A comparison between different patient groups for diabetes management during phases of the COVID-19 pandemic: a retrospective cohort study in Ontario, Canada.

BACKGROUND: With the onset of the COVID-19 pandemic and the large uptake in virtual care in primary care in Canada, the care of patients with type 2 diabetes has been greatly affected. This includes decreased in-person visits, laboratory testing and in-person assessments such as blood pressure (BP). No studies have investigated if these changes persisted with pandemic progression, and it is unclear if shifts impacted patient groups uniformly. The purpose of this paper was to examine changes in diabetes care pre, early, and later pandemic across different patient groups. METHODS: A repeated cross-sectional design with an open cohort was used to investigate diabetes care in adults with type 2 diabetes for a 6-month interval from March 14 to September 13 over three consecutive years: 2019 (pre-pandemic period), 2020 (early pandemic period), and 2021 (later pandemic period). Data for this study were abstracted from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a primary care electronic medical records database in Ontario, Canada. Changes in diabetes care, which included primary care total visits, in-person visits, hemoglobin A1c (HbA1c) testing, and BP measurements were evaluated across the phases of the pandemic. Difference in diabetes care across patient groups, including age, sex, income quintile, prior HbA1c levels, and prior BP levels, were assessed. RESULTS: A total of 39,401 adults with type 2 diabetes were included in the study. Compared to the 6-month pre-pandemic period, having any in-person visits decreased significantly early pandemic (OR = 0.079 (0.076-0.082)), with a partial recovery later pandemic (OR = 0.162 (95% CI: 0.157-0.169). Compared to the pre-pandemic period, there was a significant decrease early pandemic for total visits (OR = 0.486 (95% CI: 0.470-0.503)), HbA1c testing (OR = 0.401 (95% CI: 0.389-0.413)), and BP measurement (OR = 0.121 (95% CI: 0.116-0.125)), with partial recovery later pandemic. CONCLUSIONS: All measures of diabetes care were substantially decreased early pandemic, with a partial recovery later pandemic across all patient groups. With the increase in virtual care due to the COVID-19 pandemic, diabetes care has been negatively impacted over 1-year after pandemic onset.

Statistical sensitivity estimates for oscillating electric dipole moment measurements in storage rings.

In this paper analytical expressions are derived to describe the spin motion of a particle in magnetic and electric fields in the presence of an axion field causing an oscillating electric dipole moment (EDM). These equations are used to estimate statistical sensitivities for axion searches at storage rings. The estimates obtained from the analytic expressions are compared to numerical estimates from simulations in Chang et al. (Phys Rev D 99(8):083002, 2019). A good agreement is found.

aCORN: An experiment to measure the electron-antineutrino correlation coefficient in free neutron decay.

We describe an apparatus used to measure the electron-antineutrino angular correlation coefficient in free neutron decay. The apparatus employs a novel measurement technique in which the angular correlation is converted into a proton time-of-flight asymmetry that is counted directly, avoiding the need for proton spectroscopy. Details of the method, apparatus, detectors, data acquisition, and data reduction scheme are presented, along with a discussion of the important systematic effects.

Phase Locking the Spin Precession in a Storage Ring.

This Letter reports the successful use of feedback from a spin polarization measurement to the revolution frequency of a 0.97 GeV/c bunched and polarized deuteron beam in the Cooler Synchrotron (COSY) storage ring in order to control both the precession rate (≈121 kHz) and the phase of the horizontal polarization component. Real time synchronization with a radio frequency (rf) solenoid made possible the rotation of the polarization out of the horizontal plane, yielding a demonstration of the feedback method to manipulate the polarization. In particular, the rotation rate shows a sinusoidal function of the horizontal polarization phase (relative to the rf solenoid), which was controlled to within a 1 standard deviation range of σ=0.21 rad. The minimum possible adjustment was 3.7 mHz out of a revolution frequency of 753 kHz, which changes the precession rate by 26 mrad/s. Such a capability meets a requirement for the use of storage rings to look for an intrinsic electric dipole moment of charged particles.

Effects of potential detoxifying agents on growth performance and deoxynivalenol (DON) urinary balance characteristics of nursery pigs fed DON-contaminated wheat.

