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To deepen understanding of the relationship between food insecurity, acculturation, and diagnosis of CHD and related health outcomes among immigrant adults.
Using cross-sectional, nationally representative data from the National Health Interview Survey 2011 to 2015, we address two research questions. First, what is the relationship of household food insecurity and acculturation with: CHD, angina pectoris, heart attack, self-rated poor health and obesity? Second, what is the association of food insecurity with these health outcomes over years of living in the USA? We estimate multivariate logistic regressions without (question 1) and with (question 2) an interaction term between food insecurity and acculturation for CHD and related health outcomes.
Low-income immigrant adults.
Food insecurity and acculturation are both associated with diagnosis of CHD and related health outcomes among immigrant adults. Food insecurity and acculturation are associated with the health of female immigrants more than males. Also, the differences by food security status in the probability of having several poor health outcomes (self-rated heath, obesity, women’s angina pectoris) are largest for those in the USA for less than 5 years, decrease for those who have lived in the USA for 5–14 years, and are larger again for those in the USA for 15 or more years.
Recent and long-term food-insecure immigrants are more vulnerable to CHD and related health outcomes than those in the USA for 5–14 years. Further research is needed to understand why.
Introduction: The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, continuously updated Emergency Medical Services (EMS) evidence repository. This summary describes the research evidence for the identification and management of adult patients suffering from sepsis syndrome or septic shock. Methods: PubMed was searched in a systematic manner. One author reviewed titles and abstracts for relevance and two authors appraised each study selected for inclusion. Primary outcomes were extracted. Studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and a three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings based on the studies’ primary outcome for each intervention). LOE and DOE of each intervention were plotted on an evidence matrix (DOE x LOE). Results: Eighty-eight studies were included for 15 interventions listed in PEP. The interventions with the most evidence were related to identification tools (ID) (n = 26, 30%) and early goal directed therapy (EGDT) (n = 21, 24%). ID tools included Systematic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA) and other unique measures. The most common primary outcomes were related to diagnosis (n = 30, 34%), mortality (n = 40, 45%) and treatment goals (e.g. time to antibiotic) (n = 14, 16%). The evidence rank for the supported interventions were: supportive-high quality (n = 1, 7%) for crystalloid infusion, supportive-moderate quality (n = 7, 47%) for identification tools, prenotification, point of care lactate, titrated oxygen, temperature monitoring, and supportive-low quality (n = 1, 7%) for vasopressors. The benefit of prehospital antibiotics and EGDT remain inconclusive with a neutral DOE. There is moderate level evidence opposing use of high flow oxygen. Conclusion: EMS sepsis interventions are informed primarily by moderate quality supportive evidence. Several standard treatments are well supported by moderate to high quality evidence, as are identification tools. However, some standard in-hospital therapies are not supported by evidence in the prehospital setting, such as antibiotics, and EGDT. Based on primary outcomes, no identification tool appears superior. This evidence analysis can guide selection of appropriate prehospital therapies.
Introduction: Early and accurate diagnosis of critical conditions is essential in emergency medical services (EMS). Serum lactate testing may be used to identify patients with worse prognosis, including sepsis. Recently, the use of a point-of-care lactate (POCL) test has been evaluated in guiding treatment in patients with sepsis. Operating as part of the Prehospital Evidence Based Practice (PEP) Program, the authors sought to identify and describe the body of evidence for POCL use in EMS and the emergency department (ED) for patients with sepsis. Methods: Following PEP methodology, in May 2018, PubMed was searched in a systematic manner. Title and abstract screening were conducted by the program coordinator. These studies were collected, appraised and added to the existing body of literature contained within the PEP database. Evidence appraisal was conducted by two reviewers who assigned both a level of evidence (LOE) on a novel three tier scale and a direction of evidence (supportive, neutral or opposing; based on primary outcome). Data on setting and study design were also extracted. Results: Eight studies were included in our analysis. Three of these studies were conducted in the ED setting; each investigating the POCL test's ability to predict severe sepsis, ICU admission or death. All three studies found supportive results for POCL. A systematic review on the use of POCL in the ED determined that this test can also improve time to treatment. Five of the total 8 studies were conducted prehospitally. Two of these studies were supportive of POCL use in the prehospital setting; in terms of feasibility and the ability to predict sepsis. Both of these study sites used this early information as part of initiating a “sepsis alert” pathway. The other three prehospital studies provide neutral support for POCL. One study demonstrated moderate ability of POCL to predict severe illness. Two studies found poor agreement between prehospital POCL and serum lactate values. Conclusion: Limited low and moderate quality evidence suggest POCL may be feasible and helpful in predicting sepsis in the prehospital setting. However, there is sparse and inconsistent support for specific important outcomes, including accuracy.
