Satisfaction and Quality of Life in Patients Who Underwent Post Massive Weight Loss Body Contouring Procedures: A Tertiary Center Experience in Bahrain.

Background: Incidence of body contouring surgeries (BCS) rose significantly to overcome problems resulted from post-Bariatric Surgery (BS). We aimed to evaluate satisfaction level and quality of life (QOL) in patients' post-BCS. Methods: In this retrospective prospective study, patients who underwent BCS in Plastic Surgery Department, Salmaniya Medical Complex, Bahrain, in 2017-2018, were enrolled. Demographic and anthropometric data were collected. BS-group's QOL and satisfaction level were assessed using a questionnaire. Results: Of 929 plastic surgery admissions, 316 (34%) were for BCS (249 patients). Fifty-eight (28%) patients underwent 82 BS were recruited, mostly females (n=42, 72.4%). The mean age was 37.4±9.6 years. Excess abdominal skin was the most area of concern (n=50, 86.2%). Median pre-BCS body mass index was 26.9 (interquartile range: 25.6-29.8) kg/m2. Most patients were overweight (n=26, 44.8%). Abdominoplasty was the commonest BCS (n=172, 50.6%). This was also the case in 82 BCS in post-BS group (n=38, 46.3%). In post-BS group, post-operative complications were noted in 25/82 (30.5%) patients with wound problems being the most frequent (n=14, 17.1%). Most patients rated their experience as better in all questionnaire domains and most (n=45, 54.9%) rated their satisfaction level as excellent. Older age gave better overall satisfaction (P<0.001) while employed patients had better overall QOL (P=0.012) and self-confidence (P=0.048). Females had better satisfaction with body appearance (P<0.001) while those underwent abdominoplasty or breast surgeries had lower physical activity (P=0.042). Conclusion: This study showed improvement in patient's QOL post-BCS with excellent overall satisfaction, findings that could be affected by age, sex, and occupation.

Tympanostomy Tube Insertion Versus Myringotomy or Observation in Managing Otitis Media With Effusion Following Radiotherapy for Nasopharyngeal Carcinoma: An Updated Review.

Head and neck cancers, including nasopharyngeal carcinoma (NPC), are relatively common in Saudi Arabia. Radiotherapy is a standard treatment for NPC, but it can lead to side effects, including post-radiation otitis media with effusion (OME). Managing post-radiotherapy OME remains a topic of debate, with various interventions proposed. This study aims to review the efficacy of different methods to manage post-radiotherapy OME in NPC. This includes tympanostomy tube insertion, frequent myringotomies, and observation. A systematic review was carried out for articles published between 1975 and 2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Excluded from the analysis were articles that involved patients undergoing surgical treatment for nasopharyngeal cancer, studies that focused on patients with other head and neck cancers who developed OME after radiotherapy, research investigating the effectiveness of surgical procedures unrelated to tympanostomy tube insertion, studies written in non-English language, and case reports, reviews, or conference letters. A total of 450 studies were screened, of which six studies were included in the review, yielding 328 patients. The mean age ranged between 46 and 52 years. Follow-up varied from six months to 11 years. The intervention in all studies was tympanostomy tube insertion, and the controls were myringotomy, observation, or tympanic membrane fenestration with cauterization. The use of recurrent myringotomies for the treatment of OME in patients with NP post-radiotherapy is associated with improved chances for the resolution of effusion and decreased risk of complications when compared to tympanostomy tube insertion. Hence, we recommend following a step-wise approach when dealing with this group of patients, offering grommets for patients with persistent effusion or those who cannot tolerate frequent procedures.

In Their Own Words: Fears Expressed by People with Parkinson's Disease in an Online Symptom Database.

Parkinson's disease (PD) carries substantial psychosocial burden. Using a database of responses by people with PD reporting up to five "most bothersome problems," we identified 225 fear-based verbatims, which were organized using the framework method into 26 categories. Commonly-reported fears included uncertainty of progression (n = 60, 26.7%), fear of future cognitive impairment (n = 24, 10.7%) and fear of becoming a burden on others (n = 23, 10.2%). Fears in PD are wide-ranging and can constitute the most bothersome aspect of the condition. These data can be used to design interventions to lessen the psychosocial burden of PD.

Pain, comorbidities, and clinical decision-making: conceptualization, development, and pilot testing of the Pain in Aging, Educational Assessment of Need instrument.

