Acceptability and Effectiveness of a Locally-Produced Ready-to-Use Supplementary Food (RUSF) for Prevention of Undernutrition in Children Under Two Years in Cambodia

We tested a locally-produced, fish-based multiple micronutrient fortified lipid-based nutrient supplement (LNS) snack as a ready-to-use supplementary food (RUSF) to prevent undernutrition in Cambodian children under 2 years. Our first trial assessed the RUSF’s acceptability as a snack or mixed with borbor (white rice porridge) compared to Corn-Soy Blend Plus Plus (CSB++), and micronutrient powders (MNP) with borbor. The second assessed its effectiveness in reducing growth faltering compared to CSB++, MNP, and an unsupplemented control group. The acceptability trial with 92 children aged 9-23 months assessed children’s consumption, caregivers’ assessment of children’s preferences and caregivers’ ranking of foods. The cluster-randomised controlled effectiveness trial allocated 485 healthy children aged 6-17 months to RUSF, CSB++, MNP or control groups for 6 months. Outcomes were weight-for-age (WAZ), height-for-age (HAZ), weight- for-height (WHZ), and mid-upper arm circumference (MUAC). In acceptability testing, odds of children consuming >50% were greatest for MNP-borbor versus RUSF snack. Caregivers reported that children had the highest preference for MNP-borbor, then for the RUSF snack. Caregivers ranked the RUSF snack highest. In the effectiveness trial, growth faltered from baseline to endline, with no significant differences between interventions and control. In unadjusted analysis, the RUSF group had greater increases in MUAC than CSB++ or the control. For other outcomes, the RUSF did not differ significantly from the control, which had decreased WAZ and HAZ and no significant change in WHZ. In adjusted analysis, high consumers of RUSF had increased MUAC compared to control, but no statistically significant differences to CSB++ or MNP. Low consumers of RUSF had increased WAZ, WHZ and MUAC. Our trials demonstrated that the novel RUSF is acceptable and slowed, but did not prevent, growth faltering

Patient experience, nutritional uptake and satisfaction with hospital food services

It has been recognised that hospital food service could be improved, with malnutrition a particular concern. The problem of patients obtaining adequate nutrition in hospital is complex with many constraints at ward level. The hypothesis of this study is that patients able to see and smell the food on offer and with potential for greater server empathy, will achieve better nutritional status and increased meal satisfaction. Data were collected from two wards, Women's Health and Orthopaedic, (n=62) over two, three-day consecutive periods. Firstly, for a pre-ordered, plated meal service and secondly, nine months later, for a trolley service offering choice at the point of consumption. Food was weighed before and after the meal. Questionnaires were administered and interviews conducted with patients (n= 614) to evaluate patient acceptability of both catering systems and other pertinent data. The research methodology also involved collecting observational data during mealtimes. Focus groups were conducted with ward staff, and patients together with their visitors while open ended interviews were conducted with the catering manager, facilities manager, chief dietitian, orthopaedic ward dietitian and chief pharmacist. This was to enhance and validate information already gathered. Results show that nutritional intake was not dependent on the catering system and that possibly in hospital; unlike other `eating out' situations there are barriers to `complete nutrition'1. A theoretical model of patient experience and satisfaction with hospital food service is presented, reflecting data gathered during the case study. Texture and temperature of food were shown to be critical factors impinging on patient satisfaction and the trolley system of delivery is the preferred style of service. Service predisposition demonstrates little significance with patient satisfaction towards the overall meal experience. This research indicates that nutritionally, the method of meal delivery is immaterial but patients do prefer choice at the point of consumption. 1 A term used to define the provision of a healthy nutritionally balanced diet which meets and satisfies both physiological and psychological requirements

Metabolomic Analyses of Plasma Reveals New Insights into Asphyxia and Resuscitation in Pigs

Currently, a limited range of biochemical tests for hypoxia are in clinical use. Early diagnostic and functional biomarkers that mirror cellular metabolism and recovery during resuscitation are lacking. We hypothesized that the quantification of metabolites after hypoxia and resuscitation would enable the detection of markers of hypoxia as well as markers enabling the monitoring and evaluation of resuscitation strategies.Hypoxemia of different durations was induced in newborn piglets before randomization for resuscitation with 21% or 100% oxygen for 15 min or prolonged hyperoxia. Metabolites were measured in plasma taken before and after hypoxia as well as after resuscitation. Lactate, pH and base deficit did not correlate with the duration of hypoxia. In contrast to these, we detected the ratios of alanine to branched chained amino acids (Ala/BCAA; R(2).adj = 0.58, q-value<0.001) and of glycine to BCAA (Gly/BCAA; R(2).adj = 0.45, q-value<0.005), which were highly correlated with the duration of hypoxia. Combinations of metabolites and ratios increased the correlation to R(2)adjust = 0.92. Reoxygenation with 100% oxygen delayed cellular metabolic recovery. Reoxygenation with different concentrations of oxygen reduced lactate levels to a similar extent. In contrast, metabolites of the Krebs cycle (which is directly linked to mitochondrial function) including alpha keto-glutarate, succinate and fumarate were significantly reduced at different rates depending on the resuscitation, showing a delay in recovery in the 100% reoxygenation groups. Additional metabolites showing different responses to reoxygenation include oxysterols and acylcarnitines (n = 8-11, q<0.001).This study provides a novel strategy and set of biomarkers. It provides biochemical in vivo data that resuscitation with 100% oxygen delays cellular recovery. In addition, the oxysterol increase raises concerns about the safety of 100% O(2) resuscitation. Our biomarkers can be used in a broad clinical setting for evaluation or the prediction of damage in conditions associated with low tissue oxygenation in both infancy and adulthood. These findings have to be validated in human trials

Student understanding, attitude and achievement: assessment comparisons in genetics and photosynthesis/respiration

In the Living Environment Regents examination in New York State, there is a distinct difference between students’ ability to memorize compared to their understanding biological concepts. Consequently, this study compared a range of diagnostic assessment tools to ascertain students’ conceptual understanding in two-selected domains - photosynthesis/respiration and genetics. The Regents examination was not an adequate measure of advanced student understanding of these domains when triangulated against scores on diagnostic examinations, student opinion, and attitudes