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Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management
Febrile seizure (FS) in children is a common complication of infections with respiratory viruses and hand, foot and mouth disease (HFMD). We conducted a retrospective ecological time-series analysis to determine the temporal relationship between hospital attendances for FS and HFMD or respiratory virus infections. Epilepsy attendance was used as a control. Data from 2004 to 2012 FS and epilepsy hospital attendance, HFMD notifications to the Ministry of Health and from laboratory-confirmed viral respiratory infections among KK Women's and Children's Hospital inpatients were used. A multivariate linear regression analysis was conducted to evaluate the relationship between FS and the virus time series. Relative risks of FS by age were calculated using Bayesian statistical methods. Paediatric accident and emergency (A&E) attendances for FS were found to be associated with influenza A (extra 0.47 FS per influenza A case), B (extra 0.32 per influenza B case) and parainfluenza 3 (extra 0.35 per parainfluenza type 3 case). However, other viruses were not significantly associated with FS. None of the viruses were associated with epileptic seizure attendance. Influenza A, B and parainfluenza 3 viruses contributed to the burden of FS resulting in A&E attendance. Children at risk of FS should be advised to receive seasonal influenza vaccination.
The role of vegetable and fruit intake in reducing falls risk in elderly populations is uncertain. This study examined the associations of vegetable and fruit intake with falls-related hospitalisations in a prospective cohort study of elderly women (n 1429, ≥70 years), including effects on muscular function, which represented a potential causal pathway. Muscular function, measured using grip strength and timed-up-and-go (TUG), and vegetable and fruit intake, quantified using a validated FFQ, were assessed at baseline (1998). Incident falls-related hospitalisation over 14·5-year follow-up was captured by the Hospital Morbidity Data Collection, linked via the Western Australian Data Linkage System. Falls-related hospitalisation occurred in 568 (39·7 %) of women. In multivariable-adjusted models, falls-related hospitalisations were lower in participants consuming more vegetables (hazard ratio (HR) per 75 g serve: 0·90 (95 % CI 0·82, 0·99)), but not fruit intake (per 150 g serve: 1·03 (95 % CI 0·93, 1·14)). Only total cruciferous vegetable intake was inversely associated with falls-related hospitalisation (HR: per 20 g serve: 0·90 (95 % CI 0·83, 0·97)). Higher total vegetable intake was associated with lower odds for poor grip strength (OR: 0·87 (95 % CI 0·77, 0·97)) and slow TUG (OR: 0·88 (95 % CI 0·78, 0·99)). Including grip strength and TUG in the multivariable-adjusted model attenuated the association between total vegetable intake and falls-related hospitalisations. In conclusion, elderly women with higher total and cruciferous vegetable intake had lower injurious falls risk, which may be explained in a large part by better physical function. Falls reduction may be considered an additional benefit of higher vegetable intake in older women.
The mental health outcomes of military personnel deployed on peacekeeping
missions have been relatively neglected in the military mental health
To assess the mental health impacts of peacekeeping deployments.
In total, 1025 Australian peacekeepers were assessed for current and
lifetime psychiatric diagnoses, service history and exposure to
potentially traumatic events (PTEs). A matched Australian community
sample was used as a comparator. Univariate and regression analyses were
conducted to explore predictors of psychiatric diagnosis.
Peacekeepers had significantly higher 12-month prevalence of
post-traumatic stress disorder (16.8%), major depressive episode (7%),
generalised anxiety disorder (4.7%), alcohol misuse (12%), alcohol
dependence (11.3%) and suicidal ideation (10.7%) when compared with the
civilian comparator. The presence of these psychiatric disorders was most
strongly and consistently associated with exposure to PTEs.
Veteran peacekeepers had significant levels of psychiatric morbidity.
Their needs, alongside those of combat veterans, should be recognised
within military mental health initiatives.
