The aetiology of maxillofacial trauma in Australia: A scoping review

BACKGROUND

The oral and maxillofacial complex is subject to a range of traumas. Injuries to the region are devastating and have a great impact on social health outcomes. This review intends to investigate the aetiologies of maxillofacial trauma across Australia.

METHODS

This review was written in accordance with the PRISMA-ScR. Comprehensive searches of CINAHL, MEDLINE, Ovid, Scopus, and Web of Science databases were conducted to identify potentially relevant literature. Quantitative observational epidemiological studies were sought and were required to include at least one aetiology to the maxillofacial region in their data set. A total of 31 eligible studies were included.

RESULTS

The greatest recorded causes of maxillofacial injuries included inter-personal violence (34.98%) falls (20.87%), sports (15.62%), and motor-vehicle accidents (14.31%). These four aetiologies cumulatively accounted for more than 85% of maxillofacial injuries. From all sustained injuries (n = 7661), the orbit was the most prevalent site of fracture (31.85%), followed by the zygoma (22.01%), mandible (21%), nasal bone (12.45%), maxilla (10.04%), dentoalveolus (1.84%), antrum (<1%), and frontal bone (<1%).

CONCLUSION

Violence was an unprecedented cause of trauma-additional research is recommended to further characterize the correlation between the two variables. Research is also recommended specifically in regional/rural communities, where data was particularly limited. © 2024 Australian Dental Association.

How Livelihood Change Affects Food Choice Behaviors in Low- and Middle-Income Countries: A Scoping Review

Livelihoods have changed dramatically over the past decade in low- and middle-income countries (LMIC). These shifts are happening in tandem with shifts in individual and household food choice behaviors. This scoping review aimed to identify and characterize mechanisms through which livelihood changes could affect food choice behaviors in LMIC, including behaviors relating to food production, acquisition, preparation, distribution, and consumption. A literature search was conducted using 4 databases: PubMed, PsycInfo, AGRICOLA, and Embase. The search was further enhanced by expert solicitations. Studies were included if they measured or focused on a livelihood change, described or assessed a change in ≥1 food choice behavior, and focused on LMIC. Studies were excluded if they focused on migration from LMIC to a high-income country. Of the 433 articles that were identified, 53 met the inclusion criteria. Five mechanisms of how livelihood change can affect food choice were identified: occupation, locality, time, income, and social relations. Changes in occupation altered the balance of the availability and affordability of foods in local food environments compared with individual food production. Changes in location, time use, and income influenced where food was purchased, what types of foods were acquired, and how or where foods were prepared. Additionally, changes in social relationships and norms led to expanded food preferences, particularly among urban populations. Time limitations and higher discretionary income were associated with consumption of ultraprocessed foods. Understanding the relationships between the changes in livelihood occuring in LMIC and food choices of households in these countries can inform the development of policies, programs, and other actions to promote sustainable healthy diets and planetary health.

Fractional flow reserve and instantaneous wave-free ratio in coronary artery bypass grafting: a meta-analysis and practice review

Objective

Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive methods to assess the functional significance of intermediate severity coronary lesions. Both indexes have been extensively validated in clinical trials in guiding revascularisation in patients with stable ischaemic heart disease undergoing percutaneous coronary intervention (PCI) with improved clinical outcomes. However, the role of these tools in coronary artery bypass grafting (CABG) is less clear.

Methods

A meta-analysis of randomised trials and observational studies was carried out to help in determining the optimal strategy for assessing lesion severity and selecting graft targets in patients undergoing CABG. Electronic searches were carried out on Embase, MEDLINE, and Web of Science. A group of four authors independently screened and then assessed the retrieved records. Cochrane's Risk of Bias and Robins-I tools were used for bias assessment. A survey was conducted among surgeons and cardiologists to describe current attitudes towards the preoperative use of functional coronary investigations in practice.

Results

Clinical outcomes including mortality at 30 days, perioperative myocardial infarction, number of grafts, incidence of stroke, rate of further need for revascularisation, and patient-reported quality of life did not differ in CABG guided by functional testing from those guided by traditional angiography.The survey revealed that in half of the surgical and cardiology units functional assessment is performed in CABG patients; there is a general perception that functional testing has improved patient care and its use would clarify the role of moderate coronary lesions that often need multidisciplinary rediscussions; moderate stenosis are felt to be clinically relevant; and anatomical considerations need to be taken into account together with functional assessment.

Conclusions

At present, the evidence to support the routine use of functional testing in intermediate lesions for planning CABG is currently insufficient. The pooled data currently available do not show an increased risk in mortality, myocardial injury, and stroke in the FFR/iFR-guided group. Further trials with highly selected populations are needed to clarify the best strategy.

Systematic Review Registration

ClinicalTrials.gov, identifier (CRD42023414604).

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

A luminous fast radio burst that probes the Universe at redshift 1

Fast radio bursts (FRBs) are millisecond-duration pulses of radio emission originating from extragalactic distances. Radio dispersion is imparted on each burst by intervening plasma, mostly located in the intergalactic medium. In this work, we observe the burst FRB 20220610A and localize it to a morphologically complex host galaxy system at redshift 1.016 ± 0.002. The burst redshift and dispersion measure are consistent with passage through a substantial column of plasma in the intergalactic medium and extend the relationship between those quantities measured at lower redshift. The burst shows evidence for passage through additional turbulent magnetized plasma, potentially associated with the host galaxy. We use the burst energy of 2 × 1042 erg to revise the empirical maximum energy of an FRB.

The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM)

BACKGROUND

Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD.

METHODS

This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM.

RESULTS

340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively.

CONCLUSION

Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD.

TRIAL REGISTRATION

NCT04872933. Registered 5th May 2021.

How Perspectives on Food Safety of Vendors and Consumers Translate into Food-Choice Behaviors in 6 African and Asian Countries

Background

Consumption of unsafe foods increases morbidity and mortality and is currently an issue, particularly in low- and middle-income countries. Policy actions to ensure food safety are dominated by mitigation of biological and chemical hazards through supply-side risk management, lessening the degree to which consumer perspectives of food safety are considered.

Objectives

This study aimed to provide an in-depth understanding, from vendor and consumer perspectives, of how food-safety concerns of consumers translate into their subsequent food-choice behaviors in 6 diverse low- and middle-income countries.

Methods

Six Drivers of Food Choice projects (2016-2022) provided transcripts from 17 focus group discussions and 343 interviews conducted in Ghana, Guinea, India, Kenya, Tanzania, and Vietnam. Qualitative thematic analysis was used to identify emerging themes important to food safety.

Results

The analysis suggests that consumers constructed meaning about food safety through personal lived experience and social influences. Community and family members contributed knowledge about food safety. Concerns about food safety were influenced by reputations of and relationships with food vendors. Consumers' mistrust of food vendors was amplified by purposeful adulteration or unsafe selling practices and new methods used to produce food. Moreover, consumers were reassured of food safety by positive relationships with vendors; meals cooked at home; implementation of policies and following regulations; vendor adherence to environmental sanitation and food-hygiene practices; cleanliness of vendors' appearance; and vendors' or producers' agency to use risk mitigation strategies in production, processing, and distribution of food.

