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Investigations of drinking behavior across military deployment cycles are scarce, and few prospective studies have examined risk factors for post-deployment alcohol misuse.
Prevalence of alcohol misuse was estimated among 4645 US Army soldiers who participated in a longitudinal survey. Assessment occurred 1–2 months before soldiers deployed to Afghanistan in 2012 (T0), upon their return to the USA (T1), 3 months later (T2), and 9 months later (T3). Weights-adjusted logistic regression was used to evaluate associations of hypothesized risk factors with post-deployment incidence and persistence of heavy drinking (HD) (consuming 5 + alcoholic drinks at least 1–2×/week) and alcohol or substance use disorder (AUD/SUD).
Prevalence of past-month HD at T0, T2, and T3 was 23.3% (s.e. = 0.7%), 26.1% (s.e. = 0.8%), and 22.3% (s.e. = 0.7%); corresponding estimates for any binge drinking (BD) were 52.5% (s.e. = 1.0%), 52.5% (s.e. = 1.0%), and 41.3% (s.e. = 0.9%). Greater personal life stress during deployment (e.g., relationship, family, or financial problems) – but not combat stress – was associated with new onset of HD at T2 [per standard score increase: adjusted odds ratio (AOR) = 1.20, 95% CI 1.06–1.35, p = 0.003]; incidence of AUD/SUD at T2 (AOR = 1.54, 95% CI 1.25–1.89, p < 0.0005); and persistence of AUD/SUD at T2 and T3 (AOR = 1.30, 95% CI 1.08–1.56, p = 0.005). Any BD pre-deployment was associated with post-deployment onset of HD (AOR = 3.21, 95% CI 2.57–4.02, p < 0.0005) and AUD/SUD (AOR = 1.85, 95% CI 1.27–2.70, p = 0.001).
Alcohol misuse is common during the months preceding and following deployment. Timely intervention aimed at alleviating/managing personal stressors or curbing risky drinking might reduce risk of alcohol-related problems post-deployment.
Performing patient care while wearing high-level personal protective equipment presents risks to healthcare providers. Our failure mode effects analysis identified 81 overall risks associated with providing hygienic care and linen change to a patient with continuous watery stool. Implementation of checklists and scheduled pauses could potentially mitigate 76.5% of all risks.
Tomato product consumption and estimated lycopene intake are hypothesised to reduce the risk of prostate cancer. To define the impact of typical servings of commercially available tomato products on resultant plasma and prostate lycopene concentrations, men scheduled to undergo prostatectomy (n 33) were randomised either to a lycopene-restricted control group ( < 5 mg lycopene/d) or to a tomato soup (2–2¾ cups prepared/d), tomato sauce (142–198 g/d or 5–7 ounces/d) or vegetable juice (325–488 ml/d or 11–16·5 fluid ounces/d) intervention providing 25–35 mg lycopene/d. Plasma and prostate carotenoid concentrations were measured by HPLC. Tomato soup, sauce and juice consumption significantly increased plasma lycopene concentration from 0·68 (sem 0·1) to 1·13 (sem 0·09) μmol/l (66 %), 0·48 (sem 0·09) to 0·82 (sem 0·12) μmol/l (71 %) and 0·49 (sem 0·12) to 0·78 (sem 0·1) μmol/l (59 %), respectively, while the controls consuming the lycopene-restricted diet showed a decline in plasma lycopene concentration from 0·55 (sem 0·60) to 0·42 (sem 0·07) μmol/l ( − 24 %). The end-of-study prostate lycopene concentration was 0·16 (sem 0·02) nmol/g in the controls, but was 3·5-, 3·6- and 2·2-fold higher in tomato soup (P= 0·001), sauce (P= 0·001) and juice (P= 0·165) consumers, respectively. Prostate lycopene concentration was moderately correlated with post-intervention plasma lycopene concentrations (r 0·60, P =0·001), indicating that additional factors have an impact on tissue concentrations. While the primary geometric lycopene isomer in tomato products was all-trans (80–90 %), plasma and prostate isomers were 47 and 80 % cis, respectively, demonstrating a shift towards cis accumulation. Consumption of typical servings of processed tomato products results in differing plasma and prostate lycopene concentrations. Factors including meal composition and genetics deserve further evaluation to determine their impacts on lycopene absorption and biodistribution.
