Dmitri Nepogodiev, Sivesh K Kamarajah, Aneel Bhangu
et al.
Summary: Background: Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems. Methods: This study pooled data from three international, prospective cohort studies including patients who had a positive SARS-CoV-2 test result in the seven days before or within 30 days after surgery. Patients were included across four pandemic time periods: Period 1 (January–May 2020), Period 2 (June–July 2020), Period 3 (October 2020), and Period 4 (December–March 2022). The primary outcome measure was 30-day postoperative mortality. Hierarchical logistic regression models were developed to explore association between pandemic periods (primary analysis) and hospital-level preparedness (secondary analysis) on 30-day postoperative mortality. Hospital preparedness was classified in to poorly-, moderately-, and highly-prepared tertiles based on Surgical Preparedness Index (SPI) score. Findings: A total of 31,751 patients were included from 1589 hospitals and 102 countries. From Period 1 through to Period 4 there was a decrease in the proportion of patients aged ≥70 years and with ASA grades 3–5.30-day postoperative mortality fell from Period 1 (18.4% [1378/7502]), Period 2 (9.9% [219/2234], adjusted odds ratio (aOR) 0.65, 95% confidence interval (CI) 0.53–0.78), Period 3 (10.5% [246/2427], aOR 0.60, 95% CI 0.50–0.71), through to Period 4 (5.8% [1132/19,588], aOR 0.33, 95% CI 0.30–0.37). During Period 4, SARS-CoV-2 vaccinated patients had lower mortality compared to unvaccinated patients (4.9% [603/12,361] versus 7.4% [529/7178], aOR 0.49, 95% CI 0.42–0.57). Compared to poorly-prepared hospitals (11.2% [1019/9071]), moderately-prepared (9.4% [857/9071], aOR 0.84, 95% CI 0.75–0.94) and highly-prepared hospitals (5.8% [530/9071], aOR 0.70, 95% CI 0.62–0.80) had lower mortality. Interpretation: Postoperative mortality decreased over the course of the COVID-19 pandemic and was lower in better prepared hospitals. Hospitals are critical national infrastructure and strengthening their preparedness by developing formal pandemic plans, establishing patient and procedure prioritisation protocols, and ring-fencing surgical beds would ensure safer surgical care during future pandemics. Funding: National Institute for Health and Care Research, United Kingdom.
Dariusz Korzec, Florian Freund, Christian Bäuml
et al.
Reactive oxygen–nitrogen species (RONS) production in a Peltier-cooled hybrid dielectric barrier discharge (HDBD) reactor operated with humid air is characterized. Fourier-transform infrared spectroscopy (FTIR) is used to determine the RONS in the HDBD-produced gases. The presence of molecules <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi mathvariant="normal">O</mi><mn>3</mn></msub></mrow></mrow></semantics></math></inline-formula>, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi>NO</mi><mn>2</mn></msub></mrow></mrow></semantics></math></inline-formula>, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi mathvariant="normal">N</mi><mn>2</mn></msub></mrow></mrow></semantics></math></inline-formula>O, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi mathvariant="normal">N</mi><mn>2</mn></msub><msub><mi mathvariant="normal">O</mi><mn>5</mn></msub></mrow></mrow></semantics></math></inline-formula>, and <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi>HNO</mi><mn>3</mn></msub></mrow></mrow></semantics></math></inline-formula> is evaluated. The influence of HDBD reactor operation parameters on the FTIR result is discussed. The strongest influence of Peltier cooling on RONS chemistry is reached at conditions related to a high specific energy input (SEI): high voltage and duty cycle of plasma width modulation (PWM), and low gas flow. Both PWM and Peltier cooling can achieve a change in the chemistry from oxygen-based to nitrogen-based. <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi mathvariant="normal">N</mi><mn>2</mn></msub><msub><mi mathvariant="normal">O</mi><mn>5</mn></msub></mrow></mrow></semantics></math></inline-formula> and <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi>HNO</mi><mn>3</mn></msub></mrow></mrow></semantics></math></inline-formula> are detected at a low humidity of 7% in the reactor input air but not at humidity exceeding 90%. In addition to the FTIR analysis, the plasma-activated water (PAW) is investigated. PAW is produced by bubbling the HDBD plasma gas through 12.5 mL of distilled water in a closed-loop circulation at a high SEI. Despite the absence of <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi mathvariant="normal">N</mi><mn>2</mn></msub><msub><mi mathvariant="normal">O</mi><mn>5</mn></msub></mrow></mrow></semantics></math></inline-formula> and <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mrow><mrow><msub><mi>HNO</mi><mn>3</mn></msub></mrow></mrow></semantics></math></inline-formula> in the gas phase, the acidity of the PAW is increased. The pH value decreases on average by 0.12 per minute.
