To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Research opportunities associated with the proliferation of the electronic health record (EHR), big data initiatives, and innovative approaches to trial design can present challenges for obtaining and documenting informed consent. Broad-scale informed consent (a term used herein to describe institutional models, rather than the Common Rule’s strict regulatory definition for “broad consent”) may facilitate the use of existing data and samples and speed the pace of research by minimizing barriers to consent. We explored the use of broad-scale informed consent within the Clinical Translational Science Award (CTSA) Program Network.
We surveyed CTSA Hubs concerning policies, practices, experiences, and needs within three domains of broad-scale informed consent: (1) participant recontact; (2) biospecimens; and (3) clinical data sharing.
Of 61 CTSA Hubs surveyed, 37 (61%) indicated ongoing work related to at least 1 domain of broad-scale informed consent; 18 Hubs (30%) reported work in all 3 domains. The EHR predominated as the implementation system across all three domains. Research and IT leadership and the Institutional Review Board were most commonly endorsed as institutional drivers, while systems/technical issues and impact on clinical workflow were the most commonly reported barriers.
While survey results indicate considerable variability in the implementation of broad-scale informed consent across the CTSA consortium, it is clear that all CTSA Hubs are actively considering policy and process related to these concepts. Next steps cluster within three areas: training and workforce development, streamlined policies and templates, and implementation strategies that facilitate integration into clinical workflow.
The effect of tunnel cations on tunnel size in α-MnO2 structured (hollandite, cryptomelane) materials has long been of interest, as the tunnel size effects catalytic and transport properties. Previous research on the tunnel size has focused on potassium cryptomelane (KxMn8O16). This paper uses synthetic control of silver content in AgxMn8O16 to investigate the effect that tunnel silver occupancy has on the lattice parameters. Materials with silver (x) content between 1.14 and 1.66 were synthesized, synchrotron diffraction and Rietveld Refinement was used to determine lattice parameters. The lattice parameters were found to contract as silver content increases (from 9.774 Å to 9.738 Å), in contrast to previous investigations of other tunnel cations.
Haemodynamically unstable patients can experience potentially hazardous changes in vital signs related to the exchange of depleted syringes of epinephrine to full syringes. The purpose was to determine the measured effects of epinephrine syringe exchanges on the magnitude, duration, and frequency of haemodynamic disturbances in the hour after an exchange event (study) relative to the hours before (control).
Materials and methods
Beat-to-beat vital signs recorded every 2 seconds from bedside monitors for patients admitted to the paediatric cardiovascular ICU of Texas Children’s Hospital were collected between 1 January, 2013 and 30 June, 2015. Epinephrine syringe exchanges without dose/flow change were obtained from electronic records. Time, magnitude, and duration of changes in systolic blood pressure and heart rate were characterised using Matlab. Significant haemodynamic events were identified and compared with control data.
In all, 1042 syringe exchange events were found and 850 (81.6%) had uncorrupted data for analysis. A total of 744 (87.5%) exchanges had at least 1 associated haemodynamic perturbation including 2958 systolic blood pressure and 1747 heart-rate changes. Heart-rate perturbations occurred 37% before exchange and 63% after exchange, and 37% of systolic blood pressure perturbations happened before syringe exchange, whereas 63% occurred after syringe exchange with significant differences found in systolic blood pressure frequency (p<0.001), duration (p<0.001), and amplitude (p<0.001) compared with control data.
This novel data collection and signal processing analysis showed a significant increase in frequency, duration, and magnitude of systolic blood pressure perturbations surrounding epinephrine syringe exchange events.
Few data are available regarding the use of metolazone in infants in cardiac intensive care. Researchers need to carry out further evaluation to characterise the effects of this treatment in this population.
This is a descriptive, retrospective study carried out in patients less than a year old. These infants had received metolazone over a 2-year period in the paediatric cardiac intensive care unit at our institution. The primary goal was to measure the change in urine output from 24 hours before the start of metolazone therapy to 24 hours after. Patient demographic variables, laboratory data, and fluid-balance data were analysed.
The study identified 97 infants with a mean age of 0.32±0.25 years. Their mean weight was 4.9±1.5 kg, and 58% of the participants were male. An overall 63% of them had undergone cardiovascular surgery. The baseline estimated creatinine clearance was 93±37 ml/minute/1.73 m2. Initially, the participants had received a metolazone dose of 0.27±0.10 mg/kg/day, the maximum dose being 0.43 mg/kg/day. They had also received other diuretics during metolazone initiation, such as furosemide (87.6%), spironolactone (58.8%), acetazolamide (11.3%), bumetanide (7.2%), and ethacrynic acid (1%). The median change in urine output after metolazone was 0.9 ml/kg/hour (interquartile range 0.15–1.9). The study categorised a total of 66 patients (68.0%) as responders. Multivariable analysis identified acetazolamide use (p=0.002) and increased fluid input in the 24 hours after metolazone initiation (p<0.001) as being significant for increased urine output. Changes in urine output were not associated with the dose of metolazone (p>0.05).
Metolazone increased urine output in a select group of patients. Efficacy can be maximised by strategic selection of patients.
Sequential nephron blockade using intravenous chlorothiazide is often used to enhance urine output in patients with inadequate response to loop diuretics. A few data exist to support this practice in critically ill infants.
