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1.
J Dairy Sci ; 107(4): 2231-2240, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-37939837

RESUMO

Improved nitrogen utilization of dairy production systems should improve not only the economic output of the systems but also the environmental metrics. One strategy to improve efficiency is through breeding programs. Improving a trait through breeding is conditional on the presence of exploitable genetic variability. Using a database of 1,291 deeply phenotyped grazing dairy cows, the genetic variability for 2 definitions of nitrogen utilization was studied: nitrogen use efficiency (i.e., nitrogen output in milk and meat divided by nitrogen available) and nitrogen balance (i.e., nitrogen available less nitrogen output in milk and meat). Variance components for both variables were estimated using animal repeatability linear mixed models. Genetic variability was detected for both nitrogen utilization metrics, even though their heritability estimates were low (<0.10). Validation of genetic evaluations revealed that animals divergent for nitrogen use efficiency or nitrogen balance indeed differed phenotypically, further demonstrating that breeding for improved nitrogen efficiency should result in a shift in the population mean toward better efficiency. Nitrogen use efficiency and nitrogen balance were not genetically correlated with each other (<|0.28|), and neither metric was correlated with milk urea nitrogen (<|0.12|). Nitrogen balance was unfavorably correlated with milk yield, showing the importance of including the nitrogen utilization metrics in a breeding index to improve nitrogen utilization without negatively impacting milk yield. In conclusion, improvement of nitrogen utilization through breeding is possible, even if more nitrogen utilization phenotypic data need to be collected to improve the selection accuracy considering the low heritability estimates.


Assuntos
Lactação , Leite , Feminino , Bovinos/genética , Animais , Lactação/genética , Nitrogênio , Fenótipo , Modelos Lineares
2.
J Dairy Sci ; 106(12): 8871-8884, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37641366

RESUMO

Reducing nitrogen pollution while maintaining milk production is a major challenge of dairy production. One of the keys to delivering on this challenge is to improve the efficiency of how dairy cows use nitrogen. Thus, estimating the nitrogen utilization of lactating grazing dairy cows and exploring the association between animal factors and productivity with nitrogen utilization are the first steps to understanding the nitrogen utilization complex in dairy cows. Nitrogen utilization metrics were derived from milk and body weight records from 1,291 grazing dairy cows of multiple breeds and crossbreeds; all cows had sporadic information on nitrogen intake concurrent with information on nitrogen sinks (and other nitrogen sources, such as body tissue mobilization). Several nitrogen utilization metrics were investigated, including nitrogen use efficiency (nitrogen output as products such as milk and meat divided by nitrogen intake) and nitrogen excreted (nitrogen intake less the nitrogen output as products such as milk and meat). In the present study, a primiparous Holstein-Friesian used, on average, 20.6% of the nitrogen it ate, excreting the surplus as feces and urine, representing 402 g of nitrogen per day. Intercow variability existed, with a between-cow standard deviation of 0.0094 for nitrogen use efficiency and 24 g of nitrogen per day for nitrogen excretion. As lactation progressed, nitrogen use efficiency declined and nitrogen excretion increased. Nevertheless, nitrogen use efficiency improved (i.e., decreased) from first to second parity, even though it did not improve from second to third parity or greater. Furthermore, nitrogen excretion continued to increase from first to third parity or greater. Nitrogen use efficiency and nitrogen excretion were negatively correlated (-0.56 to -0.40), signifying that dairy cows who partition more of the ingested nitrogen into products such as milk and meat, on average, also excrete less nitrogen. Milk urea nitrogen was, at best, weakly correlated with nitrogen use efficiency and nitrogen excretion; the correlations were between -0.01 and 0.06. In conclusion, several cow-level factors such as parity, stage of lactation, and breed were associated with the range of different nitrogen efficiency metrics investigated; moreover, even after accounting for such effects, 4.8% to 6.3% of the remaining variation in the nitrogen use efficiency and nitrogen balance metrics were attributable to intercow differences.