Introduction: Pain is highly prevalent in older adults and often contextualized by multiple clinical conditions (pain comorbidities). Pain comorbidities increase with age and this makes clinical decisions more complex. To address gaps in clinical training and geriatric pain management, we established the Pain in Aging-Educational Assessment of Need (PAEAN) project to appraise the impacts of medical and mental health conditions on clinical decision-making regarding older adults with pain. We here report development and pilot testing of the PAEAN survey instrument to assess clinician perspectives. Methods: Mixed-methods approaches were used. Scoping review methodology was applied to appraise both research literature and selected Medicare-based data. A geographically and professionally diverse interprofessional advisory panel of experts in pain research, medical education, and geriatrics was formed to advise development of the list of pain comorbidities potentially impacting healthcare professional clinical decision-making. A survey instrument was developed, and pilot tested by diverse licensed healthcare practitioners from 2 institutions. Respondents were asked to rate agreement regarding clinical decision-making impact using a 5-point Likert scale. Items were scored for percent agreement. Results: Scoping reviews indicated that pain conditions and comorbidities are prevalent in older adults but not universally recognized. We found no research literature directly guiding pain educators in designing pain education modules that mirror older adult clinical complexity. The interprofessional advisory panel identified 26 common clinical conditions for inclusion in the pilot PAEAN instrument. Conditions fell into three main categories: "major medical", i.e., cardio-vascular-pulmonary; metabolic; and neuropsychiatric/age-related. The instrument was pilot tested by surveying clinically active healthcare providers, e.g., physicians, nurse practitioners, who all responded completely. Median survey completion time was less than 3 min. Conclusion: This study, developing and pilot testing our "Pain in Aging-Educational Assessment of Need" (PAEAN) instrument, suggests that 1) many clinical conditions impact pain clinical decision-making, and 2) surveying healthcare practitioners about the impact of pain comorbidities on clinical decision-making for older adults is highly feasible. Given the challenges intrinsic to safe and effective clinical care of older adults with pain, and attendant risks, together with the paucity of existing relevant work, much more education and research are needed.

Association between Subjective Cognitive Complaints and Incident Functional Impairment in Parkinson's Disease.

BACKGROUND: Early identification of subjective cognitive complaints (SCC) in Parkinson's disease (PD) may improve patient care if it predicts cognition-related functional impairment (CFI). OBJECTIVES: The aim was to determine the cross-sectional and longitudinal association between SCC and CFI in PD. METHODS: Data were obtained from Fox Insight, an online longitudinal study that collects PD patient-reported outcomes. Participants completed a PD Patient Report of Problems that asked participants for their five most bothersome disease problems. SCCs were placed into eight categories through human-in-the-loop curation and classification. CFI had a Penn Parkinson's Daily Activities Questionnaire (PDAQ-15) score ≤49. Cox proportional hazards models and Kaplan-Meier survival analyses determined if baseline SCC was associated with incident CFI. RESULTS: The PD-PROP cohort (N = 21,160) was 55.8% male, mean age was 65.9 years, and PD duration was 4.8 years. At baseline, 31.9% (N = 6750) of participants reported one or more SCCs among their five most bothersome problems, including memory (13.2%), language/word finding (12.5%), and concentration/attention (9.6%). CFI occurred in 34.7% (N = 7332) of participants. At baseline, SCC was associated with CFI (P-value <0.001). SCC at baseline was associated with incident CFI (hazard ratio [HR] = 1.58 [95% confidence interval: 1.45, 1.72], P-value <0.001), as did cognitive impairment not otherwise specified (HR = 2.31), executive abilities (HR = 1.97), memory (HR = 1.85), and cognitive slowing (HR = 1.77) (P-values <0.001). Kaplan-Meier curves showed that by year 3 an estimated 45% of participants with any SCC at baseline developed new-onset CFI. CONCLUSIONS: Self-reported bothersome cognitive complaints are associated with new-onset CFI in PD. Remote electronic assessment can facilitate widespread use of patient self-report at population scale. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Habitual food consumption, eating behavior and meal-timing among Jordanian adults with elevated Blood pressure: a cross-sectional population-based study.

