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This study aimed to investigate the impact of dietary inclusion of babassu oil (BO) associated with sunflower oil (SO) on feeding behavior, water intake, and physiological parameters of feedlot lambs. Thirty‐five castrated male lambs (16.6 kg ± 3.9 kg) were distributed in a randomized block design with 5 treatments (diets) and 7 replications. The tested diets were oil‐free diet (OF), 45 g/kg BO (BO), 30 g/kg BO with an additional 15 g/kg SO (1.5 SO), 22.5 g/kg BO with an additional 22.5 g/kg SO (2.25 SO), and 30 g/kg SO with an additional 15 g/kg BO (3.0 SO) on dry matter (DM) basis. The experimental period lasted 60 days. Animals that received BO diet and the combination of BO with SO had lower intakes of DM and neutral detergent fiber (NDF) compared to the control diet (P < 0.05). Differences on the respiratory rate (RR) was observed between animals in the control diet and those in the diets containing SO (P = 0.001), with a linear increase in RR as the levels of SO in the diets increased (P = 0.004). All physiological parameters showed a time effect (P < 0.05). Animals fed with the control diet had higher water intake via drinking fountain (P = 0.030) and total water intake (P = 0.029) compared to animals fed with diets containing SO. In relation to SO levels, water intake via drinking fountain (P = 0.002), total water intake (P = 0.002), and total water intake per kg of DM ingested (P = 0.001) linearly increased with the levels increase in the composition of the diets. The tested diets did not alter the feeding behavior of the feedlot lambs. However, the combination of BO with different levels of SO reduced DM and water intake via drinking fountain and RR. [ABSTRACT FROM AUTHOR]

Permafrost underlies about one fifth of the global land area and affects ground stability, freshwater runoff, soil chemistry, and surface-atmosphere gas exchange. The depth of thawed ground overlying permafrost (active layer thickness) has broadly increased across the Arctic in recent decades, coincident with a period of increased streamflow, especially the lowest flows (baseflow). Mechanistic links between active layer thickness and baseflow have recently been explored using linear reservoir theory, but most watersheds behave as nonlinear reservoirs. We derive theoretical nonlinear relationships between long-term average saturated soil thickness n̄ (proxy for active layer thickness) and long-term average baseflow. When applied to 38 years of daily streamflow data for the Kuparuk River basin on the North Slope of Alaska, the theory predicts n̄ increased n̄ 0.17 ± 0.22 [2δ] cm a −1 between 1983 and n̄ 2020 (6.4 ± 8.4 cm total). The rate of increase nearly doubled to n̄ 0.29 ± 0.31 cm a −1 between 1990 and 2020, during which time local field measurements from Circumpolar Active Layer Monitoring sites indicate the active layer increased 0.31 ± 0.22 cm a −1. The predicted rate of increase more than doubled again between 2002 and 2020, outpacing a near doubling of observed active layer thickening, consistent with trends in terrestrial water storage inferred from Gravity Recovery and Climate Experiment satellite gravimetry and Modern-Era Retrospective Analysis for Research and Applications climate reanalysis. Overall, hydrologic change is accelerating in the Kuparuk River basin, and we provide a theoretical framework for estimating basin-scale changes in active layer water storage from streamflow measurements. [ABSTRACT FROM AUTHOR]

Methodological "confessions" are an established genre of ethnographic writing and have contributed to the development of reflexivity in the practice of qualitative research. Yet despite their prevalence, methodological reflections on the specific challenges of conducting ethnography in institutional sport settings have not been developed. The aim of this article, therefore, is to provide a confessional representation of ethnographic fieldwork in a male academy sport environment in the United Kingdom which exhibited several institutional characteristics. Five images are used as stimuli for further methodological reflection in order to illustrate and analyze some practical, ethical, and relational qualities of ethnographic fieldwork. The interpretation and analysis draw attention to strategic ways ethnographers adapt their ethnographic presence in response to specific contextual challenges and constraints. The article concludes with a series of recommendations to guide ethnographic fieldworkers (especially novice ethnographers) in settings of a similar nature. [ABSTRACT FROM AUTHOR]

Uncomfortable conversations are necessary for a safe work environment. [ABSTRACT FROM AUTHOR]

Background Patients unable to take azoles are a neglected group lacking a standardized approach to antifungal prophylaxis. We evaluated the effectiveness and safety of intermittent liposomal amphotericin B (L-AMB) prophylaxis in a heterogenous group of hematology patients. Methods A retrospective cohort of all hematology patients who received a course of intravenous L-AMB, defined as 1 mg/kg thrice weekly from July 1, 2013 to June 30, 2018, were identified from pharmacy records. Outcomes included breakthrough-invasive fungal disease (BIFD), reasons for premature discontinuation, and acute kidney injury. Results There were 198 patients who received 273 courses of L-AMB prophylaxis. Using a conservative definition, the BIFD rate was 9.6% (n = 19 of 198) occurring either during L-AMB prophylaxis or up to 7 days from cessation in patients who received a course. Probable/proven BIFD occurred in 13 patients (6.6%, 13 of 198), including molds in 54% (n = 7) and non- albicans Candidemia in 46% (n = 6). Cumulative incidence of BIFD was highest in patients with acute myeloid leukemia (6.8%) followed by acute lymphoblastic leukemia (2.7%) and allogeneic stem cell transplantation (2.5%). The most common indication for L-AMB was chemotherapy, or anticancer drug-azole interactions (75% of courses) dominated by vincristine, or acute myeloid leukemia clinical trials, followed by gut absorption concerns (13%) and liver function abnormalities (8.8%). Acute kidney injury, using a modified international definition, complicated 27% of courses but was not clinically significant, accounting for only 3.3% (9 of 273) of discontinuations. Conclusions Our findings demonstrate a high rate of BIFD among patients receiving L-AMB prophylaxis. Pragmatic trials will help researchers find the optimal regimen of L-AMB prophylaxis for the many clinical scenarios in which azoles are unsuitable, especially as targeted anticancer drugs increase in use. [ABSTRACT FROM AUTHOR]

