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Despite the training and skills of airway managers, airway management complications still occur and may cause patient harm or death. The causes are multifactorial and may include patient, environment and clinician factors. Airway complications likely contribute to a significant proportion of deaths due to anaesthesia and are certainly more common outside the operating theatre and especially in the critical care unit. Reported incidences of failure and harm during airway management vary depending on the population studied and definitions used. Numbers may be of less value than understanding themes that help us improve care and reduce harm. The chapter emphasises that conventional research (e.g. device evaluation studies and randomised controlled trials) may be of little use in identifying low frequency events and complications because of their restricted inclusion and exclusion criteria, the use of devices only by experts and in conventional settings and because of their focus on efficacy rather than safety. The chapter highlights the important and growing role of registries and databases. Several are described in detail including the 4th National Audit Project and the Dutch ‘mini-NAP’. The value and limitations of litigation databases are explored. Specific complications of note are described at the end of the chapter.
Schizotypy is a putative risk phenotype for psychosis liability, but the overlap of its genetic architecture with schizophrenia is poorly understood.
We tested the hypothesis that dimensions of schizotypy (assessed with the SPQ-B) are associated with a polygenic risk score (PRS) for schizophrenia in a sample of 623 psychiatrically healthy, non-clinical subjects from the FOR2107 multi-centre study and a second sample of 1133 blood donors.
We did not find correlations of schizophrenia PRS with either overall SPQ or specific dimension scores, nor with adjusted schizotypy scores derived from the SPQ (addressing inter-scale variance). Also, PRS for affective disorders (bipolar disorder and major depression) were not significantly associated with schizotypy.
This important negative finding demonstrates that despite the hypothesised continuum of schizotypy and schizophrenia, schizotypy might share less genetic risk with schizophrenia than previously assumed (and possibly less compared to psychotic-like experiences).
Radiocarbon (14C) ages cannot provide absolutely dated chronologies for archaeological or paleoenvironmental studies directly but must be converted to calendar age equivalents using a calibration curve compensating for fluctuations in atmospheric 14C concentration. Although calibration curves are constructed from independently dated archives, they invariably require revision as new data become available and our understanding of the Earth system improves. In this volume the international 14C calibration curves for both the Northern and Southern Hemispheres, as well as for the ocean surface layer, have been updated to include a wealth of new data and extended to 55,000 cal BP. Based on tree rings, IntCal20 now extends as a fully atmospheric record to ca. 13,900 cal BP. For the older part of the timescale, IntCal20 comprises statistically integrated evidence from floating tree-ring chronologies, lacustrine and marine sediments, speleothems, and corals. We utilized improved evaluation of the timescales and location variable 14C offsets from the atmosphere (reservoir age, dead carbon fraction) for each dataset. New statistical methods have refined the structure of the calibration curves while maintaining a robust treatment of uncertainties in the 14C ages, the calendar ages and other corrections. The inclusion of modeled marine reservoir ages derived from a three-dimensional ocean circulation model has allowed us to apply more appropriate reservoir corrections to the marine 14C data rather than the previous use of constant regional offsets from the atmosphere. Here we provide an overview of the new and revised datasets and the associated methods used for the construction of the IntCal20 curve and explore potential regional offsets for tree-ring data. We discuss the main differences with respect to the previous calibration curve, IntCal13, and some of the implications for archaeology and geosciences ranging from the recent past to the time of the extinction of the Neanderthals.
Iodine intake affects the occurrence of thyroid disorders. However, the association of iodine intake with longevity remains to be described. This led us to perform a 20 years’ follow-up on participants from the Randers–Skagen (RaSk) study. Residents in Randers born in 1920 (n 210) and Skagen born in 1918–1923 (n 218) were included in a clinical study in 1997–1998. Mean iodine content in drinking water was 2 µg/l in Randers and 139 µg/l in Skagen. We collected baseline data through questionnaires, performed physical examinations and measured iodine concentrations in spot urine samples. Income data were retrieved from Danish registries. We performed follow-up on mortality until 31 December 2017 using Danish registries. Complete follow-up data were available on 428 out of 430 of participants (99·5 %). At baseline, the median urinary iodine concentration was 55 µg/l in Randers and 160 µg/l in Skagen residents. Participants were long-term residents with 72·8 and 92·7 % residing for more than 25 years in Randers and Skagen, respectively. Cox regression showed that living in Skagen compared with Randers was associated with a lower hazard ratio (HR) of death in both age- and sex-adjusted analyses (HR 0·60, 95 % CI 0·41, 0·87, P = 0·006), but also after adjustment for age, sex, number of drugs, Charlson co-morbidity index, smoking, alcohol and income (HR 0·60, 95 % CI 0·41, 0·87, P = 0·008). Residing in iodine-replete Skagen was associated with increased longevity. This indicates that long-term residency in an iodine-replete environment may be associated with increased longevity compared with residency in an iodine-deficient environment.
