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Heart Rate Variability (HRV) has been suggested as a useful tool to assess fatigue-sensitive psychological operations. The present study uses a between and within-subject design with a cognitively demanding task and a documentary viewing condition, to examine the temporal profile of HRV during reactivity, Time-on-Task (ToT), and recovery. In the cognitive task group, participants worked on a bimodal 2-back task with a game-like character (the Gatekeeper task) for about 1.5 hours, followed by a 12-minute break, and a post-break block of performance (about 18 min). In the other group, participants watched documentaries. We hypothesized an increasing vagal-mediated HRV as a function of Time spent on the Gatekeeper task and no HRV change in the documentary viewing group. We also analyzed the trial-based post-response cardiac activity as a physiological associate of task-related motivation. Relative to the documentary-viewing, ToT was associated with an elevated level of subjective fatigue, decreased heart rate, and increased HRV, particularly in the vagal-mediated components. Based on fatigued participants' post-error cardiac slowing, and post-error reaction time analyses, we found no evidence for motivation deficits. The present findings suggest that the parasympathetic branch of the autonomous nervous system functioning as a relaxation system tends to be activated under increasing mental fatigue. In addition, the study shows that many HRV indices also seem to change when individuals are engaged in a prolonged, less fatiguing activity (e.g. documentary viewing). This finding emphasizes the relevance of comparisons/control conditions in ToT experiments., Competing Interests: The authors have declared that no competing interests exist.

Computational flattening algorithms have been successfully applied to X-ray microtomography scans of damaged historical documents, but have so far been limited to scrolls, books, and documents with one or two folds. The challenge tackled here is to reconstruct the intricate folds, tucks, and slits of unopened letters secured shut with "letterlocking," a practice-systematized in this paper-which underpinned global communications security for centuries before modern envelopes. We present a fully automatic computational approach for reconstructing and virtually unfolding volumetric scans of a locked letter with complex internal folding, producing legible images of the letter's contents and crease pattern while preserving letterlocking evidence. We demonstrate our method on four letterpackets from Renaissance Europe, reading the contents of one unopened letter for the first time. Using the results of virtual unfolding, we situate our findings within a novel letterlocking categorization chart based on our study of 250,000 historical letters.

Numerous studies and meta-analyses have now confirmed that personality traits tend to correlate such that a general factor of personality (GFP) emerges. Nevertheless, there is an ongoing debate about what these correlations, and therefore the GFP, represents. One interpretation is that the GFP reflects a substantive factor that indicates general social effectiveness or emotional intelligence. Another interpretation is that the GFP merely is an artifact based on measurement or response bias. In the present paper, we elaborate on a selection of topics that are central to the debate about this construct. Specifically, we discuss (a) the GFP in relation to more specific personality dimensions (e.g., Big Five, facets), (b) the validity of the GFP and under what circumstances it seems to 'disappear', and (c) the theoretical and practical relevance of the general factor. Overall, the review should provide insight into the nature of the GFP and whether or not it represents a meaningful factor that can contribute to a better understanding of personality.

Flow is a state of full task absorption, accompanied with a strong drive and low levels of self-referential thinking. Flow is likely when there is a match between a person's skills and the task challenge. Despite its relevance for human performance and the vast body of research on flow, there is currently still relatively little insight in its underlying neurocognitive mechanisms. In this paper, we discuss a set of large brain networks that may be involved in establishing the core dimensions of flow. We propose that dopaminergic and noradrenergic systems mediate the intrinsic motivation and activate mood states that are typical for flow. The interaction between three large-scale attentional networks, namely the Default Mode Network, Central Executive Network and the Salience Network is proposed to play a role in the strong task engagement, low self-referential thinking, feedback and feelings of control in flow. The proposed relationships between flow and the brain networks may support the generation of new hypotheses and can guide future research in this field., (© 2020 The Authors. European Journal of Neuroscience published by Federation of European Neuroscience Societies and John Wiley & Sons Ltd.)

Behavioural studies revealed that the dog-human relationship resembles the human mother-child bond, but the underlying mechanisms remain unclear. Here, we report the results of a multi-method approach combining fMRI (N = 17), eye-tracking (N = 15), and behavioural preference tests (N = 24) to explore the engagement of an attachment-like system in dogs seeing human faces. We presented morph videos of the caregiver, a familiar person, and a stranger showing either happy or angry facial expressions. Regardless of emotion, viewing the caregiver activated brain regions associated with emotion and attachment processing in humans. In contrast, the stranger elicited activation mainly in brain regions related to visual and motor processing, and the familiar person relatively weak activations overall. While the majority of happy stimuli led to increased activation of the caudate nucleus associated with reward processing, angry stimuli led to activations in limbic regions. Both the eye-tracking and preference test data supported the superior role of the caregiver's face and were in line with the findings from the fMRI experiment. While preliminary, these findings indicate that cutting across different levels, from brain to behaviour, can provide novel and converging insights into the engagement of the putative attachment system when dogs interact with humans.

Background: Varicella and measles infections can be life-threatening after solid organ transplantation (SOT) but may be preventable with live-attenuated vaccines (LAV)., Methods: This survey conducted in January 2019 among subscribers of the International Pediatric Transplantation Association listserv aimed to explore the current strategies to prevent and manage both infections in the pediatric SOT population, including recommending LAV after SOT., Results: The answers given by 95 pediatric SOT healthcare workers show that these strategies are not yet optimal and call for further education. In particular, 59% of respondents are unnecessarily waiting for a SOT candidate to be >1 year of age to start administrating LAV before SOT. Interestingly, most respondents are willing to administer LAV after SOT (57%), and a fifth (21%) are already doing so, off-label. The survey queried the precautions taken to improve safety evaluations after LAV, and identified knowledge gaps and practitioners' concerns., Conclusion: The results of this survey could be used as a starting point for education and promotion of the safe administration of LAV in carefully selected SOT recipients; in turn, this would increase available data that would contribute to the development of evidence-based guidelines by the transplant societies and ultimately prevent these infections after SOT., (© 2020 Wiley Periodicals LLC.)

