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The Fontan Outcomes Network was created to improve outcomes for children and adults with single ventricle CHD living with Fontan circulation. The network mission is to optimise longevity and quality of life by improving physical health, neurodevelopmental outcomes, resilience, and emotional health for these individuals and their families. This manuscript describes the systematic design of this new learning health network, including the initial steps in development of a national, lifespan registry, and pilot testing of data collection forms at 10 congenital heart centres.
Olive oil (OO) is the primary source of fat in the Mediterranean diet and has been associated with longevity and a lower incidence of chronic diseases, particularly CHD. Cardioprotective effects of OO consumption have been widely related with improved lipoprotein profile, endothelial function and inflammation, linked to health claims of oleic acid and phenolic content of OO. With CVD being a leading cause of death worldwide, a review of the potential mechanisms underpinning the impact of OO in the prevention of disease is warranted. The current body of evidence relies on mechanistic studies involving animal and cell-based models, epidemiological studies of OO intake and risk factor, small- and large-scale human interventions, and the emerging use of novel biomarker techniques associated with disease risk. Although model systems are important for mechanistic research nutrition, methodologies and experimental designs with strong translational value are still lacking. The present review critically appraises the available evidence to date, with particular focus on emerging novel biomarkers for disease risk assessment. New perspectives on OO research are outlined, especially those with scope to clarify key mechanisms by which OO consumption exerts health benefits. The use of urinary proteomic biomarkers, as highly specific disease biomarkers, is highlighted towards a higher translational approach involving OO in nutritional recommendations.
Using principal component analysis, a climate index is developed to estimate the linkage between climate and crop yields. The indices based on three climate projections are then applied to forecast future crop yield responses. We identify spatial heterogeneity of crop yield responses to future climate change across a number of U.S. northern and southern states. The results indicate that future hotter/drier weather conditions will likely have significant negative impacts on southern states, whereas only mild impacts are expected in most northern states.
As a cellular signaling program, apoptosis is a highly controlled and complex process that depends on the orchestrated interactions of multiple soluble factors: ions (e.g., Ca2+), proteins (e.g., caspases, Bcl-2 family members), and nonprotein substrates (e.g., DNA). Equally important, although less well characterized, is signaling through cellular membranes and the lipids and proteins contained therein. Lipids are the primary constituents of biological membranes and thus play a structural role in defining cellular and organellar boundaries. However, lipids are not merely passive molecules serving inert, structural functions in these membranes. Many lipids are now appreciated as signaling molecules, capable of influencing diverse cellular processes and exerting powerful influence over many physiologic and pathophysiologic processes, such as programmed cell death. Sphingolipids represent one class of bioactive lipid mediators that are now recognized as key determinants of cell fate. This chapter discusses the regulated generation of bioactive sphingolipids (e.g., ceramide) and how sphingolipid signaling impacts the regulation of programmed cell death.
The imprinted insulin-like growth factor 2 gene (IGF2) encodes a fetal mitogenic hormone protein (IGF-II) and has previously been shown to be associated with performance in dairy cattle. In this study we assessed genotype-phenotype associations between four single nucleotide polymorphisms (SNPs) located within the bovine IGF2 locus on chromosome 29 and a range of performance traits related to milk production, animal growth and body size, fertility and progeny survival in 848 progeny-tested Irish Holstein-Friesian sires. Two of the four SNPs (rs42196909 and IGF2.g-3815A>G), which were in strong linkage disequilibrium (r2=0·995), were associated with milk yield (P⩽0·01) and milk protein yield (P⩽0·05); the rs42196901 SNP was also associated (P⩽0·05) with milk fat yield. Associations (P⩽0·05) with milk fat percentage and milk protein percentage were observed at the rs42196901 and IGF2.g-3815A>G SNPs, respectively. The rs42196909 and IGF2.g-3815A>G SNPs were also associated with progeny carcass conformation (P⩽0·05), while an association (P⩽0·01) with progeny carcass weight was observed at the rs42194733 SNP locus. None of the four SNPs were associated with body size, fertility and progeny survival. These findings support previous work which suggests that the IGF2 locus is an important biological regulator of milk production in dairy cattle and add to an accumulating body of research showing that imprinted genes influence many complex performance traits in cattle.
The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.
An observational study was conducted in 26 freestanding children's hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative. CVC-associated BSI protocols were implemented using a collaborative process that included catheter insertion and maintenance bundles, daily review of CVC necessity, and daily goals. The primary goal was either a 50% reduction in the CVC-associated BSI rate or a rate of 1.5 CVC-associated BSIs per 1,000 CVC-days in each ICU at the end of a 9-month improvement period. A 12-month sustain period followed the initial improvement period, with the primary goal of maintaining the improvements achieved.
The collaborative median CVC-associated BSI rate decreased from 6.3 CVC-associated BSIs per 1,000 CVC-days at the start of the collaborative to 4.3 CVC-associated BSIs per 1,000 CVC-days at the end of the collaborative. Sixty-five percent of all participants documented a decrease in their CVC-associated BSI rate. Sixty-nine CVC-associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12-month sustain period and prevent another 198 infections.
