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A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose–response and dietary modelling studies indicate dairy products, bread, hens’ eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for ‘real-world’ cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D’s importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.
An integrated study of sedimentological, sequence-stratigraphic and palaeodispersal analysis was applied to the Upper-Permian clastic sedimentary succession in the Northern Sydney Basin, Australia. The succession is subdivided into fifteen facies and three facies associations. The facies associations are further subdivided into eight sub-facies associations. The sedimentary evolution involves progradation from delta-front to delta-plain to fluvial depositional environments, with a significant increase in sediment grain size across the unconformable contact that separates the deltaic from the overlying fluvial system. In contrast to the delta front that is wave/storm- and/or river-influenced, the delta plain is significantly affected by tides, with the impact of tidal currents decreasing up-sequence in the delta plain. The general lack of wave-influenced sedimentary structures suggests low wave energy in the delta plain. The abrupt termination of the tidal impact in the fluvial realm relates to the steep topographic gradients and high sediment supply, which accompanied the uplift of the New England Orogen. The sequence-stratigraphic framework includes highstand (deltaic forest and topset) and lowstand (fluvial topset) systems tracts, separated by a subaerial unconformity. In contrast to most of the mud-rich modern counterparts, this is an example of a sand-rich tidally influenced deltaic system, developed adjacent to the source region. This investigation presents a depositional model for tidal successions in regions of tectonic uplift and confinement.
In her magisterial Plato's Philosophers, Catherine Zuckert presents a radically new interpretation of Plato's dialogues. In doing so, she insists we must overcome reading them through the lens of Aristotle, whose influence has obscured the true nature of Plato's philosophy. However, in her works dealing with Aristotle's political science, Zuckert indicates several advantages of his approach to understanding politics. In this article, I explore the reasons why Zuckert finds Aristotle a problematic guide to Plato's philosophy as well as what she sees as the character and benefits of Aristotle's political theory. I conclude by suggesting a possible reconciliation between Zuckert's Aristotle and her Plato, insofar as both the Socrates whom Plato made his hero and Aristotle agree that political communities will rarely direct citizens toward virtue by means of law and that we must instead look to informal means of doing so.
In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children’s Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children’s Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary “think-tank”. The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute, to describe the “state of the art” of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
As East Asia rapidly develops, greater demands are being placed on governments to efficiently supply energy to sustain economic growth. Simultaneously, public awareness of environmental issues has placed new imperatives on energy planning. To meet these challenges, the concept of sustainable development must be incorporated into energy security strategies in order to balance the three priorities of energy security, economic growth and environmental protection. Alternative energy forms a cornerstone of such a strategy. From a brief examination of the contemporary developments in alternative energy sources in East Asia, this chapter shows that the use of “nuclear renaissance” for describing the energy future of the region is still premature, given that progress in this field has not been uniform and has largely stagnated. Instead, renewable energy developments show better progress and hold greater promise for East Asia. Instead of a “nuclear renaissance”, a “renewables renaissance” may be taking hold in the region.
Continuing debates on energy security have been affected by two important global developments. First, the December 2009 Copenhagen Summit failed to reach a global consensus on a concrete plan to curb carbon emissions. As such, socioeconomically driven national self interests have led many states to focus on national-level carbon emissions reduction and energy efficiency strategies.
Second, as the world economy has begun to recover, it may lead to increasing energy demand. Since this increase follows patterns of population growth and development in Asia, many energy economists point to the long-term upward trend in energy prices. Michael Quah from Singapore's Energy Studies Institute has forecast that rising energy prices will continue despite erratic hydrocarbon prices and an uneven economic recovery.
A retrospective case–case control study was conducted, including 60 cases with daptomycin-nonsusceptible vancomycin-resistant enterococci (DNS-VRE) matched to cases with daptomycin-susceptible VRE and to uninfected controls (1:1:3 ratio). Immunosuppression, presence of comorbid conditions, and prior exposure to antimicrobials were independent predictors of DNS-VRE, although prior daptomycin exposure occurred rarely. In summary, a case–case control study identified independent risk factors for the isolation of DNS-VRE: immunosuppression, multiple comorbid conditions, and prior exposures to cephalosporines and metronidazole.
