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The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.
Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113
Balloon atrial septostomy is performed in infants with dextro-transposition of the great arteries to improve oxygenation before surgery. It is performed in the catheterisation laboratory with fluoroscopy or at the bedside using echocardiography. It is unclear whether procedural safety and efficacy is superior in one location versus the other, although the bedside procedure may improve resource utilisation and present an opportunity for reducing cost. This study compares safety and efficacy of atrial septostomy performed at the patient’s bedside versus the catheterisation laboratory.
Neonates with dextro-transposition of the great arteries who underwent balloon atrial septostomy from October, 2000 to January, 2014 were included. Medical and procedural records, echocardiograms, and catheterisation data were reviewed. Comparisons between the two procedural locations included patient demographics, pre- and post-procedure oxygen saturations, and outcomes. Complications reviewed included bleeding, arrhythmia, cardiac trauma, stroke, and death. Coronary artery evaluations were recorded. T-tests were used for continuous variables, and Fisher’s exact tests were used for all categorical variables. Wilcoxon rank sum and analysis of covariance modelling were used for time variables and oxygen saturation, respectively.
A total of 88 infants met the inclusion criteria. Among them, 53 underwent septostomy at the bedside and 35 underwent septostomy in the catheterisation laboratory. No safety or outcome benefit was identified between the two procedural locations.
Septostomy performed at the bedside and in the catheterisation laboratory had similar outcomes and efficacy. Further, bedside septostomy has the advantage of no radiation exposure, and obviating risks with patient transfer from the ICU to the catheterisation laboratory.
n-3 PUFA are lipids that play crucial roles in immune-regulation, cardio-protection and neurodevelopment. However, little is known about the role that these essential dietary fats play in modulating caecal microbiota composition and the subsequent production of functional metabolites. To investigate this, female C57BL/6 mice were assigned to one of three diets (control (CON), n-3 supplemented (n3+) or n-3 deficient (n3−)) during gestation, following which their male offspring were continued on the same diets for 12 weeks. Caecal content of mothers and offspring were collected for 16S sequencing and metabolic phenotyping. n3− male offspring displayed significantly less % fat mass than n3+ and CON. n-3 Status also induced a number of changes to gut microbiota composition such that n3− offspring had greater abundance of Tenericutes, Anaeroplasma and Coriobacteriaceae. Metabolomics analysis revealed an increase in caecal metabolites involved in energy metabolism in n3+ including α-ketoglutaric acid, malic acid and fumaric acid. n3− animals displayed significantly reduced acetate, butyrate and total caecal SCFA production. These results demonstrate that dietary n-3 PUFA regulate gut microbiota homoeostasis whereby n-3 deficiency may induce a state of disturbance. Further studies are warranted to examine whether these microbial and metabolic disturbances are causally related to changes in metabolic health outcomes.
We sought to evaluate the risk and image quality from cardiovascular CT in patients across all stages of single-ventricle palliation, and to define accuracy by comparing findings with intervention and surgery.
Consecutive CT scans performed in patients with single-ventricle heart disease were retrospectively reviewed at a single institution. Diagnosis, sedation needs, estimated radiation dose, and adverse events were recorded. Anatomical findings, image quality (1–4, 1=optimal), and discrepancy compared with interventional findings were determined. Results are described as medians with their 25th and 75th percentiles.
From January, 2010 to August, 2015, 132 CT scans were performed in single-ventricle patients of whom 20 were neonates, 52 were post-Norwood, 15 were post-Glenn, and 45 were post-Fontan. No sedation was used in 76 patients, 47 were under minimal or moderate sedation, and nine were under general anaesthesia. The median image quality score was 1.2. The procedural dose–length product was 24 mGy-cm, and unadjusted and adjusted radiation doses were 0.34 (0.2, 1.8) and 0.82 (0.55, 1.88) mSv, respectively. There was one adverse event. No major and two minor discrepancies were noted at the time of 79 surgical and 10 catheter-based interventions.
Cardiovascular CT can be performed with a low radiation exposure in patients with single-ventricle heart disease. Its accuracy compared with that of interventional findings is excellent. CT is an effective advanced imaging modality when a non-invasive pathway is desired, particularly if cardiac MRI poses a high risk or is contraindicated.
