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Anaemia is a public health problem in Ghana. We sought to identify factors associated with haemoglobin concentration (Hb) and anaemia among school-attending adolescents. We analysed data from 2948 adolescent girls and 609 boys (10–19 years) selected from 115 schools from regions of Ghana as a secondary analysis of baseline surveys conducted at two time-points. We measured Hb, malaria from capillary blood, anthropometry and used a modified food frequency questionnaire to assess diet. Multivariable linear and Poisson regression models were used to identify predictors of Hb and anaemia. The prevalence of anaemia, malaria and geophagy were 24, 25, and 24 %, respectively, among girls and 13, 27 and 6 %, respectively, among boys. Girls engaging in geophagy had a 53 % higher adjusted prevalence of anaemia and 0⋅39 g/dl lower Hb. There were similar results among those who tested positive for malaria (+52 % anaemia; −0⋅42 g/dl Hb). Among girls, lower anaemia prevalence and higher Hb were associated with consumption of foods rich in haeme iron (−22 %; +0⋅18 g/dl), consumption of iron-fortified cereal/beverages consumed with citrus (−50 %; +0⋅37 g/dl) and being overweight (−22 %; +0⋅22 g/dl). Age was positively associated with anaemia among girls, but negatively associated among boys. Boys who tested positive for malaria had 0⋅31 g/dl lower Hb. Boys who were overweight or had obesity and consumed flour products were also more likely to be anaemic (119 and 56 %, respectively). Factors associated with Hb and anaemia may inform anaemia reduction interventions among school-going adolescents and suggest the need to tailor them uniquely for boys and girls.
In this study, we evaluated the efficacy, expressed as a mean weight decrease of the whole echinococcal cyst mass, of novel benzimidazole salt formulations in a murine Echinococcus granulosus infection model. BALB/c mice were intraperitoneally infected with protoscoleces of E. granulosus (genotype G1). At 9 months post-infection, treatment with albendazole (ABZ), ricobendazole (RBZ) salt formulations, and RBZ enantiomer salts (R)-(+)-RBZ-Na and (S)-(−)-RBZ-Na formulations were initiated. Drugs were orally applied by gavage at 10 mg kg−1 body weight per day during 30 days. Experimental treatments with benzimidazole sodium salts resulted in a significant reduction of the weight of cysts compared to conventional ABZ treatment, except for the (S)-(−)-RBZ-Na enantiomer formulation. Scanning electron microscopy and histological inspection revealed that treatments impacted not only the structural integrity of the parasite tissue in the germinal layer, but also induced alterations in the laminated layer. Overall, these results demonstrate the improved efficacy of benzimidazole salt formulations compared to conventional ABZ treatment in experimental murine cystic echinococcosis.
Drumlins form at the ice/bed interface through subglacial processes that are not directly observable. The internal stratigraphy of drumlins provides insight into how they developed and associated subglacial processes, but traditional stratigraphic logging techniques are limited to natural exposures and excavations. Using ground-penetrating radar, we imaged the internal stratigraphy of seven drumlins from a recently exposed drumlin field in the forefield of Múlajökull, Iceland. Data were collected with 100 and 200 MHz antennas with maximum resolvable depths of 8 and 4 m, respectively. Longitudinal echograms contained coherent down-ice dipping reflectors over the lengths of the drumlins. Near the drumlin heads (i.e., stoss sides), down-glacier dipping beds lie at high angles to the surface, whereas on the lee sides, the down-glacier dipping beds lie at low angles, or conform, to drumlin surfaces. Transverse echograms exhibited unconformities along the flanks of drumlin heads and conformable bedding across the lee side widths of the drumlins. These observations were ground-truthed with stratigraphic logs from a subset of drumlins and good agreement was found. The stratigraphic patterns support previous conclusions that drumlins at Múlajökull formed on a deformable bed through both depositional and erosional processes which may alternate between its surge and quiescent phases.
