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Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions’ feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols.
Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals.
Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates.
High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.
OBJECTIVES/SPECIFIC AIMS: The DIAMOND project encourages study team workforce development through the creation of a digital learning space that brings together resources from across the CTSA consortium. This allows for widespread access to and dissemination of training and assessment materials. DIAMOND also includes access to an ePortfolio that encourages CRPs to define career goals and document professional skills and training. METHODS/STUDY POPULATION: Four CTSA institutions (the University of Michigan, the Ohio State University, University of Rochester, and Tufts CTSI) collaborated to develop and implement the DIAMOND portal. The platform is structured around eight competency domains, making it easy for users to search for research training and assessment materials. Contributors can upload links to (and meta-data about) training and assessment materials from their institutions, allowing resources to be widely disseminated through the DIAMOND platform. Detailed information about materials included in DIAMOND is collected through an easy to use submission form. DIAMOND also includes an ePortfolio designed for CRPs. This encourages workforce development by providing a tool for self-assessment of clinical research skills, allowing users to showcase evidence of experience, training and education, and fosters professional connections. RESULTS/ANTICIPATED RESULTS: To date, more than 100 items have been posted to DIAMOND from nine contributors. In the first 30 days there were 229 active users with more than 500 page views from across the U.S. as well as China and India. Training materials were viewed most often from four competency domains: 1) Scientific Concepts & Research Design, 2) Clinical Study Operations, 3) Ethical & Participant Safety, and 4) Leadership & Professionalism. Additionally, over 100 CRPs have created a DIAMOND ePortfolio account, using the platform to document skills, connect with each other, and search for internships and job opportunities. DISCUSSION/SIGNIFICANCE OF IMPACT: Lessons learned during development of the DIAMOND digital platform include defining relevant information to collect for the best user experience; selection of a standardized, user-friendly digital platform; and integration of the digital network and ePortfolio. Combined, the DIAMOND portal and ePortfolio provide a professional development platform for clinical research professionals to contribute, access, and benefit from training and assessment opportunities relevant to workforce development and their individual career development needs.
School engagement has been shown to be a strong predictor for school achievement. Previous studies have focused on the role of individual and contextual factors to explain school achievement, with few examining the role of siblings. This study used data of 451 adolescent sibling pairs from the Iowa Youth and Families Project to investigate the associations between school engagement and achievement in siblings by considering gender composition and birth order. Data were collected in families’ home and obtained for a target child in the 7th grade and for a sibling within 4 years of age. Average age of younger siblings (55% female) was 11.56 (SD = 1.27), while older siblings (49% female) had an average age of 13.92 (SD = 1.47). Using the two-member, four-group actor-partner interdependence model (APIM), results showed that older siblings’ engagement was positively related with younger siblings’ achievement in same-gender sibling pairs, but not in sibling pairs of opposite gender. Younger siblings’ engagement was independent of older siblings’ achievement regardless of siblings’ gender. Implications for parents and professionals suggest that support for older siblings could also benefit younger siblings in same gender pairs.
Revolts against English monarchs, varying in scope and intensity, marked every reign from 1100 to 1272. After that, if we consider what happened to Edward II and Richard II, and the Wars of the Roses and the troubles of the first Tudor, we see pattern emerging in the shape of constitutional change induced through revolt. Even in the context of that centuries-long pattern, there was something special in the revolt of 1173-4, when three sons of Henry II united with an array of anti Plantagenet barons and continental neighbors to try to unseat the powerful king of England, who also held Normandy, Maine, Anjou, and the feudal conglomeration that comprised Aquitaine.
For reasons that I shall attempt to develop, the complex events of those two years constituted a watershed for mediaeval England, separating an age of feudal institutions from an age of royal bureaucracy that bore hints and suggestions of the modern era. The generational gap between sons and father added drama to the conflict, and psychological forces were inextricably bound to political forces as the revolt developed.