One of the unique properties of metamaterials is the ability to manipulate electromagnetic waves at subwavelength scales, made possible by their structure on these scales. Here, rather than consider effective bulk properties, we consider the properties of microscopic features based on considering resonant unit cells. We used wire array metamaterials to form localized resonant cavities by changing the resonance frequency of one or more unit cells, surrounded by unchanged unit cells that do not support resonance for the propagating mode (i.e. forming a band gap). We validate our approach experimentally with electromagnetic waves in the terahertz range, demonstrating and characterizing subwavelength resonant cavities in this range. These resonant cavities can pave the way for ultra-compact subwavelength waveguides and other optical components. [ABSTRACT FROM AUTHOR]

We discuss shallow resonances in the nonrelativistic scattering of two particles using an effective field theory (EFT) that includes an auxiliary field with the quantum numbers of the resonance. We construct the manifestly renormalized scattering amplitude up to next-to-leading order in a systematic expansion. For a narrow resonance, the amplitude is perturbative except in the immediate vicinity of the resonance poles. It naturally has a zero in the low-energy region, analogous to the Ramsauer-Townsend effect. For a broad resonance, the leading-order amplitude is nonperturbative almost everywhere in the regime of validity of the EFT. We regain the results of an EFT without the auxiliary field, which is equivalent to the effective-range expansion with large scattering length and effective range. We also consider an additional fine tuning leading to a low-energy amplitude zero even for a broad resonance. We show that in all cases the requirement of renormalizability when the auxiliary field is not a ghost ensures the resonance poles are in the lower half of the complex momentum plane, as expected by other arguments. The systematic character of the EFT expansion is exemplified with a toy model serving as underlying theory. [ABSTRACT FROM AUTHOR]

Promoting feed hygiene with organic acids is an effective method to prevent foodborne illnesses from bacterial infection. The stability and acidification of mash and pelleted feed with sodium buffered formic acid was investigated. The acid product was incorporated to reach total formate inclusion levels of 0, 6, or 12 g/kg for swine nursery feed; 0, 4, or 9 g/kg for swine finishing feed; and 0, 3, or 6 g/kg for broiler grower feed. Samples were analyzed for total formate and pH on d 4, 32, 60, or 88 post-manufacturing. The concentration of formate remained stable across an 88-d period (P < 0.01). Treatment with the formic acid product decreased feed pH with increasing inclusion levels (all P < 0.01). Within each inclusion level of acid and across time, pH tended to increase in pelleted feed and decrease in mash feeds (all P < 0.01); however, these changes were small (0.1 units pH). These data suggest that sodium buffered formic acid can be applied to both mash and pelleted feed to provide continuous acidification over a 3-month period. [ABSTRACT FROM AUTHOR]

Between-individual variability of body temperature has been little investigated, but is of clinical importance: for example, in detection of neutropenic sepsis during chemotherapy. We studied within-person and between-person variability in temperature in healthy adults and those receiving chemotherapy using a prospective observational design involving 29 healthy participants and 23 patients undergoing chemotherapy. Primary outcome was oral temperature. We calculated each patient's mean temperature, standard deviation within each patient (within-person variability), and between patients (between-person variability). Secondary analysis explored temperature changes in the three days before admission for neutropenic sepsis. 1,755 temperature readings were returned by healthy participants and 1,765 by chemotherapy patients. Mean participant temperature was 36.16 C (95% CI 36.07-36.26) in healthy participants and 36.32 C (95% CI 36.18-36.46) in chemotherapy patients. Healthy participant within-person variability was 0.40 C (95% CI 0.36-0.44) and between-person variability was 0.26 C (95% CI 0.16-0.35). Chemotherapy patient within-person variability was 0.39 C (95% CI 0.34-0.44) and between-person variability was 0.34 C (95% CI 0.26-0.48). Thus, use of a population mean rather than personalised baselines is probably sufficient for most clinical purposes as between-person variability is not large compared to within-person variability. Standardised guidance and provision of thermometers to patients might help to improve recording and guide management. [ABSTRACT FROM AUTHOR]

Background The prevalence of mental incapacity for treatment decisions among medical and surgical hospital inpatients is poorly understood or not known in many countries, including Ireland. Aim To assess the prevalence of mental incapacity in hospital inpatients in Ireland. Design Cross-sectional observational study of mental incapacity for treatment decisions. Methods We assessed mental capacity in 300 randomly selected hospital inpatients in 2 general hospitals in Dublin (urban) and Portlaoise (rural), in Ireland, using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Results Mean MacCAT-T score was 14.80 (SD: 8.40) out of a possible maximum of 20 (with a higher score indicating greater mental capacity). Over one quarter of participants (27.7%; n = 83) lacked the mental capacity for treatment decisions; 1.7% (n = 5) had partial capacity and 70.7% (n = 212) had full capacity. Scores for each of the four sub-scales of the MacCAT-T were generally consistent across the four key areas of understanding, appreciation, reasoning and expressing a choice. Conclusions Mental incapacity for treatment decisions is common in medical and surgical hospital inpatients in Ireland. This issue both merits and requires greater attention in clinical practice, research and legislation. [ABSTRACT FROM AUTHOR]

Presents a study which investigated the addition of carbon elements into palladium/cobalt multilayers to reduce the coupling between adjacent magnetic domains. Background on palladium/cobalt multilayers; Description of the experimental setup; Results.

