Six-month Trial Research Articles

Assessing the Impact of Wheat Flour and Baker's Yeast Restricted Diet vs. Calorie Restriction in NAFLD Patients

IntroductionNon-alcoholic fatty liver disease (NAFLD) is a prevalent and nonalcoholic progressive liver disorder associated with metabolic disturbance. This study aimed to compare the efficacy of wheat flour or baker's yeast-restricted diet with traditional calorie restriction in NAFLD patients.Material and methodsAnalyzed data was obtained from 243 individuals with NAFLD who completed the study. Of these patients, 54 belonged to Group (1) (Standard Diet, SD); 104 belonged to Group (2) (Wheat Flour-Free Diet, WFFD); and 85 belonged to Group (3) (Yeast-Free Diet, YFD). The intervention period lasted 6 months, during which participants' dietary compliance was closely monitored.ResultsAt the end of the six-month trial, both the WFFD and HFD groups exhibited a noteworthy reduction in body mass index (BMI) and triglyceride (TG) levels when compared to a standard diet that only involved calorie restriction. Furthermore, a notable reduction in the severity of liver steatosis was seen in these groups (p<0.05). The SD group did not exhibit any significant changes in these metrics. The WFFD group experienced a notable reduction in HSI values (p<0.05). Cluster analysis revealed that the obese group had higher HSI, weight, and BMI values throughout the study period, indicating a more advanced stage of NAFLD.ConclusionsTo summarize, this study highlights the significance of food constituents and dietary strategies in the treatment of NAFLD. It suggests that limiting the intake of wheat flour and baker's yeast specifically could have positive effects on liver well-being.

Predictive Blood Biomarkers of Targeted Intervention for Chronic Mental Health Symptoms following Traumatic Brain Injury.

The purpose of this study was to assess the performance of predictive blood biomarkers for responsiveness to targeted treatments for chronic psychological issues years after traumatic brain injury (TBI). Targeted Evaluation Action and Monitoring of TBI was a prospective 6-month interventional trial of participants with chronic TBI sequelae (n = 95). Plasma biomarkers were analyzed pre-intervention: glial fibrillary acidic protein (GFAP), tau, hyperphosphorylated tau Thr231 (p-Tau), von Willebrand factor (vWF), brain lipid-binding protein (BLBP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), vascular endothelial growth factor-a (VEGFa), and claudin-5 (CLDN5). Clinical outcomes included the Post-Traumatic Stress Disorder (PTSD)Checklist for DSM-5 (PCL-5) and Brief Symptom Inventory-18 (BSI-18). Regression models were built for change in PCL5/BSI-18. Biomarkers and covariates were included. Two models were built to identify responders (improved beyond the minimum clinically important difference). The model to predict change in PCL5 (R2=0.64; p < 0.001) included vWF (p = 0.032), BLBP (p = 0.001), tau (p = 0.002), VEGFa (p = 0.015), female sex (p = 0.06), and military status (p = 0.014). The model to predict change in BSI-18 (R2=0.42; p = 0.003) included vWF (p = 0.042), VEGFa (p = 0.09), BLBP (p = 0.01), CLDN5 (p < 0.001), female sex (p = 0.012), and military status (p = 0.004) as predictors. The model to differentiate participants who improved for PCL5 (R2=0.68; p < 0.001; AUC = 0.93) included vWF (p = 0.02), VEGFa (p = 0.008), and BLBP (p = 0.006). The model to differentiate participants who improved for BSI-18 (R2=0.25; p = 0.04; AUC = 0.75) included UCH-L1 (p = 0.03), GFAP (p = 0.06), and vWF (p = 0.03). Combinations of pre-intervention blood biomarkers were able to differentiate responders from nonresponders in both post-traumatic stress and overall psychological health domains.

