Structured Literature Review to Identify Human Papillomavirus's Natural History Parameters for Dynamic Population Models of Vaccine Impacts

Human papillomavirus (HPV) is a common sexually transmitted virus that can cause cervical cancer and other diseases. Dynamic transmission models (DTMs) have been developed to evaluate the health and economic impacts of HPV vaccination. These models typically include many parameters, such as natural history of the disease, transmission, demographic, behavioral, and screening. To ensure the accuracy of DTM projections, it is important to parameterize them with the best available evidence. This study aimed to identify and synthesize data needed to parametrize DTMs on the natural history of HPV infection and related diseases. Parameters describing data of interest were grouped by their anatomical location (genital warts, recurrent respiratory papillomatosis, and cervical, anal, vaginal, vulvar, head and neck, and penile cancers), and natural history (progression, regression, death, cure, recurrence, detection), and were identified through a systematic literature review (SLR) and complementary targeted literature reviews (TLRs). The extracted data were then synthesized by pooling parameter values across publications, and summarized using the range of values across studies reporting each parameter and the median value from the most relevant study. Data were extracted and synthesized from 223 studies identified in the SLR and TLRs. Parameters frequently reported pertained to cervical cancer outcomes, while data for other anatomical locations were less available. The synthesis of the data provides a large volume of parameter values to inform HPV DTMs, such as annual progression rates from cervical intraepithelial neoplasia (CIN) 1 to CIN 2+ (median of highest quality estimate 0.0836), CIN 2 to CIN 3+ (0.0418), carcinoma in situ (CIS) 2 to local cancer+ (0.0396), and regional to distant cancer (0.0474). Our findings suggest that while there is a large body of evidence on cervical cancer, parameter values featured substantial heterogeneity across studies, and further studies are needed to better parametrize the non-cervical components of HPV DTMs.

Timeline to dysphagia resolution after endoscopic intervention of an interarytenoid defect based on Video Fluoroscopic Swallow Study dysphagia severity

INTRODUCTION

We previously reported that endoscopic repair of a Type 1 Laryngeal Cleft (LC1) or Deep Interarytenoid Groove (DIG) improves swallowing function postoperatively. However, caregivers often ask about the timeline to resolution of the need for thickening. This study re-examines this cohort to answer this important caregiver-centered question.

METHODS

We reassessed a 3-year retrospective, single-center dataset of children with dysphagia found to have a LC-1 or DIG on endoscopic exam. The primary outcome was rate of complete resolution of dysphagia at 2, 6, and 12 months after endoscopic intervention. A sub-group analysis was made based on severity of dysphagia prior to intervention and by type of endoscopic repair.

RESULTS

Thirty-nine patients with mean age 1.35 years that had a LC-1 or DIG met criteria for inclusion. Rate of complete dysphagia resolution increased over time. Those with mild dysphagia (flow-reducing nipple and/or IDDSI consistency 1 or 2) had brisker resolution than those with moderate dysphagia (IDDSI consistency 3 or 4) at 2 months (67% vs 5%, p < 0.01) and at 6 months (80% vs 18%, p < 0.01) after endoscopic repair. There was no difference in dysphagia resolution between patients grouped by type of endoscopic repair.

CONCLUSION

Addressing an interarytenoid defect in patients will not result in immediate, complete dysphagia resolution in most patients. However, patients that only require a flow-reducing nipple and/or thickening to an IDDSI consistency 1 or 2 have brisker resolution of the need for thickening than those that require an IDSSI consistency 3 or 4 prior to intervention. These results inform pre-operative discussions of the timeline to resolution based upon severity of dysphagia and help manage caregiver expectations.

Auto Sizing of CANDU Nuclear Reactor Fuel Channel Flaws from UT Scans

The inspection of nuclear power plants is an essential process that occurs during plant outages. During this process, various systems are inspected, including the reactor's fuel channels to ensure that they are safe and reliable for the plant's operation. The inspection of Canada Deuterium Uranium (CANDU^®) reactor pressure tubes, which are the core component of the fuel channels and house the reactor fuel bundles, is performed using Ultrasonic Testing (UT). Based on the current process that is followed by Canadian nuclear operators, the UT scans are manually examined by analysts to locate, measure, and characterize pressure tube flaws. This paper proposes solutions for the auto-detection and sizing of pressure tube flaws using two deterministic algorithms, the first uses segmented linear regression, while the second uses the average time of flight (ToF) within ±σ of µ. When compared against a manual analysis stream, the linear regression algorithm and the average ToF achieved an average depth difference of 0.0180 mm and 0.0206 mm, respectively. These results are very close to the depth difference of 0.0156 mm when comparing two manual streams. Therefore, the proposed algorithms can be adopted in production, which can lead to significant cost savings in terms of time and labor.

Critical Analysis of the Use of Semiempirical Models on the Dehydration of Thin-Layer Foods Based on Two Study Cases

Moisture transport during food drying can be phenomenologically described by Fick’s second law and by the so-called anomalous diffusion model. However, in the literature, many studies have shown the extensive use of empirical/semiempirical models (EMs/SEMs) to adjust experimental data for the drying of thin-layer foods. This research aims to perform a critical analysis of the most commonly used EMs/SEMs and compare them with Fick’s second law and an anomalous diffusion model using two different sets of hot-air drying data. Two waste byproducts from the food industry, spent coffee grounds and passion fruit peels, were selected for analysis. The selected EMs/SEMs were found to be mathematically interrelated (i.e., some are a subset of others), and their appropriateness was incorrectly justified mainly by their statistical goodness-of-fit. As shown, it is highly recommended that researchers start analyzing drying data with phenomenological models. The extensive use of EMs and SEMs can be replaced by the anomalous diffusion model, which has a high capacity to adjust empirical data and a sound phenomenological description of the process.

