Study design and methods for a randomized crossover trial substituting brown rice for white rice on diabetes risk factors in India.

India has the second largest number of people with diabetes in the world following China. Evidence indicates that consumption of whole grains can reduce the risk of type 2 diabetes. This article describes the study design and methods of a trial in progress evaluating the effects of substituting whole grain brown rice for polished (refined) white rice on biomarkers of diabetes risk (glucose metabolism, dyslipidemia, inflammation). This is a randomized controlled clinical trial with a crossover design conducted in Chennai, India among overweight but otherwise healthy volunteers aged 25-65 y with a body mass index ≥23 kg/m(2) and habitual rice consumption ≥200 g/day. The feasibility and cultural appropriateness of this type of intervention in the local environment will also be examined. If the intervention is efficacious, the findings can be incorporated into national-level policies which could include the provision of brown rice as an option or replacement for white rice in government institutions and food programs. This relatively simple dietary intervention has the potential to substantially diminish the burden of diabetes in Asia and elsewhere.

Synergistic Biophysics and Machine Learning Modeling to Rapidly Predict Cardiac Growth Probability.

Computational models that can predict growth and remodeling of the heart could have important clinical applications. However, the time it takes to calibrate and run current models while considering data uncertainty and variability makes them impractical for routine clinical use. This study aims to address this need by creating a computational framework to efficiently predict cardiac growth probability. We utilized a biophysics model to rapidly simulate cardiac growth following mitral valve regurgitation (MVR). Here we developed a two-tiered Bayesian History Matching approach augmented with Gaussian process emulators for efficient calibration of model parameters to align with growth outcomes within a 95% confidence interval. We first generated a synthetic data set to assess the accuracy of our framework, and the effect of changes in data uncertainty on growth predictions. We then calibrated our model to match baseline and chronic canine MVR data and used an independent data set to successfully validate the ability of our calibrated model to accurately predict cardiac growth probability. The combined biophysics and machine learning modeling framework we proposed in this study can be easily translated to predict patient-specific cardiac growth.

Consumer Acceptance and Preference Study (CAPS) on brown and undermilled Indian rice varieties in Chennai, India.

OBJECTIVES: To study consumer acceptance of unmilled brown and undermilled rice among urban south Indians. METHODS: Overweight and normal weight adults living in slum and nonslum residences in Chennai participated (n = 82). Bapatla (BPT) and Uma (red pigmented) rice varieties were chosen. These rice varieties were dehusked (unmilled, 0% polish) and further milled to 2.3% and 4.4% polishing (undermilled). Thus, 9 rice samples in both raw and parboiled forms were provided for consumer tasting over a period of 3 days. A 7-point hedonic scale was used to rate consumer preferences. A validated questionnaire was used to collect demographic, anthropometric, medical history, physical activity, dietary intake data, and willingness of the consumers to switch over to brown rice. RESULTS: Consumers reported that the color, appearance, texture, taste, and overall quality of the 4.4% polished rice was strongly preferred in both varieties and forms. Ratings for 0% polished (brown rice) were substantially lower than those of 2.3% polished rice, which were intermediate in ratings between 0% and 4.4% polishing. However, most of the consumers (93%) expressed a willingness to substitute brown or 2.3% polished rice, if affordable, after the taste tests and education on nutritional and health benefits of whole grains. CONCLUSION: Though most consumers preferred polished white rice, education regarding health benefits may help this population switch to brown or undermilled rice. Cooking quality and appearance of the grains were perceived as the most important factors to consider when purchasing rice among Chennai urban adults.

Evaluation of silk fibroin-based urinary conduits in a porcine model of urinary diversion.

