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Partnership between early childhood development interventions and primary health care services can help catalyse health care uptake by socially vulnerable families. This study aimed to assess the real-life effects of a large-scale home visiting programme [Primeira Infância Melhor (PIM)] in Brazil on the use of preventive (prenatal visits, well child visits, dentist visits and vaccination) and recovery (emergency room visits and hospitalization) health services. A quasi-experiment nested in a population-based birth cohort study was conducted. The intervention group was firstly defined as all children enrolled in PIM up to age 6 months, and afterwards stratified between those enrolled during pregnancy or after birth up to 6 months. Children receiving PIM were matched with controls on propensity scores based on 27 confounders to estimate effects on health service use from prenatal to age 2 years. Double adjustment was applied in outcome Quasi-Poisson regressions. No evidence was found for effects of PIM starting anytime up to 6 months (262 pairs), or for the children enrolled only after birth (133 pairs), on outcomes occurring after age 6 months. When the programme started during pregnancy (129 pairs), there was a 13% higher prevalence of adequate prenatal visits (prevalence ratio = 1.13; 95% confidence interval 1.01–1.27), but no effect on use of any other health service. Sensitivity analyses suggested longer participation in the programme with reduced visitor turnover might improve its impact on prenatal visits. Integration between PIM and primary health care was not adequate to affect overall patterns of contacts with health services. Nevertheless, prenatal home visits showed potential to increase health service contact during a sensitive period of development, indicating the need to start such programmes before birth, when there is more time for maternal care, and family engagement in a network of services is facilitated. [ABSTRACT FROM AUTHOR]

Background & aimsIt is not clear whether symptoms alone can be used to estimate the biologic activity of eosinophilic esophagitis (EoE). We aimed to evaluate whether symptoms can be used to identify patients with endoscopic and histologic features of remission.MethodsBetween April 2011 and June 2014, we performed a prospective, observational study and recruited 269 consecutive adults with EoE (67% male; median age, 39 years old) in Switzerland and the United States. Patients first completed the validated symptom-based EoE activity index patient-reported outcome instrument and then underwent esophagogastroduodenoscopy with esophageal biopsy collection. Endoscopic and histologic findings were evaluated with a validated grading system and standardized instrument, respectively. Clinical remission was defined as symptom score

We quantified groundwater discharge and associated nutrient fluxes to Monterey Bay, California, during the wet and dry seasons using excess (224)Ra as a tracer. Bioassay incubation experiments were conducted to document the response of bloom-forming phytoplankton to submarine groundwater discharge (SGD) input. Our data indicate that the high nutrient content (nitrate and silica) in groundwater can stimulate the growth of bloom-forming phytoplankton. The elevated concentrations of nitrate in groundwater around Monterey Bay are consistent with agriculture, landfill, and rural housing, which are the primary land-uses in the area surrounding the study site. These findings indicate that SGD acts as a continual source of nutrients that can feed bloom-forming phytoplankton at our study site, constituting a nonpoint source of anthropogenic nutrients to Monterey Bay.

Methane emissions in the Arctic are important, and may be contributing to global warming. While methane emission rates from Arctic lakes are well documented, methods are needed to quantify the relative contribution of active layer groundwater to the overall lake methane budget. Here we report measurements of natural tracers of soil/groundwater, radon, and radium, along with methane concentration in Toolik Lake, Alaska, to evaluate the role active layer water plays as an exogenous source for lake methane. Average concentrations of methane, radium, and radon were all elevated in the active layer compared with lake water (1.6 × 10(4) nM, 61.6 dpm⋅m(-3), and 4.5 × 10(5) dpm⋅m(-3) compared with 1.3 × 10(2) nM, 5.7 dpm⋅m(-3), and 4.4 × 10(3) dpm⋅m(-3), respectively). Methane transport from the active layer to Toolik Lake based on the geochemical tracer radon (up to 2.9 g⋅m(-2)⋅y(-1)) can account for a large fraction of methane emissions from this lake. Strong but spatially and temporally variable correlations between radon activity and methane concentrations (r(2) > 0.69) in lake water suggest that the parameters that control methane discharge from the active layer also vary. Warming in the Arctic may expand the active layer and increase the discharge, thereby increasing the methane flux to lakes and from lakes to the atmosphere, exacerbating global warming. More work is needed to quantify and elucidate the processes that control methane fluxes from the active layer to predict how this flux might change in the future and to evaluate the regional and global contribution of active layer water associated methane inputs.

