Providing supplementary food to endangered bird species is a common management action. Research has tended to focus on whether or not supplementary food should be provided, and relatively less ...attention has been paid to the form that food should take. Supplementation is also commonly made directly to adult individuals. However, the potentially long‐lasting consequences of developmental diet make it relevant to consider what type of supplementary food is most appropriate for nestling birds. We sought to explore these issues in a wild population of hihi (Notiomystis cincta), an endangered New Zealand passerine in which adults in four out of five extant populations receive supplementary food. We directly provisioned nestling hihi with four alternative dietary treatments (protein‐ or carbohydrate‐based diet with or without carotenoids) and assessed the effect of supplementation on nestling growth parameters; survival from hatching to fledging; survival from fledging to recruitment (breeding age). Firstly, we found a sex‐specific effect of protein supplementation on growth inflection point: inflection point was later for females that received a high‐protein diet compared with controls, and earlier for males. Secondly, we found an interacting effect of sex and diet on survival from hatching to fledging, such that females benefitted from a high‐protein diet while males suffered. We also found an interacting effect of protein treatment and carotenoid treatment on survival to fledging, such that the positive effects of carotenoid supplementation were negated if carotenoids were provided in combination with the protein supplement. Finally, we were unable to detect an effect of nestling dietary treatment on survival from fledging to recruitment. Our results suggest that the short‐term consequences of nestling supplementary feeding are more pronounced than any long‐term effects. We also found evidence that dietary supplementation had opposing effects on male and female nestlings, which may be an important, previously overlooked, consideration when evaluating the conservation value of feeding regimes.
The systemic immune response induced by non-infectious agents is called systemic inflammatory response syndrome (SIRS) and infection-induced systemic immune response is called sepsis. The host ...inflammatory response in SIRS and sepsis is similar and may lead to multiple organ dysfunction syndrome (MODS) and ultimately death. The mortality and morbidity in SIRS and sepsis (i.e. critical illness) remain high despite advances in diagnostic and organ supporting possibilities in intensive care units. In critical illness, the acute immune response is organized and executed by innate immunity influenced by the neuroendocrine system. This response starts with sensing of danger by pattern-recognition receptors on the immune competent cells and endothelium. The sensed danger signals, through specific signalling pathways, activate nuclear transcription factor κB and other transcription factors and gene regulatory systems which up-regulate the expression of pro-inflammatory mediators. The plasma cascades are also activated which together with the produced pro-inflammatory mediators stimulate further the production of inflammatory biomarkers. The acute inflammatory response underlies the pathophysiological mechanisms involved in the development of MODS. The inflammatory mediators directly affect organ function and cause a decline in remote organ function by mediating the production of nitric oxide leading to mitochondrial anergy and cytopathic hypoxia, a condition of cellular inability to use oxygen. Understanding the mechanisms of acute immune responses in critical illness is necessary for the development of urgently needed therapeutics. The aim of this review is to provide a description of the key components and mechanisms involved in the immune response in SIRS and sepsis.
Making "time" for preventive services Kottke, T E; Brekke, M L; Solberg, L I
Mayo Clinic proceedings,
08/1993, Letnik:
68, Številka:
8
Journal Article
Recenzirano
Although the implementation of clinical preventive services is a high priority on the national agenda and physicians acknowledge the importance of these services, implementation rates remain far ...below the target years after the recommendations have been released. Physicians repeatedly report that the reason for not providing preventive services is that they do not have "time." In this article, we identify attributes of the health-services system that create this phenomenon. We present evidence that formal delivery systems for preventive services must be developed if the "time" problem is to be solved, and we review why preventive-services systems need to be integrated into the current health-services system. Finally, we list the attributes that we believe a preventive-services system must have if it is to be successful. The success of clinical trials of such systems indicates that our goals of preventive services can be achieved if all persons who have an investment in clinical preventive services commit themselves to developing and supporting these systems.
To determine the rates at which private primary-care clinics are recommending blood pressure and cholesterol measurement, smoking cessation, clinical breast examination, screening mammography, ...Papanicolaou testing, and influenza and pneumococcus immunizations.
We conducted a mail survey of 7,997 randomly selected patients from 44 primary-care clinics in and around Minneapolis-St. Paul, Minnesota, of whom 6,830 (85.4%) completed the questionnaire on preventive services delivery rates. The responses were analyzed statistically, including stratification by reason for the clinic visit.
On the average, about two-thirds of the patients in each clinic reported being up-to-date on preventive services before their clinic visit; an exception was pneumococcus immunization (mean rate, 33%). Except for blood pressure and smoking cessation advice, less than 30% of patients who were not up-to-date on a preventive service were offered it if the clinic visit was for a reason other than a checkup or physical examination. For patients who said that they saw their physician for a checkup or physical examination, the rate was more than 50% only for Papanicolaou smear. In contrast, nearly all responding practitioners agreed that each of the eight preventive services was very important or important.
