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Malnutrition remains a leading contributor to the morbidity and mortality of children under the age of 5 years and can weaken the immune system and increase the severity of concurrent infections. Livestock milk with the protective properties of human milk is a potential therapeutic to modulate intestinal microbiota and improve outcomes. The aim of this study was to develop an infection model of childhood malnutrition in the pig to investigate the clinical, intestinal and microbiota changes associated with malnutrition and enterotoxigenic Escherichia coli (ETEC) infection and to test the ability of goat milk and milk from genetically engineered goats expressing the antimicrobial human lysozyme (hLZ) milk to mitigate these effects. Pigs were weaned onto a protein–energy-restricted diet and after 3 weeks were supplemented daily with goat, hLZ or no milk for a further 2 weeks and then challenged with ETEC. The restricted diet enriched faecal microbiota in Proteobacteria as seen in stunted children. Before infection, hLZ milk supplementation improved barrier function and villous height to a greater extent than goat milk. Both goat and hLZ milk enriched for taxa (Ruminococcaceae) associated with weight gain. Post-ETEC infection, pigs supplemented with hLZ milk weighed more, had improved Z-scores, longer villi and showed more stable bacterial populations during ETEC challenge than both the goat and no milk groups. This model of childhood disease was developed to test the confounding effects of malnutrition and infection and demonstrated the potential use of hLZ goat milk to mitigate the impacts of malnutrition and infection.
Uncertainties in estimates of glacier and ice-cap contribution to sea-level rise exist in part due to poor quantification of mass-balance errors, particularly those resulting from extrapolation of sparse measurements. Centre-line data are often assumed to be representative of the glacier as a whole, with little attention paid to extrapolation errors or their effect on mass-balance estimates. Here we present detailed digital elevation model (DEM) measurements of glacier-wide elevation changes over the last ~40 years at two glaciers on Svalbard, Norwegian Arctic. Austre Br0ggerbreen and Midtre Lovenbreen are shown to have lost 27.54 ± 0.98 and 9.65 ± 0.76 × 107m3 of ice, respectively, between 1966 and 2005, findings that we relate to trends in average summer air temperatures and winter accumulation. These volume losses correspond to geodetic balances of -0.58 ± 0.03 and -0.41 ± 0.03 mw.e. a-1, respectively. Our analysis revealed high spatial complexity in patterns of elevation change, varying between glaciers, between measurement intervals and within and between elevation bins. Balances from extrapolated centre-line geodetic data were the same (within errors) as those from full-coverage DEM differencing in the majority of comparisons, yet significantly underestimated balance in three instances. Additionally, field mass balance from centre-line ablation stake data underestimated balances from full-coverage geodetic measurements during three of six measurement periods. These findings may support the hypothesis that field measurements underestimate Svalbard glacier mass loss, at least partly as a result of the failure of centre-line measurements to account for glacier-wide variations in ablation. Our results demonstrate the importance of deriving accurate interpolation functions and constraining extrapolation errors from sparse measurements.
Photogrammetric processing of archival stereo imagery offers the opportunity to reconstruct glacier volume changes for regions where no such data exist, and to better constrain the contribution to sea-level rise from small glaciers and ice caps. The ability to derive digital elevation model (DEM) measurements of glacier volume from photogrammetry relies on good-quality, well-distributed ground reference data, which may be difficult to acquire. This study shows that ground-control points (GCPs) can be identified and extracted from point-cloud airborne lidar data and used to control photogrammetric glacier models. The technique is applied to midtre Lovénbreen, a small valley glacier in northwest Svalbard. We show that the amount of ground control measured and the elevation accuracy of GCP coordinates (based on known and theoretical error considerations) has a significant effect on photogrammetric model statistics, DEM accuracy and the subsequent geodetic measurement of glacier volume change. Models controlled with fewer than 20 lidar control points or GCPs from sub-optimal areas within the swath footprint overestimated volume change by 14–53% over a 2 year period. DEMs derived from models utilizing 20–25 or more GCPs, however, gave volume change estimates within ∼4% of those from repeat lidar data (−0.51 m a−1 between 2003 and 2005). Our results have important implications for the measurement of glacier volume change from archival stereo-imagery sources.