This work comprehensively investigates the systematic integration of highly relevant life events and physiological parameters with continuous glucose monitoring (CGM) data to understand the synergy in glucoregulatory systems. Multitask learning (MTL) is employed in learning from numerous subjects while tailoring features in patient-specific layers. Systematic combinations of inputs are fed to the system providing personalized blood glucose level (BGL) predictions at multi-step prediction horizons (PHs) as output. Three cutting-edge long-short-term memory (LSTM) networks are adapted in the shared layers of MTL architecture. Moreover, PHs are varied with 30-minute intervals up to 120 minutes to identify the long-term effects of relevant input features on BGL prediction suggesting optimal deep learning (DL) architecture. The empirical result demonstrates that the most relevant features for BGL prediction are glucose, bolus insulin, and carbohydrate estimate from meals, while exercise and basal insulin rate have momentary effects. The best predictive root means square error (RMSE) achieved are <inline-formula> <tex-math notation="LaTeX">$16.06~\pm ~2.74$ </tex-math></inline-formula>, <inline-formula> <tex-math notation="LaTeX">$30.89~\pm ~4.31$ </tex-math></inline-formula>, <inline-formula> <tex-math notation="LaTeX">$40.51~\pm ~5.16$ </tex-math></inline-formula>, and <inline-formula> <tex-math notation="LaTeX">$47.31~\pm ~5.78$ </tex-math></inline-formula> mg/dL for 30-, 60-, 90-, and 120-min PH, respectively, while maintaining <inline-formula> <tex-math notation="LaTeX">$94.06~\pm ~3.08$ </tex-math></inline-formula> % predictions in clinically safe zones (A + B) at 120-min PH in Clarke error grid analysis (EGA). The insights learned from the experiments will assist in selecting appropriate DL models, features, and timelines based on specific needs, with significant promise in improving T1D management through better therapeutic and lifestyle modification.
<p>Tropical montane forests store high amounts of soil organic carbon (SOC). However, global warming may affect these stocks via enhanced soil respiration. Improved insight into the temperature response of SOC respiration can be obtained from in and ex situ warming studies. In situ warming via the translocation of intact soil mesocosms was carried out along an elevation gradient ranging between ca. 1250 m in the Kibale Forest to ca. 3000 m in the Rwenzori Mountains in Uganda. Samples from the same transect were also warmed ex situ. Ex situ results revealed that, following the elevation gradient, which represents a natural climate gradient, specific heterotrophic <span class="inline-formula">CO<sub>2</sub></span> respiration decreased linearly by 1.01 <span class="inline-formula">±</span> 0.12 <span class="inline-formula"><math xmlns="http://www.w3.org/1998/Math/MathML" id="M3" display="inline" overflow="scroll" dspmath="mathml"><mrow class="unit"><mi mathvariant="normal">µ</mi><mi mathvariant="normal">g</mi><mspace linebreak="nobreak" width="0.125em"/><mi mathvariant="normal">C</mi><mspace width="0.125em" linebreak="nobreak"/><msup><mi mathvariant="normal">h</mi><mrow><mo>-</mo><mn mathvariant="normal">1</mn></mrow></msup><mspace linebreak="nobreak" width="0.125em"/><msup><mi mathvariant="normal">g</mi><mrow><mo>-</mo><mn mathvariant="normal">1</mn></mrow></msup></mrow></math><span><svg:svg