Neisseria meningitidis is a gram-negative bacterium that lives as a commensal in the human nasopharynx. Meningococci are generally non-invasive, but can invade the nasopharyngeal epithelia and enter the bloodstream causing life-threatening illnesses. It is generally thought that meningococci do not survive for long outside the host, and that transmission requires relatively close contact between hosts. There are some reports, however, that meningococci can survive drying on surfaces, including glass, plastic and cloth. Our examination of N. meningitidis strains dried on glass showed differences in survival of isolates belonging to serogroups B, C and W135, including persistence of Cuban, New Zealand, and Norwegian epidemic strains up to 8 days, depending on temperature and humidity. Survival of a New Zealand epidemic strain isolate NZ98/254 under ambient conditions in the laboratory was greatest in winter suggesting that environmental factors impacted survival. For most isolates, including NZ98/254, survival under controlled conditions at 30 °C was greater at 22% than 30% relative humidity. There were also some differences in survival between carriage and invasive strains. The results suggest that N. meningitidis could be transmitted through contact with surfaces outside the host, potentially including contact through shared drinking vessels.
The evidence underpinning the developmental origins of health and disease (DOHaD) is overwhelming. As the emphasis shifts more towards interventions and the translational strategies for disease prevention, it is important to capitalize on collaboration and knowledge sharing to maximize opportunities for discovery and replication. DOHaD meetings are facilitating this interaction. However, strategies to perpetuate focussed discussions and collaborations around and between conferences are more likely to facilitate the development of DOHaD research. For this reason, the DOHaD Society of Australia and New Zealand (DOHaD ANZ) has initiated themed Working Groups, which convened at the 2014–2015 conferences. This report introduces the DOHaD ANZ Working Groups and summarizes their plans and activities. One of the first Working Groups to form was the ActEarly birth cohort group, which is moving towards more translational goals. Reflecting growing emphasis on the impact of early life biodiversity – even before birth – we also have a Working Group titled Infection, inflammation and the microbiome. We have several Working Groups exploring other major non-cancerous disease outcomes over the lifespan, including Brain, behaviour and development and Obesity, cardiovascular and metabolic health. The Epigenetics and Animal Models Working Groups cut across all these areas and seeks to ensure interaction between researchers. Finally, we have a group focussed on ‘Translation, policy and communication’ which focusses on how we can best take the evidence we produce into the community to effect change. By coordinating and perpetuating DOHaD discussions in this way we aim to enhance DOHaD research in our region.
The objective of this study was to evaluate the impact of a brief parenting intervention, ‘Parents Make the Difference‘(PMD), on parenting behaviors, quality of parent-child interactions, children's cognitive, emotional, and behavioral wellbeing, and malaria prevention behaviors in rural, post-conflict Liberia.
A sample of 270 caregivers of children ages 3–7 were randomized into an immediate treatment group that received a 10-session parent training intervention or a wait-list control condition (1:1 allocation). Interviewers administered baseline and 1-month post-intervention surveys and conducted child-caregiver observations. Intent-to-treat estimates of the average treatment effects were calculated using ordinary least squares regression. This study was pre-registered at ClinicalTrials.gov (NCT01829815).
The program led to a 55.5% reduction in caregiver-reported use of harsh punishment practices (p < 0.001). The program also increased the use of positive behavior management strategies and improved caregiver–child interactions. The average caregiver in the treatment group reported a 4.4% increase in positive interactions (p < 0.05), while the average child of a caregiver assigned to the treatment group reported a 17.5% increase (p < 0.01). The program did not have a measurable impact on child wellbeing, cognitive skills, or household adoption of malaria prevention behaviors.
PMD is a promising approach for preventing child abuse and promoting positive parent-child relationships in low-resource settings.
Although post-traumatic stress disorder (PTSD) has been a focus of attention in 1990/1991 Gulf War veterans, the excess risk of depression has not been clearly identified. We investigated this through a systematic review and meta-analysis of studies comparing depression in Gulf War veterans to depression in a comparison group of non-deployed military personnel.
Multiple electronic databases and grey literature were searched from 1990 to 2012. Studies were assessed for eligibility and risk of bias according to established criteria.
Of 14 098 titles and abstracts assessed, 14 studies met the inclusion criteria. Gulf War veterans had over twice the odds of experiencing depression [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.88–2.76] and dysthymia or chronic dysphoria (OR 2.39, 95% CI 2.0–2.86) compared to non-deployed military personnel. This finding was robust in sensitivity analyses, and to differences in overall risk of bias and psychological measures used.
Despite divergent methodologies between studies, depression and dysthymia were twice as common in Gulf War veterans and are important medical conditions for clinicians and policymakers to be aware of in managing Gulf War veterans’ health.
