bluuebunny/crossref_metadata_2025 huggingface dataset:
How do caregivers understand and respond to unsettled infant behaviour in Vietnam? A qualitative study
Authors: Murray L. , Tran T. , Thang V. V. , Cass L. , Fisher J.
Published: May 2017

Background

Unsettled infant behaviours are a common source of concern for new parents and have been associated with perinatal common mental disorders amongst women in high‐income settings. There is little evidence about how unsettled infant behaviours are understood and managed in low and lower‐middle income countries. This study aimed to describe caregivers' understandings of, and responses to, unsettled infant behaviours in Vietnam and their family caregiving contexts.

Methods

Women who were mothers of infants aged 0–6 months were purposively recruited from two sites in Thua Thien Hue Province, Vietnam (one urban and one rural). An additional group of women who were grandmothers were recruited by snowball sampling. Data were collected in semi‐structured interviews about demographic information, infant feeding practices, descriptions of infant crying episodes, beliefs about why infants cry, settling strategies, infant sleeping arrangements and sources of advice on infant care. Translated interview transcripts were analysed thematically.

Results

Twenty‐four interviews were undertaken (21 with mothers and 3 with grandmothers). Five major themes emerged from the data after analysis: infant settling techniques, sources of information on unsettled infant behaviour, understandings of the causes of infant crying, the emotional responses of caregivers and the intergenerational household context. Infants were commonly cared for by people from multiple generations, particularly during the day. Infant settling was characterized by attending to infants immediately, breastfeeding and bed‐sharing with parents during the night. Most mothers received advice on caregiving from family members. Infant crying was attributed to hunger and loneliness, as well as traditional beliefs that the infant was being upset by ‘ghosts’ or becoming ‘hot’. Women described feeling anxious, frustrated and helpless in relation to unsettled behaviours amongst their infants.

Conclusions

Educational interventions on interpreting infant cues, infant sleep requirements and bed sharing may be appropriate in Vietnam if multiple generations are included and traditional beliefs about infant crying are addressed.
The Development of Theory of Mind: Historical Reflections
Authors: Wellman Henry M.
Published: May 2017

In this article, I reflect on theory of mind as a field, including how it arose and how it developed. My research has been intertwined with this process; beginning right out of graduate school, my career developed along with the field, and I contributed to the field and its development at various points. So this essay also traces my path as I strived, and still strive, to understand how theory of mind begins and unfolds in human development, what forces shape that development, and what accounts best explain the timetables and progressions of theory‐of‐mind understandings in humans. I end with my sense of where theory‐of‐mind research is likely to head in the near future.
The magnitude of Indigenous and non‐Indigenous oral health inequalities in Brazil, New Zealand and Australia
Authors: Schuch Helena S. , Haag Dandara G. , Kapellas Kostas , Arantes Rui , Peres Marco A. , Thomson W. M. , Jamieson Lisa M.
Published: May 2017

Objective

To compare the magnitude of relative oral health inequalities between Indigenous and non‐Indigenous persons from Brazil, New Zealand and Australia.

Methods

Data were from surveys in Brazil (2010), New Zealand (2009) and Australia (2004‐06 and 2012). Participants were aged 35‐44 years and 65‐74 years. Indigenous and non‐Indigenous inequalities were estimated by prevalence ratios (PR) and their corresponding 95% confidence intervals (CI), adjusting for sex, age and income. Outcomes included inadequate dentition, untreated dental caries, periodontal disease and the prevalence of “fair” or “poor” self‐rated oral health in Australia and New Zealand, and satisfaction with mouth/teeth in Brazil (SROH).

Results

Irrespective of country, Indigenous persons had worse oral health than their non‐Indigenous counterparts in all indicators. The magnitude of these ratios was greatest among Indigenous and non‐Indigenous Australians, who, after adjustments, had 2.77 times the prevalence of untreated dental caries (95% CI 1.76, 4.37), 5.14 times the prevalence of fair/poor SROH (95% CI 2.53, 10.43).

Conclusion

Indigenous people had poorer oral health than their non‐Indigenous counterparts, regardless of setting. The magnitude of the relative inequalities was greatest among Indigenous Australians for untreated dental decay and poor SROH.
Expression of the filaggrin gene in umbilical cord blood predicts eczema risk in infancy: A birth cohort study
Authors: Ziyab A. H. , Ewart S. , Lockett G. A. , Zhang H. , Arshad H. , Holloway J. W. , Karmaus W.
Published: May 2017

Background

Filaggrin gene (FLG) expression, particularly in the skin, has been linked to the development of the skin barrier and is associated with eczema risk. However, knowledge as to whether FLG expression in umbilical cord blood (UCB) is associated with eczema development and prediction is lacking.

Objective

This study sought to assess whether FLG expression in UCB associates with and predicts the development of eczema in infancy.

Methods

Infants enrolled in a birth cohort study (n=94) were assessed for eczema at ages 3, 6, and 12 months. Five probes measuring FLG transcripts expression in UCB were available from genomewide gene expression profiling. FLG genetic variants R501X, 2282del4, and S3247X were genotyped. Associations were assessed using Poisson regression with robust variance estimation. Area under the curve (AUC), describing the discriminatory/predictive performance of fitted models, was estimated from logistic regression.

