The development of a nurse-led preoperative anaesthesia screening tool by Delphi consensus

BACKGROUND

Low- and middle-income countries have a critical shortage of specialist anaesthetists. Most patients arriving for surgery are of low perioperative risk. Without immediate access to preoperative specialist care, an appropriate interim strategy may be to ensure that only high-risk patients are seen preoperatively by a specialist. Matching human resources to the burden of disease with a nurse-administered pre-operative screening tool to identify high-risk patients who might benefit from specialist review prior to the day of surgery may be an effective strategy.

OBJECTIVE

To develop a nurse-administered preoperative anaesthesia screening tool to identify patients who would most likely benefit from a specialist review before the day of surgery, and those patients who could safely be seen by the anaesthetist on the day of surgery. This would ensure adequate time for optimisation of high-risk patients preoperatively and limit avoidable day-of-surgery cancellations.

METHODS

A systematic review was conducted to identify preoperative screening questions for use in a three-round Delphi consensus process. A panel of 16 experienced full-time clinical anaesthetists representing all university-affiliated anaesthesia departments in South Africa participated to define a nurses' screening tool for preoperative assessment.

RESULTS

Ninety-eight studies were identified, which generated 79 questions. An additional 14 items identified by the facilitators were added to create a list of 93 questions for the first round. The final screening tool consisted of 81 questions, of which 37 were deemed critical to identify patients who should be seen by a specialist prior to the day of surgery.

CONCLUSION

A structured nurse-administered preoperative screening tool is proposed to identify high-risk patients who are likely to benefit from a timely preoperative specialist anaesthetist review to avoid cancellation on the day of surgery.

Extreme eutrophication and salinisation in the Coorong estuarine-lagoon ecosystem of Australia's largest river basin (Murray-Darling)

Estuaries in rainfall poor regions are highly susceptible to climatic and hydrological changes. The Coorong, a Ramsar-listed estuarine-coastal lagoon at the end of the Murray-Darling Basin (Australia), has experienced declining ecological health over recent decades. Twenty years of environmental data were analysed to assess patterns and drivers of water quality changes. Large areas of the Coorong are now persistently hyper-saline (salinity >80 psu) and hypereutrophic (total nitrogen, TN > 4 mg L^-1, total phosphorus, TP > 0.2 mg L^-1, chlorophyll a > 50 μg L^-1) which coincided with reduced flushing due to diminished freshwater inflows and increasing evapo-concentration. Sediment quality also was related to flushing, with higher concentrations of organic carbon, TN, TP and sulfides as salinity increased. While total nutrient levels are very high, dissolved inorganic nutrients are generally low. Increased lagoonal flushing would be beneficial to reduce the hypersalinisation and hypereutrophication and improve ecosystem health.

Effect of a Hands-On Chemistry Intervention on the behavioural and effective attitudes of learners from low socio-economic high schools

This research focused on the effect that three easily accessible, cost-effective, and hands-on chemistry experiments which are aligned to Curriculum Assessment Policy Statements (CAPS), had on Grade 9 learners from low socio-economic high schools. These experiments were conducted in an after-school science club format at two quintile-1 high schools situated in Gqeberha, South Africa. The learners' behavioural and affective attitudes were examined using group interviews (n = 6) and a survey (n = 61). The findings from this study showed that learners wanted to share knowledge with their peers and community after learning new scientific skills at the science-club. Learners also recognized the economic and practical importance of science related careers. Responses revealed that learners lose interest if the science does not actively connect or engage with their current circumstances. This study also showed that learners were further motivated to pursue studies in Physical Science in Grades 10 to 12.

The terminal lakes of the Murray River, Australia, were predominantly fresh before large-scale upstream water abstraction: Evidence from sedimentary diatoms and hydrodynamical modelling

The Murray River is Australia's longest river, draining the continent's largest exoreic catchment. The river is Australia's most economically valuable, but is highly degraded by water extraction. The Murray River's terminal lakes, Lakes Alexandrina and Albert, formed following the mid-Holocene marine transgression. These lakes are part of one of the most ecologically important wetland ecosystems on the Australian continent and are recognised as internationally significant by the Ramsar Convention. As a result of upstream water extraction, the Lower Lakes are threatened by rising salinity. To combat this threat, water is allocated to maintain the Lower Lakes as freshwater ecosystems. This practice is part of the Murray-Darling Basin Plan, one of the largest environmental water allocation plans in the world. The water allocations and the natural history of the Lower Lakes are the subject of academic and public debate, since the water would otherwise be used for consumptive purposes, particularly irrigated agriculture, upstream. Recent modelling postulated that the lakes were saline for much of the period between 8500 and 5000 years ago. However, using new sedimentary diatom and hydrodynamic modelling evidence, we demonstrate that the Lower Lakes were fresh for most of this time, particularly after 7200 years ago. Elevated Murray River discharge between 7200 and 6600 years ago prevented sea water ingress, despite sea levels +1 m higher than present. After 6600 years ago, the lakes remained predominately fresh. Current management is, therefore, consistent with the lakes' history before European colonisation.

