Impact of dietary porcine blood by-products in meagre (Argyrosomus regius) physiology, evaluated by welfare biomarkers and the antibacterial properties of the skin mucus.

Tools are required for quick and easy preliminary evaluation of functional feeds efficiency on fisheries. The analysis of skin mucus biomarkers is a recent alternative approach providing a faster feed-back from the laboratory which is characterized by being less invasive, more rapid and with reduced costs. The effect of replacing fishmeal and fish protein hydrolysates by means of two porcine by-products, the porcine spray-dried plasma (SDPP) and pig protein hydrolysate (PPH), in compound diets (50.4% crude protein, 16.2% crude protein, 22.1 MJ/kg feed) was evaluated in juvenile meagre (Argyrosomus regius) during a two-months period. To determine the impact of these dietary replacements, growth and food performance were measured together with digestive enzymes activities and filet proximal composition. Additionally, skin mucus was collected and characterized by determining main mucus biomarkers (protein, glucose, lactate, cortisol, and antioxidant capacity) and its antibacterial properties, measured by the quick in vitro co-culture challenges. In comparison to the control group, the inclusion of PPH and SDPP, in meagre diets reduced growth (7.4-8.8% in body weight), increased feed conversion ratios (9.0-10.0%), results that were attributed to a reduction in feed intake values (24.2-33.0%) (P < 0.05). Porcine blood by-products did not modify the activity of gastric and pancreatic digestive enzymes as well as those involved in nutrient absorption (alkaline phosphatase) nor liver oxidative stress condition (P > 0.05). In contrast, a reduction in fillet lipid content associated to an increase in fillet protein levels were found in fish fed SDPP and PPH diets (P < 0.05). As compared to the control diet, the dietary replacement did not alter the levels of the skin mucus biomarkers related to stress (cortisol and antioxidant capacity) or nutritional status (soluble protein, glucose and lactate) (P > 0.05). Interestingly, regardless of the worst performance in somatic growth, meagre fed diets containing both tested porcine by-products showed a significantly improved antibacterial capacity of their skin mucus. This enhancement was more prominent for fish fed with the PPH diet, which may be attributed to a higher content of immunomodulatory bioactive compounds in PPH. Further research will be necessary to provide insights on how the inclusion of SDPP and PPH, at the expense of dietary fishmeal and fish protein hydrolysates, affects feed intake and growth performance in meagre. However, the use of skin mucus biomarkers has been demonstrated to be an excellent methodology for a preliminary characterization of the functional feeds, in particular for their prophylactic properties by the study of mucus antibacterial activity.

Effect of Lactobacillus rhamnosus HN001 in Pregnancy on Postpartum Symptoms of Depression and Anxiety: A Randomised Double-blind Placebo-controlled Trial.

BACKGROUND: Probiotics may help to prevent symptoms of anxiety and depression through several putative mechanisms. OBJECTIVE: The aim of this study was to evaluate the effect of Lactobacillus rhamnosus HN001 (HN001) given in pregnancy and postpartum on symptoms of maternal depression and anxiety in the postpartum period. This was a secondary outcome, the primary outcome being eczema in the offspring at 12months of age. DESIGN, SETTING, PARTICIPANTS: A randomised, double-blind, placebo-controlled trial of the effect of HN001 on postnatal mood was conducted in 423 women in Auckland and Wellington, New Zealand. Women were recruited at 14-16weeks gestation. INTERVENTION: Women were randomised to receive either placebo or HN001 daily from enrolment until 6months postpartum if breastfeeding. OUTCOME MEASURES: Modified versions of the Edinburgh Postnatal Depression Scale and State Trait Anxiety Inventory were used to assess symptoms of depression and anxiety postpartum. TRIAL REGISTRATION: Australia NZ Clinical Trials Registry: ACTRN12612000196842. FINDINGS: 423 women were recruited between December 2012 and November 2014. 212 women were randomised to HN001 and 211 to placebo. 380 women (89.8%) completed the questionnaire on psychological outcomes, 193 (91.0%) in the treatment group and 187 (88.6%) in the placebo group. Mothers in the probiotic treatment group reported significantly lower depression scores (HN001 mean=7·7 (SD=5·4), placebo 9·0 (6·0); effect size -1·2, (95% CI -2·3, -0·1), p=0·037) and anxiety scores (HN001 12·0 (4·0), placebo 13·0 (4·0); effect size -1·0 (-1·9, -0·2), p=0·014) than those in the placebo group. Rates of clinically relevant anxiety on screening (score>15) were significantly lower in the HN001 treated mothers (OR=0·44 (0·26, 0·73), p=0·002). INTERPRETATION: Women who received HN001 had significantly lower depression and anxiety scores in the postpartum period. This probiotic may be useful for the prevention or treatment of symptoms of depression and anxiety postpartum. FUNDING SOURCE: Health Research Council of New Zealand (11/318) and Fonterra Co-operative Group Ltd.

