Tag Archives: TAPI-1

This study will focus on the following three aspects

This study will focus on the following three aspects:

Materials and methods

Results and discussion

Conclusions
This investigation evaluated PM10 removal efficiency of roadside greenbelts by assessing three different vegetation configurations. We also proposed the optimal vegetation structure of greenbelts for each grade road. The results indicated that all the three kinds of greenbelts can reduce the footpath PM10 concentration by 7–15% under complex meteorological conditions. The composite vegetation structure of shrubs and small trees (about 2–4.5m in height) might be most suitable for arterial roads or heavy traffic roads. The stratified vegetation structure of trees, shrubs and grass may be best for sub-arterial roads or medium traffic volume roads as these plants not only produce numerous ecological benefits but also provide a pleasant landscape for residents. Parallel tree stands can be cost-effective for branch roads or light traffic roads. The PM10 removal percentage of greenbelts showed a significant negative correlation with shelterbelt porosity (R2=0.83). Relative humidity had a greater effect than temperature or wind speed on PM10 removal efficiency of greenbelts. Additionally, the ecological benefits of greenbelts could be better improved by configuration with more evergreen vegetation and high tolerant species.
The results provided useful information for urban decision makers or planners. However, this TAPI-1 investigation was only performed in open street environments. Further work should focus on the ecological effects of greenbelts in areas with higher density construction or within deep canyons, as well as the effect mechanism of related parameters, such as aspect ratio (W/H), pollutant types and concentrations, vegetation types and seasonal changes, wind speed and direction, and some other meteorological factors.

Acknowledgements
This research was sponsored by the National Science and Technology Supporting Program (No. 2013BAJ02B0102) and the Fundamental Research Funds for the Central Universities of China (Program No. 2013PY133). We are especially appreciative of TAPI-1 the suggestion and language polishing services provided by Dr. Elizabeth Lord in the University of Toronto. We also thank Wuhan Iron and Steel (Group) Corporation for providing assistance and experimental conditions.

Introduction
The link between the environment and our well-being is robustly established, with an emphasis placed on nature\’s benefits over urban locales (Bowler et al., 2010; Beute and de Kort, 2014; Beyer et al., 2014; Pasenen et al., 2014). Yet, even when encouraged to do so, people often do not use available nature resources in need of cognitive or emotional restoration (Eriksson and Nordlund, 2013; Herzog et al., 2002).
Wilkie and Stavridou (2013) proposed a possible explanation for this lack of engagement with nature in these circumstances. They found the interaction between an individual\’s environmental preference, which Facultative heterochromatin considered representative of place identity, and environment type influenced judgements of the potential for directed attention restoration to occur. Specifically, persons who preferred nature judged the restoration potential of incongruent urban locations lower than for nature settings congruent with their preference, while those with urban preferences perceived equivalent opportunities for restoration in both congruent urban and incongruent nature environments. Wilkie and Stavridou concluded the variations in perceived restoration potential due to this congruence effect may explain when nature locations are not always chosen when in need of restoration; and speculated persons with an urban preference do not seek nature because they perceive the city as restorative. This preliminary ‘congruence effect’ finding also reinforced the importance of considering individual-level person-place factors in studies of restorative environments (Smith et al., 2011; Jun et al., 2012).

br Methods Three of the authors S S and S

Methods
Three of the authors (S1, S2 and S3, aged 31–43years), who are experienced subjects in psychophysical evaluation of peripheral vision, participated in the first set of measurements. A second set of measurement was performed on one of the author (S1) and in two more subjects (S4 and S5, aged 27 and 28years) who were naïve to the purpose of the study and were inexperienced in performing psychophysical measurements. All subjects had normal visual function and no ocular diseases. S1, S3 and S4 were emmetropic while S2 and S5 were myopic (−2.50DS and −3.00 DS respectively) and were corrected with soft contact lenses. The study protocol adhered to the tenets of the Declaration of Helsinki, approved by the regional ethics committee, and informed consent was obtained from the subjects.

