Safety of Breast Liposuction and Oncologic Considerations.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The complexities of selling fruits and vegetables in remote Navajo Nation retail outlets: perspectives from owners and managers of small stores.

OBJECTIVE: Navajo Nation residents experience extreme rates of poverty, food insecurity and diet-related diseases. While many residents travel far to shop at grocery stores, there are small stores closer to home that could provide more healthy options, like fruits and vegetables (F&V). Little is known from the perspective of store owners and managers regarding the barriers and facilitators to offering F&V; the present study contributes to filling that gap. DESIGN: Data were collected through structured interviews from a sampling frame of all store owners or managers in the setting (n 29). SETTING: Small stores in Navajo Nation, New Mexico, USA. Navajo Nation is predominantly rural and the largest federally recognized Native American tribe in the USA. PARTICIPANTS: Sixteen managers and six owners at twenty-two stores. RESULTS: When asked about the types of foods that were most commonly purchased at their stores, most participants reported snacks and drinks (82 and 68 %, respectively). Many participants reported they would like to offer more fresh F&V. However, barriers included varying perceived customer demand, limited F&V choices from distributors and (for some managers) limited authority over product selection. CONCLUSIONS: Findings contribute to the discussion on engaging store owners and managers in providing quality, healthy foods close to home in low-income, rural regions.

Remuneration systems of community health workers in India and promoted maternal health outcomes: a cross-sectional study.

BACKGROUND: This study assessed the association of remuneration systems of paid-for-performance Accredited Social Health Activists (ASHAs) and salaried Anganwadi workers (AWWs) on seven maternal health outcomes in four states in India: Andhra Pradesh (AP), Chhattisgarh, Odisha (Orissa), and Uttar Pradesh (UP). METHODS: The cross-sectional study surveyed mothers of children aged 6-23 months. A total of 3455 mothers were selected via multistage cluster sampling. The seven health outcomes related to the community health worker (CHW) visits were: institutional delivery, complete immunization, exclusive breastfeeding for six months, timely introduction of complementary feeding, continued breastfeeding during child's illness, handwashing, and awareness of Nutrition and Health Days (NHDs). RESULTS: The results varied by state. Mothers who received ASHA visits were significantly less likely to have an institutional delivery, timely introduction of complementary feeding, awareness of Nutrition and Health Days (NHDs), proper handwashing, and exclusive breastfeeding for the first six months in at least one of the four states. Conversely, AWW's home visits were positively predictive of the following health outcomes in certain states: complete immunization for index child, continued breastfeeding during the child's illness, handwashing, and awareness of NHDs. CONCLUSIONS: ASHAs' home visits were not more strongly associated with health outcomes for which they were paid than outcomes for which they were unpaid. AWWs' home visits were positively associated with awareness of NHDs, and associations varied for other recommended health behaviors. Further research could elucidate the causes for successes and failures of CHW programs in different states of India.

Factors associated with alcohol consumption patterns in a Puerto Rican urban cohort.

OBJECTIVE: There is little research on factors associated with alcohol consumption among Puerto Ricans living in the USA; thus the aim of the present study was to examine alcohol intake patterns, and factors associated with drinking categories, in a cohort of Puerto Rican adults in Massachusetts. DESIGN: Cross-sectional study. Descriptive and polytomous logistic regression analyses were used to identify factors associated with drinking patterns, stratified by gender. SETTING: Greater Boston area, MA, USA. SUBJECTS: Puerto Rican adults (n 1292), aged 45-75 years. RESULTS: Eight per cent of men and 39% of women were lifetime abstainers; 40% of men and 25% of women were former drinkers; 31 % of men and 27% of women were moderate drinkers; and 21% of men and 8% of women were heavy drinkers. Thirty-five per cent of participants reported drinking alcohol while taking medications with alcohol contraindications. After multivariable adjustment, young men were less likely than older men to be moderate drinkers. Among women, higher BMI, age, lower income and lower psychological acculturation were associated with abstention; age and lower perceived emotional support were associated with increased likelihood of former drinking; and women without v. with diabetes were more likely to be heavy drinkers. CONCLUSIONS: High prevalence of chronic disease, heavy drinking and alcohol use while taking medications with alcohol contraindications suggest an urgent need for better screening and interventions tailored to this rapidly growing Hispanic national subgroup. As heavy drinking appears to increase with acculturation for women, public health initiatives are needed to support appropriate alcohol use.

