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To assess differences in cognition functions and gross brain structure in children seven years after an episode of severe acute malnutrition (SAM), compared with other Malawian children.
Prospective longitudinal cohort assessing school grade achieved and results of five computer-based (CANTAB) tests, covering three cognitive domains. A subset underwent brain MRI scans which were reviewed using a standardized checklist of gross abnormalities and compared with a reference population of Malawian children.
Children discharged from SAM treatment in 2006 and 2007 (n 320; median age 9·3 years) were compared with controls: siblings closest in age to the SAM survivors and age/sex-matched community children.
SAM survivors were significantly more likely to be in a lower grade at school than controls (adjusted OR = 0·4; 95 % CI 0·3, 0·6; P < 0·0001) and had consistently poorer scores in all CANTAB cognitive tests. Adjusting for HIV and socio-economic status diminished statistically significant differences. There were no significant differences in odds of brain abnormalities and sinusitis between SAM survivors (n 49) and reference children (OR = 1·11; 95 % CI 0·61, 2·03; P = 0·73).
Despite apparent preservation in gross brain structure, persistent impaired school achievement is likely to be detrimental to individual attainment and economic well-being. Understanding the multifactorial causes of lower school achievement is therefore needed to design interventions for SAM survivors to thrive in adulthood. The cognitive and potential economic implications of SAM need further emphasis to better advocate for SAM prevention and early treatment.
The proportion of adults aged 60 years and over is expected to increase over the coming decades. This ageing of the population represents an important health issue, given that marked reductions to cerebral macro- and microstructural integrity are apparent with increasing age. Reduced cerebral structural integrity in older adults appears to predict poorer cognitive performance, even in the absence of clinical disorders such as dementia. As such, it is becoming increasingly important to identify those factors predicting cerebral structural integrity, especially factors that are modifiable. One such factor is nutritional intake. While the literature is limited, data from available cross-sectional studies indicate that increased intake of nutrients such as B vitamins (for example, B6, B12 and folate), choline, n-3 fatty acids and vitamin D, or increased adherence to prudent whole diets (for example, the Mediterranean diet) predicts greater cerebral structural integrity in older adults. There is even greater scarcity of randomised clinical trials investigating the effects of nutritional supplementation on cerebral structure, though it appears that supplementation with B vitamins (B6, B12 and folic acid) or n-3 fatty acids (DHA or EPA) may be beneficial. The current review presents an overview of available research examining the relationship between key nutrients or adherence to select diets and cerebral structural integrity in dementia-free older adults.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
St Patrick's Day parades have so often been a barometer of Irish identity, one day which reflects the shifting meanings of Irishness across the globe. The New York parade in 2015 was no different. Indeed, the controversial appearance in the parade, for the first time, of an LGBTQ organisation marked the culmination of decades of debate about how Irishness is (and should) be represented through the St Patrick's Day celebration. The Out@NBCUniversal group became the first gay participants officially sanctioned by the parade organisers. Representing the event's television broadcaster, the hundred or so employees of NBC who marched in 2015 were the first LGBTQ representatives to join the parade since the organising committee, led largely by the Ancient Order of Hibernians (AOH), decided to ban the Irish Lesbian and Gay Organisation (ILGO) from marching in 1991. That year, the ILGO did manage to march, but under the auspices of Division 7 of the Manhattan AOH. In protest against the decision to ban the ILGO from the main parade, Mayor David Dinkins walked with the ILGO and was pelted with beer cans by a crowd whose sympathies lay emphatically with the parade organisers. Despite being the only LGBTQ group allowed to march in 2015, the appearance of Out@NBCUniversal was significant, then, in marking a shift towards the greater acceptance of homosexuality in the Irish diaspora. More importantly, the debate about LGBTQ representation at the NYC parade reveals the great diversity of Irish identities throughout the world. While the New York parade was dominated during the 1990s and 2000s by a socially conservative (and explicitly Catholic) vision of Irishness, others reflected a greater plurality. In New York itself, since 2000 the ‘St Pat's for All’ parade in Queens has welcomed ‘all to celebrate Irish heritage and culture regardless of race, gender, creed or sexual orientation’. In Ireland, Fintan O'Toole has led criticism of the New York parade's exclusion of the ILGO and his spat in the Irish Times in March 1998 with historian Marion Casey reflects what Mary Hickman has termed ‘the heterogeneous formation’ of the Irish diaspora.
