Effects of maternal calcium supplementation on offspring blood pressure and growth in childhood and adolescence in a population with a low-calcium intake: follow-up study of a randomized controlled trial.

BACKGROUND: The World Health Organization recommends calcium supplementation (1500-2000 mg/d) during pregnancy for women with a low-calcium intake. OBJECTIVES: The purpose of this study was to investigate whether pregnancy calcium supplementation affects offspring blood pressure and growth in The Gambia where calcium intakes are low (300-400 mg/d). METHODS: Follow-up of offspring born during a randomized controlled trial of pregnancy calcium supplementation (ISRCTN96502494, 1996-2000) in which mothers were randomly assigned to 1500 mg Ca/d (Ca) or placebo (P) from 20 wk pregnancy to delivery. Offspring were enrolled at age 3 y in studies where blood pressure and anthropometry were measured under standardized conditions at approximately 2-yearly intervals. Mean blood pressure and growth curves were fitted for females and males separately, using the longitudinal SuperImposition by Translation and Rotation (SITAR) mixed effects model. This generates 3 individual-specific random effects: size, timing, and intensity, reflecting differences in size, age at peak velocity, and peak velocity through puberty relative to the mean curve, respectively. RESULTS: Five hundred twenty-three singleton infants were born during the trial (maternal group assignment: Ca/P = 259/264). Four hundred ninety-one were enrolled as children (females: F-Ca/F-P = 122/129 and males: M-Ca/M-P = 119/121) and measured regularly from 3.0 y to mean age 18.4 y; 90% were measured on ≥8 occasions. SITAR revealed differences in the systolic blood pressure and height curves between pregnancy supplement groups in females, but not in males. F-Ca had lower systolic blood pressure than F-P at all ages (size = -2.1 ± SE 0.8 mmHg; P = 0.005) and lower peak height velocity (intensity = -2.9 ± SE 1.1%, P = 0.009). No significant pregnancy supplement effects were seen for other measures. CONCLUSIONS: This study showed, in female offspring, that pregnancy calcium supplementation may lower systolic blood pressure and slow linear growth in childhood and adolescence, adding to evidence of offspring sexual dimorphism in responses to maternal supplementation. Further research is warranted on the long-term and intergenerational effects of antenatal supplementations. This trial was registered at ISRCTN Registry as ISRCTN96502494.

Beef Handling Practices Among Consumers in the U.S. Virgin Islands.

U.S. Virgin Islands (USVI) imports more than 95% of its food. Transportation limitations throughout the territory's supply chain can make temperature control of protein foods challenging for consumers. This study aimed to characterize the beef handling practices used by consumers in USVI to determine any educational needs. Printed and online surveys (n = 620 total) were disseminated in USVI through extension agents and local media sources. Three hundred and thirty-four consumers completed a 30-question food handling questionnaire on consumption patterns and food handling from purchasing to their kitchen. Frequencies and Pearson chi-square tests of independence were performed. Beef ranked second among the different meat types consumed, 92% of consumers bought beef from grocery stores, and 55% removed beef from shelves immediately after entering the store. When shopping, 59.1% of respondents always checked the use-by/freeze-by dates of beef, 46.3% always separated beef from other foods, but only 27.5% always used insulated bags. Eighty-three percent of consumers returned home within 1 h of shopping, 92% took less than 30 min to store groceries in either a freezer or refrigerator (98%) and during power outages, 45.1% maintained cold temperatures of beef. Seventy-two percent of consumers washed their hands for more than 10 s, but 33% of those from households with a vulnerable person did not use soap to wash their hands and dried them with reusable towels. When cooking, 44.6% of consumers thawed beef within the temperature danger zone, 80.1% did not check the temperature of beef for doneness, and 34 respondents cooked hamburgers below 160°F. Future consumer food safety education initiatives in the USVI should address hand hygiene among food preparers in homes with vulnerable persons, temperature control practices by promoting the use of insulated bags, safe meat thawing techniques, and the use of thermometers during cooking.

Characterizing the One Health workforce to promote interdisciplinary, multisectoral approaches in global health problem-solving.

