Healthcare aides (HCAs) are the primary caregivers for vulnerable older persons. They have many titles and are largely unregulated, which contributes to their relative invisibility. The objective of this scoping review was to evaluate the breadth and depth of the HCA workforce literature.We conducted a search of seven online bibliographic databases. Studies were included if published since 1995 in English, peer-reviewed journals. Results were iteratively synthesized within and across the following five categories: education, supply, use, demand and injury and illness.education; particularly trainee characteristics, program location, length and content. Results in supply indicated that the average HCA was female, 36–45 years and had an education level of high school or less. Home health HCAs were, on average, older and were more likely to be immigrants than those working in other settings. The review of studies exploring HCA use revealed that their role was unclear – variation in duties, level of autonomy and work setting make describing “the” role of an HCA near impossible. Projected increased demand for HCAs and high rates of turnover, both at the profession and facility-level, elicit predictions of future HCA shortages. Home health HCAs experienced comparatively lower job stability, earned less, worked the fewest hours and were less likely to have fringe benefits than HCAs employed in hospitals and nursing homes. The review of studies related to HCA illness and injury revealed that they were at comparatively higher risk of injury than registered nurses and licensed practical nurses.Of 5,045 citations screened, 82 studies met inclusion criteria. Few examined HCA This is the largest, most comprehensive scoping review of HCA workforce literature to date. Our results indicate that the HCA workforce is both invisible and ubiquitous; as long as this is the case, governments and healthcare organizations will be limited in their ability to develop and implement feasible, effective HCA workforce plans. The continued undervaluation of HCAs adversely impacts care providers, the institutions they work for and those who depend on their care. Future workforce planning and research necessitates national HCA registries, or at minimum, directories.The online version of this article (doi:10.1186/s12912-015-0090-x) contains supplementary material, which is available to authorized users. Healthcare aides (HCAs) go by many titles and are largely unregulated, which contributes to the relative invisibility of this workforce in the eyes of researchers, patients and the general public. Broadly defined, HCAs are those who provide supportive services and personal assistance to disabled, elderly and/or ill (acute or chronic) individuals requiring either short-term aide or long-term support . See FigA number of global trends have contributed to reducing the likelihood that older adults will receive care from family members, including declining birth rates , 5, enhaWhat is the breadth and depth of the HCA workforce literature? Are there notable knowledge gaps?What does existing literature tell us about the education, supply and use of HCAs, the demand for HCAs, and injury and illness among HCAs?A better societal understanding of the HCA workforce is imperative, as future demand will be high and the existing supply of these workers is poorly understood. HCA positions are proliferating globally, across all healthcare settings. In the U.S., the HCA workforce has been profiled in several national surveys, the most recent in 2010 : the majSpecific areas of focus identified in Question 2 were selected based on Birch et al.  human reWe determined that a scoping review , 13 woulThe search strategy included seven online bibliographic databases, which index journals from around the globe: MEDLINE® In-Process and Other Non-Indexed Citations, Ovid MEDLINE ® Daily and Ovid MEDLINE ® 1946-Present, EMBASE (1988-); PsycINFO (1987-); EBM Reviews– Cochrane Database of Systematic Reviews 2005-), Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, CMR, Health Technology Assessment; CINAHL, Business Source Complete, ABI Inform. A health services librarian conducted the search on March 16, 2013. See Fig. 005-, DatA single author screened each citation: the titles and abstracts were reviewed using the following inclusion and exclusion criteria. Inclusion criteria: 1) HCA or an equivalent position title, 2) Published in a peer-reviewed journal, 3) Published in 1995 or later, 4) Abstracts published in English. Exclusion criteria included: 1) Primary focus of the study was workplace violence, models of care, stress, job satisfaction or burnout as reviews on those topics have either been recently completed  or are fa priori, to build on Birch et al. [We decided, h et al.  human reAn author  extracted data elements, including author (year), journal, country, sample, setting, intervention (where applicable), data collection method, instrument(s) and measure(s), reliability and validity of instruments, data analysis and results relevant to any one of the categories of findings described above from each publication that met criteria for inclusion. HH inspected the contents of synthesis tracking tables through random verification of data elements.Two to five authors, in a number of in-person meetings over a period of two months, collated and summarized study results , as captWe retrieved a total of 7,874 citations and removed 2,829 duplicates, which left 5,045 citations for screening. Of the 181 studies retained for manuscript screening, 82 were included see Fig. . None wen = 71, 87 %) were quantitatively designed and the majority utilized some form of regression analysis. Near one-fifth of the studies provided only descriptive statistics [Most studies  [p < 0.001) [Fifty-one included studies reported on the supply of HCAs , 72–85.  < 0.05)  (p < 0.0< 0.001) . Overall< 0.001) , 75. In < 0.001)  to 52.0 < 0.001)  were rep< 0.001) . Across In the U.S., between 38.9 % of non-immigrant HCAs  and 60.5In the U.S., the proportion of HCAs working full-time ranged from 62 %  to 79.3 Mean hourly wage (in USD) ranged from $7.45 in nursing home and home health settings (year - 2002)  to $17.8None of the included studies provided information on the demographics of students entering vocational programs, methods of recruiting students into training programs or quantified existing workforce shortages or surpluses.Nineteen included studies reported on use of HCAs , 85–91. Despite ongoing interest in enhancing skill-mix in health care organizations, we found only one empirical study  related No position statements were retrieved that met our inclusion and exclusion criteria.Fifty-three included studies reported results related to demand for HCAs , 91–94.Four North American studies , 74, 84 The range for mean months of work as an HCA was 79.2 (in NHs)  to 148.8Two international studies , 65 repoThe mean range, in months, for tenure in a facility was 25.96  to 118.3Turnover rates were reported differently across studies: annually, semi-annually and quarterly. Annual turnover rates ranged from 59.4 %  to 170.5High unemployment rates in the community were correlated with reduced turnover in three , 82, 91 Several facility-level characteristics were associated with turnover of HCAs. For-profit status was positively associated with increased turnover in the U.S. , 87, 94.Higher HCA wages were negatively associated with turnover , 87, 94.Three administrative factors significantly reduced turnover among U.S. HCAs: management seeking input , flatterp < 0.05) [p ≤ 0.05) [Two intervention studies , 83, con < 0.05)  or a mulFour U.S.-based studies , 55, 79 In the U.S., word of mouth was more frequently cited , 33, 40 Two , 94 of tYounger age was positively associated with intent to leave , 68, 72.The proportion of U.S. HCAs without health insurance ranged from 12.7 % among immigrants employed in NHs  to 33 % Thirteen included studies reported on injury and illness in the HCA workforce , 90, 94.The most common types of injuries experienced by HCAs in Canada were musculoskeletal injuries , 64, whiAcross all healthcare settings in Canada, HCAs had a higher injury rate than both LPNs and RNs , 62, 64.Although injury claims and sickness absences among HCAs in Canada outnumbered those of RNs , 63, thep < 0.05) [p < 0.05) [p < 0.05) [p < 0.01 [In the U.S., HCAs with less training ( < 0.05) , less HC < 0.05)  or who r < 0.05)  were morp < 0.01 ) [50, 64p < 0.01 , 64.p < 0.05), while injury rates among male HCAs working part-time hours were higher than their full-time counterparts (p < 0.05) [The relationship between HCA age and injury and illness rates, in Canadian settings, was equivocal , 62. GenThe HCA workforce is both invisible and ubiquitous; as long as this is the case, governments and healthcare organizations will be limited in their ability to develop and implement feasible, effective workforce plans for HCAs. The continued undervaluation of HCAs adversely impacts care providers, the institutions they work for and those who depend on their care .Globally, health systems are called upon to do more with less – less space, less staff, less money. In high-income countries, current LTC costs and funding models have been characterized as unsustainable. The costs associated with LTC in high income countries, as a proportion of global domestic product, are expected to double within the next 5 years. Global aging is acknowledged by Standard and Poor’s, a credit rating agency, as a notable threat to the stability of the economy. Low and middle income countries are also affected; in these countries, where care has traditionally been provided by family members there will likely be a discernible shift from informal to formal care services [The results of this review make clear the degree to which HCAs, in general, are marginalized. Improvements to work conditions, respect and acknowledgement are hard won; HCAs cannot rely on others, be they professional groups or public-interest groups, to dedicate the time and energy required to effect change. Unfortunately, they face many challenges in their bid to achieve equitable treatment and recognition. Savage et al. , in theiOur results clearly demonstrate a hierarchy within the HCA workforce, home health aides have the least job stability, lowest pay, fewest work hours and are the least likely to have fringe benefits, as compared to HCAs employed in hospitals and NHs. This seems counter-intuitive, as home health aides work autonomously and rely on a more comprehensive knowledge and skill base than their facility-employed counterparts. Additionally, due