Characteristics and trait preferences of West African Dwarf goat keepers in Ghana.

A study was conducted to evaluate the characteristics of West African Dwarf (WAD) goat keepers and their trait preferences as part of a broader phenotypic characterisation work with the aim of providing information for improving the household management, conservation and productivity of the breed in Ghana. A total of 384 respondent households were selected from four agro-ecological zones in the middle belt and southern part of the country for questionnaire administration and direct observation of animals under field conditions. The results showed that there are slightly more women (54.2%) keeping WAD goats than men (45.8%) and fall within the economically active population of youthful and middle age categories (53.9%). A majority of these goat keepers were married (73.8%) and educated (87.3%) in one way or the other. They obtained their starter or foundation stock mainly from neighbours (80.5%) and the open market (16.0%). The average flock size from the households sampled was 7.9 ± 1.5, whereas the flock structure constituted 56.1% adult females, 27.5% adult intact males, 1.2% castrates and 15.2% kids of both sexes. Survivability, fast growth rate and larger litter size were the farmers' most preferred quantitative traits, whereas most of these respondents preferred to keep WAD goats which do not have qualitative traits such as horn, wattle and beard. From the findings of the research, it was concluded that the favourable socio-economic characteristics of WAD goat keepers could sustain intensification and increase the productivity of the breed when given the necessary input assistance along the goat value chain. The primary objective of WAD goat farmers is to produce matured animals for various purposes and the breeding goal for a WAD goat breeding programme would be to increase survival, growth rate and litter size of light coat (white, grey and light brown) goats. Finally, most farmers lack knowledge on the significance of tropically beneficial qualitative traits such as horn, wattle, beard and light coat colouration on the survivability, climate adaptability or resilience and productivity of their goats. Educating farmers on the importance of conserving and inclusion of animals possessing such traits in their selection practices under the Government's Rearing for Food and Jobs Initiative is therefore suggested.

Morphometric characterization and differentiation of West African Dwarf goat populations in Ghana.

A study was carried out to characterize and differentiate four West African Dwarf goat populations on the basis of morphometric traits and also predict their body weights using linear body measurements. A total of 384 goats were sampled from four agro-ecological zones from the middle belt and southern part of Ghana. The morphometric traits examined for phenotypic differentiation using univariate and multivariate analysis were body weight, body length, withers height, chest girth, chest depth, shoulder point width, rump length, rump width, head length, head width, shin circumference, horn length, ear length, tail length, and hair length. Results obtained showed that agro-ecological zone and age significantly (p < 0.05) influenced the performance of most traits. The phenotypic correlations among the traits were low to high (0.06-0.67) indicating linear relationships among these traits which may be caused by both genetic and environmental factors. The regression analysis also revealed that a single trait which may be used to predict the body weight of male West African Dwarf goats of ages 1-4 years is chest/heart girth and that of female counterparts is withers height. All the populations were significantly (p < 0.0001) distant (differentiated) from each other, but the largest (4.62) estimated Mahalanobis distance (D2) was between West African Dwarf goat populations in the transitional zone P1 and the rainforest P3 while the least (1.61) was observed between transitional zone P1 and semi-deciduous forest zone P2. The highest similarity between individuals within population was found in the rainforest P3 (79.76%) and the lowest in the transitional zone P1 (47.13%). The three canonical components (Can1, Can2, and Can3) explained the total (100%) between-population variation in morphometric traits. However, in partitioning of the variance, the first two canonical components (Can1 and Can2) accounted for cumulative proportion of 84.35% of between-population variance. In order of importance, tail length, head length, ear length, shin circumference, head width, and shoulder point width were the most discriminating variables responsible for the variations among the four goat populations. In conclusion, morphometric variations exist among West African Dwarf goat populations of Ghana. Yet, further studies on molecular genetic diversity of the populations are recommended to support a sustainable breed improvement strategy. Also, equations have been developed that can be used to reliably predict the body weight of WAD goats and future research should also focus on developing single variable weight estimator measuring tapes based only on either the chest girth, withers height, or body length prediction equations for farmers to use in the absence of weighing scale.