Background: The primary strategy for urinary diversion in radical cystectomy patients involves incorporation of autologous gastrointestinal conduits into the urinary tract which leads to deleterious consequences including chronic infections and metabolic abnormalities. This report investigates the efficacy of an acellular, tubular bi-layer silk fibroin (BLSF) graft to function as an alternative urinary conduit in a porcine model of urinary diversion. Materials and methods: Unilateral urinary diversion with stented BLSF conduits was executed in five adult female, Yucatan mini-swine over a 3 month period. Longitudinal imaging analyses including ultrasonography, retrograde ureteropyelography and video-endoscopy were carried out monthly. Histological, immunohistochemical (IHC), and histomorphometric assessments were performed on neoconduits at harvest. Results: All animals survived until scheduled euthanasia and displayed moderate hydronephrosis (Grades 1-3) in reconstructed collecting systems over the course of the study period. Stented BLSF constructs supported formation of vascularized, retroperitoneal tubes capable of facilitating external urinary drainage. By 3 months post-operative, neoconduits contained α-smooth muscle actin+ and SM22α+ smooth muscle as well as uroplakin 3A+ and pan-cytokeratin + urothelium. However, the degree of tissue regeneration in neotissues was significantly lower in comparison to ureteral controls as determined by histomorphometry. In addition, neoconduit stenting was necessary to prevent stomal occlusion. Conclusion: BLSF biomaterials represent emerging platforms for urinary conduit construction and may offer a functional replacement for conventional urinary diversion techniques following further optimization of mechanical properties and regenerative responses.

Escherichia coli O157:H7 Stationary-Phase Acid Resistance and Assessment of Survival in a Model Vegetable Fermentation System.

ABSTRACT: Escherichia coli O157:H7 (STEC) acid resistance may aid the pathogen's ability to cross the human gastric barrier, which makes it an organism of concern in acidic foods. Our objective was to determine how STEC acid resistance may correlate with survival during vegetable fermentations. Seven E. coli O157:H7 strains were screened to assess acid resistance in simulated stomach acid at pH 2. The strains were separated into two groups that differed in acid resistance (P < 0.05), with three being acid sensitive and four acid resistant. The growth rates of these strains were measured in a Luria broth at pH values from 4.2 to 6.8. Two strains having similar growth kinetics, B201 (acid sensitive) and B241 (acid resistant), were selected for further analysis. B201 was found to be missing (compared with B241) two glutamic acid decarboxylase regulatory genes required for acid resistance, gadE and gadX. These strains were challenged in lactic acid (100 mM) solutions, including cucumber juice (CJ) media at pH 3.3. As expected, B201 was more acid sensitive than B241, and a filtered fermented CJ was more inhibitory than similarly acidified CJ. In competitive growth studies with Lactobacillus plantarum LA445 in CJ, B201 or B241 grew from approximately 104 to 108 CFU/mL within 24 h, but the STEC strains were below the limit of detection by 48 h. In all fermentations, L. plantarum reached 108 CFU/mL by 48 h. However, in three of four independent fermentation experiments, strain B201 survived longer than B241. This was possibly due to buffering in B241-LA445 fermentation brines that had increased lactic acid for a given pH compared with B201-LA445. These data indicate that stationary-phase acid resistance may not accurately predict STEC survival during vegetable fermentations.

Cystatin C and creatinine in an HIV cohort: the nutrition for healthy living study.

BACKGROUND: Human immunodeficiency virus (HIV)-infected persons have an increased risk of chronic kidney disease (CKD). Serum creatinine level may underestimate the prevalence of CKD in subjects with decreased lean body mass or liver disease. Level of serum cystatin C, an alternative kidney function marker, is independent of lean body mass. STUDY DESIGN: Cross-sectional. SETTING & PARTICIPANTS: 250 HIV-infected subjects on highly active antiretroviral therapy in the Nutrition for Healthy Living (NFHL) cohort; 2,628 National Health and Nutrition Examination Survey (NHANES) 2001-2002 subjects. PREDICTORS & OUTCOMES: Comparison of serum creatinine levels in NFHL to those in NHANES subjects; comparison of CKD in NFHL subjects ascertained using serum creatinine versus cystatin C levels. MEASUREMENTS: Standardized serum creatinine, serum cystatin C, glomerular filtration rate (GFR) estimated from serum creatinine and cystatin C levels. RESULTS: Creatinine levels were lower in NFHL than NHANES subjects despite greater rates of hepatitis, diabetes, and drug use (mean difference, -0.18 mg/dL; P < 0.001 adjusted for age, sex, and race). Of NFHL subjects, only 2.4% had a creatinine-based estimated GFR less than 60 mL/min/1.73 m(2), but 15.2% had a cystatin-based estimated GFR less than 60 mL/min/1.73 m(2). LIMITATIONS: GFR was estimated rather than measured. Other factors in addition to GFR may affect creatinine and cystatin C levels. Measurements of proteinuria were not available. CONCLUSIONS: Serum creatinine levels may overestimate GFRs in HIV-infected subjects. Kidney disease prevalence may be greater than previously appreciated.

