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Given the common view that pre-exercise nutrition/breakfast is important for performance, the present study investigated whether breakfast influences resistance exercise performance via a physiological or psychological effect. Twenty-two resistance-trained, breakfast-consuming men completed three experimental trials, consuming water-only (WAT), or semi-solid breakfasts containing 0 g/kg (PLA) or 1·5 g/kg (CHO) maltodextrin. PLA and CHO meals contained xanthan gum and low-energy flavouring (approximately 122 kJ), and subjects were told both ‘contained energy’. At 2 h post-meal, subjects completed four sets of back squat and bench press to failure at 90 % ten repetition maximum. Blood samples were taken pre-meal, 45 min and 105 min post-meal to measure serum/plasma glucose, insulin, ghrelin, glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations. Subjective hunger/fullness was also measured. Total back squat repetitions were greater in CHO (44 (sd 10) repetitions) and PLA (43 (sd 10) repetitions) than WAT (38 (sd 10) repetitions; P < 0·001). Total bench press repetitions were similar between trials (WAT 37 (sd 7) repetitions; CHO 39 (sd 7) repetitions; PLA 38 (sd 7) repetitions; P = 0·130). Performance was similar between CHO and PLA trials. Hunger was suppressed and fullness increased similarly in PLA and CHO, relative to WAT (P < 0·001). During CHO, plasma glucose was elevated at 45 min (P < 0·05), whilst serum insulin was elevated (P < 0·05) and plasma ghrelin suppressed at 45 and 105 min (P < 0·05). These results suggest that breakfast/pre-exercise nutrition enhances resistance exercise performance via a psychological effect, although a potential mediating role of hunger cannot be discounted.
Sub-acute ruminal acidosis (SARA) can reduce the production efficiency and impair the welfare of cattle, potentially in all production systems. The aim of this study was to characterise measurable postmortem observations from divergently managed intensive beef finishing farms with high rates of concentrate feeding. At the time of slaughter, we obtained samples from 19 to 20 animals on each of 6 beef finishing units (119 animals in total) with diverse feeding practices, which had been subjectively classified as being high risk (three farms) or low risk (three farms) for SARA on the basis of the proportions of barley, silage and straw in the ration. We measured the concentrations of histamine, lipopolysaccharide (LPS), lactate and other short-chain fatty acids (SCFAs) in ruminal fluid, LPS and SCFA in caecal fluid. We also took samples of the ventral blind sac of the rumen for histopathology, immunohistopathology and gene expression. Subjective assessments were made of the presence of lesions on the ruminal wall, the colour of the lining of the ruminal wall and the shape of the ruminal papillae. Almost all variables differed significantly and substantially among farms. Very few pathological changes were detected in any of the rumens examined. The animals on the high-risk diets had lower concentrations of SCFA and higher concentrations of lactate and LPS in the ruminal fluid. Higher LPS concentrations were found in the caecum than the rumen but were not related to the risk status of the farm. The diameters of the stratum granulosum, stratum corneum and of the vasculature of the papillae, and the expression of the gene TLR4 in the ruminal epithelium were all increased on the high-risk farms. The expression of IFN-γ and IL-1β and the counts of cluster of differentiation 3 positive and major histocompatibility complex class two positive cells were lower on the high-risk farms. High among-farm variation and the unbalanced design inherent in this type of study in the field prevented confident assignment of variation in the dependent variables to individual dietary components; however, the CP percentage of the total mixed ration DM was the factor that was most consistently associated with the variables of interest. Despite the strong effect of farm on the measured variables, there was wide inter-animal variation.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
The Fontan procedure is the final stage of surgical palliation for a single-ventricle circulation. Significant complications are common including rhythm disturbance necessitating implantation of a permanent pacemaker. This has been widely considered a negative prognostic indicator.
This single-centre, retrospective case control study involved all patients who underwent the Fontan procedure at the Leeds Congenital Heart Unit between 1990 and 2015 and have had regular follow-up in Yorkshire and Humber, United Kingdom. 167 Fontan patients were identified of which 2 were excluded for having a pre-procedure pacemaker. Of the remainder, 23 patients required a pacemaker. Outcomes were survival, early and late complications, need for further intervention and oxygen saturation in long-term follow-up.
There was no difference in survival (30-day survival pacemaker 92.6%, sinus rhythm 90.5%, p = 0.66, 1-year pacemaker 11.1%, sinus rhythm 10.1%, p = 1). The pacemaker group was more likely to have cerebral or renal complications in the first-year post-procedure (acute kidney injury: sinus rhythm 0.8%, pacemaker 19.1%, p = 0.002). No difference was observed in longer term complications including protein losing enteropathy (sinus rhythm 3.5%, pacemaker 0% p = 1). There was no difference in saturations between the two groups at follow-up. Paced patients were more likely to have required further intervention, with a higher incidence of cardiopulmonary bypass procedures (sinus rhythm 6.3%, pacemaker 35%, p < 0.001).
