Comparing in-person, blended and virtual training interventions; a real-world evaluation of HIV capacity building programs in 16 countries in sub-Saharan Africa.

We sought to evaluate the impact of transitioning a multi-country HIV training program from in-person to online by comparing digital training approaches implemented during the pandemic with in-person approaches employed before COVID-19. We evaluated mean changes in pre-and post-course knowledge scores and self-reported confidence scores for learners who participated in (1) in-person workshops (between October 2019 and March 2020), (2) entirely asynchronous, Virtual Workshops [VW] (between May 2021 and January 2022), and (3) a blended Online Course [OC] (between May 2021 and January 2022) across 16 SSA countries. Learning objectives and evaluation tools were the same for all three groups. Across 16 SSA countries, 3023 participants enrolled in the in-person course, 2193 learners participated in the virtual workshop, and 527 in the online course. The proportions of women who participated in the VW and OC were greater than the proportion who participated in the in-person course (60.1% and 63.6%, p<0.001). Nursing and midwives constituted the largest learner group overall (1145 [37.9%] vs. 949 [43.3%] vs. 107 [20.5%]). Across all domains of HIV knowledge and self-perceived confidence, there was a mean increase between pre- and post-course assessments, regardless of how training was delivered. The greatest percent increase in knowledge scores was among those participating in the in-person course compared to VW or OC formats (13.6% increase vs. 6.0% and 7.6%, p<0.001). Gains in self-reported confidence were greater among learners who participated in the in-person course compared to VW or OC formats, regardless of training level (p<0.001) or professional cadre (p<0.001). In this multi-country capacity HIV training program, in-person, online synchronous, and blended synchronous/asynchronous strategies were effective means of training learners from diverse clinical settings. Online learning approaches facilitated participation from more women and more diverse cadres. However, gains in knowledge and clinical confidence were greater among those participating in in-person learning programs.

Assessing Testing Strategies and Duration of Quarantine in Contact Tracing for SARS-CoV-2: A Retrospective Study of San Francisco's COVID-19 Contact Tracing Program, June-August 2020.

We sought to assess the proportion of elicited close contacts diagnosed with coronavirus disease 2019 at the start of and before exiting quarantine in San Francisco. From June 8 to August 31, 6946 contacts were identified: 3008 (46.3%) were tested, 940 (13.5%) tested positive, and 90% tested positive in the first 9 days of quarantine.

Relation between dietary intake, serum concentrations, and retinal concentrations of lutein and zeaxanthin in adults in a Midwest population.

BACKGROUND: Information on concentrations of retinal carotenoids (macular pigment, or MP) is of particular interest because MP protects against age-related macular degeneration, the leading cause of irreversible blindness in the United States. OBJECTIVE: This study was designed to evaluate the relation between dietary intake, blood concentrations, and retinal concentrations of carotenoids in a large group of volunteers. DESIGN: Two hundred eighty volunteers in the Indianapolis area completed health and diet questionnaires, donated a blood sample, and participated in MP density assessment to determine retinal carotenoid status. Dietary intake was assessed by food-frequency questionnaire. Serum concentrations of lutein, zeaxanthin, and beta-carotene were measured by HPLC. MP optical density (MPOD) was determined psychophysically with a 460-nm, 1 degrees test stimulus. RESULTS: Average MPOD was 0.21 +/- 0.13. Average intakes of lutein + zeaxanthin and beta-carotene were 1101 +/- 838 and 2935 +/- 2698 microg/d, respectively. Although several key dietary intake variables (eg, lutein + zeaxanthin and beta-carotene) differed by sex, no significant sex differences were found in either serum concentrations of lutein and zeaxanthin or MPOD. Serum beta-carotene concentrations were significantly higher in women than in men. Serum lutein + zeaxanthin and dietary intake of lutein + zeaxanthin were significantly correlated and significantly related to variations in MPOD (r = 0.21, P < 0.001, and r = 0.25, P < 0.001, respectively). CONCLUSIONS: Retinal carotenoids can be measured in epidemiologic studies. In this study, MPOD was associated with lutein + zeaxanthin in the diet and the serum. Retinal concentrations, however, were influenced by other factors as well. To understand the effect of dietary lutein + zeaxanthin intake on the retina and risk of age-related eye disease, future studies should include measures of macular concentrations of these pigments.

Carotenoids in the retina and lens: possible acute and chronic effects on human visual performance.

