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The high-value, midwifery-led birth centre (BC) model of care is underutilized in the United States, a country with high rates of obstetric intervention and maternal morbidity and mortality. Birth setting decision-making is a complex, preference-sensitive, and resource-dependent process. Understanding how people choose BCs for care may help increase the utilization of BCs and generate positive perinatal outcomes. This study explores the decision-making experiences of people with Medicaid insurance who chose to give birth in a BC in Massachusetts by gathering interview data to interpret and provide meaning about their selection of birth setting. We employed a hermeneutic phenomenology study to interview people about their decision to give birth in a BC. Interview data were coded using a hybrid deductive-inductive approach and analyzed using reflexive thematic analysis to interpret and provide meaning. Twelve women participated in the study. Five themes emerged that described participants' decision-making processes: 1) Stepping Away from "the System," 2) Decision-Making with External Influences, 3) Accessing BC Care, 4) Finding a Home at the BC, and 5) Decision-Making as a Temporal Process. The decision to choose a BC was a dynamic process that occurred over time and was influenced by factors such as the quality of care, accessibility, external influences, and the physical environment. Prioritizing an individual's capacity to choose their birth setting and fostering awareness about options in the context of informed decision-making are pivotal steps toward attaining equity in perinatal health. Securing public insurance coverage and equitable reimbursement for BCs represent essential policies aimed at facilitating universal access to the BC model for all people. [ABSTRACT FROM AUTHOR]

Vitamin A is necessary for an adequate immune response to infections. Infection also alters vitamin A biomarkers, which interferes with assessment of vitamin A deficiency and thus impairs clinical management. Here we apply multiple strategies to adjust vitamin A biomarkers for inflammation during acute infection and evaluate associations between adjusted vitamin A status and immunologic response markers. We measured biomarkers in pediatric patients presenting with acute febrile illness in Guayaquil, Ecuador at paired acute and convalescent visits. Four adjustment strategies were applied to retinol-binding protein (RBP) concentrations: Thurnham correction factor (TCF), BRINDA regression correction (BRC), CRP-only adjustment factor (CRP), and proof-of-concept for a proposed interleukin 6 regression model (IL-6 RM). Adjusted RBP concentrations were compared between visits using the paired Wilcoxon signed-rank test. Multivariate regression analysis was used to assess associations between adjusted vitamin A status and immunologic response markers. A sample of 57 participants completed the acute visit 1, and 18 of these individuals completed the convalescent visit 2. The IL-6 RM was the only strategy resulting in adjusted RBP concentrations that were not significantly different between paired visits (p = 0.20). Following RBP adjustment, 0.0% of participants were classified as vitamin A deficient (RBP ≤ 0.70 μmol/L) and 14.0% were classified as vitamin A insufficient (RBP ≤ 1.05 μmol/L). Adjusted vitamin A insufficiency was associated with an increase in macrophage inflammatory protein 1-alpha (MIP-1α, p = 0.03) and a pro-inflammatory immune response profile (p = 0.03) during the acute visit. We introduce a strategy for adjusting vitamin A in the context of clinical illness based on IL-6 concentrations that will need to be validated in larger studies. Assessment of vitamin A during infection allows for further understanding of how vitamin A status modulates immunopathology and enables targeted strategies for vitamin A supplementation in the context of infection among children in settings with high burdens of undernutrition and infectious diseases. [ABSTRACT FROM AUTHOR]

Bovine pericardium (BP) is an extensively used biomaterial utilised in a wide range of biomedical devices such as bioprosthetic heart valves. However, the mechanical testing techniques that assess soft biomaterial tissue like BP are varied with no common method utilised across the literature, producing variations and contradictions in reported values. Uniaxial testing is a common technique used to measure traditional mechanical characteristics of ultimate tensile strength (UTS), modulus and the percentage strain at failure. The aim of this study was to take two standard uniaxial test parameters, strain rate and the number of preconditioning cycles and to elucidate recommendations for the standardisation of a uniaxial method, while also measuring not so common parameters of low modulus and hysteresis. Samples post uniaxial testing were treated and analysed with scanning electron microscopy (SEM) and an imaging software (ImageJ) to measure the effect of the parameters on the crimping structure and orientation of the collagen fibres. The study recommends an extension rate of 10 mm/min and 5 preconditioning load-unload cycles as a starting point for the standardisation of a uniaxial testing method. The image analysis of the collagen structure carried out provides a quantitative assessment of the BP post mechanical testing and allows for a better understanding of the behaviour of BP under stress. [ABSTRACT FROM AUTHOR]

