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.
N-terminal pro-brain natriuretic peptide has an established role in the diagnosis and prognosis of heart failure. In Fontan patients, this peptide is often increased, but its diagnostic value in this particular non-physiologic, univentricular circulation is unclear. We investigated whether N-terminal pro-brain natriuretic peptide represents ventricular function or other key variables in Fontan patients.
Methods and results:
Ninety-five consecutive Fontan patients ≥10 years old who attended the outpatient clinic of the Center for Congenital Heart Diseases in 2012–2013 were included. Time since Fontan completion was 16 ± 9 years. Median N-terminal pro-brain natriuretic peptide was 114 (61–264) ng/l and was higher than gender-and age-dependent normal values in 54% of the patients. Peptide Z-scores were higher in patients in NYHA class III/IV compared to those in class I/II, but did not correlate with ventricular function assessed by MRI and echocardiography, nor with peak exercise capacity. Instead, peptide Z-scores significantly correlated with follow-up duration after Fontan completion (p < 0.001), right ventricular morphology (p = 0.004), indexed ventricular mass (p = 0.001), and inferior caval vein diameter (p < 0.001) (adjusted R2 = 0.615).
N-terminal pro-brain natriuretic peptide levels in Fontan patients correlate with functional class, but do not necessarily indicate ventricular dysfunction. Increased peptide levels were associated with a longer existence of the Fontan circulation, morphologic ventricular characteristics, and signs of increased systemic venous congestion. Since the latter are known to be key determinants of the performance of the Fontan circulation, these findings suggest increase in N-terminal pro-brain natriuretic peptide levels to indicate attrition of the Fontan circulation, independent of ventricular function.
Elastic modulus and residual stress in freestanding ultrathin films (<100 nm) are characterized using bilayer cantilevers. The cantilevers comprise a test film and a well-characterized reference material (SU-8). When released from the substrate, residual stresses in the bilayer cantilever cause it to deflect with measurable curvatures, allowing the determination of both stiffness and residual stress of the test film. The technique does not require sophisticated mechanical test equipment and serves as a useful metrology tool for characterizing coatings immediately after fabrication in a clean room assembly line. The measured biaxial modulus and residual strain of 75 nm copper films are 211 ± 19 GPa and (7.05 ± 0.22) × 10−3, respectively. Additional experiments on the freestanding structures yield a mean Young’s modulus of 115 GPa. These properties are in close agreement with those measured from additional residual stress–driven structures developed on the same coatings by the authors.
The laws governing humanitarian action stand at the intersection of several fields of international law, regional agreements, soft law and domestic law. Through in-depth case studies and analyses, expert scholars and practitioners come together to offer interdisciplinary approaches which include contributions from legal policy, international relations and philosophical perspectives. Providing invaluable overviews and insights, this collection of essays sheds light on the subject and makes sense of the various elements involved to elucidate the foundations of law and policy of humanitarian action.
Reactive nitrogen (Nr) occurs in different forms, arises from a wide range of activities and sources, and leads to environmental impacts over different spatial and temporal scales.
Integrated approaches to N management are anticipated to provide more effective (larger decreases in unwanted emissions) and /or more efficient (less side effects, less costs) policy measures than policy measures based on single sources and pollutant species.
There are many notions of integrated approaches, but as yet little consensus about the best integrated approaches. There is also little quantitative empirical evidence of the performance of these approaches in practice.
The pitfall of integrated approaches is that they may be more complex to agree, leading to a delayed implementation.
Based on recent literature and a discussion among experts, the present chapter provides a conceptual framework for developing integrated approaches to N management.
Whilst discussing the framework, various examples of existing partially integrated N management approaches have been considered.
A package of key actions in different sectors is envisaged that, together, should contribute to further developing integrated approaches to N management in the future