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Mortality between stages 1 and 2 single-ventricle palliation is significant. Home-monitoring programmes are suggested to reduce mortality. Outcomes and risk factors for adverse outcomes for European programmes have not been published.
Aims:
To evaluate the performance of a home-monitoring programme at a medium-sized United Kingdom centre with regards survival and compare performance with other home-monitoring programmes in the literature.
Methods:
All fetal and postnatal diagnosis of a single ventricle were investigated with in-depth analysis of those undergoing stage 1 palliation and entered the home-monitoring programme between 2016 and 2020. The primary outcome was survival. Secondary outcomes included multiple parameters as potential predictors of death or adverse outcome.
Results:
Of 217 fetal single-ventricle diagnoses during the period 2016–2020, 50.2% progressed to live birth, 35.4% to stage 1 and 29.5% to stage 2. Seventy-four patients (including 10 with postnatal diagnosis) entered the home-monitoring programme with six deaths making home-monitoring programme mortality 8.1%. Risk factors for death were the hybrid procedure as the only primary procedure (OR 33.0, p < 0.01), impaired cardiac function (OR 10.3, p < 0.025), Asian ethnicity (OR 9.3, p < 0.025), lower mean birth-weight (2.69 kg versus 3.31 kg, p < 0.01), and lower mean weight centiles during interstage follow-up (mean centiles of 3.1 versus 10.8, p < 0.01)
Conclusion:
Survival in the home-monitoring programme is comparable with other home-monitoring programmes in the literature. Hybrid procedure, cardiac dysfunction, sub-optimal weight gain, and Asian ethnicity were significant risk factors for death. Home-monitoring programmes should continue to raise awareness of these factors and seek solutions to mitigate adverse events. Future work to generalise home-monitoring programme and single-ventricle fetus to stage 2 outcomes in the United Kingdom will require multi-centre collaboration.
Schistosoma mansoni is the main causative agent of intestinal schistosomiasis which affects millions of people worldwide. At the larval stage, miracidia are released into bodies of water where they utilize their motility to successfully infect their intermediate host, snails. Here, we revisit the motility and survival of S. mansoni miracidia throughout its life span. Briefly, miracidia motility was monitored at 30-min and 60-min intervals under the presence/absence of natural/artificial light. Based on a subjective evaluation of activity, body shape and transparency, 6 categories of miracidia activity were established from its fully active stage to its immobile larva stage. The estimated life span of miracidia was 5.8 and 3.5 h in the experiments with 60-min and 30-min observation intervals, respectively. Death was defined by an absence of cilia and body movement. When mobility was used as a proxy for infectivity, infective miracidia were detected at 2.5 and 4.5 h, respectively. The present miracidia motility and survival re-evaluation supports parameters optimization for computational modelling of schistosomiasis transmission dynamics. Target control interventions, especially at late stages next to transmission interruption, may greatly benefit from improved modelling studies.
The Pleistocene history of the leopard (Panthera pardus) in Europe has been documented by the material obtained from 312 localities, with the last dated ∼1.1 Myr. The relatively small and gracile form of the leopard was very rare during the late Early and Middle Pleistocene. Only after the disappearance of the jaguar (Panthera gombaszoegensis) did P. pardus spread widely in Europe, increasing in size and ecologically substituting P. gombaszoegensis. The number of late Middle Pleistocene localities with leopard remains, younger than 300 kyr, increased considerably. The leopard reached the maximum extension of its geographical range in the Late Pleistocene. The Iberian Peninsula was the last European refuge for this cat. Six sites, the Naciekowa, Obok Wschodniej, Radochowska, and Wschodnia Caves from the Sudety Mountains and the Biśnik and Dziadowa Skała Caves from the Kraków-Częstochowa Upland, have documented the presence of the leopard in Poland between MIS 10/9 and MIS 3. These records are from rocky regions with rugged terrain and are located in the territory of Silesia (southern Poland). A newly obtained radiocarbon date (43–42 kyr) from the Radochowska Cave directly confirms the occurrence of P. pardus in the Sudety Mountains in the middle part of MIS 3.