BACKGROUND: In recognition of the interconnected nature of complex challenges such as COVID-19, a collaborative, multisectoral, and transdisciplinary approach, referred to as One Health, has been employed to address sustainable development and strengthen global health security. Although significant investments have been made to build global health capacity, characterization of the One Health is absent from the literature. METHODS AND FINDINGS: We collected and analyzed perspectives from students, graduates, workers, and employers in One Health through a multinational online survey across health disciplines and sectors. Respondents were recruited through professional networks. A total of 828 respondents from 66 countries participated, representing governmental and academic institutions and students, among others; 57% were female, and 56% had completed professional health degrees. Interpersonal communication, communication with non-scientific audiences, and the ability to work in transdisciplinary teams were valued in the workplace and were considered essential competencies to build an interdisciplinary health workforce. Employers indicated difficulty recruiting workers, while workers indicated limited availability of positions. Employers identified limited funding and ill-defined career pathways as prominent challenges for retaining One Health workers. CONCLUSIONS: Successful One Health workers use interpersonal skills and scientific knowledge to address complex health challenges. Aligning the definition of One Health will likely improve the matching of job seekers and employers. Encouraging the employment of the One Health approach for a diverse range of positions, even if they do not explicitly include "One Health" in the job title, and clarifying the expectations, roles and responsibilities within a transdisciplinary team will lead to building a stronger workforce. As One Health has evolved to address food insecurity, emerging diseases, and antimicrobial resistance, it holds promise for supporting an interdisciplinary global health workforce that can make substantial progress on Sustainable Development Goals and improve global health security for all.

Effects of seed treatments and storage duration on Myzus persicae (Hemiptera: Aphididae) and amaranth fresh leaf yield.

The green peach aphid, Myzus persicae (Sulzer) (Hemiptera: Aphididae), is a key insect pest of amaranth in East Africa. Pest management has been restricted to indiscriminate application of insecticides to foliage. Applying systemic insecticides to seeds has been shown to manage aphid infestations in other crop systems. We evaluated two commercially available seed treatments in East Africa, Apron Star (thiamethoxam 20 g/kg + metalaxyl-M 20 g/kg + difenoconazole 2 g/kg) and Menceron (imidacloprid 233 g/L + pencycuron 50 g/L + thiram 107 g/L) for their efficacy against M. persicae and impact on fresh leaf yield with two Amaranthus species, Amaranthus blitum (2 selections), Amaranthus hybridus (4 selections) and untreated control. Two storage periods (24 h and 3 months) with seed treatments were used. Each amaranth selection was treated individually with Apron and Monceren or untreated, and seeds were planted either 24 h or 3 months after treatment. Significant reduction in live aphids was observed with A. blitum and A. hybridus selections grown with seed treatment, at 6, 8 and 10 d after infestation (DAI) when compared with seeds grown without seed treatment. Untreated seeds of A. hybridus (selection 5) had significantly higher number of live aphids up to 243, greater percentage of damaged leaves and leaf damage score up to 84% and 64% respectively when compared with treated seeds of specific amaranth at 10 DAI. No significant difference was noted between seed treatment and storage time. Amaranth seeds treated with Monceren offered more protection against infestations of Myzus persicae than amaranth seeds treated with Apron under high tunnel experiments.

Implementing Competitive Bidding in the Medicare Program: An Expressway to Solvency.

The Medicare program faces increasing budgetary pressures, with recent estimates suggesting that the Medicare Hospital Insurance Trust will be insolvent as soon as 2028. Simultaneously, the Medicare Advantage (MA) program, a managed competition model, continues to grow its market penetration as beneficiaries increasingly choose private plans over traditional fee for service (FFS) Medicare. With the relative cost of the 2 forms of Medicare a subject of debate, policy experts have proposed a variety of policy options to address the program's budgetary pressures and place it on a firmer fiscal footing. This paper explores the implementation of one of these proposals in greater detail: fully transitioning the entire Medicare program to a competitive bidding model in order to reduce overall program costs and improve price competition. Current MA plan bidding methodology is explored, followed by a description of prior proposed competitive bidding models. Implementation challenges are addressed, along with specific policy considerations to protect beneficiaries who wish to remain in FFS Medicare.