Depressed patients show a disturbed hypothalamic-pituitary-adrenal (HPA) axis regulation, resulting in increased cortisol levels, inadequate cortisol suppression following a low dose of dexamethasone, increased concentrations of corticotropin releasing hormone (CRH) in the cerebrospinal fluid, and a blunted adrenocorticotropic hormone (ACTH) response following CRH administration. Treatment with antidepressants, but seemingly also cognitive behavioral therapy (CBT), is associated with an improvement of a disturbed HPA-axis regulation, which can be most sensitively evaluated with the combined dexamethasone (dex)/CRH test. Favorable response to antidepressant treatment can be predicted at an early stage by determining the degree of normalization of HPA-axis function under treatment in a second dex/CRH test.
We report about the predictive validity of HPA-axis normalization on the favorable response of CBT in medicated depressed patients.
Medicated depressed patients receiving CBT at the Max-Planck-Institute of Psychiatry in Munich are studied using the State-Trait-Angstinventar (STAI), Beck Depression Inventory (BDI), Volitional-Components-Questionnaire (VCQ-3), Emotion-Regulation Questionnaire (EPQ) and the Self-Control and Self-Management Scale (SCMS). Neuroendocrine parameters including measures of HPA-axis regulation are measured before and after therapy via dex/CRH test.
Up to the present moment data for N=38 depressed patients have been collected (N=21 male, 25-78 years; N=17 female, 21-80 years). The mean level of depression and anxiety showed a significant decrease between pre- and post-treatment measurement. Measures of perceived self-regulation and self-estimation increased and measures of perceived self-inhibition and inhibition of will decreased.
The expected changes in depression, anxiety and self-regulation after treatment with antidepressants and CBT were observed. Endocrine data are currently under analysis.
To date, there is an absence of curative treatment for very early onset schizophrenia. The antipsychotic drugs that are currently recommended have very little effect and are often badly tolerated by children. We report a case-study which results show a beneficial and significant efficacy of fMRI-guided rTMS in the treatment of pharmaco-resistant hallucinations. Moreover, rTMS applied over several cortical regions provided the means to reveal for the first time a functional dissociation between auditory-verbal hallucinations and agency impairments. These results demonstrate the efficacy of rTMS for young patients suffering from drug-resistant hallucinations but they furthermore question the physiopathology of the hallucinatory process by suggesting that agency and hallucinations may be sub served by different neural networks.
Adverse childhood experiences (ACE) have been shown to be associated with negative outcomes in adulthood and risk factors for psychopathology.
To assess mental representations of children underwent to ACE administering a recently developed semi-projective method: the Coffy Test.
To compare mental functioning of children who underwent to one or several adverse life events with the one of a control sample of non referred children.
The sample, recruited at the Neuropsychiatry Unit after adverse life events occurred, was composed of 40 children (21 male, 19 female) (Mage= 108.10 months; SD= .26).
The control sample was composed of 160 children (86 males, 74 females) (Mage= 108.80 months; SD = 21,10). Children were administered the Coffy Test, which is a new projective method focused on assessing possible elements of distortion in emotional processing within the relationship with parental figures in middle and late childhood (Cardi, Leonardi, D'Amico, Battista, 2012).
Coffy Test scores of the sample underwent to ACE and the control sample did not differ significantly neither for gender nor for age. However, the differences of the Coffy Test scores between the two groups were statistically significant (U = 1.26, p < .0001). Only 4 children in the ACE sample reported a score higher than the median of the control one.
The Coffy Test score suggested that children underwent to ACE had a worst mental functioning and thus may be exposed to the risk of developing psychopathology in adulthood.
We report the successful management of a 49-year-old woman with an initial diagnosis of schizoaffective disorder transitioned to resistant schizophrenia. First contact with our psychiatrist service in 2000; referring problems with treatment adherence and occasional toxic abuse, she underwent 15 admissions in acute adult psychiatric hospitalisation units since then (last discharge March, 2015), and a one-year stay (2012–2013) in an adult mid-term mental health unit. She is currently followed-up throughout the major mental-health outpatient visits program.
The patient was prescribed paliperidone 6 mg 2-0-0, oxcarbazepine 600 mg 1-0-1 and clonazepam 0.5 mg 1-0-1 during the last 2 months.
