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We evaluated the safety and feasibility of high-intensity interval training via a novel telemedicine ergometer (MedBIKE™) in children with Fontan physiology.
The MedBIKE™ is a custom telemedicine ergometer, incorporating a video game platform and live feed of patient video/audio, electrocardiography, pulse oximetry, and power output, for remote medical supervision and modulation of work. There were three study phases: (I) exercise workload comparison between the MedBIKE™ and a standard cardiopulmonary exercise ergometer in 10 healthy adults. (II) In-hospital safety, feasibility, and user experience (via questionnaire) assessment of a MedBIKE™ high-intensity interval training protocol in children with Fontan physiology. (III) Eight-week home-based high-intensity interval trial programme in two participants with Fontan physiology.
There was good agreement in oxygen consumption during graded exercise at matched work rates between the cardiopulmonary exercise ergometer and MedBIKE™ (1.1 ± 0.5 L/minute versus 1.1 ± 0.5 L/minute, p = 0.44). Ten youth with Fontan physiology (11.5 ± 1.8 years old) completed a MedBIKE™ high-intensity interval training session with no adverse events. The participants found the MedBIKE™ to be enjoyable and easy to navigate. In two participants, the 8-week home-based protocol was tolerated well with completion of 23/24 (96%) and 24/24 (100%) of sessions, respectively, and no adverse events across the 47 sessions in total.
The MedBIKE™ resulted in similar physiological responses as compared to a cardiopulmonary exercise test ergometer and the high-intensity interval training protocol was safe, feasible, and enjoyable in youth with Fontan physiology. A randomised-controlled trial of a home-based high-intensity interval training exercise intervention using the MedBIKE™ will next be undertaken.
Perovskite solar cells continue to garner significant attention in the field of photovoltaics. As the optoelectronic properties of the absorbers become better understood, attention has turned to more deeply understanding the contribution of charge transport layers for efficient extraction of carriers. Titanium oxide is known to be an effective electron transport layer (ETL) in planar perovskite solar cells, but it is unlikely to result in the best device performance possible. To investigate the importance of band energy alignment between the electron transport layer and perovskite, we employ numerical modeling as a function of conduction band offset between these layers, interface recombination velocity, and ETL doping levels. Our simulations offer insight into the advantages of energy band alignment and allow us to determine a range of surface recombination velocities and ETL doping densities that will allow us to identify novel high performance ETL materials.
Wiebe examines a historical shift from deductive inference to inductive inference and then to abductive methodological approaches in philosophy and science, with regard to their bearing on religious experience. In addition, he remarks on a "theory of Spirits" that postulates theoretical entities for explanatory purposes in connection with religious phenomena, and he suggests that a new epistemology of religious experience is needed for adequate explanatory purposes.
Engagement of frontline staff, along with senior leadership, in competition-style healthcare-associated infection reduction efforts, combined with electronic clinical decision support tools, appeared to reduce antibiotic regimen initiations for urinary tract infections (P = .01). Mean monthly standardized infection and device utilization ratios also decreased (P < .003 and P < .0001, respectively).
The above famous critique of intravenous anesthesia occurred following the bombing of Pearl Harbor, where anesthesia folklore tells us more Americans died from the use of thiopentone than from the Japanese attack. However, in the same journal that published Halford’s statement there appeared a case study of the use of thiopentone in a shocked patient with a gunshot wound to her chest and upper abdomen.
Subclinical psychotic-like experiences (PLE), resembling key symptoms of psychotic disorders, are common throughout the general population and possibly associated with psychosis risk. There is evidence that such symptoms are also associated with structural brain changes.
In 672 healthy individuals, we assessed PLE and associated distress with the symptom-checklist-90R (SCL-90R) scales ‘schizotypal signs’ (STS) and ‘schizophrenia nuclear symptoms’ (SNS) and analysed associations with voxel- and surfaced-based brain structural parameters derived from structural magnetic resonance imaging at 3 T with CAT12.
For SNS, we found a positive correlation with the volume in the left superior parietal lobule and the precuneus, and a negative correlation with the volume in the right inferior temporal gyrus [p < 0.05 cluster-level Family Wise Error (FWE-corrected]. For STS, we found a negative correlation with the volume of the left and right precentral gyrus (p < 0.05 cluster-level FWE-corrected). Surface-based analyses did not detect any significant clusters with the chosen statistical threshold of p < 0.05. However, in exploratory analyses (p < 0.001, uncorrected), we found a positive correlation of SNS with gyrification in the left insula and rostral middle frontal gyrus and of STS with the left precuneus and insula, as well as a negative correlation of STS with gyrification in the left temporal pole.
Our results show that brain structures in areas implicated in schizophrenia are also related to PLE and its associated distress in healthy individuals. This pattern supports a dimensional model of the neural correlates of symptoms of the psychotic spectrum.
This applied experimental research tested the effectiveness of a universal, student-focused intervention (‘Memory Mates’), specifically focused on supporting students to use attention and working memory strategies within academic contexts, unlike computer-based programs. Memory Mates is presented in the form of icons and explanations, with the strategies embedded within the classroom. Analyses compared the impact of the intervention over 8 months in three schools with three control schools, comprising 13 Year 4 primary school classes. The intervention group students showed a significant improvement in mathematics and spelling; however, there was no differential effect on reading comprehension or academic engagement. Based on the present results, it is contended that implementing Memory Mates within classroom contexts demonstrated promising potential as a new approach to supporting academic progress.