Using "socially assigned race" to probe white advantages in health status.

OBJECTIVES: We explore the relationships between socially assigned race ("How do other people usually classify you in this country?"), self-identified race/ethnicity, and excellent or very good general health status. We then take advantage of subgroups which are discordant on self-identified race/ethnicity and socially assigned race to examine whether being classified by others as White conveys an advantage in health status, even for those who do not self-identify as White. METHODS: Analyses were conducted using pooled data from the eight states that used the Reactions to Race module of the 2004 Behavioral Risk Factor Surveillance System. RESULTS: The agreement of socially assigned race with self-identified race/ethnicity varied across the racial/ethnic groups currently defined by the United States government. Included among those usually classified by others as White were 26.8% of those who self-identified as Hispanic, 47.6% of those who self-identified as American Indian, and 59.5% of those who self-identified with More than one race. Among those who self-identified as Hispanic, the age-, education-, and language-adjusted proportion reporting excellent or very good health was 8.7 percentage points higher for those socially assigned as White than for those socially assigned as Hispanic (P=.04); among those who self-identified as American Indian, that proportion was 15.4 percentage points higher for those socially assigned as White than for those socially assigned as American Indian (P=.05); and among those who self-identified with More than one race, that proportion was 23.6 percentage points higher for those socially assigned as White than for those socially assigned as Black (P<.01). On the other hand, no significant differences were found between those socially assigned as White who self-identified as White and those socially assigned as White who self-identified as Hispanic, as American Indian, or with More than one race. CONCLUSIONS: Being classified by others as White is associated with large and statistically significant advantages in health status, no matter how one self-identifies.

Survey of Alouatta caraya, the black-and-gold howler monkey, and Alouatta guariba clamitans, the brown howler monkey, in a contact zone, State of Rio Grande do Sul, Brazil: evidence for hybridization.

Sympatry and natural hybridization between howler monkey taxa (Alouatta spp.) has only recently being confirmed in the wild. Surveys in areas of potential contact between the distribution of two taxa have shown that sympatry is rare, although more common than previously known. Here we report the results of a survey conducted in a contact zone between the only two sexually dichromatic howler monkey taxa, Alouatta caraya and A. guariba clamitans, in São Francisco de Assis, State of Rio Grande do Sul, Brazil. Our survey, covering an area of about 400 ha at the Cerro dos Negros (29 degrees 33'50''-29 degrees 35'10''S, 54 degrees 58'40''-54 degrees 59'50''W; approximately 100-279 m a.s.l.), was successful in locating seven black-and-gold and one brown howler monkey social groups living syntopically. Black-and-gold group size ranged from 5 to 15 individuals, whereas the brown group was composed of 7 individuals. The pelage color of three adult males belonging to different black-and-gold groups and another adult male belonging to the brown howler group presented a mosaic of red or rufous and black. These adult males and an adult female living in another black-and-gold group are putative hybrids. Therefore, it appears that pre-zygotic reproductive isolation has not evolved, at least not completely, between these howler monkey species, corroborating previous reports for these and other Alouatta taxa. Future genetic studies need to confirm the occurrence of hybridization in this contact zone, and to determine the viability and fertility of hybrids and their possible offspring. In addition, there is no evidence supporting the existence of significant segregation in habitat and resource utilization by black-and-gold and brown howler monkeys.