Despite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment. The Pediatric Cardiac Critical Care Consortium (PC4) has been modelled after successful collaborative quality improvement initiatives, and is positioned to provide the data platform necessary to realise these objectives. We describe the development of PC4 including the philosophical, organisational, and infrastructural components that will facilitate collaborative quality improvement in paediatric cardiac critical care.
To describe the epidemiology and healthcare costs of Clostridium difficile infection (CDI) identified in the outpatient setting.
Population-based, retrospective cohort study.
Kaiser Permanente Colorado and Kaiser Permanente Northwest members between June 1, 2005, and September 30, 2008.
We identified persons with incident CDI and classified CDI by whether it was identified in the outpatient or inpatient healthcare setting. We collected information about baseline variables and follow-up healthcare utilization, costs, and outcomes among patients with CDI. We compared characteristics of patients with CDI identified in the outpatient versus inpatient setting.
We identified 3,067 incident CDIs; 56% were identified in the outpatient setting. Few strong, independent predictors of diagnostic setting were identified, although a previous stay in a nonacute healthcare institution (odds ratio [OR], 1.45 [95% confidence interval (CI), 1.13-1.86]) was statistically associated with outpatient-identified CDI, as was age from 50 to 59 years (OR, 1.64 [95% CI, 1.18-2.29]), 60 to 69 years (OR, 1.37 [95% CI, 1.03-1.82]), and 70 to 79 years (OR, 1.36 [95% CI, 1.06-1.74]), when compared with persons aged 80-89 years.
We found that more than one-half of incident CDIs in this population were identified in the outpatient setting. Patients with outpatient-identified CDI were younger with fewer comorbidities, although they frequently had previous exposure to healthcare. These data suggest that practitioners should be aware of CDI and obtain appropriate diagnostic testing on outpatients with CDI symptoms.
Infect Control Hosp Epidemiol 2012;33(10):1031-1038
Biodiversity is the variability among living organisms, from genes to the biosphere. The value of biodiversity is multifold, from preserving the integrity of the biosphere as a whole, to providing food and medicines, to spiritual and aesthetic well-being.
One of the major drivers of biodiversity loss in Europe is atmospheric deposition of reactive nitrogen (Nr).
This chapter focuses on Nr impacts on European plant species diversity; in particular, the number and abundance of different species in a given area, and the presence of characteristic species of sensitive ecosystems.
We summarise both the scientific and the policy aspects of Nr impacts on diversity and identify, using a range of evidence, the most vulnerable ecosystems and regions in Europe.
Key findings/state of knowledge
Reactive nitrogen impacts vegetation diversity through direct foliar damage, eutrophication, acidification, and susceptibility to secondary stress.
Species and communities most sensitive to chronically elevated Nr deposition are those that are adapted to low nutrient levels, or are poorly buffered against acidification. Grassland, heathland, peatland, forest, and arctic/montane ecosystems are recognised as vulnerable habitats in Europe; other habitats may be vulnerable but are still poorly studied.
It is not yet clear if different wet-deposited forms of Nr (e.g. nitrate, NO3− versus ammonium, NH4+) have different effects on biodiversity. However, gaseous ammonia (NH3) can be particularly harmful to vegetation, especially lower plants, through direct foliar damage.
