Frequency Of Supplementation Research Articles

Intake of F-100 and honey as an effort to improve the nutritional status of children with pediatric tuberculosis

Background: Stunting remains a significant nutritional challenge in Indonesia. If malnutrition in children is not addressed appropriately, it can lead to stunting. Children under five years old with pediatric tuberculosis (TB) are particularly susceptible malnutrition. Specific interventions are needed to prevent stunting in this vulnerable group.Objective: The study aimed to improve the nutritional status of children with pediatric TB to prevent stunting. Methods: This study included 44 children under five years old with pediatric TB, who were patients at a private hospital and clinic. The subjects were divided into four groups of 10-12 children based on their arrival for treatment. Group A received standard medicine, F-100, and pure honey; Group B received standard medicine and F-100; Group C received standard medicine and pure honey; and Group D received only standard medicine. The F-100 and pure honey were administered once daily. Each group was followed up for six weeks. Weight and height were measured before and after the intervention. Statistical analysis was performed with a 95% confidence level.Results: Administration of F-100 and/or honey significantly increased Z scores for height-for-age, weight-for-age, and weight-for-length/height between the pre-test and post-intervention (p < 0.05). Conversely, no significant improvement was observed in children receiving only standard medication (p > 0.05). The differences in Z score increases between groups, however, were not statisticallysignificant. Overall, the intervention reduced the prevalence of wasting (36.4% to 22.75%) and stunting (36.4% to 29.5%)Conclusion: Supplementation with F-100 and honey improved nutritional outcomes but did not show statistically significant differences between groups. Further research is recommended to explore the effects of increased frequency and duration of supplementation.

Red blood cell transfusion and the use of intravenous iron in iron‐deficient patients presenting to the emergency department

AbstractBackground and aimsRed blood cell transfusions are often used to treat iron‐deficient patients in the emergency department (ED), while treatment with intravenous (IV) iron is preferred, as it increases hemoglobin concentration rapidly and durably. We aim to evaluate the incidence of iron deficiency anemia, frequency of blood transfusion and iron supplementation, and factors associated with blood transfusion in the ED.MethodsWe conducted a retrospective cohort study of adult patients presenting to the St. Boniface Hospital (Winnipeg, Canada) ED from 2014 to 2018. Electronic data obtained from the Emergency Department Information System and Laboratory Information Services databases identified patients presenting with iron deficiency anemia, defined as microcytic (mean corpuscular volume < 75 fL) anemia (hemoglobin < 120 g/L) with either a transferrin saturation <20% or ferritin < 30 µmol/L. Ferritin > 100 µmol excluded iron deficiency anemia. The use of blood transfusions or iron supplementation was determined for each patient. Factors associated with blood transfusion were determined using logistic regression analyses.ResultsOf 39,222 patients, 17,945 (45%) were anemic. In anemic patients, iron parameters were ordered in 1848 (10.3%) and iron deficiency anemia was diagnosed in 910 (5.1%). Ninety‐five patients (10.4%) received one red blood cell unit, and 197 patients (21.6%) received ≥2 units. Oral iron and IV iron were prescribed for 64 (7.0%) and 14 (1.5%) patients, respectively. Hemoglobin concentration was the main determinant for treatment with blood transfusion.ConclusionsIron deficiency is underinvestigated among anemic patients presenting to the ED. The only clinical factor associated with red blood cell transfusion in the ED was hemoglobin level, irrespective of symptoms or clinical stability.

Application effect of enhanced recovery after surgery on patients with hepatolithiasis undergoing hepatectomy

ObjectiveTo explore the application effect of enhanced recovery after surgery (ERAS) for patients with hepatolithiasis undergoing hepatectomy.MethodsA retrospective comparative analysis was performed on the clinical data of 120 patients with hepatolithiasis who were admitted to the Department of Hepatobiliary Surgery in our hospital between December 2017 and May 2022 using convenience sampling.ResultsThere were differences in the impact of different management modes on blood glucose and visual analogue scale (VAS) scores between the two groups of patients (Fblood glucose = 32.581, FVAS = 41.472, all P < 0.001). The average blood glucose levels in the traditional group were higher than those in the ERAS group at two time points, and the VAS scores in the former group were higher than those in the latter at 6, 12 and 24 h after surgery. The remifentanil dosage (49.89 ± 12.12 vs 57.84 ± 11.43 mL, t = − 2.475, P = 0.016), patient-controlled analgesia frequency (3.83 ± 2.23 vs 5.57 ± 3.52 times, t = − 2.481, P = 0.015) and analgesic supplementation frequency (0.57 ± 0.73 vs 1.07 ± 1.02 times, t = − 2.653, P = 0.010) in the ERAS group were all lower than those in the traditional group. Different management modes had different effects on the levels of procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP) and white blood cell count (WBC) in the two groups of patients (FPCT = 45.371, FIL-6 = 43.466, FCRP = 51.364, FWBC = 65.674, all P < 0.001). The levels of PCT, IL-6, CRP and WBC in the ERAS group were lower than those in the traditional group at three time points: postoperative day 1, 7 and 14. The postoperative hospital stay (8.41 ± 2.55 vs 11.61 ± 3.34 d, t = − 7.812, P < 0.001) and proportion of postoperative complications (9.61% vs 26.47%, χ2 = 5.403, P = 0.020) in the ERAS group were lower than those in the traditional group.ConclusionThe application of ERAS effectively reduces the perioperative stress response, shortens the postoperative length of hospital stay and lowers the overall incidence of postoperative complications in patients with hepatolithiasis.