The negative association between cognitive intelligence (CI) and religiosity has been widely studied and is now well documented. In contrast, the role of emotional intelligence (EI) in this context has been poorly investigated thus far. Some available data indicate that EI, unlike CI, correlates positively with religiosity. To date, however, no study has explored the relationship between religiosity and both intelligences simultaneously. In current studies (Ns = 301 and 200), we examined the interplay between all three constructs. The results showed that CI was positively correlated with ability EI and negatively with some measures of religiosity. EI, on the other hand, revealed no direct, significant relationship with religiosity. However, when combined into a single regression model with CI, EI became a significant positive predictor of religiosity. Moreover, Study 2 revealed that the link between EI and religiosity was mediated by empathy. Interestingly, we also found a reciprocal suppression between CI and EI, since both predictors increased their influence on religiosity when analyzed together. Although the suppression was present in both studies, it was observed for different religiosity measures in each case, indicating that this effect is probably dependent on various factors, such as sample structure or type of religiosity.

Introduction: Management of antiretroviral-drug resistance in HIV-infected children is a global health concern. We compared the long-term virological outcomes of two cohorts of children living in a rural setting of South Africa. The first cohort initiated treatment before one year and the second after two years of age. The aim of this study was to describe the long-term consequences of early treatment initiation in terms of viral load and drug-resistance., Methods: This retrospective study was conducted at the Edendale Hospital located in a peri-urban area of KwaZulu-Natal. Children were included during their planned appointment. Drug resistance was assessed genotypically on proviral DNA., Results: From the 161 children included in this study, 93 samples were successfully genotyped. Both cohorts had comparable viral loads, but children treated early more often presented NRTI or NNRTI mutations, while there was no difference for PI mutations rates., Conclusions: Treatment was highly effective when comparing virological outcomes in both early- and late-treated cohorts. The persistence of NNRTI mutations could lead to treatment failures in children older than 3 years initiating their therapy with a NNRTI, or for those switching from a PI to NNRTI based regimen. The accumulation of NRTI mutations may lead to a functional PI monotherapy and consequently to viral escape. To promote access to HIV genotyping in resource-limited settings is challenging but essential to avoid inappropriate therapy switches in case of virological failure, and to adapt national treatment guidelines in line with the epidemiology of resistance., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Severe acute malnutrition (SAM) remains a serious public health concern in low- and middle-income countries. Little is known about treatment outcomes of child inpatients in Intensive Therapeutic and Feeding Units. This study aimed to assess treatment outcomes of SAM and identify factors associated with mortality among children treated at Saint Joseph Nutritional Center, South Kivu, Eastern Democratic Republic of Congo., Methods: A retrospective hospital-based cross-sectional study was conducted on medical records of 633 severely malnourished children followed as inpatients at Saint Joseph Nutritional Center from July 2017 to December 2018. Data were entered, thoroughly cleaned and analyzed in SPSS version 25. Univariable and multivariable logistic regression model were fitted to identify factors associated with mortality., Results: Among 633 patients admitted with SAM, 13.1% were lost to follow-up and 9.2% died while in hospital. Children with late referral to the health facility (> 14 days) after the onset of main external malnutrition signs had 2.03 times higher odds of death than those referred less than 14 days [AOR = 2.03 at 95%CI (1.12, 3.68)]. The odds of death was 1.91 times higher for children with MUAC < 115 mm than for those with MUAC ≥ 115 mm [AOR = 1.91 at 95% CI (1.05, 3.50)]. Children infected with HIV were 3.90 times more likely to die compared to their counterparts [AOR = 3.90 at 95% CI (2.80, 9.41)]., Conclusion: Particular emphasis should be placed on partnering with communities to improve information on malnutrition signs and on critical importance of early referral to the health system. While HIV incidence in DRC is still low (0.21%), its impact on mortality among severely malnourished children is increased due to the limited access to HIV testing and antiretroviral therapy., Competing Interests: The authors have declared that no competing interests exist.

Numerous studies have found a negative relationship between religiousness and IQ. It is in the region of - 0.2, according to meta-analyses. The reasons for this relationship are, however, unknown. It has been suggested that higher intelligence leads to greater attraction to science, or that it helps to override evolved cognitive dispositions such as for religiousness. Either way, such explanations assume that the religion-IQ nexus is on general intelligence (g), rather than some subset of specialized cognitive abilities. In other words, they assume it is a Jensen effect. Two large datasets comparing groups with different levels of religiousness show that their IQ differences are not on g and must, therefore, be attributed to specialized abilities. An analysis of the specialized abilities on which the religious and non-religious groups differ reveals no clear pattern. We cautiously suggest that this may be explicable in terms of autism spectrum disorder traits among people with high IQ scores, because such traits are negatively associated with religiousness.

Purpose: Granulomatous inflammation is a common cause of subacute cervicofacial lymphadenitis in children. Nontuberculous mycobacterial (NTM) infections and cat-scratch disease (CSD) are the most frequent causes. Optimal treatment, which may include surgery, antibiotic treatment or wait-and-see approach, is debatable. The goal of this study was to compare the short- and long-term outcome of various surgical procedures., Methods: Case series with a chart review of all children treated by surgical excision of granulomatous lymph nodes in the cervicofacial area from 2000 to 2016 at two tertiary care centers., Results: Forty patients were included in this study. The median age at first symptoms was 3.7 years (13 months-14 years). Mean follow-up was 5.8 years (6 months-15.3 years). 25 patients fit with diagnosis of NTM infection, 6 with CSD while diagnosis remained uncertain in 9 patients. The primary surgical procedure consisted of total excision (n = 27), incision/drainage (n = 9) or incomplete excision (n = 4). None of the patients treated by primary complete excision needed further intervention contrary to the group of patients with incomplete surgical procedures where additional surgical management was required in 54%. At follow-up, all patients were healthy without evidence of recurrence., Conclusion: We advocate early surgical intervention with complete excision to reach quick resolution and reduce the need for additional surgery. The long-term outcome was favorable.