Objective: To summarize seven years of surveillance data for Lyme disease cases reported in Canada from 2009 to 2015. Methods: We describe the incidence over time, seasonal and geographic distribution, demographic and clinical characteristics of reported Lyme disease cases. Logistic regression was used to explore differences between age groups, sex and year to better understand potential demographic risk factors for the occurrence of Lyme disease. Results: The number of reported Lyme disease cases increased more than six-fold, from 144 in 2009 to 917 in 2015, mainly due to an increase in infections acquired in Canada. Most locally acquired cases were reported between May and November. An increase in incidence of Lyme disease was observed in provinces from Manitoba eastwards. This is consistent with our knowledge of range expansion of the tick vectors in this region. In the western provinces the incidence has remained low and stable. All cases reported by Alberta, Saskatchewan and Newfoundland and Labrador were acquired outside of the province, either elsewhere in Canada or abroad. There was a bimodal distribution for Lyme disease by age with peaks at 5-9 and 45-74 years of age. The most common presenting symptom was a single erythema migrans rash (74.2%) and arthritis (35.7%). Variations in the frequency of reported clinical manifestations were observed among age groups and years of study. Conclusion: Lyme disease incidence continues to increase in Canada as does the geographic range of ticks that carry the Lyme disease bacteria. Ongoing surveillance, preventive strategies as well as early disease recognition and treatment will continue to minimize the impact of Lyme disease in Canada. [ABSTRACT FROM AUTHOR]

Background The potential for an ultrasound-based screening programme for renal cell carcinoma ( RCC) to improve survival through early detection has been the subject of much debate. The prevalence of ultrasound-detected asymptomatic RCC is an important first step to establishing whether a screening programme may be feasible. Methods A systematic search of MEDLINE and Embase was performed up to March 2016 to identify studies reporting the prevalence of renal masses and RCC. Two populations of patients were chosen: asymptomatic individuals undergoing screening ultrasonography and patients undergoing ultrasonography for abdominal symptoms not related to RCC. A random-effects meta-analysis was performed. Study quality was evaluated using a validated eight-point checklist. Results Sixteen studies (413 551 patients) were included in the final analysis. The pooled prevalence of renal mass was 0·36 (95 per cent c.i. 0·23 to 0·52) per cent and the prevalence of histologically proven RCC was 0·10 (0·06 to 0·15) per cent. The prevalence of RCC was more than double in studies from Europe and North America than in those from Asia: 0·17 (0·09 to 0·27) versus 0·06 (0·03 to 0·09) per cent respectively. Data on 205 screen-detected RCCs showed that 84·4 per cent of tumours were stage T1-T2 N0, 13·7 per cent were T3-T4 N0, and only 2·0 per cent had positive nodes or metastases at diagnosis. Conclusion At least one RCC would be detected per 1000 individuals screened. The majority of tumours identified are early stage ( T1-T2). [ABSTRACT FROM AUTHOR]

Objectives: To (1) establish the extent of opportunities for members of the public to check their own blood pressure (BP) outside of healthcare consultations (BP self-screening), (2) investigate the reasons for and against hosting such a service and (3) ascertain how BP self-screening data are used in primary care. Design: A mixed methods, cross-sectional study. Setting: Primary care and community locations in Oxfordshire, UK. Participants: 325 sites were surveyed to identify where and in what form BP self-screening services were available. 23 semistructured interviews were then completed with current and potential hosts of BP selfscreening services. Results: 18/82 (22%) general practices offered BP self-screening and 68/110 (62%) pharmacies offered professional-led BP screening. There was no evidence of permanent BP self-screening activities in other community settings. Healthcare professionals, managers, community workers and leaders were interviewed. Those in primary care generally felt that practice-based BP selfscreening was a beneficial activity that increased the attainment of performance targets although there was variation in its perceived usefulness for patient care. The pharmacists interviewed provided BP checking as a service to the community but were unable to develop self-screening services without a clear business plan. Among potential hosts, barriers to providing a BP self-screening service included a perceived lack of healthcare commissioner and public demand, and a weak--if any--link to their core objectives as an organisation. Conclusions: BP self-screening currently occurs in a minority of general practices. Any future development of community BP self-screening programmes will require (1) public promotion and (2) careful consideration of how best to support--and reward--the community hosts who currently perceive little if any benefit. [ABSTRACT FROM AUTHOR]

Background: Pertussis can cause a serious respiratory bacterial infection, especially in infants. Between January 1 and December 31, 2015, there was an increase in the number of reported pertussis cases in Nova Scotia (NS). Surveillance practices for pertussis in NS were challenging because immunization coverage data are not available and rate information was neither timely nor precise with respect to geography. Public health officials in NS decided to adopt a new surveillance technique to inform public health actions across the Province.Objective: To assess the use of a 40-day rolling incidence rate to monitor pertussis activity in Nova Scotia.Intervention: A 40-day rolling incidence rate was calculated for pertussis by age groups and various levels of geography. Public health authorities continued to anticipate new cases of pertussis if the contacts of known cases were still within the incubation period (range between six and 20 days). The 40-day incubation period was chosen to reflect twice the incubation period's upper range. Rates were calculated using Statistics Canada population projections for 2014 and then compared with traditional case counts and cumulative incidences. The usefulness of the statistics was assessed by public health decision makers.Outcomes: Increased pertussis activity was noted across NS, most notably in the South West region. The use of a 40-day rolling incidence rate as a surveillance tool provided more timely and geographically precise descriptions of ongoing trends in pertussis activity and helped to inform appropriate public health action. Health officials valued the information provided from the rolling incidence because it allowed them to manage activities based on weekly estimates at various levels of geography.Conclusion: Rolling incidence proved to be a useful tool to monitor a cyclical increase in pertussis cases in Nova Scotia and to inform related public health actions. The rolling incidence provided geographically precise and timely information that was useful to estimate new cases in the absence of reliable immunization coverage information. This method could supplement traditional epidemiological surveillance of future communicable disease events, especially those characterized by long incubation periods and low case counts. [ABSTRACT FROM AUTHOR]