Mars analogue environments are some of the most extreme locations on Earth. Their unique combination of multiples extremes (e.g. high salinity, anoxia and low nutrient availability) make them valuable sources for finding new polyextremophilic microbes, and for exploring the limits of life. Mars, especially at its surface, is still considered to be very hostile to life but it probably possesses geological subsurface niches where the occurrence of (polyextremophilic) life is conceivable. Despite their well-recognized relevance, current knowledge on the capability of (facultative) anaerobic microbes to withstand extraterrestrial/Martian conditions, either as single strains or in communities, is still very sparse. Therefore, space experiments simulating the Martian environmental conditions by using space as a tool for astrobiological research are needed to substantiate the hypotheses of habitability of Mars. Addressing this knowledge gap is one of the main goals of the project MEXEM (Mars EXposed Extremophiles Mixture), where selected model organisms will be subjected to space for a period of 3 months. These experiments will take place on the Exobiology facility (currently under development and implementation), located outside the International Space Station. Such space experiments require a series of preliminary tests and ground data collection for the selected microbial strains. Here, we report on the survivability of Salinisphaera shabanensis and Buttiauxella sp. MASE-IM-9 after exposure to Mars-relevant stress factors (such as desiccation and ultraviolet (UV) radiation under anoxia). Both organisms showed survival after anoxic desiccation for up to 3 months but this could be further extended (nearly doubled) by adding artificial Mars regolith (MGS-1S; 0.5% wt/v) and sucrose (0.1 M). Survival after desiccation was also observed when both organisms were mixed before treatment. Mixing also positively influenced survival after exposure to polychromatic Mars-like UV radiation (200–400 nm) up to 12 kJ m−2, both in suspension and in a desiccated form.
Police transport (PT) of penetrating trauma patients has the potential to improve survival rates. There are no well-established guidelines for PT of penetrating trauma patients.
Study Objective:
This study examines the association between survival rate to hospital discharge of adult penetrating trauma patients and mode of transport (PT versus ground ambulance [GA]).
Methods:
A retrospective, matched cohort study was conducted using the United States (US) National Trauma Data Bank (NTDB). All adult penetrating injury patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by GA for analysis. Descriptive analysis was carried out. The patients’ demographic and clinical characteristics were tabulated and stratified by the transport mode.
Results:
Out of the 733 patients with penetrating injuries, ground Emergency Medical Services (EMS) transported 513 patients and police transported 220 patients. Most patients were 16-64 years of age with a male (95.6%) and Black/African American race (79.0%) predominance. Firearm-related injuries (68.8%) were the most common mechanism of injury with the majority of injuries involving the body extremities (62.9%). Open wounds were the most common nature of injury (75.7%). The overall survival rate to hospital discharge was similar for patients transported by GA and by police (94.5% versus 92.7%; P = .343).
Conclusion:
In this study, patients with penetrating trauma transported by police had similar outcomes to those transported by GA. As such, PT in penetrating trauma appears to be effective. Detailed protocols should be developed to further improve resource utilization and outcomes.
This chapter provides final thoughts and key takeaways from the book. It reminds you of what you have learned throughout this book – the problems – as well as encourages you to remain hopeful by taking action – through each recipe. This chapter asks you to review your past choices and behaviors in light of everything you learned from reading this book, and have a plan of action to make a difference, starting today, because you absolutely can do it. I know you can.
Tamoxifen is commonly prescribed for preventing recurrence in patients with breast cancer. However, the responses of the patients on tamoxifen treatment are variable. Cytochrome P450 genetic variants have been reported to have a significant impact on the clinical outcomes of tamoxifen treatment but no tangible conclusion can be made up till now. The present review attempts to provide a comprehensive review on the associative relationship between genetic polymorphisms in cytochrome P450 enzymes and survival in breast cancer patients on adjuvant tamoxifen therapy. The literature search was conducted using five databases, resulting in the inclusion of 58 studies in the review. An appraisal of the reporting quality of the included studies was conducted using the assessment tool from the Effective Public Health Practice Project (EPHPP). Meta-analyses were performed on CYP2D6 studies using Review Manager 5.3 software. For other studies, descriptive analyses were performed. The results of meta-analyses demonstrated that shorter overall survival, disease-free survival and relapse-free survival were found in the patients with decreased metabolisers when compared to normal metabolisers. The findings also showed that varying and conflicting results were reported by the included studies. The possible explanations for the variable results are discussed in this review.