Effect of Supplementation Plans and Frequency on Performance and Metabolic Responses of Grazing Pregnant Beef Heifers

Our objective was to evaluate the effects of protein supplementation frequency and supplementation plans during gestation on productive performance and metabolic responses of grazing super-precocious Nellore heifers. Thirty-five pregnant Nellore heifers were used in a completely randomized design in a 2 × 2 factorial arrangement with an additional control group. The factors were the following: 1. Frequency of supplementation: (a) Daily (seven times per week), (b) Infrequent (three times per week); 2. Supplementation plans: (a) Constant, (b) Increasing. A control group with no supplementation was included. Two digestibility trials were carried out on the 40th and 130th experimental days. Productive performance and body composition were evaluated in the prepartum and postpartum periods. Blood samples were collected at −114, −113, −15, −14, +15, +30, and +45 days relative to calving for measuring metabolic status. Supplementation (daily and infrequent) increased the intake of total dry matter (DM) (p ≤ 0.004), average daily gain (p &lt; 0.001), and body weight at calving (p = 0.008) at prepartum. However, frequency or supplementation plan did not alter (p &gt; 0.17) the intake of total DM and forage DM. There was an effect (p ≤ 0.02) of the supplementation plan on subcutaneous thickness fat in the prepartum period and albumin and non-esterified fatty acid concentrations (p &lt; 0.004) in the postpartum period. Nonetheless, frequency and supplementation plans did not affect (p ≥ 0.10) heifers’ productive performance during the postpartum period. In conclusion, protein supplementation frequency and supplementation plan during beef heifers’ gestation do not negatively impact their productive performance or metabolic responses.

255 Awardee Talk: Nutritional management to optimize cow-calf production in Southeast

Abstract Nearly one-half of beef cows in the United States are located in southern states where cow-calf operations predominate. Grazing management in cow-calf systems can be affected by environmental and seasonal conditions, often leading to nutrient deficiency, particularly during late gestation of beef females. Maternal nutrition during the last trimester of gestation can influence offspring development and health, and can be explored to optimize maternal and progeny performance. The objective of this presentation is to share nutritional and management strategies for pregnant beef cows and their long-term effects on offspring growth and physiology. Study 1 investigated the effects of timing of maternal protein supplementation during all last trimester of gestation (LATE84), only the first 42 d of last trimester of gestation (LATE42), or no prepartum supplementation (NOSUP) on offspring pre- and post-weaning performance. At weaning, LATE84 calves were the heaviest, followed by LATE42, and NOSUP (P ≤ 0.05). Steer serum parainfluenza-3 titers were greater (P = 0.03) for LATE42 vs. NOSUP and tended to be greater for LATE84 (P = 0.10) vs. NOSUP steers. Marbling and the proportion of steers grading choice were greater (P ≤ 0.04) for LATE42 vs. NOSUP, and intermediate for LATE84. Study 2 evaluated the effects of frequency of maternal protein supplementation on offspring pre-weaning growth. Cows received the same weekly amount of supplement (7 kg·cow⁻¹·wk⁻¹) but with different frequencies: once a week (1X), three times per week (3X), every day (7X), or no prepartum supplementation (NOSUP) during the last 80 d of gestation. At weaning, calves born from 7X cows were the heaviest (P ≤ 0.05), followed by 3X and 1X, which did not differ between them (P = 0.54), and NOSUP calves were the lightest (P ≤ 0.05). Study 3 evaluated the use of monensin supplementation during the last 77 d of gestation and its impacts on offspring performance. Treatments consisted of no prepartum supplementation (NOSUP), supplementation of dried distillers grains at 1 kg·cow⁻¹·d⁻¹ added with 0 (SUP) or 200 mg/d of monensin (SUPMO). At weaning, SUPMO calves were the heaviest (P ≤ 0.05), SUP intermediate, and NOSUP were the lightest. Experiment 4 consisted of pregnant heifers receiving the supplementation of 1 kg/d of soybean hulls dry matter added (BAC) or not (CON) with a Bacillus-based DFM mixture during late gestation (d 0 to 139) and early lactation (d 139 to 242). Post-weaning body weight gain and indicators of humoral immune response post-vaccination were greater for BAC vs. CON calves (P ≤ 0.05). Therefore, changing the time and frequency of supplementation, and the use of additives and probiotics during late gestation of beef females are effective alternatives to improve offspring pre- and post-weaning growth and immune response.

63 Impacts of protein supplementation frequency on animal performance, rumen fermentation and methane emission from growing beef cattle