Stimuli and apparatus
For both peripheral resolution cut-off and TAPI-1 sensitivity evaluations, the stimulus was a sinewave grating enveloped in a Gaussian window of 1.6° standard deviation. As the measurements were made in the horizontal visual field meridian, the grating was oriented obliquely at either 45° or 135° to avoid bias towards certain orientations (Venkataraman, Winter, Rosén, & Lundström, 2016). For the moving stimuli, the drift was produced by dynamically altering the phase of the sinewave within the stationary Gaussian envelope; the stimulus thereby stimulated the same retinal area independent of whether it was moving or stationary. The temporal drift was quantified in terms of the number of grating-cycles passing a certain retinal location per second (cps or Hz). The direction of movement was always towards the fovea. A Hartmann-Shack wavefront sensor was used to determine the eccentric optical corrections based on the second order Zernike values. All psychophysical measurements were performed with appropriate trial lenses to correct for these eccentric refractive errors.
A high contrast Maltese cross was used as an external foveal fixation target for the right eye to control the measurement angle. Additionally, the fixation stability was monitored using a Tobii X-30 eye tracker. The subject was seated 2m from the foveal fixation target and the monitor used to present the stimuli. The monitor was an analogue cathode-ray-tube monitor (Nokia 446Xpro) driven by a Linux PC with a 10-bit NVIDIA graphic card. It was calibrated to give a linear response in luminance with the mean luminance of the stimuli set to 51.5cd/m2. The entire range of the luminance table (0–103cd/m2) was used to present stimuli for the high contrast resolution cut-off measurements. Due to the insufficient number of displayable low-contrast stimuli to estimate the CSF (even with the high-end 10-bit graphic card), we redefined the gamma curve of the monitor to display a narrower range of luminance values in smaller steps. The contrast sensitivity measurements could thereby utilize the central 1/8th (luminance between 45 and 58cd/m2) of the original color look up table interpolated to 10-bit resolution.
The stimuli set for resolution acuity cut-off consisted of gratings corresponding to 0.0–1.8 logMAR (75 levels equidistant in log-space), which is equivalent to spatial frequencies of 30–0.5 cycles per degree (cpd). For contrast sensitivity measurements, stimulus contrast ranged between 12.5% and 0.4%, corresponding to a contrast sensitivity of 8–256 (64 levels equidistant in log-space). The extent and spatial frequency of the stimuli were scaled to compensate for the spectacle magnification: M=1/(1−aF) where a is the vertex distance from the trial lens to the eye and F is the spherical equivalent of the lenses. Each stimulus was presented for 500ms accompanied by an auditory cue. The generation and presentation of the stimuli and the implementation of the psychophysical algorithms were carried out in Matlab and Psychtoolbox (Brainard, 1997; Pelli, 1997). In the 2-alternative forced choice procedure, the subjects identified the orientation of the gratings and responded with a keypad. No feedback was given about the correctness of the response. A Bayesian adaptive approach was used to choose the successive stimuli and to calculate the final threshold (Kontsevich & Tyler, 1999; Rosén et al., 2011). A guess rate of 50% and a lapse rate of 5% were set. The threshold estimation consisted of 50 trials and took about 2min.

