Proceedings of the inaugural International Summit for Medical Nutrition Education and Research

© 2016 The Royal Society for Public Health Medical Nutrition Education (MNE) has been identified as an area with potential public health impact. Despite countries having distinctive education systems, barriers and facilitators to effective MNE are consistent across borders, demanding a common platform to initiate global programmes. A shared approach to supporting greater MNE is ideal to support countries to work together. In an effort to initiate this process, the Need for Nutrition Education/Innovation Programme group, in association with their strategic partners, hosted the inaugural International Summit on Medical Nutrition Education and Research on August 8, 2015 in Cambridge, UK. Speakers from the UK, the USA, Canada, Australia, New Zealand, Italy, and India provided insights into their respective countries including their education systems, inherent challenges, and potential solutions across two main themes: (1) Medical Nutrition Education, focused on best practice examples in competencies and assessment; and (2) Medical Nutrition Research, discussing how to translate nutrition research into education opportunities. The Summit identified shared needs across regions, showcased examples of transferrable strategies and identified opportunities for collaboration in nutrition education for healthcare (including medical) professionals. These proceedings highlight the key messages presented at the Summit and showcase opportunities for working together towards a common goal of improvement in MNE to improve public health at large

Long-term management of generalised anxiety disorder with low-dose continuous infusions of flumazenil: A case series

Background: Generalised anxiety disorder (GAD) is a common anxiety disorder associated with social and occupational impairment. Recently, a theory was postulated that dysfunctional gamma aminobutyric acid type A receptors (GABAA) are implicated in anxiety symptomology, which could be corrected by flumazenil, an antagonist at the benzodiazepine binding site on the GABAA receptor. Method: Participants had a primary diagnosis of GAD and were treated initially with an eight-day continuous low-dose flumazenil infusion (total 32 mg at a rate of 4 mg/24 h). Some participants were re-treated with a further four- or eight-day infusion. Treatment response was measured as a 50 % reduction in anxiety or stress scores on the Depression Anxiety Stress Scale — 21 (DASS-21). Remission was measured as scores ≤ 3 or ≤ 7 on the anxiety and stress subscales of the DASS-21, respectively. Results: Eight cases are reported. All cases met the criteria for treatment response on the anxiety and stress subscale of the DASS-21. Remission was achieved in seven participants on the anxiety subscale and in five on the stress subscale. No changes in hepatic, renal, or haematological function were likely attributed to flumazenil. Conclusion: Data suggest that low-dose continuous flumazenil infusion manages GAD symptoms and is safe. Although these results are promising, future randomised control trials are required to confirm these results

A tumor-associated β1 integrin mutation that abrogates epithelial differentiation control

SCC4 human keratinocytes are derived from a squamous cell carcinoma of the tongue and undergo very little spontaneous differentiation. Introduction of a wild-type β1 integrin subunit into SCC4 cells stimulates differentiation, suggesting either that the cells have a defect in the integrin signaling pathways that control differentiation or that the β1 subunit itself is defective. Here we describe a heterozygous mutation in the SCC4 β1 subunit. The mutation, T188I, maps to the I-like domain. It results in constitutive activation of ligand binding, irrespective of the partner α subunit, in solid phase assays with recombinant protein and in living cells. The mutation promotes cell spreading, but not proliferation, motility, or invasiveness. It results in sustained activation of Erk MAPK independent of cell spreading. When introduced into SCC4 keratinocytes, the wild-type β1 integrin stimulates differentiation, whereas the mutant is inactive. Activation of β1 integrins in normal keratinocytes also suppresses differentiation. These results establish, for the first time, mutation as a mechanism by which integrins can contribute to neoplasia, because the degree of differentiation in epithelial cancers is inversely correlated with prognosis. They also provide new insights into how integrins regulate keratinocyte differentiation

