Dietary patterns of lactating women in central North Carolina evaluated using three validated assessment tools.

Background: During lactation, there is an increased maternal need for almost all nutrients. It has been reported that maternal status of some nutrients (i.e. vitamin A, C and DHA) can affect breast milk composition. Data about dietary patterns of lactating women in the United States are scarce and only a small number of studies evaluated micronutrient intake. Objectives: The primary objective of this pilot study is to describe the dietary patterns of lactating women in central North Carolina using established and emerging dietary assessment tools, with a particular focus on fruits and vegetables (F&V). A secondary objective is to explore the relationship between maternal intake of fruits, vegetables, and vitamin A, with breast milk vitamin A and carotenoid concentrations. Methods: In this cross-sectional study, 40 lactating women residing in central North Carolina were recruited between July 2018 and April 2019. We collected dietary information using three assessment methods: 24-hour Food Record, REAP dietary screener, and Veggie Meter™, a non-invasive biomarker of F&V intake that has been validated in non-lactating individuals. A single breast milk sample was also collected. Results: Thirty-one participants (78%) were flagged for referral to a Registered Dietitian based on their REAP scores. There was a significant correlation between the Food Record F&V servings and the Veggie Meter™ for subjects who reported that the 24-hour food record was reflective of their usual intake (n=9; p=0.031; R=0.71). The relationship of breast milk beta-carotene and the Veggie Meter™ scores was also statistically significant (n=12; p=0.022; R=0.65). Conclusion: F&V intake in lactating women is often below recommendations. The Veggie Meter™ scores correlated positively with breast milk beta-carotene and F&V intake which can provide an objective method of assessing F&V intake in lactating women in future studies

Unmasking Religious Rule In Shakespeare’s Measure For Measure

In this study, I investigate the historical context surrounding the first productions of Shakespeare’s Measure for Measure and the present social and cultural climate that we live in today. Through this comparative analysis, I demonstrate how Measure for Measure is a product of the extreme uncertainties from the public during the time in which it was originally written, where James I’s ascension to the throne was a major catalyst in provoking questions towards the type of patriarchal and religious rule he would enforce after the death of Elizabeth I. Because we’re living in a similar cultural situation where Donald Trump’s 2016 presidential election has resulted in heightened awareness and widespread magnification of issues concerning racism, sexism, homophobia, and xenophobia, recent and future performances of this play have the ability to call upon these issues to critique and satirize current figures of political power who base their patriarchal rule in the manipulation of religion and the attempted control over women and their bodies. My thesis focuses on how women in Measure for Measure navigate such patriarchally dominant spaces within the play, and how current productions can base their performances within the #MeToo movement to make Shakespeare relevant in our society today

Exploring the demographic, clinical, and behavioral attributes of approved milk bank donors in the United States and United Kingdom

