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Shunt-related adverse events are frequent in infants after modified Blalock–Taussig despite use of acetylsalicylic acid prophylaxis. A higher incidence of acetylsalicylic acid-resistance and sub-therapeutic acetylsalicylic acid levels has been reported in infants. We evaluated whether using high-dose acetylsalicylic acid can decrease shunt-related adverse events in infants after modified Blalock–Taussig.
In this single-centre retrospective cohort study, we included infants ⩽1-year-old who underwent modified Blalock–Taussig placement and received acetylsalicylic acid in the ICU. We defined acetylsalicylic acid treatment groups as standard dose (⩽7 mg/kg/day) and high dose (⩾8 mg/kg/day) based on the initiating dose.
There were 34 infants in each group. Both groups were similar in age, gender, cardiac defect type, ICU length of stay, and time interval to second stage or definitive repair. Shunt interventions (18 versus 32%, p=0.16), shunt thrombosis (14 versus 17%, p=0.74), and mortality (9 versus 12%, p=0.65) were not significantly different between groups. On multiple logistic regression analysis, single-ventricle morphology (odds ratio 5.2, 95% confidence interval of 1.2–23, p=0.03) and post-operative red blood cells transfusion ⩾24 hours [odds ratio 15, confidence interval of (3–71), p<0.01] were associated with shunt-related adverse events. High-dose acetylsalicylic acid treatment [odds ratio 2.6, confidence interval of (0.7–10), p=0.16] was not associated with decrease in these events.
High-dose acetylsalicylic acid may not be sufficient in reducing shunt-related adverse events in infants after modified Blalock–Taussig. Post-operative red blood cells transfusion may be a modifiable risk factor for these events. A randomised trial is needed to determine appropriate acetylsalicylic acid dosing in infants with modified Blalock–Taussig.
A number of laser facilities coming online all over the world promise the capability of high-power laser experiments with shot repetition rates between 1 and 10 Hz. Target availability and technical issues related to the interaction environment could become a bottleneck for the exploitation of such facilities. In this paper, we report on target needs for three different classes of experiments: dynamic compression physics, electron transport and isochoric heating, and laser-driven particle and radiation sources. We also review some of the most challenging issues in target fabrication and high repetition rate operation. Finally, we discuss current target supply strategies and future perspectives to establish a sustainable target provision infrastructure for advanced laser facilities.
The Antarctic Roadmap Challenges (ARC) project identified critical requirements to deliver high priority Antarctic research in the 21st century. The ARC project addressed the challenges of enabling technologies, facilitating access, providing logistics and infrastructure, and capitalizing on international co-operation. Technological requirements include: i) innovative automated in situ observing systems, sensors and interoperable platforms (including power demands), ii) realistic and holistic numerical models, iii) enhanced remote sensing and sensors, iv) expanded sample collection and retrieval technologies, and v) greater cyber-infrastructure to process ‘big data’ collection, transmission and analyses while promoting data accessibility. These technologies must be widely available, performance and reliability must be improved and technologies used elsewhere must be applied to the Antarctic. Considerable Antarctic research is field-based, making access to vital geographical targets essential. Future research will require continent- and ocean-wide environmentally responsible access to coastal and interior Antarctica and the Southern Ocean. Year-round access is indispensable. The cost of future Antarctic science is great but there are opportunities for all to participate commensurate with national resources, expertise and interests. The scope of future Antarctic research will necessitate enhanced and inventive interdisciplinary and international collaborations. The full promise of Antarctic science will only be realized if nations act together.
There is a dearth of information on how to scale-up evidence-based psychological interventions, particularly within the context of existing HIV programs. This paper describes a strategy for the scale-up of an intervention delivered by lay health workers (LHWs) to 60 primary health care facilities in Zimbabwe.
A mixed methods approach was utilized as follows: (1) needs assessment using a semi-structured questionnaire to obtain information from nurses (n = 48) and focus group discussions with District Health Promoters (n = 12) to identify key priority areas; (2) skills assessment to identify core competencies and current gaps of LHWs (n = 300) employed in the 60 clinics; (3) consultation workshops (n = 2) with key stakeholders to determine referral pathways; and (4) in-depth interviews and consultations to determine funding mechanisms for the scale-up.
Five cross-cutting issues were identified as critical and needing to be addressed for a successful scale-up. These included: the lack of training in mental health, unavailability of psychiatric drugs, depleted clinical staff levels, unavailability of time for counseling, and poor and unreliable referral systems for people suffering with depression. Consensus was reached by stakeholders on supervision and support structure to address the cross-cutting issues described above and funding was successfully secured for the scale-up.
Key requirements for success included early buy-in from key stakeholders, extensive consultation at each point of the scale-up journey, financial support both locally and externally, and a coherent sustainability plan endorsed by both government and private sectors.
