Preventive measures in infancy to reduce under-five mortality: a case-control study in The Gambia.

OBJECTIVE: To investigate the relationship between child mortality and common preventive interventions: vaccination, trained birthing attendants, tetanus toxoid during pregnancy, breastfeeding and vitamin A supplementation. METHODS: Case-control study in a population under demographic surveillance. Cases (n = 141) were children under five who died. Each was age and sex-matched to five controls (n = 705). Information was gathered by interviewing primary caregivers. RESULTS: All but one of the interventions - whether the mother had received tetanus toxoid during pregnancy - were protective against child mortality after multivariate analysis. Having a trained person assisting at child birth (OR 0.2 95% CI 0.1-0.4), receiving all vaccinations by 9 months of age (OR 0.1; 95% CI 0.01-0.3), being breastfed for more than 12 months (Children breastfed between 13 and 24 months OR 0.1 95% CI 0.03-0.3, more than 25 months OR 0.1 95% CI 0.01-0.5) and receiving vitamin A supplementation at or after 6 months of age (OR 0.05; 95% CI 0.01-0.2) were protective against child death. CONCLUSIONS: This study confirms the value of at least four available interventions in the prevention of under-five death in The Gambia. It is now important to identify those who are not receiving them and why, and to intervene to improve coverage across the population

Operative and Radiographic Acetabular Component Orientation in Total Hip Replacement: Influence of Pelvic Orientation and Surgical Positioning Technique

Orthopaedic surgeons often experience a mismatch between perceived intra-operative and radiographic acetabular cup orientation. This research aimed to assess the impact of pelvic orientation and surgical positioning technique on operative and radiographic cup orientation. Radiographic orientations for two surgical approaches were computationally simulated: a mechanical alignment guide and a transverse acetabular ligament approach, both in combination with different pelvic orientations. Positional errors were defined as the difference between the target radiographic orientation and that achieved. The transverse acetabular ligament method demonstrated smaller positional errors for radiographic version; 4.0° ± 2.9° as compared to 9.4° ± 7.3° for the mechanical alignment guide method. However, both methods resulted in similar errors in radiographic inclination. Multiple regression analysis showed that intraoperative pelvic rotation about the anterior-posterior axis was a strong predictor for these errors (B TAL = −0.893, B MAG = −0.951, p &lt; 0.01). Application of the transverse acetabular ligament method can reduce errors in radiographic version. However, if the orthopaedic surgeon is referencing off the theatre floor to control inclination when operating in lateral decubitus, this is only reliable if the pelvic sagittal plane is horizontal. There is currently no readily available method for ensuring that this is the case during total hip replacement surgery. </p

A Qrr Noncoding RNA Deploys Four Different Regulatory Mechanisms to Optimize Quorum-Sensing Dynamics

Quorum sensing is a cell-cell communication process that bacteria use to transition between individual and social lifestyles. In vibrios, homologous small RNAs called the Qrr sRNAs function at the center of quorum-sensing pathways. The Qrr sRNAs regulate multiple mRNA targets including those encoding the quorum-sensing regulatory components luxR, luxO, luxM, and aphA. We show that a representative Qrr, Qrr3, uses four distinct mechanisms to control its particular targets: the Qrr3 sRNA represses luxR through catalytic degradation, represses luxM through coupled degradation, represses luxO through sequestration, and activates aphA by revealing the ribosome binding site while the sRNA itself is degraded. Qrr3 forms different base-pairing interactions with each mRNA target, and the particular pairing strategy determines which regulatory mechanism occurs. Combined mathematical modeling and experiments show that the specific Qrr regulatory mechanism employed governs the potency, dynamics, and competition of target mRNA regulation, which in turn, defines the overall quorum-sensing response

