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A regulated stress response is essential for healthy child growth and development trajectories. We conducted a cluster-randomized trial in rural Bangladesh (funded by the Bill & Melinda Gates Foundation, ClinicalTrials.gov NCT01590095) to assess the effects of an integrated nutritional, water, sanitation, and handwashing intervention on child health. We previously reported on the primary outcomes of the trial, linear growth and caregiver-reported diarrhea. Here, we assessed additional prespecified outcomes: physiological stress response, oxidative stress, and DNA methylation (N = 759, ages 1–2 years). Eight neighboring pregnant women were grouped into a study cluster. Eight geographically adjacent clusters were block-randomized into the control or the combined nutrition, water, sanitation, and handwashing (N + WSH) intervention group (receiving nutritional counseling and lipid-based nutrient supplements, chlorinated drinking water, upgraded sanitation, and handwashing with soap). Participants and data collectors were not masked, but analyses were masked. There were 358 children (68 clusters) in the control group and 401 children (63 clusters) in the intervention group. We measured four F2-isoprostanes isomers (iPF(2α)-III; 2,3-dinor-iPF(2α)-III; iPF(2α)-VI; 8,12-iso-iPF(2α)-VI), salivary alpha-amylase and cortisol, and methylation of the glucocorticoid receptor (NR3C1) exon 1F promoter including the NGFI-A binding site. Compared with control, the N + WSH group had lower concentrations of F2-isoprostanes isomers (differences ranging from −0.16 to −0.19 log ng/mg of creatinine, P < 0.01), elevated post-stressor cortisol (0.24 log µg/dl; P < 0.01), higher cortisol residualized gain scores (0.06 µg/dl; P = 0.023), and decreased methylation of the NGFI-A binding site (−0.04; P = 0.037). The N + WSH intervention enhanced adaptive responses of the physiological stress system in early childhood. A regulated stress response is essential for healthy child growth and development. Here, the authors show that a nutrition, water, sanitation, and hygiene intervention enhanced adaptive responses of the physiological stress system in early childhood. [ABSTRACT FROM AUTHOR]

Objective: To assess the degree of openness of communication about illness and death between patients with advanced cancer and their relatives during the last three months of the patient’s life, and its association with relatives’ characteristics and bereavement distress. Methods: We used data from bereaved relatives of patients with advanced cancer from the prospective, longitudinal, multicenter, observational eQuipe study. Univariate and multivariable linear regression analyses were used to assess the association between the degree of openness of communication (measured using the validated Caregivers’ Communication with patients about Illness and Death scale), the a priori defined characteristics of the relatives, and the degree of bereavement distress (measured using the Impact of Event Scale). Results: A total of 160 bereaved relatives were included in the analysis. The average degree of open communication about illness and death between patients with advanced cancer and their relatives was 3.86 on a scale of 1 to 5 (SE=0.08). A higher degree of open communication was associated with a lower degree of bereavement distress (p=0.003). No associations were found between the degree of open communication and the relatives’ age (p=0.745), gender (p=0.196), level of education (p>0.773), (religious) worldview (p=0.435), type of relationship with the patient (p>0.548), or level of emotional functioning before the patient’s death (p=0.075). Conclusions: Open communication about illness and death between patients and relatives seems to be important, as it is associated with a lower degree of bereavement distress. Healthcare professionals can play an important role in encouraging the dialogue. However, it is important to keep in mind that some people not feel comfortable talking about illness and death. [ABSTRACT FROM AUTHOR]