Conclusions

Consumers integrated their meanings, knowledge, and concerns about food safety to achieve assurance about the safety of their foods when making food-choice decisions. The success of food-safety policies hinges on consideration of consumers' food-safety concerns in their design and implementation, alongside actions to reduce risk in food supply.

Bedside Index of Severity in Acute Pancreatitis (BISAP) Score on Outcome of Patients Presenting with Acute Pancreatitis in a Tertiary Care Hospital

Background Acute pancreatitis is a life-threatening condition characterized by inflammation of the pancreas causing intense abdominal pain and potential harm to multiple organs. The mortality rate is 1-5% and thus requires specialized and interdisciplinary care to inhibit it. Objective To describe the bedside index of severity in acute pancreatitis score on the outcome of acute pancreatitis patients in a tertiary care hospital. Method This is a hospital based observational cross-sectional study conducted in the internal medicine inpatient department of Dhulikhel Hospital from April 2018 and March 2019. This study reviewed the medical records of the department. Result The study included 70 participants with 44 (±14) years of average age and stating common cause as gallstone (45.7%). The study showed that those with bedside index of severity in acute pancreatitis score ≥ 3 during hospital admission had significantly higher rate of organ failure (p-value < 0.05), as well as had a prolonged hospital stay (mean: 20 [±7.9] days). The mean hospital stay was 12.9 days. Conclusion Patients with bedside index of severity in acute pancreatitis score greater than three at admission were found to have an increased risk of organ failure, significantly higher chances of requiring mechanical ventilation, and a longer duration of hospital stay.

Sustaining Agriculture and Nutrition Interventions: Continued Engagement of Village Model Farmers in Nepal

BACKGROUND

In homestead food production (HFP) programs, village model farmers (VMFs), after training, implement agriculture and nutrition activities to improve household knowledge and practices. Little evidence exists on what enables VMFs to remain actively engaged and for impacts to be sustained.

OBJECTIVE

To examine variables explaining active engagement of VMFs, at least 4 years post-training, in an HFP program in Nepal.

METHODS

We used cross-sectional data, collected from 2018 to 2019, among 4750 VMFs of Suaahara, a multisectoral nutrition program. We assessed whether respondents registered their HFP group with the local government, conducted regular group meetings, discussed vegetable growing and chicken rearing practices with group members, or engaged in saving and credit activities in their HFP group. Outcome variable was a count of these 4 activities in which the VMF engaged. Socioeconomic, demographic, and programmatic explanatory variables were identified a priori and by bivariate analysis and were adjusted in ordinal regression models accounting for clusters.

RESULTS

On average, VMFs engaged in 1.4 activities. Having attended primary or secondary school (adjusted odds ratios [AOR] = 1.39), being a female community health volunteer (AOR = 1.27), being from an advantaged caste/ethnic group (AOR = 1.34), receiving additional trainings (AOR = 1.56) and inputs (AOR = 1.31) were associated with more active engagement of VMFs.

CONCLUSION

Village model farmers receiving more training and inputs were more likely to remain actively engaged. Female community health workers, people from higher caste/ethnic groups, and those with primary or secondary education were more likely to remain active VMFs and could be targeted for this role in HFP programs leading to sustained impact.

Photonics probing of pup brain tissue and molecular-specific nuclear nanostructure alterations due to fetal alcoholism via light scattering/localization approaches

SIGNIFICANCE

Light is a good probe for studying the nanoscale-level structural or molecular-specific structural properties of brain cells/tissue due to stress, alcohol, or any other abnormalities. Chronic alcoholism during pregnancy, i.e., fetal alcoholism, being teratogenic, results in fetal alcohol syndrome, and other neurological disorders. Understanding the nano-to-submicron scale spatial structural properties of pup brain cells/tissues using light/photonic probes could provide a plethora of information in understanding the effects of fetal alcoholism.

AIM

Using both light scattering and light localization techniques to probe alterations in nano- to-submicron scale mass density or refractive index fluctuations in brain cells/tissues of mice pups, exposed to fetal alcoholism.

APPROACH

We use the mesoscopic physics-based dual spectroscopic imaging techniques, partial wave spectroscopy (PWS) and molecular-specific inverse participation ratio (IPR) using confocal imaging, to quantify structural alterations in brain tissues and chromatin/histone in brain cells, respectively, in 60 days postnatal mice pup brain, exposed to fetal alcoholism.

RESULTS

The finer focusing PWS analysis on tissues shows an increase in the degree of structural disorder strength in the pup brain tissues. Furthermore, results of the molecular-specific light localization IPR technique show an increase in the degree of spatial molecular mass density structural disorder in DNA and a decrease in the degree in histone.

CONCLUSIONS

In particular, we characterize the spatial pup brain structures from the molecular to tissue levels and address the plausible reasons for such as mass density fluctuations in fetal alcoholism.

Perspectives about Food Safety in Diverse Low- and Middle-income Countries

Objectives

Concerns about unsafe food influence food choice and consumption of unsafe foods increase morbidity and mortality, particularly in low- and middle-income countries. Addressing unsafe food is dominated by mitigation of biological and chemical hazards through supply-side risk management, with less emphasis on individuals’ experiences and perspectives of food safety. We aimed to identify and categorize perspectives about food safety in five countries.

Methods

Five studies designed to address drivers of food choice in low- and middle-income countries provided transcripts from 17 focus groups discussions and 303 interviews in Kenya, Ghana, India, Guinea, and Vietnam. We analyzed transcripts using a priori and emergent coding techniques that involved a constant comparative method.

Results

Individuals constructed meaning about food safety through personal experience and social influences. Community and family members contributed knowledge about food safety. Concerns about food safety were influenced by reputations of and relationships with vendors. Concerns were amplified by mistrust of vendors’ purposeful adulteration, unsafe selling practices, and new methods to produce food. Individuals were reassured of food safety by positive relationships with vendors; home-cooked meals; implementation of policies and regulations being followed; vendor adherence to environmental sanitation and food hygiene practices; cleanliness of vendors’ appearance; vendors’ or producers’ agency to use risk mitigation strategies; and transparency in production, processing, and distribution of food.

Conclusions

Individuals’ perspectives about food safety influence food choice behaviors. The success of food-safety policies hinges on consideration of these perspectives.

Funding Sources

The Drivers of Food Choice (DFC) Competitive Grants Program, funded by the Bill & Melinda Gates Foundation and the UK Government's Foreign, Commonwealth & Development Office.

A 3D star shot to determine the gantry, collimator, and couch axes positions

A linear accelerator has three independent axes that are nominally intersecting at the isocenter. Modern treatment techniques require the coincidence of these axes to lie within a 1‐mm diameter sphere. A solution to verify this requirement is to wrap a film on a cylindrical surface, align the cylinder to the linac's isocenter and gantry axis, and take multiple exposures of slits, rotating either the gantry, collimator, or couch between exposures. The resulting exposure pattern is the 3D equivalent of the 2D star shot and encodes sufficient information to determine each axis’ position in 3D. Moreover, this method uses a single sheet 8“x10” film, a standard film scanner, and a phantom that can be readily built in‐house, making a practical solution to this 3D‐measurement problem.