The high fat content in Western diets probably affects placental function during pregnancy with potential consequences for the offspring in the short and long term. The aim of the present study was to compare genome-wide placental gene expression between rat dams fed a high-fat diet (HFD) and those fed a control diet for 3 weeks before conception and during gestation. Gene expression was measured by microarray and pathway analysis was performed. Gene expression differences were replicated by real-time PCR and protein expression was assessed by Western blot analysis. Placental and fetal weights at E17.25 were not altered by exposure to the maternal HFD. Gene pathways targeting placental growth, blood supply and chemokine signalling were up-regulated in the placentae of dams fed the HFD. The up-regulation in messenger RNA expression for five genes Ptgs2 (fatty acid cyclo-oxidase 2; COX2), Limk1 (LIM domain kinase 1), Pla2g2a (phospholipase A2), Itga1 (integrin α-1) and Serpine1 was confirmed by real-time PCR. Placental protein expression for COX2 and LIMK was also increased in HFD-fed dams. In conclusion, maternal HFD feeding alters placental gene expression patterns of placental growth and blood supply and specifically increases the expression of genes involved in arachidonic acid and PG metabolism. These changes indicate a placental response to the altered maternal metabolic environment.
Lactoferrin and lysozyme are antimicrobial and immunomodulatory proteins produced in high quantities in human milk that aid in gastrointestinal (GI) health and have beneficial effects when supplemented separately and in conjunction in human and animal diets. Ruminants produce low levels of lactoferrin and lysozyme; however, there are genetically engineered cattle and goats that respectively secrete recombinant human lactoferrin (rhLF-milk), and human lysozyme (hLZ-milk) in their milk. Effects of consumption of rhLF-milk, hLZ-milk and a combination of rhLF-and hLZ-milk were tested on young pigs as an animal model for the GI tract of children. Compared with control milk-fed pigs, pigs fed a combination of rhLF and hLZ (rhLF+hLZ) milk had a significantly deeper intestinal crypts and a thinner lamina propria layer. Pigs fed hLZ-milk, rhLF-milk and rhLF+hLZ had significantly reduced mean corpuscular volume (MCV) and red blood cells (RBCs) were significantly increased in pigs fed hLZ-milk and rhLF-milk and tended to be increased in rhLF+hLZ-fed pigs, indicating more mature RBCs. These results support previous research demonstrating that pigs fed milk containing rhLF or hLZ had decreased intestinal inflammation, and suggest that in some parameters the combination of lactoferrin and lysozyme have additive effects, in contrast to the synergistic effects reported when utilising in-vitro models.
Approximately 25% of people with bulimia nervosa (BN) who undertake therapy are treated in groups. National guidelines do not discriminate between group and individual therapy, yet each has potential advantages and disadvantages and it is unclear how their effects compare. We therefore evaluated how group therapy for BN compares with individual therapy, no treatment, or other therapies, in terms of remission from binges and binge frequency.
We performed a systematic review and meta-analysis of randomized controlled trials of group therapies for BN, following standard guidelines.
A total of 10 studies were included. Studies were generally small with unclear risk of bias. There was low-quality evidence of a clinically relevant advantage for group cognitive behavioural therapy (CBT) over no treatment at therapy end. Remission was more likely with group CBT versus no treatment [relative risk (RR) 0.77, 95% confidence interval (CI) 0.62–0.96]. Mean weekly binges were lower with group CBT versus no treatment (2.9 v. 6.9, standardized mean difference = −0.56, 95% CI −0.96 to −0.15). One study provided low-quality evidence that group CBT was inferior compared with individual CBT to a clinically relevant degree for remission at therapy end (RR 1.24, 95% CI 1.03–1.50); there was insufficient evidence regarding frequency of binges.
