Pulmonary Specific Ancillary Treatment for Pediatric Acute Respiratory Distress Syndrome:From the Second Pediatric Acute Lung Injury Consensus Conference

OBJECTIVES: We conducted an updated review of the literature on pulmonary-specific ancillary therapies for pediatric acute respiratory distress syndrome (PARDS) to provide an update to the Pediatric Acute Lung Injury Consensus Conference recommendations and statements about clinical practice and research. DATA SOURCES: MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost). STUDY SELECTION: Searches were limited to children, PARDS or hypoxic respiratory failure and overlap with pulmonary-specific ancillary therapies DATA EXTRACTION: Title/abstract review, full-text review, and data extraction using a standardized data collection form. DATA SYNTHESIS: The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Twenty-six studies were identified for full-text extraction. Four clinical recommendations were generated, related to use of inhaled nitric oxide, surfactant, prone positioning, and corticosteroids. Two good practice statements were generated on the use of routine endotracheal suctioning and installation of isotonic saline prior to endotracheal suctioning. Three research statements were generated related to: the use of open versus closed suctioning, specific methods of airway clearance, and various other ancillary therapies. CONCLUSIONS: The evidence to support or refute any of the specific ancillary therapies in children with PARDS remains low. Further investigation, including a focus on specific subpopulations, is needed to better understand the role, if any, of these various ancillary therapies in PARDS.</p

Assessing the accuracy of perceptions of intelligence based on heritable facial features

Perceptions of intelligence based on facial features can have a profound impact on many social situations, but findings have been mixed as to whether these judgements are accurate. Even if such perceptions were accurate, the underlying mechanism is unclear. Several possibilities have been proposed, including evolutionary explanations where certain morphological facial features are associated with fitness-related traits (including cognitive development), or that intelligence judgements are over-generalisation of cues of transitory states that can influence cognition (e.g., tiredness). Here, we attempt to identify the morphological signals that individuals use to make intelligence judgements from facial photographs. In a genetically informative sample of 1660 twins and their siblings, we measured IQ and also perceptions of intelligence based on facial photographs. We found that intelligence judgements were associated with both stable morphological facial traits (face height, interpupillary distance, and nose size) and more transitory facial cues (eyelid openness, and mouth curvature). There was a significant association between perceived intelligence and measured IQ, but of the specific facial attributes only interpupillary distance (i.e., wide-set eyes) significantly mediated this relationship. We also found evidence that perceived intelligence and measured IQ share a familial component, though we could not distinguish between genetic and shared environmental sources

Mountains of our future Earth: Defining priorities for mountain research

The Perth conferences, held every 5 years in Perth, Scotland, bring together people who identify as mountain researchers and who are interested in issues related to global change in mountain social-ecological systems. These conferences provide an opportunity to evaluate the evolution of research directions within the mountain research community, as well as to identify research priorities. The Future Earth Strategic Research Agenda provides a useful framework for evaluating the mountain research community\u27s progress toward addressing global change and sustainability challenges. Using a process originally set up to analyze contributions to the 2010 conference, the abstracts accepted for the 2015 conference in the context of the Future Earth framework were analyzed. This revealed a continued geographic underrepresentation in mountain research of Africa, Latin America, and South and Southeast Asia but a more even treatment of biophysical and social science themes than in 2010. It also showed that the Perth conference research community strongly focused on understanding system processes (the Dynamic Planet theme of the Future Earth research agenda). Despite the continued bias of conference contributions toward traditional observation- and conservation-oriented research, survey results indicate that conference participants clearly believe that transdisciplinary, transformative research is relevant to mountains. Of the 8 Future Earth focal challenges, those related to safeguarding natural assets, promoting sustainable land use, increasing resilience and understanding the water-energy-food nexus received considerable attention. The challenges related to sustainable consumption, decarbonizing socioeconomic systems, cities, and health were considerably less well represented, despite their relevance to mountain socioeconomic systems. Based on these findings, we outline a proposal for the future directions of mountain research