Abstract Nutrient supplementation is one of largest expenditure in forage-based beef production systems, especially when forage quality is poor or limited. Decreasing supplementation frequency may have a role in improving sustainability by increasing animal performance and minimizing cost of labor and fuel. This study evaluated the impacts of protein supplementation frequency (canola meal pellet; CMP) on animal performance, rumen fermentation, and enteric methane production from beef cattle fed forage-based diet. A total of 60 crossbred backgrounding steers [body weight (BW) = 278 ± 10 kg) was randomly assigned to one of the three treatments (n = 20/treatment): i) control (no CMP supplementation), ii) control + everyday CMP supplementation (0.83 kg/d per steer), and iii) control + every other day supplementation of CMP. The study was comprised of 21 d of adaptation followed by three 21-d periods, with enteric methane measured for 7 d per period. Animals were fed grass hay-based diets once a day at 0800 h and remained on their respective diets throughout the 63-d study. Diets were formulated considering animal BW, feed nutrient density and environmental condition in accordance with the National Academies of Sciences, Engineering and Medicine. Each treatment group was assigned to a pen, with the cattle and diets rotated among pens weekly to allow the animals to access the GreenFeed system stationed in one of the pens for enteric methane measurement. For measurement of rumen fermentation products, three ruminally canulated steers (BW = 350 ± 20 kg) were allocated to the three treatments using a 3 x 3 Latin Square Design with 21-d periods so that one animal received all the treatments over the three experimental periods. Animals were adapted to the treatments for 17 d and rumen samples were collected between d 19 and 21 at 0700 h, 1000h, 1300 h, 1600 h and 1900 h. Data were analyzed using the Mixed procedure of SAS. Relative to the control treatment (9.9 kg/d), DM intake was 4 to 5% greater (P &amp;lt; 0.001) following CMP supplementation regardless of supplementation frequency. Similarly, average daily gain was greater (7 to 11%, P = 0.01) for CPM supplemented treatments as compared with control (1.04 kg/d) irrespective of supplantation frequency. Rumen fermentation was affected by treatments. Total VFA concentration was greater (P = 0.01) for the every other day supplementation of CMP as compared with control and daily supplementation treatments. Conversely, rumen ammonia concentration was not affected by treatments. The control group had greater acetate and reduced propionate molar proportions that resulted in a 5 to 6% greater acetate:propionate ratio (P &amp;lt; 0.01) as compared with the CMP supplemented groups. Enteric methane production (g/d) was greater for the daily CMP supplementation (P = 0.02) while yield (g/kg daily weight gain) was not affected by treatment. Our results indicated that reduction of protein supplementation frequency improved animal performance without negatively impacting rumen fermentation.

402 The effect of supplemental protein degradability and frequency of supplementation on nitrogen metabolism of beef cattle consuming low-quality forage

Abstract Rumen degradable protein (RDP) is required for cattle consuming low-quality forage to ensure adequate fiber digestion. However, in situations where cattle are not supplemented daily, supplementing RDP could overwhelm the nitrogen recycling mechanisms, leading to increased nitrogen excretion. The objective of this experiment was to determine the effect of rumen degradability and frequency of supplemental protein in beef cattle consuming low-quality forage. Treatments were arranged in a 2 × 2 factorial with protein degradability (68.5% or 32.8% RDP) and supplementation frequency (daily or biweekly) as the two factors. Ruminally cannulated Angus steers [n = 8; body weight (BW) = 328 ± 12.2 kg] were used in a Latin rectangle. The low RDP treatment was composed of 50% soybean hulls and 50% corn gluten meal (40.3% CP; 32.8% RDP), and the high RDP treatment consisted of 45.4% soybean hulls, 41.4% soybean meal, 4.1% urea, and 9.1% molasses (40% CP; 68.5% RDP). The biweekly steers were supplemented on d 0, 4, 7, 11, 14, 18, and 21 of each period. Steers were given ad libitum access to low-quality (7.4% CP) native grass hay. Daily blood samples were collected from d 14 to 17 at 0630 h and d 21 at -2, 3, and 7 h relative to supplementation. Rumen fluid samples were collected every 4 h on d 18 to 21. Daily NEFA concentrations decreased (P &amp;lt; 0.001) post-supplementation in the biweekly supplemented steers and then returned to baseline values, while the daily supplemented steers had no change. Hourly NEFA concentrations in steers supplemented with high RDP biweekly increased from 2 h pre-supplementation to 3 h post-supplementation (P &amp;lt; 0.001), then decreased at 7 h post-supplementation back to pre-supplementation concentrations. Plasma urea nitrogen (PUN) increased in biweekly high RDP supplemented steers 1 d after supplementation (P &amp;lt; 0.001) and decreased from d 15 to d 17. PUN concentrations increased from 2 h pre-supplementation through 7 h post-supplementation in both high RDP treatments, while low RDP treatments did not change (P &amp;lt; 0.001). Rumen fluid lactate and ammonia concentrations rapidly increased in the biweekly high RDP-supplemented steers in response to each supplementation (P &amp;lt; 0.001). There were spikes in ammonia concentrations for the daily high RDP treatment post-supplementation; however, they were smaller in magnitude compared with the biweekly high RDP. The low RDP treatments remained steady across all hours of ammonia sampling, where daily and biweekly supplemented steers decreased slightly in the time points following supplementation and then gradually increased. Rumen pH displayed drastic changes in the biweekly high RDP-supplemented group with values ranging from 6.99 to 5.97 (P &amp;lt; 0.001), but the low RDP treatments remained consistent. Supplementing biweekly with high RDP resulted in fluctuations in metabolites not observed in the other treatments, which could reduce forage utilization and increase nitrogen excretion.

Product innovation design approach driven by implicit relationship completion via patent knowledge graph

Product innovation design process involves a great deal of discrete engineering knowledge, limiting the ability of designers to quickly utilize this knowledge to support design innovation. Nowadays, innovation design based on knowledge graphs has enhanced the ability to explore design knowledge, improving the efficiency of knowledge retrieval. Previous studies have focused on mining more design knowledge to enrich the knowledge graph overlooks the implicit relationships with potential value among design knowledge, wasting design resources. To address these issues, an approach for product innovation design based on implicit knowledge relationship completion in the patent knowledge graph is proposed, which explores the implicit relationships between design knowledge to provide new knowledge satisfying design preferences and enhance the innovativeness of solutions. First, a requirements-function-structure-benefit (RFSB) knowledge ontology is constructed and extracted from the benefit knowledge of patents to build the knowledge graph. Second, an implicit relationship completion model based on the similarity of function or benefit entities explores the implicit relationships, replacing structure entities directly connected to similar function or benefit entities to generate new relationships and outputs novel ideas. Third, a scheme improvement process based on the co-occurrence frequency of requirement and structure knowledge supplements neglected design preferences. Final, a pipeline inspection robot case study is further employed to verify the proposed approach, and a patent knowledge graph assisted design solution prototype system is developed to assist in the utilization of innovative design knowledge. Evaluation results show the significant design potential of the proposed approach in inspiring innovative thinking and knowledge reuse.