Figure a is a typical ultrasound display during breast

Figure 1a is a typical ultrasound display during breast examination; it TAPI-1 consists of an ultrasound image and the corresponding image annotation. The annotation is used to register the image location with respect to the breast (American College of Radiology [ACR] 2011). Because the follow-up diagnosis, evaluation and treatment are performed on the basis of the stored annotation, it is crucial that the annotations be accurate and complete. The stored annotation is also very important for surgery. For women with large tumors, such as a malignant lesion located across different quadrants, mastectomy is usually recommended (American Cancer Society [ACS] 2014). As illustrated in Figure 1a, there are two parts to the annotation, a graphic pictogram and a textual sequence. In the graphic pictogram, the circle represents the breast region. The irregular part next to the circle represents the arm, which is used to indicate the laterality (left or right) of the breast. The arrow is the probe icon, which represents the probe location. The arrow direction is the probe direction, and the movable arrow can be manipulated by the operator to reflect the current location of the ultrasound image. Most commonly, a trackball on the ultrasound machine is employed to manipulate the position of the probe icon relative to the breast marker region. There are three types of breast marker, as illustrated in Figure 1b. The operator can choose a suitable pictogram to annotate the image according to the image location. The spatial information is also indicated in the textual sequence. In Figure 1a, ‘L’ means it is the left breast, ‘3’ represents the 3 o\’clock radial direction and ‘4’ indicates that it is 4 cm to the nipple.
During breast examination, when one image is useful for diagnosis, a series of complex hand motions need to be performed to annotate the image (Jackson and Chenal TAPI-1 2006; Kuzara and Brown 2006). The operator first freezes the ultrasound image using the freeze button on the ultrasound machine and then the changes the probe icon position according to the estimation. Finally, the textual sequence is typed using the keyboard. In the hospital, patient care and productivity are the main concerns. However, this manual annotation method causes a variety of issues.
One issue arises from the complex manual annotation procedure. The aforementioned actions are repeated for every ultrasound image and are time consuming (Entrekin 2010). The annotation takes more time than the breast scanning procedure, especially for new staff with little experience. In China, the clinical practice guideline recommends that there are two operators in each breast ultrasound examination (Chinese Medical Association 2004). One manipulates the ultrasound machine to scan the breast, and the other records the image and annotates it. This method can effectively decrease examination time, but Multiforked chromosome is obviously a waste of human resources in health care institutions. In addition, the highly repetitive annotation procedure is also fatigue to the operator.
Another problem caused by the manual annotation method is subjective registration of the image location, which is set according to the estimation of the probe location relative to the breast by the operator. Manual estimation depends on the operator\’s training and experience and may lead to inaccurate results or even errors. Furthermore, different operators may annotate images in their own way, which can cause inconsistency in image recording (Brandli 2007). For example, as illustrated in Figure 1a, some operators may type the textual sequence near the breast marker region, whereas others may type it on the ultrasound image. The inconsistent ultrasound images can cause difficulties in follow-up image processing or statistical analysis (Cupples et al. 2004). In addition, as also illustrated in Figure 1a, the 2-D annotation cannot display all spatial information in 3-D space, such as the probe tilt angle. This can also cause problems in downstream evaluation and treatment. On the basis of the incomplete spatial information, different clinicians may make different judgments on the image location in 3-D space.

The role of macrophages in

The role of macrophages in the inflammatory infiltrate associated to SCC was not clear, since they were more evident in the deeper areas of the tumor and not in places where there was epidermis ulceration. In the literature, differentiated population###http://www.surface-antigen.com/image/1-s2.0-S1607551X1630153X-gr3.jpg####s of macrophages may have anti or pro-tumor action, because they produce different cytokines profiles and express different surface receptors. Several factors related to the tumor\’s microenvironment may activate macrophages and direct them to a M1 or M2 profile, according to published studies (Yuan, Chen, & Yang, 2008). Tumors tend to have a predominance of macrophages with M2 phenotype, induced by the microenvironment cytokines profile, which are generally anti-inflammatory, such as IL-10. These macrophages would be inefficient in activating a cytotoxic type immune response, which is efficient against tumor cells. Therefore, the M2 would stimulate angiogenesis and changes in the extracellular matrix, interesting aspects for the invasion and metastasis in more aggressive tumors (Guruvayoorappan, 2008). In the present study, the antibody used for immunostaining of macrophages was MCA874G, which has affinity in binding to calprotectin, a protein present in young macrophages. The same is used as a marker for inflammatory diseases and participates in processes such as tumorigenesis, apoptosis and cellular homeostasis, as well as responses mediated by Th1 TAPI-1 in immune and immune-pathological reactions (Dhas, Bhat, & Gane, 2012). It would be important to evaluate in future studies what is the predominant phenotype of macrophages present in SCC, in order to understand better their more invasive biological behavior.
The second most commonly found cell type in SCC in the present study were lymphocytes. They did not show significant differences between groups SCCd and SCCu, but it had greater immunodetection in SCCd group (Fig. A.2.D). Some studies highlight the presence of lymphocytes associated to tumor inflammatory infiltrate, which may indicate a protective response or a cytotoxic activity against the tumor. Currently, there are studies with neoplasias in humans that report the presence of T cells acting in favor of malignant tumor development (Nzula, Going, & Stott, 2003). Malignant neoplasias seem to suppress antitumor response of Th1 lymphocytes in tissues (Satyam et al., 2011). This anergy of T lymphocytes may also be related to the deficiency of MHC-1 molecules in the tumor\’s microenvironment, induced by some immuno-suppressor cytokines, such as IL-10 (Th2 response). These aspects facilitate tumor progression (Matsuda et al., 1994). Furthermore, in future studies, it would also be interesting to evaluate the different types of T lymphocytes (CD4 and CD8, Treg), as well as pro and anti-tumor cytokines, in order to better elucidate the activity of these lymphocytes in the tumor\’s microenvironment.
Plasma cells had a low number in both SCC groups. Their activation takes place by the interaction between cells presenting antigen and TCD4+lymphocytes, which in a standard response would lead to the production of antibodies by activated plasma cells. The profile of Th1 cytokines is one of the activators of this cell type (Murphy, Travers, & Walport, 2008).

