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The prenatal detection of structural cardiac malformations has greatly benefited from the advances in echo Doppler technology and the in-depth training of specialists in this area. This opens up new possibilities, now and in the future, for developing in utero therapies. It also allows a better knowledge of the underlying mechanisms and developmental timing that lead to structural congenital heart disease (CHD), based on a marked progress involving genetic and epigenetic causes. Gene mutations are discovered in the fetus and parents, and pathways can be unraveled using mouse transgene technology. Epigenetic causes are also receiving attention, but have thus far been underestimated as approximately 85% of CHD is determined to have a multifactorial background that combines a genetic susceptibility with epigenetic influences. Studies in animal models, including chicken, quail, zebrafish, and even more primitive Chordates, contribute relevant data. In essence, cardiac development shows basic similarities of the major processes involved between species. Therefore mechanisms unraveled in animal models can be reliably used in understanding normal human cardiac development and CHD .
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
Replicate radiocarbon (14C) measurements of organic and inorganic control samples, with known Fraction Modern values in the range Fm = 0–1.5 and mass range 6 μg–2 mg carbon, are used to determine both the mass and radiocarbon content of the blank carbon introduced during sample processing and measurement in our laboratory. These data are used to model, separately for organic and inorganic samples, the blank contribution and subsequently “blank correct” measured unknowns in the mass range 25–100 μg. Data, formulas, and an assessment of the precision and accuracy of the blank correction are presented.
Primary care physicians can play a key role in supporting patients after behavioural weight loss, though little is known about communication between patients and physicians during this time. Adults (n=139) in a behavioural weight loss trial (delivered outside of primary care) who attended a primary care appointment after an initial weight loss period were surveyed to assess weight-related communication at their most recent appointment. Most participants (78%) reported discussing weight with their physician. Participants who discussed weight, compared to those who did not, lost more weight, had higher blood pressure, and were more likely to be male. Most (89%) reported that their physician was supportive of their weight loss, but only a few participants (6.9%) reported that their physician gave feedback on medical parameters. Areas for improvement identified include physicians providing universal support for modest weight changes and providing interpretation of medical measurements that changed due to weight loss.
In the US Midwest, the working of marine shell procured through vast trade networks has typically been associated with elite prestige economies and craft specialization at major Mississippian centers. Outside of these contexts, marine shell goods are often assumed to have been brought into communities as completed goods. A recent finding suggests that local, small-scale marine shell working occurred at an early seventeenth-century village in northern Illinois, Middle Grant Creek (11Wi2739). This finding represents the first probable evidence of marine shell working in the Midwest outside of large, Mississippian contexts. Consequently, this practice may be much more geographically and temporally expansive than previously thought. This evidence encourages a rethinking of marine shell finds whenever they are assumed to be imported as finished goods.
Growth, which is intrinsically linked to environmental conditions including temperature and food availability are highly variable both temporally and spatially. Estimates of growth rates of the Southern Ocean euphausiid Thysanoessa macrura are currently restricted to limited studies which rely upon repeated sampling and length-frequency analysis to quantify growth rates. The instantaneous growth method (IGR) was used to measure the growth rate of T. macrura successfully in the southern Kerulen Plateau region during summer, providing the first IGR parameters for the Southern Ocean euphausiid species. Results of the four-day IGR incubation indicate a period of low somatic growth for adult T. macrura. Males had a longer intermoult period (IMP) (62 days) than females (42 days), but the sexes exhibited similar daily growth rates of 0.011 mm day−1 and 0.012 mm day−1 respectively. Juveniles exhibited the fastest growth, with an IMP of 13 days and daily growth rate of 0.055 mm day−1 indicating a prolonged growth season, similar to the Antarctic krill E. superba. Consequently, we highlight the usability of the IGR method and strongly encourage its use in developing a comprehensive understanding of spatial and seasonal growth patterns of T. macrura.
Many patients with advanced serious illness or at the end of life experience delirium, a potentially reversible form of acute brain dysfunction, which may impair ability to participate in medical decision-making and to engage with their loved ones. Screening for delirium provides an opportunity to address modifiable causes. Unfortunately, delirium remains underrecognized. The main objective of this pilot was to validate the brief Confusion Assessment Method (bCAM), a two-minute delirium-screening tool, in a veteran palliative care sample.
This was a pilot prospective, observational study that included hospitalized patients evaluated by the palliative care service at a single Veterans’ Administration Medical Center. The bCAM was compared against the reference standard, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Both assessments were blinded and conducted within 30 minutes of each other.
We enrolled 36 patients who were a median of 67 years (interquartile range 63–73). The primary reasons for admission to the hospital were sepsis or severe infection (33%), severe cardiac disease (including heart failure, cardiogenic shock, and myocardial infarction) (17%), or gastrointestinal/liver disease (17%). The bCAM performed well against the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, for detecting delirium, with a sensitivity (95% confidence interval) of 0.80 (0.4, 0.96) and specificity of 0.87 (0.67, 0.96).
