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BACKGROUND: As disease-modifying Alzheimer's (AD) treatments are becoming available, concerns have been raised that even high-income countries lack the diagnostic capacity to accurately identify eligible patients in a timely manner. OBJECTIVES: We analyze how much NHS England would have to invest in capacity for AD specialists, biomarker testing with PET scans or CSF testing and MRI scans to reach G7 average levels and estimate the effect on wait times in the diagnostic process. DESIGN: Desk research and expert interviews for cost and capacity data. Markov model to estimate wait times. SETTING: NHS England. MEASUREMENTS: AD specialists, and PET and MRI scanners per capita in G7 countries and wait times in England under different investment scenarios. RESULTS: England has the lowest number of PET and MRI scanners and the second-lowest of AD specialists per capita among the G7 countries. An investment of GBP 14 billion over ten years would be needed to reach G7 average levels, of which 31%, 22%, 10%, 37% would be devoted to capacity for memory assessment services, PET scanning, CSF analysis, and MRI scanning, respectively. This investment would reduce estimated average wait times by around 87% between 2023 and 2032. CONCLUSIONS: The NHS England has large gaps in diagnostic capacity for AD. Without substantial investments, AD patients in England would experience substantial wait times and avoidable disease progression.
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Doença de Alzheimer , Tomografia por Emissão de Pósitrons , Humanos , Doença de Alzheimer/diagnóstico , Inglaterra , Imageamento por Ressonância Magnética , Medicina Estatal , Investimentos em Saúde , Listas de Espera , Cadeias de MarkovRESUMO
Interest in dairy cow health continues to grow as we better understand health's relationship with production potential and animal welfare. Over the past decade, efforts have been made to incorporate health traits into national genetic evaluations. However, they have focused on the mature cow, with calf health largely being neglected. Diarrhoea and respiratory disease comprise the main illnesses with regard to calf health. Conventional methods to control calf disease involve early separation of calves from the dam and housing calves individually. However, public concern regarding these methods, and growing evidence that these methods may negatively impact calf development, mean the dairy industry may move away from these practices. Genetic selection may be a promising tool to address these major disease issues. In this review, we examined current literature for enhancing calf health through genetics and discussed alternative approaches to improve calf health via the use of epidemiological modelling approaches, and the potential of indirectly selecting for improved calf health through improving colostrum quality. Heritability estimates on the observed scale for diarrhoea ranged from 0.03 to 0.20, while for respiratory disease, estimates ranged from 0.02 to 0.24. The breadth in these ranges is due, at least in part, to differences in disease prevalence, population structure, data editing and models, as well as data collection practices, which should be all considered when comparing literature values. Incorporation of epidemiological theory into quantitative genetics provides an opportunity to better determine the level of genetic variation in disease traits, as it accounts for disease transmission among contemporaries. Colostrum intake is a major determinant of whether a calf develops either respiratory disease or diarrhoea. Colostrum traits have the advantage of being measured and reported on a continuous scale, which removes the issues classically associated with binary disease traits. Overall, genetic selection for improved calf health is feasible. However, to ensure the maximum response, first steps by any industry members should focus efforts on standardising recording practices and encouragement of uploading information to genetic evaluation centres through herd management software, as high-quality phenotypes are the backbone of any successful breeding programme.
