The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study.

BACKGROUND: Peripherally inserted central catheters (PICCs) are a common vascular access device used in clinical practice. Their use may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice. OBJECTIVES: To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event. METHOD: Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited between May and December 2013. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE. RESULTS: Data were available for 136 patients (50% cancer; 44% infection; 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one peripheral vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761; 95% CI 0.681-0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p=0.022; CI 1.445-122.788). CONCLUSION: It was found that a 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research is needed to confirm these results as although adequately powered; the number of cases of VTE was comparatively small, resulting in wide confidence intervals.

Waist-to-Hip Ratio and Unhealthy Body Change in Women

The role of waist-to-hip ratio (WHR) in unhealthy body change was examined in a sample of 143 women university students. They completed the Eating Disorder Examination-Questionnaire (EDE-Q), reported their level of concern with weight and with WHR, and used unmarked measuring tapes to record their subjective (self-perceived), ideal, and objective (measured) waist and hip circumference. Although body shape was reported as important, and concern with WHR correlated significantly with symptoms of disordered eating, the relationships involving WHR were not independent of those involving body weight. Thus, there appears to be little behavioural and/or clinical significance in the aesthetic evaluations made by women of their WHR. Reasons for this are considered in light of evidence that women regard WHR as more difficult to control and less amenable to change than their overall body weight.

Waist circumference, waist-hip ratio and BMI and their correlation with cardiovascular risk factors in Australian adults

Objectives. To compare body mass index (BMI), waist circumference and waist–hip ratio (WHR) as indices of obesity and assess the respective associations with type 2 diabetes, hypertension and dyslipidaemia.

Design and setting. A national sample of 11 247 Australians aged ≥25 years was examined in 2000 in a cross-sectional survey.

Main outcome measures. The examination included a fasting blood sample, standard 2-h 75-g oral glucose tolerance test, blood pressure measurements and questionnaires to assess treatment for dyslipidaemia and hypertension. BMI, waist circumference and WHR were measured to assess overweight and obesity.

Results. The prevalence of obesity amongst Australian adults defined by BMI, waist circumference and WHR was 20.8, 30.5 and 15.8% respectively. The unadjusted odds ratio for the fourth vs. first quartile of each obesity measurement showed that WHR had the strongest relationship with type 2 diabetes, dyslipidaemia (women only) and hypertension. Following adjustment for age, however, there was little difference between the three measures of obesity, with the possible exceptions of hypertension in women, where BMI had a stronger association, and dyslipidaemia in women and type 2 diabetes in men, where WHR was marginally superior.

Conclusions. Waist circumference, BMI and WHR identified different proportions of the population, as measured by both prevalence of obesity and cardiovascular disease (CVD) risk factors. Whilst WHR had the strongest correlations with CVD risk factors before adjustment for age, the three obesity measures performed similarly after adjustment for age. Given the difficulty of using age-adjusted associations in the clinical setting, these results suggest that given appropriate cut-off points, WHR is the most useful measure of obesity to use to identify individuals with CVD risk factors.

A new fuzzy ratio and its application to the single input rule modules connected fuzzy inference system

The principle of ratios has been applied to many real world problems, e.g. the part-to-part and part-to-whole ratio formulations. As it is difficult for humans to provide an exact ratio in many real situations, we introduce a fuzzy ratio in this paper. We use some notions from fuzzy arithmetic to analyze fuzzy ratios captured from humans. An application of the formulated fuzzy ratio to a Single Input Rule Modules connected Fuzzy Inference System (SIRMs-FIS) is demonstrated. Instead of using a precise weight, fuzzy sets are employed to represent the relative importance of each rule module. The resulting fuzzy weights are explained as a fuzzy ratio on a weight domain. In addition, a new SIRMs-FIS model with fuzzy weights and part-to-whole fuzzy ratio is devised. A simulated example is presented to clarify the proposed SIRM-FIS model.

