Baseline Monitoring Research Articles

Non-Genetic Biomarkers in Merkel Cell Carcinoma: Prognostic Implications and Predictive Utility for Response to Anti-PD-(L)1 Immune Checkpoint Inhibitors.

Merkel cell carcinoma (MCC) is a skin cancer that arises due to either Merkel cell polyomavirus infection (MCPyV) or ultraviolet (UV)radiation exposure, presenting primarily in the head and neck region of fair-skinned males. The recent success of PD-(L)1 immune checkpoint inhibitors (ICIs) in locally advanced/metastatic MCC, with an objective response rate (ORR) around 50% and improved survival, as a first-line treatment has moved ICIs to the forefront of therapy for MCC and generated interest in identifying biomarkers to predict clinical response. The MCC tumour microenvironment (TME) contains various components of the adaptive and innate immune system. These components can contribute to tumour immune escape through immunosuppression by preventing entrance of other immune cells or by aiding in the cytotoxic clearance of tumour cells. We aim to combine information from studies of baseline and on-treatment monitoring of the TME to help predict the success of ICIs in MCC. This review enhances the understanding of how CD8 T cells, γδ T cells and macrophages may impact predictions of response rates to ICIs in MCC patients. These immune cells are non-genetic biomarkers that can also be used to determine prognosis in MCC treatment.

Cytomegalovirus viremia and hepatitis B reactivation in patient with RET fusion-positive non-small cell lung cancer treated with pralsetinib.

Mutated rearranged during transfection (RET) kinase is found in approximately 1-2% non-small-cell lung cancer (NSCLC) patients. These patients are typically younger, non-smokers, and have non-squamous histology. Pralsetinib is a novel RET inhibitor that showed promising efficacy and tolerability in the ARROW trial. Due to the small percentage of patients that have RET mutated NSCLC, real world data on safety is still needed. This case report outlines a patient who was initiated on pralsetinib for RET mutated NSCLC and subsequently developed reactivation of cytomegalovirus (CMV) viremia and hepatitis B. The patient was initiated on valganciclovir and entecavir with subsequent improvement in viral loads. They were able to reinitiate pralsetinib at a lower dose following improvement of CMV and hepatitis B viral load with continuation of entecavir. RET is responsible for activation of several signaling paths including PI3K/AKT and JAK/STAT. Those pathways are involved in the immune system. When reviewing current JAK inhibitors and PI3K inhibitors on the market, there is mixed data on HBV reactivation and CMV viremia, though theoretically possible. Therefore, this should be evaluated and addressed in further studies. The educational value of this case could provide valuable insights for baseline monitoring and management for similarly effected patients.

Exploring the Clinical Spectrum of HUWE1-Related Neurodevelopmental Disorder: Five New Patients and Literature Review.

Turner-type X-linked syndromic intellectual developmental disorder (MRXST) is a neurodevelopmental disorder associated with variants in the HUWE1 gene on chromosome Xp11. The condition is characterized by variable phenotypes, including global developmental delay, intellectual disability, and distinctive facial dysmorphisms, with inheritance patterns ranging from X-linked recessive to de novo mutations in females. Here, we describe five probands in two families, highlighting their clinical features and genetic findings. Trio whole-exome sequencing identified a de novo variant in HUWE1 in the proband in one family and a maternally inherited hemizygous variant in three boys in a second family. A comprehensive review of HUWE1-associated cases from the literature assisted genotype-phenotype correlations, revealing consistent features such as intellectual disability, skeletal anomalies, and facial dysmorphisms as well as instances of intrafamilial variability. Our findings confirm the phenotypic variability of MRXST and underscore the significance of the HUWE1 gene product in neurodevelopment. We propose a baseline monitoring protocol to aid in diagnosis and management, contributing to the development of specific guidelines for patient follow-up.

Tritium determination in natural water samples in Fukushima from 2022 to 2023 using an ultra-low-level tritium counting system.

