIC, THE CHILD HAS TO 3636 02:31:36,920 --> 02:31:43,720 COPY A SHAPE WITH BLOCKS. 3637 02:31:43,720 --> 02:31:45,600 3638 02:31:45,600 --> 02:31:47,200 THAT GIVES A FLAVOR. 3639 02:31:47,200 --> 02:31:50,200 THIS IS WHAT WE FOUND IN OVERALL 3640 02:31:50,200 --> 02:31:51,600 TREND FOR POSITIVE ESTIMATES, 3641 02:31:51,600 --> 02:31:53,840 INDICATING THE GROUP THAT 3642 02:31:53,840 --> 02:31:55,040 RECEIVED MULTIPLE MICRO 3643 02:31:55,040 --> 02:32:17,120 NUTRIENTS IN PREGNANCY AND POST 3644 02:32:17,120 --> 02:32:18,360 PARTUM SCORED HIGHER. 3645 02:32:18,360 --> 02:32:21,480 AND WE ALSO FOUND POSITIVE 3646 02:32:21,480 --> 02:32:23,160 EFFECTS ON GENERAL INTELLECTUAL 3647 02:32:23,160 --> 02:32:27,120 ABILITY AMONG CHILDREN OF ANEMIC 3648 02:32:27,120 --> 02:32:27,840 MOTHERS. 3649 02:32:27,840 --> 02:32:30,480 THIS FIGURE SHOWS RESULT OF 3650 02:32:30,480 --> 02:32:36,640 REGRESSION MODEL WITH VARIOUS 3651 02:32:36,640 --> 02:32:38,400 BIOMEDICAL RISK FACTORS, SIZE OF 3652 02:32:38,400 --> 02:32:42,440 BAR IS SIZE OF REGRESSION 3653 02:32:42,440 --> 02:32:43,120 COEFFICIENT, STAR INDICATES 3654 02:32:43,120 --> 02:32:44,840 ASSOCIATION, ALL OF THESE SCORES 3655 02:32:44,840 --> 02:32:48,120 ARE SENSITIVE TO THE 3656 02:32:48,120 --> 02:32:49,000 SOCIOENVIRONMENTAL RISK LIKE 3657 02:32:49,000 --> 02:32:50,200 HOME ENVIRONMENT, MATERNAL 3658 02:32:50,200 --> 02:32:58,080 DEPRESSION, SOME ARE ALSO 3659 02:32:58,080 --> 02:33:06,200 SENSITIVE TO BIOMEDICAL RISK. 3660 02:33:06,200 --> 02:33:08,880 THE NEXT EXAMPLE IS ANOTHER 10 3661 02:33:08,880 --> 02:33:11,240 YEAR FOLLOW-UP PROGRAM IN GHANA, 3662 02:33:11,240 --> 02:33:12,720 ACKNOWLEDGING MAIN PEOPLE WHO 3663 02:33:12,720 --> 02:33:41,280 CONTRIBUTED TO THIS WORK 3664 02:33:41,280 --> 02:33:44,560 INCLUDING FUNDING FROM NIH, 3665 02:33:44,560 --> 02:33:45,680 THESE ARE THE ASSESSMENTS AT 10 3666 02:33:45,680 --> 02:33:47,120 TO 12 YEARS, MOST OF THE 3667 02:33:47,120 --> 02:33:52,120 TRANSLATED TOOLS ARE SHOWING 3668 02:33:52,120 --> 02:33:53,880 GOOD TEST-RETEST, INTERNAL 3669 02:33:53,880 --> 02:33:56,440 RELIABILITY, ABOVE .7 IN BOLD. 3670 02:33:56,440 --> 02:33:58,040 WE'RE CONDUCTING MULTIPLE 3671 02:33:58,040 --> 02:33:59,920 CAREGIVER INTERVIEWS ABOUT 3672 02:33:59,920 --> 02:34:02,200 CHILDREN STRENGTH AND 3673 02:34:02,200 --> 02:34:04,200 DIFFICULTIES, BEHAVIOR PROBLEMS, 3674 02:34:04,200 --> 02:34:05,920 SOCIAL SKILLS, TEMPERAMENT, 3675 02:34:05,920 --> 02:34:06,520 PUBERTY, MATERNAL DEPRESSION, 3676 02:34:06,520 --> 02:34:08,920 GETTING THE SAME INFORMATION 3677 02:34:08,920 --> 02:34:10,600 FROM THE CHILD, SOME OF THE SAME 3678 02:34:10,600 --> 02:34:15,880 TOOLS BY TEACHER AND CHILD 3679 02:34:15,880 --> 02:34:18,480 INTERVIEW, AND WE'RE ALSO USING 3680 02:34:18,480 --> 02:34:20,160 PETERSON SCALE, TANNER WAS 3681 02:34:20,160 --> 02:34:21,920 MENTIONED EARLIER BUT PETERSON 3682 02:34:21,920 --> 02:34:24,000 IS NICE BECAUSE IT'S SELF-REPORT 3683 02:34:24,000 --> 02:34:30,120 AND YOU CAN GET IT BY PARENT 3684 02:34:30,120 --> 02:34:31,760 REPORT ALSO, YOU DON'T HAVE TO 3685 02:34:31,760 --> 02:34:33,440 DO CLINICAL EXAM. 3686 02:34:33,440 --> 02:34:36,120 WE'RE USING SAME ASSESSMENTS IN 3687 02:34:36,120 --> 02:34:40,400 INDONESIA, BLOCK DESIGN, 3688 02:34:40,400 --> 02:34:41,320 LITERACY AND ARITHMETIC, 3689 02:34:41,320 --> 02:34:42,080 COMPUTERIZED ASSESSMENTS. 3690 02:34:42,080 --> 02:34:44,320 I DON'T HAVE RESULTS TO SHOW YOU 3691 02:34:44,320 --> 02:34:45,160 YET. 3692 02:34:45,160 --> 02:34:47,440 IF YOU COME TO ASN IN JUNE 3693 02:34:47,440 --> 02:34:49,440 YOU'LL SEE PRELIMINARY RESULTS 3694 02:34:49,440 --> 02:34:50,000 OF THIS. 3695 02:34:50,000 --> 02:34:52,720 SO JUST IN SUMMARY THERE'S NO 3696 02:34:52,720 --> 02:34:54,400 SINGLE IDEAL TEST OR ASSESSMENT 3697 02:34:54,400 --> 02:34:57,240 SO PRIORITIZE THE MOST IMPORTANT 3698 02:34:57,240 --> 02:35:00,120 CRITERIA FOR YOUR PURPOSES BASED 3699 02:35:00,120 --> 02:35:02,360 ON BOTH GOALS AND LOGISTICS AND 3700 02:35:02,360 --> 02:35:06,800 CHOOSE ASSESSMENT. 3701 02:35:06,800 --> 02:35:09,000 SEVERAL TESTS ARE PROMISING 3702 02:35:09,000 --> 02:35:12,160 ACROSS CONTEXT, STILL A NEED FOR 3703 02:35:12,160 --> 02:35:14,680 OPEN OURS USER FRIENDLY TOOLS 3704 02:35:14,680 --> 02:35:15,320 TRANSLATED ACROSS LANGUAGES AND CONTEXT. 3705 02:35:15,320 --> 02:35:16,880 THANK YOU. 3706 02:35:16,880 --> 02:35:18,600 >> I'M GOING TO ECHO ELIZABETH'S 3707 02:35:18,600 --> 02:35:22,960 FANTASTIC PRESENTATION AND 3708 02:35:22,960 --> 02:35:27,480 TRANSITION TO TALK ABOUT 3709 02:35:27,480 --> 02:35:29,480 SELF-REGULATION AND PHENOTYPING 3710 02:35:29,480 --> 02:35:30,840 EATING BEHAVIORS. 3711 02:35:30,840 --> 02:35:33,600 I'LL TAKE THE SAME APPROACH AND 3712 02:35:33,600 --> 02:35:36,920 START WITH A BRIEF INTRO IN 3713 02:35:36,920 --> 02:35:38,600 TERMS OF THE IMPORTANCE BUT 3714 02:35:38,600 --> 02:35:39,960 FOCUSING ON MEASURES THEMSELVES 3715 02:35:39,960 --> 02:35:41,720 AND PROVIDING OPTIONS AND WHERE 3716 02:35:41,720 --> 02:35:44,760 WE ARE IN SPACE THINKING ABOUT 3717 02:35:44,760 --> 02:35:45,720 WRITING THIS UP. 3718 02:35:45,720 --> 02:35:48,600 SO THANKS FOR THE INVITATION, I 3719 02:35:48,600 --> 02:35:50,800 LOOK FORWARD TO THE CONVERSATION 3720 02:35:50,800 --> 02:35:52,840 THAT FOLLOWS. 