A Trial of the Effect of Micronutrient Supplementation on Treatment Outcome, T Cell Counts, Morbidity, and Mortality in Adults with Pulmonary Tuberculosis.

Tuberculosis (TB) often coincides with nutritional deficiencies. The effects of micronutrient supplementation on TB treatment outcomes, clinical complications, and mortality are uncertain. We conducted a randomized, double-blind, placebo-controlled trial of micronutrients (vitamins A, B complex, C, and E, as well as selenium) in Dar es Salaam, Tanzania. We enrolled 471 human immunodeficiency virus (HIV)-infected and 416 HIV-negative adults with pulmonary TB at the time of initiating chemotherapy and monitored them for a median of 43 months. Micronutrients decreased the risk ofTB recurrence by 45% overall (95% confidence interval [CI], 7% to 67%; P = .02) and by 63% in HIV-infected patients (95% CI, 8% to 85%; P = .02). There were no significant effects on mortality overall; however, we noted a marginally significant 64% reduction of deaths in HIV-negative subjects (95% CI, -14% to 88%; P = .08). Supplementation increased CD3+ and CD4+ cell counts and decreased the incidence of extrapulmonary TB and genital ulcers in HIV-negative patients. Micronutrients reduced the incidence of peripheral neuropathy by 57% (95% CI, 41% to 69%; P < .001), irrespective of HIV status. There were no significant effects on weight gain, body composition, anemia, or HIV load. Micronutrient supplementation could improve the outcome in patients undergoing TB chemotherapy in Tanzania

AAHES: A hybrid expert system realization of Adaptive Autonomy for smart grid

Abstract--Smart grid expectations objectify the need for optimizing power distribution systems greater than ever. Distribution Automation (DA) is an integral part of the SG solution; however, disregarding human factors in the DA systems can make it more problematic than beneficial. As a consequence, Human-Automation Interaction (HAI) theories can be employed to optimize the DA systems in a human-centered manner. Earlier we introduced a novel framework for the realization of Adaptive Autonomy (AA) concept in the power distribution network using expert systems. This research presents a hybrid expert system for the realization of AA, using both Artificial Neural Networks (ANN) and Logistic Regression (LR) models, referred to as AAHES, respectively. AAHES uses neural networks and logistic regression as an expert system inference engine. This system fuses LR and ANN models' outputs which will results in a progress, comparing to both individual models. The practical list of environmental conditions and superior experts' judgments are used as the expert systems database. Since training samples will affect the expert systems performance, the AAHES is implemented using six different training sets. Finally, the results are interpreted in order to find the best training set. As revealed by the results, the presented AAHES can effectively determine the proper level of automation for changing the performance shaping factors of the HAI systems in the smart grid environment

Diet, the intestinal microbiota, and immune health in aging

Many countries are facing aging populations, with those over 65 years of age likely to represent the largest population over the next 10–20 years. Living longer often comes with poor health and, in particular, a decline in the immune function characterized by poor vaccine responses and increased risk of infection and certain cancers. Aging and diet represent major intrinsic and extrinsic factors that influence the makeup and activity of resident intestinal microbes, the microbiota, the efficient functioning of which is essential for sustaining overall health and the effectiveness of the immune system. The provision of elderly specific dietary recommendations appears to be lacking but is necessary since this population has an altered microbiota and immune response and may not respond in the same way as their healthy and younger counterparts. We have reviewed the evidence supporting the role of diet and, in particular, dietary carbohydrate, protein, and fat in influencing the microbiota and its generation of key metabolites that influence the efficient functioning of immune cells during aging, and how dietary intervention might be of benefit in improving the intestinal health and immune status in the elderly

Nutrition, diet and immunosenescence

Ageing is characterized by immunosenescence and the progressive decline in immunity in association with an increased frequency of infections and chronic disease. This complex process affects both the innate and adaptive immune systems with a progressive decline in most immune cell populations and defects in activation resulting in loss of function. Although host genetics and environmental factors, such as stress, exercise and diet can impact on the onset or course of immunosenescence, the mechanisms involved are largely unknown. This review focusses on identifying the most significant aspects of immunosenescence and on the evidence that nutritional intervention might delay this process, and consequently improve the quality of life of the elderly

Social Support and Reproductive Health in 15 to 24 Year Old Immigrant Latinas in the San Francisco Bay Area