Epidemiology of Neonatal Acute Respiratory Distress Syndrome:Prospective, Multicenter, International Cohort Study

OBJECTIVES: Age-specific definitions for acute respiratory distress syndrome (ARDS) are available, including a specific definition for neonates (the "Montreux definition"). The epidemiology of neonatal ARDS is unknown. The objective of this study was to describe the epidemiology, clinical course, treatment, and outcomes of neonatal ARDS. DESIGN: Prospective, international, observational, cohort study. SETTING: Fifteen academic neonatal ICUs. PATIENTS: Consecutive sample of neonates of any gestational age admitted to participating sites who met the neonatal ARDS Montreux definition criteria. MEASUREMENTS AND MAIN RESULTS: Neonatal ARDS was classified as direct or indirect, infectious or noninfectious, and perinatal (≤ 72 hr after birth) or late in onset. Primary outcomes were: 1) survival at 30 days from diagnosis, 2) inhospital survival, and 3) extracorporeal membrane oxygenation (ECMO)-free survival at 30 days from diagnosis. Secondary outcomes included respiratory complications and common neonatal extrapulmonary morbidities. A total of 239 neonates met criteria for the diagnosis of neonatal ARDS. The median prevalence was 1.5% of neonatal ICU admissions with male/female ratio of 1.5. Respiratory treatments were similar across gestational ages. Direct neonatal ARDS (51.5% of neonates) was more common in term neonates and the perinatal period. Indirect neonatal ARDS was often triggered by an infection and was more common in preterm neonates. Thirty-day, inhospital, and 30-day ECMO-free survival were 83.3%, 76.2%, and 79.5%, respectively. Direct neonatal ARDS was associated with better survival outcomes than indirect neonatal ARDS. Direct and noninfectious neonatal ARDS were associated with the poorest respiratory outcomes at 36 and 40 weeks' postmenstrual age. Gestational age was not associated with any primary outcome on multivariate analyses. CONCLUSIONS: Prevalence and survival of neonatal ARDS are similar to those of pediatric ARDS. The neonatal ARDS subtypes used in the current definition may be associated with distinct clinical outcomes and a different distribution for term and preterm neonates

Two Earth-sized planets orbiting Kepler-20

Since the discovery of the first extrasolar giant planets around Sun-like stars, evolving observational capabilities have brought us closer to the detection of true Earth analogues. The size of an exoplanet can be determined when it periodically passes in front of (transits) its parent star, causing a decrease in starlight proportional to its radius. The smallest exoplanet hitherto discovered has a radius 1.42 times that of the Earth's radius (R Earth), and hence has 2.9 times its volume. Here we report the discovery of two planets, one Earth-sized (1.03R Earth) and the other smaller than the Earth (0.87R Earth), orbiting the star Kepler-20, which is already known to host three other, larger, transiting planets. The gravitational pull of the new planets on the parent star is too small to measure with current instrumentation. We apply a statistical method to show that the likelihood of the planetary interpretation of the transit signals is more than three orders of magnitude larger than that of the alternative hypothesis that the signals result from an eclipsing binary star. Theoretical considerations imply that these planets are rocky, with a composition of iron and silicate. The outer planet could have developed a thick water vapour atmosphere.Comment: Letter to Nature; Received 8 November; accepted 13 December 2011; Published online 20 December 201

The Effect of Hot Deformation Parameters on Microstructure Evolution of the α-Phase in Ti-6Al-4V

The effect of high-temperature deformation and the influence of hot working parameters on microstructure evolution during isothermal hot forging of Ti-6Al-4V in the alpha phase field were investigated. A series of hot isothermal axis-symmetric compression tests were carried out at temperatures both low and high in the alpha stability field [(1153 K and 1223 K (880 °C and 950 °C), respectively], using three strain rates (0.01, 0.1 and 1.0/s) relevant to industrial press forging. The microstructures and orientation of the alpha laths were determined using optical microscopy and electron backscatter diffraction techniques. The experimental results show that there is a change in lath morphology of the secondary α phase under the influence of the deformation parameters, and that α lath thickness appears to have little influence on flow behavior

Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome:A PARDIE Study

Rationale: Few data exist to guide early adjunctive therapy use in pediatric acute respiratory distress syndrome (PARDS). Objectives: To describe contemporary use of adjunctive therapies for early PARDS as a framework for future investigations. Methods: This was a preplanned substudy of a prospective, international, cross-sectional observational study of children with PARDS from 100 centers over 10 study weeks. Measurements and Main Results: We investigated six adjunctive therapies for PARDS: continuous neuromuscular blockade, corticosteroids, inhaled nitric oxide (iNO), prone positioning, high-frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation. Almost half (45%) of children with PARDS received at least one therapy. Variability was noted in the median starting oxygenation index of each therapy; corticosteroids started at the lowest oxygenation index (13.0; interquartile range, 7.6–22.0) and HFOV at the highest (25.7; interquartile range, 16.7–37.3). Continuous neuromuscular blockade was the most common, used in 31%, followed by iNO (13%), corticosteroids (10%), prone positioning (10%), HFOV (9%), and extracorporeal membrane oxygenation (3%). Steroids, iNO, and HFOV were associated with comorbidities. Prone positioning and HFOV were more common in middle-income countries and less frequently used in North America. The use of multiple ancillary therapies increased over the first 3 days of PARDS, but there was not an easily identifiable pattern of combination or order of use. Conclusions: The contemporary description of prevalence, combinations of therapies, and oxygenation threshold for which the therapies are applied is important for design of future studies. Region of the world, income, and comorbidities influence adjunctive therapy use and are important variables to include in PARDS investigations

McNair Research Journal - Summer 2015

Journal articles based on research conducted by undergraduate students in the McNair Scholars Program Table of Contents Biography of Dr. Ronald E. McNair Statements: Dr. Neal J. Smatresk, UNLV President Dr. Juanita P. Fain, Vice President of Student Affairs Dr. William W. Sullivan, Associate Vice President for Retention and Outreach Mr. Keith Rogers, Deputy Executive Director of the Center for Academic Enrichment and Outreach McNair Scholars Institute Staf

A Compact Multi-Planet System With A Significantly Misaligned Ultra Short Period Planet

We report the discovery of a compact multi-planet system orbiting the relatively nearby (78pc) and bright ($K=8.9$) K-star, K2-266 (EPIC248435473). We identify up to six possible planets orbiting K2-266 with estimated periods of P$_b$ = 0.66, P$_{.02}$ = 6.1, P$_c$ = 7.8, P$_d$ = 14.7, P$_e$ = 19.5, and P$_{.06}$ = 56.7 days and radii of R$_P$ = 3.3 R$_{\oplus}$, 0.646 R$_{\oplus}$, 0.705 R$_{\oplus}$, 2.93 R$_{\oplus}$, 2.73 R$_{\oplus}$, and 0.90 R$_{\oplus}$, respectively. We are able to confirm the planetary nature of two of these planets (d & e) from analyzing their transit timing variations ($m_d= 8.9_{-3.8}^{+5.7} M_\oplus$ and $m_e=14.3_{-5.0}^{+6.4} M_\oplus$), confidently validate the planetary nature of two other planets (b & c), and classify the last two as planetary candidates (K2-266.02 & .06). From a simultaneous fit of all 6 possible planets, we find that K2-266 b's orbit has an inclination of 75.32$^{\circ}$ while the other five planets have inclinations of 87-90$^{\circ}$. This observed mutual misalignment may indicate that K2-266 b formed differently from the other planets in the system. The brightness of the host star and the relatively large size of the sub-Neptune sized planets d and e make them well-suited for atmospheric characterization efforts with facilities like the Hubble Space Telescope and upcoming James Webb Space Telescope. We also identify an 8.5-day transiting planet candidate orbiting EPIC248435395, a co-moving companion to K2-266.Comment: 18 pages, 12 figures, 7 tables, Accepted for Publication in the Astronomical Journa