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The Mediterranean and a low carbohydrate diet are two popular dietary approaches recommended for cardiovascular and metabolic health, respectively. This trial will compare the combined effect of these diets to either approach alone for the treatment of the metabolic syndrome (MetS). Males and females (n=222), 30-75 years, with at least three MetS risk factors will be randomised to one of 3 diets: i) Traditional Mediterranean (∼55% of energy carbohydrate [CHO]:15% Protein [Pro]: 30% Fat), ii) Lower Carbohydrate (∼35%CHO:20%Pro:45%Fat), or iii) Lower Carbohydrate Mediterranean (∼35%CHO:20%Pro:45%Fat) diet for 12-weeks. The primary outcome measure is the MetS Severity Z Score (MetS-Z), a composite score of risk factors, sex and ethnicity. MetS-Z will be calculated pre and post intervention using fasted blood samples for plasma triglycerides, HDL-cholesterol and glucose, systolic blood pressure, body weight and waist circumference measures. The findings from this trial will offer new insights into the most effective dietary strategy for managing diabetes and reducing cardiovascular risk in individuals with metabolic syndrome.
Responsive feeding characterised by recognising and appropriately addressing children’s hunger and satiety signals, plays a key role in health. Despite children’s innate ability to self-regulate food intake, caregivers can override these cues, especially in child care settings. The study determined the effects of a 6-month coaching intervention on the responsive feeding environments of child care centres. CELEBRATE Feeding was a 6-month, coaching, pre-post intervention design conducted in eight child care centres across Nova Scotia and Prince Edward Island, Canada. Child care centres’ feeding environments and educator practices were observed using a modified Environment and Policy Assessment and Observation tool at baseline and follow-up in two rooms per centre (n = 16). Twenty-one responsive feeding components were scored from 0–3 (3 as best practice). The average centre scores were summed for an overall score ranging from 0–63 at each time point. Paired samples t-tests and Wilcoxon signed rank tests were conducted to assess the impact of the intervention on overall rooms’ and individual responsive feeding components’ scores. There was an increase in scores from baseline (M = 38.16, SD = 6.55) to follow-up (M = 45.75, SD = 5.87), t (15) = 4.91, P < 0.001. All but one score improved, where 3 of the 21 scores were significantly more responsive after the intervention after applying a Bonferroni correction (P < 0.002). The score with the greatest positive change was ‘Educators provide gentle comments or nudges towards feeding’, with a mean difference of 1.33, P < 0.001. The CELEBRATE Feeding coaching intervention was successful in improving responsive feeding practices and environments in child care settings.
Acanthobothrium represents the most species-rich genus of onchoproteocephalidean cestodes, with adults parasitizing the spiral valves of elasmobranch fishes. Between October 2023 and August 2025, Acanthobothrium minus, previously reported from the Algerian coast in Raja asterias (Mediterranean starry ray), was collected from the spiral valve of Raja asterias, and the rough ray, Raja radula. This parasite is characterized by its small body size and reduced number of proglottids. In this study, we examine its host specificity and provide a redescription of A. minus from the type locality and host, and an additional host (R. radula) using light microscopy and molecular approaches. Furthermore, we present, for the first time, molecular and phylogenetic data based on 28S rDNA sequences for this species, along with a detailed morphometric comparison to other CategoryII Acanthobothrium species infecting Rajidae from the Mediterranean. Our phylogenetic results show all Acanthobothrium species 28S sequences from the Mediterannean grouping in the same clade and suggest close affinity with Acanthobothrium coronatum (Category 4). These results support that these taxonomic categories are a useful guide for morphological comparisons but are not correlated with true phylogenetic relationships. Furthermore, the regional grouping of these sequences from relatively distantly related definitive hosts (the shark Scyliorhinus stellaris L. and the skates R. asterias and R. radula) supports evolution of this elasmobranch-Acanthobothrium association in the Mediterranean through host switching due to shared ecological features of the hosts followed by speciation by isolation. However, additional support for this hypothesis would require more in-depth taxonomic representation of available sequence data.
Depression is a common comorbidity in neuropsychiatric disorders, affecting a significant proportion of patients with neurodegenerative diseases. Traditional antidepressants show limited efficacy, particularly in cases involving comorbid depressive symptoms, highlighting the need for alternative treatments.
Methods
Here we provide the first data on possible benefits of add-on therapy with transcranial pulse stimulation (TPS). Based on the largest patient sample in the emerging field of focused ultrasound (FUS) neuromodulation to date, a retrospective analysis was conducted on 88 patients with various neuropsychiatric diagnoses to evaluate the impact of TPS on depressive symptoms, measured by the Beck Depression Inventory (BDI-II).
