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Clinical Enterobacteriacae isolates with a colistin minimum inhibitory concentration (MIC) ≥4 mg/L from a United States hospital were screened for the mcr-1 gene using real-time polymerase chain reaction (RT-PCR) and confirmed by whole-genome sequencing. Four colistin-resistant Escherichia coli isolates contained mcr-1. Two isolates belonged to the same sequence type (ST-632). All subjects had prior international travel and antimicrobial exposure.
Evidence on long-term influences of maternal vitamin B12 deficiency or concentrations on infant cognition is limited. We examined associations between maternal plasma vitamin B12 and cognitive development in 24-month-old infants. Maternal plasma vitamin B12 concentrations were measured at 26–28 weeks’ gestation; infant cognitive development was assessed with the Bayley Scales of Infant and Toddler Development-III at 24 months, for 443 mother–infant pairs from the Growing Up in Singapore Towards Healthy Outcomes cohort. Linear regressions adjusted for key confounders examined associations of maternal vitamin B12 with cognitive, receptive and expressive language, fine and gross motor subscales. Co-occurrence of maternal vitamin B12 with folate or vitamin B6 insufficiencies on child’s cognition was explored. Average maternal plasma vitamin B12 concentrations was 220·5 ± 80·5 pmol/l; 15 % and 41 % of mothers were vitamin B12 deficient (<148 pmol/l) and insufficient (148–220·9 pmol/l), respectively. Infants of mothers with vitamin B12 deficiency had 0·42 (95 % CI −0·70, −0·14) sd lower cognitive scores, compared with infants of mothers with sufficient vitamin B12. Co-occurrence of maternal vitamins B12 and B6 insufficiencies was associated with 0·37 (95 % CI −0·69, −0·06) sd lower cognitive scores in infants compared with infants of mothers sufficient in both vitamins. No significant associations were observed with other subscales. Study findings suggest the possible need to ensure adequate vitamin B12 during pregnancy. The impact of co-occurrence of maternal B-vitamins insufficiencies on early cognitive development warrants further investigation.
Speleothem organic matter can be a powerful tracer for past environmental conditions and karst processes. Carbon isotope measurements (δ13C and 14C) in particular can provide crucial information on the provenance and age of speleothem organic matter, but are challenging due to low concentrations of organic matter in stalagmites. Here, we present a method development study on extraction and isotopic characterization of speleothem organic matter using a rapid procedure with low laboratory contamination risk. An extensive blank assessment allowed us to quantify possible sources of contamination through the entire method. Although blank contamination is consistently low (1.7 ± 0.34 – 4.3 ± 0.86 μg C for the entire procedure), incomplete sample decarbonation poses a still unresolved problem of the method, but can be detected when considering both δ13C and 14C values. We test the method on five stalagmites, showing reproducible results on samples as small as 7 μg C for δ13C and 20 μg C for 14C. Furthermore, we find consistently lower non-purgeable organic carbon (NPOC) 14C values compared to the carbonate 14C over the bomb spike interval in two stalagmites from Yok Balum Cave, Belize, suggesting overprint of a pre-aged or even fossil source of carbon on the organic fraction incorporated by these stalagmites.
Dietary intake of toddlers has been of growing interest due to its long-term consequences on health. However, previous works have focused largely on Caucasian populations and less is known about Asian toddlers. We aimed to validate a semi-quantitative FFQ designed to assess dietary intakes of 18-month-old toddlers in a multi-ethnic Asian cohort.
An FFQ of ninety-four food items, identified based on food records of 12-month-old GUSTO children, the Southampton Women’s Survey 12 Month Infancy Questionnaire and inputs from paediatric dietitians, was filled out two weeks before the 18th-month clinic visit. As the reference method, two non-consecutive 24 h recalls (24HR) were administered during and two weeks after the clinic visit. FFQ nutrient intakes were validated against averaged 24HR nutrient intakes, using the Wilcoxon signed-rank test, Spearman’s rank-order correlation, cross-classification and the Bland–Altman method.
Data from the Singapore Growing Up in Singapore Towards Healthy Outcomes (GUSTO) mother–offspring birth cohort.
Toddlers (n 188) aged 18 months.
Absolute nutrient intakes from the FFQ were significantly higher than from the 24HR, except for vitamin A. After energy adjustments, r range was 0·56–0·78 (macronutrients) and 0·40–0·54 (micronutrients). De-attenuation increased r to 0·58–0·96 and 0·45–0·65 for macro- and micronutrients, respectively. Of participants, ≥82·4 % (macronutrients) and ≥77·7 % (micronutrients) were classified in the same and adjacent quartiles. No clear systematic increase in intake differences with increasing mean intake was observed in Bland–Altman plots.
This FFQ can provide a satisfactory assessment of toddlers’ energy-adjusted nutrient intakes, as well as accurately rank them in a group.
