High-pressure x-ray diffraction study of bulk and nanocrystalline PbMoO4

We studied the effects of high-pressure on the crystalline structure of bulk and nanocrystalline scheelite-type PbMoO4. We found that in both cases the compressibility of the materials is highly non-isotropic, being the c-axis the most compressible one. We also observed that the volume compressibility of nanocrystals becomes higher that the bulk one at 5 GPa. In addition, at 10.7(8) GPa we observed the onset of an structural phase transition in bulk PbMoO4. The high-pressure phase has a monoclinic structure similar to M-fergusonite. The transition is reversible and not volume change is detected between the low- and high-pressure phases. No additional structural changes or evidence of decomposition are found up to 21.1 GPa. In contrast nanocrystalline PbMoO4 remains in the scheelite structure at least up to 16.1 GPa. Finally, the equation of state for bulk and nanocrystalline PbMoO4 are also determined.Comment: 18 pages, 4 figure

Clearance of inflammatory cytokines in patients with septic acute kidney injury during renal replacement therapy using the EMiC2 filter (Clic-AKI study)

BACKGROUND: The EMiC2 membrane is a medium cut-off haemofilter (45 kiloDalton). Little is known regarding its efficacy in eliminating medium-sized cytokines in sepsis. This study aimed to explore the effects of continuous veno-venous haemodialysis (CVVHD) using the EMiC2 filter on cytokine clearance. METHODS: This was a prospective observational study conducted in critically ill patients with sepsis and acute kidney injury requiring kidney replacement therapy. We measured concentrations of 12 cytokines [Interleukin (IL) IL-1β, IL-1α, IL-2, IL-4, IL-6, IL-8, IL-10, interferon (IFN)-γ, tumour necrosis factor (TNF)-α, vascular endothelial growth factor, monocyte chemoattractant protein (MCP)-1, epidermal growth factor (EGF)] in plasma at baseline (T0) and pre- and post-dialyzer at 1, 6, 24, and 48 h after CVVHD initiation and in the effluent fluid at corresponding time points. Outcomes were the effluent and adsorptive clearance rates, mass balances, and changes in serial serum concentrations. RESULTS: Twelve patients were included in the final analysis. All cytokines except EGF concentrations declined over 48 h (p < 0.001). The effluent clearance rates were variable and ranged from negligible values for IL-2, IFN-γ, IL-1α, IL-1β, and EGF, to 19.0 ml/min for TNF-α. Negative or minimal adsorption was observed. The effluent and adsorptive clearance rates remained steady over time. The percentage of cytokine removal was low for most cytokines throughout the 48-h period. CONCLUSION: EMiC2-CVVHD achieved modest removal of most cytokines and demonstrated small to no adsorptive capacity despite a decline in plasma cytokine concentrations. This suggests that changes in plasma cytokine concentrations may not be solely influenced by extracorporeal removal. TRIAL REGISTRATION: NCT03231748, registered on 27th July 2017

Effects of regional citrate anticoagulation on thrombin generation, fibrinolysis and platelet function in critically ill patients receiving continuous renal replacement therapy for acute kidney injury: a prospective study

Background: Regional citrate anticoagulation (RCA) is recommended for continuous renal replacement therapy (CRRT). However, filter life varies and premature filter clotting can occur. The aims of this explorative prospective study were to investigate the effects of RCA on thrombin generation, fibrinolysis and platelet function in critically ill patients receiving CRRT, to compare clotting parameters between systemic and intra-circuit blood samples, and to screen participants for coagulation disorders. We recruited critically ill adult patients admitted to a 30-bedded Intensive care unit in a tertiary care hospital who required CRRT with RCA for acute kidney injury (AKI). Patients with pre-existing thrombotic, bleeding tendencies or a CRRT duration less than 48 h were excluded. We measured coagulation and thrombophilia parameters at baseline. Thrombin generation, D-dimer and platelet function were measured pre-CRRT and at 12, 24, 36, 48 and 72 h after commencing CRRT using blood samples taken from the arterial line and the circuit. Results: At baseline, all eleven patients (mean age 62.4 years, 82% male) had Factor VIII and von Willebrand Factor concentrations above reference range and significantly increased peak thrombin generation. During CRRT, there were no significant changes in systemic maximum peak thrombin generation, time to peak thrombin generation, fibrinogen, D-dimer and platelet function analysis. We observed no significant difference between paired samples taken from the patient's arterial line and the circuit. Conclusions: Critically ill patients with AKI requiring CRRT are hypercoagulable. Citrate used for anticoagulation during CRRT does not affect thrombin generation, D-dimer or platelet function. Systemic clotting parameters reflect intra-circuit results. Trial registration: ClinicalTrials.gov Identifier: NCT02486614. Registered 01 July 2015—Registered after recruitment of first patient. https://clinicaltrials.gov/ct2/show/NCT0248661

