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Infants with moderate-to-severe CHD frequently undergo cardiopulmonary bypass surgery in childhood. Morbidity and mortality are highest in those who develop post-operative low cardiac output syndrome. Vasoactive and inotropic medications are mainstays of treatment for these children, despite limited evidence supporting their use.
To help inform clinical practice, as well as the conduct of future trials, we performed a systematic review of existing literature on inotropes and vasoactives in children after cardiac surgery using the PubMed and EMBASE databases. We included studies from 2000 to 2020, and the patient population was defined as birth – 18 years of age. Two reviewers independently reviewed studies to determine final eligibility.
The final analysis included 37 papers. Collectively, selected studies reported on 12 different vasoactive and inotropic medications in 2856 children. Overall evidence supporting the use of these drugs in children after cardiopulmonary bypass was limited. The majority of studies were small with 30/37 (81%) enrolling less than 100 patients, 29/37 (78%) were not randomised, and safety and efficacy endpoints differed widely, limiting the ability to combine data for meta-analyses.
Vasoactive and inotropic support remain critical parts of post-operative care for children after cardiopulmonary bypass surgery. There is a paucity of data for the selection and dosing of vasoactives and inotropes for these patients. Despite the knowledge gaps that remain, numerous recent innovations create opportunities to rethink the conduct of clinical trials in this high-risk population.
As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
OBJECTIVES/GOALS: 1. Understand the association between patient perceptions of care measured by the Interpersonal Processes of Care (IPC) Survey and glycemic control, appointment no-shows/cancellations and medication adherence in patients with type II diabetes. 2. Determine how these relationships differ by race for non-Hispanic White and Black patients. METHODS/STUDY POPULATION: This is a cross-sectional study of a random sample of 100 White and 100 Black Type II diabetic patients followed in Duke primary care clinics and prescribed antihyperglycemic medication. We will recruit through email and phone calls. Enrolled patients will complete the Interpersonal Processes of Care Short Form and Extent of Medication Adherence survey to measure patient perceptions of care (predictor) and medication adherence (secondary outcome). No show appointments and cancellations (secondary outcomes) and most recent hemoglobin A1c (primary outcome) will be collected from the Electronic Medical Record. We will also collect basic demographic information, insurance status, financial security, significant co-morbidities, and number and type (subcutaneous vs oral) of antihyperglycemic medications. RESULTS/ANTICIPATED RESULTS: -The study is powered to detect a 0.6% difference in HbA1c, our primary outcome, between high and low scorers on the Interpersonal Processes of Care subdomains. -We expect that higher patient scores in the positive domains of the IPC survey and lower DISCUSSION/SIGNIFICANCE OF IMPACT: This study will provide information to develop and implement targeted interventions to reduce racial and ethnic disparities in patients with Type II diabetes. We hope to gain information on potentially modifiable factors in patient-provider interactions that can be intervened upon to improve prevention and long-term outcomes in these populations.
The comorbidity of mental illness and substance abuse (dual diagnosis) can complicate both clinical picture and prognosis. It is therefore important to recognise both nosological entities and to treat them simultaneously.
Our main aim was to investigate and describe the characteristics of dual diagnosis patients who were in treatment with a community addiction service, and to assess the completeness of clinical documentation.
We created a data collection tool to measure indices of illicit substance and alcohol use, psychiatric diagnosis, and treatments received for both problems. We included measures of physical health relating to drug and alcohol use. Clinical information was collected from the electronic patient record system.
The audit is ongoing. 498 patients were under the care of the addictions service in February 2012. To date we have identified 72 patients (14.5%) with dual diagnosis. Of this group, 79% of patients were addicted to opiates and 42% were polysubstance users.
The psychiatric diagnosis included mood disorders (29%), anxiety disorders (24%) and psychosis (14%). However 28% had no formal diagnosis recorded, despite receiving treatment for psychiatric conditions.
67% were prescribed methadone. 40% of the patients were receiving medication for their mental illness.
14.5% of our addictions population had a mental health problem. We identified lapses in clinical documentation related to both illnesses. The distinction between addictions and psychiatric services can bring difficulties in communication and care provided. Quality and continuity of care is important and consideration should be given to further development of dual diagnosis services.
