The implications of the variables within the pre-analytical phase of blood culture processing are poorly understood. This study aims to explore the effect of transit times (TT) and culture volume, ...on time to microbiological diagnosis and patient outcomes. Blood cultures received between 1st March and 31st July 2020/21 were identified. TT, time in incubator (TII), and for positive samples, request to positivity times (RPT) were calculated. Demographic details were recorded for all samples, and culture volume, length of stay (LoS), and 30-day mortality for patients with positive samples. Statistical analysis examined how culture volume and TT effected culture positivity and outcome; in the context of the 4-h national TT target. Totally, 14,375 blood culture bottles were received from 7367 patients; 988 (13.4%) were positive for organisms. There was no significant difference between TT of negative and positive samples. The RPT was significantly lower for samples with TT < 4 h (
p
< 0.001). Culture bottle volume did not affect RPT (
p
= 0.482) or TII (
p
= 0.367). A prolonged TT was associated with a longer length-of-stay in those with a bacteraemia with a significant organism (
p
= 0.001). We found shorter blood culture transportation time was associated with a significantly faster time of positive culture reporting, while optimal blood culture volume did not make a significant impact. Delays in reporting for significant organisms correspond to a prolonged LoS. Laboratory centralisation makes achieving the 4-h target a logistical challenge; however, this data suggests such targets have significant microbiological and clinical impacts.
Australia has had a strong GDP growth rate, is endowed with a diversity of renewable energy resources yet has been unable to unshackle its dependency on fossil fuels. Our study identifies causes ...underlying Australia’s underachievement in its transformation towards a renewable-energy economy. We apply a combined mixed-methods case-study and multi-criteria analysis to evaluate the greenhouse gas emissions and energy targets, policies and programs of four Australian Prime Ministers between 1996 and 2015. We identify four high-impact factors that contribute to Australia’s underachievement. The Prime Minister’s political stance on climate and energy is critical in setting the direction of government. The absence of target-driven policy frameworks results in less-effective policy outcomes. Orderly and cost-effective energy system transformation requires bipartisan, strategic long-term planning and substantial capital investment to provide policy certainty and stability that can induce new investment in renewable technologies and industries. Energy policy is primarily a political and ideological issue not one driven by underlying economic conditions. Going forward, Australia must achieve a bipartisan position on climate and energy policy at both federal and state levels. This will provide long-term certainty and stability to support investment in renewable energy and so doing achieve international emission reduction obligations.
•Prime Minister’s personal climate ideology drives energy politics and policy.•Impactful renewable energy (RE) policy needs time and bipartisan support.•Renewable energy targets drive effective change and investment.•Australia remains beholden to fossil fuel industry limiting RE transformation.•Underlying economic conditions do not determine the a successful RE transition.
This paper assesses the energy transition in Germany from 1990 to 2017 with a focus on the politics and energy policies of the three German Chancellors. Its aim is to investigate the factors ...underlying the outcomes from a socio-political perspective and through this offer insight as to energy policy reforms that may be transferrable to other governments. We reveal the incremental and politically pivotal role of grassroots movements against nuclear power forming the catalyst and ongoing driver for Germany's energy transition - the Energiewende. Energiewende harbors a compelling socio-technical experiment based on government-led policy-driven structural changes to the energy system that has concurrently supported a heavily industrialized economy. Despite higher energy costs, borne disproportionally by residents, the energy vision and social experiment shared decadal and multi government cross-partisan political and community support. This socio-political policy stability provides a notable point of difference when comparing the energy transitions of lagging nations such as Australia that reveals the criticality of policy certainty to support investment towards new models of clean energy generation and distribution.
•Cross partisan policy consistency remains a key to Germany's energy transition.•Political leaders and champions for renewable energy support market stability.•Sustained social movements for renewables and against nuclear enable politics reform.•Enabling decentralised energy policies can dismantle traditional path dependencies.
