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31 Research products, page 1 of 4

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  • Restricted English
    Authors: 
    Zehua Pan; Roy Brouwer;
    Country: Netherlands

    Green infrastructure for source water protection in the form of forest protection and afforestation is gaining interest worldwide. It is considered more sustainable in the long-term than traditional engineering-based approaches. This paper presents a theoretical model to support investment decisions in green and grey infrastructure to deliver safe drinking water. We first develop a static optimal control model accounting for the uncertainties surrounding green infrastructure. This model is then extended to factor in key characteristics surrounding investment decisions aimed at optimizing the stock of green and grey infrastructure. We first include dynamic forest growth, followed by the risk of wildfires and finally the potential offsetting effect of carbon sequestration on long-term climate change and the reduced risk of wildfires. We provide a numerical example to analyze the performance of the different model specifications, interpret their outcomes and draw conclusions to guide future investment decisions in green and grey infrastructure.

  • Publication . Article . 2021
    Restricted English
    Authors: 
    Ian Fillmore; Jonathan D. Hall;
    Country: Netherlands
    Project: SSHRC

    Abstract Technological innovation can raise the returns to some skills while making others less valuable or even obsolete. We study the effects of such skill-altering technological change in the context of men’s professional tennis, which was unexpectedly transformed by the invention of composite racquets during the late 1970s. We explore the consequences of this innovation on player productivity, entry, and exit. We find that young players benefited at the expense of older players and that the disruptive effects of the new racquets persisted over two to four generations.

  • Restricted
    Authors: 
    Andrew R. Steele; Michael M. Tymko; Victoria L Meah; Lydia L. Simpson; Christopher Gasho; Tony G. Dawkins; Alexandra M. Williams; Francisco C. Villafuerte; Gustavo Vizcardo-Galindo; Rómulo Figueroa-Mujíca; +4 more
    Publisher: American Physiological Society
    Country: Peru

    The high-altitude maladaptation syndrome known as chronic mountain sickness (CMS) is characterized by polycythemia and is associated with proteinuria despite unaltered glomerular filtration rate. However, it remains unclear if indigenous highlanders with CMS have altered volume regulatory hormones. We assessed NH2-terminal pro-B-type natriuretic peptide (NT pro-BNP), plasma aldosterone concentration, plasma renin activity, kidney function (urinary microalbumin, glomerular filtration rate), blood volume, and estimated pulmonary artery systolic pressure (ePASP) in Andean males without ( n = 14; age = 39 ± 11 yr) and with ( n = 10; age = 40 ± 12 yr) CMS at 4,330 m (Cerro de Pasco, Peru). Plasma renin activity (non-CMS: 15.8 ± 7.9 ng/mL vs. CMS: 8.7 ± 5.4 ng/mL; P = 0.025) and plasma aldosterone concentration (non-CMS: 77.5 ± 35.5 pg/mL vs. CMS: 54.2 ± 28.9 pg/mL; P = 0.018) were lower in highlanders with CMS compared with non-CMS, whereas NT pro-BNP was not different between groups (non-CMS: 1394.9 ± 214.3 pg/mL vs. CMS: 1451.1 ± 327.8 pg/mL; P = 0.15). Highlanders had similar total blood volume (non-CMS: 90 ± 15 mL·kg−1 vs. CMS: 103 ± 18 mL·kg−1; P = 0.071), but Andeans with CMS had greater total red blood cell volume (non-CMS: 46 ± 10 mL·kg−1 vs. CMS: 66 ± 14 mL·kg−1; P < 0.01) and smaller plasma volume (non-CMS: 43 ± 7 mL·kg−1 vs. CMS: 35 ± 5 mL·kg−1; P = 0.03) compared with non-CMS. There were no differences in ePASP between groups (non-CMS: 32 ± 9 mmHg vs. CMS: 31 ± 8 mmHg; P = 0.6). A negative correlation was found between plasma renin activity and glomerular filtration rate in both groups (group: r = −0.66; P < 0.01; non-CMS: r = −0.60; P = 0.022; CMS: r = −0.63; P = 0.049). A smaller plasma volume in Andeans with CMS may indicate an additional CMS maladaptation to high altitude, causing potentially greater polycythemia and clinical symptoms.

