Factors influencing the relationship between the dose of amlodipine required for blood pressure control and change in blood pressure in hypertensive cats

BACKGROUND: Hypertension is a common problem in elderly cats. In most cats, systolic blood pressure (SBP) of <160 mmHg is achieved in response to amlodipine besylate at either 0.625 or 1.25 mg q24h. The individual cat factors determining dose requirement dose have not been explored. AIMS: To determine whether individual cat factors influence the dose of amlodipine required to achieve adequate blood pressure control and to determine whether factors other than the prescribed dose of drug alter the achieved plasma amlodipine concentrations. METHODS: Fifty‐nine hypertensive cats that required 0.625 mg (A) and 41 cats that required 1.25 mg (B) amlodipine to reach a target SBP of <160 mmHg were identified, and plasma amlodipine concentrations were determined. Comparisons were made between groups, and multivariable linear regression models were performed to investigate predictors of antihypertensive response. RESULTS: Cats that required a greater dose of amlodipine had significantly higher SBP at diagnosis of hypertension (A: (median [25th, 75th percentile]) 182 [175,192] mmHg; B: 207 [194,217] mmHg, P < .001), but comparable blood pressure was achieved after treatment. Plasma amlodipine concentrations were directly related to the dose of amlodipine administered. At diagnosis, cats in group B had significantly lower plasma potassium concentration (A: 4.1 [3.8,4.5]; B: 3.8 [3.6,4.2] mEq/L, P < .01). Weight did not differ between groups. The decrease in SBP was directly and independently associated with the SBP at diagnosis and the plasma amlodipine concentration. CONCLUSIONS AND CLINICAL IMPORTANCE: Cats with higher blood pressure at diagnosis might require a greater dose of amlodipine to control their blood pressure adequately. Differences in amlodipine pharmacokinetics between cats do not seem to play a role in the antihypertensive response

Procedural feature generation for volumetric terrains

© 2017 Copyright held by the owner/author(s). In this work we present separate procedural methods to generate features that are found in natural terrains which are difficult to reproduce with heightmap-based methods. We approximate overhangs, arches and caves using procedural functions and a reduced set of parameters. This produces visually plausible terrain feature topologies as well as a high degree of artistic control. Our approach is more intuitive and art-directable than other existing volumetric methods that are more complex to integrate into existing voxel engines, due to the framework changes necessary, or rely on automatic procedural generation, thus reducing the ability to provide creative input

An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care

&lt;b&gt;Background&lt;/b&gt; Provision of optimal nutrition in children in critical care is often challenging. This study evaluated exclusive enteral nutrition (EN) provision practices and explored predictors of energy intake and delay of EN advancement in critically ill children.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods&lt;/b&gt; Data on intake and EN practices were collected on a daily basis and compared against predefined targets and dietary reference values in a paediatric intensive care unit. Factors associated with intake and advancement of EN were explored.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; Data were collected from 130 patients and 887 nutritional support days (NSDs). Delay to initiate EN was longer in patients from both the General Surgical and congenital heart defect (CHD) Surgical groups [Median (IQR); CHD Surgical group: 20.3 (16.4) vs General Surgical group: 11.4 (53.5) vs Medical group: 6.5 (10.9) hours; p &lt;= 0.001]. Daily fasting time per patient was significantly longer in patients from the General Surgical and CHD Surgical groups than those from the Medical group [% of 24 h, Median (IQR); CHD Surgical group: 24.0 (29.2) vs General Surgical group: 41.7 (66.7) vs Medical group: 9.4 (21.9); p &lt;= 0.001]. A lower proportion of fluids was delivered as EN per patient (45% vs 73%) or per NSD (56% vs 73%) in those from the CHD Surgical group compared with those with medical conditions. Protein and energy requirements were achieved in 38% and 33% of the NSDs. In a substantial proportion of NSDs, minimum micronutrient recommendations were not met particularly in those patients from the CHD Surgical group. A higher delivery of fluid requirements (p &lt; 0.05) and a greater proportion of these delivered as EN (p &lt; 0.001) were associated with median energy intake during stay and delay of EN advancement. Fasting (31%), fluid restriction (39%) for clinical reasons, procedures requiring feed cessation and establishing EN (22%) were the most common reasons why target energy requirements were not met.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions&lt;/b&gt; Provision of optimal EN support remains challenging and varies during hospitalisation and among patients. Delivery of EN should be prioritized over other "non-nutritional" fluids whenever this is possible.&lt;p&gt;&lt;/p&gt