Household-level dietary quality indicator for countries in nutritional transition: application to vulnerable communities in El Salvador.

OBJECTIVE: To develop a household-level diet quality indicator (HDQI) using the Salvadorian dietary guidelines to assess the dietary quality of households in vulnerable communities in El Salvador. DESIGN: The Salvadorian dietary guidelines were reviewed and eighteen HDQI components were identified (nine foods and nine nutrients). The components were evaluated using a proportional scoring system from 0 to 1, penalizing over- and under-consumption, where appropriate. The HDQI was validated in consultations with experts in El Salvador and by statistical analyses of the study sample data. Dietary variety and energy, nutrient and food intakes were compared among households above and below the median HDQI score using Student's t test. SETTING: Vulnerable, border communities in El Salvador. SUBJECTS: Households (n 140) provided food consumption information using an FFQ and sociodemographic data. RESULTS: The mean HDQI score was 63·5, ranging from 43·6 to 90·0. The indicator showed a positive, significant association with the dietary variety components. The statistical associations of the indicator with the energy and nutrient components were as expected. CONCLUSIONS: Based on the indicator's demonstrated face validity and the results of the expert consultations, the indicator is suggested as a good measure of diet quality for households in El Salvador.

Community development and livestock promotion in rural Nepal: effects on child growth and health.

BACKGROUND: More than 50% of children in Nepal are malnourished. Economic growth and poverty reduction are not always sufficient to improve the health and nutritional status of children. Heifer Nepal uses livestock training as a tool for community development and poverty alleviation but does not directly address child health and nutrition. OBJECTIVE: To systematically assess the effects of Heifer activities on child health and nutrition. METHODS: The study was a 2-year, longitudinal, randomized, controlled trial in six communities in Nepal (both Terai and hills), pair-matched for specific characteristics, randomly assigned to receive Heifer community development activities at baseline (intervention) or 1 year (control). At 6-month intervals over a period of 2 years, child anthropometric and comprehensive household surveys were performed. RESULTS: Four hundred fifteen households were enrolled containing 607 children 6 months to 5 years of age. The intervention and control communities were equivalent for baseline socioeconomic status, household size, ownership of land and animals, and child nutrition and health. At 12 months (prior to animal donations), the Terai intervention group had improved child weight (p = .04), improved child height (p = .05), and reduced sick days (p = .03), as well as increased household income (p = .004), increased ownership of animals (p = .04) and land (p = .04), and improved sanitation practices (p < .01). In all districts, longer participation in Heifer activities corresponded to more improvement in child height-for-age z-scores. CONCLUSIONS: Heifer interventions resulted in improved socioeconomic status and household income per family member. Children under 60 months of age in the intervention group had greater incremental improvement in height-for-age and weight-for-age z-scores than children in the control group, and longer participation in Heifer activities was associated with better growth. Poverty alleviation programs, such as Heifer, may indirectly benefit child growth.

Isolation and characterization of a bis(dithiolene)-supported tungsten-acetylenic complex as a model for acetylene hydratase.