Despite an increase in early complications and the need for further interventions, pacemaker requirement does not appear to affect long-term survival following the Fontan procedure.
We present an extension of Thomson’s (J. Fluid Mech., vol. 210, 1990, pp. 113–153) two-particle Lagrangian stochastic model that is constructed to be consistent with the
law of turbulence. The rate of separation in the new model is reduced relative to the original model with zero skewness in the Eulerian longitudinal relative velocity distribution and is close to recent measurements from direct numerical simulations of homogeneous isotropic turbulence. The rate of separation in the equivalent backwards dispersion model is approximately a factor of 2.9 larger than the forwards dispersion model, a result that is consistent with previous work.
Although the pain caused by castration of calves is a significant animal welfare issue for the beef industry, analgesia is not always used for this procedure, largely because of practical limitations associated with injectable forms of pain relief. Novel analgesic formulations have now been developed for livestock to allow topical and buccal administration, offering practical options to improve cattle welfare if shown to be effective. To assess the effects of topical anaesthetic (TA) and buccal meloxicam (BM) on average daily gain (ADG), behaviour and inflammation following surgical castration of beef calves, a total of 50 unweaned bull calves were randomly allocated to: (1) sham castration (SHAM, n=10); (2) surgical castration (C, n=10); (3) surgical castration with pre-operative buccal meloxicam (CBM, n=10); (4) surgical castration with post-operative topical anaesthetic (CTA, n=10); and (5) surgical castration with pre-operative buccal meloxicam and post-operative topical anaesthetic (CBMTA, n=10). Calves were recorded on video for 5 h following treatment and the frequency and duration of specific behaviours displayed by each animal was later observed for 5 min every hour (total of 25 min). Average daily gain was calculated 1, 2 and 6 days following treatment. Scrotal diameter measurements and photographs of wounds were collected from all castrated calves 1, 2 and 6 days following treatment to evaluate inflammation and wound healing. Infrared photographs were used to identify maximum scrotal temperature. Digital photographs were used to visually score wounds on a numerical rating scale of 1 to 5, with signs of inflammation increasing and signs of healing decreasing with progressive scores. Sham castration calves displayed significantly less, and C calves displayed significantly more foot stamps than all other calves (P=0.005). Observations on the duration of time that calves displayed a hypometric ‘stiff gait’ locomotion, indicated that SHAM calves tended to spend no time, C calves tended to spend the greatest time and all other calves tended to spend an intermediate time displaying this behaviour (P=0.06). Maximum scrotal temperatures were lower in CBM and CBMTA calves than C and CTA calves 2 days following treatment (P=0.004). There was no significant effect of treatment on ADG (P=0.7), scrotal diameter (P=0.09) or wound morphology score (P=0.5). These results suggest that TA and BM, alone or in combination, reduced pain and BM reduced inflammation following surgical castration of calves.
The objective was to assess the effects of inclusion rate and chop length of lucerne silage, when fed in a total mixed ration (TMR), on milk yield, dry matter (DM) intake (DMI) and digestion in dairy cows. Diets were formulated to contain a 50 : 50 ratio of forage : concentrate (DM basis) and to be isonitrogenous (170 g/kg CP). The forage portion of the offered diets was comprised of maize and lucerne silage in proportions (DM basis) of either 25 : 75 (high Lucerne (HL)) or 75 : 25 (low lucerne (LL)). Lucerne was harvested and conserved as silage at either a long (L) or short (S) chop length. These variables were combined in a 2×2 factorial arrangement to give four treatments (HLL, HLS, LLL, LLS) which were fed in a Latin square design study to Holstein dairy cows in two separate experiments. In total, 16 and 8 multiparous, mid-lactation cows were used in experiments 1 and 2, respectively. To ensure sufficient silage for both experiments, different cuts of lucerne silage (taken from the same sward) were used for each experiment: first cut for experiment 1 (which was of poorer quality) and second cut for experiment 2. Dry matter intake, milk yield and milk composition where measured in both experiments, and total tract digestibility and nitrogen (N) balance were assessed using four cows in experiment 2. In experiment 1, cows fed LL had increased DMI (+3.2 kg/day), compared with those fed HL. In contrast, there was no difference in DMI due to lucerne silage inclusion rate in experiment 2. A reduction in milk yield was observed with the HL treatment in both experiment 1 and 2 (−3.0 and −2.9 kg/day, respectively). The HL diet had reduced digestibility of DM and organic matter (OM) (−3% and −4%, respectively), and also reduced the efficiency of intake N conversion into milk N (−4%). The S chop length increased total tract digestibility of DM and OM (both +4%), regardless of inclusion rate. Inclusion of lucerne silage at 25% of forage DM increased milk yield relative to 75% inclusion, but a S chop length partially mitigated adverse effects of HL on DMI and milk yield in experiment 1 and on DM digestibility in experiment 2.
