To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Using existing data from clinical registries to support clinical trials and other prospective studies has the potential to improve research efficiency. However, little has been reported about staff experiences and lessons learned from implementation of this method in pediatric cardiology.
We describe the process of using existing registry data in the Pediatric Heart Network Residual Lesion Score Study, report stakeholders’ perspectives, and provide recommendations to guide future studies using this methodology.
The Residual Lesion Score Study, a 17-site prospective, observational study, piloted the use of existing local surgical registry data (collected for submission to the Society of Thoracic Surgeons-Congenital Heart Surgery Database) to supplement manual data collection. A survey regarding processes and perceptions was administered to study site and data coordinating center staff.
Survey response rate was 98% (54/55). Overall, 57% perceived that using registry data saved research staff time in the current study, and 74% perceived that it would save time in future studies; 55% noted significant upfront time in developing a methodology for extracting registry data. Survey recommendations included simplifying data extraction processes and tailoring to the needs of the study, understanding registry characteristics to maximise data quality and security, and involving all stakeholders in design and implementation processes.
Use of existing registry data was perceived to save time and promote efficiency. Consideration must be given to the upfront investment of time and resources needed. Ongoing efforts focussed on automating and centralising data management may aid in further optimising this methodology for future studies.
Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions’ feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols.
Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals.
Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates.
High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.
Introduction: Point-of-Care Ultrasound (PoCUS) is being increasingly utilized during cardiac arrests for prognosis. Following the publication of recent studies, the goal of this study was to systematically review and analyze the literature to evaluate the accuracy of PoCUS in predicting return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) in adult patients with non-traumatic, non- shockable out- of-hospital or emergency department cardiac arrest. Methods: A systematic review and meta-analysis was completed. A search of Medline, EMBASE, Cochrane, CINAHL, ClinicalTrials.gov and the World Health Organization Registry was completed from 1974 until August 24th 2018. Adult randomized controlled trials and observational studies were included. The QUADAS-2 tool was applied by two independent reviewers. Data analysis was completed according to PRISMA guidelines and with a random effects model for the meta-analysis. Heterogeneity was assessed using I-squared statistics. Results: Ten studies (1,485 participants) were included. Cardiac activity on PoCUS had a pooled sensitivity of 59.9% (95% confidence interval 36.5%-79.4%) and specificity of 91.5% (80.8%-96.5%) for ROSC; 74.7% (58.3%-86.2%) and 80.5% (71.7%-87.4%) for SHA; and 69.4% (45.5%-86.0%) and 74.6% (59.8%-85.3%) for SHD. The sensitivity of cardiac activity on PoCUS for predicting ROSC was 24.7%(6.8%-59.4%) in the asystole subgroup compared with 77% (59.4%-88.5%) within the PEA subgroup. Cardiac activity on PoCUS, compared to an absence had an odd ratio of 15.9 (5.9-42.5) for ROSC, 9.8 (4.9-19.4) for SHA and 5.7 (2.1-15.6) for SHD. Positive likelihood ratio (LR) was 6.65 (3.16-14.0) and negative LR was 0.27 (0.12-0.61) for ROSC. Conclusion: Cardiac activity on PoCUS was associated with improved odds for ROSC, SHA, and SHD among adults with non-traumatic asystole and PEA. We report lower sensitivity and higher negative likelihood ratio, but with greater heterogeneity compared to previous systematic reviews. PoCUS may provide valuable information in the management of non-traumatic PEA or asystole, but should not be viewed as the sole predictor in determining outcomes in these patients.
