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Introduction: Prompt defibrillation is critical during paediatric cardiac arrest. The main objective of this systematic review was to determine the initial defibrillation energy dose for ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) that is associated with sustained return of spontaneous circulation (ROSC) during paediatric cardiac arrest. Associations between initial defibrillation energy dose with any ROSC, survival and defibrillation-induced complications were also assessed. Methods: A systematic review was performed using four databases (Medline, Embase, Web of Science, Cochrane Library) (PROSPERO: CRD42016036734). Human studies (cohort studies or controlled trials) and animal model studies (controlled trials) of pediatric cardiac arrest involving assessment of external defibrillation energy dosing were considered. The primary outcome was sustained ROSC. Two researchers independently reviewed all the titles and abstracts of the retrieved citations, selected the studies and extracted the data using a standardized template. Risk of bias of human non-randomised studies were assessed using the ROBIN-I tool (formerly ACROBAT-NRSI) tool proposed by the Cochrane Collaboration group. Results: The search strategy identified 14,471 citations of which 232 manuscripts were reviewed. Ten human and 10 animal model studies met the inclusion criteria. Human studies were prospective (n = 6) or retrospective (n = 4) cohort studies and included between 11 and 266 patients (median = 46 patients). Sustained ROSC rates ranged from 0 to 61% (n = 7). No studies reported a statistically significant association between the initial defibrillation energy dose and the rate of sustained ROSC (n = 7) or survival (n = 6). No human studies reported defibrillation-induced complications. Meta-analysis was not considered appropriate due to clinical heterogeneity. The overall risk of bias was moderate. All animal studies were randomized controlled trials with 8 and 52 (median = 27) piglets. ROSC was frequently achieved (more than 85%) with energy dose ranging from 2 to 7 joules/kg (n = 7). The defibrillation threshold varied according to the body weight and appears to be higher in infant models. Conclusion: Defibrillation energy doses and thresholds varied according to the body weight and trended higher for infants. No definitive association between initial defibrillation doses and the outcomes of sustained ROSC or survival could be demonstrated.
To examine the association between household food insecurity and dietary diversity in the past 24h (dietary diversity score (DDS, range: 0–9); minimum dietary diversity (MDD, consumption of three or more food groups); consumption of nine separate food groups) among pregnant and lactating women in rural Malawi.
Two rural districts in Central Malawi.
Pregnant (n 589) and lactating (n 641) women.
Of surveyed pregnant and lactating women, 66·7 and 68·6 %, respectively, experienced moderate or severe food insecurity and only 32·4 and 28·1 %, respectively, met MDD. Compared with food-secure pregnant women, those who reported severe food insecurity had a 0·36 lower DDS (P<0·05) and more than threefold higher risk (OR; 95 % CI) of not consuming meat/fish (3·19; CI 1·68, 6·03). The risk of not consuming eggs (3·77; 1·04, 13·7) was higher among moderately food-insecure pregnant women. Compared with food-secure lactating women, those who reported mild, moderate and severe food insecurity showed a 0·36, 0·44 and 0·62 lower DDS, respectively (all P<0·05). The risk of not achieving MDD was higher among moderately (1·95; 1·06, 3·59) and severely (2·82; 1·53, 5·22) food-insecure lactating women. The risk of not consuming meat/fish and eggs increased in a dose–response manner among lactating women experiencing mild (1·75; 1·01, 3·03 and 2·81; 1·09, 7·25), moderate (2·66; 1·47, 4·82 and 3·75; 1·40, 10·0) and severe (5·33; 2·63, 10·8 and 3·47; 1·19, 10·1) food insecurity.
Addressing food insecurity during and after pregnancy needs to be considered when designing nutrition programmes aiming to increase dietary diversity in rural Malawi.