to the informal nature of many home health care employment arrangements, existing workforce data does not truly reflect their numbers or working conditions. Evidence suggests that HCAs can be hired on the grey market at an appreciable ‘discount’ . ProportA clear knowledge gap exists in relation to the education of the HCA workforce. None of the included studies reported on program entrance requirements or provided information related to program structure and length. We were unable to make any conclusions about: which content is essential to a HCA program curriculum; which types of students are attracted to these programs; how much time is required for students to learn all that is needed or how much of that time should be spent in the classroom versus in a practice setting. The lack of clarity surrounding the education of HCAs is, undoubtedly, related to the lack of clarity regarding the HCA role(s). The delineation of HCA competencies and scope of practice is essential prior to moving forward with standardization of educational programs. A recent Alzheimer’s Disease International (ADI) report  echoed tGoverning bodies that have jurisdiction over care provider regulation and educational institutions vary from country to country. Regardless of the country, multiple governmental departments need to be involved in the development of policy that impacts the HCA workforce . Policy makers, as civil servants, are duty-bound to collaborate with all relevant departments and ministries in order to develop and rally support for policies that optimize HCA education and employment and, in turn, optimize the safety and quality of care provided to those persons accessing the services of a HCA.Education: Optimal program content and delivery – What is the best location for training programs? Is there a benefit to offering setting-specific streams for training  or should all HCAs be trained to work in all settings? Internationally, how do existing programs compare?Supply: None of the included studies described the students entering HCA training programs, methods used to attract students into programs or quantified existing surpluses/ shortages of HCAs. Are HCAs-to-be similar to existing HCAs? What is the attrition rate between training and employment? What made students decide to enter the training program? Are there international differences? Is there an existing shortage of HCAs? How has/would regulation and/or mandatory certification of HCAs impacted supply?Use: Heterogeneity of role descriptions – What tasks and competencies are universally accepted as appropriate for HCAs? What are the motivations of health administrators asking HCAs to complete tasks not traditionally completed by HCAs? What is the optimal setting-specific skill-mix?Demand: Turnover and continuity of care – Are the predictors of turnover among HCAs similar or different to the predictors of turnover among other health professionals or among similarly-educated employees in other sectors? Would the introduction of career laddering opportunities enhance job satisfaction and reduce turnover?Injury and illness: Safe practice, absenteeism and continuity of care – Does regulation of the workforce by policy makers ensure safe and quality practice? What is the average rate of absence among HCAs? How does it compare across professions (both in frequency and in reason for absence)? Does absenteeism related to injury and illness in this workforce negatively impact client and resident outcomes? What are employers currently doing to reduce rates of injury and illness among HCAs?Many questions remain unanswered about the current and future state of the HCA workforce. We recommend future research, including targeted systematic reviews of the literature, in five areas:Future research on the HCA workforce will depend on repeated, institutionalized collection of demographic information. In the absence of regulation, at minimum, inclusive HCA registries should be instituted in all countries. It takes time to successfully plan and implement a nation-wide registry. Assuming countries heed our advice and begin the process of instituting a nation-wide, inclusive registry of HCAs, it will be a minimum of three years before workforce planners and researchers will have reliable access to registry data. Many countries have publicized projected future care needs  but few a priori, identified positions statements as sources of information on the HCA workforce (particularly in the category of Use), we excluded many of them by including only peer-reviewed literature; many position statements are never published in peer-reviewed journals. In the absence of formal quality assessments, following a thorough reading and review of all included studies, we would rate the overall quality of included papers as fair. This is in recognition of identified weaknesses in either or all of study design, methodology, and analysis.We conducted a scoping review of the HCA workforce literature. We are confident in the rigour of our methodology but recognize that independent review of all titles and abstracts by more than one author may have enhanced the reliability of our screening. We excluded articles published before 1995; it is possible that the inclusion of relevant articles published prior to 1995 may have added to our results. Use of validated tools to evaluate the quality of included studies may have allowed us to more definitively evaluate the reliability of the synthesized findings. However, as we were seeking to determine the breadth and depth of the HCA workforce literature, and thus planned to include all studies meeting inclusion criteria in synthesis, completion of quality assessments is unlikely to have significantly altered our results. Although we had, This scoping review offers policy makers a review of the breadth and depth of current knowledge of the HCA workforce. Categorization of results into education, supply, use, demand and injury and illness allowed for maximal clarity in synthesis and in the presentation of results. The results present a picture of a marginalized workforce charged with caring for a vulnerable segment of the global population. Home health aides face the poorest working conditions. Notable gaps in the literature were apparent, particularly in the areas of education and HCA use. Future research will require national HCA registries or, at minimum, directories; policy-makers in countries without registries seeking to better plan for this workforce should seek to initiate their development. Proactive, strategic initiatives and legislation may lead to a better understanding of the existing workforce and could serve to protect all involved – employers, employees and dependent clients. The consequences of inaction – on workers, clients and the global economy – will be significant and universally experienced.


Good For You!, a randomized trial that tested the efficacy of innovative, individually tailored videos in helping worksite employees decrease dietary fat and increase fruit and vegetable (F&V) intake.Effective, low-cost approaches are needed to enhance dietary behavior change. While both video and tailoring technology have been effective interventions to improve diet, these approaches have never been combined to study the effectiveness of tailored videos. The purpose of this paper is to discuss the results of n = 14), Tailored Written information (TW) (n = 14), or Tailored Written + Tailored Video (TW + TV) (n = 15). Evaluation was conducted at baseline, 4 and 7 months. We used the NCI Fat Screener and an adapted Food Habits Questionnaire (FHQ) to estimate fat intake and fat-related behaviors, the NCI F&V Screener and F&V Habits Questionnaire (FVHQ) to measure F&V intake and behaviors. Generalized linear models were examined for all outcome measurements.Worksites were matched on approximate size, type of company and workforce composition and randomized to one of three experimental conditions: Non-Tailored written information (NT)  and TW + TV (−3.14 %) compared with NT (−2.42 %). FHQ scores decreased significantly more for TW + TV than the other two groups. Fruit intake increased the most for TW + TV compared to NT and TW. Both TW (1.30 cups) and TW + TV (1.59 cups) increased F&V intake significantly more than NT (0.78 cups). TW + TV showed the largest increase in F&V behaviors on the FVFQ. At 8 months, dietary fat change continued to be significantly better for TW + TV (−3.48 %) than NT (3.01 %). F&V intake increased significantly more for the TW + TV group (1.38 cups) compared to the NT group (1.04 cups) and FVHQ changes were significantly greater in TW + TV and TW than for NT.The tailored intervention participants were more likely to decrease fat and increase F&V intake. The TW + TV group was generally the stronger of the two tailored interventions, especially at the longer term follow-up, demonstrating the promise of tailored video as an intervention to change eating habits. Future studies should explore newer channels and technologies in addition to DVDs for delivering tailored video interventions such as the internet and smart phones.NCT00301678ClinicalTrials.gov identifier:  Increasing fruit and vegetable consumption and limiting intake of dietary fat, especially saturated fat, have been recommendations of the Dietary Guidelines for Americans, the American Heart Association, and the American Cancer Society –3. HowevOne-on-one dietary counseling can be effective,  but is tUsing computer programming to tailor education materials to an individual’s needs and interests is a potential solution as it mimics the process of interpersonal interaction and is much less expensive to deliver than one-on-one counseling. Tailoring is defined as any combination of information or change strategies intended to reach one specific person, based on characteristics that are unique to that person, related to the outcome of interest, and have been derived from an individual assessment , 8. TherVideo is another potential effective educational method for enhancing behavior change –18. VideGood For You! that tested the efficacy of individually tailored videos in helping individuals decrease dietary fat and increase fruit and vegetable intake.While both video and tailoring technology have been used to improve dietary changes, no studies have yet combined these approaches to test the effectiveness of tailored videos on changing health and/or dietary behavior. The purpose of this paper is to discuss the results of a randomized trial entitled Good For You! was funded by the National Cancer Institute (Grant # CA86066). The aims of this project were 