  • Restricted
    Authors: 
    Guy Helman; Marisa I. Mendes; Francesco Nicita; Lama Darbelli; Omar Sherbini; Travis Moore; Alexa Derksen; Amy Pizzino; Rosalba Carrozzo; Alessandra Torraco; +27 more
    Publisher: Elsevier BV
    Country: Netherlands

    Purpose: Recent reports of individuals with cytoplasmic transfer RNA (tRNA) synthetase-related disorders have identified cases with phenotypic variability from the index presentations. We sought to assess phenotypic variability in individuals with AARS1-related disease. Methods: A cross-sectional survey was performed on individuals with biallelic variants in AARS1. Clinical data, neuroimaging, and genetic testing results were reviewed. Alanyl tRNA synthetase (AlaRS) activity was measured in available fibroblasts. Results: We identified 11 affected individuals. Two phenotypic presentations emerged, one with early infantile–onset disease resembling the index cases of AARS1-related epileptic encephalopathy with deficient myelination (n = 7). The second (n = 4) was a later-onset disorder, where disease onset occurred after the first year of life and was characterized on neuroimaging by a progressive posterior predominant leukoencephalopathy evolving to include the frontal white matter. AlaRS activity was significantly reduced in five affected individuals with both early infantile–onset and late-onset phenotypes. Conclusion: We suggest that variants in AARS1 result in a broader clinical spectrum than previously appreciated. The predominant form results in early infantile–onset disease with epileptic encephalopathy and deficient myelination. However, a subgroup of affected individuals manifests with late-onset disease and similarly rapid progressive clinical decline. Longitudinal imaging and clinical follow-up will be valuable in understanding factors affecting disease progression and outcome.

  • Publication . Other literature type . Part of book or chapter of book . 2021
    Restricted
    Authors: 
    Thomas Tannert; Philipp Dietsch; Jorge M. Branco;
    Publisher: Springer International Publishing
    Country: Portugal

    Wood and engineered wood products, herein also referred to as timber, have been used as structural building material for centuries and countless examples demonstrate its longevity if properly designed, built, maintained and assessed [1, 2]. The more recent development of new engineered wood products, connector systems and growing awareness about sustainability in the construction sector have led to legislative changes in the building sector and as a consequence also a significant widening in the range of structural applications of timber [3, 4]. Revised proof - (undefined)

  • Restricted English
    Authors: 
    Steele Gray, Carolyn; Ross Baker, G.; Breton, Mylaine; Kee, Karin; Minkman, Mirella; Shaw, James; Tietschert, Maike; Wankah, Paul; Wodchis, Walter; Zonneveld, Nick; +5 more
    Publisher: Palgrave / MacMillan
    Country: Netherlands

    Health, social, and community care agencies are undergoing rapid changes in response to the COVID-19 pandemic, arguably offering a “window of opportunity” for health system transformation. What is required is theoretical guidance to help determine whether rapid system responses are likely to be sustained as part of broader transformation efforts. We performed a single-phenomenon two theory integration to develop the Rapid and Sustainable Transformation (or RAST) framework, aligning theories from the disaster response and sustainability literature to propose a framework exploring the long-term impact of rapid health system changes and interventions related to COVID-19. In this chapter, the proposed theoretical framework is applied to three cases from Quebec and Ontario in Canada and The Netherlands to examine ongoing efforts to improve health system delivery prior to the pandemic. By applying the framework to these cases, this chapter demonstrates how the framework can help to identify components that require attention for studying sustainability in a disaster response environment. The RAST framework helps advance organizational research around health system transformation by demonstrating how the components of sustainability are interrelated and may be weighed differently in their influence on longer-term transformation.