Assuntos
Dieta , Lactação , Feminino , Gravidez , Bovinos , Animais , Dieta/veterinária , Estudos Transversais , Leite/química , Nitrogênio/metabolismo , Ração Animal/análise
3.
QJM ; 116(8): 659-666, 2023 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-37220898

RESUMO

BACKGROUND: The Coronavirus pandemic (COVID-19) curtailed endoscopy services, adding to diagnostic backlogs. Building on trial evidence for a non-endoscopic oesophageal cell collection device coupled with biomarkers (Cytosponge), an implementation pilot was launched for patients on waiting lists for reflux and Barrett's oesophagus surveillance. AIMS: (i) To review reflux referral patterns and Barrett's surveillance practices. (ii) To evaluate the range of Cytosponge findings and impact on endoscopy services. DESIGN AND METHODS: Cytosponge data from centralized laboratory processing (trefoil factor 3 (TFF3) for intestinal metaplasia (IM), haematoxylin & eosin for cellular atypia and p53 for dysplasia) over a 2-year period were included. RESULTS: A total of 10 577 procedures were performed in 61 hospitals in England and Scotland, of which 92.5% (N = 9784/10 577) were sufficient for analysis. In the reflux cohort (N = 4074 with gastro-oesophageal junction sampling), 14.7% had one or more positive biomarkers (TFF3: 13.6% (N = 550/4056), p53: 0.5% (21/3974), atypia: 1.5% (N = 63/4071)), requiring endoscopy. Among samples from individuals undergoing Barrett's surveillance (N = 5710 with sufficient gland groups), TFF3-positivity increased with segment length (odds ratio = 1.37 per cm (95% confidence interval: 1.33-1.41, P < 0.001)). Some surveillance referrals (21.5%, N = 1175/5471) had ≤1 cm segment length, of which 65.9% (707/1073) were TFF3 negative. Of all surveillance procedures, 8.3% had dysplastic biomarkers (4.0% (N = 225/5630) for p53 and 7.6% (N = 430/5694) for atypia), increasing to 11.8% (N = 420/3552) in TFF3+ cases with confirmed IM and 19.7% (N = 58/294) in ultra-long segments. CONCLUSIONS: Cytosponge-biomarker tests enabled targeting of endoscopy services to higher-risk individuals, whereas those with TFF3 negative ultra-short segments could be reconsidered regarding their Barrett's oesophagus status and surveillance requirements. Long-term follow-up will be important in these cohorts.


Assuntos
Esôfago de Barrett , COVID-19 , Neoplasias Esofágicas , Humanos , Esôfago de Barrett/diagnóstico , Triagem , Proteína Supressora de Tumor p53 , Endoscopia , Biomarcadores/análise , Neoplasias Esofágicas/diagnóstico
4.
Cereb Cortex ; 33(6): 2997-3011, 2023 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-35830871

RESUMO

Research studies based on tractography have revealed a prominent reduction of asymmetry in some key white-matter tracts in schizophrenia (SCZ). However, we know little about the influence of common genetic risk factors for SCZ on the efficiency of routing on structural brain networks (SBNs). Here, we use a novel recall-by-genotype approach, where we sample young adults from a population-based cohort (ALSPAC:N genotyped = 8,365) based on their burden of common SCZ risk alleles as defined by polygenic risk score (PRS). We compared 181 individuals at extremes of low (N = 91) or high (N = 90) SCZ-PRS under a robust diffusion MRI-based graph theoretical SBN framework. We applied a semi-metric analysis revealing higher SMR values for the high SCZ-PRS group compared with the low SCZ-PRS group in the left hemisphere. Furthermore, a hemispheric asymmetry index showed a higher leftward preponderance of indirect connections for the high SCZ-PRS group compared with the low SCZ-PRS group (PFDR < 0.05). These findings might indicate less efficient structural connectivity in the higher genetic risk group. This is the first study in a population-based sample that reveals differences in the efficiency of SBNs associated with common genetic risk variants for SCZ.


