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The ability to use the internet frequently is likely to provide a useful means of engaging with society and using services in later life, yet older people are the most likely to suffer digital exclusion, with those of the oldest ages at the greatest risk. Using six waves (2002–2012) of the English Longitudinal Study of Ageing, we model cohort-specific patterns of frequent internet use for people aged 50 and over. Multi-level growth models are used to observe trajectories of internet use over the ten-year period. Firstly, analyses are stratified by gender and wealth, and secondly we additionally test for health effects. The study finds cohort-specific differences in patterns of internet use. Rates of internet use increase faster among younger cohorts yet, despite initially increasing, begin to decline among older cohorts. Poor health is shown to be a key factor in shaping the trajectory of internet use over time. Rates of internet use are consistently lower for women than men and for those in poorer financial circumstances, independently of age cohort. The findings demonstrate the importance of ensuring older people can remain digitally included throughout later life, including after the onset of poorer health, especially as some of these individuals might benefit the most from some of the services the internet can provide.
The intensely active 2017 Atlantic basin hurricane season provided an opportunity to examine how climate drivers, including warming oceans and rising seas, exacerbated tropical cyclone hazards. The season also highlighted the unique vulnerabilities of populations residing on Small Island Developing States (SIDS) to the catastrophic potential of these storms. During 2017, 22 of the 29 Caribbean SIDS were affected by at least one named storm, and multiple SIDS experienced extreme damage. This paper aims to review the multiplicity of storm impacts on Caribbean SIDS throughout the 2017 season, to explicate the influences of climate drivers on storm formation and intensity, to explore the propensity of SIDS to sustain severe damage and prolonged disruption of essential services, to document the spectrum of public health consequences, and to delineate the daunting hurdles that challenged emergency response and recovery operations for island-based, disaster-affected populations. (Disaster Med Public Health Preparedness. 2019;13:5–17)
An internationally approved and globally used classification scheme for the diagnosis of CHD has long been sought. The International Paediatric and Congenital Cardiac Code (IPCCC), which was produced and has been maintained by the International Society for Nomenclature of Paediatric and Congenital Heart Disease (the International Nomenclature Society), is used widely, but has spawned many “short list” versions that differ in content depending on the user. Thus, efforts to have a uniform identification of patients with CHD using a single up-to-date and coordinated nomenclature system continue to be thwarted, even if a common nomenclature has been used as a basis for composing various “short lists”. In an attempt to solve this problem, the International Nomenclature Society has linked its efforts with those of the World Health Organization to obtain a globally accepted nomenclature tree for CHD within the 11th iteration of the International Classification of Diseases (ICD-11). The International Nomenclature Society has submitted a hierarchical nomenclature tree for CHD to the World Health Organization that is expected to serve increasingly as the “short list” for all communities interested in coding for congenital cardiology. This article reviews the history of the International Classification of Diseases and of the IPCCC, and outlines the process used in developing the ICD-11 congenital cardiac disease diagnostic list and the definitions for each term on the list. An overview of the content of the congenital heart anomaly section of the Foundation Component of ICD-11, published herein in its entirety, is also included. Future plans for the International Nomenclature Society include linking again with the World Health Organization to tackle procedural nomenclature as it relates to cardiac malformations. By doing so, the Society will continue its role in standardising nomenclature for CHD across the globe, thereby promoting research and better outcomes for fetuses, children, and adults with congenital heart anomalies.
A previously unresearched Early Bronze Age dagger-grave found in 1989 at Racton, West Sussex, is profiled here through a range of studies. The dagger, the only grave accompaniment, is of the ‘transitional’ Ferry Fryston type, this example being of bronze rather than copper. Bayesian analysis of relevant radiocarbon dates is used to refine the chronology of the earliest bronze in Britain. While the Ferry Fryston type was current in the earlier half of the twenty-second century bc, the first butt-riveted bronze daggers did not emerge until the second half. The Racton dagger is also distinguished by its elaborate rivet-studded hilt, an insular innovation with few parallels.
The excavated skeleton was that of a senior male, buried according to the appropriate rites of the time. Isotopic profiling shows an animal-protein rich diet that is typical for the period, but also the likelihood that he was brought up in a region of older silicate sedimentary rocks well to the west or north west of Racton. He had suffered injury at or close to the time of death; a slice through the distal end of his left humerus would have been caused by a fine-edged blade, probably a dagger. Death as a result of combat-contested leadership is explored in the light of other injuries documented among Early Bronze Age burials. Codified elite-level combat could help to explain the apparent incongruity between the limited efficacy of early dagger forms and their evident weapon-status.