This study aimed to determine prevalence of Ralstonia spp. in cystic fibrosis patients, look for any evidence of cross infection and to describe clinical outcomes for patients infected by Ralstonia spp. Prevalence of Ralstonia spp. was calculated annually from 2008 to 2016. Pulsed-field gel electrophoresis was performed on ⩾1 sample from patients with an isolation of Ralstonia spp. between 2008 and 2016. A prospective, longitudinal observational study of adult patients was performed with 12 months follow-up from recruitment. Prevalence of Ralstonia spp. rose from 0·6% in 2008 to 2·4% in 2016. In total 12 out of 14 (86%) patients with ⩾1 isolation of Ralstonia spp. developed chronic infection. A pair and a group of three unrelated patients with epidemiological connections shared strains of Ralstonia mannitolilytica. Lung function of Ralstonia spp. infected patients was moderately to severely impaired. Prevalence of Ralstonia spp. is low but increasing. The risk of a patient developing chronic Ralstonia spp. infection following first acquisition is high and cross-infection may be possible. Whether Ralstonia spp. infection causes increased pulmonary exacerbation frequency and lung function decline needs to be evaluated in larger prospective studies.
Feral swine Sus scrofa have been implicated as a major threat to sensitive habitats and ecosystems as well as threatened wildlife. Nevertheless, direct and indirect impacts on threatened species (especially small, fossorial species) are not well documented. The decline of the U.S. federally endangered reticulated flatwoods salamander Ambystoma bishopi, categorized as Vulnerable on the IUCN Red List, has been rapid and there are few remaining breeding locations for this species. The flatwoods salamander depends on complex herbaceous vegetation in all life stages, including eggs, larvae and adults. Historically sets of hog tracks have been observed only occasionally in the vicinity of monitored reticulated flatwoods salamander breeding wetlands, and damage to the wetlands had never been recorded. However, during the autumn–winter breeding season of 2013–2014 we observed a large increase in hog sign, including extensive rooting damage, in known flatwoods salamander breeding wetlands. Our objective was to assess the amount of hog sign and damage in these wetlands and to take corrective management actions to curb additional impacts. Of 28 wetlands surveyed for hog sign, presence was recorded at 68%, and damage at 54%. Of the 11 sites known to be occupied by flatwoods salamanders in 2013–2014, 64% had presence, and 55% had damage. We found that regular monitoring of disturbance in wetland habitats was a valuable tool to determine when intervention was needed and to assess the effectiveness of intervention. Habitat damage caused by feral hogs poses a potentially serious threat to the salamanders, which needs to be mitigated using methods to control and exclude hogs from this sensitive habitat.
Training for the clinical research workforce does not sufficiently prepare workers for today’s scientific complexity; deficiencies may be ameliorated with training. The Enhancing Clinical Research Professionals’ Training and Qualifications developed competency standards for principal investigators and clinical research coordinators.
Clinical and Translational Science Awards representatives refined competency statements. Working groups developed assessments, identified training, and highlighted gaps.
Forty-eight competency statements in 8 domains were developed.
Training is primarily investigator focused with few programs for clinical research coordinators. Lack of training is felt in new technologies and data management. There are no standardized assessments of competence.
We have designed and manufactured a multi-purpose electronic, computer-operated blink-comparator and measuring engine. It has been specifically designed to facilitate the examination of stellar images on Uppsala Schmidt photographic plates, identify and establish coordinates of new suspect variable stars appearing on the plates being examined, and also to derive photometric values for those stars manifesting variability.
We obtained simultaneous images of solar plage on 7 May 1991 with Goddard Space Flight Center’s Solar EUV Rocket Telescope and Spectrograph (SERTS), the Very Large Array (VLA), and the NASA/NSO spectromagnetograph at Kitt Peak. Using intensity ratios of Fe XVI to Fe XV emission lines, we find that the coronal plasma temperature is 2.5 ± 0.3 ×lO6 K throughout the region. The column emission measure ranges from 2.6 × 1027 to 1.3 × 1028 cm−5. The calculated structure and intensity of the 20 cm wavelength thermal bremsstrahlung emission from the hot plasma observed by SERTS is quite similar to the observed structure and intensity of the 20 cm microwave emission observed by the VLA. Using the revised coronal iron abundance of Meyer (1991, 1992), we find no evidence for either cool absorbing plasma or for contributions from thermal gyroemission. Combining the observed microwave polarization and the SERTS plasma parameters, we calculate a map of the coronal longitudinal magnetic field. The resulting values, ~ 30 – 60 Gauss, are comparable to extrapolated values of the potential field at heights of 5,000 and 10,000 km.