Results
The study revealed significant improvements in BDI-II scores posttreatment (N = 88), with the most substantial effects observed in more severely impacted patients: individuals with minimal to severe depression (BDI-II ≥9; N = 32) experienced an average reduction of 5.22 points (29.46%), while those with mild to severe depression (BDI-II ≥14; N = 15) showed an even greater mean improvement of 10.40 points (40.51%). These results surpassed established thresholds for clinical relevance and substantially exceeded placebo effect sizes observed in relevant brain stimulation studies. Moreover, depression score improvement was independent of diagnostic group (dementia, movement disorders, or other), improvement of the primary diagnosis, antidepressant medication, and baseline cognitive status, highlighting the potential of TPS as an effective therapeutic add-on intervention for patients receiving state-of-the-art treatments.
Conclusions
The study’s findings indicate that TPS enhances depression outcomes in neuropsychiatric patients, particularly in those with more severe depressive symptoms.
Many parasitic nematodes exhibit a range of behavioural responses to host-associated stimuli, especially chemicals. The infective juveniles (IJs) of specialized insect-infecting nematodes, i.e., entomopathogenic nematodes (EPNs), can show directed movement (taxis) or other behaviours in response to odorants. However, relatively little is known in terms of IJ responses in the context of increases in non-directed movement (kinesis) resulting from physical contact with host chemicals, or the effects of insect semiochemicals on EPN behaviours. We individually exposed IJs of the EPN Steinernema carpocapsae to solutions representing five different treatments, including those containing the macerated tissues of a suitable insect host (greater wax moth larvae – waxworms) or a semiochemical (1-pentadecene) secreted by various insects. We conducted behavioural observations at six time points over an 8-h period, measuring the total number of movements by each IJ (orthokinesis), along with the occurrence of side-to-side movements (klinokinesis) or head-waving. We found that IJs in the waxworm or 1-pentadecene solutions showed high levels of overall movement, but waxworm-exposed IJs also exhibited the most sinusoidal movement, whereas IJs exposed to 1-pentadecene exhibited far more head-waving than nematodes in the other treatments. These results indicate that S. carpocapsae shows behavioural responses through kinesis when exposed to host chemical cues in an aqueous medium. As our study is only the second report of EPNs responding to an insect semiochemical, this is a promising area for future studies to better understand host-finding strategies by these nematodes, with possible applications for their use in insect biocontrol.
To pilot a registry to evaluate the use and effectiveness of interventional cancer pain management.
Methods
Upon interventional pain procedure scheduling, patient demographics, cancer, and pain information were entered into the longitudinal clinical registry in 2 tertiary hospitals in Sydney, Australia (Royal Prince Alfred Hospital and Chris O’Brien Lifehouse). Details of the procedure (including proceduralist, nature of the intervention, and site of treatment), post-procedure patient-reported outcomes and quality of life surveys, adverse events, and mortality data (when known) were collected longitudinally.
Results
Between October 2021 and March 2023, 48 patients underwent 55 procedures. Procedures included treatment targeting autonomic plexuses, peripheral nerves, fascial planes, and neuraxial structures. Celiac plexus neurolysis was the most frequently reported procedure (33.3%). Post-procedure, there was a trend in reduction in pain intensity on the Patient-Reported Outcome Measurement Information System (p < 0.01), reduction in opioid consumption, and improvement in quality of life on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core-15-Palliative Care.
Significance of results
This is a vital first step in creating a more widely applicable registry evaluating cancer pain intervention. It provided valuable information on the range of available pain intervention procedures and data on patient-reported outcome measures using validated instruments. This will facilitate a timely review of clinical practice to improve future patient care. An Australian-wide database of cancer pain will be a valuable next step in the improvement of cancer pain management.
Health systems have finite capacity. During crises, policymakers may explicitly reallocate health system resources, or capacity limitations may necessitate implicit resource reallocation. This study modelled timing and intensity of pre-vaccination health system resource reallocation policies to predict excess mortality during the COVID-19 pandemic.
Methods
This longitudinal panel analysis included 85 countries (752 country-months, January 2020-January 2021). The predictor was resource reallocation scope, scale (summarized as intensity, 0-100), and timing. The outcome was all-cause excess mortality (percentage deaths greater than historical average/month). Covariates included COVID-19 incidence and health system parameters.
Results
Simultaneous health system resource reallocation was associated with increased mortality in multivariate models (b = 0.80, 95%CI 0.42-1.18). However, preemptive (previous month’s) resource reallocation was protective against excess mortality (b = −0.58, 95%CI −0.93–0.23: e.g., 42,010 fewer deaths per unit increased resource reallocation, March 2020, all study countries). Effects were magnified in older populations. Health system capacity and preparedness were associated with lower mortality.
