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The range and number of educational and networking events that are available for fellows, trainees, and junior faculty to attend grows every year. Each meeting useful in its own way; each adding value to the development and the growth of an interventionist. Within paediatric, congenital, and structural heart disease, three of the standout meetings are: Pediatric and Interventional Cardiac Symposium (PICS-AICS), Congenital and Structural Interventions (CSI), and International Workshop on Interventional Pediatric and Adult Congenital Cardiology (IPC). All of these were started by leaders in our field; people known to be passionate educators and innovators. International congresses focusing more broadly on congenital cardiac disease in children and adults are rare. These forums allow more interdisciplinary discussions between the interventionist, surgeon, and non-invasive specialists. Purely interventional meetings are essential to allow colleagues to debate and explore the nuances and intricacies of technique and approach, developing concepts to be challenged in wider forums. During the recent 21st PICS-AICS meeting Prof. Ziyad M. Hijazi, Shakeel A. Qureshi, Mario Carminati, and Dr Damien Kenny shared their time to engage in frank, recorded conversations which provide a unique insight in to the process and concepts behind three of our most important educational congresses.
The Stac Fada Member of the Stoer Group, within the Torridonian succession of NW Scotland, is a melt-rich, impact-related deposit that has not been conclusively correlated with any known impact structure. However, a gravity low approximately 50 km east of the preserved Stac Fada Member outcrops has recently been proposed as the associated impact site. We investigate the location of the impact structure through a provenance study of detrital zircon and apatite in five samples from the Stoer Group. Our zircon U–Pb data are dominated by Archaean grains (> 2.5 Ga), consistent with earlier interpretations that the detritus was largely derived from local Lewisian Gneiss Complex, whereas the apatite data (the first for the Stoer Group) display a single major peak at c. 1.7 Ga, consistent with regional Laxfordian metamorphism. The almost complete absence of Archaean-aged apatite is best explained by later heating of the > 2.5 Ga Lewisian basement (the likely source region) above the closure temperature of the apatite U–Pb system (c. 375–450°C). The U–Pb age distributions for zircon and apatite show no significant variation with stratigraphic height. This may be interpreted as evidence that there was no major change in provenance during the course of deposition of the Stoer Group or, if there was any significant change, the different source regions were characterized by similar apatite and zircon U–Pb age populations. Consequently, the new data do not provide independent constraints on the location of the structure associated with the Stac Fada Member impact event.
X-ray fluorescence spectroscopy is usually not considered a surface technique in the same sense as ESCA or Auger spectroscopies. However, it can be a useful tool in studying the “surface” and bulk concentrations of elements in heterogeneous catalysts. The “surface” is defined by the effective penetration depth of the analyte line of the element of interest in a specific matrix. In the example which is presented, silver on alumina, the “surface” using the Ag KB1,3 is defined by a shell 3000 microns deep while for the Ag LAI it is 15 microns. Two methods of sample preparation are discussed and data obtained using three different calculation methods is presented. Data from the x-ray fluorescence method is compared to the silver depth profile in the alumina pellets obtained by electron microprobe analysis. The XRFS method allows rapid screening of many catalyst samples for the fraction of the cost of the microprobe technique.
Important differences exist between various databases in the digestibility of ruminant feed ingredients (INRA, 1989; MAFF, 1992). The objective of this experiment was to measure the digestibility of some the more important ruminant feed ingredients and the variation associated with them.
It has been suggested that cattle have a greater ability to digest fibrous feeds and a lower ability to digest non-fibrous feeds than sheep (Mc Donald et al., 1995). This statement applies mainly to forages and few direct comparisons have been conducted using concentrate ingredients. The digestibility of concentrate ingredients may be influenced by the level of consumption since an increase in intake of a complete diet resulted in a decrease in digestibility (El Khidir and Vestergaard Thomsen, 1983). The aims of this study were (a) to determine the effect of level of consumption by cattle and (b) to examine the effect of animal species (sheep and cattle) on the digestibility of concentrate ingredients.
Mandatory fortification of staple grains with folic acid and/or vitamin B12 (B12) is under debate in many countries including Ireland, which has a liberal, but voluntary, fortification policy. Older adults can be at risk of both deficiency and high folate status, although little is known on the actual prevalence and the major predictors. Population prevalence estimates from older adults (n 5290 ≥50 years) from the Irish Longitudinal Study on Ageing (TILDA) (Wave 1) are presented here. Measures included plasma total vitamin B12 and folate, whereas predictors included detailed demographic, socio-economic, geographic, seasonal and health/lifestyle data. The prevalence of deficient or low B12 status (<185 pmol/l) was 12 %, whereas the prevalence of deficient/low folate status was 15 %. High folate status (>45 nmol/l) was observed in 8·9 %, whereas high B12 status was observed in 3·1 % (>601 pmol/l). The largest positive predictor of B12 concentration was self-reported B12 injection and/or supplement use (coefficient 51·5 pmol/; 95 % CI 9·4, 93·6; P=0·016) followed by sex and geographic location. The largest negative predictor was metformin use (−33·6; 95 % CI −51·9, −15·4; P<0·0001). The largest positive predictor of folate concentration was folic acid supplement use (6·0; 95 % CI 3·0, 9·0 nmol/l; P<0·001) followed by being female and statin medications. The largest negative predictor was geographic location (−5·7; 95 % CI −6·7, −4·6; P<0·0001) followed by seasonality and smoking. B-vitamin status in older adults is affected by health and lifestyle, medication, sampling period and geographic location. We observed a high prevalence of low B12 and folate status, indicating that the current policy of voluntary fortification is ineffective for older adults.