A recent outbreak of Q fever was linked to an intensive goat and sheep dairy farm in Victoria, Australia, 2012-2014. Seventeen employees and one family member were confirmed with Q fever over a 28-month period, including two culture-positive cases. The outbreak investigation and management involved a One Health approach with representation from human, animal, environmental and public health. Seroprevalence in non-pregnant milking goats was 15% [95% confidence interval (CI) 7–27]; active infection was confirmed by positive quantitative PCR on several animal specimens. Genotyping of Coxiella burnetii DNA obtained from goat and human specimens was identical by two typing methods. A number of farming practices probably contributed to the outbreak, with similar precipitating factors to the Netherlands outbreak, 2007-2012. Compared to workers in a high-efficiency particulate arrestance (HEPA) filtered factory, administrative staff in an unfiltered adjoining office and those regularly handling goats and kids had 5·49 (95% CI 1·29–23·4) and 5·65 (95% CI 1·09–29·3) times the risk of infection, respectively; suggesting factory workers were protected from windborne spread of organisms. Reduction in the incidence of human cases was achieved through an intensive human vaccination programme plus environmental and biosecurity interventions. Subsequent non-occupational acquisition of Q fever in the spouse of an employee, indicates that infection remains endemic in the goat herd, and remains a challenge to manage without source control.
There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.
Antarctic and Southern Ocean science is vital to understanding natural variability, the processes that govern global change and the role of humans in the Earth and climate system. The potential for new knowledge to be gained from future Antarctic science is substantial. Therefore, the international Antarctic community came together to ‘scan the horizon’ to identify the highest priority scientific questions that researchers should aspire to answer in the next two decades and beyond. Wide consultation was a fundamental principle for the development of a collective, international view of the most important future directions in Antarctic science. From the many possibilities, the horizon scan identified 80 key scientific questions through structured debate, discussion, revision and voting. Questions were clustered into seven topics: i) Antarctic atmosphere and global connections, ii) Southern Ocean and sea ice in a warming world, iii) ice sheet and sea level, iv) the dynamic Earth, v) life on the precipice, vi) near-Earth space and beyond, and vii) human presence in Antarctica. Answering the questions identified by the horizon scan will require innovative experimental designs, novel applications of technology, invention of next-generation field and laboratory approaches, and expanded observing systems and networks. Unbiased, non-contaminating procedures will be required to retrieve the requisite air, biota, sediment, rock, ice and water samples. Sustained year-round access to Antarctica and the Southern Ocean will be essential to increase winter-time measurements. Improved models are needed that represent Antarctica and the Southern Ocean in the Earth System, and provide predictions at spatial and temporal resolutions useful for decision making. A co-ordinated portfolio of cross-disciplinary science, based on new models of international collaboration, will be essential as no scientist, programme or nation can realize these aspirations alone.
In this paper we illustrate the application of electron beam techniques to the measurement of strain, defect and alloy concentrations in nitride thin films. We present brief comparative studies of CL spectra of AlGaN and InGaN epilayers and EBSD patterns obtained from two silicon-doped 3 μm thick GaN epilayers grown on an on-axis (0001) sapphire substrate and a sapphire substrate misoriented by 10° toward the m-plane (10 0).
In this paper we examine a series of four GaN epilayers grown by MOVPE on sapphire substrates with different AlN buffer layer thicknesses. We examine the effect of the buffer layer thickness on the physical and optical properties of the samples via optical microscopy, cathodoluminescence imaging and photoluminescence and cathodoluminescence spectroscopy. While the morphological and optical properties of all the films (excepting that with the thinnest buffer layer of 30 nm) are good, i.e., the films are smooth and the luminescence is dominated by excitonic luminescence, a number of circular island like features are observed in all the films whose density decrease with increasing buffer layer thickness. A large circular island present on the sample with the thinnest buffer layer and surrounded by cracks in the directions, displays some interesting acceptor related luminescence.
Three silicon-doped 3 µm thick GaN epilayers were grown simultaneously by metalorganic chemical vapour deposition on (0001) sapphire substrates misorientated by 0°, 4° and 10° toward the m-plane (100). A comparative study of these epilayers was undertaken using photoluminescence (PL) spectroscopy, atomic force microscopy (AFM), scanning electron microscopy (SEM), cathodoluminescence (CL) imaging, CL spectroscopy and Hall effect measurements. Low temperature PL of the 0° and 4° epilayers shows donor bound exciton (BE) emission between 3.47 and 3.48 eV and a low level of yellow band emission. The peak intensities of both emission bands are a factor of 2 higher for the 4° layer. In the 10° epilayer, the BE band is 3x stronger than in the 0° epilayer but there is no discernible yellow band. However, a number of additional bands appear at 3.459, 3.417, 3.362, 3.345, 3.309, and 3.285 eV. These bands, some of which are acceptor related, may be attributed to the presence of structural defects in this epilayer, pointing to an abrupt degradation of its structural quality compared to the others. This degradation is confirmed by AFM studies. On a 20 µm x 20 µm image the 0° and 4° epilayers exhibit smooth surface morphologies, while the 10° epilayer shows a high density of hexagonal pits. Finally, SEM images reveal the surface of the 10° epilayer to be “streaked” and pitted. Low temperature CL images at 3.48 eV (bound exciton region) show random spotty emission, while those at 3.28 eV and 3.41 eV exhibit a streaky appearance similar to the SEM image. This suggests that these luminescence bands are indeed associated with structural defects.