We use numerical simulations from the Community Coordinated Modeling Center to provide, for the first time, a coherent temporal description of the magnetic reconnection process of two dayside Electron Diffusion Regions (EDRs) identified in Magnetospheric Multiscale Mission data. The model places the MMS spacecraft near the separator line in these most intense and long-lived events. A listing of 31 dayside EDRs identified by the authors is provided to encourage collaboration in analysis of these unique encounters.
Introduction: We characterised tobacco use, cessation patterns, and patient satisfaction with a cessation support program at an NCI Designated Comprehensive Cancer Center following a mandatory tobacco assessment and automatic referral.
Methods: A 3-month follow-up survey (via web, paper, or telephone) was administered between March 2013 and November 2013 for all patients referred to and contacted by a cessation support service, and who consented to participation three months prior to administration. Patients were asked about their perceived importance and self-efficacy to quit smoking, quit attempts, and satisfaction with the cessation service.
Results: Fifty-two percent (257/499) of patients who participated in the cessation support service, and consented to be contacted again, completed a follow-up survey. Of those who participated, 9.7% were referred to the service as having recently quit tobacco (in the past 30 days) and 23.6% reported having quit at the time of first contact. At the 3-month follow-up, 48.1% reported being smoke-free for the previous seven days. When patients were asked about their experience with the cessation service, 86.4% reported being very or mostly satisfied with the service, and 64.3% reported that their experience with the service increased their satisfaction with the care received at the cancer centre.
Conclusions: Our findings suggest that recently diagnosed cancer patients are aware that quitting tobacco is important, are making attempts to quit, and are amenable to an opt-out automatic referral cessation support service as part of their cancer care.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development.
To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events.
Randomized, prospective study.
Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts.
Patients undergoing surgery.
Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections.
A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); P<.001. Use of the hand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82–1.40], P=.626).
The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy.
We analyze relationships among a range of ecological and biological traits—geographic range size, body size, life mode, larval type, and feeding type—in order to identify those traits that are associated significantly with species duration in New Zealand Cenozoic marine molluscs, during a time of background extinction. Using log-linear modeling, we find that bivalves have only a small number of simple, two-way associations between the studied traits and duration. In contrast, gastropods display more complex interactions involving three-way associations between traits, a pattern that suggests greater macroecological complexity of gastropods. This is not an artifact caused by the larger number of gastropods than bivalves in our data set. We used stratified randomized resampling of families to test for associations between traits that might result from shared inheritance rather than ecological trait interactions; we found no evidence of phylogenetic effects in any associations examined. The relationships revealed by our study should serve to constrain the range of possible biological mechanisms that underlie these relationships. As previously observed, two-way associations are present between large geographic range and increased duration, and between large geographic range and large body size, in both bivalves and gastropods. In gastropods, planktotrophic larval type is associated with large range size through a three-way interaction that also involves duration; there is no direct association of larval type and geographic range. Gastropods also display two-way associations between duration and life mode, and duration and feeding type. We note that in gastropods, an infaunal life mode is associated with large range size, whereas in bivalves infaunality is associated with reduced range size.
In recent years several authors have questioned the reality of a widely accepted and apparently large increase in marine biodiversity through the Cenozoic. Here we use collection-level occurrence data from the rich and uniquely well documented New Zealand (NZ) shelfal marine mollusc fauna to test this question at a regional scale. Because the NZ data were generated by a small number of workers and have been databased over many decades, we have been able to either avoid or quantify many of the biases inherent in analyses of past biodiversity. In particular, our major conclusions are robust to several potential taphonomic and systematic biases and methodological uncertainties, namely non-uniform loss of aragonitic faunas, biostratigraphic range errors, taxonomic errors, choice of time bins, choice of analytical protocols, and taxonomic rank of analysis.
