Exploratory Multisite MR Spectroscopic Imaging Shows White Matter Neuroaxonal Loss Associated with Complications of Type 1 Diabetes in Children.

BACKGROUND AND PURPOSE: Type 1 diabetes affects over 200,000 children in the United States and is associated with an increased risk of cognitive dysfunction. Prior single-site, single-voxel MRS case reports and studies have identified associations between reduced NAA/Cr, a marker of neuroaxonal loss, and type 1 diabetes. However, NAA/Cr differences among children with various disease complications or across different brain tissues remain unclear. To better understand this phenomenon and the role of MRS in characterizing it, we conducted a multisite pilot study. MATERIALS AND METHODS: In 25 children, 6-14 years of age, with type 1 diabetes across 3 sites, we acquired T1WI and axial 2D MRSI along with phantom studies to calibrate scanner effects. We quantified tissue-weighted NAA/Cr in WM and deep GM and modeled them against study covariates. RESULTS: We found that MRSI differentiated WM and deep GM by NAA/Cr on the individual level. On the population level, we found significant negative associations of WM NAA/Cr with chronic hyperglycemia quantified by hemoglobin A1c (P < .005) and a history of diabetic ketoacidosis at disease onset (P < .05). We found a statistical interaction (P < .05) between A1c and ketoacidosis, suggesting that neuroaxonal loss from ketoacidosis may outweigh that from poor glucose control. These associations were not present in deep GM. CONCLUSIONS: Our pilot study suggests that MRSI differentiates GM and WM by NAA/Cr in this population, disease complications may lead to neuroaxonal loss in WM in children, and deeper investigation is warranted to further untangle how diabetic ketoacidosis and chronic hyperglycemia affect brain health and cognition in type 1 diabetes.

Patient-Centred Outcomes Following Tracheostomy in Critical Care.

INTRODUCTION: Around 20% of intensive care unit (ICU) patients undergo tracheostomy insertion and expect high-quality care concentrating on patient-centered outcomes including communication, oral intake, and mobilization. The majority of data has focused on timing, mortality, and resource utilization, with a paucity of information on quality of life following tracheostomy. METHODS: Single center retrospective study including all patients requiring tracheostomy from 2017 to 2019. Information collected on demographics, severity of illness, ICU and hospital length of stay (LOS), ICU and hospital mortality, discharge disposition, sedation, time to vocalization, swallow and mobilization. Outcomes were compared for early versus late tracheostomy (early =

Affective touch perception and longing for touch during the COVID-19 pandemic.

Interpersonal touch and affective touch play a crucial role in social interactions and have a positive influence on mental health. The social distancing regulations implemented during the COVID-19 pandemic have reduced the ability to engage in interpersonal touch. This could cause longing for touch, and it might subsequently alter the way in which affective touch is perceived. To investigate this, we conducted an online survey and included 1982 participants, which contained questions regarding the COVID-19 regulations, longing for touch, and the perceived pleasantness of affective and non-affective touch. Results showed that participants reported feelings of longing for touch. This significantly increased with the duration and severity of the COVID-19 regulations. In addition, participants who experienced more longing for touch rated videos of affective and non-affective touch as more pleasant. Current results provide insight in the impact of sudden and prolonged COVID-19 regulations and show that increasing the duration and severity of these regulations is associated with a higher desire for touch, which is associated with increased perceived pleasantness of observing touch.

Tomography reconstruction of beams extracted from an ion source.

Commissioning of the CANREB (CANadian Rare isotope facility with Electron Beam ion source) system and its associated beamlines has recently begun at TRIUMF. At the head of this beamline is an ion source used to produce stable alkaline ions with energy up to 60 keV for the CANREB system. Throughout commissioning, it is essential to have a means of verifying beam quality and ensuring that the required beam parameters along the beamline are met. This is accomplished using tomography reconstruction, which consists of taking one-dimensional scans at different projections and reconstructing an image of the beam in two dimensions using the maximum entropy algorithm. Tomography enables the visualization of the shape of the beam as well as the investigation into the possible presence of aberrations. Initially, tomography reconstruction is performed by using simulated beam profiles at the measurement locations and is then performed by using measured beam profiles. Additionally, these measurements are benchmarked by fitting the initial beam parameters in our beam optics model, and the results are presented.

