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Paediatric hearing loss rates in Ghana are currently unknown.
A cross-sectional study was conducted in peri-urban Kumasi, Ghana; children (aged 3–15 years) were recruited from randomly selected households. Selected children underwent otoscopic examination prior to in-community pure tone screening using the portable ShoeBox audiometer. The LittlEars auditory questionnaire was also administered to caregivers and parents.
Data were collected from 387 children. After conditioning, 362 children were screened using monaural pure tones presented at 25 dB. Twenty-five children could not be conditioned to behavioural audiometric screening. Eight children were referred based on audiometric screening results. Of those, four were identified as having hearing loss. Four children scored less than the maximum mark of 35 on the LittleEars questionnaire. Of those, three had hearing loss as identified through pure tone screening. The predominant physical finding on otoscopy was ear canal cerumen impaction.
Paediatric hearing loss is prevalent in Ghana, and should be treated as a public health problem warranting further evaluation and epidemiology characterisation.
This paper reviews the effects of extended lactation (EXT) as a strategy in dairy cattle on milk production and persistency, reproduction, milk quality, lifetime performance of the cow and finally the economic effects on herd and farm levels as well as the impact on emission of greenhouse gas at product level. Primiparous cows are able to produce equal or more milk per feeding day during EXT compared with a standard 305-d lactation, whereas results for multiparous cows are inconsistent. Cows managed for EXT can achieve a higher lifetime production while delivering milk with unchanged or improved quality properties. Delaying insemination enhances mounting behaviour and allows insemination after the cow’s energy balance has become positive. However, in most cases EXT has no effect or a non-significant positive effect on reproduction. The EXT strategy sets off a cascade of effects at herd and farm level. Thus, the EXT strategy leads to fewer calvings and thereby expected fewer diseases, fewer replacement heifers and fewer dry days per cow per year. The optimal lifetime scenario for milk production was modelled to be an EXT of 16 months for first parity cows followed by an EXT of 10 months for later lactations. Modelling studies of herd dynamics indicate a positive effect of EXT on lifetime efficiency (milk per dry matter intake), mainly originating from benefits of EXT on daily milk yield in primiparous cows and the reduced number of replacement heifers. Consequently, EXT also leads to reduced total meat production at herd level. For the farmer, EXT can give the same economic return as a traditional lactation period. At farm level, EXT can contribute to a reduction in the environmental impact of dairy production, mainly as a consequence of the reduced production of beef. A wider dissemination of the EXT concept will be supported by methods to predict which cows may be most suitable for EXT, and clarification of how milking frequency and feeding strategy through the lactation can be organised to support milk yield and an appropriate body condition at the next calving.
Both national and international laws apply to collisions by space vehicles and objects in outer space and with the surface of the Earth. International treaties govern collisions involving commercial operators from different states, while domestic laws govern claims by nationals against national commercial operators. Commercial operators may find themselves as defendants or become plaintiffs when others cause them damage. This essay discusses liability in the new space era from the point of view of these operators, including both outer space and surface liabilities. It examines liability exposure, describes different regimes governing liability, and identifies prospective legal changes.
The process of agglutination causes firm cream layers in bovine milk, and a functioning agglutination mechanism is paramount to the quality of non-homogenized milks. The phenomenon is not well-described, but it is believed to occur due to interactions between immunoglobulins (Ig) and milk fat globules. For the first time, this paper demonstrates how the process of agglutination can be visualized using confocal laser scanning microscopy, rhodamine red and a fluoresceinisothiocynat-conjugated immunoglobulin M antibody. The method was used to illustrate the effect on agglutination of storage temperature and pasteurization temperature. Storage at 5 °C resulted in clearly visible agglutination which, however, was markedly reduced at 15 °C. Increasing storage temperature to 20 or 37 °C cancelled any detectable interaction between IgM and milk fat globules, whereby the occurrence of cold agglutination was documented. Increasing 20 s pasteurization temperatures from 69 °C to 71 °C and further to 73 °C lead to progressively higher inactivation of IgM and, hence, reduction of agglutination. Furthermore, 2-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis showed that changes in storage temperature caused a redistribution of Ig-related proteins in milk fat globule membrane isolates. Poly-immunoglobulin G receptor was present in milk fat globule preparations stored at cold (4 °C) conditions, but absent at storage at higher temperature (25 °C). The findings provide valuable knowledge to dairy producers of non-homogenized milk in deciding the right pasteurization temperature to retain the crucial agglutination mechanism.