The Fukushima Daiichi Nuclear Power Plant (FDNPP) accident created large stockpiles of tritium containing cooling water, which is to be gradually released into the Pacific Ocean, gaining attention from surrounding countries, environmental groups, and local residents concerned with the possibility of increasing tritium concentrations in the water and food cycle. Establishing baseline concentration levels and monitoring tritium immission values are important for assuring public safety, providing data for scientific research and risk communication. Tritium concentrations in the environment are very low; therefore, tritium measurements require enrichment in order to estimate the radiation exposure from drinking water intake and provide information on the water cycle. Natural water samples were collected at Tomioka Town located south of the FDNPP. Samples were distilled, enriched by electrolysis, and re-distilled using an improved SPE method to preconcentrate tritium to measureable levels. Tritium concentrations were determined by a low-background liquid scintillation counter. The observed tritium concentrations were relatively low, rainwater had a mean and SD value of 0.40±0.13Bq/L, and freshwater samples showed similar concentrations, while brackish coastal water samples were below 0.13±0.02Bq/L. The observed tritium concentrations in this study are considered safe as effective doses based on annual drinking water intake; however, continous monitoring is necessary to assure public safety.

Holistic Management Approach for Social-Ecological Systems in Iran

Social-ecological systems (SESs) in Iran face escalating challenges and pressures due to a multitude of environmental and social factors, such as global warming, population growth, and unsustainable resources management practices. This paper presents a comprehensive review of the historical context and evolution of SESs in Iran and examines the current challenges and pressures confronting these systems. The methods utilized include literature review, case studies, framework development, analysis and synthesis, comparative analysis, integration of feedback, and Driver-Pressure-State-Impact-Response (DPSIR) framework analysis. We also discuss opportunities for enhancing resilience and sustainability in the country’s SESs, including case studies of successful management approaches. This analysis highlights the urgent need for integrated and interdisciplinary approaches to manage SES in Iran, including with community engagement and inclusive participation. Our findings develop and recommend a holistic management approach that can effectively respond to changing social and ecological conditions over time. The suggested holistic management approach involves various processes and aspects, such as stakeholder engagement, baseline data collection and monitoring, scenario planning, adaptive management strategies, and evaluation. Overall, this paper provides a valuable resource for different stakeholders, especially researchers and policymakers interested in the management of SESs in Iran and offers insights to other neighboring nations encountering similar challenges in their SESs.

Cardiac toxicity of HER-2 targeting antibody-drug conjugates: overview and clinical implications.

Antibody-drug conjugates (ADCs) have recently emerged as a promising therapeutic option that combine the specificity of monoclonal antibodies and the cytotoxic effect of chemotherapy. With numerous ADCs approved and on the market, a particular concern of ADCs that target HER-2 has been their cardiac side effects, in view of the crucial role of HER-2 in cardiac development and physiology. While rarely toxic and generally safe, numerous publications have outlined the consistent association of trastuzumab emtansine (T-DM1) and trastuzumab deruxtecan (T-DXd) with the development of cardiac toxicity. Despite not being clinically relevant in most cases, cardiac baseline evaluation, monitoring and early detection of cardiac adverse events remain pivotal with HER-2 targeting ADCs. This review aims to summarize and better characterize the complete cardiac toxicity profile of HER-2 ADCs, with the goal of improving clinical understanding of this adverse event, leading to better recognition, monitoring and management.

GROUNDWATER CONDITION AND VULNERABILITY IN THE ATHABASCA AND COLD LAKE OIL SANDS REGIONS: GAPS, OPPORTUNTIES AND CHALLENGES

