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It has been suggested that the risk of adverse perinatal outcomes in twin pregnancies is exacerbated by concomitant gestational diabetes mellitus (GDM). This study aimed to assess the risk incurred by twin pregnancy and by a diagnosis of GDM, separately, on the development of poor perinatal outcomes. A retrospective cohort study was conducted on all pregnant women at a tertiary center between 2016 and 2017. The impact of GDM and twin pregnancies on perinatal outcomes — birth weight above the 90th centile for gestational age, cesarean delivery, clinical neonatal hypoglycemia, and premature delivery (before 37 weeks’ gestation) — was assessed using univariate and multivariate analyses. Overall, 13,527 women were eligible for the study; 11,915 were uncomplicated singleton pregnancies; 1379 of these had GDM; 194 were twin pregnancies, and 39 of these had GDM. Univariate analyses showed that twin pregnancies were associated with a higher risk of all perinatal outcomes except macrosomia. In the multivariate analyses, twin pregnancy was a much higher predictor of cesarean delivery (OR 8.40, 95% CI [6.25, 11.49], p < .0001) and preterm birth (OR 58.82, 95% CI [31.25, 125], p < .0001) compared to GDM but GDM was a higher predictor of neonatal hypoglycemia (OR 4.87, 95% CI [3.74, 6.29], p < .0001). Twin pregnancy is more strongly associated with all adverse perinatal outcomes except macrosomia. GDM does not increase risk of adverse perinatal outcomes except for neonatal hypoglycemia.
To determine the relationship between falls and deficits in specific cognitive domains in older adults.
An analysis of the English Longitudinal Study of Ageing (ELSA) cohort.
United Kingdom community-based.
5197 community-dwelling older adults recruited to a prospective longitudinal cohort study.
Data on the occurrence of falls and number of falls, which occurred during a 12-month follow-up period, were assessed against the specific cognitive domains of memory, numeracy skills, and executive function. Binomial logistic regression was performed to evaluate the association between each cognitive domain and the dichotomous outcome of falls in the preceding 12 months using unadjusted and adjusted models.
Of the 5197 participants included in the analysis, 1308 (25%) reported a fall in the preceding 12 months. There was no significant association between the occurrence of a fall and specific forms of cognitive dysfunction after adjusting for self-reported hearing, self-reported eyesight, and functional performance. After adjustment, only orientation (odds ratio [OR]: 0.80; 95% confidence intervals [CI]: 0.65–0.98, p = 0.03) and verbal fluency (adjusted OR: 0.98; 95% CI: 0.96–1.00; p = 0.05) remained significant for predicting recurrent falls.
The cognitive phenotype rather than cognitive impairment per se may predict future falls in those presenting with more than one fall.
At the end of the Ordovician many marine benthonic and planktonic faunas underwent a global extinction that has been attributed to climatic changes and glacio-eustatic fluctuations in sea-level (Berry and Boucot, 1973; Sheehan, 1973, 1975; Brenchley, 1984). Raup and Sepkoski (1982) found that the Late Ordovician-Early Silurian extinction event was one of the five major Phanerozoic mass extinctions.
The aim of this study was to ascertain farmers’ knowledge of the risk of spread of infection from animals to humans, and their transmission prevention practices. This was a survey of farmers who submitted material to Ireland's Regional Veterinary Laboratories in 2015. There was an 84% response rate (1044 farmers). Ninety per cent of farmers were not aware that infection can be acquired from apparently healthy animals. Over half were not aware that disease could be contracted from sick poultry or pets. Conversely, the knowledge of the risk to pregnant women of infection from birthing animals was high (88%). Four-fifths of farmers sourced drinking water from a private well, and of these, 62% tested their water less frequently than once a year. Of dairy farmers, 39% drank unpasteurised milk once a week or more frequently. Veterinarians were the most commonly cited information source for diseases on farms. The survey findings indicate that the level of farmers’ knowledge and awareness of the spread of infection from animals to humans is a concern. Further education of the farming community is needed to increase awareness of both the potential biohazards present on farms and the practical measures that can be taken to mitigate the risk of zoonoses.
Mental disorder is common among individuals with neurological illness. We aimed to characterise the patient population referred for psychiatry assessment at a tertiary neurology service in terms of neurological and psychiatric diagnoses and interventions provided.
