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The use of a linear accelerator (LINAC) in ultrahigh-dose-rate (UHDR) mode can provide a conduit for wider access to UHDR FLASH effects, sparing normal tissue, but care needs to be taken in the use of such systems to ensure errors are minimized. The failure mode and effects analysis was carried out in a team that has been involved in converting a LINAC between clinical use and UHDR experimental mode for more than 1 year after the proposed methods of TG100. A team of 9 professionals with extensive experience were polled to outline the process map and workflow for analysis, and developed fault trees for potential errors, as well as failure modes that would result. The team scored the categories of severity magnitude, occurrence likelihood, and detectability potential in a scale of 1 to 10, so that a risk priority number (RPN = severity×occurrence×detectability) could be assessed for each. A total of 46 potential failure modes were identified, including 5 with an RPN >100. These failure modes involved (1) patient set up, (2) gating mechanisms in delivery, and (3) detector in the beam stop mechanism. The identified methods to mitigate errors included the (1) use of a checklist post conversion, (2) use of robust radiation detectors, (3) automation of quality assurance and beam consistency checks, and (4) implementation of surface guidance during beam delivery. The failure mode and effects analysis process was considered critically important in this setting of a new use of a LINAC, and the expert team developed a higher level of confidence in the ability to safely move UHDR LINAC use toward expanded research access. [ABSTRACT FROM AUTHOR]

There have been recent disruptions in supply chains related to centering baskets intended for use with high dose rate (HDR) endobronchial brachytherapy. The standard plastic catheter (1.6mm diameter) without a centering basket gives too high of a surface dose to the bronchial mucosa to safely prescribe at distances of 5-10mm. We present on the commissioning and first reported clinical use of intraluminal endobronchial HDR brachytherapy by placing a standard plastic catheter within a robotic bronchoscope working channel, functioning as a fixed spacer of the source from the bronchial mucosa. In this first in-human hybrid technique, a 68-year-old patient with an endobronchial tumor obstructing the lower left lobe in the superior segment of the bronchus received a definitive treatment with the HDR source. The patient previously received external beam radiation to the right upper lobe (24Gy in 1 Fractions) and 2 nodules in the left lower lobe (60Gy in 5 Fractions) of the lungs. The system was commissioned by measuring attenuation from the robotic bronchoscope (Intuitive Surgical, Inc., Sunnyvale, CA, USA) to determine scaling required for water-based TG43 dose calculations. Well chamber readings were taken with the Ir-192 HDR source inside the plastic catheter with and without the bronchoscope using a custom 3D printed well chamber insert. In preparation for clinical use, standard treatment plans were created in Eclipse (Varian Medical Systems, Inc., Palo Alto, CA, USA) in cm increments prescribing at 5mm or 10mm from the bronchoscope wall. Following general anesthesia, a therapeutic bronchoscope was inserted to perform tumor ablation and mechanical dilation in the occluded airway. After airway patency was achieved, the shape sensing robotic assisted bronchoscope was passed distal the endobronchial tumor. Tumor length was determined with the robotic bronchoscope, by marking the junction of the robotic catheter at its intersection of the endotracheal tube, both distal and proximal to the tumor. The HDR brachytherapy catheter was then inserted through the robotic catheter and placement was verified with fluoroscopic imaging and a radiopaque wire with fiducials in cm increments. Once alignment was verified, the brachytherapy catheter was secured to the robotic catheter using adhesive. The treatment plan was created with 1 cm proximal and distal margins. Catheter length was confirmed and obstruction check through the catheter was completed prior to delivery. The attenuation measurements from the bronchoscope were <1% over a length of 1 to 8 cm indicating no need to scale treatment delivery time. The bronchoscope's diameter of 3.8 mm significantly reduced the bronchial mucosal dose (by ∼2 times, ∼70 Gy vs. ∼30 Gy at tissue surface for 7.5 Gy/Fraction) compared to the standard plastic catheter without a centering basket. The patients' tumor was 2 cm in length, and the treatment plan ensured dose (22.5 Gy in 3 Fraction) ±1 cm of the tumor (4 cm treatment length) prescribed at a depth of 0.5 cm from tissue surface. The patient was discharged home the same day in stable condition without acute complications. HDR brachytherapy with a catheter within a robotic bronchoscope's channel was feasible as an alternative to the standard plastic catheter for endobronchial treatment. [ABSTRACT FROM AUTHOR]