An insect trap constructed using three-dimensional (3D) printing technology was tested in potato (Solanum tuberosum Linnaeus; Solanaceae) fields to determine whether it could substitute for the standard yellow sticky card used to monitor Bactericera cockerelli (Šulc) (Hemiptera: Psylloidea: Triozidae). Sticky cards have shortcomings that prompted search for a replacement: cards are messy, require weekly replacement, are expensive to purchase, and accumulate large numbers of nontarget insects. Bactericera cockerelli on sticky cards also deteriorate enough that specimens cannot be tested reliably for the presence of vectored plant pathogens. A prototype trap constructed using 3D printing technology for monitoring Diaphorina citri Kuwayama (Hemiptera: Psylloidea: Liviidae) was tested for monitoring B. cockerelli. The trap was designed to attract B. cockerelli visually to the trap and then funnel specimens into preservative-filled vials at the trap bottom. Prototype traps were paired against yellow sticky cards at multiple fields to compare the captures of B. cockerelli between cards and traps. The prototype trap was competitive with sticky cards early in the growing season when B. cockerelli numbers were low. We estimated that two or three prototype traps would collect as many B. cockerelli as one sticky card under these conditions. Efficacy of the prototype declined as B. cockerelli numbers increased seasonally. The prototype trap accumulated nontarget taxa that are common on sticky cards (especially Thysanoptera and Diptera), and was also found to capture taxa of possible interest in integrated pest management research, including predatory insects, parasitic Hymenoptera, and winged Aphididae (Hemiptera), suggesting that the traps could be useful outside of the purpose targeted here. We believe that 3D printing technology has substantial promise for developing monitoring tools that exploit behavioural traits of the targeted insect. Ongoing work includes the use of this technology to modify the prototype, with a focus on making it more effective at capturing psyllids and less susceptible to capture of nontarget species.
In 785 mother–child (50% male) pairs from a longitudinal epidemiological birth cohort, we investigated associations between inflammation-related epigenetic polygenic risk scores (i-ePGS), environmental exposures, cognitive function, and child and adolescent internalizing and externalizing problems. We examined prenatal and postnatal effects. For externalizing problems, one prenatal effect was found: i-ePGS at birth associated with higher externalizing problems (ages 7–15) indirectly through lower cognitive function (age 7). For internalizing problems, we identified two effects. For a prenatal effect, i-ePGS at birth associated with higher internalizing symptoms via continuity in i-ePGS at age 7. For a postnatal effect, higher postnatal adversity exposure (birth through age 7) associated with higher internalizing problems (ages 7–15) via higher i-ePGS (age 7). Hence, externalizing problems were related mainly to prenatal effects involving lower cognitive function, whereas internalizing problems appeared related to both prenatal and postnatal effects. The present study supports a link between i-ePGS and child and adolescent mental health.
Disease incidence in dairy cattle is to be reduced for animal welfare and economical reasons. This should be achieved not only by improvement of management but preferably also by genetic means. This study looks at the possibility of decreasing disease incidence in first lactation cows by increasing food intake. The latter is not measured on the cows directly but on young bulls during their performance test. Data consisted of 2203 Danish Red, 4527 Danish Black and White and 1022 Danish Jersey potential AI-bulls and 56 494 Danish Red, 264107 Danish Black and White and 57 661 Danish Jersey first lactation cows. Measures of food intake were provided by two Danish performance test stations. Information on incidence of mastitis, retained placenta, metritis, sole ulcer and ketosis as well as calving interval and energy corrected milk yield of first lactation cows was based on data extracted from the national data base in Denmark. Genetic (co)variances were estimated using restricted maximum likelihood. Heritability estimates of disease incidence and calving interval were low, ranging from <0.01 to 0.13 depending on breed. Heritability estimates of energy corrected milk yield were in the range of 0.28 to 0.33. In all breeds, an unfavourable genetic relationship between milk yield and disease incidence was found, while genetic correlations between food intake and ketosis were favourable, ranging between -0.03 and -0.25. Fertility disorders had an inconsistent correlation with food intake traits across breeds. Food intake of bulls could be included in the selection process in order to avoid nutrition-related disorders like ketosis.
