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Women and the Army in the Roman Empire
- Edited by Lee L. Brice, Elizabeth M. Greene
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- November 2024
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- 01 November 2025
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The presence of women in Roman military contexts has been established beyond doubt by scholars in recent decades. Nevertheless, very little sustained attention has been paid to who these women were, how they fit into the fabric of settlements, and what their contributions were to these communities. This volume offers new insights into the associations, activities, and social roles of women in the context of the Roman army, emphasizing the tangible evidence for the lived realities of women and families at different social levels. The various chapters adopt dynamic perspectives and shed new light on archaeological and historical evidence to provide novel conclusions about women's lives in antiquity. Histories of the Roman army can no longer ignore the women who lived and worked in its midst and histories of Roman women must acknowledge their important military role.
The Frith Prescribing Guidelines for People with Intellectual Disability
- 4th edition
- Edited by David M. L. Branford, Satheesh K. Gangadharan, Mary Barrett, Regi T. Alexander
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- August 2024
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- 31 August 2024
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People with intellectual disability are more likely to experience mental health difficulties, and their treatment responses may differ from those in the general population. This book, written by leading clinical practitioners from around the world, provides comprehensive guidance on prescribing for people with intellectual disability, as well as general information on their clinical care. The guidelines have been conceived and developed by clinicians working in intellectual disability services. Combining the latest evidence and expert opinion, they provide a consensus approach to prescribing as part of a holistic package of care, and include numerous case examples and scenarios. Now in its fourth edition, this update reflects the changes in prescribing practice; it places emphasis on clinical scenarios and case examples and includes input from service users and their families. This is a practical guide for busy clinicians, and a valuable reference for all primary and secondary healthcare professionals.
LGBTQ+ Affirmative Counseling
- A Student and Practitioner Handbook
- Edited by Jeffry Moe, Amber L. Pope, Dilani M. Perera, Narketta Sparkman-Key
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- July 2024
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- 31 July 2024
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Addressing a need for LGBTQ+ affirmative counselling in training, this meticulously crafted book is designed for graduate counselling students, new practitioners, and cross-disciplinary professionals. Authored by top researchers and clinicians, this collection synthesizes best practices in training and intervention, presenting a blueprint to seamlessly integrate affirmative counselling into academic curricula. Individual chapters cover topics including history, culture, assessment, treatment planning, crisis response, international perspectives, technology, and training. Enriched with resources, real-life case examples, and thoughtful reflection questions, the book moves beyond theory to provide actionable insights for effective LGBTQ+ affirmative counselling in diverse organizational settings. Tailored for graduate programs, this book equips future practitioners to adeptly navigate the complexities of affirmative counselling.
Boundary-layer instability on a highly swept fin on a cone at Mach 6
- Madeline M. Peck, Koen J. Groot, Helen L. Reed
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- Journal of Fluid Mechanics / Volume 987 / 25 May 2024
- Published online by Cambridge University Press:
- 16 May 2024, A13
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The growth and characteristics of linear, oblique instabilities on a highly swept fin on a straight cone in Mach 6 flow are examined. Large streamwise pressure gradients cause doubly inflected cross-flow profiles and reversed flow near the wall, which necessitates using the harmonic linearized Navier–Stokes equations. The cross-flow instability is responsible for the most-amplified disturbances, however, not all disturbances show typical cross-flow characteristics. Distinct differences in perturbation structure are shown between small ($\sim$3–5 mm) and large ($\sim$10 mm) wavelength disturbances at the unit Reynolds number $Re' = 11 \times 10^6$ m$^{-1}$. As a result, amplification measurements based solely on wall quantities bias a most-amplified disturbance assessment towards larger wavelengths and lower frequencies than would otherwise be determined by an off-wall total-energy approach. A spatial-amplification energy-budget analysis demonstrates (i) that wall-normal Reynolds-flux terms dictate the local growth rate, despite other terms having a locally larger magnitude and (ii) that the Reynolds-stress terms are responsible for large-wavelength disturbances propagating closer to the wall compared with small-wavelength disturbances. Additionally, the effect of free-stream unit Reynolds number and small yaw angles on the perturbation amplification and energy budget is considered. At a higher Reynolds number ($Re' = 22 \times 10^6$ m$^{-1}$), the most-amplified wavelength shrinks. Perturbations do not behave self-similarly in the thinner boundary layer, and the shift in most-amplified wavelength is due to decreased dissipation relative to the lower-Reynolds-number case. Small yaw angles produce a streamwise shift in the boundary layer and disturbance amplification. The yaw results quantify a potential uncertainty source in experiments and flight.