BACKGROUND: The prevalence of elevated blood pressure (BP) has been raised worldwide. Food consumption, eating habits, and nutritional lifestyle related to meal timing, skipping meals, and meal contents have recently received more attention in studies on BP and metabolic syndrome. Purpose: This study evaluated the association between habitual food consumption, eating behavior, and meal timing with BP among Jordanian adults. METHODS: A cross-sectional study included 771 Jordanian adults. A food frequency questionnaire was completed. Data about eating habits, meal timing, and emotional eating were collected. BP was measured. RESULTS: The prevalence of less than recommended intake of vegetables, milk, protein, and fruits was higher in participants with elevated BP (69.2%, 90.2%, 58.9%, and 25.5%, respectively) as compared to the normal BP group (p < 0.001). Consuming vegetables and milk less than the recommended was reported to significantly increase the likelihood of elevated BP by OR= (1.60, and 2.75 (95%CI: 1.06-2.40; 1.62-4.66). Hence, consuming more than recommended fruit reduced the risk of elevated BP by OR = 0.56 (95%CI: 0.38-0.82). A 63.2% of elevated BP participants have three meals daily, a higher percentage of intake of one (23.5%) and two (45.7%) snacks. However, they had a higher percentage of morning eaters (50.7%), had lunch between 1:00-6:00 PM (92.7%), and had dinner between 6:00 and 9:00 PM (68.1%). CONCLUSIONS: Although Jordanian adults with elevated BP appear to have healthy eating habits and meal timing and frequency, their habitual food consumption falls short of the daily recommendations for milk, fruits, vegetables, and protein.

Numerous epidemiological studies have revealed a steadily rising prevalence of elevated BP, and one critical independent and modifiable risk factor for this condition is obesity.One global non-communicable diseases (NCD) target adopted by the World Health Assembly in 2013 is to lower the prevalence of raised BP by 25% by 2025 compared with its 2010 level.Lifestyle improvement is a cornerstone of CVD prevention; diet is one of the most effective strategies for attaining BP reduction and control as low-salt diets, dietary approaches to stop hypertension (DASH), a low-salt Mediterranean diet, an energy-restriction diet, vegetarian diet, and alternate-day fasting.Eating habits and nutritional lifestyle related to meal timing, skipping meals, and meal contents have recently received more attention in studies on BP and metabolic syndrome.a relationship between elevated BP and metabolic syndrome, infrequent fruit eating, skipping meals, irregular meal frequency and timing, and obesity has been found among adults.It has been found that earlier meal timing could reduce cardiometabolic disease burden and aid in weight loss; on the other hand, meal frequency was inversely associated with the prevalence of abdominal obesity, elevated BP, and elevated triglycerides. Morning eating was associated with a lower prevalence of metabolic syndrome than no morning eating.

The cognitive apprenticeship model as a framework for desired precepting qualities to inform preceptor development.

INTRODUCTION: Positive learner perceptions of learning experiences have been linked to better learning outcomes. More information is needed on learners' desired qualities of preceptors and learning experiences to inform preceptor development. Aligning learners' perceptions with a teaching framework, such as the Cognitive Apprenticeship (CA) framework, may be useful to guide preceptor self-assessment and development. However, information is lacking regarding whether the CA framework is consistent with learners' expectations. The purpose of this study was to determine pharmacy learner perspectives on desired preceptor behaviors and qualities and to evaluate their alignment with the CA framework to inform preceptor development. METHODS: Twenty-two learners (nine residents and 13 introductory and advanced pharmacy practice students) participated in nine focus group interviews. Data were analyzed qualitatively by inductive coding and pattern coding and then condensed into themes. After initial analysis, the CA framework was adapted into codes and applied to the data to explore the alignment of quality preceptor characteristics with CA. RESULTS: Learners identified desired general preceptor characteristics, teaching behaviors, and qualities of sites and experience structure in their discussion. All four CA dimensions (Methods, Sociology, Sequencing, and Content) were represented in the described desired preceptor qualities. Most comments were connected to the Methods dimension. CONCLUSIONS: This study supports the use of CA as a framework to guide preceptor development and assessment for desired precepting qualities, preceptor behaviors, and learning environments. Additional research is needed for best practices in implementing CA in preceptor assessment and professional development.

A biological definition of neuronal α-synuclein disease: towards an integrated staging system for research.