Pyrimidine compounds comprise a class of acetohydroxyacid synthase (AHAS) inhibitors, thus possessing herbicidal activity. Due to the ongoing development of resistance by weeds to current herbicides, the design of new agrochemical candidates is often required. This work reports the proposition of unprecedented pyrimidines as herbicides guided by quantitative structure-activity relationship (QSAR) modeling. Multivariate image analysis (MIA) descriptors for 66 pyrimidine derivatives obtained from different sources were regressed against inhibitory activity data, and the resulting QSAR models were found to be reliable and predictive (r2 = 0.88 ± 0.07, q2 = 0.53 ± 0.06, and r2 pred = 0.51 ± 0.10 in a bootstrapping experiment using electronegativity-based descriptors). The chemical features responsible for the herbicidal activities were analyzed through MIA contour maps that describe the substituent effects on the response variables, whereas the interaction between the proposed compounds and AHAS was analyzed through docking studies. From the proposed compounds, at least five pyrimidine derivatives exhibited promising performance as AHAS inhibitors compared to the known analogs. [Display omitted] • MIA-QSAR was applied to model the herbicidal activities of 80 pyrimidine derivatives. • The MIA-QSAR models were reliable and presented satisfactory prediction capability. • New pyrimidine analogs guided by MIA-QSAR and docking studies were proposed. • MIA contour maps indicated the substituents most affecting the herbicidal activity. [ABSTRACT FROM AUTHOR]

Background: To demonstrate the technical feasibility of interfacing transcranial Doppler (TCD) and carotid "duplex" ultrasonography (CUS) peripherals with telemedicine end points to provide real-time spectral waveform and duplex imaging data for remote review and interpretation. Methods: We performed remote TCD and CUS examinations on a healthy, volunteer employee from our institution without known cerebrovascular disease. The telemedicine end point was stationed in our institution's hospital where the neurosonology examinations took place and the control station was in a dedicated telemedicine room in a separate building. The examinations were performed by a postgraduate level neurohospitalist trainee (M.N.R.) and interpreted by an attending vascular neurologist, both with experience in the performance and interpretation of TCD and CUS. Residts: Spectral waveform and duplex ultrasound data were successfully transmitted from TCD and CUS instruments through a telemedicine end point to a remote reviewer at a control station. Image quality was preserved in all cases, and technical failures were not encountered. Conclusions: This proof-of-concept study demonstrates the technical feasibility of interfacing TCD and CUS peripherals with a telemedicine end point to provide real-time spectral waveform and duplex imaging data for remote review and interpretation. Medical diagnostic and telemedicine devices should be equipped with interfaces that allow simple transmission of high-quality audio and video information from the medical devices to the telemedicine technology. Further study is encouraged to determine the clinical impact of teleneurosonology. [ABSTRACT FROM AUTHOR]

Abstract: Objective: to test the predictive value of women''s self-identified criteria in place of birth decisions in the event of uncomplicated childbirth in a setting where facility based skilled birth attendants are available. Design: a retrospective, cross-sectional study was conducted in two phases. The first phase used data from in-depth interviews. The second phase used data from semi-structured questionnaires. Setting: the service area of Matlab, Bangladesh. Participants: women 18–49 years who had an uncomplicated pregnancy and delivery resulting in a live birth. Findings: a women''s intention about where to deliver during pregnancy, her perception of labour progress, the availability of transportation at the time of labour, and the close proximity of a dai to the household were independent predictors of facility-based SBA use. Marital age was also significant predictor of use. Key conclusions: the availability of delivery services does not guarantee use and instead specific considerations and conditions during pregnancy and in and around the time of birth influence the preventive health seeking behaviour of women during childbirth. Our findings have implications for birth preparedness and complication readiness initiatives that aim to strengthen timely use of SBAs for all births. Demand side strategies to reduce barriers to health seeking, as part of an overall health system strengthening approach, are needed to meet the Millennium Development 5 goal. [Copyright &y& Elsevier]