Global biodiversity hotspots contain exceptional concentrations of endemic species in areas of escalating habitat loss. However, most hotspots are geographically constrained and consequently ...vulnerable to climate change as there is limited ability for the movement of species to less hostile conditions. Predicted changes to rainfall and temperature will undoubtedly further impact on freshwater ecosystems in these hotspots. Southwestern Australia is a biodiversity hotspot and, as one of the first to experience significant climate change, is an example and potentially a global bellwether for issues associated with river restoration. In this hotspot, current and predicted water temperatures may exceed thermal tolerances of aquatic fauna. Gondwanic aquatic fauna, characteristic of southwestern Australia, are typically cold stenotherms and consequently intolerant of elevated temperatures. The hotspot in southwestern Australia is geographically restricted being surrounded by ocean and desert, and many important national parks are located on the extreme south coast, where the landscape is relatively flat. Consequently, fauna cannot change their distribution southwards or with altitude as a response to increasing temperatures. Therefore, any mitigation responses need to be in situ to produce a suitable biophysical envelope to enhance species' resilience. This could be through "over restoration" by increased riparian replanting at a catchment scale. A rule-of-thumb of a 10% increase in riparian cover would be required to reduce water temperatures by 1°C. These restoration techniques are considered applicable to other global biodiversity hotspots where geography constrains species' movement and the present condition is the desired restoration endpoint.
To gather data and investigate if ownership and duration of using electronic devices determines the weight status in an urban Saudi school-aged child. Methods: A multicenter, cross-sectional study ...conducted in Riyadh, Saudi Arabia between December 2015 and March 2016. A total of 1023 child were randomly selected, aged 9.00 to 11.99 years. The participants were divided into 2 groups (normal weight and obese), and further stratified by gender. A self-paced questionnaire was used to collect sedentary behaviors data, in addition to the anthropometric measurements and body fat composition of the participants.
Hours spent watching TV/DVD/videos were not significantly different between the participating groups or both genders, be it during weekdays (p=0.75) or on weekends (p=0.93). Electronic device utilization hours were significantly different between the groups, specifically in boys. Obese children, particularly during weekdays, had higher utilization rates of tablets and mobile phones at p less than 0.01 in weekdays and weekends. The most popular electronic device owned was a tablet (67.1% among normal weight and 70.2% obese groups). This was followed by gaming consoles owned, predominantly by boys rather than girls. Ownership of a smartphone was significantly higher in the obese group p=0.01), especially in boys (p=0.01).
Using modern electronic screen devices has begun to replace TV viewing. Excessive use of internet, and watching electronic screen devices, especially mobiles and tablets, have been associated with the increasing risk of obesity in urban Saudi school-aged child.
Blood vessels are exposed to multiple mechanical forces that are exerted on the vessel wall (radial, circumferential and longitudinal forces) or on the endothelial surface (shear stress). The ...stresses and strains experienced by arteries influence the initiation of atherosclerotic lesions, which develop at regions of arteries that are exposed to complex blood flow. In addition, plaque progression and eventually plaque rupture is influenced by a complex interaction between biological and mechanical factors-mechanical forces regulate the cellular and molecular composition of plaques and, conversely, the composition of plaques determines their ability to withstand mechanical load. A deeper understanding of these interactions is essential for designing new therapeutic strategies to prevent lesion development and promote plaque stabilization. Moreover, integrating clinical imaging techniques with finite element modelling techniques allows for detailed examination of local morphological and biomechanical characteristics of atherosclerotic lesions that may be of help in prediction of future events. In this ESC Position Paper on biomechanical factors in atherosclerosis, we summarize the current 'state of the art' on the interface between mechanical forces and atherosclerotic plaque biology and identify potential clinical applications and key questions for future research.
Scope. Milk provides a natural means of nutrient supply to infants. Exosomes are an important component of milk that are not only being studied for their promise in translational medicine but also in ...infant nutrition. They also play important roles in intercellular communication and immune function in mammary glands and are able to transfer their materials to the recipient. Therefore, the isolation of high-quality exosomes is an important aspect of exosome research. Methods and Results. This study is a technical study, which provides a detailed methodology for the isolation and enrichment of exosomes from milk. In this study, we evaluate the suitability of using the exosome enrichment method that we have recently published for bovine milk, on human milk. We initially isolated extracellular vesicles from human and bovine milk on a fresh set of samples, using ultracentrifugation, and then exosomes were subsequently enriched via size exclusion chromatography (SEC). Following isolation and enrichment, exosomes from both species were characterized by particle concentration (nanoparticle tracking analysis, NTA), morphology (transmission electron microscopy, TEM), and the presence of exosomal markers (immunoblotting and mass spectrometry using information dependant acquisition (IDA)). The key exosomal characteristics of spherical/donut-shaped morphology, the presence of exosomal markers, e.g., FLOT-1 and the tetraspanins, CD9 and CD81), and particle concentration were confirmed in both human and bovine milk exosomes. Conclusion. We conclude that our robust exosome enrichment method, previously published for bovine milk, is suitable for use on human milk.