Background:Novel substances often referred to as “designer drugs” have emerged as drugs of abuse, and recognition of these is difficult as routine blood and urine screening tests do not detect these agents. U-47700 is a synthetic selective μ-opioid agonist that can be bought online for as little as $40 per gram. We report two patients presenting after insufflation of U-47700, with subsequent confirmation of this substance in urine samples. Case details:A 26-year-old man and 24-year-old woman insufflated a substance they believed to be “synthetic cocaine.” The man was found down with cyanosis and agonal respirations. He was intubated and taken to hospital where he recovered well with supportive care. The woman presented with anxiety, tremors and drowsiness and was admitted for observation. Urine samples from both patients were analyzed using GC/MS/MS and LC/QToF, and U-47700 was isolated in both cases. No other opioids were detected. Discussion:These cases are concerning because U-47700 is a relatively new agent that is easy to obtain over the internet and has the potential to cause significant morbidity and mortality. [ABSTRACT FROM PUBLISHER]

We present an elemental-abundance analysis of an extremely metal-poor (EMP; [Fe/H] <-3.0) star, SDSS J134338.67+484426.6, identified during the course of the Multi-object Apache Point Observatory Radial Velocity Exoplanet Large-area Survey spectroscopic pre-survey of some 20 000 stars to identify suitable candidates for exoplanet searches. This star, with an apparent magnitude V = 12.14, is the lowest metallicity star found in the pre-survey, and is one of only ~20 known EMP stars that are this bright or brighter. Our high-resolution spectroscopic analysis shows that this star is a subgiant with [Fe/H] = -3.42, having 'normal' carbon and no enhancement of neutron-capture abundances. Strontium is underabundant, [Sr/Fe] = -0.47, but the derived lower limit on [Sr/Ba] indicates that Sr is likely enhanced relative to Ba. This star belongs to the sparsely populated class of a-poor EMP stars that exhibit low ratios of [Mg/Fe], [Si/Fe], and [Ca/Fe] compared to typical halo stars at similar metallicity. The observed variations in radial velocity from several epochs of (low- and high-resolution) spectroscopic follow-up indicate that SDSS J134338.67+484426.6 is a possible long-period binary. We also discuss the abundance trends in EMP stars for r-process elements, and compare with other magnesium-poor stars. [ABSTRACT FROM AUTHOR]

Evidence suggests that living with asthma is linked with psychological and behavioural factors including self-management and treatment adherence, and therefore, there is a reasonable hypothesis that nonpharmacological treatments may improve health outcomes in people living with this condition. A systematic review of randomized controlled trials (RCTs) of nonpharmacological interventions for adults with asthma was designed. Databases searched included The Cochrane Airways Group Register of trials, CENTRAL and Psychinfo. The literature search was conducted until May 2014. Twenty-three studies met the inclusion criteria and were organized into four groups: relaxation-based therapies ( n = 9); mindfulness ( n = 1), biofeedback techniques ( n = 3); cognitive behavioural therapies ( CBT) ( n = 5); and multicomponent interventions ( n = 5). A variety of outcome measures were used, even when trials belonged to the same grouping, which limited the ability to conduct meaningful meta-analyses. Deficiencies in the current evidence base, notably trial heterogeneity, means that application to clinical practice is limited and clear guidelines regarding the use of nonpharmacological therapies in asthma is limited. Relaxation and CBT, however, appear to have a consistent positive effect on asthma-related quality of life and some psychological outcomes, and lung function (relaxation only). Future trials should be informed by previous work to harmonize the interventions under study and outcome measures used to determine their effectiveness; only then will meaningful meta-analyses inform clinical practice. [ABSTRACT FROM AUTHOR]

Network theory is applied to an array of streamflow gauges located in the Coast Mountains of British Columbia (BC) and Yukon, Canada. The goal of the analysis is to assess whether insights from this branch of mathematical graph theory can be meaningfully applied to hydrometric data, and, more specifically, whether it may help guide decisions concerning stream gauge placement so that the full complexity of the regional hydrology is efficiently captured. The streamflow data, when represented as a complex network, have a global clustering coefficient and average shortest path length consistent with small-world networks, which are a class of stable and efficient networks common in nature, but the observed degree distribution did not clearly indicate a scale-free network. Stability helps ensure that the network is robust to the loss of nodes; in the context of a streamflow network, stability is interpreted as insensitivity to station removal at random. Community structure is also evident in the streamflow network. A network theoretic community detection algorithm identified separate communities, each of which appears to be defined by the combination of its median seasonal flow regime (pluvial, nival, hybrid, or glacial, which in this region in turn mainly reflects basin elevation) and geographic proximity to other communities (reflecting shared or different daily meteorological forcing). Furthermore, betweenness analyses suggest a handful of key stations which serve as bridges between communities and might be highly valued.We propose that an idealized sampling network should sample high-betweenness stations, small-membership communities which are by definition rare or undersampled relative to other communities, and index stations having large numbers of intracommunity links, while retaining some degree of redundancy to maintain network robustness. [ABSTRACT FROM AUTHOR]

