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Digital health technologies may improve the management of individuals with mental health disorders by targeting important barriers to effective care. For patients with schizophrenia, for example, addressing:
•The challenge of dealing with individual variation in treatment response. No specific tools are available to facilitate the delivery of truly patient-centric care. Predictors of an individual's side effects or treatment efficacy are not available, patients’ views on care are often not recorded, clinical state between appointments cannot be easily assessed, precise symptoms and side effects experiences are not captured in a reliable way and physical health is often neglected.
•The challenge of effectively accessing and utilizing the vast amounts of evidence-based information to direct patient management at the point-of-care. Valuable evidence-based information, including guidelines and systematic reviews, is not used to guide care because there is too much information to assimilate, it is inaccessible at the point-of-care and it is difficult to personalize to any individual patient.
Optimal Medicine will present findings related to use of a web-based clinical decision support software system which enables clinicians to deliver individualised, evidence-based treatment at the point of care including:
• Delivery of context-specific personalized decision support through a workflow driven interface
• Interactive visualisation and monitoring of longitudinal status
• Side effect risk profiling based on an individual's unique and evolving characteristics
• Symptom and side effect rapid evaluation and monitoring using a hierarchical data selection
• Integrated remote-monitoring technologies (iTunes app) for use between clinical contacts at times of particular vulnerability, such as discharge from hospital.
Characterizing ruminal parameters in the context of sampling routine and feed efficiency is fundamental to understand the efficiency of feed utilization in the bovine. Therefore, we evaluated microbial and volatile fatty acid (VFA) profiles, rumen papillae epithelial and stratum corneum thickness and rumen pH (RpH) and temperature (RT) in feedlot cattle. In all, 48 cattle (32 steers plus 16 bulls), fed a high moisture corn and haylage-based ration, underwent a productive performance test to determine residual feed intake (RFI) using feed intake, growth, BW and composition traits. Rumen fluid was collected, then RpH and RT logger were inserted 5.5±1 days before slaughter. At slaughter, the logger was recovered and rumen fluid and rumen tissue were sampled. The relative daily time spent in specific RpH and RT ranges were determined. Polynomial regression analysis was used to characterize RpH and RT circadian patterns. Animals were divided into efficient and inefficient groups based on RFI to compare productive performance and ruminal parameters. Efficient animals consumed 1.8 kg/day less dry matter than inefficient cattle (P⩽0.05) while achieving the same productive performance (P⩾0.10). Ruminal bacteria population was higher (P⩽0.05) (7.6×1011v. 4.3×1011 copy number of 16S rRNA gene/ml rumen fluid) and methanogen population was lower (P⩽0.05) (2.3×109v. 4.9×109 copy number of 16S rRNA gene/ml rumen fluid) in efficient compared with inefficient cattle at slaughter with no differences (P⩾0.10) between samples collected on-farm. No differences (P⩾0.10) in rumen fluid VFA were also observed between feed efficiency groups either on-farm or at slaughter. However, increased (P⩽0.05) acetate, and decreased (P⩽0.05) propionate, butyrate, valerate and caproate concentrations were observed at slaughter compared with on-farm. Efficient had increased (P⩽0.05) rumen epithelium thickness (136 v. 126 µm) compared with inefficient cattle. Efficient animals also spent 318% and 93.2% more time (P⩽0.05) in acidotic (4.14% v. 1.30%) (pH⩽5.6) and optimal (5.6<pH<6.0) (8.53% v. 4.42%) RpH range compared with inefficient cattle. The circadian patterns revealed lower (P⩽0.05) RpH and no differences (P⩾0.10) in RT pre-, during, and post-prandial periods in efficient compared with inefficient cattle. In essence, superior feed efficiency in cattle seems linked to rumen features consistent with improved efficiency of feed utilization. Microbial abundance, rumen epithelial histomorphology, and RpH, may serve as indicators for feed efficiency in cattle. The divergences of assessments made on-farm and at slaughter should be considered in the development of proxies for feed efficiency.
