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To assess trends in consumption of soda, sweetened fruit drinks/sports drinks and any sugar-sweetened beverage (SSB) from 2013 to 2016 among all children in California aged 2–5 and 6–11 years and by racial-ethnic group.
Serial cross-sectional study using the California Health Interview Survey (CHIS).
CHIS is a telephone survey of households in California designed to assess population-level estimates of key health behaviours. Previous research using CHIS documented a decrease in SSB consumption among children in California from 2003 to 2009 coinciding with state-level policy efforts targeting child SSB consumption.
Parents of children in California aged 2–11 years (n 4901 in 2013–2014; n 3606 in 2015–2016) were surveyed about the child’s consumption of soda and sweetened fruit drinks/sports drinks on the day prior.
Among 2–5-year-olds, consumption of soda, sweetened fruit drinks/sports drinks and any SSB remained stable. Sweetened fruit drink/sports drink consumption was higher than soda consumption in this age group. Latino 2–5- year-olds were more likely to consume any SSB in both 2013–2014 and 2015–2016 compared with Whites. Among 6–11-year-olds, consumption of soda, sweetened fruit drinks/sports drinks and any SSB also remained stable over time. Latino and African-American 6–11-year-olds were more likely to consume an SSB in 2013–2014 compared with White children.
SSB consumption among children in California was unchanged from 2013 to 2016 and racial-ethnic disparities were evident. Increased policy efforts are needed to further reduce SSB consumption, particularly among children of Latino and African-American backgrounds.
Case-Finding for Complex Chronic Conditions in Seniors 75+ (C5-75) is a systematic approach to identify frailty using gait speed and hand-grip strength and to screen for co-morbid conditions. We identified the C5-75 features offering the highest yield for identifying frailty and to streamline the screening program. Analyses included 1,948 C5-75 assessments completed from 2013 to 2018. Age 85 or older, less than regular physical activity, and more than two falls in the previous six months had the strongest associations with frailty. Exempting patients under 85 who reported regular physical activity and less than two falls excluded 39.1 per cent of the cohort while maintaining a sensitivity of 95.2 per cent and a negative predictive value of 99.4 per cent for frailty. These findings provide insight into optimizing screening for frailty, making it more feasible to implement and to identify co-existing conditions that may contribute to or be affected by frailty.
In psychiatric and emergency healthcare settings, episodes of agitation and violence are relatively common. One meta-analysis reported that 32.4% of patients behaved violently during admission to a psychiatric ward; this was the mean rate of violence based on 122 studies from 11 countries (Bowers et al., 2011). The comparable rate in the UK studies was 41.7%. A study of general adult wards of a UK inner-city mental health trust found violence rates for 49% of men and 39% of women in the 6-month period studied (Hodgins et al., 2007).
In 1922, a group of wealthy Parsis in Bombay founded an organization that they dubbed the Iran League. Originally designed to assist their fellow Zoroastrians in Iran, who had suffered from centuries of oppression, the League quickly expanded its objectives to include the promotion of broader Indo-Iranian cultural and economic relations. It became a major player in the flow of ideas, literature, business, and tourist traffic between the two countries. Parsi fervour for Iran stemmed from the brand of Iranian nationalism promoted by Reza Shah, which celebrated the country's Zoroastrian past. In response, the League's leaders argued that the Parsis of India could play a special role in the ‘regeneration’ of Iran under the shah's supposedly benign rule. By the 1930s, however, Parsis’ embrace of Iranian nationalism became a clear reflection of their deep concerns about Indian nationalist politics: they cast Iran as an idealized alternative to contemporary India, where the Indian National Congress had supposedly taken an ominously ‘anti-Parsi’ turn. The Iran League, therefore, was caught between two nationalisms. Worry about India's future even prompted some Parsis to argue that their community should ‘return’ to their ancestral homeland of Iran. The story of the Iran League thus demonstrates the complex position of minorities vis-à-vis the brands of nationalism in development during the interwar years. The Parsis, a wealthy but microscopic minority, responded to political anxieties at home by romanticizing a foreign country and taking part in a wholly foreign nationalist project.