This paper presents an integrated design and costing method for large stiffened panels for the purpose of investigating the influence and interaction of lay-up technology and production rate on manufacturing cost. A series of wing cover panels (≈586kg, 19·9m2) have been sized with realistic requirements considering manual and automated lay-up routes. The integrated method has enabled the quantification of component unit cost sensitivity to changes in annual production rate and employed equipment maximum deposition rate. Moreover the results demonstrate the interconnected relationship between lay-up process and panel design, and unit cost. The optimum unit cost solution when using automated lay-up is a combination of the minimum deposition rate and minimum number of lay-up machines to meet the required production rate. However, the location of the optimum unit cost, at the boundaries between the number of lay-up machines required, can make unit cost very sensitive to small changes in component design, production rate, and equipment maximum deposition rate.
In this paper we illustrate the application of electron beam techniques to the measurement of strain, defect and alloy concentrations in nitride thin films. We present brief comparative studies of CL spectra of AlGaN and InGaN epilayers and EBSD patterns obtained from two silicon-doped 3 μm thick GaN epilayers grown on an on-axis (0001) sapphire substrate and a sapphire substrate misoriented by 10° toward the m-plane (1010).
Electron self-injection and acceleration until dephasing in the blowout regime is studied for a set of initial conditions typical of recent experiments with 100-terawatt-class lasers. Two different approaches to computationally efficient, fully explicit, 3D particle-in-cell modelling are examined. First, the Cartesian code vorpal (Nieter, C. and Cary, J. R. 2004 VORPAL: a versatile plasma simulation code. J. Comput. Phys.196, 538) using a perfect-dispersion electromagnetic solver precisely describes the laser pulse and bubble dynamics, taking advantage of coarser resolution in the propagation direction, with a proportionally larger time step. Using third-order splines for macroparticles helps suppress the sampling noise while keeping the usage of computational resources modest. The second way to reduce the simulation load is using reduced-geometry codes. In our case, the quasi-cylindrical code calder-circ (Lifschitz, A. F. et al. 2009 Particle-in-cell modelling of laser-plasma interaction using Fourier decomposition. J. Comput. Phys.228(5), 1803–1814) uses decomposition of fields and currents into a set of poloidal modes, while the macroparticles move in the Cartesian 3D space. Cylindrical symmetry of the interaction allows using just two modes, reducing the computational load to roughly that of a planar Cartesian simulation while preserving the 3D nature of the interaction. This significant economy of resources allows using fine resolution in the direction of propagation and a small time step, making numerical dispersion vanishingly small, together with a large number of particles per cell, enabling good particle statistics. Quantitative agreement of two simulations indicates that these are free of numerical artefacts. Both approaches thus retrieve the physically correct evolution of the plasma bubble, recovering the intrinsic connection of electron self-injection to the nonlinear optical evolution of the driver.
New organic nonlinear optical crystal : dicyanovinyl anisole (DIVA) has been grown from vapor by low pressure sublimation and from saturated solution by solvent evaporation. Crystallographic structure and quadratic nonlinear optical properties were investigated. Molecular orientation in DIVA crystal with space group P21, is favorable for the highest possible value of bulk phase-matchable coefficient. Both type I and type II phase matched second harmonic generation (PMSHG) were observed from naturally grown faces of single crystals. Efficient PMSHG was achieved at a fundamental wavelength of 812 and 1064 nm. The efficient type I PMSHG coefficient was determined as deff = 4.9 × 10−8 esu = 40 × (d11 of α-quartz) at a wave.LH length of 1064 nm. Blue light generation was demonstrated by both PMSHG and sum-frequency mixing of the 812 nm laser with 1064 nm.
The improvement of the processibility and mechanical properties of poly-aniline (PAn) by processing a concentrated sulfuric acid solution of the mixture of chemically prepared conductive PAn powders and poly(p-phenylene-terephthalamide) (PPTA) in different weight ratios are presented.
The concentrated sulfuric acid solution of PAn and PPTA were processed to films and threads, they are liquid crystalline conductive polymer composites, the electrical conductivities of the composites are between 10−4 -10−1 s/cm.
PAn enhanced the tensile strength of PPTA, but does not effect the elongation. The morphology of the PPTA/PAn composite surfaces are fiberlike texture.
We present magnetotransport data and the phase diagram derived from them for (TMTSF)2PF6 under sufficient pressure that the zero field Spin Density Wave (SDW) is suppressed and the material is superconducting. Application of a large magnetic field perpendicular to the conducting plane then leads to the cascade of Field Induced Spin Density Wave (FISDW) transitions. The transitions are in good agreement with the Standard model for these transitions and in contrast to the more complicated behavior seen in the ClO4 salt. In addition Hall and longitudinal resistivity indicates a behavior much closer to that observed in conventional Quantum Hall devices than in the ClO4 salt or previous studies of PF6. We do observe the “rapid” Schubnikov de Haas like oscillations in magnetoresistance at high field similar to those seen in ClO4, even though in the present case there is no evidence for anion ordering as some theories would require.