Several authors have pointed out that in the next few decades dementia will affect a considerably increasing number of the elderly. To our knowledge there exist no calculations of the number of demented persons for the whole European region. We made calculations on the number of dementia cases for the period 2000–2050 based on the population projections of the United Nations. For this purpose, we used the results of several meta-analyses of epidemiological studies. The number of prevalent dementia cases in the year 2000 was 7.1 million. Within the next 50 years, this number will rise to about 16.2 million dementia sufferers. The number of new dementia cases per year will increase from about 1.9 million in the year 2000 to about 4.1 million in the year 2050. Contrarily, the working-age population will considerably decrease during the next 50 years. In the year 2000, 7.1 million dementia cases faced 493 million persons in working-age. This equals a ratio of 69.4 persons in working-age per one demented person. Until the year 2050, this ratio will decrease to only 21.1. Thus, the financial and emotional burden placed by dementia on the working-age population will markedly rise.
Hyperthermia (i.e. heating of tumor tissue to 40–43°C) is used in clinical oncology to enhance the therapeutic effect of chemotherapy and radiotherapy. Many tumor sites are heated either by a single RF or MW antenna positioned on the tumor location, or by a phased array positioned around the patient. Superficial tumors are generally heated with MW antennas (434–2450 MHz) and deep-seated tumors with RF antennas (70–150 MHz). These devices cover the major, more common tumor sites, but more rare locations require more dedicated applicators. We discuss dedicated RF systems aiming for heating semi-deep-seated tumors in the leg, breast, and upper thorax. Clinical results show that adequate heating is possible with these systems, with achieved temperatures in the therapeutic range.
Gollier proposed in 2008 a model for the analysis of pension schemes that is helpful to focus attention on the impact of intergenerational risk sharing and on the role of the participation constraint. He uses the model to analyze the relative attractiveness of a collective scheme with respect to schemes that may be implemented by individuals for themselves. The analysis makes use of an assumption concerning the ownership rights of investment returns realized by generations that are between career start and retirement at the time of the transition from an individual to a collective system. The present paper investigates the consequences of adopting an alternative assumption. In a calibration exercise, the increase of the effective rate of return obtained by switching from an existing ‘autarky’ scheme to an infinite-horizon ‘collective’ scheme is found to be 8 basis points, as opposed to 72 basis points as reported by Gollier. Additionally, the effects are considered of changes in the specification of agents' preferences, aiming to express the specific nature of retirement income provision in the second pillar. The Black–Scholes assumptions are used to model the economic environment, so that many results can be obtained in closed form.
Placental function can be modified by maternal obesity affecting the materno-fetal fatty acid transport process. We analyze for the first time the in vivo materno-fetal kinetic transfer of fatty acids (FA) labeled with stable isotopes in control and obese pregnant women.
Materials and Methods:
Labelled FA with similar metabolism (stearic acid: 13C-SA, palmitic acid: 13C-PA and oleic acid: 13C-OA) were orally administered at -4 h, -8 h, and -12 h, respectively prior to elective caesarean section to 10 pregnant women with a body mass index (BMI) > 30 and 10 with BMI 25–30 (control). Placenta, venous and arterial cord blood were collected obtaining a wide range of FA enrichments. A combined experimental and computational modeling analysis was applied.
FA Fractional synthesis rate (FSR) in placenta was 11–12% per hour. No differences were observed between control and normo-lipidemic obese pregnant women. It was not possible to estimate FA FSR in cord blood with this oral bolus dose approach. Computational modelling demonstrated a good fit to the data when all maternal plasma lipid classes were included but not with modelling based only on the non-esterified FA fraction (NEFA). The estimated materno-fetal 13C-FA transfer was around 1%.
Our approach using multiple 13C-FA tracers allowed us to estimated FSR in placental/maternal plasma but not in fetal/maternal compartments. Computational modelling showed a consistent time course of placental 13C-FA transfer and predicted total fetal FA accumulation during the experiment. We conclude that in addition to NEFA in the maternal circulation, maternal plasma VLDL and other lipoproteins are important contributors to placental FA transfer to the fetus.
