To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline.
A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus
60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations.
Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.
Ethnohistoric accounts indicate that the people of Australia's Channel Country engaged in activities rarely recorded elsewhere on the continent, including food storage, aquaculture and possible cultivation, yet there has been little archaeological fieldwork to verify these accounts. Here, the authors report on a collaborative research project initiated by the Mithaka people addressing this lack of archaeological investigation. The results show that Mithaka Country has a substantial and diverse archaeological record, including numerous large stone quarries, multiple ritual structures and substantial dwellings. Our archaeological research revealed unknown aspects, such as the scale of Mithaka quarrying, which could stimulate re-evaluation of Aboriginal socio-economic systems in parts of ancient Australia.
To assess the relationship between food insecurity, sleep quality, and days with mental and physical health issues among college students.
An online survey was administered. Food insecurity was assessed using the ten-item Adult Food Security Survey Module. Sleep was measured using the nineteen-item Pittsburgh Sleep Quality Index (PSQI). Mental health and physical health were measured using three items from the Healthy Days Core Module. Multivariate logistic regression was conducted to assess the relationship between food insecurity, sleep quality, and days with poor mental and physical health.
Twenty-two higher education institutions.
College students (n 17 686) enrolled at one of twenty-two participating universities.
Compared with food-secure students, those classified as food insecure (43·4 %) had higher PSQI scores indicating poorer sleep quality (P < 0·0001) and reported more days with poor mental (P < 0·0001) and physical (P < 0·0001) health as well as days when mental and physical health prevented them from completing daily activities (P < 0·0001). Food-insecure students had higher adjusted odds of having poor sleep quality (adjusted OR (AOR): 1·13; 95 % CI 1·12, 1·14), days with poor physical health (AOR: 1·01; 95 % CI 1·01, 1·02), days with poor mental health (AOR: 1·03; 95 % CI 1·02, 1·03) and days when poor mental or physical health prevented them from completing daily activities (AOR: 1·03; 95 % CI 1·02, 1·04).
College students report high food insecurity which is associated with poor mental and physical health, and sleep quality. Multi-level policy changes and campus wellness programmes are needed to prevent food insecurity and improve student health-related outcomes.
Alteplase is an effective treatment for ischaemic stroke patients, and it is widely available at all primary stroke centres. The effectiveness of alteplase is highly time-dependent. Large tertiary centres have reported significant improvements in their door-to-needle (DTN) times. However, these same improvements have not been reported at community hospitals.
Red Deer Regional Hospital Centre (RDRHC) is a community hospital of 370 beds that serves approximately 150,000 people in their acute stroke catchment area. The RDRHC participated in a provincial DTN improvement initiative, and implemented a streamlined algorithm for the treatment of stroke patients. During this intervention period, they implemented the following changes: early alert of an incoming acute stroke patient to the neurologist and care team, meeting the patient immediately upon arrival, parallel work processes, keeping the patient on the Emergency Medical Service stretcher to the CT scanner, and administering alteplase in the imaging area. Door-to-needle data were collected from July 2007 to December 2017.
A total of 289 patients were treated from July 2007 to December 2017. In the pre-intervention period, 165 patients received alteplase and the median DTN time was 77 minutes [interquartile range (IQR): 60–103 minutes]; in the post-intervention period, 104 patients received alteplase and the median DTN time was 30 minutes (IQR: 22–42 minutes) (p < 0.001). The annual number of patients that received alteplase increased from 9 to 29 in the pre-intervention period to annual numbers of 41 to 63 patients in the post-intervention period.
Community hospitals staffed with community neurologists can achieve median DTN times of 30 minutes or less.
Molecular studies have shown the type collection of Omphalina oreades to be conspecific with a small brown basidiolichen from the Appalachian range in Newfoundland, both with 4-spored basidia. Two sequences deposited in GenBank, originally identified as O. grisella, fell in the same clade. Sequences of the type collection of Omphalia grisella, with 2-spored basidia, formed a sister clade together with two GenBank deposits, one identified as O. grisella and the other as Omphalina velutina. Omphalina oreades is recombined here as Lichenomphalia oreades comb. nov., and the species redescribed and illustrated. Sequences of the internal transcribed spacer regions of nuclear ribosomal DNA (ITS rDNA) from the algae associated with two collections of L. oreades fell within a highly supported clade with members of an undetermined species of Coccomyxa. The most abundant algal ribosomal large subunit sequence from granules at the base of a different collection matched GenBank sequences identified as Chloroidium ellipsoideum, which is probably either a free-living algal species or a partner to a species of Trapeliopsis. The second most abundant sequence matched Coccomyxa subellipsoidea and is the most likely photobiont of L. oreades. Further studies are required to elucidate the relationship of L. velutina to these taxa.