3721 02:35:52,840 --> 02:35:56,760 IF WE THINK ABOUT ENERGY INTAKE 3722 02:35:56,760 --> 02:35:59,880 AND THINK ABOUT NUTRIENT AND 3723 02:35:59,880 --> 02:36:02,880 PROGRAMS DESIGNED TO INTERVENE 3724 02:36:02,880 --> 02:36:05,600 ON THOSE OUTCOMES, OUR GROUP AND 3725 02:36:05,600 --> 02:36:08,880 OTHERS TURN TO THINKING ABOUT 3726 02:36:08,880 --> 02:36:09,240 SELF-REGULATION. 3727 02:36:09,240 --> 02:36:11,600 SO I'M STARTING WITH THIS FIRST 3728 02:36:11,600 --> 02:36:13,200 SLIDE, THE FIRST EVIDENCE THAT 3729 02:36:13,200 --> 02:36:15,680 CHILDREN ARE POTENTIALLY BORN 3730 02:36:15,680 --> 02:36:18,200 WITH ABILITY TO SELF-REGULATE. 3731 02:36:18,200 --> 02:36:23,000 THIS WORK CAME FROM A PEDIATRICS 3732 02:36:23,000 --> 02:36:26,840 CLARA DAVIS IN THE '30s, SHE 3733 02:36:26,840 --> 02:36:28,600 STUDIED 15 ORPHANS OVER SEVERAL 3734 02:36:28,600 --> 02:36:30,640 YEARS AND COLLECTED DATA ON 3735 02:36:30,640 --> 02:36:34,120 EVERYTHING THAT THEY ATE AND 3736 02:36:34,120 --> 02:36:34,320 DRANK. 3737 02:36:34,320 --> 02:36:36,200 THERE WAS THE -- NURSES WERE 3738 02:36:36,200 --> 02:36:38,560 INSTRUCTED NOT TO INTERVENE, NOT 3739 02:36:38,560 --> 02:36:40,760 TO INFLUENCE CHOICE, AND/OR FOOD 3740 02:36:40,760 --> 02:36:41,800 INTAKE. 3741 02:36:41,800 --> 02:36:43,360 WHAT SHE FOUND WAS THAT 3742 02:36:43,360 --> 02:36:45,400 THROUGHOUT THIS TIME THERE WAS 3743 02:36:45,400 --> 02:36:47,520 VARIABILITY FROM DAY TO DAY IN 3744 02:36:47,520 --> 02:36:51,200 DIETS BUT OVERALL SHE OBSERVED 3745 02:36:51,200 --> 02:36:53,840 THAT THE INFANTS GREW HEALTHY 3746 02:36:53,840 --> 02:36:55,400 AND WERE MEETING NUTRITIONAL 3747 02:36:55,400 --> 02:36:55,600 NEEDS. 3748 02:36:55,600 --> 02:36:59,800 AND SHE REFERRED TO THIS AS BODY 3749 02:36:59,800 --> 02:37:00,320 WISDOM. 3750 02:37:00,320 --> 02:37:04,520 AND FROM THAT STUDY IT WIDELY 3751 02:37:04,520 --> 02:37:07,120 BECAME INTERPRETED THAT INFANTS 3752 02:37:07,120 --> 02:37:11,320 HAVE ABILITY TO REGULATE. 3753 02:37:11,320 --> 02:37:14,200 AND THEN SEVERAL YEARS LATER THE 3754 02:37:14,200 --> 02:37:16,600 MANIPULATION OF ENERGY DENSITY 3755 02:37:16,600 --> 02:37:20,080 FORMULA AND FOUND SIMILAR 3756 02:37:20,080 --> 02:37:20,720 RESULTS. 3757 02:37:20,720 --> 02:37:22,280 BUT IN THAT STUDY THE ONE THING 3758 02:37:22,280 --> 02:37:23,720 ABOUT THAT STUDY THAT WAS UNIQUE 3759 02:37:23,720 --> 02:37:27,800 IF YOU LOOK AT THE LIST OF FOODS 3760 02:37:27,800 --> 02:37:29,360 IS THEY WERE VERY HEALTHY SO 3761 02:37:29,360 --> 02:37:33,320 FROM THIS POINT FORWARD TODAY 3762 02:37:33,320 --> 02:37:36,680 I'M GOING TO FOCUS ON THE 3763 02:37:36,680 --> 02:37:38,720 INTERSECTION BETWEEN ENVIRONMENT 3764 02:37:38,720 --> 02:37:40,280 AND GENETICS AND THINKING ABOUT 3765 02:37:40,280 --> 02:37:42,000 DRIVERS OF FOOD INTAKE AND WHAT 3766 02:37:42,000 --> 02:37:44,360 WE SHOULD BE THINKING ABOUT 3767 02:37:44,360 --> 02:37:48,160 POTENTIALLY MEASURING AS PROXY 3768 02:37:48,160 --> 02:37:50,920 INDICATORS OF DIETARY INTAKE AND 3769 02:37:50,920 --> 02:37:54,640 NUTRITIONAL STATUS, AS WE THINK 3770 02:37:54,640 --> 02:37:55,880 ABOUT THESE INTERVENTIONS. 3771 02:37:55,880 --> 02:37:57,400 SO AS WE ALL VERY WELL KNOW 3772 02:37:57,400 --> 02:38:02,240 THESE ARE SOME OF THE THINGS WE 3773 02:38:02,240 --> 02:38:03,600 CONSIDER IN TERMS OF OBESOGENIC 3774 02:38:03,600 --> 02:38:06,800 ENVIRONMENT. 3775 02:38:06,800 --> 02:38:08,120 BARBARA ROLLS AND OTHERS HAVE 3776 02:38:08,120 --> 02:38:10,640 DONE MANIPULATION OF PORTION 3777 02:38:10,640 --> 02:38:12,680 SIZE AND ENERGY DENSITY SHOWING 3778 02:38:12,680 --> 02:38:13,560 DIFFERENCE PARTICULARLY IN 3779 02:38:13,560 --> 02:38:15,080 ADULTS, HOW WE RESPONSIVE TO 3780 02:38:15,080 --> 02:38:17,560 ENVIRONMENT AND WILL EAT MORE 3781 02:38:17,560 --> 02:38:19,480 WHEN PORTIONS ARE LARGER OR 3782 02:38:19,480 --> 02:38:21,800 MEALS ARE MORE ENERGY DENSE. 3783 02:38:21,800 --> 02:38:25,520 THERE'S A BIG BODY OF LITERATURE 3784 02:38:25,520 --> 02:38:27,200 LOOKING AT FOOD AVAILABILITY AS 3785 02:38:27,200 --> 02:38:27,480 WELL. 3786 02:38:27,480 --> 02:38:32,000 AND SO AS WE THINK ABOUT 3787 02:38:32,000 --> 02:38:33,360 RESPONSIVENESS TO FOOD 3788 02:38:33,360 --> 02:38:36,000 ENVIRONMENT AND MEASURING FOOD 3789 02:38:36,000 --> 02:38:39,160 INTAKE, I REALLY THINK ABOUT 3790 02:38:39,160 --> 02:38:44,600 THIS VERY NICE MODEL THAT 3791 02:38:44,600 --> 02:38:47,360 LLEWELLYN PUT TOGETHER 3792 02:38:47,360 --> 02:38:56,040 REFERENCING BEHAVIORAL 3793 02:38:56,040 --> 02:38:57,280 SUSCEPTIBILITY THEORY, IMPACTING 3794 02:38:57,280 --> 02:38:59,360 POTENTIAL IMBALANCE OR 3795 02:38:59,360 --> 02:39:03,960 DYSREGULATION OF INTAKE, AND 3796 02:39:03,960 --> 02:39:06,720 THEN ULTIMATELY WEIGHT GAIN. 3797 02:39:06,720 --> 02:39:08,800 IF WE THINK OF DIALING IN MORE 3798 02:39:08,800 --> 02:39:11,440 