Background: Up to 40% of vulvar cancer patients present with local recurrence within 10 years of follow-up. An inguinofemoral lymphadenectomy (IFL) is indicated if not performed at primary treatment. The incidence and risk factors for lymph node metastases (LNM) at first local recurrence, however, are unclear. Our aim was to determine the incidence of LNM at first local recurrence, in relation to previous groin treatment and clinicopathological factors. Methods: A multicenter cohort study including vulvar cancer patients with a first macroinvasive local recurrence after primary surgical treatment between 2000 and 2015 was conducted in the Netherlands. Groin status at local recurrence was defined as positive (N+), negative (N−) or unknown (N?) and based on histology, imaging and follow-up. Patient-, tumour- and treatment characteristics of primary and recurrent disease were analysed. Results: Overall, 16.3% (66/404) had a N+groin status at first local recurrence, 66.4% (268/404) N− and 17.3% (70/404) N?groin status. The incidence of a N+groin status was comparable after previous SLN and IFL, 11.5% and 13.8%, respectively. A N+ groin status was related to tumour size (25 vs.12 mm; P < 0.001), depth of invasion (5 vs. 3 mm; P < 0.001) and poorly differentiated tumours (22.9 vs. 11.9%; P = 0.050) at local recurrence. Conclusions: The incidence of LNM at first local recurrence in vulvar cancer patients was 16.3%, and independent of previous type of groin surgery. In accordance with primary diagnosis, tumour size, depth of invasion, and tumour grade were significantly associated with a positive groin status. [ABSTRACT FROM AUTHOR]

The impact of fertility decline on economic development remains central to population studies. Recent scholarship emphasizes parental investment in education as a mediator. We further develop the theoretical foundation, and empirical evidence, for the role of child health—specifically how fertility changes promote children's physical and cognitive development and thereby complement human capital accumulation through educational gains. We test this using a two-generation model applied to Indonesian longitudinal data from 1993 to 2015. Characteristics of modern fertility regimes—older maternal ages, longer interpregnancy intervals, and lower average birth orders—generally benefit offspring cognitive development and schooling. We estimate that family planning expansion, and the resulting shift in fertility traits, induced an average increase of 0.34 years of offspring educational attainment by age 18 years. Maximal maternal educational and family planning expansion would jointly produce a 1.12-year gain, including 0.20 years more directly attributable to fertility shifts. Evidence is strengthened in parallel simulations from models of within-mother shifts, in which fertility shifts resulted in a 0.16-year gain in offspring schooling. Findings contribute new evidence for the rounding effects of women's education and family planning expansion on human capital formation through child health within families and across generations. [ABSTRACT FROM AUTHOR]

This paper considers an integrated approach to two common problems in a precision agriculture framework: management zone delineation and selective harvest scheduling. Our model minimizes the total costs of harvest operations, establishing planning and scheduling for selective harvest of each selected management zone. Therefore, this tool provides important information for decision making of farmers in the field. Our integrated model is contrasted with the hierarchical approach commonly used in the literature for these cases, where the result of zoning problem is an input to schedule the harvest problem. Both problems were solved through a complete enumeration of all the potential management zones and demonstrated the advantages of our proposed model over the hierarchical approach. Our model reached an average reduction of 10% in harvest operations costs for different instances in a case study. [ABSTRACT FROM AUTHOR]

This study tests whether women's relationship power modifies the effect of a conditional cash transfer (CCT) on STI risk. We analyzed 988 women enrolled in the RESPECT study in Tanzania, a yearlong, randomized-controlled trial testing the effectiveness of a CCT to reduce STI incidence. Women were randomized at the individual level to a no-cash control group, a low-cash, or a high-cash study arm. After one year, there was no main effect of study arm on risk of having an STI among women. However, in tests of heterogeneity, the effect of the CCT varied by a woman's relationship power (adjusted RRs of the interaction term for women with higher relationship power: RR 0.567 (95% CI 0.240-0.895) for high cash and RR 1.217 (95% CI 0.794-1.641) for low cash). Specifically, women with higher relationship power in the low cash transfer arm had an elevated risk of testing positive for an STI, whereas women with high relationship power in the high cash transfer arm had a decreased risk of testing positive for an STI. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Intestinal endometriosis (IE) can present with varied symptoms, making the diagnosis difficult. Modalities have been described to evaluate IE, but few can provide a confirmatory diagnosis. A preoperative diagnosis of IE may help guide management. We sought to describe the presentation, diagnostic evaluation, histology and operative management of 89 patients with tissue-confirmed symptomatic IE.METHODS:The records of 89 patients from a single institution with histologically confirmed, symptomatic IE from 1 January 1994 to 30 September 2009 were reviewed.RESULTS:Abdominal pain was the most common symptom in patients with IE; however, rectal bleeding was significantly associated with IE of the distal colon (P=0.02), while dysfunctional uterine bleeding was seen more in patients with proximal IE (P=0.01). Preoperative confirmation of IE was uncommon; colonoscopy with biopsy confirmed the diagnosis in 29.6% of patients tested and only 15% of patients with IE had histologic lesions involving mucosa. In the five patients who underwent endoscopic ultrasound (EUS), the diagnosis of IE was established in all cases (n=4) where histology or cytology was obtained. Malignancy was considered nearly as frequently as IE preoperatively, and 90.4% of patients underwent laparotomy as the initial surgical approach.CONCLUSIONS:IE can present with a variety of manifestations, which may provide clues to location of bowel affected. Patients with known pelvic endometriosis and rectal bleeding are more likely to have distal bowel affected; EUS with tissue sampling may play a role if routine endoscopy fails to reveal the diagnosis. Making a diagnosis of IE preoperatively may allow for less invasive surgical approaches and better patient outcomes. [ABSTRACT FROM AUTHOR]

