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Postural tachycardia syndrome is more frequently being recognised in adolescents and adults. However, its pathophysiology remains undefined. We evaluated our database for patterns in family history of clinical symptoms and associated disorders in these patients.
Materials and methods:
Patients with postural tachycardia syndrome diagnosed in our clinic between 2014 and 2018 and who were less than 19 years at diagnosis were included. The history was reviewed for family members with postural tachycardia syndrome, dizziness and/or syncope, joint hypermobility with or without hypermobile Ehlers–Danlos syndrome, and autoimmune disorders. Statistical analysis assessed the entire cohort plus differences in gender, presence or absence of joint hypermobility, and presence or absence of familial autoimmune disease.
A total of 579 patients met inclusion criteria. We found that 14.2% of patients had a family member with postural tachycardia syndrome, with male patients more likely to have an affected family member (20% versus 12.7%, p = 0.04). If the patient also had joint hypermobility, male patients were more likely to have a family member with postural tachycardia syndrome (25% versus 12.6%, p = 0.017), more than one affected family member (7.1% versus 0.74%, p = 0.001), and a family member with joint hypermobility (37.5% versus 23.7%, p = 0.032). Autoimmune disease was seen in 45.1% of family members, but more likely in female patients with concurrent hypermobility (21.1% versus 8.9%, p = 0.035).
This in-depth analysis of associated familial disorders in patients with postural tachycardia syndrome offers further insight into the pathophysiology of the disorder, and informs further screening of family members in these patients.
Neurodevelopment is sensitive to genetic and pre/postnatal environmental influences. These effects are likely mediated by epigenetic factors, yet current knowledge is limited. Longitudinal twin studies can delineate the link between genetic and environmental factors, epigenetic state at birth and neurodevelopment later in childhood. Building upon our study of the Peri/postnatal Epigenetic Twin Study (PETS) from gestation to 6 years of age, here we describe the PETS 11-year follow-up in which we will use neuroimaging and cognitive testing to examine the relationship between early-life environment, epigenetics and neurocognitive outcomes in mid-childhood. Using a within-pair twin model, the primary aims are to (1) identify early-life epigenetic correlates of neurocognitive outcomes; (2) determine the developmental stability of epigenetic effects and (3) identify modifiable environmental risk factors. Secondary aims are to identify factors influencing gut microbiota between 6 and 11 years of age to investigate links between gut microbiota and neurodevelopmental outcomes in mid-childhood. Approximately 210 twin pairs will undergo an assessment at 11 years of age. This includes a direct child cognitive assessment, multimodal magnetic resonance imaging, biological sampling, anthropometric measurements and a range of questionnaires on health and development, behavior, dietary habits and sleeping patterns. Data from complementary data sources, including the National Assessment Program — Literacy and Numeracy and the Australian Early Development Census, will also be sought. Following on from our previous focus on relationships between growth, cardiovascular health and oral health, this next phase of PETS will significantly advance our understanding of the environmental interactions that shape the developing brain.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
Sodium bismuth titanate (NBT) and its solid solutions with other ABO3 perovskites are of great interest for lead-free ferroelectric and piezoelectric applications. In this article, we provide an introduction to the complex structure of NBT, including atomic displacements and nanoscale defects. We also review poling effects and properties as well as NBT-ABO3 phase equilibria. The interesting relaxor properties, frequency dispersion in dielectric permittivity, and field-induced structural phase transitions of these systems are discussed. Finally, we describe other functional, mechanical, and electrical properties of NBT.
Previously known to form only under high pressure synthetic conditions, here we report that the T′-type 214-structure cuprate based on the rare earth atom Tb is stabilized for ambient pressure synthesis through partial substitution of Pd for Cu. The new material is obtained in purest form for mixtures of nominal composition Tb1.96Cu0.8Pd0.2O4. The refined formula, in orthorhombic space group Pbca, with a = 5.5117(1) Å, b = 5.5088(1) Å, and c = 11.8818(1) Å, is Tb2Cu0.83Pd0.17O4. An incommensurate structural modulation is seen along the a axis by electron diffraction and high resolution imaging. Magnetic susceptibility measurements reveal long-range antiferromagnetic ordering at 7.9 K, with a less pronounced feature at 95 K; a magnetic moment reorientation transition is observed to onset at a field of approximately 1.1 T at 3 K. The material is an n-type semiconductor.