Suboptimal uptake of the measles, mumps and rubella (MMR) vaccine by certain socioeconomic groups may have contributed to recent large measles outbreaks in the UK. We investigated whether socioeconomic deprivation was associated with MMR vaccine uptake over 16 years. Using immunization data for 72 351 children born between 1995 and 2012 in Liverpool, UK, we examined trends in vaccination uptake. Generalized linear models were constructed to examine the relative effect of socioeconomic deprivation and year of birth on MMR uptake. Uptake of MMR1 by age 24 months ranged between 82·5% in 2003 [95% confidence interval (CI) 81·2–83·7] and 93·4% in 2012 (95% CI 92·7–94·2). Uptake of MMR2 by age 60 months ranged between 65·3% (95% CI 64·4–67·4) in 2006 and 90·3% (95% CI 89·4–91·2) in 2012. In analysis adjusted for year of birth and sex, children in the most deprived communities were at significantly greater risk of not receiving MMR1 [risk ratio (RR) 1·70, 95% CI 1·45–1·99] and MMR2 (RR 1·36, 95% CI 1·22–1·52). Higher unemployment and lower household income were significantly associated with low uptake. Contrary to concerns about lower MMR uptake in affluent families, over 16 years, children from the most socioeconomically deprived communities have consistently had the lowest MMR uptake. Targeted catch-up campaigns and strategies to improve routine immunization uptake in deprived areas are needed to minimize the risk of future measles outbreaks.
Teouma, an archaeological site on Efate Island, Vanuatu, features the earliest cemetery yet discovered of the colonizers of Remote Oceania, from the late second millennium B.C. In order to investigate potential migration of seventeen human individuals, we measured isotopes of strontium (87Sr/86Sr), oxygen (δ18O), and carbon (δ13C), as well as barium (Ba) and strontium (Sr) concentrations, in tooth enamel from skeletons excavated in the first two field seasons. The majority of individuals cluster with similar isotope and Ba/Sr ratios, consistent with a diet of marine resources supplemented with plants grown on the local basaltic soils. Four outliers, with distinctive 87Sr/86Sr and δ18O, are probably immigrants, three of which were buried in a distinctive position (supine, with the head to the south) with higher Ba/Sr and δ13C, consistent with a terrestrial, nonlocal diet. Among the probable immigrants was a male buried with the crania of three of the locally raised individuals on his chest.
This paper offers a critical perspective on the changing organisational structure of the Western commercial aircraft industry. The role of systems integration based on risk-sharing partnerships for new aircraft programmes is explored. We find that build-to-print subcontracting relationships are being replaced by internationally devolved design and engineering tasks for airframe development, signaling a profound change in the geography of commercial aircraft production. While sensible from a financial standpoint, the international outsourcing of design-intensive production entails substantial amounts of technology transfer–including the delivery of proprietary knowledge to risk-sharing partners. For several of the advanced market economies, including Canada, France, Germany, the UK, and the US, the long-range strategic downside is that foreign risk-sharing partners could eventually become competitors. Systems integration on a risk-sharing basis also implies home-country joblosses among skilled workers with expertise in design, engineering, and R&D.
Following the introduction of E. granulosus into Australia with domestic animals during European settlement, the parasite quickly became established in the E. granulosus-naive native animals of the continent. The distribution of E. granulosus in wildlife in Australia is restricted by rainfall, but nevertheless the parasite is currently widespread and highly prevalent in many areas including numerous national parks and privately owned farms. The human population of Africa is rapidly increasing resulting in ever more pressure on wild-life populations and habitat. National parks, reserves and conservation areas now provide important tracts of preserved habitat for maintaining populations of wildlife that are also important in the maintenance of E. granulosus. In some parts of Africa, hydatid-infected humans provide a source of E. granulosus infection to wildlife definitive hosts. In many areas felids may also act as important definitive hosts for E. granulosus with the parasite being maintained in a prey/predator relationship between lions and a range of intermediate hosts. Populations of E. granulosus-infected wild-life both in Australia and Africa act as important reservoirs in perpetuating the transmission of E. granulosus to both domestic animals and humans. In Australia, E. granulosus-infected wild-life is infiltrating urban areas and currently represents a potentially important new public health problem.