Ultra-compact x-ray spectrometer for high-repetition-rate laser-plasma experiments

We present in this work the development of an ultra-compact, multi-channel x-ray spectrometer (UCXS). This diagnostic has been specially built and adapted to perform at high-repetition-rate (>1 Hz) for high-intensity, short-pulse laser plasma experiments. X-ray filters of varying materials and thicknesses are chosen to provide spectral resolution up to ΔE ≈ 1 keV over the x-ray energy range of 1-30 keV. These filters are distributed over a total of 25 channels, where each x-ray filter is coupled to a single scintillator. The UCXS is designed to detect and resolve a large variety of laser-driven x-ray sources such as low energy bremsstrahlung emission, fluorescence, and betatron radiation (up to 30 keV). Preliminary results from commissioning experiments at the ABL laser facility at Colorado State University are provided.

Disparities in Food Insecurity During the Coronavirus Disease 2019 Pandemic

Objectives

The prevalence and severity of food insecurity exists disproportionately among different population groups in the United States, with the potential to exacerbate health disparities among at-risk communities. Overall food insecurity has increased during the COVID-19 pandemic, but whether this additional burden is experienced differentially among certain population groups requires further study. This study seeks to investigate the association between food insecurity and socioeconomic factors among the US population during the COVID-19 pandemic, comparing rate of food insecurity by age, gender, and racial groups to identify vulnerable populations.

Methods

Data from the 2020–21 US Census Bureau's Household Pulse Survey were used, from 06-January 2021 to 05-July 2021 (N = 884,695). The data were combined to increase the sample size and statistical power. Complex survey design was applied to represent the US population. The outcome of being food insecure was defined as “Sometimes/always don't have enough food to eat,” and a logistic regression model was fitted to show the association with sociodemographic factors. Proportion of participants reporting food insecurity were examined by age, gender, and racial group to identify the intersection of demographic factors with the highest food insecurity rate.

Results

We found that compared to males, females had higher likelihood of being food insecure (OR = 1.25, 95%CI:1.21,1.29); compared to 65+ years, people aged 25–39 years were more food insecure (OR = 3.3, 95%CI: 3.06,3.56); compared to white, the non-Hispanic black (NHB) shows an elevated likelihood of food insecurity (OR = 2.18, 95%CI: 2.1,2.27). We also found that the probability of food insecurity increases with more children in the household and decreases with higher education level. Among all job types, people who are self-employed had lowest likelihood of being food insecure. Loss of job was strongly associated with food insecurity (OR = 3.21, 95%CI: 3.10,3.31). The most vulnerable group was NHB, 25–39 years old, male, with a 24.8% (N = 3,857) rate of food insecurity.

Conclusions

This analysis shows national food insecurity disparities among demographic and socioeconomic factors during the COVID-19 pandemic. Future research aims to examine how the additional burden from COVID-19 was managed by communities identified as most at-risk.

Funding Sources

N/A.

Foodborne Illness Outbreak Severity Across Geographic and Supply Chain Contamination Locations in the United States, 2009–2019

Objectives

In 2009, the Centers for Disease Control and Prevention's National Outbreak Reporting System (NORS) began collecting supply chain contamination data as part of foodborne outbreak (FBO) traceback investigations. We created an integrated FBO severity score measure and examined differences in FBO severity by geographic and supply chain contamination locations. We used 9,407 NORS records between 2009–2019 to demonstrate the utility of the proposed methodology.

Methods

The severity scores were composed of 11 metrics based on outbreak intensity and duration characteristics and metrics’ completeness. Metrics were normalized (with natural log-transformation), calibrated (to 0–1 scale), and weighed (by completeness) across all recorded outbreaks. Individual outbreak scores ranged from 0 (lowest severity) to 1 (highest severity). We compared averages of severity scores across geographic (i.e., multistate and single state exposure outbreak) and supply chain contamination locations (i.e., suspected or confirmed before preparation, preparation, unknown and missing) using tobit-regression models.

Results

All FBOs reported the state of exposure; 5,500 (58.5%) reported supply chain contamination location. Multistate exposure FBOs had higher median severity scores than single state outbreaks (0.54 [0.44, 0.67] vs 0.28 [0.16, 0.41], P < 0.001). FBOs with reported point of contamination that occurred before preparation had higher median severity scores than all other stages (0.36 [0.27, 0.49] vs 0.26 [0.15, 0.41], 0.25 [0.13, 0.39], and 0.29 [0.16, 0.43], P < 0.001, for preparation, unknown and missing stages respectively).

Conclusions

Understanding an FBO's severity by geographic and supply chain contamination location helps to quantify supply chain vulnerability and improve monitoring of food safety. Identification of supply chain contamination at high level granularity and completeness is critical for developing foodborne outbreak (FBO) prediction analytics aimed to reduce both the volume and severity of outbreaks and illnesses.

Funding Sources

DoD, ODNI, NIFA, NSF, USIAD.

Using Deep Learning to Automate the Detection of Flaws in Nuclear Fuel Channel UT Scans

Nuclear reactor inspections are critical to ensure the safety and reliability of a nuclear facility's operation. In Canada, ultrasonic testing (UT) is used to inspect the health of pressure tubes that are part of Canada's Deuterium Uranium (CANDU) reactor's fuel channels. Currently, analysis of UT scans is performed by manual visualization and measurement to locate, characterize, and disposition flaws. Therefore, there is motivation to develop an automated method that is fast and accurate. In this article, a proof of concept (PoC) that automates the detection of flaws in nuclear fuel channel UT scans using a convolutional neural network (CNN) is presented. The CNN model was trained after constructing a dataset using historical UT scans and the corresponding inspection results. The requirement for this prototype was to identify the location of at least a portion of each flaw in UT scans while minimizing false positives (FPs). The proposed CNN model achieves this target by automatically identifying at least a portion of each flaw where further manual analysis is performed to identify the width, the length, and the type of the flaw.

