Beyond Refeeding: The Effect of Including a Dietitian in Eating Disorder Treatment. A Systematic Review

Eating disorders are potentially life-threatening mental health disorders that require management by a multidisciplinary team including medical, psychological and dietetic specialties. This review systematically evaluated the available literature to determine the effect of including a dietitian in outpatient eating disorder (ED) treatment, and to contribute to the understanding of a dietitian’s role in ED treatment. Six databases and Google Scholar were searched for articles that compared treatment outcomes for individuals receiving specialist dietetic treatment with outcomes for those receiving any comparative treatment. Studies needed to be controlled trials where outcomes were measured by a validated instrument (PROSPERO CRD42021224126). The searches returned 16,327 articles, of which 11 articles reporting on 10 studies were included. Two studies found that dietetic intervention significantly improved ED psychopathology, and three found that it did not. Three studies reported that dietetic input improved other psychopathological markers, and three reported that it did not. One consistent finding was that dietetic input improved body mass index/weight and nutritional intake, although only two and three studies reported on each outcome, respectively. A variety of instruments were used to measure each outcome type, making direct comparisons between studies difficult. Furthermore, there was no consistent definition of the dietetic components included, with many containing psychological components. Most studies included were also published over 20 years ago and are now out of date. Further research is needed to develop consistent dietetic guidelines and outcome measures; this would help to clearly define the role of each member of the multidisciplinary team, and particularly the role of dietitians, in ED treatment.

EP.WE.453Impact of COVID 19 pandemic on colorectal rapid access investigations

Aim The impact of the COVID-19 pandemic on delays in diagnosis of cancer has been highlighted at a national level. Such a delay represents an ongoing source of mortality and morbidity missing from the COVID-19 statistics. This study examines the delay in investigation of patients referred to the urgent colorectal cancer referral service at a single centre. Method Retrospective data was collated from prospective database for all 1,894 referrals to the urgent colorectal cancer referral service for the period 21 January to 24 December 2020. The time to appointment (TTA) was compared by date of referral and outcome type (endoscopy, CT abdomen pelvis (CT-AP), CT colonography (CT-C), clinic appointment). Results Across 2020, fewer than 25% of patients met the NICE recommendation of appointment within 14 days (median TTA 30 days, first quartile 19). TTA increased dramatically in the first months of the pandemic (February median: 19; March: 80.5). TTA remained high, not falling below a median wait of 28 days until November. CT-C tests were particularly delayed (median TTA: 86) due to concerns regarding aerosol generation and COVID-19 transmission. Patients were offered CT-AP tests while awaiting their delayed CT-C, as CT-AP had a significantly better wait of 15 days. Conclusion COVID-19 was a major disruptor of colorectal cancer diagnosis in 2020, with patients waiting more than twice as long as NICE recommends. This will likely continue into 2021, with further research required to assess the impact of this disruption on mortality and morbidity.

Secondary Attack Rate among the Contacts of COVID-19 Patients at the Beginning of the Pandemic in Pune City of WesternMaharashtra, India

Introduction: The COVID-19 was the emerging disease caused by SARS-COV 2. Efficient transmission of this disease occurs through droplets and fomites. As COVID-19 has high transmission and hence susceptible household & non-household close contacts are at high risk of developing disease. Study Objectives: 1) To estimate secondary attack rate of COVID-19 among the contacts during the pandemic in Pune city; 2) To identify factors associated with transmission and development of COVID-19 disease. Material & Methods: This was a retrospective cohort study conducted in the month of June 2020. The sample includes 741 contacts of 119 Laboratory confirmed cases for COVID-19, resides in 15 ward offices areas of Pune Municipal Corporation after written informed consent. A confidential telephonic interview was taken by using a prestructured questionnaire which includes socio demographic data, duration of stay, family background, outcome, type of house, development of symptoms etc. Results: The overall Secondary Attack Rate estimated to be 32.5%, 33.7% among the high risk contacts while 13.3% among the low risk contacts. In this city, 6 wards (40%) out of 15 wards showed SAR of more than 40%. The characteristics of primary cases associated with spread of disease were presence of symptoms and duration between onset of disease and isolation of primary case. The factors significantly affecting SAR were age, comorbidity, no. of family members, type of family, type of house, overcrowding, no. of rooms, bedroom attached with toilet, type of contact & containment zone. Conclusion: Higher SAR was seen in the household contacts. It is necessary to adopt rigorous measures to cut the transmission chain in this area of close contact.