Acetylene hydratase is currently the only known mononuclear tungstoenzyme that does not catalyze a net redox reaction. The conversion of acetylene to acetaldehyde is proposed to occur at a W(IV) active site through first-sphere coordination of the acetylene substrate. To date, a handful of tungsten complexes have been shown to bind acetylene, but many lack the bis(dithiolene) motif of the native enzyme. The model compound, [W(O)(mnt)2]2-, where mnt2- is 1,2-dicyano-1,2-dithiolate, was previously reported to bind an electrophilic acetylene substrate, dimethyl acetylenedicarboxylate, and characterized by FT-IR, UV-vis, potentiometry, and mass spectrometry (Yadav, J; Das, S. K.; Sarkar, S., J. Am. Chem. Soc., 1997, 119, 4316-4317). By slightly changing the electrophilic acetylene substrate, an acetylenic-bis(dithiolene)­tungsten(IV) complex has been isolated and characterized by FT-IR, UV-vis, NMR, X-ray diffraction, and X-ray absorption spectroscopy. Activation parameters for complex formation were also determined and suggest coordination-sphere reorganization is a limiting factor in the model complex reactivity.

Associations between three school-based measures of health: is BMI enough?

School-based body mass index (BMI) notification programs are often used to raise parental awareness of childhood overweight and obesity, but how BMI results are associated with physical fitness and diet is less clear. This study examined the relationship between BMI, fitness, and diet quality in a diverse sample of urban schoolchildren (n = 122) utilizing a school-based cardiorespiratory fitness test and a food frequency questionnaire. Fifty-two percent of children were overweight/obese. Fit children were more likely to be normal weight than unfit children (p < .001). Weight status was not associated with adherence to any specific dietary guidelines; however, greater overall adherence to the recommendations was associated with normal weight (p < .05). These findings suggest a potential benefit may be gained by combining BMI reports with results of in-school fitness testing and basic information on how children's diets compare to recommendations.

Dietary supplement use pattern of U.S. adult population in the 2007-2008 National Health and Nutrition Examination Survey (NHANES).

Data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) suggested that nearly half of U.S. adults aged 20 to 69 reported taking at least one dietary supplement in the past month. Logistic regression showed that the following factors were independently associated with a greater likelihood of supplement use: being female, older, white, having higher level of education, non-SNAP participation, and living in a food-secure household. To compare nutrient intakes between supplement users and non-supplement users, daily intakes of eight nutrients were examined. When considering nutrients from food, supplement users tended to consume greater amounts of vitamin A, vitamin C, vitamin E, folic acid, calcium, and iron; meanwhile there was no association between supplement use and daily intakes of vitamin B12 and zinc from food sources only. Including nutrients from daily supplement use, supplement users consumed greater amounts of all eight nutrients.

Injectable pulverized electrospun poly(lactic-co-glycolic acid) fibers improve human adipose tissue engraftment and volume retention.

Autologous adipose tissue is commonly used for tissue engraftment for the purposes of soft tissue reconstruction due to its relative abundance in the human body and ease of acquisition using liposuction methods. This has led to the adoption of autologous adipose engraftment procedures that allow for the injection of adipose tissues to be used as a "filler" for correcting cosmetic defects and deformities in soft tissues. However, the clinical use of such methods has several limitations, including high resorption rates and poor cell survivability, which lead to low graft volume retention and inconsistent outcomes. Here, we describe a novel application of milled electrospun poly(lactic-co-glycolic acid) (PLGA) fibers, which can be co-injected with adipose tissue to improve engraftment outcomes. These PLGA fibers had no significant negative impact on the viability of adipocytes in vitro and did not elicit long-term proinflammatory responses in vivo. Furthermore, co-delivery of human adipose tissue with pulverized electrospun PLGA fibers led to significant improvements in reperfusion, vascularity, and retention of graft volume compared to injections of adipose tissue alone. Taken together, the use of milled electrospun fibers to enhance autologous adipose engraftment techniques represents a novel approach for improving upon the shortcomings of such methods.

What is the impact of nutritional status on health-related quality of life in hemodialysis patients?

