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The Repugnant Conclusion is an implication of some approaches to population ethics. It states, in Derek Parfit's original formulation,
For any possible population of at least ten billion people, all with a very high quality of life, there must be some much larger imaginable population whose existence, if other things are equal, would be better, even though its members have lives that are barely worth living. (Parfit 1984: 388)
In children, the first episode of supraventricular tachycardia occurs at various ages. The aim of this study is to describe age-specific tachycardia mechanisms, clinical findings, and outcome in a contemporary cohort of paediatric patients with supraventricular tachycardia.
Retrospective analysis of 531 consecutive patients with structurally normal hearts under the age of 18 years who underwent invasive electrophysiological study for supraventricular tachycardia. The study population was divided into two groups, early-onset group (n = 57) and late-onset group (n = 474), according to the age of the occurrence of the first tachycardia before or after the age of 12 months.
Accessory pathway-mediated tachycardia was more common (82.5 versus 50.1%, p < 0.001) and the proportion of left-sided accessory pathways was more pronounced (74.5 versus 53.7%, p = 0.01) in the early-onset group than in the late-onset group. The antegrade and retrograde refractory periods of the accessory pathways were similar in both groups, but pre-excitation was more common in the early-onset group (50.9 versus 31.9%, p = 0.007). Typical atrioventricular nodal re-entrant tachycardia was more common (36.7 versus 7.0%, p < 0.001) in the late-onset group. There was no difference among the two groups regarding overall outcome.
Accessory pathway-mediated re-entrant tachycardia is the most common mechanism of recurrent supraventricular tachycardia in infants with structurally normal hearts who are later referred to an electrophysiological study. These pathways often cause pre-excitation and tend to be located on the left side whereas their refractory period is not different from that of patients with late-onset tachycardia.
The study aimed at assessing stunting, wasting and breast-feeding as correlates of body composition in Cambodian children. As part of a nutrition trial (ISRCTN19918531), fat mass (FM) and fat-free mass (FFM) were measured using 2H dilution at 6 and 15 months of age. Of 419 infants enrolled, 98 % were breastfed, 15 % stunted and 4 % wasted at 6 months. At 15 months, 78 % were breastfed, 24 % stunted and 11 % wasted. Those not breastfed had lower FMI at 6 months but not at 15 months. Stunted children had lower FM at 6 months and lower FFM at 6 and 15 months compared with children with length-for-age z ≥0. Stunting was not associated with height-adjusted indexes fat mass index (FMI) or fat-free mass index (FFMI). Wasted children had lower FM, FFM, FMI and FFMI at 6 and 15 months compared with children with weight-for-length z (WLZ) ≥0. Generally, FFM and FFMI deficits increased with age, whereas FM and FMI deficits decreased, reflecting interactions between age and WLZ. For example, the FFM deficits were –0·99 (95 % CI –1·26, –0·72) kg at 6 months and –1·44 (95 % CI –1·69; –1·19) kg at 15 months (interaction, P<0·05), while the FMI deficits were –2·12 (95 % CI –2·53, –1·72) kg/m2 at 6 months and –1·32 (95 % CI –1·77, –0·87) kg/m2 at 15 months (interaction, P<0·05). This indicates that undernourished children preserve body fat at the detriment of fat-free tissue, which may have long-term consequences for health and working capacity.
Chronic paediatric heart disease is often associated with residual symptoms, persisting functional restrictions, and late sequelae for psychosocial development. It is, therefore, increasingly important to evaluate the health-related quality of life of children and adolescents with chronic heart disease. The aim of this study was to determine medical and socio-demographic variables affecting health-related quality of life in school-aged children and adolescents with chronic heart disease.
Patients and methods
The Pediatric Cardiac Quality of Life Inventory was administered to 375 children and adolescents and 386 parental caregivers. Medical information was obtained from the charts. The socio-demographic information was provided by the patients and caregivers.
Greater disease severity, low school attendance, current cardiac medication, current parental employment, uncertain or limited prognosis, history of connection to a heart–lung machine, number of nights spent in a hospital, and need for treatment in a paediatric aftercare clinic independently contributed to lower health-related quality of life (self-report: R2=0.41; proxy-report: R2=0.46). High correlations between self-reports and parent-proxy reports indicated concordance regarding the evaluation of a child’s health-related quality of life.
