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Abstract Background Childcare centres are important environments for promoting physical activity and healthy eating. Blended approaches to professional learning may help overcome existing challenges for educators in promoting these behaviours. This study aimed to test the effect of a blended professional learning program on healthy eating and physical activity in childcare. Methods Cluster randomized stepped-wedge trial in 15 childcare centres in Tasmania, Australia. Children aged 2-5y who attended at least two days per week were eligible to participate. Random assignment occurred at the centre level. Centre names were drawn out of a hat and then subsequently allocated to one of the three steps. The intervention comprised a 12-week blended professional learning program for educators. The main outcome was centre-level physical activity and healthy eating, assessed using the Environment and Policy Assessment Observation System (EPAO). All data collectors were blinded to step allocation. Analyses were according to intention to treat. The trial was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12618000346279, date registered: 07/03/2018). Results Centres were recruited between January 2016 and February 2016. All centres were retained for the duration of the study. A total of 313 children were recruited with 291 analysed at the completion of the study (93%). The difference between groups for the EPAO total score was significant at the end of the maintenance period (adjusted difference = 14.63, 95% CI [1.33, 27.92], p = 0.03). Significant differences were found for the percentage of time children spent in light-intensity physical activity at the end of the intervention (adjusted difference = 0.01, 95% CI [0.00,0.01], p = 0.02) and maintenance periods (adjusted difference = 0.01, 95% CI [0.00,0.02], p = 0.04). To the best of the authors knowledge, there were no adverse events. Conclusion This intervention achieved a sustained improvement in physical activity and healthy eating in childcare centres. Further, it can be easily integrated into existing service provision, especially among centres with limited access to professional learning. Trial registration The study was registered with the Australian and New Zealand Clinical Trials Registry ( ACTRN12618000346279 , date registered: 07/03/2018).

Hyperspectral microscope images (HMIs) have previously shown promise as a means for rapid and early detection of foodborne bacteria at the cellular level. System calibration and data normalization are critical for comparing information obtained from HMIs collected with multiple instruments and system parameters. Here, we implement a wavelength and radiometric calibration for spectral data obtained from a hyperspectral microscope, assess the spatial uniformity of HMIs, and show the need to normalize data from single-cell regions of interest (ROIs). A hyperspectral microscope with a tungsten halogen light source, acousto-optical tunable filter, and electron multiplying camera with variable gain and exposure time settings were used. HMIs were collected at additional gain settings of 0%, 1.6%, 3.5%, and 5.1% along with ten exposure time settings between 100 and 1000 ms with both calibration lamps. Wavelength peak shift started to occur at an exposure time of 600 ms for 1.6% gain, at 400 ms for 3.5% gain, and at 200 ms for 5.1% gain. HMIs of E. coli, Salmonella Typhimurium, and Staphylococcus sciuri cells were collected to assess spectral data normalcy and the need for preprocessing spectra from single bacteria cells. Spatial characteristics of cells were assessed by HMIs of a glass slide with a micrometer for determining pixel size from the field of view. HMIs were preprocessed by normalizing cell spectra to the light source and applying multiplicative scatter correction. Data normalcy was assessed on both the raw and preprocessed data sets. Preprocessing the data was found to reduce the cell-to-cell variation associated with a single-cell ROI method, while outliers were detected and verified through HMIs as physically different from other cells. [ABSTRACT FROM AUTHOR]