A clean hot-water drill was used to gain access to Subglacial Lake Whillans (SLW) in late January 2013 as part of the Whillans Ice Stream Subglacial Access Research Drilling (WISSARD) project. Over 3 days, we deployed an array of scientific tools through the SLW borehole: a downhole camera, a conductivity–temperature–depth (CTD) probe, a Niskin water sampler, an in situ filtration unit, three different sediment corers, a geothermal probe and a geophysical sensor string. Our observations confirm the existence of a subglacial water reservoir whose presence was previously inferred from satellite altimetry and surface geophysics. Subglacial water is about two orders of magnitude less saline than sea water (0.37–0.41 psu vs 35 psu) and two orders of magnitude more saline than pure drill meltwater (<0.002 psu). It reaches a minimum temperature of –0.55~C, consistent with depression of the freezing point by 7.019 MPa of water pressure. Subglacial water was turbid and remained turbid following filtration through 0.45 µm filters. The recovered sediment cores, which sampled down to 0.8 m below the lake bottom, contained a macroscopically structureless diamicton with shear strength between 2 and 6 kPa. Our main operational recommendation for future subglacial access through water-filled boreholes is to supply enough heat to the top of the borehole to keep it from freezing.
The Middle Jurassic is a poorly sampled time interval for non-pelagic neosuchian crocodyliforms, which obscures our understanding of the origin and early evolution of major clades. Here we report a lower jaw from the Middle Jurassic (Bathonian) Duntulm Formation of the Isle of Skye, Scotland, UK, which consists of an isolated and incomplete left dentary and part of the splenial. Morphologically, the Skye specimen closely resembles the Cretaceous neosuchians Pachycheilosuchus and Pietraroiasuchus, in having a proportionally short mandibular symphysis, shallow dentary alveoli and inferred weakly heterodont dentition. It differs from other crocodyliforms in that the Meckelian canal is dorsoventrally expanded posterior to the mandibular symphysis and drastically constricted at the 7th alveolus. The new specimen, together with the presence of Theriosuchus sp. from the Valtos Formation and indeterminate neosuchians from the Kilmaluag Formation, indicates the presence of a previously unrecognised, diverse crocodyliform fauna in the Middle Jurassic of Skye, and Europe more generally. Small-bodied neosuchians were present, and ecologically and taxonomically diverse, in nearshore environments in the Middle Jurassic of the UK.
Pulmonary balloon valvuloplasty is a safe and effective treatment for children with pulmonary valve stenosis. A few studies evaluate the long-term outcomes of the procedure, particularly the degree of pulmonary regurgitation. We evaluated the outcomes of children >1 year following valvuloplasty for pulmonary valve stenosis.
A retrospective analysis of children with pulmonary valve stenosis following pulmonary balloon valvuloplasty at a single institution was performed. Clinic summaries, catheterisation data, and echocardiographic data were reviewed. Inclusion criteria were isolated pulmonary valve stenosis, age <19 years at the time of intervention, and at least one echocardiogram performed at least 1 year after valvuloplasty.
A total of 53 patients met inclusion criteria. The median age at valvuloplasty was 0.4 years (0.01–10.6 years). The last follow-up was 4.8±2.3 years following valvuloplasty. The pre-valvuloplasty peak instantaneous gradient by echocardiography was 60.6±14.6 mmHg. The peak gradient at the first postoperative echocardiography was reduced to 25.5±12 mmHg (p<0.001), and further decreased to 14.8±15.8 mmHg (p<0.001) at the most recent follow-up. The degree of regurgitation increased from before valvuloplasty to after valvuloplasty (p<0.001) but did not progress at the most recent follow-up (p=0.17). Only three patients (5.7%) required re-intervention for increasing pulmonary stenosis (two surgical; one repeat balloon). No significant procedural complications occurred.
Pulmonary balloon valvuloplasty remains a safe and effective treatment for children with isolated pulmonary valve stenosis, with excellent long-term outcomes and no mortality. A few patients require further intervention. Long-term follow-up demonstrates decreased, residual stenosis. Patients have a small, acute increase in pulmonary regurgitation following valvuloplasty, but no long-term progression.