OBJECTIVES: To develop a nutrition-specific quality of life (NSQOL) questionnaire that combines the Appetite and Diet Assessment Tool and the Food Enjoyment in Dialysis tool, and to measure the association between nutritional status and both the NSQOL and the generic health-related quality of life (HRQOL) in hemodialysis patients. METHODS: Cross-sectional study of 89 hemodialysis patients. Nutritional status was measured by subjective global assessment and biochemical indices, including serum albumin concentration. Adequacy of dialysis was also measured. To determine the correlation between quality of life and nutritional status, both the NSQOL and the HRQOL instruments were used. RESULTS: The mean NSQOL score for the entire cohort was 8.9 ± 4.5. The NSQOL was positively correlated with the mental component score (r = 0.52, P < .001) and the physical component score (PCS) (r = 0.29, P < .05) of the HRQOL questionnaire. There was no difference in the NSQOL score between the moderately malnourished and the mildly malnourished to well-nourished patients. The mean PCS was significantly lower in the moderately malnourished group as compared with the mildly malnourished and well-nourished groups (33.4 ± 10.7 vs. 38.9 ± 10.2, P < .05); however, there was no difference in the mean mental component score between the groups. Nutritional status, as assessed by subjective global assessment, was positively correlated with the PCS (r = 0.33, P < .05) and serum albumin concentration (r = 0.35, P = .01). CONCLUSION: We developed an NSQOL questionnaire by combining the Appetite and Diet Assessment Tool and the Food Enjoyment in Dialysis tool. The NSQOL questionnaire is a rapid self-administered tool that can be used to assess appetite-related quality of life in patients receiving maintenance hemodialysis. This instrument correlated well with HRQOL indices in this cohort of hemodialysis patients.

Measuring Governance: Developing a Novel Metric for Assessing Whether Policy Environments are Conducive for the Development and Implementation of Nutrition Interventions in Nepal.

BACKGROUND: The Nutrition Governance Index (NGI) defines a first standardized approach to quantifying the 'quality of governance' in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Numerous past efforts to measure 'governance,' most notably World Health Organization's (WHO's) NGI and the separate Hunger and Nutrition Commitment Index (HANCI), both of which lack granularity below the national level and each of which fails to capture pinch points related to necessary cross-sectoral actions. This paper addresses such caveats by introducing an innovative metric to assess self-reported practices of, and perceptions held by, administration officials tasked with implementing government policy at the sub-national level. The paper discusses the development of this metric, its methodology, and explores its application in the context of Nepal. METHODS: Conducted as part of a nationally representative longitudinal survey across 21 of Nepal's 75 districts, the substudy??? on which this paper is based used data from 520 government and non-government officials at different geographic and administrative tiers of authority. Using robust statistical techniques, structured questionnaire data were condensed into a score using a scale from 0 to 100. RESULTS: Six domains were identified through the analysis: Understanding Nutrition and related responsibilities; Collaboration; Financial Resources; Nutrition Leadership, Capacity, and Support. About half of all health sector representatives achieved a high score (>3 on 5-point scale) compared to representatives in other sectors of government activity (such as agriculture or education) (χ2=12.99, P<.003). The health sector also showed the most improvement in mean NGI score over a two-year follow-up period. CONCLUSION: This paper shows that self-reported perceptions and behaviors of those responsible for policy implementation can be usefully quantified. The NGI can be used to assess countries' readiness for the application of nutrition policies.

Tetradentate vs pentadentate coordination in copper(II) complexes of pyridylbis(aminophenol) ligands depends on nucleophilicity of phenol donors.