Conclusion

Conflict of interest

Acknowledgements
FAPESP – Fundação de Amparo à Pesquisa do Estado de São Paulo (Process number 2011/14232-5). The authors wish to acknowledge Mrs. Francisca de Assis Ardisson for her histotechnical assistance.

Introduction
Administration of antimicrobials to chickens at therapeutic and sub-therapeutic levels has been an integral part of poultry production in the US. Antimicrobials have been widely used in the poultry industry, for therapeutic purposes, disease prevention and growth promotion. It is now accepted that use of antibiotics in farms selects for drug resistant organisms which can then spread from farm to humans through consumption of contaminated food (Hawkey, 2008). Research on antimicrobial resistance in foodborne pathogens have demonstrated that use of antimicrobials in agriculture can result in drug resistant bacteria isolated from humans (Angulo, Baker, Olsen, Anderson & Barrett, 2004; Hawkey, 2008; Hawser, 2012; USDA National Organic Program, 2008).

We found a total prevalence of of

We found a total prevalence of 18/120 (15 %) of DNA in the collected fecal samples (). The majority of the positive samples (10/120) were collected in Central Park West in Manhattan resulting in a prevalence of 17% for that park, while four positive samples were from Van Cortland Park in the Bronx, resulting in a prevalence of 12% (). Additionally, four -positive samples were found in Prospect Park in Brooklyn, resulting in a prevalence of 11% (). We were not able to obtain sequence data from one of the positive sample. Sequence analysis of 17 of the positive amplicons revealed 16 isolates of the zoonotic TAPI-1 A (94.1%) and one isolate of the dog-specific D genotype (5.9%). Other genotypes were not observed in this study. DNA from both parasites was not detected concurrently in any the samples collected. All the samples in our studies were found to be from domestic dogs (data not shown).
This study uncovered the prevalence of and infections in domestic dogs frequenting three popular and active public parks in New York City. Toxoplasmosis and giardiasis are serious public health concerns worldwide because and are zoonotic parasites. In the United States alone, it is estimated that 60 million individuals are infected with (CDC, 2015). Since dogs are intermediate hosts for , our data indicate environmental contamination with oocysts.
In conclusion, this study reveals and protozoan parasites in domestic dogs frequenting New York City parks. The finding of assemblage I and genotype A in these popular and frequently visited parks is noteworthy and has significant implications for public health, particularly for individuals with impaired immune system frequenting these parks as well as children who play in those parks. In both cases, thorough handwashing prior to food consumption is advisable. In the future, we will sample at different time frames and expand to other parks.
Conflict of interest statement

Acknowledgements
The authors would like to thank the Department of Biology and the School of Science at Manhattan College for financial support. The authors are also grateful to Drs. Steven Singer (Georgetown University, Washington D.C.) and Dr. Gustavo Arrizabalaga (Indiana School of Medicine, Indianapolis, IN) for Giardia duodenalis and T. gondii genomic DNA, respectively. Preliminary results were presented as an Abstract at the 89th Annual Meeting of the American Society of Parasitologists, New Orleans, USA, 24th–27th July 2014.