Population Genomics of Nymphon australe Hodgson, 1902 (Pycnogonida, Nymphonidae) in the Western Antarctic.

Within the Southern Ocean, the Antarctic Circumpolar Current is hypothesized to facilitate a circumpolar distribution for many taxa, even though some, such as pycnogonids, are assumed to have limited ability to disperse, based on brooding life histories and adult ambulatory capabilities. With a number of contradictions to circumpolarity reported in the literature for other pycnogonids, alternative hypotheses have been explored, particularly for Nymphon australe, the most common species of Pycnogonida (sea spider) in the Southern Ocean. Glacial events have been hypothesized to impact the capacity of organisms to colonize suitable areas without ice coverage as refuge and without the eurybathic capacity to colonize deeper areas. In this study, we examine populations of one presumed circumpolar species, the pycnogonid N. australe, from throughout the Western Antarctic, using a 2b-RAD approach to detect genetic variation with single-nucleotide polymorphisms. Using this approach, we found that N. australe included two distinct groups from within >5000-km sampling region. By using a discriminant analysis of principle components, sparse nonnegative matrix factorization, and admixture coefficient analysis, two distinctive populations were revealed in the Western Antarctic: one covered distances greater than 5000 km (Weddell, Western Antarctic Peninsula, and Ross Sea), and the other shared limited connectivity entrained within the Amundsen Sea. Under further scrutiny of the 3086 single-nucleotide polymorphisms in the data set, only 78 loci had alignment stacks between the two populations. We propose that the populations analyzed are divergent enough to constitute two different species from within this common Antarctic genus known for its phenotypic plasticity.

Microplastics in Sewage Sludge: Effects of Treatment.

Waste water treatment plants (WWTPs) are receptors for the cumulative loading of microplastics (MPs) derived from industry, landfill, domestic wastewater and stormwater. The partitioning of MPs through the settlement processes of wastewater treatment results in the majority becoming entrained in the sewage sludge. This study characterized MPs in sludge samples from seven WWTPs in Ireland which use anaerobic digestion (AD), thermal drying (TD), or lime stabilization (LS) treatment processes. Abundances ranged from 4196 to 15 385 particles kg-1 (dry weight). Results of a general linear mixed model (GLMM) showed significantly higher abundances of MPs in smaller size classes in the LS samples, suggesting that the treatment process of LS shears MP particles. In contrast, lower abundances of MPs found in the AD samples suggests that this process may reduce MP abundances. Surface morphologies examined using scanning electron microscopy (SEM) showed characteristics of melting and blistering of TD MPs and shredding and flaking of LS MPs. This study highlights the potential for sewage sludge treatment processes to affect the risk of MP pollution prior to land spreading and may have implications for legislation governing the application of biosolids to agricultural land.

Characterization of patients with diabetic foot disease presenting to an Irish Podiatry Centre: profiling suitability for entry to a clinical trial of advanced wound therapeutics.

BACKGROUND: Diabetes mellitus, coined the 'Black Death of the Twenty-First Century', is associated with complications, including foot ulceration with potential loss of limb. There is a need for development of new wound therapies through completion of robust clinical trials. AIMS: To profile demographics and wound characteristics of an Irish cohort with diabetes, forecast eligibility for entry to a clinical trial of advanced wound therapeutics, and adjust criteria to optimize eligibility for enrolment. METHODS: A cross-sectional study of out-patients attending a Podiatry centre over 12 weeks was conducted. Information was collected through clinical assessment, including Neuropathy Disability Score and Ankle-Brachial Pressure Index. Ulcers were characterised as 'healing' or 'non-healing'; a 'healing' wound decreased by 30 % over the previous month, accomplished by retrospective analysis of files. Statistics, including binomial logistic regression and column analysis for eligibility assessment, were conducted. RESULTS: Seventy-four participants were identified with a mean age of 67 (± 8.79) years. Non-healing DFU status correlated significantly with larger wound area (P = 0.013), infection (P = 0.009), and greater degrees of ischaemia (P = 0.015). The eligibility criteria were modelled after those proposed by the EU consortium project REDDSTAR. In this Irish population, these criteria limit eligibility to 1.4 %. CONCLUSIONS: This research found an eligibility criterion of wound area 2-10 cm2 for enrolment in a clinical trial of mesenchymal stromal cell therapy too restrictive. Extension of wound area to 1-10 cm2 and the inclusion of neuro-ischaemic ulcers increased eligibility for enrolment from 1.4 to 20 %.