Use of Natural Spoken Language With Automated Mapping of Self-reported Food Intake to Food Composition Data for Low-Burden Real-time Dietary Assessment: Method Comparison Study

Background

Self-monitoring food intake is a cornerstone of national recommendations for health, but existing apps for this purpose are burdensome for users and researchers, which limits use.

Objective

We developed and pilot tested a new app (COCO Nutritionist) that combines speech understanding technology with technologies for mapping foods to appropriate food composition codes in national databases, for lower-burden and automated nutritional analysis of self-reported dietary intake.

Methods

COCO was compared with the multiple-pass, interviewer-administered 24-hour recall method for assessment of energy intake. COCO was used for 5 consecutive days, and 24-hour dietary recalls were obtained for two of the days. Participants were 35 women and men with a mean age of 28 (range 20-58) years and mean BMI of 24 (range 17-48) kg/m².

Results

There was no significant difference in energy intake between values obtained by COCO and 24-hour recall for days when both methods were used (mean 2092, SD 1044 kcal versus mean 2030, SD 687 kcal, P=.70). There were also no significant differences between the methods for percent of energy from protein, carbohydrate, and fat (P=.27-.89), and no trend in energy intake obtained with COCO over the entire 5-day study period (P=.19).

Conclusions

This first demonstration of a dietary assessment method using natural spoken language to map reported foods to food composition codes demonstrates a promising new approach to automate assessments of dietary intake.

Universal use of surgical masks is tolerated and prevents respiratory viral infection in stem cell transplant recipients

Prevention of respiratory viral infection in stem cell transplant patients is important due to its high risk of adverse outcome. This single-centre, mixed methods study, conducted before the severe acute respiratory syndrome coronavirus-2 pandemic, explored the barriers and facilitators to a policy of universal mask use by visitors and healthcare workers, and examined the impact of the first year of introduction of the policy on respiratory viral infection rates compared with preceding years, adjusted for overall incidence. Education around universal mask use was highlighted as being particularly important in policy implementation. A significant decrease in respiratory viral infection was observed following introduction.

Thermal decoupling of deuterium and tritium during the inertial confinement fusion shock-convergence phase

A series of thin glass-shell shock-driven DT gas-filled capsule implosions was conducted at the OMEGA laser facility. These experiments generate conditions relevant to the central plasma during the shock-convergence phase of ablatively driven inertial confinement fusion (ICF) implosions. The spectral temperatures inferred from the DTn and DDn spectra are most consistent with a two-ion-temperature plasma, where the initial apparent temperature ratio, T_{T}/T_{D}, is 1.5. This is an experimental confirmation of the long-standing conjecture that plasma shocks couple energy directly proportional to the species mass in multi-ion plasmas. The apparent temperature ratio trend with equilibration time matches expected thermal equilibration described by hydrodynamic theory. This indicates that deuterium and tritium ions have different energy distributions for the time period surrounding shock convergence in ignition-relevant ICF implosions.

Direct Measurements of DT Fuel Preheat from Hot Electrons in Direct-Drive Inertial Confinement Fusion

Hot electrons generated by laser-plasma instabilities degrade the performance of laser-fusion implosions by preheating the DT fuel and reducing core compression. The hot-electron energy deposition in the DT fuel has been directly measured for the first time by comparing the hard x-ray signals between DT-layered and mass-equivalent ablator-only implosions. The electron energy deposition profile in the fuel is inferred through dedicated experiments using Cu-doped payloads of varying thickness. The measured preheat energy accurately explains the areal-density degradation observed in many OMEGA implosions. This technique can be used to assess the viability of the direct-drive approach to laser fusion with respect to the scaling of hot-electron preheat with laser energy.

Seasonal Associations Between Foodborne Campylobacter Infections and Ambient Temperature in US, 2010–2019

Objectives

In order to effectively mitigate the effects of climate change on human health, spatiotemporal relationships between Campylobacter infections and environmental drivers have to be systematically examined to determine whether common seasonal summer peaks observed in Campylobacter infections are well aligned with peaks in raising ambient temperatures.  This study aims to evaluate the seasonal relationship between monthly ambient temperature and the monthly Campylobacter infections routinely collected by the CDC Foodborne Diseases Active Surveillance Network (FoodNet) in the United States in 2010–2019.

Methods

We created time series of monthly Campylobacter infection rates from the FoodNet Fast platform for ten participating states from January 2010 to December 2019 (120 months). We estimated average monthly temperatures for the ten states for the study period using the National Climate and Data Center's Global Summary of the Day database. To assess the seasonal synchronization and determine

the lag effect, we used serial cross-correlation analysis. To examine the associations between Campylobacter rates with ambient temperature and adjust for seasonality and trend, we applied a harmonic negative binomial mixed-effects regression model. We also estimated peak timing and amplitude for infections and temperature using the δ-method.

Results

Serial synchronization between monthly Campylobacter infection rates and ambient temperature was observed in all FoodNet Surveillance states except for California. A one-month delay in peak infection after the peak in temperature was detected in Colorado, Connecticut, Maryland, Minnesota, New Mexico, New York, and Oregon.  After adjusting for seasonality and trend across ten states, the relative risk of infection rates increased by 5% with the increase in monthly average temperature by 5.45°C equivalent to a shift from 75th to 95th percentile (95%CI: 1.02–1.09, p &lt; 0.002).

