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This chapter seeks to give an overview of the place of Quality Management (QM) in contemporary fertility practice. It provides the reader with an understanding of the terminology used in QM and explores the definition of quality and success in fertility care. An examination of process modelling in the organisation of services is outlined and an analysis in practical terms as to how QM is applied in practice is provided, covering key issues such as document control, organisational structure and the role of the quality manager. Audit as a tool for improving quality is a fundamental tool and its use within a clinical governance framework including risk management/assessment, and other key responsibilities is detailed. Measuring what we do, analysing performance and setting targets to improve should be fundamental to how we approach our work in contemporary clinical practice.
Trepanning of the bone is one of the oldest known procedures carried out by man and the use of the modern trephine biopsy has a venerable history. Parapia has published an admirable summary of the history of the topic and this should be consulted for the excellent illustrations of historical instruments . The history is briefly summarized here . Trepanning of the skull is the oldest known surgical procedure in humans and evidence of this practice has been found in Europe, North Africa, South America, Asia and New Zealand. In Peru, where the procedure is likely to have been carried out to treat headache, mental illness and to relieve intracranial pressure, sharp knives of obsidian, stone and bronze were used for trephination. Celsus, the Roman physician, described a modiolus – an iron instrument with a serrated cylinder that was rotated over a central pin by means of a strap. The early interventions were therapeutic and the first diagnostic biopsy was undertaken in Pianese in Italy in 1903. In 1922, Morris and Falconer used a drill-like instrument to biopsy the tibia, producing similar specimens to modern biopsies and, in the same year, Seyfarth developed a puncture needle for open biopsy of the sternum, producing smears, touch preparations and blocks for sectioning. The modern era probably began in 1958 when McFarland and Dameshek described a technique for biopsy of the right posterior iliac crest using a Silverman needle, which had been described in 1938. Further improvements followed, with modified instruments described by Jamshidi in 1971 and an electric drill technique by Burkhardt in 1971. Recent developments are described later in the chapter.
To date, all human studies of mass-casualty decontamination for chemical incidents have relied on the collection and analysis of external samples, including skin and hair, to determine decontamination efficacy. The removal of a simulant contaminant from the surface of the body with the assumption that this translates to reduced systemic exposure and reduced risk of secondary contamination has been the main outcome measure of these studies. Some studies have investigated systemic exposure through urinary levels of simulant metabolites. The data obtained in these studies were confounded by high background concentrations from dietary sources. The unmetabolized simulants have never been analyzed in urine for the purposes of decontamination efficacy assessment.
Urinary simulant analysis could obviate the need to collect skin or hair samples during decontamination trials and provide a better estimate of both decontamination efficacy and systemic exposure. The study objective therefore was to determine whether gross skin contamination as part of a decontamination study would yield urine levels of simulants sufficient to evaluate systemic availability free from dietary confounders.
In this study, a gas chromatography-tandem mass spectrometry method was developed for the analysis of two chemical simulants, methyl salicylate (MeS) and benzyl salicylate (BeS), in urine. An extraction and sample clean-up method was validated, enabling quantitation of these simulants in urine. The method was then applied to urine collected over a 24-hour period following simulant application to the skin of volunteers.
Both MeS and BeS were present in all urine samples and were significantly increased in all post-application samples. The MeS levels peaked one hour after skin application. The remaining urinary levels were variable, possibly due to additional MeS exposures such as inhalation. In contrast, the urinary excretion pattern for BeS was more typical for urinary excretion curves, increasing clearly above baseline from four hours post-dose and peaking between 12.5 and 21 hours, a pattern consistent with dermal absorption and rapid excretion.
The authors propose BeS is a useful simulant for use in decontamination studies and that its measurement in urine can be used to model systemic exposures following skin application and therefore likely health consequences.
