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The present study used a sheep model of intrauterine growth restriction, combining maternal undernutrition and twinning, to determine possible markers of early damage to the fetal kidney. The occurrence of early deviations in fetal hemodynamics which may be indicative of changes in blood perfusion was assessed by Doppler ultrasonography. A total of 24 sheep divided in two groups were fed with the same standard grain-based diet but fulfilling either their daily maintenance requirements for pregnancy (control group; n=12, six singleton and six twin pregnancies) or only the 50% of such quantity (food-restricted group; n=12; four singleton and eight twin pregnancies). All the fetuses were assessed by both B-mode and Doppler ultrasonography at Day 115 of pregnancy. Fetal blood supply was affected by maternal undernutrition, although there were still no evidences of brain-sparing excepting in fetuses at greatest challenge (twins in underfed pregnancies). However, there were early changes in the blood supply to the kidneys of underfed fetuses and underfed twins evidenced decreases in kidney size.
Over the period 1995–2012, the incidence of invasive meningococcal disease (IMD) caused by Neisseria meningitidis serogroup Y (NmY) increased significantly in Sweden. This is mainly due to the emergence of a predominant cluster named strain type YI subtype 1, belonging to the ST-23 clonal complex (cc). The aim of this study was to examine the clinical picture of patients with invasive disease caused by NmY and to analyse whether the predominant cluster exhibits certain clinical characteristics that might explain the increased incidence. In this retrospective observational study, the medical records available from patients with IMD caused by Nm serogroup Y in Sweden between 1995 and 2012 were systematically reviewed. Patient characteristics, in-hospital findings and outcome were studied and differences between the dominating cluster and other isolates were analysed. Medical records from 175 of 191 patients were retrieved. The median age was 62 years. The all-cause mortality within 30 days of admission was 9% (15/175) in the whole material; 4% (2/54) in the cohort with strain type YI subtype 1 and 11% (12/121) among patients with other isolates. Thirty-three per cent of the patients were diagnosed with meningitis, 19% with pneumonia, 10% with arthritis and 35% were found to have bacteraemia but no apparent organ manifestation. This survey included cases with an aggressive clinical course as well as cases with a relatively mild clinical presentation. There was a trend towards lower mortality and less-severe disease in the cohort with strain type YI subtype 1 compared with the group with other isolates.
Cognitive deficits are considered central and persistent features of schizophrenia and have a significant impact on outcome and quality of life. The computerized interactive remediation of cognition (CIRCuiTS) is a new computerized cognitive remediation program aimed at improving different cognitive domains in patients with schizophrenia. In particular, the program was designed to mainly rehabilitate executive functions, attention and memory by training each cognitive function through several exercises and by improving metacognition.
In the present study, CIRCuiTS was translated and adapted into Italian. The applicability and feasibility of the Italian version was evaluated. Moreover, preliminary data on the effectiveness of the program were investigated.
Four patients with a diagnosis of schizophrenia were recruited for the study. We investigated the changes in neurocognition, psychopathology, self-esteem and functional outcome at the end of the remediation program. The level of satisfaction of operators and participants was evaluated by means of the client satisfaction questionnaire (CSQ).
For each patient, the entire program took place through 2 weekly sessions of 50 minutes for a total duration of 40 sessions.
CIRCuiTS produced an improvement in all domains of neurocognition, disorganization, self-esteem and real-life functioning in the areas “self-care” and “interpersonal relationships”. Moreover, high levels of satisfaction were shown by CSQ for both, operators and participants.
The Italian version of CIRCuiTS demonstrates high levels of acceptability and feasibility for both, patients and clinicians. Additionally, preliminary data suggest that the use of CIRCuiTS provides an improvement on several aspects of the disease.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6–7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 μg/l, and 17·9 % of children showed UI<100 μg/l. The median UI was higher in males (180·8 v. 153·6 μg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.
In old age, both apathy and depression have been associated with an increased cardiovascular disease (CVD) risk. This study evaluated the mediating role of cardiovascular risk factors in the relationship of apathy and mood symptoms with incident CVD.