Conclusions

An increase in monthly average temperature is associated with an increased risk of Campylobacter infection after adjusting for common summer seasonal patterns. Knowledge of the relationship will potentially improve the reliability and accuracy of integrated early warning outbreak forecasts and could guide climate mitigation strategies.

Funding Sources

None.

Is urinary incontinence associated with lichen sclerosus in females? A systematic review and meta‐analysis

Background

Lichen sclerosus (LS) is a scarring chronic inflammatory disease with a predilection for genital skin in both sexes. The aetiology of LS is controversial, but evidence increasingly suggests that the occluded exposure of susceptible epithelium to urine is involved in the pathogenesis of genital LS in males. This theory has not yet been robustly investigated in females.

Objectives

This review and meta‐analysis examined whether there is an association between urinary incontinence (UI) and genital lichen LS in females.

Methods

We performed a comprehensive search of MEDLINE, Embase and CINAHL to identify observational studies assessing the prevalence of UI in females with LS. DerSimonian and Laird random‐effects models were used to estimate the overall pooled prevalence and risk ratio compared to controls. Heterogeneity was assessed.

Results

In total, eight studies met the inclusion criteria and five studies were included in a meta‐analysis. Three studies were graded as moderate quality and five were poor. The pooled prevalence for UI in LS was 0.35 (95% confidence interval [CI] 0.13–0.58, I² = 98.4%). The risk ratio of UI in LS was 0.97 (95% CI 0.53–1.75, I² = 87.5%).

Conclusion

There appears to be no difference between patients with LS and those without LS in terms of UI. Studies are limited by clinical and methodological quality and heterogeneity is high. Well‐designed prospective studies are needed.

Trans-Atlantic aeromedical repatriation of multiple COVID-19 patients: a hybrid military-civilian model

Here, we report the first known transcontinental aeromedical evacuation of a large number (55) of patients with known and suspected positive COVID-19. These patients were evacuated from Havana, Cuba, to the UK through MOD Boscombe Down as part of Operation BROADSHARE, the British military's overseas response to COVID-19. We describe the safe transfer of patients with COVID-19 using a combined military-civilian model. In our view, we have demonstrated that patients with COVID-19 can be aeromedically transferred while ensuring the safety of patients and crew using a hybrid military-civilian model; this report contains lessons for future aeromedical evacuation of patients with COVID-19.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Assessment of Adult Weight Status by Body Mass index (BMI) and the Association with Socio-Demographic Factors and Commonly Eaten Foods in Indonesia Between 2014–2015

Objectives

Factors associated with the double burden of underweight and overweight/obesity are not well investigated in Indonesia. Insufficient information leaves policy makers without tools to develop coherent, impactful legislation on these issues. We aim to describe and explain the association between weight status, socio-demographic factors, and food consumption patterns in Indonesia.

Methods

We used the 5th Wave of the Indonesia Family Life Survey (IFLS) collected in 2014/15. From the total sample (50,148), we included only adults aged ≥20 years (27,496). We converted BMI into three categories: underweight (BMI &lt; 18.5), healthy weight (18.5 ≤ BMI ≤ 25), overweight/obese (BMI &gt; 25). Sociodemographic factors included location, education, sex, age category, and frequency of commonly eaten food items. We examined associations using multinomial logistic regression models (α &lt; 0.05).

Results

Urban residents were less likely to be underweight (RRR = 0.90 [0.82, 0.98]; P = 0.014) and more likely to be overweight/obesity (RRR = 1.38 [1.31, 1.46]; P &lt; 0.001) than rural residents. University educated respondents were nearly half as likely of being underweight (RRR = 0.58 [0.46, 0.72]; P &lt; 0.001) but more than twice as likely of being overweight/obesity (RRR = 2.15 [1.82, 2.53]; P &lt; 0.001) compared to uneducated respondents. Women were 25% less likely to be underweight (RRR = 0.76 [0.70, 0.83]; P &lt; 0.001) but over twice as likely of being overweight/obesity (RRR = 2.40 [2.28, 2.54]; P = 0.001) compared to men. Those 40 – 49 and 50 – 59 years were over twice as likely of being overweight/obese (RRR = 2.49 [2.30, 2.71]; P &lt; 0.001; RRR = 2.40 [2.19, 2.65]; P &lt; 0.001, respectively) compared to those 20 –29 years. Interestingly, high rice consumption (≥4 servings/week) was associated with decreased risk of both underweight and overweight/obesity (RRR = 0.62 [0.38, 0.98]; P = 0.043 and RRR = 0.69 [0.49, 0.96]; P = 0.27, respectively).

Conclusions

Since 2007, underweight prevalence has decreased in Indonesia from 14.4% to 9.8%, while overweight/obesity prevalence increased from 17.9% to 34.4%. Closer examination of the factors driving over- and under-nutrition in Indonesia can inform policy makers of specific target populations for existing national food subsidy programs.

Funding Sources

NSF IRES US-Indonesian Research Experience #1,826,939.

Associations Between Peaks of Foodborne Infections and Food Recalls

Objectives

Food delivery and supply chains represent complex dynamic systems susceptible to pathogen introduction. However, seasonal infections are rarely compared with the timing of food recalls. Gaps between peak infections and recalls illustrate inefficient food inspection and monitoring. We use seasonality features (peak timing and amplitude) to examine associations between peaks of pathogen infectiousness and food recalls.

