A qualitative investigation of experiences of breastfeeding twins and multiples.

BACKGROUND: Research has found that twins and multiples are less likely to be breastfed than singleton babies. Exploration of the experience of breastfeeding twins and multiples from parents' perspectives is limited, and we know little about the experiences of those who breastfeed twins and multiples and the possible barriers they face. AIM: The aim of the research was to explore experiences of breastfeeding twins and multiples in the UK from the perspective of birthing parents. METHODS: A qualitative online survey was carried out (n = 94), followed by online semi-structured interviews (n = 18). The data were analysed using reflexive thematic analysis. FINDINGS: Four themes were developed from the data: (1) "It's one of the things I'm most proud of in my life" (2) The importance of support: "it definitely takes a village with twins" (3) Barriers and the pressure to formula feed: "all they wanted to do was stuff 'em full of formula" and (4) The dynamic experience of breastfeeding twins. DISCUSSION: Many of the participants were able to feed their babies in part due to sheer determination and the refusal to give up when met with challenges. Breastfeeding was an important part of their identity as a mother, however mental health was often impacted by their experiences, as well as the challenges they faced when seeking support. CONCLUSION: Breastfeeding twins and multiples is a challenging yet rewarding experience. Our findings indicate that further training and support is needed to enable healthcare providers to support parents of twins on their breastfeeding journey.

Evaluation of Empiric Coverage of Previously Cultured Multidrug Resistant Organisms in Critically Ill Patients Admitted for Sepsis.

Purpose: Multidrug-resistant organisms (MDROs) are associated with an increased length of stay and a higher risk of mortality in hospitalized patients. A lack of literature exists that evaluates the need to empirically cover patients for historic MDROs upon readmission. Methods: A retrospective, single-center, cohort study was conducted to evaluate the impact of empiric MDRO antibiotic coverage in patients with a history of MDROs. Differences in length of stay were assessed between two groups of patients: those empirically treated for their historic MDRO and those not. Secondary outcomes included in-hospital mortality, ICU length of stay, need for antibiotic escalation, need for antibiotic de-escalation, and antibiotic duration. Results: Seventy-two patients with historic MDRO(s) were readmitted to the hospital and met inclusion criteria for this study. Hospital length of stay was similar between those empirically covered and those not (11 days vs 15.1 days; P = 0.149). When analyzed in a population only including Gram-negative MDROs, hospital length of stay was shorter in those who received empiric coverage (10.7 days vs 17.2 days; P = 0.032). Conclusion: In the total study population, empiric coverage of historic MDROs failed to significantly reduce hospital length of stay. When analyzed in a population of only Gram-negative MDROs, empiric coverage of historic organisms reduced hospital length of stay by 6.5 days. This suggests that in patients readmitted to the ICU for sepsis, empiric coverage of historic Gram-negative MDROs may be beneficial.

Influence of demographics, exposure, and habitat use in an urban, coastal river on tumor prevalence in a demersal fish.

Neoplasia and associated tissue biomarkers in benthic fishes are commonly used to characterize effects of contaminated sediments in aquatic ecosystems. However, these fish are often migratory or partially-migratory, and thus assessing the effect of location-specific contamination is challenging because the fish will have a complex exposure history. We determined liver and skin neoplasia prevalence for a benthic, partially-migratory fish, white sucker (Catostomus commersonii), and used carbon and nitrogen stable isotope ratios to determine the diet contribution associated with areas of contaminated sediments within the urbanized portion of the St. Louis River. We then tested which factors were significantly related to neoplasia prevalence, including age, sex, and the percent diet obtained from contaminated areas within the St. Louis River relative to Lake Superior, the reference area. Overall, the prevalence of contaminant-related internal and external tumors was low, <5%. For skin neoplasia prevalence, both sex and age were significant factors, whereas location-specific diet contribution based on stable isotope analysis was not a significant factor. For liver neoplasia prevalence, only age was a significant factor. Nevertheless, for all contaminants measured (polychlorinated biphenyls [PCBs], polychlorinated dibenzodioxins [PCDDs], and polychlorinated dibenzofurans [PCDFs]), there was a significant, negative correlation between liver tissue concentration and Lake Superior diet contribution, confirming that the St. Louis River is the primary source of contaminant exposure. The research highlights the complexity of exposure to location-specific contaminants and potentially infectious agents associated with neoplasia at urban, contaminated sites in the Great Lakes, and elsewhere. It also demonstrates the need to determine the full set of risk factors across life-stages, habitats, and biological endpoints.

