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Multi-messenger observations of the transient sky to detect cosmic explosions and counterparts of gravitational wave mergers critically rely on orbiting wide-FoV telescopes to cover the wide range of wavelengths where atmospheric absorption and emission limit the use of ground facilities. Thanks to continuing technological improvements, miniaturised space instruments operating as distributed-aperture constellations are offering new capabilities for the study of high-energy transients to complement ageing existing satellites. In this paper we characterise the performance of the upcoming joint SpIRIT and HERMES-TP/SP constellation for the localisation of high-energy transients through triangulation of signal arrival times. SpIRIT is an Australian technology and science demonstrator satellite designed to operate in a low-Earth Sun-synchronous Polar orbit that will augment the science operations for the equatorial HERMES-TP/SP constellation. In this work we simulate the improvement to the localisation capabilities of the HERMES-TP/SP constellation when SpIRIT is included in an orbital plane nearly perpendicular (inclination = 97.6°) to the HERMES-TP/SP orbits. For the fraction of GRBs detected by three of the HERMES satellites plus SpIRIT, we find that the combined constellation is capable of localising 60% of long GRBs to within
on the sky, and 60% of short GRBs within
confidence regions), though it is beyond the scope of this work to characterise or rule out systematic uncertainty of the same order of magnitude. Based purely on statistical GRB localisation capabilities (i.e., excluding systematic uncertainties and sky coverage), these figures for long GRBs are comparable to those reported by the Fermi Gamma Burst Monitor instrument. These localisation statistics represents a reduction of the uncertainty for the burst localisation region for both long and short GRBs by a factor of
compared to the HERMES-TP/SP alone. Further improvements by an additional factor of 2 (or 4) can be achieved by launching an additional 4 (or 6) SpIRIT-like satellites into a Polar orbit, respectively, which would both increase the fraction of sky covered by multiple satellite elements, and also enable localisation of
of long GRBs to within a radius of
(statistical uncertainty) on the sky, clearly demonstrating the value of a distributed all-sky high-energy transient monitor composed of nano-satellites.
Growth failure in infants born with CHD is a persistent problem, even in those provided with adequate nutrition.
To summarise the published data describing the change in urinary metabolites during metabolic maturation in infants with CHD and identify pathways amenable to therapeutic intervention
Studies using qualitative or quantitative methods to describe urinary metabolites pre- and post-cardiac surgery and the relationship with growth in infants with CHD.
Sources of evidence:
NICE Healthcare Databases website was used as a tool for multiple searches.
347 records were identified, of which 37 were duplicates. Following the removal of duplicate records, 310 record abstracts and titles were screened for inclusion. The full texts of eight articles were reviewed for eligibility, of which only two related to infants with CHD. The studies included in the scoping review described urinary metabolites in 42 infants. A content analysis identified two overarching themes of metabolic variation predictive of neurodevelopmental abnormalities associated with anaerobic metabolism and metabolic signature associated with the impact on gut microbiota, inflammation, energy, and lipid digestion.
The results of this scoping review suggest that there are considerable gaps in our knowledge relating to metabolic maturation of infants with CHD, especially with respect to growth. Surgery is a key early life feature for CHD infants and has an impact on the developing biochemical phenotype with implications for metabolic pathways involved in immunomodulation, energy, gut microbial, and lipid metabolism. These early life fingerprints may predict those individuals at risk for neurodevelopmental abnormalities.
Chronic Hepatitis C infection is considered a systemic disease with extrahepatic manifestations, mainly neuropsychiatric symptoms,
which is associated with a chronic low-grade inflammatory state. Hepatitis C virus (HCV) eradication is currently achieved in >98% of cases with oral direct-acting antivirals (DAA).
To study potential clinical neuropsychiatric changes (mood, cognition, sleep, gastrointestinal, sickness, and motion) in HCV-infected patients after HCV eradication with DAA.
Design: Cohort study. Subjects: 37 HCV-infected patients, aged<55 years old, with non-advanced liver disease receiving DAA; free of current mental disorder. 24 healthy controls were included at baseline. Assessment: -Baseline (BL) (socio-demographic and clinical variables, MINI-DSM-IV, and Neurotoxicity Scale (NRS), (mood, cognitive, sleep, gastrointestinal, sickness and motor dimensions). Follow-up: End-of-treatment, 12weeks-after and 48weeks-after DAA: NRS. Analysis: Descriptive and bivariate non-parametrical analysis.
NRS total score and dimensions where different between cases and controls (.000) at baseline. NRS total score (.000) and mood (.000), cognition (.000), sleep (.002), gastrointestinal (.017), and sickness (.003), except motor dimension score (.130) showed significant longitudinal improvement.
