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Outcomes for children with heart disease improved over the past decades. Quality improvement (QI) research in paediatric cardiac critical care is a key driver of improvement. The availability and variability of QI research across the field is unknown. This project represents a step in understanding the role. The Pediatric Cardiac Intensive Care Society (PCICS) can serve to support institutions’ needs, drive collaborations, and utilise available infrastructure at member institutions for improvement work.
Methods:
The PCICS Quality Improvement and Safety Committee developed a survey to assess the state of QI research. The survey was disseminated over several months and available via QR code at the World Congress of Pediatric Cardiology and Cardiac Surgery in 2023.
Results:
Fifty-eight respondents completed the survey representing at least 38 unique institutions. Most respondents participated in QI research (52/58, 90%). Most QI projects were single centre (41% of respondents), and of those, the majority were from a minority of institutions (13 institutions [34% of total institutions]). QI support is available at slightly more than half of units, and 55% (32/58) have access to a QI specialist. QI support and rate of publications is significantly lower for small/medium units as compared to large units. Respondents suggested most interest from PCICS in networking with other members with similar project ideas (50/58, 86%).
Conclusion:
PCICS member institutions are committed to QI research, with limitations in support, local specialists, and networking. Increasing connectivity and accessibility to QI resources may reduce burden to individual members and institutions to achieve QI research.
It is unclear how extracorporeal membrane oxygenation use varies across paediatric cardiac surgical programmes and how it relates to post-operative mortality. We aimed to determine hospital-level variation in post-operative extracorporeal membrane oxygenation use and its association with case-mix adjusted mortality.
Methods:
Retrospective analysis of 37 hospitals contributing to the Pediatric Cardiac Critical Care Consortium clinical registry from 1 August 2014 to 31 December 2019. Hospitalisations including cardiothoracic surgery and post-operative admission to paediatric cardiac ICUs were included. Two-level multivariable logistic regression with hospital random effect was used to determine case-mix adjusted post-operative extracorporeal membrane oxygenation use rates and in-hospital mortality. Hospitals were grouped into extracorporeal membrane oxygenation use tertiles, and mortality was compared across tertiles.
Results:
There were 43,640 eligible surgical hospitalisations; 1397 (3.2%) included at least one post-operative extracorporeal membrane oxygenation run. Case-mix adjusted extracorporeal membrane oxygenation rates varied more than sevenfold (0.9–6.9%) across hospitals, and adjusted mortality varied 10-fold (0–5.5%). Extracorporeal membrane oxygenation rates were 2.0%, 3.5%, and 5.2%, respectively, for low, middle, and high extracorporeal membrane oxygenation use tertiles (P < 0.0001), and mortality rates were 1.9%, 3.0%, and 3.1% (p < 0.0001), respectively. High extracorporeal membrane oxygenation use hospitals were more likely to initiate extracorporeal membrane oxygenation support intraoperatively (1.6% vs. 0.6% low and 1.1% middle, p < 0.0001). Extracorporeal membrane oxygenation indications were similar across hospital tertiles. When extracorporeal cardiopulmonary resuscitation was excluded, variation in extracorporeal membrane oxygenation use rates persisted (1.5%, 2.6%, 3.8%, p < 0.001).
Conclusions:
There is hospital variation in adjusted post-operative extracorporeal membrane oxygenation use after paediatric cardiac surgery and a significant association with adjusted post-operative mortality. These findings suggest that post-operative extracorporeal membrane oxygenation use could be a complementary quality metric to mortality to assess performance of cardiac surgical programmes.
Silvopastoral systems (SPSs) are sustainable alternatives for pasture intensification. Management practices such as thinning are options to diminish competition for resources between pasture and trees, ensuring appropriate forage production. The objective of this study was to evaluate the productive and nutritive traits of Piatã palisadegrass (Urochloa brizantha cv. BRS Piatã) after thinning the forest component of a SPS. Forage production and nutritive value, along with microclimate variables were assessed in a SPS and in an intensive system (INT) in São Carlos-SP, Brazil, from 2016 to 2018. The INT was a full sun pasture of Piatã palisadegrass, while the SPS was established with Piatã palisadegrass shaded by eucalyptus (Eucalyptus urograndis clone GG100) spaced 15 × 2 m but thinned to 15 × 4 m before the onset of the experiment. In the SPS, measurements were made under the tree row (SPS_1), 3.75-m (SPS_2), 7.5-m (SPS_3) and 11.25-m (SPS_4) distant from the North row. Forage accumulation in the two systems were similar, whereas the pre-grazing forage mass in most of the SPS positions were smaller than that of the INT during the autumn of 2017 and summer of 2018. Crude protein (CP) content was greater in the SPS than in the INT in most positions and seasons. Forage production was favoured by the thinning of the trees mainly in the seasons close to the event, while forage CP was consistently greater in the understory pasture. Thinning of trees in SPSs can be adopted to provide forage production similar to intensive pastures with higher protein content.
