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Introduction Previous studies have shown an association between number of stroke admissions and outcomes. Small hospitals often support more remote areas and we studied national data to determine if an association exists between hospital remoteness and stroke care. Methods Data from the Irish National Audit of Stroke (INAS) on average stroke admissions, adjusted mortality for ischaemic stroke, thrombolysis rate and proportion with door to needle (DTN) ≤45 min were analysed. Hospital remoteness was quantified by distance to the next hospital, nearest neurointerventional centre and location within 10 km of the national motorway network. Results Data for 23 of 24 stroke services were evaluated. Median number of strokes admitted per year was 186 (range 84–497). Nine hospitals (39%) admitted ≥200 stroke patients per year (mean 332). Average adjusted mortality (7.0 vs. 7.3, P  = 0.67 t -test), mean thrombolysis rate (12.1% vs. 9.2%, P  = 0.09) and mean proportion of patients treated ≤45 min (40.4% vs. 31.3%, P  = 0.2) did not differ significantly between higher and lower volume hospitals. Hospitals close to the motorway network (n  = 15) had a higher mean thrombolysis rate (11.9% vs. 7.5%, P  = 0.01 t -test) and proportion DTN ≤45 min (43.7–18.4%, P  < 0.001). Number of stroke admissions did not correlate with mortality (r  = 0.06, P  = 0.78), DTN (r  = 0.12, P  = 0.95) or thrombolysis rate (r  = 0.35, P  = 0.20). Distance to next hospital correlated strongly negatively with DTN (r  = −0.47, P  = 0.02) and thrombolysis rate (−0.43, P  = 0.04). Conclusion Remoteness of hospitals is associated with worse measures of stroke outcome and management. [ABSTRACT FROM AUTHOR]

Community development (CD) is widely accepted within the mining industry as a major part of the industry's sustainability strategy. Consequently, over the last two decades, community development has gained root in the mining industry, providing a framework for mining company interactions with local communities around the world. Dedicated CD departments stocked with development specialists have since become a common fixture of mining company structures at all levels. This development has naturally triggered an avalanche of scholarly interest in the mining industry CD practices and outcomes. However, current literature on the subject has rarely explored mining companies' discourse on the "community" as is applied within the context of CD practice. Based on Wiering and Arts' three-level analysis of discourse, the paper interrogates the concept of the "community" as is understood and applied within the Ghanaian mining industry, at the ontological, normative, and strategic levels. The paper shows that mining companies hold three simultaneous ontological conceptualizations of the community: communities as victims; as enclaves of poverty; and as owners of social license, each differing slightly in its underlying logic to CD. Of all three conceptualizations, the owners of social license view, which is driven by an instrumentalist logic, dominates CD practice, allowing mining companies to approach CD largely as a risk management tool. At the normative level, companies have advocated "value creation" (for communities). At the strategic level, company–community partnerships have been proposed as the preferred method of accomplishing CD. These views of the community and their accompanying industry practices are dissected and policy proposals suggested. [ABSTRACT FROM AUTHOR]

This document is a response to a letter regarding the impact of prehospital care and door-to-computed tomography scan time on stroke outcomes. The authors address the issues raised by the letter and provide information about the prehospital assessment and care of stroke patients in Ireland. They explain that Ireland has a standardized training protocol for paramedics, and all hospitals can receive pre-notification of suspected strokes from ambulances. They also mention that technical solutions like mobile stroke units have not been extensively assessed in remote areas due to cost and low frequency of use. The authors conclude that optimizing prehospital and emergency care for stroke patients is important, but there is no evidence that patients attending remote hospitals in Ireland receive poorer care in these respects. [Extracted from the article]

African immigrants in the United States experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) effectively prevents HIV infection, yet uptake is low among racial and ethnic minorities. To better understand PrEP adoption among African immigrants, in March 2020, we conducted interviews with Ghanaian immigrants (N = 40) to explore the barriers and ways to overcome these barriers to PrEP adoption. Participants described several barriers (e.g., low HIV knowledge and risk perception, fear of social judgment, cultural values, and norms), which may impede PrEP adoption. We categorized these barriers according to the levels of the socioecological model (individual, interpersonal, community, and organizational/structural factors). Participants also identified strategies to overcome the barriers, such as providing comprehensive education on HIV and PrEP. Our research provides foundational knowledge that can inform future PrEP research with Ghanaian and other African immigrants and offers important insights into factors that may impact PrEP adoption in this population. [ABSTRACT FROM AUTHOR]