To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
Descriptive retrospective cohort with nested case-control study.
Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.
Children≤18 years ventilated for≥1 calendar day.
We identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.
Among 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20–67%; PICU, 0–70%; and NICU, 0–43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.
Antimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.
Millions of people across the world suffer from disabling hearing loss. Appropriate interventions lead to improved speech and language skills, educational advancement, and improved social integration. A major limitation to improving care is identifying those with disabling hearing loss in low-resource countries.
This review article summarises information on currently available hearing screening platforms and technology available from published reports and the authors’ personal experiences of hearing loss identification in low-resource areas of the world. The paper reviews the scope and capabilities of portable hearing screening platforms, including the pros and cons of each technology and how they have been utilised in low-resource environments.
Portable hearing screening tools are readily available to assess hearing loss in low-resource areas. Each technology has advantages and limitations that should be considered when identifying the optimal methods to assess needs in each country.
Reduced absorption capacity in patients with intestinal resections (IR) could result in malabsorption of fat-soluble components like carotenoids, which are of clinical interest in relation to visual health. In this case cohort, we investigated the association between IR and serum lutein, zeaxanthin, β-carotene and macular pigment optical density, when compared with healthy controls. Ten patients with IR and twelve healthy controls were included in the study. Baseline characteristics were comparable between groups, except for higher serum TAG (P < 0·05) and shorter bowel length (P < 0·0001) in the group with IR. Serum lutein, zeaxanthin, β-carotene and macular pigment optical density were >15 % lower in the patient group compared with healthy controls (P < 0·05, adjusted for age) and, in the case of serum lutein and zeaxanthin, also for dietary intake of carotenoids. Results suggest that for a test of macular carotenoid supplementation, subjects with a potentially clinically significant carotenoid deficit could be recruited among patients with IR.
Thrust-block naled in front of Kuannersuit Glacier, West Greenland, appears to have formed during the termination of a terrestrial surge event by a combination of enhanced winter runoff, rapid advance of the glacier terminus, and proglacial stress release by thrusting and stacking of naled blocks. This process is equivalent to the formation of thrust-block moraines. The thrust-block naled consists of at least seven thrust sheets, which are characterized by stratified ice with beds composed of a lower debris-rich lamina, an intermediate dispersed lamina and a top clean-ice lamina, and underlain by frozen outwash deposits. The thrust-block naled differs from basal stratified ice in the absence of internal deformation structures, a relatively low debris concentration, a clay-rich particle-size distribution and a preferential sorting of lighter minerals. The oxygen isotope composition of the thrust-block naled is indistinguishable from δ18O values from meteoric glacier ice and bulk meltwater, but different from basal stratified ice facies. The d–δD relationship indicates that thrust-block naled has been formed by freezing of successive thin layers of bulk waters with variable isotopic composition, whereas basal stratified ice has developed in a subglacial environment with regelation. This work shows that the association between proglacial naled and rapidly advancing glaciers may have significant consequences for the proglacial geomorphology and the interpretation of basal ice layers.
