Objective To evaluate in-hospital formula supplementation among first-time mothers who intended to exclusively breastfeed and determined if in-hospital formula supplementation shortens breastfeeding ...duration after adjusting for breastfeeding intention. Study design We assessed strength of breastfeeding intentions prenatally in a diverse cohort of expectant primiparae and followed infant feeding practices through day 60. Among mothers planning to exclusively breastfeed their healthy term infants for ≥1 week, we determined predictors, reasons, and characteristics of in-hospital formula supplementation, and calculated the intention-adjusted relative risk (ARR) of not fully breastfeeding days 30-60 and breastfeeding cessation by day 60 with in-hospital formula supplementation (n = 393). Results Two hundred ten (53%) infants were exclusively breastfed during the maternity stay and 183 (47%) received in-hospital formula supplementation. The most prevalent reasons mothers cited for in-hospital formula supplementation were: perceived insufficient milk supply (18%), signs of inadequate intake (16%), and poor latch or breastfeeding (14%). Prevalence of not fully breastfeeding days 30-60 was 67.8% vs 36.7%, ARR 1.8 (95% CI, 1.4-2.3), in-hospital formula supplementation vs exclusively breastfed groups, respectively, and breastfeeding cessation by day 60 was 32.8% vs 10.5%, ARR 2.7 (95% CI, 1.7-4.5). Odds of both adverse outcomes increased with more in-hospital formula supplementation feeds (not fully breastfeeding days 30-60, P = .003 and breastfeeding cessation, P = .011). Conclusions Among women intending to exclusively breastfeed, in-hospital formula supplementation was associated with a nearly 2-fold greater risk of not fully breastfeeding days 30-60 and a nearly 3-fold risk of breastfeeding cessation by day 60, even after adjusting for strength of breastfeeding intentions. Strategies should be sought to avoid unnecessary in-hospital formula supplementation and to support breastfeeding when in-hospital formula supplementation is unavoidable.
MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) measurements taken during passes over Mercury's dayside hemisphere indicate that on four occasions the spacecraft remained in ...the magnetosheath even though it reached altitudes below 300 km. During these disappearing dayside magnetosphere (DDM) events, the spacecraft did not encounter the magnetopause until it was at very high magnetic latitudes, ~66 to 80°. These DDM events stand out with respect to their extremely high solar wind dynamic pressures, Psw ~140 to 290 nPa, and intense southward magnetic fields, Bz ~ −100 to −400 nT, measured in the magnetosheath. In addition, the bow shock was observed very close to the surface during these events with a subsolar altitude of ~1,200 km. It is suggested that DDM events, which are closely associated with coronal mass ejections, are due to solar wind compression and/or reconnection‐driven erosion of the dayside magnetosphere. The very low altitude of the bow shock during these events strongly suggests that the solar wind impacts much of Mercury's sunlit hemisphere during these events. More study of these disappearing dayside events is required, but it is likely that solar wind sputtering of neutrals from the surface into the exosphere maximizes during these intervals.
Key Points
The dayside magnetosphere of Mercury is observed to disappear at MESSENGER's orbit during some coronal mass ejection impacts
The cause appears to be extreme solar wind compression and/or reconnection‐driven erosion of Mercury's dayside magnetic field
The low altitude of the bow shock during these events strongly suggests that Mercury's dayside surface experiences direct solar wind impact
This evidence-based guideline is an update of the 2005 American Academy of Neurology practice parameter on the treatment of essential tremor (ET).
A literature review using MEDLINE, EMBASE, Science ...Citation Index, and CINAHL was performed to identify clinical trials in patients with ET published between 2004 and April 2010.
Conclusions and recommendations for the use of propranolol, primidone (Level A, established as effective); alprazolam, atenolol, gabapentin (monotherapy), sotalol, topiramate (Level B, probably effective); nadolol, nimodipine, clonazepam, botulinum toxin A, deep brain stimulation, thalamotomy (Level C, possibly effective); and gamma knife thalamotomy (Level U, insufficient evidence) are unchanged from the previous guideline. Changes to conclusions and recommendations from the previous guideline include the following: 1) levetiracetam and 3,4-diaminopyridine probably do not reduce limb tremor in ET and should not be considered (Level B); 2) flunarizine possibly has no effect in treating limb tremor in ET and may not be considered (Level C); and 3) there is insufficient evidence to support or refute the use of pregabalin, zonisamide, or clozapine as treatment for ET (Level U).