Exploring Inclusion, Diversity, Equity, and Accessibility in the Built Environment: A Case Study

Continuous changes in society and the need for sustainable development demand updates in designing better built environments to respond to the variety of user needs. Notwithstanding the growing interest of research and the introduction of guidelines and standards on inclusion, diversity, equity, and accessibility, there are still several limitations in effectively and efficiently embedding such principles for the design of buildings and neighborhoods. Previous research demonstrated the critical need for innovative tools and methods to support professionals in designing responsive, inclusive spaces for an extended range of users. This article reports the results of a pilot study using the new IDEA Audit Tool for assessing how inclusion, diversity, equity, and accessibility are perceived by building occupants in a specific facility. The analysis of significant data provided by this study shows the challenges and highlights the benefits of the tool, including fostering an evidence-based decision-making process, speeding up the prioritization of critical design improvements, demonstrated through a six-month trial with a London-based inclusive design firm. The research-driven outcomes showcase the huge potential that the tool offers to improve the company strategy while evolving towards more inclusive, accessible spaces that foster diversity and equity, and has the potential to be replicated in several fields of action to raise awareness and improve the application of IDEA principles in all phases of the design process.

Scalable development of photocatalysis-mediated aquatic habitat restoration devices based on TiO2/graphene/BiVO4 and the application in black-odorous river treatment

A novel concept of photocatalysis-mediated aquatic habitat restoration materials (PMAHRM) has been introduced in this study. The primary objective of development lies in enhancing the aquatic habitat, indirectly fostering favorable living conditions for aquatic organisms and fostering their growth. TiO2/Graphene/BiVO4 (TGB), serving as a PMAHRM, was constructed through a hydrothermal process. The absorption wavelength extends to 504 nm. Furthermore, a PMAHRM device with a dual-function area structure based on TGB and in-situ microorganisms immobilized separately has been designed. Both sections were seamlessly integrated through the use of conductive fibers. The device demonstrates a RhB removal rate of 85.70 % under visible light. During the nearly six-month field trial for the restoration of a black-odorous river, the scalable developed TGB devices, in conjunction with Myriophyllum verticillatum, were employed to achieve comprehensive restoration outcomes. The results showed significant decreases in NH3-N, TP, and COD concentrations by 85.96 %, 77.78 % and 73.53 %. The transparent index rising 3.3 times. TN, TP, and OM concentrations of sediment decreased by 10.64 %, 9.60 % and 34.08 % respectively. The enhancement of habitat quality led to various positive biological responses. The Shannon-Wiener biodiversity index increased for plankton and zoobenthos. Furthermore, the density of Cyanophyta decreased by 57.33 %, and the emergence of a substantial population of Chlorophyta and Bacillariophyta contributed to a balance algal facies. Additionally, the average density of zooplankton increased fivefold, while the density of zoobenthos decreased slightly. PMAHRM devices, utilizing newly developed TGB materials, played a pivotal role in aquatic habitat restoration, thereby fostering the sustainable development of aquatic ecosystems.

Hybrid working from home improves retention without damaging performance

Working from home has become standard for employees with a university degree. The most common scheme, which has been adopted by around 100 million employees in Europe and North America, is a hybrid schedule, in which individuals spend a mix of days at home and at work each week1,2. However, the effects of hybrid working on employees and firms have been debated, and some executives argue that it damages productivity, innovation and career development3–5. Here we ran a six-month randomized control trial investigating the effects of hybrid working from home on 1,612 employees in a Chinese technology company in 2021–2022. We found that hybrid working improved job satisfaction and reduced quit rates by one-third. The reduction in quit rates was significant for non-managers, female employees and those with long commutes. Null equivalence tests showed that hybrid working did not affect performance grades over the next two years of reviews. We found no evidence for a difference in promotions over the next two years overall, or for any major employee subgroup. Finally, null equivalence tests showed that hybrid working had no effect on the lines of code written by computer-engineer employees. We also found that the 395 managers in the experiment revised their surveyed views about the effect of hybrid working on productivity, from a perceived negative effect (−2.6% on average) before the experiment to a perceived positive one (+1.0%) after the experiment. These results indicate that a hybrid schedule with two days a week working from home does not damage performance.

