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To assess the potential contribution of large-scale food fortification (LSFF) towards meeting dietary micronutrient requirements in Tanzania.
Design:
We used household food consumption data from the National Panel Survey 2014–15 to estimate fortifiable food vehicle coverage and consumption (standardised using the adult female equivalent approach) and the prevalence at risk of inadequate apparent intake of five micronutrients included in Tanzania’s fortification legislation. We modelled four LSFF scenarios: no fortification, status quo (i.e. compliance with current fortification contents) and full fortification with and without maize flour fortification.
Setting:
Tanzania.
Participants:
A nationally representative sample of 3290 Tanzanian households.
Results:
The coverage of edible oils and maize and wheat flours (including products of wheat flour and oil such as bread and cakes) was high, with 91 percent, 88 percent and 53 percent of households consuming these commodities, respectively. We estimated that vitamin A-fortified oil could reduce the prevalence of inadequate apparent intake of vitamin A (retinol activity equivalent) from 92 percent without LSFF to 80 percent with LSFF at current fortification levels. Low industry LSFF compliance of flour fortification limits the contribution of other micronutrients, but a hypothetical full fortification scenario shows that LSFF of cereal flours could substantially reduce the prevalence at risk of inadequate intakes of iron, zinc, folate and vitamin B12.
Conclusions:
The current Tanzania LSFF programme likely contributes to reducing vitamin A inadequacy. Policies that support increased compliance could improve the supply of multiple nutrients, but the prominence of small-scale maize mills restricts this theoretical benefit.
Passive, wearable sensors can be used to obtain objective information in infant feeding, but their use has not been tested. Our objective was to compare assessment of infant feeding (frequency, duration and cues) by self-report and that of the Automatic Ingestion Monitor-2 (AIM-2).
Design:
A cross-sectional pilot study was conducted in Ghana. Mothers wore the AIM-2 on eyeglasses for 1 d during waking hours to assess infant feeding using images automatically captured by the device every 15 s. Feasibility was assessed using compliance with wearing the device. Infant feeding practices collected by the AIM-2 images were annotated by a trained evaluator and compared with maternal self-report via interviewer-administered questionnaire.
Setting:
Rural and urban communities in Ghana.
Participants:
Participants were thirty eight (eighteen rural and twenty urban) breast-feeding mothers of infants (child age ≤7 months).
Results:
Twenty-five mothers reported exclusive breast-feeding, which was common among those < 30 years of age (n 15, 60 %) and those residing in urban communities (n 14, 70 %). Compliance with wearing the AIM-2 was high (83 % of wake-time), suggesting low user burden. Maternal report differed from the AIM-2 data, such that mothers reported higher mean breast-feeding frequency (eleven v. eight times, P = 0·041) and duration (18·5 v. 10 min, P = 0·007) during waking hours.
Conclusion:
The AIM-2 was a feasible tool for the assessment of infant feeding among mothers in Ghana as a passive, objective method and identified overestimation of self-reported breast-feeding frequency and duration. Future studies using the AIM-2 are warranted to determine validity on a larger scale.
Inflammation and infections such as malaria affect estimates of micronutrient status. Medline, Embase, Web of Science, Scopus and the Cochrane library were searched to identify studies reporting mean concentrations of ferritin, hepcidin, retinol or retinol binding protein in individuals with asymptomatic or clinical malaria and healthy controls. Study quality was assessed using the US National Institute of Health tool. Random effects meta-analyses were used to generate summary mean differences. In total, forty-four studies were included. Mean ferritin concentrations were elevated by: 28·2 µg/l (95 % CI 15·6, 40·9) in children with asymptomatic malaria; 28·5 µg/l (95 % CI 8·1, 48·8) in adults with asymptomatic malaria; and 366 µg/l (95 % CI 162, 570) in children with clinical malaria compared with individuals without malaria infection. Mean hepcidin concentrations were elevated by 1·52 nmol/l (95 % CI 0·92, 2·11) in children with asymptomatic malaria. Mean retinol concentrations were reduced by: 0·11 µmol/l (95 % CI −0·22, −0·01) in children with asymptomatic malaria; 0·43 µmol/l (95 % CI −0·71, −0·16) in children with clinical malaria and 0·73 µmol/l (95 % CI −1·11, −0·36) in adults with clinical malaria. Most of these results were stable in sensitivity analyses. In children with clinical malaria and pregnant women, difference in ferritin concentrations were greater in areas with higher transmission intensity. We conclude that biomarkers of iron and vitamin A status should be statistically adjusted for malaria and the severity of infection. Several studies analysing asymptomatic infections reported elevated ferritin concentrations without noticeable elevation of inflammation markers, indicating a need to adjust for malaria status in addition to inflammation adjustments.
To evaluate the effect of the FAST (Find cases Actively, Separate safely, Treat effectively) strategy on time to tuberculosis diagnosis and treatment for patients at a general hospital in a tuberculosis-endemic setting.
Design:
Prospective cohort study with historical controls.
