Dietary outcomes of overweight fathers and their children in the Healthy Dads, Healthy Kids community randomised controlled trial

BACKGROUND

Few studies have examined dietary intake changes following a weight loss intervention in fathers and the association between father-child dietary intakes. The present study aimed to: (i) evaluate the change in dietary intake in overweight fathers randomised to a family-based lifestyle intervention [Healthy Dads Healthy Kids (HDHK)] versus controls and (ii) investigate whether an association exists between father-child dietary intakes.

METHODS

A secondary analysis was conducted of father-child baseline and 3-month post-intervention data (n = 93) collected in the HDHK community randomised controlled trial. Intention-to-treat linear mixed models were used to assess dietary changes by group, time (baseline and 3-month) and the group-by-time interaction. Cohens d was used to determine effect sizes.

RESULTS

Significant group-by-time effects (all P < 0.05) favouring fathers in the intervention group were identified for total daily energy intake (-1956 kJ, d = 0.74), total sugars (-45 g, d = 0.63), sodium (-414 mg, d = 0.58) and % energy from nutrient-dense, core foods (+10.1%, d = 0.86), fruit (+2.4%, d = 0.71), vegetarian protein sources (+1.2%, d = 0.57), pre-packed snacks (+1.7%, d = 0.58) and sugar-sweetened beverages (-4.1%, d = 0.58). At baseline, positive correlations were observed between father-child intakes for a number of dietary variables, and significant correlations were observed between father-child change scores for % energy carbohydrate (r = 0.35, P = 0.023), % energy from fruit (r = 0.47, P = 0.002), vegetarian protein sources (r = 0.46, P = 0.002) and frequency of consuming meals with vegetables (r = 0.38, P = 0.012).

CONCLUSIONS

The HDHK intervention successfully improved some aspects of father's dietary intakes compared to controls. The fathers' eating patterns also correlated with those of their children for several dietary variables. These novel data suggest that fathers can be targeted as agents of dietary change within obesity prevention and treatment programmes.

Advanced Copper Composites Against Copper-Tolerant Xanthomonas perforans and Tomato Bacterial Spot

Bacterial spot, caused by Xanthomonas spp., is a widespread and damaging bacterial disease of tomato (Solanum lycopersicum). For disease management, growers rely on copper bactericides, which are often ineffective due to the presence of copper-tolerant Xanthomonas strains. This study evaluated the antibacterial activity of the new copper composites core-shell copper (CS-Cu), multivalent copper (MV-Cu), and fixed quaternary ammonium copper (FQ-Cu) as potential alternatives to commercially available micron-sized copper bactericides for controlling copper-tolerant Xanthomonas perforans. In vitro, metallic copper from CS-Cu and FQ-Cu at 100 μg/ml killed the copper-tolerant X. perforans strain within 1 h of exposure. In contrast, none of the micron-sized copper rates (100 to 1,000 μg/ml) from Kocide 3000 significantly reduced copper-tolerant X. perforans populations after 48 h of exposure compared with the water control (P < 0.05). All copper-based treatments killed the copper-sensitive X. perforans strain within 1 h. Greenhouse studies demonstrated that all copper composites significantly reduced bacterial spot disease severity when compared with copper-mancozeb and water controls (P < 0.05). Although there was no significant impact on yield, copper composites significantly reduced disease severity when compared with water controls, using 80% less metallic copper in comparison with copper-mancozeb in field studies (P < 0.05). This study highlights the discovery that copper composites have the potential to manage copper-tolerant X. perforans and tomato bacterial spot.

Fractures of the femoral shaft in children: national epidemiology and treatment trends in England following activation of major trauma networks

AIMS

The aim of this study was to describe the epidemiology of closed isolated fractures of the femoral shaft in children, and to compare the treatment and length of stay (LOS) between major trauma centres (MTCs) and trauma units (TUs) in England.

PATIENTS AND METHODS

National data were obtained from the Trauma and Audit Research Network for all isolated, closed fractures of the femoral shaft in children from birth to 15 years of age, between 2012 and 2015. Age, gender, the season in which the fracture occurred, non-accidental injury, the mechanism of injury, hospital trauma status, LOS and type of treatment were recorded.

RESULTS

A total of 1852 fractures were identified. The mean annual incidence was 5.82 per 100 000 children (95% confidence interval (CI) 5.20 to 6.44). The age of peak incidence was two years for both boys and girls; this decreased with increasing age. Children aged four to six years treated in MTCs were more likely to be managed with open reduction and internal fixation compared with those treated in TUs (odds ratio 3.20; 95% CI 1.12 to 9.14; p = 0.03). The median LOS was significantly less in MTCs than in TUs for children aged between 18 months and three years treated in both a spica (p = 0.005) and traction (p = 0.0004).