An evolutionary stage model of outsourcing and competence destruction : a Triad comparison of the consumer electronics industry

Outsourcing has gained much prominence in managerial practice and academic discussions in the last two decades or so. Yet, we still do not understand the full implications of outsourcing strategy for corporate performance. Traditionally outsourcing across borders is explained as a cost-cutting exercise, but more recently the core competency argument states that outsourcing also leads to an increased focus, thereby improving effectiveness. However, no general explanation has so far been provided for how outsourcing could lead to deterioration in a firm‟s competence base. We longitudinally analyze three cases of major consumer electronics manufacturers, Emerson Radio from the U.S., Japan‟s Sony and Philips from the Netherlands to understand the dynamic process related to their sourcing strategies. We develop an evolutionary stage model that relates outsourcing to competence development inside the firm and shows that a vicious cycle may emerge. Thus it is appropriate to look not only at how outsourcing is influenced by an organization‟s current set of competences, but also how it alters that set over time. The four stages of the model are offshore sourcing, phasing out, increasing dependence on foreign suppliers, and finally industry exit or outsourcing reduction. The evolutionary stage model helps managers understand for which activities and under which conditions outsourcing across borders is not a viable option. Results suggest that each of these firms had faced a loss of manufacturing competitiveness in its home country, to which it responded by offshoring and then outsourcing production. When a loss of competences occurred, some outsourcing decisions were reversed

Determinants of response to a parent questionnaire about development and behaviour in 3 year olds: European multicentre study of congenital toxoplasmosis.

Background: We aimed to determine how response to a parent-completed postal questionnaire measuring development, behaviour, impairment, and parental concerns and anxiety, varies in different European centres. Methods: Prospective cohort study of 3 year old children, with and without congenital toxoplasmosis, who were identified by prenatal or neonatal screening for toxoplasmosis in 11 centres in 7 countries. Parents were mailed a questionnaire that comprised all or part of existing validated tools. We determined the effect of characteristics of the centre and child on response, age at questionnaire completion, and response to child drawing tasks. Results: The questionnaire took 21 minutes to complete on average. 67% (714/1058) of parents responded. Few parents (60/1058) refused to participate. The strongest determinants of response were the score for organisational attributes of the study centre (such as direct involvement in follow up and access to an address register), and infection with congenital toxoplasmosis. Age at completion was associated with study centre, presence of neurological abnormalities in early infancy, and duration of prenatal treatment. Completion rates for individual questions exceeded 92% except for child completed drawings of a man (70%), which were completed more by girls, older children, and in certain centres. Conclusion: Differences in response across European centres were predominantly related to the organisation of follow up and access to correct addresses. The questionnaire was acceptable in all six countries and offers a low cost tool for assessing development, behaviour, and parental concerns and anxiety, in multinational studies

Rates of referable eye disease in the Scottish National Diabetic Retinopathy Screening Programme

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.Peer reviewedPublisher PD

Genetic Diversity of PCR-Positive, Culture-Negative and Culture-Positive Mycobacterium ulcerans Isolated from Buruli Ulcer Patients in Ghana.