xmlns:svg="http://www.w3.org/2000/svg" width="59pt" height="15pt" class="svg-formula" dspmath="mathimg" md5hash="26b723d455dc08481db68dbfe9475668"><svg:image xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="bg-20-719-2023-ie00001.svg" width="59pt" height="15pt" src="bg-20-719-2023-ie00001.png"/></svg:svg></span></span> of SOC per 100 m of elevation increase. The coefficient of temperature sensitivity increased from 1.50 <span class="inline-formula">±</span> 0.13 in the lowest- to 2.68 <span class="inline-formula">±</span> 0.25 in the highest-elevation cluster, showing a linear increase of 0.09 <span class="inline-formula">±</span> 0.03 per 100 m of elevation increase. Additionally, respired <span class="inline-formula">CO<sub>2</sub></span> was more depleted in <span class="inline-formula"><sup>13</sup>C</span> in the warmer lower elevations as compared to colder higher elevations, with a linear decrease of 0.23 ‰ <span class="inline-formula">±</span> 0.04 ‰ per 100 m of elevation increase. Furthermore, the microbial community structure indicated a weak trend along the elevation gradient, with higher elevations more dominated by fungi relative to bacteria. The results indicate an increased recalcitrance and decreased mineralisation of SOC, with elevation likely driven by decreasing soil temperature and pH. Subsequently, after 2 years of in situ warming (0.9 to 2.8 <span class="inline-formula"><sup>∘</sup>C</span>), specific heterotrophic SOC respiration tended to be lower for warmed soil compared to control soil. Furthermore, in warmed soils, <span class="inline-formula"><i>δ</i><sup>13</sup></span>C values and SOC content tended to increase and decrease, respectively. Collectively, this points towards the increased mineralisation and depletion of readily available C during 2 years of warming. In conclusion, our results suggest that climate warming may trigger enhanced losses of SOC from tropical montane forests due to a combination of a higher temperature sensitivity of mineralisation and higher SOC content at higher elevations.</p>
Dr. rer. nat. Maria Katharina Schweitzer, Dr. rer. nat. Manuel Nico Dold, Dr. rer. nat. Astrid Genet
et al.
Bei Markteintritt oder Zulassungserweiterung eines neuen Arzneimittels sind pharmazeutische Unternehmer in Deutschland seit 2011 zur Einreichung eines AMNOG-Nutzendossiers beim G-BA verpflichtet. Auf Basis der IQWiG-Nutzenbewertung nimmt der G-BA eine Bewertung des Zusatznutzens des Arzneimittels vor und folgt dabei mehrheitlich der Beurteilung durch das IQWiG. Im April 2020 trat eine überarbeitete, aktuell gültige Dossiervorlage für Modul 4 in Kraft, die den bereits großen Darstellungsaufwand für die pharmazeutischen Unternehmer drastisch erhöht. Bei gestiegenem Darstellungsaufwand scheint allerdings ein erheblicher Anteil nicht fazitrelevant für den vom G-BA vergebenen Zusatznutzen zu sein. In einem effizienten AMNOG-Prozess sollten künftig nur Auswertungen mit tatsächlichem Mehrwert verpflichtend gemacht werden.
This is a protocol to describe the materials and methods utilized by the submitter to perform preclinical traumatic brain injury (TBI) using the open-skull controlled cortical impact (CCI) model. The posting of this protocol is part of the mission of PRE Clinical Interagency reSearch resourcE-TBI (PRECISE-TBI, www.precise-tbi.org) to improve clinical translation of therapeutics by providing an online catalogue and standardized protocols to reduce the variability of model usage between laboratories.