Ducks are frequently infected by and without showing clinical signs and may serve as a carrier of spp. to other animals (). Hatcheries are a potential source of infection for 1-day-old chicks through environmental contamination, but it is uncertain whether vertical transmission occurs through the egg ().
Erythromycin, fluoroquinolones (FQ), gentamicin and tetracycline are effective treatments for disease due to spp., but careful use of antibiotics is required to reduce the risk of emergence of resistant strains, which could be transmitted to humans (). The resistance of spp. to tetracycline is commonly associated with the presence of the (O) gene, which could be transferred from resistant strains to sensitive strains (). Likewise, mutations in the quinolone resistance-determining region () of , especially T86I, have been linked to the resistance of spp. to FQ with incidence of hypermutable phenotype in resistant strains to FQ (). The aim of this study was to provide information on antibiotic resistance of spp. in 1-day-old ducklings in Egypt.
A total of 150 faecal meconium samples (~1 g each) were collected in 9 mL Bolton broth (Oxoid) from 1-day-old commercial meat ducklings (e.g. Muscovy, Mallard). All samples were submitted to the Reference Laboratory for Veterinary Quality Control on Poultry Production, Giza, for routine examination in 2011 and 2012. Isolation and biochemical identification of spp. were performed according to ISO 10272-1 using blood-free selective media (CCD agar and Karmali agar; Oxoid). Resistance against ampicillin, tetracycline, erythromycin, ciprofloxacin, ofloxacin, sulfamethoxazole-trimethoprim (SXT), gentamicin, amikacin and chloramphenicol (Oxoid) was determined using the disc diffusion method test conducted following the recommendations of the Clinical and Laboratory Standards Institute.

br Recently dynamic chest radiography using a flat panel

Recently, dynamic chest radiography using a flat panel detector (FPD) system with a large field of view was introduced for clinical use. This technique can provide sequential chest radiographs with high temporal resolution during respiration (17), and the TAPI-1 dose is much lower than that of CT. Also, whereas CT and MRI are performed in the supine or prone position, dynamic chest radiology can be performed in a standing or sitting position, which is physiologically relevant. To the best of our knowledge, no detailed study has analyzed diaphragmatic motion during tidal breathing by using dynamic chest radiography.

The purpose of this study was to evaluate diaphragmatic motion during tidal breathing in a standing position in a health screening center cohort using dynamic chest radiography in association with participants\’ demographic characteristics.

Materials and Methods

Study Population

This cross-sectional study was approved by the institutional review board, and all the participants provided written informed consent. From May 2013 to February 2014, consecutive 220 individuals who visited the health screening of our hospital and met the following inclusion criteria for the study were recruited: age greater than 20 years, scheduled for conventional chest radiography, and underwent pulmonary function test. Patients with any of the following criteria were excluded: pregnant (n  =  0), potentially pregnant or lactating (n  =  0), refused to provide informed consent (n  =  22), had incomplete datasets of dynamic chest radiography (n  =  3), had incomplete datasets of pulmonary function tests (n  =  1), could not follow tidal breathing instructions (eg, holding breath or taking a deep breath) (n  =  18), or their diaphragmatic motion could not be analyzed by the software described next (n  =  4). Thus, a total of 172 participants (103 men, 69 women; mean age 56.3 ± 9.8 years; age range 36–85 years) were finally included in the analysis ( Fig 1). The data from 47 participants of this study population were analyzed in a different study (under review). The heights and weights of the participants were measured, and the body mass index (BMI, weight in kilograms divided by height squared in meters) was calculated.