Proxies have the potential to accelerate feed efficiency (residual feed intake (RFI); kg dry matter/day) improvement, assisting with the reduction of beef cattle feed costs and environmental impact. Heart rate (HR) (beats per minute (BPM)) is associated with feed efficiency and influenced by autonomic activity and peripheral metabolism, suggesting HR could be used as a proxy for feed efficiency. Objectives were to assess associations between overnight HR, lying patterns and RFI, and between acute stress HR and RFI. Heifer calves (n=107; 408±28 days of age, 341±42.2 kg) and yearling heifers (n=36; 604±92 days of age, 539±52.2 kg) were exposed to a performance test to determine productive performance. Overnight HR (electrode based) and lying patterns (accelerometer based) were monitored on a subgroup of heifer calves (n=40; 20 lowest RFI; 20 highest RFI). In the 10-min acute stress assessment, all heifers were individually exposed to the opening and closing of an umbrella and HR before (HRBEF), in response to (HRMAX), after (HRAFT) and change (HRCHG; HRAFT−HRBEF) as a result of exposure were determined. Using polynomial regression, rate of HR decrease pre-exposure (β1) and rates of HR increase (β2) and decrease (β3, β4) post-exposure were determined. Heifer calves in the overnight assessment were classified into equal RFI groups (low RFI; high RFI) and HR means were treated as repeated measures and compared using multiple regression. In the acute stress assessment, heifers were classified within cattle category into equal RFI groups (low RFI; high RFI) and means and polynomial regression parameters were compared using multiple regression. Low-RFI heifer calves had a lower overnight HR (69.2 v. 72.6 BPM), similar HR change from lying to standing intervals (8.9 v. 9.2 BPM) and similar time lying (61.1% v. 64.5%) compared with high-RFI heifer calves. Low-RFI heifer calves had a higher absolute HRMAX (162.9 v. 145.7 BPM) and β2 (−0.34 v. −0.20) than high-RFI heifer calves. Low-RFI yearling heifers had similar acute stress HR means and a lower β1 (0.003 v. 0.006) than high-RFI yearling heifers. Overnight HR and acute stress HR are potential indicators of RFI in heifer calves. However, acute stress HR results varied in yearling heifers, suggesting previous handling experience and/or age influence stress response. Pending further development (predictive ability, repeatability), the acute stress assessment could have potential for on-farm application as a feed efficiency proxy in young heifers with minimal handling experience.
Understanding the timing of mountain glacier and paleolake expansion and retraction in the Great Basin region of the western United States has important implications for regional-scale climate change during the last Pleistocene glaciation. The relative timing of mountain glacier maxima and the well-studied Lake Bonneville highstand has been unclear, however, owing to poor chronological limits on glacial deposits. Here, this problem is addressed by applying terrestrial cosmogenic 10Be exposure dating to a classic set of terminal moraines in Little Cottonwood and American Fork Canyons in the western Wasatch Mountains. The exposure ages indicate that the main phase of deglaciation began at 15.7 ± 1.3 ka in both canyons. This update to the glacial chronology of the western Wasatch Mountains can be reconciled with previous stratigraphic observations of glacial and paleolake deposits in this area, and indicates that the start of deglaciation occurred during or at the end of the Lake Bonneville hydrologic maximum. The glacial chronology reported here is consistent with the growing body of data suggesting that mountain glaciers in the western U.S. began retreating as many as 4 ka after the start of northern hemisphere deglaciation (at ca. 19 ka).
Bulimic eating disorders are common among female students, yet the majority do not access effective treatment. Internet-based cognitive-behavioural therapy (iCBT) may be able to bridge this gap.
