Search

Coronavirus disease 2019 (COVID-19) rapidly changed the landscape of health care, particularly in the New York City area. The elderly population is particularly vulnerable to both the novel coronavirus and the effects of a fracture. The goal of this study was to compare trends and outcomes of hip fracture patients during the pandemic. This was a retrospective chart review of hip fracture patients from a suburban academic hospital on Long Island, New York, who presented from March 1 to May 30, 2020. Patient COVID-19 status, demographics, and hospital outcome measures were recorded. Statistical analysis was performed using heteroscedastic t tests for quantitative variables and chi-square tests for qualitative variables. There were 82 patients in the 2020 cohort and 111 in the 2019 control group, representing a 29.9% decrease in cases. The 2020 cohort presented to the hospital an average of 2.77 days after injury compared with 1.15 days for the 2019 control group ( P =.0976). Patients in the 2020 cohort were more likely to be discharged home than to rehabilitation ( P P =.0809). There was no increase in 1-, 3-, or 6-month complications or mortality. During the pandemic, fewer patients were admitted with hip fractures, and the time from injury to presentation doubled. Patients were significantly less likely to be discharged to rehabilitation and more were discharged with oral anticoagulants. Overall, there was no increase in complications, and these data indicate that the authors were successfully able to provide high-quality care to hip fracture patients during the pandemic. [ Orthopedics . 2021;44(5):293–298.]

Background Since the reopening of ambulatory centers, minimal data has been reported regarding positive tests among patients undergoing ambulatory procedures, associated delays in care, and outcomes of patients previously positive for Coronavirus-19 (COVID-19). Methods A retrospective observational case series of ambulatory procedures was performed. Records since the reopening of ambulatory centers in New York were searched for patients with positive COVID-19 nasal swab results who underwent ambulatory procedures. Chart reviews were conducted to determine COVID history and hospitalizations, demographic information, procedure details, and 30-day admissions. Results 3762 patients underwent ambulatory procedures. 53 were previously diagnosed with COVID-19, but recovered and tested negative at pre-procedural testing. 37 of 3709 asymptomatic patients (1.00%) tested positive during pre-procedural testing; 21 patients had their procedures delayed on average 28.6 days until testing negative, while 16 had their procedures performed before testing negative due to the time sensitivity of the procedure. There were no major complications or 30-day admissions in any of these asymptomatic patients. Three patients tested positive for COVID after having an ambulatory procedure. Conclusions Positive tests in asymptomatic patients led to procedure delays of 28.6 days. No patients who underwent ambulatory procedures after a positive COVID-19 test had any COVID-related complications, regardless of whether or not the procedure was delayed until testing negative. 3 patients tested positive for COVID-19 after having an ambulatory procedure, however at an average of 19.7 days after these cases were likely community acquired making the rate of nosocomial infection negligible., Of 3762 procedures, 53 patients previously had COVID-19 and tested negative at pre-procedural testing. 37 of 3709 asymptomatic patients (1.00%) tested positive at pre-procedural testing; 21 had procedures delayed on average 28.6 days until a negative test, while 16 had their procedures performed before testing negative. All patients underwent ambulatory procedures with no COVID-19-related complications.

International audience; Although lifestyle-based interventions are the most effective to prevent metabolic syndrome (MetS), there is no definitive agreement on which nutritional approach is the best. The aim of the present retrospective analysis was to identify a multivariate model linking energy and macronutrient intake to the clinical features of MetS. Volunteers at risk of MetS (F = 77, M = 80) were recruited in four European centres and finally eligible for analysis. For each subject, the daily energy and nutrient intake was estimated using the EPIC questionnaire and a 24-h dietary recall, and it was compared with the dietary reference values. Then we built a predictive model for a set of clinical outcomes computing shifts from recommended intake thresholds. The use of the ridge regression, which optimises prediction performances while retaining information about the role of all the nutritional variables, allowed us to assess if a clinical outcome was manly dependent on a single nutritional variable, or if its prediction was characterised by more complex interactions between the variables. The model appeared suitable for shedding light on the complexity of nutritional variables, which effects could be not evident with univariate analysis and must be considered in the framework of the reciprocal influence of the other variables.

Two studies were conducted in 2017 to investigate children's competencies seen as important by communities in Mtwara, Tanzania. Qualitative data from 95 parents (34 women) and 27 teachers (11 women) in Study 1 indicated that dimensions of social responsibility, such as obedience, were valued highly. In Study 2, the competencies of 477 children (245 girls), aged 4-13 years, were rated by teachers and parents. Factor analysis found the obedient factor explained the most variance in parent rating. In line with predictions, urban residence, parental socioeconomic status (SES), and parental education were all positively associated with ratings of curiosity, and parental SES was negatively associated with obedience and emotional regulation. Findings illustrate the need for culturally specific frameworks of social-emotional learning.

Background Many transfusion services determine the titer of potentially incompatible plasma-containing products by performing a one-dilution titer at their selected titer threshold. This study compared the results of immediate spin (IS) one-dilution titers determined by three methods with a reference standard method. Methods Plasma-containing products from group A and O donors were titered using the participant's routine IS one-dilution titer method. No time or temperature incubations were performed, and antihuman globulin reagent was not used. The samples were then tested using a reference method, which was a saline tube test with a 1-hour room temperature incubation; antihuman globulin was not used in the reference method. The results of the one-dilution titer were then compared to that obtained in the reference method. Results Nine centers participated in this study. There were 698 antibodies from 374 units tested by the manual IS tube one-dilution titer method; sensitivity was 0.88 (95% confidence interval [CI], 0.83-0.92), and specificity was 1.00 (95% CI, 0.98-1.00). There were 412 antibodies from 206 units tested by the manual and automated IS buffered gel card one-dilution titer method; sensitivity was 0.95 (95% CI, 0.91-0.98), and specificity was 0.87 (95% CI, 0.81-0.91). There were 98 antibodies from 49 units tested by an automated microplate IS one-dilution titer method; sensitivity was 0.76 (95% CI, 0.71-0.93), and specificity was 0.96 (95% CI, 0.92-0.99). All three methods had an accuracy rate of 90% or greater. Conclusion The manual and automated one-dilution titer methods are suitable for screening plasma-containing units, although more evaluation of the automated microplate method might be required.

Background Current evidence regarding COVID‐19 convalescent plasma (CCP) transfusion practices is limited and heterogeneous. We aimed to determine the impact of the use of CCP transfusion in patients with previous circulating neutralizing antibodies (nAbs) in COVID‐19. Methods Prospective cohort including 102 patients with COVID‐19 transfused with ABO compatible CCP on days 0–2 after enrollment. Clinical status of patients was assessed using the adapted World Health Organization (WHO) ordinal scale on days 0, 5, and 14. The nAbs titration was performed using the cytopathic effect‐based virus neutralization test with SARS‐CoV‐2 (GenBank MT126808.1). The primary outcome was clinical improvement on day 14, defined as a reduction of at least two points on the adapted WHO ordinal scale. Secondary outcomes were the number of intensive care unit (ICU)‐free days and the number of invasive mechanical ventilation‐free days. Results Both nAbs of CCP units transfused (p

Background Recent studies focused on modulating factors of paraoxonase-1 (PON1) activity. In some studies the association between pro-inflammatory markers and PON1 activity was examined, but so far no population-based investigations on this issue have been conducted. The present study investigated the relationships between the pro-inflammatory markers tumor necrosis factor (TNF)-α, leptin, interleukin (IL)-6, and high-sensitive C-reactive protein (hs-CRP) and paraoxonase and arylesterase, two hydrolytic activities of PON1, in the population-based Bavarian Food Consumption Survey II. Methods Based on 504 participants (217 men, 287 women), the relationship between the pro-inflammatory markers and the outcomes paraoxonase and arylesterase activities were investigated using multivariable linear models. Results Circulating plasma levels of leptin (P-value P-value = 0.031) and IL-6 (P-value = 0.045) were significantly non-linearly associated with arylesterase activity. Leptin levels were also significantly associated with paraoxonase activity (P-value = 0.024) independently from confounding factors, including high-density lipoprotein (HDL) cholesterol. With increasing levels of these inflammatory parameters, arylesterase and paraoxonase activities increased; however, at higher levels (> 75th percentile) the activities reached a plateau or even decreased somewhat. After Bonferroni-Holm correction, only leptin remained non-linearly but significantly associated with arylesterase activity (adjusted overall P-value Conclusions The present findings suggest that in persons with very high levels of inflammation, PON1 activity may be impaired, a fact that might subsequently be accompanied by a higher risk for cardiometabolic diseases. Whether or not the measurement of PON1 activity in combination with a lipid profile and certain inflammatory markers could improve the prediction of cardiometabolic diseases in middle-aged individuals from the general population should be evaluated in clinical studies.

