Exploring the Relationship Between Morphine Concentration and Oversedation in Children After Cardiac Surgery

Titrating analgesic and sedative drugs in pediatric intensive care remains a challenge for caregivers due to the lack of pharmacodynamic knowledge in this population. The aim of the current study is to explore the concentration-effect relationship for morphine-associated oversedation after c

Complete solutions to the metric of spherically collapsing dust in an expanding spacetime with a cosmological constant

We present semi-analytical solutions to the background equations describing the Lema\^itre-Tolman-Bondi (LTB) metric as well as the homogeneous Friedmann equations, in the presence of dust, curvature and a cosmological constant Lambda. For none of the presented solutions any numerical integration has to be performed. All presented solutions are given for expanding and collapsing phases, preserving continuity in time and radius. Hence, these solutions describe the complete space time of a collapsing spherical object in an expanding universe. In the appendix we present for completeness a solution of the Friedmann equations in the additional presence of radiation, only valid for the Robertson-Walker metric.Comment: 23 pages, one figure. Numerical module for evaluation of the solutions released at http://web.physik.rwth-aachen.de/download/valkenburg/ColLambda/ Matches published version, published under Open Access. Note change of titl

Perceiving the equation of state of Dark Energy while living in a Cold Spot

The Cold Spot could be an adiabatic perturbation on the surface of last scattering, in which case it is an over-density with comoving radius of the order of 1 Gpc. We assess the effect that living in a similar structure, without knowing it, has on our perception of the equation of state of Dark Energy. We find that structures of dimensions such that they could cause the Cold Spot on the CMB, affect the perceived equation of state of Dark Energy possibly up to ten percent.Comment: 17 pages, 5 figures, matches published versio

Population-based impact of COVID-19 on incidence, treatment, and survival of patients with pancreatic cancer

Background: The COVID-19 pandemic has put substantial strain on the healthcare system of which the effects are only partly elucidated. This study aimed to investigate the impact on pancreatic cancer care. Methods: All patients diagnosed with pancreatic cancer between 2017 and 2020 were selected from the Netherlands Cancer Registry. Patients diagnosed and/or treated in 2020 were compared to 2017–2019. Monthly incidence was calculated. Patient, tumor and treatment characteristics were analyzed and compared using Chi-squared tests. Survival data was analyzed using Kaplan–Meier and Log-rank tests. Results: In total, 11019 patients were assessed. The incidence in quarter (Q)2 of 2020 was comparable with that in Q2 of 2017–2019 (p = 0.804). However, the incidence increased in Q4 of 2020 (p = 0.031), mainly due to a higher incidence of metastatic disease (p = 0.010). Baseline characteristics, surgical resection (15% vs 16%; p = 0.466) and palliative systemic therapy rates (23% vs 24%; p = 0.183) were comparable. In 2020, more surgically treated patients received (neo)adjuvant treatment compared to 2017–2019 (73% vs 67%; p = 0.041). Median overall survival was comparable (3.8 vs 3.8 months; p = 0.065). Conclusion: This nationwide study found a minor impact of the COVID-19 pandemic on pancreatic cancer care and outcome. The Dutch health care system was apparently able to maintain essential care for patients with pancreatic cancer

Average luminosity distance in inhomogeneous universes

The paper studies the correction to the distance modulus induced by inhomogeneities and averaged over all directions from a given observer. The inhomogeneities are modeled as mass-compensated voids in random or regular lattices within Swiss-cheese universes. Void radii below 300 Mpc are considered, which are supported by current redshift surveys and limited by the recently observed imprint such voids leave on CMB. The averaging over all directions, performed by numerical ray tracing, is non-perturbative and includes the supernovas inside the voids. Voids aligning along a certain direction produce a cumulative gravitational lensing correction that increases with their number. Such corrections are destroyed by the averaging over all directions, even in non-randomized simple cubic void lattices. At low redshifts, the average correction is not zero but decays with the peculiar velocities and redshift. Its upper bound is provided by the maximal average correction which assumes no random cancelations between different voids. It is described well by a linear perturbation formula and, for the voids considered, is 20% of the correction corresponding to the maximal peculiar velocity. The average correction calculated in random and simple cubic void lattices is severely damped below the predicted maximal one after a single void diameter. That is traced to cancellations between the corrections from the fronts and backs of different voids. All that implies that voids cannot imitate the effect of dark energy unless they have radii and peculiar velocities much larger than the currently observed. The results obtained allow one to readily predict the redshift above which the direction-averaged fluctuation in the Hubble diagram falls below a required precision and suggest a method to extract the background Hubble constant from low redshift data without the need to correct for peculiar velocities.Comment: 34 pages, 21 figures, matches the version accepted in JCA

