Interventions to Increase Affordable Care Act Marketplace Enrollment: A Systematic Review And Meta-Analysis.

Over 10 million uninsured individuals are eligible for subsidized health insurance coverage through the Affordable Care Act (ACA) marketplaces, and millions more were projected to become eligible with the end of the federal COVID-19 Public Health Emergency in 2023. Individual studies on behaviorally informed interventions designed to encourage enrollment suggest that some are more effective than others. This study summarizes evidence on the efficacy of these interventions and suggests which administrative burdens might be most relevant for potential enrollees. Published and unpublished studies were identified through a systematic review of studies assessing the impact of behaviorally informed interventions on ACA marketplace enrollment from 2014 to 2022. Thirty-four studies comprising over 18 million participants were included (32 randomized controlled trials and 2 quasiexperimental studies). At the time of data extraction, 8 were published. Twenty-seven of the studies qualified for inclusion in a meta-analysis, which found that the average rate of enrollment was about 1 percentage point higher for those who received an intervention (0.009, P < 0.001), a 24% increase relative to control households; for every 1000 people who receive an intervention, that would correspond to about 9 additional enrollees. When stratifying by intervention intensity, support-based interventions increased enrollment by 2 percentage points (0.020, P = 0.004), while information-based interventions increased enrollment by 0.6 percentage points (0.006, P < 0.001). The meta-analysis found that behaviorally informed interventions can increase ACA marketplace enrollment. Interventions aimed at alleviating compliance costs by providing enrollment support were about three times as effective as information alone.

Immunoadsorption and Plasma Exchange are Comparable in Anti-Neutrophil Cytoplasmic Antibodies or Anti-Glomerular Basement Membrane Removal Kinetics.

Introduction: Apheresis allows the fast removal of autoantibodies in anti-glomerular basement membrane (anti-GBM) disease, and in severe antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. The CINEVAS study tested whether immunoadsorption (IA) allowed a faster removal of ANCA and/or anti-GBM antibodies than plasma exchanges (PEx). Methods: CINEVAS was a prospective multicenter study comparing IA to PEx in consecutive patients with ANCA and/or anti-GBM vasculitides. The primary objective was the reduction rate in autoantibody titers between the beginning of the first and the end of the seventh apheresis session. Secondary objectives were number of sessions needed to obtain desired reduction rates; reduction rates of total Ig levels; tolerance of sessions; and patients' outcome. Results: The results of 38 patients (16 treated with IA and 22 with PEx), and 43 autoantibodies, were analyzed. There was no difference in the reduction rates in autoantibody titers between IA and PEx over 7 sessions (respectively 98% vs. 96%, P = 0.39). The numbers of sessions needed to obtain undetectable autoantibodies, or 50%, 75%, or 90% reductions, did not differ between techniques. Greater reduction rates of autoantibodies were observed when plasma was separated by filtration compared to centrifugation, with IA and PEx. IA allowed a greater reduction in total IgG levels, and better preservation of total IgA and IgM levels than PEx. PEx sessions required higher volumes of plasma, IA sessions higher volumes of citrate; IA sessions were longer. Conclusions: IA and PEx were comparable in ANCA or anti-GBM removal kinetics, despite a faster reduction in total IgG with IA.

Sexual exchanges explain the association between attachment insecurities and sexual satisfaction in long-term couples.

Although attachment insecurity has been linked to sexual dissatisfaction in cross-sectional research, little is known about the mechanisms by which attachment is associated with sexual satisfaction over time. This study examined the role of attachment insecurities in sexual satisfaction over time using the Interpersonal Exchange Model of Sexual Satisfaction (IEMSS) as a theoretical framework. Participants were 151 Canadian mixed-gender couples in a long-term relationship (M = 9.7 years) who completed questionnaires at two time points. The results demonstrate that sexual exchanges explained the associations between attachment insecurities (anxiety and avoidance) and sexual satisfaction in both men and women in long-term relationships, although the specific pathways differed by gender. These results are discussed in the context of the IEMSS and attachment theory.

Surface-air exchanges of H2S and SO2 in an urban wetland in eastern China.