Seventy-six students with bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) were randomly assigned to immediate iCBT with e-mail support over 3 months or to a 3-month waiting list followed by iCBT [waiting list/delayed treatment control (WL/DTC)]. ED outcomes were assessed with the Eating Disorder Examination (EDE) at baseline, 3 months and 6 months. Other outcomes included depression, anxiety and quality of life.
Students who had immediate iCBT showed significantly greater improvements at 3 and 6 months than those receiving WL/DTC in ED and other symptoms.
iCBT with e-mail support is efficacious in students with bulimic disorders and has lasting effects.
In August, 1980 a rare serotype S. zanzibar was isolated in the North of Scotland from a man home on leave from Malaysia, whence he returned in November having been bacteriologically negative 2 months previously. In December however, S. Zanzibar was isolated from a bulk milk sample taken at a nearby dairy farm. No illness occurred among milking cows which had been brought inside from pasture in mid-October. Since 1972 a variety of different salmonella serotypes had been identified in cattle, milk and other samples at this farm, with seagulls being implicated as the vector transmitting infection from the sewage of a local town on to farmland and an adjacent loch. Although water from this source has not been used in recent years for drinking by cattle, it is utilized for washing floors within the dairy premises. Since 1979, following an outbreak affecting consumers, all milk produced at the farm has been pasteurized.
Isolates of Salmonella typhimurium, recovered over a 9-month period from a child with gastroenteritis, were characterized by biotyping, phage-typing and plasmid-profile analysis. Because the data from the different methods were discrepant, it was difficult to establish whether her infection was due to a single strain that had changed character in vivo or was due to recurrent infections with different, unrelated strains. Restriction-enzyme fingerprinting of the plasmids from the different isolates provided an explanation for the initial discrepancy and highlighted a source of potential confusion in epidemiological studies.
Among 622 cultures of Salmonella montevideo, 27 biotypes belonging to two biogroups were recognized. One biogroup (10di) was predominant in all animals in Scotland but only in sheep in England and Wales. The other (biogroup 2d) was responsible for almost all human, cattle and poultry infection in England and Wales, but only 24% of human infection in Scotland.
Gravity currents intruding into a uniformly stratified ambient are examined in a series of finite-volume full-depth lock-release laboratory experiments and in numerical simulations. Previous studies have focused on gravity currents which are denser than fluid at the bottom of the ambient or on symmetric cases in which the intrusion is the average of the ambient density. Here, we vary the density of the intrusion between these two extremes. After an initial adjustment, the intrusions and the internal waves they generate travel at a constant speed. For small departures from symmetry, the intrusion speed depends weakly upon density relative to the ambient fluid density. However, the internal wave speed approximately doubles as the waves change from having a mode-2 structure when generated by symmetric intrusions to having a mode-1 structure when generated by intrusions propagating near the bottom. In the latter circumstance, the interactions between the intrusion and internal waves reflected from the lock-end of the tank are sufficiently strong and so the intrusion stops propagating before reaching the end of the tank. These observations are corroborated by the analysis of two-dimensional numerical simulations of the experimental conditions. These reveal a significant transfer of available potential energy to the ambient in asymmetric circumstances.
Attempts were made to identify the causative organism of Lyme disease in Australia from possible tick vectors.
Ticks were collected in coastal areas of New South Wales, Australia, from localities associated with putative human infections. The ticks were dissected; a portion of the gut contents was examined for spirochaetes by microscopy, the remaining portion inoculated into culture media. The detection of spirochaetes in culture was performed using microscopy, and immunochemical and molecular (PCR) techniques. Additionally, whole ticks were tested with PCR for spirochaetes.
From 1990 to 1992, approximately 12000 ticks were processed for spirochaetes. No evidence of Borrelia burgdorferi or any other spirochaete was recovered from or detected in likely tick vectors. Some spirochaete–like objects detected in the cultures were shown to be artifacts, probably aggregates of bacterial flagellae.