Chinese sturgeon (Acipenser sinensis) is an endangered species, listed as a grade I protected animal in China. The females rarely successfully develop their gonads from stage II to III in captivity, which handicaps the propagation of cultured Chinese sturgeon. The present study aimed to understand the effects of dietary lipid level on the ovarian development and the related regulation mechanism in female Chinese sturgeon. A 24-month feeding trial was conducted with 10-year-old Chinese sturgeons with ovaries at the developmental stage II, with three experimental diets containing 10, 14 and 18 % lipids. Ovary, muscle and serum samples were collected at four time points (6, 12, 18 and 24 months) for further analyses. Serum metabolomics and ovary transcriptomics analyses were conducted at 18 months. Results showed that only the 18 % lipid diet promoted ovary development to stage IV. Oocytes at stage II in this group also exhibited higher diameter and more lipid droplets. Serum TAG content in the 18 % group was significantly higher than in 10 and 14 % groups (both at 12 and 18 months). Oestradiol content in the 14 % group was significantly higher than in 10 and 18 % groups, except at 24 months. Metabolomic and transcriptomic results indirectly indicated that 14 % of dietary lipids benefited steroid hormone synthesis, while 18 % lipid facilitated arachidonic acid metabolism, cholesterol biosynthesis and vitellogenesis, although serum cholesterol content did not vary with dietary lipid level. In conclusion, 18 % dietary lipid is the optimal level for improving gonad development of female Chinese sturgeon.
Contrary to popular belief, states long have played crucial policy-making roles in the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps). The goals of state involvement has evolved as various interest groups have gained and lost power and as those groups’ attention to SNAP has risen or fallen. In the program’s early days, many states saw themselves as disciplinarians of the poor, anxious to keep food assistance from dampening low-income people’s willingness to perform hard labor for small wages. As agriculture mechanized and urban areas asserted greater power in state politics, states shifted to seeking to maximizing federal SNAP funding, both for themselves and for low-income households. The federal quality control (QC) system pitted state administrators’ interests against those of recipient households. It also led to two decades of strife between states and federal administrators, destabilizing the program. More recently, right-wing groups have sought to make state SNAP policy a vehicle for ideological warfare. The American Legislative Exchange Council (ALEC) and allied groups have won passage of legislation requiring states to adopt options that deny food assistance to many low-income households in genuine need.
Folic acid (FA) supplementation is recommended in the periconceptional period, for the prevention of neural tube defects. Limited data are available on the folate status of New Zealand (NZ) pregnant women and its association with FA supplementation intake. Objectives were to examine the relationship between plasma folate (PF) and reported FA supplement use at 15 weeks’ gestation and to explore socio-demographic and lifestyle factors associated with PF. We used data and blood samples from NZ participants of the Screening for Pregnancy Endpoints cohort study. Healthy nulliparous women with singleton pregnancy (n 1921) were interviewed and blood samples collected. PF was analysed via microbiological assay. Of the participants, 73 % reported taking an FA supplement at 15 weeks’ gestation – of these, 79 % were taking FA as part of/alongside a multivitamin supplement. Of FA supplement users, 56 % reported consuming a daily dose of ≥800 μg; 39 % reported taking less than 400 µg/d. Mean PF was significantly higher in women reporting FA supplementation (54·6 (se 1·5) nmol/l) v. no FA supplementation (35·1 (se 1·6) nmol/l) (P<0·0001). Reported daily FA supplement dose and PF were significantly positively correlated (r 0·41; P<0·05). Younger maternal age, Pacific and Maori ethnicity and obesity were negatively associated with PF levels; vegetarianism was positively associated with PF. Reported FA supplement dose was significantly associated with PF after adjustment for socio-demographic, lifestyle confounders and multivitamin intake. The relationship observed between FA supplementation and PF demonstrates that self-reported intake is a reliable proxy for FA supplement use in this study population.