Goal: Little is known about how physicians conceptualize leadership, what factors influence that conceptualization, and how their conceptualization may impact willingness to lead. We sought to explore how physicians conceptualize leadership. Methods: We conducted an exploratory study of data from a convenience sample of physicians across the United States using an anonymous, 54-item, online survey. We devised a novel leadership resonance score (LRS) to distinguish between leadership and management based on published definitions and prior pilot work. The activities fit on a spectrum from purely leadership actions to purely management actions, and we assigned a numeric value to each activity, allowing for quantification of a respondent's conceptualization of leadership as either more managing or more leading. Principal Findings: There were 206 respondents (57% male; median age of 43 years [interquartile ranges, IQR: 32, 72]) who completed the survey. Respondents viewed leadership abilities to be highly important for physicians, with a median importance score of 80 (range 0-100, IQR: 50, 100). LRS indicated most physicians conflate leadership and management. Compared to other physicians, respondents assessed their own preparedness for leadership highly (median preparedness score: 70, IQR: 2, 100). Respondents' assessment of their preparedness for leadership was associated with age (Spearman's rho = 0.24, p <.001). LRS was not associated with preparedness for leadership (Spearman's rho = 0.12, p =.08). "Aversion to politics" was the most common barrier to interest in leadership (45%, 93/206), with "loss of personal time" being second (30%, 62/206). Applications to Practice: Our data demonstrate physicians misunderstand the differences between leadership and management. We surmise that if an accurate conceptualization of leadership by physicians is associated with increased willingness to lead, then educational activities designed to improve physicians' understanding of leadership could be beneficial in increasing physicians' willingness to take on leadership positions. An increased willingness by physicians to take on leadership roles would ultimately have a positive impact not only on individual patient care, but also on the healthcare system as a whole. [ABSTRACT FROM AUTHOR]

The North Dublin Population Stroke Study in 2012[5] showed a 9.5% non-presentation rate of stroke patients. All had active thrombolysis protocols, all had nationally developed imaging protocols and all had access to thrombectomy services with imaging review by Interventional Neuroradiologists through a central imaging system.[3] All units undergo continuous audit. All the stroke patients in the study were admitted to hospitals with organized stroke services, with accredited stroke units and with senior medical and specialized nursing staff trained in stroke care. [Extracted from the article]

Humans are exposed to potentially harmful amounts of the neurotoxin monomethylmercury (MMHg) through consumption of marine fish and mammals. However, the pathways of MMHg production and bioaccumulation in the ocean remain elusive. In anaerobic environments, inorganic mercury (Hg) can be methylated to MMHg through an enzymatic pathway involving the hgcAB gene cluster. Recently, hgcA‐like genes have been discovered in oxygenated marine water, suggesting the hgcAB methylation pathway, or a close analog, may also be relevant in the ocean. Using polymerase chain reaction amplification and shotgun metagenomics, we searched for but did not find the hgcAB gene cluster in Arctic Ocean seawater. However, we detected Hg‐cycling genes from the mer operon (including organomercury lyase, merB), and hgcA‐like paralogs (i.e., cdhD) in Arctic Ocean metagenomes. Our analysis of Hg biogeochemistry and marine microbial genomics suggests that various microorganisms and metabolisms, and not just the hgcAB pathway, are important for Hg methylation in the ocean. [ABSTRACT FROM AUTHOR]

A demonstration of the principles of quantum key distribution (QKD) is performed using a single-photon source in a proof of concept test-bed over a distance of 2 km in standard telecommunications optical fiber. The single-photon source was an optically-pumped quantum dot in a microcavity emitting at a wavelength of 895 nm. Characterization of the QKD parameters was performed at a range of different optical excitation powers. An investigation of the effect of varying the optical excitation power of the quantum dot microcavity on the quantum bit error rate and cryptographic key exchange rate of the system are presented. [ABSTRACT FROM AUTHOR]

Presents information on a study which measured the unnormalized Stokes vector by using a rotating-compensator multichannel ellipsometer. Polarization state of light reflected from specular and textured SnO2: F films; Experimental details; Results and discussions.

Presents a study which calculated the atomic depth distribution in solids produced by high-speed ion bombardment using the concept of the effective displacement volume of an atom. General equations used; Constraints on variation of the effective displacement volume with composition; Overview of an extensive survey of binary metal alloys.

Studies the annealing effect on porosity of amorphous hydrogenated carbon films using a quartz crystal microbalance. Background to the study; Experimental procedures; Results and discussion.

Presents a study that investigated the reliability of the diffusion approximation for the ballistic relocation function in atomic mixing by ion beams. Information on mixing equations; Numerical results; Conclusion.

Presents a study which reported the results of ellipsometry measurements performed during the growth of hydrogenated amorphous silicon thin films on crystalline silicon substrates. Formation of low-density microstructure in the initial stages of growth; Effect of sputtering on the glow-discharge decomposition of gases; Discussion on the pseudodielectric function trajectories.

Presents information on a study which extended in situ ellipsometry characterization of the nucleation and microstrucutral evolution of amorphous silicon (a-Si:H) to the effect of deposition parameters on these processes. Details about the structural evolution of a-Si:H; Important aspects of the ellipsometer/glow-discharge reactor system; General features of in situ trajectories.

Presents a study which examined the effect of substrate microstructure on the growth habit of high-quality hydrogenated amorphous silicon. Experimental details; Results and discussion; Conclusion.

Presents information on a study that examined the growth and microstructure of α-Si:H/α-SiN [subx] :H heterojunctions. Experimental details; Results and discussion on the study; Conclusions.

Presents information on a study which analyzed the in situ ellipsometry measurements taken during the deposition of hydrogenated amorphous silicon on crystalline silicon substrates in a convention rf glow-discharge apparatus. Nucleation behavior of hydrogenated amorphous silicon; Experimental details; Results and discussion; Conclusions.

