Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.

Background: Biallelic variants in POLR1C are associated with POLR3-related leukodystrophy (POLR3-HLD), or 4H leukodystrophy (Hypomyelination, Hypodontia, Hypogonadotropic Hypogonadism), and Treacher Collins syndrome (TCS). The clinical spectrum of POLR3-HLD caused by variants in this gene has not been described. Methods: A cross-sectional observational study involving 25 centers worldwide was conducted between 2016 and 2018. The clinical, radiologic and molecular features of 23 unreported and previously reported cases of POLR3-HLD caused by POLR1C variants were reviewed. Results: Most participants presented between birth and age 6 years with motor difficulties. Neurological deterioration was seen during childhood, suggesting a more severe phenotype than previously described. The dental, ocular and endocrine features often seen in POLR3-HLD were not invariably present. Five patients (22%) had a combination of hypomyelinating leukodystrophy and abnormal craniofacial development, including one individual with clear TCS features. Several cases did not exhibit all the typical radiologic characteristics of POLR3-HLD. A total of 29 different pathogenic variants in POLR1C were identified, including 13 new disease-causing variants. Conclusions: Based on the largest cohort of patients to date, these results suggest novel characteristics of POLR1C-related disorder, with a spectrum of clinical involvement characterized by hypomyelinating leukodystrophy with or without abnormal craniofacial development reminiscent of TCS.

Background: To attain the most comprehensive view of the quality of life (QoL) of a child with Duchenne Muscular Dystrophy (DMD), the completion of a pediatric QoL measure by the child and his/her parent and the assessment of QoL and health-related quality of life (HRQoL) as separate constructs is crucial. Previous QoL research has not assessed HRQoL as a separate construct. By using the Quality of My Life (QoML) questionnaire, our objective was to describe QoL and HRQoL in boys with DMD based on child-and parent-reports. Methods: Parent and child dyads identified via the Canadian Neuromuscular Disease Registry received QoML questionnaires (2013-2016). Children and parent-proxy each completed the QoL and HRQoL Visual Analog Scales. Responses were marked on a 10-cm line, with higher scores (max=10) reflecting higher QoL and HRQoL. Descriptive statistics were computed for child- and parent-reports of QoL and HRQoL at three time-points. Results: Mean(SD) QoL and HRQoL scores for child- and parent-reports were: 1) Baseline (n=20 dyads), 8.32(1.72) vs. 6.73(2.23) and 7.63(2.51) vs. 6.73(2.19); 2)18-months (n=10 dyads, n=9 dyads), 7.83(2.05) vs 7.66(1.66) and 7.62(2.41) vs 7.41(2.16); 3) 36-months (n=15 dyads) 7.38(2.00) vs. 6.99(1.77) and 7.19(2.70) vs. 6.76(2.26). Conclusions: Boys with DMD report higher QoL and HRQoL compared to their parents.

Background: SMA is characterized by reduced levels of survival of motor neuron (SMN) protein from deletions and/or mutations of the SMN1 gene. While SMN1 produces full-length SMN protein, a second gene, SMN2, produces low levels of functional SMN protein. Risdiplam (RG7916/RO7034067) is an investigational, orally administered, centrally and peripherally distributed small molecule that modulates pre-mRNA splicing of SMN2 to increase SMN protein levels. Methods: FIREFISH (NCT02913482) is an ongoing, multicenter, open-label operationally seamless study of risdiplam in infants aged 1–7 months with Type 1 SMA and two SMN2 gene copies. Exploratory Part 1 (n=21) assesses the safety, tolerability, pharmacokinetics and pharmacodynamics of different risdiplam dose levels. Confirmatory Part 2 (n=40) is assessing the safety and efficacy of risdiplam. Results: In a Part 1 interim analysis (data-cut 09/07/18), 93% (13/14) of babies had ≥4-point improvement in CHOP-INTEND total score from baseline at Day 245, with a median change of 16 points. The number of infants meeting HINE-2 motor milestones (baseline to Day 245) increased. To date (data-cut 09/07/18), no drug-related safety findings have led to patient withdrawal. No significant ophthalmological findings have been observed. Conclusions: In FIREFISH Part 1, risdiplam improved motor function in infants with Type 1 SMA.