Two experiments were conducted to evaluate potential detoxifying agents on growth of nursery pigs fed deoxynivalenol (DON)-contaminated diets. Naturally DON-contaminated wheat (6 mg/kg) was used to achieve desired DON levels. In a 21-d study, 238 pigs (13.4 ± 1.8 kg BW) were used in a completely randomized design with a 2 × 2 + 1 factorial arrangement. Diets were: 1) Positive control (PC; < 0.5 mg/kg DON), 2) PC + 1.0% Product V (Nutriquest LLC, Mason City, IA), 3) Negative control (NC; 4.0 mg/kg DON), 4) NC + 1.0% Product V, and 5) NC + 1.0% sodium metabisulfite (SMB; Samirian Chemicals, Campbell, CA). There were 6 or 7 replicate pens/treatment and 7 pigs/pen. Analyzed DON was decreased by 92% when pelleted with SMB, but otherwise matched formulated levels. Overall, a DON × Product V interaction was observed for ADG ( 0.05) with a tendency for an interaction for ADFI ( 0.10). As anticipated, DON reduced ( 0.001) ADG and ADFI, but the interaction was driven by even poorer growth when Product V was added to NC diets. Pigs fed NC diets had 10% poorer G:F ( 0.001) than PC-fed pigs. Reductions in ADG due to DON were most distinct (50%) during the initial period. Adding SMB to NC diets improved ( 0.01) ADG, ADFI, and G:F, and improved ( 0.02) ADG and G:F compared to the PC diet. A urinary balance study was conducted using diets 3 to 5 from Exp. 1 to evaluate Product V and SMB on DON urinary metabolism. A 10 d adaptation was followed by a 7 d collection using 24 barrows in a randomized complete block design. Pigs fed NC + SMB diet had greater urinary DON output ( 0.05) than pigs fed NC + Product V, with NC pigs intermediate. Daily DON excretion was lowest ( 0.05) in the NC + SMB pigs. However, degradation of DON-sulfonate back to the parent DON molecule was observed as pigs fed NC + SMB excreted more DON than they consumed (164% of daily DON intake), greater ( 0.001) than pigs fed the NC (59%) or NC + Product V (48%). Overall, Product V did not alleviate DON effects on growth nor did it reduce DON absorption and excretion. However, hydrothermally processing DON-contaminated diets with 1.0% SMB restored ADFI and improved G:F. Even so, the urinary balance experiment revealed that some of the converted DON-sulfonate can degrade back to DON under physiological conditions. While further research is needed to discern the stability of the DON-sulfonate, SMB appears promising to restore performance in pelleted DON-contaminated diets.

The aCORN Backscatter-Suppressed Beta Spectrometer.

Backscatter of electrons from a beta spectrometer, with incomplete energy deposition, can lead to undesirable effects in many types of experiments. We present and discuss the design and operation of a backscatter-suppressed beta spectrometer that was developed as part of a program to measure the electronantineutrino correlation coefficient in neutron beta decay (aCORN). An array of backscatter veto detectors surrounds a plastic scintillator beta energy detector. The spectrometer contains an axial magnetic field gradient, so electrons are efficiently admitted but have a low probability for escaping back through the entrance after backscattering. The design, construction, calibration, and performance of the spectrometer are discussed.

Determining the impact of increasing standardized ileal digestible lysine for primiparous and multiparous sows during lactation.

