Do Right, Be Bright: A Protocol on the Development of an Inter-Professional Health Intervention Model for Pre-School Children Through a Community-Based Service-Learning Initiative.

An inter-professional project with a collaborative endeavor between the programs of Dentistry, Nutrition and Medicine was carried out with the aim to emphasise oral health maintenance, making the right nutritional choices and effective hand washing among pre-school children. The purpose of this paper is to share a detailed description of the design, development process, implementation, and planned evaluation of an interprofessional school-based health promotion intervention model "Do Right, Be Bright". This model is part of a quasi-experimental study, targeting pre-school children as the "Targets of Change" through the empowerment of school teachers as the "Agents of Change". The program design was based on Bartholomew's Intervention Mapping Approach, which proposes a direction for developing a theory-based health promotion intervention and on the most extensively applied theories of health behavior, the Health Belief Model. Therefore, based on a thorough literature review and needs assessment, three key areas of needs were identified for the targeted preschool children: oral hygiene, hand hygiene and nutrition. The efficacy of this model will be pilot tested in a preschool in Kuala Lumpur Malaysia.

AWANet: Attentive-Aware Wide-Kernels Asymmetrical Network with Blended Contour Information for Salient Object Detection.

Although deep learning-based techniques for salient object detection have considerably improved over recent years, estimated saliency maps still exhibit imprecise predictions owing to the internal complexity and indefinite boundaries of salient objects of varying sizes. Existing methods emphasize the design of an exemplary structure to integrate multi-level features by employing multi-scale features and attention modules to filter salient regions from cluttered scenarios. We propose a saliency detection network based on three novel contributions. First, we use a dense feature extraction unit (DFEU) by introducing large kernels of asymmetric and grouped-wise convolutions with channel reshuffling. The DFEU extracts semantically enriched features with large receptive fields and reduces the gridding problem and parameter sizes for subsequent operations. Second, we suggest a cross-feature integration unit (CFIU) that extracts semantically enriched features from their high resolutions using dense short connections and sub-samples the integrated information into different attentional branches based on the inputs received for each stage of the backbone. The embedded independent attentional branches can observe the importance of the sub-regions for a salient object. With the constraint-wise growth of the sub-attentional branches at various stages, the CFIU can efficiently avoid global and local feature dilution effects by extracting semantically enriched features via dense short-connections from high and low levels. Finally, a contour-aware saliency refinement unit (CSRU) was devised by blending the contour and contextual features in a progressive dense connected fashion to assist the model toward obtaining more accurate saliency maps with precise boundaries in complex and perplexing scenarios. Our proposed model was analyzed with ResNet-50 and VGG-16 and outperforms most contemporary techniques with fewer parameters.

A Discriminative Level Set Method with Deep Supervision for Breast Tumor Segmentation.

BACKGROUND: Breast tumor segmentation in B-mode ultrasound imaging is important for analyzing, identifying, and diagnosing tumors. The level set is an approach most widely used in breast segmentation, and the refinement is still in progress. However, its effectiveness is harmed by a dearth of semantic information. On the other hand, deep networks contain rich semantic information but loss much influential low-level details. METHOD: This paper proposes a novel deep-feature embedded level set group to exploit semantically enriched features for breast tumor segmentation. First, a UNet-based network is trained to extract different features at different stages. Each stage has unique features depiction. Then, a novel level-set method is integrated at the end of each stage to approach more accurate and precise features maps. A new feature-discriminator is devised in the energy function of the level set method to refine the low confidence pixels at the boundaries. Lastly, the outputs of the level set method at different stages are incorporated into final feature maps to further empower the segmentation process. Two datasets comprising 349 breast ultrasound images from various hospitals have been utilized to assess the proposed approach's performance. The model's effectiveness is estimated on different metrics, including Accuracy, Sensitivity or True Positive rate, Specificity or True Negative rate, False Positive rate Dice, and IoU values for both datasets. Furthermore, the efficiency of the model is investigated by performing a comparison with several state-of-the-art classic segmentation methods and deep learning methods. RESULT: The proposed method outperformed segmenting breast ultrasound tumors in terms of Dice and IoU for datasets A and B (with p-value < 0.005 against compared methods). Additionally, the performance of the proposed approach is evaluated using the Area Under Receiver Operating Characteristics curve (AUC) and Mean Absolute Error (MAE). Our findings indicate that the proposed method seems to gain superiority over other methods by obtaining a lower MAE rate with the highest value of the AUC. CONCLUSION: Experiments determine that our method has obtained the best cut-off to deal with the noticeable glitches present in other approaches and generates more accurate segmentation results for tumors in complex images. Hence, the results confirm the proposed method's effectiveness compared to classic segmentation methods over ultrasound images with blurry boundaries, noise, and intensity inhomogeneity. Moreover, our approach gives unprecedented prediction accuracy and similarity for malignant tumors.

