New Dibenzocyclooctadiene Lignans and Phenolics from Kadsura heteroclite with Anti-Inflammatory Activity.

A chemical investigation of K. heteroclite led to isolation of two new dibenzocyclooctadienes (1 and 2) together with 14 known compounds (3-16) by using multiple chromatographic techniques. New compounds (1 and 2) were obtained and identified by spectroscopic methods (HR-ESI-MS, 1D and 2D NMR, and ECD) as well as by comparison of their experimental data with those reported in the literatures. All the isolates were evaluated for their ability to modulate TNF-α production in lipopolysaccharide (LPS) stimulated RAW264.7 cells. Among them, compound 5 displayed the most inhibition against tumor necrosis factor (TNF)-α production with IC50 value of 6.16±0.14 µM. Whereas, compounds (1, 3, and 6) showed the significant inhibition (IC50 values ranging from 9.41 to 14.54 µM), and compounds (2, 4, 9, 10, 13, 15, and 16) exhibited moderate inhibition (IC50 values ranging from 19.27 to 40.64 µM) toward TNF-α production, respectively.

Normal values for high-resolution anorectal manometry in healthy young adults: evidence from Vietnam.

BACKGROUND: High-resolution anorectal manometry (HRAM) has been developed to improve measurement of anorectal functions. This study aims to identify normal HRAM values in healthy young Vietnamese adults. METHODS: We conducted a cross-sectional study at the National Hospital of Traditional Medicine (Hanoi, Vietnam) from July through December 2014. Healthy young adults were invited to participate in the study. All anorectal measurement values were performed using the ISOLAB high-resolution manometry system. Differences between groups were analyzed using Student's t-tests. RESULTS: Thirty healthy young adults, including 15 males and 15 females aged 19-26 years, were recruited. Mean functional anal canal length was 3.4 ± 0.5 cm (range: 2.4-4.8 mm). Mean maximum resting pressure, mean maximum squeezing pressure, mean maximum coughing pressure, and mean maximum strain pressure were 65.5, 168.0, 125.9, and 84.2 mm Hg, respectively. All anal pressure values were significantly different between males and females. For rectal sensation measurements, only the volume at first sensation was significantly higher in males than in females. CONCLUSIONS: This study provides normal HRAM value for healthy young adults in Vietnam. Sex may influence anal pressure and first rectal sensation values in this cohort. Further studies should be conducted in order to improve the quality of HRAM normal values and to confirm the effects of sex.

Pseudomonas neustonica sp. nov., isolated from the sea surface microlayer of the Ross Sea (Antarctica).

Gram-stain-negative, aerobic and rod-shaped bacterial strains, designated SSM26T and SSM44, were isolated from a sea surface microlayer sample from the Ross Sea, Antarctica. Analysis of the 16S rRNA gene sequences of strains SSM26T and SSM44 revealed a clear affiliation with the genus Pseudomonas. Based on the results of phylogenetic analysis, strains SSM26T and SSM44 showed the closest phylogenetic relationship with the species Pseudomonas sabulinigri KCTC 22137T with the 16S rRNA gene sequence similarity level of 98.5 %. Strains SSM26T and SSM44 grew optimally at 30 °C, pH 7.0-7.5 and 0.5-10.0 % NaCl (w/v). The major cellular fatty acids were C18 : 1 ω7c (31.3-34.9 %), C16 : 0 (15.5-20.2 %), summed feature 3 (C16 : 1 ω7c/C16 : 1 ω6c; 19.5-25.4 %) and C12 : 0 (6.0-9.3 %). The genomic DNA G+C content of each strain was 56.2 mol%. Genomic relatedness analyses based on the average nucleotide identity and the genome-to-genome distance showed that strains SSM26T and SSM44 constituted a single species that was clearly distinguishable from its phylogenetically close relatives. The combined phenotypic, chemotaxonomic, genomic and phylogenetic data also showed that strains SSM26T and SSM44 could be distinguished from validly published members of the genus Pseudomonas. Thus, these strains should be classified as representing a novel species in the genus Pseudomonas, for which the name Pseudomonas neustonica sp. nov. is proposed with the type strain SSM26T (=KCCM 43193T=JCM 31284T=PAMC 28426T) and a sister strain SSM44 (=KCCM 43194=JCM 31285=PAMC 28427).

Pretyphoon panic attack history moderates the relationship between degree of typhoon exposure and posttyphoon PTSD and depression in a Vietnamese sample.