Introduction: Head injury is a common presentation to all emergency departments. Previous research has shown that such injuries may be complicated by delayed intracranial hemorrhage (D-ICH) after the initial scan is negative. Exposure to anticoagulant or anti-platelet medications (ACAP) may be a risk factor for D-ICH. We have conducted a systematic review and meta-analysis to determine the incidence of delayed traumatic intracranial hemorrhage in patients taking anticoagulants, anti-platelets or both. Methods: The literature search was conducted in March 2017 with an update in April 2017. Keyword and MeSH terms were used to search OVID Medline, Embase and the Cochrane database as well as grey literature sources. All cohort and experimental studies were eligible for selection. Inclusion criteria included pre-injury exposure to oral anticoagulant and / or anti-platelet medication and a negative initial CT scan of the brain (CT1). The primary outcome was delayed intracranial hemorrhage present on repeat CT scan (CT2) within 48 hours of the presentation. Only patients who were rescanned or observed minimally were included. Clinically significant D-ICH were those that required neurosurgery, caused death or necessitated a change in management strategy, such as admission. Results: Fifteen primary studies were ultimately identified, comprising a total of 3801 patients. Of this number, 2111 had a control CT scan. 39 cases of D-ICH were identified, with the incidence of D-ICH calculated to be 1.31% (95% CI [0.56, 2.27]). No more than 12 of these patients had a clinically significant D-ICH representing 0.09% (95% CI [0.00, 0.31]). 10 of them were on warfarin and two on aspirin. There were three deaths recorded and three patients needed neurosurgery. Conclusion: The relatively low incidence suggests that repeat CT should not be mandatory for patients without ICH on first CT. This is further supported by the negligibly low rate of clinically significant D-ICH. Evidence-based assessments should be utilised to indicate the appropriate discharge plan, with further research required to guide the balance between clinical observation and repeat CT.
New simultaneous X-ray and radio observations of the archetypal mode-switching pulsar PSR B0943+10 have been carried out with XMM-Newton and the LOFAR, LWA and Arecibo radio telescopes in November 2014. They allowed us to better constrain the X-ray spectral and variability properties of this pulsar and to detect, for the first time, the X-ray pulsations also during the X-ray-fainter mode. The combined timing and spectral analysis indicates that unpulsed non-thermal emission, likely of magnetospheric origin, and pulsed thermal emission from a small polar cap are present during both radio modes and vary in a correlated way.
Introduction: Mild traumatic brain injury (mTBI) is a major cause of morbidity but there are no validated tools to help clinicians predict post-concussion symptoms. This systematic review and meta-analysis aimed to determine the prognostic value of S-100B protein to predict post-concussion symptoms following a mTBI in adults. Methods: The protocol of this systematic review was registered with the PROSPERO database (CRD42016032578). A search strategy was performed on seven databases (CINAHL, Cochrane CENTRAL, EMBASE, MEDLINE, Web of Knowledge, PyscBITE, PsycINFO) from their inception to October 2016. Studies evaluating the association between S-100B protein level and post-concussion symptoms assessed at least seven days after the mTBI were eligible. Individual patient data were requested. Studies eligibility assessment, data extraction and risk of bias assessment were performed independently by two researchers. Analyses were done following the meta-analysis using individual participant data or summary aggregate data guidelines from the Cochrane Methodology Review Group. Results: Outcomes were dichotomised as persistent (≥3 months) or early (≥7 days <3 months). Our search strategy yielded 23,298 citations of which 29 studies presenting between seven and 223 patients (n=2505) were included. Post-concussion syndrome (PCS) (16 studies), neuropsychological symptoms (9 studies) and health-related quality of life (4 studies) were the most frequently presented outcomes. The S-100B protein serum level of patients with no PCS was similar to that of patients experiencing persistent PCS (mean difference 0.00 [-0.05, 0.04]) or early PCS (mean difference 0.03 [-0.02, 0.08]). The odds of having persistent PCS (OR 0.56 (95% CI: 0.29-1.10) or early PCS (OR 1.67 (95% CI: 0.98-2.85) in patients with an elevated S-100B protein serum level was not significantly different from that of patients with normal values. No meta-analysis was performed for other outcomes than PCS due to heterogeneity and small samples. Studies’ overall risk of bias was considered moderate. Conclusion: Results suggest that the prognostic value of S-100B protein serum level to predict persistent and early post-concussion symptoms is limited. Variability in injury to S-100B protein sample time and outcomes assessed could potentially explain the lack of association and needs further evaluation.