Results

Increased level of FLG expression measured by probe A_24_P51322 was associated with reduced risk of eczema during the first year of life (RR=0.60, 95% CI: 0.38‐0.95). In contrast, increased level of FLG antisense transcripts measured by probe A_21_P0014075 was associated with increased risk of eczema (RR=2.02, 95% CI: 1.10‐3.72). In prediction models including FLG expression, FLG genetic variants, and sex, discrimination between children who will and will not develop eczema at 3 months of age was high (AUC: 0.91, 95% CI: 0.84‐0.98).

Conclusions and Clinical Relevance

This study demonstrated, for the first time, that FLG expression in UCB is associated with eczema development in infancy. Moreover, our analysis provided prediction models that were capable of discriminating, to a great extent, between those who will and will not develop eczema in infancy. Therefore, early identification of infants at increased risk of developing eczema is possible and such high‐risk newborns may benefit from early stratification and intervention.
BK viremia surveillance and outcomes in simultaneous pancreas‐kidney transplant recipients
Authors: Westphal Scott G. , Lyden Elizabeth R. , Langewisch Eric D. , Miles Clifford D.
Published: May 2017

Background

While screening for asymptomatic BK viremia (BKV) has been well studied in isolated kidney transplant recipients, there is a paucity of published outcomes in simultaneous pancreas‐kidney (SPK) transplant recipients who underwent BKV screening followed by pre‐emptive reduction in immunosuppression.

Methods

This is a single‐center, retrospective review of 31 consecutive SPK recipients who were transplanted over a 5‐year period following the initiation of a serum BKV screening protocol.

Results

BK viremia developed in 11 (35.5%) patients, and all patients achieved complete viral clearance following reduction in immunosuppression. Two patients (6.5%) developed BK virus nephropathy, but both had preserved allograft function. One patient developed mild rejection of the kidney allograft following clearance of BKV, and two patients developed mild rejection of the pancreas allograft after reduction in immunosuppression, but there were no kidney or pancreas allograft losses due to rejection. The development of BK viremia did not impact overall patient survival or kidney and pancreas allograft survival.

Conclusion

Screening asymptomatic SPK recipients for BKV followed by reduction in maintenance immunosuppression appears to be an effective strategy to prevent kidney allograft dysfunction and graft loss due to BK virus nephropathy, without compromising pancreas allograft outcomes.
Contrasting impacts of an alien invasive shrub on mammalian savanna herbivores revealed on a landscape scale
Authors: Rozen‐Rechels David , te Beest Mariska , Dew L. Alexander , le Roux Elizabeth , Druce Dave J. , Cromsigt Joris P. G. M.
Published: May 2017

Aim

Habitat loss and fragmentation is one of the main drivers of defaunation, that is the loss of large mammals. Biological invasions could be drivers of such phenomenon. However, their impact on large herbivore communities has not been studied to our knowledge. We made use of a landscape‐scale control programme of one of the world's worst invaders, the shrub Chromolaena odorata, as a natural experiment to assess how this alien invader affects habitat use by 14 species of ungulates in an African savanna.

Location

Hluhluwe‐iMfolozi Park, KwaZulu‐Natal, South Africa.

Methods

At the height of the invasion in 2004, a large‐scale control programme was initiated that successfully reduced densities of C. odorata across the park. We estimated mammalian herbivore habitat and patch use by dung counts and the presence and density of C. odorata along 24 line transects with a total length of 190 km during the peak of the invasion (2004) and a decade after the initiation of a successful control programme (2014). To account for differences in herbivore assemblies between habitats and the preferential invasion of closed savanna woodlands, we analysed the recolonization of previously invaded patches by herbivores based on the change in dung abundance.

Results

Herbivore species differed in how they responded to invaded patches of this non‐native shrub. Grazers were the most negatively affected, especially those that avoid predators by running. Browsers were negatively impacted only at the highest invasive shrub densities. Some species, especially bushpig, positively selected invaded patches.

Main conclusions

Large herbivores varied in their response to invasion with differences in impact depending on feeding strategy and predator avoidance strategy, but the majority of ungulates responded positively to the removal of this invasive shrub.
Bird responses to forest loss are influence by habitat specialization
Authors: Zurita G. A. , Pe'er G. , Bellocq M. I.
Published: May 2017

Aim

Due to intrinsic differences in the sensitivity to habitat grain among species, studies performed at different extent are necessary to understand the consequences of forest loss and fragmentation. Using a large database, we explored the responses of birds to changes in forest cover and the role of habitat specialization in the strength of this response.

Location

Southern Atlantic forest of Argentina, Brazil and Paraguay.

Methods

We used data on bird occurrences recorded in 1,384 point counts (2004–2011), estimated forest cover and number of forest fragments in two radii (60 and 960 m), centred at each point count. For each bird species, we extracted the geographical and altitudinal range as two indirect measures of habitat specialization. We used general linear model and Akaike information criterion to explore the influence of the type of habitat, the amount of habitat and fragmentation pattern on the probability of species occurrence and the influence of habitat specialization on the strength of response.