Fructose consumption in the USA has increased over the past three decades. During this time, obesity, insulin resistance and the metabolic syndrome have also increased in prevalence. While diets high in fructose have been shown to promote insulin resistance and increase TAG concentrations in animals, there are insufficient data available regarding the long-term metabolic effects of fructose consumption in humans. The objective of the present study was to investigate the metabolic effects of 10-week consumption of fructose-sweetened beverages in human subjects under energy-balanced conditions in a controlled research setting. Following a 4-week weight-maintaining complex carbohydrate diet, seven overweight or obese (BMI 26·8–33·3 kg/m2) postmenopausal women were fed an isoenergetic intervention diet, which included a fructose-sweetened beverage with each meal, for 10 weeks. The intervention diet provided 15 % of energy from protein, 30 % from fat and 55 % from carbohydrate (30 % complex carbohydrate, 25 % fructose). Fasting and postprandial glucose, insulin, TAG and apoB concentrations were measured. Fructose consumption increased fasting glucose concentrations and decreased meal-associated glucose and insulin responses (P = 0·0002, P = 0·007 and P = 0·013, respectively). Moreover, after 10 weeks of fructose consumption, 14 h postprandial TAG profiles were significantly increased, with the area under the curve at 10 weeks being 141 % higher than at baseline (P = 0·04). Fructose also increased fasting apoB concentrations by 19 % (P = 0·043 v. baseline). In summary, consumption of fructose-sweetened beverages increased postprandial TAG and fasting apoB concentrations, and the present results suggest that long-term consumption of diets high in fructose could lead to an increased risk of CVD.
Increasing breeding success in the giant panda requires a better understanding of its complex reproductive biology. We know that the female is typically mono-oestrus during a breeding season which occurs from February to May (within and outside China). Behavioural and physiological changes associated with pro-oestrus and oestrus last one to two weeks, during which the female exhibits proceptive behaviours, such as scent marking, to advertise her sexual receptivity (Lindburg et al., 2001). During the peri-ovulatory interval, receptive behaviours (e.g. tail-up lordotic posture) climax with copulation generally occurring over a one- to three-day interval. Birthing occurs from June to October with a gestation of 85 to 185 days (Zhu et al., 2001). This unusually wide gestation span is due to the phenomenon of delayed implantation, a varied interval before the conceptus implants in the uterus and begins foetal development. The driving force behind implantation in this species is unknown. The giant panda also experiences pseudopregnancy, whereby the female exhibits behavioural, physiological and hormonal changes similar to pregnancy.
Behavioural and physiological cues associated with both pregnancy and pseudopregnancy include decreased appetite, nest-building and cradling behaviours, vulvar swelling and colouration, mammary gland enlargement and lethargy. Additionally, temporal and quantitative progesterone patterns (tracked by assessing urinary hormone by-products and progestins) are indistinguishable between pregnancy and pseudopregnancy. Therefore, no definitive test currently exists for identifying pregnant from pseudopregnant giant pandas.
The evolutionary history of the living African rodent families is a topic of considerable debate, yet it is generally agreed that the modern cane rats (Thryonomys Fitzinger, 1867) and dassie rats (Petromus Smith, 1831) have an evolutionary history within the infraorder Phiomorpha (e.g., Wood, 1968). Phiomorphs possess hystricognathous mandibular morphology, multiserial incisor enamel, and hystricomorphous attachment of the masseteric musculature (e.g., Lavocat, 1978; Holroyd, 1994). In his initial work on the group, Wood (1968) placed all phiomorph taxa into a single family, and named a handful of morphologically diverse species based mainly on size. Lavocat (1978) later revised the taxonomy of the group, raising many of the differences among species to the family level. More recently, Holroyd (1994) observed that these contrasting views likely stemmed from the fact that Wood's phiomorph work emphasized the overall similarity of Paleogene specimens from the Fayum of Egypt, whereas Lavocat endeavored to explain the diverse Miocene rodent faunas from East Africa, envisioning that each of the Miocene forms had an ancestor among the Paleogene taxa. In this paper we adopt Holroyd's (1994) revised version of family-level relationships among the phiomorphs.