In intensive livestock production systems, estimating forage production and its nutritive value can assist farmers in optimizing pasture management, stocking rate, and feed supplementation to animals. In this study, we aimed to use vegetation indices, determined using a proximal canopy reflectance sensor, to estimate the forage mass, crude protein content, and nitrogen in live forage of Marandu palisadegrass (Urochloa brizantha). Pasture canopy reflectance was measured at three wavelengths (670, 720, and 760 nm) using a Crop Circle device equipped with an ACS-430 sensor. Total forage mass, plant-part composition, leaf area index (LAI), and crude protein content were assessed during 14 growth cycles in a pasture under four management regimes, comprising different combinations of two N fertilization rates and two irrigation schedules. For each forage assessment, pasture canopy reflectance data were used to calculate the following vegetation indices: normalized difference vegetation index, normalized difference red edge, simple ratio index (SRI), modified simple ratio, and chlorophyll index. In addition, we also performed analyses of the linear and exponential regressions between vegetation indices and total forage mass, leaf + stem mass, leaf mass, LAI, crude protein content, and nitrogen in live forage. The best estimates were achieved for total forage mass, leaf + stem mass, leaf mass, and nitrogen in live forage using SRI (R2 values between 0.72 and 0.79). When estimating pasture productive variables (total forage mass, leaf + stem mass, leaf mass, and LAI) from SRI, the equations showed R2 values between 0.69 (leaf mass) and 0.74 (LAI) and relative errors ranging from 19% to 21%. For each of the water and nitrogen supply conditions evaluated, this index facilitated the monitoring of forage mass time series and nitrogen in live forage and the extraction of this nutrient by the pasture.
Non-equilibrium evolution of wave fields, as occurring over sudden bathymetry variations, can produce rogue seas with anomalous wave statistics. We handle this process by modifying the Rayleigh distribution through the energetics of second-order theory and a non-homogeneous reformulation of the Khintchine theorem. The resulting probability model reproduces the enhanced tail of the probability distribution of unidirectional wave tank experiments. It also describes why the peak of rogue wave probability appears atop the shoal, and explains the influence of depth on variations in peak intensity. Furthermore, we interpret rogue wave likelihoods in finite depth through the $H$–$\sigma$ diagram, allowing a quick prediction for the effects of rapid depth change apart from the probability distribution.
In questo contributo gli autori pubblicano una statua con iscrizione inedita proveniente dall'antico sito di Careiae, nell'Etruria meridionale. Essa offre l'opportunità di riflettere sul ruolo di questo piccolo centro nei pressi di Roma, di cui poco sappiamo, sulla rarissima connessione tra il collegio dei dendrofori e Virtus e sul ruolo che il collegio dei dendrofori poteva avere anche al di fuori dai contesti urbani. L'edizione di questo nuovo testo ha offerto anche l'occasione di riconsiderare un analogo plinto iscritto di statua, oggi conservato a Vienna e attribuito finora a Roma.
We study trading and risk management decisions of banks in over-the-counter markets, accounting for 2 types of risk: payoff risk from loans and counterparty risk from trading activities. Our model provides empirically supported predictions on the structure of the interbank credit default swap (CDS) market: i) banks with high default probabilities either buy or sell CDS contracts; ii) because of the counterparty risk friction, payoff risk is only partially shared; and iii) safe banks act as intermediaries and help diversify counterparty risk. Banks manage their default probabilities to become creditworthy counterparties, but they do so in a socially inefficient way.
Genetic structure may be highly variable across seabird species, and particularly among those that are distributed over large geographical areas. The Adélie penguin (Pygoscelis adeliae) is a numerically dominant Antarctic seabird that is considered to be a key species in coastal ecosystems. Since the Last Glacial Maximum, penguin colonization of the Antarctic coastline occurred at varying geographical and temporal scales, contributing to an incomplete understanding of how modern colonies relate to each other at local or regional scales. We assessed the population genetic structure of Adélie penguins (n = 86 individuals) from three adjacent colonies along the Victoria Land coast using molecular genetic markers (i.e. seven microsatellite loci isolated through next-generation sequencing). Our results indicate meta-population dynamics and possibly relationships with habitat quality. A generally low genetic diversity (Nei's index: 0.322–0.667) was observed within each colony, in contrast to significant genetic heterogeneity among colonies (pairwise FST = 0.071–0.148), indicating that populations were genetically structured. Accordingly, an assignment test correctly placed individuals within the respective colonies from which they were sampled. The presence of inter-colony genetic differentiation contrasts with previous studies on this species that showed a lack of genetic structure, possibly due to higher juvenile or adult dispersal. Our sampled colonies were not panmictic and suggest a lower migration rate, which may reflect relatively stable environmental conditions in the Ross Sea compared to other regions of Antarctica, where the ocean climate is warming.
