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The Fontan Outcomes Network was created to improve outcomes for children and adults with single ventricle CHD living with Fontan circulation. The network mission is to optimise longevity and quality of life by improving physical health, neurodevelopmental outcomes, resilience, and emotional health for these individuals and their families. This manuscript describes the systematic design of this new learning health network, including the initial steps in development of a national, lifespan registry, and pilot testing of data collection forms at 10 congenital heart centres.
Coronavirus disease 2019 (COVID-19) has caused a global pandemic which has affected patients and healthcare systems around the world. Patients with underlying health conditions seem to be more severely affected. There are limited reports of patients with univentricular circulations and COVID 19; thus, we report a case of COVID-19 in a patient with a univentricular circulation.
Given the common view that pre-exercise nutrition/breakfast is important for performance, the present study investigated whether breakfast influences resistance exercise performance via a physiological or psychological effect. Twenty-two resistance-trained, breakfast-consuming men completed three experimental trials, consuming water-only (WAT), or semi-solid breakfasts containing 0 g/kg (PLA) or 1·5 g/kg (CHO) maltodextrin. PLA and CHO meals contained xanthan gum and low-energy flavouring (approximately 122 kJ), and subjects were told both ‘contained energy’. At 2 h post-meal, subjects completed four sets of back squat and bench press to failure at 90 % ten repetition maximum. Blood samples were taken pre-meal, 45 min and 105 min post-meal to measure serum/plasma glucose, insulin, ghrelin, glucagon-like peptide-1 and peptide tyrosine-tyrosine concentrations. Subjective hunger/fullness was also measured. Total back squat repetitions were greater in CHO (44 (sd 10) repetitions) and PLA (43 (sd 10) repetitions) than WAT (38 (sd 10) repetitions; P < 0·001). Total bench press repetitions were similar between trials (WAT 37 (sd 7) repetitions; CHO 39 (sd 7) repetitions; PLA 38 (sd 7) repetitions; P = 0·130). Performance was similar between CHO and PLA trials. Hunger was suppressed and fullness increased similarly in PLA and CHO, relative to WAT (P < 0·001). During CHO, plasma glucose was elevated at 45 min (P < 0·05), whilst serum insulin was elevated (P < 0·05) and plasma ghrelin suppressed at 45 and 105 min (P < 0·05). These results suggest that breakfast/pre-exercise nutrition enhances resistance exercise performance via a psychological effect, although a potential mediating role of hunger cannot be discounted.
This paper examines the determinants of financial industry actors’ regulatory preferences—examining why some financial industry actors prefer less stringent financial regulations while others prefer more stringent regulations. The determination of preferences, we argue, can be understood as mutually dependent. How an organization is connected to other organisations through network ties may help to explain its regulatory preferences. Our empirical point of focus is financial industry lobbying in the context of the European Union (EU). Using data from nearly nine hundred lobbying letters related to legislation on banking, insurance, and securities regulation, we map out a “socialization network” that models connections between financial industry firms, their associations, as well as a broad range of other organisations and actors that are auxiliary to this community of organizations. Using these data we find evidence that organizations’ preferences are informed by their location within this socialization network. Controlling for a range of other plausible factors, we find that 1) those connected via common associational ties, 2) those closer to one another in the network and 3) those more “embedded” in this network are all less likely to diverge in terms of their preferences from one another.
We are interested in understanding how socially desirable traits like sympathy, reciprocity, and fairness can survive in environments that include aggressive and exploitative agents. Social scientists have long theorized about ingrained motivational factors as explanations for departures from self-seeking behaviors by human subjects. Some of these factors, namely reciprocity, have also been studied extensively in the context of agent systems as tools for promoting cooperation and improving social welfare in stable societies. In this paper, we evaluate how other factors like sympathy and parity can be used by agents to seek out cooperation possibilities while avoiding exploitation traps in more dynamic societies. We evaluate the relative effectiveness of agents influenced by different social considerations when they can change who they interact with in their environment using both an experimental framework and a predictive analysis. Such rewiring of social networks not only allows possibly vulnerable agents to avoid exploitation but also allows them to form gainful coalitions to leverage mutually beneficial cooperation, thereby significantly increasing social welfare.
This chapter, reviews the basics for children undergoing epilepsy surgery. The authors discuss the incidence and types of seizures as well as various modalities for seizure suppression (e.g. ketogenic diet, vagal nerve stimulation). The chapter presents the surgical approaches to epilepsy surgery, MRI mapping followed by laser ablation and electrocorticography with mapping followed by surgical excision. The anesthetic implications related to these complex patients are presented.
Low and middle-income countries (LMICs) bear a disproportionately high burden of sepsis, contributing to an estimated 90% of global sepsis-related deaths. Critical care capabilities needed for septic patients, such as continuous vital sign monitoring, are often unavailable in LMICs.
This study aimed to assess the feasibility and accuracy of using a small wireless, wearable biosensor device linked to a smartphone, and a cloud analytics platform for continuous vital sign monitoring in emergency department (ED) patients with suspected sepsis in Rwanda.
