Investigating Differences in Nutritional Parameters in Ugandan Children with Plasmodium falciparum Severe Malaria

Background: The past two decades have witnessed a 60% decline in global malaria mortality. However, two thirds of all malaria deaths continue to occur among children <5 years, with a majority in the WHO African Region. Malnutrition is an important risk factor for malaria. Wasting, Stunting and Underweight are crucial indicators of malnutrition, and are associated with increased mortality in children <5. Annually, 14 million children <5 are classified as wasted and 59 million children are classified as stunted. Objective: The objective of this study is to look at nutritional parameters, weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ), and how they differ over time in children <5 with severe malaria (SM) from the Ugandan cities Mulago and Jinja and the outcomes of mortality and nutritional parameters, underweight, stunting, and wasting. Methods: We defined underweight, stunting, and wasting as 2SD below the WAZ, HAZ, and WHZ means. We evaluated Z-scores and mortality status from children <5 years enrolled in a prospective cohort study (NDI, Neurodevelopmental Impairment in Children with Severe Malaria) at enrollment and 12-month follow-up between two sites. Results: WAZ, HAZ and WHZ at baseline were significantly lower among SM groups than in CC (p<0.01), and the SM group maintained significantly lower WHZ (p<0.01) and HAZ (p<0.001) at 12-month follow-up. Among the children who died, there were no significant differences of nutritional markers in Mulago, but in Jinja there was found to be a significant association between mortality and low WAZ (p<0.05) and underweight (p<0.05). Of children classified as underweight in Jinja, 37.5% of them died compared to 15.9% who survived; additionally, the odds ratio for decreased WAZ and mortality was 0.58 (p<0.05). Conclusion: Underweight, stunting, and wasting may be risk factors for SM, and underweight may exacerbate poor mortality outcomes in rural areas like Jinja. While underweight is worsened among children with SM at 1 month and normalizes by 12 months, stunting remains persistently low at 12 months. Nutritional interventions must be aimed at maintaining linear growth throughout the first year of SM in children <5 to reduce the risk factor of underweight on poor mortality outcomes

Renin as a biomarker of acute kidney Injury and mortality in children with severe malaria or sickle cell disease

Background: Globally, a very high percentage of acute kidney injury (AKI) occurs in low- and middle-income countries (LMICs) where late recognition contributes to increased mortality. There are challenges with using existing biomarkers of AKI in LMICs. Emerging evidence suggests renin may serve as a biomarker of kidney injury that can overcome limitations in creatinine-based diagnostics. Methods: Two study populations in Uganda were assessed. Cohort #1 was a two-site, prospective cohort study enrolling 600 children with severe malaria (SM). Cohort #2 was a prospective cohort study enrolling 185 children with sickle cell disease (SCD) hospitalized with a vaso-occlusive crisis. Plasma or serum renin concentrations were measured in both cohorts of children at the time of hospital admission using Luminex® (Luminex Corporation, Austin, Texas, United States) or enzyme-linked immunosorbent assay (ELISA), respectively. We assessed the ability of renin to discriminate between children with or without AKI and between children who survived and children who died using receiver operating characteristic curves. Results: In both cohorts, renin concentrations were strongly associated with AKI and mortality. Renin was able to discriminate between children with or without AKI with an area under the curve (AUC) of 0.70 (95%CI, 0.65-0.74) in children with SM and 0.72 (95%CI, 0.6co3-0.81) in children with SCD. Renin was able to discriminate between children who survived and children who died with an AUC of 0.73 (95%CI, 0.63- 0.83) in children with SM and 0.94 (95%CI, 0.89-0.99) in children with SCD. In Cohort #2, we compared renin against urine neutrophil gelatinase-associated lipocalin (NGAL) as the leading biomarker of AKI, and it had comparable performance in discriminating AKI and predicting mortality. Conclusions: In two independent populations of children at risk of AKI with key differences in the etiology of kidney injury, renin was strongly associated with AKI and mortality and had moderate to good diagnostic performance to predict mortality

Modeling Perennial Bioenergy Crops in the E3SM Land Model (ELMv2)

