ComBating inter-site differences in field strength: harmonizing preclinical traumatic brain injury MRI data.

Integrating datasets from multiple sites and scanners can increase statistical power for neuroimaging studies but can also introduce significant inter-site confounds. We evaluated the effectiveness of ComBat, an empirical Bayes approach, to combine longitudinal preclinical MRI data acquired at 4.7 or 9.4 T at two different sites in Australia. Male Sprague Dawley rats underwent MRI on Days 2, 9, 28, and 150 following moderate/severe traumatic brain injury (TBI) or sham injury as part of Project 1 of the NIH/NINDS-funded Centre Without Walls EpiBioS4Rx project. Diffusion-weighted and multiple-gradient-echo images were acquired, and outcomes included QSM, FA, and ADC. Acute injury measures including apnea and self-righting reflex were consistent between sites. Mixed-effect analysis of ipsilateral and contralateral corpus callosum (CC) summary values revealed a significant effect of site on FA and ADC values, which was removed following ComBat harmonization. Bland-Altman plots for each metric showed reduced variability across sites following ComBat harmonization, including for QSM, despite appearing to be largely unaffected by inter-site differences and no effect of site observed. Following harmonization, the combined inter-site data revealed significant differences in the imaging metrics consistent with previously reported outcomes. TBI resulted in significantly reduced FA and increased susceptibility in the ipsilateral CC, and significantly reduced FA in the contralateral CC compared with sham-injured rats. Additionally, TBI rats also exhibited a reversal in ipsilateral CC ADC values over time with significantly reduced ADC at Day 9, followed by increased ADC 150 days after injury. Our findings demonstrate the need for harmonizing multi-site preclinical MRI data and show that this can be successfully achieved using ComBat while preserving phenotypical changes due to TBI.

Epilepsy phenotype and its reproducibility after lateral fluid percussion-induced traumatic brain injury in rats: Multicenter EpiBioS4Rx study project 1.

OBJECTIVE: This study was undertaken to assess reproducibility of the epilepsy outcome and phenotype in a lateral fluid percussion model of posttraumatic epilepsy (PTE) across three study sites. METHODS: A total of 525 adult male Sprague Dawley rats were randomized to lateral fluid percussion-induced brain injury (FPI) or sham operation. Of these, 264 were assigned to magnetic resonance imaging (MRI cohort, 43 sham, 221 traumatic brain injury [TBI]) and 261 to electrophysiological follow-up (EEG cohort, 41 sham, 220 TBI). A major effort was made to harmonize the rats, materials, equipment, procedures, and monitoring systems. On the 7th post-TBI month, rats were video-EEG monitored for epilepsy diagnosis. RESULTS: A total of 245 rats were video-EEG phenotyped for epilepsy on the 7th postinjury month (121 in MRI cohort, 124 in EEG cohort). In the whole cohort (n = 245), the prevalence of PTE in rats with TBI was 22%, being 27% in the MRI and 18% in the EEG cohort (p > .05). Prevalence of PTE did not differ between the three study sites (p > .05). The average seizure frequency was .317 ± .725 seizures/day at University of Eastern Finland (UEF; Finland), .085 ± .067 at Monash University (Monash; Australia), and .299 ± .266 at University of California, Los Angeles (UCLA; USA; p < .01 as compared to Monash). The average seizure duration did not differ between UEF (104 ± 48 s), Monash (90 ± 33 s), and UCLA (105 ± 473 s; p > .05). Of the 219 seizures, 53% occurred as part of a seizure cluster (≥3 seizures/24 h; p >.05 between the study sites). Of the 209 seizures, 56% occurred during lights-on period and 44% during lights-off period (p > .05 between the study sites). SIGNIFICANCE: The PTE phenotype induced by lateral FPI is reproducible in a multicenter design. Our study supports the feasibility of performing preclinical multicenter trials in PTE to increase statistical power and experimental rigor to produce clinically translatable data to combat epileptogenesis after TBI.

Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea.

BACKGROUND: Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders' perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. METHODS: Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. RESULTS: Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers' safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. CONCLUSIONS: The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.

Detecting recovery of the stratospheric ozone layer.

As a result of the 1987 Montreal Protocol and its amendments, the atmospheric loading of anthropogenic ozone-depleting substances is decreasing. Accordingly, the stratospheric ozone layer is expected to recover. However, short data records and atmospheric variability confound the search for early signs of recovery, and climate change is masking ozone recovery from ozone-depleting substances in some regions and will increasingly affect the extent of recovery. Here we discuss the nature and timescales of ozone recovery, and explore the extent to which it can be currently detected in different atmospheric regions.

