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Social outings can trigger influenza transmission, especially in children and elderly. In contrast, school closures are associated with reduced influenza incidence in school-aged children. While influenza surveillance modelling studies typically account for holidays and mass gatherings, age-specific effects of school breaks, sporting events and commonly celebrated observances are not fully explored. We examined the impact of school holidays, social events and religious observances for six age groups (all ages, ⩽4, 5–24, 25–44, 45–64, ⩾65 years) on four influenza outcomes (tests, positives, influenza A and influenza B) as reported by the City of Milwaukee Health Department Laboratory, Milwaukee, Wisconsin from 2004 to 2009. We characterised holiday effects by analysing average weekly counts in negative binomial regression models controlling for weather and seasonal incidence fluctuations. We estimated age-specific annual peak timing and compared influenza outcomes before, during and after school breaks. During the 118 university holiday weeks, average weekly tests were lower than in 140 school term weeks (5.93 vs. 11.99 cases/week, P < 0.005). The dampening of tests during Winter Break was evident in all ages and in those 5–24 years (RR = 0.31; 95% CI 0.22–0.41 vs. RR = 0.14; 95% CI 0.09–0.22, respectively). A significant increase in tests was observed during Spring Break in 45–64 years old adults (RR = 2.12; 95% CI 1.14–3.96). Milwaukee Public Schools holiday breaks showed similar amplification and dampening effects. Overall, calendar effects depend on the proximity and alignment of an individual holiday to age-specific and influenza outcome-specific peak timing. Better quantification of individual holiday effects, tailored to specific age groups, should improve influenza prevention measures.
We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.
Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113
We assessed whether paternal demographic, anthropometric and clinical factors influence the risk of an infant being born large-for-gestational-age (LGA). We examined the data on 3659 fathers of term offspring (including 662 LGA infants) born to primiparous women from Screening for Pregnancy Endpoints (SCOPE). LGA was defined as birth weight >90th centile as per INTERGROWTH 21st standards, with reference group being infants ⩽90th centile. Associations between paternal factors and likelihood of an LGA infant were examined using univariable and multivariable models. Men who fathered LGA babies were 180 g heavier at birth (P<0.001) and were more likely to have been born macrosomic (P<0.001) than those whose infants were not LGA. Fathers of LGA infants were 2.1 cm taller (P<0.001), 2.8 kg heavier (P<0.001) and had similar body mass index (BMI). In multivariable models, increasing paternal birth weight and height were independently associated with greater odds of having an LGA infant, irrespective of maternal factors. One unit increase in paternal BMI was associated with 2.9% greater odds of having an LGA boy but not girl; however, this association disappeared after adjustment for maternal BMI. There were no associations between paternal demographic factors or clinical history and infant LGA. In conclusion, fathers who were heavier at birth and were taller were more likely to have an LGA infant, but maternal BMI had a dominant influence on LGA.
There is lack of evidence on the differential impact of maternal macronutrient consumption: carbohydrates (CHO), fats and protein on birth weight. We investigated the association between maternal dietary macronutrient intakes and their sub-components such as saccharides and fatty acids and birth weight. This analyses included 1,196 women with singleton pregnancies who were part of the CAffeine and REproductive health study in Leeds, UK between 2003 and 2006. Women were interviewed in each trimester. Dietary information was collected twice using a 24-h dietary recall about 8–12 weeks and 13–27 weeks of gestation. Multiple linear regression models adjusted for alcohol and smoking in trimester 1, showed that each additional 10 g/d CHO consumption was associated with an increase of 4 g (95 % CI 1, 7; P=0·003) in birth weight. Conversely, an additional 10 g/d fat intake was associated with a lower birth weight of 8 g (95 % CI 0, 16; P=0·04) when we accounted for energy contributing macronutrients in each model, and maternal height, weight, parity, ethnicity, gestational age at delivery and sex of the baby. There was no evidence of an association between protein intake and birth weight. Maternal diet in trimester 2 suggested that higher intakes of glucose (10 g/d) and lactose (1 g/d) were both associated with higher birth weight of 52 g (95 % CI 4, 100; P=0·03) and 5 g (95 % CI 2, 7; P<0·001) respectively. These results show that dietary macronutrient composition during pregnancy is associated with birth weight outcomes. An appropriately balanced intake of dietary CHO and fat during pregnancy could support optimum birth weight.