(MP) that is composed of the hydroxy-carotenoids lutein and zeaxanthin. Although it appears that all humans have some quantity of these pigments within their retina, foveal concentrations tend to vary quite dramatically. This wide individual variability has prompted questions regarding possible functional consequences. At least two major nonexclusive hypotheses regarding the function of MP have been proposed. The "protection hypothesis" has received the most attention and is based on the possibility that MP could reduce the cumulative effects of damage due to light and oxygen and retard the development of age-related eye disease. The "acuity hypothesis" states that MP could improve visual resolution by absorbing short-wave light, which is easily scattered and poorly focused. In this article, we review evidence that lutein and zeaxanthin could improve human visual performance through both acute optical effects at the site of the retina and by maintaining health and functional integrity of the retina and crystalline lens.

Olestra consumption is not associated with macular pigment optical density in a cross-sectional volunteer sample in Indianapolis.

The associations between the intake of the fat-substitute olestra and the concentrations of macular carotenoid pigments and serum lutein and zeaxanthin were investigated in a volunteer cross-sectional sample in Indianapolis. The study was conducted in January through March, 1998 after olestra-containing savory snacks had been sold in central Indiana for a year. Volunteers (n = 280) aged 18-50 y were recruited to make a single clinic visit during which macular pigment optical density (MPOD) was determined by psychophysical flicker photometry, serum was obtained for determination of lutein and zeaxanthin concentration, usual intake of olestra, carotenoids and nutrients were assessed by 1-y food frequency questionnaire, and health habits including smoking, physical characteristics such as eye color, demographics and medical history were determined by questionnaire. Intake of olestra at least one time per month for the past year was reported by 81:280 subjects and their mean, median and 90(th) percentile intakes were 1.09, 0.34 and 2.43 g olestra/d, respectively. Mean macular pigment optical density was not significantly different between olestra consumers and nonconsumers (0.213 +/- 0.014 vs. 0.211 +/- 0.010) nor was serum lutein and zeaxanthin concentration (0.361 +/- 0.017 vs. 0.375 +/- 0. 013 micromol/L) or intake (1242 +/- 103 mg/d vs. 1042 +/- 58 mg/d) in one-way or two-way ANOVA. Olestra intake was not associated with MPOD or serum lutein and zeaxanthin before or after correction for significant covariates of MPOD. Thus, olestra intake over the past year in a cross-sectional volunteer sample in Indianapolis was not associated with MPOD.

The effects of hormone replacement therapy on antithrombin III and protein C levels in menopausal women.

OBJECTIVE: To determine if menopausal women taking estrogen with and without progestin are at increased risk for thrombotic disease as evidenced by decreased levels of antithrombin III and protein C. DESIGN: A case controlled study. SETTING: General community in southeastern New Hampshire. PARTICIPANTS: One hundred seventy-one healthy women aged 38 to 65 years. Women were defined as premenopausal if follicle stimulating hormone levels were < 40 mIU/ml and menopausal if follicle stimulating hormone levels were > 40 mIU/ml. Menopausal women were subdivided according to hormone replacement therapy status; women not taking estrogen or progestin, and women taking estrogen with and without progestin for at least 1 year. MAIN OUTCOME MEASURES: Significant differences in antithrombin III and protein C levels. RESULTS: Premenopausal women had significantly less antithrombin III than menopausal women not taking hormone replacement therapy. Premenopausal women had significantly less protein C than menopausal women taking estrogen for at least 1 year with and without progestin. CONCLUSION: Estrogen taken for at least 1 year with and without progestin by menopausal women will not increase the risk of thrombotic disease by lowering the levels of antithrombin III or protein C. On the contrary, estrogen is associated with an increase in circulating levels of protein C in menopausal women, and could create a protective effect not seen in premenopausal women or menopausal women not taking estrogen therapy.

Nutritional management of eating disorders.

Abnormal nutritional status and dietary patterns are central features of the eating disorders. Normalization of these features are key components of treatment and recovery because they are powerful perpetuating factors. Restrictive diets, fat avoidance, and abnormal cognitive and perceptual patterns are typically present, in addition to altered nutritional parameters because of hormonal and metabolic factors. The primary goal of nutrition intervention in the patient with anorexia nervosa is to promote weight gain through increased energy intake, expansion of the diet, and knowledgeable and empathetic dietary counseling. A regular pattern of nutritionally balanced, planned meals and snacks, and the avoidance of restrictive dieting, are essential elements of treatment for the patient with bulimia nervosa. As a member of the multidisciplinary treatment team, the dietitian or nutrition professional with knowledge of nutritional science, counseling skills, and a nonjudgmental attitude can provide expertise in this area.

