Early infant feeding and adiposity risk: from infancy to adulthood

Introduction: Systematic reviews suggest that a longer duration of breast-feeding is associated with a reduction in the risk of later overweight and obesity. Most studies examining breast-feeding in relation to adiposity have not used longitudinal analysis. In our study, we aimed to examine early infant feeding and adiposity risk in a longitudinal cohort from birth to young adulthood using new as well as published data. Methods: Data from the Western Australian Pregnancy Cohort (Raine) Study in Perth, W.A., Australia, were used to examine associations between breast-feeding and measures of adiposity at 1, 2, 3, 6, 8, 10, 14, 17, and 20 years. Results: Breast-feeding was measured in a number of ways. Longer breast-feeding (in months) was associated with reductions in weight z-scores between birth and 1 year (β = -0.027; p \u3c 0.001) in the adjusted analysis. At 3 years, breast-feeding for \u3c4 months increased the odds of infants experiencing early rapid growth (OR 2.05; 95% CI 1.43-2.94; p \u3c 0.001). From 1 to 8 years, children breast-fed for ≤4 months compared to ≥12 months had a significantly greater probability of exceeding the 95th percentile of weight. The age at which breast-feeding was stopped and a milk other than breast milk was introduced (introduction of formula milk) played a significant role in the trajectory of the BMI from birth to 14 years; the 4-month cutoff point was consistently associated with a higher BMI trajectory. Introduction of a milk other than breast milk before 6 months compared to at 6 months or later was a risk factor for being overweight or obese at 20 years of age (OR 1.47; 95% CI 1.12-1.93; p = 0.005). Discussion: Breast-feeding until 6 months of age and beyond should be encouraged and is recommended for protection against increased adiposity in childhood, adolescence, and young adulthood. Adverse long-term effects of early growth acceleration are fundamental in later overweight and obesity. Formula feeding stimulates a higher postnatal growth velocity, whereas breast-feeding promotes slower growth and a reduced likelihood of overweight and obesity. Biological mechanisms underlying the protective effect of breast-feeding against obesity are based on the unique composition and metabolic and physiological responses to human milk

Safety of an intravenous formulation of lamotrigine

AbstractPurposeIntravenous (IV) formulations are useful when treating patients where oral administration is not possible and to study certain pharmacokinetic parameters such as bioavailability. We developed a stable-labeled IV formulation of lamotrigine (LTG) for studying pharmacokinetics in epilepsy patients.MethodsStable-labeled IV LTG was given to 20 persons with epilepsy (6 men; 14 women) with a mean age of 34.8 years (SD 11.7). A 50mg dose of LTG (stable labeled) was given intravenously and replaced 50mg of the regular morning oral dose of LTG (unlabeled, commercially available formulation).ResultsNo significant changes in blood pressure, heart rate, or adverse events including rash were attributed to administration of a 50-mg dose of the intravenous LTG formulation.ConclusionOur results show that LTG base that is complexed with 2-hydroxypropyl-β-cyclodextrin and stable-labeled can be given safely as a tracer replacement dose

Fracture assessment of HSST Plate 14 shallow-flaw cruciform bend specimens tested under biaxial loading conditions

A technology to determine shallow-flaw fracture toughness of reactor pressure vessel (RPV) steels is being developed for application to the safety assessment of RPVs containing postulated shallow surface flaws. Matrices of cruciform beam tests were developed to investigate and quantify the effects of temperature, biaxial loading, and specimen size on fracture initiation toughness of two-dimensional (constant depth), shallow, surface flaws. The cruciform beam specimens were developed at Oak Ridge National Laboratory (ORNL) to introduce a far-field, out-of-plane biaxial stress component in the test section that approximates the nonlinear stresses resulting from pressurized-thermal-shock or pressure-temperature loading of an RPV. Tests were conducted under biaxial load ratios ranging from uniaxial to equibiaxial. These tests demonstrated that biaxial loading can have a pronounced effect on shallow-flaw fracture toughness in the lower transition temperature region for an RPV material. The cruciform fracture toughness data were used to evaluate fracture methodologies for predicting the observed effects of biaxial loading on shallow-flaw fracture toughness. Initial emphasis was placed on assessment of stress-based methodologies, namely, the J-Q formulation, the Dodds-Anderson toughness scaling model, and the Weibull approach. Applications of these methodologies based on the hydrostatic stress fracture criterion indicated an effect of loading-biaxiality on fracture toughness; the conventional maximum principal stress criterion indicated no effect. A three-parameter Weibull model based on the hydrostatic stress criterion is shown to correlate the experimentally observed biaxial effect on cleavage fracture toughness by providing a scaling mechanism between uniaxial and biaxial loading states