Kokumi taste perception is functional in a model carnivore, the domestic cat (Felis catus)

Kokumi taste is a well-accepted and characterised taste modality and is described as a sensation of enhancement of sweet, salty, and umami tastes. The Calcium Sensing Receptor (CaSR) has been designated as the putative kokumi taste receptor for humans, and a number of kokumi-active ligands of CaSR have been discovered recently with activity confirmed both in vivo and in vitro. Domestic cats (Felis catus) are obligate carnivores and accordingly, their diet is abundant in proteins, peptides, and amino acids. We hypothesised that CaSR is a key taste receptor for carnivores, due to its role in the detection of different peptides and amino acids in other species. Using in silico, in vitro and in vivo approaches, here we compare human CaSR to that of a model carnivore, the domestic cat. We found broad similarities in ligand specificity, but differences in taste sensitivity between the two species. Indeed our in vivo data shows that cats are sensitive to CaCl₂ as a kokumi compound, but don't show this same activity with Glutathione, whereas for humans the reverse is true. Collectively, our data suggest that kokumi is an important taste modality for carnivores that drives the palatability of meat-derived compounds such as amino acids and peptides, and that there are differences in the perception of kokumi taste between carnivores and omnivores.

South African Society of Anaesthesiologists Perioperative Patient Blood Management Guidelines 2020

Anaesthesiologists regularly request and administer blood components to their patients, a potentially life-saving intervention. All anaesthesiologists must be familiar with the indications and appropriate use of blood and blood components and their alternatives, but close liaison with haematologists and their local haematology blood sciences laboratory is encouraged. In the last decade, there have been considerable changes in approaches to optimal use of blood components, together with the use of alternative products, with a need to update previous guidelines and adapt them for anaesthesiologists working throughout the hospital system.

Quality of the Evidence Supporting the Role of Oral Nutritional Supplements in the Management of Malnutrition: An Overview of Systematic Reviews and Meta-Analyses

There is considerable heterogeneity across the findings of systematic reviews of oral nutritional supplement (ONS) interventions, presenting difficulties for healthcare decision-makers and patients alike. It is not known whether heterogeneity arises from differences in patient populations or relates to methodological rigor. This overview aimed to collate and compare findings from systematic reviews of ONSs compared with routine care in adult patients who were malnourished or at risk of malnutrition with any clinical condition and to examine their methodological quality. Three electronic databases were searched to July 2019, supplemented with hand-searching. Data on all outcomes were extracted and review methodological quality assessed using A MeaSurement Tool for Assessment of systematic Reviews (AMSTAR). Twenty-two reviews were included, 11 in groups from mixed clinical backgrounds and 11 in specific clinical conditions. Ninety-one meta-analyses were identified for 12 different outcomes but there was discordance between results. Significant benefits of ONSs were reported in 4 of 4 analyses of energy intake, 7 of 11 analyses of body weight, 7 of 22 analyses of mortality, 10 of 17 analyses of complications (total and infectious), 1 of 3 analyses of muscle strength, 4 of 9 analyses of body composition/nutritional status, 2 of 14 analyses of length of stay, and 2 of 5 analyses of hospital readmissions. Ten reviews were high quality (AMSTAR scores 8-11), 9 moderate (AMSTAR scores 3-8), and 3 poor (AMSTAR scores 0-3). Methodological deficiencies were limitations to searches, poor reporting of heterogeneity, and failure to incorporate quality of evidence into any recommendations. Discordance between reviews was not markedly reduced when only high-quality reviews were considered. Evidence for the effects of ONS in malnourished patients or those who are at risk of malnutrition is uncertain, and discordance in results can arise from differences in clinical background of patients or the etiological basis of malnutrition.

