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Antenatal corticosteroids are given to pregnant people at risk of preterm birth to reduce newborn morbidity, including respiratory distress syndrome. However, there has been concern surrounding potential adverse effects on subsequent generations. Animal studies have demonstrated endocrine and metabolic changes in those exposed to corticosteroids in utero (F1) and in the second generation (F2). We aimed to assess the effects of parental antenatal corticosteroid exposure on health of the second generation (F2) of Auckland Steroid Trial (AST) participants. In the AST, women (F0) expected to birth between 24 and 36 weeks’ gestation were randomised to betamethasone or placebo. When their children (F1) were 50 years old, they and their children (F2) were followed up with a self-report questionnaire and data linkage. The primary outcome for this analysis was body mass index (BMI) z-score in the F2 generation. Secondary outcomes included respiratory, cardiovascular, neurodevelopmental, mental and general health, and social outcomes. Of the 213 F2 participants, 144 had BMI data available. There was no difference in BMI z-score between participants whose parent was exposed to betamethasone versus placebo (mean (SD) 0.63 (1.45), N = 77 vs 0.41 (1.28), N = 67, adjusted mean difference (95% confidence interval) = 0.16 (-0.37, 0.69)). There was no evidence of a difference in rates of overweight, diabetes, respiratory disease, cardiometabolic risk factors, neurodevelopmental difficulties, mental health difficulties and social outcomes between parental betamethasone versus placebo exposure groups, but confidence intervals were wide. These findings are reassuring regarding the intergenerational safety of antenatal corticosteroids.
Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Current clinical guidelines for people at risk of heart disease in Australia recommend nutrition intervention in conjunction with pharmacotherapy(1). However, Australians living in rural and remote regions have less access to medical nutritional therapy (MNT) provided by Accredited Practising Dietitians (APDs) than their urban counterparts(2). The aim of the HealthyRHearts study was to trial the delivery of MNT by APDs using telehealth to eligible patients of General Practitioners (GPs) located in small to large rural towns in the Hunter New England region(3) of New South Wales, Australia. The study design was a 12-month pragmatic randomised controlled trial. The key outcome was reduced total cholesterol. The study was place-based, meaning many of the research team and APDs were based rurally, to ensure the context of the GPs and patients was already known. Eligible participants were those assessed as moderate-to-high risk of CVD by their GP. People in the intervention group received five MNT consults (totalling two hours) delivered via telehealth by APDs, and also answered a personalised nutrition questionnaire to guide their priorities and to support personalised dietary behaviour change during the counselling. Both intervention and control groups received usual care from their GP and were provided access to the Australian Eating Survey (Heart version), a 242-item online food frequency questionnaire with technology-supported personalised nutrition reports that evaluated intake relative to heart healthy eating principles. Of the 192 people who consented to participate, 132 were eligible due to their moderate-to-high risk. Pre-post participant medication use with a registered indication(4) for hypercholesterolemia, hypertension and glycemic control were documented according to class and strength (defined daily dose: DDD)(5). Nine GP practices (with 91 participants recruited) were randomised to the intervention group and seven practices (41 participants) were randomised to control. Intervention participants attended 4.3 ± 1.4 out of 5 dietetic consultations offered. Of the132 people with baseline clinical chemistry, 103 also provided a 12-month sample. Mean total cholesterol at baseline was 4.97 ± 1.13 mmol/L for both groups, with 12-m reduction of 0.26 ± 0.77 for intervention and 0.28 ± 0.79 for control (p = 0.90, unadjusted value). Median (IQR) number of medications for the intervention group was 2 (1–3) at both baseline and 12 months (p = 0.78) with 2 (1–3) and 3 (2–3) for the control group respectively. Combined DDD of all medications was 2.1 (0.5–3.8) and 2.5 (0.75–4.4) at baseline and 12 months (p = 0.77) for the intervention group and 2.7 (1.5–4.0) and 3.0 (2.0–4.5) for the control group (p = 0.30). Results suggest that medications were a significant contributor to the management of total cholesterol. Further analysis is required to evaluate changes in total cholesterol attributable to medication prescription relative to the MNT counselling received by the intervention group.
Clinicians often rely on caregiver proxy symptom reports to treat cancer-related symptoms in children. Research has described disagreement between children’s and caregivers’ symptom reports. Factors influencing the level of agreement is an understudied area. Thus, this study aimed to examine potential factors contributing to the level of agreement between symptom reports provided by children and their caregivers.