Sex differences in macular pigment optical density: relation to plasma carotenoid concentrations and dietary patterns.

Sex differences in macular pigment (MP) optical density (measured psychophysically) were examined. Concentrations of lutein and zeaxanthin (L and Z) (non-separated) and beta-carotene (BC) in the blood were determined using reverse phase high-performance liquid chromatography. Dietary intake of L and Z, BC, fat, and iron were estimated by questionnaire. Males had 38% higher MP density than females (P < 0.001) despite similar plasma carotenoid concentrations and similar dietary intake (except for fat). Dietary intake of carotenoids, fat and iron, as well as plasma concentrations of L and Z were positively related to MP density in males. Conversely, only plasma L and Z was related to MP density for females, and dietary fat was negatively related to MP density. Sex differences in protection of the retina by MP and in the relationship between the retina, blood and diet could be a factor in the incidence of retinal diseases, especially age-related macular degeneration.

The lack of effect of beta-carotene on restenosis in cholesterol-fed rabbits.

The success of percutaneous transluminal coronary angioplasty is limited by restenosis in 30-50% of cases. Cellular production of reactive oxygen species at the site of injury has been implicated as a contributing factor in the process of restenosis. beta-Carotene is a lipid-soluble antioxidant whose effects on this process have not been previously investigated. We attempted to elucidate whether beta-carotene treatment was capable of reducing restenosis. Femoral artery stenoses were produced by nitrogen-desiccation in rabbits fed a high-cholesterol diet. The animals were randomized to receive either a parenteral bolus of beta-carotene immediately prior to angioplasty, followed by 5 days of subcutaneous treatment (Acute Treatment); 5 days of subcutaneous pretreatment with beta-carotene followed by a parenteral bolus immediately prior to angioplasty and then another 5 days of subcutaneous treatment (Pretreatment); or vehicle only (Control). Angiography was performed immediately before and after angioplasty, and 28 days after angioplasty. The animals were then sacrificed, and the femoral arteries were harvested for histopathology. By quantitative angiography, the late loss of luminal diameter between angioplasty and final angiography was not significantly different between the acute treatment group, the pretreatment group and the control group. By histopathology, the area of intimal hyperplasia and the percent cross-sectional area stenosis were also not significantly different. The late loss in luminal diameter after angioplasty correlated significantly with the acute gain in luminal diameter produced by angioplasty. The amount of intimal hyperplasia correlated significantly with the arterial injury score assessed by histopathology. In summary, in this animal model of restenosis, parenteral beta-carotene failed to significantly reduce the amount of either intimal hyperplasia or late loss in luminal diameter after angioplasty.

The 1994 Northridge earthquake disaster response: the local emergency medical services agency experience.

INTRODUCTION: This paper describes the 1994 Northridge earthquake experience of the local emergency medical services (EMS) agency. Discussed are means that should improve future local agency disaster responses. METHODS: Data reported are descriptive and were collected from multiple independent sources, and can be reviewed publicly and confirmed. Validated data collected during the disaster by the Local EMS Agency also are reported. RESULTS: The experience of the Los Angeles County EMS Agency was similar to that of earthquake disasters previously reported. Communication systems, water, food, shelter, sanitation means, power sources, and medical supplies were resources needed early in the disaster. Urban Search and Rescue Teams and Disaster Medical Assistance Teams were important elements in the response to the Northridge earthquake. The acute phase of the disaster ended within 48 to 72 hours and public health then became the predominant health-care issue. Locating community food and water supplies near shelters, providing transportation to medical care, and public-health visits to shelter locations helped prevent the development of long-term park encampments. An incident command system for the field, hospitals, and government responders was necessary for an organized response to the disaster. CONCLUSION: Disaster preparedness, multiple forms of reliable communication, rapid mobilization of resources, and knowledge of available state and federal resources are necessary for a disaster response by a local EMS agency.

Macular pigment density in monozygotic twins.