Overweight and human immunodeficiency virus (HIV) progression in women: associations HIV disease progression and changes in body mass index in women in the HIV epidemiology research study cohort.

An association of increased weight with a slower progression of human immunodeficiency virus (HIV) disease has been reported in studies that have not included large numbers of women. We evaluated the association of HIV disease progression with body mass index (BMI) in 871 women and present cross-sectional, survival, and longitudinal analyses. A higher baseline BMI was associated with a lower rate of occurrence of the first CD4 cell count <200 cells/mm(3). In analyses that incorporated time-varying BMI, underweight and normal women had an increased risk of clinical acquired immune deficiency syndrome, and underweight women had increased risk of HIV-related death, compared with obese women. The association between change in BMI and CD4 cell count was estimated; increases in BMI were associated with slight increases in CD4 cell counts, even after controlling for prior values of CD4 cell count, viral load, and treatment. Higher BMI and increases in BMI are associated with a decreased risk of HIV progression.

Effect of dietary intake and protease inhibitors on serum vitamin B12 levels in a cohort of human immunodeficiency virus-positive patients.

The dietary intake of micronutrients and serum micronutrient status have been topics of concern in relation to human immunodeficiency virus (HIV) progression. Most data, however, were collected prior to the introduction of protease inhibitors (PIs). We analyzed dietary intake and serum values of vitamin B(12), including the effect of PIs, in a cohort of persons with HIV infection. During intervals with no PI use, each 1 microg/day increase in B(12) intake was associated with a 1.06 pg/mL increase in serum B(12) levels. However, during intervals with PI use, each 1 microg/day increase in intake was associated with only a 0.12 increase in serum B(12) levels. Adequate serum B(12) levels (>350 pg/mL) cannot be assumed even in the presence of PIs, and dietary supplementation may not be adequate to significantly increase serum B(12) levels. Serum B(12) levels should be determined yearly in persons with HIV infection, regardless of whether they are receiving PI treatment.

Hunting restraint by Creoles at the Community Baboon Sanctuary, Belize: a preliminary survey.

This study surveyed 33 male hunters between the ages of 17 and 54 at the Community Baboon Sanctuary (CBS), Belize, to evaluate attitudes and behaviors in relation to hunting black howler monkeys (Alouatta pigra). The study defined hunting restraint as a learned predisposition not to hunt 1 or more species of nonhuman animal. Consistent with Belizean folklore, Creoles at the CBS exhibited hunting restraint with respect to black howlers, preferring to kill bushmeat other than monkeys. The most cited reasons for the observed hunting restraint were utilitarian. Historical and cultural factors also appeared significant. The study results are interpreted in terms of economic theory and suggest that disinhibition of hunting restraint might depend on changes in opportunity costs of hunting these primates. Nonetheless, a change in hunting attitudes and behaviors by Belizean Creoles seems unlikely in the near future because the local and national government and the benefits of ecotourism economically and legally protect howlers. The Creoles' culturally transmitted hunting restraint also culturally protects A. pigra, and the species is not a preferred source of food.

Micronutrient concentrations and subclinical atherosclerosis in adults with HIV.