Wetlands are widely recognized as hot spots for the emission or deposition of biogenic sulfur gases, including hydrogen sulfur (H2S) and sulfur dioxide (SO2), which significantly affect air quality and climate change. With the expansion of urban wetlands, it is critical to know the roles that urban wetlands played in atmospheric H2S and SO2 budget. In this study, the surface-air exchange fluxes of H2S and SO2 were measured by the Dynamic Flux Chamber (DFC) method in a typical urban wetland in eastern China from Sep 2022 to July 2023. It was found that the urban wetland did not have the expected high H2S emission, might be caused by the relatively high pH value and low sulfate concentration in the soil. Although H2S showed emission in the daytime of spring and summer, an overall H2S flux of -0.04 kg S ha-1 yr-1 was observed throughout the year. Meanwhile, the urban wetland presented a net sink of SO2, with a deposition flux of 0.14 kg S ha-1 yr-1. The negative peaks of SO2 flux corresponded to the suddenly elevated SO2 concentration in the ambient air especially in spring and winter. Through linear fitting of SO2 flux and concentration, the concept of SO2 "compensation point" was proposed. The compensation point is the concentration level at which the observed SO2 flux equals zero. The "compensation point" changed with the season and was related to temperature and humidity. The "compensation point" in summer and autumn were larger, being 2.37 ppb and 1.40 ppb, respectively, while they were 1.07 ppb and 0.86 ppb in spring and winter respectively. Our results suggest that the urban wetland expansion may have little risk of increasing air H2S but could act as a significant sink of SO2 with high SO2 concentration in the urban region.

Unveiling the human fetal-maternal interface during the first trimester: biophysical knowledge and gaps.

The intricate interplay between the developing placenta and fetal-maternal interactions is critical for pregnancy outcomes. Despite advancements, gaps persist in understanding biomechanics, transport processes, and blood circulation parameters, all of which are crucial for safe pregnancies. Moreover, the complexity of fetal-maternal interactions led to conflicting data and methodological variations. This review presents a comprehensive overview of current knowledge on fetal-maternal interface structures, with a particular focus on the first trimester. More in detail, the embryological development, structural characteristics, and physiological functions of placental chorionic plate and villi, fetal membranes and umbilical cord are discussed. Furthermore, a description of the main structures and features of maternal and fetal fluid dynamic exchanges is provided. However, ethical constraints and technological limitations pose still challenges to studying early placental development directly, which calls for sophisticated in vitro, microfluidic organotypic models for advancing our understanding. For this, knowledge about key in vivo parameters are necessary for their design. In this scenario, the integration of data from later gestational stages and mathematical/computational simulations have proven to be useful tools. Notwithstanding, further research into cellular and molecular mechanisms at the fetal-maternal interface is essential for enhancing prenatal care and improving maternal and fetal health outcomes.

Improving the performance of the photosynthetic apparatus of Citrus sinensis with the use of chitosan-selenium nanocomposite (CS + Se NPs) under salinity stress.

BACKGROUND: Abiotic stress, such as salinity, affects the photosynthetic apparatus of plants. It is reported that the use of selenium nanoparticles (Se NPs), and biochemical compounds such as chitosan (CS) increase the tolerance of plants to stress conditions. Therefore, this study aimed to elucidate the potential of Se NPs, CS, and their composite (CS + Se NPs) in improving the photosynthetic apparatus of C. sinensis under salt stress in greenhouse conditions. The grafted seedlings of C. sinensis cv. Valencia after adapting to the greenhouse condition, were imposed with 0, 50, and 100 mM NaCl. After two weeks, the plants were foliar sprayed with distilled water (control), CS (0.1% w/v), Se NPs (20 mg L- 1), and CS + Se NPs (10 and 20 mg L- 1). Three months after treatment, the levels of photosynthetic pigments, leaf gas exchange, and chlorophyll fluorescence in the treated plants were evaluated. RESULTS: Under salinity stress, total chlorophyll, carotenoid, and SPAD values decreased by 31%, 48%, and 28% respectively, and Fv/Fm also decreased compared to the control, while the ratio of absorption flux (ABS), dissipated energy flux (DI0) and maximal trapping rate of PSII (TR0) to RC (a measure of PSII apparent antenna size) were increased. Under moderate (50 mM NaCl) and intense (100 mM NaCl) salinity stress, the application of CS + Se NPs significantly increased the levels of photosynthetic pigments and the Fv/Fm value compared to plants treated with distilled water. CONCLUSIONS: It may be inferred that foliar treatment with CS + Se NPs can sustain the photosynthetic ability of C. sinensis under salinity stress and minimize its deleterious effects on photosynthesis.

