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We collected dietary records over the course of nine months to comprehensively characterize the consumption patterns of Malagasy people living in remote rainforest areas of north-eastern Madagascar.
The present study was a prospective longitudinal cohort study to estimate dietary diversity and nutrient intake for a suite of macronutrients, micronutrients and vitamins for 152 randomly selected households in two communities.
Madagascar, with over 25 million people living in an area the size of France, faces a multitude of nutritional challenges. Micronutrient-poor staples, especially rice, roots and tubers, comprise nearly 80 % of the Malagasy diet by weight. The remaining dietary components (including wild foods and animal-source foods) are critical for nutrition. We focus our study in north-eastern Madagascar, characterized by access to rainforest, rice paddies and local agriculture.
We enrolled men, women and children of both sexes and all ages in a randomized sample of households in two communities.
Although the Household Dietary Diversity Score and Food Consumption Score reflect high dietary diversity, the Minimum Dietary Diversity–Women indicator suggests poor micronutrient adequacy. The food intake data confirm a mixed nutritional picture. We found that the median individual consumed less than 50 % of his/her age/sex-specific Estimated Average Requirement (EAR) for vitamins A, B12, D and E, and Ca, and less than 100 % of his/her EAR for energy, riboflavin, folate and Na.
Malnutrition in remote communities of north-eastern Madagascar is pervasive and multidimensional, indicating an urgent need for comprehensive public health and development interventions focused on providing nutritional security.
Michael M Myers, Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, USA Department of Pediatrics, Columbia University, New York, USA Department of Psychiatry, Columbia University, New York, USA,
Nina Burtchen, Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany,
Maria Ordonez Retamar, Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, USA,
Maristella Lucchini, DEIB, Politecnico di Milano, Milano, Italy,
William P Fifer, Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, USA Department of Pediatrics, Columbia University, New York, USA Department of Psychiatry, Columbia University, New York, USA
It has been nearly 30 years since the publication of a seminal book that defined the state of knowledge related to the epidemiology of, and mechanisms underlying, sudden infant death syndrome (SIDS) (1). Despite decades of subsequent research, much of which is summarized in other chapters in this book, we must acknowledge that SIDS remains an enigma. Indeed, two longstanding definitions of SIDS (2, 3) are testament to our lack of understanding of why infants die of SIDS — that is, these deaths remain unexplained after thorough investigation. Although infrequent, SIDS remains the most common cause of infant death between 1 month and 1 year of age, and the deaths of 2,000 infants annually in the United States (US) alone are unimaginable tragedies for these 2,000 families. At the heart of the reason why we have such an incomplete understanding of SIDS is, fortunately, its rarity. In the US, the 2014 estimates suggest that SIDS is the cause of death for about 3.9 of every 10,000 infants born each year (4). Over the past few decades, our understanding of the external factors that contribute to why infants die of SIDS has come from numerous, worldwide, epidemiological studies. Associations gleaned from these studies have led to recommendations including strong discouragement for mothers not to smoke during pregnancy paired with specific guidance for safe sleeping practices. Subsequent to these recommendations, the rate of SIDS was reduced in many countries (5). However, the physiological mechanisms that underlie SIDS remain unknown.
By definition, SIDS deaths are unexpected. While there may be evidence of low-grade infection prior to the time of death (6) in general, there are no overt, chronic signs of the impending demise. These deaths do not seem to be “programmed”, in the sense that they are inevitable; rather, they appear to be due to suboptimal physiological regulatory responses to what may be rather common challenges faced by infants during the first year of life. Nonetheless, these deaths are not random. Some infants are more likely to experience the failure of adequate physiological responses to environmental challenges than others, hence the concept of the vulnerable infant. Infants born prematurely are at greater risk for SIDS (7), as are infants of mothers who smoked or drank during pregnancy (8, 9).
Hemorrhage remains the major cause of preventable death after trauma. Recent data suggest that earlier blood product administration may improve outcomes. The purpose of this study was to determine whether opportunities exist for blood product transfusion by ground Emergency Medical Services (EMS).
