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To evaluate insulin resistance (IR) among outpatients with bipolar disorder (BD) in order to determine clinical correlates of IR in this patient population.
We performed a cross-sectional study in sixty-five DSM-IV-TR BD patients consecutively assessed from January to August 2007 at the Bipolar Disorder Program, Hospital de Clínicas de Porto Alegre, Brazil. IR was diagnosed using the homeostatic model assessment - insulin resistance (HOMA-IR). Metabolic syndrome (MS) diagnosis and metabolic variables were assessed using three definitions: National Cholesterol Educational Program - Adult Treatment Panel III (NCEP-ATP III); NCEP-ATP III modified criteria and International Diabetes Federation (IDF).
IR was present in 43.1% of the sample (women 40%, men 44.4%). The prevalence of MS defined by the NCEP-ATP III criteria was 32.3%, NCEP-ATP III modified was 40% and IDF was 41.5%. NCEP-ATP III modified criteria showed the best trade-off between sensitivity (78.6%) and specificity (89.2%) to detect insulin resistance. Waist circumference was the best clinical parameter associated with IR in the linear regression model (B=0.014, SE 0.002, t=6.18, p< 0.001). Areas under ROC curves were similar for waist circumference and different MS definitions (chi2=2.98, df=3, p=0.39).
Currently MS criteria may provide reasonable sensitivity and specificity for the detection of insulin resistance in patients with bipolar disorder. Waist circumference may be a simple and inexpensive means to predict insulin resistance in this population.
Il est fréquent de penser que les femmes souffrant de trouble des conduites alimentaires (TCA) ne peuvent pas être enceintes (aménorrhée, irrégularités du cycle ovulatoire), mais plusieurs études [1–3] révèlent un nombre croissant de femmes souffrant d’un TCA parmi la population ayant recours aux divers traitements de l’infertilité. La stimulation ovarienne par pompe à GnRH est l’un des traitements de l’infertilité, étant très efficace avec un taux de réussite de 91,8 % , il a été conçu pour les femmes présentant une aménorrhée de type hypothalamohypophysaire, dont les deux principales causes sont le syndrome de Kalmann et un apport calorique insuffisant. L’objectif de cette étude est de diagnostiquer la prévalence d’un TCA parmi une population de femmes ayant recours à la pompe à GnRH. Nous avons créé un groupe « étude » constitué de femmes sous ce type de traitement, et un groupe « contrôle », constitué de femmes sous traitement par d’autres méthodes de procréation médicalement assistée (PMA). Nous avons utilisé le « Composite International Diagnostic Interview » (CIDI), un hétéro-questionnaire capable de diagnostiquer la présence d’un TCA, actuel ou passé. Chaque groupe est constitué de 21 patientes. Parmi les femmes en traitement sous pompe à GnRH, 20 sur 21 présentent un diagnostic positif de TCA, soit 95,2 % du groupe. Parmi celles traitant leur infertilité par d’autres méthodes de PMA, ce diagnostic a été établi chez seulement 5, soit 23,8 % du groupe (p = 0,00002). En conclusion de cette étude, nous souhaitons alerter la communauté scientifique et médicale : la périnatalité chez les femmes souffrant d’un TCA est un enjeu de santé publique. Il nous paraît nécessaire d’effectuer un dépistage dans les PMA et l’accès de ces femmes doit être réfléchi en cas d’un TCA actif. De plus, nous recommandons la mise en place d’équipes multidisciplinaires spécialisées pour les accompagner pendant le processus de périnatalité/maternité.
