Studies on plant growth and trait variation along environmental gradients can provide important information for identifying drivers of plant invasions and for deriving management strategies. We used ...seeds of the annual plant invader Ambrosia artemisiifolia L. (common ragweed) collected from an agricultural site in Northern Italy (226 m. a.s.l; Mean Annual Air Temperature: 12.9 °C; precipitations: 930 mm) to determine variation in growth trajectories and plant traits when grown along a 1000-m altitudinal gradient in Northern Italy, and under different temperature conditions in the growth chamber (from 14/18 °C to 26/30 °C, night/day), using a non-liner modeling approach. Under field conditions, traits related to plant height (maximum height, stem height, number of internodes) followed a three-parameter logistic curve. In contrast, leaf traits (lateral spread, number of leaves, leaf length and width) followed non-monotonic double-Richards curves that captured the decline patterns evident in the data. Plants grew faster, reaching a higher maximum plant height, and produced more biomass when grown at intermediate elevations. Under laboratory conditions, plants exhibited the same general growth trajectory of field conditions. However, leaf width did not show the recession after the maximum value shown by plants grown in the field, although the growth trajectories of some individuals, particularly those grown at 18 °C, showed a decline at late times. In addition, the plants grown at lower temperatures exhibited the highest value of biomass and preserved reproductive performances (e.g., amount of male inflorescence, pollen weight). From our findings, common ragweed exhibits a high phenotypic plasticity of vegetative and reproductive traits in response to different altitudes and temperature conditions. Under climate warming, this plasticity may facilitate the shift of the species towards higher elevation, but also the in situ resistance and (pre)adaptation of populations currently abundant at low elevations in the invasive European range. Such results may be also relevant for projecting the species management such as the impact by possible biocontrol agents.
Genetic predisposition controlled by susceptibility quantitative trait loci (QTLs) contributes to a large proportion of common cancers. Studies of genetics of cancer susceptibility, however, did not ...address systematically the relationship between susceptibility to cancers in different organs. We present five sets of data on genetic architecture of colon and lung cancer susceptibility in mice, humans and rats. They collectively show that the majority of genes for colon and lung cancer susceptibility are linked pair-wise and are likely identical or related. Four CcS/Dem recombinant congenic strains, each differing from strain BALB/cHeA by a different small random subset of ±12.5% of genes received from strain STS/A, suggestively show either extreme susceptibility or extreme resistance for both colon and lung tumors, which is unlikely if the two tumors were controlled by independent susceptibility genes. Indeed, susceptibility to lung cancer (Sluc) loci underlying the extreme susceptibility or resistance of such CcS/Dem strains, mapped in 226 (CcS-10 x CcS-19)F2 mice, co-localize with susceptibility to colon cancer (Scc) loci. Analysis of additional Sluc loci that were mapped in OcB/Dem strains and Scc loci in CcS/Dem strains, respectively, shows their widespread pair-wise co-localization (P = 0.0036). Finally, the majority of published human and rat colon cancer susceptibility genes map to chromosomal regions homologous to mouse Sluc loci. 12/12 mouse Scc loci, 9/11 human and 5/7 rat colon cancer susceptibility loci are close to a Sluc locus or its homologous site, forming 21 clusters of lung and colon cancer susceptibility genes from one, two or three species. Our data shows that cancer susceptibility QTLs can have much broader biological effects than presently appreciated. It also demonstrates the power of mouse genetics to predict human susceptibility genes. Comparison of molecular mechanisms of susceptibility genes that are organ-specific and those with trans-organ effects can provide a new dimension in understanding individual cancer susceptibility.
To define a magnetic resonance (MR) imaging pattern suggestive of congenital cytomegalovirus (CMV) infection by using polymerase chain reaction (PCR) testing to detect CMV DNA in neonatal blood on ...Guthrie cards for validation.
On the basis of findings in eight patients with documented congenital CMV infection, the authors developed MR imaging inclusion criteria, including multifocal lesions predominantly located in the deep parietal white matter. If gyral abnormalities were present, white matter lesions were either multifocal or diffuse. The criteria were applied to 152 patients with static leukoencephalopathy of unknown etiology. Guthrie cards for 22 of the 43 patients fulfilling the MR imaging criteria, 20 patients not fulfilling them, and 300 control subjects were analyzed. Fisher exact testing was used to evaluate the association between MR imaging characteristics and CMV status, and backward elimination linear discriminant analysis was used to identify MR imaging characteristics predictive of CMV infection in addition to the initial criteria.