The ligand binding preferences of a series of potentially pentadentate pyridylbis(aminophenol) ligands were explored. In addition to the previously reported ligands 2,2'-(2-methyl-2-(pyridin-2-yl)propane-1,3-diyl)bis(azanediyl)bis(methylene)diphenol (H(2)L(1)) and 6,6'-(2-methyl-2-(pyridin-2-yl)propane-1,3-diyl)bis(azanediyl)bis(methylene)bis(2,4-di-tert-butylphenol) (H(2)L(1-tBu)), four new ligands were synthesized: 6,6'-(2-methyl-2(pyridine-2-yl)propane-1,3-diyl)bis(azanediyl)bis(methylene)bis(2,4-dibromophenol) (H(2)L(1-Br)), 6,6'-(2-methyl-2(pyridine-2-yl)propane-1,3diyl)bis(azanediyl)bis(methylene)bis(2-methoxyphenol) (H(2)L(1-MeO)), 2,2'-(2-methyl-2(pyridine-2-yl)propane-1,3diyl)bis(azanediyl)bis(methylene)bis(4-nitrophenol) (H(2)L(1-NO2)), and 2,2'-(2-phenylpropane-1,3-diyl)bis(azanediyl)bis(methylene)diphenol (H(2)L(2)). These ligands, when combined with copper(II) salts and base, form either tricopper(II) species or monocopper(II) species depending on the nucleophilicity of the phenol groups in the ligands. All copper complexes were characterized by X-ray crystallography, cyclic voltammetry, and spectroscopic methods in solution. The ligands in trimeric complexes [{CuL(1)(CH(3)CN)}(2)Cu](ClO(4))(2) (1), [{CuL(1)Cl}(2)Cu] (1a), and [{CuL(2)(CH(3)CN)}(2)Cu](ClO(4))(2) (1b) and monomeric complex [CuL(1-tBu)(CH(3)OH)] (2) coordinate in a tetradentate mode via the amine N atoms and the phenolato O atoms. The pyridyl groups in 1, 1a, and 2 do not coordinate, but instead are involved in hydrogen bonding. Monomeric complexes [CuL(1-Br)] (3a), [CuL(1-NO2)] (3b), and [CuL(1-MeO)Na(CH(3)OH)(2)]ClO(4) (3c) have their ligands coordinated in a pentadentate mode via the amine N atoms, the phenolato O atoms, and the pyridyl N atom. The differences in tetradentate vs pentadentate coordination preferences of the ligands correlate to the nucleophilicity of the phenolate donor groups, and coincide with the electrochemical trends for these complexes.

Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India.

Anemia and micronutrient deficiencies are common among Indian schoolchildren. We assessed the effectiveness of micronutrient fortification of meals cooked and fortified at school on anemia and micronutrient status of schoolchildren in Himalayan villages of India. In this placebo-controlled, cluster-randomized study, 499 schoolchildren (6-10 y) received either multiple micronutrients (treatment group) or placebo (control group) as part of school meals (6 d/wk) for 8 mo. Both groups were dewormed at the beginning of the study. The micronutrient premix provided 10 mg iron, 375 microg vitamin A, 4.2 mg zinc, 225 microg folic acid, and 1.35 microg vitamin B-12 for each child per day (approximately 75% recommended dietary allowance). Blood samples drawn before and after the intervention were analyzed for hemoglobin, ferritin, retinol, zinc, folate, and vitamin B-12. Baseline prevalence of anemia (37%), iron deficiency anemia (10%), low serum ferritin (24%), retinol (56%), zinc (74%), folate (68%), and vitamin B-12 (17%) did not differ between groups. Postintervention, fewer in the treatment group had lower serum retinol [odds ratio (OR) (95% CI): 0.57 (0.33-0.97)] and folate [OR (95% CI): 0.47 (0.26-0.84)] than the control group. The serum vitamin B-12 concentration decreased in both groups, but the magnitude of change was less in the treatment than in the control group (P < 0.05). Total body iron (TBI) increased in both groups; however, the change was greater in the treatment than in the control group (P < 0.05). Micronutrient fortification of school meals by trained school personnel was effective in improving vitamin A, folate, and TBI status while also reducing the magnitude of a decrease in vitamin B-12 status.

Nutritional status of primary schoolchildren in Garhwali Himalayan villages of India.