Comparing spending across Medicare programs.

As Medicare Advantage increasingly becomes the dominant form of Medicare, meaningful and accurate comparisons with traditional fee-for-service Medicare will be increasingly important for both beneficiaries and policy makers. Recent debate among policy experts, government advisory bodies, and health plans highlights the need to create standardized comparison between the 2 Medicare programs. Supplemental benefits, Part B cost-sharing differences, and prescription drug benefits should be valued with a series of structured comparisons. Making this information transparent to beneficiaries through the plan finder would improve beneficiary decision-making. Finally, pragmatic comparisons would support policy makers in making improvements to Medicare Advantage program policy, undertaking comparative program evaluation, and engaging in Medigap plan oversight.

Health Insurance Coverage After the COVID-19 Public Health Emergency Ends.

This JAMA Forum discusses the potential ramifications after the COVID-19 public health emergency ends such as limiting telehealth, ending the continuous enrollment requirement in Medicaid, and decreasing regulatory flexibility that has allowed pharmacists to administer COVID-19 vaccines.

Evolution and expansion of the One Health approach to promote sustainable and resilient health and well-being: A call to action.

One Health is a transdisciplinary approach used to address complex concerns related to human, animal, plant, and ecosystem health. One Health frameworks and operational tools are available to support countries and communities, particularly for the prevention and control of zoonotic diseases and antimicrobial resistance and the protection of food safety. However, One Health has yet to be implemented in a manner that fully considers the complexities and interconnectedness of the diverse influences that have impacts at a larger system level. This lack of consideration can undermine the sustainability of any positive outcomes. To ensure the One Health approach can function effectively within the new global context of converging and escalating health, social, economic, and ecological crises, it must evolve and expand in three overlapping dimensions: (1) Scope: the partners, knowledge, and knowledge systems included, (2) Approach: the techniques, methodologies, and scholarship considered, and (3) Worldview inclusivity: the interweaving of other worldviews together with the mainstream scientific worldview that currently predominates. Diverse partners and knowledge from outside the mainstream health and scientific sectors, including Indigenous peoples and representatives of local communities, and traditionally generated knowledge, must be included. These systems of knowledge can then be braided together with mainstream science to comprise a holistic framework for decision-making. Scholarship and methodologies being applied in other fields and contexts to solve complex challenges and manage uncertainty, such as collaborative governance, social-ecologic systems theory, and complexity science, must be recognized and incorporated. The spectrum of considered worldviews must also expand to authentically integrate the expanded scope and approach into action and sustainable impact. By increasing community and social engagement and by recognizing and entwining different worldviews, the plurality of disciplines, and traditional and scientific ways of knowing to address community concerns in the contexts in which they exist, we can ensure that One Health remains effective and true to its paradigm in our rapidly changing and complex world.

Comparison of wrist watch type device (GT-103) and oscillometric device for blood pressure measurement following the AAMI/ESH/ISO standards

