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Optimising short- and long-term outcomes for children and patients with CHD depends on continued scientific discovery and translation to clinical improvements in a coordinated effort by multiple stakeholders. Several challenges remain for clinicians, researchers, administrators, patients, and families seeking continuous scientific and clinical advancements in the field. We describe a new integrated research and improvement network – Cardiac Networks United – that seeks to build upon the experience and success achieved to-date to create a new infrastructure for research and quality improvement that will serve the needs of the paediatric and congenital heart community in the future. Existing gaps in data integration and barriers to improvement are described, along with the mission and vision, organisational structure, and early objectives of Cardiac Networks United. Finally, representatives of key stakeholder groups – heart centre executives, research leaders, learning health system experts, and parent advocates – offer their perspectives on the need for this new collaborative effort.
Serotonergic signaling is considered critical for an appropriate adaptation to stress. We have previously observed that in healthy volunteers, prefrontal serotonin transporter (SERT) binding is positively associated with hypothalamic-pituitary-adrenal (HPA)-axis output in terms of the cortisol awakening response (CAR). Here, we tested (1) if such a correlation persists in a human model of chronic serotonin depletion, namely in 3,4-Methylenedioxymethamphetamine (MDMA or ‘Ecstasy’) users, and (2) if CAR differed between MDMA users (N = 18) and non-using healthy volunteers (N = 32). Participants underwent SERT brain imaging with [11C]DASB-PET, and performed home-sampling of CAR, defined as the area under curve with respect to cortisol increase from awakening level. When adjusting for age and group, CAR was positively coupled to prefrontal SERT binding (p = 0.006) and MDMA users showed significantly higher CAR than the control group (p = 0.0003). In conclusion, our data confirm the recently described positive association between prefrontal SERT binding and CAR, this time in a human model of serotonin deficiency. Also, we find that CAR was higher in MDMA users relative to non-users. We suggest that the inhibitory control on HPA-axis output is less efficient in the off-balance state established by recent MDMA use, most likely through mechanisms other than those that can be compensated by lowering SERT levels.
Non-steady-state vertical velocities of up to 5 m a−1 exceed the vertical surface-parallel flow (SPF) components over much of the ablation area of Storstrømmen, a large outlet glacier from the East Greenland ice sheet. Neglecting a contribution to the vertical velocity of this magnitude results in substantial errors (up to 20%) also on the south–north component of horizontal velocities derived by satellite synthetic aperture radar interferometry (InSAR) measurements. In many glacier environments, the steady-state vertical velocity component required to balance the annual ablation rate is 5–10 m a−1 or more. This indicates that the SPF assumption may be problematic also for glaciers in steady state. Here we derive the three-dimensional surface velocity distribution of Storstrømmen by using the principle of mass conservation (MC) to combine InSAR measurements from ascending and descending satellite tracks with airborne ice-sounding radar measurement of ice thickness. The results are compared to InSAR velocities previously derived by using the SPF assumption, and to velocities obtained by in situ global positioning system (GPS) measurements. The velocities derived by using the MC principle are in better agreement with the GPS velocities than the previously calculated velocities derived with the SPF assumption.
We present a method for analyzing the errors involved in measuring three-dimensional glacier velocities with interferometric radar. We address the surface-parallel flow assumption and an augmented approach with a flux-divergence (FD) term. The errors in an interferometric ERS-1/-2 satellite radar dataset with ascending- and descending-orbit data covering Storstrømmen glacier, northeast Greenland, are assessed. The FD error assessment is carried out on airborne 60 MHz ice-sounding radar data from the same area. A simple model of an interferometric radar system is developed and analyzed. The error sources considered include phase noise, atmospheric distortions, baseline calibration errors, a dry snow layer, and the stationary-flow assumption used in differential interferometry. The additional error sources in the analysis of FD errors are noise, bias and unknown variations of the ice thickness, and approximations of the ice-flow model. The example glacier is now building up following a surge. The analysis shows that in the case study presented the errors are small enough to justify the use of both the estimated surface-parallel flow term of the vertical velocity and the estimated FD term of the vertical velocity.
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