Assuntos
Esquizofrenia , Adulto Jovem , Humanos , Esquizofrenia/diagnóstico por imagem , Esquizofrenia/genética , Predisposição Genética para Doença/genética , Encéfalo/diagnóstico por imagem , Fatores de Risco , Genótipo
5.
Psychol Med ; 53(8): 3345-3354, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35074035

RESUMO

BACKGROUND: Sleep disturbances are important symptoms to monitor in people with bipolar disorder (BD) but the precise longitudinal relationships between sleep and mood remain unclear. We aimed to examine associations between stable and dynamic aspects of sleep and mood in people with BD, and assess individual differences in the strength of these associations. METHODS: Participants (N = 649) with BD-I (N = 400) and BD-II (N = 249) provided weekly self-reports of insomnia, depression and (hypo)mania symptoms using the True Colours online monitoring tool for 21 months. Dynamic structural equation models were used to examine the interplay between weekly reports of insomnia and mood. The effects of clinical and demographic characteristics on associations were also assessed. RESULTS: Increased variability in insomnia symptoms was associated with increased mood variability. In the sample as a whole, we found strong evidence of bidirectional relationships between insomnia and depressive symptoms but only weak support for bidirectional relationships between insomnia and (hypo)manic symptoms. We found substantial variability between participants in the strength of prospective associations between insomnia and mood, which depended on age, gender, bipolar subtype, and a history of rapid cycling. CONCLUSIONS: Our results highlight the importance of monitoring sleep in people with BD. However, researchers and clinicians investigating the association between sleep and mood should consider subgroup differences in this relationship. Advances in digital technology mean that intensive longitudinal data on sleep and mood are becoming increasingly available. Novel methods to analyse these data present an exciting opportunity for furthering our understanding of BD.


Assuntos
Transtorno Bipolar , Distúrbios do Início e da Manutenção do Sono , Humanos , Transtorno Bipolar/complicações , Estudos Longitudinais , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/complicações , Afeto , Sono
7.
Nat Commun ; 13(1): 1407, 2022 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-35301290

RESUMO

Barrett's esophagus is a pre-malignant lesion that can progress to esophageal adenocarcinoma. We perform a multi-omic analysis of pre-cancer samples from 146 patients with a range of outcomes, comprising 642 person years of follow-up. Whole genome sequencing reveals complex structural variants and LINE-1 retrotransposons, as well as known copy number changes, occurring even prior to dysplasia. The structural variant burden captures the most variance across the cohort and genomic profiles do not always match consensus clinical pathology dysplasia grades. Increasing structural variant burden is associated with: high levels of chromothripsis and breakage-fusion-bridge events; increased expression of genes related to cell cycle checkpoint, DNA repair and chromosomal instability; and epigenetic silencing of Wnt signalling and cell cycle genes. Timing analysis reveals molecular events triggering genomic instability with more clonal expansion in dysplastic samples. Overall genomic complexity occurs early in the Barrett's natural history and may inform the potential for cancer beyond the clinically discernible phenotype.


Assuntos
Esôfago de Barrett , Neoplasias Esofágicas , Esôfago de Barrett/genética , Esôfago de Barrett/patologia , Estudos de Coortes , Estudos Transversais , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/patologia , Humanos , Retroelementos/genética
9.
Hum Genet ; 141(5): 1069-1084, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34453583