Introduction: In most industrialized countries, human immunodeficiency virus (HIV) infection remains a formal contraindication to breastfeeding. However, for the past 9 years, the World Health Organization (WHO) has recommended, for developing countries, that mothers infected with HIV and treated by combined antiretroviral therapy (cART) should breastfeed their infants. HIV-infected women coming from developing countries and living in industrialized settings are increasingly expressing their natural desire to breastfeed. To avoid uncontrolled breastfeeding practices and reduce the risk of mother-to-child transmission of the virus, there is an urgent need to consider the wishes of these women. Discussion: We report two cases in which specific guidelines were implemented in order to support the mothers' choice to breastfeed in Belgium. As a result of different prophylactic measures including antiretrovirals in mothers and infants and close follow-up, none of the infants were infected. Conclusions: National or international recommendations for HIV-infected mothers who choose to breastfeed in industrialized countries remain unclear and discordant. There is an unmet need for experts to address this emerging issue and to develop an international consensus for the monitoring and prophylactic management of exposed-infants., (Copyright © 2020 Bansaccal, Van der Linden, Marot and Belkhir.)

Computational approaches were called for to address the challenges of more objective behavior assessment which would be less reliant on owner reports. This study aims to use computational analysis for investigating a hypothesis that dogs with ADHD-like (attention deficit hyperactivity disorder) behavior exhibit characteristic movement patterns directly observable during veterinary consultation. Behavioral consultations of 12 dogs medically treated due to ADHD-like behavior were recorded, as well as of a control group of 12 dogs with no reported behavioral problems. Computational analysis with a self-developed tool based on computer vision and machine learning was performed, analyzing 12 movement parameters that can be extracted from automatic dog tracking data. Significant differences in seven movement parameters were found, which led to the identification of three dimensions of movement patterns which may be instrumental for more objective assessment of ADHD-like behavior by clinicians, while being directly observable during consultation. These include (i) high speed, (ii) large coverage of space, and (iii) constant re-orientation in space. Computational tools used on video data collected during consultation have the potential to support quantifiable assessment of ADHD-like behavior informed by the identified dimensions., Competing Interests: The authors declare no conflict of interest.

A 7-year-old child of Turkish origin presented with headache and vomiting in the context of prolonged fever of unknown source. At examination, oral candidiasis and chronic onychomycosis were noted. A Candida meningoencephalitis was diagnosed and intravenous Amphotericin B liposomal was given during 6 months relayed by oral Fluconazole after regression of CNS lesions was observed on MRI. A complete immune evaluation was performed, and genetic analysis detected homozygous CARD9 mutation. CARD9 deficiency have been associated with invasive candidiasis in otherwise healthy patients. Culture of the cerebrospinal fluid grew for multisensitive Candida albicans . Brain magnetic resonance (MRI) showed the presence of focal lesions in the left caudate nucleus and in the right cerebellar hemisphere. Medullar MRI showed diffuse meningeal nodular lesions. Treatment with intravenous amphotericin B liposomal was given during 6 months relayed by oral fluconazole after regression of CNS lesions was observed on MRI. A complete immune evaluation was performed and genetic analysis detected a homozygous CARD9 mutation. CARD9 deficiency have been associated with invasive candidiasis in otherwise healthy patients., (© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The modality appropriateness hypothesis argues that the auditory modality is preferred over the visual modality in tasks demanding temporal operations; hence, we predicted that responses to visual stimuli would be more sensitive to the detrimental effect of Time-on-Task. We used a bimodal temporal discrimination task. The factors were durational congruency between the modalities and the direction of modality-transmission. Participants needed to decide the duration of the cued stimulus (visual or auditory). The first five blocks of the task lasted about 1.5 h without rest [Time-on-Task (ToT) period]. The participants then had a 12-min break followed by an additional block of trials. Subjective fatigue, reaction time, error rates, and electrocardiographic data were recorded. In the visual modality, we found an enhanced congruency effect as a function of ToT. The cost of attentional shifting was higher in the auditory modality, but remained constant, suggesting that processing of auditory stimuli is robust against the effects of fatigue. Performance did not improve after the break, indicating that the effects of fatigue could not be overcome by taking a brief break. The heart rate variability (HRV) data showed that vagal inhibition increased with ToT, but this increase was not associated with the changes in performance., (Copyright © 2019 Matuz, Van der Linden, Topa and Csathó.)

Background: Meningitis can be caused by several viruses and bacteria. Identifying the causative pathogen as quickly as possible is crucial to initiate the most optimal therapy, as acute bacterial meningitis is associated with a significant morbidity and mortality. Bacterial meningitis requires antibiotics, as opposed to enteroviral meningitis, which only requires supportive therapy. Clinical presentation is usually not sufficient to differentiate between viral and bacterial meningitis, thereby necessitating cerebrospinal fluid (CSF) analysis by PCR and/or time-consuming bacterial cultures. However, collecting CSF in children is not always feasible and a rather invasive procedure., Methods: In 12 Belgian hospitals, we obtained acute blood samples from children with signs of meningitis (49 viral and 7 bacterial cases) (aged between 3 months and 16 years). After pathogen confirmation on CSF, the patient was asked to give a convalescent sample after recovery. 3' mRNA sequencing was performed to determine differentially expressed genes (DEGs) to create a host transcriptomic profile., Results: Enteroviral meningitis cases displayed the largest upregulated fold change enrichment in type I interferon production, response and signaling pathways. Patients with bacterial meningitis showed a significant upregulation of genes related to macrophage and neutrophil activation. We found several significantly DEGs between enteroviral and bacterial meningitis. Random forest classification showed that we were able to differentiate enteroviral from bacterial meningitis with an AUC of 0.982 on held-out samples., Conclusions: Enteroviral meningitis has an innate immunity signature with type 1 interferons as key players. Our classifier, based on blood host transcriptomic profiles of different meningitis cases, is a possible strong alternative for diagnosing enteroviral meningitis.