This was a prospective observational study of adult and pediatric patients (≥ 2 months) with suspected sepsis presenting to Kigali University Teaching Hospital ED. Biosensor devices were applied to patients’ chest walls and continuously recorded vital signs (including heart rate and respiratory rate) for the duration of their ED course. These vital signs were compared to intermittent, manually-collected vital signs performed by a research nurse every 6-8 hours. Pearson’s correlation coefficients were calculated over the study population to determine the correlation between the vital signs obtained from the biosensor device and those collected manually.
42 patients (20 adults, 22 children) were enrolled. Mean duration of monitoring with the biosensor device was 34.4 hours. Biosensor and manual vital signs were strongly correlated for heart rate (r=0.87, p<0.001) and respiratory rate (r=0.74 p<0.001). Feasibility issues occurred in 9/42 (21%) patients, although were minor and included biosensor falling off (4.8%), technical/connectivity problems (7.1%), removal by a physician (2.4%), removal for a procedure (2.4%), and patient/parent desire to remove the device (4.8%).
Wearable biosensor devices can be feasibly implemented and provide accurate continuous vital sign measurements in critically ill pediatric and adult patients with suspected sepsis in a resource-limited setting. Further prospective studies evaluating the impact of biosensor devices on improving clinical outcomes for septic patients are needed.
Many important scientific and technical problems are best addressed using multiple, microscopy-based analytical techniques that combine the strengths of complementary methods. Here, we provide two examples from biomedical challenges: unravelling the attachment zone between dental implants and bone, and uncovering the mechanism of Alzheimer's disease. They combine synchrotron-based scanning transmission X-ray microscopy (STXM) with transmission electron microscopy ((S)TEM), electron tomography (ET), EELS tomography, and/or atom probe tomography (APT). STXM provides X-ray absorption based chemical sensitivity at mesoscale resolution (10–30 nm), which complements higher spatial resolution electron microscopy and APT.
In the prehospital setting, many providers advocate for video laryngoscopy as the initial method of intubation to improve the likelihood of a successful first attempt. However, bright ambient light can worsen visualization of the video laryngoscope liquid crystal display (LCD).
A patient involved in a motor vehicle accident was evaluated by an Emergency Medical Services (EMS) crew. Initial endotracheal intubation attempt using video laryngoscopy was aborted after the patient desaturated. The primary reason for the failure was poor visualization of the video laryngoscope LCD, despite attempts to block direct sunlight. Debriefing revealed that the intubating provider was wearing polarized sunglasses.
Because LCDs emit polarized light, use of polarized sunglasses may cause the display to appear dark. Thus, the purpose of this Case Report is to raise awareness of a potential safety issue that is likely under-recognized by prehospital providers but can be easily avoided.
SmithAJ, JackimczykK, HorwoodB, ChristensonD. Use of Polarized Sunglasses During Video Laryngoscopy: A Cause of Difficult Prehospital IntubationPrehosp Disaster Med. 2019;34(1):104–107.
The deep subsurface of other planetary bodies is of special interest for robotic and human exploration. The subsurface provides access to planetary interior processes, thus yielding insights into planetary formation and evolution. On Mars, the subsurface might harbour the most habitable conditions. In the context of human exploration, the subsurface can provide refugia for habitation from extreme surface conditions. We describe the fifth Mine Analogue Research (MINAR 5) programme at 1 km depth in the Boulby Mine, UK in collaboration with Spaceward Bound NASA and the Kalam Centre, India, to test instruments and methods for the robotic and human exploration of deep environments on the Moon and Mars. The geological context in Permian evaporites provides an analogue to evaporitic materials on other planetary bodies such as Mars. A wide range of sample acquisition instruments (NASA drills, Small Planetary Impulse Tool (SPLIT) robotic hammer, universal sampling bags), analytical instruments (Raman spectroscopy, Close-Up Imager, Minion DNA sequencing technology, methane stable isotope analysis, biomolecule and metabolic life detection instruments) and environmental monitoring equipment (passive air particle sampler, particle detectors and environmental monitoring equipment) was deployed in an integrated campaign. Investigations included studying the geochemical signatures of chloride and sulphate evaporitic minerals, testing methods for life detection and planetary protection around human-tended operations, and investigations on the radiation environment of the deep subsurface. The MINAR analogue activity occurs in an active mine, showing how the development of space exploration technology can be used to contribute to addressing immediate Earth-based challenges. During the campaign, in collaboration with European Space Agency (ESA), MINAR was used for astronaut familiarization with future exploration tools and techniques. The campaign was used to develop primary and secondary school and primary to secondary transition curriculum materials on-site during the campaign which was focused on a classroom extra vehicular activity simulation.
