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Neutrophil–lymphocyte ratio has been associated with clinical outcomes in several groups of cardiac patients, including patients with coronary artery disease, cardiac failure, and cardiac transplant recipients. We hypothesised that pre- and/or post-operative haematological cell counts are associated with clinical outcomes in children undergoing cardiac surgery for CHD. We performed a post hoc analysis of data collected as part of a prospective observational cohort study (n = 83, data available n = 47) of children evaluated for glucocorticoid receptor levels after cardiac surgery (July 2015–January 2016). The association of neutrophil–lymphocyte ratio with low cardiac output syndrome, time to inotrope free, and vasoactive-inotropic score was examined using proportional odds analysis, cox regression, and linear regression models, respectively. A majority (80%) of patients were infants (median/interquartile range 4.1/0.2–7.6 months) with conotruncal (36%) and left-sided obstructed lesions (28%). Two patients required mechanical circulatory support and three died. Higher pre-operative neutrophil–lymphocyte ratio was associated with higher cumulative odds of severe/moderate versus mild low cardiac output on post-operative day 1 (odds ratio 2.86; 95% confidence interval 1.18–6.93; p = 0.02). Pre-operative neutrophil–lymphocyte ratio was not significantly associated with time to inotrope free or vasoactive-inotrope score. Post-operative neutrophil–lymphocyte ratio was also not associated with outcomes. In children after congenital heart surgery, higher pre-operative neutrophil–lymphocyte ratio was associated with a higher chance of low cardiac output in the early post-operative period. Pre-operative neutrophil–lymphocyte ratio maybe a useful prognostic marker in children undergoing congenital heart surgery.
The shape gradient is a local sensitivity function defined on the surface of an object which provides the change in a characteristic quantity, or figure of merit, associated with a perturbation to the shape of the object. The shape gradient can be used for gradient-based optimization, sensitivity analysis and tolerance calculations. However, it is generally expensive to compute from finite-difference derivatives for shapes that are described by many parameters, as is the case for typical stellarator geometry. In an accompanying work (Antonsen, Paul & Landreman J. Plasma Phys., vol. 85 (2), 2019), generalized self-adjointness relations are obtained for magnetohydrodynamic (MHD) equilibria. These describe the relation between perturbed equilibria due to changes in the rotational transform or toroidal current profiles, displacements of the plasma boundary, modifications of currents in the vacuum region or the addition of bulk forces. These are applied to efficiently compute the shape gradient of functions of MHD equilibria with an adjoint approach. In this way, the shape derivative with respect to any perturbation applied to the plasma boundary or coil shapes can be computed with only one additional MHD equilibrium solution. We demonstrate that this approach is applicable for several figures of merit of interest for stellarator configuration optimization: the magnetic well, the magnetic ripple on axis, the departure from quasisymmetry, the effective ripple in the low-collisionality
(Nemov et al.Phys. Plasmas, vol. 6 (12), 1999, pp. 4622–4632) and several finite-collisionality neoclassical quantities. Numerical verification of this method is demonstrated for the magnetic well figure of merit with the VMEC code (Hirshman & Whitson Phys. Fluids, vol. 26 (12), 1983, p. 3553) and for the magnetic ripple with modification of the ANIMEC code (Cooper et al.Comput. Phys. Commun., vol. 72 (1), 1992, pp. 1–13). Comparisons with the direct approach demonstrate that, in order to obtain agreement within several per cent, the adjoint approach provides a factor of
in computational savings.
Corporate Social Responsibility (CSR) is rooted in the idea that corporations must focus on issues beyond the balance sheet. For instance, CSR has had an impact in reducing child labor in developing countries, making extractive industries more responsible to local communities, and reducing the environmental impact of hotels. It is also applicable to the airline industry where it has promoted various types of positive behavior. In a world increasingly concerned with climate change and that sees as problematic the airline industry release of greenhouse gas (GHG) emissions at high altitude, regulators are about to set emissions reduction targets for the airline industry. Given that fuel is the single greatest cost for airlines, and that any reduction in fuel consumed involves a consequential reduction in GHGs emitted, the airline industry is generally eager to reduce GHG emissions. However, several emerging CSR best practices in civil aviation have incentivized the industry to become more environmentally friendly in recent years. In this context, this chapter argues that CSR should encourage airlines to go beyond mere self-interest or regulatory compliance in leading the way to meeting increasingly ambitious GHG reduction targets.