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Doenças dos Bovinos , Indústria de Laticínios , Seleção Genética , Animais , Bovinos/genética , Doenças dos Bovinos/genética , Doenças dos Bovinos/epidemiologia , Indústria de Laticínios/métodos , Feminino , Diarreia/veterinária , Diarreia/genética , Diarreia/epidemiologia , Colostro , Cruzamento , Doenças Respiratórias/veterinária , Doenças Respiratórias/genéticaRESUMO
Genetic selection could be a tool to help improve the health and welfare of calves; however, to date, there is limited research on the genetics of calfhood diseases. This study aimed to understand the current impact of calf diseases, by investigating incidence rates, estimating genetic parameters, and providing industry recommendations to improve calf disease recording practices on farms. Available calf disease data composed of 69,695 Holstein calf disease records for respiratory problems (RESP) and diarrhea (DIAR), from 62,361 calves collected on 1,617 Canadian dairy herds from 2006 to 2021. Single- and multiple-trait analysis using both a threshold and linear animal model for each trait were evaluated. Furthermore, each trait was analyzed using 2 scenarios with respect to minimum disease incidence threshold criterion (herd-year incidence of at least 1% and 5%) to highlight the effect of different filtering thresholds on selection potential. Observed scale heritability estimates for RESP and DIAR ranged from 0.02 to 0.07 across analyses, while estimated genetic correlations between the traits ranged from 0.50 to 0.62. Sires were compared based on their estimated breeding value and their diseased daughter incidence rates. On average, calves born to the bottom 10% of sires were 1.8 times more likely to develop RESP and 1.9 times to develop DIAR compared with daughters born to the top 10% of sires. Results from the current study are promising for the inclusion of both DIAR and RESP in Canadian genetic evaluations. However, for effective genetic evaluation, standardized approaches on data collection and industry outreach to highlight the importance of collecting and uploading this information to herd management software is required. In particular, it is important that the herd management software is accessible to the national milk recording system to allow for use in national genetic evaluation.
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Doenças dos Bovinos , Leite , Animais , Bovinos/genética , Canadá , Fenótipo , Doenças dos Bovinos/genética , Doenças dos Bovinos/epidemiologia , Diarreia/veterinária , Seleção Genética , Indústria de Laticínios/métodosRESUMO
OBJECTIVES: To determine maternal factors associated with low fetal fraction (FF). To determine the proportion of women who receive a result from repeat non-invasive prenatal testing (NIPT) testing. To identify any significant associations between pregnancy interventions or outcomes and low FF. STUDY DESIGN: Retrospective observational study of 4465 women undergoing antenatal screening by targeted cell free DNA (cfDNA) testing at an Irish tertiary maternity hospital between January 2017 and December 2022. Patients who failed to obtain a result after the first NIPT were analyzed in two cohorts; those who received a result on a repeat sample and those who failed to ever achieve a result despite a second, third or fourth cfDNA test. RESULTS: Risk of insufficient FF significantly increased with elevated maternal BMI (OR 1.07; 95% CI 1.01-1.13, p = 0.03) and in-vitro fertilization (IVF) (OR 3.4; 95% CI 1.19-9.4, p = 0.02). Women with no result were more likely to have diagnostic invasive testing (p < 0.01), but had no increased risk of aneuploidy. Repeated failed NIPT attempts due to low FF were significantly associated with the subsequent development of hypertensive diseases of pregnancy (p = 0.03). Greater than 70% of patients who were unsuccessful in a first or second attempt at NIPT due to low FF yielded a result following a second or third sample. CONCLUSIONS: High BMI and IVF conceptions are greater contributors to low FF than fetal aneuploidy. Repeating NIPT yields a result in greater than 70% of cases. WHAT'S ALREADY KNOWN ABOUT THIS TOPIC?: Fetal fraction (FF) in prenatal cfDNA testing is influenced by maternal and pregnancy factors including body mass index (BMI) and IVF. Low FF has been associated with adverse pregnancy outcomes including fetal aneuploidy and hypertensive diseases of pregnancy. WHAT DOES THIS STUDY ADD?: In a large Irish population, increasing maternal BMI and in-vitro fertilization are the most significant contributors to repeated test failures due to low FF. Greater than 70% of patients with test failure due to low FF will receive a result on 2nd and 3rd NIPT attempts. Patients with no result from NIPT were more likely to undergo diagnostic invasive testing but the risk of aneuploidy was not significantly increased.
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Ácidos Nucleicos Livres , Feminino , Humanos , Gravidez , Aneuploidia , Irlanda , Cuidado Pré-Natal , Diagnóstico Pré-Natal , Estudos RetrospectivosRESUMO
Confusion of drug names has been identified as a leading cause of medication errors and potential iatrogenic harm. Most of these errors occur because of look-alike or sound-alike drugs. This case series gives examples of duplication errors due to brand confusion, where there are no similarities in the names.