The prevalence of childhood overweight is high in Mexican immigrant communities in the United States. Understanding mother's perceptions of child weight in immigrants' country of origin may help to understand this high prevalence. The goal of this study was to examine and compare mothers' perception of weight in Mexico (MX) and in an immigrant community in California (CA). We assessed perceptions of child weight using a pictorial scale with 314 mothers of 5-year-old children in MX and 60 mothers of 5 year-old-children in CA. We compared maternal reports with children's objectively measured weight. Using chi-square and Analysis of Variance, we investigated associations of maternal perception of and satisfaction with weight according to socio-demographic characteristics. Mothers were more likely to underestimate their children's weight in CA than in MX. On average, CA mothers wanted their children to be smaller than they currently were and mothers in MX wanted their children to be bigger than they currently were. This differed by weight status in CA with mothers of normal weight and at-risk-for-overweight children wanting them to be bigger and mothers of overweight children wanting them to be smaller. In order for programs to be effective, mothers must be able to recognize their children as overweight and want to address it. Because underestimation of weight and a desire for a larger size is common in this population, programs to address overweight may be more effective if they focus on alternative benefits of weight control strategies, such as healthy child development. [ABSTRACT FROM AUTHOR]

We investigated the contributions of individual, family, and community-level factors for explaining anxiety symptoms among rural adolescents in Mexico. As part of a large-scale survey, 3,553 adolescents and their mothers from 333 poor, rural communities in seven Mexican states provided cross-sectional data on family level, socio-economic and psychosocial factors, and individual-level data on anxiety symptoms. Community standard of living indicators were also gathered. Linear regressions adjusted for sampling design indicated that adolescents’ anxiety symptoms were uniquely predicted by mothers’ depressive symptoms, maternal perceived stress, larger family size, and lower maternal and adolescent educational attainment. Family income and community standard of living were not directly associated with adolescent symptoms. Adolescent females reported more symptoms than males, but gender did not moderate the relationship between the predictors and adolescents’ symptoms. We found that maternal mental health was a key factor in adolescent children’s psychological wellbeing; this finding extends prior research in economically developed countries that emphasizes the importance of maternal functioning for child mental health. Family size, gender, and the educational attainment of mothers and adolescents also uniquely contributed to adolescents’ anxiety symptoms in these rural Mexican communities. [ABSTRACT FROM AUTHOR]

Purpose: Changes in GABA(A)-receptor density and affinity play an important role in many forms of epilepsy. A novel approach, using positron emission tomography (PET) and [C-11]flumazenil ([C-11]FMZ), was developed for simultaneous estimation of GABA(A)-receptor properties, characterized by B (max) and K (D).Procedures: Following an injection of [C-11]FMZ (dose range: 1-2,000 mug) to 21 rats, concentration time curves of FMZ in brain (using PET) and blood (using HPLC-UV) were analyzed simultaneously using a population pharmacokinetic (PK) model, containing expressions to describe the time course of the plasma concentration (including distribution to the body), the brain distribution, and the specific binding within the brain.Results: Application of this method in control rats resulted in estimates of B (max) and K (D) (14.5 +/- 3.7 ng/ml and 4.68 +/- 1.5 ng/ml, respectively).Conclusions: The proposed population PK model allowed for simultaneous estimation of B (max) and K (D) for a group of animals using single injection PET experiments per animal. [ABSTRACT FROM AUTHOR]

