bluuebunny/crossref_metadata_2025 huggingface dataset:
No effects of pilot performance-based intervention implementation and withdrawal on the coverage of maternal and child health services in the Koulikoro region, Mali: an interrupted time series analysis
Authors: Zombré David , De Allegri Manuela , Ridde Valéry
Published: January 2020

Performance-based financing (PBF) has been promoted and increasingly implemented across low- and middle-income countries to increase the utilization and quality of primary health care. However, the evidence of the impact of PBF is mixed and varies substantially across settings. Thus, further rigorous investigation is needed to be able to draw broader conclusions about the effects of this health financing reform. We examined the effects of the implementation and subsequent withdrawal of the PBF pilot programme in the Koulikoro region of Mali on a range of relevant maternal and child health indicators targeted by the programme. We relied on a control interrupted time series design to examine the trend in maternal and child health service utilization rates prior to the PBF intervention, during its implementation and after its withdrawal in 26 intervention health centres. The results for these 26 intervention centres were compared with those for 95 control health centres, with an observation window that covered 27 quarters. Using a mixed-effects negative binomial model combined with a linear spline regression model and covariates adjustment, we found that neither the introduction nor the withdrawal of the pilot PBF programme bore a significant impact in the trend of maternal and child health service use indicators in the Koulikoro region of Mali. The absence of significant effects in the health facilities could be explained by the context, by the weaknesses in the intervention design and by the causal hypothesis and implementation. Further inquiry is required in order to provide policymakers and practitioners with vital information about the lack of effects detected by our quantitative analysis.
Health literacy promotion among young adults: a web-based intervention in German vocational schools
Authors: Stassen Gerrit , Grieben Christopher , Sauzet Odile , Frob�se Ingo , Schaller Andrea
Published: January 2020

Against the background of an ageing population, the target group of young adults holds strong societal relevance as the future workforce. At the same time, young adults find themselves in a critical phase of life regarding the manifestation of a healthy lifestyle. In this context, young adults’ health literacy gains importance. Web-based interventions implemented in educational settings offer the potential for promoting health literacy, although longitudinal studies remain scarce. Within a pre–post cluster randomized controlled trial with 6-month follow-up, this study investigated whether an 8-week web-based intervention in vocational schools (with or without an additional initial face-to-face measure) improves individual competencies within a structural model of health literacy (‘self-perception’, ‘proactive approach to health’, ‘dealing with health information’, ‘self-control’, ‘self-regulation’ and ‘communication and cooperation’). The control condition was regular school lessons following the curriculum only. A multi-level regression analysis was performed using the control group as reference. None of the interventions showed a significant improvement in any of the dimensions. Significant differences between the intervention and control were obtained for some dimensions, albeit showing reductions. Future research must examine how to build impactful health literacy promotion in educational settings. Investigations into linking digital and face-to-face measures should continue.
Deep genotype imputation captures virtually all heritability of autoimmune vitiligo
Authors: Roberts Genevieve H L , Santorico Stephanie A , Spritz Richard A
Published: January 2020

Autoimmune vitiligo is a complex disease involving polygenic risk from at least 50 loci previously identified by genome-wide association studies. The objectives of this study were to estimate and compare vitiligo heritability in European-derived patients using both family-based and ‘deep imputation’ genotype-based approaches. We estimated family-based heritability (h2FAM) by vitiligo recurrence among a total 8034 first-degree relatives (3776 siblings, 4258 parents or offspring) of 2122 unrelated vitiligo probands. We estimated genotype-based heritability (h2SNP) by deep imputation to Haplotype Reference Consortium and the 1000 Genomes Project data in unrelated 2812 vitiligo cases and 37 079 controls genotyped genome wide, achieving high-quality imputation from markers with minor allele frequency (MAF) as low as 0.0001. Heritability estimated by both approaches was exceedingly high; h2FAM = 0.75–0.83 and h2SNP = 0.78. These estimates are statistically identical, indicating there is essentially no remaining ‘missing heritability’ for vitiligo. Overall, ~70% of h2SNP is represented by common variants (MAF > 0.01) and 30% by rare variants. These results demonstrate that essentially all vitiligo heritable risk is captured by array-based genotyping and deep imputation. These findings suggest that vitiligo may provide a particularly tractable model for investigation of complex disease genetic architecture and predictive aspects of personalized medicine.
Follow-up results of aortic arch cervical debranching performed with the help of a temporary crossover external carotid artery bypass for cerebral protection followed by endovascular thoracic aortic aneurysm repair
Authors: Oztas Didem Melis , Ugurlucan Murat , Beyaz Metin Onur , Ulukan Mustafa Ozer , Unal Orcun , Onal Yilmaz , Umutlu Muzaffer , Acunas Bulent , Alpagut Ufuk
Published: January 2020

OBJECTIVES

Treating aortic arch aneurysms with conventional open surgical and endovascular stent graft procedures is challenging due to the complex anatomy of the arch and the arteries arising from it that nourish the brain. Cerebral protection is of the utmost importance during the treatment of thoracic aneurysms involving the aortic arch.

