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Reductions in insulin sensitivity in periparturient dairy cows develop as a means to support lactation; however, excessive mobilization of fatty acids (FA) increases the risk for peripartal metabolic disorders. Our objectives were to investigate the effect of prepartum body condition score (BCS) on systemic glucose and insulin tolerance, and to compare direct and indirect measurements of insulin sensitivity in peripartal lean and overweight dairy cows. Fourteen multiparous Holstein cows were allocated into two groups according to their BCS at day −28 prepartum: lean (n = 7; BCS ≤ 3.0) or overweight; (n = 7; BCS ≥ 4.0). Liver biopsies were performed on day −27, −14 and 4, relative to expected parturition. Intravenous insulin or glucose tolerances tests were performed following each liver biopsy. Relative to lean cows, overweight cows exhibited lower dry matter intake, lost more BCS and displayed increased plasma FA and β-hydroxybutyrate concentrations and elevated liver lipid content during peripartum. Glucose clearance rate was lower for all cows postpartum. Prepartum BCS had minimal effects on insulin and glucose tolerance; however, the ability of the cow to restore blood glucose levels following an insulin challenge was suppressed by increased BCS. Glucose-dependent parameters of insulin and glucose tolerance were not correlated with surrogate indices of insulin sensitivity. We conclude that prepartum BCS had minimal effect on systemic insulin sensitivity following parturition. The observed inconsistency between surrogate indices of insulin sensitivity and direct measurements of insulin and glucose tolerance adds support to growing concerns regarding their usefulness as tools to estimate systemic insulin action in periparturient cows.
The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.
The second year of life is a period of nutritional vulnerability. We aimed to investigate the dietary patterns and nutrient intakes from 1 to 2 years of age during the 12-month follow-up period of the Growing Up Milk – Lite (GUMLi) trial. The GUMLi trial was a multi-centre, double-blinded, randomised controlled trial of 160 healthy 1-year-old children in Auckland, New Zealand and Brisbane, Australia. Dietary intakes were collected at baseline, 3, 6, 9 and 12 months post-randomisation, using a validated FFQ. Dietary patterns were identified using principal component analysis of the frequency of food item consumption per d. The effect of the intervention on dietary patterns and intake of eleven nutrients over the duration of the trial were investigated using random effects mixed models. A total of three dietary patterns were identified at baseline: ‘junk/snack foods’, ‘healthy/guideline foods’ and ‘breast milk/formula’. A significant group difference was observed in ‘breast milk/formula’ dietary pattern z scores at 12 months post-randomisation, where those in the GUMLi group loaded more positively on this pattern, suggesting more frequent consumption of breast milk. No difference was seen in the other two dietary patterns. Significant intervention effects were seen on nutrient intake between the GUMLi (intervention) and cows’ milk (control) groups, with lower protein and vitamin B12, and higher Fe, vitamin D, vitamin C and Zn intake in the GUMLi (intervention) group. The consumption of GUMLi did not affect dietary patterns, however, GUMLi participants had lower protein intake and higher Fe, vitamins D and C and Zn intake at 2 years of age.
Introduction: Analyzing the charts of patients who have a return visit to an emergency department (ED) requiring hospital admission (termed ‘RV’) is an efficient way to identify adverse events (AEs). Investigating these AEs can inform efforts to improve the quality of care provided. The ED RV Quality Program (RVQP) is a new initiative supported by Ontario’s Ministry of Health and Long-Term Care and managed by Health Quality Ontario. It aims to promote a culture of continuous quality improvement through routine audit/investigation of RVs. Methods: The provincial program is mandatory for high-volume EDs and requires auditing of some 72-hour RVs and all 7-day RVs involving ‘sentinel diagnoses’ (subarachnoid hemorrhage [SAH], acute myocardial infarction [AMI], or pediatric sepsis [PS]). A standardized audit template is followed that includes assessment of the type/severity and underlying causes of AEs, and potential actions for improvement. Results: 73 high-volume EDs and 16 smaller EDs (collectively receiving 90% of all ED visits in Ontario) are participating in the program. Nine months’ data have been released to date, comprising 33,956 RVs (1.05% of 3,235,751 ED visits). Of these, 233 RVs (0.69%) were for a sentinel diagnosis (SAH=11, AMI=191, PS=31). The most common presenting complaint on the index visit was abdominal pain (18%). The most common discharge diagnosis following RV admission was acute appendicitis (3.8%). Conclusion: The ED RVQP aims to improve the quality of care provided in Ontario’s EDs by requiring hospitals to conduct audits of RVs and plan actions for improvement when quality gaps are identified. Participating hospitals have completed hundreds of audits to date.
Data obtained by the AS&E X-ray Telescope Experiment during the first Skylab mission have revealed a variety of temporal changes in both the form and brightness of coronal structures. Dynamical changes have been noted in active regions, in large scale coronal structures, and in coronal bright points. The coronal activity accompanying a series of Hα flares and prominence activity between 0800 and 1600 UT on 10 June 1973 in active region 137 (NOAA) at the east limb is shown in Figure 1. It is characterized by increases in the brightness and temperature of active region loops and a dramatic change in the shape and brightness of a loop structure. Figure 2 shows the reconfiguration of an apparent polar crown filament cavity between 1923 UT on 12 June 1973 and 1537 UT on 13 June 1973. A ridge of emitting material which attains a peak brightness at least four times that of the surrounding coronal structures appears within the cavity during the course of the event. Typical X-ray photographs with filters passing relatively soft X-ray wavelengths (3–32, 44–54 Å) show 90 to 100 X-ray bright points (Vaiana et al., 1973). On twelve occasions in the data from the first mission, such bright points were seen to increase in intensity by two orders of magnitude in less than 4 min. Such an event is shown in Figure 3.