Parkinson's disease and dementia with Lewy bodies are currently defined by their clinical features, with α-synuclein pathology as the gold standard to establish the definitive diagnosis. We propose that, given biomarker advances enabling accurate detection of pathological α-synuclein (ie, misfolded and aggregated) in CSF using the seed amplification assay, it is time to redefine Parkinson's disease and dementia with Lewy bodies as neuronal α-synuclein disease rather than as clinical syndromes. This major shift from a clinical to a biological definition of Parkinson's disease and dementia with Lewy bodies takes advantage of the availability of tools to assess the gold standard for diagnosis of neuronal α-synuclein (n-αsyn) in human beings during life. Neuronal α-synuclein disease is defined by the presence of pathological n-αsyn species detected in vivo (S; the first biological anchor) regardless of the presence of any specific clinical syndrome. On the basis of this definition, we propose that individuals with pathological n-αsyn aggregates are at risk for dopaminergic neuronal dysfunction (D; the second biological anchor). Our biological definition establishes a staging system, the neuronal α-synuclein disease integrated staging system (NSD-ISS), rooted in the biological anchors (S and D) and the degree of functional impairment caused by clinical signs or symptoms. Stages 0-1 occur without signs or symptoms and are defined by the presence of pathogenic variants in the SNCA gene (stage 0), S alone (stage 1A), or S and D (stage 1B). The presence of clinical manifestations marks the transition to stage 2 and beyond. Stage 2 is characterised by subtle signs or symptoms but without functional impairment. Stages 2B-6 require both S and D and stage-specific increases in functional impairment. A biological definition of neuronal α-synuclein disease and an NSD-ISS research framework are essential to enable interventional trials at early disease stages. The NSD-ISS will evolve to include the incorporation of data-driven definitions of stage-specific functional anchors and additional biomarkers as they emerge and are validated. Presently, the NSD-ISS is intended for research use only; its application in the clinical setting is premature and inappropriate.

Chronotropic Incompetence During Exercise Testing as a Marker of Autonomic Dysfunction in Individuals with Early Parkinson's Disease.

BACKGROUND: An attenuated heart rate response to exercise, termed chronotropic incompetence, has been reported in Parkinson's disease (PD). Chronotropic incompetence may be a marker of autonomic dysfunction and a cause of exercise intolerance in early stages of PD. OBJECTIVE: To investigate the relationship between chronotropic incompetence, orthostatic blood pressure change (supine - standing), and exercise performance (maximal oxygen consumption, VO2peak) in individuals with early PD within 5 years of diagnosis not on dopaminergic medications. METHODS: We performed secondary analyses of heart rate and blood pressure data from the Study in Parkinson's Disease of Exercise (SPARX). RESULTS: 128 individuals were enrolled into SPARX (63.7±9.3 years; 57.0% male, 0.4 years since diagnosis [median]). 103 individuals were not taking chronotropic medications, of which 90 had a normal maximal heart rate response to exercise testing (155.3±14.0 bpm; PDnon-chrono) and 13 showed evidence of chronotropic incompetence (121.3±11.3 bpm; PDchrono, p < 0.05). PDchrono had decreased VO2peak compared to PDnon-chrono (19.7±4.5 mL/kg/min and 24.3±5.8 mL/kg/min, respectively, p = 0.027). There was a positive correlation between peak heart rate during exercise and the change in systolic blood pressure from supine to standing (r = 0.365, p < 0.001). CONCLUSIONS: A subgroup of individuals with early PD not on dopaminergic medication had chronotropic incompetence and decreased VO2peak, which may be related to autonomic dysfunction. Evaluation of both heart rate responses to incremental exercise and orthostatic vital signs may serve as biomarkers of early autonomic impairment and guide treatment. Further studies should investigate whether cardiovascular autonomic dysfunction affects the ability to exercise and whether exercise training improves autonomic dysfunction.

Are There Any Correlations between Vitamin D, Calcium, and Magnesium Intake and Coronary and Obesity Indices?

