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Little information exists on how to garner political commitment to strengthen large-scale breastfeeding policies and programmes by targeting key decision makers. The present study aims to map and describe the influence of stakeholders involved in breastfeeding policy and programming and identify opportunities to strengthen the breastfeeding-friendly environment in Mexico. A total of nine key informants from seventeen stakeholder organisations were selected based on their in-depth knowledge of the breastfeeding environment in Mexico and were individually interviewed using Net-Map methodology. This participatory interview technique combines stakeholder mapping, social network analysis and influence mapping to identify relevant stakeholders. Participants identified a total of fifty-five stakeholders shaping breastfeeding programmes and policies through four domains of influence: commands (n 32 stakeholders), dissemination (n 40), funding (n 35) and technical assistance (n 37). The Federal Ministry of Health emerged as the most influential stakeholder of breastfeeding policy and programming decisions in Mexico among all domains of influence. The Ministry of Finance and Public Credit as well as the National Institute of Public Health were identified as additional key stakeholders providing funding and technical assistance to the Federal Ministry of Health, respectively. Engaging identified key stakeholders can generate a multisectoral commitment to breastfeeding and strengthen the breastfeeding-friendly environment in Mexico.
We develop a model of the forces on a spherical particle suspended in flow through a curved duct under the assumption that the particle Reynolds number is small. This extends an asymptotic model of inertial lift force previously developed to study inertial migration in straight ducts. Of particular interest is the existence and location of stable equilibria within the cross-sectional plane towards which particles migrate. The Navier–Stokes equations determine the hydrodynamic forces acting on a particle. A leading-order model of the forces within the cross-sectional plane is obtained through the use of a rotating coordinate system and a perturbation expansion in the particle Reynolds number of the disturbance flow. We predict the behaviour of neutrally buoyant particles at low flow rates and examine the variation in focusing position with respect to particle size and bend radius, independent of the flow rate. In this regime, the lateral focusing position of particles approximately collapses with respect to a dimensionless parameter dependent on three length scales: specifically, the particle radius, duct height and duct bend radius. Additionally, a trapezoidal-shaped cross-section is considered in order to demonstrate how changes in the cross-section design influence the dynamics of particles.
Urbanisation and climate change are altering the pattern of California serogroup viruses in North America. As La Crosse virus (LACV) is the most pathogenic of the California serogroup, it is important to identify changes in distribution, transmission and pathogenesis. A scoping review (ScR) was prioritised to summarise the global evidence on LACV. A comprehensive search strategy was used, identified references were screened for relevance and relevant articles were characterised. Each step was conducted by two independent reviewers using pre-tested forms. Analysis identified areas of research saturation and gaps. The ScR included 481 research articles that were mostly journal articles (78.2%) conducted in North America (90.9%) from 1969 to 2016. Most evidence focused on epidemiology (44.9%), virus characteristics (25.8%), transmission conditions (18.7%) and pathogenesis of LACV in hosts (18.3%). Fewer studies evaluated the accuracy of diagnostic tests (8.7%), the efficacy of treatments (3.5%), prevention and control strategies (3.1%), the economic burden of infection (0.6%) and social impact (0.2%) of LACV. None of the literature predicted the impact of climate change on LACV, nor were any cases reported in Canada. These findings are intended to guide research to close knowledge gaps and inform evidence-based decisions surrounding activities for the prevention and control of LACV.
‘Hidden hunger’ is a term used to describe human deficiencies of key vitamins and minerals, also known as micronutrients. While global in scale, the prevalence of micronutrient deficiencies is particularly high in South Asia despite recent successes in economic growth, agricultural output and health care. The present paper reviews the most recent evidence on patterns and trends of hidden hunger across the region, with a focus on the most significant deficiencies – iodine, Fe, vitamin A and Zn – and interprets these in terms of health and economic consequences. The challenge for South Asian policy makers is to invest in actions that can cost-effectively resolve chronic nutrient gaps facing millions of households. Appropriate solutions are available today, so governments should build on evidence-based successes that combine targeted health system delivery of quality services with carefully designed multisector actions that help promote healthier diets, reduce poverty and ensure social protection simultaneously.
Pulsed non-thermal quiescent emission between 10 keV and around 150 keV has been observed in ~10 magnetars. For inner magnetospheric models of such hard X-ray signals, resonant Compton upscattering of soft thermal photons from the neutron star surface is the most efficient radiative process. We present angle-dependent hard X-ray upscattering model spectra for uncooled monoenergetic relativistic electrons. The spectral cut-off energies are critically dependent on the observer viewing angles and electron Lorentz factor. We find that electrons with energies less than around 15 MeV will emit most of their radiation below 250 keV, consistent with the observed turnovers in magnetar hard X-ray tails. Moreover, electrons of higher energy still emit most of the radiation below around 1 MeV, except for quasi-equatorial emission locales for select pulses phases. Our spectral computations use new state-of-the-art, spin-dependent formalism for the QED Compton scattering cross section in strong magnetic fields.