We studied all individuals referred for psychiatry assessment at a tertiary neurology service over a 2-year period (n= 82).
The most common neurological diagnoses among those referred were epilepsy (16%), Parkinson’s disease (15%) and multiple sclerosis (8%). The most common reasons for psychiatric assessment were low mood or anxiety (48%) and medically unexplained symptoms or apparent functional or psychogenic disease (21%). The most common diagnoses among those with mental disorder were mood disorders (62%), and neurotic, stress-related and somatoform disorders, including dissociative (conversion) disorders (28%). Psychiatric diagnosis was not related to gender, neurological diagnosis or psychiatric history.
Individuals with neurological illness demonstrate significant symptoms of a range of mental disorders. There is a need for further research into the characteristics and distribution of mental disorder in individuals with neurological illness, and for the enhancement of integrated psychiatric and neurological services to address the comorbidities demonstrated in this population.
We present a new reel-to-reel method for growth of high temperature super-conducting (HTS) films by reactive co-evaporation on flexible metal tapes. We have demonstrated proof of principle for this method with a small laboratory-scale setup using 8 cm long tape pieces. YBa2Cu3O7-δ is deposited on ion-beam assisted deposition textured MgO layers on top of flexible polycrystalline metal tapes. Critical current densities at 75.5 K of over 2 MA/cm2 have been achieved in HTS films with over 2 μm in thickness, yielding a self field critical current of 450 A/cm-width. A 4.5 μm thick film had a self field critical current of 590 A/cm. We discuss some practical possibilities for manufacturing of superconducting wire using this process and present new areas of research that are still needed.
We examine the influence of various substrate preparation procedures for ion-beam assist deposition (IBAD) texturing of MgO. IBAD-MgO nano-texturing is very sensitive to the nucleation surface, and surface roughness has an important influence on the texture of the MgO layer. We studied Hastelloy C-276 metal alloy as the substrate. The untreated substrate is leveled by either electropolishing, mechanical polishing or solution deposition. All three methods are applied to continuously moving tapes in long lengths. The RMS surface roughness decreases from 20-50 nm for the untreated substrate to 0.5 nm, 0.3 nm and 1 nm respectively. The in-plane and out-of plane crystalline alignment of the MgO layer improves as the roughness is decreased below 2 nm.
Coated conductor samples, prepared by reactive co-evaporation, are investigated with respect to the hole-doping dependence of the critical current density. The samples are annealed in an atmosphere of variable oxygen content after which critical currents, critical temperature and the c-axis lattice spacing are measured. The lattice spacing increases with decreasing oxygen content, consistent with literature data. These co-evaporated samples show hole overdoped behavior with respect to the maximum Tc. The achievable range of hole doping in these samples seems to depend on surface coverage. Both self-field and in-field Jc at 75.5 K have a maximum in the overdoped region but at less than maximum oxygen content. The reason for the overdoping of these samples is discussed briefly in terms of Y-Ba disorder.
We present an ion-beam based fabrication method for growth of single-crystal-like films that does not utilize epitaxy on single crystal substrates. We use ion-beam assisted texturing to obtain biaxial crystalline alignment in a film. This ion-beam assisted deposition (IBAD) texturing can be done on arbitrary, but smooth substrates, including flexible polycrystalline metal tapes. With IBAD texturing of MgO and subsequent homoepitaxial growth we have demonstrated an in-plane mosaic spread FWHM as low as 2° and out-of-plane alignment of 1°. The deposition system we use includes reel-to-reel tape transport for a linear transport of substrate materials through the deposition zones. This allows for high-throughput experimentation via a linear combinatorial experimental design.
Much of the vast research on corporate control over the past 30 years as well as many of the policy recommendations that have found their way into the securities law over the past 60 years are premised on the separation of ownership from control in public corporations. Thorstein Veblen first raised this issue in 1923 when he wrote of “absentee ownership” (Veblen, 1964). It was also the central concern of Adolf Berle and Gardiner Means in their hugely influential book The Modern Corporation and Private Property written in 1932. They warned that the separation of ownership and control “destroys the very foundation on which the economic order of the past three centuries has rested” and asserted that the “[d]ispersion in the ownership of separate enterprises … has already proceeded far, it is rapidly increasing, and appears to be an inevitable development” (Berle and Means, 1932) of the modern corporate system. More recently, academics such as Michael Jensen and Mark Roe have argued that a wide variety of tax incentives, antitrust policies, regulations, and political pressures, rather than anything inherent in capitalism, has led to the rise of what Roe calls “strong managers and weak owners.