Women's Cancer Screening in Haiti: Increasing Access by Bringing Services to the Workplace

Background: Cervical cancer is the leading cause of cancer-related death in Haiti yet the country does not provide sufficient screening. Working class women in Haiti are less likely to receive cancer screening or education than the poorest quartile of women. This is an untouched demographic not necessarily because of financial burdens but because most women work 6 days weekly and lack the time to seek healthcare and appropriate screening. Innovating Health International (IHI) and Share Hope recently implemented a cancer screening program using vaginal HPV self-swabs and clinical breast exams for working class women in Port-au-Prince. Aim: To not only bring much needed cervical cancer education, screening and treatment to an unreached demographic but also to assess the plausibility and acceptance by female factory workers to receive routine screening and treatment in clinics that reside within the workplace. Methods: The project began in September 2017 and will run for 12 months with plans to screen 4000 women with vaginal HPV swabs (QIAGEN careHPV) and clinical breast exams. Nurses perform clinical breast exam, teach self-breast exam, and instruct patients how to perform vaginal self-swab in the factory infirmary. Inclusion criteria for women include age 30 to 50 years. Women who screen positive for HPV will then be followed with visual inspection of the cervix with acetic acid (VIA) and thermocoagulation. Those who have suspicious masses in their breast have a breast ultrasound performed at the factory clinic. A smaller percentage of women with advanced disease will be referred to outside gynecology clinics. Results: Data collection is half-way completed and we´ll present full data in October. Over 3122 women have participated and received education on women's health issues during their lunch hour at the factories. Of all those sensitized, 2691 or 86.1% chose to have clinical breast exam. Of those who are eligible for HPV screening, 1948 or 93.8% of those eligible accepted testing. Of those tested, 344 or 16% were HPV-positive and all but a 5 completed VIA. For women who are HPV-positive, 69 or 20% were also VIA positive. All HPV-positive women received thermocoagulation except for 2, who were referred for colposcopy and loop electrocautery excisional procedure. There were 141 women who had a positive clinical breast exam and underwent breast ultrasound with only 2 requiring a biopsy. Conclusion: We seek to expand access to cervical cancer screening for the rural and working poor through using mobile health technologies coupled with community-based education and screening. HPV-positive women can undergo treatment by a traveling nurse with portable thermocoagulation therapy where they live or work, without the need to travel or leave work. With no doctor, no electricity, no pelvic exam for most women, and no stable infrastructure, we can screen women in rural areas and the working poor at their place of employment.

Oral nutrition support interventions for patients who are malnourished or at risk of malnutrition: a survey of clinical practice amongst UK dietitians

BACKGROUND

Guidance on choosing oral nutritional support strategies varies and the evidence for different approaches is discordant. The present study aimed to examine opinion and practice in the use of oral nutritional support amongst UK dietitians and to assess the factors that influence these clinical decisions.

METHODS

The study comprised a cross-sectional, anonymous, national survey of UK dietitians.

RESULTS

There were 207 completed responses (3% response rate). More dietitians reported using combined approaches (COMB) [n = 129 (62%)] over food-based (FB) strategies [n = 70 (34%)] or oral nutritional supplements (ONS) alone [n = 8 (4%)] (N = 207, P < 0.001). Intervention choice was associated with clinical setting and clinical speciality; community dietitians reported more frequent use of FB or ONS alone [n = 48 (59%)] versus COMB [n = 34 (41%)] compared to acute dietitians [COMB: n = 83 (78%) COMB versus FB or ONS alone: n = 24 (22%)] (N = 207, P < 0.0001). Specialist nutrition support dietitians reported more frequent use of FB or ONS alone [n = 22 (54%)] versus COMB [n = 19 (46%)] compared to nonspecialists [FB or ONS alone: n = 17 (45%) versus COMB: n = 21 (55%)] and other specialist dietitians [FB or ONS: n = 39 (30%) alone versus COMB: n = 89 (70%)] (P = 0.017). The greatest influences on choice were ease of implementation [n = 192 (93%)], departmental protocols [n = 184 (89%)], professional management pathways [n = 179 (87%)] and published research [n = 165 (80%)]. Patient circumstances [n = 117 (57%) and n = 99 (48%)] and ease of implementation [n = 35 (17%) and n = 48 (24%)] were reported as most influential in the first and second case scenarios, respectively.

CONCLUSIONS

There is a need for further research on approaches to the dietetic management of adult malnutrition.

Complex history of dog (Canis familiaris) origins and translocations in the Pacific revealed by ancient mitogenomes

Archaeological evidence suggests that dogs were introduced to the islands of Oceania via Island Southeast Asia around 3,300 years ago, and reached the eastern islands of Polynesia by the fourteenth century AD. This dispersal is intimately tied to human expansion, but the involvement of dogs in Pacific migrations is not well understood. Our analyses of seven new complete ancient mitogenomes and five partial mtDNA sequences from archaeological dog specimens from Mainland and Island Southeast Asia and the Pacific suggests at least three dog dispersal events into the region, in addition to the introduction of dingoes to Australia. We see an early introduction of dogs to Island Southeast Asia, which does not appear to extend into the islands of Oceania. A shared haplogroup identified between Iron Age Taiwanese dogs, terminal-Lapita and post-Lapita dogs suggests that at least one dog lineage was introduced to Near Oceania by or as the result of interactions with Austronesian language speakers associated with the Lapita Cultural Complex. We did not find any evidence that these dogs were successfully transported beyond New Guinea. Finally, we identify a widespread dog clade found across the Pacific, including the islands of Polynesia, which likely suggests a post-Lapita dog introduction from southern Island Southeast Asia.

