Monomorphic Ventricular Arrhythmias in Athletes.

Ventricular arrhythmias are challenging to manage in athletes with concern for an elevated risk of sudden cardiac death (SCD) during sports competition. Monomorphic ventricular arrhythmias (MMVA), while often benign in athletes with a structurally normal heart, are also associated with a unique subset of idiopathic and malignant substrates that must be clearly defined. A comprehensive evaluation for structural and/or electrical heart disease is required in order to exclude cardiac conditions that increase risk of SCD with exercise, such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Unique issues for physicians who manage this population include navigating athletes through the decision of whether they can safely continue their chosen sport. In the absence of structural heart disease, therapies such as radiofrequency catheter ablation are very effective for certain arrhythmias and may allow for return to competitive sports participation. In this comprehensive review, we summarise the recommendations for evaluating and managing athletes with MMVA

Stepwise dissection of Plasmodium falciparum merozoite invasion of the human erythrocyte

A critical step in establishing malaria parasite infection is the ability of the blood stage merozoite to invade erythrocytes. However, much of our understanding about the cell biology of this process has remained unchanged since seminal work, more than 30 years ago, defined the steps of entry by light and electron microscopy. These studies were, however, only possible using merozoites from simian and avian malaria parasite species, given the poor viability of merozoites from human parasites, specifically Plasmodium falciparum. In contrast, critical invasion proteins have been best described for human or mouse parasite species. Thus our understanding about the molecular and cellular coordination of the entire process of invasion is still largely unknown. Towards addressing this gap, we recently developed a method for harvesting viable P. falciparum merozoites, permitting detailed investigation of the molecular events of merozoite invasio

The X-ray surface brightness distribution from diffuse gas

We use simulations to predict the X-ray surface brightness distribution arising from hot, cosmologically distributed diffuse gas. The distribution is computed for two bands: 0.5-2 keV and 0.1-0.4 keV, using a cosmological-constant dominated cosmology that fits many other observations. We examine a number of numerical issues such as resolution, simulation volume and pixel size and show that the predicted mean background is sensitive to resolution such that higher resolution systematically increases the mean predicted background. Although this means that we can compute only lower bounds to the predicted level, these bounds are already quite restrictive. Since the observed extra-galactic X-ray background is mostly accounted for by compact sources, the amount of the observed background attributable to diffuse gas is tightly constrained. We show that without physical processes in addition to those included in the simulations (such as radiative cooling or non-gravitational heating), both bands exceed observational limits. In order to examine the effect of non-gravitational heating we explore a simple modeling of energy injection and show that substantial amounts of heating are required (i.e. 5 keV per particle when averaged over all baryons). Finally, we also compute the distribution of surface brightness on the sky and show that it has a well-resolved characteristic shape. This shape is substantially modified by non-gravitational heating and can be used as a probe of such energy injection.Comment: 11 pages, 11 figures, submitted to Ap

HILT : High-Level Thesaurus Project M2M Feasibility Study : [Final Report]

The project was asked to investigate the feasibility of developing SOAP-based interfaces between JISC IE services and Wordmap APIs and non-Wordmap versions of the HILT pilot demonstrator created under HILT Phase II and to determine the scope and cost of the provision of an actual demonstrator based on each of these approaches. In doing so it was to take into account the possibility of a future Zthes1-based solution using Z39.50 or OAI-PMH and syntax and data-exchange protocol implications of eScience and semantic-web developments. It was agreed that the primary concerns of the study should be an assessment of the feasibility, scope, and cost of a follow-up M2M pilot that considered the best options in respect of: o Query protocols (SOAP, Z39.50, SRW, OAI) and associated data profiles (e.g. Zthes for Z39.50 and for SRW); o Standards for structuring thesauri and thesauri-type information (e.g. the Zthes XML DTD and SRW version of it and SKOS-Core2); The study was carried out within the allotted timescale, with this Final Report submitted to JISC on 31st March 2005 as scheduled. The detailed proposal for a follow-up project is currently under discussion and will be finalised – as agreed with JISC – by mid-April. It was concluded that an M2M pilot was feasible. A proposal for a follow-up M2M pilot project has been scoped, and is currently being costed

Demographic profiles and environmental drivers of variation relate to individual breeding state in a long-lived trans-oceanic migratory seabird, the Manx shearwater.

Understanding the points in a species breeding cycle when they are most vulnerable to environmental fluctuations is key to understanding interannual demography and guiding effective conservation and management. Seabirds represent one of the most threatened groups of birds in the world, and climate change and severe weather is a prominent and increasing threat to this group. We used a multi-state capture-recapture model to examine how the demographic rates of a long-lived trans-oceanic migrant seabird, the Manx shearwater Puffinus puffinus, are influenced by environmental conditions experienced at different stages of the annual breeding cycle and whether these relationships vary with an individual's breeding state in the previous year (i.e., successful breeder, failed breeder and non-breeder). Our results imply that populations of Manx shearwaters are comprised of individuals with different demographic profiles, whereby more successful reproduction is associated with higher rates of survival and breeding propensity. However, we found that all birds experienced the same negative relationship between rates of survival and wind force during the breeding season, indicating a cost of reproduction (or central place constraint for non-breeders) during years with severe weather conditions. We also found that environmental effects differentially influence the breeding propensity of individuals in different breeding states. This suggests individual spatio-temporal variation in habitat use during the annual cycle, such that climate change could alter the frequency that individuals with different demographic profiles breed thereby driving a complex and less predictable population response. More broadly, our study highlights the importance of considering individual-level factors when examining population demography and predicting how species may respond to climate change

