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Children with congenital heart disease (CHD) require lifelong cardiology follow-up. Many experience gaps in care around the age of transition to adult-oriented care with associated comorbidity. We describe the impact of a clinic-based intervention on follow-up rates in this high-risk population.
Patients ≥11 years seen in a paediatric outpatient CHD Transition Clinic completed self-assessment questionnaires, underwent focused teaching, and were followed on a clinic registry with assessment of care continuation. The cohort “lost to follow-up” rate, defined as absence from care at least 6 months beyond the recommended timeframe, was compared with a control group. Secondary outcomes included questionnaire scores and adult cardiology referral trends.
Over 26 months, 53 participants completed an initial Transition Clinic visit; 43% (23/53) underwent a second visit. Median participant age was 18.0 years (interquartile range 16.0, 22.0). The cohort’s “lost to follow-up” rate was 7.3%, which was significantly lower than the control rate (25.9%, p < 0.01). Multivariable regression analyses demonstrated clinic participation as the only factor independently associated with follow-up rates (p = 0.048). Transition readiness was associated with older age (p = 0.01) but not sex, univentricular heart, interventional history, or surgical complexity. One-third of adult participants transferred to adult care.
A CHD Transition Clinic intervention can improve follow-up rates in adolescents and young adults. Age is an important factor in transition readiness, and retention of adults in paediatric care appears multi-factorial. We postulate that serial assessments of self-management, focused education, and registry utilisation may improve patient outcomes by reducing lapses in care.
We describe an algorithm that can fit the properties of the dwarf galaxy progenitor of a tidal stream, given the properties of that stream. We show that under ideal conditions (the Milky Way potential, the orbit of the dwarf galaxy progenitor, and the functional form of the dwarf galaxy progenitor are known exactly), the density and angular width of stars along the stream can be used to constrain the mass and radial profile of both the stellar and dark matter components of the progenitor dwarf galaxy that was ripped apart to create the stream. Our provisional fit for the parameters of the dwarf galaxy progenitor of the Orphan Stream indicates that it is less massive and has fewer stars than previous works have indicated.
Although researchers have described numerous risk factors for salmonellosis and for infection with specific common serotypes, the drivers of Salmonella serotype diversity among human populations remain poorly understood. In this retrospective observational study, we partition records of serotyped non-typhoidal Salmonella isolates from human clinical specimens reported to CDC national surveillance by demographic, geographic and seasonal characteristics and adapt sample-based rarefaction methods from the field of community ecology to study how Salmonella serotype diversity varied within and among these populations in the USA during 1996–2016. We observed substantially higher serotype richness in children <2 years old than in older children and adults and steadily increasing richness with age among older adults. Whereas seasonal and regional variation in serotype diversity was highest among infants and young children, variation by specimen source was highest in adults. Our findings suggest that the risk for infection from uncommon serotypes is associated with host and environmental factors, particularly among infants, young children and older adults. These populations may have a higher proportion of illness acquired through environmental transmission pathways than published source attribution models estimate.
Sepsis – syndrome of infection complicated by organ dysfunction – is responsible for over 750 000 hospitalisations and 200 000 deaths in the USA annually. Despite potential nutritional benefits, the association of diet and sepsis is unknown. Therefore, we sought to determine the association between adherence to a Mediterranean-style diet (Med-style diet) and long-term risk of sepsis in the REasons for Geographic Differences in Stroke (REGARDS) cohort. We analysed data from REGARDS, a population-based cohort of 30 239 community-dwelling adults age ≥45 years. We determined dietary patterns from a baseline FFQ. We defined Med-style diet as a high consumption of fruit, vegetables, legumes, fish, cereal and low consumption of meat, dairy products, fat and alcohol categorising participants into Med-style diet tertiles (low: 0–3, moderate: 4–5, high: 6–9). We defined sepsis events as hospital admission for serious infection and at least two systematic inflammatory response syndrome criteria. We used Cox proportional hazard models to determine the association between Med-style diet tertiles and first sepsis events, adjusting for socio-demographics, lifestyle factors, and co-morbidities. We included 21 256 participants with complete dietary data. Dietary patterns were: low Med-style diet 32·0 %, moderate Med-style diet 42·1 % and high Med-style diet 26·0 %. There were 1109 (5·2 %) first sepsis events. High Med-style diet was independently associated with sepsis risk; low Med-style diet referent, moderate Med-style diet adjusted hazard ratio (HR) 0·93 (95 % CI 0·81, 1·08), high Med-style diet adjusted HR=0·74 (95 % CI 0·61, 0·88). High Med-style diet adherence is associated with lower risk of sepsis. Dietary modification may potentially provide an option for reducing sepsis risk.