The Pitti crystal column, preserved at the Uffizi Museum, is one of the most refined glyptic objects of the Renaissance age. Owing to its decorative system on a miniature scale, the significance of many of its scenes has remained unclear, and hence, as a consequence, so have its function, iconological message, the meaning of its all'antica style, and its intended recipient. Using detailed images of each engraved scene, this paper shows how the decorative system of the artefact (originally a mirror) is related to King Philip II of Spain (1527–1598). The entire decoration was designed to eulogize Philip II, and especially the Battle of Saint-Quentin (1557), and his consequent control over some Italian lands (Milan, Naples, Sicily and Sardinia) after the Treaty of Cateau-Cambrésis (1559). The paper investigates the reasons why Trajan's Column was chosen as an inspirational model for the Pitti column and how such an ancient model was re-elaborated and renewed through the combination of other elements that came from a wider antiquarian all'antica repertoire. In this way, it is possible to show that this valuable artefact is a clear example of how the use of all'antica style in the Renaissance was not purely referencing a glorious past, but was adapted to the use of the object itself.
Glacial extent and mass balance are sensitive climate proxies providing solid information on past climatic conditions. However, series of annual mass-balance measurements of more than 60 years are scarce. To our knowledge, this is the first time the latewood density data (MXD) of the Swiss stone pine (Pinus cembra L.) have been used to reconstruct the summer mass balance (Bs) of an Alpine glacier. The MXD-based Bs well correlates with a Bs reconstruction based on the May to September temperature. Winter precipitation has been used as an independent proxy to infer the winter mass balance and to obtain an annual mass-balance (Bn) estimate dating back to the glaciological year 1811/12. The reconstructed MXD/precipitation-based Bn well correlates with the data both of the Careser and of other Alpine glaciers measured by the glaciological method. A number of critical issues should be considered in both proxies, including non-linear response of glacial mass balance to temperature, bedrock topography, ice thinning and fragmentation, MXD acquisition and standardization methods, and finally the ‘divergence problem’ responsible for the recently reduced sensitivity of the dendrochronological data. Nevertheless, our results highlight the possibility of performing MXD-based dendroglaciological reconstructions using this stable and reliable proxy.
Recent findings point at novel benefits of specific fibres, like inulin, as their fermentation metabolites can improve mucosal immunity and protect against infections (1,2). This outcome is desirable for athletes, who are at increased exposure to oxidative damage and thus risk of upper respiratory tract infections (URTI). However, whether inulin can improve immune function in athletes is unknown. We investigated the effect of supplementation with inulin-enriched foods on salivary immunoglobulin A (sIgA), a marker of immunity associated with URTI, in rugby players. We hypothesised that inulin supplementation would increase sIgA, and such change would be greater than that observed in a group following a diet without inulin supplementation. Ten rugby players volunteered for this pilot study (24.2 ± 5.4 years, 93.2 ± 18.7 kg). Participants were randomly assigned to either control (CON) or intervention diet (IN) for 3-weeks; and provided with 2% inulin-enriched pasta and bread (IN) or the same products without inulin (CON), to be consumed as part of a prescribed diet plan. sIgA was measured before and after each condition by collecting saliva with validated swabs, and was quantified with enzyme-linked immunoassay. Differences within and between groups were assessed with paired-samples t-test and ANOVA, respectively. Relationships between inulin intake and sIgA were explored with Spearman's correlation and regression analysis. There was a significant increase in sIgA following inulin supplementation (p = 0.002), which was significantly different to CON (+ 53.6 ± 44.7 and 5.8 ± 37.2 mg/dL, p = 0.054). Average inulin intake was 10.9 ± 1.6 g/day, and it was positively associated with sIgA (rs = 0.661, p = 0.038) and correlated with sIgA changes (r2 = 0.438, p = 0.037). There were no significant differences in energy intake between and within groups (p > 0.10). There were no reports of upper-respiratory tract or other infections during the study period (winter). Some IN participants reported improved bowel function. Inulin-enriched products could represent a simple approach to promote mucosal immunity and gut health in athletes. Larger controlled trials are warranted to confirm the dose-response and long-term effects of inulin supplementation including metabolic and performance outcomes.