METHODS

Between May 2014 and November 2018, 7 patients with thoracic aortic aneurysms involving the aortic arch who underwent aortic arch cervical debranching with our technique were reviewed retrospectively. Because all the patients being considered for conventional surgical aortic arch replacement had serious comorbidities, they were selected to receive hybrid therapy. The mean age of the patients was 71.2 ± 9.4 years. One patient was a woman and 6 patients were men. One patient was given general anaesthesia; the remaining 6 patients had a regional block. A crossover temporary bypass was performed between the external carotid arteries with a 6-mm polytetrafluoroethylene graft for cerebral protection in all patients. Thoracic endovascular aortic repair (TEVAR) was successfully performed in all patients except 1 following debranching.

RESULTS

Neurological complications did not occur during the procedures. Patients were followed for a mean of 18.3 ± 4.9 months. One female patient died of exacerbating chronic obstructive pulmonary disease within the first follow-up year. Three other patients died: 1 died of natural causes; 1 died of pneumonia followed by multiorgan failure; and 1 died of myocardial infarction during the mid-term follow-up period. The remaining patients are still being followed and are event free.

CONCLUSIONS

Endovascular treatment of thoracic aortic diseases involving the aortic arch is facilitated when the aortic arch is debranched. Our cerebral protection method with a temporary crossover bypass between the external carotid arteries provides continuous pulsatile blood flow to the brain; hence, neurologically, it is a reliable procedure. The follow-up results of the patients who underwent aortic arch cervical debranching followed by TEVAR depended on their comorbidities.
Association of Neisseria gonorrhoeae Plasmids With Distinct Lineages and The Economic Status of Their Country of Origin
Authors: Cehovin Ana , Jolley Keith A , Maiden Martin C J , Harrison Odile B , Tang Christoph M
Published: January 2020

Plasmids are vehicles for horizontal gene transfer between bacteria, and in Neisseria gonorrhoeae plasmids can mediate high-level antimicrobial resistance (AMR). Using genomic and phylogenetic analyses, we show that plasmids are widespread in a collection of 3724 gonococcal isolates from 56 countries, and characterized the conjugative, β-lactamase and cryptic plasmids. We found that variants of the conjugative plasmid (which can mediate tetracycline resistance) and the β-lactamase plasmid expressing TEM-135 are associated with distinct gonococcal lineages. Furthermore, AMR plasmids are significantly more prevalent in gonococci from less wealthy countries, highlighting the need for further studies. More than 94% of gonococci possess the cryptic plasmid, with its absence correlated with the presence of a novel chromosomal type IV secretion system. Our results reveal the extent of plasmid-mediated AMR in the gonococcus, particularly in less wealthy countries, where diagnostic and therapeutic options can be limited, and highlight the risk of their global spread.
Human Immunodeficiency Virus Prevention for People Who Use Drugs: Overview of Reviews and the ICOS of PICOS
Authors: Johnson Wayne D , Rivadeneira Natalie , Adegbite Adebukola H , Neumann Mary S , Mullins Mary M , Rooks-Peck Cherie , Wichser Megan E , McDonald Christina M , Higa Darrel H , Sipe Theresa Ann
Published: January 2020

Background

This article summarizes the results from systematic reviews of human immunodeficiency virus (HIV) prevention interventions for people who use drugs (PWUD). We performed an overview of reviews, meta-analysis, meta-epidemiology, and PROSPERO Registration CRD42017070117.

Methods

We conducted a comprehensive systematic literature search using the Centers for Disease Control and Prevention HIV/AIDS Prevention Research Synthesis Project database to identify quantitative systematic reviews of HIV public heath interventions with PWUD published during 2002–2017. We recombined results of US studies across reviews to quantify effects on HIV infections, continuum of HIV care, sexual risk, and 5 drug-related outcomes (sharing injection equipment, injection frequency, opioid use, general drug use, and participation in drug treatment). We conducted summary meta-analyses separately for reviews of randomized controlled trials (RCTs) and quasi-experiments. We stratified effects by 5 intervention types: behavioral-psychosocial (BPS), syringe service programs (SSP), opioid agonist therapy (OAT), financial and scheduling incentives (FSI), and case management (CM).

Results

We identified 16 eligible reviews including >140 US studies with >55 000 participants. Summary effects among US studies were significant and favorable for 4 of 5 outcomes measured under RCT (eg, reduced opioid use; odds ratio [OR] = 0.70, confidence interval [CI] = 0.56–0.89) and all 6 outcomes under quasi-experiments (eg, reduced HIV infection [OR = 0.42, CI = 0.27–0.63]; favorable continuum of HIV care [OR = 0.68, CI = 0.53–0.88]). Each intervention type showed effectiveness on 1–6 outcomes. Heterogeneity was moderate to none for RCT but moderate to high for quasi-experiments.

Conclusions

Behavioral-psychosocial, SSP, OAT, FSI, and CM interventions are effective in reducing risk of HIV and sequelae of injection and other drug use, and they have a continuing role in addressing the opioid crisis and Ending the HIV Epidemic.
The effect of community hypertension management on blood pressure control and its determinants in southwest China
Authors: Liang Xiaohua , Zhong Haiying , Xiao Lun
Published: January 2020

Background

Hypertension is a leading cause of cardiovascular disease (CVD). The purpose of this study was to examine the effectiveness of community healthcare in controlling blood pressure (BP) and mitigating related risk factors after 5 y of follow-up.