Lowering protein level in diets for piglets urge to have knowledge on the piglet’s requirements for essential amino acids (AA) and their interactions. The present studies aimed to determine the interaction between the dietary level of valine (Val) and tryptophan (Trp) and the effect of AA imbalance at two levels of dietary Val on the growth performance of post-weaning piglets. In Experiment 1 (duration 4 weeks), the effects of supplementation of free l-Val (1.0 g/kg) and/or l-Trp (0.5 g/kg) in a low-CP diet (CP 17.7%), marginal in Trp and Val, was studied in a 2×2 factorial design and using an additional reference treatment (CP 19.5%). In Experiment 2 (duration 5 weeks), the influence of a stepwise increase in excess supply of isoleucine (Ile), histidine (His) and leucine (Leu), up to 10, 10% and 30% relative to their requirement values respectively, was evaluated at 60% or 70% standardized ileal digestible (SID) Val relative to SID lysine, using a 3×2 factorial design. In Experiment 1, over the whole experimental period, feed intake (FI) was affected by dietary Trp level (P<0.05) and feed conversion ratio (FCR) by both the level of Trp and Val in the diet (both P<0.05). Increasing Trp level increased FI and decreased FCR while increasing dietary Val level reduced FI and increased FCR. For BW gain (BWG), there was an interaction between dietary level of Trp and Val (P<0.05). Valine supplementation decreased BWG using a diet marginal in Trp, whereas it increased BWG when using a Trp sufficient diet. Piglets fed the low-CP diet with adequate levels of Val and Trp showed at least same performance compared to piglets fed the high CP reference diet. In Experiment 2, increasing dietary Val improved FI and BWG (P<0.001) and tended to improve FCR. Dietary AA excess for Ile, His and Leu reduced FI and BWG (P<0.05) and only affected FCR (P<0.01) in the 1st week of the study. Dietary level of Val and AA excess did not show interactive effects, except for FCR over the final 2 weeks of the study (P<0.05). In conclusion, an interaction exists between dietary supply of Val and Trp on the zootechnical performance of post-weaning piglets and dietary AA excess for Ile, Leu and His, reduces growth performance of piglets in low-protein diets, independent of the dietary level of Val.
In order to control and optimize chicken quality products, it is necessary to improve the description of the responses to dietary amino acid (AA) concentration in terms of carcass composition and meat quality, especially during the finishing period. The aim of this study was to investigate the effects of Lysine (Lys, i.e. a limiting AA used as reference in AA nutrition) and AA other than Lys (AA effect). In total, 12 experimental diets were formulated with four levels of digestible Lys content (7, 8.5, 10 and 11.5 g/kg) combined with either a low (AA−), adequate control (AAc) and high (AA+) amount of other essential AA (EAA) expressed as a proportion of Lys. They were distributed to male Ross PM3 from 3 to 5 weeks of age. No significant AA×Lys interaction was found for growth performance or carcass composition. Body weight and feed conversion ratio were significantly improved by addition of Lys but were impaired in broilers receiving the AA− diets, whereas breast meat yield and abdominal fat were only affected by Lys. No additional benefit was found when the relative amount of other EAA was increased. There was a significant AA×Lys interaction on most of the meat quality traits, including ultimate pH, color and drip loss, with a significant effect of both AA and Lys. For example, AA− combined with reduced Lys level favored the production of meat with high ultimate pH (>6.0), dark color and low drip loss whereas more acid, light and exudative meat (<5.85) was produced with AA+ combined with a low Lys level. In conclusion, growth performance, carcass composition and meat quality are affected by the levels of dietary Lys and AA in finishing broilers. In addition, interactive responses to Lys and AA are found on meat quality traits, leading to great variations in breast pHu, color and drip loss according AA balance or imbalance.
We performed a spatial-temporal analysis to assess household risk factors for Ebola virus disease (Ebola) in a remote, severely-affected village. We defined a household as a family's shared living space and a case-household as a household with at least one resident who became a suspect, probable, or confirmed Ebola case from 1 August 2014 to 10 October 2014. We used Geographic Information System (GIS) software to calculate inter-household distances, performed space-time cluster analyses, and developed Generalized Estimating Equations (GEE). Village X consisted of 64 households; 42% of households became case-households over the observation period. Two significant space-time clusters occurred among households in the village; temporal effects outweighed spatial effects. GEE demonstrated that the odds of becoming a case-household increased by 4·0% for each additional person per household (P < 0·02) and 2·6% per day (P < 0·07). An increasing number of persons per household, and to a lesser extent, the passage of time after onset of the outbreak were risk factors for household Ebola acquisition, emphasizing the importance of prompt public health interventions that prioritize the most populated households. Using GIS with GEE can reveal complex spatial-temporal risk factors, which can inform prioritization of response activities in future outbreaks.