BACKGROUND: Predisaster risk factors are related to postdisaster psychopathology even at relatively low levels of disaster exposure. A history of panic attacks (PA) may convey risk for postdisaster psychopathology and has been linked to a wide range of psychiatric disorders in Western and non-Western samples. The present study examined the main and interactive effects of pretyphoon PA and level of typhoon exposure in the onset of posttyphoon posttraumatic stress disorder (PTSD), major depression (MDD), and generalized anxiety disorder (GAD) in a Vietnamese sample of typhoon survivors. METHODS: Typhoon Xangsane interrupted a Vietnamese epidemiological mental health needs assessment, providing a rare opportunity for preand posttyphoon assessments. Hierarchical logistic regression analyses evaluated whether the main and interactive effects of typhoon exposure severity and PA history were significantly related to posttyphoon diagnoses, above and beyond age, health status, pretyphoon psychiatric screening results, and history of potentially traumatic events. RESULTS: PA history moderated the relationship between severity of typhoon exposure and posttyphoon PTSD and MDD, but not GAD. Specifically, greater degree of exposure to the typhoon was significantly related to increased likelihood of postdisaster PTSD and MDD among individuals without a history of PA, above and beyond variance accounted for by pretyphoon psychiatric screening results. Individuals with a history of PA evidenced greater risk for postdisaster PTSD and MDD regardless of severity of typhoon exposure. CONCLUSIONS: Preexisting PA may affect the nature of the relationship between disaster characteristics and prevalence of postdisaster PTSD and MDD within Vietnamese samples.

Evaluation of the psychometric properties of the Self-Reporting Questionnaire (SRQ-20) in a sample of Vietnamese adults.

PURPOSE: There are significant gaps in the literature on the prevalence of mental health problems and associated needs in Vietnam. A thorough understanding of culture-specific expressions of psychiatric distress is vital for the identification of the mental health needs of a community, and more research on the development and evaluation of culturally-sensitive mental health assessments is warranted. This study aims to evaluate the psychometric properties of the World Health Organization 20-item Self-Reporting Questionnaire (SRQ-20) in an epidemiologic study of Vietnamese adults. METHODS: A latent variable modeling approach investigated the underlying factor structure of the SRQ-20 items. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted on SRQ-20 item-level data gathered from 4980 participants. RESULTS: Based on scree plots and EFA results, two latent structures were deemed plausible and were subsequently subjected to further modeling. A bi-factor model (BFM) and a correlated three-factor model solution (Negative Affect, Somatic Complaints, and Hopelessness) provided reasonable fits. The BFM specifies a single dominant General Distress factor (all SRQ-20 items) with orthogonal group factors for the subsets of items: Negative Affect (9 items), Somatic Complaints (8 items), and Hopelessness (3 items). This model fit the data as well or better than the three-factor model. Results also showed differences in endorsement rates of SRQ-20 items among males and females. CONCLUSIONS: Study results provide an evaluation of the psychometric properties of a commonly used screening tool and offer insight into the presentation of mental distress in a representative sample of Vietnamese adults.

Pre-typhoon socioeconomic status factors predict post-typhoon psychiatric symptoms in a Vietnamese sample.

PURPOSE: Exposure to natural disasters has been associated with increased risk for various forms of psychopathology. Evidence indicates that socioeconomic status (SES) may be important for understanding post-disaster psychiatric distress; however, studies of SES-relevant factors in non-Western, disaster-exposed samples are lacking. The primary aim of the current study was to examine the role of pre-typhoon SES-relevant factors in relation to post-typhoon psychiatric symptoms among Vietnamese individuals exposed to Typhoon Xangsane. METHODS: In 2006, Typhoon Xangsane disrupted a mental health needs assessment in Vietnam in which the Self Reporting Questionnaire-20 (SRQ-20), and the Demographic and Health Surveys Wealth Index, a measure of SES created for use in low-income countries, were administered pre-typhoon. The SRQ-20 was re-administered post-typhoon. RESULTS: Results of a linear mixed model indicated that the covariates of older age, female sex, and higher levels of pre-typhoon psychiatric symptoms were associated with higher levels of post-typhoon psychiatric symptoms. Analysis of SES indicators revealed that owning fewer consumer goods, having lower quality of household services, and having attained less education were associated with higher levels of post-typhoon symptoms, above and beyond the covariates, whereas quality of the household build, employment status, and insurance status were not related to post-typhoon psychiatric symptoms. CONCLUSION: Even after controlling for demographic characteristics and pre-typhoon psychiatric symptoms, certain SES factors uniquely predicted post-typhoon psychiatric distress. These SES characteristics may be useful for identifying individuals in developing countries who are in need of early intervention following disaster exposure.

