A Pilot Randomized Clinical Trial of Intranasal Oxytocin to Promote Weight Loss in Individuals With Hypothalamic Obesity.

Context: Hypothalamic obesity is a rare, treatment-resistant form of obesity. In preliminary studies, the hypothalamic hormone oxytocin (OXT) has shown promise as a potential weight loss therapy. Objective: To determine whether 8 weeks of intranasal OXT (vs 8 weeks of placebo) promotes weight loss in children, adolescents, and young adults with hypothalamic obesity. Methods: This randomized, double-blind, placebo-controlled, crossover pilot trial (NCT02849743), conducted at an outpatient academic medical center, included patients aged 10 to 35 years with hypothalamic obesity from hypothalamic/pituitary tumors. Participants received intranasal OXT (Syntocinon, 40 USP units/mL, 4 IU/spray) vs excipient-matched placebo, 16 to 24 IU 3 times daily at mealtimes. Weight loss attributable to OXT vs placebo and safety (adverse events) were assessed. Results: Of 13 individuals randomized (54% female, 31% pre-pubertal, median age 15.3 years, IQR 13.3-20.6), 10 completed the entire study. We observed a nonsignificant within-subject weight change of -0.6 kg (95% CI: -2.7, 1.5) attributable to OXT vs placebo. A subset (2/18 screened, 5/13 randomized) had prolonged QTc interval on electrocardiography prior to screening and/or in both treatment conditions. Overall, OXT was well-tolerated, and adverse events (epistaxis and nasal irritation, headache, nausea/vomiting, and changes in heart rate, blood pressure, and QTc interval) were similar between OXT and placebo. In exploratory analyses, benefits of OXT for anxiety and impulsivity were observed. Conclusion: In this pilot study in hypothalamic obesity, we did not detect a significant impact of intranasal OXT on body weight. OXT was well-tolerated, so future larger studies could examine different dosing, combination therapies, and potential psychosocial benefits.

Vulnerabilities and risk perceptions of contracting COVID-19 among Nepali migrant workers.

Social, economic, and demographic characteristics influence public disaster risk perception, including the risk of COVID-19. Migrant workers are one the most vulnerable groups to disasters. More than four million Nepali migrant workers are employed abroad, and millions are working in cities and towns in the country. This study analyzes how the social, economic, and demographic conditions of returning Nepali migrant workers determine their risk perceptions of COVID-19. An online national survey was administered from May 10 to July 30, 2020, targeting returning Nepali migrant workers nationwide. A total of 782 responses from migrant workers were recorded, covering 67 of 74 districts. Using descriptive statistics and binary logistic regression models, the results show that migrant workers in blue-collar jobs, female, older than 29 years, with pre-existing health conditions, from low-income families, and from larger families are more likely to perceive higher risks of COVID-19. The migrant workers who believe in non-pharmaceutical COVID-19 control measures, including awareness campaigns and stay-at-home orders, have higher risk perceptions of the virus than other groups. The research contributes to identifying the program and policy priority areas to address the needs and COVID-19 vulnerabilities of returning Nepali migrant workers during and after the pandemic.

Retrospective dataset and survey analyses identify gaps in data collection for craniopharyngioma and priorities of patients and families affected by the disease.

INTRODUCTION: Craniopharyngioma is a rare, low-grade tumor located in the suprasellar region of the brain, near critical structures like the pituitary gland. Here, we concurrently investigate the status of clinical and genomic data in a retrospective craniopharyngioma cohort and survey-based data to better understand patient-relevant outcomes associated with existing therapies and provide a foundation to inform new treatment strategies. METHODS: Clinical, genomic, and outcome data for a retrospective cohort of patients with craniopharyngioma were collected and reviewed through the Children's Brain Tumor Network (CBTN) database. An anonymous survey was distributed to patients and families with a diagnosis of craniopharyngioma to understand their experiences throughout diagnosis and treatment. RESULTS: The CBTN repository revealed a large proportion of patients (40 - 70%) with specimens that are available for sequencing but lacked relevant quality of life (QoL) and functional outcomes. Frequencies of reported patient comorbidities ranged from 20-35%, which is significantly lower than historically reported. Survey results from 159 patients/families identified differences in treatment considerations at time of diagnosis versus time of recurrence. In retrospective review, patients and families identified preference for therapy that would improve QoL, rather than decrease risk of recurrence (mean 3.9 vs. 4.4 of 5) and identified endocrine issues as having the greatest impact on patients' lives. CONCLUSIONS: This work highlights the importance of prospective collection of QoL and functional metrics alongside robust clinical and molecular correlates in individuals with craniopharyngioma. Such comprehensive measures will facilitate biologically relevant therapeutic strategies that also prioritize patient needs.

A Survey of Patient-Relevant Outcomes in Pediatric Craniopharyngioma: Focus on Hypothalamic Obesity.