Background: Isoniazid is a leading tuberculosis treating medication. Global supply chains provide essential medicines such as isoniazid to resource-limited areas. Ensuring the safety and efficaciousness of these medicines is essential to public health programs. Handheld spectrometers are becoming increasingly approachable in cost and usability. As supply chains expand, quality compliance screening of essential medications is necessary in site-specific locations. Here, a brand-specific qualitative discrimination analysis of isoniazid is approached by collecting data from two handheld spectrometers in two countries with the intent to build a multi-location quality compliance screening method for a brand of isoniazid., Methods: Two handheld spectrometers (900-1700 nm) were used to collect spectra from five manufacturing sources (N = 482) in Durham, North Carolina, USA, and Centurion, South Africa. A qualitative brand differentiation method was established from both locations by applying a Mahalanobis distance thresholding method as a measure of assessing similarity., Results: Combining data from both locations resulted in a 100% classification accuracy, at both locations, for brand 'A' and resulted in the four other brands classifying as dissimilar. Bias was found between sensors in terms of resulting Mahalanobis distances, but the classification method proved to be robust enough to accommodate. Several spectral peaks found in isoniazid references appear within the 900-1700 nm range, as well as variation in the excipients per manufacturer., Conclusions: Results show promise for compliance screening isoniazid as well as other tablets in multiple geographic locations using handheld spectrometers.

Salmonella is commonly found on broiler chickens during processing. This study investigates the Salmonella detection method that reduces the necessary time for confirmation, by collecting surface-enhanced Raman spectroscopy (SERS) spectra from bacteria colonies, applied to a substrate of biopolymer encapsulated AgNO 3 nanoparticles. Chicken rinses containing Salmonella Typhimurium (ST) were analyzed by SERS and compared to traditional plating and PCR analyses. SERS spectra from confirmed ST and non-Salmonella colonies appear similar in spectra composition, but with different peak intensities. t-Test on the peak intensities showed that ST and non-Salmonella colonies were significantly different (α = 0.0045) at 5 peaks, 692 cm -1 , 718 cm -1 , 791 cm -1 , 859 cm -1 , and 1018 cm -1 . A support vector machine (SVM) classification algorithm was able to separate ST and non-Salmonella samples with an overall classification accuracy of 96.7 %., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier B.V.)

Objectives: To place Smart Snacks in vending machines and determine if different sales strategies affect Smart Snack selection., Participants: University students living in resident halls., Methods: Vending machines included 50% Smart Snacks and 50% non compliant snacks. Three sales strategies targeted student selection of Smart Snacks : Reduced price, signage, and nutrition education activities. Three-way ANOVA was used for analysis., Results: There was a statistically significant three-way interaction on snack selection between sales strategy, study period, and snack type, F (4, 77) = 3.33, P = .01. There were no statistically significant simple two-way interaction between study period and sales strategy for either Smart Snack , F (1, 77) = 1.62, P  = 0.18, or NC snack types, F (1, 77) = 2.02, P  = 0.07., Conclusions: Sales strategies did not affect Smart Snack selections. Advocates for healthier snacks in vending machines can align with university administrations to establish nutrient guidelines.

Background: Sotrovimab is a neutralizing monoclonal antibody (mAb) that seems to remain active against recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. The evidence on its use in kidney transplant (KT) recipients, however, is limited., Methods: We performed a multicenter, retrospective cohort study of 82 KT patients with SARS-CoV-2 infection {coronavirus disease 2019 [COVID-19]} treated with sotrovimab., Results: Median age was 63 years. Diabetes was present in 43.9% of patients, and obesity in 32.9% of patients; 48.8% of patients had an estimated glomerular filtration rate under 30 mL/minute/1.73 m 2 . Additional anti-COVID-19 therapies were administered to 56 patients, especially intravenous steroids (65.9%). Sotrovimab was administered early (<5 days from the onset of the symptoms) in 46 patients (56%). Early-treated patients showed less likely progression to severe COVID-19 than those treated later, represented as a lower need for ventilator support (2.2% vs 36.1%; P  < .001) or intensive care admission (2.2% vs 25%; P  = .002) and COVID-19-related mortality (2.2% vs 16.7%; P  = .020). In the multivariable analysis, controlling for baseline risk factors to severe COVID-19 in KT recipients, early use of sotrovimab remained as a protective factor for a composite outcome, including need for ventilator support, intensive care, and COVID-19-related mortality. No anaphylactic reactions, acute rejection episodes, impaired kidney function events, or non-kidney side effects related to sotrovimab were observed., Conclusions: Sotrovimab had an excellent safety profile, even in high-comorbidity patients and advanced chronic kidney disease stages. Earlier administration could prevent progression to severe disease, while clinical outcomes were poor in patients treated later. Larger controlled studies enrolling KT recipients are warranted to elucidate the true efficacy of monoclonal antibody therapies., (© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.)

