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The Bonebridge is an active transcutaneous bone conduction implant recommended as a surgical option for adults and children (aged 5–18 years). Successful implantation of the Bonebridge is often restricted by an insufficient amount of temporal bone to house the transducer in the paediatric patient.
Method and results
In this unique paediatric case, bilateral Bonebridge devices were implanted simultaneously in the right sinodural angle and the left middle cranial fossa.
The simultaneous implantation of bilateral Bonebridge devices was well tolerated in this paediatric patient, with significant improvement in her hearing. The middle cranial fossa is a viable option for housing the transducer.
Little evidence exists to support pharmacotherapeutic strategies for heart failure management in paediatrics. A recent Europe-wide survey suggests that this translates into substantial variability in clinical practice.
To conduct a formal discussion among an expert group of paediatric cardiology physicians on controversial aspects regarding the pharmacotherapy of children heart failure, facilitate consensus, and highlight areas of agreement and disagreement.
A two-round modified Delphi process was conducted between July and August 2015. Topics addressed were predominantly selected from the results of a previous Europe-wide survey. Fourteen statements were presented for discussion grouped under three categories; Angiotensin-converting-enzyme-inhibitors: Considerations for optimal dosage; Angiotensin-converting-enzyme-inhibitors for the management of CHDs; Neurohumoral antagonists for the management of dilated cardiomyopathy-related heart failure.
A total of 13 paediatricians dedicated to cardiology from across Europe and the United States of America completed the study; of them, 92% had a working experience in the field of more than 10 years and were working in a specific paediatric cardiology unit. Agreement on the acceptance/rejection of 11 statements was achieved. Results show agreement on the importance of a set of topics relevant to the standardisation of the therapy as well as consensus upon specific therapeutic attitudes.
We have found areas of common thinking and motivation, which can provide a means of triggering scientific collaboration. Our results might also contribute to disseminate available paediatric evidence and promote reducing unjustified variability in everyday practice. Until solid evidence is available, other research methods can contribute to advancing the goal of safe and effective paediatric heart failure pharmacotherapy.
Introduction: There is increasing evidence to support the integration of simulation into medical training; however, no national emergency medicine (EM) simulation curriculum currently exists. Using Delphi methodology, we aimed to identify and establish content validity evidence for EM curricular content best suited for simulation-based training to inform national postgraduate EM training. Methods: A national panel of experts in EM simulation-related education iteratively rated potential curricular topics, on a 4-point scale, to determine those best suited for simulation-based training. After each round, responses were analyzed and topics scoring <2/4 were removed. Remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics that were rated ≥3.5/4 were considered core curricular topics, while those rated 3.0-3.5 were considered extended curricular topics. Results: Forty-four experts from 13 Canadian centres participated. Two hundred and eighty potential curricular topics, in 29 domains, were generated from a systematic review of the literature, analysis of relevant educational documents and a survey of Delphi panelists. Three rounds of Delphi surveys were completed before consensus was achieved, with response rates ranging from 93-100%. Twenty-eight topics, in 8 domains, reached consensus as core curricular topics. An additional 35 topics, in 14 domains, reached consensus as extended curricular topics. Conclusion: Delphi methodology allowed for achievement of expert consensus and content validation of EM curricular content best suited for simulation-based training. These results provide a foundation for improved integration of simulation into postgraduate EM training and can be used to inform a national simulation curriculum to supplement clinical training and optimize learning.
Major and trace element data are presented for the basic, intermediate, and acid rocks of the Beinn Chaisgidle Centre of the Tertiary igneous complex on the Isle of Mull. The variation in the bulk chemical composition, the iron enrichment trend in the clinopyroxenes, the systematic decrease in concentrations of the transition metal cations, and the increase in the incompatible elements suggest that the magma from which these rocks formed underwent crystal fractionation. The rocks show a coherence of rare earth element patterns for all the rocks in the sequence, and there is a progressive increase in negative Eu anomaly with increasing silica content.
Anti-retroviral therapy (ART) regimes for HIV are associated with raised levels of circulating triglycerides (TGs) in western populations. However, there are limited data on the impact of ART on cardiometabolic risk in sub-Saharan African (SSA) populations.