Physiological and biochemical processes underlying the differential sucrose yield and biomass production in sugarcane varieties
- Tamires Da Silva Martins, José R. Magalhães Filho, Larissa Prado Cruz, Daniela F. S. P. Machado, Norma M. Erismann, Rose M. A. Gondim-Tomaz, Paulo E. R. Marchiori, André L. B. O. Silva, Eduardo Caruso Machado, Rafael Vasconcelos Ribeiro
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- Experimental Agriculture / Volume 60 / 2024
- Published online by Cambridge University Press:
- 14 May 2024, e13
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Sucrose yield in sugarcane is a complex process regulated by both environmental and endogenous factors. However, the metabolic balance driving vegetative growth and sucrose accumulation remains poorly understood. Herein, we carried out a comprehensive assessment of carbohydrate dynamics throughout the crop cycle in two sugarcane varieties varying in biomass production, evaluating the carbon metabolism in both leaves and stalks. Our data revealed that the decline in photosynthetic rates during sugarcane maturation is associated not only to accumulation of sugars in leaves but also due to stomatal and non-stomatal limitations. We found that metabolic processes in leaves and stalks were intrinsically linked. While IACSP94-2094 had higher stalk sucrose concentration than IACSP95-5000, this latter produced more biomass. Compared to IACSP95-5000, IACSP94-2094 showed higher sucrose phosphate synthase (SPS) activity in leaves and stalks, along with lower soluble acid invertase (SAI) activity in leaves during the maximum growth stage. Interestingly, IACSP94-2094 also exhibited higher stalk SPS activity and lower stalk SAI activity than IACSP95-5000 during maturation. High biomass production by IACSP95-5000 was associated with higher sucrose synthase (SuSy) and SAI activity in leaves and higher SuSy and soluble neutral invertase (SNI) activity in stalks when compared to IACSP94-2094 during the maximum growth. Despite the contrasting strategies, both varieties displayed similar total sucrose yield, a balance between sucrose concentration and biomass production. This phenomenon implies the presence of a compensatory mechanism in sugarcane, with high biomass production compensating low sucrose accumulation and vice versa.
Human milk, breastfeeding, and early neurodevelopmental outcomes for infants with critical CHD
- Kristin M. Elgersma, Melissa L. Engel, Sara E. Ramel, Jessica A. Davis, Anne C. McKechnie, Katie M. Pfister
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- Journal:
- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 13 May 2024, pp. 1-9
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Human milk improves neurodevelopment for preterm infants, but relationships between human milk and neurodevelopment for infants with critical CHD are unknown. We aimed to (1) explore associations between human milk/direct breastfeeding and neurodevelopment at 1-year and 2-year follow-up and (2) describe patterns of human milk (maternal, donor) and commercial formula during hospitalisation in the first year of life.
This retrospective cohort study included infants who underwent surgery for CHD < 6 months old. The primary outcome was neurodevelopment via Bayley Scales of Infant Development-IV. Analysis included adjusted linear regression for associations between exclusive human milk while inpatient during the first 6 months or any direct breastfeeding while inpatient during the first year of life and 1-year Bayley-IV scores. Models were adjusted for race, insurance type, genetic diagnosis, and length of stay.
Of 98 eligible infants, 40% followed up at 1 year; 27% at 2 years. There were differences in follow-up related to demographics (race, ethnicity) and social determinants of health (insurance type, distance from clinic). In adjusted models, infants who directly breastfed had 13.18 points higher cognition (95% CI: 0.84–25.53, p = 0.037); 14.04 points higher language (2.55–25.53, p = 0.018); and 15.80 points higher motor scores (3.27–28.34, p = 0.015) at 1-year follow-up. Infants fed exclusive human milk had 12.64 points higher cognition scores (−0.53–25.82, p = 0.059).
Future investigation into nutrition and neurodevelopment in the context of critical CHD is warranted. As neurodevelopmental follow-up becomes standard of care in this population, efforts are needed to mitigate disparities in access to this care.
Methods and associations of suicidality in Kenyan high school students: clinical and public health implications
- David M. Ndetei, Danuta Wasserman, Victoria Mutiso, Jenelle R. Shanley, Christine Musyimi, Pascalyne Nyamai, Timothy Munyua, Monica H. Swahn, Tom L. Osborn, Natalie E. Johnson, Peter Memiah, Kamaldeep Bhui, Sonja Gilbert, John R. Weisz, Afzal Javed, Andre Sourander
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- Journal:
- BJPsych Open / Volume 10 / Issue 3 / May 2024
- Published online by Cambridge University Press:
- 13 May 2024, e112
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Background
Most evidence on suicidal thoughts, plans and attempts comes from Western countries; prevalence rates may differ in other parts of the world.
AimsThis study determined the prevalence of suicidal thoughts, plans and attempts in high school students in three different regional settings in Kenya.