The use of psychopharmacotherapy in subjects exposed to trauma: an observational study.
Introduction
PTSD is a disorder which occurs after a person is exposed to a trauma, or to threats of imminent death, characterized by symptoms such as intrusive thoughts, avoidance, and hyperarousal.
Aim
To observe the relation occurring between psychic trauma and psychopharmacotherapy in subjects exposed to trauma.
Methods
Among the DMH and the Department of Neuroscience and Imaging of Chieti, we recruited 50 subjects exposed to trauma. Rating scales (CAPS, HAMILTON-A e D, BARRAT IMPULSIVNESS SCALE) were handed out to each person; 38 subjects (Group A) never assumed psychiatric drugs before, the 12 left over (Group B) had used psychiatric drugs before: 11 of the latter (Group B) were diagnosed PTSD with comorbidity (9 mood disorders; 1 anxiety disorder; 1 borderline disorder); the only one remaining patient from Group B was suffering from bipolar disorder with psychotic symptoms even though he was never diagnosed with PTSD before. For this disorder came out after being exposed to trauma.
Results
Among the 50 recruited subjects, those who develop PTSD (38%) take a drug therapy. Data analisys show a more significant relation between PTSD diagnosys and other comorbity treated with psychiatric drugs (Fisher exact two tailed p=0.0077), than with patients exposed to trauma do not develop PTSD.
Conclusions
The intake of drugs is often associated with comorbidity with other psychiatric disorders. The isolated exposure to trauma does not seem to generate the need for intake of psychiatric drugs.
We present a Vlasov–DArwin numerical code (ViDA) specifically designed to address plasma physics problems, where small-scale high accuracy is requested even during the nonlinear regime to guarantee a clean description of the plasma dynamics at fine spatial scales. The algorithm provides a low-noise description of proton and electron kinetic dynamics, by splitting in time the multi-advection Vlasov equation in phase space. Maxwell equations for the electric and magnetic fields are reorganized according to the Darwin approximation to remove light waves. Several numerical tests show that ViDA successfully reproduces the propagation of linear and nonlinear waves and captures the physics of magnetic reconnection. We also discuss preliminary tests of the parallelization algorithm efficiency, performed at CINECA on the Marconi-KNL cluster. ViDA will allow the running of Eulerian simulations of a non-relativistic fully kinetic collisionless plasma and it is expected to provide relevant insights into important problems of plasma astrophysics such as, for instance, the development of the turbulent cascade at electron scales and the structure and dynamics of electron-scale magnetic reconnection, such as the electron diffusion region.
This chapter provides a description of colour changes in the Amsterdam Sunflowers due to chemical alteration of pigments, with a focus on geranium lakes and chrome yellows.
The brilliant and forceful colours of these and other late nineteenth-century synthetic materials offered artists such as Vincent van Gogh new means of artistic expression that exploited a range of contrasting hues and tints. However, geranium lakes have a strong tendency to fade and chrome yellows to darken under the influence of light. Van Gogh, like other artists of his day, was aware of this drawback, yet he continued to favour the use of both pigments up until his death in July 1890 due to the unparalleled effects they gave. In April 1888, Vincent wrote to his brother Theo:
You were right to tell Tasset that the geranium lake should be included after all, he sent it, I’ve just checked – all the colours that Impressionism has made fashionable are unstable, all the more reason boldly to use them too raw, time will only soften them too much. So the whole order I made up, in other words the 3 chromes (the orange, the yellow, the lemon), the Prussian blue, the emerald, the madder lakes, the Veronese green, the orange lead, all of that is hardly found in the Dutch palette, Maris, Mauve and Israëls. But it's found in that of Delacroix, who had a passion for the two colours most disapproved of, and for the best of reasons, lemon and Prussian blue. All the same, I think he did superb things with them, blues and lemon yellows.
Van Gogh's use of unstable colours opens a series of questions regarding the extent to which colour change affects the way his paintings look today, as discussed here in relation to the Amsterdam Sunflowers. Furthermore, given the frequency with which geranium lakes and chrome yellows occur in Van Gogh's paintings of the period 1888–90 and the predominance of chrome yellows in Sunflowers, it becomes important to understand the factors that can drive these processes of deterioration in order to develop appropriate strategies for conserving the artist's works.
