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Healthcare personnel (HCP) were recruited to provide serum samples, which were tested for antibodies against Ebola or Lassa virus to evaluate for asymptomatic seroconversion.
From 2014 to 2016, 4 patients with Ebola virus disease (EVD) and 1 patient with Lassa fever (LF) were treated in the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital. Strict infection control and clinical biosafety practices were implemented to prevent nosocomial transmission of EVD or LF to HCP.
All personnel who entered the SCDU who were required to measure their temperatures and complete a symptom questionnaire twice daily were eligible.
No employee developed symptomatic EVD or LF. EVD and LF antibody studies were performed on sera samples from 42 HCP. The 6 participants who had received investigational vaccination with a chimpanzee adenovirus type 3 vectored Ebola glycoprotein vaccine had high antibody titers to Ebola glycoprotein, but none had a response to Ebola nucleoprotein or VP40, or a response to LF antigens.
Patients infected with filoviruses and arenaviruses can be managed successfully without causing occupation-related symptomatic or asymptomatic infections. Meticulous attention to infection control and clinical biosafety practices by highly motivated, trained staff is critical to the safe care of patients with an infection from a special pathogen.
Nutrient profiling (NP) is a method for evaluating the healthfulness of foods. Although many NP models exist, most have not been validated. This study aimed to examine the content and construct/convergent validity of five models from different regions: Australia/New Zealand (FSANZ), France (Nutri-Score), Canada (HCST), Europe (EURO) and Americas (PAHO). Using data from the 2013 UofT Food Label Information Program (n15342 foods/beverages), construct/convergent validity was assessed by comparing the classifications of foods determined by each model to a previously validated model, which served as the reference (Ofcom). The parameters assessed included associations (Cochran–Armitage trend test), agreement (κ statistic) and discordant classifications (McNemar’s test). Analyses were conducted across all foods and by food category. On the basis of the nutrients/components considered by each model, all models exhibited moderate content validity. Although positive associations were observed between each model and Ofcom (all Ptrend<0·001), agreement with Ofcom was ‘near perfect’ for FSANZ (κ=0·89) and Nutri-Score (κ=0·83), ‘moderate’ for EURO (κ=0·54) and ‘fair’ for PAHO (κ=0·28) and HCST (κ=0·26). There were discordant classifications with Ofcom for 5·3 % (FSANZ), 8·3 % (Nutri-Score), 22·0 % (EURO), 33·4 % (PAHO) and 37·0 % (HCST) of foods (all P<0·001). Construct/convergent validity was confirmed between FSANZ and Nutri-Score v. Ofcom, and to a lesser extent between EURO v. Ofcom. Numerous incongruencies with Ofcom were identified for HCST and PAHO, which highlights the importance of examining classifications across food categories, the level at which differences between models become apparent. These results may be informative for regulators seeking to adapt and validate existing models for use in country-specific applications.
This mixed-method national survey has obtained original data on attention deficit hyperactivity disorder (ADHD) attitudes, assessment and treatment regimes reported by paediatricians and child psychiatrists; and has compared their clinics. It has examined the extent of involvement of Irish paediatricians in the management of ADHD.
A questionnaire was designed, based on a review of literature and ADHD guidelines, and piloted by expert clinicians. Universal recruitment was conducted among Child and Adolescent Mental Health Services (CAMHS) consultants (n=71) and community/general paediatric consultants (n=72). Quantitative and qualitative data was collected and analysed.
There was an overall response rate of 43%. A dedicated ADHD clinic is offered in 79% of CAMHS services, but only in one paediatric service. Participants reported that the assessment of ADHD involves multidisciplinary work and this was only established in CAMHS clinics. Medication is initiated by 82% of child psychiatrists and only 22% of paediatricians.
This first national study of ADHD attitudes and practices presents comprehensive data regarding the management of children with ADHD in CAMHS and paediatric settings in Ireland. Paediatricians reported a minor role in managing ADHD. Study limitations are related to subjective reporting rather than case note audit, and a moderate response rate for the paediatricians’ participants.