Methods

Hierarchical clustering sampling was employed to choose a representative sample of 10 rural and 10 urban community populations (N=4235). The 5y prospective cohort study was completed by the medical group in the community clinical centre.

Results

The study included 4235 patients, median age 69 y (range 61–76), with hypertension in 2009; 2533 (59.81%) were female. The rate of BP control increased from 28.33% in 2009 to 64.05% in 2014. The BP control rate was higher in patients with CVD and kidney disease and lower in those with obesity than in those without. Comparing 2009 and 2014 values, the intervention resulted in median systolic BP and diastolic BP reductions of 7.0 mmHg and 6.5 mmHg, respectively. Age, medication treatment, antihypertensive agents, BP at baseline and follow-up, complications of diabetes, CVD, obesity and kidney disease, the aspartate aminotransferase:aminotransferase ratio and smoking were identified as risk factors for BP control.

Conclusions

Community management of hypertension by general practitioners achieved significant BP control over 5 y of intervention.
C-Myc-activated long non-coding RNA PVT1 enhances the proliferation of cervical cancer cells by sponging miR-486-3p
Authors: Wang Chang , Zou Hao , Chen Aiping , Yang Hongjuan , Yu Xinping , Yu Xiao , Wang Yankui
Published: January 2020

Cervical cancer is one of the most prevalent gynecological malignancies. Although the functions of long non-coding RNA (lncRNA) plasmacytoma variant translocation 1 (PVT1) and c-Myc in tumorigenesis have been acknowledged, the roles of c-Myc and lncRNA-PVT1 in the proliferation of cervical cancer are still unclear. Our study is designed to demonstrate the regulatory network involving c-Myc and lncRNA-PVT1 in cervical cancer. Quantitative real-time PCR and western blot assays were performed in our research to estimate the expression levels of RNA and proteins. CCK8 assays were applied to demonstrate the viability of HeLa and SiHa cells. Immunofluorescence assay was then used to investigate the co-localization of lncRNA-PVT1 and miR-486-3p. Binding of c-Myc to the promoter region of PVT1 was identified by ChIP-assay. Functionally, upregulation of lncRNA-PVT1 enhanced the proliferation and viability of cervical cancer cells. Mechanistically, lncRNA-PVT1 sponged miR-486-3p and released its repression of extracellular matrix protein 1. Besides, c-Myc functioned as an activator of lncRNA-PVT1 and upregulated its expression by binding to the promoter of PVT1 in cervical cancer cells. lncRNA-PVT1 was upregulated by c-Myc and thus enhanced the proliferation of cervical cancer cells by sponging miR-486-3p.
Surveillance for Amblyomma maculatum (Acari: Ixodidae) and Rickettsia parkeri (Rickettsiales: Rickettsiaceae) in the State of Delaware, and Their Public Health Implications
Authors: Maestas Lauren P , Reeser Sean R , McGay Patrick J , Buoni Michael H
Published: January 2020

Amblyomma maculatum Koch is the primary vector of Rickettsia parkeri, the etiologic agent of tidewater spotted fever, and can also carry and transmit a variety of other pathogens. This tick historically has been a costly nuisance to livestock owners in the southeastern United States. Over the past 6 yr, A. maculatum has been collected in numbers sufficient to demonstrate their establishment in Kent County, Delaware, and the presence of R. parkeri has been documented. Our goals were to determine the geographic distribution of A. maculatum and R. parkeri in Delaware, and to equate this to relative risk to the public of encountering R. parkeri-infected ticks. We surveyed for ticks in four locations throughout the state from May to August 2019, and found established A. maculatum populations in all three counties. Laboratory analysis of collected specimens by quantitative polymerase chain reaction detected R. parkeri in A. maculatum populations across the state. These results indicate that A. maculatum could present a health risk to inhabitants of the state, and they also historically have posed a risk to the livestock industry, making them an important consideration in the development and implementation of continued tick surveillance efforts and future policies regarding tick management.
Impaired actin dynamics and suppression of Shank2-mediated spine enlargement in cortactin knockout mice
Authors: Tanaka Shinji , Masuda Yasutaka , Harada Akihiro , Okabe Shigeo
Published: January 2020

Cortactin regulates actin polymerization and stabilizes branched actin network. In neurons, cortactin is enriched in dendritic spines that contain abundant actin polymers. To explore the function of cortactin in dendritic spines, we examined spine morphology and dynamics in cultured neurons taken from cortactin knockout (KO) mice. Histological analysis revealed that the density and morphology of dendritic spines were not significantly different between wild-type (WT) and cortactin KO neurons. Time-lapse imaging of hippocampal slice cultures showed that the extent of spine volume change was similar between WT and cortactin KO neurons. Despite little effect of cortactin deletion on spine morphology and dynamics, actin turnover in dendritic spines was accelerated in cortactin KO neurons. Furthermore, we detected a suppressive effect of cortactin KO on spine head size under the condition of excessive spine enlargement induced by overexpression of a prominent postsynaptic density protein Shank2. These results suggest that cortactin may have a role in maintaining actin organization by stabilizing actin filaments near the postsynaptic density.
Explaining How Human Rights Protections Change After Internal Armed Conflicts
Authors: Karreth Johannes , Sullivan Patricia Lynne , Dezfuli Ghazal
Published: January 2020