Population pharmacokinetics of intravenous artesunate: a pooled analysis of individual data from patients with severe malaria.

There are ~660,000 deaths from severe malaria each year. Intravenous artesunate (i.v. ARS) is the first-line treatment in adults and children. To optimize the dosing regimen of i.v. ARS, the largest pooled population pharmacokinetic study to date of the active metabolite dihydroartemisinin (DHA) was performed. The pooled dataset consisted of 71 adults and 195 children with severe malaria, with a mixture of sparse and rich sampling within the first 12 h after drug administration. A one-compartment model described the population pharmacokinetics of DHA adequately. Body weight had the greatest impact on DHA pharmacokinetics, resulting in lower DHA exposure for smaller children (6-10 kg) than adults. Post hoc estimates of DHA exposure were not significantly associated with parasitological outcomes. Comparable DHA exposure in smaller children and adults after i.v. ARS was achieved under a dose modification for intramuscular ARS proposed in a separate analysis of children.

Melioidosis in an adult male.

Infection with Burkholderia pseudomallei has been described, albeit rarely, patients in Bangladesh. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, which is present in soil and surface water in the endemic region. A 35-year-young male farmer presented with prolonged fever and significant weight loss. Patient gradually deteriorated despite getting different antibiotics including intravenous ceftriaxone and metronidazole. Panels of investigations were done which revealed no diagnostic confirmation except uncontrolled diabetes and multiple abscesses in different organs. Melioidosis was suspected and serum samples were positive for Burkholderia pseudomallei antibody. The case illustrates the importance of non-specific nature of the clinical presentation and high index of suspicion of uncommon diseases like melioidosis where the disease has not been considered as an endemic.

An automatic vision-based malaria diagnosis system.

Malaria is a worldwide health problem with 225 million infections each year. A fast and easy-to-use method, with high performance is required to differentiate malaria from non-malarial fevers. Manual examination of blood smears is currently the gold standard, but it is time-consuming, labour-intensive, requires skilled microscopists and the sensitivity of the method depends heavily on the skills of the microscopist. We propose an easy-to-use, quantitative cartridge-scanner system for vision-based malaria diagnosis, focusing on low malaria parasite densities. We have used special finger-prick cartridges filled with acridine orange to obtain a thin blood film and a dedicated scanner to image the cartridge. Using supervised learning, we have built a Plasmodium falciparum detector. A two-step approach was used to first segment potentially interesting areas, which are then analysed in more detail. The performance of the detector was validated using 5,420 manually annotated parasite images from malaria parasite culture in medium, as well as using 40 cartridges of 11,780 images containing healthy blood. From finger prick to result, the prototype cartridge-scanner system gave a quantitative diagnosis in 16 min, of which only 1 min required manual interaction of basic operations. It does not require a wet lab or a skilled operator and provides parasite images for manual review and quality control. In healthy samples, the image analysis part of the system achieved an overall specificity of 99.999978% at the level of (infected) red blood cells, resulting in at most seven false positives per microlitre. Furthermore, the system showed a sensitivity of 75% at the cell level, enabling the detection of low parasite densities in a fast and easy-to-use manner. A field trial in Chittagong (Bangladesh) indicated that future work should primarily focus on improving the filling process of the cartridge and the focus control part of the scanner.

Caregiver mental health and racial/ethnic disparities in stroke: implications for culturally sensitive interventions.

PURPOSE/OBJECTIVE: The purpose of this study was to create a set of culturally sensitive mental-health-intervention recommendations for the caregivers of Latino/Puerto-Rican, Black, and White individuals with stroke. The study examined whether the mental health of stroke caregivers and functioning of individuals with stroke differed according to race/ethnicity, changed differentially over time according to race/ethnicity, and showed relationships between the two sets of constructs that differed according to race/ethnicity. RESEARCH METHOD/DESIGN: Data on caregiver mental health and functioning of individuals with stroke were collected from 124 (n = 248) White, Black, and Latino/Puerto-Rican dyads at 1, 6, and 12 months post-hospital discharge. RESULTS: Out of the three racial/ethnic groups, Latino/Puerto-Rican individuals with stroke showed the lowest functioning, and their caregivers showed the poorest mental health, though the mental-health effects did not reach statistical significance. Consistent patterns which differed as a function of race/ethnicity emerged over time in the relationships between caregiver mental health and functioning of individuals with stroke. CONCLUSIONS/IMPLICATIONS: Critical knowledge may be lost regarding the connections between caregiver mental health and the functioning of individuals with stroke when researchers and clinicians look only across race/ethnicity as opposed to also within. A monolithic racial/ethnic approach to mental-health interventions for stroke rehabilitation is likely limited, and race/ethnicity may affect how caregiver mental health and functioning of individuals with stroke reciprocally influence each other.

