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The aim of this study was to review our institution’s experience with truncus arteriosus from prenatal diagnosis to clinical outcome.
Methods:
and results: We conducted a single-centre retrospective cohort study for the years 2005–2020. Truncus arteriosus antenatal echocardiographic diagnostic accuracy within our institution was 92.3%. After antenatal diagnosis, five parents (31%) decided to terminate the pregnancy. After inclusion from referring hospitals, 16 patients were offered surgery and were available for follow-up. Right ventricle-to-pulmonary artery continuity was preferably established without the use of a valve (direct connection), which was possible in 14 patients (88%). There was no early or late mortality. Reinterventions were performed in half of the patients at latest follow-up (median follow-up of 5.4 years). At a median age of 5.5 years, 13 out of 14 patients were still without right ventricle-to-pulmonary artery valve, which was well tolerated without signs of right heart failure. The right ventricle demonstrated preserved systolic function as expressed by tricuspid annular plane systolic excursion z-score (−1.4 ± 1.7) and fractional area change (44 ± 12%). The dimensions and function of the left ventricle were normal at latest follow-up (ejection fraction 64.4 ± 6.2%, fractional shortening 34.3 ± 4.3%).
Conclusions:
This study demonstrates good prenatal diagnostic accuracy of truncus arteriosus. There was no mortality and favourable clinical outcomes at mid-term follow-up, with little interventions on the right ventricle-to-pulmonary artery connection and no right ventricle deterioration. This supports the notion that current perspectives of patients with truncus arteriosus are good, in contrast to the poor historic outcome series. This insight can be used in counselling and surgical decision-making.
Mental disorders are common in people living with HIV (PLWH) but often remain untreated. This study aimed to explore the treatment gap for mental disorders in adults followed-up in antiretroviral therapy (ART) programmes in South Africa and disparities between ART programmes regarding the provision of mental health services.
Methods
We conducted a cohort study using ART programme data and linked pharmacy and hospitalisation data to examine the 12-month prevalence of treatment for mental disorders and factors associated with the rate of treatment for mental disorders among adults, aged 15–49 years, followed-up from 1 January 2012 to 31 December 2017 at one private care, one public tertiary care and two pubic primary care ART programmes in South Africa. We calculated the treatment gap for mental disorders as the discrepancy between the 12-month prevalence of mental disorders in PLWH (aged 15–49 years) in South Africa (estimated based on data from the Global Burden of Disease study) and the 12-month prevalence of treatment for mental disorders in ART programmes. We calculated adjusted rate ratios (aRRs) for factors associated with the treatment rate of mental disorders using Poisson regression.
Results
In total, 182 285 ART patients were followed-up over 405 153 person-years. In 2017, the estimated treatment gap for mental disorders was 40.5% (95% confidence interval [CI] 19.5–52.9) for patients followed-up in private care, 96.5% (95% CI 95.0–97.5) for patients followed-up in public primary care and 65.0% (95% CI 36.5–85.1) for patients followed-up in public tertiary care ART programmes. Rates of treatment with antidepressants, anxiolytics and antipsychotics were 17 (aRR 0.06, 95% CI 0.06–0.07), 50 (aRR 0.02, 95% CI 0.01–0.03) and 2.6 (aRR 0.39, 95% CI 0.35–0.43) times lower in public primary care programmes than in the private sector programmes.
Conclusions
There is a large treatment gap for mental disorders in PLWH in South Africa and substantial disparities in access to mental health services between patients receiving ART in the public vs the private sector. In the public sector and especially in public primary care, PLWH with common mental disorders remain mostly untreated.
Camera-based systems in dairy cattle were intensively studied over the last years. Different from this study, single camera systems with a limited range of applications were presented, mostly using 2D cameras. This study presents current steps in the development of a camera system comprising multiple 3D cameras (six Microsoft Kinect cameras) for monitoring purposes in dairy cows. An early prototype was constructed, and alpha versions of software for recording, synchronizing, sorting and segmenting images and transforming the 3D data in a joint coordinate system have already been implemented. This study introduced the application of two-dimensional wavelet transforms as method for object recognition and surface analyses. The method was explained in detail, and four differently shaped wavelets were tested with respect to their reconstruction error concerning Kinect recorded depth maps from different camera positions. The images’ high frequency parts reconstructed from wavelet decompositions using the haar and the biorthogonal 1.5 wavelet were statistically analyzed with regard to the effects of image fore- or background and of cows’ or persons’ surface. Furthermore, binary classifiers based on the local high frequencies have been implemented to decide whether a pixel belongs to the image foreground and if it was located on a cow or a person. Classifiers distinguishing between image regions showed high (⩾0.8) values of Area Under reciever operation characteristic Curve (AUC). The classifications due to species showed maximal AUC values of 0.69.
