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Diet is a modifiable risk factor for chronic disease and a potential modulator of telomere length (TL). The study aim was to investigate associations between diet quality and TL in Australian adults after a 12-week dietary intervention with an almond-enriched diet (AED). Participants (overweight/obese, 50–80 years) were randomised to an AED (n 62) or isoenergetic nut-free diet (NFD, n 62) for 12 weeks. Diet quality was assessed using a Dietary Guideline Index (DGI), applied to weighed food records, that consists of ten components reflecting adequacy, variety and quality of core food components and discretionary choices within the diet. TL was measured by quantitative PCR in samples of lymphocytes, neutrophils, and whole blood. There were no significant associations between DGI scores and TL at baseline. Diet quality improved with AED and decreased with NFD after 12 weeks (change from baseline AED + 9·8 %, NFD − 14·3 %; P < 0·001). TL increased in neutrophils (+9·6 bp, P = 0·009) and decreased in whole blood, to a trivial extent (–12·1 bp, P = 0·001), and was unchanged in lymphocytes. Changes did not differ between intervention groups. There were no significant relationships between changes in diet quality scores and changes in lymphocyte, neutrophil or whole blood TL. The inclusion of almonds in the diet improved diet quality scores but had no impact on TL mid-age to older Australian adults. Future studies should investigate the impact of more substantial dietary changes over longer periods of time.
Most reports on the outcome of children who present with heart failure, due to heart muscle disease, are from an era when ventricular assist devices were not available. This study provides outcome data for the current era where prolonged circulatory support can be considered for most children.
Methods & Results:
Data was retrieved on 100 consecutive children, who presented between 2010 – 2016, with a first diagnosis of unexplained heart failure. Hospital outcome was classified as either death, transplantation, recovery of function or persistent heart failure. Median age at presentation was 24 months and 58% were < 5 years old. Hospital mortality was 12% and 59% received a heart transplant. Most, 79%, of the transplants were carried out on patients with a device. Recovery of function was observed in 18% and 10% stabilised on oral therapy. Eighty-four percent of the deaths occurred in the <5 year old group. Shorter duration of support was associated with survival (34 days in survivors versus 106 in non-survivors, p = 0.01) and 72% were on an assist device at time of death.
Heart failure in children who require referral to a transplant unit is a serious illness with a high chance of either transplantation or death. Modifications in assist devices will be required to improve safety, especially for children < 5 years old where the donor wait may be prolonged. The identification of children who may recover function requires further study.
In November 2017, a working feasibility analysis commenced of a local anaesthetic endonasal procedures out-patient clinic service at Freeman Hospital, Newcastle upon Tyne. Fundamental to introducing an innovative ambulatory out-patient practice is the development of a novel local safety standard for invasive procedures to support this service.
This paper presents the new safety standard developed for this purpose and implemented in our institution.
Increasingly, there is a shift toward ambulatory services, directed by patient choice, technological advances and the opportunity for cost savings. It is hoped that this local safety standard for invasive procedures will provide a useful template for those considering implementing ambulatory endonasal services, or other novel procedures, within the specialty of ENT.
Anecdotal reports suggest that children and young adults with CHD frequently experience pain in their legs. The purpose of this pilot study, performed by Little Hearts Matter patient organisation, was to assess the burden of leg pains in this group and begin to investigate associated factors and consequences for daily living.
An internet-based survey was distributed by Little Hearts Matter patient organisation. After anonymisation and collation, responses were analysed and compared with their healthy siblings.
Of the 220 patients who responded, 94% reported leg pains compared with 30% of siblings (n=107; p<0.001). In respondents, pain was typically reported to occur in the lower legs or around the knees or ankles, often associated with crying and screaming (49.0%) and most commonly occurring at night-time (82.0%). Individuals taking aspirin and those who were more active were more likely to report leg pains. Older age was associated with leg pain that occurred with stress (p=0.02) and at night (p=0.05). Analgesia (64.1%) or massage (53.9%) was the preferred option for alleviation. There was no gender bias, association with diagnosis, surgical history, and/ or relationship with diagnosed orthopaedic issues.
Leg pains are more frequent in those with CHD compared with their healthy siblings. Aetiology is uncertain, but pains share many common characteristics with benign “growing pains”.