Background and Aims: Acute tubulointerstitial nephritis (ATIN) is a potentially reversible cause of acute kidney injury with the majority of cases drug related. Our aims were to examine the incidence profile of patients with ATIN in Scotland and to assess the impact of corticosteroid treatment. Design and Methods: All adult patients with biopsyproven ATIN, diagnosed between 2000 and 2012, presenting to renal units serving 1.9 of Scotland's 5 million population were included. Patient demographics, presenting, aetiologic and pathologic features, treatment given and outcome were extracted from patient records. Results: In total, 171 cases representing 4.7% of native renal biopsies were identified. Median serum creatinine (sCr) was 327 mmol/l at biopsy (106 mmol/l at baseline). Eosinophilia, fever or rash was present in 57% with all 3 in only 1.1%. Active urinary sediment was found in 68%. Aetiology appeared drug induced in 73%. Proton pump inhibitors (PPIs) were likely causative in almost as many cases as antibiotics (35% each) and were more frequently implicated than non-steroidal anti-inflammatory drugs (20%). Number of PPI-related cases paralleled the rising prescription of these drugs. Corticosteroids were prescribed in 59% of drug-induced ATIN (median sCr at biopsy: 356 mmol/l vs. 280 mmol/l in those managed conservatively). There was no difference in sCr at 1, 6 and 12 months, with similar proportions of both groups experiencing complete renal recovery (48% vs. 41%) and becoming dialysis dependent (10% in both). Conclusions: Incidence of biopsy-proven ATIN in Scotland has been rising over the past decade with the majority of cases drug induced. Evidence supporting corticosteroid treatment is lacking. [ABSTRACT FROM AUTHOR]

Objectives: To summarize the first four years of national surveillance for Lyme disease in Canada from 2009 to 2012 and to conduct a preliminary comparison of presenting clinical manifestations in Canada and the United States.Methods: The numbers and incidence of reported cases by province, month, year, age and sex were calculated. Logistic regression was used to examine trends over time. Acquisition locations were mapped and presenting clinical manifestations reported for jurisdictions where data was available. Variations by province, year, age and sex as well as presenting clinical symptoms were explored by logistic regression. An initial comparative analysis was made of presenting symptoms in Canada and the United States.Results: The numbers of reported cases rose significantly from 144 in 2009 to 338 in 2012 (coefficient = 0.34, standard error = 0.07, P <0.05), mostly due to an increased incidence of infections acquired in Canada. More cases were classified as 'confirmed' (71.5%) than 'probable' (28.5%). Most cases occurred in locations where vector tick populations were known to be present. More men than women were affected (53.4% versus 46.6%), incidence was highest in adults aged 55 to 74 years and in children aged five to 14 years. Most cases (95%) were acquired from April to November. Of cases acquired in endemic areas, 39.7% presented with manifestations of early Lyme disease, while 60.3% had manifestations of disseminated Lyme disease. There were significant differences among age groups, sexes and provinces in the frequencies of reported clinical manifestations. The proportion of cases acquired in endemic areas presenting with early Lyme disease was lower than that reported in the US.Conclusion: Lyme disease incidence is increasing in Canada. Most cases are acquired where vector tick populations are spreading and this varies geographically within and among provinces. There is also variation in the frequency of age, season and presenting manifestations. The lower proportion of cases presenting with early Lyme disease in Canada compared with the US suggests lower awareness of early Lyme disease in Canada, but this requires further study. [ABSTRACT FROM AUTHOR]

There is a strong argument for the use of antifungal prophylaxis in high-risk patients given the significant mortality associated with invasive fungal disease, the late identification of these infections, and the availability of safe and well-tolerated prophylactic medications. Clinical decisions about which patients should receive prophylaxis and choice of antifungal agent should be guided by risk stratification, knowledge of local fungal epidemiology, the efficacy and tolerability profile of available agents, and estimates such as number needed to treat and number needed to harm. There have been substantial changes in practice since the 2008 guidelines were published. These include the availability of new medications and/or formulations, and a focus on refining and simplifying patient risk stratification. Used in context, these guidelines aim to assist clinicians in providing optimal preventive care to this vulnerable patient demographic. [ABSTRACT FROM AUTHOR]

Network theory is applied to an array of streamflow gauges located in the Coast Mountains of British Columbia and Yukon, Canada. The goal of the analysis is to assess whether insights from this branch of mathematical graph theory can be meaningfully applied to hydrometric data, and more specifically, whether it may help guide decisions concerning stream gauge placement so that the full complexity of the regional hydrology is efficiently captured. The streamflow data, when represented as a complex network, has a global clustering coefficient and average shortest path length consistent with small-world networks, which are a class of stable and efficient networks common in nature, but the results did not clearly suggest a scale-free network. Stability helps ensure that the network is robust to the loss of nodes; in the context of a streamflow network, stability is interpreted as insensitivity to station removal at random. Community structure is also evident in the streamflow network. A community detection algorithm identified 10 separate communities, each of which appears to be defined by the combination of its median seasonal flow regime (pluvial, nival, hybrid, or glacial, which in this region in turn mainly reflects basin elevation) and geographic proximity to other communities (reflecting shared or different daily meteorological forcing). Betweenness analyses additionally suggest a handful of key stations which serve as bridges between communities and might therefore be highly valued. We propose that an idealized sampling network should sample high-betweenness stations, as well as small-membership communities which are by definition rare or undersampled relative to other communities, while retaining some degree of redundancy to maintain network robustness. [ABSTRACT FROM AUTHOR]

