Insights into Chinese Canadian culture: enablers and barriers for fruit and vegetable intake.

Background: Fruits and vegetables (F&V) play a vital role in promoting health and preventing diseases. Numerous studies have demonstrated the association between F&V consumption and reduced risks of cardiovascular disease, cancer, and mortality. Despite the high priority of public health in promoting F&V intake, Chinese immigrants in Canada often fall below national guidelines in their consumption. Understanding the factors influencing F&V intake in this community is crucial for developing effective interventions. Methods: This study used an applied ethnographic research approach to gain insight into the enablers and barriers that influence F&V intake among Chinese-Canadian adults in Richmond, BC. Semi-structured interviews and 'photovoice' group sessions were conducted to gather qualitative data from community participants and health care providers (HCPs). Results: The research identified four key themes: (1) Cultural differences around how vegetables are perceived, consumed and prepared; (2) Motivators and strategies for increasing vegetable and fruit intake; (3) Lack of culturally relevant dietary education and resources; and (4) Importance of value in vegetable/fruit-related decisions. Participants showed a strong preference for the traditional Eastern diet, with cost of food and lack of knowledge about Western vegetables acting as barriers to dietary diversity. The study also highlighted the need for culturally tailored educational resources to effectively promote F&V consumption. Conclusion: By adopting a multi-modal approach, incorporating both interviews and 'photovoice' sessions, this research provided comprehensive insights into the participants' perspectives and experiences related to F&V intake. Understanding these factors can guide the development of culturally appropriate interventions to increase F&V consumption among Chinese-Canadian adults in Richmond, BC, and potentially improve their overall health and well-being. Future studies should consider the heterogeneity within the Chinese immigrant population and target a more balanced representation of age groups to further enhance our understanding of F&V intake patterns in this community.

Complement-dependent loss of inhibitory synapses on pyramidal neurons following Toxoplasma gondii infection.

The apicomplexan parasite Toxoplasma gondii has developed mechanisms to establish a central nervous system infection in virtually all warm-blooded animals. Acute T. gondii infection can cause neuroinflammation, encephalitis, and seizures. Meanwhile, studies in humans, nonhuman primates, and rodents have linked chronic T. gondii infection with altered behavior and increased risk for neuropsychiatric disorders, including schizophrenia. These observations and associations raise questions about how this parasitic infection may alter neural circuits. We previously demonstrated that T. gondii infection triggers the loss of inhibitory perisomatic synapses, a type of synapse whose dysfunction or loss has been linked to neurological and neuropsychiatric disorders. We showed that phagocytic cells (including microglia and infiltrating monocytes) contribute to the loss of these inhibitory synapses. Here, we show that these phagocytic cells specifically ensheath excitatory pyramidal neurons, leading to the preferential loss of perisomatic synapses on these neurons and not those on cortical interneurons. Moreover, we show that infection induces an increased expression of the complement C3 gene, including by populations of these excitatory neurons. Infecting C3-deficient mice with T. gondii revealed that C3 is required for the loss of perisomatic inhibitory synapses. Interestingly, loss of C1q did not prevent the loss of perisomatic synapses following infection. Together, these findings provide evidence that T. gondii induces changes in excitatory pyramidal neurons that trigger the selective removal of inhibitory perisomatic synapses and provide a role for a nonclassical complement pathway in the remodeling of inhibitory circuits in the infected brain.

Early neonatal hypoglycemia in exclusively breastfed babies in a developing country - India.

