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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.
Methods:
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.
Results:
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.
Conclusion:
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.
We examine the Holocene loess record in the Heye Catchment on the margins of the Tibetan Plateau (TP) and China Loess Plateau (CLP) to determine: the region to which the Heye Catchment climate is more similar; temporal change in wind strength; and modification of the loess record by mass wasting and human activity. Luminescence and radiocarbon dating demonstrate loess deposited in two periods: >11–8.6 ka and <5.1 ka. The 8.6–5.1 ka depositional hiatus, which coincides with the Mid-Holocene Climatic Optimum, is more similar to the loess deposition cessation in the TP than to the loess deposition deceleration in the CLP. Grain-size analysis suggests the Heye loess is a mixture of at least three different grain-size distributions and that it may derive from multiple sources. A greater proportion of coarse sediments in the older loess may indicate stronger winds compared with the more recent depositional period. Gravel incorporated into younger loess most likely comes from bedrock exposed in slump scarps. Human occupation of the catchment, for which the earliest evidence is 3.4 ka, postdates the onset of slumping; thus the slumps may have created a livable environment for humans.
The skin functions as a critical external barrier and serves a vital role in protecting against pathogens but also in thermoregulation, management of fluids and electrolytes, and protection from trauma. Small size burns cause relatively minor sequelae while larger burns can trigger a massive inflammatory response, secondary organ dysfunction, and result in death. The depth and extent of a burn will determine the severity of the response to this trauma.
Apolipoprotein E (APOE) E4 is the main genetic risk factor for Alzheimer’s disease (AD). Due to the consistent association, there is interest as to whether E4 influences the risk of other neurodegenerative diseases. Further, there is a constant search for other genetic biomarkers contributing to these phenotypes, such as microtubule-associated protein tau (MAPT) haplotypes. Here, participants from the Ontario Neurodegenerative Disease Research Initiative were genotyped to investigate whether the APOE E4 allele or MAPT H1 haplotype are associated with five neurodegenerative diseases: (1) AD and mild cognitive impairment (MCI), (2) amyotrophic lateral sclerosis, (3) frontotemporal dementia (FTD), (4) Parkinson’s disease, and (5) vascular cognitive impairment.
Methods:
Genotypes were defined for their respective APOE allele and MAPT haplotype calls for each participant, and logistic regression analyses were performed to identify the associations with the presentations of neurodegenerative diseases.
Results:
Our work confirmed the association of the E4 allele with a dose-dependent increased presentation of AD, and an association between the E4 allele alone and MCI; however, the other four diseases were not associated with E4. Further, the APOE E2 allele was associated with decreased presentation of both AD and MCI. No associations were identified between MAPT haplotype and the neurodegenerative disease cohorts; but following subtyping of the FTD cohort, the H1 haplotype was significantly associated with progressive supranuclear palsy.
Conclusion:
This is the first study to concurrently analyze the association of APOE isoforms and MAPT haplotypes with five neurodegenerative diseases using consistent enrollment criteria and broad phenotypic analysis.
The effect of animal characteristics and placement decisions on retained ownership profitability of Tennessee cattle from 2005 to 2015 was determined using a mixed model regression. Ex post simulation analysis examined retained ownership profitability by placement season under different animal characteristic and corn price scenarios. Regression results indicate that placement weight, placement season, days on feed, animal health, and animal sex affect retained ownership profitability. Simulation results indicate that winter placement of cattle in feedlots had the highest expected retained ownership profits. Results provide risk-averse producers information regarding the profitability of retained ownership.
Chronic ICV administration of NGF stimulates the activity of the cholinergic neuronal markers, HACU and ChAT, as well as the evoked release of both endogenous and newly synthesized acetylcholine in the brain of aging Fischer 344 male rats. However, the pattern of cholinergic phenotype stimulation indicates an age-related differential regulation of ChAT, HACU, and ACh release between specific brain areas, with the largest.effects found in the striatum. NGF treatment also increases the effectiveness of neurotransmission between basal forebrain cholinergic neurons and postsynaptic amygdaloid target neurons. The stimulation of central cholinergic transmitter function after NGF treatment affects behavior in a Y-maze brightness discrimination paradigm. NGF treatment does not affect the cognitive measure of brightness discrimination, but reduces the number of avoidance attempts, a measure of motor function.