Many women who are deciding on fertility preservation (FP) are doing so at an advanced reproductive age, probably because this option has become available relatively recently, or due to the lack of awareness in young women about the depletion of the ovarian reserve and its effects on fertility. Recent studies show that age is the most powerful variable related to success after FP, which directly affects the number of oocytes vitrified, oocyte survival and cumulative live birth rate, with highest outcomes achieved by women aged ≤35y. Nonetheless, women in the ‘over 40’s’ can also succeed with their vitrified oocytes, although their probability of success is extremely low. An individualised treatment in older women, together with a comprehensive explanation of their situation to avoid creating false expectations, would be more advisable in order to set an age limit at 40 and deny the opportunity to these women. Likewise, women should be encouraged to decide on FP at young ages, when the chances are significantly higher.
The Afterword begins by reflecting on the form of ecological relation that has been sketched out in the preceding chapters through animating figures of species like the passenger pigeon, coral, or seaweed. These relations are based on a material and metaphorical transport from one to another that joins but also keeps apart. Taking up this conjunctive and disjunctive as a figure of partial relations, the afterword moves on to consider how this defines how things come to matter or mean to one another, whether at the close-reading scale of linguistic significance, at the scale of relations between the fields of literature and science, or at the scale of interspecies figuration. Ending with a reminder of contemporary anthropogenic environmental change, the book concludes by observing the tensions of romantic holism and partial ecology that continue to beset strategies for the survival of species like coral.
Following the collapse of the Ottoman Empire and the founding of the Republic in 1923 under the rule of Atatürk and his Republican People's Party, Turkey embarked on extensive social, economic, cultural and administrative modernization programs which would lay the foundations for modern day Turkey. The Power of the People shows that the ordinary people shaped the social and political change of Turkey as much as Atatürk's strong spurt of modernization. Adopting a broader conception of politics, focusing on daily interactions between the state and society and using untapped archival sources, Murat Metinsoy reveals how rural and urban people coped with the state policies, local oppression, exploitation, and adverse conditions wrought by the Great Depression through diverse everyday survival and resistance strategies. Showing how the people's daily practices and beliefs survived and outweighed the modernizing elite's projects, this book gives new insights into the social and historical origins of Turkey's backslide to conservative and Islamist politics, demonstrating that the making of modern Turkey was an outcome of intersection between the modernization and the people's responses to it.
Although we know more about the natural history of elephant seals than most other animals, some things remain a mystery. The first is that most seals die at sea; the exception is numerous young pups and some weanlings that die on the rookery. We know some causes of death at sea but much more needs to be done to solve this mystery. The second unknown is when and with whom do virgin females mate. When future researchers determine this, the next question is “How important is it?” We conclude that tracking individuals throughout their lives is vital for understanding how natural selection operates. It shows us how individuals maximize their reproductive success and that the two sexes do this in entirely different ways.
The editors present the topic, review the historiography, and outline the goals of the present volume, focusing on the high survival rates of cities and economic recovery.
Fenestration in the total cavopulmonary connection system may improve the outcome of patients with significant risk factors for Fontan haemodynamics. Our study aims to analyse the difference in long-term survival between non-fenestrated and fenestrated patients.
Methods:
All consecutive patients (n = 351) who underwent total cavopulmonary connection between 1992 and 2016 were identified. Six early deaths were excluded resulting in a group of 345 patients. Median (interquartile range,) length of follow-up was 14.4 (7.1–19.7) years. Freedom from the composite endpoint of death, total cavopulmonary connection take-down or indication for a heart transplant was analysed.