Utilization of Moringa oleifera leaf meal as a protein source in diets for Cirrhinus mrigala: effects on growth, body composition, and hematology

IntroductionIn the current study, Cirrhinus mrigala was used as an animal model to investigate the impacts of Moringa oleifera leaf meal (MOLM) on their overall performance reared in six earthen ponds.MethodsIn this study, fishmeal (FM) was substituted with MOLM at various levels in the diet: 0% (control), 10, 15, 20, 25, and 30%, for a six-month feeding trial. A total of 270 fish with 15 fingerlings (15.31 ± 0.12 g/fish) stocked in each of the six earthen ponds in triplicates.ResultsWhen compared to other experimental and control groups, analyses revealed that fish given a diet having 10% MOLM had the highest growth performance (final weight: 422.32 g, weight gain: 406.97 g). Fingerlings fed a diet which substituted with 10% of FM with MOLM showed the greatest results for body composition (crude protein: 19.31%; crude fat: 3.01%). The results of hematology, i.e., WBCs: 7.65 × 103 mm−3, PLT: 58.38, hemoglobin level: 8.52 g 100 mL−1, PCV: 25.12%, MCHC: 30.45%, MCH: 48.81 pg., MCV: 159.50 fl, also showed that 10% MOLM was the optimum level for FM substitution. Furthermore, the outcomes of body mineralization (P, Ca, Na, Mn, Fe, Mg, Zn, K, and Cu, 1.06, 0.92%, 5.53 mg/g, 9.90 ug/g, 54.62 ug/g, 3.09%, 3.81 ug/g, 8.31%, and 3.76 ug/g respectively) also indicated that 10% level was the best.ConclusionConclusively, the current study found that substituting 10% of FM with MOLM in the diet of C. mrigala fingerlings improved growth performance, carcass, hematology, and mineral status.

National Food Authority (NFA): Stocks Monitoring and Management System

Objectives: This study aims to develop and evaluate the National Food Authority (NFA) Stocks Monitoring and Management System, focusing on enhancing stock management efficiency and reducing food waste.  Method: A comprehensive analysis of the existing NFA stock management practices was conducted. Subsequently, a sophisticated software system was developed to streamline stock monitoring, forecasting, and distribution. This system was compared quantitatively with traditional manual methods over a six-month trial period.  Findings: The NFA Stocks Monitoring and Management System resulted in a significant reduction in food wastage, with a 40% decrease in expired stock and a 25% increase in on-time deliveries to beneficiaries compared to manual methods. Additionally, stock forecasting accuracy improved by 30%, leading to optimized resource utilization.  Novelty: This study presents an innovative approach to stock management within a governmental food authority, integrating advanced software solutions. The quantitative results highlight the system's effectiveness in minimizing food wastage and enhancing distribution efficiency, offering a novel contribution to food security initiatives.  Conclusion: The NFA Stocks Monitoring and Management System represents a significant advancement in stock management practices, offering tangible benefits in terms of reduced food wastage and improved distribution efficiency. The quantitative data from our study demonstrates its superiority over manual methods, reinforcing its potential for widespread adoption within governmental food authorities, thereby contributing to enhanced food security and resource utilization.

Episodic memory improvement in illiterate adults attending late-life education irrespective of low socioeconomic status: insights from the PROAME study.

This manuscript aims to explore the relationship between SES and learning, as well as cognitive outcomes, in an older illiterate population. This six-month clinical trial (NCT04473235) involved 108 participants, of which 77 concluded all assessments, enrolled in late-life basic education. SES assessments included Quality of Urban Living Index, Municipal Human Development Index and Household SES calculated for each participant. Cognitive assessments encompassed the Free and Cued Selective Reminding Test (FCSRT), a word list to assess reading, and the Beta III matrix. The sample consisted primarily of women, with a mean age of 58.5. Participants improved their reading (p=0.01) and their FCSRT (p=0.003). Regarding episodic memory, women outperformed men (p=0.007) and younger participants improved more than their older counterparts (p=0.001). There was no association observed between SES and cognitive outcomes. Irrespective of SES, participants demonstrated positive outcomes after attending basic education. These findings highlight that late life education could be an important non-pharmacologic preventative measure, especially in LMICs.