Oil sands development in the Athabasca and Cold Lake oil sands regions of Alberta has raised concerns about potential impacts to groundwater and groundwater dependent ecosystems. This review summarizes the current state of understanding as to how oil sands mining and in situ activities can affect groundwater systems using a stressor-mechanism-response framework. Specific oil sands activities and practices are reviewed, and where possible, described in terms of how they can impact hydraulic head, the hydraulic properties of aquifers, recharge and transport of constituents of concern and linked to observed or potential impacts to groundwater quantity and quality. Groundwater is an important component of the water balance in boreal ecosystems, and specific vulnerabilities related to development are reviewed, including water use, landscape disturbance, groundwater withdrawals, tailings pond seepage, deep well disposal and thermal impacts. Knowledge gaps include lack of baseline data and monitoring of the quantity and quality of groundwater discharge to rivers, lakes and wetlands. One key monitoring challenge is attribution of hydrogeologic responses to specific oil sands stressors given the range of other natural and anthropogenic factors contributing to their variability. Quantitative groundwater exchange mapping, regional-scale isotope mass balance assessment, and broader incorporation of isotopic and geochemical tracers for fingerprinting water sources and incorporation of Indigenous Knowledge appear promising for improved effectiveness of monitoring.

Evaluation of Cyto-Genotoxic Effects of Mucuna Bracteata DC. Ex Kurz Leaf Extracts by Allium Cepa

This study was conducted to evaluate the cyto-genotoxicity of leaf decoctions of Mucuna bracteata by Allium cepa bioassay. This kind of study can be used as a baseline monitoring system for plant products before their use. It is an inexpensive, simple, and reliable test to determine the cytotoxic and genotoxic effects of various plant extracts on living organisms. In this experiment, Allium cepa bulbs were placed in five concentrations (0.5 mg/mL, 2.5 mg/mL, 5.0 mg/mL, 7.5 mg/mL, and 10.0 mg/mL) of leaf decoction, with tap water as the negative control and 20.0 µL/L EMS (Ethylmethene sulphonate) as the positive control. Each concentration had five replicates. The cyto-genotoxicity assay exhibited a dose-dependent influence on the mitotic index. The mitotic index of the negative control and the positive control were 16.8 ± 0.37% and 6.86 ± 1.71%, respectively. The lowest dose of the extract, 0.5 mg/mL, had the highest mitotic index (14.2 ± 0.73%), while the highest dose, 10.0 mg/mL, had the lowest (9.6 ± 0.40%), and all indices were significantly higher than the positive control. Except for the 10 mg/mL concentration, the mitotic indices of other concentrations were significantly lower than the negative control. Different types of chromosome disorders, namely, disorderly prophase, sticky chromosomes, chromosome bridges, laggard chromosomes, pole deviation, vagrant chromosomes, nuclear filaments with terminal expansion, c-mitosis, micronuclei, and elongated nuclei, were observed. Various changes in root size, growth, and color were revealed by macroscopic examinations. Tumors were formed in roots at the highest doses but not at lower concentrations. Therefore, M. bracteata leaf extract showed cytotoxic and genotoxic effects on the Allium root meristem. J. Bio-Sci. 32(2): 71-82, 2024

Topiramate induced glaucoma: A light on the management

Purpose: To highlight the importance of the use of atropine instead of pilocarpine in topiramate-induced acute angle closure glaucoma. Case report: A 22-year-old female was diagnosed as a case of bilateral topiramate-induced acute angle closure glaucoma. Topiramate was discontinued. She was started on intravenous Mannitol (20 mg) TDS, oral Acetazolamide (250 mg) QID, Brimonidine (0.2%) with Timolol (0.5%) eye drops BD, Prednisolone eye drops (1%) four times and Atropine eye drop (1%) OD. Vision and intraocular pressures were documented twice daily. The patient was symptomatically better, with improvement in visual acuity, normalization of intraocular pressure, and restoration of anterior chamber depth. Conclusion: Baseline ophthalmic evaluation and monitoring throughout the topiramate course should be recommended for early detection and prompt management to maintain optimum visual function.