1. To develop an innovative intervention  to help individuals improve their eating habits (decrease fat and increase F&V intake); and 2. To conduct a randomized controlled trial to test the effectiveness of this approach in achieving these dietary changes as compared to written tailored materials only or non-tailored materials. Study protocols for the research were approved by the Brown University Institutional Review Board.Good For You! intervention as part of their worksite wellness programs if it was found to be effective. We created an Advisory Board including representatives from BCBSRI, a local hospital worksite wellness program, the RI Department of Health and the CEO of a large worksite in RI. The purpose of the Advisory Board was help us to recruit sites, plan the intervention and evaluation methodologies and strategize around problems.We chose to conduct a randomized trial in worksites because we envisioned that worksites could be a potential future site for dissemination of the intervention delivered through organizations such as third party payers that offer wellness programs to worksites. Blue Cross Blue Shield of RI (BCBSRI) was interested in participating in the study and potentially replicating/disseminating the n = 6 groups with 46 total participants) were conducted at three different worksites (ranging in size from 250–350 employees) to gather information about barriers, facilitators, and motivators for healthy eating and to determine important factors affecting food choice and behaviors. This information was incorporated into the content of a phone survey (n = 216 employees from five worksites) to enumerate and narrow the foci in terms of eating habits, barriers, facilitators and motivators of dietary change that would be considered for message development. Lastly, five confirmatory focus groups were conducted with 41 employees from five different worksites (ranging in size from 110–2000 employees) to confirm and clarify general conclusions drawn from the exploratory focus groups and telephone survey, to explore the acceptability of behavioral strategies and study logistics and to pre-test scenarios and messages for intervention materials. Results from the formative research determined the content of the tailored written and video interventions and the format of the video segments.The first phase of the study was formative research to inform the development of the intervention. A mixed-methods triangulation approach including qualitative exploratory focus groups, a quantitative telephone survey, and qualitative confirmatory focus groups was conducted with employees from various worksites. Exploratory focus groups . Company size ranged from 145 to 2333 employees and were from New England, the Midwest and the Southern U.S. Companies were selected in groups of 3 matched on approximate size, type , and workforce composition . Triplets of worksites began participant recruitment simultaneously with one triplet starting approximately every 2 months. Five of the 52 initially recruited worksites were ultimately not able to participate before matching and baselines began. In addition, several smaller worksites with low initial recruitment were ultimately combined with other similar sites prior to randomization and two smaller hospital sites were combined prior to randomization so that four hospitals that were part of the same system could be rolled out together. Thus, a total of 43 worksites were ultimately involved in the study. Randomization to one of the three experimental groups occurred after baseline measurements were completed: 1. Non-Tailored written information (NT) (14 worksites); 2. Tailored Written information (TW) (14 worksites); 3. Tailored Written information + Tailored Video (TW + TV) (15 worksites).Participant recruitment methods differed somewhat by worksite but generally included posters, flyers, emails, an on-site kick-off event, payroll stuffers, table tents, home mailings, blurbs in newsletters and piggybacking with other events already taking place such as health fairs and employee appreciation days. Participants could contact project staff via email or toll-free telephone line. Project staff would then mail potential participants the registration/consent materials with a business reply envelope to mail the completed materials back. Participants could also fill out the registration materials in person at the on-site events.After baseline recruitment was completed, all worksites were randomly assigned by the data manager (using a computer assigned system) to one of three intervention groups: 1. Non-Tailored written information (NT), which received three separate mailings of traditional nutrition education and other wellness brochures (see below). The nutrition brochures contained messages that were consistent with the tailored intervention. Upon study completion, NT participants had the option of receiving the tailored nutrition materials; 2. Tailored written information (TW), which received three separate mailings of written materials tailored for participants; 3. Tailored written information + tailored video (TW + TV), which received three separate tailored videotapes plus the tailored written materials. The tailored materials were mailed at three time points: one week after the baseline survey was completed, four weeks after mailing one, and four weeks after mailing two.Tailoring was based on participants’ answers to the baseline telephone survey and two brief “re-tailoring” assessments that were conducted by mail or phone after mailing 1 and 2 to determine the information that would be included in the participant’s next packet and/or video. The baseline tailoring questions were based on the following: Dietary intake data from the screeners were used to provide micro-tailored feedback about current fat and F&V intake to participants in comparison to national guidelines. Feedback from the FHQ and FVFQ about fat and F&V-related behaviors of participants was also provided. Then participants chose food and meal pages for topics where they had a need for behavior changes. Questions were also asked about participants’ personal motivators; barriers, and other psychosocial issues related to healthy eating and participants chose pages based on their needs and interests. In addition, participants were asked to choose special topics of interest to them. See Tables The “retailoring” surveys were mailed two weeks after the tailored intervention packets were mailed. Because of the complexity of the computer programming involved, and the time required of participants, we did not reassess all questions asked at baseline, but asked a smaller subset of questions to see if participants had attempted changes, which barriers were encountered, which food categories they wanted to work on next, and specific areas on which they wanted more information. If a participant did not mail back the retailoring survey, the participant was called to complete the survey on the phone. If the re-tailoring survey was not completed, the materials were defaulted to baseline responses to prepare the next set of materials.Good For You! binder to hold their tailored materials. The binder had five sections, three of which were for the three installments of tailored materials and two sections that contained non-tailored topics such as goal setting, recipes and a list of resources. Participants received 28 tailored topics split over the three mailings out of a library of 56 potential tailored topics. They received a combination of macro-tailored (entire topic chosen for the participant based on survey answers) and micro-tailored (messages within a topic were tailored for the participant based on survey answers) content. This included micro-tailored feedback about participants’ current intake of fat and F&V (as measured on the baseline survey). Table Participants received a In addition to the tailored written materials, participants in the TW + TV group received three tailored DVDs or video-tapes that each contained approximately one hour of content. In the three videos, participants received a total of 24 video segments out of a possible 46 segments in the video library. Video segments mirrored the written materials. The food and meal segments were filmed in a variety of locations, with most filmed in a kitchen with a chef giving cooking demonstrations, augmented by food and meal segments filmed at worksite, restaurant, grocery store and home locations. The videos also featured a variety of other segment styles such as testimonials from real people that had succeeded in making changes, vignettes telling stories, and educational segments featuring experts in the field including registered dietitians, a psychologist and a chef. The videos focused mostly on real people modeling positive behaviors and/or providing narratives about behavior change, which has been shown to be more effective than using only spoken or graphically represented health information , 18. VidTo create each tailored video, participants’ telephone survey responses were entered into an in-house developed software application which collected all data using a FoxPro® database see Fig. . The FoxThe NT group received nationally available materials purchased from national health promotion agencies such as Wellness Council of America, American Cancer Society, etc. Each of the three mailings in the NT group included a nutrition brochure with content that was very similar to the content in the TW and TW + TV groups . Each mailing also included one non-nutrition-related brochure .Evaluation measures were collected at 3 time points: baseline, 4 and 8 months. In addition to the evaluation questions, the baseline survey also included questions for tailoring purposes and the follow-up surveys included process evaluation questions.p < .0001), which demonstrated that the FHQ score with the adapted scoring does reflect dietary fat intake.Percentage of calories from fat was estimated using the validated NCI Fat Screener . To measF&V intake was measured using the 7-item validated National Cancer Institute (NCI) F&V screener assessment tool . A FruitAll statistical and test procedures were performed with SAS software version 9.4 . Descriptive statistics were obtained with mean and standard deviation for continuous variables and frequencies and proportions for categorical variables. Mean change scores were calculated as the outcome (month 4 or 8) minus the baseline value. To decrease the potential for bias associated with missing values, missing values were imputed for all variables as the baseline value plus the mean change reported by those with