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To quantify diet-related burdens of cardiometabolic diseases (CMD) by country, age and sex in Latin America and the Caribbean (LAC).
Intakes of eleven key dietary factors were obtained from the Global Dietary Database Consortium. Aetiologic effects of dietary factors on CMD outcomes were obtained from meta-analyses. We combined these inputs with cause-specific mortality data to compute country-, age- and sex-specific absolute and proportional CMD mortality of eleven dietary factors in 1990 and 2010.
Thirty-two countries in LAC.
Adults aged 25 years and older.
In 2010, an estimated 513 371 (95 % uncertainty interval (UI) 423 286–547 841; 53·8 %) cardiometabolic deaths were related to suboptimal diet. Largest diet-related CMD burdens were related to low intake of nuts/seeds (109 831 deaths (95 % UI 71 920–121 079); 11·5 %), low fruit intake (106 285 deaths (95 % UI 94 904–112 320); 11·1 %) and high processed meat consumption (89 381 deaths (95 % UI 82 984–97 196); 9·4 %). Among countries, highest CMD burdens (deaths per million adults) attributable to diet were in Trinidad and Tobago (1779) and Guyana (1700) and the lowest were in Peru (492) and The Bahamas (504). Between 1990 and 2010, greatest decline (35 %) in diet-attributable CMD mortality was related to greater consumption of fruit, while greatest increase (7·2 %) was related to increased intakes of sugar-sweetened beverages.
Suboptimal intakes of commonly consumed foods were associated with substantial CMD mortality in LAC with significant heterogeneity across countries. Improved access to healthful foods, such as nuts and fruits, and limits in availability of unhealthful factors, such as processed foods, would reduce diet-related burdens of CMD in LAC.
The present study investigated the structure of the Spanish version of the Iowa-Netherlands Comparison Orientation Measure (INCOM-E), an 11-item measure that assesses individual differences in social comparison orientation (SCO), i.e., the extent to which people compare themselves with others. Data came from samples from Spain (n = 1,133) and Chile (n = 2,757). Confirmatory Factor Analyses and Mokken Scale Analyses supported in both samples not the assumed two-factor structure, but a single factor structure, consisting of eight items. The resulting eight-item version of the INCOM-E was reliable in both samples, according the Gutmann’s lambda–2 (.82 in Spain and .83 in Chile), and correlated very strongly with the full-length INCOM-E (.93 in Spain and .97 in Chile). In both samples, there were significant sex differences, ps < .001 with small effect sizes, ƞ2 in both samples = .01,but in the Spanish sample women scored higher, and in the Chilean sample men scored higher in SCO. The relationship with age was negative and significant (ps < .001) in both samples, albeit small (r = .22 in Spain and .13 in Chile) Based on the present research, it is advised to use the shortened eight-item version of the INCOM-E in Spanish speaking countries.
When Hurricane Harvey landed along the Texas coast on August 25, 2017, it caused massive flooding and damage and displaced tens of thousands of residents of Harris County, Texas. Between August 29 and September 23, Harris County, along with community partners, operated a megashelter at NRG Center, which housed 3365 residents at its peak. Harris County Public Health conducted comprehensive public health surveillance and response at NRG, which comprised disease identification through daily medical record reviews, nightly “cot-to-cot” resident health surveys, and epidemiological consultations; messaging and communications; and implementation of control measures including stringent isolation and hygiene practices, vaccinations, and treatment. Despite the lengthy operation at the densely populated shelter, an early seasonal influenza A (H3) outbreak of 20 cases was quickly identified and confined. Influenza outbreaks in large evacuation shelters after a disaster pose a significant threat to populations already experiencing severe stressors. A holistic surveillance and response model, which consists of coordinated partnerships with onsite agencies, in-time epidemiological consultations, predesigned survey tools, trained staff, enhanced isolation and hygiene practices, and sufficient vaccines, is essential for effective disease identification and control. The lessons learned and successes achieved from this outbreak may serve for future disaster response settings. (Disaster Med Public Health Preparedness. 2019;13:97-101)
Since the introduction of laser-assisted atom probe, analysis of nonconductive materials by atom probe tomography (APT) has become more routine. To obtain high-quality data, a number of acquisition variables needs to be optimized for the material of interest, and for the specific question being addressed. Here, the rutile (TiO2) reference material ‘Windmill Hill Quartzite,’ used for secondary ion mass spectrometry U–Pb dating and laser-ablation inductively coupled plasma mass spectrometry, was analyzed by laser-assisted APT to constrain optimal running conditions. Changes in acquisition parameters such as laser energy and detection rate are evaluated in terms of their effect on background noise, ionization state, hit-multiplicity, and thermal tails. Higher laser energy results in the formation of more complex molecular ions and affects the ionization charge state. At lower energies, background noise and hit-multiplicity increase, but thermal tails shorten. There are also correlations between the acquisition voltage and several of these metrics, which remain to be fully understood. The results observed when varying the acquisition parameters will be discussed in detail in the context of utilizing APT analysis of rutile within geology.