Raw Fish-based Moist Pellet and Extruded Pellet on Growth, Levels and Expression of GH/IGF Axis, Intestinal Enzyme Activity and Gastrointestinal Morphology of Olive Flounder (Paralichthys olivaceus): An Actual Field Study

A six-month feeding trial was conducted to investigate the effect of moist pellet (MP) and commercial extruded pellet (EP) on the somatic growth, level and expression of GH/IGF axis, intestinal enzyme activity and gastrointestinal morphology of olive flounder (Paralichthys olivaceus) reared under actual farm conditions. MP was a raw fish-based diet composed of mackerel and cutlass fish while EP diet was a locally-produced commercial feed. Weight growth rate showed no significant difference (P&gt;0.05), although EP-fed fish had a better somatic yield. Feed conversion ratio was better and condition factor has significantly improved when given EP diet (P&lt;0.05). Plasma level of growth hormone and insulin-like growth factor 1 was comparably similar between diets, but EP-fed olive flounder had a higher hepatic IGF-1 expression (P&lt;0.05). The activity of trypsin, chymotrypsin and lipase were insignificantly influenced by diets (P&gt;0.05). The overall gastrointestinal morphology was in similitude regardless of diets, but EP- fed fish had a longer intestinal villi length and goblet cell count in the pyloric caeca (P&lt;0.05). These dietary induced differences are discussed to have partly promoted better growth in EP diet. The findings suggest an equivalent, or better utilization of EP diet in the actual farm operation.

SAT395 Gender Dysphoria In A Patient With Ovotesticular Disorder Of Sex Development

Abstract Disclosure: T. Moreno: None. P. Rodrigues: None. S. Ribeiro: None. D.M. Carvalho: None. Introduction: Ovotesticular disorder of sex development (OT-DSD) is a rare condition characterized by the presence of both ovarian and testicular tissue in the gonads. Management and sex designation of these patients depend on several factors and an underlying potential for gender dysphoria should be acknowledged.Clinical Case: A 12-month-old patient from Guinea-Bissau, born from consanguineous parents, was referred to Pediatric Surgery due to atypical genitalia. Karyotype was 46,XX and SRY gene analysis was negative. Genitoscopy showed absence of a vagina and a uterus was not found on magnetic resonance imaging. An exploratory laparotomy and biopsy of the gonads was performed. The pathology report confirmed the presence of gonadal ovarian and testicular tissue, establishing the diagnosis of OT-DSD. Surgical removal of both gonads and clitoroplasty was performed and a female sex designation was attributed. Endocrinology follow-up was started at the age of 8 and the first physical examination revealed weight 48.6 kg (&amp;gt; P97), height 135.5 cm (P90–97); Tanner stage I (P1A1M0) and a blind vagina with normal clitoris size. Blood tests showed FSH 12.53 mUI/L, LH 1.07 mUI/L, estradiol 5.8 pg/mL and total testosterone 0.04 ng/mL. Reconstructive surgery for a neovagina was performed at 13-years-old and, two years later, the patient was started on hormone replacement therapy with transdermic estradiol. At the age of 16, the patient manifested gender dysphoria issues, decided to stop estradiol and was referred for psychiatric evaluation. Two years later, intramuscular testosterone enanthate was initiated but treatment was stopped after a six-month trial, as the patient claims to identify as male but is not interested in seeking hormone treatment at this point.Conclusion: OT-DSD is an uncommon condition, raising issues of gender assignment that are dependent on factors such as age at diagnosis, phenotype, internal structures and reproductive potential. Scarce data exists on long-term outcomes in OT-DSD, including the frequency of gender dysphoria in these patients. Gender identity is an important factor to consider on long-term follow-up of OT-DSD patients. Presentation: Saturday, June 17, 2023