• So far, UHDR electron TP studies focussed on dosimetric aspects of treatment delivery • Importance of FLASH RT TP will augment when shifting to more complex treatments • FLASH predictors for TP comprise: delivery parameter-based metrics, DMF, and TCP/NTCP • FLASH predictors used by current TP studies often not based on solid exp. evidence • This is due to lack of an established mechanism and a limited exp. characterization The FLASH effect designates normal tissue sparing at ultra-high dose rate (UHDR, >40 Gy/s) compared to conventional dose rate (∼0.1 Gy/s) irradiation while maintaining tumour control and has the potential to improve the therapeutic ratio of radiotherapy (RT). UHDR high-energy electron (HEE, 4–20 MeV) beams are currently a mainstay for investigating the clinical potential of FLASH RT for superficial tumours. In the future very-high energy electron (VHEE, 50–250 MeV) UHDR beams may be used to treat deep-seated tumours. UHDR HEE treatment planning focused at its initial stage on accurate dosimetric modelling of converted and dedicated UHDR electron RT devices for the clinical transfer of FLASH RT. VHEE treatment planning demonstrated promising dosimetric performance compared to clinical photon RT techniques in silico and was used to evaluate and optimise the design of novel VHEE RT devices. Multiple metrics and models have been proposed for a quantitative description of the FLASH effect in treatment planning, but an improved experimental characterization and understanding of the FLASH effect is needed to allow for an accurate and validated modelling of the effect in treatment planning. The importance of treatment planning for electron FLASH RT will augment as the field moves forward to treat more complex clinical indications and target sites. In this review, TPS developments in HEE and VHEE are presented considering beam models, characteristics, and future FLASH applications. [ABSTRACT FROM AUTHOR]

Background: While the prevalence of undernutrition in children has decreased in many low- and middle-income countries since the 1990s, prevalences of overweight and obesity have increased. Frequent consumption of sugar-sweetened food might have contributed to this change, although very little is known about sugar-sweetened food consumption in early life.Objectives: The objective of this study was to explore the associations between individual, household, and maternal factors and the prevalence of sugar-sweetened food consumption in 6- to 24-month-old children in Bangladesh.Methods: Multistage sampling was used to select households with children aged 6-24 months in rural Chatmohar, a subdistrict of Bangladesh (n = 1635). Research assistants conducted a 24-hour qualitative dietary recall questionnaire with the enrolled child's primary caregiver to measure maternal and child dietary patterns. We examined factors associated with the prevalence of child sugar-sweetened food consumption with multivariate logistic regression models. We conducted tests of heterogeneity to explore differential associations between the child sugar-sweetened food consumption prevalence and household income by maternal nutrition knowledge and wealth.Results: Primary caregivers reported that 62% of toddlers had consumed sugar-sweetened food in the past 24 hours. A higher prevalence of child sugar-sweetened food consumption was associated with both a higher dietary diversity score (OR, 1.19; 95% CI, 1.09-1.29) and a higher prevalence of maternal sugar-sweetened food consumption (OR, 2.54; 95% CI, 1.97-3.28). At higher levels of maternal nutrition knowledge and wealth, more household income was associated with a lower prevalence of child sugar-sweetened food consumption.Conclusions: Almost two-thirds of 6- to 24-month-old children in rural Chatmohar, Bangladesh, had consumed sugar-sweetened food in the last day. This is a high and concerning prevalence, and the associated factors identified in this study should be investigated further to identify potential areas of intervention to decrease the prevalence of child sugar consumption in Bangladesh. [ABSTRACT FROM AUTHOR]

The development of electrospun nanofibrous scaffolds (NFSs) have aroused much attraction in the field of biomedical engineering, due to their small fiber diameter, high specific surface area, and excellent extracellular matrix comparability. The main focus of this study is to design and fabricate novel zeolitic imidazole framework-8 (ZIF-8)-loaded silk fibrin/polycaprolactone (SF/PCL) nanofiber composite scaffolds by using the electrospinning strategy. Firstly, ZIF-8 was synthesized and characterized, which showed remarkable features in terms of shape, size, chemical and physical properties. Then, three different amounts of ZIF-8 were encapsulated into SF/PCL nanofibers during electrospinning, to investigate how the addition of ZIF-8 affected the morphology, and structure, as well as physical, mechanical, and biological properties of the nanofiber composite scaffolds. It was found that the addition of ZIF-8 didn't change the nanofibrous morphology of the composite scaffold, and no bead-like structure were found for the SF/PCL composite scaffolds loading with or without ZIF-8. The appropriate addition of ZIF-8 could significantly increase the mechanical properties of SF/PCL NFSs. The SF/PCL NFS containing 5% ZIF-8 showed high ultimate stress and initial modulus, which were 40.31 ± 2.31 MPa, and 569.19 ± 21.38 MPa, respectively. Furthermore, the MTT assay indicated that the pure SF/PCL scaffold and one with 1% ZIF-8 exhibited nearly identical cell compatibility toward human dermal fibroblast (HDF) cells, but some obvious cytotoxicity was observed with the increase of ZIF-8 content. However, the incorporation of ZIF-8 into SF/PCL NFSs was found to have excellent antibacterial rate against both E. coli and S. aureus. In all, the incorporation of 1% ZIF-8 could impart the SF/PCL NFS with balanced bio-function, making it a promising candidate for diverse biomedical applications such as tissue engineering and wound healing. [ABSTRACT FROM AUTHOR]

