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Alcohol milestones and internalizing, externalizing, and executive function: longitudinal and polygenic score associations
- Sarah E. Paul, David A.A. Baranger, Emma C. Johnson, Joshua J. Jackson, Aaron J. Gorelik, Alex P. Miller, Alexander S. Hatoum, Wesley K. Thompson, Michael Strube, Danielle M. Dick, Chella Kamarajan, John R. Kramer, Martin H. Plawecki, Grace Chan, Andrey P. Anokhin, David B. Chorlian, Sivan Kinreich, Jacquelyn L. Meyers, Bernice Porjesz, Howard J. Edenberg, Arpana Agrawal, Kathleen K. Bucholz, Ryan Bogdan
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- Journal:
- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 09 May 2024, pp. 1-14
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Background
Although the link between alcohol involvement and behavioral phenotypes (e.g. impulsivity, negative affect, executive function [EF]) is well-established, the directionality of these associations, specificity to stages of alcohol involvement, and extent of shared genetic liability remain unclear. We estimate longitudinal associations between transitions among alcohol milestones, behavioral phenotypes, and indices of genetic risk.
MethodsData came from the Collaborative Study on the Genetics of Alcoholism (n = 3681; ages 11–36). Alcohol transitions (first: drink, intoxication, alcohol use disorder [AUD] symptom, AUD diagnosis), internalizing, and externalizing phenotypes came from the Semi-Structured Assessment for the Genetics of Alcoholism. EF was measured with the Tower of London and Visual Span Tasks. Polygenic scores (PGS) were computed for alcohol-related and behavioral phenotypes. Cox models estimated associations among PGS, behavior, and alcohol milestones.
ResultsExternalizing phenotypes (e.g. conduct disorder symptoms) were associated with future initiation and drinking problems (hazard ratio (HR)⩾1.16). Internalizing (e.g. social anxiety) was associated with hazards for progression from first drink to severe AUD (HR⩾1.55). Initiation and AUD were associated with increased hazards for later depressive symptoms and suicidal ideation (HR⩾1.38), and initiation was associated with increased hazards for future conduct symptoms (HR = 1.60). EF was not associated with alcohol transitions. Drinks per week PGS was linked with increased hazards for alcohol transitions (HR⩾1.06). Problematic alcohol use PGS increased hazards for suicidal ideation (HR = 1.20).
ConclusionsBehavioral markers of addiction vulnerability precede and follow alcohol transitions, highlighting dynamic, bidirectional relationships between behavior and emerging addiction.
The contribution of cannabis use to the increased psychosis risk among minority ethnic groups in Europe
- J. P. Selten, M. Di Forti, D. Quattrone, P. B. Jones, H. E. Jongsma, C. Gayer-Anderson, A. Szöke, P. M. Llorca, C. Arango, M. Bernardo, J. Sanjuan, J. L. Santos, M. Arrojo, I. Tarricone, D. Berardi, A. Lasalvia, S. Tosato, C. la Cascia, E. Velthorst, E. M. A. van der Ven, L. de Haan, B. P. Rutten, J. van Os, J. B. Kirkbride, C. M. Morgan, R. M. Murray, F. Termorshuizen
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- Journal:
- Psychological Medicine , First View
- Published online by Cambridge University Press:
- 09 May 2024, pp. 1-10
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Background
We examined whether cannabis use contributes to the increased risk of psychotic disorder for non-western minorities in Europe.
MethodsWe used data from the EU-GEI study (collected at sites in Spain, Italy, France, the United Kingdom, and the Netherlands) on 825 first-episode patients and 1026 controls. We estimated the odds ratio (OR) of psychotic disorder for several groups of migrants compared with the local reference population, without and with adjustment for measures of cannabis use.
ResultsThe OR of psychotic disorder for non-western minorities, adjusted for age, sex, and recruitment area, was 1.80 (95% CI 1.39–2.33). Further adjustment of this OR for frequency of cannabis use had a minimal effect: OR = 1.81 (95% CI 1.38–2.37). The same applied to adjustment for frequency of use of high-potency cannabis. Likewise, adjustments of ORs for most sub-groups of non-western countries had a minimal effect. There were two exceptions. For the Black Caribbean group in London, after adjustment for frequency of use of high-potency cannabis the OR decreased from 2.45 (95% CI 1.25–4.79) to 1.61 (95% CI 0.74–3.51). Similarly, the OR for Surinamese and Dutch Antillean individuals in Amsterdam decreased after adjustment for daily use: from 2.57 (95% CI 1.07–6.15) to 1.67 (95% CI 0.62–4.53).
ConclusionsThe contribution of cannabis use to the excess risk of psychotic disorder for non-western minorities was small. However, some evidence of an effect was found for people of Black Caribbean heritage in London and for those of Surinamese and Dutch Antillean heritage in Amsterdam.
