Nurses Improving Nutrition Group Attendance Through RN Invitations

Background: Gestational diabetes (GDM), a common pregnancy complication, increases the risk of dangerous birth outcomes, fetal anomalies, and sustained disease and comorbidity for mothers and infants throughout the lifespan. Insulin use is an independent predictor of anomalies. Our prenatal care did not include detailed nutrition assessments and modifications such as Mediterranean diet, a lifestyle associated with reduction in non-pregnant adult diabetes incidence, even reversal. Adding hands-on cooking to nutrition counseling has improved A1c outcomes. We hypothesized a comprehensive package of diet review, nutrition guidelines, and participation in an onsite cooking class initiated at the beginning of prenatal care (Green Pregnancy – GP) would reduce GDM incidence and insulin use. Methods: Study conducted in two obstetric clinics, control period 2018, GP intervention 2019. Participation in GP was voluntary. We standardized GP, inviting all pregnant patients at their orientation to care visit. Participants attended a single culinary medicine group where families and nurses cooked together while exploring patient-selected topics woven in with cooking skills and GDM prevention principles. Results: 2018 baseline: 146 pregnant patients developed GDM, 53 (36%) required insulin. 2019: 229 patients developed GDM, 48 (21%) required insulin; none of the 20 women who participated in GP developed GDM. There was no anemia in GP pregnancies, and there were no NICU admissions in their infants. Conclusions of Prior Work and Problem Statement: Comprehensive culinary nutrition lifestyle modification with an onsite cooking class emphasizing Mediterranean diet is associated with a reduction in GDM, though moving into 2020, attendance was lower than projected. Nurses aimed to discover if adding RN in-person invitations vs. RN reminder calls alone would improve Green Pregnancy nutrition group attendance. Nurses imagined that when they placed a reminder phone call and invited patients to attend nutrition groups in-person, there would be an increased opportunity for enrollment and attendance. Based on the small change nurses implemented with adding in-person invitations to reminder calls, enrollment and attendance at the Women\u27s Clinic Green Pregnancy nutrition group improved over a three-week period. Nurses reported the connection made during the patient-facing invitation impacts the conversation during the reminder call. Explore the same nurse who met the patient in-person being the nurse to place the reminder call to capitalize on that connection. Well-designed, systematic studies of specific methods of appointment invitations and reminders are needed to discover the link between the intervention and attendance rates

Recollimation Boundary Layers in Relativistic Jets

We study the collimation of relativistic hydrodynamic jets by the pressure of an ambient medium in the limit where the jet interior has lost causal contact with its surroundings. For a jet with an ultrarelativistic equation of state and external pressure that decreases as a power of spherical radius, p \propto r^(-eta), the jet interior will lose causal contact when eta > 2. However, the outer layers of the jet gradually collimate toward the jet axis as long as eta < 4, leading to the formation of a shocked boundary layer. Assuming that pressure-matching across the shock front determines the shape of the shock, we study the resulting structure of the jet in two ways: first by assuming that the pressure remains constant across the shocked boundary layer and looking for solutions to the shock jump equations, and then by constructing self-similar boundary-layer solutions that allow for a pressure gradient across the shocked layer. We demonstrate that the constant-pressure solutions can be characterized by four initial parameters that determine the jet shape and whether the shock closes to the axis. We show that self-similar solutions for the boundary layer can be constructed that exhibit a monotonic decrease in pressure across the boundary layer from the contact discontinuity to the shock front, and that the addition of this pressure gradient in our initial model generally causes the shock front to move outwards, creating a thinner boundary layer and decreasing the tendency of the shock to close. We discuss trends based on the value of the pressure power-law index eta.Comment: 10 pages, 8 figures. Accepted to MNRAS; minor revisions from original submitted versio

Short- and long-term effects of 56Fe irradiation on cognition and hippocampal DNA methylation and gene expression.