Medical registries are frequently used to generate quality measures with the objective of improving the provision of medical care. Assisted reproductive technology (ART) registries can be used in this manner even if they were initially created for other purposes. Aggregate registry outcomes can be used for internal benchmarking purposes by individual programs. This data can also be used for external Quality Assurance purposes to identify programs that are outliers (low success rates or high multiple gestation rates). Collection of detailed cycle specific information allows benchmarking of process measures that can allow easy identification of specific areas for improvement. Ongoing, daily collection and reporting of key performance indicators (e.g. fertilization rates, embryo development rates) can be used to produce Shewart type control charts to promptly identify and remediate issues that could ultimately result in low birth rates or high risk of multiple gestation.
This work reports our study to commission a radiochromic film dosimetry system using the timely EBT3 film. We carried out dosimetric evaluations on different characteristics of photon beams (e.g., flatness, symmetry and penumbra) in radiation dose delivery.
Materials and Methods
A Varian linear accelerator producing 6 and 15 MV photon beams with 120 multi-leaf collimator was used in this study. PTW ionisation chamber was used to measure the beam characteristics such as symmetry, flatness and penumbra and these measurements were used to commission the radiochormic EBT3 film dosimetry system. The results of irradiated films were analysed using the radiochromic film QA Pro software 2016.
The measured film doses were analysed at two different colour channels (green and red) using two scanning geometries (i.e., upper or lower side of film facing the scanner light source) at two dose levels (10 and 40 Gy). The difference between the ionisation chamber and film results was found insignificant and within the acceptable range as per the World Health Organisation standard.
Results of the comparison between the ionisation chamber and film measurements show that our radiochormic EBT3 film dosimetry system is reliable and cost-effective in the output measurement of a linear accelerator. Our measurements confirm that our EBT3 film dosimetry agreed well with the ionisation chamber, and can be used as a re-validation tool for linear accelerator quality control.
Consumption of diets containing medium-chain TAG (MCT) has been shown to confer neuroprotective effects. We aim to identify the global metabolic perturbations associated with consumption of a ketogenic diet (medium-chain TAG diet (MCTD)) in dogs with idiopathic epilepsy. We used ultra-performance liquid chromatography-MS (UPLC-MS) to generate metabolic and lipidomic profiles of fasted canine serum and made comparisons between the MCTD and standardised placebo diet phases. We identified metabolites that differed significantly between diet phases using metabolite fragmentation profiles generated by tandem MS (UPLC–MS/MS). Consumption of the MCTD resulted in significant differences in serum metabolic profiles when compared with the placebo diet, where sixteen altered lipid metabolites were identified. Consumption of the MCTD resulted in reduced abundances of palmitoylcarnitine, octadecenoylcarnitine, stearoylcarnitine and significant changes, both reduced and increased abundances, of phosphatidylcholine (PC) metabolites. There was a significant increase in abundance of the saturated C17 : 0 fatty acyl moieties during the MCTD phase. Lysophosphatidylcholine (17 : 0) (P=0·01) and PC (17:0/20:4) (P=0·03) were both significantly higher in abundance during the MCTD. The data presented in this study highlight global changes in lipid metabolism, and, of particular interest, in the C17 : 0 moieties, as a result of MCT consumption. Elucidating the global metabolic response of MCT consumption will not only improve the administration of current ketogenic diets for neurological disease models but also provides new avenues for research to develop better diet therapies with improved neuroprotective efficacies. Future studies should clarify the involvement and importance of C17 : 0 moieties in endogenous MCT metabolic pathways.
Vitamin D deficiency is a common occurrence globally, and particularly so in pregnancy. There is conflicting evidence regarding the role of vitamin D during pregnancy in non-skeletal health outcomes for both the mother and the neonate. The aim of this study was to investigate the associations of maternal total 25-hydroxy vitamin D (25OHD) with neonatal anthropometrics and markers of neonatal glycaemia in the Belfast centre of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study. Serological samples (n 1585) were obtained from pregnant women in the Royal Jubilee Maternity Hospital, Belfast, Northern Ireland, between 24 and 32 weeks’ gestation as part of the HAPO study. 25OHD concentrations were measured by liquid chromatography tandem-MS. Cord blood and neonatal anthropometric measurements were obtained within 72 h of birth. Statistical analysis was performed. After adjustment for confounders, birth weight standard deviation scores (SDS) and birth length SDS were significantly associated with maternal total 25OHD. A doubling of maternal 25OHD at 28 weeks’ gestation was associated with mean birth weight SDS and mean birth length SDS higher by 0·05 and 0·07, respectively (both, P=0·03). There were no significant associations with maternal 25OHD and other measures of neonatal anthropometrics or markers of neonatal glycaemia. In conclusion, maternal total 25OHD during pregnancy was independently associated with several neonatal anthropometric measurements; however, this association was relatively weak.