RESUMO

Genetic testing to identify genetic syndromes and copy number variants (CNVs) via whole genome platforms such as chromosome microarray (CMA) or exome sequencing (ES) is routinely performed clinically, and is considered by a variety of organizations and societies to be a "first-tier" test for individuals with developmental delay (DD), intellectual disability (ID), or autism spectrum disorder (ASD). However, in the context of schizophrenia, though CNVs can have a large effect on risk, genetic testing is not typically a part of routine clinical care, and no clinical practice guidelines recommend testing. This raises the question of whether CNV testing should be similarly performed for individuals with schizophrenia. Here we consider this proposition in light of the history of genetic testing for ID/DD and ASD, and through the application of an ethical analysis designed to enable robust, accountable and justifiable decision-making. Using a systematic framework and application of relevant bioethical principles (beneficence, non-maleficence, autonomy, and justice), our examination highlights that while CNV testing for the indication of ID has considerable benefits, there is currently insufficient evidence to suggest that overall, the potential harms are outweighed by the potential benefits of CNV testing for the sole indications of schizophrenia or ASD. However, although the application of CNV tests for children with ASD or schizophrenia without ID/DD is, strictly speaking, off-label use, there may be clinical utility and benefits substantive enough to outweigh the harms. Research is needed to clarify the harms and benefits of testing in pediatric and adult contexts. Given that genetic counseling has demonstrated benefits for schizophrenia, and has the potential to mitigate many of the potential harms from genetic testing, any decisions to implement genetic testing for schizophrenia should involve high-quality evidence-based genetic counseling.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Deficiência Intelectual , Esquizofrenia , Adulto , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/genética , Transtorno Autístico/diagnóstico , Transtorno Autístico/genética , Criança , Aberrações Cromossômicas , Variações do Número de Cópias de DNA , Deficiências do Desenvolvimento/genética , Análise Ética , Testes Genéticos , Humanos , Deficiência Intelectual/genética , Esquizofrenia/diagnóstico , Esquizofrenia/genética
10.
Transl Psychiatry ; 11(1): 592, 2021 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-34785639

RESUMO

Gamma oscillations (30-90 Hz) have been proposed as a signature of cortical visual information processing, particularly the balance between excitation and inhibition, and as a biomarker of neuropsychiatric diseases. Magnetoencephalography (MEG) provides highly reliable visual-induced gamma oscillation estimates, both at sensor and source level. Recent studies have reported a deficit of visual gamma activity in schizophrenia patients, in medication naive subjects, and high-risk clinical participants, but the genetic contribution to such a deficit has remained unresolved. Here, for the first time, we use a genetic risk score approach to assess the relationship between genetic risk for schizophrenia and visual gamma activity in a population-based sample drawn from a birth cohort. We compared visual gamma activity in a group (N = 104) with a high genetic risk profile score for schizophrenia (SCZ-PRS) to a group with low SCZ-PRS (N = 99). Source-reconstructed V1 activity was extracted using beamformer analysis applied to MEG recordings using individual MRI scans. No group differences were found in the induced gamma peak amplitude or peak frequency. However, a non-parametric statistical contrast of the response spectrum revealed more robust group differences in the amplitude of high-beta/gamma power across the frequency range, suggesting that overall spectral shape carries important biological information beyond the individual frequency peak. Our findings show that changes in gamma band activity correlate with liability to schizophrenia and suggest that the index changes to synaptic function and neuronal firing patterns that are of pathophysiological relevance rather than consequences of the disorder.


Assuntos
Esquizofrenia , Coorte de Nascimento , Ritmo Gama , Humanos , Magnetoencefalografia , Fatores de Risco , Esquizofrenia/genética
11.
Animal ; 15(9): 100335, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34392192