MethodThis was a cross-sectional study of 2652 high school students. We asked structured questions to determine the prevalence of various types of suicidality, the methods planned or effected, and participants’ gender, age and form (grade level). We provided descriptive statistics, testing significant differences by chi-squared and Fisher's exact tests, and used logistic regression to identify relationships among different variables and their associations with suicidality.
ResultsThe prevalence rates of suicidal thoughts, plans and attempts were 26.8, 14.9 and 15.7%, respectively. These rates are higher than those reported for Western countries. Some 6.7% of suicide attempts were not associated with plans. The most common method used in suicide attempts was drinking chemicals/poison (18.8%). Rates of suicidal thoughts and plans were higher for older students and students in urban rather than rural locations, and attempts were associated with female gender and higher grade level – especially the final year of high school, when exam performance affects future education and career prospects.
ConclusionSuicidal thoughts, plans and attempts are prevalent in Kenyan high school students. There is a need for future studies to determine the different starting points to suicidal attempts, particularly for the significant number whose attempts are not preceded by thoughts and plans.
Angiographic tool to detect pulmonary arteriovenous malformations in single ventricle physiology
- Stephen B. Spurgin, Yousef M. Arar, Thomas M. Zellers, Jijia Wang, Nicolas L. Madsen, Surendranath R. Veeram Reddy, Ondine Cleaver, Abhay A. Divekar
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- Journal:
- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 10 May 2024, pp. 1-6
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Objective:
Individuals with single ventricle physiology who are palliated with superior cavopulmonary anastomosis (Glenn surgery) may develop pulmonary arteriovenous malformations. The traditional tools for pulmonary arteriovenous malformation diagnosis are often of limited diagnostic utility in this patient population. We sought to measure the pulmonary capillary transit time to determine its value as a tool to identify pulmonary arteriovenous malformations in patients with single ventricle physiology.
Methods:We defined the angiographic pulmonary capillary transit time as the number of cardiac cycles required for transit of contrast from the distal pulmonary arteries to the pulmonary veins. Patients were retrospectively recruited from a single quaternary North American paediatric centre, and angiographic and clinical data were reviewed. Pulmonary capillary transit time was calculated in 20 control patients and compared to 20 single ventricle patients at the pre-Glenn, Glenn, and Fontan surgical stages (which were compared with a linear-mixed model). Correlation (Pearson) between pulmonary capillary transit time and haemodynamic and injection parameters was assessed using angiograms from 84 Glenn patients. Five independent observers calculated pulmonary capillary transit time to measure reproducibility (intraclass correlation coefficient).
Results:Mean pulmonary capillary transit time was 3.3 cardiac cycles in the control population, and 3.5, 2.4, and 3.5 in the pre-Glenn, Glenn, and Fontan stages, respectively. Pulmonary capillary transit time in the Glenn population did not correlate with injection conditions. Intraclass correlation coefficient was 0.87.
Conclusions:Pulmonary angiography can be used to calculate the pulmonary capillary transit time, which is reproducible between observers. Pulmonary capillary transit time accelerates in the Glenn stage, correlating with absence of direct hepatopulmonary venous flow.
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.
Dietary fibre intake, adiposity, and metabolic disease risk in Pacific and New Zealand European women
- N. Renall, B. Merz, J. Douwes, M. Corbin, J. Slater, G.W. Tannock, R. Firestone, R. Kruger, B.H. Breier, L. Te Morenga
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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, E21
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The aim of this study was to explore associations between habitual dietary fibre intake, adiposity, and biomarkers of metabolic health in Pacific and New Zealand European women who are known to have different metabolic disease risks. Pacific (n = 126) and New Zealand European (NZ European; n = 161) women (18-45years) were recruited to the PROMISE cross-sectional study(1) based on normal (18-24.9kg/m2) and obese BMI (≥30kg/m2). Body fat percentage (BF%), measured using whole body DXA, was used to stratify participants into low (<35%) or high (≥35%) BF% groups. Habitual dietary intake was calculated using the National Cancer Institute method, involving a 5-day-food-record and a semi-quantitative FFQ. Fasting blood was analysed for glucose, insulin, and lipid profile. NZ European women in the low- and high-BF% groups were older, less socioeconomically deprived, and consumed more dietary fibre (median 23.7g/day [25-75-percentile, 20.1, 29.9]; 20.9 [19.4, 24.9]) than Pacific women (18.8 [15.6, 22.1]; 17.8 [15.0, 20.8]; both p<0.001), respectively. Pacific women consumed a higher proportion of their total fibre intake from discretionary fast foods, in contrast NZ European women consumed more dietary fibre from wholegrains. Regression analysis controlling for ethnicity, age, socioeconomic deprivation, energy intake, protein, total carbohydrate, and fat intake showed significant inverse associations between higher dietary fibre intake and BF% and visceral fat% (β = −0.47, 95% CI = −0.62, −0.31, p<0.001; β = −0.61, [−0.82, −0.40], p<0.001, respectively) among both Pacific and NZ European women. LDL-C (β = −0.04, [−0.06, −0.01]) was inversely associated with fibre intake following further adjustment for BF%-groups in NZ European women. Despite differences in intake, dietary fibre was inversely associated with adiposity and metabolic disease risk in both Pacific and NZ European women. However younger woman living in areas of higher socio-economic deprivation who consumed a higher proportion of total dietary fibre intake from discretionary fast foods were more likely to have low dietary fibre intakes than older, wealthier women. These women were also more likely to be Pacific women. Increasing habitual dietary fibre intake could help to reduce adiposity and metabolic disease risk; so implementing policies that make health-promoting high fibre foods more affordable, ensuring households have sufficient income to purchase nutritious food and limiting the amount of unhealthy food marketing that low income communities are exposed to should be public health priorities.