Results

Of the 28 species analysed, 15 (55%) responded either to forest loss or the number of fragments, either positively or negatively. In these 15 species, the probability of occurrence of 67% was better explained by a specific extent (either 60 or 960 m). The strength of the response to forest loss decreased with both the geographical and the altitudinal range of species.

Main conclusions

Our study shows that a large proportion of species responded to forest loss at a specific extent and that the magnitude of the response is related to species specialization. A single‐extent approach to multispecies studies may not be enough to preserve the whole community due to differences in sensitivity to habitat grain. Maintaining forest cover at multiple extents and managing anthropogenic habitats to increase their suitability for native species are essential to preserve communities in highly fragmented landscapes such as the Atlantic forest.
Opt‐in or opt‐out to increase organ donation in South Africa? Appraising proposed strategies using an empirical ethics analysis
Authors: Etheredge Harriet , Penn Claire , Watermeyer Jennifer
Published: May 2017

Utilising empirical ethics analysis, we evaluate the merits of systems proposed to increase deceased organ donation in South Africa (SA). We conclude that SA should maintain its soft opt‐in policy, and enhance it with ‘required transplant referral’ in order to maximise donor numbers within an ethically and legally acceptable framework.

In SA, as is the case worldwide, the demand for donor organs far exceeds the supply thereof. Currently utilising a soft opt‐in system, SA faces the challenge of how to increase donor numbers in a context which is imbued with inequalities in access to healthcare, multiplicitous personal beliefs and practices, distrust of organ transplant and varying levels of education and health literacy.

We argue that a hard opt‐in, opt‐out or mandated consent system would be problematic, and we present empirical data from Gauteng Province illustrating barriers to ethically sound practice in soft consent systems. Ultimately, we argue that in spite of some limitations, a soft opt‐in system is most realistic for SA because its implementation does not require extensive public education campaigns at national level, and it does not threaten to further erode trust at a clinical level.

However, to circumvent some of the clinical‐level barriers identified in our empirical study, we propose a contextually sensitive option for “enabling” soft opt‐in through “required transplant referral”. We argue that this system is legally defensible, enhances ethical practice and could also increase donor numbers as it has in many other countries.
Assessments of pain in children and adolescents with cerebral palsy: a retrospective population‐based registry study
Authors: Westbom Lena , Rimstedt Amanda , Nordmark Eva
Published: May 2017

Aim

To explore pain screening in CPUP, a follow‐up surveillance programme for people with cerebral palsy (CP), specifically to describe reported pain prevalence, localizations, patterns of distribution; to compare with studies using psychometrically sound assessment instruments; and to assess agreement between pain documented in CPUP and medical records.

Method

Registry study of a population with CP, born 1993 to 2008, living in Skåne, Sweden in 2013. Descriptive data, cross‐tabulations, and chi‐square tests to characterize and compare the study groups. Kappa analysis to test the concordance between register and medical record reports on pain.

Results

Pain was reported by 185 out of 497 children (37%; females 40%, males 35%). Level V in both Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) was associated with highest prevalence of pain (50% and 54%), and level I with lowest prevalence of pain (30% and 32%). Pain was most frequent in dyskinetic CP (46%) and least frequent in unilateral spastic CP (33%). Feet and knees were the dominant localizations. Fair–moderate agreement (kappa 0.37, prevalence‐adjusted bias‐adjusted kappa [PABAK] 0.44) was found between documented pain in CPUP and medical records, although more seldom recognized in medical records.

Interpretation

The distribution of pain between CP subtypes, functional levels, sex, and age in CPUP is concordant with previous population‐based studies, indicating the validity of the CPUP pain screening. Despite this, further clinical evaluation with extended pain assessments and pain management were largely neglected in children reporting chronic pain.
Adult height and glucose tolerance: a re‐appraisal of the importance of body mass index
Authors: Rehunen S. K. J. , Kautiainen H. , Eriksson J. G. , Korhonen P. E.
Published: May 2017

Aim

To study both the association between adult height and glucose regulation based on findings from a 75‐g oral glucose tolerance test, and the combined effect of height and adiposity on glucose values.

Methods

We conducted a population‐based, cross‐sectional study among apparently healthy people with high cardiovascular risk living in south‐western Finland. The study included 2659 participants aged 45–70 years, who had at least one cardiovascular risk factor but no previously diagnosed diabetes or manifested cardiovascular disease. An oral glucose tolerance test was performed in all participants. Height and weight were measured and BMI was calculated. The participants were divided into five height groups based on normal distribution. For further analysis of the association between height and glucose concentrations the participants were divided into four BMI groups (<25.0 kg/m2; 25–29.9 kg/m2; 30–34.9 kg/m2; ≥35 kg/m2). Data were analysed using age‐adjusted linear regression models.

Results

Height was inversely associated with 2‐h plasma glucose, but not with fasting plasma glucose concentration. No gender difference was observed. The 2‐h plasma glucose values increased with an increase in BMI, so that height was inversely associated with 2‐h plasma glucose in the three lowest BMI groups, but not in the highest BMI group (P=0.33).