Societies emerging from internal armed conflicts display surprising variation in the degree to which governments protect human rights. Employing new data on civilian victimization by both government and rebel forces, we find that the human rights climate of a post-conflict country is not simply a perpetuation of pre-conflict conditions, or the result of repressive regimes remaining in power. Instead, the treatment of civilians during conflict has an independent impact on post-conflict human rights protections (HRP). Analyses of ninety-six post-conflict periods (1960–2015) show that when governments systematically and extensively target civilians during counterinsurgency campaigns, post-conflict human rights conditions decline substantially compared to pre-conflict levels, even accounting for other predictors of human rights violations, including pre-conflict human rights conditions. This holds regardless of who is in power after conflicts end. These findings have implications for theoretical models of repression and conflict cycles, and for practitioners and policymakers aiming to restore and protect human rights after war.
Investigation of 4D dose in volumetric modulated arc therapy-based stereotactic body radiation therapy: does fractional dose or number of arcs matter?
Authors: Shintani Takashi , Nakamura Mitsuhiro , Matsuo Yukinori , Miyabe Yuki , Mukumoto Nobutaka , Mitsuyoshi Takamasa , Iizuka Yusuke , Mizowaki Takashi
Published: January 2020

The aim of this study was to assess the impact of fractional dose and the number of arcs on interplay effects when volumetric modulated arc therapy (VMAT) is used to treat lung tumors with large respiratory motions. A three (fractional dose of 4, 7.5 or 12.5 Gy) by two (number of arcs, one or two) VMAT plan was created for 10 lung cancer cases. The median 3D tumor motion was 17.9 mm (range: 8.2–27.2 mm). Ten phase-specific subplans were generated by calculating the dose on each respiratory phase computed tomography (CT) scan using temporally assigned VMAT arcs. We performed temporal assignment of VMAT arcs using respiratory information obtained from infrared markers placed on the abdomens of the patients during CT simulations. Each phase-specific dose distribution was deformed onto exhale phase CT scans using contour-based deformable image registration, and a 4D plan was created by dose accumulation. The gross tumor volume dose of each 4D plan (4D GTV dose) was compared with the internal target volume dose of the original plan (3D ITV dose). The near-minimum 4D GTV dose (D99%) was higher than the near-minimum 3D internal target volume (ITV) dose, whereas the near-maximum 4D GTV dose (D1%) was lower than the near-maximum 3D ITV dose. However, the difference was negligible, and thus the 4D GTV dose corresponded well with the 3D ITV dose, regardless of the fractional dose and number of arcs. Therefore, interplay effects were negligible in VMAT-based stereotactic body radiation therapy for lung tumors with large respiratory motions.
Treatment outcomes of patients with adenocarcinoma of the uterine cervix after definitive radiotherapy and the prognostic impact of tumor-infiltrating CD8+ lymphocytes in pre-treatment biopsy specimens: a multi-institutional retrospective study
Authors: Miyasaka Yuhei , Yoshimoto Yuya , Murata Kazutoshi , Noda Shin-ei , Ando Ken , Ebara Takeshi , Okonogi Noriyuki , Kaminuma Takuya , Yamada Seiji , Ikota Hayato , Yokoo Hideaki , Ohno Tatsuya , Nakano Takashi
Published: January 2020

The current study aimed to evaluate the outcomes of patients with adenocarcinoma (AC) of the uterine cervix after definitive radiotherapy (RT) and to evaluate prognostic factors, including immunity-related molecules. A total of 71 patients with AC of the uterine cervix from multiple Japanese institutions were retrospectively analysed. Histological subtypes were diagnosed according to the 2014 World Health Organization classification. All patients underwent definitive RT comprising external beam RT and intracavitary brachytherapy with or without concurrent chemotherapy. Immunohistochemical studies were performed to detect the expression of programmed cell death-ligand 1(PD-L1) and CD8. The 5-year locoregional control (LC), overall survival (OS) and progression-free survival (PFS) rates for all patients were 61.8, 49.7 and 36.1%, respectively. The LC, OS and PFS rates were not significantly different among the histological subtypes. Membranous PD-L1 expression was not significantly associated with prognosis. Patients with CD8-positive tumor-infiltrating lymphocytes (CD8+TILs) in the tumor nests had significantly better OS than patients without CD8+TILs in the tumor nests (5-year OS: 53.8 vs 23.8%, P = 0.038). As expected, the International Federation of Gynecology and Obstetrics (FIGO) stage (2008) III–IVA and maximum tumor diameter > 40 mm were significantly associated with worse prognosis. In summary, the presence of CD8+TILs in the tumor nests has the potential to be an independent favorable prognostic factor for patients with AC of the uterine cervix after definitive RT.
Mucinous appendiceal adenocarcinomas: a diagnostic challenge
Authors: Sharma Ekta , Gokani Shyam Ajay , Neville Jonathan , Sinha Ashish , Agarwal Tushar
Published: January 2020