Two experiments were conducted to evaluate the effects of increasing dietary SID Lys in lactation on sow and litter performance. In Exp. 1, a total of 111 primiparous sows (Line 241; DNA Genetics, Columbus, NE) were allotted to 1 of 4 dietary treatments on d 110 of gestation. Dietary treatments included increasing dietary standardized ileal digestible (SID) Lys (0.80, 0.95, 1.10, and 1.25%). During lactation, there were no differences in ADFI or sow BW at weaning (d 21), resulting in no differences in BW loss. However, backfat loss during lactation decreased (linear, P = 0.046) as SID Lys increased. There were no differences in litter weaning weight, litter gain from d 2 to weaning, percentage of females bred by d 7 after weaning, d 30 conception rate, farrowing rate or subsequent litter characteristics. In Exp. 2, a total of 710 mixed parity sows (Line 241; DNA Genetics) were allotted to 1 of 4 dietary treatments at d 112 of gestation. Dietary treatments included increasing SID Lys (0.75, 0.90, 1.05, and 1.20%). Sow BW at weaning increased (quadratic, P = 0.046), and sow BW loss from post-farrow to weaning or d 112 to weaning decreased (quadratic, P ≤ 0.01) as SID Lys increased. Sow backfat loss increased (linear, P = 0.028) as SID Lys increased. Conversely, longissimus muscle depth loss decreased (linear, P = 0.002) as SID Lys increased. Percentage of females bred by d 7 after weaning increased (linear, P = 0.047) as SID Lys increased in parity 1 sows, with no difference in parity 2 or 3+ sows. Litter weight at d 17 and litter gain from d 2 to 17 increased (quadratic, P = 0.01) up to 1.05% SID Lys with no improvement thereafter. For subsequent litter characteristics, there were no differences in total born, percentage born alive, stillborn, or mummies. In conclusion, our results suggest that increasing dietary SID Lys can reduce sow protein loss in lactation. The optimal level of dietary SID Lys required by the sow may vary based on response criteria and parity.

T-cell immunity in myocardial inflammation: pathogenic role and therapeutic manipulation.

T-cell-mediated immunity has been linked not only to a variety of heart diseases, including classic inflammatory diseases such as myocarditis and post-myocardial infarction (Dressler's) syndrome, but also to conditions without an obvious inflammatory component such as idiopathic dilated cardiomyopathy and hypertensive cardiomyopathy. It has been recently proposed that in all these conditions, the heart becomes the focus of T-cell-mediated autoimmune inflammation following ischaemic or infectious injury. For example, in acute myocarditis, an inflammatory disease of heart muscle, T-cell responses are thought to arise as a consequence of a viral infection. In a number of patients, persistent T-cell-mediated responses in acute viral myocarditis can lead to autoimmunity and chronic cardiac inflammation resulting in dilated cardiomyopathy. In spite of the major progress made in understanding the mechanisms of pathogenic T-cell responses, effective and safe therapeutic targeting of the immune system in chronic inflammatory diseases of the heart has not yet been developed due to the lack of specific diagnostic and prognostic biomarkers at an early stage. This has also prevented the identification of targets for patient-tailored immunomodulatory therapies that are both disease- and organ-selective. In this review, we discuss current knowledge of the development and functional characteristics of pathogenic T-cell-mediated immune responses in the heart, and, in particular, in myocarditis, as well as recent advances in experimental models which have the potential to translate into heart-selective immunomodulation. LINKED ARTICLES: This article is part of a themed section on Targeting Inflammation to Reduce Cardiovascular Disease Risk. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.22/issuetoc and http://onlinelibrary.wiley.com/doi/10.1111/bcp.v82.4/issuetoc.

Measurement of the Electron-Antineutrino Angular Correlation in Neutron ß Decay.

We report the first result for the electron-antineutrino angular correlation (a coefficient) in free neutron ß decay from the aCORN experiment. aCORN uses a novel method in which the a coefficient is proportional to an asymmetry in proton time of flight for events where the ß electron and recoil proton are detected in delayed coincidence. Data are presented from a 15 month run at the NIST Center for Neutron Research. We obtained a=-0.1090±0.0030(stat)±0.0028(sys), the most precise measurement of the neutron a coefficient reported to date.

Influence of dietary fat source and feeding duration on finishing pig growth performance, carcass composition, and fat quality.