To: (i) determine the prevalence of self-reported eating less and eating down during early and late pregnancy and postpartum, and explore risk factors associated with eating less; (ii) examine the association between eating less and diet quality; and (iii) determine the association between eating less and weight gain during pregnancy.
Data were collected longitudinally from a cohort of women participating in a community health programme. Diet was assessed at three time points (≤20 weeks’ gestation, 36 weeks’ gestation, 6 months’ postpartum), body weight was measured during study enrolment (≤20 weeks’ gestation) and at 36 weeks’ gestation, and information about the woman and her household was collected at enrolment.
The Rang-Din Nutrition Study in the Rangpur and Dinajpur districts of Bangladesh.
Women (n 4011).
The prevalence of self-reported eating less differed by time point (75·9 % in early pregnancy, 38·8 % in late pregnancy, 7·4 % postpartum; P<0·001). The most common reason for eating less across all time periods was food aversion or loss of appetite. Women who reported eating less in late pregnancy had consumed animal-source foods less frequently in the preceding week than women who reported eating more (mean (sd): 11·7 (7·4) v. 14·8 (9·2) times/week; P<0·001) and had lower weekly weight gain than women who reported eating more (mean (se): 0·27 (0·004) v. 0·33 (0·004) kg/week; P<0·001).
Eating less has negative implications with respect to diet quality and pregnancy weight gain in this context.
The perinatal environment has a major influence on long-term health and disease risk. Preterm birth alters early-life environment and is associated with altered metabolic function in adulthood. Whether preterm birth per se or the early nutritional interventions used to support growth in preterm infants underpins this association is unknown. Lambs born preterm, following dexamethasone induction of labour, or spontaneously at term were randomised to receive nutrient supplementation, analogous to the milk fortifier used clinically or water as a control for the first 2 weeks after birth. Thereafter, nutrition was not different between groups. Growth was monitored, and the glucose–insulin axis function was assessed in juvenile (4 months) and adult life (14 months). Early nutrition influenced adult metabolic function and body composition to a greater extent than preterm birth. In supplemented females, arginine-stimulated insulin secretion was increased in preterm but reduced in term-born juveniles compared with controls (repeated-measures ANOVA P<0·01). In supplemented preterm males, adult weight, ponderal index (PI) and fasting insulin concentrations were elevated compared with preterm controls (weight, 75 (sem 3) v. 69 (sem 2) kg; PI, 48·0 (sem 2·1) v. 43·7 (sem 1·7) kg/m3; fasting insulin, 0·19 (sem 0·02) v. 0·10 (sem 0·02) ng/ml). Conversely, supplemented term-born males had reduced adult weight, PI and fasting insulin concentrations compared with term-born controls (weight, 64 (sem 2) v. 70 (sem 2) kg; PI, 44·4 (sem 1·8) v. 48·2 (sem 1·7) kg/m3; fasting insulin, 0·09 (sem 0·02) v. 0·14 (sem 0·02) ng/ml; all group×supplement interactions P<0·05). Adult metabolic health may reflect both gestational age at birth and early nutrition. Human studies are urgently needed to investigate the adult sex-specific health implications of neonatal nutritional strategies.
There has been increasing emphasis on performing ‘same-day’ or ‘out-patient’ thyroidectomy to reduce associated costs. However, acceptance has been limited by the risk of potentially life-threatening post-operative bleeding. This study aimed to review current rates of post-operative bleeding in a metropolitan teaching hospital and identify risk factors.
Medical records of patients undergoing thyroidectomy between January 2007 and March 2012 were reviewed retrospectively. Pre-operative, operative and pathological data, and post-operative complication data, were examined.
The study comprised 205 thyroidectomy cases. Mean age was 51.6 years (standard deviation = 14.74), with 80 per cent females. Unilateral thyroidectomy was performed in 81 cases (39.5 per cent) and total thyroidectomy was performed in 74 cases (36.1 per cent; 5.3 per cent with concomitant lymph node dissection). Nine patients (4.4 per cent) suffered post-operative bleeding, of which six required re-operation. Analysis showed that post-operative systolic blood pressure of 180 mmHg or greater was associated with post-operative bleeding (p = 0.003, chi-square test).
Rates of significant post-operative bleeding are consistent with recent literature. Post-operative hypertension, diabetes and high post-operative drain output were identified as independent risk factors on multivariate analysis; when identified, these may be caveats to same-day discharge of thyroidectomy patients.