Lacking the 'protective label' of diabetes: Phenytoin-induced distal symmetrical peripheral neuropathy. A clinical case report.

This report documents an unusual case of distal symmetrical peripheral neuropathy (DSPN) in an otherwise healthy patient without diabetes mellitus (DM) presenting to a podiatric wound care clinic. The development of gas gangrene coupled with Charcot neuroarthropathic changes ultimately resulted in a potentially life-saving transmetatarsal (TMT) amputation. Causation of, or at least a contributor to, the DSPN was likely phenytoin usage for epileptic seizures. Long-term use of phenytoin can lead to axonal shrinkage and random clusters of nerve demyelination [1]. Clinical standards for DM-induced DSPN indicate that annual comprehensive neurological assessment to detect nerve function deterioration is warranted [2]. This can aid in identifying patients at high risk of diabetic foot ulceration. However, oftentimes, patients exhibiting medication-induced neuropathy are not assessed to determine severity of the neuropathy nor are they educated about ulcer prevention in the same manner as patients with DM. This report advocates for a standardized threshold of diagnostic and preventative investigation for neuropathy of all aetiologies; diabetic, traumatic, viral, medication-induced and idiopathic.

Heart rate recovery and parasympathetic modulation in boys and girls following maximal and submaximal exercise.

PURPOSE: This study examined heart rate recovery (HRR) and heart rate variability (HRV) following submaximal and maximal exercise in boys (n = 13; 10.1 ± 0.8 years) and girls (n = 12; 10.1 ± 0.7 years). METHODS: Participants completed 10 min of supine rest followed by a graded exercise test to maximal effort. On a separate day, participants performed submaximal exercise at ventilatory threshold. Immediately following both exercise bouts, 1-min HRR was assessed in the supine position. HRV variables were analyzed under controlled breathing in the time and frequency domains over the final 5 min of rest and recovery. RESULTS: There were no significant differences in HRR following maximal and submaximal exercise between boys (58 ± 8 and 59 ± 8 beats min(-1), respectively) and girls (54 ± 6 and 52 ± 19 beats min(-1), respectively). There also were no significant interactions between groups from rest to recovery from maximal exercise for any HRV variables. However, there was a difference in the response between sexes from rest to recovery from submaximal exercise for log transformed standard deviation of NN intervals (lnSDNN) and log transformed total power (lnTP). No differences were observed for lnSDNN at rest (boys = 4.61 ± 0.28 vs. girls = 4.28 ± 0.52 ms) or during recovery (lnSDNN: boys 3.78 ± 0.46 vs. girls 3.87 ± 0.64 ms and lnTP: boys 7.33 ± 1.09 vs. girls; 7.44 ± 1.24 ms(2)). Post hoc pairwise comparisons showed a significant difference between boys and girls for lnTP at rest (boys = 9.14 ± 0.42 vs. girls = 8.30 ± 1.05 ms(2)). CONCLUSION: Parasympathetic modulation was similar between boys and girls at rest and during recovery from exercise, which could explain similarities observed in HRR.

Counting platelets at transfusion threshold levels: impact on the decision to transfuse. A BEST Collaborative - UK NEQAS(H) International Exercise.

