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To evaluate the association between novel pre- and post-operative biomarker levels and 30-day unplanned readmission or mortality after paediatric congenital heart surgery.
Children aged 18 years or younger undergoing congenital heart surgery (n = 162) at Johns Hopkins Hospital from 2010 to 2014 were enrolled in the prospective cohort. Collected novel pre- and post-operative biomarkers include soluble suppression of tumorgenicity 2, galectin-3, N-terminal prohormone of brain natriuretic peptide, and glial fibrillary acidic protein. A model based on clinical variables from the Society of Thoracic Surgery database was developed and evaluated against two augmented models.
Unplanned readmission or mortality within 30 days of cardiac surgery occurred among 21 (13%) children. The clinical model augmented with pre-operative biomarkers demonstrated a statistically significant improvement over the clinical model alone with a receiver-operating characteristics curve of 0.754 (95% confidence interval: 0.65–0.86) compared to 0.617 (95% confidence interval: 0.47–0.76; p-value: 0.012). The clinical model augmented with pre- and post-operative biomarkers demonstrated a significant improvement over the clinical model alone, with a receiver-operating characteristics curve of 0.802 (95% confidence interval: 0.72–0.89; p-value: 0.003).
Novel biomarkers add significant predictive value when assessing the likelihood of unplanned readmission or mortality after paediatric congenital heart surgery. Further exploration of the utility of these novel biomarkers during the pre- or post-operative period to identify early risk of mortality or readmission will aid in determining the clinical utility and application of these biomarkers into routine risk assessment.
The illegal wildlife trade is driving declines in populations of a number of large, charismatic animal species but also many lesser known and restricted-range species, some of which are now facing extinction as a result. The ploughshare tortoise Astrochelys yniphora, endemic to the Baly Bay National Park of north-western Madagascar, is affected by poaching for the international illegal pet trade. To quantify this, we estimated population trends during 2006–2015, using distance sampling surveys along line transects, and recorded national and international confiscations of trafficked tortoises for 2002–2016. The results suggest the ploughshare tortoise population declined > 50% during this period, to c. 500 adults and subadults in 2014–2015. Prior to 2006 very few tortoises were seized either in Madagascar or internationally but confiscations increased sharply from 2010. Since 2015 poaching has intensified, with field reports suggesting that two of the four subpopulations are extinct, leaving an unknown but almost certainly perilously low number of adult tortoises in the wild. This study has produced the first reliable population estimate of the ploughshare tortoise and shows that the species has declined rapidly because of poaching for the international pet trade. There is an urgent need for increased action both in Madagascar and along international trade routes if the extinction of the ploughshare tortoise in the wild is to be prevented.
The correlation between objective and subjective nasal obstruction is poor, and dissatisfaction rates after surgery for nasal obstruction are high. Accordingly, novel assessment techniques may be required. This survey aimed to determine patient experience and preferences for the measurement of nasal obstruction.
Prospective survey of rhinology patients.
Of 72 questionnaires distributed, 60 were completed (response rate of 83 per cent). Obstruction duration (more than one year) (χ2 = 13.5, p = 0.00024), but not obstruction severity, affected willingness to spend more time being assessed. Questionnaires (48 per cent) and nasal inspiratory peak flow measurement (53 per cent) are the most commonly used assessment techniques. Forty-nine per cent of participants found their assessment unhelpful in understanding their obstruction. Eighty-two per cent agreed or strongly agreed that a visual and numerical aid would help them understand their blockage.
Many patients are dissatisfied with current assessment techniques; a novel device with visual or numerical results may help. Obstruction duration determines willingness to undergo longer assessment.
Anxiety is debilitating and associated with numerous mental and physical comorbidities. There is a need to identify and investigate low-risk prevention and treatment strategies. Therefore, the purpose of this study was to investigate cross-sectional and longitudinal associations between different volumes of moderate-to-vigorous physical activity (PA) and anxiety symptoms and status among older adults in Ireland.
Participants (n = 4175; 56.8% female) aged ⩾50 years completed the International PA Questionnaire (IPAQ) at baseline, and the anxiety subscale of the Hospital Anxiety and Depression Scale at baseline and follow-up (2009–2013). Participants were classified according to meeting World Health Organisation PA guidelines, and divided into IPAQ categories. Respondents without anxiety at baseline (n = 3165) were included in prospective analyses. Data were analysed in 2017.
Anxiety symptoms were significantly higher among females than males (p < 0.001). Models were adjusted for age, sex, waist circumference, social class, smoking status and pain. In cross-sectional analyses, meeting PA guidelines was associated with 9.3% (OR = 0.91, 95% confidence interval 0.78–1.06) lower odds of anxiety. Compared with the inactive group, the minimally- and very-active groups were associated with 8.4% (OR = 0.92, 0.76–1.10) and 18.8% (OR = 0.81, 0.67–0.98) lower odds of anxiety, respectively. In prospective analyses, meeting guidelines was associated with 6.3% (OR = 0.94, 0.63–1.40) reduced odds of anxiety. Compared with the inactive group, the minimally and very-active groups were associated with 43.5% (OR = 1.44, 0.89–2.32) increased, and 4.3% (OR = 0.96, 0.56–1.63) reduced odds of anxiety. The presence of pain, included in models as a covariate, was associated with a 108.7% (OR = 2.09, 1.80–2.42) increase in odds of prevalent anxiety, and a 109.7% (OR = 2.10, 1.41–3.11) increase in odds of incident anxiety.