Quality assurance of finished pharmaceuticals is a necessity in ensuring the safety of consumers. There is a need for low-cost and portable rapid screening methods of pharmaceuticals in resource limited areas. Recent advances in technology have made handheld and low-cost diffuse reflectance spectrometers available to the public. While these handheld spectrometers offer advantages over benchtop spectrometers, the accuracy and repeatability must be assessed before these instruments can be used for quality assurance screening. Here, five handheld spectrometers of the same model were purchased, where an in-house installation qualification and operational qualification (IQOQ) was subsequently established for the instruments. Wavelength and photometric accuracy (and repeatability), spectroscopic noise, stray light, and bandpass were assessed between instruments. Results were found to be consistent between the spectrometers, passing IQOQ procedures, and were determined to be ready for field use. Once the handheld spectrometer's performance was verified, a practical and low-cost daily performance verification was established using common high density polyethylene vial caps on location in South Africa, Thailand, and the United States. A Mahalanobis distance-based classifier found the five spectrometers to be in agreement., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Medroxyprogesterone acetate (MPA) injectable suspensions are used by millions of women for family planning and hormonal therapy. Falsified or substandard medications may result in a health risk for consumers. Near-infrared spectroscopy (NIR) has previously been applied as a means of non-destructive and rapid screening of product quality compliance. These methods offer advantages but can be logistically and cost prohibitive for field use in resource limited areas. Here, a handheld spectrometer (900-1700 nm) with open-sourced software is used to evaluate vials of MPA from three suppliers (N = 227 vials) and verified by a benchtop UV-VIS-NIR (350-2500 nm) with licensed software. Multivariate data analysis assesses the spectral signatures of samples and builds a discriminant classification method based on Mahalanobis distances calculated from a principal component analysis scores. The handheld device paired with open-source software resulted in a product discrimination accuracy of 100% (verified by benchtop UV-VIS-NIR and chemical testing data) as well indicating that the low-cost field portable device is suitable for rapidly assessing samples in resource limited areas for consistency of manufacturing and sourcing., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Issue Addressed: To develop, implement and evaluate the impact of a short education intervention on the understanding of dementia through visual art by primary school-aged children., Methods: A series of three lessons were developed in consultation with a local schoolteacher and community artists and taught in a local primary school. Stage 2 students (8-10 years old) created an artwork about memory, learned about dementia and adapted their artworks to represent their developing understanding of dementia. Empirical data were collected through pre and postinterventions surveys and content analysis of the artworks., Results: Matched pre and postintervention survey data were obtained for 74 students and showed a significant improvement in seven domains. This indicated that the students had an increased understanding of dementia and its impact on the individual following the intervention. Matched artwork was analysed from lessons 1 and 3 for 109 students using a coding schema developed specifically for this project. The students developed their artwork to show memories fading or being lost altogether. They also used abstract shapes to create a sense of disorder and chaos., Conclusion: Participation in the intervention was shown to increase students' understanding and knowledge of dementia using both qualitative and quantitative measures. SO WHAT?: It is likely that by educating children about dementia, we have the potential to reduce the stigma faced by people living with dementia and their carers. This is important, as the ageing population means that more people within the community, including children, will know someone living with dementia. Further, this represents the cornerstone in creating dementia-friendly communities., (© 2020 Australian Health Promotion Association.)