This chapter explains the materials and techniques employed in the Amsterdam Sunflowers, enabling a comparison with the London version described in chapter 3. Building upon the 2016 article published in the National Gallery Technical Bulletin, it incorporates the latest findings gained by computer-assisted methods used to characterize the canvas support, as well as in-situ campaigns of non-invasive investigation together with further analysis of microscopic paint samples. The chapter sequence follows the steps in Van Gogh's working practice. Starting with the canvas, automated analysis of the weave enables the provenance of the canvas to be traced back to a particular roll of linen ordered by Van Gogh. Combining technical evidence with knowledge of historical manufacturing techniques further allows us to reconstruct the way in which Van Gogh divided his canvas roll into pieces used for Sunflowers and other paintings. We go on to consider how, with the original painting at hand, he used charcoal to transfer the motif of the London Sunflowers onto his blank canvas. Despite careful planning of the composition, an adjustment was required late in the working process, when Van Gogh added a painted wooden strip to extend the background above the flower at the top edge of the canvas. The artist's process of working up the composition in paint is described, paying special attention to his use of colour. The pigments and pigment mixtures used in the Amsterdam Sunflowers have been comprehensively mapped and are compared with the London picture, with discussion of some similarities and differences that account for the distinctive colour scheme of each painting. This understanding of colour application in the Amsterdam Sunflowers lays the foundation for subsequent chapters that will go on to consider the impact of light-induced colour changes that have taken place over time, and the related need to define appropriate lighting guidelines for the future safe preservation of this painting and others made with similar materials (chapters 5 and 7).
Canvas
Studying the physical characteristics of canvas picture supports is an established means of acquiring valuable information about a painter's working methods. The canvas itself is hidden by paint on the front and a second canvas is often applied to its reverse for added support.
Evidence supports the role of vitamin D in various conditions of development and ageing. Serum 25-hydroxyvitamin D (25(OH)D) is the best indicator for current vitamin D status. However, the cost of its measurement can be prohibitive in epidemiological research. We developed and validated multivariable regression models that quantified the relationships between vitamin D determinants, measured through an in-person interview, and serum 25(OH)D concentrations. A total of 200 controls participating in a population-based case–control study in Montreal, Canada, provided a blood specimen and completed an in-person interview on socio-demographic, reproductive, medical and lifestyle characteristics and personal attributes. Serum 25(OH)D concentrations were quantified by liquid chromatography–tandem MS. Multivariable least squares regression was used to build models that predict 25(OH)D concentrations from interview responses. We assessed high-order effects, performed sensitivity analysis using the lasso method and conducted cross-validation of the prediction models. Prediction models were built for users and non-users of vitamin D supplements separately. Among users, alcohol intake, outdoor time, sun protection, dose of supplement use, menopausal status and recent vacation were predictive of 25(OH)D concentrations. Among non-users, BMI, sun sensitivity, season and recent vacation were predictive of 25(OH)D concentrations. In cross-validation, 46–47 % of the variation in 25(OH)D concentrations were explained by these predictors. In the absence of 25(OH)D measures, our study supports that predicted 25(OH)D scores may be used to assign exposure in epidemiological studies that examine vitamin D exposure.
This work is part of the interlaboratory collaboration to study the stability of organic solar cells containing PCDTBT polymer as a donor material. The varieties of the OPV devices with different device architectures, electrode materials, encapsulation, and device dimensions were prepared by seven research laboratories. Sets of identical devices were aged according to four different protocols: shelf lifetime, laboratory weathering under simulated illumination at ambient temperature, laboratory weathering under simulated illumination, and elevated temperature (65 °C) and daylight outdoor weathering under sunlight. The results generated in this study allow us to outline several general conclusions related to PCDTBT-based bulk heterojunction (BHJ) solar cells. The results herein reported can be considered as practical guidance for the realization of stabilization approaches in BHJ solar cells containing PCDTBT.
Several cool-core clusters are known to host a radio mini-halo, a diffuse, steep-spectrum radio source located in their cores, thus probing the presence of non-thermal components as magnetic field and relativistic particles on scales not directly influenced by the central AGN. The nature of the mechanism that produces a population of radio-emitting relativistic particles on the scale of hundreds of kiloparsecs is still unclear. At the same time, it is still debated if the central AGN may play a role in the formation of mini-halos by providing the seed of the relativistic particles. We aim to investigate these open issues by studying the connection between thermal and non-thermal components of the intra-cluster medium. We performed a point-to-point analysis of the radio and the X-ray surface brightness of a compilation of mini-halos. We find that mini-halos have super-linear scalings between radio and X-rays, with radio brightness declining more steeply than the X-ray brightness. This trend is opposite to that generally observed in giant radio halos, thus marking a possible difference in the physics of the two radio sources. Finally, using the scalings between radio and X-rays and assuming a hadronic origin of mini-halos we derive constraints on the magnetic field in the core of the hosting clusters.