Grain-cooking traditions in Neolithic China have been characterised as a ‘wet’ cuisine based on the boiling and steaming of sticky varieties of cereal. One of these, broomcorn millet, was one of the earliest Chinese crops to move westward into Central Asia and beyond, into regions where grains were typically prepared by grinding and baking. Here, the authors present the genotypes and reconstructed phenotypes of 13 desiccated broomcorn millet samples from Xinjiang (1700 BC–AD 700). The absence in this area of sticky-starch millet and vessels for boiling and steaming suggests that, as they moved west, East Asian cereal crops were decoupled from traditional cooking practices and were incorporated into local cuisines.

High-intensity vortex beams with tunable topological charges and low coherence are highly demanded in applications such as inertial confinement fusion (ICF) and optical communication. However, traditional optical vortices featuring nonuniform intensity distributions are dramatically restricted in application scenarios that require a high-intensity vortex beam owing to their ineffective amplification resulting from the intensity-dependent nonlinear effect. Here, a low-coherence perfect vortex beam (PVB) with a topological charge as high as 140 is realized based on the super-pixel wavefront-shaping technique. More importantly, a globally adaptive feedback algorithm (GAFA) is proposed to efficiently suppress the original intensity fluctuation and achieve a flat-top PVB with dramatically reduced beam speckle contrast. The GAFA-based flat-top PVB generation method can pave the way for high-intensity vortex beam generation, which is crucial for potential applications in ICF, laser processing, optical communication and optical trapping.

ABSTRACT IMPACT: Understanding dietary patterns and nutrient intakes of the aging population may help address concerns and dietary guidelines regarding their nutritional needs. OBJECTIVES/GOALS: The objective of this study is to test the hypothesis that a healthy dietary pattern in the oldest old (aged 80 years and older) is related to greater compliance with dietary recommendations and better nutrient intake profiles. METHODS/STUDY POPULATION: We conducted a cross-sectional study of 122 participants aged 82 to 97 years old from the Geisinger Rural Aging Study (GRAS) cohort in rural Pennsylvania (n = 56 men and 66 women). The main outcome measures of the investigation were the daily nutrient intakes and food group intakes evaluated from the average of three 24-hour dietary recalls. The dietary patterns were determined by cluster analysis from 28 food groups. Diet quality and adherence to the Dietary Guidelines for Americans was assessed by the Healthy Eating Index (HEI)-2015 and the Dietary Screening Tool (DST). Recommended intakes were determined by the Recommended Dietary Allowances (RDAs) or Adequate Intakes (AIs). RESULTS/ANTICIPATED RESULTS: Less than 50% of participants met the dietary recommended intakes for vitamins D, E, K, B6, dietary fiber, zinc, potassium, and calcium. The more-nutrient-dense cluster was characterized by higher intakes of fruits and vegetables. The less-nutrient-dense cluster was characterized by higher intakes of foods including desserts and sweets. After adjusting for age, sex, and energy intake, participants in the more-nutrient-dense dietary pattern had a higher intake of vitamins A, D, K, C, fiber, and potassium (p < 0.05 for all). After adjusting for age and sex, participants in the more-nutrient-dense pattern had better diet quality assessed by the (HEI)-2015 (p < 0.001) and DST (p = 0.006). DISCUSSION/SIGNIFICANCE OF FINDINGS: Among the oldest old, many participants were found to have nutrient intakes lower than the recommended levels for fundamental nutrients suggesting that dietary guidance in addition to a dietary pattern more aligned with dietary guidelines may be beneficial for supporting healthy aging.