Poor nutrition and exposure to faecal contamination are associated with diarrhoea and growth faltering, both of which have long-term consequences for child health. We aimed to assess whether water, ...sanitation, handwashing, and nutrition interventions reduced diarrhoea or growth faltering.
The WASH Benefits cluster-randomised trial enrolled pregnant women from villages in rural Kenya and evaluated outcomes at 1 year and 2 years of follow-up. Geographically-adjacent clusters were block-randomised to active control (household visits to measure mid-upper-arm circumference), passive control (data collection only), or compound-level interventions including household visits to promote target behaviours: drinking chlorinated water (water); safe sanitation consisting of disposing faeces in an improved latrine (sanitation); handwashing with soap (handwashing); combined water, sanitation, and handwashing; counselling on appropriate maternal, infant, and young child feeding plus small-quantity lipid-based nutrient supplements from 6–24 months (nutrition); and combined water, sanitation, handwashing, and nutrition. Primary outcomes were caregiver-reported diarrhoea in the past 7 days and length-for-age Z score at year 2 in index children born to the enrolled pregnant women. Masking was not possible for data collection, but analyses were masked. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01704105.
Between Nov 27, 2012, and May 21, 2014, 8246 women in 702 clusters were enrolled and randomly assigned an intervention or control group. 1919 women were assigned to the active control group; 938 to passive control; 904 to water; 892 to sanitation; 917 to handwashing; 912 to combined water, sanitation, and handwashing; 843 to nutrition; and 921 to combined water, sanitation, handwashing, and nutrition. Data on diarrhoea at year 1 or year 2 were available for 6494 children and data on length-for-age Z score in year 2 were available for 6583 children (86% of living children were measured at year 2). Adherence indicators for sanitation, handwashing, and nutrition were more than 70% at year 1, handwashing fell to less than 25% at year 2, and for water was less than 45% at year 1 and less than 25% at year 2; combined groups were comparable to single groups. None of the interventions reduced diarrhoea prevalence compared with the active control. Compared with active control (length-for-age Z score −1·54) children in nutrition and combined water, sanitation, handwashing, and nutrition were taller by year 2 (mean difference 0·13 95% CI 0·01–0·25 in the nutrition group; 0·16 0·05–0·27 in the combined water, sanitation, handwashing, and nutrition group). The individual water, sanitation, and handwashing groups, and combined water, sanitation, and handwashing group had no effect on linear growth.
Behaviour change messaging combined with technologically simple interventions such as water treatment, household sanitation upgrades from unimproved to improved latrines, and handwashing stations did not reduce childhood diarrhoea or improve growth, even when adherence was at least as high as has been achieved by other programmes. Counselling and supplementation in the nutrition group and combined water, sanitation, handwashing, and nutrition interventions led to small growth benefits, but there was no advantage to integrating water, sanitation, and handwashing with nutrition. The interventions might have been more efficacious with higher adherence or in an environment with lower baseline sanitation coverage, especially in this context of high diarrhoea prevalence.
Bill & Melinda Gates Foundation, United States Agency for International Development.
We report the first result for the electron-antineutrino angular correlation (a coefficient) in free neutron β decay from the aCORN experiment. aCORN uses a novel method in which the a coefficient is ...proportional to an asymmetry in proton time of flight for events where the β electron and recoil proton are detected in delayed coincidence. Data are presented from a 15 month run at the NIST Center for Neutron Research. We obtained a=-0.1090±0.0030(stat)±0.0028(sys), the most precise measurement of the neutron a coefficient reported to date.