Smoking cessation behaviors and reasons for use of electronic cigarettes and heated tobacco products among Romanian adults.

We report cessation behaviors, reasons for use of electronic cigarettes (EC) and heated tobacco products (HTP) and association of their use with quit attempts and smoking intensity using Romania Global Adult Tobacco Survey 2018. Weighted estimates of EC and HTP by cigarette smoking (CS) status were assessed. Quit attempts, intention to quit, reasons for lack of intention to quit among current CS, and reasons for current use of EC and HTP were estimated. The association of 'ever use' of EC and HTP with cigarette smoking intensity and quit attempts was explored using binary logistic regression. Of the total 4571 surveyed, 1243 (27.3%) were current CS, 300 (24.4%) made quit attempts in the past 12 months. Only 38 (12.5%) and 26 (8.6%) had used EC and HTP as an aid to quit. Among current CS, 512 (41.2%) had no intention to quit. Reasons for this were, 'enjoy smoking' (86.1%), 'reduce stress' (65.9%), and 'staying alert' (46.3%). Awareness and use of EC and HTP were significantly higher among current CS. 'Dual use' of EC and HTP with CS was manifolds higher than stand-alone use. Reasons for current use of EC and HTP were 'enjoyment', and 'use in places where smoking was prohibited'.

Harnessing the power of the electronic health record for ALS research and quality improvement: CReATe CAPTURE-ALS and the ALS Toolkit.

The electronic health record (EHR) is designed principally to support the provision and documentation of clinical care, as well as billing and insurance claims. Broad implementation of the EHR, however, also yields an opportunity to use EHR data for other purposes, including research and quality improvement. Indeed, effective use of clinical data for research purposes has been a long-standing goal of physicians who provide care for patients with ALS, but the quality and completeness of clinical data, as well as the burden of double data entry into the EHR and into a research database, have been persistent barriers. These factors provided motivation for the development of the ALS Toolkit, a set of interactive digital forms within the EHR that enable easy, consistent, and structured capture of information relevant to ALS patient care (as well as research and quality improvement) during clinical encounters. Routine use of the ALS Toolkit within the context of the CReATe Consortium's institutional review board-approved Clinical Procedures to Support Research in ALS (CAPTURE-ALS) study protocol, permits aggregation of structured ALS patient data, with the goals of empowering research and driving quality improvement. Widespread use of the ALS Toolkit through the CAPTURE-ALS protocol will help to ensure that ALS clinics become a driving force for collecting and aggregating clinical data in a way that reflects the true diversity of the populations affected by this disease, rather than the restricted subset of patients that currently participate in dedicated research studies.

Challenges and opportunities for Multi-National Investigator-Initiated clinical trials for ALS: European and United States collaborations.

An inherent challenge to clinical trials that aim to test the efficacy of experimental therapeutics for patients with amyotrophic lateral sclerosis (ALS) is the relative rarity of the disease. A promising solution to this problem is a multi-center approach that ideally includes sites distributed across a broad geographic area. In support of such an approach, the European E-RARE program and the United States National Institutes of Health (NIH) partnered to support the investigator-initiated ROCK-ALS trial (Eudra-CT-Nr.: 2017-003676-31, NCT03792490) as a multi-national collaboration between centers in Europe and North America that is led by European investigators. During the set-up of this international trial, however, a number of unanticipated legal, administrative, and financial complexities emerged that required significant adaptation of the proposed trial scheme. Here, we report our experience navigating these obstacles and describe the potential solutions that we explored. Our experience may inform future efforts to implement multi-national investigator-initiated trials that involve both European and United States centers.

