Childhood Obesity and Obstructive Sleep Apnea

The global epidemic of childhood and adolescent obesity and its immediate as well as long-term consequences for obese individuals and society as a whole cannot be overemphasized. Obesity in childhood and adolescence is associated with an increased risk of adult obesity and clinically significant consequences affecting the cardiovascular and metabolic systems. Importantly, obesity is additionally complicated by obstructive sleep apnea (OSA), occurring in up to 60% of obese children. OSA, which is diagnosed using the gold standard polysomnogram (PSG), is characterised by snoring, recurrent partial (hypopneas) or complete (apneas) obstruction of the upper airway. OSA is frequently associated with intermittent oxyhemoglobin desaturations, sleep disruption, and sleep fragmentation. There is emerging data that OSA is associated with cardiovascular burden including systemic hypertension, changes in ventricular structure and function, arterial stiffness, and metabolic syndromes. Thus, OSA in the context of obesity may independently or synergistically magnify the underlying cardiovascular and metabolic burden. This is of importance as early recognition and treatment of OSA in obese children are likely to result in the reduction of cardiometabolic burden in obese children. This paper summarizes the current state of understanding of obesity-related OSA. Specifically, this paper will discuss epidemiology, pathophysiology, cardiometabolic burden, and management of obese children and adolescents with OSA

Plate-based transfection and culturing technique for genetic manipulation of Plasmodium falciparum

Genetic manipulation of malaria parasites remains an inefficient, time-consuming and resource-intensive process. Presented here is a set of methods for 96-well plate-based transfection and culture that improve the efficiency of genetic manipulation of Plasmodium falciparum. Compared to standard protocols plate-based transfection requires 20-fold less DNA, transient transfection efficiency achieved is approximately seven-fold higher, whilst stable transfection success rate is above 90%. Furthermore the utility of this set of protocols to generate a knockout of the PfRH3 pseudogene, screened by whole-cell PCR, is demonstrated. The methods and tools presented here will facilitate genome-scale genetic manipulation of P. falciparum

In vivo investigation of the tissue response to commercial Teflon insulin infusion sets in large swine for 14 days: the effect of angle of insertion on tissue histology and insulin spread within the subcutaneous tissue.

Objective: This study investigated the effects of the inflammatory tissue response (ITR) to an insulin infusion set (IIS) on insulin bolus spread over wear time, as well as the effect of cannula insertion angle on the ITR, bolus shape, and pump tubing pressure. Research design and methods: Angled or straight IISs were inserted every other day for 14 days into the subcutaneous tissue of 11 swine and insulin was delivered continuously. Prior to euthanasia, a 70 µL bolus of insulin/X-ray contrast agent was infused while recording a pressure profile (peak tubing pressure, pmax; area under the pressure curve, AUC), followed by the excision of the tissue-catheter specimen. Bolus surface area (SA) and volume (V) were assessed via micro-CT. Tissue was stained to analyze total area of inflammation (TAI) and inflammatory layer thickness (ILT) surrounding the cannula. Results: A bolus delivered through an angled IIS had a larger mean SA than a bolus delivered through a straight cannula (314.0±84.2 mm2 vs 229.0±99.7 mm2, p\u3c0.001) and a larger volume (198.7±66.9 mm3 vs 145.0±65.9 mm3, p=0.001). Both decreased significantly over wear time, independent of angle. There was a significant difference in TAI (angled, 9.1±4.0 mm2 vs straight, 14.3±8.6 mm2, p\u3c0.001) and ILT (angled, 0.7±0.4 vs straight, 1.2±0.7 mm, p\u3c0.001). pmax (p=0.005) and AUC (p=0.014) were lower using angled IIS. As ILT increased, pmax increased, while SA and V decreased. Conclusions: The progression of the ITR directly affected bolus shape and tubing pressure. Although straight insertion is clinically preferred, our data suggest that an angled IIS elicits lower grades of ITR and delivers a bolus with lower tubing pressure and greater SA and V. The subcutaneous environment plays a crucial role in IIS longevity, and the insertion angle needs to be considered in future IIS designs and clinical trials