Variation in human cognitive ability is of consequence to a large number of health and social outcomes and is substantially heritable. Genetic linkage, genome-wide association, and copy number variant studies have investigated the contribution of genetic variation to individual differences in normal cognitive ability, but little research has considered the role of rare genetic variants. Exome sequencing studies have already met with success in discovering novel trait-gene associations for other complex traits. Here, we use exome sequencing to investigate the effects of rare variants on general cognitive ability. Unrelated Scottish individuals were selected for high scores on a general component of intelligence (g). The frequency of rare genetic variants (in n = 146) was compared with those from Scottish controls (total n = 486) who scored in the lower to middle range of the g distribution or on a proxy measure of g. Biological pathway analysis highlighted enrichment of the mitochondrial inner membrane component and apical part of cell gene ontology terms. Global burden analysis showed a greater total number of rare variants carried by high g cases versus controls, which is inconsistent with a mutation load hypothesis whereby mutations negatively affect g. The general finding of greater non-synonymous (vs. synonymous) variant effects is in line with evolutionary hypotheses for g. Given that this first sequencing study of high g was small, promising results were found, suggesting that the study of rare variants in larger samples would be worthwhile.
This study aimed to identify genetic evaluation models (GEM) to accurately select cattle for milk production when only limited data are available. It is based on a data set from the Pakistani Sahiwal progeny testing programme which includes records from five government herds, each consisting of 100 to 350 animals, with lactation records dating back to 1968. Different types of GEM were compared, namely: (1) multivariate v. repeatability model when using the first three lactations, (2) an animal v. a sire model, (3) different fixed effects models to account for effects such as herd, year and season; and (4) fitting a model with genetic parameters fixed v. estimating the genetic parameters as part of the model fitting process. Two methods were used for the comparison of models. The first method used simulated data based on the Pakistani progeny testing system and compared estimated breeding values with true breeding values. The second method used cross-validation to determine the best model in subsets of actual Australian herd-recorded data. Subsets were chosen to reflect the Pakistani data in terms of herd size and number of herds. Based on the simulation and the cross-validation method, the multivariate animal model using fixed genetic parameters was generally the superior GEM, but problems arise in determining suitable values for fixing the parameters. Using mean square error of prediction, the best fixed effects structure could not be conclusively determined. The simulation method indicated the simplest fixed effects structure to be superior whereas in contrast, the cross-validation method on actual data concluded that the most complex one was the best. In conclusion it is difficult to propose a universally best GEM that can be used in any data set of this size. However, some general recommendations are that it is more appropriate to estimate the genetic parameters when evaluating for selection purposes, the animal model was superior to the sire model and that in the Pakistani situation the repeatability model is more suitable than a multivariate.
The aim of this study was to retrospectively assess the value of whole genome sequencing (WGS) compared to conventional typing methods in the investigation and control of an outbreak of Shigella sonnei in the Orthodox Jewish (OJ) community in the UK. The genome sequence analysis showed that the strains implicated in the outbreak formed three phylogenetically distinct clusters. One cluster represented cases associated with recent exposure to a single strain, whereas the other two clusters represented related but distinct strains of S. sonnei circulating in the OJ community across the UK. The WGS data challenged the conclusions drawn during the initial outbreak investigation and allowed cases of dysentery to be implicated or ruled out of the outbreak that were previously misclassified. This study showed that the resolution achieved using WGS would have clearly defined the outbreak, thus facilitating the promotion of infection control measures within local schools and the dissemination of a stronger public health message to the community.
We consider large-eddy simulation (LES) of buoyant plumes in uniform and stably stratified environments. We show that in the former case the results agree well with the simple plume model of Morton, Taylor & Turner (Proc. R. Soc. Lond. A, vol. 234, 1956, p. 1). In particular, we calculate an entrainment constant which is consistent with laboratory and field measurements and find no significant difference between the radial spreading rates of vertical velocity and buoyancy. In a stably stratified environment, the LES plume shows better agreement with Morton et al. (1956) below the level at which the buoyancy first vanishes than above this level. Above the level of neutral buoyancy, the LES plume is characterized by an ascending core of negative buoyancy surrounded by a descending annulus of positive buoyancy. We compare the LES data with the model of Bloomfield & Kerr (J. Fluid Mech., vol. 424, 2000, p. 197), which explicitly accounts for these coherent motions. The model exhibits many qualitative aspects of the LES plume and quantitative agreement can be improved by adjusting the downward volume flux relative to the upward volume flux in a manner consistent with the LES plume. This simple adjustment, along with revised values of the entrainment constants, represents the combined effects of an overturning region at the top of the plume (where a fluid element reverses direction), ‘plume-top’ entrainment (whereby the plume entrains ambient fluid above the plume) as well as lateral entrainment and detrainment processes (both external and internal) occurring above the top of the model plume.
