ABSTRACT
Necrotic enteritis (NE) caused by Clostridium perfringens has emerged as an important disease associated with major economic losses in the poultry industry worldwide. The ban and voluntary ...withdraw of antimicrobial growth promoters used to control NE have resulted in resurgence of NE. Moreover, consumer demand for antibiotic free poultry product has continued to grow. The presence of the netB gene encoding for pore forming toxin in C. perfringens has been shown to be essential for pathogenesis of NE. The aim of this study was to characterize C. perfringens isolates recovered from broiler chickens affected by NE. A total of 230 isolates obtained from commercially raised broilers between 3 and 4 wk of age affected by NE were characterized using multiplex PCR (mPCR) and antibiotic susceptibility test. A subset of isolates (n = 75) were analyzed using pulsed-field gel electrophoresis (PFGE). Toxin typing using mPCR revealed that all C. perfringens isolates were toxinotype A. However, 68% (59 of 85) of the isolates from apparently healthy birds and 81% (119 of 145) from dead birds were positive for netB gene. Antimicrobial susceptibility testing using a disk diffusion method indicated that 53% of the isolates had a multidrug resistant profile that comprised of streptomycin, gentamicin, erythromycin, tetracycline, and bacitracin. PFGE analysis of 53 typeable isolates indicated a wide genetic relatedness even among isolate from the same state with the same antibiotic resistance profile. The results obtained from this study suggest that the presence of C. perfringens with netB gene in broiler chicken does not automatically result in death but other factors such as health of the bird before proliferation of virulent C. perfringens may be critical for development of NE.
The iron-based high temperature superconductors exhibit a rich phase diagram reflecting a complex interplay between spin, lattice, and orbital degrees of freedom. The nematic state observed in these ...compounds epitomizes this complexity, by entangling a real-space anisotropy in the spin fluctuation spectrum with ferro-orbital order and an orthorhombic lattice distortion. A subtle and less-explored facet of the interplay between these degrees of freedom arises from the sizable spin-orbit coupling present in these systems, which translates anisotropies in real space into anisotropies in spin space. We present nuclear magnetic resonance studies, which reveal that the magnetic fluctuation spectrum in the paramagnetic phase of BaFe2As2 acquires an anisotropic response in spin-space upon application of a tetragonal symmetry-breaking strain field. Our results unveil an internal spin structure of the nematic order parameter, indicating that electronic nematic materials may offer a route to magneto-mechanical control.
Abstract
Background
Regular exercise and physical activity can maintain function and cardiovascular health, and prevent cognitive decline, in older adults. However, studies show that there is often ...poor adherence to home exercise programmes (HEP). The purpose of this study was to explore how HEP are perceived by both older adults and physiotherapists.
Methods
A convenience sample of 28 older adults attending outpatient physiotherapy clinics were given an exercise journal to record their adherence to the HEP prescribed by their physiotherapists for six weeks. Subsequently, semi-structured interviews were conducted with a purposive sample, and the corresponding prescribing physiotherapists, to achieve maximal variation in terms of HEP adherence, age and sex. The interviews were audio recorded, transcribed, and simple content analysis performed.
Results
Fourteen participants returned their exercise journal. Median age was 80; half were female; median Berg Balance Score and Timed-up-and-Go-Test were 49 and 16 seconds respectively. Participants exercised a median 79.8% of the prescribed dose, or 5.6 days per week. Seven older adults were interviewed; about half had a positive attitude towards exercise. They were also moderately positive about their HEP (comments ranged from “doable” and “nothing bad about it” to “enjoyable”). Barriers included time, mood, boredom, remembering to do the HEP, and variable health status. Enablers included simple instructions and design, family encouragement, and sense of achievement. Physiotherapists (n=5) perceived that many older adults aren’t compliant with HEPs, but there was some therapeutic nihilism (“you can’t force them”). Their HEP instructions varied from verbal to written instructions/diagrams; one physiotherapist used individualised video content. Notably, participants with good adherence understood their HEP well in terms of content and purpose, although this may be cause or effect.