Is higher fruit and vegetable intake associated with a reduced risk of depression in middle-aged and older adults? Data from 10 diverse international cohorts
- A. Matison, V. Flood, B. Lam, D. Lipnicki, K. Tucker, P. Preux, M. Guerchet, E. d’Ors, I. Skoog, N. Scarmeas, O. Gureje, S. Shahar, K. Anstey, R. Ho, H. Brodaty, P. Sachdev, S. Reppermund, K. Mather, for Cohort Studies of Memory in an International Consortium (COSMIC)
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E73
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Depression is the largest global contributor to non-fatal disease burden(1). A growing body of evidence suggests that dietary behaviours, such as higher fruit and vegetable intake, may be protective against the risk of depression(2). However, this evidence is primarily from high-income countries, despite over 80% of the burden of depression being experienced in low- and middle-income countries(1). There are also limited studies to date focusing on older adults. The aim of this study was to prospectively examine the associations between baseline fruit and vegetable intake and incidence of depression in adults aged 45-years and older from 10 cohorts across six continents, including four cohorts from low and middle-income countries. The association between baseline fruit and vegetable intake and incident depression over a 3–6-year follow-up period was examined using Cox proportional hazard regression after controlling for a range of potential confounders. Participants were 7771 community-based adults aged 45+ years from 10 diverse cohorts. All cohorts were members of the Cohort Studies of Memory in an International Consortium collaboration(3). Fruit intake (excluding juice) and vegetable intake was collected using either a comprehensive food frequency questionnaire, short food questionnaire or diet history. Depressive symptoms were assessed using validated depression measures, and depression was defined as a score greater than or equal to a validated cut-off. Prior to analysis all data were harmonised. Analysis was performed by cohort and then cohort results were combined using meta-analysis. Subgroup analysis was performed by sex, age (45 – 64 versus 65+ years) and income level of country (high income countries versus low- and middle-income countries). There were 1537 incident cases of depression over 32,420 person-years of follow-up. Mean daily intakes of fruit were 1.7 ± 1.5 serves and vegetables 1.9 ± 1.4. serves. We found no association between fruit and vegetable intakes and risk of incident depression in any of the analyses, and this was consistent across the subgroup analyses. The low intake of fruit and vegetables of participants, diverse measures used across the different cohorts, and modest sample size of our study compared with prior studies in the literature, may have prevented an association being detected. Further investigation using standardised measures in larger cohorts of older adults from low- to middle-income countries is needed. Future research should consider the potential relationship between different types of fruits and vegetables and depression.
Price, social life and proximity influence food choices: Engaging young people as co-researcher collaborators to better understand their surrounding school food environments
- S. Jia, A.A. Gibson, R. Raeside, R. Valanju, E. McMahon, B. Ren, F. Yan, K. Tse, M. X. Zeng, M. Allman-Farinelli, S.R. Partridge
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- Journal:
- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E157
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Food environments around secondary schools are a strong influence on adolescents’ food purchasing habits1. We conducted a repeat cross-sectional study using Google Street View to examine school food environments in regional and metropolitan NSW, Australia over 17-years. Findings showed that unhealthful food outlets such as fast-food franchises, consistently dominated school food environments over 2007-2023. Increasing levels of poor nutrition among youth has been raised as a concern2 by the Health Advisory Panel for Youth at the University of Sydney [HAPYUS] - an established group of 16 adolescents aged 13-18 years residing in NSW3. To gain further insight into the study findings and how it may impact adolescents’ health, it is critical to include voices of adolescents in this research. The aim of this sub-study was to engage with members of our youth advisory group and conduct a consultation exercise on these study findings, drawing upon their lived experiences of school food environments. In Aug-2023, we engaged four youth advisors from HAPYUS. Study authors provided an overview of the study and its findings to the youth advisors via a Zoom call. Youth advisors formulated a 500-word statement on their perspectives and lived experiences of food environments surrounding their high schools over the subsequent 4 weeks. Adolescents agreed that physical proximity to unhealthy food outlets around schools was a key contributor to unhealthy eating habits however also recognised social and economic factors which play a significant role in shaping poor diets. The following quotes from their combined statement reflect social and economic concerns: i) “[We] observed on a daily basis young people were opting to travel to the closest food court for fast food, or in some extreme cases, even order fast food via a meal delivery app, to be delivered to the school - as opposed to choosing the closest outlet” ii) “Overpriced foods in schools with some drinks costing 2x more than a heavily discounted KFC meal, no meaningful difference between foods sold at canteens and those sold at fast food outlets - heavily processed, packaged snacks, pre-made reheated foods” iii) “Most unhealthy food outlets choose a location that is not only close to schools but also close to major shopping centres and food courts… ideal for an after-school social catchup as it appears to accommodate the needs of a large group of people.” Consultation findings revealed the importance of social and economic factors that must be analysed in addition to adolescents’ physical proximity to food outlets around their schools. Youth advisors call for governments to take immediate action to implement policies that ensure schools have cheap and healthy foods at canteens to mitigate against the purchase of foods from nearby unhealthy food outlets.