It is well-known that Kant defends a conception of God and the final end of our moral striving, called the highest good. In this article, I outline Kant's argument for why we ought to have faith in God and hope for the highest good, and argue that the Kantian argument can be extended in such a way as to show the unity of the theological virtues. This feature of the Kantian account can then have ramifications in further questions regarding the relationship of faith and moral action.
The purpose of this study was to describe the prevalence of hearing loss (HL), vision loss (VL), and dual sensory loss (DSL) in Canadians 45–85 years of age. Audiometry and visual acuity were measured. Various levels of impairment severity were described. Results were extrapolated to the 2016 Canadian population. In 2016, 1,500,000 Canadian males 45–85 years of age had at least mild HL, 1,800,000 had at least mild VL, and 570,000 had DSL. Among females, 1,200,000 had at least mild HL, 2,200,000 had at least mild VL, and 450,000 had DSL. Among Canadians 45–85 years of age, mild, moderate, and severe HL was prevalent among 13.4 per cent, 3.7 per cent, and 0.4 per cent of males, and among 11.3 per cent, 2.3 per cent, and 0.2 per cent of females, respectively. Mild and moderate, or severe VL was prevalent among 19.8 per cent and 2.4 per cent of males, and among 23.9 per cent and 2.6 per cent of females, respectively. At least mild DSL was prevalent among 6.4 per cent of males and 6.1 per cent of females.
To draw lessons from Fiji regarding the challenges and opportunities for policy initiatives to restrict (i) food marketing to children and (ii) marketing of breast milk substitutes, to inform policy for the double burden of malnutrition.
Qualitative political economy analysis of two policy case studies.
Eleven key informants from relevant sectors, representing public health, economic and consumer interests.
This study used two policy initiatives as case studies to examine factors influencing decision-making: Marketing Controls (Foods for Infants and Young Children) Regulations 2010, amended in 2016 to remove guidelines and restrictions on marketing in the form of labelling, and the draft Advertising and Promotion of Unhealthy Foods and Non-Alcoholic Beverages to Children Regulation developed in 2014 but awaiting review by the Solicitor General’s Office. Factors identified included: a policy paradigm in which regulation of business activity contradicts economic policy goals; limited perception by key policy actors of links between nutrition and marketing of breast milk substitutes, foods and beverages; and a power imbalance between industry and public health stakeholders in policymaking. Regulation of marketing for health purposes sits within the health sector’s interest but not its legislative remit, while within the economic sector’s remit but not interest. Opportunities to strengthen restrictions on marketing to improve nutrition and health include reframing the policy issue, strategic advocacy and community engagement.
Restricting marketing should be recognised by public health actors as a public health and an industry policy issue, to support strategic engagement with economic policy actors.
The data regarding the effectiveness of chemical prophylaxis against recurrent C. difficile infection (CDI) remain conflicting.
Retrospective cohort study on the effectiveness of oral vancomycin for prevention of recurrent CDI.
Two academic centers in New York.
Two participating hospitals implemented an automated alert recommending oral vancomycin 125 mg twice daily in patients with CDI history scheduled to receive systemic antimicrobials. Measured outcomes included breakthrough and recurrent CDI rates, defined as CDI during and 1 month after initiation of prophylaxis, respectively. A self-controlled, before-and-after study design was employed to examine the effect of vancomycin prophylaxis on the prevalence of vancomycin-resistant Enterococcus spp (VRE) colonization and infection.
We included 264 patients in the analysis. Breakthrough CDI was identified in 17 patients (6.4%; 95% confidence interval [CI], 3.8%–10.1%) and recurrent in 22 patients (8.3%; 95% CI, 5.3%–12.3%). Among the 102 patients with a history of CDI within the 3 months preceding prophylaxis, 4 patients (3.9%; 95% CIs, 1.1%–9.7%) had breakthrough CDI and 9 had recurrent disease (8.8%; 95% CIs, 4.1%–16.1%). In the 3-month period following vancomycin prophylaxis, we detected a statistically significant increase in both the absolute number of VRE (χ2, 0.003) and the ratio of VRE to VSE isolates (χ2, 0.003) compared to the combined period of 1.5 months preceding and the 3–4.5 months following prophylaxis. This effect persisted 6 months following prophylaxis.
Prophylactic vancomycin is an effective strategy to prevent CDI recurrence, but it increases the risk of VRE colonization. Thus, a careful selection of patients with high benefit-to-risk ratio is needed for the implementation of this preventive policy.
Obtaining objective, dietary exposure information from individuals is challenging because of the complexity of food consumption patterns and the limitations of self-reporting tools (e.g., FFQ and diet diaries). This hinders research efforts to associate intakes of specific foods or eating patterns with population health outcomes.
Dietary exposure can be assessed by the measurement of food-derived chemicals in urine samples. We aimed to develop methodologies for urine collection that minimised impact on the day-to-day activities of participants but also yielded samples that were data-rich in terms of targeted biomarker measurements.
Urine collection methodologies were developed within home settings.
Different cohorts of free-living volunteers.
Home collection of urine samples using vacuum transfer technology was deemed highly acceptable by volunteers. Statistical analysis of both metabolome and selected dietary exposure biomarkers in spot urine collected and stored using this method showed that they were compositionally similar to urine collected using a standard method with immediate sample freezing. Even without chemical preservatives, samples can be stored under different temperature regimes without any significant impact on the overall urine composition or concentration of forty-six exemplar dietary exposure biomarkers. Importantly, the samples could be posted directly to analytical facilities, without the need for refrigerated transport and involvement of clinical professionals.
This urine sampling methodology appears to be suitable for routine use and may provide a scalable, cost-effective means to collect urine samples and to assess diet in epidemiological studies.