Abstract SES disparities in early math achievement are large and persistent across development and yet relatively understudied. Given the early emergence of these gaps, it is unlikely that school factors can explain why low-SES children tend to start school behind their peers in math skills. Rather, we argue that characteristics of parents, including their beliefs about math, their practices to support math, and their language about math concepts, mediate the observed associations between SES and math learning in early childhood. We first review the existing theoretical frameworks that support this conceptualization, including academic socialization, the home numeracy model, and concerted cultivation, with particular emphasis on the intersections and limitations of these past theories for understanding the early emergence of math disparities. We then propose a hybrid conceptualization of these frameworks and review research describing each proposed pathway. Specifically, we describe studies addressing how parents’ beliefs, practices, and language might explain SES disparities in children’s math achievement. Finally, we review the implications for our conceptual framework, major limitations of this literature, and remaining questions for future studies.
Extensive evidence has suggested that early academic skills are a robust indicator of later academic achievement; however, there is mixed evidence of the effectiveness of intervention on academic skills in early years to improve later outcomes. As such, it is clear there are other contributing factors to the development of academic skills. The present study tests the role of executive function (EF) (a construct made up of skills complicit in the achievement of goal-directed tasks) in predicting 5th grade math and reading ability above and beyond math and reading ability prior to school entry, and net of other cognitive covariates including processing speed, vocabulary, and IQ. Using a longitudinal dataset of N = 1292 participants representative of rural areas in two distinctive geographical parts of the United States, the present investigation finds EF at age 5 strongly predicts 5th grade academic skills, as do cognitive covariates. Additionally, investigation of an interaction between early math ability and EF reveals the magnitude of the association between early math and later math varies as a function of early EF, such that participants who have high levels of EF can “catch up” to peers who perform better on assessments of early math ability. These results suggest EF is pivotal to the development of academic skills throughout elementary school. Implications for further research and practice are discussed.
Soil pH is a master variable in soils because it controls many chemical and biochemical processes operating within the soil. It is a measure of the acidity or alkalinity of a soil. The study of soil pH is very important in agriculture due to the fact that soil pH regulates plant nutrient availability by controlling the chemical forms of the different nutrients and also influences their chemical reactions. As a result, soil and crop productivities are linked to soil pH value. Though soil pH generally ranges from 1 to 14, the optimum range for most agricultural crops is between 5.5 and 7.5. However, some crops have adapted to thrive at soil pH values outside this optimum range. The United States Department of Agricultural National Resources Conservation Service groups soil pH values as follows: ultra acidic (9.0) [1].
This paper argues that the socialist episode in East Germany, which constituted a radical experiment in gender equality in the labor market and other instances, has left persistent tracks on gender norms. We focus on one of the most resilient and pervasive gender gaps in modern societies: mathematics. Using the German division as a natural experiment, we show that the underperformance of girls in math is sharply reduced in the regions of the former GDR, in contrast with those of the former FRG. We show that this East-West difference is due to girls' attitudes, confidence and competitiveness in math, and not to other confounding factors, such as the difference in economic conditions or teaching styles across the former political border. We also provide illustrative evidence that the gender gap in math is smaller in European countries that used to be part of the Soviet bloc, as opposed to the rest of Europe. The lesson is twofold: (1) a large part of the pervasive gender gap in math is due to social stereotypes; (2) institutions can durably modify these stereotypes.
There is a growing literature concerning the role of the home math environment in children’s math development. In this study, we examined the relation between these constructs by specifically addressing three goals. The first goal was to identify the measurement structure of the home math environment through a series of confirmatory factor analyses. The second goal was to examine the role of the home math environment in predicting parent report of children’s math skills. The third goal was to test a series of potential alternative explanations for the relation between the home math environment and parent report of children’s skills, specifically the direct and indirect role of household income, parent math anxiety, and parent math ability as measured by their approximate number system performance. A final sample of 339 parents of children aged 3 through 8 drawn from Mechanical Turk answered a questionnaire online. The best fitting model of the home math environment was a bifactor model with a general factor representing the general home math environment, and three specific factors representing the direct numeracy environment, the indirect numeracy environment, and the spatial environment. When examining the association of the home math environment factors to parent report of child skills, the general home math environment factor and the spatial environment were the only significant predictors. Parents who reported doing more general math activities in the home reported having children with higher math skills, whereas parents who reported doing more spatial activities reported having children with lower math skills.