This chapter describes various imaging modalities and safety concerns associated with a person when used during pregnancy or in the immediate postpartum period. The radiation effects to the fetus are categorized into deterministic and stochastic effects. Plain radiography and fluoroscopy, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine scan are the most commonly used imaging modalities during pregnancy. Following intravenous administration, very low level of iodinated or gadolinium-based contrast agents is excreted in breast milk and ingested by the infant. The advantages of the nuclear medicine scan are lower radiation dose to the maternal breast and the avoidance of intravenous iodinated contrast. Trauma is a major cause of maternal and fetal mortality, and imaging choices in this setting should be prioritized for fast and accurate diagnosis. CT evaluation is strongly recommended in patients with an acute abdomen who suffered abdominal trauma.
The objective of this study was to determine the prevalence of Staphylococcus-contaminated stethoscopes belonging to emergency department (ED) staff and to identify the proportion of these that were Staphylococcus aureus or methicillin-resistant Staphylococcus aureus (MRSA).
Methods:
We conducted a prospective observational cohort study of bacterial cultures from 100 ED staff members' stethoscopes at three EDs. Study participants were asked to complete a questionnaire.
Results:
Fifty-four specimens grew coagulase-negative staphylococci and one grew methicillin-susceptible S. aureus. No MRSA was cultured. Only 8% of participants, all of whom were nurses, reported cleaning their stethoscope before or after each patient assessment. Alcohol-based wipes were most commonly used to clean stethoscopes. A lack of time, being too busy, and forgetfulness were the most frequently reported reasons for not cleaning the stethoscope in the ED.
Conclusions:
This study indicates that although stethoscope contamination rates in these EDs are high, the prevalence of S. aureus or MRSA on stethoscopes is low.
The cognitive profile of early onset Parkinson’s disease (EOPD) has not been clearly defined. Mutations in the parkin gene are the most common genetic risk factor for EOPD and may offer information about the neuropsychological pattern of performance in both symptomatic and asymptomatic mutation carriers. EOPD probands and their first-degree relatives who did not have Parkinson’s disease (PD) were genotyped for mutations in the parkin gene and administered a comprehensive neuropsychological battery. Performance was compared between EOPD probands with (N = 43) and without (N = 52) parkin mutations. The same neuropsychological battery was administered to 217 first-degree relatives to assess neuropsychological function in individuals who carry parkin mutations but do not have PD. No significant differences in neuropsychological test performance were found between parkin carrier and noncarrier probands. Performance also did not differ between EOPD noncarriers and carrier subgroups (i.e., heterozygotes, compound heterozygotes/homozygotes). Similarly, no differences were found among unaffected family members across genotypes. Mean neuropsychological test performance was within normal range in all probands and relatives. Carriers of parkin mutations, whether or not they have PD, do not perform differently on neuropsychological measures as compared to noncarriers. The cognitive functioning of parkin carriers over time warrants further study. (JINS, 2011, 17, 1–10)
We present the results of a systematic benchmarking study, using 45nm-groundrule structures, of a commercially-available ionized PVD Cu technology which employs an in-situ Ar+ radio-frequency (Rf) plasma capability for enhanced coverage, and compare its performance and extendibility against the same seedlayer process operated in conventional low-pressure mode. Studies of single-damascene lines and dual-damascene via structures indicate that the PVD Cu seedlayer with Rf-Plasma enhancement enables a reduction of the PVD Cu seed thickness on the order of 35%, based on studies of Cu voiding, via-yield degradation, and transmission-electron microscopy (TEM). These results illustrate the critical importance of the Rf-plasma resputter capability in extending the PVD Cu process to advanced groundrules at 45nm and beyond.
Silicon germanium pMOSFETs with channel lengths down to 0.4m have been fabricated on limited area silicon germanium virtual substrates. The devices have a 5nm thick Si0.3Ge0.7 active layer grown by MBE on top of relaxed Si0.7Ge0.3 virtual substrate. Virtual substrates were grown on top of 10μm square silicon pillars defined by etching trenches around their perimeter into the original silicon substrate. This limits the area of the growth zone, which in turn promotes the relaxation of the virtual substrate. Electrical measurements on 2μm long channel devices show that the maximum mobility in the strained SiGe devices is 211cm2V-1cm-1, compared to 104cm2V-1cm-1 for silicon reference devices. This increase in hole mobility increases the current drive of 0.4m devices measured at Vgt=-2V, Vds=-2.5V from 154μA/m to 192μA/μm.