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The sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.
To provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.
A literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.
Reported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.
The sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.
This study evaluated the efficacy of a family-centered preventive intervention, the Family Check-Up (FCU), delivered as an online, eHealth model to middle school families. To increase accessibility of family-centered prevention in schools, we adapted the evidence-based FCU to an online format, with the goal of providing a model of service delivery that is feasible, given limited staffing and resources in many schools. Building on prior research, we randomly assigned participants to waitlist control (n = 105), FCU Online as a web-based intervention (n = 109), and FCU Online with coaching support (n = 108). We tested the effects of the intervention on multiple outcomes, including parental self-efficacy, child self-regulation, and child behavior, in this registered clinical trial (NCT03060291). Families engaged in the intervention at a high rate (72% completed the FCU assessment) and completed 3-month posttest assessments with good retention (94% retained). Random assignment to the FCU Online with coaching support was associated with reduced emotional problems for children (p = .003, d = −0.32) and improved parental confidence and self-efficacy (p = .018, d = 0.25) when compared with waitlist controls. Risk moderated effects: at-risk youth showed stronger effects than did those with minimal risk. The results have implications for online delivery of family-centered interventions in schools.
To describe snacking characteristics and patterns in children and examine associations with diet quality and BMI.
Children’s weight and height were measured. Participants/adult proxies completed multiple 24 h dietary recalls. Snack occasions were self-identified. Snack patterns were derived for each sample using exploratory factor analysis. Associations of snacking characteristics and patterns with Healthy Eating Index-2010 (HEI-2010) score and BMI were examined using multivariable linear regression models.
Childhood Obesity Prevention and Treatment Research (COPTR) Consortium, USA: NET-Works, GROW, GOALS and IMPACT studies.
Two snack patterns were derived for three studies: a meal-like pattern and a beverage pattern. The IMPACT study had a similar meal-like pattern and a dairy/grains pattern. A positive association was observed between meal-like pattern adherence and HEI-2010 score (P for trend < 0⋅01) and snack occasion frequency and HEI-2010 score (β coefficient (95 % CI): NET-Works, 0⋅14 (0⋅04, 0⋅23); GROW, 0⋅12 (0⋅02, 0⋅21)) among younger children. A preference for snacking while using a screen was inversely associated with HEI-2010 score in all studies except IMPACT (β coefficient (95 % CI): NET-Works, −3⋅15 (−5⋅37, −0⋅92); GROW, −2⋅44 (−4⋅27, −0⋅61); GOALS, −5⋅80 (−8⋅74, −2⋅86)). Associations with BMI were almost all null.
Meal-like and beverage patterns described most children’s snack intake, although patterns for non-Hispanic Blacks or adolescents may differ. Diets of 2–5-year-olds may benefit from frequent meal-like pattern snack consumption and diets of all children may benefit from decreasing screen use during eating occasions.
Introduction: Low acuity patients have been controversially tagged as a source of emergency department (ED) misuse. Authorities for many Canadian health regions have set up policies so these patients preferably present to walk-in clinics (WIC). We compared the cost and quality of the care given to low acuity patients in an academic ED and a WIC of Québec City during fiscal year 2015-16. Methods: We conducted an ambidirectional (prospective and retrospective) cohort study using a time-driven activity-based costing method. This method uses duration of care processes (e.g., triage) to allocate to patient care all direct costs (e.g., personnel, consumables), overheads (e.g., building maintenance) and physician charges. We included consecutive adult patients, ambulatory at all time and discharged from the ED or WIC with a diagnosis of upper respiratory tract infection (URTI), urinary tract infection (UTI) or low back pain. Mean cost [95%CI] per patient per condition was compared between settings after risk-adjustment for age, sex, vital signs, number of regular medications and co-morbidities using generalized log-gamma regression models. Proportions [95%CI] of antibiotic prescription and chest X-Ray use in URTI, compliance with provincial guidelines on use of antibiotics in UTI, and column X-Ray use in low back pain were compared between settings using a Pearson Chi-Square test. Results: A total of 409 patients were included. ED and WIC groups were similar in terms of age, sex and vital signs on presentation, but ED patients had a greater burden of comorbidities. Adjusted mean cost (2016 CAN$) of care was significantly higher in the ED than in the WIC (p < 0.0001) for URTI (78.42[64.85-94.82] vs. 59.43[50.43-70.06]), UTI (78.88[69.53-89.48] vs. 53.29[43.68-65.03]), and low back pain (87.97[68.30-113.32] vs. 61.71[47.90-79.51]). For URTI, antibiotics were more frequently prescribed in the WIC (44.1%[34.3-54.3] vs. 5.8%[1.2-16.0]; p < 0.0001) and chest X-Rays, more frequently used in the ED (26.9%[15.6-41.0] vs. 13.7%[7.7-22.0]; p = 0.05). No significant differences were observed in the compliance with guidelines on use of antibiotics in UTI and in the use of column X-Ray in low back pain. Conclusion: Total cost of care for low acuity patients is lower in walk-in clinics than in EDs. However, our results suggest that quality-of-care issues should be considered in determining the best alternate setting for treating ambulatory emergency patients.