  • Restricted
    Authors: 
    Mehmet N. Cizmeci; Linda S. de Vries; Maria Luisa Tataranno; Alexandra Zecic; Laura A. van de Pol; Ana Alarcon; Floris Groenendaal; Peter A. Woerdeman;
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Country: Netherlands

    OBJECTIVE Decompressing the ventricles with a temporary device is often the initial neurosurgical intervention for preterm infants with hydrocephalus. The authors observed a subgroup of infants who developed intraparenchymal hemorrhage (IPH) after serial ventricular reservoir taps and sought to describe the characteristics of IPH and its association with neurodevelopmental outcome. METHODS In this multicenter, case-control study, for each neonate with periventricular and/or subcortical IPH, a gestational age-matched control with reservoir who did not develop IPH was selected. Digital cranial ultrasound (cUS) scans and term-equivalent age (TEA)–MRI (TEA-MRI) studies were assessed. Ventricular measurements were recorded prior to and 3 days and 7 days after reservoir insertion. Changes in ventricular volumes were calculated. Neurodevelopmental outcome was assessed at 2 years corrected age using standardized tests. RESULTS Eighteen infants with IPH (mean gestational age 30.0 ± 4.3 weeks) and 18 matched controls were included. Reduction of the ventricular volumes relative to occipitofrontal head circumference after 7 days of reservoir taps was greater in infants with IPH (mean difference −0.19 [95% CI −0.37 to −0.004], p = 0.04). Cognitive and motor Z-scores were similar in infants with and those without IPH (mean difference 0.42 [95% CI −0.17 to 1.01] and 0.58 [95% CI −0.03 to 1.2]; p = 0.2 and 0.06, respectively). Multifocal IPH was negatively associated with cognitive score (coefficient −0.51 [95% CI −0.88 to −0.14], p = 0.009) and ventriculoperitoneal shunt with motor score (coefficient −0.50 [95% CI −1.6 to −0.14], p = 0.02) after adjusting for age at the time of assessment. CONCLUSIONS This study reports for the first time that IPH can occur after a rapid reduction of the ventricular volume during the 1st week after the initiation of serial reservoir taps in neonates with hydrocephalus. Further studies on the use of cUS to guide the amount of cerebrospinal fluid removal are warranted.

  • Restricted
    Authors: 
    Anaïs Remili; Robert J. Letcher; Filipa I. P. Samarra; Rune Dietz; Christian Sonne; Jean-Pierre Desforges; Gísli A. Víkingsson; David A.D. Blair; Melissa A. McKinney;
    Publisher: American Chemical Society (ACS)

    Interindividual variation in prey specialization is an essential yet overlooked aspect of wildlife feeding ecology, especially as it relates to intrapopulation variation in exposure to toxic contaminants. Here, we assessed blubber concentrations of an extensive suite of persistent organic pollutants in Icelandic killer whales (Orcinus orca). Polychlorinated biphenyl (PCB) concentrations in blubber were >300-fold higher in the most contaminated individual relative to the least contaminated, ranging from 1.3 to 428.6 mg·kg-1 lw. Mean PCB concentrations were 6-to-9-fold greater in individuals with a mixed diet including marine mammals than in fish specialist individuals, whereas males showed PCB concentrations 4-fold higher than females. Given PCBs have been identified as potentially impacting killer whale population growth, and levels in mixed feeders specifically exceeded known thresholds, the ecology of individuals must be recognized to accurately forecast how contaminants may threaten the long-term persistence of the world's ultimate marine predator.

  • Restricted English
    Authors: 
    Malcom Anastasius; Paul Maggiore; Alex L. Huang; Phillip Blanke; Manesh R. Patel; Bjarne L. Nørgaard; Timothy A. Fairbairn; Koen Nieman; Takashi Akasaka; Daniel S. Berman; +17 more
    Countries: Netherlands, Denmark