We integrated complementary and alternative medicine (CAM)-related content into selected core courses in our master's-level curriculum. To facilitate students' application of the content, we developed evidence-based online case studies and evaluated their effectiveness by comparing students' pretest and posttest scores on multiple-choice quizzes. Findings suggest that evidence- based online case studies are an effective strategy for teaching graduate nursing students about the clinical issues surrounding patients' use of CAM therapies. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines the association of women’s social networks with the use of skilled birth attendants in uncomplicated pregnancy and childbirth in Matlab, Bangladesh. The Network-Episode Model was applied to determine if network structure variables (density/kinship homogeneity/strength of ties) together with network content (endorsement for or against a particular type of birth attendant) explain the type of birth attendant used by women above and beyond the variance explained by women’s individual attributes. Data were collected by interviewing a representative sample of 246 women, 18–45 years of age, using survey and social network methods between October and December 2008. Logistic regression models were used to examine the associations. Results suggest that the structural properties of networks did not add to explanatory value but instead network content or the perceived advice of network members add significantly to the explanation of variation in service use. Testing aggregate network variables at the individual level extends the ability of the individual profile matrix to explain outcomes. Community health education and mobilization interventions attempting to increase demand for skilled attendants need to reflect the centrality of kinship networks to women in Bangladesh and the likelihood of women to heed the advice of their network of advisors with regard to place of birth. [ABSTRACT FROM AUTHOR]

Abstract: The popularity and prevalence of herbal products and dietary supplements in the US has grown steadily. Patients are increasingly using them to prevent disease, complement conventional therapies, and promote well being and health. Nurse practitioners play a critical role in discussion, communication, and education of herbal supplement use. This article provides a review of commonly used herbal supplements regarding recent evidence for efficacy, possible drug interactions, and safety considerations. [Copyright &y& Elsevier]

Background: HIV infection is associated with dyslipidemia and increased risk for cardiovascular events. Few studies have described lipid status in medically underserved, HIV-infected ethnic minorities, a group that is characterized by health disparities. Objective: We sought to characterize the lipid profile of a medically underserved, largely ethnic minority sample of HIV-infected persons by using standard lipid panels and nuclear magnetic resonance (NMR)-derived lipoprotein particle profiles. Methods: Participants were recruited from a randomized controlled trial of a dietary supplement to manage HIV-related dyslipidemia (N=132). At the initial screening visit, sociodemographic, clinical, and behavioral data were collected, and fasting peripheral venous blood specimens were obtained and lipid status was analyzed by the use of the standard lipid panel and the NMR-derived lipoprotein particle profile. Results: By using NMR-derived LDL particle cutoffs, we found that a greater percentage of participants was outside the target range (50%) than when standard LDL cholesterol NCEP cutoffs were used (24%). Antiretroviral therapy, especially protease inhibitor-containing regimens, was associated with greater LDL particle concentration. Conclusion: Substantial numbers of medically underserved, asymptomatic HIV-infected minorities may be at increased risk for CHD on the basis of NMR-derived lipoprotein values. [Copyright &y& Elsevier]

While geographical information systems (GIS) have applications in a range of diverse fields, they remain underused by decision-makers in health settings. Through analysis of data captured in semi-structured interviews, the paper explores four thematic areas (the ontological, power, functionality and collaboration discourses) to understand how GIS are perceived and valued by public health decision-makers. The findings suggest that although GIS are viewed as useful tools to inform decision-making, they are in no way a panacea for practice. Participants' concerns that GIS outputs can potentially be misinterpreted or used erroneously might partly explain resistance to their use. GIS are, therefore, likely to be most effective in decision-making when applied in a multi-disciplinary context to facilitate sharing of data, knowledge and expertise across the public health landscape. [ABSTRACT FROM AUTHOR]

