Lactobacillus helveticus is one of the species of lactic acid bacteria (LAB) most commonly used in the production of fermented milk beverages and some types of hard cheese. The versatile nature of ...this bacterium is based on its highly efficient proteolytic system consisting of cell-envelope proteinases (CEPs), transport system and intracellular peptidases. Besides use of L. helveticus in cheese processing, the production of fermented milk preparations with health promoting properties has become an important industrial application. Studies have shown that fermented dairy products are able to decrease blood pressure, stimulate the immune system, promote calcium absorption, and exert an anti-virulent effect against pathogens. These beneficial effects are produced by a variety of peptides released during the hydrolysis of milk proteins by the proteolytic system of L. helveticus, which provides the bacterium with its nutritional requirements for growth. In recent years, studies have focused on understanding the factors that affect the kinetics of milk protein hydrolysis by specific strains and have concentrated on the effect of pH, temperature, growth phase, and matrix composition on the bacterial enzymatic system. This review focuses on the role of the proteolytic system of L. helveticus in the production of bioactive compounds formed during fermentation of dairy products. Taking advantage of the powerful proteolytic system of this bacterium opens up future opportunities to search for novel food-derived compounds with potential health promoting properties.
BACKGROUND AND AIMS:Pediatric ulcerative colitis (UC) shares many features with adult-onset disease but there are some unique considerations; therefore, therapeutic approaches have to be adapted to ...these particular needs. We aimed to formulate guidelines for managing UC in children based on a systematic review (SR) of the literature and a robust consensus process. The present article is a product of a joint effort of the European Crohnʼs and Colitis Organization (ECCO) and the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN).
METHODS:A group of 27 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to ESPGHAN and ECCO members. A list of 23 predefined questions were addressed by working subgroups based on a SR of the literature.
RESULTS:A total of 40 formal recommendations and 68 practice points were endorsed with a consensus rate of at least 89% regarding initial evaluation, how to monitor disease activity, the role of endoscopic evaluation, medical and surgical therapy, timing and choice of each medication, the role of combined therapy, and when to stop medications. A management flowchart, based on the Pediatric Ulcerative Colitis Activity Index (PUCAI), is presented.
CONCLUSIONS:These guidelines provide clinically useful points to guide the management of UC in children. Taken together, the recommendations offer a standardized protocol that allows effective, timely management and monitoring of the disease course, while acknowledging that each patient is unique.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Professional development (PD) in a range of occupations has become increasingly digitised. Numerous digital courses are available, with evidence that social media, blogs and apps are increasingly ...being used for PD. Yet despite clear benefits, there is little robust evidence on the characteristics of digital PD that impact positively on learning and practice, particularly for physical education (PE) teachers and youth sport coaches. This paper provides new insights into the characteristics of effective PD in the context of a complex digital landscape.
While advocated as an innovative genre from which to optimise learners' proclivity for sharing, curiosity and discovery, little is known about how professional learners respond to massive open online courses (MOOCs) courses to inform their practice. The purpose of this study was to understand how participants responded to the learning design of two MOOCs (n = 13,104 from 155 countries) in the fields of physical education and youth sport coaching.
Drawing from a mixed methodology, data were generated from semi-structured interviews (n = 27) and online survey methods (n = 66) with participants across both MOOCs.
New data offer insights into the features of course design that practitioners found positive in promoting engagement. It was apparent in the data, for example, that four features were influential: establishing relevance, facilitating bridging, designing for personalisation, and building community. Constructed themes reflect how participants organised and negotiated MOOC experiences, and illuminate the ways in which they navigated and used course content. Evidence from this study provides insights into the ways in which digital genre for PD might be structured to facilitate engagement and presents broader challenges to the ways in which pedagogy is conceptualised and practiced online.
The refined focus on digital genre as a form of social action in this study seeks to ensure that learners needs can be met in a complex and ever-changing PD digital landscape. In this regard, a more nuanced approach is required that helps explicate the cognitive tools that participants engage as they organise their learning experiences on digital platforms, and how this aligns with their expectations and needs of online PD.
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BFBNIB, FSPLJ, NUK, PILJ, SAZU, UL, UM, UPUK
During early pregnancy, decidual innate lymphoid cells (dILCs) interact with surrounding maternal cells and invading fetal extravillous trophoblasts (EVT). Here, using mass cytometry, we characterise ...five main dILC subsets: decidual NK cells (dNK)1-3, ILC3s and proliferating NK cells. Following stimulation, dNK2 and dNK3 produce more chemokines than dNK1 including XCL1 which can act on both maternal dendritic cells and fetal EVT. In contrast, dNK1 express receptors including Killer-cell Immunoglobulin-like Receptors (KIR), indicating they respond to HLA class I ligands on EVT. Decidual NK have distinctive organisation and content of granules compared with peripheral blood NK cells. Acquisition of KIR correlates with higher granzyme B levels and increased chemokine production in response to KIR activation, suggesting a link between increased granule content and dNK1 responsiveness. Our analysis shows that dILCs are unique and provide specialised functions dedicated to achieving placental development and successful reproduction.