This study examines how social support is related to reproductive health risk among 15-24 year old immigrant Latinas residing in the San Francisco Bay Area. This is a cross-sectional, clinic-based study, composed of a sample of 68 immigrant Latina women, aged 15-24 (mean 18.7, S.D. 2.2), recruited from waiting rooms at two clinics in Oakland. Participants completed an interviewer-administered questionnaire and provided blood and self-obtained vaginal swab specimens to test for sexually transmitted infections. Three dimensions of social support were assessed: 1) functional support, using the Medical Outcomes Study (MOS) Social Support Survey; 2) structural support (quantity of support sources); and 3) social network characteristics. Primary reproductive health outcomes assessed included: 1) high risk sexual behaviors; 2) history of teen pregnancy and/or abortion; and 3) prevalence of Herpes Simplex Virus 2 (HSV-2), Chlamydia trachomatis, and Trichomonas vaginalis. Analyses examined relationships between social support measures and reproductive health behaviors and outcomes using multivariate logistic regression, adjusting for age, religiosity, length of stay in the U.S., and socioeconomic and marital status. 95.6% of participants were sexually active, with the mean age of sexual initiation being 15.6 years (S.D. 1.7). 30.8% had more than one sexual partner over the past year, 44.6% reported a teen pregnancy, and 12.3% had an abortion. Overall STI prevalence was 13.3%. Compared to those with lower support measures, participants with higher functional tangible support scores, as well as those who identified more people available for affectionate support and positive social interactions (structural support measures), were significantly more likely to have used condoms in the past year (adjusted odds ratios [A.O.R.s]: 2.31, 4.59, and 4.0, respectively, p\u3c0.05). Several measures of structural social support were protective against teen pregnancy: participants who identified more people they could count on for informational, affectionate support and positive social interactions, were less likely to have had a teen pregnancy (A.O.R.s: 0.27, 0.36, and 0.32, respectively, p\u3c0.05,). Overall functional social support was protective against abortion (A.O.R. 0.16, p\u3c0.05). No significant associations were found between measures of social support and STI prevalence; however, a trend was noted whereby participants with higher measures of perceived functional support were more likely to have an STI. Social network characteristics found to be related to outcomes included gender proportions of the network and presence or absence of U.S.-born people in the network. Several different dimensions of social support are associated with decreased risk of specific reproductive health behaviors and outcomes among young Latina immigrants. Use of a multi-dimensional social support instrument provides for richer analyses of these relationships, generating information that could be utilized for targeting support interventions and risk prevention in this population

Long-term moderate calorie restriction inhibits inflammation without impairing cell-mediated immunity: A randomized controlled trial in non-obese humans

Calorie restriction (CR) inhibits inflammation and slows aging in many animal species, but in rodents housed in pathogen-free facilities, CR impairs immunity against certain pathogens. However, little is known about the effects of long-term moderate CR on immune function in humans. In this multi-center, randomized clinical trial to determine CR's effect on inflammation and cell-mediated immunity, 218 healthy non-obese adults (20-50 y), were assigned 25% CR (n=143) or an ad-libitum (AL) diet (n=75), and outcomes tested at baseline, 12, and 24 months of CR. CR induced a 10.4% weight loss over the 2-y period. Relative to AL group, CR reduced circulating inflammatory markers, including total WBC and lymphocyte counts, ICAM-1 and leptin. Serum CRP and TNF-α concentrations were about 40% and 50% lower in CR group, respectively. CR had no effect on the delayed-type hypersensitivity skin response or antibody response to vaccines, nor did it cause difference in clinically significant infections. In conclusion, long-term moderate CR without malnutrition induces a significant and persistent inhibition of inflammation without impairing key in vivo indicators of cell-mediated immunity. Given the established role of these pro-inflammatory molecules in the pathogenesis of multiple chronic diseases, these CR-induced adaptations suggest a shift toward a healthy phenotype