Figure 1. Flow diagram of the study population.Figure optionsDownload full-size imageDownload high-quality image (83 K)Download as PowerPoint slide

Imaging Protocol of Dynamic Chest Radiology (“Dynamic X-Ray Phrenicography”)

Posteroanterior dynamic chest radiography (“dynamic X-ray phrenicography”) was performed using a prototype system (Konica Minolta, Inc., Tokyo, Japan) composed of an FPD (PaxScan 4030CB, Varian Medical Systems, Inc., Salt Lake City, UT, USA) and a pulsed X-ray generator (DHF-155HII with Cineradiography option, Hitachi Medical Corporation, Tokyo, Japan). All participants were scanned in the standing position and instructed to breathe normally in a relaxed way without deep inspiration or expiration (tidal breathing). The exposure conditions were as follows: tube voltage, 100 kV; tube current, 50 mA; pulse duration of pulsed X-ray, 1.6 ms; source-to-image distance, 2 m; additional filter, 0.5 mm Al + 0.1 mm Cu. The additional filter was used to filter out soft X-rays. The exposure time was approximately 10–15 seconds. The pixel size was 388 × 388 µm, the TAPI-1 matrix size was 1024  × 768, and the overall image area was 40 × 30 cm. The gray-level range of the images was 16,384 (14 bits), and the signal intensity was proportional to the incident exposure of the X-ray detector. The dynamic image data, captured at 15 frames/s, were synchronized with the pulsed X-ray. The pulsed X-ray prevented excessive radiation exposure to the subjects. The entrance surface dose was approximately 0.3–0.5 mGy.

For kinetics studies Nevirapine M diluted in either LC

For kinetics studies Nevirapine (4 μM) diluted in either LC-MS grade water, 10 mM phosphate buffer pH 5.8, 10 mM phosphate buffer pH 8 or WWTW effluent from the Zeekoegat plant was combined in equal volumes with NaOCl diluted in either of the aforementioned solvents (to yield 2 μM Nevirapine and 20 μM NaOCl) and stirred at room temperature (20 °C + ?1 °C). Aliquots were taken from the reaction at 10 s intervals and combined with NH4Cl to give a two-fold molar excess with respect to NaOCl. Samples were analysed by UHPLC-QTOF immediately after the last time course was sampled. An external 6 point calibration of Nevirapine in the matching reaction solvent was utilised for quantitative purposes and analysed in MassHunter Quant (Agilent).
2.3. LC-UV analysis of chlorination reactions
2.4. Large scale preparation of nevirapine chlorination reaction products
1.8 g of pharmaceutical Nevirapine (Aspen) tablets were crushed and resuspended in 25% HCl. The solution was clarified by centrifugation (3000 rpm for 30 min) and the supernatant containing approximately 1 g of Nevirapine was collected. The yield of this TAPI-1 extraction was determined by UHPLC-QTOF analysis as compared to an external calibration curve.
Acid extracted Nevirapine was diluted in either 100 mM phosphate buffer (pH 8) or 10 mM Phosphate buffer (pH 5.8) to 1.5 mg/mL, 0.4 M NaOCl was added daily for a period of four days and the reactions were monitored by UHPLC-QTOF analysis. Upon reaching the maximum diversity of reaction products, the mixtures were dried by rotary evaporation (Buchi, Switzerland) at 40 °C under vacuum. The total basic and acidic reactions were diluted in dimethyl sulphoxide to 1 mg/mL for toxicity studies.
The dried and crushed acidic reaction mixture was dissolved in water and fractioned by centrifugation into aqueous and non-aqueous fractions. These were dried, as before, and diluted in dimethyl sulphoxide to 1 mg/mL for toxicity studies.
Both the acidic and basic reactions were separated using preparative chromatography. 100 mg of each reaction in water (100 mg/mL) was loaded onto a Biotage SNAP Ultra C18 (12 g) column and separated on a gradient of acetonitrile and water (both with 0.1% formic acid) over 30 min at a flow rate of 10 mL/min. Fractions were collected and dried by vacuum centrifugation (Martin Christ RVC 2-33IR) at 2 mBar, 40 °C, 900 rpm for 12 h. Dried fractions were resuspended in DMSO (1 mg/mL) and subjected to toxicity and activity screening.
2.5. Environmental sample collection and extraction
Grab samples were collected from all the major rivers and lakes (man-made) in South Africa as part of a multi-year water quality study. Samples were collected in “virgin” borosilicate Schott bottles and transported to the laboratory at room temperature. Sampling locations were chosen based on proximities to wastewater treatment works (WWTW) and human settlements. To provide a comprehensive picture of a specific body of water, multiple samples were taken from different locations in a sampling site. Samples were stored at ?20 °C until extraction after which extracts were stored at ?20 °C until analysis.
500 mL of each environmental sample was filtered using a 1 μm glass-fibre syringe driven filter (Pall) and extracted using the Smart Prep Extraction (Horizon, Salem, USA); an automated offline solid phase extraction instrument. Briefly 6 cc Oasis HLB, 500 mg (Waters) cartridges were conditioned with 4 mL methanol followed by 6 mL of HPLC Grade water. 500 mL of sample TAPI-1 was then introduced at a flow rate of 10 mL/min after which cartridges were dried under nitrogen for three minutes. Cartridges were then eluted twice with 5 mL of methanol and dried under a gentle stream of nitrogen to 500 μL. All extractions were performed at 18 °C (+-2 °C).
2.6. UHPLC QTOF analysis
Environmental concentrations of Nevirapine were reported previously and national samples were analysed by UHPLC-QTOF in full scan, “auto MS” and “all ions” mode. Similarly, chlorination reactions of Nevirapine at varying concentrations of NaOCl and pH (after 1 min) were analysed in order to characterise the resulting reaction products. In addition to these, the large scale chlorination reactions were monitored by UHPLC-QTOF.