Presents the results of the application of photoresponse techniques to the study of the transport of electrons past an energy barrier. Investigations of electron transport through gallium arsenide/aluminum arsenide heterostructures; Model for the absorption of the light in the structures used; Change in the band gap as compared to the shift in the peak position in the voltage spectrum of the second sample.

Examines the optical properties of ion-beam-sputtered silicon and germanium using spectroscopic ellipsometry. Discrepancies between the structure of the p-silicon deduced from Raman and ellipsometry spectra; Significance of thin-film polycrystalline silicon; Psuedodielectric functions for ion-beam-deposited silicon prepared at different substrate temperatures.

Analyzes the structure of a hydrogenated amorphous silicon based n-1 two-layer system using spectroscopic ellipsometry measurements. Details on the experiment; Data analysis; Results of the study.

Presents a study which examined the optimization and analysis of solar selective surfaces with continuous and multilayer profiles. Theory and computation method; Results and discussion; Conclusions.

Abstract: Background: Malnutrition is a problem within hospitals, which impacts upon clinical outcomes. The present audit assesses whether a hospital menu meets the energy and protein standards recommended by the British Dietetic Association's (BDA) Nutrition and Hydration Digest and determines the contribution of oral nutrition supplements (ONS) and additional snacks. Methods: Patients in a UK South West hospital were categorised as ‘nutritionally well’ or ‘nutritionally vulnerable’ in accordance with their Malnutrition Universal Screening Tool score. Energy and protein content of food selected from the menu (‘menu choice’), menu food consumed (‘hospital intake’) and total food consumed including snacks (‘overall intake’) were calculated and compared with the standards. Results: In total, 93 patients were included. For ‘nutritionally well’ patients (n = 81), energy and protein standards were met by 11.1% and 33.3% (‘menu choice’); 7.4% and 22.2% (‘hospital intake’); and 14.8% and 28.4% (‘overall intake’). For ‘nutritionally vulnerable’ patients (n = 12), energy and protein standards were met by 0% and 8.3% (‘menu choice’); 0% and 8.3% (‘hospital intake’); and 8.3% and 16.7% (‘overall intake’). Ten percent of patients consumed ONS. Patients who consumed hospital snacks (34%) were more likely to meet the nutrient standards (P ≤ 0.001). Conclusions: The present audit demonstrated that most patients are not meeting the nutrient standards recommended by the BDA Nutrition and Hydration Digest. Recommendations include the provision of energy/protein‐dense snacks, as well as menu, offering ONS where clinically indicated, in addition to training for staff. A food services dietitian is ideally placed to lead this, forming a vital link between patients, caterers and clinical teams. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the safety and indications for cardiac magnetic resonance (CMR) with myocardial perfusion imaging (MPI) in a cohort of children and young adults. A retrospective review of 178 children and young adults who underwent CMR with MPI was performed. Studies were categorized based on study protocols as MPI with resting perfusion only, adenosine stress MPI, exercise-induced stress MPI, and MPI for cardiac mass diagnosis. Relevant clinical history, exam indications, and adverse reactions following gadolinium-based contrast agent and adenosine administration were recorded. Studies were reviewed for the presence of myocardial perfusion defects, wall motion abnormalities, and delayed myocardial enhancement. The most common indications from MPI were congenital heart disease (CHD), Kawasaki disease, anomalous coronary artery, or myocardial mass characterization. Of these, 51% were protocoled with adenosine stress, 23% without stress, 6% with exercise stress, and 20% for cardiac mass evaluation. Excluding patients for myocardial mass evaluation, MPI defects were present in 16% (14 with adenosine stress, 1 with exercise stress, 8 on resting studies only). For cardiac mass evaluation, a mass was confirmed in 58%. No adverse reactions occurred with intravenous administration of a gadolinium-based contrast agent. Three self-limited adverse reactions, 2 patients with chest pain, and 1 patient with bradycardia, occurred following adenosine administration. MPI is a safe modality for the evaluation of pediatric and young adults with minimal adverse events. The most common indications for MPI were for the evaluation of CHD, Kawasaki disease, anomalous coronary artery, or myocardial mass characterization. [ABSTRACT FROM AUTHOR]

In this article, we describe an unmanned aerial system equipped with a thermal-infrared camera and software pipeline that we have developed to monitor animal populations for conservation purposes. Taking a multi-disciplinary approach to tackle this problem, we use freely available astronomical source detection software and the associated expertise of astronomers, to efficiently and reliably detect humans and animals in aerial thermal-infrared footage. Combining this astronomical detection software with existing machine learning algorithms into a single, automated, end-to-end pipeline, we test the software using aerial video footage taken in a controlled, field-like environment. We demonstrate that the pipeline works reliably and describe how it can be used to estimate the completeness of different observational datasets to objects of a given type as a function of height, observing conditions, etc. – a crucial step in converting video footage to scientifically useful information such as the spatial distribution and density of different animal species. Finally, having demonstrated the potential utility of the system, we describe the steps we are taking to adapt the system for work in the field, in particular systematic monitoring of endangered species at National Parks around the world. [ABSTRACT FROM PUBLISHER]