The effectiveness of a Lactobacillus probiotic on measures of psychosocial health in adults diagnosed with subthreshold depression: a double-blind, randomised, placebo-controlled trial
- G. Moschonis, K. Sarapis, S. Resciniti, R. Hall, K. Yim, M. Tonkovic, C. Fitzgerald, F. Anixiadis, Q. Nhu Dinh, M. Hale, B. Wright, M. Pane, C.J. Tuck, J.R. Biesiekierski
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E58
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Depression is the leading cause of disability worldwide(1). The microbiota-gut-brain axis may play a role in the aetiology of depression, and probiotics show promise for improving mood and depressive state(2). Further evidence is required to support mechanisms and in high-risk populations, such as those with sub-threshold depression (which may be 2-3 times more prevalent than diagnosed depression)(3). The aims were to assess the efficacy of a probiotic compared with placebo in reducing the severity of depressive symptoms in participants with subthreshold depression, and to investigate potential mechanistic markers of inflammatory, antioxidant status and stress response. A double-blind, randomised, placebo-controlled trial was conducted in participants meeting diagnosis of subthreshold depression (DSM-5); aged 18-65 years; ≥18.5 kg/m2 body mass index; not taking antidepressants, centrally acting medications, probiotics nor antibiotics for at least 6 weeks. The probiotic (4 × 109 AFU/CFU, 2.5 g freeze-dried powder containing Lactobacillus fermentum LF16 (DSM26956), L. rhamnosus LR06 (DSM21981), L. plantarum LP01 (LMG P-21021), Bifidobacterium longum BL04 (DSM 23233)) or placebo was taken daily for 3-months. Data was collected at 3 study visits (pre-, mid- (6 weeks), post-intervention). Self-reported questionnaires measured psychological symptoms (Beck Depression Inventory, BDI; Hospital Anxiety Depression Scale, HADS) and quality of life. Blood and salivary samples were collected for biomarkers including cortisol awakening response (CAR). General linear models examined within-group and between-group differences across all time points. Thirty-nine participants completed the study (n = 19 probiotic; n = 20 placebo) using intention-to-treat analysis. The probiotic group decreased in BDI score by −6.5 (95% CI −12.3; −0.7) and −7.6 (95% CI −13.4; −1.8) at 6 and 12 weeks, respectively. The HADS-A score decreased in the probiotic group by −2.8 (95% CI −5.2; −0.4) and −2.7 (95% CI −5.1; −0.3) at 6 and 12, respectively. The HADS-D score decreased in the probiotic group by −3.0 (95% CI −5.4; −0.7) and −2.5 (−4.9; −0.2) at 6 and 12 weeks of intervention, respectively. No between group differences were found. There were no changes in perceived stress or quality of life scores. The probiotic group had reduced hs-CRP levels (7286.2 ± 1205.8 ng/dL vs. 5976.4 ± 1408.3; P = 0.003) and increased total glutathione (14.2 ± 8.9 ng/dL vs. 9.3 ± 4.7; P = 0.049) compared to placebo, post intervention. Lower levels of CAR were found in the probiotic compared to placebo (−0.04 ± 0.17 μg/dL vs. 0.16 ± 0.25; P = 0.009). A significant reduction in depressive symptoms and anxiety was observed within the probiotic group only. These results were supported by improvements observed in biomarkers, suggesting probiotics may improve psychological wellbeing in adults experiencing sub-threshold depression, by potential pathways involved in central nervous system homeostasis and inflammation. Future analyses are required to understand changes within the intestinal microbiota and to clarify how their metabolites facilitate emotional processing.
Validating an electronic snacking questionnaire among New Zealand adolescents and young adults with type 1 diabetes – feasibility study
- S. Styles, J. Haszard, S. Rose, A. Barea, B. Wheeler
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E195
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Type 1 diabetes (T1D) is a chronic autoimmune disease characterised by a deficiency in insulin production and consequent hyperglycaemia. A glycated haemoglobin (HbA1c) value < 53 mmol/mol (< 7%) is recommended to reduce the risk for diabetes-specific complications(1). However, most adolescents and young adults (AYAs) have an HbA1c above the target(2). Dietary behaviours, including a routine meal plan with snacks, play a significant role in self-management(3). Snacks without an insulin bolus, grazing or snacking to cope with stress contribute to out-of-target glucose levels. Although modifying AYAs’ snacking behaviours could be a low-cost, equitable, and effective approach to improving glycaemic control, there is a dearth of evidence to inform effective snacking interventions. Importantly, no brief, validated tool exists to assess snacking behaviour among individuals with T1D. This research explored the acceptability and feasibility of validating a snacking questionnaire adapted for AYAs with T1D; a crucial step before a larger validation study. Twenty-five AYAs (aged 13-20 years) with T1D and receiving diabetes care through Te Whatu Ora Southern were invited to participate in a feasibility study. Purposive sampling was used for maximum variability in participants’ demographic characteristics. All study procedures were completed remotely, with electronic questionnaires administered in the morning via a secure web platform. On days 1 and 8 of the 8-day study, participants completed a 30-item snacking questionnaire that assessed the timing and frequency of snacking and types of food or drinks consumed as a snack in the past seven days. The snacking questionnaire was adapted from questionnaires previously used in population-level surveys. An experienced diabetes dietitian ensured that items reflected foods commonly consumed by AYAs with T1D. Before recruitment, two diabetes dietitians and a young adult with T1D critically reviewed the adapted snacking questionnaire. On days 2-8, participants recalled their snacking behaviour (timing, frequency, food/drink consumed) over the previous day. The proportion of completed snacking questionnaires assessed feasibility, defined as a response rate ≥ 80%. The ease of completing the snacking questionnaires was self-reported on a Likert-type scale (1-completely agree, 5-completely disagree) to assess acceptability, defined as ≤ 20% of participants reporting the questionnaires were not easy to complete. Participants (n = 10) were aged 16.2 ± 1.69 years, 60% male, and 90% self-identified as New Zealand or Other European. All participants completed the proposed validation study. Most (95%) of the snacking questionnaires were completed. All (100%) daily snacking behaviour questionnaires were completed. All participants (100%) agreed that the questionnaires were easy to complete. The snacking behaviours questionnaire validation procedures are feasible and acceptable to New Zealand and Other European AYAs with T1D. Feasibility and acceptability must be explored among ethnically diverse AYAs before conducting a larger rigorous validation study.