Chemical separation techniques with their roots in classical analysis have been highly developed since the turn of the century. During the last two decades, X-ray spectrography has proven to be a very acceptable method of analysis because of the relative ease and rapidity of measurement of the intensity of characteristic wavelengths, the ready knowledge of the precision of the measurement, the facility of automating the analysis, and the nondestructive nature of the method. When chemical separation techniques are combined with X-ray spectrography, the problem of matrix effects is eliminated and the element being analyzed is substantially concentrated, which affords a means of performing trace element analyses. Published examples of preconcentration followed by X-ray measurement both outside and in the field of metallurgy are cited.
OBJECTIVES/SPECIFIC AIMS:.Outline the development and purpose of the partnership brokering database in REDCap. Provide an overview of the tool and how it works. Discuss how this tool facilitates partnership-brokering activities and discuss plans for future use METHODS/STUDY POPULATION: Research Electronic Data Capture (REDCap) is a secure, web-based application developed at Vanderbilt University to assist with systematic data management of small and medium sized projects. CCH utilized REDCap to build a custom data management warehouse entitled the Partnership Brokering Tool. Information compiled in various formats (handwritten notes, spreadsheets, etc.) over the past 10 years by CCH staff, was then systematically organized and entered into the Partnership Brokering Tool. The tool captures information such as individual contact information, organizational affiliation (academic, community, faith, government etc.), research interests (35 categories - asthma, diabetes, heart disease, etc.), communities of foci (children, elderly, LGBTQ, ethnicity, etc.), and target geographic community served (Chicago north, south, suburban, Illinois, etc.). RESULTS/ANTICIPATED RESULTS: Data was compiled on 451 community groups and organizations and 77 partners in academia thus far. Community organizations represent a range of community sectors including advocacy and policy groups, community-based, faith-based organizations, foundations, media, schools, etc. throughout the Chicagoland area. Data analysis activities are underway, however, results will also be shared regarding characteristics of the communities these organizations serve including:. Age range. Special populations (as defined by the CSTI grant). Underrepresented racial and ethnic communities. DISCUSSION/SIGNIFICANCE OF IMPACT: The Partnership Brokering Tool has provided a format for CCH to systematically gather information about the relationships staff have cultivated with community groups and organizations. Unlike an email management system, this REDCap project is highly useful in capturing the parameters of our partner pool, identifying partnership gaps, and matching individuals interested in collaborating with researchers or community organizations that have a particular skill set or research interest. The Partnership Brokering Tool has also facilitated stakeholder engagement dedicated to guiding the centers’ overall goals, objectives, and programming. Finally, utilizing REDCap has streamlined efforts in reporting quantitative and qualitative data about these organizations. In the next phase of this project, CCH will utilize the database to assess the nature of the relationship between CCH and community groups and organizations.
OBJECTIVES/SPECIFIC AIMS: Intensive lifestyle change (e.g., the Diabetes Prevention Program) and metformin reduce type 2 diabetes risk among patients with prediabetes. However, real-world uptake remains low. Shared decision-making (SDM) may increase awareness and help patients select and follow through with informed options for diabetes prevention that are aligned with their preferences.The objective was to test the effectiveness of a prediabetes SDM intervention. METHODS/STUDY POPULATION: This was a cluster-randomized controlled trial in 20 primary care clinics within a large regional health system. Participants were overweight/obese adults with prediabetes (BMI>24 kg/m2 and HbA1c 5.7-6.4%) were enrolled from 10 SDM intervention clinics. Propensity score matching was used to identify control patients from 10 usual care clinics.Intervention clinic patients were invited to participate in a face-to-face SDM visit with a pharmacist who used a decision aid (DA) to describe prediabetes and four possible options for diabetes prevention; DPP, DPP +/− metformin, metformin only, or usual care. RESULTS/ANTICIPATED RESULTS: Uptake of DPP and/or metformin was higher among SDM participants (n=351) than controls receiving usual care (n = 1,028; 38% vs. 2%, p<.001). At 12-months follow-up, adjusted weight loss (lbs.) was greater among SDM participants than controls (−5.3 vs. −0.2, p < .001). DISCUSSION/SIGNIFICANCE OF IMPACT: A prediabetes SDM intervention led by pharmacists increased patient engagement in evidence-based options for diabetes prevention and was associated with significantly greater uptake of DPP and/or metformin at 4-months and weight loss at 12-months. Prediabetes SDM may be a promising approach to enhance prevention efforts among patients at increased risk.
