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Some studies found that providing micronutrient powder (MNP) causes adverse health outcomes; modifying factors are unknown. We aimed to investigate if iron status and inherited hemoglobin disorders (IHbD) modify the impact of MNP on growth and diarrhea among young Lao children. In a double-blind controlled trial, 1704 children ages 6-23mo were randomized to: daily MNP (with 6mg iron plus 14 micronutrients) or placebo for ~36wks. IHbD, and baseline and final hemoglobin (Hb), iron status, and anthropometrics were assessed. Caregivers provided weekly morbidity reports. At enrollment 55.6% were anemic; only 39.3% had no sign of clinically significant IHbD. MNP had no overall impact on growth and longitudinal diarrhea prevalence. Baseline Hb modified the effect of MNP on LAZ (P for interaction=0.082). Among children who were initially non-anemic, final mean LAZ in the MNP group was slightly lower (−1.93 (95%CI: −1.88, −1.97)) vs. placebo (−1.88 (95%CI: −1.83, −1.92)), and the opposite occurred among initially anemic children (final mean LAZ −1.90 (95% CI: −1.86, −1.94) in MNP vs. −1.92 (95% CI: −1.88, −1.96) in placebo). IHbD modified the effect on diarrhea prevalence (P=0.095). Among children with IHbD, the MNP group had higher diarrhea prevalence (1.37 (95%CI: 1.17, 1.59) vs. 1.21 (95%CI: 1.04, 1.41)), while it was lower among children without IHbD who received MNP (1.15 (95%CI: 0.95, 1.39) vs. 1.37 (95%CI: 1.13, 1.64)). In conclusion, there was a small adverse effect of MNP on growth among non-anemic children and on diarrhea prevalence among children with IHbD.
Obesity is considered a risk factor for surgical site infection (SSI). We quantified impact of body mass index (BMI) on the risk of SSI for a variety of surgical procedures.
We included 2012–2017 data from the Dutch national surveillance network PREZIES on a selection of frequently performed surgical procedures across different specialties. Patients were stratified into 5 categories: underweight (BMI, <18.5 kg/m2), normal weight (BMI, 18.5–25), overweight (BMI, 25–30), obese (BMI, 30–40) and morbidly obese (BMI, ≥40). Multilevel log binomial regression analyses were performed to assess the effect of BMI category on the risk of superficial, deep (including organ-space) and total SSI.
Of the 387,919 included patients (ranging from 2,616 for laparoscopic appendectomy to 119,834 for total hip prosthesis), 3,676 (1%) were underweight, 116,778 (30%) had normal weight, 154,339 (40%) were overweight, 104,288 (27%) had obesity, and 8,838 (2%) were morbidly obese. A trend of increasing risk of SSI when BMI increased from normal to morbidly obese was observed for almost all surgery types. The increase was most profound in surgeries with clean wounds, with relative risks for morbidly obese patients ranging up to 7.8 (95% CI, 6.0–10.2) for deep SSI in total hip prosthesis. In chest and abdominal surgeries, the impact was larger for superficial SSI than for deep SSI.
The results of our research provide evidence for the need of preventive programs targeting SSI in overweight and obese patients, as well as for the prevention of obesity in the general population.
High-rate lithium ion batteries with long cycling lives can provide electricity grid stabilization services in the presence of large fractions of intermittent generators, such as photovoltaics. Engineering for high rate and long cycle life requires an appropriate selection of materials for both electrode and electrolyte and an understanding of how these materials degrade with use. High-rate lithium ion batteries can also facilitate faster charging of electric vehicles and provide higher energy density alternatives to supercapacitors in mass transport applications.
High-rate lithium ion batteries can play a critical role in decarbonizing our energy systems both through their underpinning of the transition to use renewable energy resources, such as photovoltaics, and electrification of transport. Their ability to be rapidly and frequently charged and discharged can enable this energy storage technology to play a key role in stabilizing future low-carbon electricity networks which integrate large fractions of intermittent renewable energy generators. This decarbonizing transition will require lithium ion technology to provide increased power and longer cycle lives at reduced cost. Rate performance and cycle life are ultimately limited by the materials used and the kinetics associated with the charge transfer reactions and ionic and electronic conduction. We review material strategies for electrode materials and electrolytes that can facilitate high rates and long cycle lives and discuss the important issues of cost, resource availability and recycling.
