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Malnutrition remains a major public health issue in Sub-Saharan Africa, with one-third of all malnourished children residing in the region. In Malawi, 37.1% of children under five are stunted, and 63% are anaemic. Poor diets and poverty contribute significantly. Legumes, being rich in protein, fibre, and micronutrients, offer a sustainable food-based approach to improve child nutrition and support local agriculture. This study aimed at assessing the association between legume consumption and nutritional status in children aged 6–59 months in rural Malawi. A community-based cross-sectional study was conducted in Mzimba, Mchinji, and Mangochi districts, involving 1275 children. Data were collected on dietary intake, socioeconomic status, and anthropometry using semi-structured questionnaires. Nutritional status was determined using WHO Anthro, and associations were analysed using logistic regression in Stata. Prevalence of stunting was 42.8%, underweight 17.4%, and wasting 8.4%. Over half of the children did not consume legumes. Pigeon pea consumption significantly reduced odds of wasting (AOR = 0.14), and common beans were associated with lower odds of both wasting and stunting. Conversely, groundnut consumption was linked to increased underweight (AOR = 1.68). Animal food consumption was associated with lower underweight but higher odds of wasting. Legume consumption showed both protective and adverse associations with child malnutrition. In conclusion, this study has shown that promoting dietary diversity and appropriate legume use could enhance nutrition outcomes. Findings highlight the potential of legumes in addressing undernutrition but also the need for targeted nutrition education and interventions in rural Malawi.
Paleontology provides insights into the history of the planet, from the origins of life billions of years ago to the biotic changes of the Recent. The scope of paleontological research is as vast as it is varied, and the field is constantly evolving. In an effort to identify “Big Questions” in paleontology, experts from around the world came together to build a list of priority questions the field can address in the years ahead. The 89 questions presented herein (grouped within 11 themes) represent contributions from nearly 200 international scientists. These questions touch on common themes including biodiversity drivers and patterns, integrating data types across spatiotemporal scales, applying paleontological data to contemporary biodiversity and climate issues, and effectively utilizing innovative methods and technology for new paleontological insights. In addition to these theoretical questions, discussions touch upon structural concerns within the field, advocating for an increased valuation of specimen-based research, protection of natural heritage sites, and the importance of collections infrastructure, along with a stronger emphasis on human diversity, equity, and inclusion. These questions offer a starting point—an initial nucleus of consensus that paleontologists can expand on—for engaging in discussions, securing funding, advocating for museums, and fostering continued growth in shared research directions.
Introduction: Blood culture (BCx) diagnostic stewardship is crucial for optimizing health resources and ensuring appropriate clinical testing while minimizing unnecessary cultures that could lead to increased false positives and subsequent antibiotic overuse. BCx algorithms have effectively lowered BCx rates across various patient populations without compromising patient safety. However, patients with a durable left ventricular assist device (LVAD) represent a unique group where the safety and applicability of these algorithms remain underexplored. Methods: We adapted the BCx algorithm from the DISTRIBUTE study by Fabre et al (Figure 1) and retrospectively applied it to HeartMate 3 LVAD recipients with BCx testing performed between July 1, 2019, and April 30, 2024. Each BCx was reviewed and adjudicated according to the algorithm to determine the appropriateness of BCx indication. We also assessed the incidence of true positives, contaminants, and negative cultures among BCx testing deemed as inappropriate to evaluate the algorithm’s potential impact on clinical decision-making in this specialized patient population. We used the Centers for Disease Control and Prevention’s standard definition of a contaminated BCx. Results: We reviewed 1531 blood cultures in 121 unique LVAD recipients. The most common clinical indications for BCx collection were for documenting bloodstream clearance (363, 23.7%), suspected infective endocarditis or endovascular infection (260, 17.0%), and isolated fever and/or leukocytosis (217, 14.2%). We adjudicated 945 (61.7%) BCx collections as appropriate and 586 (38.3%) as inappropriate. Out of the 586 inappropriate BCx collections, 577 (98.5%) were negative and 8 (1.4%) resulted in a contaminant (Figure 2). Only 1 (0.2%) BCx adjudicated as inappropriate resulted in a true positive, which isolated Streptococcus infantarius in an LVAD patient receiving active chemotherapy for colorectal cancer and was felt to represent gastrointestinal translocation. Discussion: We retrospectively applied a BCx algorithm to LVAD recipients to determine the clinical impact of applying such an algorithm to a high-risk patient population. We found that the BCx algorithm missed only 1 true positive bloodstream infection in a patient with additional risk factors. This study provides preliminary support that a BCx algorithm could reduce BCx testing in LVAD recipients without compromising clinical safety. Future studies on BCx diagnostic stewardship in this population should prospectively collect data and monitor for additional adverse events, such as readmission, mortality, length of stay, and antibiotic days of therapy.