Abstract: The oxytocin receptor antagonist barusiban, currently being developed for treatment of preterm labour, was investigated in pregnant cynomolgus monkeys with a 9-month postnatal follow-up of their offspring. The nature of barusiban, its indication, and the potential exposure of pre- and postnatal infants entailed the design of a unique protocol to investigate all aspects of maternal and offspring well-being. Barusiban was administered to the mothers from gestation day 85 until delivery with daily subcutaneous dosages up to 2.5mg/kg body weight/day. There were no test article-related effects seen in the mothers at any time during the study. The postnatal examination of offspring included routine toxicological parameters, as well as specialised investigation of the immune, cardiovascular, renal and central nervous systems, including a full behavioural assessment. A full pathology examination of offspring was performed at the end of the 9-month postnatal period. No adverse infant findings occurred. [Copyright &y& Elsevier]

At Loma Linda University Children’s Hospital, the medical information of 405 pediatric patients who received orthotopic cardiac transplantation were reviewed. Of those who died (n = 136), 86% (n = 117) underwent postmortem examinations, and the brain was examined in 61% (n = 82, male = 39). The number and type of intracranial lesions present were compiled, and these were matched to underlying functional cardiac disease categories. Intracranial abnormalities were present in 87%. Infarct was the most common primary central nervous system pathology in hypoplastic left heart syndrome (41%) but was also observed frequently in children with obstructive lesions (37%), cyanotic disease (31%), or cardiac shunting (29%). Secondary findings included extraparenchymal hemorrhage in obstructive lesions (31%); hypoxic changes occurred in 15% of patients with cyanotic disease and in 14% of those with cardiac shunting. Thirty-three percent of children with restrictive lesions had no neuropathology reported. Postmortem examination brain weights were matched against age and sex norms, with 29% of females and 36% of males below two standard deviations. These findings revealed that intracranial pathology was present in the majority of transplanted children who underwent postmortem examination, and that infarctive changes constituted the most common neuropathologic abnormality. Additionally, a number of children had significantly reduced brain weight. [Copyright &y& Elsevier]

Abstract: A transgene constructed from the rat liver fatty acid binding protein gene (Fabp1) promoter is active in all murine small intestinal crypt and villus epithelial cells. Coincident Cdx and C/EBP transcription factor binding sites were identified spanning Fabp1 nucleotides −90 to −78. CDX-1, CDX-2, C/EBPα, and C/EBPβ activated the Fabp1 transgene in CaCo-2 cells, and mutagenizing the −78 site prevented activation by these factors. CDX but not C/EBP factors bound to the site in vitro, although C/EBP factors competed with CDX factors for transgene activation. The −78 site adjoins an HNF-1 site, and CDX and C/EBP family factors cooperated with HNF-1α but not HNF-1β to activate the transgene. Furthermore, CDX-1, CDX-2, C/EBPα, and C/EBPβ bound to HNF-1α and HNF-1β. The transgene with a mutagenized −78 site was silenced in vivo specifically in small intestinal crypt epithelial cells but remained active in villus cells. These results demonstrate functional interactions between HNF-1, C/EBP, and CDX family factors and suggest that these interactions may contribute to differential transcriptional regulation in the small intestinal crypt and villus compartments. [Copyright &y& Elsevier]

Background: There are few published data regarding the long-term outcome of “large” cardiac allografts in children. This study examines the effect of cardiac graft oversizing on the survival of pediatric patients with congenital heart disease (CHD).Methods: Two hundred ninety-one children, age 1 day to 17 years (median 50 days), with CHD underwent primary cardiac transplantation between 1985 and 2002. Patients were analyzed according to donor-recipient weight ratio (D-R): Group (Gp) I (n = 252) with D-R <2.5 (range 0.59 to 2.49, median 1.4), and Gp II (n = 39) with D-R ≥2.5 (range 2.5 to 4.65, median 2.78). CHD diagnoses included hypoplastic left heart syndrome (138 in Gp I, 13 in Gp II), single ventricle (29 in Gp I, 1 in Gp II) and other (85 in Gp I, 13 in Gp II). Patients with cardiomyopathy were excluded. Pre-transplant cardiac palliation was performed in 36% of Gp I and 15% of Gp II patients. The average graft ischemic times (minutes) were 266 ± 7.5 and 283 ± 18.9 for Gp I and Gp II, respectively (p < 0.2).Results: The operative mortality for Gp I was 10.3% and 10.2% for Gp II (p < 0.99). There was no significant difference between the 2 groups in length of hospital stay (p < 0.15) or duration of ventilator support (p < 0.6) post-transplantation. However, the incidence of open chest was higher (p < 0.003) in Gp II (28%) compared with Gp I (8%). The survival rates for Gp I and Gp II were: 82 ± 2.4% vs 84 ± 5.7% at 1 year; 71 ± 2.9% vs 72 ± 7.2% at 5 years; and 63 ± 3.2% vs 65% ± 7.4 at 10 years.Conclusions: Post-transplant morbidity and short- and long-term survival of pediatric recipients with CHD are not adversely influenced by the use of oversized cardiac allografts. [Copyright &y& Elsevier]