We included 100 consecutive patients <1 year of age who were administered intravenous chlorothiazide while receiving furosemide therapy in the cardiac ICU in our study. The primary end point was change in urine output 24 hours after chlorothiazide administration, and patients were considered to be responders if an increase in urine output of 0.5 ml/kg/hour was documented. Data on demographic, clinical, fluid intake/output, and furosemide and chlorothiazide dosing were collected. Multivariable regression analyses were performed to determine variables significant for increase in urine output after chlorothiazide administration.
The study population was 48% male, with a mean weight of 4.9±1.8 kg, and 69% had undergone previous cardiovascular surgery. Intravenous chlorothiazide was initiated at 89 days (interquartile range 20–127 days) of life at a dose of 4.6±2.7 mg/kg/day (maximum 12 mg/kg/day). Baseline estimated creatinine clearance was 83±42 ml/minute/1.73 m2. Furosemide dose before chlorothiazide administration was 2.8±1.4 mg/kg/day and 3.3±1.5 mg/kg/day after administration. A total of 43% of patients were categorised as responders, and increase in furosemide dose was the only variable significant for increase in urine output on multivariable analysis (p<0.05). No graphical trends were noted for change in urine output and dose of chlorothiazide.
Sequential nephron blockade with intravenous chlorothiazide was not consistently associated with improved urine output in critically ill infants.
This chapter discusses congenital diaphragmatic hernia (CDH) from a perspective of antenatal management, including fetal intervention. It summarizes actual survival rates when this condition is managed after birth, essentially showing that there is no effective postnatal therapy in a subset of fetuses. Prediction methods are typically based on estimation of lung size by ultrasound and determination of liver herniation into the thorax. Three-dimensional (3D) ultrasound (US) and MRI both allow measurement of absolute lung volumetry. MRI allows better visualization of the ipsilateral lung than 3D US. Preliminary work on the use of diffusion-weighted imaging (DWI)-MRI as a tool to differentiate between normal and pathological lung development has shown a significant relationship between DWI-MRI parameters and gestational age in the normal fetus. The chapter also describes the current clinical experience with fetal surgery, including the design of trials that will have to determine the place of fetal surgery.
Researchers at the Pacific Northwest National Laboratory (PNNL) investigated the effects of gadolinium oxide concentration on the air oxidization of gadolinium oxide-doped uranium dioxide using thermogravimetry and differential scanning calorimetry to determine if such doping could improve uraniumdioxide's stability as a nuclear fuel during potential accident scenarios in a nuclear reactor or during long-term disposal. We undertook this study to determine whether the resistance of the uranium dioxide to oxidation to the orthorhombic U3O8 with its attendant crystal expansion could be prevented by addition of gadolinium oxide. Our studies found that gadolinium has little effect on the thermal initiation of the first step of the reported two-step air oxidation of UO2; however, increasing gadolinium oxide content does stabilize the initial tetragonal or cubic product allowing significant oxidation before the second expansive step to U3O8 begins.
Citizens do not choose sides on issues like busing or abortion whimsically. They have reasons for their preferences – certainly they can give reasons for them. But how is this possible? Citizens as a rule pay little attention to politics, indeed take only a modest interest in it even during election campaigns when their interest in politics is at its height. And since they pay little attention to politics, it is hardly surprising that they know little about it. Many, in fact, are quite ignorant of basic facts of political life – such as the identity of the party that controls Congress or indeed the name of the congressman who represents them. Which, of course, raises a question of some interest: how do citizens figure out what they think about political issues, given how little they commonly know about them?
This article shows that citizens can estimate what politically strategic groups—liberals and conservatives, Democrats and Republicans, and blacks and whites—stand for on major issues. These attitude attributions follow from a simple calculus, a likability heuristic. This heuristic is rooted in people's likes and dislikes of political groups. Thanks to this affective calculus, many in the mass public are able to estimate who stands for what politically, notwithstanding shortfalls in information and information processing.
Carbon and nitrogen isotope ratios in collagen from bones of individuals who lived in the Tehuacan Valley during the period 8000–1000 years B.P. have been interpreted as indicating earlier use of maize and more utilization of legumes as food sources than is suggested by the occurrence of the remains of these plants in the coprolites and debris excavated along with the bones. Reassessment of the assumptions made in interpreting the bone collagen isotope ratios reduces some but not all of the discrepancy between the isotopic and archaeological reconstructions of diet. The original archaeological reconstruction relied entirely on remains from cave sites, thus introducing seasonal and locational biases into the dietary reconstruction. Using the bone collagen isotope ratios as a guide, we re-interpreted the archaeological data to produce a more complete picture of temporal changes in the overall diet. We suggest that heavy dependence on grains began in the Coxcatlan phase and then may have remained unchanged for the next 5,500–6,500 years. These conclusions, which are based on a relatively small isotopic data base, need to be verified by an extensive program of isotopic analysis of the floral, faunal, and human remains from Tehuacan.
Deep muscular relaxation is an active component of systematic desensitization therapy. Most behaviour therapists induce relaxation in their patients by an abbreviated version of a technique originally described by Jacobson (4) called progressive relaxation. This report concerns a new way to facilitate deep muscular relaxation which is efficient, reliable and convenient.
Email your librarian or administrator to recommend adding this to your organisation's collection.