Mesothelioma trends in the ACT and comparisons with the rest of Australia

OBJECTIVES Inhalation of asbestos fibres is the predominant cause of malignant mesothelioma. Domestic exposure to asbestos is a major community concern in the Australian Capital Territory (ACT) because of loose-fill asbestos home insulation. Little is known about how trends in mesothelioma rates in the ACT compare with those elsewhere. The objective of this study was to describe trends in mesothelioma rates in the ACT and compare them with those for the rest of Australia. METHODS We used de-identified data from the ACT Cancer Registry (1982- 2014), and the Western Australia (WA) Cancer Registry and the Australian Cancer Database (1982-2011). We calculated crude mesothelioma rates, by 3-year periods, for the ACT and for the rest of Australia (excluding WA). We used Poisson regression to analyse mesothelioma trends from 1994 to 2011 (complete reporting period) using an indirect standardisation approach to adjust for age and sex. RESULTS There were 140 mesothelioma cases reported to the ACT Cancer Registry between 1982 and 2014 - 81% male and 19% female. Between 1994 and 2011, age- and sex-adjusted mesothelioma rates in the ACT increased over time, on average by 12% per 3-year period (relative risk [RR] 1.12; 95% confidence interval [CI] 0.99, 1.26). Compared with the rest of Australia (excluding WA), ACT rates were, on average, lower (RR 0.84; 95% CI 0.69, 1.02), but they increased at a higher rate (RR 1.12 per 3-year period; 95% CI 0.99, 1.27). These results are strongly influenced by the higher rate of mesothelioma observed in the ACT in 2009-2011, when ACT rates became similar to those for the rest of Australia (excluding WA). CONCLUSIONS Although mesothelioma rates may have increased more in the ACT than the rest of Australia (excluding WA) during the past two decades, there is considerable uncertainty in the trends. More information is needed regarding the health risks associated with living in a house with loose-fill asbestos insulation. This is the subject of further studies within the ACT Asbestos Health Study.Includes Appendix table: Number of mesothelioma cases and person-years (PY) by sex, age group and year, ACT, 1982 to 201

The role of the subtropical jet in deficient winter precipitation across the mid-Holocene Indus basin

The mid-Holocene (7-5 ka) was a period with an increased seasonal insolation cycle, resulting from decreased insolation during northern hemisphere winter. Here, a set of six CMIP5 models is used to show that the decreased insolation reduced the upper-tropospheric meridional temperature gradient, producing a weaker subtropical jet with less horizontal shear. These effects work to reduce the baroclinic and barotropic instability available for perturbations to grow, and in consequence, storm-tracking results show that there are fewer winter storms over India and Pakistan (known as western disturbances). These western disturbances are weaker, resulting in a reduction in winter precipitation of around 15% in the north Indus Basin. Combined with previous work showing greater northwestward extent of the Indian monsoon during the mid-Holocene, our GCM-derived results are consistent with the Indus Basin changing from a summer-growing season in the mid-Holocene to a winter-growing season in the present day

In situ H(2)S passivation of In(0.53)Ga(0.47)As/InP metal-oxide-semiconductor capacitors with atomic-layer deposited HfO(2) gate dielectric

We have studied an in situ passivation of In(0.53)Ga(0.47)As, based on H(2)S exposure (50-350 degrees C) following metal organic vapor phase epitaxy growth, prior to atomic layer deposition of HfO(2) using Hf[N(CH(3))(2)](4) and H(2)O precursors. X-ray photoelectron spectroscopy revealed the suppression of As oxide formation in air exposed InGaAs surfaces for all H(2)S exposure temperatures. Transmission electron microscopy analysis demonstrates a reduction of the interface oxide between the In(0.53)Ga(0.47)As epitaxial layer and the amorphous HfO(2) resulting from the in situ H(2)S passivation. The capacitance-voltage and current-voltage behavior of Pd/HfO(2)/In(0.53)Ga(0.47)As/InP structures demonstrates that the electrical characteristics of samples exposed to 50 degrees C H(2)S at the end of the metal-organic vapor-phase epitaxy In(0.53)Ga(0.47)As growth are comparable to those obtained using an ex situ aqueous (NH(4))(2)S passivation. (c) 2008 American Institute of Physics. (DOI: 10.1063/1.2829586