Conclusion
To improve compliance with HEP, healthcare professionals need to take time to motivate the recipient, simplify their instructions, and trouble-shoot potential barriers at the time of prescription.
Dementia is the most common neurologic disease, affecting approximately 55 million people worldwide. Dementia is a terminal illness, although not always recognized as such. This chapter discusses the ...key issues in providing palliative care for people with living with dementia and their families. Common palliative care needs and symptoms are presented, including psychosocial, physical, emotional, and spiritual, and the need to actively anticipate and seek symptoms according to the dementia type and stage is emphasized. Families are hugely impacted by a dementia diagnosis, and throughout this chapter, they are considered in the unit of care, and also as a member of the care team. Multiple challenges particular to dementia palliative care are highlighted throughout, such as the lack of timely dementia diagnoses, difficulty with symptom prognostication, the person's inability to verbally express their symptoms and care preferences, and a low threshold for medication side effects. Finally, service models for dementia palliative care in community, residential, and acute hospital settings are discussed, along with the evidence for each. Overall, this chapter reinforces that the individual needs of the person living with dementia and their family must be considered to provide person-centered and comprehensive palliative care, enabling them to live well until death.
There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries.
To formulate a consensus ...statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel.
Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery.
Based on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed.
Prior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco2 ≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability.
This report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between countries.
•Research design leverages randomized audit reports from Brazil.•Research question asks whether revealed corruption affects fiscal outcomes.•We find that municipal property tax revenue responds to ...revealed corruption.•Revealed corruption also increases participatory budgeting adoption rates.•Results indicate demand-side constraints on taxation and budgetary institutions.
Fiscal contract theories hypothesize that government performance affects tax collection and that institutions that foster representation and accountability link taxes and services. We use randomly generated municipal audit reports with objective measures of corruption from Brazil to assess whether new information about corruption affects municipal property tax collection and the structure of fiscal institutions. We find short-run effects consistent with this theory: property tax revenue rises with clean audit reports and falls as revealed corruption increases; furthermore revealed corruption increases the probability that a municipality adopts participatory budgeting. Our results indicate modest demand-side constraints on taxation and budgetary institutions.
For n≥k≥4, let ARX+Y=Z+Tk(n) be the maximum number of rainbow solutions to the Sidon equation X+Y=Z+T over all k-colorings c:n→k. It can be shown that the total number of solutions in n to the Sidon ...equation is n3∕12+O(n2) and so, trivially, ARX+Y=Z+Tk(n)≤n3∕12+O(n2). We improve this upper bound to ARX+Y=Z+Tk(n)≤112−124kn3+Ok(n2)for all n≥k≥4. Furthermore, we give an explicit k-coloring of n with more rainbow solutions to the Sidon equation than a random k-coloring, and gives a lower bound of 112−13kn3−Ok(n2)≤ARX+Y=Z+Tk(n).When k=4, we use a different approach based on additive energy to obtain an upper bound of 3n3∕96+O(n2), whereas our lower bound is 2n3∕96−O(n2) in this case.
Exposure to radon gas is a leading cause of lung cancer. Testing homes for the gas is straightforward, yet most people do not undertake tests even when offered freely. We report a pre-registered ...randomised controlled trial of communications to encourage test uptake. Households (N = 3500) in areas at high risk of radon exposure were randomly assigned to receive (i) a the control letter from the national Environmental Protection Agency; (ii) a behaviourally-informed version of the control letter that incorporated multiple nudges, including reciprocity messages and numeric frequencies of risk; (iii) this same behaviourally-informed letter in a re-designed envelope; (iv) the behaviourally-informed letter in the re-designed enveloped with a radon risk map of the household's county. The behaviourally-informed letter led to a large increase in test uptake, from 22% in the control condition to 33% (a 50% increase). There was no additional benefit of the re-designed envelope, which generated uptake of 30%. Including the map led some households to respond faster, but the overall uptake (26%) was weaker. The results have implications for public health communications with households and show the potential for techniques from behavioural science to help mitigate environmental risks.
