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Anecdotal evidence suggests the use of bolus tube feeding is increasing in long term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from 10 centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding, (n=604, 60% male, age 58years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients’ complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37%). Patients were long-term tube fed (4.1years tube feeding, 3.5years bolus tube feeding), living at home (71%) and sedentary (70%). The majority were head and neck cancer patients (22%) who were significantly more active (79%) and lived at home (97%), while those with cerebral palsy (12%) were typically younger (age 31years) but sedentary (94%). Most patients used bolus feeding as their sole feeding method (46%), because it was quick and easy to use, as a top up to oral diet or to mimic meal times. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85% of patients, with 51% of these being compact-style ONS (2.4kcal/ml, 125ml). This survey shows that bolus tube feeding is common amongst UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.
Dry permafrost - ground with temperature always below 0°C and containing negligible ice - overlying ice-cemented ground has been reported in the Dry Valleys of Antarctica and on Mars. Here we report on a new site (79°49.213'S, 83°18.860'W, 718 m elevation) located on the side of Mount Dolence in Ellsworth Land, Antarctica. Year-round temperature and humidity measurements indicate that dry permafrost is present between depths of 13.5 and 49.0 cm - the location of ice-cemented ground. The mean annual frost point of the ice-cemented ground is -17.0 ± 0.2°C and the mean annual frost point of the atmosphere is -22.7 ± 1°C. The corresponding mean annual temperatures are -19.2°C and -20.3°C. Neither the temperature of the ice-cemented ground nor the air rise above freezing. Both the dry permafrost and the ice table may be habitable. In the dry soil at 3 cm depth there are 80 hours in the summer when temperature exceeds -5°C and water activity exceeds 0.8. At the ice table, temperature exceeds -10°C and water activity exceeds 0.8 for 35 hours in the year. The ice table and the dry permafrost above it would be considered a ‘Special Region’ on Mars. Further microbial investigation of this site is indicated.
The effects of psychoactive substance abuse are not limited to the user, but extend to the entire family system, with children of substance abusers being particularly at risk. This meta-analysis attempted to quantify the longitudinal relationship between parental alcohol, tobacco, and drug use and child well-being, investigating variation across a range of substance and well-being indices and other potential moderators. We performed a literature search of peer-reviewed, English language, longitudinal observational studies that reported outcomes for children aged 0 to 18 years. In total, 56 studies, yielding 220 dependent effect sizes, met inclusion criteria. A multilevel random-effects model revealed a statistically significant, small detriment to child well-being for parental substance abuse over time (r = .15). Moderator analyses demonstrated that the effect was more pronounced for parental drug use (r = .25), compared with alcohol use (r = .13), tobacco use (r = .13), and alcohol use disorder (r = .14). Results highlight a need for future studies that better capture the effect of parental psychoactive substance abuse on the full breadth of childhood well-being outcomes and to integrate substance abuse into models that specify the precise conditions under which parental behavior determines child well-being.
To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.
In 2013 a prediction was made that the South-East Asian subspecies of Bengal Florican Houbaropsis bengalensis blandini would be extinct within 10 years. In 2018 we conducted a survey in the Tonle Sap floodplain, Cambodia, of the last population of Bengal Florican in South-East Asia. We found that the rate of decline in displaying males was 55% over five years, a decline comparable to that recorded between 2005–2007 and 2012. The estimated number of displaying males in 2018 was 104 (95% CI: 89–117), down from 216 (156–275) in 2012. We also conducted surveys by flushing birds in the non-breeding season, which indicated that the sex ratio of males to females is 3:1. We therefore estimate that the total population of adult Bengal Floricans in Cambodia in 2018 was 138 (119–156), making H. b. blandini the most threatened bustard taxon. The number of sites that support displaying male Bengal Floricans was reduced from 10 to four between 2012 and 2018. Between 2012 and 2018 we monitored numbers of displaying males in most years at the sites that support 80% of the total population. The only site where numbers of birds are stable is Stoung-Chikraeng Bengal Florican Conservation Area, where there were 44 (25–63) displaying males in 2018. This is the only site that has an ongoing NGO-government conservation programme. Our data indicate that Bengal Floricans are lost from sites when the area of grassland falls below 25 km2. We found evidence that displaying male Bengal Floricans abandon display territories when grassland is lost, this also creates hope that they may disperse and could colonise newly created habitat. All remaining sites that support Bengal Floricans in Cambodia are imperilled and we outline what must be done to reduce the possibility that H. b. blandini will be extinct by 2023.
We define a measure for the accuracy of tomographic reconstruction in atom probe tomography, named here the spatial error index. We demonstrate that this index can be used to compare rigorously the spatial accuracy of various different approaches to the calculation of tomographic reconstruction. This is useful, for example, to evaluate the performance of alternate tomographic reconstruction approaches, and ensures that the comparisons are independent of individual data quality or other instrumental parameters. We then introduce a new “adaptive reconstruction” formalism that uses a progression of reconstruction parameters based on a per-atom correction from the cube root of the inverse of the voltage, along with linear correction factors linked to the evaporation sequence. We apply the measure for spatial accuracy to this new reconstruction protocol.