follow-up data in the control group. Prior to this, we ran several different imputation procedures and found no differences in the results. We hence decided that the methods are robust to the imputation procedure. Descriptive statistics were computed for each outcome variable by intervention groups (NT vs. TW vs. TW + TV).). Linear models were constructed for all change in outcome measurements entered as the dependent variable with independent variables of worksite entered into the class statement (to adjust for intraclass correlation among worksites), baseline of the outcome, gender, job code (to adjust for baseline differences between groups), and group. Robust standard errors are presented in the tables. P values for the individual experimental group differences were calculated.A participation flow chart is shown in Fig. When asked at follow-up, over 70 % of participants in the TW and TW + TV groups reported having read most or all of the tailored pages; an additional 19 % reported reading some pages and 72.6 % reported that they were still using the materials at 4-months with 54.8 % still using them at 8-months. Over 90 % thought the written materials were very or somewhat helpful and over 88 % would recommend the program to others. About 84 % of participants in TW + TV watched at least some of the first video, with over half reporting that they watched it all. About 71 and 55 % watched at least some of the second and the third video respectively, with over half reporting they watched the entire video. The mean video minutes watched for the first, second and third videos were 48, 45 and 43 min respectively. In terms of retailoring, 93.9 % of participants in the TW and TW + TV were reached for the first retailoring survey and 92.7 % were reached for the second retailoring survey.For the 4 month follow-up survey, we reached 84.3 % and for the 8 month survey, we reached 84.1 % of the baseline participants. At both time points, drop-out was not differential between experimental groups. At the 4 month follow-up, drop-outs were more likely than continuing participants to be men, younger, of lower education, mixed race and clerical staff or machine operators. At the 8 month follow-up, the drop-outs were more likely to be younger, less educated, of mixed race, hourly employed, and clerical in their job type. No differences in baseline dietary outcome variables were noted between those who continued and those who stopped participating at either 4 or 8 month time point.p =0.0055 for NT vs TW, and 0.0004 for NT vs. TW + TV. Similarly, FHQ scores decreased for TW + TV (−0.42) in comparison to TW (−0.39), and NT (−0.36), with TV + TW significantly different from both comparison groups  + TV). Fruit intake increased for all groups with TW + TV increasing the most (0.99 cups), TW next (0.75 cups) and NT the least (0.43 cups), . Vegetable intake change was not statistically different by group, but there was a trend in the same direction as for fruit. F&V together increased for all groups, with both TW (1.30 cups) and TW + TV (1.59 cups) increasing more than NT (0.78 cups), p = 0.0037 for NT vs TW, and 0.0002 for NT vs. TW + TV); however, there was no statistically significant difference between TW + TV and TW. The FVHQ increased (meaning higher FV intake) for all groups with TW + TV showing the largest change (2.65) compared with TW (2.26) and NT (2.02),  + TV).Final outcomes are presented in Tables p = 0.0253. No differences in FHQ score were observed between any groups at 8 months. Increases in fruit intake were greater for TW + TV (0.66 cups) compared with NT (0.48 cups), p = .0548, but no differences between other groups were found. Also, no differences in vegetable consumption were found between groups. F&V intake increased more for the TW + TV group (1.38 cups) compared to the NT group (1.04 cups), p = .0443, but no other differences were found. The FVHQ changes were greater in TW + TV (2.34) and TW (2.17) groups than for NT (1.96). .At 8 months, some of the differences observed at 4 months were no longer evident. Dietary fat change from the screener continued to be greater for TW + TV (−3.48 %) than NT (3.01 %), Good For You! tailored interventions were more likely to decrease fat intake and increase F&V intake than the non-tailored intervention, and that for the most part, the TW + TV group was the stronger of the two tailored interventions, especially at the longer term follow-up. This demonstrates (as in other studies) that tailored interventions are more effective than non-tailored interventions in changing diet [Overall, the study results demonstrate that the ing diet , 35.Systematic reviews suggest that tailoring is more efficacious for improving total F&V consumption than either generic nutrition education materials or no nutrition education –40. AddiThe current study findings indicate significant improvement in dietary fat for TW and TW + TV. However existing research findings provide mixed support for tailoring on dietary fat outcomes. While one systematic review of tailored interventions did not find significant improvements in total fat intake,  meta-anaThis study also demonstrates the promise of tailored video as an intervention to help people change their eating habits. No other studies to date have examined the effectiveness of tailored video for improving dietary habits. A colleague did use our tailored video approach for medication adherence with older adults and found that it was feasible and well-liked by patients,  and seveTo our knowledge, no other existing studies have paired tailored written and tailored video materials within the context of a dietary intervention study. The fact that the TW + TV intervention achieved more lasting dietary changes than TW alone may be due to the visual nature of the video intervention creating better attention to the information that led to improved retention . AlternaGood For You! intervention was delivered with high fidelity, but the viewership of the videos decreased over time with the third video being watched less than the first video. The videos were long  with segments averaging 5–6 min. In the future, it might be more effective to deliver fewer videos and/or the videos could be shorter overall and with shorter segments. In addition, future studies should further examine the mechanism of change including the important mediating variables and tailored content to hone the intervention to its most crucial elements.Overall, the The current study was conducted with worksite employees who volunteered as participants and they were generally Non-Hispanic White, middle income and at least somewhat educated. Future studies should be conducted with ethnic minority, lower income and/or lower literate audiences to see if tailored video may be even more powerful with these groups. Tailoring in general has been shown to help lower educated individuals change behavior even more than higher educated individuals perhaps because the tailored materials are more personally relevant , 51–53. It is also very important to find ways to disseminate effective tailored nutrition interventions. Third party payers such as Blue Cross Blue Shield or other companies delivering worksite wellness programs are a potential distribution mechanism for tailored video and print interventions. A potential limitation for dissemination is the expense of video production and the hardware necessary for video tailoring. However, while initially video production can be somewhat expensive, the reproductions of DVDs are very inexpensive. DVDs can be reproduced for less than 70 cents each, whereas written materials with similar amounts of content cost much more, especially if in color. Thus, tailored video may be cheaper in the long run than tailored print.Good For You! study began. The hardware and software that we used to create the tailored DVDs has since been simplified and is much less costly. Furthermore, at the beginning of the study, tailored DVDs made more sense than an internet intervention using video, because few individuals had internet connections that supported streaming video. With the changes in technology and the increasing penetration of computers and internet [Moreover, technology has changed since the internet , 23, 54,internet  a tailorinternet , 57. Mininternet  and incointernet . HoweverEnwald et al. suggest that there are three generations of computer-tailored interventions. The first generation consists of tailored print items; the second generation refers to interventions that use interactive media; and intervention via mobile devices make up the third generation , 57. TheGood For You! originally did include a 12 month follow-up measure, but this follow-up was shortened to 8 months when funding was cut prior to the start of the study. Future studies should measure whether such tailored interventions maintain dietary changes over a longer timeframe (i.e. one year or greater). Furthermore, the study participants were mainly Non-Hispanic white and middle to upper income, which somewhat limits the generalizability of the findings, so future studies should be done with more diverse groups.Before discussing the study implications, it is important to mention several study limitations. The assessment tool that measured change in fat-related behaviors (FHQ) did not include a quantitative measure of fat intake ; however, this tool has been used in other studies and was calibrated in the current study against a quantitative measure and found to reflect dietary fat intake. In addition, we had another more quantitative measure of fat intake from the fat screener. Regarding measurement of F&V intake, recent studies have shown that the NCI F&V screener may overestimate F&V intake, , 41, 64 This study demonstrated that tailored interventions are effective methods for changing diet and that tailored video may offer even more promise. Future research should determine whether tailored video is potentially even more effective for lower income, ethnic and lower literate audiences. In addition, future studies should isolate the effectiveness of the tailored video by comparing effectiveness tailored video vs. untailored video and whether tailored video interventions are more effective with and without tailored written information. Future research should also examine the mechanisms of change. Future studies should further explore “third generation” channels for delivering tailored video interventions including the internet and smart phones in addition to DVDs for delivering tailored video interventions and develop partnerships to explore dissemination of effective interventions.