Docosahexaenoic acid (DHA) has been reported to have a positive impact on many diet-related disease risks, including metabolic syndrome. Although many DHA-enriched foods have been marketed, the impact of different food matrices on the effect of DHA is unknown. As well, the possibility to enhance DHA effectiveness through the co-administration of other bioactives has seldom been considered. We evaluated DHA effects on the serum metabolome administered to volunteers at risk of metabolic syndrome as an ingredient of three different foods. Foods were enriched with DHA alone or in combination with oat beta-glucan or anthocyanins and were administered to volunteers for 4 weeks. Serum samples collected at the beginning and end of the trial were analysed by NMR-based metabolomics. Multivariate and univariate statistical analyses were used to characterize modifications in the serum metabolome and to evaluate bioactive-bioactive and bioactive-food matrix interactions. DHA administration induces metabolome perturbation that is influenced by the food matrix and the co-presence of other bioactives. In particular, when co-administered with oat beta-glucan, DHA induces a strong rearrangement in the lipoprotein profile of the subjects. The observed modifications are consistent with clinical results and indicate that metabolomics represents a possible strategy to choose the most appropriate food matrices for bioactive enrichment.

This article belongs to the Special Issue Dietary Bioactives and Human Health; Around a quarter of the global adult population have metabolic syndrome (MetS) and therefore increased risk of cardiovascular mortality and diabetes. Docosahexaenoic acid, oat beta-glucan and grape anthocyanins have been shown to be effective in reducing MetS risk factors when administered as isolated compounds, but their effect when administered as bioactive-enriched foods has not been evaluated. OBJECTIVE: The overall aim of the PATHWAY-27 project was to evaluate the effectiveness of bioactive-enriched food consumption on improving risk factors of MetS. A pilot study was conducted to assess which of five bioactive combinations provided within three different food matrices (bakery, dairy or egg) were the most effective in adult volunteers. The trial also evaluated the feasibility of production, consumer acceptability and gastrointestinal tolerance of the bioactive-enriched food. METHOD: The study included three monocentric, parallel-arm, double-blind, randomised, dietary intervention trials without a placebo. Each recruiting centre tested the five bioactive combinations within a single food matrix. RESULTS: The study was completed by 167 participants (74 male, 93 female). The results indicated that specific bioactive/matrix combinations have effects on serum triglyceride or HDL-cholesterol level without adverse effects. CONCLUSION: The study evidenced that bioactive-enriched food offers a promising food-based strategy for MetS prevention, and highlighted the importance of conducting pilot studies.

Background A risk assessment model for predicting the risk of haemolytic disease of the fetus and newborn (HDFN) in future pregnancies following the transfusion of Rh(D)-positive red blood cell (RBC)-containing products to females of childbearing potential (FCP) was developed, accounting for the age that the FCP is transfused in various countries. Methods The HDFN risk prediction model included the following inputs: risk of FCP death in trauma, Rh(D) alloimmunization rate following Rh(D)-positive RBC transfusion, expected number of live births following resuscitation, probability of carrying an Rh(D)-positive fetus, the probability of HDFN in an Rh(D)-positive fetus carried by an alloimmunized mother. The model was implemented in Microsoft R Open, and one million FCPs of each age between 18 and 49 years old were simulated. Published data from eight countries, including the United States, were utilized to generate country-specific HDFN risk estimates. Results The risk predictions showed similar characteristics for each country in that the overall risk of having a pregnancy affected by HDFN was higher if the FCP was younger when she received her Rh(D)-positive transfusion than if she was older. In the United States, the overall risk of HDFN if the FCP was transfused at age 18 was 3·4% (mild: 1·20%, moderate: 0·45%; severe: 1·15%; IUFD: 0·57%); the risk was approximately 0% if the FCP was 43 years or older at the time of transfusion. Conclusion This model can be used to predict HDFN outcomes when establishing transfusion policies as it relates to the administration of Rh(D)-positive products for massively bleeding FCPs.

BACKGROUND One of the strategies used to reduce the risk of haemolysis due to ABO-minor incompatible platelet transfusions is to perform a screening test to identify group O donors with high titres of anti-A and anti-B. However, critical immunoglobulin M/ immunoglobulin G (IgM/IgG) titres remain unclear. OBJECTIVE This study aimed to determine IgM titres of anti-A and anti-B in individual donor serum vs platelet products plasma and identify a possible association between IgM/IgG titres, haemolysin test and IgG subclasses in Brazilian blood donors from group O. METHODS IgM anti-A and Anti-B titration tests were performed on single-donor serum and platelet product plasma by gel agglutination (GA) at room temperature. For IgG anti-A and anti-B titration, serum was first treated with 0.01 M dithiothreitol (DTT), and the test was performed by GA with incubation at 37°C. Dilution of 1:64 as the cut-off was considered for both IgM/IgG. The qualitative haemolysin test was performed in tube, adding AB fresh serum, with incubation at 37°C. IgG subclasses were determined by GA using specific monoclonal antibodies. RESULTS An association between anti-A and anti-B IgM titres and haemolysin were demonstrated (P

Background Coronavirus disease 2019 (COVID‐19) convalescent plasma (CCP) collection began in two Brazilian hospitals for treatment of severe/critical patients. Methods and Materials Mild/moderate COVID‐19 convalescents were selected as CCP donors after reverse transcription polymerase chain reaction (RT‐PCR) confirmed severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and absence of symptoms for ≥14 days plus (a) age (18‐60 years), body weight greater than 55 kg; (b) immunohematological studies; (c) no infectious markers of hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human T‐lymphotropic virus‐1/2, Chagas and syphilis infection; (d) no HLA antibodies (multiparous); (e) second RT‐PCR (nasopharyngeal swab and/or blood) negativity; (f) virus neutralization test (cytopathic effect–based virus neutralization test neutralizing antibody) and anti–nucleocapsid protein SARS‐CoV‐2 IgM, IgG, and IgA enzyme‐linked immunosorbent assays. Results Among 271 donors (41 females, 230 males), 250 presented with neutralizing antibodies. Final RT‐PCR was negative on swab (77.0%) or blood (88.4%; P = .46). Final definition of RT‐PCR was only defined at more than 28 days after full recovery in 59 of 174 (33.9%) RT‐PCR –ve, and 25/69 RT‐PCR +ve (36.2%; 13 between 35 and 48 days). Neutralizing antibody titers of 160 or greater were found in 63.6%. Correlation between IgG signal/cutoff of 5.0 or greater and neutralizing antibody of 160 or greater was 82.4%. Combination of final RT‐PCR –ve with neutralizing antibody ≥160 was 41.3% (112/271). Serial plasma collection showed decline in neutralizing antibody titers and IgA levels (P

Background Although sugars and sugar derivatives are an important class of metabolites involved in many physiologic processes, there is limited knowledge on their occurrence and pattern in biofluids. Objective Our aim was to obtain a comprehensive urinary sugar profile of healthy participants and to demonstrate the wide applicability and usefulness of this sugar profiling approach for nutritional as well as clinical studies. Design In the cross-sectional KarMeN study, the 24-h urine samples of 301 healthy participants on an unrestricted diet, assessed via a 24-h recall, were analyzed by a newly developed semitargeted gas chromatography–mass spectrometry (GC-MS) profiling method that enables the detection of known and unknown sugar compounds. Statistical analyses were performed with respect to associations of sex and diet with the urinary sugar profile. Results In total, 40 known and 15 unknown sugar compounds were detected in human urine, ranging from mono- and disaccharides, polyols, and sugar acids to currently unknown sugar-like compounds. A number of rarely analyzed sugars were found in urine samples. Maltose was found in statistically higher concentrations in the urine of women compared with men and was also associated with menopausal status. Further, a number of individual sugar compounds associated with the consumption of specific foods, such as avocado, or food groups, such as alcoholic beverages and dairy products, were identified. Conclusions We here provide data on the complex nature of the sugar profile in human urine, of which some compounds may have the potential to serve as dietary markers or early disease biomarkers. Thus, comprehensive urinary sugar profiling not only has the potential to increase our knowledge of host sugar metabolism, but can also reveal new dietary markers after consumption of individual food items, and may lead to the identification of early disease biomarkers in the future. The KarMeN study was registered at drks.de as DRKS00004890.