Porous coatings at the surface of living cells have application in human cell transplantation by controlling the transport of biomolecules to and from the cells. Sol-gel-derived mesoporous silica materials are good candidates for such coatings, owing to their biocompatibility, facile solution-based synthesis conditions, and thin film formation. Diffusion and transport across the coating correlates to long-range microstructural properties, including pore size distribution, porosity, and pore morphology. Here, we investigated collagen-fibril matrices with known biocompatibility to serve as templating systems for directed silica deposition. Type 1 collagen oligomers derived from porcine skin are extensively characterized such that we can predict and customize the final collagen-fibril matrix with respect to fibril density, interfibril branching and viscoelasticity. We show that these matrices template and direct the deposition of mesoporous silica at the level of individual collagen fibrils. We varied the fibril density, silicic acid concentration, and time of exposure to silicifying solution and characterized the resulting hybrid materials by scanning electron microscopy, energy-dispersive x-ray spectroscopy, and rheology. Microstructural properties of the collagen-fibril template are preserved in the silica surface of hybrid materials. Results for three different collagen fibril densities, corresponding to shear storage moduli of 200 Pa, 1000 Pa, and 1600 Pa, indicate that increased fibril density increases the absolute amount of templated silica when all other silica synthesis conditions are kept constant. Additionally, mechanical properties of the hybrid material are dominated by the presence of the silica coating rather than the starting collagen matrix stiffness.
Maternal undernutrition during pregnancy increases offspring obesity and metabolic disease risk. We hypothesized that periconceptional undernutrition in sheep from 60 days before conception through to day 30 of gestation (UN) would decrease voluntary locomotor activity in adult offspring. Distance travelled was measured at 18 months of age for ∼48 h in the paddock. Data were analysed using multiple regression analysis, with explanatory variables including sex, nutrition group, birth weight, average time between GPS measurements and percentage of time during the measurement period spent in daylight. Mean (±s.e.) distance walked (m/h) was greater for control (CON) than UN animals, and greater for females than males [110.2 (6.5), CON females; 110.7 (6.3), CON males; 105.1 (5.3), UN females and 95.5 (5.8), UN males; P = 0.02 for nutrition group effect and for sex effect]. Periconceptional undernutrition may lead to a significant decrease in voluntary physical activity in adult offspring.
Approximately 10% of all babies worldwide are born preterm, and preterm birth is the leading cause of perinatal mortality in developed countries. Although preterm birth is associated with adverse short- and long-term health outcomes, it is not yet clear whether this relationship is causal. Rather, there is evidence that reduced foetal growth, preterm birth and the long-term health effects of both of these may all arise from a suboptimal intrauterine environment. Further, most infants born preterm also experience suboptimal postnatal growth, with potential adverse effects on long-term health and development. A number of interventions are used widely in the neonatal period to optimise postnatal growth and development. These commonly include supplementation with macronutrients and/or micronutrients, all of which have potential short-term risks and benefits for the preterm infant, whereas the long-term health consequences are largely unknown. Importantly, more rapid postnatal growth trajectory (and the interventions required to achieve this) may result in improved neurological outcomes at the expense of increased cardiovascular risk in later life.
Type I collagen is one of the most vital proteins in our bodies and serves a number of structural roles. Despite collagen’s importance, little is known about its nanoscale morphology in tissues and how morphology relates to mechanical function. This study directly probes nanoscale structure and mechanics in collagen as a function of hydration utilizing atomic force microscopy investigations of the mouse tail tendon. We demonstrate that collagen morphology and mechanical properties at the nanoscale change with dehydration, indicating that hydration is a factor which must be considered when performing studies at any length scale in collagen-based tissues. Studies are underway to further investigate this phenomenon and to determine how these properties change with disease in tendon and other Type I collagen-based tissues.
Aragonite can grow from calcium carbonate solutions as the favored phase, at ambient conditions, in the presence of 1:1 volume % water:ethanol. Its form is single and branched needles, with pseudohexagonal symmetry. Morphological evidence demonstrates that all precipitated aragonite is twinned. The recently popularized hypothesis of nonclassical growth by nanocrystal self assembly cannot describe the aragonite crystal form. Rather, its formation is effectively described as spherulitic growth, i.e. by classical crystal growth theory.
Biomineralized composite materials found in nature have a compromise of good mechanical properties and relatively small embodied energies in the process of their formation. The Alternate Soaking Process (ASP) is a laboratory technique that has only recently been applied to replicating composite biomineralization. The nexus of the ASP – heterogeneous nucleation – makes it ideal for replicating biominerals where the mineral is templated onto an organic substrate, such as occurs in avian eggshell. Here we demonstrate the deposition of a calcium carbonate gelatin composite on either glass cover slips or demineralized eggshell membranes using an automated ASP. SEM images and FTIR spectra of the resulting mineral show that by altering the amount of gelatin in the growth solutions the final organic component can be controlled accurately in the range of 1-10%, similar to that of natural eggshell. This study shows for the first time the co-precipitation of a CaCO3 – gelatin composite by an ASP and that the organic fraction of this mineral can be tuned to mimic that of natural biomineralized composites.