Mapping workforce contributions to the Sustainable Development Goals: a tool to enhance staff capacity and inspire action
- M. Murray, A. Hill, E. Jenkins, E. Barber, L. Barbour
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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, E131
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The United Nations’ Agenda 2030 provides a framework of 17 Sustainable Development Goals (SDGs) to achieve peace and prosperity for people and planet, now and into the future(1). The United Nations Decade of Action on Nutrition emphasises that food and nutrition are key levers for optimising both human and planetary health and that individuals working in food, nutrition and health play an essential role in contributing to the SDGs(2,3). This project aimed to (i) map the work being done by staff and higher degree students at Monash University’s Department of Nutrition, Dietetics and Food and its alignment with the SDGs, and (ii) assess the impact of this process on workforce capacity to embed the SDGs in future work activities. Three mapping workshops; one pilot, one in-person and one online, were conducted (n = 28), beginning with a short expert-led seminar about the SDGs before participants engaged in an interactive activity to record their work activities (research, education or engagement) relating to the SDGs. Mapping data were analysed to determine which SDGs were being prioritised and in what type of activities. To determine the impact on workforce capacity, participants completed pre- and post-workshop surveys that assessed their knowledge of and confidence regarding the SDGs. From the three workshops, 129 work activities were described, each linked to one or more of the SDGs. Of those, 41% were education, 36% were research, and 23% were engagement activities. Work activities spanned all 17 of the SDGs, with the most commonly aligned being Goal 3 Good Health and Wellbeing (53% of work activities), Goal 10 Reduced Inequalities (37% of work activities), Goal 4 Quality Education (36% of work activities), Goal 12 Responsible Consumption and Production (34% of work activities), and Goal 17 Partnerships for the Goals (27% of work activities). The pre- and post-workshop surveys indicated increased staff knowledge and confidence related to the SDGs. The percentage of participants that could correctly identify the number of SDGs increased from 43% to 96%, and the percentage of participants that recognised the correct aim of the SDGs increased from 43% to 86%. Regarding confidence in talking about the SDGs, the percentage of staff who indicated that they ‘avoid talking about them’ or are ‘not confident’ decreased from 39% to 4%, and the number of staff who were confident talking about the SDGs ‘in general terms’ increased from 39% to 75%. Nutrition professionals are well-placed to support progress towards each of the SDGs. Workshops such as these provide an opportunity to increase workforce capacity to discuss, share and relate their work to the SDGs and provide a periodic pulse-check to identify opportunities for greater contribution to this urgent, global Agenda.
Several genetic SNPs identified in acute appendicitis patients including the HLA-C known to be related to coeliac disease in a Genome-Wide Association Study
- M. Ryoo, L-D. Hwang, O. Wright, J. Brown, L.R. de Pouplana, E. Roura
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E154
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Acute Appendicitis (AA) is an inflammatory condition of the vermiform appendix in the caecum of the colon. Genetic polymorphisms have been suggested as risk factors predisposing to AA susceptibility but have remained relatively unknown, due to insufficient sample size in previous analyses. Therefore, the primary research aim was to identify genetic variants associated with AA. It was hypothesised that gene polymorphisms associated with AA will provide a connection to other diet-related inflammatory diseases. Genetic variants associated with AA were studied via a Genome-Wide Association Scan (GWAS) using the Global Biobank Meta-Analysis Initiative (GBMI). The GBMI is a collaborative consortium of 23 biobanks with a publicly released repository of de-identified genetic data linked with digital health records spanning 4 continents with a study population size of over 2.2 million consented individuals of multiple ancestral backgrounds1. A linear regression model was used to estimate the association between single nucleotide polymorphisms (SNPs), across the human genome, and AA by each contributing biobank. The results were then meta-analysed with a total of 32,706 cases and 1,075,763 controls. In the present study, the free open-source Complex Traits Genetic Virtual Lab (CTG-VL) platform was used to access, analyse, and visualise the GWAS summary statistics of AA2. Genome-wide significantly associated SNPs (p-value < 5 x 10-8) were further searched for their associations with health-related traits in publicly available GWAS summary statistics. Upon analysis, significantly associated SNPs for AA were identified within or nearby nine genes. HLX, NKX2-3, LTBR, and DLEU1 are genes involved in immune responses; IRF8 associated with maturation of myeloid cells; OSR-1 responsible for transmembrane ion transporter activity; NCALD a regulator of G protein-coupled signal transduction. In addition, based on the hypothesis, the SNP of key clinical importance was the HLA-C rs2524046 (p-value = 2.38 x 10-8), with the AA risk-increasing allele C being also strongly associated with a higher risk of coeliac disease (CD). The CD is an autoimmune condition where gluten, a protein present in grains such as barley, rye, and wheat, elicits an inflammatory response that results in damage to the small intestine lining. Considering how both AA and CD share the same SNP, it is possible to speculate whether gluten initiates a similar pathophysiological mechanism that exacerbates inflammation in the vermiform appendix in AA. In conclusion, the top AA associated SNPs suggests its development could be due to immunological responses influenced by dietary nutrient intake. The HLA-C SNP is common to AA and CD, suggesting that the gluten protein found in certain cereal grains possibly contributes to the pathophysiology of AA like CD. This warrants further investigations into whether dietary gluten could play a key role in AA development.