Prospective cohort study of 1,790 community-dwelling older individuals (70–78 years) without a history of CVD or stroke. At baseline, apathy and mood symptoms were assessed with the 15-item Geriatric Depression Scale (GDS-15), of which three items represent apathy symptoms. The mediational risk factors included were diabetes mellitus (DM), body mass index (BMI), current smoking, physical inactivity, systolic blood pressure, and total cholesterol. Incident CVD was evaluated after two years of follow-up. Data were analyzed using structural equation modeling (SEM).
Incident CVD occurred in 59 (3.3%) participants. Apathy symptoms had a significant estimated total effect on incident CVD, with increases of 2.2% for each unit increase in apathy score. Of this total effect, 22.7% was due to the mediational effects of physical inactivity (13.6%), current smoking (4.5%), and DM (4.5%). The remaining 77.3% was due to direct effects reflecting other mediational dynamics. No significant (in)direct effects of mood symptoms on incident CVD were found.
Physical inactivity, smoking, and DM account for nearly one-fourth of the variation reflecting the link between apathy symptoms and incident CVD. This illustrates the relevance of unfavorable health behaviors and assessment of DM in older individuals with apathy. The majority of the effect of apathy symptoms on incident CVD is caused by other, yet unknown, factors.
The aim of this study was to evaluate the quality of life in patients with vascular chronic Q fever at time of diagnosis and during follow-up. Based upon the SF-36 questionnaire, the mean physical and mental health of each patient were assessed at 3-month intervals for up to 18 months. A total of 26 patients were included in the study. At time of diagnosis, the mean physical health and mental health score was 50·6 [95% confidence interval (CI) 46·7–54·4] and 44·6 (95% CI 41·6–47·5), respectively. During treatment, the mean physical health score declined significantly by 1·7 points each 3 months (P < 0·001) to 40·8 (95% CI 34·4–45·1). The mean mental health score significantly and steadily increased towards 51·2 (95% CI 46·9–54·3) during follow-up (P = 0·026). A total of 23% of patients were cured after 18 months of follow-up. In conclusion, quality of life at time of diagnosis for patients with vascular chronic Q fever is lower compared to a similar group of patients, matched for age and gender, with an aortic abdominal aneurysmal disease, and physical health decreases further after starting treatment. Considering the low percentage of cure, the current treatment of vascular chronic Q fever patients may require a separate strategy from that of endocarditis in order to increase survival.
Systemic low-grade inflammation has repeatedly been associated with depression in old age, but the relationship with apathy is less clear. The present study assessed whether C-reactive protein (CRP) is differentially associated with symptoms of apathy and depression.
A population-based cohort study was carried-out. At baseline and after two and four years of follow-up, CRP levels were assessed and symptoms of apathy and depression were measured using the 15-item Geriatric Depression Scale. Logistic regression analysis was used to investigate the cross-sectional and longitudinal associations of CRP with symptoms of apathy and depression.
Two thousand forty-seven community-dwelling participants (70–78 years) without a history of cardiovascular disease or stroke were studied. A cross-sectional association was found between CRP and apathy symptoms at three time points (odds ratio (OR) per natural log unit increase in CRP: baseline visit = 1.40, 95% CI = 1.12–1.75; two-year follow-up visit = 1.62, 95% CI = 1.17–2.25; four-year follow-up visit = 1.51, 95% CI = 1.03–2.21). This did not change after adjustment for demographics and depressive symptoms, and was slightly attenuated after adjustment for cardiovascular risk factors. No cross-sectional association was found with depressive symptoms. Baseline CRP did not predict incident apathy or depressive symptoms during four years of follow-up.
Increased CRP levels are associated with apathy symptoms but not with depressive symptoms. This suggests a differential effect of inflammation on apathy and depression. In older persons, symptoms of apathy may be a behavioral manifestation of concurrent low-grade inflammation.
Although severe hoarding symptoms have been considered rare among obsessive-compulsive disorder (OCD) samples, the prevalence of animal hoarding in OCD is unknown. To help clarifying this issue, we searched for cases of animal hoarding among patients attending a university OCD clinic (n=420).