Economists typically use seasonally adjusted data in which the assumption is imposed that seasonality is uncorrelated with trend and cycle. The importance of this assumption has been highlighted by the Great Recession. The paper examines an unobserved components model that permits nonzero correlations between seasonal and nonseasonal shocks. Identification conditions for estimation of the parameters are discussed from the perspectives of both analytical and simulation results. Applications to UK household consumption expenditures and US employment reject the zero correlation restrictions and also show that the correlation assumptions imposed have important implications about the evolution of the trend and cycle in the post-Great Recession period.
Prospective data on the associations between vitamin D intake and risk of CVD and all-cause mortality are limited and inconclusive. The aim of the present study was to investigate the associations between vitamin D intake and CVD risk and all-cause mortality in the Caerphilly Prospective Cohort Study.
The associations of vitamin D intake with CVD risk markers were examined cross-sectionally at baseline and longitudinally at 5-year, 10-year and >20-year follow-ups. In addition, the predictive value of vitamin D intake for CVD events and all-cause mortality after >20 years of follow-up was examined. Logistic regression and general linear regression were used for data analysis.
Participants in the UK.
Men (n 452) who were free from CVD and type 2 diabetes at recruitment.
Higher vitamin D intake was associated with increased HDL cholesterol (P=0·003) and pulse pressure (P=0·04) and decreased total cholesterol:HDL cholesterol (P=0·008) cross-sectionally at baseline, but the associations were lost during follow-up. Furthermore, higher vitamin D intake was associated with decreased concentration of plasma TAG at baseline (P=0·01) and at the 5-year (P=0·01), but not the 10-year examination. After >20 years of follow-up, vitamin D was not associated with stroke (n 72), myocardial infarctions (n 142), heart failure (n 43) or all-cause mortality (n 281), but was positively associated with increased diastolic blood pressure (P=0·03).
The study supports associations of higher vitamin D intake with lower fasting plasma TAG and higher diastolic blood pressure.
Previous studies have investigated the association between dietary inflammatory potential and the development of cancer. For breast cancer the results have been equivocal. The present study aimed to investigate whether higher Dietary Inflammatory IndexTM (DII) scores were associated with increased risk of breast cancer among Chinese women. A total of 867 cases and 824 controls were recruited into the present case–control study from September 2011 to February 2016. DII scores were computed based on baseline dietary intake assessed by a validated 81-item FFQ. The OR and 95 % CI were assessed by multivariable logistic regression after adjusting for various potential confounders. DII scores in this study ranged from −5·87 (most anti-inflammatory score) to +5·71 (most proinflammatory score). A higher DII score was associated with a higher breast cancer risk (adjusted ORquartile 4 v. 1 2·28; 95 % CI 1·71, 3·03; adjusted ORcontinuous 1·40; 95 %CI 1·25, 1·39). In stratified analyses, positive associations also were observed except for underweight women or women with either oestrogen receptor+ or progesterone receptor+ status (but not both). Results from this study indicated that higher DII scores, corresponding to more proinflammatory diets, were positively associated with breast cancer risk among Chinese women.
This paper reviews our recent investigations of compound semiconductors and heterovalent interfaces using the technique of aberration-corrected scanning transmission electron microscopy. Bright-field imaging of compound semiconductors with a collection angle that is comparable in size to the incident-beam convergence angle is demonstrated to provide better atomic-column visibility for lighter elements in comparison with the more traditional high-angle annular-dark-field approach. Several pairs of Group II–VI/Group III–V compound semiconductors with zincblende structure have been studied in detail. These combinations are all valence-mismatched (i.e., heterovalent), and include CdTe/InSb (Δa/a ≤ 0.05%), ZnTe/InP (Δa/a = 3.8%), and ZnTe/GaAs (Δa/a = 7.4%). CdTe/InSb (001) interfaces are observed to be defect-free with a slight lattice contraction at the interface plane. For interfaces with larger lattice-parameter mismatch, the primary interfacial defects are identified as Lomer edge dislocations and perfect 60° dislocations. However, the atomic structure of the dislocation cores has not yet been unambiguously determined.
