Maximizing the benefits and minimizing the risks of intervention programs to address micronutrient malnutrition: symposium report.

Interventions to address micronutrient deficiencies have large potential to reduce the related disease and economic burden. However, the potential risks of excessive micronutrient intakes are often not well determined. During the Global Summit on Food Fortification, 9-11 September 2015, in Arusha, a symposium was organized on micronutrient risk-benefit assessments. Using case studies on folic acid, iodine and vitamin A, the presenters discussed how to maximize the benefits and minimize the risks of intervention programs to address micronutrient malnutrition. Pre-implementation assessment of dietary intake, and/or biomarkers of micronutrient exposure, status and morbidity/mortality is critical in identifying the population segments at risk of inadequate and excessive intake. Dietary intake models allow to predict the effect of micronutrient interventions and their combinations, e.g. fortified food and supplements, on the proportion of the population with intakes below adequate and above safe thresholds. Continuous monitoring of micronutrient intake and biomarkers is critical to identify whether the target population is actually reached, whether subgroups receive excessive amounts, and inform program adjustments. However, the relation between regular high intake and adverse health consequences is neither well understood for many micronutrients, nor do biomarkers exist that can detect them. More accurate and reliable biomarkers predictive of micronutrient exposure, status and function are needed to ensure effective and safe intake ranges for vulnerable population groups such as young children and pregnant women. Modelling tools that integrate information on program coverage, dietary intake distribution and biomarkers will further enable program makers to design effective, efficient and safe programs

Comparison of the Effects of Supplemental Red Palm Oil and Sunflower oil on Maternal Vitamin A Status.

Conflicting results have been reported on the ability of dietary carotenoids to improve vitamin A status in lactating women. Red palm oil is one of the richest dietary sources of beta-carotene. We aimed to determine the efficacy of red palm oil in increasing retinol and provitamin A status in pregnant and lactating women. Ninety rural, pregnant Tanzanian women from 3 randomly selected villages were recruited during their third trimester to participate in 3 dietary intervention groups: a control group, who were encouraged to maintain the traditional practice of eating staples with dark-green leafy vegetables, and 2 study groups, who were given either sunflower or red palm oil for use in household food preparations. The intervention lasted 6 mo. Plasma samples were collected at the third trimester and 1 and 3 mo postpartum, and breast-milk samples were collected 1 and 3 mo postpartum. Supplementation with red palm oil, which is rich in provitamin A, increased alpha- and beta-carotene concentrations significantly (P < 0.001) in both plasma and breast milk. Plasma retinol concentrations were similar in all dietary groups. Breast-milk retinol concentrations tended to decrease from 1 to 3 mo postpartum in the control group, but were maintained in both oil groups. The difference in change in breast-milk retinol concentration between the red palm oil group and the control group was significant (P = 0.041). Consumption of red palm oil increases concentrations of alpha- and beta-carotene in both breast milk and serum and maintains breast-milk retinol concentrations. Sunflower oil consumption seems to conserve breast-milk retinol similarly to consumption of red palm oil. Breast-milk retinol might be maintained through increased dietary intake of these vegetable oils and use of mild cooking preparation methods (such as the addition of oil at the end of cooking and avoidance of frying)

Quartäre Sedimente auf der Atlantik-Insel Porto Santo (Madeira-Archipel) und ihre paläoklimatische Deutung