New trends in X-ray crystallography are concerned with the study of transient conditions of atomic structures, which take place after an energy activation agent is introduced. These time-resolved experiments require a fast mechanical shutter to interrupt the X-ray beam in a pump–probe cycle, with the aim to generate a stroboscopic effect. Thus, only diffraction data that are representative of the activated structure are actually collected. A rotating type of shutter, also known as chopper, is presented with the purpose to enable time-resolved experiments to be performed at I19 small-molecule single-crystal diffraction beamline. Exceptional stability in the rotational speed is critical to achieve the desired stroboscopic effect with minimum jitter. This requirement can be addressed only through design by the specification of suitable components and implementation of high-precision methods in manufacturing. The proposed equipment is comprised of a spindle supported on air bearings coupled to a slotted disc rotating inside a vacuum enclosure and driven by a brushless servo motor. Advanced control features are proposed to ensure that speed stability is achieved. Preliminary tests produced very encouraging results, giving strong indication that the chopper satisfies the specifications required for time-resolved experiments.
Ellis – van Creveld syndrome is an autosomal recessive disorder manifest by short-limb dwarfism, thoracic dystrophy, postaxial polydactyly, dysplastic nails and teeth, and an approximately 60% incidence of congenital malformations of the heart. Despite patients with Ellis – van Creveld syndrome being regarded as having a high surgical risk, few data are available regarding their outcomes following surgery for congenital malformations of the heart in the current era.
Materials and methods
In this retrospective report, we summarise the clinical observations and outcomes of nine infants with Ellis – van Creveld syndrome who underwent surgery for congenital malformations of the heart between 2004 and 2009.
We identified 15 patients with Ellis – van Creveld syndrome during the study period; 11 (73%) had haemodynamically significant congenital malformations of the heart warranting surgery. In two of these patients, surgery was not performed. Of the nine patients who underwent surgery, all of whom were infants, eight (89%) had various forms of an atrioventricular septal defect and one patient (11%) had hypoplastic left heart syndrome (mitral and aortic atresia). Among the nine patients who underwent surgery, four (44%) died at a median of 102 days with a range of 25–149 days post-operatively, mostly from respiratory failure. Respiratory morbidity was seen in all surviving patients, of whom three underwent tracheostomy.
Surgery for congenital malformations of the heart can be successful in infants with Ellis – van Creveld syndrome, but mortality is high and post-operative respiratory morbidity should be expected.
The key to metabolic management during cardiopulmonary bypass (CPB) is the maintenance of adequate blood flow and oxygen delivery to the body's tissues. Utilizing the CPB machine, the perfusionist provides the optimum conditions necessary for operations on the heart, lungs or major vessels, while supporting the patient's physiological and metabolic needs. The perfusionist calculates a CPB blood flow utilizing the patient's body surface area (BSA) and cardiac index (CI). Metabolic acidosis during CPB is almost always the result of hypoperfusion leading to oxygen delivery inadequate to meet metabolic demands for aerobic respiration. Oxygen consumption is thus a major determinant of CPB flow requirements. Deep hypothermic circulatory arrest (DHCA) is used to dramatically lower the body's metabolic demand while protecting organs, particularly the brain, during a period in which perfusion is suspended. Some in-line devices provide a continuous calculation of oxygen consumption based on pump flow and the arterio-venous oxygen differential.
Probiotics (PRO) modulate immunity in humans, while the effect of prebiotics (PRE) and synbiotics (SYN) on the human immune system are not well studied yet. The objective of this study was to investigate whether daily intake of a SYN modulates immune functions. In a randomised double-blind, placebo-controlled trial, thirty-four colon cancer patients who had undergone ‘curative resection’ and forty polypectomised patients participated. Subjects of the SYN group daily received encapsulated bacteria (1 × 1010 colony-forming units of Lactobacillus rhamnosus GG (LGG) and 1 × 1010 colony-forming units of Bifidobacterium lactis Bb12 (Bb12)) and 10 g of inulin enriched with oligofructose. Controls received encapsulated maltodextrin and 10 g of maltodextrin. Prior to intervention (T1), and 6 (T2) and 12 weeks after the start of the intervention (T3), phagocytic and respiratory burst activity of neutrophils and monocytes, lytic activity of natural killer cells and production of interleukin (IL)-2, IL-10 and IL-12, as well as tumour necrosis factor-α and interferon-γ (IFN-γ) by activated peripheral blood mononuclear cells (PBMC) were measured. In faeces, the concentrations of transforming growth factor-β1 and prostaglandin E2 were measured. IL-2 secretion by activated PBMC from the polyp group increased significantly between T1 or T2 and T3 (P < 0·05). In the cancer group, SYN treatment resulted in an increased capacity of PBMC to produce IFN-γ at T3 (P < 0·05). Other immunity-related parameters were not affected by SYN treatment, neither in the cancer nor in the polyp group. In conclusion, supplementation with this SYN has minor stimulatory effects on the systemic immune system of the two study groups. Further studies in humans should aim to focus on the gut-associated immune system.