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Consumption of fruits and vegetables has been shown to contribute to mental and cognitive health in older adults from Western industrialized countries. However, it is unclear whether this effect replicates in older adults from non-Western developing countries. Thus, the present study examined the contribution of fruit and vegetable consumption to mental and cognitive health in older persons from China, India, Mexico, Russia, South Africa and Ghana.
Representative cross-sectional and cross-national study.
We used data from the WHO Study on Global Ageing and Adult Health (SAGE), sampled in 2007 to 2010. Our final sample size included 28 078 participants.
Fruit and vegetable consumption predicted an increased cognitive performance in older adults including improved verbal recall, improved delayed verbal recall, improved digit span test performance and improved verbal fluency; the effect of fruit consumption was much stronger than the effect of vegetable consumption. Regarding mental health, fruit consumption was significantly associated with better subjective quality of life and less depressive symptoms; vegetable consumption, however, did not significantly relate to mental health.
Consumption of fruits is associated with both improved cognitive and mental health in older adults from non-Western developing countries, and consumption of vegetables is associated with improved cognitive health only. Increasing fruit and vegetable consumption might be one easy and cost-effective way to improve the overall health and quality of life of older adults in non-Western developing countries.
Leishmania kinetoplast DNA contains thousands of small circular molecules referred to as kinetoplast DNA (kDNA) minicercles. kDNA minicircles are the preferred targets for sensitive Leishmania detection, because they are present in high copy number and contain conserved sequence blocks in which polymerase chain reaction (PCR) primers can be designed. On the other hand, the heterogenic nature of minicircle networks has hampered the use of this peculiar genomic region for strain typing. The characterization of Leishmania minicirculomes used to require isolation and cloning steps prior to sequencing. Here, we show that high-throughput sequencing of single minicircle PCR products allows bypassing these laborious laboratory tasks. The 120 bp long minicircle conserved region was amplified by PCR from 18 Leishmania strains representative of the major species complexes found in the Neotropics. High-throughput sequencing of PCR products enabled recovering significant numbers of distinct minicircle sequences from each strain, reflecting minicircle class diversity. Minicircle sequence analysis revealed patterns that are congruent with current hypothesis of Leishmania relationships. Then, we show that a barcoding-like approach based on minicircle sequence comparisons may allow reliable identifications of Leishmania spp. This work opens up promising perspectives for the study of kDNA minicercles and a variety of applications in Leishmania research.
Trypanosoma evansi, the causative agent of surra, is widespread in domestic livestock and wildlife in South East Asia. Surra can affect cattle, buffaloes, horses and also Asian elephants (Elephas maximus). Despite the ‘threatened to extinction’ CITES status of elephant, surra's impact has not been thoroughly assessed yet in this species. This work offers to adapt an antibody enzyme-linked immunosorbent assay (ELISA) protocol, to detect Trypanosoma evansi antibodies in elephant serum. The test was validated with 365 negative-reference samples, which allowed the determination of a 16% positive threshold. The test was applied to a serological survey including 375 individuals. The estimated global seroprevalence was 2·1% (95% CI 1·1–4·2%). Therefore, surra does not appear to be endemic in Thai domestic elephants, but occasional outbreaks were reported to our laboratory during the survey period. These outbreaks seemed to be linked to close proximity to cattle or buffaloes, and led to severe clinical signs in elephants. Frequent relapses were observed after treatment with diminazene aceturate, the only trypanocide drug currently available in Thailand. Therefore, care should be taken to keep elephants away from bovine reservoirs, and to monitor the disease in this endangered species. ELISA proved to be reliable for screening purposes as well as for post-treatment monitoring.