The Economic Impact of Space Weather: Where Do We Stand?

Space weather describes the way in which the Sun, and conditions in space more generally, impact human activity and technology both in space and on the ground. It is now well understood that space weather represents a significant threat to infrastructure resilience, and is a source of risk that is wide-ranging in its impact and the pathways by which this impact may occur. Although space weather is growing rapidly as a field, work rigorously assessing the overall economic cost of space weather appears to be in its infancy. Here, we provide an initial literature review to gather and assess the quality of any published assessments of space weather impacts and socioeconomic studies. Generally speaking, there is a good volume of scientific peer-reviewed literature detailing the likelihood and statistics of different types of space weather phenomena. These phenomena all typically exhibit "power-law" behavior in their severity. The literature on documented impacts is not as extensive, with many case studies, but few statistical studies. The literature on the economic impacts of space weather is rather sparse and not as well developed when compared to the other sections, most probably due to the somewhat limited data that are available from end-users. The major risk is attached to power distribution systems and there is disagreement as to the severity of the technological footprint. This strongly controls the economic impact. Consequently, urgent work is required to better quantify the risk of future space weather events.

Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults

BACKGROUND

Supportive interventions such as serving meals in a dining room environment or the use of assistants to feed patients are frequently recommended for the management of nutritionally vulnerable groups. Such interventions are included in many policy and guideline documents and have implications for staff time but may incur additional costs, yet there appears to be a lack of evidence for their efficacy.

OBJECTIVES

To assess the effects of supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults.

SEARCH METHODS

We identified publications from comprehensive searches of the Cochrane Library, MEDLINE, Embase, AMED, British Nursing Index, CINAHL, SCOPUS, ISI Web of Science databases, scrutiny of the reference lists of included trials and related systematic reviews and handsearching the abstracts of relevant meetings. The date of the last search for all databases was 31 March 2013. Additional searches of CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP were undertaken to September 2016. The date of the last search for these databases was 14 September 2016.

SELECTION CRITERIA

Randomised controlled trials of supportive interventions given with the aim of enhancing dietary intake in nutritionally vulnerable adults compared with usual care.

DATA COLLECTION AND ANALYSIS

Three review authors and for the final search, the editor, selected trials from titles and abstracts and independently assessed eligibility of selected trials. Two review authors independently extracted data and assessed risk of bias, as well as evaluating overall quality of the evidence utilising the GRADE instrument, and then agreed as they entered data into the review. The likelihood of clinical heterogeneity amongst trials was judged to be high as trials were in populations with widely different clinical backgrounds, conducted in different healthcare settings and despite some grouping of similar interventions, involved interventions that varied considerably. We were only able, therefore, to conduct meta-analyses for the outcome measures, 'all-cause mortality', 'hospitalisation' and 'nutritional status (weight change)'.

MAIN RESULTS

Forty-one trials (10,681 participants) met the inclusion criteria. Trials were grouped according to similar interventions (changes to organisation of nutritional care (N = 13; 3456 participants), changes to the feeding environment (N = 5; 351 participants), modification of meal profile or pattern (N = 12; 649 participants), additional supplementation of meals (N = 10; 6022 participants) and home meal delivery systems (N = 1; 203 participants). Follow-up ranged from 'duration of hospital stay' to 12 months.The overall quality of evidence was moderate to very low, with the majority of trials judged to be at an unclear risk of bias in several risk of bias domains. The risk ratio (RR) for all-cause mortality was 0.78 (95% confidence interval (CI) 0.66 to 0.92); P = 0.004; 12 trials; 6683 participants; moderate-quality evidence. This translates into 26 (95% CI 9 to 41) fewer cases of death per 1000 participants in favour of supportive interventions. The RR for number of participants with any medical complication ranged from 1.42 in favour of control compared with 0.59 in favour of supportive interventions (very low-quality evidence). Only five trials (4451 participants) investigated health-related quality of life showing no substantial differences between intervention and comparator groups. Information on patient satisfaction was unreliable. The effects of supportive interventions versus comparators on hospitalisation showed a mean difference (MD) of -0.5 days (95% CI -2.6 to 1.6); P = 0.65; 5 trials; 667 participants; very low-quality evidence. Only three of 41 included trials (4108 participants; very low-quality evidence) reported on adverse events, describing intolerance to the supplement (diarrhoea, vomiting; 5/34 participants) and discontinuation of oral nutritional supplements because of refusal or dislike of taste (567/2017 participants). Meta-analysis across 17 trials with adequate data on weight change revealed an overall improvement in weight in favour of supportive interventions versus control: MD 0.6 kg (95% CI 0.21 to 1.02); 2024 participants; moderate-quality evidence. A total of 27 trials investigated nutritional intake with a majority of trials not finding marked differences in energy intake between intervention and comparator groups. Only three trials (1152 participants) reported some data on economic costs but did not use accepted health economic methods (very low-quality evidence).