Neural Networks for Portfolio Analysis in High-Frequency Trading.

High-frequency trading proposes new challenges to classical portfolio selection problems. Especially, the timely and accurate solution of portfolios is highly demanded in financial market nowadays. This article makes progress along this direction by proposing novel neural networks with softmax equalization to address the problem. To the best of our knowledge, this is the first time that softmax technique is used to deal with equation constraints in portfolio selections. Theoretical analysis shows that the proposed method is globally convergent to the optimum of the optimization formulation of portfolio selection. Experiments based on real stock data verify the effectiveness of the proposed solution. It is worth mentioning that the two proposed models achieve 5.50 % and 5.47 % less cost, respectively, than the solution obtained by using MATLAB dedicated solvers, which demonstrates the superiority of the proposed strategies.

Egret Swarm Optimization Algorithm: An Evolutionary Computation Approach for Model Free Optimization.

A novel meta-heuristic algorithm named Egret Swarm Optimization Algorithm (ESOA) is proposed in this paper, which is inspired by two egret species' hunting behavior (Great Egret and Snowy Egret). ESOA consists of three primary components: a sit-and-wait strategy, aggressive strategy as well as discriminant conditions. The learnable sit-and-wait strategy guides the egret to the most probable solution by applying a pseudo gradient estimator. The aggressive strategy uses random wandering and encirclement mechanisms to allow for optimal solution exploration. The discriminant model is utilized to balance the two strategies. The proposed approach provides a parallel framework and a strategy for parameter learning through historical information that can be adapted to most scenarios and has well stability. The performance of ESOA on 36 benchmark functions as well as 3 engineering problems are compared with Particle Swarm Optimization (PSO), Genetic Algorithm (GA), Differential Evolution (DE), Grey Wolf Optimizer (GWO), and Harris Hawks Optimization (HHO). The result proves the superior effectiveness and robustness of ESOA. ESOA acquires the winner in all unimodal functions and reaches statistic scores all above 9.9, while the scores are better in complex functions as 10.96 and 11.92.

Secondary metabolites from Valeriana jatamansi with their anti-inflammatory activity.

Valeriana jatamansi is hired as multiple remedies for treatment of insomnia, blood and circulatory disorders, asthma, dry cough, jaundice, seminal weakness, cardiac debility, and skin diseases in Vietnam. Our research discovered the phytochemical investigation of constituents from this herbal medicine resulted in the isolation of two new compounds (jatamansides A (4) and B (7)) together with 16 known ones from the whole plant. Their structures were established by using spectroscopic techniques (multinuclear and multidimensional nuclear magnetic resonance, infrared, ultraviolet-visible), mass spectrometry, hydrolysis analysis, or comparing their NMR data to those reported in the literature. In addition, all the isolates were evaluated for their inhibitory effect against TNF-α production in LPS-stimulated on RAW264.7 cells with significant inhibition.

Cytotoxic and PPARs transcriptional activities of sterols from the Vietnamese soft coral Lobophytum laevigatum.

A new unusual sterol, named lobophytosterol (1), and five known metabolites (2-6) were isolated from the methanol extract of the soft coral Lobophytum laevigatum. Their chemical structures were elucidated by extensive spectroscopic analysis and comparison with those reported in the literature. The absolute stereochemistry of 1 was determined using a modified Mosher's method. Compounds 1-3 showed cytotoxic activity against HCT-116 cells with IC(50) values of 3.2, 6.9 and 18.1 µM, respectively. Compound 1 additionally displayed cytotoxic effects on A549 and HL-60 cells with IC(50) values of 4.5 and 5.6 µM, respectively. Treatment of these cells with compound 1 resulted in an induction of apoptosis evident by chromatin condensation in treated cells. Besides, compounds 2, 4, and 6 significantly upregulated PPARs transcriptional activity dose-dependently in Hep-G2 cells. Taken together, these data suggest that compound 1 might inhibit the growth of the cancer cells by the induction of apoptosis, and compounds 2, 4, and 6 might act as specific agonists for PPARα, PPARδ, and PPARγ and may therefore regulate cellular glucose, lipid, and cholesterol metabolism.

Cytotoxic and anti-inflammatory cembranoids from the Vietnamese soft coral Lobophytum laevigatum.

