A cluster randomized trial of a transition intervention for adolescents with congenital heart disease: rationale and design of the CHAPTER 2 study

BACKGROUND: The population of adolescents and young adults with congenital heart disease (CHD) is growing exponentially. These survivors are at risk of late cardiac complications and require lifelong cardiology care. However, there is a paucity of data on how to prepare adolescents to assume responsibility for their health and function within the adult health care system. Evidence-based transition strategies are required. METHODS: The Congenital Heart Adolescents Participating in Transition Evaluation Research (CHAPTER 2) Study is a two-site cluster randomized clinical trial designed to evaluate the efficacy of a nurse-led transition intervention for 16–17 year olds with moderate or complex CHD. The primary endpoint is excess time to adult CHD care, defined as the time interval between the final pediatric cardiology appointment and the first adult CHD appointment, minus the recommended time interval between these appointments. Secondary endpoints include the MyHeart score (CHD knowledge), Transition Readiness Assessment Questionnaire score, and need for catheter or surgical re-intervention. Participants are enrolled in clusters based on week of attendance in the pediatric cardiology clinic. The intervention consists of two one-hour individualized sessions between a cardiology nurse and study participant. Session One focuses on knowledge of the participant’s CHD, review of their cardiac anatomy and prior interventions, and potential late cardiac complications. Session Two focuses on self-management and communication skills through review and discussion of videos and role-play. The study will recruit 120 participants. DISCUSSION: Many adolescents and young adults experience a gap in care predisposing them to late cardiac complications. The CHAPTER 2 Study will investigate the impact of a nurse-led transition intervention among adolescents with CHD. Fidelity of the intervention is a major focus and priority. This study will build on our experience by (i) enrolling at two tertiary care programs, (ii) including a self-management intervention component, and (iii) evaluating the impact of the intervention on time to ACHD care, a clinically relevant outcome. The results of this study will inform pediatric cardiology programs, patients and policy makers in judging whether a structured intervention program provides clinically meaningful outcomes for adolescents and young adults living with CHD. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT0172333

β-diversity of deep-sea holothurians and asteroids along a bathymetric gradient (NE Atlantic)

Measuring and understanding patterns of ?-diversity remain major challenges in community ecology. Recently, ?-diversity has been shown to consist of 2 distinct components: (1) spatial turnover and (2) species loss leading to nestedness. Both components structure deep-sea macrofaunal assemblages but vary in importance among taxa and ocean basins and with energy availability. Here, we present the first evidence for turnover and nestedness along a bathymetric gradient in 2 major megafaunal taxa, holothurians and asteroids. Turnover is the dominant component of ?-diversity throughout bathyal and abyssal zones in both taxa, despite major differences in ?-diversity and trophic composition. High spatial turnover suggests a role for evolutionary adaptation to environmental circumstances within depth bands. This pattern differs fundamentally from those in some macrofaunal groups in low-energy environments where abyssal nestedness is high and diversity low, with diversity maintained partly by source-sink dynamics

The Effects of Natural Iron Fertilisation on Deep-Sea Ecology: The Crozet Plateau, Southern Indian Ocean

The addition of iron to high-nutrient low-chlorophyll (HNLC) oceanic waters stimulates phytoplankton, leading to greater primary production. Large-scale artificial ocean iron fertilization (OIF) has been proposed as a means of mitigating anthropogenic atmospheric CO2, but its impacts on ocean ecosystems below the photic zone are unknown. Natural OIF, through the addition of iron leached from volcanic islands, has been shown to enhance primary productivity and carbon export and so can be used to study the effects of OIF on life in the ocean. We compared two closely-located deep-sea sites (~400 km apart and both at ~4200 m water depth) to the East (naturally iron fertilized; +Fe) and South (HNLC) of the Crozet Islands in the southern Indian Ocean. Our results suggest that long-term geo-engineering of surface oceanic waters via artificial OIF would lead to significant changes in deep-sea ecosystems. We found that the +Fe area had greater supplies of organic matter inputs to the seafloor, including polyunsaturated fatty acid and carotenoid nutrients. The +Fe site also had greater densities and biomasses of large deep-sea animals with lower levels of evenness in community structuring. The species composition was also very different, with the +Fe site showing similarities to eutrophic sites in other ocean basins. Moreover, major differences occurred in the taxa at the +Fe and HNLC sites revealing the crucial role that surface oceanic conditions play in changing and structuring deep-sea benthic communities

The Porcupine Abyssal Plain fixed-point sustained observatory (PAP-SO): variations and trends from the Northeast Atlantic fixed-point time-series

The Porcupine Abyssal Plain sustained observatory (PAP-SO) in the Northeast Atlantic (49°N 16.5°W; 4800 m) is the longest running open-ocean multidisciplinary observatory in the oceans around Europe. The site has produced high-resolution datasets integrating environmental and ecologically relevant variables from the surface to the seabed for >20 years. Since 2002, a full-depth mooring has been in place with autonomous sensors measuring temperature, salinity, chlorophyll-a fluorescence, nitrate, and pCO2. These complement ongoing mesopelagic and seabed observations on downward particle flux and benthic ecosystem structure and function. With national and European funding, the observatory infrastructure has been advanced steadily, with the latest development in 2010 involving collaboration between the UK's Meteorological Office and Natural Environment Research Council. This resulted in the first simultaneous atmospheric and ocean datasets at the site. All PAP-SO datasets are open access in near real time through websites and as quality-controlled datasets for a range of remote users using ftp sites and uploaded daily to MyOcean and the global telecommunications system for use in modelling activities. The combined datasets capture short-term variation (daily–seasonal), longer term trends (climate-driven), and episodic events (e.g. spring-bloom events), and the data contribute to the Europe-wide move towards good environmental status of our seas, driven by the EU's Marine Strategy Framework Directive (http://ec.europa.eu/environment/water/marine)

The Effect of Lenders' Credit Risk Transfer Activities on Borrowing Firms' Equity Returns

Although innovative credit risk transfer techniques help to allocate risk more optimally, policy-makers worry that they may detrimentally affect the effort spent by financial intermediaries in screening and monitoring credit exposures.This paper examines the equity market's response to loan announcements.In common with the literature it reports a significantly positive average excess return – the well known 'bank certification' effect.However, if the lending bank is known to actively manage its credit risk exposure through large scale securitization programmes then the magnitude of the effect falls by two-thirds.The equity market does not appear to place any value on news of loans extended by banks that are known to transfer credit risk off their books