Scanning resources to build an international nursing knowledge network.

This paper reports the gathered information from an international environmental scan of university-baseline information for the creation of a Nursing Knowledge Network. An online environment scan of organizational context (February to October 2021) explored the identification of research areas, existing resources, expected benefits, innovations in teaching research, barriers to knowledge dissemination, and prospective contributions of the Network. Target informants were 200 nursing faculty affiliated with 63 universities located in 13 countries, as well as nursing networks in the Ibero-American context. One informant per university was asked to respond to the questionnaire. The participation rate was nearly 70% (42/63). The informants' universities per country included Brazil (n = 21), Canada (n = 4), Portugal and Spain (n = 3 each), Colombia, Mexico, Peru and USA (n = 2 each), Chile, Italy and Paraguay (n = 1 each). Nursing faculty provided rich information and shared knowledge confirming a strong commitment to global co-creation of innovations and research partnership capacities through collaboration, cooperation, and knowledge exchange among nursing higher education institutions. Seldom researched areas are a potential focus for the Network to generate appropriate evidence to inform local scientific practices. The gathered information will inform further review of nursing and governmental policies and programs related to the application and dissemination of nursing evidence across local, regional, and global levels.

Regional Active Transcription Associates with Homoeologous Exchange Breakpoints in Synthetic Brassica Tetraploids.

Polyploidization plays a crucial role in plant evolution and is becoming increasingly important in breeding. Structural variations and epigenomic repatterning have been observed in synthetic polyploidizations. However, the mechanisms underlying the occurrence and their effects on gene expression and phenotype remain unknown. Here, we investigated genome-wide large deletion/duplication regions (DelDups) and genomic methylation dynamics in leaf organs of progeny from the first eight generations of synthetic tetraploids derived from Chinese cabbage (Brassica rapa L. ssp. pekinensis) and cabbage (Brassica oleracea L. var. capitata). One- or two-copy DelDups, with a mean size of 5.70 Mb (400 kb - 65.85 Mb), occurred from the first generation of selfing and thereafter. The duplication of a fragment in one subgenome consistently coincided with the deletion of its syntenic fragment in the other subgenome, and vice versa, indicating that these DelDups were generated by homoeologous exchanges (HEs). Interestingly, the larger the genomic syntenic region, the higher the frequency of DelDups, further suggesting that the pairing of large homoeologous fragments is crucial for HEs. Moreover, we found that the active transcription of continuously distributed genes in local regions is positively associated with the occurrence of HE breakpoints. In addition, the expression of genes within DelDups exhibited a dosage effect, and plants with extra parental genomic fragments generally displayed phenotypes biased towards the corresponding parent. Genome-wide methylation fluctuated remarkably, which did not clearly affect gene expression on a large scale. Our findings provide insights into the early evolution of polyploid genomes, offering valuable knowledge for polyploidization-based breeding.

Update on targeted treatments for ANCA-associated vasculitis.