Parents’ perceptions of the Tasmanian School Lunch Project - interim findings
- K.J. Smith, V. Cleland, J. Dunbabin, B. Fraser, M. Reardon, C. Galloway, K. DePaoli, L. Sutton, F. Proudfoot, K. Jose
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E27
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Most Australian school students take a packed lunch to school(1). However, parents have reported many barriers to packing a healthy lunch(2). Subsequently, foods eaten during school hours are not consistent with the Australian Dietary Guidelines, with discretionary foods providing about 44% of energy consumed during this time(3). In addition, some children go to school without any food for lunch or money to buy lunch. The Tasmanian School Lunch Project provides free nutritious cooked lunches for Kinder to Year 10 students attending 30 government schools (15 commenced 2022, 15 commenced 2023) in areas of high socioeconomic disadvantage. The lunches were provided 1-3 days/week. The menu and recipes were designed by dietitians. This analysis aimed to describe parents’ perceptions of the School Lunch Project during the first year. Six of the 15 schools that commenced in term 2 2022 were invited, and agreed, to participate in the evaluation. During term 3 or 4 2022, parents completed online or written surveys (n = 159) and/or participated in discussion groups (n = 26) to share their thoughts on the menu, their concerns, likes, and willingness to pay. Survey data were analysed descriptively and open-ended survey responses and discussion group data thematically. During 2022, 78,832 nutritious cooked lunches were provided to 1,678 students. Most parents felt there was enough variety on the menu (66%) and the right amount of food was served (69%). Most students (79%) ate the lunches every day they were provided yet 52% of parents continued to provide a packed lunch. Parents enjoyed that their child was having a healthy lunch (66%) and trying new foods (74%). Some parents in the discussion groups indicated positive flow on effects at home with students trying new foods and sitting down together as a family to eat the evening meal. Half the parents (50%) had no concerns about the school providing lunches. The most commonly reported concerns were their child might not like the food (36%) or their child does not try new foods (8.6%). These concerns were also raised in the discussion groups. Most parents (93%) were prepared to pay for the lunches in future (median $3, range $1-$12) and 85% thought there should be a family discount. Parents acknowledged some payment was necessary for the sustainability of the program but some expressed concern for those who may struggle to pay. More direct communication with families about the meals offered, the availability of bread (from term 4 2022) for students who choose not to eat the cooked lunch or want more to eat, and allowing families time to adjust to the new lunch system, may address some of the concerns raised. Further data on parents’ perceptions of the school lunches will be collected during term 3 2023.