Long-term clinical recovery and treatment resistance in first-episode psychosis: a 10-year follow-up study

Illness trajectories in people with first-episode psychosis (FEP) vary significantly over time. Identifying early-course parameters predicting outcomes is essential, but long-term data still needs to be provided. We conducted a 10-year follow-up study of a comprehensive first-episode psychosis (FEP) cohort investigating the prevalence of clinical recovery (CR) and treatment resistance (TR) after ten years, as well as clinical, demographic, and pre-illness predictors of long-term outcomes. 102 participants with FEP DSM-IV Schizophrenia spectrum disorders were recruited within their first year of treatment. The Treatment Response and Resistance in Psychosis Working Group (TRRIP) and the Remission in Schizophrenia Working Group (RSWG) criteria were used to define TR and CR, respectively. At 10-year follow-up, 29 (29%) of the participants were classified as in CR, while 32 (31%) were classified as TR. We also identified a larger middle group (n = 41, 40%) consisting of participants in partial recovery. 7% of all participants had tried Clozapine at the 10-year follow-up. Logistic regression analyses identified insidious onset (OR = 4.16) and baseline disorganized symptoms (OR = 2.96) as significantly associated with an increased risk of developing TR. Good premorbid academic adjustment (OR = 1.60) and acute onset (OR = 3.40) were associated with an increased chance of CR. We identified three long-term outcome groups by using recent consensus definitions. We also identified the potential importance of assessing baseline disorganized symptoms and monitoring patients with insidious onset more closely. Further, the findings suggest that clinicians should pay close attention to early-course parameters and provide adequate treatment to improve long-term outcomes of FEP.

A baseline monitoring of radiological sediment quality and associated risk assessment in coastal ecosystems of the Republic of Congo.

This study presents the first data on levels of natural radioactive elements in sediments from coastal ecosystems of the Republic of Congo. Sediment samples from five coastal sites were collected and analyzed by high-resolution gamma spectrometry for determination of activities of long-lived gamma-emitting radionuclides (234Th, 238U, 226Ra, 210Pb, 228Th, 228Ra, and 40K). The specific activities were of the same order of magnitude as those measured in sediments of most countries neighboring the Republic of Congo. However, variations in activities were observed from one site to another and also from one sampling point to another within the same site without exceeding the global average reference values. It can be assumed, therefore, that no significant anthropogenic impact is perceptible in the study area. The most commonly used radiological hazard parameters, based mainly on 238U, 232Th, and 40K activities, were assessed and the ERICA tool was applied to quantify the radiation exposure burden to human and biota resulting from radionuclides in sediments. Besides being useful for future monitoring efforts, the data produced in this work could be important for the worldwide database on radioactivity in the oceans and seas (MARIS) since no data are available in the Congolese marine environment.

Disentangling eukaryotic biodiversity patterns from man‐made environments (port and marina) and nearby coral reefs in the Red Sea: A focus on the surveillance of non‐indigenous species

AbstractMan‐made environments such as ports and marinas are gateways for many marine non‐indigenous species (mNIS) transported via shipping worldwide. These habitats are often the focus of biosecurity programs for the surveillance of mNIS, but there have been few studies investigating the distribution of biofouling communities in natural habitats and nearby artificial habitats. Here, following a DNA metabarcoding approach, we tested for differences in spatio‐temporal trends of biological pioneer communities established after one‐week colonization between a port, a marina, and coral reefs using two different matrices (PVC panels and water samples) in the central Red Sea. In addition, we aimed to investigate differences in the prevalence of mNIS between man‐made and natural habitats during the summer and winter seasons, and whether the number and patterns of mNIS differed between the port (an active historic port subjected to intense shipping traffic) and the marina (a small recently developed marina utilized by small and medium research vessels). The community structure from samples collected at the two coral reefs showed greater similarity to each other compared to that obtained from the port and the marina. A total of 29 mNIS were detected across all sites, of which 16 were reported in the Red Sea for the first time, with Jeddah port hosting 28 mNIS. By applying standardized methodological approaches, this study provides comparable data regarding the monitoring of introduced and invasive species, particularly within the data‐poor Red Sea, a major shipping corridor. This study serves as the foundation for implementing a robust and rapid baseline monitoring system to assess native biodiversity and facilitate the early detection of NIS.

Fluorine-18 fluorodeoxyglucose uptake change in liver, mediastinal blood pool, and lymphoid cell-rich organs during programmed cell death-1 immunotherapy in lymphoma.

