Ownership of small livestock species, but not aggregate livestock, is associated with an increased risk of anemia among children in Ethiopia: A propensity score matching analysis.

Consumption of animal source foods, through livestock production, improves children's growth and micronutrient status. However, research on the relationship between livestock ownership and childhood anemia has produced conflicting results. The current study used robust analytical approaches to examine the effect of household livestock ownership on children's anemia using the most recent secondary data from the national demographic and health survey. We followed a 1:1 closest neighborhood propensity score matching analysis. A propensity score was generated using the binary logistic regression model to compute the probability of owning livestock. From a total of 18,008 households enrolled in the latest Ethiopian Demographic and Health Survey (EDHS 2016), data of 721 index children aged 6-59 months from households owning livestock were matched with a comparable number (721) of children from households without livestock. The paired and independent t-test, matched relative risk (RR), and standardized mean differences were used to compare the distributions of hemoglobin concentration and anemia risks between treatment and control groups. Anemia was found in more than half (54.1% and 58.8%) of children aged 6-59 months from livestock-owning and nonowning families, respectively (p > .05). Aggregate ownership of livestock was not associated with hemoglobin concentration or anemia status (RR = 0.95, 95% confidence interval [95% CI] [0.87-1.04]). Species-wise, poultry was associated with a lower (RR = 0.88, 95% CI [0.84-0.95]) anemia risk, while ownership of goat/sheep was associated with higher (RR = 1.10, 95% CI [1.03-1.17]) risk. In conclusion, ownership of small livestock species (sheep/goats and poultry), but not aggregate livestock ownership, was associated with the risk of anemia among children in Ethiopia. Therefore, agriculture-sensitive nutrition, with a One Health lens approach, is recommended to mitigate the high burden of anemia among children in Ethiopia. In the future, a well-controlled interventional study with more extended periods may be required to fully understand the effects of livestock production and highlight the differences seen across livestock species.

Associations between livestock keeping, morbidity and nutritional status of children and women in low- and middle-income countries: a systematic review.

Livestock keeping can positively influence the nutritional status of populations and households through increased consumption of animal-source foods (ASF) and other indirect pathways, but can also adversely affect health by increasing the risk of diseases. We conducted a systematic review synthesising the current state of knowledge on the associations among livestock keeping, infectious disease and the nutritional status of children under 5 years and women of reproductive age in low- and lower-middle-income countries (LMICs). A comprehensive search of 12 electronic databases and grey literature sources published from 1991 to the end of December 2020 was conducted. Investigations exploring relationships between livestock keeping and risk of infectious disease transmission and nutritional status were selected using pre-defined inclusion criteria. After screening and filtering of 34,402 unique references, 176 references were included in the final synthesis. Most (160/176, 90.1%) of the references included in the final synthesis were from sub-Saharan Africa (SSA) and Asia. About two out of every five (42%) studies reviewed showed that livestock production is associated with improved height-for-age Z scores (HAZ) and weight-for-length/height Z scores (WHZ), while close to a third (30.7%) with improved weight-for-age Z scores (WAZ). Similarly, livestock production showed a positive or neutral relationship with women's nutritional status in almost all the references that reported on the topic. Conversely, four-fifths (66/81, 79.5%) of the references reporting on infection and morbidity outcomes indicated that livestock keeping is linked to a wide range of infectious disease outcomes, which are spread primarily through water, food and insects. In conclusion, in many LMIC settings, livestock production is associated with better nutritional outcomes but also a higher risk of disease transmission or morbidity among women and children.This review was prospectively registered on PROSPERO 2020 [CRD42020193622].

Slipped Capital Femoral Epiphysis: Early Intervention and Referral.

Slipped capital femoral epiphysis is the most common hip pathology in children aged 8-15 years old. Research has shown that when a nonorthopedic provider evaluates this patient population, there can be a significant delay in the appropriate treatment, which may have serious consequences for the prognosis of the patient. The delays are often caused by the practitioner's inability to put the clinical picture into focus with regard to how these patients typically present.. This article presents the demographics, clinical presentation, differential diagnosis, radiological and physical examination techniques, and prevention strategies to recognize this condition and provide early intervention.

Improving adoption of technologies and interventions for increasing supply of quality livestock feed in low- and middle-income countries.