We answer a question of Masser by showing that for the Weierstrass zeta function ζ corresponding to a given lattice Λ, the density of algebraic points of absolute multiplicative height bounded by T and degree bounded by k lying on the graph of ζ, restricted to an appropriate domain, does not exceed c(log T)15 for an effective constant c > 0 depending on k and on Λ. Using different methods, we also give two bounds of the same form for the density of algebraic points of bounded height in a fixed number field lying on the graph of ζ restricted to an appropriate subset of (0, 1). In one case the constant c can be shown not to depend on the choice of lattice; in the other, the exponent can be improved to 12.
Our aim is to explore some connections between word problems of groups and formal language theory. One question is whether any finitely presented group has a recursive word problem, i.e., if there is an algorithm to decide if a given word in the generators of such a group represents the identity; this was shown not to be the case by Novikov and Boone independently [37, 6]. A finitely presented group has a recursively enumerable word problem however, i.e., there is a process listing the words representing the identity; the process will not terminate (there are infinitely many such words) but any word representing the identity will eventually appear.
We are interested in relating the complexity of the word problem (as a formal language) to the algebraic structure of the group. With regards to the classes of languages we have just mentioned, there is the beautiful Higman embedding theorem  which says that a finitely generated group has a recursively enumerable word problem if and only if it can be embedded in a finitely presented group. For recursive languages it was shown by Boone and Higman  that a finitely generated group has a recursive word problem if and only if it can be embedded in a simple group which can, in turn, be embedded in a finitely presented group. This was strengthened by Thompson  who showed that a finitely generated group has a recursive word problem if and only if it can be embedded in a finitely generated simple group which can, in turn, be embedded in a finitely presented group. There is a natural (and seemingly difficult) question (attributed to Higman) which asks if we can strengthen this further by proving that every finitely generated group with a recursive word problem can be embedded in a finitely presented simple group.
We will survey some work concerning groups whose word problem is a simpler type of language. We will concentrate on the class of context-free languages, some subclasses of the context-free languages and some other related classes (such as intersections and complements of context-free languages); there are many other interesting classes of languages we have not discussed such as the the class of real-time languages (see [18, 20, 23] for example) the class of growing context-sensitive languages (see [22, 29]) and the class of context-sensitive languages (see [31, 41]).
Beaches and dunes of the open coast form one of the globe’s longest ecological interfaces, linking the oceans with the land. These systems are of great importance to society as prime sites for housing and recreation, buffers against storms, and providers of fisheries and mineral resources. By contrast, their unique ecological attributes and biodiversity are much less recognized. In this chapter, we provide a synthesis of the key ecological features and functions of beaches and dunes, outline the main elements of their faunal biodiversity, examine human threats and their biological consequences, and sketch some salient issues in management to achieve conservation of these unique ecosystems. It is apparent that the range of ecosystem goods and services is broad, but nutrient cycling, water filtration, and the provision of habitat and prey for a diverse range of animals are often the key ecological traits. Contrary to common perceptions, beaches and dunes contain a diverse and unique set of species, many of which are found nowhere else. In addition to the complement of highly adapted invertebrates, many wildlife species (e.g. birds, turtles, fishes) are dependent on beaches and dunes for nesting and feeding, and they use these habitats extensively. Human pressures on sandy shorelines and their biodiversity are numerous. Coastal squeeze is, however, the most pervasive, trapping beaches and their biota between the pressures of development from the terrestrial side and the consequences of climate change from the marine side. Beaches are also naturally malleable habitats whose interlinkages, including the exchange of organisms, with the abutting dunes and surf zones are essential to their functioning. Unfortunately, human actions intended to arrest the dynamics of beach habitats, such as seawalls and dune stabilizations, run counter to these natural dynamics and generally produce negative environmental outcomes. These present a set of formidable management challenges when the primary goal is to conserve intact ecosystems and biodiversity, calling for more systematic approaches in conservation design and implementation for beach and dune ecosystems.