Plasmodium malariae is a slow-growing parasite with a wide geographic distribution. Although generally regarded as a benign cause of malaria, it has been associated with nephrotic syndrome, particularly in young children, and can persist in the host for years. Morbidity associated with P. malariae infection has received relatively little attention, and the risk of P. malariae-associated nephrotic syndrome is unknown.P. malariae infection in southern Papua, Indonesia. Between April 2004 and December 2013 there were 1,054,674 patient presentations to Mitra Masyarakat Hospital of which 196,380 (18.6%) were associated with malaria and 5,097 were with P. malariae infection . The proportion of malaria cases attributable to P. malariae increased with age from 0.9% for patients under one year old to 3.1% for patients older than 15 years. Overall, 8.5% of patients with P. malariae infection required admission to hospital and the median length of stay for these patients was 2.5 days (Interquartile Range: 2.0–4.0 days). Patients with P. malariae infection had a lower mean hemoglobin concentration (9.0g/dL) than patients with P. falciparum (9.5g/dL), P. vivax (9.6g/dL) and mixed species infections (9.3g/dL). There were four cases of nephrotic syndrome recorded in patients with P. malariae infection, three of which were in children younger than 5 years old, giving a risk in this age group of 0.47% . Overall, 2.4% (n = 16) of patients hospitalized with P. malariae infection subsequently died in hospital, similar to the proportions for the other endemic Plasmodium species .We used data from a very large hospital-based surveillance system incorporating information on clinical diagnoses, blood cell parameters and treatment to describe the demographic distribution, morbidity and mortality associated with Plasmodium malariae infection is relatively uncommon in Papua, Indonesia but is associated with significant morbidity from anemia and a similar risk of mortality to patients hospitalized with P. falciparum and P. vivax infection. In our large hospital database, one in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome. Plasmodium malariae is a relatively rare, but widely distributed, cause of malaria. It can persist in the human host for years, often without causing significant symptoms. As a result, P. malariae will be a very difficult species to eradicate. Our study used data from a routine hospital-based surveillance system in southern Papua, Indonesia to describe the clinical epidemiology of P. malariae infections. Over a 10-year period there were 5,097 patient presentations to Mitra Masyarakat Hospital associated with P. malariae infection constituting 2.6% of all malaria cases. Patients with P. malariae malaria had a significantly older age distribution than those with P. vivax infections. They also had lower mean hemoglobin concentrations than patients infected with P. falciparum, P. vivax or mixed Plasmodium species. We speculate that this may be due to chronic hemolysis of parasitized and non-parasitized red cells as a result of persistent infection. One in 200 children under the age of 5 years with P. malariae infection were recorded as having nephrotic syndrome, a well-known but to date unquantified complication. Overall, 0.3% of patients with P. malariae malaria died. These findings emphasize the need to consider this parasite when designing comprehensive malaria elimination strategies. Plasmodium malariae is one of the five Plasmodium species that commonly infect humans. The global incidence of infection by this species is unknown but is thought to be significantly lower than for P. falciparum  86–266) with no significant difference in the crude risk between those treated with oral quinine and those treated with dihydroartemisinin-piperaquine (5.9% versus 4.4%). Only 1.3%  of patients without malaria, 1.9%  of patients with falciparum malaria and 1.3%  of patients with vivax malaria represented with P. malariae infection within a year.Between April 2004 and December 2013 there were 1,054,674 presentations to RSMM of which 196,380 (18.6%) were associated with malaria. viduals) . Other PP. malariae monoinfection was similar to P. falciparum (median 21.7 and 20.1 years respectively), but substantially older than for P. vivax (median 10.0 years) and mixed infections (15.1 years). For all species, there was a bimodal distribution of age at presentation with a peak in children under 5 years of age and another in early adulthood. The childhood peak for P. malariae was less pronounced than for the other species   for patients less than one year of age to 3.1%  for patients older than 15 years  see . The pro15 years .P. malariae were in Highland Papuans , but this predominance was also apparent for the other Plasmodium species (range 81.0–88.3%) and patients without malaria (67.2%).The majority of presentations with P. malariae monoinfection required admission to hospital, less than the proportion for patients with P. falciparum (17.4%) and mixed infections (15.3%), but similar to those with P. vivax (9.4%) and P. ovale (8.3%) infections. The median length of stay for those admitted with P. malariae infection was 2.5 days (IQR 2.0–4.0 days); shorter than for those without malaria 3.0 days (IQR 2.0–5.0 days) but longer than for patients with other Plasmodium species infections , P. vivax, 2.0 days (2.0–4.0), P. ovale, 2.0 days (1.0–3.0) and mixed species, 2.0 days (2.0–4.0). Admission for greater than 5 days was required for 17.4% (75/432) of patients with P. malariae infection, 19.4%  of those without malaria, 11.2%  with P. falciparum, 13.0%  with P. vivax, 10.0% (1/10) with P. ovale and 12.0%  with mixed species infections. Assuming 100% bed occupancy over the study period, patients with P. malariae infection accounted for 0.4%  of total hospital bed occupancy. The corresponding figures for the other Plasmodium species were 14.6%  for P. falciparum, 5.4%  for P. vivax, 0.006% (24 bed days) for P. ovale and 3.4%  for mixed species infections.In total, 8.5%  of the patients with P. malariae infection were matched with corresponding pharmacy data. In 4,459 of these cases (95.1%), treatment was with oral therapy alone. Prior to March 2006 (401 cases), the majority of patients received either oral quinine , chloroquine  or doxycycline  with small numbers receiving sulphadoxine-pyrimethamine . After the change of malaria treatment protocols to ACT in March 2006 , 4,157 (96.9%) were treated with ACT  with dihydroartemisinin-piperaquine and 261 (6.1%) with artesunate-amodiaquine (two patients received both combinations)). In 232 cases (4.9%), patients with P. malariae were treated with parenteral therapy; intravenous quinine prior to April 2006  and intravenous artesunate after this date .Overall, 4,691 (92.0%) patient presentations with P. malariae monoinfection, 1,516 (29.7%) were associated with at least one additional clinical diagnosis and this figure rose to 96.5% (417 presentations) in those admitted to hospital. The overall proportions with comorbidity for those with P. falciparum, P. vivax and mixed infections were slightly higher: 32.7%, 30.5% and 31.0% respectively. Thirty (0.6%) patients with P. malariae infection presented following trauma and therefore presumably had incidental parasitemias  were recorded as having nephrotic syndrome. Although numbers were small, this proportion was approximately 10-fold higher than for the other Plasmodium species  in children under 15 years and 0.47%  in children aged under 5 years old. None of the 4 patients with nephrotic syndrome died at the hospital prior to the end of the study.Of the 5,097 presentations with sitemias . Overall species . All fouP. malariae cases being 34.3% , 33.6%  and 34.1%  respectively. The mean hemoglobin concentration was 9.0 g/dL in patients with P. malariae infection, the lowest of all the Plasmodium species . Overall, 5.7% (n = 100) of patients presenting with P. malariae infections had a hemoglobin <5g/dL . This was similar to the crude proportions for P. falciparum and P. vivax  of those ≥12 years) and 1,128 (64.5%) had a hemoglobin under 10g/dL. After controlling for confounding factors, those with P. malariae infection were at significantly greater risk of severe anemia compared to those without Plasmodium infection both when defined as a hemoglobin of less than 5g/dL  [Hemoglobin concentrations, platelet counts and white cell counts were available in 22.9% , 22.4%  and 22.7%  of all patient presentations with the corresponding figures for P. vivax . Three h was present in 123 (7.2%) patients with P. malariae (3/μL) in 16 (0.9%) cases. None of the patients with platelet counts <50x103/μL) were recorded as having clinical evidence of bleeding. After controlling for confounding factors, P. malariae infection was associated with a two-fold higher odds of severe thrombocytopenia compared to those with no malaria   .P. malariae infection had an abnormal age-adjusted white cell count; a similar proportion to patients infected with the other Plasmodium species, but lower than that in patients without malaria . In 36.8% of cases the abnormal white cell count was above the age-adjusted normal range and in the remaining 63.2% it was below the normal range.Overall 34.4% (n = 598) of patients with P. malariae infection died compared to 0.5%  of those without malaria, 0.4%  with P. falciparum, 0.2%  with P. vivax, none with P. ovale and 0.3%  with mixed infections. The corresponding risk of mortality for patients who were admitted to hospital or seen in the emergency department was 2.4% (16/663) for P. malariae, 3.4%  for those without Plasmodium infection, 1.6%  for P. falciparum, 1.4%  for P. vivax and 1.6%  for mixed infections. The median age of the 16 patients who died with P. malariae parasitemia was 23.4 years , with a risk of mortality of 1/1,481 (0.07%) in children <12 years and 15/3,616 (0.4%) in adults ≥12 years. Nine (56.3%) of the patients who died were male, 4 (26.7%) had a hemoglobin <5g/dL and 6 (40%) had severe anemia according to 2014 WHO criteria  of patients with criteria . Two patP. malariae is responsible for a minority (2.6%) of clinical malaria cases but has potential to cause significant morbidity. Compared to patients infected with other Plasmodium species, those with P. malariae infection had a lower mean hemoglobin concentration and a similar risk of being admitted to hospital (8.5%) or dying (0.3%). Overall P. malariae malaria accounted for almost 0.5% of hospital bed occupancy.This large case series from southern Papua shows that P. malariae infections tended to be older than those with non P. malariae malaria, particularly compared to those with P. vivax mono- or mixed infections. This probably reflects the low transmission intensity in this area. Whereas the majority of children in Timika are likely to have been infected with P. vivax by the age of 5 years (and therefore have started to acquire immunity early in life), fewer than one in ten children could be expected to have been infected with P. malariae by the same age  [Plasmodium malariae has a predilection for senescent red blood cells whereas P. vivax preferentially infects young red cells, in particular reticulocytes [P. malariae infection.Patients with ulocytes , 29. It P. malariae parasitemia and substantial hematological morbidity. The mean hemoglobin in patients with P. malariae infection was 0.3–0.6g/dL lower than the other locally prevalent Plasmodium species with an associated 2.3-fold greater odds of severe anemia compared to individuals without malaria. There are several potential explanations for this finding. Plasmodium malariae replicates slowly and does not typically reach high parasitemias [P. falciparum or P. vivax infections. A chronic, low-level parasitemia resulting in ongoing destruction of both parasitized but, more importantly, non-parasitized red cells as well as marrow dyserythropoiesis may have a cumulative effect on lowering hemoglobin concentrations. Previous observation of malariatherapy patients treated with P. malariae infection demonstrated that those with naturally-induced infections typically had a nadir in hemoglobin concentration between day 30 and 90 of infection with only a slight improvement in concentrations thereafter [P. vivax infection significantly underestimate total parasite biomass [P. malariae, capable of contributing to a degree of anemia out of proportion to circulating parasitemia.A major finding of our study  is the sitemias . Prolongereafter . Recent P. malariae infection is partially a result of comorbid conditions as opposed to the infection itself. However, given the similar frequency of major comorbidities such as pneumonia, renal disease and HIV compared with the other species, a major bias from differential rates of comorbidities seems unlikely. Finally, Highland Papuans are the ethnic group with the highest risk of severe anemia in Timika–possibly due to nutritional factors, red cell and hemoglobin abnormalities or gastrointestinal helminth infection. Whether for geographical or biological reasons, a particularly high proportion of P. malariae patients were highlanders, potentially contributing to the lower mean hemoglobin seen in these patients. After adjusting for various risk factors, including ethnicity, in the multivariable model, the risk of severe anemia in P. malariae infections was similar to that for P. falciparum and P. vivax monoinfections.It is also possible that the significant anemia seen with P. malariae infection and relatively high burden of falciparum and vivax malaria means that the latter species are more common causes of severe anemia and therefore more important targets for public health intervention. Nevertheless, on an individual basis, those with P. malariae parasitemia need to be investigated for anemia and treated aggressively if present. In this context, the relatively high rates of representation with P. malariae over the subsequent year (~4%), raises the possibility of partial response to ACT treatment coupled with prolonged subclinical carriage. There have been few studies of ACT drug efficacy in P. malariae and most have had only 28 days of follow-up [The low incidence of ollow-up . FurtherP. malariae infection, is mostly described in children living in endemic areas [P. malariae infections and nephrotic syndrome. Nevertheless, we have, for the first time been able to estimate the risk of this condition at 1 in 200 presentations to hospital for children with P. malariae infection under the age of 5 years. None of the 4 patients with nephrotic syndrome and P. malariae infection were reported to have died during the follow-up period however 3 of the 16 patients who died were recorded as having chronic renal failure (not further specified) and one had acute renal failure. Unfortunately we did not have access to information on the presence or absence of albuminuria  and thus was not the sole attributable cause of death.A similar proportion of all patients presenting to hospital with  species , 36 and/Plasmodium malariae’s tendency to cause prolonged asymptomatic and/or subpatent infections will confound elimination strategies that are based on active case detection or mass screening and treatment. Chronically infected patients with low-level parasitemia probably have substantial transmission potential and therefore mass drug administration campaigns could potentially have a significant impact on this species. Given the older age distribution of patients infected with P. malariae, it would be important to deliver the antimalarial drug to all age groups rather than just children.P. falciparum cases confirmed using rapid diagnostic tests), and parasitemia quantitation was not available. Previous studies have clearly demonstrated that microscopic diagnosis of P. malariae significantly underestimates the true prevalence of parasitemia when compared with PCR-based diagnosis and that correctly differentiating between P. malariae and P. falciparum based on morphology alone is fraught with error [P. malariae monoinfection with 5.3% of P. malariae cases actually deemed to be mixed P. malariae/P. falciparum infections and 26.3% of cases originally diagnosed as mixed P. malariae infections reclassified as P. malariae monoinfections [Plasmodium malariae infection is often asymptomatic or minimally symptomatic, it is therefore likely that a smaller proportion of individuals infected with this species in the community presented to hospital for assessment and treatment when compared to infections by the other Plasmodium species. A potentially large ascertainment bias will therefore have occurred leading to an underestimation of the true prevalence and burden of P. malariae parasitemia in this region. Previous studies have shown that subpatent infection with Plasmodium species is associated with under-recognised morbidity (as well as ongoing risk of transmission), mostly in the form of chronic anemia [Some important limitations of our study should be considered. Malaria diagnosis and species identification was based on microscopy alone Click here for additional data file.S1 Data(TXT)Click here for additional data file.


AbstractLonchophyllainexpectatasp. n. from the Caatinga of Brazil. This new species can be distinguished from all known species of Lonchophylla that occur in Brazil by dental traits, cranial size, and fur colour. Specimens of Lonchophyllainexpectata have been misidentified as Lonchophyllamordax; but Lonchophyllainexpectata is a pale-venter species, similar in external appearance to Lonchophylladekeyseri. We have found Lonchophyllainexpectata in the Caatinga of North-eastern Brazil; Lonchophyllamordax along the eastern border of the Caatinga and in the Atlantic Forest–Caatinga ecotone in North-eastern Brazil; and Lonchophylladekeyseri in the Cerrado of Mid-western Brazil, in the Brazilian Cerrado–Caatinga ecotone, and as far west as the Cerrado of Bolivia.We describe  Lonchophylla Thomas, 1903 (Phyllostomidae) comprises 12 species of nectar-feeding bats restricted to the Neotropics , includes the holotype (BM 1903.9.5.34) and seven paratypes. One of the paratypes was sent to the Smithsonian’s National Museum of Natural History, Washington, DC (USNM 123392). A few years after Thomas described Lonchophyllamordax, a series of Lonchophylla were collected in Barra, Bahia by Ernest Garbe and Robert H. Becker in 1908 and 1914, respectively. Barra, Bahia is in the sertão sub region (450 to 500 km west of Lamarão), a semi-arid environment that is characteristic of the Caatinga , one of those specimens collected by Garbe is housed in the Smithsonian’s National Museum of Natural History (USNM 238008). After comparing skins and skulls of Garbe’s and Thomas’s USNM specimens from Barra  and Lamarão , PageBreakwe determined that the pale-venter Lonchophylla from Barra could be distinguished from Lonchophyllamordax, and represented an undescribed species. Among distinctive traits distinguishing the Barra specimen from Lonchophyllamordax are the paler colour of the ventral fur and the smaller skull that has a narrower and more delicate rostrum.the west . AccordiCaatinga . Accordiax e.g., : 321. AsLonchophylla from localities in the Caatinga, Cerrado, and Atlantic Forest, as well as from transitional zones between these habitats. The material used in our comparisons represents all Lonchophylla species known to occur in Brazil. During this process we found additional features that support our hypothesis that the pale-venter Lonchophylla from the Caatinga represents a new species, which we describe below.To test this hypothesis and