Mucinous appendiceal neoplasms are rare and diagnosis is often difficult as patients present with non-specific symptoms often suggestive of appendicitis only and most diagnoses are made following post-surgery histology examination. Here we present a case of a mucinous appendiceal adenocarcinoma with areas of both Low-grade Appendiceal Mucinous Neoplasm and High-grade Appendiceal Mucinous Neoplasm, in a ruptured appendix at a district general hospital. Without early detection and treatment these pathologies can lead to pseudomyxoma peritonei, a syndrome of progressive mucinous ascites. This case highlights the limitations of radiological studies, benefits of diagnostic laparoscopy and provides a rationale for removing the mesoappendix with the appendix during routine appendectomies.
14-3-3η Protein in Rheumatoid Arthritis: Promising Diagnostic Marker and Independent Risk Factor for Osteoporosis
Authors: Zeng Tingting , Tan Liming , Wu Yang , Yu Jianlin
Published: January 2020

Background

Early identification and disease monitoring are challenges facing rheumatologists in the management of rheumatoid arthritis (RA).

Methods

We utilized enzyme-linked immunosorbent assay (ELISA) to determine 14-3-3η and anticyclic citrullinated peptide antibody (anti-CCP) levels, with rheumatoid factor (RF) level detected by rate nephelometry. The diagnostic value of each index was determined via receiver operating characteristic (ROC) curve, and the association between 14-3-3η and osteoporosis was assessed using multiple logistic regression analysis.

Results

Serum levels of 14-3-3η were 3.26 ng per mL in patients with RA. These levels were helpful in identifying patients with the disease, with the area under the curve (AUC) being 0.879 and 0.853, respectively, from all healthy control individuals and patients with RA. Combining 14-3-3η with RF or anti-CCP increased the diagnostic rate. Logistic regression analysis identified 14-3-3η as an independent risk factor for RA-related osteoporosis (odds ratio [OR], 1.503; 95% confidence interval [CI], 1.116–2.025; P <.01).

Conclusions

Serum 14-3-3η detection by itself or combined with other serum indices was helpful in differentiating patients with RA. Also, it was a promising biomarker for disease monitoring in RA.
Augmented Reality–Assisted Dementia Care
Authors: Zhao Mengyu Y. , Ong S. K. , Nee Andrew Y. C.
Published: January 2020

With the increasing aging population, the number of people suffering from dementia continues to grow at a high rate. Emerging technologies have been applied to support the independence of patients with dementia. Among these technologies, augmented reality (AR) technology augments computer-generated virtual content on the real-world environment. There is an increasing interest in the use of AR tools and applications for dementia care as these tools and applications are capable of providing intuitive interaction and reducing the workload of caregivers. This chapter presents a state-of-the-art overview of AR-assisted applications for dementia care. An AR-assisted healthcare exercising system that enhances the user’s motor skills and cognition capability is presented to illustrate the use of AR in dementia care. Furthermore, an outlook of the future of AR-assisted dementia care applications is presented.
Caring for Older Adults with Dementia
Authors: Wangmo Tenzin
Published: January 2020

In light of increasing life expectancy and population aging, healthcare systems today face the challenge of addressing the care-related needs of an increasingly aging population. Aging compounded with physical and neurological deteriorations means greater caregiving demands for both the formal healthcare sector and informal care from family members and friends. Unpaid informal caregiving is cost effective for the healthcare system as a whole; however, providing care for a family member with dementia can negatively impact the health of the caregiver. The increasing development and deployment of assistive technology is predicted to alleviate caregiving burden and allow the older person with dementia to remain independent and continue to live at home for as long as possible. This chapter presents the landscape of information on informal caregiving for patients with dementia and its associated caregiving burden. It also discusses the evidence available on the potential of assistive technology for alleviating informal caregiving burden. The chapter concludes with some considerations about the governance of assistive technology. It argues that assistive technologies that are proven to be clinically effective should be made fairly and ubiquitously available to improve the quality of life of the person with dementia and his or her family caregiver. This is important to ensure the sustainability of the overall healthcare system.
Pharmacology and fluids
Authors: Engelhardt Thomas
Published: January 2020

Differences in pharmacokinetics and pharmacodynamics are important in small children. This chapter provides an overview of essential pharmacokinetic parameters and developmental aspects. Intravenous anaesthetic agents, including total intravenous anaesthesia models, are described. An overview of commonly used inhalational anaesthetic agents, sedatives, and neuromuscular blockers is given. The analgesic sections describe opioids, simple analgesics, and local anaesthetic agents. Paediatric indications, common side effects, and dosing are included for each agent. A fundamental understanding of developmental differences is key to the safe and effective use of anaesthetic drugs in children.
Pain and sedation
Authors: Roberts Steve
Published: January 2020

Pain is amongst the most frequently occurring problems anaesthetists are confronted with in paediatric clinical settings and can be due to trauma, illness, surgery, or procedures. It remains one of the most challenging issues that clinicians have to manage during hospital admission. Despite the significant strides made over the last 30 years, pain management practices continue to fall short of exemplary and children continue to experience needless moderate to severe pain in hospital. ‘Child’ refers to any individual between birth and eighteen years of age. Within this age range there are broad variations in cognitive, physical and socio-emotional development that significantly impact and influence pain assessment and pain management strategies. Effective pain management requires adaptation and tailoring of treatment strategies for each individual rather than a rigid application of formulae, and while it is not always possible or feasible to eradicate all pain, practitioners should endeavour to reduce it to a tolerable level. This chapter aims to provide trainees with a highly practical and easy-to-access overview of pain management strategies that are appropriate and effective. It contain core information that will enable anaesthetic trainees to identify the most appropriate pain management therapies for paediatric patients. The information presented is brief and succinct, providing an essential up-to-date, rational, and logical approach to pain management in children.
Neurosurgery
Authors: Wright Elizabeth
Published: January 2020

