Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Background: The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. Methods: Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. Results: Of the 751 369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49 962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0–3, 10.1% had ASN, compared with 9.1% of those scoring 4–7 and 6.6% of those scoring 7–10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. Conclusions: Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level

Isomerisation of cis-9 trans-11 conjugated linoleic acid (CLA) to trans-9 trans-11 CLA during acidic methylation can be avoided by a rapid base catalysed methylation of milk fat

This study investigated the evolution of trans-9 trans-11 conjugated linoleic acid (CLA) from cis-9 trans-11 CLA during methylation and its avoidance through a rapid base methylation of milk fat. The study examined three conditions shown to result in loss of cis-9 trans-11 CLA during methylation namely: temperature, methylation time, water contamination in old reagents and acidic conditions. Three techniques currently used for the conversion of milk fat into fatty acid methyl esters for analysis of CLA content by gas liquid chromatography and a fourth procedure designed to eliminate acidic conditions and to limit methylation temperature and time were used. The four methods were: (i) acidic methylation (AM); (ii) acidic and basic bimethylation with fresh reagents (FBM); (iii) acidic and basic bimethylation with pre-prepared reagents (PBM) and (iv) basic methylation (BM). Each regime was carried out on six milk samples over two periods and methylated 1 ml freeze-dried milk (n=12 per regime). Total CLA was not different across methylation regimes (0.30 mg/ml). Isomer cis-9 trans-11 was higher (P <0.01) with BM than the other regimes and lowest with AM: 21.2, 17.8, 18.8 and 14.7 mg/100 ml for BM, FBM, PBM and AM, respectively. The inverse relationship was shown for trans-9 trans-11 with higher (P <0.001) amounts with AM than the other regimes and lowest with BM: 0.57, 2.55, 2.36 and 3.69 mg/100 ml for BM, FBM, PBM and AM, respectively. The trans-10 cis-12 isomer was also shown to alter with methylation procedure being higher (P <0.001) with AM than the other regimes: 0.43, 0.47, 0.29 and 1.20 mg/100 ml for BM, FBM, PBM and AM, respectively. Validation with known CLA free fatty acid and triacylglycerol standards confirmed that AM resulted in conversion of cis-9 trans-11 to trans-9 trans-11, and also elevated trans-10 cis-12 whilst BM of triacylglycerol CLA did not isomerise cis-9 trans-11 and was comparable to FBM

1862-01-06 Professor B.F. Tweed recommends Benjamin F. Heald for commission

https://digitalmaine.com/chamberlain_corr/1083/thumbnail.jp

Proton Lateral Broadening Distribution Comparisons Between GRNTRN, MCNPX, and Laboratory Beam Measurements

Recent developments in NASA s deterministic High charge (Z) and Energy TRaNsport (HZETRN) code have included lateral broadening of primary ion beams due to small-angle multiple Coulomb scattering, and coupling of the ion-nuclear scattering interactions with energy loss and straggling. This new version of HZETRN is based on Green function methods, called GRNTRN, and is suitable for modeling transport with both space environment and laboratory boundary conditions. Multiple scattering processes are a necessary extension to GRNTRN in order to accurately model ion beam experiments, to simulate the physical and biological-effective radiation dose, and to develop new methods and strategies for light ion radiation therapy. In this paper we compare GRNTRN simulations of proton lateral broadening distributions with beam measurements taken at Loma Linda University Proton Therapy Facility. The simulated and measured lateral broadening distributions are compared for a 250 MeV proton beam on aluminum, polyethylene, polystyrene, bone substitute, iron, and lead target materials. The GRNTRN results are also compared to simulations from the Monte Carlo MCNPX code for the same projectile-target combinations described above

An \u3cem\u3eIn Vitro\u3c/em\u3e Investigation of Forage Factors Which Affect the Production of Conjugated Linoleic Acid and \u3cem\u3eTrans\u3c/em\u3e Vaccenic Acid in the Rumen. II. Wilting & Cell Damage

Previous studies have shown that cis 9 trans 11 conjugated linoleic acid (CLA) concentrations are higher for summer milk produced from cows grazing fresh pastures than for winter milk when conserved forages are fed (Jahreis et al., 1997). Furthermore, Offer (2003) showed that a similar depression in milk fat CLA occurred if grass was simply cut and fed after a short wilt. This experiment investigated the effect of wilting on the production of CLA and trans vaccenic acid (TVA) in an in vitro rumen simulation, and whether any differences could be related to changes in plant structure. It was hypothesised that fresh turgid grass may have a greater propensity for cell damage during mastication than the much more flaccid wilted grass, which in turn may increase microbial metabolism of the grass lipid

Promising New Assays and Technologies for the Diagnosis and Management of Infectious Diseases

Recent advancements in technology have led to the development of new techniques that hold promise for improved diagnosis and management of infectious diseases. Here, we review new assays that help better identify pathogens and tailor antibiotic therapy to patients' need

The Development Of An Interactive Industry/Academic Power Engineering Education Program At The University Of Missouri-Rolla

This paper describes the development of a unique andinno-vative program in power engineering education enhanced through an Industry/Academic interrelationship. This program is devoted to both the teaching and the practice of power engineering. The development of the Industry/Academic relationship and its value as a model for power engineering education are related. A summary of present and proposed future activities concludes the report. Copyright © 1978 by The Institute of Electrical and Electronics Engineers, Inc

Ten Years of Experience Training Non-Physician Anesthesia Providers in Haiti.

Surgery is increasingly recognized as an effective means of treating a proportion of the global burden of disease, especially in resource-limited countries. Often non-physicians, such as nurses, provide the majority of anesthesia; however, their training and formal supervision is often of low priority or even non-existent. To increase the number of safe anesthesia providers in Haiti, Médecins Sans Frontières has trained nurse anesthetists (NAs) for over 10 years. This article describes the challenges, outcomes, and future directions of this training program. From 1998 to 2008, 24 students graduated. Nineteen (79%) continue to work as NAs in Haiti and 5 (21%) have emigrated. In 2008, NAs were critical in providing anesthesia during a post-hurricane emergency where they performed 330 procedures. Mortality was 0.3% and not associated with lack of anesthesiologist supervision. The completion rate of this training program was high and the majority of graduates continue to work as nurse anesthetists in Haiti. Successful training requires a setting with a sufficient volume and diversity of operations, appropriate anesthesia equipment, a structured and comprehensive training program, and recognition of the training program by the national ministry of health and relevant professional bodies. Preliminary outcomes support findings elsewhere that NAs can be a safe and effective alternative where anesthesiologists are scarce. Training non-physician anesthetists is a feasible and important way to scale up surgical services resource limited settings