Abstract: Objectives: This study assessed thenutritional status of the elderly and their functional ability becausepoor nutritional status in the elderly is associated with poorfunctionalability. Methods: Anthropometricmeasurements, demographic and socioeconomic data, dietary assessment bya food frequency list, and activities of daily life data were collectedcross sectionally in 2002. Participants (n= 100) were randomly selected and the response rate was95.2%. Results: Theoverall prevalences of undernutrition were 33.3% based on bodymass index (<18.5 kg/m2) and 52% based onmid-upper arm circumference (<24 cm). There was a large, significantdifference between prevalences of malnutrition by sex: 68% ofwomen were undernourished (body mass index < 18.5kg/m2) compared with 32.4% of men. Dietaryassessment showed that intake of fish, cereals, vegetables, tubers, andlegumes was moderate (three to six times/wk). Evaluation of the abilityof elderly people to perform basic activities of daily living showedthat 33% of subjects were independent in all activities of dailyliving, except for mobility and feeding. The relation between body massindex and variables associated with functional ability were significantwith regard to mobility, continence, and feeding(P <0.05). Conclusion: This study found that alarge percentage of older men and women are malnourished. Thisinfluenced their daily activities, especially mobility and feeding. Theelderly need to be incorporated into health programs andpolicy. [Copyright &y& Elsevier]

Abstract: Objective: Highly active antiretroviral therapy has been implicated in the development of metabolic toxicities, including insulin resistance. Because it is “clinically silent,” insulin resistance is often undetected, thus precluding the initiation of treatments that may prevent progression to frank diabetes. Previous studies have documented associations between dyslipidemic profiles and insulin resistance in patients who do not have the human immunodeficiency virus (HIV). Therefore, we explored whether serum lipids, parameters that are routinely measured in patients who have HIV or the acquired immunodeficiency syndrome, could be used to facilitate the identification of insulin resistance in patients infected with HIV. Methods: Thirty-three adult patients who had clinically stable HIV infection and treated with highly active antiretroviral therapy fasted overnight and underwent phlebotomy to measure the following parameters: insulin levels, blood glucose, triacylglycerols, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol. Results: Of the 33 participants, 15 had dyslipidemia, defined according to Adult Treatment Panel (ATP) III criteria, and 18 did not have dyslipidemia. The two groups did not differ significantly with respect to mean fasting insulin levels (P = 0.68). Only two participants had insulin levels that were higher than the laboratory reference range. No significant correlations were found between fasting insulin levels and any lipid parameters. Conclusions: Serum lipids are not predictive of fasting insulin levels in adult patients who are treated with highly active antiretroviral therapy. The findings are limited by the low prevalence of insulin resistance in the study sample and the small sample size. [Copyright &y& Elsevier]

Seizures are common in infants undergoing cardiac transplant and are usually attributed to a non-specific “post-pump” phenomenon. In this study, we determined which variables were associated with the occurrence of post-transplant seizures in infants with hypoplastic left heart syndrome and the need for continued treatment with antiepileptic medication. Of 127 infants studied over an 11-year period, 27 (21%), ages 9 to 90 days, had post-transplant seizures. These patients were compared to 27 age-matched transplanted infants without seizures. We compared multiple variables before, during, and after transplant including growth parameters, time of diagnosis, cyclosporine levels, maternal variables, circulatory and bypass parameters, laboratory data, neuroimaging and electroencephalographic studies, neurologic examination findings, and peri-operative complications. Post-transplant seizures were associated with total cardiopulmonary bypass time and the presence of post-transplant complications. Deep hypothermic circulatory arrest time was inversely correlated with seizure severity. Pre-transplant electroencephalographic abnormalities and total bypass time were associated with seizures requiring continued use of antiepileptic therapy. Post-transplant electroencephalograms were not associated with the need for continued treatment. Identification of variables associated with the development of post-transplant seizures is essential for early intervention to reduce long-term morbidity and mortality. Future studies to reduce risk of post-transplant seizures are warranted. [Copyright &y& Elsevier]