Site use and connectivity of female grey seals (Halichoerus grypus) around Wales

The UK Natural Environment Research Council (NERC) provided core funding to the Sea Mammal Research Unit during this work and NERC Grant No. NE/G008930/1 to PP and LH to develop photo-ID use for grey seals. The Esmée Fairbairn Foundation provided additional funding to PP and LH for photo-ID work with grey seals. NRW funded survey work by MB, LM, SW and PS; contracted LH for survey design, software development and data management; IL and PP for work related to the production of this manuscript.Grey seals (Halichoerus grypus) are a qualifying feature of three special areas of conservation (SACs) in Wales, yet relatively little is known of their site use along this coastline. Since 1992, many individuals and organisations have contributed to a grey seal photographic identification database held by Natural Resources Wales, which is one of the largest and oldest of its kind, providing key information from grey seal haul-out sites around the Celtic and Irish Seas. Here, we investigated spatial connectivity of haul-out sites and fidelity of adult females to breeding sites. The minimum number of adult female grey seals using the area between 1992 and 2016 was 2688. Individual capture histories and relative spatial transition probabilities (Pij) between pairs of location groups were calculated. Adjacent locations were highly connected (e.g. Lleyn Peninsula and Bardsey, Pij = 0.7) but connections spanned the entire region, up to 230 km apart (e.g. Skomer and Dee Estuary, Pij = 0.004). Resights were recorded within SACs (e.g. Lleyn Peninsula and Bardsey [Lleyn Peninsula and the Sarnau SAC], Pij = 0.7), between SACs (e.g. Bardsey and Skomer [Pembrokeshire Marine], Pij = 0.03), between SACs and non-designated areas (e.g. Skerries and Bardsey, Pij = 0.09) and between sites outside any protected area (e.g. Dee Estuary and Anglesey, Pij = 0.5). While inter-annual fidelity to breeding sites was high (Pij = 0.82–1), individual female grey seals moved throughout the region. This evidence of extensive site use beyond protected areas is important for the management and conservation of grey seals around Wales.Publisher PDFPeer reviewe

Improving risk models for patients having emergency bowel cancer surgery using linked electronic health records: a national cohort study

BACKGROUND: Life-saving emergency major resection of colorectal cancer (CRC) is a high-risk procedure. Accurate prediction of post-operative mortality for patients undergoing this procedure is essential for both healthcare performance monitoring and pre-operative risk assessment. Risk-adjustment models for CRC patients often include patient and tumour characteristics, widely available in cancer registries and audits. We investigated to what extent inclusion of additional physiological and surgical measures, available through linkage or additional data collection, improves accuracy of risk models. METHODS: Linked, routinely-collected data on patients undergoing emergency CRC surgery in England between December 2016 and November 2019 were used to develop a risk model for 90-day mortality. Backwards selection identified a 'selected model' of physiological and surgical measures in addition to patient and tumour characteristics. Model performance was assessed compared to a 'basic model' including only patient and tumour characteristics. Missing data was multiply imputed. RESULTS: 846 of 10,578 (8.0%) patients died within 90 days of surgery. The selected model included seven pre-operative physiological and surgical measures (pulse rate, systolic blood pressure, breathlessness, sodium, urea, albumin, and predicted peritoneal soiling), in addition to the ten patient and tumour characteristics in the basic model (calendar year of surgery, age, sex, ASA grade, TNM T stage, TNM N stage, TNM M stage, cancer site, number of comorbidities, emergency admission). The selected model had considerably better discrimination compared to the basic model (C-statistic: 0.824 versus 0.783, respectively). CONCLUSION: Linkage of disease-specific and treatment-specific datasets allowed the inclusion of physiological and surgical measures in a risk model alongside patient and tumour characteristics which improves the accuracy of the prediction of the mortality risk for CRC patients having emergency surgery. This improvement will allow more accurate performance monitoring of healthcare providers and enhance clinical care planning

The Space Infrared Interferometric Telescope (SPIRIT): High-resolution imaging and spectroscopy in the far-infrared

We report results of a recently-completed pre-Formulation Phase study of SPIRIT, a candidate NASA Origins Probe mission. SPIRIT is a spatial and spectral interferometer with an operating wavelength range 25 - 400 microns. SPIRIT will provide sub-arcsecond resolution images and spectra with resolution R = 3000 in a 1 arcmin field of view to accomplish three primary scientific objectives: (1) Learn how planetary systems form from protostellar disks, and how they acquire their inhomogeneous composition; (2) characterize the family of extrasolar planetary systems by imaging the structure in debris disks to understand how and where planets of different types form; and (3) learn how high-redshift galaxies formed and merged to form the present-day population of galaxies. Observations with SPIRIT will be complementary to those of the James Webb Space Telescope and the ground-based Atacama Large Millimeter Array. All three observatories could be operational contemporaneously.Comment: 20 pages, 12 figures, accepted for publication in J. Adv. Space Res. on 26 May 200