Biaxial loading effects on fracture toughness of reactor pressure vessel steel

The preliminary phases of a program to develop and evaluate fracture methodologies for assessing crack-tip constraint effects on fracture toughness of reactor pressure vessel (RPV) steels have been completed by the Heavy-Section Steel Technology (HSST) Program. Objectives were to investigate effect of biaxial loading on fracture toughness, quantify this effect through existing stress-based, dual-parameter, fracture-toughness correlations, or propose and verify alternate correlations. A cruciform beam specimen with 2-D, shallow, through-thickness flaw and a special loading fixture was designed and fabricated. Tests were performed using biaxial loading ratios of 0:1 (uniaxial), 0.6:1, and 1:1 (equi-biaxial). Critical fracture-toughness values were calculated for each test. Biaxial loading of 0.6:1 resulted in a reduction in the lower bound fracture toughness of {approximately}12% as compared to that from the uniaxial tests. The biaxial loading of 1:1 yielded two subsets of toughness values; one agreed well with the uniaxial data, while one was reduced by {approximately}43% when compared to the uniaxial data. Results were evaluated using J-Q theory and Dodds-Anderson (D-A) micromechanical scaling model. The D-A model predicted no biaxial effect, while the J-Q method gave inconclusive results. When applied to the 1:1 biaxial data, these constraint methodologies failed to predict the observed reduction in fracture toughness obtained in one experiment. A strain-based constraint methodology that considers the relationship between applied biaxial load, the plastic zone width in the crack plane, and fracture toughness was formulated and applied successfully to the data. Evaluation of this dual-parameter strain-based model led to the conclusion that it has the capability of representing fracture behavior of RPV steels in the transition region, including the effects of out-of-plane loading on fracture toughness. This report is designated as HSST Report No. 150

Are antenatal interventions effective in improving multiple health behaviours among pregnant women? A systematic review protocol.

BACKGROUND: Maternal behaviours in pregnancy associated with adverse pregnancy, birth and health outcomes include tobacco smoking, poor nutrition, alcohol consumption and low physical activity, collectively referred to as the SNAP risk factors. Due to the high prevalence, co-occurrence and possible interactive health effects of such health behaviours in pregnancy, antenatal interventions that support pregnant women to improve multiple SNAP behaviours have a greater potential impact on the health outcomes of women and their children than interventions addressing single behaviours. The objective of this review is to determine the effectiveness of interventions delivered as part of antenatal care that aim to improve multiple SNAP behaviours among pregnant women. METHODS: Seven electronic databases will be searched for potentially eligible studies. Eligible studies will include those where pregnant women are attending antenatal care. Studies that examine the effect of an intervention that addresses multiple SNAP behaviours (≥ 2 behaviours) during pregnancy and are delivered or instigated through antenatal care in a healthcare service will be included. Systematic reviews of randomised controlled trials (RCTs), RCTs, cluster RCTs, stepped-wedge RCTs and non-randomised control trials will be eligible. Studies that include a no-intervention control, wait-list control group, standard/usual care, or another active single behavioural intervention (e.g. addressing one behaviour only) will be considered. Two independent reviewers will conduct study screening, data extraction and risk of bias assessment. Discrepancies will be resolved by consensus or a third reviewer if required. A random effects model will be used to synthesise the results. Alternative synthesis methods will be investigated in instances where a meta-analysis is not appropriate, such as summarising effect estimates, combining P values, vote counting based on direction of effect, or synthesis in narrative form. DISCUSSION: The review will synthesise the evidence on the effect of interventions that address multiple SNAP behaviours in antenatal care and will help researchers, policy-makers and health services to develop and deliver best practice integrated models of antenatal care that have the potential to impact on both the short- and long-term health outcomes for women and their children. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018095315

