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Right ventricular outflow tract intervention spans transcatheter, surgical, or hybrid pulmonary valve replacement methodologies. Standardised pre-procedure workup includes cardiac MRI to identify an intended valve site (landing zone). Our institutional practice includes measurement of the right ventricular outflow tract perimeter (circumference) of this site in end-systole. Our primary aim was to compare patients by their perimeter values to the palliative interventions performed (transcatheter versus surgical/hybrid methodologies).
Retrospective review of patients undergoing pulmonary valve replacement from January 2017 to 2021. We performed perimeter measurements at the intended valve site on advanced imaging; the outcomes of interventions were outlined via descriptive and statistical analyses.
A total of 37 patients underwent pulmonary valve replacement that met study criteria – 21 transcatheter, 7 surgical, and 9 hybrid. Median age at intervention was 26 years (range 8–70). The mean end-systolic perimeter of the transcatheter cohort was 88.9 ± 8.7 mm and in the surgical/hybrid cohort measured 106.6 ± 7.5 mm. For the transcatheter cohort, the median “circularised” diameter derived from the perimeter measurement (divided by π) was 27.7 mm (range 24.3–32.4). Notably, this correlated (r = 0.93, p < 0.01) with the median diameter of the narrowest region during actual transcatheter right ventricular outflow tract balloon sizing (lateral imaging) of 27.1 mm (range 23.2–30.1).
Right ventricular outflow tract perimeter measurement to determine circularised diameter is useful in planning pulmonary valve replacement in terms of candidacy of transcatheter versus the need for a surgical/hybrid approach. The circularised diameter correlates with transcatheter right ventricular outflow tract balloon sizing.
Reacting sharply against the whiggish thesis that religious tolerance was a heritage of the Enlightenment, revisionist scholars have pointed to the many pragmatic concessions people made to tolerate those of other faiths prior to the eighteenth century. While they have underscored the contingent relationship of tolerance with neighbourliness in many important case studies, the historiography portrays early modern London as an essentially intolerant society for the city’s Catholics and a church on the margins. Through an examination of London’s embassy chapels reflected in vicious anti-Catholic polemic, this article argues that tolerance was not lacking in Jacobean London. It additionally shows how ambassadors’ chapels sustained a vibrant and visible form of Counter-Reformation Catholicism in the capital. Finally, it assesses how contemporaries connected both of these issues to tensions surrounding the ‘king’s two bodies’ and the execution of the royal prerogative. While this places London’s Catholics at the heart and centre of Jacobean religio-political tensions, the article concludes that it is ultimately the circular relationship between tolerance and intolerance that is key to understanding why a contested form of corporate Catholicism survived in the very heart of England’s Protestant kingdom.
Colleges and universities around the world engaged diverse strategies during the COVID-19 pandemic. Baylor University, a community of ˜22,700 individuals, was 1 of the institutions which resumed and sustained operations. The key strategy was establishment of multidisciplinary teams to develop mitigation strategies and priority areas for action. This population-based team approach along with implementation of a “Swiss Cheese” risk mitigation model allowed small clusters to be rapidly addressed through testing, surveillance, tracing, isolation, and quarantine. These efforts were supported by health protocols including face coverings, social distancing, and compliance monitoring. As a result, activities were sustained from August 1 to December 8, 2020. There were 62,970 COVID-19 tests conducted with 1435 people testing positive for a positivity rate of 2.28%. A total of 1670 COVID-19 cases were identified with 235 self-reports. The mean number of tests per week was 3500 with approximately 80 of these positive (11/d). More than 60 student tracers were trained with over 120 personnel available to contact trace, at a ratio of 1 per 400 university members. The successes and lessons learned provide a framework and pathway for similar institutions to mitigate the ongoing impacts of COVID-19 and sustain operations during a global pandemic.
UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential.
Describe the development, implementation and results of this questionnaire.
An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use.
A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45–82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Non-invasive prenatal testing (NIPT) for the detection of foetal aneuploidy through analysis of cell-free DNA (cfDNA) in maternal blood is offered routinely by many healthcare providers across the developed world. This testing has recently been recommended for evaluative implementation in the UK National Health Service (NHS) foetal anomaly screening pathway as a contingent screen following an increased risk of trisomy 21, 18 or 13. In preparation for delivering a national service, we have implemented cfDNA-based NIPT in our Regional Genetics Laboratory. Here, we describe our validation and verification processes and initial experiences of the technology prior to rollout of a national screening service.
Data are presented from more than 1000 patients (215 retrospective and 840 prospective) from ‘high- and low-risk pregnancies’ with outcome data following birth or confirmatory invasive prenatal sampling. NIPT was by the Illumina Verifi® test.
Our data confirm a high-fidelity service with a failure rate of ~0.24% and a high sensitivity and specificity for the detection of foetal trisomy 13, 18 and 21. Secondly, the data show that a significant proportion of patients continue their pregnancies without prenatal invasive testing or intervention after receiving a high-risk cfDNA-based result. A total of 46.5% of patients referred to date were referred for reasons other than high screen risk. Ten percent (76/840 clinical service referrals) of patients were referred with ultrasonographic finding of a foetal structural anomaly, and data analysis indicates high- and low-risk scan indications for NIPT.
NIPT can be successfully implemented into NHS regional genetics laboratories to provide high-quality services. NHS provision of NIPT in patients with high-risk screen results will allow for a reduction of invasive testing and partially improve equality of access to cfDNA-based NIPT in the pregnant population. Patients at low risk for a classic trisomy or with other clinical indications are likely to continue to access cfDNA-based NIPT as a private test.