AUTHORS' CONCLUSIONS

There is evidence of moderate to very low quality to suggest that supportive interventions to improve nutritional care results in minimal weight gain. Most of the evidence for the lower risk of all-cause mortality for supportive interventions comes from hospital-based trials and more research is needed to confirm this effect. There is very low-quality evidence regarding adverse effects; therefore whilst some of these interventions are advocated at a national level clinicians should recognise the lack of clear evidence to support their role. This review highlights the importance of assessing patient-important outcomes in future research.

Factors Affecting Credibility in a Simulated Sexual Harassment Hearing

Two hundred forty male and female undergraduates participated in two studies investigating judgments in a simulated sexual harassment hearing. A transcript presented a female student's allegations of sexual harassment against a male professor. The first experiment varied the status of the accused professor (national prominence vs. moderate status) and his style of defense (aggressive vs. nonaggressive). The second study varied the emotionality of both the victim and the accused and the time between the occurrence and the reporting of the alleged harassment incident (1 month vs. 6 months). Findings included negative effects on the student's credibility ratings when the professor attacked aggressively and more severe punishment of the defendant when the victim was emotional. It was concluded that process variables may be important in the perception of sexual harassment.

Diurnal postprandial responses to low and high glycaemic index mixed meals

BACKGROUND & AIMS

Glycaemic index testing is conducted in the morning, however postprandial glycaemia has a diurnal rhythm. The study aimed to evaluate the effect of glycaemic index on glucose tolerance at different times during the day.

METHODS

A randomised controlled crossover study was conducted in ten healthy participants after a standardised premeal and eight hour fast. Low (37) and high glycaemic index (73) meals, matched for energy, available carbohydrate, protein and fat, were consumed at 08:00 h and 20:00 h. Blood samples were taken for 2 h postprandially.

RESULTS

Postprandial glucose area under curve showed effect with time of day after both meals (Low p < 0.001, High p = 0.003), and a trend (p = 0.06) to higher glycaemic responses in the evening for low glycaemic index meal. No differences were observed in insulin responses. Despite the calculated difference in meal glycaemic index little difference was observed in morning responses, but differences were seen in the evening when insulin insensitivity is increasing, the glycaemic response increase was proportionally greater for low glycaemic index meals.

CONCLUSIONS

Low glycaemic index foods are of less value in glycaemic control in the evening than the morning. Consuming food late in the day has a detrimental metabolic impact irrespective of glycaemic index.

Offspring birth weight and maternal fasting lipids in women screened for gestational diabetes mellitus (GDM)

OBJECTIVES

Maternal lipid metabolism is altered during pregnancy but little is known about the influence of these alterations on either intrauterine fetal development or maternal wellbeing. The purpose of this study was to examine the relationship between both fasting cholesterol and triglycerides and offspring birth weight in women screened selectively for gestational diabetes mellitus (GDM).

STUDY DESIGN

In a prospective observational study in a University Maternity Hospital, women were recruited at their convenience when they were screened for GDM with a diagnostic 75 g oral glucose tolerance test (OGTT). An additional sample was taken for a lipid profile at the time the fasting glucose was obtained. Clinical and socio-demographic details were recorded.

RESULTS

Of the 189 women recruited, the mean age was 32 years, 35.4% (n=67) were primigravidas, 44.1% (n=82) were obese and 11.6% (n=22) had an abnormal OGTT. On univariate analysis, increasing birth weight was correlated positively with multiparity, first trimester body mass index (BMI), GDM and hypertriglyceridaemia but not with cholesterol levels. On multivariate analysis, increased birth weight correlated positively only with hypertriglyceridaemia.

CONCLUSIONS

This study provides further evidence that maternal hypertriglyceridaemia is important in programming intrauterine fetal growth and raises questions about whether women should be screened selectively for dyslipidaemia before, during and after pregnancy.

