Nutritional support of children with chronic liver disease

Anorexia, malabsorption and metabolic derangements contribute to the malnutrition that occurs in most children with chronic liver disease. Nutritional support should be started early in the management of these children with the co-operation of a paediatric dietitian to improve quality of life and decrease post-transplant mortality.Nutritional assessment entails a detailed dietary history, physical examination and anthropometry. Weight-based anthropometric measures are unreliable while mid-upper-arm circumference and skinfold thickness provide more reliable estimates of nutritional status. Special investigations such as serum vitamin levels and skeletal X-rays further guide management.High energy (130 - 150% of recommended daily intake (RDI)) and protein (3 - 4 g/kg/day) intakes are recommended. Diets are usually enriched with medium-chain fatty acids because of their better absorption in cholestatic liver disease. High-dose fat-soluble vitamin supplements are given while care is taken to avoid toxicity. Initial doses are two to three times the RDI and then adjusted according to serum levels or international normalised ratio (INR) in the case of vitamin K.Children with good appetites are fed orally. Feeds should be more regular than for other children to avoid prolonged periods of fasting and improve energy intake. Some children require supplementary nasogastric feeds to increase energy intake and avoid overnight fastin

A new chironomid (Insecta : Diptera) from Wealden amber (Lower Cretaceous) of the Isle of Wight (UK)

The first insect from the Wealden amber of the Isle of Wight (early Barremian) is formally described. Dungeyella gavini n. gen., n. sp. (Diptera: Chironomidae) is a tiny buchonomyiine/podonomian with specialised wing venation and probably lived in an araucarian riparian woodland with seasonal resin production. It is in one of the oldest-known ambers with insect inclusions

The outcome of HIV-positive patients admitted to intensive care units with acute kidney injury

The original publication is available at http://www.intechopen.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Acute kidney injury is a serious clinical problem with significant morbidity and mortality. Several factors are recognized to aggravate the outcome including advanced age, gender, oliguria and the serum creatinine level. What is currently unknown is whether the presence of the human immunodeficiency virus (HIV) aggravates the outcome of patients who develop acute kidney injury (AKI). Sub-Saharan Africa currently bears the brunt of the global HIV pandemic. In South Africa alone more than 5.7 million people are infected ((UNAIDS 2008 report on the global AIDS epidemic, 2009), creating substantial additional pressure on already inadequate social and healthcare infrastructures. Acute kidney injury occurs commonly in HIV-infected patients admitted to hospital and carries with it substantial mortality. In a resource-poor environment clinicians are often forced to select patients with a better chance of survival for admission to the intensive care unit (ICU). A rigorous evaluation of the outcomes of HIV-positive patients admitted to ICU with AKI may assist in identifying factors associated with better survival, and thus aid in the cost-effective management of these patients.Publishers' Versio

The Outcome of HIV-Positive Patients Admitted to Intensive Care Units with Acute Kidney Injury

The original publication is available at http://www.intechopen.comPublication of this article was funded by the Stellenbosch University Open Access Fund.Acute kidney injury is a serious clinical problem with significant morbidity and mortality. Several factors are recognized to aggravate the outcome including advanced age, gender, oliguria and the serum creatinine level. What is currently unknown is whether the presence of the human immunodeficiency virus (HIV) aggravates the outcome of patients who develop acute kidney injury (AKI). Sub-Saharan Africa currently bears the brunt of the global HIV pandemic. In South Africa alone more than 5.7 million people are infected ((UNAIDS 2008 report on the global AIDS epidemic, 2009), creating substantial additional pressure on already inadequate social and healthcare infrastructures. Acute kidney injury occurs commonly in HIV-infected patients admitted to hospital and carries with it substantial mortality. In a resource-poor environment clinicians are often forced to select patients with a better chance of survival for admission to the intensive care unit (ICU). A rigorous evaluation of the outcomes of HIV-positive patients admitted to ICU with AKI may assist in identifying factors associated with better survival, and thus aid in the cost-effective management of these patients.Publishers' Versio

TB or not TB?