Influence of stocking rate and mixed grazing of Angora goats and Merino sheep on animal and pasture production in southern Australia : 1 : botanical composition, sward characteristics and availability of components of annual temperate pastures

The effects of animal species (AS; Angora goats, Merino sheep or goats and sheep mixed grazed together at ratio 1:1) and stocking rate (SR; 7.5, 10 and 12.5 animals/ha) on the availability, botanical composition and sward characteristics of annual temperate pastures under continuous grazing were determined in a replicated experiment from 1981 to 1984. AS and SR had significant effects on pasture availability and composition and many AS SR interactions were detected. The pastures grazed by sheep had significantly reduced content and proportion of subterranean clover and more undesirable grasses compared with those grazed by goats. There were no differences in dry matter availabilities between goat- and sheep-grazed pastures at 7.5/ha, but at 10 and 12.5/ha goat pastures had significantly increased availabilities of green grass, dead and green clover and less weeds compared with sheep pastures. There was a significant AS SR interaction for the density of seedlings in May following pasture germination. Between July and January, the height of pastures was greater under goats than sheep but from January to March pasture height declined more on goat-grazed than on sheep-grazed pastures. There was an AS SR interaction for incidence of bare ground. Increasing the SR increased bare ground in pastures grazed by sheep but no change occurred on pastures grazed by goats. Changes in pasture characteristics due to increased SR were minimised on pastures grazed by goats but the grazing of sheep caused larger and faster changes and the pastures were damaged at the highest SR. Goats did not always select the same herbage material as sheep, changed their selection between seasons and were not less selective than sheep. Angora goats were flexible grazers and continually adapted their grazing behaviour to changing herbage conditions. Goat grazing led to an increase in subterranean clover, an accumulation of dead herbage at the base of the sward, reduced bare ground, taller pastures in spring and a more stable botanical composition. Mixed-grazed pasture characteristics were altered with SR. With careful management Angora goats on sheep farms may be used to manipulate pasture composition, to speed up establishment of subterranean clover, to decrease soil erosion and to reduce weed invasion.

Contribution of fungi to primary biogenic aerosols in the atmosphere : active discharge of spores, carbohydrates, and inorganic ions by Asco- and Basidiomycota

Spores and related chemical compounds from actively spore-discharging Ascomycota (AAM) and actively spore-discharging Basidiomycota (ABM) are primary biogenic components of air particulate matter (characteristic size range 1–10 μm). Measurement results and budget calculations based on investigations in Amazonia (Balbina, Brazil, July 2001) indicate that the forcible discharge of fungal spores may account for a large proportion of coarse air particulate matter in tropical rainforest regions during the wet season. For the particle diameter range of 1–10 μm, the estimated proportions are ~25% during day-time, ~45% at night, and ~35% on average. For the sugar alcohol, mannitol, the budget calculations indicate that it is suitable for use as a molecular tracer for actively discharged basidiospores (ABS), and that the literature-derived emission ratio of about 5 pg per ABS may be taken as a representative average. ABM emissions may account for most of the atmospheric abundance of mannitol, and can explain the observed diurnal cycle (higher abundance at night). ABM emissions of hexose carbohydrates might also account for a significant proportion of glucose and fructose in air particulate matter, but the literature-derived ratios are not consistent with the observed diurnal cycle (lower abundance at night). AAM emissions appear to account for a large proportion of potassium in air particulate matter over tropical rainforest regions during the wet season, and they can also explain the observed diurnal cycle (higher abundance at night). The results of our investigations and budget calculations for tropical rainforest aerosols are consistent with measurements performed at other locations.

Based on the average abundance of mannitol in particulate matter, which is consistent with the above emission ratio and the observed abundance of ABS, we have also calculated a value of ~17 Tg yr−1 as a first estimate for the global average emission rate of ABS over land surfaces. Comparisons with estimated rates of emission and formation of other major types of organic aerosol (~47 Tg yr−1 of anthropogenic primary organic aerosol; 12–70 Tg yr−1 of secondary organic aerosol) indicate that emissions from actively spore-discharging fungi should be taken into account as a significant source of organic aerosol. Their effects might be particularly important in tropical regions, where both physicochemical processes in the atmosphere and biological activity at the Earth's surface are particularly intense, and where the abundance of fungal spores and related chemical compounds are typically higher than in extratropical regions.

