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The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
To explore the prevalence and drivers of hospital-level variability in antibiotic utilization among hematopoietic cell transplant (HCT) recipients to inform antimicrobial stewardship initiatives.
Retrospective cohort study using data merged from the Pediatric Health Information System and the Center for International Blood and Marrow Transplant Research.
The study included 27 transplant centers in freestanding children’s hospitals.
The primary outcome was days of broad-spectrum antibiotic use in the interval from day of HCT through neutrophil engraftment. Hospital antibiotic utilization rates were reported as days of therapy (DOTs) per 1,000 neutropenic days. Negative binomial regression was used to estimate hospital utilization rates, adjusting for patient covariates including demographics, transplant characteristics, and severity of illness. To better quantify the magnitude of hospital variation and to explore hospital-level drivers in addition to patient-level drivers of variation, mixed-effects negative binomial models were also constructed.
Adjusted hospital rates of antipseudomonal antibiotic use varied from 436 to 1121 DOTs per 1,000 neutropenic days, and rates of broad-spectrum, gram-positive antibiotic use varied from 153 to 728 DOTs per 1,000 neutropenic days. We detected variability by hospital in choice of antipseudomonal agent (ie, cephalosporins, penicillins, and carbapenems), but gram-positive coverage was primarily driven by vancomycin use. Considerable center-level variability remained even after controlling for additional hospital-level factors. Antibiotic use was not strongly associated with days of significant illness or mortality.
Among a homogenous population of children undergoing HCT for acute leukemia, both the quantity and spectrum of antibiotic exposure in the immediate posttransplant period varied widely. Antimicrobial stewardship initiatives can apply these data to optimize the use of antibiotics in transplant patients.
X-ray computed tomography (CT) measurements of live sheep have been used to predict carcass composition very accurately (Macfarlane et al., 2006). The utilisation of spiral CT scans (SCTS) for quantifying muscle volumes and weights, using automatic image analysis procedures has also been shown to be very accurate in sheep (Navajas et al., 2006). Although the limiting size of the CT gantry prevents CT scanning of live beef cattle, beef primal joints are small enough to be scanned. Hence, SCTS could be used to quantify beef carcass composition, and provide valuable information for breeding programmes including composition faster than by anatomical dissection. The objective of this study was to develop a CT image analysis procedure to assess fat, muscle and bone weights of beef carcasses and to evaluate its accuracy.
Perennial ryegrass varieties bred to express high water-soluble carbohydrate (WSC) concentrations have been shown to improve liveweight gain in pre-weaned lambs of grazing ewes (Lee et al., 2001) compared to conventional ryegrass. Studies have shown that the largest differential in WSC between ryegrass varieties bred for high WSC concentrations and control ryegrasses occurs 5-6 weeks after the plant is allowed to re-grow following cutting or grazing (Miller et al., 2001). Therefore, the benefits, in terms of lamb performance, of using these grasses with high WSC concentrations may be best achieved when they are rotationally rather than continuously grazed. The aim of this experiment was to compare lambs rotationally or continuously grazing either a ryegrass variety bred for high WSC concentrations or a control ryegrass.
Nutritional manipulation during the dry period can alter subsequent animal responses to feeding in terms of milk yield and composition. Previous research has shown interesting differences in milk production and composition due to energy or protein supply in the dry period (Moorby et al., 1996). The objective of this experiment was to test the interaction between energy and protein supplies during the dry period on subsequent milk production and composition. Effects on live weight gains and condition scores are reported in a separate summary (Jaurena et al., 2001).
Modern retailing of venison through supermarkets requires that the product be on the shelf for an extended period compared with the traditional short season in autumn/early winter. However, deer are highly seasonal animals and a range of strategies is needed to increase marketing opportunities for venison. One strategy utilizes extended winter daylength and high levels of nutrition to advance the slaughter season (Davies, 1995; Fisher et al., 1995). Another strategy is to adopt more natural, low input systems with reduced production costs, in which deer reach slaughter condition during their third summer at 22-26 months of age, but this needs full investigation. This study involved sequential slaughtering of deer to ascertain how rapidly carcass composition and meat quality changes over this period.