Cancer burden and alarm signals: a community based study from Kerala, India

Background: Cancer is emerging as a major public health concern in many countries including India. Kerala state has the highest burden of cancer in the country. Objective of this study was to estimate the prevalence of diagnosed cancers, warning signs and selected risk factors of cancer in Kadapra Panchayath of Pathanamthitta district, Kerala.Methods: A total of 16,391 population was covered by door to door survey using a structured questionnaire. The questionnaire collected information on the sociodemographic variables of the residents, source of water supply, warning signs of cancer and details of diagnosed cancer cases.Results: The mean age of the population was 40.9+21 years. The prevalence of diagnosed cases of cancer in our study population was 776/100,000 population. Breast cancer was the most common cancer (43.5%) identified in the population. The prevalence of any warning sign among the study population was 220/100,000 population. Breast lump was the common warning sign identified. Increasing age and female gender were the factors found to be significantly associated with cancer.Conclusions: As prevalence of cancer was found to be high in this population, an active community based screening along with teaching self-breast examination to the women in the community are required. Improving community awareness could help in early diagnosis, treatment and prevention. Soil and water testing for carcinogens is recommended

Analysis of Coaxial Soil Cell in Reflection and Transmission

Accurate measurement of moisture content is a prime requirement in hydrological, geophysical and biogeochemical research as well as for material characterization and process control. Within these areas, accurate measurements of the surface area and bound water content is becoming increasingly important for providing answers to many fundamental questions ranging from characterization of cotton fiber maturity, to accurate characterization of soil water content in soil water conservation research to bio-plant water utilization to chemical reactions and diffusions of ionic species across membranes in cells as well as in the dense suspensions that occur in surface films. In these bound water materials, the errors in the traditional time-domain-reflectometer, “TDR”, exceed the range of the full span of the material’s permittivity that is being measured. Thus, there is a critical need to re-examine the TDR system and identify where the errors are to direct future research. One promising technique to address the increasing demands for higher accuracy water content measurements is utilization of electrical permittivity characterization of materials. This technique has enjoyed a strong following in the soil-science and geological community through measurements of apparent permittivity via time-domain-reflectometery as well in many process control applications. Recent research however, is indicating a need to increase the accuracy beyond that available from traditional TDR. The most logical pathway then becomes a transition from TDR based measurements to network analyzer measurements of absolute permittivity that will remove the adverse effects that high surface area soils and conductivity impart onto the measurements of apparent permittivity in traditional TDR applications. This research examines the theoretical basis behind the coaxial probe, from which the modern TDR probe originated from, to provide a basis on which to perform absolute permittivity measurements. The research reveals currently utilized formulations in accepted techniques for permittivity measurements which violate the underlying assumptions inherent in the basic models due to the TDR acting as an antenna by radiating energy off the end of the probe, rather than returning it back to the source as is the current assumption. To remove the effects of radiation from the experimental results obtain herein, this research utilized custom designed coaxial probes of various diameters and probe lengths by which to test the coaxial cell measurement technique for accuracy in determination of absolute permittivity. In doing so, the research reveals that the basic models available in the literature all omitted a key correction factor that is hypothesized by this research as being most likely due to fringe capacitance. To test this theory, a Poisson model of a coaxial cell was formulated to calculate the effective extra length provided by the fringe capacitance which is then used to correct the experimental results such that experimental measurements utilizing differing coaxial cell diameters and probe lengths, upon correction with the Poisson model derived correction factor, all produce the same results thereby lending support for the use of an augmented measurement technique, described herein, for measurement of absolute permittivity, as opposed to the traditional TDR measurement of apparent permittivity