Only two patients from our sample exhibited animal hoarding (<0.5%) and only one of them presented additional obsessive-compulsive symptoms. Both cases also collected inanimate objects, presented low insight, exhibited poor response to serotonin reuptake inhibitors and did not adhere to therapy.
There seems to be a lack of relationship between animal hoarding and OCD. However, further studies with larger numbers of patients are needed to better define their psychopathological profile and more appropriate nosological insertion.
In August 2011, one of the earliest cases of influenza A(H3N2) variant [A(H3N2)v] virus infection was hospitalized with severe illness. To investigate the potential for healthcare-associated transmission of influenza A(H3N2)v, we evaluated both healthcare providers and patient contacts of the case. We found that healthcare-associated transmission was unlikely.
In July 2011, a cluster of Yersinia enterocolitica infections was detected in southwestern Pennsylvania, USA. We investigated the outbreak's source and scope in order to prevent further transmission. Twenty-two persons were diagnosed with yersiniosis; 16 of whom reported consuming pasteurized dairy products from dairy A. Pasteurized milk and food samples were collected from this dairy. Y. enterocolitica was isolated from two products. Isolates from both food samples and available clinical isolates from nine dairy A consumers were indistinguishable by pulsed-field gel electrophoresis. Environmental and microbiological investigations were performed at dairy A and pasteurization deficiencies were noted. Because consumption of pasteurized milk is common and outbreaks have the potential to become large, public health interventions such as consumer advisories or closure of the dairy must be implemented quickly to prevent additional cases if epidemiological or laboratory evidence implicates pasteurized milk as the outbreak source.
The massive use of air gaps in tooling, per the Evisto® concept, can confine the heat
contributed by the cast alloy in a small volume. The resulting high die wall temperatures
are turned to account to cast parts having ultra-thin walls, of the order of one
millimetre thick. Effective thermal insulation limits thermal exchanges to slow the
cooling of a cast alloy. The property that best characterizes this effectiveness is the
reciprocal of thermal conductivity, thermal resistance. Air was chosen as the insulating
material because of its many advantages: very favourable thermal conductivity, limited
application cost, and zero purchase cost. Evisto®, an innovative tooling design, has
been used to produce plates 1 mm thick measuring 130 by 200 mm and automobile seat backs
1.2 mm thick measuring 390 by 576 mm. The mechanical properties of the castings so
produced complied with standard EN 1706 of May 2010 for aluminium alloy castings. A patent
application was filed for the Evisto®concept in August 2010.
A questionnaire was sent to 2099 dairy farms to investigate the occurrence of poor milkability. Based on that, the frequency of poor milkability in Swiss dairy cows was 4% and the percentage of cows treated with oxytocin (OT) was 2%. In addition, 270 dairy farms that had reported cases of animals with poor milkability were contacted for an interview to classify the disorders. Farmers suspected disturbed milk ejection in 52%, anatomical dysfunction of the teat and/or the udder in 16% and milk ejection disorder or impaired milkability caused by discernable environmental factors in 32% of the cases. Forty-eight animals from 18 farms with suspected milk ejection disorders were selected for an experimental field study which included milk flow recording and OT administration to induce milk ejection. After cessation of the spontaneous milk flow, a low dose of OT (0·2, 0·5 or 1 i.u.) was injected i.v. to test the responsiveness of the udder to OT at a physiological level. When milk flow ceased again, 10 i.u. OT was injected i.v. (supraphysiological) to ensure complete udder emptying and to determine the residual milk. Milk ejection disorder could be confirmed in 69% of the cases, i.e. if residual milk was >20% of the total milk. Because in 27% of the animals milk ejection disorder was not confirmed on the basis of elevated residual milk, an anatomical disorder of the teat and/or the udder was suspected. Milk ejection disorder could be confirmed in 69% of the cases whereas in 27% of the suspected cases an anatomical disorder of the teat and/or the udder was suspected. An increased cortisol production in cows with milk ejection disorder was not obvious because faecal concentrations of cortisol metabolites with a 5β-androstane-3α,11oxo-structure were not augmented in animals with disturbed milk ejection.