OBJECTIVE: The association between nutrient intake and obesity and coronary problems has received great attention. So, this study aimed to examine the association between vitamin D, calcium, and magnesium intake and obesity and coronary indices. METHODS: A total of 491 male and female university employees (18-64 years) were randomly included in a cross-sectional study. Blood samples were drawn, and the lipid profile was analyzed. Different anthropometrics were measured. Obesity and coronary indices were calculated based on standard formulas. A 24-h recall was used to measure the average dietary intake of vitamin D, calcium, and magnesium. RESULTS: For the total sample, vitamin D had a significantly weak correlation with the abdominal volume index (AVI) and weight-adjusted waist index (WWI). However, calcium intake had a significant moderate correlation with the AVI and a weak correlation with the conicity index (CI), body roundness index (BRI), body adiposity index (BAI), WWI, lipid accumulation product (LAP), and atherogenic index of plasma (AIP). In males, there was a significant weak correlation between calcium and magnesium intake and the CI, BAI, AVI, WWI, and BRI. Additionally, magnesium intake had a weak correlation with the LAP. In female participants, calcium and magnesium intake had a weak correlation with CI, BAI, AIP, and WWI. Additionally, calcium intake showed a moderate correlation with the AVI and BRI and a weak correlation with the LAP. CONCLUSION: Magnesium intake had the greatest impact on coronary indices. Calcium intake had the greatest impact on obesity indices. Vitamin D intake had minimal effects on obesity and coronary indices.

Environment predicts the maintenance of reproductive isolation in a mosaic hybrid zone of rubber rabbitbrush.

Widely distributed plants of western North America experience divergent selection across environmental gradients, have complex histories shaped by biogeographic barriers and distributional shifts and often illustrate continuums of reproductive isolation. Rubber rabbitbrush (Ericameria nauseosa) is a foundational shrub species that occurs across diverse environments of western North America. Its remarkable phenotypic diversity is currently ascribed to two subspecies-Ericameria nauseosa nauseosa and Ericameria nauseosa consimilis-and 22 named varieties. To understand how genetic variation is partitioned across subspecies, varieties, and environments, we used high throughput sequencing of reduced representation libraries. We found clear evidence for divergence between the two subspecies, despite largely sympatric distributions. Numerous locations exhibiting admixed ancestry were not geographically localized but were widely distributed across a mosaic hybrid zone. The occurrence of hybrid and subspecific ancestries was strongly predicted by environmental variables as well as the proximity to major ecotones between ecoregions. Although this repeatability illustrates the importance of environmental factors in shaping reproductive isolation, variability in the prevalence of hybridization also indicates these factors likely differ across ecological contexts. There was mixed evidence for the evolutionary cohesiveness of varieties, but several genetically distinct and narrow endemic varieties exhibited admixed subspecific ancestries, hinting at the possibility for transgressive hybridization to contribute to phenotypic novelty and the colonization of new environments in E. nauseosa.

The Novelty of using Obesity Indices as Blood Pressure Predictors.

AIMS: To study the association between selected obesity indices, systolic blood pressure (SBP), and diastolic blood pressure (DBP). METHODS: A cross-sectional study was conducted on 491 Jordanian adults (19-65 years old). The sociodemographic data, anthropometrics, and blood pressure were measured and recorded. Obesity indices (Conicity Index (CI), Abdominal volume index (AVI), Body Roundness Index (BRI), and Weight-adjusted-waist index (WWI)) were calculated using standard validated formulas. RESULTS: Based on age, the SBP had a significant moderate correlation with BRI and AVI in all age groups. In the age group 20 to 34 years, SBP had a significantly moderate correlation with CI, and DBP had a significantly moderate correlation with BRI and AVI. In the age group of 35 to 44 years, DBP had a significantly moderate correlation with CI, BRI, WWI, and AVI. For the age group of 45 to 65 years, the SBP had a significantly moderate correlation with all the obesity indexes, opposite to DBP. Obesity indices explain 23.6 to 24.1 % of the changeability in SBP, and one unit increase in them, increased SBP ranges from 0.61±0.14 to 19.88±4.45. For DBP, obesity indices explained 15.9% to 16.3% of the variability in DBP, and raising them by one unit led to an increase in the DBP range from 0.27±0.11 to 10.08±4.83. CONCLUSION: All the studied obesity indices impacted SBP and DBP with the highest reported effect for AVI and BRI and a lower impact for WWI. The impact of obesity indices on DBP was affected by age group.

Internal tremor in people with Parkinson's Disease: Demographic characteristics and comorbid symptoms.

