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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.
Dr Nick Martin has made enormous contributions to the field of behavior genetics over the past 50 years. Of his many seminal papers that have had a profound impact, we focus on his early work on the power of twin studies. He was among the first to recognize the importance of sample size calculation before conducting a study to ensure sufficient power to detect the effects of interest. The elegant approach he developed, based on the noncentral chi-squared distribution, has been adopted by subsequent researchers for other genetic study designs, and today remains a standard tool for power calculations in structural equation modeling and other areas of statistical analysis. The present brief article discusses the main aspects of his seminal paper, and how it led to subsequent developments, by him and others, as the field of behavior genetics evolved into the present era.
Designing complex products involves working with uncertainties as the product, the requirements and the environment in which it is used co-evolve, and designers and external stakeholders make decisions that affect the evolving design. Rather than being held back by uncertainty, designers work, cooperate and communicate with each other notwithstanding these uncertainties by making assumptions to carry out their own tasks. To explain this, the paper proposes an adaptation of Kendall Walton’s make-believe theory to conceptualise designing as playing games of make-believe by inferring what is required and imagining what is possible given the current set of assumptions and decisions, while knowing these are subject to change. What one is allowed and encouraged to imagine, conclude or propose is governed by socially agreed rules and constraints. The paper uses jet engine component design as an example to illustrate how different design teams make assumptions at the beginning of design activities and negotiate what can and cannot be done with the design. This often involves iteration – repeating activities under revised sets of assumptions. As assumptions are collectively revised, they become part of a new game of make-believe in the sense that there is social agreement that the decisions constitute part of the constraints that govern what can legitimately be inferred about the design or added to it.
Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
Optimising short- and long-term outcomes for children and patients with CHD depends on continued scientific discovery and translation to clinical improvements in a coordinated effort by multiple stakeholders. Several challenges remain for clinicians, researchers, administrators, patients, and families seeking continuous scientific and clinical advancements in the field. We describe a new integrated research and improvement network – Cardiac Networks United – that seeks to build upon the experience and success achieved to-date to create a new infrastructure for research and quality improvement that will serve the needs of the paediatric and congenital heart community in the future. Existing gaps in data integration and barriers to improvement are described, along with the mission and vision, organisational structure, and early objectives of Cardiac Networks United. Finally, representatives of key stakeholder groups – heart centre executives, research leaders, learning health system experts, and parent advocates – offer their perspectives on the need for this new collaborative effort.
Understanding the nutritional demands on serving military personnel is critical to inform training schedules and dietary provision. Troops deployed to Afghanistan face austere living and working environments. Observations from the military and those reported in the British and US media indicated possible physical degradation of personnel deployed to Afghanistan. Therefore, the present study aimed to investigate the changes in body composition and nutritional status of military personnel deployed to Afghanistan and how these were related to physical fitness. In a cohort of British Royal Marines (n 249) deployed to Afghanistan for 6 months, body size and body composition were estimated from body mass, height, girth and skinfold measurements. Energy intake (EI) was estimated from food diaries and energy expenditure measured using the doubly labelled water method in a representative subgroup. Strength and aerobic fitness were assessed. The mean body mass of volunteers decreased over the first half of the deployment ( − 4·6 (sd 3·7) %), predominately reflecting fat loss. Body mass partially recovered (mean +2·2 (sd 2·9) %) between the mid- and post-deployment periods (P< 0·05). Daily EI (mean 10 590 (sd 3339) kJ) was significantly lower than the estimated daily energy expenditure (mean 15 167 (sd 1883) kJ) measured in a subgroup of volunteers. However, despite the body mass loss, aerobic fitness and strength were well maintained. Nutritional provision for British military personnel in Afghanistan appeared sufficient to maintain physical capability and micronutrient status, but providing appropriate nutrition in harsh operational environments must remain a priority.
Species distribution models (SDMs), which are well established in many fields of biological research, are still uncommon in the agricultural risk analysis of pest insects. To exemplify the use of SDMs, we investigated the influence of environmental factors on the occurrence of Hyalesthes obsoletus Signoret (Hemiptera: Cixiidae). The planthopper is the only known vector of the grapevine yellows disease ‘bois noir’. The study was conducted in 145 locations in the Baden region of southwest Germany. The planthopper was surveyed on host plant patches, consisting of stinging nettle and/or bindweeds. We used a stratified modelling framework where (1) species presence–absence data were related to an extensive environmental dataset using logistic regressions; and (2) different types of average models were developed based on an information theoretic method. The results show that the incidence of H. obsoletus is associated to above- as well as below-ground environmental factors, particularly to the amount of fine soil and average annual precipitation. This result was consistent across all average models. The relative importance of other environmental variables was dependent upon the average model under consideration and thus may vary according to their intended use, either the explanation of habitat requirements or the prediction and mapping of occurrence risks. The study showed that SDMs offer a quantification of species’ habitat requirements and thus, could represent a valuable tool for pest management purposes. By providing examples of current issues of grapevine pests in viticulture, we discuss the use of SDMs in agricultural risk analysis and highlight their advantages and caveats.
This paper reflects on experience gained through MARS (Making Architecture Research Studio) at the University of Nottingham. It argues for a densification of design teaching and learning through a direct, practical and tactile engagement with materials and making. It sets out the pedagogical benefits of exploring and theorising the practical, combined with the value and relevance of material practices. As a methodology of design teaching it suggests a multi-level, synergistic approach to pedagogy and practice that can build key knowledge and skills while avoiding a narrowly instrumental view of architectural education and practice. A key aim of the pedagogy of the studio is the development of an empathetic imagination, as clearly articulated by William Hazlitt (1805) in An Essay on the Principles of Human Action:
The imagination, by means of which alone I can anticipate future objects, or be interested in them, must carry me out of myself into the feelings of others by one and the same process by which I am thrown forward as it were into my future being.
Chronic venous insufficiency (CVI) is a term that is used to describe changes in the leg that include a variety of different clinical problems, which are caused by several types of abnormalities in the veins, and which may occur at a number of different locations in the leg. For these reasons it has been difficult to make accurate comparisons of reports of chronic venous insufficiency from different institutions. As a result attempts have been made to formulate systems of classification that enable accurate comparisons to be made.
The most recent classification, referred to as the CEAP classification, was devised by an international panel and encompasses features of some of the earlier classifications. This classification has four categories which include – Clinical (C), Etiology (E), Anatomy (A) and Pathophysiology (P). Within each category the different levels are each given a number or a letter or both. The clinical classification has seven levels from no visible or palpable signs of venous disease through to skin changes with active ulceration (table 25.1). In addition the Clinical categories are further characterized according to the presence or absence of symptoms. The Etiological classification recognizes the roles of congenital (Ec), primary (Ep) and secondary (Es) causes in venous dysfunction. The Anatomical classification can be represented as a simple or more detailed form. The simple form refers to the site at which the veins are involved as superficial (As), deep (Ad) or perforating (Ap).
The act of making links hand and eye, and connects the intellect to physical change. A sculptor carving stone requires precision of thought before deploying manual dexterity. The challenge for an architect until the recent past has been to communicate such thoughtfulness, embodied in a design, to the people who will make the building and its component parts. Making architecture and the pursuit of excellence in the physical delivery of quality in built projects is a challenging and collaborative process . It is not possible to legislate for excellence, however it is possible to create contexts in which high-quality architecture is probable. By comparison, John Ruskin in The Seven Lamps of Architecture (1849) set his aspirations low: ‘We may not be able to command good, or beautiful, or inventive architecture, but we can command an honest architecture’.