Plasmodium malariae in Bangladesh.

We describe a 32-year-old Bangladeshi male presenting with severe malaria caused by a mono-infection with Plasmodium malariae. Rosetting of infected and uninfected erythrocytes, a putative virulence factor in falciparum malaria, was observed in the blood slide. Severe disease caused by P. malariae is extremely rare. The patient made a rapid recovery with intravenous quinine treatment.

Identifying at-risk, ethnically diverse stroke caregivers for counseling: a longitudinal study of mental health.

PURPOSE: This study examined (1) causality in the relationship between stroke caregiver mental health and care-recipient functioning, and (2) the prediction from stroke caregiver and care-recipient variables 5 months and 11 months later. RESEARCH METHOD: Questionnaire, interview, and observational data were collected from 124 ethnically diverse stroke caregiver/care-recipient dyads in the homes of care recipients at 1, 6, and 12 months after discharge. RESULTS: The magnitudes of the causal pathways between stroke caregiver mental health and care-recipient functioning were not significantly different. At 1 month after discharge, the best predictors of poor caregiver mental health 11 months later were care-recipient low daily functioning and caregiver low sense of coherence, high burden, and high depression. CONCLUSIONS: Caregiver mental health and care-recipient functioning may have reciprocal causal influence on each other, so one of the first steps in stroke rehabilitation may be providing counseling to the primary caregiver. Caregivers with high burden, a low sense of coherence, and a low-functioning care recipient are those most at risk for poor mental health outcomes.

Influence of sense of coherence on caregiver burden and depressive symptoms at 12 months poststroke.

PURPOSE: The purpose of this study was to examine the relationship of sense of coherence for informal stroke caregivers with sociodemographic variables and caregiving outcomes of depressive symptoms and burden. METHOD: Using path analysis, data 1 month after the stroke (stroke survivor and caregiver characteristics) from 87 dyads (stroke survivors and their caregivers) were used to predict caregiver outcomes of burden and depressive symptoms at 12 months poststroke. RESULTS: Sense of coherence, although not predicted by sociodemographic variables, had a significant inverse relationship with caregiver burden and depressive symptoms, indicating that caregivers with a higher sense of coherence at 1 month experience less burden and depressive symptoms at 12 months. Caregiver burden was also predicted by stroke survivor comorbidities, caregiver gender, and time spent per day providing care. Caregiver depressive symptoms were predicted by race, gender, and hours spent providing care per day. CONCLUSION: Caregivers who have high sense of coherence experience less burden and depressive symptoms at 12 months poststroke. Suggestions for improving caregiver sense of coherence are discussed.

Associations in sense of coherence and depression in caregivers of stroke survivors across 2 years.

The objective of this longitudinal study was to detect the relationship between the sense of coherence (SOC), which is an adaptive coping response, and depression in informal caregivers of stroke survivors across 2 years. One-hundred-fifteen veterans, who were hospitalized after experiencing an acute stroke, and their informal caregivers were enrolled prior to discharge. Data were collected via face-to-face in-home interviews at 1, 6, 12, 18, and 24 months after discharge. A linear mixed model was fitted to estimate the effects of the time-dependent covariates (SOC) while considering the dependence of outcome measures at repeated times. Based on the linear mixed model, caregivers with a stronger SOC were associated with lower levels of caregiver depression across 2 years following a stroke (p < 0.0001). SOC seems to be an important aspect of a caregiver's capacity to cope after tending to the needs of a stroke patient.

Stroke caregiver information needs: comparison of Mainland and Puerto Rican caregivers.

Research indicates that informal caregivers of stroke survivors often do not have the information necessary to adequately manage the recovery process at home. This article presents findings on the information sources and needs of stroke caregivers both in Puerto Rico and the Mainland United States. Data were collected from 120 caregivers (42 Puerto Rican, 78 Mainland) of veterans who had experienced a stroke. Of all caregivers, 22% to 50% reported the need for information related to stroke recovery. This need was greater for Puerto Rican caregivers compared with Mainland caregivers. Caregivers receive most of their information from their doctors, the Veterans Health Administration (VHA), and the Internet. This study highlights the need for information dissemination to Puerto Rican and Mainland caregivers within the VHA system. This dissemination is an important and ongoing goal of the Stroke Quality Enhancement Research Initiative and the VHA/ Department of Defense Clinical Practice Guidelines.