RESUMO

Extending the grazing season in pasture based systems of dairy production can increase farm profitability; poor weather and soil conditions can reduce the number of grazing days. The study objectives were to (i) examine the effect of restricted access to pasture in the autumn on the milk production, grazing behaviour and DM intake (DMI) of late lactation spring-calving dairy cows and (ii) establish the effect of alternating restricted and continuous access to pasture on dairy cow production, DMI and grazing behaviour. Cows were randomly assigned to one of four grazing treatments: (i) 22 h (full-time) access to pasture (22H; control); (ii) Two 5-h periods of access to pasture (2×5H); (iii) Two 3-h periods of access to pasture (2×3H); and (iv) alternating between full-time and 3-h access to pasture with no more than three continuous days on any one regime, e.g. Monday - full-time access, Tuesday - 2x3H access, Wednesday - 2x3H access; Thursday - full-time access, etc. (2×3HV). Restricted access to pasture was offered after a.m. and p.m. milking. Swards of similar quality and pregrazing herbage mass were offered. Treatment had no effect on milk yield (13.2 kg/day), milk fat (48.2 g/kg), protein (39.0 g/kg) or lactose content (42.6 g/kg) and milk solid yield (1.15 kg/day). Similarly, there was no effect of treatment on final BW (483 kg) or final BCS (2.66). There was no significant difference in DMI (15.1 kg DM/cow/day) between treatments. There was an effect on daily grazing time, 22H cows (565 min/cow/day) grazed for longest time, however, when the 2x3HV treatment had full-time access to pasture, they had a similar grazing time (543 min/cow/day) to the 22H cows and were similar to the 2x3H treatment on days with restricted access to pasture (357 min/cow/day). The 22H and 2x5H animals had similar grass DMI/min (29.2 g/min), the 2x3HV were higher (33.9 g/min) but were similar to the comparable treatment when offered 2x3H access time (41.6 g/min) and when offered 22H access time (27.7 g/min). The results from this study show how when offered a grass only diet of autumn pasture grazing behaviour can be modified by restricting pasture access time without reducing dairy cow production in late lactation at low production levels. There was also no effect of alternating access time between 22H and 2x3H on milk production and DMI in the 2x3HV treatment. Restricted access time to pasture in autumn may be a strategy which farmers can use to extend the grazing season.


Assuntos
Ração Animal , Leite , Ração Animal/análise , Animais , Bovinos , Dieta/veterinária , Feminino , Lactação , Estações do Ano
12.
J Dairy Sci ; 104(10): 10841-10853, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34253368

RESUMO

Grazing efficiency has been shown to differ between perennial ryegrass varieties. Such differences affect the utilization of grass within grazing systems, influencing the profitability of grass-based ruminant production systems. The Pasture Profit Index (PPI) is an economic merit grass variety selection tool developed to identify varieties with the greatest economic potential for grass-based dairy production systems. A new grass utilization subindex was developed and incorporated into the PPI to identify varieties with superior grazing efficiency. The subindex rewards varieties with superior grazing efficiency, measured as Residual grazed height, as these varieties allow increased amounts of herbage dry matter to be used by grazing animals. The economic values of all other traits within the PPI were reviewed and updated to ensure that the index was reflective of the current economic scenarios with appropriate assumptions included in the models, thus ensuring that varieties excelling in the agronomic traits with the greatest effect on profitability were recognized. The difference between the highest and lowest performing varieties for the grass utilization trait ranged from €23 to -€24. A range of €211 to €43 was recorded between the highest and lowest ranked varieties within the updated PPI. Spearman's rank correlation between the updated and original PPI lists was 0.96. The introduction of the utilization subindex will allow farmers to make informed variety selection decisions when reseeding pasture, particularly on their grazing platforms and it will allow a demand-based communication process between the farmer and the grass merchant or breeder, ultimately affecting trait selection for future breeding strategies.


Assuntos
Ração Animal , Lactação , Ração Animal/análise , Animais , Indústria de Laticínios , Dieta , Leite , Melhoramento Vegetal
13.
Animal ; 15(6): 100258, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34126413