Action and Inaction in Moral Judgments and Decisions: Meta-Analysis of Omission Bias Omission-Commission Asymmetries

Omission bias is people’s tendency to evaluate harm done through omission as less morally wrong and less blameworthy than commission when there is harm. However, findings are inconsistent. We conducted a preregistered meta-analysis, with 21 samples (13 articles, 49 effects) on omission-commission asymmetries in judgments and decisions. We found an overall effect of g = 0.45, 95% confidence interval (CI) = [0.14, 0.77], with stronger effects for morality and blame than for decisions. Publication bias tests produced mixed results with some indication for publication bias, though effects persisted even after most publication bias adjustments. The small sample of studies included limited our ability to draw definite conclusions regarding moderators, with inconclusive findings when applying different models. After compensating for low power, we found indication for moderation by role responsibility, perspective (self vs. others), outcome type, and study design. We hope this meta-analysis will inspire research on this phenomenon and applications to real-life, especially given the raging pandemic. Materials, data, and code are available on https://osf.io/9fcqm/ .

Assessing the risk of performance and detection bias in Cochrane reviews as a joint domain is less accurate compared to two separate domains

Background Initially, the Cochrane risk of bias (RoB) tool had a domain for “blinding of participants, personnel and outcome assessors”. In the 2011 tool, the assessment of blinding was split into two domains: blinding of participants and personnel (performance bias) and blinding of outcome assessors (detection bias). The aims of this study were twofold; first, to analyze the frequency of usage of the joint blinding domain (a single domain for performance and detection bias), and second, to assess the proportion of adequate assessments made in the joint versus single RoB domains for blinding by comparing whether authors’ RoB judgments were supported by explanatory comments in line with the Cochrane Handbook recommendations. Methods We extracted information about the assessment of blinding from RoB tables (judgment, comment, and whether it was specified which outcome type; e.g., objective, subjective) of 729 Cochrane reviews published in 2015-2016. In the Cochrane RoB tool, judgment (low, unclear or high risk) needs to be accompanied by a transparent comment, in which authors provide a summary justifying RoB judgment, to ensure transparency in how these judgments were reached. We reassessed RoB based on the supporting comments reported in Cochrane RoB tables, in line with instructions from the Cochrane Handbook. Then, we compared our new assessments to judgments made by Cochrane authors. We compared the frequency of adequate judgments in reviews with two separate domains for blinding versus those with a joint domain for blinding. Results The total number of assessments for performance bias was 6918, with 8656 for detection bias and 3169 for the joint domain. The frequency of adequate assessments was 74% for performance bias, 78% for detection bias, and 59% for the joint domain. The lowest frequency of adequate assessments was found when Cochrane authors judged low risk – 47% in performance bias, 62% in detection bias, and 31% in the joint domain. The joint domain and detection bias domain had a similar proportion of specified outcome types (17% and 18%, respectively). Conclusions Splitting joint RoB assessment about blinding into two domains was justified because the frequency of adequate judgments was higher in separate domains. Specification of outcome types in RoB domains should be further scrutinized.

β-Catenin and FAT1 Protein Expressions for Prediction of Survival Outcome in Type I Endometrial Cancer

ackground: Endometrial cancer (EC) is the second most common female genital tract malignancy and has adverse outcome in the advanced stage. A prognostic marker is needed for marking an accurate prognostic. Objective: To evaluate expression and clinical outcome of CTNNB1 (β-catenin) and FAT atypical cadherin 1 (FAT1), by using immunohistochemical staining in EC type I. Materials and Methods: Seventy-two EC type I cases were selected from Songklanagarind Hospital with clinical data collection. All cases were evaluated by immunohistochemistry using antibodies against β-catenin and FAT1. Results: All cases of EC type I were β-catenin positive and FAT1 negative. Moderate and strong intensity (2+ and 3+) β-catenin cytoplasmic staining showed statistically significant association with low grade EC, and low risk of recurrence disease or metastasis (p<0.05). β-catenin nuclear staining was present in 19 of 28 cases (68%) of EC grade 1 and associated with low grade EC. β-catenin and FAT1 expression were not associated with 5-year overall survival in both univariate and multivariate analyses. Conclusion: β-catenin cytoplasmic staining may be associated with low grade EC, and helpful to predict recurrent risk. However, FAT1 and β-catenin expressions have no statically significant correlation with 5-year overall survival and cannot be used to determine the prognosis in type I EC patients. Keywords: β-catenin, FAT1, Immunohistochemistry, Metastasis, Recurrence, Survival outcome, Type I endometrial cancer

Toxoplasma GRA Peptide-Specific Serologic Fingerprints Discriminate Among Major Strains Causing Toxoplasmosis