Objectives: We sought to clarify the nature of self-reported cognitive function among healthy older adults by considering the short-term, within-person association (coupling) of subjective cognitive function with objective cognitive performance. We expected this within-person coupling to differ between persons as a function of self-perceived global cognitive decline and depression, anxiety, or neuroticism. Methods: This was an intensive measurement (short-term longitudinal) study of 29 older adult volunteers between the ages of 65 and 80 years without an existing diagnosis of dementia or mild cognitive impairment. Baseline assessment included neuropsychological testing and self-reported depression, anxiety, and neuroticism, as well as self- and informant-reported cognitive decline (relative to 10 years previously). Intensive within-person measurement occasions included subjective ratings of cognitive function paired with performance on a computerized working memory (n-back) task; each participant attended four or five assessments separated by intervals of at least one day. Statistical analysis was comprised of multilevel linear regression. Results: Comparison of models suggested that both neuroticism and self-rated cognitive decline explained unique variance in the within-person, across-occasion coupling of subjective cognitive function with objective working memory performance. Conclusions: Self-ratings of cognition may accurately reflect day-to-day variations in objective cognitive performance among older adults, especially for individuals lower in neuroticism and higher in self-reported cognitive decline. Clinicians should consider these individual differences when determining the validity of complaints about perceived cognitive declines in the context of otherwise healthy aging. (JINS, 2018, 24, 57–66)
The Vasarhelyi Method of Child Art Psychotherapy (CAP) is a largely understudied psychotherapeutic modality. This study aims to describe the Vasarhelyi Method of CAP and to describe a stakeholder survey of the views and attitudes of CAP placement supervisors towards CAP among various Child and Adolescent Mental Health Services (CAMHS) teams nationwide.
A phone- and letter-based survey of 17 CAP placement supervisors who oversee CAP masters students attached to CAMHS teams was performed. A questionnaire was designed enquiring about their experiences with CAP in their clinic and their thoughts on the validity of CAP in various conditions/patient demographics. Participants received written correspondence and were asked to return the survey by post; this was followed up by a telephone call to complete missing surveys.
In all, 12 (70.6%) complete surveys were returned. Of the 12 respondents, all considered the CAP student to be a valuable member of the team. In total, 10 respondents (83.33%) stated they would make regular use of the service if it were made available to them. With regard to the therapy itself, nine respondents (75%) believed it was better for internalising symptoms than externalising symptoms. Depression, anxiety, attachment difficulties, trauma, deliberate self-harm and possible psychosomatic illnesses are the conditions viewed as receiving the most benefit from CAP. No gender difference was reported.
CAP is considered an effective modality and valuable addition to a psychotherapeutic repertoire. Further, more extensive studies are needed in this field.
To investigate familial influences on the full range of variability in attention and activity across adolescence, we collected maternal ratings of 339 twin pairs at ages 12, 14, and 16, and estimated the transmitted and new familial influences on attention and activity as measured by the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior Scale. Familial influences were substantial for both traits across adolescence: genetic influences accounted for 54%–73% (attention) and 31%–73% (activity) of the total variance, and shared environmental influences accounted for 0%–22% of the attention variance and 13%–57% of the activity variance. The longitudinal stability of individual differences in attention and activity was largely accounted for by familial influences transmitted from previous ages. Innovations over adolescence were also partially attributable to familial influences. Studying the full range of variability in attention and activity may facilitate our understanding of attention-deficit/hyperactivity disorder's etiology and intervention.
The objective of the present study was to investigate associations between sugar intake and overweight using dietary biomarkers in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).
Prospective cohort study.
EPIC-Norfolk in the UK, recruitment between 1993 and 1997.
Men and women (n 1734) aged 39–77 years. Sucrose intake was assessed using 7 d diet diaries. Baseline spot urine samples were analysed for sucrose by GC-MS. Sucrose concentration adjusted by specific gravity was used as a biomarker for intake. Regression analyses were used to investigate associations between sucrose intake and risk of BMI>25·0 kg/m2 after three years of follow-up.
After three years of follow-up, mean BMI was 26·8 kg/m2. Self-reported sucrose intake was significantly positively associated with the biomarker. Associations between the biomarker and BMI were positive (β=0·25; 95 % CI 0·08, 0·43), while they were inverse when using self-reported dietary data (β=−1·40; 95 % CI −1·81, −0·99). The age- and sex-adjusted OR for BMI>25·0 kg/m2 in participants in the fifth v. first quintile was 1·54 (95 % CI 1·12, 2·12; Ptrend=0·003) when using biomarker and 0·56 (95 % CI 0·40, 0·77; Ptrend<0·001) with self-reported dietary data.
Our results suggest that sucrose measured by objective biomarker but not self-reported sucrose intake is positively associated with BMI. Future studies should consider the use of objective biomarkers of sucrose intake.
Health-beneficial effects of adhering to a healthy Nordic diet index have been suggested. However, it has not been examined to what extent the included dietary components are exclusively related to the Nordic countries or if they are part of other European diets as well, suggesting a broader preventive potential. The present study describes the intake of seven a priori defined healthy food items (apples/pears, berries, cabbages, dark bread, shellfish, fish and root vegetables) across ten countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) and examines their consumption across Europe.