OBJECTIVE: We collected preliminary safety and efficacy data on the effects of Cholestin, a statin-containing dietary supplement, in individuals with dsylipidemia related to human immunodeficiency virus.METHODS: Fourteen adults with dsylipidemia related to human immunodeficiency virus characterized by hypercholesterolemia, hypertriacylglycerolemia, or both participated in a randomized, double-blind, placebo-controlled pilot study in an infectious disease clinic based in an academic medical center. Participants were randomly assigned to receive 1.2 g of Cholestin twice daily (n = 7) or placebo (n = 7) for 8 wk. The main outcome measures were safety (hepatic function tests, plasma human immunodeficiency virus-1 RNA levels, CD4+ cell counts, adverse effects) and efficacy (fasting serum cholesterol: total, high- and low-density lipoproteins, and fasting serum triacylglycerols). Safety and efficacy outcomes were evaluated at 2- and 8-wk intervals.RESULTS: Twelve participants (n = 6 per group) completed the 8-wk treatment protocol. After 8 wk of treatment with Cholestin, there were significant declines from baseline in mean (± standard error of the mean) fasting total cholesterol (−30.8 ± 8.8 versus 7.7 ± 5.6; P = 0.01) and low-density lipoprotein cholesterol (−32.2 ± 7.2 versus 26.3 ± 14.2; P = 0.01) versus placebo. Moreover, the decline in fasting total cholesterol was significant (−40.2 ± 4.8 versus 2.8 ± 11.9; P = 0.006) after 2 wk of therapy, at which time the low-density lipoprotein cholesterol approached significance (−30.2 ± 7.4 versus 4.4 ± 15.2; P = 0.068). High-density lipoprotein cholesterol and triacylglycerol levels did not change at either time point. No adverse effects were seen with Cholestin.CONCLUSIONS: Cholestin may safely lower total and low-density lipoprotein cholesterol in patients with dsylipidemia related to human immunodeficiency virus. Larger and longer-term trials of this approach are warranted. [ABSTRACT FROM AUTHOR]

Studies the effect of zinc supplementation on growth and body composition of preschool children by using the outcome measures of weight, height and midupper arm circumference. Role of zinc in normal growth and development of animals and humans; Changes in weight, height and midupper arm circumference after 5 months.

Objective: To ascertain the descriptive epidemiology of infant botulism, the flaccid paralysis that results when neurotoxigenic Clostridium species produce botulinum toxin (BoNT) in the infant colon, in its first 40 years following initial recognition in California in 1976.Study Design: Cases were defined by laboratory identification of BoNT and/or neurotoxigenic Clostridium species in patients' feces. Parents were interviewed using a structured questionnaire. Descriptive epidemiologic characteristics were compared between 1976-1996 and 1997-2016.Results: From 1976-2016, 1345 cases of infant botulism occurred in 45 of 58 California counties (6.5 cases/100 000 live-births/year) caused by BoNT types A, B, Ba, Bf, and F; 88% of cases were ≤6 months of age and 51% were female. Cases were white (84.2%), Asian (8.9%), other races (3.8%), and African American (2.8%); 29.4% of cases were Hispanic. More than 99% of cases were hospitalized. Case occurrence peaked in summer-fall. Of 8 designated geographic regions, the Central Coast counties had 3 times the statewide incidence in both 20-year time periods. Breast-fed patients (83%) were more than twice as old at onset as formula-fed patients (median, 4.4 vs 1.7 months, respectively; P < .001). BoNT/A cases were older at onset than BoNT/B cases (median, 3.8 vs 2.9 months, respectively; P < .001).Conclusions: Comprehensive continuous surveillance of infant botulism for 40 years in a large, diversely populated state identified fundamental epidemiologic characteristics of this uncommon illness. Unusual features included greater than 99% case hospitalization, absence of male preponderance, and a distinctive age distribution. [ABSTRACT FROM AUTHOR]