PCR test results were positive in 12 of 22 patients suspected of having congenital CMV infection, in no patient not suspected of having infection (P <.001), and in two of 300 control subjects (negative predictive value NPV of MR imaging criteria, 100% 95% CI: 83%, 100%; positive predictive value PPV, 55% 95% CI: 32%, 76%). The most important additional MR imaging finding predicting a positive PCR result was abnormality of the anterior part of the temporal lobe, including abnormal white matter, cysts, and enlargement of inferior horns. Including this finding in the MR imaging criteria enhanced the PPV (89%; 95% CI: 52%, 99%) at the expense of the NPV (88%; 95% CI: 72%, 97%).
In patients with static encephalopathy, an MR imaging pattern of multifocal lesions predominantly involving deep parietal white matter, with or without gyral abnormalities, is predictive of congenital CMV infection. When gyral abnormalities are present, leukoencephalopathy may also be diffuse. The presence of abnormalities in the anterior part of the temporal lobe increases the likelihood that CMV infection is present.
Summary Background Every year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised controlled trials estimated that home visits by trained community members in ...programme settings in Ghana and south Asia reduced neonatal mortality by 12% (95% CI 5–18). We aimed to estimate the costs and cost-effectiveness of newborn home visits in a programme setting. Methods We prospectively collected detailed cost data alongside the Newhints trial, which tested the effect of a home-visits intervention in seven districts in rural Ghana and showed a reduction of 8% (95% CI −12 to 25%) in neonatal mortality. The intervention consisted of a package of home visits to pregnant women and their babies in the first week of life by community-based surveillance volunteers. We calculated incremental cost-effectiveness ratios (ICERs) with Monte Carlo simulation and one-way sensitivity analyses and characterised uncertainty with cost-effectiveness planes and cost-effectiveness acceptability curves. We then modelled the potential cost-effectiveness for baseline neonatal mortality rates of 20–60 deaths per 1000 livebirths with use of a meta-analysis of effectiveness estimates. Findings In the 49 zones randomly allocated to receive the Newhints intervention, a mean of 407 (SD 18) community-based surveillance volunteers undertook home visits for 7848 pregnant women who gave birth to 7786 live babies in 2009. Annual economic cost of implementation was US$203 998, or $0·53 per person. In the base-case analysis, the Newhints intervention cost a mean of $10 343 (95% CI 2963 to −7674) per newborn life saved, or $352 (95% CI 104 to −268) per discounted life-year saved, and had a 72% chance of being highly cost effective with respect to Ghana's 2009 gross domestic product per person. Key determinants of cost-effectiveness were the discount rate, protective effectiveness, baseline neonatal mortality rate, and implementation costs. In the scenarios modelled with the meta-analysis results, the ICER increased from $127 per life-year saved at a neonatal mortality rate of 60 deaths per 1000 livebirths, to $379 per life-year saved at a rate of 20 deaths per 1000 livebirths. The strategy had at least a 99% probability of being highly cost effective for lower-middle-income countries in all neonatal mortality rate scenarios modelled, and at least a 95% probability of being highly cost effective for low-income countries at neonatal mortality rates of 30 or more deaths per 1000 livebirths. Interpretation Our findings show that the seemingly modest mortality reductions achieved by a newborn home-visit strategy might in fact be cost effective. In Ghana, such strategies are also likely to be affordable. Our findings support recommendations from WHO and UNICEF that low-income and middle-income countries implement newborn home visits. Funding The Bill & Melinda Gates Foundation, UK Department for International Development, WHO.
Predictors of the rate of decline of residual renal function in incident dialysis patients.
Residual renal function (RRF) influences morbidity, mortality and quality of life in chronic dialysis ...patients. Few studies have been published on risk factors for loss of RRF in dialysis patients. These studies were either retrospective, performed in a small number of patients, or estimated GFR without a urine collection.
