Whether preemptive analgesic interventions are more effective than conventional regimens in managing acute postoperative pain remains controversial. We systematically searched for randomized ...controlled trials that specifically compared preoperative analgesic interventions with similar postoperative analgesic interventions via the same route. The retrieved reports were stratified according to five types of analgesic interventions: epidural analgesia, local anesthetic wound infiltration, systemic N-methyl-d-aspartic acid (NMDA) receptor antagonists, systemic nonsteroidal antiinflammatory drugs (NSAIDs), and systemic opioids. The primary outcome measures analyzed were the pain intensity scores, supplemental analgesic consumption, and time to first analgesic consumption. Sixty-six studies with data from 3261 patients were analyzed. Data were combined by using a fixed-effect model, and the effect size index (ES) used was the standardized mean difference. When the data from all three outcome measures were combined, the ES was most pronounced for preemptive administration of epidural analgesia (ES, 0.38; 95% confidence interval CI, 0.28-0.47), local anesthetic wound infiltration (ES, 0.29; 95% CI, 0.17-0.40), and NSAID administration (ES, 0.39; 95% CI, 0.27-0.48). Whereas preemptive epidural analgesia resulted in consistent improvements in all three outcome variables, preemptive local anesthetic wound infiltration and NSAID administration improved analgesic consumption and time to first rescue analgesic request, but not postoperative pain scores. The least proof of efficacy was found in the case of systemic NMDA antagonist (ES, 0.09; 95% CI, -0.03 to 0.22) and opioid (ES, -0.10; 95% CI, -0.26 to 0.07) administration, and the results remain equivocal.
Plasticity in developmental programming has evolved to provide the best chances of survival and reproductive success to the organism under changing environments. The window of developmental ...plasticity extends from preconception to early childhood, and involves epigenetic responses to environmental changes, which exert their effects during life history phase-transitions. This review provides a comprehensive presentation of translational epigenetics as it pertains to child health, growth, and maturation. Identifying the epigenetic consequences of fetal programming creates potential applications in clinical practice: the development of epigenetic biomarkers for early diagnosis of disease, the ability to identify susceptible individuals at risk for adult diseases, and the development of novel preventive and curative measures that are based on diet and/or novel epigenetic drugs.
Plasticity in developmental programming has evolved in order to provide the best chances of survival and reproductive success to the organism under changing environments. Environmental conditions that are experienced in early life can profoundly influence human biology and long-term health. Developmental origins of health and disease and life-history transitions are purported to use placental, nutritional, and endocrine cues for setting long-term biological, mental, and behavioral strategies in response to local ecological and/or social conditions. The window of developmental plasticity extends from preconception to early childhood and involves epigenetic responses to environmental changes, which exert their effects during life-history phase transitions. These epigenetic responses influence development, cell- and tissue-specific gene expression, and sexual dimorphism, and, in exceptional cases, could be transmitted transgenerationally. Translational epigenetic research in child health is a reiterative process that ranges from research in the basic sciences, preclinical research, and pediatric clinical research. Identifying the epigenetic consequences of fetal programming creates potential applications in clinical practice: the development of epigenetic biomarkers for early diagnosis of disease, the ability to identify susceptible individuals at risk for adult diseases, and the development of novel preventive and curative measures that are based on diet and/or novel epigenetic drugs.
Abstract
Asteroseismology is an exceptional tool for studying stars using the properties of observed modes of oscillation. So far the process of performing an asteroseismic analysis of a star has ...remained somewhat esoteric and inaccessible to nonexperts. In this software paper we describe
PBjam
, an open-source Python package for analyzing the frequency spectra of solar-like oscillators in a simple but principled and automated way. The aim of
PBjam
is to provide a set of easy-to-use tools to extract information about the radial and quadropole oscillations in stars that oscillate like the Sun, which may then be used to infer bulk properties such as stellar mass, radius, age, or even structure. Asteroseismology and its data analysis methods are becoming increasingly important as space-based photometric observatories are producing a wealth of new data, allowing asteroseismology to be applied in a wide range of contexts such as exoplanet, stellar structure and evolution, and Galactic population studies.
Cosmic-ray electrons and positrons (CREs) at GeV-TeV energies are a unique probe of our local Galactic neighborhood. CREs lose energy rapidly via synchrotron radiation and inverse-Compton scattering ...processes while propagating within the Galaxy, and these losses limit their propagation distance. For electrons with TeV energies, the limit is on the order of a kiloparsec. Within that distance, there are only a few known astrophysical objects capable of accelerating electrons to such high energies. It is also possible that the CREs are the products of the annihilation or decay of heavy dark matter (DM) particles. VERITAS, an array of imaging air Cherenkov telescopes in southern Arizona, is primarily utilized for gamma-ray astronomy but also simultaneously collects CREs during all observations. We describe our methods of identifying CREs in VERITAS data and present an energy spectrum, extending from 300 GeV to 5 TeV, obtained from approximately 300 hours of observations. A single power-law fit is ruled out in VERITAS data. We find that the spectrum of CREs is consistent with a broken power law, with a break energy at 710±40stat±140syst GeV.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including both traditional nonselective NSAIDs and the selective cyclooxygenase (COX)-2 inhibitors, are widely used for their anti-inflammatory and ...analgesic effects. NSAIDs are a necessary choice in pain management because of the integrated role of the COX pathway in the generation of inflammation and in the biochemical recognition of pain. This group of drugs has recently come under scrutiny because of recent focus in the literature on the various adverse effects that can occur when applying NSAIDs. This review will provide an educational update on the current evidence of the efficacy and adverse effects of NSAIDs. It aims to answer the following questions: (1) are there clinically important differences in the efficacy and safety between the different NSAIDs, (2) if there are differences, which are the ones that are more effective and associated with fewer adverse effects, and (3) which are the effective therapeutic approaches that could reduce the adverse effects of NSAIDs. Finally, an algorithm is proposed which delineates a general decision-making tree to select the most appropriate analgesic for an individual patient based on the evidence reviewed.
