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The cardiovascular adaptations associated with structured exercise training in Fontan patients remain unknown. We hypothesised that short-term training causes cardiac remodelling and parallel improvement in maximal exercise capacity (VO2 max) in these patients.
Methods and Results:
Five patients, median age 19.5 (17.6–21.3) years, with a history of Fontan operation meeting inclusion/exclusion criteria, participated in a 3-month training programme designed to improve endurance. Magnetic resonance images for assessment of cardiac function, fibrosis, cardiac output, and liver elastography to assess stiffness were obtained at baseline and after training. Maximal exercise capacity (VO2 max) and cardiac output Qc (effective pulmonary blood flow) at rest and during exercise were measured (C2H2 rebreathing) at the same interval. VO2 max increased from median (IQR) 27.2 (26–28.7) to 29.6 (28.5–32.2) ml/min/kg (p = 0.04). There was an improvement in cardiac output (Qc) during maximal exercise testing from median (IQR) 10.3 (10.1–12.3) to 12.3 (10.9–14.9) l/min, but this change was variable (p = 0.14). Improvement in VO2 max correlated with an increase in ventricular mass (r = 0.95, p = 0.01), and improvement in Quality-of-life inventory (PedsQL) Cardiac scale scores for patient-reported symptoms (r = 0.90, p = 0.03) and cognitive problems (r = 0.89, p = 0.04). The correlation between VO2 max and Qc showed a positive trend but was not significant (r = 0.8, p = 0.08). No adverse cardiac or liver adaptations were noted.
Short-term training improved exercise capacity in this Fontan pilot without any adverse cardiac or liver adaptations. These results warrant further study in a larger population and over a longer duration of time.
The Residual Lesion Score is a novel tool for assessing the achievement of surgical objectives in congenital heart surgery based on widely available clinical and echocardiographic characteristics. This article describes the methodology used to develop the Residual Lesion Score from the previously developed Technical Performance Score for five common congenital cardiac procedures using the RAND Delphi methodology.
A panel of 11 experts from the field of paediatric and congenital cardiology and cardiac surgery, 2 co-chairs, and a consultant were assembled to review and comment on validity and feasibility of measuring the sub-components of intraoperative and discharge Residual Lesion Score for five congenital cardiac procedures. In the first email round, the panel reviewed and commented on the Residual Lesion Score and provided validity and feasibility scores for sub-components of each of the five procedures. In the second in-person round, email comments and scores were reviewed and the Residual Lesion Score revised. The modified Residual Lesion Score was scored independently by each panellist for validity and feasibility and used to develop the “final” Residual Lesion Score.
The Residual Lesion Score sub-components with a median validity score of ≥7 and median feasibility score of ≥4 that were scored without disagreement and with low absolute deviation from the median were included in the “final” Residual Lesion Score.
Using the RAND Delphi methodology, we were able to develop Residual Lesion Score modules for five important congenital cardiac procedures for the Pediatric Heart Network’s Residual Lesion Score study.
Chemical weed control remains a widely used component of integrated weed management strategies because of its cost-effectiveness and rapid removal of crop pests. Additionally, dicamba-plus-glyphosate mixtures are a commonly recommended herbicide combination to combat herbicide resistance, specifically in recently commercially released dicamba-tolerant soybean and cotton. However, increased spray drift concerns and antagonistic interactions require that the application process be optimized to maximize biological efficacy while minimizing environmental contamination potential. Field research was conducted in 2016, 2017, and 2018 across three locations (Mississippi, Nebraska, and North Dakota) for a total of six site-years. The objectives were to characterize the efficacy of a range of droplet sizes [150 µm (Fine) to 900 µm (Ultra Coarse)] using a dicamba-plus-glyphosate mixture and to create novel weed management recommendations utilizing pulse-width modulation (PWM) sprayer technology. Results across pooled site-years indicated that a droplet size of 395 µm (Coarse) maximized weed mortality from a dicamba-plus-glyphosate mixture at 94 L ha–1. However, droplet size could be increased to 620 µm (Extremely Coarse) to maintain 90% of the maximum weed mortality while further mitigating particle drift potential. Although generalized droplet size recommendations could be created across site-years, optimum droplet sizes within each site-year varied considerably and may be dependent on weed species, geographic location, weather conditions, and herbicide resistance(s) present in the field. The precise, site-specific application of a dicamba-plus-glyphosate mixture using the results of this research will allow applicators to more effectively utilize PWM sprayers, reduce particle drift potential, maintain biological efficacy, and reduce the selection pressure for the evolution of herbicide-resistant weeds.
The crop-weed interference relationship is a critical component of bioeconomic weed management models. Multi-year field experiments were conducted at five locations to determine the stability of corn-velvetleaf interference relationships across years and locations. Two coefficients (I and A) of a hyperbolic equation were estimated for each data set using nonlinear regression procedures. The I and A coefficients represent percent corn yield loss as velvetleaf density approaches zero, and maximum percent corn yield loss, respectively. The coefficient I was stable across years at two locations, but varied across years at one location. The coefficient A did not vary across years within locations. Both coefficients, however, varied among locations. Results do not support the use of common coefficient estimates for all locations within a region.