A review of phytate, iron, zinc, and calcium concentrations in plant-based complementary foods used in low-income countries and implications for bioavailability

Plant-based complementary foods often contain high levels of phytate, a potent inhibitor of iron, zinc, and calcium absorption. This review summarizes the concentrations of phytate (as hexa- and penta-inositol phosphate), iron, zinc, and calcium and the corresponding phytate:mineral molar ratios in 26 indigenous and 27 commercially processed plant-based complementary foods sold in low-income countries. Phytate concentrations were highest in complementary foods based on unrefined cereals and legumes (approximately 600 mg/100 g dry weight), followed by refined cereals (approximately 100 mg/100 g dry weight) and then starchy roots and tubers (< 20 mg/100 g dry weight); mineral concentrations followed the same trend. Sixty-two percent (16/26) of the indigenous and 37% (10/27) of the processed complementary foods had at least two phytate:mineral molar ratios (used to estimate relative mineral bioavailability) that exceeded suggested desirable levels for mineral absorption (i.e., phytate:iron < 1, phytate:zinc < 18, phytate:calcium < 0.17). Desirable molar ratios for phytate:iron, phytate:zinc, and phytate:calcium were achieved for 25%, 70%, and 57%, respectively, of the complementary foods presented, often through enrichment with animal-source foods and/or fortification with minerals. Dephytinization, either in the household or commercially, can potentially enhance mineral absorption in high-phytate complementary foods, although probably not enough to overcome the shortfalls in iron, zinc, and calcium content of plant-based complementary foods used in low-income countries. Instead, to ensure the World Health Organization estimated needs for these minerals from plant-based complementary foods for breastfed infants are met, dephytinization must be combined with enrichment with animal-source foods and/or fortification with appropriate levels and forms of mineral fortificants.

Circadian Aspects of Postprandial Metabolism

Time-dependent variations in the hormonal and metabolic responses to food are of importance to human health, as postprandial metabolic responses have been implicated as risk factors in a number of major diseases, including cardiovascular disease. Early work reported decreasing glucose tolerance in the evening and at night with evidence for insulin resistance at night. Subsequently an endogenous circadian component, assessed in constant routine (CR), as well as an influence of sleep time, was described for glucose and insulin. Plasma triacylglycerol (TAG), the major lipid component of dietary fat circulating after a meal, also appears to be influenced by both the circadian clock and sleep time with higher levels during biological night (defined as the time between the onset and offset of melatonin secretion) despite identical hourly nutrient intake. These time-dependent differences in postprandial responses have implications for shiftworkers. In the case of an unadapted night shift worker, meals during work time will be taken during biological night. In simulated night shift conditions the TAG response to a standard meal, preceded by either a low-fat or a high-fat premeal, was higher after a nighttime meal than during a daytime meal, and the day/night difference was larger in men than in women. In real night shift workers in Antarctica, insulin, glucose, and TAG all showed an increased response after a nighttime meal (second day of night shift) compared to a daytime meal. Night shift workers are reported to have an approximately 1.5 times higher incidence of heart disease risk and also demonstrate higher TAG levels compared with matched dayworkers. As both insulin resistance and elevated circulating TAG are independent risk factors for heart disease, it is possible that meals at night may contribute to this risk.

Stability of asthma control with regular treatment: an analysis of the Gaining Optimal Asthma controL (GOAL) study

BACKGROUND

Uncontrolled asthma is characterized by variability. Current asthma guidelines recommend focussing on the achievement and maintenance of control but few studies have examined in detail, using composite measures of control, the stability and potential duration of control once achieved. In this post-hoc analysis of the results of the Gaining Optimal Asthma controL (GOAL) study, we examine the association between the level of asthma control achieved during the step-up phase of the study and the stability of control experienced during the maintenance phase.

METHODS

GOAL was a 1-year, randomized, stratified, double-blind study of 3421 patients with uncontrolled asthma, which compared salmeterol/fluticasone propionate combination with fluticasone propionate in achieving two composite, guideline-based measures of control: totally controlled and well-controlled asthma. We analysed the proportion and duration of time spent in control, the effect of treatment on asthma stability, and the impact of asthma control stability on unscheduled use of healthcare resources.

RESULTS

In patients achieving well-controlled or totally controlled asthma, at least well-controlled asthma was maintained for a median of almost 3 and 6 months, and for more than 85% and 95% of weeks of follow-up, respectively. A high level of stability was confirmed in a Markov analysis investigating transitional probability of change in control status. Variability in control was associated with increased probability of an unscheduled healthcare resource use (odds ratio: 1.06, P < 0.001).

CONCLUSIONS

Most patients achieving guideline-defined control can maintain at least a similar level of control with regular, stable dosing, with little likelihood of losing control.