The Principal INvestigator Development and Resources (PINDAR) program was developed at the NYU-H+H Clinical and Translational Science Award (CTSA) hub in response to a perceived need for focused good clinical practice (GCP) training designed specifically for principal investigators (PIs) performing human subject research. PINDAR is a novel 6-hour, instructor lead, participatory, in-person course for PIs developed de novo, piloted, and implemented. One hundred and seventeen faculty PIs participated in PINDAR from November 2016 through September 2018. All obtained mutual recognition for ICH E6 GCP training from TransCelerate Biopharma. PINDAR was well received by participant PIs, and feedback surveys have revealed a high degree of satisfaction with the program. Other CTSA hubs and research-intensive health systems should consider adopting a similar course focused on GCP for PIs.
Replacing a portion of a glucose challenge with whole eggs (EGG) or egg whites (WHITE) was shown to protect against glucose-induced impairments in vascular function. We hypothesised in the present study that previously observed vasoprotection following co-ingestion of EGG or WHITE with glucose was attributed to limiting postprandial hyperglycaemia-induced oxidative stress that improves NO∙ bioavailability. Prediabetic men completed a randomised, cross-over study in which they ingested isoenergetic meals containing 100 g glucose (GLU), or 75 g glucose with 1·5 EGG, seven WHITE or two egg yolks (YOLK). At 30 min intervals for 3 h, we assessed plasma NO∙ metabolites, the lipid peroxidation biomarker malondialdehyde, antioxidants, arginine and its methylated metabolites (asymmetric dimethylarginine and symmetric dimethylarginine), tetrahydrobiopterin redox status, vasoconstrictors and inflammatory markers. Compared with GLU, malondialdehyde was lower and NO∙ metabolites were greater in EGG and WHITE, but YOLK was not different from GLU. Malondialdehyde was inversely correlated with NO∙ metabolites and vascular function, whereas NO∙ metabolites were positively correlated with vascular function. Compared with GLU, arginine was greater, but asymmetric and symmetric dimethylarginine and angiotensin-II were lower in all egg-based meals. Antioxidants, tetrahydrobiopterin redox status and inflammatory markers did not differ among treatments. Thus, while each egg-based meal improved arginine metabolism, only EGG and WHITE limited lipid peroxidation. This suggests that vasoprotection mediated by EGG and WHITE likely occurs in an NO∙-dependent manner by improving arginine metabolism and attenuating oxidative stress that otherwise limit NO∙ biosynthesis and bioavailability to the vascular endothelium.