Perennial bioenergy crops are increasingly important for the production of ethanol and other renewable fuels, and as part of an agricultural system that alters the climate through its impact on biogeophysical and biogeochemical properties of the terrestrial ecosystem. Few Earth System Models (ESMs) represent such crops, however. In this study, we expand the Energy Exascale Earth System Land Model to include perennial bioenergy crops with a high potential for mitigating climate change. We focus on high-productivity miscanthus and switchgrass, estimating various parameters associated with their different growth stages and performing a global sensitivity analysis to identify and optimize these parameters. The sensitivity analysis identifies five parameters associated with phenology, carbon/nitrogen allocation, stomatal conductance, and maintenance respiration as the most sensitive parameters for carbon and energy fluxes. We calibrated and validated the model against observations and found that the model closely captures the observed seasonality and the magnitude of carbon fluxes. The validated model represents the latent heat flux fairly well, but sensible heat flux for miscanthus is not well captured. Finally, we validated the model against observed leaf area index (LAI) and harvest amount and found modeled LAI captured observed seasonality, although the model underestimates LAI and harvest amount. This work provides a foundation for future ESM analyses of the interactions between perennial bioenergy crops and carbon, water, and energy dynamics in the larger Earth system, and sets the stage for studying the impact of future biofuel expansion on climate and terrestrial systems

Objectively-assessed physical activity and weight change in young adults: a randomized controlled trial

Abstract Background Reductions in physical activity (PA) are common throughout young adulthood and low PA is associated with weight gain. The SNAP Trial previously reported that two self-regulation approaches to weight gain prevention reduced weight gain over a 2-year period in 18–35 year olds. Presented here are secondary analyses examining changes in PA and the relationship between PA and weight change over 2 years. Methods 599 young adults (age: 27.4 ± 4.4 yrs.; BMI: 25.4 ± 2.6 kg/m2) were randomly assigned to 1 of 3 treatment arms: Small Changes (reduce calorie intake by 100 kcals/day & add 2000 steps/day), Large Changes (lose 2.3–4.5 kg initially & increase PA to ≥250 min/wk), or Self-guided (control condition). Small and Large Changes received 10, face-to-face group sessions (months 1–4), and two 4-week refresher courses each subsequent year. Body weight and PA were objectively-measured at baseline, 4 months, 1 and 2 years. Daily steps and bout-related moderate-to-vigorous intensity PA (MVPA: ≥3 METs, ≥10-min bouts) was calculated. Results Changes in bout-related MVPA and daily steps did not differ among treatment groups over the 2-year period (p’s > 0.16). Collapsed across groups, participants gaining >1 lb. (n = 187; 39.6%) had smaller changes in bout-related MVPA at 4 months, 1 and 2 years relative to those maintaining or losing weight (≤1 lb. weight gain; n = 282, 60.4%, p’s 1 lb. did not differ on daily steps (p’s > 0.10). Among participants engaging in ≥250 min/wk. of MVPA at 2 years (n = 181), 30% gained >1 lb. from baseline to 2 years, which was not different from those engaging in 150–250 min/wk. (n = 87; 36%; p = 0.40), but this percentage was significantly lower when compared to those engaging in 150 min/week of MVPA is needed for weight gain prevention and that increasing MVPA, rather than steps, should be targeted. Trial registration www.clinicaltrials.gov (NCT01183689). Registered Aug 13, 2010

Identifying Risk Factors That Distinguish Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection From Common Upper Respiratory Infections in Children