We analyzed the decline rates of residual GFR (rGFR) prospectively in 522 incident HD and PD patients who had structured follow-up assessments. GFR was measured as the mean of urea and creatinine clearance, calculated from urine collections. The initial value was obtained 0 to 4 weeks before the start of dialysis. The measurements were repeated 3, 6, and 12 months after the start of dialysis treatment. After logarithmic transformation, differences in rGFR changes over time were analyzed using repeated measurement analysis of variance.
Baseline factors that were negatively associated with rGFR at 12 months were a higher diastolic blood pressure (P < 0.001) and a higher urinary protein loss (P < 0.001). Primary kidney disease did not affect rGFR. Averaged over time, PD patients had a higher rGFR (P < 0.001) than HD patients. This relative difference increased over time (P = 0.04). Investigation of possible effects of the dialysis procedure on the decline rate between 0 and three months showed that dialysis hypotension (P = 0.02) contributed to the decline in HD and the presence of episodes with dehydration contributed in PD (P = 0.004).
rGFR is better maintained in PD patients than in HD patients. The associated factors such as a higher diastolic blood pressure, proteinuria, dialysis hypotension and dehydration can either be treated or avoided.
Objective
To evaluate whether the Newhints home visits intervention increased the adoption of skin‐to‐skin care (SSC), in particular, among low birthweight (LBW) (<2.5 kg) babies.
Methods
A ...cluster‐randomised trial, with 49 Newhints zones and 49 control zones, was conducted in seven districts in the Brong Ahafo Region, Ghana. It included all live births between November 2008 and December 2009. In Newhints zones, existing community‐based surveillance volunteers were trained to conduct home visits during which they weighed babies and counselled mothers of LBW babies on SSC. Performance of any SSC and SSC for more than 2 h was evaluated.
Results
Of 15,615 live births, 68.5% had recorded birthweights; 10.1% were LBW. Any SSC was 19.4% higher among babies in Newhints vs. control zones (risk ratio, RR: 1.81; 95% confidence interval, CI: 1.40–2.35). Performance of SSC for more than 2 h was, however, low, at only 7.5%, although more than double compared with control zones (RR: 2.72; 95% CI: 1.80–4.10). LBW babies visited and weighed by a volunteer were more likely to receive SSC (PAny = 0.005; P > 2 h = 0.021), greater for LBW babies, particularly for more than 2 h of SSC (Pinteraction = 0.050).
Conclusion
Newhints successfully promoted the uptake of SSC in rural Ghana. Although findings are encouraging, promotion in rural community settings in sub‐Saharan Africa is challenging. Lessons learned can help shape SSC promotion in efforts to increase adoption and save newborn lives.
ObjectifEvaluer si l'intervention Newhints de visites à domicile augmente l'adoption des soins de contact peau contre peau (SCPCP), en particulier, chez les bébés de faible poids de naissance (FPN) (<2,5 kg).MéthodesUn essai randomisé par grappes, avec 49 zones Newhints et 49 zones témoins, a été mené dans sept districts de la région de Brong Ahafo, au Ghana. Il comprenait toutes les naissances vivantes de novembre 2008 à décembre 2009. Dans les zones Newhints, les surveillantes communautaires bénévoles existantes ont été formées pour effectuer des visites à domicile au cours desquelles elles pesaient les bébés et conseillaient aux mères de bébés de faible poids de naissance au sujet des SCPCP. Les performances de tout SCPCP et de SCPCP de plus de deux heures ont été évaluées.RésultatsSur 15.615 naissances vivantes, 68,5% avaient un poids à la naissance enregistré, 10,1% étaient de FPN. Tous les SCPCP étaient de 19,4% plus élevés chez les bébés dans la zone Newhints que chez ceux dans les zones témoins (rapport des risques, RR: 1,81, intervalle de confiance à 95%, IC: 1,40 à 2,35). Les performances des SCPCP de plus de deux heures étaient toutefois faibles, 7,5% seulement, quoique plus du double par rapport aux zones témoins (RR: 2,72, IC95%: 1,80 à 4,10). Les bébés avec un FPN visités et pesés par une bénévole étaient plus susceptibles de recevoir des SCPCP (Ptotal = 0,005, P>2 h = 0,021), plus pour les bébés de FPN, particulièrement pour les SCPCP de plus de deux heures (Pinteraction = 0,050).ConclusionL'intervention Newhints a réussi à promouvoir l'adoption des SCPCP dans les régions rurales du Ghana. Bien que les résultats soient encourageants, la promotion dans les milieux communautaires ruraux en Afrique subsaharienne reste difficile. Les leçons apprises peuvent aider à façonner la promotion des SCPCP dans les efforts visant à accroître son adoption et à sauver des vies de nouveau‐nés.