Accurate and sufficiently detailed medical records are an essential component of good patient care. Their main purpose is to store clinical data for use in patient management and as a means of communication with other doctors and health-care professionals. Thus, the medical record of any patient should contain sufficient information to enable another doctor to carry on the management of the patient. This need is particularly obvious in situations such as in public hospitals where resident medical cover and nursing cover are arranged in shifts; in group practices where patients may see different doctors; and in after-hours deputising locum services where the only communication between the locum and the treating doctor is in writing.
Medical records are an important repository of personal information. They include records held in private doctors' surgeries, in private and public hospitals, in medical clinics in industry and in community health centres. Medical or health information is also held in a variety of state and federal government departments including those of Health, Veterans Affairs, Education and Defence, and Medicare Australia.
Medical records can also be important for clinical and epidemiological research, teaching and health administration, and in litigation. Requests for information about patients come not only from other doctors but also from insurers, employers, police, lawyers and government agencies for legal, financial or other reasons and can be properly complied with only via recourse to accurate medical records.
Most Australian doctors undertake full-time or part-time private clinical practice as general or specialist practitioners and are thus effectively running a small business. To successfully manage such an enterprise requires knowledge, some skill, and investment of time and energy. For larger medical groups, a practice manager may be employed to undertake some of this work or the task may be allocated to a medical member of the group who has the necessary skills and interest. This chapter is intended to give a broad overview of the tasks involved in establishing and managing a practice and to direct the reader to more detailed sources of information and professional help. It does not attempt to address the management issues specific to the investigative branches of clinical medicine such as radiology, pathology, day procedure centres and the like.
IMPORTANCE OF GOOD PRACTICE MANAGEMENT
Good practice management may appear superficially to be based on self-interest, aimed to maximise income and improve quality of life. While this is of some relevance, good practice management is a prerequisite to good patient care and is in the best interests of patients, as in such a practice appointment systems work, patient records are not misplaced, investigation results are not overlooked, direct-billing errors to Medicare do not occur and patients are guided efficiently to the help and resources they need. As mentioned in Chapter 3, better patient outcomes are achieved where there is good communication and a good patient–doctor relationship is established.
Doctors have significant responsibilities in regard to certifying the death of a person and in regard to reporting particular types of death to the coroner. In the field of organ transplantation, specialist doctors have the responsibility for accurately diagnosing brain death. This chapter covers these responsibilities and provides advice about such matters, including the additional requirements to be met where a deceased person is to be cremated and the ethical use of tissues removed at autopsy.
RECENT DEVELOPMENTS IN THE DIAGNOSIS OF DEATH
Before the modern advances of intensive care and life-support systems, there was little conflict between the law and medicine on the issue of the diagnosis of death. At common law, a breathing person with a circulation was alive; conversely, a person with irreversible cessation of cardiac and respiratory function was dead. In the USA in 1968, an ad hoc committee at Harvard Medical School developed guidelines for the withdrawal of circulatory and respiratory support in patients diagnosed with ‘irreversible coma’ or ‘brain death’. The authors emphasised that the primary purpose of the guidelines was to assist decision making in regard to withdrawal of futile treatment; organ donation was seen as a secondary aspect. As part of the response to developments in organ transplantation, by the mid-1970s there was widespread acceptance by doctors, lawyers and theologians, if not by the public, that the death of the brain was equivalent to the death of a person.
Good Medical Practice: Professionalism, Ethics and Law brings together information that is central to the professional, ethical and legal requirements of being a doctor. It covers a core curriculum for medical students, doctors in training and international medical graduates preparing for the Australian Medical Council examinations. A useful guide for busy doctors, giving sound advice for issues that arise in practice, ensuring that all approaches meet professional standards. Effective and compassionate practice depends equally upon good communication skills, an empathetic attitude, truthfulness, self-reflection and an awareness of the responsibilities arising under relevant laws. Good Medical Practice encapsulates these attributes and includes practice management, inter-professional relationships, sexual misconduct, complaints processes, the Australian health care system and doctors' health within its broad and comprehensive purview. Written by specialist practitioners with vast teaching experience, this is a unique, timely and accessible text that reinforces a contemporary focus on professionalism in medical practice.