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Anecdotal evidence suggests the use of bolus tube feeding is increasing in long term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from 10 centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding, (n=604, 60% male, age 58years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients’ complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37%). Patients were long-term tube fed (4.1years tube feeding, 3.5years bolus tube feeding), living at home (71%) and sedentary (70%). The majority were head and neck cancer patients (22%) who were significantly more active (79%) and lived at home (97%), while those with cerebral palsy (12%) were typically younger (age 31years) but sedentary (94%). Most patients used bolus feeding as their sole feeding method (46%), because it was quick and easy to use, as a top up to oral diet or to mimic meal times. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85% of patients, with 51% of these being compact-style ONS (2.4kcal/ml, 125ml). This survey shows that bolus tube feeding is common amongst UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.
Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
Herbicide active ingredients, formulation type, ambient temperature, and humidity can influence volatility. A method was developed using volatility chambers to compare relative volatility of different synthetic auxin herbicide formulations in controlled environments. 2,4-D or dicamba acid vapors emanating after application were captured in air-sampling tubes at 24, 48, 72, and 96 h after herbicide application. The 2,4-D or dicamba was extracted from sample tubes and quantified using liquid chromatography and tandem mass spectrometry. Volatility from 2,4-D dimethylamine (DMA) was determined to be greater than that of 2,4-D choline in chambers where temperatures were held at 30 or 40 C and relative humidity (RH) was 20% or 50%. Air concentration of 2,4-D DMA was 0.399 µg m−3 at 40 C and 20% RH compared with 0.005 µg m−3 for 2,4-D choline at the same temperature and humidity at 24 h after application. Volatility from 2,4-D DMA and 2,4-D choline increased as temperature increased from 30 to 40 C. However, volatility from 2,4-D choline was lower than observed from 2,4-D DMA. Volatility from 2,4-D choline at 40 C increased from 0.00458 to 0.0263 µg m−3 and from 0.00341 to 0.025 µg m−3 when humidity increased from 20% to 50% at 72 and 96 h after treatment, respectively, whereas, volatility from 2,4-D DMA tended to be higher at 20% RH compared with 50% RH. Air concentration of dicamba diglycolamine was similar at all time points when measured at 40 C and 20% RH. By 96 h after treatment, there was a trend for lower air concentration of dicamba compared with earlier timings. This method using volatility chambers provided good repeatability with low variability across replications, experiments, and herbicides.
Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans.
This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey.
Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks.
Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.
We assess the gas-phase abundances of Si, C, and Fe from our recent measurements of Si++, C++, and Fe++ in the Orion Nebula by expanding on our earlier “blister” models. The Fe++ 22.9 μm line measured with the KAO yields Fe/H ~ 3 × 10−6 - considerably larger than in the diffuse ISM, where relative to solar, Fe/H is down by ~ 100. However, in Orion, Fe/H is still lower than solar by a factor ~ 10. The C and Si abundances are derived from new IUE high dispersion spectra of the C++ 1907, 1909 Å and Si++ 1883, 1892 Å lines. Gas-phase Si/C = 0.016 in the Orion ionized volume and is particularly insensitive to uncertainties in extinction and temperature structure. The solar value is 0.098. Gas-phase C/H = 3 × 10−4 and Si/H = 4.8 × 10−6. Compared to solar, Si is depleted by 0.135 in the ionized region, while C is essentially undepleted. This suggests that most Si and Fe resides in dust grains even in the ionized volume.
We apply a 2-D, axisymmetric code for modeling H II regions (Rubin Ap. J. 287, 653, 1984) to observations of the Orion Nebula. The model solves for the ionization and thermal structure and radiative transfer for the quasi-equilibrium volume. Assuming that the Orion Nebula is viewed face-on (along the symmetry axis) and that the geometry/density distribution is plane parallel with an exponential density gradient perpendicular to the slab, we use a x2 minimization technique to best fit the radio continuum maps. The best fit to the Schraml and Mezger map (Astrophys. J. 156, 269, 1969) has a density at the star of ∼1800 cm−3, a scale height of ∼0.23 pc, and ∼1.5x1049 ionizing photons s−1 so that ∼ 1/3 of the ionizing photons from the exciting source are escaping the nebula through the frontal density-bounded direction. Our model for Orion requires circular symmetry in the plane of the sky; nonsymmetrical features such as the ionization bar toward the SE cannot be reproduced. Further modeling that compares with line observations has been delayed to incorporate the important role played by recombinations in populating low-lying [O II] levels (Rubin 1985, Astrophys. J., submitted).