Previous results have shown that during late gestation even under conditions of live weight (LW) gain, maternal body protein can be in negative balance due to the highly demanding gravid uterus and udder. It has also been claimed that current feeding standards underpredict dry cow nitrogen (N) requirement. Considering that it is not possible to measure maternal body N status independently of the requirements of the conceptus and the udder, estimation of conceptus and udder N requirements by mathematical models can help to predict maternal N requirement. The aim of this study was to assess cow N requirement during late gestation by predicting maternal N balance through a mathematical model. Previous results related with this study were presented in Jaurena et al, (2001).
Energy and protein supply during the dry period can affect subsequent milk production and composition (Moorby et al., 1996). Grass silage is a common ingredient of dry cow diets, but although it is usually adequate in crude protein concentration (CP), a high proportion is frequently in non-protein forms. Red clover silage has shown interesting characteristics that would increase true protein supply to ruminants (Broderick et al., 2000), which could avoid the use of more expensive concentrate supplements. The objective of this experiment was to compare red clover and ryegrass silage when fed as the sole source of forage to dry cows with a diet comprising ryegrass silage and a protein supplement.
Earlier studies (e.g. Dewhurst et al., 1996, 1999) have shown marked declines in forage voluntary intake as calving approaches. The resultant reduction in nutrient supply may compromise performance in the next lactation, because it coincides with a period of intense metabolic activity in preparation for the next lactation. Feeding concentrates to dry cows did not overcome this problem (Dewhurst et al., 1999). The objective of the current experiment was to investigate alternative dry cow strategies, using only high-quality grass silage, to minimise the severity and consequences for subsequent milk production of the reduction in nutrient supply in this period.
Our earlier studies with dry cows have highlighted a number of factors that affect performance in the subsequent lactation, including forage intake in the peri-parturient period, body condition at calving and supply of Metabolisable Protein (MP) (Moorby et al., 1996; Dewhurst et al., 2000). There is now increased interest in making more use of grazed grass, as a cheap feed, particularly through extending grazing into the late-autumn and winter. Dry cows are suited to extended grazing because they do not need to be brought in for milking each day. The high voluntary intakes of grass may be beneficial for dry cows, though the low MP supply from autumn-grass might be a disadvantage. This experiment evaluated the effects of extended grazing, compared with housing and silage-feeding of dry cows.
Earlier work showed that red clover silage has considerable potential for milk production (e.g. Thomas et al., 1985), though low digestibility and difficulties ensiling clovers were seen as problems that needed to be addressed. Advances in legume breeding and conservation technology as well as a renewed emphasis on extensive organic production systems within Agenda 2000 meant that it was timely to reconsider the potential of legume silages for milk production.
Body fat and protein reserves at calving can affect milk production and composition (Garnsworthy, 1988; Moorby et al., 1996). Milk producers frequently feed their dry cows with a low quality diet to prevent them from becoming too fat before calving. However, the cow must nourish the foetus and develop mammary secretory tissues, which can be a problem if she is offered a low protein diet. This experiment was designed to test the interaction between energy and protein supplies during the dry period on changes in live weight (LW), condition score (CS) and muscle Longissimus dorsi depth (LD). Subsequent milk production and composition data are reported in a separate summary (Jaurena et al., 2001).
Genetic potential for milk production has increased rapidly in the Holstein-Friesian breed and there is concern that this might be causing an increased incidence of health problems. We have recently (Ingvartsen et al., 2002) reviewed the inter-relationships between lactation performance and health, demonstrating the importance of considering effects on/of body reserves as well as effects on/of milk production. Whilst we identified mechanisms whereby body reserves can have a direct effect on susceptibility to disease, disease also affects body reserves making it difficult to study their inter-relationships. The dry period is a particularly interesting period in this regard, because additional nutrients are directed towards reserves, whilst it is followed by a period (early lactation) of high disease incidence. The objective of this study was to investigate the effects of body condition score (BCS) at calving, as well as the effects of dry period diets designed to alter BCS, on disease incidences in the first 100 days of lactation.