This chapter will enable trainee anaesthetists to understand the practical considerations of neuroanaesthesia for children and neonates undergoing elective and emergency neurosurgical procedures in a tertiary centre. It includes the management of head injury, the use of intraoperative MRI, and anaesthesia for neuroradiology.
Plastic surgery
Authors: Johnson Doug
Published: January 2020

Elective and emergency plastic surgical patients make up a significant proportion of cases in paediatric anaesthesia. Frequently, patients are fit and well, the surgical site is peripheral, and the surgery is done in normal working hours as a day case. Certain presentations such as syndactyly or congenital microtia may be part of a syndrome, and anaesthesia for surgery in these patients may present specific difficulties for the paediatric anaesthetist. Laser treatment for pigmented lesions or scars may present a challenging working environment, and anaesthesia for free flap reconstructive surgery challenges the anaesthetist to provide optimum conditions for graft success. Acute trauma, including small burns and scalds, is common in children and is usually minor. Major burns require a structured approach in resuscitation, surgical and anaesthetic management, and aftercare, including pain management.
Stabilizing and transferring the critically ill child in a general hospital
Authors: Murphy Pete , Stibbards Sarah
Published: January 2020

This chapter provides the reader with a simple approach to managing the sick child who needs medical stabilization and then transfer to a tertiary centre. The dangers of transferring a patient and a joint approach by referring and receiving centres is discussed. A pre-transfer checklist is included to promote safe practice in an often stressful and unfamiliar environment. The chapter also briefly covers some of the issues of air transfer with these patients.
Signatures of bimodality in nebular phase Type Ia supernova spectra
Authors: Vallely P J , Tucker M A , Shappee B J , Brown J S , Stanek K Z , Kochanek C S
Published: January 2020

One observational prediction for Type Ia supernovae (SNe Ia) explosions produced through white dwarf–white dwarf collisions is the presence of bimodal velocity distributions for the 56Ni decay products, although this signature can also be produced by an off-centre ignition in a delayed detonation explosion. These bimodal velocity distributions can manifest as double-peaked or flat-topped spectral features in late-time spectroscopic observations for favourable viewing angles. We present nebular-phase spectroscopic observations of 17 SNe Ia obtained with the Large Binocular Telescope. Combining these observations with an extensive search of publicly available archival data, we collect a total sample of 48 SNe Ia and classify them based on whether they show compelling evidence for bimodal velocity profiles in three features associated with 56Ni decay products: the [Fe ii] and [Fe iii] feature at ∼5300 Å, the [Co iii] λ5891 feature, and the [Co iii] and [Fe ii] feature at ∼6600 Å. We identify nine bimodal SNe in our sample, and we find that these SNe have average peak MV about 0.3 mag fainter than those that do not. This is consistent with theoretical predictions for explosions created by nearly head-on collisions of white dwarfs due to viewing angle effects and 56Ni yields.
Galaxies hosting an active galactic nucleus: a view from the CALIFA survey
Authors: Lacerda Eduardo A D , Sánchez Sebastián F , Cid Fernandes R , López-Cobá Carlos , Espinosa-Ponce Carlos , Galbany L
Published: January 2020

We study the presence of optically-selected active galactic nuclei (AGNs) within a sample of 867 galaxies extracted from the extended Calar-Alto Legacy Integral Field spectroscopy Area (eCALIFA) spanning all morphological classes. We identify 10 Type-I and 24 Type-II AGNs, amounting to ∼4 per cent of our sample, similar to the fraction reported by previous explorations in the same redshift range. We compare the integrated properties of the ionized and molecular gas, and stellar population of AGN hosts and their non-active counterparts, combining them with morphological information. The AGN hosts are found in transitory parts (i.e. green-valley) in almost all analysed properties which present bimodal distributions (i.e. a region where reside star-forming galaxies and another with quiescent/retired ones). Regarding morphology, we find AGN hosts among the most massive galaxies, with enhanced central stellar-mass surface density in comparison to the average population at each morphological type. Moreover, their distribution peaks at the Sab-Sb classes and none are found among very late-type galaxies (>Scd). Finally, we inspect how the AGN could act in their hosts regarding the quenching of star-formation. The main role of the AGN in the quenching process appears to be the removal (or heating) of molecular gas, rather than an additional suppression of the already observed decrease of the star-formation efficiency from late-to-early type galaxies.
A study of the high-inclination population in the Kuiper belt – III. The 4:7 mean-motion resonance
Authors: Li Jian , Lawler S M , Zhou Li-Yong , Sun Yi-Sui
Published: January 2020