Thoracic trauma, whether blunt or penetrating, is the leading cause of death in trauma victims in Europe and North America after injuries to the head and spinal cord. The proportion of penetrating trauma varies geographically. In Europe, the incidence of penetrating trauma is generally lower (about 10%) than in the United States (about 20%). While blunt trauma frequently leads to respiratory compromise with hypoxia, hypercarbia and acidosis, penetrating forces often result in a certain degree of blood loss and occasionally in life-threatening, exsanguinating injuries to the heart and great vessels. The majority of traumatic chest injuries can be managed by airway control and placement of a chest tube.
After elucidating some general aspects of blunt and penetrating injuries to the chest, the diagnosis and management of specific injuries are discussed.
Blunt chest trauma
Blunt injury to the thorax directly accounts for approximately 25% of trauma-related mortality and is a major contributor in another more than 25% of deaths, as it is often associated with trauma to the abdomen and particularly the head. In-hospital mortality rates for isolated blunt chest injuries are in the range of 1–2%. The most important causes of blunt chest trauma in Europe and Northern America include traffic accidents, followed by violence. Fortunately, approximately 90% of blunt chest injuries can be managed non-operatively by appropriate analgesia, tube thoracostomy and aggressive respiratory therapy, eventually including endotracheal intubation and mechanical ventilation. Emergency thoracotomy is rarely required (in about 2%) in blunt thoracic trauma victims and is generally only indicated in patients suffering from cardiac arrest due to pericardial tamponade and in situations of a witnessed cardiac arrest in the emergency department.
Important details, which should be obtained in the patient's clinical history in order to raise suspicion of specific injuries, are the mechanism (fall/car crash, height/velocity) and time of injury as well as cardiopulmonary co-morbidities. As direct impacts over the thorax may lead to rib fractures (including flail chest), pulmonary and cardiac contusions, high-velocity impacts with simultaneous presence of a closed glottis may even cause bronchial disruption. In addition, impacts on the abdomen lead to associated injuries of abdominal organs and may cause diaphragmatic rupture due to a sudden rise in intra-abdominal pressure. Rapid deceleration (fall from height, car crash) can lead to aortic rupture as well as tracheobronchial injuries as a result of antero-posterior compression of the chest.
Qualitative historical knowledge is essential for validating natural experiments. Specifically, the validity of a natural experiment depends on the historical processes of treatment assignment and administration, including broader macro-historical dynamics. But if validating a natural experiment requires trust in the ability of qualitative evidence to establish the causal processes through which the data were generated, there is no good reason for natural experiments to be considered epistemically superior to historical research. To the contrary, the epistemic status of natural experiments is on a par with that of the historical research on which their validation depends. They are two modes of social-scientific explanation, each with its own pros and cons; neither is privileged. We illustrate this argument by re-examining an important recent contribution to the literature on violent conflict: Ferwerda and Miller’s 2014 natural experiment estimating the causal effect of the German decision to devolve authority to the Vichy French government on violent resistance during World War II.
The most commonly used statistical models of civil war onset fail to correctly predict most occurrences of this rare event in out-of-sample data. Statistical methods for the analysis of binary data, such as logistic regression, even in their rare event and regularized forms, perform poorly at prediction. We compare the performance of Random Forests with three versions of logistic regression (classic logistic regression, Firth rare events logistic regression, and L1-regularized logistic regression), and find that the algorithmic approach provides significantly more accurate predictions of civil war onset in out-of-sample data than any of the logistic regression models. The article discusses these results and the ways in which algorithmic statistical methods like Random Forests can be useful to more accurately predict rare events in conflict data.
Exogenous enzymes are commonly added to poultry diets to improve nutrient utilisation, reduce excretion of nutrients into the environment as well as to improve zootechnical performance and reduce the cost of production. A series of four experiments were conducted in broilers to determine the efficacy and tolerance to an enzyme product (Vegpro™) containing protease and xylanase activities in wheat-soybean meal (SBM) diets fed to broilers from 1 to 39 or 42 d of age. Collectively, four experiments tested the following exogenous protease activity levels in wheat-SBM diet at levels of 0, 2,500, 5,000, 10,000, 20,000, 30,000, 40,000 or 100,000 HUT/kg of feed. Analysis of the four experiments together confirmed that Vegpro™ improved average daily gain and feed conversion ratio, especially in birds up to 21 d of age. Overall, inclusion of Vegpro™ to broiler diets at 10,000 HUT protease per kg of feed was shown to provide the maximum performance benefit (i.e. weight gain and feed conversion ratio). An exceptionally high protease activity (100,000 HUT/kg, ten times the manufacturer's recommended inclusion rate) was well tolerated and did not adversely affect the measured health and performance indicators from 1 to 42 d of age.
To identify predictors of good outcome in acute basilar artery occlusion (BAO).
Acute ischemic stroke (AIS) caused by BAO is often associated with a severe and persistent neurological deficit and a high mortality rate.
The set consisted of 70 consecutive AIS patients (51 males; mean age 64.5±14.5 years) with BAO. The role of the following factors was assessed: baseline characteristics, stroke risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, estimated time to therapy procedure initiation, treatment method, recanalization rate, change in neurological deficit, post-treatment imaging findings. 30- and 90-day outcome was assessed using the modified Rankin scale with a good outcome defined as a score of 0–3.
The following statistically significant differences were found between patients with good versus poor outcomes: mean age (54.2 vs. 68.9 years; p=0.0001), presence of arterial hypertension (52.4% vs. 83.7%; p=0.015), diabetes mellitus (9.5% vs. 55.1%; p=0.0004) and severe stroke (14.3% vs. 65.3%; p=0.0002), neurological deficit at time of treatment (14.0 vs. 24.0 median of National Institutes of Health Stroke Scale [NIHSS] points; p=0.001), successful recanalization (90.0% vs. 54.2%; p=0.005), change in neurological deficit (12.0 vs. 1.0 median difference of NIHSS points; p=0.005). Stepwise binary logistic regression analysis identified age (OR=0.932, 95% CI=0.882–0.984; p=0.012), presence of diabetes mellitus (OR=0.105, 95% CI=0.018–0.618; p=0.013) and severe stroke (OR=0.071, 95% CI=0.013–0.383; p=0.002) as significant independent negative predictors of good outcome.
In the present study, higher age, presence of diabetes mellitus and severe stroke were identified as significant independent negative predictors of good outcome.
Ammonia production in commercial poultry sheds poses a problem for farmers as high levels can affect animal's respiratory health, resulting in hock and foot pad lesions and thereby affecting performance. A study was conducted to evaluate the suitability of whole, chopped and dried Yucca schidigera (De-Odorase™, Alltech Inc, USA) to reduce ammonia excretion from broilers and investigate the impact on broiler performance. Nine hundred and two, one-day-old Cobb broilers were randomly assigned to one of two diets, without (control) or supplemented with 500 g/t De-Odorase™. Birds fed the treatment diet had significantly higher body weight (P < 0.05) at 42 d and improved FCR (P < 0.05). Significant reductions in ammonia from litter were reported at 37 and 42 days old (P < 0.05 and P < 0.1, respectively). No significant differences were seen in foot pad, gait score, feather score or carcass data; although the birds fed De-Odorase™ had consistent numerical improvements in these parameters. The results of this study suggest that feeding whole, chopped and dried Yucca schidigera as a functional ingredient in the diet can be part of an ammonia management programme to improve broiler welfare and zootechnical performance.
The primary aim of this study was to compare the sleep macroarchitecture of children and adolescents whose mothers have a history of depression with children and adolescents whose mothers do not.
Polysomnography (PSG) and Holter electroencephalogram (EEG) were used to compare the sleep architecture of 35 children whose mothers had at least one previous depressive episode (19 boys, aged 4–18 years, “high-risk” group) and 25 controls (13 males, aged 4–18 years, “low-risk” group) whose mothers had never had a depressive episode. The total sleep time, wakefulness after sleep onset (WASO), sleep latency, sleep efficiency, number of awakenings per hour of sleep, percentages of time spent in each sleep stage, rapid eye movement (REM) latency and the depressive symptoms of participants were measured.