The high intake characteristics of red clover silage has been recognised for many years (e.g. Thomas et al., 1985). Our previous study (Dewhurst et al., 2000) demonstrated the considerable intake and milk production potential of clover silages made using a new approach based on preparation of big-bales from wilted material with the use of biological inoculant additives. The objective of this study was to verify the positive results obtained with red and white clover silages using material taken from a further series of cuts taken in a subsequent year and to evaluate the legume silages with low levels of concentrate feeding.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration.
This was a quality assurance project that monitored training of combat medics to administer parenteral medications and to ensure patient safety. Combat medics were provided training that included direct supervision during medication administration. Once proficiency was demonstrated, combat medics would prepare the medications under direct supervision, followed by indirect supervision during administration. As part of the quality assurance and safety processes, combat medics were required to document all medication administrations, supervising provider, and unexpected adverse events. Additional quality assurance follow-up occurred via complete chart review by the project lead.
During the project period, the combat medics administered the following medications: ketamine (n=13), morphine (n=8), ketorolac (n=7), fentanyl (n=5), ondansetron (n=4), and other (n=6). No adverse events or patient safety events were reported by the combat medics or discovered during the quality assurance process.
In this limited case series, combat medics safely administered parenteral medications under indirect provider supervision. Future research is needed to further develop this training model for both the military and civilian setting.
SchauerSG, CunninghamCW, FisherAD, DeLorenzoRA. A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department. Prehosp Disaster Med. 2017;32(6):679–681.
We examined functional outcomes and quality of life of whole brain radiotherapy (WBRT) with integrated fractionated stereotactic radiotherapy boost (FSRT) for brain metastases treatment. Methods Eighty seven people with 1-3 brain metastases were enrolled on this Phase II trial of WBRT (30Gy/10)+simultaneous FSRT, (60Gy/10). Results Mean (Min-Max) baseline KPS, Mini Mental Status Exam (MMSE) and FACT-BR quality of life were 83 (70-100), 28 (21-30) and 143 (98-153). Lower baseline MMSE (but not KPS or FACT-Br) was associated with worse survival after adjusting for age, number of metastases, primary and extra-cranial disease status. Crude rates of deterioration (>10 points decrease from baseline for KPS and FACT-Br, MMSE fall to<27) ranged from 26-38% for KPS, 32-59% for FACT-Br and 0-16%for MMSE depending on the time-point assessed with higher rates generally noted at earlier time points (<6months post-treatment). Using a linear mixed models analysis, significant declines from baseline were noted for KPS and FACT-Br (largest effects at 6 weeks to 3 months) with no significant change in MMSE. Conclusions The effects on function and quality of life of this integrated treatment of WBRT+simultaneous FSRT were similar to other published series combining WBRT+SRS.
The following is a partial list of samples of archaeological interest processed between February 1981 and October 1985 at the Illinois State Geological Survey (ISGS) Radiocarbon Dating Laboratory. The list contains samples from west-central Illinois that were related to projects conducted by current or former researchers at the Center for American Archeology (CAA) (formerly Foundation for Illinois Archaeology) and Northwestern University, Department of Anthropology, or, as noted, by colleagues from other institutions. Although some of the samples reported here came from non-cultural contexts and are primarily of geological significance, all were from or related to archaeological investigations.
Data on the depth distribution of the major atmospheric gases and the abundance of gaseous 12CO2, 13CO2, and 14CO2 in the subsoil unsaturated zone have been obtained from several sites in the western Great Plains of the United States. Sample profiles range from land surface to depths of 50m. Although each site must be considered on an individual basis, several general statements can be made regarding the profiles. 1) Diffusion of these gaseous molecules through the unsaturated zone is an important transport mechanism. 2) As predicted by diffusion theory, depth profiles of the various isotopic species of CO2 differ substantially from one another, depending on individual sources and sinks such as root respiration and oxidation of organic carbon at depth. 3) In general, post-bomb (> 100% modern) 14C activities are not observed in the deep unsaturated zone, in contrast to diffusion model predictions. 4) In spite of generally decreasing 14C activities with depth, absolute partial pressures of 14CO2 in the subsoil unsaturated zone are 1–2 orders of magnitude higher than the partial pressure of 14CO2 in the atmosphere.