Full coverage crowns for rehabilitation of MIH affected molars: 24 month randomized clinical trial

BACKGROUND

Teeth affected with severe molar incisor hypomineralization (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations.

AIM

To evaluate and compare the clinical performance of zirconia, lithium disilicate, and cast metal crowns as full-coverage restorations on MIH-affected first permanent molars (FPMs).

METHODS

60 MIH affected FPMs requiring full-coverage crowns were identified in children aged 8-15 years and were randomly allocated to the three treatment groups according to the type of full coverage restoration received using block randomization technique. After an adequate removal of the MIH defect and restoration with composite resin, the tooth preparation was done followed by fabrication of crown and its cementation using resin cement. The intergroup comparison was done on the basis of USPHS criteria, gingival, plaque scores, patient and parents acceptance through a visual analog scale to decipher their clinical performance at 6, 12, 24 months.

RESULTS

After 24 months, the crowns showed similar clinical success in terms of the criterias used to compare their clinical performance. The retention, marginal adaptation, relief from hypersensitivity, proximal contact, gingival health with no statistically significant difference among the three groups.

CONCLUSION

Based on the observations, Lithium disilicate, Zirconia and full cast metal crowns showed similar clinical success in rehabilitation of First permanent molars with severe MIH over 24 months of evaluation. The clinical success is not influenced by the material of the restoration. However, prospective studies with a longer follow-up are required to reach a more definitive conclusion.

Cardiac magnetic resonance strain and mechanical dispersion assessment in patients with chronic total coronary artery occlusion

Background

Chronic total occlusions (CTO) are a frequent angiographic finding. Viability of CTO-subtended myocardium is dependent on the presence of an adequate collateral circulation. At rest, collateral supply may be sufficient to avert ischaemia and maintain normal systolic function. However, it remains unclear whether CTO-subtended myocardium may be considered truly normal, or whether subtle functional abnormalities may be present at rest.

Purpose

To determine whether, in the absence of infarction and hibernation, CTO-subtended myocardium remains functionally normal or whether abnormalities of strain and/or mechanical dispersion may be present at rest.

Methods

In a retrospective, single centre, observational study, we studied patients with ≥1 angiographically-diagnosed CTO referred for clinical stress perfusion cardiovascular magnetic resonance (CMR), and compared healthy volunteers (HVs) with a normal stress CMR scan. CMR imaging comprised functional and scar assessment with qualitative [visual] evaluation of infarction and segmental wall motion. Patients with infarction and/or wall motion score index (WMSI) ≥1 were excluded from further analysis. In remaining CTO subjects and HVs, segmental peak systolic longitudinal strain and circumferential strain were analysed (in 3 long-axis planes and 3 short-axis planes, respectively) and mechanical dispersion for both orientations was computed. Image analysis was performed using Medis (QStrain) software blinded to all clinical information.

Results

From a total of 389 patients with ≥1 angiographically-diagnosed CTO, 68 had normal WMSI and no infarction (63.0±11.7 years, 79.4% male, LVEF 62.6±4.5%). Fifty HVs (61.1±7.0 years, 74.0% males, LVEF 61.1±5.3%) were also studied. The majority of CTO patients had concomitant coronary artery disease in at least one non-CTO vessel (n=37, 54.4%). GLS was lower in CTO patients than HVs (−21.8%±1.5% versus −24.0±1.1%; p&lt;0.0001; Figure 1). By contrast, GCS was greater in CTO patients (−32.7±2.5% versus −28.8±2.1%; p&lt;0.0001). Mechanical dispersion was increased in CTO patients (Figure 2), both longitudinally (90.3±14.6 ms in CTO patients versus 68.6±11.1 ms in HVs; p&lt;0.0001) and circumferentially (66.7±9.1 ms versus 55.3±6.6 ms, respectively; p=0.02).

Conclusion

Subclinical changes in left ventricular dynamics are present at rest in CTO patients with fully viable myocardium and no evidence of resting regional wall abnormality. Further study is warranted to evaluate the potential association between mechanical dispersion and arrhythmic events in CTO.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): NIHR Clinician Scientist Award (CS-2018-18-ST2-007 to J.R.A.) and Research Professorship award (RP-2017-08-ST2-007 to G.P.M.). Figure 1. Strain analysis. CTO vs HVFigure 2. Mechanical dispersion. CTO vs HV

Seroprevalence of Scrub Typhus in Patients Attending Dhulikhel Hospital, Kavre

Background Scrub typhus is a largely ignored tropical disease and a leading cause of undifferentiated febrile illness. It is caused by Orientia tsutsugamushi. Scrub Typhus is frequently observed in South Asian countries. However, clear epidemiological information of this disease is lacking in case of Nepal. Nepal has shown steady increase in cases of Scrub Typhus since 2015. The epidemiological data related to this disease would support the decision making and surveillance design for early outbreak detection and immediate responses including prevention and treatment of scrub typhus in Nepal. Objective To understand prevalence of Scrub Typhus in subjects who had visited outpatient department at Dhulikhel Hospital. Method In this study, we have studied antibody test data (n=784) for Scrub Typhus from 2019 to 2021. The tests were performed on serum samples of patients who had visited OPD at Dhulikhel Hospital with fever lasting more than 5 days. The kit used in analysis was Scrub Typhus Detect™ IgM ELISA Kit from InBios International. Result Out of the total subjects (n=784), 133 were positive (16.9%) for IgM antibody of Scrub Typhus. The positivity in female (18.6%) was higher than the male subjects (15.3%). The positivity rate was variable among the different age groups, with highest positivity for age group 0-14 years (25%). The seasonal variation was also observed among the seropositive cases. Conclusion Scrub Typhus being a neglected tropical disease has high prevalence. It can be postulated that female subjects and subjects of age group 0-14 years are vulnerable to the infection with Scrub Typhus. There is need to increase the surveillance of Scrub Typhus to add the knowledge for diagnosis and treatment.

Recommended Actions in Global Nutrition Initiatives That Link Food Environment and Food Choice

Objectives

To understand how actions that link food environment and food choice, recommended by global nutrition initiatives, seek to promote sustainable healthy diets.

Methods

We reviewed recommended actions addressing food environments and food choice by global nutrition initiatives published between 2015 and 2020. Internal debriefing, expert solicitation, and targeted web searches were used to identify 20 documents, with 12 selected for review. Specific action descriptions were used to generate overarching actions present across the documents, were extracted into a matrix, and then were tabulated across overarching actions retaining document affiliation. The content assigned to each overarching action was disaggregated by environmental and individual focus guided by concepts from existing frameworks pertinent to food environments and food choice.