Methods

Monthly counts of 3 foodborne infections (Salmonella, Listeria, and Shiga toxin-producing E.coli) were abstracted from the CDC's public database, FoodNet Fast, for 10 representative states (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) from 1996–2018. We applied Negative Binomial harmonic regression models with the δ-method to derive peak timing and amplitude estimates (with confidence intervals). Food recalls were extracted using the United States Department of Agriculture's (USDA) Food Safety and Inspection Service (FSIS) Recall Case Archive. We extracted recall dates and durations for each infection in each state. We compared lagged associations between infection peaks and recall dates using Spearman correlations.

Results

Seasonal peaks of Salmonella and Shiga Toxin-producing E.Coli (STEC) are tightly clustered (7.79 [7.71, 7.87], and 7.80 [7.65, 7.95], respectively) while Listeria falls later in August (8.35 [8.05, 8.65]). Peak timing estimates were positively synchronized between New York and Connecticut for Listeria (ρ = 0.780, P = 0.001), and between Georgia and Tennessee for STEC (ρ = 0.666, P = 0.009) indicating possible regional hotspots. From 1996–2018, inspection recalls tended to lag behind peaks of confirmed infections for all infections by 1–2 months, with most recalls occurring during August and September annually.

Conclusions

Measurements of infection seasonality coupled with food recall information shows lagged associations between population infectiousness and supply chain reporting. This suggests the need for improved food inspection scheduling and monitoring to minimize fiscal and food waste losses.

Funding Sources

The Office of the Director of National Intelligence (ODNI), Intelligence Advanced Research Projects Activity (IARPA), via 2017–17,072,100,002.

Demographic and Psychosocial Correlates of Exclusive Breastfeeding Duration in Indonesia

Objectives

In Indonesia, exclusive breastfeeding practices are followed by only 46% of mothers, resulting in USD $118 million in health costs annually [2, 3]. Though previous studies have addressed demographic factors related to breastfeeding [5, 6], few studies have examined the relationship between exclusive breastfeeding duration and mother's psychosocial characteristics [5, 6, 7, 8]. Our study used the Indonesian Family Life Survey 5th Wave survey (IFLS5) from 2014–2015 to evaluate if demographic and psychosocial factors are associated with exclusive breastfeeding duration among Indonesian mothers [7, 8].

Methods

Our study included mothers (n = 3024) with children &lt;8 years of age. We stratified breastfeeding duration (0, 1–3, 4–6 and &gt;6 months) according to WHO standards [1]. We described individual mother's characteristics including age, education level, socioeconomic status, and psychosocial factors by these breastfeeding categories. We developed binary breastfeeding duration variables by those never breastfeeding or breastfeeding ≤4 months to perform binary logistic regression models. Finally, we examined differences between categories of breastfeeding duration using multinomial logistic models.

Results

Mothers with primary and secondary education had lower odds of having breastfed exclusively for ≤4 months (OR 0.43 [0.30, 0.60] and 0.64 [0.46, 0.89]), respectively, compared to mothers with higher education. Mothers with primary education were also 2.21 [1.05, 4.50] times as likely to have never breastfed relative to breastfeeding exclusively for 4–6 months compared to highly-educated mothers. Compared to younger mothers (30–39 years), older mothers (40 + years) had a greater likelihood of never exclusively breastfeeding, relative to exclusively breastfeeding for 4–6 months (RR 3.28 [1.80, 5.96]). Finally, mothers who had lower perceived life-satisfaction had a lower likelihood (RR 0.60 [0.45, 0.77]) of exclusively breastfeeding &gt;6 months compared to mothers with very high satisfaction.

Conclusions

Our results can help to inform policy makers about disparities in exclusive breastfeeding practices to better tailor services to underserved mothers within Indonesia.

Funding Sources

NSF IRES US-Indonesian Research Experience #182,693.

Evaluating Indirect Impacts of Climate Change on Fishing and Farm Productivity Using the Indonesian Family Life Survey: An Example Exploring Natural Disasters and Migration

Objectives

Destruction of agricultural lands and fisheries due to climate-related disasters has implications for food production and food security in Indonesia. We examine how natural disasters affect the economic productivity of fishing and farming households in Indonesia by exploring whether flooding and landslide disasters trigger differing migratory behaviors by the type of farming/fishery operation.

Methods

We assessed farming and fishing households in the 5th Wave of the IFLS survey (2014/2015) adjusting for household survey weighting. Farming and fishing households are described by the presence or absence of migration since the previous IFLS survey (IFLS4: 2007/2008). Next, we further evaluated households by the type of disaster experienced (flooding or landslides) and other characteristics (region, urban/rural, type of operation). Logistic regression models were used to explain the likelihood of migration, assessing effect modification between the type of disaster (flooding or landslide) and type of farm business to better understand their joint influence on migration.

Results

Since IFLS4, approximately 33% of farming households migrated and predominantly moved within the same village or sub-district. Flooding and landslides impacted 8% of households and rice was the most common farm business type (45%). A higher percentage of fishing households were affected by flooding or landslides compared to non-fishing households (23% and 7%, respectively). There were lower odds of migration among rice (OR: 0.75 [95% CI: 0.63,0.89]), corn (0.67 [0.48,0.93]), cassava (0.49 [0.34,0.71]), coffee (0.44 [0.28,0.68]), and cattle (0.49 [0.34,0.70]) farming operations. Migration likelihood was not significantly affected by the joint effect of disaster type and operation type.

Conclusions

Understanding how climate change is impacting agricultural lands and fisheries must coincide with responsive efforts to encourage food production and ensure food security in Indonesia. Our results suggest that farming households may be adapting rather than migrating in response to flooding or landslide disasters. The IFLS provides a tool for examining response efforts of farm and fishing businesses in relation to natural disasters.

Funding Sources

NSF IRES US-Indonesian Research Experience #1,826,939.