Objective: To evaluate epidemiological patterns and lifetime costs of traumatic brain injury (TBI) identified in the emergency department (ED) within a publicly insured population in Ontario, Canada, in 2009. Methods: A nationally representative, population-based database was used to identify TBI cases presenting to Ontario EDs between April 2009 and March 2010. We calculated unit costs for medical treatment and productivity loss, and multiplied these by corresponding incidence estimates to determine the lifetime costs of identified TBI cases across age group, sex, and mechanism of injury. Results: In 2009, there were more than 133,000 ED visits for TBI in Ontario, resulting in a conservative estimate of $945 million in lifetime costs. Lifetime cost estimates ranged from $279 million to $1.22 billion depending on the diagnostic criteria used to define TBI. Peak rates of TBI occurred among young children (ages 0-4 year) and the elderly (ages 85+ years). Males experienced a 53% greater rate of TBI and incurred two-fold higher costs compared with females. Falls, sports/bicyclist-related injuries, and motor vehicle crashes represented 47%, 12%, and 10% of TBI presenting to ED, respectively, and accounted for a significant proportion of costs. Conclusions: This study revealed an enormous health and economic burden associated with TBI identified in the ED setting. Our findings underscore the importance of ongoing surveillance and prevention efforts targeted to vulnerable populations. More research is needed to fully appreciate the burden of TBI across a variety of health care settings.
The work was intended to explore the effect of the widely available cationic polymer polyethylenimine (PEI) on small diameter poly(ɛ-caprolactone) (PCL) blood vessel grafts. PEI was blended with PCL and electrospun into nanofibrous vascular scaffolds. The morphologies, wettabilities, mechanical properties, and biological activities of the PCL/PEI electrospun nanofibers were investigated. It was found that by increasing the content of PEI to 5% within the scaffolds, the fiber diameters decreased from 469.7 ± 212.1 to 282.5 ± 107.1 nm, the water contact angle was reduced from 126.6 ± 1.1° to 27.6 ± 3.9°, while the Young's modulus increased from 2.0 ± 0.2 to 4.1 ± 0.1 MPa, the suture retention strength increased from 4.2 ± 0.4 to 6.1 ± 0.7 N, and the burst pressure increased from 801.2 ± 14.1 to 926.2 ± 22.8 mmHg. The in vitro evaluations demonstrated that the nanofibers containing 2% PEI promoted the attachment and proliferation of human umbilical vein endothelial cells (HUVECs).
Background: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability, and most TBIs are treated in the Emergency Department (ED). We examined the incidence and epidemiological patterns of TBIs presenting to Ontario EDs over an eight-year period. Methods: All TBI-related ED visits between April 2002 and March 2010 were identified using a population-based database that is mandatory for ambulatory care facilities in Ontario. Incidence rates were reported across multiple strata, including age group, sex, and mechanism of injury. Results: From 2002-2010, there were 1,032,249 ED visits for TBI in Ontario. Peak rates occurred among young children ages 0-4 (349 per 10,000) and elderly adults ages 85+ (243 per 10,000). Overall, males experienced a 53% greater rate of TBI compared to females. Falls (47%), motor vehicle crashes (MVC; 10%), and sports-related injuries (9%) were the most common causes of TBI. The highest rates of TBI-related falls, MVCs, and sports-related injuries occurred among young children (0-4) and elderly adults (85+), adolescents/young adults (15-24), and children (5-14), respectively. Conclusions: Our study reveals a substantial health system burden associated with TBI in the ED setting, underscoring the need for enhanced surveillance and prevention efforts targeted to vulnerable demographic groups.
Background: Traumatic brain injury (TBI) is the leading cause of traumatic death and disability worldwide. We examined nationwide trends in TBI-related hospitalizations and in-hospital mortality between April 2006 and March 2010 using a population-based database that is mandatory for all hospitals in Canada. Methods: Trends in hospitalization rates were analyzed using linear regression. Independent predictors of in-hospital mortality were evaluated using logistic regression. Results: Hospitalization rates remained stable for children and young adults, but increased considerably among elderly adults (ages 65 and older). Falls and motor vehicle collisions (MVCs) were the most common causes of TBI hospitalizations. TBIs caused by falls increased by 24% (p=0.01), while MVC-related hospitalization rates decreased by 18% (p=0.03). Elderly adults were most vulnerable to falls, and experienced the greatest increase (29%) in fall-related hospitalization rates. Young adults (ages 15-24) were most at risk for MVCs, but experienced the greatest decline (28%) in MVC-related admissions. There were significant trends towards increasing age, injury severity, comorbidity, hospital length of stay, and in-hospital mortality. However, multivariate regression showed that the odds of death decreased over time after controlling for relevant factors. Conclusions: Hospitalizations for TBI are increasing in severity and involve older populations with more complex comorbidities.
