Analyzing food value chains for nutrition goals

First proposed in 2010, the use of ‘value chain analysis’ to identify opportunities for targeted nutrition interventions in food systems is still an emerging method. This review explores and summarizes the application of value chain analysis to nutrition and from this provides five insights into how to more effectively conduct value chain analysis for nutrition: 1) use a consumer perspective to inform selection of foods and chains; 2) consider the research question, available resources, and the type of chain; 3) situate consumer research at the center of the analysis; 4) assess economic trade-offs; and 5) pay attention to governance and stakeholders’ capacity for and incentives to change

Higher Prevalence of Obesity Among Children With Asthma

The aim of this study is to investigate the association between childhood obesity and asthma, and whether this relationship varies by race/ethnicity. For this population-based, cross-sectional study, measured weight and height, and asthma diagnoses were extracted from electronic medical records of 681,122 patients aged 6–19 years who were enrolled in an integrated health plan 2007–2009. Weight class was assigned based on BMI-for-age. Overall, 18.4% of youth had a history of asthma and 10.9% had current asthma. Adjusted odds of current asthma for overweight, moderately obese, and extremely obese youth relative to those of normal weight were 1.22 (95% confidence interval (CI): 1.20, 1.24), 1.37 (95% CI: 1.34, 1.40), and 1.68 (95% CI: 1.64, 1.73), respectively (P trend < 0.001). Black youth are nearly twice as likely (adjusted odds ratio (OR) = 1.93, 95% CI: 1.89, 1.99), and Hispanic youth are 25% less likely (adjusted OR = 0.75, 95% CI: 0.74, 0.77), to have current asthma than to non-Hispanic white youth. However, the relationship between BMI and asthma was strongest in Hispanic and weakest in black youth. Among youth with asthma, increasing body mass was associated with more frequent ambulatory and emergency department visits, as well as increased inhaled and oral corticosteroid use. In conclusion, overweight, moderate, and extreme obesity are associated with higher odds of asthma in children and adolescents, although the association varies widely with race/ethnicity. Increasing BMI among youth with asthma is associated with higher consumption of corticosteroids and emergency department visits

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Change in Pictures: Creating best practices in archiving ecological imagery for reuse

The research data repository of the Environmental Data Initiative (EDI) is building on over 30 years of data curation research and experience in the National Science Foundation-funded US Long-Term Ecological Research (LTER) Network. It provides mature functionalities, well established workflows, and now publishes all ‘long-tail’ environmental data. High quality scientific metadata are enforced through automatic checks against community developed rules and the Ecological Metadata Language (EML) standard. Although the EDI repository is far along in making its data findable, accessible, interoperable, and reusable (FAIR), representatives from EDI and the LTER are developing best practices for the edge cases in environmental data publishing. One of these is the vast amount of imagery taken in the context of ecological research, ranging from wildlife camera traps to plankton imaging systems to aerial photography. Many images are used in biodiversity research for community analyses (e.g., individual counts, species cover, biovolume, productivity), while others are taken to study animal behavior and landscape-level change.Some examples from the LTER Network include: using photos of a heron colony to measure provisioning rates for chicks (Clarkson and Erwin 2018) or identifying changes in plant cover and functional type through time (Peters et al. 2020). Multi-spectral images are employed to identify prairie species. Underwater photo quads are used to monitor changes in benthic biodiversity (Edmunds 2015). Sosik et al. (2020) used a continuous Imaging FlowCytobot to identify and measure phyto- and microzooplankton. Cameras at McMurdo Dry Valleys assess snow and ice cover on Antarctic lakes allowing estimation of primary production (Myers 2019).It has been standard practice to publish numerical data extracted from images in EDI; however, the supporting imagery generally has not been made publicly available. Our goal in developing best practices for documenting and archiving these images is for them to be discovered and re-used. Our examples demonstrate several issues. The research questions, and hence, the image subjects are variable. Images frequently come in logical sets of time series. The size of such sets can be large and only some images may be contributed to a dedicated specialized repository. Finally, these images are taken in a larger monitoring context where many other environmental data are collected at the same time and location.Currently, a typical approach to publishing image data in EDI are packages containing compressed (ZIP or tar) files with the images, a directory manifest with additional image-specific metadata, and a package-level EML metadata file. Images in the compressed archive may be organized within directories with filenames corresponding to treatments, locations, time periods, individuals, or other grouping attributes. Additionally, the directory manifest table has columns for each attribute. Package-level metadata include standard coverage elements (e.g., date, time, location) and sampling methods. This approach of archiving logical ‘sets’ of images reduces the effort of providing metadata for each image when most information would be repeated, but at the expense of not making every image individually searchable. The latter may be overcome if the provided manifest contains standard metadata that would allow searching and automatic integration with other images

PS2-23: Prevalence of Extreme Obesity in Southern California

Background and Aims: Specific weight goals and treatment options for extremely obese children and adolescents have been suggested. The objective of this study is to provide current estimates of the prevalence of extreme obesity in a large multiethnic youth cohort