AND THINK ABOUT HOW THESE 3799 02:39:11,440 --> 02:39:15,560 ENVIRONMENTAL FACTORS SUCH AS 3800 02:39:15,560 --> 02:39:16,160 FOOD AVAILABILITY, ENERGY 3801 02:39:16,160 --> 02:39:17,280 DENSITY, PORTION SIZE AND WHAT 3802 02:39:17,280 --> 02:39:21,240 NOT, TODAY I'M GOING TO FOCUS ON 3803 02:39:21,240 --> 02:39:22,800 THESE POTENTIAL INDIVIDUAL 3804 02:39:22,800 --> 02:39:24,440 DIFFERENCES OR FACTORS RELATED 3805 02:39:24,440 --> 02:39:26,000 TO APPETITE, FOOD INTAKE WHICH 3806 02:39:26,000 --> 02:39:27,360 YOU SEE LISTED HERE. 3807 02:39:27,360 --> 02:39:30,560 AND SO ONE OF THE QUESTIONS, 3808 02:39:30,560 --> 02:39:32,080 OBSERVATIONALLY WE KNOW THERE'S 3809 02:39:32,080 --> 02:39:35,440 LINKS BETWEEN THESE FACTORS AND 3810 02:39:35,440 --> 02:39:37,080 ENERGY INTAKE AND WEIGHT, AND 3811 02:39:37,080 --> 02:39:38,920 MORE RECENTLY STUDIES HAVE 3812 02:39:38,920 --> 02:39:41,880 SOUGHT OUT TO MANIPULATE THESE 3813 02:39:41,880 --> 02:39:44,200 OUTCOMES, DESIGN INTERVENTIONS 3814 02:39:44,200 --> 02:39:48,160 TO HOPEFULLY TARGET THESE 3815 02:39:48,160 --> 02:39:49,760 OUTCOMES AND SO THINKING ABOUT 3816 02:39:49,760 --> 02:39:56,040 THESE NOT JUST AS MODERATORS OF 3817 02:39:56,040 --> 02:39:57,720 A RELATIONSHIP BUT PROXIMAL 3818 02:39:57,720 --> 02:40:00,040 OUTCOMES WE CAN MODIFY TO CHANGE 3819 02:40:00,040 --> 02:40:03,600 ENERGY INTAKE AND HEALTH 3820 02:40:03,600 --> 02:40:04,200 OUTCOMES. 3821 02:40:04,200 --> 02:40:06,320 AND THAT REALLY POSES THE 3822 02:40:06,320 --> 02:40:07,200 QUESTION CAN FOOT INTAKE 3823 02:40:07,200 --> 02:40:08,800 REGULATION AND EATING BEHAVIOR 3824 02:40:08,800 --> 02:40:14,560 BE IMPROVED AND HOW? 3825 02:40:14,560 --> 02:40:15,920 THINKING ABOUT THOSE INDIVIDUAL 3826 02:40:15,920 --> 02:40:17,560 DIFFERENCES. 3827 02:40:17,560 --> 02:40:21,320 I LIKED ELIZABETH'S SLIDE WHEN 3828 02:40:21,320 --> 02:40:23,000 PLANNING, THE SAME FRAMEWORK 3829 02:40:23,000 --> 02:40:27,200 FOLLOWS WHEN WE THINK ABOUT 3830 02:40:27,200 --> 02:40:28,840 SELF-REGULATION, THERE WAS A 3831 02:40:28,840 --> 02:40:33,360 LOVELY TALK PROVIDED IN WORKSHOP 3832 02:40:33,360 --> 02:40:38,720 1 ON MORE OF A NEURAL MECHANISM, 3833 02:40:38,720 --> 02:40:40,080 SO I'LL FOCUS ON THE BEHAVIORAL 3834 02:40:40,080 --> 02:40:42,560 SIDE, A BIG BOLD OF LITERATURE. 3835 02:40:42,560 --> 02:40:45,680 SO I'M GOING TO GIVE SOME OF THE 3836 02:40:45,680 --> 02:40:47,800 HIGH POINTS AND THEN REALLY LOOK 3837 02:40:47,800 --> 02:40:52,400 TO THE AUDIENCE AS WE GET TO Q&A 3838 02:40:52,400 --> 02:40:53,600 AND THINKING ABOUT THINGS THAT 3839 02:40:53,600 --> 02:40:55,120 WERE NOT ADDRESSED THAT WE 3840 02:40:55,120 --> 02:40:58,040 SHOULD BE CONSIDERING IN OUR 3841 02:40:58,040 --> 02:40:58,600 REPORT. 3842 02:40:58,600 --> 02:41:01,760 AND BEFORE DOING SO I ALSO 3843 02:41:01,760 --> 02:41:03,400 WANTED TO DRAW THE AUDIENCE'S 3844 02:41:03,400 --> 02:41:07,480 ATTENTION TO THIS RESOURCE, A 3845 02:41:07,480 --> 02:41:10,400 GREAT RESOURCE THAT HAS HUNDREDS 3846 02:41:10,400 --> 02:41:12,600 OF MEASURES AVAILABLE THAT CAN 3847 02:41:12,600 --> 02:41:16,840 BE DOWN SELECTED BASED ON AGE OF 3848 02:41:16,840 --> 02:41:18,800 POPULATION, IN ADDITION TO THE 3849 02:41:18,800 --> 02:41:21,680 OUTCOME OF INTEREST AND MODE OF 3850 02:41:21,680 --> 02:41:22,800 DELIVERY WITH FEASIBILITY OF 3851 02:41:22,800 --> 02:41:25,240 WHAT CAN BE MEASURED AND ALSO 3852 02:41:25,240 --> 02:41:26,040 CONSIDERING RESEARCH QUESTIONS 3853 02:41:26,040 --> 02:41:29,320 OF WHAT SHOULD BE MEASURED. 3854 02:41:29,320 --> 02:41:31,400 TODAY I'M NOT GOING TO GO 3855 02:41:31,400 --> 02:41:33,040 THROUGH, THIS IS NOT A 3856 02:41:33,040 --> 02:41:34,920 COMPREHENSIVE LIST OF WHERE WE 3857 02:41:34,920 --> 02:41:38,360 ARE WITH SPACE AND THINKING 3858 02:41:38,360 --> 02:41:41,960 ABOUT THE BROAD OPTIONS THAT WE 3859 02:41:41,960 --> 02:41:45,600 CAN BE CONSIDERING IN TERMS OF 3860 02:41:45,600 --> 02:41:46,160 SELF-REGULATION AND EATING 3861 02:41:46,160 --> 02:41:48,120 BEHAVIOR, BUT WE ARE THINKING 3862 02:41:48,120 --> 02:41:49,800 ABOUT IN THIS REPORT THINKING 3863 02:41:49,800 --> 02:41:51,840 ABOUT BREAKING IT DOWN OBVIOUSLY 3864 02:41:51,840 --> 02:41:54,080 BY TARGET AUDIENCE THAT IT'S 3865 02:41:54,080 --> 02:41:55,960 BEEN VALIDATED ON. 3866 02:41:55,960 --> 02:41:58,320 THE TYPE AND PRO AND CONNING IN 3867 02:41:58,320 --> 02:42:00,800 TERMS OF STRENGTH AND 3868 02:42:00,800 --> 02:42:04,320 LIMITATIONS, AND ALSO THINKING 3869 02:42:04,320 --> 02:42:06,720 ABOUT VALIDITY AMONG THESE 3870 02:42:06,720 --> 02:42:09,480 DIFFERENT MEASURES WITH THE 3871 02:42:09,480 --> 02:42:10,720 SPECIFIC OUTCOME OF INTEREST. 3872 02:42:10,720 --> 02:42:12,960 AND THIS IS A PARALLEL TABLE 3873 02:42:12,960 --> 02:42:14,800 THAT WE'VE STARTED IN THE SPACE 3874 02:42:14,800 --> 02:42:16,000 OF EATING BEHAVIOR. 3875 02:42:16,000 --> 02:42:19,160 WHAT YOU'LL SEE ON THESE TWO 3876 02:42:19,160 --> 02:42:21,000 SLIDES IS SEVERAL OF WHAT YOU 3877 02:42:21,000 --> 02:42:23,200 SEE LISTED HERE ARE 3878 02:42:23,200 --> 02:42:23,760 QUESTIONNAIRES. 