In children (4–12 years old), the high-risk group exhibited significantly more depressive symptoms than controls (P = 0.02). However, PSG parameters were not significantly different between high-risk children and controls. In adolescents (13–18 years old), the high-risk subjects presented with significantly more depressive symptoms (P = 0.003), a significant increase in WASO (P = 0.019) and a significant decrease in sleep efficiency compared to controls (P = 0.009).
This study shows that children and adolescents born from mothers with a history of at least one depressive episode had significantly more depressive symptoms than controls. However, only high-risk adolescents presented with concurrent alterations of sleep macroarchitecture.
The globalised world offers companies opportunities to capitalise on global labour markets: production can be organised globally in proprietary businesses or by means of an elaborate supply chain. However, the transnational organisation of business activities can also entail substantial risks. Both the press and the public have increasingly taken an interest in events that occur in far-off parts of the world and these incidents can turn into risks in consumer markets in industrialised nations. Just imagine the following scenario: the Clean Clothes Campaign claims that, according to accounts by female workers, a Central American textile producer was locking pregnant women in the cafeteria as punishment for failing to reach their production targets. The factory was closed in 2005 after being unionised. Whilst these allegations are being heard in the courts of the Central American country in which they occurred (in cases brought by, among others, the local trade union), they have simultaneously reached the attention of the German public, because the textile producer in question supplies a sportswear company based in Germany. Human rights groups such as the Clean Clothes Campaign (but also the local union and a local women's association) have invoked, among other things, the German sportswear company's code of conduct, which guarantees compliance with national laws, protection against discrimination and freedom of association.
That rebels face a collective action problem is one of the most widely shared assumptions in the literature on civil wars. The authors argue that the collective action paradigm can be both descriptively inaccurate and analytically misleading when it comes to civil wars. They question both pillars of the paradigm as applied to the study of civil wars, namely, the free-riding incentive generated by the public goods dimension of insurgency and the risks of individual participation in insurgent collective action. The authors argue, instead, that although insurgent collective action may entail the expectation of future collective benefits, public (rather than just private) costs tend to predominate in the short term. Moreover, the costs of nonparticipation and free riding may equal or even exceed those of participation. The authors support these claims by triangulating three types of evidence: historical evidence from counterinsurgency operations in several civil wars; data from the Vietnam War's Phoenix Program; and regional evidence from the Greek Civil War. They conclude by drawing implications for the study of civil wars.
Losses of pigs (dead and non-ambulatory) during transport are of great concern from both animal welfare and also economic perspectives. Based on several field studies, we have reported the incidence of transport losses in market weight pigs to be ~1% (Ellis et al. , 2003). Transport losses can be influenced by numerous factors including genetics, carcass muscling, health status, structural soundness, live weight, nutrition, handling, facility design, and conditions during transport to the plant. Few, if any, of these factors have been examined under typical commercial conditions. Floor space on the trailer during transport is a potential contributing factor that can be easily changed by varying the number of pigs placed on the truck and represents a simple approach to managing transport losses. The objective of this study was to investigate effects of two floor spaces (0.39 and 0.48 m2/pig) during transport, that represent the range currently being used in commercial practice in the U.S., on the incidence of dead and non-ambulatory pigs and to evaluate relationships between transport conditions and transport losses.