Household food insecurity and associations with energy, nutrient intake, and sociodemographic characteristics in young New Zealand children
- R. Jupiterwala, C. Conlon, K. Beck, R. Taylor, A-L. Heath, J. Haszard, I. Katiforis, R. Paul, K. Brown, M. Casale, E. Jones, A. Wei, L. Fangupo, B. Bruckner, V. Pulu, M. Healy, P. von Hurst
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E85
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Although food insecurity affects a significant proportion of young children in New Zealand (NZ)(1), evidence of its association with dietary intake and sociodemographic characteristics in this population is lacking. This study aims to assess the household food security status of young NZ children and its association with energy and nutrient intake and sociodemographic factors. This study included 289 caregiver and child (1-3 years old) dyads from the same household in either Auckland, Wellington, or Dunedin, NZ. Household food security status was determined using a validated and NZ-specific eight-item questionnaire(2). Usual dietary intake was determined from two 24-hour food recalls, using the multiple source method(3). The prevalence of inadequate nutrient intake was assessed using the Estimated Average Requirement (EAR) cut-point method and full probability approach. Sociodemographic factors (i.e., socioeconomic status, ethnicity, caregiver education, employment status, household size and structure) were collected from questionnaires. Linear regression models were used to estimate associations with statistical significance set at p <0.05. Over 30% of participants had experienced food insecurity in the past 12 months. Of all eight indicator statements, “the variety of foods we are able to eat is limited by a lack of money,” had the highest proportion of participants responding “often” or “sometimes” (35.8%). Moderately food insecure children exhibited higher fat and saturated fat intakes, consuming 3.0 (0.2, 5.8) g/day more fat, and 2.0 (0.6, 3.5) g/day more saturated fat compared to food secure children (p<0.05). Severely food insecure children had lower g/kg/day protein intake compared to food secure children (p<0.05). In comparison to food secure children, moderately and severely food insecure children had lower fibre intake, consuming 1.6 (2.8, 0.3) g/day and 2.6 (4.0, 1.2) g/day less fibre, respectively. Severely food insecure children had the highest prevalence of inadequate calcium (7.0%) and vitamin C (9.3%) intakes, compared with food secure children [prevalence of inadequate intakes: calcium (2.3%) and vitamin C (2.8%)]. Household food insecurity was more common in those of Māori or Pacific ethnicity; living in areas of high deprivation; having a caregiver who was younger, not in paid employment, or had low educational attainment; living with ≥2 other children in the household; and living in a sole-parent household. Food insecure young NZ children consume a diet that exhibits lower nutritional quality in certain measures compared to their food-secure counterparts. Food insecurity was associated with various sociodemographic factors that are closely linked with poverty or low income. As such, there is an urgent need for poverty mitigation initiatives to safeguard vulnerable young children from the adverse consequences of food insecurity.
Private practice dietetics workforce: A review of the literature
- J. Donnelly, R. Lane, M. Dalton, L. Walsh, R. Hughes
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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, E106
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Private practice is the fastest growing employment sector for dietitians in Australia, including for new graduates(1). There is an anecdotal concern that current graduate cohorts are not adequately prepared for private practice. The present study aims to assess the existing literature relevant to workforce development specific to private practice dietetics, including areas such as workforce size, distribution, competency, practices and global challenges. The secondary aim is to identify gaps in the literature to inform future priority areas and to inform private practice dietetics workforce development research. Five databases were systematically searched from inception to August 2023 and grey-literature was searched using the Google search engine using key search terms to identify studies for inclusion. Of the 2361 peer-reviewed publications and 1800 grey literature, eighty were included. Directed content analysis and qualitative constant comparison technique were used to deductively extract data from eligible private practice literature. Intelligence sources covering the following themes proved to be limited: workforce size, distribution, attributes, demography, supply/preparation, competencies, continued professional development and challenges. However, clear structural issues present workforce challenges for private practice dietitians. There is an overwhelming paucity of comprehensive literature on the private practice dietetics workforce across the world. Private practice dietetics workforce development research is warranted to address current research gaps in a coordinated, collaborative approach to ensure this rapidly expanding workforce is well supported.
Intake of free sugars by 11–13-year-old schoolchildren living in Delhi, India
- A. Ivaturi, L. Giles, L.G. Do, M. Arora, T. Rawal, P.J. Moynihan
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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, E153
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Intake of free sugars is associated with a risk of non-communicable diseases including dental caries, and authoritative organisations recommend limiting intake to <5% energy intake (E) or lower (1, 2). National surveys of schoolchildren in India indicate the prevalence of obesity is rising >10%/year(3) and that 52.5% of young adolescents are affected with dental caries(4), yet, there is a dearth of data on dietary intake of sugars by this population. The objective of this research was to assess the intake of total and free sugars, and the contribution of food sources to free sugars intake, in a random sample of 11–13-year-old schoolchildren in Delhi, India. The study was approved by The University of Adelaide Human Research Ethics Committee and the Independent Ethics Committee of the Centre for Chronic Disease Control, New Delhi. The target sample size of 360 was based on a ± 5% margin of error in estimated sugars intake. A statistician external to the research team generated a random sample of 150 schools stratified by district (n = 11). Schools were recruited in turn from the list until 10 schools had consented. Teachers shared study information with parents who were invited to complete an online consent form. Child assent was obtained before data collection. Participants recorded all food and drink consumed over three consecutive days, including one weekend day, in a food diary. The information recorded was entered into an online dietary assessment tool, Intake24 (Southeast Asia version), during an interview with each participant during which portion size was ascertained with reference to the database of over 2400 food photographs of more than 100 foods. The Intake24 database converted food and drink reported into the intake of total and free sugars through integrated food compositional tables. Of 514 pupils providing consent, 393 participants (76.5%) (169 girls, 224 boys) completed the study. In girls, the median (IQR) daily intakes of total and free sugars were 95.0 (70.1-120.2) g/day and 43.0 (28.1-68.5) g/day respectively. The corresponding values in boys were significantly higher at 104.0 (80.2-138.7) g/day and 53.1 (34.1-76.5) g/day (p = 0.004). No between-gender difference was observed in the median percent contribution of sugars to E: total and free sugars contributed 14.9% (IQR 11.4-18.1%) and 7.1% (IQR 4.8-10.1%) respectively. The percent contribution of the main sources of sugars to free sugars intake were: (i) Sugars Preserves and Syrups (31.2% (IQR. 9.6-51.7%)); (ii) Cakes and Biscuits (13.7% (IQR 0-26.4%)); (iii) Desserts (5.4% (0-17.5%)) and (iv) Sugar-Sweetened Beverages and Juices (2.1% (IQR 0-15.7%)). In conclusion, in this sample of 11-13-year-old schoolchildren from Delhi, free sugars intake was above the WHO <5% E threshold. Forms of sugars that are added to foods by the consumer made the largest contribution to intake.