Switching between competing grasp postures incurs costs on speeded performance. We examined switch costs between lift versus use actions under task conditions that required subjects to identify familiar objects. There were no asymmetrical interference effects, though reliable costs occurred when the same object required a different action on consecutive trials. In addition, lift actions were faster to objects targeted for a prospective use action than objects irrelevant to this intended goal. The benefit of a lift-then-use action sequence was not merely due to the production of two different actions in short order on the same object; use actions to an object marked for the distal goal of a lift action were not faster than use actions applied to another object. We propose that the intention to use an object facilitates the prior action of lifting it because the motor sequence lift-then-use is habitually conscripted to enact the proper function of an object.

Seeing pictures of objects activates the motor cortex and can have an influence on subsequent grasping actions. However, the exact nature of the motor representations evoked by these pictures is unclear. For example, action plans engaged by pictures could be most affected by direct visual input and computed online based on object shape. Alternatively, action plans could be influenced by experience seeing and grasping these objects. We provide evidence for a dual-route theory of action representations evoked by pictures of objects, suggesting that these representations are influenced by both direct visual input and stored knowledge. We find that that familiarity with objects has a facilitative effect on grasping actions, with knowledge about the object's canonical orientation or its name speeding grasping actions for familiar objects compared to novel objects. Furthermore, the strength of contributions from each route to action can be modulated by the manner in which the objects are attended. Thus, evocation of grasping representations depends on an interaction between one's familiarity with perceived objects and how those objects are attended while making grasp actions. (PsycINFO Database Record

Gendered harassment, including sexual harassment and homophobic name-calling, is prevalent in adolescents and is linked to negative outcomes including depression, anxiety, suicidality, substance abuse, and personal distress. However, much of the extant literature is cross-sectional and rarely are perpetrators of these behaviors included in studies of outcomes. Therefore, the current study examined the effects of longitudinal changes in gendered harassment perpetration and victimization on changes in mental health outcomes among a large sample of early adolescents. Given that these behaviors commonly occur in the context of a patriarchal society (males hold power), we also investigated the impact of gender on gendered harassment. Participants included 3,549 students from four Midwestern middle schools (50.4% female, 49% African American, 34% White) at two time points (13 and 17 years old). Results indicated that increases from age 13 to 17 years in sexual harassment perpetration and victimization and homophobic name-calling perpetration and victimization predicted increases in depression symptoms and substance use. Gender did not moderate these pathways. These findings highlight that negative outcomes are associated with changes in gendered harassment among adolescents and emphasize the importance of prevention efforts. Implications for school interventions are discussed.

To examine associations between insufficient sleep and neurobehavioral functioning in childhood as reported by mothers and teachers.Participants were 1046 children in a prebirth cohort study. Main exposures were insufficient sleep durations at 3 time points: 6 months to 2 years, defined as sleep11 h/d, 11 to12 h/d (vs ≥12); 3 to 4 years, defined as sleep10 h/d, 10 to11 h/d (vs ≥11); and 5 to 7 years, sleep9 h/d, 9 to10 h/d (vs ≥10). Outcomes at age 7 years were executive function, behavior, and social-emotional functioning, assessed using the Behavioral Rating Inventory of Executive Function (BRIEF) and the Strengths and Difficulties Questionnaire (SDQ). Higher scores indicate poorer functioning. Mothers and teachers completed both instruments independently.At age 7 years, mean (SD) mother and teacher report of the BRIEF global executive composite scale were 48.3 (7.9) and 50.7 (9.4) points, respectively, and of the SDQ total difficulties score was 6.5 (4.7) and 6.2 (5.7). In multivariable models, children who slept10 h/d at 3 to 4 years had worse maternal-reported scores for the BRIEF (2.11 points; 95% confidence interval, 0.17-4.05) and SDQ (1.91 points; 95% confidence interval, 0.78-3.05) than those with age-appropriate sleep. Children who slept9 h/d at 5 to 7 years also had worse scores. At both ages, associations with teacher-reported results were consistent with those of mothers. Infants who slept 11 to12 h/d had higher teacher- but not mother-reported scores.Insufficient sleep in the preschool and early school years is associated with poorer mother- and teacher-reported neurobehavioral processes in midchildhood.

BACKGROUND Warm autoantibodies (WAA) are antibodies that react with an antigen on a patient's own red-blood-cells and can complicate compatibility testing whether or not they cause clinical haemolysis. The goal of this study was to understand the overall prevalence of WAA, the risk of RBC alloimmunization and determine whether RBC selection practices have an impact on alloimmunization. MATERIALS AND METHODS Records of patients (>1 year of age) with an indirect antibody detection test (IAT) and serologic evidence of WAA over a 10-year-period were included. Eight centres from 5 countries collectively reviewed 1 122 245 patients who had an IAT. RESULTS Of patients having IAT, 1214 had WAA (0·17%). Transfusion information for 1002 of the patients was available; 631 were transfused after identification of the WAA (63%); of the transfused patients, 390 received prophylactic antigen-matched (PAM) RBCs and 241 did not. Of the 372 patients with WAA who were transfused and had serologic testing 30+ days following transfusion (30-2765 days), 56 developed new RBC alloimmunization (15·1%). Patients who were transfused using a PAM strategy were not protected from new RBC alloimmunization [14·6% (31 of 212 patients) having PAM transfusion approach compared with those not receiving PAM approach (15·6%, 25 of 160 patients, P = 0·8837)]. CONCLUSIONS The prevalence of WAA in patients having an IAT is low (

Rationale Methylated amino compounds and basic amino acids are important analyte classes with high relevance in nutrition, physical activity and physiology. Reliable and easy quantification methods covering a variety of metabolites in body fluids are a prerequisite for efficient investigations in the field of food and nutrition. Methods Targeted ultra-performance liquid chromatography/tandem mass spectrometric (UHPLC/MS) analysis was performed using HILIC separation and timed ESI-MRM detection, combined with a short sample preparation. Calibration in urine and blood plasma was achieved by matrix-matched standards, isotope-labelled internal standards and standard addition. The method was fully validated and the performance was evaluated using a subset from the Karlsruhe Metabolomics and Nutrition (KarMeN) study. Results Within this method, a total of 30 compounds could be quantified simultaneously in a short run of 9 min in both body fluids. This covers a variety of free amino compounds which are present in very different concentrations. The method is easy, precise and robust, and has a broad working range. As a proof of principle, literature-based associations of certain metabolites with dietary intake of respective foods were clearly confirmed in the KarMeN subset. Conclusions Overall, the method turned out to be well suited for application in nutrition studies, as shown for the example of food intake biomarkers in KarMeN. Application to a variety of questions such as food-related effects or physical activity will support future studies in the context of nutrition and health.