Targeted therapy has revolutionized the management of ANCA-associated vasculitis (AAV) over the last fifteen years. Rituximab, an approved induction and maintenance agent for severe AAV, is no less effective than cyclophosphamide as induction therapy and particularly useful in relapsing or refractory disease, or in women. In patients with relapsing AAV, granulomatosis with polyangiitis or PR3-ANCA, it is more effective than cyclophosphamide. Rituximab maintenance is superior to the conventional immunosuppressive drugs that it replaces. Low-dose preemptive rituximab infusions are recommended every 6months for 18months, followed by re-evaluation to decide whether 4 additional biannual infusions should be administered, balancing the probability of relapse and the risk of serious infections on rituximab. A growing body of experimental and clinical data shows that C5a pathway inhibition is a promising therapeutic option for AAV, which could reduce glucocorticoids needs. Avacopan is a first approved oral C5A receptor antagonist, used when there is a high risk that glucocorticoids will cause serious adverse events. In eosinophilic granulomatosis with polyangiitis, the importance of IL-5 for eosinophil activation and survival led to evaluation and approval of mepolizumab, a humanized monoclonal antibody directed against IL-5. Mepolizumab showed a steroid-sparing effect. Its effectiveness in active vasculitis remains uncertain and is currently being evaluated. Benralizumab targeting the IL-5 receptor was recently shown to be noninferior to mepolizumab. Rituximab has had disappointing results in non-severe active vasculitis and is being evaluated as maintenance therapy. Plasma exchange is not indicated as first-line treatment but remains recommended when creatinine levels exceed 300µmol/L.

Predictors of membrane oxygenator failure in pediatric extracorporeal membrane oxygenation.

BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly utilized in pediatric patients. Failure to recognize membrane oxygenator failure can lead to critical complications due to rapid deterioration of membrane oxygenator function. Therefore, identifying the predictors for membrane oxygenator exchange is crucial. However, risk factors for membrane oxygenator exchange in pediatric V-A ECMO remain unclear; therefore, this study aimed to evaluate these risk factors. METHODS: This retrospective cohort study enrolled all pediatric patients aged <18 years who received V-A ECMO between August 2018 and July 2023 at a tertiary-care pediatric hospital in Japan. The Cox proportional hazards model was used to evaluate the predictors of membrane oxygenator failure within 72 h after initiation. RESULTS: During the study period, membrane oxygenator failure occurred in 18/55 (32.7%) children within 72 h; membrane oxygenator failure within 72 h occurred in 4/29 (13.8%) and 14/26 (53.8%) in the groups with ratio of blood flow divided by the blood flow limit of the membrane oxygenator (B/L) of <0.5 and ≥0.5, respectively (adjusted hazards ratio, 4.97 [95% confidence interval, 1.33-18.5]; p = 0.017). After adjusting for delta pressure of the oxygenator, an increase in body weight and aspartate aminotransferase levels were associated with an increase in early membrane oxygenator failure. CONCLUSIONS: This retrospective study demonstrated that a B/L ratio >0.5, an increase in body weight, and elevated aspartate aminotransferase were independent risk factors for early membrane oxygenator failure in pediatric V-A ECMO. However, a prospective multicenter study with an appropriate sample size is warranted to mitigate potential bias, and enhance generalizability for further investigation of the association between a B/L ratio and early membrane oxygenator failure.

Ecophysiological and nutritional characterisation of two morphotypes of Cakile maritima subsp. maritima Scop. from Puglia region, Southern Italy.

Cakile maritima subsp. maritima Scop. (sea rocket) is a succulent halophyte with significant potential as a nutritious food source, being rich in essential nutrients such as vitamins, minerals, and antioxidants. This annual species exhibits two distinct leaf morphotypes: entire lamina (EL) and pinnatifid lamina (PL). Our understanding of their ecophysiological and nutritional profiles is still limited. The present study investigated the wild EL and PL sea rocket plants from southern Italy during their vegetative stage. The bio-morphological traits (leaf mass area-LMA, dry matter and chlorophyll concentrations), main inorganic ions, key antioxidants (carotenoids, anthocyanins, phenols, flavonoids, glucosinolates, vitamin C as ascorbic and dehydroascorbic acid), and antioxidant activity (by FRAP, DPPH, ABTS assays) were analyzed. Additionally, photosynthetic gas exchange and chlorophyll fluorescence were measured. PL plants showed thicker leaves (higher LMA) and greater accumulation of photo-protective pigments (carotenoids and anthocyanins), despite similar chlorophyll levels. The PL plants also demonstrated higher photosynthetic activity, transpiration rates, and stomatal conductance, with reduced non-photochemical quenching. The EL morphotype had higher cation (K, Mg, Ca, Na) and vitamin C (135.3 mg 100 g-1 FW) concentrations, while no significant disparities were observed between the morphotypes in phenolic concentration (208.5 mg g.a.e. 100 g-1 FW), flavonoids (71.5 mg q.e. 100 g-1 FW), or glucosinolates (61 mg g-1 FW). Interestingly, while the EL type had higher vitamin C, the PL morphotype showed superior antioxidant activity (FRAP, DPPH) and seems to be better adapted to water/nutrient scarcity typical of southern Italy. Both morphotypes offer potential as high-nutritional foods, however, future research should investigate the genotype-specific production of antioxidant compounds in EL and PL plants in response to environmental stresses, including salinity for potential exploitation as a new crop.