Predicting symptom response and quality of life to the low FODMAP diet in irritable bowel syndrome: a 6-month longitudinal study
- L.P. Manning, C.J. Tuck, M. Van den Houte, L. Van Oudenhove, 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, E65
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The low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet is recommended as a first line therapeutic management strategy for irritable bowel syndrome (IBS)(1). The low FODMAP diet is supported by meta-analytical evidence(2), and demonstrates acceptability and effectiveness for improving symptoms and quality of life (QoL) in 50-75% of individuals with IBS. However, a subset of individuals (25-50%) do not respond to the diet(3). The identification of individual-level predictors of treatment response across all three phases of the low FODMAP diet is currently lacking. The study aims were to assess psychological predictors of symptom and QoL response to the low FODMAP diet in patients with IBS. Adults with IBS underwent a three-phase low FODMAP diet, guided by individualised dietetic education. Predictor variables included levels of depressive, anxiety, and extraintestinal somatic symptoms, stress, treatment beliefs and expectations, behavioural avoidance, and illness perceptions. Symptom severity and QoL were the main outcomes. Questionnaires assessing psychological predictors, symptoms and QoL were administered at five points: pre-dietitian (week 0), post-dietitian, end of elimination (week 5), end of reintroduction (week 13), and end of personalisation (week 25) phases. Latent class growth analysis was used to identify classes of response trajectories for symptoms. Linear mixed models were used to test the effect of baseline psychological scores on symptoms and QoL over time. Cross lagged panel models determined the directional predictive relationship between psychological predictors and symptom severity. 112 participants (89% F) median age 30 ± 17 years were included. There were three classes of symptom response trajectories, including ‘non-improvers’ (21.3% of participants) with high initial symptom severity and minimal improvement, ‘improvers’ (22.5% of participants) with low initial symptom severity and significant improvement, and an ‘intermediate’ group (56.2% of participants) with moderate initial symptom severity and significant improvement. Higher treatment beliefs predicted a stronger initial symptom response (effect on linear slope p = 0.036). Lower gut-specific anxiety, as well as higher levels of personal and treatment control at baseline predicted a stronger reduction in IBS symptom severity and improved QoL from week 0 to week 25. Participants with higher levels of baseline psychological symptoms and negative illness perceptions (i.e., lower emotional representations) predicted a stronger initial and later QoL response (effect on linear (p = 0.006) and quadratic (p = 0.049) slopes). Increased cyclical time beliefs predicted poorer initial and later QoL response (effect on linear (p = 0.015) and quadratic (p = 0.029) slopes). Individuals experiencing lower to mid-range symptom severity at baseline had greater improvement with the low FODMAP diet. Lower anxiety, positive illness views and higher treatment beliefs predict better QoL and symptom response. Personalised strategies are crucial for optimising low FODMAP diet effectiveness in IBS.