Economic analysis of prenatal fetoscopic vs open-hysterotomy repair of open neural tube defect.

OBJECTIVE: Fetal repair of an open neural tube defect (ONTD) by open hysterotomy has been shown to reduce the need for ventriculoperitoneal shunting and improve motor outcomes for infants, but increases the risk of Cesarean section and prematurity. Fetoscopic repair is an alternative approach that may confer similar neurological benefits but allows for vaginal delivery and reduces the incidence of hysterotomy-related complications. We sought to compare the costs of care from fetal surgery until neonatal discharge, as well as the clinical outcomes, associated with each surgical approach. METHODS: This was a retrospective cohort study of patients who underwent prenatal ONTD repair, using either the open-hysterotomy or the fetoscopic approach, at a single institution between 2012 and 2018. Clinical outcomes were collected by chart review. A cost-consequence analysis was conducted from the hospital perspective, and included all inpatient and ambulatory hospital and physician costs incurred for the care of mothers and their infants, from the time of maternal admission for fetal ONTD repair up to postnatal maternal and infant discharge. Costs were estimated using cost-to-charge ratios for hospital billing and the Medicare physician fee schedule for physician billing. RESULTS: Seventy-eight patients were included in the analysis, of whom 47 underwent fetoscopic repair and 31 underwent open-hysterotomy repair. In the fetoscopic-repair group, compared with the open-repair group, fewer women underwent Cesarean section (53% vs 100%; P < 0.001) and the median gestational age at birth was significantly higher (38.1 weeks (interquartile range (IQR), 35.2-39.1 weeks) vs 35.7 weeks (IQR, 33.9-37.0 weeks); P < 0.001). No case of uterine dehiscence was observed in the fetoscopic-repair group, compared with an incidence of 16% in the open-repair group. After adjusting for baseline characteristics, there was no significant difference in the total cost of care between the fetoscopic-repair and the open-repair groups (median, $76 978 (IQR, $60 312-$115 386) vs $65 103 (IQR, $57 758-$108 103); P = 0.458). CONCLUSIONS: Fetoscopic repair of ONTD, when compared with the open-hysterotomy approach, reduces the incidence of Cesarean section and preterm delivery with no significant difference in total costs of care from surgery to infant discharge. This novel approach may represent a cost-effective alternative to improve maternal and neonatal outcomes for this high-risk population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Meta-analysis comparing temperature on arrival at the referral hospital of newborns with hypoxic ischemic encephalopathy cooled with a servo-controlled device versus no device during transport.

BACKGROUND: Therapeutic hypothermia reduces mortality and neurological injury for neonates with hypoxic ischemic encephalopathy (HIE). The aim of this meta-analysis is to evaluate use of servo-controlled devices during transport to the referral hospital. METHODS: PubMed and Medline (Ovid) searches were used to identify studies comparing HIE patients' temperatures on arrival at the referral hospital for those cooled with servo-controlled devices versus no device during transport. Random effects models were used to conduct a meta-analysis comparing the two groups' proportion of patients arriving in the target temperature range as well as the mean and variability in body temperature on arrival. Studies' level of evidence and risk of bias were also assessed. RESULTS: Eight published studies with total of 573 patients met the inclusion criteria, with a "B" grade of recommendation overall. A significantly higher proportion of infants cooled with a servo-controlled device arrived in the target temperature range (pooled relative risk = 2.47, 95% confidence interval: 1.46-4.17, p < 0.001). The arrival temperature in the device cooled group was on average 0.82°C lower (95% CI: 0.29-1.35°C, p = 0.002) with an 82% lower temperature variance. CONCLUSIONS: Although the predominance of observational studies and presence of some risks of bias somewhat limits the strength of recommendation, the existing research consistently indicates that using a servo-controlled device during transport of neonates with HIE increases the probability of arriving at the referral hospital in the target temperature range, with a lower body temperature and less variability. Future research is needed to investigate differences in mortality and neurological impairment.