Due to lack of treatment adherence and toxic abuse she suffered a psychotic decompensation in May 2015. She was then prescribed clozapine 200 mg 1-0-2, boosted with aripiprazole 400 mg once monthly. The adjunction of aripiprazole once monthly (AOM) was intended to improve treatment adherence, and to supplement the psychotic control of clozapine without entailing a worsening of therapy tolerability. The patient was monitored during 5 months in our unit.
We observed a positive psychopathological evolution of the patient, which allowed us to re-evaluate the initial diagnostic, ascribing the previous mood fluctuations to toxic consumption.
Previous works have been published about the combination of clozapine and oral aripiprazole for the treatment of resistant schizophrenia, but, as far as we know, this is the first repost of the combined use of clozapine and AOM. Based on our results, this antipsychotic combination resulted in a psychopathological improvement of the patient, with good tolerability.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We report the successful management of a 57-year-old woman with a 20 year diagnostic of paranoid schizophrenia (first visit November, 1995). She presented several comorbidities (arterial hypertension, diabetes mellitus and morbid obesity), with a history of five previous hospitalizations (1995, 2012, January and May 2014, and April 2016).
The patient was always prescribed depot antipsychotics: she was treated for 14 years with Zuclopentixol depot (discontinued due to dermic adverse reactions and weight gain). After a period with oral paliperidone (from 2012 until 2013) and due to lack of adherence to oral therapy, in August 2013 she was prescribed paliperidone palmitate. The treatment was discontinued after nine months (May 2014) due to weight gain, a significant increase of serum prolactin levels and two psychotic relapses that led to hospital admissions.
She was then prescribed Fluphenazine decanoate depot for one year and 4 months, but she was switched to Aripiprazole once monthly (AOM) in September 2015 to avoid metabolic syndrome.
Non-personalized antipsychotic treatment in a patient with a complicated comorbidity history can result in lack of compliance and a risk of relapse, and in a worsening of her medical conditions, with the consequential negative impact in her functioning and quality of life. Based on our results, the treatment with AOM resulted in a positive evolution of the patient, with a good tolerability profile, in an improvement of treatment-caused adverse events (weight loss, and prolactin serum levels normalization); all factors that enable treatment adherence and good clinical response.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Acifluorfen is a nonsystemic PPO-inhibiting herbicide commonly used for POST Palmer amaranth control in soybean, peanut, and rice across the southern United States. Concerns have been raised regarding herbicide selection pressure and particle drift, increasing the need for application practices that optimize herbicide efficacy while mitigating spray drift. Field research was conducted in 2016, 2017, and 2018 in Mississippi and Nebraska to evaluate the influence of a range of spray droplet sizes [150 μm (Fine) to 900 μm (Ultra Coarse)], using acifluorfen to create a novel Palmer amaranth management recommendation using pulse width modulation (PWM) technology. A pooled site-year generalized additive model (GAM) analysis suggested that 150-μm (Fine) droplets should be used to obtain the greatest Palmer amaranth control and dry biomass reduction. Nevertheless, GAM models indicated that only 7.2% of the variability observed in Palmer amaranth control was due to differences in spray droplet size. Therefore, location-specific GAM analyses were performed to account for geographical differences to increase the accuracy of prediction models. GAM models suggested that 250-μm (Medium) droplets optimize acifluorfen efficacy on Palmer amaranth in Dundee, MS, and 310-μm (Medium) droplets could sustain 90% of maximum weed control. Specific models for Beaver City, NE, indicated that 150-μm (Fine) droplets provide maximum Palmer amaranth control, and 340-μm (Medium) droplets could maintain 90% of greatest weed control. For Robinsonville, MS, optimal Palmer amaranth control could be obtained with 370-μm (Coarse) droplets, and 90% maximum control could be sustained with 680 μm (Ultra Coarse) droplets. Differences in optimal droplet size across location could be a result of convoluted interactions between droplet size, weather conditions, population density, plant morphology, and soil fertility levels. Future research should adopt a holistic approach to identify and investigate the influence of environmental and application parameters to optimize droplet size recommendations.
Quality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents’ perspectives on the level of QIPS education and support available to them.
An electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement.