Accurate and reproducible patient positioning is a critical step in radiotherapy for breast cancer. This has seen the use of permanent skin markings becoming standard practice in many centres. Permanent skin markings may have a negative impact on long-term cosmetic outcome, which may in turn, have psychological implications in terms of body image. The aim of this study was to investigate the feasibility of using a semi-permanent tattooing device for the administration of skin marks for breast radiotherapy set-up.
Materials and methods
This was designed as a phase II double-blinded randomised-controlled study comparing our standard permanent tattoos with the Precision Plus Micropigmentation (PPMS) device method. Patients referred for radical breast radiotherapy were eligible for the study. Each study participant had three marks applied using a randomised combination of the standard permanent and PPMS methods and was blinded to the type of each mark. Follow up was at routine appointments until 24 months post radiotherapy. Participants and a blind assessor were invited to score the visibility of each tattoo at each follow-up using a Visual Analogue Scale. Tattoo scores at each time point and change in tattoo scores at 24 months were analysed by a general linear model using the patient as a fixed effect and the type of tattoo (standard or research) as covariate. A simple questionnaire was used to assess radiographer feedback on using the PPMS.
In total, 60 patients were recruited to the study, of which 55 were available for follow-up at 24 months. Semi-permanent tattoos were more visible at 24 months than the permanent tattoos. Semi-permanent tattoos demonstrated a greater degree of fade than the permanent tattoos at 24 months (final time point) post completion of radiotherapy. This was not statistically significant, although it was more apparent for the patient scores (p=0·071) than the blind assessor scores (p=0·27). No semi-permanent tattoos required re-marking before the end of radiotherapy and no adverse skin reactions were observed.
The PPMS presents a safe and feasible alternative to our permanent tattooing method. An extended period of follow-up is required to fully assess the extent of semi-permanent tattoo fade.
Objectives: Human immunodeficiency virus (HIV) disproportionately affects Hispanics/Latinos in the United States, yet little is known about neurocognitive impairment (NCI) in this group. We compared the rates of NCI in large well-characterized samples of HIV-infected (HIV+) Latinos and (non-Latino) Whites, and examined HIV-associated NCI among subgroups of Latinos. Methods: Participants included English-speaking HIV+ adults assessed at six U.S. medical centers (194 Latinos, 600 Whites). For overall group, age: M=42.65 years, SD=8.93; 86% male; education: M=13.17, SD=2.73; 54% had acquired immunodeficiency syndrome. NCI was assessed with a comprehensive test battery with normative corrections for age, education and gender. Covariates examined included HIV-disease characteristics, comorbidities, and genetic ancestry. Results: Compared with Whites, Latinos had higher rates of global NCI (42% vs. 54%), and domain NCI in executive function, learning, recall, working memory, and processing speed. Latinos also fared worse than Whites on current and historical HIV-disease characteristics, and nadir CD4 partially mediated ethnic differences in NCI. Yet, Latinos continued to have more global NCI [odds ratio (OR)=1.59; 95% confidence interval (CI)=1.13–2.23; p<.01] after adjusting for significant covariates. Higher rates of global NCI were observed with Puerto Rican (n=60; 71%) versus Mexican (n=79, 44%) origin/descent; this disparity persisted in models adjusting for significant covariates (OR=2.40; CI=1.11–5.29; p=.03). Conclusions: HIV+ Latinos, especially of Puerto Rican (vs. Mexican) origin/descent had increased rates of NCI compared with Whites. Differences in rates of NCI were not completely explained by worse HIV-disease characteristics, neurocognitive comorbidities, or genetic ancestry. Future studies should explore culturally relevant psychosocial, biomedical, and genetic factors that might explain these disparities and inform the development of targeted interventions. (JINS, 2018, 24, 163–175)
A detailed description is given of the fossil pollen floras of two lignite seams associated with the Tertiary igneous rocks of Western Scotland. One of the seams occurs at the base of the lava succession at Ardslignish, Ardnamurchan; the other is exposed at two localities, Shiaba and Bremanoir, within the lava succession on the island of Mull.
Seventy-one species belonging to forty-four genera are described. All the species and two of the genera are new. Comparisons are made with modern pollen grains and some close resemblances are noted between the fossil species and species now living in various distant parts of the world, in particular Eastern Asia, Australasia and North America.
