The Role of Tobacco, Alcohol, and Obesity in Neoplastic Progression to Esophageal Adenocarcinoma: A Prospective Study of Barrett's Esophagus

Background: Esophageal adenocarcinoma (EA) incidence in many developed countries has increased dramatically over four decades, while survival remains poor. Persons with Barrett's esophagus (BE), who experience substantially elevated EA risk, are typically followed in surveillance involving periodic endoscopy with biopsies, although few progress to EA. No medical, surgical or lifestyle interventions have been proven to safely lower EA risk. Design: We investigated whether smoking, obesity or alcohol could predict progression to EA in a prospective cohort of 411 BE patients. Data were collected during personal interview. Adjusted hazard ratios (HR) were estimated using Cox regression. Results: 39% had body mass index (BMI) over 30 and 64% had smoked cigarettes. Main analyses focused on those with at least 5 months of follow-up (33,635 person-months), in whom 45 developed EA. Risk increased by 3% per year of age (trend p-value 0.02), with approximate doubling of risk among males. EA risk increased with smoking pack-years (trend p-value 0.04) and duration (p-value 0.05). Compared to never-smokers, the HR for those in the highest pack-year tertile was 2.29 (95%CI 1.04–5.07). No association was found with alcohol or BMI, whereas a suggestion of increased risk was observed in those with higher waist-hip ratio, especially among males. Conclusion: EA risk significantly increased with increasing age and cigarette exposure. Abdominal obesity, but not BMI, was associated with a modest increased risk. Continued follow-up of this and other cohorts is needed to precisely define these relationships so as to inform risk stratification and preventive interventions

(2R*,3R*,4aS*,6aR*,11aS*,11bS*)-Methyl 2-acet­oxy-11b-hydr­oxy-3,7-dimethyl-1,2,3,4,4a,5,6,6a,7,11,11a,11b-dodeca­hydro­phenanthro[3,2-b]furan-3-carboxyl­ate

In the title compound, C22H30O6, the conformation of the mol­ecule is dictated by an intra­molecular C—H⋯O contact. The crystal structure is stabilized via inter­molecular C—H⋯O, O—H⋯O and C—H⋯π contacts

Improving Seventh Grade Students' Learning of Ratio and Proportion: The Role of Schema-Based Instruction

The present study evaluated the effectiveness of an instructional intervention (schema-based instruction, SBI) that was designed to meet the diverse needs of middle school students by addressing the research literatures from both special education and mathematics education. Specifically, SBI emphasizes the role of the mathematical structure of problems and also provides students with a heuristic to aid and self-monitor problem solving. Further, SBI addresses well-articulated problem solving strategies and supports flexible use of the strategies based on the problem situation. One hundred forty eight seventh-grade students and their teachers participated in a 10-day intervention on learning to solve ratio and proportion word problems, with classrooms randomly assigned to SBI or a control condition. Results suggested that students in SBI treatment classes outperformed students in control classes on a problem solving measure, both at posttest and on a delayed posttest administered 4 months later. However, the two groups' performance was comparable on a state standardized mathematics achievement test

Understanding the “Social” in “Social Media”. An Analysis of Twitter Engagement of Pulmonary and Critical Care Fellowship Programs

Background: Social media is ubiquitous as a tool for collaboration, networking, and dissemination. However, little is known about use of social media platforms by pulmonary and critical care medicine fellowship programs. Objective: We identify and characterize pulmonary and critical care fellowship programs using Twitter and Instagram, as well as the posting behaviors of their social media accounts. Methods: We identified all adult and pediatric pulmonary, critical care medicine (CCM), and combined pulmonary and critical care medicine (PCCM) programs in the United States using the Electronic Residency Application Service. We searched for Twitter profiles for each program between January 1, 2018, and September 30, 2018. Tweets and Twitter interactions were classified into the following three types: social, clinical, or medical education (MedEd) related. We collected data about content enhancements of tweets, including the use of pictures, graphics interchange format or videos, hashtags, links, and tagging other accounts. The types of tweets, content enhancement characteristics, and measures of engagement were analyzed for association with number of followers. Results: We assessed 341 programs, including 163 PCCM, 36 adult CCM, 20 adult pulmonary, 67 pediatric CCM, and 55 pediatric pulmonary programs. Thirty-three (10%) programs had Twitter accounts. Of 1,903 tweets by 33 of the 341 programs with Twitter accounts, 476 (25%) were MedEd related, 733 (39%) were clinical, and 694 (36%) were social. The median rate of tweets per month was 1.65 (interquartile range [IQR], 0.4-6.65), with 55% programs tweeting more than monthly. Accounts tweeting more often had significantly more followers than those tweeting less frequently (median, 240 followers; 25-75% IQR, 164-388 vs. median, 107 followers; 25-75% IQR, 13-188; P = 0.006). Higher engagement with clinical and social Twitter interactions (tweets, retweets, likes, and comments) was associated with more followers but not for the MedEd-related Twitter interactions. All types of content enhancements (pictures, graphics interchange format/videos, links, and tagging) were associated with a higher number of followers, except for hashtags. Conclusion: Despite the steadily increasing use of social media in medicine, only 10% of the pulmonary and critical care fellowship programs in the United States have Twitter accounts. Social and clinical content appears to gain traction online; however, additional evaluation is needed on how to effectively engage audiences with MedEd content

Reliability Estimates For assessing Meal Timing Derived From Longitudinal Repeated 24-Hour Dietary Recalls