Genetic and non-genetic factors influencing the performance of the West African Dwarf (WAD) goat kept at the Kintampo Goat Breeding Station of Ghana.

A study was conducted to analyze the effect of genetic and non-genetic factors influencing the growth performance of the West African Dwarf goat. Breed records of 836 kids born by 259 does, and 8 bucks from 2011 to 2017 at the station were used. Growth performance traits studied were birth weight, weaning weight, 6-month body weight, 9-month body weight, yearling weight, and pre-weaning and post-weaning growth rates. The fixed effects of sex of kid (male or female), season of kidding (major, minor, and dry), year of kidding (2011-2017), and type of birth (single, twins, or triplets) on growth performance were determined. Genetic parameters such as heritability and correlations among the traits were also estimated. The non-genetic data (fixed factors) obtained were analyzed using the general linear model procedures of GenStat (Discovery Edition 12). Heritability estimates obtained for the growth traits were 0.45 ± 0.15, 0.57 ± 0.29, 0.04 ± 0.05, 0.74 ± 0.59, 0.49 ± 0.35, 0.55 ± 0.39, and 0.54 ± 0.36, respectively, an indication of high genetic variation existing among the traits (with the exception of 6-month body weight). This could be harnessed and utilized for genetic improvement within the flock. The phenotypic correlation coefficients among the traits ranged from low to high (0.04-0.95), indicating that there is a linear relationship among body traits of the goats which may be caused by either genetic or environmental factors of correlation. The genetic correlations were also medium to high (0.30-0.96). The general implications are that selection for any of these growth traits in a breed improvement programme would have a considerable simultaneous positive impact on each other. The overall birth weight, weaning weight, 6-month body weight, 9-month body weight, yearling weight, and pre- and post-weaning growth rates obtained were 1.48 kg, 5.35 kg, 6.56 kg, 8.30 kg, 10.00 kg, 32.26 g/day, and 19.39 g/day, respectively. These growth performances were found to be significantly influenced by the non-genetic factors studied. There is therefore the need to factor these in future breed improvement programmes to ensure their success.

The effects of breed, season and parity on the reproductive performance of pigs reared under hot and humid environments.

A research aimed at evaluating the reproductive performance of pigs as influenced by breed, season, and parity was carried out. Reproductive performance records of 1383 sows made up of 204 primiparous and 1179 multiparous large white (687) and Duroc × large white crosses (696) obtained over a 3-year period (2013 to 2016) were used. Data on reproductive performance taken were farrowing rate, litter size at birth and at weaning, piglet weight at birth and at weaning farrowing interval and pre-weaning mortality. To determine the effect of season, parity and breed on reproductive performance, the 4-way analysis of variance (ANOVA) was used. A mixed model was fitted using the generalized linear model (GLM) procedure of the GenStat (Discovery Edition) to investigate the fixed effects of breed (two classes), season of birth (three classes) and parity (five classes) on the reproductive traits. Where differences in means were observed, the means were separated using the least significant difference at 5% level of significance. Results obtained indicated litter size at birth of 12.5 ± 0.3 and 14.2 ± 0.5 for the large white and the Duroc × large white respectively and farrowing rates of 90.0 ± 2.3 and 94.5 ± 2.5% for the large white and the Duroc × large white respectively. Litter size at birth and at weaning, farrowing rate and piglet weight at birth were all influenced by parity and season with increasing parity significantly reducing litter size at birth and at weaning. Reproductive traits of the sows were superior during the rainy season, an indication of the need to consider season of birth in making decision.

Neonatologists less frequently discuss long term complications: A simulation-based study of prenatal consults beyond the threshold of viability.