The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD).
This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery–Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery.
Patients improved on the clinical measure of depression after surgery by −21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred.
With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.
Geological data show that high Andean habitats have been available for plant colonization only since the end of the Tertiary. The manner in which plant species moved into these habitats, the times during which, and the methods by which they differentiated during the Pleistocene varied altitudinally and latitudinally along the tropical Andes. The process of speciation in all areas, however, was the same as that in temperate environments, namely, geographic isolation and subsequent divergence. Except on the Altiplano, most plant species expanded their ranges during glacial periods when vegetation zones were lowered. In the northern paramos at elevations above treeline, colonization was greatest during glacial periods but has always occurred in a manner similar to that of oceanic islands. At lower elevations in the northern Andes, and along the Eastern Cordillera, direct migration was possible in glacial times because of increased contiguity of upper montane forest habitats. On the upper slopes of the west coast of Perú, glacial-age plant migrations were fostered more by changes in precipitation than by the lowering of vegetation belts. In all of these areas, interglacial periods were, and are, times of isolation and differentiation. Across the Altiplano in contrast, glacial periods were times of population fragmentation accompanied by differentiation and/or speciation.
To evaluate the reliability and validity of the FFQ administered to participants in the follow-up of the Melbourne Collaborative Cohort Study (MCCS), and to provide calibration coefficients.
A random sample stratified by country of birth, age, sex and BMI was selected from MCCS participants. Participants completed two FFQ and three 24 h recalls over 1 year. Reliability was evaluated by intraclass correlation coefficients (ICC). Validity coefficients (VC) were estimated from structural equation models and calibration coefficients obtained from regression calibration models.
Adults born in Australia, Greece or Italy.
Nine hundred and sixty-five participants consented to the study; of these, 459 participants were included in the reliability analyses and 615 in the validity and calibration analyses.
The FFQ showed good repeatability for twenty-three nutrients with ICC ranging from 0·66 to 0·80 for absolute nutrient intakes for Australian-born and from 0·51 to 0·74 for Greek/Italian-born. For Australian-born, VC ranged from 0·46 (monounsaturated fat) to 0·83 (Ca) for nutrient densities, comparing well with other studies. For Greek/Italian-born, VC were between 0·21 (Na) and 0·64 (riboflavin). Calibration coefficients for nutrient densities ranged from 0·39 (retinol) to 0·74 (Mg) for Australian-born and from 0·18 (Zn) to 0·54 (riboflavin) for Greek/Italian-born.
The FFQ used in the MCCS follow-up study is suitable for estimating energy-adjusted nutrients for Australian-born participants. However, its performance for estimating intakes is poorer for southern European migrants and alternative dietary assessment methods ought to be considered if dietary data are to be measured in similar demographic groups.
Fe deficiency anaemia during early pregnancy has been linked with low birth
weight and preterm birth. However, this evidence comes mostly from studies
measuring Hb levels rather than specific measures of Fe deficiency. The present
study aimed to examine the association between maternal Fe status during the
first trimester of pregnancy, as assessed by serum ferritin, transferrin
receptor and their ratio, with size at birth and preterm birth. In the Baby VIP
(Baby's Vascular health and Iron in Pregnancy) study, we recruited 362
infants and their mothers after delivery in Leeds, UK. Biomarkers were measured
in maternal serum samples previously obtained in the first trimester of
pregnancy. The cohort included sixty-four (18 %) small for gestational
age (SGA) babies. Thirty-three babies were born preterm (9 %; between 34
and 37 weeks). First trimester maternal Fe depletion was associated with a
higher risk of SGA (adjusted OR 2·2, 95 % CI 1·1,
4·1). This relationship was attenuated when including early pregnancy Hb
in the model, suggesting it as a mediator (adjusted OR 1·6, 95 %
CI 0·8, 3·2). For every 10 g/l increase in maternal Hb
level in the first half of pregnancy the risk of SGA was reduced by 30 %
(adjusted 95 % CI 0, 40 %); levels below 110 g/l were
associated with a 3-fold increase in the risk of SGA (95 % CI 1·0,
9·0). There was no evidence of association between maternal Fe depletion
and preterm birth (adjusted OR 1·5, 95 % 0·6, 3·8).