Results:
Fenestration was absent in 237 patients (68.7%, Group 1), was created and closed later in 79 patients (22.9%, Group 2), and remained open in 29 patients (8.4%, Group 3). Mean survival probability until composite endpoint was 97.1 and 92.9% at 10 and 20 years, respectively. Patients with patent fenestration had worse survival (p < 0.001) as compared to both the non-fenestrated and fenestration closure groups. Despite a similar outcome, exercise capacity was lower in Group 2 than 1 (p = 0.013). In 58 patients with interventional fenestration closure, Nakata index was lower at the time of closure than pre-operatively, and both the pressure in the circuit and oxygen saturation in the aorta increased significantly (p < 0.001).
Conclusions:
Patients with persisting risk factors preventing fenestration closure are at higher risk of reaching the composite endpoint. Patients after fenestration closure have the worse functional outcome; their survival is, however, not different from the non-fenestrated group.
The leopard Panthera pardus is in range-wide decline, and many populations are highly threatened. Prey depletion is a major cause of global carnivore declines, but the response of leopard survival and density to this threat is unclear: by reducing the density of a dominant competitor (the lion Panthera leo) prey depletion could create both costs and benefits for subordinate competitors. We used capture–recapture models fitted to data from a 7-year camera-trap study in Kafue National Park, Zambia, to obtain baseline estimates of leopard population density and sex-specific apparent survival rates. Kafue is affected by prey depletion, and densities of large herbivores preferred by lions have declined more than the densities of smaller herbivores preferred by leopards. Lion density is consequently low. Estimates of leopard density were comparable to ecosystems with more intensive protection and favourable prey densities. However, our study site is located in an area with good ecological conditions and high levels of protection relative to other portions of the ecosystem, so extrapolating our estimates across the Park or into adjacent Game Management Areas would not be valid. Our results show that leopard density and survival within north-central Kafue remain good despite prey depletion, perhaps because (1) prey depletion has had weaker effects on preferred leopard prey compared to larger prey preferred by lions, and (2) the density of dominant competitors is consequently low. Our results show that the effects of prey depletion can be more complex than uniform decline of all large carnivore species, and warrant further investigation.
No relevant studies have yet been conducted to explore which measurement can best predict the survival time of patients with cancer cachexia. This study aimed to identify an anthropometric measurement that could predict the 1-year survival of patients with cancer cachexia. We conducted a nested case–control study using data from a multicentre clinical investigation of cancer from 2013 to 2020. Cachexia was defined using the Fearon criteria. A total of 262 patients who survived less than 1 year and 262 patients who survived more than 1 year were included in this study. Six candidate variables were selected based on clinical experience and previous studies. Five variables, BMI, mid-arm circumference, mid-arm muscle circumference, calf circumference and triceps skin fold (TSF), were selected for inclusion in the multivariable model. In the conditional logistic regression analysis, TSF (P = 0·014) was identified as a significant independent protective factor. A similar result was observed in all patients with cancer cachexia (n 3084). In addition, a significantly stronger positive association between TSF and the 1-year survival of patients with cancer cachexia was observed in participants aged > 65 years (OR: 0·94; 95 % CI 0·89, 0·99) than in those aged ≤ 65 years (OR: 0·96; 95 % CI 0·93, 0·99; Pinteraction = 0·013) and in participants with no chronic disease (OR: 0·92; 95 % CI 0·87, 0·97) than in those with chronic disease (OR: 0·97; 95 % CI 0·94, 1·00; Pinteraction = 0·049). According to this study, TSF might be a good anthropometric measurement for predicting 1-year survival in patients with cancer cachexia.