Evidence from the Ross embayment, Antarctica, suggests an abrupt cooling and a concomitant increase in sea-ice cover at about 6000 BP (6 ka). Stable-isotope (δD) concentrations in the Taylor Dome ice core, at the western edge of the Ross embayment, decline rapidly after 6 ka, and continue to decline through the late Holocene. Methanesulfonic acid concentrations at Taylor Dome show opposite trends to δD Sediment cores from the western Ross Sea show a percentage minimum for the sea-ice diatom Fragilariopsis curta between 9 and 6 ka, whenTaylor Dome δD values are highest, followed by an increase through the late Holocene. Radiocarbon dates from raised beach deposits indicate that the retreat of ice shelves in the Ross embayment ceased at about 6 ka, coincident with the environmental changes inferred from the sediment and ice-core records. The similarity in timing suggests an important role for climate in controlling the evolution of ice-shelf margins following the end of the last glaciation.
We report on the present status of the Lawrence Livermore AMS spectrometer, including sample throughput and progress towards routine 1% measurement capability for 14C, first results on other isotopes and experience with a multisample high-intensity ion source.
Weed suppression is one possible benefit of including cover crops in crop rotations. The late spring planting date of dry beans allows for more growth of cover crops in the spring. We assessed the influence of cover crops on weed dynamics in organic dry beans and weed seed persistence. Medium red clover, oilseed radish, and cereal rye were planted the year before dry beans; a no-cover-crop control was also included. After cover-crop incorporation, common lambsquarters, giant foxtail, and velvetleaf seeds were buried in the red clover, cereal rye, and no-cover control treatments and then retrieved 0, 1, 2, 4, 6, and 12 mo after cover-crop incorporation. Dry beans were planted in June and weed emergence and biomass measured. Eleven or more site-years of data were collected for each cover-crop treatment between 2011 and 2013, allowing for structural equation modeling (SEM), in addition to traditional analyses. Cereal rye residue increased giant foxtail and velvetleaf seed persistence by up to 12%; red clover decreased common lambsquarters seed persistence by 22% in 1 of 2 yr relative to the no-cover-crop control. Oilseed radish and incorporated cereal rye rarely reduced weed densities. When red clover biomass exceeded 5 Mg ha−1, soil inorganic N was often higher (5 of 6 site-years), as were weed density and biomass (5 and 4 of 12 main site sample times, respectively). Using SEM, we identified one causal relationship between cover-crop N content and weed biomass at the first flower stage (R1), as mediated through soil N at the time of dry bean planting and at the stage with two fully expanded trifoliates. Increasing cover-crop C : N ratios directly reduced weed biomass at R1, not mediated through changes in soil N. Cover crops that make a significant contribution to soil N may also stimulate weed emergence and growth.
The present account refers mainly to research work published in the period 1973–1975. Due to the limited space available, and the rapidly increasing number of contributions in the field of Commission. 28, it has not been possible to write an all-inclusive report. As in the previous IAU volumes, the report is not intended as a repetition of the summaries given in the Astronomy and Astrophysics Abstracts. In stressing the importance of certain areas of research, the personal views of the writer(s) cannot be entirely avoided.
Generalized anxiety disorder (GAD) and panic disorder (PD) differ in their biology and co-morbidities. We hypothesized that GAD but not PD symptoms at the age of 15 years are associated with depression diagnosis at 18 years.
Using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we examined relationships of GAD and PD symptoms (measured by the Development and Well-Being Assessment) at 15 years with depression at 18 years (by the Clinical Interview Schedule – Revised) using logistic regression. We excluded adolescents already depressed at 15 years and adjusted for social class, maternal education, birth order, gender, alcohol intake and smoking. We repeated these analyses following multiple imputation for missing data.
In the sample with complete data (n = 2835), high and moderate GAD symptoms in adolescents not depressed at 15 years were associated with increased risk of depression at 18 years both in unadjusted analyses and adjusting for PD symptoms at 15 years and the above potential confounders. The adjusted odds ratio (OR) for depression at 18 years in adolescents with high relative to low GAD scores was 5.2 [95% confidence interval (CI) 3.0–9.1, overall p < 0.0001]. There were no associations between PD symptoms and depression at 18 years in any model (high relative to low PD scores, adjusted OR = 1.3, 95% CI 0.3–4.8, overall p = 0.737). Missing data imputation strengthened the relationship of GAD symptoms with depression (high relative to low GAD scores, OR = 6.2, 95% CI 3.9–9.9) but those for PD became weaker.
Symptoms of GAD but not PD at 15 years are associated with depression at 18 years. Clinicians should be aware that adolescents with GAD symptoms may develop depression.
This paper presents our experience of managing children with a tracheostomy in a multidisciplinary team clinic consisting of an ENT consultant, paediatric respiratory consultant, a nurse specialist, and speech and language therapist.
A retrospective case note review was conducted of all children seen in the multidisciplinary team tracheostomy clinic (at a tertiary paediatric hospital) between February 2009 and September 2014.
Ninety-seven patients were examined. The most common indications for tracheostomy were: lower airway and respiratory problems (66 per cent), upper airway obstruction (64 per cent), and neurodevelopmental problems (60.8 per cent).
Children with a tracheostomy are a diverse group of patients. The most common indications for paediatric tracheostomy have changed from infective causes to airway obstruction and anomalies, long-term ventilation requirement, and underlying neuromuscular or respiratory problems. Our unified approach empowers the carers and patient, as a home management plan, long-term plan and goals are generated at the end of each appointment.
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.