Cognitively testing Aotearoa’s food security questionnaire in the modern context
- B. Follong, C. Haliburton, S. Mackay, J. Grey, M. Maiquez, C. Ni Mhurchu
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E156
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The eight well-known food security indicators were developed in 1997 using a stepwise process that involved five focus group interviews (one Māori, one Pakeha, two Pacific, and one mixed ethnicity) of 8-16 people, all of whom were either on a low income or were government beneficiaries(1). As part of the development of the tools and methods for a future New Zealand National Nutrition Survey, these eight indicators were considered for inclusion. The Māori and Technical Advisory Groups convened for the development of the National Nutrition Survey foresaw issues with the interpretation of some of the questions given the changes in the food environment and sources of food assistance in the last 25 years and recommended that cognitive testing should be conducted to see if changes were required. Participants were recruited through two community organisations, a local marae, and community Facebook pages. Participants were given the option of participating in a one-on-one interview or as part of a focus group. During each session, participants were asked five (three original and two new) questions relating to food security (running out of basics, use of food assistance, household food preparation and storage resources). After each question, the participants were asked a series of additional probing questions to ascertain whether they had interpreted the question as intended. All interviews were audio recorded and transcribed, and a qualitative analysis was performed on the transcripts to determine areas of concern with each question. A total of 46 participants completed the cognitive testing of the food security questions, including 26 aged 18-64 years, and 20 aged 65+ years. Participants also spanned a range of ethnicities including 8 Māori, 15 Pasifika, 15 Asian, and 8 New Zealand European or Other. Just over half of the participants (n=24) reported themselves to be financially secure, 16 participants reported that their financial security was borderline, 1 participant reported that they were not at all financially secure, and 5 participants declined to answer. Variable interpretations of terms by participants were found in all questions that were tested. Therefore, answers to the food security questions may have not reflected the actual experience of participants. This study also identified other dimensions of food security not assessed by the current eight indicators (e.g., lack of time, poor accessibility). These findings indicate that the food security questions need to be improved to ensure they are interpreted as intended and that new questions are needed that considers all dimensions of food insecurity (i.e., access, availability, utilisation, and stability). These new and amended questions should be cognitively tested in groups that are more likely to be experiencing food insecurity.
Exploring school food provision programs and links to local foods in Pacific Island countries
- J. Perry, B. Horsey, J. Raneri, D. Hunter, S. O’Connor, M. Hyland-Wood, E. Casey, S. Burkhart
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E20
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Providing access to food in schools can serve as a platform for food system transformation, while simultaneously improving educational outcomes and livelihoods. Locally grown and procured food is a nutritious, healthy, and efficient way to provide schoolchildren with a daily meal while, at the same time, improving opportunities for smallholder farmers(1). While there is significant potential for school food provision activities to support healthy dietary behaviours in the Pacific Islands region, there is limited evidence of these types of activities(2), including scope and links to local food production in the region. Therefore, the aim of this scoping study was to understand the current state of school food activities (school feeding, gardening and other food provision activities) and any current, and potential links to local agriculture in the Pacific Islands. A regional mapping activity was undertaken, initially covering 22 Pacific Island countries. The mapping included two steps: 1) a desk based scoping review including peer-reviewed and grey literature (2007-2022) and 2) One-hour semi-structured online Zoom interviews with key country stakeholders. Twelve sources were identified, predominately grey literature (n = 9). Thirty interviews were completed with at least 1 key stakeholder from 15 countries. A variety of school food provision activities were identified, including school feeding programs (n = 16, of varying scale), programs covering both school feeding and school gardens (n = 2), school garden programs (n = 12), and other school food provision activities (n = 4, including taste/sensory education, food waste reduction, increasing canteen capacity for local foods, supply chain distribution between local agriculture and schools). Existing links to local agriculture varied for the different programs. Of the 16 school feeding programs, 8 had a requirement for the use of local produce (policy requirement n = 6, traditional requirement from leaders n = 2). Of the 12 school garden programs, 6 used local or traditional produce in the garden and 5 involved local farmers in varying capacities. Challenges to linking local agriculture into school food provision programs were reported for 17 activities and were context dependent. Common challenges included limited funding, inflation, Covid-19, inadequate produce supply for the scale of program, limited farmer capacity, limited institutional support for local produce, low produce storage life, climatic conditions and disasters, water security, delayed procurement process, and limited professional development and upskilling opportunities. Modernisation and colonisation of food systems resulting in a preference for hyperpalatable foods and challenges in incorporating local produce in a way that is accepted by students was also identified as a challenge. This evidence can be used to develop a pathway to piloting and implementing models of school food provision programs and promoting opportunities for shared learning and collaboration with key stakeholders across the Pacific Islands region.