Participants:
Patients diagnosed with pulmonary tuberculosis during hospitalization at Hospital Nacional Hipolito Unanue in Lima, Peru.
Methods:
The FAST strategy was implemented from July 24, 2016, to December 31, 2019. We compared the proportion of patients with drug susceptibility testing and tuberculosis treatment during FAST to the 6-month period prior to FAST. Times to diagnosis and tuberculosis treatment were also compared using Kaplan-Meier plots and Cox regressions.
Results:
We analyzed 75 patients diagnosed with pulmonary tuberculosis through FAST. The historical cohort comprised 76 patients. More FAST patients underwent drug susceptibility testing (98.7% vs 57.8%; OR, 53.8; P < .001), which led to the diagnosis of drug-resistant tuberculosis in 18 (24.3%) of 74 of the prospective cohort and 4 (9%) of 44 of the historical cohort (OR, 3.2; P = .03). Overall, 55 FAST patients (73.3%) started tuberculosis treatment during hospitalization compared to 39 (51.3%) controls (OR, 2.44; P = .012). FAST reduced the time from hospital admission to the start of TB treatment (HR, 2.11; 95% CI, 1.39–3.21; P < .001).
Conclusions:
Using the FAST strategy improved the diagnosis of drug-resistant tuberculosis and the likelihood and speed of starting treatment among patients with pulmonary tuberculosis at a general hospital in a tuberculosis-endemic setting. In these settings, the FAST strategy should be considered to reduce tuberculosis transmission while simultaneously improving the quality of care.
In this study, we examined coping strategies as a mediator of the association between loneliness and depressive symptoms. A sample of 364 Spanish young adults (75.5% females) completed measures of loneliness, coping, and depressive symptoms. In general, results from computing correlations (controlling for gender) indicated that loneliness was negatively associated with the use of one engaged coping strategy (viz., problem solving) and positively associated with the use of disengaged coping strategies (e.g., problem avoidance). A multiple mediation analysis (controlling for gender) was conducted to test for mediation. Results of this analysis indicated that part of the association between loneliness and depressive symptoms can be explained by the use of one engaged coping strategy (viz., problem solving; indirect effect, p < .05) and a variety of disengaged coping strategies (viz., problem avoidance, wishful thinking, social withdrawal, & self criticism; indirect effects, p < .05). Overall, the prediction model including loneliness and coping strategies was found to account for a large (f2 = .68) 40.5% of the variance in depressive symptoms in Spanish young adults. The present findings are the first to clarify how the association between loneliness and depressive symptoms in Spanish young adults might be due in part to the use of different coping strategies. Some implications for theory and practice are discussed.
Velocities have been derived from motion-picture film of two different avalanches falling in known terrain. These data are used to calculate avalanche behavior according to the method of Voellmy and the method of Lang and others. Results suggest that Voellmy’s coefficient of turbulent flow may be related to snow density and temperature as much as it is to terrain roughness. For avalanche flow modelled as a transient, viscous process, specification of friction coefficient and kinetic viscosity over a limited range of values successfully predicts a wide range of avalanche behavior.
The search for life on other planets is an active area of research. Many of the likeliest planetary bodies, such as Europa, Enceladus, and Mars are characterized by cold surface environments and ice-rich terrains. Both Raman and ultraviolet-induced fluorescence (UIF) spectroscopies have been proposed as promising tools for the detection of various kinds of bioindicators in these environments. We examined whether macro-scale Raman and UIF spectroscopy could be applied to the analysis of unprocessed terrestrial frozen peat and clear ground ice samples for detection of bioindicators. It was found that this approach did not provide unambiguous detection of bioindicators, likely for a number of reasons, particularly due to strong broadband induced fluorescence. Other contributing factors may include degradation of organic matter in frozen peat to the point that compound-specific emitted fluorescence or Raman peaks were not resolvable. Our study does not downgrade the utility of either UIF or Raman spectroscopy for astrobiological investigations (which has been demonstrated in previous studies), but does suggest that the choice of instrumentation, operational conditions and sample preparation are important factors in ensuring the success of these techniques.
For a well-read medieval monk, as Guillaume de Deguileville must have been, remembering what he read involved memory techniques centered on the visualization of unusual, if not bizarre and startling, scenes and figures. Thus, as a writer who wanted his writing to be remembered, Deguileville conveyed the content of his three Pèlerinages through vivid and detailed descriptions of unusual figures and scenes, including interactions between personifications and biblical characters, which beg for visualization. Apparently unwilling to rely entirely on the reader's ability to create these memory-images in the imagination, the author himself planned for some illustrations, though we cannot know whether he devised complete programs of miniatures or supervised the production of any illustrated manuscripts. Each of his three French pilgrimage poems appeared individually with illustrations, but manuscripts that collect all three Pèlerinages include some of the most ambitious programs of illustration. It is as if the desire for uniformity stimulated designers and artists to continue the dense level of visualization frequently found in manuscripts of the PVH into the other two poems. Images, in fact, provide the most striking evidence for the high level of familiarity with Deguileville's three Pèlerinages from the late fourteenth to mid-fifteenth centuries: in the book of hours known as the Hours of Isabella Stuart (Cambridge, Fitzwilliam Museum MS 62), picture cycles for each of the poems – in the unusual sequence PJC, PVH, PA – accompany not Deguileville's poems but the familiar cycle of texts found in this personal book of hours, an indication that the images alone enabled readers to recall the poems.