THU569 Steroid Receptor Coactivator 3 Is Required To Prevent Early Pregnancy Loss In The Mouse

Abstract Disclosure: V. Maurya: None. L. Hai: None. M.M. Szwarc: None. W. San-Pin: None. F.J. DeMayo: None. J.P. Lydon: None. Members of the Steroid Receptor Coactivator (SRC) family enact distinct transcriptional coregulator functions within a broad spectrum of physiologies and pathologies. We previously demonstrated that endometrial SRC-3 is critical for in vitro human endometrial stromal cell decidualization, a critical cellular process in the establishment of the maternofetal interface. To address SRC-3’s in vivo role in endometrial periimplantation biology, we recently generated a SRC-3 conditional knockout mouse model (SRC-3d/d) in which SRC-3 is selectively ablated in cells that express the progesterone receptor. A six-month breeding trial with wild type proven stud males demonstrated that the SRC-3d/d female fails to produce litters (n&amp;gt;10 per genotype). Unlike the SRC-2d/d female, however, both embryo attachment and implantation into the stromal compartment of the SRC-3d/d endometrium are not impaired at gestation day (GD) 5 or 6. While endometrial stromal decidualization initiates with embryo invasion, pregnant SRC-3d/d mice exhibit early pregnancy loss (EPL) by GD-7.5 (before placentation). At GD-6, the SRC-3d/d decidua is significantly smaller than those of sibling controls. Histological analyses reveal extensive decidual cell death in the SRC-3d/d decidua by GD-7, which results in the sudden demise of the embryo. These histological findings are supported by recent genome-wide RNA profiling studies that show a pro-survival role for SRC-3 in this tissue. Based on these results, we conclude that endometrial SRC-3 is critical for maintaining the functionality and survival of the decidual stromal cell and embryo developmental progression to placentation. Therefore, endometrial SRC-3 (and its downstream signaling networks) are predicted to represent new molecular determinants of non-aneuploid EPL, a poorly understood pregnancy complication for which diagnostic and treatment options are limited. Presentation Date: Thursday, June 15, 2023

Predicting Parkinson's Disease Severity using Telemonitoring Data and Machine Learning Models: A Principal Component Analysis-based Approach for Remote Healthcare Services during COVID-19 Pandemic

Parkinson's disease (PD) is a progressive and chronic neurological condition that affects about 1% of the world's over-60 population. The COVID-19 pandemic has emphasized the significance of remote healthcare services, such as telemedicine, in managing chronic diseases such as PD. This research intends to construct machine learning (ML) models to predict PD severity utilizing vocal data derived from the UCI database for motor and total Unified Parkinson's disease rating scale (UPDRS) ratings. ML was used to study the association between voice vibration and PD, and PCA and ML models were utilized to minimize model complexity and compare the predictive performance of various statistical models for PD regression. The dataset included 5,875 medical voice records from 42 patients with early-stage PD who participated in a six-month clinical trial. The proposed PCA model simplified the model and achieved a root-mean-square error of 1.78 with an R-squared value of 0.95 for predicting the motor UPDRS and 1.78 with an R-squared value of 0.97 for predicting the total UPDRS. This work can give a framework for developing remote healthcare services for Parkinson's disease and other chronic conditions, which can be helpful during pandemics and other situations where access to in-person care is limited.