Polyurethane (PUF) foam market has grown rapidly in recent years due to its wide variety of applications. Their environmental impact is a matter of significant concern as so far, the production of ...PUF is essentially dependent on fossil raw materials, namely isocyanates and polyols. With the purpose of reducing climate change and decoupling economic growth from resource use, the use of renewable polyols is already a reality in the PUF industry, namely vegetable oils, recycled polyols, and CO2-based polyols. However, this only contributes in part to the total polyol used in some formulations in various industrial-scale applications. Even though there are other potential renewable polyol counterparts (e.g. lignin, as well as alternative synthetic routes to produce PUF including variations of the so-called via Non-Isocyanate Polyurethane (NIPU)), there are still several limitations compared to the conventional manufacturing processes involving petroleum-derived raw materials, which hampers the availability of these alternatives. The possible benefits of these potentially greener alternatives need to be quantified and compared with the environmental performance of well-established conventional processes.
This review work encompasses the results from a systematic literature analysis regarding Life Cycle Assessment (LCA) studies on PUF produced using a variety of raw materials, classified as four different feedstocks in this work. This timely work identifies the main trends in methodological choices, including functional unit, system boundaries, multifunctionality, impact assessment methods, and sensitivity analysis, and enables the understanding of their effect on the environmental sustainability of PUF, namely in the most evaluated impact category-the climate change (CC). A wide range of CC variation was observed, ranging from 2.95 kgCO2eq/FU for a fossil-based to 7.67 kgCO2eq/FU for a recovered fossil polyol. The main issues for this high variability are addressed, highlighting the need for further harmonization and consistency in data collection and methodological choices used in LCA studies.
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•Bio-based polyols are the most studied type of feedstock for polyurethane foams (PUF).•Isocyanates are the main hotspot for climate change of polyurethane foams.•Harmonization of the functional unit is critical for comparing impact assessment results.•More consistent data and consensus are necessary for the harmonization of all impact categories in the literature.
BACKGROUND/OBJECTIVE
Barriers and facilitators of exercise maintenance and residual effects of exercise training intervention on physical and cognitive function after the cessation of training are ...inadequately described in older adults.
DESIGN AND SETTING
One year after the cessation of a supervised exercise training intervention, a mixed methods approach employed a quantitative phase that assessed body composition and physical and cognitive function and a qualitative phase that explored determinants of exercise maintenance after participation in the intervention.
PARTICIPANTS
Community‐dwelling older Irish adults (aged >65 years) who had completed 12 weeks of supervised exercise training 1 year previously.
MEASUREMENTS
Fifty‐three participants (male/female ratio = 30:23; age = 70.8 ± 3.9 years) completed the follow‐up testing comprising body composition and physical and cognitive function. Semistructured interviews were conducted with 12 participants (male/female ratio = 6:6) using the Theoretical Domains Framework to inform the interview guide.
RESULTS
At 1 year follow‐up, body fat increased (mean = 4.3%; 95% confidence limit = 2.2% to 6.3%), while lean body mass (mean = −0.6%; 95% confidence limit = −1.2% to −0.1%), strength (leg press, mean = −5.6%; 95% confidence limit = −8.3% to −2.8%; chest press, mean = −11.0%; 95% confidence limit = −14.8% to −7.8%), and cognitive function (mean = −3.7%; 95% confidence limit = −5.7% to −1.8%) declined (all P < .05). Interviews revealed key facilitators (social aspects and beliefs about benefits of exercise) and barriers (affordability and general aversion to gyms) to exercise maintenance in this population.
CONCLUSION
Key barriers and facilitators to exercise maintenance were identified, which will inform the development of future behavior change interventions to support exercise participation and maintenance in older adults to mitigate adverse changes in body composition and physical and cognitive function with advancing age. J Am Geriatr Soc 68:163–169, 2019
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