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Although lignin has been negatively correlated with neutral detergent fibre (NDF) digestibility (NDFD) in ruminants and used to predict potential extent of NDF digestion of forages, selection of an analysis, Klason lignin (KL) or acid detergent lignin (ADL), to describe the nutritionally relevant lignin has not been resolved. Dismissed as an artifact is the difference between KL and ADL (∆L). A question is whether ∆L influences digestibility of NDF. We evaluated the relationships of ∆L, KL, and ADL with NDFD in order to determine the nutritionally homogeneous or heterogeneous nature of KL. Data sets from 2 laboratories (DS1, DS2) were used that included ADL, KL, and in vitro NDFD at 48 h (NDFD48). DS1 contained 7 C3 grasses, 17 C4 maize forages and 19 alfalfas, and DS2 had 15 C3 grasses, 8 C4 forages, and 6 alfalfas. Mean ∆L was greater than ADL in C3 and C4 samples, and less in alfalfas. Within forage type and laboratory, ∆L was not correlated with NDFD48 (r = -0.34 to 0.49; all P>0.17). ADL was more consistently correlated with NDFD48 (r = -0.47 to -0.95; P <0.01-0.21) than was KL (r = 0.03 to -0.91; P <0.01-0.94). ∆L as a proportion of KL was correlated with NDFD48 in C3 and C4 samples (r = 0.44 to 0.76; P <0.01-0.08). The differing behaviors of ∆L and ADL relative to NDFD48 indicate that KL is a nutritionally heterogeneous fraction, the behavior of which may vary by forage type and ratios of ADL and ∆L present.
Reconstructing the provenance of siliciclastic marine sediment is important for understanding sediment pathways and constraining palaeoclimate and erosion records. However, physical fractionation of different size fractions can occur during sediment transport, potentially biasing records derived from bulk sediment. In this study, records of radiogenic Sr and Nd isotopic composition and K/Al ratio of the separated clay fraction, as well as bulk grain size, are presented, measured from deep-sea sediments recovered from International Ocean Discovery Program (IODP) Sites U1456 and U1457 in the Arabian Sea. These new records are compared with published bulk sediment records to investigate the influence of sediment transport on these proxies and to constrain provenance evolution and its relationship to climate variability since middle Miocene time. Correlations between grain size and the bulk sediment isotopic composition confirm that transport processes are influencing the bulk sediment record. This relationship, although present, is not as strong in the clay-fraction isotopic records. Heterogeneity of bulk sediment likely drives differences between bulk and clay records, thought to be largely controlled by sediment transport processes. The isotopic records reveal variations in provenance that correlate with climatic change at 8–7 Ma, as well as an increase in overall provenance variability beginning at c. 3.5 Ma, likely linked to monsoon strength and glacial–interglacial cycles. The clay-fraction records highlight the potential value of measuring proxy records from multiple size fractions to help constrain provenance records as well as investigate sediment transport and/or weathering and erosion processes recorded in deep-sea sediment archives.
Medical experts may be instructed by designated bodies such as the coroner or the court, to provide expert witness statements concerning patients treated under their care. Such reports are factual and are prepared on the basis of the medical records and personal recollection of events. Other authorities such as the Driving Vehicle and Licensing Agency can also seek information on patients with traumatic brain injury. In the civil court, experts may advise on matters relating to personal injury and medical negligence. Reports are usually based upon review of records, and often medical examination of the claimant. The expert may be instructed to provide reports on condition, prognosis and/or causation. This chapter discusses liaison with the various authorities that require medico-legal input relevant to head injury and whiplash.
A traumatic skull base fracture can breach the dura, leading to a communication, or fistula, from the intracranial cavity to the external environment. This leads to a risk of cerebrospinal fluid (CSF) leak in 10%–30% of patients, highest in fractures of the anterior cranial fossa.1 CSF can subsequently leak from the nose (rhinorrhoea) or ear (otorrhoea). Many CSF leaks will seal spontaneously within 1–2 weeks with conservative management, but if CSF leakage is prolonged, then operative repair of the fistula is needed (see Chapter 18 for details on CSF leak diagnosis and management).