Results

We identified 13 overarching actions from the documents reviewed, ranging from reorienting agricultural priorities for improved nutrition to creating consumer demand for nutritious foods. The documents differed in the extent of detail describing specific actions. Between 3 and 11 documents were represented in each action. Environmental actions focused on building better bridges across the food value chain, regulation, and investment. Regulation ranged from municipal zoning restrictions of food outlets near schools to national and international strengthening of legally binding agreements for nutrient profiling, labeling, and marketing restrictions. Actions addressing individual behavior were fewer and focused on building capacity with special attention to smallholder farmers and women, recognizing their duality as suppliers and consumers, protecting traditional practices, and applied communication strategies to promote healthy diets.

Conclusions

Actions portrayed prioritization of environmental change to achieve healthy diets with some attention to sustainability, but much less detail was presented about what, how, or why individuals may consider changes to their dietary choices. Better linking individuals’ perspective into environmental change may propel the success of active global efforts.

Funding Sources

UK Government's Foreign, Commonwealth & Development Office and the Bill & Melinda Gates Foundation.

Perspectives on Food Safety and Their Influence on Food Choice in Low- and Middle-Income Countries

Objectives

Current efforts to address food safety through supply-side risk management consider food safety primarily in terms of biological and chemical hazards, ignoring the importance of individuals’ experiences and perspectives. This study aimed to understand how experiences and perspectives of food safety influence food choice in low- and middle-income countries (LMICs).

Methods

The Drivers of Food Choice Competitive Grants Program funded 15 projects that aimed to understand food choice among the poor across 10 LMICs in Sub Saharan Africa and South and South East Asia. Summaries of the role of food safety in decisions about food choice were reviewed with principal investigators from 6 projects with significant findings. We used an iterative process of thematic analysis across all project summaries followed by respondent validation to categorize findings with shared meaning into themes of conditions

and characteristics that either contributed to perceptions of a lack of food safety or to an overall perspective on food safety.

Results

Food was considered to be safe if purchased from vendors who had good food and personal hygiene practices or with whom individuals had positive relationships. Food was also considered to be safe if it was prepared at home. Perceptions of a lack of food safety were increased by fears of adulteration by vendors and contamination in physical environments with poor sanitation or handling practices. Policies and regulations offered increased guarantees of safety but were not always trusted nor convenient, and social networks and the media were important sources of both real and false information about food safety.

Conclusions

Individuals rely on their experiences, attitudes, knowledge, and perceptions in making decisions about what foods to buy, prepare, and consume, and from which sources. Understanding how perspectives of food safety influence food choice can be harnessed to improve food safety and contribute to sustainable healthy diets. Efforts to achieve sustainable healthy diets through behavior change communication or incentives to supply chain actors must acknowledge perspectives on food safety as important drivers of food choice.

Funding Sources

UK Government's Foreign, Commonwealth & Development Office and the Bill & Melinda Gates Foundation.

A multicentre prospective double blinded randomised controlled trial of intravenous iron (ferric Derisomaltose (FDI)) in Iron deficient but not anaemic patients with chronic kidney disease on functional status

BACKGROUND

Iron deficiency (ID) is common in patients with chronic kidney disease (CKD). Intravenous (IV) iron in heart failure leads to improvement in exercise capacity and improvement in quality-of-life measurements; however, data in patients with CKD are lacking.

METHODS

The Iron and the Heart Study was a prospective double blinded randomised study in non-anaemic CKD stages 3b-5 patients with ID which investigated whether 1000 mg of IV iron (ferric derisomaltose (FDI)) could improve exercise capacity in comparison to placebo measured at 1 and 3 months post infusion. Secondary objectives included effects on haematinic profiles and haemoglobin, safety analysis and quality of life questionnaires (QoL).

RESULTS

We randomly assigned 54 patients mean (SD) age for FDI (n = 26) 61.6 (10.1) years vs placebo (n = 28; 57.8 (12.9) years) and mean eGFR (33.2 (9.3) vs. 29.1 (9.6) ml/min/1.73m2) at baseline, respectively. Adjusting for baseline measurements, six-minute walk test (6MWT) showed no statistically significant difference between arms at 1 month (p = 0.736), or 3 months (p = 0.741). There were non-significant increases in 6MWT from baseline to 1 and 3 months in the FDI arm. Haemoglobin (Hb) at 1 and 3 months remained stable. There were statistically significant increases in ferritin (SF) and transferrin saturation (TSAT) at 1 and 3 months (p < 0.001). There was a modest numerical improvement in QoL parameters. There were no adverse events attributable to IV iron.

CONCLUSION

This study demonstrated a short-term beneficial effect of FDI on exercise capacity, but it was not significant despite improvements in parameters of iron status, maintenance of Hb concentration, and numerical increases in functional capacity and quality of life scores. A larger study will be required to confirm if intravenous iron is beneficial in iron deficient non-anaemic non-dialysis CKD patients without heart failure to improve the 6MWT.

TRIAL REGISTRATION

European Clinical Trials Database (EudraCT) No: 2014-004133-16 REC no: 14/YH/1209 Date First Registered: 2015-02-17 and date of end of trail 2015-05-23 Sponsor ref R1766 and Protocol No: IHI 141.

Sustaining Agriculture-Nutrition Interventions: Analysis of Determinants of Village Model Farmer Active Engagement in Nepal

Objectives

Homestead food production (HFP) programs rely on village model farmers (VMFs) for implementation of agriculture-nutrition activities. No studies have assessed sustainability of VMFs. Our objective was to test determinants of VMFs remaining and actively working several years after being selected as VMFs.

Methods

We used cross-sectional monitoring data, collected in 2018 and 2019 among VMFs in Suaahara (2011–2021), a multi-sectoral integrated nutrition program that includes HFP in Nepal. Remaining as a VMF was assessed from self-report. Actively working as a VMF was based on whether s/he was leading an HFP beneficiary group, registered the HFP group, conducting regular group meetings, and engaging in saving and credit activities. Potential socio-economic and demographic determinants were identified a priori: gender, age, education, caste, being a female community health volunteer, socio-economic status, agricultural land size, household size, duration of being a VMF, residing in disaster-affected districts, agro-ecological zone, and number of trainings and inputs received. Multivariable logistic regression was used to estimate adjusted odds ratios among 4732 VMFs.

Results

The odds of remaining and actively working were greater among those with some education compared to those without education. VMFs having more agricultural land were 2.25 and 1.14 times more likely to be remaining and actively working as a VMF, respectively. VMFs working for longer were less likely to remain and be active. More types of trainings and inputs received were associated with greater odds of remaining and actively working as an VMF. VMFs older than 35 y, other caste than Dalit, and living in Mountains and Hills were more likely to remain and actively work. We did not find significant association for household size and richer households.

Conclusions

Age, education, caste, agricultural land size, household wealth, time since becoming a VMF, and number of trainings and inputs received were important determinants of VMFs remaining and actively working in the program. Examining these factors can help selection of front-line workers to ensure their engagement and sustainability.

Funding Sources

United States Agency for International Development (USAID) under Cooperative Agreement No. AID-367-A-16–00006.