On February 6, 1968, leaders of the Southern Christian Leadership Conference drafted a letter addressed to the president, Congress, and the U.S. Supreme Court. The letter argued that the U.S. constitution facilitated economic and social second-class citizenship because the constitution did not protect economic and social rights but instead protected only civil and political rights. The letter’s authors demanded that the nation repent for its continued subordination of the poor and minorities and atone by recognizing economic and social rights. In this article, the authors recover the draft letter—a proposed economic and social bill of rights—and assert it was and remains a morally compelling call to recognize and protect positive fundamental rights under the constitution. The authors maintain that while the SCLC leaders who drafted the letter were clear that law alone could not end the sinful conditions that created racism and poverty, they were becoming more adamant that a radical redesign of the constitution was a necessary step toward building a beloved community.
When and why did House parties identify exclusive committees? The nexus of parties and standing committees defines the distribution of power in the U.S. House of Representatives, shapes legislators’ careers, and affects Congress's ability to address the nation's problems. Yet, political science provides inadequate and often misleading characterizations of the parties and the most important standing committees. We provide missing detail and offer a historical perspective on party efforts to arrange standing committees in the period since the revolt against Speaker Joseph Cannon in 1909–1910. Our narrative offers a foundation for explaining party efforts to regulate committee membership and meet legislators’ demands. For the first time, we define three periods in committee assignment limitations. In doing so, we place key events in historical context: We report that the modern exclusive committees (Appropriations, Rules, and Ways and Means) did not become defined until the 1950s; the identification by the two parties of a larger set of exclusive committees for which a one-assignment limitation applied began decades earlier; the Legislative Reorganization Act of 1946 placed a one-assignment limitation in House rules that had been party practice for three decades by then. In recent decades, deep partisanship has been accompanied by a loosening, not tightening, of restrictions. In fact, there are no fully exclusive committees remaining in practice.
Edited by
Dharti Patel, Mount Sinai West and Morningside Hospitals, New York,Sang J. Kim, Hospital for Special Surgery, New York,Himani V. Bhatt, Mount Sinai West and Morningside Hospitals, New York,Alopi M. Patel, Rutgers Robert Wood Johnson Medical School, New Jersey
Transfusion of blood products can lead to a number of complications. In this chapter, the presentation, diagnosis, mechanism of action, incidence, treatment, and prevention of transfusion reactions are outlined. The reactions summarized in comparison with one another are febrile non-hemolytic, allergic, and hemolytic transfusion reactions. Other complications of transfusions, such as infections, immunosuppression, citrate intoxication, and acid–base and electrolyte abnormalities, are also explained, along with those associated with massive transfusions, such as coagulopathies and hypothermia. Pulmonary complications of transfusions, namely Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO), have been reviewed with the most up-to-date literature. The presentation, diagnosis, mechanism of action, incidence, treatment, and prevention of these two reactions are outlined, as well.
Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.
Aims:
To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre–post effect size.
Method:
Nine children and adolescents (aged 8–17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.
Results:
No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).
Conclusions:
These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.
This study examined the power of theory-derived models to account for the development of PTSD, Complex PTSD (CPTSD), depression, and anxiety in children and adolescents who had experienced a single-event trauma.
Methods
Children (n = 234, aged 8–17 years) recruited from local Emergency Departments were assessed at two and nine weeks post-trauma. Data obtained from self-report questionnaires completed by the child, telephone interviews with parents, and hospital data were used to develop four predictive models of risk factors for PTSD, CPTSD, depression, and Generalized Anxiety Disorder (GAD). ICD-11 proposed diagnostic criteria were used to generate measures for CPTSD and PTSD to assess for risk factors and identify the sample prevalence of these disorders.