We conclude that our collaborative quality improvement project demonstrated that significant reduction in CVC-associated BSI rates and related costs can be realized by means of evidence-based prevention interventions, enhanced communication among caregivers, standardization of CVC insertion and maintenance processes, enhanced measurement, and empowerment of team members to enforce adherence to best practices.
If the presentations and discussions of the Program Assessment track are any indication, assessment in political science is slowly moving forward. Several presentations provided excellent ideas for instructors and departments seeking to get started and move beyond to take assessment seriously. Presenters and discussants were a mix of veterans and newcomers to assessment from a range of institutions, but the group largely shared an understanding that assessment done well is really a conversation about teaching. Teaching political science is something that we all care about.
Co-treatment of mice infected with different strains of Leishmania donovani with a non-ionic surfactant vesicle formulation of buthionine sulfoximine (BSO-NIV), and sodium stibogluconate (SSG), did not alter indicators of Th1 or Th2 responses but did result in a significant strain-independent up-regulation of IL6 and nitrite levels by stimulated splenocytes from treated mice compared to controls. The efficacy of BSO-NIV/SSG treatment was dependent on the host being able to mount a respiratory burst indicating that macrophages are important in controlling the outcome of treatment. In vitro studies showed that SSG resistance was associated with a greater resistance to killing by activated macrophages, treatment with hydrogen peroxide or potassium antimony tartrate. Longitudinal studies showed that a SSG resistant (SSG-R) strain was more virulent than a SSG susceptible (SSG-S) strain, resulting in significantly higher parasite burdens by 4 months post-infection. These results indicate that SSG exposure may favour the emergence of more virulent strains.
The cw absorption, steady state photoluminescence (PL), photoinduced absorption (PA), PL-detected magnetic resonance (PLDMR), and the time resolved PL of a novel polyfluorene (PF) prepared with bulky polyphenylene dendrimer substituents are compared with those of (PF) with ethyl-hexyl substituents. We show that the dendronic sidechains suppress the contribution from unwanted low energetic emission, yielding a polymer with pure blue emission. The sidechains also strongly alter the dynamics of the excited entities. In particular, the time-resolved PL and temperature-dependence of the cw PL from 20-320 K reveal distinct singlet exciton (SE) dynamics in the polymer films, while the behavior in solution is essentially the same. However, the PA results show that the dynamics of polarons and triplet excitons (TEs) are similar, and the PLDMR shows that the interaction between the SEs and polarons are also similar.
Authors have suggested that the high rate of schizophrenia reported for African–Caribbeans living in the UK is due to misdiagnosis by British psychiatrists.
To compare the diagnoses made by a Black Jamaican psychiatrist with those of White British psychiatrists.
All in-patients on four wards at the Maudsley hospital were approached for the study; 66 participated: 24 White, 29 Black African–Caribbeans and 13 Blacks from other countries of origin. F. W. H., a Black Jamaican psychiatrist, conducted his standard clinical assessment and performed the Present State Examination (PSE) on these patients. His diagnoses were compared with the case note diagnoses made by British psychiatrists, and with the PSE CATEGO diagnoses.
Of 29 African and African–Caribbean patients diagnosed with schizophrenia, the diagnoses of the British and the Jamaican psychiatrists agreed in 16 instances (55%) and disagreed in 13 (45%). Hence, interrater reliability was poor (κ=0.45). PSE CATEGO diagnosed a higher proportion of subjects as having schizophrenia than the Jamaican psychiatrist did (χ2=3.74, P=0.052)
Agreement between the Jamaican psychiatrist and his UK counterparts about which patients had schizophrenia was poor. PSE CATEGO may overestimate rates of schizophrenia.
Public support for integrated pest management (IPM) is derived in part from concerns over food safety and the environment, yet few studies have assessed the economic value of health and environmental benefits of IPM. An approach is suggested for such an assessment and applied to the Virginia peanut IPM program. Effects of IPM on environmental risks posed by pesticides are assessed and society's willingness to pay to reduce those risks is estimated. The annual environmental benefits of the peanut IPM program are estimated at $844,000. The estimates of pesticide risks and willingness to pay can be applied elsewhere in economic assessments of IPM.
A series of grazed and cut experiments were conducted in Bali and North Sulawesi, Indonesia, between 1992 and 1994, to evaluate a range of selected forages for both intensive and extensive ruminant production under mature, tall coconuts. Yield, botanical composition and persistence of grass–legume mixtures were assessed under regular grazing and cutting regimes.
In North Sulawesi, total dry matter yields of most grass–legume treatments were relatively stable over the two-year period but yields of legume components within treatments declined sharply. In Bali, the grazed plots maintained stable yield and legume components over the experimental period but yield and legume components of cut plots declined sharply. Paspalum malacophyllum and Setaria sphacelata cv. Splenda were productive and persistent grasses and formed weed-free swards but
did not combine well with prostrate legumes. The erect growth habit of these grasses may limit their suitability in coconut production systems by impeding nut collection. The prostrate species Brachiaria humidicola and Stenotaphrum secundatum were slightly less productive but equally weed-free and persistent, and established rapidly from cuttings. S. secundatum also formed stable associations with prostrate legumes under grazing. Arachis pintoi cv. Amarillo and A.
glabrata CPI 93483 were the most persistent of a range of prostrate legumes. The tree legume, Calliandra calothyrsus, showed promise as a productive cut-and-carry species.