Objective To described the allele and haplotype frequencies of human leukocyte antigen genes at the -A, -B loci and human platelet antigen genes for human platelet antigen systems 1 to 9, 11 and 15 in blood. Methods We included 867 healthy unrelated volunteer donors who donated platelets between January 2011 and December 2014. Microarray genotyping was performed using a BeadChip microarray. Medium resolution typing of the human leukocyte antigen at loci A and B was carried out using sequence-specific oligonucleotide probe hybridization. We used multivariate analysis and our human leukocyte antigen population was compared to data from the United States national bone marrow donor program. Human platelet antigen results were compared to a literature review and data from around the world. Results Our human leukocyte antigen haplotype results were more similar to those of hispanics, followed by caucasians. Likewise, our human platelet antigen sample is more similar to those of Argentina, Rio Grande do Sul and Italy. Conclusion This was the first article that discusses human platelet antigen and human leukocyte antigen data together. Rare genotypes or antibody associations can make patient management difficult. A blood bank with genotyped donors allows for optimal transfusion and can contribute to better results. Our information can serve as basis for a database of platelet antigen polymorphisms. RESUMO Objetivo Descrever as frequências alélicas e haplotípicas de genes dos antígenos leucocitários humanos nos loci -A,- B e dos antígenos plaquetários humanos para os sistemas HPA-1 a 9, 11 e 15. Métodos Foram incluídos 867 doadores voluntários, saudáveis, não relacionados, que doaram plaquetas por aférese entre janeiro de 2011 e dezembro de 2014. A genotipagem foi realizada usando microarray BeadChip. A tipificação de resolução intermediária dos antígenos leucocitários humanos loci A e B foi realizada por meio de hibridização com sonda para oligonucleotídeos por sequência específica. Utilizamos análises multivariadas e o antígeno leucocitário humano de nossa população foi comparado com a do programa nacional de doadores de medula óssea norte-americano. Já os resultados dos antígenos plaquetários humanos foram comparados à revisão da literatura e a dados de populações de outros países. Resultados Os resultados do haplótipo de antígenos leucocitários humanos são mais parecidos com os dos hispânicos, seguidos dos caucasianos. Igualmente, a amostra de antígenos plaquetários humanos foi mais semelhante às da Argentina, do Rio Grande do Sul e da Itália. Conclusão Este foi o primeiro artigo a discutir antígenos plaquetários e leucocitários humanos simultaneamente. Genótipos raros ou associações de anticorpos podem dificultar o manejo clínico do paciente. Um banco de sangue com doadores genotipados permite um melhor resultado e transfusão possíveis. Estas informações podem servir de base para um banco de dados sobre polimorfismos de antígenos plaquetários.

Within the context of a community-academic partnership, we undertook a mixed-methods study to identify and explore health status, priorities, and management strategies among aging Wisconsin rural women. A questionnaire measuring diverse wellness needs was administered to women participating in personal development programming offered by a rural nonprofit organization. A subgroup participated in qualitative interviews to deepen the understanding of identified health priorities and methods of coping and healing. Findings provide insight into the prevalence of self-silencing among rural women and highlight mechanisms that help to facilitate the dismantling of self-silencing.

Parenting and attachment are critical in the emergence of self-regulation (SR) in preschool. However, most studies use general indexes of parenting quality, failing to explore the unique contributions of sensitivity and home quality to SR. Further, the nature of the interplay between parenting and attachment history is not well understood. Using a sample of 938 children from The National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, a series of structural equation models were fit to determine whether sensitivity and home quality concurrently predicted SR at 54 months, and whether attachment mediated or moderated these pathways. Results suggest that both sensitivity and home quality uniquely predict SR. Further, these early parenting variables were each indirectly associated with SR through children's attachment history. That is, higher levels of sensitivity and home quality predicted secure attachment history, which, along with parenting, predicted more advanced SR skills at 54 months. No moderated pathways emerged, suggesting that attachment history may be best conceptualized as a mediating mechanism.

Aims To conduct a needs assessment of public hospitals in Mexico to determine workforce specific capacity building needs in the care of older people. Background The older population in Mexico is growing rapidly. The healthcare system and workforce may not be prepared to handle the needs of older people, especially those with chronic illnesses who are also disadvantaged socioeconomically. Determining workforce and system needs is important to strategically develop capacity. Methods A needs assessment using a pragmatic qualitative approach structured this study. Semi-structured interviews and focus groups were conducted with healthcare professionals at five public hospitals in Mexico. Directed content analysis techniques analysed the data. Results Ninety-two healthcare professionals participated in the study. Three themes emerged, including geriatric service delivery, social changes and human resources for health. Participants reported a lack of gerontology knowledge and related clinical skills deficits to provide care for hospitalised elders and expressed emotional distress related to the lack of resources in their institutions. All healthcare professionals expressed strong concern at the social toll the ageing population had on families. The support of government organisations emerged as a facilitator for adoption of geriatric care principles. Conclusions This qualitative study uncovered important data to inform the implementation of quality improvement and capacity building models for older people care in Mexico. There appears to be strong potential for a culturally appropriate translation of high-income country older people care models within the Mexican healthcare context. Implications for practice Findings suggests there is a need to increase geriatric capacity building among helathcare professionals in Mexico. This will be an important step in improving care for hospitalised older people.

Purpose Differences in resting energy expenditure (REE) between men and women mainly result from sex-related differences in lean body mass (LBM). So far, a little is known about whether REE and LBM are reflected by a distinct human metabolite profile. Therefore, we aimed to identify plasma and urine metabolite patterns that are associated with REE and LBM of healthy subjects. Methods We investigated 301 healthy male and female subjects (18–80 years) under standardized conditions in the cross-sectional KarMeN (Karlsruhe Metabolomics and Nutrition) study. REE was determined by indirect calorimetry and LBM by dual X-ray absorptiometry. Fasting blood and 24 h urine samples were analyzed by targeted and non-targeted metabolomics methods using GC × GC–MS, GC–MS, LC–MS, and NMR. Data were evaluated by predictive modeling of combined data using different machine learning algorithms, namely SVM, glmnet, and PLS. Results When evaluating data of men and women combined, we were able to predict REE and LBM with high accuracy (> 90%). This, however, was a clear effect of sex, which is supported by the high degree of overlap in identified important metabolites for LBM, REE, and sex, respectively. The applied machine learning algorithms did not reveal a metabolite pattern predictive of REE or LBM, when analyzing data for men and women, separately. Conclusions We could not identify a sex independent predictive metabolite pattern for REE or LBM. REE and LBM have no impact on plasma and urine metabolite profiles in the KarMeN Study participants. Studies applying metabolomics in healthy humans need to consider sex specific data evaluation. Electronic supplementary material The online version of this article (10.1007/s00394-018-1767-1) contains supplementary material, which is available to authorized users.

Regular physical activity and physical fitness are closely related to a positive health status in humans. In this context, the muscle becomes more important due to its function as an endocrine organ. Muscle tissue secretes “myokines” in response to physical activity and it is speculated that these myokines are involved in physical activity induced positive health effects. Recently, the newly discovered myokine Irisin thought to be secreted by the muscle in response to physical activity and might be related to the health inducing effect by inducing browning of white adipose tissue. Speculating that myokines at least partly mediate exercise related health effects one would assume that regular physical activity and physical fitness are associated with resting Irisin concentrations in healthy humans. To investigate the association between resting Irisin concentration and either short-term physical activity, habitual physical activity, or physical fitness, data of 300 healthy participants from the cross-sectional KarMeN-study were analyzed. By applying different activity measurements we determined short-term and habitual physical activity, as well as physical fitness. Fasting serum samples were collected to determine resting Irisin concentrations by Enzyme-linked Immunosorbent Assay. Multivariate linear regression analysis served to investigate associations of the individual physical activity parameters with Irisin concentrations. Therefore, lean body mass and total fat mass (both determined by dual-energy X-ray absorptiometry) as well as age and parameters of glucose metabolism were included as confounders in multivariate linear regression analysis. Results showed that Irisin serum concentrations were not related to measures of physical activity and physical fitness in healthy humans under resting conditions, irrespective of the applied methods. Therefore we assume that if physical activity related effects are partly induced by myokines, permanently increased Irisin serum concentration may not be necessary to induce health-related exercise effects.

Given the heightened risk for HIV and other STIs among young men who have sex with men (YMSM) as well as the racial/ethnic disparities in HIV/STI risk, an understanding of longitudinal trends in sexual behaviors is warranted as YMSM emerge into adulthood. Drawing from an ongoing prospective cohort study, the present analysis employed latent growth curve modeling to examine trends in distinct types of sexual activity without condoms over time in sample of YMSM and examine differences by race/ethnicity and perceived familial socioeconomic status (SES). Overall, White and Mixed race YMSM reported more instances of oral sex without condoms as compared to other racial/ethnic groups with rates of decline over time noted in Black YMSM. White YMSM also reported more receptive and insertive anal sex acts without a condom than Black YMSM. Declines over time in both types of anal sex acts without condoms among Black men were noted when compared to White men, while increases over time were noted for mixed race YMSM for condomless insertive anal sex. The effects for race/ethnicity were attenuated with the inclusion of perceived familial SES in these models. These findings build on previous cross sectional studies showing less frequent sex without condoms among Black YMSM despite higher rates of HIV incidence in emerging adulthood, as well as the importance of considering economic conditions in such models. Efforts to understand racial/ethnic disparities in HIV/STIs among YMSM must move beyond examination of individual-level sexual behaviors and consider both race/ethnicity and socioeconomic conditions in order to evaluate how these factors shape the sexual behaviors of YMSM.