ObjetivoEvaluar si la intervención con visitas domiciliarias del Newhints aumentó el uso del contacto piel a piel (COPAP), en particular para bebés con bajo peso (<2.5 kg) al nacer (BPN)MétodosEnsayo aleatorizado en conglomerados con 49 zonas de intervención (Newhints) y 49 zonas de control, realizado en siete distritos en la Región de Brong Ahafo, Ghana. Se incluyeron todos los nacidos vivos entre Noviembre 2008 y Diciembre 2009. En las zonas de intervención se entrenó a todos los trabajadores comunitarios voluntarios para realizar visitas domiciliarias, durante las cuales se pesaban los bebés y se aconsejaba a las madres sobre los CPP para sus bebés con BPN. Se evaluó el desempeño de cualquier COPAP y del COPAP durante más de dos horas.ResultadosDe 15,615 nacidos vivos, se tenían registro del peso al nacer de un 68.5%; un 10.1% tenía un BPN. Cualquier COPAP era un 19.4% mayor entre los bebes del Newhints, comparado con las zonas control (coeficiente de riesgo, RR: 1.81; 95% intervalo de confianza, IC: 1.40‐2.35). El desempeño del COPAP durante más de dos horas era sin embargo bajo, con solo un 7.5%, aunque más del doble comparado con las zonas control (RR: 2.72; IC95%: 1.80‐4.10). Los bebes con BPN visitados y pesados por un voluntario tenían una mayor probabilidad de recibir COPAP (PAny = 0.005; P>2 hrs = 0.021); y en particular más de dos horas de COPAP (Pinteraction = 0.050).ConclusiónNewhints promovió exitosamente la toma del COPAP en zonas rurales de Ghana. Aunque los hallazgos son alentadores, los retos de promover el COPAP en zonas rurales del África subsahariana son grandes. Las lecciones aprendidas pueden ayudar a dar forma a la promoción de los COPAP como parte del esfuerzo para aumentar su adopción y salvar la vida de recién nacidos.
Abstract Background While depression during pregnancy is one of the strongest risk factors for postnatal depression, it has been comparatively little studied, particularly in sub-Saharan Africa. ...Methods Cohort study nested within 4-weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for depression during pregnancy using the P atient H ealth Qu estionnaire to ascertain DSM-IV major or minor depression. Information on demographic factors, indicators of social and economic disadvantage, and previous obstetric history were also collected which were examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals. Results 21,135 pregnant women were screened of whom 20,920 (98.9%) had complete data on potential determinants. 2086 (9.9%, 95% CI: 9.5%–10.3%) had AND. Determinants of AND were: maternal age 30+ years (relative risk RR, 1.16 (1.06–1.27); never married (RR 1.34, (1.14–1.58); lower wealth quintile (RR, 1.30 (1.13–1.50); unplanned pregnancy (RR, 1.55 (1.43–1.69); previous pregnancy loss (RR, 1.30 (1.18–1.43). Limitations We did not assess women for physical health during pregnancy, and lacked information on some potentially relevant psychosocial factors. Conclusion Prevalence of antenatal depression, applying clinical criteria, is similar to that seen in high income countries. Factors related to chronic social and economic disadvantage are among the most important co-determinants. Population-level interventions that address these problems among women of reproductive age may be the most effective strategy for reducing the prevalence and impact of depression in pregnancy.