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BACKGROUND: Attention-deficit/Hyperactivity Disorder (ADHD) is the single most frequent reason for attendance at Child and Adolescent Mental Health Services (CAMHS) in Ireland. Research has suggested that parents of children with ADHD experience more parenting stress than parents of non-clinical controls, yet routine treatment for ADHD rarely addresses parental well-being. Mindfulness-based interventions (MBIs) have been found to result in a reduction in parental stress. METHOD: An adapted Mindfulness-Based Stress Reduction (MBSR) intervention was delivered to parents (n = 23) of children with ADHD recruited from CAMHS and ADHD Ireland. RESULTS: Following the intervention a significant improvement was documented within the social relationships domain of quality of life (WHOQOL-BREF) and a significant reduction on the child hyperactivity scale of the Strengths and Difficulties (SDQ) questionnaire. CONCLUSION: This pilot study suggests that an MBSR intervention is both feasible and effective for parents whose children have ADHD. Larger scale studies need to be conducted before inclusion in routine CAMHS.
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Transtorno do Deficit de Atenção com Hiperatividade , Atenção Plena , Adolescente , Criança , Humanos , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estudos de Viabilidade , Projetos Piloto , Qualidade de Vida , Pais/psicologiaRESUMO
Dairy farmers are motivated to ensure cows become pregnant in an optimal and timely manner. Although timed artificial insemination (TAI) is a successful management tool in dairy cattle, it masks an animal's innate fertility performance, likely reducing the accuracy of genetic evaluations for fertility traits. Therefore, separating fertility traits based on the recorded management technique involved in the breeding process or adding the breeding protocol as an effect to the model can be viable approaches to address the potential bias caused by such management decisions. Nevertheless, there is a lack of specificity and uniformity in the recording of breeding protocol descriptions by dairy farmers. Therefore, this study investigated the use of 8 supervised machine learning algorithms to classify 1,835 unique breeding protocol descriptions from 981 herds into the following 2 classes: TAI or other than TAI. Our results showed that models that used a stacking classifier algorithm had the highest Matthews correlation coefficient (0.94 ± 0.04, mean ± SD) and maximized precision and recall (F1-score = 0.96 ± 0.03) on test data. Nonetheless, their F1-scores on test data were not different from 5 out of the other 7 algorithms considered. Altogether, results presented herein suggest machine learning algorithms can be used to produce robust models that correctly identify TAI protocols from dairy cattle breeding records, thus opening the opportunity for unbiased genetic evaluation of animals based on their natural fertility.
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Fertilidade , Inseminação Artificial , Algoritmos , Animais , Canadá , Bovinos , Sincronização do Estro/métodos , Feminino , Hormônio Liberador de Gonadotropina , Inseminação Artificial/métodos , Inseminação Artificial/veterinária , Lactação , Aprendizado de Máquina , Gravidez , ProgesteronaRESUMO
Uniform magnetic behavior within arrays of magnetoelectric heterostructures is important for the development of reliable strain-mediated microdevices. Multiple mechanisms may contribute to observed nonuniform magnetization reversal including surface roughness, non-uniform strain, and fabrication induced imperfections. Here, Co/Ni microdisks of 7 µm diameter were produced on both [Pb(Mg1/3Nb2/3)O3]1-x-[PbTiO3]x with x = 0.3 nominal composition (PMN-30PT) (011) and Si substrates, and the out-of-plane magnetization reversal was characterized using magneto-optical Kerr effect (MOKE). Coercivity variation across the microdisks within the arrays was observed on both the PMN-30PT and Si specimens with zero electric field applied. Co/Ni microdisks on a PMN-30PT substrate displayed relatively larger coercivity than those on a Si substrate due to the surface roughness effect. Quasistatic electric fields of varying magnitude were applied to the PMN-30PT substrate to assess the dependence of the coercivity on electric field induced strain. Our results indicate that while coercivity decreases with the increase of electric field induced strain, interfacial and edge roughness combine to realize a prohibitively large coercivity to overcome within the Co/Ni microdisks as well as a broad distribution of coercive field across a patterned microdisk array.