The global increase in the demand for and production of animal-source foods (four-to five-fold increase between 1960 and 2015), which has been mostly concentrated in low- and middle-income countries (LMIC), provides smallholder livestock producers with an opportunity for improving their livelihoods and food and nutrition security. However, across livestock production systems in many LMIC, limited supplies and high cost of good quality feed severely constrains exploitation of this opportunity. In many of such countries, feeds and feeding-related issues are often ranked as the primary constraint to livestock production and increased consumption of animal-source foods. Here we review the complex biophysical, socio-economic and technological challenges related to improving quality feed supply and the reasons for generally low adoption of apparently proven feed enhancement technologies. We describe also successful interventions and conclude by recommending strategies for improving quality feed supply in LMIC that account for and overcome the prevailing challenges.

A scoping review of feed interventions and livelihoods of small-scale livestock keepers.

Livestock support the livelihoods of one billion people in Africa, Asia and Latin America, but the productivity of animals remains low, reducing the potential of the sector to support higher incomes and better nutrition. Improved livestock feeding has been identified as the most important step towards higher productivity. This scoping review assessed the evidence for the uptake of improved ruminant livestock feed options, the effect of this uptake on livestock productivity and the degree to which this improves smallholder farmer livelihoods. In total, 22,981 papers were identified, of which 73 papers were included in the final analysis after a rigorous double-blind screening review. Only papers that reported farmers' decision to use a new feed intervention were selected, thereby excluding feeding trials and participatory feed assessments. Of the 73 papers, only 6 reported combined evidence of adoption, effect on productivity and livelihood changes. A total of 58 papers looked at adoption, 19 at productivity change and 22 at livelihood change. This scoping review highlights the gap in evidence for the adoption of new livestock feeding practices and provides recommendations to support farmers' uptake of feed interventions.

Interferometric imaging using Si3N4 photonic integrated circuits for a SPIDER imager.

This paper reports design, fabrication, and experimental demonstration of a silicon nitride photonic integrated circuit (PIC). The PIC is capable of conducting one-dimensional interferometric imaging with twelve baselines near λ = 1100-1600 nm. The PIC consists of twelve waveguide pairs, each leading to a multi-mode interferometer (MMI) that forms broadband interference fringes or each corresponding pair of the waveguides. Then an 18 channel arrayed waveguide grating (AWG) separates the combined signal into 18 signals of different wavelengths. A total of 103 sets of fringes are collected by the detector array at the output of the PIC. We keep the optical path difference (OPD) of each interferometer baseline to within 1 µm to maximize the visibility of the interference measurement. We also constructed a testbed to utilize the PIC for two-dimension complex visibility measurement with various targets. The experiment shows reconstructed images in good agreement with theoretical predictions.

Experimental demonstration of interferometric imaging using photonic integrated circuits.

This paper reports design, fabrication, and demonstration of a silica photonic integrated circuit (PIC) capable of conducting interferometric imaging with multiple baselines around λ = 1550 nm. The PIC consists of four sets of five waveguides (total of twenty waveguides), each leading to a three-band spectrometer (total of sixty waveguides), after which a tunable Mach-Zehnder interferometer (MZI) constructs interferograms from each pair of the waveguides. A total of thirty sets of interferograms (ten pairs of three spectral bands) is collected by the detector array at the output of the PIC. The optical path difference (OPD) of each interferometer baseline is kept to within 1 µm to maximize the visibility of the interference measurement. We constructed an experiment to utilize the two baselines for complex visibility measurement on a point source and a variable width slit. We used the point source to demonstrate near unity value of the PIC instrumental visibility, and used the variable slit to demonstrate visibility measurement for a simple extended object. The experimental result demonstrates the visibility of baseline 5 and 20 mm for a slit width of 0 to 500 µm in good agreement with theoretical predictions.

Yield gap analyses to estimate attainable bovine milk yields and evaluate options to increase production in Ethiopia and India.

Livestock provides an important source of income and nourishment for around one billion rural households worldwide. Demand for livestock food products is increasing, especially in developing countries, and there are opportunities to increase production to meet local demand and increase farm incomes. Estimating the scale of livestock yield gaps and better understanding factors limiting current production will help to define the technological and investment needs in each livestock sector. The aim of this paper is to quantify livestock yield gaps and evaluate opportunities to increase dairy production in Sub-Saharan Africa and South Asia, using case studies from Ethiopia and India. We combined three different methods in our approach. Benchmarking and a frontier analysis were used to estimate attainable milk yields based on survey data. Household modelling was then used to simulate the effects of various interventions on dairy production and income. We tested interventions based on improved livestock nutrition and genetics in the extensive lowland grazing zone and highland mixed crop-livestock zones of Ethiopia, and the intensive irrigated and rainfed zones of India. Our analyses indicate that there are considerable yield gaps for dairy production in both countries, and opportunities to increase production using the interventions tested. In some cases, combined interventions could increase production past currently attainable livestock yields.