A novel accelerometer-based method to describe day-to-day exposure to potentially osteogenic vertical impacts in older adults: findings from a multi-cohort study

Summary: This observational study assessed vertical impacts experienced in older adults as part of their day-to-day physical activity using accelerometry and questionnaire data. Population-based older adults experienced very limited high-impact activity. The accelerometry method utilised appeared to be valid based on comparisons between different cohorts and with self-reported activity. Introduction: We aimed to validate a novel method for evaluating day-to-day higher impact weight-bearing physical activity (PA) in older adults, thought to be important in protecting against osteoporosis, by comparing results between four cohorts varying in age and activity levels, and with self-reported PA levels. Methods: Participants were from three population-based cohorts, MRC National Survey of Health and Development (NSHD), Hertfordshire Cohort Study (HCS) and Cohort for Skeletal Health in Bristol and Avon (COSHIBA), and the Master Athlete Cohort (MAC). Y-axis peaks (reflecting the vertical when an individual is upright) from a triaxial accelerometer (sampling frequency 50 Hz, range 0–16 g) worn at the waist for 7 days were classified as low (0.5–1.0 g), medium (1.0–1.5 g) or higher (≥1.5 g) impacts. Results: There were a median of 90, 41 and 39 higher impacts/week in NSHD (age 69.5), COSHIBA (age 76.8) and HCS (age 78.5) participants, respectively (total n = 1512). In contrast, MAC participants (age 68.5) had a median of 14,322 higher impacts/week. In the three population cohorts combined, based on comparison of beta coefficients, moderate-high-impact activities as assessed by PA questionnaire were suggestive of stronger association with higher impacts from accelerometers (0.25 [0.17, 0.34]), compared with medium (0.18 [0.09, 0.27]) and low impacts (0.13 [0.07,0.19]) (beta coefficient, with 95 % CI). Likewise in MAC, reported moderate-high-impact activities showed a stronger association with higher impacts (0.26 [0.14, 0.37]), compared with medium (0.14 [0.05, 0.22]) and low impacts (0.03 [−0.02, 0.08]). Conclusions: Our new accelerometer method appears to provide valid measures of higher vertical impacts in older adults. Results obtained from the three population-based cohorts indicate that older adults generally experience very limited higher impact weight-bearing PA

Structural analysis, elemental profiling, and electrical characterization of HfO2 thin films deposited on In0.53Ga0.47As surfaces by atomic layer deposition

In this work results are presented on the structural analysis, chemical composition, and interface state densities of HfO2 thin films deposited by atomic layer deposition (ALD) from Hf[N(CH3)(2)](4) and H2O on In0.53Ga0.47As/InP substrates. The structural and chemical properties are investigated using high resolution cross-sectional transmission electron microscopy and electron energy loss spectroscopy. HfO2 films (3-15 nm) deposited on In0.53Ga0.47As are studied following a range of surface treatments including in situ treatment of the In0.53Ga0.47As surface by H2S exposure at 50-350 degrees C immediately following the metal organic vapor phase epitaxy growth of the In0.53Ga0.47As layer, ex situ treatment with (NH4)(2)S, and deposition on the native oxides of In0.53Ga0.47As with no surface treatment. The structural analysis indicates that the In0.53Ga0.47As surface preparation prior to HfO2 film deposition influences the thickness of the HfO2 film and the interlayer oxide. The complete interfacial self-cleaning of the In(0.53)Gas(0.47)As native oxides is not observed using an ALD process based on the Hf[N(CH3)(2)](4) precursor and H2O. Elemental profiling of the HfO2/In0.53Ga0.47As interface region by electron energy loss spectroscopy reveals an interface oxide layer of 1-2 nm in thickness, which consists primarily of Ga oxides. Using a conductance method approximation, peak interface state densities in the range from 6 x 10(12) to 2 x 10(13) cm(-2) eV(-1) are estimated depending on the surface preparation. (C) 2009 American Institute of Physics. [doi:10.1063/1.3243234