The current study was carried out to examine the effect of cottonseed processing and chitosan supplementation on lamb performance, digestibility and nitrogen digestion. Eighty uncastrated Santa Inês lambs (23 ± 2.2 kg average weight, 4 months old) were distributed in a completely randomized design in a 2 × 2 factorial arrangement that consisted of two cottonseed processing forms (whole or ground) and two chitosan levels (0 or 136 mg/kg live weight). Higher dry matter and organic matter apparent digestibility coefficient (ADC) was achieved with the diets containing the whole cottonseed. Ether extract ADC was higher in the animals fed the chitosan-containing diet. There was an interaction effect on the ADC of neutral detergent fibre corrected for ash and protein, which increased with chitosan inclusion associated with the whole cottonseed. The lambs that received the treatment containing the whole cottonseed showed higher microbial protein synthesis. Chitosan addition increased nitrogen retention. The animals fed chitosan-containing diets showed higher microbial protein synthesis. There was an interaction effect on microbial protein synthesis. Whole cottonseed associated with chitosan in lamb diets increases ether extract ADC and microbial protein synthesis.
Intake, digestibility, nitrogen (N) balance, microbial protein synthesis, weight gain, yields of the main commercial cuts and carcass morphometric measurements were evaluated in lambs fed diets containing different levels of chitosan. Sixty Santa Inês crossbred sheep with an average body weight (BW) of 24 ± 2.2 kg were assigned to three treatments (diets containing 0, 136 or 272 mg chitosan/kg BW) in a completely randomized design. There was no effect of chitosan on dry matter (DM) intake. Ingested and retained N showed a quadratic response, with the highest values estimated at the chitosan levels of 142 and 152 mg/kg BW, respectively. Similar to N balance, microbial protein synthesis showed the same quadratic response, in which the level of 136 mg/kg BW resulted in higher synthesis when compared with the other levels. No effect of chitosan was detected on average daily gain, final weight, or carcass variables (hot carcass weight, cold carcass weight, yield of commercial cuts and morphometric measurements of the carcass). Conformation, visceral fat content and fatness of carcasses were also not altered by the use of chitosan. Chitosan improves the digestibility of DM, crude protein and neutral detergent fibre, and increases N balance and microbial protein synthesis but does not change the production performance of feedlot lambs.
Keto analogues and amino acids (KAAA) supplementation can reduce blood ammonia concentrations in athletes undergoing high-intensity exercise under both ketogenic and thermoneutral conditions. This study evaluated the acute effects of KAAA supplementation on ammonia metabolism during extenuating endurance exercise in rats fed a ketogenic diet. In all, eighty male Fischer rats at 90 d of age were divided into eight groups, and some were trained using a swimming endurance protocol. A ketogenic diet supplemented with keto analogues was administered for 10 d. Administration of the ketogenic diet ended 3 d before the exhaustion test (extenuating endurance exercise). A ketogenic diet plus KAAA supplementation and extenuating endurance exercise (trained ketogenic diet supplemented with KAAA (TKKa)) increased blood ammonia concentrations by approximately 50 % compared with the control diet (trained control diet supplemented with KAAA (TCKa)) and similar training (effect size=1·33; statistical power=0·50). The KAAA supplementation reduced blood urea concentrations by 4 and 18 % in the control and ketogenic diet groups, respectively, compared with the groups fed the same diets without supplementation. The trained groups had 60 % lower blood urate concentrations after TCKa treatment than after TKKa treatment. Our results suggest that KAAA supplementation can reduce blood ammonia concentrations after extenuating endurance exercise in rats fed a balanced diet but not in rats fed a ketogenic diet.
This study aimed to explore effects of adjunctive treatment with N-acetyl cysteine (NAC) on markers of inflammation and neurogenesis in bipolar depression.
This is a secondary analysis of a placebo-controlled randomised trial. Serum samples were collected at baseline, week 8, and week 32 of the open-label and maintenance phases of the clinical trial to determine changes in interleukin (IL)-6, IL-8, IL-10, tumour necrosis factor-α (TNF-α), C-reactive protein (CRP) and brain-derived neurotrophic factor (BDNF) following adjunctive NAC treatment, and to explore mediation and moderator effects of the listed markers.
Levels of brain-derived neurotrophic factor (BDNF), tumour necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukins (IL) -6, 8, or 10 were not significantly changed during the course of the trial or specifically in the open-label and maintenance phases. There were no mediation or moderation effects of the biological factors on the clinical parameters.