La-doped ZrO2 thin films were grown by O3-based atomic layer deposition on III-V (GaAs, In0.15Ga0.85As) substrates. The direct oxide deposition and the insertion of a Ge passivation layer in between the oxide and the substrate are compared in terms of the resulting density of interface traps. An improved electrical quality of the Ge-passivated interfaces concerning the energy region close to the conduction band edge in the semiconductor band-gap is demonstrated through conductance maps at various temperatures and it is attributed to Ga-related interfacial defects.
Objectives: Recently, we developed a diagnostic rule for the diagnosis and treatment of children with meningeal signs. This rule may provide the physician with a rationale to decide on the use of diagnostic and treatment procedures in these children and to improve their care. In this study, we estimated cost savings of the rule compared with current practice.
Methods: Routine care data of 360 children visiting the emergency department of the Sophia Children's Hospital with meningeal signs between 1988 and 1998 were used. Costs of diagnostic tests and treatment were estimated by using financial accounts of an academic and a general pediatric hospital. The number of procedures actually performed and the resulting cost estimates (i.e. unit costs×volume) were compared with the estimated figures after application of the decision rule.
Results: The population of children with meningeal signs comprised 99 with bacterial meningitis (27%), 36 with another serious bacterial infection (10%), and 225 with a self-limiting disease (63%). Application of the rule would reduce lumbar punctures by 12% and hospitalizations for empirical treatment by 15% with the same diagnostic accuracy as current practice. Cost savings were estimated at €292 per patient (relative reduction 10%) and were mainly achieved in the treatment course (€259).
Conclusions: A diagnostic decision rule for children with meningeal signs has the potential to improve the appropriate use of medical resources, to be cost-effective, and to ascertain the absence of bacterial meningitis earlier.
Objectives: We designed a model of diagnostic and therapeutic interventions applied in children with meningeal signs. Using this model, we determined in a cost-utility analysis the consequences for society of different diagnostic strategies in terms of quality-adjusted life-years (QALYs) and costs.
Methods: Data were used from 360 children (0.1–15 years) visiting the pediatric emergency department of the Sophia Children's Hospital Rotterdam, The Netherlands (1988–98) with meningeal signs. Model inputs included probabilities of meningitis and adverse outcome, QALYs for years lived with long-term sequelae, and costs of tests and treatments. Mean outcome measures were costs and effects of diagnostic and therapeutic interventions in children suspected of bacterial meningitis, key determinants of the model outcomes, and evaluation of alternative diagnostic strategies and two vaccination programs in an analysis.
Results: The population comprised 99 children with bacterial meningitis (adverse outcome in 10), 36 with serious other bacterial infections, and 225 with self-limiting diseases. Key determinants were the risk of bacterial meningitis or sequelae, costs of treatment, and long-term morbidity. Minimizing lumbar punctures and empirical treatments using a diagnostic decision rule, without missing a single case of meningitis, was a dominant strategy to actual practice. Vaccination strategies of Streptococcus pneumoniae and Neisseria meningitidis resulted in our model in incremental cost-utility ratios of 401,965 Euro dollar ()/QALY and 22,635/QALY, respectively.
Conclusions: Costs of long-term morbidity of bacterial meningitis largely outweigh diagnostic and treatment costs. Modeling interventions in children at risk of bacterial meningitis should include long-term consequences in terms of costs and QALYs.