OBJECTIVES/SPECIFIC AIMS: The goals in this project were two-fold:. Develop metrics that assessed community engagement support the center provides, and. Systematically document the fluid and time-intensive nature of providing community engaged research support, as well as key outcomes. METHODS/STUDY POPULATION: The CCH utilized REDCap software in combination with Excel, to create and implement a data collection system to monitor and report on the full spectrum of engagement activities offered by the center. Center staff collaborated in identifying relevant metrics, developing the data collection instruments, and beta-testing instruments with real examples. This facilitated the integration of contextual factors (defined as factors such as the history, size, and diversity of the community, the organizational mission, the structure and size of the CE team, the number of years a university has been supporting community-engaged research work, etc.). Taking a collaborative approach in developing the center’s evaluation plan offered the added benefit of facilitating staff/faculty buy-in, building staff capacity, and engaging the team in understanding concepts related to performance measurement versus management. RESULTS/ANTICIPATED RESULTS: Key benefits of these engagement tracking systems include: consolidating data into a central location, standardizing tracking processes and critical definitions, and supporting more automated reporting systems (e.g., dashboards) that facilitate quality improvement and highlight success stories. Data were compiled and reported via on-line dashboard (REDCap and Tableau) to help center leadership and staff analyze:. Quality improvement issues (How quickly are we responding to a request for support? Are we providing resources that meet the needs of community partners? Academics? Community-academic partnerships?);. Qualitative process analysis (In what research phase are we typically receiving requests for support (e.g. proposal development phase, implementation phase, etc.)? What types of projects are applying for seed grants? After the seed grant ends, are the community-academic partnerships continuing to partner on research activities?);. Outcomes (Are new partnerships stemming from our support? Are supported research projects leading to new policies, practices, programs?). DISCUSSION/SIGNIFICANCE OF IMPACT: There is a gap in the literature regarding meaningful, actionable, and feasible community engaged metrics that capture critical processes and outcomes. This project identified many more relevant metrics and demonstrates that it is worthwhile to take a collaborative, inclusive approach to identifying, tracking, and reporting on key process and outcome metrics in order to convey a more comprehensive picture of community engagement activities and to inform continuous improvement efforts. Community engagement centers across CTSIs offer a similar range of programs and services. At the same time, much of the community-engaged research literature describes metrics related to community-academic grant submissions, funds awarded, and peer-reviewed publications. Experts that work in the arena of providing community engagement support recognize that these metrics are sufficient in understanding the spectrum of engagement opportunities. Community engagement (CE) teams nationally can utilize these metrics in developing their evaluation infrastructure. At the national level, NCATS can utilize the metrics for CE common metrics related to these programs and services. Critical to this process:. Leveraging resources that will facilitate collecting generalizable data (national metrics) while allowing sites to continue collecting nuanced data (local programs and services). Gathering input from CE teams, stakeholders, and researchers to further refine these metrics and data collection methods. Utilizing REDCap, Tableau and other resources that can facilitate data collection and analysis efforts.
Inappropriate antibiotic use is associated with increased antimicrobial resistance and adverse events that can lead to further downstream patient harm. Preventative strategies must be employed to improve antibiotic use while reducing avoidable harm. We use the term “antibiotic never events” to globally recognize and define the most inappropriate antibiotic use.
To examine the association between household food insecurity and dietary diversity in the past 24h (dietary diversity score (DDS, range: 0–9); minimum dietary diversity (MDD, consumption of three or more food groups); consumption of nine separate food groups) among pregnant and lactating women in rural Malawi.
Two rural districts in Central Malawi.
Pregnant (n 589) and lactating (n 641) women.
Of surveyed pregnant and lactating women, 66·7 and 68·6 %, respectively, experienced moderate or severe food insecurity and only 32·4 and 28·1 %, respectively, met MDD. Compared with food-secure pregnant women, those who reported severe food insecurity had a 0·36 lower DDS (P<0·05) and more than threefold higher risk (OR; 95 % CI) of not consuming meat/fish (3·19; CI 1·68, 6·03). The risk of not consuming eggs (3·77; 1·04, 13·7) was higher among moderately food-insecure pregnant women. Compared with food-secure lactating women, those who reported mild, moderate and severe food insecurity showed a 0·36, 0·44 and 0·62 lower DDS, respectively (all P<0·05). The risk of not achieving MDD was higher among moderately (1·95; 1·06, 3·59) and severely (2·82; 1·53, 5·22) food-insecure lactating women. The risk of not consuming meat/fish and eggs increased in a dose–response manner among lactating women experiencing mild (1·75; 1·01, 3·03 and 2·81; 1·09, 7·25), moderate (2·66; 1·47, 4·82 and 3·75; 1·40, 10·0) and severe (5·33; 2·63, 10·8 and 3·47; 1·19, 10·1) food insecurity.
Addressing food insecurity during and after pregnancy needs to be considered when designing nutrition programmes aiming to increase dietary diversity in rural Malawi.