RESUMO

Sheep are often used as a proxy for dairy cows when measuring the digestibility of a feed. In recent years grassland management guidelines for ruminant animals have been re-evaluated in accordance with the progression in animal genetics and the acknowledgement that genetic potential has an influence on both feed intake and digestibility. Recommended pre-grazing herbage mass (HM) targets are now much lower with improved perennial ryegrass varieties available for grazing swards. The objective of this study was to compare the in vivo digestibility of perennial ryegrass in wether sheep and lactating dairy cows. The experimental design was selected to measure the effect of animal species (cows, sheep), sward HM measured cutting herbage at 4 cm above ground level (low: 1 700 kg DM/ha and high: 4 000 kg DM/ha) and season (Spring: Apr-May, Summer: Jul-Aug) on the digestibility of perennial ryegrass. Each HM treatment was offered to each animal within species and season for 12 d using a 2 HM × 2 period changeover Latin square design. There were eight cows and eight sheep, so there were four 2 × 2 Latin squares for each animal species (two) at each season (two), giving 64 observations. During each 12 d experimental period, the first 6 d were used for adaptation (adaptation phase) and the final 6 d were used for measurement (measurement phase). In vivo organic matter digestibility (OMD) in spring did not differ between animal species but in summer sheep had higher in vivo OMD than cows. The results described herein highlight the suitability of wether sheep as an alternative to dairy cows for determining the digestibility of perennial ryegrass in spring but not in summer. Stage of growth of the plant, which is intrinsically linked to season, should be considered as results show that digestibility in the ruminant was affected by season but not differentially affected by changing sward HM.


Assuntos
Lolium , Ração Animal/análise , Animais , Bovinos , Dieta , Feminino , Lactação , Masculino , Leite , Ovinos
14.
Epidemiol Psychiatr Sci ; 29: e182, 2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33200977

RESUMO

AIMS: Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene-environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum. METHODS: The sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components). RESULTS: Both genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene-environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions. CONCLUSIONS: The interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.


Assuntos
Herança Multifatorial , Transtornos Psicóticos/genética , Esquizofrenia/genética , Adulto , Feminino , Interação Gene-Ambiente , Predisposição Genética para Doença , Genômica , Humanos , Masculino , Transtornos Psicóticos/psicologia , Psicologia do Esquizofrênico
15.
Transl Med UniSa ; 19: 5-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31360661

RESUMO

Frailty requires concerted integrated approaches to prevent functional decline. Although there is evidence that integrating care is effective for older people, there is insufficient data on outcomes from studies implementing integrated care to prevent and manage frailty. We systematically searched PubMed and Cochrane Library database for peer-reviewed medical literature on models of care for frailty, published from 2002 to 2017. We considered the effective and transferable components of the models of care and evidence of economic impact, where available. Information on European Union-funded projects or those registered with the European Innovation Partnership on Active and Healthy Ageing, and grey literature (including good practices) were also considered. We found 1,065 potential citations and 170 relevant abstracts. After excluding reports on specific diseases, processes or interventions and service models that did not report data, 42 full papers met the inclusion criteria. The evidence showed that few models of integrated care were specifically designed to prevent and tackle frailty in the community and at the interface between primary and secondary (hospital) care. Current evidence supports the case for a more holistic and salutogenic response to frailty, blending a chronic care approach with education, enablement and rehabilitation to optimise function, particularly at times of a sudden deterioration in health, or when transitioning between home, hospital or care home. In all care settings, these approaches should be supported by comprehensive assessment and multidimensional interventions tailored to modifiable physical, psychological, cognitive and social factors.