First Report of Phoma terrestris Causing Red Root Rot on Sweet Corn (Zea mays) in North Carolina

Red root rot, caused by Phoma terrestris E. M. Hansen, caused premature senescence and yield reductions to fresh-market sweet corn in Hyde County, North Carolina in July 2006. Foliar symptoms developed over a period of 5 to 8 days approximately 1 to 2 weeks after anthesis and included desiccation of leaves and poor development of ears. By 3 weeks after pollination, when the sweet corn was harvested, crowns and the first aboveground internode of affected plants were rotted and reddish colored, but roots appeared normal. The root mass of affected plants tended to be greater than that of unaffected plants. Incidence of symptomatic plants was greater than 30% in some fields and was lower on crops planted and harvested early. Symptomatic and asymptomatic plants were adjacent in affected fields. Diseased plants were more common in fields of sweet corn that followed soybean (Glycine max) or a double-crop of onions (Allium cepa) than in fields that followed corn. Incidence of symptomatic plants also differed among adjacent plantings of different sweet corn hybrids. Hybrids '173A', '182A', '378a', and 'XTH1178' had a high incidence of symptomatic plants and '372A', '278A', '8101', and '8102' were less affected. Samples of symptomatic plants of the hybrid '182A' were examined at the North Carolina Plant Disease and Insect Clinic during August. Olivaceous black pycnidia with long setae around the ostioles were imbedded in the stalk near the first node aboveground. Numerous conidia (1.8 to 2.3 × 4.5 to 5.5 μm) were released in cirri from pycnidia. When cultured on potato dextrose agar (PDA), the fungus produced a red pigment and intercalary and terminal chlamydospores. Pathogenicity was demonstrated in the greenhouse by transplanting corn seedlings or direct-seeding corn into pots of soil infested with plates of PDA containing chlamydospores and hyphae. A suspension of chlamydospores and hyphae also was injected into the stems of plants 28 days after transplanting. Five replicates of the pathogenicity experiments were repeated twice with noninoculated controls. After 8 weeks, P. terrestris was recovered from the roots of all inoculated plants. Soil inoculation resulted in necrotic root tissue in approximately 25% of inoculated plants. Approximately 90% of inoculated plants had discolored crowns that resembled symptoms from field infected plants. Stem inoculations resulted in necrosis extending 2 to 5 cm from the point of injection and resulted in shoot death of 40% of inoculated plants that resulted in the development of an adventitious shoot. Red root rot was prevalent on field corn in the Delmarva Peninsula throughout the late 1980s and 1990s (1). To our knowledge, this is the first report of this disease causing damage to sweet corn in North Carolina. Foliar symptoms and discoloration of crowns of diseased sweet corn plants were similar to previously described symptoms of red root rot on field corn (2), however, roots of affected sweet corn plants were not substantially rotted and did not have a symptomatic reddish pink or dark carmine color, presumably because sweet corn is harvested prior to the development of root symptoms. References: (1) K. W. Campbell et al. Plant Dis. 75:1186, 1991. (2) D. G. White, ed. Compendium of Corn Diseases. The American Phytopathological Society, St Paul, MN, 1999.

Flesh quality of market-size farmed and wild British Columbia salmon

This study compared the flesh quality of farmed and wild sources of British Columbia (BC) salmon with respect to concentrations of polychlorinated biphenyl compounds, polychlorinated dibenzodioxins/dibenzofurans and their associated toxic equivalents, total mercury (THg), methylmercury (MeHg), and selected fatty acids of known importance for human health viz., omega-3 (n-3) highly unsaturated fatty acids (n-3 HUFAs) and (n-6) fatty acids. Skinned fillets from known sources of farmed Atlantic, coho, and chinook salmon (n = 110) and wild coho, chinook, chum, sockeye, and pink salmon (n = 91) were examined. Atlantic salmon contained higher PCB concentrations (means, 28-38 ng/g) than farmed coho or chinook salmon, and levels in these latter species were similar to those in wild counterparts (means, 2.8-13.7 ng/g). PCB levels in Atlantic salmon flesh were, nevertheless, 53-71-fold less than the level of concern for human consumption of fish, i.e., 2000 ng/g as established by Health Canada and the U.S. Food and Drug Administration (US-FDA). Similarly, THg and MeHg levels in all samples were well below the Health Canada guideline (0.5 microg/g) and the US-FDA action level (1.0 microg/g). On average, THg in farmed salmon (0.021 microg/g) was similar to or lower than wild salmon (0.013-0.077 microg/g). Atlantic salmon were a richer source (mean, 2.34 g/100 g fillet) of n-3 HUFAs than the other farmed and wild sources of salmon examined (means, 0.39-1.17 g/100 g). The present findings support the recommended weekly consumption guidelines for oily fish species (includes all BC salmon sources) for cardio-protective benefits as made by the American Heart Association and the UK Food Standards Agency.