Purpose: To present a Monte Carlo (MC) beam model and its implementation in a clinical treatment planning system (TPS, Varian Eclipse) for a modified ultrahigh dose-rate electron FLASH radiation therapy (eFLASH-RT) linear accelerator (LINAC) using clinical accessories and geometry.Methods and Materials: The gantry head without scattering foils or targets, representative of the LINAC modifications, was modeled in the Geant4-based GAMOS MC toolkit. The energy spectrum (σE) and beam source emittance cone angle (θcone) were varied to match the calculated open-field central-axis percent depth dose (PDD) and lateral profiles with Gafchromic film measurements. The beam model and its Eclipse configuration were validated with measured profiles of the open field and nominal fields for clinical applicators. An MC forward dose calculation was conducted for a mouse whole-brain treatment, and an eFLASH-RT plan was compared with a conventional (Conv-) RT electron plan in Eclipse for a human patient with metastatic renal cell carcinoma.Results: The eFLASH beam model agreed best with measurements at σE = 0.5 MeV and θcone = 3.9° ± 0.2°. The model and its Eclipse configuration were validated to clinically acceptable accuracy (the absolute average error was within 1.5% for in-water lateral, 3% for in-air lateral, and 2% for PDDs). The forward calculation showed adequate dose delivery to the entire mouse brain while sparing the organ at risk (lung). The human patient case demonstrated the planning capability with routine accessories to achieve an acceptable plan (90% of the tumor volume receiving 95% and 90% of the prescribed dose for eFLASH and Conv-RT, respectively).Conclusions: To our knowledge, this is the first functional beam model commissioned in a clinical TPS for eFLASH-RT enabling planning and evaluation with minimal deviation from the Conv-RT workflow. It facilitates the clinical translation because eFLASH-RT and Conv-RT plan quality were comparable for a human patient involving complex geometries and tissue heterogeneity. The methods can be expanded to model other eFLASH irradiators with different beam characteristics. [ABSTRACT FROM AUTHOR]

Purpose: In this study, procedures were developed to achieve efficient reversible conversion of a clinical linear accelerator (LINAC) and deliver ultrahigh-dose-rate (UHDR) electron or conventional beams to the treatment room isocenter for FLASH radiation therapy.Methods and Materials: The LINAC was converted to deliver UHDR beam within 20 minutes by retracting the x-ray target from the beam's path, positioning the carousel on an empty port, and selecting 10 MV photon beam energy in the treatment console. Dose rate surface and depth dose profiles were measured in solid water phantom at different field sizes with Gafchromic film and an optically stimulated luminescent dosimeter (OSLD). A pulse controller counted the pulses via scattered radiation signal and gated the delivery for a preset pulse count. A fast photomultiplier tube-based Cherenkov detector measured the per pulse beam output at a 2-ns sampling rate. After conversion back to clinical mode, conventional beam output, flatness, symmetry, field size, and energy were measured for all clinically commissioned energies.Results: The surface average dose rates at the isocenter for 1-cm diameter and 1.5-in diameter circular fields and for a jaws-wide-open field were 238 ± 5 Gy/s, 262 ± 5 Gy/s, and 290 ± 5 Gy/s, respectively. The radial symmetry of the beams was within 2.4%, 0.5%, and 0.2%, respectively. The doses from simultaneous irradiation of film and OSLD were within 1%. The photomultiplier tube showed the LINAC required ramp up time in the first 4 to 6 pulses before the output stabilized, after which its stability was within 3%.Conclusions: At the isocenter of the treatment room, 10 MeV UHDR beams were achieved. The beam output was reproducible but requires further investigation of the ramp up time, equivalent to ∼1 Gy, requiring dose monitoring. The UHDR beam can irradiate both small and large subjects to investigate potential FLASH radiobiological effects in minimally modified clinical settings, and the dose rate can be further increased by reducing the source-to-surface distance. [ABSTRACT FROM AUTHOR]