Maruca vitrata (Fabricius, 1787) is a cryptic pantropical species of Lepidoptera that are comprised of two unique strains that inhabit the American continents (New World strain) and regions spanning from Africa through to Southeast Asia and Northern Australia (Old World strain). In this study, we de novo assembled the complete mitochondrial genome sequence of the New World legume pod borer, M. vitrata, from shotgun sequence data generated on an Illumina HiSeq 2000. Phylogenomic comparisons were made with other previously published mitochondrial genome sequences from crambid moths, including the Old World strain of M. vitrata. The 15,385 bp M. vitrata (New World) sequence has an 80.7% A+T content and encodes the 13 protein-coding, 2 ribosomal RNA and 22 transfer RNA genes in the typical orientation and arrangement of lepidopteran mitochondrial DNAs. Mitochondrial genome-wide comparison between the New and Old World strains of M. vitrata detected 476 polymorphic sites (4.23% nucleotide divergence) with an excess of synonymous substitution as a result of purifying selection. Furthermore, this level of sequence variation suggests that these strains diverged from ~1.83 to 2.12 million years ago, assuming a linear rate of short-term substitution. The de novo assemblies of mitochondrial genomes from next-generation sequencing (NGS) reads provide readily available data for similar comparative studies.
Introduction: Bronchiolitis is the most common lower respiratory tract infection among infants, characterized by wheeze and respiratory distress. Reliance on pulse oximetry has been associated with increased hospitalizations, prolonged hospital stay and escalation of care. The objectives were to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of emergency department discharge in infants with bronchiolitis who desaturate to <90% for at least one minute during home oximetry monitoring versus those without desaturations. Methods: This is a prospective cohort study from 2008 to 2013 enrolling 118 otherwise healthy infant aged 6 weeks to 12 months discharged home from a tertiary care pediatric emergency department with a diagnosis of acute bronchiolitis. The primary outcome was unscheduled medical visits for bronchiolitis, a visit to any health care provider due to concerns about respiratory symptoms, within 72 hours of discharge in infants with and without desaturations. Secondary outcomes included examination of the severity and duration of the desaturations, delayed hospitalizations within 72 hours of discharge and the effect of activity on desaturations. Results: During a mean monitoring period of 19 hours, 75/118 (64%) infants had at least one desaturation event (median continuous duration 3.4 minutes). 59/118 infants (50%) had at least 3 desaturations, 12 (10%) desaturated for >10% monitored time and 51(43%) had desaturations lasting ≥ 3 minutes continuously. 59/118 (50%) infants desaturated to ≤ 80% and 29 (24%) to ≤ 70% for ≥ 1 minute. A total 18/75 infants with desaturations (24.0%) had an unscheduled visit for bronchiolitis versus 11/43 of their non-desaturating counterparts (25.6%) [Difference - 1.6%; 95%CI -0.15 to ∞, p=0.66]. One of 75 desaturating infants (1.3%) and 2/43 (4.6%) of those without desaturations were hospitalized within 72 hours [Difference of -3.3%; 95% CI -0.04 to 0.10, p = 0.27]. Seventy seven percent of infants with desaturations experienced them during sleep or while feeding. Conclusion: The majority of infants with mild bronchiolitis experienced recurrent or sustained desaturations after discharge home. Children with and without desaturations had comparable rates of return for care, with no difference in unscheduled return medical visits and delayed hospitalizations.
We present an overview of the survey for radio emission from active stars that has been in progress for the last six years using the observatories at Fleurs, Molonglo, Parkes and Tidbinbilla. The role of complementary optical observations at the Anglo-Australian Observatory, Mount Burnett, Mount Stromlo and Siding Spring Observatories and Mount Tamborine are also outlined. We describe the different types of star that have been included in our survey and discuss some of the problems in making the radio observations.