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INTRODUCTION: A European Union amalgam phase-down has recently been implemented. Publicly funded health care predominates in the United Kingdom with the system favoring amalgam use. The current use of amalgam and its alternatives has not been fully investigated in the United Kingdom. OBJECTIVES: The study aimed to identify direct posterior restorative techniques, material use, and reported postoperative complication incidence experienced by primary care clinicians and differences between clinician groups. METHODS: A cross-sectional survey was distributed to primary care clinicians through British dentist and therapist associations (11,092 invitations). The questionnaire sought information on current provision of direct posterior restorations and perceived issues with the different materials. Descriptive statistical and hypothesis testing was performed. RESULTS: Dentists' response rate was 14% and therapists' estimated minimum response rate was 6% (total N = 1,513). The most commonly used restorative material was amalgam in molar teeth and composite in premolars. When placing a direct posterior mesio-occluso-distal restoration, clinicians booked on average 45% more time and charged 45% more when placing composite compared to amalgam (P < 0.0001). The reported incidences of food packing and sensitivity following the placement of direct restorations were much higher with composite than amalgam (P < 0.0001). Widely recommended techniques, such as sectional metal matrix use for posterior composites, were associated with reduced food packing (P < 0.0001) but increased time booked (P = 0.002). CONCLUSION: Amalgam use is currently high in the publicly funded sector of UK primary care. Composite is the most used alternative, but it takes longer to place and is more costly. Composite also has a higher reported incidence of postoperative complications than amalgam, but time-consuming techniques, such as sectional matrix use, can mitigate against food packing, but their use is low. Therefore, major changes in health service structure and funding and posterior composite education are required in the United Kingdom and other countries where amalgam use is prevalent, as the amalgam phase-down continues. KNOWLEDGE TRANSFER STATEMENT: This study presents data on the current provision of amalgam for posterior tooth restoration and its directly placed alternatives by primary care clinicians in the United Kingdom, where publicly funded health care with copayment provision predominates. The information is important to manage and plan the UK phase-down and proposed phase-out of amalgam and will be of interest to other, primarily developing countries where amalgam provision predominates in understanding some of the challenges faced.
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Resinas Compostas , Restauração Dentária Permanente , Resinas Compostas/uso terapêutico , Estudos Transversais , Amálgama Dentário/efeitos adversos , Materiais Dentários/química , Restauração Dentária Permanente/métodosRESUMO
INTRODUCTION: Amalgam use has recently been phased down, and the potential for a phase-out is being investigated. OBJECTIVES: The study aimed to identify knowledge of the phase-down and opinions of a potential phase-out of amalgam by UK primary care clinicians and assess their confidence in using different materials in different situations. METHODS: An anonymized, prepiloted cross-sectional e-survey was used to assess primary care clinicians' knowledge and opinions of the amalgam phase-down and potential phase-out and their confidence in using amalgam and the alternatives in different situations. In total, 11,902 invitations were distributed through British dentist and therapist associations. Prior hypotheses were tested alongside descriptive statistics. RESULTS: Response rate was 13% (n = 1,513). Knowledge of the amalgam phase-down was low, with just 3% clinicians correctly identifying all patient groups in whom amalgam use should be avoided in the United Kingdom. Postgraduate education on posterior composite placement was high (88%), but a large majority had personal and patient-centered concerns over the suitability of the alternatives and lacked confidence when placing composite in comparison to amalgam in difficult situations (P < 0.0001). Logistic regressions revealed that the best predictors of high confidence in placing mesio-occluso-distal composites and composites in difficult situations were being a private general dentist or being primarily a composite user. CONCLUSION: Primary care clinicians have major personal and patient-centered concerns regarding the amalgam phase-down (of which they have limited knowledge) and potential phase-out. Many lack confidence in using the alternative, composite, to restore posterior teeth in difficult situations, whereas confidence in using amalgam in similar situations is high. Effective education of clinicians and understanding patients' needs, alongside policy changes, are required to enable a successful amalgam phase-down and potential phase-out. KNOWLEDGE TRANSFER STATEMENT: This study shows that UK primary care clinicians are worried about the phase-down of amalgam for themselves and their patients. Many lack confidence in the alternative, composite, when used in difficult situations, which is in stark contrast to amalgam. Knowledge of the phase-down is limited. There is a need for more effective education of clinicians, an understanding of patients' values, and policy changes to ensure the success of the phase-down and potential phase-out of amalgam.
