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Sediments that accumulate in high-latitude lakes serve as valuable environmental archives of changing conditions in a region currently undergoing rapid change. A previously unexplored sedimentary sequence reaching back 16,000 years from Lakes Peters and Schrader (Neruokpuk Lakes) in the northeastern Brooks Range (69°N), Alaska, shows distinct changes in accumulation rates and biophysical properties including bulk density (BD), organic matter (OM) content, and grain-size distribution at five widely distributed core sites. The oldest sediments contain little OM and accumulated rapidly as glaciers retreated around 15 ka. OM peaked between 12 and 10 ka along with Northern Hemisphere summer insolation. BD increased and OM decreased until around 5 ka, possibly reflecting a decrease in river-transported terrestrial OM. From 5–2 ka, OM consistently increased, suggesting a rise in river discharge, or a rise in summer temperatures, which led to higher productivity, or both. After 2 ka, sediments increased in BD and decreased in OM, suggesting glacier growth. Evidence for glacier expansion late during the Little Ice Age is weak, but increased sedimentation rates may reflect glacier retreat during the last century. This study provides a framework for future paleoenvironmental research of a rare archive in a relatively pristine Arctic setting.
Assessment of right ventricular size and function is an important part of the clinical cardiac evaluation; however, these quantitative measures are challenging by echocardiography. Automated software could be useful in place of manual measurements and qualitative assessment. This study evaluates a semi-automated software by comparing automated to manual measures in normal children.
Neonates to adolescents with normal echocardiograms were prospectively enrolled. Measurements were performed using manual techniques and semi-automated software (EchoInsight®, Epsilon Imaging, Ann Arbor, Michigan, United States of America). Right ventricular measurements included end-diastolic and end-systolic area, fractional area change, chamber dimensions, and tricuspid annular plane systolic excursion. Agreement between manual and semi-automated measures was compared.
Echocardiograms for 233 patients were included in the analysis. Intra- and inter-observer reliabilities for semi-automated measures were good with intraclass correlation coefficients all over 0.9 and 0.85, respectively. There was very strong correlation between manual and semi-automated methods for areas and dimensions (r = 0.93–0.99) and low bias (1.4–10.8%). For functional measures, tricuspid annular plane systolic excursion measures correlated well (r = 0.84), but fractional area change did not (r = 0.50). Both demonstrated significant bias (33.5–43.0%). The semi-automated method consistently underestimated fractional area change with a mean of 26.6% versus a manual mean of 36.1%.
The semi-automated software is capable of generating quantitative right ventricular measures in children with good reliability. The software demonstrates very good correlation and low bias when compared to manual methods for right ventricular areas and dimensions. There is a significant difference between manual and semi-automated techniques for the functional measures.
The preservation of genetic diversity is an important aspect of conservation biology. Low genetic diversity within a population can lead to inbreeding depression and a reduction in adaptive potential, which may increase extinction risk. Here we report changes in genetic diversity over 12 years in a declining population of the Corncrake Crex crex, a grassland bird species of high conservation concern throughout Europe. Despite a twofold demographic decline during the same period, we found no evidence for a reduction of genetic diversity. The gradual genetic differentiation observed among populations of Corncrake across Europe suggests that genetic diversity is maintained in western populations by constant gene flow from the larger and more productive populations in eastern Europe and Asia. The maintenance of genetic diversity in this species is an opportunity that may help the implementation of effective conservation actions across the Corncrake’s European range.
Understanding perceptions of family caregivers’ roles and responsibilities regarding their child with complex cardiac needs has potential to help care teams better support parents. Paternal experience has been under-explored in pediatric cardiac cohorts.
Ten fathers of children undergoing cardiac surgery completed quantitative surveys on their knowledge needs and preferred format of communication. In face-to-face recorded interviews, they responded to open-ended questions about the definition of being a good father to a child with a complex cardiac condition, perceived paternal responsibilities, personal growth as a parent to a child with a complex heart condition, support needs, and recommendations to medical staff for paternal inclusion. Semantic content analysis was utilised. The study reports strictly followed COnsolidated criteria for REporting Qualitative research guidelines.
The fathers reported high preference for knowledge about the child’s heart condition, communication about the treatment plan, and desire for inclusion in the care of their child. Paternal role was defined thematically as: providing a supportive presence, being there, offering bonded insight, serving as strong provider, and acting as an informed advocate. The fathers revealed that their responsibilities sometimes conflicted as they strove to serve as an emotional and economic stabiliser for their family, while also wanting to be foundationally present for their child perioperatively.
This study provides insight into paternal experience and strategies for paternal inclusion. This summary of the self-defined experience of the fathers of pediatric cardiac patients offers constructive and specific advice for medical teams.
In a recent paper (J. Fluid Mech., vol. 861, 2019, pp. 328–348), Benilov derived equations governing a laminar liquid sheet (a curtain) that emanates from a slot whose centreline is inclined to the vertical. The equations are valid for slender sheets whose characteristic length scale in the direction of flow is much larger than its cross-sectional thickness. For a liquid that leaves a slot with average speed,
, volumetric flow rate per unit width,
, surface tension,
, and density,
, Benilov obtains parametric equations that predict steady-state curtain shapes that bend upwards against gravity provided
. Benilov’s parametric equations are shown to be identical to those derived by Finnicum, Weinstein, and Ruschak (J. Fluid Mech., vol. 255, 1993, pp. 647–665). In the latter form, it is straightforward to deduce an alternative solution of Benilov’s equations where a curtain falls vertically regardless of the slot’s orientation. This solution is consistent with prior experimental and theoretical results that show that a liquid curtain can emerge from a slot at an angle different from that of the slot centreline.
The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.
We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.