Another possible explanation for low

Another possible explanation for low level of confidence in discussing specific nutrition related issues is that some of these issues might be perceived by the midwives as out of their scope of knowledge and practice, and should be referred to dietitians who are the experts in the area of nutrition. However, as was identified from midwives’; comments in this study, referral to dietitians (for issues other than gestational diabetes and to a lesser extent obesity) is limited, mainly due to limited access to dietitians even if the referral was made. This is a health system issue that needs to be addressed, so midwives can confidently refer pregnant women with nutrition education needs out of their scope of knowledge to dietitians as required. Given the rising rates of obesity, it TAPI-1 is vital that midwives are equipped to provide nutrition education and support to all pregnant women. Our study identified health professionals such as dietitians as the most frequently used source of nutrition information for midwives, therefore, (with their current limited access to pregnant women), dietitians could contribute to enhancing maternal and foetal health by educating midwives via the provision of regular education sessions, updates and resources.
Midwives’; inadequate level of pregnancy general nutrition knowledge (in several areas) and moderate to low levels of confidence in discussing general and specific nutrition related issues observed in this study could reflect that they had not received adequate nutrition information or education about these issues. Indeed, in this study, only half of the midwives reported receiving nutrition education during midwifery education or during practice. Midwives need to be equipped with adequate nutrition education both while obtaining their basic qualifications and during practice, if mesentary are expected to discuss healthy nutrition with pregnant women as outlined in the new Antenatal Care Guidelines (model one12 and two13), and fulfil their role in improving the health of mothers and future generations.
A number of limitations of this study are identified. Not all Australian midwives had the opportunity to respond to the survey as not all Australian midwives are members of the ACM. The completion rate was 6.9% of the 4770 midwives but the number of respondents (n = 329) was very close to the estimated required sample size (n = 356) and provided sufficient power to detect statistical significance. The response rate was also comparable to previous research conducted with this group.38 Online surveys are known to have a significantly lower response rate compared to paper surveys.39 The frame of convenience sampling of the study has some inherent limitations as midwives who chose to undertake the survey might have been more interested, motivated or knowledgeable about nutrition than the rest of the population. Recall bias cannot be totally excluded, especially in terms of receiving nutrition information TAPI-1 or education during midwifery education, as three quarters of the responding midwives were aged 41 and older, and may have undertaken their midwifery education a long time ago. Some midwives also reported difficulty in listing everything they included in their advice. Taking in consideration the feedback from the piloting of the survey (that the survey was long), the knowledge part was kept short and general. It might have not been reflective of all aspects of nutrition during pregnancy.