Consumption of dietary supplements and their determinants among adults in six Arabic countries: a cross-sectional survey

BackgroundSince the onset of the coronavirus (COVID-19) pandemic crisis, the supplement market has consistently grown. Therefore, we conducted this survey during the fourth wave of the COVID-19 pandemic to study the frequency and context of dietary supplement (DS) consumption (vitamins and mineral intake) and explore the consumer’s pharmaceutical buying behaviour; and (3) to study its determinants as regards the demographics, Fatigue Severity Scale (FSS), and healthy eating pyramids.MethodsWe conducted a cross-sectional web-based survey on 1333 Arabic adults aged 18 years or more residing in six Arabic-speaking countries in May 2022, using a validated self-administrated questionnaire. The survey-involved questions about sociodemographic characteristics, physical activity, FSS, healthy eating pyramid, DS consumption, and consumers’ pharmaceutical purchasing behaviour.ResultsMost participants were aged 20 to less than 35 years, and 64.6% used dietary supplements. There was a statistically significant difference between supplement users and nonusers as regards consumers’ pharmaceutical buying behaviour in terms of advertising quality, safety rules, pharmaceutical forms, and packet quality. Arabic adults consumed the following dietary supplements: 63.5% vitamin C, 60.1% vitamin D, 47.1% iron, and 44.4% zinc. Authorised products (76.0%), natural contents (75.0%), and safety rules (68%), were the most common factors influencing Arabic consumers’ pharmaceutical purchasing behavior. Multi-logistic regression analysis showed that being female, having a history of COVID-19, having a positive attitude about the benefits, and being recommended for supplement use were predictors of dietary supplement use.ConclusionThe dietary consumption of supplements is prevalent, mainly including vitamin C, vitamin D, iron, zinc, vitamin B, and magnesium. In addition, Arabic adults are poorly adherent to healthy eating pyramids. Given the ongoing COVID-19 pandemic, Arabic health authorities should prioritize this issue to minimize the potential for misusing dietary supplements.

Effect of source and frequency of rumen-protected protein supplementation on mammary gland amino acid metabolism and nitrogen balance of dairy cattle

The AA profile of MP affects mammary gland metabolism and milk N efficiency of dairy cattle. Further, the frequency of dietary protein supplementation may influence N partitioning leading to reduced N excretion. This study investigated the effect of source and frequency of rumen-protected (RP) protein supplementation on apparent total-tract digestibility, milk production, mammary gland AA metabolism, and N balance of dairy cattle. Twenty-eight Holstein-Friesian cows (2.3 ± 0.9 lactations; 93 ± 27 DIM; mean ± SD) were used in a randomized complete block design and fed a basal TMR consisting of 41% corn silage, 32% grass silage, and 27% concentrate (DM basis) and formulated to meet 100% and 95% of net energy and MP requirements, respectively. Cows were adapted to the basal TMR in a freestall barn for 7 d, moved to individual tiestalls for 13 d of adaptation to dietary treatments, and then moved into climate respiration chambers for a 4-d measurement period. Treatments consisted of the basal TMR (CON; 159 g CP/kg DM) or the basal TMR including 1 of 3 iso-MP supplements: (1) 315-g mixture of RP soybean meal and RP rapeseed meal fed daily (ST-RPSR), (2) 384-g mixture of RP His, RP Lys, and RP Met fed daily (ST-RPAA), and (3) 768-g mixture of RP His, RP Lys, and RP Met fed every other day (OS-RPAA). The basal TMR with the addition of treatment supplements was designed to deliver 100% of required MP over a 48-h period. The mixture of His, Lys, and Met was formulated to deliver digestible AA in amounts relative to their concentration in casein. Compared with ST-RPSR, ST-RPAA increased milk protein and fat concentration, increased the arterial concentration of total His, Lys, and Met (HLM), decreased mammary clearance of HLM, and increased clearance of Phe, Leu, and Tyr (tendency for Leu and Tyr). Rumen-protected protein source did not affect N balance, but the marginal use efficiency (efficiency of transfer of RP protein supplement into milk protein) of ST-RPAA (67%) was higher than that of ST-RPSR (17%). Milk protein concentration decreased with OS-RPAA compared with ST-RPAA. Arterial concentration of HLM increased on the nonsupplemented day compared with the supplemented day with OS-RPAA, and there was no difference in arterial HLM concentration across days with ST-RPAA. Mammary uptake of HLM tended to increase on the nonsupplemented day compared with the supplemented day with OS-RPAA. Supplementation frequency of RP AA did not affect N balance or overall milk N efficiency, but the marginal use efficiency of OS-RPAA (49%) was lower compared with ST-RPAA. Overall, mammary glands responded to an increased supply of His, Lys, and Met by reducing efflux of other EAA when RP His, RP Lys, and RP Met were supplemented compared with RP plant proteins. Mammary glands increased sequestration of EAA (primarily HLM) on the nonsupplemented day with OS-RPAA, but supplementing RP AA according to a 24-h oscillating pattern did not increase N efficiency over static supplementation.