An optical blood hydration monitor for use with extracorporeal haemodialysis circuits is described. Studies in five stable haemodialysis patients demonstrate good correlations between measured blood water, haemoglobin concentration and optical attenuation during ultrafiltration. There are no significant errors introduced as a result of a changing extracorporeal circuit pressure and errors resulting from a changing state of oxygenation of haemoglobin are small. Changes in blood volume effected by ultrafiltration may be deduced if it is assumed that these are due solely to shifts of water into or out of the vascular compartment. [ABSTRACT FROM AUTHOR]

Background:Wider clinical applications of 9p status in clear cell renal cell carcinoma (ccRCC) are limited owing to the lack of validation and consensus for interphase fluorescent in situ hybridisation (I-FISH) scoring technique. The aim of this study was to analytically validate the applicability of I-FISH in assessing 9p deletion in ccRCC and to clinically assess its long-term prognostic impact following surgical excision of ccRCC.Methods:Tissue microarrays were constructed from 108 renal cell carcinoma (RCC) tumour paraffin blocks. Interphase fluorescent in situ hybridisation analysis was undertaken based on preset criteria by two independent observers to assess interobserver variability. 9p status in ccRCC tumours was determined and correlated to clinicopathological variables, recurrence-free survival and disease-specific survival.Results:There were 80 ccRCCs with valid 9p scoring and a median follow-up of 95 months. Kappa statistic for interobserver variability was 0.71 (good agreement). 9p deletion was detected in 44% of ccRCCs. 9p loss was associated with higher stage, larger tumours, necrosis, microvascular and renal vein invasion, and higher SSIGN (stage, size, grade and necrosis) score. Patients with 9p-deleted ccRCC were at a higher risk of recurrence (P=0.008) and RCC-specific mortality (P=0.001). On multivariate analysis, 9p deletion was an independent predictor of recurrence (hazard ratio 4.323; P=0.021) and RCC-specific mortality (hazard ratio 4.603; P=0.007). The predictive accuracy of SSIGN score improved from 87.7% to 93.1% by integrating 9p status to the model (P=0.001).Conclusions:Loss of 9p is associated with aggressive ccRCC and worse prognosis in patients following surgery. Our findings independently confirm the findings of previous reports relying on I-FISH to detect 9p (CDKN2A) deletion. [ABSTRACT FROM AUTHOR]

Intrastriatal injection of recombinant adeno-associated viral vector serotype 2/1 (rAAV2/1) to overexpress the neurotrophic factor pleiotrophin (PTN) provides neuroprotection for tyrosine hydroxylase immunoreactive (THir) neurons in the substantia nigra pars compacta (SNpc), increases THir neurite density in the striatum (ST) and reverses functional deficits in forepaw use following 6-hydroxydopamine (6-OHDA) toxic insult. Glial cell line-derived neurotrophic factor (GDNF) gene transfer studies suggest that optimal neuroprotection is dependent on the site of nigrostriatal overexpression. The present study was conducted to determine whether enhanced neuroprotection could be accomplished via simultaneous rAAV2/1 PTN injections into the ST and SN compared with ST injections alone. Rats were unilaterally injected in the ST alone or injected in both the ST and SN with rAAV2/1 expressing either PTN or control vector. Four weeks later, all rats received intrastriatal injections of 6-OHDA. Rats were euthanized 6 or 16 weeks relative to 6-OHDA injection. A novel selective total enumeration method to estimate nigral THir neuron survival was validated to maintain the accuracy of stereological assessment. Long-term nigrostriatal neuroprotection and functional benefits were only observed in rats in which rAAV2/1 PTN was injected into the ST alone. Results suggest that superior preservation of the nigrostriatal system is provided by PTN overexpression delivered to the ST and restricted to the ST and SN pars reticulata and is not improved with overexpression of PTN within SNpc neurons. [ABSTRACT FROM AUTHOR]

Prototheca species are achlorophyllus algae. Prototheca wickerhamii and Prototheca zopfii cause human disease. In immunocompetent individuals, they cause soft tissue infections and olecranon bursitis, but in transplant recipients, these organisms can cause disseminated disease. We report a fatal case of disseminated P. zopfii infection in an hematopoietic stem cell transplant (HSCT) recipient with bloodstream infection and involvement of multiple soft tissue sites. We review all previous cases of protothecosis in HSCT reported in the literature. Protothecosis is uncommon after HSCT, but has a disseminated presentation that is frequently fatal. It is commonly misidentified as a yeast. Tumor necrosis factor-alpha inhibitors and contamination of central venous catheters may contribute to development of protothecosis. Optimal treatment approaches are yet to be defined. New agents such as miltefosine may be possible future therapies. [ABSTRACT FROM AUTHOR]

Background We aimed to develop tools that could be reliably used to evaluate self-efficacy for consuming vegetables and low-sugar foods and beverages for African American and Latino children living in inner-city communities. Methods A total of 112 children, aged 8-11 years, identified by a parent as being either African-American or Latino, were recruited and administered questionnaires. Internal consistency, a measure of reliability, was assessed by calculating the Cronbach's alpha of test scores. Results Cronbach's alpha exceeded the threshold of acceptability of 0.70 for the Authors' Vegetables Self-Efficacy Index, and all three Low-Sugar Self-Efficacy Indices, including the Reference Index, the Authors' Low-Sugar Food and Beverage Index, and the Low-Sugar Beverages Index. Conclusions We present internally consistent tools that could be reliably used to evaluate self-efficacy for consuming vegetables and low-sugar foods and beverages in 8-11-year-old African-American and Latino children from low socio-economic communities. [ABSTRACT FROM AUTHOR]