To understand caregivers’ perceptions of children’s linear growth and to identify the cultural meanings and perceptions of risk associated with poor height attainment.
Three investigators from Bangladesh conducted twelve focus group discussions.
The study was conducted in rural and slum settings in Bangladesh.
Participants included mothers and alternative caregivers (n 81) who were recruited by household screening. No eligible, recruited subjects refused participation.
Caregivers reported limited experience with growth monitoring services from the health system. Caregivers mainly use visual cues and developmental milestones to understand if children are growing properly, and recognize that children normally experience both weight gain and linear growth with age. Mothers expressed concern over children’s malnutrition and short stature, but did not discuss children’s failure to attain a ‘growth potential’ or distinguish inherited short stature from stunting. Caregivers interpret the consequences of poor height attainment as primarily social and economic and cite few health risks.
Linear growth interpretation is determined more by community norms than by guidance from nutrition programming or the health system. Interventions to prevent or reduce linear growth failure may be perceived to have limited value where appropriate linear growth in children is determined by comparison to peers and siblings. Such perceptions may be significant barriers to programmes addressing stunting prevention in settings where many children are stunted. Efforts to raise awareness about the risks of linear growth faltering may need to consider delivering messages to caregivers that emphasize the social and economic consequences of stunting.
Spilonota ocellana (Denis and Schiffermüller) (Lepidoptera: Tortricidae) can be a serious pest of organic apples (Malus domestica Borkhausen (Rosaceae)) in British Columbia, Canada. Recent discovery that S. ocellana moths are attracted by a lure combining acetic acid (AA) and benzyl nitrile (BN), identified as a caterpillar-induced apple leaf volatile, provides an opportunity to develop bisexual mass-trapping or monitoring systems. Sticky white delta traps baited with benzyl nitrile (10 mg/red rubber septum) and an acetic-acid co-lure (3 mL AA/3-mm open 8-mL vial) caught significantly more moths than either component alone. Acetic-acid co-lures were weakly attractive but benzyl-nitrile-loaded septa were not attractive. Moth catches with AA+BN lures were unaffected by the size and type of rubber septum used to release benzyl nitrile, but catches increased with increasing loads of benzyl nitrile. Male and total moth catches were maximised using membrane release devices loaded with a mixture of benzyl nitrile and a second caterpillar-induced volatile, 2-phenylethanol (PET), in combination with an acetic-acid co-lure (AA+BN-PET). Female catches with AA+BN-PET and AA+BN lures were equivalent. Placing AA+BN lures in traps baited with female sex pheromone lures reduced male catches, but female catches were unchanged. When sticky liners were replaced weekly, white delta traps baited with AA+BN lures caught more moths than similarly baited white Multipher®-I bucket traps, or transparent UnitrapsTM. Multipher-I traps with a propylene glycol killing agent (250 mL) caught more moths than those with Vapona insecticide strips. In apple orchards treated with mating disruption sex pheromones, traps baited with AA+BN caught slightly more total moths than traps baited with sex pheromone. Weekly, total male+female moth catches with either AA+BN or sex pheromone lures showed similar seasonal patterns in both untreated and pheromone-disrupted orchards, respectively. Long-lasting release devices and an organic killing agent are needed to develop certified organic mass-trapping technologies for management of S. ocellana with the AA+BN kairomone.
