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Recurrent aortic arch obstruction following the Norwood procedure is recognised as an important complication. Balloon arch angioplasty is associated with a high recoarctation rate.
We sought to evaluate the prevalence and outcome of stent implantation for recoarctation in children following Norwood or Damus–Kaye–Stansel procedure over the past decade at a single national cardiology centre.
Of 114 children who underwent Norwood procedure or Damus–Kaye–Stansel procedure between January 2003 and June 2013, 80 patients survived. Of these 15 children underwent stent implantation for recoarctation. Six of these patients had previous balloon angioplasty. The median age at stent implantation was 4.4 months (range 2–82 months). The median peak aortic arch gradient at catheterisation decreased from 26mmHg (range 10–70mmHg) to 2mmHg (range 0–20mmHg). The median luminal diameter increased from 4.7 mm (range 3.2–7.9 mm) to 8.6 mm (range 6.2–10.9 mm). The median coarctation index increased by 0.49 (range = 0.24–0.64). A Valeo stent was employed in 11 children, a Palmaz Genesis stent in 2 patients, a MultiLink stent in 1 child, and a Jomed covered stent in 1 child. Two factors were associated with the need for stent placement: previous arch angioplasty (p valve < 0.001, χ-square 11.5) and borderline left ventricle (p = 0.04, χ-square = 4.1). Stent migration occurred in one child. There were two deaths related to poor right ventricular systolic function and severe tricuspid regurgitation. Six patients underwent redilation of the stent with no complications.
The prevalence of recurrent aortic arch obstruction following Norwood/Damus–Kaye–Stansel procedure was 18%. Stent implantation is safe and reliably eliminates the aortic obstruction. Redilation can be successfully achieved to accommodate somatic growth or development of stent recoarctation.
The widespread use of herbicides in cropping systems has led to the evolution of resistance in major weeds. The resultant loss of herbicide efficacy is compounded by a lack of new herbicide sites of action, driving demand for alternative weed control technologies. While there are many alternative methods for control, identifying the most appropriate method to pursue for commercial development has been hampered by the inability to compare techniques in a fair and equitable manner. Given that all currently available and alternative weed control methods share an intrinsic energy consumption, the aim of this review was to compare methods based on energy consumption. Energy consumption was compared for chemical, mechanical, and thermal weed control technologies when applied as broadcast (whole-field) and site-specific treatments. Tillage systems, such as flex-tine harrow (4.2 to 5.5 MJ ha−1), sweep cultivator (13 to 14 MJ ha−1), and rotary hoe (12 to 17 MJ ha−1) consumed the least energy of broadcast weed control treatments. Thermal-based approaches, including flaming (1,008 to 4,334 MJ ha−1) and infrared (2,000 to 3,887 MJ ha−1), are more appropriate for use in conservation cropping systems; however, their energy requirements are 100- to 1,000-fold greater than those of tillage treatments. The site-specific application of weed control treatments to control 2-leaf-stage broadleaf weeds at a density of 5 plants m−2 reduced energy consumption of herbicidal, thermal, and mechanical treatments by 97%, 99%, and 97%, respectively. Significantly, this site-specific approach resulted in similar energy requirements for current and alternative technologies (e.g., electrocution [15 to 19 MJ ha−1], laser pyrolysis [15 to 249 MJ ha−1], hoeing [17 MJ ha−1], and herbicides [15 MJ ha−1]). Using similar energy sources, a standardized energy comparison provides an opportunity for estimation of weed control costs, suggesting site-specific weed management is critical in the economically realistic implementation of alternative technologies.