The World Health Organization and the American Academy of Pediatrics support that low and very-low-birth-weight infants receive pasteurized donor human milk (DHM) from established milk banks when there is limited or no access to mother’s own milk. It is estimated that over 60 countries have operating milk banks, totalizing over 700 milk banks around the world and consequently, more than 800,000 infants receiving DHM annually. Although human milk banking continues to grow around the world, information about the individuals who donate their milk is limited. It is important to note that different milk banking models may have differing influences on donors. For example, the Human Milk Banking Association of North America (HMBANA) is a non-profit organization that currently has 31-member milk banks. In 2021, they had 13,000 donors and dispensed over 9 million ounces of milk. While the main focus of this research was the United States (US), we have included the United Kingdom (UK), another high-income geography, as a comparison for our study. The United Kingdom Association for Milk Banking (UKAMB) is also a non-profit organization and currently has 15 milk bank members. In aim 1, we described and compared milk bank donors’ demographic, clinical and lifestyle characteristics, and breastfeeding experiences in the US and UK. Donors were predominantly in their early 30s, White, married, educated, and identified as female. Donors from the UK were more frequently on maternity leave than donors from the US (32.6% vs 5.4%, p<0.001). Moreover, more donors in the US reported pumping several times a day compared to donors in the UK (57% vs 36%, p<0.001). Donors in the UK reported a longer average duration of breastfeeding a single child (21.2 vs. 13.3 months, p<0.001) and lifetime milk production (30.9 vs. 19.4 months, p<0.001) compared to donors in the US. The most common primary reason reported for pumping milk among US donors was returning to work (34% vs 11%, p<0.001 in the UK). While in the UK, the most common primary reason reported was related to breastfeeding difficulties (e.g., latching issues, sick infant) (45/187, 24.0%). Donors in both settings received information/assistance from more sources related to breastfeeding than to pumping (US – 2.8 vs 2.0 sources, UK – 2.8 vs 1.8 sources). In aim 2, we described and compare enablers, barriers, and patterns of donation among milk bank donors in the US and UK. Donors in the US donated on average a higher lifetime volume of milk than UK donors (1126 vs 966 fl. oz, p=0.002). Donors in both settings often reported participating in other forms of milk exchange including peer-to-peer milk sharing (51% of US donors and 39% of UK donors). The average number of information sources donors received about milk banks was relatively small in the US and UK (1.3 vs 1.2 sources, p=0.096), where the most common source of information about milk banks was the internet/social media (US: 63% vs UK: 70%, p=0.112), followed by information from healthcare providers (US: 41% vs UK: 30%, p=0.012). The top reasons reported for donating were wanting to help others (UK 66%, US 51%) and having excess milk (UK 27%, US 43%) with statistical differences by geography (p=0.039). In terms of donation barriers, 69-79% of donors reported encountering a barrier. In aim 3, we identified factors that predict lifetime donation volume of milk bank donors in the US. Our backward elimination model started by considering 14 variables and resulted in a final six-factor model to predict lifetime milk bank donation volume of US donors (R2=0.327). The significant predictors were: number of days since approved as a donor, number of milk types donated (e.g., colostrum, mature milk), pumping frequency, milk sharing/selling practices, duration breastfeeding single child, and child’s age at first donation. In conclusion, we observed that US donors are less frequently on maternity leave than UK donors and they also started pumping breast milk earlier and more frequently. In addition, US donors donated more milk to milk banks and participated more frequently in peer-to-peer milk sharing. Both pumping frequency and milk sharing practices were identified as significant positive predictor variables of donation volumes in US donors. Factors that impact donation volume in other milk banking settings warrants further investigation

Losing Minds and Hearts: Ideology, Education, and the Development of Youth Nonconformity Under European Fascisms

2022 University Libraries Undergraduate Research Award Winner --- This paper explores the successes and failures of European fascist regimes in implementing their methods for the “total education” of youth, diving into the educational policy of Fascist Italy, Nazi Germany, Salazarist Portugal, and Francoist Spain, with a special focus on the German case. It reassesses the challenges and contradictions of fascist education, and the intrinsic failures of these educational models that led to the emergence of dissent among youths, as well as the development of nonconforming subcultures opposed to the hegemonic official ones. I conclude that the structural failures of fascist educational models, rooted in ideological irregularity, contradictory and decentralized policy, and the attempt to control all aspects of youth socialization in ways that conflicted with generational and universal youth values, inevitably created nonconformity. This nonconformity came in several forms and was shaped by social context and class divisions. At times, group behavior developed into broader subcultures that, by rejecting official and doctrinaire youth values, assumed political meaning

Tophus burden reduction with pegloticase: results from phase 3 randomized trials and open-label extension in patients with chronic gout refractory to conventional therapy