CONCLUSION

This study highlights the current national trends in the management of closed isolated fractures of the femoral shaft in children following activation of major trauma networks in 2012. Future studies focusing on the reasons for the differences which have been identified may help to achieve more consistency in the management of these injuries across the trauma networks. Cite this article: Bone Joint J 2018;100-B:109-18.

The rapid and accurate categorisation of critically ill patients (RACE) to identify outcomes of interest for longitudinal studies: a feasibility study

The capacity to measure the impact of an intervention on long-term functional outcomes might be improved if research methodology reflected our clinical approach, which is to individualise goals of care to what is achievable for each patient. The objective of this multicentre inception cohort study was to evaluate the feasibility of rapidly and accurately categorising patients, who were eligible for simulated enrolment into a clinical trial, into unique categories based on premorbid function. Once a patient met eligibility criteria a rapid 'baseline assessment' was conducted to categorise patients into one of eight specified groups. A subsequent 'gold standard' assessment was made by an independent blinded assessor once patients had recovered sufficiently to allow such an assessment to occur. Accuracy was predefined as agreement in >80% of assessments. One hundred and twenty-two patients received a baseline assessment and 104 (85%) were categorised to a unique category. One hundred and six patients survived to have a gold standard assessment performed, with 100 (94%) assigned to a unique category. Ninety-two patients had both a baseline and gold standard assessment, and these agreed in 65 (71%) patients. It was not feasible to rapidly and accurately categorise patients according to premorbid function.

Genetic basis for variation in plasma IL-18 levels in persons with chronic hepatitis C virus and human immunodeficiency virus-1 infections

Inflammasomes are multi-protein complexes integrating pathogen-triggered signaling leading to the generation of pro-inflammatory cytokines, including interleukin-18 (IL-18). Hepatitis C virus (HCV) and human immunodeficiency virus-1 (HIV) infections are associated with elevated IL-18, suggesting inflammasome activation. However, there is marked person-to-person variation in the inflammasome response to HCV and HIV. We hypothesized that host genetics may explain this variation. To test this, we analyzed the associations of plasma IL-18 levels and polymorphisms in 10 genes in the inflammasome cascade. 1538 participants with active HIV and/or HCV infection in 3 ancestry groups are included. Samples were genotyped using the Illumina Omni 1-quad and Omni 2.5 arrays. Linear regression analyses were performed to test the association of variants with logIL-18 including HCV and HIV infection status and HIV-RNA, in each ancestry group and then meta-analyzed. Eleven highly correlated SNPs (r2=0.98-1) in the IL18-BCO2 region were significantly associated with logIL-18; Each T allele of rs80011693 confers a decrease of 0.06 log pg/mL of IL-18 after adjusting for covariates (rs80011693; rs111311302 β=-0.06, P-value=2.7×10^-4). In conclusion, genetic variation in IL18 is associated with IL-18 production in response to HIV and HCV infection and may explain variability in the inflammatory outcomes of chronic viral infections.

Potential of Nano-Formulated Zinc Oxide for Control of Citrus Canker on Grapefruit Trees

Antimicrobial activity of experimental formulations of two structurally different nano-zinc oxide materials, plate-like Zinkicide SG4 and particulate Zinkicide SG6, was evaluated against Xanthomonas citri subsp. citri, the cause of citrus canker. In vitro assay demonstrated Zinkicide SG4 had a twofold lower minimum inhibitory concentration (MIC) against Escherichia coli and X. alfalfae subsp. citrumelonis (62.5 to 250 µg/ml) compared with copper sulfate (250 µg/ml), copper hydroxide (250 to 500 µg/ml), or cuprous oxide/zinc oxide (125 to 250 µg/ml). Zinkicide SG6 had a sevenfold to eightfold lower MIC against Escherichia coli and X. alfalfae subsp. citrumelonis (31 to 250 μg/ml). Leaves of sweet orange (Citrus sinensis) and fruit of 'Ruby Red' grapefruit (C. paradisi) were evaluated for citrus canker disease control. A greenhouse assay with foliage demonstrated that spray treatment with Zinkicide reduced citrus canker lesion development after injection-infiltration of X. citri subsp. citri into the leaf intercellular space. In field trials conducted in Southeast Florida in 2014 and 2015, Zinkicide SG4 and SG6 reduction of grapefruit canker incidence exceeded that of cuprous oxide and cuprous oxide/zinc oxide bactericides. Zinkicide formulations were also effective against the fungal diseases, citrus scab (Elsinoe fawcetti) and melanose (Diaporthe citri), on grapefruit. No sign of phytotoxicity to the fruit rind was observed during either season. Antimicrobial activity of Zinkicide for protection of leaves and fruit against X. citri subsp. citri was comparable or exceeded that for commercial copper and zinc oxide formulations which may be attributed to translaminar movement of Zinkicide.

