Good quality clinical practice guidelines (CPGs) are a vehicle to implementing evidence into allied health (AH) care. This paper reports on the current 'state of play' of CPGs in a ...lower-to-middle-income country (South Africa), where primary healthcare (PHC) AH activities face significant challenges in terms of ensuring quality service delivery in the face of huge PHC need.
A qualitative study was conducted, using semi-structured interviews with purposively-sampled individuals involved in AH PHC CPGs in South Africa. They included national and state government policy-makers, academics and educators, service managers, clinicians, representatives of professional associations, technical writers, and members of informal professional networks. The interview data was transcribed and de-identified, and analysed descriptively by hand-coding. The COREQ statement guided study conduct and reporting. A framework to guide research in other countries into perspectives of AH PHC CPG activities was established.
Of the 32 invited, 29 people participated: of these 25 were interviewed and four provided meeting notes. Most participants had multiple professional roles, being engaged concurrently in clinical practice, academia, professional associations and / or government. Key themes comprised Players (sub-themes of sampling frame, participants, advice, role players and collaboration); Guidance (sub-themes of nomenclature, drivers, purpose, evidence sources) and Role of AH in PHC (sub-themes of discipline groupings, disability and rehabilitation, AH recognition).
There was consistently-expressed desire for quality guidance to support better quality AH PHC activities around the country. However no international CPGs were used, and there were no South African CPGs specific to local PHC AH practice. The guidance gap was filled by non-evidence-based documents produced often without training, to deal with specific clinical situations. This led to frustration, duplication and fragmentation of effort, confusing nomenclature, and an urgent need for standardised and agreed guidance. We provided a standardised framework to capture perspectives on CPGs activities in other AH PHC settings.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Several studies have used grape harvest date (GHD) as a proxy for temperature variations of the last centuries in Europe. However, the use of grape harvest dates to reconstruct climate is not ...straightforward, with four possible causes of major flaws. In this study we identify and evaluate the accuracy of GHD as a proxy to past temperature anomalies, uncertainties in the model used to relate temperature to GHD, identity of the grape varieties cultivated in the past, type of wine produced in the past and cultural practices used in the past. Our analyses are based on several phenological and crop models, and on the most complete data set on grape vine phenology and harvest quality. We show that the two methodologies currently used — linear regression models and process-based phenological models — can be accurate, but process-based phenological models ascertain robustness to be applied confidently in different vineyards and different periods. However, we show that several factors can induce a bias in temperature reconstructions using process-based models. We demonstrate the importance of historical information on the studied areas such as the varieties cultivated, the style of wine produced, the quality sought, the agricultural practices, in order to build the most robust model.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Reintroductions, essential to many conservation programmes, disrupt both abiotic and social environments. Despite growing recognition that social connections in animals might alter survival (e.g. ...social transmission of foraging skills, or transmission of disease), there has thus far been little focus on the consequences of social disruption during reintroductions. Here we investigate if moving familiar social groups may help a threatened species to adjust to its new environment and increase post‐release survival. For a reintroduction of 40 juvenile hihi Notiomystis cincta (a threatened New Zealand passerine), we observed social groups before and after translocation to a new site and used social network analysis to study three levels of social change: overall group structure, network associations and individual sociality. We also tested alternate translocation strategies where birds were kept temporarily in aviaries in either a familiar group, or where their prior association was mixed. Although social structure remained similar among juveniles that remained at the source site, we detected significant changes in translocated birds at both the group‐ and individual‐ level post‐release. However, our holding treatments did not affect these social bonds so we remain unable to maintain or manipulate social groups during translocation. Crucially, there was a small tendency for translocated juveniles that gained more associates during re‐assortment of social groups to be more likely to survive their first year post‐release. We suggest that prior sociality may not be important during translocations, but rather individuals that are most able to adapt and form associations at a new site are most likely to be the surviving founders of reintroduced populations.
Reintroductions are essential to many conservation programmes, but disrupt both abiotic and social environments. During a reintroduction of a threatened New Zealand passerine (hihi, Notiomystis cincta), we investigated if moving familiar social groups helps a new population adjust to their post‐release environment and increase survival. Using social network analysis, we show that social structure remained similar in birds left at the source site, but we detected significant social changes in translocated birds post‐release and did not improve social cohesion by keeping familiar birds temporarily in aviaries. There was a small tendency for translocated juveniles that gained more associates during social group re‐assortment to survive better in their first year post‐release; thus, individuals that are most able to adapt and form associations at a new site may be most likely to be the surviving founders of reintroduced populations.