PURPOSE: Research shows wide variation in macular pigment density between individuals. As are other ocular pigments, this variation may be genetic. To test this hypothesis, the authors measured macular pigment density, serum carotenoid concentrations, and general dietary patterns in 10 pairs of identical twins. METHODS: Macular pigment was measured psychophysically by a 1 degree test stimulus. Foveal and parafoveal sensitivities to 460-nm and 530-nm light were compared. Determining the difference in log sensitivity to the 460-nm light for the fovea (where macular pigment is most dense) and the parafovea (where macular pigment is optically immeasurable), after normalizing with respect to 530 nm, yields a measurement of the optical density of macular pigment. Concentrations of carotenoids within the serum were measured using reverse-phase, high-performance liquid chromatography. Dietary patterns were determined using a food-frequency questionnaire. RESULTS: Statistically significant differences in macular pigment optical density were found for 5 of the 10 twin pairs. For these five pairs, differences in macular pigment density were moderately related to differences in the intake of dietary fat, iron, linoleic and oleic acid, fiber, and total calories (P < 0.10, individually; P < 0.05, for an equally weighted composite of these variables). There was no significant relationship, however, found between macular pigment density and carotenoids in the blood and diet. CONCLUSIONS: Given the putative protective role of macular pigment, variations in macular pigment density may have clinical significance. The conclusion that macular pigment is not completely determined genetically allows the possibility that macular pigment density may be modified for the protective purposes. The current data suggest that dietary fat, iron, and fiber may influence macular pigment levels (perhaps through their influence on carotenoid metabolism). These data suggest that the eventual deposition of macular pigment in the retina is complex and probably is influenced by a number of variables.

Multiphasic desensitization of the GABAA receptor in outside-out patches.

GABAA receptor function was studied in outside-out patches from guinea pig hippocampal neurons using a drug application system with an exchange time of under 1.5 ms. Application of GABA to these patches induced a Cl- conductance that desensitized with prolonged exposure. Increasing GABA concentrations induced larger conductance increases that were associated with more complex patterns of desensitization. Smaller GABA responses desensitized with monophasic kinetics, whereas large responses displayed bi- and triphasic kinetics. Desensitization of the response to 1 mM GABA was triphasic in about 70% of the patches (tau = 15.4, 207, and 1370 ms) and biphasic in about 30% of the patches (tau = 44 and 725 ms). All phases of desensitization reversed at the Cl- equilibrium potential. Over the concentration range from 3 microM to 3 mM, both the rate and the extent of desensitization increased; however, complete desensitization was rarely observed. The increase in desensitization rate was due to an increase in the relative contribution of the faster phases with increasing GABA. The time constants of the three phases were independent of concentration. The different phases are not mediated by separate receptor populations, because double pulse experiments demonstrated interconversion among the fastest phase and the two slower phases. We demonstrate the plausibility of a model in which multiphasic desensitization is a consequence of the faster association rate at higher GABA concentrations.

Nutritional disorder of anorexia nervosa: a review.

In the treatment of anorexia nervosa, the importance of weight restoration has been well documented. Resting energy expenditure, which is initially reduced, often increases markedly in association with refeeding. Previous studies that have examined micronutrient status in anorexia nervosa have reported inconsistent and sometimes contradictory conclusions, due to the heterogeneity of the population, the cross-sectional nature of these investigations, and, at times, the use of inappropriate methods to determine nutrient status. Abnormal nutritional findings in patients with anorexia nervosa are primarily a consequence of semistarvation. Neuroendocrine abnormalities, degree of recovery, and phase of treatment affect interpretation of data. Despite the importance of nutritional rehabilitation, few controlled studies that address the clinical efficacy of various dietary treatment regimens have been conducted.

Low-dose alpha-tocopherol improves and high-dose alpha-tocopherol worsens endothelial vasodilator function in cholesterol-fed rabbits.

Abnormalities in endothelium-dependent arterial relaxation develop early in atherosclerosis and may, in part, result from the effects of modified low-density lipoprotein (LDL) on agonist-mediated endothelium-derived relaxing factor (EDRF) release and EDRF degradation. alpha-Tocopherol (AT) is the main lipid-soluble antioxidant in human plasma and lipoproteins, therefore, we investigated the effects of AT on endothelium-dependent arterial relaxation in male New Zealand White rabbits fed diets containing (a) no additive (controls), (b) 1% cholesterol (cholesterol group), or 1% cholesterol with either (c) 1,000 IU/kg chow AT (low-dose AT group) or (d) 10,000 IU/kg chow AT (high-dose AT group). After 28 d, we assayed endothelial function and LDL susceptibility to ex vivo copper-mediated oxidation. Acetylcholine-and A23187-mediated endothelium-dependent relaxations were significantly impaired in the cholesterol group (P < 0.001 vs. control), but preserved in the low-dose AT group (P = NS vs. control). Compared to the control and cholesterol groups, vessels from the high-dose AT group demonstrated profound impairment of arterial relaxation (P < 0.05) and significantly more intimal proliferation than other groups (P < 0.05). In normal vessels, alpha-tocopherol had no effect on endothelial function. LDL derived from both the high- and low-dose AT groups was more resistant to oxidation than LDL from control animals (P < 0.05). These data indicate that modest dietary treatment with AT preserves endothelial vasodilator function in cholesterol-fed rabbits while a higher dose of AT is associated with endothelial dysfunction and enhanced intimal proliferation despite continued LDL resistance to ex vivo copper-mediated oxidation.