During the 1999 conflict in Kosovo, an estimated 850,000 people were displaced from Kosovo. Many thousands of these people arrived in the Former Yugoslav Republic of Macedonia (FYROM), for whom a humanitarian evacuation programme (HEP) was conducted by the United Nations High Commissioner for Refugees (UNHCR) and the International Organization for Migration (IOM). More than 91,000 people were moved to third countries under this programme.
A health assessment tool was designed, validated, and implemented to document the health status of the refugees prior to departure. The IOM evaluated 41,652 pre-travel “fitness to travel” medical assessments for refugees transported by the Organization. A colour coding system for fitness-to-travel was used to clearly identify refugees to the receiving health authorities according to their health condition at the time of departure.
A total of 41,652 fitness-to-travel assessments were performed between 05 April and 25 June 1999, and were entered into a database. There were 21,923 females and 19,566 males. The average age was 25.3 years (women, 26 years; men, 24.3 years). Of these assessments, 4,647 (11.2%) individuals who were deemed fit-to-travel required medical assessment at the host destination, and of those 1,204 required urgent care. The majority of health complaints were acute respiratory tract infections and hypertension.
A rapid and efficient system for fitness-to-travel was created to assist in the management of health issues related to the urgent and mass movement of refugees. The collected health information was of use to health-care planners during the crisis and for those responsible for the health-care of newly arrived refugees. The lessons learned have implications for future similar operations and for the development of research and education programs for both the refugees and the host recipient nations.
Direct solar flare neutrons are a valuable diagnostic of high-energy ion acceleration in these events, and COMPTEL improves over all previous cosmic neutron detectors in its capacity for neutron energy measurement. Previous studies of COMPTEL neutron data have worked with an incomplete model of the instrumental response, applying energy-by-energy detection efficiencies. Here we employ statistical regularisation techniques with the full (Monte Carlo simulation derived) response matrix to produce improved estimates of neutron numbers and energy distribution. These techniques are applied to data from the well-observed 15 June 1991 flare. Our improved treatment of the instrumental response results in a reduction of 73% in total neutron numbers, compared with previously deduced values. Implications for the picture of primary ion acceleration in this flare are briefly discussed.
In complex human emergency (CHE)-aid situations, the international community responds to provide assistance to reduce morbidity and mortality related to environmental and civil disruptions. The political and social situation in Kosovo, in combination with the military activity from 23 March to 09 June, 1999, created a crisis associated with mass movement of the population of Kosovo into neighbouring provinces and nations. This forced migration of people seeking protection increased demands for -water, food, shelter, and health care in the refugee areas. The United Nations High Commission for Refugees (UNHCR) estimated that 771,900 ethnic Albanians, and 30,700 Serbians, Croatians, and Montenegrins had been displaced from Kosovo during this time period, and that 439,500 of these people had arrived in Albania. Given the limited health-care resources in Albania to respond to the increasing demands for health care, a field epidemiological study was conducted by the International Organization for Migration (IOM) to assess the need for a medical evacuation program from Albania related to the crisis in Kosovo. Outcome measurements in this assessment were: 1) health-care capacity and health-care utilization rates in Albania before the crisis and by the refugees during the crisis; 2) the frequency of war-related injuries; 3) the frequency of medical evacuation; 4) nature of medical conditions of the patients being evacuated; and 5) destination for medical evacuation (internal or international) during the crisis. The results of the field assessment, which gathered health outcome data during the first eight weeks of the conflict (23 March 1999 to 25 May 1999), indicated that there was a need for a specifically designed medical evacuation programme in Albania. The study demonstrated that the implementation of a medical evacuation programme must be integrated with the national health care objectives. It also was found that the magnitude of an evacuation programme could be reduced markedly by strategic support of existing medical programmes in Albania (haemodialysis, trauma and orthopaedics, blood banking). Implementation of this strategy could permit containment of the majority of cases within Albania or to regional, health-care facilities. The results of such targeted support for specific services could result in a national programme for internal medical evacuation, with limited dependence upon the international movement of patients.