The aim of this study was to evaluate metabolism change in reference organs (liver and mediastinum) and lymphoid cell-rich organs (spleen and bone marrow) during programmed cell death-1 immunotherapy in relapsed or refractory lymphoma patients. A total of 66 patients with baseline and serial monitoring fluorodeoxyglucose (FDG) PET/computed tomography scans were retrospectively enrolled. Mean standardized uptake value (SUV) and maximum SUV of evaluated organs were obtained by two reviewers, and their association with tumor burden and clinical response were evaluated. Immune-related adverse events detected by FDG PET/computed tomography were also recorded. The SUV values of reference organs and lymphoid cell-rich organs did not change significantly during the immunotherapy process. The intersubject variability of these values ranged from 13.0 to 28.5%. Meanwhile, metabolism of reference organs was affected by neither the tumor burden nor clinical response. SUV change of lymphoid cell-rich organs was associated with clinical response to immunotherapy. Responders showed decreased metabolism, while nonresponders showed a reverse trend (spleen SUV max : -0.30 ± 0.47 vs. 0.18 ± 0.39, P = 0.001, spleen SUV mean : -0.24 ± 0.39 vs. 0.14 ± 0.31, P = 0.001; and bone marrow SUV max : -0.14 ± 0.37 vs. 0.07 ± 0.46, P = 0.042, respectively). The influence of immune-related adverse events on the SUV change in evaluated organs was not significant. During programmed cell death-1 immunotherapy, metabolism change of reference organs is influenced neither by tumor burden nor by clinical response, while FDG uptake change of lymphoid cell-rich organs is significantly associated with clinical response.

Development of indicators to measure health system capacity for quality abortion care in 10 countries: a rapid assessment of a measurement framework and indicators

IntroductionA significant gap exists in the availability of indicators and tools to monitor health system capacity for quality abortion care at input and process levels. In this paper, we describe...

Design of a Temporally Augmented Text Messaging Bot to Improve Adolescents' Physical Activity and Engagement: Proof-of-Concept Study.

Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (eg, timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions. The study examined the feasibility and acceptability, as well as the technical and functional reliability, of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents' moderate to vigorous physical activity (MVPA) levels. Consistent with the Obesity-Related Behavioral Interventions Trials (ORBIT) model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials. Ten adolescents completed a 7-day baseline monitoring period and Temporally Augmented Goal Setting (TAGS), a 20-day digital physical activity intervention that included a midday self-monitoring message that occurred when adolescents typically start to exercise (3 PM). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement (average number of text message responses to the midday self-monitoring message) were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from preintervention to intervention. In addition, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention, Network Underwritten Dynamic Goals Engine (NUDGE), without the midday self-monitoring message, to explore differences in MVPA between interventions. The TAGS intervention was mostly feasible, acceptable, and technically and functionally reliable. Adolescents showed adequate levels of engagement. Preintervention to intervention changes in MVPA were small (approximately a 2-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared with NUDGE. TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical and functional reliability, participants' rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3 PM decision point. Further optimization of TAGS will inform the design of a Just-in-Time Adaptive Intervention for adolescent physical activity and prepare the intervention for more rigorous testing.

From science to practice: The AGSUS protocol for monitoring and certification of sustainable soil management and carbon sequestration