Modelling lung diffusion-perfusion limitation in mechanically ventilated SARS-CoV-2 patients.

This is the first study to describe the daytime evolution of respiratory parameters in mechanically ventilated COVID-19 patients. The data base refers to patients hospitalised in the intensive care unit (ICU) at Arequipa Hospital (Peru, 2335 m) in 2021. In both survivors (S) and non-survivors (NS) patients, a remarkable decrease in respiratory compliance was observed, revealing a proportional decrease in inflatable alveolar units. The S and NS patients were all hyperventilated and their SatO2 was maintained at >90%. However, while S remained normocapnic, NS developed progressive hypercapnia. We compared the efficiency of O2 uptake and CO2 removal in the air blood barrier relying on a model allowing to partition between diffusion and perfusion limitations to gas exchange. The decrease in O2 uptake was interpreted as diffusion limitation, while the impairment in CO2 removal was modelled by progressive perfusion limitation. The latter correlated with the increase in positive end-expiratory pressure (PEEP) and plateau pressure (Pplat), leading to capillary compression, increased blood velocity, and considerable shortening of the air-blood contact time.

Harnessing Pb-S Interactions for Long-Term Water Stability in Cesium Lead Halide Perovskite Nanocrystals.

Lead halide perovskite nanocrystals (LHP NCs) have garnered attention as promising light-harvesting materials for optoelectronics and photovoltaic devices, attributed to their impressive optoelectronic properties. However, their susceptibility to moisture-induced degradation has hindered their practical applications. Despite various encapsulation strategies, challenges persist in maintaining their stability and optoelectronic performance simultaneously. Here, a ligand exchange approach is proposed using (11-mercaptoundecyl)-N,N,N-trimethylammonium bromide (MUTAB) to enhance the stability and dispersibility of CsPbBr3 (CPB) NCs in aqueous environments. MUTAB enables effective surface passivation of the CPB NCs via robust Pb-S interactions at the S-terminal while concurrently directing water molecules through the unbound cationic N-terminal or vice versa, ensuring water dispersibility and stability. Spectroscopic analysis confirms retained structural and optical integrity post-ligand exchange. Crucially, MUTAB-bound CPB NCs exhibit sustained charge transfer properties, demonstrated by aqueous colloidal oxidation reactions. This ligand exchange strategy offers a promising pathway for advancing LHP NCs toward practical optoelectronic and photocatalytic applications.

Drought Stress Responses in Arabica Coffee Genotypes: Physiological and Metabolic Insights.

Understanding the impact of drought stress on Arabica coffee physiology and metabolism is essential in the pursuit of developing drought-resistant varieties. In this study, we explored the physiological and metabolite changes in coffee genotypes exhibiting varying degrees of tolerance to drought-namely, the relatively tolerant Ca74110 and Ca74112, and the sensitive Ca754 and CaJ-19 genotypes-under well-watered conditions and during terminal drought stress periods at two time points (0 and 60 days following the onset of stress). The metabolite profiling uncovered significant associations between the growth and the physiological characteristics of coffee genotypes with distinct drought tolerance behaviors. Initially, no marked differences were observed among the genotypes or treatments. However, at the 60-day post-drought onset time point, notably higher shoot growth, biomass, CO2 assimilation, pigments, and various physiological parameters were evident, particularly in the relatively tolerant genotypes. The metabolite profiling revealed elevations in glucose, maltose, amino acids, and organic acids, and decreases in other metabolites. These alterations were more pronounced in the drought-tolerant genotypes, indicating a correlation between enhanced compatible solutes and energy-associated metabolites crucial for drought tolerance mechanisms. This research introduces GC-MS-based metabolome profiling to the study of Ethiopian coffee, shedding light on its intricate responses to drought stress and paving the way for the potential development of drought-resistant coffee seedlings in intensified agro-ecological zones.