    Background: CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFR CT) is a safe alternative to invasive coronary angiography. A negative FFR CT has been shown to have low cardiac event rates compared to those with a positive FFR CT. However, the clinical utility of FFR CT according to age is not known. Methods: Patients’ in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry, were stratified into those ≥65 or <65 years of age. The impact of FFR CT on clinical decision-making, as assessed by patient age, was determined by evaluating patient management using CTA results alone, followed by site investigators submitting a report on the treatment plan based upon the newly provided FFR CT data. Outcomes at 1-year post CTA were assessed, including major adverse cardiovascular events (myocardial infarction, all-cause mortality or unplanned hospitalization for ACS leading to revascularisation) and total revascularisation. Positive FFR CT was deemed to be ≤ 0.8. Results: FFR CT was calculated in 1849 (40.6%) subjects aged <65 and 2704 (59.4%) ≥ 65 years of age. Subjects ≥65 years were more likely to have anatomic obstructive disease on CTA (≥50% stenosis), compared to those aged <65 (69.7% and 73.2% respectively, p = 0.008). There was a similar graded increase in recommended and actual revascularisation with either CABG or PCI, with declining FFR CT strata for subjects above and below the age of 65. MACE and revascularisation rates were not significantly different for those ≥ or <65, regardless of FFR CT positivity or stenosis severity <50% or ≥50%. With a negative FFR CT result, and anatomical stenosis ≥50%, those ≥ and <65 years of age, had similar rates of MACE (0.2% for both, p = 0.1) and revascularisation (8.7% and 10.4% respectively p = 0.4). Logistic regression analysis, with age as a continuous variable, and adjustment for Diamond Forrester Risk, baseline FFR CT and treatment (CABG, PCI, medical therapy), indicated a statistically significant, but small increase in the odds of a MACE event with increasing age (OR 1.04, 95% CI 1.006–1.08, p = 0.02). Amongst patients with a FFR CT > 0.80, there was no effect of age on the odds of revascularisation. Conclusion: The findings of this study point to a low risk of MACE events or need for revascularisation in those aged ≥ or <65 with a FFR CT>0.80, despite the higher incidence of anatomic obstructive CAD in those ≥65 years. The findings show the clinical usefulness and outcomes of FFR CT are largely constant regardless of age.

  • Restricted
    Authors: 
    Ju Lee Oei; Vishal S. Kapadia; Yacov Rabi; Ola Didrik Saugstad; Denise Rook; Marijn J. Vermeulen; Nuria Boronat; Valerie Thamrin; William Tarnow-Mordi; John Smyth; +5 more
    Publisher: BMJ
    Country: Netherlands

    ObjectiveTo determine the effects of lower (≤0.3) versus higher (≥0.6) initial fractional inspired oxygen (FiO2) for resuscitation on death and/or neurodevelopmental impairment (NDI) in infants <32 weeks’ gestation.DesignMeta-analysis of individual patient data from three randomised controlled trials.SettingNeonatal intensive care units.Patients543 children <32 weeks’ gestation.InterventionRandomisation at birth to resuscitation with lower (≤0.3) or higher (≥0.6) initial FiO2.Outcome measuresPrimary: death and/or NDI at 2 years of age.Secondary: post-hoc non-randomised observational analysis of death/NDI according to 5-minute oxygen saturation (SpO2) below or at/above 80%.ResultsBy 2 years of age, 46 of 543 (10%) children had died. Of the 497 survivors, 84 (17%) were lost to follow-up. Bayley Scale of Infant Development (third edition) assessments were conducted on 377 children. Initial FiO2 was not associated with difference in death and/or disability (difference (95% CI) −0.2%, −7% to 7%, p=0.96) or with cognitive scores <85 (2%, −5% to 9%, p=0.5). Five-minute SpO2 >80% was associated with decreased disability/death (14%, 7% to 21%) and cognitive scores >85 (10%, 3% to 18%, p=0.01). Multinomial regression analysis noted decreased death with 5-minute SpO2 ≥80% (odds (95% CI) 09.62, 0.98 to 0.96) and gestation (0.52, 0.41 to 0.65), relative to children without death or NDI.ConclusionInitial FiO2 was not associated with difference in risk of disability/death at 2 years in infants <32 weeks’ gestation but CIs were wide. Substantial benefit or harm cannot be excluded. Larger randomised studies accounting for patient differences, for example, gestation and gender are urgently needed.