Measuring and mitigating methane (CH4) emissions from livestock is of increasing importance for the environment and for policy making. Potentially, the most sustainable way of reducing enteric CH4 emission from ruminants is through the estimation of genomic breeding values to facilitate genetic selection. There is potential for adopting genetic selection and in the future genomic selection, for reduced CH4 emissions from ruminants. From this review it has been observed that both CH4 emissions and production (g/day) are a heritable and repeatable trait. CH4 emissions are strongly related to feed intake both in the short term (minutes to several hours) and over the medium term (days). When measured over the medium term, CH4 yield (MY, g CH4/kg dry matter intake) is a heritable and repeatable trait albeit with less genetic variation than for CH4 emissions. CH4 emissions of individual animals are moderately repeatable across diets, and across feeding levels, when measured in respiration chambers. Repeatability is lower when short term measurements are used, possibly due to variation in time and amount of feed ingested prior to the measurement. However, while repeated measurements add value; it is preferable the measures be separated by at least 3 to 14 days. This temporal separation of measurements needs to be investigated further. Given the above issue can be resolved, short term (over minutes to hours) measurements of CH4 emissions show promise, especially on systems where animals are fed ad libitum and frequency of meals is high. However, we believe that for short-term measurements to be useful for genetic evaluation, a number (between 3 and 20) of measurements will be required over an extended period of time (weeks to months). There are opportunities for using short-term measurements in standardised feeding situations such as breath ‘sniffers’ attached to milking parlours or total mixed ration feeding bins, to measure CH4. Genomic selection has the potential to reduce both CH4 emissions and MY, but measurements on thousands of individuals will be required. This includes the need for combined resources across countries in an international effort, emphasising the need to acknowledge the impact of animal and production systems on measurement of the CH4 trait during design of experiments.
It has been suggested that efficacy and safety are the core issues for technology assessment in health care (1). To this must be added the issue of appropriateness (2). Efficacy remains the first issue nonetheless, for surely no one would knowingly evaluate the safety of an ineffective technology.
Plasmas of high reproducibility that are suitable for beam-plasma experiments are generated by a pulsed-power z-pinch discharge. The z-pinch device is designed as a plasma target for the investigation of ion beam-plasma interactions. The dynamic plasma state is characterized by the electron density, the electron temperature, and the magnetic field distribution, which are observed using time-resolved diagnostics. For z-pinch discharges in hydrogen, average electron densities of up to (2.6 ± 0.1) × 1018 electrons/cm3 were measured interferometrically. Electron temperatures in the range 2–7 eV are determined by time-resolved spectroscopy. The reproducibility of the electron density of the z-pinch discharge in terms of shot-to-shot fluctuations is estimated to be better than 3%. This is a favorable condition for performing beam-plasma experiments.
The aim of this study was to describe a systematic process of record-linkage, cross-validation, case-ascertainment and capture–recapture analysis to assess the quality of tuberculosis registers and to estimate the completeness of notification of incident tuberculosis cases in The Netherlands in 1998. After record-linkage and cross-validation 1499 tuberculosis patients were identified, of whom 1298 were notified, resulting in an observed under-notification of 13·4%. After adjustment for possible imperfect record-linkage and remaining false-positive hospital cases observed under-notification was 7·3%. Log-linear capture–recapture analysis initially estimated a total number of 2053 (95% CI 1871–2443) tuberculosis cases, resulting in an estimated under-notification of 36·8%. After adjustment for possible imperfect record-linkage and remaining false-positive hospital cases various capture–recapture models estimated under-notification at 13·6%. One of the reasons for the higher than expected estimated under-notification in a country with a well-organized system of tuberculosis control might be that some tuberculosis cases, e.g. extrapulmonary tuberculosis, are managed by clinicians less familiar with notification of infectious diseases. This study demonstrates the possible impact of violation of assumptions underlying capture–recapture analysis, especially the perfect record-linkage, perfect positive predictive value and absent three-way interaction assumptions.