GM trust shaped by trust determinants with the impact of risk/benefit framework: the contingent role of food technology neophobia.

The present study is comparative in natures that focus on understanding the factors that influence the GM food trust level in the BRA framework and food technology neophobia in China and the USA. For this purpose, we collected 300 and 350 valid responses, respectively, through a structured questionnaire. By carefully evaluating the above relationships, we found that trust determinants such as institutional trust, technology trust, information revealed with GM food vary across both datasets. However, GM knowledge has a better association with GM food trust in both cases. Apart from this, the food technology neophobia slightly moderates the benefits-risk perception of consumers and GM trust. This study guides the policymakers to enhance GM knowledge, as GM food is scientifically proven safe for health and environment and can be a financial incentive for the farmers. Further, the study also provides direction for corporate managers to design effective marketing and communication strategies in two different countries by investigating GM food trust's primary motivators in both nations.

The psychological perspective on the adoption of approved genetically modified crops in the presence of acceptability constraint: the contingent role of passion.

This study contributes to the literature on genetically modified crops by examining the impact of psychological distance on farmer adoption. The existing body of literature suggests that some farmers have the conservative perception to adopt genetically modified crops because of controversies regarding the side effects and profitability. To understand these social problems, we have relied upon construal-level theory which argues farmer passion about dynamics like here and now, likely or unlikely and the near or far from self are vital for the adoption of approved genetically modified crops. The data for the present study collected from three Asian countries through questionnaire, for China 300, India 350, Philippines 300 valid responses collected. The study founds a positive relation of psychological distance based on passion with farmer trust behavior to adopt genetically modified crops over time. The findings of the present study provide new insights into the development of farmer acceptability and encourage the use of novel crop technologies.Abbreviations: GM, genetically modified; TD, temporal distance; SPD, Spatial distance; SD, Social distance; TB, trust behavior; AGMC, Approved Genetically modified crops; CLT, Construal Level Theory.

3Ts of low cure rate: taxonomy, themes and theory of low cure rate in Pakistan's TB control programme and gathering a 360-degree perspective through qualitative, in-depth interviewing approach.

OBJECTIVE: WHO recommends cure of tuberculosis (TB) as the best prevention strategy; however, information about factors associated with low cure rate in patients with drug-susceptible TB is limited in Pakistan. Therefore, the purpose of this study was to explore the factors that account for low TB cure rate. METHODOLOGY: The present qualitative study recruited diverse informants through purposive sampling to explore low cure rate situation in Badin between March and June 2017. Data were collected from clinicians, paramedics, lab technicians, district field supervisors, patients and treatment supporters through indepth and face-to-face interviews. Interviews were conducted in local languages (Urdu and Sindhi) and transcribed into English. Coding structure was developed inductively and applied on textual data to draw output at the levels of taxonomy, themes and theory, as proposed by Bradley et al. FINDINGS: Thirty-seven individuals consented to participate in this study and provided detailed account of the subject under enquiry. Review of interview data collected from a variety of informants resulted in the identification of four broad factors (taxonomy) that contributed to the situation of low cure rate in one of the districts implementing the public-private mix intervention. These factors were (1) health-seeking behaviour, (2) technical capacity of the healthcare provider, (3) managerial capacity of the healthcare provider, and (4) access to healthcare facility and services. Each factor is deconstructed into key dimensions (themes) that emerged from the dialogue between the interviewer and the respondents. Moreover, dimensions were exemplified through underlying concepts that correspond to theories for low cure rate. CONCLUSION: Change in programme reporting requirement has demeaned the significance of having cure as treatment outcome. Therefore, returning the focus to achieving cure status for TB cases will be beneficial for assessing the effectiveness of TB control efforts. In parallel to the care delivery system, a mechanism for disseminating disease-related and treatment-related information should be introduced.

Identification of compound heterozygous variants in OPTN in an ALS-FTD patient from the CReATe consortium: a case report.

