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Sulphoraphane originates from glucoraphanin in broccoli and is associated with anti-cancer effects. A preclinical study suggested that daily consumption of broccoli may increase the production of sulphoraphane and sulphoraphane metabolites available for absorption. The objective of this study was to determine whether daily broccoli consumption alters the absorption and metabolism of isothiocyanates derived from broccoli glucosinolates. We conducted a randomised cross-over human study (n 18) balanced for BMI and glutathione S-transferase μ 1 (GSTM1) genotype in which subjects consumed a control diet with no broccoli (NB) for 16 d or the same diet with 200 g of cooked broccoli and 20 g of raw daikon radish daily for 15 d (daily broccoli, DB) and 100 g of broccoli and 10 g of daikon radish on day 16. On day 17, all subjects consumed a meal of 200 g of broccoli and 20 g of daikon radish. Plasma and urine were collected for 24 h and analysed for sulphoraphane and metabolites of sulphoraphane and erucin by triple quadrupole tandem MS. For subjects with BMI >26 kg/m2 (median), plasma AUC and urinary excretion rates of total metabolites were higher on the NB diet than on the DB diet, whereas for subjects with BMI <26 kg/m2, plasma AUC and urinary excretion rates were higher on the DB diet than on the NB diet. Daily consumption of broccoli interacted with BMI but not GSTM1 genotype to affect plasma concentrations and urinary excretion of glucosinolate-derived compounds believed to confer protection against cancer. This trial was registered as NCT02346812.
There is very little research into the challenges of training in intellectual disability psychiatry or into interventions which may address these challenges. Using focus groups, we explored the experiences of intellectual disability psychiatry trainees, and evaluated a leaderless trainee support group developed in Bristol.
Five distinct themes were identified via framework analysis: that trainees felt unprepared for the difference from previous posts; the need for support; the value of the group; that trainees were concerned about judgement in supervision; that the group structure was valued.
Our findings highlight the support needs specific to intellectual disability psychiatry trainees. Leaderless peer support groups may be a valued resource to address such issues, and may be a useful model to be considered by other training schemes.
It is difficult to gauge the success of programmatic efforts to reduce unmet need for contraception without knowing whether individual women have had their need met and adopted contraception. However, the number of true longitudinal datasets tracking the transition of panels of individual women in and out of states of contraceptive use is limited. This study analyses changes in contraceptive use states using Demographic and Health Survey data for 22 sub-Saharan African countries. A cohort approach, tracking representative samples of five-year age groups longitudinally across surveys, as well as period-based techniques, are applied to indicate whether new users of contraception have been drawn from women who previously had no need and/or those who had unmet need for family planning. The results suggest that a greater proportion of increases in contraceptive use in recent years can be attributed to decreases in the percentage of women with no need, especially among younger women, than to decreases in the proportion with unmet need.
Hemolytic disease of the fetus and newborn (HDFN) is the immune-mediated destruction of fetal red blood cells by maternal antibody. HDFN results when the fetal red blood cells express a paternally inherited red blood cell antigen not present on maternal red blood cells. The spectrum of illness ranges from clinically insignificant to the most severe form of a critically ill, anemic, hydropic, and jaundiced infant who may have subcutaneous edema, ascites, pleural effusions, and pericardial effusions.
There is no agreement when HDFN was first recognized. As reviewed by Stockman, Rosse suggested that the marriage of Catherine of Aragon and Henry VIII illustrates the natural history of HDFN (1). Catherine had five children, three boys and one girl dying in utero with only one surviving girl, Mary I, Tudor Queen of England. A clearer description of the disorder came in 1607 with the description of a twin-birth by a French midwife who delivered a hydropic dead child and a twin that died of jaundice – what we now recognize as kernicterus (2). It was the pivotal paper by Dr. Louis K. Diamond in 1932 that clearly identified the development of the maternal antibody in response to the incompatibility of the fetal red cells with maternal red cells even though the Rhesus red cell antigen had not yet been identified. Parallel to the understanding of HDFN, Landsteiner began the process of identification of the red cell antigens at the start of the 20th century, first with the identification of the ABO system and then with the identification of the Rh system (3). He described the development of antibodies against rhesus monkey red cells in rabbits. He suggested that this was a new antigen distinct from the ABO system and called it the Rhesus antigen. This name is now well established in spite of the early controversy, since the antigen identified was a simian antigen related to but not the same as the human antigen.