Background: Given the growing legalization of recreational marijuana use and related increase in its prevalence in the United States, it is important to understand marijuana's appeal. We used a behavioral economic (BE) approach to examine whether the reinforcing properties of marijuana, including "demand" for marijuana, varied as a function of its perceived quality.Methods: Using an innovative, Web-based marijuana purchase task (MPT), a sample of 683 young-adult recreational marijuana users made hypothetical purchases of marijuana across three qualities (low, mid and high grade) at nine escalating prices per joint, ranging from $0/free to $20.Results: We used nonlinear mixed effects modeling to conduct demand curve analyses, which produced separate demand indices (e.g., Pmax, elasticity) for each grade of marijuana. Consistent with previous research, as the price of marijuana increased, marijuana users reduced their purchasing. Demand also was sensitive to quality, with users willing to pay more for higher quality/grade marijuana. In regression analyses, demand indices accounted for significant variance in typical marijuana use.Conclusions: This study illustrates the value of applying BE theory to young adult marijuana use. It extends past research by examining how perceived quality affects demand for marijuana and provides support for the validity of a Web-based MPT to examine the appeal of marijuana. Our results have implications for policies to regulate marijuana use, including taxation based on the quality of different marijuana products. [ABSTRACT FROM AUTHOR]

Studies pressure relaxation in atomic mixing and preferential sputtering. Determination of relocation without relaxation; Measurement of relaxation current; Analysis of the motion of the surface.

Reports on the application of real time spectroscopic ellipsometry to characterize the nucleation of diamond on c-silicon by tungsten filament-assisted chemical vapor deposition (CVD). Stages of diamond growth by filament-assisted CVD; Preparation of the diamond; Information on the structural model and parameters deduced in a linear regression analysis of the final spectra.

Provides information on a study which proposed a field-effect transistor structure based on strain-induced polarization charges. Discussion of the pseudomorphic growth of a barrier layer on a substrate oriented in a polar direction; Observation concerning polarization and piezoelectric effect; Forms at the heterointerface to screen the polarization charges.

Probes the evolution of surface roughness over a wide range of film thickness during the growth of glow discharge hydrogenated amorphous silicon (a-Si:H) using in situ ellipsometry. Differences in the resulting film properties; Factor to which the columnar morphology observed for SiH[sub4]:argon films is attributed; Description of the pseudodielectric function.

SUMMARY Objectives To determine what percentage of red blood cell ( RBC) units that were issued to the operating room ( OR) were returned unused, and to determine how often all of the RBCs that were issued for a patient were returned unused using the institution's maximum surgical blood ordering schedule ( MSBOS) as a guide. Background The MSBOS provides guidelines for blood ordering, but is merely a suggestion for the ordering clinicians. This study examined how closely ordering practices followed the MSBOS, and how often ordered RBCs were actually transfused. Methods For a 4-week period, RBC issue and utilization data were collected on elective surgery patients who were eligible for electronic cross-match at a tertiary care hospital. These data were compared to the MSBOS. Results There were 1350 surgical procedures performed. Of these cases, 439 patients had a type and screen (T&S) performed, and 215/439 (49%) patients had at least 1 RBC issued during their case. To these 215 patients, 742 RBC units were issued and 537/742 (72%) of these units were returned to the blood bank unused. In 152/215 (71%) cases with issued RBCs, all of the RBCs were returned to the blood bank unused. Amongst the surgical categories in this study, the percentage of cases where none of the issued RBCs were transfused ranged from 38 to 93%. Conclusions Significant numbers of RBC units are issued but not transfused during surgery. Involving the surgical team in the blood issuing process and using a data-driven MSBOS may reduce the number of unused units. [ABSTRACT FROM AUTHOR]

Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting 1 in 3,000 people. Cardiovascular involvement is a prominent feature of MFS, with aortic dissection and/or rupture being the leading cause of death. Advances in the medical and surgical care of patients with MFS have improved survival. Hospital resource utilization and outcomes have not been evaluated in a large population of patients with MFS. We sought to analyze pediatric hospital resource utilization and outcomes in patients with MFS. Nationally distributed data from 43 pediatric hospitals in the 2004-2011 Pediatric Health Information System database were used to identify patients admitted to the hospital with International Classification of Diseases-9th Revision codes for a diagnosis of MFS. Aortic aneurysm (AA) with or without dissection, length of stay (LOS), and hospital charges were determined. During the study period, there were 1,978 admissions in 1,228 patients with MFS. AA was present in 217 (11 %) admissions in 188 (15 %) patients (63 % male). Mean age of patients with AA was 13.8 ± 5.9 years. Aortic dissection or rupture was present in 15 (7 % with AA) admissions in 15 (8 % with AA) patients (mean age 15.7 ± 5.2 years). Other cardiac diagnoses occurred more commonly in the AA cohort ( p < 0.0001), regardless of the reason for admission. Cardiothoracic surgical procedures were performed in 116 AA admissions (53 %). Mean LOS, hospital charges per admission, and charges per day were significantly higher in AA cohort compared to those without AA. In-hospital mortality for AA was 2 %. The presence of AA in patients with MFS increases hospital resource utilization. Cardiothoracic surgeries are commonly performed in this cohort. Other cardiovascular diagnoses are more prevalent in patients with AA suggesting a more severe phenotype. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the relationship between sport participation, global self-esteem and physical self-concept in female adolescent equestrian athletes. 239 participants (239 females aged 12-20 years old, 15.96±2.422 years) completed the Physical Self-Description Questionnaire (PSDQ) and a modified version of the Sport Activity Questionnaire through an online survey. Seven of the original 11 PSDQ subscales were chosen to be analysed: physical activity, body fat, sports competence, global physical self-concept, appearance, flexibility and global self- esteem. Global self-esteem and appearance were significantly affected by participant age (H(2) = 7.27, P<0.05 and H(2) = 9.58, P<0.01, respectively). Physical activity was significantly affected by discipline (H(4) = 13.39, P<0.05). Implications of these findings suggest that equestrian sport could act as a contributor to self-esteem in female adolescents and as such more emphasis on psychosocial development within the British Equestrian Federation's Long Term Athlete Development programme (LTAD) and the training of equestrian coaches needs to be implemented by governing bodies. [ABSTRACT FROM AUTHOR]