Introduction: Internal tremor (IT) occurs in > 30 % of people with Parkinson's Disease (PwPD), but remains largely uninvestigated. Our objective was to describe demographic characteristics and associated symptoms in PwPD who reported IT. Methods: This was a matched case-control survey study. Data were from PwPD in the Fox Insight study who answered the Patient Report of Problems (PD-PROP) assessment, a series of open-ended questions that asks people to report in their own words their most bothersome PD-related problems. Cases were those who reported IT ≥ 1 times compared with PwPD controls who did not report IT and were matched 1:3 by age and disease duration. Results: 243 PwPD reported IT as a bothersome problem. Mean (SD) age of cases was 64.9 (9.4) years and disease duration was 3.8 (4.0) years. The proportion of women was greater among cases compared to controls (74 % vs 47 %, p < 0.0001). External tremor as a PD-PROP symptom was reported by 98 % cases and 48 % controls (p < 0.0001). Several non-motor symptoms were more common among cases than controls, including anxiety (35 % vs 20 %), fatigue (41 % vs 31 %), and pain (57 % vs 37 %). The odds of IT was significantly higher in women when adjusting for anxiety and motor experiences of daily living score (OR 3.07, 95 %CI 2.14-4.41, p < 0.0001). Conclusion: PwPD with IT report a range of associated symptoms, including external tremor, anxiety, and pain. Sex differences in the experience of IT may exist. Studies of IT are needed to understand its etiology and inform clinical care.

Dietary fat types consumption association with obesity and coronary indices.

This article aims to study the different dietary fat types associated with obesity and coronary indices. A sample of 491 healthy adults was included in a cross-sectional manner. Dietary fats intake, obesity indices (conicity index (CI), body adiposity index (BAI), abdominal volume index (AVI), body roundness index (BRI), and weight-adjusted-waist index (WWI)), and cardiovascular indices (cardiometabolic index (CMI), lipid accumulation product (LAP), and atherogenic index of plasma (AIP)) were calculated and studied. Participants with an acceptable intake of omega-3 had a higher BRI score (1⋅90 ± 0⋅06 v. 1⋅70 ± 0⋅06). Participants with an unacceptable intake of cholesterol had a higher CI (1⋅31 ± 0⋅11 v. 1⋅28 ± 0⋅12; P = 0⋅011), AVI (20⋅24 ± 5⋅8 v. 18⋅33 ± 6⋅0; P < 0⋅001), BRI (2⋅00 ± 1⋅01 v. 1⋅70 ± 1⋅00; P = 0⋅003), WWI (11⋅00 ± 0⋅91 v. 10⋅80 ± 0⋅97; P = 0⋅032), and lower AIP (0⋅46 ± 0⋅33 v. 0⋅53 ± 0⋅33; P = 0⋅024). Total fat, saturated fat (SFA), and polyunsaturated fat (PUFA) intake had a significant moderate correlation with AVI and BRI. The monounsaturated fat (MUFA) intake had a significantly weak correlation with CI, AVI, BRI, WWI, and AIP. Cholesterol and omega-6 had weak correlations with all indices. Similar correlations were seen among male and female participants. The different types of fat intake significantly affected obesity and coronary indices, especially SFA and PUFA, as well as omega-3 and cholesterol. Gender and the dietary type of fat intake have a relationship to influence the indicators of both obesity and coronary indices.

A sweet deal for domestic industry: the political economy and framing of Vanuatu's sugar-sweetened beverage tax.

INTRODUCTION: The Government of Vanuatu introduced an excise tax on sugar-sweetened beverages (SSBs) in 2015. While lauded for its alignment with the WHO's Best Buys recommendations for addressing non-communicable diseases (NCDs), little is known about the tax's adoption process or whose interests it serves. METHODS: Using case study methodology, this study examined how and why Vanuatu's SSB tax was introduced. Policy documents, key informant interviews (n=33) and direct observations were analysed using theories of policy analysis, power analysis and postcolonial theory to map the policy's adoption, surrounding political economy and the ideas, interests and institutions that shaped the tax and its framing. RESULTS: The SSB tax emerged during a politically and economically unstable time in Vanuatu's history. The tax's links to the national health agenda were tenuous despite its ostensible framing as a way to combat NCDs. Rather, the tax was designed to respond to tightening economic and trade conditions. Spearheaded by several finance-focused bureaucrats, and with limited input from health personnel, the tax targeted less frequently consumed carbonated SSBs (which are mostly imported) without any revenue reinvestments into health. Driven by the desire to generate much-needed government revenue and instal domestic protections via selective implementation and carve-outs for local producers, the Vanuatu SSB tax did meet national objectives, just not the dual health and economic 'win-win' projected by the NCD Best Buys. CONCLUSION: Vanuatu's SSB tax adoption process reveals the limitations of decontextualised policy recommendations, such as the NCD Best Buys, whose framing may be overcome by local political realities. This research highlights the need for further political economy considerations in global health recommendations, since contextual forces and power dynamics are key to shaping both how and why policies are enacted and also whose interest they serve.