This work is based on a recent theoretical study of how the hydrostatic pressure and core/shell sizes affect the optical properties associated with the transition from the ground state to first excited state (1s–1p), of an exciton confined in spherical core/shell quantum dots (SCSQDs). We have computed under an effective mass framework, linear, third-order nonlinear, and total absorption coefficients (AC) and refractive index (RI) as functions of photon energy for different sizes of SCSQDs with varying hydrostatic pressure. Our results show that the optical absorption is deeply dependent on the incident light intensity. Both AC and RI significantly influenced by the confinement and pressure effects.

Monoclinic VO2 is a known polymorph of vanadium dioxide that has received much attention due to its oxidative capabilities, geometric configuration, and promising applications in functional windows. VO2 can usually be obtained through a hydrothermal method under high pressure. In this work we report a synthesis of VO2 doped with Manganese using a rapid single-step hydrothermal process with V2O5, manganese (II) acetate and citric acid as precursors. Different syntheses were carried out in which the concentration of V2O5 and citric acid remained constant whereas the concentration of manganese (II) acetate was varied. The reactants underwent a stirring phase for 30 minutes before being loaded into a hydrothermal reactor for 2.5 hours at 200°C. The resultant was washed three times to remove the residual precursors. Imaging and spectroscopy characterizations such as TEM, SEM and UV-VIS-NIR have been performed on different doping concentration and the results display a dependence on doping concentrations.

The status of rabies as a neglected disease has made its eradication rather challenging in different parts of the world despite the availability of a successful vaccine. Lebanon, in particular, is a country endemic to the disease with several cases of rabies deaths reported over the past 30 years. The risk of rabies, however, has taken a new turn over the past few years in Lebanon with two emerging situations that have made the control of the disease rather challenging: the neighbouring Syrian war and the local garbage crisis. Both of these milestone events might have contributed to an increase in the number of disease vectors as well as individuals at risk, thus nourishing the cycle of disease transmission. In this observational study, the effect of these two events are investigated, with an update on the status of this preventable, yet often neglected, disease in the country. Both events were found to be concomitant with a notable increase in the number of dog bites and thus possible rabies exposure. Current regulations are explored through interviews with veterinarians, and custom recommendations, ranging from policies to control dog populations to awareness campaigns in high-risk individuals, are then proposed to help control the disease.

The current study investigated the influence of selection for body weight (BW) on growth curve parameters in two lines of Japanese quail through a mixed model approach. Live BWs of 1400 Japanese quail were recorded at 3-day intervals from hatching to 42 days of age. Birds were distributed equally across lines (selected and control) and sexes (male and female). The asymptotic weight parameter (β0) values were always higher in Gompertz than Richards models in both lines. The values of β0 were higher in the selected than control lines and in females than males across models. Differences were found in the inflection point for age and weight across lines and sexes. Values of the growth rate parameter (β2) ranged from 0.06 to 0.10 in both models, favouring males over females in both lines. Lower weights at the inflection point of both models were observed in the control line. Determination coefficient (R2) of both models in different genetic groups and sexes was similar. Mean square error (MSE) values of the Gompertz model were lower for females in selected v. control lines. In contrast, MSE values of the Richards model were lower for selected males v. control males. According to the criteria of choice (highest R2 and lowest MSE, Akaike information criterion and Bayesian information criterion), the Richards model was considered the best fitting model for the growth data of males, while the Gompertz model was the best for growth data of female quails in both lines.

Background: Longitudinal data on health-related quality of life (HRQOL) and fatigue in paediatric Duchenne muscular dystrophy (DMD) are limited. Recently, fatigue was reported to be the greatest predictor of poor HRQOL in paediatric DMD. Understanding the trajectory of HRQOL and its relationship with fatigue may facilitate the development of improved therapeutic strategies. Our objective was to describe three-year changes in HRQOL and fatigue in children with DMD. Methods: Patients identified via the Canadian Neuromuscular Disease Registry received mailed questionnaires (2013–2016). HRQOL was assessed using the PedsQLTM GCS and NMM domains, and fatigue was assessed using the MFS domain (patient- and parent-report). Mean three-year change in scores were computed. Pearson correlations were computed between three-year change in HRQOL and fatigue. Results: Mean decline in MFS scores for patient- and parent-reports were 1.03 and 1.19, respectively. Mean decline in GCS scores for patient- and parent-report were 1.75 and 4.13, respectively. Mean change in NMM scores for patient- and parent-report were 0.72 and -8.36, respectively. Change in MFS score was associated with changes in GCS (r=0.72, p<0.001) and NMM scores (r=0.84, p<0.001) by patient-report. Conclusions: Children with DMD experience worse fatigue and HRQOL over time. Parents perceive a greater decline in HRQOL over time compared to patients.