A total of 160 finishing pigs (PIC 327 × 1050; initially 45.6 kg) were used in an 84-d experiment to evaluate the effects of dietary fat source and feeding duration on growth performance, carcass characteristics, and carcass fat quality. There were 2 pigs per pen with 8 pens per treatment. The 10 dietary treatments were a corn-soybean meal control diet with no added fat and a 3 × 3 factorial with main effects of fat source (4% tallow, 4% soybean oil, or a blend of 2% tallow and 2% soybean oil) and feeding duration (d 0 to 42, 42 to 84, or 0 to 84). The control corn-soybean meal diet was fed in place of added fat diets when needed for duration treatment purposes. On d 0, 1 pig was identified in each pen and fat biopsy samples of the back, belly, and jowl were collected on d 0, 41, and 81 for fatty acid analysis. At the conclusion of the study, all pigs were harvested, carcass characteristics were determined, and back, belly, and jowl fat samples were collected for analysis. Overall (d 0 to 84), there were no differences among pigs fed the different fat sources for growth and carcass characteristics; however, pigs fed diets with added fat for the entire study had improved ( = 0.036) G:F compared with pigs fed the control diet without added fat. Pigs fed supplemental fat throughout the entire study also had improved ( < 0.05) ADG and G:F as well as heavier d-84 BW ( = 0.006) compared with pigs fed additional fat during only 1 period. Adding fat for the entire study increased ( = 0.032) backfat and tended to reduce ( = 0.079) the fat free lean index compared with pigs fed the control diet without added fat. Added fat also increased ( < 0.05) the iodine value (IV) when compared with pigs fed the control diet. Increasing the feeding duration of soybean oil lowered MUFA and increased PUFA concentrations for all fat depots, whereas these values remained relatively unchanged by the addition of tallow (duration × fat source interactions, < 0.05). Our study failed to show any feeding period × fat source interactions ( < 0.05) in fatty acid composition or IV for jowl fat, whereas this interaction occurred for belly fat and backfat, which would indicate a longer turnover rate for jowl fat. In conclusion, feeding additional fat improved ADG and G:F; however, feeding soybean oil for an increased duration, either alone or in combination with tallow, negatively affected the fatty acid composition and IV of different fat depots.

How to Reach a Thousand-Second in-Plane Polarization Lifetime with 0.97-GeV/c Deuterons in a Storage Ring.

We observe a deuteron beam polarization lifetime near 1000 s in the horizontal plane of a magnetic storage ring (COSY). This long spin coherence time is maintained through a combination of beam bunching, electron cooling, sextupole field corrections, and the suppression of collective effects through beam current limits. This record lifetime is required for a storage ring search for an intrinsic electric dipole moment on the deuteron at a statistical sensitivity level approaching 10^{-29} e cm.

Closing system-wide yield gaps to increase food production and mitigate GHGs among mixed crop-livestock smallholders in Sub-Saharan Africa.

In this study we estimate yield gaps for mixed crop-livestock smallholder farmers in seven Sub-Saharan African sites covering six countries (Kenya, Tanzania, Uganda, Ethiopia, Senegal and Burkina Faso). We also assess their potential to increase food production and reduce the GHG emission intensity of their products, as a result of closing these yield gaps. We use stochastic frontier analysis to construct separate production frontiers for each site, based on 2012 survey data prepared by the International Livestock Research Institute for the Climate Change, Agriculture and Food Security program. Instead of relying on theoretically optimal yields-a common approach in yield gap assessments-our yield gaps are based on observed differences in technical efficiency among farms within each site. Sizeable yield gaps were estimated to be present in all of the sites. Expressed as potential percentage increases in outputs, the average site-based yield gaps ranged from 28 to 167% for livestock products and from 16 to 209% for crop products. The emission intensities of both livestock and crop products registered substantial falls as a consequence of closing yield gaps. The relationships between farm attributes and technical efficiency were also assessed to help inform policy makers about where best to target capacity building efforts. We found a strong and statistically significant relationship between market participation and performance across most sites. We also identified an efficiency dividend associated with the closer integration of crop and livestock enterprises. Overall, this study reveals that there are large yield gaps and that substantial benefits for food production and environmental performance are possible through closing these gaps, without the need for new technology.

Equations generated to predict iodine value of pork carcass back, belly, and jowl fat.