BACKGROUND: Extremes in micronutrient intakes are common in HIV-infected patients in developed countries and may affect the progression of atherosclerosis in this population. OBJECTIVE: We completed a cross-sectional study examining the association between serum micronutrient concentrations and surrogate markers of atherosclerosis in a cohort of HIV-infected adults. DESIGN: We measured serum selenium, zinc, vitamin A, and vitamin E concentrations as well as carotid intima-media thickness (c-IMT) and coronary artery calcium (CAC) in 298 Nutrition for Healthy Living participants. We assessed cardiovascular disease risk factors, c-IMT, and CAC for each micronutrient tertile by using a chi-square test for binary variables and analysis of variance for continuous variables. We performed multivariate regression of c-IMT and CAC with each micronutrient with adjustment for HIV-related and cardiovascular disease risk factors. RESULTS: In the multivariate analysis, the highest tertile of serum vitamin E concentration was associated with higher common and internal c-IMT and CAC scores (P < 0.05 for c-IMT and CAC). Participants with higher vitamin E concentrations were more likely to have detectable CAC (50% compared with 44% compared with 67% for tertiles 1, 2, and 3, respectively; P = 0.004) and common c-IMT >0.8 mm (5% compared with 4% compared with 17% for tertiles 1, 2, and 3, respectively; P = 0.002). Other than vitamin E, micronutrients had no association with markers of atherosclerosis. CONCLUSIONS: Our study showed that elevated serum vitamin E concentrations are associated with abnormal markers of atherosclerosis and may increase the risk of cardiovascular complications in HIV-infected adults.

Addressing the social determinants of children's health: a cliff analogy.

This paper presents a "Cliff Analogy" illustrating three dimensions of health intervention to help people who are falling off of the cliff of good health: providing health services, addressing the social determinants of health, and addressing the social determinants of equity. In the terms of the analogy, health services include an ambulance at the bottom of the cliff, a net or trampoline halfway down, and a fence at the top of the cliff. Addressing the social determinants of health involves the deliberate movement of the population away from the edge of the cliff. Addressing the social determinants of equity acknowledges that the cliff is three-dimensional and involves interventions on the structures, policies, practices, norms, and values that differentially distribute resources and risks along the cliff face. The authors affirm that we need to address both the social determinants of health, including poverty, and the social determinants of equity, including racism, if we are to improve health outcomes and eliminate health disparities.

Multimodal communication by male mantled howler monkeys (Alouatta palliata) in sexual contexts: a descriptive analysis.

We analyzed continuously sampled focal and ad libitum data of male mantled howler monkeys (Alouatta palliata) observed in random order. Males resided in two groups in a Costa Rican tropical dry forest environment (riparian habitat group: 3 males, 15 females, 402 h observation; deciduous habitat group: 2 males, 8 females, 114 h observation). Samples were limited to sexual contexts, in particular, the 60-min periods before and after each copulation observed within each group for each male. Time samples for each male were distributed equally before and after their own copulations. Before statistical analyses were conducted, data were corrected for differences in time sampled for males within each group. Four types of multimodal signaling were resolved: (1) audiovisual, (2) olfactory-visual, (3) olfactory-visual-tactile and (4) tactile-gustatory. Olfactory and tactile signals were never observed in combination with auditory signals. Consistent with expectation for a Neotropical, arboreal species, audiovisual signals were the most frequently observed type of multimodal communication in both groups (riparian habitat group: n = 139; deciduous habitat group: n = 66). Our evidence strongly suggests that unimodal signals may be combined and recombined to form complex, multimodal signals. Subordinate males in each group were more likely than dominant males to emit audiovisual signals before their own copulations. Male dyads were compared to assess the relative rate of audiovisual signaling by one male before another male's copulations. On average, the subordinate male of the riparian habitat group exhibited audiovisual signals at a higher rate before his own copulations compared to the rate of audiovisual signaling by his dominant challengers. The same comparisons are not significant for males in the deciduous habitat group. The pattern of male response that we report whereby subordinates emit some complex signals at a higher rate than dominants supports the 'terminal investment hypothesis' predicting that organisms should increase reproductive effort with age since, in mantled howlers, age correlates negatively with dominance rank. Additional, qualitative observations suggested that subordinates in both groups were most likely to obtain copulations when they increased rates of complex signaling and/or escalated interactions with their male challengers. Group differences were apparent, however, and we suggest factors that may account for these patterns. We assessed responses by female receivers of complex signals emitted by males in sexual contexts. In general, higher-ranking males are more attractive to females and are more successful at monopolizing them. Findings for other, less frequently displayed, multimodal signals (olfactory-visual, olfactory-visual-tactile and tactile-gustatory) are presented and discussed. We conclude with the suggestion that howlers may be a robust model for the investigation of complex signals in Neotropical primates, including research on functionally referential communication and context-dependent syntax.