Injection of urethral bulking agents is a low-risk, minimally invasive surgical procedure to treat stress urinary incontinence (SUI). In this study, we developed a promising injectable bulking agent comprising extracellular matrix fragments of adipose-derived stem cell sheets (ADSC ECM) and investigated its effectiveness in urethral bulking therapy. The structural integrity and proteins of ADSC sheet ECM were well retained in decellularized ADSC ECM fragments. To locate transplanted ADSC ECM fragments, they were labeled with ultrasmall super-paramagnetic iron oxide nanoparticles, which enabled in vivo monitoring after implantation in a SUI rat model for up to 4 weeks. When ADSC ECM fragments were injected into the rat urethra, they became fully integrated with the surrounding tissue within 1 week. Four weeks after transplantation, host cells had regenerated within the ADSC ECM fragment injection area. Moreover, new smooth muscle tissue had formed around the ADSC ECM fragments, as confirmed by positive staining of myosin. These results indicate that injection of ECM fragments may be a promising minimally invasive approach for treating SUI. Image, graphical abstract [ABSTRACT FROM AUTHOR]

• Wet-milled griseofulvin (GF) using polystyrene (CPS) and zirconia (YSZ) beads. • Examined impact of CPS bead loading–stirred speed and compared CPS to YSZ beads. • A microhydrodynamic model was used to gain fundamental insights into the process. • Higher CPS loading–stirrer speed led to faster breakage–higher energy consumption. • YSZ achieved faster breakage than CPS, albeit with a higher energy consumption. While crosslinked polystyrene (CPS) beads and yttrium-stabilized zirconia (YSZ) beads have been commonly used as media for wet milling of poorly soluble drugs and their dissolution enhancement, no first-principle rationale exists for selecting the bead material. The aim of this study is to investigate the impact of stirrer speed (2000–4000 rpm) and CPS bead loading (~20–60%) on the breakage kinetics–energy consumption during milling of griseofulvin, a model poorly soluble drug, and compare the performance of CPS vs. YSZ at the highest bead loading. Laser diffraction, SEM, rheological analysis, and XRPD were used for characterization. The milling was most effective at the highest bead loading–stirrer speed. A microhydrodynamic model suggests that an increase in stirrer speed led to faster breakage due to more frequent and forceful CPS bead–bead collisions. Despite causing slight decrease in maximum contact pressure, an increase in CPS bead loading caused a dramatic increase in average frequency of drug particle compressions, which dominated the faster breakage observed. While YSZ generally required higher specific energy consumption than CPS, it achieved the same product fineness faster than CPS. The microhydrodynamic model rationalized the favorable use of YSZ over CPS beads within the experimental domain studied. [ABSTRACT FROM AUTHOR]

• Prepared HyNASDs and ASDs of GF having identical formulation via spray drying. • Formulated GF with Sol/HPC at 1:1 and 1:3 GF:polymer mass ratio and SDS. • HPC-based HyNASDs and ASDs did not lead to significant GF supersaturation. • Sol-based ASDs and HyNASDs led to 360% and 180% GF supersaturation, respectively. • HyNASDs boosted the dissolution enhancement capability of nanocrystal formulations. A major shortcoming of drug nanocomposites as compared with amorphous solid dispersions (ASDs) is their limited supersaturation capability in dissolution media. Here, we prepared drug hybrid nanocrystal–amorphous solid dispersions (HyNASDs) and compare their performance to ASDs. A wet-milled griseofulvin (GF, BCS II drug) nanosuspension and a GF solution, both containing the same dissolved polymer–surfactant (SDS: sodium dodecyl sulfate) with 1:1 and 1:3 GF:polymer mass ratios, were spray-dried. Hydroxypropyl cellulose (HPC) and Soluplus (Sol) were used as matrix-forming polymers. XRPD, DSC, and Raman spectroscopy reveal that ASDs were formed upon spray-drying the solution-based feed, whereas nanocomposites and nanocomposites with >10% amorphous content, HyNASDs, were formed with the nanosuspension-based feed. Sol provided higher GF relative supersaturation, up to 180% and 360% for HyNASDs and ASDs, respectively, in the dissolution tests than HPC (up to 50% for both) owing to Sol's stronger intermolecular interactions and miscibility with GF and its recrystallization inhibition. Besides the higher kinetic solubility of GF in Sol, presence of GF nanoparticles vs. micron-sized particles in the nanocomposites enabled fast supersaturation. This study demonstrates successful preparation of fast supersaturating (190% within 20 min) HyNASDs, which renders nanoparticle formulations competitive to ASDs in bioavailability enhancement of poorly soluble drugs. [ABSTRACT FROM AUTHOR]