Pandemis limitata (Robinson) (Lepidoptera: Tortricidae) is one of several leaf-feeding caterpillar pests of commercial tree-fruit crops in British Columbia, Canada. Recent discovery that European Pandemis Hübner species are attracted by lures combining acetic acid and the caterpillar-induced apple-leaf volatiles, 2-phenylethanol, and phenylacetonitrile, prompted our examination of P. limitata response to these compounds. Trapping tests in organic apple orchards revealed that neither of these individual benzenoids, nor their binary combination, was attractive. Acetic acid alone was weakly attractive, but more importantly, catches increased significantly when an acetic-acid co-lure was combined with 2-phenylethanol or phenylacetonitrile, individually and together. Catches of male and female P. limitata with acetic acid+2-phenylethanol, or acetic acid+2-phenylethanol+phenylacetonitrile were similar, respectively, and both sexes were caught significantly less often in traps baited with acetic acid+phenylacetonitrile. When combined with acetic-acid co-lures, traps baited with membrane dispensers releasing 2-phenylethanol at ~1 mg/day caught significantly more moths than traps baited with rubber septa lures releasing 2-phenylethanol at ~0.6 mg/day. Moth catches in traps baited with 2-phenylethanol were unaffected when the emission of acetic-acid co-lures was increased from ~28 to 63 mg/day. Catches of male P. limitata in traps baited with sex pheromone were significantly greater than catches in traps baited with acetic acid+2-phenylethanol, or traps baited with a ternary blend of acetic acid+2-phenylethanol+sex pheromone. Catches of female P. limitata in traps baited with acetic acid+2-phenylethanol were significantly reduced when it was combined with sex pheromone. Use of the ternary acetic acid+2-phenylethanol+phenylacetonitrile blend provides an opportunity to develop multispecies bisexual trapping systems to improve management of sympatric tortricid pests currently causing economic losses in organic apples in British Columbia. More work on long-lasting release devices, nonsaturating traps, and organically acceptable killing agents are needed to develop organic mass-trapping systems.
Identifying factors that contribute to the preservation of cognitive function is imperative to maintaining quality of life in advanced years. Of modifiable risk factors, diet quality has emerged as a promising candidate to make an impact on cognition. The objective of this study was to evaluate associations between empirically derived dietary patterns and cognitive function. This study included 18 080 black and white participants aged 45 years and older from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Principal component analysis on data from the Block98 FFQ yielded five dietary patterns: convenience, plant-based, sweets/fats, Southern, and alcohol/salads. Incident cognitive impairment was defined as shifting from intact cognitive status (score >4) at first assessment to impaired cognitive status (score ≤4) at latest assessment, measured by the Six-Item Screener. Learning, memory and executive function were evaluated with the Word List Learning, Word List Delayed Recall, and animal fluency assessments. In fully adjusted models, greater consumption of the alcohol/salads pattern was associated with lower odds of incident cognitive impairment (highest quintile (Q5) v. lowest quintile (Q1): OR 0·68; 95 % CI 0·56, 0·84; P for trend 0·0005). Greater consumption of the alcohol/salads pattern was associated with higher scores on all domain-specific assessments and greater consumption of the plant-based pattern was associated with higher scores in learning and memory. Greater consumption of the Southern pattern was associated with lower scores on each domain-specific assessment (all P < 0·05). In conclusion, dietary patterns including plant-based foods and alcohol intake were associated with higher cognitive scores, and a pattern including fried food and processed meat typical of a Southern diet was associated with lower scores.
The objective of the present study was to examine the relationship of dietary fried fish consumption and risk of cardiovascular events and all-cause mortality.
Prospective cohort study among participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who resided in the USA.
The primary outcome measures included the hazard ratios (HR) of incident CVD including first incident fatal or non-fatal ischaemic stroke or myocardial infarction and all-cause mortality, based on cumulative average fish consumption ascertained at baseline.
Participants (n 16 479) were enrolled between 2003 and 2007, completed the self-administered Block98 FFQ and were free of CVD at baseline.
There were 700 cardiovascular events over a mean follow-up of 5·1 years. After adjustment for sociodemographic variables, health behaviours and other CVD risk factors, participants eating ≥2 servings fried fish/week (v. <1 serving/month) were at a significantly increased risk of cardiovascular events (HR=1·63; 95 % CI 1·11, 2·40). Intake of non-fried fish was not associated with risk of incident CVD. There was no association found with dietary fried or non-fried fish intake and cardiovascular or all-cause mortality.