HCV-infected patients with mild liver disease presented significantly worse scores for neurotoxicity symptomatology in all dimensions compared to healthy individuals. After HCV eradication with DAA, both at short and long follow-up a significant improvement of the NRS total score and each of the dimensions (except motor) were observed. However, they did not reach the values of healthy individuals, suggesting a not complete neuropsychiatric restoration in the period studied. Grant: ICIII-FIS:PI17/02297.(One way to make Europe) (RMS) and Gilead Fellowship-GLD17/00273 (ZM); and the support of SGR17/1798 (RMS)
The WHO would increase diagnosis and treatment of viral hepatitis in the world by 2030, based on the high efficacy of direct-acting-antivirals against HCV, extended vaccination programs in HBC, and epidemiological data. Diagnostic of HCV/HBV infection has been simplified by point-of-care (POC) devices (cheap/easy-to-use/interprete/qick-results), detecting anti-HCV-antibodies or HBV-antigen in capillary blood at the patients´site. The current seroprevalence of viral hepatitis B/C in general population in Spain is 0.5%/1% and would be higher (3-17%) in people with severe-mental-disorder due to risk factors and traditionally less access to health care.
To design a screening protocol for HCV eradication and HBV-detection, and risk factors among severe-mental-disorder patients in a CommunityMentalHealthCenter. To guarantee equal access to viral hepatitis screening and therapy among this population.
Outpatients visited along one-year who accepts participate. Using POC-device for qualitative detection of anti-HCV-antibodies (Quickview-of-Lumiquick-Diagnostics®)/HBsAG (Abbott-Rapid-Diagnostics®). Socio-demographic data; mental disorder(ICD-10); HCV/HBV risk-factors; Neurotoxicity-scale (mood/cognition/sleep/gastrointestinal/sickness/motor); SF-12; Patient-satisfaction. Subjects with positive HCV/HBV POC-test will have a on-site venopuncture to assess hemograme/liver tests, and HCV-RNA (Cobas-TaqMan-RocheDiagnostics)/HBsAg-ELISA (Atellica-Siemens). In positive HCV-RNA (active infection) the psychiatric-team will inform the hepatology-team for non-invasive liver fibrosis assessment and DAA prescription. The patient will receive 8-12-weeks on-site treatment, and assessed (Neurotoxicity/SF-12).HCV cure will be confirmed by HCV-RNA in blood. Chronic-cases will be managed at Hepatology-Unit.
We will present the results of the implementation of the programme and their ability to detect viral-hepatitis-positive cases among patients with severe-mental-disorders and to treat them effectively.
Our results may support the generalisation of the programme in among CMHC’s.
Access to adequate healthcare is the best means we have for detecting and preventing complications during pregnancy and childbirth. Identifying and preventing factors that can interfere with this access become essential (Gulliford et al., 2002). Mother dual pathology during pregnancy is a condition with severe consequences (Cosp & Ontano, 2009). However there is scarce literature regarding barriers to obstetric care among women at risk for dual pathology.
The main objective was to explore healthcare access barriers among pregnant women at risk for dual pathology.
Framed in a broader research (The WOMAP project) 2014 adult pregnant women less than 26 weeks of pregnancy were screened in five hospitals in Madrid (Spain) between 2016-2019. If the screening test (AC-Ok scale) identified the presence of dual pathology during the last month, women were included in the clinical trial and assessed with a more extensive battery (compound by PHQ-9; GAD-7; PCL-5; AUDIT; DAST; and Fagerström Test) and a semi-structured interview.
163 women at risk for dual pathology were assessed. Of them, 152 (93,2%) referred to having attended all scheduled appointments. Socioeconomic level (0.184, p=0.024), depression (-0.174, p=0.034), post-traumatic stress symptoms (-0.214, p=0.011) and alcohol reporting (-0.259, p=0.045) were significantly correlated with attendance level.
Women with more severe symptoms of dual pathology are at higher risk for misatending obstetrical appointments. Social criticism, even subtle or unintentional, related to dual pathology during pregnancy could be restraining these women to attend properly. Thus, care providers should pay attention to women’s mental health and alcohol abuse to prevent miss-attention.