3879 02:42:23,760 --> 02:42:26,040 AND SO FOR THE REMAINDER OF THE 3880 02:42:26,040 --> 02:42:27,800 PRESENTATION I'M GOING TO TURN 3881 02:42:27,800 --> 02:42:32,760 TO SOME OF THE MORE PROTOCOL 3882 02:42:32,760 --> 02:42:38,760 TASK BASED ASSESSMENTS COMMONLY 3883 02:42:38,760 --> 02:42:40,960 DONE IN LABS AND SHARE HOW THEY 3884 02:42:40,960 --> 02:42:43,880 ARE NOT OR ARE RELATED TO 3885 02:42:43,880 --> 02:42:44,360 SELF-REPORTED MEASURES 3886 02:42:44,360 --> 02:42:45,680 SUGGESTING THAT MAYBE SOME OF 3887 02:42:45,680 --> 02:42:49,120 THE SELF-REPORTED MEASURE ARE 3888 02:42:49,120 --> 02:42:51,600 GETTING AT DIFFERENT 3889 02:42:51,600 --> 02:43:00,200 SUBCONSTRUCTS OR SUBDOMAINS OF 3890 02:43:00,200 --> 02:43:03,960 BEHAVIOR OF INTEREST. 3891 02:43:03,960 --> 02:43:09,920 SUSAN JOHNSON'S WORK AND BIRCWH 3892 02:43:09,920 --> 02:43:10,840 DEVELOPED THIS PROTOCOL DONE A 3893 02:43:10,840 --> 02:43:12,920 CUP OF WAYS. 3894 02:43:12,920 --> 02:43:17,760 THIS EXAMPLE IS THE MANIPULATION 3895 02:43:17,760 --> 02:43:20,120 OF FLUID, SO THIS IS A KOOL-AID 3896 02:43:20,120 --> 02:43:30,240 SHOULD SUGAR DRINK VERSUS SUGAR 3897 02:43:30,240 --> 02:43:31,480 DRINK WHERE YOU PRE-LOAD, 15 TO 3898 02:43:31,480 --> 02:43:36,320 20 MINUTES, YOU PROVIDE A SET 3899 02:43:36,320 --> 02:43:40,840 COURSE MEAL, SET MEAL, AND YOU 3900 02:43:40,840 --> 02:43:45,560 THEN CAN CALCULATE THE COMPX 3901 02:43:45,560 --> 02:43:48,120 SCORE, LOW E.D. MINUS HIGH E.D. 3902 02:43:48,120 --> 02:43:50,840 OF THE MEAL DIVIDED BY PRE-LOAD 3903 02:43:50,840 --> 02:43:54,000 TIMES 100. 3904 02:43:54,000 --> 02:43:56,960 SO THAT COMPX SCORE, 100 WOULD 3905 02:43:56,960 --> 02:43:58,000 INDICATE PERFECT COMPENSATION, 3906 02:43:58,000 --> 02:44:02,200 WHAT YOU MORE COMMONLY SEE IS 3907 02:44:02,200 --> 02:44:07,600 SCORES LESS THAN 100 WHICH WOULD 3908 02:44:07,600 --> 02:44:10,440 REFLECT OVEREATING. 3909 02:44:10,440 --> 02:44:11,800 EATING MORE OR ULTIMATELY NOT 3910 02:44:11,800 --> 02:44:13,800 EATING LESS IN THE MEAL 3911 02:44:13,800 --> 02:44:15,360 FOLLOWING THE HIGH E.D. 3912 02:44:15,360 --> 02:44:15,800 PRE-LOAD. 3913 02:44:15,800 --> 02:44:19,680 AND THIS IS THIS HAS BEEN DONE 3914 02:44:19,680 --> 02:44:22,200 WITH A FLUID, OR LIQUID, ALSO 3915 02:44:22,200 --> 02:44:29,040 DONE WITH SEMI SOLID IN TERMS OF 3916 02:44:29,040 --> 02:44:31,560 PUDDING, AND YOGURTS, WITH 3917 02:44:31,560 --> 02:44:35,680 CHILDREN SHOWING ON AVERAGE 3918 02:44:35,680 --> 02:44:37,680 BETTER REGULATION THAN ADULTS, 3919 02:44:37,680 --> 02:44:39,720 BUT BIG INDIVIDUAL DIFFERENCES 3920 02:44:39,720 --> 02:44:41,360 IN EVEN CHILD REGULATION. 3921 02:44:41,360 --> 02:44:43,720 THAT I THINK IS ALSO 3922 02:44:43,720 --> 02:44:46,200 DEMONSTRATED IN PORTION SIZE 3923 02:44:46,200 --> 02:44:48,080 STUDIES WHERE YOU SEE PORTION 3924 02:44:48,080 --> 02:44:50,880 MANIPULATION IN E.D. 3925 02:44:50,880 --> 02:44:51,200 MANIPULATION. 3926 02:44:51,200 --> 02:44:55,600 THIS IS A STUDY I WAS MENTIONED 3927 02:44:55,600 --> 02:44:57,320 THAT LEE ANN DID, INCLUDING BOTH 3928 02:44:57,320 --> 02:44:58,720 CHILDREN AND ADULTS, WHAT YOU 3929 02:44:58,720 --> 02:45:01,080 CAN SEE IF YOU CAN -- I DON'T 3930 02:45:01,080 --> 02:45:02,920 HAVE MY CURSOR -- YOU CAN SEE 3931 02:45:02,920 --> 02:45:05,720 CHILD TO CHILD IN THE LOW TO 3932 02:45:05,720 --> 02:45:07,640 HIGH, NICE COMPENSATION 3933 02:45:07,640 --> 02:45:08,440 HAPPENING WHEREAS IN ADULT 3934 02:45:08,440 --> 02:45:13,520 POPULATION YOU DID NOT SEE THAT. 3935 02:45:13,520 --> 02:45:14,680 THERE'S BEEN DEBATE YOU SHOULD 3936 02:45:14,680 --> 02:45:18,520 HAVE A TRUE BASELINE OF JUST THE 3937 02:45:18,520 --> 02:45:21,360 ENTREE ALONE WITH NOT THE 3938 02:45:21,360 --> 02:45:22,280 MANIPULATION OF THE PRE-LOAD, 3939 02:45:22,280 --> 02:45:25,640 TANIA CALL HAS DONE THIS IN HER 3940 02:45:25,640 --> 02:45:25,880 STUDIES. 3941 02:45:25,880 --> 02:45:27,800 BUT IN GENERAL THEY ARE ALL 3942 02:45:27,800 --> 02:45:30,960 GETTING AT THE SAME COMPX 3943 02:45:30,960 --> 02:45:32,320 APPROACH. 3944 02:45:32,320 --> 02:45:38,400 OUTSIDE OF THAT, IN TERMS OF 3945 02:45:38,400 --> 02:45:40,440 REGULATION, CHANGING PRE-LOAD 3946 02:45:40,440 --> 02:45:43,520 E.D., SEEING RESPONSIVENESS, IN 3947 02:45:43,520 --> 02:45:44,920 CHILDREN THIS IS ONLY APPROACH 3948 02:45:44,920 --> 02:45:47,000 I'M AWARE OF THAT HAS BEEN 3949 02:45:47,000 --> 02:45:47,440 TAKEN. 3950 02:45:47,440 --> 02:45:50,160 BUT WE KNOW THERE ARE THESE 3951 02:45:50,160 --> 02:45:51,120 INDIVIDUAL DIFFERENCES. 3952 02:45:51,120 --> 02:45:54,520 WE ALSO KNOW THAT NOT ALL 3953 02:45:54,520 --> 02:45:56,000 CHILDREN ARE GREAT AT 3954 02:45:56,000 --> 02:45:56,440 REGULATING. 3955 02:45:56,440 --> 02:45:59,200 SO PROGRAMS ARE TRYING TO 3956 02:45:59,200 --> 02:46:02,000 INTERVENE ON REGULATION IN 3957 02:46:02,000 --> 02:46:05,320 CHILDREN'S ABILITY TO REGULATE 3958 02:46:05,320 --> 02:46:07,000 RESPONDING TO THEIR HUNGER 3959 02:46:07,000 --> 02:46:09,120 SIGNALS, EATING LESS IN RESPONSE 3960 02:46:09,120 --> 02:46:11,960 TO, FOR EXAMPLE, HIGH E.D. 3961 02:46:11,960 --> 02:46:12,320 PROTOCOL. 