Dietary antioxidants preserve endothelium-dependent vessel relaxation in cholesterol-fed rabbits.

Recent evidence suggests that dietary therapy with lipid-soluble antioxidants may be beneficial for patients with atherosclerotic vascular disease but the potential mechanism(s) for these observations remain obscure. Abnormalities in endothelium-dependent control of vascular tone develop early in the course of atherosclerosis and may result from oxidative modification of low density lipoproteins. We examined the role of dietary antioxidants in preserving normal endothelial cell vasodilator function in cholesterol-fed rabbits with particular attention to possible effects on serum lipoproteins, low density lipoprotein oxidation, and atherogenesis. Male New Zealand White rabbits were fed diets containing no additive (controls), 1% cholesterol (cholesterol group), or 1% cholesterol chow supplemented with either beta-carotene (0.6 g/kg of chow) or alpha-tocopherol (1000 international units/kg of chow) for a 28-day period. After dietary therapy, thoracic aortae were harvested for assay of vascular function and for pathologic examination and tissue antioxidant levels. Compared to controls, acetylcholine- and A23187-mediated endothelium-dependent relaxations were significantly impaired in vessels from the cholesterol group (P < 0.001), whereas vessels from animals treated with beta-carotene or alpha-tocopherol demonstrated normal endothelium-dependent arterial relaxation. Preservation of endothelial function was associated with vascular incorporation of alpha-tocopherol and beta-carotene but was unrelated to plasma lipoprotein levels, smooth muscle cell function, or the extent of atherosclerosis. Increased low density lipoprotein resistance to ex vivo copper-mediated oxidation was observed only in the alpha-tocopherol group. Our results suggest that dietary antioxidants may benefit patients with atherosclerosis by preserving endothelial vasodilator function through a mechanism related to vascular tissue antioxidant content and not reflected by assay of low density lipoprotein resistance to ex vivo oxidation.

Negative modulation of the gamma-aminobutyric acid response by extracellular zinc.

We have studied the effects of divalent cations on the gamma-aminobutyric acid (GABA) response of voltage-clamped spinal cord neurons, using the whole-cell recording configuration. Zn, Cd, Ni, and Mn (but not Ba, Ca, or Mg) inhibit GABA-induced whole-cell currents when applied extracellularly. Although Zn is an effective inhibitor when applied extracellularly, it is ineffective when applied intracellularly. Inhibition by these cations is mediated by a common saturable recognition site that is distinct from the recognition sites for GABA, benzodiazepines, barbiturates, picrotoxin, or steroids. The maximal inhibition, or efficacy of inhibition, of GABA-induced currents is greater for Zn than for Cd, Ni, or Mn. The order of potency is Cd greater than Zn much greater than Ni much greater than Mn. Inhibition by Zn is partially surmountable by GABA, consistent with a decrease in both the maximum response and the affinity for GABA. The dose-response curve for inhibition of the GABA response by Zn is shifted to the right at a high GABA concentration but is unaffected by the presence of chlordiazepoxide, pentobarbital, or 5 beta-pregnan-3 alpha-ol-20-one. The results are consistent with a model in which a Zn-sensitive modulatory site exerts negative allosteric control over GABA receptor function.

Ethanol potentiates GABA- and glycine-induced chloride currents in chick spinal cord neurons.

The effects of acute ethanol exposure of chick spinal cord neurons were studied in tissue culture, using whole-cell voltage-clamp techniques. Results indicate that ethanol produces a persistent increase in the sensitivity of spinal neurons to GABA and glycine, with no change in input resistance or resting membrane potential. Glutamate responses, in contrast, are unaffected by ethanol.