Preventive services consensus goals are not being met, even for patients who report that their clinic visit was for a checkup or physical examination. This finding suggests that it may be necessary to develop clinical systems that support and enable the delivery of preventive services.
We present a community data set of daily forcing and hydrologic response data for 671 small- to medium-sized basins across the contiguous United States (median basin size of 336 km2) that spans a ...very wide range of hydroclimatic conditions. Area-averaged forcing data for the period 1980-2010 was generated for three basin spatial configurations - basin mean, hydrologic response units (HRUs) and elevation bands - by mapping daily, gridded meteorological data sets to the subbasin (Daymet) and basin polygons (Daymet, Maurer and NLDAS). Daily streamflow data was compiled from the United States Geological Survey National Water Information System. The focus of this paper is to (1) present the data set for community use and (2) provide a model performance benchmark using the coupled Snow-17 snow model and the Sacramento Soil Moisture Accounting Model, calibrated using the shuffled complex evolution global optimization routine. After optimization minimizing daily root mean squared error, 90% of the basins have Nash-Sutcliffe efficiency scores greater than or equal to 0.55 for the calibration period and 34% greater than or equal to 0.8. This benchmark provides a reference level of hydrologic model performance for a commonly used model and calibration system, and highlights some regional variations in model performance. For example, basins with a more pronounced seasonal cycle generally have a negative low flow bias, while basins with a smaller seasonal cycle have a positive low flow bias. Finally, we find that data points with extreme error (defined as individual days with a high fraction of total error) are more common in arid basins with limited snow and, for a given aridity, fewer extreme error days are present as the basin snow water equivalent increases.
Summary
There is a close cross‐talk between complement, Toll‐like receptors (TLRs) and coagulation. The role of the central complement component 5 (C5) in physiological and pathophysiological ...hemostasis has not, however, been fully elucidated. This study examined the effects of C5 in normal hemostasis and in Escherichia coli‐induced coagulation and tissue factor (TF) up‐regulation. Fresh whole blood obtained from six healthy donors and one C5‐deficient individual (C5D) was anti‐coagulated with the thrombin inhibitor lepirudin. Blood was incubated with or without E. coli in the presence of the C5 inhibitor eculizumab, a blocking anti‐CD14 monoclonal antibody (anti‐CD14) or the TLR‐4 inhibitor eritoran. C5D blood was reconstituted with purified human C5. TF mRNA was measured by quantitative polymerase chain reaction (qPCR) and monocyte TF and CD11b surface expression by flow cytometry. Prothrombin fragment 1+2 (PTF1·2) in plasma and microparticles exposing TF (TF‐MP) was measured by enzyme‐linked immunosorbent assay (ELISA). Coagulation kinetics were analyzed by rotational thromboelastometry and platelet function by PFA‐200. Normal blood with eculizumab as well as C5D blood with or without reconstitution with C5 displayed completely normal biochemical hemostatic patterns. In contrast, E. coli‐induced TF mRNA and TF‐MP were significantly reduced by C5 inhibition. C5 inhibition combined with anti‐CD14 or eritoran completely inhibited the E. coli‐induced monocyte TF, TF‐MP and plasma PTF1·2. Addition of C5a alone did not induce TF expression on monocytes. In conclusion, C5 showed no impact on physiological hemostasis, but substantially contributed to E. coli‐induced procoagulant events, which were abolished by the combined inhibition of C5 and CD14 or TLR‐4.
Effect of eculizumab, anti‐CD14 or the TLR‐4 inhibitor eritoran on Escherichia coli (E. coli)‐induced monocyte tissue factor (TF) surface expression (a), tissue factor function in plasma microparticles (TF‐MP) (b) and prothrombin fragment 1+2 (PTF1·2) levels in plasma (c). Inhibition of C5 using eculizumab reduced the E. coli‐induced TF‐MP level. C5 inhibition combined with anti‐CD14 or eritoran completely inhibited the E. coli‐induced monocyte TF, TF‐MP and plasma PTF1·2.
Meta-analysis was used to examine 108 intervention comparisons in 39 controlled smoking cessation trials. Type of intervention (face-to-face advice being better than all others), type of intervenor ...(both physician and nonphysician counselors better than either alone), the number of reinforcing sessions, and the duration of reinforcing sessions were related to success six months after the initiation of intervention. The number of modalities used by the intervention predicted success with borderline statistical significance. Multivariate analysis predicted that a team of physicians and nonphysicians using multiple intervention modalities to deliver individualized advice on multiple occasions would produce the best result. Program success 12 months after the initiation of intervention was related to the type of intervention session (group and individual sessions combined better than either alone), the number of intervention modalities, and the number of reinforcing sessions. With multivariate adjustment for confounding, the number of intervention modalities alone had a positive association with intervention success.
Numerous intrauterine factors may affect the offspring's growth during childhood. We aimed to explore if maternal and paternal prenatal lipid, apolipoprotein (apo)B and apoA1 levels are associated ...with offspring weight, length, and body mass index from 6 weeks to eight years of age. This has previously been studied to a limited extent.