Utilizing polypropylene fibers to improve physical and mechanical properties of concrete

The influence of polypropylene fibers has been studied in different proportioning and fiber aspect ratios to improve physical and mechanical properties of fiber-reinforced concretes. Fibers are used in two different lengths (12 mm and 19 mm) and proportions (0.1% and 0.3%) in concrete mixture design. Hardened concrete properties, such as 7- and 28-day compressive strength, splitting tensile strength, flexural strength, water and air absorption, and restrained shrinkage cracking were evaluated.

No statistically significant effects were observed for polypropylene fibers on the compressive strength of concrete, while toughness indexes, splitting tensile and flexural strength and durability parameters showed an increase in the presence of polypropylene fibers. Increased fiber availability (fiber aspect ratio) in the concrete matrix, in addition to the ability of longer polypropylene fibers to bridge on the micro cracks, are suggested as the reasons for the enhancement in mechanical properties. Finally, crack width in fiber-reinforced concrete is calculated analytically with fiber property variables (fiber type, length, diameter and proportion). Results are compared with experimental values and concluded that with an increase in fiber length and/or decrease in fiber diameter crack width, decrease significantly.

Effects of variation in wool fiber curvature and yarn hairiness on sensorial assessment of knitted fabrics

Previous investigations have shown that prickle discomfort sensations of wool fabrics are primarily determined by the mean fiber diameter of the wool. It is also known that differences in wool fiber curvature (crimp) affect softness of handle of greasy wool and of wool textiles. In a replicated experiment, we investigated if wearers could detect the effect of using 17 µm superfine wool of low (74°/mm) or high (114°/mm) fiber curvature, and when the wools were blended with 17 µm cashmere (fiber curvature 49°/mm) in differing proportions, on four comfort sensations. Eight single jersey knitted fabrics were assessed under a controlled protocol using forearm sleeves made of the test fabric and a control fabric. Data (37 sensorial assessments of high curvature wool fabrics; 38 sensorial assessments of low curvature wool fabrics) were analyzed using linear mixed model analysis (restricted maximum likelihood), which included fixed effects for wool type and blend ratio and a random effect for participant. The use of a control sleeve fabric reduced variance due to participant effects by providing an anchor for each sensation over time. Wool fiber curvature affected participant assessment of breathability, comfort, feel after exercise (damp/dry) and skin feel (prickly/soft), with preferred values associated with high curvature (crimp) superfine wool. Increasing the proportion of cashmere in fabrics increased skin feel (better assessed softness). Skin feel was strongly associated with the evaluation of the fabrics by the Wool ComfortMeter and with increasing hairiness of yarns.

Fuzzy portfolio allocation models through a new risk measure and fuzzy sharpe ratio

A new portfolio risk measure that is the uncertainty of portfolio fuzzy return is introduced in this paper. Beyond the well-known Sharpe ratio (i.e., the reward-to-variability ratio) in modern portfolio theory, we initiate the so-called fuzzy Sharpe ratio in the fuzzy modeling context. In addition to the introduction of the new risk measure, we also put forward the reward-to-uncertainty ratio to assess the portfolio performance in fuzzy modeling. Corresponding to two approaches based on TM and TW fuzzy arithmetic, two portfolio optimization models are formulated in which the uncertainty of portfolio fuzzy returns is minimized, while the fuzzy Sharpe ratio is maximized. These models are solved by the fuzzy approach or by the genetic algorithm (GA). Solutions of the two proposed models are shown to be dominant in terms of portfolio return uncertainty compared with those of the conventional mean-variance optimization (MVO) model used prevalently in the financial literature. In terms of portfolio performance evaluated by the fuzzy Sharpe ratio and the reward-to-uncertainty ratio, the model using TW fuzzy arithmetic results in higher performance portfolios than those obtained by both the MVO and the fuzzy model, which employs TM fuzzy arithmetic. We also find that using the fuzzy approach for solving multiobjective problems appears to achieve more optimal solutions than using GA, although GA can offer a series of well-diversified portfolio solutions diagrammed in a Pareto frontier.