The high-inclination population in the 4:7 mean-motion resonance (MMR) with Neptune has also substantial eccentricities (e ≳ 0.1), with more inclined objects tending to occupy more eccentric orbits. For this high-order resonance, there are two different resonant modes. The principal one is the eccentricity-type mode, and we find that libration is permissible for orbits with $e\ge e_\mathrm{ c}^0$, where the critical eccentricity $e_\mathrm{ c}^0$ increases as a function of increasing inclination i. Correspondingly, we introduce a limiting curve $e_\mathrm{ c}^0(i)$, which puts constraints on the (e, i) distribution of possible 4:7 resonators. We then perform numerical simulations on the sweep-up capture and long-term stability of the 4:7 MMR, and the results show that the simulated resonators are well constrained by this theoretical limiting curve. The other 4:7 resonant mode is the mixed-(e, i)-type, and we show that stable resonators should exist at i ≳ 20○. We predict that the intrinsic number of these mixed-(e, i)-type resonators may provide a new clue into the Solar system’s evolution, but, so far, only one real object has been observed resonating in this mode.
Embedding globular clusters in dark matter minihaloes solves the cusp–core and timing problems in the Fornax dwarf galaxy
Authors: Boldrini Pierre , Mohayaee Roya , Silk Joseph
Published: January 2020

We use a fully GPU N-body code to demonstrate that dark matter (DM) minihaloes, as a new component of globular clusters (GCs), resolve both the timing and cusp–core problems in Fornax if the (five or six) GCs were recently accreted (≤3 Gyr ago) by Fornax. Under these assumptions, infall of these GCs does not occur and no star clusters form in the centre of Fornax in accordance with observations. We find that crossings of GCss that have DM minihaloes near the Fornax centre induce a cusp-to-core transition of the DM halo and hence resolve the cusp–core problem in this dwarf galaxy. The DM core size depends on the frequency of GC crossings. Our simulations clearly demonstrate also that between the passages, the DM halo can regenerate its cusp. Moreover, our models are in good agreement with constraints on the DM masses of GCs as our clusters lose a large fraction of their initial DM minihaloes. These results provide circumstantial evidence for the universal existence of DM haloes in GCs.
Investigation of chemical differentiation among the NGC 2264 cluster-forming clumps
Authors: Taniguchi Kotomi , Plunkett Adele , Herbst Eric , Dobashi Kazuhito , Shimoikura Tomomi , Nakamura Fumitaka , Saito Masao
Published: January 2020

We have carried out mapping observations of molecular emission lines of HC3N and CH3OH toward two massive cluster-forming clumps, NGC 2264-C and NGC 2264-D, using the Nobeyama 45-m radio telescope. We derive an I(HC3N)/I(CH3OH) integrated intensity ratio map, showing a higher value at clumps including 2MASS (Two Micron All Sky Survey) point sources at the northern part of NGC 2264-D. Possible interpretations of the I(HC3N)/I(CH3OH) ratio are discussed. We have also observed molecular emission lines from CCS and N2H+ toward five positions in each clump. We investigate the N(N2H+)/N(CCS) and N(N2H+)/N(HC3N) column density ratios among the ten positions in order to test whether they can be used as chemical evolutionary indicators in these clumps. The N(N2H+)/N(CCS) ratio shows a very high value toward a bright embedded IR source (IRS1), whereas the N(N2H+)/N(HC3N) ratio at IRS1 is comparable with those at the other positions. These results suggest that ultraviolet radiation affects the chemistry around IRS1. We find that there are positive correlations between these column density ratios and the excitation temperatures of N2H+, which implies the chemical evolution of clumps. These chemical evolutionary indicators likely reflect the combination of evolution along the filamentary structure and evolution of each clump.
Winds and feedback from supermassive black holes accreting at low rates: hydrodynamical treatment
Authors: Almeida Ivan , Nemmen Rodrigo
Published: January 2020

Outflows produced by a supermassive black hole (SMBH) can have important feedback effects in its host galaxy. An unresolved question is the nature and properties of winds from SMBHs accreting at low rates in low-luminosity active galactic nuclei (LLAGNs). We performed two-dimensional numerical, hydrodynamical simulations of radiatively inefficient accretion flows on to non-spinning black holes. We explored a diversity of initial conditions in terms of rotation curves and viscous shear stress prescriptions, and evolved our models for very long durations of up to 8 × 105GM/c3. Our models resulted in powerful subrelativistic, thermally driven winds originated from the corona of the accretion flow at distances 10−100 GM/c2 from the SMBH. The winds reached velocities of up to 0.01c with kinetic powers corresponding to $0.1\!-\!1 {\,{\rm per\, cent}}$ of the rest-mass energy associated with inflowing gas at large distances, in good agreement with models of the ‘radio mode’ of AGN feedback. The properties of our simulated outflows are in broad agreement with observations of winds in quiescent galaxies that host LLAGNs, which are capable of heating ambient gas and suppressing star formation.
The properties of prompt emission in short gamma-ray bursts with extended emission observed by Fermi/GBM
Authors: Lan Lin , Lu Rui-Jingi , Lü Hou-Jun , Shen Jun , Rice Jared , Li Long , Liang En-Wei
Published: January 2020