Methods
Sixteen child–caregiver dyads participated separately in semi-structured interviews after completing a brief symptom measure independently using an electronic device. Child and caregiver quantitative symptom responses were reviewed in real-time and incorporated into the semi-structured interview. Sample characteristics and the level of agreement between symptom reports were calculated using descriptive statistics. Transcribed participant interviews were analyzed using content analysis.
Results
Nearly half of child–caregiver dyads exhibited a moderate (37.5%, n = 6) or low (18.75%, n = 3) level of agreement on the abbreviated symptom measure. Qualitative analysis identified 5 themes: recognizing symptoms, experiencing symptoms, communicating symptoms, re-assessing and treating symptoms, and influencing individual and relationship factors. Influencing individual, including a child’s tendencies or personality traits, and relationship factors intersected the other themes, partially explained their symptom perceptions, and served to facilitate or hinder symptom communication.
Significance of Results
Symptom communication is an important part of the symptom cycle, comprised of symptom recognition, experience, and management. Individual and relational factors may influence discrepancies in symptom perceptions between the child and caregiver. Clinicians and researchers should consider developing interventions to enhance symptom communication and promote collaboration between children and their caregivers to address symptom suffering during cancer treatment.
The authors report on ancient DNA data from two human skeletons buried within the chancel of the 1608–1616 church at the North American colonial settlement of Jamestown, Virginia. Available archaeological, osteological and documentary evidence suggest that these individuals are Sir Ferdinando Wenman and Captain William West, kinsmen of the colony's first Governor, Thomas West, Third Baron De La Warr. Genomic analyses of the skeletons identify unexpected maternal relatedness as both carried the mitochondrial haplogroup H10e. In this unusual case, aDNA prompted further historical research that led to the discovery of illegitimacy in the West family, an aspect of identity omitted, likely intentionally, from genealogical records.
Salmonella spp. is a common zoonotic pathogen, causing gastrointestinal infections in people. Pigs and pig meat are a major source of infection. Although farm biosecurity is believed to be important for controlling Salmonella transmission, robust evidence is lacking on which measures are most effective. This study enrolled 250 pig farms across nine European countries. From each farm, 20 pooled faecal samples (or similar information) were collected and analysed for Salmonella presence. Based on the proportion of positive results, farms were categorised as at higher or lower Salmonella risk, and associations with variables from a comprehensive questionnaire investigated. Multivariable analysis indicated that farms were less likely to be in the higher-risk category if they had ‘<400 sows’; used rodent baits close to pig enclosures; isolated stay-behind (sick) pigs; did not answer that the hygiene lock/ anteroom was easy to clean; did not have a full perimeter fence; did apply downtime of at least 3 days between farrowing batches; and had fully slatted flooring in all fattener buildings. A principal components analysis assessed the sources of variation between farms, and correlation between variables. The study results suggest simple control measures that could be prioritised on European pig farms to control Salmonella.
With persistent incidence, incomplete vaccination rates, confounding respiratory illnesses, and few therapeutic interventions available, COVID-19 continues to be a burden on the pediatric population. During a surge, it is difficult for hospitals to direct limited healthcare resources effectively. While the overwhelming majority of pediatric infections are mild, there have been life-threatening exceptions that illuminated the need to proactively identify pediatric patients at risk of severe COVID-19 and other respiratory infectious diseases. However, a nationwide capability for developing validated computational tools to identify pediatric patients at risk using real-world data does not exist.
Methods:
HHS ASPR BARDA sought, through the power of competition in a challenge, to create computational models to address two clinically important questions using the National COVID Cohort Collaborative: (1) Of pediatric patients who test positive for COVID-19 in an outpatient setting, who are at risk for hospitalization? (2) Of pediatric patients who test positive for COVID-19 and are hospitalized, who are at risk for needing mechanical ventilation or cardiovascular interventions?
Results:
This challenge was the first, multi-agency, coordinated computational challenge carried out by the federal government as a response to a public health emergency. Fifty-five computational models were evaluated across both tasks and two winners and three honorable mentions were selected.
Conclusion:
This challenge serves as a framework for how the government, research communities, and large data repositories can be brought together to source solutions when resources are strapped during a pandemic.
Efficacy studies show early nutrition interventions improving infant nutrition status, but understanding caregiver acceptability is required for implementation of such interventions. This systematic review examines caregivers’ perceptions of nutrition interventions in young children.