Agricultural and Finance Intervention Increased Dietary Intake and Weight of Children Living in HIV-Affected Households in Western Kenya

We tested whether a multisectoral household agricultural and finance intervention increased the dietary intake and improved the nutritional status of HIV-affected children. Two hospitals in rural Kenya were randomly assigned to be either the intervention or the control arm. The intervention comprised a human-powered water pump, microfinance loan for farm commodities, and training in sustainable farming practices and financial management. In each arm, 100 children (0-59 mo of age) were enrolled from households with HIV-infected adults 18-49 y old. Children were assessed beginning in April 2012 and every 3 mo for 1 y for dietary intake and anthropometry. Children in the intervention arm had a larger increase in weight (β: 0.025 kg/mo, P = 0.030), overall frequency of food consumption (β: 0.610 times · wk-1 · mo-1, P = 0.048), and intakes of staples (β: 0.222, P = 0.024), fruits and vegetables (β: 0.425, P = 0.005), meat (β: 0.074, P < 0.001), and fat (β: 0.057, P = 0.041). Livelihood interventions have potential to improve the nutrition of HIV-affected children. This trial was registered at clinicaltrials.gov as NCT01548599.

Small-Scale Livestock Production in Nepal Is Directly Associated with Children's Increased Intakes of Eggs and Dairy, But Not Meat

Animal source foods (ASF) provide nutrients essential to child growth and development yet remain infrequently consumed in rural Nepal. Agriculture and nutrition programs aim to increase ASF intake among children through small-scale animal husbandry projects. The relationship between livestock ownership and children's consumption of ASF, however, is not well established. This study examined associations between livestock ownership and the frequency with which Nepali children consume eggs, dairy, and meat. We analyzed longitudinal 7-day food frequency data from sentinel surveillance sites of the Policy and Science of Health, Agriculture and Nutrition (PoSHAN) study. Data consisted of surveys from 485 Nepali farming households conducted twice per year for two years (a total of 1449 surveys). We used negative binomial regression analysis to examine the association between the number of cattle, poultry, and meat animals (small livestock) owned and children's weekly dairy, egg, and meat intakes, respectively, adjusting for household expenditure on each food type, mother's education level, caste/ethnicity, agroecological region, season, and child age and sex. We calculated predicted marginal values based on model estimates. Children consumed dairy 1.4 (95% CI 1.1-2.0), 2.3 (1.7-3.0) and 3.0 (2.1-4.2) more times per week in households owning 1, 2-4 and >4 cattle, respectively, compared to children in households without cattle. Children consumed eggs 2.8 (2.1-3.7) more times per week in households owning 1 or 2 chickens compared to children in households without chickens. Child intake of meat was higher only in households owning more than seven meat animals. Children's intakes of dairy, eggs, and meat rose with household expenditure on these foods. Small-scale animal production may be an effective strategy for increasing children's consumption of eggs and dairy, but not meat. Increasing household ability to access ASF via purchasing appears to be an important approach for raising children's intakes of all three food types.

Vitamin D in Infant Formula and Enteral Products by Liquid Chromatography: Collaborative Study

Results from a collaborative study of a new liquid chromatographic (LC) method for determination ofvitamin D in infant formulas and enteral products are presented. Each of 15 laboratories was provided with 11 blind duplicate samples covering a range ofapproximately 200-500 International Units/quart (normal dilution), a system suitability sample, and the U.S. Pharmacopeia ergo- and cholecalciferol standards. Product types included liquid and powder forms of milk (whey and casein), soy, and hydrolyzed protein-based infant formulas and enteral products. The method includes a single liquid-liquid extraction following saponification, solid-phase extraction,and then concentration by evaporation. An isocratic, nonaqueous, chromatographic system with reversed-phase, zero end- capped C18 column, and UV detector set at 265 nm are used. Statistical evaluation ofdata from participating laboratories showthe average reproducibility and repeatability of the method across all samples to be excellent, with RSDR and RSDr values of 13.48 and 9.44, respectively, after elimination of out liers. The LC method for determination of vitamin D in infant formulas and enteral products has been adopted by AOAC INTERNATIONAL.

Determination of Ethoxyquin in Feeds by Liquid Chromatography: Collaborative Study

Ethoxyquin is a chemical antioxidant used in feeds, ingredients, fats, and oils. A liquid chromatographic (LC) method for determination of ethoxyquin was developed. The method involves acetonitrile extraction of the sample and isocratic Cis reversed-phase chromatography with ammonium acetate buffer-acetonitrile as mobile phase and fluorescence detection. A collaborative study of the determination of ethoxyquin in various meals and extruded pet foods was conducted by The lams Company Research Laboratory. Eleven laboratories analyzed 16 samples (including 2 blind duplicates) consisting of 7 meat meals and 9 extruded pet foods. Sample means ranged from 0.25 to 289 ppm. Repeatability standard deviations ranged from 0.08 to 3.2 ppm, and repeatability relative standard deviations ranged from 4.5 to 32%. Reproducibility standard deviations ranged from 0.12 to 13 ppm, and reproducibility relative standard deviations ranged from 4.5 to 55%. The LC method for determination of ethoxyquin in feeds has been adopted first action by AOAC INTERNATIONAL.

Determination of Total Dietary Fiber (CODEX Definition) by Enzymatic-Gravimetric Method and Liquid Chromatography: Collaborative Study

A method for the determination of total dietary fiber (TDF), as defined by the CODEX Alimentarius, was validated in foods. Based upon the principles of AOAC Official MethodsSM 985.29, 991.43, 2001.03, and 2002.02, the method quantitates high- and low-molecular-weight dietary fiber (HMWDF and LMWDF, respectively). In 2007, McCleary described a method of extended enzymatic digestion at 37C to simulate human intestinal digestion followed by gravimetric isolation and quantitation of HMWDF and the use of LC to quantitate low-molecular-weight soluble dietary fiber (LMWSDF). The method thus quantitates the complete range of dietary fiber components from resistant starch (by utilizing the digestion conditions of AOAC Method 2002.02) to digestion resistant oligosaccharides (by incorporating the deionization and LC procedures of AOAC Method 2001.03). The method was evaluated through an AOAC collaborative study. Eighteen laboratories participated with 16 laboratories returning valid assay data for 16 test portions (eight blind duplicates) consisting of samples with a range of traditional dietary fiber, resistant starch, and nondigestible oligosaccharides. The dietary fiber content of the eight test pairs ranged from 11.57 to 47.83. Digestion of samples under the conditions of AOAC Method 2002.02 followed by the isolation and gravimetric procedures of AOAC Methods 985.29 and 991.43 results in quantitation of HMWDF. The filtrate from the quantitation of HMWDF is concentrated, deionized, concentrated again, and analyzed by LC to determine the LMWSDF, i.e., all nondigestible oligosaccharides of degree of polymerization 3. TDF is calculated as the sum of HMWDF and LMWSDF. Repeatability standard deviations (sr) ranged from 0.41 to 1.43, and reproducibility standard deviations (sR) ranged from 1.18 to 5.44. These results are comparable to other official dietary fiber methods, and the method is recommended for adoption as Official First Action.