Vacuum glazing is an innovative transparent thermal insulator that has applications in high performance windows. Two sheets of glass are separated by an evacuated space maintained by a regular array of support pillars, and the structure is sealed around the edges with solder glass or a metal bond. The evacuated internal gap reduces the heat transfer across the glazing by eliminating air conduction and convection between the glass sheets. This review paper traces the development of vacuum glazing from the initial proposal 100 years ago, to the fi rst reported manufacture in 1989 by the University of Sydney, the subsequent commercialisation of that design in 1996 and recent advances. The various design challenges are discussed along with the innovative ways they were successfully addressed by two research groups. Several key non-technical factors that have been equally important to the commercialisation and acceptance of this new technology are also presented. The future prospects for vacuum glazing are discussed in the context of the growing interest in energy effi cient buildings and higher standards for the thermal performance of windows. [ABSTRACT FROM AUTHOR]

Lentil (Lens culinaris Medic.) is a pulse crop that belongs to the family Leguminosae. Lentils are rich in proteins, have 18 of the 20 amino acids including all 8 essential amino acids and provide a number of essential minerals and vitamins. Thus, lentils occupy an important place in the human diet, especially in developing countries, as a rich source of protein, vitamins and minerals. Although in many developing countries in Asia rice contributes significantly to human daily energy and nutritional requirements, its amino acid profile shows that rice lacks some essential amino acids. Therefore, given their rich composition of amino acids, lentils could act as an ideal supplement for rice-based diets. Although all red lentils are imported, they are the most widely consumed pulse among Sri Lankans. Red lentil consumption levels are significantly greater in the estate sector where the prevalence of under nutrition is high. Thus, this review was undertaken to understand the potential role of lentils in the Sri Lankan diet and how lentils can potentially be utilized to meet the nutritional needs of Sri Lankans. The study was based on an extensive literature review and information obtained through personal interviews with key participants in the red lentil industry of Sri Lanka. It was evident that red lentils are a rich source of nutrients, especially micro-nutrients, but their bioavailability is poor due to the presence of multiple anti-nutritive factors such as protease inhibitors, phenolic compounds and phytates. Although bioavailability of nutrients can be enhanced by changing food processing techniques, fortification and bio-fortification, lentil cooking patterns in Sri Lanka pose difficulties in adopting changed food processing techniques and fortification. Thus, bio-fortification would be the most viable option for enhancing nutrient availability in lentils. Since Sri Lanka does not produce lentils, such initiatives may have to be undertaken in exporting countries or in collaboration with international agricultural research centres. Any strategic investments in breeding new lentil varieties with high bioavailability would provide exporting countries a unique competitive edge in export markets. Such improvements would meet the nutritional needs, not only of Sri Lankans, but also of millions other Asian consumers who face similar nutritional challenges. [ABSTRACT FROM AUTHOR]

The article offers information on the financial disadvantage faced by the pediatricians and pediatric subspecialists as compared to other physicians. Topics discussed include problems faced by new pediatricians due to lack of financial training, book "The White Coat Investo" written by James Dahle on the same, and retirement accounts for employed pediatricians.

A stratospheric sudden warming (SSW) is a dynamical phenomenon of the wintertime stratosphere caused by the interaction between planetary Rossby waves propagating from the troposphere and the stratospheric zonal-mean flow. While the effects of SSW events are seen predominantly in high latitudes, they can also produce significant changes in middle and low latitude temperature and winds. In this study we quantify the middle and low latitude effects of SSW events on temperature and zonal-mean winds using a composite of SSW events between 1988 and 2010 simulated with the specified dynamics version of the Whole Atmosphere Community Climate Model (WACCM). The temperature and wind responses seen in the tropics also extend into the low latitudes in the other hemisphere. There is variability in observed zonal-mean winds and temperature depending on the observing location within the displaced or split polar vortex and propagation direction of the planetary waves. The propagation of planetary waves show that they originate in mid-high latitudes and propagate upward and equatorward into the mid-latitude middle atmosphere where they produce westward forcing reaching peak values of ~60- 70ms-1 day-1. These propagation paths in the lower latitude stratosphere appear to depend on the phase of the quasibiennial oscillation (QBO). During the easterly phase of the QBO, waves originating at high latitudes propagate across the equator, while in the westerly phase of the QBO, the planetary waves break at ~20-25° N and there is no propagation across the equator. The propagation of planetary waves across the equator during the easterly phase of the QBO reduces the tropical upwelling and poleward flow in the upper stratosphere. [ABSTRACT FROM AUTHOR]