Cord blood monocyte-derived inflammatory cytokines suppress IL-2 and induce nonclassic "T(H)2-type" immunity associated with development of food allergy

Food allergy is a major health burden in early childhood. Infants who develop food allergy display a proinflammatory immune profile in cord blood, but how this is related to interleukin-4 (IL-4)/T helper 2 (T(H)2)-type immunity characteristic of allergy is unknown. In a general population-derived birth cohort, we found that in infants who developed food allergy, cord blood displayed a higher monocyte to CD4(+) T cell ratio and a lower proportion of natural regulatory T cell (nT(reg)) in relation to duration of labor. CD14(+) monocytes of food-allergic infants secreted higher amounts of inflammatory cytokines (IL-1β, IL-6, and tumor necrosis factor-α) in response to lipopolysaccharide. In the presence of the mucosal cytokine transforming growth factor-β, these inflammatory cytokines suppressed IL-2 expression by CD4(+) T cells. In the absence of IL-2, inflammatory cytokines decreased the number of activated nT(reg) and diverted the differentiation of both nT(reg) and naïve CD4(+) T cells toward an IL-4-expressing nonclassical TH2 phenotype. These findings provide a mechanistic explanation for susceptibility to food allergy in infants and suggest anti-inflammatory approaches to its prevention.

Wastewater reuse and treatment options for the dairy industry

Milk-processing plants generate significant quantities of wastewater with relatively high organic matter concentrations on a daily basis. In addition to environmental damage that can result from the discharge of these wastewaters into the natural waterways, the presence of products such as milk solids into wastewater streams represents a loss of valuable product for the plants. This paper presents a review of wastewater management practices employed by six milk-processing plants in Victoria, Australia. In all six plants investigated, milk powder represents a major product. During the milk powder production, water is evaporated, condensed and can be reused for various purposes with a significant impact on water usage. Other major products are anhydrous milk fat, cheese, butter, and UHT milk. The effectiveness of the practices was assessed through two main criteria: first through the water to milk intake ratio, and the waste volume coefficient. Both parameters characterise the plant efficiency in regard of water consumption and water reuse, Information on cleaning chemical usage and recovery was also assessed as part of the review. Significant discrepancies emerge between the plants first due to the products manufacturad and water reuse possibilities available in each plant. Second the type of treatment technologies used for condensate and cleaning solution influences the figures. One of the investigated plants is almost self-sufficient for water, emphasising the benefits gained from the use of technologies like membrane separations for condensate and cleaning solution treatment. In some cases, less cost-intensive technologies such as a clarifier are successful to improve cleaning agent recovery.

Performance of intensively farmed Murray cod Maccullochella peelii peelii (Mitchell) fed newly formulated vs. currently used commercial diets, and a comparison of fillet composition of farmed and wild fish