Patient-reported outcomes of curcumin supplementation in rheumatoid arthritis and psoriatic arthritis: a cross-sectional survey.

Curcumin is suggested to possess potent anti-inflammatory properties. This study focuses on determining the prevalence and perceived efficacy of curcumin supplementation in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) population. We conducted a cross-sectional study on patients with RA and PsA who visited a rheumatology outpatient clinic from October 2019 to March 2020. A brief, voluntary, and anonymous Qualtrics survey of specific questions regarding curcumin use, source, form, method, dosage, side effects, and perceived efficacy was distributed to the patients. Descriptive and correlation analyses were performed. Among the 291 patients included, 46.4% of patients reported taking curcumin supplementation. Majority patients supplemented once a day (53.4%) and took dosages ranging from less than 200mg/day to around 1000mg/day of curcumin. Pain scores decreased significantly after starting curcumin therapy (p < 0.0001). Patients who were taking curcumin for years reported better symptomatic control when compared with patients taking it for months (p 0.01), weeks (p 0.02), or days (p 0.02). There was a significant difference in symptom improvement in patients taking 200-1000mg compared to patients taking less than 200mg (p 0.01). Patients taking curcumin once or twice a day reported significant symptom improvement compared to patients taking it sporadically. Symptomatic improvement was reported as pain (35.7%), swelling (25%), stiffness (23.21%), and fatigue (16.07%). An interesting correlation exists between the symptom relief and the frequency, dosages (200-1000mg), and duration (years) of curcumin supplementation. Our study indicates that curcumin supplementation positively influenced outcomes in 46.4% of individuals with RA and PsA, reducing pain, swelling, stiffness, and fatigue. This suggests curcumin's potential as an adjunct therapy for these conditions.

Long chain n-3 polyunsaturated fatty acid intake across the life span for cardiovascular disease prevention in women.

Cardiovascular diseases (CVDs) are a major health concern for women. Historically there has been a misconception that men are at greater risk because CVD tends to occur earlier in life compared to women. Clinical guidelines for prevention of heart disease are currently the same for both sexes, but accumulating evidence demonstrates that risk profiles diverge. In fact, several CVD risk factors confer an even greater risk in women relative to men, including high blood pressure, obesity, diabetes and raised triglycerides. Furthermore, many female-specific CVD risk factors exist, including early menarche, pregnancy complications, polycystic ovary syndrome, reproductive hormonal treatments and menopause. Little is known about how diet interacts with CVD risk factors at various stages of a woman’s life. Long chain (LC) n-3 polyunsaturated fatty acid (PUFA) intakes are a key dietary factor that may impact risk of CVD throughout the life course differentially in men and women. Oestrogen enhances conversion of the plant n-3 PUFA, alpha-linolenic acid, to LCn-3 PUFA. Increasing the frequency of oily fish consumption or LCn-3 PUFA supplementation may be important for reducing coronary risk during the menopausal transition, during which time oestrogen levels decline and the increase in CVD risk factors is accelerated. Women are under-represented in the evidence base for CVD prevention following LC n-3 PUFA supplementation. Therefore it is not clear whether there are sex differences in response to treatment. Furthermore, there is a lack of evidence on optimal intakes of LC n-3 PUFA across the lifespan for CVD prevention in women.

LCC-HVDC Frequency Robust Control Strategy Based on System Parameter Identification in Islanded Operation Mode

To enhance the stability of the frequency at the sending terminal of the HVDC island during operation, a novel DC supplemental frequency robust controller is proposed in this paper. The proposed controller utilizes the fast controllability of a DC power supply to maintain system frequency stability. The identification of a low-order linearized model of the system can be obtained from a high-precision Prony algorithm based on the second derivative method (SDM). Subsequently, utilizing a robust design methodology based on linear matrix inequalities, an additional frequency robust controller is devised, striking a balance between optimal performance and robustness. This supplementary frequency robust controller exhibits a straightforward control structure with a modest order, making it readily implementable. Simulation experiments conducted within the PSCAD/EMTDC framework substantiate that the designed supplemental frequency robust controller significantly enhances the frequency stability of the sending terminal system. Furthermore, when compared with traditional proportional integral (PI) controllers, it demonstrates superior control efficacy and robustness against various types of faults under different operational modes. Even in interconnected operational modes, it continues to operate effectively. The research findings offer valuable insights for practical applications in islanded power systems.

Early and Higher Volumes of Formula Supplementation after Birth Impact Breastfeeding Rates at Discharge in Well-Baby Nursery: A Retrospective Cohort Study.