The lattice parameters of iron-ruthenium solid-solution alloys of 0.10, 0.20, 0.50, 0.75, 1.50, 2.25, and 3.00 wt, % ruthenium have been determined at 310°K using a Philips back-reflection focusing camera and annealed-powder specimens.
The Debye characteristic temperature, θ, of carbonyl iron has been determined as being between 433 and 445°K at an ambient temperature of 310°K from an X-ray diffraction study utilizing both monochromatlzed and filtered radiation by both stationary and scanning slit methods.
In computing θ, several factors have been taken into consideration; the diffracted integrated intensities have been corrected for temperature diffuse scattering (TDS); the temperature gradient through the specimen was found to be critical and given as 160°K/in. at 95°K; corrections for the temperature dependence of θ have been made; and extinction effects were investigated, and results contrary to those of U'lna, Krltskaya, and Kurdyumov have been found.
The TDS corrected values for static and dynamic atomic displacements are also given.
X-Ray diffraction measurements of MnO confirm the hypothesis that the structural temperature and the magnetic transition temperature, or Néel temperature) are the same. The usefulness of X-ray diffraction intensity data of MnO, with respect to an atomic structural refinement problem involving α-Mn powders, is discussed. Lattice constant values of MnO are listed between 100 and 310°K
The mathematical description of an X-ray peak, diffracted from a powder or polycrystalline material, using physically meaningful parameters has been of interest for many years. With the popularity of computers, this need to characterize a diffraction peak has intensified.
A key problem which persists is how to describe the instrumental diffracted profile and therefore the observed diffracted characteristic peak with subsequent combinations of Kα doublets and mixed overlapping peaks. Many attempts have been made at finding a “true“ function to fit the observed diffracted peak; however, a practical solution has yet to be found.
Values of the Debye temperature 0 for iron-manganese solid-solution alloys have been determined from X-ray diffracted intensity measurements of powder specimens at ambient temperatures of 310, 239, and 98°K. Corrections to 0 were made with respect to the temperature-dependence of Θ, temperature diffuse scattering, dispersion, volume expansion of the alloy, and the temperature gradient through the specimen. The variation of Θ with temperature has been found to be approximately linear, the value of Θ decreasing 3 % between 98 and SICTK. for a nominal Fe–4%Mn alloy.
Increasing the concentration of manganese in an iron-manganese solid-solution alloy decreases Θ in qualitative agreement with Lindemann's equation. The values of Θ for other s olid-solution alloys computed using Lindemann's equation also agree with reported experimental values of Θ. The Debye temperature of a nominal Fe-3%Mn alloy annealed for 2 hr at 300, 600, and 700°C has not been found to maximize at 600°C as has been reported by Il'ina et al. On the contrary, Θ decreases with increasing annealing temperature until, in the range 600 to 700°C, it reaches its true value; and at these temperatures the powder was found to be fully annealed.
Major depressive disorder (MDD) is a leading cause of disease burden worldwide, with lifetime prevalence in the United States of 17%. Here we present the results of the first prospective, large-scale, patient- and rater-blind, randomized controlled trial evaluating the clinical importance of achieving congruence between combinatorial pharmacogenomic (PGx) testing and medication selection for MDD.
1,167 outpatients diagnosed with MDD and an inadequate response to ≥1 psychotropic medications were enrolled and randomized 1:1 to a Treatment as Usual (TAU) arm or PGx-guided care arm. Combinatorial PGx testing categorized medications in three groups based on the level of gene-drug interactions: use as directed, use with caution, or use with increased caution and more frequent monitoring. Patient assessments were performed at weeks 0 (baseline), 4, 8, 12 and 24. Patients, site raters, and central raters were blinded in both arms until after week 8. In the guided-care arm, physicians had access to the combinatorial PGx test result to guide medication selection. Primary outcomes utilized the Hamilton Depression Rating Scale (HAM-D17) and included symptom improvement (percent change in HAM-D17 from baseline), response (50% decrease in HAM-D17 from baseline), and remission (HAM-D17<7) at the fully blinded week 8 time point. The durability of patient outcomes was assessed at week 24. Medications were considered congruent with PGx test results if they were in the ‘use as directed’ or ‘use with caution’ report categories while medications in the ‘use with increased caution and more frequent monitoring’ were considered incongruent. Patients who started on incongruent medications were analyzed separately according to whether they changed to congruent medications by week8.