Assessing the relationship between antimicrobial usage (AMU) and antimicrobial resistance (AMR) requires the accurate and precise utilisation of register data. Therefore, validation of register-based data is essential for evaluating the quality and, subsequently, the internal validity of studies based on the data.
In this study, different smoothing methods for Veterinary Medicine Statistic Program database (VetStat)-records were validated by comparing these with farm-records. Comparison between measurements included accuracy as; completeness and correctness, and precision as; a relative difference of the error, correlation with Fisher's z transformation and reliability coefficient. The most valid methods of those examined were then used in re-analyses of the abundance of AMR genes in 10 finisher batches from a previous study.
Improved accuracy was found when detailed smoothing methods were applied. Although the precision also increased, the effect was not as pronounced, as the usage estimate of all smoothing methods deviated moderately compared with the farm-registrations. Applying the most valid methods to the 10 finisher batches increased estimates of statistical model fit for aminoglycosides, lincosamides, tetracyclines and decreased estimates of statistical model fit for macrolides. The estimates of statistical model fit for sulfonamides and broad-spectrum penicillins remained the same.
Through refined data transformation, VetStat-records can be used to calculate a daily amount of AMU per pig reflecting the true usage accurately and moderately precisely, which is the foundation for calculating lifetime AMU.
The use of taxes to promote healthy nutritional behaviour has gained ground in the past decade. The present paper reviews existing applications of fiscal instruments in nutrition policy and derives some perspectives and recommendations from the experiences gained with these instruments. Many countries in different parts of the world have experiences with the taxation of sugar-sweetened beverages, in some cases in combination with taxes on unhealthy food commodities such as confectionery or high-fat foods. These tax schemes have many similarities, but also differ in their definitions of tax objects and in the applied tax rates. Denmark has been the only country in the world to operate a tax on saturated fat content in foods, from 2011 to 2012. Most of the existing food tax schemes have been introduced from fiscal motivations, with health promotion as a secondary objective, but a few have been introduced with health promotion as the primary objective. The diversity in experiences from existing tax schemes can provide valuable insights for future use of fiscal instruments to promote healthy nutrition, in terms of designing effective and efficient tax or subsidy instruments, and in terms of smooth and politically viable implementation of the instruments.
A simple combined heat and ice-sheet model has been used to calculate temperatures at the base of the Laurentide ice sheet. We let the ice sheet surge when the basal temperature reaches the pressure-melting temperature. Driving the system with the observed accumulation and temperature records from the GRIP ice core, Greenland, produces surges corresponding to the observed Heinrich events. This suggests that the mechanism of basal sliding, initiated when the basal temperature reaches the melting point, can explain the surges of the Laurentide ice sheet. This study highlights the importance of the surface temperature and accumulation rate as a means of forcing the timing and strength of the Heinrich events, thus implying important ice-sheet climate feedbacks.
This study measures willingness to pay (WTP) for extrinsic attributes (Angus, local, DNA traceable, raised carbon friendly, and humanely treated cattle) in steak and ground beef using choice-based experiments from a national consumer survey. Belief that survey responses could have consequences on beef products offered by the steak and ground beef industry is investigated, as well as its effect on attribute WTP. For most attributes, belief in consequentiality increases WTP. Results suggest that although consequentiality believers tend to place greater importance on certain food industry issues, they are less certain about the attribute's provision actually effecting change in the industry.
Radio-echo sounding surveys over the Greenland ice sheet show clear, extensive internal layering, and comparisons with age–depth scales from deep ice cores allow for dating of the layering along the ice divide. We present one of the first attempts to extend the dated layers beyond the ice core drill sites by locating the depth of the Bølling–Allerød transition in >400 flight-lines using an automated fitting method. Results show that the transition is located in the upper one-third of the ice column in the central part of North Greenland, while the transition lowers towards the margin. This pattern mirrors the present surface accumulation, and also indicates that a substantial amount of pre-Holocene ice must be present in central North Greenland.