Adapting Intake24 for Aotearoa - New Zealand
- B. Follong, S. Mackay, C. Haliburton, J. Grey, M. Maiquez, C. Ni Mhurchu
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E23
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National nutrition surveys play a pivotal role in shaping public health policies and programmes by providing valuable insights into dietary intake and the nutritional wellbeing of a population. A team from the University of Auckland and Massey University worked alongside the Ministry of Health and the Ministry for Primary Industries to develop the methods and tools for a future New Zealand Nutrition Survey. Throughout these developmental stages, we partnered and engaged with Māori as tangata whenua, and other key ethnic groups in Aotearoa - New Zealand, ensuring that their unique dietary practices and preferences were accurately captured. This presentation centres on the adaptation of Intake24, an innovative web-based 24-hour dietary recall tool, to optimize dietary data collection within the New Zealand context. The adaptation process involved several key steps including rationalisation of a New Zealand-specific food list, incorporating cultural dishes, adding new portion size estimation aids, and further customisation of the user interface(1). We provide new insights into the user experience and the tool’s functionality, sharing findings from field testing and valuable user feedback. This approach ensures collection of dietary data that is truly representative of the New Zealand population and acknowledges the rich diversity and dietary nuances within the country. As such, this adapted New Zealand version of Intake24 could serve as an essential tool for use in a future National Nutrition Survey or other research initiatives to collect accurate, culturally sensitive, and actionable nutrition data providing evidence to inform future public health programmes and policies.
Supporting Food and Nutrition Education in The Pacific Islands: Scoping Resources and Professional Development Opportunities for Teachers
- B. Horsey, J. Perry, D. Craven, J. Nyemah, S. Burkhart
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E144
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Schools provide a unique opportunity to educate and motivate Pacific Island students and the wider Pacific Island community about food systems, food production activities (e.g., gardening and cooking) and to focus on the knowledge and skills needed to make healthy and sustainable food choices. Recent work(1) has identified limited access to appropriate and credible learning and teaching resources and varying integration of food and nutrition in the curriculum across the Pacific Islands (P.I) region. Teachers reported an ardent desire to incorporate nutrition into the curriculum, but were not sure how to do this, or where to source assistance, including credible learning materials. Stakeholders also reported requiring assistance to develop contextualised learning materials, and that there were limited options for upskilling in food, nutrition and agriculture. Recommendations from this work included the development of a tool to assist teachers to bridge the gap between understanding the benchmark or learning outcomes provided in curriculum and designing engaging and authentic activities and assessment to meet these. Therefore, this project aimed to identify food and nutrition curriculum materials available for Pacific Island educators, to inform the development of a web-based resource. In 2022, a systematic desk-based scoping activity was undertaken to identify any resources available to teach food and nutrition in Pacific Island schools (primary and secondary level) and professional development opportunities relevant for educators. The mapping identified over 70 resources, with resources from almost all countries identified. Some are available for specific countries, but few that are designed for use regionally. Some of these resources are directly aligned to food-based dietary guidelines, while others appear to be developed for specific activities by non-governmental organisations. Very few professional development activities were identified. Once a resource was identified, the project team used the CRAAP test(2) to evaluate the credibility of this. If deemed credible, the resource was tagged with key words (e.g., Tonga, gardening) and added for inclusion. The key resource categories (for tagging) were cooking, ocean and waterway foods, food in schools, food safety, healthy eating, sustainability, pacific research, teaching practice, gardening and WASH. A web designer developed the web-based resource through collaboration with the project team. Users can search for resources by country and/or topic. Based on the mapping of professional development activities, a professional development activity based on assessing the credibility of information was developed and added to the L&T toolkit. Users of the hub can share resources (their own) or identify other resources that could be added to the hub. There are limited resources and opportunities for Pacific Island food and nutrition teachers to upskill in food and nutrition education. School educators may benefit from more food and nutrition resources and professional development activities to complement those that are currently available.
Assessing the Impact of Reducing Food-Related Choking for Babies and Young Children at Early Learning Services Guidance: Online survey in four regions of New Zealand
- L. Young, S. Agar, B. Chiwawa, B. Edge, T. Goodsell-Mathews, S. Gerritsen
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E89
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Young children, especially those under one year of age, are at higher risk of choking on food due to their body’s immature physiology and chewing, swallowing and coughing ability(1). In 2020, the Ministry of Education mandated the Ministry of Health’s food-related choking guidance for babies and young children at early learning services (ELS), adding it to the licensing criteria(2). Some ELS managers reported that this policy may negatively influence the food and nutrition environment within ELS(3).This study aimed to assess the impact of the food-related choking policy on the food and nutrition environment within ELS. Data were collected using an online Qualtrics questionnaire from ELS in four District Health Board regions: Waikato, Bay of Plenty, Lakes, and Auckland (N = 1066), sourced from the Ministry of Education, Education Counts database. Responses were received from 179 ELS (17%) and most reported making changes due to the food-related choking guidance. The main changes were to the food provided by the ELS (75%), education for whānau/family (73%), and supervision of children (70%). Over half of the centres reported adjusting staff duties to allow for increased supervision of eating (60%) and changed/ceased celebrations or fundraisers (58%). Over half of the respondents (55%) reported that changes to reduce the risk of food-related choking had affected the ‘cultural kaupapa’ (plan/policy) of the ELS. A key theme from written responses was that centres had ‘not come together as whānau’, which refers to reduced hosting of centre events/celebrations within the centre and externally with children and whānau (families). The main reason appeared to be that the food restrictions in the guidance made the management of ‘shared kai (food)’ too difficult. Approximately two-thirds of centres (61%) reported removing foods from menus, and around half (49%) modified the texture of foods. Fifty-one per cent of ELS reported that there had been no change in parent-supplied food. The main foods removed from ELS menus were fruit, vegetables, hard crackers, sausages/other meats, and popcorn. Soft fruit, e.g., canned fruit, soft crackers, and soft meats (hamburger patties, mince, luncheon, and ham), were the main foods added to menus. ELS have responded to most of the new food-related choking guidance requirements regarding food provision, texture modification, and supervision; however, some ELS may need support to implement fully. Ceasing shared kai events at ELS has reduced opportunities to engage with whānau and limits cultural expression, connection and reciprocal learning and teaching about food and nutrition between the centre and whānau as outlined in Te Whariki Early Childhood Curriculum. Improved communication and support for parents and ELS to implement the recommendations for home and centre-supplied foods is needed. Together with sufficient funding for supervision and nutrition education to support children’s learning and cultural needs around food.