BackgroundAstronauts are exposed to 56Fe ions that may pose a significant health hazard during and following prolonged missions in deep space. We showed previously that object recognition requiring the hippocampus, a structure critical for cognitive function, is affected in 2-month-old mice irradiated with 56Fe ions. Here we examined object recognition in 6-month-old mice irradiated with 56Fe ions, a biological age more relevant to the typical ages of astronauts. Moreover, because the mechanisms mediating the detrimental effects of 56Fe ions on hippocampal function are unclear, we examined changes in hippocampal networks involved in synaptic plasticity and memory, gene expression, and epigenetic changes in cytosine methylation (5mC) and hydroxymethylation (5hmC) that could accompany changes in gene expression. We assessed the effects of whole body 56Fe ion irradiation at early (2 weeks) and late (20 weeks) time points on hippocampus-dependent memory and hippocampal network stability, and whether these effects are associated with epigenetic changes in hippocampal DNA methylation (both 5mC and 5hmC) and gene expression.ResultsAt the two-week time point, object recognition and network stability were impaired following irradiation at the 0.1 and 0.4 Gy dose, but not following irradiation at the 0.2 Gy dose. No impairments in object recognition or network stability were seen at the 20-week time point at any irradiation dose used. Consistent with this pattern, the significance of pathways for gene categories for 5hmC was lower, though not eliminated, at the 20-week time point compared to the 2-week time point. Similarly, significant changes were observed for 5mC gene pathways at the 2-week time point, but no significant gene categories were observed at the 20-week time point. Only the 5hmC changes tracked with gene expression changes.ConclusionsDose- and time-dependent epigenomic remodeling in the hippocampus following 56Fe ion exposure correlates with behavioral changes

Bi-directional and shared epigenomic signatures following proton and 56Fe irradiation.

The brain's response to radiation exposure is an important concern for patients undergoing cancer therapy and astronauts on long missions in deep space. We assessed whether this response is specific and prolonged and is linked to epigenetic mechanisms. We focused on the response of the hippocampus at early (2-weeks) and late (20-week) time points following whole body proton irradiation. We examined two forms of DNA methylation, cytosine methylation (5mC) and hydroxymethylation (5hmC). Impairments in object recognition, spatial memory retention, and network stability following proton irradiation were observed at the two-week time point and correlated with altered gene expression and 5hmC profiles that mapped to specific gene ontology pathways. Significant overlap was observed between DNA methylation changes at the 2 and 20-week time points demonstrating specificity and retention of changes in response to radiation. Moreover, a novel class of DNA methylation change was observed following an environmental challenge (i.e. space irradiation), characterized by both increased and decreased 5hmC levels along the entire gene body. These changes were mapped to genes encoding neuronal functions including postsynaptic gene ontology categories. Thus, the brain's response to proton irradiation is both specific and prolonged and involves novel remodeling of non-random regions of the epigenome

Promoting dietary changes for achieving health and sustainability targets

Globally, about 21–37% of total greenhouse gas (GHG) emissions are attributable to food systems. Dietary-related non-communicable diseases have increased significantly from 1990–2019 at a global scale. To achieve carbon emissions targets, increase resilience, and improve health there is a need to increase the sustainability of agricultural practises and change dietary habits. By considering these challenges together and focusing on a closer connection between consumers and sustainable production, we can benefit from a positive interaction between them. Using the 2019 EAT Lancet Commission dietary guidelines, this study analysed interview data and food diaries collected from members of Community Supported Agriculture (CSA) schemes and the wider UK population. By comparing the environmental sustainability and nutritional quality of their respective diets, we found that CSA members consumed diets closer to the EAT Lancet recommendations than controls. We identified significant differences in daily intakes of meat; dairy; vegetables; legumes; and sugar, and the diets of CSA members emitted on average 28% less CO2 compared to controls. We propose that agricultural and wider social and economic policies that increase the accessibility of CSAs for a more diverse demographic could support achieving health, biodiversity, and zero-emission policy targets

A systematic review of studies reporting the development of Core Outcome Sets for use in routine care.