Egg size-number trade-off and a decline in oviposition site choice quality: female Pararge aegeria butterflies pay a cost of having males present at oviposition

Once mated, the optimal strategy for females of the monandrous butterfly, Pararge aegeria, is to avoid male contact and devote as much time as possible to ovipositing, as there is little advantage for females to engage in multiple matings. In other butterfly species the presence of males during egg laying has been shown to affect aspects of oviposition behavior and it has been suggested that repeated interference from males has the potential to reduce reproductive output. The aim of this study was to assess the effects of male presence during oviposition on reproductive output and behavior of a population of P. aegeria obtained from Madeira Island, Portugal, and maintained in the laboratory. Two experiments were performed where females were housed individually in small cages. Experiment 1 examined how social factors influenced the egg laying behavior of females. To do this the presence or absence of males was manipulated and egg size and number was measured over the first 14 days of oviposition. It was observed that when males were present during oviposition females made a trade-off between egg size and number. Experiment 2 examined how social factors affected oviposition site choice. Again, male presence/absence was manipulated, but in this experiment where the female laid her egg in relation to host quality was scored, and the size of the egg laid was measured. In the absence of males females selectively positioned their larger eggs on good quality host plants. However, selective oviposition was no longer observed when females were in the presence of males. We suggest that P. aegeria females from the Madeira Island population are adapted for a flexible oviposition strategy, governed by external cues, allowing a trade-off between egg size and number when the time available for egg laying is limiting.

The impact of the 2003 heat wave on daily mortality in England and Wales and the use of rapid weekly mortality estimates

This paper describes a retrospective analysis of the impact of the 2003 heat wave on mortality in England and Wales, and compares this with rapid estimates based on the Office for National Statistics routine weekly deaths reporting system. Daily mortality data for 4 to 13 August 2003, when temperatures were much hotter than normally seen in England, were compared with averages for the same period in years 1998 to 2002. The August 2003 heat wave was associated with a large short-term increase in mortality, particularly in London. Ozone and particulate matter concentrations were also elevated during the heat wave. Overall, there were 2139 (16%) excess deaths in England and Wales. Worst affected were people over the age of 75 years. The impact was greatest in the London region where deaths in those over the age of 75 increased by 59%. Estimated excess mortality was greater than for other recent heat waves in the United Kingdom. The estimated number of deaths registered each week is reported by the Office for National Statistics. The first clear indication of a substantial increase in deaths was published on 21 August 2003. This provided a quick first estimate of the number of deaths attributable to the heat wave and reflected the pattern of daily deaths in relation to the hottest days, but underestimated the excess when compared with the later analysis.

The impact of the 2003 heat wave on daily mortality in England and Wales and the use of rapid weekly mortality estimates

This paper describes a retrospective analysis of the impact of the 2003 heat wave on mortality in England and Wales, and compares this with rapid estimates based on the Office for National Statistics routine weekly deaths reporting system. Daily mortality data for 4 to 13 August 2003, when temperatures were much hotter than normally seen in England, were compared with averages for the same period in years 1998 to 2002. The August 2003 heat wave was associated with a large short-term increase in mortality, particularly in London. Ozone and particulate matter concentrations were also elevated during the heat wave. Overall, there were 2139 (16%) excess deaths in England and Wales. Worst affected were people over the age of 75 years. The impact was greatest in the London region where deaths in those over the age of 75 increased by 59%. Estimated excess mortality was greater than for other recent heat waves in the United Kingdom. The estimated number of deaths registered each week is reported by the Office for National Statistics. The first clear indication of a substantial increase in deaths was published on 21 August 2003. This provided a quick first estimate of the number of deaths attributable to the heat wave and reflected the pattern of daily deaths in relation to the hottest days, but underestimated the excess when compared with the later analysis.

Probabilistic methods in BCI research

This paper suggests a probabilistic treatment of the signal processing part of a brain-computer interface (BCI). We suggest two improvements for BCIs that cannot be obtained easily with other data driven approaches. Simply by using one large joint distribution as a model of the entire signal processing part of the BCI, we can obtain predictions that implicitly weight information according to its certainty. Offline experiments reveal that this results in statistically significant higher bit rates. Probabilistic methods are also very useful to obtain adaptive learning algorithms that can cope with nonstationary problems. An experimental evaluation shows that an adaptive BCI outperforms the equivalent static implementations, even when using only a moderate number of trials. This suggests that adaptive translation algorithms might help in cases where brain dynamics change due to learning effects or fatigue.