745 research outputs found

    Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial

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    Introduction Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. Methods and analysis The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. Ethics and dissemination The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. Trial registration number ACTRN12617000821392.</p

    Proceedings of TripleA 5

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    Proceedings of the 5th Workshop on the Semantics of African, Asian and Austronesian Language

    Wild state secrets: ultra-sensitive measurement of micro-movement can reveal internal processes in animals

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    Assessment of animal internal "state" - which includes hormonal, disease, nutritional, and emotional states - is normally considered the province of laboratory work, since its determination in animals in the wild is considered more difficult. However, we show that accelerometers attached externally to animals as diverse as elephants, cockroaches, and humans display consistent signal differences in micro-movement that are indicative of internal state. Originally used to elucidate the behavior of wild animals, accelerometers also have great potential for highlighting animal actions, which are considered as responses stemming from the interplay between internal state and external environment. Advances in accelerometry may help wildlife managers understand how internal state is linked to behavior and movement, and thus clarify issues ranging from how animals cope with the presence of newly constructed roads to how diseased animals might change movement patterns and therefore modulate disease spread

    The Extraordinary X-ray Light Curve of the Classical Nova V1494 Aquilae (1999 #2) in Outburst: The Discovery of Pulsations and a "Burst"

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    V1494 Aql (Nova Aql 1999 No. 2) was discovered on 2 December 1999. We obtained Chandra ACIS-I spectra on 15 April and 7 June 2000 which appear to show only emission lines. Our third observation, on 6 August, showed that its spectrum had evolved to that characteristic of a Super Soft X-ray Source. We then obtained Chandra LETG+HRC-S spectra on 28 September (8 ksec) and 1 October (17 ksec). We analyzed the X-ray light curve of our grating observations and found both a short time scale ``burst'' and oscillations. Neither of these phenomena have previously been seen in the light curve of a nova in outburst. The ``burst'' was a factor of 10 rise in X-ray counts near the middle of the second observation, and which lasted about 1000 sec; it exhibited at least two peaks, in addition to other structure. Our time series analysis of the combined 25 ksec observation shows a peak at 2500 s which is present in independent analyses of both the zeroth order image and the dispersed spectrum and is not present in similar analyses of grating data for HZ 43 and Sirius B. Further analyses of the V1494 Aql data find other periods present which implies that we are observing non-radial g+ modes from the pulsating, rekindled white dwarf.Comment: ApJ accepte

    Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort.

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    BACKGROUND & AIMS: Direct-acting antiviral therapies (DAA) are an important tool for hepatitis C virus (HCV) elimination. However, reinfection among people who inject drugs (PWID) may hamper elimination targets. Therefore, we estimated HCV reinfection rates among DAA-treated individuals, including PWID. METHODS: We analyzed data from the British Columbia Hepatitis Testers Cohort which included ∼1.7 million individuals screened for HCV in British Columbia, Canada. We followed HCV-infected individuals treated with DAAs who achieved a sustained virologic response (SVR) and had ≥1 subsequent HCV RNA measurement to April 22nd, 2018. Reinfection was defined as a positive RNA measurement after SVR. PWID were identified using a validated algorithm and classified based on recent (<3 years) or former (≥3 years before SVR) use. Crude reinfection rates per 100 person-years (PYs) were calculated. Poisson regression was used to model adjusted incidence rate ratios (IRRs) and 95% CIs. RESULTS: Of 4,114 individuals who met the inclusion criteria, most were male (n = 2,692, 65%), born before 1965 (n = 3,411, 83%) and were either recent (n = 875, 21%) or former PWID (n = 1,793, 44%). Opioid-agonist therapy (OAT) was received by 19% of PWID. We identified 40 reinfections during 2,767 PYs. Reinfection rates were higher among recent (3.1/100 PYs; IRR 6.7; 95% CI 1.9-23.5) and former PWID (1.4/100 PYs; IRR 3.7; 95% CI 1.1-12.9) than non-PWID (0.3/100 PYs). Among recent PWID, reinfection rates were higher among individuals born after 1975 (10.2/100 PYs) and those co-infected with HIV (5.7/100 PYs). Only one PWID receiving daily OAT developed reinfection. CONCLUSIONS: Population-level reinfection rates remain elevated after DAA therapy among PWID because of ongoing exposure risk. Engagement of PWID in harm-reduction and support services is needed to prevent reinfections. LAY SUMMARY: Direct-acting antivirals are an effective tool for the treatment of hepatitis C virus, enabling the elimination of the virus. However, some patients who have been successfully treated with direct-acting antivirals are at risk of reinfection. Our findings showed that the risk of reinfection was highest among people with recent injection drug use. Among people who inject drugs, daily use of opioid-agonist therapy was associated with a lower risk of reinfection
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