In this study, a C-series linear accelerator was configured to enable rapid and reliable conversion between the production of conventional electron beams and an ultrahigh-dose-rate (UHDR) electron beamline to the treatment room isocenter for FLASH radiation therapy. Efforts to tune the beam resulted in a consistent, stable UHDR beamline. The linear accelerator was configured to allow for efficient switching between conventional and modified electron output modes within 2 minutes. Additions to the air system allow for retraction of the x-ray target from the beamline when the 10 MV photon mode is selected. With the carousel set to an empty port, this grants access to the higher current pristine electron beam normally used to produce clinical photon fields. Monitoring signals related to the automatic frequency control system allows for tuning of the waveguide while the machine is in a hold state so a stable beam is produced from the initial pulse. A pulse counting system implemented on an field-programmable gate array-based controller platform controls the delivery to a desired number of pulses. Beam profiles were measured with Gafchromic film. Pulse-by-pulse dosimetry was measured using a custom electrometer designed around the EDGE diode. This method reliably produces a stable UHDR electron beam. Open-field measurements of the 16-cm full-width, half-maximum gaussian beam saw average dose rates of 432 Gy/s at treatment isocenter. Pulse overshoots were limited and ramp up was eliminated. Over the last year, there have been no recorded incidents that resulted in machine downtime due to the UHDR conversions. Stable 10 MeV UHDR beams were generated to produce an average dose rate of 432 Gy/s at the treatment room isocenter. With a reliable pulse-counting beam control system, consistent doses can be delivered for FLASH experiments with the ability to accommodate a wide range of field sizes, source-to-surface distances, and other experimental apparatus that may be relevant for future clinical translation. [ABSTRACT FROM AUTHOR]

The unregulated use of antibiotics is linked with intensive poultry farming in developing economies. In low-and middle-income countries, the dissemination of antimicrobial resistance (AMR) has also been attributed to contamination, poor public health infrastructure and inadequate waste disposal practices. There are limited data on hygiene and waste disposal practices in small-scale commercial and household poultry farming and market sales in Bangladesh. Our objective was to explore human exposures, hygiene and waste disposal practices in poultry raising and processing to identify probable pathways for transmission of AMR bacteria. We employed mixed methods approaches of in-depth interviews and structured observations to assess exposures, hygiene behaviours and waste-disposal practices relating to poultry production in Bangladesh. Interviews (n = 18) were conducted with commercial poultry farmers, backyard poultry owners, and live poultry market workers. Structured observations were conducted for 6-h in five households, five commercial farms and five urban live bird markets to assess the frequency of transmission/exposure events in these settings. Interviews highlighted existing practices that can contribute to transmission of antimicrobial resistant bacteria from poultry to humans. In households and farms, untreated poultry waste and carcasses were disposed of on agricultural fields and in water bodies which may contaminate surface water and soil with poultry faeces. Biosecurity precautions were not used, and hands were rarely washed with soap after handling poultry. In urban markets, live poultry slaughter and processing was done on site with bare hands which were subsequently rinsed in water stored in containers without soap. Solid waste from poultry processing was disposed into municipal waste disposal stations and liquid waste was discarded into open drains. Structured observations revealed that workers in live poultry markets had the highest direct contact with poultry and poultry waste, almost tenfold higher than those working in poultry farms or with domestic poultry (59 vs 544 observed direct poultry exposure events) placing them at particularly high risk of exposure to faecal bacteria. Biosecurity measures were limited; in some cases, workers in commercial farms and urban markets had gloves and masks but often did not use them. In 88% (606/689) of exposure events no handwashing took place. Eating and drinking after handling poultry and without washing hands was observed in all three settings. These data suggest effective intervention strategies to reduce environmental contamination and to decrease risks of transmission should be prioritized. Data on prevalence of risk behaviours and AMR transmission to humans along environmental pathways can inform policy and intervention strategies. [ABSTRACT FROM AUTHOR]