Significance of Results
Delirium was present in 27% of patients enrolled and never recognized by the palliative care service in routine clinical care. The bCAM provided good sensitivity and specificity in a pilot of palliative care patients, providing a method for nonpsychiatrically trained personnel to detect delirium.
To evaluate the long-term safety and tolerability of deutetrabenazine in patients with tardive dyskinesia (TD) at 2years.
In the 12-week ARM-TD and AIM-TD studies, deutetrabenazine showed clinically significant improvements in Abnormal Involuntary Movement Scale scores compared with placebo, and there were low rates of overall adverse events (AEs) and discontinuations associated with deutetrabenazine.
Patients who completed ARM-TD or AIM-TD were included in this open-label, single-arm extension study, in which all patients restarted/started deutetrabenazine 12mg/day, titrating up to a maximum total daily dose of 48mg/day based on dyskinesia control and tolerability. The study comprised a 6-week titration period and a long-term maintenance phase. Safety measures included incidence of AEs, serious AEs (SAEs), and AEs leading to withdrawal, dose reduction, or dose suspension. Exposure-adjusted incidence rates (EAIRs; incidence/patient-years) were used to compare AE frequencies for long-term treatment with those for short-term treatment (ARM-TD and AIM-TD). This analysis reports results up to 2 years (Week106).
343 patients were enrolled (111 patients received placebo in the parent study and 232 received deutetrabenazine). There were 331.4 patient-years of exposure in this analysis. Through Week 106, EAIRs of AEs were comparable to or lower than those observed with short-term deutetrabenazine and placebo, including AEs of interest (akathisia/restlessness [long-term EAIR: 0.02; short-term EAIR range: 0–0.25], anxiety [0.09; 0.13–0.21], depression [0.09; 0.04–0.13], diarrhea [0.06; 0.06–0.34], parkinsonism [0.01; 0–0.08], somnolence/sedation [0.09; 0.06–0.81], and suicidality [0.02; 0–0.13]). The frequency of SAEs (EAIR 0.15) was similar to those observed with short-term placebo (0.33) and deutetrabenazine (range 0.06–0.33) treatment. AEs leading to withdrawal (0.08), dose reduction (0.17), and dose suspension (0.06) were uncommon.
These results confirm the safety outcomes seen in the ARM-TD and AIM-TD parent studies, demonstrating that deutetrabenazine is well tolerated for long-term use in TD patients.
Presented at: American Academy of Neurology Annual Meeting; April 21–27, 2018, Los Angeles, California,USA
Funding Acknowledgements: Funding: This study was supported by Teva Pharmaceuticals, Petach Tikva, Israel
Tall weeds escaping early weed management, such as weeds resistant to one or multiple herbicides, are an increasing concern. When weeds reach a certain size, few options other than hand weeding will limit the production and dispersal of seeds. The objective of this project was to evaluate the efficacy of the Bourquin Organic Weed Puller® (a rotating series of wheels that grab and pull) at removing tall weeds before they shed seeds in soybean and adzuki bean. Trials were set up in Canada at the Agriculture and Agri-Food Canada research farms at Saint-Jean-sur-Richelieu (SJR), QC (2 yr), and Harrow (HAR), ON (1 yr), on a loamy and a sandy soil, respectively. The experimental design included crops of different potential heights (different soybean cultivars and adzuki bean), two weed species per location (common lambsquarters [both locations] and common ragweed or redroot pigweed at HAR), and two pulling dates. The set-up also included weedy and herbicide-treated control plots. Weeds overtopping the crop canopy by at least 10 cm were tagged and characterized. Damage from the weed puller was rated as 1, pulled (desired effect); 2, cut; 3, folded; 4, stripped; and 5, intact. The seed production of damaged and intact weeds was also recorded. Less than one-third of common ragweed or redroot pigweed plants were pulled during any treatment combination. The highest pulling rates were observed for common lambsquarters at SJR (43%), but very few were pulled at HAR (3.1% max). Pulling rates were not high enough to potentially control seed inputs from herbicide-resistant populations, and successfully pulled common lambsquarters left on the ground produced thousands of viable seeds.
To evaluate long-term efficacy of deutetrabenazine in patients with tardive dyskinesia (TD) by examining response rates from baseline in Abnormal Involuntary Movement Scale (AIMS) scores. Preliminary results of the responder analysis are reported in this analysis.
In the 12-week ARM-TD and AIM-TD studies, the odds of response to deutetrabenazine treatment were higher than the odds of response to placebo at all response levels, and there were low rates of overall adverse events and discontinuations associated with deutetrabenazine.