Street-scale dispersion modelling framework of road-traffic derived air pollution in Hanoi, Vietnam.

Traffic is an important source of air pollution in Vietnamese cities. The spatio-temporal variation of air pollution derived from traffic is poorly understood. Application of dispersion modelling can help but is hindered by the local scarcity of suitable input data. This study fills the data gap, by establishing a framework employing open-access global data to model emission from traffic activities in Hanoi. The outlined methodology explicitly defines road sources, calculates their emission, and employs background pollution profiles from Copernicus Atmospheric Monitoring Service (CAMS) to produce street-scale distribution maps for CO, PM10 and PM2.5. Pollution hotspots are found near major traffic flows with the highest hourly average CO, PM10 and PM2.5 concentrations at 1206, 87.5 and 61.5 µgm-3, respectively. The relationship between concentrations and properties of the road network is assessed. Motorcycles are the main emitters of the traffic sector. Emission from Heavy Good Vehicles dominate during the night, with contribution percentages increase as it gets further away from the city core. Modelled concentrations are underestimated mainly due to low vehicular emission factor. Adjusting emission factors according to vehicle quality in Vietnam greatly improves agreement. The presence of non-traffic emission sources contributes to the model underestimation. Results for comparisons of daily averaged PM values are broadly in agreement between models and observations; however, diurnal patters are skewed. This results partly from the uncertainties linked with background pollution levels from CAMS, and partly from non-traffic sources which are not accounted for here. Further work is needed to assess the use of CAMS's concentrations in Vietnam. Meteorological input contributes to the temporal disagreement between the model and observations. The impact is most noticeable with CO concentrations during morning traffic rush hours. This study recommends approaches to improve input for future model iterations and encourage applications of dispersion modelling studies in similar economic settings.

An Analysis of Crisis Communication Delivered by the Chief Health Officer During the COVID-19 Pandemic in Queensland, Australia.

During the first year of the COVID-19 pandemic, the state of Queensland, Australia, had relative success in containing viral transmission, presenting a unique case for potential insights into effective crisis management. Limited research exists into the communication style and effectiveness of Chief Health Officers (CHOs) throughout pandemic scenarios. Using an adapted Crisis Emergency and Risk Communication (CERC) framework based on 12 themes which indirectly assess domains of trust, credibility, transparency, and accountability. A content analysis of 107 press conferences dating from January 30th to December 24th, 2020 was conducted to analyze crisis communication style delivered by the Queensland CHO and guest speakers. Our analysis found that most communication aligned with the CERC framework, suggesting that adherence to CERC themes in crisis communication may have played an important role in the state's success. However, areas which were lacking included themes relating to efforts to address, search and gather knowledge. Analysis also revealed that some CERC themes overlapped or were missing, thus triggering the development of a modified framework to provide a more succinct coding model. Our findings demonstrate the importance communication plays in successful crisis management and the modified framework can be applied to analyze communication at national and sub-national levels.

The Vave campaign: impact evaluation of a cancer awareness raising multi-media campaign in Samoa.

Cancer is a leading cause of premature death and disability in Samoa. Recognizing the importance of symptom awareness and early detection, the Samoa Cancer Society (SCS) developed the 'Vave' (quickly) campaign as the first multi-media cancer awareness campaign in Samoa. The campaign adopted a three-pronged community engagement approach including mass media; printed resources; and community outreach at culturally appropriate locations including churches, villages and schools. The campaign promoted three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To measure impact, data were collected using several methods around the outreach education sessions (pre- and post-surveys), campaign recall (survey) and Vave-related enquiries received by SCS. The findings revealed the campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. However, it is of note that almost 30% of campaign recall respondents stated they were unsure or would not see a doctor if concerned about a sign of cancer. The reasons given being a lack of knowledge, lack of trust in hospitals and preference for traditional healing. This suggests more targeted culturally sensitive strategies are needed including partnering with traditional healers. Further, advocacy efforts are needed to address the structural barriers to cancer detection and treatment together with continuing education around causes and symptoms of cancer targeting the hard-to-reach communities in Samoa.