Beyond medical treatment, integration into school is important to increase health-related quality of life in children and adolescents surviving with chronic heart disease. Regular screening of health-related quality of life is recommended to identify patients with special needs.
The present study investigated the impact of a Lactobacillus rhamnosus CGMCC1.3724 (LPR) supplementation on weight loss and maintenance in obese men and women over 24 weeks. In a double-blind, placebo-controlled, randomised trial, each subject consumed two capsules per d of either a placebo or a LPR formulation (1·6 × 108 colony-forming units of LPR/capsule with oligofructose and inulin). Each group was submitted to moderate energy restriction for the first 12 weeks followed by 12 weeks of weight maintenance. Body weight and composition were measured at baseline, at week 12 and at week 24. The intention-to-treat analysis showed that after the first 12 weeks and after 24 weeks, mean weight loss was not significantly different between the LPR and placebo groups when all the subjects were considered. However, a significant treatment × sex interaction was observed. The mean weight loss in women in the LPR group was significantly higher than that in women in the placebo group (P= 0·02) after the first 12 weeks, whereas it was similar in men in the two groups (P= 0·53). Women in the LPR group continued to lose body weight and fat mass during the weight-maintenance period, whereas opposite changes were observed in the placebo group. Changes in body weight and fat mass during the weight-maintenance period were similar in men in both the groups. LPR-induced weight loss in women was associated not only with significant reductions in fat mass and circulating leptin concentrations but also with the relative abundance of bacteria of the Lachnospiraceae family in faeces. The present study shows that the Lactobacillus rhamnosus CGMCC1.3724 formulation helps obese women to achieve sustainable weight loss.
In the last decade, the authorities require the use of safe, comfortable vehicles to assure a door to door aspect with respect of environment in the urban context. In this paper, we propose an advanced approach of transport regulation where we integrate cybercars into a regulation process as an alternative in disruption cases. For that, we propose an ITS architecture including public transportation and cybercars into the same framework. We will show that collaboration between these two systems provides better results than managing them separably.
La connaissance de l'effort de contact entre le pantographe et la
caténaire est un élément essentiel de l'évaluation de la
qualité du captage du courant. La SNCF étudie cet effort pour
qualifier le matériel et les infrastructures nouvelles, ou en vue de
détecter les défauts dans la caténaire.
La méthode de mesure utilisée jusqu'à présent, basée sur
une hypothèse d'archet rigide, a une bande passante limitée bien en
deçà de la première fréquence propre de l'archet.
Pour franchir cette limitation, notamment pour les trains à grande
vitesse, et pour la détection de défaut par analyse de la signature
vibratoire, une nouvelle méthodologie, basée sur la prise en compte
des modes propres de l'archet, est proposée. Vibratec développe
depuis plusieurs années des méthodes inverses [6,7] pour remonter
aux efforts injectés à partir des vibrations mesurées.
L'originalité du contact pantographe caténaire réside dans le
fait que la position du point de contact est une inconnue du problème.
La méthode inverse utilisée est basée sur l'analyse modale des
premiers modes de l'archet. L'écriture de l'équilibre dynamique de
l'archet permet d'aboutir à un système d'équations dont la
résolution donne le module de l'effort et son point d'application. Les
résultats obtenus sur un dispositif expérimental de validation,
à partir d'une base modale limitée aux 3 premiers modes de l'archet,
montrent un gain important sur la bande utile de la mesure, qui passe de
45 Hz à 120 Hz. Par la suite, la bande passante pourra encore être
étendue en considérant davantage de modes de déformation de
l'archet. Un utilitaire a été développé sous Matlab pour la
mise en œuvre de la méthode à partir de données
Heroin-assisted treatment has been found to be effective for people with severe opioid dependence who are not interested in or do poorly on methadone maintenance.
To study heroin-assisted treatment in people on methadone who continue intravenous heroin and in those who are heroin dependent but currently not in treatment.
In an open-label multicentre randomised controlled trial, 1015 people with heroin dependence received a variable dose of injectable heroin (n=515) or oral methadone (n=500) for 12 months. Two response criteria, improvement of physical and/or mental health and decrease in illicit drug use, were evaluated in an intent-to-treat analysis.