Why do issues “fade” from the problem stream? This is an important but underresearched question, which this article examines by looking at the dynamic interaction between frames and frame sponsors. We develop a novel methodological approach that combines algorithmic coding (topic modelling) with hand-coding to track changes in the presence of frames and frame sponsors during periods of intense problematisation (“problem windows”) both within continuous contexts and diachronically across different contexts. We apply this approach empirically in a corpus of newspaper articles that pertain to the coal seam gas controversy in Australia – a divisive policy issue where frame conflicts are common. We find that elite actors have a particularly decisive impact on the problem stream in terms of both the evolution and duration of debate. Further, problem windows close in response to three different mechanisms: elite frame convergence; public statements (by government and industry); and elections.
Tumor profiling tests can help to identify whether women with breast cancer need chemotherapy due to their risk of relapse, and some may be able to predict benefit from chemotherapy. We focused on four genetic tests: Oncotype DX (O-DX), MammaPrint (MMP), EndoPredict and Prosigna, and one immunohistochemistry test, IHC4, for the National Institute of Health and Care Excellence as part of their Diagnostic Appraisal Programme.
A systematic review was undertaken, including searching of nine databases in February 2017 plus other sources including a previous review published in 2013. The review included studies assessing clinical effectiveness of the five tumor profiling tests, with or without clinicopathological factors, to guide decisions about adjuvant chemotherapy in people with ER-positive, HER-2 negative, Stage I-II cancer with 0 to 3 positive lymph nodes (LN). The PROBAST tool and Cochrane risk of bias tools were used to assess risk of bias.
A total of 153 studies were included; the strength of evidence base for individual tests was varied. Results suggest all tests are prognostic for risk of relapse, though results were more varied in LN positive (+) patients than in LN negative (0) patients. Evidence was limited about whether tests can predict benefit from chemotherapy (available for MMP and O-DX only). Studies that assessed the impact of the tests on clinical decisions indicate that the net change in chemotherapy recommendations or decisions pre-/post-test ranged from an increase of one percent to a decrease of 23 percent among UK studies, and a decrease of zero percent to 64 percent across European studies.
The studies included in the review suggest that all of the tests can provide prognostic information on the risk of relapse; however results were more varied in LN+ patients than in LN0 patients. There is limited and varying evidence for prediction of chemotherapy benefit.
Background: Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review (Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews. Method: A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis. Results: Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77–1.25), as well as at 6- and 12-month follow-up. Conclusions: This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies.
Recent work in sociolinguistics has illustrated that language features can become explicitly linked with numerous and multiple social values for certain speakers1. These language features can include pronunciations, words, or phrases, and the kind of associated social values can include social class or geographical region, notions of aesthetics or correctness, or more abstract concepts like ‘authenticity’ or ‘friendliness’. When speaker awareness leads to the linking of language features with social values in this way, the features may have undergone enregisterment, defined by Agha (2003: 231) as ‘processes through which a linguistic repertoire becomes differentiable within a language as a socially recognized register of forms’. I will focus here on the explicit association of a geographical location, Yorkshire2, with a distinct set of language features.
Ice-free regions of Antarctica are concentrated along the coastal margins but are scarce throughout the continental interior. Environmental changes, including the introduction of non-indigenous species, increasingly threaten these unique habitats. At the same time, the unique biotic communities subsisting in isolation across the continent are difficult to survey due to logistical constraints, sampling challenges and problems related to the identification of small and cryptic taxa. Baseline biodiversity data from remote Antarctic habitats are still missing for many parts of the continent but are critical to the detection of community changes over time, including newly introduced species. Here we review the potential of standardized (non-specialist) sampling in the field (e.g. from soil, vegetation or water) combined with high-throughput sequencing (HTS) of bulk DNA as a possible solution to overcome some of these problems. In particular, HTS metabarcoding approaches benefit from being able to process many samples in parallel, while workflow and data structure can stay highly uniform. Such approaches have quickly gained recognition and we show that HTS metabarcoding surveys are likely to play an important role in continent-wide biomonitoring of all Antarctic terrestrial habitats.