Coping by stroke caregivers: sex similarities and differences.

Informal care provision presents many challenges. As the population ages, more people are forced to enter the role of informal caretaker. Despite the increase in the need for caregivers and the importance of providing care, there is little empirical research examining how men and women approach and cope with providing care. The current study examined stroke patients and their care providers to assess possible gender differences in the impact of caretaking on caretakers and care recipients. Results indicate no significant difference in patient well-being based on the gender of the caregiver. Some measures indicated that men have advantages as caregivers. Results are discussed with regard to the accuracy and utility of sex-role stereotypes about caregivers. In addition, these data provide potential insight about how to decrease caregiver burden, delay long-term hospitalization of the patient, and increase the quality of life for caretakers and patients.

Locomotor training: experiencing the changing body.

This study examined the experiences of persons with incomplete spinal cord injury who participated in loco-motor training (LT). LT is an emerging rehabilitation intervention for enhancing the recovery of walking in persons with central nervous system disorders. Multiple interviews and field observations provided data from eight participants, including four veterans. Findings indicate that experiences of bodily changes were prevalent among participants. Themes included (1) experiencing impaired or absent proprioception, (2) struggling for bodily control, and (3) experiencing emergent bodily sensations. Themes 1 and 2 reflected bodily disruption as a result of spinal cord injury and were challenging to participants as they attempted to reconnect the body and self through LT. Theme 3 reflected bodily sensations (burning, soreness) that were seen as positive signs of recovery and resulted in hope and motivation. Understanding how LT participants experience bodily changes may enable therapists to develop improved participant-centered intervention approaches.

Qualitative and quantitative measurement of depression in veterans recovering from stroke.

This analysis triangulates qualitative and quantitative data from interviews, Geriatric Depression Scale scores, and patient records to evaluate poststroke depression. Participants were veterans who were discharged home following a new stroke. Findings indicated underrecognition and treatment of depression. Narrative data uncovered a rich description of respondents' perceptions and emotional experiences during stroke recovery.

Recovery of cohesion in narrative discourse after left-hemisphere stroke.

Little is known about the recovery of narrative discourse after stroke. While several studies have analyzed the recovery of language in individuals with aphasia, few known studies exist on the recovery of narrative discourse in stroke survivors, particularly those who have not been diagnosed with aphasia. In this study, we evaluated the cohesiveness of narrative discourse in a cohort of individuals who had suffered a left-hemisphere stroke and had not been diagnosed with expressive language impairment. We analyzed their narrative discourse at 1, 6, and 12 months poststroke. Our findings indicate that, while the mean number of cohesive ties in narrative discourse remained generally constant during the first year poststroke, the percentage correct use of cohesive ties increased significantly during the same time period. These findings suggest that subtle disruptions in expressive language can be present initially in narrative discourse, and recovery from these disruptions can occur naturally over time.

Quality-of-life predictors for caregivers at 1 and 6 months poststroke: Results of path analyses.

In this study, weused path analyses to test a theoretical model of influences on quality of life (QOL) for stroke caregivers at 1 and 6 months poststroke. We examined data from two points in time to determine the influence of stroke survivor and caregiver characteristics on QOL for stroke caregivers. Stroke survivor and caregiver characteristics had some direct influence on QOL outcomes for stroke caregivers at both 1 and 6 months poststroke. However, the most influential factor at both time points on each QOL component was sense of coherence (SOC). SOC is a relatively new factor in QOL and caregiver literature and is essentially the ability of caregivers to mobilize their coping resources during periods of stress. Caregivers who were able to mobilize these resources effectively experienced less burden in four QOL components and fewer symptoms of depression.

Benchmarking as everyday functional assessment in stroke recovery.

OBJECTIVES: Functional assessment in stroke recovery extends beyond formal testing and evaluation. Stroke survivors themselves continuously engage in the process of reckoning their functional capacities as they go about their everyday lives. This process is called benchmarking. The aim of this article is to discuss and illustrate how it operates in three areas of experience--self-definition, comorbidity and age, and the tasks of daily life. METHODS: Benchmarking data are drawn from in-depth qualitative interviews with male stroke survivors of various ages and from three ethnic groups (Hispanic, African American, and non-Hispanic White). RESULTS: The results show that the benchmarking process is evident in all social categories in which survivors fall, but specific kinds of benchmarks may be more prominent in some categories than others. DISCUSSION: The lessons provided by everyday functional assessment for understanding the stroke experience, as well as directions for further study, are discussed in the conclusion.