Background: Traumatic brain injury (TBI) is a leading cause of death and disability, yet there is limited research on its economic burden. We estimated the incidence and lifetime costs of TBI identified in the Emergency Department (ED) in Ontario, Canada between April 2009 and March 2010. Methods: ED visits for TBI were identified using a population-based database that is mandatory for ambulatory care facilities in Ontario. The authors calculated unit costs for medical treatment and productivity loss, and multiplied these by incidence estimates to determine the lifetime costs of identified TBI cases. Results: In 2009, there were over 133,000 ED visits for TBI in Ontario, resulting in a conservative estimate of $945 million in total lifetime costs. Costs were greater for males than females across nearly all age groups, with males incurring two-fold higher costs overall. Together, falls ($407 million), struck by/against ($309 million), and motor vehicle injuries ($161 million) represented 93% of lifetime costs associated with TBI. Conclusions: This study revealed a high incidence and economic burden associated with TBI identified in the ED. More research is needed to fully appreciate the burden of TBI across a variety of healthcare settings.
Although the current literature offers some preliminary information about seeking feedback from various sources, a variable-centered approach has been adopted in which seeking feedback from supervisors and from subordinates was treated separately. We endeavored to extend this work through model-based cluster analysis, a person-centered approach, to identify distinct feedback source profiles in our sample of 209 front-line manager–supervisor dyads. Additionally, we aimed to explore whether such profiles differed between two feedback motives, perceived instrumental value and perceived image cost, as well as managers’ emotion regulation strategies. Results revealed six feedback source profiles and such profiles are associated not only with their perceived image cost and instrumental value but also with their emotion regulation strategies.
Future time orientation is essential if an employee is to be motivated to conduct activities that generate long-term rather than immediate gain, and which may involve risk. Given that feedback seeking requires the employee to slow down and seek input, it is surprising that little is known about the relationship between future time orientation and feedback seeking. Drawing upon psychological ownership theory and construal-level theory, we hypothesized a positive influence of future time orientation on feedback seeking from various sources (i.e., supervisors and co-workers). We also hypothesized job-based psychological ownership as a newly identified motive of feedback seeking and employed it to explain how future time orientation exerts influences. Tested with data from a sample of 228 subordinate–supervisor dyads from China, the results revealed that (1) future time orientation was positively related to feedback seeking from supervisors and co-workers and (2) job-based psychology ownership mediated the relationship between future time orientation and feedback seeking.
Delayed senescence, or stay-green, contributes to a longer grain-filling period and has been regarded as a desirable characteristic for the production of a number of crops including wheat. In the present study, in order to identify quantitative trait loci (QTLs) for traits related to the progression of wheat flag leaf senescence, green leaf area duration (GLAD) of a doubled haploid (DH) population, derived from two winter wheat varieties Hanxuan10 and Lumai14, was visually estimated under two water conditions and was recorded at 3-day intervals from 10 days after anthesis to physiological maturity using a 0–9 scale. According to GLAD, parameters related to the progression of senescence of DH lines and their parents were estimated by the Gompertz statistical model. Based on the model parameters, DH lines were categorized into three groups under drought stress and four groups under well-watered conditions. A total of 24 additive QTLs and 23 pairs of epistatic QTLs for parameters related to the progression of senescence were identified on 18 chromosomes, except for 3B, 1D and 6D. Of the QTLs detected, 14 and 10 additive QTLs were associated with the investigated traits under drought stress and well-watered conditions, respectively. Furthermore, 4, 7, 6, 2 and 2 additive QTLs for traits related to progression of senescence were clustered around the same or similar regions of chromosomes 1A, 1B, 5A, 5B and 7A, respectively. The present data provided the genetic basis for high phenotypic correlations among traits related to the progression of wheat flag leaf senescence. In addition, 17 loci were co-located or linked with previously reported QTLs regulating chlorophyll fluorescence, high-light-induced photo-oxidation, or heat stress and dark-induced senescence. The marker Xwmc336 on chromosome 1A, responsible for the onset and end times of leaf senescence, the time to maximum rate of senescence, the time to reach 75% senescence and chlorophyll content under drought stress may be helpful for marker-assisted selection breeding of wheat.