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The following results are related to Canada. Are you interested to view more results? Visit OpenAIRE - Explore.
31 Research products, page 1 of 4
  • Restricted English
    Authors: 
    Zehua Pan; Roy Brouwer;
    Country: Netherlands

    Green infrastructure for source water protection in the form of forest protection and afforestation is gaining interest worldwide. It is considered more sustainable in the long-term than traditional engineering-based approaches. This paper presents a theoretical model to support investment decisions in green and grey infrastructure to deliver safe drinking water. We first develop a static optimal control model accounting for the uncertainties surrounding green infrastructure. This model is then extended to factor in key characteristics surrounding investment decisions aimed at optimizing the stock of green and grey infrastructure. We first include dynamic forest growth, followed by the risk of wildfires and finally the potential offsetting effect of carbon sequestration on long-term climate change and the reduced risk of wildfires. We provide a numerical example to analyze the performance of the different model specifications, interpret their outcomes and draw conclusions to guide future investment decisions in green and grey infrastructure.

  • Publication . Article . 2021
    Restricted English
    Authors: 
    Ian Fillmore; Jonathan D. Hall;
    Country: Netherlands
    Project: SSHRC

    Abstract Technological innovation can raise the returns to some skills while making others less valuable or even obsolete. We study the effects of such skill-altering technological change in the context of men’s professional tennis, which was unexpectedly transformed by the invention of composite racquets during the late 1970s. We explore the consequences of this innovation on player productivity, entry, and exit. We find that young players benefited at the expense of older players and that the disruptive effects of the new racquets persisted over two to four generations.

  • Restricted
    Authors: 
    Andrew R. Steele; Michael M. Tymko; Victoria L Meah; Lydia L. Simpson; Christopher Gasho; Tony G. Dawkins; Alexandra M. Williams; Francisco C. Villafuerte; Gustavo Vizcardo-Galindo; Rómulo Figueroa-Mujíca; +4 more
    Publisher: American Physiological Society
    Country: Peru

    The high-altitude maladaptation syndrome known as chronic mountain sickness (CMS) is characterized by polycythemia and is associated with proteinuria despite unaltered glomerular filtration rate. However, it remains unclear if indigenous highlanders with CMS have altered volume regulatory hormones. We assessed NH2-terminal pro-B-type natriuretic peptide (NT pro-BNP), plasma aldosterone concentration, plasma renin activity, kidney function (urinary microalbumin, glomerular filtration rate), blood volume, and estimated pulmonary artery systolic pressure (ePASP) in Andean males without ( n = 14; age = 39 ± 11 yr) and with ( n = 10; age = 40 ± 12 yr) CMS at 4,330 m (Cerro de Pasco, Peru). Plasma renin activity (non-CMS: 15.8 ± 7.9 ng/mL vs. CMS: 8.7 ± 5.4 ng/mL; P = 0.025) and plasma aldosterone concentration (non-CMS: 77.5 ± 35.5 pg/mL vs. CMS: 54.2 ± 28.9 pg/mL; P = 0.018) were lower in highlanders with CMS compared with non-CMS, whereas NT pro-BNP was not different between groups (non-CMS: 1394.9 ± 214.3 pg/mL vs. CMS: 1451.1 ± 327.8 pg/mL; P = 0.15). Highlanders had similar total blood volume (non-CMS: 90 ± 15 mL·kg−1 vs. CMS: 103 ± 18 mL·kg−1; P = 0.071), but Andeans with CMS had greater total red blood cell volume (non-CMS: 46 ± 10 mL·kg−1 vs. CMS: 66 ± 14 mL·kg−1; P < 0.01) and smaller plasma volume (non-CMS: 43 ± 7 mL·kg−1 vs. CMS: 35 ± 5 mL·kg−1; P = 0.03) compared with non-CMS. There were no differences in ePASP between groups (non-CMS: 32 ± 9 mmHg vs. CMS: 31 ± 8 mmHg; P = 0.6). A negative correlation was found between plasma renin activity and glomerular filtration rate in both groups (group: r = −0.66; P < 0.01; non-CMS: r = −0.60; P = 0.022; CMS: r = −0.63; P = 0.049). A smaller plasma volume in Andeans with CMS may indicate an additional CMS maladaptation to high altitude, causing potentially greater polycythemia and clinical symptoms.