The objectives were to present three approaches for calculating antimicrobial (AM) use in pigs that take into account the rearing period and rearing site, and to study the association between these measurements and phenotypical resistance and abundance of resistance genes in faeces samples from 10 finisher batches. The AM use was calculated relative to the rearing period of the batches as (i) ‘Finisher Unit Exposure’ at unit level, (ii) ‘Lifetime Exposure’ at batch level and (iii) ‘Herd Exposure’ at herd level. A significant effect on the occurrence of tetracycline resistance measured by cultivation was identified for Lifetime Exposure for the AM class: tetracycline. Furthermore, for Lifetime Exposure for the AM classes: macrolide, broad-spectrum penicillin, sulfonamide and tetracycline use as well as Herd Unit Exposure for the AM classes: aminoglycoside, lincosamide and tetracycline use, a significant effect was observed on the occurrence of genes coding for the AM resistance classes: aminoglycoside, lincosamide, macrolide, β-lactam, sulfonamide and tetracycline. No effect was observed for Finisher Unit Exposure. Overall, the study shows that Lifetime Exposure is an efficient measurement of AM use in finisher batches, and has a significant effect on the occurrence of resistance, measured either by cultivation or metagenomics.
Attention-deficit/hyperactivity disorder (ADHD) is characterized by problems in regulating attention and in suppressing disruptive motor activity, i.e. hyperactivity and impulsivity. We recently found evidence that aberrant distribution of posterior α band oscillations (8–12 Hz) is associated with attentional problems in ADHD. The sensorimotor cortex also produces strong 8–12 Hz band oscillations, namely the μ rhythm, and is thought to have a similar inhibitory function. Here, we now investigate whether problems in distributing α band oscillations in ADHD generalize to the μ rhythm in the sensorimotor domain.
In a group of adult ADHD (n = 17) and healthy control subjects (n = 18; aged 21–40 years) oscillatory brain activity was recorded using magnetoencephalography during a visuo-spatial attention task. Subjects had to anticipate a target with unpredictable timing and respond by pressing a button.
Preparing a motor response, the ADHD group failed to increase hemispheric μ lateralization with relatively higher μ power in sensorimotor regions not engaged in the task, as the controls did (F1,33 = 8.70, p = 0.006). Moreover, the ADHD group pre-response μ lateralization not only correlated positively with accuracy (rs = 0.64, p = 0.0052) and negatively with intra-individual reaction time variability (rs = −0.52, p = 0.033), but it also correlated negatively with the score on an ADHD rating scale (rs = −0.53, p = 0.028).
We suggest that ADHD is associated with an inability to sufficiently inhibit task-irrelevant sensorimotor areas by means of modulating μ oscillatory activity. This could explain disruptive motor activity in ADHD. These results provide further evidence that impaired modulation of α band oscillations is involved in the pathogenesis of ADHD.
The Learning Health System Network clinical data research network includes academic medical centers, health-care systems, public health departments, and health plans, and is designed to facilitate outcomes research, pragmatic trials, comparative effectiveness research, and evaluation of population health interventions.
The Learning Health System Network is 1 of 13 clinical data research networks assembled to create, in partnership with 20 patient-powered research networks, a National Patient-Centered Clinical Research Network.
Results and Conclusions
Herein, we describe the Learning Health System Network as an emerging resource for translational research, providing details on the governance and organizational structure of the network, the key milestones of the current funding period, and challenges and opportunities for collaborative science leveraging the network.
A new deep ice-core drilling site has been identified in north Greenland at 75.12° N, 42.30° W, 316 km north-northwest (NNW) of the GRIР drill site on the summit of the ice sheet. The ice thickness here is 3085 m; the surface elevation is 2919 m.The North GRIP (NGRIP) site is identified so that ice of Eemian age (115–130 ka BP,calendar years before present) is located as far above bedrock as possible and so the thickness of the Eemian layer is as great as possible. An ice-flow model, similar to the one used to date the GRIP ice core, is used to simulate the flow along the NNW-trending ice ridge. Surface and bedrock elevations, surface accumulation-rate distribution and radio-echo sounding along the ridge have been used as model input.The surface accumulation rate drops from 0.23 m fee equivalent year−1 at GRIP to 0.19 m ice equivalent year−1 50 km from GRIP. Over the following 300km the accumulation is relatively constant, before it starts decreasing again further north. Ice thicknesses up to 3250 m bring the temperature of the basal ice up to the pressure-melting point 100–250 km from GRIP. The NGRIP site islocated 316 km from GRIP in a region where the bedrock is smooth and the accumulation rate is 0.19 m ice equivalent year−1. The modeled basal ice here has always been a few degrees below the pressure-melting point. Internal radio-echo sounding horizons can be traced between the GRIP and NGRIP sites, allowing us to date the ice down to 2300 m depth (52 ka BP). An ice-flow model predicts that the Eemian-age ice will be located in the depth range 2710–2800 m, which is 285 m above the bedrock. This is 120 m further above the bedrock, and the thickness of the Eemian layer of ice is 20 m thicker, than at the GRIP ice-core site.