Objectives: Studies of neurocognitively elite older adults, termed SuperAgers, have identified clinical predictors and neurobiological indicators of resilience against age-related neurocognitive decline. Despite rising rates of older persons living with HIV (PLWH), SuperAging (SA) in PLWH remains undefined. We aimed to establish neuropsychological criteria for SA in PLWH and examined clinically relevant correlates of SA. Methods: 734 PLWH and 123 HIV-uninfected participants between 50 and 64 years of age underwent neuropsychological and neuromedical evaluations. SA was defined as demographically corrected (i.e., sex, race/ethnicity, education) global neurocognitive performance within normal range for 25-year-olds. Remaining participants were labeled cognitively normal (CN) or impaired (CI) based on actual age. Chi-square and analysis of variance tests examined HIV group differences on neurocognitive status and demographics. Within PLWH, neurocognitive status differences were tested on HIV disease characteristics, medical comorbidities, and everyday functioning. Multinomial logistic regression explored independent predictors of neurocognitive status. Results: Neurocognitive status rates and demographic characteristics differed between PLWH (SA=17%; CN=38%; CI=45%) and HIV-uninfected participants (SA=35%; CN=55%; CI=11%). In PLWH, neurocognitive groups were comparable on demographic and HIV disease characteristics. Younger age, higher verbal IQ, absence of diabetes, fewer depressive symptoms, and lifetime cannabis use disorder increased likelihood of SA. SA reported increased independence in everyday functioning, employment, and health-related quality of life than non-SA. Conclusions: Despite combined neurological risk of aging and HIV, youthful neurocognitive performance is possible for older PLWH. SA relates to improved real-world functioning and may be better explained by cognitive reserve and maintenance of cardiometabolic and mental health than HIV disease severity. Future research investigating biomarker and lifestyle (e.g., physical activity) correlates of SA may help identify modifiable neuroprotective factors against HIV-related neurobiological aging. (JINS, 2019, 25, 507–519)
The purpose of this work was to develop accurate calibration standards which were fully characterized in terms of uniformity and concentration using fundamental measuring methods. Three similar sets of vacuum deposits were commercially made, each set containing the single deposits CuS, KCl, CaF2, Cr, Fe, Cu, RbNO3, SrF2, MoO3 , BaF2, and Pb. Thickness variations in each deposit were measured with PIXEA (proton induced x-ray excitation analysis) measurements taken at 6 to 8 positions along the deposit diameters. Relative elemental concentrations on corresponding deposits from each set were measured using multiple XRF intercomparisons. One set of deposits was destructively analyzed at the National Bureau of Standards with isotope dilution thermal ionization mass spectrometry (IDMS) in order to calibrate the remaining sets of vacuum deposits. The calibrated deposits were compared with standards from two commercial sources. For seven elements heavier than chlorine there was an average deviation of 13.5% between the calibrated deposits and the commercial standards. Disagreements as large as 15% were observed between standards from the two commercial suppliers.
