A Positive Deviance-based Antenatal Nutrition Project Improves Birth-weight in Upper Egypt

The positive deviance approach identifies and promotes existing uncommon healthy behaviours. A positive deviance-informed antenatal project was pilot-tested in Al-Minia Governorate, Upper Egypt, during 2003–2004, after a positive deviance study in 2000 found that successful pregnancies had increased consumption of meat and vegetables, daytime rest, and antenatal care; less second-hand smoke exposure; and symptoms of no urinary tract infection. Accordingly, health facilities were upgraded in target and comparison areas to provide quality antenatal care, including treatment of urinary tract infection. Additionally, in the target villages, women at-risk of delivering low-birth-weight infants were enrolled in weekly ‘IMPRESS’ (improved pregnancy through education and supplementation) sessions with counselling and supplemental food. In total, 519 women (344 target, 175 comparison) were enrolled in the third or fourth month of pregnancy and were followed through delivery. Birth-weights of the target mothers increased 2.2 times more than birth-weights of the comparison mothers over baseline (mean increase: 0.58 vs 0.26 g respectively, p<0.01). Similarly, the decrease in prevalence of low birth-weight from baseline was greater in the target villages than in the comparison mothers (% of decrease: 26.9 vs 11.9 respectively, p<0.01). The target at-risk women were far more likely than their counterparts to report eating more food (54.9% vs 10.6%), more meat (57.1% vs 4.2%), more vegetables (66.9% vs 5.3%), increasing daytime rest (64.1% vs 11.7%), and avoiding second-hand smoke (91.3% vs 51.6%) during pregnancy. The cost per 100 g of improvement in birth-weight was US$ 3.98. The Government of Egypt and partners are scaling up the elements of the project

A Positive Deviance-based Antenatal Nutrition Project Improves Birth-weight in Upper Egypt

The positive deviance approach identifies and promotes existing uncommon healthy behaviours. A positive deviance-informed antenatal project was pilot-tested in Al-Minia Governorate, Upper Egypt, during 2003-2004, after a positive deviance study in 2000 found that successful pregnancies had in\uadcreased consumption of meat and vegetables, daytime rest, and antenatal care; less second-hand smoke exposure; and symptoms of no urinary tract infection. Accordingly, health facilities were upgraded in target and comparison areas to provide quality antenatal care, including treatment of urinary tract in\uadfection. Additionally, in the target villages, women at-risk of delivering low-birth-weight infants were enrolled in weekly 'IMPRESS' (improved pregnancy through education and supplementation) ses\uadsions with counselling and supplemental food. In total, 519 women (344 target, 175 comparison) were enrolled in the third or fourth month of pregnancy and were followed through delivery. Birth-weights of the target mothers increased 2.2 times more than birth-weights of the comparison mothers over baseline (mean increase: 0.58 vs 0.26 g respectively, p&lt;0.01). Similarly, the decrease in prevalence of low birth-weight from baseline was greater in the target villages than in the comparison mothers (% of decrease: 26.9 vs 11.9 respectively, p&lt;0.01). The target at-risk women were far more likely than their counterparts to report eating more food (54.9% vs 10.6%), more meat (57.1% vs 4.2%), more vegeta\uadbles (66.9% vs 5.3%), increasing daytime rest (64.1% vs 11.7%), and avoiding second-hand smoke (91.3% vs 51.6%) during pregnancy. The cost per 100 g of improvement in birth-weight was US$ 3.98. The Government of Egypt and partners are scaling up the elements of the project

α−α Cross-Links Increase Fibrin Fiber Elasticity and Stiffness

Fibrin fibers, which are ∼100 nm in diameter, are the major structural component of a blood clot. The mechanical properties of single fibrin fibers determine the behavior of a blood clot and, thus, have a critical influence on heart attacks, strokes, and embolisms. Cross-linking is thought to fortify blood clots; though, the role of α–α cross-links in fibrin fiber assembly and their effect on the mechanical properties of single fibrin fibers are poorly understood. To address this knowledge gap, we used a combined fluorescence and atomic force microscope technique to determine the stiffness (modulus), extensibility, and elasticity of individual, uncross-linked, exclusively α–α cross-linked (γQ398N/Q399N/K406R fibrinogen variant), and completely cross-linked fibrin fibers. Exclusive α–α cross-linking results in 2.5× stiffer and 1.5× more elastic fibers, whereas full cross-linking results in 3.75× stiffer, 1.2× more elastic, but 1.2× less extensible fibers, as compared to uncross-linked fibers. On the basis of these results and data from the literature, we propose a model in which the α-C region plays a significant role in inter- and intralinking of fibrin molecules and protofibrils, endowing fibrin fibers with increased stiffness and elasticity