Accidental paradiplomats? The curious case of Ontario school board budgets and Canadian soft power projection.

From the earliest studies of soft power in International Relations, the importance of educational exchanges has been well-established. Studies of international education in the context of Canadian soft power often draw on cases from the higher education sector. This article argues that greater attention should be paid to the K-12 level, especially as budgetary pressures in Ontario's education system are leading school boards to rapidly expand their international student recruitment efforts. Although this is not an example of intentional soft power projection, it nevertheless represents an important reminder that subnational actors may accidentally become paradiplomats whose actions have consequences on the international level. Further, this case reveals the importance of paying attention to actors typically overlooked by IR scholarship. Drawing on Joseph Nye's theory of soft power and in conversation with prior research on international education as a mechanism of soft power projection, this article traces the thread between budgetary pressures in Ontario school boards and the broader context of soft power projection.

Dynamic Thermosetting Resins with Synergistic Enhanced Strength and Toughness through Combination with Rigid and Soft Microdomains.

Preparation of materials that possess highly strong and tough properties simultaneously is a great challenge. Thermosetting resins as a type of widely used polymeric materials without synergistic strength and toughness limit their applications in some special fields. In this report, an effective strategy to prepare thermosetting resins with synergistic strength and toughness, is presented. In this method, the soft and rigid microspheres with dynamic hemiaminal bonds are fabricated first, followed by hot-pressing to crosslink at the interfaces. Specifically, the rigid or soft microspheres are prepared via precipitation polymerization. After hot-pressing, the resulting rigid-soft blending materials exhibit superior strength and toughness, simultaneously. As compared with the precursor rigid or soft materials, the toughness of the rigid-soft blending films (RSBFs) is improved to 240% and 2100%, respectively, while the strength is comparable to the rigid precursor. As compared with the traditional crushing, blending, and hot-pressing of rigid or soft materials to get the nonuniform materials, the strength and toughness of the RSBFs are improved to 168% and 255%, respectively. This approach holds significant promise for the fabrication of polymer thermosets with a unique combination of strength and toughness.

Vitamin B12 Protects against Genotoxicity Induced by Cisplatin.

BACKGROUND: Cisplatin is an effective synthetic chemotherapeutic drug used for cancer treatment. Vitamin B12 has been shown to possess anti-genotoxic activity. This study aimed to investigate the effect of vitamin B12 on chromosomal damage induced by cisplatin. METHODS: The level of sister chromatid exchanges (SCEs) and chromosomal aberrations (CAs) were measured in cultured human blood lymphocytes treated with cisplatin and/or vitamin B12. RESULTS: The results showed a significantly elevated frequency of CAs and SCEs of cisplatin-treated cultures compared to the control (P < 0.05). The CAs and SCEs induced by cisplatin were significantly lowered by pretreatment of cell cultures with vitamin B12. In addition, cisplatin caused a slight reduction in the mitotic index (MI), while vitamin B12 did not modulate the effect of cisplatin on MI. CONCLUSION: Vitamin B12 can protect human lymphocytes against genotoxicity associated with cisplatin.

Quantity and spatial distribution of earth-air activity in Cave 108 of the Dunhuang Mogao Grottoes.