The number of taxa sampled increases through the Cenozoic. Once diversity estimates are standardized for sampling biases, however, we see no evidence for an increase in marine mollusc diversity in the NZ region through the middle and late Cenozoic. Instead, diversity has been approximately constant for much of the past 40 Myr and, at the species and genus levels, has declined over the past ~5 Myr. Assuming that the result for NZ shelfal molluscs is representative of other taxonomic groups and other temperate faunal provinces, then this suggests that the postulated global increase in diversity is either an artifact of sampling bias or analytical methods, resulted from increasing provinciality, or was driven by large increases in diversity in tropical regions. We see no evidence for a species-area effect on diversity. Likewise, we are unable to demonstrate a relationship between marine temperature and diversity, although this question should be re-examined once refined shallow marine temperature estimates become available.
We have taken a novel approach using oral rapamycin – sirolimus – as a medical adjunct to percutaneous therapy in patients with in-stent stenosis and high risk of right ventricular failure.
Peripheral pulmonary artery stenosis can result in right ventricular hypertension, dysfunction, and death. Percutaneous pulmonary artery angioplasty and stent placement acutely relieve obstructions, but patients frequently require re-interventions due to re-stenosis. In patients with tetralogy of Fallot or arteriopathy, the problem of in-stent stenosis contributes to the rapidly recurrent disease.
Rapamycin was administered to 10 patients (1.5–18 years) with peripheral pulmonary stenosis and in-stent stenosis and either right ventricular hypertension, pulmonary blood flow maldistribution, or segmental pulmonary hypertension. Treatment was initiated around the time of catheterisation and continued for 1–3 months. Potential side-effects were monitored by clinical review and blood tests.
Target serum rapamycin level (6–10 ng/ml) was accomplished in all patients; eight of the nine patients who returned for clinically indicated catheterisations demonstrated reduction in in-stent stenosis, and eight of the 10 patients experienced no significant side-effects. Among all, one patient developed diarrhoea requiring drug discontinuation, and one patient experienced gastrointestinal bleeding while on therapy that was likely due to an indwelling feeding tube and this patient tolerated rapamycin well following tube removal.
Our initial clinical experience supports that patients with peripheral pulmonary artery stenosis can be safely treated with rapamycin. Systemic rapamycin may provide a novel medical approach to reduce in-stent stenosis.
In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children’s Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children’s Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary “think-tank”. The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute, to describe the “state of the art” of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
The Life Tables which we have prepared and have now the honour of submitting to the Faculty, are based on the Male and Female Populations of Scotland as ascertained by the Census taken on 2nd April 1911, and on the average of the deaths registered in Scotland during the years 1910, 1911, and 1912.
In having used the censal population for the purpose of this study, and not a middle year estimate of the population, we lay ourselves open to some criticism, as a middle year estimate is more generally approved of for this purpose.
Nitride-Arsenide materials were grown by molecular beam epitaxy (MBE) using a radio frequency (rf) nitrogen plasma. The plasma conditions that maximize the amount of atomic nitrogen versus molecular nitrogen were determined using the emission spectrum of the plasma. Under constant plasma source conditions and varying group III flux, the nitrogen concentration in the film is inversely proportional to the group III flux (i. e. the nitrogen sticking coefficient is unity). The relationship between nitrogen concentration in the film and lattice parameter of the film is not linear for nitrogen concentrations above 2.9 mole % GaN, indicating that some nitrogen is incorporated on other locations than the group V lattice sites. For films with these higher nitrogen concentrations, XPS indicates that the nitrogen exists in two configurations: a Gallium-Nitrogen bond and another type of nitrogen complex in which nitrogen is less strongly bonded to Gallium atoms. Annealing removes this nitrogen complex and allows some of the nitrogen to diffuse out of the film. Annealing also improves the crystal quality of GaAsN quantum wells.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
The Gemini Planet Imager (GPI) is a high contrast coronagraph designed to directly image exoplanets and circumstellar disks. GPI includes a polarimetry mode designed to characterize dust grains and enhance the contrast of scattered, polarized light by a factor of 100. Reflections and birefringence of optics within the optical train induce a polarization signature that needs to be measured a priori and calibrated out during data reduction. Here we report on the results of an extensive laboratory characterization campaign of the polarimetry mode. The linear instrumental polarization has been measured in 4 GPI passbands and found to be between 3.5 ± 0.3 % at 1.0 micron and 1.1 ± 0.3 % at 2.0 microns. Modulation efficiency has been measured to be 94% at 1.0 micron increasing to 97% at 2.0 microns. Stability has been shown to better than 0.6% over timescales of ~ 3 months and over cool down cycles. The tests show that GPI passes all polarimetry design requirements and should be able to measure circumstellar disk linear polarization to 1% accuracy.