Obesity is increasingly prevalent in bipolar disorder (BD) but data about the impact of elevated body mass index (BMI) on brain white-matter integrity in BD are sparse. Based on extant literature largely from structural magnetic resonance imaging (MRI) studies, we hypothesize that increased BMI is associated with decreased fractional anisotropy (FA) in the frontal, temporal, parietal and occipital brain regions early in the course of BD.
A total of 26 euthymic adults (12 normal weight and 14 overweight/obese) with remitted first-episode mania (FEM) and 28 controls (13 normal weight and 15 overweight/obese) matched for age, handedness and years of education underwent structural MRI and diffusion tensor imaging scans.
There are significant effects of diagnosis by BMI interactions observed especially in the right parietal lobe (adjusted F1,48 = 5.02, p = 0.030), occipital lobe (adjusted F1,48 = 10.30, p = 0.002) and temporal lobe (adjusted F1,48 = 7.92, p = 0.007). Specifically, decreased FA is found in the right parietal (F1,23 = 5.864, p = 0.023) and occipital lobes (F1,23 = 4.397, p = 0.047) within overweight/obese patients compared with normal-weight patients with FEM. Compared with overweight/obese controls, decreased FA is observed in right parietal (F1,25 = 6.708, p = 0.015), temporal (F1,25 = 10.751, p = 0.003) and occipital (F1,25 = 9.531, p = 0.005) regions in overweight/obese patients with FEM.
Our findings suggest that increased BMI affects temporo-parietal-occipital brain white-matter integrity in FEM. This highlights the need to further elucidate the relationship between obesity and other neural substrates (including subcortical changes) in BD which may clarify brain circuits subserving the association between obesity and clinical outcomes in BD.
Energy is essential for human development and energy systems are a crucial entry point for addressing the most pressing global challenges of the 21st century, including sustainable economic, and social development, poverty eradication, adequate food production and food security, health for all, climate protection, conservation of ecosystems, peace, and security. Yet, more than a decade into the 21st century, current energy systems do not meet these challenges.
In this context, two considerations are important. The first is the capacity and agility of the players within the energy system to seize opportunities in response to these challenges. The second is the response capacity of the energy system itself, as the investments are long-term and tend to follow standard financial patterns, mainly avoiding risks and price instabilities. This traditional approach does not embrace the transformation needed to respond properly to the economic, environmental, and social sustainability challenges of the 21st century.
A major transformation is required to address these challenges and to avoid potentially catastrophic consequences for human and planetary systems. The GEA identifies strategies that could help resolve the multiple challenges simultaneously and bring multiple benefits. Their successful implementation requires determined, sustained, and immediate action.
The industrial revolution catapulted humanity onto an explosive development path, whereby reliance on muscle power and traditional biomass was replaced mostly by fossil fuels. In 2005, approximately 78% of global energy was based on fossil energy sources that provided abundant and ever cheaper energy services to more than half the world's population.
Energy is essential for human development and energy systems are a crucial entry point for addressing the most pressing global challenges of the 21st century, including sustainable economic and social development, poverty eradication, adequate food production and food security, health for all, climate protection, conservation of ecosystems, peace and security. Yet, more than a decade into the 21st century, current energy systems do not meet these challenges.
A major transformation is therefore required to address these challenges and to avoid potentially catastrophic future consequences for human and planetary systems. The Global Energy Assessment (GEA) demonstrates that energy system change is the key for addressing and resolving these challenges. The GEA identifies strategies that could help resolve the multiple challenges simultaneously and bring multiple benefits. Their successful implementation requires determined, sustained and immediate action.
Transformative change in the energy system may not be internally generated; due to institutional inertia, incumbency and lack of capacity and agility of existing organizations to respond effectively to changing conditions. In such situations clear and consistent external policy signals may be required to initiate and sustain the transformative change needed to meet the sustainability challenges of the 21st century.
The industrial revolution catapulted humanity onto an explosive development path, whereby, reliance on muscle power and traditional biomass was replaced mostly by fossil fuels. In 2005, some 78% of global energy was based on fossil energy sources that provided abundant and ever cheaper energy services to more than half the people in the world.