The Social Context of Mental Health and Illness: Introduction to Part II
John Mirowsky, Professor, Department of Sociology and Population Research Center, University of Texas,
Catherine E. Ross, Professor, Department of Sociology and Population Research Center, University of Texas at Austin
What are the best years of adult life? The answer may surprise you: middle age. How do we know that middle age is the best time of life? The term “best” implies a common standard of value by which we can measure and compare. Emotional distress serves as that standard. Research on well-being across the life course usually maps the average levels of depression and anxiety. Depression is a feeling of sadness and dejection marked by trouble sleeping, concentrating, and acting. Anxiety is a state of unease and apprehension, characterized by worry, tension, and restlessness. Both are unpleasant feelings that most persons would rather avoid. They arouse the attention of psychiatrists when they are extreme, prolonged, or inexplicable. More commonly, depression and anxiety come and go with the challenges and adaptations of life. Life course researchers have begun studying other emotions too, particularly anger (Mirowsky & Schieman, 2008; Ross & Van Willigen, 1996; Schieman, 1999, 2003) and positive feelings such as happiness, serenity, and elation (Ross & Mirowsky, 2008; Simon & Nath, 2004). These researchers add important details that will be summarized. However, the age-group differences in depression and anxiety tell the main story, as detailed below. Both forms of distress decline from a peak in early adulthood. The predominant type of distress shifts from active (anxiety and anger) to passive (depression) as people age. This chapter has three main sections. The first describes the emotional trajectories of adulthood. The second describes the five views of age that help researchers understand why emotions change as people age. The third describes the conditions and beliefs that change across adulthood, shaping the trajectories of emotions. Readers can consider how their own experiences, or those of family members, vary across the life course.
Adulthood Trajectories of Emotions
In terms of depression, middle age is the best time of life. Figure 17.1 illustrates results from the survey of Aging, Status, and the Sense of Control (ASOC), a six-year follow-up survey (1995–2001) of about 2,500 US adults selected at random. (Appendix A gives details about ASOC.) Depression was measured by asking, “On how many days in the past week have you felt sad? Felt lonely? Felt you couldn't shake the blues?
Seabird bycatch is widely regarded as the greatest threat globally to procellariiform seabirds. Although measures to reduce seabird–fishery interactions have been in existence for many years, uptake in fleets with high risk profiles remains variable. We recorded seabird bycatch and other interactions in the Namibian demersal longline fishery. Interaction rates were estimated for seasonal and spatial strata and scaled up to fishing effort data. Bycatch rates were 0.77 (95% CI 0.24–1.39) and 0.37 (95% CI 0.11–0.72) birds per 1,000 hooks in winter and summer, respectively. Scaling up to 2010, the most recent year for which complete data are available, suggests 20,567 (95% CI 6,328–37,935) birds were killed in this fishery that year. We compared bycatch rates to those from experimental fishing sets using mitigation measures (one or two bird-scaring lines and the replacement of standard concrete weights with 5 kg steel weights). All mitigation measures significantly reduced the bycatch rate. This study confirms the Namibian longline fishery has some of the highest known impacts on seabirds globally, but implementing simple measures could rapidly reduce those impacts. In November 2015 the Ministry of Fisheries and Marine Resources introduced regulations requiring the use of bird-scaring lines, line weighting and night setting in this fishery. A collaborative approach between NGOs, industry and government was important in achieving wide understanding and acceptance of the proposed mitigation measures in the lead up to the introduction of new fishery regulations.
Life on Earth spans a range of temperatures and exhibits biological growth rates that are temperature dependent. While the observation that growth rates are temperature dependent is well known, we have recently shown that the statistical distribution of specific growth rates for life on Earth is a function of temperature (Corkrey et al., 2016). The maximum rates of growth of all life have a distinct limit, even when grown under optimal conditions, and which vary predictably with temperature. We term this distribution of growth rates the biokinetic spectrum for temperature (BKST). The BKST possibly arises from a trade-off between catalytic activity and stability of enzymes involved in a rate-limiting Master Reaction System (MRS) within the cell. We develop a method to extrapolate quantile curves for the BKST to obtain the posterior probability of the maximum rate of growth of any form of life on Earth. The maximum rate curve conforms to the observed data except below 0°C and above 100°C where the predicted value may be positively biased. The deviation below 0°C may arise from the bulk properties of water, while the degradation of biomolecules may be important above 100°C. The BKST has potential application in astrobiology by providing an estimate of the maximum possible growth rate attainable by terrestrial life and perhaps life elsewhere. We suggest that the area under the maximum growth rate curve and the peak rate may be useful characteristics in considerations of habitability. The BKST can serve as a diagnostic for unusual life, such as second biogenesis or non-terrestrial life. Since the MRS must have been heavily conserved the BKST may contain evolutionary relics. The BKST can serve as a signature summarizing the nature of life in environments beyond Earth, or to characterize species arising from a second biogenesis on Earth.