Three xylanase products, xylanase A derived from Thermomyces lanuginosus, xylanase B from Humicola insolens and xylanase C from Aspergillus aculeatus, were examined for their effects on the nutritive value of wheat. The study investigated the effects of enzyme addition to broiler diets based on a low-metabolisable-energy (ME) wheat and a normal-ME wheat, with the emphasis on changes in composition of the NSP along the digestive tract in broiler chickens. There were significant (P>0·01) enzyme and wheat effects on the apparent ME, but there was no wheat×enzyme interaction on apparent ME. Weight gain and feed conversion efficiency (except xylanase C for normal wheat) were also significantly (P>0·01) increased by the xylanases. The enzymes differed in their effect on a number of important nutritional parameters. Xylanase A reduced (P>0·05) the excreta moisture level from 77·1% in birds fed the normal-ME wheat control to 73·4% and from 77·4% in those fed the low-ME wheat to 73·0%. The other two enzymes did not affect excreta moisture levels. The digesta viscosity in the duodenum, jejunum and ileum of birds fed both types of wheat was reduced (P>0·01) by xylanases A and C, but was increased (P>0·01) in the jejunum and ileum by xylanase B. The digestibility of the soluble NSP was mostly negative in the small intestine. The digestibility of the insoluble NSP differed (P>0·01) between the two wheats, with those in the low-ME wheat being more digestible (14 v. 28%). When supplemented with xylanase A, the ileal digestibility of the insoluble NSP in the normal- and low-ME wheats was increased by 28 and 42?%, respectively. Xylanases B and C did not affect the digestibility of the insoluble NSP regardless of wheat type. It may be concluded that wheats with low or normal ME values vary in their responses to xylanase supplementation. Apart from having an elevated level of soluble NSP, low-ME wheat may also contain insoluble NSP, which in the present study appeared to be more easily degradable in the gut of the chicken.
The insurance industry is not known for risk-taking – and with good reason. Our job is to help our customers avoid risk; this is the cornerstone of our business and everything we do. For us, taking a conservative approach is not a choice so much as a calling.
I understand this style of doing business because I come from a long line of insurance people. My grandmother was an Aetna employee in the 1970s. My father, my uncle, and my aunt worked in insurance. We were an insurance family. So, after college, I worked in various aspects of the business myself, from medical cost containment to workers' compensation.
When I was hired to manage the CIGNA Technology Institute (CTI), an education-focused organization that helps CIGNA implement technology and ensures that all employees use technology productively, I knew I would be facing a big challenge. CIGNA, a leading provider of employee benefits in the United States, with a workforce of 40,000, established CTI in 2001. As I took over the leadership of CTI, I realized that not only would I need to find ways to encourage innovation within the confines of the tradition on which our company thrives, but I would have to do this while meeting the demands of a highly regulated environment.
In this chapter I describe how we at CIGNA have tried to achieve a balance between innovation and conservatism, between helping employees do their best work and helping them and the organization observe important guidelines.
Before September 11, 2001, a mass-casualty terrorist attack on American soil was generally considered a remote possibility. Similarly, before October 4, 2001—the first confirmed case of anthrax caused by intentional release — widespread bioterrorism seemed implausible. Among the arguments that such a biological artack was unlikely included: the lack of a historical precedent; the technological and organizational challenges to acquiring and weaponizing a biological agent; and the almost universal moral opprobrium that would certainly accompany the use by terrorists of such a weapon. In the wake of September 11th and October 4th, however, many are reconsidering the likelihood of a large-scale bioterrorist attack against civilians.
The Centers for Disease Control and Prevention (CDC) defines bioterrorism as the intentional release of viruses, bacteria, or toxins for the purpose of harming or killing civilian. One measurement of the public health system's level of bioterrorism preparedness is the quality and distribution of laws mandating the reporting of diseases caused by certain biological agents.
An 11-year-old boy's epileptic seizures started with a feeling of impending crisis, dizziness, headache, and a bad taste in the mouth. This was followed by swallowing and a burning sensation in the left hand. At the same time, other parts of the body experienced allodynia. MRI and CT scans showed a right anteromesial temporal lesion which proved at neuropathology to be a ganglioglioma. Lesionectomy resulted in complete cessation of seizures. Seizures were absent at an 18-month follow-up. Allodynia is discussed in relation to the locality of the lesion.