further understand the geographic distribution of Brazilian species, we examined series of Lonchophylla from the Caatinga of NE Brazil ; Cerrado of Bolivia (Santa Cruz) and Mid-western Brazil ; Atlantic Forest of SE Brazil ; and the Atlantic Forest–Caatinga ecotone in NE Brazil . This material includes representatives of all currently recognized Brazilian species of Lonchophylla, and includes primary and secondary types of Lonchophyllabokermanni (6 specimens from the type series), Lonchophylladekeyseri (holotype and one paratype), Lonchophyllamordax (holotype and one paratype), and Lonchophyllaperacchii (holotype and two paratypes). Vouchers are preserved in the American Museum of Natural History ; Carnegie Museum of Natural History ; Museu Nacional ; Muséum d’histoire naturelle ; Natural History Museum ; Smithsonian’s National Museum of Natural History ; Universidade Estadual Paulista Júlio de Mesquita Filho ; Universidade Federal do Espírito Santo ; Universidade Federal Rural do Rio de Janeiro . A complete list of specimens examined is in the Appendix. Most geographical coordinates follow The material we used in the comparisons includes series of PageBreakthe crown of M3; breadth across canines (BAC), greatest breadth across outer surface of the crowns of upper canines, including cingulae; breadth across molars (BAM), greatest breadth across outer edges of the crowns of upper molars; postorbital breadth (POB), least breadth across frontals posterior to the postorbital bulges; braincase breadth (BCB), greatest breadth of the globular part of the braincase; mastoid breadth (MAB), greatest breadth across the mastoid region; mandibular length (MAL), from the mandibular symphysis to the condyloid process; and the mandibular toothrow length (MAN), from the anterior crown of the lower canine, including cingulum, to the posterior crown of m3. Craniodental measurements were taken under binocular dissection microscopes with low magnification . Dimensions were taken by only one of us, using digital callipers accurate to 0.02 mm. Measurements were recorded and analysed to the nearest 0.01 mm, but values were rounded off to 0.1 mm throughout the text because this is the smallest unit that allows accurate repeatability with callipers  or grams ([g] body mass). The body mass was recorded from skin labels. Other dimensions include: the forearm length (FA), from the elbow to the distal end of the forearm including carpals, measured with the wing partially folded; greatest length of skull (GLS), from the posteriormost point of the occiput to the tips of the upper inner incisors; condylo-incisive length (CIL), from the line connecting the occipital condyles to the tips of the upper inner incisors; basal length (BAL), from the anterior margin of the foramen magnum to the tips of the upper inner incisors; maxillary toothrow length (MTL), from the anterior surface of the upper canine, including the cingulum, to the posterior surface of M3; molariform toothrow length (M1M3), from the crown of M1 to allipers . Descripallipers .Discriminant Function Analysis (DFA) was used to compare taxa. For the analysis, we selected a subset of the cranial dimensions  to represent different axes of length and width of the skull. As multivariate procedures require complete datasets, missing values  were substituted by means. Measurements were transformed to natural logarithms and the covariance matrices were computed considering all variables. DFA was performed in SPSS.Nomenclature of tooth morphology follows Taxon classificationAnimaliaChiropteraPhyllostomidaehttp://zoobank.org/610DFBAE-1726-4666-9B3F-BDCC063D25D2LonchophyllamordaxLonchophyllamordax Thomas, 1903. : LonchophyllamordaxLonchophyllamordax Thomas, 1903. : LonchophyllamordaxLonchophyllamordax Thomas, 1903. : LonchophylladekeyseriLonchophylladekeyseri Taddei, Vizotto & Sazima, 1983. : LonchophyllamordaxLonchophyllamordax Thomas, 1903. : LonchophylladekeyseriLonchophylladekeyseri Taddei, Vizotto & Sazima, 1983. : PageBreak12°42'S, 41°33'W), Bahia, Brazil, on January 1908. Skull and mandible are in good condition except for the minimally damaged anteriormost portion of the foramen magnum. The body is prepared as dry skin. PageBreakbranes seem to be faded. External and craniodental measurements for the holotype and paratypes are in Table An adult male, USNM 238008, with skin and skull Figures , 2, incl08°37'S, 37°09'W [coordinates for Catimbau National Park]), PageBreakand was collected by D. Guerra in 1970. Thirty-eight vouchers are from 17 km south of Exu, Pernambuco , elevation ca. 480 m, and were collected by M. R. Willig in 1976. Paratypes from Barra , and Buíque (FMNH 137414) are in spirits, others are prepared as dry skin.The paratype series comprises 46 vouchers. Three paratypes are from the type locality in Barra, Bahia , and were collected by R. H. Becker in 1914. One is from Serra do Catimbau, Buíque, Pernambuco  from the Caatinga of Andaraí, Bahia may represent Lonchophyllainexpectata occurs in the Caatinga of North-eastern (NE) Brazil, with confirmed records from Pernambuco (NE), and Bahia (NE)  Figure .Lonchophyllainexpectata can be distinguished from all South American species that occur east of the Andes by the following set of traits: presence of a lingual cusp in the P4, absence of a lingual cusp in the P3, absence of a deep longitudinal groove in the posterior face of the upper canine, proximal portion of the dorsal surface of the forearm not furred, and ventral fur pale.PageBreakLonchophylla, the dental formula of Lonchophyllainexpectata is 2/2, 1/1, 2/3, 3/3 = 34. Lonchophyllainexpectata, Lonchophylladekeyseri and Lonchophyllabokermanni are the three pale-venter Brazilian species of the genus, whereas Lonchophyllamordax and Lonchophyllaperacchii have pale-brown ventral pelage. We did not find evidence of Lonchophyllabokermanni and Lonchophyllaperacchii in sympatry with Lonchophyllainexpectata—Lonchophyllabokermanni is restricted to a small area in the Serra do Espinhaço, Cerrado of Minas Gerais; and PageBreakLonchophyllaperacchii occurs in the Atlantic Forest, from Espírito Santo southward to São Paulo. Lonchophyllainexpectata can be distinguished from these two species by the presence of a well-developed lingual cusp in the P4, with lingual root in the median portion of the tooth; absence of a groove along the anterior surface of the upper canines; and proximal portion of the dorsal surface of the forearm not covered with fur.Like other Lonchophyllainexpectata resembles Lonchophylladekeyseri in the pale ventral fur, and Lonchophyllamordax in the dental morphology. These three species overlap partially in external and cranial size, but in general, cranial measurements for Lonchophyllainexpectata average significantly larger than those for Lonchophylladekeyseri and smaller than those for Lonchophyllamordax , along with one other specimen from the same locality of the type series (MHNG 667.13 [identified as Lonchophyllamordax by Thomas]), and samples from a nearby locality having similar habitat —whose external and skull morphology fit with those of the type series of Lonchophyllamordax —we concluded that Lonchophyllamordax has a light-brown ventral pelage, which is consistently darker than the paler ventral pelage of the type material of PageBreakLonchophylladekeyseri and other samples of this species. The ventral pelage of specimens from Barra, Bahia (Lonchophyllainexpectata) is similar to that of Lonchophylladekeyseri. Under “historical remarks” we discuss the reasons for previous assignments of pale-venter samples from the Caatinga of NE Brazil (= Lonchophyllainexpectata) to Lonchophyllamordax.es e.g., , and subazil see . HoweverLonchophyllainexpectata averages significantly smaller than Lonchophyllamordax in all cranial dimensions except in POB and BCB . Lonchophyllainexpectata can also be distinguished by the ventral pelage, which varies from whitish  to pale greyish , but near Buffy Brown in Lonchophyllamordax . The throat and the posterior region of the belly are consistently paler, tending to whitish, in Lonchophyllainexpectata , but Lonchophylladekeyseri averages slightly larger in those measurements of the width of skull and rostrum , indicating a longer but narrower skull in Lonchophyllainexpectata (Table Lonchophyllainexpectata can be distinguished from Lonchophylladekeyseri by the narrower first upper premolar (P3) in occlusal view, with lingual lobe absent or obsolete ; upper molars (M1 and M2) with low crowns in lateral view (molars with higher crowns in dekeyseri); parastyle of M1 projecting labially over the posterior labial margin of the last upper premolar (P4); mesostyle of M1 shorter; metastyle of M1 well developed ; mesostyle of M2 shorter; metastyle of M2 distinct, moderate or well developed (reduced or absent in dekeyseri).i Figure ); absenci Figure ); parastLonchophylladekeyseri (three groups from the Cerrado of Mid-western Brazil), Lonchophyllainexpectata (two groups from the Caatinga of NE Brazil), and Lonchophyllamordax . The first two discriminant functions  summarized 47% and 40% of the total variation, respectively  new taxonomic status of pale-venter populations of Lonchophylla from the Caatinga of North-eastern Brazil.The name “PageBreakHistorical remarks. Previous assignments of Lonchophyllainexpectata to Lonchophyllamordax seem to have originated with Lonchophyllamordax on the series from Barra, which was collected by Garbe and deposited in the Museu de Zoologia da Universidade de São Paulo. Barra is in the sertão of Bahia (Caatinga), ca. 450–500 km west of Lamarão, which is in the agreste of Bahia . Lonchophyllamordax as follows:General external appearance, so far as can be judged by skins, exactly as inGlossophagasoricina, except that the colour averages paler. The type is near “cinnamon-brown” above, the