Sketching is a natural and intuitive communication tool used for expressing concepts or ideas which are difficult to communicate through text or speech alone. Sketching is therefore used for a variety of purposes, from the expression of ideas on two-dimensional (2D) physical media, to object creation, manipulation, or deformation in three-dimensional (3D) immersive environments. This variety in sketching activities brings about a range of technologies which, while having similar scope, namely that of recording and interpreting the sketch gesture to effect some interaction, adopt different interpretation approaches according to the environment in which the sketch is drawn. In fields such as product design, sketches are drawn at various stages of the design process, and therefore, designers would benefit from sketch interpretation technologies which support these differing interactions. However, research typically focuses on one aspect of sketch interpretation and modeling such that literature on available technologies is fragmented and dispersed. In this paper, we bring together the relevant literature describing technologies which can support the product design industry, namely technologies which support the interpretation of sketches drawn on 2D media, sketch-based search interactions, as well as sketch gestures drawn in 3D media. This paper, therefore, gives a holistic view of the algorithmic support that can be provided in the design process. In so doing, we highlight the research gaps and future research directions required to provide full sketch-based interaction support.
Comparisons of antipsychotics with placebo can be biased by unblinding due to side effects. Therefore, this meta-analysis compared the efficacy of antipsychotics for acute schizophrenia in trials using barbiturates or benzodiazepines as active placebos.
Randomized controlled trials (RCTs) in acute schizophrenia with at least 3 weeks duration and comparing any antipsychotic with barbiturates or benzodiazepines were eligible. ClinicalTrials.gov, CENTRAL, EMBASE, MEDLINE, PsycINFO, PubMed, WHO-ICTRP as well as previous reviews were searched up to 9 January 2018. Two separate meta-analyses, one for barbiturates and one for benzodiazepines, were conducted using random-effects models. The primary outcome was response to treatment, and mean values of schizophrenia rating scales and dropouts were analyzed as secondary outcomes. This study is registered with PROSPERO (CRD42018086263).
Seven barbiturate-RCTs (number of participants n = 1736), and two benzodiazepine-RCTs (n = 76) were included in the analysis. The studies were published between 1960 and 1968 and involved mainly chronically ill patients. More patients on antipsychotics in comparison to barbiturates achieved a ‘good’ response (36.2% v. 16.8%; RR 2.15; 95% CI 1.36–3.41; I2 = 48.9) and ‘any’ response (57.4% v. 27.8%; RR 2.07; 95% CI 1.35–3.18; I2 = 68.2). In a single small trial (n = 60), there was no difference between antipsychotics and benzodiazepines on ‘any’ response (74.7% v. 65%; RR 1.15; 95% CI 0.82–1.62).
Antipsychotic drugs were more efficacious than barbiturates, based on a large sample size. Response ratios were similar to those observed in placebo-controlled trials. The results on benzodiazepines were inconclusive due to the small number of studies and participants.
A female neonate with in utero selective serotonin reuptake inhibitor exposure presented with bradycardia shortly after birth. Electrocardiography showed severe QT prolongation and second-degree atrioventricular block. Over time QT-times spontaneously normalised and genetic testing did not show mutations associated with long QT syndrome making maternal selective serotonin reuptake inhibitor usage the most likely explanation for the observed severe transient neonatal QT prolongation.
A major limitation in nanoindentation analysis techniques is the inability to accurately quantify pile-up/sink-in around indentations. In this work, the contact area during indentation is determined simultaneously using both contact mechanical models and direct in situ observation in the scanning electron microscope. The pile-up around indentations in materials with low H/E ratios (nanocrystalline nickel and ultrafine-grained aluminum) and the sink-in around a material with a high H/E ratio (fused silica) were quantified and compared to existing indentation analyses. The in situ projected contact area measured by Scanning Electron Microscopy using a cube-corner tip differs significantly from the classical models for materials with low H/E modulus ratio. Using a Berkovich tip, the in situ contact area is in good agreement with the contact model suggested by Loubet et al. for materials with low H/E ratio and in good agreement with the Oliver and Pharr model for materials with high H/E ratio.
Studies on neighbourhood characteristics and depression show equivocal results.
This large-scale pooled analysis examines whether urbanisation, socioeconomic, physical and social neighbourhood characteristics are associated with the prevalence and severity of depression.
Cross-sectional design including data are from eight Dutch cohort studies (n= 32 487). Prevalence of depression, either DSM-IV diagnosis of depressive disorder or scoring for moderately severe depression on symptom scales, and continuous depression severity scores were analysed. Neighbourhood characteristics were linked using postal codes and included (a) urbanisation grade, (b) socioeconomic characteristics: socioeconomic status, home value, social security beneficiaries and non-Dutch ancestry, (c) physical characteristics: air pollution, traffic noise and availability of green space and water, and (d) social characteristics: social cohesion and safety. Multilevel regression analyses were adjusted for the individual's age, gender, educational level and income. Cohort-specific estimates were pooled using random-effects analysis.