Research on the oxide perovskites has uncovered electronic properties that are strikingly enhanced compared with those in conventional metals. Examples are the high critical temperatures of the ...cuprate superconductors and the colossal magnetoresistance in the manganites. The conducting layered cobaltate Na(x)CoO2 exhibits several interesting electronic phases as the Na content x is varied, including water-induced superconductivity and an insulating state that is destroyed by field. Initial measurements showed that, in the as-grown composition, Na(x)CoO2 has moderately large thermopower S and conductivity sigma. However, the prospects for thermoelectric cooling applications faded when the figure of merit Z was found to be small at this composition (0.6<x<0.7). Here we report that, in the poorly explored high-doping region x>0.75, S undergoes an even steeper enhancement. At the critical doping x(p) approximately 0.85, Z (at 80 K) reaches values approximately 40 times larger than in the as-grown crystals. We discuss prospects for low-temperature thermoelectric applications.
Diets rich in whole grain are associated with several health benefits. Little is known however, about whole grain consumption patterns in Malaysia. The aim of this study was to assess whole grain ...intakes and dietary source in Malaysian children and adolescents.
This analysis is from the MyBreakfast study, a national cross sectional study investigating eating habits among primary and secondary school children throughout Malaysia, conducted in 2013. Children (n = 5,165) and adolescents (n = 2,947) who completed two days of dietary assessment using a food record or recall respectively were included. The whole grain content of foods was estimated mainly through the use of quantitative ingredient declarations on food labels. All wholegrain foods were considered irrespective of the amount of whole grain they contained.
Overall, only 25% of children and 19% of adolescents were wholegrain consumers. Mean daily intakes in the total sample were 2.3g/d (SD 5.8 g/d) in children and 1.7 g/d (SD 4.7 g/d) in adolescents and in the consumer's only sample, mean intakes reached 9.1g/d (SD 8.6) and 9.2g/d (SD 7.1g/d) respectively. Wheat was the main grain source of whole grain while ready to eat breakfast cereals and hot cereals were the main food contributors. Less than 3% of the children and adolescents reached the US quantitative whole grain recommendation of 48 g/day.
Whole grain is consumed by only a minority of Malaysian children and adolescents and even among consumers, intakes are well below recommendations. Efforts are needed to firstly understand the barriers to whole grain consumption among Malaysian children in order to design effective health promotion initiatives to promote an increase in whole grain consumption.
We present a detailed analysis of week-long simultaneous observations of the blazar Mrk 421 at 2-60 keV X-rays (RXTE) and TeV -rays (Whipple and HEGRA) in 2001. Accompanying optical monitoring was ...performed with the Mt. Hopkins 48 inch telescope. The unprecedented quality of this data set enables us to establish the existence of the correlation between the TeV and X-ray luminosities, and also to start unveiling some of its characteristics, in particular its energy dependence and time variability. The source shows strong variations in both X-ray and -ray bands, which are highly correlated. No evidence of an X-ray/-ray interband lag tau is found on the full week data set, with tau image 3 ks. A detailed analysis of the March 19 flare, however, reveals that data are not consistent with the peak of the outburst in the 2-4 keV X-ray and TeV band being simultaneous. We estimate a image ks TeV lag. The amplitudes of the X-ray and -ray variations are also highly correlated, and the TeV luminosity increases more than linearly with respect to the X-ray one. The high degree of correlation lends further support to the standard model in which a unique electron population produces the X-rays by synchrotron radiation and the -ray component by inverse Compton scattering. However, the finding that for the individual best observed flares the -ray flux scales approximately quadratically with respect to the X-ray flux poses a serious challenge to emission models for TeV blazars, as it requires rather special conditions and/or fine tuning of the temporal evolution of the physical parameters of the emission region. We briefly discuss the astrophysical consequences of these new findings in the context of the competing models for the jet emission in blazars.
Type 2 diabetes risk is associated with low birth weight, rapid weight gain during childhood, and shorter stature and lower circulating IGF-I levels in adults. The largest variations in growth rates ...occur during the first postnatal years. We hypothesised that early postnatal variations in height and weight gain and IGF-I levels may be associated with risk markers for adult disease.
We measured the fasting insulin sensitivity (Homeostasis model) and insulin secretion post-oral glucose (insulinogenic index 0-30 min) in 851 normal 8-year-old children from a prospective birth cohort. We examined associations between size at birth, postnatal weight gain and circulating IGF-I levels with insulin sensitivity and secretion at 8 years of age.
Fasting insulin sensitivity at 8 years was closely related to current BMI (r= -0.33, p<0.0005). Lower insulin sensitivity and higher BMI and waist circumference were all predicted by greater weight gain between birth to 3 years of age (all p<0.0005); lower birth weight was associated with reduced insulin sensitivity only in the highest current BMI tertile ( r=0.17, p=0.006). In contrast, lower insulin secretion was related to smaller size at birth ( p=0.01), independent of postnatal weight gain and insulin sensitivity. Lower insulin secretion was also independently related to shorter stature at 8 years of age relative to parental height ( p=0.047) and with lower plasma IGF-I levels at 5 years of age ( n=252, p=0.004).
Associations between lower birth weight and insulin resistance may be dependent on rapid weight gain during the early postnatal years. However, irrespective of postnatal weight gain, smaller size at birth, lower IGF-I levels and lower childhood height predicted reduced compensatory insulin secretion.
PDF