Increasing the efficiency of delivery operations and customer profitability analysis with a time-driven activity-based costing model

Learning outcomes Upon completion of the case study discussion, successful students will be able to define and list the steps of time-driven activity-based costing system (TDABC); understand and explain the ideas behind the TDABC; implement the TDABC in customer profitability analysis; draw connections among the cost and profitability analysis; evaluate the importance of better costing techniques in profitability analysis; and make managerial decisions based on TDABC analysis. Case overview/synopsis Gluten Limited’s financial affairs and operations manager, Fatih, was aware that the company was making very little profit from its operations with its biggest customer. The main reason appeared to be that it delivered its products in bulk to the main warehouses of the customer, which then distributed them to the stores. Fatih believed that products were being sent to stores late, so that their expiration dates passed quickly and they ended up being returned. The case study documents the past year of Gluten Limited’s delivery operations with one of its biggest customers. It focuses on the effectiveness of its delivery operations and ways to increase profitability by reducing sales returns. The case dilemma involves the choices that Fatih faced following a six-month trial period: either delivering products in bulk to the customer’s main warehouses at lower cost but higher return rates or delivering small amounts directly to stores at higher cost but lower return rates. Fatih needed to decide which mode of customer operations was more profitable and continue that way. Knowing the importance of determining costs properly in profitability analysis, Fatih made the cost calculations using the TDABC system. Complexity academic level This case was written for use in Cost Accounting and Managerial Accounting classes at the undergraduate level. The focus of the case aligns well with discussions of customer profitability analysis, cost reductions, eliminating non-value-added activities, and profitability of operations. Instructors seeking to emphasize the most suitable costing methods for customer profitability analysis could assign this case. Supplementary material Teaching notes are available for educators only. Subject code CSS 7: Management Science

Short-Term Growth Response of Young Pine (Pinus silvestris) Seedlings to the Different Types of Soil Media Mixture with Phosphogypsum Formulations under Poland Forest Environmental Conditions

The production of phosphoric acid produces “waste heaps” that have not yet been tapped, but which have the character of weak fertilizers and can perhaps be reintroduced into the elemental cycle in the forests. Two variants of mixing with organic ash and with sewage sludge were carried out. One-year-old pine seedlings (Pinus sylvestris L.) from the Trzebieź forest district (northern Poland) were planted in pots with soil that also came from the same field. Preparations containing phosphogypsum were applied topically to the soil in four doses (1, 2, 3 and 5 t/ha). The trial, which lasted one growing season, was conducted in four replicates. At the end of the trial, the height of the above-ground parts and root length, needle and root area, root neck diameter and photosynthetic performance were measured. The phosphogypsum-based preparations used showed no harmful (toxic) effects on the potted pine seedlings during the six-month trial period. The loosely prepared preparation made from a mixture of phosphogypsum and organic ash began to have a positive effect on the development of the seedlings’ root system, and it was also easier to mix with the soil surface than phosphogypsum with sewage sludge, which also contained a sticky form. The photosynthetic performance of one-year-old pine seedlings decreased after one growing season following the application of phosphogypsum preparations and most of the growth parameters tested did not differ from the control, so observations over a longer period (at least two to three growing seasons) are required. However, dosages of 1 and 2 t/ha seem to be the most promising, and these lower dosages are more economical to manage in nurseries or plantations, especially on poor sites. Formulations should be tested for heavy metals and their effects on seedling development. Testing should also be continued to monitor changes in the microbiome.

An integrated monitoring system for disaster-causing organisms in the water intake areas of coastal nuclear power plants

Nowadays, nuclear power plays an important role in the energy structure of many countries. However, A bloom of a disaster-causing organism (DCO) in the cold-water intake area of a coastal nuclear power plant can block the water cooling system and seriously affect the operational safety of the nuclear power unit. Currently, the traditional method of protection is to estimate the DCO abundance by regular manual investigation and sampling, but that method cannot give continuous real-time data. Instead, proposed and implemented here is a seafloor in situ integrated monitoring system for DCOs (known as IMSDCO), which is equipped with an optical microscopic imager (OMI) and hydrometric sensors to monitor automatically the DCO abundance and hydrology. All the data are transmitted to a terminal in the shore station through a photoelectric composite cable for real-time display. When the DCO abundance reaches a preset threshold, software automatically raises an alarm. Since placing IMSDCO at the cold-water intake of the Changjiang nuclear power plant, a six-month field trial has been completed, during which large amounts of hydrology data and DCO images were obtained. IMSDCO successfully identified and estimated the abundances of various DCOs (e.g., Phaeocystis globosa, Acetes chinensis, and small fish) and predicted their movements based on hydrology data. Based on the analysis of the experimental data, we discussed the reasons for the error in the abundance estimation of DCO and the methods to reduce the error. The experimental results show that the OMI-based IMSDCO can monitor and give early warning of DCOs in the water intake areas of costal nuclear power plants and is worthy of long-term deployment.