Conclusions
In the pre-vaccination COVID-19 pandemic, preemptive health system resource reallocation was associated with lower mortality, whereas simultaneous resource reallocation was associated with greater mortality. This longitudinal multinational study indicates that readiness, capacity building, and proactive resource reallocation improve crisis response.
The objective of this study was to develop and validate an educational comic book designed to promote healthy eating among caregivers of young children. The study was conducted in four phases: (1) literature review and script development; (2) creation of the initial version of the comic book, including illustrations, layout and design, and calculation of the Flesch Readability Index (FI); (3) expert validation of the initial version and calculation of the Content Validity Index (CVI); and (4) adaptation of the comic book based on expert suggestions, recalculation of the FI, and pilot testing (CVI) with a lay population. A total of 64 volunteers participated in the validation process, including 14 expert judges and 50 caregivers responsible for feeding children aged 0 to 5 years. Statistical analysis included descriptive measures and inferential testing using the Wilcoxon signed-rank test. The FI score for the initial version was 85.0%, indicating a reading level classified as “easy to understand.” After expert evaluation, the CVI reached 94%, reflecting high agreement among participants. In the revised version, the FI remained high at 84.7%, reinforcing the “easy to understand” reading level, while the CVI increased to 98% following the pilot test, demonstrating strong consensus among participants. A significant improvement in knowledge regarding healthy eating was observed after reading the comic book (p < 0.05). The comic book was validated for appearance, content and readability, showing a positive impact on caregivers’ knowledge about healthy eating practices. It represents an accessible and effective resource that can be integrated into community-based nutrition education programmes.
There is limited data describing statewide pediatric surge response during times of capacity strain.
Objective
Characterize the burden and response to a surge in pediatric respiratory admissions in Oregon in 2022.
Design, Setting, and Participants
This analysis utilized data from the Oregon Capacity System (OCS) and the state discharge database to describe patient characteristics, census changes, and admission pattern shifts during an RSV epidemic in 2022.
Main Outcome and Measure
Statewide pediatric census, weekly pediatric admissions, weekly admissions from non-children’s hospital emergency departments (EDs) to non-children’s hospitals.
Results
The median census in Oregon’s pediatric inpatient hospitals increased by 19% during the surge period (306 vs 364, P < 0.001), while the median pediatric intensive care unit census increased by 50% (24 vs 36, P < 0.001). Weekly elective pediatric admissions to children’s hospitals decreased by 33% (30 vs 20, P = 0.03). ED admissions to non-children’s hospitals increased by 160% (15 vs 39 per week, P = 0.02).
Conclusion and Relevance
As the statewide pediatric inpatient census increased, targeted reductions in elective admissions and increased utilization of non-children’s hospitals increased capacity during a respiratory surge. This analysis underscores the importance of real-time situational awareness and coordinated surge response between hospitals.
In recent years, we have seen an immense expansion in recombinant DNA, especially in its use in gene therapy applications. Throughout its history, the United States set up several mechanisms of national safety and ethical oversight for rDNA to ensure that we proceeded with its use appropriately. As our knowledge and experience with it grew, there has been increasing pressure to decrease the oversight and monitoring requirements for its use. In 2019, the National Institutes of Health amended the NIH Guidelines for Research Involving Recombinant DNA Molecules eliminated three national mechanisms for guidance, monitoring, and review of this biotechnology. Four years later, we revisit these changes and their implications for a current emerging biotechnology: xenotransplantation. By better understanding the motivations for these mechanisms and analyzing the test case, we argue that these changes have worrisome implications for our ethical oversight of emerging biotechnologies both in the realm of gene transfer technologies and beyond.
This study provides the description of a new species of Anisakidae, Contracaecum cocoi sp. nov., as well as the record of Contracaecum jorgei, both species parasitizing the Cocoi heron Ardea cocoi (Ardeidae) in a locality from the Buenos Aires Province, Argentina. An integrative taxonomic approach was used, involving phylogenetic analyses and the examination of diagnostic morphological features in the studied specimens. Among other features, the new species can be morphologically distinguished by the papillae arrangement on the male tail: while C. jorgei exhibits a simple morphotype A, C. cocoi sp. nov. presents an intermediate morphotype B. Mainly, the possession of three adcloacal papillae pairs is a diagnostic feature separating this new species from the rest of the Contracaecum species. The cox2 mtDNA isolates exhibited C. cocoi sp. nov. as a single node and grouped close to the clade formed by both species Contracaecum micropapillatum and C. bancrofti. The other cox2 mtDNA sequences showed a great concordance with C. jorgei. The K2P distances calculated for the cox2 mtDNA isolates of C. cocoi sp. nov. displayed a distance of 0.12 with C. bancrofti, 0.13 with C. micropapillatum, and 0.16 with C. jorgei. Contracaecum cocoi sp. nov. is proposed as a new taxon clearly supported by both phylogenetic analysis and distinctive morphological features that distinguish it from its congeners. The occurrence of C. cocoi sp. nov. together with C. jorgei in sympatric and syntopic conditions suggests that ecological or reproductive isolating mechanisms may be acting to maintain distinct lineages in shared environments. New records, particularly those involving intermediate and definitive hosts, will contribute to elucidating the distribution of these parasites in the Americas and potentially lead to the discovery of new species.