Introduction: Alcohol use disorder (AUD) is a chronic relapsing and highly comorbid disease. Patients suffering from AUD are frequently seen in the emergency department (ED) presenting intoxicated or in withdrawal. Brief interactions in the ED are often the only portal of entry to the healthcare system for many of these patients. Oral naltrexone and long acting injectable naltrexone are effective treatment options for AUD associated with decreased cravings, shorter length of hospital stay, and lower cost of healthcare utilization. This study's objective was to perform a systematic review of the literature evaluating initiation of naltrexone in the ED. Methods: Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were conducted and reference lists were hand-searched. Randomized controlled trials (RCTs) comparing initiation of naltrexone in patients (≥18 years) to standard care in the ED were included. Two reviewers independently screened titles and abstracts, reviewed full text articles for inclusion, assessed quality of the studies, and extracted data. Results: The search strategy yielded 183 potentially relevant citations. After eliminating duplicate citations and studies that did not meet eligibility criteria, 10 articles were retrieved for full text review. There were no published RCTs that examined naltrexone initiation in the ED. There is one ongoing study being conducted in New York, which aims to assess naltrexone initiation in the ED and measure health outcomes and quality of life of study participants, as well as potential healthcare cost savings. Conclusion: The lack of published research in this area demonstrates a significant gap in knowledge. It is clear that well-designed RCTs are needed to evaluate the effectiveness of initiating naltrexone for those with AUD at the ED visit.
Zn plays an important role in maintaining the anti-oxidant status within the heart and helps to counter the acute redox stress that occurs during myocardial ischaemia and reperfusion. Individuals with low Zn levels are at greater risk of developing an acute myocardial infarction; however, the impact of this on the extent of myocardial injury is unknown. The present study aimed to compare the effects of dietary Zn depletion with in vitro removal of Zn (N,N,N′,N′-tetrakis(2-pyridinylmethyl)-1,2-ethanediamine (TPEN)) on the outcome of acute myocardial infarction and vascular function. Male Sprague–Dawley rats were fed either a Zn-adequate (35 mg Zn/kg diet) or Zn-deficient (<1 mg Zn/kg diet) diet for 2 weeks before heart isolation. Perfused hearts were subjected to a 30 min ischaemia/2 h reperfusion (I/R) protocol, during which time ventricular arrhythmias were recorded and after which infarct size was measured, along with markers of anti-oxidant status. In separate experiments, hearts were challenged with the Zn chelator TPEN (10 µm) before ischaemia onset. Both dietary and TPEN-induced Zn depletion significantly extended infarct size; dietary Zn depletion was associated with reduced total cardiac glutathione (GSH) levels, while TPEN decreased cardiac superoxide dismutase 1 levels. TPEN, but not dietary Zn depletion, also suppressed ventricular arrhythmias and depressed vascular responses to nitric oxide. These findings demonstrate that both modes of Zn depletion worsen the outcome from I/R but through different mechanisms. Dietary Zn deficiency, resulting in reduced cardiac GSH, is the most appropriate model for determining the role of endogenous Zn in I/R injury.
A special purpose, automated, four circle goniometer arrangement has been developed for the rapid orientation of large specimens of single crystal turbine hardware. This system rapidly establishes the complete orientation of these large components and generates a fully documented stereographic projection. The system is also capable of generating detailed information on crystal quality including rocking curves in several dimensions. X, Y translational capability of the specimen makes it possible to characterize crystallographic defects such as sub-grain boundaries.
Effective assessment and remediation of hazardous waste sites dictates that analytical methodologies be developed which assist in the evaluation of site contamination and simultaneously make efficient use of sampling time and resources (1). Optimally, a technique would provide on-site personnel with immediate and accurate information concerning the identity and concentration of inorganic soil contaminants (2).
While contemporary scholarship on Erasmus’ Praise of Folly has been unusually productive, it has dealt primarily with structure and theme. It appears, however, that not nearly enough attention has been paid by scholars to the Listrius commentary which, after the 1515 Basel edition, became a standard appendage to the work. A close analysis of the commentary demonstrates that while at times it is ostentatious and irrelevant, its critical and interpretative remarks are often quite valuable. It can be seen not only as an objective statement of Erasmus' satiric method, but also as a kind of humanist courtesy book.