Object: The aim of the study was to identify diagnoses that are confused with pulmonary tuberculosis in children. Design: Prospective, investigative clinical study. Setting: Tertiary care teaching hospital and an urban tuberculosis clinic in an area with a very high incidence of pulmonary tuberculosis (> 800 new cases/100 ODD/year). Patients: Children suspected of having tuberculosis, children followed up for pulmonary infiltrates with eosinophilia and children with congenital pulmonjiry anomalies were investigated. Intervention(s): None. Outcome measure: Pulmonary tuberculosis was diagnosed using modified World Health Organisation criteria and the diagnoses of those children not suffering from pulmonary tuberculosis were analysed. Results: Of the 354 children initially suspected of suffering from tuberculosis 71 (20%) were found to be suffering from other pulmonary disease, viz. pneumonia or bronchopneumonia (29%), bronchopneumonia with Wheezing (18%), and asthma with lobar or segmental collapse (12%). Of 14 children suffering from pulmonary infiltrates with peripheral eosinophilia 6 (43%) were initially incorrectly diagnosed and treated for tuberculosis. Of 54 children with congenital pulmonary anomalies, 8 (15%) were treated for tuberculosis before the correct diagnosis was made. Congenital anomalies most often confused with tuberculosis were unilateral lung hypoplasia, bronchogenic cyst and tracheal bronchus with an anomalous lobe. Conclusions: The criteria for diagnosing tuberculosis in children is complicated in areas with a high incidence of tuberculosis and poor socio-economic circumstances where many children presenting with conditions other than tuberculosis will be in contact with an adult case of pulmonary tuberculosis. The commonest conditions confused with tuberculosis are pneumonia, bronchopneumonia and asthma. Pulmonary infiltrates with  peripheral eosinophilia and congenital lung abnormalities should be considered especially if the children have an atypical clinical picture or do not respond to tuberculosis treatment.S Afr Med J 1995; 85: 658-66

SATRE: Standardised Architecture for Trusted Research Environments

The SATRE DARE UK-funded Driver Project was challenged to create a trusted research environment (TRE) architecture supporting the research community's need to have suitable data analytics and research environments for working with sensitive data. The project developed an inclusive and transparent way of working to ensure that what was created was representative of the TRE community in the UK. We have created, for the first time, an open specification for TRE operators by which to evaluate themselves against a set of capabilities. It is a thorough specification, perhaps definition, for TREs informed not only by the experience of the project team who have been running a TRE and supporting sensitive data projects for a combined 15 years but also the expansive knowledge of the wider UK research community. The public has also been involved throughout the development of the specification to ensure their voices are heard and reflected in the specification. The specification has been informed through one survey completed by 105 individuals representing approximately 60 organisations, 14 Collaboration Cafés with up to 75 participants, 26 individuals contributing directly, 44 issues raised and six public engagement sessions online and in-person. Despite the breadth and diversity of the individuals included, we have been able to create a single specification encompassing four architectural principles, four pillars, 29 capabilities and 160 statements. The 75 mandatory statements are what is considered the minimum required to be a SATRE-compliant TRE. Now, with a stable version 1.0 release, the specification is ready for use by the UK TRE community. We are and will continue to work with all organisations to evaluate themselves against the specification and also identify what works and what doesn't, which will be captured in future versions of the specification. The specification has been developed with the long-term in mind and can be a basis for a common understanding between operators, data controllers, accreditors, researchers, industry and government organisations for how TREs can federate and interoperate better.This work was funded by UK Research & Innovation [Grant Number MC_PC_23008] as part of Phase 1 of the DARE UK (Data and Analytics Research Environments UK) programme, delivered in partnership with Health Data Research UK (HDR UK) and Administrative Data Research UK (ADR UK)

Humans and elephants as treefall drivers in African savannas

Humans have played a major role in altering savanna structure and function, and growing land-use pressure will only increase their influence on woody cover. Yet humans are often overlooked as ecological components. Both humans and the African elephant Loxodonta africana alter woody vegetation in savannas through removal of large trees and activities that may increase shrub cover. Interactive effects of both humans and elephants with fire may also alter vegetation structure and composition. Here we capitalize on a macroscale experimental opportunity – brought about by the juxtaposition of an elephant-mediated landscape, human-utilized communal harvesting lands and a nature reserve fenced off from both humans and elephants – to investigate the influence of humans and elephants on height-specific treefall dynamics. We surveyed 6812 ha using repeat, airborne high resolution Light Detection and Ranging (LiDAR) to track the fate of 453 685 tree canopies over two years. Human-mediated biennial treefall rates were 2–3.5 fold higher than the background treefall rate of 1.5% treefall ha–1, while elephant-mediated treefall rates were 5 times higher at 7.6% treefall ha–1 than the control site. Model predictors of treefall revealed that human or elephant presence was the most important variable, followed by the interaction between geology and fire frequency. Treefall patterns were spatially heterogeneous with elephant-driven treefall associated with geology and surface water, while human patterns were related to perceived ease of access to wood harvesting areas and settlement expansion. Our results show humans and elephants utilize all height classes of woody vegetation, and that large tree shortages in a heavily utilized communal land has transferred treefall occurrence to shorter vegetation. Elephant- and human-dominated landscapes are tied to interactive effects that may hinder tree seedling survival which, combined with tree loss in the landscape, may compromise woodland sustainability.Andrew Mellon Foundation; Council for Scientific and Industrial Research (CSIR) Strategic Research Panel; Dept of Science and Technology (DST); Avatar Alliance Foundation; Margaret A. Cargill Foundation; David and Lucile Packard Foundation; Gordon and Betty Moore Foundation; Grantham Foundation for the Protection of the Environment; W. M. Keck Foundation; John D. and Catherine T. MacArthur Foundation; Exxaro Chairman's Fund; Applied Centre for Climate and Earth System Science; DST/NRF Centre of Excellence in Tree Health Biotechnology; NRF Innovation Scholarship [UID: 95030].http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1600-05872018-11-30hj2017Geography, Geoinformatics and Meteorolog