The results suggest that these particular biological parameters may not be directly involved in the therapeutic mechanism of action of adjunctive NAC in bipolar depression.
This study systematised and synthesised the results of observational studies that were aimed at supporting the association between dietary patterns and cardiometabolic risk (CMR) factors among adolescents. Relevant scientific articles were searched in PUBMED, EMBASE, SCIENCE DIRECT, LILACS, WEB OF SCIENCE and SCOPUS. Observational studies that included the measurement of any CMR factor in healthy adolescents and dietary patterns were included. The search strategy retained nineteen articles for qualitative analysis. Among retained articles, the effects of dietary pattern on the means of BMI (n 18), waist circumference (WC) (n 9), systolic blood pressure (n 7), diastolic blood pressure (n 6), blood glucose (n 5) and lipid profile (n 5) were examined. Systematised evidence showed that an unhealthy dietary pattern appears to be associated with poor mean values of CMR factors among adolescents. However, evidence of a protective effect of healthier dietary patterns in this group remains unclear. Considering the number of studies with available information, a meta-analysis of anthropometric measures showed that dietary patterns characterised by the highest intake of unhealthy foods resulted in a higher mean BMI (0·57 kg/m²; 95 % CI 0·51, 0·63) and WC (0·57 cm; 95 % CI 0·47, 0·67) compared with low intake of unhealthy foods. Controversially, patterns characterised by a low intake of healthy foods were associated with a lower mean BMI (−0·41 kg/m²; 95 % CI −0·46,−0·36) and WC (−0·43 cm; 95 % CI −0·52,−0·33). An unhealthy dietary pattern may influence markers of CMR among adolescents, but considering the small number and limitations of the studies included, further studies are warranted to strengthen the evidence of this relation.
To examine changes in the spatial clustering of malnutrition in children under 5 years of age (under-5s) for the period 1999 to 2011 in Bangladesh.
We used data from four nationally representative Demographic and Health Surveys (DHS) conducted in 1999–2000, 2004, 2007 and 2011 in Bangladesh involving a total of 24 211 under-5s located in 1661 primary sampling units (PSU; geographical unit of analysis) throughout Bangladesh. The prevalence of stunting (height/length-for-age Z-score <−2), underweight (weight-for-age Z-score <−2) and wasting (weight-for-height/length Z-score <−2) at each PSU site and for each survey year were estimated based on the WHO child growth standard. The extent of spatial clustering was quantified using semivariograms.
Whole of Bangladesh.
Children under 5 years of age.
Our results demonstrate that in 1999–2000 most PSU throughout Bangladesh experienced stunting, underweight and wasting prevalence which exceeded the WHO thresholds. By 2011, this situation improved, although in two of the six divisions (Barisal and Sylhet) PSU still exhibited higher levels of malnutrition compared with other divisions of the country. The pattern of spatial clustering for stunting, underweight and wasting also changed between 1999 and 2011 both at national and sub-national (division) levels.
We identified divisions where malnutrition indicators (stunting, underweight and wasting) remain highly clustered and other divisions where they are more widely spread in Bangladesh. This has important implications on how interventions for malnutrition need to be delivered (geographically targeted interventions v. random interventions) within each division of the country.
Among the polychaetes, the family Cirratulidae is one of the most challenging taxonomically because most of the currently used diagnostic characters change during ontogeny. It is therefore necessary to use a combination of characters to make an accurate identification. The present work is the first of a planned revision of the genus Cirratulus from coastal zones of Argentina. The examined material came from the two largest natural history museums of the country, and showed several morphotypes. Some specimens corresponded to described species, but others were undoubtedly undescribed. Among the previously known Cirratulidae, Cirratulus jucundus (Kinberg, 1866) and Cirratulus patagonicus (Kinberg, 1866), formerly distributed for Antarctica are now also present in coastal continental areas of Argentina. The new species Cirratulus mianzanii sp. nov. is described from subtidal areas off Peninsula Valdés, Patagonia. This species is distinguished from its congeners by the segmental origin of both tentacular filaments and first pair of branchiae in the junction between the peristomium and first chaetiger. Branchiae arise some distance from the notopodium but not at the dorsal midline of the body. Ventral groove present along the body, with a fine dark midline. Capillary chaetae are serrate seen under an optical microscope, and the segmental origin of neuro- and notopodial spines is different from other species of the genus.