Do macronutrient intakes affect obesity indices in Jordanian adults?

OBJECTIVE: To determine whether macronutrient intake is associated with novel obesity indices, including the conicity index (CI), body adiposity index (BAI), abdominal volume index (AVI), body roundness index (BRI), and weight-adjusted-waist index (WWI). METHODOLOGY: A cross-sectional survey was conducted with 491 adults (344 males and 147 females) working at different universities in Jordan (July-December 2019). Daily intake of energy (kcal), carbohydrates (g), protein (g), and fat (g) was obtained using 24-h recalls collected over 2 days. Additionally, obesity indices were calculated. RESULTS: Regardless of sex, energy, and carbohydrate intakes had a moderately significant positive association, whereas protein and fat intakes had a weakly significant association with BAI, AVI, and BRI. CI and WWI showed a weakly significant association with all macronutrients in males, a moderate correlation with energy and carbohydrate intake, and a weak association with fat and protein intake in females. Male participants had significant increases in the CI (T1 = 1.29 ± 0.01 vs. T3 = 1.36 ± 0.01, p = .018), AVI (T1 = 17.96 ± 0.52 vs. T3 = 22.81 ± 0.57, p = .011), and WWI (T1 = 10.72 ± 0.11 vs. T3 = 11.29 ± 0.09, p = .047) indices scores through the carbohydrate intake tertiles. Additionally, there was a significant increase in scores of AVI (T1 = 18.60 ± 0.56 vs. T3 = 21.42 ± 0.46, p = .048) and an almost significant increase in CI (T1 = 1.30 ± 0.01vs. T3 = 1.33 ± 0.01, p = .056) through the tertiles of protein intake. CONCLUSION: Macronutrients were significantly associated with all indices. The effect of macronutrients on obesity indices is sex-based. Among men, CI, AVI, and WWI were the indices most affected by carbohydrate and protein intakes. Future studies should further investigate food sources and macronutrient quality.

Does probiotic supplementation improve quality of life in mild-to-moderately active ulcerative colitis patients in Jordan? A secondary outcome of the randomized, double-blind, placebo-controlled study.

PURPOSE: Recent findings revealed a potential effect of a probiotic in improving quality of life (QoL) in ulcerative colitis (UC). In Jordan, there is scarce data about UC patients and QoL. METHODS: Twenty-four UC patients were included in the study and were randomly allocated into probiotic (3 × 1010 probiotic capsules containing nine Lactobacillus and five Bifidobacterium species) and placebo control groups (containing polysaccharide supplied in an identical bottle) 3 times daily/6 weeks. A short inflammatory bowel disease questionnaire (SIBDQ) was used to assess the change in the quality of life in both groups at the beginning and the end of the intervention; The study was completed during the COVID-19 pandemic. RESULTS: Patients treated with probiotics showed a higher score of social (6.92 ± 0.29, p = 0.019), bowel (6.31 ± 0.46, p = 0.001), emotional (6.47 ± 0.46, p < 0.001), and total SIBDQ scores (6.54 ± 0.29, p < 0.001) compared to the placebo group (5.75 ± 1.57, 4.72 ± 1.34, 4.42 ± 1.67 and 4.96 ± 1.27; respectively). Also, the probiotic group had significantly better scores in the systemic, social, bowel, emotional, and total SIBDQ scores in terms of pre- to post-treatment (p < 0.001). CONCLUSIONS: The use of probiotic therapy containing Lactobacillus and Bifidobacterium species had significantly improved the quality of life among UC patients, this was shown by the improvement in the scores of the systemic domain, social domain, bowel domain, emotional domain, and total SIBDQ. This study is part of a registered study at ClinicalTrials.gov with the number NCT04223479.

Stable expression of shRNA for the control of recombinant adenovirus replication.