Arrhythmia in Adults with Single Ventricles Objectives The study sought to identify the impact of cardiac arrhythmias on hospitalizations in adults with single ventricle (SV) congenital heart disease (CHD). Background Surgical advances have dramatically improved survival in patients with CHD. Cardiac arrhythmias and sudden cardiac death are common in adults with CHD. Methods and Results Data from 43 pediatric hospitals in the 2004 to 2011 Pediatric Health Information System database were used to identify patients ≥18 years of age admitted with International Classification of Diseases-9th Revision codes for a diagnosis of either hypoplastic left heart syndrome (HLHS), tricuspid atresia (TA) or common ventricle (CV), and a cardiac arrhythmia. Primary and secondary diagnoses, length of stay (LOS), hospital charges, and interventional procedures were determined. Multilevel models were used to evaluate differences in demographics, diagnoses, and clinical outcomes among the 3 subgroups (HLHS, TA, and CV). Interactions of charges with arrhythmia and admission year were examined using ANOVA. There were 642 admissions in 424 patients with SV CHD and an arrhythmia diagnosis. A single arrhythmia diagnosis was present in 454 admissions (71%). Total hospital charges were $80.7 million with mean charge per admission of $127,296 ± 243,094. The mean charge per hospital day was $16,653 ± 17,516 and increased across the study period (P < 0.01). Arrhythmia distributions were impacted by SV anatomic subtype (P < 0.001). Hospital resource utilization was significantly different among arrhythmia groups (P < 0.001). Conclusions In adults with SV CHD, arrhythmias are affected by SV anatomic subtype and impact adversely upon hospital resource utilization. [ABSTRACT FROM AUTHOR]

Despite the broad benefits that DNA barcoding can bring to a diverse range of biological disciplines, a number of shortcomings still exist in terms of the experimental design of studies incorporating this approach. One underlying reason for this lies in the confusion that often exists between species discovery and specimen identification, and this is reflected in the way that hypotheses are generated and tested. Although these aims can be associated, they are quite distinct and require different methodological approaches, but their conflation has led to the frequently inappropriate use of commonly used analytical methods such as neighbour-joining trees, bootstrap resampling and fixed distance thresholds. Furthermore, the misidentification of voucher specimens can also have serious implications for end users of reference libraries such as the Barcode of Life Data Systems, and in this regard we advocate increased diligence in the a priori identification of specimens to be used for this purpose. This commentary provides an assessment of seven deficiencies that we identify as common in the DNA barcoding literature, and outline some potential improvements for its adaptation and adoption towards more reliable and accurate outcomes. [ABSTRACT FROM AUTHOR]

Background: Most patients with single ventricle congenital heart disease (SV) are now expected to survive to adulthood. Medical comorbidities are common in SV. Methods: We used data from 43 pediatric hospitals in the 2004 to 2011 Pediatric Health Information System database to identify patients ≥18years of age admitted with International Classification of Diseases-9th Revision codes for a diagnosis of either hypoplastic left heart syndrome (HLHS), tricuspid atresia (TA) or common ventricle (CV). Primary (PD) and secondary diagnoses (SD), length of stay (LOS) and hospital charges were determined. Multilevel models were used to evaluate differences in demographics, diagnoses, and admission outcomes among the three subgroups (HLHS, TA, and CV). Interactions of charges with PD and admission year were examined using ANOVA. Results: There were 801 SV patients with 1330 admissions during the study period. Mean age was 24.8±6.2years (55% male) and mean LOS was 6.8±11.3days. Total hospital charges were $135million with mean charge per admission of $101,131±205,808. The mean charge per day was $15,407±16,437. Hospital charges correlated with PD group (p<0.001). Admission rate remained stable (~180/year) from 2006 to 2011. LOS decreased (p=0.0308) and hospital charges per day increased across the study period (p<0.001). PD was non-cardiac in 28% of admissions. Liver-related conditions were more common in patients with HLHS (p<0.001). Conclusions: Hospitalization costs in adults with SV are significant and are impacted by comorbid medical conditions. Hospitalization rates for adults with SV are not increasing. Gastroenterologic comorbidities including protein-losing enteropathy (PLE) are common in HLHS. [ABSTRACT FROM AUTHOR]