Cancer is a number one killer and cause of disability in Samoa. Identifying cancer early can lead to better health outcomes. Ability to understand signs and symptoms of cancer among community members is crucial in facilitating early detection. Recognizing this, the Samoa Cancer Society (SCS) developed the first ever multi-media cancer awareness campaign in Samoa­the 'Vave' which means 'quickly'. The campaign used mass media; printed resources; and community outreach to spread three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To understand how effective the campaign was, data were collected through surveys and statistics on Vave-related calls to SCS. The campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. Efforts are needed to address the structural barriers to cancer early detection and continuing education targeting the hard-to-reach communities in Samoa.

Parental food communication and child eating behaviours: A systematic literature review.

AIM: To review current evidence for parental food communication practices and their association with child eating behaviours. METHODS: The PRISMA framework guided the reporting of the review; registered with Prospero in July 2020. Eligible studies were critically appraised using the Joanna Briggs Institute tools. Only quantitative studies that included a parental measure of food communication and a child measure of eating behaviour were included. RESULTS: From 11 063 articles 23 were eligible for synthesis. The vast majority (82%) of studies used observational cross-sectional designs. Three involved observing parent-child dyads, with the remainder using questionnaires. Two quasi-experimental designs tested interventions and two randomised control trial were reported. The majority of measures assessing parental food communication were subscales of larger questionnaires. The Caregiver's Feeding Style Questionnaire (CFSQ) was the most direct and relevant measure of parental food communication. Findings of reviewed studies highlighted that "how" parents communicate about food appears to impact child eating behaviours. Using child-centred communication provided promising outcomes for positive child eating behaviours, while parental "diet" communication was found to be associated with poorer dietary outcomes in children. CONCLUSIONS: Food communication research is in its infancy. However, evidence for the importance of parents' child-focused food communication is emerging, providing a focus for future research and interventions. SO WHAT?: Given the gaps in our understanding about prevention of disordered eating, there is a significant opportunity to explore what food communication strategies may assist parents to communicate about food in a positive way.

Why "mealtime chatter matters": A process evaluation of a preventive health brief intervention.

How parents communicate about food is important for building children's emotional relationships with food. "Mealtime Chatter Matters" (MCM) is an evidence-informed brief intervention providing behavioral strategies for parents focusing on positive communication at mealtimes. This process study explored parents' experiences of the brief intervention. Nine mothers participated in interviews, followed by a qualitative inductive analysis. Findings revealed the strengths and weaknesses of MCM and critical reflections of participants' experiences that can be used to inform future program strategies. This study has important health marketing implications for developing preventive health resources and indicates that future research on mealtime communication is warranted.

Disordered eating prevention: Co-designing a brief intervention for use in Community Child Health Services.

Dietary habits established in childhood, often persist into adulthood highlighting the importance of early intervention. However, limited interventions exist promoting "how" to establish healthful eating behaviors in children. To create impactful interventions, it is important they are based on evidence and co-designed with end-users. Fifteen child health nurses participated in this co-design study, underpinned by the Knowledge to Action Framework. Child health nurses reviewed evidence-based statements and then workshopped practical strategies. Findings from the co-design sessions were used to inform the development of a preventive intervention. The study has important health marketing implications for conducting co-design with child health nurses.

What tuberculosis infection control measures are effective in resource-constrained primary healthcare facilities? A systematic review of the literature.

INTRODUCTION: Tuberculosis (TB) remains a major global health challenge, killing millions of people, despite the availability of preventive TB medication. The majority of these infections and deaths occur in low-income countries. Therefore, practical public health strategies are required to reduce the global TB burden in these countries effectively. The purpose of this review was to examine the current evidence of tuberculosis infection control (TBIC) measures in reducing TB transmission and explore the barriers and enablers of TBIC measures in resource-constrained primary healthcare settings. METHODS: The PRISMA framework was adopted to identify studies that report on the evidence and barriers and facilitators of administrative, environmental and respiratory control measures at healthcare settings in low- and middle-income countries (LMICs). ProQuest, Scopus, ScienceDirect, Embase and PubMed were searched for English language peer-reviewed studies published since the introduction of TBIC guidelines. Studies not relevant to the topic, were not on TBIC measures or were reviews or commentary-style papers were excluded. Included articles were evaluated based on their aim, study design, geography and health settings interventions (TBIC measures), economic setting (ie LMICs) and main findings. RESULTS: Our review of the 15 included studies identified a cough officer screening system, isolation of TB patients, modification of consultation rooms, and opening windows and doors as effective TB prevention measures. Lack of patient education, unsupportive workplace culture, inadequate supply of particulate respirators, insufficient isolation facilities and poor physical infrastructures were identified as barriers to TBIC practices. Triaging TB patients, maintenance of health infrastructure, appropriate use of personal protective equipment (PPE) and healthcare workers (HCWs) training on the correct use of PPE were reported as facilitators of TBIC in primary healthcare facilities. CONCLUSION: Our review provides consistent evidence of TBIC measures in reducing TB transmission in resource-constrained primary healthcare settings. This review has demonstrated that TB transmission can be successfully controlled using multiple and simple low-cost TBIC measures including administrative, environmental and respiratory controls. Effective implementation of triaging patients with suspected TB alongside maintenance of health infrastructure, appropriate use of PPE and robust HCWs training on TBIC could improve implementation of TBIC measures in primary healthcare settings. Healthcare management should address these areas particularly in rural and remote locations to improve the implementation of TBIC measures in primary healthcare facilities in LMICs.