Background:Proteomics-based approaches for biomarker discovery are promising strategies used in cancer research. We present state-of-art label-free quantitative proteomics method to assess proteome of renal cell carcinoma (RCC) compared with noncancer renal tissues.Methods:Fresh frozen tissue samples from eight primary RCC lesions and autologous adjacent normal renal tissues were obtained from surgically resected tumour-bearing kidneys. Proteins were extracted by complete solubilisation of tissues using filter-aided sample preparation (FASP) method. Trypsin digested proteins were analysed using quantitative label-free proteomics approach followed by data interpretation and pathways analysis.Results:A total of 1761 proteins were identified and quantified with high confidence (MASCOT ion score threshold of 35 and P-value <0.05). Of these, 596 proteins were identified as differentially expressed between cancer and noncancer tissues. Two upregulated proteins in tumour samples (adipose differentiation-related protein and Coronin 1A) were further validated by immunohistochemistry. Pathway analysis using IPA, KOBAS 2.0, DAVID functional annotation and FLink tools showed enrichment of many cancer-related biological processes and pathways such as oxidative phosphorylation, glycolysis and amino acid synthetic pathways.Conclusions:Our study identified a number of differentially expressed proteins and pathways using label-free proteomics approach in RCC compared with normal tissue samples. Two proteins validated in this study are the focus of on-going research in a large cohort of patients. [ABSTRACT FROM AUTHOR]

Purpose: The aetiology of primary brain tumours is largely unknown; the role of non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin use and glioma risk has been inconclusive, but few population-based studies with reliable prescribing data have been conducted, and the association with meningioma risk has yet to be assessed. Methods: The UK Clinical Practice Research Datalink was used to assess the association between aspirin and non-aspirin NSAID use and primary brain tumour risk using a nested case-control study design. Conditional logistic regression analysis was performed on 5,052 brain tumour patients aged 16 years and over, diagnosed between 1987 and 2009 and 42,678 controls matched on year of birth, gender and general practice, adjusting for history of allergy and hormone replacement therapy use in the glioma and meningioma models, respectively. Results: In conditional logistic regression analysis, excluding drug use in the year preceding the index date, there was no association with non-aspirin NSAID use (OR 0.96, 95 % CI 0.81-1.13) or glioma risk comparing the highest category of daily defined dose to non-users; however, non-aspirin NSAID use was positively associated with meningioma risk (OR 1.35, 95 % CI 1.06-1.71). No association was seen with high- or low-dose aspirin use irrespective of histology. Conclusions: This large nested case-control study finds no association between aspirin or non-aspirin NSAID use and risk of glioma but a slight increased risk with non-aspirin NSAIDs and meningioma. [ABSTRACT FROM AUTHOR]

Objective:The placement of a peripherally inserted central catheter (PICC) routinely incorporates tip position confirmation using standard radiographs. In this study, we sought to determine whether real-time ultrasound (RTUS) could be used to place a PICC in a shorter time period, with fewer manipulations and fewer radiographs than the use of radiographs to determine accurate placement.Study Design:This was a prospective, randomized, trial of infants who required PICC placement. Catheters were placed using either standard radiograph, with blinded evaluation of the catheters using RTUS or with RTUS guidance, with input on catheter tip location. The number of radiographs required to confirm proper positioning, duration of the procedure and manipulations of the lines were recorded for both groups. Final confirmation of PICC placement was by radiographs in both groups.Result:A total of 64 patients were enrolled in the study, with 16 failed PICC attempts. Of the 48 remaining infants, 28 were in the standard placement group and 20 were in the RTUS-guided group. The mean±s.d. gestational ages and weight at time of placement were 30±4 weeks and 1229±485 g, respectively. The RTUS use significantly decreased the time of line placement by 30 min (P=0.034), and decreased the median number of manipulations (0 vs 1, P=0.032) and radiographs (1 vs 2 P=0.001) taken to place the catheters. Early identification of the PICC by RTUS was possible in all cases and would have saved an additional 38 min if radiographs were not required.Conclusion:In the hands of ultrasound (US)-experienced neonatologists, RTUS-guided PICC placement reduces catheter insertion duration, and is associated with fewer manipulations and radiographs when compared with conventional placement. [ABSTRACT FROM AUTHOR]

Introduction BK virus ( BKV) is an ubiquitous human polyomavirus that establishes latency in urothelium. BKV is known to re-activate in immunosuppressed individuals, and is an increasingly important cause of nephropathy and graft loss in kidney transplant recipients. Animal studies have demonstrated BKV has a potential role as a tumor virus. However, its role in precipitating or facilitating oncogenesis in humans is still debated. Report We report 2 cases of aggressive micropapillary urothelial carcinoma of the bladder in kidney transplant recipients with persistent BK viruria and preserved graft function. Results In both cases, polyomavirus immunohistochemistry performed on the tumor specimens was strongly positive, and limited to the malignant tissue. BKV DNA, viral protein 1, and large T antigen mRNA were detected in the tumor; however, no viral particles were seen on electron microscopy. Conclusion In one of the cases, BKV integration into the host genome was identified, leading to the truncation of the major viral capsid gene. This finding raises the concern that persisting BK viruria may be a risk factor for this aggressive form of bladder cancer. Further studies to determine screening and management strategies are required. [ABSTRACT FROM AUTHOR]