Pertussis epidemics have displayed substantial spatial heterogeneity in countries with high socioeconomic conditions and high vaccine coverage. This study aims to investigate the relationship between pertussis risk and socio-environmental factors on the spatio-temporal variation underlying pertussis infection. We obtained daily case numbers of pertussis notifications from Queensland Health, Australia by postal area, for the period January 2006 to December 2012. A Bayesian spatio-temporal model was used to quantify the relationship between monthly pertussis incidence and socio-environmental factors. The socio-environmental factors included monthly mean minimum temperature (MIT), monthly mean vapour pressure (VAP), Queensland school calendar pattern (SCP), and socioeconomic index for area (SEIFA). An increase in pertussis incidence was observed from 2006 to 2010 and a slight decrease from 2011 to 2012. Spatial analyses showed pertussis incidence across Queensland postal area to be low and more spatially homogeneous during 2006–2008; incidence was higher and more spatially heterogeneous after 2009. The results also showed that the average decrease in monthly pertussis incidence was 3·1% [95% credible interval (CrI) 1·3–4·8] for each 1 °C increase in monthly MIT, while average increase in monthly pertussis incidences were 6·2% (95% CrI 0·4–12·4) and 2% (95% CrI 1–3) for SCP periods and for each 10-unit increase in SEIFA, respectively. This study demonstrated that pertussis transmission is significantly associated with MIT, SEIFA, and SCP. Mapping derived from this work highlights the potential for future investigation and areas for focusing future control strategies.
We conducted a longitudinal assessment in 466 underweight and 446 normal-weight children aged 6–24 months living in the urban slum of Dhaka, Bangladesh to determine the association between vitamin D and other micronutrient status with upper respiratory tract infection (URI) and acute lower respiratory infection (ALRI). Incidence rate ratios of URI and ALRI were estimated using multivariable generalized estimating equations. Our results indicate that underweight children with insufficient and deficient vitamin D status were associated with 20% and 23–25% reduced risk of URI, respectively, compared to children with sufficient status. Underweight children, those with serum retinol deficiency were at 1·8 [95% confidence interval (CI) 1·4–2·4] times higher risk of ALRI than those with retinol sufficiency. In normal-weight children there were no significant differences between different vitamin D status and the incidence of URI and ALRI. However, normal-weight children with zinc insufficiency and those that were serum retinol deficient had 1·2 (95% CI 1·0–1·5) times higher risk of URI and 1·9 (95% CI 1·4–2·6) times higher risk of ALRI, respectively. Thus, our results should encourage efforts to increase the intake of retinol-enriched food or supplementation in this population. However, the mechanisms through which vitamin D exerts beneficial effects on the incidence of childhood respiratory tract infection still needs further research.
To estimate the average annual rates of reduction of stunting, underweight and wasting for the period 1996 to 2011, and to evaluate whether Bangladesh will be expected to achieve the target of Millennium Development Goal 1C of reducing the prevalence of underweight by half by 2015.
We used five nationwide, cross-sectional, Demographic and Health Survey data sets to estimate prevalence of undernutrition defined by stunting, underweight and wasting among children under 5 years of age using the WHO child growth standards. We then computed the average annual rates of reduction of prevalence of undernutrition using the formula derived by UNICEF. Finally, we projected the prevalence of undernutrition for the year 2015 using the estimated average annual rates of reduction.
Nationwide covering Bangladesh.
Children under 5 years of age (n 28 941).