The North Greenland Icecore Project (NorthGRIP) was initiated in 1995 as a joint international programme involving Denmark, Germany, Japan, Belgium, Sweden, Iceland, the U.S.A., France and Switzerland. the main goal was to obtain undisturbed high-resolution information about the Eemian climatic period (115–130 kyr BP). the records from the Greenland Icecore Project (GRIP) and Greenland Ice Sheet Project 2 (GISP2) in central Greenland are different and disturbed down in the ice covering this period. Internal radio-echo sounding layers show that NorthGRIP, placed 325 km north-northwest of GRIP at the Summit of the Greenland ice sheet, is located on a gently sloping ice ridge with very flat bedrock and internal layers found so high that an undisturbed Eemian record is possible. Internal layers much farther above bedrock than their apparent counter parts at GRIP suggest that conditions are favourable for recovery of an undisturbed Eemian record. So far, a 1351 mdeep ice core (NorthGRIP1) and a 3001 mdeep ice core (NorthGRIP 2) have been recovered. the ice thickness is expected to be 3080 m, and the ice temperature at 3001 m is –5.6°C, so we expect basal melting at the bedrock. Most of the Eemian ice will be melted away, leaving only the last part and the transition between the Eem and the Last Glacial Period. At 3001 m the age of the ice is 110 kyr BP and the annual layers are of the order 1 cm.With modern methods the annual layers can be resolved, resulting in detailed information on the decline of the warm Eemian period into the Last Glacial Period.
The mass changes of the Gulf of Alaska (GoA) glaciers are computed from the Gravity Recovery and Climate Experiment (GRACE) inter-satellite range-rate data for the period April 2003–September 2007. Through the application of unique processing techniques and a surface mass concentration (mascon) parameterization, the mass variations in the GoA glacier regions have been estimated at high temporal (10 day) and spatial (2 × 2 arc-degrees) resolution. The mascon solutions are directly estimated from a reduction of the GRACE K-band inter-satellite range-rate data and, unlike previous GRACE solutions for the GoA glaciers, do not exhibit contamination by leakage from mass change occurring outside the region of interest. The mascon solutions reveal considerable temporal and spatial variation within the GoA glacier region, with the largest negative mass balances observed in the St Elias Mountains including the Yakutat and Glacier Bay regions. The most rapid losses occurred during the 2004 melt season due to record temperatures in Alaska during that year. The total mass balance of the GoA glacier region was −84 ± 5 Gt a−1 contributing 0.23 ± 0.01 mm a−1 to global sea-level rise from April 2003 through March 2007. Highlighting the large seasonal and interannual variability of the GoA glaciers, the rate determined over the period April 2003–March 2006 is −102 ± 5 Gt a−1, which includes the anomalously high temperatures of 2004 and does not include the large 2007 winter balance-year snowfall. The mascon solutions agree well with regional patterns of glacier mass loss determined from aircraft altimetry and in situ measurements.
We acquired center-line surface elevations from glaciers in the St Elias Mountains of Alaska/northwestern Canada using aircraft laser altimetry during 2000–05, and compared these with repeat measurements acquired in 2007. The resulting elevation changes were used to estimate the mass balance of 32 900 km2 of glaciers in the St Elias Mountains during September 2003 to August 2007, yielding a value of −21.2 ± 3.8 Gt a−1, equivalent to an area-averaged mass balance of −0.64 ± 0.12 m a−1 water equivalent (w.e.). High-resolution (2 arc-degrees spatial and 10 day temporal) Gravity Recovery and Climate Experiment (GRACE) mass-balance estimates during this time period were scaled to glaciers of the St Elias Mountains, yielding a value of −20.6 ± 3.0 Gt a−1, or an area-averaged mass balance of −0.63 ± 0.09 m a−1 w.e. The difference in balance estimates (altimetry minus GRACE) was −0.6 ± 4.8 Gt a−1, well within the estimated errors. Differences likely resulted from uncertainties in subgrid sampling of the GRACE mass concentration (mascon) solutions, and from errors in assigning an appropriate near-surface density in the altimetry estimates. The good correspondence between GRACE and aircraft altimetry data suggests that high-resolution GRACE mascon solutions can be used to accurately assess mass-balance trends of mountain glacier regions that are undergoing large changes.