Infrared thermography and ulcer prevention in the high-risk diabetic foot: data from a single-blind multicentre controlled clinical trial

AIM

To assess the usefulness of monthly thermography and standard foot care to reduce diabetic foot ulcer recurrence.

METHODS

People with diabetes (n = 110), neuropathy and history of ≥ 1 foot ulcer participated in a single-blind multicentre clinical trial. Feet were imaged with a novel thermal imaging device (Diabetic Foot Ulcer Prevention System). Participants were randomized to intervention (active thermography + standard foot care) or control (blinded thermography + standard foot care) and were followed up monthly until ulcer recurrence or for 12 months. Foot thermograms of participants from the intervention group were assessed for hot spots (areas with temperature ≥ 2.2°C higher than the corresponding contralateral site) and acted upon as per local standards.

RESULTS

After 12 months, 62% of participants were ulcer-free in the intervention group and 56% in the control group. The odds ratios of ulcer recurrence (intervention vs control) were 0.82 (95% CI 0.38, 1.8; P = 0.62) and 0.55 (95% CI 0.21, 1.4; P = 0.22) in univariate and multivariate logistic regression analyses, respectively. The hazard ratios for the time to ulcer recurrence (intervention vs control) were 0.84 (95% CI 0.45, 1.6; P = 0.58) and 0.67 (95% CI 0.34, 1.3; P = 0.24) in univariate and multivariate Cox regression analyses, respectively.

CONCLUSIONS

Monthly intervention with thermal imaging did not result in a significant reduction in ulcer recurrence rate or increased ulcer-free survival in this cohort at high risk of foot ulcers. This trial has, however, informed the design of a refined study with longer follow-up and group stratification, further aiming to assess the efficacy of thermography to reduce ulcer recurrence.

NPL contributions to the standardisation and validation of contemporary medical thermometry methods

Since the advent of reliable mercury-in-glass thermometers in the latter part of the 19th century the practice of clinical thermometry was thought to be a solved issue. However with advances in technology there has, in recent decades, been a proliferation of temperature measurement methods applied to medical science. Many of these have been introduced because of the clinical benefit they confer, nevertheless, in some cases the metrological foundation and infrastructure to ensure sound measurement was not in place. This paper will focus on the standardisation activity undertaken by the UK's National Physical Laboratory (NPL) to support reliable temperature measurement, using a number of innovative methods, in a clinical setting.

Optimization of hot-air drying conditions for cassava flour for its application in gluten-free pasta formulation

The design and development of gluten-free foods requires a comprehensive understanding of the behavior of the raw materials to attain the same cooking and nutritional quality as gluten-based food. The objective of this study was to determine the optimal hot-air drying conditions for elaboration of cassava flour to be used in a gluten-free pasta formulation. The results showed that the operational conditions to minimize the hot-air drying time (57 min) to produce cassava flour with higher water holding capacity was 57 ℃ at 3 m/s. Then, the optimal formulation for the pasta was found to be cassava (26 g/100 g), amaranth flour (12 g/100 g), and carboxymethyl cellulose (0.23 g/100 g), which maximized the A_w (0.160), moisture content (3.10 g/100 g), hardness (5.02 N), and protein content (9.30 g/100 g), and it is used for the sensorial analysis, which showed that an earthy taste was the main problem with consumer satisfaction.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Reliability of a novel thermal imaging system for temperature assessment of healthy feet

Background

Thermal imaging is a useful modality for identifying preulcerative lesions (“hot spots”) in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. This paper reports the reliability of this device for temperature assessment of healthy feet.

Methods

Plantar skin foot temperatures were measured with the novel thermal imaging device (Diabetic Foot Ulcer Prevention System (DFUPS), constructed by Photometrix Imaging Ltd) and also with a hand-held infrared spot thermometer (Thermofocus® 01500A3, Tecnimed, Italy) after 20 min of barefoot resting with legs supported and extended in 105 subjects (52 males and 53 females; age range 18 to 69 years) as part of a multicentre clinical trial. The temperature differences between the right and left foot at five regions of interest (ROIs), including 1st and 4th toes, 1st, 3rd and 5th metatarsal heads were calculated. The intra-instrument agreement (three repeated measures) and the inter-instrument agreement (hand-held thermometer and thermal imaging device) were quantified using intra-class correlation coefficients (ICCs) and the 95% confidence intervals (CI).

Results

Both devices showed almost perfect agreement in replication by instrument. The intra-instrument ICCs for the thermal imaging device at all five ROIs ranged from 0.95 to 0.97 and the intra-instrument ICCs for the hand-held-thermometer ranged from 0.94 to 0.97. There was substantial to perfect inter-instrument agreement between the hand-held thermometer and the thermal imaging device and the ICCs at all five ROIs ranged between 0.94 and 0.97.

Conclusions

This study reports the performance of a novel thermal imaging device in the assessment of foot temperatures in healthy volunteers in comparison with a hand-held infrared thermometer. The newly developed thermal imaging device showed very good agreement in repeated temperature assessments at defined ROIs as well as substantial to perfect agreement in temperature assessment with the hand-held infrared thermometer. In addition to the reported non-inferior performance in temperature assessment, the thermal imaging device holds the potential to provide an instantaneous thermal image of all sites of the feet (plantar, dorsal, lateral and medial views).

Trial registration

Diabetic Foot Ulcer Prevention System NCT02317835, registered December 10, 2014

Culturally Effective Care for Refugee Populations: Interprofessional, Interactive Case Studies

Introduction

Within health sciences education literature, the majority of reported student experiences with refugee populations are limited to traditional, professionally independent, elective courses and extracurricular volunteer opportunities. A simulated patient exercise is a learning opportunity that helps participants engage with material in real time in a realistic environment, demanding higher levels of learning. This session utilized a simulated patient facilitator in interprofessional small groups to explore common health needs and barriers to care among refugee populations.