We have studied the effect of hydrostatic pressure on the confined exciton in a spherical core–shell quantum dot. Using a simple variational approach under the framework of effective mass approximation, we have computed the excitonic binding energy as a function of the shell thickness under the applied hydrostatic pressure. Our results show that the ground state binding energy of exciton depends greatly on the shell thickness, which tends to the two-dimensional limit of 4RX, when the ratio a/b tends to unity. The numerical calculations also suggest that the applied hydrostatic pressure favors the attraction between electrons and holes so the excitonic binding energy increases when pressure increases.

The present investigation was carried out to estimate the effects of genotype and sex on growth and laying performance and assess the variations in plasma constituents in the tested genotypes and their relations with productive traits after four generations of selection. Data of growth and laying performance on 1440 females and males of Japanese quail were taken from the three quail genotypes: maternal (MG), long shank length (LSG28) and control (CG) genotypes. Genotype significantly affected all studied growth productive traits, favouring selected genotypes. The LSG28 surpassed MG in total protein, albumin (Alb), globulin (Glob), triglycerides and Alb/Glob ratio and lowered both cholesterol and total lipids (TL). Sex significantly favoured females, which had higher body weight, longer shank length at 35 days of age and higher body weight gain during the period from 1 to 35 days of age. Females showed significantly higher concentrations of both Alb and TL than males. The MG exceeded LSG28 in fertility and hatchability per cent. Correlations for both growth and productive traits with plasma constituents revealed inconsistent trends in either magnitude or direction. Four generations of selection resulted in substantial phenotypic improvements in most growth and productive traits, as well as plasma constituents studied in LSG28, and favoured MG in maturity, days needed to produce the first ten eggs, higher egg production per cent and heavier egg mass.

The purpose of the Reliability-Based Design Optimization (RBDO) is to find the best compromise between safety and cost. Therefore, several methods, such as the Hybrid Method (HM) and the Optimum Safety Factor (OSF) method, are developed to achieve this purpose. However, these methods have been applied only on static cases and some special dynamic ones. But, in real mechanical applications, structures are subject to random vibrations and these vibrations can cause a fatigue damage. So, in this paper, we propose an extension of these methods in the case of structures under random vibrations and then demonstrate their efficiency. Also, a Robust Hybrid Method (RHM) is then developed to overcome the difficulties of the classical one. A numerical application is then used to present the advantages of the modified hybrid method for treating problem of structures subject to random vibration considering fatigue damage.

The potential therapeutic value of Moringa oleifera extract (MOE), due to its anti-inflammatory and anti-oxidant effects, has been reported previously. In this study, Hymenolepis nana antigen (HNA) in combination with MOE was used in immunization against H. nana infection. Adult worm and egg counts were taken, while histological changes in the intestine were observed. Mucosal mast (MMCs) and goblet cells (GCs) were stained with specific stains, while serum and intestinal IgA were assayed using enzyme-linked immunosorbent assay (ELISA). Reduced glutathione (GSH) and lipid peroxidation (thiobarbituric acid reactive substances, TBARS) were assayed. Real-time polymerase chain reaction (PCR) was used for detection of mRNA expression in ileum tissue. The results demonstrated an improvement in the architecture of intestinal villi, decreased inducible nitric oxide synthase (iNOs) and TBARS, and increased GSH in HNA, MOE and MOE + HNA groups. In the same groups, an increase in GCs, mucin 2 (MUC2), interleukins (IL)-4, -5 and -9, and stem cell factor (SCF) versus a decrease in both interferon-gamma (IFN-γ) and transforming growth factor (TGF-β) expression appeared. HNA and MOE + HNA increased serum and intestinal IgA, respectively. MOE decreased MMCs and achieved the highest reductions in both adult worms and eggs. In conclusion, MOE could achieve protection against H. nana infections through decreased TGF-β, IFN-γ and MMC counts versus increased GC counts, T-helper cell type 2 (Th2) cytokines and IgA level.