Short-term skin carotenoid changes following consumption of a typical Australian diet versus a healthy Australian diet: findings from a randomised crossover feeding trial
- E.D. Clarke, J. Stanford, M. Gómez Martín, J.J.A. Ferguson, Burrows, L. Wood, C.E. Collins
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- Proceedings of the Nutrition Society / Volume 83 / Issue OCE1 / April 2024
- Published online by Cambridge University Press:
- 07 May 2024, E91
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Carotenoids, a group of phytochemicals found in plant-based foods with yellow, red, or orange pigments, have been shown to be stored in the skin upon consumption of carotenoid-rich foods(1). Skin carotenoid levels can be measured using skin reflectance spectroscopy, which assesses skin lightness (L*), redness (a*), and yellowness (b*)(2). Previous research has demonstrated significant increases in skin yellowness (b*) after a 4-week high-carotenoid diet(2). The aim was to examine shorter-term changes (two weeks) in skin yellowness following the consumption of a Healthy Australian Diet rich in carotenoids compared to a Typical Australian Diet with low carotenoid content. The study analysed data from an eight-week randomised, cross-over feeding trial involving 34 adults (53% female, aged 38.44 ± 18.05 years). Participants were randomly assigned to each diet for two weeks, separated by a two-week washout period. The Healthy Australian Diet adhered to the Australian Dietary Guidelines(3), emphasising the consumption of carotenoid-rich fruits and vegetables such as carrots, pumpkin, tomatoes, red capsicum, and sweet potatoes. In contrast, the Typical Australian Diet was formulated based on apparent consumption patterns in Australia(4) and emphasised the intake of fruits and vegetables low in beta-carotene, such as white potatoes, onions, cauliflower, and pears. Skin carotenoids were measured using skin reflectance spectroscopy at three sites (palm, inner and outer arm), and each measurement was taken thrice. Overall skin yellowness (b*) was calculated as the average of all three measurements at all three sites. Measurements were conducted at four key visits: week 0 (end of run-in; baseline 1), week 2 (post-feeding phase 1), week 4 (end of washout; baseline 2), and week 8 (post-feeding phase 2). Differential changes in skin carotenoid levels between intervention groups were assessed using linear mixed-effect models, adjusting for diet sequence, feeding phase, body fat percentage, total fat intake, and subject ID as a random variable to account for potential autocorrelation. Post-hoc pairwise comparisons were conducted to evaluate the relative effects of each diet. Although there was a trend towards higher skin yellowness (0.215 ± 0.517; p = 0.41) following consumption of the Healthy Australian diet relative to baseline, and an inverse trend following the Typical Australian Diet (−0.118 ± 0.539, p = 0.56), the difference in change between the two diets was not statistically significant (p = 0.32). Notably, baseline values within this participant cohort were higher than previously reported at b* = 16.7(1) (baseline 1 b*: 17.57 ± 2.23, baseline 2 b*: 17.71 ± 2.26), which may influence the magnitude of observable change. The findings suggest that the two-week intervention duration may be insufficient to achieve statistically significant changes in skin carotenoid levels. Future investigations into whether plasma carotenoids increase first, with skin changes occurring later, could offer valuable insights into the potential utility of this as a biomarker validation of change in fruit and vegetable intake.
A systematic review of nutritional guidelines for preterm infants
- M. Meiliana, T. Alexander, F.H. Bloomfield, B.E. Cormack, J.E. Harding, O. Walsh, L. Lin
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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, E86
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The estimated global preterm birth rate in 20201 was more than 10% of livebirths or 13.4 million infants. Nutrition in the neonatal period is a key factor to optimise growth, neurodevelopment, and later metabolic disease risk2. There is no consensus on optimal nutrition for preterm infants, leading to substantial practice variation3. We aimed to assess the quality of nutritional guidelines for preterm infants, the consistency of recommendations, and the gaps in these recommendations. This review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 checklist. The study protocol was registered with PROSPERO (CRD42022327248). We searched six databases and 44 websites for nutritional guidelines for preterm infants before first hospital discharge, which were endorsed, prepared, or authorised by a regional, national, or international body, written in English, and published between 2012-2023. Two reviewers independently screened articles and extracted relevant data including nutritional recommendations (ranges or descriptions), the quality of recommendations (certainty of evidence and strength of recommendation), and gaps in recommendations, defined as those identified by the guidelines or when recommendations were based on very low certainty evidence. Disagreements were resolved by discussion or a third reviewer. Four reviewers appraised the included guidelines using AGREE II. We identified 7051 records, 27 guidelines were included in the review, 26% of which were of high quality. Most guidelines lacked stakeholder involvement and rigour of development. Twelve guidelines had recommendations for macronutrient intake, 18 for micronutrient intake, 12 for feeding, eight for fortification, and 14 for monitoring of nutritional adequacy. Only two guidelines provided recommendations for all five of these aspects. We found considerable variation in recommendations, many of which lacked details of certainty of evidence and strength of recommendation. Recommendations for feeding types and breastmilk fortification were consistent among high quality guidelines, but recommendations varied for intakes of almost all nutrients and monitoring of nutritional adequacy. Different guidelines gave different certainty of evidence for the same recommendations. Most gaps in recommendations were due to a very low certainty of evidence. Future development of nutritional guidelines for preterm infants should follow the standard guideline development method and ensure rigorous process including stakeholders’ involvement to improve the reporting of strength of recommendation, certainty of evidence, and gaps in recommendation. Evidence is needed to support recommendations about macro and micronutrient intakes, breastmilk fortification, and markers on adequacy of intake of different nutrients.