Methods

Health professions students from nine degree programs participated in a refugee health session in interprofessional teams of nine to 10 students to explore patient cases. The session concluded with a debriefing discussing the outcomes of the student-patient interaction, best practices, and exemplary practice models as takeaways. The simulated patient facilitators completed an Observation Checklist to assess students' grasp of learning objectives.

Results

Five hundred twenty-four students participated in the refugee session, divided into 61 groups. Observation Checklists were completed for 58 groups (95%). Assessment of student engagement focused on general health needs common to refugee populations: barriers to health care, team and individual roles, bias, consequences of nontreatment, and social determinants of health. Most of the groups (95%) reported engagement between the simulated patient facilitator and the group of student providers. Qualitative data indicated student groups were knowledgeable in each of the overarching learning objectives.

Discussion

This session allowed health sciences students to focus on culturally effective patient care for refugee populations as a part of an interprofessional team.

Upregulation of epidermal gap junctional proteins in patients with venous disease

Background

Leg ulceration is a feared complication of venous insufficiency. It is not known whether varicose veins predispose skin to poor wound healing. The expression pattern of gap junctional protein connexin, a known marker of poor wound healing, was investigated across various stages of venous disease.

Methods

Patients undergoing intervention for varicose veins were assessed according to the Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification of varicose veins. Paired 4-mm punch biopsies were taken from above the ankle (pathological) and above the knee (control). Tissues were stained with haematoxylin and eosin, and for connexin 43, connexin 30 and connexin 26.

Results

Forty-eight paired biopsies were taken (12 each for CEAP class C0, C2, C4 and C6). The pathological skin showed progressive epithelial hyperthickening, an increase in the number and depth of rete ridges, increased inflammation and loss of dermal architecture with disease progression from C4 onwards. The overall absolute connexin expression and mean connexin expression per cell in the pathological skin similarly increased across the CEAP classes from as early as C2. Increasing levels of connexin in control skin were also noted, indicating progression of the disease proximally. Connexin 43 expression showed the strongest positive correlation between pathological and control skin.

Conclusion

Connexins were overexpressed in patients with simple varicose veins, with a stepwise increased expression through venous eczema to ulceration. Connexin 43 is a potential biomarker for venous disease. This finding suggests that varicose veins predispose skin to poor wound healing. Surgical relevanceThe overexpression of connexins, a family of gap junctional proteins, is known to cause poor healing in venous leg ulceration. It is not known whether there is any association with superficial venous disease. Here, connexin proteins were overexpressed in patients with uncomplicated varicose veins, before histological skin changes. Connexin could be a biomarker of venous disease progression.

Mindfulness-based stress reduction in Parkinson's disease: a systematic review

BACKGROUND

Mindfulness based stress reduction (MBSR) is increasingly being used to improve outcomes such as stress and depression in a range of long-term conditions (LTCs). While systematic reviews on MBSR have taken place for a number of conditions there remains limited information on its impact on individuals with Parkinson's disease (PD).

METHODS

Medline, Central, Embase, Amed, CINAHAL were searched in March 2016. These databases were searched using a combination of MeSH subject headings where available and keywords in the title and abstracts. We also searched the reference lists of related reviews. Study quality was assessed based on questions from the Cochrane Collaboration risk of bias tool.

RESULTS

Two interventions and three papers with a total of 66 participants were included. The interventions were undertaken in Belgium (n = 27) and the USA (n = 39). One study reported significantly increased grey matter density (GMD) in the brains of the MBSR group compared to the usual care group. Significant improvements were reported in one study for a number of outcomes including PD outcomes, depression, mindfulness, and quality of life indicators. Only one intervention was of reasonable quality and both interventions failed to control for potential confounders in the analysis. Adverse events and reasons for drop-outs were not reported. There was also no reporting on the costs/benefits of the intervention or how they affected health service utilisation.

CONCLUSION

This systematic review found limited and inconclusive evidence of the effectiveness of MBSR for PD patients. Both of the included interventions claimed positive effects for PD patients but significant outcomes were often contradicted by other results. Further trials with larger sample sizes, control groups and longer follow-ups are needed before the evidence for MBSR in PD can be conclusively judged.

Interprofessional LGBT Health Equity Education for Early Learners

INTRODUCTION

The eQuality project at the University of Louisville aims to train future physicians to deliver equitable quality care for all people by creating an integrated educational model utilizing the competencies identified in the AAMC's Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born With DSD. This foundational interprofessional health equity session for early learners addresses knowledge and attitude milestones relating to interprofessional collaboration, professionalism, and systems-based practice competencies for lesbian, gay, bisexual, and transgender (LGBT) populations.

METHODS

First-year medical students were assigned to interprofessional teams of approximately 10 health sciences students each. Students participated in a 75-minute session utilizing a group case study activity, including a systems lecture exploring social determinants and community resources related to LGBT health. Students collaboratively discussed the case and recorded strategies for optimal patient care. The Readiness for Interprofessional Learning Scale and health disparities attitudes and knowledge scales were administered pre-/postsession.

RESULTS

One hundred fifty-eight first-year medical students participated in the session. Posttest scores reflected an improvement for all disparities knowledge items (p < .001), and an increased interest in working with other health professions students on future projects (p < .001). Changes in attitudes toward systemic and social factors affecting health were also observed. However, content analysis of worksheets revealed that only 36% of teams identified specific action steps for the case scenarios.

DISCUSSION

This session was effective in improving knowledge and attitudes related to LGBT health equity and interprofessional education.