The prevalence of stunting decreased by 18·8 % (from 60·0 % to 41·2 %), underweight by 16·0 % (from 52·2 % to 36·2 %) and wasting by 5·1 % (from 20·6 % to 15·5 %) during 1996 to 2011. The overall average annual rates of reduction were 2·84 %, 2·69 % and 2·47 %, respectively, for stunting, underweight and wasting. We forecast that in 2015, the prevalence of stunting, underweight and wasting will be 36·7 %, 32·5 % and 14·0 %, respectively, at the national level. The prevalence of undernutrition is likely to remain high in rural areas, in the Sylhet division and in the poorest wealth quintile.
Bangladesh is likely to achieve the Millennium Development Goal 1C target of reducing the prevalence of underweight by half by 2015. However, it is falling behind in reducing stunting and further investment is needed to reduce individual, household and environmental determinants of stunting in Bangladesh.
Starlight polarization provides insight into the physical mechanisms in and around the source as well as its geometry, whether or not the source is resolved. In this talk we will review mechanisms that polarize light in stellar envelopes. The observations and modeling can be used to probe the physics of the circumstellar environment as well as its relation to the ambient interstellar environment.
The course of bipolar disorder progressively worsens in some patients. Although responses to pharmacotherapy appear to diminish with greater chronicity, less is known about whether patients' prior courses of illness are related to responses to psychotherapy.
Embedded in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) was a randomized controlled trial of psychotherapy for bipolar depression comparing the efficacy of intensive psychotherapy with collaborative care (a three-session psycho-educational intervention). We assessed whether the number of previous mood episodes, age of illness onset, and illness duration predicted or moderated the likelihood of recovery and time until recovery from a depressive episode in patients in the two treatments.
Independently of treatment condition, participants with one to nine prior depressive episodes were more likely to recover and had faster time to recovery than those with 20 or more prior depressive episodes. Participants with fewer than 20 prior manic episodes had faster time to recovery than those with 20 or more episodes. Longer illness duration predicted a longer time to recovery. Participants were more likely to recover in intensive psychotherapy than collaborative care if they had 10–20 prior episodes of depression [number needed to treat (NNT) = 2.0], but equally likely to respond to psychotherapy and collaborative care if they had one to nine (NNT = 32.0) or >20 (NNT = 9.0) depressive episodes.
Number of previous mood episodes and illness duration are associated with the likelihood and speed of recovery among bipolar patients receiving psychosocial treatments for depression.
To evaluate the association between weight gain in the first two years of life and the occurrence of wheezing, asthma, serum IgE, skin reactivity and pulmonary function.
The metropolitan region of Salvador, Bahia, Brazil.
The association was studied between 1997 and 2005 in 669 children up to 11 years of age. Data were collected on asthma and risk factors, both current factors and those present in the first years of life. Weight gain was considered fast when the Z-score was >0·67. Poisson regression was used in the multivariate statistical analysis.
Wheezing was reported in 25·6 % of the children. Weight gain was considered fast (Z-score >0·67) in 29·6 % of the children and slow (Z-score <−0·67) in 13·9 %. Children in the slow weight gain group had 36 % fewer symptoms of asthma (prevalence ratio = 0·65; 95 % CI 0·42, 0·99).
Slower weight gain in the early years of life may constitute a protective factor against symptoms of asthma. The relevance of this finding for public health is not yet certain, since it is known that children with slow and fast weight gain may be more likely to develop adverse health consequences related to both these situations.
Due to an increasing demand for natural products to control coccidiosis in broilers, we investigated the effects of supplementing a combination of ethanolic extracts of Artemisia annua and Curcuma longa in drinking water. Three different dosages of this herbal mixture were compared with a negative control (uninfected), a positive control (infected and untreated), chemical coccidiostats (nicarbazin+narazin and, later, salinomycin), vaccination, and a product based on oregano. Differences in performance (weight gain, feed intake, and feed conversion rate), mortality, gross intestinal lesions and oocyst excretion were investigated. Broilers given chemical coccidiostats performed better than all other groups. Broilers given the two highest dosages of the herbal mixture had intermediate lesion scores caused by Eimeria acervulina, which was higher than in broilers given coccidiostats, but less than in broilers given vaccination, oregano and in negative controls. There was a trend for lower mortality (P = 0·08) in the later stage of the growing period (23–43 days) in broilers given the highest dosage of herbal mixture compared with broilers given chemical coccidiostats. In conclusion, the delivery strategy of the herbal extracts is easy to implement at farm level, but further studies on dose levels and modes of action are needed.