Despite the absence of artificial light pollution at Antarctic plateau sites such as Dome A, other factors such as airglow, aurorae and extended periods of twilight have the potential to adversely affect optical observations. We present a statistical analysis of the airglow and aurorae at Dome A using spectroscopic data from Nigel, an optical/near-IR spectrometer operating in the 300–850 nm range. The median auroral contribution to the B, V and R photometric bands is found to be 22.9, 23.4 and 23.0 mag arcsec−2 respectively. We are also able to quantify the amount of annual dark time available as a function of wavelength; on average twilight ends when the Sun reaches a zenith distance of 102.6°.
As it was originally proposed, the extended phenotype comprised ‘all effects of a gene upon the world’ (Dawkins, 1989) and portrayed how the effects of a gene borne by an organism influenced its biotic and abiotic environments. The consideration of indirect genetic effects, in which an organism’s phenotype becomes part of the selective environment of conspecifics (Wolf et al., 1998), was developed rigorously in the population genetics context and the concept subsequently extended to include effects on heterospecifics (Whitham et al., 2003). The extended phenotype concept has been adopted as a framework by some evolutionary biologists and ecologists to study the roles of plant secondary metabolites (PSMs) since Whitham et al. (2003) used heritable variation in tissue tannin concentrations among Populus species and hybrids to develop the concept of community and ecosystem genetics (Antonovics, 1992).
Many studies of how genetically determined variation in plant traits, including PSMs, drive associated community phenotypes and processes, have been based on differences between hybrids (Dungey et al., 2000; Hochwender & Fritz, 2004; Bailey et al., Chapter 14). Fewer studies have investigated the effects on extended phenotypes of continuously varying PSMs or between known genotypes within a species (Whitham et al., 2006; Schweitzer et al., 2008; Barbour et al., 2009; O’Reilly-Wapstra et al., Chapter 2). A convenient approach to identification and utilisation of genotypic variation for the study of multiple effects of PSMs is provided by the use of genetic polymorphisms. A polymorphism can be defined as occurring when a trait such as a morphological or biochemical character exists in two or more distinct forms in a randomly mating population within a species (Ford, 1975). The approach is particularly useful in species that cannot be readily cloned. Here, we review examples of how intra-specific variation in a particular group of PSMs, the monoterpenes, has informed our understanding of how PSMs can play multiple ecological roles and mediate the extended phenotype of plants. The monoterpenes are a group of low-molecular-weight, volatile terpenoids which form a very diverse group in terms of number of compounds, structure and function (Gershenzon & Dudareva, 2007). We use variation within species which are polymorphic for concentrations or presence of monoterpenes to provide an insight into their ecological ramifications and larger-scale consequences, against the background of intra-specific variation in other traits.
Electron traps in ALD and MOCVD HfO2 and HfSiO high-k dielectrics were investigated using both conventional DC and pulse measurements. It was found that the traps in the gate stack could be associated with defects of different activation energies and capture cross-sections. This points to potentially different origins of the electrically active defects, which can be either intrinsic or process-related. Structural non-uniformity of the high-k film, associated with grain formation and phase separation, may lead to variation of electrical properties of the gate dielectric along the transistor channel. Effects of such dielectric non-uniformity, as well as electron trapping, on the measured transistor mobility were evaluated.
Several progenitor scenarios have been suggested for Type Ia supernovae. Here we discuss the consequences for the explosion mechanism and for observables of some of them, which are explored by means of multi-dimensional hydrodynamic and radiation transfer simulations. While the observables predicted from delayed detonations of Chandrasekhar-mass white dwarfs agree reasonably well with the data, the corresponding progenitor systems may be too rare to account for the observed rate of Type Ia supernovae. Several alternatives are investigated of which violent mergers of two white dwarfs and, perhaps, double detonations of sub-Chandrasekhar mass white dwarfs hold promise for reproducing the observables of normal Type Ia supernovae.
We argue that detonations of sub-Chandrasekhar mass white dwarfs can lead to bright explosions with light curves and spectra similar to those of observed Type Ia supernovae. Given that binary systems containing accreting sub-Chandrasekhar mass white dwarfs should be common, this suggests that a non-negligible fraction of the observed Type Ia supernova rate may arise from sub-Chandrasekhar mass explosions, if they can be ignited. We discuss aspects of how such explosions might be realized in nature and both merits and challenges associated with invoking sub-Chandrasekhar mass explosion models to account for observed Type Ia supernovae.