Ureterorenoscopy training on cadavers embalmed by Thiel's method: simulation or a further step towards reality? Initial report.

INTRODUCTION: The technique of ureterorenoscopy has a significant learning curve. Cadavers embalmed by the Thiel method have been successfully used for simulation training in a number of surgical specialties. Here we present our experience of the first use of Thiel cadavers in a formal ureteroscopy training course. MATERIAL AND METHODS: The inaugural 'Masterclass in Flexible Ureterorenoscopy' was run with participants performing ureterorenoscopy on three Thiel cadavers under expert supervision. A qualitative questionnaire was delivered to the participants and faculty. Assessed domains were tissue characteristics of the cadaveric urinary tract, anatomical features and procedural aspects. A five-point Likert score was used to assess responses. Data regarding participant experience in endourology were also collected. RESULTS: 8 questionnaires were collected. All participants completed cadaveric ureterorenoscopy. Three-quarters reported the overall quality of tissue in the cadaveric bladder, ureters and pelvicalyceal system as high or excellent. Half reported the cadaveric bladder as being softer than in a live patient, whilst five out of eight thought that the cadaveric ureter was softer and more prone to trauma. Seven out of eight were satisfied with the overall quality of the cadaveric model. The quality of vision and irrigation in the upper urinary tracts was reported as high. CONCLUSIONS: Thiel cadavers have been shown to have excellent tissue characteristics, as well as being durable and reusable. We have described the first use of Thiel cadavers in a designated ureterorenoscopy course, with high levels of delegate satisfaction. Further work is required to develop the role of Thiel cadavers as part of an integrated, modular urology training.

The application of design principles to innovate clinical care delivery.

Clinical research centers that support hypothesis-driven investigation have long been a feature of academic medical centers but facilities in which clinical care delivery can be systematically assessed and evaluated have heretofore been nonexistent. The Institute of Medicine report "Crossing the Quality Chasm" identified six core attributes of an ideal care delivery system that in turn relied heavily on system redesign. Although manufacturing and service industries have leveraged modern design principles in new product development, healthcare has lagged behind. In this article, we describe a methodology utilized by our facility to study the clinical care delivery system that incorporates modern design principles.

An in-house learning laboratory for patient-centered innovation.

Profound economic and social forces are challenging healthcare organizations to deliver higher quality care that is more patient-centered and evidence-based. We describe a novel way in which organizations can respond to the challenge of patient-centered, evidence-based innovation--an in-house learning laboratory for healthcare delivery services and processes. Mayo Clinic's SPARC Innovation Program, initiated in 2002 and fully operational in 2005, facilitates the generation of new ideas, tests prototypes, and disseminates the knowledge required for systemic, repeatable organizational innovation. Results from the innovation program suggest that healthcare organizations can successfully develop and realize value from such learning laboratories.

Therapeutic interventions in dementia 1: cognitive symptoms and function.

The first in this two-part unit on therapeutic interventions in dementia outlines how to maintain function and independence for patients with dementia. It also examines specific interventions for cognitive symptoms.

Therapeutic interventions in dementia. 2: Non-cognitive symptoms.

This is a two-part unit on therapeutic interventions in dementia, based on NICE and SCIE (2006) guidance. Part 1 outlined management strategies for cognitive symptoms and how to maintain function. This second part examines interventions for non-cognitive symptoms.

Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine.

BACKGROUND: The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote "best practices" and to improve patient outcomes. OBJECTIVE: 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock. PARTICIPANTS: Society of Critical Care Medicine members with special interest in neonatal and pediatric septic shock were identified from general solicitation at the Society of Critical Care Medicine Educational and Scientific Symposia (2001-2006). METHODS: The Pubmed/MEDLINE literature database (1966-2006) was searched using the keywords and phrases: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation (ECMO), and American College of Critical Care Medicine guidelines. Best practice centers that reported best outcomes were identified and their practices examined as models of care. Using a modified Delphi method, 30 experts graded new literature. Over 30 additional experts then reviewed the updated recommendations. The document was subsequently modified until there was greater than 90% expert consensus. RESULTS: The 2002 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and AHA sanctioned recommendations. Centers that implemented the 2002 guidelines reported best practice outcomes (hospital mortality 1%-3% in previously healthy, and 7%-10% in chronically ill children). Early use of 2002 guidelines was associated with improved outcome in the community hospital emergency department (number needed to treat = 3.3) and tertiary pediatric intensive care setting (number needed to treat = 3.6); every hour that went by without guideline adherence was associated with a 1.4-fold increased mortality risk. The updated 2007 guidelines continue to recognize an increased likelihood that children with septic shock, compared with adults, require 1) proportionally larger quantities of fluid, 2) inotrope and vasodilator therapies, 3) hydrocortisone for absolute adrenal insufficiency, and 4) ECMO for refractory shock. The major new recommendation in the 2007 update is earlier use of inotrope support through peripheral access until central access is attained. CONCLUSION: The 2007 update continues to emphasize early use of age-specific therapies to attain time-sensitive goals, specifically recommending 1) first hour fluid resuscitation and inotrope therapy directed to goals of threshold heart rates, normal blood pressure, and capillary refill 70% and cardiac index 3.3-6.0 L/min/m.

