Acute viral bronchiolitis in South Africa : intensive care management for severe disease

It is estimated that 2 - 3% of children will be hospitalised with viral bronchiolitis during their first year of life, and a small proportion of them will have a severe course of the disease, requiring intensive care and ventilatory support. In South Africa, 20% of children admitted to a paediatric intensive care unit (PICU) had positive respiratory viral isolates (especially respiratory syncytial virus), with symptomatic respiratory disease. Rapid laboratory-based diagnosis using multiplex polymerase chain reaction is recommended to reduce overall antibiotic use in the PICU and neonatal ICU (NICU) and improve the targeted use of antibiotics (antibiotic stewardship). The mainstay of bronchiolitis management in the PICU and NICU is supportive, comprising fluid management, oxygen supplementation and/or respiratory ventilatory support, and antipyretics if needed. Non-invasive nasal continuous positive airway pressure and high-flow nasal cannula oxygen therapy are increasingly being used in children with severe bronchiolitis, and may reduce the need for intubation. Infants with bronchiolitis may have a variety of clinical presentations, which may require different ventilatory approaches. Children may present predominantly with apnoeas, air trapping and wheeze, atelectasis and parenchymal disease (in acute respiratory distress syndrome), or a combination of these. Lung-protective ventilation, using a low tidal volume pressure-limited approach, is essential to limit ventilator-induced lung injury.http://www.samj.org.zaam2016Paediatrics and Child Healt

Inadequacy of protein intake in older UK adults

The current dietary recommendation for protein intake in the UK is 0.75 g/kg/day, however, this population-wide recommendation does not necessarily reflect altered requirements for older adults to maintain muscle protein synthesis, nor does it encompass the potential impact of intake timing. Optimal muscle protein synthesis in older adults requires both higher intake requirements and a distribution of protein intake above a 25 g threshold, three times across the day. This study aimed to describe the protein intake of older adults in a UK region and compare the results to recommendations. The study re-assessed two existing datasets with rich diet information for older adults in the South Yorkshire area. Data were extracted from food diaries of 256 adults aged between 65 and 89 years old (mean ± SD 72.4 ± 5.3 years). Quantity and timing of intake were coded using Nutritics software and compared to recommendations. The relationship between body mass index (BMI), age, and protein intake was explored. Fewer than 50% of the participants met current UK recommendations (0.75 g/kg/day) and fewer than 15% met the ESPEN 1.2 g/kg/day age-specific recommendation. Only one participant met the 25 g/meal recommendation across three meals. These findings suggest that the older adult population is not achieving recommendations to maintain muscle protein synthesis. Nonetheless it identifies several straightforward opportunities for improvement, notably elevation of morning intake

Hamilton-Jacobi Approach for First Order Actions and Theories with Higher Derivatives

In this work we analyze systems described by Lagrangians with higher order derivatives in the context of the Hamilton-Jacobi formalism for first order actions. Two different approaches are studied here: the first one is analogous to the description of theories with higher derivatives in the hamiltonian formalism according to [Sov. Phys. Journ. 26 (1983) 730; the second treats the case where degenerate coordinate are present, in an analogy to reference [Nucl. Phys. B 630 (2002) 509]. Several examples are analyzed where a comparison between both approaches is made

Sinh-Gordon, Cosh-Gordon and Liouville Equations for Strings and Multi-Strings in Constant Curvature Spacetimes

We find that the fundamental quadratic form of classical string propagation in $2+1$ dimensional constant curvature spacetimes solves the Sinh-Gordon equation, the Cosh-Gordon equation or the Liouville equation. We show that in both de Sitter and anti de Sitter spacetimes (as well as in the $2+1$ black hole anti de Sitter spacetime), {\it all} three equations must be included to cover the generic string dynamics. The generic properties of the string dynamics are directly extracted from the properties of these three equations and their associated potentials (irrespective of any solution). These results complete and generalize earlier discussions on this topic (until now, only the Sinh-Gordon sector in de Sitter spacetime was known). We also construct new classes of multi-string solutions, in terms of elliptic functions, to all three equations in both de Sitter and anti de Sitter spacetimes. Our results can be straightforwardly generalized to constant curvature spacetimes of arbitrary dimension, by replacing the Sinh-Gordon equation, the Cosh-Gordon equation and the Liouville equation by higher dimensional generalizations.Comment: Latex, 19 pages + 1 figure (not included

Human epidermal growth receptor-2 overexpressing early operable primary breast cancers in older (>=70 years) women: biology and clinical outcome in comparison with younger (less than 70 years) patients