Effect of dietary methionine on methylmercury and atrazine toxicities

The effects of methionine (Met) on the toxicities of methylmercury (MeHg) and atrazine in male Wistar rats were investigated. Three levels of dietary Met, three levels of MeHg by gavage, and two levels of dietary atrazine were used. A two-choice form light discrimination test was used to investigate behavioral effects of the treatments. Samples of blood, liver, kidney, and brain were collected for glutathione peroxidase (GSH-Px), glutathione reductase (GSH-Rd), glutathione-S-transferase (GSH-S-trans), total glutathione (GSH), prostaglandin (PG), and mercury analyses. Excess dietary Met had a protective effect on MeHg and atrazine toxicities in rats, using weight gain as the index of toxicity. Liver weight in response to the toxicants was increased in the groups of rats which were fed the lower Met levels but there was no change in those fed the highest level of Met. The highest Met level caused a lower increase in kidney weight in rats treated with MeHg. The lowest Met level caused greater mercury uptake in the organs. Atrazine caused a significant increase in mercury excretion in urine after three weeks of exposure but not at the end of the experiment, suggesting adaption. In whole blood but not in liver, GSH-Px activity declined as mercury concentration increased. Atrazine lowered liver GSH-S-trans activity. Increases in MeHg dose caused a decrease in GSH-S-trans activity in the rats fed the lowest Met level but increased it with the other diets. Treatments with MeHg caused increased synthesis of PG by platelets. Dietary Met had no effect on liver GSH but increased oxidized and total GSH in blood. Atrazine increased urinary mercapturic acid excretion. Despite clinical and biochemical effects of the treatments, the behavioral tests were negative

Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-exposed Uninfected Tanzanian Infants.

Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of multivitamin supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P > 0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P = 0.032) and greater for infants whose mothers had a CD4 T-cell count of <200 cells/μl than for infants whose mothers had a CD4 T-cell count of >350 cells/μl (P = 0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P = 0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P = 0.031). Maternal CD4 T-cell counts of <200 cells/μl were associated with decreased avidity compared to counts of >350 cells/μl (P = 0.047), as were lower infant height-for-age z-scores (P = 0.016). Supplementation with multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered at ClinicalTrials.gov under registration no. NCT00197730.)

Lipid-soluble Vitamins A, D, and E in HIV-Infected Pregnant women in Tanzania.

There is limited published research examining lipid-soluble vitamins in human immunodeficiency virus (HIV)-infected pregnant women, particularly in resource-limited settings. This is an observational analysis of 1078 HIV-infected pregnant women enrolled in a trial of vitamin supplementation in Tanzania. Baseline data on sociodemographic and anthropometric characteristics, clinical signs and symptoms, and laboratory parameters were used to identify correlates of low plasma vitamin A (<0.7 micromol/l), vitamin D (<80 nmol/l) and vitamin E (<9.7 micromol/l) status. Binomial regression was used to estimate risk ratios and 95% confidence intervals. Approximately 35, 39 and 51% of the women had low levels of vitamins A, D and E, respectively. Severe anemia (hemoglobin <85 g/l; P<0.01), plasma vitamin E (P=0.02), selenium (P=0.01) and vitamin D (P=0.02) concentrations were significant correlates of low vitamin A status in multivariate models. Erythrocyte Sedimentation Rate (ESR) was independently related to low vitamin A status in a nonlinear manner (P=0.01). The correlates of low vitamin D status were CD8 cell count (P=0.01), high ESR (ESR >81 mm/h; P<0.01), gestational age at enrollment (nonlinear; P=0.03) and plasma vitamins A (P=0.02) and E (P=0.01). For low vitamin E status, the correlates were money spent on food per household per day (P<0.01), plasma vitamin A concentration (nonlinear; P<0.01) and a gestational age <16 weeks at enrollment (P<0.01). Low concentrations of lipid-soluble vitamins are widely prevalent among HIV-infected women in Tanzania and are correlated with other nutritional insufficiencies. Identifying HIV-infected persons at greater risk of poor nutritional status and infections may help inform design and implementation of appropriate interventions

TOWARDS A MODEL OF POLARIZATION REDUCTION WITH RECOMMENDER SYSTEMS

Polarization occurs within society\u27s networks when highly connected groups form with weak intergroup links, leading to echo chambers and filter bubbles. These phenomena hinder exposure to diverse viewpoints, posing significant challenges to democracy and societal welfare. Despite extensive research on measuring and mitigating social network polarization, the effectiveness of existing metrics remains largely uncharted. This study reevaluates these metrics and recommender system-based reduction strategies, pinpointing inherent limitations. It highlights key factors influencing polarization and adopts a design science research approach to craft a recommender system-based model for reducing polarization in online networks, recognizing its complex nature