The rapid and accurate clinical assessment of a head-injured patient is crucial. The initial management should be governed by attention to the airway, breathing and circulation according to the principles of the Advanced Trauma Life Support (ATLS) care system. This is vital not only to identify immediately life-threatening injuries but also to prevent secondary cerebral insults. The cervical spine should be immobilised, since patients with a head injury may also harbour a cervical spine injury.1 The level of consciousness and pupil size and reaction should be determined early and at regular intervals when managing patients with TBI.
This chapter reviews the indications for surgical intervention and operative nuances that may facilitate neurosurgical procedures. We discuss the surgical management of patients with traumatic intracranial haematomas, depressed skull fractures, the placement of external ventricular drains and the application of decompressive craniectomy.
The overall goal of all surgical treatment is to prevent secondary injury by helping to maintain blood flow and oxygen to the brain and minimise swelling and pressure. Survival from traumatic head injury has improved significantly over the last 20 years, reflecting improved pre-hospital and neuro-intensive care management of head-injured patients, as well as the introduction of the NICE head injury guidelines in 2003, which has led to a greater number of trauma patients undergoing computed tomography (CT) of the head.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
Advocating a pragmatic and multidisciplinary approach to the management of patients with brain injuries, Traumatic Brain Injury provides a detailed description of care along the whole-patient pathway. Delivering an evidence-based update on the optimal care of both adult and paediatric patients who have sustained injuries ranging from mild to severe, information from on-going multi-centre studies in neurotrauma is included. The basic scientific principles of neuropathology, head injury research and scoring systems are presented before detailed sections on emergency department care, patient transfer, intensive care and longer-term care. Rehabilitation is reviewed in detail with chapters discussing the aims and roles of physiotherapy, occupational therapy and neuropsychology amongst others. Discussing medico-legal issues in detail, the effect of injury on the individual and their family are also examined. Emphasising a holistic approach to caring for patients with brain injuries, this is an essential guide for all involved.
Epigenetic programming is essential for lineage differentiation, embryogenesis and placentation in early pregnancy. In epigenetic association studies, DNA methylation is often examined in DNA derived from white blood cells, although its validity to other tissues of interest remains questionable. Therefore, we investigated the tissue specificity of epigenome-wide DNA methylation in newborn and placental tissues. Umbilical cord white blood cells (UC-WBC, n = 25), umbilical cord blood mononuclear cells (UC-MNC, n = 10), human umbilical vein endothelial cells (HUVEC, n = 25) and placental tissue (n = 25) were obtained from 36 uncomplicated pregnancies. Genome-wide DNA methylation was measured by the Illumina HumanMethylation450K BeadChip. Using UC-WBC as a reference tissue, we identified 3595 HUVEC tissue-specific differentially methylated regions (tDMRs) and 11,938 placental tDMRs. Functional enrichment analysis showed that HUVEC and placental tDMRs were involved in embryogenesis, vascular development and regulation of gene expression. No tDMRs were identified in UC-MNC. In conclusion, the extensive amount of genome-wide HUVEC and placental tDMRs underlines the relevance of tissue-specific approaches in future epigenetic association studies, or the use of validated representative tissues for a certain disease of interest, if available. To this purpose, we herewith provide a relevant dataset of paired, tissue-specific, genome-wide methylation measurements in newborn tissues.
The ‘jumping to conclusions’ (JTC) bias is associated with both psychosis and general cognition but their relationship is unclear. In this study, we set out to clarify the relationship between the JTC bias, IQ, psychosis and polygenic liability to schizophrenia and IQ.
A total of 817 first episode psychosis patients and 1294 population-based controls completed assessments of general intelligence (IQ), and JTC, and provided blood or saliva samples from which we extracted DNA and computed polygenic risk scores for IQ and schizophrenia.
The estimated proportion of the total effect of case/control differences on JTC mediated by IQ was 79%. Schizophrenia polygenic risk score was non-significantly associated with a higher number of beads drawn (B = 0.47, 95% CI −0.21 to 1.16, p = 0.17); whereas IQ PRS (B = 0.51, 95% CI 0.25–0.76, p < 0.001) significantly predicted the number of beads drawn, and was thus associated with reduced JTC bias. The JTC was more strongly associated with the higher level of psychotic-like experiences (PLEs) in controls, including after controlling for IQ (B = −1.7, 95% CI −2.8 to −0.5, p = 0.006), but did not relate to delusions in patients.