Effect of inulin on the human gut microbiota: stimulation of Bifidobacterium adolescentis and Faecalibacterium prausnitzii.

Prebiotics are food ingredients that improve health by modulating the colonic microbiota. The bifidogenic effect of the prebiotic inulin is well established; however, it remains unclear which species of Bifidobacterium are stimulated in vivo and whether bacterial groups other than lactic acid bacteria are affected by inulin consumption. Changes in the faecal microbiota composition were examined by real-time PCR in twelve human volunteers after ingestion of inulin (10 g/d) for a 16-d period in comparison with a control period without any supplement intake. The prevalence of most bacterial groups examined did not change after inulin intake, although the low G+C % Gram-positive species Faecalibacterium prausnitzii exhibited a significant increase (10.3% for control period v. 14.5% during inulin intake, P=0.019). The composition of the genus Bifidobacterium was studied in four of the volunteers by clone library analysis. Between three and five Bifidobacterium spp. were found in each volunteer. Bifidobacterium adolescentis and Bifidobacterium longum were present in all volunteers, and Bifidobacterium pseudocatenulatum, Bifidobacterium animalis, Bifidobacterium bifidum and Bifidobacterium dentium were also detected. Real-time PCR was employed to quantify the four most prevalent Bifidobacterium spp., B. adolescentis, B. longum, B. pseudocatenulatum and B. bifidum, in ten volunteers carrying detectable levels of bifidobacteria. B. adolescentis showed the strongest response to inulin consumption, increasing from 0.89 to 3.9% of the total microbiota (P=0.001). B. bifidum was increased from 0.22 to 0.63% (P<0.001) for the five volunteers for whom this species was present.

Influence of cooking duration of cabbage and presence of colonic microbiota on the excretion of N-acetylcysteine conjugates of allyl isothiocyanate and bioactivity of phase 2 enzymes in F344 rats.

Isothiocyanates have been implicated in the cancer-protective effects of brassica vegetables. When cabbage is consumed, sinigrin is hydrolysed by plant or microbial myrosinase partly to allyl isothiocyanate (AITC), which is mainly excreted as N-acetylcysteine conjugates (NAC) of AITC in urine. The effect of cooking cabbage on the excretion of NAC of AITC, and glutathione-S-transferase (GST) and uridine 5'-diphospho-glucuronosyl transferase (UGT) activity in rat liver and colon was investigated. Germ-free (GF) and human faecal microbiota-associated (HFM) rats were fed a control diet containing 20 % raw, lightly cooked, or fully cooked cabbage for 14 d. When plant myrosinase was present, excretion of NAC of AITC/24 h was increased by 1.4 and 2.5 times by the additional presence of microbial myrosinase after consumption of raw and lightly cooked cabbage respectively. When plant myrosinase was absent, as after consumption of fully cooked cabbage, excretion of the AITC conjugate was almost zero in GF and HFM rats. None of the cabbage diets modified hepatic GST activity. When microbiota was absent, colonic GST was 1.3-fold higher after fully cooked cabbage, and hepatic UGT was increased by 1.4-1.8-fold after all cabbage diets, compared with the control feed. There were no differences in GST or UGT following cabbage consumption when microbiota was present. It is possible that other constituents of cabbage, rather than metabolites of glucosinolates per se, may be responsible for changes in phase 2 enzyme activity. The main effect of cooking cabbage and altering colonic microbiota was on excretion of NAC of AITC.

Influence of cabbage processing methods and prebiotic manipulation of colonic microflora on glucosinolate breakdown in man.