Cross-sectional study. A 24 h dietary recall was administered through a software program containing country-specific recipes. Sex-specific mean food intake was calculated for each centre/country, as well as percentage of overall food groups consumed as healthy Nordic food items. All analyses were weighted by day and season of data collection.
Multi-centre, European study.
Persons (n 36 970) aged 35–74 years, constituting a random sample of 519 978 EPIC participants.
The highest intakes of the included diet components were: cabbages and berries in Central Europe; apples/pears in Southern Europe; dark bread in Norway, Denmark and Greece; fish in Southern and Northern countries; shellfish in Spain; and root vegetables in Northern and Central Europe. Large inter-centre variation, however, existed in some countries.
Dark bread, root vegetables and fish are strongly related to a Nordic dietary tradition. Apples/pears, berries, cabbages, fish, shellfish and root vegetables are broadly consumed in Europe, and may thus be included in regional public health campaigns.
The prediction of grass dry matter intake (GDMI) and milk yield (MY) are important to aid sward and grazing management decision making. Previous evaluations of the GrazeIn model identified weaknesses in the prediction of GDMI and MY for grazing dairy cows. To increase the accuracy of GDMI and MY prediction, GrazeIn was adapted, and then re-evaluated, using a data set of 3960 individual cow measurements. The adaptation process was completed in four additive steps with different components of the model reparameterised or altered. These components were: (1) intake capacity (IC) that was increased by 5% to reduce a general GDMI underprediction. This resulted in a correction of the GDMI mean and a lower relative prediction error (RPE) for the total data set, and at all stages of lactation, compared with the original model; (2) body fat reserve (BFR) deposition from 84 days in milk to next calving that was included in the model. This partitioned some energy to BFR deposition after body condition score nadir had been reached. This reduced total energy available for milk production, reducing the overprediction of MY and reducing RPE for MY in mid and late lactation, compared with the previous step. There was no effect on predicted GDMI; (3) The potential milk curve was reparameterised by optimising the rate of decrease in the theoretical hormone related to secretory cell differentiation and the basal rate of secretory cell death to achieve the lowest possible mean prediction error (MPE) for MY. This resulted in a reduction in the RPE for MY and an increase in the RPE for GDMI in all stages of lactation compared with the previous step; and (4) finally, IC was optimised, for GDMI, to achieve the lowest possible MPE. This resulted in an IC correction coefficient of 1.11. This increased the RPE for MY but decreased the RPE for GDMI compared with the previous step. Compared with the original model, modifying this combination of four model components improved the prediction accuracy of MY, particularly in late lactation with a decrease in RPE from 27.8% in the original model to 22.1% in the adapted model. However, testing of the adapted model using an independent data set would be beneficial and necessary to make definitive conclusions on improved predictions.
The IceCube Neutrino Observatory was constructed at the South Pole during the 2004/05 to 2010/11 austral summer seasons. IceCube transforms 1 km3 of Antarctic ice into an astrophysical particle detector composed of 86 cables (strings) of optical sensors buried deep beneath the surface. Each string required drilling a borehole ∼60 cm in diameter to a depth of 2500 m. The 5 MW Enhanced Hot Water Drill was designed and built specifically for this task, capable of producing the required boreholes at a rate of one hole per 48 hours. Hot-water drilling on this scale presented unique challenges and was rich in lessons learned, yielding a collection of notable developments and takeaways (e.g. fuel-saving measures, thermal modeling, firn drilling and closed-loop computer control). Descriptions of system functionality and of lessons learned from IceCube drilling are presented.
Nitrogen (N) losses from dairy production systems are a cause for environmental concern. Excreted primarily as urea N in the urine, this volatile form of N can be lost as ammonia (NH3) contributing to ground-level ozone, the greenhouse effect and the deterioration of terrestrial and aquatic ecosystems. In addition, the production of urea N places a metabolic demand for energy on the dairy cow and excessively high levels of blood urea N are known to have deleterious effects on reproductive performance. Therefore, it is of interest to develop strategies that reduce N excretion from dairy cows and to this end, dietary manipulation of N efficiency offers great potential. There are a significant number of reports in the literature on N efficiency in the lactating dairy cow, including reducing dietary CP intake, improving the balance of amino acids reaching the small intestine, optimising the forage mix and optimising the energy sources in the diet. Across these experiments, N intake ranged from 0.33 to 0.67 kg/day with N efficiency ranging from 0.21 to 0.42. This paper will report on recent N balance experiments conducted at University College Dublin, as well as reports in the literature on studies aimed at improving N efficiency in the lactating dairy cow.