OBJECTIVES/SPECIFIC AIMS: Leadership is an essential and recognized team science competency. Modeled after the successful LEAD (Leadership in Emerging Academic Departments) program at University of Texas Southwestern (UTSW), ConduITS LEAD Program is designed to: (1) provide personal and professional development opportunities for participants; (2) promote organizational change through applied leadership skills; (3) provide a platform for integrating multiple disciplines and fostering interprofessional relationships among investigators and clinicians. METHODS/STUDY POPULATION: The 1-year structured LEAD program curriculum includes monthly interactive seminars covering: personal and situational leadership; unconscious bias; communication and influence; navigating personal conflict; negotiation and networking; selecting and managing the right team; teamwork; financing the academic mission, budgets and business plan development; strategic planning and vision; presentation skills. To foster the development of leadership skills participants engage in Hogan Assessments, individual and peer mentoring from an executive coach and self-directed learning activities and assignments. Completion of an individual Capstone leadership project empowers learners to enact practice change through the implementation of leadership concepts in practice. RESULTS/ANTICIPATED RESULTS: In collaboration with the Office of Academic Enrichment & Development (OADE), the first competitive RFA was issued in November of 2016. In total, 63 applications were received including: gender: 29 M: 34 F; URM: 10; Degrees: M.D. (40); Ph.D. (11); M.D./Ph.D. (6); M.D./M.P.H. (3); M.D./M.S.C.R. (2); PharmD (1); Departments: 19; Institutes/Centers: 12; MSHS: 3 sites. Through a competitive and rigorous application process, 24 junior faculty with evidence of leadership potential and trajectory were chosen to participate. The current cohort of LEAD participants joined in February 2017, and will complete the program in January 2018. Using qualitative and quantitative survey methodology, participants will be evaluated for self-reported change to attitudes, belief, skills and development of new relationships and collaborations. Submitted Capstone projects were mainly focused on implementing situational and personal leadership concepts to practice, with one additionally focused on the use of behavioral interviewing techniques to optimize team building and teamwork. At the time of abstract submission 30% of the cohort has implemented their Capstone project in practice. Participants will be followed-up in 6 months’ time to evaluate the impact of the LEAD program on their practice. Following a second RFA, 24/52 candidates have been selected as our next cohort, and will start in February 2018. DISCUSSION/SIGNIFICANCE OF IMPACT: Leadership is known to be a core component of team science, and the ability to implement leadership into practice may advance personal and professional change. This program addresses the need to empower Junior Faculty to engage in leadership in practice. In addition, this program is able to provide added value to extend the reach of the OADE, promote new individual collaborations and facilitate additional leadership training efforts at our Institution. Future collaborative studies will focus on common outcomes as well as institutional differences between these 2 CTSA institutions.
Introduction: Point of care ultrasound (PoCUS) has become an established tool in the initial management of patients with undifferentiated hypotension in the emergency department (ED). Current established protocols (e.g. RUSH and ACES) were developed by expert user opinion, rather than objective, prospective data. Recently the SHoC Protocol was published, recommending 3 core scans; cardiac, lung, and IVC; plus other scans when indicated clinically. We report the abnormal ultrasound findings from our international multicenter randomized controlled trial, to assess if the recommended 3 core SHoC protocol scans were chosen appropriately for this population. Methods: Recruitment occurred at seven centres in North America (4) and South Africa (3). Screening at triage identified patients (SBP<100 or shock index>1) who were randomized to PoCUS or control (standard care with no PoCUS) groups. All scans were performed by PoCUS-trained physicians within one hour of arrival in the ED. Demographics, clinical details and study findings were collected prospectively. A threshold incidence for positive findings of 10% was established as significant for the purposes of assessing the appropriateness of the core recommendations. Results: 138 patients had a PoCUS screen completed. All patients had cardiac, lung, IVC, aorta, abdominal, and pelvic scans. Reported abnormal findings included hyperdynamic LV function (59; 43%); small collapsing IVC (46; 33%); pericardial effusion (24; 17%); pleural fluid (19; 14%); hypodynamic LV function (15; 11%); large poorly collapsing IVC (13; 9%); peritoneal fluid (13; 9%); and aortic aneurysm (5; 4%). Conclusion: The 3 core SHoC Protocol recommendations included appropriate scans to detect all pathologies recorded at a rate of greater than 10 percent. The 3 most frequent findings were cardiac and IVC abnormalities, followed by lung. It is noted that peritoneal fluid was seen at a rate of 9%. Aortic aneurysms were rare. This data from the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients, supports the use of the prioritized SHoC protocol, though a larger study is required to confirm these findings.