Comfort and utility of school-based weight screening: the student perspective

<p>Abstract</p> <p>Background</p> <p>Weight screening in schools has been proposed as one strategy to address childhood obesity. Students' response to such screening is unexplored, however. In this study we evaluated the perceived comfort, utility and impact of school-based weight screening from the perspective of middle school-aged students.</p> <p>Methods</p> <p>A cross-sectional study of 852 ethnically diverse 5^th–8^thgrade students. Associations were investigated between measured height and weight screening data and responses to a self-administered questionnaire completed immediately following weight screening in physical education class. BMI categories were based on the revised 2000 CDC growth chart and definitions: 5^th–85^thBMI percentile = healthy weight, 85^th–95^thBMI percentile = at risk for overweight, and >95^thpercentile BMI = overweight.</p> <p>Results</p> <p>Overall, students' comfort level with weight screening varied depending on the student's own weight status. More overweight students (38.1%) reported being uncomfortable than healthy weight students (8.1%) (p < 0.001). In particular, overweight female students (54.8%) compared to healthy weight female students (21.6%) reported being uncomfortable (p < 0.01). About half (54.9%) of all students reported knowing their weight prior to screening, and 58.9% reported that it was useful to learn their height and weight. Compared to healthy weight students, overweight students were significantly more likely to report the intention to perform weight modification related activities such as visiting a doctor (Odds ratio (OR) = 2.0, 95% CI = 1.3, 3.1), eating more fruits and vegetables (OR = 2.7, 95% CI = 1.7, 4.1), and increasing physical activity (OR = 4.3, 95% CI = 2.7, 7.0).</p> <p>Conclusion</p> <p>Overall, the majority of the middle school students did not report discomfort with school-based weight screening, did report that receiving height and weight information was useful, and generally report appropriate weight control intentions. These proportions varied across weight status categories, however, with students who were at risk for overweight or overweight reporting higher levels of discomfort. For schools that conduct weight screening, it is essential that they also provide comfortable and private settings as well as education or counseling regarding healthy weight control practices.</p

The observed state of the water cycle in the early twenty-first century

Author Posting. © American Meteorological Society, 2015. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Climate 28 (2015): 8289–8318, doi:10.1175/JCLI-D-14-00555.1.This study quantifies mean annual and monthly fluxes of Earth’s water cycle over continents and ocean basins during the first decade of the millennium. To the extent possible, the flux estimates are based on satellite measurements first and data-integrating models second. A careful accounting of uncertainty in the estimates is included. It is applied within a routine that enforces multiple water and energy budget constraints simultaneously in a variational framework in order to produce objectively determined optimized flux estimates. In the majority of cases, the observed annual surface and atmospheric water budgets over the continents and oceans close with much less than 10% residual. Observed residuals and optimized uncertainty estimates are considerably larger for monthly surface and atmospheric water budget closure, often nearing or exceeding 20% in North America, Eurasia, Australia and neighboring islands, and the Arctic and South Atlantic Oceans. The residuals in South America and Africa tend to be smaller, possibly because cold land processes are negligible. Fluxes were poorly observed over the Arctic Ocean, certain seas, Antarctica, and the Australasian and Indonesian islands, leading to reliance on atmospheric analysis estimates. Many of the satellite systems that contributed data have been or will soon be lost or replaced. Models that integrate ground-based and remote observations will be critical for ameliorating gaps and discontinuities in the data records caused by these transitions. Continued development of such models is essential for maximizing the value of the observations. Next-generation observing systems are the best hope for significantly improving global water budget accounting.This research was funded by multiple grants from NASA’s Energy and Water Cycle Study (NEWS) program.2016-05-0

Standardizing Postoperative Handoffs Using the Evidence-Based IPASS Framework Improves Handoff Communication for Postoperative Neurosurgical Patients in the Neuro-Intensive Care Unit

Aims for Improvement Within one year of initiation of the process improvement plan, we wanted to improve: Direct communication of airway and hemodynamic concerns Direct communication of operative events, complications, and perioperative management goals. Attendance at postoperative handoffs Confirmation of information by receiving teams Staff perceptions of handoff efficacy and teamwork

Reimagining large river management using the Resist–Accept–Direct (RAD) framework in the Upper Mississippi River

Background: Large-river decision-makers are charged with maintaining diverse ecosystem services through unprecedented social-ecological transformations as climate change and other global stressors intensify. The interconnected, dendritic habitats of rivers, which often demarcate jurisdictional boundaries, generate complex management challenges. Here, we explore how the Resist–Accept–Direct (RAD) framework may enhance large-river management by promoting coordinated and deliberate responses to social-ecological trajectories of change. The RAD framework identifies the full decision space of potential management approaches, wherein managers may resist change to maintain historical conditions, accept change toward different conditions, or direct change to a specified future with novel conditions. In the Upper Mississippi River System, managers are facing social-ecological transformations from more frequent and extreme high-water events. We illustrate how RAD-informed basin-, reach-, and site-scale decisions could: (1) provide cross-spatial scale framing; (2) open the entire decision space of potential management approaches; and (3) enhance coordinated inter-jurisdictional management in response to the trajectory of the Upper Mississippi River hydrograph. Results: The RAD framework helps identify plausible long-term trajectories in different reaches (or subbasins) of the river and how the associated social-ecological transformations could be managed by altering site-scale conditions. Strategic reach-scale objectives may reprioritize how, where, and when site conditions could be altered to contribute to the basin goal, given the basin’s plausible trajectories of change (e.g., by coordinating action across sites to alter habitat connectivity, diversity, and redundancy in the river mosaic). Conclusions: When faced with long-term systemic transformations (e.g., \u3e 50 years), the RAD framework helps explicitly consider whether or when the basin vision or goals may no longer be achievable, and direct options may open yet unconsidered potential for the basin. Embedding the RAD framework in hierarchical decision-making clarifies that the selection of actions in space and time should be derived from basin-wide goals and reach-scale objectives to ensure that site-scale actions contribute effectively to the larger river habitat mosaic. Embedding the RAD framework in large-river decisions can provide the necessary conduit to link flexibility and innovation at the site scale with stability at larger scales for adaptive governance of changing social-ecological systems

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS