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This study examined adolescents with anorexia nervosa admitted to a tertiary referral unit in Dublin over a 3 year period.The aims of the study were to assess changes if any in patient clinical and laboratory parameters specifically weight change, body mass index (BMI), cardiovascular, haematological and biochemical measurements over the course of in-patient stay.
Hospital computerized databases and clinical case notes were examined for each patient.Results were compared with Royal College of Psychiatrists (RCP) and National Institute for Clinical Evidence (NICE) guidelines for treatment of in-patients with anorexia nervosa.
There were at total of 42 admissions over the 3 years.7 males and 35 females were admitted.Median length of admission was 88 days. Female patients gained on average 7.2 kilograms during their admission.The average female BMI on admission was 14.9 on admission and 17.6 on discharge. 82.3% of female admissions had blood abnormalities, the most common being anaemia and hypokalaemia.45.7% of female patients had an abnormal electrocariograph.25% of female patients required transfer out during their admission for medical review.
The eating disorder unit fulfilled the RCP and NICE guidelines for 97.6% of patients in terms of blood results performed and 92.8% in terms of electrocardiographs performed.The average BMI on discharge for both males and females was above 17.5 which is regarded as the normal cut off point for anorexia nervosa.The importance of this study despite its limited sample size is that it is the first study of investigations and outcomes in an Irish in-patient adolescent eating disorder sample.
Patients with SMI receive long term intervention with psychotropic agents often associated with weight gain. Weight and lifestyle management programmes may prevent, reduce or reverse weight gain, however most data is short-term. Categorical data is not often reported
A group programme (Solutions for Wellness) designed to address weight and other cardiovascular risk factors commenced 2002 in Ireland. Each group provided open-ended access to referred SMI patients. Weekly group sessions consisted weighing, discussion and an 8-week rotational cycle of educational topics on aspects of weight, dietary choices and lifestyle changes. Groups were led by trained healthcare professionals.
Data is reported up to 24 months from 55 patients (27 male; 28 female) from 6 centres. Mean age 49.4 years (range 21-74). Schizophrenia 63%, Affective disorders 26%, other 11%. Patients completing 1 year - 55% and 2 years 22%. Baseline mean weight 98.6 kg (SD 19.2) decreased to final visit weight 96.9kg (SD 18.4).Paired t –test, p = 0.0030; CI Mean 2.53 (0.9-4.159). Weight increased in 11/55, maintained 7/55 and decreased 37/55.
Weight gain in SMI patients is not inevitable and was found in only 20% of patients attending weight clinics in Ireland. Patients may benefit if similar interventions were widely available.
Addressing the obesity epidemic depends on a holistic understanding of the reasons that people become and maintain excessive fat. Theories about the causes of obesity usually focus proximately or evoke evolutionary mismatches, with minimal clinical value. There is potential for substantial progress by adapting strategic body mass regulation models from evolutionary ecology to human obesity by assessing the role of information.
Rates of multidrug-resistant gram-negative organisms are surpassing those of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in nursing homes (NHs).
To characterize the incidence and duration of carriage of ciprofloxacin-resistant Escherichia coli (CipREc) in NHs and identify those in the O25b-ST131 lineage.
We collected 227 CipREc isolates obtained by routine and regular surveillance of high-risk NH residents with indwelling devices. Repetitive element palindromic (REP)–polymerase chain reaction assay and multiplex polymerase chain reaction amplification for O25b-ST131 E. coli detection were performed using (GTG)5-primers and O25pabBspe and trpA2 primer pairs, respectively.
We found a high period prevalence of CipREc colonization (21.5%), high rates of recolonization with the same strain following clearing (0.46 recolonizations/ person/ year), and an acquisition incidence of 1.05 cases/1,000 person-days. Almost three-quarters of colonized residents carried strains in the O25b-ST131 E. coli lineage. Compared with isolates not in the lineage, O25b-ST131 isolates were carried significantly longer (10 vs 3 months). We identified 18 different REP-types; 2 occurred in 55% of the residents colonized with CipREc, and in more than 1 NH. Duration of CipREc carriage varied by REP-type and averaged 6 months.
CipREc occurred frequently in NH residents and is carried for long durations, and reacquisition following clearance is common
Milrinone may be an appropriate adjuvant therapy for infants with persistent pulmonary hypertension of the newborn. We aimed to describe the effect of milrinone administration on right and left ventricular function in infants with persistent pulmonary hypertension not responding to inhaled nitric oxide after 4 hours of administration.
Materials and methods
This is a retrospective review of infants born after or at 34 weeks of gestation with persistent pulmonary hypertension who received milrinone treatment. The primary endpoint was the effect of milrinone on myocardial performance and haemodynamics, including right and left ventricular outputs, tissue Doppler velocities, right ventricle and septal strain, and strain rate. Secondary endpoints examined included duration of inhaled nitric oxide and oxygen support.
A total of 17 infants with a mean (standard deviation) gestation and birth weight of 39.8 (2.0) weeks and 3.45 (0.39) kilograms, respectively, were included in the study. The first echocardiogram was performed 15 hours after the commencement of nitric oxide inhalation. Milrinone treatment was started at a median time of 1 hour after the echocardiogram and was associated with an increase in left ventricular output (p=0.04), right ventricular output (p=0.004), right ventricle strain (p=0.01) and strain rate (p=0.002), and left ventricle s` (p<0.001) and a` (p=0.02) waves. There was a reduction in nitric oxide dose and oxygen requirement over the subsequent 72 hours (all p<0.05).
The use of milrinone as an adjunct to nitric oxide is worth further exploration, with preliminary evidence suggesting an improvement in both oxygenation and myocardial performance in this group of infants.
We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
Influenza causes significant morbidity and mortality in children. This study's objectives were to describe influenza A(H1N1)pdm09 during the pandemic, to compare it with circulating influenza in 2010/2011, and to identify risk factors for severe influenza defined as requiring admission to a paediatric intensive care unit (PICU). Children hospitalized with influenza during the pandemic were older, and more likely to have received antiviral therapy than children hospitalized during the 2010/2011 season. In 2010/2011, only one child admitted to a PICU with underlying medical conditions had been vaccinated. The risk of severe illness in the pandemic was higher in females and those with underlying conditions. In 2010/2011, infection with influenza A(H1N1)pdm09 compared to other influenza viruses was a significant risk factor for severe disease. An incremental relationship was found between the number of underlying conditions and PICU admission. These findings highlight the importance of improving low vaccination uptake and increasing the use of antivirals in vulnerable children.
To examine how the introduction of amplitude-integrated electroencephalography (aEEG) to our neonatal intensive care unit (NICU) influenced clinical practice.
This was a retrospective study examining clinical practice three years before and three years after the introduction of aEEG monitors to our NICU. A time series analysis was performed to explore whether aEEG introduction was associated with changes in the rates of conventional EEGs performed, neurology consultations and neonates diagnosed with seizures.
Following aEEG introduction, the total number of conventional EEGs performed remained constant; however, there was significant shift in conventional EEG utilization towards neonates receiving fewer multiple EEGs and more single EEGs. There was no change in the rate of neurology consultations or the number of neonates diagnosed with seizures.
Introduction of aEEG monitors to our NICU has led to less reliance on conventional EEG as a tool for the serial evaluation of brain function. Since the number of neonates diagnosed with seizures did not increase, aEEG monitoring did not appear to uncover a significant subgroup of patients with subclinical seizures that would previously have gone undetected. Conventional EEG and aEEG are complementary tools for the assessment of newborn cerebral function.
We expect that natural selection has resulted in behavioural rules that perform well, however, animals (including humans) sometimes make bad decisions. Researchers account for these with a variety of explanations; we concentrate on two of them. One is that the outcome is a side-effect; what matters is how a rule performs (in terms of reproductive success). Several rules may perform well in the environment in which they evolved, but their performance may differ in a ‘new’ environment (e.g., the lab). Some rules may perform very badly in this environment. We use the debate about whether animals follow the matching law rather than maximising their gains as an illustration. A second possibility is that we were wrong about what is optimal. The general idea here is that the setting in which optimal decisions are investigated is too simple and may not include elements that add extra degrees of freedom to the situation.