The subsurface exploration of other planetary bodies can be used to unravel their geological history and assess their habitability. On Mars in particular, present-day habitable conditions may be restricted to the subsurface. Using a deep subsurface mine, we carried out a program of extraterrestrial analog research – MINe Analog Research (MINAR). MINAR aims to carry out the scientific study of the deep subsurface and test instrumentation designed for planetary surface exploration by investigating deep subsurface geology, whilst establishing the potential this technology has to be transferred into the mining industry. An integrated multi-instrument suite was used to investigate samples of representative evaporite minerals from a subsurface Permian evaporite sequence, in particular to assess mineral and elemental variations which provide small-scale regions of enhanced habitability. The instruments used were the Panoramic Camera emulator, Close-Up Imager, Raman spectrometer, Small Planetary Linear Impulse Tool, Ultrasonic drill and handheld X-ray diffraction (XRD). We present science results from the analog research and show that these instruments can be used to investigate in situ the geological context and mineralogical variations of a deep subsurface environment, and thus habitability, from millimetre to metre scales. We also show that these instruments are complementary. For example, the identification of primary evaporite minerals such as NaCl and KCl, which are difficult to detect by portable Raman spectrometers, can be accomplished with XRD. By contrast, Raman is highly effective at locating and detecting mineral inclusions in primary evaporite minerals. MINAR demonstrates the effective use of a deep subsurface environment for planetary instrument development, understanding the habitability of extreme deep subsurface environments on Earth and other planetary bodies, and advancing the use of space technology in economic mining.
Three-dimensional large-eddy simulations of two-stream mixing layers developing spatially from laminar boundary layers are presented, replicating wind-tunnel experiments carried out in Part 1 of this study. These simulations have been continued through the mixing transition and into the fully turbulent self-similar flow beyond. In agreement with the experiments, the simulations show that the familiar mechanism of growth by vortex amalgamation is replaced at the mixing transition by a previously unrecognised mechanism in which the spanwise-coherent large structures individually undergo continuous linear growth. In the post-transition flow it is this continuous linear growth of the individual structures that produces the self-similar growth of the mixing-layer thickness, the large-structure interactions occurring as a consequence of the growth, not its cause. New information is also presented on the topography of the organised post-transition flow and on its cyclical evolution through the lifetimes of the individual large structures. The dynamic and kinematic implications of these findings are discussed and shown to define quantitatively the growth rate of the homogeneous post-transition mixing layer in its organised state.
To study the natural recovery from sports concussion, 12 concussed high school football athletes and 12 matched uninjured teammates were evaluated with symptom rating scales, tests of postural balance and cognition, and an event-related fMRI study during performance of a load-dependent working memory task at 13 h and 7 weeks following injury. Injured athletes showed the expected postconcussive symptoms and cognitive decline with decreased reaction time (RT) and increased RT variability on a working memory task during the acute period and an apparent full recovery 7 weeks later. Brain activation patterns showed decreased activation of right hemisphere attentional networks in injured athletes relative to controls during the acute period with a reversed pattern of activation (injured > controls) in the same networks at 7 weeks following injury. These changes coincided with a decrease in self-reported postconcussive symptoms and improved cognitive test performance in the injured athletes. Results from this exploratory study suggest that decreased activation of right hemisphere attentional networks mediate the cognitive changes and postconcussion symptoms observed during the acute period following concussion. Conversely, improvement in cognitive functioning and postconcussive symptoms during the subacute period may be mediated by compensatory increases in activation of this same attentional network. (JINS, 2013, 19, 1–10)
The Monash University Physics Department is constructing a spectrograph, to be attached to a 0·46-m Cassegrainian telescope. To help future users of the spectrograph determine the operational capabilities of the spectrograph a PC-based software package was created. This program allows the user to simulate the response of the spectrograph to various stellar types under differing observational constraints. We have estimated the precision of measurements of stellar radial velocities with the spectrograph. The estimates are reasonable but are yet to be compared with real data.
Traumatic brain injury (TBI) is a leading cause of death and disability among children and young adults in the United States (NCIPC, 2000). Each year TBI results in approximately 3000 childhood deaths, 29,000 hospitalizations, and 400,000 emergency department visits. The predominant causes of TBI in young children are motor vehicle accidents, firearm incidents, falls, and child abuse.
Since the 1940s biomechanics has made a significant contribution to understanding the mechanisms and tolerances of adult traumatic brain injury and it continues to play a crucial role in forming guidelines for adult motor vehicle occupancy and sports safety (Goldsmith, 2001; Goldsmith & Monson, 2005). Biomechanical research specific to pediatric traumatic brain injury did not begin until the late 1970s and the paucity of pediatric biomechanical data at the time forced researchers to make assumptions regarding the relationship of infant material properties to adult material properties (Mohan et al., 1979). Since then, biomechanical researchers have measured many pediatric tissue properties directly. Biomechanical studies of the intact skull and brain and the properties of individual tissues have demonstrated that the pediatric brain and skull respond differently to loads than adult tissue, and previous linear extrapolation from adult data does not provide an accurate estimate of pediatric properties (Coats & Margulies, 2006; Prange & Margulies, 2002).