Patients with TD who completed ARM-TD or AIM-TD were included in this open-label, single-arm extension study, in which all patients restarted/started deutetrabenazine 12mg/day, titrating up to a maximum total daily dose of 48mg/day based on dyskinesia control and tolerability. The study comprised a 6-week titration and a long-term maintenance phase. The cumulative proportion of AIMS responders from baseline was assessed. Response was defined as a percent improvement from baseline for each patient from 10% to 90% in 10% increments. AlMS score was assessed by local site ratings for this analysis.
343 patients enrolled in the extension study (111 patients received placebo in the parent study and 232 patients received deutetrabenazine). At Week 54 (n=145; total daily dose [mean±standard error]: 38.1±0.9mg), 63% of patients receiving deutetrabenazine achieved ≥30% response, 48% of patients achieved ≥50% response, and 26% achieved ≥70% response. At Week 80 (n=66; total daily dose: 38.6±1.1mg), 76% of patients achieved ≥30% response, 59% of patients achieved ≥50% response, and 36% achieved ≥70% response. Treatment was generally well tolerated.
Patients who received long-term treatment with deutetrabenazine achieved response rates higher than those observed in positive short-term studies, indicating clinically meaningful long-term treatment benefit.
Presented at: American Academy of Neurology Annual Meeting; April 21–27, 2018, Los Angeles, California, USA.
Funding Acknowledgements: This study was supported by Teva Pharmaceuticals, Petach Tikva, Israel.
Metal–insulator–metal (MIM) resonant absorbers comprise a conducting ground plane, a dielectric of thickness t, and thin separated metal top-surface structures of dimension l. The fundamental resonance wavelength is predicted by an analytic standing-wave model based on t, l, and the dielectric refractive index spectrum. For the dielectrics SiO2, AlN, and TiO2, values for l of a few microns give fundamental resonances in the 8-12 μm long-wave infrared (LWIR) wavelength region. Agreement with theory is better for t/l exceeding 0.1. Harmonics at shorter wavelengths were already known, but we show that there are additional resonances in the far-infrared 20 - 50 μm wavelength range in MIM structures designed to have LWIR fundamental resonances. These new resonances are consistent with the model if far-IR dispersion features in the index spectrum are considered. LWIR fundamental absorptions are experimentally shown to be optimized for a ratio t/l of 0.1 to 0.3 for SiO2- and AlN-based MIM absorbers, respectively, with TiO2-based MIM optimized at an intermediate ratio.
Adverse pregnancy outcomes including prematurity and low birth weight (LBW) have been associated with life-long chronic disease risk for the infant. Stress during pregnancy increases the risk of adverse pregnancy outcomes. Many studies have reported the incidence of adverse pregnancy outcomes in Indigenous populations and a smaller number of studies have measured rates of stress and depression in these populations. This study sought to examine the potential association between stress during pregnancy and the rate of adverse pregnancy outcomes in Australian Indigenous women residing in rural and remote communities in New South Wales. This study found a higher rate of post-traumatic stress disorder, depression and anxiety symptoms during pregnancy than the general population. There was also a higher incidence of prematurity and LBW deliveries. Unfortunately, missing post-traumatic stress disorder and depressive symptomatology data impeded the examination of associations of interest. This was largely due to the highly sensitive nature of the issues under investigation, and the need to ensure adequate levels of trust between Indigenous women and research staff before disclosure and recording of sensitive research data. We were unable to demonstrate a significant association between the level of stress and the incidence of adverse pregnancy outcomes at this stage. We recommend this longitudinal study continue until complete data sets are available. Future research in this area should ensure prioritization of building trust in participants and overestimating sample size to ensure no undue pressure is placed upon an already stressed participant.
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.
The objective of this WSSA Weed Loss Committee report is to provide quantitative data on the potential yield loss in sugar beet due to weed interference from the major sugar beet growing areas of the United States and Canada. Researchers and extension specialists who conducted research on weed control in sugar beet in the United States and Canada provided quantitative data on sugar beet yield loss due to weed interference in their regions. Specifically, data were requested from weed control studies in sugar beet from up to 10 individual studies per calendar year over a 15-yr period between 2002 and 2017. Data collected indicated that if weeds are left uncontrolled under optimal agronomic practices, growers in Idaho, Michigan, Minnesota, Montana, Nebraska, North Dakota, Ontario, Oregon, and Wyoming would potentially lose an average of 79%, 61%, 66%, 68%, 63%, 75%, 83%, 78%, and 77% of the sugar beet yield. The corresponding monetary loss would be approximately US$234, US$122, US$369, US$43, US$40, US$211, US$12, US$14, and US$32 million, respectively. The average yield loss due to weed interference for the primary sugar beet growing areas of North America was estimated to be 70%. Thus, if weeds are not controlled, growers in the United States would lose approximately 22.4 million tonnes of sugar beet yield valued at approximately US$1.25 billion, and growers in Canada would lose approximately 0.5 million tonnes of sugar beet yield valued at approximately US$25 million. The high return on investment in weed management highlights the importance of continued weed science research for sustaining high crop yield and profitability of sugar beet production in North America.