Physiologic breast milk production in the first 24 hours is estimated to be between 2 and 10 mL per feed. Many mothers intending to breastfeed use formula supplementation (FS) early on, which can affect successful breastfeeding. Whether the volume and timing of FS introduced in the first 24 hours of life (24 HOL) impacts the rate of "breastfeeding at discharge" (BFAD) is not well-studied and was investigated herein. Single-center, retrospective, chart review of breastfeeding infants born at ≥35 weeks who received supplementation in the first 24 HOL. Comprehensive demographic data pertaining to maternal and infant characteristics, along with infant feeding data, were collected. Four supplementation characteristics, (timing, rate, volume [mL/kg per feed], and type [expressed breast milk (EBM) or formula]) were correlated with BFAD. Among 3,102 supplemented infants in whom mothers intended to breastfeed, 1,031 (33.2%) infants were BFAD. At baseline, African American, Medicaid-insured, and single mothers had lower odds of BFAD. The overall maximum volume of FS per feed was 11.0 mL/kg (interquartile range 8.0-14.4). With each hour of delay in first supplementation, the odds of BFAD increased by 2.8% (95% confidence interval [CI] 0.022, 0.035). With every 1 mL/kg increase in the first formula volume, subsequent supplementation frequency increased by 4.5%. A positive association was observed between BFAD and a lower rate of supplementation (cutoff value ≤35.1%). However, among infants with these lower rates of supplementation, each unit increase in maximum FS, from 2 to 15 mL/kg, decreased the probability of BFAD by 4.2% (3.6-4.7%). Additionally, we observed that infants who were given at least one EBM supplementation (n = 223; 7.2%) had substantially increased rates of BFAD (odds ratio [OR] = 9.8, 95% CI 7.2-13.3). Early and higher volumes of FS negatively impacted BFAD. Birthweight-based FS of feeding with physiological volumes may increase breastfeeding rates at discharge. · Higher volumes of first supplementation increases subsequent supplementation frequency.. · For each unit increase in maximum supplementation, BFAD probability decreases by 4.2%.. · Even one EBM supplementation increases rates of BFAD..

Maternal Serum Folic Acid Levels and Onset of Kawasaki Disease in Offspring During Infancy

Kawasaki disease is an acute systemic vasculitis that primarily affects infants and young children. No reproducible risk factors have yet been identified, but a possible association between maternal folic acid supplementation and Kawasaki disease has been reported previously. To investigate the associations of exposure to maternal serum folic acid levels and maternal folic acid supplementation with onset of Kawasaki disease during infancy among offspring. This cohort study used data from the Japan Environment and Children's Study, a nationwide birth cohort, which has enrolled children since 2011. This study used the data set released in October 2019, and analysis was performed in January 2023. Maternal serum folic acid levels (≥10 ng/mL classified as exposed) during the second and third trimesters and the frequency of maternal folic acid supplementation during the first trimester and during the second and third trimesters of pregnancy (once a week or more was classified as exposed). The primary outcome was onset of Kawasaki disease in offspring up to age 12 months. Odds ratios (ORs) for each exposure were estimated, and propensity score-adjusted logistic regression was conducted on the basis of the sets of variables. The study population comprised 87 702 children who were followed-up for 12 months. Of these, 336 children developed Kawasaki disease. Mothers who took folic acid supplements (31 275 mothers [35.7%]; mean [SD] age, 32 [5] years) had higher serum folic acid levels than those who did not take supplements. Higher maternal serum folic acid levels were associated with a significantly lower risk of Kawasaki disease in offspring than lower levels (folic acid ≥10 vs <10 ng/mL, 56 of 20 698 children [0.27%] vs 267 of 64 468 children [0.41%]; OR, 0.68; 95% CI, 0.50-0.92). Children whose mothers took folic acid supplementation during the first trimester had a lower prevalence of Kawasaki disease than children whose mothers did not take folic acid (131 of 39 098 children [0.34%] vs 203 of 48 053 children [0.42%]), although the difference was not statistically significant (OR, 0.83; 95% CI, 0.66-1.04). Supplementation during the second and third trimesters was associated with a significantly lower risk of Kawasaki disease compared with no supplementation (94 of 31 275 children [0.30%] vs 242 of 56 427 children [0.43%]; OR, 0.73; 95% CI, 0.57-0.94). In this cohort study, higher serum folic acid levels (≥10 ng/mL) and maternal folic acid supplementation more than once a week during the second and third trimesters were associated with reduced risk of Kawasaki disease in offspring during infancy.

Characteristics and outcomes of patients hospitalized for infection with influenza, SARS-CoV-2 or respiratory syncytial virus in the season 2022/2023 in a large German primary care centre

BackgroundIn 2022/2023, Influenza A and Respiratory Syncytial Virus (RSV) reappeared in hospitalized patients, which was in parallel to ongoing SARS-CoV-2 infections. The aim of our study was to compare the characteristics and outcomes of these infections during the same time.MethodsWe included patients of all ages with a positive polymerase chain reaction (PCR) test for Influenza A/B, RSV, or SARS-CoV-2 virus hospitalized in the neurological, internal or paediatric units of the RoMed Hospital Rosenheim, Germany, between October 1st 2022 and February 28th 2023.ResultsA total of 906 patients were included (45.6% female; median age 68.0 years; 21.9% Influenza A, 48.2% SARS-CoV-2, 28.3% RSV). Influenza B (0.2%) and co-infections (1.5%) played a minor role. In patients aged ≥ 18 years (n = 637, 71%), Influenza A, SARS-CoV-2 and RSV groups differed in age (median 72, 79, 76 years, respectively; p < 0.001). Comorbidities, particularly asthma and COPD, were most prevalent for RSV. 103 patients were admitted to the intensive care unit (ICU) (16.3% Influenza A, 15.3% SARS-CoV-2, 19.2% RSV; p = 0.649), 56 died (6.8% Influenza A, 9% SARS-CoV-2, 11.1% RSV; p = 0.496). RSV showed the highest frequencies of low-flow oxygen supplementation for admission and stay. Differences in the length of stay were minor (median 7 days). Conversely, in patients aged < 18 years (n = 261, 28,8%), 19.5%, 17.6% and 60.2% were in the Influenza A, SARS-CoV-2 and RSV groups, respectively; 0.4% showed Influenza B and 2.3% co-infections. 17 patients were admitted to ICU (3.9% Influenza A, 9.6% RSV, 0% SARS-CoV-2); none died. RSV showed the highest frequencies of high- and low-flow oxygen supplementation, SARS-CoV-2 the lowest.ConclusionWhen comparing infections with Influenza, SARS-CoV-2 and RSV in the winter 2022/2023 in hospitalized adult patients, rates of ICU admission and mortality were similar. RSV showed the highest frequencies of obstructive airway diseases, and of oxygen supplementation. The latter was also true in children/adolescents, in whom RSV dominated. Thus, in the situation of declining importance of SARS-CoV-2, RSV showed a disease burden that was relatively higher than that from Influenza and SARS-CoV-2 across ages, and this might be relevant for the seasons coming.