Transitioning from administration of monthly palivizumab to a single dose at discharge was associated with substantial pharmacy cost savings. With the concurrent adoption of private hospital rooms and visitor restriction policies, hospital-wide and neonatal intensive care unit healthcare-associated respiratory syncytial virus infections decreased following these changes.
Early-life nutrition affects calf development and thus subsequent performance. The aim of this study was to examine the effect plane of nutrition on growth, feeding behaviour and systemic metabolite concentrations of artificially reared dairy bull calves. Holstein-Friesian (F; n=42) and Jersey (J; n=25) bull calves with a mean±SD age (14±4.7 v. 27±7.2 days) and BW (47±5.5 v. 33±4.7 kg) were offered a high, medium or low plane of nutrition for 8 weeks using an electronic feeding system which recorded a range of feed-related events. Calves were weighed weekly and plasma samples were collected via jugular venipuncture on weeks 1, 4 and 7 relative to the start of the trial period. The calves offered a high plane of nutrition had the greatest growth rate. However, the increased consumption of milk replacer led to a reduction in feed efficiency. Holstein-Friesian calves offered a low plane of nutrition had the greatest number of daily unrewarded visits to the feeder (P<0.001). β-hydroxybutyrate (BHB) concentrations were greater in F calves on a low plane of nutrition (P<0.001). Although there was no effect of plane of nutrition, BHB concentrations in F calves increased before weaning, concomitant with an increase in concentrate consumption. Urea concentrations were unaffected by plane of nutrition within either breed. Jersey calves on a low plane of nutrition tended to have lower triglycerides than those on a high plane (P=0.08), but greater than those on a medium plane (P=0.08). Holstein-Friesian calves offered a high plane of nutrition tended to have greater triglyceride concentrations than those on a medium plane (P=0.08). Triglycerides increased from the start to the end of the feeding period (P<0.05), across both breeds. A medium plane of nutrition resulted in a growth, feeding behaviour and metabolic response comparable with a high plane of nutrition in pre-weaned bull calves of both F and J breeds.
We present MERLIN maps of V1016 Cyg at 6 cm, observed on 1992 July 21 and 1995 March 23. Previously discovered bipolar structure is resolved into three distinct peaks. Evolution and proper motion of these peaks has been measured.
Smaller hippocampal volume has often been observed in patients with post-traumatic stress disorder (PTSD). However, there is no consensus whether this is a result of stress/trauma exposure, or constitutes a vulnerability factor for the development of PTSD. Second, it is unclear whether hippocampal volume normalizes with successful treatment of PTSD, or whether a smaller hippocampus is a risk factor for the persistence of PTSD.
Magnetic resonance imaging (MRI) scans and clinical interviews were collected from 47 war veterans with PTSD, 25 healthy war veterans (combat controls) and 25 healthy non-military controls. All veterans were scanned a second time with a 6- to 8-month interval, during which PTSD patients received trauma-focused therapy. Based on post-treatment PTSD symptoms, patients were divided into a PTSD group who was in remission (n = 22) and a group in whom PTSD symptoms persisted (n = 22). MRI data were analysed with Freesurfer.
Smaller left hippocampal volume was observed in PTSD patients compared with both control groups. Hippocampal volume of the combat controls did not differ from healthy controls. Second, pre- and post-treatment analyses of the PTSD patients and combat controls revealed reduced (left) hippocampal volume only in the persistent patients at both time points. Importantly, hippocampal volume did not change with treatment.
Our findings suggest that a smaller (left) hippocampus is not the result of stress/trauma exposure. Furthermore, hippocampal volume does not increase with successful treatment. Instead, we demonstrate for the first time that a smaller (left) hippocampus constitutes a risk factor for the persistence of PTSD.
Post-traumatic stress disorder (PTSD) is thought to be characterized by general heightened amygdala activation. However, this hypothesis is mainly based on specific studies presenting fear or trauma-related stimuli, hence, a thorough investigation of trauma-unrelated emotional processing in PTSD is needed.