Fried fish intake of two or more servings per week is associated with an increased risk of cardiovascular events. Given the increased intake of fried fish in the stroke belt and among African Americans, these data suggest that dietary fried fish intake may contribute to geographic and racial disparities in CVD.
The turkey (Meleagris gallopavo) was independently domesticated in Mesoamerica and the Southwest, the latter as the only case of Native American animal domestication north of Mexico. In the upland (non-desert) portion of the American Southwest, distinctive closely related mtDNA lineages belonging to haplogroup H1 (thought to indicate domestication) occur from ca. 1 A.D. (Basketmaker II period) through early historic times. At many sites, low frequencies of lineages belonging to haplogroup H2 also occur, apparently derived from the local Merriam’s subspecies. We report genetic, stable isotope, and coprolite data from turkey remains recovered at three early sites in SE Utah and SW Colorado dating to the Basketmaker II, III, and early Pueblo II periods. Evidence from these and other early sites indicates that both the H1 and H2 turkeys had a predominantly maize-based diet similar to that of humans; prior to late Pueblo II times, the birds were kept primarily to provide feathers for blankets and ritual uses; and ritualized burials indicate turkeys’ symbolic value. We argue that viewing individuals from the H1 and H2 haplogroups as “domestic” versus “wild” is an oversimplification.
Socio-economic status (SES) has been associated with measures of diet quality; however, such measures have not directly captured overall eating practices in individuals. Based on the factor analysis of fifty-six food groups from FFQ, associations between patterns of food consumption and SES were examined in a nationwide sample of 17 062 black (34·6 %) and white participants (age >45 years) from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Logistic regression models adjusted for age, sex, racial group and geographic region were used to examine adherence to five emergent dietary patterns (convenience, plant-based, sweets/fats, southern and alcohol/salads) according to four levels each of individual education, household income and community-level SES. Further models assessed adherence to these dietary patterns by racial group, and an overall model including both racial groups examined whether the relationships between SES and adherence to these dietary patterns differed among black and white participants. For all the three measures of SES, higher SES had been associated with greater adherence to plant-based and alcohol/salads patterns, but lower adherence to sweets/fats and southern patterns. Statistically significant differences between black and white participants were observed in the associations between household income and adherence to alcohol/salads, individual education and adherence to plant-based and sweets/fats, and community SES and adherence to convenience patterns. As adherence to dietary patterns has been shown to be associated with health outcomes in this population (e.g. stroke), the present study offers valuable insight into behavioural and environmental factors that may contribute to health disparities in the diverse US population.
We present the results of an approximately 6 100 deg2 104–196 MHz radio sky survey performed with the Murchison Widefield Array during instrument commissioning between 2012 September and 2012 December: the MWACS. The data were taken as meridian drift scans with two different 32-antenna sub-arrays that were available during the commissioning period. The survey covers approximately 20.5 h < RA < 8.5 h, − 58° < Dec < −14°over three frequency bands centred on 119, 150 and 180 MHz, with image resolutions of 6–3 arcmin. The catalogue has 3 arcmin angular resolution and a typical noise level of 40 mJy beam− 1, with reduced sensitivity near the field boundaries and bright sources. We describe the data reduction strategy, based upon mosaicked snapshots, flux density calibration, and source-finding method. We present a catalogue of flux density and spectral index measurements for 14 110 sources, extracted from the mosaic, 1 247 of which are sub-components of complexes of sources.
This indispensable sourcebook covers conceptual and practical issues in research design in the field of social and personality psychology. Key experts address specific methods and areas of research, contributing to a comprehensive overview of contemporary practice. This updated and expanded second edition offers current commentary on social and personality psychology, reflecting the rapid development of this dynamic area of research over the past decade. With the help of this up-to-date text, both seasoned and beginning social psychologists will be able to explore the various tools and methods available to them in their research as they craft experiments and imagine new methodological possibilities.