Emotional intelligence (EI) contributes to good performance and well-being in jobs that involve frequent interpersonal contact. However, as EI is composed of self- and other-focused dimensions, it remains unclear which dimensions are responsible for better performance and well-being. We hypothesized that other-focused EI dimensions in particular relate to task performance, whereas self-focused EI dimensions relate to employees' subjective stress and physiological responses to emotional job demands. We asked Dutch secretaries ( N = 110) to professionally respond to five emotionally demanding work-related phone calls. The secretaries' skin conductance levels were recorded during the calls, and the secretaries had to indicate their stress levels after each call. Two independent raters coded the secretaries' effectiveness and the number of emotion regulation attempts during the phone calls. The results showed that other-focused emotion regulation was positively related to only one of the task performance indicators during three phone calls. In line with the hypotheses, self-focused emotion appraisal was negatively related to the secretaries' subjective stress levels after all the phone calls. Self-focused emotion regulation was positively related to the secretaries' skin conductance levels during all but one of the phone calls. This outcome suggests that self-focused EI dimensions decrease the subjective experience of stress but are accompanied by physiological costs, whereas other-focused emotion regulation may be positively but weakly related to task performance in emotionally demanding contexts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Introduction: The presence of infections in the immediate pretransplant period poses challenges in decision-making. Delaying transplantation because of these infections may be required, but is associated with a risk to the potential recipient. The aim of this project was to develop a structured framework based on expert opinion to guide decision-making regarding the safety of transplantation for candidates with infection immediately before transplant, and to show how this framework can be applied to clinical scenarios., Methods: Categories were created as follows: Category A: no delay; Category B: brief delay (≤1 week); Category C: intermediate delay (>1 week); and Category D: more prolonged or indefinite delay. A survey containing 59 clinical scenarios was sent to members of the IPTA ID CARE committee. Answers were reviewed, and the level of agreement was characterized as follows: Level 1: ≥75% agreement; Level 2:51%-74% agreement; and Level 3: ≤50% agreement. 95% CIs were calculated for the mean overall agreement across 59 scenarios., Results: Among the panel, the agreement level ranged from 33% to 92% with the mean overall agreement across the 59 scenarios being 61%. For 7/59 scenarios, the lower bound of 95% CI was greater than 50%, indicating a difference at the 5% level of significance between the observed proportion and the chance level of 0.5., Summary: The document provides expert opinion regarding the need to delay transplantation in the setting of different infections. The most important points in the decision to proceed to SOT included the urgency of transplantation and the severity of infection., (© 2019 Wiley Periodicals, Inc.)

In various personality models, such as the Big Five, a consistent higher order general factor of personality (GFP) can be identified. One view in the literature is that the GFP reflects general social effectiveness. Most GFP studies, however, have been conducted in Western, educated, industrialized, and rich democracies (WEIRD). Therefore, to address the question of the universality of the GFP, we test whether the GFP can also be identified in a preliterate indigenous sample of Tsimane by using self-reports, spouse reports, and interviewer ratings. In the Tsimane, a viable GFP could be identified and the intercorrelations between personality traits were significantly stronger than in samples from industrial countries. The GFP correlated with the ratings of social engagement. In addition, self and spouse ratings of the GFP overlapped. Overall, the findings are in line with the notion that the GFP is a human universal and a substantive personality factor reflecting social effectiveness., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In response to the influx of displaced Syrians since 2011, the Jordanian National Tuberculosis Program (NTP) implemented a specific Tuberculosis (TB) reduction strategy, including contact-tracing (CT). Contacts of all refugees diagnosed with pulmonary TB (PTB) were registered by the International Organization for Migration and screened for active & latent TB infection (LTBI) in 6 NTP centres.The objectives of this study were to assess prevalence of active TB and LTBI, risk factors for LTBI as well as program performance., Methods: We performed a retrospective study among contacts ( N  = 481) of all PTB cases diagnosed between March 2011 and May 2014 ( N  = 76). CT was performed using verbal screening of TB-related symptoms, tuberculin skin test (TST) and chest X-ray., Results: LTBI was diagnosed in 24.1% of contacts tested with TST while active TB was diagnosed in 2.1% of contacts. Main risk factors for positive TST included smear-positive index case (IC) (OR: 6.33) and previous TB infection in the family (OR: 4.94). Among children, the risk of LTBI was higher when their IC was a care-giving female (OR: 2.83). Prevalence of active TB was two times higher in children under five (U5 s) (5.3%) compared to adults (2.5%)., Conclusion: We found a high prevalence of active TB and LTBI among contacts of PTB cases in the Syrian refugee population, emphasizing the urgent need for host countries to implement CT strategies for refugees. Our results underscore the vulnerability of U5s and contacts of smear-positive IC highlighting the need for specific actions focusing on those groups., Competing Interests: This study was reviewed and approved by the institutional ethical committee of the Université Catholique de Louvain (UCL), Brussels.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

A previous meta-analysis (Van der Linden et al., Psychol Bull 143:36-52, 2017) showed that the General Factor of Personality (GFP) overlaps with ability as well as trait emotional intelligence (EI). The correlation between trait EI and the GFP was so high (ρ = 0.88) in that meta-analysis that these two may be considered virtually identical constructs. The present study builds on these findings by examining whether the strong phenotypic correlation between the GFP and trait EI has a genetic component. In a sample of monozygotic and dizygotic twins, the heritability estimates for the GFP and trait EI were 53 and 45%, respectively. Moreover, there was a strong genetic correlation of r = .90 between the GFP and trait EI. Additional analyses suggested that a substantial proportion of the genetic correlations reflects non-additive genetic effects (e.g., dominance and epistasis). These findings are discussed in light of evolutionary accounts of the GFP.

Introduction: Current international guidelines recommend to treat all HIV-1 infected patients regardless of CD4 cell count. Despite the remarkable worldwide progress for universal access to antiretroviral during the last decade, the pediatric population remains fragile due to lack of randomized studies, inappropriate antiretroviral formulations, adherence difficulties, drug toxicity and development of resistance., Areas Covered: This review summarizes the latest recommendations and advances for the treatment of HIV-infected children and highlights the potential complications of a lifelong antiretroviral treatment initiated early in life., Expert Opinion: International guidelines recommend to start combination antiretroviral therapy (cART) as fast as possible in all children diagnosed with HIV-1. The principal goal is to improve survival and reduce mortality as well as rapidly decrease HIV reservoirs. This remains a challenge in resource-limited settings were diagnostic tools and treatment access may be limited. Different new strategies are in the pipeline such as immunotherapy in combination with very early cART initiation to seek remission or functional cure. For the time being and awaiting for long term remission or cure, there is a need for further pharmacokinetics studies, more pediatric formulations with improved palatability and implementation of randomized trials for the newer antiretroviral drugs.