BACKGROUND: Guidelines exist for counseling expectant families of infants at periviable gestational ages (22-25 weeks), but it is much more common for neonatologists to counsel families at gestational ages beyond the threshold of viability when several aspects of these guidelines do not apply. We aimed to develop an understanding of what information is shared with mothers at risk of preterm delivery beyond periviability and to evaluate communication skills of our participants. METHODS: We developed a checklist of elements to include in counseling based on a comprehensive literature review. The checklist was divided into an information sharing section and a connect score. The information sharing list was sub-divided into general information and specific complications. Neonatologists engaged in a simulated prenatal counseling session with a standardized patient. Videotaped encounters were then analyzed for checklist elements. RESULTS: Neonatologists all scored well in communication using our tool and two other validated communication tools - the SEGUE and the analytic global OSCE. There was no difference in scoring based on years of experience or level of training. Information sharing from neonatologists more often discussed general information over specific. Neonatologists also focused more on early outcomes over long-term outcomes. Only 12% of neonatologists quoted the correct survival rate for the case. CONCLUSIONS: Neonatologists generally communicate well but share less information specific to prematurity and the long-term sequelae of prematurity. Our tool may be used to test if other interventions improve information sharing or communication.

Sun exposure of indoor workers in the UK - survey on the time spent outdoors.

Assessment of ultraviolet (UV) exposure is essential for evaluation of the risks and benefits to optimise public health outcomes. The exposure depends on available environmental UV radiation and individual behaviour, and it can be obtained from dosimetry studies; however, the use of dosimeters is often not feasible for large population groups or over long periods of time. In this study, a lifestyle questionnaire has been used to obtain information on the time spent outdoors by indoor workers that could be used in combination with dosimetry studies in smaller targeted groups to quantify UV exposure for health risk/benefit analysis. 894 office and laboratory workers at the Public Health England, UK, responded to the survey. Questions addressed the time of day and the duration of time; staff were outdoors on weekdays, at weekends and during holidays. The majority of the responders spent negligible time outdoors on weekdays. Outdoor activities before and after work were constrained by the work pattern and commuting. The average time for those who go outdoors before and after commuting was 22.5 ± 16.2 min and 30.4 ± 21.4 min, respectively. Only 7% of participants regularly spent their lunch break outdoors for 21.5 ± 12.2 min and weekday exposure may contribute less than 13% of the daily available erythema dose. At the weekend, on average responders spend 5.0 ± 2.6 h outdoors over the two days: if taken around midday, it accounts for approximately 50% of available UV exposure. In winter months in the UK, November to March, the combination of very low environmental UV and low ambient temperatures results in negligible UV exposure. Holidays contributed to the majority of the annual UV exposure. In summer, 45% of responders went to destinations where the UV levels may be up to 2 times higher than in the UK; durations of overseas holidays are also longer than UK breaks. The UV dose from two weeks of holiday in extreme UV index level destinations could be comparable to a 1.5-2 summer months holiday in the UK. The survey data were validated with 6 months of dosimetry within the same cohort; very strong and strong correlation was found between the survey and measurements. This shows that a lifestyle survey can be used in combination with targeted dosimetry studies in small groups to obtain information about the time spent outdoors.

Long term variations in erythema effective solar UV at Chilton, UK, from 1991 to 2015.

In this paper erythema effective UV radiant exposure data from the PHE solar network Chilton site for the 25 year period from 1991 to 2015 are presented. The year with the highest average daily erythema effective radiant exposure was 2003 at 1577 J m-2 and the year with the lowest average daily radiant exposure was 2010 at 1149 J m-2. Overall, the average daily radiant exposure per year ranged from 5655 J m-2 to 9.98 J m-2 with the average being 1306 J m-2. A preliminary analysis of the data set is carried out. A statistically significant (p = 0.01) increase in annual radiant exposure of 4.4% per year was observed from 1991-1995. Thereafter a small decrease in annual erythema effective radiant exposure of 0.8% (p = 0.002) per year was observed from 1995-2015 with a slightly faster rate of decrease from 2000-2015 of 1.0% (p = 0.007) per year. In terms of seasonal analyses, a statistically significant increase in erythema effective UV radiant exposure of 5.1% (p = 0.02) per year in the summer during 1991-1995 has been found along with small decreases in spring and summer during 1995-2015 (-1.0%; p = 0.01 and -0.7%; p = 0.01 respectively) and 2000-2015 (-1.1%; p = 0.03 and -1.2%; p = 0.003 respectively). The data suggest that the erythema effective UV dose available for impacting public health has been decreasing in recent years.