Immigration and its consequences is one of the most contentious issues in the contemporary world, and historians are engaged in this debate by offering a longer-term perspective. In recent years, research on the United Kingdom's population has placed greater emphasis on population movement in shaping Britain's story, identifying waves of migrants from elsewhere alongside migration within Britain. One neglected aspect of this narrative, however, is the migration of Scots to England, particularly in the age of the regal and parliamentary union, when the changing political relationship between the two kingdoms had an impact on the scale, geographic spread, and opportunities and obstacles of that migration. While a minority of Scottish migrants were unwelcome, or chose to return home, the overwhelming weight of evidence is for those migrants who remained in England. The focus in this article is on that majority group for whom migration was a positive experience, thus raising questions about why these Scots were so successful and why they faced so little native opposition. That process of segmented assimilation offers an insight into the formation of Britain and the shifting ground of national identity associated with the emerging British state. The Scots, moreover, provide a model for “successful” migration, suggesting that a range of factors—principally, an educated, culturally malleable, and economically responsive migrant population, alongside an institutionally and attitudinally flexible host community—need to be in place in order to optimize the chances of migrant assimilation.
The quasi-geostrophic dynamo model (QGDM) is a multiscale, fully nonlinear Cartesian dynamo model that is valid in the asymptotic limit of low Rossby number. In the additional limit of small magnetic Prandtl number investigated here, the QGDM is a self-consistent, asymptotically exact form of an
large-scale dynamo. This article explores methods for simulating the multiscale QGDM and investigates how convection is altered by the magnetic field in the planetary regime of small Rossby number and small magnetic Prandtl number. At present, this combination is beyond the reach of direct numerical simulations. We use a simplified class of solutions whose horizontal structure is restricted to a periodic hexagonal lattice characterized by a single horizontal wavenumber (single mode). In contrast with previous kinematic investigations of the QGDM, the Lorentz force is included to study saturated, self-consistent dynamos. Two methodologies are used to assess handling of the multiple time scales of the QGDM: a stiff, common-in-time approach where all time scales are converted to a single time variable and a heterogeneous multiscale modelling approach employing fast time averaging on the Reynolds, magnetic and buoyancy eddy fluxes that feed back onto the slow scales. These strategies produce consistent results and each illustrates self-similar dynamics as the time-averaging window is increased. The properties of the convection are significantly altered by the dynamo-generated magnetic field. All solutions show a decrease in the overall heat transfer efficiency as compared to non-magnetic convection, suggesting that a change in length scale or flow planform plays a critical role in the enhanced heat transfer efficiency observed in previous dynamo studies. All dynamo solutions show a trend of increasing ohmic dissipation relative to viscous dissipation as the buoyancy forcing is increased.
The phase-sensitive radio-echo sounder (pRES) is a powerful new instrument that can measure the depth of internal layers and the glacier bed to millimetre accuracy. We use a stationary 16-antenna pRES array on Store Glacier in West Greenland to measure the three-dimensional orientation of dipping internal reflectors, extending the capabilities of pRES beyond conventional depth sounding. This novel technique portrays the effectiveness of pRES in deriving the orientation of dipping internal layers that may complement profiles obtained through other geophysical surveying methods. Deriving ice vertical strain rates from changes in layer depth as measured by a sequence of pRES observations assumes that the internal reflections come from vertically beneath the antenna. By revealing the orientation of internal reflectors and the potential deviation from nadir of their associated reflections, the use of an antenna array can correct this assumption. While the array configuration was able to resolve the geometry of englacial layers, the same configuration could not be used to accurately image the glacier bed. Here, we use simulations of the performance of different array geometries to identify configurations that can be tailored to study different types of basal geometry for future deployments.
Arachidonic acid (ARA) and DHA, supplied primarily from the mother, are required for early development of the central nervous system. Thus, variations in maternal ARA or DHA status may modify neurocognitive development. We investigated the relationship between maternal ARA and DHA status in early (11·7 weeks) or late (34·5 weeks) pregnancy on neurocognitive function at the age of 4 years or 6–7 years in 724 mother–child pairs from the Southampton Women’s Survey cohort. Plasma phosphatidylcholine fatty acid composition was measured in early and late pregnancy. ARA concentration in early pregnancy predicted 13 % of the variation in ARA concentration in late pregnancy (β=0·36, P<0·001). DHA concentration in early pregnancy predicted 21 % of the variation in DHA concentration in late pregnancy (β=0·46, P<0·001). Children’s cognitive function at the age of 4 years was assessed by the Wechsler Preschool and Primary Scale of Intelligence and at the age of 6–7 years by the Wechsler Abbreviated Scale of Intelligence. Executive function at the age of 6–7 years was assessed using elements of the Cambridge Neuropsychological Test Automated Battery. Neither DHA nor ARA concentrations in early or late pregnancy were associated significantly with neurocognitive function in children at the age of 4 years or the age of 6–7 years. These findings suggest that ARA and DHA status during pregnancy in the range found in this cohort are unlikely to have major influences on neurocognitive function in healthy children.