Murray cod is a top-order carnivore with high culture potential. Currently, there are no commercial diets formulated specifically for Murray cod. In this study, results of two growth trials on Murray cod (80–83.5-g mean initial weight), conducted in commercial settings, using two laboratory-formulated diets (DU1 and DU2; 48.9% and 49.1% protein, and 16.9% and 16.1% lipid, respectively, on a dry matter basis), and two commercial diets, formulated for other species (salmon – CD/S and barramundi – CD/B) but used in Murray cod farming are presented. The two commercial diets had less protein (46.6% and 44.4%) but higher lipid (21.7% and 19.5%). The energy content of the feeds tested was similar (about 20–22 kJ g−1). The growth performance and feed utilization of Murray cod did not differ significantly amongst the diets, but the food conversion ratio and % protein efficiency ratio in fish fed the DU1 and DU2 diets were consistently better. There was significantly less carcass and muscle lipid deposition in fish fed with the latter diets. Of the fatty acids in muscle, the lowest amounts (in μg mg lipid−1) of n-3 (262.5±2.9), n-6 (39.8±0.9) and polyunsaturated fatty acid (PUFA) (302.3±3.8) were observed in fish fed CD/S, and the highest in fish fed DU2 and CD/B. Fatty acids 16:0 and 18:0, 18:1n-9 and 16:1n-7, and 22:6n-3, 20:5n-3, 22:5n-3 and 18:2n-6 were the dominant fatty acids amongst the saturates, monoenes and PUFA, respectively, and accounted for 80.8–88.7% of all identified fatty acids (23) in muscle of Murray cod. The study showed that Murray cod could be cultured successfully on a diet (DU2) containing 20% soybean meal without compromising growth and/or carcass quality. Differences in the proximate composition and fatty acid composition of muscle of wild and farmed Murray cod were observed, the most obvious being in the latter. Wild Murray cod had significantly less (P<0.05) saturates (192.6±1.84 vs. 266.3±3.51), monoenes (156.5±8.7 vs. 207.6±6.19), n-3 (145.2±5.24 vs. 261.8±3.2) but higher n-6 (144.3±2.73 vs. 48.3±1.38) in muscle (all values are in μg mg lipid−1) than in farmed fish. Wild fish also had a much lower n-3 to n-6 ratio (1.0±0.03 vs. 5.4±0.09).

In the shadow of the volcanoes: the impact of intervention on the nutrition and health status of Rwandan refugee children in Zaire two years from the exodus

Objective: To evaluate the public health and nutritional situation of refugee children in Katale camp, Eastern Zaire, after two years of nutritional and health intervention from 1994 to 1996.
Design: Cross-sectional survey using a two-stage cluster sampling method. Anthropometric data were collected from 28 May 1996 to 4 June 1996. Retrospective review of food basket monitoring data over the preceding six months and the United Nations High Commission for Refugees' weekly mortality data was conducted. Measles immunisation coverage data were surveyed simultaneously, using child health records.
Main outcome measures: Nutritional status measured by weight-for-height index (W/H), measles immunisation status, average daily energy content of the general food ration and crude mortality rate.
Setting: Katale refugee camp, Zaire, June 1996.
Analysis: Weight-for-height index and proportion of immunised children were computed using EPINUT, part of EPINFO computer package.
Results: Malnutrition was found to be most prevalent in children aged six to 29 months old (W/H < -2 Z-score and/or oedema: 6.2%; 95% CI: 3.4%, 10.6%), among whom the malnutrition rate was almost double the overall malnutrition prevalence (W/H < -2 Z-score and/or oedema: 3.5% (95% CI: 1.5%, 7.2%). The general food ration, although conforming to the World Food Program minimum standards of adequacy in terms of variety (being composed of cereals, oil, beans, blended cereal and legume mixes and salt), provided only 6240 kJ on average (95% CI: 5040, 7140 kJ) per person per day, thus meeting only 57% to 84% of the minimum energy requirements for an adult, and falling well below the needs for sub groups with higher nutritional requirements such as children, pregnant and breastfeeding women and the sick. Measles immunisation coverage in children nine to 59 months was 88.6%. The crude mortality rate was found to be 0.3 per 10 000 per day. Refugees received 15 litres of clean water per person per day.
Conclusion: Public health interventions in Katale camp 1994 to 1996 had reduced mortality and morbidity rates dramatically. This was not reflected in the malnutrition rates for children under five years, that remained stable after an initial fall despite two years of nutritional intervention. The factors contributed to this were related to an inadequate general food ration (due to food shortages), lack of ability to supplement the diet, (due to economic restrictions that were imposed in the camp) and inequities in the food distribution process (due to food being siphoned off by camp leaders for military purposes).