Hemodynamically stable very low birth neonates weight gain is affected by the early initiation of full enteral feedings compared to standard feeding.

Premature babies need to develop similarly to fetuses of the same gestational age. The majority of premature neonates experience a growth-restricted status while in the patent ductus arteriosus (PDA). Extrauterine growth failure is a significant barrier for infants with very low birth weight (VLBW). The study was conducted for six months at the Neonatology Unit, Department of Pediatrics, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India. Neonates with VLBW who met the inclusion criteria were assigned randomly to one of two feeding strategies, that is, full enteral feeding or partial feeding, based on the randomization sequence discovered by opening the sealed cover. The duration of stay, weight variation, neonatal variables, feeding intolerance, necrotizing enterocolitis (NEC), septicemia, apnea, newborn hyperbilirubinemia, PDA, hypoglycemia, intracranial bleeding, and mortality of neonatal recruits were all carefully evaluated. Two thousand two hundred eighty-four neonates were hospitalized throughout the six-month trial period, and 408 had low birth weight. Three hundred forty-two babies were eliminated from the study due to hemodynamic instability, persistent respiratory distress, infections, metabolic issues, and congenital abnormalities. Sixty-six babies met the study's inclusion criteria, and thus participated in the study. Sixty-six newborns weighed between 1.251 and 1.500 kg. Randomly assigning intervention and control groups. Thirty-three newborns were assigned to group A (intervention) and another 33 to group B (control). The study concluded that enteral feeding was effective, inexpensive, secure, and feasible. Early full enteral feeding reduced septicemia and infant hyperbilirubinemia. Thus, we must start enteral feeding as soon as possible to avoid inadequate nutrition in neonates with VLBW during a crucial growth period.

Does Cranberry Supplementation Decrease Noninvasive Fibrosis Scores in NAFLD Patients? A Randomized Clinical Trial

Background: Due to the lack of effective treatment for non-alcoholic fatty liver disease (NAFLD), we assumed that cranberry supplementation may be effective in these patients. Therefore, we investigated the effect of cranberry supplementation on fibrosis levels in patients with NAFLD. Methods: This trial was designed as a randomized controlled clinical trial. It included 110 adult patients (aged&gt;18 years) with NAFLD. All patients were visited by an expert dietitian and received the hypocaloric diet plus vitamin E supplement. Then, the patients entered into a six-month trial to receive cranberry capsules (55 patients) or placebo (55 patients). We calculated the NAFLD fibrosis score (NFS), fibrosis scores based on 4 factors (FIB-4), and aspartate aminotransferase (AST) to platelet ratio index (APRI). The intention-to-treat (ITT) approach was used to analyze the data. Results: The participants’ mean age was 43.16±10.23 years. The demographic and baseline clinical features were similar in the two groups. In the cranberry group, there were significant changes in APRI (P=0.03), and NFS (P&lt;0.001) scores. In the placebo groups, there were significant changes in APRI (P=0.005), FIB-4 (P=0.03), and NFS (P&lt;0.001) scores. However, no between-group significant differences were observed in the changes in FIB-4 (P=0.64), APRI (P=0.78), and NFS score (P=0.38). Conclusion: Based on the results, cranberry supplementation was not more effective than placebo in liver fibrosis grade.