The link between autoimmune diseases and primary immunodeficiency syndromes has been increasingly appreciated. Immunologic evaluation of a young man with autoimmune enterocolopathy and unexplained infections revealed evidence of immunodeficiency, including IgG subclass deficiency, impaired Ag-induced lymphocyte proliferation, reduced cytokine production by CD8(+) T lymphocytes, and decreased numbers of NK cells. Genetic evaluation identified haploinsufficiency of NFAT5, a transcription factor regulating immune cell function and cellular adaptation to hyperosmotic stress, as a possible cause of this syndrome. Inhibition or deletion of NFAT5 in normal human and murine cells recapitulated several of the immune deficits identified in the patient. These results provide evidence of a primary immunodeficiency disorder associated with organ-specific autoimmunity linked to NFAT5 deficiency.

We performed a genome-wide association study (GWAS) of 1550 North American celiac disease cases and 3084 controls. Twelve SNPs, distributed across four regions (3p21.31, 4q27, 6q15, 6q25), were significantly associated with disease (p-value

There is great interest in examining the consequences of the COVID-19 pandemic on adolescent mental health, but most studies were conducted in high-income countries. The identification of overall effects and protective factors is essential to understand the determinants of mental wellbeing in contexts of stress. We aimed to study changes in adolescent mental health during the pandemic and the risk and protective factors associated with these changes in a Brazilian birth cohort. One thousand nine hundred forty nine adolescents from the 2004 Pelotas Birth Cohort were assessed prepandemic (T1, November 2019 to March 2020, mean age 15.69 years) and mid-pandemic (T2, August to December 2021, mean age 17.41 years). Mental health was assessed using the Strengths and Difficulties Questionnaire. Prepandemic and pandemic-related predictors were examined as predictors of change in multivariate latent change scores models. There was a mean increase in adolescent total mental health difficulties (M = 1.071, p <.001), hyperactivity/inattention (M = 0.208, p <.001), emotion symptoms (M = 0.409, p <.001), and peer problems (M = 0.434, p <.001) during the pandemic. This increase was associated with several negative family context variables, including harsh parenting and maternal depressive symptoms at T2. Higher emotion regulation levels protected against increases in adolescent mental health difficulties related to the COVID-19 pandemic. Family-context variables emerged as important risk factors for the deterioration of adolescent mental health during the COVID-19 pandemic. Interventions promoting emotion regulation strategies are a promising approach to protecting adolescent wellbeing in periods of stress. [ABSTRACT FROM AUTHOR]

The widespread adoption of machine learning and other matrix intensive computing algorithms has renewed interest in analog optical computing, which has the potential to perform large-scale matrix multiplications with superior energy scaling and lower latency than digital electronics. However, most optical techniques rely on spatial multiplexing, requiring a large number of modulators and detectors, and are typically restricted to performing a single kernel convolution operation per layer. Here, we introduce a fiber-optic computing architecture based on temporal multiplexing and distributed feedback that performs multiple convolutions on the input data in a single layer. Using Rayleigh backscattering in standard single mode fiber, we show that this technique can efficiently apply a series of random nonlinear projections to the input data, facilitating a variety of computing tasks. The approach enables efficient energy scaling with orders of magnitude lower power consumption than GPUs, while maintaining low latency and high data-throughput. Optical techniques adopted in optical computing rely on spatial multiplexing, requiring numerous integrated elements and restricting the architecture to perform a single kernel convolution per layer. The authors demonstrate a fiber-optic computing architecture based on temporal multiplexing that performs multiple convolutions in a single layer. [ABSTRACT FROM AUTHOR]