Determination of β-Carotene in Supplements and Raw Materials by Reversed-Phase High Pressure Liquid Chromatography: Collaborative Study

Twelve laboratories representing 4 countries participated in an interlaboratory study conducted to determine all-trans-β-carotene and total β-carotene in dietary supplements and raw materials. Thirteen samples were sent as blind duplicates to the collaborators. Results obtained from 11 laboratories are reported. For products composed as softgels and tablets that were analyzed for total β-carotene, the reproducibility relative standard deviation (RSDR) ranged from 3.35 to 23.09% and the HorRat values ranged from 1.06 to 3.72. For these products analyzed for trans β-carotene, the reproducibility relative standard deviation (RSDR) ranged from 4.28 to 22.76% and the HorRat values ranged from 0.92 to 3.37. The RSDr and HorRat values in the analysis of a beadlet raw material were substantial and it is believed that the variability within the material itself introduced significant variation in subsampling. The method uses high pressure liquid chromatography (LC) in the reversed-phase mode with visible light absorbance for detection and quantitation. If high levels of α-carotenes are present, a second LC system is used for additional separation and quantitation of the carotene species. It is recommended that the method be adopted as an AOAC Official Method.

Determination of Retinyl Palmitate (Vitamin A) in Fortified Fluid Milk by Liquid Chromatography: Collaborative Study

A liquid chromatographic (LC) method was developed for fast and simple measurement of retinyl palmitate (vitamin A) in fortified milk. Retinyl acetate internal standard was added to a test portion of milk followed by extraction into hexane. The hexane extract was analyzed by LC using a normal-phase silica gel column equilibrated with mobile phase (conditioned hexane–isopropanol, 99.85 + 0.15, v/v) about 1 h before injections. The retinyl palmitate concentration was calculated by using a relative response factor determined with calibration standards. In the collaborative study, 11 laboratories analyzed 13 pairs of fluid milk materials in blind duplicate. Twelve of the materials were composed of skim milk (&lt;0.5% fat), 1% fat milk, 2% fat milk, and 1% fat chocolate milk. Each material was fortified at 3 concentrations of retinyl palmitate of approximately 581 μg/L (1000 IU/qt), 1163 μg/L (2000 IU/qt), and 2236 μg/L (4000 IU/qt). The 13th material, unfortified skim milk, served as a matrix blank. Repeatability standard deviations (RSDr) without outliers ranged from 1.5 to 5.7% and reproducibility standard deviations (RSDR) without outliers ranged from 5.0 to 22.7%. cis-Isomers co-eluted with the predominant trans-retinyl palmitate isomer and were included in the results reported by all the collaborative laboratories. Endogenous long-chain esters from milk fat were also measured with the retinyl palmitate additive. The Study Director recommends that this method for determination of retinyl palmitate in fluid milk by LC be adopted First Action.

Oral Cysticercosis Presenting as an Innocuous Lesion

Cysticercosis is a parasitic infection with potential of causing significant morbidity especially in developing countries. The larval form of the parasite Taenia Solium, 'Cysticercus Cellulosae' primarily colonizes in the small intestine and has the potential to disseminate to different sites of the body. Oral presentation is rare and difficult to detect owing to its innocuous presentation. This report describes the presentation of cysticercosis involving the tongue and presenting as a submucosal mass. An incisional biopsy was performed and evaluation of the histopathological features lead to the diagnosis of oral cysticercosis. This article highlights the importance of inter-departmental collaboration for the accurate diagnosis and effective management of oral cysticercosis in order to avoid potential systemic complications.

A single fast radio burst localized to a massive galaxy at cosmological distance

Fast radio bursts (FRBs) are brief radio emissions from distant astronomical sources. Some are known to repeat, but most are single bursts. Nonrepeating FRB observations have had insufficient positional accuracy to localize them to an individual host galaxy. We report the interferometric localization of the single-pulse FRB 180924 to a position 4 kiloparsecs from the center of a luminous galaxy at redshift 0.3214. The burst has not been observed to repeat. The properties of the burst and its host are markedly different from those of the only other accurately localized FRB source. The integrated electron column density along the line of sight closely matches models of the intergalactic medium, indicating that some FRBs are clean probes of the baryonic component of the cosmic web.

An Agricultural and Finance Intervention Improved Dietary Intake and Nutritional Status of Children Living in HIV-affected Households in Western Kenya (P10-129-19)

Objectives

To test whether an intervention that was shown previously to have improved food security, dietary intake of adults, and HIV health outcomes also improved dietary intake and nutritional status of children living in HIV-affected households.

Methods

The study was conducted in the Nyanza Region, Kenya where two health facilities were randomly assigned as intervention or control arms. The intervention included a human-powered water pump, a microfinance loan to purchase farm commodities, and training in sustainable farming practices and financial management. One hundred children (6 to 60 months of age) were enrolled in each arm from households with HIV-infected adults 18 to 49 years old on antiretroviral therapy and with access to surface water and land. Children were assessed beginning in April 2012 and every three months for one year. Data were collected on dietary intake, height, weight, and mid-upper arm circumference (MUAC). The difference in differences from first visit and in linear trends over visits were tested using fixed-effects regression models.

Results

Compared to the control arm, children in the intervention arm had a larger increase in weight at the 12-month visit (β: 0.42, 95% CI: 0.08, 0.76) and increase in MUAC at the 6-month visit (β: 0.28, 95% CI: 0.08, 0.49), with no difference in changes in height over time. Compared to the control arm, the intervention arm had a larger increasing linear trend over time in intake of staples (β: 0.22, 95% CI: 0.02, 0.44), fruits and vegetables (β: 0.42, 95% CI: 0.10, 0.75), and meat (β: 0.07, 95% CI: 0.03, 0.12), and a larger decreasing linear trend in intake of condiments (β: -0.16, 95% CI: -0.23, -0.09) and tea (β: -0.12, 95% CI: -0.19, -0.05), with no differences in intake of eggs, dairy and fat over time.

Conclusions

This intervention that improved food security, dietary intake, and HIV health outcomes of HIV-infected adults also improved dietary intake and nutritional status of children living in those households. Multisectoral agricultural and financial interventions have the potential to improve the nutritional status of HIV-affected children in rural Kenya and should be further explored.

Funding Sources

National Institute of Mental Health.

Optical study of stress hormone-induced nanoscale structural alteration in brain using partial wave spectroscopic microscopy

Chronic stress affects nano to microscale structures of the brain cells/tissues due to suppression of neural growths and reconnections, hence the neuronal activities. This results in depression, memory loss and even death of the brain cells. Our recently developed novel optical technique, partial wave spectroscopic microscopy has nanoscale sensitivity, and hence, can detect nanoscale changes in brain tissues due to stress. In this study, we applied this technique to quantify the stress related structural changes in the corticosterone-treated mouse model of stress. Our results show that brains from corticosterone-treated mice showed higher nanoscale structural disorder in the hippocampal region as compared to the brain from normal (vehicle) mice. The increase in structural alteration correlates with the duration of the stress. We further quantified the relative changes and the spatial localization of these changes in this mouse model and found out that the maximum changes occurred nearly symmetrically in both regions of the hippocampus. The mRNA for stress-related genes, brain-derived neurotrophic factor and tyrosine kinase-coupled receptor were also significantly reduced in the hippocampus of corticosterone-treated mice compared to that in control mice. These results indicate that chronic corticosterone treatment induces nanoscale structural alterations in mouse brain that corresponds to changes in stress-related gene expression.

