Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Hematopoietic stem cell transplantation (HSCT) involves the administration of chemotherapy followed by the infusion of donor stem cells. After treatment, children can consequently experience nausea, vomiting, diarrhea, anorexia, and mucositis, which negatively impact oral intake, leading to rapid deterioration in nutritional status and risk of malnutrition. Nutrition support therefore becomes necessary to circumvent these adverse effects. This has traditionally been provided via parenteral nutrition (PN), but pediatric evidence is increasingly advocating enteral nutrition (EN) as a preferential alternative. The objective of this review is to determine the efficacy of any forms of EN versus PN provided during admission to children aged ≤ 18 years undergoing HSCT. Primary outcomes considered efficacy in relation to various nutritional parameters, and secondary outcomes included a range of post-transplantation parameters. Data sources included English and non-English articles from the start date of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Controlled Trials register, up to July 2018. Key journals were also hand searched, reference lists scanned, clinical experts contacted, and gray literature searched using EThOS and Open Grey. Randomized and observational studies comparing any forms of EN versus PN in children aged ≤ 18 years undergoing HSCT investigating nutritional or post-transplantation outcomes were eligible. Data were extracted from included studies using a custom extraction form that had previously been piloted. Because included studies were observational, risk of bias was assessed using Risk of Bias in Non-randomised Studies of Interventions. Because only a small number of heterogenous studies reporting a wide range of differently defined outcomes were included, meta-analyses were not performed and data were presented in narrative form. Conflicting results in favor of either method of nutrition support or no difference between methods were seen for duration of interventions, nutritional intakes, biochemical and anthropometric changes, mortality, infections, length of admission, and neutrophil engraftment. EN may provide favorable benefits over PN regarding acute graft-versus-host-disease (aGVHD) and platelet engraftment. A paucity of studies was found investigating the question posed by this review. Included studies were clinically heterogenous regarding populations, interventions, and outcomes, at moderate to serious risk of bias due to the absence of randomization, confounding parameters, statistical control, retrospective designs, and participant selection. Some studies were more than 15 years old. Despite the limited number and poor quality of identified studies, results support the growing body of pediatric evidence that EN is feasible during HSCT. Similar differences regarding many nutritional and post-transplantation outcomes were seen in both forms of nutrition support, but EN could provide benefits above PN including reduced incidence of aGVHD and faster platelet engraftment

Warming temperatures and smaller body sizes : synchronous changes in growth of North Sea fishes

Funded by Marine Scotland SciencePeer reviewedPostprin

The impact of electronic monitoring on fleet wide discarding of small cod in Scottish demersal fisheries

Acknowledgments The authors of this paper would like to acknowledge the fishers, fisheries inspectors, and video reviewers who participated in or supported the Scottish cod catch quota management scheme. Additionally, we thank two anonymous reviewers for their encouraging and insightful comments and suggestions.Peer reviewedPublisher PD

Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drugusing populations in Cape Town, Durban and Pretoria, South Africa

This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known ‘hotspots\' for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues relate to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug- intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations. Keywords: Drug use, sexual risk behaviour, HIV/AIDS, South Africa.SAHARA-J Vol. 5 (3) 2008: pp. 113-11

Systematic bias in estimates of reproductive potential of cod stocks: implications for stock/recruit theory and management

Stock/recruit relationships, describing the relationship between the parental population and the number of offspring produced, are a central tool in population ecology. For fish populations the stock/recruit relationship uses spawning stock biomass (SSB) to represent reproductive potential of the parental population. This assumes that the proportion of SSB comprised of females and the relative fecundity (number of eggs produced per unit mass) are both constant over time. To test these two constancy assumptions female-only spawner biomass (FSB) and total egg production (TEP) were estimated for the Northeast Arctic cod stock over a 56-year time period (1946-2001). During that time period the proportion of females (FSB/SSB) varied between 24 and 68% and the variation was systematic with length such that SSB became more female-biased as the mean length of spawners increased and more male-biased as mean length decreased. Over the same time period, relative fecundity of the stock (TEP/SSB) varied between 115 and 355 eggs g-1 and, like FSB/SSB, was significantly, positively correlated mean length of spawners. Because both FSB/SSB and TEP/SSB covaried with length composition, SSB is systematically biased estimate of reproductive potential. FSB and TEP were evaluated as possible replacements for SSB in stock/recruit relationship. Both indices gave a different interpretation of the recruitment response to reductions in stock size (over-compensatory) compared to that obtained using SSB (either compensatory or depensatory). The threshold level of stock size below which recruitment becomes impaired was estimated for each of the different stock/recruit relationships using piecewise linear regression. There was no difference between SSB and FSB in the assessment of stock status, however, in recent years (1980-2001) TEP fell below the threshold level more frequently than SSB fell below. This suggests that using SSB as a measure of stock reproductive potential may lead to overly optimistic assessments of stock status

Cardioprotection by systemic dosing of thymosin beta four following ischemic myocardial injury