Homozygous loss-of-function mutations in optineurin (OPTN) are a rare cause of amyotrophic lateral sclerosis (ALS), whereas heterozygous loss-of-function mutations have been suggested to increase ALS disease risk. We report a patient with ALS and frontotemporal dementia (FTD) from the Clinical Research in ALS and Related Disorders for Therapeutic Development (CReATe) Consortium carrying compound heterozygous loss-of-function variants in OPTN. Quantitative real-time mRNA expression analyses revealed a 75-80% reduction in OPTN expression in blood in the OPTN carrier as compared to controls, suggesting at least partial nonsense-mediated decay of the mutant transcripts. This case report illustrates the diverse inheritance patterns and variable clinical presentations associated with OPTN mutations, and underscores the importance of complete OPTN gene screening in patients with ALS and related disorders, especially in the context of clinical genetic testing.

Assessment of Nutritional Status of Infants Living in Arsenic-Contaminated Areas in Bangladesh and Its Association with Arsenic Exposure.

Data is scarce on early life exposure to arsenic and its association with malnutrition during infancy. This study followed the nutritional status of a cohort of 120 infants from birth to 9 months of age in an arsenic contaminated area in Bangladesh. Anthropometric data was collected at 3, 6 and 9 months of the infant's age for nutritional assessment whereas arsenic exposure level was assessed via tube well drinking water arsenic concentration at the initiation of the study. Weight and height measurements were converted to Z-scores of weight for age (WAZ-underweight), height for age (HAZ-stunting), weight for height (WHZ-wasting) for children by comparing with WHO growth standard. Arsenic exposure levels were categorized as <50 µg/L and ≥50 µg/L. Stunting rates (<-2 SD) were 10% at 3 months and 44% at both 6 and 9 months. Wasting rates (<-2 SD) were 23.3% at 3 months and underweight rates (<-2 SD) were 25% and 10% at 3 and 6 months of age, respectively. There was a significant association of stunting with household drinking water arsenic exposure ≥50 µg/L at age of 9 months (p = 0.009). Except for stunting at 9 months of age, we did not find any significant changes in other nutritional indices over time or with levels of household arsenic exposure in this study. Our study suggests no association between household arsenic exposure and under-nutrition during infancy; with limiting factors being small sample size and short follow-up. Difference in stunting at 9 months by arsenic exposure at ≥50 µg/L might be a statistical incongruity. Further longitudinal studies are warranted to establish any association.

Prospective Study of Dietary Zinc Intake and Risk of Cardiovascular Disease in Women.

Several animal and human studies have shown that zinc is associated with cellular damage and cardiac dysfunction. This study aims to investigate dietary zinc and the zinc-iron ratio, as predictors of incident cardiovascular disease (CVD) in a large longitudinal study of mid-age Australian women (aged 50-61 years). Data was self-reported and validated food frequency questionnaires were used to assess dietary intake. Energy-adjusted zinc was ranked using quintiles and predictors of incident CVD were examined using stepwise logistic regression. After six years of follow-up, 320 incident CVD cases were established. A positive association between dietary zinc intake, zinc-iron ratio and risk of CVD was observed even after adjusting for potential dietary and non-dietary confounders. Compared to those with the lowest quintile of zinc, those in the highest quintile (Odds Ratio (OR) = 1.67, 95% Confidence Interval (CI) = 1.08-2.62) and zinc-iron ratio (OR = 1.72, 95% CI = 1.05-2.81) had almost twice the odds of developing CVD (p trend = 0.007). This study shows that high dietary zinc intake and zinc-iron ratio is associated with a greater incidence of CVD in women. Further studies are required detailing the source of zinc and iron in diet and their precise roles when compared to other essential nutrients.

Trapped in Statelessness: Rohingya Refugees in Bangladesh.