Context: Individuals treated for pediatric craniopharyngioma, a rare, grade 1 brain tumor, frequently develop hypothalamic obesity, a complication often recalcitrant to intervention. Although hypothalamic obesity is known to adversely impact quality of life, less is known about how caregivers and patients experience this condition. Objective: Our goal was to examine the approaches that families take towards weight management and the impact on social function in individuals with craniopharyngioma and obesity. Individuals with craniopharyngioma without obesity were included as a comparison. Subjects and Methods: Adult caregivers of children <18y with craniopharyngioma completed a web-based survey posted by a patient advocacy organization between February and July 2020. Questions related to the child's diagnosis, medications, lifestyle modifications, and social function along with research priorities. Descriptive statistics were generated. Linear regression was used to assess the independent effects of obesity and other covariates on social function. Results: Of 106 respondents, 60 (57%) reported their child had obesity at the time of survey completion. In contrast, only 6 (5.7%) had obesity prior to craniopharyngioma diagnosis. A majority (92%) of those with obesity had tried limiting calories or carbohydrates; 31% and 69% found these helpful, respectively. Thirty-eight percent had tried weight loss medications (stimulants, metformin, GLP1R-agonists, and topiramate) and 48% found at least one helpful. Both stimulant and anti-depressant use were reported more frequently with obesity. An index (T-score) reflecting social function was lower in the cohort than a population reference, 41 (SD 11) vs. 50 (SD 10), p<0.001. In a linear model, both older age and obesity were independently associated with greater social impairment. Ninety-four percent of respondents caring for a child with obesity (and 79% of all respondents) identified "improving treatments and prevention for hypothalamic obesity" as a key research priority. Conclusions: Only a minority of individuals with hypothalamic obesity had trialed medication, even though many reported that lifestyle modification was inadequate. Furthermore, social function was significantly impaired overall in survivors compared to a reference cohort, and even more so in individuals with obesity. These findings highlight the opportunity to improve social functioning as an additional potential benefit of improved treatments for hypothalamic obesity.

Disaster debris management best practice case studies.

OBJECTIVE: To identify debris management best practices for planning and responding to debris-generating disaster events. METHODOLOGY: Four best practice county case studies were selected through the responses of emergency management directors to an initial survey about debris management. Interviews were setup with the emergency management directors, and additional interviewees were identified through snowballing. Interviews were conducted, transcribed, and coded to identify six themes. RESULTS: The six themes that were identified through the coding include: debris management plans, challenges, collaboration, learning, communication, and debris operations. Case study interviewees identified their pre-event debris management plans as important for an effective and efficient debris management process. Interviewees also demonstrated a strong willingness to work together on debris management as well as an understanding of individual roles and responsibilities. Furthermore, interviewees address the concept of learning from past disaster events as a means of managing the uncertainty of disaster debris management.

A measurement of the effectiveness and efficiency of pre-disaster debris management plans.

Disaster debris management operations make up a significant portion of recovery expenses. The following study aims to examine how the presence of a plan makes disaster debris management effective and efficient. Ninety-five counties in the United States who received major disaster declarations between 2012 and 2015 were surveyed to examine the quality of their debris management processes. Forty-nine of these counties had debris management plans while forty-six did not. Statistical tests were conducted to address discrepancies in the effectiveness and efficiency of the debris management processes between the two groups. Such tests suggest that counties with pre-disaster debris management plans were more effective. These counties recycled almost twice as much disaster debris as counties without plans, and received over three times as much Public Assistance from the Federal Emergency Management Agency (FEMA). Counties with plans also reported higher levels of perceived preparedness for future debris challenges than counties without plans. Overall, counties with pre-disaster debris management plans were partially more efficient than counties without plans. They removed more cubic yards of debris per day, but there were no statistically significant differences between the two groups in the volume of debris removed per dollar.

The right to water in rural Punjab: assessing equitable access to water in the context of the ongoing Punjab Rural Water Supply Proejct.

Although India is poised to meet its Millennium Development Goal for providing access to safe drinking water, there remains a worrying discrepancy in access between urban and rural areas. In 2006, 96% of the urban population versus 86% of the rural population obtained their drinking water from an improved water source. To increase access to potable water in rural areas, the World Bank and the state of Punjab have implemented the Punjab Rural Water Supply and Sanitation Project (PRWSS) to improve or construct water supply systems in 3,000 villages deemed to have inadequate access to clean drinking water. This study aimed to examine whether the right to water was fulfilled in six towns in rural Punjab during implementation of the PRWSS. The normative content of the right to water requires that water be of adequate quantity, safety, accessibility, affordability, and acceptability in terms of quality. While our findings suggest that the PRWSS improved water quality, they also indicate that access to water was limited due to affordability and the low socioeconomic status of some people living in the target communities.