Sustainable soil management is indispensable for achieving the UN Sustainable Development goals and soil carbon sequestration for climate change mitigation has gained importance in recent years, yet there are few examples of projects carried out to this purpose, and protocols that facilitate this task. Here we present a monitoring system that relies on sampling soils in the field, as opposed to a modeling approach. The high spatial variability of SOC was addressed by requiring that the participating farms divide their land according to management zones, based on soil type, slope position and land use history, and the sampling density was established as one sampling point per one hundred hectares, while for environments smaller than 500 ha minimum of five points must be used. These points are georeferenced and will be revisited for annual monitoring of sustainable soil management, and every five years for soil sampling for SOC, texture, bulk density, pH, electric conductivity (if indicated), and available phosphorus determinations. The monitoring of sustainable soil management will be carried out through a visual evaluation of 12 soil quality parameters, as described in the handbook published by the AGSUS group. The data obtained from the visual evaluation and the soil analyses (bulk density, particle size fractions, C content, and pH) in the baseline monitoring of Argentinean and Brazilian farms during 2022 were analyzed for the relation between visual evaluation score and the means of these soil parameters. The organic matter indicator (OMI)was calculated by the formula OMI = OM/clay plus silt*100. The data base contained visual soil evaluation scores at 80 georeferenced sampling points, representing 12 farms located in different agroecological zones of the Argentinean Pampas, and 47 sampling points on two farms in Mato Grosso, Brazil. Our results showed a relationship between the VE (Visual Evaluation) score and SOC contents of the soils, especially when these were expressed in relation to their fine mineral particles as with the OMI for the soils of the Argentinean Pampa and the Brazilian Mato Grosso. The OMI showed differences between the three VE scores ranging from 4.7 to 6.7 and from 3.1 to 5.1 in the 0–0.1 m and 0.1–0.2 m depths, respectively. Relationships between the VE score and SOC, OMI, Sand, Silt and Clay plus Silt were only found for the 39 cases of VE “moderate” score in Pampas soils, whereas for the 39 cases of “good” scores no significant relations were encountered. These soils had high SOC and OMI, indicating that they are healthy soils, near saturation level, with low C sequestration potential.

Nationwide Screening Practices for Tamoxifen Retinal Toxicity in South Korea: A Population-Based Cohort Study.

(1) Background/Objectives: To investigate the nationwide screening practices and trends in tamoxifen retinal toxicity (tamoxifen retinopathy) in South Korea using national health insurance claims data. (2) Methods: A total of 43,848 patients who started tamoxifen therapy between 2015 and 2020 and had no prior ophthalmic diseases or other conditions requiring screening for retinopathy were included. The annual numbers of tamoxifen users and new initiators of tamoxifen therapy were assessed. The screening examinations were separated into baseline (first ophthalmic examination after tamoxifen administration) and subsequent monitoring examinations. The timing and modalities for the baseline and subsequent monitoring examinations performed between 2015 and 2021 were assessed in tamoxifen users. (3) Results: The annual number of tamoxifen users increased over the study period from 54,056 in 2015 to 81,720 in 2021. The number of patients who underwent ophthalmic examination after tamoxifen administration was 8961 (20.4%). Baseline screening was performed in 6.5% of patients within 1 year of use, and subsequent monitoring was performed in 27.8% of patients who underwent baseline screening. Funduscopy or fundus photography was performed most commonly for baseline screening and subsequent monitoring (99.0% and 98.6%, respectively), while optical coherence tomography was performed only in 21.9% and 29.6% of baseline and monitoring examinations, respectively. The average number of monitoring examinations per year was 0.68 ± 0.45. Although the annual percentage of patients receiving a baseline examination within 1 year gradually increased over time, the percentage of those with subsequent monitoring performed within 1 year was similar over the study period. (4) Conclusions: Our finding, appropriate screening in a small proportion of patients receiving tamoxifen, suggests the need to promote awareness among healthcare professionals and develop a standardized approach for screening for tamoxifen retinopathy.

Are we asking the right questions to people with Achilles tendinopathy? The best questions to distinguish mild versus severe disability to improve your clinical management

ObjectiveDetermine the capacity of individual items on the Tendinopathy Severity Assessment – Achilles (TENDINS-A), Foot and Ankle Outcome Score (FAOS), and Victorian Institute of Sports Assessment – Achilles (VISA-A) to differentiate patients with mild and severe tendon-related disability in order to provide clinicians the best questions when they are consulting patients with Achilles tendinopathy. DesignCross-sectional. ParticipantsSeventy participants with Achilles tendinopathy (61.4% mid-portion only, 31.4% insertional only, 7.2% both). Outcome measuresThe discrimination index was determined for each TENDINS-A, FAOS, and VISA-A item to determine if items could discriminate between mild and severe disability. A Guttman analysis for polytomous items was conducted. ResultsAll 62 tems from the TENDINS-A, FAOS, and VISA-A were ranked with the best items relating to pain with physical tendon loading, time for pain to settle following aggravating activities and time for the tendon to ‘warm-up’ following inactivity. ConclusionsPain with loading the Achilles tendon, time for pain to settle following aggravating activity, as well as time taken for the tendon symptoms to subside after prolonged sitting or sleeping are the best questions indicative of the severity of disability in patients with Achilles tendinopathy. These questions can assist clinicians with assessing baseline severity and monitoring treatment response.