Objective: To ascertain possible risk factors for infant botulism, the intestinal infectious form of human botulism, in the years immediately following its initial recognition in California in 1976.Study Design: Parents of 159 California laboratory-confirmed cases of infant botulism from 1976 to 1983 and 318 healthy controls were interviewed using a comprehensive (>300 factors) questionnaire. "Neighborhood controls" (n = 184) were matched on date of birth, sex, race/ethnicity, and neighborhood of residence. "County controls" (n = 134) were matched only on date of birth, sex, and county of residence. Age-stratified bivariate and multivariate conditional logistic regression analyses were performed using SAS.Results: All cases required hospitalization. Bivariate analyses identified several risk factors that in multivariate analyses were not significant. In multivariate analyses, risk factors differed with stratification by age. For the ≤2 month-old neighborhood controls comparison, birth order >1, cesarean delivery, ≤1 bowel movements (BMs) per day, and windy residence area were associated with illness hospitalization, and for the county controls comparison, only pacifier use was associated. For the <2 month-old neighborhood controls comparison, <1 bowel movements (BMs) per day, cesarean delivery, birth order >1, and windy residence area were associated with illness hospitalization, and for the county controls comparison, pets in the home was an additional risk factor.Conclusions: With the exception of the ≤2-month-old county controls group, slower intestinal transit time (≤1 BM/d) was associated with illness. Otherwise, our case-control investigation identified few physiologic, environmental, and maternal factors associated with infant botulism hospitalization in California. [ABSTRACT FROM AUTHOR]

OBJECTIVE:We collected preliminary data on the safety and efficacy of supplemental arginine to improve natural killer cell cytotoxicity in a sample of persons with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS).METHODS:In a randomized, double-blind, placebo-controlled pilot study in an academic medical center—based infectious disease clinic, 11 clinically stable, HIV-infected adults had been treated with highly active, antiretroviral therapy and had HIV plasma RNA levels of less than 10 000 copies/mL. Participants were randomly assigned to receive 19.6 g of arginine/d (n = 6) or placebo (n = 5) for 14 d. Plasma HIV RNA levels, neuropsychologic functioning, and self-reported adverse events were analyzed for safety of treatment. Efficacy was measured by natural killer cell cytotoxicity.RESULTS:None of the participants experienced any adverse clinical, virologic, or neuropsychologic events that necessitated withdrawal from the study. The arginine-supplemented group showed a mean natural killer cell cytotoxicity increase of 18.9 lytic units, whereas the placebo group showed an increase of 0.3 lytic units. This difference was not statistically significant (P = 0.79).CONCLUSIONS:Short-term arginine supplementation is safe for persons with HIV/AIDS. Additional studies with larger samples and longer periods are warranted to determine the effects of arginine supplementation on other indices of immune function and on clinical outcomes such as intercurrent illnesses. [ABSTRACT FROM AUTHOR]