This paper provides a description of a structured template which allows review of the operation of the Mental Health Act 2001 at St Patrick's Mental Health Services (incorporating St Patrick's University Hospital, St Edmundsbury Hospital and Willow Grove Adolescent Unit). These structured processes were implemented to ensure rigorous monitoring of all clinical governance activities associated with adherence to the Mental Health Act (MHA) 2001. The paper describes in detail the information contained in the St Patrick's Mental Health Services dashboard for 2012. The dashboard displays the key performance indicators that are monitored and the paper describes how these were reviewed by the Hospital's Clinical Governance Committee on a weekly basis for the three approved centres. The dashboard has also been used by the Clinical Governance Committee to provide ongoing education and engagement with staff in order to improve the operation of the MHA 2001. The use of this structured monitoring process has allowed the hospital to measure adherence to the MHA 2001 and also to measure activities that impact directly on the care and treatment of patients detained under the Act. The use of structured monitoring tools (i.e. the dashboard) to review the operation of the MHA 2001 allows for coherent observation of key events and issues which can cause concern in terms of the operation of the Act.
Predicting the grass dry matter intake (GDMI), milk yield (MY) or milk fat and protein yield (milk solids yield (MSY)) of the grazing dairy herd is difficult. Decisions with regard to grazing management are based on guesstimates of the GDMI of the herd, yet GDMI is a critical factor influencing MY and MSY. A data set containing animal, sward, grazing management and concentrate supplementation variables recorded during weeks of GDMI measurement was used to develop multiple regression equations to predict GDMI, MY and MSY. The data set contained data from 245 grazing herds from 10 published studies conducted at Teagasc, Moorepark. A forward stepwise multiple regression technique was used to develop the multiple regression equations for each of the dependent variables (GDMI, MY, MSY) for three periods during the grazing season: spring (SP; 5 March to 30 April), summer (SU; 1 May to 31 July) and autumn (AU; 1 August to 31 October). The equations generated highlighted the importance of different variables associated with GDMI, MY and MSY during the grazing season. Peak MY was associated with an increase in GDMI, MY and MSY during the grazing season with the exception of GDMI in SU when BW accounted for more of the variation. A higher body condition score (BCS) at calving was associated with a lower GDMI in SP and SU and a lower MY and MSY in all periods. A higher BCS was associated with a higher GDMI in SP and SU, a higher MY in SU and AU and a higher MSY in all periods. The pre-grazing herbage mass of the sward (PGHM) above 4 cm was associated with a quadratic effect on GDMI in SP, on MY in SP and SU and on MSY in SU. An increase in daily herbage allowance (DHA) above 4 cm was associated with an increase in GDMI in AU, an increase in MY in SU and AU and MSY in AU. Supplementing grazing dairy cows with concentrate reduced GDMI and increased MY and MSY in all periods. The equations generated can be used by the Irish dairy industry during the grazing season to predict the GDMI, MY and MSY of grazing dairy herds.
A greater adherence to the traditional Mediterranean (MED) diet is associated with a reduced risk of developing chronic diseases. This dietary pattern is based on higher consumption of plant products that are rich in flavonoids. We compared the total flavonoid dietary intakes, their food sources and various lifestyle factors between MED and non-MED countries participating in the EPIC study. Flavonoid intakes and their food sources for 35 628 subjects, aged 35–74 years and recruited between 1992 and 2000, in twenty-six study centres were estimated using standardised 24 h dietary recall software (EPIC-Soft®). An ad hoc food composition database on flavonoids was compiled using analytical data from the United States Department of Agriculture and Phenol-Explorer databases. Moreover, it was expanded to include using recipes, estimations of missing values and flavonoid retention factors. No significant differences in total flavonoid mean intake between non-MED countries (373·7 mg/d) and MED countries (370·2 mg/d) were observed. In the non-MED region, the main contributors were proanthocyanidins (48·2 %) and flavan-3-ol monomers (24·9 %) and the principal food sources were tea (25·7 %) and fruits (32·8 %). In the MED region, proanthocyanidins (59·0 %) were by far the most abundant contributor and fruits (55·1 %), wines (16·7 %) and tea (6·8 %) were the main food sources. The present study shows similar results for total dietary flavonoid intakes, but significant differences in flavonoid class intakes, food sources and some characteristics between MED and non-MED countries. These differences should be considered in studies about the relationships between flavonoid intake and chronic diseases.