Data from existing literature were used to generate equations to predict finishing pig back, belly, and jowl fat iodine values (IV) and an experiment was conducted to evaluate these equations. The final database included 24, 21, and 29 papers for back, belly, and jowl fat IV, respectively. For experiments that changed dietary fatty acid composition, initial (INT) diets were defined as those fed before the change in diet composition and final (FIN) diets were those fed after. The predictor variables tested were divided into 5 groups: 1) diet fat composition (dietary percent C16:1, C18:1, C18:2, C18:3, EFA, unsaturated fatty acids, and IV product) for both INT and FIN diets, 2) day feeding the INT and FIN diets, 3) ME or NE of the INT and FIN diet, 4) live performance criteria (initial BW, final BW, ADG, ADFI, and G:F), and 5) carcass criteria (HCW and backfat thickness). The PROC MIXED procedure of SAS (SAS Inst., Inc., Cary, NC) was used to develop regression equations. Evaluation of models with significant terms was then conducted based on the Bayesian information criterion. The optimum equations to predict back, belly, and jowl fat IV were backfat IV = 84.83 + (6.87 × INT EFA) - (3.90 × FIN EFA) - (0.12 × INT days) - (1.30 × FIN days) - (0.11 × INT EFA × FIN days) + (0.048 × FIN EFA × INT days) + (0.12 × FIN EFA × FIN days) - (0.0060 × FIN NE) + (0.0005 × FIN NE × FIN days) - (0.26 × backfat depth); belly fat IV = 106.16 + (6.21 × INT EFA) - (1.50 × FIN days) - (0.11 × INT EFA × FIN days) - (0.012 × INT NE) + (0.00069 × INT NE × FIN days) - (0.18 × HCW) - (0.25 × backfat depth); and jowl fat IV = 85.50 + (1.08 × INT EFA) + (0.87 × FIN EFA) - (0.014 × INT days) - (0.050 × FIN days) + (0.038 × INT EFA × INT days) + (0.054 × FIN EFA × FIN days) - (0.0066 × INT NE) + (0.071 × INT BW) - (2.19 × ADFI) - (0.29 × backfat depth). Dietary treatments from the evaluation experiment consisted of a corn-soybean meal control diet with no added fat or a 3 × 3 factorial arrangement with main effects of fat source (4% tallow, 4% soybean oil, or a blend of 2% tallow and 2% soybean oil) and feeding duration (d 0 to 42, 42 to 84, or 0 to 84). The back, belly, and jowl fat IV equations tended to overestimate IV when observed IV were less than approximately 65 g/100 g and underestimate belly fat IV when actual IV are greater than approximately 74 g/100 g or when the fat blend was fed from d 0 to 84 or 42 to 84. Overall, with the exceptions noted, the regression equations were an accurate tool for predicting carcass fat quality based on dietary and pig performance factors.

HPV vaccine education: enhancing knowledge and attitudes of community counselors and educators.

Educational efforts targeting parents of preadolescents may help them make informed decisions about having their children vaccinated against the human papillomavirus (HPV). We conducted a pilot study examining knowledge, attitudes, and beliefs of community-based health educators and counselors who routinely disseminate sexual health and prevention information through counseling and supporting these parents. We evaluated the impact of a single, brief workshop by administering questionnaires before and after the session. The workshop consisted of an educational intervention that was presented orally by an expert in gynecological oncology and was followed by an open discussion period. Following the information and discussion session, improvements were seen in knowledge accuracy, confidence in being able to discuss HPV vaccine issues with parents, greater willingness to recommend the vaccine, and a better understanding of potential barriers to vaccine uptake. These results suggest that health educators and counselors may be better prepared to encourage their clients to make well-informed decisions regarding HPV vaccination.

Creation of a gilded trap by the high economic value of the Maine lobster fishery.

Unsustainable fishing simplifies food chains and, as with aquaculture, can result in reliance on a few economically valuable species. This lack of diversity may increase risks of ecological and economic disruptions. Centuries of intense fishing have extirpated most apex predators in the Gulf of Maine (United States and Canada), effectively creating an American lobster (Homarus americanus) monoculture. Over the past 20 years, the economic diversity of marine resources harvested in Maine has declined by almost 70%. Today, over 80% of the value of Maine's fish and seafood landings is from highly abundant lobsters. Inflation-corrected income from lobsters in Maine has steadily increased by nearly 400% since 1985. Fisheries managers, policy makers, and fishers view this as a success. However, such lucrative monocultures increase the social and ecological consequences of future declines in lobsters. In southern New England, disease and stresses related to increases in ocean temperature resulted in more than a 70% decline in lobster abundance, prompting managers to propose closing that fishery. A similar collapse in Maine could fundamentally disrupt the social and economic foundation of its coast. We suggest the current success of Maine's lobster fishery is a gilded trap. Gilded traps are a type of social trap in which collective actions resulting from economically attractive opportunities outweigh concerns over associated social and ecological risks or consequences. Large financial gain creates a strong reinforcing feedback that deepens the trap. Avoiding or escaping gilded traps requires managing for increased biological and economic diversity. This is difficult to do prior to a crisis while financial incentives for maintaining the status quo are large. The long-term challenge is to shift fisheries management away from single species toward integrated social-ecological approaches that diversify local ecosystems, societies, and economies.