3962 02:46:12,320 --> 02:46:16,120 WE ALSO SEE A SEX DIFFERENCE. 3963 02:46:16,120 --> 02:46:20,200 WHERE WE SEE BOYS VERSUS GIRLS 3964 02:46:20,200 --> 02:46:21,960 RESPONDING DIFFERENTLY TO COMPX. 3965 02:46:21,960 --> 02:46:27,320 THAT BEGS THE QUESTION WITH THIS 3966 02:46:27,320 --> 02:46:28,600 COMPX IN OBSERVATIONAL SETTING 3967 02:46:28,600 --> 02:46:32,080 IS IT SENSITIVE ENOUGH TO PICK 3968 02:46:32,080 --> 02:46:33,960 UP INTERVENTION DIFFERENCES POST 3969 02:46:33,960 --> 02:46:34,600 INTERVENTION? 3970 02:46:34,600 --> 02:46:35,880 SO THERE'S BEEN SOME WORK, 3971 02:46:35,880 --> 02:46:40,720 THERE'S BEEN A FEW THAT HAVE 3972 02:46:40,720 --> 02:46:49,760 USED COMPX IN RESPONSE TO 3973 02:46:49,760 --> 02:46:50,120 INTERVENTIONS. 3974 02:46:50,120 --> 02:46:52,120 SUCH AS KATHLEEN KELLER WHO HAS 3975 02:46:52,120 --> 02:46:55,560 HAD SOME SUCCESS. 3976 02:46:55,560 --> 02:46:58,720 BUT A FEW THINGS TO BE 3977 02:46:58,720 --> 02:47:00,360 CONSIDERING, CARRY GIVER FEEDING 3978 02:47:00,360 --> 02:47:02,360 PRACTICES ARE INFLUENCING 3979 02:47:02,360 --> 02:47:03,360 RESPONSE TO COMPX, THERE'S DATA 3980 02:47:03,360 --> 02:47:07,560 ON THOSE LINES. 3981 02:47:07,560 --> 02:47:09,680 WE KNOW PARENT EATING STYLE HOW 3982 02:47:09,680 --> 02:47:12,440 THEY PERFORM IN TERM ALSO OF 3983 02:47:12,440 --> 02:47:15,000 SELF-REPORT MEASURES, THAT IS A 3984 02:47:15,000 --> 02:47:17,920 MODERATOR AND CAN INFLUENCE 3985 02:47:17,920 --> 02:47:21,800 COMPX RESPONSE, ALSO PARADIGM 3986 02:47:21,800 --> 02:47:22,000 ITSELF. 3987 02:47:22,000 --> 02:47:23,600 THERE'S A LOT OF VARIABILITY IN 3988 02:47:23,600 --> 02:47:27,000 HOW THIS IS BEING IMPLEMENTED. 3989 02:47:27,000 --> 02:47:31,000 IN TERMS OF INTERVENTION WE DO 3990 02:47:31,000 --> 02:47:34,640 SEE DIFFERENCES ON COMPX. 3991 02:47:34,640 --> 02:47:36,600 KATHLEEN KELLER HAS NOT YET 3992 02:47:36,600 --> 02:47:37,840 PUBLISHED, GAVE PERMISSION TO 3993 02:47:37,840 --> 02:47:40,120 SHARE, WE SEE DIFFERENCES OF 3994 02:47:40,120 --> 02:47:41,440 BOYS VERSUS GIRLS, BOYS 3995 02:47:41,440 --> 02:47:44,160 RESPONDING BUT NOT GIRLS TO 3996 02:47:44,160 --> 02:47:47,480 INTERVENTIONS DESIGNED TO 3997 02:47:47,480 --> 02:47:49,520 MANIPULATE REGULATION. 3998 02:47:49,520 --> 02:47:50,760 CHANGING GEARS WITH APPETITE, 3999 02:47:50,760 --> 02:47:54,280 THERE IS SOME DEBATE IN TERMS OF 4000 02:47:54,280 --> 02:47:56,320 THESE TRAITS BEING STABLE OR 4001 02:47:56,320 --> 02:47:59,760 MODIFIABLE BUT YOU CAN SEE 4002 02:47:59,760 --> 02:48:02,600 LISTED LONG LIST OF POTENTIAL 4003 02:48:02,600 --> 02:48:04,400 CHARACTERISTICS WE COULD BE 4004 02:48:04,400 --> 02:48:05,120 CONSIDERING. 4005 02:48:05,120 --> 02:48:06,360 WHEN CONSIDERING IN TERMS OF 4006 02:48:06,360 --> 02:48:08,560 MEASUREMENT WE NEED TO BE 4007 02:48:08,560 --> 02:48:10,560 CONSIDERING RELIABILITY, WHETHER 4008 02:48:10,560 --> 02:48:14,600 IT'S VALID AGAINST OTHER 4009 02:48:14,600 --> 02:48:15,120 VALIDATED MEASURES. 4010 02:48:15,120 --> 02:48:16,760 ALSO THE FEASIBILITY AND REAL 4011 02:48:16,760 --> 02:48:19,480 LACK OF MEASUREMENT IN MORE 4012 02:48:19,480 --> 02:48:20,640 DIVERSE POPULATIONS, SO MOST ALL 4013 02:48:20,640 --> 02:48:25,200 OF THIS WORK HAS BEEN CONDUCTED 4014 02:48:25,200 --> 02:48:26,800 IN WHITE MIDDLE UPPER INCOME AND 4015 02:48:26,800 --> 02:48:29,320 THE FEW STUDIES THAT HAVE BEEN 4016 02:48:29,320 --> 02:48:31,600 DONE IN MORE DIVERSE POPULATIONS 4017 02:48:31,600 --> 02:48:34,200 YOU SEE SOME DIFFERENCES IN 4018 02:48:34,200 --> 02:48:34,760 PERFORMANCE. 4019 02:48:34,760 --> 02:48:36,400 A FEW WE'RE CONSIDERING IN THE 4020 02:48:36,400 --> 02:48:37,920 REPORT ARE LISTED HERE. 4021 02:48:37,920 --> 02:48:39,480 OBVIOUSLY WE DO NOT HAVE TIME TO 4022 02:48:39,480 --> 02:48:41,920 GO OVER ALL OF THESE BUT WE ARE 4023 02:48:41,920 --> 02:48:43,320 CONSIDERING THESE FROM 4024 02:48:43,320 --> 02:48:46,200 BEHAVIORAL TASKS AND THEN LAYING 4025 02:48:46,200 --> 02:48:48,680 OVER TOP OF THOSE POTENTIAL 4026 02:48:48,680 --> 02:48:51,000 SELF-REPORT MEASURES THAT ARE 4027 02:48:51,000 --> 02:48:55,360 EASIER TO PICK UP THAT MAY 4028 02:48:55,360 --> 02:48:56,960 POTENTIALLY SOME ARE MORE 4029 02:48:56,960 --> 02:49:01,240 SENSITIVE THAN OTHERS LOOKING AT 4030 02:49:01,240 --> 02:49:01,680 CHANGE. 4031 02:49:01,680 --> 02:49:02,920 >> SORRY TO INTERRUPT BUT WOULD 4032 02:49:02,920 --> 02:49:04,800 YOU MIND WRAPPING UP. 4033 02:49:04,800 --> 02:49:07,000 >> YEP, SURE. 4034 02:49:07,000 --> 02:49:12,280 IN TERMS OF THESE TRAITS I'LL 4035 02:49:12,280 --> 02:49:17,360 SKIP DOWN TO ONE I WANTED TO 4036 02:49:17,360 --> 02:49:20,800 HIGHLIGHT IN LOOKING AT APPROACH 4037 02:49:20,800 --> 02:49:21,920 AND AVOIDANTS, HEDONIC, THE 4038 02:49:21,920 --> 02:49:25,480 REPORT WILL INCLUDE ALL THE 4039 02:49:25,480 --> 02:49:27,080 OBSERVATIONAL MEASURES AND 4040 02:49:27,080 --> 02:49:38,040 ASSESS HOW THOSE PERFORM AGAINST 4041 02:49:38,040 --> 02:49:39,600 TRADITIONAL PROTOCOLS. 