Design:
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL and PsychINFO from date of online journal inception through December 2020. Interventions included oral (powder/liquid/tablet) and/or intravenous supplementation, food fortification and nutrition counselling. Inclusion criteria included primary research, data presented on caregiver perception and studies published in English. Quality assessment was performed using the Critical Appraisal Skills Programme tool. Studies underwent narrative synthesis using inductive thematic analysis.
Setting:
No restriction.
Participants:
Caregivers of children under 24 months of age.
Results:
Of 11 798 records identified, thirty-seven publications were included. Interventions included oral supplementation, food fortification and nutrition counselling. Caregivers included mothers (83 %), fathers, grandparents and aunts. Perceptions were gathered through individual interviews, focus group discussions, questionnaires, surveys and ratings. Totally, 89 % of studies noted high acceptability (n 33 most notably increased appetite (n 17). In total, 57 % of studies (n 21) cited low acceptability, commonly from side effects (n 13) such as gastrointestinal issues, appetite loss and stained teeth.
Conclusions:
Positive perceptions and enthusiasm for interventions were frequently reported. Key to implementation was the increased appetite noted by caregivers. A substantial proportion of studies reported negative perceptions, mainly due to side effects. In future interventions, mitigation and education around common side effects are crucial for acceptability. Understanding both positive and negative caregiver perceptions is important for informing future nutrition interventions and strengthening sustainability and implementation.
Having a sense of calling toward one's work has key benefits for both the employee and the employer. Yet, little is known about whether and what kind of work climate facilitates employees' senses of calling, hindering efforts toward positive changes from managers and organizations. This research introduces the concept of ‘career calling climate’ and describes the development of a scale (i.e., Career Calling Climate Scale) to measure the level of support that a work unit provides for its employees' pursuit of a calling. We established the scale's validity and reliability using survey responses from participants of various occupations and age. To provide evidence of its predictive validity, we examined career calling climate's relation with career callings using a sample of 189 healthcare employees nested in 34 work units. Results suggested that career calling climate predicted individuals' career callings. Implications for theory and practice are discussed.
To date, a limited number of studies have examined aspects of food choice values and food literacy in relation to some aspects of dietary behaviours. The aim of this cross-sectional study was to comprehensively examine the associations of food choice values and food literacy with diet quality. In total, 2231 Japanese adults aged 19–80 years completed questionnaires asking about food choice values (accessibility, convenience, health/weight control, tradition, sensory appeal, organic, comfort and safety) and food literacy characterised by nutrition knowledge, cooking skills, food skills and eating behaviours (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness and slowness in eating). As a measure of diet quality, the Healthy Eating Index-2015 (HEI-2015) was calculated using a brief-type diet history questionnaire (BDHQ) or a food combination questionnaire (FCQ). In males, after adjustment for potential confounding factors (including age, BMI and the ratio of reported energy intake to estimated energy requirement), the HEI-2015 derived from BDHQ and that derived from FCQ were associated significantly (P ≤ 0·02) and positively with the food choice values of organic and inversely with food fussiness. In females, the HEI-2015 showed positive associations with the food choice values of health/weight control, nutrition knowledge and cooking skills and an inverse association with food fussiness, irrespective of the dietary assessment questionnaire (P ≤ 0·03). In conclusion, this study suggests that several aspects of food choice values and food literacy were associated with diet quality, and the aspects related differed between males and females.
Sentences that have more than one possible meaning are said to be syntactically ambiguous (SA). Because the correct interpretation of these sentences can be unclear, resolving SA sentences can be cognitively demanding for children, particularly with regards to inhibitory control (IC). In this study we provide three lines of evidence supporting the importance of IC in SA resolution. First, we show that children with higher IC resolve more SA sentences correctly. Second, we show that SA resolution is worse on tasks that place higher demands on IC, even for children with high IC. Third, we show that children with higher IC make different types of SA errors than children with lower IC. This study expands understanding of the cognitive skills underlying language and suggests a need to consider task demands on IC when developing educational curriculums.