The East Kunlun Orogen (EKO) is the NW part of the Central China Orogenic Belt, which records the evolutionary history of the Proto- and Palaeo-Tethys Oceans from the Cambrian to the Triassic. An Early Palaeozoic eclogite belt has been recognized in recent years, which extends discontinuously for ∼500 km as three eclogite-bearing terranes. In this study, we report an integrated study of zircon grains from mica-schists accompanying the eclogites, in terms of mineral inclusions, U–Pb age systematics and P–T conditions. The presence of coesite is identified, as inclusions within the metamorphic domain of zircons, which provides unambiguous evidence for subducted terrigenous clastic rocks of the Proto-Tethys Ocean exhumed from coesite-forming depths. U–Pb dating of the metamorphic zircons yields a concordia age of 426.5 ± 0.88 Ma, which is likely to be the time of ultrahigh-pressure metamorphism in the Kehete terrane. P–T calculations suggest that metapelite may have experienced a clockwise P–T path with peak P/T conditions of 685 ± 41 °C and >28 kbar, and equilibrated at 482–566 °C and 5.6–8.9 kbar during subsequent exhumation. The high-pressure – ultrahigh-pressure (HP-UHP) metamorphic belt within the EKO may have formed by collision between the Qaidam Block and the South Kunlun Block, as a consequence of the closure of the Proto-Tethys Ocean.
AGB stars play a major role in the chemical evolution of the galaxies. It thus is important to establish reliable photometric selection criteria to count them, especially AGB stars at the last stages of AGB evolution like OH/IR stars. Here, we have identified about 1500 OH/IR stars and 500 YSOs with methanol masers, in all major mid– and far–infrared surveys (IRAS, MSX, AKARI, WISE, GLIMPSE, and Hi–Gal). We show that AGB stars with high mass-loss rates cannot be disentagled from YSOs with only mid–infrared photometry; far–infrared photometry is essential. In the region observed by GLIMPSE, we show that the proportion of AGB stars has been severely underestimated in previous works: about 70% of “intrinsically” red objects in GLIMPSE are AGB stars rather than YSOs.
The powder-bed laser additive manufacturing (AM) process is widely used in the fabrication of three-dimensional metallic parts with intricate structures, where kinetically controlled diffusion and microstructure ripening can be hindered by fast melting and rapid solidification. Therefore, the microstructure and physical properties of parts made by this process will be significantly different from their counterparts produced by conventional methods. This work investigates the microstructure evolution for an AM fabricated AlSi10Mg part from its nonequilibrium state toward equilibrium state. Special attention is placed on silicon dissolution, precipitate formation, collapsing of a divorced eutectic cellular structure, and microstructure ripening in the thermal annealing process. These events alter the size, morphology, length scale, and distribution of the beta silicon phase in the primary aluminum, and changes associated with elastic properties and microhardness are reported. The relationship between residual stress and silicon dissolution due to changes in lattice spacing is also investigated and discussed.
To determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children.
Individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors.
We searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality.
Probiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25–0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23–0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11–4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is ≥5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89–1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89–1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness.
Moderate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is ≥5%.
UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors.
An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders.
An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders.
157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation.
The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
Declaration of interest
G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
Guest Editors Olivier Lacombe, Jonas Ruh, Dennis Brown and Faramarz Nilforoushan are to be congratulated for their efforts in putting together this exciting and comprehensive special issue on basement-involved fold-and-thrust belts. On behalf of Geological Magazine, I also thank the numerous authors and reviewers, whose efforts have made the special issue possible.
We present an overview of the survey for radio emission from active stars that has been in progress for the last six years using the observatories at Fleurs, Molonglo, Parkes and Tidbinbilla. The role of complementary optical observations at the Anglo-Australian Observatory, Mount Burnett, Mount Stromlo and Siding Spring Observatories and Mount Tamborine are also outlined. We describe the different types of star that have been included in our survey and discuss some of the problems in making the radio observations.
Imago Dei is the Christian theological view that all people are made in the image and likeness of God and thus have surpassing equal worth and dignity. It gained prominence in the late Roman Empire when Christianity began to offer a broad critique of common practices that we now see as unjust, cruel, or exploitative – such as slavery, sexual coercion, and indifference to the poor. It was in these arenas that the gulf between Christian dignity and societal practices seemed most glaring. In his chapter on the Christian responses to this gulf in late antiquity (Volume 1), Kyle Harper documents how the idea of universal dignity provided the underpinning and fulcrum for the later development of human rights in the modern era. In other words, he shows how the liberal revolutions of the eighteenth century proclaiming the “universal rights of man” are inconceivable without the concept of all humans as beings of incomparable worth and value, made in the image and likeness of God. To be sure, Christian-influenced societies fall short of this ideal, sometimes egregiously so. But as Harper and other contributors to these volumes show, Christianity carries deep in its DNA this radical notion of universal dignity, which serves as a challenge or rebuke to societal conditions and practices of the age.
What we find stunning is the resonance between the concerns raised by Christians in the ancient world and those expressed through global Christian networks in the twenty-first century. Today we see campaigns against human trafficking, sexual coercion, slavery, poverty, illiteracy, religious persecution, exploitation, violence, and war – echoing and expanding on the early social witness of Christians in the ancient world. But today these are global campaigns fueled by the resources of transnational Christian networks. The momentous globalization of Christianity marries the idea of dignity with the striking capacities of transnational Christian networks of communication, solidarity, and assistance. This chapter focuses on the global impact of the Christian ethic by examining some of its most important contemporary initiatives. We will see how the Christian DNA reaches across the globe, magnified by considerable resources and unparalleled transnational linkages.
FRAMEWORK FOR UNDERSTANDING THE ROLE OF GLOBAL CHRISTIAN NETWORKS
One of the driving factors in the emergence and clout of international Christian networks has been the tectonic shift of the Christian population to the developing nations of the Global South.