Objective To assess the structural capacity for, and quality of, immediate and essential newborn care (ENC) in health facilities in rural Ghana, and to link this with demand for facility deliveries ...and admissions. Design Health facility assessment survey and population-based surveillance data. Setting Seven districts in Brong Ahafo Region, Ghana. Participants Heads of maternal/neonatal wards in all 64 facilities performing deliveries. Main outcome measures Indicators include: the availability of essential infrastructure, newborn equipment and drugs, and personnel; vignette scores and adequacy of reasons given for delayed discharge of newborn babies; and prevalence of key immediate ENC practices that facilities should promote. These are matched to the percentage of babies delivered in and admitted to each type of facility. Results 70% of babies were delivered in health facilities; 56% of these and 87% of neonatal admissions were in four referral level hospitals. These had adequate infrastructure, but all lacked staff trained in ENC and some essential equipment (including incubators and bag and masks) and/or drugs. Vignette scores for care of very low-birth-weight babies were generally moderate-to-high, but only three hospitals achieved high overall scores for quality of ENC. We estimate that only 33% of babies were born in facilities capable of providing high quality, basic resuscitation as assessed by a vignette plus the presence of a bag and mask. Promotion of immediate ENC practices in facilities was also inadequate, with coverage of early initiation of breastfeeding and delayed bathing both below 50% for babies born in facilities; this represents a lost opportunity. Conclusions Unless major gaps in ENC equipment, drugs, staff, practices and skills are addressed, strategies to increase facility utilisation will not achieve their potential to save newborn lives. Trial registration http://clinicaltrials.gov NCT00623337.
One of the biggest challenges in classical biological control of invasive weeds is predicting the likelihood of success.
Ambrosia artemisiifolia
, a North American plant species that has become ...invasive in Europe, causes economic losses due to health problems resulting from its huge amount of highly allergenic pollen and as a weed to agricultural crops resulting from high seed densities. Here we assessed whether the pollen and seed output of the annual
A. artemisiifolia
(at the end of the season) is related to in-season abundance of, or damage by, the accidentally introduced biological control agent
Ophraella communa
. We monitored the growth and leaf damage of individually labelled
A. artemisiifolia
plants at four locations in Northern Italy and recorded abundance of different
O. communa
life stages at regular intervals. We found that the in-season level of leaf damage by
O. communa
consistently helped to explain seed production in combination with plant volume and site throughout the season. Feeding damage, plant volume and site also explained pollen production by
A. artemisiifolia
six weeks before male flower formation. At three out of four sites, plants with more than 10% leaf damage in mid-June or early July had a very low likelihood of seed formation. Leaf damage proved to be a better explanatory variable than
O. communa
abundance. Our results suggest that the monitoring of the in-season leaf damage can help to project the local impact of
O. communa
on
A. artemisiifolia
at the end of the season and thus inform management regarding the needs for additional measures to control this prominent invader.
Cisplatin concomitantly administered with radiotherapy is increasingly used in locally advanced head and neck squamous cell carcinoma. We aimed to compare the incidence of hearing loss between ...patients treated with intra-arterial high-dose cisplatin chemoradiation with sodium thiosulfate (CRT-IA) and intravenous high-dose cisplatin chemoradiation without sodium thiosulfate (CRT-IV).
We conducted a prospective analysis of hearing thresholds at low and (ultra-) high frequencies obtained before, during, and after treatment in 158 patients. Patients were randomly assigned for either CRT-IA (150 mg/m(2), four courses) with sodium thiosulfate cisplatin neutralization or CRT-IV (100 mg/m(2), three courses) without rescue. All patients received concomitant radiation therapy (RT; 70 Gy).
CRT-IA resulted in approximately 10% less hearing loss at frequencies vital for speech perception, compared with CRT-IV (P < .001). In CRT-IA, fewer ears qualified for hearing aids (36% v 49%; P = .03). However, in both treatment arms, the incidence expressed in National Cancer Institute Common Terminology Criteria of Adverse Events (version 3) did not deviate (P > .14). Age, cumulative cisplatin dose, cumulative RT dose, and the considered frequency area determine the degree of hearing loss (P < .001). Cisplatin induced increasing hearing loss of 24% to 60% with increasing frequencies. RT induced hearing loss at speech frequencies of 9% to 12%.
Depending on the criteria used to assess hearing loss due to treatment, differences in ototoxicity between CRT-IA and CRT-IV were found in favor of CRT-IA. It is desirable to specify hearing loss criteria toward frequencies vital for speech perception, and to refine grading scales to reveal subtle and clinically relevant dissimilarities in ototoxicity between different treatment protocols.
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