Introduction: Point of care ultrasound (PoCUS) is an established tool in the initial management of patients with undifferentiated hypotension in the emergency department (ED). While PoCUS protocols have been shown to improve early diagnostic accuracy, there is little published evidence for any mortality benefit. We report the findings from our international multicenter randomized controlled trial, assessing the impact of a PoCUS protocol on survival and key clinical outcomes. Methods: Recruitment occurred at 7 centres in North America (4) and South Africa (3). Scans were performed by PoCUS-trained physicians. Screening at triage identified patients (SBP<100 or shock index>1), randomized to PoCUS or control (standard care and no PoCUS) groups. Demographics, clinical details and study findings were collected prospectively. Initial and secondary diagnoses were recorded at 0 and 60 minutes, with ultrasound performed in the PoCUS group prior to secondary assessment. The primary outcome measure was 30-day/discharge mortality. Secondary outcome measures included diagnostic accuracy, changes in vital signs, acid-base status, and length of stay. Categorical data was analyzed using Fishers test, and continuous data by Student T test and multi-level log-regression testing. (GraphPad/SPSS) Final chart review was blinded to initial impressions and PoCUS findings. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. There was no difference between groups for the primary outcome of mortality; PoCUS 32/129 (24.8%; 95% CI 14.3-35.3%) vs. Control 32/129 (24.8%; 95% CI 14.3-35.3%); RR 1.00 (95% CI 0.869 to 1.15; p=1.00). There were no differences in the secondary outcomes; ICU and total length of stay. Our sample size has a power of 0.80 (α:0.05) for a moderate effect size. Other secondary outcomes are reported separately. Conclusion: This is the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients. We did not find any mortality or length of stay benefits with the use of a PoCUS protocol, though a larger study is required to confirm these findings. While PoCUS may have diagnostic benefits, these may not translate into a survival benefit effect.
Introduction: Point of Care Ultrasound (PoCUS) protocols are commonly used to guide resuscitation for emergency department (ED) patients with undifferentiated non-traumatic hypotension. While PoCUS has been shown to improve early diagnosis, there is a minimal evidence for any outcome benefit. We completed an international multicenter randomized controlled trial (RCT) to assess the impact of a PoCUS protocol on key resuscitation markers in this group. We report diagnostic impact and mortality elsewhere. Methods: The SHoC-ED1 study compared the addition of PoCUS to standard care within the first hour in the treatment of adult patients presenting with undifferentiated hypotension (SBP<100 mmHg or a Shock Index >1.0) with a control group that did not receive PoCUS. Scans were performed by PoCUS-trained physicians. 4 North American, and 3 South African sites participated in the study. Resuscitation outcomes analyzed included volume of fluid administered in the ED, changes in shock index (SI), modified early warning score (MEWS), venous acid-base balance, and lactate, at one and four hours. Comparisons utilized a T-test as well as stratified binomial log-regression to assess for any significant improvement in resuscitation amount the outcomes. Our sample size was powered at 0.80 (α:0.05) for a moderate effect size. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. There was no significant difference in mean total volume of fluid received between the control (1658 ml; 95%CI 1365-1950) and PoCUS groups (1609 ml; 1385-1832; p=0.79). Significant improvements were seen in SI, MEWS, lactate and bicarbonate with resuscitation in both the PoCUS and control groups, however there was no difference between groups. Conclusion: SHOC-ED1 is the first RCT to compare PoCUS to standard of care in hypotensive ED patients. No significant difference in fluid used, or markers of resuscitation was found when comparing the use of a PoCUS protocol to that of standard of care in the resuscitation of patients with undifferentiated hypotension.