  • Restricted
    Authors: 
    Guy Helman; Marisa I. Mendes; Francesco Nicita; Lama Darbelli; Omar Sherbini; Travis Moore; Alexa Derksen; Amy Pizzino; Rosalba Carrozzo; Alessandra Torraco; +27 more
    Publisher: Elsevier BV
    Country: Netherlands

    Purpose: Recent reports of individuals with cytoplasmic transfer RNA (tRNA) synthetase-related disorders have identified cases with phenotypic variability from the index presentations. We sought to assess phenotypic variability in individuals with AARS1-related disease. Methods: A cross-sectional survey was performed on individuals with biallelic variants in AARS1. Clinical data, neuroimaging, and genetic testing results were reviewed. Alanyl tRNA synthetase (AlaRS) activity was measured in available fibroblasts. Results: We identified 11 affected individuals. Two phenotypic presentations emerged, one with early infantile–onset disease resembling the index cases of AARS1-related epileptic encephalopathy with deficient myelination (n = 7). The second (n = 4) was a later-onset disorder, where disease onset occurred after the first year of life and was characterized on neuroimaging by a progressive posterior predominant leukoencephalopathy evolving to include the frontal white matter. AlaRS activity was significantly reduced in five affected individuals with both early infantile–onset and late-onset phenotypes. Conclusion: We suggest that variants in AARS1 result in a broader clinical spectrum than previously appreciated. The predominant form results in early infantile–onset disease with epileptic encephalopathy and deficient myelination. However, a subgroup of affected individuals manifests with late-onset disease and similarly rapid progressive clinical decline. Longitudinal imaging and clinical follow-up will be valuable in understanding factors affecting disease progression and outcome.

  • Publication . Other literature type . Part of book or chapter of book . 2021
    Restricted
    Authors: 
    Thomas Tannert; Philipp Dietsch; Jorge M. Branco;
    Publisher: Springer International Publishing
    Country: Portugal

    Wood and engineered wood products, herein also referred to as timber, have been used as structural building material for centuries and countless examples demonstrate its longevity if properly designed, built, maintained and assessed [1, 2]. The more recent development of new engineered wood products, connector systems and growing awareness about sustainability in the construction sector have led to legislative changes in the building sector and as a consequence also a significant widening in the range of structural applications of timber [3, 4]. Revised proof - (undefined)

  • Restricted English
    Authors: 
    Steele Gray, Carolyn; Ross Baker, G.; Breton, Mylaine; Kee, Karin; Minkman, Mirella; Shaw, James; Tietschert, Maike; Wankah, Paul; Wodchis, Walter; Zonneveld, Nick; +5 more
    Publisher: Palgrave / MacMillan
    Country: Netherlands

    Health, social, and community care agencies are undergoing rapid changes in response to the COVID-19 pandemic, arguably offering a “window of opportunity” for health system transformation. What is required is theoretical guidance to help determine whether rapid system responses are likely to be sustained as part of broader transformation efforts. We performed a single-phenomenon two theory integration to develop the Rapid and Sustainable Transformation (or RAST) framework, aligning theories from the disaster response and sustainability literature to propose a framework exploring the long-term impact of rapid health system changes and interventions related to COVID-19. In this chapter, the proposed theoretical framework is applied to three cases from Quebec and Ontario in Canada and The Netherlands to examine ongoing efforts to improve health system delivery prior to the pandemic. By applying the framework to these cases, this chapter demonstrates how the framework can help to identify components that require attention for studying sustainability in a disaster response environment. The RAST framework helps advance organizational research around health system transformation by demonstrating how the components of sustainability are interrelated and may be weighed differently in their influence on longer-term transformation.