Breast milk is the only source of the essential amino acid tryptophan (TRP) in breast-fed infants. Low levels of TRP could have implications for infant neurodevelopment. The objectives of the present study were to compare the relationship of TRP and its neuroactive pathway metabolites kynurenine (Kyn) and kynurenic acid (KynA) in preterm and term expressed breast milk (EBM) in the first 14 d following birth, and the relationship of TRP metabolism to maternal stress and immune status. A total of twenty-four mothers were recruited from Cork University Maternity Hospital: twelve term (>38 weeks) and twelve preterm (<35 weeks). EBM samples were collected on days 7 and 14. Free TRP, Kyn and KynA were measured using HPLC, total TRP using MS, cytokines using the Meso Scale Discovery (MSD) assay system, and cortisol using a cortisol ELISA kit. Although total TRP was higher in preterm EBM in comparison with term EBM (P < 0·05), free TRP levels were lower (P < 0·05). Kyn, KynA and the Kyn:TRP ratio increased significantly in term EBM from day 7 to day 14 (P < 0·05), but not in preterm EBM. TNF-α, IL-6 and IL-8 were higher in day 7 preterm and term EBM in comparison with day 14. There were no significant differences between term and preterm EBM cortisol levels. Increased availability of total TRP, lower levels of free TRP and alterations in the temporal dynamics of TRP metabolism in preterm compared with term EBM, coupled with higher EBM inflammatory markers on day 7, may have implications for the neurological development of exclusively breast-fed preterm infants.
High flavonoid consumption can improve vascular health. Exploring flavonoid–metabolome relationships in population-based settings is challenging, as: (i) there are numerous confounders of the flavonoid–metabolome relationship; and (ii) the set of dependent metabolite variables are inter-related, highly variable and multidimensional. The Metabolite Fingerprint Score has been developed as a means of approaching such data. This study aims to compare its performance with that of more traditional methods, in identifying the metabolomic fingerprint of high and low flavonoid consumers. This study did not aim to identify biomarkers of intake, but rather to explore how systemic metabolism differs in high and low flavonoid consumers. Using liquid chromatography–tandem MS, 174 circulating plasma metabolites were profiled in 584 men and women who had complete flavonoid intake assessment. Participants were randomised to one of two datasets: (a) training dataset, to determine the models for the discrimination variables (n 399); and (b) validation dataset, to test the capacity of the variables to differentiate higher from lower total flavonoid consumers (n 185). The stepwise and full canonical variables did not discriminate in the validation dataset. The Metabolite Fingerprint Score successfully identified a unique pattern of metabolites that discriminated high from low flavonoid consumers in the validation dataset in a multivariate-adjusted setting, and provides insight into the relationship of flavonoids with systemic lipid metabolism. Given increasing use of metabolomics data in dietary association studies, and the difficulty in validating findings using untargeted metabolomics, this paper is of timely importance to the field of nutrition. However, further validation studies are required.