Introduction: Point of care ultrasonography (PoCUS) is an established tool in the initial management of hypotensive patients in the emergency department (ED). It has been shown rule out certain shock etiologies, and improve diagnostic certainty, however evidence on benefit in the management of hypotensive patients is limited. We report the findings from our international multicenter RCT assessing the impact of a PoCUS protocol on diagnostic accuracy, as well as other key outcomes including mortality, which are reported elsewhere. Methods: Recruitment occurred at 4 North American and 3 Southern African sites. Screening at triage identified patients (SBP<100 mmHg or shock index >1) who were randomized to either PoCUS or control groups. Scans were performed by PoCUS-trained physicians. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses were recorded at 0 and 60 minutes, with ultrasound performed in the PoCUS group prior to secondary assessment. Final chart review was blinded to initial impressions and PoCUS findings. Categorical data was analyzed using Fishers two-tailed test. Our sample size was powered at 0.80 (α:0.05) for a moderate effect size. Results: 258 patients were enrolled with follow-up fully completed. Baseline comparisons confirmed effective randomization. The perceived shock category changed more frequently in the PoCUS group 20/127 (15.7%) vs. control 7/125 (5.6%); RR 2.81 (95% CI 1.23 to 6.42; p=0.0134). There was no significant difference in change of diagnostic impression between groups PoCUS 39/123 (31.7%) vs control 34/124 (27.4%); RR 1.16 (95% CI 0.786 to 1.70; p=0.4879). There was no significant difference in the rate of correct category of shock between PoCUS (118/127; 93%) and control (113/122; 93%); RR 1.00 (95% CI 0.936 to 1.08; p=1.00), or for correct diagnosis; PoCUS 90/127 (70%) vs control 86/122 (70%); RR 0.987 (95% CI 0.671 to 1.45; p=1.00). Conclusion: This is the first RCT to compare PoCUS to standard care for undifferentiated hypotensive ED patients. We found that the use of PoCUS did change physicians’ perceived shock category. PoCUS did not improve diagnostic accuracy for category of shock or diagnosis.
In species that aggregate for reproduction, the social and fitness costs of movement between groups frequently lead to restricted exchange between breeding areas. We report on four individual humpback whales identified in both the Cape Verde Islands and Guadeloupe; locations separated by an ocean basin and >4000 km. This rate of exchange is rarely encountered between such geographically discrete breeding areas. Two individuals returned to the area where they were originally identified. In contrast, no individuals from the Cape Verde Islands were resighted to the much larger sample from the Dominican Republic, though the migratory distances from the feeding areas are comparable between these areas. The social factors driving the stark difference between groups that is observed here are not clear. Effective conservation requires an understanding of the extent and pattern of movement between population units. The findings presented here suggest that there may well be more than one behaviourally distinct group within the West Indies. More broadly, they argue that considerable caution is warranted in assumptions made regarding the number, boundaries and status of population units based solely on spatial separation or proximity.
The unprecedented Ebola Virus Disease (EVD) outbreak in West Africa, with its first cases documented in March 2014, has claimed the lives of thousands of people, and it has devastated the health care infrastructure and workforce in affected countries. Throughout this outbreak, there has been a critical lack of health care workers (HCW), including physicians, nurses, and other essential non-clinical staff, who have been needed, in most of the affected countries, to support the medical response to EVD, to attend to the health care needs of the population overall, and to be trained effectively in infection protection and control. This lack of sufficient and qualified HCW is due in large part to three factors: 1) limited HCW staff prior to the outbreak, 2) disproportionate illness and death among HCWs caused by EVD directly, and 3) valid concerns about personal safety among international HCWs who are considering responding to the affected areas. These guidelines are meant to inform institutions who deploy professional HCWs. (Disaster Med Public Health Preparedness. 2015;9:586–590)
Based on material collected during oceanographic campaigns in the western Atlantic from 1958 to 2011, two species of primnoid octocorals belonging to the genus Callogorgia were identified: Callogorgia americana and Callogorgia arawak sp. nov. These species are described and illustrated herein and their geographic and bathymetric are given. This is the first record of the genus in the south-western Atlantic. Additionally, the elevation of C. americana americana and C. a. delta to species level is proposed, keeping Callogorgia gilberti, C. delta and C. americana as separate species.