4042 02:49:39,600 --> 02:49:41,360 EAH HAD BEEN PUBLISHED FOR 4043 02:49:41,360 --> 02:49:43,600 CLASSROOM SETTINGS, AND THINKING 4044 02:49:43,600 --> 02:49:44,840 ABOUT INDICATORS OF ACHIEVEMENT 4045 02:49:44,840 --> 02:49:48,000 AS WELL AS A BUNCH OF OTHER 4046 02:49:48,000 --> 02:49:51,000 PERFORMANCE AND HEALTH OUTCOMES, 4047 02:49:51,000 --> 02:49:52,080 AND IRONICALLY THIS IS ALSO DONE 4048 02:49:52,080 --> 02:49:54,360 IN MANY OF THE FEEDING STUDIES 4049 02:49:54,360 --> 02:49:55,600 AND THERE ARE SEVERELY REPORT 4050 02:49:55,600 --> 02:49:58,200 MEASURES THAT COULD POTENTIALLY 4051 02:49:58,200 --> 02:50:04,600 BE PICKING UP INHIBITORS CONTROL 4052 02:50:04,600 --> 02:50:06,800 INCLUDING MARY RATHBART'S 4053 02:50:06,800 --> 02:50:07,160 QUESTIONNAIRE. 4054 02:50:07,160 --> 02:50:09,000 I'LL CLOSE IN THE INTEREST OF 4055 02:50:09,000 --> 02:50:09,480 TIME. 4056 02:50:09,480 --> 02:50:11,400 I HAVE A FEW GAPS HIGHLIGHTED 4057 02:50:11,400 --> 02:50:13,000 THAT ARE IMPORTANT FOR US TO 4058 02:50:13,000 --> 02:50:13,240 CONSIDER. 4059 02:50:13,240 --> 02:50:14,480 WE DON'T HAVE VERY GREAT 4060 02:50:14,480 --> 02:50:15,680 SCREENING TOOLS AT THIS POINT 4061 02:50:15,680 --> 02:50:17,600 WHICH IS REALLY IMPORTANT FOR US 4062 02:50:17,600 --> 02:50:19,360 TO CONSIDER. 4063 02:50:19,360 --> 02:50:20,200 AND THEN ALSO BASED ON 4064 02:50:20,200 --> 02:50:23,280 POPULATION A LOT OF STUDIES ARE 4065 02:50:23,280 --> 02:50:25,080 DONE WITH PARENTING APPROACH AND 4066 02:50:25,080 --> 02:50:28,720 THINKING ABOUT OTHER AUDIENCES 4067 02:50:28,720 --> 02:50:30,360 AND FOR CARE PROVIDERS AND 4068 02:50:30,360 --> 02:50:33,200 TEACHERS AND REALLY THE NEED FOR 4069 02:50:33,200 --> 02:50:34,600 MORE STANDARDIZED PROTOCOLS. 4070 02:50:34,600 --> 02:50:36,640 THEY ARE QUITE VARIABLE IN HOW 4071 02:50:36,640 --> 02:50:38,800 THEY ARE IMPLEMENTED AND SOME 4072 02:50:38,800 --> 02:50:39,720 MORE TRANSPARENCY WITH OPEN 4073 02:50:39,720 --> 02:50:43,000 ACCESS TO THOSE I THINK WOULD BE 4074 02:50:43,000 --> 02:50:47,160 REALLY VALUABLE TO THE FIELD. 4075 02:50:47,160 --> 02:50:49,080 I'LL CLOSE THERE. 4076 02:50:49,080 --> 02:50:56,120 THANK YOU. 4077 02:50:56,120 --> 02:50:58,800 >> THANK YOU SO MUCH. 4078 02:50:58,800 --> 02:51:02,240 WITH APOLOGIES TO THE AUDIENCE 4079 02:51:02,240 --> 02:51:05,280 FOR MY POOR TIME MANAGEMENT 4080 02:51:05,280 --> 02:51:06,640 BECAUSE I'VE BEEN ENJOYING AND 4081 02:51:06,640 --> 02:51:08,200 WITHOUT INTERRUPTING. 4082 02:51:08,200 --> 02:51:10,400 THE LAST PRESENTATION I'M GOING 4083 02:51:10,400 --> 02:51:14,760 TO FOCUS QUICKLY ON INFLAMMATION 4084 02:51:14,760 --> 02:51:16,120 IMMUNE FUNCTION ASSESSMENT AND 4085 02:51:16,120 --> 02:51:18,600 NOVEL APPROACHES. 4086 02:51:18,600 --> 02:51:26,360 I'VE HIGHLIGHTED THE DISCLOSURE 4087 02:51:26,360 --> 02:51:30,400 PIECE HERE. 4088 02:51:30,400 --> 02:51:32,920 NOW LINKING INFECTION WITH 4089 02:51:32,920 --> 02:51:34,120 NUTRITION FOCUSING ON NUTRITION 4090 02:51:34,120 --> 02:51:36,200 INCREASING RISK OF INFECTION AND 4091 02:51:36,200 --> 02:51:39,800 VICIOUS CYCLE, WE'VE ADDED MORE 4092 02:51:39,800 --> 02:51:42,640 EVIDENCE AND WHAT MIGHT BE THE 4093 02:51:42,640 --> 02:51:44,600 MEDIATING FACTORS FOR EXAMPLE 4094 02:51:44,600 --> 02:51:49,000 THIS ONE ABOUT FIVE YEARS AGO 4095 02:51:49,000 --> 02:51:52,200 NOW, FRAMEWORK SUMMARIZING STATE 4096 02:51:52,200 --> 02:51:53,400 OF KNOWLEDGE AROUND THIS AND 4097 02:51:53,400 --> 02:51:56,800 WHAT IT BOILS DOWN TO IS SINGLE 4098 02:51:56,800 --> 02:51:59,280 NUTRIENT LEVEL ALL IMMUNE 4099 02:51:59,280 --> 02:52:09,240 FUNCTION REQUIRES ADEQUATE 4100 02:52:09,240 --> 02:52:12,960 NUTRIENT SUPPLY. 4101 02:52:12,960 --> 02:52:17,280 WHETHER IT BE INFECTION, CANCER, 4102 02:52:17,280 --> 02:52:21,760 ANY DISEASE, NUTRITION 4103 02:52:21,760 --> 02:52:22,600 INFLAMMATION IS ALTERED. 4104 02:52:22,600 --> 02:52:25,200 THIS WAS COVERED IN WORKING 4105 02:52:25,200 --> 02:52:25,800 GROUP 1. 4106 02:52:25,800 --> 02:52:28,240 TO HIGHLIGHT A LOT OF WORK 4107 02:52:28,240 --> 02:52:29,600 AROUND MALNUTRITION AND 4108 02:52:29,600 --> 02:52:31,400 INFECTION OR INFLAMMATION HAS 4109 02:52:31,400 --> 02:52:33,040 FOCUSED IN THE 0 TO 5 YEAR AGE 4110 02:52:33,040 --> 02:52:36,280 GROUP TO HIGHLIGHT FROM THIS 4111 02:52:36,280 --> 02:52:37,640 PAPER THAT REVIEWED DEVELOPMENT 4112 02:52:37,640 --> 02:52:42,600 OF IMMUNE RESPONSE THROUGH 4113 02:52:42,600 --> 02:52:44,400 NEONATAL AND ADULT LIFE, A FAIR 4114 02:52:44,400 --> 02:52:46,120 AMOUNT OF WORK IN THE 5 TO 19 4115 02:52:46,120 --> 02:52:47,600 AGE GROUP, WE NEED TO PAY 4116 02:52:47,600 --> 02:52:49,400 ATTENTION AND ALSO BUILD 4117 02:52:49,400 --> 02:52:52,120 EVIDENCE AROUND THAT. 4118 02:52:52,120 --> 02:52:54,680 WHEN IT COMES TO ASSESSMENT, 4119 02:52:54,680 --> 02:52:57,200 THESE ARE RECOGNIZED, WE SAY 4120 02:52:57,200 --> 02:52:58,040 NUTRITION AFFECTED IMMUNE 4121 02:52:58,040 --> 02:52:59,760 FUNCTION AND INFLAMMATION. 