The severity of toxoplasmosis depends on a combination of host and parasite factors. Among them, the Toxoplasma strain causing the infection is an important determinant of the disease outcome. Type 2 strains dominate in Europe, whereas in North America type 2, followed by type 3 and 12 strains are commonly isolated from wildlife and patients. To identify the strain type a person is infected with, serological typing provides a promising alternative to the often risky and not always possible biopsy-based DNA methods of genotyping. However, despite recent advances in serotyping, improvements in the sensitivity and specificity are still needed, and it does not yet discriminate among the major Toxoplasma lineages infecting people. Moreover, since infections caused by non-1/2/3 strains have been associated with more severe disease, the ability to identify these is critical. In the present study we investigated the diagnostic potential of an ELISA-based assay using 28 immunogenic Toxoplasma peptides derived from a recent large-scale peptide array screen. Our results show that a discrete number of peptides, derived from Toxoplasma dense granule proteins (GRA3, GRA5, GRA6, and GRA7) was sufficient to discriminate among archetypal strains that infect mice and humans. The assay specifically relies on ratios that compare individual serum reactivities against GRA-specific polymorphic peptide variants in order to determine a “reactivity fingerprint” for each of the major strains. Importantly, nonarchetypal strains that possess a unique combination of alleles, different from types 1/2/3, showed either a non-reactive, or different combinatorial, mixed serum reactivity signature that was diagnostic in its own right, and that can be used to identify these strains. Of note, we identified a distinct “HG11/12” reactivity pattern using the GRA6 peptides that is able to distinguish HG11/12 from archetypal North American/European strain infections.

Study on demographic variables of controlled ovarian Hyperstimulation and Intrauterine Insemination (husband) in a tertiary medical college and hospital in Kolkata

Background: Intrauterine Insemination (IUI) is anage old reliable and safe procedure for couples having infertility. Success rate of IUI with ovulation induction ranges from 8-20% depending on many factors. Aims and Objectives: The current study was to assess the factors which are responsible for favourable outcome of IUI after ovulation induction. Materials and Methods: Total 67 couples were included fulfilling inclusion and exclusion criteria. They underwent 90 cycles of IUI with each couple having maximum of 3 cycles. Ovulation induction was done byeitherclomiphene citrate or letrozole or gonadotrophins. Semen preparation was done by density gradient method. The participant’s demographic parameters were analyzed. Results: Out of 90 IUI, 8 were successful resulting in a success rate of 8.8% per cycle and 11.9% per couple. Factors which had positive impact were age less than 35 years, less than 10 years of infertility, normal and overweight BMI. Anovulation and unexplained infertility had better outcome. Type of infertility did not have any impact on the outcome. Conclusion: The study concluded that IUI after ovulation induction is more useful in cases like unexplained infertility and anovulation in a patient aged less than 35 years with less than 10 years of infertility and normal or overweight BMI.

Exploring the ecological outcomes of mandatory Biodiversity Net Gain using evidence from early-adopter jurisdictions in England

Net outcome-type biodiversity policies are proliferating globally as perceived mechanisms to reconcile economic development and conservation objectives. The UK government’s Environment Bill will mandate that most new developments in England demonstrate they deliver a biodiversity net gain (BNG) to receive planning permission, representing the most wide-ranging net outcome-type policy globally. However, as with many nascent net-outcome policies, the likely outcomes of mandatory BNG have not been explored empirically. We assemble all BNG assessments (accounting for ~1% of England’s annual housebuilding and other infrastructure) submitted from January-November 2020 in four early-adopter councils who are implementing mandatory No Net Loss or BNG requirements in advance of the national adoption of mandatory BNG, and analyse the aggregate habitat changes proposed. Our sample is associated with a 21% reduction in the area of non-urban habitats, compensated by commitments to deliver smaller areas of higher-quality habitats years later in the development project cycle. Eighty-seven percent of biodiversity units delivered in our sample come from habitats within or adjacent to the development footprint managed by the developers. However, we find that these gains fall within a governance gap whereby they risk being unenforceable; a challenge which is shared with other net outcome-type policies implemented internationally.

Relationship between Land Use/Land-Use Change and Human Health in Australia: A Scoping Study

We undertook a scoping study to map the relevant evidence, summarise the findings, and to help identify gaps in the knowledge base on the relationship between land use/land-use change and human health in Australia. Our systematic search of the scientific literature for relevant articles up to August 2020 identified 37 articles. All 37 articles meeting our inclusion criteria were published after 2003. Zoonotic or vector-borne disease constituted the most common health outcome type studied. Agriculture/grazing was the land use/land-use change type most frequently represented in the literature, followed by coal seam gas extraction and open cut coal mining. The relationship between land use/land use change and human health in Australia, is not conclusive from the existing evidence. This is because of (1) a lack of comprehensive coverage of the topic, (2) a lack of coverage of the geography, (3) a lack of coverage of study types, and (4) conflicting results in the research already undertaken. If we are to protect human health and the ecosystems which support life, more high-quality, specific, end-user driven research is needed to support land management decisions in Australia. Until the health effects of further land use change are better known and understood, caution ought to be practiced in land management and land conversion.