The bioconcentration factor (BCF) is an important parameter used to estimate the propensity of chemicals to accumulate in aquatic organisms from the ambient environment. While simple regressions for estimating the BCF of chemical compounds from water solubility or the n -octanol/water partition coefficient have been proposed in the literature, these models do not always yield good correlations and more descriptive variables are required for better modeling of BCF data for a given series of organic pollutants, such as some herbicides. Thus, the logBCF values for a set of carbonyl herbicides comprising amide, urea, carbamate and thiocarbamate groups were quantitatively modeled using multivariate image analysis (MIA) descriptors, derived from colored image representations for chemical structures. The logBCF model was calibrated and vigorously validated ( r 2 = 0.79, q 2 = 0.70 and r test 2 = 0.81), providing a comprehensive three-parameter linear equation after variable selection (logBCF = 5.682 − 0.00233 × X9774 − 0.00070 × X813 − 0.00273 × X5144 ); the variables represent pixel coordinates in the multivariate image. Finally, chemical interpretation of the obtained models in terms of the structural characteristics responsible for the enhanced or reduced logBCF values was performed, providing key leads in the prospective development of more eco-friendly synthetic herbicides. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the association between the Mini Nutritional Assessment (MNA) or MNA Screening Form and standard indicators of nutritional status in male elders with pressure ulcers. Design: Cross-sectional study. MNA and MNA Screening Form scores were related to nutritional indicators using the Pearson correlation. Subjects/Setting: Residents (79±1 years, N=23 men) of Veterans Affairs medical center nursing home care units with stage I to IV pressure ulcers were enrolled. Main Outcome Measures: Correlation coefficients were obtained from correlations between the MNA or MNA Screening Form scores and biochemical and anthropometric indices of nutritional status or measures of body composition normalized for height by dividing by height in meters2. Results: Hemoglobin (106±4 g/L; r=0.43, P=.0409, mean, standard error of the mean, Pearson’s r, P value), hematocrit (0.32±0.01; r=0.44, P=.0358), body mass index (23.1±1.0; r=0.66, P=.0006), calf circumference (30.4±1.1 cm; r=0.46, P=.0286), fat-free mass index (18.3±0; r=0.60, P=.0063), body cell mass index (8.3±0.5; r=0.64, P=.0033), and fat mass index (3.7±0.4; r=0.50, P=.0275) positively correlated with MNA score. Serum albumin (31±1 g/L) and prealbumin (180±17 mg/L) did not correlate with MNA, but prealbumin inversely correlated with erythrocyte sedimentation rate (r=−0.52, P=.0134), a marker of inflammation. The inverse correlation between albumin and erythrocyte sedimentation rate approached statistical significance (r=−0.42, P=.0542). The MNA Screening Form showed similar correlations or lack of correlations observed with the MNA with the exception of hemoglobin and hematocrit. Conclusions: The MNA and MNA Screening Form provide advantages over using visceral proteins in screening and assessing nutritional status of elderly people with pressure ulcers. [Copyright &y& Elsevier]

Autonomic dysfunction is common in α-synucleinopathies such as Lewy Body dementias (LBD), Parkinson's disease (PD), and isolated REM Sleep Behavior Disorder (iRBD). We analyzed pulse-rate changes during sleep to index autonomic nervous system (ANS) dysfunction in patients with α-synucleinopathies vs. non-synucleinopathy groups expected to have normal ANS function. Patients with LBD (n = 16), PD (PD, n = 14) or iRBD (n = 12) were compared to the non-synucleinopathy groups Alzheimers disease dementia (ADem, n = 26), mild cognitive impairment (MCI, n = 34) or controls (CG, n = 54). Sleep Profiler was used to derive a sleep autonomic activation index (AAI), i.e., ≥6 beat-per-minute increase/decrease, pulse rate coefficient of variation (PR-CV), and automated sleep staging with sleep-spindles and non-REM hypertonia (NRH). Analysis included statistical group comparisons and receiver operating characteristics curves to determine optimal classification of groups. AAI and PR-CV were moderately correlated across all recordings (r s = 0.58, P < 0.0001), except in the LBD and PD groups. AAI but not PR-CV differentiated the LBD, PD and iRBD from non-Parkinsonian groups. AAI was decreased in LBD and PD patients compared to the CG (p < 0.003) and MCI (p < 0.03). AAI decreased based on age and its receiver operating characteristic area under the curve ranged from 0.63 to 0.75. AAI had a weak negative correlation to NRH (r s ≤ −0.26) but not sleep-spindles. Synucleinopathy-related ANS dysfunction can reasonably discriminate prodromal and manifest PD/LBD diseased groups from non-synucleinopathies. Further studies incorporating AAI into a multivariate classifier of neurodegenerative disorders based on sleep characteristics acquired in the patient's home are planned. • The autonomic activation index (AAI) detects sharp changes in pulse rate. • The AAI is generally blunted in patients with Parkinsonian spectrum disorders. • The proportion with blunted AAI is consistent with disease progression. • AAI during sleep is unrelated to sleep spindles. • AAI is weakly negatively correlated with non-REM hypertonia (NRH). [ABSTRACT FROM AUTHOR]