Bangladesh is a country with a high burden of micronutrient malnutrition. Stunting affects 41 % of children aged under 5 years. Zn is one of the key micronutrients that is associated with stunting. The present study, as part of the national micronutrient survey 2011–2012, revealed for the first time the nationally representative prevalence of Zn deficiency and determined the associations of the condition. A cross-sectional ‘nationwide’ survey was conducted in pre-school-age children (6–59 months; PSAC) and non-pregnant non-lactating women (15–49 years; NPNLW). Multistage random sampling was done in 150 clusters; fifty in each of the rural, urban and slum strata. Data were analysed on 662 PSAC and 1073 NPNLW. Serum Zn was assayed by atomic absorption spectrophotometry. Zn deficiency was defined as serum Zn of <9·9 and <10·1 µmol/l in PSAC and NPNLW, respectively. The national prevalence of Zn deficiency was 44·6 and 57·3 % in PSAC and NPNLW, respectively. In PSAC, it was 29·5, 48·6 and 51·7 %, respectively, in urban, rural and slum strata. Household expenses (β = 0·13; P = 0·007), Hb (β = 0·10; P = 0·005), intake of animal-source Zn (β = 0·096; P = 0·02) and asset score (β = 0·11; P = 0·03) were positively associated with serum Zn in NPNLW. Residence in an urban area (β = 0·33; P = 0·03) and intake of plant-origin Zn (β = −0·13; P = 0·038) determined higher and lower status of Zn in PSAC, respectively. Zn deficiency was highly prevalent in Bangladesh, and it was principally related to inadequate quality of diet. To improve Zn nutrition, Bangladesh needs to strengthen research and programmes related to Zn biofortification, fortification and phytate-reducing technologies in the food system in the short and medium term. In addition, promotion of animal-source Zn for all is important in the long run.
Quality control of sample material (e.g. charcoal, collagen) is receiving considerable attention in the effort to obtain more reliable 14C dates. The atomic carbon to nitrogen (C:N) ratio is a useful indicator of contamination and/or degradation of bone collagen. Wool and silk are also composed of proteinaceous material such as bone collagen, and the C:N ratio may also be a useful quality indicator for archaeological wool and silk. Analyses of modern undyed, mordanted, non-mordanted, and naturally dyed silk and wool were done in order to determine a C:N range that indicates the sample quality. The C:N range can be different for every material as the amino acid composition of wool, silk, and bone collagen are distinct. The measured minimum and maximum C:N values were used to set up a C:N range of uncontamined and undegraded wool and silk. Then, the C:N ratio and 14C were analyzed of archaeological wool and silk samples. The applicability of the C:N ratio as a quality indicator for archaeological silk and wool was shown by the good agreement of the 14C dates with the presumed historical dates for the uncontaminated samples and the disagreement of the 14C dates with the presumed historical dates for contaminated samples.
In this study, rearing systems for, and the quality and demographic parameters of, a wild strain (WS) and two laboratory strains (LSs; one maintained on a torula yeast-casein diet and the other on a starter-gel diet) were determined for the American guava fruit fly Anastrepha striata (Schiner). No differences were observed between the LSs, but there were significant differences between the LSs and WSs. The LSs had the highest values for larval recovery, pupal weight, egg hatch, number of eggs/female per day, net reproductive rate and intrinsic rate of increase. Therefore, during a short oviposition period, the LSs had a high fecundity. There were no differences in pupation at 24 h and larval weight between the WS and LS. However, the values of parameters, adult emergence, female and male life expectancies, age at first oviposition, oviposition and post-oviposition periods and mean generation time were the highest in the WS.
In this study, new methods to improve the mass production of the Philippines fruit fly Bactrocera philippinensis Drew & Hancock were assessed. A new adult screen cage equipped with perforated egging tubes was designed. The replacement of sweet potato with sugarcane bagasse, rice straw or powdered corn as an alternative bulking agent in the standard artificial larval diet was found to lead to positive results in large-scale rearing. Rearing protocols and product quality control procedures for egg incubation, sieving of pupae and pupal holding were examined. The adoption of these new rearing procedures at low cost was found to increase the production of the Philippines fruit fly in a mass-rearing facility without reducing the fitness of the insect.