Mind the gap: can videolaryngoscopy bridge the competency gap in neonatal endotracheal intubation among pediatric trainees? a randomized controlled study.

BACKGROUND: To study the impact of videolaryngoscopy (VL) on intubation success among pediatric trainees compared with direct laryngoscopy (DL). METHODS: One hundred pediatric residents were enrolled in a randomized, crossover, simulation study comparing VL to DL. Following a didactic session on neonatal intubation, residents intubated a standard neonatal mannequin. Three Neonatal Resuscitation Program (NRP) scenarios were then conducted, followed by a mannequin intubation with the alternate device. Number of attempts and time to intubation were recorded for all intubations. RESULTS: Proportion of successful intubations on first attempt was greater with VL compared with DL (88% versus 63%; P=0.008). The DL group increased success after crossover with VL (63% versus 89%; P=0.008). Exposure to VL also reduced intubation time after device crossover (median intubation time: 31 versus 17 s; P=0.048). CONCLUSIONS: VL increased the success of endotracheal intubation by pediatric residents in simulation, with skills transferrable to DL.

Low-energy light bulbs, computers, tablets and the blue light hazard.

The introduction of low energy lighting and the widespread use of computer and mobile technologies have changed the exposure of human eyes to light. Occasional claims that the light sources with emissions containing blue light may cause eye damage raise concerns in the media. The aim of the study was to determine if it was appropriate to issue advice on the public health concerns. A number of sources were assessed and the exposure conditions were compared with international exposure limits, and the exposure likely to be received from staring at a blue sky. None of the sources assessed approached the exposure limits, even for extended viewing times.

'Toy' laser macular burns in children: 12-month update.

PURPOSE: There is increasing evidence that high-powered hand-held laser devices cause retinal injury. We present 12-month follow-up data for three patients that we previously reported with such retinal injuries. METHODS: A retrospective case series of three children with maculopathy secondary to exposure to high-power hand-held laser devices. All children underwent clinical examination and spectral domain optical coherence tomography (SD-OCT) at presentation and follow-up. Fundus-controlled microperimetry was also undertaken 12-19 months after exposure. RESULTS: Three children sustained macular injury after exposure to a high-powered hand-held laser. Acutely, they presented with a 'vitelliform-like' maculopathy with reduced vision. Over the course of follow-up, the best corrected Snellen acuity in all three patients improved to 'normal' levels (range 6/6-6/9). Long-term deficits in foveal retinal sensitivity were identified in two patients using fundus-controlled microperimetry. SD-OCT imaging showed persistent disruption of the foveal outer photoreceptor layers in all three children. CONCLUSION: Although visual acuity improved over time, deficits in microperimetry and SD-OCT persisted. All three children had retinal pigment epithelium changes, requiring follow-up for longer-term sequelae of laser injuries such as expansion of retinal atrophy and development of choroidal neovascular membranes.

Dose Estimation for a Study of Nuclear Workers in France, the United Kingdom and the United States of America: Methods for the International Nuclear Workers Study (INWORKS).

In the framework of the International Nuclear Workers Study conducted in France, the UK and the U.S. (INWORKS), updated and expanded methods were developed to convert recorded doses of ionizing radiation to estimates of organ doses or individual personal dose equivalent [H(p)(10)] for a total number of 308,297 workers, including 40,035 women. This approach accounts for differences in dosimeter response to predominant workplace energy and geometry of exposure and for the recently published ICRP report on dose coefficients for men and women separately. The overall mean annual individual personal dose equivalent, including zero doses, is 1.73 mSv [median = 0.42; interquartile range (IQR): 0.07, 1.59]. Associated individual organ doses were estimated. INWORKS includes workers who had potential for exposure to neutrons. Therefore, we analyzed neutron dosimetry data to identify workers potentially exposed to neutrons. We created a time-varying indicator for each worker, classifying them according to whether they had a positive recorded neutron dose and if so, whether their neutron dose ever exceeded 10% of their total external penetrating radiation dose. The number of workers flagged as being exposed to neutrons was 13% for the full cohort, with 15% of the cohort in France, 12% of the cohort in the UK and 14% in the U.S. We also used available information on in vivo and bioassay monitoring to identify workers with known depositions or suspected internal contaminations. As a result of this work, information is now available that will allow various types of sensitivity analyses.