The theme of this volume is modelling natural action selection. In this chapter we are concerned with modelling the action of natural selection. Selecting the best action when making a decision can be of great importance to an individual's fitness; we often term making the right choice as being ‘rational’. Ultimately, however, decision-making processes are products of an individual's evolutionary history, influenced to a greater or lesser degree by natural selection. Here we are concerned with whether we should expect ‘rational’ behaviour to be a product of naturally selected systems. In a general sense, rationality involves thinking and behaving reasonably and logically, but the term holds different meanings for researchers in different intellectual fields. The meaning and implications of the term ‘rationality’ have been discussed at great length. We do not intend to try to review all of these here, but use the categorisations of Kacelnik (2006) as a guide (for further introductions to the debate, see Manktelow and Over, 1993; Moser, 1990; Wilson, 1974). The general area of evolution and rationality is vast and our coverage is highly selective; many issues have not been considered. For other topics and perspectives, see Bernardo and Welch (2001), Bogacz et al. (this volume), Bateson and Healy (2005), Binmore (1997), Cooper (2001), Dickson (2006, 2008), Kirkpatrick et al. (2006), Nozick (1993), Pothos and Busemeyer (2009), Rieskamp et al. (2006), Robson (2002; 2003), Shafir and Le Boeuf (2002), Sober (1981), Stein (1996), and Waldman (1994).
An electronic surveillance tool was developed for CAUTI and urinary catheter utilization based on the objective components of the National Healthcare Safety Network (NHSN) definitions including fever, urinalysis, and urine culture. Results were compared to manual chart review by an infection preventionist (IP).
During January and February 2010, 204 positive urine cultures (≥103 colony-forming units/mL) were identified in 136 patients with indwelling urinary catheters during their hospitalization. The electronic surveillance tool detected 60 CAUTI cases and 7,098 catheter-days, yielding a CAUTI incidence rate of 8.5 per 1,000 catheter-days. Urinary catheter utilization ratios (Foley-days/patient-days) were: acute care units, 0.27 (3,637 of 13,229); intensive care units, 0.77 (3,461 of 4,469); and overall, 0.40 (7,098 of 17,698). In comparison, the IP identified 59 cases by manual review with a sensitivity of 51 of 59 (86.4%), specificity 136 of 145 (93.8%), and negative predictive value of 136 of 144 (94.4%). Fever was present in 54 of 59 (91.5%) of CAUTI cases identified manually, while subjective criteria were documented in only 6 of 59 (10.2%) infections. Agreement between the electronic surveillance and manual IP review was assessed as very good (k, 0.80; 95% confidence interval, 0.71–0.89).
We report an attempt at automating surveillance for CAUTI. With a high negative predictive value, the electronic tool allows for more efficient CAUTI surveillance and facilitates housewide trending of rates and catheter utilization. This approach should be validated in different patient populations.
Variations in maternal nutrition during gestation can influence foetal growth, foetal development and permanently ‘programme’ offspring for postnatal life. The objective of this study was to analyse the effect of increased maternal nutrition during different gestation time windows on offspring growth, carcass quality, meat quality and gene expression in skeletal muscle. A total of 64 sows were assigned to the following feeding treatments: a standard control diet at a feed allocation of 2.3 kg/day throughout gestation, increased feed allowance of 4.6 kg/day from 25 to 50 days of gestation (dg), from 50 to 80 dg and from 25 to 80 dg. At weaning, Light, Medium and Heavy pigs of the same gender, within litter, were selected based on birth weight, individually penned and monitored until slaughter at 130 days post weaning. Carcass and meat quality traits of the semimembranosus (SM) muscle were recorded post mortem. A cross section of the semitendinosus (ST) muscle encompassing the deep and superficial regions were harvested from pigs (n = 18 per treatment) for RNA extraction and quantification of gene expression by real-time PCR. The results showed that doubling the feed intake from 25 to 50 dg reduced offspring growth, carcass weight, intramuscular fat content and increased drip loss of the SM muscle. Interestingly, protein phosphatase 3 catalytic subunit – α-isoform, which codes for the transcription factor calcineurin, was upregulated in the ST muscle of offspring whose mothers received increased feed allowance from 25 to 50 dg. This may provide an explanation for the previous observed increases in Type IIa muscle fibres of these offspring. Increasing the maternal feed intake from 50 to 80 dg negatively impacted pig growth and carcass weight, but produced leaner male pigs. Extending the increased maternal feed intake from 25 to 80 dg had no effect on offspring over the standard control gestation diet. Although intra-litter variation in pig weight is a problem for pig producers, increased maternal feeding offered no improvement throughout life to the lighter birth weight littermates in our study. Indeed, increased maternal nutrition at the three-gestation time windows selected provided no major benefits to the offspring.