Fuelwood extraction intensity drives compensatory regrowth in African savanna communal lands

Woody biomass remains the primary energy source for domestic use in the developing world, raising concerns about woodland sustainability. Yet woodland regenerative capacity and the adaptive response of harvesters to localised fuelwood shortages are often underestimated or unaccounted for in fuelwood supply–demand models. Here, we explore the rates and patterns of height‐specific woody vegetation structural dynamics in three communal lands in a semiarid savanna in South Africa. Using repeat, airborne light detection and ranging, we measured height‐specific change in woody vegetation structure, and the relative influence of geology, fire, and ease of access to fuelwood. Monitoring 634,284 trees canopies over 4 years revealed high compensatory growth, particularly in the high wood extraction communal land: 34.1% of trees increased in height >1 m. Vegetation structural patterns were associated with ease of access to the communal land but were mediated by wood extraction intensity. In these communal lands, vegetation structural dynamics show rapid woody thickening as a response to repeat harvesting. However, loss of height in vegetation structure did not follow a gradient of wood extraction intensity. We propose a conceptual framework to better understand change in vegetation structural metrics and the paradoxical phenomenon of high growth in high wood extraction scenarios. We also show coadaptive responses of humans and woody vegetation to fuelwood harvesting in human–environment systems through patterns of regrowth response relative to ease of access to fuelwood resources.LiDAR data collection was funded by the Andrew Mellon Foundation, the Council for Scientific and Industrial Research (CSIR) Strategic Research Panel and the Department of Science and Technology (DST). The CAO has been made possible by grants and donations from the Avatar Alliance Foundation, Margaret A. Cargill Foundation, David and Lucile Packard Foundation, Gordon and Betty Moore Foundation, Grantham Foundation for the Protection of the Environment, W. M. Keck Foundation, John D. and Catherine T. MacArthur Foundation, Andrew Mellon Foundation, Mary Anne Nyburg Baker and G. Leonard Baker Jr, and William R. Hearst III. B. F. N. E. is supported by the Exxaro Chairman's Fund. P. J. M. is funded by the DST/NRF Centre of Excellence in Tree Health Biotechnology and an NRF Innovation Scholarship (grant UID: 95030).http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1099-145X2020-01-30hj2018Geography, Geoinformatics and Meteorolog

What lies beneath : detecting sub-canopy changes in savanna woodlands using a three-dimensional classification method

QUESTION : Increasing population pressure, socio-economic development and associated natural resource use in savannas are resulting in large-scale land cover changes, which can be mapped using remote sensing. Is a three-dimensional (3D) woody vegetation structural classification applied to LiDAR (Light Detection and Ranging) data better than a 2D analysis to investigate change in fine-scale woody vegetation structure over 2 yrs in a protected area (PA) and a communal rangeland (CR)? LOCATION : Bushbuckridge Municipality and Sabi Sand Wildtuin, NE South Africa. METHODS : Airborne LiDAR data were collected over 3 300 ha in April 2008 and 2010. Individual tree canopies were identified using object-based image analysis and classified into four height classes: 1–3, 3–6, 6–10 and >10 m. Four structural metrics were calculated for 0.25-ha grid cells: canopy cover, number of canopy layers present, cohesion and number of height classes present. The relationship between top-of-canopy cover and sub-canopy cover was investigated using regression. Gains, losses and persistence (GLP) of cover at each height class and the four structural metrics were calculated. GLP of clusters of each structural metric (calculated using LISA – Local Indicators of Spatial Association – statistics) were used to assess the changes in clusters of eachmetric over time. RESULTS : Top-of-canopy cover was not a good predictor of sub-canopy cover. The number of canopy layers present and cohesion showed gains and losseswith persistence in canopy cover over time, necessitating the use of a 3D classification to detect fine-scale changes, especially in structurally heterogeneous savannas. Trees >3 min height showed recruitment and gains up to 2.2 times higher in the CR where they are likely to be protected for cultural reasons, but losses of up to 3.2-foldmore in the PA, possibly due to treefall caused by elephant and/or fire. CONCLUSION : Land use has affected sub-canopy structure in the adjacent sites, with the low intensity use CR showing higher structural diversity. A 3D classification approach was successful in detecting fine-scale, short-term changes between land uses, and can thus be used as amonitoring tool for savannawoody vegetation structure. Remove selectedThe Carnegie Airborne Observatory is made possible by the Avatar Alliance Foundation, Margaret A. Cargill Foundation, John D. and Catherine T. MacArthur Foundation, Grantham Foundation for the Protection of the Environment, W.M. Keck Foundation, Gordon and Betty Moore Foundation, Mary Anne Nyburg Baker and G. Leonard Baker Jr. and William R. Hearst III. Application of the CAO data in South Africa is made possible by the Andrew Mellon Foundation and the endowment of the Carnegie Institution for Science.http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1654-109X2016-07-31hb201