Conclusions

Taller people had lower 2‐h plasma glucose concentrations than shorter people, up to a BMI of 35 kg/m2. Adjustment for height and BMI is needed for accurate interpretation of oral glucose tolerance tests.
Insulin‐associated weight gain in obese type 2 diabetes mellitus patients: What can be done?
Authors: Brown Adrian , Guess Nicola , Dornhorst Anne , Taheri Shahrad , Frost Gary
Published: May 2017

Insulin therapy (IT) is initiated for patients with type 2 diabetes mellitus when glycaemic targets are not met with diet and other hypoglycaemic agents. The initiation of IT improves glycaemic control and reduces the risk of microvascular complications. There is, however, an associated weight gain following IT, which may adversely affect diabetic and cardiovascular morbidity and mortality. A 3 to 9 kg insulin‐associated weight gain (IAWG) is reported to occur in the first year of initiating IT, predominantly caused by adipose tissue. The potential causes for this weight gain include an increase in energy intake linked to a fear of hypoglycaemia, a reduction in glycosuria, catch‐up weight, and central effects on weight and appetite regulation. Patients with type 2 diabetes who are receiving IT often have multiple co‐morbidities, including obesity, that are exacerbated by weight gain, making the management of their diabetes and obesity challenging. There are several treatment strategies for patients with type 2 diabetes, who require IT, that attenuate weight gain, help improve glycaemic control, and help promote body weight homeostasis. This review addresses the effects of insulin initiation and intensification on IAWG, and explores its potential underlying mechanisms, the predictors for this weight gain, and the available treatment options for managing and limiting weight gain.
The real East Asian Aid model: Development assistance as an instrument of comprehensive security in Japan, South Korea and Taiwan
Authors: Atkinson Joel
Published: May 2017

Discussion of East Asian aid modes has remained superficial. And one donor, Taiwan, has been overlooked. This article reconsiders East Asian donorship, and places Taiwan within this category. It argues that East Asian donors are insecure, and see aid as part of a wider security policy. Aid policy pursues two main goals: economic strength and international influence. The aid apparatus is insulated from legislative and public pressure. Due to the nature of the goals pursued, relations with recipient governments in general are good, and recipient publics bad, relative to other Development Assistance Committee (DAC) donors. Relations with other donors are ambivalent; good relations are important, but can interfere with other goals. As such, Taiwan is a quintessential East Asian donor.
Bank Size and Lending Specialisation
Authors: Bonfim Diana , Dai Qinglei
Published: May 2017

Using micro‐level data on the entire population of business loans of a bank‐based economy, we empirically test some of the core predictions of the small and medium enterprise (SME) financing literature, examining banks’ lending specialisations in firm size and lending technologies. Rejecting the conventional belief that smaller banks focus more on relationship loans than larger banks, we find that relationship lending is equally common for small and large banks. However, supporting the SME finance theories on the organizational advantages of small banks, we find that smaller banks provide more access to relationship loans to small firms, though such loans are usually more expensive.
Movement behaviour of large female yellow European eel (Anguilla anguilla L.) in a freshwater polder area
Authors: Verhelst Pieterjan , Reubens Jan , Pauwels Ine , Buysse David , Aelterman Bart , Van Hoey Stijn , Goethals Peter , Moens Tom , Coeck Johan , Mouton Ans
Published: May 2017

Due to a recruitment decline of more than 90% in 30 years, the European eel (Anguilla anguilla L.) has been classified by IUCN as critically endangered. Although the species has been studied intensively to obtain knowledge to improve management, studies about the resident yellow stage are relatively scarce. In this study, 52 large female yellow eels were tagged with acoustic transmitters in a Belgian polder system and tracked by a network of 23 automatic listening stations. We studied both circadian and seasonal movement patterns and the effect of environmental variables on these patterns. Large female yellow eels were most active at night in late summer and early autumn. A generalised linear mixed model showed that their movement is only slightly influenced by environmental variables. Moreover, as yellow eels show high site fidelity (i.e., the majority was detected only in the habitat type of their catch‐release location), they do not encounter many human‐induced connectivity problems in polder systems, which makes these systems highly suitable as eel growth habitat. These results can contribute to an effective eel management regarding habitat protection and restoration.
Pilot study of client outcomes from exercise physiology in a youth mental health service
Authors: Woodhead Gina , Hitch Danielle , Bolton Kate , Albiston Dianne , Killackey Eoin
Published: May 2017