Background and Objectives Transfusion support for immune-mediated platelet refractoriness (PR) is clinically challenging, technically laborious and costly. The development of ‘EpHLA/EpVix software’ has been used successfully to select kidney donors. Here, we sought to evaluate this new software as a tool for platelet virtual crossmatch (VxM). Materials and Methods This is a prospective study from 2007 to 2014 of PR patients in a tertiary hospital. Platelet components selected by HLAMatchmaker program were crossmatched by EpHLA/EpVix, anti-human globulin complement-dependent lymphocytotoxicity test (AHG-CDC), flow cytometry platelet crossmatch (FCxM) and then compared. Effectiveness of platelet components transfused was evaluated by CCI. Results Ninety-seven crossmatched platelet transfusions for 27 patients were enrolled. Partial matches were analysed for 75 transfusions by the 3 methods, and 22% showed discrepant results among the assays. After further analysis, data showed that all divergent cases could be explained by HPA alloimmunization, prozone effect (FCxM), low sensitivity of AHG-CDC and possible interference in FCxM/AHG-CDC assays. Notably, sensitivity and specificity of VxM analysis was excellent (100%). Satisfactory CCI counts were obtained for the majority (22/30) of the transfusions. Conclusion The new EpHLA/EpVix method showed to be effective, feasible and fast for VxM at no cost and able to minimize labour on donor identification. However, platelet crossmatching may be a necessary step because EpHLA/EpVix does not formally exclude HPA alloimmunization.

Background Autologous peripheral blood hematopoietic stem cell (PBSC) collection efficiency (CE) is reportedly affected by the patient's blood properties; however, studies to identify factors correlated with CE have shown inconsistent results. Additionally, variables such as stem cell graft granulocyte content and patient age, sex, and underlying disease, may be associated with hematopietic stem cell (HSC) infusion-related adverse reactions. In this study, we evaluated the correlation of preleukapheresis PB granulocyte count and PBSC harvest variables with CD34+ collection yield and efficiency, and thawed HSC infusion side effect occurrence. Patients and methods We evaluated data from 361 patients who had undergone autologous PBSC transplant. Large volume leukapheresis was the method for PBSC collection. Complete Blood Count and CD34+ cell enumeration were performed in the preapheresis PB and the apheresis product sample. The PBSC grafts were submitted to non-controlled rate freezing after addition of 5% DMSO plus 6% hidroxyethylstarch as a cryoprotectant solution. The cryopreserved graft was thawed in a 37°C water bath and then infused without further manipulation. Results The CD34+ yield was associated with preapheresis PB CD34+ count and immature granulocyte count. The PBSC CE was negatively correlated with preapheresis white blood cell (WBC), immature granulocyte and granulocyte count. The leukapheresis product total nucleated cell (TNC) and granulocyte content was correlated with the thawed graft infusion side effect occurrence. Conclusion This study has shown that preapheresis PB WBC and granulocyte counts were associated with leukapheresis CE. Additionally, the leukapheresis product TNC and granulocyte content was correlated with thawed graft infusion side effect occurrence.

Background A considerable number of RHD alleles responsible for weak and partial D phenotypes have been identified. Serologic determination of these phenotypes is often doubtful and makes genetic analysis of RHD gene highly desirable in transfusion recipients and pregnant women. We analyzed the RHD gene in a cohort of pregnant women with doubtful D phenotypes. Methods RHD genotyping was performed on 104 cases with D typing discrepancies or with history of serologic weak D phenotype. Laboratory-developed DNA tests, RHD BeadChip (Bioarray Solutions, Immucor), and sequencing were used to identify the RHD alleles. Results Molecular analyses showed 23 of 104 (22%) pregnant women were RHD*weak D types 1, 2, or 3 and not at risk for anti-D. Fifty-one (49%) were RHD*weak partial 4.0, 6 RHD*weak D type 38 (6%), 1 RHD*weak D type 45 (1%), 1 RHD*weak D type 67 (1%), and potentially at risk for being alloimmunized and making anti-D. Partial D was identified in 22 of 104 (21%) patients and definitively at risk for anti-D. Discussion Appropriate classification of RhD phenotypes is recommended for correct indication of RhIG in pregnant women. However, the serologic distinction between RhD-negative and RhD-positive phenotypes is a difficult task in the case of D variants due to the variations in serologic testing. Our results show a great variability in RHD variant alleles in pregnant women from this population of high admixture. According to these results, 78% of these obstetric patients are at risk for anti-D and candidates for RhIG.

Aims and objectives To describe healthcare professionals’ perceptions of neglect of older people in Mexico. Background Mistreatment of older people, particularly neglect, has emerged as a significant public health concern worldwide. However, few studies have been conducted to examine neglect of older people in low- and middle-income countries. Most research has focused on estimating the prevalence of neglect in older populations with little emphasis on the perceptions of healthcare professionals and their role in addressing neglect of older people. Design Qualitative secondary analysis. Methods The parent study consisted of nine focus groups conducted with healthcare professionals at five public hospitals in Mexico. The purpose of the parent study was to perform a needs assessment to determine the feasibility of adapting the Nurses Improving Care for Healthsystem Elders programme to Mexico. A qualitative secondary analysis with directed content analysis approach was used to extract data related to neglect of older people. Results A total of 89 participants representing healthcare professionals from several disciplines were interviewed. Three themes emerged: (i) The main point is not here; (ii) We feel hopeless; and (iii) We need preparation. Participants reported distress and hopelessness related to neglect of older people. Lack of community-based resources was noted as contributing to neglect. Increased education regarding care of older people for both caregivers and healthcare professionals and greater interdisciplinary collaboration were identified as potential solutions to combat neglect. Conclusions Community-based services and resource allocation need to be re-evaluated to improve the care of older Mexicans. Interdisciplinary models of care should be developed to address concerns related to neglect of older people. Implications for practice Neglect negatively impacts healthcare professionals’ ability to adequately care for older patients. There is a need to invest in community-based services and models of care to address these concerns.

The cost of care of chronically ill individuals is estimated to be more than $1 trillion annually, and it is estimated that it will reach $6 trillion by mid-century if changes are not made in the health system's response to chronic illness,1 but little is known about the cost-effectiveness of the majority of interventions delivered to people who are chronically ill. More than half of all Medicare beneficiaries report being treated for five or more conditions during a year.2 For most chronically ill persons, care is a complicated maze of providers and complex medication regimens that are often difficult to self-manage, especially for frail older adults. Poor care coordination is identified as the heart of the problem in care of chronically ill people,3and the Institute of Medicine has identified it as a priority area for healthcare improvement.4 Care coordination is delivered in a wide variety of approaches in different settings, with different providers and different clinical populations. The challenge in evaluation of care coordination programs is the heterogeneity of the approaches, which makes it difficult to conduct systematic reviews or compare the effectiveness of different strategies.5 Disease management programs, one type of care coordination initiative, have demonstrated mixed results with regard to cost savings. A meta-analysis found a small positive effect for cost savings, which was greater with severely ill persons,6 but another review found that disease management programs improved some health outcomes but did not reduce costs.7 Care coordination programs based in primary care settings have demonstrated significant positive clinical advantages over usual care in functional ability,8 depression,8 satisfaction,9 quality of life,10–12 and mortality.13,14 Utilization outcomes were less impressive, with one study noting reduction in emergency visits 11 and two identifying reductions in hospital use.11,14 Hospital-to-home and transitional care programs have been among the most effective at improving clinical outcomes and reducing utilization, with heart failure being the most prevalent focus of the programs.6,15 The Transitional Care Model, in which advanced practice nurses (APNs) visit individuals in the hospital and follow them after discharge, demonstrated improvement in quality of life, had high levels of satisfaction, and reduced hospital admissions and cost of care.16 A different study that used the Care Transitions Model reported significant reductions in hospitalizations and hospital costs.17 Home-based nurse care coordination (NCC) programs have not led to consistent significant quality or cost improvements. A small to moderate reduction in hospital days related to home-based care coordination was identified in a meta-analysis,18 but a recent review found that home-based programs had no significant influence on outcomes of care.19 Problems in the studies included infrequent contacts with participants, which in some cases were as little as four times during a 12-month period, and older adults most in need of intervention were not necessarily the targets of these programs. The Centers for Medicare and Medicaid Services (CMS) conducted the Medicare Coordinated Care Demonstration (MCCD) to test whether care coordination and disease management can lower costs and improve outcomes and well-being for Medicare fee-for-service beneficiaries with chronic illnesses.20 Fifteen sites participated and varied widely in how they delivered the care coordination intervention. Of the 15 sites, only three (Health Quality Partners, Georgetown, and Mercy) had treatment groups whose monthly Medicare expenditures were less than those in the control group. The current study evaluated the cost-effectiveness of a home-based care coordination program that targeted older adults with problems self-managing their chronic illnesses. The ability to self-manage a medication regimen was used as a proxy measure for general self-management ability, because medication management is usually a major component of self-management in chronically ill persons. In the intention-to-treat (ITT) analysis of the clinical outcomes over a 12-month period, participants who received the NCC intervention scored significantly better than participants in the control group in depression (P

