Lupin yields are not what they should be : viewpoint

Mike Ferguson has been in charge of the Three Springs office of the Department of Agriculture since 1977. Based on trials he has done and others he has seen, he believes farmers can greatly increase their yield of lupins

Derivation of a clinical decision-making aid to improve the insertion of clinically indicated peripheral intravenous catheters and promote vessel health preservation. An observational study

Background It is well established that the idle peripheral intravenous catheter (PIVC) provides no therapeutic value and is a clinical, economic and above all, patient concern. This study aimed to develop a decision aid to assist with clinical decision making to promote clinically indicated peripheral intravenous catheter (CIPIVC) insertion in the emergency department (ED) setting. Providing evidence for a uniform process could assist clinicians in a decision-making process for PIVC insertion. This could enable patients receive appropriate vascular access healthcare. Methods We performed a secondary analysis of data from a multicentre cohort of emergency department clinicians who performed PIVC insertion. We defined CIPIVC a priori as one used for a specific clinical treatment and or procedure such as prescribed intravenous (IV) fluids; prescribed IV medication; or IV contrast (for computerized tomography scans). We sought to refute or validate an assumption if the clinician performing or requesting the insertion decided the patient was >80% likely to need a PIVC. Using logistic regression, we derived a decision aid for CIPIVCs. Results In 817 patients undergoing PIVC insertion, we observed 68% of these to be CIPIVCs. Admitted patients were significantly more likely to have a CIPIVC, Odds Ratio (OR) = 3.05, 95% confidence interval (CI) = 2.17–4.30, p = <0.0001. Before insertion, patients who definitely needed IV fluids/medicines OR = 3.30, 95% CI = 2.02–5.39, p = <0.0001 and who definitely needed a contrast scan OR = 3.04, 95% CI = 1.15–8.03, p = 0.0250 were significantly more likely to have a device inserted for a clinical indication. Patients who presented with an existing vascular access device were more likely to have a new CIPIVC inserted for use OR = 4.35, 95% CI = 1.58–11.95, p = 0.0043. The clinician’s pre-procedural judgment of the likelihood of therapeutic use >80% was independently associated with CIPIVC; OR 3.16, 95% CI = 2.06–4.87, p<0.0001. The area under the receiver operating characteristic curve was 0.81, and at the best cut-off, the model had a specificity of 0.81, sensitivity of 0.71, a positive predictive value of 0.89 and negative predictive value of 0.57. Conclusions Using the derived decision aid, clinicians could ask:- “Does this patient need A-PIVC?” Clinicians can decide to insert a CIPIVCs when: (i) Admission to hospital is anticipated and when (ii) a Procedure requires a PIVC, e.g., computerised tomography scans and where an existing suitable vascular access device is not present and or; (iii) there is an indication for IV fluids and or medicines that cannot be tolerated enterally and are suitable for dilution in peripheral veins; and, (iv) the Clinician’s perceived likelihood of use is greater than 80%.Full Tex

Three Linked Vasculopathic Processes Characterize Kawasaki Disease: A Light and Transmission Electron Microscopic Study

Kawasaki disease is recognized as the most common cause of acquired heart disease in children in the developed world. Clinical, epidemiologic, and pathologic evidence supports an infectious agent, likely entering through the lung. Pathologic studies proposing an acute coronary arteritis followed by healing fail to account for the complex vasculopathy and clinical course.Specimens from 32 autopsies, 8 cardiac transplants, and an excised coronary aneurysm were studied by light (n=41) and transmission electron microscopy (n=7). Three characteristic vasculopathic processes were identified in coronary (CA) and non-coronary arteries: acute self-limited necrotizing arteritis (NA), subacute/chronic (SA/C) vasculitis, and luminal myofibroblastic proliferation (LMP). NA is a synchronous neutrophilic process of the endothelium, beginning and ending within the first two weeks of fever onset, and progressively destroying the wall into the adventitia causing saccular aneurysms, which can thrombose or rupture. SA/C vasculitis is an asynchronous process that can commence within the first two weeks onward, starting in the adventitia/perivascular tissue and variably inflaming/damaging the wall during progression to the lumen. Besides fusiform and saccular aneurysms that can thrombose, SA/C vasculitis likely causes the transition of medial and adventitial smooth muscle cells (SMC) into classic myofibroblasts, which combined with their matrix products and inflammation create progressive stenosing luminal lesions (SA/C-LMP). Remote LMP apparently results from circulating factors. Veins, pulmonary arteries, and aorta can develop subclinical SA/C vasculitis and SA/C-LMP, but not NA. The earliest death (day 10) had both CA SA/C vasculitis and SA/C-LMP, and an "eosinophilic-type" myocarditis.NA is the only self-limiting process of the three, is responsible for the earliest morbidity/mortality, and is consistent with acute viral infection. SA/C vasculitis can begin as early as NA, but can occur/persist for months to years; LMP causes progressive arterial stenosis and thrombosis and is composed of unique SMC-derived pathologic myofibroblasts

Lupin yields are not what they should be : viewpoint

Mike Ferguson has been in charge of the Three Springs office of the Department of Agriculture since 1977. Based on trials he has done and others he has seen, he believes farmers can greatly increase their yield of lupins