Results
At nine weeks post-trauma, 64% did not meet criteria for any disorder, 23.5% met criteria for PTSD, and 5.2% met criteria for CPTSD. 23.9% and 10.7% had developed clinically significant symptoms of depression and GAD, respectively. A cognitive model was the most powerful predictive model, a psychosocial model was weak, and subjective markers of event severity were more powerful than objective measures.
Conclusions
Youth exposed to single-incident trauma may develop different forms of psychopathology, and PTSD and CPTSD are frequently experienced alongside other conditions. The cognitive model of PTSD shows utility in identifying predictors of PTSD, CPTSD, depression, and GAD, particularly the role of trauma-related negative appraisals. This supports the application of cognitive interventions which focus upon re-appraising trauma-related beliefs in youth.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Helium or neopentane can be used as surrogate gas fill for deuterium (D2) or deuterium-tritium (DT) in laser-plasma interaction studies. Surrogates are convenient to avoid flammability hazards or the integration of cryogenics in an experiment. To test the degree of equivalency between deuterium and helium, experiments were conducted in the Pecos target chamber at Sandia National Laboratories. Observables such as laser propagation and signatures of laser-plasma instabilities (LPI) were recorded for multiple laser and target configurations. It was found that some observables can differ significantly despite the apparent similarity of the gases with respect to molecular charge and weight. While a qualitative behaviour of the interaction may very well be studied by finding a suitable compromise of laser absorption, electron density, and LPI cross sections, a quantitative investigation of expected values for deuterium fills at high laser intensities is not likely to succeed with surrogate gases.
To establish outcomes following photobiomodulation therapy for tinnitus in humans and animal studies.
Methods
A systematic review and narrative synthesis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The databases searched were: Medline, Embase, Cochrane Central Register of Controlled Trials (‘Central’), ClinicalTrials.gov and Web of Science including the Web of Science Core collection. There were no limits on language or year of publication.
Results
The searches identified 194 abstracts and 61 full texts. Twenty-eight studies met the inclusion criteria, reporting outcomes in 1483 humans (26 studies) and 34 animals (2 studies). Photobiomodulation therapy parameters included 10 different wavelengths, and duration ranged from 9 seconds to 30 minutes per session. Follow up ranged from 7 days to 6 months.
Conclusion
Tinnitus outcomes following photobiomodulation therapy are generally positive and superior to no photobiomodulation therapy; however, evidence of long-term therapeutic benefit is deficient. Photobiomodulation therapy enables concentrated, focused delivery of light therapy to the inner ear through a non-invasive manner, with minimal side effects.
Despite theoretical support for including mental health and psychosocial support (MHPSS) with peacebuilding, few programmes in conflict-affected regions fully integrate these approaches.
Aims
To describe and assess preliminary outcomes of the Counselling on Wheels programme delivered by the NEEM Foundation in the Borno State of North-East Nigeria.
Method
We first describe the components of the Counselling on Wheels programme, including education and advocacy for peace and social cohesion through community peacebuilding partnerships and activities, and an MHPSS intervention open to all adults, delivered in groups of eight to ten people. We then conducted secondary analysis of data from 1550 adults who took part in the MHPSS intervention, who provided data at baseline and 1–2 weeks after the final group session. Vulnerability to violent extremism was assessed with a locally developed 80-item scale. Symptoms of common mental disorders were assessed with the Depression, Anxiety and Stress Scale (DASS-21) and Post-Traumatic Stress Disorder Scale (PTSD-8). Data were analysed through a mixed-effect linear regression model, accounting for clustering by community and adjusted for age and gender.
Results
After taking part in group MHPSS, scores fell for depression (−5.8, 95% CI −6.7 to −5.0), stress (−5.5, 95% CI −6.3 to −4.6), post-traumatic stress disorder (−2.9, 95% CI −3.4 to −2.4) and vulnerability to violent extremism (−44.6, 95% CI −50.6 to −38.6).
Conclusions
The Counselling on Wheels programme shows promise as a model for integrating MHPSS with community peacebuilding activities in this conflict-affected region of Africa.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.