The correspondences between the names in the Scylding genealogy at the beginning of Beowulf and three names in the upper reaches of the genealogy of Æthelwulf in the Anglo-Saxon Chronicle, Beaw, Sceldwa and Sceaf, frequently appear in arguments for a late dating of Beowulf. But these arguments overlook many aspects of Æthelwulf's genealogy that disrupt their case for a late dating. As H. Munro Chadwick pointed out over a century ago, the forms Sceldwa and Beaw found in the Chronicle for Scyld and Beow are not West Saxon spellings, and the -wa suffix of Sceldwa and Tætwa suggests that these forms may be archaic. Thus spelling alone indicates that these names were probably copied from an older, non-West Saxon text. Furthermore, the very presence of these names in the royal pedigree is puzzling. On one level the presence of Scyld is easy to explain: Scyld and the Scyldings were famous in heroic legend, and his inclusion in Æthelwulf's pedigree provides reflected glory for the West Saxon dynasty and implies genealogical, political and cultural connections between the West Saxons and the Danes that could be useful for Alfred and his heirs to foster. But on another level his inclusion is rather surprising: according to genealogical conventions, the presence of Scyld implies that the West Saxon royal family is a cadet branch of the Scylding dynasty, and is thus potentially subordinate to Scandinavian rulers in England claiming direct descent from Scyld.
Since the date of the Beowulf manuscript is widely agreed upon, the very question which prompts this volume (and the conference it derives from, and even the 1980 conference with its 1981 proceedings volume) must assume that the date of the poem may not be the same as the date of the manuscript. It is certain that there must have been a moment of first inscription for the poem, and that the time and place of that moment remains a central point of interest for students of the poem. In this essay, I will bring new evidence to bear on this venerable question, and my argument shall be that Beowulf is metrically conservative according to a variety of independent metrical criteria. Further, I will suggest that that conservatism is so varied and consistent as to strongly indicate that the original version of Beowulf must be placed among the very earliest of the longer narrative Old English poems that survive, probably in the eighth century.
Of course, it remains true, I believe, that the moment of inscription is only one of the moments of interest which might engage modern scholars of the poem. As I argued in Authors, Audiences, and Old English Verse, our focus on authorship (and on moments of authorship) may sometimes cause us to lose sight of what can be gained by also considering audience, and I proposed there two later audiences for Beowulf, one located at Alfred's Wessex court in the late ninth century, and another, sometime around the turn of the eleventh century, perhaps in Canterbury, represented most clearly by the author of Maldon.
As the introduction to this collection makes clear, the various forms of linguistic and metrical evidence bearing on the dating of Beowulf point to a date of composition fairly early in the Anglo-Saxon period. In his article for The Dating of Beowulf in 1980, Thomas Cable proposed a rough guide to the metrical dating of poems using the incidence of type C, D, and E verses, which decline in frequency over the Anglo-Saxon period. Cable's criterion places Beowulf toward the beginning of a relative chronology. Since then, much additional metrical and linguistic evidence has been gathered that places Beowulf in the early to mid-eighth century. R.D. Fulk's A History of Old English Meter is the most substantial work of this kind, for it examines the presence of archaic metrical features through-out the corpus of Old English poetry and finds that Beowulf is by far the most archaic poem. Since that work, other scholars have written articles on individual metrical or linguistic features of the poetic corpus, which have corroborated the conclusions that Fulk so carefully reached.
Some scholars, however, remain dubious about the reliability of this type of evidence. At this point, the force of linguistic scholarship is too formidable to be undermined by the doubts raised by E.G. Stanley, who urged that the poem should not be dated by means of sundry linguistic oddities that could well be scribal error or just a few bad lines.