Outpatient Letters in Real Time for Better Patient Outcomes

The Sunshine Coast Hospital and Health Service commenced a six-month proof-of-concept to trial speech recognition and self-type software in 2020. This action was taken in response to an ageing medical transcription workforce; an increase in outpatient letters due to population growth and the novel coronavirus pandemic; and more timely transfer of care communication to GPs. The proof-of-concept presented the health service with a unique opportunity as no other public hospital in Queensland had leveraged speech recognition or self-type software for the production and distribution of outpatient letters. The proof-of-concept trial provided 18 clinicians with the choice to type or dictate outpatient letters, electronically sign, and distribute to referring general practitioners (GPs) in one transaction. The results of the proof-of-concept demonstrated a 39% uptake of speech recognition and self-type software, demonstrating an opportunity to supplement the medical transcription workforce to address the rising outpatient activity. The proof-of-concept also demonstrated an average reduction in transaction time of 25% from the baseline measure over the six-month trial period. This finding supports the timely transfer of communication to GPs. However, it will need to be carefully analysed against the participant frustrations of voice to text accuracy to minimise the risk of poor adoption.

Protocol for a Pilot Randomized Controlled Mixed Methods Feasibility Trial of a Culturally Adapted Peer Support and Self-Management Intervention for African Americans

Due to diabetes disparities commonly seen among African Americans, it is important to address psychosocial and sociocultural barriers to medication adherence among African Americans with diabetes. Building on our prior work testing a culturally adapted peer supported diabetes self-management intervention for African Americans, this study will conduct a pilot randomized controlled feasibility trial that compares the culturally adapted intervention with a standard diabetes self-management program. Using an intervention mixed-methods design, the six-month trial will be conducted at two sites. Twenty-four African Americans with uncontrolled type 2 diabetes will be randomized to the intervention or control arm. Feasibility and acceptability outcomes in four domains (recruitment, intervention acceptability, intervention adherence, retention) will be collected. Primary clinical outcome (A1C), secondary outcome (medication adherence) and patient-specific psychosocial measures will be collected at baseline, 2 months, and 6 months. Document review, interview and focus groups will be used to gather qualitative data on feasibility and acceptability. Expected results are that the trial protocol will be feasible to implement and acceptable for participants, and there will be a signal of clinically meaningful reduction in A1C and improvements in medication adherence. The results of this trial will inform a future powered large-scale randomized controlled trial testing the effectiveness of the culturally tailored intervention.

Effect of personalized dietary advice to increase protein intake on food consumption and the environmental impact of the diet in community-dwelling older adults: results from the PROMISS trial

PurposeDiet modelling studies suggest that increasing protein intake with no consideration for sustainability results in a higher environmental impact on the diet. To better understand the impact in real life, the aim of this study was to assess the effect of dietary advice to increase protein intake on food consumption and the environmental impact of the diet in community-dwelling older adults.MethodsFood consumption and environmental impact were analyzed among 124 Dutch older adults with lower habitual protein intake (< 1.0 g/kg adjusted body weight/day) participating in the six-month PROMISS trial. Dietary intake data from three 24-h dietary recalls, aided by food diaries, and results from life cycle assessments were used to examine the differences in changes in food consumption and environmental impact between those who received dietary advice to isocalorically increase protein intake to ≥ 1.2 g/kg aBW/d (Protein + ; n = 84) and those who did not receive dietary advice (Control; n = 40).ResultsCompared to the Control, Protein + increased protein intake from animal-based food products (11.0 g protein/d, 95% CI 6.6–15.4, p < 0.001), plant-based food products (2.1 g protein/d, 95% CI 0.2–4.0, p = 0.031) and protein-enriched food products provided during the trial (18 g protein/d, 95% CI 14.5–21.6, p < 0.001) at the 6-month follow-up. Diet-associated greenhouse gas emissions increased by 16% (p < 0.001), land use by 19% (p < 0.001), terrestrial acidification by 20% (p = 0.01), and marine eutrophication by 16% (p = 0.035) in Protein + compared to the Control.ConclusionThis study found that dietary advice increased protein intake, favoring animal-based protein, and increased the environmental impact of the diet in older adults.Trial registrationClinicalTrials.gov. NCT03712306. October 2018.