As Fabienne Pomel's contribution to this volume demonstrates vividly, Deguileville's corpus reads like nothing so much as a collection of legal documents. The saga of Deguileville's poetic persona. Here distinguished by the Latinized name Guillermus de Deguilevilla, resembles a case file; both narrator and author are put on trial repeatedly, and poetic and juridical authority are closely related. Two instances of judgment stand out in particular, found respectively in PVH2 and in PA. First, in PVH2. Guillermus loses a judgment aboard the Ship of Religion, from which he is exiled as a result and deprived of his good name. Because of the poet's insistence on the (pseudo-) autobiographical nature of the episode, modern scholars have usually seen in it a reflection of Deguileville's own legal troubles, presumably at the hands of fellow monks at Chaalis. And because Deguileville linked this affair to the high-profile literary scandals of other authors – namely, Abelard and Ovid – it is plausible that he suffered for something he wrote. If so, this would doubtless have been the earlier PVH1, which the 1355 version (PVH2) was destined to correct and supplement.
The Castillian prose translation of PVH1, El pelegrino de la vida humana, underwent a number of transformations before even appearing in the workshop of Henrico Mayer Aleman in Toulouse, where it was eventually printed in 1490. The Spanish version is based on a French printed prose adaptation of PVH1, produced in Lyon by Mathis Husz in 1485 and reprinted in 1486, itself based on an anonymous prose adaptation of PVH1 produced for Jeanne de Laval in Angers in 1465. The translator is identified in Mayer's print as Vinçente de Maçuelo, who appears to have had close connections with the Dominican order and the university of Toulouse on the one hand, and with the Royal family of Castile and Aragon on the other. Indeed, a copy of Mayer's print was acquired by the Royal Family in 1492, presumably for the spiritual education of the young Prince John, whose training was entrusted to a fellow Dominican, Diego de Deza. The connections between Mayer, Maçuelo, the Dominican order and the Royal Family thus provide the main context for the reception of this work in Spain. Mayer's print also lends the text a more militant, combative tone, notably with the addition of a full-page frontispiece woodcut showing a hybrid figure of a pilgrim-knight. This addition may have heightened the book's appeal for an aristocratic readership, allowing the volume to serve as a ‘mirror for princes’ within the court.
This essay discusses how Croatian Renaissance literature reflects the influence of Deguileville's allegory of human life as a pilgrimage, looking in particular for possible borrowings from PVH. uncovering intertextual relations, this study also sheds light on how medieval poetic paradigms permeated Renaissance literature, bringing into focus dynamic continuities amid the shifting historical, cultural and linguistic contexts of Europe in this era. Croatia's position – suspended between Byzantine (Greek) and western (Latin) influence – invites us to look beyond traditional geographic boundaries as well as across the conceptual division of the ‘Middle Ages’ from the ‘Renaissance’. The openness of this literature to different forms of cultural translation is further enhanced by the linguistic complexities of late medieval Croatian culture, which is both trilingual (Latin, Croatian and Old Slavic languages) and triliterate (relying on Glagolitic, Cyrilic and Roman script).
Croatia's geographical position at the crossroads of Central Europe and the Mediterranean determined its role as an intermediary between the two large cultural arenas. During the fourteenth century, Croatian literature became increasingly receptive to the influence of western literature; in the fifteenth century, this influence became dominant, significantly contributing to the development of Croatian Renaissance culture. The fourteenth century – often considered the golden age of Croatian political history and court culture – witnessed the ascent of the French Angevin dynasty, the Capetian House of Anjou, to the Croatian-Hungarian throne (1301–1409).
Readers of the Pèlerinages encounter multiple embedded texts, presented as autonomous lyrics, letters, documents and prayers; such text disrupts the flow of the allegorical narrative on both a formal and a conceptual level, inviting readers to reflect on the authority of the allegorical narrative itself. These disruptions are marked in varied ways: shifts in metre, rhyme, or language; narrative presentation emphasising the material forms or extraneous uses of lyrics or prayers; even the use of acrostics that literally disrupt the linearity of the reading experience.
All these embedded texts identify specific speakers and/or addressees in a manner that suggests analogies with both medieval epistolary convention and judicial practice. Such formalised textual exchanges are characterised by an asymmetrical communication between different levels of authority, participating in a vertical system of exchange. In the case of the Pèlerinages, these texts also reciprocally connect different levels of reality, enabling a two-way system of communication between ordinary human agents and representatives of divine authority, absent or present. This creative emulation of epistolary and judicial models invites readers to explore the performative value of authorised speech and authorised text. Embedded text functions at once as language, as event and as object: it can be manifested as verbal performance and can also take on the material form of scrolls and letters, handled and exchanged within the narrative, thus intervening in the action of the poem.