Immunological profiling in chronic rhinosinusitis with nasal polyps reveals distinct VEGF and GM-CSF signatures during symptomatic exacerbations.

BACKGROUND: The mechanisms and immune pathways associated with chronic rhinosinusitis (CRS) are not fully understood. Immunological changes during acute exacerbation of CRS may provide valuable clues to the pathogenesis and perpetuation of the disease. OBJECTIVE: To characterize local and systemic immune responses associated with acute worsening of sinonasal symptoms during exacerbation in CRS with nasal polyps (CRSwNP) compared to controls. METHODS: This was a non-interventional prospective study of individuals with CRSwNP and normal controls. Subjects underwent a baseline visit with collection of nasal secretions, nasal washes, and serum specimens. Within 3 days of acute worsening of sinonasal symptoms, subjects underwent a study visit, followed by a post-visit 2 weeks later. The sinonasal outcome test-22 (SNOT-22) scores and immunological parameters in the specimens were analysed using a novel, unsupervised learning method and by conventional univariate analysis. RESULTS: Both CRSwNP patients and control subjects showed a significant increase in SNOT-22 scores during acute exacerbation. Increased nasal levels of IL-6, IL-5, and eosinophil major basic protein were observed in CRSwNP patients. A network analysis of serum specimens revealed changes in a set of immunological parameters, which are distinctly associated with CRSwNP but not with controls. In particular, systemic increases in VEGF and GM-CSF levels were notable and were validated by a conventional analysis. CONCLUSIONS: CRSwNP patients demonstrate distinct immunological changes locally and systemically during acute exacerbation. Growth factors VEGF and GM-CSF may be involved in the immunopathogenesis of subjects with CRS and nasal polyps experiencing exacerbation.

Effect of the frizzle gene (F) on egg production and egg quality of laying hens kept in tropical villages.

1. Two experiments were conducted to determine the influence of the frizzle gene (F) on the production and quality of chicken eggs kept on village farms in Ghana. 2. In the first experiment, 144 pullets, 72 each of Ff and ff pullets from F1 birds, were compared in a randomised complete block design (RCBD), with three villages and 4 batches of hatch as blocks and the two feather genotypes (Ff and ff) as the treatments. 3. The Ff pullets were superior (P < 0.05) to their ff counterparts in terms of the number of eggs per clutch, egg mass and hen-housed and hen-d rates of lay, whereas age at first egg was lower (P < 0.05) in ff layers compared to Ff ones. 4. The eggs of the F1 heterozygous frizzle (Ff) layers had higher values for albumen height, Haugh unit and yolk height compared with eggs from their normal feathered counterparts. 5. In the second experiment, 144 pullets, 48 each of FF, Ff and ff pullets, were compared in a RCBD, with three villages and 4 batches of hatch as blocks and the two feather genotypes (Ff and ff) as the treatments. 6. The F2 birds with genotypes Ff and FF were better than their ff counterparts in terms of the number of eggs per clutch, egg mass, and hen-housed and hen-d rates of lay. Age at first egg was significantly lower in ff layers compared to FF and Ff ones. 7. The Haugh unit value was higher in the homozygous and heterozygous frizzles compared to the normal feathered ones. 8. The presence of the frizzle gene (F) in egg type chickens led to an improvement in egg production and egg quality traits in village chickens, and the cross-breeding scheme evaluated in this project could contribute to improved productivity.

Growth performance of crossbred naked neck and normal feathered laying hens kept in tropical villages.