This parental negative control study is based on the Norwegian Mother, Father and Child Cohort Study and uses data from the Medical Birth Registry of Norway. We included 713 mothers and fathers with or without self-reported hypercholesterolemia and their offspring. Seven parental metabolites were measured by nuclear magnetic resonance spectroscopy, and offspring weight and length were measured at 12 time points. Data were analyzed by linear spline mixed models, and the results are presented as the interaction between parental metabolite levels and offspring spline (age).
Higher maternal total cholesterol (TC) level was associated with a larger increase in offspring body weight up to 8 years of age (0.03 ≤ P
≤ 0.04). Paternal TC level was not associated with change in offspring body weight (0.17 ≤ P
≤ 0.25). Higher maternal high-density lipoprotein cholesterol (HDL-C) and apoA1 levels were associated with a lower increase in offspring body weight up to 8 years of age (0.001 ≤ P
≤ 0.005). Higher paternal HDL-C and apoA1 levels were associated with a lower increase in offspring body weight up to 5 years of age but a larger increase in offspring body weight from 5 to 8 years of age (0.01 ≤ P
≤ 0.03). Parental metabolites were not associated with change in offspring height or body mass index up to 8 years of age (0.07 ≤ P
≤ 0.99).
Maternal compared to paternal TC, HDL-C, and apoA1 levels were more strongly and consistently associated with offspring body weight during childhood, supporting a direct intrauterine effect.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Although most physicians believe that smoking cessation assistance is important for their patients, the majority of smokers report that they have not received smoking cessation advice from a ...physician. We therefore tested whether on-site recruitment, training, and organizational assistance in incorporating a smoking intervention system of documented efficacy into nonvolunteer primary care practices would result in higher rates of smoking cessation advice to patients.
This was a nonrandomized trial comparing all 10 primary care clinics in an intervention area to all 8 primary care clinics from a geographically separate control area. The evaluation was based on the smoking intervention activities of each of the clinics as reported on preintervention and postintervention mail surveys of cohorts of regular smokers seen in the clinics.
Preintervention, 22.9% +/- 11.2% of the intervention clinic cohort and 21.9% +/- 9.6% (P = .84) of the control clinic cohort reported that they had been asked about tobacco during a clinic visit in the prior 6 months. Postintervention, the intervention clinic cohort was significantly more likely to report that someone had asked them if they smoked (39.8% +/- 12.3% vs 26.0% +/- 12.2%; P less than .05), that their physician asked them to quit if they were currently smoking (40.5% +/- 12.1% vs 26.4% +/- 14.6%; P less than .05), and that someone had commended them if they had recently quit smoking (28.2% +/- 19.8 vs 11.3% +/- 11.8%; P less than .05).
The intervention significantly increased the rates at which a population of primary care clinics identified their patients who smoked, advised them to quit smoking, and commended those who had recently quit smoking.
Essentials
Complement, Toll‐like receptors and coagulation cross‐talk in the process of thromboinflammation.
This is explored in a unique human whole‐blood model of S. aureus bacteremia.
Coagulation ...is here shown as a downstream event of C5a‐induced tissue factor (TF) production.
Combined inhibition of C5 and CD14 efficiently attenuated TF and coagulation.
Summary
Background
There is extensive cross‐talk between the complement system, the Toll‐like receptors (TLRs), and hemostasis. Consumptive coagulopathy is a hallmark of sepsis, and is often mediated through increased tissue factor (TF) expression.
Objectives
To study the relative roles of complement, TLRs and TF in Staphylococcus aureus‐induced coagulation.
Methods
Lepirudin‐anticoagulated human whole blood was incubated with the three S. aureus strains Cowan, Wood, and Newman. C3 was inhibited with compstatin, C5 with eculizumab, C5a receptor 1 (C5aR1) and activated factor XII with peptide inhibitors, CD14, TLR2 and TF with neutralizing antibodies, and TLR4 with eritoran. Complement activation was measured by ELISA. Coagulation was measured according to prothrombin fragment 1 + 2 (PTF1 + 2) determined with ELISA, and TF mRNA, monocyte surface expression and functional activity were measured with quantitative PCR, flow cytometry, and ELISA, respectively.
Results
All three strains generated substantial and statistically significant amounts of C5a, terminal complement complex, PTF1 + 2, and TF mRNA, and showed substantial TF surface expression on monocytes and TF functional activity. Inhibition of C5 cleavage most efficiently and significantly inhibited all six markers in strains Cowan and Wood, and five markers in Newman. The effect of complement inhibition was shown to be completely dependent on C5aR1. The C5 blocking effect was equally potentiated when combined with blocking of CD14 or TLR2, but not TLR4. TF blocking significantly reduced PTF1 + 2 levels to baseline levels.
Conclusions
S. aureus‐induced coagulation in human whole blood was mainly attributable to C5a‐induced mRNA upregulation, monocyte TF expression, and plasma TF activity, thus underscoring complement as a key player in S. aureus‐induced coagulation.
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