Biomass increases go under cover : woody vegetation dynamics in South African rangelands

Woody biomass dynamics are an expression of ecosystem function, yet biomass estimates do not provide information on the spatial distribution of woody vegetation within the vertical vegetation subcanopy. We demonstrate the ability of airborne light detection and ranging (LiDAR) to measure aboveground biomass and subcanopy structure, as an explanatory tool to unravel vegetation dynamics in structurally heterogeneous landscapes. We sampled three communal rangelands in Bushbuckridge, South Africa, utilised by rural communities for fuelwood harvesting. Woody biomass estimates ranged between 9 Mg ha-1 on gabbro geology sites to 27 Mg ha-1 on granitic geology sites. Despite predictions of woodland depletion due to unsustainable fuelwood extraction in previous studies, biomass in all the communal rangelands increased between 2008 and 2012. Annual biomass productivity estimates (10–14% p.a.) were higher than previous estimates of 4% and likely a significant contributor to the previous underestimations of modelled biomass supply. We show that biomass increases are attributable to growth of vegetation <5 m in height, and that, in the high wood extraction rangeland, 79% of the changes in the vertical vegetation subcanopy are gains in the 1-3m height class. The higher the wood extraction pressure on the rangelands, the greater the biomass increases in the low height classes within the subcanopy, likely a strong resprouting response to intensive harvesting. Yet, fuelwood shortages are still occurring, as evidenced by the losses in the tall tree height class in the high extraction rangeland. Loss of large trees and gain in subcanopy shrubs could result in a structurally simple landscape with reduced functional capacity. This research demonstrates that intensive harvesting can, paradoxically, increase biomass and this has implications for the sustainability of ecosystem service provision. The structural implications of biomass increases in communal rangelands could be misinterpreted as woodland recovery in the absence of three-dimensional, subcanopy information.S1 Dataset. Biomass model data. Data include 2012 LiDAR-derived average height and canopy cover extraction metrics, as well as field-work based allometry. Each line item is per 25 m x 25 m grid cell. Metadata are included in the dataset.S2 Dataset. Biomass and subcanopy data. Data include 2008 and 2012 biomass estimates derived from biomass models as well as % subcanopy returns for voxel data for the height class categories: 1-3m, 3-5m, 5-10m and >10m. Each line item is per 25 m x 25 m grid cell. Data are organized per land extraction category into separate worksheets. Metadata are included in the dataset.S3 Dataset. Biomass changes (Mg ha-1) in relation to relative height and canopy cover change. Data include biomass change estimates (2008–2012), percentage height and canopy cover changes for each 25 m x 25 m grid cell. Each height class (relative to height in 2008) are shown on separate worksheets. Metadata are included in the dataset.S1 Fig. Site-specific biomass model residuals. The residual spread demonstrates heteroskedasticity with increasing biomass fitted values for rangelands with a) high, b) intermediate and c) low extraction pressure.S2 Fig. Biomass changes (%) relative to height-specific change in subcanopy returns (%). Height categories are: 1–3 m, 3–5 m, 5–10 m and >10 m.The Carnegie Airborne Observatory (CAO) is made possible by the Avatar Alliance Foundation, Margaret A. Cargill Foundation, John D. and Catherine T. MacArthur Foundation, Grantham Foundation for the Protection of the Environment, W. M. Keck Foundation, Gordon and Betty Moore Foundation, Mary Anne Nyburg Baker and G. Leonard Baker, Jr., and William R. Hearst III. Application of the CAO data in South Africa is made possible through the Andrew Mellon Foundation and the endowment of the Carnegie Institution for Science, the Council for Scientific and Industrial Research (CSIR), and the South African Department of Science and Technology (grant agreement DST/ CON 0119/2010, Earth Observation Application Development in Support of SAEOS). CSIR coauthors are supported by the European Union’s Seventh Framework Programme (FP7/2007-2013, grant agreement n°282621, AGRICAB). PJM acknowledges funding from the National Research Foundation (NRF: SFH1207203615). Additionally, PJM and ETFW acknowledge the DST-NRF Centre of Excellence in Tree Health Biotechnology (CTHB) and, PJM and BFNE, the Applied Centre for Climate and Earth Systems Science (ACCESS). BFNE acknowledges financial support from Exxaro.http://www.plosone.orgam201