Parenting, Eating and Activity for Child Health (PEACH) is a multi-component lifestyle intervention for families with overweight and obese children. PEACH was translated from an efficacious randomised-controlled trial (RCT) and delivered at scale as PEACH Queensland (QLD) in Queensland, Australia. The aim of this study is to explore pre–post changes in parenting, and child-level eating, activity and anthropometry, in the PEACH QLD service delivery project. PEACH QLD enrolled 926 overweight/obese children (817 families). Pre-programme evaluation was completed for 752 children and paired pre–post-programme evaluation data were available for 388 children. At baseline, children with pre–post-programme data were (mean) 8·8 years old, and at follow-up were 9·3 years old, with mean time between pre–post-programme measures of 0·46 years. Outcomes reflected each domain of the PEACH programme: parenting, eating behaviour of the child and activity behaviours (means reported). Parents reported improvements in parenting self-efficacy (3·6 to 3·7, P=0·001). Children had improved eating behaviours: eating more daily serves of vegetables (2·0 to 2·6, P=0·001) and fewer non-milk sweetened beverages (0·9 to 0·6, P=0·001) and discretionary foods (2·2 to 1·5, P=0·001). Children spent more time in moderate-to-vigorous physical activity (86 to 105 min/d, P=0·001) and less time in sedentary screen-based behaviours (190 to 148 min/d, P=0·001). Consequently, there were significant improvements in mean BMIz (−0·112; P<0·001) and weight status (healthy weight/overweight/obese/morbidly obese prevalence from 0/22/33/45 % to 2/27/34/37 %, P<0·001). When delivered at scale, PEACH remains an effective family-based, multi-component, lifestyle weight management programme for overweight and obese children whose families engage in the programme.
A hierarchy of models is formulated for the deflection of a thin two-dimensional liquid jet as it passes over a thin air-cushioning layer above a rigid flat impermeable substrate. We perform a systematic derivation of the leading-order equations of motion for the jet in the distinguished limit in which the air pressure jump, surface tension and gravity affect the displacement of the centreline of the jet, but not its thickness or velocity. We identify thereby the axial length scales for centreline deflection in regimes in which the air layer is dominated by viscous or inertial effects. The derived length scales and reduced equations aim to expand the suite of tools available for future analyses of the evolution of lamellae and ejecta in impact problems. Assuming that the jet is sufficiently long that tip and entry effects can be neglected, we demonstrate that the centreline of a constant-thickness jet moving with constant axial speed is destabilised by the air layer for sufficiently small surface tension. Expressions for the fastest-growing modes are obtained in both the viscous-dominated air and inertia-dominated air regimes. For a finite-length jet emanating from a nozzle, we show that, in one particular asymptotic limit, the evolution of the jet centreline is akin to the flapping of an unfurling flag above a thin air layer. We discuss the distinguished limit in which tip retraction can be neglected and perform numerical investigations into the resulting model. We show that the cushioning layer causes the jet centreline to bend, leading to rupture of the air layer. We discuss how our toolbox of models can be adapted and utilised in the context of recent experimental and numerical studies of splash dynamics.
Traumatic stressors during childhood and adolescence are associated with psychopathology, mostly studied in the context of post-traumatic stress disorder (PTSD) and depression. We investigated broader associations of traumatic stress exposure with psychopathology and cognition in a youth community sample.
The Philadelphia Neurodevelopmental Cohort (N = 9498) is an investigation of clinical and neurobehavioral phenotypes in a diverse (56% Caucasian, 33% African American, 11% other) US youth community population (aged 8–21). Participants were ascertained through children's hospital pediatric (not psychiatric) healthcare network in 2009–2011. Structured psychiatric evaluation included screening for lifetime exposure to traumatic stressors, and a neurocognitive battery was administered.
Exposure rate to traumatic stressful events was high (none, N = 5204; one, N = 2182; two, N = 1092; three or more, N = 830). Higher stress load was associated with increased psychopathology across all clinical domains evaluated: mood/anxiety (standardized β = .378); psychosis spectrum (β = .360); externalizing behaviors (β = .311); and fear (β = .256) (controlling for covariates, all p < 0.001). Associations remained significant controlling for lifetime PTSD and depression. Exposure to high-stress load was robustly associated with suicidal ideation and cannabis use (odds ratio compared with non-exposed 5.3 and 3.2, respectively, both p < 0.001). Among youths who experienced traumatic stress (N = 4104), history of assaultive trauma was associated with greater psychopathology and, in males, vulnerability to psychosis and externalizing symptoms. Stress load was negatively associated with performance on executive functioning, complex reasoning, and social cognition.