The aim of this pilot study was to evaluate the utilisation and experience of an exercise physiology programme, known as Bod Squad at a youth mental health service. Individual sessions were offered in an outpatient setting, while both group and individual sessions occurred in an inpatient unit. This pilot study used a mixed methodology to collect data from young people who attended Bod Squad. A database of exercise physiology records for 47 young people were analysed for attendance and physiological indicators. In addition, 7 semi‐structured interviews were conducted with young people to explore their experience of Bod Squad. Young people attended a total of 169 sessions during the programmes tenure, with an overall mean of 3.6 sessions. Pre‐post measures for 10 young people (who had attended at least 4 sessions) showed modest average reductions for body mass index, waist circumference, chest circumference and resting heart rate. Five themes emerged from the interviews—(1) My reasons for attending, (2) The social aspect, (3) An individualized approach, (4) Outcomes from Bod Squad and (5) My experience of the service. All of these themes included positive experiences of Bod Squad, which young people perceived as relevant to their needs and helpful to their recovery. These findings are congruent with previous studies that have concluded that exercise physiology may be an effective, acceptable and valued intervention for addressing physical and metabolic health issues for young people.
Constraints on trait combinations explain climatic drivers of biodiversity: the importance of trait covariance in community assembly
Authors: Dwyer John M. , Laughlin Daniel C.
Published: May 2017

Trade‐offs maintain diversity and structure communities along environmental gradients. Theory indicates that if covariance among functional traits sets a limit on the number of viable trait combinations in a given environment, then communities with strong multidimensional trait constraints should exhibit low species diversity. We tested this prediction in winter annual plant assemblages along an aridity gradient using multilevel structural equation modelling. Univariate and multivariate functional diversity measures were poorly explained by aridity, and were surprisingly poor predictors of community richness. By contrast, the covariance between maximum height and seed mass strengthened along the aridity gradient, and was strongly associated with richness declines. Community richness had a positive effect on local neighbourhood richness, indicating that climate effects on trait covariance indirectly influence diversity at local scales. We present clear empirical evidence that declines in species richness along gradients of environmental stress can be due to increasing constraints on multidimensional phenotypes.
Why Sexual Assault Survivors Do Not Report to Universities: A Feminist Analysis
Authors: Spencer Chelsea , Mallory Allen , Toews Michelle , Stith Sandra , Wood Leila
Published: May 2017

The present study analyzed responses from 220 female survivors of sexual assault at a U.S. college campus. Guided by feminist thought, we used thematic analysis to analyze survivors' reasons for not reporting their sexual assault to university officials. Drawing on participants' own words, the most common reasons for not reporting included “It was not a big enough deal,” “I didn't know who to report to or that I could report,” “It wasn't related to the university,” “I was afraid,” “Because I was drunk,” “Too ashamed to report,” “I didn't want to get him in trouble,” and “Felt as if I would be blamed for putting myself in the situation.” We conducted a series of binary logistic regressions to determine which demographic and experiential variables were associated with the thematic reason(s) for not reporting. In the spirit of feminist praxis, we offer implications for universities to remove barriers for reporting sexual violence.
Large‐scale responses of herbivore prey to canid predators and primary productivity
Authors: Letnic Mike , Ripple William J.
Published: May 2017

Aim

The primacy of top‐down (consumption) and bottom‐up effects (primary productivity) as forces structuring ecological communities is a controversial topic. The exploitation ecosystems hypothesis (EEH) was invoked to explain biogeographical trends in plant and consumer biomass, and differs from the top‐down/bottom‐up dichotomy by predicting that the relative strength of these processes will vary along gradients of primary productivity. Here we test the prediction of the EEH that herbivore biomass should increase with increasing primary productivity where predators are rare, but show a negligible response to primary productivity where predators are common due to population regulation by predators.

Location

Boreal and temperate regions of North America and Eurasia, and deserts of Australia.

Time period

1970–2016.

Major taxa studied

Cervids and kangaroos.

Methods

We obtained abundance indices of cervids at 42 locations from the literature and conducted spotlight surveys at 27 locations to derive estimates of kangaroo abundance. For analyses, herbivore abundances were converted to biomass per km2. We tested our prediction using linear mixed effects models.

Results

Herbivore biomass showed divergent responses to increasing primary productivity and the abundance of canid predators (grey wolves, Canis lupus/dingoes, Canis dingo). The slope of the relationship between herbivore biomass and net primary productivity did not differ between Australia and the northern boreal and temperate regions. Herbivore biomass increased in response to primary productivity where canid predators were rare, but showed muted responses to increasing productivity where canid predators were common.

Main conclusions

Canid predators have strong suppressive effects on herbivore biomass that scale with primary productivity. Our study shows that the EEH has wide application to canid‐predator–herbivore dynamics and may be relevant to the management of herbivores because it can provide an indication of how herbivore biomass and densities may vary in relation to ecosystem productivity and the presence and absence of canid predators.
High sodium continuous veno‐venous hemodialysis with regional citrate anticoagulation and online dialysate generation in patients with acute liver failure and cerebral edema
Authors: Hamdi Tamim , Yessayan Lenar , Yee Jerry , Szamosfalvi Balazs
Published: May 2017

Introduction: Acute liver failure is associated with a high mortality rate. Induction of plasma hypertonicity with mannitol or hypertonic saline remains the cornerstone in the management of resultant cerebral edema. Significant disadvantages of this approach include poor or unpredictable control of serum sodium concentration and volume expansion, among others.

Methods: We used high sodium continuous veno‐venous hemodialysis with regional citrate anticoagulation and online dialysate generation to accurately control the serum sodium in eleven patients with acute liver failure, renal failure, and cerebral edema. We used a Fresenius 2008 K/K2 machine in hemodialysis mode to deliver a blood flow of 60 ml/minute and dialysate flow of 400 ml/minute. Our previously published protocol results in complete removal of infused citrate by the dialyzer. On‐line clearance calculations were used to model the time required to reach the target serum sodium.