To investigate the variations of serum ghrelin levels in children with left-to-right shunt CHD, and analyse the correlation with the geometric structure of the heart. It may provide some clinical guidance for evaluating the early changes of cardiac structure and function in CHD children.
Methods:
A total of 93 children with left-to-right shunt CHD who were hospitalised to Children’s Hospital of Soochow University from September 2021 to February 2023 were included in the CHD group (of which 58 were ventricular septal defect and 35 were patent ductus arteriosus). In addition, 57 cases (mainly inguinal hernia) were selected as the control group. The corresponding clinical data were recorded, and the fasting serum ghrelin levels of the two groups were detected by enzyme-linked immunosorbent assay on the day of admission. Then, the clinical data and serum ghrelin levels of the two groups were compared, and the Spearman correlation was analysed.
Results:
The serum ghrelin level in CHD group was higher than that in control group, and the difference was statistically significant (P < 0.05). Z score of weight for age and Z score of height for age in CHD group were lower than those in control group were statistically significant difference (P < 0.05). But there was no correlation between serum ghrelin and BMI, weight-for-age Z-score, and height-for-age Z-score (P > 0.05). Ghrelin in the enlarged heart group was lower than that in the non-enlarged heart group, and there were statistical significance of among those groups (P < 0.05). There were no significant differences in left ventricular ejection fraction and left ventricular fractional shortening among different cardiac load groups (P > 0.05). The left ventricular end-systolic diameter Z-scores, left ventricular mass Z-scores, left ventricular mass index, and left ventricular end-diastolic volume-scores in the cardiomegaly groupwere higher than those in the non-cardiomegaly group, and those two groups were significantly different (P < 0.05). The relative wall thickness and left ventricular remodelling index in the cardiomegaly group were lower than those in the non-cardiomegaly group, and the differences between the groups were statistically significant (P < 0.05). Serum ghrelin was negatively correlated with left ventricular end-diastolic diameter Z-scores, left ventricular end-systolic diameter Z-scores, and left ventricular end-diastolic volume Z-scores in cardiac indexes (P < 0.05), positively correlated with left ventricular remodelling index (P < 0.05), and had no correlation with relative wall thickness, left ventricular mass Z-scores, and left ventricular mass index (P > 0.05).
Conclusion:
The levels of serum ghrelin are increased in CHD children, and serum ghrelin is negatively correlated with left ventricular end-diastolic diameter and left ventricular end-diastolic volume in cardiac geometric structure, and positively correlated with left ventricular remodelling index. Additionally, patients with cardiac enlargement present with a low serum ghrelin level. These findings collectively suggest that serum ghrelin may play a potential role in cardiac remodelling.
Prenatal exposure to polyunsaturated fatty acids (PUFAs) has been associated with child weight at birth and may have a persistent effect on adiposity development across childhood. Fish is the richest source of n-3 PUFAs within the diet; albeit few studies have investigated associations between maternal fish consumption during pregnancy and child weight. This study examines associations between maternal fish consumption and prenatal PUFA status (n-3 and n-6), with longitudinal measures of child weight in the high-fish-eating Seychelles Child Development Study Nutrition Cohort 2. Maternal fish consumption during pregnancy was assessed using a Fish Use Questionnaire administered at 28-weeks’ gestation. Serum PUFAs were quantified in maternal blood collected at 28-weeks’ gestation and in cord blood collected at delivery. Birth weight was measured at delivery and classified according to WHO growth standards (n=1185). Child length/height (m) and weight (kg) were recorded at 20 months (n=1182), 7 (n=1167) and 13 (n=878) years. Child BMI was classified according to child z-scores. Maternal total fish consumption (range: 0.0-584.71 g/day) was not associated with child weight at any age. At 7 and 13 years maternal total n-6 PUFAs were associated with an increased risk of overweight/obesity (7yr; OR=1.62, p=0.037, 13yr; OR=2.05, p=0.005). Lower (<0.071mg/ml) cord docosahexaenoic acid (DHA) concentrations were associated with a greater likelihood of being large for gestational age (LGA; >90th percentile) when compared to higher (>0.129mg/ml) cord DHA concentrations (OR 4.17, p=0.017). This study suggests prenatal maternal n-3 and n-6 PUFA status may influence postnatal outcomes, including child adiposity from birth until adolescence.