Objectives To identify the evidence base behind the neuroradiological features that differentiate abusive head trauma (AHT) from non-abusive head trauma (nAHT). Design Systematic review. Setting ...Literature search of 14 databases, websites, textbooks, conference abstracts and references (1970–February 2010). Studies had two independent reviews (three if disputed) and critical appraisal. Patients Primary comparative studies of children <11 years old hospitalised with AHT and nAHT diagnosed on CT or MRI. Main outcome measures Neuroradiological features that differentiated AHT from nAHT. Results 21 studies of children predominantly <3 years old were analysed. Subdural haemorrhages (SDH) were significantly associated with AHT (OR 8.2, 95% CI 6.1 to 11). Subarachnoid haemorrhages were seen equally in AHT and nAHT and extradural haemorrhages (EDH) were significantly associated with nAHT (OR for AHT 0.1, 95% CI 0.07 to 0.18). Multiple (OR 6, 95% CI 2.5 to 14.4), interhemispheric (OR 7.9, 95% CI 4.7 to 13), convexity (OR 4.9, 95% CI 1.3 to 19.4) and posterior fossa haemorrhages (OR 2.5, 95% CI 1 to 6) were associated with AHT. Hypoxic-ischaemic injury (HII) (OR 3.7, 95% CI 1.4 to 10) and cerebral oedema (OR 2.2, 95% CI 1.0 to 4.5) were significantly associated with AHT, while focal parenchymal injury was not a discriminatory feature. SDH of low attenuation were more common in AHT than in nAHT. Conclusion Multiple SDH over the convexity, interhemispheric haemorrhages, posterior fossa SDH, HII and cerebral oedema are significantly associated with AHT and should be considered together with clinical features when identifying the condition.
Summary
Predicting who will benefit from admission to an intensive care unit is not straightforward and admission processes vary. Our aim was to understand how decisions to admit or not are made. We ...observed 55 decision‐making events in six NHS hospitals. We interviewed 30 referring and 43 intensive care doctors about these events. We describe the nature and context of the decision‐making and analysed how doctors make intensive care admission decisions. Such decisions are complex with intrinsic uncertainty, often urgent and made with incomplete information. While doctors aspire to make patient‐centred decisions, key challenges include: being overworked with lack of time; limited support from senior staff; and a lack of adequate staffing in other parts of the hospital that may be compromising patient safety. To reduce decision complexity, heuristic rules based on experience are often used to help think through the problem; for example, the patient’s functional status or clinical gestalt. The intensive care doctors actively managed relationships with referring doctors; acted as the hospital generalist for acutely ill patients; and brought calm to crisis situations. However, they frequently failed to elicit values and preferences from patients or family members. They were rarely explicit in balancing burdens and benefits of intensive care for patients, so consistency and equity cannot be judged. The use of a framework for intensive care admission decisions that reminds doctors to seek patient or family views and encourages explicit balancing of burdens and benefits could improve decision‐making. However, a supportive, adequately resourced context is also needed.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
We derive reduced models for extrusion problems where it is necessary to account for fluid compressibility. We consider the two-dimensional extensional flow of a compressible viscous fluid and ...discuss two specific applications: weakly compressible fluids and bubbly liquid–gas mixtures that behave as a single compressible fluid. The mathematical model we present consists of equations for conservation of mass, conservation of momentum and a closure relationship between the pressure and density. The most substantial differences between compressible extrusion problems is in the closure relationship. By integrating the conservation equations across the fluid cross-section and exploiting a slender aspect ratio, we derive reduced equations for conservation of mass and conservation of momentum in the direction of flow. The reduced system of equations relating cross-sectionally averaged quantities is closed by a relationship between the averaged pressure and density, which will differ substantially depending on the application. We demonstrate the utility of a reduced model for both the weakly compressible fluid and bubbly mixture applications; namely, in providing valuable quantitative insights without needing to solve a complicated free-boundary problem.