Findings: All patients achieved serum sodium within 2 mEq/L of target without fluctuations or rebound. Nine patients survived without requiring liver transplantation and two died despite reaching the prescribed serum sodium target. We did not encounter any citrate toxicity.

Discussion: We describe a novel approach for delivering continuous osmotherapy to patients with acute liver failure, renal failure, and cerebral edema. In comparison to standard therapy, the described modality enables precise titration of serum sodium without undesirable fluctuations in extracellular fluid volume. A particular advantage is zero delivery of citrate to this vulnerable group of patients with acute liver failure.
37 year snacking trends for US children 1977–2014
Authors: Dunford E. K. , Popkin B. M.
Published: May 2017

Background

Previous studies have indicated that snacking is contributing to increased calorie intake of American children and that the energy density of snacks in US diets has increased in recent decades.

Objective

Examine short‐term and long‐term trends in the energy density and food sources of snacks for US children from 1977 to 2014, and examine whether trends differ between socio‐demographic groups.

Methods

We used data collected from eight nationally representative surveys of food intake in 49,952 US children age 2–18 years, between 1977 and 2014. Overall patterns of snacking, trends in energy intake from snacking, trends in food and beverage sources and energy density of snacks across race‐ethnic, age, gender, education and income groups were examined.

Results

In all socio‐demographic groups, there was a significant increase in per capita energy intake deriving from snacks from 1977 to 2014 (P < 0.01). Salty snack intake doubled over the study period, and sugar‐sweetened beverage intake decreased overall from 1977 to 2014 but increased in Non‐Hispanic Blacks. Non‐Hispanic Blacks had the largest increase in per capita intake from foods as a snack from 1977 to 2014. Children in the lowest poverty level and household education groups had more than 100% increase in calorie intake from snacks from 1977 to 2014.

Conclusions

We found that snacking behaviour in the USA differs between race‐ethnic, household education, gender and income groups, yet snacking remains a significant component of children's diets and the foods consumed at these snacks are not the types of foods recommended by the US dietary guidelines.
Inpatient iron deficiency detection and management: how do general physicians and gastroenterologists perform in a tertiary care hospital?
Authors: Fazal Muhammad W. , Andrews Jane M. , Thomas Josephine , Saffouri Eliana
Published: May 2017

Background

Iron deficiency (ID) is often an indicator of underlying pathology. Early detection and treatment avoids long‐term morbidity and allows for prompt iron repletion, avoiding ID anaemia (IDA) and the need for blood transfusion.

Aim

To evaluate the management of ID in two internal medicine units (general medical (GM) and gastroenterology (GE)) in a large metropolitan hospital and compare it to international guidelines.

Methods

All consecutive inpatient admissions in the GM and GE units were retrospectively reviewed until 40 patients in each service were identified with anaemia and/or microcytic hypochromic blood counts. Patient records and electronic discharge summaries were then reviewed to assess the recognition, investigation and management of these abnormalities.

Results

Overall, only 60% (48/80) of the cases of microcytic hypochromic picture and/or anaemia were recognised. Cases were more likely to be detected under the GE unit, 77.5% (31/40) versus 42% (17/40) in GM (P < 0.002). Of the 31 recognised GE cases, 28 (90%) were investigated further with iron studies and/or endoscopic procedures. ID was confirmed in nearly half (5/11) of those tested; however, only 2 of 5 received iron replacement. Among GM patients, only 11 of the 17 recognised cases (64%) were investigated further. Iron studies were performed in all 11, confirming IDA in 4 (36%), all of whom received intravenous iron. A faecal human haemoglobin test was performed in two GM patients and one GE patient.

Conclusion

There remains significant room for improvement in the recognition, investigation and management of ID in hospital practice in Australia.
Association of renin angiotensin antagonists with adverse perioperative events in patients undergoing elective orthopaedic surgery: a case–control study
Authors: Zainudheen Amith , Scott Ian A. , Caney Xenia
Published: May 2017

Background

Renin angiotensin antagonists (RAA) may block protective vasopressor responses during surgery. Evidence linking RAA with intraoperative hypotension and perioperative adverse events is conflicting.

Aim

To compare the incidence of intraoperative hypotension and adverse events between patients receiving or not receiving RAA.

Methods

This is a retrospective case–control study of 258 consecutive patients who underwent elective total knee or hip replacement between 1 January 2013 and 31 August 2016 and who were chronically prescribed a single blood pressure‐lowering agent up to the time of surgery. Primary outcome measures were differences between patients receiving RAA (cases; n = 129) and patients receiving non‐RAA medications (controls; n = 129) in incidence of intraoperative hypotension (systolic blood pressure <90 mmHg), perioperative acute kidney injury (AKI, >30% increase in serum creatinine from baseline on Day 1 post‐operatively) and new onset major adverse cardiac or cerebrovascular events (MACCE) or in‐hospital death over 72 h post‐operatively.

