Dietary assessment can be based on pattern recognition rather than recall.

Diet is the leading predictor of health status, including all-cause mortality, in the modern world, yet is rarely measured; whereas virtually every adult in a developed country knows their approximate blood pressure, hardly any knows their objective diet quality. Leading authorities have called for the inclusion of nutrition in every electronic health record as one of the many remedial steps required to give dietary quality the routine attention it warrants. Existing tools to capture dietary intake are based on either real-time journaling or recall. Journaling, or logging, is time and labor intensive. Recall is notoriously unreliable, as humans are notably bad at remembering detail. Even allowing for the challenge of recall, these dietary intake methods are labor and time intensive, and require analysis at the n-of-1 level. We hypothesize that dietary intake assessment can be "reverse engineered"-predicating assessment on the recognition of fully formed dietary patterns-rather than endeavoring to assemble such a representation one food, meal, dish, or day at a time. This pattern recognition-based method offers potential advantages over existing methods, including speed, efficiency, cost, and applicability. We have developed and provisionally tested such a system, and the results thus far support our hypothesis. We are convinced that leveraging pattern recognition to make dietary assessment quick, user-friendly, economical, and scalable can allow for the conversion of dietary quality into a universally measured and routinely managed vital sign. In this paper, we present the supporting case.

Associations between asthma trigger reports, mental health conditions, and asthma morbidity among world trade center rescue and recovery workers.

Aim: There is limited information regarding asthma triggers in World Trade Center (WTC) rescue and recovery workers (RRW) or how mental health conditions affect the perception of triggers. Methods: We included 372 WTC workers with asthma. The Asthma Trigger Inventory (ATI) assessed triggers along five domains: psychological, allergens, physical activity, infection, and pollution. We administered the Structured Clinical Interview to diagnose post-traumatic stress disorder (PTSD), major depression and panic disorder (PD). The Asthma Control Questionnaire (ACQ) and Mini Asthma Quality of Life Questionnaire (AQLQ) measured asthma control and quality of life, respectively. Linear regression models were fitted to examine the association of ATI total and subdomain scores with mental health conditions as well as the percent of ACQ and AQLQ variance explained by ATI subscales. Results: The most common triggers were air pollution (75%) and general allergens (68%). PTSD was significantly associated with psychological triggers (partial r2=0.05, p < 0.01), physical activity (partial r2=0.03, p < 0.01) and air pollution (partial r2=0.02, p = 0.04) subscales while PD was significantly associated with air pollution (partial r2=0.03, p = 0.03) and general allergens (partial r2=0.02, p = 0.03). ATI subscales explained a large percentage of variance in asthma control (r2=0.37, p < 0.01) and quality of life scores (r2=0.40, p < 0.01). Psychological subscale scores explained the largest portion of the total variability in ACQ (partial r2= 0.11, p = 0.72) and AQLQ (partial r2=0.14, p = 0.64) scores. Conclusion: RRW with mental health conditions reported more asthma triggers and these triggers were associated with asthma morbidity. These data can help support interventions in RRW with asthma.

Early versus delayed closure of bladder exstrophy: A National Surgical Quality Improvement Program Pediatric analysis.