  • Restricted
    Authors: 
    Mehmet N. Cizmeci; Linda S. de Vries; Maria Luisa Tataranno; Alexandra Zecic; Laura A. van de Pol; Ana Alarcon; Floris Groenendaal; Peter A. Woerdeman;
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Country: Netherlands

    OBJECTIVE Decompressing the ventricles with a temporary device is often the initial neurosurgical intervention for preterm infants with hydrocephalus. The authors observed a subgroup of infants who developed intraparenchymal hemorrhage (IPH) after serial ventricular reservoir taps and sought to describe the characteristics of IPH and its association with neurodevelopmental outcome. METHODS In this multicenter, case-control study, for each neonate with periventricular and/or subcortical IPH, a gestational age-matched control with reservoir who did not develop IPH was selected. Digital cranial ultrasound (cUS) scans and term-equivalent age (TEA)–MRI (TEA-MRI) studies were assessed. Ventricular measurements were recorded prior to and 3 days and 7 days after reservoir insertion. Changes in ventricular volumes were calculated. Neurodevelopmental outcome was assessed at 2 years corrected age using standardized tests. RESULTS Eighteen infants with IPH (mean gestational age 30.0 ± 4.3 weeks) and 18 matched controls were included. Reduction of the ventricular volumes relative to occipitofrontal head circumference after 7 days of reservoir taps was greater in infants with IPH (mean difference −0.19 [95% CI −0.37 to −0.004], p = 0.04). Cognitive and motor Z-scores were similar in infants with and those without IPH (mean difference 0.42 [95% CI −0.17 to 1.01] and 0.58 [95% CI −0.03 to 1.2]; p = 0.2 and 0.06, respectively). Multifocal IPH was negatively associated with cognitive score (coefficient −0.51 [95% CI −0.88 to −0.14], p = 0.009) and ventriculoperitoneal shunt with motor score (coefficient −0.50 [95% CI −1.6 to −0.14], p = 0.02) after adjusting for age at the time of assessment. CONCLUSIONS This study reports for the first time that IPH can occur after a rapid reduction of the ventricular volume during the 1st week after the initiation of serial reservoir taps in neonates with hydrocephalus. Further studies on the use of cUS to guide the amount of cerebrospinal fluid removal are warranted.

  • Restricted
    Authors: 
    Anaïs Remili; Robert J. Letcher; Filipa I. P. Samarra; Rune Dietz; Christian Sonne; Jean-Pierre Desforges; Gísli A. Víkingsson; David A.D. Blair; Melissa A. McKinney;
    Publisher: American Chemical Society (ACS)

    Interindividual variation in prey specialization is an essential yet overlooked aspect of wildlife feeding ecology, especially as it relates to intrapopulation variation in exposure to toxic contaminants. Here, we assessed blubber concentrations of an extensive suite of persistent organic pollutants in Icelandic killer whales (Orcinus orca). Polychlorinated biphenyl (PCB) concentrations in blubber were >300-fold higher in the most contaminated individual relative to the least contaminated, ranging from 1.3 to 428.6 mg·kg-1 lw. Mean PCB concentrations were 6-to-9-fold greater in individuals with a mixed diet including marine mammals than in fish specialist individuals, whereas males showed PCB concentrations 4-fold higher than females. Given PCBs have been identified as potentially impacting killer whale population growth, and levels in mixed feeders specifically exceeded known thresholds, the ecology of individuals must be recognized to accurately forecast how contaminants may threaten the long-term persistence of the world's ultimate marine predator.

  • Restricted English
    Authors: 
    Malcom Anastasius; Paul Maggiore; Alex L. Huang; Phillip Blanke; Manesh R. Patel; Bjarne L. Nørgaard; Timothy A. Fairbairn; Koen Nieman; Takashi Akasaka; Daniel S. Berman; +17 more
    Countries: Netherlands, Denmark