Foodborne pathogens have become ongoing threats in the food industry, whereas their rapid detection and classification at an early stage are still challenging. To address early and rapid detection, hyperspectral microscope imaging (HMI) technology combined with convolutional neural networks (CNN) was proposed to classify foodborne bacterial species at the cellular level. HMI technology can simultaneously obtain both spatial and spectral information of different live bacterial cells, while two CNN frameworks, U-Net and one-dimensional CNN (1D-CNN), were employed to accelerate the data analysis process. U-Net was used for automating cellular regions of interest (ROI) segmentation, which generated accurate cell-ROI masks in a shorter timeframe than the conventional Otsu or Watershed methods. The 1D-CNN was employed for classifying the spectral profiles extracted from cell-ROI and resulted in a higher accuracy (90%) than k-nearest neighbor (81%) and support vector machine (81%). Overall, the CNN-assisted HMI technology showed potential for foodborne bacteria detection.

Abstract: Campylobacter is an organism of concern for food safety and is one of the leading causes of foodborne bacterial gastroenteritis. This pathogen can be found in broiler chickens, and the level of allowable contamination of processed poultry is regulated by federal agency guidelines. Traditional methods for detecting and isolating this pathogen from broiler chicken carcasses require time, expensive reagents, and artificially generated microaerophilic atmospheres. An aerobic medium that simplifies the procedure and reduces the expense of culturing Campylobacter has been recently described, and Campylobacter can be grown in this medium in containers that are incubated aerobically. Hyperspectral microscopic imaging (HMI) has been proposed for early and rapid detection of pathogens at the cellular level. The objective of the present study was to utilize HMI to compare differences between Campylobacter cultures grown under artificially produced microaerobic atmospheres and cultures grown in aerobic medium. Hyperspectral microscopic images of three Campylobacter strains were collected cultures grown for 48 h microaerophilically and for 24 and 48 h aerobically, and a quadratic discriminant analysis was used to characterize the bacterial variability. Microaerobically cultured bacteria were detected with 98.7% accuracy, whereas detection accuracy of cultures grown in the novel medium was slightly reduced (-4.8 and -3.2% for 24 and 48 h, respectfully). The Mahalanobis distance multivariate metric was applied to quantify strain variability under all three treatment conditions. Across all strains and treatments, little cluster variation was present (4.22 to 4.42), indicating the consistency of the images collected from the three strains. The classification and spectral consistency was similar for cultures incubated in the aerobic medium for 24 h and cultures grown for 48 h under microaerobic conditions., (Published 2020 by the International Association for Food Protection. Not subject to U.S. Copyright.)

Salmonella is an organism of importance to the poultry industry with increasingly stringent government regulatory standards. Real-time polymerase chain reaction (RT-PCR) and plating procedures on nutrient enriched growth media have been the standard detection methods of Salmonella from broiler chicken carcasses for years. These methods are proven, but offer disadvantages in the amount of time or reoccurring sample cost. Here, we propose the use of a hyperspectral microscope imaging system (HMI) for comparison to standard detection methods. Broiler chicken carcasses were rinsed and plated on Salmonella selective agar. Colonies from plates were picked and RT-PCR was used as a confirmation test to verify plating results, while HMI was collected from the same colonies. Spectral signatures of cells were extracted between 450 and 800 nm from HMI collected with 100x objective. A quadratic discriminant analysis (QDA) was used to classify cells as either Salmonella positive or negative (n = 341). Spectra preprocessing minimized the influence of cellular shape on the spectra, increasing the initial classification accuracy of 81.8-98.5%, yielding a sensitivity of 1.0, and a specificity of 0.963. Results showed the potential as an initial investigation of HMI as a microbial confirmation tool, compared to RT-PCR., (Published by Elsevier B.V.)