The objectives of this paper are to: (1) identify contextual factors such as policy that impacted the implementation of community-based primary health care (CBPHC) innovations among 12 Canadian research teams and (2) describe strategies used by the teams to address contextual factors influencing implementation of CBPHC innovations. In primary care settings, consideration of contextual factors when implementing change has been recognized as critically important to success. However, contextual factors are rarely recorded, analyzed or considered when implementing change. The lack of consideration of contextual factors has negative implications not only for successfully implementing primary health care (PHC) innovations, but also for their sustainability and scalability. For this evaluation, data collection was conducted using self-administered questionnaires and follow-up telephone interviews with team representatives. We used a combination of directed and conventional content analysis approaches to analyze the questionnaire and interview data. Representatives from all 12 teams completed the questionnaire and 11 teams participated in the interviews; 40 individuals participated in this evaluation. Four themes representing contextual factors that impacted the implementation of CBPHC innovations were identified: (I) diversity of jurisdictions (II) complexity of interactions and collaborations (III) policy, and (IV) the multifaceted nature of PHC. The teams used six strategies to address these contextual factors including: (1) conduct an environmental scan at the beginning (2) maintaining engagement among partners and stakeholders by encouraging open and inclusive communication; (3) contextualizing the innovation for different settings; (4) anticipating and addressing changes, delays, and the need for additional resources; (5) fostering a culture of research and innovation among partners and stakeholders; and (6) ensuring information about the innovation is widely available. Implementing CBPHC innovations across jurisdictions is complex and involves navigating through multiple contextual factors. Awareness of the dynamic nature of context should be considered when implementing innovations.
Knowledge of the effects of burial depth and burial duration on seed viability and, consequently, seedbank persistence of Palmer amaranth (Amaranthus palmeri S. Watson) and waterhemp [Amaranthus tuberculatus (Moq.) J. D. Sauer] ecotypes can be used for the development of efficient weed management programs. This is of particular interest, given the great fecundity of both species and, consequently, their high seedbank replenishment potential. Seeds of both species collected from five different locations across the United States were investigated in seven states (sites) with different soil and climatic conditions. Seeds were placed at two depths (0 and 15 cm) for 3 yr. Each year, seeds were retrieved, and seed damage (shrunken, malformed, or broken) plus losses (deteriorated and futile germination) and viability were evaluated. Greater seed damage plus loss averaged across seed origin, burial depth, and year was recorded for lots tested at Illinois (51.3% and 51.8%) followed by Tennessee (40.5% and 45.1%) and Missouri (39.2% and 42%) for A. palmeri and A. tuberculatus, respectively. The site differences for seed persistence were probably due to higher volumetric water content at these sites. Rates of seed demise were directly proportional to burial depth (α=0.001), whereas the percentage of viable seeds recovered after 36 mo on the soil surface ranged from 4.1% to 4.3% compared with 5% to 5.3% at the 15-cm depth for A. palmeri and A. tuberculatus, respectively. Seed viability loss was greater in the seeds placed on the soil surface compared with the buried seeds. The greatest influences on seed viability were burial conditions and time and site-specific soil conditions, more so than geographical location. Thus, management of these weed species should focus on reducing seed shattering, enhancing seed removal from the soil surface, or adjusting tillage systems.
Family-based strategies to reduce the risk of overweight in childhood are needed in the Caribbean.
To investigate the associations between parental characteristics and risk of overweight and explore possible mechanisms.
Data from a parenting intervention were analysed. Parental characteristics were obtained by questionnaire at enrolment. At 18 months, 501 infants (82.9% of cohort) had weight and length measured using standardized methods. The association of parents’ characteristics with risk of infant overweight was assessed using random-effects logistic regression. Four focus groups among mothers in Jamaica were conducted to explore mechanisms.
Overall, 20.6% of infants were ‘at risk of overweight’. Fathers were present in 52% of households. Fathers’ presence [OR (95% CI) 0.60 (0.37–0.96)] was associated with reduced risk of overweight independent of socioeconomic status. Mothers reported that fathers encouraged healthier practices.
Fathers may be important agents of change in intervention strategies to prevent childhood overweight.
