Evidence for Interventions to Prevent and Control Obesity Among Children and Adolescents: Its Applicability to India

Childhood obesity is on the rise worldwide and its increasing prevalence in low and middle income countries is well-known. Obesity interventions have the potential to prevent adverse health outcomes; however, large gaps in research and knowledge about the efficacy and sustainability of such interventions remain. The objectives of this article were to review the evidence for interventions to prevent and control obesity among children and adolescents, evaluate their applicability in India, and discuss the challenges to sustain such interventions. The authors reviewed published research focusing on childhood obesity interventions, especially in India and other lower-resource countries. Nine observational and 10 interventional studies were reviewed. Most studies identified were from developed countries and took place at day-care settings, schools, and after school programs. Nineteen reported studies were grouped into categories: diet (2), physical activity (4), childcare programs (2), media-based programs (2), parental involvement (2), multi-component studies (1), and screen time (6). Most interventions were effective in reducing BMI, decreasing sedentary behaviors, and increasing physical activity. Sustainability of these interventions was not evaluated. While there is no one method or simple intervention to address obesity, multi-component approaches involving home and school environments are promising and warrant evaluation in India. Literature on obesity prevention and control in India and in lower-resource countries, however, is sparse. Existing gaps in knowledge about obesity should be addressed by conducting research in India and carrying out interventions to determine what strategies will be successful and sustainable locally.     

Sensitivity studies of pediatric material properties on juvenile lumbar spine responses using finite element analysis

The objective of the study was to determine the sensitivity of material properties of the juvenile spine to its external and internal responses using a finite element model under compression, and flexion–extension bending moments. The methodology included exercising the 8-year-old juvenile lumbar spine using parametric procedures. The model included the vertebral centrum, growth plates, laminae, pedicles, transverse processes and spinous processes; disc annulus and nucleus; and various ligaments. The sensitivity analysis was conducted by varying the modulus of elasticity for various components. The first simulation was done using mean material properties. Additional simulations were done for each component corresponding to low and high material property variations. External displacement/rotation and internal stress–strain responses were determined under compression and flexion–extension bending. Results indicated that, under compression, disc properties were more sensitive than bone properties, implying an elevated role of the disc under this mode. Under flexion–extension moments, ligament properties were more dominant than the other components, suggesting that various ligaments of the juvenile spine play a key role in modulating bending behaviors. Changes in the growth plate stress associated with ligament properties explained the importance of the growth plate in the pediatric spine with potential implications in progressive deformities.     

Brain temperature measurement: A study of in vitro accuracy and stability of smart catheter temperature sensors

The injured brain is vulnerable to increases in temperature after severe head injury. Therefore, accurate and reliable measurement of brain temperature is important to optimize patient outcome. In this work, we have fabricated, optimized and characterized temperature sensors for use with a micromachined smart catheter for multimodal intracranial monitoring. Developed temperature sensors have resistance of 100.79 ± 1.19Ω and sensitivity of 67.95 mV/°C in the operating range from15–50°C, and time constant of 180 ms. Under the optimized excitation current of 500 μA, adequate signal-to-noise ratio was achieved without causing self-heating, and changes in immersion depth did not introduce clinically significant errors of measurements (<0.01°C). We evaluated the accuracy and long-term drift (5 days) of twenty temperature sensors in comparison to two types of commercial temperature probes (USB Reference Thermometer, NIST-traceable bulk probe with 0.05°C accuracy; and IT-21, type T type clinical microprobe with guaranteed 0.1°C accuracy) under controlled laboratory conditions. These in vitro experimental data showed that the temperature measurement performance of our sensors was accurate and reliable over the course of 5 days. The smart catheter temperature sensors provided accuracy and long-term stability comparable to those of commercial tissue-implantable microprobes, and therefore provide a means for temperature measurement in a microfabricated, multimodal cerebral monitoring device.     