INTRODUCTION: Delayed closure of bladder exstrophy has become more popular; however, there is limited the evidence of its success. Existing literature focuses on intermediate and long-term outcomes, and short-term postoperative outcomes are limited by the small number of cases and varying follow-up methods. OBJECTIVE: The objectives of the current study were to: 1) compare 30-day complications after early and delayed closure of bladder exstrophy, and 2) evaluate practice patterns of bladder exstrophy closure. STUDY DESIGN: The National Surgical Quality Improvement Program Pediatric (NSQIPP) database from 2012 to 2015 was reviewed for all cases of bladder exstrophy closure. Early closure was defined as surgery at age 0-3 days, and delayed closure was defined as age 4-120 days at time of surgery. Demographic, clinical, and peri-operative characteristics were collected, as were postoperative complications, readmissions, and re-operations up to 30 days. Descriptive statistics were performed, and multivariate linear and logistic regression analyses were performed for salient complications. RESULTS: Of 128 patients undergoing bladder exstrophy closure, 62 were included for analysis, with 44 (71%) undergoing delayed closure. Mean anesthesia and operative times were greater in the delayed closure group, and were associated with more concurrent procedures, including inguinal hernia repairs and osteotomies. The delayed closure group had a higher proportion of 30-day complications, due to a high rate of blood transfusion (57% vs 11%). Wound dehiscence occurred in 6/44 (14%) delayed closures, as compared with 0/18 (0%) early closures. When compared with prior published reports of national data from 1999 to 2010, delayed closure was performed more frequently in this cohort (71% vs 27%). DISCUSSION: The NSQIPP provides standardized reporting of peri-operative characteristics and 30-day complications, allowing a comparison of early to delayed closure of bladder exstrophy across multiple institutions. Assessing short-term risks in conjunction with long-term follow-up is crucial for determining optimal management of this rare but complex condition. CONCLUSION: Delayed closure of bladder exstrophy is performed frequently, yet it carries a high rate of 30-day complications worthy of further investigation. This can be useful in counseling patients and families, and to understand practice patterns across the country.

Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers.

OBJECTIVE: Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. METHODS: Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. RESULTS: Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). CONCLUSIONS: There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.

Impact of Community Interventions on the Social Representation of Depression in Rural Gujarat.

There is a pressing need to develop community interventions that will address stigma against mental illness in rural India. This cross-sectional study will compare social representations of depression in villages where educational programs have targeted mental illness and stigma versus control villages. Participants from the villages exposed to the educational interventions (n = 146) will be compared with a sample from six control villages (n = 187) in the same geographic region, using a structured questionnaire. The impact of the intervention as a predictor for questionnaire score will be assessed along with socio-demographic variables. The intervention villages showed higher levels of literacy regarding depression and lower levels of stigma, after adjusting for all other socio-demographic variables. While some demographic factors associated with the knowledge and attitudes towards depression are not modifiable, our research provides evidence in favor of the positive influence a community grassroots intervention can have on mental health literacy in rural settings.

Trajectories of PTSD risk and resilience in World Trade Center responders: an 8-year prospective cohort study.

BACKGROUND: Longitudinal symptoms of post-traumatic stress disorder (PTSD) are often characterized by heterogeneous trajectories, which may have unique pre-, peri- and post-trauma risk and protective factors. To date, however, no study has evaluated the nature and determinants of predominant trajectories of PTSD symptoms in World Trade Center (WTC) responders. METHOD: A total of 10835 WTC responders, including 4035 professional police responders and 6800 non-traditional responders (e.g. construction workers) who participated in the WTC Health Program (WTC-HP), were evaluated an average of 3, 6 and 8 years after the WTC attacks. RESULTS: Among police responders, longitudinal PTSD symptoms were best characterized by four classes, with the majority (77.8%) in a resistant/resilient trajectory and the remainder exhibiting chronic (5.3%), recovering (8.4%) or delayed-onset (8.5%) symptom trajectories. Among non-traditional responders, a six-class solution was optimal, with fewer responders in a resistant/resilient trajectory (58.0%) and the remainder exhibiting recovering (12.3%), severe chronic (9.5%), subsyndromal increasing (7.3%), delayed-onset (6.7%) and moderate chronic (6.2%) trajectories. Prior psychiatric history, Hispanic ethnicity, severity of WTC exposure and WTC-related medical conditions were most strongly associated with symptomatic trajectories of PTSD symptoms in both groups of responders, whereas greater education and family and work support while working at the WTC site were protective against several of these trajectories. CONCLUSIONS: Trajectories of PTSD symptoms in WTC responders are heterogeneous and associated uniquely with pre-, peri- and post-trauma risk and protective factors. Police responders were more likely than non-traditional responders to exhibit a resistant/resilient trajectory. These results underscore the importance of prevention, screening and treatment efforts that target high-risk disaster responders, particularly those with prior psychiatric history, high levels of trauma exposure and work-related medical morbidities.

The behavior patterns of abused children as described in their testimonies.