Introduction: Mild traumatic brain injury (mTBI) is an understudied worldwide health problem and a socio-economic burden that remains a major cause of morbidity. However, there is no prognostication tool to help clinicians predict the occurrence of post-concussion symptoms. This systematic review aimed to determine the prognostic value of neuron-specific enolase (NSE) to predict post-concussion symptoms following a mTBI in adults. Methods: The protocol of this systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (registration number CRD42016033683). Seven databases (CINAHL, Cochrane CENTRAL, EMBASE, MEDLINE, PsycBITE, PsycINFO, Web of Knowledge/Biosis) were searched for cohort studies evaluating the association between NSE levels and post-concussion symptoms assessed at least seven days after the mild TBI. Grey literature was also screened using databases on dissertations and theses as well as abstracts from relevant congresses. Two researchers independently screened studies for inclusion, extracted data, and appraised their quality using the Quality in Prognostic Studies (QUIPS) tool from the Cochrane Collaboration Group. Results: Our search strategy yielded a total of 23,298 citations from which eight cohorts presented in 10 studies were included. Studies included between 45 and 141 patients (total=608 patients). The most frequently assessed outcomes were post-concussion syndrome (PCS) (13 assessments), neuropsychological disorders (10 assessments), return to work or sick leave (2 assessments) and Glasgow Outcome Scale (GOS) (2 assessments). No association was found between an elevated NSE serum level and the occurrence of PCS. Of the 33 outcomes assessments performed, only three showed an association between a higher level of serum NSE and a post-concussion symptom (alteration of at least three cognitive domains at 2 weeks, standardised physician assessment at 6 weeks and headache at 6 months following a mild TBI). Included studies’ overall risk of bias was considered moderate. Conclusion: Results of this systematic review conclude that based on current levels of evidence, serum NSE levels alone do not provide prognostic information on persistent or early post-concussion symptoms after a mTBI.
Ni-Zr alloy thin films were processed by DC magnetron sputtering of high purity Ni and Zr targets in ultrahigh vacuum at ambient temperature, with the substrate being subjected to either 0 V or -60 V bias. Some of the as-deposited films were annealed in vacuum at 700°C for 1 h. Surface profilometer and atomic force microscope were used to measure the film thickness and surface roughness, respectively. X-ray diffraction and cross-sectional TEM analysis have shown dispersion of nano-sized Ni3Zr dispersed in nanocrystalline Ni matrix. Nano-indentation and scratch tests conducted at 2 mN load have shown variation of hardness, Young′s modulus, scratch resistance, and coefficient of friction with substrate bias and annealing due to changes in grain size and surface roughness.
Silver nanoparticle inks are increasingly applied for the manufacture of inkjet-printed electrically conductive patterns. In order to obtain high conductivity, the printed liquid patterns have to be functionalized by an appropriate post- treatment step. Modern post-treatment methods using e.g. microwaves, intense pulsed light or adopted infrared radiation, are nevertheless the basis of the thermal process. The thermal treatment e.g. in furnaces or on heating plates, is applicable for a great variety of inks and ensures an efficient sintering without major technical efforts. It has been studied intensively wherein the reports mainly focus on reduction of the resistivity by controlling the parameters of the thermal treatment. Our researches exceed these comparative studies by investigating multi-layered patterns, their manufacturing and post-treatment.
Two silver nanoparticle inks were inkjet printed on a rigid and a flexible substrate. The geometry of the patterns was varied. The different drying behaviors of the inks were investigated. In addition, the number of layers which were printed on top of each other was varied. The sintering temperatures and time durations were varied.
The morphology of the patterns is investigated by profilometry and optical microscopy. The microstructure is analyzed by scanning electron microscope and X-ray diffraction. Furthermore, the electrical characteristics were determined by the measurement of the resistance. The results indicate the relation between the manufacture and the resulting microstructure and functionality of the patterns. The knowledge of these parameters enables us to control the industrial manufacturing of similar conductive patterns.