Using data from the Texas Twin Project, it was recently reported that 7 measures of character covaried to the extent that they formed a general factor of character (Tucker-Drob, Briley, Engelhardt, Mann, & Harden, 2016 ). In turn the relationship between the general factor of character and the Big Five personality traits were examined. It was found that personality was associated with the general factor of character primarily through the traits of conscientiousness and openness. For several reasons we propose that a more accurate interpretation of the data is that a Big Five personality traits form a general factor of personality, and that the relationship between the general character factor and personality is primarily through the general factor of personality. The results lend some support to this contention and are discussed in relation to the growing interest in covariation among multiple personality traits.

Aims: To examine nurse-perceived quality of care, controlling for overall job satisfaction among critical care nurses and to explore associations with work environment characteristics., Background: Nurse-perceived quality of care and job satisfaction have been positively linked to quality outcomes for nurses and patients. Much evidence exists on factors contributing to job satisfaction. Understanding specific factors that affect nurse-perceived quality potentially enables for improvements of nursing care quality., Design: A multicentre survey study was conducted in three Dutch intensive care units., Methods: The Dutch version of the Essentials of Magnetism II questionnaire was used; including the single-item indicators: (i) nurse-perceived quality of care; (ii) overall job satisfaction; and (iii) 58 statements on work environments. Data were collected between October 2013 - June 2014., Results: The majority of 123 responding nurses (response rate 45%) were more than satisfied with quality of care (55%) and with their job (66%). No associations were found with nurse characteristics, besides differences in job satisfaction between the units. After controlling for job satisfaction, nurse-perceived quality was positively associated with the work environment characteristics: adequacy of staffing, patient-centeredness, competent peers and support for education. Patient-centeredness and autonomy were the most important predictors for overall job satisfaction., Conclusion: Factors that contribute to nurse-perceived quality of care in intensive care units, independent from the effects of overall job satisfaction, were identified. Hereby, offering opportunities to maximize high quality of care to critically ill patients. Research in a larger sample is needed to confirm our findings., (© 2016 John Wiley & Sons Ltd.)

Aim: To identify nurses' barriers and facilitators to monitoring of nurse-sensitive outcomes in intensive care units (ICUs), and to explore influential nurse characteristics and work environment factors., Design: A cross-sectional survey in three Dutch ICUs between October 2013 - June 2014., Methods: A questionnaire with questions regarding facilitators and three types of barriers: knowledge, attitude and behaviour. The Dutch Essentials of Magnetism II was used to examine work environments., Results: All 126 responding nurses identified pressure ulcers and patient satisfaction as outcomes that are nurse-sensitive and nurses' full responsibility. Lack of time (behaviour) was perceived as the most prominent barrier, followed by unfamiliarity with mandatory indicators (knowledge), and unreliability of indicators as benchmark data (attitude). Education and clear policies were relevant facilitators. Of nurse characteristics, only regularity of shifts was related to perceived attitude related barriers. The work environment factor "clinical autonomy" was potentially associated with behaviour related barriers.

We conducted an online survey including 306 participants aged 18-64 years to assess the general factor of personality (GFP) and Big Five personality traits in relation to individual stress and coping reactions following a shooting emergency alarm at a Swiss university campus. Although the emergency eventually turned out to be a false alarm, various witnesses showed pronounced distress owing to a vast police operation. The GFP structure was replicated using two alternative modelling approaches. Neuroticism related substantially to acute fear and traumatic distress as well as to more enduring maladaptive coping. Agreeableness was negatively associated with the coping strategy of medication use, whereas both agreeableness and conscientiousness related positively to social activity following the emergency. The GFP related moderately to peri-traumatic distress and showed a substantial negative association with medication use and a strong positive association with social activity. In conclusion, both the GFP and Big Five traits significantly moderate stress responses following a stressful life event. The GFP predominantly relates to socially adaptive coping, whereas in particular neuroticism accounts for acute stress reactions such as fear and traumatic distress. These findings support the notion that personality influences how persons react in the face of adversity. Copyright © 2016 John Wiley & Sons, Ltd., (Copyright © 2016 John Wiley & Sons, Ltd.)

Introduction: In the field of tuberculosis (TB), and particularly in regard to paediatric TB (PedTB), clinical skills of health professionals play an important role in determining quality of care. In an era where novel diagnostic technologies and efficient treatment regimens are being made available for the poorest, we must not divert our attention from the importance of clinical skills, as this deliverable remains the cornerstone of individualized patient care and ultimately the best assurance for optimal use of resources. The aim of our work was to study the epidemiology of PedTB and the determinants of PedTB under-detection in the South-Kivu Province of the Democratic Republic of Congo (DRC), a setting with nearly no technical resources allowing to support the clinical diagnosis of PedTB, i.e. chest X-rays, rapid molecular tests or culture laboratories., Methods: We collected TB notification data from 2010 to 2015 and analysed the space-time variations in notification for the different forms of TB among the 113 health facilities (HF) the South-Kivu Province, a region with a low HIV incidence. The different forms of TB notified were: smear positive pulmonary TB (SS+PTB), smear negative pulmonary TB (SS-PTB) and extra-pulmonary TB (EPTB). We further analysed the distribution of these different forms of the disease per age group and explored the possibility to predict the detection of PedTB., Results: Significant differences were observed between HF in regard to the proportion of paediatric TB and the proportion of SS-TB among adults. We found a strong correlation between the proportion of PedTB and three major factors: the proportion of TB cases with no bacteriological confirmation (SS-TB) among adults, the number of TB cases notified by the HF and the fact that the HF was supported or not by Médecins Sans Frontières (MSF). The proportion of SS-TB among adults was found to be a valid indicator for predicting the level of detection of PedTB at the same HF., Conclusion: Our observations strongly suggest that under-detection of PedTB is associated with insufficient clinical skills and technical resources at the HF level which similarly affects other forms of the disease, in particular SS-TB. We demonstrated that, in the specific context of South-Kivu, under-detection of PedTB can be predicted by a low SS-TB/SS+PTB ratio in the adult population. In the context of severely under-resourced settings, this ratio could be used to rapidly identify HF that should benefit in priority from deeper evaluation, and eventually targeted interventions., Competing Interests: The authors have declared that no competing interests exist.