Beyond Gaussians: a study of single-spot modeling for scanning proton dose calculation

Active spot scanning proton therapy is becoming increasingly adopted by proton therapy centers worldwide. Unlike passive-scattering proton therapy, active spot scanning proton therapy, especially intensity-modulated proton therapy, requires proper modeling of each scanning spot to ensure accurate computation of the total dose distribution contributed from a large number of spots. During commissioning of the spot scanning gantry at the Proton Therapy Center in Houston, it was observed that the long-range scattering protons in a medium may have been inadequately modeled for high-energy beams by a commercial treatment planning system, which could lead to incorrect prediction of field size effects on dose output. In this study, we developed a pencil beam algorithm for scanning proton dose calculation by focusing on properly modeling individual scanning spots. All modeling parameters required by the pencil beam algorithm can be generated based solely on a few sets of measured data. We demonstrated that low-dose halos in single-spot profiles in the medium could be adequately modeled with the addition of a modified Cauchy-Lorentz distribution function to a double-Gaussian function. The field size effects were accurately computed at all depths and field sizes for all energies, and good dose accuracy was also achieved for patient dose verification. The implementation of the proposed pencil beam algorithm also enabled us to study the importance of different modeling components and parameters at various beam energies. The results of this study may be helpful in improving dose calculation accuracy and simplifying beam commissioning and treatment planning processes for spot scanning proton therapy.     

Characterization of a peptide domain within the GB virus C envelope glycoprotein (E2) that inhibits HIV replication

GB virus C (GBV-C) infection is associated with prolonged survival in HIV-infected cohorts, and GBV-C E2 protein inhibits HIV entry when added to CD4+ T cells. To further characterize E2 effects on HIV replication, stably transfected Jurkat cell lines expressing GBV-C E2 or control sequences were infected with HIV and replication was measured. HIV replication (all 6 isolates studied) was inhibited in all cell lines expressing a region of 17 amino acids of GBV-C E2, but not in cell lines expressing E2 without this region. In contrast, mumps and yellow fever virus replication was not inhibited by E2 protein expression. Synthetic GBV-C E2 17mer peptides did not inhibit HIV replication unless they were fused to a tat-protein-transduction-domain (TAT) for cellular uptake. These data identify the region of GBV-C E2 protein involved in HIV inhibition, and suggest that this GBV-C E2 peptide must gain entry into the cell to inhibit HIV.     

Recognition of a non-recurrent laryngeal nerve during carotid endarterectomy

Cranial nerve injury during carotid endarterectomy (CEA), while infrequent, may have serious consequences. The recurrent laryngeal nerve is one of the most commonly injured cranial nerves. Fortunately, most of these injuries are temporary. Anatomic variations in the position of cranial nerves present challenges to surgeons during CEA. Although the occurrence of a non-recurrent laryngeal nerve (NRLN) is rare, proper recognition of this anatomic variation is critical in order to minimize complications. We present a case in which a NRLN was discovered intraoperatively and carefully preserved.     

The role of T-helper cells in atherosclerosis

Atherosclerosis is rapidly gaining recognition as an inflammatory disease showing contribution from innate and adaptive immunity pathways towards disease initiation and progression. Components of adaptive immunity especially T cells, are shown to be involved in atherogenesis and subsets of T cells are known to drive/ dampen inflammatory processes in atherosclerosis. However, the regulatory balance between the T cell subsets remains unclear. In this review, we summarize the role of T helper cells Th1, 2, 3 and 17, and regulatory cells Treg in atherosclerosis by studying the cytokines involved in Th cell functioning. We further examine the diverse roles of T helper cells for regulating the progression of atherosclerosis.     

The role of interpersonal communication in preventing unsafe abortion in communities: the dialogues for life project in Nepal

Legal, procedural, and institutional restrictions on safe abortion services-such as laws forbidding the practice or policies preventing donors from supporting groups who provide legal services-remain a major access barrier for women worldwide. However, even when abortion services are legal, women face social and cultural barriers to accessing safe abortion services and preventing unwanted pregnancy. Interpersonal communication interventions play an important role in overcoming these obstacles, including as part of broad educational- and behavioral-change efforts. This article presents results from an interpersonal communication behavior change pilot intervention, Dialogues for Life, undertaken in Nepal from 2004 to 2006, after abortion was legalized in 2002. The project aimed to encourage and enable women to prevent unplanned pregnancies and unsafe abortions and was driven by dialogue groups and select community events. The authors' results confirm that a dialogue-based interpersonal communication intervention can help change behavior and that this method is feasible in a low-resource, low-literacy setting. Dialogue groups play a key role in addressing sensitive and stigmatizing health issues such as unsafe abortion and in empowering women to negotiate for the social support they need when making decisions about their health.