Retention was higher in the heroin (67.2%) than in the methadone group (40.0%) and the heroin group showed a significantly greater response on both primary outcome measures. More serious adverse events were found in the heroin group, and were mainly associated with intravenous use.
Heroin-assisted treatment is more effective for people with opioid dependence who continue intravenous heroin while on methadone maintenance or who are not enrolled in treatment. Despite a higher risk, it should be considered for treatment resistance under medical supervision.
A burn patient was infected with Acinetobacter baumannii on transfer to the hospital after a terrorist attack. Two patients experienced cross-infection. Environmental swab samples were negative for A. baumannii. Six months later, the bacteria reemerged in 6 Patients. Environmental swab samples obtained at this time were inoculated into a minimal mineral broth, and culture results showed widespread contamination. No case of infection occurred after closure of the unit for disinfection.
We report a single-electron transistor concept and its related process enabling the fabrication of ultrasmall junction capacitance. The method utilizes a nanodamascene approach where trenches in silicon oxide are covered with a filling material and planarized with chemical mechanical polishing. Single-electron transistors fabricated with this approach were characterized up to 433 K and demonstrated that the nanodamascene process has high resolution, is relatively simple and is highly scalable.
To acquire data on pediatric nosocomial infections (NIs), which are associated with substantial morbidity and mortality and for which data are scarce.
Prevalence survey and evaluation of a new comorbidity index.
Seven Swiss pediatric hospitals.
Those hospitalized for at least 24 hours in a medical, surgical, intensive care, or intermediate care ward.
Thirty-five NIs were observed among 520 patients (6.7%; range per hospital, 1.4% to 11.8%). Bacteremia was most frequent (2.5 per 100 patients), followed by urinary tract infection (1.3 per 100 patients) and surgical-site infection (1.1 per 100 patients; 3.2 per 100 patients undergoing surgery). The median duration until the onset of infection was 19 days. Independent risk factors for NI were age between 1 and 12 months, a comorbidity score of 2 or greater, and a urinary catheter. Among surgical patients, an American Society of Anesthesiologists (ASA) score of 2 or greater was associated with any type of NI (P = .03). Enterobacteriaceae were the most frequent cause of NI, followed by coagulase-negative staphylococci; viruses were rarely the cause.
This national prevalence survey yielded valuable information about the rate and risk factors of pediatric NI. A new comorbidity score showed promising performance. ASA score may be a predictor of NI. The season in which a prevalence survey is conducted must be considered, as this determines whether seasonal viral infections are observed. Periodic prevalence surveys are a simple and cost-effective method for assessing NI and comparing rates among pediatric hospitals.
The Organization for Security and Co-operation in Europe (OSCE) pursues a concept of co-operative security which encompasses commitments by participating States in the areas of military security, political co-operation, human rights, economy, culture and the environment. Its priorities are to consolidate common values and build civil societies, prevent local conflicts, restore stability and bring peace to war-torn areas, overcome real and perceived security deficits and avoid the creation of new divisions by promoting a co-operative system of security. The OSCE is the primary instrument for early warning, conflict management and crisis management in the OSCE region, i.e. Europe, Central Asia and North America. Its basic feature is the strict equality of all 55 participating States, which is well reflected in its decision-making process. With a few exceptions, decision-making at meetings within the framework of the OSCE is only possible by consensus, which is considered to be achieved if no State has expressed an objection. States are, however, allowed to make reservations or interpretative statements.
A two-dimensional model which links the atmosphere, the mixed layer of the ocean, the sea ice, the continents, the ice sheets and their underlying bedrock has been used to test the Milankovitch theory over the last glacial—interglacial cycle. It was found that the orbital variations alone can induce, in such a system, feed-backs sufficient to generate the low-frequency part of the climatic variations over the last 122 kyear. These simulated variations at the astronomical time-scale are broadly in agreement with ice volume and sea-level reconstructions independently obtained from geological data. Imperfections in the simulated climate were the insufficient southward extent of the ice sheets and the too small hemispheric cooling during the last glacial maximum. These deficiencies were partly remedied in a further experiment (Gallée and others, in press) by using the time-dependent CO2 atmospheric concentration given by the Vostok ice core in addition to the astronomical forcing. For this second experiment, the main mechanisms and feedbacks responsible for the glaciation and the deglaciation in the model are discussed here.