Almost from its inception, printers and translators made use of the commentary.
Like many other oceanic islands around the globe, environmental conditions, social circumstances and forces of globalization combine to challenge the sustainability of the Galapagos Archipelago of Ecuador. This paper describes a food-supply system in Galapagos that is mainly controlled by population growth, weak local agriculture, imports from mainland Ecuador and the influence of a growing tourism industry. We use system dynamics (SD) as a modeling technique in this paper to identify the main driving forces operating on the Galapagos food system to create a series of future scenarios and to examine the subsequent implications across the supply system structures. We model the supply side of the food system using secondary data collected from governmental and non-governmental sources. We find that the consumption profile of the local inhabitants of the Galapagos is on average higher than consumption in the Ecuadorian mainland. This fact, plus rapid growth of the local population fueled by the tourism industry, has created a decrease in per capita local food production and an increase on food import dependence that now, challenges the sustainability of the archipelago. Imports are the largest source of food in the archipelago. Approximately 75% of the agricultural food supply was transported from the mainland in 2017. Our model projects that this fraction will increase to 95% by 2037 with no changes in food policy. Moreover, any plan to increase tourism arrivals must be accompanied by a plan to address the subsistence needs of the new population that the tourism industry attracts. Policies to promote local agricultural growth should be central to the development strategy implemented in the Galapagos.
The evolution of material wealth-based inequality is an important topic in archaeological research. While a number of explanatory models have been proposed, rarely have they been adequately tested. A significant challenge to testing such models concerns our ability to define distinct, temporally short-term, residential occupations in the archaeological record. Sites often lack evidence for temporally persistent inequality, or, when present, the palimpsest nature of the deposits often make it difficult to define the processes of change on scales that are fine enough to evaluate nuanced model predictions. In this article, we use the detailed record of Housepit 54 from the Bridge River site, interior British Columbia, to evaluate several alternative hypotheses regarding the evolution of persistent material wealth-based inequality. Results of our analyses indicate that inequality appeared abruptly coincident with a decline in intra-house cooperation associated with population packing and the initiation of periodic subsistence stress. We conclude that persistent inequality in this context was a byproduct of altered social networks linked to a Malthusian transition and ceiling.
Harvest weed seed control (HWSC) is an Australian innovation, developed to target high proportions of weed seed retained at crop maturity by many major weed species. There is the potential, however, that a reduction in the average height of retained seed is an adaptation to the long-term use of HWSC practices. With the aim of examining the distribution of rigid ryegrass (Lolium rigidum Gaudin) seed through crop canopies, a survey of Australian wheat (Triticum aestivum L.) fields was conducted at crop maturity. Nine sites with medium to long-term HWSC use were specifically included to examine the influence of HWSC use on seed retention height. During the 2013 wheat harvest, L. rigidum and wheat plant samples were collected at five heights downward through the crop canopy (40, 30, 20, 10, and 0 cm above ground level) in 71 wheat fields. Increased crop competition resulted in higher proportions of L. rigidum seed in the upper crop canopy (>40 cm). The increase in plant height is likely a shade-intolerance response of L. rigidum plants attempting to capture more light. This plant attribute creates the opportunity to use crop competition to improve HWSC efficacy by increasing the average height of seed retention. Crop competition can, therefore, have a double impact by reducing overall L. rigidum seed production and increasing seed retention height. Examining the distribution of wheat biomass and L. rigidum seed through the crop canopy, we determined that reducing harvest height for HWSC considerably increased the collection of L. rigidum seed (25%) but to a lesser extent wheat crop biomass (14%). Comparison of + and − HWSC use at nine locations found no evidence of adaptation to this form of weed control following 5 to 10 yr of use. Although the potential for resistance to HWSC remains, these results indicate that this will not readily occur in the field.