Pre-eclampsia is a serious complication of pregnancy, and maternal nutritional factors may play protective roles or exacerbate risk. The tendency to focus on single nutrients as a risk factor obscures the complexity of possible interactions, which may be important given the complex nature of pre-eclampsia. An evidence review was conducted to compile definite, probable, possible and indirect nutritional determinants of pre-eclampsia to map a nutritional conceptual framework for pre-eclampsia prevention. Determinants of pre-eclampsia were first compiled through an initial consultation with experts. Second, an expanded literature review was conducted to confirm associations, elicit additional indicators and evaluate evidence. The strength of association was evaluated as definite relative risk (RR) < 0·40 or ≥3·00, probable RR 0·40–0·69 or 1·50–2·99, possible RR 0·70–0·89 or 1·10–1·49 or not discernible RR 0·90–1·09. The quality of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation. Twenty-five nutritional factors were reported in two umbrella reviews and twenty-two meta-analyses. Of these, fourteen were significantly associated with pre-eclampsia incidence. Higher serum Fe emerged as a definite nutritional risk factors for pre-eclampsia incidence across populations, while low serum Zn was a risk factor in Asia and Africa. Maternal vitamin D deficiency was a probable risk factor and Ca and/or vitamin D supplementation were probable protective nutritional factors. Healthy maternal dietary patterns were possibly associated with lower risk of developing pre-eclampsia. Potential indirect pathways of maternal nutritional factors and pre-eclampsia may exist through obesity, maternal anaemia and gestational diabetes mellitus. Research gaps remain on the influence of household capacities and socio-cultural, economic and political contexts, as well as interactions with medical conditions.
Palau is a small island/large ocean nation in the Pacific with a population of approximately 18,000 and a high level of vulnerability to natural or climate-related disasters. In June 2022, Palau became the smallest nation in the world by population to establish a national Emergency Medical Team (EMT). The team is named “Klemat,” after the rope that holds the sails of Palau’s traditional canoes.
Objectives:
To establish a national EMT capable of self-sufficient, high-quality clinical response to disasters and outbreaks that may occur locally or in neighboring jurisdictions.
Method/Description:
The development of Klemat required a multi-step process with support from technical and funding partners. Online orientation webinars and meetings were held in 2019 and 2020, and a national Technical Working Group (TWG) was formed in 2022. A national EMT coordinator was jointly hired by the WHO and the Ministry of Health and Human Services of Palau in 2022, and EMT Standard Operating Procedures were drafted.
Results/Outcomes:
Klemat is the nation’s deployable clinical response capacity, capable of fully self-sufficient tented out-patient and emergency care in the most austere disaster or outbreak circumstances. There are now 18 fully trained clinical and support team members. Klemat is working with relevant stakeholders to be codified in the national disaster risk management framework of Palau.
Conclusion:
Palau’s development of a national EMT demonstrates that even the smallest of countries can establish self-sufficient EMTs capable of national or regional response.
A substantial increase in wind energy deployment worldwide is required to help achieve international targets for decreasing global carbon emissions and limiting the impacts of climate change. In response to global concerns regarding the environmental effects of wind energy, the International Energy Agency Wind Technical Collaborative Program initiated Task 34 – Working Together to Resolve Environmental Effects of Wind Energy or WREN. As part of WREN, this study performed an international assessment with the global wind energy and environmental community to determine priority environmental issues over the next 5‒10 years and help support collaborative interactions among researchers, developers, regulators, and stakeholders.
Technical summary
A systematic assessment was performed using feedback from the international community to identify priority environmental issues for land-based and offshore wind energy development. Given the global nature of wind energy development, feedback was of interest from all countries where such development is underway or planned to help meet United Nations Intergovernmental Panel on Climate Change targets. The assessment prioritized environmental issues over the next 5–10 years associated with wind energy development and received a total of 294 responses from 28 countries. For land-based wind, the highest-ranked issues included turbine collision risk for volant species (birds and bats), cumulative effects on species and ecosystems, and indirect effects such as avoidance and displacement. For offshore wind, the highest-ranked issues included cumulative effects, turbine collision risk, underwater noise (e.g. marine mammals and fish), and displacement. Emerging considerations for these priorities include potential application to future technologies (e.g. larger turbines and floating turbines), new stressors and species in frontier regions, and cumulative effects for multiple projects at a regional scale. For both land-based and offshore wind, effectiveness of minimization measures (e.g. detection and deterrence technologies) and costs for monitoring, minimization, and mitigation were identified as overarching challenges.
Social media summary
Turbine collisions and cumulative effects among the international environmental priorities for wind energy development.