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Resinas Compostas , Amálgama Dentário , Estudos Transversais , Amálgama Dentário/uso terapêutico , Humanos , Reino UnidoRESUMO
Estrus detection has become more difficult over the years due to decreases in the estrus expression of high-producing dairy cows, and increased herd sizes and animal density. Through the use of hormonal synchronization protocols, also known as timed artificial insemination (TAI) protocols, it is possible to alleviate some of the challenges associated with estrus detection. However, TAI masks cows' fertility performance, resulting in an unfair comparison of treated animals and innately fertile animals. Consequently, genetically inferior and superior cows show similar phenotypes, making it difficult to distinguish between them. As genetic programs rely on the collection of accurate phenotypic data, phenotypes collected on treated animals likely add bias to genetic evaluations. In this study, to assess the effect of TAI, the rank correlation of bulls for a given trait using only TAI records were compared with the same trait using only heat detection records. A total of 270,434 records from 192,539 animals split across heifers, first and second parity cows were analyzed for the traits: calving to first service, first service to conception, and days open. Results showed large reranking across all traits and parities between bulls compared based on either having only TAI records or only heat detection records, suggesting that a bias does indeed exist. Large reranking was also observed for both the heat detection and TAI groups among the top 100 bulls in the control group, which included all records. Furthermore, breeding method was added to the model to assess its effect on bull ranking. However, there were only minor changes in the rank correlations between scenario groups. Therefore, more complex methods to account for the apparent bias created by TAI should be investigated; for this, the method by which these data are collected needs to be improved through creating a standardized way of recording breeding codes. Though the results of this study suggest the presence of bias within current fertility evaluations, additional research is required to confirm the findings of this study, including looking at high-reliability bulls specifically, to determine if the levels of reranking remain. Future studies should also aim to understand the potential genetic differences between the fertility traits split via management technology, possibly in a multiple-trait analysis.
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Fertilidade , Inseminação Artificial , Animais , Bovinos/genética , Detecção do Estro , Sincronização do Estro , Feminino , Fertilidade/genética , Inseminação Artificial/veterinária , Lactação , Masculino , Fenótipo , Gravidez , Reprodutibilidade dos TestesRESUMO
During the past few years, the Orion high-resolution x-ray spectrometers have been successful tools for measuring x-ray spectra from plasmas generated in the Orion laser facility. Duplicate spectrometers also operate successfully at the Livermore EBIT-I and SuperEBIT electron beam ion traps for measuring x-ray polarization. We have recently implemented very high-quality, optically bonded, spherically bent quartz crystals to remove the structure in the x-ray image that had been observed in earlier measurements. The structure had been caused by focusing defects and limited the accuracy of our measurements. We present before and after images that show a drastic improvement. We, furthermore, have implemented a spherically bent potassium acid phthalate (KAP) crystal on one of our spectrometers. The KAP crystal was prepared in a similar fashion, and we present measurements of the N Ly-ß and Ne Lyß lines taken in first- and second-order reflections at 600 and 1200 eV, respectively. These measurements confirm that KAP crystals can be produced at a quality suitable for extending the spectral coverage to wavelengths longer than those accessible by different quartz crystals, especially those that cover the astrophysically important lines of iron.