Carbon dots are synthesized alone and in the presence of commercial magnetite nanoparticles using a simple hydrothermal reaction. The spectroscopic and structural characteristics of CDot and ...CDot–magnetite materials are presented and their behaviors under combustion conditions are studied. A careful examination of their combustion behaviors reveals interesting results for the CDot–magnetite material: it undergoes early catalytic combustion at ~200 °C and a strong endothermic process that quenches combustion. By investigating the physical mixtures of pre-formed CDots and magnetite and the starting material ascorbic acid and magnetite, it is determined that the strong endothermic behavior requires intimate interactions between the carbon source and the magnetite, highlighting the importance of the nano-interface of the CDots being synthesized onto the magnetite substrate. The results are discussed in the context of the fuels used for low-temper combustion, materials with stored endothermic potential, and the use of combustion-quenching materials for fire control.
Climate change has challenged growers and researchers alike to better understand how warm temperatures may impact winegrape plant development across varieties. Yet multi-variety studies present ...challenges. Here we review studies of controlled warming on winegrape varieties alongside a new study of the budburst and flowering phenology of 50 varieties of
Vitis vinifera
subsp.
vinifera
in the lab, with a small set of plants exposed to higher temperatures (20, 26, 30, 34, and 37°C mean temperatures in growth chambers) during flowering. We found few studies have examined more than one variety, which may be due to the challenge of growing diverse varieties together. Indeed, we found high variability in flowering success across varieties in the lab (28 out of 50 varieties had no flowering), which made it impossible to study variety-specific response to temperature. Across varieties, however, we found results in line with a literature review (which we also present): higher temperatures did not have a significant effect on the rate at which vines progressed through the flowering stage, but higher temperatures did correlate with flower abortion. These results suggest a potential decrease in winegrape yields in a warmer climate due to flower abortion, but also highlight the challenges of understanding heat responses across many varieties.
Summary
Background
Sleep has emerged as a potentially modifiable risk factor for obesity in children.
Objectives
The purpose of this investigation was to evaluate the association between overnight ...sleep duration and obesity among American Indian (AI) children ages 2–5 years.
Methods
Data were examined from the baseline assessment of children enrolling in the Healthy Children, Strong Families study, which is a randomized lifestyle intervention trial in five diverse rural and urban AI communities nationally among children ages 2–5 years. Multivariable models were built to assess the relationship between sleep duration and BMI z‐score while controlling for potential sociodemographic and behavioural covariates.
Results
Three hundred and ninety‐eight children had sufficient data to be included in analysis. In multivariable models controlling for potential covariates, overnight sleep duration was significantly and inversely associated with BMI z‐score (B = −0.158, t = −1.774, P = 0.006). Similarly, when controlling for covariates, children who slept 12 or more hours had significantly lower BMI z‐scores compared with those who slept 8 to 10 h (P = 0.018) or less than 8 h (P = 0.035); the difference between 12+ hours and 10 to 12‐h groups did not reach statistical significance (P = 0.073) but supported a linear relationship between overnight sleep duration and BMI. Weekday‐to‐weekend variability in overnight sleep duration was not associated with BMI z‐score (B = 0.010, t = 0.206, P = 0.837).
Conclusions
Overnight sleep duration is independently and inversely related to BMI z‐score among AI children ages 2–5 years, even when controlling for important sociodemographic and obesogenic lifestyle factors. This represents the first report, to our knowledge, of sleep duration as a risk factor for obesity among AI children.
In recent times, practice in cardiac surgery has shifted towards using endoscopic techniques to harvest the saphenous vein from the leg for use as a bypass graft. A paper published in the New England ...Journal of Medicine (NEJM) in 2009 raised concerns over increased graft occlusion rates in veins harvested endoscopically. This NEJM paper has been criticized, but has nonetheless been influential in guiding practice. We have undertaken this meta-analysis to provide evidence on the clinical outcomes of endoscopic vein harvesting (EVH), so that clinicians can make an informed judgement about whether this technique, popular as it is with patients, should still be offered. We systematically reviewed the global literature and performed a meta-analysis of clinical outcomes after endoscopic and open vein harvesting. In all outcomes, endoscopic harvesting appears to be equal, if not superior, to open harvesting. The suspicion of higher rates of vein graft occlusion was not borne out by randomized studies. When considering evidence from only randomized studies, there is no statistical difference in vein graft stenosis or occlusion between open and endoscopically harvested veins. In conclusion, EVH reduces pain and leg wound complications. At a median follow-up of 2.6 years, we found no significant difference in mortality, myocardial infarction, repeat revascularization, angina recurrence, vein graft stenosis or occlusion. Therefore, the authors support the ongoing use of endoscopic harvesting techniques.
