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Despite improvements in the medical and surgical management of infants with CHD, growth failure before surgery in many infants continues to be a significant concern. A nutritional pathway was developed, the aim of which was to provide a structured approach to nutritional care for infants with CHD awaiting surgery.
Materials and methods
The modified Delphi process was development of a nutritional pathway; initial stakeholder meeting to finalise draft guidelines and develop questions; round 1 anonymous online survey; round 2 online survey; regional cardiac conference and pathway revision; and final expert meeting and pathway finalisation.
Paediatric Dietitians from all 11 of the paediatric cardiology surgical centres in the United Kingdom contributed to the guideline development. In all, 33% of participants had 9 or more years of experience working with infants with CHD. By the end of rounds 1 and 2, 76 and 96% of participants, respectively, were in agreement with the statements. Three statements where consensus was not achieved by the end of round 2 were discussed and agreed at the final expert group meeting.
Nutrition guidelines were developed for infants with CHD awaiting surgery, using a modified Delphi process, incorporating the best available evidence and expert opinion with regard to nutritional support in this group.
In 1998 a circle of timber posts within the intertidal zone on the north Norfolk coast was brought to the attention of the Norfolk County Council Archaeological Service. A subsequent programme of archaeological recording and dating revealed that the structure was constructed in the spring or early summer of 2049 BC, during the Early Bronze Age. Because of the perceived threat of damage and erosion from the sea a rescue excavation was undertaken during the summer months of 1999. The structure was entirely excavated, involving the removal of the timbers and a programme of stratigraphic recording and environmental analysis. A survey was also undertaken within the environs of the site which has identified further timber structures dating from the Bronze Age. Detailed examination of the timber from the circle has produced a wealth of unexpected information which has added greatly to our understanding of Early Bronze Age woodworking, organisation of labour and the layout and construction of timber ritual monuments.
The antimalarial drug artemisinin (ART) is commercially extracted from the medicinal plant Artemisia annua L. Here, we report the screening of 70 A. annua plants representing 14 diverse germplasm accessions sourced from around the world, and identify lines containing >2% ART. These extremely high-yielding individuals have been maintained as vegetative clones, and they represent promising germplasm resources for future A. annua breeding programmes.
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