We examined risk factors associated with the intestinal acquisition of antimicrobial-resistant extraintestinal pathogenic Escherichia coli (ExPEC) and development of community-acquired urinary tract infection (UTI) in a case-control study of young women across Canada. A total of 399 women were recruited; 164 women had a UTI caused by E. coli resistant to ⩾1 antimicrobial classes and 98 had a UTI caused by E. coli resistant to ⩾3 antimicrobial classes. After adjustment for age, student health service (region of Canada) and either prior antibiotic use or UTI history, consumption of processed or ground chicken, cooked or raw shellfish, street foods and any organic fruit; as well as, contact with chickens, dogs and pet treats; and travel to Asia, were associated with an increased risk of UTI caused by antimicrobial resistant E. coli. A decreased risk of antimicrobial resistant UTI was associated with consumption of apples, nectarines, peppers, fresh herbs, peanuts and cooked beef. Drug-resistant UTI linked to foodborne and environmental exposures may be a significant public health concern and understanding the risk factors for intestinal acquisition of existing or newly emerging lineages of drug-resistant ExPEC is important for epidemiology, antimicrobial stewardship and prevention efforts.
NGC 253 is one of the closest starburst galaxies to the Milky Way and as such it has been studied in detail across the electromagnetic spectrum. Recent observations have detected the first extragalactic class I methanol masers at 36 and 44 GHz and the first extragalactic HC3N (cyanoacetylene) masers in this source. Here we discuss the location of the masers with respect to key morphological features within NGC 253 and the association between the masers and the ongoing starburst.
Methanol masers at 6.7 GHz are the brightest of class II methanol masers and have been found exclusively towards massive star forming regions. These masers can thus be used as a unique tool to probe the early phases of massive star formation. We present here the SED studies of 284 methanol masers chosen from the MMB catalogue, which falls in the Hi-GAL range (|l| ≤ 60°, |b| ≤ 1°). The masers are studied using the ATLASGAL, MIPSGAL and Hi-GAL data at wavelengths ranging from 24−870 micrometers. A single grey body component fit was used to model the cold dust emission whereas the emission from the warm dust is modelled by a black body. The clump properties such as isothermal mass, FIR luminosity and MIR luminosity were obtained using the best fit parameters of the SED fits. We discuss the physical properties of the sources and explore the evolutionary stages of the sources having 6.7 GHz maser emission in the timeline of high mass star formation.
Masers are becoming increasingly important probes of high-mass star formation, revealing details about the kinematics and physical conditions at the elusive, early stages of formation. Over the last decade significant investment has been made in a number of large-scale, sensitive maser surveys targeting transitions found in the vicinity of young, high-mass stars. Individually, these searches have led to valuable insights into maser populations, their associated star formation regions, and often revealed further details such as Galactic structure. In combination, they become even more powerful, especially when considered together with complementary multi-wavelength data. Another consequence of large maser surveys has been the identification of a number of especially interesting sources that have been the subject of subsequent detailed studies. I summarize the recent plethora of maser surveys, their results, and how they are contributing to our understanding of star formation. Ongoing searches will ensure a bright future of maser surveys in the decade to come.
Ventspils International Radio Astronomy Centre (VIRAC) has two fully steerable Cassegrean System 32 and 16 m radio telescopes. After renovation and modernization program the Galactic masers, particularly CH3OH research and monitoring program became one of the most important realized on these telescopes. Both telescopes are equipped with broadband cryogenic receivers covering 4.5-8.8 GHz frequency band. Digital backend consisting from DBBC-2 (Digital Base Band Convertor developed by HAT-LAB, Italy) and FLEXBUFF (data storage system based on commercially available server system) is used for data digitalization and registration. A special program complex for spectral line data reduction and correction was developed and implemented.
Methanol masers observed at high angular resolution are useful tool to investigate the processes of high-mass star formation. Here, we present the results of statistical analysis of the 6.7 GHz methanol maser structures in 60 sources observed with the EVN. The parameters of the maser clouds and exciting stars were derived. There is evidence that the emission structures composed of larger number of maser clouds are formed in the vicinity of more luminous exciting stars.