In Britain, the water vole (Arvicola terrestris) has declined in numbers and distribution (Jefferies, Morris & Mulleneux, 1989; Strachan & Jefferies, 1993). This species now enjoys a higher profile than hitherto and many local surveys have been initiated, following published methods. To monitor the status of the population or the effectiveness of habitat restoration projects, a method for estimating numbers of water voles is often needed, preferably based on latrines (a characteristic field sign of this species). Unfortunately, the published literature includes two potentially misleading components. In view of the significance of population size in a declining species, and the heightened interest in this animal, we felt it would be helpful to publish clarification and corrections in the hope of forestalling erroneous reports and conclusions in future investigations.
Surface precipitation-rate estimates derived from radar data are potentially of considerable value to high-resolution Numerical Weather Prediction (NWP) models. This paper describes a scheme developed to assimilate precipitation rates derived from the UK weather radar network into the UK Met. Office Mesoscale Model, with the aim of improving the analysis and forecast of precipitation. It is based on 'latent heat nudging', in which the model profiles of latent heating are scaled by the ratio of observed and model precipitation rates. This causes the model to adjust so that the diagnosed precipitation rate agrees more closely with observations.
The assimilation algorithm is outlined, and the results of a trial of the scheme are described. The scheme brings an increase in forecast skill for precipitation distribution in the first six to nine hours of the forecast, a conclusion supported both by objective verification against radar data and subjective assessment of 14 forecasts. The main benefit was found to occur in frontal cases. The scheme was implemented operationally on 16 April 1996.
Despite their limitations, mental status tests and self/proxy reports of instrumental activities of daily living (IADL) are often used to predict functional competence. In contrast, the Assessment of Motor and Process Skills (AMPS) is a direct observational assessment of IADL competence. Sixty-four community-dwelling elderly (20 Alzheimer's disease [AD] patients and 44 nondemented) were assessed with the AMPS, the Mini-Mental State Examination (MMSE), and the Older Americans Resources and Services (OARS)-IADL. Performance on all three assessments was significantly lower for the AD sample. The MMSE did not correlate significantly with the AMPS motor ability measures but it correlated modestly with the AMPS process ability measures. The OARS-IADL correlated significantly with the AMPS motor ability measure for the nondemented sample alone. Although mental status and self/proxy assessments provide some insight into individuals' IADL competence, direct observation of IADL task performance provides additional information regarding the subtle process and motor skills changes that occur in progressive dementing conditions.
Nine vervet monkeys and nine baboons were infected with eggs of Echinococcus granulosus per as. Six of the vervets and one of the baboons possessed hydatid cysts at autopsy, 15–28 months post-infection. The sequential IgG response to hydatid fluid and protoscolex antigens showed considerable inter-animal variation. Infected vervets and baboons became seropositive after an average of 8 months post-infection. Considerable fluctuation in the IgG response was observed, particularly to the hydatid fluid antigen which, in humans, may contribute to the existence of a significant proportion of seronegative individuals. Vervets, in particular, may be useful to study immunological events associated with exposure, development and resolution of hydatid disease in outbred human populations.
Let L be a finite relational language. The age of a structure over L is the set of isomorphism types of finite substructures of . We classify those ages for which there are less than 2ω countably infinite pairwise nonisomorphic L-structures of age .
Several studies (Bryce Jones, 1964; Rhodes, 1970; Dransfield et al, 1984) have attempted to examine the comparative eating qualities of beef from entire male cattle with that from steers. In the past, most sensory evaluation studies have used specialised taste panels (Shearer Dunn, 1990) and/or objective measurements (Dransfield et al, 1984). Few have considered the preferences and opinions of the general public. A study was therefore conducted with 100 members of the general public to determine whether the quality parameters of texture, flavour and overall acceptability did in fact differ between bull and steer beef samples. A second aim of the experiment was to establish if any of the variability in personal preferences was related to the demographic factors tested. These were the respondents’ sex, age, area of residence and the frequency with which they consumed beef.