Von Willebrand factor and disease: a review for laboratory professionals.

Given that von Willebrand disease (VWD) is one of the most common bleeding disorders, the diagnosis or the exclusion is essential in the workup of individuals that have unexplained bleeding. For the clinical laboratory, the challenge is highlighted by the variable presentations of this disorder and the multiple assays that are available from different vendors. This review will give a brief overview of primary hemostasis with a detailed explanation of the biosynthesis, structure, and mechanics of von Willebrand factor (VWF). The final sections will focus on the distinguishing characteristics of the different types of VWD and the array of clinical laboratory tests currently available to assist in the diagnosis.

Analysis of College of American Pathologists von Willebrand Factor Proficiency Testing Program.

Von Willebrand factor (VWF) level and/or function is altered in von Willebrand disease (VWD), the most common heritable bleeding disorder worldwide. Laboratory assessment of VWF is continually evolving. Historically, the primary method for the assessment of VWF platelet-binding activity was the ristocetin cofactor assay (VWF:RCo). Contemporary alternative measures of VWF platelet-binding activity include VWF:GPIbR (recombinant; using ristocetin), VWF:GPIbM (recombinant; gain-of-function mutant), and monoclonal antibody. Recently, the American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Federation of Hemophilia collaboration issued guidelines recommending the use of newer assays of VWF platelet-binding activity (VWF: GPIbM, VWF: GPIbR) over VWF:RCo, given known limitations of the VWF:RCo assay. Despite this recommendation, the newer VWF:GPIbM and VWF:GPIbR assays are not United States Food and Drug Administration cleared, limiting their availability in the United States. We sought to assess assay utilization trends, agreement of VWF testing methods, and imprecision of VWF testing (based on assigned sample type) from the College of American Pathologists Proficiency Testing Surveys. The analysis confirms that, while VWF antigen testing has low imprecision, the various VWF activity assays have significant interassay variability, with VWF:RCo showing greater imprecision than the newer GPIb-binding assays. The overall trends in assay utilization reflect the barriers to complete compliance with modern VWD diagnostic guidelines in North America.

Analysis of College of American Pathologists von Willebrand Factor Proficiency Testing Program.

Von Willebrand factor (VWF) level and/or function is altered in von Willebrand disease (VWD), the most common heritable bleeding disorder worldwide. Laboratory assessment of VWF is continually evolving. Historically, the primary method for the assessment of VWF platelet-binding activity was the ristocetin cofactor assay (VWF:RCo). Contemporary alternative measures of VWF platelet-binding activity include VWF:GPIbR (recombinant; using ristocetin), VWF:GPIbM (recombinant; gain-of-function mutant), and monoclonal antibody. Recently, the American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Federation of Hemophilia collaboration issued guidelines recommending the use of newer assays of VWF platelet-binding activity (VWF: GPIbM, VWF: GPIbR) over VWF:RCo, given known limitations of the VWF:RCo assay. Despite this recommendation, the newer VWF:GPIbM and VWF:GPIbR assays are not United States Food and Drug Administration cleared, limiting their availability in the United States. We sought to assess assay utilization trends, agreement of VWF testing methods, and imprecision of VWF testing (based on assigned sample type) from the College of American Pathologists Proficiency Testing Surveys. The analysis confirms that, while VWF antigen testing has low imprecision, the various VWF activity assays have significant interassay variability, with VWF:RCo showing greater imprecision than the newer GPIb-binding assays. The overall trends in assay utilization reflect the barriers to complete compliance with modern VWD diagnostic guidelines in North America.

Understanding Sources and Drivers of Size-Resolved Aerosol in the High Arctic Islands of Svalbard Using a Receptor Model Coupled with Machine Learning.