Thymosin beta 4 (Tβ4) was previously shown to reduce infarct size and improve contractile performance in chronic myocardial ischemic injury via two phases of action: an acute phase, just after injury, when Tβ4 preserves ischemic myocardium via antiapoptotic or anti-inflammatory mechanisms; and a chronic phase, when Tβ4 activates the growth of vascular or cardiac progenitor cells. In order to differentiate between the effects of Tβ4 during the acute and during the chronic phases, and also in order to obtain detailed hemodynamic and biomarker data on the effects of Tβ4 treatment suitable for use in clinical studies, we tested Tβ4 in a rat model of chronic myocardial ischemia using two dosing regimens: short term dosing (Tβ4 administered only during the first 3 days following injury), and long term dosing (Tβ4 administered during the first 3 days following injury and also every third day until the end of the study). Tβ4 administered throughout the study reduced infarct size and resulted in significant improvements in hemodynamic performance; however, chamber volumes and ejection fractions were not significantly improved. Tβ4 administered only during the first 3 days following injury tended to reduce infarct size, chamber volumes and improve hemodynamic performance. Plasma biomarkers of myocyte injury were significantly reduced by Tβ4 treatment during the acute injury period, and plasma ANP levels were significantly reduced in both dosing groups. Surprisingly, neither acute nor chronic Tβ4 treatment significantly increased blood vessel density in peri-infarct regions. These results suggest the following: repeated dosing may be required to achieve clinically measureable improvements in cardiac function post-myocardial infarction (MI); improvement in cardiac function may be observed in the absence of a high degree of angiogenesis; and that plasma biomarkers of cardiac function and myocardial injury are sensitive pharmacodynamic biomarkers of the effects of Tβ4

Variations in the uptake of telemental health technologies in community and crisis mental health services during the early pandemic: a survey of mental health professionals in the UK

Background One of the many challenges faced by mental health services during the COVID-19 pandemic was how to deliver care during lockdown. In community and crisis services, this often meant rapidly adopting or expanding the use of telemental health technologies, including phone and video calls. The aim of this study is to explore variations in use and report staff views of such technologies during the early stages of the pandemic. The primary analysis compared rates of use between professions, demographic groups, genders, regions, and crisis and community services. Methods We used data from an online survey conducted by the Mental Health Policy Research Unit in Spring 2020 regarding the impact of the pandemic on mental healthcare in the United Kingdom. We included quantitative data from all professional groups working in community or crisis services providing care to working age adults, including general and specialist services. Our outcome of interest was the percentage of clients whom clinicians primarily interacted with via videocall. We also collected demographics and professional characteristics such as the type of mental health service respondents worked in. In addition, we explored respondents’ views and experiences of telemental health as a medium for providing care. Results 978 participants were included in the primary analysis (834 provided outcome data for community services, 193 for crisis services). In community services, virtually all staff reported stopping some or all face-to-face appointments following the onset of the pandemic, with a large majority using video or phone call appointments where possible instead. Telemental health use was higher in community than in crisis services, and amongst professionals who mainly provided psychotherapy or peer support than in other groups. There was also evidence of use being lower in regions in Northern England, Scotland, and Wales than elsewhere. There was no evidence of an association with staff gender, age, or ethnicity. Staff were generally positive about telemental health and intended to make more use of technologies following the pandemic. However, significant barriers to its use were also reported, often involving skills and available infrastructure. Conclusions Despite its rapid implementation, telemental health was viewed positively by clinicians who saw it as an effective alternative to face-to-face appointments in some contexts, including during the pandemic. However, adoption of the technology also has the potential to exacerbate existing or create new inequalities without effective management of training and infrastructure needs

The Pine Needle, February 1947

Libraries and archives collect materials from different cultures and time periods to preserve and make available the historical record. As a result, materials such as those presented here may reflect sexist, misogynistic, abusive, racist, or discriminatory attitudes or actions that some may find disturbing, harmful, or difficult to view. Both a humor and literary magazine, The Pine Needle was a University of Maine student-produced periodical that began publication in the fall of 1946, the first post-World War II semester that saw GIs returning to campus. The Needle reflected an edginess and rebellion not found in previous UMaine student publications. While past student publications relied on euphemisms for alcohol and dating on campus, The Needle overtly sexualized co-eds and discussed the use of drugs, tobacco, and alcohol by students. Cover art for this issue is an unsigned pen-and-ink illustration produced by a member of The Needle\u27s art staff. It depicts the five members of the editorial staff gathered around a wood coffin labeled, The Needle. Included in this issue is a piece about former History Professor C. Dewitt Hardy II\u27s (1911-1992), term paper assignment entitled, Social Problems in My Home Town. The work mentions the birth of Hardy\u27s son and future artist, Clarion Dewitt Hardy III (1940-2017)

Fishing for MSY: using “pretty good yield” ranges without impairing recruitment

Pretty good yield (PGY) is a sustainable fish yield corresponding to obtaining no less than a specified large percentage of the maximum sustainable yield (MSY). We investigated 19 European fish stocks to test the hypothesis that the 95% PGY yield range is inherently precautionary with respect to impairing recruitment. An FMSY range was calculated for each stock as the range of fishing mortalities (F) that lead to an average catch of at least 95% of MSY in long-term simulations. Further, a precautionary reference point for each stock (FP.05) was defined as the F resulting in a 5% probability of the spawning-stock biomass falling below an agreed biomass limit below which recruitment is impaired (Blim) in long-term simulations. For the majority of the stocks analysed, the upper bound of the FMSY range exceeded the estimated FP.05. However, larger fish species had higher precautionary limits to fishing mortality, and species with larger asymptotic length were less likely to have FMSY ranges impairing recruitment. Our study shows that fishing at FMSY generally is precautionary with respect to impairing recruitment for highly exploited teleost species in northern European waters, whereas the upper part of the range providing 95% of MSY is not necessarily precautionary for small- and medium-sized teleosts.</jats:p