We present a study of the filamentary structure in the neutral atomic hydrogen (H
I
) emission at the 21 cm wavelength toward the Galactic plane using the 16′.2-resolution observations in the H
I
4
...π
(HI4PI) survey. Using the Hessian matrix method across radial velocity channels, we identified the filamentary structures and quantified their orientations using circular statistics. We found that the regions of the Milky Way’s disk beyond 10 kpc and up to roughly 18 kpc from the Galactic center display H
I
filamentary structures predominantly parallel to the Galactic plane. For regions at lower Galactocentric radii, we found that the H
I
filaments are mostly perpendicular or do not have a preferred orientation with respect to the Galactic plane. We interpret these results as the imprint of supernova feedback in the inner Galaxy and Galactic rotation and shear in the outer Milky Way. We found that the H
I
filamentary structures follow the Galactic warp and flaring and that they highlight some of the variations interpreted as the effect of the gravitational interaction with satellite galaxies. In addition, the mean scale height of the filamentary structures is lower than that sampled by the bulk of the H
I
emission, thus indicating that the cold and warm atomic hydrogen phases have different scale heights in the outer galaxy. Finally, we found that the fraction of the column density in H
I
filaments is almost constant up to approximately 18 kpc from the Galactic center. This is possibly a result of the roughly constant ratio between the cold and warm atomic hydrogen phases inferred from the H
I
absorption studies. Our results indicate that the H
I
filamentary structures provide insight into the dynamical processes shaping the Galactic disk. Their orientations record how and where the stellar energy input, the Galactic fountain process, the cosmic ray diffusion, and the gas accretion have molded the diffuse interstellar medium in the Galactic plane.
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FMFMET, NUK, UL, UM, UPUK
Although several studies have been conducted in Bangladesh regarding sleep problems during the COVID-19 pandemic, none have utilized a large nationwide sample or presented their findings based on ...nationwide geographical distribution. Therefore, the aim of the present study was to explore the total sleep duration, night-time sleep, and daily naptime and their associated factors as well as geographic information system (GIS) distribution. A cross-sectional survey was carried out among 9730 people in April 2020, including questions relating to socio-demographic variables, behavioral and health factors, lockdown, depression, suicidal ideation, night sleep duration, and naptime duration. Descriptive and inferential statistics, both linear and multivariate regression, and spatial distribution were performed using Microsoft Excel, SPSS, Stata, and ArcGIS software. The results indicated that 64.7% reported sleeping 7-9 h a night, while 29.6% slept less than 7 h nightly, and 5.7% slept more than 9 h nightly. 43.7% reported 30-60 min of daily nap duration, whereas 20.9% napped for more than 1 h daily. Significant predictors of total daily sleep duration were being aged 18-25 years, being unemployed, being married, self-isolating 4 days or more, economic hardship, and depression. For nap duration, being aged 18-25 years, retired, a smoker, and a social media user were at relatively higher risk. The GIS distribution showed that regional division areas with high COVID-19 exposure had higher rates of non-normal sleep duration. Sleep duration showed a regional heterogeneity across the regional divisions of the country that exhibited significant associations with a multitude of socioeconomic and health factors.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Health administrative databases can be used to track chronic diseases. The aim of this study was to validate a case ascertainment definition of paediatric-onset inflammatory bowel disease (IBD) using ...administrative data and describe its epidemiology in Ontario, Canada.
A population-based clinical database of patients with IBD aged <15 years was used to define cases, and patient information was linked to health administrative data to compare the accuracy of various patterns of healthcare use. The most accurate algorithm was validated with chart data of children aged <18 years from 12 medical practices. Administrative data from the period 1991-2008 were used to describe the incidence and prevalence of IBD in Ontario children. Changes in incidence were tested using Poisson regression.
Accurate identification of children with IBD required four physician contacts or two hospitalisations (with International Classification of Disease (ICD) codes for IBD) within 3 years if they underwent colonoscopy and seven contacts or three hospitalisations within 3 years in those without colonoscopy (children <12 years old, sensitivity 90.5%, specificity >99.9%; children <15 years old, sensitivity 89.6%, specificity >99.9%; children <18 years old, sensitivity 91.1%, specificity 99.5%). Age- and sex-standardised prevalence per 100 000 population of paediatric IBD has increased from 42.1 (in 1994) to 56.3 (in 2005). Incidence per 100 000 has increased from 9.5 (in 1994) to 11.4 (in 2005). Statistically significant increases in incidence were noted in 0-4 year olds (5.0%/year, p = 0.03) and 5-9 year olds (7.6%/year, p<0.0001), but not in 10-14 or 15-17 year olds.
Ontario has one of the highest rates of childhood-onset IBD in the world, and there is an accelerated increase in incidence in younger children.
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