Short gamma-ray bursts (GRB) with extended emission (EE) that are composed of an initial short hard spike followed by a long-lasting EE are thought to comprise a sucategory of short GRBs. The narrow energy band available during the Swift era, combined with a lack of spectral information, prevented the discovery of the intrinsic properties of these events. In this paper, we perform a systematic search of short GRBs with EE using all available Fermi/GBM data. The search identified 26 GBM-detected short GRBs with EE that are similar to GRB 060614 observed by Swift/BAT. We focus on investigating the spectral and temporal properties of both the hard spike and the EE component of all 26 GRBs, and explore differences and possible correlations between them. We find that while the peak energy (Ep) of the hard spikes is slightly harder than that of the EE, their fluences are comparable. The harder Ep seems to correspond to a larger fluence and peak flux, with a large scatter for both the hard spike and the EE component. Moreover, the Ep of both the hard spike and the EE are compared with other short GRBs. Finally, we also compare the properties of GRB 170817A with those of short GRBs with EE and find no significant statistical differences between them. We find that GRB 170817A has the lowest Ep, probably because it is off-axis.
Evidence for Galactic disc RR Lyrae stars in the solar neighbourhood
Authors: Prudil Z , Dékány I , Grebel E K , Kunder A
Published: January 2020

We present a kinematical study of 314 RR Lyrae stars in the solar neighbourhood using the publicly available photometric, spectroscopic, and Gaia DR2 astrometric data to explore their distribution in the Milky Way. We report an overdensity of 22 RR Lyrae stars in the solar neighbourhood at a pericentre distance of between 5 and 9 kpc from the Galactic Centre. Their orbital parameters and their chemistry indicate that these 22 variables share the kinematics and the [Fe/H] values of the Galactic disc, with an average metallicity and tangential velocity of [Fe/H] = −0.60 dex and vθ = 241 km s−1, respectively. From the distribution of the Galactocentric spherical velocity components, we find that these 22 disc-like RR Lyrae variables are not consistent with the Gaia Sausage (Gaia-Enceladus), unlike almost half of the local RR Lyrae stars. Chemical information from the literature shows that the majority of the selected pericentre-peak RR Lyrae variables are α-poor, a property shared by typically much younger stars in the thin disc. Using the available photometry, we rule out a possible misclassification with the known classical and anomalous Cepheids. The similar kinematic, chemical, and pulsation properties of these disc RR Lyrae stars suggest they share a common origin. In contrast, we find that the RR Lyrae stars associated with the Gaia-Enceladus based on their kinematics and chemical composition show a considerable metallicity spread in the old population (∼1 dex).
Standard siren speeds: improving velocities in gravitational-wave measurements of H0
Authors: Howlett Cullan , Davis Tamara M
Published: January 2020

We re-analyse data from the gravitational-wave event GW170817 and its host galaxy NGC 4993 to demonstrate the importance of accurate total and peculiar velocities when measuring the Hubble constant using this nearby standard siren. We show that a number of reasonable choices can be made to estimate the velocities for this event, but that systematic differences remain between these measurements depending on the data used. This leads to significant changes in the Hubble constant inferred from GW170817. We present Bayesian model averaging as one way to account for these differences, and obtain $H_{0}=66.8^{+13.4}_{-9.2}\, \mathrm{km\, s^{-1}\, Mpc^{-1}}$. Adding additional information on the viewing angle from high-resolution imaging of the radio counterpart refines this to $H_{0}=64.8^{+7.3}_{-7.2}\, \mathrm{km\, s^{-1}\, Mpc^{-1}}$. During this analysis, we also present an alternative Bayesian model for the posterior on H0 from standard sirens that works more closely with observed quantities from redshift and peculiar velocity surveys. Our results more accurately capture the true uncertainty on the total and peculiar velocities of NGC 4993 and show that exploring how well different data sets characterize galaxy groups and the velocity field in the local Universe could improve this measurement further. These considerations impact any low-redshift distance measurement, and the improvements we suggest here can also be applied to standard candles like Type Ia supernovae. GW170817 is particularly sensitive to peculiar velocity uncertainties because it is so close. For future standard siren measurements, the importance of this error will decrease as (i) we will measure more distant standard sirens and (ii) the random direction of peculiar velocities will average out with more detections.
On short GRBs similar to GRB 170817A detected by Fermi-GBM
Authors: Matsumoto Tatsuya , Piran Tsvi
Published: January 2020

Von Kienlin et al. (2019) selected 11 short gamma-ray bursts (sGRBs) whose characteristics are similar to GRB 170817A. These bursts, like GRB 170817A, have a hard spike followed by a soft thermal tail. However, as their redshifts are unknown it is not clear if their luminosities are as low as that of GRB 170817A. Comparing the positions in the ϵp–Eγ,iso (spectral peak energy – isotropic-equivalent energy) plane and using compactness arguments to estimate the minimal Lorentz factor, Γ, we find that all the bursts in this sample are consistent with being regular sGRBs if they are located at $z$ ≃ 0.3–3. They are also consistent with being similar to GRB 170817A if they are located at $z$ ≲ 0.1. Even in the latter case, the events must involve at least mildly relativistic (Γ ≳ 2) motion within the sources. We, further, find that at most one or two bursts in the sample are consistent with the cocoon shock-breakout model. Finally, we calculate the event rate of off-axis emission either from a jet core or from a jet wing (surrounding the core). We find that the off-axis emission model as an origin of the sample is rejected as it predicts too small event rate. The wing model can be consistent with the observed rate but the model parameters cannot be constrained by the current observations.