Pooled analyses of 14 studies comprising 21 023 individuals, on whom relevant cardiometabolic risk factors (including TG), HIV and ART status were assessed between 2003 and 2014, in SSA. The association between ART and raised TG (>2.3 mmol/L) was analysed using regression models.
Among 10 615 individuals, ART was associated with a two-fold higher probability of raised TG (RR 2.05, 95% CI 1.51–2.77, I2 = 45.2%). The associations between ART and raised blood pressure, glucose, HbA1c, and other lipids were inconsistent across studies.
Evidence from this study confirms the association of ART with raised TG in SSA populations. Given the possible causal effect of raised TG on cardiovascular disease (CVD), the evidence highlights the need for prospective studies to clarify the impact of long term ART on CVD outcomes in SSA.
The Greater Sunda region of South-east Asia supports a rich diversity of economically and ecologically important species. However, human pressures are reshaping contemporary biogeography across the region. Megafaunal distributional patterns have been particularly affected because of deforestation, poaching and human–wildlife conflict. Crocodilians are at the centre of these conflicts in Indonesia and yet remain poorly studied across much of the archipelago. We conducted population surveys of salt-water crocodiles Crocodylus porosus and false gharials Tomistoma schlegelii in Sumatra, and examined whether crocodile abundance and distribution are correlated with variations in human disturbance, fishing pressure, and habitat type. We then used these data to model remaining suitable habitat for T. schlegelii across South-east Asia. We found that abundance of T. schlegelii and C. porosus was correlated with distance from human settlements, and fish-trapping pressure. We recorded the presence of T. schlegelii in a river system in which it was previously unknown, thus expanding the known range of the species. We also found that the predicted remaining suitable habitat for T. schlegelii in Indonesia is largely limited to areas of low human activity. From these empirical and modelling approaches we propose several key conservation priorities: (1) eliminate the use of fish traps in remaining patches of T. schlegelii habitat, (2) prioritize crocodile population surveys in remaining suitable habitat, particularly in remote areas, (3) consider T. schlegelii to be potentially Endangered locally in Sumatra, and (4) expand existing reserves around the Lower Kampar River and Berbak National Park/Sembilang National Park areas of Sumatra.
A range of endophenotypes characterise psychosis, however there has been limited work understanding if and how they are inter-related.
This multi-centre study includes 8754 participants: 2212 people with a psychotic disorder, 1487 unaffected relatives of probands, and 5055 healthy controls. We investigated cognition [digit span (N = 3127), block design (N = 5491), and the Rey Auditory Verbal Learning Test (N = 3543)], electrophysiology [P300 amplitude and latency (N = 1102)], and neuroanatomy [lateral ventricular volume (N = 1721)]. We used linear regression to assess the interrelationships between endophenotypes.
The P300 amplitude and latency were not associated (regression coef. −0.06, 95% CI −0.12 to 0.01, p = 0.060), and P300 amplitude was positively associated with block design (coef. 0.19, 95% CI 0.10–0.28, p < 0.001). There was no evidence of associations between lateral ventricular volume and the other measures (all p > 0.38). All the cognitive endophenotypes were associated with each other in the expected directions (all p < 0.001). Lastly, the relationships between pairs of endophenotypes were consistent in all three participant groups, differing for some of the cognitive pairings only in the strengths of the relationships.
The P300 amplitude and latency are independent endophenotypes; the former indexing spatial visualisation and working memory, and the latter is hypothesised to index basic processing speed. Individuals with psychotic illnesses, their unaffected relatives, and healthy controls all show similar patterns of associations between endophenotypes, endorsing the theory of a continuum of psychosis liability across the population.