The aim of the current study is to identify how children describe their behavior during abuse and to explore their behavior further with respect to the type of the abuse (physical or sexual), frequency of abuse (single or multiple incidents), familiarity with the suspect, and children's age and gender, with the assumption that this information may have a significant effect on the children's recovery process. The study involved 224 transcripts of interviews with alleged victims aged 5-14 in Israel. The sample was randomly selected from all of the forensic investigations with children that were conducted in Israel in 2011. The results show that abuse type has a strong effect on children's behavior, with children in the sexual abuse group reporting more fight and flight behavior and children in the physical abuse group reporting more self-change behavior. This finding was interacted with the severity of abuse variable, with children in the sexual abuse group reporting less flight behavior and an increase in the self-change behavior with the highest level of severity of abuse (touch under the clothes and penetration). Investigative interviews with children can be a significant source of information for practitioners within the clinical context. The current study stresses the consequences that abuse can have on children's behavior during these incidents and the implications for the therapy process with the children.

Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders.

BACKGROUND: Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations. METHOD: Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11. RESULTS: CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time. CONCLUSIONS: Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.

Clinical implication of lung fluid balance in the perinatal period.

At birth, lung fluid produced during fetal life must be cleared immediately and efficiently before the first breath takes place, in order for infants to achieve a normal and successful transition from prenatal to postnatal life. Postnatal lung fluid resorption is mediated through activation of airway epithelial sodium channels (ENaC). The observation that ENaC expression is a gestational age-dependent process contributes to our understanding of the development of respiratory distress in both term and preterm infants due to impaired clearing of fluid from their lungs. As fluid absorption, mediated by ENaC activity, in postnatal life has a significant biological role in preventing respiratory distress, any strategy that enhances ENaC activity can potentially help to decrease its incidence and associated morbidity.

Insights into the structure and protein-protein interactions of the pro-apoptotic protein ASPP2.

ASPP (apoptosis-stimulating protein of p53) 2 is a pro-apoptotic protein that stimulates the p53-mediated apoptotic response. Here, we provide an overview of the structure and protein-protein interactions of ASPP2. The C-terminus of ASPP2 contains Ank (ankyrin) repeats and an SH3 domain (Src homology 3 domain). The Ank-SH3 domains mediate interactions between ASPP2 and numerous proteins involved in apoptosis such as p53 and Bcl-2. The proline-rich domain of ASPP2 is unfolded in its native state, but was not shown to mediate intermolecular interactions. Instead, it makes an intramolecular domain-domain interaction with the Ank-SH3 C-terminal domains of ASPP2. This intramolecular interaction between the unstructured proline-rich domain and the structured Ank-SH3 domains in ASPP2, which is possible due to the unfolded nature of the proline-rich domain, is proposed to have an important role in regulating the intermolecular interactions of ASPP2 with its partner proteins.

Field measurements and modeling of dilution in the wake of a US navy frigate.

A field measurement and computer modeling effort was made to assess the dilution field of pulped waste materials discharged into the wake of a US Navy frigate. Pulped paper and fluorescein dye were discharged from the frigate's pulper at known rates. The subsequent particle and dye concentration field was then measured throughout the wake by a following vessel using multiple independent measures. Minimum dilution of the pulped paper reached 3.2 x 10(5) within 1900 m behind the frigate, or about 8 min after discharge. Independent measures typically agreed within 25% of one another and within 20% of model predictions. Minimum dilution of dye reached 2.3 x 10(5) at a down-wake distance of approximately 3500 m, or roughly 15 min. Comparison to model measurements were again within 20%. The field test was not only successful at characterizing wake dilution under one set of at-sea conditions, but was successful at validating the computer model used for assessing a wide range of ships and conditions.

Determinación de límites de vuelco de efluentes líquidos para Mar del Plata

La ciudad de Mar del Plata posee un ecosistema cuyas características difieren notablemente de otras ciudades de la provincia, por lo que es fundamental la obtención de límites locales. Este trabajo tiene como objetivo la actualización de los límites de vuelco vigentes para efluentes líquidos a colectora cloacal, establecidos por Resolución Provincial y Municipal. Para esto, se analizó la afectación del mar y del sistema cloacal por el vuelco de efluentes industriales, utilizando información propia. Los resultados obtenidos fueron consensuados posteriormente en un Foro Público

Short term citrus flavonoid supplementation of type II diabetic women: no effect on lipoprotein oxidation tendencies.