A bacteriophage-based validation of a personal protective equipment doffing procedure to be used with high-consequence pathogens
- Brandon A. Berryhill, Kylie B. Burke, Andrew P. Smith, Jill S. Morgan, Jessica Tarabay, Josia Mamora, Jay B. Varkey, Joel M. Mumma, Colleen S. Kraft
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- Infection Control & Hospital Epidemiology , First View
- Published online by Cambridge University Press:
- 06 May 2024, pp. 1-7
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Objective:
To determine if the high-level personal protective equipment used in the treatment of high-consequence infectious diseases is effective at stopping the spread of pathogens to healthcare personnel (HCP) while doffing.
Background:Personal protective equipment (PPE) is fundamental to the safety of HCPs. HCPs treating patients with high-consequence infectious diseases use several layers of PPE, forming complex protective ensembles. With high-containment PPE, step-by-step procedures are often used for donning and doffing to minimize contamination risk to the HCP, but these procedures are rarely empirically validated and instead rely on following infection prevention best practices.
Methods:A doffing protocol video for a high-containment PPE ensemble was evaluated to determine potential contamination pathways. These potential pathways were tested using fluorescence and genetically marked bacteriophages.
Results:The experiments revealed existing protocols permit contamination pathways allowing for transmission of bacteriophages to HCPs. Updates to the doffing protocols were generated based on the discovered contamination pathways. This updated doffing protocol eliminated the movement of viable bacteriophages from the outside of the PPE to the skin of the HCP.
Conclusions:Our results illustrate the need for quantitative, scientific investigations of infection prevention practices, such as doffing PPE.
Aeolian dynamics at the northern edge of Deliblato (Banat) Sand Sea, Vojvodina, Serbia, at the time of the last deglaciation
- Rastko S. Marković, Zoran M. Perić, Milivoj B. Gavrilov, Slobodan B. Marković, Jef Vandenberghe, Randall J. Schaetzl, Igor Obreht, Tamás Bartyik, Milica G. Radaković, Aleksandar Radivojević, Miloš Marjanović, Tin Lukić, György Sipos
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- Journal:
- Quaternary Research , First View
- Published online by Cambridge University Press:
- 03 May 2024, pp. 1-14
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The Deliblato (Banat) Sand Sea, which is one of the largest areas of аeolian sand in Europe, is located near the Iron Gate, which marks the crossing of the Danube River through the biggest gorge of this river. Here, Danubian alluvium has served as the sand source for the Banat Sand Sea, which was formed primarily through southeasterly (Košava) winds. Utilizing a multi-proxy approach, the objective of this study is to gain a better understanding of the environmental dynamics of the Banat Sand Sea. To achieve this goal, we conducted an analysis of an archive representing an approximately 20-m-thick dune formation on the northern edge of this dune field. Using optically stimulated luminescence (OSL) dating, we calculated aeolian sedimentation rates and dune ages. Sand was deposited here approximately between 17 ka and 13 ka. Magnetic susceptibility, grain size, and colorimetric analyses were interpreted in terms of local paleoenvironmental conditions. Calculated sedimentation rates (SR) indicate intensive aeolian deposition during the study period that range from 483 cm/ka to 502 cm/ka. We compared our data with regional and other European archives, as well as with climatic variations recorded in the Greenland ice core North Greenland Ice Core Project (NGRIP).
5 - Patient Self-Administered Screening for Cardiovascular Disease Using Artificial Intelligence in the Home
- from Part II - Digital Home Diagnostics for Specific Conditions
- Edited by I. Glenn Cohen, Harvard Law School, Massachusetts, Daniel B. Kramer, Harvard Medical School, Massachusetts, Julia Adler-Milstein, University of California, San Francisco, Carmel Shachar, Harvard Law School, Massachusetts
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- Book:
- Digital Health Care outside of Traditional Clinical Settings
- Published online:
- 25 April 2024
- Print publication:
- 02 May 2024, pp 65-78
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Summary
The UK National Health Service (NHS) has committed £250 million toward the deployment of artificial intelligence (AI). One compelling use case involves patient-recorded cardiac waveforms, interpreted in real-time by AI to predict the presence of common, clinically actionable cardiovascular diseases. Waveforms are recorded by a handheld device applied by the patient at home in a self-administered “smart” stethoscope examination. The deployment of such a novel home-based screening program, combining hardware, AI, and a cloud-based administrative platform, raises ethical challenges, including considerations of equity, agency, data rights, and, ultimately, responsibility for safe, effective, and trustworthy implementation. The meaningful use of these devices without direct clinician involvement transfers the responsibility for conducting a diagnostic test with potentially life-threatening consequences onto the patient. The use of patients’ own smartphones and internet connections should also meet the data security standards expected of NHS activity. Additional complexity arises from rapidly evolving questions around data “ownership,” according to European law a term applicable only to the patient from whom the data originate, when “controllership” of patient data falls to commercial entities. Clarifying the appropriate consent mechanism requires the reconciliation of commercial, patient, and health system rights and obligations. Oriented to this real-world clinical setting, this chapter evaluates the ethical considerations of extending home-based, self-administered AI diagnostics in the NHS. It discusses the complex field of stakeholders, including patients, academia, and industry, all ultimately beholden to governmental entities. It proposes a multi-agency approach to balance permissive regulation and deployment (to align with the speed of innovation) against ethical and statutory obligations to safeguard public health. It further argues that a strong centralized approach to carefully evaluating and integrating home-based AI diagnostics is necessary to balance the considerations outlined above. The chapter concludes with specific, transferable policy recommendations applicable to NHS stewardship of this novel diagnostic pathway.