Airborne and spaceborne altimeters provide measurements of sea-ice elevation, from which sea-ice freeboard and thickness may be derived. Observations of the Arctic ice pack by satellite altimeters indicate a significant decline in ice thickness, and volume, over the last decade. NASA’s Ice, Cloud and land Elevation Satellite-2 (ICESat-2) is a next-generation laser altimeter designed to continue key sea-ice observations through the end of this decade. An airborne simulator for ICESat-2, the Multiple Altimeter Beam Experimental Lidar (MABEL), has been deployed to gather pre-launch data for mission development. We present an analysis of MABEL data gathered over sea ice in the Greenland Sea and assess the capabilities of photon-counting techniques for sea-ice freeboard retrieval. We compare freeboard estimates in the marginal ice zone derived from MABEL photon-counting data with coincident data collected by a conventional airborne laser altimeter. We find that freeboard estimates agree to within 0.03 m in the areas where sea-ice floes were interspersed with wide leads, and to within 0.07 m elsewhere. MABEL data may also be used to infer sea-ice thickness, and when compared with coincident but independent ice thickness estimates, MABEL ice thicknesses agreed to within 0.65 m or better.
Recent cases of acute kidney injury due to Seoul hantavirus infection from exposure to wild or pet fancy rats suggest this infection is increasing in prevalence in the UK. We conducted a seroprevalence study in England to estimate cumulative exposure in at-risk groups with contact with domesticated and wild rats to assess risk and inform public health advice. From October 2013 to June 2014, 844 individual blood samples were collected. Hantavirus seroprevalence amongst the pet fancy rat owner group was 34.1% (95% CI 23·9–45·7%) compared with 3·3% (95% CI 1·6–6·0) in a baseline control group, 2·4% in those with occupational exposure to pet fancy rats (95% CI 0·6–5·9) and 1·7% with occupational exposure to wild rats (95% CI 0·2–5·9). Variation in seroprevalence across groups with different exposure suggests that occupational exposure to pet and wild rats carries a very low risk, if any. However incidence of hantavirus infection among pet fancy rat owners/breeders, whether asymptomatic, undiagnosed mild viral illness or more severe disease may be very common and public health advice needs to be targeted to this at-risk group.
Functional neurological disorders (FNDs), also known as conversion disorder, are unexplained neurological symptoms unrelated to a neurological cause. The disorder is common, yet poorly understood. The symptoms are experienced as involuntary but have similarities to voluntary processes. Here we studied intention awareness in FND.
A total of 26 FND patients and 25 healthy volunteers participated in this functional magnetic resonance study using Libet's clock.
FND is characterized by delayed awareness of the intention to move relative to the movement itself. The reporting of intention was more precise, suggesting that these findings are reliable and unrelated to non-specific attentional deficits. That these findings were more prominent with aberrant positive functional movement symptoms rather than negative symptoms may be relevant to impairments in timing for an inhibitory veto process. Attention towards intention relative to movement was associated with lower right inferior parietal cortex activity in FND, a region early in the processing of intention. During rest, aberrant functional connectivity was observed with the right inferior parietal cortex and other motor intention regions.
The results converge with observations of low inferior parietal activity comparing involuntary with voluntary movement in FND, emphasizing core deficiencies in intention. Heightened precision of this impaired intention is consistent with Bayesian theories of impaired top-down priors that might influence the sense of involuntariness. A primary impairment in voluntary motor intention at an early processing stage might explain clinical observations of slowed effortful voluntary movement, heightened self-directed attention and underlie functional movements. These findings further suggest novel therapeutic targets.
Star formation in the Galactic disc is primarily controlled by gravity, turbulence, and magnetic fields. It is not clear that this also applies to star formation near the Galactic Centre. Here we determine the turbulence and star formation in the CMZ cloud G0.253+0.016. Using maps of 3 mm dust emission and HNCO intensity-weighted velocity obtained with ALMA, we measure the volume-density variance σρ /ρ 0=1.3±0.5 and turbulent Mach number
= 11±3. Combining these with turbulence simulations to constrain the plasma β = 0.34±0.35, we reconstruct the turbulence driving parameter b=0.22±0.12 in G0.253+0.016. This low value of b indicates solenoidal (divergence-free) driving of the turbulence in G0.253+0.016. By contrast, typical clouds in the Milky Way disc and spiral arms have a significant compressive (curl-free) driving component (b > 0.4). We speculate that shear causes the solenoidal driving in G0.253+0.016 and show that this may reduce the star formation rate by a factor of 7 compared to nearby clouds.