Dobutamine stress cardiovascular magnetic resonance at 3 Tesla

<p>Abstract</p> <p>Purpose</p> <p>The assessment of inducible wall motion abnormalities during high-dose dobutamine-stress cardiovascular magnetic resonance (DCMR) is well established for the identification of myocardial ischemia at 1.5 Tesla. Its feasibility at higher field strengths has not been reported. The present study was performed to prospectively determine the feasibility and diagnostic accuracy of DCMR at 3 Tesla for depicting hemodynamically significant coronary artery stenosis (≥ 50% diameter stenosis) in patients with suspected or known coronary artery disease (CAD).</p> <p>Materials and methods</p> <p>Thirty consecutive patients (6 women) (66 ± 9.3 years) were scheduled for DCMR between January and May 2007 for detection of coronary artery disease. Patients were examined with a Philips Achieva 3 Tesla system (Philips Healthcare, Best, The Netherlands), using a spoiled gradient echo cine sequence. Technical parameters were: spatial resolution 2 × 2 × 8 mm³, 30 heart phases, spoiled gradient echo TR/TE: 4.5/2.6 msec, flip angle 15°. Images were acquired at rest and stress in accordance with a standardized high-dose dobutamine-atropine protocol during short breath-holds in three short and three long-axis views. Dobutamine was administered using a standard protocol (10 μg increments every 3 minutes up to 40 μg dobutamine/kg body weight/minute plus atropine if required to reach target heart rate). The study protocol included administration of 0.1 mmol/kg/body weight Gd-DTPA before the cine images at rest were acquired to improve the image quality. The examination was terminated if new or worsening wall-motion abnormalities or chest pain occurred or when > 85% of age-predicted maximum heart rate was reached. Myocardial ischemia was defined as new onset of wall-motion abnormality in at least one segment. In addition, late gadolinium enhancement (LGE) was performed. Images were evaluated by two blinded readers. Diagnostic accuracy was determined with coronary angiography as the reference standard. Image quality and wall-motion at rest and maximum stress level were evaluated using a four-point scale.</p> <p>Results</p> <p>In 27 patients DCMR was performed successfully, no patient had to be excluded due to insufficient image quality. Twenty-two patients were examined by coronary angiography, which depicted significant stenosis in 68.2% of the patients. Patient-based sensitivity and specificity were 80.0% and 85.7% respectively and accuracy was 81.8%. Interobserver variability for assessment of wall motion abnormalities was 88% (κ = 0.760; p < 0.0001). Negative and positive predictive values were 66.7% and 92.3%, respectively. No significant differences in average image quality at rest versus stress for short or long-axis cine images were found.</p> <p>Conclusion</p> <p>High-dose DCMR at 3T is feasible and an accurate method to depict significant coronary artery stenosis in patients with suspected or known CAD.</p

Gated myocardial perfusion SPECT underestimates left ventricular volumes and shows high variability compared to cardiac magnetic resonance imaging -- a comparison of four different commercial automated software packages

Abstract Background We sought to compare quantification of left ventricular volumes and ejection fraction by different gated myocardial perfusion SPECT (MPS) programs with each other and to magnetic resonance (MR) imaging. Methods N = 100 patients with known or suspected coronary artery disease were examined at rest with 99 mTc-tetrofosmin gated MPS and cardiac MR imaging. Left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were obtained by analysing gated MPS data with four different programs: Quantitative Gated SPECT (QGS), GE MyoMetrix, Emory Cardiac Toolbox (ECTb) and Exini heart. Results All programs showed a mean bias compared to MR imaging of approximately -30% for EDV (-22 to -34%, p Conclusions Gated MPS, systematically underestimates left ventricular volumes by approximately 30% and shows a high variability, especially for ESV. For EF, accuracy was better, with a mean bias between -15 and 6% of EF. It may be of value to take this into consideration when determining absolute values of LV volumes and EF in a clinical setting.</p

Nested radiations and the pulse of angiosperm diversification: increased diversification rates often follow whole genome duplications

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111924/1/nph13491-sup-0001-FigS1-TableS1-S2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/111924/2/nph13491.pd