Nutrition security and traditional food markets in Africa: gender insights

Malnutrition is a major global challenge. Multiple forms, from underweight to obesity, exist, and several forms coexist within communities and households. Traditional food markets, also known as wet, local, or informal markets, are widespread in sub-Saharan Africa (SSA) and are a key place where people buy and sell food and socially interact, especially those vulnerable to malnutrition. As such they are vital to food and nutrition security. While it is recognized that gender is an important consideration in food and nutrition security, very little has been published in peer reviewed journals, with respect to gender and traditional food markets in SSA. This mini review aims to explore the nexus role of traditional food markets and gender in food and nutrition security. This study presents a narrative literature review, informed by literature identified in a systematic manner. Four databases were searched for key terms, including nutrition, different forms of malnutrition, gender, traditional food markets, and vendors. The papers provided insight into two main topics pertaining to the role of traditional food market practices, gender, and food and nutrition security. While few papers were identified in this mini review, they illustrated insightful nuances into traditional food markets, gender, and food and nutrition security. There is a need for explicitly framed gender studies that can better inform the limited existing knowledge of the experiences of gender and nutritional security of women and men in traditional food markets in SSA

Development and validation of an algorithm to temporally align polysomnography and actigraphy data

Current actigraphic sleep/wake detection algorithms have predominantly been validated against polysomnography, although the accuracy of such validations is dependent on the degree to which the timestamps of these two methods of data collection are synchronised. We created and validated an algorithm to temporally align actigraphy and polysomnography data using a sample of 100 healthy young adults, recruited from a pool of participants in the Western Australian Pregnancy Cohort (Raine) Study. Each participant underwent one night of polysomnography with simultaneous wrist actigraphy (Actigraph GT3X+). Our alignment algorithm incorporates the raw acceleration data and considers the best alignment when the sum of the products of acceleration and polysomnography values are maximised. Segments of the night of various lengths and locations were considered as input values in addition to several values for the maximum allowable discrepancy. The optimal input values were determined by comparing accuracies, sensitivities and specificities calculated from two commonly used sleep/wake classification methods, and then validated using a simulation study. Validation suggested that our alignment algorithm can successfully align polysomnography and actigraphy timestamps. This allows for more accurate and detailed actigraphic sleep/wake detection algorithms to be created, thus strengthening the use of actigraphy as an appropriate method for sleep detection

Thinking about Waste: A Case Study on the Perceptions and Practices of Food Waste in The Hague

Global Challenges (FGGA

Positive heterospecific interactions can increase long‐term diversity of plant communities more than negative conspecific interactions alone

Negative conspecific interactions have been shown to promote diversity in plant communities, as have some heterospecific interactions such as intransitive competition and facilitation. However, it is unclear whether combinations of conspecific and other heterospecific interactions can also promote diversity in plant communities. We therefore investigated the effects of heterospecific plant interaction network architecture with and without conspecific interactions on alpha diversity, beta diversity and long-term diversity. We simulated long-term plant community dynamics for theoretical plant interaction scenarios with modular, ring and nested networks of positive or negative heterospecific interactions and conspecific interactions, using a spatially explicit cellular automaton model that accounted for stochastic effects. Throughout the simulations several measures of diversity were recorded. The way that heterospecific interactions affected diversity depended strongly on various characteristics of the architecture of the interaction network. Negative conspecific interactions generally promoted alpha diversity and reduced beta diversity, with a few key exceptions. Positive heterospecific ring interactions that resulted in cyclic appearance and disappearance of species groups led to the greatest long-term diversity (a measure of the total diversity over time). This study provides new theoretical insights into how the network architecture of heterospecific plant interactions can affect the diversity of plant communities over time and provides the first evidence that heterospecific plant interactions can increase long-term diversity more than negative conspecific interactions alone

The revolving door: Antibiotic allergy labelling in a tertiary care centre

Background Patients frequently report antibiotic allergies; however, only 10% of labelled patients have a true allergy. Aim We investigated the documentation of antibiotic ‘allergy’ labels (AAL) and the effect of labelling on clinical outcomes, in a West Australian adult tertiary hospital. Methods Retrospective cross-sectional analysis of patients captured in the 2013 and 2014 National Antimicrobial Prescribing Surveys was carried out. Data were collected on documented antibiotic adverse drug reactions, antibiotic cost, prescribing appropriateness, prevalence of multi-drug resistant organisms, length of stay, intensive care admission and readmissions. Results Of the 687 patients surveyed, 278 (40%) were aged 70 or above, 365 (53%) were male and 279 (41%) were prescribed antibiotics. AAL were recorded in 122 (18%) patients and the majority were penicillin labels (n  = 87; 71%). Details of AAL were documented for 80 of 141 (57%) individual allergy labels, with 61 describing allergic symptoms. Patients with beta-lactam allergy labels received fewer penicillins (P = 0.0002) and more aminoglycosides (P = 0.043) and metronidazole (P  = 0.021) than patients without beta-lactam labels. Five patients received an antibiotic that was contraindicated according to their allergy status. Patients with AAL had significantly more hospital readmissions within 4 weeks (P = 0.001) and 6 months (P =  0.025) of discharge, compared with unlabelled patients. The majority (81%) of readmitted labelled patients had major infections. Conclusions AAL are common, but poorly documented in hospital records. Patients with AAL are significantly more likely to require alternative antibiotics and hospital readmissions. There may be a role for antibiotic allergy delabelling to mitigate the clinical and economic burdens for patients with invalid allergy labels