Forecasting the Impacts of Silver and Bighead Carp on the Lake Erie Food Web

Nonindigenous bigheaded carps (Bighead Carp Hypophthalmichthys nobilis and Silver Carp H. molitrix; hereafter, “Asian carps” [AC]) threaten to invade and disrupt food webs and fisheries in the Laurentian Great Lakes through their high consumption of plankton. To quantify the potential effects of AC on the food web in Lake Erie, we developed an Ecopath with Ecosim (EwE) food web model and simulated four AC diet composition scenarios (high, low, and no detritus and low detritus with Walleye Sander vitreus and Yellow Perch Perca flavescens larvae) and two nutrient load scenarios (the 1999 baseline load and 2× the baseline [HP]). We quantified the uncertainty of the potential AC effects by coupling the EwE model with estimates of parameter uncertainty in AC production, consumption, and predator diets obtained using structured expert judgment. Our model projected mean ± SD AC equilibrium biomass ranging from 52 ± 34 to 104 ± 75 kg/ha under the different scenarios. Relative to baseline simulations without AC, AC invasion under all detrital diet scenarios decreased the biomass of most fish and zooplankton groups. The effects of AC in the HP scenario were similar to those in the detrital diet scenarios except that the biomasses of most Walleye and Yellow Perch groups were greater under HP because these fishes were buffered from competition with AC by increased productivity at lower trophic levels. Asian carp predation on Walleye and Yellow Perch larvae caused biomass declines among all Walleye and Yellow Perch groups. Large food web impacts of AC occurred in only 2% of the simulations, where AC biomass exceeded 200 kg/ha, resulting in biomass declines of zooplankton and planktivorous fish near the levels observed in the Illinois River. Our findings suggest that AC would affect Lake Erie's food web by competing with other planktivorous fishes and by providing additional prey for piscivores. Our methods provide a novel approach for including uncertainty into forecasts of invasive species' impacts on aquatic food webs. Received December 6, 2014; accepted July 15, 201

Bronchiectasis Rheumatoid Overlap Syndrome Is an Independent Risk Factor for Mortality in Patients With Bronchiectasis:A Multicenter Cohort Study

BACKGROUND: This study assessed if bronchiectasis (BR) and rheumatoid arthritis (RA), when manifesting as an overlap syndrome (BROS), were associated with worse outcomes than other BR etiologies applying the Bronchiectasis Severity Index (BSI). METHODS: Data were collected from the BSI databases of 1,716 adult patients with BR across six centers: Edinburgh, United Kingdom (608 patients); Dundee, United Kingdom (n = 286); Leuven, Belgium (n = 253); Monza, Italy (n = 201); Galway, Ireland (n = 242); and Newcastle, United Kingdom (n = 126). Patients were categorized as having BROS (those with RA and BR without interstitial lung disease), idiopathic BR, bronchiectasis-COPD overlap syndrome (BCOS), and "other" BR etiologies. Mortality rates, hospitalization, and exacerbation frequency were recorded. RESULTS: A total of 147 patients with BROS (8.5% of the cohort) were identified. There was a statistically significant relationship between BROS and mortality, although this relationship was not associated with higher rates of BR exacerbations or BR-related hospitalizations. The mortality rate over a mean of 48 months was 9.3% for idiopathic BR, 8.6% in patients with other causes of BR, 18% for RA, and 28.5% for BCOS. Mortality was statistically higher in patients with BROS and BCOS compared with those with all other etiologies. The BSI scores were statistically but not clinically significantly higher in those with BROS compared with those with idiopathic BR (BSI mean, 7.7 vs 7.1, respectively; P < .05). Patients with BCOS had significantly higher BSI scores (mean, 10.4), Pseudomonas aeruginosa colonization rates (24%), and previous hospitalization rates (58%). CONCLUSIONS: Both the BROS and BCOS groups have an excess of mortality. The mechanisms for this finding may be complex, but these data emphasize that these subgroups require additional study to understand this excess mortality

Novel Associations of Nonstructural Loci with Paraoxonase Activity

The high-density-lipoprotein-(HDL-) associated esterase paraoxonase 1 (PON1) is a likely contributor to the antioxidant and antiatherosclerotic capabilities of HDL. Two nonsynonymous mutations in the structural gene, PON1, have been associated with variation in activity levels, but substantial interindividual differences remain unexplained and are greatest for substrates other than the eponymous paraoxon. PON1 activity levels were measured for three substrates—organophosphate paraoxon, arylester phenyl acetate, and lactone dihydrocoumarin—in 767 Mexican American individuals from San Antonio, Texas. Genetic influences on activity levels for each substrate were evaluated by association with approximately one million single nucleotide polymorphism (SNPs) while conditioning on PON1 genotypes. Significant associations were detected at five loci including regions on chromosomes 4 and 17 known to be associated with atherosclerosis and lipoprotein regulation and loci on chromosome 3 that regulate ubiquitous transcription factors. These loci explain 7.8% of variation in PON1 activity with lactone as a substrate, 5.6% with the arylester, and 3.0% with paraoxon. In light of the potential importance of PON1 in preventing cardiovascular disease/events, these novel loci merit further investigation