Glucosinolate consumption from brassica vegetables has been implicated in reduction of cancer risk. The isothiocyanate breakdown products of glucosinolates appear to be particularly important as chemoprotective agents. Before consumption, brassica vegetables are generally cooked, causing the plant enzyme, myrosinase, to be denatured, influencing the profile of glucosinolate breakdown products produced. Some human intestinal microflora species show myrosinase-like activity (e.g. bifidobacteria). We aimed to increase bifidobacteria by offering a prebiotic (inulin) in a randomised crossover study. Six volunteers consumed inulin (10 g/d) for 21 d followed by a 21 d control period (no inulin). Treatment periods were reversed for the remaining six volunteers. During the last 5 d of each period two cabbage-containing meals were consumed. Total urine output was collected for 24 h following each meal. Cabbage was microwaved for 2 min (lightly cooked) or 5.5 min (fully cooked). Faecal samples were collected at the start and after the inulin and control treatments. Bifidobacteria were enumerated by real-time PCR. Allyl isothiocyanate production was quantified by measuring urinary excretion of allyl mercapturic acid (AMA). Bifidobacteria increased following prebiotic supplementation (P < 0.001) but there was no impact of this increase on AMA excretion. AMA excretion was greater following consumption of lightly cooked cabbage irrespective of prebiotic treatment (P < 0.001). In conclusion, the most effective way to increase isothiocyanate production may be to limit the length of time that brassica vegetables are cooked prior to consumption.

Effect of meal composition and cooking duration on the fate of sulforaphane following consumption of broccoli by healthy human subjects.

The isothiocyanate, sulforaphane, has been implicated in the cancer-protective effects of brassica vegetables. When broccoli is consumed, sulforaphane is released from hydrolysis of glucoraphanin by plant myrosinase and/or colonic microbiota. The influence of meal composition and broccoli-cooking duration on isothiocyanate uptake was investigated in a designed experiment. Volunteers (n 12) were each offered a meal, with or without beef, together with 150 g lightly cooked broccoli (microwaved 2.0 min) or fully cooked broccoli (microwaved 5.5 min), or a broccoli seed extract. They received 3 g mustard containing pre-formed allyl isothiocyanate (AITC) with each meal. Urinary output of allyl (AMA) and sulforaphane (SFMA) mercapturic acids, the biomarkers of production of AITC and sulforaphane respectively, were measured for 24 h after meal consumption. The estimated yield of sulforaphane in vivo was about 3-fold higher after consumption of lightly cooked broccoli than fully cooked broccoli. Absorption of AITC from mustard was about 1.3-fold higher following consumption of the meat-containing meal compared with the non meat-containing alternative. The meal matrix did not significantly influence the hydrolysis of glucoraphanin and its excretion as SFMA from broccoli. Isothiocyanates may interact with the meal matrix to a greater extent if they are ingested pre-formed rather than after their production from hydrolysis of glucosinolates in vivo. The main influence on the production of isothiocyanates in vivo is the way in which brassica vegetables are cooked, rather than the effect of the meal matrix.

Effect of cooking brassica vegetables on the subsequent hydrolysis and metabolic fate of glucosinolates.

The protective effects of brassica vegetables against cancer may be partly related to their glucosinolate content. Glucosinolates are hydrolysed by plant myrosinase following damage of plant tissue. Isothiocyanates are one of the main groups of metabolites of glucosinolates and are implicated in the preventive effect against cancer. During cooking of brassica the glucosinolate-myrosinase system may be modified as a result of inactivation of plant myrosinase, loss of enzymic cofactors such as epithiospecifier protein, thermal breakdown and/or leaching of glucosinolates and their metabolites or volatilisation of metabolites. Cooking brassica affects the site of release of breakdown products of glucosinolates, which is the upper gastrointestinal tract following consumption of raw brassica containing active plant myrosinase. After consumption of cooked brassica devoid of plant myrosinase glucosinolates are hydrolysed in the colon under the action of the resident microflora. Feeding trials with human subjects have shown that hydrolysis of glucosinolates and absorption of isothiocyanates are greater following ingestion of raw brassica with active plant myrosinase than after consumption of the cooked plant with denatured myrosinase. The digestive fate of glucosinolates may be further influenced by the extent of cell rupture during ingestion, gastrointestinal transit time, meal composition, individual genotype and differences in colonic microflora. These sources of variation may partly explain the weak epidemiological evidence relating consumption of brassica to prevention against cancer. An understanding of the biochemical changes occurring during cooking and ingestion of brassica may help in the design of more robust epidemiological studies to better evaluate the protective effects of brassica against cancer.