This study was conducted to investigate the physiological response of sugarcane genotypes to drought and its consequence for stalk yield. Sugarcane genotypes IACSP94-2094, IACSP96-2042 and SP87-365 were subjected to water deficit during the initial growth phase by withholding water. Resistance and sensitivity patterns were defined by the impact of drought on the stalk yield and content of soluble solids in the stalk juice. IACSP94-2094 and SP87-365 were considered drought-resistant genotypes, as the stalk dry matter production and yield of soluble solids were not reduced by the water deficit. Although drought caused reductions in leaf gas exchange in all the genotypes, IACSP96-2042 was most affected when considering the cumulative reduction in photosynthesis throughout the experimental period. This photosynthetic impairment of IACSP96-2042 was related to both non-stomatal and stomatal limitations, whereas photosynthesis in SP87-365 and IACSP94-2094 were only stomatally limited under drought. In general, a reduced photosynthetic sensitivity to water deficit was an important physiological trait for dry matter production in sugarcane plants, and the concentrations of soluble carbohydrates, sucrose, starch and proline in the leaves did not reveal consistent differences between the patterns of resistance and sensitivity. Even though IACSP96-2042 was severely affected by water shortage, this genotype presented a similar stalk yield under drought and the highest stalk yield under well-watered conditions when compared to the other genotypes. This response to variable water conditions is interesting for regions with seasonal drought, whereas the pattern of drought resistance is more appropriate for regions in which drought occurs for long periods during the crop season. Our findings are also discussed from the point of view that increases in sugarcane yield and sustainable agriculture may be reached by choosing the best genotype for each specific environmental condition.
In this paper, we present the first laboratory experiments that show the generation of internal solitary waves by the impingement of a quasi-two-dimensional internal wave beam on a pycnocline. These experiments were inspired by observations of internal solitary waves in the deep ocean from synthetic aperture radar (SAR) imagery, where this so-called mechanism of ‘local generation’ was argued to be at work, here in the form of internal tidal beams hitting the thermocline. Nonlinear processes involved here are found to be of two kinds. First, we observe the generation of a mean flow and higher harmonics at the location where the principal beam reflects from the surface and pycnocline; their characteristics are examined using particle image velocimetry (PIV) measurements. Second, we observe internal solitary waves that appear in the pycnocline, detected with ultrasonic probes; they are further characterized by a bulge in the frequency spectrum, distinct from the higher harmonics. Finally, the relevance of our results for understanding ocean observations is discussed.
To evaluate the association between overweight and the occurrence of asthma and atopy in a cohort of children of 4–12 years of age living in the city of Salvador in 2005.
Cross-sectional study nested in a cohort.
The metropolitan region of Salvador, Bahia, Brazil.
The study included 1129 children of 4–12 years age who presented complete information on the variables used here. Skin tests for allergy, spirometry, faecal parasitology, serum IgE and anthropometric surveys were conducted. Poisson's multivariate regression was adopted.
Wheezing was found in 29·1% and asthma in 22·8% of children, both conditions being more common in those under 6 years of age and 34% more common in overweight children (prevalence ratio (PR) = 1·34; 95% CI 1·07, 1·67) following adjustment. The ratio between forced expiratory volume in 1s and forced vital capacity was associated with overweight (PR = 1·35; 95% CI 1·11, 1·61). No statistically significant association was found between overweight and allergen-specific IgE or with wheezing.
These results are in agreement with the hypothesis that overweight is associated with asthma and pulmonary function, even following adjustment for intervening variables known to be associated with the pathogeny of asthma.