Background: Audit-and-feedback interventions track clinician practice patterns for a targeted practice behavior. Audit and feedback of antibiotic prescribing data for acute respiratory infections (ARI) is an effective stewardship strategy that relies on administrative coding to identify eligible visits for audit. Diagnostic shifting is the misclassification of a patient’s diagnosis in response to audit and feedback and is a potential unintended consequence of audit and feedback. Objective: To develop a method to identify patterns consistent with diagnostic shifting including both positive shifting (improved diagnosis and documentation) and negative shifting (intentionally altering documentation of diagnosis to justify antibiotic prescribing), after implementation of an audit-and-feedback intervention to improve ARI management. Methods: We evaluated the intervention effect on diagnostic shifting within 12 University of Utah pediatric clinics (293 providers). Data included 66,827 ARI diagnoses: pneumonia, sinusitis, bronchitis, pharyngitis, upper respiratory infection (URI), acute otitis media (AOM), or serous otitis with effusion (OME). To determine whether rates of ARI diagnoses changed after the intervention, we developed logistic generalized estimating equation (GEE) models with robust sandwich standard error estimates to account for clinic-wise clustering. Outcomes included the change in each ARI diagnosis relative to the competing 6 diagnoses included in audit-and-feedback reports before and after intervention implementation. Models tested for a change in outcomes after the intervention (ie, diagnostic shift) after adjustment for month of diagnosis. For each diagnosis, we estimated the population attributable fraction (PAF) for antibiotic prescriptions due to combined shifts in diagnostic frequencies and prescription rates for each diagnosis. The PAF is the estimated fraction of antibiotic prescriptions that would have changed under a population-level intervention. Results: In month-adjusted analyses, diagnoses of pneumonia and OME decreased after the intervention: odds ratio (OR), 0.46 (95% CI, 0.31–0.68) and OR, 0.81 (95% CI, 0.67–0.99), respectively. In addition, URI diagnoses increased: OR, 1.05 (95% CI 1.00, 1.11). We did not detect changes in the diagnosis rates of sinusitis, AOM, bronchitis, and pharyngitis post intervention. The intervention effect on the PAF for antibiotics prescriptions was consistently positive but relatively small in magnitude. PAF was highest for URIs (PAF, 8.87%), followed by AOM (PAF, 3.56%) and sinusitis (PAF, 2.76%), and was lowest for pneumonia and bronchitis (PAF, 0.41% for both). Conclusions: Our analysis found minimal evidence overall of diagnostic shifting after a stewardship intervention using audit and feedback in these pediatric clinics. Small changes in diagnostic coding may reflect more appropriate diagnosis and coding, a positive effect of audit and feedback, rather than intentional negative diagnostic shift.

Funding: None

Disclosures: None

Background: The Press Ganey (PG) Medical Practice Survey is a commonly used questionnaire for measuring patient experience in healthcare. Our objective was to evaluate the PG surveys completed by caregivers of children presenting for urgent care evaluation of acute respiratory infections (ARIs) to determine any correlation with receipt of antibiotics during their visit. Methods: We evaluated responses to the PG urgent-care surveys for encounters of children <18 years presenting with ARIs (ie, sinusitis, bronchitis, pharyngitis, upper respiratory infection, acute otitis media, or serous otitis media with effusion) within 9 University of Utah urgent-care centers. Scores could range from 0 to 100. Because the distributions of scores followed right- skewed distribution with a high ceiling effect, we defined scores as dissatisfied with their care (≤25th percentile) and satisfied with their care (scores >25th percentile). Univariate and multivariable generalized mixed-effects logistic regression was used to assess correlates of patient dissatisfaction. Random intercepts were included for each provider to account for correlation within the same provider. Separate models were used for each PG component score. Multivariable models adjusted for receipt of antibiotics, age, gender, race, ethnicity, and provider type. Results: Overall, 388 of 520 responses (74.6%) indicated satisfaction and 132 responses (25.4%) indicated dissatisfaction. Among patients who did not receive antibiotics, 87 of 284 responses (30.6%) indicated dissatisfaction versus 45 of 236 (19.1%) who did receive antibiotics. Among patients who were dissatisfied with their clinician, raw clinician PG scores were higher among patients who received antibiotics (mean, 64.5; standard deviation [SD], 16.9) versus those who did not receive antibiotics (mean, 54.7; SD, 24.4; P = .015) (Table 1). In a multivariable analysis, receipt of antibiotics was associated with a reduction in patient dissatisfaction overall (odds ratio, 0.55; 95% CI, 0.36–0.85). Conclusions: Overall, most responses for patients seen for ARIs in pediatric urgent care were satisfied. However, a significantly higher proportion of responses for patients who did not receive antibiotics were dissatisfied than for those patients who received antibiotics. Antibiotic stewardship strategies to communicate appropriate prescribing while preserving patient satisfaction are needed in pediatric urgent-care settings.

Funding: None

Disclosures: None

The desire to image specimens in liquids has led to the development of open-cell and closed-cell techniques in transmission electron microscopy (TEM). The closed-cell approach is currently more common in TEM and has yielded new insights into a number of biological and materials processes in liquid environments. The open-cell approach, which requires an environmental TEM (ETEM), is technically challenging but may be advantageous in certain circumstances due to fewer restrictions on specimen and detector geometry. Here, we demonstrate a novel approach to open-cell liquid TEM, in which we use salt particles to facilitate the in situ formation of droplets of aqueous solution that envelope specimen particles coloaded with the salt. This is achieved by controlling sample temperature between 1 and 10°C and introducing water vapor to the ETEM chamber above the critical pressure for the formation of liquid water on the salt particles. Our use of in situ hydration enables specimens to be loaded into a microscope in a dry state using standard 3 mm TEM grids, allowing specimens to be prepared using trivial sample preparation techniques. Our future aim will be to combine this technique with an in situ light source to study photocorrosion in aqueous environments.