Auf der kleinen Atlantik-Insel Porto Santo (Madeira-Archipel) bedecken ausgedehnte quartäre Ablagerungen vielfach den tertiären, meist vulkanischen Sockel. Äolinite, d. h. Dünenbildungen aus z. T. regelmäßig schräggeschichteten marin-bioklastischen Kalkareniten, werden bis 50 m mächtig; sie führen (ebenso wie andere quartäre Ablagerungen) Landschnecken (Fossil-Liste, V). Als Ausblasungsgebiet ist der weit ausgedehnte Schelf zu betrachten, der in den Glazialen trockenlag. Die Äolinite sind also kaltzeitlich und ergaben entsprechende C14-Alter (21.570 und 13.480 B. P., jüngeres Würm). Auf die andersartige neuere Deutung der Bermudas-Äolinite durch Bretz u. a. wird kurz eingegangen. Die Äolinite sind durch autochthone und allochthone Böden (Braunlehme, rötliche Kalksandböden) in drei Abschnitte geteilt. Im Liegenden finden sich ebenfalls Braunlehme. Kolluvium, d. h. geringfügig verfrachtetes Schuttmaterial, tritt als Gehängeschutt und als Ausfüllung flacher Depressionen auf. Es führt gleichfalls Landschnecken und ist z. T. mit den Äoliniten verzahnt, d. h. gleichfalls kaltzeitlich. Nur eine Strandterrasse ist nachzuweisen. Sie ist als Brandungskonglomerat ausgebildet, führt eine marine Fauna und liegt 0—3 m über NN; C14-Alter: ≥ 40.000 a. Vielleicht gehört sie ins Tyrrhen III (Letztes Interglazial). — Zwei Talgenerationen sind vorhanden. Die stratigraphische Eingliederung der flachen alten Täler ist nicht möglich, die junge Zerschluchtung ist nicht älter als Würm. Die Steilküste ist jung und durch Brandungserosion geformt. An der N-Küste könnte die rückschreitende Erosion maximal 12 cm/a betragen. Das Klima der Glazialzeiten (mit Äolinit- und Kolluvialbildungen) war kühler als heute und vermutlich relativ trocken — also nicht pluvial; die Winde wehten aus mehr westlicher Richtung als heute. Eine genauere stratigraphische Einordnung des Quartärs ist nur z.T. möglich: die obersten Äolinite und ein Teil des Kolluviums sind jüngeres Wurm. Die tieferen Äolinite können älteres Wurm oder Prä-Würm sein.researc

Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy

Objectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis. Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-generation devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field. Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (.2 percent) for devices costing as much as £60,000. Sensitivity of the conclusions to both device cost and QALY valuation is examined. Conclusions: In the event that the price of the device in use would reduce to £40,000, the value of the survival information can readily justify investment in further trials

I know your face but can’t remember your name:Age-related differences in the FNAME-12NL

OBJECTIVE: The Face-Name Associative Memory test (FNAME) has recently received attention as a test for early diagnosis of Alzheimer’s disease. So far, however, there has been no systematic investigation of the effects of aging. Here, we aimed to assess the extent to which the FNAME performance is modulated by normal ageing. METHOD: In a first step, we adapted the FNAME material to the Dutch population. In a second step, younger (n = 29) and older adults (n = 29) were compared on recall and recognition performance. RESULTS: Significant age effects on name recall were observed after the first exposure of new face-name pairs: younger adults remembered eight, whereas older adults remembered a mean of four out of twelve names. Although both age groups increased the number of recalled names with repeated face-name exposure, older adults did not catch up with the performance of the younger adults, and the age-effects remained stable. Despite of that, both age groups maintained their performance after a 30-min delay. Considering recognition, no age differences were demonstrated, and both age groups succeeded in the recognition of previously shown faces and names when presented along with distractors. CONCLUSIONS: This study presents for the first time the results of different age groups regarding cross-modal associative memory performance on the FNAME. The recall age effects support the hypothesis of age-related differences in associative memory. To use the FNAME as an early cognitive biomarker, further subscales are suggested to increase sensitivity and specificity in the clinical context

Empowering Latino parents to transform the education of their children

This article emphasizes the role of parental involvement in the college preparation of Latino elementary and secondary school students. Although literature shows that education is highly valued in Latino families, actual college enrollment rates for Latino youth are below average. This has been attributed to barriers including lack of financial resources, problems in communication with schools, and low familiarity with the college planning process. The American Dream Academy is a university outreach program that is designed to help Latino families overcome these barriers. We conducted a qualitative analysis of speeches that were prepared and delivered by parents at graduation ceremonies of the program from 2007 to 2009. Our analysis revealed six themes: facing challenges, envisioning success, understanding the school system, taking ownership, community raising a child, and creating a supportive home environment. The findings enrich existing literature and help understand the complex systems that are at play with parental involvement in Latino families