Flavonoids, which are dietary components and have possible drug uses, inhibit lipoprotein oxidation in vitro. The present study considered whether flavonoid supplementation in humans could influence lipoprotein vulnerability to oxidation. Citrus flavonoid supplementation (about 1g/day, 3 weeks), or placebo, was given to 40 Type II diabetic women, a population prone to oxidative stress. Absorbance spectra of plasma from 4 subjects revealed that some flavonoid absorption occurred. When tested in vitro, a supplement extract, with spectrum peak height similar to that of plasma samples, completely inhibited copper-induced oxidation of very low plus low density lipoproteins. In contrast, neither flavonoid supplementation nor placebo influenced lipoprotein susceptibility to copper-stimulated oxidation in vitro (lag time or propagation rate). Thus, this study demonstrated that increased flavonoid consumption by humans does not necessarily alter lipoprotein susceptibility to oxidation assessed in vitro.

Group-therapy of couples after breast cancer diagnosis: experimental pilot study.

Cancer is a family affair. Clinical work and research studies have shown that cancer affects the entire family and that spouses especially are often highly distressed. Breast cancer has a special importance for a couple. It is convenient to help the patient and her husband together. In the first six months especially psychooncological intervention seems to be necessary. Psychotherapy of groups of couples has shown benefits in their improved ability to talk to one another, especially using social learning by a model (e.g. A. Bandura et al). Less helplessness and more acceptance of support from outside are further effects. Moreover, this form of intervention has economic benefits due to the amount of time needed and reduced costs in comparison with individual therapy.

Defining the physician's duty to warn: consensus statement of Ontario's Medical Expert Panel on Duty to Inform.

Ontario's Medical Expert Panel on Duty to Inform was formed to consider the duty of Ontario physicians in circumstances where a patient threatens to kill or cause serious bodily harm to a third party. The panel was concerned about the implications of any duty to inform on the integrity of the physician-patient relationship, particularly with respect to confidentiality. The panel agreed that regulations safeguarding the confidentiality of patient information ought to be changed only if there is a critical reason for doing so, but, after deliberation, the panel members concluded that the need to protect the public from serious risk of harm is a paramount concern that should supersede the duty of confidentiality. The recommendations reported here were endorsed in principle by the panelists and the groups they represented (the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Protective Association, the College of Physicians and Surgeons of Ontario, the Ontario College of Family Physicians and the Ontario Medical Association) and are being implemented by the College of Physicians and Surgeons of Ontario.

Short-term zinc supplementation in women with non-insulin-dependent diabetes mellitus: effects on plasma 5'-nucleotidase activities, insulin-like growth factor I concentrations, and lipoprotein oxidation rates in vitro.

Non-insulin-dependent diabetes mellitus (NIDDM) may cause vulnerability to moderate zinc deficiency. In this study, short-term zinc supplementation (30 mg/d as amino acid chelate for 3 wk) elevated plasma zinc and activities of 5'-nucleotidase, a zinc-dependant enzyme, in 20 postmenopausal women with NIDDM. Placebo, given to 20 other women with NIDDM, had no effects on these indexes nor on any others taken in this study. Although zinc supplementation doubled the mean value for 5'-nucleotidase activity, values were still significantly lower than those of age-matched control subjects. Plasma insulin-like growth factor I concentrations increased with zinc treatment if starting concentrations were < 165 microg/L but were unchanged if they were > 165 microg/L. Lipoprotein oxidation in vitro, which has abnormal lag times and propagation rates for subjects with NIDDM and for moderately zinc-deficient rats, were unchanged by zinc supplementation. Possibly, this lack of effect occurred because the zinc treatment did not normalize zinc status. In conclusion, this study supports the contention that moderate zinc deficiency occurs frequently in subjects with NIDDM.