We performed spectroscopy of globular clusters associated with NGC 1399 and measured radial velocities of about 450 clusters, the largest sample ever obtained for dynamical studies. In this progress report, we present the sample and the first preliminary results. Red and blue clusters have slightly different velocity dispersions in accordance with their different density profiles in the case of a spherical and isotropic model. We then measure a constant circular velocity of 422 ± 20 km/s, which agrees well with that of the inner luminous component.
The time at which the Laurentide Ice Sheet reached its maximum extent and subsequently retreated from its terminal moraine in New Jersey has been constrained by bracketing radiocarbon ages on preglacial and postglacial sediments. Here, we present measurements of in situ produced 10Be and 26Al in 16 quartz-bearing samples collected from bedrock outcrops and glacial erratics just north of the terminal moraine in north-central New Jersey; as such, our ages represent a minimum limit on the timing of ice recession from the moraine. The data set includes field and laboratory replicates, as well as replication of the entire data set five years after initial measurement. We find that recession of the Laurentide Ice Sheet from the terminal moraine in New Jersey began before 25.2±2.1 ka (10Be, n=16, average, 1 standard deviation). This cosmogenic nuclide exposure age is consistent with existing limiting radiocarbon ages in the study area and cosmogenic nuclide exposure ages from the terminal moraine on Martha’s Vineyard ~300 km to the northeast. The age we propose for Laurentide Ice Sheet retreat from the New Jersey terminal position is broadly consistent with regional and global climate records of the last glacial maximum termination and records of fluvial incision.
In a longitudinal study including 642 healthy 8–11-year-old Danish children, we investigated associations between vitamin D dependent SNP and serum 25-hydroxyvitamin D (25(OH)D) concentrations across a school year (August–June). Serum 25(OH)D was measured three times for every child, which approximated measurements in three seasons (autumn, winter, spring). Dietary and supplement intake, physical activity, BMI and parathyroid hormone were likewise measured at each time point. In all, eleven SNP in four vitamin D-related genes: Cytochrome P450 subfamily IIR1 (CYP2R1); 7-dehydrocholesterol reductase/nicotinamide adenine dinucleotide synthetase-1(DHCR7/NADSYN1); group-specific complement (GC); and vitamin D receptor were genotyped. We found minor alleles of CYP2R1 rs10500804, and of GC rs4588 and rs7041 to be associated with lower serum 25(OH)D concentrations across the three seasons (all P<0·01), with estimated 25(OH)D differences of −5·8 to −10·6 nmol/l from major to minor alleles homozygosity. In contrast, minor alleles homozygosity of rs10741657 and rs1562902 in CYP2R1 was associated with higher serum 25(OH)D concentrations compared with major alleles homozygosity (all P<0·001). Interestingly, the association between season and serum 25(OH)D concentrations was modified by GC rs7041 (Pinteraction=0·044), observed as absence of increase in serum 25(OH)D from winter to spring among children with minor alleles homozygous genotypes compared with the two other genotypes of rs7041 (P<0·001). Our results suggest that common genetic variants are associated with lower serum 25(OH)D concentrations across a school year. Potentially due to modified serum 25(OH)D response to UVB sunlight exposure. Further confirmation and paediatric studies investigating vitamin D-related health outcomes of these genotypic differences are needed.
The world is full of educational materials created by faculty but there has been insufficient progress in disseminating even the best of these and without broad dissemination there is little penetration of open materials into higher education. Dissemination of open educational materials cannot be limited to textbooks but systems must be created to support students and faculty as are provided by commercial publishers. LibreTexts addresses this across a broad range of science and technology fields with a new reach into social science and liberal arts. LibreTexts design makes it simple for instructors to build their own courseware, either by mapping components created by others or writing their own. LibreTexts is working towards implementing a complete learning management system including testing software, homework systems guided by artificial intelligence, classroom response software and more to provide an open, online educational system suited to the students and faculty of today.
Medical and educational partnerships between high- and low-resourced countries provide opportunities to have a long-term meaningful impact on medical training and healthcare delivery.
An otolaryngology partnership between Komfo Anokye Teaching Hospital in Kumasi, Ghana, and the University of Michigan Department of Otolaryngology/Head and Neck Surgery has been undertaken to enhance healthcare delivery at both institutions.
