| 1. |
- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Beal, Jacob, et al.
(författare)
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Robust estimation of bacterial cell count from optical density
- 2020
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Ingår i: Communications Biology. - : Springer Science and Business Media LLC. - 2399-3642. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data.
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| 3. |
- Boyd, Roslyn N., et al.
(författare)
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REACH : study protocol of a randomised trial of rehabilitation very early in congenital hemiplegia
- 2017
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 7:9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Congenital hemiplegia is the most common form of cerebral palsy (CP). Children with unilateral CP show signs of upper limb asymmetry by 8 months corrected age (ca) but are frequently not referred to therapy until after 12 months ca. This study compares the efficacy of infant-friendly modified constraint-induced movement therapy (Baby mCIMT) to infant friendly bimanual therapy (Baby BIM) on upper limb, cognitive and neuroplasticity outcomes in a multisite randomised comparison trial.METHODS AND ANALYSIS: 150 infants (75 in each group), aged between 3 and 6 months ca, with asymmetric brain injury and clinical signs of upper extremity asymmetry will be recruited. Children will be randomised centrally to receive equal doses of either Baby mCIMT or Baby BIM. Baby mCIMT comprises restraint of the unimpaired hand using a simple restraint (eg, glove, sock), combined with intensive parent implemented practice focusing on active use of the impaired hand in a play-based context. In contrast, Baby BIM promotes active play requiring both hands in a play-based context. Both interventions will be delivered by parents at home with monthly home visits and interim telecommunication support by study therapists. Assessments will be conducted at study entry; at 6, 12 months ca immediately postintervention (primary outcome) and 24 months ca (retention). The primary outcome will be the Mini-Assisting Hand Assessment. Secondary outcomes include the Bayley Scale for Infant and Toddler Development (cognitive and motor domains) and the Hand Assessment of Infants. A subset of children will undertake MRI scans at 24 months ca to evaluate brain lesion severity and brain (re)organisation after intervention.ETHICS AND DISSEMINATION: Full ethical approvals for this study have been obtained from the relevant sites. The findings will be disseminated in peer-reviewed publications.TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trials Registry: ACTRN12615000180516, Pre results.
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| 4. |
- Brown, Sabrina R., et al.
(författare)
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Multi-proxy record of Holocene paleoenvironmental conditions from Yellowstone Lake, Wyoming, USA
- 2021
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Ingår i: Quaternary Science Reviews. - : Elsevier BV. - 0277-3791. ; 274
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Tidskriftsartikel (refereegranskat)abstract
- A composite 11.82 m-long (9876–67 cal yr BP) sediment record from Yellowstone Lake, Wyoming was analyzed using a robust set of biological and geochemical proxies to investigate the paleoenvironmental evolution of the lake and its catchment in response to long-term climate forcing. Oxygen isotopes from diatom frustules were analyzed to reconstruct Holocene climate changes, and pollen, charcoal, diatom assemblages, and biogenic silica provided information on terrestrial and limnological responses. The long-term trends recorded in the terrestrial and limnic ecosystems over the last 9800 years reflect the influence of changes in the amplification of the seasonal cycle of insolation on regional climate. The early Holocene (9880–6700 cal yr BP) summer insolation maximum and strengthening of the northeastern Pacific subtropical high-pressure system created warm dry conditions and decreasing summer insolation in the middle (6700–3000 cal yr BP) and late (3000–67 cal yr BP) Holocene resulted in progressively cooler, wetter conditions. Submillenial climate variation is also apparent, with a wetter/cooler interval between 7000 and 6800 cal yr BP and warmer and/or drier conditions from 4500 to 3000 cal yr BP and at ca. 1100 cal yr BP. These data show that the Yellowstone Lake basin had a climate history typical of a summer-dry region, which helps to better define the spatial variability of Holocene climate in the Greater Yellowstone Ecosystem.
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| 5. |
- Cartier, Rosine, et al.
(författare)
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Hydrological changes in Yellowstone Lake (USA) during the Holocene based on the analysis of oxygen isotopes in diatoms
- 2019
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Ingår i: Hydrological changes in Yellowstone Lake (USA) during the Holocene based on the analysis of oxygen isotopes in diatoms.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Northern Yellowstone Lake is on the southeast edge of the 631-ka Yellowstone caldera and is an area with high heat flow, high seismicity, and an abundance of active hydrothermal features and structures. Several large hydrothermal explosions since the last glacial recession formed craters of more than 100 m in diameter. These large craters raise the question on how climate and hydrological changes have affected the hydrothermal system and the lake ecosystem at millennial timescales.This study focuses on an 11.6-m-long core collected in 2016 in the Lake Hotel graben covering the last 9,900 cal years according to radiocarbon ages. Past hydrological changes were inferred from oxygen isotopes values of biogenic silica that comprises the cell wall of the diatoms. d 18O values reflect silica-lake water fractionation during diatom growth. The d 18O values vary according to changes in sources of precipitation, supply of runoff by tributaries, lake water temperature, and evaporation. Currently, precipitation occurs mainly as winter snow from weather systems originating in the Pacific.Periods of high d 18O in diatoms (enrichment in the heavy isotope) occur from the base of the record 9900 to ca. 7500 cal years BP, from 4500 to 3000 cal years BP and ca. 1000 cal years BP. These isotopic enrichments have been interpreted as to be mostly the result of increased water evaporation and/or reduced snowmelt flowing into the lake from the Yellowstone River and other tributaries. This inference is supported by d 18O measurements from water samples showing that lake water is progressively more evaporated with increased distance from the Yellowstone River inlet . The base of the record also is characterized by lower abundance of Pinus pollen suggesting a more open Pinus contorta forest until 5800 cal years BP, with more-frequent fire than today. Additionally, a long-term decrease in d 18Odiatomin the record and a progressive increase in the duration of spring water mixing shown by diatom assemblages (i.e. higher A. subarctica/S. minutulusratio) are associated with decreased summer insolation during the Holocene. These results compare well with other paleoclimatic records from the Yellowstone region that show a transition to cool, wet conditions in the late Holocene.
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| 6. |
- Fazey, Ioan, et al.
(författare)
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Transforming knowledge systems for life on Earth : Visions of future systems and how to get there
- 2020
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Ingår i: Energy Research & Social Science. - : Elsevier. - 2214-6296 .- 2214-6326. ; 70
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Tidskriftsartikel (refereegranskat)abstract
- Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent.
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| 9. |
- Novak, Iona, et al.
(författare)
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Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy : Advances in Diagnosis and Treatment
- 2017
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Ingår i: JAMA pediatrics. - : American Medical Association. - 2168-6203 .- 2168-6211. ; 171:9, s. 897-907
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Forskningsöversikt (refereegranskat)abstract
- Importance: Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age.Objectives: To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.Evidence Review: This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument.Findings: Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence.Conclusions and Relevance: Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
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