Aqueous two-phase systems and related emulsion-based structures defined within micro- and nanoscale environments enable a bottom-up synthetic biological approach to mimicking the dynamic compartmentation of biomaterial that naturally occurs within cells. Model systems we have developed to aid in understanding these phenomena include on-demand generation and triggering of reversible phase transitions in ATPS confined in microscale droplets, morpho-logical changes in networks of femtoliter-volume aqueous droplet interface bilayers (DIBs) formulated in microfluidic channels, and temperature-driven phase transitions in interfacial lipid bilayer systems supported on micro and nanostructured substrates. For each of these cases, the dynamics were intimately linked to changes in the chemical potential of water, which becomes increasingly susceptible to confinement and crowding. At these length scales, where interfacial and surface areas predominate over compartment volumes, both evaporation and osmotic forces become enhanced relative to ideal dilute solutions. Consequences of confinement and crowding in cell-sized microcompartments for increasingly complex scenarios will be discussed, from single-molecule mobility measurements with fluorescence correlation spectroscopy to spatio-temporal modulation of resource sharing in cell-free gene expression bursting.
The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD).
This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery–Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery.
Patients improved on the clinical measure of depression after surgery by −21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred.
With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.
We present new far-infrared line observations of the planetary nebulae (PNs) NGC 7027, NGC 7009, NGC 6210, NGC 6543, and IC 4997 obtained with the Kuiper Airborne Observatory (KAO). The bulk of our data are for NGC 7027 and NGC 7009, including [Ne V] 24 μm, [O IV] 26 μm, [O III] (52, 88μm), and [Nm] 57 μm. Our data for [O III] (52, 88) and [N III] 57 in NGC 7027 represent the first measurements of these lines in this source. The large [O III] 52/88 flux ratio implies an electron density (cm–3) of log Ne[O III] = 4.19, the largest Ne ever inferred from these lines. We derive N++/O++ = 0.394±0.062 for NGC 7027 and 0.179±0.043 for NGC 6210. We are able to infer the O+3/O++ ionic ratio from our data. As gauged by this ionic ratio, NGC 7027 is substantially higher ionization than is NGC 7009 – consistent with our observation that the former produces copious [Ne V] emission while the latter does not. These data help characterize the stellar ionizing radiation field.
To assess current salt† reduction policies in countries of the WHO European Region against the backdrop of varying levels of human development adjusted for income, education and health (longevity) inequalities.
Population-based, cross-sectional study, with data gathered through systematic review of relevant databases and supplementary information provided by WHO Nutrition Counterparts.
Member States of the WHO European Region.
Inequality-adjusted Human Development Index scores were analysed against assessed levels of development and implementation of national nutrition policies and initiatives targeting population-level salt reduction.
Within the WHO European Region, Inequality-adjusted Human Development Index values among countries with no existing salt reduction initiatives (mean 0·643 (se 0·022)) were significantly lower than among those with either partially implemented/planned salt initiatives (mean 0·766 (se 0·017), P < 0·001) or fully implemented salt initiatives (mean 0·780 (se 0·021), P < 0·001).
Where salt reduction strategies are implemented as an integral part of national policy, outcomes have been promising. However, low- and middle-income countries may face severe resource constraints that keep them from emulating more comprehensive strategies pursued in high-income countries. Care must be taken to ensure that gaps are not inadvertently widened by monitoring differential policy impacts of salt policies, particularly regarding trade flows.