Background Demographic and clinical risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children presenting with respiratory viral symptoms are not well defined. An understanding of risk factors for SARS-CoV-2 infection can help prioritize testing. Methodology We evaluated potential demographic and clinical factors in children who had respiratory viral symptoms and were tested by polymerase chain reaction (PCR) for SARS-CoV-2 and other respiratory viral infections. Results Among the 263 symptomatic children tested for routine seasonal respiratory viruses by PCR, 18 (6.8%) tested positive for SARS-CoV-2. Overall, 22.2% of SARS-CoV-2-infected children and 37.1% of SARS-CoV-2-uninfected children had infection with one or more non-SARS-CoV-2 pathogens (p = 0.31). Higher proportions of children with compared to without SARS-CoV-2 infection were male (77.8 vs. 51.8%, p = 0.05), Hispanic (44.4% vs. 9.8%, p < 0.001), or had the symptoms of fatigue (22.2% vs. 2.5%, p = 0.003) or anosmia/ageusia (11.1% vs. 0%, p = 0.004). History of hypoxic-ischemic encephalopathy (HIE) and obesity were more common in children with versus without SARS-CoV-2 infection (11.1% vs. 1.2%, p = 0.04, and 11.1% vs. 0%, p = 0.004, respectively). In a multivariate analysis, Hispanic ethnicity, symptoms of fatigue or anosmia/ageusia, and presence of obesity (as noted on physical examination) or HIE were independently associated with SARS-CoV-2 infection. Numbers in each category were small, and these preliminary associations require confirmation in future studies. Conclusions In this area of the United States, infection with other viruses did not rule out infection with SARS-CoV-2. Additionally, children with respiratory viral symptoms who were of Hispanic ethnicity, had symptoms of weakness/fatigue, or had obesity or HIE were at an increased risk for SARS-CoV-2 infection. Future studies should assess if these factors are associated with risk in populations in other areas of the United States

The Stars of the HETDEX Survey. I. Radial Velocities and Metal-Poor Stars from Low-Resolution Stellar Spectra

The Hobby-Eberly Telescope Dark Energy Experiment (HETDEX) is an unbiased, massively multiplexed spectroscopic survey, designed to measure the expansion history of the universe through low-resolution (R∼750) spectra of Lyman-Alpha Emitters. In its search for these galaxies, HETDEX will also observe a few 105 stars. In this paper, we present the first stellar value-added catalog within the internal second data release of the HETDEX Survey (HDR2). The new catalog contains 120,571 low-resolution spectra for 98,736 unique stars between 10∘) Galactic latitudes. With these spectra, we measure radial velocities (RVs) for ∼42,000 unique FGK-type stars in the catalog and show that the HETDEX spectra are sufficient to constrain these RVs with a 1σ precision of 28.0 km/s and bias of 3.5 km/s with respect to the LAMOST surveys and 1σ precision of 27.5 km/s and bias of 14.0 km/s compared to the SEGUE survey. Since these RVs are for faint (G≥16) stars, they will be complementary to Gaia. Using t-Distributed Stochastic Neighbor Embedding (t-SNE), we also demonstrate that the HETDEX spectra can be used to determine a star's Teff, and log g and its [Fe/H]. With the t-SNE projection of the FGK-type stars with HETDEX spectra we also identify 416 new candidate metal-poor ([Fe/H] <−1~dex) stars for future study. These encouraging results illustrate the utility of future low-resolution stellar spectroscopic surveys

Transitioning to a consensually nonmonogamous relationship: an investigation using relational turbulence theory

Nonmonogamous behaviors have interested the public and researchers for decades. For many years, attention to nonmonogamous behaviors has been paid primarily to infidelity. Within recent decades, however, the focus has begun widening to include a different kind of nonmonogamous arrangement. Consensual nonmonogamy, a relationship style that allows for nonmonogamous behaviors and avoids the many negative consequences associated with infidelity. Consensually nonmonogamous (CNM) relationships have been woefully underrepresented in research and only a handful of studies have attempted to understand the process by which CNM relationships are negotiated into existence from monogamous relationships. This paper responds to this need for understanding by using relational turbulence theory to explore the transitional period when a monogamous couple first decides to explore consensual nonmonogamy. We recruited 210 participants over 18 years of age who had been in a monogamous relationship that transitioned to a CNM relationship. Participants completed a quantitative questionnaire comprised of several survey measures, new and old, designed to assess their feelings and perceptions of their relationship before, during, and after the initial conversations regarding implementing consensual nonmonogamy. Results indicated that feelings of relational uncertainty, partner’s facilitation and interference, and their conversational valence were significant predictors of relational turbulence and conversational satisfaction. This research provides valuable information to researchers and practitioners regarding CNM relationships, as well as expanding relational turbulence theory by applying it to new relational contexts.Communication & MediaCollege of Liberal Art