Results

Patients receiving RAA had significantly higher preoperative systolic blood pressure, greater prevalence of hypertension and chronic kidney disease, lower prevalence of ischaemic heart disease and lower cardiac risk compared to controls. Age, gender, type of operation, operative fitness, mode and duration of anaesthesia and prevalence of other types of cardiovascular disease, dyslipidaemia and diabetes were similar between groups. Compared to controls, patients receiving RAA had higher incidence of intraoperative hypotension (76.0 vs 45.9%, P < 0.001), AKI (11.6 vs 1.6%, P = 0.002) and MACCE (6.2 vs 0%, P = 0.007), with all adverse events associated with intraoperative hypotension.

Conclusion

This study provides further observational evidence of RAA‐induced harm in patients undergoing elective surgery, although determining benefits and harms of preoperative withdrawal of RRA requires prospective randomised trials.
A combined hands‐on teaching programme and clinical pathway focused on pleural ultrasound and procedure supervision transforms pleural procedure outcomes
Authors: Edwards Timothy , Cook Alistair , Salamonsen Matthew , Bashirzadeh Farzad , Fielding David
Published: May 2017

Background

Management of pleural effusions is a common diagnostic and management problem.

Aims

We reviewed the outcomes from pleural procedures after the instigation of pleural effusion management guidelines, focusing on pleural ultrasound and a hands‐on teaching programme followed by procedure supervision that enabled many operators to perform such procedures.

Methods

This is a retrospective analysis of all procedures performed for pleural effusions on medical patients. Outcomes were assessed prior to the instigation of pleural effusion management guidelines (pleural pathway) and hands‐on teaching (January 2010 to June 2011) and following these interventions (January 2012 to June 2013).

Results

A total of 171 procedures involving 129 patients (pre‐pathway group) and 146 procedures involving 115 patients (post‐pathway group) was analysed. The rate of complications prior to the pleural pathway was 22.2% (38 of 171 procedures). Following the pathway, the rate of complications declined to 7.5% (11 of 146 procedures, P < 0.003). The use of pleural ultrasound increased dramatically (72.5 vs 90.2%). The number of patients who underwent repeated procedures (defined as ≥3) reduced dramatically (21 vs 7, P < 0.01). This improvement occurred using many supervised operators who completed the hands‐on teaching programme (n = 32) and followed the pleural pathway (127 of 146 procedures).

Conclusion

The instigation of a clinical pathway focused on the use of bedside pleural ultrasound, and teaching of drainage techniques with procedure supervision vastly improved patient outcomes. This not only allowed better quality of care for patients, it also provided the acquisition of new skills to medical staff, not limiting these skills to specialised staff.
Humanized NOG mice as a model for tuberculosis vaccine‐induced immunity: a comparative analysis with the mouse and guinea pig models of tuberculosis
Authors: Grover Ajay , Troy Amber , Rowe Jenny , Troudt JoLynn M. , Creissen Elizabeth , McLean Jennifer , Banerjee Prabal , Feuer Gerold , Izzo Angelo A.
Published: May 2017

The humanized mouse model has been developed as a model to identify and characterize human immune responses to human pathogens and has been used to better identify vaccine candidates. In the current studies, the humanized mouse was used to determine the ability of a vaccine to affect the immune response to infection with Mycobacterium tuberculosis. Both human CD4+ and CD8+ T cells responded to infection in humanized mice as a result of infection. In humanized mice vaccinated with either BCG or with CpG‐C, a liposome‐based formulation containing the M. tuberculosis antigen ESAT‐6, both CD4 and CD8 T cells secreted cytokines that are known to be required for induction of protective immunity. In comparison to the C57BL/6 mouse model and Hartley guinea pig model of tuberculosis, data obtained from humanized mice complemented the data observed in the former models and provided further evidence that a vaccine can induce a human T‐cell response. Humanized mice provide a crucial pre‐clinical platform for evaluating human T‐cell immune responses in vaccine development against M. tuberculosis.
Does influenza pandemic preparedness and mitigation require gain‐of‐function research?
Authors: Adam Dillon C. , Magee Daniel , Bui Chau M. , Scotch Matthew , MacIntyre C. Raina
Published: May 2017

The risk and benefits of gain‐of‐function studies on influenza A have been widely debated since 2012 when the methods to create two respiratory transmissible H5N1 mutant isolates were published. Opponents of gain‐of‐function studies argue the biosecurity risk is unacceptable, while proponents cite potential uses for pandemic surveillance, preparedness and mitigation. In this commentary, we provide an overview of the background and applications of gain‐of‐function research and argue that the anticipated benefits have yet to materialize while the significant risks remain.
Solving efficiently large single‐step genomic best linear unbiased prediction models
Authors: Strandén I. , Matilainen K. , Aamand G.P. , Mäntysaari E.A.
Published: May 2017