We present new Very Large Array (VLA) H I spectral line imaging of five sources discovered by the ALFALFA extragalactic survey. Roughly 75% of the 200 objects without identified counterparts in the ...alpha .40 database (Haynes et al. 2011) fall into category 1 (likely tidal), and were not considered for synthesis follow-up observations. The pilot sample presented here (AGC193953, AGC208602, AGC208399, AGC226178, and AGC233638) contains the first five sources observed as part of a larger effort to characterize H I sources with no readily identifiable optical counterpart at single dish resolution (3'.5). Four of the sources with uncertain or no optical counterpart in the ALFALFA data are identified with low surface brightness optical counterparts in Sloan Digital Sky Survey imaging when compared with VLA H I intensity maps, and appear to be galaxies with clear signs of ordered rotation in the H I velocity fields.
Aberrant epithelial repair is a key event in the airway remodelling which characterises obliterative bronchiolitis (OB) in the transplanted lung. The potential for airway epithelium from lung ...transplant recipients to undergo epithelial to mesenchymal cell transition (EMT) was assessed in culture and in vivo in lung allograft tissue.
Change in epithelial and mesenchymal marker expression was assessed after stimulation with transforming growth factor beta(1) (TGF-beta(1)) alone or in combination with tumour necrosis factor alpha (TNFalpha) and compared with untreated controls. The ability of cells to deposit extracellular matrix, secrete matrix metalloproteinases (MMPs) and invade collagen was investigated. Immunolocalisation of epithelial and mesenchymal markers was compared in airway tissue from stable recipients and those with OB.
Untreated cells maintained epithelial morphology and phenotype. TGF-beta(1) reduced expression of epithelial markers, increased expression of vimentin and fibronectin, promoted collagen I and fibronectin deposition and increased MMP-9 production. Co-treatment with TNFalpha dramatically accentuated phenotypic and some functional features of EMT. Airway epithelial biopsies from recipients with OB demonstrated significantly increased staining for mesenchymal markers and significantly reduced E-cadherin staining compared with stable recipients.
These observations demonstrate the ability of human airway epithelium to undergo EMT and suggest this phenomenon may be a potential link between inflammatory injury and TGF-beta(1)-driven airway remodelling in the development of OB.
Aims: To determine the presence of infection and co-infection of Plasmodium lineages in introduced birds at translocation sites for the North Island saddleback (Philesturnus rufusater), to ...investigate their role as Plasmodium spp. reservoirs.
Methods: Blood samples were collected from introduced bird species, with a special focus on blackbirds (Turdus merula) and song thrushes (Turdus philomelos), at six locations in the North Island of New Zealand that were the origin, or translocation sites, for North Island saddleback. Where available, blood smears were examined, and blood samples were tested using nested PCR with subsequent sequence analysis, for the presence of Plasmodium spp.
Results: Of the 55 samples tested using PCR analysis, 39 (71%) were positive for Plasmodium spp., and 28/40 (62%) blood smears were positive for Plasmodium spp. Overall, 31 blood samples were from blackbirds with 28/31 (90%) samples positive for Plasmodium spp. Six distinct avian Plasmodium lineages were identified, including three cosmopolitan lineages; Plasmodium vaughani SYAT05 was detected in 16 samples, Plasmodium matutinum Linn1 in 10 samples and Plasmodium elongatum GRW6 in eight samples. Mixed infections with more than one lineage were detected in 12 samples. Samples from two Australian magpies (Gymnorhina tibicen) were positive for Plasmodium. sp. lineage MYNA02, previously not identified in New Zealand.
Conclusions and clinical relevance: This is the first report from New Zealand in which specific Plasmodium spp. mixed infections have been found in introduced birds. Co-infections with several cosmopolitan Plasmodium lineages were identified, as well as the first report in New Zealand of an exotic avian Plasmodium sp. lineage, in Australian magpies. Whilst the role of introduced birds in maintaining and spreading pathogenic avian malaria in New Zealand is unclear, there is a potential infection risk to native birds, especially where distributions overlap.
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