The physiological demands of weight-pulling dogs have yet to be investigated. Two groups of competitive weight-pulling dogs both underwent two identical pull series 3 h apart. The control group (n 8) was compared with a group fed a rapidly digestible carbohydrate and protein supplement after the first pull series (n 9). Blood was drawn before and after each pull series as well as at 15 and 30 min after the first pull series finished. Biochemistry values remained unremarkable throughout the study in both groups regardless of supplementation or exercise over time. Lactic acid showed mild significant increases post-exercise (2·1 (sd 1·2) mmol/l) compared with baseline (1·4 (sd 0·3) mmol/l; P = 0·03) after the initial pull series. When examining the effects of time there was a significant increase in insulin from baseline (median of 10·8 (range 6·8–17·4) μIU/ml) compared with 30 min after supplementation (17·0 (range 8·1–33·0) μIU/ml) and at 3 h after supplementation (19·2 (range 9·7–53·4) μIU/ml). In the treatment group there was also a time effect, with glucagon being elevated from baseline (median of 100 (range 79–115) pg/ml) compared with 30 min after supplementation (114 (range 90–183) pg/ml) and after the second pull series (131 (range 107–152) pg/ml). Evaluation of each dog's ability to pull the same or greater amount of weight on the second pull series revealed no significant differences. In conclusion, weight-pulling dogs have mild elevations in lactate reflecting little anaerobic metabolism compared with other canine sprinting athletes; hormonal changes associated with carbohydrate absorption are reflected within the treatment group, and supplementation had no effect on performance.
The current project seeks to integrate literatures on personality risk for antisocial behavior (ASB) by examining how callous–unemotional traits relate to (a) the development of disinhibited traits and (b) the association between disinhibited traits and ASB. In Study 1, using a nationally representative sample of youth (N > 7,000), we examined whether conduct problems and lack of guilt assessed during ages 4–10 years predicted levels of and changes in disinhibited traits over the course of adolescence, and moderated associations between these traits and ASB. High levels of childhood conduct problems were associated with higher levels of impulsivity, sensation seeking, and ASB in early adolescence, whereas lack of guilt was associated with lower levels of sensation seeking. Neither conduct problems nor lack of guilt significantly predicted changes in impulsivity or sensation seeking, and associations among changes in sensation seeking, impulsivity, and ASB were also consistent across levels of conduct problems and lack of guilt. In Study 2, using a cross-sectional sample of adolescents (N = 970), we tested whether callous–unemotional traits moderated associations between disinhibited traits and ASB. Consistent with the results of Study 1, associations between disinhibited personality and ASB were consistent across a continuous range of callous–unemotional traits.
The rapid sol–gel synthesis of macroscopic quantities of nanodiamond aerogel (NDAG) is reported at standard temperature and pressure using acid-catalyzed covalent crosslinking of air-oxidized detonation nanodiamond (DND) nanocrystals. Acetonitrile acts as a polar, aprotic solvent both to form a colloidal dispersion of DND particles and to conduct acid-catalyzed polycondensation reactions between resorcinol and formaldehyde (RF) small molecule precursors. Several characterization techniques show that nanodiamond grains are connected via covalent bonding with RF molecules to form a porous, three-dimensional network. Solvent exchange into liquid carbon dioxide and subsequent supercritical drying of NDAGs are used to recover low-density (151 mg/cm3), three-dimensional monolithic aerogels that exhibit surface areas in excess of 589 m2/g. The large accessible pore volume from the rapidly synthesized, macroscopic NDAG materials suggests a range of potential applications in catalysis, sensing, energy storage, as well as inert excipients for small-molecule pharmaceuticals.
Objectives: The aim of this study was to compare the predictive value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein (hs-CRP)-screening in addition to traditional risk factor screening in apparently healthy persons as a means of preventing coronary artery disease.
Methods and Results: The systematic review was performed according to internationally recognized methods. Seven studies on risk prediction, one clinical decision-analytic modeling study, and three decision-analytic cost-effectiveness studies were included. The adjusted relative risk of high hs-CRP-level ranged from 0.7 to 2.47 (p < .05 in four of seven studies). Adding hs-CRP to the prediction models increased the areas under the curve by 0.00 to 0.027. Based on the clinical decision analysis, both individuals with elevated hs-CRP-levels and those with hyperlipidemia have a similar gain in life expectancy following statin therapy. One high-quality economic modeling study suggests favorable incremental cost-effectiveness ratios for persons with elevated hs-CRP and higher risk. However, many model parameters were based on limited evidence.
Conclusions: Adding hs-CRP to traditional risk factors improves risk prediction, but the clinical relevance and cost-effectiveness of this improvement remain unclear.
The Mars Society is an international private organisation advocating the exploration and settlement of Mars. Part of its mission involves selecting areas for Martian analogue research, to test hardware, technology, strategies and human factors relevant to sending people to Mars. Mars Society Australia has selected an area in the Arkaroola region in the Flinders Ranges as the site for the first Australian analogue facility. The facility will be an invaluable public education and outreach tool for Australian science, focusing on astrobiology, and its role in future human Mars missions; demonstrating Australian contributions to astrobiology related science and work on terrestrial analogues to Martian environments.
Email your librarian or administrator to recommend adding this to your organisation's collection.