Scope The human volatilome has gained high interest for the discovery of potential biomarkers of diseases. However, knowledge about the diet as a crucial factor affecting the volatilome is scarce. Therefore, the search for disease biomarkers, as well as the potential use of volatiles as dietary markers is so far limited. The aim of this study is to investigate the association of the diet with the urinary volatilome with the special task to find potential markers of coffee consumption in 24 h urine samples from the Karlsruhe Metabolomics and Nutrition (KarMeN) study. Methods and results Acidified urine samples are analyzed using an approach combining headspace solid phase microextraction (HS-SPME) sampling with untargeted GC×GC-MS. Overall, 138 reliably occurring volatiles are detected. To account for the unequally concentrated urine samples, results of six different commonly used normalization methods are compared. Statistical analysis evidences six potential markers of coffee consumption, the most promising being 3,4-dimethyl-2,5-furandione. A correlation analysis between the 24 h dietary recall data and the urinary volatilome reveals further promising associations. Conclusion The human urinary volatilome is highly affected by the diet, enabling access to a high level of information about potential diet-related biomarkers. Therefore, it is a very promising source for further investigations on dietary markers.

Fruit and vegetable consumption produces changes in several biomarkers in blood. The present study aimed to examine the dose-response curve between fruit and vegetable consumption and carotenoid (α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin), folate and vitamin C concentrations. Furthermore, a prediction model of fruit and vegetable intake based on these biomarkers and subject characteristics (i.e. age, sex, BMI and smoking status) was established. Data from twelve diet-controlled intervention studies were obtained to develop a prediction model for fruit and vegetable intake (including and excluding fruit and vegetable juices). The study population in the present individual participant data meta-analysis consisted of 526 men and women. Carotenoid, folate and vitamin C concentrations showed a positive relationship with fruit and vegetable intake. Measures of performance for the prediction model were calculated using cross-validation. For the prediction model of fruit, vegetable and juice intake, the root mean squared error (RMSE) was 258.0 g, the correlation between observed and predicted intake was 0.78 and the mean difference between observed and predicted intake was -1.7 g (limits of agreement: -466.3, 462.8 g). For the prediction of fruit and vegetable intake (excluding juices), the RMSE was 201.1 g, the correlation was 0.65 and the mean bias was 2.4 g (limits of agreement: -368.2, 373.0 g). The prediction models which include the biomarkers and subject characteristics may be used to estimate average intake at the group level and to investigate the ranking of individuals with regard to their intake of fruit and vegetables when validating questionnaires that measure intake. Copyright © The Authors 2015.

Rationale : Sarcomere length (SL) is a key indicator of cardiac mechanical function, but current imaging technologies are limited in their ability to unambiguously measure and characterize SL at the cell level in intact, living tissue. Objective : We developed a method for measuring SL and regional cell orientation using remote focusing microscopy, an emerging imaging modality that can capture light from arbitrary oblique planes within a sample. Methods and Results : We present a protocol that unambiguously and quickly determines cell orientation from user-selected areas in a field of view by imaging 2 oblique planes that share a common major axis with the cell. We demonstrate the effectiveness of the technique in establishing single-cell SL in Langendorff-perfused hearts loaded with the membrane dye di-4-ANEPPS. Conclusions : Remote focusing microscopy can measure cell orientation in complex 2-photon data sets without capturing full z stacks. The technique allows rapid assessment of SL in healthy and diseased heart experimental preparations.

Purpose Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. We aimed to clarify the impact of dietary walnut oil versus animal fat on hepatic steatosis, representing the initial step of multistage pathogenesis of NAFLD, in Zucker obese rats. Methods Zucker lean ad libitum (a.l.), Zucker obese a.l. or Zucker obese pair fed (p.f.) to the lean received isocaloric diets containing 8 % walnut oil (W8), W14 or 14 % lard (L14) (n = 10/group). Body weight, clinical serology, liver weight, lipid content and fatty acid composition and hepatic lipid metabolism-related transcripts were evaluated. Results Compared to lean, Zucker obese a.l. and p.f. showed hepatic triacylglyceride (TAG) accumulation. In Zucker obese p.f., W14 compared to W8 and L14 reduced liver lipids, TAG as well as hepatic omega-6 (n-6)/n-3 ratio and SCD activity index [(C18:0 + C18:1)/C18:0 ratio] paralleled by decreased lipoprotein lipase mRNA in obese p.f. and elevated microsomal triglyceride transfer protein mRNA in lean and obese. Further, W14 elevated the fasting blood TAG and reduced cholesterol levels in obese. Conclusions In our model, consumption of W14 inhibited hepatic lipid accumulation along with modulated hepatic gene expression implicated in hepatic fatty acid influx or lipoprotein assembly. These results provide first indication that dietary lipids from walnut oil are modulators of hepatic steatosis as the initial step of progressive NAFLD pathogenesis.

Adipose tissue-associated chronic inflammation is involved in the pathogenesis of obesity-related diseases. Dietary fatty acids are known to influence inflammatory processes. The aim of this study was to investigate, whether diets with regular fat contents but variable fat qualities affect adipose tissue-associated inflammation through the fatty acid composition of mesenteric adipose tissue (MAT).Obese Zucker rats were fed diets containing 7 % wt:wt rapeseed oil, corn oil, or lard for 10 weeks. Fatty acid composition and endocrine function regarding adipokines and cytokines of MAT, number of total CD3(+) T cells, and cytokine secretion of mesenteric lymph node (MLN)-derived lymphocytes were determined. Local effects in MAT and MLN were compared to systemic effects assessed in serum and peripheral blood mononuclear cells.Fatty acid composition of MAT reflected dietary fatty acid intake, without affecting endocrine function. Feeding the lard diet for 10 weeks increased the serum adiponectin and TNF-α secretion of blood lymphocytes, whereas CD3(+) T cells in blood were decreased. No effects were seen for the secretion of adipokines and cytokines from MAT, the amount of T cells in MLN, and cytokine secretion of MLN lymphocytes.In conclusion, feeding obese rats a diet with regular fat content but variable fat sources for 10 weeks, changed the fatty acid composition of MAT but not its secretory properties or MLN functions. Although the local immune system was not influenced, lard-feeding induced minor changes in systemic immune function.

Background Strong interindividual differences in the microbial conversion of some dietary polyphenols have been reported. In-depth studies of trans-resveratrol metabolism by human gut microbiota, however, are lacking, and only one bacterial metabolite, namely dihydroresveratrol, has been described. Objective The aim of this study was to elucidate interindividual differences in trans-resveratrol metabolism by human gut microbiota and to identify bacterial strains involved. Design In the first part of the study, in vitro fermentation experiments were performed with feces samples from 7 healthy volunteers, and metabolite formation was measured by liquid chromatography-ultraviolet/visible (UV/Vis)-mass spectrometry (MS)/MS detection. Microbial diversities in 3 feces samples were analyzed by high-throughput pyrosequencing and quantitative real-time polymerase chain reaction. In addition, trans-resveratrol conversion experiments were conducted with selected fecal bacterial strains in pure culture. The second part of the study was a controlled intervention study with 12 healthy volunteers. After a washout period, all of the subjects received a one-time oral dose of 0.5 mg trans-resveratrol/kg body weight in the form of a grapevine-shoot supplement, and 24-h urine samples were analyzed by liquid chromatography-UV/Vis-MS/MS. Results Besides dihydroresveratrol, 2 previously unknown bacterial trans-resveratrol metabolites were identified in vitro and in vivo: 3,4'-dihydroxy-trans-stilbene and 3,4'-dihydroxybibenzyl (lunularin). Their formation, however, varied among the volunteers. Two strains, Slackia equolifaciens and Adlercreutzia equolifaciens, were identified as dihydroresveratrol producers. Gut bacteria able to produce dehydroxylated metabolites could, however, not be identified. Conclusions trans-Resveratrol metabolism by human gut microbiota shows pronounced interindividual differences, which should be taken into account during investigation of health-related effects of this stilbene. This trial was registered at the German Clinical Trials Register as DRKS00004311, Universal Trial Number (WHO) UTN: U1111-1133-4621.