Atmospheric aerosols are important drivers of Arctic climate change through aerosol-cloud-climate interactions. However, large uncertainties remain on the sources and processes controlling particle numbers in both fine and coarse modes. Here, we applied a receptor model and an explainable machine learning technique to understand the sources and drivers of particle numbers from 10 nm to 20 µm in Svalbard. Nucleation, biogenic, secondary, anthropogenic, mineral dust, sea salt and blowing snow aerosols and their major environmental drivers were identified. Our results show that the monthly variations in particles are highly size/source dependent and regulated by meteorology. Secondary and nucleation aerosols are the largest contributors to potential cloud condensation nuclei (CCN, particle number with a diameter larger than 40 nm as a proxy) in the Arctic. Nonlinear responses to temperature were found for biogenic, local dust particles and potential CCN, highlighting the importance of melting sea ice and snow. These results indicate that the aerosol factors will respond to rapid Arctic warming differently and in a nonlinear fashion.

Clinically relevant mitochondrial-targeted therapy improves chronic outcomes after traumatic brain injury.

Pioglitazone, an FDA-approved compound, has been shown to target the novel mitochondrial protein mitoNEET and produce short-term neuroprotection and functional benefits following traumatic brain injury. To expand on these findings, we now investigate the dose- and time-dependent effects of pioglitazone administration on mitochondrial function after experimental traumatic brain injury. We then hypothesize that optimal pioglitazone dosing will lead to ongoing neuroprotection and cognitive benefits that are dependent on pioglitazone-mitoNEET signalling pathways. We show that delayed intervention is significantly more effective than early intervention at improving acute mitochondrial bioenergetics in the brain after traumatic brain injury. In corroboration, we demonstrate that mitoNEET is more heavily expressed, especially near the cortical contusion, in the 18 h following traumatic brain injury. To explore whether these findings relate to ongoing pathological and behavioural outcomes, mice received controlled cortical impact followed by initiation of pioglitazone treatment at either 3 or 18 h post-injury. Mice with treatment initiation at 18 h post-injury exhibited significantly improved behaviour and tissue sparing compared to mice with pioglitazone initiated at 3 h post-injury. Further using mitoNEET knockout mice, we show that this therapeutic effect is dependent on mitoNEET. Finally, we demonstrate that delayed pioglitazone treatment improves serial motor and cognitive performance in conjunction with attenuated brain atrophy after traumatic brain injury. This study illustrates that mitoNEET is the critical target for delayed pioglitazone intervention after traumatic brain injury, mitochondrial-targeting is highly time-dependent after injury and there is an extended therapeutic window to effectively treat mitochondrial dysfunction after brain injury.

Fixed-dose aspirin monotherapy compared with thromboelastography directed antiplatelet therapy in long-term management of left ventricular assist devices.

BACKGROUND AND AIM: The role of thromboelastography (TEG) in managing antiplatelet therapy (APT) in left ventricular assist devices (LVADs) is controversial. Our aim was to determine whether removal of TEG from an LVAD-specific APT protocol reduced late-onset bleeding without increasing thromboembolic complications. METHODS: We performed a single-center, retrospective cohort study including all recipients of a continuous-flow LVAD between April 2005 and November 2019 (n = 293). LVAD recipients before June 1, 2017 (n = 221) whose APT was monitored and adjusted using TEG were compared with LVAD recipients after June 1, 2017 (n = 72) where TEG was not utilized. Occurrence of late-onset bleeding events after postoperative Day 7 and thromboembolic events were collected. APT doses, warfarin use and International normalized ratio (INR) values were collected at discharge and at 1, 3, 6, and 12-months postimplantation. RESULTS: Over a median 12-month follow-up, INTERMACS major bleeding events occurred in 35% of patients where TEG was utilized compared with 29% where TEG was not utilized (p = 0.375), and procedural intervention was required in 29% compared with 18%, respectively (p = 0.058). Use of TEG was associated with higher doses of aspirin (>325 mg) (41% compared with none) and use of a second antiplatelet (dipyridamole) (43% compared to 1%). Despite this, there was no significant difference in thromboembolic events (15% in each). CONCLUSIONS: Our study suggests the use of TEG led to increased doses of aspirin as well as adding a second antiplatelet agent, without improving outcomes in LVAD recipients. Furthermore, the removal of TEG from an LVAD-specific APT protocol did not worsen thromboembolic outcomes.

Self-identified motivators for physical activity: Perspectives of older residential care facility residents.