Obesity in HIV-infection: dietary correlates.

OBJECTIVE: To describe the prevalence of obesity among a cohort of individuals living with HIV infection, and to determine differences in dietary intake among those subjects who are normal weight, overweight, and obese. DESIGN: A cross-sectional study among participants enrolled in the Nutrition for Healthy Living (NFHL) study. SETTING: Eligible participants included HIV-positive adults living in the greater Boston, MA and Providence, RI, areas. Subjects and Measures of Outcome: In total, 321 (265 males, 56 females) subjects were studied. Body composition measurements, demographic and health data, and fasting blood samples were analyzed. Dietary intake was assessed by three-day food records. Statistical analyses were performed using Statistical Package for Social Science (SPSS). RESULTS: 13% of males and 29% females were found to be obese. Energy intake per kilogram decreased by body mass index (BMI) category for both men and women (p <0.05). Although not different between groups, mean total fat and saturated fat intakes were above recommendations for both men and women in all BMI categories, while total grams dietary fiber decreased as BMI increased. Individuals in all BMI groups had micronutrient intakes below the Dietary Reference Intakes. Serum markers of insulin resistance were significantly different by BMI category among men and women, as well as triglycerides and total cholesterol for the males. CONCLUSIONS: Obesity and diet in individuals living with HIV-infection needs to be addressed, as quality of dietary intake may have future implications regarding cardiovascular disease, metabolic syndrome, and other health risks associated with overweight and obesity.

Micronutrient levels and HIV disease status in HIV-infected patients on highly active antiretroviral therapy in the Nutrition for Healthy Living cohort.

BACKGROUND: Low serum micronutrient levels were common before widespread use of highly active antiretroviral therapy (HAART) and were associated with adverse outcomes. Few data are available on micronutrient levels in subjects taking HAART. OBJECTIVE: To determine the prevalence of low serum retinol, alpha-tocopherol, zinc, and selenium in HIV-infected subjects taking HAART and to assess the association of micronutrient levels with HIV disease status. DESIGN: Cross-sectional. SETTING: Nutrition for Healthy Living (NFHL) study. PARTICIPANTS: HIV-infected subjects on HAART. METHODS: Retinol, alpha-tocopherol, zinc, and selenium were determined in frozen serum samples from 171 men and 117 women. Low serum levels were defined as retinol <30 microg/dL, selenium <85 microg/L, alpha-tocopherol <500 microg/dL, and zinc <670 microg/L. Association of micronutrient quartiles with CD4 cell count, CD4 count <200 cells/mm, HIV viral load (VL), and undetectable VL was assessed using adjusted multivariate regression. RESULTS: Five percent of men and 14% of women had low retinol, 8% of men and 3% of women had low selenium, and 7% of men and no women had low alpha-tocopherol. Forty percent of men and 36% of women had low zinc, however. Subjects in the upper quartiles of zinc had lower log VL levels than those in the lowest quartile (significant for women). Subjects in the upper quartiles of selenium also tended to have lower VL levels compared with those in the lowest quartile. Surprisingly, women in the upper quartiles of retinol had higher log VLs than those in the lowest quartile. There was no significant association of any micronutrient with CD4 cell count or likelihood of CD4 count <200 cells/mm. The level of CD4 cell count influenced the association of retinol with log VL in men, however. In men with CD4 counts >350 cells/mm, those with higher retinol had higher log VLs compared with the lowest quartile, whereas in men with CD4 counts <350, those with higher retinol levels had lower log VLs compared with the lowest quartile. CONCLUSIONS: Low retinol, alpha-tocopherol, and selenium are uncommon in HIV-infected subjects on HAART. Zinc deficiency remains common, however. Decreased retinol levels in women and in men with CD4 counts >350 cells/mm and increased zinc and selenium levels in both genders may be associated with improved virologic control.