A dynamic-thermodynamic sea-ice model (Hibler 1979) is used to simulate northern hemisphere sea ice for a 20-year period, 1961 to 1980. The model is driven by daily atmospheric grids of sea-level pressure (geo-strophic wind) and by temperatures derived from the Russian surface temperature data set. Among the modifications to earlier formulations are the inclusion of snow cover and a multilevel ice-thickness distribution in the thermodynamic computations.
The time series of the simulated anomalies show relatively large amounts of ice during the early 1960s and middle 1970s, and relatively small amounts during the late 1960s and early 1970s. The fluctuations of ice mass, both in the entire domain and in individual regions, are more persistent than are the fluctuations of ice-covered area. The ice dynamics tend to introduce more high-frequency variability into the regional (and total) amounts of ice mass. The simulated annual ice export from the Arctic Basin into the East Greenland Sea varies interannually by factors of 3 to 4.
This article analyses male contraceptive use, both globally and for developing countries. Shares of all contraceptive use due to males are examined, in the context of female use and all use. Patterns according to wealth quintiles are analysed, as well as time trends and geographic variations. Data are drawn primarily from compilations by the UN Population Division and from the Demographic and Health Series and subjected to relatively simple statistical methods including correlation/regression applications. Contraceptive methods that men use directly, or that require their co-operation to use, including condoms, withdrawal, rhythm and male sterilization, account for one-quarter of all contraceptive use worldwide. This represents 13% of married/in-union women. Both the share and the prevalence of male methods vary widely by geography and by the four methods, as well as by quintile wealth groups. With greater wealth there is an unbroken rise for total use; among the male methods, the shares of condom use and rhythm rise by wealth quintiles, while the share of withdrawal drops. The share for male sterilization is highest in the lowest and highest wealth quintiles and dips for the middle quintiles. The overall time trend since the 1980s has been steady at one-quarter of all use involving men; moreover, the share is about the same at all levels of total use. The female-only methods continue to dominate: female sterilization, IUD, pill, injectable and implant, again with great diversity geographically. In surveys men report less total use but more condom use, while females report more injectable use. For the future the male share of one-quarter of use seems secure, with little prospect of an increase unless concerted programmatic efforts are made to expand access to male methods and promote their use as part of a broadened contraceptive method mix.
We report on a formative project to develop an organization-level planning framework for obesity prevention and management services.
It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity.
The initial draft was developed by the research team, based on results from provider and patient focus groups in one large Family Health Team (FHT) in Ontario. This draft was reviewed and activities prioritized by 20 FHTs using a moderated electronic consensus process. A national panel then reviewed the draft.
Providers identified five main target groups: pregnancy to 2, 3–12, 13–18, 18+ years at health risk, and 18+ with complex care needs. Desired outcomes were identified and activities were prioritized under categories: raising awareness (eg, providing information and resources on weight-health), identification and initial management (eg, wellness care), follow-up management (eg, group programs), expanded services (eg, availability of team services), and practice initiatives (eg, interprofessional education). Overall, there was strong support for raising awareness by providing information on the weight-health connection and on community services. There was also strong support for growth assessment in pediatric care. In adults, there was strong support for wellness care/health check visits and episodic care to identify people for interventions, for group programs, and for additional provider education.
Joint development by different teams proved useful for consensus on outcomes and for ensuring relevancy across practices. While priorities will vary depending on local context, the basic descriptions of care processes were endorsed by reviewers. Key next steps are to trial the use of the framework and for further implementation studies to find optimally effective approaches for obesity prevention and management across the lifespan.
The collective response of electrons in an ultrathin foil target irradiated by an ultraintense (
) laser pulse is investigated experimentally and via 3D particle-in-cell simulations. It is shown that if the target is sufficiently thin that the laser induces significant radiation pressure, but not thin enough to become relativistically transparent to the laser light, the resulting relativistic electron beam is elliptical, with the major axis of the ellipse directed along the laser polarization axis. When the target thickness is decreased such that it becomes relativistically transparent early in the interaction with the laser pulse, diffraction of the transmitted laser light occurs through a so called ‘relativistic plasma aperture’, inducing structure in the spatial-intensity profile of the beam of energetic electrons. It is shown that the electron beam profile can be modified by variation of the target thickness and degree of ellipticity in the laser polarization.