The incidence of invasive meningococcal disease (IMD) in Germany in 2003 was estimated by the two-source capture–recapture method. As a unique personal identifier was unavailable, cases with IMD tested at the National Reference Centre for Meningococci (NRZM) were matched with cases reported to the Robert Koch Institute (RKI) through the statutory surveillance system by using demographic and disease-specific variables common to both datasets. The estimated overall incidence was 1·1 IMD cases/100 000 inhabitants, with a sensitivity of ascertainment of 64·8% for NRZM and 89·4% for RKI. Case-fatality rate was estimated at 8·8%. Adjustment for heterogeneity of capture according to age, region and serogroup observed in the NRZM (but not RKI) source had minimal effect on the estimated incidence. The IMD incidence estimated by capture–recapture analysis is thus only slightly higher than through statutory surveillance data. As a degree of positive dependence between the systems cannot be ruled out, this estimate may still be an underestimate. However, under ascertainment appears insufficient to explain the low incidence of IMD in Germany compared to other European countries.
A shock front in the concentration between two miscible fluids flowing through a porous medium becomes dispersed owing to the heterogeneous structure of the porous medium. If the fluids have equal viscosity and density and the heterogeneity of the porous medium is statistically homogeneous, the length of the dispersion zone between the fluids is known to increase as (βX)½, where β is the dispersivity and X is the average displacement distance. At present the dispersivity is considered to be a property of only the porous medium. For the case where the fluids differ in density and/or in viscosity we have investigated the effect of the dynamics of the fluid flow on the magnitude of the dispersivity β and on the validity of the X½ dependence of the dispersion zone's length. First, we measured the dispersivity in a 1.8 m long sandstone core with brine displacing water and with gas displacing oil. The measurements demonstrate that the dispersivity does indeed depend on the displacement velocity. Second, we monitored the expansion of the dispersion zone using detailed numerical simulations of the flow in a porous medium with statistically homogeneous heterogeneity. We found that the dispersion zone does grow as X½ in the presence of a density contrast and a viscosity contrast, in spite of the nonlinearity of the governing equations. Third, we quantified the magnitude of the dispersivity by means of a random-walk model and tested the model against the experiments and the numerical simulations. Experiments, simulations and the model show that the dispersivity is strongly dependent on the displacement velocity in the conditionally stable flow regime. They also show that a nearly non-dispersive development of the shock front between the fluids occurs when gravity segregation dominates the dispersive effect of the porous medium. Even a very small difference in density, such as that between water and brine, can suppress the dispersivity significantly.
Emission-line observations made with the Spitzer Space Telescope are used to test the predicted ionizing spectral energy distributions of various stellar atmosphere models.
M. Samimy, Ohio State University,K. S. Breuer, Brown University, Rhode Island,L. G. Leal, University of California, Santa Barbara,P. H. Steen, Cornell University, New York
The dynamics of competitive colonisation of necrotic cyclamen tissue by the plant pathogenic fungus Botrytis cinerea and the saprophytic fungal antagonist Ulocladium atrum were studied immuno-histologically, while sporulation was studied macroscopically. The effect of different time intervals between inoculation of both fungi on resource capture by each species was explored. Colonisation and sporulation were used as indicators for competitive resource capture and the effectiveness of biological control of B. cinerea, using U. atrum. Mycelial biomass and sporulation showed logistical time courses in both species, in monocultures as well as in mixed cultures. Final colonisation and sporulation levels were lowered by competition, indicating competitive resource capture. Analysis of the extent to which sporulation of either fungus could be reduced by co-inoculation with the other fungus at different times, showed that B. cinerea can be completely excluded by ‘early’ pre-inoculation with U. atrum, but not vice versa, indicating that U. atrum can exploit resources in the leaf that are not accessible to B. cinerea. A model of competitive substrate colonisation and resource capture was developed on the basis of the experimental results. Model results confirm that competition for resources provides a sufficient biological explanation for the dynamic interactions between the fungi. The model provides a tool to optimise dose and timing of U. atrum applications providing effective biological control of B. cinerea.