ObjectivesCore outcome sets (COS) represent the minimum health outcomes to be measured for a given health condition. Interest is growing in using COS within routine care to support delivery of patient-focussed care. This review aims to systematically map COS developed for routine care to understand their scope, stakeholder involvement and development methods.MethodsMedline (OVID), Scopus and Web of Science Core collection were searched for studies reporting development of COS for routine care. Data on scope, methods and stakeholder groups were analysed in subgroups defined by setting.ResultsScreening 25,301 records identified 262 COS: 164 for routine care only; 98 for routine care and research. Nearly half of the COS (112/254, 44%) were developed with patients, alongside input from experts in: registries; insurance; legal; outcomes measurement; performance management. Research publications were often searched to generate an initial list of outcomes (115/198, 58%) with few searching routine health records (47/198, 24%).ConclusionAn increasing number of COS are being developed for routine care. Although involvement of patient stakeholders has increased in recent years further improvements are needed. Methodology and scope are broadly similar to COS for research but implementation of the final set is a greater consideration during development

Magnetic Domination of Recollimation Boundary Layers in Relativistic Jets

We study the collimation of relativistic magnetohydrodynamic jets by the pressure of an ambient medium, in the limit where the jet interior loses causal contact with its surroundings. This follows up a hydrodynamic study in a previous paper, adding the effects of a toroidal magnetic field threading the jet. As the ultrarelativistic jet encounters an ambient medium with a pressure profile with a radial scaling of p ~ r^-eta where 2<eta<4, it loses causal contact with its surroundings and forms a boundary layer with a large pressure gradient. By constructing self-similar solutions to the fluid equations within this boundary layer, we examine the structure of this layer as a function of the external pressure profile. We show that the boundary layer always becomes magnetically dominated far from the source, and that in the magnetic limit, physical self-similar solutions are admitted in which the total pressure within the layer decreases linearly with distance from the contact discontinuity inward. These solutions suggest a `hollow cone' behavior of the jet, with the boundary layer thickness prescribed by the value of eta. In contrast to the hydrodynamical case, however, the boundary layer contains an asymptotically vanishing fraction of the jet energy flux.Comment: 6 pages, 1 figure; accepted to MNRAS for publicatio

Venous thromboembolism in children with cancer – a population-based cohort study

Introduction: Cancer is a known risk factor for venous thromboembolism (VTE) in adults, but population-based data in children are scarce. Materials and methods: We conducted a cohort study utilising linkage of the Clinical Practice Research Database (primary care), Hospital Episodes Statistics (secondary care), UK Cancer Registry data and Office for National Statistics cause of death data. From these databases, we selected 498 children with cancer diagnosed between 1997 and 2006 and 20,810 controls without cancer. We calculated VTE incidence rates in children with cancer vs. controls, and hazard ratios (HRs) using Cox regression. Results: We identified four VTE events in children with cancer compared with four events in the larger control population corresponding to absolute risks of 1.52 and 0.06 per 1000 person-years respectively. The four children with VTE and cancer were diagnosed with hematological, bone or non-specified cancer. Childhood cancer was hence associated with a highly increased risk of VTE (HR adjusted for age and sex: 28.3; 95%CI = 7.0-114.5). Conclusions: Children with cancer are at increased relative risk of VTE compared to those without cancer. Physicians could consider thromboprophylaxis in children with cancer to reduce their excess risk of VTE however the absolute risk is extremely small and the benefit gained therefore would need to be balanced against the risk invoked of implementing such a strategy. Novelty & Impact Statements: While there is a reasonable level of knowledge about the risk of VTE in adult populations, it is not well known whether this risk is reflected in paediatric patients. We found a substantial increase in risk of VTE in children with cancer compared to a child population without cancer. While this finding is important, the absolute risk of VTE is still low and must be balanced with the risks of anticoagulation