Quantifying the effects of standing waves within the skull for ultrasound mediated opening of the blood-brain-barrier

Ultrasound mediated opening of the blood-brain barrier (BBB) has been shown to be effective in enhancing the delivery of therapeutic agents to the brain. However, challenges remain in targeting and specificity of BBB opening due to attenuation, aberration and reverberation of transcranial ultrasound fields. In this study, experimental and numerical assessment was performed of standing waves within an ex vivo human skull when delivering ultrasound pulses of varying lengths at 300 kHz using a large aperture focused ultrasound transducer. Simulations showed minimal distortion of the focal region but low amplitude standing waves were established within the skull with bursts of 50 cycles or more. Under the same conditions, the experimental measurements showed small variations in focal pressure which took 300 to 600 µs to stabilise. The pattern of sidelobes and superimposed standing waves was generally more complex when the focus was placed closer to the side and base of the skull. This data supports the use of large aperture diameter transducers and short pulse lengths for targeted BBB opening

Uncertainty in weather and climate prediction

Following Lorenz's seminal work on chaos theory in the 1960s, probabilistic approaches to prediction have come to dominate the science of weather and climate forecasting. This paper gives a perspective on Lorenz's work and how it has influenced the ways in which we seek to represent uncertainty in forecasts on all lead times from hours to decades. It looks at how model uncertainty has been represented in probabilistic prediction systems and considers the challenges posed by a changing climate. Finally, the paper considers how the uncertainty in projections of climate change can be addressed to deliver more reliable and confident assessments that support decision-making on adaptation and mitigation

Formula milk supplementation on the postnatal ward: a cross-sectional analytical study

Breastfeeding rates are low in the UK, where approximately one quarter of infants receive a breastmilk substitute (BMS) in the first week of life. We investigated the reasons for early BMS use in two large maternity units in the UK, in order to understand the reasons for the high rate of early BMS use in this setting. Data were collected through infant feeding records, as well as maternal and midwife surveys in 2016. During 2016, 28% of infants received a BMS supplement prior to discharge from the hospital maternity units with only 10% supplementation being clinically indicated. There was wide variation in BMS initiation rates between different midwives, which was associated with ward environment and midwife educational level. Specific management factors associated with non-clinically indicated initiation of BMS were the absence of skin-to-skin contact within an hour of delivery (p = 0.01), and no attendance at an antenatal breastfeeding discussion (p = 0.01). These findings suggest that risk of initiating a BMS during postnatal hospital stay is largely modifiable. Concordance with UNICEF Baby Friendly 10 steps, attention to specific features of the postnatal ward working environment, and the targeting of midwives and mothers with poor educational status may all lead to improved exclusive breastfeeding rates at hospital discharge

The effect of Maillard reaction products on zinc metabolism in the rat

The effect of giving Maillard reaction products (MRP) on zinc metabolism was investigated in the rat. In Expt 1, MRP were prepared by incubating casein with either glucose or lactose under controlled reaction conditions, and were quantified as either ‘early' or ‘advanced' after estimation of lysine loss and lysine destruction respectively. In Expt 2, the effect of the purified early MRP fructose-lysine (FL) on Zn metabolism was studied. The experimental diets containing 20 mg Zn/kg were given to weanling rats for 21 d. Zn balance was assessed over 9-14 d (Expt 1), or 1-14 d (Expt 2). Femur, liver, kidney and serum Zn concentrations were determined at 21 d. The major effect of the MRP in the casein-sugar mixtures was on urinary Zn excretion. The casein-glucose MRP induced up to a 6-fold increase in the quantity of Zn excreted in the urine. The magnitude of the hyperzincuria increased with the extent of the Maillard reaction. Similar dietary levels of casein-lactose MRP increased urinary Zn loss 2-fold. Free FL had no effect on urinary Zn. Faecal Zn, Zn retention, liver, femur and serum Zn were generally not influenced by giving MRP from casein-sugar mixtures or by giving free FL, although kidney Zn was decreased in rats fed on FL. It was concluded that although urinary Zn excretion can be increased by the presence of MRP in the diet, this is only a minor excretory pathway and would have little influence on overall Zn nutrition in individuals fed on a diet adequate in Z