Malignant melanoma of brown bullhead (Ameiurus nebulosus) in Lake Memphremagog, Vermont/Quebec.

In 2012, brown bullhead (Ameiurus nebulosus) with large, raised, black growths were first reported from multiple areas within the Vermont portion of Lake Memphremagog. Subsequent surveys conducted from 2014 to 2017 at two sites within the lake indicated a prevalence of 30% in adult brown bullhead 200 mm and above total length. These lesions ranged from slightly raised smooth black areas to large nodular areas on the body surface and fins and within the oral cavity. Microscopically, these lesions were determined to be malignant melanoma with invasion into surrounding hypodermis, skeletal muscle and bone as well as metastases to gill, ovary and intestine. Liver neoplasms were also observed in 8% of the bullhead collected from Lake Memphremagog in 2015. Neither skin nor liver neoplasms were noted in Ticklenaked Pond, a site used for comparison.

Indicators of exposure to estrogenic compounds at Great Lakes Areas of Concern: species and site comparisons.

Adverse effects resulting from potential exposure of wild fishes to estrogenic endocrine disruptors were assessed at seven United States Great Lakes Areas of Concern using biomarkers ranging from organismal (gonadosomatic indices) to tissue/plasma (histology, plasma vitellogenin) and molecular (hepatic gene transcripts) levels. Biomonitoring was conducted on pelagic, top predator species, largemouth Micropterus salmoides and smallmouth M. dolomieu bass and benthic, omnivorous white sucker Catostomus commersonii. Seasonal (spring and fall) comparisons were conducted at select sites. Intersex (testicular oocytes), plasma vitellogenin, and hepatic vitellogenin transcripts were commonly observed in bass species. Testicular oocyte severity was positively, although weakly, correlated with plasma vitellogenin, hepatic transcripts of vitellogenin, estrogen receptor α, and estrogen receptor ß2, while negatively correlated with androgen receptor ß and phosphoenolpyruvate carboxykinase. No testicular oocytes were observed in white sucker; however, plasma vitellogenin and hepatic vitellogenin transcripts were commonly detected in the males. The results demonstrate the importance of utilizing multiple endpoints to assess exposure to estrogenic compounds as well as the importance of choosing sensitive species.

Differential expression and evolution of three tandem, interleukin-1 receptor-like 1 genes in rainbow trout (Oncorhynchus mykiss).

Interleukin-1 receptor-like 1 (Il1rl1 or ST2), a member of the interleukin-1 receptor family, has pleiotropic roles including tissue homeostasis, inflammation, immune polarization, and disease resistance in mammals. A single orthologue was previously described in salmonid fish; however, a recently improved genome assembly of rainbow trout (Oncorhynchus mykiss) revealed three adjacent, tandem il1rl1 orthologues on chromosome Omy 03. Here, we report the genomic organization and evolution of the three il1rl1 genes (il1rl1α, il1rl1ß, il1rl1γ), and use both RNA-seq and gene-specific qPCR methods to quantify expression patterns. Nucleotide sequence homology between the three genes is >95% and each predicted protein contains three IG/IG-like domains, a transmembrane region and a TIR domain. The amino acid sequence homology of the rainbow trout il1rl1 genes are highly related to two functional copies in Atlantic and Coho salmon (∼94%) but relatively low (22-26%) with avian and mammalian species. Transcript abundance measured by RNA-seq in 15 tissues of healthy adult rainbow trout indicate constitutive expression of each gene. In whole body lysates, il1rl1α was shown to have >20 fold mRNA expression compared to il1rl1ß and il1rl1γ as measured by qPCR assays specific to il1rl1α or il1rl1γ, as well as a multi-gene qPCR assay (il1rl1α,ß,γ). Unrooted phylogenetic trees grouped the rainbow trout il1rl1 genes apart from other interleukin-1 receptor family genes and genomic comparisons identify preserved synteny between mammals, birds and salmonids albeit a pseudogene is present in both Atlantic salmon and Coho salmon. Phylogenetic analyses suggest that the three genes arose by tandem duplication but are inconclusive whether these events occurred prior-to or after salmonid speciation. These findings further the understanding of interleukin receptor family evolution and their contribution to teleost immune function.