Assessing the need to use sport supplements: The mediating role of sports supplement beliefs

AimSport supplement use by athletes can lead to unintentional anti-doping rule violations (ADRVs) due to the contamination of prohibited substances. This phenomenon underscores the need for athletes to reconsider their supplement use and assess their safety, efficacy, and necessity—a process we referred to as ‘reconsideration of supplement use’. Additionally, a body of research using the Sport Supplement Beliefs Scale (SSBS) has shown that when an athlete believes that supplements improve performance, they may be more likely to progress to doping in the future. However, most research is conducted in English speaking countries and there is a lack of validated measures in other languages. Therefore, in this multi-study research, we validated a Japanese version of the SSBS (Study 1) and examined relationships between perceived risk of ADRV due to supplements, reconsideration of supplement use, sports supplement beliefs and sport supplement use (Study 2). MethodsIn Study 1, we created a Japanese version of the SSBS (SSBS-J) using back-translation. In order to evaluate the reliability and validity of the scale, we utilized data from 356 university athletes, which were divided into two distinct cohorts, who reported their frequency and number of supplements used. Internal consistency and fit of the SSBS-J were evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) and the scale's ability to determine supplement use was assessed using linear regression analysis and t-tests. In Study 2, 525 university athletes (64.6 % men, Mage = 18.7 ± 0.7 years) were asked to complete measures related to the perceived risk of committing an ADRV due to supplement use, SSBS-J and sport supplement use. ResultsIn Study 1, the SSBS-J showed high internal consistency (α = 0.876), a one-factor structure similar to the original version, and good model fit. Linear regression indicated that the SSBS-J scores were significantly associated with the frequency and number of supplements used and differences were found between scores of supplement users (21.51 ± 6.54) and non-users (16.48 ± 6.14) (p < .001). Discriminant analysis correctly classified 64.7 % of supplement users and 61.0 % of non-users. In Study 2, ADRV awareness was indirectly related to sport supplement use via sport supplement beliefs (p < .001). ConclusionsOur findings suggest that ADRV awareness can influence reconsideration of supplement use and subsequently deter supplement use mediated by sport supplement beliefs. These insights emphasize the importance of promoting doping risk awareness, revisiting supplement use, and mitigating sport supplement beliefs to reduce inappropriate or unnecessary supplement use among athletes. From an anti-doping perspective, this insight is valuable in guiding athlete education regarding supplement use.

Flat Dose Intravenous Immunoglobulin Primary Infection Prophylaxis in Multiple Myeloma Patients on Bispecific Antibody Therapy: Vanderbilt Experience

BACKGROUND Bispecific antibodies (BsAbs) are novel immunotherapeutic agents with prolific anti-multiple myeloma (MM) efficacy in highly relapsed/refractory disease (RRMM). They have been associated with profound and prolonged hypogammaglobinemia which represents a unique challenge regarding increased risk of serious (sometimes fatal) infections. Though IVIG has historically been dosed at 0.4g/kg for secondary prophylaxis, there is still uncertainty in optimal timing, schedule and frequency of supplementation in MM patients. At Vanderbilt University Medical Center, we have adopted a flat dose 10g IVIG prophylaxis schedule, which on average delivers ~36% of historical, weight-based dosing. At present, expert recommendations advise IVIG replacement every 4 weeks in recipients of BsAb starting the second month of therapy and continuing until the end of therapy or until serum IgG levels reach &amp;gt; 400 mg/dL, whichever is longer ( Mohan M et al. Br J Haematol.2023;00:1-11). Considering that MM BsAbs are currently used with continued dosing schedule, adoption and anticipated new BsAb approvals are increasing, IVIG has previously been on national/global shortage (occasionally unavailable), IVIG replacement during hypogammaglobulinemia represents a crucial aspect of adequate infection prophylaxis in MM, we explored the impact of our institutional 10g IVIG prophylaxis on infection rates in RRMM patients receiving BsAbs. Prior studies with comparable BsAbs reported Grade (G) ≥3 infection rate of 32-45% and 18%, in anti-BCMA and anti-GPRC5D BsAbs, respectively. In these trials, overall, 14-53% of patients received IVIG prophylaxis. METHODS We performed a retrospective review using electronic medical record of RRMM patients receiving anti-BCMA or anti-GPRC5D BsAbs from Jan 2019 to Dec 2022, either on clinical trials or as a standard of care at our institution. The inclusion criteria were minimum of two months of BsAb therapy, and the use of at least one month of monthly IVIG prophylaxis for serum IgG &amp;lt; 400 mg/dL. All patients were also on baseline valacyclovir, trimethoprim-sulfamethoxazole and levofloxacin prophylaxis. Routine disease and treatment specifics as well as infection rates and grades were collected. Infections were defined as mild (infections treated outpatient), moderate (required hospital admission) or severe (hospital admission with intensive care unit level of care), next to also being graded by CTCAE v5 with the rest of hematologic and non-hematologic adverse events (AEs). RESULTS A total of 30 patients with RRMM were identified. Table 1 illustrates the demographic and disease specifics: 79% received a median (range) of 4 (2-7) lines of prior therapy, over half were penta-class exposed, 27% were triple and quad refractory, 67% received a prior autologous stem cell transplant and 17% underwent prior treatment with BCMA targeting CAR-T therapy. All except 2 patients received BsAb therapy on clinical trials. Anti-GPRC5D BsAb was used to treat 60% of patients, while the rest (40%) received anti-BCMA BsAb, all of which were given for a median of 27 (12-45) months (Table 1). Overall, 30% of patients had one infectious episode, while 43% had ≥2. Viral infections (57%) were twice as common as bacterial (30%) (Table 2). Infections were mild in 60%, moderate in 23%, and severe in 6.6% of patients. We observed 27% rate of G ≥3 infectious complications. Patients had a median (range) IgG at diagnosis of 1284(196-5431), and 499(210-2246) at the time of onset of first infection (IgG values at the start of BsAb therapy, at first and at ≥2 infections are outlined in Table 2). The rate of G ≥3 neutropenia and lymphopenia was 6.6% and 30% respectively. There were 2 (6.6%) sepsis related deaths, one each with anti-BCMA and anti-GPRC5D BsAbs. Table 2 also describes severity and the rates of cytokine release syndrome and neurotoxicity. CONCLUSIONS We observed relatively lower rate of severe or ≥ G3 infectious events with 10g flat IVIG dosing schedule. While our results represent a small, single-institutional cohort of predominantly anti-GPRC5D treated RRMM patients and require prospective validation in a randomized (IVIG 10g vs 0.4g/kg body weight) fashion, they demonstrate feasibility of reduced level dosing of a critical resource such as IVIG, in the fast expanding, national/global BsAb-based MM armamentarium.