Traumatic stress exposure in community non-psychiatric help-seeking youth is substantial, and is associated with more severe psychopathology and neurocognitive deficits across domains, beyond PTSD and depression.
It is now widely recognised that feeding high levels of cereal-based concentrate feeds to horses can precipitate episodes of colic, laminitis and developmental orthopaedic disease. However, when feeding performance horses or fast-growing young stock, particularly Thoroughbreds, traditional feeding regimes still persist whereby animals are fed high-cereal, low-fibre diets. When considering the knowledge to-date on the digestibility and availability of crude protein, this feeding regime is not surprising as previous work by Gibbs et al (1988 and 1996) and Potter et al (1992), have reported that the large intestine was the major site for crude protein degradation in hay. Protein is held within the cell wall matrix in fibre feeds and is fermented by microbes to NH3, which may be subsequently processed in the liver to urea, recycled or excreted via the urine. Moreover, a high proportion of the protein passing through the ileo-caecal junction is excreted with the faeces as intact microbial protein and therefore is unavailable for metabolic purposes in the horse.
The carbohydrate (CHO) fraction of pasture grasses is a major source of energy for many domestic herbivores. However, the amounts, and types, of the water–soluble carbohydrate (WSC) fraction (i.e. glucose, fructose, sucrose, and polymers of sucrose and fructose, the fructans) present in such grasses, varies with species and environmental conditions. As the WSC constitute a highly digestible, energy yielding fraction of grasses, it is important to be able to measure their levels in a sward so that the diets of pastured animals may be designed to elicit optimal health and productivity. The aim of this study was to characterise the WSC profile of six UK pasture grasses, and to develop a technique for extracting the fructan portion of the WSC.
Six species of UK pasture grasses [Cocksfoot (C), Timothy (T), Meadow Fescue (M), Italian Ryegrass (IR), Perennial Ryegrass (PR) and Hybrid Ryegrass (HR)] were grown in experimental field plots at IGER.
The water content of feedstuffs is an important factor when considering both the nutritive value of a feed for dietary rationing purposes and when assessing the functional properties associated with the practical inclusion of a feedstuff in animal diets. Water is a vital nutrient in its own right and must be supplied on a daily basis. Feed associated water provides one source of this obligatory requirement. In addition, the water holding capacity (WHC) of a feedstuff and its relationship with other constituents of the feed may have important effects. Water can be associated with feedstuff in one of three ways (Robertson and Eastwood, 1981b). Firstly, water can be bound by the hydrophilic polysaccharides of the fibre component of feeds. Secondly, water can be held within the structural fibre matrix of feeds and finally, water can be associated with feedstuff fibre other than bound or matrix water and is usually considered as water trapped within the cell wall lumen.
Fibrous foods are major sources of energy and protein for equids. The potentially energy yielding fraction of dietary fibre consists of non-starch polysaccharides (NSP). NSP cannot be digested by equine enzymes and in order for the animal to obtain energy from NSP it must be fermented by the gut microflora to yield volatile fatty acid. This fermentation process is less efficient in terms of yield of ATP than the digestion of starch to glucose, and is generally believed to occur solely in the large intestine. Plant protein may be associated with the NSP or the protoplast. However, horses can only utilize that protein which has been digested and absorbed in the small intestine. Thus, knowledge of the site and extent of nutrient degradation is important to enable the accurate formulation of diets for horses. Therefore in the current study the site and extent of NSP and crude protein (CP) degradation from four fibrous foods commonly given to horses in the United Kingdom were determined in caecally fistulated ponies using mobile bags.
The trial was a 4 X 3 incomplete Latin square design with three caecally fistulated Welsh X pony geldings (ca. 250 kg live weight) and four botanically diverse sources of dietary fibre. The ponies were maintained on a basal diet of hay and grass nuts and water was available ad libitum. Bags (6X1 cm) of monofilament polyester mesh pore size 4 μm were filled with 350 mg of either unmolassed sugar-beet pulp (SB), hay cubes (HC), soya hulls (SH) or oat hulls : naked oats (2:1) (OH: NO), which had been ground to pass a 1-mm steel mesh. On two consecutive mornings 20 bags were introduced into the ponies via a naso-gastric tube. Each bag contained two 100 mg steel washers which enabled their capture by a magnet placed inside the caecal fistula: the cannulae were positioned just posterior to the ileo-caecal junction. Between 10 and 16 bags were recovered on the magnet, the remaining bags were allowed to continue through the hind-gut and were subsequently collected in the faeces.