The words people use and the way they use them can reveal a great deal about their mental states when they attempt to deceive. The challenge for researchers is how to reliably distinguish the linguistic features that characterize these hidden states. In this study, we use a natural language processing tool called Coh-Metrix to evaluate deceptive and truthful conversations that occur within a context of computer-mediated communication. Coh-Metrix is unique in that it tracks linguistic features based on cognitive and social factors that are hypothesized to influence deception. The results from Coh-Metrix are compared to linguistic features reported in previous independent research, which used a natural language processing tool called Linguistic Inquiry and Word Count. The comparison reveals converging and contrasting alignment for several linguistic features and establishes new insights on deceptive language and its use in conversation.
In the UK, South Asian adults have increased risks of CHD, type 2 diabetes and central obesity. Black African-Caribbeans, in contrast, have increased risks of type 2 diabetes and general obesity but lower CHD risk. There is growing evidence that these risk differences emerge in early life and that nutritional factors may be important. We have therefore examined the variations in nutritional composition of the diets of South Asian, black African-Caribbean and white European children, using 24 h recalls of dietary intake collected during a cross-sectional survey of cardiovascular health in eighty-five primary schools in London, Birmingham and Leicester. In all, 2209 children aged 9–10 years took part, including 558 of South Asian, 560 of black African-Caribbean and 543 of white European ethnicity. Compared with white Europeans, South Asian children reported higher mean total energy intake; their intakes of total fat, polyunsaturated fat and protein (both absolute and as proportions of total energy intake) were higher and their intakes of carbohydrate as a proportion of energy (particularly sugars), vitamin C and D, Ca and haem Fe were lower. These differences were especially marked for Bangladeshi children. Black African-Caribbean children had lower intakes of total and saturated fat (both absolute and as proportions of energy intake), NSP, vitamin D and Ca. The lower total and saturated fat intakes were particularly marked among black African children. Appreciable ethnic differences exist in the nutritional composition of children's diets, which may contribute to future differences in chronic disease risk.
The antimicrobial resistance profiles of Campylobacter isolates recovered from a range of retail food samples (n=374) and humans (n=314) to eight antimicrobial compounds were investigated. High levels of resistance in food C. jejuni isolates were observed for ceftiofur (58%), ampicillin (25%) and nalidixic acid (17%) with lower levels observed for streptomycin (7·9%) and chloramphenicol (8·3%). A total of 80% of human C. jejuni isolates were resistant to ceftiofur, while 17% showed resistance to ampicillin and nalidixic acid, 8·6% to streptomycin and 4·1% to chloramphenicol. Resistance to clinically relevant antimicrobials such as erythromycin, ciprofloxacin and tetracycline was 6·7, 12, and 15% respectively for all food isolates and was similar to corresponding resistance prevalences observed for human isolates, where 6·4, 12 and 13% respectively were found to be resistant. Comparisons of C. jejuni isolates in each location showed a high degree of similarity although some regional variations did exist. Comparison of total C. jejuni and C. coli populations showed minor differences, with C. jejuni isolates more resistant to ampicillin and ceftiofur. Multidrug resistance patterns showed some profiles common to human and clinical isolates.