The pooled analysis showed that higher urbanisation grade (odds ratio (OR) = 1.05, 95% CI 1.01–1.10), lower socioeconomic status (OR = 0.90, 95% CI 0.87–0.95), higher number of social security beneficiaries (OR = 1.12, 95% CI 1.06–1.19), higher percentage of non-Dutch residents (OR = 1.08, 95% CI 1.02–1.14), higher levels of air pollution (OR = 1.07, 95% CI 1.01–1.12), less green space (OR = 0.94, 95% CI 0.88–0.99) and less social safety (OR = 0.92, 95% CI 0.88–0.97) were associated with higher prevalence of depression. All four socioeconomic neighbourhood characteristics and social safety were also consistently associated with continuous depression severity scores.
This large-scale pooled analysis across eight Dutch cohort studies shows that urbanisation and various socioeconomic, physical and social neighbourhood characteristics are associated with depression, indicating that a wide range of environmental aspects may relate to poor mental health.
This qualitative study explores the experiences of older adults participating in a creative visual arts program at a residential care facility in Victoria, British Columbia. A narrative inquiry approach was used to conduct face-to-face interviews with 10 residents and three program staff in addition to the systematic observations of program activities and an arts exhibit. The findings reveal the program fostered a sense of community among participants and enhanced their sense of self-worth as artists. A public art exhibition at a community centre underlined the value of residents’ artwork and gave meaning and purpose to their involvement in the program. Findings show the importance of arts programs in fostering creativity in later life and illustrate how people living in institutions can experience multiple dimensions of the self through artistic forms of expression. This study highlights the need to increase access to arts programs for individuals living in residential care.
The ‘Vulnerable’ Swinhoe’s Rail Coturnicops exquisitus is believed to occur in only two regions in Russia’s Far East and China’s Heilongjiang province, separated by more than 1,000 km. Recent observations suggest that the Amur region, situated between the two known populations, might be inhabited by this secretive species as well. As the species is rather similar in appearance and field characteristics to its Nearctic sister taxon, the Yellow Rail C. noveboracensis, and almost all field records relate to flushed individuals in flight, we aimed to complement the field observations by genetic evidence. Samples were obtained from four individuals and one eggshell and their mitochondrial cytochrome b genes were amplified and sequenced. The genetic analyses unequivocally confirmed that swab samples and eggshell were attributable to Swinhoe’s Rail, thus constituting the first known breeding record of this species for 110 years. It is therefore likely that the individuals observed in the field also belonged to this species. It seems possible that Swinhoe’s Rail is more widely distributed in the Amur region and was overlooked in the past, possibly due to a misleading description of its calls in the literature.
In a risk exchange, participants trade a privately owned risk for a share in a pool. If participants agree on a valuation rule, it can be decided whether or not, according to the given rule, these trades take place at equal value. If equality of values holds for all participants, then the exchange is said to be “financially fair”. It has been shown by Bühlmann and Jewell (1979) that, under mild assumptions, the constraint of financial fairness singles out a unique solution among the set of all Pareto efficient risk exchanges. In this paper, we find that an analogous statement is true if we limit ourselves to linear exchanges. Conditions are provided for existence and uniqueness of linear sharing rules that are both financially fair and Pareto efficient among all linear sharing rules. The performance of the linear rule is compared to that of the general (nonlinear) rule in a number of specific cases.
Improvement in depression within the first 2 weeks of antidepressant treatment predicts good outcomes, but non-improvers can still respond or remit, whereas improvers often do not.
We aimed to investigate whether early improvement of individual depressive symptoms better predicts response or remission.
We obtained individual patient data of 30 trials comprising 2184 placebo-treated and 6058 antidepressant-treated participants. Primary outcome was week 6 response; secondary outcomes were week 6 remission and week 12 response and remission. We compared models that only included improvement in total score by week 2 (total improvement model) with models that also included improvement in individual symptoms.
For week 6 response, the area under the receiver operating characteristic curve and negative and positive predictive values of the total improvement model were 0.73, 0.67 and 0.74 compared with 0.77, 0.70 and 0.71 for the item improvement model. Model performance decreased for week 12 outcomes. Of predicted non-responders, 29% actually did respond by week 6 and 43% by week 12, which was decreased from the baseline (overall) probabilities of 51% by week 6 and 69% by week 12. In post hoc analyses with continuous rather than dichotomous early improvement, including individual items did not enhance model performance.
Examining individual symptoms adds little to the predictive ability of early improvement. Additionally, early non-improvement does not rule out response or remission, particularly after 12 rather than 6 weeks. Therefore, our findings suggest that routinely adapting pharmacological treatment because of limited early improvement would often be premature.