Foredune erosion, overtopping and destruction in 2022 at Bengello Beach, southeastern Australia
- Thomas S. N. Oliver, Michael A. Kinsela, Thomas B. Doyle, Roger F. McLean
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- Journal:
- Cambridge Prisms: Coastal Futures / Volume 2 / 2024
- Published online by Cambridge University Press:
- 26 April 2024, e7
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The beach–foredune system at Bengello Beach has been monitored monthly to bimonthly at four profiles (P1–P4) since 1972 and documented the building of a foredune. This paper addresses the remarkable changes which occurred in 2022 as storm waves overtopped and trimmed this foredune at all profiles, then later removed this entire feature at two of the profiles (P3, P4) but not the others (P1, P2). Wave parameters for these storm events, measured by deepwater and nearshore wave buoys, enable a comparison of storm characteristics and resulting beach–foredune impact. During the storm event which destroyed the foredune, nearshore wave height exceeded deepwater wave height, in contrast with other storms that year. The beach–foredune lost 78 m3/m in 2022 and the notable 1974 storms that impacted this coastline resulted in 95 m3/m volume loss. During 2023, beach recovery has occurred, but not rebuilt the foredune. It had persisted for ~40 years enduring many other severe storm events, and the coastal protection afforded by the dune system has been compromised. This highlights the need to consider dune morphology in assessments of erosion hazard and inundation risk along similar coastlines.
The Alagoas Antwren Myrmotherula snowi is in imminent danger of extinction
- Hermínio A. L. S. Vilela, Arthur B. Andrade, Helder F. P. Araujo, Tony A. Bichinski, Bárbara Cavalcante, Pedro F. Develey, Alice Reisfeld, Benjamin T. Phalan
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- Journal:
- Bird Conservation International / Volume 34 / 2024
- Published online by Cambridge University Press:
- 25 April 2024, e12
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The “Critically Endangered” Alagoas Antwren Myrmotherula snowi is found only in the Atlantic Rainforest of north-east Brazil. We surveyed all sites where the species has been recorded, as well as 15 other potential sites. We summarise all observations of the species, focusing on the period from 2016 onwards, and including systematic censuses in three breeding seasons (October–March 2018/19, 2019/20, and 2020/21) at the type locality, Murici, where we also searched for nests of the species. We did not locate any individuals at sites other than Murici. The number of apparent individuals detected declined by 67% over seven years (a decline of 50% over the three years in which standardised systematic counts were made), and only six adults were observed in the most recent breeding season. The global population is now likely to be in single-digit figures. Of five nests found, four failed, through predation by snakes and opossums, and abandonment. We installed protective barriers to protect two of these nests from predators, which may have contributed to the single successful fledging. Such methods offer most hope for now of stalling the decline. Efforts to develop captive breeding methods with model species have been underway since 2019 but face many difficulties. Improving habitat protection and restoration is crucial but will only take effect in the long term.
Vortex shedding behind porous flat plates normal to the flow
- M.M. Cicolin, S. Chellini, B. Usherwood, B. Ganapathisubramani, Ian P. Castro
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- Journal:
- Journal of Fluid Mechanics / Volume 985 / 25 April 2024
- Published online by Cambridge University Press:
- 25 April 2024, A40
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This work examines the influence of body porosity on the wake past nominally two-dimensional rectangular plates of fixed width $D$ in the moderate range of Reynolds numbers $Re = UD/\nu$ (with $U$ the incoming velocity and $\nu$ the kinematic viscosity) between 15 000 and 70 000. With porosity $\beta$ defined as the ratio of open to total area of the plate, it is well established that as porosity increases, the wake shifts from the periodic von Kármán shedding behaviour to a regime where this vortex shedding is absent. This change impacts the fluid forces acting on the plate, especially the drag, which is significantly lower for a wake without vortex shedding. We analyse experimentally the transition between these two regimes using hot-wire anemometry, particle-image velocimetry and force measurements. Coherence and phase measurements are used to determine the existence of regular, periodic vortex shedding based on the velocity fluctuations in the two main shear layers on either side of the wake. Results show that, independent of $Re$, the wake exhibits the classical Kármán vortex shedding pattern for $\beta <0.2$ but this is absent for $\beta >0.3$. In the intermediate range, $0.2<\beta <0.3$, there is a transitional regime that has not previously been identified; it is characterised by intermittent shedding. The flow alternates randomly between a vortex shedding and a non-shedding pattern and the total proportion of time during which vortex shedding is observed (the intermittency) decreases with increasing porosity.