Prevalence of endoparasitic infection in captive macaques in Kerala zoos

The study was conducted in three macaque species namely Lion-tailed macaque (Macaca silenus), Rhesus macaque (Macaca mulatta) and Bonnet macaque (Macaca radiata) in the zoos of Kerala. Faecal samples were collected from individual macaques kept in open enclosures and retiring cages. The samples were examined by sedimentation method for assessing the endoparasitic infection and its prevalence percentage in captive macaques. The degree of infection was assessed by faecal egg counts of samples by McMaster technique. The study found zero prevalence of strongyles in Lion-tailed macaques; 20 per cent in Rhesus macaque and 100 per cent in Bonnet macaques. The eggs per gram of strongyles in Rhesus macaques were 100 ± 39.22 and in Bonnet macaques were 312 ± 47.94. The prevalence of coccidia was 16.6 per cent in Lion-tailed macaques; 40 per cent in Rhesus macaque and 100 per cent in Bonnet macaques. The oocysts per gram of coccidia in Lion-tailed macaques were 166 ± 98.88; in Rhesus macaques were 200 ± 89.44 and in Bonnet macaques were 1850 ± 53.54. The present study revealed the higher prevalence and degree of infection of coccidia and strongyles in Bonnet macaques when compared to the other two macaque species

Feasibility of a mHealth Approach to Nutrition Counseling in an Appalachian State

Abstract: West Virginia is a rural state with an aging population that may experience barriers to accessing nutritional and lifestyle counseling. This study examined feasibility of an online personalized nutrition tracking application, Good Measures (GM), with patients at seven health care clinics throughout the state. Fourteen healthcare providers and 64 patients 18 years or older with a Body Mass Index (BMI) greater than or equal to 30 and access to the Internet were recruited for this 12-week feasibility study. Patient participants logged meals and exercise into the GM application via smart phone, tablet, or computer and virtually engaged with a Registered Dietitian Nutritionist (RDN) in one-on-one sessions. The primary endpoint was to examine feasibility of the program by usage of the application and feedback questions regarding the benefits and challenges of the application. Participants were predominately white (92%) and female (76%). Minimal improvements in weight and systolic blood pressure were found. Participant attitude survey data declined from 4-weeks to 12-weeks of the intervention. Interestingly though, patients in a rural clinic had lesser declines in attitudes than peri-urban participants. Qualitative feedback data identified participants predominately had a positive overall feeling toward the approach. Participants expressed favorability of RDN access, the variety of foods, but did give suggestions for in-person meetings and more updating of the application. Implementing a technology approach to nutrition in rural areas of West Virginia using a mobile application with RDN access may be one strategy to address public health issues such as obesity

Estimating and Reporting on the Quality of Inpatient Stroke Care by Veterans Health Administration Medical Centers

Background—Reporting of quality indicators (QIs) in Veterans Health Administration Medical Centers is complicated by estimation error caused by small numbers of eligible patients per facility. We applied multilevel modeling and empirical Bayes (EB) estimation in addressing this issue in performance reporting of stroke care quality in the Medical Centers. Methods and Results—We studied a retrospective cohort of 3812 veterans admitted to 106 Medical Centers with ischemic stroke during fiscal year 2007. The median number of study patients per facility was 34 (range, 12–105). Inpatient stroke care quality was measured with 13 evidence-based QIs. Eligible patients could either pass or fail each indicator. Multilevel modeling of a patient's pass/fail on individual QIs was used to produce facility-level EB-estimated QI pass rates and confidence intervals. The EB estimation reduced interfacility variation in QI rates. Small facilities and those with exceptionally high or low rates were most affected. We recommended 8 of the 13 QIs for performance reporting: dysphagia screening, National Institutes of Health Stroke Scale documentation, early ambulation, fall risk assessment, pressure ulcer risk assessment, Functional Independence Measure documentation, lipid management, and deep vein thrombosis prophylaxis. These QIs displayed sufficient variation across facilities, had room for improvement, and identified sites with performance that was significantly above or below the population average. The remaining 5 QIs were not recommended because of too few eligible patients or high pass rates with little variation. Conclusions—Considerations of statistical uncertainty should inform the choice of QIs and their application to performance reporting