Prevalence of Human-Immunodeficiency-Virus/Hepatitis-B-virus (HIV/HBV) coinfection and HBV vaccination response in children are unknown in Kwazulu-Natal. This study included 183 HIV-infected and 108 HIV-uninfected children aged between 5 and 15 years screened for HBV infection and vaccination. HBV infection occurred in 2.1% and 0% of HIV-infected and uninfected children respectively. Serological response to immunization was shown in 15.8% and 61.1% of HIV-infected and uninfected children, respectively (P < 0.001). Even if prevalence of HBV infection was low in these cohorts, HIV-infected children will stay at risk of infection if the vaccine schedule is not adapted. J. Med. Virol. 89:182-185, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Apparently inconsistent with the CLASH model, animal research relates predictable environments to rigid routine behaviors and aggression. However, our work on evolutionary and neural adaptations to (un)predictable environments may be able to reconcile the CLASH model with the animal research, but also suggests complexities beyond the dichotomous approach of CLASH.

We examine the relationship between the general factor of personality (GFP) and emotional intelligence (EI) and specifically test the hypothesis that the GFP is a social effectiveness factor overlapping conceptually with EI. Presented is an extensive meta-analysis in which the associations between the GFP, extracted from the Big Five dimensions, with various EI measures is examined. Based on a total sample of k = 142 data sources (N = 36,268) the 2 major findings from the meta-analysis were (a) a large overlap between the GFP and trait EI (r ≈ .85); and (b) a positive, but more moderate, correlation with ability EI (r ≈ .28). These findings show that high-GFP individuals score higher on trait and ability EI, supporting the notion that the GFP is a social effectiveness factor. The findings also suggest that the GFP is very similar, perhaps even synonymous, to trait EI. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Background: Deliberate screening allows detection of health risks that are otherwise not noticeable and allows expedient intervention to minimize complications and optimize outcomes, especially during critical events like hospitalization. Little research has evaluated the usefulness of screening performance and outcome indicators as measures to differentiate nursing quality, although policymakers are using them to benchmark hospitals., Objectives: The aims of this study were to examine hospital performance based on nursing-sensitive screening indicators and to assess associations with hospital characteristics and nursing-sensitive outcomes for patients., Methods: A secondary use of nursing-sensitive data from the Dutch Health Care Inspectorate was performed, including the mandatory screening and outcome indicators related to delirium, malnutrition, pain and pressure ulcers. The sample consisted of all 93 hospitals in the Netherlands in 2011. High- and low-performing hospitals were determined based on the overall proportion of screened patients. Descriptive statistics and analysis of variance were used to examine screening performances in relation to hospital characteristics and nursing-sensitive outcomes., Results: Over all hospitals, the average screening rates ranged from 59% (delirium) to 94% (pain). Organizational characteristics were not different in high- and low-performing hospitals. The hospitals with the best overall screening performances had significantly better results regarding protein intake within malnourished patients (p < .01). For mortality, marginal significant effects did not remain after controlling for organizational structures. No associations were found with prevalence of pressure ulcers and patient self-reported pain scores., Discussion: The screening for patient risks is an important nursing task. Our findings suggest that nursing-sensitive screening indicators may be relevant measures for benchmarking nursing quality in hospitals. Time-trend studies are required to support our findings and to further investigate relations with nursing-sensitive outcomes.

Background: Little is known on outcomes after transition to adult care among adolescents with perinatal HIV infection. Though there is data from other chronic pediatric diseases suggesting increased morbidity and mortality following transfer to adult care, this has not well been studied among the first wave of survivors of perinatal HIV infection. The primary objective of this study was to determine outcomes after transition to adult care among a cohort of HIV-infected adolescents in Québec, Canada. Secondary objectives were to document participant experiences with the transition process, identify barriers to successful transition, and potential changes to improve the transition process., Methods: Clinic records were reviewed to identify all perinatally-infected youth who transitioned from the Centre Maternel et Infantile sur le Sida pediatric HIV clinic (Montreal) at age 18 to an adult care provider between 1999 and 2012. Transitioned patients were contacted using last available patient or parental listed phone number on hospital record, internet based telephone directory, or social media. A standardized questionnaire was administered by telephone or in-person interview, and copies of current medical records obtained from treating physicians., Results: Forty-five patients were transferred between 1999 and 2012, among whom 25 consented to the study, eight were lost to follow-up, eight refused participation, and four were deceased. Overall 76 % of patients remained engaged in care, defined by at least one physician visit within 6 months of the interview. Over 50 % reported difficulty with adherence to their current drug regimens. At one-year post-transfer, there was a decrease in the proportion of patients with CD4 count >500 cells/mm(3) from 64 to 29 %, and a statistically significant decrease in absolute CD4 count (mean 370 vs 524 cells/mm(3), p = 0.04.). The majority (92 %) of participants felt that 18 was too young an age to transfer to adult care, and provided suggestions for improving the transition process., Conclusions: This group of perinatally-infected youth remained engaged in care after transition, however difficulties with adherence and assuming responsibility for their own care were identified as issues in their post-transition care. The high rate of mortality among them and the changes to their health status post-transition suggest that further work is necessary to document the health outcomes of this group in larger, more diverse cohort settings.

There is an increasing amount of evidence that during mental fatigue, shifts in motivation drive performance rather than reductions in finite mental energy. So far, studies that investigated such an approach have mainly focused on cognitive indicators of task engagement that were measured during controlled tasks, offering limited to no alternative stimuli. Therefore it remained unclear whether during fatigue, attention is diverted to stimuli that are unrelated to the task, or whether fatigued individuals still focused on the task but were unable to use their cognitive resources efficiently. With a combination of subjective, EEG, pupil, eye-tracking, and performance measures the present study investigated the influence of mental fatigue on a cognitive task which also contained alternative task-unrelated stimuli. With increasing time-on-task, task engagement and performance decreased, but there was no significant decrease in gaze toward the task-related stimuli. After increasing the task rewards, irrelevant rewarding stimuli where largely ignored, and task engagement and performance were restored, even though participants still reported to be highly fatigued. Overall, these findings support an explanation of less efficient processing of the task that is influenced by motivational cost/reward tradeoffs, rather than a depletion of a finite mental energy resource. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