Child sleep problems (Meltzer & Mindell, 2006) are highly prevalent and are associated with adjustment problems (El-Sheikh, Kelly, Buckhalt, & Hinnant, 2010). Research is clarifying relations between sleep and adjustment yet several important gaps remain. Longitudinal studies with more than two waves are scarce, not much is known about sleep trajectories of school-age children or their sequelae and studies of the impact of persistent sleep problems are scant (Jansen et al., 2011). Using data collected over three years, we examined whether initial levels and rates of change in children’s sleep problems predicted T3 adjustment. We also assessed the moderating role of child sex, ethnicity, and family socioeconomic status (SES) in these links. We examined sleep problems along a continuum in typically developing children, which were indicated by increased sleepiness and sleep/wake problems (S/WP) (i.e., insufficient sleep and difficulty initiating and maintaining sleep). We examined the effects of these sleep measures on children’s cognitive functioning in Bub, El-Sheikh, & Buckhalt (2011) using the same sample. Child sleep problems including duration, quality, and daytime sleepiness are associated with symptoms of depression and anxiety (Chorney, Detweiler, Morris, & Kuhn, 2008) as well as anger and aggression (Chervin, Dillon, Archbold, & Ruzicka, 2003). Across two waves of data, parent-reported child sleep problems at age four years predicted an increase in depression, anxiety and aggression during mid-adolescence (Gregory & O’Connor, 2002). With an independent sample from that utilized in the present study, more S/WP were associated with increases in internalizing and externalizing symptoms two years later (El-Sheikh et al. 2010). Sleep problems can disrupt processes mediated in the prefrontal cortex (PFC), including executive functioning needed for emotion regulation (Jones & Harrison, 2000), which in turn put children at risk for both internalizing and externalizing problems (Dahl, 1996). Researchers have begun to use individual or latent growth modeling to examine cross-domain associations but work in this area is relatively nascent. Adolescents who experienced a faster decline in sleep duration over time were more likely to exhibit increases in depression symptoms over three years (Fredriksen, Rhodes, Reddy & Way, 2004). Further, children whose sleep problems (mother report) increased at a faster rate also exhibited increasing externalizing behaviors (teacher report) (Goodnight, Bates, Staples, Pettit, & Dodge, 2007). The prevalence of children’s sleep problems may be higher among African (AAs) than European Americans (EAs), and among those from lower SES backgrounds (Buckhalt, El-Sheikh, Keller & Kelly, 2009). Examination of sociocultural moderators of the link between children’s sleep and their adjustment is critical for identifying for whom and under which conditions sleep has a protective or vulnerability function. Consistent with views of cumulative risk (e.g., Buckhalt, 2011), ethnic minority or economically disadvantaged children may be especially vulnerable to the negative effects of sleep problems and emerging evidence supports this proposition for children’s adjustment (El-Sheikh et al., 2010). Findings pertaining to sex differences in children’s sleep are inconsistent and little work has examined child sex as a moderator of the sleep-adjustment connection. Girls may have better sleep quality (Buckhalt et al., 2009) or longer duration (Fredriksen et al., 2004); opposite findings have been reported (Gaina et al., 2007). In their 3-wave study with adolescents, Meijer, Reitz, Dekovic, van den Wittenboer, and Stoel (2010) found that sleep problems predicted increased adjustment problems more robustly for boys. Further, because girls compared to boys are more susceptible to internalizing symptoms in adolescence (Hankin & Abramson, 2001; Van Oort et al., 2009), we investigated child sex as a moderator of the sleep-adjustment link. This study builds on the literature in important ways. We examined several outcomes including depression symptoms, anxiety, and anger/aggression (referred to as anger for brevity). Building on the scarce longitudinal literature most of which is with two study waves, research questions were examined using three waves of data, a requirement for linear growth modeling, thereby allowing for a more thorough explication of associations. With an independent sample, we found that S/WP predicted increases in internalizing and externalizing symptoms two years later (El-Sheikh et al., 2010). The present investigation utilizes three waves of data and examines not only initial S/WP but also changes in sleep as predictors of adjustment. We expected that children with more sleep problems at T1 and increases in sleep problems over time would have poorer adjustment at T3 and expected more pronounced relations for AA children, those from lower SES homes, and girls (similar to findings reported by Bub et al., 2011 in relation to cognitive outcomes).

When listening to a sentence describing an interaction with a manipulable object, understanding the actor’s intentions is shown to have a striking influence on action representations evoked during comprehension. Subjects performed a cued reach and grasp response while listening to a context sentence. Responses were primed when they were consistent with the proximal intention of an actor (“John lifted the cell phone . . .”), but this effect was evanescent and appeared only when sentences mentioned the proximal intention first. When the sentence structure was changed to mention the distal intention first (“To clear the shelf . . .”), priming effects were no longer context specific and actions pertaining to the function of an object were clearly favored. These results are not compatible with a straightforward mental-simulation account of sentence comprehension but instead reflect a hierarchy of intentions distinguishing how and why actions are performed.

Blood donors are, in principle, healthy individuals who may be revealed as infectious for blood-borne agents by the laboratory screening process, depicting the asymptomatic burden of the disease. Therefore, monitoring hepatitis C virus (HCV)-infected donor and human immunodeficiency virus (HIV)-infected donor and associating to their demographical and behavioural characteristics may shed light on the dynamics and contemporary changes in these viruses' epidemiology.Donors presenting repeatedly reactive HCV or HIV serology/nucleic acid testing (NAT) screening results were submitted to confirmatory testing. Confirmed positive donors were invited to return to the blood bank for notification and counselling when a follow-up sample was obtained and an interview performed to eventually disclose potential risks. HCV- or HIV-infected donors identified over 11 years of screening (2004-2015) were evaluated for demographic and behavioural parameters.In the period, 139 160 donations were screened, and 36 (0.025%) were found positive for HIV, stemming from 29 male and 7 female donors. Among those, eight subjects were repeat donors. A total of 95 donations were found repeatedly reactive for HCV (0.068%), obtained from 60 men and 35 women. Noticeably, in despite of a higher HCV prevalence in the donor population, the incidence of HIV among repeat donors was 10 times that of HCV (18 × 1.6/100 000 persons-year, respectively). On average, HIV-seroreactive men were found to be younger (mean = 34 years old) than women (mean = 40 years old). A total of 10 donors acknowledged sexual behaviours not previously informed, including 2 who were aware of their HIV-positive status and another 2 who admitted to be seeking HIV testing. No window period donation was verified.The majority of the HIV-infected donors are young males who deny risk factors in the interview and also ignore the confidence self-exclusion opportunity. As they may reiterate this behaviour in serial donations, use of the most sensitive laboratory testing is justified in this setting.