Efficacy of intermittent versus daily vitamin D supplementation on improving circulating 25(OH)D concentration: a Bayesian network meta-analysis of randomized controlled trials.

Vitamin D deficiency is a widespread issue globally, resulting in increased use of vitamin D supplements. However, it is unclear whether intermittent (weekly or monthly) vitamin D supplementation is as effective as daily supplementation in improving circulating 25-hydroxyvitamin D [25(OH)D] levels. Three databases including Medline, EMBASE, and the Cochrane Library were systematically searched up to 10 November 2020. The risk of bias was evaluated according to Cochrane Collaboration's tool for rating methodological quality assessment. Direct and indirect comparisons between interventions and controls were performed by a Bayesian network meta-analysis (NMA), where the mean difference (MD) and its 95% confidence interval (CI) were used to indicate the efficacy. This NMA analysis included 116 RCTs with a total of 11,376 participants. Generally, we observed that 25(OH)D concentrations were significantly elevated regardless of vitamin D supplementation frequency. Although the findings of SUCRA indicated that daily vitamin D supplementation had a higher rank value than intermittent supplementation when the supplement dosage was similar, no statistically significant pooled mean differences of 25(OH)D concentration were noted between the daily supplementation group and intermittent supplementation group. Additionally, weekly supplementation with a total of 600,000 IU vitamin D supplementation during 3 months had the best efficacy in elevating 25(OH)D concentration (pooled MD = 63 nmol/L, 95%CI: 49-77). To achieve optimal 25(OH)D concentration (>75 nmol/L), we recommend 60,000 IU vitamin D supplementation monthly (~2,000 IU/day). The efficacy of intermittent vitamin D supplementation was similar to daily supplementation. Coupled with its convenience, the frequency and dosage of intermittent vitamin D supplements were recommended to reach the optimal 25(OH)D level.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257257, PROSPERO CRD42021257257.

Cross sectional study of vitamin B12 supplementation in Slovak and Czech vegans.

The number of vegans in the world is growing and in Slovakia and the Czech Republic they make up 1% of the population. Vegan diet excludes all foods of animal origin and vegans who do not use vitamin B12 supplements are at risk of the vitamin B12 deficiency. The aim of this study was to determine what proportion of Czech and Slovak vegans use vitamin B12 supplements regularly, irregularly or not at all and what is their supplemental cobalamin intake. The research involved 1337 self-identified vegans from Slovakia and the Czech Republic who were interviewed using the CAWI (Computer-Assisted Web Interview) method. Participants were recruited by posts in veganism-themed social media groups. Out of 1337 vegans 55.5% supplemented cobalamin regularly, 32.54% irregularly and 11.97% were not supplementing. Rate of not supplementing individuals was 5.04% higher in Slovaks than in Czechs. Short-term vegans had a significantly higher rate of not supplementing individuals (17.99%) compared to medium-term (8.37%) and long-term vegans (7.50%). Mean weekly cobalamin intake from supplements was 2938.34±2566.60 μg in regularly supplementing vegans compared to 1630.31±1949.27 μg in irregularly supplementing vegans, particularly due to the lower weekly supplementation frequency among irregularly (2.93) compared to regularly supplementing vegans (5.27). The rate of supplementation in Slovak and particularly Czech vegans was higher than in other countries. The number of not supplementing individuals was significantly higher among short-term vegans, indicating that there is still a need for education on the importance of adequate and regular cobalamin supplementation, especially in new vegans. Our results support the hypothesis that the reason for higher rate of cobalamin deficiency in irregularly compared to regularly supplementing vegans is the lower cobalamin intake caused by lower supplementation frequency.