Edited by
Marie Roué, Centre National de la Recherche Scientifique (CNRS), Paris,Douglas Nakashima, United Nations Educational, Scientific and Cultural Organization (UNESCO), France,Igor Krupnik, Smithsonian Institution, Washington DC
The objective of this chapter is to describe the ways in which traditional (ribeirinho) and Indigenous (Cocama) farmers of Central Amazonia are modifying their agricultural and livelihood practices in response to extreme flood events, linked to global climate change, which have occurred over the last ten years. Data were gathered through observation and semi-structured interviews conducted by researchers and technicians of the Mamirauá Institute for Sustainable Development, Brazil. Farmers from upland and floodplain environments agree that large floods are more frequent in the region. Extreme floods have resulted in the disappearance of farmers’ local varieties of manioc and diverse fruit species. Residents also discuss the social consequences of floods, including cyclical migration of families between upland and lowland areas and a deteriorating quality of community life during floods. While our initial results demonstrate farmers’ abilities to adapt in the face of rapid global change, we continue to try to understand the processes of ongoing social, economic and environmental change and the extent and limits of local adaptive capacity.
Wild oat (Avena fatua L.) and false cleavers (Galium spurium L.) are currently a challenge to manage in less competitive crops such as flax (Linum usitatissimum L.). Increasing the functional diversity in crop rotations can be an option to improve weed management. Nonetheless, this strategy had not been tested in flax in western Canada. A 5-yr (2015 to 2019) crop rotation study was carried at three locations in western Canada to determine the effect of diverse flax-based crop rotations with differences in crop species, crop life cycles, harvesting time, and reduced herbicides on managing A. fatua and G. spurium. The perennial rotation (flax–alfalfa [Medicago sativa L.]–alfalfa–alfalfa–flax) under reduced herbicide use was found to be the most consistent cropping system, providing A. fatua and G. spurium control similar to the conventional annual flax crop rotation (flax–barley [Hordeum vulgare L.]–flax–oat [Avena sativa L.]–flax) with standard herbicides. At Carman, this alfalfa rotation provided even better weed control (80% A. fatua, 75% G. spurium) than the conventional rotation. Furthermore, greater A. fatua control was identified compared with a conventional rotation in which two consecutive winter cereal crops were grown successfully in rotation (flax–barley–winter triticale [×Triticosecale Wittm. ex A. Camus (Secale × Triticum)]–winter wheat [Triticum aestivum L.]–flax). Incorporation of silage oat crops did not show consistent management benefits compared with the perennial alfalfa rotation but was generally similar to the conventional rotation with standard herbicides. The results showed that perennial alfalfa in the rotation minimized G. spurium and A. fatua in flax-cropping systems, followed by rotations with two consecutive winter cereal crops.
The neural mechanisms contributing to the social problems of pediatric brain tumor survivors (PBTS) are unknown. Face processing is important to social communication, social behavior, and peer acceptance. Research with other populations with social difficulties, namely autism spectrum disorder, suggests atypical brain activation in areas important for face processing. This case-controlled functional magnetic resonance imaging (fMRI) study compared brain activation during face processing in PBTS and typically developing (TD) youth.
Methods:
Participants included 36 age-, gender-, and IQ-matched youth (N = 18 per group). PBTS were at least 5 years from diagnosis and 2 years from the completion of tumor therapy. fMRI data were acquired during a face identity task and a control condition. Groups were compared on activation magnitude within the fusiform gyrus for the faces condition compared to the control condition. Correlational analyses evaluated associations between neuroimaging metrics and indices of social behavior for PBTS participants.
Results:
Both groups demonstrated face-specific activation within the social brain for the faces condition compared to the control condition. PBTS showed significantly decreased activation for faces in the medial portions of the fusiform gyrus bilaterally compared to TD youth, ps ≤ .004. Higher peak activity in the left fusiform gyrus was associated with better socialization (r = .53, p < .05).
Conclusions:
This study offers initial evidence of atypical activation in a key face processing area in PBTS. Such atypical activation may underlie some of the social difficulties of PBTS. Social cognitive neuroscience methodologies may elucidate the neurobiological bases for PBTS social behavior.
Motivated by the industrial manufacture of organic light-emitting-diode displays, we formulate and analyse a mathematical model for the evolution of a thin droplet in a shallow axisymmetric well of rather general shape both before and after touchdown that accounts for the spatially non-uniform evaporation of the fluid, perform physical experiments using three cylindrical wells with different small aspect ratios, and validate the mathematical model by comparing the present experimental results with the corresponding theoretical predictions for a cylindrical well.
Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youth n 13, Age (Mean ± sd) 20 y ± 5⋅4, Parents (n 6) and Grandparents (n 6) age 58⋅7 ± 9⋅7) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US.