Micronuclei and other erythrocyte nuclear abnormalities in fishes from the Great Lakes Basin, USA.

Biological markers (biomarkers) sensitive to genotoxic and mutagenic contamination in fishes are widely used to identify exposure effects in aquatic environments. The micronucleus assay was incorporated into a suite of indicators to assess exposure to genotoxic and mutagenic contamination at five Great Lakes Areas of Concern (AOCs), as well as one non-AOC (reference) site. The assay allowed enumeration of micronuclei as well as other nuclear abnormalities for both site and species comparisons. Erythrocyte abnormality data was also compared to skin and liver tumor prevalence and hepatic transcript abundance. Erythrocyte abnormalities were observed at all sites with variable occurrence and severity among sites and species. Benthic-oriented brown bullhead (Ameiurus nebulosus) and white sucker (Catostomus commersonii) expressed lower rates of erythrocyte abnormalities, but higher rates of skin and liver neoplasms, when compared to pelagic-oriented largemouth bass (Micropterus salmoides) or smallmouth bass (Micropterus dolomieu) at the same site. The reduced erythrocyte abnormalities, increased transcript abundance associated with Phase I and II toxicant responsive pathways, and increased neoplastic lesions among benthic-oriented taxa may indicate the development of contaminant resistance of these species to more acute effects. Environ. Mol. Mutagen. 58:570-581, 2017. © 2017 This article is a U.S. Government work and is in the public domain in the USA. Environmental and Molecular Mutagenesis published by Wiley Periodicals, Inc. on behalf of Environmental Mutagen Society.

The myeloperoxidase-derived oxidant hypothiocyanous acid inhibits protein tyrosine phosphatases via oxidation of key cysteine residues.

Phosphorylation of protein tyrosine residues is critical to cellular processes, and is regulated by kinases and phosphatases (PTPs). PTPs contain a redox-sensitive active site Cys residue, which is readily oxidized. Myeloperoxidase, released from activated leukocytes, catalyzes thiocyanate ion (SCN(-)) oxidation by H2O2 to form hypothiocyanous acid (HOSCN), an oxidant that targets Cys residues. Dysregulated phosphorylation and elevated MPO levels have been associated with chronic inflammatory diseases where HOSCN can be generated. Previous studies have shown that HOSCN inhibits isolated PTP1B and induces cellular dysfunction in cultured macrophage-like cells. The present study extends this previous work and shows that physiologically-relevant concentrations of HOSCN alter the activity and structure of other members of the wider PTP family (including leukocyte antigen-related PTP, PTP-LAR; T-cell PTP, TC-PTP; CD45 and Src homology phosphatase-1, Shp-1) by targeting Cys residues. Isolated PTP activity, and activity in lysates of human monocyte-derived macrophages (HMDM) was inhibited by 0-100 µM HOSCN with this being accompanied by reversible oxidation of Cys residues, formation of sulfenic acids or sulfenyl-thiocyanates (detected by Western blotting, and LC-MS as dimedone adducts), and structural changes. LC-MS/MS peptide mass-mapping has provided data on the modified Cys residues in PTP-LAR. This study indicates that inflammation-induced oxidants, and particularly myeloperoxidase-derived species, can modulate the activity of multiple members of the PTP superfamily via oxidation of Cys residues to sulfenic acids. This alteration of the balance of PTP/kinase activity may perturb protein phosphorylation and disrupt cell signaling with subsequent induction of apoptosis at sites of inflammation.

Preventing NIDDM among aboriginal people: is exercise the answer? Description of a pilot project using exercise to prevent gestational diabetes.

Rates of diabetes and its complications have reached epidemic proportions among North American Aboriginal peoples. This appears largely due to changes in diet and activity levels associated with a shift away from traditional lifestyles. Since exercise has been shown to be effective in preventing non-insulin-dependent diabetes mellitus (NIDDM), Aboriginal communities may be able to reduce their rates of the disease by incorporating exercise programs into their public health programs. We describe a pilot project in Saskatoon, Saskatchewan, whose ultimate purpose is to evaluate the effect of exercise in preventing gestational diabetes. If successful, this would reduce the risk of developing NIDDM for both women and their offspring.

The team approach.

Cardiovascular disease continues to be the major cause of death and illness in Canada. But the news is not all bad. The incidence can be reduced by minimizing one or more cardiovascular risk factors.