Association of oily fish intake, sex, age, BMI and APOE genotype with plasma long-chain n-3 fatty acid composition

n-3 Fatty acids are associated with better cardiovascular and cognitive health. However, the concentration of EPA, DPA and DHA in different plasma lipid pools differs and factors influencing this heterogeneity are poorly understood. Our aim was to evaluate the association of oily fish intake, sex, age, BMI and APOE genotype with concentrations of EPA, DPA and DHA in plasma phosphatidylcholine (PC), NEFA, cholesteryl esters (CE) and TAG. Healthy adults (148 male, 158 female, age 20–71 years) were recruited according to APOE genotype, sex and age. The fatty acid composition was determined by GC. Oily fish intake was positively associated with EPA in PC, CE and TAG, DPA in TAG, and DHA in all fractions (P≤0·008). There was a positive association between age and EPA in PC, CE and TAG, DPA in NEFA and CE, and DHA in PC and CE (P≤0·034). DPA was higher in TAG in males than females (P<0·001). There was a positive association between BMI and DPA and DHA in TAG (P<0·006 and 0·02, respectively). APOE genotype×sex interactions were observed: the APOE4 allele associated with higher EPA in males (P=0·002), and there was also evidence for higher DPA and DHA (P≤0·032). In conclusion, EPA, DPA and DHA in plasma lipids are associated with oily fish intake, sex, age, BMI and APOE genotype. Such insights may be used to better understand the link between plasma fatty acid profiles and dietary exposure and may influence intake recommendations across population subgroups

Initial experience with off-pump left ventricular assist device implantation in single center: retrospective analysis

<p>Abstract</p> <p>Background</p> <p>We hypothesize that implantation of left ventricular assist device through off-pump technique is feasible and has a comparable result to implantation on cardiopulmonary bypass and could improve one-year survival.</p> <p>Methods</p> <p>This retrospective, observational, single-center study was conducted on 29 consecutive patients at our institution who underwent off-pump left ventricular assist device implantation by a single surgeon.</p> <p>Results</p> <p>Twenty-seven procedures were performed successfully using the off-pump technique. The survival rate was 92% at 30 days, 76% at 90 days, and 67% at one year. We compared the one-year survival of different implantation periods, and divided our study into three time intervals (2004-2005, 2006, and 2007). There was a trend in reduction in number of deaths over one year that demonstrated a decrease in death rate from 50% to 17%, as well as improvement in our experience over time. However, this trend is not statistically significant (p = 0.08) due to limited sample size.</p> <p>Conclusions</p> <p>Based upon our findings, off-pump left ventricular assist device implantation is a feasible surgical technique, and combining this technique with improved device technology in the future may provide even greater improvement in patient outcomes.</p

Anosognosia in Amnestic Mild Cognitive Impairment is Related to Diminished Hippocampal Volume Comparable to Alzheimer's Disease Dementia:Preliminary MRI Findings

Although the presence of anosognosia in amnestic mild cognitive impairment (aMCI) may be predictive of conversion to Alzheimer’s disease (AD), little is known about its neural correlates in AD and aMCI. Four different groups were compared using volumetric and diffusion magnetic resonance imaging metrics in regions of interest (hippocampus and cingulum cortex gray matter, cingulum bundle white matter): aMCI subjects with anosognosia (n = 6), aMCI subjects without anosognosia (n = 12), AD subjects with anosognosia (n = 6), and AD subjects without anosognosia (n = 9). aMCI subjects with anosognosia displayed a significantly lower gray matter density (GMD) in the bilateral hippocampus than aMCI subjects without anosognosia, which was accounted for by bilateral hippocampal differences. Furthermore, we identified that the mean hippocampal gray matter density of aMCI subjects with anosognosia was not statistically different than that of AD subjects. The groups of aMCI and AD subjects with anosognosia also displayed a lower GMD in the bilateral cingulum cortex compared to subjects without anosognosia, but these differences were not statistically significant. No statistically significant differences were found in the fractional anisotropy or mean diffusivity of the hippocampus or cingulum between subjects with and without anosognosia in aMCI or AD groups. While these findings are derived from a small population of subjects and are in need of replication, they suggest that anosognosia in aMCI might be a useful clinical marker to suspect brain changes associated with AD neuropathology