The purpose was to reexamine cognitive performance and cortisol levels of initial clinical burnout patients, non-clinical burnout individuals, and healthy controls. After 1.5-years of the initial measurement, clinical burnout patients showed a reduction of burnout symptoms and general physical and psychological complaints, but these were still elevated compared with controls. Nonetheless, they continued to report cognitive problems and still showed a minor impaired cognitive test performance. However, they no longer reported larger subjective costs associated with cognitive test performance and their cortisol awakening response (CAR) returned to a normal level. Compared with controls, non-clinical burnout individuals still reported the same, elevated, level of burnout symptoms, general physical and psychological complaints, and cognitive problems. Their cognitive test performance and associated subjective costs remained normal. However, they seemed to continue to display a lowered CAR. To conclude, after 1.5-years, clinical burnout patients got better, but not 'well', and non-clinical burnout individuals remained not 'well'., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care., Methods: To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the publicly reported nurse-sensitive indicators: screening of delirium, screening of malnutrition, and pain assessments, were averaged (2011). Nurse-perceived quality ratings were obtained from staff nurses working in the same hospitals by the Dutch Essentials of Magnetism II survey (2010). Concordance between the quality measures was analyzed using Spearman's rank correlation., Results: The mean screening performances ranged from 63% to 93% across the six hospitals. Nurse-perceived quality of care differed significantly between the hospitals, also after adjusting for nursing experience, educational level, and regularity of shifts. The hospitals with high-levels of nurse-perceived quality were also high-performing hospitals according to nurse-sensitive indicators. The relationship was true for high-performing as well as lower-performing hospitals, with strong correlations between the two quality measures (rS = 0.943, p = 0.005)., Conclusions: Our findings showed that there is a significant positive association between objectively measured nurse-sensitive screening indicators and subjectively measured perception of quality. Moreover, the two indicators of quality of nursing care provide corresponding quality rankings. This implies that improving factors that are associated with nurses' perception of what they believe to be quality of care may also lead to better screening processes. Although convergent validity seems to be established, we emphasize that different kinds of quality measures could be used to complement each other, because various stakeholders may assign different values to the quality of nursing care.

Although mental fatigue is a complex, multi-facetted state that involves changes in motivation, cognition, and mood, one of its main characteristics is reduced task engagement. Despite its relevance for performance and safety, knowledge about the underlying neurocognitive processes in mental fatigue is still limited. Inspired by the idea that central norepinephrine plays an important role in regulating task engagement, we test a set of predictions that have been derived from recent studies that relate pupil dynamics to the levels of norepinephrine in the brain. Participants worked on a 2-back task for 2h while we used pupil measures to further explore the link between task engagement and the effects of mental fatigue. We hypothesized that baseline pupil diameter and stimulus-evoked pupil dilations decrease with increasing fatigue. Also, because previous studies have shown that the effects of fatigue are reversible by increasing the task rewards, we hypothesized that increasing the task rewards after 2h on the task would restore these pupil measures to pre-fatigue levels. While we did not find a decrease in baseline pupil diameter, we found that increasing mental fatigue coincided with diminished stimulus-evoked pupil dilation. Also, we confirmed that when sufficient rewards were presented to a fatigued individual, the pupil dilations could be restored. This supports the view that motivational factors are important in predicting engagement versus disengagement during fatigue., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Parkinson's disease (PD) is preceded by a premotor phase of unknown duration. Dopaminergic degeneration during this phase may lead to subtle cognitive and behavioural changes, such as decreased novelty seeking. Consequently, premotor subjects might be most comfortable in jobs that do not require optimal dopamine levels, leading to an overrepresentation in structured and predictable occupations, or an underrepresentation in artistic occupations. In a case-control study, 750 men with PD (onset ≥40 years) and 1300 healthy men completed a validated questionnaire about their lifetime occupational status. Occupations were classified using the RIASEC model. Odds ratios (ORs) were calculated for the conventional and artistic categories, both for the most recent occupation before symptom onset, and for the very first occupation. Because farming has been associated with a PD risk, ORs were calculated separately for farming. A reduced risk of PD was found for men with an artistic occupation late in life (OR 0.14, 95% CI 0.04-0.53), while an artistic first occupation did not prevent PD (OR 0.72, CI 0.32-1.59). Conventional occupations showed no increased risk (recent: OR 1.07, CI 0.70-1.64; first: OR 1.14, CI 0.77-1.71). In support of previous reports, farming was associated with an increased risk of PD (recent: OR 2.6, CI 1.4-4.6; first: OR 2.7, CI 1.6-4.5). PD patients were older than controls, but various statistical corrections for age all lead to similar results. Artistic occupations late in life are associated with a reduced risk of subsequent PD, perhaps because this reflects a better preserved dopaminergic state. No initial occupation predicted PD, suggesting that the premotor phase starts later in life.

Objective: Tiredness, low energy, and listlessness are common symptoms to be associated with depression. The question remains to what extent these symptoms influence the effects of fatigue on sustained performance tasks, such as impaired task engagement and performance. Based on earlier findings, it was hypothesized that dysphoric (i.e., mildly depressed) individuals, compared to healthy controls, would display earlier fatigue onset and more severe fatigue effects on task engagement and performance during a cognitive task., Methods: Sixty-one dysphoric and twenty-one non-dysphoric control participants were compared during one hour of continuous performance on a 2-back task. During the task subjective fatigue, subjective engagement, objective task performance, baseline pupil diameter and stimulus-evoked pupil dilation were measured., Results: While we found that the dysphoric group reported relatively higher subjective fatigue than the healthy control group at the start of the experiment, we did not find any other divergent fatigue effects during the experimental task., Conclusion: One explanation for the absence of divergent effect is that dysphoria may not have such a profound impact on available cognitive resources, like attention, as initially thought. Based on the results of the present study, we conclude that dysphoria is not necessarily an increased risk factor for impaired sustained performance on cognitive tasks that may induce mental fatigue.