BACKGROUND AND OBJECTIVES: Obtaining accurate and precise platelet enumeration in automatic platelet analysers at low platelet counts is a challenge. To explore the performance of current haematology analysers in counting platelet concentrations usually used as platelet transfusion threshold. MATERIAL AND METHODS: An international exercise where four blood samples with platelet levels near usual platelet transfusion thresholds was prepared and distributed. RESULTS: The samples shipped had a platelet count of 6·3, 13·3, 21·6 and 53·0 × 10(9) /l according to the international reference method. We received 82 sets of results from nine countries. Instruments from six different manufacturers were represented. Although the mean count for each of the four samples was very similar to the values, according to the reference method (9·0, 16·2, 23·0 and 57·6 × 10(9) /l), significant variability in the results was found. Assuming that these were patient samples and the result of the count used to indicate a prophylactic platelet transfusion, undertransfusion would have occurred for 24·5% of the LP1 samples at a transfusion threshold of 10 × 10(9) /l and, at a threshold of 20 × 10(9) /l, undertransfusion would have occurred for 7·2% of the LP1 and 16·2% of the LP2 samples and overtransfusion would have occurred with 23·1% of the LP3 samples. CONCLUSION: The results suggest that significant inaccuracy exists in counting low levels of platelets and that this inaccuracy might have a significant impact in under- and overtransfusion of platelet concentrates to patients.

DNA-based species detection capabilities using laser transmission spectroscopy.

Early detection of invasive species is critical for effective biocontrol to mitigate potential ecological and economic damage. Laser transmission spectroscopy (LTS) is a powerful solution offering real-time, DNA-based species detection in the field. LTS can measure the size, shape and number of nanoparticles in a solution and was used here to detect size shifts resulting from hybridization of the polymerase chain reaction product to nanoparticles functionalized with species-specific oligonucleotide probes or with the species-specific oligonucleotide probes alone. We carried out a series of DNA detection experiments using the invasive freshwater quagga mussel (Dreissena bugensis) to evaluate the capability of the LTS platform for invasive species detection. Specifically, we tested LTS sensitivity to (i) DNA concentrations of a single target species, (ii) the presence of a target species within a mixed sample of other closely related species, (iii) species-specific functionalized nanoparticles versus species-specific oligonucleotide probes alone, and (iv) amplified DNA fragments versus unamplified genomic DNA. We demonstrate that LTS is a highly sensitive technique for rapid target species detection, with detection limits in the picomolar range, capable of successful identification in multispecies samples containing target and non-target species DNA. These results indicate that the LTS DNA detection platform will be useful for field application of target species. Additionally, we find that LTS detection is effective with species-specific oligonucleotide tags alone or when they are attached to polystyrene nanobeads and with both amplified and unamplified DNA, indicating that the technique may also have versatility for broader applications.

Measurement of body composition changes with weight loss in postmenopausal women: comparison of methods.

BACKGROUND: The accurate measurement of body composition changes is important when evaluating the efficacy of medical nutrition therapy and weight management programs, yet is not well documented in older women. OBJECTIVE: We compared methods of estimating energy-restriction-induced body composition changes in postmenopausal women. DESIGN: 27 women (59 +/- 8 y; BMI 29.0 +/- 2.9 kg/m2; mean +/- SD) completed a 9-wk energy restriction period (5233 kJ/d, (1250 kcal/d)). Changes in % body fat (delta%BF), fat mass (deltaFM), and fatfree mass (deltaFFM) were measured by hydrostatic weighing (HW), air-displacement plethysmography (ADP), dual-energy x-ray absorptiometry (DXA), and deuterium oxide dilution (D2O). The Baumgartner et al. (Am J Clin Nutr 53:1345-1353, 1991) four-compartment (4C) model with body volume from HW was the criterion method. The 4C model with body volume from ADP was also compared. Regression equations were developed based on 4CHW (dependent variable) utilizing results of change (POST-PRE) for each method. RESULTS: The women lost 6.8 +/- 3.2 kg; 9% of baseline weight. Based on 4CHW, the body composition changes were -2.4 +/- 4.5 delta%BF, -4.7 +/- 3.3 kg deltaFM, and -2.6 +/- 4.4 kg deltaFFM. No differences were detected by ANOVA for delta%BF, deltaFM, and deltaFFM among 4CHW, HW, ADP, DXA, D2O, and 4CADP. Bland-Altman limits of agreement showed differences between methods that ranged from 14.5 to -14.1 delta%BF, 7.8 to -8.1 kg deltaFM, and 7.5 to -8.4 kg deltaFFM for individuals. A bias was shown with 4CADP overestimating delta%BF (1.4 %) and FM (0.6 kg) and underestimating deltaFFM (-1.2 kg) compared to 4CHW. The regression model was acceptable for %BF (4CADP, 2CHW, and 2CD2O); FM and FFM (4CADP, 3CDXA, 2CHW, and 2CD2O), but not for other estimates of %BF, FM, FFM. CONCLUSIONS: These body composition assessment methods may be used interchangeably to quantify changes in % body fat, fat mass, and fat-free mass with weight loss in groups of postmenopausal women. 4CADP overestimates delta%BF and underestimates deltaFFM. When utilizing one of these comparison methods (4CADP, 3CDXA, 2CHW, 2CD2O) to quantify changes in fat mass and fat-free mass for an individual postmenopausal woman, regression equations may be used to relate the data to 4CHW.