Two different atmospheric pressure microplasma systems are discussed and used for the synthesis and surface engineering of a range of nanomaterials. Specifically a gas-phase approach from vaporized tetramethylsilane has been used to synthesize silicon carbide nanoparticles with diameters below 10 nm. A different microplasma system that interfaces with a liquid solution has then been used for the synthesis of surfactant-free electrically stabilized gold nanoparticles with varying size. A similar microplasma-liquid system has been finally successfully used to tailor surface properties of silicon nanoparticles and to reduce graphene oxide into graphene. The synthesis and surface engineering mechanisms are also discussed.
The material characterization toolbox has recently experienced a number of parallel revolutionary advances, foreshadowing a time in the near future when material scientists can quantify material structure evolution across spatial and temporal space simultaneously. This will provide insight to reaction dynamics in four-dimensions, spanning multiple orders of magnitude in both temporal and spatial space. This study presents the authors’ viewpoint on the material characterization field, reviewing its recent past, evaluating its present capabilities, and proposing directions for its future development. Electron microscopy; atom probe tomography; x-ray, neutron and electron tomography; serial sectioning tomography; and diffraction-based analysis methods are reviewed, and opportunities for their future development are highlighted. Advances in surface probe microscopy have been reviewed recently and, therefore, are not included [D.A. Bonnell et al.: Rev. Modern Phys. in Review]. In this study particular attention is paid to studies that have pioneered the synergetic use of multiple techniques to provide complementary views of a single structure or process; several of these studies represent the state-of-the-art in characterization and suggest a trajectory for the continued development of the field. Based on this review, a set of grand challenges for characterization science is identified, including suggestions for instrumentation advances, scientific problems in microstructure analysis, and complex structure evolution problems involving material damage. The future of microstructural characterization is proposed to be one not only where individual techniques are pushed to their limits, but where the community devises strategies of technique synergy to address complex multiscale problems in materials science and engineering.
We report on random laser emission in pulsed laser deposited nanocrystalline ZnO thin films. The deposition was done on silicon and glass substrates in ambient oxygen pressure ranging from 10 mTorr to 1 Torr at room temperature. The deposited films were characterized using XRD, RBS, PL and AFM. The films grown at pressures less than 300 mTorr are found to be preferentially oriented along (002) plane. Morphology of the films deposited at different background pressures showed that the films deposited at lower pressures are significantly smoother than those at higher back ground pressure. PL intensity depends on the stoichiometry of the films and hence on oxygen pressure. Laser action was observed on optically pumping the films with 355 nm radiation. At excitation intensity above threshold, very narrow peaks are observed in the emission spectrum. The dependence of the laser emission on the size of nanocrystallites at different pressures of the ambient gas is presented.
Mg ion-implantation of A12O3 wafers followed by air annealing at high temperatures was investigated as a way to provide bulk doped samples for studies of Mg surface segregation and its effect on surface mass transport. SIMS was used to analyse Mg concentrations in implanted and unimplanted near-surface regions and in the bulk. It was found that the concentration of Mg decreases dramatically with depth from both surfaces of an annealed wafer and is also observed in the bulk. These observations are attributed to bulk diffusion of the Mg combined with equilibrium surface segregation. Surface mass transport associated with the (1120) surface of an A12 O3 single crystal wafer doped and equilibrated by such a method was studied by the grating decay method; the Mg doped sample showed a decay rate in air higher than that in the undoped wafer by a factor of ∼ 2.4 at 1500°C.
Amorphous thin films of SixGe1-x:O (x = 0.70) were prepared by RF-sputtering at several substrate temperatures. The structural properties of these films were studied by IR spectroscopy and revealed features characteristic of hydrogen and/or oxygen bonded to silicon. The optical constants (n,k) were determined from reflection and transmission measurements at near-normal incidence for photon energies in the range of 1 eV and 2.6 eV. The optical gap was derived from the Taue plot and correlated with the composition of the samples. The increase of hydrogen and/or oxygen decreases the value of the refractive index and increases the optical gap.