Small-scale egg and orange-fleshed sweet potato production and utilisation in selected communities in Ghana: A mixed-methods study

BackgroundNutrition-related exposures during the first 1,000 days of life are a predictor of health outcomes later in life. World Vision Ghana’s ‘Improved Feeding practices for the 1,000 days’ (IFP) project aimed to improve dietary practices of women and children utilising an integrated intervention approach including nutrition, health, and agriculture strategies.ObjectiveThis paper reports on the production and utilisation of orange-fleshed sweet potatoes (OFSP) and eggs for improving diets of women in reproductive age and young children during the first 1,000 days of life.MethodsPrimary data from Kassena-Nankana West (KNW), Sekyere East (SE) and Kintampo South (KS) districts were triangulated with project routine data for this analysis. Univariate analyses of quantitative data from baseline and implementation monitoring data were conducted to describe the sociodemographic characteristics of beneficiaries, inputs disbursed, outputs produced, and utilisation of the food commodities. Qualitative interviews from 61 participants were transcribed, coded, and thematically analysed; these were triangulated with the quantitative data to capture main themes and findings.ResultsOFSP and egg production and consumption increased annually across beneficiary communities. In 2021, 100% of OFSP produced was consumed in KS; in SE, 95.0% was consumed and 5.0% lost to post-harvest losses. In 2022, 90% OFSP produced in KNW was consumed and 9.0% sold. In KS, 90.3% was consumed and 9.0% sold. In SE, 82.3% was consumed and 17.1% sold. Egg production at the end of the first production year (2022) was 18,720 crates in KNW, 19,680 crates in KS and 40,128 crates in SE. Egg consumption in sample households was less than 10% in 2022 and showed a decreased trend in the first half of 2023. In SE and KS, egg and OFSP production, respectively, increased, exponentially; sale for income was the most common mode of utilisation in eggs but OFSP was consumed in these districts. In KNW, climate, irrigation and socio-cultural barriers hindered the maximal production and utility of the produce, which was not observed in SE and KS, which did not have any of these identified barriers. Reported unintended benefits of production and utilisation included increased household income, food security, and availability of organic manure as a side-product of poultry.ConclusionsThe IFP project resulted in increased household level production, use and distribution of Eggs and OFSP across the three focal districts. Similar settings may benefit from this intervention by adapting the strategies to become easier for beneficiaries to better cope with likely potential barriers such as poultry mortality and water scarcity.

Adolescent Wilderness Therapy: The Relationship of Client Outcomes to Reasons for Referral, Motivation for Change, and Clinical Measures

Outdoor behavioral healthcare is a specific model and industry utilizing wilderness therapy (WT), a residential treatment approach comprised of outdoor travel and living for youth experiencing mental health, substance use, and behavioral concerns. We present data from 6417 participants about reasons for referral, admission, and discharge scores from the Youth-Outcome Questionnaire (Y-OQ), youth interest and commitment to treatment, reliable change scores, and the relationship between these variables. One-third of youth entered WT with sub-clinical scores, varying levels of client motivation and voluntariness in relation to clinical outcomes, a diverse range of presenting problems without clear indication of specialized treatment planning, and differing responses to treatment by referral reason. Identifying those not responding to WT and those at risk of deterioration from the time of admission requires further investigation to improve client outcomes for this treatment modality. Recommendations include placing increased importance on accurate and thorough screening and assessment, utilizing baseline and routine outcome monitoring, reducing coercion, and considering specialized intervention.