Protected areas are central to global efforts to prevent species extinctions, with many countries investing heavily in their establishment. Yet the designation of protected areas alone can only abate certain threats to biodiversity. Targeted management within protected areas is often required to achieve fully effective conservation within their boundaries. It remains unclear what combination of protected area designation and management is needed to remove the suite of processes that imperil species. Here, using Australia as a case study, we use a dataset on the pressures facing threatened species to determine the role of protected areas and management in conserving imperilled species. We found that protected areas that are not resourced for threat management could remove one or more threats to 1,185 (76%) species and all threats to very few (n = 51, 3%) species. In contrast, a protected area network that is adequately resourced to manage threatening processes within their boundary could remove one or more threats to almost all species (n = 1,551; c. 100%) and all threats to almost half (n = 740, 48%). However, 815 (52%) species face one or more threats that require coordinated conservation actions that protected areas alone could not remove. This research shows that investing in the continued expansion of Australia's protected area network without providing adequate funding for threat management within and beyond the existing protected area network will benefit few threatened species. These findings highlight that as the international community expands the global protected area network in accordance with the 2020 Strategic Plan for Biodiversity, a greater emphasis on the effectiveness of threat management is needed.
Survey and laboratory experiments are increasingly common in political science. Investment in experimental data collection comes with costs and benefits, particularly for graduate students and advisers. This article describes a set of institutionalized procedures we have adopted with the goal of capitalizing on the advantages that come with experimental research. This includes requiring planning documents, holding research-group meetings, and centralizing data collection. We conclude by discussing the limitations of our approach, ultimately highlighting the need for more disciplinary conversation about how to best structure research groups to produce quality research and advising.
To examine the impacts of Seattle’s minimum wage ordinance on food prices by food processing category.
Supermarket food prices were collected for 106 items using a University of Washington Center for Public Health Nutrition market basket at affected and unaffected supermarket chain stores at three times: March 2015 (1-month pre-policy enactment), May 2015 (1-month post-policy enactment) and May 2016 (1-year post-policy enactment). Food items were categorized into four food processing groups, from minimally to ultra-processed. Data were analysed across time using a multilevel, linear difference-in-differences model at the store and price level stratified by level of food processing.
Six large supermarket chain stores located in Seattle (‘intervention’) affected by the policy and six same-chain but unaffected stores in King County (‘control’), Washington, USA.
One hundred and six food and beverage items.
The largest change in average price by food item was +$US 0·53 for ‘processed foods’ in King County between 1-month post-policy and 1-year post-policy enactment (P < 0·01). The smallest change was $US 0·00 for ‘unprocessed or minimally processed foods’ in Seattle between 1-month post-policy and 1-year post-policy enactment (P = 0·94). No significant changes in averaged chain prices were observed across food processing level strata in Seattle v. King County stores at 1-month or 1-year post-policy enactment.
Supermarket food prices do not appear to be differentially impacted by Seattle’s minimum wage ordinance by level of the food’s processing. These results suggest that the early implementation of a city-level minimum wage policy does not alter supermarket food prices by level of food processing.
It is not clear how to effectively recruit healthy research volunteers.
We developed an electronic health record (EHR)-based algorithm to identify healthy subjects, who were randomly assigned to receive an invitation to join a research registry via the EHR’s patient portal, letters, or phone calls. A follow-up survey assessed contact preferences.
The EHR algorithm accurately identified 858 healthy subjects. Recruitment rates were low, but occurred more quickly via the EHR patient portal than letters or phone calls (2.7 vs. 19.3 or 10.4 d). Effort and costs per enrolled subject were lower for the EHR patient portal (3.0 vs. 17.3 or 13.6 h, $113 vs. $559 or $435). Most healthy subjects indicated a preference for contact via electronic methods.
Healthy subjects can be accurately identified from EHR data, and it is faster and more cost-effective to recruit healthy research volunteers using an EHR patient portal.
The epistemic approach to liberalism not only clarifies some of the core features of progress-based arguments for liberty. For two reasons it provides grounds for doubting those arguments’ persuasiveness. The first reason emerges from the epistemic liberal explanation of economic recessions and of social regress as necessary consequences of our enjoying the individual liberty to adapt to our circumstances. Precisely because it secures personal choice with respect to the ends of life and the means to pursue them, liberty must be construed as at best necessary for the imperfect and costly realization of the interest individuals may have in personal advancement. Second, and in revealing the underlying logic of the economic and cultural processes that liberty makes possible, epistemic liberalism shows that it is to the notion of complex adaptation that we must look when seeking to evaluate the overall or aggregate results of liberty. Crucially, however, this means rejecting the notion of progress as fit to perform this ethico-historical evaluative role.
X-ray micro-computed tomography (μCT) is a technique which can obtain three-dimensional images of a sample, including its internal structure, without the need for destructive sectioning. Here, we review the capability of the technique and examine its potential to provide novel insights into the lifestyles of parasites embedded within host tissue. The current capabilities and limitations of the technology in producing contrast in soft tissues are discussed, as well as the potential solutions for parasitologists looking to apply this technique. We present example images of the mouse whipworm Trichuris muris and discuss the application of μCT to provide unique insights into parasite behaviour and pathology, which are inaccessible to other imaging modalities.