The effect of animal characteristics and placement decisions on retained ownership profitability of Tennessee cattle from 2005 to 2015 was determined using a mixed model regression. Ex post simulation analysis examined retained ownership profitability by placement season under different animal characteristic and corn price scenarios. Regression results indicate that placement weight, placement season, days on feed, animal health, and animal sex affect retained ownership profitability. Simulation results indicate that winter placement of cattle in feedlots had the highest expected retained ownership profits. Results provide risk-averse producers information regarding the profitability of retained ownership.
Reducing the dietary CP content is an efficient way to limit nitrogen excretion in broilers but, as reported in the literature, it often reduces performance, probably because of an inadequate provision in amino acids (AA). The aim of this study was to investigate the effect of decreasing the CP content in the diet on animal performance, meat quality and nitrogen utilization in growing-finishing broilers using an optimized dietary AA profile based on the ideal protein concept. Two experiments (1 and 2) were performed using 1-day-old PM3 Ross male broilers (1520 and 912 for experiments 1 and 2, respectively) using the minimum AA:Lys ratios proposed by Mack et al. with modifications for Thr and Arg. The digestible Thr (dThr): dLys ratio was increased from 63% to 68% and the dArg:dLys ratio was decreased from 112% to 108%. In experiment 1, the reduction of dietary CP from 19% to 15% (five treatments) did not alter feed intake or BW, but the feed conversion ratio was increased for the 16% and 15% CP diets (+2.4% and +3.6%, respectively), while in experiment 2 (three treatments: 19%, 17.5% and 16% CP) there was no effect of dietary CP on performance. In both experiments, dietary CP content did not affect breast meat yield. However, abdominal fat content (expressed as a percentage of BW) was increased by the decrease in CP content (up to +0.5 and +0.2 percentage point, in experiments 1 and 2, respectively). In experiment 2, meat quality traits responded to dietary CP content with a higher ultimate pH and lower lightness and drip loss values for the low CP diets. Nitrogen retention efficiency increased when reducing CP content in both experiments (+3.5 points/CP percentage point). The main consequence of this higher efficiency was a decrease in nitrogen excretion (−2.5 g N/kg BW gain) and volatilization (expressed as a percentage of excretion: −5 points/CP percentage point). In conclusion, this study demonstrates that with an adapted AA profile, it is possible to reduce dietary CP content to at least 17% in growing-finishing male broilers, without altering animal performance and meat quality. Such a feeding strategy could therefore help improving the sustainability of broiler production as it is an efficient way to reduce environmental burden associated with nitrogen excretion.
Molecules in space are synthesized via a large variety of gas-phase reactions, and reactions on dust-grain surfaces, where the surface acts as a catalyst. Especially, saturated, hydrogen-rich molecules are formed through surface chemistry. Astrochemical models have developed over the decades to understand the molecular processes in the interstellar medium, taking into account grain surface chemistry. However, essential input information for gas-grain models, such as binding energies of molecules to the surface, have been derived experimentally only for a handful of species, leaving hundreds of species with highly uncertain estimates. Moreover, some fundamental processes are not well enough constrained to implement these into the models.
The proceedings gives three examples how computational chemistry techniques can help answer fundamental questions regarding grain surface chemistry.
The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest.
The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol.
Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the “4 F” approach: fluid, form, function, filling.
An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.
We examined functional outcomes and quality of life of whole brain radiotherapy (WBRT) with integrated fractionated stereotactic radiotherapy boost (FSRT) for brain metastases treatment. Methods Eighty seven people with 1-3 brain metastases were enrolled on this Phase II trial of WBRT (30Gy/10)+simultaneous FSRT, (60Gy/10). Results Mean (Min-Max) baseline KPS, Mini Mental Status Exam (MMSE) and FACT-BR quality of life were 83 (70-100), 28 (21-30) and 143 (98-153). Lower baseline MMSE (but not KPS or FACT-Br) was associated with worse survival after adjusting for age, number of metastases, primary and extra-cranial disease status. Crude rates of deterioration (>10 points decrease from baseline for KPS and FACT-Br, MMSE fall to<27) ranged from 26-38% for KPS, 32-59% for FACT-Br and 0-16%for MMSE depending on the time-point assessed with higher rates generally noted at earlier time points (<6months post-treatment). Using a linear mixed models analysis, significant declines from baseline were noted for KPS and FACT-Br (largest effects at 6 weeks to 3 months) with no significant change in MMSE. Conclusions The effects on function and quality of life of this integrated treatment of WBRT+simultaneous FSRT were similar to other published series combining WBRT+SRS.