Summarizing content contributed by individuals can be challenging, because people make different lexical choices even when describing the same events. However, there remains a significant need to summarize such content. Examples include the student responses to post-class reflective questions, product reviews, and news articles published by different news agencies related to the same events. High lexical diversity of these documents hinders the system’s ability to effectively identify salient content and reduce summary redundancy. In this paper, we overcome this issue by introducing an integer linear programming-based summarization framework. It incorporates a low-rank approximation to the sentence-word cooccurrence matrix to intrinsically group semantically similar lexical items. We conduct extensive experiments on datasets of student responses, product reviews, and news documents. Our approach compares favorably to a number of extractive baselines as well as a neural abstractive summarization system. The paper finally sheds light on when and why the proposed framework is effective at summarizing content with high lexical variety.

We aimed to study the fate of fat during digestion. For this purpose, we validated and investigated the non-invasive quantification of gastric and duodenal fat emptying and emulsion processing (creaming and phase separation) using the MRI method iterative decomposition with echo asymmetry and least squares estimation (IDEAL). In total, twelve healthy subjects were studied on two separate visits in a single-blind, randomised, cross-over design study. IDEAL was utilised to repeatedly acquire quantitative fat fraction maps of the gastrointestinal tract after infusion of one of two fat emulsions: E1 (acid stable, droplet size 0·33 mm) and E4 (acid unstable, 0·38 mm). In vitro and in vivo validation was carried out using diluted emulsion and gastric content samples, respectively, and resulted in Lin’s concordance correlation coefficients of 1·00 (95 % CI 0·98, 1·00) and 0·91 (95 % CI 0·87, 0·94), respectively. Fat fraction maps and intragastric emulsion profiles enabled the identification of features of intraluminal phase separation and creaming that were not visible in conventional MRI. Gastric fat emptying was faster for E4 compared with E1 with a difference of 2·5 (95 % CI 1·9, 3·1) ml/h. Duodenal content volumes were larger for E1 than for E4 with a difference of 4·9 (95 % CI 3·9, 8·5) ml. This study demonstrated that with IDEAL it was possible (1) to visualise the intragastric and duodenal fat distribution and (2) to quantify the differences in emptying, phase separation and creaming of an acid-stable and an acid-unstable emulsion. This method has potential to bridge the gap between current in vitro digestive models and in vivo behaviour and to be applied in the development of effective functional foods.

Introduction. Breadfruit, Artocarpus spp., is a staple crop with the potential to alleviate hunger and increase food security in tropical regions. Guidelines and recommendations for cultivar selection and production practices are now required for establishment of breadfruit in new areas. Materials and methods. To respond to this need for spreading breadfruit, our study quantified the growth, development, yield and seasonality of 24 breadfruit cultivars (26 trees) established in Kauai, Hawaii, over a 7-year period from 2006–2012. Individual production profiles were generated for each accessioned cultivar based on major agricultural factors. Results. Across all cultivars of breadfruit ( A. altilis), an average of 269 fruits per year was produced by each tree with an average fruit weight of 1.2 kg. Based on the planting density of 50 trees×ha–1, this translates to an average projected yield of 5.23 t×ha–1 after 7 years. Hybrids (A. altilis × A. mariannensis) had a higher yield than breadfruit. The data of our article support the previously proposed hypothesis for predicting breadfruit seasonality. On average, the peak season occurred from July to November. Conclusions. Ma’afala, the first widely available commercial cultivar, started to bear fruit within 22 to 23 months of planting. Other cultivars with potential for commercial production include Toneno, White, Rotuma and Meinpadahk.

Epidemiological and other evidence suggests that vitamin D may be protective against several chronic diseases. Assessing vitamin D status in epidemiological studies, however, is challenging given finite resources and limitations of commonly used approaches. Using multivariable linear regression, we derived predicted 25-hydroxyvitamin D (25(OH)D) scores based on known determinants of circulating 25(OH)D, including age, race, UV-B radiation flux at residence, dietary and supplementary vitamin D intakes, BMI, physical activity, alcohol intake, post-menopausal hormone use (women only) and season of blood draw, in three nationwide cohorts: the Nurses' Health Study, Nurses' Health Study II and the Health Professionals Follow-up Study. The model r2 for each cohort ranged from 0·25 to 0·33. We validated the prediction models in independent samples of participants from these studies. Mean measured 25(OH)D levels rose with increasing decile of predicted 25(OH)D score, such that the differences in mean measured 25(OH)D between the extreme deciles of predicted 25(OH)D were in the range 8·7–12·3 ng/ml. Substituting predicted 25(OH)D scores for measured 25(OH)D in a previously published case–control analysis of colorectal cancer yielded similar effect estimates with OR of approximately 0·8 for a 10 ng/ml difference in either plasma or predicted 25(OH)D. We conclude that these data provide reasonable evidence that a predicted 25(OH)D score is an acceptable marker for ranking individuals by long-term vitamin D status and may be particularly useful in research settings where biomarkers are not available for the majority of a study population.