Effects of in ovo supplementation of probiotics on performance and immunocompetence of broiler chicks to an Eimeria challenge

Coccidiosis is regarded as the parasitic disease with the greatest economic impact on the poultry industry due to reduced performance and increased mortality. A study was conducted to investigate the effects of in ovo administration of probiotics on hatchability, performance, immune organ weights, and lesion scores in broiler chicks during a mixed Eimeria infection. At embryonic day 18, 210 eggs were injected with either sterile water or 1×106 cfu probiotic bacteria. On day 3 post-hatch, half of the chicks from each treatment group were challenged with a mixed inoculum of Eimeria acervulina, Eimeria maxima and Eimeria tenella. Measurements and tissue samples were taken on day of hatch (DOH) and days 3, 9 and 15. On day 9, 24 birds per treatment were scored for intestinal Eimeria lesions. No differences were seen among groups for hatchability as well as for body weight (BW), BW gain (BWG), or immune organ weights prior to the Eimeria challenge. On day 9, the non-challenged birds with probiotic supplementation had higher BW and BWG than the non-supplemented controls while no differences were seen among the challenged groups. On day 15, probiotic supplemented birds had improved BW compared to the non-supplemented birds as well as increased BWG from day 9 to 15. Bursa weight was not affected by treatment at any time point while spleen weight was greater in supplemented birds on day 15. Birds receiving the probiotic had significantly lower mortality than non-treated birds. Additionally, gross lesion severity was reduced due to probiotic supplementation in all intestinal segments evaluated. These results suggest that in ovo supplementation of probiotics may improve early performance and provide protection against a mixed Eimeria infection.

Increasing patient involvement in the diabetic foot pathway: a pilot randomized controlled trial

AIMS

This pilot study aimed to explore whether the use of an intervention to increase shared decision-making (Decision Navigation) increased decision self-efficacy and foot-treatment adherence in patients with a diabetic foot ulcer.

METHODS

Fifty-six patients with a diabetic foot ulcer were randomized to receive Decision Navigation (N = 30) or usual care (N = 26). Primary outcomes included decision self-efficacy, adherence to foot treatment as reported by the participant and adherence to foot treatment as reported by the clinician. Secondary outcomes included foot ulcer healing rate, health-related quality of life, decision conflict and decision regret.

RESULTS

Despite participants rating Decision Navigation as very helpful, mixed analyses of variance revealed no differences in decision self-efficacy or adherence between those receiving Decision Navigation and those receiving usual care. There were no differences between groups with regards to the secondary outcomes, with the exception of decision conflict which increased over time (12 weeks) for those receiving Decision Navigation.

CONCLUSIONS

An intervention that facilitated patient involvement in treatment decisions did not have any impact on decisional confidence or adherence to foot treatment. This does not provide support for the suggestion that personalized care can improve health-related outcomes at this progressed stage of the patient's disease trajectory. We suggest that the diabetic foot population may benefit from interventions aimed at increasing motivation to engage with care pathways, centred on challenging personal controllability beliefs.

A Comparison of Gas-Liquid Chromatography and a Titration Method for the Determination of Plasma Non-Esterified Fatty Acid Levels during Pregnancy

The level of plasma non-esterified fatty acids (NEFA) was measured by gas-liquid chromatography (GLC) and a titration method in 194 samples collected during pregnancy and from four days to 24 weeks post partum. Both techniques indicated a similar pattern of changes in plasma NEFA associated with pregnancy. The titration estimates of NEFA level were usually greater than those measured by GLC, and there was some suggestion that the disparity between the methods was increased at the end of pregnancy and was reduced at six weeks after delivery.

Radiation delivered to patients during endourological surgery – are they overexposed?

Introduction:

Ionising radiation is commonly used in urological practice in the form of fluoroscopy. To date there is a remarkable scarcity of information concerning patient exposure to ionising radiation during urological procedures and the potential risk of developing of a lethal malignancy due to excessive radiation exposure.