Background: Invasive infections of the central nervous system (CNS) or digestive tract caused by commensal fungi of the genus Candida are rare and life-threatening. The known risk factors include acquired and inherited immunodeficiencies, with patients often displaying a history of multiple infections. Cases of meningoencephalitis, colitis, or both caused by Candida species remain unexplained., Objective: We studied 5 previously healthy children and adults with unexplained invasive disease of the CNS, digestive tract, or both caused by Candida species. The patients were aged 39, 7, 17, 37, and 26 years at the time of infection and were unrelated, but each was born to consanguineous parents of Turkish (2 patients), Iranian, Moroccan, or Pakistani origin. Meningoencephalitis was reported in 3 patients, meningoencephalitis associated with colitis was reported in a fourth patient, and the fifth patient had colitis only., Methods: Inherited caspase recruitment domain family, member 9 (CARD9) deficiency was recently reported in otherwise healthy patients with other forms of severe disease caused by Candida, Trichophyton, Phialophora, and Exophiala species, including meningoencephalitis but not colitis caused by Candida and Exophiala species. Therefore we sequenced CARD9 in the 5 patients., Results: All patients were found to be homozygous for rare and deleterious mutant CARD9 alleles: R70W and Q289* for the 3 patients with Candida albicans-induced meningoencephalitis, R35Q for the patient with meningoencephalitis and colitis caused by Candida glabrata, and Q295* for the patient with Candida albicans-induced colitis. Regardless of their levels of mutant CARD9 protein, the patients' monocyte-derived dendritic cells responded poorly to CARD9-dependent fungal agonists (curdlan, heat-killed C albicans, Saccharomyces cerevisiae, and Exophiala dermatitidis)., Conclusion: Invasive infections of the CNS or digestive tract caused by Candida species in previously healthy children and even adults might be caused by inherited CARD9 deficiency., (Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Objective: Although the relationship between burnout and cortisol levels has been examined in previous studies, the results are mixed. By adopting a design in which we attempted to overcome important limitations of earlier research, the purpose of the present study was to improve the understanding of the biological underpinnings of burnout and to further the knowledge about the relationship between burnout and cortisol., Methods: A clinical burnout patient group (n =32), a non-clinical burnout group (n =29), and a healthy control group (n =30) were compared on burnout symptoms, physical and psychological complaints, and on cortisol levels. In order to examine a broad range of cortisol indices, including different measures of the cortisol awakening response (CAR) and several day-curve measures, salivary cortisol was collected six times a day during two consecutive non-workdays., Results: As expected, the clinical burnout group reported more burnout symptoms, and physical and psychological complaints than the non-clinical burnout group, which in turn reported more burnout symptoms and physical and psychological complaints than the healthy control group. With regard to cortisol levels, we found that until 30 min after awakening, the CAR of both the clinical and the non-clinical burnout group was lower compared with the healthy control group. Furthermore, there was some evidence that the decline of cortisol during the day was smaller in the non-clinical burnout group than in the healthy control group., Conclusion: The results of the present study provide support for lowered cortisol in both clinical and non-clinical burnout., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Mental fatigue is often characterized by reduced motivation for effortful activity and impaired task performance. We used subjective, behavioral (performance), and psychophysiological (P3, pupil diameter) measures during an n-back task to investigate the link between mental fatigue and task disengagement. After 2 h, we manipulated the rewards to examine a possible reengagement effect. Analyses showed that, with increasing fatigue and time-on-task, performance, P3 amplitude, and pupil diameter decreased. After increasing the rewards, all measures reverted to higher levels. Multilevel analysis revealed positive correlations between the used measures with time-on-task. We interpret these results as support for a strong link between task disengagement and mental fatigue., (© 2014 Society for Psychophysiological Research.)

Relatively little is known about cognitive performance in burnout. The aim of the present study was to further our knowledge on this topic by examining, in one study, cognitive performance in both clinical and non-clinical burnout while focusing on three interrelated aspects of cognitive performance, namely, self-reported cognitive problems, cognitive test performance, and subjective costs associated with cognitive test performance. To this aim, a clinical burnout patient group (n = 33), a non-clinical burnout group (n = 29), and a healthy control group (n = 30) were compared on self-reported cognitive problems, assessed by a questionnaire, as well as on cognitive test performance, assessed with a cognitive test battery measuring both executive functioning and more general cognitive processing. Self-reported fatigue, motivation, effort and demands were assessed to compare the different groups on subjective costs associated with cognitive test performance. The results indicated that the clinical burnout patients reported more cognitive problems than the individuals with non-clinical burnout, who in turn reported more cognitive problems relative to the healthy controls. Evidence for impaired cognitive test performance was only found in the clinical burnout patients. Relative to the healthy controls, these patients displayed some evidence of impaired general cognitive processing, reflected in slower reaction times, but no impaired executive functioning. However, cognitive test performance of the clinical burnout patients was related to larger reported subjective costs. In conclusion, although both the clinical and the non-clinical burnout group reported cognitive problems, evidence for a relatively mild impaired cognitive test performance and larger reported subjective cost associated with cognitive test performance was only found for the clinical burnout group.

The objective of this study was to evaluate the effects of parenteral administration of L-arginine (Arg) to well-fed twin-bearing ewes from day (d) 100 of pregnancy to birth on fetal growth, body composition and neonatal behavior. Ewes received an i.v. bolus of either 345 μmol Arg-HCl/kg bodyweight or saline solution (control) 3 times a day. At d 140 of pregnancy, Arg-supplemented and control ewes were euthanized and fetal weight and fetal organ weight recorded, and maternal and fetal plasma concentrations of amino acids, hormones and metabolites analyzed. A subset of ewes was allowed to lamb and birth weight, body dimensions and behavior of the lambs in the first 2 hours(h) following birth recorded and blood samples collected. At d 140 of pregnancy, fetal weight internal organ weights were unaffected by treatment with the exception of brown fat stores which were increased by 16% in fetuses from Arg-supplemented ewes relative to controls (P < 0.05). At birth, there was an interaction (P = 0.06) between treatment and sex for birth weight of the lamb. The ewe lambs from Arg-supplemented ewes were 12% (P < 0.05) heavier at birth compared with controls whereas birth weight of male lambs did not differ. These results indicate that maternal Arg supplementation enhanced brown fat stores in the fetus and countered some effect of fetal growth restriction due to litter size in female lambs. Increasing birth weight of female lambs and enhancing brown fat stores of all lambs may have important implications for lamb survival and postnatal growth.