This study was designed to evaluate hyperspectral microscope images for early and rapid detection of Salmonella serotypes Enteritidis, Heidelberg, Infantis, Kentucky, and Typhimurium at incubation times of 6, 8, 10, 12, and 24 h. Images were collected by an acousto-optical tunable filter hyperspectral microscope imaging system with a metal halide light source measuring 89 contiguous wavelengths every 4 nm between 450 and 800 nm. Pearson correlation values were calculated for incubation times of 8, 10, and 12 h and compared with data for 24 h to evaluate the change in spectral signatures from bacterial cells over time. Regions of interest were analyzed at 30% of the pixels in an average cell size. Spectral data were preprocessed by applying a global data transformation algorithm and then subjected to principal component analysis (PCA). The Mahalanobis distance was calculated from PCA score plots for analyzing serotype cluster separation. Partial least-squares regression was applied for calibration and validation of the model, and soft independent modeling of class analogy was utilized to classify serotype clusters in the training set. Pearson correlation values indicate very similar spectral patterns for reduced incubation times ranging from 0.9869 to 0.9990. PCA score plots indicated cluster separation at all incubation times, with incubation time Mahalanobis distances of 2.146 to 27.071. Partial least-squares regression had a maximum root mean squared error of calibration of 0.0025 and a root mean squared error of validation of 0.0030. Soft independent modeling of class analogy correctly classified values at 8 h (98.32%), 10 h (96.67%), 12 h (88.33%), and 24 h (98.67%) with the optimal number of principal components (four or five). The results of this study suggest that Salmonella serotypes can be classified by applying a PCA to hyperspectral microscope imaging data from samples after only 8 h of incubation.

The breath-actuated nebulizer (BAN) is a new respiratory device to deliver short-acting β-agonists to patients with asthma exacerbations. This pediatric convenience sample experimental study compares the BAN with conventional nebulizers and demonstrates that the BAN allows for shorter treatment times to achieve improved clinical asthma scores with less albuterol, shorter emergency department length of stay, and fewer hospitalizations.

Introduction: Cardiovascular diseases are the main cause of morbidity-mortality in Spain. Hypertension and the other cardiovascular factors are important in the pathophysiological basis of this fact. Control of the main risk factors in treated hypertensives was evaluated in this study., Patients and Methods: Multicenter study in hypertensive patients treated in Primary Care. Blood pressure, cardiovascular risk factors as well as registered target organ damage and clinical diseases were measured. Finally, global cardiovascular risk was calculated., Results: Only 17.3% of pharmacologically treated hypertensives were controlled (3.9% of diabetic patients). LDL-cholesterol control deteriorated as the patient's cardiovascular risk pattern increased (90.4% in low risk and 19.9% in high-very high risk). High levels of serum creatinine were detected in 8.3%, microalbuminuria being positive in 15.6%, with 20.8% ventricular hypertrophy. A total of 31% of the patients were diabetic, 59.8% of them having HbA1c > or = 6.5%. Global CV risk was high very high in many subjects (65.4%) when European Society of Hypertension-European Society of Cardiology (ESH-ESC) guidelines were used. This percentage was 3.6% when the Spanish-validated Framingham score was used., Conclusions: Blood pressure control as well as main cardiovascular risk factors is poor in this population. Considering this fact plus the number of target organ damage, the global risk is high in many patients according to the European guidelines. Guidelines that do not consider target organ damage do not estimate adequately the risk of this uncontrolled population. This conclusion could explain the clinical tendency of many doctors when attending uncontrolled patients.

Objectives: To describe the referral of hypertense patients from primary care to a hospital arterial hypertension unit, the quality of the information sent and the profile of the referred patients., Design: A descriptive crossover study., Setting: The Hospital Clínico of San Carlos in Madrid., Patients and Other Participants: A simple random sample of 368 clinical records belonging to patients attended at the unit over the last 3 years., Measurements and Main Results: 54.6% of patients were referred from primary care. 48.9% of the interclinical (IC) notes were high-quality, with 28.7% acceptable. 36.8% of referrals were considered incorrect, 30.3% because of false unresponsiveness to treatment. Good or acceptable IC notes were associated with 94.1% of correct referrals and only 65.4% of incorrect referrals., Conclusions: A high proportion of referrals which were incorrect by the consensus criteria were detected and were caused by inadequate or insufficient medical treatment. There was a statistically significant relationship found between correct referrals and the quality of information sent in the IC note.