Comparison of polystyrene scintillator fiber array and monolithic polystyrene for neutron imaging and radiography

The neutron imaging diagnostic at the National Ignition Facility has been operating since 2011 generating neutron images of deuterium-tritium (DT) implosions at peak compression. The current design features a scintillating fiber array, which allows for high imaging resolution to discern small-scale structure within the implosion. In recent years, it has become clear that additional neutron imaging systems need to be constructed in order to provide 3D reconstructions of the DT source and these additional views need to be on a shorter line of sight. As a result, there has been increased effort to identify new image collection techniques that improve upon imaging resolution for these next generation neutron imaging systems, such as monolithic deuterated scintillators. This work details measurements performed at the Weapons Neutron Research Facility at Los Alamos National Laboratory that compares the radiographic abilities of the fiber scintillator with a monolithic scintillator, which may be featured in a future short line of sight neutron imaging systems.

OCD is associated with an altered association between sensorimotor gating and cortical and subcortical 5-HT1b receptor binding

Obsessive-compulsive disorder (OCD) is characterized by impaired sensorimotor gating, as measured using prepulse inhibition (PPI). This effect may be related to abnormalities in the serotonin (5-HT) system. 5-HT1B agonists can impair PPI, produce OCD-like behaviors in animals, and exacerbate OCD symptoms in humans. We measured 5-HT1B receptor availability using (11)C-P943 positron emission tomography (PET) in unmedicated, non-depressed OCD patients (n=12) and matched healthy controls (HC; n=12). Usable PPI data were obtained from 20 of these subjects (10 from each group). There were no significant main effects of OCD diagnosis on 5-HT1B receptor availability ((11)C-P943 BPND); however, the relationship between PPI and (11)C-P943 BPND differed dramatically and significantly between groups. 5-HT1B receptor availability in the basal ganglia and thalamus correlated positively with PPI in controls; these correlations were lost or even reversed in the OCD group. In cortical regions there were no significant correlations with PPI in controls, but widespread positive correlations in OCD patients. Positive correlations between 5-HT1B receptor availability and PPI were consistent across diagnostic groups only in two structures, the orbitofrontal cortex and the amygdala. Differential associations of 5-HT1B receptor availability with PPI in patients suggest functionally important alterations in the serotonergic regulation of cortical/subcortical balance in OCD.

Solid polystyrene and deuterated polystyrene light output response to fast neutrons

The Neutron Imaging System has proven to be an important diagnostic in studying DT implosion characteristics at the National Ignition Facility. The current system depends on a polystyrene scintillating fiber array, which detects fusion neutrons born in the DT hotspot as well as neutrons that have scattered to lower energies in the surrounding cold fuel. Increasing neutron yields at NIF, as well as a desire to resolve three-dimensional information about the fuel assembly, have provided the impetus to build and install two additional next-generation neutron imaging systems. We are currently investigating a novel neutron imaging system that will utilize a deuterated polystyrene (CD) fiber array instead of standard hydrogen-based polystyrene (CH). Studies of deuterated xylene or deuterated benzene liquid scintillator show an improvement in imaging resolution by a factor of two [L. Disdier et al., Rev. Sci. Instrum. 75, 2134 (2004)], but also a reduction in light output [V. Bildstein et al., Nucl. Instrum. Methods Phys. Res., Sect. A 729, 188 (2013); M. I. Ojaruega, Ph.D. thesis, University of Michigan, 2009; M. T. Febbraro, Ph.D. thesis, University of Michigan, 2014] as compared to standard plastic. Tests of the relative light output of deuterated polystyrene and standard polystyrene were completed using 14 MeV fusion neutrons generated through implosions of deuterium-tritium filled capsules at the OMEGA laser facility. In addition, we collected data of the relative response of these two scintillators to a wide energy range of neutrons (1-800 MeV) at the Weapons Neutrons Research Facility. Results of these measurements are presented.

Adenoid cystic carcinoma of head and neck: clinical predictors of outcome from a Canadian centre

OBJECTIVES

Adenoid cystic carcinoma (acc) is often treated with surgery, with or without adjuvant radiation therapy (rt). We evaluated disease characteristics, treatments, and potentially prognostic variables in patients with acc.

METHODS

Our retrospective analysis considered consecutive cases of acc presenting at a tertiary care hospital between 2000 and 2014. Factors predictive of overall survival (os) and disease-free survival (dfs) were identified by univariate analysis.

RESULTS

The 60 patients analyzed had a mean age of 58 years (range: 22-88 years), with a 2:1 female:male ratio. Tumour locations included the major salivary glands (40% parotid, 17% submandibular and sublingual), the oro-nasopharyngeal cavity (27%), and other locations (16%). Of the 60 patients, 35 (58%) received surgery with adjuvant rt; 12 (20%), rt only; 13 (22%), surgery only. Of 18 patients (30%) who experienced a recurrence within 5 years, 3 (5%) developed local recurrence only, and the remaining 15 (25%), distant metastasis. The 5-year os and dfs were 64.5% [95% confidence interval (ci): 45.9% to 78.1%] and 46.2% (95% ci: 29.7% to 61.2%) respectively. In patients without recurrence, 5-year os was 77% (95% ci: 52.8% to 89.9%), and in patients with recurrence, it was 42.7% (95% ci: 15.8% to 67.6%). Patients treated with rt only had a 5-year os of 9.2%. Predictors of 5-year dfs were TNM stage, T stage, nodal status, treatment received, and margin status; age, nodal status, treatment received, and margin status predicted 5-year os.

CONCLUSIONS

Despite surgery and rt, one third of patients with acc experience distant recurrence. Patients whose tumours are not amenable to surgery have a poor prognosis, indicating a need for alternative approaches to improve outcomes.