Impairments in social cognition contribute significantly to disability in schizophrenia patients (SzP). Perception of facial expressions is critical for social cognition. Intact perception requires an individual to visually scan a complex dynamic social scene for transiently moving facial expressions that may be relevant for understanding the scene. The relationship of visual scanning for these facial expressions and social cognition remains unknown.
In 39 SzP and 27 healthy controls (HC), we used eye-tracking to examine the relationship between performance on The Awareness of Social Inference Test (TASIT), which tests social cognition using naturalistic video clips of social situations, and visual scanning, measuring each individual's relative to the mean of HC. We then examined the relationship of visual scanning to the specific visual features (motion, contrast, luminance, faces) within the video clips.
TASIT performance was significantly impaired in SzP for trials involving sarcasm (p < 10−5). Visual scanning was significantly more variable in SzP than HC (p < 10−6), and predicted TASIT performance in HC (p = 0.02) but not SzP (p = 0.91), differing significantly between groups (p = 0.04). During the visual scanning, SzP were less likely to be viewing faces (p = 0.0001) and less likely to saccade to facial motion in peripheral vision (p = 0.008).
SzP show highly significant deficits in the use of visual scanning of naturalistic social scenes to inform social cognition. Alterations in visual scanning patterns may originate from impaired processing of facial motion within peripheral vision. Overall, these results highlight the utility of naturalistic stimuli in the study of social cognition deficits in schizophrenia.
Additively manufactured parts produced via laser powder bed fusion (LPBF) have limitations in their applications due to post-processing requirements caused by high surface roughness. The characteristics of side-skin surfaces are generally assumed to be dominated by adhered powder particles. This work aims to analyze and interpret the effects of LPBF processing parameters on side-skin surfaces. As such, this work has two sections to investigate the effect of (i) core and (ii) border LPBF parameters on side-skin surface roughness for Ti–6Al–4V. The findings show that there is a robust correlation between both core and border LPBF parameters on side-skin surface morphologies. In terms of core LPBF parameters, an interaction between laser power and beam velocity is shown to influence side-skin surface roughness, resulting in Sa values in the range of 11–26 μm. Additionally, a preliminary investigation into the effect of melting mode phenomena at the border leads to a possibility of obtaining Sa values of <10 μm, with reduced effects of adhered and partially fused powder.
To evaluate whether incorporating mandatory prior authorization for Clostridioides difficile testing into antimicrobial stewardship pharmacist workflow could reduce testing in patients with alternative etiologies for diarrhea.
Single center, quasi-experimental before-and-after study.
Tertiary-care, academic medical center in Ann Arbor, Michigan.
Adult and pediatric patients admitted between September 11, 2019 and December 10, 2019 were included if they had an order placed for 1 of the following: (1) C. difficile enzyme immunoassay (EIA) in patients hospitalized >72 hours and received laxatives, oral contrast, or initiated tube feeds within the prior 48 hours, (2) repeat molecular multiplex gastrointestinal pathogen panel (GIPAN) testing, or (3) GIPAN testing in patients hospitalized >72 hours.
A best-practice alert prompting prior authorization by the antimicrobial stewardship program (ASP) for EIA or GIPAN testing was implemented. Approval required the provider to page the ASP pharmacist and discuss rationale for testing. The provider could not proceed with the order if ASP approval was not obtained.
An average of 2.5 requests per day were received over the 3-month intervention period. The weekly rate of EIA and GIPAN orders per 1,000 patient days decreased significantly from 6.05 ± 0.94 to 4.87 ± 0.78 (IRR, 0.72; 95% CI, 0.56–0.93; P = .010) and from 1.72 ± 0.37 to 0.89 ± 0.29 (IRR, 0.53; 95% CI, 0.37–0.77; P = .001), respectively.
We identified an efficient, effective C. difficile and GIPAN diagnostic stewardship approval model.