4122 02:52:59,760 --> 02:53:02,760 WE DON'T HAVE AS MUCH CONSENSUS 4123 02:53:02,760 --> 02:53:05,120 AS ONE WILL EXPECT OR 4124 02:53:05,120 --> 02:53:06,480 AVAILABILITY OF BIOMARKERS OR 4125 02:53:06,480 --> 02:53:18,240 METHODS TO ASSESS INFLAMMATION, 4126 02:53:18,240 --> 02:53:19,920 EFFORTS LIKE BRINDA HAS TRIED TO 4127 02:53:19,920 --> 02:53:21,920 HARMONIZE BUT THERE'S STILL A 4128 02:53:21,920 --> 02:53:24,800 FAIR AMOUNT OF WORK TO BE DONE. 4129 02:53:24,800 --> 02:53:26,600 THE POPULAR MARKERS FOR 4130 02:53:26,600 --> 02:53:29,880 ASSESSING ARE CRP AND AGP, 4131 02:53:29,880 --> 02:53:33,440 C-REACTIVE PROTEIN IS BIOMARKER 4132 02:53:33,440 --> 02:53:34,440 OF ACUTE INFLAMMATION RISING 4133 02:53:34,440 --> 02:53:35,640 QUICKLY AND THERE ARE A FAIR 4134 02:53:35,640 --> 02:53:37,760 NUMBER OF LABORATORY AND RAPID 4135 02:53:37,760 --> 02:53:39,920 TESTS AVAILABLE NOW FOR 4136 02:53:39,920 --> 02:53:43,600 MEASURING CRP. 4137 02:53:43,600 --> 02:53:46,680 THE OTHER ONE IS AGP, WHICH 4138 02:53:46,680 --> 02:53:48,600 RISES LIKELY SLOWLY SO OVER DAY 4139 02:53:48,600 --> 02:53:50,680 2 TO DAY 7, AND LARGELY MOST OF 4140 02:53:50,680 --> 02:53:52,600 THE TESTS ARE LAB BASED AND 4141 02:53:52,600 --> 02:53:56,120 MOSTLY IN THE NUTRITION SPACE. 4142 02:53:56,120 --> 02:53:58,560 THE OTHER BIOMARKERS ARE 4143 02:53:58,560 --> 02:54:02,720 FERRITIN AND RETINOL, AND THOSE 4144 02:54:02,720 --> 02:54:04,120 ARE MARKERS OF VITAMIN STATUS 4145 02:54:04,120 --> 02:54:13,640 AND ALSO IN OUR WORK AND OTHER 4146 02:54:13,640 --> 02:54:17,320 PEOPLE'S FERRITIN USED TO 4147 02:54:17,320 --> 02:54:18,240 PROGNOSTICATE SEVERITY INFECTION 4148 02:54:18,240 --> 02:54:23,440 FOR DENGUE AND RECENTLY FOR 4149 02:54:23,440 --> 02:54:23,720 COVID-19. 4150 02:54:23,720 --> 02:54:28,280 AND THAT'S BECAUSE ALL OF THIS 4151 02:54:28,280 --> 02:54:31,200 IS HAPPENING IN PARALLEL, ANY 4152 02:54:31,200 --> 02:54:33,680 MEASUREMENT OF THESE ACUTE PHASE 4153 02:54:33,680 --> 02:54:35,720 PROTEINS FOR ASSESSING NUTRIENT 4154 02:54:35,720 --> 02:54:37,000 STATUS NEEDS TO ACCOUNT FOR 4155 02:54:37,000 --> 02:54:38,880 INFLAMMATION STAYED IN THE BODY, 4156 02:54:38,880 --> 02:54:40,680 CONTEXT, WHAT'S THE DISEASE 4157 02:54:40,680 --> 02:54:47,120 STATE, HEALTH STATE, AND THAT'S 4158 02:54:47,120 --> 02:54:51,480 WHY RECOMMENDED TO ADJUST FOR 4159 02:54:51,480 --> 02:54:58,320 MARKER OF INFLAMMATION. 4160 02:54:58,320 --> 02:54:59,000 BRINDA DEVELOPED EQUATIONS, 4161 02:54:59,000 --> 02:55:00,920 FIGURING OUT A TRUE STATUS FOR 4162 02:55:00,920 --> 02:55:02,400 VITAMIN A AND IRON IN THE 4163 02:55:02,400 --> 02:55:03,200 POPULATION. 4164 02:55:03,200 --> 02:55:12,000 A LOT OF WORK DOESN'T APPLY TO 4165 02:55:12,000 --> 02:55:14,200 PEOPLE WITH ACTIVE INFECTION OR 4166 02:55:14,200 --> 02:55:16,000 ACTIVE DISEASE. 4167 02:55:16,000 --> 02:55:18,600 IMMUNE FUNCTION, THIS IS STILL 4168 02:55:18,600 --> 02:55:21,320 VERY AMORPHOUS AND LAB BASED. 4169 02:55:21,320 --> 02:55:23,000 I WILL POINT FOR THOSE 4170 02:55:23,000 --> 02:55:25,400 INTERESTED, I WILL POINT TO THE 4171 02:55:25,400 --> 02:55:28,160 REVIEW LIST AT THE BOTTOM, 2005, 4172 02:55:28,160 --> 02:55:32,160 A GOOD STARTING POINT. 4173 02:55:32,160 --> 02:55:36,360 REVIEW TEAM SUMMARIZED IMMUNE 4174 02:55:36,360 --> 02:55:37,480 BIOMARKERS WITH SUITABILITY. 4175 02:55:37,480 --> 02:55:43,520 THERE IS HARDLY ANY CONSENSUS OR 4176 02:55:43,520 --> 02:55:44,720 HARDLY ANY HARMONIZATION. 4177 02:55:44,720 --> 02:55:47,320 THIS AGAIN A WORK IN PROGRESS, 4178 02:55:47,320 --> 02:55:52,040 GOING BACK TO CONCEPTUAL 4179 02:55:52,040 --> 02:55:53,360 FRAMEWORK. 4180 02:55:53,360 --> 02:55:55,120 THERE ARE -- FERRITIN, WHETHER 4181 02:55:55,120 --> 02:55:58,000 POINT OF CARE FORMAT OR IN A 4182 02:55:58,000 --> 02:56:01,680 LAB, RBP RETINOL KIND OF WHERE 4183 02:56:01,680 --> 02:56:04,360 THEY WILL FALL IN TERMS OF 4184 02:56:04,360 --> 02:56:06,000 RESPONSIVENESS TO NUTRITION AND 4185 02:56:06,000 --> 02:56:07,360 ORDER OF COMPLEXITY. 4186 02:56:07,360 --> 02:56:10,600 THERE'S EXCITING WORK IN THIS 4187 02:56:10,600 --> 02:56:11,880 SPACE, WORK AROUND IL6 THAT OUR 4188 02:56:11,880 --> 02:56:13,600 TEAM IS DOING AND OTHER PEOPLE 4189 02:56:13,600 --> 02:56:26,760 HAVE BEEN DOING BECAUSE IT'S 4190 02:56:26,760 --> 02:56:31,680 IT'S AN UPSTREAM MARKER. 4191 02:56:31,680 --> 02:56:36,680 WE USED THIS LAST YEAR, FROM MY 4192 02:56:36,680 --> 02:56:39,000 Ph.D. STUDENT, WE'RE LOOKING 4193 02:56:39,000 --> 02:56:41,800 AT CLUSTERS OF CORRELATED IMMUNE 4194 02:56:41,800 --> 02:56:44,720 RESPONSE MARKERS TO IDENTIFY 4195 02:56:44,720 --> 02:56:47,880 SIMILAR CYTOKINES OR SIMILAR 4196 02:56:47,880 --> 02:56:50,200 CYTOKINES HAVING SIMILAR EFFECT 4197 02:56:50,200 --> 02:56:53,000 OR FUNCTION IN ACUTE FEBRILE 4198 02:56:53,000 --> 02:56:53,200 ILLNESS. 4199 02:56:53,200 --> 02:56:57,440 WE FOUND ONE OF THE CLUSTER 1 4200 02:56:57,440 --> 02:56:58,600 VARIABLES COMPRISED OF 4201 02:56:58,600 --> 02:56:59,520 PRO-INFLAMMATORY MEDIATORS WAS 4202 02:56:59,520 --> 02:57:04,800 ADJUSTED IN THE FULLY ADJUSTED 4203 02:57:04,800 --> 02:57:06,720 MODEL, PANELS ARE BECOMING MORE 4204 02:57:06,720 --> 02:57:07,760 ACCESSIBLE AND MORE AFFORDABLE 4205 02:57:07,760 --> 02:57:10,320 SO BUT THERE ARE STILL A FAIR 4206 02:57:10,320 --> 02:57:12,000 NUMBER OF LIMITATIONS AND A LOT 4207 02:57:12,000 --> 02:57:13,520 OF CHALLENGES IN FUTURE 4208 02:57:13,520 --> 02:57:15,080 DIRECTIONS LISTED HERE. 4209 02:57:15,080 --> 02:57:15,800 INFLAMMATION, FOR EXAMPLE, 4210 02:57:15,800 --> 02:57:19,960 REQUIRE MORE THAN ONE MARKER. 