Despite the increased research in the field, not enough key pieces of information are in place to establish realistic injury tolerances for children.
To estimate the sensitivity and specificity of computed tomography used for the detection of extranodal spread of metastatic head and neck squamous cell carcinoma, by experienced head and neck radiologists.
Materials and methods:
Participants had undergone a neck dissection for head and neck squamous cell carcinoma, together with computed tomography scanning prior to surgery (accessible for reporting). Computed tomography images were independently examined by two experienced head and neck radiologists. Nodal involvement by squamous cell carcinoma and the presence or absence of extranodal spread were recorded. Results were compared to the histological specimen. The sensitivity, specificity and positive predictive value of using computed tomography for the detection of nodal involvement and presence or absence of extranodal spread were estimated, and 95 per cent confidence intervals were calculated.
Results and analysis:
The study analysed 149 neck dissections. When using computed tomography to detect the extranodal spread of head and neck squamous cell carcinoma, radiologists A and B had sensitivities of 66 and 80 per cent, specificities of 91 and 90 per cent, and positive predictive values of 85 and 87 per cent, respectively.
The sensitivity and specificity of radiological detection of extranodal spread from head and neck squamous cell carcinoma is not well reported in the literature. Accuracy of reporting improves in the hands of experienced head and neck radiologists. This finding has clinical implications for surgical planning and adjuvant therapy requirements.
X-ray spectromicroscopy is a powerful tool for addressing key questions in the environmental sciences due to its high spectral and spatial resolution. It has been used successfully for material research, biology and environmental studies, e.g. in the form of μ-X-ray fluorescence and spectromicroscopy with a spatial resolution of <100 nm. With the combination of high-resolution microscopy and spectroscopy it is possible to determine elemental composition as well as chemical speciation, and also identify trace elements to nm-resolution. Samples from soils and groundwater aquifers have been imaged to visualize the appearance of structures on the nm- and μm-scale. The effectof changing chemical conditions in an aqueous environment on the appearance of these structures has been imaged and evaluated. Clay dispersions, microhabitats and morphological effects of biologically-induced redox changes of humic substances have been imaged tomographically, conveying a detailed threedimensional presentation of the specimen structure. Using the spectromicroscopy potential, the distribution of organic and inorganic components, as well as different inorganic components, has been studied. Spectra were analysed for major chemical constituents and were used, for example, to assess differentsulphur species in an entire soil profile.
The terrorist attacks of September 11, 2001, made mental health professionals keenly aware of the need for relationally and developmentally focused interventions for traumatized young children and their families with greater urgency than ever before. Healthcare providers, educators, the media, and politicians were barraged by questions about parents who were concerned about the effects of this very public political violence on their young children,whether or not they were directly affected by the attacks.
Those young children who were directly affected by the attacks in New York or who witnessed the crashing of the two passenger planes into the World Trade Center (WTC) and the toppling of the Twin Towers were many in number: over 3000 children lost a parent, thousands of children attending schools and day-care centers near Ground Zero directly witnessed the attacks. Additionally, untold millions of children around the world watched the attacks repeatedly on TV. Children worldwide were reported to suffer from nightmares following the events of 9/11, and for weeks had difficulty concentrating in school (Hoven et al., 2003).
Historical overview of understanding trauma in a relational context
One of the most important observations which has informed our current relational view of child traumatic stress came from the study by Anna Freud and Dorothy Burlingham (1943). They noted the following during the London Blitz of World War II: “The war acquires comparatively little significance for children so long as it only threatens their lives, disturbs their material comfort, or cuts their food rations.
Nurse Prescribing in mental health care is now a reality. As part of a long-term plan to introduce the prescribing role for mental health nurses in the local area, Doncaster and South Humber Health Care Trust and the School of Nursing and Midwifery at the University of Sheffield conducted a study tour of centres well established in the clinical practice and educational preparation for prescriptive authority for nurses. The findings from the visit are explored, for example: a) how is a competence in prescribing achieved by nurse, b) what is the educational delivery needed to prepare the potential prescriber? Insights are offered based on the provision of care by nurse prescribers in the states of Massachusetts and Connecticut that we visited. These are then discussed in the context of the future development of this role, which is now being introduced as an innovation aimed at meeting the mental health care needs of patients in the UK.