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Genetic improvement is a crucial tool to deal with the increasing demand for high quality, sustainably produced dairy. Breeding programs are based on genetic parameters, such as heritability and genetic correlations, for economically important traits in a population. In this study, we estimated population genetic parameters and genetic trends for 67 traits evaluated on heifers and first-lactation Canadian Holstein cows. The data consisted of approximately 500,000 records with pedigree information collected from 1980 to 2019. Genetic parameters were estimated using bivariate linear animal models under a Bayesian approach. Analyses for the 67 traits resulted in 2,211 bivariate combinations, from which the estimated genetic parameters are reported here. The most highly heritable traits were fat percent (0.66) and protein percent (0.69), followed by stature (0.47). Lowest heritabilities (0.01) were observed for disease-related traits, such as lameness and toe ulcer, and calf survival. The genetic correlations between gestation length, calf size, and calving ease measured on both heifer and cows were close to unity. On the other hand, traits such as body condition score and pin width, cystic ovaries and sole ulcer, rear teat placement, and toe ulcer were genetically unrelated. This study reports genetic parameters that have not been previously published for Canadian Holstein cows, and provides updates of those previously estimated. These estimates are useful for building new indexes, updating existing selection indexes, and for predicting correlated responses due to inclusion of novel traits in the breeding programs.
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Lactação , Leite , Animais , Teorema de Bayes , Canadá , Bovinos/genética , Feminino , Lactação/genética , FenótipoRESUMO
OBJECTIVES: We examined whether provision of contraception at discharge following delivery was associated with lower rates of postpartum visit (PPV) attendance. METHODS: We conducted a retrospective cohort study of women who received pregnancy care at a Midwestern medical center in 2013. Attendance at the postpartum visit was compared for women with sterilization, contraception initiated prior to discharge (depot medroxyprogesterone acetate or etonogestrel implant), hormonal contraception prescription, or no contraception provided at postpartum discharge. Poisson regression models with robust standard errors were used to estimate the relative risk of postpartum visit attendance controlling for age, race, and parity, insurance status, and histories of both depression and drug abuse. RESULTS: Of the 1015 women who met inclusion criteria, 55% had been prescribed contraception, had initiated contraception prior to discharge, or were sterilized at the time of discharge following delivery. After adjustment for confounders, there was no association between receiving contraception and PPV attendance (relative risk for prescribed contraceptionâ¯=â¯1.09 [95% CI 0.85, 1.39], for contraception initiated prior to dischargeâ¯=â¯0.83 [95% CI 0.67, 1.03], for sterilizationâ¯=â¯0.86 [95% CI 0.63, 1.17] compared to no contraception). CONCLUSIONS: We found no evidence that prescribing or administering contraception post-delivery was associated with lower rates of return for postpartum follow up. IMPLICATIONS: This single site study suggests that providing effective contraception at discharge following delivery does not appear to impact PPV attendance.
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Anticoncepção , Alta do Paciente , Feminino , Humanos , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Esterilização ReprodutivaAssuntos
Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/normas , Gestão de Antimicrobianos/normas , Infecções por Coronavirus/prevenção & controle , Guias como Assunto , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , COVID-19 , Humanos , SARS-CoV-2RESUMO
1. Campylobacteriosis is the leading cause of human bacterial gastroenteritis. Broilers are considered the most important source of human Campylobacter infection. In the 2008 European baseline survey Ireland had a 98% prevalence of campylobacter-contaminated broiler carcases. 2. Randomly-selected Campylobacter isolates (296 C. jejuni, 54 C. coli) recovered in 2017 and 2018, from Irish broiler neck skin and caeca were tested for their resistance to tetracycline, erythromycin, gentamicin, ciprofloxacin, nalidixic acid and streptomycin. 3. Overall, 45% of the Campylobacter spp. isolates tested were resistant to at least one antimicrobial. Tetracycline resistance (38%) was most prevalent in C. jejuni, followed by ciprofloxacin and nalidixic acid resistance (29%). In C. coli, resistance to ciprofloxacin and nalidixic acid (26%) was most prevalent followed by resistance to tetracycline (13%). Gentamicin resistance was undetected and resistance to streptomycin was low for C. jejuni (1%) and C. coli (4%). All C. jejuni isolates examined were erythromycin-sensitive, while 9% of C. coli isolates were erythromycin-resistant. Three multidrug-resistant C. coli isolates were recovered. 4. While antibiotic resistance rates were somewhat similar to figures reported nationally over the past 20 years, the prevalence of tetracycline resistance in C. jejuni has increased. The persistence of substantial ciprofloxacin resistance in the Irish broiler population was noteworthy, despite fluoroquinolones having been banned for growth promotion in Europe since 2006.