The present study shows that depleted Fe stores in early pregnancy are
associated with higher risk of SGA.
Associated with the volcanic rocks of Tertiary age that bulk so largely in the Mull, Morvern, and Ardnamurchan districts of Argyllshire, western Scotland, are occasional sedimentary deposits of insignificant proportions. The sediments, for the most part, consist of sandstones and conglomerates, but there may also be shaly bands and thin, impersistent seams of lignites (Mull Memoir, 1924, Chap. III). These lignites have been found to possess an abundant pollen-content of great interest and considerable variety, and this paper is a preliminary account of some of the forms isolated. It has not yet been possible to make a detailed examination of each seam throughout its entire thickness and thus get a complete picture of its pollen-aspect—but it is hoped to attempt this interesting task in the near future.
EPA has conducted several ex post assessments of regulatory compliance costs, with the ultimate goal of identifying ways to improve ex ante cost estimation. The work to date has culminated in four case studies that examine five regulations using a common conceptual framework. The standardized framework provides a systematic way to investigate key drivers of compliance costs to see if judgments can be made about why and how ex ante and ex post estimates of costs differ. In addition to describing this conceptual framework, we describe the criteria used to select the rules to be analyzed, summarize the main hypotheses for why ex ante and ex post cost estimates may differ and discuss some of the challenges encountered in conducting these ex post analyses.
Hans Blumenberg's early historical examination of the metaphorology of the shipwreck, Schiffbruch mit Zuschauer (Shipwreck with spectator), lays out the existential import this image held for Western thought from antiquity through to philosophical modernism. For Blumenberg, the metaphor of the ocean voyage assumes a place along-side that of air flight and the Promethean theft of fire as one of the staple concretizations of human arrogance in its attempts to challenge and tame the laws of nature (14–15). The sea voyage in particular encapsulates, according to Blumenberg, a paradigmatic moment of human blasphemy, codified in the attempt to transgress those natural conditions that bind human existence to terra firma, and to venture out into that element that paradigmatically embodies the forces of incalculability, lawlessness, and total lack of orientation: the infinitely vast and wholly unpredictable ocean (10). Blumenberg identifies precisely that liminal space between terra firma and the immeasurable expanse of the ocean as the place that embodies and symbolically invokes this constant human drive toward transgression of its existential limitations. Blumenberg's language points immediately to the relevance this model holds specifically for Faust in part 2 of Goethe's drama: “Daß hier, an der Grenze vom festen Land zum Meer, zwar nicht der Sündenfall, aber doch der Verfehlungsschritt ins Ungemäße und Maßlose zuerst getan wurde, ist von der Anschaulichkeit, die dauerhafte Topoi trägt” (11; The fact that this border between firm land and the sea marks the place where, to be sure, not the fall from grace per se, but the first transgressive step into inexpedience and immoderation was taken, has the vividness that only lasting topoi possess).
What does it mean to think “I,” to say “I,” to write “I”? These foundational questions of subjectivity inform Annette von Droste-Hulshoff's literary production to such an extent that one might arguably define her oeuvre in terms of the early German Romantic notion of autopoiesis, the self-reflexive, self-critical self-creation of the subject, das Ich (the I), in and through poesy. Yet in contradistinction to the unitary structure of early Romantic subjectivity, for Droste the self frequently is presented as an object, an object often watched by—and at times watching—the subject, an object that is irreconcilable with the subject. significantly, many of these scenes of objectified self-definition are explicitly presented as aesthetic events, indicating their programmatic status in Droste's poetics, and they recur emblematically throughout her writing.
The following analysis seeks to elucidate Droste's object-driven conception of subjectivity and poetic production through a series of examples. The first section considers the early prose fragment Ledwina (1818/19–26). The second presents brief readings of a selection of her more famous poems and ballads, written between 1840 and 1844: “Das Spiegelbild” (The mirror image), “Im Moose” (In the moss), “Das Fraulein von Rodenschild” (Lady von Rodenschild), “Das erste Gedicht” (The first poem), “Das alte schloss” (The old castle), “Im Grase” (In the grass), “Die todte Lerche” (The dead lark), “Die Taxuswand” (The yew wall), “Die Mergelgrube” (The marl pit) and “Lebt wohl” (Farewell).