Successful treatment of peripartum cardiomyopathy with extracorporeal membrane oxygenation.

A 24-year-old female developed heart failure within four months of delivering her first child. Echocardiogram revealed a moderately dilated left ventricle with severely reduced systolic function. She continued to decompensate, requiring intubation and inotropic support. When the use of an intra-aortic balloon pump failed to stabilize the patient, the decision was made to place her on ECMO. The circuit consisted of a Quadrox D membrane oxygenator and a CentriMag centrifugal pump. After 11 days of support, the patient met the weaning criteria and was successfully removed from ECMO. She was discharged one month after her admission. The new technology available allows for ECMO to be considered as an earlier option for the treatment and management of these patients as a bridge to recovery.

Preimplantation genetic diagnosis as a source of human embryonic stem cells for disease research and drug discovery.

Embryos surplus to therapeutic requirements following preimplantation genetic diagnosis can be used to derive human embryonic stem cell (hESC) lines carrying mutations significant to human disease. These cells provide a powerful in vitro tool for modelling disease progression in a number of cell types as well as having the potential to revolutionise drug discovery. Robust and reproducible directed differentiation protocols are needed to maximise the potential of these cells. In this review, we explore the current use of hESC and induced pluripotent stem cells in disease-specific research and discuss the use of stem cell technology in drug discovery and toxicity testing.

'Always the guiding hand': parents' accounts of the long-term implications of developmental co-ordination disorder for their children and families.

BACKGROUND: There has been little investigation of the long-term implications of developmental co-ordination disorder (DCD) and, particularly, its impact on families. This is despite the prevalence of the disorder (4.5% to 6%) of the child population, and the high rates of referral to occupational therapy departments. The study reported here was part of an evaluation of an innovative screening clinic for the assessment of children with DCD. METHODS: Within the case study approach of the evaluation, questionnaires, including open-end questions, were sent to 70 families. All had attended the screening clinic 6 years earlier and had little subsequent contact with the occupational therapy service. Semi-structured interviews were held with 12 mothers who volunteered to participate. These enabled specific issues raised in the questionnaires to be explored in greater depth. Interviews were audiotaped and full text transcripts produced for analysis. RESULTS: Over half the questionnaires were returned despite the length of time elapsed since hospital contact. Parents who responded reported a high persistence of problems in their children. Difficulties spanned motor and academic performance, emotional/behavioural responses and social interaction. Twenty-eight children (80%) of respondents were reported as having difficulties in three or more areas. Bullying was a commonly identified problem. At interview mothers spoke at length about their experiences and reported feeling stressed and distressed. Mothers reported a lack of support and expressed feelings of isolation. They said that their time investment in their child with DCD had pronounced effects on themselves and other family members. Specifically they highlighted time spent fighting the system, primarily for educational support. CONCLUSIONS: The study suggests a need for occupational therapists to reframe their current ideas regarding service provision, with improved support for families, increased interagency working and more service-user involvement.

Experimental verification of predicted beam-polarization oscillations near a spin resonance.

The Chao matrix formalism allows analytic calculations of a beam's polarization behavior inside a spin resonance. We recently tested its prediction of polarization oscillations occurring in a stored beam of polarized particles near a spin resonance. Using a 1.85 GeV/c polarized deuteron beam stored in the COoler SYnchrotron, we swept a new rf solenoid's frequency rather rapidly through 400 Hz during 100 ms, while varying the distance between the sweep's end frequency and the central frequency of an rf-induced spin resonance. Our measurements of the deuteron's polarization near and inside the resonance agree with the Chao formalism's predicted oscillations.