Background: Neonatal hypoglycemia has been a cause for concern due to increasingly frequent reports of long-term sequelae, leading to undue concern and inadvertent administration of formula feeds. Though hypoglycemia is usually encountered only in neonates with classical risk factors, hypoglycemia is also rarely seen even in babies with no known risk factors. These babies may present only with sequelae in later childhood. Methods: This is a hospital-based observational, prospective study. We included 299 exclusively breastfed neonates who were shifted to mother's side with no congenital malformation or need for neonatal intensive care unit (NICU) admission. The neonates were studied in two groups: " At Risk" and "No Risk." The "At Risk" group included babies with known risk factors like low birth weight, late preterm (34-36 weeks), small for gestational age (birth weight <10th centile), infant of a diabetic mother, or large for gestational age (birth weight >90th centile). Hypoglycemia was the primary outcome measured independent of feeding time for both groups. For the "At Risk" group, monitoring was done at 0, 1, 2, 3, 4, 12, 24 plus 48 h. For the "Not At Risk" group, it was done at 12 and 24 h of life. The factors associated with both groups were studies as the secondary outcome. Results and Conclusion: Out of 299 exclusively breastfed neonates, 13% were hypoglycemic. 27.06% were hypoglycemic in the "At Risk" group. In the "At Risk" group, low birth weight and primiparity were significant risk factors. The incidence of hypoglycemia in the "No Risk" group was 1.80%. Breast problems and breastfeeding problems, low education status of mother, young age, and primiparity were significant risk factors in the "No Risk" group.

Depression and Diabetes Distress in South Asian Adults Living in Low- and Middle-Income Countries: A Scoping Review.

OBJECTIVES: In this study, we conducted a scoping review to identify the prevalence of both depression and diabetes distress in patients with type 2 diabetes in low- and middle-income countries in South Asia. METHODS: This scoping review was grounded in the methodology of Arksey and O'Malley by searching for relevant studies using Ovid MEDLINE, PsycINFO and Cumulative Index of Nursing and Allied Health Literature databases, as well as grey literature sources and hand searches. Two reviewers independently screened and extracted data from articles that met the inclusion criteria. RESULTS: A total of 46 studies were included, with only 1 addressing both depression and diabetes distress. We present 42 total articles on depression and 5 on diabetes distress. The prevalence of type 2 diabetes and elevated depressive symptoms ranged from 11.6% to 67.5%, whereas the prevalence of diabetes distress ranged from 18.0% to 76.2%. CONCLUSIONS: The prevalence of elevated depressive symptoms was found to be much higher than that reported in data from high-income countries and in data on South Asians living in high-income countries. Diabetes distress was found to be lower compared with other studies; however, the scarcity of data makes this observation inconclusive. Variations in depression inventories, lack of culturally tailored inventories and the focus on urban clinic-based populations are identified as limitations and areas requiring further research. Our review provides evidence for the need of increased mental health screening and treatment in diabetes care in South Asian countries.

Artificial intelligence outperforms human students in conducting neurosurgical audits.

OBJECTIVES: Neurosurgical audits are an important part of improving the safety, efficiency and quality of care but require considerable resources, time, and funding. To that end, the advent of the Artificial Intelligence-based algorithms offered a novel, more economically viable solution. The aim of the study was to evaluate whether the algorithm can indeed outperform humans in that task. PATIENTS & METHODS: Forty-six human students were invited to inspect the clinical notes of 45 medical outliers on a neurosurgical ward. The aim of the task was to produce a report containing a quantitative analysis of the scale of the problem (e.g. time to discharge) and a qualitative list of suggestions on how to improve the patient flow, quality of care, and healthcare costs. The Artificial Intelligence-based Frideswide algorithm (FwA) was used to analyse the same dataset. RESULTS: The FwA produced 44 recommendations whilst human students reported an average of 3.89. The mean time to deliver the final report was 5.80 s for the FwA and 10.21 days for humans. The mean relative error for factual inaccuracy for humans was 14.75 % for total waiting times and 81.06 % for times between investigations. The report produced by the FwA was entirely factually correct. 13 out of 46 students submitted an unfinished audit, 3 out of 46 made an overdue submission. Thematic analysis revealed numerous internal contradictions of the recommendations given by human students. CONCLUSION: The AI-based algorithm can produce significantly more recommendations in shorter time. The audits conducted by the AI are more factually accurate (0 % error rate) and logically consistent (no thematic contradictions). This study shows that the algorithm can produce reliable neurosurgical audits for a fraction of the resources required to conduct it by human means.

Australasian recommendations for quality assurance in kilovoltage radiation therapy from the Kilovoltage Dosimetry Working Group of the Australasian College of Physical Scientists and Engineers in Medicine.

The Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) Radiation Oncology Specialty Group (ROSG) formed a series of working groups to develop recommendations for guidance of radiation oncology medical physics practice within the Australasian setting. These recommendations provide a standard for safe work practices and quality control. It is the responsibility of the medical physicist to ensure that locally available equipment and procedures are sufficiently sensitive to establish compliance. The recommendations are endorsed by the ROSG, have been subject to independent expert reviews and have also been approved by the ACPSEM Council. For the Australian audience, these recommendations should be read in conjunction with the Tripartite Radiation Oncology Practice Standards and should be read in conjunction with relevant national, state or territory legislation which take precedence over the ACPSEM publication Radiation Oncology Reform Implementation Committee (RORIC) Quality Working Group, RANZCR, 2011a; Kron et al. Clin Oncol 27(6):325-329, 2015; Radiation Oncology Reform Implementation Committee (RORIC) Quality Working Group, RANZCR, 2018a, b).

In vivo dosimetric impact of breast tissue expanders on post-mastectomy radiotherapy.

INTRODUCTION: Temporary tissue expanders with metallic ports for gradual saline injection are increasingly employed to facilitate breast reconstruction after post-mastectomy radiotherapy (PMRT). Treatment beams therefore pass through a high-density rare-earth magnet. Measurements ex vivo suggest attenuation of dose to the skin and chest wall at clinical risk of relapse. The purpose of the study was to quantify the resulting dose reduction in vivo, compared with treatment planning system (TPS). METHODS: Sixteen patients receiving PMRT had in vivo dosimetry prospectively performed with ethics board approval. Port was located within the expanded chest wall using the planning CT scan. Strips of radiochromic film were laid on the skin surface underneath the bolus. To aid interpretation, ex vivo measurements were also performed, including comparison with TPS predictions. RESULTS: An average 7% reduction in dose to skin surface was measured in 15 of 16 patients. This was reproducibly located in the 'shadow' of the magnet, corresponding to each of the paths of the medial and lateral tangents. The average area was 1.07 cm(2) (range 0.39 cm(2) to 2.36 cm(2)). Ex vivo measurements confirmed attenuation of the beam in the shadow of the port. The surface area of the 'cold-spot' varied with angle of the beam relative to the metallic port. Dose attenuation in vivo differed from that predicted by the TPS. CONCLUSION: Dose is attenuated in the 'shadow' of the tissue expander port in patients receiving PMRT. This is likely to be clinically insignificant for most, but centres should undertake appropriate measurements before utilising TPS predictions.

A study on the use of Gafchromic™ EBT3 film for output factor measurements in kilovoltage X-ray beams.

Relative output factors are used in radiation therapy for treatment planning purposes including treatments using kilovoltage X-ray beams. The output factor is the relative dose output for a particular applicator relative to a reference applicator. Due to the differences in the scatter contribution from the inside of an applicator, it is more accurate if output factors are measured for all combinations of X-ray beam energy and applicator. Previously published papers and various kilovoltage X-ray beam dosimetry protocols have discussed the validity of using various cylindrical and parallel plate ionization chambers for relative output factor measurements. In this work, we evaluated the suitability of Gafchromic™ EBT3 film for the determination of output factors for kilovoltage X-ray beams. Output factors were measured with Gafchromic™ EBT3 film for beam qualities of 50, 75, 100 and 125 kVp and applicator sizes of 2, 3, 4 cm diameter, 8 × 8 and 12 × 12 cm(2) square applicators. The film read out was performed with a flatbed EPSON Expression 10000XL scanner. The measured data was compared with benchmark data from measurements using an Advanced Markus ionisation chamber as well as comparing with ratios of published backscatter factor values. The agreement between output factors measured with EBT3 film and the ionisation chamber was generally better than 2 %, with the largest difference of 3.3 % occurring for the 2 cm diameter field with the 50 kVp X-ray beam. These differences were consistent with the estimated total uncertainty in the measurements as calculated by the ISO GUM. The agreement between the output factors measured with film and the published BSFs was generally better than 5 % but differences of up to 12 % occurred for the smallest field size. The results demonstrate that Gafchromic™ EBT3 film is a suitable dosimeter for output factor measurements of kilovoltage X-ray beams.