The present study evaluated whether fat mass assessment using the triceps skinfold (TSF) thickness provides additional prognostic value to the Global Leadership Initiative on Malnutrition (GLIM) framework in patients with lung cancer (LC). We performed an observational cohort study including 2672 LC patients in China. Comprehensive demographic, disease and nutritional characteristics were collected. Malnutrition was retrospectively defined using the GLIM criteria, and optimal stratification was used to determine the best thresholds for the TSF. The associations of malnutrition and TSF categories with survival were estimated independently and jointly by calculating multivariable-adjusted hazard ratios (HR). Malnutrition was identified in 808 (30·2 %) patients, and the best TSF thresholds were 9·5 mm in men and 12 mm in women. Accordingly, 496 (18·6 %) patients were identified as having a low TSF. Patients with concurrent malnutrition and a low TSF had a 54 % (HR = 1·54, 95 % CI = 1·25, 1·88) greater death hazard compared with well-nourished individuals, which was also greater compared with malnourished patients with a normal TSF (HR = 1·23, 95 % CI = 1·06, 1·43) or malnourished patients without TSF assessment (HR = 1·31, 95 % CI = 1·14, 1·50). These associations were concentrated among those patients with adequate muscle mass (as indicated by the calf circumference). Additional fat mass assessment using the TSF enhances the prognostic value of the GLIM criteria. Using the population-derived thresholds for the TSF may provide significant prognostic value when used in combination with the GLIM criteria to guide strategies to optimise the long-term outcomes in patients with LC.
Several studies supported the usefulness of “the surprise question” in terms of 1-year mortality of patients. “The surprise question” requires a “Yes” or “No” answer to the question “Would I be surprised if this patient died in [specific time frame].” However, the 1-year time frame is often too long for advanced cancer patients seen by palliative care personnel. “The surprise question” with shorter time frames is needed for decision making. We examined the accuracy of “the surprise question” for 7-day, 21-day, and 42-day survival in hospitalized patients admitted to palliative care units (PCUs).
Method
This was a prospective multicenter cohort study of 130 adult patients with advanced cancer admitted to 7 hospital-based PCUs in South Korea. The accuracy of “the surprise question” was compared with that of the temporal question for clinician's prediction of survival.
Results
We analyzed 130 inpatients who died in PCUs during the study period. The median survival was 21.0 days. The sensitivity, specificity, and overall accuracy for the 7-day “the surprise question” were 46.7, 88.7, and 83.9%, respectively. The sensitivity, specificity, and overall accuracy for the 7-day temporal question were 6.7, 98.3, and 87.7%, respectively. The c-indices of the 7-day “the surprise question” and 7-day temporal question were 0.662 (95% CI: 0.539–0.785) and 0.521 (95% CI: 0.464–0.579), respectively. The c-indices of the 42-day “the surprise question” and 42-day temporal question were 0.554 (95% CI: 0.509–0.599) and 0.616 (95% CI: 0.569–0.663), respectively.
Significance of results
Surprisingly, “the surprise questions” and temporal questions had similar accuracies. The high specificities for the 7-day “the surprise question” and 7- and 21-day temporal question suggest they may be useful to rule in death if positive.
Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently.
Study Objective:
This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance).
Methods:
A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients’ characteristics and their survival rates in terms of the mode of transportation.
Results:
Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000).
Conclusion:
In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further.
This chapter considers the central place of dystopia in Atwood’s work since 2000 in its discussion of the MaddAddam trilogy, The Heart Goes Last, and The Testaments. The focus is on the contrasts between the trilogy with its epic dimensions of postapocalyptic speculation and the two later dystopias that return to the network of human relations in situations close to our contemporary world. Analysis of the trilogy traces its narrative arc across three volumes from global disaster to futuristic vision, while The Heart Goes Last is darkly comic social satire addressing anxieties around threats to human freedom in the age of corporate capitalism, high-tech surveillance, and biomedical experiments. In The Testaments Atwood reclaims her story in real time with its update of Gilead, focusing on patriarchal tyranny and women’s strategies of resistance, ending with a glimmer of hope. An emphasis on Atwood’s storytelling with its genre-crossing strategies establishes connections between these dystopias, identifying the distinctive Atwood idiom.
This chapter examines parapsychology – the study of anomalous experience. It first distinguishes between telepathy, clairvoyance, ESP, psychokinesis (PK) and psi. It examines experimental evidence for psi, focussing on methodological difficulties in finding evidence for it, as well as at experimenter effects. It looks in particular at experiments in the Ganzfeld state as evidence for psi, and discusses meta-analyses of these experiments. We also look at remote viewing. We then look at spontaneous cases, including poltergeists. The chapter also looks at correlates of psi, in trait and state experiments. The chapter concludes with a survey of survival, particularly at the evidence for reincarnation.