The (co-)occurrence of problematic video gaming, substance use, and psychosocial problems in adolescents

Aims. The current study explored the nature of problematic (addictive) video gaming and the association with game type, psychosocial health, and substance use. Methods. Data were collected using a paper and pencil survey in the classroom setting. Three samples were aggregated to achieve a total sample of 8478 unique adolescents. Scales included measures of game use, game type, the Video game Addiction Test (VAT), depressive mood, negative self-esteem, loneliness, social anxiety, education performance, and use of cannabis, alcohol and nicotine (smoking). Results. Findings confirmed problematic gaming is most common amongst adolescent gamers who play multiplayer online games. Boys (60%) were more likely to play online games than girls (14%) and problematic gamers were more likely to be boys (5%) than girls (1%). High problematic gamers showed higher scores on depressive mood, loneliness, social anxiety, negative self-esteem, and self-reported lower school performance. Nicotine, alcohol, and cannabis using boys were almost twice more likely to report high PVG than non-users. Conclusions. It appears that online gaming in general is not necessarily associated with problems. However, problematic gamers do seem to play online games more often, and a small subgroup of gamers – specifically boys – showed lower psychosocial functioning and lower grades. Moreover, associations with alcohol, nicotine, and cannabis use are found. It would appear that problematic gaming is an undesirable problem for a small subgroup of gamers. The findings encourage further exploration of the role of psychoactive substance use in problematic gaming

Serum sex hormone-binding globulin levels are reduced and inversely associated with intrahepatic lipid content and saturated fatty acid fraction in adult patients with glycogen storage disease type 1a

PURPOSE: De novo lipogenesis has been inversely associated with serum sex hormone-binding globulin (SHBG) levels. However, the directionality of this association has remained uncertain. We, therefore, studied individuals with glycogen storage disease type 1a (GSD1a), who are characterized by a genetic defect in glucose-6-phosphatase resulting in increased rates of de novo lipogenesis, to assess the downstream effect on serum SHBG levels. METHODS: A case-control study comparing serum SHBG levels in patients with GSD1a (n = 10) and controls matched for age, sex, and BMI (n = 10). Intrahepatic lipid content and saturated fatty acid fraction were quantified by proton magnetic resonance spectroscopy. RESULTS: Serum SHBG levels were statistically significantly lower in patients with GSD1a compared to the controls (p = 0.041), while intrahepatic lipid content and intrahepatic saturated fatty acid fraction-a marker of de novo lipogenesis-were significantly higher in patients with GSD1a (p = 0.001 and p = 0.019, respectively). In addition, there was a statistically significant, inverse association of intrahepatic lipid content and saturated fatty acid fraction with serum SHBG levels in patients and controls combined (β: - 0.28, 95% CI: - 0.47;- 0.09 and β: - 0.02, 95% CI: - 0.04;- 0.01, respectively). CONCLUSION: Patients with GSD1a, who are characterized by genetically determined higher rates of de novo lipogenesis, have lower serum SHBG levels than controls

Characterization of invasive and colonizing isolates of Streptococcus agalactiae in East African adults

Ninety-five colonizing isolates and 74 invasive isolates of Streptococcus agalactiae from Kenyan adults were characterized by using capsular serotyping and multilocus sequence typing. Twenty-two sequence types clustering into five clonal complexes were found. Data support the view that S. agalactiae isolates belonging to a limited number of clonal complexes are invasive in adults worldwide

Cosmological background solutions and cosmological backreactions

The cosmological backreaction proposal, which attempts to account for observations without a primary dark energy source in the stress-energy tensor, has been developed and discussed by means of different approaches. Here, we focus on the concept of cosmological background solutions in order to develop a framework to study different backreaction proposals.Comment: 14 pages, 5 figures; major changes, replaced to match the version published in General Relativity and Gravitatio

Investigation of the association of the CRTM and CRTL1 genes with radiographically evident osteoarthritis in subjects from the Rotterdam study

__Objective:__ To investigate whether radiographically evident osteoarthritis (ROA) in 55-65-year-old men and women is associated with specific alleles or genotypes of the cartilage matrix protein (CRTM) and cartilage link protein (CRTLl) genes. __Methods:__ Cases were selected from a populationbased study on the presence of ROA of the knee or hip. Further radiographic analysis included scoring for spine and hand ROA. Controls, selected from the same population, were free of ROA in all joints. __Results:__ The CRTM locus was significantly associated with hip ROA in men (odds ratio 0.50, 95% confidence interval 0.26-0.95). A significant association between ROA and the CRTLl gene was not observed. __Conclusion:__ These results suggest that the CRTM locus may play a role in the sex- and joint site-specific pattern of ROA development