Fifteen lactating Damascus goats (44 ± 0·8 kg body weight) were used in a completely randomized design to evaluate the supplementation of Chlorella vulgaris microalgae at 0 (Control), 5 (Alg05) and 10 g/goat/day (Alg10) for 12 weeks. Chlorella vulgaris treatments increased feed intake and apparent diet digestibility compared with a control diet. No differences were noted in the ruminal pH and ammonia-N concentrations, but increased concentration of total volatile fatty acids and propionic acid were observed in goats fed with Alg05 and Alg10. Diets of Alg05 and Alg10 increased serum glucose concentration but decreased glutamate-oxaloacetate transaminase, glutamate-pyruvate transaminase and cholesterol concentrations. Additionally, C. vulgaris supplementation moderately increased milk yield, energy corrected milk, total solids, solids not fat and lactose. Feeding Alg05 and Alg10 diets increased milk unsaturated fatty acids with concomitant increases in total conjugated linoleic acid concentrations. It is concluded that the daily inclusion of 5 or 10 g of C. vulgaris in the diets of Damascus goats increased milk yield and positively modified milk fatty acid profile.

Tropical and sub-tropical climates are characterized by high temperature and humidity, during at least part of the year. Consequently, heat stress is common in Holstein cattle and productive and reproductive losses are frequent. Our objectives were as follows: (1) to quantify losses in production and quality of milk due to heat stress; (2) to estimate genetic correlations within and between milk yield (MY) and milk quality traits; and (3) to evaluate the trends of genetic components of tolerance to heat stress in multiple lactations of Brazilian Holstein cows. Thus, nine analyses using two-trait random regression animal models were carried out to estimate variance components and genetic parameters over temperature–humidity index (THI) values for MY and milk quality traits (three lactations: MY×fat percentage (F%), MY×protein percentage (P%) and MY×somatic cell score (SCS)) of Brazilian Holstein cattle. It was demonstrated that the effects of heat stress can be harmful for traits related to milk production and milk quality of Holstein cattle even though most herds were maintained in a modified environment, for example, with fans and sprinklers. For MY, the effect of heat stress was more detrimental in advanced lactations (−0.22 to −0.52 kg/day per increase of 1 THI unit). In general, the mean heritability estimates were higher for lower THI values and longer days in milk for all traits. In contrast, the heritability estimates for SCS increased with increasing THI values in the second and third lactation. For each trait studied, lower genetic correlations (different from unity) were observed between opposite extremes of THI (THI 47 v. THI 80) and in advanced lactations. The genetic correlations between MY and milk quality trait varied across the THI scale and lactations. The genotype×environment interaction due to heat stress was more important for MY and SCS, particularly in advanced lactations, and can affect the genetic relationship between MY and milk quality traits. Selection for higher MY, F% or P% may result in a poor response of the animals to heat stress, as a genetic antagonism was observed between the general production level and specific ability to respond to heat stress for these traits. Genetic trends confirm the adverse responses in the genetic components of heat stress over the years for milk production and quality. Consequently, the selection of Holstein cattle raised in modified environments in both tropical and sub-tropical regions should take into consideration the genetic variation in heat stress.

Guinea-Bissau is host to the westernmost subpopulation of the common hippopotamus Hippopotamus amphibius, which is one of only two known populations inhabiting coastal waters. The presence of hippopotamuses causes conflict with rice farmers as a result of crop damage and the absence of effective measures to protect crops. To develop an effective method for protecting rice fields, we studied the patterns of access to flooded and rain-fed rice fields by hippopotamuses and assessed the effect of the installation of electric fences. Hippopotamuses were detected in 54% of the flooded fields (n = 100) and in 31.9% of the rain-fed fields (n = 91). They were detected more frequently in fields on offshore islands than on the mainland, in unfenced than in fenced fields, and in fields closer to running water. Hippopotamuses entered fenced flooded fields less frequently than unfenced, and were detected most frequently at the end of the rainy season and the start of the dry season, and in the period of vegetative stem growth. Electric fences were an effective deterrent and facilitated increased rice production. The maintenance and cost of the electric fencing were acceptable to farmers, and therefore the use of such fencing is recommended to resolve the conflict between hippopotamuses and farmers in Guinea-Bissau and in other areas with similar conditions.