Emerging research suggests that maternal immune activation (MIA) may be associated with an increased risk of adverse neurodevelopmental and mental health outcomes in offspring. Using data from the Raine Study, we investigated whether MIA during pregnancy was associated with increased behavioral and emotional problems in offspring longitudinally across development.
Mothers (Generation 1; N = 1905) were classified into the following categories: AAAE (Asthma/Allergy/Atopy/Eczema; N = 1267); infection (during pregnancy; N = 1082); no AAAE or infection (N = 301). The Child Behavior Checklist (CBCL) was administered for offspring at ages 5, 8, 10, 14, and 17. Generalized estimating equations were used to investigate the effect of maternal immune status on CBCL scores.
AAAE conditions were associated with significant increases in CBCL Total (β 2.49; CI 1.98–3.00), Externalizing (β 1.54; CI 1.05–2.03), and Internalizing (β 2.28; CI 1.80–2.76) scores. Infection conditions were also associated with increased Total (β 1.27; CI 0.77–1.78), Externalizing (β 1.18; CI 0.70–1.66), and Internalizing (β 0.76; CI 0.28–1.24) scores. Exposure to more than one AAAE and/or infection condition was associated with a greater elevation in CBCL scores than single exposures in males and females. Females showed greater increases on the Internalizing scale from MIA, while males showed similar increases on both Internalizing and Externalizing scales.
MIA was associated with increased behavioral and emotional problems in offspring throughout childhood and adolescence. This highlights the need to understand the relationship between MIA, fetal development, and long-term outcomes, with the potential to advance early identification and intervention strategies.
N95 respirators are personal protective equipment most often used to control exposures to infections transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of N95 respirators in health care settings while maximizing the level of protection offered to health care personnel when there is limited supply in the United States during the 2019 coronavirus disease pandemic. The strategies are intended for use by professionals who manage respiratory protection programs, occupational health services, and infection prevention programs in health care facilities to protect health care personnel from job-related risks of exposure to infectious respiratory illnesses. Consultation with federal, state, and local public health officials is also important. We use the framework of surge capacity and the occupational health and safety hierarchy of controls approach to discuss specific engineering control, administrative control, and personal protective equipment measures that may help in optimizing N95 respirator supplies.
As the systems that people depend on are increasingly strained by the coronavirus disease–2019 (COVID-19) outbreak, public health impacts are manifesting in different ways beyond morbidity and mortality for elderly populations. Loneliness is already a chief public health concern that is being made worse by COVID-19. Agencies should recognize the prevalence of loneliness among elderly populations and the impacts that their interventions have on loneliness. This letter describes several ways that loneliness can be addressed to build resilience for elderly populations as part of the public health response to COVID-19.
The need for experimental traumatic brain injury (TBI) models comes from the drive to better understand TBI pathophysiology in order to improve outcome. Models are surrogates for human pathology, they can be cellular (in vitro) or whole organism (in vivo). Although no model can entirely replace the need for human studies, the use of cell cultures and animals offer unique advantages. There is uniformity of subjects, and the same injury can be repeatedly recreated. They allow for the creation of simple or complex injuries, whilst offering the ability to investigate global or focal change(s) from minutes to days following the insult, and there are no recruitment or loss of follow-up issues. The greatest advantages are possibly the ability to perform multiple and invasive sampling of tissues, measure fatal end points and trial widest range of drug doses which is precluded in clinical studies.
This paper describes a method to determine global navigation satellite systems (GNSS) satellite orbits and clocks for advanced receiver autonomous integrity monitoring (ARAIM). The orbit and clock estimates will be used as a reference truth to monitor signal-in-space integrity parameters of the ARAIM integrity support message (ISM). Unlike publicly available orbit and clock products, which aim to maximise estimation accuracy, a straightforward and transparent approach is employed to facilitate integrity evaluation. The proposed monitor is comprised of a worldwide network of sparsely distributed reference stations and will employ parametric satellite orbit models. Two separate analyses, covariance analysis and model fidelity evaluation, are carried out to assess the impact of measurement errors and orbit model uncertainty on the estimated orbits and clocks, respectively. The results indicate that a standard deviation of 30 cm can be achieved for the estimated orbit/clock error, which is adequate for ISM validation.