Abstract Background Nanotechnology can offer the advantages of increasing solubility and bioavailability of delivering drugs like Furosemide. The aim of the current study is to investigate the in vitro and in vivo performance of furosemide nanosuspensions. Methods Furosemide nanosuspensions were prepared by antisolvent precipitation method using full factorial experimental design. Four factors were employed namely; Stirring time, Injection rate, antisolvent: solvent ratio & stabilizer: drug ratio (at two levels = high & low). The in vitro dissolution experiments were conducted to compare the representative formulation with raw drug powder. The bioavailability of nanosuspension was, also, evaluated in mice as an animal model. Results Solid state characterization (PXRD, DSC and FESEM) did show physical changes during preparation and optimization of the furosemide nanosuspensions. Individual material attributes showed more significant impact on the average particle size of the nanocrystals compared to process parameters. Two-way interactions between material attributes and process parameters significantly affected nanosuspension particle size distribution. Dissolution rate of furosemide nanosuspemsion was significantly higher than that observed for raw furosemide powder. The in vivo pharmacokinetics parameters of nanosuspension in comparison to pure drug showed significant increase in C max and AUC (0-t), about 233% and 266%, respectively. The oral bioavailability of furosemide from nanosuspension was about 2.3 fold higher as compared with the bioavailability from pure drug. Conclusions Furosemide nanosuspensions prepared using antisolvent precipitation method enhanced the dissolution rate and oral bioavailability compared to raw furosemide powder. [ABSTRACT FROM AUTHOR]

Background: Anemia in young children is a global health problem. Risk factors include poor nutrient intake and poor water quality, sanitation, or hygiene. Objective: We evaluated the effects of water quality, sanitation, handwashing, and nutrition interventions on micronutrient status and anemia among children in rural Kenya and Bangladesh. Design: We nested substudies within 2 cluster-randomized controlled trials enrolling pregnant women and following their children for 2 y. These substudies included 4 groups: water, sanitation, and handwashing (WSH); nutrition (N), including lipid-based nutrient supplements (LNSs; ages 6–24 mo) and infant and young child feeding (IYCF) counseling; WSH+N; and control. Hemoglobin and micronutrient biomarkers were measured after 2 y of intervention and compared between groups using generalized linear models with robust SEs. Results: In Kenya, 699 children were assessed at a mean ± SD age of 22.1 ± 1.8 mo, and in Bangladesh 1470 participants were measured at a mean ± SD age of 28.0 ± 1.9 mo. The control group anemia prevalences were 48.8% in Kenya and 17.4% in Bangladesh. There was a lower prevalence of anemia in the 2 N intervention groups in both Kenya [N: 36.2%; prevalence ratio (PR): 0.74; 95% CI: 0.58, 0.94; WSH+N: 27.3%; PR: 0.56; 95% CI: 0.42, 0.75] and Bangladesh (N: 8.7%; PR: 0.50; 95% CI: 0.32, 0.78; WSH+N: 7.9%, PR: 0.46; 95% CI: 0.29, 0.73). In both trials, the 2 N groups also had significantly lower prevalences of iron deficiency, iron deficiency anemia, and low vitamin B-12 and, in Kenya, a lower prevalence of folate and vitamin A deficiencies. In Bangladesh, the WSH group had a lower prevalence of anemia (12.8%; PR: 0.74; 95% CI: 0.54, 1.00) than the control group, whereas in Kenya, the WSH+N group had a lower prevalence of anemia than did the N group (PR: 0.75; 95% CI: 0.53, 1.07), but this was not significant (P = 0.102). Conclusions: IYCF counseling with LNSs reduced the risks of anemia, iron deficiency, and low vitamin B-12. Effects on folate and vitamin A varied between studies. Improvements in WSH also reduced the risk of anemia in Bangladesh but did not provide added benefit over the nutrition-specific intervention [ABSTRACT FROM AUTHOR]

[Display omitted] Metal-organic frameworks (MOFs) possess some excellent characteristics like high porosity and surface areas, as well as controlled but changeable pore sizes and topographies, which have been recognized as one of the most promising nanomaterials to modify traditional textile materials and generate advanced MOFs/textile composites with predetermined functions and even multiple functions. This review starts with a brief introduction of the basic information about the fabrication strategies of both MOFs and textiles. Importantly, the merits and demerits of different fabrication methods are highlighted. Then, the commonly utilized integration and combination methods that were utilized to apply the advanced MOFs to traditional textile materials are systematically summarized. After that, we introduce the functional applications of MOFs/textile composites in different fields, such as gas storage, energy storage, antimicrobial activity, drug delivery, the removal of heavy and toxic metals from water, the capture of toxic substances and detoxification, and ultraviolet (UV) radiation protection, as well as others. Eventually, the challenges, limitations, and future prospects of MOFs/textile composites are intensively discussed. This review mainly aims to provide necessary guidance and reference for the future design and development of advanced MOFs/textile composites and to speed their industrial transformation and applications. [ABSTRACT FROM AUTHOR]