Although the premise of the separation of ownership from management plays such a central role, little, if any, evidence has been presented to support the proposition that managerial ownership has declined over time.
Bone-anchored hearing aid surgery in younger children is a two-stage procedure, with a titanium fixture being allowed to osseointegrate for several months before an abutment is fitted through a skin graft. In the first procedure, it has been usual to place a reserve or sleeper fixture approximately 5 mm from the primary fixture as a backup in case the primary fixture fails to osseointegrate. This ipsilateral sleeper fixture is expensive, is often not used, and is placed in thinner calvarial bone where it is less likely to osseointegrate successfully. The authors have implanted the sleeper fixture on the contralateral side, with the additional objective of reducing the number of procedures for bilateral bone-anchored hearing aid implantation, providing a cost-effective use for the sleeper.
The authors implanted the bone-anchored hearing aid sleeper fixture in the contralateral temporal bone instead of on the ipsilateral side in seven successive paediatric cases with bilateral conductive hearing loss requiring two-stage bone-anchored hearing aids, treated at the Royal Manchester Children's Hospital, UK.
The seven patients ranged in age from five to 15 years, with a mean age of 10 years; in addition, a 20-year-old with learning disability was also treated. In each case, the contralateral sleeper fixture was not needed as a backup fixture, but was used in four patients (57 per cent) as the basis for a second-side bone-anchored hearing aid.
In children with bilateral conductive hearing loss, in whom a bilateral bone-anchored hearing aid is being considered and the second side is to be operated upon at a later date, we recommend placing the sleeper fixture on the contralateral side at the time of primary first-side surgery. Our technique provides a sleeper fixture located in an optimal position, where it also offers the option of use for a second-side bone-anchored hearing aid and reduces the number of procedures needed.
Aims: To evaluate parents' satisfaction with medical and allied health services provided to children with Down syndrome in north-west England, comparing ENT and its allied services with other areas of health service provision.
Methods: A questionnaire survey of parents attending a north-west England Down syndrome association conference. Demographic data, departments visited, satisfaction with each service (scored one to five), waiting times for each service (scored one to five), service need (scored one to three) and accessibility (scored one to three) were recorded.
Results: Otolaryngology had been used by 50 per cent of children, with a satisfaction of 2.63 (the second worst score). Speech and language therapy was used by 90 per cent of the children, with a satisfaction of 3.26 (the worst score). The service felt to be most needed and also most difficult to access was speech and language therapy.
Conclusion: Otorhinolaryngology departments should assess how they can improve their service to this population with specific ENT needs. Speech and language services for children with Down syndrome should be expanded.
A detailed investigation was undertaken to determine the effects of four single starter strains, Lactococcus lactis subsp. lactis 303, Lc. lactis subsp. cremoris HP, Lc. lactis subsp. cremoris AM2, and Lactobacillus helveticus DPC4571 on the proteolytic, lipolytic and sensory characteristics of Cheddar cheese. Cheeses produced using the highly autolytic starters 4571 and AM2 positively impacted on flavour development, whereas cheeses produced from the poorly autolytic starters 303 and HP developed off-flavours. Starter selection impacted significantly on the proteolytic and sensory characteristics of the resulting Cheddar cheeses. It appeared that the autolytic and/or lipolytic properties of starter strains also influenced lipolysis, however lipolysis appeared to be limited due to a possible lack of availability or access to suitable milk fat substrates over ripening. The impact of lipolysis on the sensory characteristics of Cheddar cheese was unclear, possibly due to minimal differences in the extent of lipolysis between the cheeses at the end of ripening. As anticipated seasonal milk supply influenced both proteolysis and lipolysis in Cheddar cheese. The contribution of non-starter lactic acid bacteria towards proteolysis and lipolysis over the first 8 months of Cheddar cheese ripening was negligible.