We discuss specific aspects of space-ground VLBI (SVLBI) data processing of spectral line experiments (H2O & OH masers) in Radioastron project. In order to meet all technical requirements of the Radioastron mission a new software FX correlator (ASCFX) and the unique data archive which stores raw data from all VLBI stations for all experiments of the project were developed in Astro Space Center. Currently all maser observations conducted in Radioastron project were correlated using the ASCFX correlator. Positive detections on the space-ground baselines were found in 38 sessions out of 144 (detection rate of about 27%). Finally, we presented upper limits on the angular size of the most compact spots observed in two galactic H2O masers, W3OH(H2O) and OH043.8-0.1.
We report astrometric results for seven 6.7 GHz CH3OH and one 22 GHz H2O masers in the Perseus arm with VLBA and VERA observations. Among the eight sources, we succeeded in obtaining trigonometric parallaxes for all sources, except G098.03+1.44 at 6.7 GHz band. By combining our results with previous astrometry results (Choi et al. 2014), we determined an arm width of 0.41 kpc and a pitch angle of 8.2 ± 2.5 deg for the Perseus arm. By using a large sample of the Perseus arm (26 sources), we examined the three-dimensional, non-circular motions (defined as U, V and W) of sources in the Perseus arm as a function of the distance (D) perpendicular to the arm. Interestingly, we found a weighted mean of <U > = 12.7 ± 1.2 km s−1 for 14 sources with D < 0 kpc (i.e. sources on the interior side of the arm) and <U > = −0.3 ± 1.5 km s−1 for 12 sources with D > 0 kpc (i.e. sources exterior to the arm). These findings might be the first observational indication of the ”damping phase of a spiral arm” suggested by the non-steady spiral arm model of Baba et al. (2013). The small pitch angle of the Perseus arm (< 10 deg) also supports the damping phase, based on ”pitch angle vs. arm amplitude” relation shown in Grøsbol et al. (2004).
The first long-term maser (mainly methanol) monitoring program is under way with the radio telescopes of Ventspils International Radio Astronomy Center. The first activity of this program was to develop an observations methodology and data registration and reduction software for the Ventspils telescopes. The developed routines are to be used for maser variability monitoring, investigating short bursts of intensity and a search for new, previously unknown, maser sources. Currently the program consists of 41 methanol masers observed at 6.7 GHz, while new ones are periodically added. The maser sources are observed at 3 – 5 day intervals. It was found that most the sources display a significant level of variability with time, ranging from a few days, up to several months and, perhaps, years. In addition to non-varying masers, several types of maser variability behavior were observed, including: monotonic increases or decreases, un-periodical, quasi-periodic and periodic variations.
In this proceeding, we summarize the key science goals and reference design for a next-generation Very Large Array (ngVLA) that is envisaged to operate in the 2030s. The ngVLA is an interferometric array with more than 10 times the sensitivity and spatial resolution of the current VLA and ALMA, that will operate at frequencies spanning ~1.2 – 116 GHz, thus lending itself to be highly complementary to ALMA and the SKA1. As such, the ngVLA will tackle a broad range of outstanding questions in modern astronomy by simultaneously delivering the capability to: unveil the formation of Solar System analogues; probe the initial conditions for planetary systems and life with astrochemistry; characterize the assembly, structure, and evolution of galaxies from the first billion years to the present; use pulsars in the Galactic center as fundamental tests of gravity; and understand the formation and evolution of stellar and supermassive blackholes in the era of multi-messenger astronomy.
A strong outburst of 6.7 GHz methanol maser occurred in the high-mass young stellar object (HMYSO) G24.33+0.14 between November 2010 and January 2013. The target was observed with the Torun 32 m radio telescope as a part of a long-term monitoring programme. Almost all twelve spectral features from 108 to 120 km s−1 varied synchronously with time delays between the flux minima of about two weeks. This may indicate that the variability is driven by global changes in the pump rate. The flare peaks of the two features with the highest relative amplitude of 40-60 are delayed by about 2.5 months while their profiles undergo essential transformation with a velocity drift of 0.23 km s−1yr−1. This may suggest that the variability is caused by a rapid increase of the pump rate and excitation of a large portion of the HMYSO environment by an accretion event.