• The world is becoming increasingly urban, with most of this growth occurring in slums of the developing world. • The burden of infectious diseases is high in slums, particularly enteric diseases transmitted fecal-orally. • Water, santation and hygiene (WaSH) will need to be combined with vaccination and/or treatment when available if sustainable control of infectious diseases in slums is to be achieved. The world is becoming increasingly urban and most of this growth is taking place in urban slums of the developing world. The current (2019) global population stands at 7.7 billion, with approximately one billion (13%) living in urban slums. By 2030 the world's population is projected to grow to 8.5 billion, with an estimated two billion (24%) living in slums. Slums are typically overcrowded, with most residents sharing a single room with four to five family members. There is usually no formal sewage or waste disposal system. Open sewage, with antimicrobial-resistant organisms, typically flows just outside the door, which during the rainy season often enters the home and contaminates the household drinking source. Hygiene is difficult if not impossible to maintain, hence the significant burden of infectious diseases, especially those with a faecal–oral mode of transmission. Transmission is year-round and the leading enteric pathogens are rotavirus, Cryptosporidium , S higella , Campylobacter , Salmonella typhi , and Vibrio cholera. Water, sanitation, and hygiene (WaSH) will be crucial components of a future integrated control strategy for infectious diseases in slums. Cheap WaSH interventions have been trialled, but their impact has been modest and short-lived. More expensive WaSH alternatives that will provide lasting change now need to be explored. Can we 'WaSH' infectious diseases out of slums? [ABSTRACT FROM AUTHOR]

This study aimed to formulate black seed oil ( Nigella sativa ) loaded liposomes using the ethanol injection method to enhance oral bioavailability and improve therapeutic activity in small animal studies of analgesia. The impact of formulation attributes and process parameters on the liposomal system was evaluated with key quality attributes being particle size, morphology, and entrapment efficiency. The particle size and entrapment efficiency of the liposome preparation were found to be between the range of 50–900 nm and 34–87% respectively. Particle size distribution data suggested that increasing the percentage of oil, up to a certain concentration, reduced the size of the liposomes significantly from 520 ± 81.2 nm to 51.48 ± 1.31 nm. Stirring and injection rate were shown to have marked impact on the average particle size of liposome. It was observed that entrapment efficiency of liposomes was greatly influenced by the amount of cholesterol and type of cryoprotectant used during formulation. The stability study indicated that the liposomal preparation was stable at ambient conditions for one month. In vivo studies showed that the liposomal preparation demonstrated significant analgesic activity in mice. [ABSTRACT FROM AUTHOR]

In this experimental work, the influence of the grounded anode geometry is studied on the X-ray production from the laboratory sparks in air at atmospheric pressure when a negative impulse voltage is applied to a high voltage rod which served as a cathode. The result shows that the smaller the diameter of the anode, the higher the energy of X-ray bursts. This observation can be explained by the mechanism that the encounter of negative and positive streamer fronts just before the final breakdown is the event that accelerates electrons to X-ray generating energies, but may not be the only mechanism that generates X-rays. [ABSTRACT FROM AUTHOR]

Sanitation interventions typically result in modest increases in latrine access, and any gains in latrine access and use are often not sustained over time. Sanitation programs also rarely include child-focused interventions such as potties. We aimed to assess the sustained effect of a multi-component sanitation intervention on access to and use of latrines and child feces management tools in rural Bangladesh. We conducted a longitudinal substudy nested within the WASH Benefits randomized controlled trial. The trial provided latrine upgrades, child potties and sani-scoops for feces removal, along with behavior change promotion to encourage use of the delivered hardware. Promotion visits to intervention recipients were frequent during the first 2 years after intervention initiation, decreased in frequency between years 2–3, and ceased after 3 years. We enrolled a random subset of 720 households from the sanitation and control arms of the trial in a substudy and visited them quarterly between 1 and 3.5 years after intervention initiation. At each visit, field staff recorded sanitation-related behaviors through spot-check observations and structured questionnaires. We assessed intervention effects on observed indicators of hygienic latrine access, potty use and sani-scoop use and investigated whether these effects were modified by duration of follow-up, ongoing behavior change promotion and household characteristics. The intervention increased hygienic latrine access from 37% among controls to 94% in the sanitation arm (p < 0.001). Access among intervention recipients remained high 3.5 years after intervention initiation, including periods with no active promotion. Gains in access were higher among households with less education, less wealth and larger number of residents. The intervention increased availability of child potties from 29% among controls to 98% in the sanitation arm (p < 0.001). However, fewer than 25% of intervention households reported exclusive child defecation in a potty or had observed indicators of potty and sani-scoop use, and gains in potty use declined over the follow-up period, even with ongoing promotion. Our findings from an intervention that provided free products and intensive initial behavior change promotion suggest a sustained increase in hygienic latrine access up to 3.5 years after intervention initiation but infrequent use of child feces management tools. Studies should investigate strategies to ensure sustained adoption of safe child feces management practices. [ABSTRACT FROM AUTHOR]