This was a single EMS agency retrospective study of ground and helicopter responses from January 1, 2011 through December 31, 2015 for adult trauma patients transported from the scene of injury who met predetermined hemodynamic (HD) parameters for potential transfusion (heart rate [HR]≥120 and/or systolic blood pressure [SBP]≤90).
A total of 7,900 scene trauma ground transports occurred during the study period. Of 420 patients meeting HD criteria for transfusion, 53 (12.6%) had a significant mechanism of injury (MOI). Outcome data were available for 51 patients; 17 received blood products during their emergency department (ED) resuscitation. The percentage of patients receiving blood products based upon HD criteria ranged from 1.0% (HR) to 5.9% (SBP) to 38.1% (HR+SBP). In all, 74 Helicopter EMS (HEMS) transports met HD criteria for blood transfusion, of which, 28 patients received prehospital blood transfusion. Statistically significant total patient care time differences were noted for both the HR and the SBP cohorts, with HEMS having longer time intervals; no statistically significant difference in mean total patient care time was noted in the HR+SBP cohort.
In this study population, HD parameters alone did not predict need for ED blood product administration. Despite longer transport times, only one-third of HEMS patients meeting HD criteria for blood administration received prehospital transfusion. While one-third of ground Advanced Life Support (ALS) transport patients manifesting HD compromise received blood products in the ED, this represented 0.2% of total trauma transports over the study period. Given complex logistical issues involved in prehospital blood product administration, opportunities for ground administration appear limited within the described system.
MixFM, ZielinskiMD, MyersLA, BernsKS, LukeA, StubbsJR, ZietlowSP, JenkinsDH, SztajnkrycerMD. Prehospital Blood Product Administration Opportunities in Ground Transport ALS EMS – A Descriptive Study. Prehosp Disaster Med. 2018;33(3):230–236.
Electron microscopy of biological, polymeric, and other beam-sensitive structures is often hampered by deleterious electron beam interactions. In fact, imaging of such beam-sensitive materials is limited by the allowable radiation dosage rather that capabilities of the microscope itself, which has been compounded by the availability of high brightness electron sources. Reducing dwell times to overcome dose-related artifacts, such as radiolysis and electrostatic charging, is challenging due to the inherently low contrast in imaging of many such materials. These challenges are particularly exacerbated during dynamic time-resolved, fluidic cell imaging, or three-dimensional tomographic reconstruction—all of which undergo additional dosage. Thus, there is a pressing need for the development of techniques to produce high-quality images at ever lower electron doses. In this contribution, we demonstrate direct dose reduction and suppression of beam-induced artifacts through under-sampling pixels, by as much as 80% reduction in dosage, using a commercial scanning electron microscope with an electrostatic beam blanker and a dictionary learning in-painting algorithm. This allows for multiple sparse recoverable images to be acquired at the cost of one fully sampled image. We believe this approach may open new ways to conduct imaging, which otherwise require compromising beam current and/or exposure conditions.
Ammonia was searched in the direction of 46 sources placed in the southern hemisphere where H2CO or H2O was detected previously. Observations were carried out at Itapetinga Radio Observatory, Atibaia, Brazil using a 13.7 m paraboloid. The receiver used for these observations had a K-band ruby travelling wave maser as a preamplifier and the system temperature ranged from 250 to 300K. All sources were observed at least twice, each observation lasting for 30 minutes. The filter bank used consisted of 47 contiguous channels with 100 kHz bandwidth. Results are presented on Table 1 — Positive results and Table 2 — Negative results.
Recent progress is reviewed in describing the physical processes of star cluster formation, from the viewpoint of theoretical models and numerical simulations. In many studies, supersonic turbulent flows structure the gas into a network of clumps, filaments, and cores. Self-gravity drives star formation, moderated by turbulence, magnetic fields, and stellar feedback. Recent models and simulations describe the core mass function, the protostar mass function, and the star-formation rate. Several simulations indicate similar protostar birthrates, a mass advantage for firstborn protostars, and accretion rates that are superthermal and nearly constant. Recently observed core-filament systems with sonic line widths and parsec lengths present challenges for turbulent models.