Single‐step genomic BLUP (ssGBLUP) requires a dense matrix of the size equal to the number of genotyped animals in the coefficient matrix of mixed model equations (MME). When the number of genotyped animals is high, solving time of MME will be dominated by this matrix. The matrix is the difference of two inverse relationship matrices: genomic (G) and pedigree (A22). Different approaches were used to ease computations, reduce computing time and improve numerical stability. Inverse of A22 can be computed as where Aij, i, j = 1,2, are sparse sub‐matrices of A−1, and numbers 1 and 2 refer to non‐genotyped and genotyped animals, respectively. Inversion of A11 was avoided by three alternative approaches: iteration on pedigree (IOP), matrix iteration in memory (IM), and Cholesky decomposition by CHOLMOD library (CM). For the inverse of G, the APY (algorithm for proven and young) approach using Cholesky decomposition was formulated. Different approaches to choose the APY core were compared. These approaches were tested on a joint genetic evaluation of the Nordic Holstein cattle for fertility traits and had 81,031 genotyped animals. Computing time per iteration was 1.19 min by regular ssGBLUP, 1.49 min by IOP, 1.32 min by IM, and 1.21 min by CM. In comparison with the regular ssGBLUP, the total computing time decreased due to omitting the inversion of the relationship matrix A22. When APY used 10,000 (20,000) animals in the core, the computing time per iteration was at most 0.44 (0.63) min by all the APY alternatives. A core of 10,000 animals in APY gave GEBVs sufficiently close to those by regular ssGBLUP but needed only 25% of the total computing time. The developed approaches to invert the two relationship matrices are expected to allow much higher number of genotyped animals than was used in this study.
Prediction of whole‐genome risk for selection and management of hyperketonemia in Holstein dairy cattle
Authors: Weigel K.A. , Pralle R. S. , Adams H. , Cho K. , Do C. , White H.M.
Published: May 2017

Hyperketonemia (HYK), a common early postpartum health disorder characterized by elevated blood concentrations of β‐hydroxybutyrate (BHB), affects millions of dairy cows worldwide and leads to significant economic losses and animal welfare concerns. In this study, blood concentrations of BHB were assessed for 1,453 Holstein cows using electronic handheld meters at four time points between 5 and 18 days postpartum. Incidence rates of subclinical (1.2 ≤ maximum BHB ≤ 2.9 mmol/L) and clinical ketosis (maximum BHB ≥ 3.0 mmol/L) were 24.0 and 2.4%, respectively. Variance components, estimated breeding values, and predicted HYK phenotypes were computed on the original, square‐root, and binary scales. Heritability estimates for HYK ranged from 0.058 to 0.072 in pedigree‐based analyses, as compared to estimates that ranged from 0.071 to 0.093 when pedigrees were augmented with 60,671 single nucleotide polymorphism genotypes of 959 cows and 801 male ancestors. On average, predicted HYK phenotypes from the genome‐enhanced analysis ranged from 0.55 mmol/L for first‐parity cows in the best contemporary group to 1.40 mmol/L for fourth‐parity cows in the worst contemporary group. Genome‐enhanced predictions of HYK phenotypes were more closely associated with actual phenotypes than pedigree‐based predictions in five‐fold cross‐validation, and transforming phenotypes to reduce skewness and kurtosis also improved predictive ability. This study demonstrates the feasibility of using repeated cowside measurement of blood BHB concentration in early lactation to construct a reference population that can be used to estimate HYK breeding values for genomic selection programmes and predict HYK phenotypes for genome‐guided management decisions.
“Conversion” of epistatic into additive genetic variance in finite populations and possible impact on long‐term selection response
Authors: Hill W.G.
Published: May 2017

The role of epistasis in understanding the genetic architecture and variation of quantitative traits and its role, if any, in artificial selection and livestock improvement more generally has a long and sometimes controversial history. Its presence has been clearly demonstrated in, for example, laboratory experiments, but the amount of variation it contributes is likely to be small in outbred populations. In a finite population, although additive x additive epistatic variance is lost by genetic drift, it also contributes by conversion to additive variance through drift sampling and therefore has a potential indirect role in medium and long‐term selection response, with superficial similarity to and hard to distinguish from mutation. Whilst predictions of response require knowledge of genetic parameters, an infinitesimal model provides some analytic results. Otherwise there is little quantitative information relevant to animal populations on which to judge this potential role of epistasis and reach firm conclusions.
Beyond genomic selection: The animal model strikes back (one generation)!
Authors: Cantet R.J.C. , García‐Baccino C.A. , Rogberg‐Muñoz A. , Forneris N.S. , Munilla S.
Published: May 2017

Genome inheritance is by segments of DNA rather than by independent loci. We introduce the ancestral regression (AR) as a recursive system of simultaneous equations, with grandparental path coefficients as novel parameters. The information given by the pedigree in the AR is complementary with that provided by a dense set of genomic markers, such that the resulting linear function of grandparental BV is uncorrelated to the average of parental BV in the absence of inbreeding. AR is then connected to segmental inheritance by a causal multivariate Gaussian density for BV. The resulting covariance structure (Σ) is Markovian, meaning that conditional on the BV of parents and grandparents, the BV of the animal is independent of everything else. Thus, an algorithm is presented to invert the resulting covariance structure, with a computing effort that is linear in the number of animals as in the case of the inverse additive relationship matrix.