OBJECTIVES: To inform strategies to increase physical activity amongst Older Residential Care Facility Residents (ORCFR), this research explored self-identified motivators for, benefits of and barriers to physical activity engagement. METHODS: The research was framed within a salutogenic model of health, viewing health as a continuum shaped by one's health resources and life stressors. This exploratory qualitative research examined the physical activity experiences of seven ORCFR in Brisbane, Australia. Semi-structured interviews with open-ended questions assessed basic demographics, Physical Activity (PA) levels, perceived benefits of and barriers to PA. The resulting data underwent thematic analysis. RESULTS: After seven interviews, data saturation was reached, revealing three major themes and seven subthemes. These were positive socialisation (inclusion) with subthemes of enjoying social contact and avoiding "zombieland" (loneliness). Negative socialisation (isolation) with subthemes of avoiding conflict and feeling awkward. Maintaining independence was the benefit, with subthemes of getting around to socialise, activities of daily living and preserving health to socialise. CONCLUSION: Conventional physical activity programs emphasising medical and clinical benefits are disconnected from ORCFR motivators, as residents perceive benefits in terms of mobility and socialisation. This disconnect partially explains poor acceptability and uptake of ORCFR physical activity interventions over the last 25 years.

Topographical reorganization of brain functional connectivity during an early period of epileptogenesis.

OBJECTIVE: The current study aims to investigate functional brain network representations during the early period of epileptogenesis. METHODS: Eighteen rats with the intrahippocampal kainate model of mesial temporal lobe epilepsy were used for this experiment. Functional magnetic resonance imaging (fMRI) measurements were made 1 week after status epilepticus, followed by 2-4-month electrophysiological and video monitoring. Animals were identified as having (1) developed epilepsy (E+, n = 9) or (2) not developed epilepsy (E-, n = 6). Nine additional animals served as controls. Graph theory analysis was performed on the fMRI data to quantify the functional brain networks in all animals prior to the development of epilepsy. Spectrum clustering with the network features was performed to estimate their predictability in epileptogenesis. RESULTS: Our data indicated that E+ animals showed an overall increase in functional connectivity strength compared to E- and control animals. Global network features and small-worldness of E- rats were similar to controls, whereas E+ rats demonstrated increased small-worldness, including increased reorganization degree, clustering coefficient, and global efficiency, with reduced shortest pathlength. A notable classification of the combined brain network parameters was found in E+ and E- animals. For the local network parameters, the E- rats showed increased hubs in sensorimotor cortex, and decreased hubness in hippocampus. The E+ rats showed a complete loss of hippocampal hubs, and the appearance of new hubs in the prefrontal cortex. We also observed that lesion severity was not related to epileptogenesis. SIGNIFICANCE: Our data provide a view of the reorganization of topographical functional brain networks in the early period of epileptogenesis and how it can significantly predict the development of epilepsy. The differences from E- animals offer a potential means for applying noninvasive neuroimaging tools for the early prediction of epilepsy.

A 6-week healthy eating intervention with family engagement improves food knowledge and preferences but not dietary diversity among urban preschool children in Sri Lanka.

OBJECTIVE: To evaluate the effectiveness of a multicomponent intervention (MCI) on children's dietary diversity and its impact pathway components of children's food knowledge and healthy food preferences. DESIGN: A 6-week cluster randomised controlled trial with a MCI consisting of child nutrition education plus family engagement through parental nutrition education, meal preparation and tasting was compared with two groups: single component intervention (SCI) of child nutrition education, and control, conducted during February to July 2018. Preschool centres were randomly assigned to one of the three arms. Children's food knowledge, healthy food preferences and dietary diversity scores were collected. Intervention effects were analysed using a pre-post analysis and a difference-in-difference model. SETTING: Fourteen preschool centres in an urban area of Kurunegala, Sri Lanka. PARTICIPANTS: Child-parent dyads of children aged 4-6 years. Final analyses included 306 (for food knowledge and preferences) and 258 (for dietary diversity) dyads. RESULTS: MCI significantly influenced the impact pathways to children's dietary diversity by increasing children's food knowledge and healthy food preferences scores by 3·76 and 2·79 (P < 0·001), respectively, but not the dietary diversity score (P = 0·603), compared with the control arm. Relative to SCI, MCI significantly improved children's food knowledge score by 1·10 (P < 0·001), but no significant effects were noted for other outcome variables. CONCLUSIONS: Improved food knowledge and preferences require a positive food environment and time to develop into healthy eating behaviours. Research into dietary diversity should broaden to incorporate the contextual roles of the home and general food environments to more completely understand food choices of children.