Conclusions could only be reached for CBT. Low-quality evidence suggests that group CBT is effective compared with no treatment, but there was insufficient or very limited evidence about how group and individual CBT compared. The risk of bias and imprecise estimates of effect invite further research to refine and increase confidence in these findings.
Thin films have been grown on Si (100) substrates by pulsed laser evaporation of graphite using both IR and UV radiation. The character of the resulting film is found to be independent of the presence of H°. Diamond-like films are found to be a result of low (RT) temperature deposition of the higher energy incident particles of the UV (versus IR) laser ablation process.
Speed distributions were determined for the ions, ground state and electronicallyexcited neutrals ejected from a graphite target by 248 nm laser ablation. Mass distributions were measured for the laser-ejected ions. The measurements were carried out normal to the graphite target as well as at an angle of 45°. Significant differences were observed in both the speed and mass distributions at the two angles.
Application of CHG-impregnated or control (Comfort Bath; Sage) cloths applied over entire body thrice weekly.
Recruits were monitored daily for SSTI. Baseline and serial nasal and/or axillary swabs were collected to assess S. aureus colonization.
Of 1,562 subjects enrolled, 781 (from 23 platoons) underwent CHG-impregnated cloth application and 781 (from 21 platoons) underwent control cloth application. The rate of compliance (defined as application of 50% or more of wipes) at 2 weeks was similar (CHG group, 63%; control group, 67%) and decreased over the 6-week period. The mean 6-week SSTI rate in the CHG-impregnated cloth group was 0.094, compared with 0.071 in the control group (analysis of variance model rate difference, 0.025 ± 0.016; P = .14). At baseline, 43% of subjects were colonized with methicillin-susceptible S. aureus (MSSA), and 2.1% were colonized with MRSA. The mean incidence of colonization with MSSA was 50% and 61% (P = .026) and with MRSA was 2.6% and 6.0% (P = .034) for the CHG-impregnated and control cloth groups, respectively.
CHG-impregnated cloths applied thrice weekly did not reduce rates of SSTI among recruits. S. aureus colonization rates increased in both groups but to a lesser extent in those assigned to the CHG-impregnated cloth Intervention. Antecedent S. aureus colonization was not a risk factor for SSTI. Additional studies are needed to identify effective measures for preventing SSTI among military recruits.
Diverse group of injuries – note metatarsal/Lisfranc section above.
Navicular fractures are divided into four types – dorsal lip (avulsion), tuberosity, body and stress fractures.
Cuboid injury is usually undisplaced fracture which responds well to hard-soled shoe orthoses. Beware of the ‘Nutcracker fracture’, a high energy abduction injury, crushing the cuboid, shortening the lateral column and potentially extruding the cuboid. This requires ORIF usually.
Cuneiform injury is rarely isolated and responds to POP immobilisation unless significantly displaced when ORIF is the normal treatment.
Most phalangeal fractures occur in the proximal phalanx of the fifth toe following indirect trauma – stubbing of the toe.
Metatarsophalangeal and interphalangeal dislocations should be reduced a soon as possible but rarely require surgery unless open injuries.
Pain, swelling and sometimes deformity.
Careful identification of the most tender area will be particularly beneficial when assessing the X-ray.
Foot compartment syndrome must be suspected in a painful swollen foot and tested for by passively stretching the muscles of the relevant compartment.
AP and lateral X-rays centred on the area of tenderness are essential.
Look for significant angulation, intra-articular steps and joint subluxation.
If there is doubt regarding fracture extent or joint congruity then CT scanning is extremely helpful.
ABCs, assess soft tissues, neurovascular status, reduce fractures/dislocations obviously threatening the skin and immobilise with backslab.
Admit, elevate and assess for compartment syndrome in the severely injured foot even without fractures.
General trauma principles apply such that joint congruity must be restored, either following joint dislocation or in intra-articular fractures.
Navicular body fractures usually require ORIF.
Nutcracker cuboid fractures are normally treated with ORIF and bone graft.