INTRODUCTION: Two replicate randomized, placebo-controlled six-month trials (RCTs) and an open-label treatment extension (OLE) comprised the pegloticase development program in patients with gout refractory to conventional therapy. In the RCTs, approximately 40% of patients treated with the approved dose saw complete response (CR) of at least one tophus. Here we describe the temporal course of tophus resolution, total tophus burden in patients with multiple tophi, tophus size at baseline, and the relationship between tophus response and urate-lowering efficacy. METHODS: Baseline subcutaneous tophi were analyzed quantitatively using computer-assisted digital images in patients receiving pegloticase (8 mg biweekly or monthly) or placebo in the RCTs, and pegloticase in the OLE. Tophus response, a secondary endpoint in the trials, was evaluated two ways. Overall tophus CR was the proportion of patients achieving a best response of CR (without any new/enlarging tophi) and target tophus complete response (TT-CR) was the proportion of all tophi with CR. RESULTS: Among 212 patients randomized in the RCTs, 155 (73%) had ≥ 1 tophus and 547 visible tophi were recorded at baseline. Overall tophus CR was recorded in 45% of patients in the biweekly group (P = 0.002 versus placebo), 26% in the monthly group, and 8% in the placebo group after six months of RCT therapy. TT-CR rates at six months were 28%, 19%, and 2% of tophi, respectively. Patients meeting the primary endpoint of sustained urate-lowering response to therapy (responders) were more likely than nonresponders to have an overall tophus CR at six months (54% vs 20%, respectively and 8% with placebo). CONCLUSIONS: Pegloticase reduced tophus burden in patients with refractory tophaceous gout, especially those achieving sustained urate-lowering. Complete resolution of tophi occurred in some patients by 13 weeks and in others with longer-term therapy

Clinical phenotype and genetic associations in autosomal dominant familial Alzheimer's disease: a case series

Background - The causes of phenotypic heterogeneity in familial Alzheimer’s disease with autosomal dominant inheritance are not well understood. We aimed to characterise clinical phenotypes and genetic associations with APP and PSEN1 mutations in symptomatic autosomal dominant familial Alzheimer’s disease (ADAD). Methods - We retrospectively analysed genotypic and phenotypic data (age at symptom onset, initial cognitive or behavioural symptoms, and presence of myoclonus, seizures, pyramidal signs, extrapyramidal signs, and cerebellar signs) from all individuals with ADAD due to APP or PSEN1 mutations seen at the Dementia Research Centre in London, UK. We examined the frequency of presenting symptoms and additional neurological features, investigated associations with age at symptom onset, APOE genotype, and mutation position, and explored phenotypic differences between APP and PSEN1 mutation carriers. The proportion of individuals presenting with various symptoms was analysed with descriptive statistics, stratified by mutation type. Findings - Between July 1, 1987, and Oct 31, 2015, age at onset was recorded for 213 patients (168 with PSEN1 mutations and 45 with APP mutations), with detailed history and neurological examination findings available for 121 (85 with PSEN1 mutations and 36 with APP mutations). We identified 38 different PSEN1 mutations (four novel) and six APP mutations (one novel). Age at onset differed by mutation, with a younger onset for individuals with PSEN1 mutations than for those with APP mutations (mean age 43·6 years [SD 7·2] vs 50·4 years [SD 5·2], respectively, p<0·0001); within the PSEN1 group, 72% of age at onset variance was explained by the specific mutation. A cluster of five mutations with particularly early onset (mean age at onset <40 years) involving PSEN1’s first hydrophilic loop suggests critical functional importance of this region. 71 (84%) individuals with PSEN1 mutations and 35 (97%) with APP mutations presented with amnestic symptoms, making atypical cognitive presentations significantly more common in PSEN1 mutation carriers (n=14; p=0·037). Myoclonus and seizures were the most common additional neurological features; individuals with myoclonus (40 [47%] with PSEN1 mutations and 12 [33%] with APP mutations) were significantly more likely to develop seizures (p=0·001 for PSEN1; p=0·036 for APP), which affected around a quarter of the patients in each group (20 [24%] and nine [25%], respectively). A number of patients with PSEN1 mutations had pyramidal (21 [25%]), extrapyramidal (12 [14%]), or cerebellar (three [4%]) signs. Interpretation - ADAD phenotypes are heterogeneous, with both age at onset and clinical features being influenced by mutation position as well as causative gene. This highlights the importance of considering genetic testing in young patients with dementia and additional neurological features in order to appropriately diagnose and treat their symptoms, and of examining different mutation types separately in future research. Funding - Medical Research Council and National Institute for Health Research