16.
Dis Esophagus ; 32(1)2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30496496

RESUMO

Progression from Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC) is uncommon but the consequences are serious. Predictors of progression are essential to optimize resource utilization. This study assessed the utility of a promising panel of biomarkers applicable to routine paraffin embedded biopsies (FFPE) to predict progression of BE to EAC in a large population-based, nested case-control study.We utilized the Amsterdam-based ReBus nested case-control cohort. BE patients who progressed to high-grade dysplasia (HGD)/EAC (n = 130) and BE patients who never progressed (n = 130) were matched on age, sex, length of the BE segment, and duration of endoscopic surveillance. All progressors had minimum 2 years of endoscopic surveillance without HGD/EAC to exclude prevalent neoplasia. We assessed abnormal DNA content, p53, Cyclin A, and Aspergillus oryzae lectin (AOL) in FFPE sections. We performed conditional logistic regression analysis to estimate odds ratio (OR) of progression based on biomarker status.Expert LGD (OR, 8.3; 95% CI, 1.7-41.0), AOL (3 vs. 0 epithelial compartments abnormal; OR, 3.6; 95% CI, 1.2-10.6) and p53 (OR, 2.3; 95% CI, 1.2-4.6) were independently associated with neoplastic progression. Cyclin A did not predict progression and DNA ploidy analysis by image cytometry was unsuccessful in the majority of cases, both were excluded from the multivariate analysis. The multivariable biomarker model had an area under the receiver operating characteristic curve of 0.73.Expert LGD, AOL, and p53 independently predict neoplastic progression in BE patients and are applicable to routine practice. These biomarkers can aid in selecting patients for endoscopic ablation or more intensive surveillance.


Assuntos
Adenocarcinoma/etiologia , Esôfago de Barrett/complicações , Esôfago de Barrett/patologia , Neoplasias Esofágicas/etiologia , Esôfago/patologia , Vigilância da População/métodos , Medição de Risco/métodos , Adenocarcinoma/patologia , Idoso , Área Sob a Curva , Biomarcadores Tumorais/análise , Biópsia/métodos , Estudos de Casos e Controles , Progressão da Doença , Neoplasias Esofágicas/patologia , Esofagoscopia/estatística & dados numéricos , Feminino , Humanos , Hiperplasia , Masculino , Pessoa de Meia-Idade , Países Baixos , Inclusão em Parafina/métodos , Valor Preditivo dos Testes , Curva ROC
17.
QJM ; 112(4): 261-267, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30541151

RESUMO

BACKGROUND: Burden of disease (BoD) using disability-adjusted life years (DALY) is a useful summary measure of population health and estimates are provided for Ireland annually. We hypothesized that BoD may be used as a predictor of frailty prevalence. AIM: To examine the correlation between frailty measured by the accumulation of deficits (frailty index, FI) and Fried frailty phenotype (FFP) classifications and BoD, in an Irish context. DESIGN: Cross-sectional secondary analysis. METHODS: Data were obtained from waves two and three of The Survey of Health, Ageing and Retirement in Europe for Irish adults aged ≥65 in 2007. Frailty was defined by a 70-item FI and the FFP. Years lived with disability (YLD), years of life lost (YLL) and DALY were calculated using adapted equations from the World Health Organization and, where possible, disability weights, sequelae and durations as in the Global BoD (GBD) project (2016). RESULTS: Of 1035 participants, 442 were ≥65 years. Mean DALY were significantly higher in those identified as frail (FI: 3.31, P < 0.0001, n = 406; FFP: 2.46, P = 0.005, n = 319). For the FI, stronger correlation was found for DALY (r = 0.5431, P < 0.0001) than for age (r = 0.275, P < 0.0001). Controlling for confounders, DALY were an independent predictor of frailty when measured with the FI (OR 1.17, 95% CI: 1.10-1.24) but not with the FFP (OR 1.079, 95%% CI 1.00-1.17). CONCLUSIONS: Frailty correlates significantly with DALY, and more so with the FI than the FFP, reaffirming that these measures are different constructs. GBD data could represent a predictor of population-level frailty estimates, facilitating improved comparisons.


