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Periconceptional folic acid (FA) has an established role in the prevention of neural tube defects (NTDs), leading to global recommendations for FA supplementation before and in early pregnancy. However, it is unclear whether there are any benefits for offspring brain health arising from continued maternal FA supplementation beyond the first trimester. The aim of this study was to investigate the role of maternal folate nutrition during pregnancy in relation to cognitive performance and brain function in the offspring at 11 years. The children of mothers who had participated in a randomised trial of Folic Acid Supplementation in the Second and Third Trimesters (FASSTT) were investigated, providing a unique opportunity to examine offspring brain health in relation to maternal folate (the FASSTT Offspring trial; n = 68). Cognitive performance was assessed using the Wechsler Intelligence Scale for Children, Fourth UK Edition (WISC-IV). The WISC-IV measures Full Scale IQ and specific domains of cognitive performance: Verbal Comprehension, Perceptual Reasoning, Working Memory and Processing Speed. Brain function was measured using magnetoencephalography (MEG) in a subset of the child participants (n = 33). The results showed no significant difference in Full Scale IQ between the children of mothers who had received folic acid versus placebo during pregnancy (P = 0.993). Processing Speed subtest scores were however significantly higher in the folic acid group compared with placebo (Symbol Search: P = 0.046 and Cancellation: P = 0.011). The application of MEG analysis showed that at rest, there were differences in brain functioning with significantly lower overall power at Broad band [1–48Hz] (P = 0.041) and a trend (not significant) towards lower power in all other frequency bands (Theta, Mu, Beta, Low Gamma and High Gamma) in children from the FA group compared with placebo. Results for the responses to the language task (congruent and incongruent sentences) in children from the FA group showed significantly lower power within the Theta band [4–8Hz] and significantly higher power within high frequency bands i.e. Beta [13–30 Hz] and High Gamma [49–70 Hz]. This suggested more efficient language processing abilities in these children compared to children of mothers in the placebo group. The findings provide scientific evidence that continuing FA supplementation beyond the periconceptional period that is protective against NTDs, may be beneficial for brain health in the offspring. Furthermore, this study demonstrates that MEG is a useful tool for objective assessment of functional brain activity in healthy children in response to nutrition intervention.
Aboriginal children in Australia are over-represented in both the child protection and juvenile justice systems. Using Western therapeutic models of practice with Aboriginal people who live in remote communities can be highly problematic. Moreover, the historical legacy of past and present legislation, government interventions and racist service provision needs to be acknowledged and addressed prior to any service implementation. This paper presents a therapeutic model of practice that incorporates Aboriginal concepts of healing and spirit within a creative therapeutic framework. It will demonstrate how the model works through principles of community engagement and capacity building, enabling the provision of a culturally derived therapeutic intervention that involves a synergy of both Aboriginal- and Western-based healing practices. The findings from the implementation of the TeaH model affirm the need to incorporate Aboriginal concepts of healing, spirit and creative therapies into mainstream practice with Aboriginal people.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Studies have found positive correlations between prenatal exposure to testosterone and masculinization of offspring traits, particularly among females. The present study sought to determine if physical or sexual activity by the mother during pregnancy was related to masculinized/defeminized offspring traits in adulthood. Data were obtained from a large sample of North American college students (offspring) and their mothers. Information about maternal activity levels during pregnancy were reported retrospectively by each mother. The offspring provided self-ratings of various sexually dimorphic traits. Several significant correlations were found. By and large, as maternal physical activity increased, feminine mannerisms decreased and masculine mannerisms increased in the offspring, particularly for females. Maternal physical activity was also associated with increased upper- and lower-body strength and especially with adult height among offspring. Sexual activity by the mother was only associated with upper-body strength and adult height, particularly of the female offspring. Several sexually dimorphic physical traits in offspring are associated with maternal activity levels during pregnancy. Prenatal testosterone is almost certainly involved. The associations could either reflect genetic influences (given that prenatal testosterone is highly heritable) or an effect of maternal testosterone being transferred to the developing fetus. More research is needed to assess the relative merit of these two possibilities.
Smith’s Cloud is a large few × 106 Solar Mass cloud which will impact the Milk Way disk in about 35 Million Years (Lockman et al., 2008). Green Bank Telescope OH observations indicate that there are no molecules present in Smith’s Cloud, and thus there is no active ongoing chemistry in Smith’s Cloud.
In this study, we propose a design methodology for a switching-mode RF CMOS power amplifier with an output transformer. For a given supply voltage, output power, and target efficiency, the initial values of the transistor size, output inductance, and capacitance can be sequentially determined during the design of the power amplifier. The breakdown voltage of the power transistor is considered in the design methodology. To prove the feasibility of the proposed design methodology, we provide the design example of a 2.4-GHz switching-mode CMOS power amplifier with 180-nm RF CMOS technology. From the measured results, the feasibility of the proposed design methodology is proved.
Background: Global variation in the incidence of multiple sclerosis (MS) is generally ascribed to differences in genetic and environmental risk factors. Here we investigate temporal trends in the incidence of MS and related disorders in British Columbia, Canada, from 1986 to 2010, focusing particularly on the Asian ethnic subpopulation.
Methods: A longitudinal database was screened to identify newly diagnosed cases of MS and related disorders, including neuromyelitis optica and clinically isolated syndromes. Age-standardized, sex-specific mean annual incidence was calculated for the Asian and non-Asian population of British Columbia for 5-year intervals from 1986 to 2010. Temporal changes and cohort differences in incidence rates and demographic characteristics were evaluated. Results: During this period, the incidence of MS and related disorders in the non-Asian population remained relatively unchanged, from 10.41 (95% confidence interval [CI]: 9.87-10.97) to 9.91 (95% CI: 9.46-10.39) per 100,000 (p=0.167). In contrast, incidence in the Asian population doubled during the same period. This increase was driven by a precipitous rise in the incidence of MS in females from 0.71 (95% CI: 0.01-1.50) to 2.08 (95% CI: 1.43-2.91) per 100,000 (p=0.004), including both Canadian-born and immigrant Asians. The incidence of neuromyelitis optica did not change significantly during this period. Conclusions: The incidence of MS may be increasing among females in the Asian ethnic population of British Columbia.