A temporal bone dissection laboratory, with the equipment to perform dedicated otological surgery, and academic platforms for clinical and medical education and residency training have been established.
This article describes the details of this partnership in otological surgery and hearing health, with an emphasis on creating in-country surgical simulation, training on newly acquired medical equipment and planning regarding the formulation of objectified metrics to gauge progress going forward.
A relatively lightweight and simple airborne system for surface elevation profiling of glaciers in narrow mountain valleys has been developed and tested. The aircraft position is determined by kinematic global positioning system (GPS) methods. The distance to the glacier surface is determined with a laser ranger. The accuracy is about 0.3 m, sufficient to permit future changes to be observed over short time intervals. Long-term changes can be estimated by comparison of profiles with existing maps. Elevation profiles obtained in 1993–94 from three glaciers in central and south-central Alaska are compared with maps made about 1950. The resulting area-averaged, seasonally corrected thickness changes during the interval are: Gulkana Glacier (central Alaska Range)–11 m, Worthington Glacier (central Chugach Mountains) +7 m, and Bear Lake Glacier (Kenai Mountains) −12 m. All three glaciers retreated during the interval of comparison. The estimated uncertainty in the average thickness change is ±5 m. which is mainly due to errors in the existing maps. Constraints on the accuracy of the maps are obtained by profiling in proglacial areas.
This study presents estimates of snow creep pressures from the centre section of an avalanche defence structure in western Norway. The structure is 15 in long and is erected on a 25° slope characterized by deep snow covers. Two methods of measurement are described: (1) direct estimates from earth pressure cells, and (2) construction of force, shear and moment diagrams from strains measured using vibrating wire strain gauges mounted on the steel beams of the structure.
In addition to the estimates of pressure, relevant snowpack data were measured, including snow depth, density, temperature and rammsonde hardness profiles as well as snow crystal stratigraphy. Snow gliding was also measured, and was found to be negligible. The snowpack measurements were made at approximately monthly intervals during each of the four winters which yielded useable data for the study.
Analysis of the pressure distributions along with the snowpack data yielded the following results: (1) the average pressure on the structure is linearly proportional to the product of average density times snow depth, (2) the average pressures are predicted fairly accurately by a linear, viscous creep model, (3) the maximum pressure depends strongly on the snowpack stiffness and decreases rapidly when warming and melt soften the snowpack, and (4) the maximum pressures are of the order of 254 higher than predicted by a linear, viscous creep model.
Angiopoietin-like protein 4 (ANGPTL4) is a lipoprotein lipase inhibitor that is involved in lipid metabolism and angiogenesis. Animal studies have suggested that the ANGPTL4 protein is modulated by the gut microbiota, possibly through increased concentrations of SCFA, such as C4, found in whole-fat milk or as a result of fermentation of inulin. This study investigated whether a standardised diet either high in fat content or supplemented with inulin powder would increase plasma ANGPTL4 in overweight men and whether this increase was mediated through a compositional change of the gut microbiota. The study had a crossover design with three arms, where participants were given a standardised isoenergetic diet supplemented with inulin powder, whole-fat milk or water (control). Plasma and urine samples were collected before and after each intervention period. Faecal samples and adipose tissue biopsies were collected after each intervention period. The study included twenty-one participants of whom eighteen completed the study. The dietary interventions did not change ANGPTL4 plasma concentration, nor was plasma ANGPTL4 associated with plasma lipids, TAG or NEFA concentration. The relative abundance of bifidobacteria following the inulin diet was higher, compared with the control diet. However, the changes in microbiota were not associated with plasma ANGPTL4 and the overall composition of the microbiota did not change between the dietary periods. Although weight was maintained throughout the dietary periods, weight was negatively associated with plasma ANGPTL4 concentration. In the adipose tissue, ANGPTL4 expression was correlated with leptin expression, but not with hypoxia-inducible factor 1α (HIF-1α) expression.