Objectives:

We aimed to determine the radiation exposure for a patient during the most commonly performed urological procedures, and to assess the potential risk of developing a fatal cancer as a result of endourological fluoroscopy.

Methods:

Data was collected prospectively in two institutions on endoscopic urological operations. Procedures were classified as retrographic, semi-rigid ureteroscopic and flexible ureterorenoscopic (FURS). Data collected included procedure type and difficulty, Dose Area Product [DAP (Gy*Cm2)]. The effective dose (ED) measured in millisievert (mSv) was determined from the DAP by using the Monte Carlo calculation.

Results:

In total 395 consecutive operations from two institutions were assessed. The mean ED for all procedures in this study was 0.394 mSv, IQR (0.1184–0.7583). The maximum ED was 5.93 mSv. The radiation exposure for all procedures was relatively small; for diagnostic retrographic procedures the median ED was 0.112 mSv. For retrograde procedures that involved stent insertion, the median ED was 0.438 mSv. The median ED for all ureteroscopic surgeries was 0.295 mSv, and the median ED for all FURS procedures was 0.491.

Conclusion:

The findings of this study are reassuring. Endoscopic urological procedures appear to expose patients to relatively small radiation compared with other procedures requiring fluoroscopy, thus conferring a very low lifetime risk of malignancy.

Two Decades of Measuring Ins and Outs: 20 Years of Paediatric Intensive Care Unit Admissions and DISCHARGES At A Small, Tertiary Care Paediatric Hospital with A Large Geographic Catchment Area

BACKGROUND: Over the past three decades, pediatric critical care has become recognized as its own subspecialty, with well documented benefits for critically ill children cared for by a pediatric intensivist, in the Pediatric Intensive Care Unit (PICU) of a tertiary care hospital. Previous studies describing the demographic of critically ill children have been conducted in large hospitals that provide tertiary and quaternary care, or nation-wide studies including several PICUs.

OBJECTIVES: The primary objective of this study was to describe the volume and type of patients admitted to the PICU of a small, tertiary care pediatric hospital with a large geographic catchment area over a period of 20 years.

DESIGN/METHODS: We audited a prospectively maintained, administrative database to determine the age, primary diagnosis, length of stay, and outcome for all children, newborn to 18 years of age, who were admitted to the PICU at the Janeway Children’s Health and Rehabilitation Centre in St. John’s, Newfoundland between January 1, 1995 and December 31, 2015.

RESULTS: Data were available for 3800 admissions. Children requiring admission to PICU were a median age of 7.1 years (IQR 1.5 - 13.6 years). Medical patients accounted for 60% of admissions with most common diagnoses being respiratory insufficiency (32%), metabolic conditions (15%), neurological conditions (15%), trauma (14%), and cardiac insufficiency (6%). The remainder of admissions were for surgical patients from general surgery (50%), orthopedics (29%), and neurosurgery (21%). Median length of stay for admitted children was 2 days (IQR 1 – 5 days). Overall mortality rates were 2.8%.

CONCLUSION: Despite the benefits associated with regionalization of pediatric critical care for acutely ill children, positive outcomes and low mortality rates are observed in a small, tertiary care hospital with a large catchment area that is geographically isolated from other parts of the country. We were able to identify common admission diagnoses for our patient population, comparable to those reported at larger institutions.

Upregulation of Haploinsufficient Gene Expression in the Brain by Targeting a Long Non-coding RNA Improves Seizure Phenotype in a Model of Dravet Syndrome

Dravet syndrome is a devastating genetic brain disorder caused by heterozygous loss-of-function mutation in the voltage-gated sodium channel gene SCN1A. There are currently no treatments, but the upregulation of SCN1A healthy allele represents an appealing therapeutic strategy. In this study we identified a novel, evolutionary conserved mechanism controlling the expression of SCN1A that is mediated by an antisense non-coding RNA (SCN1ANAT). Using oligonucleotide-based compounds (AntagoNATs) targeting SCN1ANAT we were able to induce specific upregulation of SCN1A both in vitro and in vivo, in the brain of Dravet knock-in mouse model and a non-human primate. AntagoNAT-mediated upregulation of Scn1a in postnatal Dravet mice led to significant improvements in seizure phenotype and excitability of hippocampal interneurons. These results further elucidate the pathophysiology of Dravet syndrome and outline a possible new approach for the treatment of this and other genetic disorders with similar etiology.