There is no definitive evidence for the existence in Australia of B. burgdorferi the causative agent of true Lyme disease, or for any other tick–borne spirochaete that may be responsible for a local syndrome being reported as Lyme disease.
Effects of Praseodymium doping on the ferroelectric properties of Bi4Ti3O12 were investigated using dense ceramics from room temperature to 730 °C. DRX and XPS studies shows that the structure can accept only 10% of praseodymium without the precipitation of second phases. Thermoelectric analysis and ferroelectric hysteresis measurements were performed and show that the incorporation of praseodymium modified the transition temperature Tc and slightly the polarization values. The incorporation of praseodymium resulted in a variation in the permittivity and in the remanent polarization (2Pr). The polarization characteristics in the samples doping were different to Bi4Ti3O12.
t haplotypes are naturally occurring, variant forms of the t complex on mouse chromosome 17, characterized by the presence of four inversions with respect to wild-type. They harbour mutations causing male sterility, male transmission ratio distortion (TRD) and embryonic lethality. Mice carrying t haplotypes have been found throughout the world, and genetic studies of the lethal mutations have identified at least 16 complementation groups. The embryonic lethal phenotypes of many t haplotypes have been characterized in detail, and are thought to be the consequence of homozygosity for single gene mutations. However, the existence of additional mutations in genes that function at later stages of development would be obscured. Here we investigated the possibility of multiple mutations in t haplotypes by screening the tw73 haplotype for the presence of novel mutations. Since genetic analysis of t haplotype mutations is hindered by recombination suppression due to the inversions, deletion complexes covering the proximal two-thirds of the t complex were used to uncover the presence of any new lethal alleles. This analysis revealed a novel mutation between D17Jcs41 and D17Mit100, causing mice carrying both tw73 and selected deletions to die at birth, prior to feeding. The finding of a new, cryptic lethal mutation in t haplotypes is an indication that these recombinationally isolated chromosomes, which already contain at least one lethal mutation that prevents homozygosity, may serve as sinks for the accumulation of additional recessive mutations.
Neuropsychologists often diagnose cerebral dysfunction based, in part, on marked variation in an individual's cognitive test performance. However, little is known about what constitutes the normal range of intraindividual variation. In this study, after excluding 54 individuals with significant health problems, we derived 32 z-transformed scores from 15 tests administered to 197 adult participants in a study of normal aging. The difference between each person's highest and lowest scores was computed to assess his or her maximum discrepancy (MD). The resulting MD values ranged from 1.6 to 6.1 meaning that the smallest MD shown by any person was 1.6 standard deviations (SDs) and the largest MD shown by any person was 6.1 SDs. Sixty-six percent of participants produced MD values that exceeded 3 SDs. Eliminating each person's highest and lowest test scores decreased their MDs, but 27% of the participants still produced MD values exceeding 3. Although MD values appeared to increase with age, adjusting test scores for age, which is standard in clinical practice, did not correct for this. These data reveal that marked intraindividual variability is very common in normal adults, and underscore the need to base diagnostic inferences on clinically recognizable patterns rather than psychometric variability alone. (JINS, 2003, 9, 864–870.)
An examination of salmonella isolates collected by the Scottish
Agricultural College Veterinary
Services Division from April 1994 to May 1995 was conducted to determine
which Salmonella enterica serotype Typhimurium phage type 104
occurred and to
investigate the antimicrobial resistance patterns of isolates. Typhimurium
predominant salmonella and was isolated from nine species of animal. All
isolates of this phage
type possessed resistance to at least one antimicrobial and 98% of the
were resistant to
multiple antimicrobials with R-type ACTSp the predominant resistance pattern.
resistance patterns were identified and transferable resistance to the
antimicrobial apramycin was demonstrated in three strains. A retrospective
gentamicin resistance in isolates from the Scottish Salmonella Reference
revealed a human isolate of Typhimurium DT104 resistant to gentamicin but
apramycin and a bovine isolate with apramycin and gentamicin resistance.