The most precise determination of the neutron lifetime using the beam method was completed in 2005 and reported a result of τ(n)=(886.3±1.2stat±3.2syst) s. The dominant uncertainties were attributed ...to the absolute determination of the fluence of the neutron beam (2.7 s). The fluence was measured with a neutron monitor that counted the neutron-induced charged particles from absorption in a thin, well-characterized 6Li deposit. The detection efficiency of the monitor was calculated from the areal density of the deposit, the detector solid angle, and the evaluated nuclear data file, ENDF/B-VI 6Li(n,t)4He thermal neutron cross section. In the current work, we measure the detection efficiency of the same monitor used in the neutron lifetime measurement with a second, totally absorbing neutron detector. This direct approach does not rely on the 6Li(n,t)4He cross section or any other nuclear data. The detection efficiency is consistent with the value used in 2005 but is measured with a precision of 0.057%, which represents a fivefold improvement in the uncertainty. We verify the temporal stability of the neutron monitor through ancillary measurements, allowing us to apply the measured neutron monitor efficiency to the lifetime result from the 2005 experiment. The updated lifetime is τ(n)=(887.7±1.2stat±1.9syst) s.
The standard model predicts that, in addition to a proton, an electron, and an antineutrino, a continuous spectrum of photons is emitted in the β decay of the free neutron. We report on the RDK II ...experiment which measured the photon spectrum using two different detector arrays. An annular array of bismuth germanium oxide scintillators detected photons from 14 to 782 keV. The spectral shape was consistent with theory, and we determined a branching ratio of 0.00335±0.00005stat±0.00015syst. A second detector array of large area avalanche photodiodes directly detected photons from 0.4 to 14 keV. For this array, the spectral shape was consistent with theory, and the branching ratio was determined to be 0.00582±0.00023stat±0.00062syst. We report the first precision test of the shape of the photon energy spectrum from neutron radiative decay and a substantially improved determination of the branching ratio over a broad range of photon energies.
Mercury's flux transfer event (FTE) showers are dayside magnetopause crossings accompanied by large numbers (≥10) of magnetic flux ropes (FRs). These shower events are common, occurring during 52% ...(1,953/3,748) of the analyzed crossings. Shower events are observed with magnetic shear angles (θ) from 0° to 180° across the magnetopause and magnetosheath plasma β from 0.1 to 10 but are most prevalent for high θ and low plasma β. Individual FR duration correlates positively, while spacing correlates negatively, with θ and plasma β. FR flux content and core magnetic field intensity correlate negatively with plasma β, but they do not correlate with θ. During shower intervals, FRs carry 60% to 85% of the magnetic flux required to supply Mercury's Dungey cycle. The FTE showers and the large amount of magnetic flux carried by the FTE‐type FRs appear quite different from observations at Earth and other planetary magnetospheres visited thus far.
Plain Language Summary
Any planet with an interior dynamo will interact with the outward streaming stellar wind and likely form a magnetosphere. The magnetopause is a boundary between the shocked solar wind and planetary magnetic field, which can prevent most of the solar wind from directly entering into the magnetosphere. The multiple X‐line reconnection that frequently occurs in the magnetopause creates helical magnetic fields that are termed magnetic flux ropes (FRs) about which open and interplanetary magnetic fields drape. FTE‐type FRs generally have magnetic field lines with one end embedded in the solar wind and the other end connected to the planet through the magnetospheric cusp. The investigation of FTEs in Mercury's magnetosphere is of particular interest because they often occur in large numbers with extremely small temporal spacing, i.e., FTE showers, that are not seen elsewhere. We find that the properties of the FTE‐type flux ropes in these showers depend upon plasma β in the magnetosheath and the magnetic shear angle across the magnetopause. The magnetic flux carried by these flux ropes dominates magnetic flux transfer between Mercury's dayside and nightside magnetosphere. These new results may contribute significantly to our understanding of solar wind‐magnetosphere‐exosphere coupling at Mercury.
Key Points
Flux transfer event (FTE) showers (≥10 flux ropes in a magnetopause crossing) are prevalent when shear angle is large and plasma β is small
FTE‐type flux rope duration, spacing, core field, and flux content during shower events are shown to depend upon shear angle and plasma β
FTE‐type flux ropes in shower events carry between 60% and 85% of the magnetic flux required to supply Mercury's Dungey cycle
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