Much uncertainty remains about the origin and public health implications of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA). This study aimed to investigate the occurrence ...and prevalence of MRSA in general and LA-MRSA in particular in pigs and farm workers in five states. We collected nasal swabs from pigs and farm workers at 45 swine herds (21 antibiotic-free herds; 24 conventional herds) in Illinois, Iowa, Minnesota, North Carolina and Ohio. MRSA was isolated from 50 of 1085 pigs (4.6%) and 31 of 148 (20.9%) of farm workers. MRSA-positive pigs and people were clustered in four conventional swine farms in Iowa and Illinois. Based on genotyping, spa type t034, a common livestock associated variant, was predominant among both human and swine isolates. These results confirm the presence of LA-MRSA in pigs and swine farm workers in the USA, but the prevalence found is relatively low compared with European studies.
Adolescent obesity is difficult to treat and the optimal dietary pattern, particularly in relation to macronutrient composition, remains controversial. This study tested the effect of two structured ...diets with differing macronutrient composition versus control, on weight, body composition and metabolic parameters in obese adolescents.
A randomized controlled trial conducted in a children's hospital.
Eighty seven obese youth (means: age 13.6 years, BMI z-score 2.2, waist: height ratio 0.65, 69% female) completed a psychological preparedness program and were then randomized to a short term 'structured modified carbohydrate' (SMC, 35% carbohydrate; 30% protein; 35% fat, n = 37) or a 'structured low fat' (SLF, 55% carbohydrate; 20% protein; 25% fat, n = 36) or a wait listed control group (n = 14). Anthropometric, body composition and biochemical parameters were measured at randomization and after 12 weeks, and analyzed under the intention to treat principle using analysis of variance models.
After 12 weeks, data was collected from 79 (91%) participants. BMI z-scores were significantly lower in both intervention groups compared to control after adjusting for baseline values, SLF vs. control, mean difference = -0.13 (95%CI = -0.18, -0.07), P<0.001; SMC vs. control, -0.14 (-0.19, -0.09), P<0.001, but there was no difference between the two intervention diet groups: SLF vs. SMC, 0.00 (-0.05, 0.04), P = 0.83.
Both dietary patterns resulted in similar changes in weight, body composition and metabolic improvements compared to control. The use of a structured eating system which allows flexibility but limited choices can assist in weight change and the rigid application of a low fat eating pattern is not exclusive in its efficacy.
International Clinical Trials Registry ISRCTN49438757.
Introduction
Obesity is a global problem that is challenging to prevent and expensive to treat. Early childhood interventions show promise in establishing lifelong healthy eating patterns, however a ...better understanding of how parental feeding practices develop is needed. The study aimed to investigate maternal perception of infant weight and its relationship to feeding practices and infant dietary intake.
Methods
A questionnaire was completed by 263 Queensland mothers of infants aged between 5 and 13 months. Logistic regression was used to describe the association between maternal feeding practices (restriction, pressure-to-eat, monitoring), parenting style (warmth, hostility), infant weight concern and infant dietary intake. Correlation and linear regression were used to identify relationships between maternal feeding practices, parenting style, infant weight concern and infant weight.
Results
Mothers were found to be more concerned about underweight than overweight, misjudge infants as being underweight and failed to recognise overweight infants. Underweight concern was associated with infant weight (
r
= −0.27, p < 0.01), early introduction of solids (OR 0.24, CI 0.11–0.51) and pressure-to-eat (
r
= 0.19, p < 0.01). Pressure-to-eat was associated to maternal perception of infant weight (
r
= − 0.21, p < 0.01), infant weight (
r
= − 0.17, p < 0.05) and lower fruit and vegetable intake (OR 0.50, CI 0.27–0.92). Restrictive feeding practices were correlated to overweight concern (
r
= 0.08, p < 0.05).
Discussion
Maternal infant weight perception and concerns are related to control feeding practices which can be detrimental to infant dietary intake. Inability to recognise healthy weight may ignite these concerns or fail to address infant feeding risk factors. Discussing healthy growth should be a fundamental component of strategies to support healthy infant feeding and eating.
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