This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.
Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).
Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.
Declaration of interest
F.G. has received honoraria for advisory work and lectures or CME activity support from Roche, BMS, Lundbeck, Otsuka, Janssen and Sunovion, is a collaborator on an NHS Innovations project co-funded by Janssen and has a family member with professional links to Lilly and GSK, including shares. R.M.M. has received honoraria for lectures from Lundbeck, Otsuka, Janssen and Sunovian. M.D.F. has received honoraria for lectures from Janssen and Sunovian. Z.A. has received honoraria for advisory work and lectures from Roche, Sanofi, Lilly and Otsuka. O.H. has received investigator-initiated research funding from and/or participated in advisory/speaker meetings organised by Astra-Zeneca, Autifony, Biogen, BMS, Eli Lilly, Heptares, Jansenn, Lundbeck, Lyden-Delta, Otsuka, Servier, Sunovion, Rand and Roche. D.T. has received funding for lectures and research from Janssen, Otsuka, Servier, Lundbeck, Sunovion.
We present a case of pulmonary venous baffle obstruction in a child with a history of congenitally corrected transposition status post double switch repair. We highlight two forms of volume rendering three-dimensional reconstructions from computed tomographic data which allowed for detailed pre-surgical planning. These reconstructions emphasise the concept of maximizing previously obtained two-dimensional data in a time-efficient and cost-effective manner. The benefits of these reconstructions are reviewed, highlighting the relatively novel virtual dissection reconstruction technique that appeared identical to what the surgeon encountered in the operating theatre. This technique allowed the surgeon to quickly advance a preconceived detailed surgical repair.
Coupling semiconductors with electrochemical processes can lead to unusual materials, and attractive, practical device configurations. This work examines the reaction mechanism for single-step electrodeposition approach that creates device quality copper-indium-selenide (CISe) films with either polycrystalline or nanocrystalline morphologies on Cu and steel foils, respectively. The polycrystalline CISe film grows from In3+/Se4+ solution on Cu foil as Cu→ CuxSe→ CuInSe2; it may be used in standard planar pn devices. The nanocrystalline CISe film grown from Cu+/In3+/Se4+ solution follows the CuSe(In)→ CuInSe2→ CuIn3Se5 sequence. The latter approach leads to naturally ordered, space-filling nanocrystals, comprising interconnected 3-dimensional network of sharp, abrupt, p-CISe/n-CISe bulk homojunctions with extraordinary electro-optical attributes. Sandwiching these films between band-aligned contact electrodes can lead to high performance third generation devices for solar cells, light emitting diodes or photoelectrodes for fuel cells. Both approaches produce self-stabilized CISe absorbers that avoid recrystallization steps and can be roll-to-roll processed in simple flexible thin-film form factor for easy scale-up.
The concept of exoplanetary habitability is evolving. The driving force is a desire to define the biological potential of planets and identify which can host complex and possibly intelligent life. To assess this in a meaningful manner, climate models need to be applied to realistic surfaces. However, the vast majority of climate models are developed using generic aquaplanet, or swamp planet, scenarios that provide uniform, surface frictional coefficients. However, aside from planets with largely uniform oceans, these models are not obviously useful when it comes to understanding the impact of climate on biodiversity. Here, we show that contrary to expectation, the aquaplanet models can be directly applied to planets with a variety of land areas, with little need for modification. Using this premise, this paper provides a simple mathematical framework that may be applied to more complex planetary surfaces and identifies the majority of the climate-model components that are needed to accurately determine the biological potential of habitable exoplanets. As a proof-of-concept, an available climate model for Proxima b is used to determine its biological potential, given a suitable atmosphere.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
One major challenge facing policy-makers is to design education and workplace training programs that are appropriately challenging. We review previous research that suggests that difficult training is better than easy training. However, surveys we conducted of students and of expert sport coaches showed that many prescribed easy rather than difficult training for those they coached. We analyzed the performance of National Collegiate Athletic Association (NCAA) basketball teams in postseason tournaments to see whether the existing research, largely on individuals in short-term situations, would generalize to teams in the long run. Indeed, playing difficult nonconference (training) games modestly improved performance for NCAA teams in the postseason. Difficult training particularly benefitted teams that lost many nonconference games, and the effect of difficulty was positive within the range of difficulty NCAA teams actually encounter, making it clear that difficult training is superior. We suggest that our results can be generalized beyond sports, although with careful consideration of differences between NCAA basketball teams and other teams that may limit generalizability. These results suggest that policy-makers might consider amplifying the difficulty of team training exercises under certain conditions.
In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.
An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.
We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.
Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.
This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
Most reports on the outcome of children who present with heart failure, due to heart muscle disease, are from an era when ventricular assist devices were not available. This study provides outcome data for the current era where prolonged circulatory support can be considered for most children.
Methods & Results:
Data was retrieved on 100 consecutive children, who presented between 2010 – 2016, with a first diagnosis of unexplained heart failure. Hospital outcome was classified as either death, transplantation, recovery of function or persistent heart failure. Median age at presentation was 24 months and 58% were < 5 years old. Hospital mortality was 12% and 59% received a heart transplant. Most, 79%, of the transplants were carried out on patients with a device. Recovery of function was observed in 18% and 10% stabilised on oral therapy. Eighty-four percent of the deaths occurred in the <5 year old group. Shorter duration of support was associated with survival (34 days in survivors versus 106 in non-survivors, p = 0.01) and 72% were on an assist device at time of death.
Heart failure in children who require referral to a transplant unit is a serious illness with a high chance of either transplantation or death. Modifications in assist devices will be required to improve safety, especially for children < 5 years old where the donor wait may be prolonged. The identification of children who may recover function requires further study.