The effects of body condition score (BCS) of 2·0 or 3·0 units at calving (low v. moderate), post-partum energy intake at 0·6 or 1·0 MJ metabolizable energy (ME) per day per kg M0·75 (low v. high) and unrestricted or restricted (once daily) suckling on the ability of cows to ovulate were studied in a 2 ✕ 2 ✕ 2 factorial design with each treatment replicated eight times. Calf isolation and restricted suckling were imposed shortly after selection of the first dominant follicle (DF) to emerge after day 21 post partum. The episodic release of LH (sampled at 15-min intervals for 10 h) was determined 48 h before and 48 h after the day calf isolation and restricted suckling commenced. Additional blood samples were collected weekly for plasma insulin determination. The mean interval from calving to first ovulation was shorter for cows in moderate than low BCS at calving (47·8 v. 57·1 days, s.e.d. = 4·50, P < 0·05), and for cows suckling once daily than for those with unrestricted suckling (42·9 v. 62·0 days, s.e.d. = 4·50, P < 0·001). Post-partum nutrition did not affect this interval. Mean LH pulse frequency prior to the start of restricted suckling was higher for cows of moderate than low BCS at calving (3·2 v. 1·6 pulses per 10 h, s.e.d. = 0·60, P < 0·05). Subsequently, LH pulse frequency was higher for cows suckling once daily than for those with unrestricted suckling (4·0 v. 2·2 pulses per 10 h, s.e.d. = 0·82, P < 0·05). More cows in moderate than low BCS ovulated the first DF to emerge after day 21 post partum (within 4 to 6 days) in response to restricted suckling (69 v. 25%, P < 0·05). LH pulse frequency prior to restricted suckling increased (P < 0·05) with plasma insulin concentration (categorized as low, < 5; moderate, 5 to 8; and high, >8 mIU per l). There were indications of interactions between suckling treatment and BCS (P < 0·08), and suckling treatment and plasma insulin concentration (P < 0·06), on LH pulse frequency, which suggested that calf restriction could alleviate the suppressive effects of under nutrition on episodic LH release. Amongst cows suckling once daily, the non-ovulating animals had fewer LH pulses prior to restricted suckling and smaller, slower growing DF, indicating an inability of the DF to respond to increased LH pulse frequency following calf restriction. Cows of moderate BCS, particularly those with moderate to high levels of plasma insulin (³ 5 mIU per l), responded favourably to restricted suckling. In contrast, excessively thin cows with low plasma insulin concentrations (<5 mIU per l), that had most to gain from restricted suckling, responded poorly.
As an indicator of cortical excitability, direct
current (DC) potentials were recorded from thirsted subjects
before, during and after drinking 400 ml of water. Self-rated
thirst was distinctly reduced after drinking. Compared
with control conditions in which the subjects remained
thirsty, during drinking a widespread negative potential
shift occurred averaging over −70 μV at Cz. At
the transition from the consumatory phase to the postconsumption
phase, a slow positive potential shift commenced that was
most pronounced over the anterior cortex (averaging over
+40 μV at Fz) and persisted for more than 3 min after
drinking. Control conditions excluded muscle activity,
ocular movements, and changes in body fluid and serum osmolality
as possible non-neuronal sources of the DC-potential changes.
The sequence of negative and positive potential shifts
associated with drinking indicates a coordinate regulation
of cortical excitability that may facilitate consumatory
behavior and its context-dependent encoding into memory.
We examined the incidence rate and prognosis of tuberculosis in a cohort of patients with liver
cirrhosis in Denmark. In a study cohort of 22675 patients with liver cirrhosis, we identified 151
cases of tuberculosis from 1977 to 1993. The incidence rate was 168·6 per 100000 person-years
of risk, and the highest incidence rate was among men above 65 years of age, with an
incidence rate of 246·0 per 100000 person-years of risk. The 30-day case-fatality rate was
27·3% and the 1-year case fatality rate was 47·7%. The results demonstrate that patients with
liver cirrhosis are at increased risk of tuberculosis. Additionally, it is suggested that liver
cirrhosis is an independent risk factor for tuberculosis, and that patients with liver cirrhosis
who acquire tuberculosis have a poor prognosis.
We are concerned with positive solutions decaying at infinity for a class of semilinear elliptic equations in all of RN having superlinear subcritical nonlinearity. The corresponding variational problem lacks compactness because of the unboundedness of the domain and, in particular, it cannot be solved by minimization methods. However, we prove the existence of a positive solution, corresponding to a higher critical value of the related functional, under a suitable fast decay condition on the coefficient of the linear term. Moreover, we analyse the behaviour of the solution as this coefficient goes to infinity and show that the solution tends to split as the sum of two positive functions sliding to infinity in opposite directions. Finally, we use this property to prove the existence of at least 2k − 1 distinct positive solutions, when this coefficient splits as the sum of k bumps sufficiently far apart.