Two-Dimensional Gold Quantum Dots with Tunable Bandgaps

Metallic gold nanoparticles (Au NPs) with multilayer Au atoms are useful for plasmonic, chemical, medical, and metamaterial application. In this article, we report the opening of the bandgap in substrate-supported two-dimensional (2D) gold quantum dots (Au QDs) with monolayer Au atoms. Calculations based on density functional theory suggest that 2D Au QDs are energetically favorable over 3D Au clusters when coated on hexagonal boron nitride (BN) surfaces. Experimentally, we find that BN nanotubes (BNNTs) can be used to stabilize 2D Au QDs on their cylindrical surfaces as well as Au atoms, dimers, and trimers. The electrically insulating and optically transparent BNNTs enable the detection of the optical bandgaps of the Au QDs in the visible spectrum. We further demonstrate that the size and shapes of 2D Au QDs could be atomically trimmed and restructured by electron beam irradiation. Our results may stimulate further exploration of energetically stable, metal-based 2D semiconductors, with properties tunable atom by atom.

Determinants of infant breastfeeding practices in Nepal: a national study

Background

Optimal breastfeeding practices, reflected by early initiation and feeding of colostrum, avoidance of prelacteal feeds, and continued exclusivity or predominance of breastfeeding, are critical for assuring proper infant nutrition, growth and development.

Methods

We used data from a nationally representative survey in 21 district sites across the Mountains, Hills and Terai (southern plains) of Nepal in 2013. Determinants of early initiation of breastfeeding, feeding of colostrum, prelacteal feeding and predominant breastfeeding were explored in 1015 infants < 12 months of age. Prelacteal feeds were defined as food/drink other than breast milk given to newborns in first 3 days. Predominant breastfeeding was defined as a child < 6 months of age is mainly breastfed, not fed solid/semi-solid foods, infant formula or non-human milk, in the past 7 days. Adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated, using log Poisson regression models with robust variance for clustering.

Results

The prevalence of breastfeeding within an hour of birth, colostrum feeding, prelacteal feeding and predominant breastfeeding was 41.8, 83.5, 32.7 and 57.2% respectively. Compared to infants not fed prelacteal feeds, infants given prelacteal feeds were 51% less likely to be breastfed within the first hour of birth (APR 0.49; 95% CI 0.36, 0.66) and 55% less likely to be predominantly breastfed (APR 0.45; 95% CI 0.32, 0.62). Infants reported to have received colostrum were more likely to have begun breastfeeding within an hour of birth (APR 1.26; 95% CI 1.04, 1.54) compared to those who did not receive colostrum. Infants born to mothers ≥ 20 years of age were less likely than adolescent mothers to initiate breastfeeding within 1 hour of birth. Infants in the Terai were 10% less likely to have received colostrum (APR 0.90; 95% CI 0.83, 0.97) and 2.72 times more likely to have received prelacteal feeds (APR 2.72; 95% CI 1.67, 4.45) than those in the Mountains.

Conclusions

Most infants in Nepal receive colostrum but less than half initiate breastfeeding within an hour of birth and one-third are fed prelacteal feeds, which may negatively affect breastfeeding and health throughout early infancy.

Electronic supplementary material

The online version of this article (10.1186/s13006-019-0208-y) contains supplementary material, which is available to authorized users.

Chronic hyponatremia and association with osteoporosis among a large racially/ethnically diverse population

Chronic hyponatremia may contribute to decreased bone density. We studied 341,003 men and women who underwent DXA testing and observed that individuals with chronic hyponatremia (sodium < 135 mEq/L) had an 11% greater likelihood of having osteoporosis. There was a dose-dependent effect with lower sodium and stronger association with osteoporosis.

INTRODUCTION

Chronic hyponatremia has been associated with both neurologic deficits and increased risk of gait abnormalities leading to falls and resultant bone fractures. Whether chronic hyponatremia contributes to decreased bone density is uncertain. We evaluated whether chronic, mild hyponatremia based on serial sodium measurements was associated with increased risk of osteoporosis within a large, ethnically diverse population.

METHODS

This is a retrospective cohort study between January 1, 1998 and December 31, 2014 within Kaiser Permanente Southern California, an integrated healthcare delivery system. Men and women were aged ≥ 55 years with ≥ 2 serum sodium measurements prior to dual-energy X-ray absorptiometry (DXA) testing. Time-weighted (TW) mean sodium values were calculated by using the proportion of time (weight) elapsed between sodium measurements and defined as < 135 mEq/L. Osteoporosis defined as any T-score value ≤ - 2.5 of lumbar spine, femoral neck, or hip.

RESULTS

Among 341,003 individuals with 3,330,903 sodium measurements, 11,539 (3.4%) had chronic hyponatremia and 151,505 (44.4%) had osteoporosis. Chronic hyponatremic individuals had an osteoporosis RR (95% CI) of 1.11 (1.09, 1.13) compared to those with normonatremia. A TW mean sodium increase of 3 mEq/L was associated with a lower risk of osteoporosis [adjusted RR (95% CI) 0.95 (0.93, 0.96)]. A similar association was observed when the arithmetic mean sodium value was used for comparison.

CONCLUSIONS

We observed a modest increase in risk for osteoporosis in people with chronic hyponatremia. There was also a graded association between higher TW mean sodium values and lower risk of osteoporosis. Our findings underscore the premise that chronic hyponatremia may lead to adverse physiological effects and responses which deserves better understanding.

Abstract P1-12-12: Bubble packaging of adjuvant endocrine therapy:updated analysis of compliance and survival

Introduction: Adherence to endocrine therapy is a long recognized problem despite efficacy of these drugs with reported compliance rates of 89% in first year and 50% in fourth year. Most of our knowledge of noncompliance is observational and retrospective. This final analysis of the Bubble Study reports the compliance rate of adjuvant endocrine therapy among women with early stage breast cancer using “bubble” packaging. We previously reported adherence rates of 97% with bubble packaging. This updated analysis includes disease free survival (DFS) and overall survival (OS) at 5 years.

Methods: The Bubble study is a non-blinded, prospective observational cohort study, which enrolled 86 patients between August 2012 and April 2014. Demographic and clinical data were collected prospectively including age, race, insurance, duration of therapy, stage, treatment, comorbidities, recurrence and survival. Duration of therapy was divided into 3 cohorts: &lt;12 months, 12-36 months, and 37-60 months. All patients received routine prescriptions in a “bubble” pack or daily blister pack. Patients returned all used bubble packs at follow up appointments for review and kept a diary of missed doses for analysis. DFS and OS data were obtained at 78 months. Compliance was defined as &gt;90% adherence. We calculated institutional DFS and OS for breast cancer patients treated within a similar time frame from the tumor registry.