1. Two experiments were conducted to develop naked neck (Na/na) and normal feathered (na/na) crossbreds and compare their growth performance, linear body measurements and carcass characteristics in the first and second filial generations. 2. In the first experiment, 4 indigenous naked neck males (Na/na) were mated to 36 Lohmann commercial females (na/na) in a ratio of 1:9. The two genotypes (Na/na, na/na) were allocated randomly according to batches of hatch, sire lines and sex to three different villages. 3. In the second experiment, 10 males and 100 females of F1 Na/na birds were selected and mated inter se in a ratio of 1:10. The three genotypes (Na/Na, Na/na and na/na) were compared in a randomised complete block design experiment, with the three villages, hatch and sex as blocks and the three genotypes as treatments. F1 Na/na birds had significantly higher (P < 0.05) feed conversion ratio, body weight, body weight gain, linear body measurements, survivability and carcass yield than their na/na counterparts. 4. In the F2 generation, Na/Na and Na/na birds had significantly higher (P < 0.05) feed conversion ratio, body weight, body weight gain, linear body measurements, survivability and carcass yield compared to their na/na counterparts. 5. The birds showing the naked neck phenotype appeared to show superior performance compared to normal feathered birds and could be exploited for potential utilisation in local poultry production.

The risk of asthma exacerbation after reducing inhaled corticosteroids: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Asthma guidelines suggest reducing controller medications when asthma is stable. METHODS: The purpose of the study is to estimate the risk of asthma exacerbation in stable asthmatics who reduce inhaled corticosteroids (ICS) compared to those who maintain a stable ICS dose. We identified articles from a systematic review of English and non-English articles using MEDLINE, EMBASE, Web of Science, and CENTRAL (inception to May 25, 2013). We included randomized controlled trials (RCTs) with a stable asthma run-in period of 4 weeks or more, an intervention to reduce ICS, and a follow-up period of at least 3 months. RESULTS: The search strategy identified 2253 potential articles, of which 206 were reviewed at the full-text level and 6 met criteria for inclusion. The relative risk of an asthma exacerbation in individuals who reduced ICS compared to those who maintained the same ICS dose was 1.25 (95% CI 0.96, 1.62; P = 0.10; I(2)  = 0%) in studies with a mean follow-up of 22 weeks. Individuals who reduced ICS had a decreased% predicted FEV1 of 0.87% (95% CI -1.58%,3.33%; P = 0.49, I(2)  = 58%) and a decreased mean morning peak expiratory flow of 9.57 l/min (95% CI 1.25, 17.90; P = 0.02; I(2)  = 74%) compared to those individuals who maintained a stable ICS dose. CONCLUSIONS: Asthma exacerbations were statistically no more likely among individuals who reduced ICS compared to those who maintained their ICS dose, supporting current guidelines which recommend decreasing ICS by 50% after a period of asthma stability.

Evaluation of short-term fluoride release from fluoride varnishes.

OBJECTIVE: The aim of this study was to compare the rate of fluoride release from fluoride varnishes over a 48-hour period and ascertain the time at which a plateau occurred. This data provides clinically relevant time points to resume tooth brushing after fluoride varnish application. STUDY DESIGN: Four commercially available fluoride varnishes, Premier Enamel ProVarnish (EP), Colgate PreviDent (CP), Omni Vanish (OV) and Omni VanishXT (OVXT) were applied on 40 extracted permanent human teeth. Ten teeth served as controls. The teeth were immersed in artificial saliva. At 1, 2, 4, 8, 12, 24 and 48 hours, the teeth were sequentially transferred to new vials. TISAB III and ion selective electrode was used to measure fluoride release. Statistical tools were used to compare the rates of fluoride release and plateau of fluoride release. RESULTS: CP, EP and OV showed a plateau of fluoride release after 4 hours. OVXT did not show a significant change in fluoride release at any time point. EP had the highest fluoride release in the first 8 hours. CONCLUSIONS: CP, EP and OV released maximum rate of fluoride release in the first 4 hours whereas OVXT did not have a plateau. The studied varnishes released different concentrations of fluoride despite the fact that they all contained 5% sodium fluoride.