Rett syndrome (RTT, MIM 312750) is an X-linked neurodevelopmental disorder which occurs in 1. 09/10,000 females. RTT individuals with R168X, R294X, and C-terminal methyl-CpG-binding protein 2 (MECP2) mutations have been observed to be less likely to have seizure onset before 4 years of age. Partial and generalized seizures are reported to occur in RTT. Video-electroencephalogram (EEG) studies have been performed in RTT individuals with a history of seizures. Early onset of seizures is reported to be linked to the combined MECP2 mutations and brain-derived neurotrophic factor (BDNF) polymorphisms. In addition to efficacy in treatment of seizures and potential side effects, antiepileptic drugs (AEDs) may improve non-epileptic behaviors, such as anxiety and breathing dysrhythmia, commonly observed in RTT. A changing epilepsy phenotype has been described in individuals with X-linked cyclin-dependent kinase-like 5 (CDKL5) mutations. The pathogenesis of epilepsy in CDKL5 mutations may be similar to that of MECP2 mutations.
Echocardiography detects a greater prevalence of rheumatic heart disease than heart auscultation. Echocardiographic screening for rheumatic heart disease combined with secondary prophylaxis may potentially prevent severe rheumatic heart disease in high-risk populations. We aimed to determine the prevalence of rheumatic heart disease in children from an urban New Zealand population at high risk for acute rheumatic fever.
Methods and results
To optimise accurate diagnosis of rheumatic heart disease, we utilised a two-step model. Portable echocardiography was conducted on 1142 predominantly Māori and Pacific children aged 10–13 years. Children with an abnormal screening echocardiogram underwent clinical assessment by a paediatric cardiologist together with hospital-based echocardiography. Rheumatic heart disease was then classified as definite, probable, or possible. Portable echocardiography identified changes suggestive of rheumatic heart disease in 95 (8.3%) of 1142 children, which reduced to 59 (5.2%) after cardiology assessment. The prevalence of definite and probable rheumatic heart disease was 26.0 of 1000, with 95% confidence intervals ranging from 12.6 to 39.4. Portable echocardiography overdiagnosed rheumatic heart disease with physiological valve regurgitation diagnosed in 28 children. A total of 30 children (2.6%) had non-rheumatic cardiac abnormalities, 11 of whom had minor congenital mitral valve anomalies.
We found high rates of undetected rheumatic heart disease in this high-risk population. Rheumatic heart disease screening has resource implications with cardiology evaluation required for accurate diagnosis. Echocardiographic screening for rheumatic heart disease may overdiagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.
This book has described the conservation activities generated by seven African long-term research stations. They are the sites where research has been on-going for the longest period – the six oldest sites for chimpanzees, and the single oldest site for gorillas. In all of them the impacts on conservation appear to be diverse and positive, suggesting that the presence of researchers is an important predictor of conservation success. There is also informal evidence suggesting that the conservation status of these sites is better than comparable areas without such research. Gombe National Park, for example, was once surrounded by forest but is now an island of forest in a sea of agriculture. However, our sample of field stations is small, and various kinds of bias could temper the conclusion that long-term research has been responsible for conservation. In this chapter, therefore, we first summarize the conservation activities carried out by long-term researchers. We then suggest that the increased establishment and support of field stations might lead to improved conservation success in the future.
THE CONSERVATION IMPACTS OF LONG-TERM RESEARCH
Conservation consequences emanating from long-term research are diverse both within and across sites. Within sites, the variety is illustrated by the case considered in the greatest detail, Makerere University Biological Field Station (MUBFS) at Kibale National Park in Uganda. Across sites, researchers from the six other sites considered in this book (Bossou, Budongo, Gombe, Mahale, Taï, Virungas) report on major activities that vary from ecotourism and education to community-based conservation projects.