    Background: CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFR CT) is a safe alternative to invasive coronary angiography. A negative FFR CT has been shown to have low cardiac event rates compared to those with a positive FFR CT. However, the clinical utility of FFR CT according to age is not known. Methods: Patients’ in the ADVANCE (Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care) registry, were stratified into those ≥65 or <65 years of age. The impact of FFR CT on clinical decision-making, as assessed by patient age, was determined by evaluating patient management using CTA results alone, followed by site investigators submitting a report on the treatment plan based upon the newly provided FFR CT data. Outcomes at 1-year post CTA were assessed, including major adverse cardiovascular events (myocardial infarction, all-cause mortality or unplanned hospitalization for ACS leading to revascularisation) and total revascularisation. Positive FFR CT was deemed to be ≤ 0.8. Results: FFR CT was calculated in 1849 (40.6%) subjects aged <65 and 2704 (59.4%) ≥ 65 years of age. Subjects ≥65 years were more likely to have anatomic obstructive disease on CTA (≥50% stenosis), compared to those aged <65 (69.7% and 73.2% respectively, p = 0.008). There was a similar graded increase in recommended and actual revascularisation with either CABG or PCI, with declining FFR CT strata for subjects above and below the age of 65. MACE and revascularisation rates were not significantly different for those ≥ or <65, regardless of FFR CT positivity or stenosis severity <50% or ≥50%. With a negative FFR CT result, and anatomical stenosis ≥50%, those ≥ and <65 years of age, had similar rates of MACE (0.2% for both, p = 0.1) and revascularisation (8.7% and 10.4% respectively p = 0.4). Logistic regression analysis, with age as a continuous variable, and adjustment for Diamond Forrester Risk, baseline FFR CT and treatment (CABG, PCI, medical therapy), indicated a statistically significant, but small increase in the odds of a MACE event with increasing age (OR 1.04, 95% CI 1.006–1.08, p = 0.02). Amongst patients with a FFR CT > 0.80, there was no effect of age on the odds of revascularisation. Conclusion: The findings of this study point to a low risk of MACE events or need for revascularisation in those aged ≥ or <65 with a FFR CT>0.80, despite the higher incidence of anatomic obstructive CAD in those ≥65 years. The findings show the clinical usefulness and outcomes of FFR CT are largely constant regardless of age.

  • Restricted
    Authors: 
    Ju Lee Oei; Vishal S. Kapadia; Yacov Rabi; Ola Didrik Saugstad; Denise Rook; Marijn J. Vermeulen; Nuria Boronat; Valerie Thamrin; William Tarnow-Mordi; John Smyth; +5 more
    Publisher: BMJ
    Country: Netherlands

    ObjectiveTo determine the effects of lower (≤0.3) versus higher (≥0.6) initial fractional inspired oxygen (FiO2) for resuscitation on death and/or neurodevelopmental impairment (NDI) in infants <32 weeks’ gestation.DesignMeta-analysis of individual patient data from three randomised controlled trials.SettingNeonatal intensive care units.Patients543 children <32 weeks’ gestation.InterventionRandomisation at birth to resuscitation with lower (≤0.3) or higher (≥0.6) initial FiO2.Outcome measuresPrimary: death and/or NDI at 2 years of age.Secondary: post-hoc non-randomised observational analysis of death/NDI according to 5-minute oxygen saturation (SpO2) below or at/above 80%.ResultsBy 2 years of age, 46 of 543 (10%) children had died. Of the 497 survivors, 84 (17%) were lost to follow-up. Bayley Scale of Infant Development (third edition) assessments were conducted on 377 children. Initial FiO2 was not associated with difference in death and/or disability (difference (95% CI) −0.2%, −7% to 7%, p=0.96) or with cognitive scores <85 (2%, −5% to 9%, p=0.5). Five-minute SpO2 >80% was associated with decreased disability/death (14%, 7% to 21%) and cognitive scores >85 (10%, 3% to 18%, p=0.01). Multinomial regression analysis noted decreased death with 5-minute SpO2 ≥80% (odds (95% CI) 09.62, 0.98 to 0.96) and gestation (0.52, 0.41 to 0.65), relative to children without death or NDI.ConclusionInitial FiO2 was not associated with difference in risk of disability/death at 2 years in infants <32 weeks’ gestation but CIs were wide. Substantial benefit or harm cannot be excluded. Larger randomised studies accounting for patient differences, for example, gestation and gender are urgently needed.