Renal anaemia: recent developments and future directions for improved management.

The global burden of chronic kidney disease (CKD) and associated anaemia is substantial. With the increasing numbers of patients that are likely to be affected in the future, approaches are required to improve anaemia management without increasing the workload of renal units. Advocating early treatment may improve patient outcomes and nurses are in an ideal position to identify and manage anaemia at an early stage in patients with CKD. In addition, adopting a multidisciplinary approach, alongside nephrologists, diabetologists, cardiologists, social workers, nutritionists and pharmacists, may allow nurses to detect and treat anaemia earlier in patients with CKD. Maintaining awareness of factors associated with decreased erythropoiesis-stimulating agents (ESAs) efficacy (e.g. iron deficiency or poor nutritional status) is also important. To reduce the burden on healthcare providers, anaemia management could be simplified by extending the administration interval of ESAs. Recent studies have explored the clinical efficacy of administration of currently available agents at intervals of up to once monthly in highly selected, stable patients. The use of an ESA that can control anaemia while maintaining haemoglobin levels within guideline ranges with extended administration intervals in all patients without the need for additional screening or stepwise dose adjustments with attendant monitoring may help improve patient care while reducing the workload of healthcare providers.

Nutritional, functional and psychosocial correlates of disability among older adults.

PURPOSE: The purpose of the present study was to examine the nutritional, functional and psychosocial correlates of disability among 54 older adults aged 65 years of age or older. METHODS: Using validated questionnaires and tests, nutritional risk (Mini-Nutritional Assessment), functional capacity (mobility, balance, endurance, grip strength and lower extremity strength), the psychosocial factors (life satisfaction, depression, and social support) and level of disability of the participants were examined. RESULTS: The study showed that functional mobility was the strongest correlate of disability, even after controlling for age, gender and residential living status (p<.05). Life satisfaction and nutrition risk had marginal significance as being related to disability. CONCLUSION: The results of the present study have implications for the development of evidence-based health promotion interventions for older adults.

Renal anaemia--the patient experience.

In progress within the United Kingdom (UK) is the provision of a National Service Framework (NSF) for Renal Services. The Renal NSF aims to raise standards, provide equity of care, reduce variations in services and improve the health care of renal patients (1). The Renal NSF will be published in four distinct modules, each relating to a major area of renal care: effective delivery of dialysis, transplantation, prevention and primary care and alternative models of care. Taking into account the opinions of patients based on national surveys, has been recognised as an essential component in the modernisation programme of the NHS (2), and therefore this national survey represents consultation on current service provision. In 2000, the UK's National Kidney Federation (NKF) (supported by an educational grant from Amgen Ltd) conducted a postal survey of UK patients with renal diseases. This paper provides the patient perspective on anaemia management from this survey together with the implications for clinical practice for nurses and renal healthcare teams.