The higher spatial resolution and sensitivity of ISO allowed several extragalactic surveys to be extended to greater depth than obtained with IRAS. With the extended wavelength range deep surveys were performed for the first time at wavelengths up to ~ 200 μm. They favour galaxy models with strong evolution. With ISO's new capabilities the spectral energy distributions of larger samples of ULIRGs in the local universe and those of quasars and radio galaxies were determined. These data are applicable as templates to the more distant universe. Foreground components from zodiacal light and cirrus to the intracluster dust emission were studied in connection with their separation from the extragalactic background radiation.
This paper discusses the induction of residual stresses during the curing process of thin titania layers, which are derived using a sol-gel process. During this process, stresses may build up in the spinning stage, the drying stage, and the consolidation stage. The magnitude and character of these stresses depend heavily on the morphology of the layers in the various stages and the processing conditions. Dried layers are densified using two different processes, conventional furnace heating and laser heating. X-ray analysis and scanning electron microscopy are used as tools to study crystallization, grain growth, phase transformation, and the evolution of residual stress fields in the thin titania layers. Through an extensive study of the residual stress state in the layers, more insight is gained in the evolution of stresses during the curing process of sol-gel-derived thin titania layers.
Nucleation and growth of metal clusters at defect sites is discussed in terms of rate equation models, which are applied to the cases of Pd and Ag on MgO(001) and NaCl(001) surfaces. Pd/MgO has been studied experimentally by variable temperature atomic force microscopy (AFM). The island density of Pd on Ar-cleaved surfaces was determined in-situ by AFM for a wide range of deposition temperature and flux, and stays constant over a remarkably wide range of parameters; for a particular flux, this plateau extends from 200 K ≤ T ≤ 600 K, but at higher temperatures the density decreases. The range of energies for defect trapping, adsorption, surface diffusion and pair binding are deduced, and compared with earlier data for Ag on NaCl, and with recent calculations for these metals on both NaCl and MgO
We present new far-infrared line observations of the planetary nebulae (PNs) NGC 7027, NGC 7009, NGC 6210, NGC 6543, and IC 4997 obtained with the Kuiper Airborne Observatory (KAO). The bulk of our data are for NGC 7027 and NGC 7009, including [Ne V] 24 μm, [O IV] 26 μm, [O III] (52, 88μm), and [Nm] 57 μm. Our data for [O III] (52, 88) and [N III] 57 in NGC 7027 represent the first measurements of these lines in this source. The large [O III] 52/88 flux ratio implies an electron density (cm–3) of log Ne[O III] = 4.19, the largest Ne ever inferred from these lines. We derive N++/O++ = 0.394±0.062 for NGC 7027 and 0.179±0.043 for NGC 6210. We are able to infer the O+3/O++ ionic ratio from our data. As gauged by this ionic ratio, NGC 7027 is substantially higher ionization than is NGC 7009 – consistent with our observation that the former produces copious [Ne V] emission while the latter does not. These data help characterize the stellar ionizing radiation field.
Far UV high resolution spectra of 3 LMC and SMC stars were obtained with the Echelle spectrograph during the second ORFEUS mission in Dec. 1996. We present the first results from observations of the LMC star HDE 269546. We find definitely components of very hot gas identified as OVI and SVI absorption in the galactic halo of the Milky Way and in the LMC. Additionally, more than 30 ions of the most abundant elements in different stages of ionization can be identified in both our galaxy and the LMC. For the first time we can identify a significant absorption component of molecular hydrogen in the ORFEUS II Echelle spectrum with a redshift of 200 km s−1, doubtlessly to be attributed to the LMC.
During the second flight of the ORFEUS-SPAS satellite (Nov./Dec. 96) high resolution (λ/∆λ = 10,000) Echelle-spectra of BD+28° 4211 in the wavelength regime 912–1400 Å have been taken. Deuterium can be clearly identified in the ORFEUSII Echelle-spectra of this star. For the first time it was possible to take spectra of faint, not redshifted objects in the far ultraviolet with a sufficient spectral resolution to study the deuterium column density in the whole spectral range of the Lyman-series down to the Lyman-limit. We obtained a value of log(ND) = 14.7 (±0.3) towards BD+28° 4211. The hydrogen column density has been determined using ORFEUS Echelle- and IUE-spectra of Ly-α (log(NH) = 19.8 (±0.2)). Thus a value of 8 × 10−6 can be obtained for the D/H-ratio on the line-of-sight towards BD+28° 4211.