This study aims to develop an expedited radiotherapy (RT) process and evaluate its time savings in women requiring whole breast RT.
Material and methods
An inter-professional RT team streamlined the computed tomography (CT) simulation and treatment pathway for a ‘QuickStart’ process. Target delineation was performed by an advanced practice radiation therapist and approved by the radiation oncologist (RO) for planning. Automated breast planning software was used for treatment planning and standard quality checks were performed. To assess time savings, the initial 25 QuickStart patients were matched with women who underwent whole breast simulation on the same day (±3 days), treated using the conventional process.
A total of 73 post-lumpectomy women were treated through the QuickStart process; the median consent-to-RT was 2 days (range: 0–13) and the mean CT simulation-to-RT treatment was 2 hours and 42 minutes (SD 0:30). In the subgroup analysis, QuickStart patients saved an average of 11 days from CT simulation-to-RT and had shorter median wait-times for both surgery/chemotherapy-to-RT (60 versus 38 days; p=0·002) and consultation-to-RT (7 versus 20 days; p<0·001).
Through inter-professional team efforts and the application of automated planning software, we have achieved a process that significantly decreases patient wait-times while maintaining the quality of whole breast RT.
Despite evidence for the effectiveness of structured psychological
therapies for bipolar disorder no psychological interventions have been
specifically designed to enhance personal recovery for individuals with
recent-onset bipolar disorder.
A pilot study to assess the feasibility and effectiveness of a new
intervention, recovery-focused cognitive–behavioural therapy (CBT),
designed in collaboration with individuals with recent-onset bipolar
disorder intended to improve clinical and personal recovery outcomes.
A single, blind randomised controlled trial compared treatment as usual
(TAU) with recovery-focused CBT plus TAU (n = 67).
Recruitment and follow-up rates within 10% of pre-planned targets to
12-month follow-up were achieved. An average of 14.15 h (s.d. = 4.21) of
recovery-focused CBT were attended out of a potential maximum of 18 h.
Compared with TAU, recovery-focused CBT significantly improved personal
recovery up to 12-month follow-up (Bipolar Recovery Questionnaire mean
score 310.87, 95% CI 75.00–546.74 (s.e. = 120.34), P =
0.010, d=0.62) and increased time to any mood relapse
during up to 15 months follow-up (χ2 = 7.64,
P<0.006, estimated hazard ratio (HR) = 0.38, 95%
CI 0.18–0.78). Groups did not differ with respect to medication
Recovery-focused CBT seems promising with respect to feasibility and
potential clinical effectiveness. Clinical- and cost-effectiveness now
need to be reliably estimated in a definitive trial.
The scholarly study of fifteenth-century English verse is very much a late twentieth-century phenomenon. A number of the writings associated with the fifteenth-century authors covered in this collection of essays were not accessible in usable editions until some point in the twentieth century, and the critical tendency to overlook fifteenth-century poetry was in part an inevitable result of its simple unavailability. But the early decades of the twentieth century saw significant changes in the landscape of fifteenth-century verse, attributable largely to the efforts of dedicated individuals working in isolation. Henry Bergen, most significantly, produced in the first two decades of the twentieth century notable editions of the two longest poetic works of the fifteenth century, John Lydgate's Troy Book and Fall of Princes, each over 30,000 lines (Bergen 1906–35 and 1924-27). The work of Eleanor Hammond on fifteenth-century manuscript and textual culture in England generated partial editions and an important survey of fifteenth-century poetry in the form of English Verse between Chaucer and Surrey (1927). And Walter Schirmer's study of John Lydgate, published originally in German in 1952 and translated into English in 1961, offered a Kulturbild, a historical and cultural analysis of the most prolific poet of the century that has still not been superseded. These figures stand apart from a general tendency to see the verse of the period between Chaucer and the early sixteenth century as largely unrewarding.
In the fervent, contentious, and sometimes ostentatious religious culture of fifteenth-century England, one writer stands out as a particularly prolific and versatile author of devotional texts: the monk of Bury St Edmunds, John Lydgate (c.1370–1449). Lydgate wrote thousands of lines of religious poetry for a wide range of patrons, both individual and institutional, and his poetry provides a comprehensive picture of orthodox fifteenth-century English religious life and its concerns: highly sacramental, habitually influenced by meditative spirituality and imitatio Christi, defiantly anti-Lollard, and profoundly invested in the cults of the saints and of the Virgin. Perhaps more surprisingly, however, Lydgate's religious poetry is, like his more overtly political poems, often highly topical. Lydgate was long viewed as a repetitive monk, cloistered in self-indulgent rhetoric (Mortimer 2005: 2–20, summarises the relevant unflattering assessments and Lydgate's changing critical fortunes). Now, Lydgate is increasingly seen as a poet who innovated and experimented: he negotiated the vernacular translation of religious material, the incorporation of Chaucerian diction and themes, and the use of aureate language and humanist ideas all within the parameters of orthodoxy. Lydgate's poetry also inaugurates several new European traditions into English devotional culture: subjects such as the Dance of Death and visual-material forms such as mural poetry and the pietà or image of pity find early English expressions in Lydgate's poetry. In short, Lydgate provides us with a ready conspectus of religious literary forms, from short prayers to epic narratives, poised between cloistered monasticism and a vigorous patronage culture of ‘pray and display’.