BACKGROUND: Anemia and micronutrient deficiencies are common among Indian schoolchildren. However, past studies have narrowly focused on only a few micronutrients and have not carefully evaluated the association between sociodemographic factors and nutritional status of schoolchildren. OBJECTIVE: To assess the nutritional status of schoolchildren in Himalayan villages of India and to determine the relationships between their nutritional status, intestinal helminth infection, and sociodemographic characteristics. METHODS: A random sample of 499 children 6 to 10 years of age from 20 public primary schools was selected. Household sociodemographic data and morbidity data on children were collected through interviews with their caretakers. Height and weight were measured, and venous blood was drawn for assessment of hemoglobin, serum ferritin, soluble transferrin receptor, retinol, zinc, folic acid, vitamin B12, and C-reactive protein. Stool samples were analyzed for parasitic infections. Results. Underweight, stunting, and wasting were present in 60.9%, 56.1%, and 12.2% of schoolchildren, respectively. Anemia, iron-deficiency anemia, and low serum concentrations of ferritin, zinc, retinol, folate, and vitamin B12 were found in 36.7%, 10.2%, 24.1%, 57.1%, 56.1%, 67.9%, and 17.4% of the children, respectively. One-fifth of the children had intestinal parasites. Being underweight was associated with lower household wealth (p < .05). Helminth infection was associated with stunting, anemia, and low serum retinol (p < .05). Living at higher altitude was associated with low serum levels of ferritin, retinol, and vitamin B12. There were no associations between any sociodemographic variables and serum zinc orfolate. CONCLUSIONS: Growth impairment and micronutrient deficiencies are prevalent among schoolchildren in Himalayan villages of India.

Daily use of Sprinkles micronutrient powder for 2 months reduces anemia among children 6 to 36 months of age in the Kyrgyz Republic: a cluster-randomized trial.

BACKGROUND: Iron-deficiency anemia is widespread among young children in the Kyrgyz Republic, and there is an urgent need to identify an effective intervention to address this significant public health problem. OBJECTIVE: To test the effectiveness of a 2-month intervention with daily home fortification of complementary food using micronutrient powder (Sprinkles) in reducing anemia among children 6 to 36 months of age in the Kyrgyz Republic. METHODS: In this cluster-randomized, community-based effectiveness trial conducted in three regions of the Kyrgyz Republic, 24 clusters of children aged 6 to 36 months were randomly assigned to two groups. The intervention group (12 clusters, n = 1,103) received 60 sachets of micronutrient powder (12.5 mg elemental iron), which were taken as one sachet daily for 2 months. The control group (12 clusters, n = 1,090) did not receive micronutrient powder until after the study period. Blood hemoglobin concentration was assessed at the start and end of the intervention. RESULTS: From baseline to follow-up, the mean hemoglobin concentration in the intervention group increased by 7 g/L, whereas it decreased by 2 g/L in the control group (p < .001). The prevalence of anemia (hemoglobin < 110 g/L) in the intervention group decreased from 72% at baseline to 52% at follow-up, whereas it increased from 72% to 75% in the control group (p < .001). Compliance with the intervention was high, with children consuming on average 45 of the 60 sachets given. CONCLUSIONS: A course of 60 Sprinkles micronutrient powder sachets taken daily for 2 months is effective in improving hemoglobin levels and reducing the prevalence of anemia among young children in the Kyrgyz Republic.

Bis{2-hydr-oxy-N-[2-(2-pyrid-yl)eth-yl]benzamide}copper(I) tetra-fluoridoborate.

The title complex, [Cu(C(14)H(14)N(2)O(2))(2)]BF(4), is a monomeric copper(I) species with linear two-coordinate geometry around the Cu(I) atom. The asymmetric unit contains two half-cations that sit on crystallographic twofold rotation axes. The selected crystal was non-merohedrally twinned by a twofold rotation about an axis normal to the (100) family of planes. The ratio of the twin components refined to 0.4123 (6). Two 2-hydr-oxy-N-[2-(2-pyrid-yl)eth-yl]benzamide ligands coordinate to each Cu(I) atom via the pyridyl N atom. Intra-molecular hydrogen bonding between the phenol OH groups and the amide O atoms imparts rigidity and planarity to the non-coordinating end of the ligand. The cationic complex is linked to the BF(4) (-) anions via hydrogen bonding between the amide NH groups in the cations and BF(4) (-) anions.