Four new cembranoids, namely laevigatol A-D (1-4), and six known metabolites (5-10), were isolated from the Vietnamese soft coral Lobophytum laevigatum. The structures of these compounds were elucidated by extensive spectroscopic analyses, and the absolute stereochemistry of 1 was determined using the modified Mosher's method. Compounds 5, and 7-10 exhibited cytotoxic activity against selected human cancer cell lines. Compounds 1, 2, 8, and 9 showed dose-dependent inhibitory effects on the TNFα-induced NF-κB transcriptional activity in Hep-G2 cells. Moreover, compounds 1, 2, 8, and 9 significantly inhibited the induction of COX-2 and iNOS mRNA dose-dependently, indicating that these compounds attenuated the synthesis of these transcripts at the transcriptional level.

Prevalence and correlates of probable adolescent mental health problems reported by parents in Vietnam.

PURPOSE: The purpose of the present study was to estimate the prevalence of probable mental health problems in an epidemiologic study of Vietnamese adolescents. A secondary aim was to examine the correlates of probable mental health caseness. METHODS: Interviewers visited 1,914 households that were randomly selected to participate in a multi-agency study of mental health in select provinces of Vietnam. Semi-structured interviews assessed adolescent mental health problems using the Strengths and Difficulties Questionnaire (SDQ) parent informant version, and additionally the interviewers collected information on demographic variables (age, gender, ethnic group, religious affiliation, social capital). The final sample included data on 1,368 adolescents (aged 11-18 years). RESULTS: The average score on the total problem composite of the SDQ scale was 6.66 (SD=4.89), and 9.1% of the sample was considered a case (n=124). Bivariate analyses were conducted to determine which demographic variables were related to the SDQ case/non-case score. All variables except gender were significant in bivariate analyses, and therefore were entered into a logistic regression. Results indicated that age, religion, and wealth remained significant predictors of probable caseness. CONCLUSIONS: Overall, prevalence estimates of mental health problems generated by the SDQ were consistent with those reported in the US and other Western and non-Western samples. Results of the current study suggest some concordance of risk and protective factors between Western and Vietnamese youth (i.e., age and SES).

Anorectal Functional Outcomes Following Doppler-Guided Transanal Hemorrhoidal Dearterialization: Evidence from Vietnam.

INTRODUCTION: Doppler-guided transanal hemorrhoidal dearterialization (THD) was considered a less invasive and innovative method to treat hemorrhoidal disease, but it may impact the anal area during dearterialization and mucopexy. Thus, this study aimed to assess any changes in anorectal manometry of grade III and IV hemorrhoidal patients following THD treatment. METHODS: This prospective observational study was conducted with patients who had grades III and IV hemorrhoidal disease. The patients were treated using THD at the Department of Surgery in the National Hospital of Traditional Medicine (Hanoi, Vietnam) between June 2012 and December 2013. Anorectal manometry was performed prior to THD and again between 6 and 12 months following the procedure. RESULTS: A total of 40 patients were enrolled in the study, including 32 with grade III hemorrhoids and 8 with grade IV hemorrhoids. The proportion of male patients (65%) was higher than that of female patients (35%), and the majority of patients (82.5%) were > 40 years old. The mean duration of symptoms prior to treatment was 12.3 years. The mean length of the anal sphincter was unchanged before and after THD (3.64 ± 0.40 cm prior to treatment vs. 3.66 ± 0.48 cm following treatment; p = 0.57). Significant differences in treatment-related changes were detected for all anorectal manometric measurements except maximum squeezing pressure (p < 0.05). No patient showed anal stenosis or fecal incontinence. CONCLUSION: The THD technique did not change the length of the anal sphincter 6 months after hemorrhoid treatment. The values of anal pressure and rectal sensation decreased almost significantly between treatment and the follow-up visit. We suggest that further studies, which include larger sample sizes, should be conducted to confirm THD effectiveness in terms of anorectal functions.

Posttyphoon prevalence of posttraumatic stress disorder, major depressive disorder, panic disorder, and generalized anxiety disorder in a Vietnamese sample.

In 2006, typhoon Xangsane disrupted a multiagency health needs study of 4,982 individuals in Vietnam. Following this disaster, 798 of the original participants were reinterviewed to determine prevalence and risk factors associated with posttraumatic stress disorder (PTSD), major depressive disorder (MDD), panic disorder (PD), and generalized anxiety disorder (GAD). Posttyphoon prevalences were PTSD 2.6%, MDD 5.9%, PD 9.3%, and GAD 2.2%. Of those meeting criteria for a disorder, 70% reported only one disorder, 15% had two, 14% had three, and 1% met criteria for all four disorders. Risk factors for posttyphoon psychopathology differed among disorders, but generally were related to high typhoon exposure, prior trauma exposure, and in contrast to Western populations, higher age, but not gender.