Introduction: There is dearth of literature reporting the prevalence and biological characteristics as well as the long-termclinical outcome of human epidermal growth factor receptor-2 (HER2) overexpressing tumours in older women. Currently,research involving trastuzumab at large focuses on the younger population. This study aimed to analyse their biological characteristicsand to compare them with their younger counterparts from a single centre with a long-term clinical follow-up.Methods: Over 37 years (1973–2010), 1758 older (≥70 years) women with early operable (less than 5 cm) primary breast cancer were managed in a dedicated clinic and have complete clinical information available. Of these, 813 patients underwent primary surgery and 575 had good quality tumour samples available for tissue microarray analysis using indirect immunohistochemistry. Comparison was made with data from a well-characterised younger (70 years = 70%, P = 0.51).Conclusion:HER2 overexpressing tumours in older women showed relatively a less aggressive phenotype and did not show any inferior long-term clinical outcome despite not having received chemotherapy when compared with the younger patients. The precise role of different adjuvant systemic therapies in this population needs to be delineated

Predicting university performance in psychology: the role of previous performance and discipline-specific knowledge

Recent initiatives to enhance retention and widen participation ensure it is crucial to understand the factors that predict students' performance during their undergraduate degree. The present research used Structural Equation Modeling (SEM) to test three separate models that examined the extent to which British Psychology students' A-level entry qualifications predicted: (1) their performance in years 1-3 of their Psychology degree, and (2) their overall degree performance. Students' overall A-level entry qualifications positively predicted performance during their first year and overall degree performance, but negatively predicted their performance during their third year. Additionally, and more specifically, students' A-level entry qualifications in Psychology positively predicted performance in the first year only. Such findings have implications for admissions tutors, as well as for students who have not studied Psychology before but who are considering applying to do so at university

Regularizing Property of the Maximal Acceleration Principle in Quantum Field Theory

It is shown that the introduction of an upper limit to the proper acceleration of a particle can smooth the problem of ultraviolet divergencies in local quantum field theory. For this aim, the classical model of a relativistic particle with maximal proper acceleration is quantized canonically by making use of the generalized Hamiltonian formalism developed by Dirac. The equations for the wave function are treated as the dynamical equations for the corresponding quantum field. Using the Green's function connected to these wave equations as propagators in the Feynman integrals leads to an essential improvement of their convergence properties.Comment: 9 pages, REVTeX, no figures, no table

Ferromagnetic transition in a double-exchange system

We study ferromagnetic transition in three-dimensional double-exchange model. The influence of strong spin fluctuations on conduction electrons is described in coherent potential approximation. In the framework of thermodynamic approach we construct for the system "electrons (in a disordered spin configuration) + spins" the Landau functional, from the analysis of which critical temperature of ferromagnetic transition is calculated.Comment: 4 pages, 1 eps figure, LaTeX2e, RevTeX. References added, text change

Protein for Life: Review of Optimal Protein Intake, Sustainable Dietary Sources and the Effect on Appetite in Ageing Adults

With an ageing population, dietary approaches to promote health and independence later in life are needed. In part, this can be achieved by maintaining muscle mass and strength as people age. New evidence suggests that current dietary recommendations for protein intake may be insufficient to achieve this goal and that individuals might benefit by increasing their intake and frequency of consumption of high-quality protein. However, the environmental effects of increasing animal-protein production are a concern, and alternative, more sustainable protein sources should be considered. Protein is known to be more satiating than other macronutrients, and it is unclear whether diets high in plant proteins affect the appetite of older adults as they should be recommended for individuals at risk of malnutrition. The review considers the protein needs of an ageing population (>40 years old), sustainable protein sources, appetite-related implications of diets high in plant proteins, and related areas for future research

Short-term protein supplementation does not alter energy intake, macronutrient intake and appetite in 50–75 year old adults

Ageing is associated with a reduction in muscle mass and strength, termed sarcopenia. Dietary protein is important for the maintenance of muscle mass through the promotion of muscle protein synthesis. However, protein is also reported to be a highly satiating nutrient. This raises concerns that protein intake for musculoskeletal health reasons in older adults may exacerbate age-related decreased appetite and may result in reduced energy and nutrient intake. This study aimed to investigate the effect of short-term protein supplementation and its timing (morning vs. evening), on energy and nutrient intake and appetite measures in middle-older age adults. Twenty-four 50–75 year olds were recruited to a randomised cross-over trial. In phase 1 (pre-supplementation) participants completed a food diary and reported hunger and appetite on three alternate days. During the second and third phases, participants consumed a 20 g whey protein gel (78 mL/368 kJ), for four days, either in the morning (after breakfast) or the evening (before bed), whilst completing the same assessments as phase 1. No differences in dietary intakes of energy, macronutrients and micronutrients were recorded when comparing the pre-supplementation phase to the protein supplementation phases, irrespective of timing (excluding the contribution of the protein supplement itself). Similarly, no differences were observed in self-reported feelings of hunger and appetite. In conclusion, a 20 g/day whey protein supplement given outside of meal-times did not alter habitual dietary intakes, hunger or appetite in this middle-older age adult population in the short-term. This approach may be a useful strategy to increasing habitual protein intake in the middle-older age population