OBJECTIVES/SPECIFIC AIMS: Delirium, a form of acute brain dysfunction, characterized by changes in attention and alertness, is a known independent predictor of mortality in the Intensive Care Unit (ICU). We sought to understand whether catatonia, a more recently recognized form of acute brain dysfunction, is associated with increased 30-day mortality in critically ill older adults. METHODS/STUDY POPULATION: We prospectively enrolled critically ill patients at a single institution who were on a ventilator or in shock and evaluated them daily for delirium using the Confusion Assessment for the ICU and for catatonia using the Bush Francis Catatonia Rating Scale. Coma, was defined as a Richmond Agitation Scale score of −4 or −5. We used the Cox Proportional Hazards model predicting 30-day mortality after adjusting for delirium, coma and catatonia status. RESULTS/ANTICIPATED RESULTS: We enrolled 335 medical, surgical or trauma critically ill patients with 1103 matched delirium and catatonia assessments. Median age was 58 years (IQR: 48 - 67). Main indications for admission to the ICU included: airway disease or protection (32%; N=100) or sepsis and/or shock (25%; N=79. In the unadjusted analysis, regardless of the presence of catatonia, non-delirious individuals have the highest median survival times, while delirious patients have the lowest median survival time. Comparing the absence and presence of catatonia, the presence of catatonia worsens survival (Figure 1). In a time-dependent Cox model, comparing non-delirious individuals, holding catatonia status constant, delirious individuals have 1.72 times the hazards of death (IQR: 1.321, 2.231) while those with coma have 5.48 times the hazards of death (IQR: 4.298, 6.984). For DSM-5 catatonia scores, a 1-unit increase in the score is associated with 1.18 times the hazards of in-hospital mortality. Comparing two individuals with the same delirium status, an individual with a DSM-5 catatonia score of 0 (no catatonia) will have 1.178 times the hazard of death (IQR: 1.086, 1.278), while an individual with a score of 3 catatonia items (catatonia) present will have 1.63 times the hazard of death. DISCUSSION/SIGNIFICANCE OF IMPACT: Non-delirious individuals have the highest median survival times, while those who are comatose have the lowest median survival times after a critical illness, holding catatonia status constant. Comparing the absence and presence of catatonia, the presence of catatonia seems to worsen survival. Those individual who are both comatose and catatonic have the lowest median survival time.
Covering a broad optical spectrum, ternary InxGa1−xAs nanowires, grown by bottom-up methods, have been receiving increasing attention due to the tunability of the bandgap via In composition modulation. However, inadequate knowledge about the correlation between growth and properties restricts our ability to take advantage of this phenomenon for optoelectronic applications. Here, three different InGaAs nanowires were grown under different experimental conditions and atom probe tomography was used to quantify their composition, allowing the direct observation of the nanowire composition associated with the different growth conditions.
Current approaches to reconstruction in atom probe tomography produce results that exhibit substantial distortions throughout the analysis depth. This is largely because of the need to apply a multitude of assumptions when estimating the evolution of the tip shape, and other pseudo-empirical reconstruction factors, which vary both across the face of the tip and throughout the analysis depth. We introduce a new crystallography-mediated reconstruction to improve the spatial accuracy and dramatically reduce these in-depth variations. To achieve this, we developed a barycentric transform to directly relate atomic positions in detector space to real space. This is mediated by novel crystallographic analysis techniques, including: (1) calculating the orientation of a crystal directly from the field evaporation map, (2) tracking pole locations throughout the evaporation sequence, and (3) accounting for the evolving tip radius in a manner that removes the dependence on the geometric field factor. By improving the in-depth spatial accuracy of the atom probe reconstruction, a greater accuracy of the atomic neighborhood relationships is available. This is critical in modern materials science and engineering, where an understanding of the solid solution architecture, precipitate dispersions, and descriptions of the interfaces between phases or grains are key inputs to microstructure–property relationships.
Anxiety symptoms gradually emerge during childhood and adolescence. Individual differences in behavioral inhibition (BI), an early-childhood temperament, may shape developmental paths through which these symptoms arise. Cross-sectional research suggests that level of early-childhood BI moderates associations between later anxiety symptoms and threat-related amygdala–prefrontal cortex (PFC) circuitry function. However, no study has characterized these associations longitudinally. Here, we tested whether level of early-childhood BI predicts distinct evolving associations between amygdala–PFC function and anxiety symptoms across development.
Eighty-seven children previously assessed for BI level in early childhood provided data at ages 10 and/or 13 years, consisting of assessments of anxiety and an fMRI-based dot-probe task (including threat, happy, and neutral stimuli). Using linear-mixed-effects models, we investigated longitudinal changes in associations between anxiety symptoms and threat-related amygdala–PFC connectivity, as a function of early-childhood BI.
In children with a history of high early-childhood BI, anxiety symptoms became, with age, more negatively associated with right amygdala–left dorsolateral-PFC connectivity when attention was to be maintained on threat. In contrast, with age, low-BI children showed an increasingly positive anxiety–connectivity association during the same task condition. Behaviorally, at age 10, anxiety symptoms did not relate to fluctuations in attention bias (attention bias variability, ABV) in either group; by age 13, low-BI children showed a negative anxiety–ABV association, whereas high-BI children showed a positive anxiety–ABV association.
Early-childhood BI levels predict distinct neurodevelopmental pathways to pediatric anxiety symptoms. These pathways involve distinct relations among brain function, behavior, and anxiety symptoms, which may inform diagnosis and treatment.