Major and trace element data are presented for the basic, intermediate, and acid rocks of the Beinn Chaisgidle Centre of the Tertiary igneous complex on the Isle of Mull. The variation in the bulk chemical composition, the iron enrichment trend in the clinopyroxenes, the systematic decrease in concentrations of the transition metal cations, and the increase in the incompatible elements suggest that the magma from which these rocks formed underwent crystal fractionation. The rocks show a coherence of rare earth element patterns for all the rocks in the sequence, and there is a progressive increase in negative Eu anomaly with increasing silica content.
Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.
Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.
Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.
Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
Harvest weed seed control (HWSC) techniques have been implemented in Australian cropping systems to target and reduce the number of weed seeds entering the seedbank and thereby reduce the number of problematic weeds emerging in subsequent years to infest subsequent crops. However, the influence of HWSC on ameliorating herbicide-resistance (HR) evolution has not been investigated. This research used integrated spatial modeling to examine how the frequency and efficacy of HWSC affected the evolution of resistance to initially effective herbicides. Herbicides were, in all cases, better protected from future resistance evolution when their use was combined with annual HWSC. Outbreaks of multiple HR were very unlikely to occur and were nearly always eliminated by adding annual, efficient HWSC. The efficacy of the HWSC was important, with greater reductions in the number of resistance genes achieved with higher-efficacy HWSC. Annual HWSC was necessary to protect sequences of lower-efficacy herbicides, but HWSC could still protect herbicides if it was used less often than once per year, when the HWSC and the herbicides were highly effective. Our results highlight the potential benefits of combining HWSC with effective herbicides for controlling weed populations and reducing the future evolution of HR.
The intensely active 2017 Atlantic basin hurricane season provided an opportunity to examine how climate drivers, including warming oceans and rising seas, exacerbated tropical cyclone hazards. The season also highlighted the unique vulnerabilities of populations residing on Small Island Developing States (SIDS) to the catastrophic potential of these storms. During 2017, 22 of the 29 Caribbean SIDS were affected by at least one named storm, and multiple SIDS experienced extreme damage. This paper aims to review the multiplicity of storm impacts on Caribbean SIDS throughout the 2017 season, to explicate the influences of climate drivers on storm formation and intensity, to explore the propensity of SIDS to sustain severe damage and prolonged disruption of essential services, to document the spectrum of public health consequences, and to delineate the daunting hurdles that challenged emergency response and recovery operations for island-based, disaster-affected populations. (Disaster Med Public Health Preparedness. 2019;13:5–17)
Individuals who were born very preterm have higher rates of psychiatric diagnoses compared with term-born controls; however, it remains unclear whether they also display increased sub-clinical psychiatric symptomatology. Hence, our objective was to utilize a dimensional approach to assess psychiatric symptomatology in adult life following very preterm birth.
We studied 152 adults who were born very preterm (before 33 weeks’ gestation; gestational range 24–32 weeks) and 96 term-born controls. Participants’ clinical profile was examined using the Comprehensive Assessment of At-Risk Mental States (CAARMS), a measure of sub-clinical symptomatology that yields seven subscales including general psychopathology, positive, negative, cognitive, behavioural, motor and emotional symptoms, in addition to a total psychopathology score. Intellectual abilities were examined using the Wechsler Abbreviated Scale of Intelligence.
Between-group differences on the CAARMS showed elevated symptomatology in very preterm participants compared with controls in positive, negative, cognitive and behavioural symptoms. Total psychopathology scores were significantly correlated with IQ in the very preterm group only. In order to examine the characteristics of participants’ clinical profile, a principal component analysis was conducted. This revealed two components, one reflecting a non-specific psychopathology dimension, and the other indicating a variance in symptomatology along a positive-to-negative symptom axis. K-means (k = 4) were used to further separate the study sample into clusters. Very preterm adults were more likely to belong to a high non-specific psychopathology cluster compared with controls.
Conclusion and Relevance
Very preterm individuals demonstrated elevated psychopathology compared with full-term controls. Their psychiatric risk was characterized by a non-specific clinical profile and was associated with lower IQ.