Synthesis and characterization of polynuclear copper(II) complexes with pyridylbis(phenol) ligands.

Three new pyridylbis(phenol) ligands with imine (H(2)L(imine)), amine (H(2)L(amine)), or amide (H(4)L(amide)) linkages, along with their copper complexes, were synthesized and characterized. Treatment of H(2)L(imine) with copper(II) in the presence of base produced mononuclear copper complex [Cu(L(imine))(MeOH)] (1), while the same procedure with H(2)L(amine) produced trinuclear [Cu(3)(L(amine))(2)(CH(3)CN)(2)](ClO(4))(2) (2). The more rigid H(4)L(amide) forms tetranuclear [Cu(4)(L(amide))(2)(H(2)O)(4)] (3), which upon recrystallization yielded crystals of hexanuclear [Cu(6)(HL(amide))(4)(H(2)O)(2)] (4).

Environmental Factors Variably Impact Tea Secondary Metabolites in the Context of Climate Change.

Climate change is impacting food and beverage crops around the world with implications for environmental and human well-being. While numerous studies have examined climate change effects on crop yields, relatively few studies have examined effects on crop quality (concentrations of nutrients, minerals, and secondary metabolites). This review article employs a culturally relevant beverage crop, tea (Camelia sinensis), as a lens to examine environmental effects linked to climate change on the directionality of crop quality. Our systematic review identified 86 articles as relevant to the review question. Findings provide evidence that shifts in seasonality, water stress, geography, light factors, altitude, herbivory and microbes, temperature, and soil factors that are linked to climate change can result in both increases and decreases up to 50% in secondary metabolites. A gap was found regarding evidence on the direct effects of carbon dioxide on tea quality, highlighting a critical research area for future study. While this systematic review provides evidence that multiple environmental parameters are impacting tea quality, the directionality and magnitude of these impacts is not clear with contradictory evidence between studies likely due to confounding factors including variation in tea variety, cultivar, specific environmental and agricultural management conditions, and differences in research methods. The environmental factors with the most consistent evidence in this systematic review were seasonality and water stress with 14 out of 18 studies (78%) demonstrating a decrease in concentrations of phenolic compounds or their bioactivity with a seasonal shift from the spring and /or first tea harvest to other seasons and seven out of 10 studies (70%) showing an increase in levels of phenolic compounds or their bioactivity with drought stress. Herbivory and soil fertility were two of the variables that showed the greatest contradictory evidence on tea quality. Both herbivory and soil fertility are variables which farmers have the greatest control over, pointing to the importance of agricultural management for climate mitigation and adaptation. The development of evidence-based management strategies and crop breeding programs for resilient cultivars are called for to mitigate climate impacts on crop quality and overall risk in agricultural and food systems.

Experts stress both wellness and amenity aspects of food and nutrition services in assisted living facilities for older adults.

OBJECTIVES: There has been no consensus on best practices in food and nutrition services in assisted living facilities for older adults. We documented experts' views on optimal food and nutrition services emphases in assisted living facilities, and factors affecting their views. METHODS: One hundred thirty-five national experts specializing in health, aging, nutrition and assisted living facilities completed a survey consisting four scenarios (ie, home-style, restaurant/hotel, and health/medical, and a combination of these three) in six food and nutrition services areas: dining room environment, meal services, meal quality, nutrition services, employees' qualifications, and therapeutic nutrition services. RESULTS: Sixty-three percent of experts favored the combination scenario. Dietetics education and experts' beliefs that assisted living facilities should be health promotion and maintenance facilities were significant predictors of emphases, including wellness considerations. Experts' personal views exerted a powerful influence. CONCLUSIONS: Experts chose food and nutrition service quality indicators that emphasized a focus on both wellness and amenities as their ideal scenarios for optimal food and nutrition services in assisted living facilities.