and microplastic (NP/MP) is one of the most challenging types of micropollutants, coming from either direct release or degradation of plastic items into ecosystems. NP/MP can adsorb hazardous pollutants (such as heavy metals and pharmaceutical compounds) and pathogens onto their surface that are consumed by humans, animals, and aquatic living organisms. This paper presents the interaction of NP/MP with other pollutants in the water environment and mechanisms involved to enable the ultimate fate of NP/MP as well as the effectiveness of metal-organic frame (MOF)-based membrane over conventional membrane processes for NP/MP removal. It is found that conventional membranes could remove MPs when their size is usually more than 1000 nm, but they are ineffective in removing NPs. These NPs have potentially greater health impacts due to their greater surface area. MOF-based membrane could effectively remove both NP and MP due to its large porous structure, high adsorption capacity, and low density. This paper also discusses some challenges associated with MOF-based membranes for NP/MP removal. Finally, we conclude a specific MOF-based ultrafiltration membrane (ED-MIL-101 (Cr)) that can potentially remove both negative and positive charged NP/MP from wastewater by electrostatic attraction and repulsion force with efficient water permeability. [Display omitted] • Properties of NP/MP changes after their interaction with co-existing pollutants. • Conventional membranes could not effectively remove nanoplastics. • MOF could effectively remove MPs with more than 90%. • MOF based ED- MIL 101(Cr) UF membrane is potential for both negatively and positively charged NP/MP removal. [ABSTRACT FROM AUTHOR]

Choice of antibiotic for treatment of serious bacterial infection is rapidly diminishing by plasmid mediated transfer of antibiotic resistance. Here, we report a possible horizontal transfer of plasmid carrying third-generation-cephalosporin (TGC) resistance between Escherichia coli and Shigella sonnei . Two different types of colonies were identified in MacConkey agar plate from a faecal specimen collected from a patient with shigellosis. The colonies were identified as E. coli and S. sonnei . Both of the isolates were resistant to ampicillin, chloramphenicol, co-trimoxazole, erythromycin, azithromycin, nalidixic acid, ceftriaxone, cefixime, ceftazidime, cefotaxime and susceptible to co-amoxiclave, amikacin, imipenam, astreonam, levofloxacin, moxifloxacin, mecillinam. These two strains were positive for extended spectrum β -lactamase. We were able to transfer ESBL producing property from both ceftriaxone-resistant isolates to the ceftriaxone susceptible recipient E. coli K12 and S. sonnei . Plasmid profile analysis revealed that the first-generation E. coli K12 and S. sonnei transconjugants harbored a 50 MDa R plasmid, as two-parent ESBL-producing S. sonnei and E. coli strains. Similar patterns of ESBL producing plasmid and transferable antimicrobial phenotype suggests that the ESBL producing plasmid might transferred between E. coli and S. sonnei through conjugation in the human gut. [ABSTRACT FROM AUTHOR]

Highlights: [•] Provider-verified HPV vaccination status on 13–17 year old girls collected through National Immunization Survey-Teen 2011 were analyzed. [•] Weighted HPV vaccine initiation and completion rates were the lowest in the South. [•] Interventions programs may reduce these regional disparities. [ABSTRACT FROM AUTHOR]

Highlights: [•] Association between well-woman visit of mothers and HPV vaccine uptake among their adolescent children was examined. [•] HPV vaccine uptake among daughters, but not among sons, was higher among women who had well-woman visit in the past 2 years. [•] Well-woman visit may be a missed opportunity for physicians to educate about the benefits of adolescent HPV vaccination. [ABSTRACT FROM AUTHOR]

Highlights: [•] Data from 2632 young adult women from 12 US states collected during 2008–2010 were analyzed. [•] Weighted vaccine initiation and completion rates were the lowest in the South compared to other regions in the US. [•] Interventions programs to improve HPV vaccine uptake in the South are warranted. [ABSTRACT FROM AUTHOR]