In this study, 31 male medication-naive veterans with PTSD, 28 male control veterans (combat controls; CC) and 25 non-military men (healthy controls; HC) were included. Participants underwent functional MRI while trauma-unrelated neutral, negative and positive emotional pictures were presented. In addition to the group analyses, PTSD patients with and without major depressive disorder (MDD) were compared.
All groups showed an increased amygdala response to negative and positive contrasts, but amygdala activation did not differ between groups. However, a heightened dorsal anterior cingulate cortex (dACC) response for negative contrasts was observed in PTSD patients compared to HC. The medial superior frontal gyrus was deactivated in the negative contrast in HC, but not in veterans. PTSD+MDD patients showed decreased subgenual ACC (sgACC) activation to all pictures compared to PTSD–MDD.
Our findings do not support the hypothesis that increased amygdala activation in PTSD generalizes to trauma-unrelated emotional processing. Instead, the increased dACC response found in PTSD patients implicates an attentional bias that extends to trauma-unrelated negative stimuli. Only HC showed decreased medial superior frontal gyrus activation. Finally, decreased sgACC activation was related to MDD status within the PTSD group.
The effect of prenatal distress on the risk of a small for gestational age (SGA) infant is uncertain. We have addressed the influences of prenatal stress, anxiety and depression on the risk of SGA. We also examined the effects of infant sex and timing of distress during pregnancy on any observed associations.
The study population comprised 5606 healthy nulliparous pregnant women who participated in the international prospective Screening for Obstetric and Pregnancy Endpoints (SCOPE) study. Women completed the Perceived Stress Scale (PSS), the short form of the Spielberger State–Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at 15 ± 1 and 20 ± 1 weeks' gestation. SGA was defined as birthweight below the 10th customized percentile. Logistic regression was used for data analysis, adjusting for several potential confounders such as maternal age, body mass index (BMI), smoking, socio-economic status and physical exercise.
The risk of SGA was increased in relation to mild [adjusted odds ratio (aOR) 1.35, 95% confidence interval (CI) 1.07–1.71], moderate (aOR 1.26, 95% CI 1.06–1.49), high (aOR 1.45, 95% CI 1.08–1.95) and very high stress scores (aOR 1.56, 95% CI 1.03–2.37); very high anxiety score (aOR 1.45, 95% CI 1.13–1.86); and very high depression score (aOR 1.14, 95% CI 1.05–1.24) at 20 ± 1 weeks' gestation. Sensitivity analyses showed that very high anxiety and very high depression increases the risk of SGA in males but not in females whereas stress increases the risk of SGA in both males and females.
These findings suggest that prenatal stress, anxiety and depression measured at 20 weeks' gestation increase the risk of SGA. The effects of maternal anxiety and depression on SGA were strongest in male infants.
Resting-state functional magnetic resonance imaging (fMRI) can be used to measure correlations in spontaneous low-frequency fluctuations in the blood oxygen level-dependent (BOLD) signal which represent functional connectivity between key brain areas.
To investigate functional connectivity with regions hypothesised to be differentially affected in dementia with Lewy bodies (DLB) compared with Alzheimer's disease and controls.
Fifteen participants with probable DLB, 16 with probable Alzheimer's disease and 16 controls were scanned in the resting-state using a 3T scanner. The BOLD signal time-series of fluctuations in seed regions were correlated with all other voxels to measure functional connectivity.
Participants with DLB and Alzheimer's disease showed greater caudate and thalamic connectivity compared with controls. Those with DLB showed greater putamen connectivity compared with those with Alzheimer's disease and the controls. No regions showed less connectivity in DLB or Alzheimer's disease v. controls, or in DLB v. Alzheimer's disease.
Altered connectivity in DLB and Alzheimer's disease provides new insights into the neurobiology of these disorders and may aid in earlier diagnosis.
We sought to determine whether the introduction of a health screening and promotion clinic might serve as a useful addition to existing services for patients prescribed antipsychotic medication. In particular, we wished to assess whether such a clinic might improve adherence to best practice guidelines. We also wished to determine the level of patient interest in such a clinic and how readily this service might be provided within the constraints of existing clinical resources.
We conducted an audit of outpatient records before and following the introduction of a health screening and promotion clinic.
Of the eligible patients, 73% attended the clinic. The proportion of patients who had fasting blood tests within the previous 12 months increased from 45% at baseline to 85% at follow-up (χ2 = 14.1, p < 0.001). The proportion of patients with appropriate physical observations completed increased from 5% at baseline to 80% at follow-up (χ2 = 46.0, p < 0.001).
We found that the introduction of a health screening and promotion clinic improved adherence to best practice guidelines. This service was well received and readily provided within the constraints of existing resources. Ultimately, the structure of services to screen and advise patients prescribed antipsychotic medication will be determined by local resource considerations and configuration of services.