Culture of Mycobacterium ulcerans from Buruli ulcer patients has very low sensitivity. Thus confirmation of M. ulcerans infection is primarily based on PCR directed against IS2404. In this study we compare the genotypes obtained by variable number of tandem repeat analysis of DNA from IS2404-PCR positive cultures with that obtained from IS2404 positive, culture-negative tissue. A significantly greater genetic heterogeneity was found among culture-negative samples compared with that found in cultured strains but a single genotype is over-represented in both sample sets. This study provides evidence that both the focal location of bacteria in a lesion as well as differences in the ability to culture a particular genotype may underlie the low sensitivity of culture. Though preliminary, data from this work also suggests that mycobacteria previously associated with fish disease (M. pseudoshottsii) may be pathogenic for humans

An investigation of the pressaccidic spike potential

A large negative spike potential, which is closely related to the onset of saccadic eyemovements, can be recorded from electrodes adjacent to the orbits. This potential, thepresaccadic spike potential, has often been regarded as an artefact related to eyemovement recordings and little work has been performed to establish its normal waveformand parameters. A positive spike potential, exactly coincident with the frontal negativespike, has also been recorded from electrodes positioned over the posterior scalp andthere has been some debate regarding any possible relationship between the twopotentials. The frontal spike potential has been associated with motor unit activity in theextraocular muscles prior to the saccade. This thesis investigates both the large anteriorand smaller posterior spike potentials and relates these recordings to the saccadic eyemovements associated with them. The anterior spike potential has been recorded from normal subjects to ascertain its normallatency and amplitude parameters for both horizontal and vertical saccades. A relationshipbetween saccade size and spike potential amplitude is described, the spike potentialamplitude reducing with smaller saccades. The potential amplitude also reduces withadvancing age. Studying the topographical distribution of the spike potential across thescalp shows the posterior spike activity may arise from potential spread of the larger frontalspike potential. Spike potential recordings from subjects with anomalous eye movements further implicate the extraocular muscles and their innervation in the generation of the spike potential. These recordings indicate that the spike potential may have some use as a clinical recording from patients with disease conditions affecting either their extraocular muscles or the innervational pathways to these muscles. Further recordings of the potential are necessary, however, to determine the exact nature of the changes which may occur with such conditions

Ferritins: furnishing proteins with iron

Ferritins are a superfamily of iron oxidation, storage and mineralization proteins found throughout the animal, plant, and microbial kingdoms. The majority of ferritins consist of 24 subunits that individually fold into 4-α-helix bundles and assemble in a highly symmetric manner to form an approximately spherical protein coat around a central cavity into which an iron-containing mineral can be formed. Channels through the coat at inter-subunit contact points facilitate passage of iron ions to and from the central cavity, and intrasubunit catalytic sites, called ferroxidase centers, drive Fe2+ oxidation and O2 reduction. Though the different members of the superfamily share a common structure, there is often little amino acid sequence identity between them. Even where there is a high degree of sequence identity between two ferritins there can be major differences in how the proteins handle iron. In this review we describe some of the important structural features of ferritins and their mineralized iron cores and examine in detail how three selected ferritins oxidise Fe2+ in order to explore the mechanistic variations that exist amongst ferritins. We suggest that the mechanistic differences reflect differing evolutionary pressures on amino acid sequences, and that these differing pressures are a consequence of different primary functions for different ferritins

40Ar/39Ar and U-Pb mineral ages from the Brookville Gneiss: implications for terrane analysis and evolution of Avalonian "basement" in southern New Brunswick