It has been shown that horses and ponies at pasture usually graze for 15-17 hours per day, and consume between 16 and 33g dry matter (DM) /kg live weight per day, depending on animal size and physiological status. However, many predominantly stabled horses have restricted access to pasture, often only 1-3 hours/day. There is no information on voluntary food intake (VFI) of horses under such regimens. Therefore the aim of this pilot study was to determine the voluntary intake of fresh herbage by ponies when their access to pasture was restricted.
Little information is available on digestion of the non-starch polysaccharide (NSP) fraction of fibrous feeds in equines. Two studies were conducted which examined the in vivo apparent digestibilities of proximate constituents and NSP in ponies offered diets based on botanically diverse fibrous foodstuffs.
In study 1 (S1), three mature caecally-fistulated Welsh-cross pony geldings (266 kg LW) were used in a 3 x 3 latin square changeover design experiment consisting of three 21 day periods. Ponies were offered 4 kg dry matter (DM) per day of either unmolassed sugar beet pulp (USBP), hay cubes (HC) or a 2:1 mix of oat hulls:naked oats (OHNO) plus minerals in 2 equal meals per day. After completion of S1 the same 3 ponies were used in study 2 (S2) where they were offered 4 kg DM/day of a 50:50 mix of USBP:HC (USHC) plus minerals fed as in S1 for a 21 day period.
Estimates of digesta passage through specific segments of the alimentary tract are a vital component of modelling approaches which attempt to quantitatively partition digestive processes in equines. This study reports results from three studies where digesta passage of Chromium (Cr) mordanted feeds was determined in the caecum of ponies.
Caecal outflow rates were determined during three in vivo apparent digestibility studies conducted using three caecally-fistulated ponies as described by Moore-Colyer et al, (1999) for studies 1 and 2; and McLean et al, (1999) for study 3. Pony basal diets consisted of unmolassed sugar beet pulp (USBP), hay cubes (HC) or a 2:1 mix of oat hulls:naked oats (OHNO) in study 1; a 1:1 mix of USBP:HC (USHC) in study 2 and either 100% HC or one of 3 diets consisting of a 1:1 HC:barley mix where the barley was either rolled (RBHC), micronised (MBHC) or extruded (EBHC) in study 3.
A wide range of roughage foodstuffs is available for feeding to horses. Considerable variation exists in the quality of these feeds in terms of nutrient composition and freedom from dust, fungal and bacterial contamination and infestation by mites. Many horse-owners are now feeding forages such as haylage and baled silage to horses as opposed to hay. However, limited information is available regarding the effect of chop length on digestibility and thus the feeding value of chopped or long-cut silage to horses. More information on fodder type and preparation could help to provide the basis for improvements in the practical guidelines and recommendations for those involved with the production and feeding of forages to horses.
Feeding horses high levels of cereal starch can result in diet-related azoturia, laminitis and colic, whereas high fibre, forage-based diets do not generally elicit these conditions. Therefore, it would be advantageous to develop fibrous feeds with increased digestibilities, permitting horses with high energy demands to be sustained on greater forage: cereal starch ratios. High temperature dried (HT) alfalfa has been fed to horses for a number of years and it is common practise to combine this with sugar beet pulp (SB) another nutritious fibrous feed for horses. Synergistic effects of SB when added to fibre-based diets have been observed in other species in vivo (Longland et al., 1994) whereby the digestibility of graminaceous feeds has been increased. However, such effects have been little examined in horses fed a leguminous-forage diet. The aim of this study therefore, was to determine if SB enhanced the digestibility of alfalfa, a forage legume that is increasingly being fed to equines in the UK.
There is a dearth of information available on the effects of donor animal on the fermentative capacity of equine faecal inocula for use in in vitro digestibility determinations. Furthermore, there is little knowledge of the degradation characteristic of feedstuffs incubated with equine faecal inocula. As such this study aimed to elucidate the effect of donor animal on the fermentation of feedstuffs in vitro and to assess the in vitro degradation characteristics of three commonly fed components of horse diets incubated with equine faecal inocula.