The integration and mandatory study of research method courses by university students is a global phenomenon. However, students demonstrate apprehension and disinterest in research methods courses. Consequently, this study investigated the interplay among research methods anxiety, positive disposition toward research, perception of usefulness, self-efficacy, and academic effort in research. Paper-and-pencil questionnaires were used to collect data from a convenience sample of 636 technical university students in Ghana. Based on partial least squares structural equation modeling results, research anxiety reduces students' self-beliefs (β = −0.172; t = 2.729; p =.000) and negatively affects perception of research usefulness (β = −0.172; t = 2.729; p =.000). A positive disposition towards research enhances students' academic efforts in research (β = 0.919; t = 3.308; p = 0.001). Furthermore, self-efficacy drives students' efforts (β = −0.172; t = 2.729; p =.000), enhances positive disposition toward research (β = 0.191; t = 3.308; p =.001) and perception of research usefulness among students (β = 0.224; t = 3.064; p =.002). Students' perception of research usefulness mediates the relationship between anxiety and effort in research (β = −0.075; t = 3.653; p =.000), positive research disposition and effort (β = −0.056; t = 2.519; p =.012) as well as research self-efficacy and effort in studies (β = 0.083; t = 3.02; p =.003). [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Children with Alagille syndrome often have complex forms of congenital heart defects with the majority having peripheral pulmonary artery stenosis (PPAS) and pulmonary valve atresia (PA) or pulmonary valve stenosis. Children with Alagille syndrome also have variable amounts of liver dysfunction. The purpose of this study was to evaluate the impact of liver dysfunction on outcomes in children with Alagille syndrome undergoing congenital heart surgery. METHODS This was a retrospective review of 69 patients with Alagille syndrome who underwent congenital heart surgery at our institution. The underlying diagnoses included PPAS (n  = 29), tetralogy of Fallot with PPAS (n  = 14), tetralogy with PA (n  = 3), PA with ventricular septal defect and major aortopulmonary collateral arteries (n  = 21) and one each with D-transposition and supravalvar aortic stenosis. RESULTS The median age at surgery was 16 months (range 0–228 months). Procedures performed included PPAS repair (n  = 43), tetralogy with PA repair (n  = 3), unifocalization procedures (n  = 21) and other (n  = 2). Forty-two (61%) patients had mild or no liver dysfunction, while 26 (38%) had moderate or severe liver dysfunction. The median cardiopulmonary bypass time was 345 min (341 with liver dysfunction, 345 without liver dysfunction). There were a total of 8 operative (12%) deaths and 3 late (4%) deaths. Six operative and 2 late deaths occurred in patients with liver dysfunction (combined 30.7%) versus 2 operative and 1 late death (combined 7.1%) for patients without liver dysfunction (P  < 0.05). CONCLUSIONS These results suggest that liver dysfunction has a profound impact on survival in children with Alagille syndrome undergoing congenital heart surgery. [ABSTRACT FROM AUTHOR]

Colwellia is a genus of mostly psychrophilic halophilic Gammaproteobacteria frequently isolated from polar marine sediments and sea ice. In exploring the capacity of Colwellia psychrerythraea 34H to survive and grow in the liquid brines of sea ice, we detected a duplicated 37 kbp genomic island in its genome based on the abnormally high G + C content. This island contains an operon encoding for heterotetrameric sarcosine oxidase and is located adjacent to several genes used in the serial demethylation of glycine betaine, a compatible solute commonly used for osmoregulation, to dimethylglycine, sarcosine, and glycine. Molecular clock inferences of important events in the adaptation of C. psychrerythraea 34H to compatible solute utilization reflect the geological evolution of the polar regions. Validating genomic predictions, C. psychrerythraea 34H was shown to grow on defined media containing either choline or glycine betaine, and on a medium with sarcosine as the sole organic source of carbon and nitrogen. Growth by 8 of 9 tested Colwellia species on a newly developed sarcosine-based defined medium suggested that the ability to catabolize glycine betaine (the catabolic precursor of sarcosine) is likely widespread in the genus Colwellia. This capacity likely provides a selective advantage to Colwellia species in cold, salty environments like sea ice, and may have contributed to the ability of Colwellia to invade these extreme niches. [ABSTRACT FROM AUTHOR]

Quantitative and isotopic measurement of actinide elements is required in many circumstances in the nuclear industry. For example, determination of very low levels of these alpha emitters in human urine samples is used to assess the internal committed dose for nuclear workers. Quantifying actinide isotopes in radioactive waste from nuclear processing and nuclear facility decommissioning provides important information for waste management. Accurate determination of the uranium isotopic ratios in reactor fuels provides fuel burnup information. Inductively coupled plasma mass spectrometry (ICP-MS) has been used for the determination of Th, U, and Pu in various samples including urine, nuclear waste, and nuclear fuel in our laboratory. In order to maximize the capability of the technique and ensure quality analyses, ICP-MS was used to analyze samples directly, or after pre-treatment to separate complicated matrices or to concentrate the analyte(s). High-efficiency sample introduction techniques were investigated. Spectral interferences to minor isotopes caused by peak tails and hydride ions of major actinide isotopes were studied in detail using solutions prepared with light and heavy waters. The quality of the isotopic ratio measurement was monitored using standard reference materials. [ABSTRACT FROM AUTHOR]

We describe the VISTA Science Archive (VSA) and its first public release of data from five of the six VISTA public surveys. The VSA exists to support the VISTA surveys through their lifecycle: the VISTA Public Survey consortia can use it during their quality control assessment of survey data products before submission to the ESO Science Archive Facility (ESO SAF); it supports their exploitation of survey data prior to its publication through the ESO SAF; and, subsequently, it provides the wider community with survey science exploitation tools that complement the data product repository functionality of the ESO SAF. This paper has been written in conjunction with the first public release of public survey data through the VSA and is designed to help its users understand the data products available and how the functionality of the VSA supports their varied science goals. We describe the design of the database and outline the database-driven curation processes that take data from nightly pipeline-processed and calibrated FITS files to create science-ready survey datasets. Much of this design, and the codebase implementing it, derives from our earlier WFCAM Science Archive (WSA), so this paper concentrates on the VISTA-specific aspects and on improvements made to the system in the light of experience gained in operating the WSA. [ABSTRACT FROM AUTHOR]