Aim There is evidence that preoperative carbohydrate drinks and postoperative nutritional supplements improve the outcome of colorectal surgery. There is little information on their individual contribution. Method A prospective four-arm double-blind controlled trial was carried out in which patients were randomized to carbohydrate or placebo drinks preoperatively and a polymeric supplement or placebo drink postoperatively. The primary outcome was insulin resistance (using the short insulin tolerance test and HOMA- IR). Secondary outcomes included handgrip strength, pulmonary function, intestinal permeability and postoperative complications. Results A total of 120 patients were randomized to four demographically well matched groups. Patients who received preoperative and postoperative supplements had better glucose homeostasis ( P = 0.004), peak expiratory flow rate ( P = 0.035), handgrip strength ( P = 0.002) and less insulin resistance ( P = 0.001) compared with those who only received placebo drinks. Conclusion Oral nutritional supplements given preoperatively and postoperatively improve postoperative handgrip strength, pulmonary function and insulin resistance. A weaker effect was seen in patients who received supplements either preoperatively or postoperatively. Oral nutritional supplements should be given both preoperatively and postoperatively. [ABSTRACT FROM AUTHOR]

The tapeworm Echinococcus granulosus is the causative agent of hydatid disease and affects sheep, cattle, dogs and humans worldwide. It has a two-stage life cycle existing as worms in the gut of infected dogs (definitive host) and as cysts in herbivores and humans (intermediate host). The disease is debilitating and can be life threatening where the cysts interfere with organ function. Interruption of the hydatid life cycle in the intermediate host by vaccination may be a way to control the disease, and a protective oncosphere antigen EG95 has been shown to protect animals against challenge with E. granulosus eggs. We explored the use of recombinant vaccinia virus as a delivery vehicle for EG95. Mice and sheep were immunized with the recombinant vector, and the result monitored at the circulating antibody level. In addition, sera from immunized mice were assayed for the ability to kill E. granulosus oncospheres in vitro. Mice immunized once intranasally developed effective oncosphere-killing antibody by day 42 post-infection. Antibody responses and oncosphere killing were correlated and were significantly enhanced by boosting mice with either EG95 protein or recombinant vector. Sheep antibody responses to the recombinant vector or to EG95 protein mirrored those in mice. [ABSTRACT FROM AUTHOR]

Background:Observations that diabetics treated with biguanide drugs have a reduced risk of developing cancer have prompted an enthusiasm for these agents as anti-cancer therapies. We sought to determine the efficacy of the biguanide phenformin in the chemoprophylaxis and in the treatment of oestrogen receptor (ER)-positive MCF7 and receptor triple-negative MDAMB231 xenografts in immunocompromised mice. We also compared the efficacy of phenformin and metformin in the treatment of MDAMB231.Methods:Immunocompromised mice were divided into groups: (1) phenformin administered for 2 weeks prior to cell injection; (2) established tumours treated with phenformin; (3) established tumours treated with metformin (only for MDAMB231 tumours); (4) untreated controls. Post-treatment tumours, liver and spleen were harvested for further analysis.Results:Phenformin significantly inhibited both the development and growth of MCF7 and MDAMB231 tumours, and for MDAMB231 at greater efficacy than metformin without murine toxicity. The number of mitotic figures was significantly fewer in xenografts treated with phenformin compared with controls. Results suggested that the mechanism of action of phenformin in vivo is consistent with AMPK activation.Conclusion:Phenformin has clinical potential as an antineoplastic agent and should be considered for clinical trials both in ER-positive and triple-negative breast cancer. [ABSTRACT FROM AUTHOR]

A cohort study was conducted with a random sample of 33 healthy infants evaluated at birth and at 1, 2, 3, 4, 5, 6, 9, and 12 months to determine the frequency of respiratory rate changes in response to air blown over the face (diving reflex) in the first year of life, and to standardize the description of diving reflex occurrence. All 33 infants remained neurologically normal throughout follow-up. Diving reflex was observed in 95.3% of newborns and in 100% of infants between 2 and 6 months of age. At 6 months, it started to decrease but persisted in 90% of the infants up to 12 months. The diving reflex is highly prevalent in the first year of life and can be easily elicited by applying a flow of air over the infant’s face, particularly during crying. [ABSTRACT FROM AUTHOR]

Objective:Umbilical catheter placement is a routine neonatal emergency procedure that has large variability in technical methods. Commonly used methods are unable to accurately estimate insertion lengths, and X-rays cannot always identify malpositioned catheters. In clinical practice, the placement of umbilical lines takes time away from nursing during a critical transition period. Ultrasound is a safe and commonly used tool in the nursery for clinical management of sick neonates and has been shown to readily identify central catheter tip position. In this study, we sought to determine a more time-efficient and accurate means of umbilical catheter placement using bedside ultrasound.Study Design:This is a prospective, randomized, pilot trial of infants of any age or weight admitted to the neonatal intensive care unit who required umbilical catheter placement. Infants were excluded if they had congenital heart disease, abdominal wall defects or had a single umbilical artery. Catheters were placed using either the conventional method, with blinded evaluation of the catheters using ultrasound, or with ultrasound guidance, with input pertaining to catheter tip location. The number of X-rays required to confirm proper positioning, completion time points throughout the procedure and manipulations of the lines were recorded for both groups.Result:Ultrasound use decreased the time of line placement with an average saving of 64 min, as well as decreased the number of manipulations required and X-rays taken to place the catheters. The average X-ray time from request to viewing per X-ray was 40 min for all subjects.Conclusion:Ultrasound-guided umbilical catheter placement is a faster method to place catheters requiring fewer manipulations and X-rays when compared with conventional catheter placement. [ABSTRACT FROM AUTHOR]