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
Over the past century, the Santa Cruz Formation of coastal Argentina (late Early
Miocene) has yielded a remarkable collection of platyrrhine primates. With few
notable exceptions, most of the specimens have been included in Homunculus patagonicus Ameghino, 1891, a stem
platyrrhine. Homunculus patagonicus was
approximately 1.5 to 2.5 kg in body mass, about the size of a living saki monkey
(Pithecia) or a female Cebus. Molar structure indicates that the diet
consisted of a mixture of fruit and leaves. A deep jaw, large postcanine tooth
roots, large postglenoid processes and moderately large chewing muscle
attachments (i.e. massive zygomatic arches, sculpted temporalis origins) suggest
that physically resistant foods were key components of the diet. Heavy tooth
wear suggests large amounts of ingested silica or exogenous abrasives. Incisor
morphology suggests that exudate harvesting may have been part of the behavioral
repertoire, although not a specialization. The canines were small, providing no
evidence of sclerocarpic foraging. Canines were sexually dimorphic, suggesting
that the taxon experienced some intrasexual competition rather than being
solitary or pair-bonded. Brain size was small and the frontal cortical region
was proportionately small. From the small size and structure of the orbits, the
structure of the organ of hearing, the reduced olfactory fossae and the
relatively large infraorbital foramina, we infer that Homunculus was probably diurnal, with acute vision and hearing,
but with a poor sense of smell and little reliance on tactile vibrissae.
Homunculus was an above-branch arboreal
quadruped with leaping abilities. The semicircular canals show evidence of
considerable agility, reinforcing the inference of leaping behavior. The overall
locomotor repertoire is not unlike that of the forest-dwelling extant saki
monkey Pithecia. Considered together, the
mosaic of dietary and locomotor morphology in Homunculus suggests that Homunculus inhabited an environment – as compared with
earlier Colhuehuapian and Pinturan primate habitats – shifting towards
greater seasonality in patchy forests near river courses.
Organic light-emitting devices (OLEDs) emitting near-infrared (NIR) light have many potential applications, yet the efficiency of these devices remains very low, typically ˜0.1% or less. Here we report efficiency NIR OLEDs based on two fluorescent donor-acceptor-donor oligomers and a phosphorescent Pt-containing organometallic complex. External quantum efficiencies in the range of 0.5–3.8% with emission peak ranging from 700 to 890 nm have been achieved.
A central paradox of the modern American presidency is that citizens regularly call for strong presidential leadership while at the same time their political culture predisposes them to be reluctant followers.1 One of the ways contemporary presidents resolve this paradox is by invoking an electoral mandate. By persuading others that he possesses a mandate from the voters to pursue a particular policy agenda, a president can disguise his leadership under the pretense of simply carrying out “the will of the people.” The presidential mandate thus enables presidents to lead while seeming to follow, to exercise power over people under the guise of empowering the people.
At the 2003 Sydney IAU meeting, Marion Schmitz (Caltech, USA) took over the chair of the Commission 5 Working Group Designations, succeeding Helene Dickel. The Working Group Designations of IAU Commission 5 clarifies existing astronomical nomenclature and helps astronomers avoid potential problems when designating their sources. The most important function of WG Designations during the period 2003-2005 was overseeing the IAU REGISTRY FOR ACRONYMS (for newly discovered astronomical sources of radiation: see the website <http://cdsweb.u-strasbg.fr/cgi-bin/DicForm>) which is sponsored by the WG and operated by the Centre de Données de Strasbourg (CDS). The Clearing House, a subgroup of the WG, screens the submissions for accuracy and conformity to the IAU Recommendations for Nomenclature (<http://cdsweb.u-strasbg.fr/iau-spec.html>). From its beginning in 1997 through August 2006, there have been 132 submissions and 111 acceptances. Attempts to register asterisms, common star names, and suspected variable stars were rejected. The past three years saw 61 acronyms submitted with 50 of them being accepted. (GIRL - yes; WOMEN - no).
It is not clear if the frequency of deliberate self-harm (DSH) is the same in patients taking different pharmacological classes of antidepressant drugs.
To compare the frequency of DSH in patients who had been prescribed a tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI) prior to the DSH event.
This was a prospective study in 2776 consecutive DSH cases attending an accident and emergency department. The incidence of DSH in TCA-treated cases and SSRI-treated cases is expressed as number of DSH events per 10 000 prescriptions of each antidepressant.
Significantly more DSH events occurred following the prescription of an SSRI than that of a TCA (P < 0.001). The occurrence of DSH was highest with fluoxetine and lowest with amitriptyline.
Merely prescribing safer-in-overdose antidepressants is unlikely to reduce the overall morbidity from DSH.
The challenge of composing both sound and moving image within a coherent
computer-mediated framework is addressed, and some of the aesthetic issues
highlighted. A conceptual model for an audiovisual delivery system is
proposed, and this model acts as a guide for detailed discussion of some
illustrative examples of audiovisual composition. Options for types of score
generated as graphical output of the system are outlined. The need for
extensive algorithmic control of compositional decisions within an
interactive framework is proposed. The combination of Tabula Vigilans Audio
Interactive (TVAI), an algorithmic composition language for electroacoustic
music and realtime image generation, with MIDAS, a multiprocessor
audiovisual system platform, is shown to have the features desired for the
conceptual outline given earlier, and examples are
given of work achieved using these resources. It is shown that ultimately
delivery of new work may be efficiently distributed via the World Wide Web,
with composers' interactive scripts delivered remotely but rendered
locally by means of a user's ‘rendering black box’.