Objective There is some evidence to suggest that one's ability to delay gratification is associated with a lower body mass index (BMI) and slower overall weight gain. Less is known about the role that a broader set of self-regulatory skills, including attention focusing, inhibitory control, and impulsivity, might play in fostering not only a healthy weight but also better overall health and health-related behaviors such as sleep. Method Participants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were followed from birth through age 15 beginning in 1991. Self-regulation was assessed when children were 4.5 years old, whereas health-related outcomes were assessed regularly between toddlerhood and adolescence. Structural equation modeling was used to test direct associations between self-regulation and either physical health or sleep in childhood and adolescence. Results Findings suggest that there are long-term benefits of self-regulation, indexed by multiple dimensions, for children's health-related outcomes. Children with better self-regulatory skills demonstrated smaller increases in standardized BMI scores and maintained greater mother-reported health across childhood and adolescence. Furthermore, better self-regulation predicted fewer sleep problems and longer sleep duration when children were 8 and 11 but not when they were 15. Conclusions Early self-regulation, marked by numerous skills, appears to have long-term benefits for children's health-related outcomes. These findings provide some evidence that targeting childhood self-regulatory skills for improvement may help reduce poor health-related outcomes later in life and offer important insight into potential avenues for intervention. (PsycINFO Database Record

High alcohol consumption is an important risk factor for chronic disease and liver degeneration. Paraoxonase (PON1) and arylesterase (AE) are functions of the enzyme paraoxonase, which is synthesised by the liver. Paraoxonase circulates in plasma bound to HDL and hydrolyses lipid peroxides, protecting lipoproteins against oxidative modification. It has been shown that excessive alcohol consumption leads to a reduction of serum PON1 and AE activities; however, studies investigating the association with low and moderate alcohol consumption are scarce. We investigated the cross-sectional association between alcohol consumption and serum activities of PON1 and AE using data from the population-based Bavarian Food Consumption Survey II survey. PON1 and AE activities were quantified in serum samples of 566 male and female study participants (aged 18–80 years), and dietary intake including alcohol consumption was estimated from three 24-h dietary recalls. The association between alcohol consumption and PON1 and AE activities was analysed using linear regression, adjusted for age, sex and socio-economic status. There was no strong association between alcohol consumption and enzymatic activities of PON1 and AE in the Bavarian population. PON1 activity was seen to be lowest in non-drinkers (0 g/d) and highest in people who consumed 15·1–30 g of alcohol/d. AE activity increased across alcohol consumption categories, with a mean maximum difference of 14 U/ml (Pfor linear trend0·04). These associations were attenuated after adjustment for blood concentrations of HDL. The results of this study do not support the hypothesis that alcohol consumption is related to important alterations in PON1 and AE activities.

Bile acids (BA) play an important role in lipid metabolism. They facilitate intestinal lipid absorption, and BA synthesis is the main catabolic pathway for cholesterol. The objective of this study was to investigate associations of age, sex, diet (fat intake) and parameters of lipid metabolism (triglycerides, LDL, HDL, body fat content) with fasting plasma BA concentration of healthy individuals. Fasting plasma samples from a cross-sectional study were used to determine the concentrations of 14 BA using an LC-MS stable isotope dilution assay. Triglycerides, LDL and HDL were analyzed by standard clinical chemistry methods and body fat content was measured with a DXA instrument. The dietary fat intake of the 24 h period prior to the sampling was assessed on the basis of a 24 h recall. Subsequent statistical data processing was done by means of a median regression model. Results revealed large inter-individual variations. Overall, higher median plasma concentrations of BA were observed in men than in women. Quantile regression showed significant interactions of selected BA with age and sex, affecting primarily chenodeoxycholic acid and its conjugates. No associations were found for LDL and the amount of fat intake (based on the percentage of energy intake from dietary fat as well as total fat intake). Additional associations regarding body fat content, HDL and triglycerides were found for some secondary BA plasma concentrations. We conclude that age and sex are associated with the fasting plasma concentrations. Those associations are significant and need to be considered in studies investigating the role of BA in the human metabolism.

According to the expertise account of face specialization, a deficit that affects general expertise mechanisms should similarly impair the expert individuation of both faces and other visually homogeneous object classes. To test this possibility, we attempted to train a prosopagnosic patient, LR, to become a Greeble expert using the standard Greeble expertise-training paradigm (Gauthier & Tarr, 2002). Previous research demonstrated that LR's prosopagnosia was related to an inability to simultaneously use multiple features in a speeded face recognition task (Bukach, Bub, Gauthier, & Tarr, 2006). We hypothesized that LR's inability to use multiple face features would manifest in his acquisition of Greeble expertise, even though his basic object recognition is unimpaired according to standard neuropsychological testing. Although LR was eventually able to reach expertise criterion, he took many more training sessions than controls, suggesting use of an abnormal strategy. To further explore LR's Greeble processing strategies, we assessed his ability to use multiple Greeble features both before and after Greeble training. LR's performance in two versions of this task demonstrates that, even after training, he relies heavily on a single feature to identify Greebles. This correspondence between LR's face recognition and post-training Greeble recognition supports the idea that impaired face recognition is simply the most visible symptom of a more general object recognition impairment in acquired prosopagnosia.

We examine the nature of motor representations evoked during comprehension of written sentences describing hand actions. We distinguish between two kinds of hand actions: a functional action, applied when using the object for its intended purpose, and a volumetric action, applied when picking up or holding the object. In Experiment 1, initial activation of both action representations was followed by selection of the functional action, regardless of sentence context. Experiment 2 showed that when the sentence was followed by a picture of the object, clear context-specific effects on evoked action representations were obtained. Experiment 3 established that when a picture of an object was presented alone, the time course of both functional and volumetric actions was the same. These results provide evidence that representations of object-related hand actions are evoked as part of sentence processing. In addition, we discuss the conditions that elicit context-specific evocation of motor representations.

In daily life, face identification requires that the observer select a single representation from hundreds if not thousands in memory. This breadth of choice is nearly impossible to replicate in the laboratory using newly learned faces, especially in the context of a Bubbles experiment (Gosselin & Schyns, 2001). In this study, we obviated this concern by studying the performance of observers in a face-naming task using 210 faces of celebrities. On each trial, we presented a face randomly sampled with Bubbles. We performed least-square multiple linear regressions on the location of the samples and on accuracy to pinpoint the facial features that were used effectively in this task. Correct face identification relied primarily on the eye areas in spatial frequency bands ranging from 4.37 to 70 cycles per face (cpf) and on the mouth and the nose in a spatial frequency band ranging from 8.75 to 17.5 cpf. A comparison with other studies (Caldara et al., 2005; Schyns, Bonnar, & Gosselin, 2002) in which Bubbles was used with a set of 10 newly learned faces revealed that although the eye areas were useful across studies, the mouth area and higher spatial frequencies gained in importance when few newly learned faces were used.

Branched-chain amino acids (BCAA) in plasma are discussed as risk factors for the onset of several diseases. Information about the contribution of the overall diet to plasma BCAA concentrations is controversial. Our objective was to investigate which dietary pattern is associated with plasma BCAA concentrations and whether other additional nutrients besides BCAA further characterize this dietary pattern. Based on the cross-sectional KarMeN study, fasting plasma amino acid (AA) concentrations, as well as current and habitual dietary intake were assessed in 298 healthy individuals. Using reduced rank regression, we derived a habitual dietary pattern that explained 32.5% of plasma BCAA variation. This pattern was high in meat, sausages, sauces, eggs, and ice cream but low in nuts, cereals, mushrooms, and pulses. The age, sex, and energy intake adjusted dietary pattern score was associated with an increase in animal-based protein together with a decrease in plant-based protein, dietary fiber, and an unfavorable fatty acid composition. Besides BCAA, alanine, lysine and the aromatic AA were positively associated with the dietary pattern score as well. All of these factors were reported to be associated with risk of type 2 diabetes and cardiovascular diseases before. Our data suggest that rather than the dietary intake of BCAA, the overall dietary pattern that contributes to high BCAA plasma concentrations may modulate chronic diseases risk.

Background: The aim of the study was to compare the effects of different pacing strategies to prevent paroxysmal atrial fibrillation (AF): triggered atrial overdrive pacing versus the combination of triggered and continuous overdrive pacing. Methods: Patients with an indication for dual-chamber pacing (Selection 9000, Prevent AF; Vitatron B.V., Arnhem, the Netherlands) and a history of paroxysmal AF were randomized to triggered atrial pacing (three pacing functions, “triggered group”: PAC Suppression™, Post-PAC Response™, and Post-Exercise Response™) or to the combination of continuous (Pace Conditioning™) and triggered atrial pacing (four pacing functions, “combined group”). After 3 months, there was a crossover to the other pacemaker setting. Results: In 171 enrolled patients, the median AF burden of the combined group was with 2.1% versus 0.1% in the triggered group (P = 0.014). Fewer AF episodes were observed in the triggered (median: 7) than in the combined group (median: 116; P = 0.016). The combined group had more frequent atrial pacing (median 97%) than the triggered group with 85% (P < 0.001), but ventricular pacing was not significantly different with 95% and 96% in the combined and triggered group, respectively. After the crossover, the AF burden increased in the triggered group to 0.3% and decreased in the combined group to 0.4%. Conclusions: Triggered atrial pacing functions alone resulted in a low AF burden. The additional activation of continuous atrial overdrive pacing increased the percentage of atrial pacing, but had no beneficial effects on the prevention of paroxysmal AF.