Preventing the replication of adenovirus could have practical uses, such as controlling infection with wild-type virus or in applications involving recombinant vectors. Mainly transient methods have been used to inhibit adenovirus replication, including siRNA or drugs. Here, we tested whether stable expression of shRNA designed to target hexon, Iva2, or pol can inhibit the replication of a recombinant adenoviral vector, Ad-LacZ (serotype 5, E1/E3 deleted), in 293T cells. Significant knockdown correlating with reduced Ad-LacZ replication was achieved only when hexon was targeted. Cell sorting and isolation of cellular clones further accentuated knockdown of the hexon transcript, reduced protein levels by more than 90%, and diminished adenovirus production. As visualized by transmission electron microscopy, the cellular clone expressing the hexon-specific shRNA yielded 89.2% fewer particles compared to the parental 293T cells. Full scale production followed by purification revealed a 90.2% reduction in Ad-LacZ biological titer. These results support the notion that stable expression of shRNA can be used as a means to control adenovirus replication.

Parkinson's Progression Markers Initiative: A Milestone-Based Strategy to Monitor Parkinson's Disease Progression.

BACKGROUND: Identifying a meaningful progression metric for Parkinson's disease (PD) that reflects heterogeneity remains a challenge. OBJECTIVE: To assess the frequency and baseline predictors of progression to clinically relevant motor and non-motor PD milestones. METHODS: Using data from the Parkinson's Progression Markers Initiative (PPMI) de novo PD cohort, we monitored 25 milestones across six domains ("walking and balance"; "motor complications"; "cognition"; "autonomic dysfunction"; "functional dependence"; "activities of daily living"). Milestones were intended to be severe enough to reflect meaningful disability. We assessed the proportion of participants reaching any milestone; evaluated which occurred most frequently; and conducted a time-to-first-event analysis exploring whether baseline characteristics were associated with progression. RESULTS: Half of participants reached at least one milestone within five years. Milestones within the cognitive, functional dependence, and autonomic dysfunction domains were reached most often. Among participants who reached a milestone at an annual follow-up visit and remained active in the study, 82% continued to meet criteria for any milestone at one or more subsequent annual visits and 55% did so at the next annual visit. In multivariable analysis, baseline features predicting faster time to reaching a milestone included age (p < 0.0001), greater MDS-UPDRS total scores (p < 0.0001), higher GDS-15 depression scores (p = 0.0341), lower dopamine transporter binding (p = 0.0043), and lower CSF total α-synuclein levels (p = 0.0030). Symptomatic treatment was not significantly associated with reaching a milestone (p = 0.1639). CONCLUSION: Clinically relevant milestones occur frequently, even in early PD. Milestones were significantly associated with baseline clinical and biological markers, but not with symptomatic treatment. Further studies are necessary to validate these results, further assess the stability of milestones, and explore translating them into an outcome measure suitable for observational and therapeutic studies.

Association between dietary fatty acid patterns and obesity indices in Jordanian adults: A cross-sectional study.

Background: The ratios of fatty acids in different diets and their connection to chronic diseases including obesity and CVD have been researched. The current study set out to detect the dietary fatty acid patterns among Jordanian adults and their relationships with obesity indices. Methods: The data of 1096 adults were extracted from a household food consumption patterns survey study. Food intake was analyzed, and fatty acid patterns were determined. After anthropometric measurements, obesity indices were calculated. Results: Two fatty acid patterns were determined (High fatty acids from Protein and Olive Oil sources pattern, and the low Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) pattern), explaining an overall variance of 41.78% and 24.31%, respectively. A significant difference in obesity scores through fatty acids pattern quartiles was only seen among female participants. Q4 of the "High fatty acids from Protein and Olive Oil sources" pattern had a significantly higher means of body mass index (25.12 ± 0.46; p = 0.015), waist-to-height-ratio (0.51 ± 0.01; p = 0.002), weight-adjusted waist index (10.13 ± 0.09; p = 0.021) and body roundness index (3.61 ± 0.15; p = 0.007) compared to Q1, while Q4 of "Low EPA and DHA" pattern had significantly higher means of waist circumference (WC) (86.28 ± 1.34) and a body shape index (ABSI) (10.12 ± 0.30) in comparison to Q1 (WC = 81.55 ± 1.08 and ABSI = 9.07 ± 0.22; p = 0.025, 0.013; respectively). In females, there was a significant association between the "High fatty acids from Protein and Olive Oil sources" pattern and all the obesity indices. Conclusion: Our results suggest that an increase in the high fatty acids from Protein and Olive Oil sources pattern is associated with a reduction in obesity indices, which is opposite to the low EPA and DHA pattern. This was a sex-specific association.