Architecture for a Social Assistive Robot in Cardiac Rehabilitation

Social robots are demonstrating to have potential in several healthcare applications, especially in rehabilitation areas. This paper presents an architecture for a socially assistive robot system for cardiac rehabilitation, based on a model-controller structure through a finite-state machine and a behaviour module. The platform has been designed to provide social support and assistance during the therapy, aiming to improve the quality of the provided service, as well as the engagement and performance of the patients. This architecture has been tested under clinical conditions with a patient during a typical therapy session. The results show that the proposed architecture is able to adapt to the various situations present during a session, providing a robust framework to further develop the robot's behaviour towards a more natural and intuitive interaction with the patients

Using a Personalised Socially Assistive Robot for Cardiac Rehabilitation: A Long-Term Case Study

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The Genomic Signature of Crop-Wild Introgression in Maize

The evolutionary significance of hybridization and subsequent introgression has long been appreciated, but evaluation of the genome-wide effects of these phenomena has only recently become possible. Crop-wild study systems represent ideal opportunities to examine evolution through hybridization. For example, maize and the conspecific wild teosinte Zea mays ssp. mexicana, (hereafter, mexicana) are known to hybridize in the fields of highland Mexico. Despite widespread evidence of gene flow, maize and mexicana maintain distinct morphologies and have done so in sympatry for thousands of years. Neither the genomic extent nor the evolutionary importance of introgression between these taxa is understood. In this study we assessed patterns of genome-wide introgression based on 39,029 single nucleotide polymorphisms genotyped in 189 individuals from nine sympatric maize-mexicana populations and reference allopatric populations. While portions of the maize and mexicana genomes were particularly resistant to introgression (notably near known cross-incompatibility and domestication loci), we detected widespread evidence for introgression in both directions of gene flow. Through further characterization of these regions and preliminary growth chamber experiments, we found evidence suggestive of the incorporation of adaptive mexicana alleles into maize during its expansion to the highlands of central Mexico. In contrast, very little evidence was found for adaptive introgression from maize to mexicana. The methods we have applied here can be replicated widely, and such analyses have the potential to greatly informing our understanding of evolution through introgressive hybridization. Crop species, due to their exceptional genomic resources and frequent histories of spread into sympatry with relatives, should be particularly influential in these studies

Experience and Challenges from Clinical Trials with Malaria Vaccines in Africa.

Malaria vaccines are considered amongst the most important modalities for potential elimination of malaria disease and transmission. Research and development in this field has been an area of intense effort by many groups over the last few decades. Despite this, there is currently no licensed malaria vaccine. Researchers, clinical trialists and vaccine developers have been working on many approached to make malaria vaccine available.African research institutions have developed and demonstrated a great capacity to undertake clinical trials in accordance to the International Conference on Harmonization-Good Clinical Practice (ICH-GCP) standards in the last decade; particularly in the field of malaria vaccines and anti-malarial drugs. This capacity is a result of networking among African scientists in collaboration with other partners; this has traversed both clinical trials and malaria control programmes as part of the Global Malaria Action Plan (GMAP). GMAP outlined and support global strategies toward the elimination and eradication of malaria in many areas, translating in reduction in public health burden, especially for African children. In the sub-Saharan region the capacity to undertake more clinical trials remains small in comparison to the actual need.However, sustainability of the already developed capacity is essential and crucial for the evaluation of different interventions and diagnostic tools/strategies for other diseases like TB, HIV, neglected tropical diseases and non-communicable diseases. There is urgent need for innovative mechanisms for the sustainability and expansion of the capacity in clinical trials in sub-Saharan Africa as the catalyst for health improvement and maintained