Our findings suggest that the JTC reasoning bias in psychosis might not be a specific cognitive deficit but rather a manifestation or consequence, of general cognitive impairment. Whereas, in the general population, the JTC bias is related to PLEs, independent of IQ. The work has the potential to inform interventions targeting cognitive biases in early psychosis.
In the Philippines, morbidity control of soil-transmitted helminth (STH) infections is done through mass drug administration (MDA) of anthelmintics to school-age children (SAC). In 2013, the Philippines was devastated by the deadliest cyclone ever recorded, Typhoon Haiyan. The study aimed to understand the impact of Typhoon Haiyan on the MDA of anthelmintics to SAC in the provinces of Capiz and Iloilo in the Philippines from the perspectives of local health and education officials.
The study was conducted in the municipalities of Panay and Pilar in Capiz and the municipalities of Estancia and Sara in Iloilo, areas that were devastated by Typhoon Haiyan. Qualitative, semi-structured key informant interviews were conducted with 16 total participants, which included officials of the Department of Health, Department of Education, and concerned local government units. All interviews were transcribed verbatim and coded in an open, iterative manner. Codes were reviewed to identify patterns and themes.
Participants described the following themes: (1) their perception that the typhoon had no effect on the MDA program or on resources necessary to complete the program; (2) the program’s simple design allowed for 1-time administration to a pre-assembled population; (3) the program allowed a sense of community cohesiveness; (4) the program served as a vehicle for altruism, particularly regarding helping needy children, in this time of calamity.
Our informants perceived that the MDA program in Region VI was not affected by Typhoon Haiyan. They attributed the resilience to the program’s simple procedure, attitudes of altruism, program importance, and community cohesiveness. Despite Typhoon Haiyan’s mass destruction of infrastructure and livelihood leading to incredible challenges, mobilization of the community allowed for the continuation and successful implementation of the MDA program. The experience of Region VI may serve as a model for other low- and middle-income countries prone to natural disasters.
Dielectric breakdown in a thin oxide is presented in terms of an interacting particle system on a two-dimensional lattice. All edges in the system are initially assumed to be closed. An edge between two adjacent vertices will open according to an exponentially distributed random variable. Breakdown occurs at the time an open path connects the top layer of the lattice to the bottom layer. Using the extreme value theory, we show that the time until breakdown is asymptotically Weibull distributed.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
The American Academy of Pediatrics (AAP) calls for the inclusion of office-based pediatricians in disaster preparedness and response efforts. However, there is little research about disaster preparedness and response on the part of pediatric practices. This study describes the readiness of pediatric practices to respond to disaster and delineates factors associated with increased preparedness.
An AAP survey was distributed to members to assess the state of pediatric offices in readiness for disaster. Potential predictor variables used in chi-square analysis included community setting, primary employment setting, area of practice, and previous disaster experience.
Three-quarters (74%) of respondents reported some degree of disaster preparedness (measured by 6 indicators including written plans and maintaining stocks of supplies), and approximately half (54%) reported response experience (measured by 3 indicators, including volunteering to serve in disaster areas). Respondents who reported disaster preparation efforts were more likely to have signed up for disaster response efforts, and vice versa.
These results contribute information about the state of pediatric physician offices and can aid in developing strategies for augmenting the inclusion of office-based pediatricians in community preparedness and response efforts.
The necessity of using subject-specific data analysis of nonergodic psychological processes is explained while emphasizing the difference between interindividual and intraindividual variation. The chapter argues that subject-specific data analysis not only matches the principles underlying developmental systems theory, which is relevant to obtaining a comprehensive understanding of change in human psychopathology, but also enables testing of all principles of person-oriented theory, which is fundamental to the formation and implementation of individualized treatments. A new generalized perspective on measurement equivalence in subject-specific data analysis is introduced. The importance of adaptive optimal control of psychological processes within the context of subject-specific data analysis is emphasized. In addition, some broader aims of subject-specific data analysis are considered, including principled ways to bridge the nomothetic and idiographic levels of analysis.