Exposure to endocrine-disrupting chemicals during critical windows of development may lead to functional abnormalities in adulthood. Isoflavones are a flavonoid group of phytoestrogens that are recognized by their estrogenic activity and are highly abundant in soybean. Since the thyroid gland presents estrogen receptors and infants, toddlers and teenagers may consume isoflavones from soy-based infant formula and beverages as alternatives to animal milk, we propose to investigate the potential effects of relevant concentrations of soy isoflavones in the regulation of the hypothalamic–pituitary (HP) thyroid axis using peripubertal male rats as an experimental model. Thirty-two 23-day-old male rats were exposed to 0.5, 5, or 50 mg of soy isoflavones/kg from weaning to 60 days of age, when they were euthanized, and the tissues were collected to evaluate the mRNA expression of genes involved in the regulation of the HP thyroid axis and dosages of thyroid hormones (THs). Serum TSH concentrations were increased, while alterations were not observed in serum concentrations of triiodothyronine and thyroxine. Regarding mRNA gene expression, Mct-8 was increased in the hypothalamus, Mct-8, Thra1, and Thrb2 were decreased in the pituitary, and Nis and Pds were reduced in the thyroid. In the heart, Mct8 and Thrb2 were increased, and Thra1 was decreased. In the liver, Mct8, Thra1, and Thrb2 were decreased. These results suggest that the consumption of relevant doses of soy isoflavones during the peripubertal period in males may induce subclinical hypothyroidism, with alterations in the regulation of the HP thyroid axis, modulation of TH synthesis, and peripheral alterations in TH target organs.
Anatomically corrected malposition of the great arteries is a rare CHD, involving alignment and position of the great arteries. We report an infant with situs solitus, atrioventricular discordance, and ventriculoarterial concordance with the aorta arising anteriorly and to the right of the pulmonary artery. A mutation of Nodal gene, implicated in the pathogenesis of human left–right patterning defects, was found.
We explored the interactive role of an organization's sector prototypicality (the extent to which the organization embodies the prototype of its market sector) and employees' identification with their organization in buffering crises' negative effects on perceived organizational performance. We propose (1) that highly prototypical organizations are perceived as more able to cope with organizational crisis, because of their capacity to reduce the threat associated with crisis, and (2) that this effect is augmented when employees more strongly identify with their organization, presumably because of a higher trust in the organization's capacity to efficiently cope with crisis. Findings from two studies confirmed the hypotheses, by manipulating (study 1) and measuring (study 2) organizational crisis and the organization's sector prototypicality, and by focusing on potential employees (study 1) and on employees of a company facing a financial crisis (study 2). Theoretical and applied implications of results are discussed.
To assess the training and the future workforce needs of paediatric cardiac critical care faculty.
REDCap surveys were sent May−August 2019 to medical directors and faculty at the 120 US centres participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database. Faculty and directors were asked about personal training pathway and planned employment changes. Directors were additionally asked for current faculty numbers, expected job openings, presence of training programmes, and numbers of trainees. Predictive modelling of the workforce was performed using respondents’ data. Patient volume was projected from US Census data and compared to projected provider availability.
Measurements and main results:
Sixty-six per cent (79/120) of directors and 62% (294/477) of contacted faculty responded. Most respondents had training that incorporated critical care medicine with the majority completing training beyond categorical fellowship. Younger respondents and those in dedicated cardiac ICUs were more significantly likely to have advanced training or dual fellowships in cardiology and critical care medicine. An estimated 49–63 faculty enter the workforce annually from various training pathways. Based on modelling, these faculty will likely fill current and projected open positions over the next 5 years.
Paediatric cardiac critical care training has evolved, such that the majority of faculty now have dual fellowship or advanced training. The projected number of incoming faculty will likely fill open positions within the next 5 years. Institutions with existing or anticipated training programmes should be cognisant of these data and prepare graduates for an increasingly competitive market.
This chapter presents Feynman’s formulation of quantum mechanics, based on a path integral representation of the evolution operator. The chapter presents detailed examples which make it possible to understand clearly Feynman’s “sum over paths,” and it contains a complete discussion of how to calculate Gaussian path integrals. It also discusses the Euclidean version of the path integral, as well as Wick’s theorem and Feynman diagrams. Finally, it discusses instantons in quantum mechanics.
This chapter discusses metastable states or resonances in quantum mechanics. It develops different techniques to compute their complex energies, like complex dilatation techniques, and the uniform and the exact WKB method. The cubic and the inverted quartic oscillators are discussed in detail to exemplify these procedures. Finally, the chapter discusses the analytic continuation of eigenvalue problems, and the path integral formulation of metastable states.
It presents the unitary time evolution operator and its integral kernel in the space representation, also known as the quantum-mechanical propagator. It introduces the resolvent operator and its analytical properties, and it discusses in some detail scattering theory in one dimension.