Using an Ontology to Determine English Countability

In this paper we show to what degree the countability of English nouns is predictable from their semantics. We found that at 78% of nouns&apos; countability could be predicted using an ontology of 2,710 nodes. We also show how this predictability can be used to aid non-native speakers to determine the countability of English nouns when building a bilingual machine translation lexicon

Using an ontology to determine English countability

In this paper we show to what degree the countability of English nouns is predictable from their semantics. We found that at 78% of nouns' countability could be predicted using an ontology of 2,710 nodes. We also show how this predictability can be used to aid non-native speakers to determine the countability of English nouns when building a bilingual machine translation lexicon.Accepted versio

Underweight is Associated with Mortality Among Ugandan Children with Plasmodium falciparum Severe Malaria

Background: The past two decades have witnessed a 60% decline in global malaria mortality. However, two thirds of all malaria deaths continue to occur among children <5 years, with a majority in the WHO African Region. Malnutrition is an important risk factor for malaria. Globally, wasting, stunting and being underweight are crucial indicators of malnutrition, and are associated with increased mortality in children <5. Those most vulnerable to malaria and malnutrition are children <5 living in Sub-Saharan Africa, particularly in rural areas often facing a higher burden of disease.Objective: The objective of this study was to assess the prevalence and persistence of nutritional abnormalities causing children to be underweight, stunted, or show signs of wasting, and the association of these abnormalities with in-hospital and post-discharge mortality, risk of repeat illness and long-term sequelae in Ugandan children with 5 different forms of severe malaria (SM) compared to community children (CC).Methods: We conducted a prospective observational study investigating neurocognitive outcomes at 12-months after severe malaria episode in 600 children with SM and 120 CC, aged 0.5-4 years, between 2014-2017 at 2 hospitals (Kampala and Jinja) in Uganda. Using age-adjusted scores from healthy CC, we calculated z-scores for weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). We defined underweight, stunting, and wasting as 2SD below the WAZ, HAZ, and WHZ means. Results: At baseline, children with SM had significantly lower mean WAZ and HAZ compared to CC (-1.1 [1.1 SD] vs. -0.47 [1.1], p<0.001; -0.68 [1.1] vs. 0.30 [1.0], p<0.001, respectively), with no difference by site. By 12-month follow-up there were no significant differences in nutritional markers between SM and CC. During admission, 44 (7.3%) children with SM died. Higher baseline WAZ was associated with decreased risk of in-hospital death in children with SM across the two sites (OR [95% CI] = 0.70 [0.51, 0.95], p=0.02), with no significant interaction between WAZ and site. Baseline HAZ and WHZ were not significantly associated with in-hospital mortality (OR [95% CI]) = 0.84 [0.66, 1.06] and 0.77 [0.57, 1.02], respectively). During the post-discharge period, 23 (4.4%) children with SM and 1 (0.9%) CC died prior to 12-month follow-up. Nutritional marker z-scores were not significantly associated with risk of post-discharge mortality in children with SM, overall and by site. However, children in Kampala who were underweight had increased odds of post-discharge mortality compared to those who were normal weight (OR [95% CI] = 4.18 [1.36, 12.84], p=0.01). Among those who survived in Kampala, higher WAZ was associated with increased risk of returning to clinic for any cause within 12-month follow-up (HR [95% CI] = 1.16 [1.06, 1.28], p=0.002), but was not significant for malaria sick visits or readmission. HAZ and WHZ in Kampala and all nutritional markers in Jinja were not significantly associated with return sick visits or readmission. Conclusion: Underweight and stunting were worse in both sites among children with SM versus the controls at 1 month, and both of these nutritional parameters normalized by 12 months. In Kampala, low WAZ was associated with worse mortality outcomes after discharge, while high WAZ was associated with repeat clinic visits. In both sites, high WAZ was protective against in-hospital mortality. Chronic malnutrition and SM remain severe risk factors for mortality in Uganda. Weight status was found to have the most significant impact on mortality outcomes. The high incidence of mortality among children <5 with SM requires urgent intervention, and nutrition programs should be aimed at increasing weight, especially in the early months of disease