Williams syndrome (WS) is a congenital, developmental disorder affecting 1 in 8,000 live births. The corrected QT (QTc) interval is prolonged in 13% of patients with WS. No data exist characterizing the ambulatory electrocardiographic findings in WS. A retrospective review of all patients with WS evaluated at our institution from January 1, 1980 to December 31, 2007 was performed. Patients with ≥1 ambulatory electrocardiogram (AECG) with sinus rhythm and measurable intervals were included. QTc measurements were made at the minimum and maximum heart rate. Logistic regression analysis was used to evaluate the correlation of ventricular ectopic complexes with QTc measurements. A statistical probability of p <0.05 was considered significant. Of 270 patients identified, 32 had AECGs available for review. Complete data were available for 56 AECGs from 26 patients (15 female; 58%). Their mean age was 15.6 ± 7.2 years at the initial AECG and 20.6 ± 8.6 years for all AECGs. The QTc interval increased with increasing heart rate. Ventricular premature complexes occurred in 40 (73%) of 56 AECGs and 21 (81%) of 26 patients. Ventricular tachycardia occurred in 5 (9%) of 56 AECGs and 4 (15%) of 26 patients. The mean length of ventricular tachycardia was 3.6 ± 0.5 beats at a rate of 171 ± 40 beats/min. The QTc interval at the minimum heart rate correlated directly with age (p <0.001), total ventricular premature complexes (p = 0.007), ventricular couplets (p = 0.002), and ventricular tachycardia (p = 0.011). The QTc interval at the maximum heart rate correlated directly with age (p <0.001), total ventricular premature complexes (p = 0.016), and ventricular couplets (p = 0.006). In conclusion, the QTc interval correlated with ventricular ectopic complexes in patients with WS. The type of ventricular ectopic complexes suggested an alternate etiology of the QTc prolongation seen in WS from that seen in congenital long QT syndrome. [Copyright &y& Elsevier]

Sports concussion research and clinical guidelines have evolved rapidly. The most recent concussion consensus statement and guidelines (Zurich, 2008) provided clinicians with the Sports Concussion Assessment Tool version 2 (SCAT2) as a clinical template for the assessment of acute concussion. For the subsequent serial examinations required for the complete assessment of the concussed athlete, SCAT2 may be inadequate. This paper describes the experience and suggestions of South African sports physicians in evolving a more comprehensive clinical evaluation tool and record of patient care, the Sports Concussion Office Assessment Tool. [ABSTRACT FROM AUTHOR]

This study aimed to identify the anatomic and pathologic structural cardiac abnormalities in conjoined twins and to focus on those that have prevented the successful separation of conjoined hearts. A retrospective review was undertaken to examine consecutive cases of thoracopagus conjoined twins with conjoined hearts evaluated at The Children's Hospital of Philadelphia from 1 January 1980 through 6 October 2008. The records included autopsy and surgical findings as well as clinical reports. The study group included nine sets of conjoined twins with a mean gestational age at birth of 33.8 ± 5.5 weeks. Three twin pairs were stillborn. Five twin pairs died afterward. One pair died of cardiopulmonary failure. The median age at death was 22 days (range, 0-345 days). Major congenital heart disease was present in 94.4% (17/18) of the hearts, and 72.2% (13/18) of the hearts had single-ventricle physiology. Total anomalous pulmonary venous return occurred in 39% (7/18) of the cases. The clinical outcome for thoracopagus twins with conjoined hearts remains poor because of inability to separate conjoined and single ventricles. Surgical nonintervention and palliative care should be strongly considered for these patients. [ABSTRACT FROM AUTHOR]

The porous medium of sea ice, a surface-rich environment characterized by low temperature and high salinity, has been proposed as a favorable site for horizontal gene transfer, but few measurements are available to assess the possibility of this mode of evolution in ice. Here, we report the first measurements of dissolved DNA in sea ice, measured by fluorescent dye staining of centrifugal-filter-concentrated samples of melted ice. Newly formed landfast and pack ice on the Canadian Arctic Shelf (ca. 71°N, 125°W) contained higher concentrations (scaled to volume of brine) of the major components of dissolved DNA-extracellular DNA and viruses-than the underlying seawater. Dissolved DNA was dominated by extracellular DNA in surface seawater (up to 95%), with viruses making up relatively larger fractions at depths below 100 m (up to 27%) and in thick sea ice (66-78 cm; up to 100%). Extracellular DNA was heterogeneously distributed, with concentrations up to 135 μg DNA L brine detected in landfast sea ice, higher than previously reported from any marine environment. Additionally, extracellular DNA was significantly highly enriched at the base of ice of medium thickness (33-37 cm), suggestive of in situ production. Relative to underlying seawater, higher concentrations of extracellular DNA, viruses, and bacteria, and the availability of numerous surfaces for attachment within the ice matrix suggest that sea ice may be a hotspot for HGT in the marine environment. [ABSTRACT FROM AUTHOR]