Background@#Cuffless devices have been studied and developed in the past and in recent years products that employ photoplethysmography became available in the market. However, the vast majority of available product’s accuracy have not yet been studied.@*Objective@#The main objective of this study was to compare a wristwatch device GT 103 to an oscillometric blood pressure device Omron HEM 7120 using the standards set by Association for the Advancement of Medical Instrumentation (AAMI) / The European Society of Hypertension (ESH) Working Group on Blood Pressure / International Organization for Standardization (ISO).@*Methods@#This is a cross sectional study involving blood pressure measurements of 85 individuals using the test device (GT 103) and the reference device (Omron HEM 7120). Demographic characteristics such as age, arm circumference, diagnosis of hypertension, and treatment status were also reported. Sequential blood pressure measurements followed the prescribed steps of AAMI/ESH/ ISO. Paired measurements were statistically treated using the Paired T test. Mean differences of the paired measurements are reported in mean±SD, and proportions of blood pressure differences at ±5mmHg, ±10mmHg, and ±15mmHg are also reported.@*Results@#The mean SBP difference of GT 103 and Omron 7120 was 1.5±20.5mmHg which is not significant (p=0.25) and mean DBP difference of 3±12.6 which is significant (p=0.00017). The result is in accordance with the criterion 1 of ANSI/AAMI/ISO 81060–2:2013 standard requirements (≤5±8 mmHg), but did not fulfil the criterion 2 which requires an SD of less than or equal to 6.47 for SBP and less than or equal to 6.90 mmHg for DBP. The proportion of paired blood pressure readings within ±5mmHg, ±10mmHg, and ±15mmHg were 19.61%, 36.08%, 45.1% for SBP and 30.98%, 56.07%, 69.8% for DBP. This shows that SBP and DBP measurements did not meet the requirement of AAMI/ESH/ISO.@*Conclusions and Recommendations@#This study showed that GT 103 did not fulfill the requirements for acceptable device accuracy. The use of the device for blood pressure measurement is still not recommended by the researcher. Future studies of other similar devices can be done to ensure accuracy of blood pressure measurement.

Inertial Cavitation Behaviors Induced by Nonlinear Focused Ultrasound Pulses.

Inertial cavitation induced by pulsed high-intensity focused ultrasound (pHIFU) has previously been shown to successfully permeabilize tumor tissue and enhance chemotherapeutic drug uptake. In addition to HIFU frequency, peak rarefactional pressure ( p- ), and pulse duration, the threshold for cavitation-induced bioeffects has recently been correlated with asymmetric distortion caused by nonlinear propagation, diffraction and formation of shocks in the focal waveform, and therefore with the transducer F -number. To connect previously observed bioeffects with bubble dynamics and their attendant physical mechanisms, the dependence of inertial cavitation behavior on shock formation was investigated in transparent agarose gel phantoms using high-speed photography and passive cavitation detection (PCD). Agarose phantoms with concentrations ranging from 1.5% to 5% were exposed to 1-ms pulses using three transducers of the same aperture but different focal distances ( F -numbers of 0.77, 1.02, and 1.52). Pulses had central frequencies of 1, 1.5, or 1.9 MHz and a range of p- at the focus varying within 1-18 MPa. Three distinct categories of bubble behavior were observed as the acoustic power increased: stationary near-spherical oscillation of individual bubbles, proliferation of multiple bubbles along the pHIFU beam axis, and fanned-out proliferation toward the transducer. Proliferating bubbles were only observed under strongly nonlinear or shock-forming conditions regardless of frequency, and only where the bubbles reached a certain threshold size range. In stiffer gels with higher agarose concentrations, the same pattern of cavitation behavior was observed, but the dimensions of proliferating clouds were smaller. These observations suggest mechanisms that may be involved in bubble proliferation: enhanced growth of bubbles under shock-forming conditions, subsequent shock scattering from the gel-bubble interface, causing an increase in the repetitive tension created by the acoustic wave, and the appearance of a new growing bubble in the proximal direction. Different behaviors corresponded to specific spectral characteristics in the PCD signals: broadband noise in all cases, narrow peaks of backscattered harmonics in the case of stationary bubbles, and broadened, shifted harmonic peaks in the case of proliferating bubbles. The shift in harmonic peaks can be interpreted as a Doppler shift from targets moving at speeds of up to 2 m/s, which correspond to the observed bubble proliferation speeds.

Health Costs And Financing: Challenges And Strategies For A New Administration.

It is likely that 2021 will be a dynamic year for US health care policy. There is pressing need and opportunity for health reform that helps achieve better access, affordability, and equity. In this commentary, which is part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2021 initiative, we draw on our collective backgrounds in health financing, delivery, and innovation to offer consensus-based policy recommendations focused on health costs and financing. We organize our recommendations around five policy priorities: expanding insurance coverage, accelerating the transition to value-based care, advancing home-based care, improving the affordability of drugs and other therapeutics, and developing a high-value workforce. Within each priority we provide recommendations for key elected officials and political appointees that could be used as starting points for evidence-based policy making that supports a more effective, efficient, and equitable health system in the US.