At week 8, symptom improvement for individuals in the guided-care arm was not significantly different than TAU (27.2% versus 24.4%, p=0.11). However, individuals in the guided-care arm were more likely than those in TAU to achieve remission (15% versus 10%; p<0.01) and response (26% versus 20%; p=0.01). Remission rates, response rates, and symptom reductions continued to improve in the guided-treatment arm until the 24week time point. Congruent prescribing increased to 91% in the guided-care arm by week 8. Among patients who were taking one or more incongruent medication at baseline, those who changed to congruent medications by week 8 demonstrated significantly greater symptom improvement (p<0.01), response (p=0.04), and remission rates (p<0.01) compared to those who persisted on incongruent medications.
Combinatorial PGx testing improves short- and long-term response and remission rates for MDD compared to standard of care. In addition, prescribing congruency with PGx-guided medication recommendations is important for achieving symptom improvement, response, and remission for MDD patients.
Funding Acknowledgements: This study was supported by Assurex Health, Inc.
This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling.
Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication.
The IPS–WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS–WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS–WFM intervention (45 v. 26 weeks, p < 0.004).
The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.
This research originated from a request that the American Bar Foundation provide information to the Chicago Bar Association's Committee on the Development of the Law in its study of the Association's “role and purpose.” The resulting research by the Foundation is much broader than that originally contemplated in our early conversations with the Committee, and it now constitutes a major study of the Chicago legal profession and its relation to the organizations that represent it A significant part of the study, however, has been addressed to the CBA's concerns, and this article was originally prepared as a report to the Committee. It is being published because we believe that its findings and analyses will be of wider interest. The form of the article remains that of the report to the Committee, though it has been revised for publication.
A total of eight ileal and caecal cannulated Yorkshire barrows were used to determine the interactions of dietary fibre (DF) and lipid types on apparent digestibility of DM and fatty acids (FA) and FA flows in gastrointestinal segments. Pigs were offered four diets that contained either pectin or cellulose with or without beef tallow or maize oil in two Youden square designs (n 6). Each period lasted 15 d. Faeces, ileal and caecal contents were collected to determine apparent ileal digestibility (AID), apparent caecal digestibility and apparent total tract digestibility (ATTD) of dietary components. The interactions between DF and lipid types influenced (P <0·05) the digestibility of DM and FA flows. The addition of maize oil decreased (P <0·05) AID of DM in pectin diets, and the addition of beef tallow depressed (P <0·001) ATTD of DM in cellulose diets. Dietary supplementation with beef tallow decreased (P <0·05) the AID of FA in pectin-containing diets but had no effects in cellulose-containing diets. Dietary supplementation with beef tallow increased (P <0·05) AID of SFA and PUFA and the flow of ileal oleic, vaccenic, linolenic and eicosadienoic acids and reduced the flow of faecal lauric, docosatetraenoic and docosapentaenoic acids in pectin- and cellulose-containing diets. In conclusion, the interaction between DF type and lipid saturation modulates digestibility of DM and lipids and FA flows but differs for soluble and insoluble fibre sources, SFA and unsaturated fatty acids and varies in different gastrointestinal segments.
While social scientists have long advocated the use of statistical methodology in legal analysis, its practical application has not been tested. Statistical models based on social science theories have been used to predict judicial decisions and explain court behavior, but the legal profession has failed to develop statistical models based on traditional legal theories and using data familiar to the lawyer. This article seeks to demonstrate by practical application of statistical methodologies, coupled with traditional legal research methods, that such research can produce important insight into a court's decision making and provide a useful model for predicting the probability of a favorable decision. The zoning amendment decisions of the Connecticut Supreme Court are the data base of this study, which also provides a comprehensive explanation of zoning amendment law in Connecticut as a backdrop against which to evaluate the insights gained by statistical analysis.