New 40Ar/39Ar hornblende and U-Pb zircon data from units previously thought to represent basement to the Avalon composite terrane in southern New Brunswick yield latest Precambrian or early Cambrian metamorphic cooling ages and a late Precambrian protolith age. Hornblendes from the Brookville Gneiss and from an intrusive amphibolite body within the gneiss yield 40Ar/39Ar isotope correlation ages of 542 ± 4 and 338 ± 2 Ma, respectively. These ages are interpreted to date post-amphibolite facies metamorphic cooling. Euhedral zircons from the Point Pleasant orthogneiss, a quartz dioritic gneiss previously interpreted to be the oldest component of the Brookville Gneiss, show slight inheritance and yield 247Pb/206Pb ages ranging from 603 to 631 Ma. The youngest of these is interpreted to be a maximum age for the orthogneiss protolith. These results, together with other recent U-Pb age data, conflict with previous interpretations of the Brookville Gneiss and the metasedimentary Green Head Group with which it is associated, as a mobilized Proterozoic basement-cover succession upon which an Avalonian ensialic arc developed at c. 600-633 Ma. Instead, the age of the orthogneiss matches that of the arc, and the orthogneiss protolith is likely to have been originally intrusive into the Green Head Group. Although the arc succession is unaffected by high-grade metamorphism, the metamorphic cooling age recorded in the "basement" closely follows evidence of within-arc extension at c. 330 Ma. Hence, the arc/"basement" contrasts in tectonothermal regime could be those of varying structural level within the Avalonian arc rather than requiring the proposed existence of entirely separate terranes. R&#xC9;SUM&#xC9; De nouvelles donn&#xE9;es 40Ar/39Ar sur hornblendes et U-Pb sur zircons, issues d'unit&#xE9;s consid&#xE9;r&#xE9;es jadis comme repr&#xE9;sentant le socle de la Lani&#xE8;re composite d'Avalon au Nouveau-Brunswick meridional, ont livr&#xE9; des &#xE2;ges de refroidissement m&#xE9;tamorphique finipr&#xE9;cambriens ou &#xE9;ocambriens ainsi qu'un &#xE2;ge de protolithe tardipr&#xE9;ambrien. Des hornblendes extraites du Gneiss de Brookville ont livr&#xE9; un &#xE2;ge de corr&#xE9;lation isotopique par 40Ar/39Ar de 542 ± 4 Ma; d'autres, provenant d'un b&#xE2;ti amphibolitique intrusif au sein du gneiss, ont livr&#xE9; un &#xE2;ge de 538 ± 2 Ma. On interpr&#xE8;te ces &#xE2;ges comme datant le refroidissement m&#xE9;tamorphique au-del&#xE2; du faci&#xE8;s &#xE0; amphibolites. Des zircons idiomorphes provenant de l'orthogneiss de Point Pleasant, un gneiss quartzodioritique interpr&#xE8;t auparavant comme le plus ancient constituant du Gneiss de Brookville, montrent un 1&#xE9;ger remaniement et livrent des &#xE2;ges 247Pb/206Pb s'&#xE9;talant de 603 &#xE0; 631 Ma. On interpr&#xE8;t&#xE9; le plus jeune de ces &#xE2;ges comme l'&#xE2;ge maximal du protolithe de l'orthogneiss. Ces r&#xE9;sultats, tout comme d'autres donn&#xE9;es U-Pbrecentes, contredisent les interpr&#xE8;tations ant&#xE9;rieures consid&#xE9;ranl le Gneiss de Brookville et le Groupe m&#xE9;tas&#xE9;dimentaire de Green Head, auquel il s'associe, comme une succession socle-couverture mobilis&#xE9;e prot&#xE9;rozoique sur laquelle un arc sialique avalonien s'est d&#xE9;velopp&#xE9; il y a en v. 600 &#xE0; 635 Ma. L'&#xE2;ge de l'orthogneiss correspond plut&#xF4;t &#xE2; celui de l'arc et il est probable que le protolithe de l'orthogneiss faisait &#xE0; l'origine intrusion au sein du Groupe de Green Head. Bien que la succession d'arc n'ait subi aucun m&#xE9;tamorphisme de degr&#xE9; &#xE9;1ev&#xE9; l'&#xE2;ge de refroidissement m&#xE9;tamorphique enregistr&#xE9; dans le "socle" Concorde &#xE9;troitement avec la manifestation d 'une extension intra-arc vers 550 Ma. Par consequent, les contrastes de r&#xE9;gime tectonothermique arc/"socle" pourraient refl&#xE8;ter les variations du niveau structural au sein de l'arc avalonien plut&#xF4;t que necessiter l'existence propos&#xE9;e de lani&#xE8;res tout a fait distinctes. [Traduit par le journal