The Rohingya people are one of the most ill-treated and persecuted refugee groups in the world, having lived in a realm of statelessness for over six generations, and who are still doing so. In recent years, more than 500,000 Rohingyas fled from Myanmar (Burma) to neighboring countries. This article addresses the Rohingya refugee crisis in Bangladesh, with special emphasis on the living conditions of this vulnerable population. We reviewed several documents on Rohingya refugees, visited a registered refugee camp (Teknaf), collected case reports, and conducted a series of meetings with stakeholders in the Cox's Bazar district of Bangladesh. A total of 33,131 registered Rohingya refugees are living in two registered camps in Cox's Bazar, and up to 80,000 additional refugees are housed in nearby makeshift camps. Overall, the living conditions of Rohingya refugees inside the overcrowded camps remain dismal. Mental health is poor, proper hygiene conditions are lacking, malnutrition is endemic, and physical/sexual abuse is high. A concerted diplomatic effort involving Bangladesh and Myanmar, and international mediators such as the Organization of Islamic Countries and the United Nations, is urgently required to effectively address this complex situation.

A Review of the Effects of Chronic Arsenic Exposure on Adverse Pregnancy Outcomes.

Exposure to arsenic has a number of known detrimental health effects but impact on pregnancy outcomes is not as widely recognized. This narrative review examines existing epidemiological evidence investigating the association between arsenic exposure via drinking water and adverse pregnancy outcomes. We reviewed published epidemiological studies from around the world on impact of chronic arsenic exposure on spontaneous abortion, stillbirth, neonatal death, post neonatal death, low birth weight and preterm baby. Plausible mechanisms of arsenic toxicity causing adverse pregnancy outcomes were also determined through literature review. There is convincing evidence to support the association between high inorganic arsenic exposure (>50 ppb) and spontaneous abortion, stillbirth and low birth weight. Limitations of certain studies include study design, small sample size, recall constraints and exposure assessment. There needs to be further research investigating the dose metered impact of arsenic exposure on pregnancy outcomes. Further research on impact of low-moderate arsenic concentration exposure on pregnancy outcomes will allow for appropriate public health policy recommendations.

Presymptomatic ALS genetic counseling and testing: Experience and recommendations.

Remarkable advances in our understanding of the genetic contributions to amyotrophic lateral sclerosis (ALS) have sparked discussion and debate about whether clinical genetic testing should routinely be offered to patients with ALS. A related, but distinct, question is whether presymptomatic genetic testing should be offered to family members who may be at risk for developing ALS. Existing guidelines for presymptomatic counseling and testing are mostly based on small number of individuals, clinical judgment, and experience from other neurodegenerative disorders. Over the course of the last 8 years, we have provided testing and 317 genetic counseling sessions (including predecision, pretest, posttest, and ad hoc counseling) to 161 first-degree family members participating in the Pre-Symptomatic Familial ALS Study (Pre-fALS), as well as testing and 75 posttest counseling sessions to 63 individuals with familial ALS. Based on this experience, and the real-world challenges we have had to overcome in the process, we recommend an updated set of guidelines for providing presymptomatic genetic counseling and testing to people at high genetic risk for developing ALS. These recommendations are especially timely and relevant given the growing interest in studying presymptomatic ALS.

A Review of Groundwater Arsenic Contamination in Bangladesh: The Millennium Development Goal Era and Beyond.

Arsenic contamination in drinking water has a detrimental impact on human health which profoundly impairs the quality of life. Despite recognition of the adverse health implications of arsenic toxicity, there have been few studies to date to suggest measures that could be taken to overcome arsenic contamination. After the statement in 2000 WHO Bulletin that Bangladesh has been experiencing the largest mass poisoning of population in history, we researched existing literature to assess the magnitude of groundwater arsenic contamination in Bangladesh. The literature reviewed related research that had been initiated and/or completed since the implementation of the Millennium Development Goals (MDGs) under four domains: (1) extent of arsenic contamination; (2) health consequences; (3) mitigation and technologies and (4) future directions. To this means, a review matrix was established for analysis of previous literature based on these four core domains. Our findings revealed that several high-quality research articles were produced at the beginning of the MDG period, but efforts have dwindled in recent years. Furthermore, there were only a few studies conducted that focused on developing suitable solutions for managing arsenic contamination. Although the government of Bangladesh has made its population's access to safe drinking water a priority agenda item, there are still pockets of the population that continue to suffer from arsenic toxicity due to contaminated water supplies.