Of 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS; 47.2% and 51.5% of respondents reported either “not knowing” or “not having readily available” opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives.
Many Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.
Herbicide applications performed with pulse width modulation (PWM) sprayers to deliver specific spray droplet sizes could maintain product efficacy, minimize potential off-target movement, and increase flexibility in field operations. Given the continuous expansion of herbicide-resistant Palmer amaranth populations across the southern and midwestern United States, efficacious and cost-effective means of application are needed to maximize Palmer amaranth control. Experiments were conducted in two locations in Mississippi (2016, 2017, and 2018) and one location in Nebraska (2016 and 2017) for a total of 7 site-years. The objective of this study was to evaluate the influence of a range of spray droplet sizes [150 (Fine) to 900 μm (Ultra Coarse)] on lactofen and acifluorfen efficacy for Palmer amaranth control. The results of this research indicated that spray droplet size did not influence lactofen efficacy on Palmer amaranth. Palmer amaranth control and percent dry-biomass reduction remained consistent with lactofen applied within the aforementioned droplet size range. Therefore, larger spray droplets should be used as part of a drift mitigation approach. In contrast, acifluorfen application with 300-μm (Medium) spray droplets provided the greatest Palmer amaranth control. Although percent biomass reduction was numerically greater with 300-μm (Medium) droplets, results did not differ with respect to spray droplet size, possibly as a result of initial plant injury, causing weight loss, followed by regrowth. Overall, 900-μm (Ultra Coarse) droplets could be used effectively without compromising lactofen efficacy on Palmer amaranth, and 300-μm (Medium) droplets should be used to achieve maximum Palmer amaranth control with acifluorfen.
There is no agreement regarding which solvent is more suitable to obtain sol–gel–derived titania (TiO2) samples with an enhanced photocatalytic behavior. Furthermore, the solvent effect on the preparation of TiO2-RGO (reduced graphene oxide) nanocomposites has not been published yet and could be an attractive experimental strategy to modulate structure and properties. On the basis of these observations, TiO2-RGO nanocomposites were fabricated in this study. It was evaluated for the influence of using either isopropyl (IsoprOH) or ethyl (EtOH) alcohol on the textural and photocatalytic properties of the prepared materials. The use of IsoprOH led to samples with smaller crystallite size, narrower apparent band gap, smaller isoelectric point, larger adsorption capacity, and higher photocatalytic activity. In addition, the incorporation of RGO into TiO2 greatly improved the adsorption capacity and photocatalytic activity of the latter. However, the optimal loading of RGO to prepare composites with enhanced photocatalytic activities was 1 wt%. This finding can be related to the stacking of RGO sheets when concentrations above 1 wt% are used, which could prevent UV light to reach the TiO2 particles and also decrease the photocatalytic capacity of the composites. Moreover, materials with RGO concentration above 1 wt% could exhibit a highly negatively charged surface, which may decrease the separation of the generated electron–hole pairs and lead to faster recombination rates of charge carriers.
Cover crops provide a number of agronomic benefits, including weed suppression, which is important as cases of herbicide resistance continue to rise. To effectively suppress weeds, high cover crop biomass is needed, which necessitates later termination timing. Cover crop termination is important to mitigate potential planting issues and prevent surviving cover crop competition with cash crops. Field studies were conducted in Virginia to determine the most effective herbicide options alone or combined with glyphosate or paraquat to terminate a range of cover crop species. Results revealed that grass cover crop species were controlled (94% to 98%) by glyphosate alone 4 wk after application (WAA). Overall, legume species varied in response to the single active-ingredient treatments, and control increased with the addition of glyphosate or paraquat. Mixes with glyphosate provided better control of crimson clover and hairy vetch by 7% to 8% compared with mixes containing paraquat 4 WAA. Mix partner did not influence control of Austrian winter pea. No treatment adequately controlled rapeseed in this study, with a maximum of 58% control observed with single active-ingredient treatments and 62% control with mixes. Height reduction for all cover crop species supports visible rating data. Rapeseed should be terminated when smaller, which could negate weed suppressive benefits from this cover crop species. Growers should consider herbicide selection and termination timing in their cover crop plan to ensure effective termination.