High volumes of PA are cross-sectionally associated with lower anxiety symptoms and status, with a potential dose–response apparent. However, significant associations were not observed in prospective analyses. The low absolute number of incident anxiety cases (n = 109) potentially influenced these findings. Further, as older adults may tend to experience and/or report more somatic anxiety symptoms, and the HADS focuses primarily on cognitive symptoms, it is plausible that the HADS was not an optimal measure of anxiety symptoms in the current population.
We present low-frequency spectral energy distributions of 60 known radio pulsars observed with the Murchison Widefield Array telescope. We searched the GaLactic and Extragalactic All-sky Murchison Widefield Array survey images for 200-MHz continuum radio emission at the position of all pulsars in the Australia Telescope National Facility (ATNF) pulsar catalogue. For the 60 confirmed detections, we have measured flux densities in 20 × 8 MHz bands between 72 and 231 MHz. We compare our results to existing measurements and show that the Murchison Widefield Array flux densities are in good agreement.
Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.
Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.
A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29–0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit–risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.
Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
This paper presents the design and optimisation of an aerofoil with active continuous trailing-edge flap (CTEF) investigated as a potential rotorcraft active control device. Several structural cross-section models are developed: high-fidelity NASA STRucture ANalysis (NASTRAN) and University of Michigan/Variational Asymptotic Beam Section Code (UM/VABS) models and a reduced-order analysis model. The validation of the reduced-order model is established by comparing its predictions of CTEF deformations with those of NASTRAN and UM/VABS analyses, which both show good agreement. The 2D aerodynamic characteristics of the CTEF aerofoil are evaluated using XFOIL and Computational Fluid Dynamics (CFD) analyses: FUN3D and Overset Transonic Unsteady Rotor Navier-Stokes (OVERTURNS). XFOIL, coupled with the reduced-order structure model, is adopted for optimisation study. The accuracy of XFOIL in predicting the aerodynamic pressure of the CTEF aerofoil is verified using CFD simulations, which shows sufficient fidelity. The predicted variations of aerodynamic coefficients with a CTEF angle are compared among the aerodynamic analyses. The optimisation process is developed and applied to two bimorph bender configurations: a Macro-Fibre Composite (MFC) solid bender and an MFC stack bender. The solid bender is used to confirm the functioning of the optimisation procedure and to use its optimal layout as a reference to the stack design, the primary design object. A linear tapered shape is found to be the optimum for a MFC solid bender, which generates an average of 63% more CTEF angles than those of an optimal rectangular bender. An optimised MFC stack bender is shown to resemble the shape of the solid bender. A four-ply bimorph is considered the best choice among the stack layouts because of its large output of CTEF angles and relatively less plies required. The CTEF angle produced by the four-ply optimal layout ranges from 7.6° to 5.3° with speeds from 0 to 200m/s at an angle of attack (AoA) of 6°. The reduction in the CTEF angle with AoA is less steep than that with speed, ranging from 6.5° to 5.8° with AoA from 0 to 8° at speed of 166m/s. An average of 14% increase in CTEF angles is achieved through optimisation for the four-ply bimorph.
Obese individuals are at an increased risk of developing CVD, hypertension, type 2 diabetes, and bacterial and viral infections when compared with the normal-weight population. In a 9-week randomised, double-blind, cross-over study, twenty-four obese subjects aged between 20 and 60 years and with a BMI between 30 and 45 kg/m2 were fed grape or placebo powder for 3-week intervals to determine the effects of dietary grapes on blood lipid profiles, plasma inflammatory marker concentrations and immune cell function. Blood samples were collected on days 1 and 8 for obtaining baseline information and at weeks 3, 4, 8 and 9. Comprehensive chemistry panels, lipid profile analyses by NMR, measurement of plasma inflammatory marker concentrations, and analyses of cytokine production by activated T lymphocytes and monocytes were performed for each blood draw. Dietary grape powder reduced the plasma concentrations of large LDL-cholesterol and large LDL particles compared with the placebo powder (P< 0·05). The concentrations of interferon-γ, TNF-α, IL-4 and IL-10 were measured in supernatants from peripheral blood mononuclear cells (PBMC) activated with anti-CD3/CD28 antibodies and those of TNF-α, IL-1β, IL-6 and IL-8 were measured in supernatants from PBMC activated with lipopolysaccharide (LPS). No difference in the production of T-cell cytokines was observed between the two intervention groups. The production of IL-1β and IL-6 was increased in supernatants from LPS-activated PBMC in the grape powder group compared with the placebo powder group (P< 0·05). These data suggest that dietary grapes may decrease atherogenic lipid fractions in obese individuals and increase the sensitivity of monocytes in a population at a greater risk of developing infections.