Comparison of Doppler-Guided Transanal Hemorrhoidal Dearterialization for Grade III and IV Hemorrhoids in Vietnam.

INTRODUCTION: This study aimed to assess the short- and long-term outcomes of Doppler-guided transanal hemorrhoidal dearterialization (THD) for grade III and IV hemorrhoidal disease in Vietnam. METHODS: In a prospective observational design, patients treated for grade III and IV hemorrhoidal disease with the THD method at the National Hospital of Traditional Medicine (Hanoi, Vietnam) were included between June 2012 and December 2013. Patients were evaluated postoperatively at the time they were discharged from the hospital (short-term outcome) and 6 months after surgery (long-term outcome). RESULTS: A total of 128 patients were enrolled in the study, 94 were classified with grade III disease and 34 with grade IV. Grade IV hemorrhoidal patients reported on average 18.2 years of disease symptom duration, while grade III hemorrhoidal patients reported 11.2 years. All patients with grade III and grade IV hemorrhoidal disease had good outcomes at discharge day and reported to return to work in a median of 6 days after THD. At long-term follow-up, the results were good for 80.9% of patients from grade III hemorrhoidal disease and 61.8% of patients from grade IV hemorrhoidal disease. Patient satisfaction with the procedure and outcomes was 93.6% for grade III and 85.3% for grade IV hemorrhoidal patients. CONCLUSIONS: The THD technique was shown to be safe for both grade III and IV hemorrhoidal patients. The THD technique showed better results with grade III hemorrhoidal patients as compared to grade IV hemorrhoidal patients.

Accuracy of child growth-monitoring weights obtained by commune volunteers in Phu Tho Province, Vietnam.

BACKGROUND: Weight-for-age is a commonly used indicator of the health of children and communities. We determined the accuracy of health volunteers' weight measurements in a nutrition project in Vietnam. OBJECTIVE: To report the accuracy of the volunteers' weight measurements and to assess the likely effect of any inaccuracies. METHODS: Save the Children /USA trained health volunteers to weigh children (6-36 months old) every other month from December 1999 to August 2000. Trained researchers randomly rechecked 257 weights (range, 24-114 per session). We computed nondirectional and directional differences between the weights measured by volunteers and those measured by researchers. RESULTS: The weights recorded by volunteers were lower than those recorded by researchers by an average of 30 g (p < .05). Almost all of the error occurred during the first weighing session, at which the average weight recorded by volunteers was 280 g below that recorded by researchers (p = .01). The error at subsequent weighings was minimal (< 20 g below reference at each session). CONCLUSIONS: One-time directional error suggests bias. Perhaps some communities (or families) influenced the volunteers to report weights lower than those actually observed to justify the programmatic food supplements or to give the impression at subsequent weighings that the level of malnutrition had been successfully reduced from that at the first session. Careful supervision of measurements of weight at baseline is essential.

An integrated child nutrition intervention improved growth of younger, more malnourished children in northern Viet Nam.

Integrated nutrition programs are widely used to prevent and/or reverse childhood malnutrition, but rarely rigorously evaluated. The impact of such a program on the physical growth of young rural Vietnamese children was measured. We randomized six communes to receive an integrated nutrition program implemented by Save the Children. We matched six communes to serve as controls. Our sample consisted of 238 children (n = 119 per group) who were 5 to 25 months old on entry. Between December 1999 and December 2000, we measured weight and height monthly for seven months and again at month 12. Principle outcomes were weight-for-age Z score (WAZ), height-for-age Z score (HAZ), and weight-for-height Z score (WHZ), and the changes among these measures. As expected, anthropometric indicators relative to international references worsened as the children aged. Overall, children in the intervention communes who were exposed to the integrated nutrition program did not show statistically significant better growth than comparison children. Intervention children who were younger (15 months or less) and more malnourished (less than-2 Z) at baseline, however, deteriorated significantly less than their comparable counterparts. Between baseline and month four, for example, intervention children who were malnourished and less than 15 months old at entry lost on average 0.05 WAZ while similar comparison children lost 0.25 WAZ (p = .02). Lack of overall impact on growth may be due to a lower than expected prevalence of malnutrition at baseline and/or deworming of comparison children. Targeting nutrition interventions at very young children will have the maximum impact on growth.