La centralisation au Bureau international de l’Heure des résultats d’observations de l’Opération internationale de 1933 a été très lente, puisque les dernières données attendues ont été reçues vers la fin de 1937.
Le nombre des stations ayant coopéré à l’Opération internationale et ayant transmis leurs observations à l’organisme centralisateur s’élève à soixante et onze. Ainsi qu’il a été expliqué à notre Commission mixte, lors du Congrès de l’Union géodésique et géophysique internationale tenu à Édimbourg en 1936, ces stations ont été réparties en trois groupes:
Le Ier comprenant vingt Observatoires, disposant chacun de plusieurs horloges de première classe (soit à poids sous pression et à température constantes, soit à quartz piézoélectrique);
M. le Président fait connaître que, à la suite du concours financier apporté au B.I.H. par l’Union internationale de Géodésie et Géophysique à partir du 1er janvier 1933, la Commission 31 s’est transformée en une commission mixte, et aux membres appartenant à l’Union astronomique se sont donc ajoutés des membres de l’Union de Géodésie et Géophysique.
M. le Président a examiné les comptes du Bureau international de l’Heure pour les années 1932 à 1934 et a reconnu que les règlements ont été respectés; les revenus ont été en 1932 de 55773.50 fr.; en 1933 la subvention de l’Union astronomique a été de 39487.30 fr. français; et celle de l’Union de Géodésie et Géophysique de 19980.80 fr. français. En 1934 les subventions ont été respectivement de 39424 fr. et de 20000 fr.
Sur la proposition du Comité exécutif, l’Assemblée générale du 13 juillet 1928, réunie à Leyde, adopta la résolution suivante:
“Le Comité exécutif espère que d’ici à la fin de la présente convention (31 décembre 1931) la direction du Bureau de l’Heure pourra être exercée par le Directeur de l’Observatoire de Paris, et qu’après cette date l’activité actuelle du Bureau pourra être conservée sans faire appel aux fonds limités de l’Union, peut-être avec la coopération d’observatoires et autres institutions.”
Trois résolutions ont été adoptées par la 4e Assemblée générale de l’Union astronomique internationale, à Cambridge (Mass.) en 1932.
Elles se rapportaient à l’opération internationale des longitudes (réalisée en 1933) et avaient pour objet:
(1)L’émission d’un trait d’une durée de 10 secondes après tout envoi de signaux horaires.
(2)La mission confiée au Bureau international de l’Heure (B.I.H.) de centraliser, discuter et publier les résultats de l’opération.
(3)L’approbation du programme des opérations, exposé dans le Rapport présenté à Cambridge par le Président et le Secrétaire de la Commission.
Le Président est heureux de constater que les propositions de ce Rapport ont pu être réalisées dans une très large part. Il remercie tous les Observatoires et organismes participants de leur collaboration et les félicite vivement de l’activité qu’ils ont déployée pendant la campagne scientifique de 1933.
Les premiers mots de ce Rapport seront un souvenir ému à la mémoire de notre regretté Président, le Général Ferrie, brutalement arraché, en pleine activité physique et intellectuelle, au respect et à l’affection de tous, le 16 février 1932. Il fut l’instigateur et l’animateur des travaux auxquels se consacre notre Commission. Nous ne saurions lui rendre de plus bel hommage—celui-là même qu’il eut souhaité sans doute—qu’en nous attachant à poursuivre, dans la voie qu’il avait tracée en 1926 et qu’il avait commencé de prolonger en vue des opérations de 1933, la mise au point d’une entreprise de haute portée scientifique et qui était au tout premier plan de ses préoccupations.
In consequence of the decision made by the Fifth General Assembly of the I.A.U. I have been entrusted, from January 1936, with the direction of the Central Bureau for the International Service of Latitudes.
I am much indebted to Prof. Kimura, who preceded me as Director and to Prof. Kohlschütter, Director of the Geodetic Institute of Potsdam, for information and advice, which has been of great assistance to me; therefore I desire to acknowledge to them my deep gratitude.