Mood instability and sleep disturbance are common symptoms in people with mental illness. Both features are clinically important and associated with poorer illness trajectories. We compared clinical outcomes in people presenting to secondary mental health care with mood instability and/or sleep disturbance with outcomes in people without either mood instability or sleep disturbance.
Data were from electronic health records of 31,391 patients ages 16–65 years presenting to secondary mental health services between 2008 and 2016. Mood instability and sleep disturbance were identified using natural language processing. Prevalence of mood instability and sleep disturbance were estimated at baseline. Incidence rate ratios were estimates for clinical outcomes including psychiatric diagnoses, prescribed medication, and hospitalization within 2-years of presentation in persons with mood instability and/or sleep disturbance compared to individuals without either symptom.
Mood instability was present in 9.58%, and sleep disturbance in 26.26% of patients within 1-month of presenting to secondary mental health services. Compared with individuals without either symptom, those with mood instability and sleep disturbance showed significantly increased incidence of prescription of any psychotropic medication (incidence rate ratios [IRR] = 7.04, 95% confidence intervals [CI] 6.53–7.59), and hospitalization (IRR = 5.32, 95% CI 5.32, 4.67–6.07) within 2-years of presentation. Incidence rates of most clinical outcomes were considerably increased among persons with both mood instability and sleep disturbance, relative to persons with only one symptom.
Mood instability and sleep disturbance are present in a wide range of mental disorders, beyond those in which they are conventionally considered to be symptoms. They are associated with poor outcomes, particularly when they occur together. The poor prognosis associated with mood instability and sleep disorder may be, in part, because they are often treated as secondary symptoms. Mood instability and sleep disturbance need better recognition as clinical targets for treatment in their own right.
Parthenium hysterophorus Linnaeus (Asteraceae) is a toxic weed found abundantly in major agroecosystems of the world. The weed is inhabited by both phytophagous Chrysomelidae (Coleoptera), used as biocontrol agents, and the predaceous Coccinellidae (Coleoptera). The present investigation was designed to assess the feeding attributes and larval development of Zygogramma bicolorata Pallister (Coleoptera: Chrysomelidae) in the presence of semiochemical tracks of coccinellid beetles. Results revealed that the presence of coccinellid semiochemical tracks on the weed reduced larval consumption rates, conversion efficiencies, and growth rates. The feeding deterrent effects of the semiochemical tracks were species specific. Larvae accumulated lower concentrations of glucose, proteins, and triacylglycerols and exhibited reduced body biomass in the presence of semiochemical tracks. The coccinellid semiochemical tracks also promoted Z. bicolorata larvae to accelerate their developmental rates and develop faster than the larvae reared in the absence of semiochemical tracks. While the fourth instars consumed food maximally and were heavier, their food use efficiencies were lower than the other instars. Our findings, therefore, suggest that the presence of semiochemical tracks of coccinellids on P. hysterophorus impedes its biological control by Z. bicolorata larvae.
Since the 1940s pro-European elites have embedded concrete steps towards European integration within a narrative that the member states were on the road to an ever closer union. The unification process was posited to be unidirectional and irreversible, resting on the twin motors of ever progressing deepening and enlargement. Nevertheless, Algeria managed to leave in 1962, as did Greenland in 1985. Long before Brexit, the narrative of the ‘ever closer union’ has also been called into question by other events and processes. For example, the Luxembourg compromise of 1966 ditched an integration step laid out in the treaty. A plethora of small and tiny changes also accumulated to disintegrate existing achievements or make them dysfunctional. The European Coal and Steel Community, for example, was largely non-functioning only a few years after its establishment. Overall, this chapter argues that disintegration and dysfunctionality are part of the political normality of the integration process. They are produced by the treatment of complex problems and knock-on effects of the integration process itself. The trend has strengthened further since Maastricht, and since the 1990s it has been shaping the debate over the European Union more strongly than ever before.