We describe the headache characteristics of two patients with intracranial hypotension (IH) and correlate the magnetic resonance imaging (MRI) pattern to the clinical aspects of this type of headache. The first case was that of a patient with spontaneous IH, whereas the second patient had IH following rhinorrhoea. Cerebral computed tomography (CT) performed at presentation of symptoms was normal in both patients. Cerebral MRI in the first case showed meningeal contrast enhancement and an MRI pattern consistent with a subdural hygroma, while in the second case there was only a mild meningeal thickening. The symptoms improved spontaneously in both cases in about 2-3 months, confirming that invasive manoeuvres are not mandatory in these patients. [ABSTRACT FROM AUTHOR]

We describe a new implementation of a parallel Tree-SPH code with the aim of simulating galaxy formation and evolution. The code has been parallelized using SHMEM, a Cray proprietary library to handle communications between the 256 processors of the Silicon Graphics T3E massively parallel supercomputer hosted by the Cineca Super-computing Center (Bologna, Italy). The code combines the smoothed particle hydrodynamics (SPH) method to solve hydrodynamical equations with the popular Barnes and Hut (1986) tree-code to perform gravity calculation with a N × log N scaling, and it is based on the scalar Tree-SPH code developed by Carraro et al. (1998). Parallelization is achieved by distributing particles along processors according to a workload criterion. Benchmarks of the code, in terms of load balance and scalability, are analysed and critically discussed against the adiabatic collapse of an isothermal gas sphere test using 2 × 104 particles on eight processors. The code turns out to be balanced at more than 95% level. If the number of processors is increased, the load balance worsens slightly. The deviation from perfect scalability at increasing number of processors is negligible up to 64 processors. Additionally we have incorporated radiative cooling, star formation, feedback and an algorithm to follow the chemical enrichment of the interstellar medium. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate temporal changes of stroke in an Italian community by comparing the present incidence rates with those reported in the same area for 1989. The two studies were conducted by the same research group and met almost all the criteria proposed for an "ideal" stroke incidence study. The annual incidence rate per 1000 inhabitants increased (p < 0.01) by 29%, from 2.23 (95% CL, 1.96-2.50) in 1989 to 2.89 (95% CL, 2.58-3.20) in 1997. No statistically significant change was found when these rates were adjusted to the 1991 Italian population. The overall incidence rate was 2.40 (95% CL, 2.14-2.66) in 1989 and 2.65 (95% CL, 2.39-2.91) in 1997. The thirty-day case fatality rate declined dramatically (p < 0.001) from 31% (95% CL, 26-36) to 20% (95% CL, 16-24) between 1989 and 1997. Ageing of the population and better identification of cases could explain the high incidence rate, whereas the decrease of fatality rate may be due to a general improvement in acute care and inclusion of milder cases. [ABSTRACT FROM AUTHOR]

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Chronic migraine (CM) is a complex neurological disorder associated with substantial disability that affects approximately 2 % of general population. Onabotulinumtoxin A is employed for patients suffering from CM refractory to common therapeutic prophylaxis. Since May 2013, we have selected 22 patients referring to our headache centre with a history of CM which meets the diagnostic criteria of ICHD-3 beta (2013). The patients have been treated with onabotulinumtoxin A injection in 31 sites according to the protocol of the PREEMPT study at the total dosage of 155 U/treatment every 3 months. So far, eight patients have been subjected to three treatment sessions, five patients to two treatments and nine patients to one treatment. Three patients dropped for low compliance, but there were no serious adverse events. The frequency of headache days, the intensity of headache and the headache disability have been measured using headache diary, migraine disability assessment (MIDAS) questionnaire and headache impact test (HIT)-6 score. Data concerning the 13 patients who have been submitted to at least two treatment sessions have already shown a decrease of headache days of 20.64 % after the first treatment; MIDAS and HIT-6 scores have been significantly improved with a reduction of the scores, respectively, of 38.45 % for MIDAS and of 6.95 % for HIT-6. These are preliminary results because the observation time, the number of treatment sessions and the number of patients treated are still few. [ABSTRACT FROM AUTHOR]