Results: 53 patients were included in the analysis. The remaining patients withdrew from the study prior to data collection or were deemed ineligible. The overall compliance rate was 97%; however, only 72% of enrolled patients were continued in the analysis. None of the variables examined (race, age, insurance status and stage) had an impact on compliance. Only duration of endocrine therapy had a marginal effect on compliance (p value = 0.06). The latest cohort (duration of therapy 37-60 months) was least likely to be compliant at 89.53%. Our 5-year DFS is 92% and 5-year OS is 96%. There is no statistically significant difference in DFS and OS between patients with compliance&gt;90% and &lt;90%. For ER+ breast cancer patients treated during similar timeframe at our institution outside the trial, 5-year DFS is 94% and 5-year OS is 90%.

Conclusion: There was no difference in OS or DFS based on compliance to oral anti-estrogens. Given the high overall compliance rate in this small patient population, the lack of OS and DFS difference is not surprising. However, the compliance rate of bubble packaging (&gt;90%) is higher than expected based on current literature. Although this may suggest improved compliance with bubble packaging, more studies are necessary to confirm this given small sample size and high trial dropout rate. Trial withdrawal likely altered analysis of adherence rates as it selects for a largely compliant group of patients.This bias may also explain the lack of difference in compliance rate among race, insurance status and/ or age, which contradicts our current knowledge of high-risk groups.There was a trend towards lower DFS in the bubble cohort, but overall better survival when comparing to institutional rate. Studies are ongoing to confirm bubble packaging adherence rates and compare this to established strategies to improve adherence.

Citation Format: Bhandari S, Ngo PT, Mandadi M, Wu X, Brown C, Rai S, Riley EC. Bubble packaging of adjuvant endocrine therapy:updated analysis of compliance and survival [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-12.

Optical study of chemotherapy efficiency in cancer treatment via intracellular structural disorder analysis using partial wave spectroscopy

As cancer progresses, macromolecules, such as DNA, RNA or lipids, inside cells undergo spatial structural rearrangements and alterations. Mesoscopic light transport-based optical partial wave spectroscopy (PWS) was recently introduced to quantify changes in the nanoscale structural disorder in biological cells. The PWS measurement is performed using a parameter termed as "disorder strength" (L _d ), which represents the degree of nanoscale structural disorder inside the cells. It was shown that cancerous cells have higher disorder strength than normal cells. In this work, we first used the PWS to analyze the hierarchy of different types of prostate cancer cells, namely, C4-2, DU-145 and PC-3, by quantifying their average disorder strengths. Results expectedly showed that L _d values increases in accordance with the increasing aggressiveness/tumorigenicity levels of these cells. Using the L _d parameter, we then analyzed the chemoresistance properties of these prostate cancer cells to docetaxel drug compared to their chemosensitivity. Results show that chemoresistant cancer cells have increased L _d values, that is, higher disorder strength, relative to chemosensitive cancer cells. Thus, use of the L _d metric can be effective in determining the efficacy of particular chemotherapy.

Nutritional resilience in Nepal following the earthquake of 2015

Background

The 2015 earthquake in Nepal caused massive damages and triggered relief activities to minimize human suffering. The post-earthquake nutrition and food security situation in the hardest hit areas remains uncertain.

Methods

Two national cross-sectional surveys were conducted in 2014 and 2016 among households (HH) with pre-school aged children or newly married women. Of the 21 village development committees (VDCs) included in this sample, 7 fell within “earthquake-affected” areas. This paper presents data from 982 HH, 1015 women, and 883 children from 2014 and 1056 HH, 1083 women, and 998 children from 2016 living in these areas, with longitudinal overlap of about 55%. Prevalence estimates and 95% confidence intervals were calculated, and logistic regression was used to calculate p-values, both using robust estimates of standard errors to account for clustering.

Results

From 2014 to 2016, child wasting (weight-for-height z score <-2) fell from 4.5% (95% CI 3.3%– 6.1%) to 2.1% (1.4%– 3.1%) and food insecurity (assessed using the household food insecurity access scale) dropped from 17.6% (11.7%– 25.6%) to 12.4% (6.9%– 21.2%). Child stunting prevalence remained similar at both time-points. Improvements were also evident in dietary diversity and breastfeeding indicators.

Conclusions

Nutrition and food security conditions remained comparable or improved one year after the earthquake despite evidence of structural and other damage. Livelihood resilience to shocks and/or effective nutrition, food or health interventions may have helped buffer the impact on nutrition, although this hypothesis requires further exploration.

Induction of labor in Mid-Western Hospital in Nepal: Practice and Solution

 IntroductionInduction of labour has been common intervention in modern obstetrics. This study is aimed to determine the distribution of practice and outcomes related to induction of labour in Mid-Western Regional Hospital in Nepal. MethodsThis is a retrospective cross-sectional study conducted at Mid-Western Regional Hospital in Surkhet, Nepal. Secondary data were collected from patients’ records of the hospital dating from 16 July 2016 to 15 July 2017. All women who underwent induction of labour with oral misoprostol were included in this study. For induction of labour, maximum five doses of 50 microgram oral misoprostol was administered in every four hours. Descriptive summary statistics such as frequency and percentages were calculated.ResultsOut of total 3,694 pregnant women who delivered in MWRH, 10.5% (n = 387) were induced by oral misoprostol. Majority of labour induced women were in the age group of 20 – 24 years (52.9%), 37 – 42 weeks of gestation (69.5%), and multi-gravida (49.9%). Majority (77.0%) who underwent induction of labour had vaginal delivery. Among total induction of labour, 88.9% had healthy babies. Majority of new borns had APGAR score of six or more in both one minute (87.9%) and five minutes (93.6%). More than half of the new borns (54.5%) had birth weight of 3000 – 3500 grams. Most of the induced cases (97.4%) were free of complications. Only 1.3% of cases had post-partum haemorrhage. ConclusionsInduction of labour using oral misoprostol is a common practice in Mid-Western Regional hospital in Nepal and majority (77.0%) who underwent induction of labour had vaginal delivery. 

Imaging quantum dot formation in MoS2 nanostructures

Among two-dimensional materials, semiconducting ultrathin sheets of MoS₂ are promising for nanoelectronics. We show how a scanning probe microscope (SPM) can be used to image the flow of electrons in a MoS₂ Hall bar sample at 4.2 K allowing us to understand device physics at the nanoscale. The SPM tip acts as a movable gate and capacitively couples the SPM tip to the device below. By measuring the change in device conductance as the tip is raster scanned across the sample, spatial maps of the device conductance can be obtained. We present images showing the characteristic 'bullseye' pattern of Coulomb blockade conductance rings around a quantum dot formed in a narrow contact as the carrier density is depleted with a backgate. These images show that multiple dots are created by the disorder potential in MoS₂. From these SPM images, we estimate the size and position of these quantum dots using a capacitive model.