Monitoring of earth-air humidity in soil has revealed extensive rising/falling activity on the land. Alternation of dry and wet air is the main root cause deterioration in cave wall paintings. However, the quantity and spatial distribution of earth-air activity in caves remain unclear. This study used air flowmeters to monitor the earth-air outflow at 136 points on the west, south, and north walls of Cave 108 in the Dunhuang Mogao Grottoes, and to determine its spatial distribution. Results showed that under the influence of atmospheric fluctuation, there is frequent air exchange between the atmosphere and the earth-air, and that the daily outflow of earth-air from Cave 108 is 50.893 m3/d. Earth-air flux is negatively correlated with atmospheric pressure, and the fluctuation of atmospheric pressure is the main driving force of earth-air activity. The average outflow of earth-air from the ground of Cave 108 is 0.109 L/(min·m2). Apart from that, the overall spatial distribution of earth-air quantity showed the following pattern: ground > west wall > north wall > south wall. What's more, the outflow of earth-air is inversely proportional to the wall height, while proportional to the depth of the cave embedded in the cliff. In such case, sealing the cave floor with concrete will heighten earth-air flow on the walls, thereby quickening the deterioration process of wall paintings. This study unveiled the deterioration mechanism of wall paintings in the context of earth-air conditions, thus establishing a foundation for the scientific protection of wall paintings.

Intake of Pistachios as a Nighttime Snack Has Similar Effects on Short- and Longer-Term Glycemic Control Compared with Education to Consume 1-2 Carbohydrate Exchanges in Adults with Prediabetes: A 12-Wk Randomized Crossover Trial.

BACKGROUND: Nut intake is associated with better glycemic control and lower cardiovascular disease (CVD) risk. It remains unclear if nut intake timing affects glycemic control and CVD risk factors. Intake of pistachios as a nighttime snack may attenuate morning glucose production and lower fasting plasma glucose (FPG). OBJECTIVES: We assessed the effects of a nighttime (after dinner and before bedtime) pistachio snack (57 g/d) on glycemic control markers, vascular health, lipids/lipoproteins, and diet quality compared with education to consume 1-2 carbohydrate (CHO) exchanges (usual care) in individuals with prediabetes. METHODS: A 2-period, randomized crossover trial was conducted. Participants were provided 57 g/d of dry roasted unsalted pistachios (319 kcal; fat 26 g; CHO 16 g; protein 12 g; fiber 6 g) as a nighttime snack or received usual care for 12 wk. Primary (FPG) and secondary outcomes [hemoglobin A1c (HbA1c), insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), lipids/lipoproteins, vascular health, and Healthy Eating Index-2015 (HEI-2015)] were measured before and after each condition. RESULTS: A total of 66 participants (50.9 ± 11.6 y, FPG: 106.2 ± 6.4 mg/dL) were randomly assigned, and 51 participants completed the trial. No between-condition differences in FPG {0.9 mg/dL [95% confidence interval (CI): -1.2, 3.1]}, HbA1c, insulin, HOMA-IR, lipids/lipoproteins, blood pressure, or vascular health were observed. The HEI-2015 score was higher after the pistachio condition [6.8 points (95% CI: 1.5, 12.1)] than after usual care driven by higher component scores for seafood and plant proteins [2.0 points (95% CI: 1.0, 2.9)], refined grains [2.3 points (95% CI: 1.1, 3.5)], and the fatty acid ratio [1.7 points (95% CI: 0.0, 3.5)]. CONCLUSIONS: In adults with prediabetes, consuming 57 g/d of pistachios as a nighttime snack increased diet quality but had similar effects on glycemic markers, lipids/lipoproteins, blood pressure, and vascular health compared with the usual care comparator. Pistachios may be a healthful alternative to carbohydrate-rich nighttime snacks to increase alignment with Dietary Guidelines for Americans. This trial was registered at clinicaltrials.gov as NCT04056208.

Intergenerational ties in late life.

At the turn of the twenty-first century, scholars predicted that ties between aging parents and grown offspring would grow in prominence and become the primary relationship for many adults. These ties are often emotionally complex, in both positive and negative ways, and resource rich with regard to support. Contact between generations has become both more frequent in the form of coresidence and less frequent due to high rates of migration. Support exchanges are often high in this tie involving, emotional, financial and practical assistance. A burgeoning literature addresses the implications of loss of this tie via death or estrangement. Collectively, recent studies address strengths of these ties, and explanations for their absence when that occurs.