Dried leaves of Satureja khuzestanica Jamzad are a popular herbal medicine and dental anesthetic among the nomadic inhabitants of southwestern Iran. The present study establishes criteria for identification of S. khuzestanica dried whole, fragmented and powdered leaves for specification as a herbal substance using macroscopic and microscopic characterization. Quantitative microscopy techniques were also considered. Macroscopically leaves exhibit a grayish-green color, are broadly ovate in shape with an acute apex, attenuate base, and ciliate margin and have a surface covered by an indumentum of glandular and non-glandular trichomes. Microscopically leaves have an isobilateral amphistomatic structure containing peltate glandular trichomes consisting of a multiseriate stalk (five cells) and an enlarged secretory head composed of 12 cells, capitate glandular trichomes of variable morphology together with two types of non-glandular trichomes. Oval-shaped hygromorphic diacytic stomata with an adaxial stomatal index of 13.54, collateral vascular bundles consisting of xylem, and three layers of sclerenchymatous tissue close to phloem together with cluster, prismatic and raphide calcium oxalate crystals were also identified as useful pharmacognostic parameters for identification of S. khuzestanica dried leaves.
The papers presented in this special issue are focused on developing and validating procedures for artificial rearing of selected fruit fly species of economic importance for use in area-wide integrated pest programmes with a sterile insect technique (SIT) component. They are the result of a 5-year coordinated research project (CRP) on ‘Development and Improvement of Rearing Techniques for Anastrepha and Bactrocera Fruit Flies’ that was coordinated by the Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture. Twenty-two CRP participants from 18 countries worked on both basic and advanced rearing procedures of different fruit fly species to overcome technical bottlenecks and to develop appropriate and relevant procedures for use in mass-rearing facilities. A variety of studies were undertaken for three groups of tephritid species: (1) those for which mass-rearing for SIT application was available, but further refinement would be useful; (2) those for which mass-rearing for SIT application was under development in the laboratory, but that had not reached mass-rearing status; and (3) those for which research to develop colonization and rearing methods was needed. Many of the protocols developed or improved during the CRP have been transferred to the different fruit fly mass-rearing facilities worldwide.
Lychee on the European markets.
With approximately 2.8 Mt of annual global production, lychee constitutes
a minor fruit in terms of production. The world production is mainly
located in the northern hemisphere (95%). However, most of the quantity
exported to the EU comes from the southern hemisphere. In this context,
with its 100,000 t of annual production, Madagascar is ranked fourth
in the producing world and first in the southern hemisphere producing
countries. This rank is due to the fact that supplies in the EU
are seasonal and mainly concentrated during the end of the year
holiday season. This market can only be supplied in quantity by
the Malagasy lychee because of its earlier date of harvest in the
Indian Ocean. The lychee industry in Madagascar. Lychee
cultivation in Madagascar dates from the early twentieth century.
It is primarily grown in wet tropical lowlands of the island with
some production in areas with a subtropical climate with dry and
cool winters. The stand is not structured into orchards. Therefore,
the volumes currently exported are based on a stand established
by a multitude of small producers. The characteristics of Malagasy
lychee export and the consequences of the production context on
export are analyzed. Changes in European legislation on lychee
importation. The regulatory changes since 1987 and the commercial developments
since 1994 are reviewed by analyzing the resulting effects on the
Malagasy lychee exports. Learning experience from fifteen
years of Malagasy lychee export campaigns. Data on Malagasy
lychee export campaigns from 1996 to 2012 and the history of the changes
in volumes exported allow a close analysis of the factors affecting
the Malagasy lychee industry. Success factors of the Malagasy
lychee exports. These factors are related to securing market
position and to the components of a marketing campaign (supply date
to the European market, exported volumes and competition from produce
from other countries). Conclusions. Lychees from Madagascar, although
marketed for a very brief period, currently occupy the first rank on
the European markets and have managed, through the development of transport
logistics using very large-capacity cargoes, to eliminate all competition.
However, this sector is mainly structured downstream and its production,
which comprises a network of 30,000 small producers, has been neglected.
This lack of intervention (boosting of production, improving crop management,
etc.) upstream of the chain does not support sustaining the industry
in the medium term.