The interest of organic farmers in adopting conservation agriculture principles, including minimal soil disturbance, permanent soil cover and crop rotation has been growing since the early 2000s. However, currently there is no network for organic farmers practicing conservation agriculture, and a lack of knowledge on how organic farmers implement conservation agriculture in practice. Consequently, few technical references are available for organic farmers when they start applying conservation agriculture practices, in particular on controlling weeds without the use of herbicides. The main objectives of this study were: (1) to explore the diversity of conservation agriculture techniques (i.e., reduced tillage, no-tillage and green manures) practiced among European farmers, and (2) to identify farmers’ main strategies for implementing conservation agriculture and the agronomic and environmental factors that determine these strategies. Strategies were identified by analyzing survey results on: (1) the type and degree of use of conservation agriculture practices by farmers, and (2) the effects it produces in terms of soil disturbance and soil cover (low, medium and high). We carried out a survey of 159 European organic farmers and collected 125 data sets on management of winter-sown crops. Among the conservation agriculture practices, reduced tillage was used by 89%, no-tillage by 27% and green manure by 74% of the 159 interviewed farmers. Green manures were more frequently used in northern Europe than in the south (below 45°N). Most of the farmers used crop rotations, with a mean duration of 6 years. A wide diversity of conservation agriculture practices were used, with farmers rarely using all three techniques (no-till, reduced till and green manures) within one system. The range of practices was grouped into five strategies ranging from intensive non-inversion tillage without soil cover to very innovative techniques with no-tillage and intercrops. The five strategies for conservation agriculture could be grouped into two larger categories based on weed control approach: (1) intensification of the mechanical work without soil inversion or (2) biological regulation of weeds with cover crops. The diversity of strategies identified in this study shows that organic farmers use innovative approaches to implement conservation agriculture without herbicides. This study's findings will help organic farmers to experiment with innovative practices based on conservation agriculture principles and also benefit conventional farmers who use conservation agriculture practices and would like to reduce or eliminate the use of herbicides.
To assess whether a home treatment team acute relapse prevention (ARP) strategy reduces admissions to hospital with mania. A retrospective design was used to analyse records for manic admissions since 2002. The number and length of admissions and detentions pre- and post-ARP were determined and rates of admissions and detentions calculated from this.
We found reductions in admission and detention rates following the introduction of the ARP: 0.3 fewer admissions per person per year (95% bootstrap CI 0.09–0.62) and 0.25 fewer detentions per person per year (95% bootstrap CI 0.0–0.48). Wilcoxon signed-rank tests gave P < 0.0001.
A person-centred care plan such as the ARP which enables quick action in response to relapse-warning signs of mania appears to reduce rates of admission to hospital. The ARP could be used anywhere in the UK and fits with current mental health policy.
Trypanosoma brucei is the causative agent of African sleeping
sickness in humans and one of several pathogens that cause the related
veterinary disease Nagana. A complex co-evolution has occurred between these
parasites and primates that led to the emergence of trypanosome-specific
defences and counter-measures. The first line of defence in humans and several
other catarrhine primates is the trypanolytic protein
apolipoprotein-L1 (APOL1) found within two serum protein complexes, trypanosome
lytic factor 1 and 2 (TLF-1 and TLF-2). Two sub-species of T.
brucei have evolved specific mechanisms to overcome this innate
resistance, Trypanosoma brucei gambiense and
Trypanosoma brucei rhodesiense. In T. b.
rhodesiense, the presence of the serum resistance associated
(SRA) gene, a truncated variable surface glycoprotein
(VSG), is sufficient to confer resistance to lysis. The resistance mechanism of
T. b. gambiense is more complex, involving multiple
components: reduction in binding affinity of a receptor for TLF, increased
cysteine protease activity and the presence of the truncated VSG, T. b.
gambiense-specific glycoprotein (TgsGP). In a
striking example of co-evolution, evidence is emerging that primates are
responding to challenge by T. b. gambiense and T. b.
rhodesiense, with several populations of humans and primates
displaying resistance to infection by these two sub-species.
Dual-Polarization Radar and Twitter were analyzed to determine the impact on injuries sustained by the Hattiesburg EF-4 tornado.
Tracking data provided from the Dual-Pol radar systems in National Weather Service Jackson were reviewed. Twitter data from four local Twitter handles were obtained. The change in tweets and followers for the day of the storm were compared to historical averages. A Student t-test was utilized in determining statistical significance (p<0.05). Medical records from two local emergency departments were reviewed for patients treated up to 24 hours after the tornado. An Injury Severity Score (ISS) was calculated for trauma records related to the tornado.
Radar detection of the tornado gave approximately 30 minutes of advanced warning time. Statistical significance in follower growth was seen in all four Twitter handles. Out of 50 patients, the average ISS was 3.9 with a range of 1 to 29. There were zero fatalities.
An ISS average of 3.9 was significantly less than two previous tornadoes of similar strength that occurred prior to increased usage of Dual-pol radar and Twitter as a means for communicating severe weather information. Early detection from Dual-pol radar improved warning time. Tweets informed citizens to seek appropriate shelter. (Disaster Med Public Health Preparedness. 2013;7:585-592)