bases of the hairs whitish, and “wood-brown” below, but there is some variation in tone, and the darker specimens are quite as dark as the paler examples ofGlossophagaobtained at the same place.Lonchophyllamordax] are quite as dark as the paler examples of Glossophaga obtained at the same place.” Lima’s conclusion might be biased by the series he had at hand, primarily composed by pale-venter specimens from Barra, Bahia. However, at that time, Lonchophyllamordax was unquestionably the closest species—geographically and morphologically. Although Lima had identified this series from Barra as Lonchophyllamordax, the label of the USNM 238008 bears the notation “Subsp. n.?”Lonchophyllamordax on the same specimens collected by Garbe. Both recognized Lonchophyllamordax as a pale-venter species. This was followed by Lonchophylladekeyseri) with “Lonchophyllamordax”—the other pale-venter species from NE Brazil, according to those authors. However, according to Lonchophyllamordax is “wood-brown”, but with some variation, with darker specimens almost as dark as paler specimens of Glossophaga from the same area. PageBreakGlossophagasoricina (Phyllostomidae)—the only species of the genus that occur in the region—has ventral pelage varying from “buffy to fuscous” , qualitative cranial features, and karyotypes .la sensu  as a parla sensu . Combini species . HoweverLonchophylladekeyseri and Lonchophyllamordax are in parapatry with Lonchophyllainexpectata: Lonchophylladekeyseri occurs in the Cerrado of Brazil and possibly in the Bolivian savannah  and the Cerrado–Caatinga ecotone in NE Brazil (DZSJRP 11459); and Lonchophyllamordax occurs in the Atlantic Forest–Caatinga ecotone (agreste), and along the eastern border of the Caatinga (sertão). We are not convinced that Lonchophylladekeyseri occurs in the Bolivian savannah and in the Cerrado–Caatinga ecotone in NE Brazil. One of the specimens supporting these records was examined a long time ago (DZSJRP 11459), and the other two  are distinct from other samples of Lonchophylladekeyseri as determined in a previous discriminant function analysis. These specimens are not included in this analysis because we were not able to compare them with samples from other localities. Records previously assigned to Lonchophyllamordax from N Brazil are based primarily on Lonchophyllathomasi, now Hsunycteristhomasi. Similarly, previous unvouchered records of Lonchophyllamordax from the Atlantic Forest of SE Brazil apparently represent Lonchophyllaperacchii based on the identity of material we have examined from nearby localities.The samples we have available show that Lonchophyllathomasi J. A. Allen, 1904 to Hsunycteris, Lonchophyllainexpectata is the fifth Lonchophylla reported from Brazil—all pending phylogenetic positioning. There are several specimens pending verification of identity, particularly those from the Caatinga. Additional material, particularly from NE and Mid-western Brazil, will be important to a clearer understanding of the taxonomic diversity, and the geographic distribution of Brazilian species of Lonchophylla.After


Plasmodium falciparum (Pf)-infected patients may be helpful for malaria control. This study aims to determine nutritional status and evaluate the influence of malnutrition on the immune response of infected patients in Lagos, Nigeria.In malaria endemic regions, malnutrition has also been reported to be a public health problem. Considering that the pattern of host cytokines-mediated innate immunity is critical in determining malaria outcomes-understanding the impact of malnutrition on innate immune response in 2 was taken as an index of malnutrition while participants <20 years were further classified based on Z-scores (Z-Scores ≤-2) into stunted, wasted or underweight. TNF-α, interleukin-1β and interleukin-12 were determined by ELISA and haematological parameters (Full blood count) were measured using Beckman Coulter Closed Tube Automated Hematology System. Statistical analysis was done using SPSS Version 17. The study protocol was approved by NIMR Institutional Review Board.Volunteers  with a history of fever or axilliary temperature ≥37°C were screened microscopically for Pf in a cross-sectional study at Ijede General Hospital, Lagos, Nigeria. Body mass index (BMI) of patients was determined and used as a measure of nutritional status. A BMI of <18.5 kg/mP = 0.001). Mean levels of TNF-α were significantly higher in malnourished patients P < 0.05.A total of 364 patients comprising of 47% males and 53% females with a median age of 10 years were recruited for which average BMI was 18.19+6.10. Malaria prevalence was 20.85% and malnutrition rate 62.5%. In the <20 years group, 24 (16.7%) were stunted, 30 (20.8%) were underweight and 48 (33.3%) were wasted. TNF-α was associated with age, observed to be higher in <5 years (This study suggests that nutritional status modulates malaria outcomes and pattern of progression in all ages with an inference of high malnutrition rate in the studied population.


We have previously demonstrated that miR-1180-5p has potent ability to upregulate p21 expression by targeting promoter and inhibit bladder cancer. This prompted us to conjecture that a candidate dsRNA (dsP21-397) with perfect complementarity to the miR-1180-5p target site of p21 promoter may also trigger p21 expression. Transfection of dsP21-397 into T24 and EJ cells significantly activated p21 expression at 72 h and the activation presented in a time-course and dose-dependent manner. Moreover, the p21-activated activities of dsP21-397 and miR-1180-5p are not significantly different. Overexpression of p21 downregulated Cyclin D1, CDK4/6, and Cyclin A2 expression, and thereby induced cell cycle arrest and inhibited proliferation. Moreover, dsP21-397 suppressed bladder cancer largely depended on manipulating p21. In conclusion, our study identifies a pair of miRNA-dsRNA mediating endogenous p21 overexpression. WAF1/CIP1 (p21) is a broad-acting cyclin-dependent kinase (CDK) inhibitor that binds and inhibits Cyclin-CDK complexes and thereby mediates cell cycle in the G1 phase and leads to proliferation arrest . It Next, we evaluated the time-course effects of dsP21-397-mediated upregulation of p21 in BC cell lines. As shown in Figures To investigate the effect of p21 upregulation induced by dsP21-397 on BC cells development, we analyzed the expression of Cyclin-CDK which manipulates the cell cycle progression. As shown in ueous One Solution Cell Proliferation Assay demonstrated that compared to mock and dsControl groups, both T24 and EJ cells transfected dsP21-397 exhibited progressive retarded growth from day 2 following transfection , which is completely complementary to putative miR-1180-5p target site of p21 promoter, exhibits considerable potency to activate p21 expression in BC cells. And this activation presents a time-course and dose-dependent effect. Moreover, dsP21-397 possesses a similar capacity with miR-1180-5p to enhance p21 expression. Several Cyclin-CDK genes  associated with cell cycle are downregulated following dsP21-397 transfection. Hereby, transfection of dsP21-397 causes BC cells' cycle arrest and impedes proliferation. In addition, this dsRNA's antitumor function is mainly achieved by regulating p21 expression.One distinctive feature of cancer cells is their sustained proliferative activity; thus blockade of cell cycle is regarded as effective strategy for cancer therapy . Cell cyEarlier studies indicated that p21 is frequently low expressed in BC cells and correlates with prognosis , 23; enhRNAi is a posttranscriptional gene silencing mechanism while RNAa functions at the transcriptional level , 26. RNAAs we know, high complementarity of sequences between miRNA/dsRNA and its target promoter is essential for RNAa . PreviouRecently, noncoding RNAs, such as enhancer RNAs (eRNAs) and natural antisense transcripts (NATs), have been recognized to regulate genes expression by interacting with promoter. However, their gene modulating modes are distinct from RNAa. Generally, eRNAs are transcribed from enhancers and contribute to enhancers function by mediating enhancer-promoter interaction , 32. SeqBC arising contains numerous genetic alternations, such as inactivation of tumor suppressor genes , 36. TheTaken together, our results provide evidences that dsP21-397 stimulated p21 expression by targeting promoter-derived sequences which is identical to miR-1180-5p target site. Moreover, dsP21-397 also has the capacity to induce cell cycle arrest and inhibits proliferation of BC cells. Our study first identifies a pair of miRNA-dsRNA which both mediate endogenous p21 overexpression and suppress BC.Supplementary Table S1: All dsRNAs used in present study werechemically synthesized with dTdT 3'overhangs. The dsP21-397 complementary to the p21 promoter at sequences position -397 relative to the transcription starting site was used to activate p21 expression. The control dsRNA (dsControl) was designed to lack significant homology to all known human genes' sequences. The dsRNA (siP21) was used to silence p21 expression by targeting p21 mRNA 3' untranslated regions.Supplementary Table S2: The primes were used to detect p21 and GAPDH mRNA relative expression levels in BC cell lines by real-time PCR.Figure S1: In order to compare the activating activities between miR-1180-5p and dsP21-397, we transfected T24 and EJ cells with miR-1180-5p or dsP21-397 at 0nM, 25nM, 50nM and 100nM, respectively. 72 h later, p21 mRNA was determined by real-time PCR and the miR-1180-5p induced p21 mRNA expression levels were normalized to dsP21-397 groups at the same concentrations. As shown in Figure S1A and S1B, the p21 expression was not significantly different between miR-1180-5p and dsP21-397 at the same transfecting concentrations in T24 and EJ cells.