Following a severe traumatic brain injury (TBI) there is a complex presentation of psychological symptoms which may impact on recovery. Validated treatments addressing these symptoms for this group of people are limited. This article reports on the protocol for a single-centre, two-armed, Phase II Randomised Control Trial (RCT) to address the adjustment process following a severe TBI. Participants will be recruited from Liverpool Brain Injury Rehabilitation Unit and randomly allocated to one of two groups, Acceptance and Commitment Therapy (ACT) or an active control (Befriending). The active treatment group utilises the six core processes of ACT with the intention of increasing participation and psychological flexibility and reducing psychological distress. A number of primary and secondary outcome measures, administered at assessment, post-treatment and 1-month follow-up, will be used to assess clinical outcomes. The publication of the protocol before the trial results are available addresses fidelity criterion (intervention design) for RCTs. This ensures transparency in the RCT and that it meets the guidelines according to the CONSORT statement. The protocol has also been registered on the Australian New Zealand Clinical Trials Registry ACTRN12610000851066.
A study has been made of B transient enhanced diffusion (TED) in heavily P-doped Si using secondary ion mass spectroscopy (SIMS) and positron annihilation spectroscopy (PAS). The Pdoped silicon was implanted with boron ions of 40 keV energy to a dose of 3 × 1014 cm-2, and then annealed at temperatures ranging from 700–1000°C in a N2 ambient for varying durations. As P doping concentration increased from 3 × 1019 to 1 × 1020 cm-3, boron diffusivity and the immobile boron fraction decreased. Our experimental results are inconsistent with the predictions of the Fermi-level model and suggest that the clustering between B atoms and Si interstitials should be invoked in order to explain the immobile portion of the B peak during TED.
It is now clear that the epoch when the Universe was half of its current age is a crucial period during which galaxies assembled their mass and evolved into the galaxies we observe in the local Universe. However, so far only very few direct studies of mass assembly in action, hence galaxy merging, were conducted over z=1 and usually relied on very small or biased samples. Based on very deep near infrared survey data, the latest UKIDSS-UDS DR8, combined with the optical data conducted by Subaru and CFHT and Spitzer IRAC observations, we explored the evolution of the merging rate up to z = 2, over the largest volume of the Universe at 0.4<z<2 ever sampled. The pair fraction is found to decrease by a factor of two during this period, and wet (gas rich) mergers dominate largely. The dry mergers are very rare, ruling it out as the main mechanism for the mass assembly of passive massive galaxies. Also while massive galaxies undergo a decrease of their pair fraction during this period, less massive systems follow an increase during the same period.
The origin of sub-diffraction-limit apertures in Sb-based thin films is discussed. Electromagnetic energy can be channeled by these apertures thus allowing near-field focussing- the Super-RENS effect. The aperture formation within Sb, Sb2Te3, Sb2Te, SbTe and Ge2Sb2Te5 is investigated by time resolved optical pump-probe techniques and found to occur without melting. Density functional calculations have shown that these materials exhibit a thresholdlike change in their optical properties below their melting temperatures. The threshold is shown to be a consequence of thermally induced misalignment of p-orbital bonds. It is the non-linearity of this process that leads to the formation of the sub-diffraction-limit apertures.
The relatively poor efficiency of phosphor materials in cathodoluminescence with low accelerating voltages is a major concern in the design of field emission flat panel displays operated below 5 kV. Our research on rare-earth-activated phosphors indicates that mechanisms involving interactions of excited activators have a significant impact on phosphor efficiency. Persistence measurements in photoluminescence (PL) and cathodoluminescence (CL) show significant deviations from the sequential relaxation model. This model assumes that higher excited manifolds in an activator de-excite primarily by phonon-mediated sequential relaxation to lower energy manifolds in the same activator ion. In addition to sequential relaxation, there appears to be strong coupling between activators, which results in energy transfer interactions. Some of these interactions negatively impact phosphor efficiency by nonradiatively de-exciting activators. Increasing activator concentration enhances these interactions. The net effect is a significant degradation in phosphor efficiency at useful activator concentrations, which is exaggerated when low–energy electron beams are used to excite the emission.