BACKGROUND: Regulating meal timing may have efficacy for improving metabolic health for preventing or managing chronic disease. However, the reliability of measuring meal timing with commonly used dietary assessment tools needs characterization prior to investigating meal timing and health outcomes in epidemiologic studies. OBJECTIVES: to evaluate the reliability of estimating meal timing parameters, including overnight fasting duration, the midpoint of overnight fasting time, the number of daily eating episodes, the period with the largest percentage of daily caloric intake, and late last eating episode (\u3e 09:00 pm) from repeated 24-h dietary recalls (24HRs). METHODS: Intraclass correlation coefficients (ICC), Light\u27s Kappa estimates, and 95% CIs were calculated from repeated 24HR administered in 3 epidemiologic studies: The United States-based Interactive Diet and Activity Tracking in AARP (IDATA) study (n = 996, 6 24HR collected over 12-mo), German EPIC-Potsdam Validation Study (European Prospective Investigation into Cancer and Nutrition Potsdam Germany cohort) (n = 134, 12 24HR collected over 12-mo) and EPIC-Potsdam BMBF-II Study (Federal Ministry of Education and Research, Bundesministerium für Bildung und Forschung ) (n = 725, 4 24HR collected over 36 mo). RESULTS: Measurement reliability of overnight fasting duration based on a single 24HR was poor in all studies [ICC range: 0.27; 95% CI: 0.23, 0.32 - 0.46; 95% CI: 0.43, 0.50]. Reliability was moderate with 3 24HR (ICC range: 0.53; 95% CI: 0.47, 0.58 in IDATA, 0.62; 95% CI: 0.52, 0.69 in the EPIC-Potsdam Validation Study, and 0.72; 95% CI: 0.70-0.75 in the EPIC-Potsdam BMBF-II Study). Results were similar for the midpoint of overnight fasting time and the number of eating episodes. Reliability of measuring late eating was fair in IDATA (Light\u27s Kappa: 0.30; 95% CI: 0.21, 0.39) and slight in the EPIC-Potsdam Validation study and the EPIC-Potsdam BMBF-II study (Light\u27s Kappa: 0.19; 95% CI: 0.15, 0.25 and 0.09; 95% CI: 0.06, 0.12, respectively). Reliability estimates differed by sex, BMI, weekday, and season of 24HR administration in some studies. CONCLUSIONS: Our results show that ≥ 3 24HR over a 1-3-y period are required for reliable estimates of meal timing variables

A trait-based framework for seagrass ecology: Trends and prospects

In the last three decades, quantitative approaches that rely on organism traits instead of taxonomy have advanced different fields of ecological research through establishing the mechanistic links between environmental drivers, functional traits, and ecosystem functions. A research subfield where trait-based approaches have been frequently used but poorly synthesized is the ecology of seagrasses; marine angiosperms that colonized the ocean 100M YA and today make up productive yet threatened coastal ecosystems globally. Here, we compiled a comprehensive trait-based response-effect framework (TBF) which builds on previous concepts and ideas, including the use of traits for the study of community assembly processes, from dispersal and response to abiotic and biotic factors, to ecosystem function and service provision. We then apply this framework to the global seagrass literature, using a systematic review to identify the strengths, gaps, and opportunities of the field. Seagrass trait research has mostly focused on the effect of environmental drivers on traits, i.e., “environmental filtering” (72%), whereas links between traits and functions are less common (26.9%). Despite the richness of trait-based data available, concepts related to TBFs are rare in the seagrass literature (15% of studies), including the relative importance of neutral and niche assembly processes, or the influence of trait dominance or complementarity in ecosystem function provision. These knowledge gaps indicate ample potential for further research, highlighting the need to understand the links between the unique traits of seagrasses and the ecosystem services they provide

Cooperation Between Systemic and Mucosal Antibodies Induced by Virosomal Vaccines Targeting HIV-1 Env: Protection of Indian Rhesus Macaques Against Low-Dose Intravaginal SHIV Challenges.

A virosomal vaccine inducing systemic/mucosal anti-HIV-1 gp41 IgG/IgA had previously protected Chinese-origin rhesus macaques (RMs) against vaginal SHIVSF162P3 challenges. Here, we assessed its efficacy in Indian-origin RMs by intramuscular priming/intranasal boosting (n=12/group). Group K received virosome-P1-peptide alone (harboring the Membrane Proximal External Region), Group L combined virosome-rgp41 plus virosome-P1, and Group M placebo virosomes. Vaccination induced plasma binding but no neutralizing antibodies. Five weeks after boosting, all RMs were challenged intravaginally with low-dose SHIVSF162P3 until persistent systemic infection developed. After SHIV challenge #7, six controls were persistently infected versus only one Group L animal (vaccine efficacy 87%; P=0.0319); Group K was not protected. After a 50% SHIV dose increase starting with challenge #8, protection in Group L was lost. Plasmas/sera were analyzed for IgG phenotypes and effector functions; the former revealed that protection in Group L was significantly associated with increased binding to FcγR2/3(A/B) across several time-points, as were some IgG measurements. Vaginal washes contained low-level anti-gp41 IgGs and IgAs, representing a 1-to-5-fold excess over the SHIV inoculum's gp41 content, possibly explaining loss of protection after the increase in challenge-virus dose. Virosomal gp41-vaccine efficacy was confirmed during the initial seven SHIV challenges in Indian-origin RMs when the SHIV inoculum had at least 100-fold more HIV RNA than acutely infected men's semen. Vaccine protection by virosome-induced IgG and IgA parallels the cooperation between systemically administered IgG1 and mucosally applied dimeric IgA2 monoclonal antibodies that as single-agents provided no/low protection - but when combined, prevented mucosal SHIV transmission in all passively immunized RMs

Infection control in delivery care units, Gujarat state, India: A needs assessment

Peer reviewedPublisher PD