Effect of an integrated child nutrition intervention on the complementary food intake of young children in rural north Viet Nam.

Forty-two percent of Vietnamese children are stunted by two years of age. Since 1990, Save the Children Federation/US (SC) has implemented integrated nutrition programs targeting young children. We evaluated the effect of SC's nutrition program on the complementary food intake of young rural Vietnamese children. Using a longitudinal, prospective, randomized design, we followed 238 children (119 each from intervention and comparison communes) age 5 to 25 months old for six months with a re-survey at 12 months. We gathered 24-hour recall data at baseline and at months 2, 4, 6, and 12. Dietary energy intake was calculated using the 1972 Vietnamese food composition table. Key outcomes were daily frequency of consuming intervention-promoted food and non-breastmilk liquids and food, daily quantity of non-breastmilk liquids and food consumed, daily energy intake, and proportion of children meeting daily median energy requirements. Young rural children exposed to SC's program consumed intervention-promoted, and any, foods more frequently, ate a greater quantity of any food, consumed more energy, and were more likely to meet their daily energy requirements than comparison children. Some effects were only observed during the intensive intervention period; others persisted into or were evident only at the 12-month follow-up, approximately four months after program completion. Based on the mothers' reports, the intervention did not apparently compromise breastfeeding prevalence or frequency. The intervention improved children's food and energy intake and protected them from declining as rapidly as comparison children in meeting their energy requirements.

Effect of an integrated nutrition program on child morbidity due to respiratory infection and diarrhea in northern Viet Nam.

Infectious disease and poor diet are the two proximal causes of malnutrition in children. During the 1990s, integrated nutrition programs implemented by Save the Children (SC) in Viet Nam reduced severe child malnutrition, but it has not been clear if this impact was due primarily to improved diet or reduced disease. The aim of this study was to determine whether a community-based, integrated nutrition program in Viet Nam reduced child morbidity due to diarrhea or acute respiratory infections. Children 5 to 25 months old were randomly selected from randomly assigned intervention and comparison communes. Caregivers of children from the intervention and comparison groups (n = 119 per group) were interviewed about their child's morbidity at program baseline and at study months 2, 4, 6, and 12. Multiple logistic regression and general estimating equations (GEE) were used to evaluate the effect of the intervention on the occurrence of any diarrhea and respiratory illness in the preceding two weeks. Respiratory illness, mainly upper respiratory illness, was more common than diarrheal disease at baseline (54% vs. 6%, respectively). During follow-up, children in the intervention communes had approximately half the respiratory illness experienced by those in comparison communes (AOR = 0.5; p = .001). Diarrheal disease was also lower in the intervention group, although differences were not statistically significant. We conclude that SC's integrated nutrition program was associated with reduced upper respiratory illness, perhaps due to improved hygiene practices and/or improved micronutrient intakes.

Implementation of nutrition education and rehabilitation programs (NERPs) in Viet Nam.

Rigorous assessments of program quality are uncommon in developing countries. We evaluated the quality of the two-week, volunteer-facilitated, caregiver-child rehabilitation "hearth," or nutrition education and rehabilitation program (NERP), sessions in Save the Children's integrated nutrition program in Viet Nam. Field workers observed attendance, food contribution, food preparation, meal consumption, health message delivery, hygiene, and weighing at 240 NERP days at 59 NERP centers during seven months of implementation. Participation in cooking NERP meals (75.8%), washing mothers' and children's hands (75.7% and 81.6%, respectively), and weighing (74.5% on days 1 and 12) were high, but attendance rates (50.3%), food contributions (20.3%), and health message delivery (20.0%) were lower than expected, all with wide variation among communes, ecology, NERP day, and NERP round. Contrary to protocol, food was often delivered to malnourished children who stayed at home to accommodate caregivers' workloads and other constraints. While home-delivery of food prevented caregivers from learning from each other in a group, it did bring "tangible messages" (i.e., a large serving size of a new food) to the doorstep. Health volunteers were wise to stress active learning over repetitive message delivery. In summary, these NERPs were probably typical of previous NERPs although comparable quality measures are lacking. Despite imperfect implementation, the NERP's active-learning and local problem-solving helped achieve measurable impact on growth, diet, morbidity, and empowerment despite uncommon program challenges, such as uncharacteristically low baseline levels of malnutrition and high population dispersion. Regular quality monitoring may enhance impact even further.