4211 02:57:19,960 --> 02:57:21,440 LACK OF LAB INFRASTRUCTURE, 4212 02:57:21,440 --> 02:57:23,320 NOVEL METHODS REQUIRE VALIDATION 4213 02:57:23,320 --> 02:57:34,960 FOR IMMUNE FUNCTION, LACK OF 4214 02:57:34,960 --> 02:57:35,600 HARMONIZATION, AND NORMAL RANGES 4215 02:57:35,600 --> 02:57:42,800 FOR A LOT OF MARKERS ARE NOT 4216 02:57:42,800 --> 02:57:43,120 ESTABLISHED. 4217 02:57:43,120 --> 02:57:45,920 THERE'S AN EXPLOSION IN NEAR 4218 02:57:45,920 --> 02:57:47,000 PATIENT ANALYZERS. 4219 02:57:47,000 --> 02:57:49,720 THE ONE ON THE RIGHT IS A 4220 02:57:49,720 --> 02:57:51,960 DESKTOP AVAILABLE IN THE CLINIC 4221 02:57:51,960 --> 02:57:53,920 OR COMMUNITY HEALTH CENTER THAT 4222 02:57:53,920 --> 02:57:58,280 CAN MAKE FAST AND EASY 4223 02:57:58,280 --> 02:57:59,640 DETERMINATION OF THINGS LIKE 4224 02:57:59,640 --> 02:58:05,360 HBA1C AND SO ON. 4225 02:58:05,360 --> 02:58:08,200 DR. ALLEN MENTIONED QUANSYS 4226 02:58:08,200 --> 02:58:11,320 PLATFORM, THE LAB-BASED FORM AND 4227 02:58:11,320 --> 02:58:12,680 INDEPENDENT EVALUATION BY CDC 4228 02:58:12,680 --> 02:58:14,960 TEAM SHOWS A LOT OF PROMISE, 4229 02:58:14,960 --> 02:58:17,800 ESPECIALLY IF IT'S ABLE TO PROVE 4230 02:58:17,800 --> 02:58:20,000 ACCESS AROUND RECEPTOR AND 4231 02:58:20,000 --> 02:58:22,800 RETINOL BINDING PROTEIN. 4232 02:58:22,800 --> 02:58:26,000 WE'RE WORKING IN THIS SPACE WITH 4233 02:58:26,000 --> 02:58:27,760 THE NEUTRIPHONE, FOR THOSE 4234 02:58:27,760 --> 02:58:33,440 FAMILIAR WITH LATERAL FLOW OR 4235 02:58:33,440 --> 02:58:35,920 ANTIGEN TESTS FOR COVID-19, 4236 02:58:35,920 --> 02:58:37,960 WE'VE BEEN DOING THIS FOR TEN 4237 02:58:37,960 --> 02:58:39,480 YEARS, 15 OR SO PUBLICATIONS AND 4238 02:58:39,480 --> 02:58:42,440 A COUPLE ARE HIGHLIGHTED HERE 4239 02:58:42,440 --> 02:58:45,480 WHERE WE'RE AGE TO MEASURE IRON 4240 02:58:45,480 --> 02:58:47,840 AND VITAMIN A DEFICIENCY ON A 4241 02:58:47,840 --> 02:58:49,480 SINGLE PLATFORM, PUBLISHED FOR 4242 02:58:49,480 --> 02:59:03,960 THIS FOR PROCALKITRAN. 4243 02:59:03,960 --> 02:59:04,640 THE REGULATORY PATHWAYS FOR 4244 02:59:04,640 --> 02:59:08,800 GETTING THESE TO MARKET IS VERY 4245 02:59:08,800 --> 02:59:11,120 LONG AND THIS IS A SNAPSHOT OF 4246 02:59:11,120 --> 02:59:16,920 THE WORK WE'RE DOING AND WHERE 4247 02:59:16,920 --> 02:59:18,200 WE ARE. 4248 02:59:18,200 --> 02:59:20,360 AND I'LL STOP THERE AND THANK 4249 02:59:20,360 --> 02:59:23,400 YOU TO THE NICHD AND TEAM AND 4250 02:59:23,400 --> 02:59:33,360 LEADERSHIP AND SECRETARIATE, 4251 02:59:33,360 --> 02:59:35,720 IT'S WANT TO THANK MY POSTDOCS 4252 02:59:35,720 --> 02:59:40,080 WHO HELPED ME PUT TOGETHER THE 4253 02:59:40,080 --> 02:59:40,320 SLIDES. 4254 02:59:40,320 --> 02:59:42,000 >> CATCH YOUR BREATH. 4255 02:59:42,000 --> 02:59:43,000 THAT WAS TERRIFIC. 4256 02:59:43,000 --> 02:59:45,400 I WANT TO THANK EVERYBODY. 4257 02:59:45,400 --> 02:59:46,880 WE'RE AT TIME BUT I WANTED TO 4258 02:59:46,880 --> 02:59:54,800 HIGHLIGHT WHAT WE HEARD TODAY. 4259 02:59:54,800 --> 02:59:59,800 CLEARLY IRRESPECTIVE, THE KEY 4260 02:59:59,800 --> 03:00:01,280 MESSAGES ARE COMPLEMENTARY IN 4261 03:00:01,280 --> 03:00:02,840 YOUR CHOICE OF METHODS, NO ONE 4262 03:00:02,840 --> 03:00:07,600 MEASURE IS GOING TO GET YOU THE 4263 03:00:07,600 --> 03:00:11,400 ANSWERS THAT WE NEED, CONTEXT IS 4264 03:00:11,400 --> 03:00:13,400 CRITICAL AND CLEAR AND PRECISE 4265 03:00:13,400 --> 03:00:16,400 PROCESS FOR MEASURING YOUR 4266 03:00:16,400 --> 03:00:17,400 OBJECTIVES AND WHAT YOU'RE 4267 03:00:17,400 --> 03:00:18,480 LOOKING AT. 4268 03:00:18,480 --> 03:00:19,880 THESE ARE ALL CRITICAL ASPECTS, 4269 03:00:19,880 --> 03:00:23,000 THEY WILL BE COVERED BY WORKING 4270 03:00:23,000 --> 03:00:25,960 GROUP 3, THEY DID A GREAT JOB AT 4271 03:00:25,960 --> 03:00:27,920 TYING TOGETHER WORKING GROUP 1, 4272 03:00:27,920 --> 03:00:31,000 ASPECTS OF WORKING GROUP 2. 4273 03:00:31,000 --> 03:00:34,320 NEXT WEEK WE'LL COVER THE ISSUES 4274 03:00:34,320 --> 03:00:38,840 ADDRESSED TODAY BY THE OTHER 4275 03:00:38,840 --> 03:00:43,320 THREE GROUPS BUT THEY WILL COVER 4276 03:00:43,320 --> 03:00:46,400 ISSUES RELATED TO TRANSLATION 4277 03:00:46,400 --> 03:00:49,480 IMPLEMENTATION, TAKING THESE 4278 03:00:49,480 --> 03:00:51,200 DATA, INFORMATION, APPROACHES TO 4279 03:00:51,200 --> 03:00:52,800 ASSESSMENT TO THE FIELD IN A 4280 03:00:52,800 --> 03:00:55,200 MEANINGFUL EQUITABLE WAY. 4281 03:00:55,200 --> 03:00:56,880 I THANK EVERYBODY WHO PRESENTED 4282 03:00:56,880 --> 03:00:57,360 TODAY. 4283 03:00:57,360 --> 03:00:58,520 I THANK THE TEAM AND THANK ALL 4284 03:00:58,520 --> 03:01:00,200 OF YOU FOR JOINING US. 4285 03:01:00,200 --> 00:00:00,000 WE'LL SEE YOU NEXT WEEK.