Ground-state OH masers identified in the Southern Parkes Large-Area Survey in Hydroxyl were observed with the Australia Telescope Compact Array to obtain positions with high accuracy (~1 arcsec). We classified these OH masers into evolved star OH maser sites, star formation OH maser sites, supernova remnant OH maser sites, planetary nebula OH maser sites and unknown maser sites using their accurate positions. Evolved star and star formation OH maser sites in the Galactic Centre region (between Galactic longitudes of −5° to +5° and Galactic latitudes of −2° and +2°) were studied in detail to understand their distributions.
The inner few hundred parsecs of the Milky Way, the Central Molecular Zone (CMZ), is our closest laboratory for understanding star formation in the extreme environments (hot, dense, turbulent gas) that once dominated the universe. We present an update on the first large-area survey to expose the sites of star formation across the CMZ at high-resolution in submillimeter wavelengths: the CMZoom survey with the Submillimeter Array (SMA). We identify the locations of dense cores and search for signatures of embedded star formation. CMZoom is a three-year survey in its final year and is mapping out the highest column density regions of the CMZ in dust continuum and a variety of spectral lines around 1.3 mm. CMZoom combines SMA compact and subcompact configurations with single-dish data from BGPS and the APEX telescope, achieving an angular resolution of about 4″ (0.2 pc) and good image fidelity up to large spatial scales.
The discovery of many dense, dusty condensations in the Helix Nebula, NGC 7293, by Meaburn et al. (1992) was the first direct evidence of the real inhomogeneity of the medium of a planetary nebula. On account of the small distance of the Helix nebula from the Sun (~200pc), the knots (cometary globules) can be resolved from the ground and studied in detail from HST imaging (O'Dell & Handron, 1996). The condensations typically have a projected diameter of <2″ and hence sizes of <6 x 1015 cm. The condensations consist of a dusty core, visible as absorption against the background high ionization central region of the nebula for the foreground globules, and with a bow-shaped ionization front, strong in low ionization emission. The emission is displaced in the direction towards the central star, often with an outwardly-directed radial tail.
The Local Group Census is a narrowband survey of all the galaxies of the Local Group (LG) with Dec ≥ −30°, being carried out as part of the Isaac Newton Group's Wide Field Survey programme. Observations are being obtained with the Wide Field Camera at the 2.5m Isaac Newton telescope, equipped with a mosaic of four 2k x 4k EEV CCDs covering a field of view of 34′ x 34′.
As the nearest large elliptical galaxy, NGC 5128 is ideal for planetary nebula studies. Its size, favourable aspect, small distance and reddening allow low mass stellar evolution in a whole galaxy to be surveyed. The surface density and properties of the PN can be compared with stars of various ages, metallicities and components (bulge, halo). The PN provide the α-element abundances whilst stellar photometry is calibrated against Fe/H; applied to the same stellar population, the PN abundances can be related to those of the stars. Gradients and non-radial trends in the abundance can be mapped using spectral observations of a large number of PN, allowing star formation history to be studied.
The [O II]3726,3729Å doublet is sensitive to electron densities in the range 100 to 104 cm–3, typical of planetary nebulae, and thus provides an ideal tool for mapping the projected density structure. The first use of the imaging Fabry-Perot TAURUS-II to observe both the [O II] doublet lines, and hence map the electron density, is reported for NGC 6826. If sufficient spectral resolution is achieved both the [O II] lines can be resolved into separate components, opening the way to full 3-D density mapping of PN. Given the low finesse of the etalon and the low expansion velocity in NGC 6826 (10-15 kms–1), this original hope could not be fulfilled. However, a restricted aim of seeing-limited electron density mapping was accepted.
The Abell catalogue of planetary nebulae (PN) are distinguished by their large size, low surface brightness and generally faint central stars. They are thought to be old PN approaching the White Dwarf cooling track. A number have evidence for late thermal pulses (H-poor ejecta near the central star, e.g. A78) and binary central stars.