Assuntos
Efeitos Psicossociais da Doença , Fragilidade/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Fatores de Confusão Epidemiológicos , Estudos Transversais , Avaliação da Deficiência , Feminino , Avaliação Geriátrica/métodos , Humanos , Irlanda/epidemiologia , Masculino , Prevalência
18.
Animal ; 12(s2): s262-s271, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30345940

RESUMO

Precision technologies and data have had relatively modest impacts in grass-based livestock ruminant production systems compared with other agricultural sectors such as arable. Precision technologies promise increased efficiency, reduced environmental impact, improved animal health, welfare and product quality. The benefits of precision technologies have, however, been relatively slow to be realised on pasture based farms. Though there is significant overlap with indoor systems, implementing technology in grass-based dairying brings unique opportunities and challenges. The large areas animals roam and graze in pasture based systems and the associated connectivity challenges may, in part at least, explain the comparatively lower adoption of such technologies in pasture based systems. With the exception of sensor and Bluetooth-enabled plate metres, there are thus few technologies designed specifically to increase pasture utilisation. Terrestrial and satellite-based spectral analysis of pasture biomass and quality is still in the development phase. One of the key drivers of efficiency in pasture based systems has thus only been marginally impacted by precision technologies. In contrast, technological development in the area of fertility and heat detection has been significant and offers significant potential value to dairy farmers, including those in pasture based systems. A past review of sensors in health management for dairy farms concluded that although the collection of accurate data was generally achieved, the processing, integration and presentation of the resulting information and decision-support applications were inadequate. These technologies' value to farming systems is thus unclear. As a result, it is not certain that farm management is being sufficiently improved to justify widespread adoption of precision technologies currently. We argue for a user need-driven development of technologies and for a focus on how outputs arising from precision technologies and associated decision support applications are delivered to users to maximise their value. Further cost/benefit analysis is required to determine the efficacy of investing in specific precision technologies, potentially taking account of several yet to ascertained farm specific variables.


Assuntos
Bem-Estar do Animal , Indústria de Laticínios/economia , Meio Ambiente , Poaceae , Ruminantes/fisiologia , Agricultura , Animais , Análise Custo-Benefício , Coleta de Dados , Fazendas , Feminino , Gado
20.
Psychol Med ; 48(10): 1608-1615, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29310738

RESUMO

BACKGROUND: The longstanding association between the major histocompatibility complex (MHC) locus and schizophrenia (SZ) risk has recently been accounted for, partially, by structural variation at the complement component 4 (C4) gene. This structural variation generates varying levels of C4 RNA expression, and genetic information from the MHC region can now be used to predict C4 RNA expression in the brain. Increased predicted C4A RNA expression is associated with the risk of SZ, and C4 is reported to influence synaptic pruning in animal models. METHODS: Based on our previous studies associating MHC SZ risk variants with poorer memory performance, we tested whether increased predicted C4A RNA expression was associated with reduced memory function in a large (n = 1238) dataset of psychosis cases and healthy participants, and with altered task-dependent cortical activation in a subset of these samples. RESULTS: We observed that increased predicted C4A RNA expression predicted poorer performance on measures of memory recall (p = 0.016, corrected). Furthermore, in healthy participants, we found that increased predicted C4A RNA expression was associated with a pattern of reduced cortical activity in middle temporal cortex during a measure of visual processing (p < 0.05, corrected). CONCLUSIONS: These data suggest that the effects of C4 on cognition were observable at both a cortical and behavioural level, and may represent one mechanism by which illness risk is mediated. As such, deficits in learning and memory may represent a therapeutic target for new molecular developments aimed at altering C4's developmental role.


Assuntos
Disfunção Cognitiva/fisiopatologia , Complemento C4a/metabolismo , Complexo Principal de Histocompatibilidade/genética , Transtornos da Memória/fisiopatologia , Transtornos Psicóticos/genética , Transtornos Psicóticos/fisiopatologia , Lobo Temporal/fisiopatologia , Adulto , Disfunção Cognitiva/diagnóstico por imagem , Feminino , Neuroimagem Funcional , Expressão Gênica/genética , Humanos , Irlanda , Imageamento por Ressonância Magnética , Masculino , Transtornos da Memória/diagnóstico por imagem , Memória de Curto Prazo/fisiologia , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico por imagem , Lobo Temporal/diagnóstico por imagem
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