Exploration of COLREG-relevant parameters from historical AIS-data
- Inger B. Hagen, Karen S. Knutsen, Tor Arne Johansen, Edmund Brekke
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- Journal:
- The Journal of Navigation , First View
- Published online by Cambridge University Press:
- 18 April 2024, pp. 1-19
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Reliable anti-collision control algorithms conforming with the rules regulating traffic at sea, the International Regulations for Preventing Collisions at Sea (COLREG), are essential for the deployment of autonomous vessels in waters shared with other ships. The development of such methods is an active field of research. However, little attention has been given to how these rules are interpreted by experienced mariners, and how such information can be parametrised for use in automatic control systems and autonomous ships. This paper presents a method for exploiting historical automatic identification system (AIS) data to characterise parameters indicating the prevalent practices at sea in encounters with high collision risk. The method has been tested on data gathered in areas off the Norwegian coast over several years. Statistics on relevant parameters from the resulting dataset and the relation between them is presented. The results indicate that the strongest influence on vessel behaviour is the type of situation, and the amount of land and grounding hazards in the vessel's proximity.
Modeling weed seedling emergence for time-specific weed management: a systematic review
- Caroline A. Marschner, Isabella Colucci, Rebecca S. Stup, Anna S. Westbrook, Caio A.C.G. Brunharo, Antonio DiTommaso, Mohsen B. Mesgaran
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- Journal:
- Weed Science / Accepted manuscript
- Published online by Cambridge University Press:
- 17 April 2024, pp. 1-44
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Understanding the timing of weed emergence is crucial to effective management. Management practices implemented too early may fail to completely control late-emerging seedlings, whereas management practices implemented too late will suffer from low efficacy. Weed emergence times reflect biological factors, such as seed dormancy and germination requirements, as well as environmental conditions. We conducted a systematic review of studies that developed models to predict weed emergence temporal patterns. We screened 1,854 studies, 98 of which were included in the final dataset. Most included studies were conducted in North America (51) or Europe (30). A wide variety of weed species (102) and families (21) were included, and many studies modeled several weeds. Grass weeds (Poaceae) were modeled most frequently (83 instances). Most weeds (40%) had base temperature Tb values between 0 to 5 C and 38% had base water potential ψb ranging from -1.0 to -0.5 MPa. Most studies used empirical parametric models, such as Weibull (40%) or Gompertz (30%) models. Non-parametric and mechanistic models were also represented. Models varied in their biological and environmental data requirements. In general, empirical parametric models based on hydrothermal time (i.e., time above base temperature and water potential thresholds) represented a good balance between ease of use and prediction accuracy. Soft computing approaches such as artificial neural networks demonstrated substantial potential in situations with complex emergence patterns and limited data availability, although they can be susceptible to overfitting. Our study also demonstrated variability in model performance and limited generalizability across species and regions. This finding underscores the need for context-specific and well-validated weed emergence models to inform management, especially in the context of climate change.
Impact of elevated body mass index (BMI) on cognitive functioning and inflammation in persons with post-COVID-19 condition: a secondary analysis
- Gia Han Le, Angela T.H. Kwan, Ziji Guo, Sabrina Wong, Sebastian Badulescu, Hartej Gill, Kayla M. Teopiz, Shakila Meshkat, Felicia Ceban, Lee Phan, Mehala Subramaniapillai, Joshua D. Di Vincenzo, Joshua D. Rosenblat, Rodrigo B. Mansur, Giacomo d’Andrea, Roger Ho, Taeho Greg Rhee, Roger S. McIntyre
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- Journal:
- Acta Neuropsychiatrica , First View
- Published online by Cambridge University Press:
- 12 April 2024, pp. 1-7
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Background:
Individuals who have recovered from the acute stage of SARS-CoV-2 infection may be at risk of developing post-COVID-19 condition (PCC), characterised by a spectrum of persisting, non-specific, and functionally impairing symptoms across multiple organ systems. Obesity has been implicated as a risk factor for PCC, mediated by chronic systemic inflammation. The foregoing has also been separately reported to mediate cognitive dysfunction in PCC.
Methods:This is a post-hoc analysis of a randomised, double-blinded, placebo-controlled clinical trial evaluating vortioxetine treatment for cognitive impairments in persons with PCC who received vortioxetine or placebo for eight weeks. This analysis comprises baseline data, examining the impact of BMI on cognitive functioning measured by the Digit Symbol Substitution Test (DSST) and Trails Making Tests (TMT)-A/B, as well as inflammation, via serum c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
Results:Complete data from 70 participants were statistically analysed and adjusted for age and sex. BMI was negatively correlated with performance on the DSST (β = −0.003, p = 0.047), TMT-A (β = −0.006, p = 0.025), and TMT-B (β = −0.006, p = 0.002). BMI was positively correlated with serum CRP (unstandardized β = 0.193, standardized β = 0.612, p < 0.001) and ESR (β = 0.039, p < 0.001) levels.
Conclusion:We observed a significant negative correlation between BMI and cognitive functioning, and a significant positive correlation between BMI and inflammation in persons with PCC, suggesting a bidirectional interplay between BMI, PCC, and cognitive function; individuals with an elevated BMI may be at a greater risk of developing PCC and/or presenting with greater cognitive deficits mediated by chronic systemic inflammation.