Immersive multi-user decision training games with ARLearn

Serious gaming approaches so far focus mainly on skill development, motivational aspects or providing immersive learning situations. Little work has been reported to foster awareness and decision competencies in complex deci-sion situations involving incomplete information and multiple stakeholders. We address this issue exploring the technical requirements and possibilities to de-sign games for such situations in three case studies: a hostage taking situation, a multi-stakeholder logistics case, and a health-care related emergency case. To implement the games, we use a multi-user enabled mobile game development platform (ARLearn). We describe the underlying real world situations and edu-cational challenges and analyse how these are reflected in the ARLearn games realized. Based on these cases we propose a way to increase the immersiveness of mobile learning games.SALOM

A survey of statistics in three UK general practice journal

Background Many medical specialities have reviewed the statistical content of their journals. To our knowledge this has not been done in general practice. Given the main role of a general practitioner as a diagnostician we thought it would be of interest to see whether the statistical methods reported reflect the diagnostic process. Methods Hand search of three UK journals of general practice namely the British Medical Journal (general practice section), British Journal of General Practice and Family Practice over a one-year period (1 January to 31 December 2000). Results A wide variety of statistical techniques were used. The most common methods included t-tests and Chi-squared tests. There were few articles reporting likelihood ratios and other useful diagnostic methods. There was evidence that the journals with the more thorough statistical review process reported a more complex and wider variety of statistical techniques. Conclusions The BMJ had a wider range and greater diversity of statistical methods than the other two journals. However, in all three journals there was a dearth of papers reflecting the diagnostic process. Across all three journals there were relatively few papers describing randomised controlled trials thus recognising the difficulty of implementing this design in general practice

Effect of dexamethasone exposure on the neonatal unit on the school age lung function of children born very prematurely

The objective of this study was to determine the impact of postnatal dexamethasone treatment on the neonatal unit on the school age lung function of very prematurely born children. Children born prior to 29 weeks of gestational age had been entered into a randomised trial of two methods of neonatal ventilation (United Kingdom Oscillation Study). They had comprehensive lung function measurements at 11 to 14 years of age. One hundred and seventy-nine children born at a mean gestational age of 26.9 (range 23–28) weeks were assessed at 11 to 14 years; 50 had received postnatal dexamethasone. Forced expiratory flow at 75% (FEF75), 50%, 25% and 25–75% of the expired vital capacity, forced expiratory volume in one second, peak expiratory flow and forced vital capacity and lung volumes including total lung capacity and residual volume were assessed. Lung function outcomes were compared between children who had and had not been exposed to dexamethasone after adjustment for neonatal factors using linear mixed effects regression. After adjustment for confounders all the mean spirometry results were between 0.38 and 0.87 standard deviations lower in those exposed to dexamethasone compared to the unexposed. For example, the mean FEF75z-score was 0.53 lower (95% CI 0.21 to 0.85). The mean lung function was lower as the number of courses of dexamethasone increased. In conclusion, postnatal dexamethasone exposure was associated with lower mean lung function at school age in children born extremely prematurely. Our results suggest the larger the cumulative dose the greater the adverse effect on lung function at follow-up

The Atacama Cosmology Telescope: Physical Properties of Sunyaev-Zel'dovich Effect Clusters on the Celestial Equator

We present the optical and X-ray properties of 68 galaxy clusters selected via the Sunyaev-Zel'dovich Effect at 148 GHz by the Atacama Cosmology Telescope (ACT). Our sample, from an area of 504 square degrees centered on the celestial equator, is divided into two regions. The main region uses 270 square degrees of the ACT survey that overlaps with the co-added ugriz imaging from the Sloan Digital Sky Survey (SDSS) over Stripe 82 plus additional near-infrared pointed observations with the Apache Point Observatory 3.5-meter telescope. We confirm a total of 49 clusters to z~1.3, of which 22 (all at z>0.55) are new discoveries. For the second region the regular-depth SDSS imaging allows us to confirm 19 more clusters up to z~0.7, of which 10 systems are new. We present the optical richness, photometric redshifts, and separation between the SZ position and the brightest cluster galaxy (BCG). We find no significant offset between the cluster SZ centroid and BCG location and a weak correlation between optical richness and SZ-derived mass. We also present X-ray fluxes and luminosities from the ROSAT All Sky Survey which confirm that this is a massive sample. One of the newly discovered clusters, ACT-CL J0044.4+0113 at z=1.1 (photometric), has an integrated XMM-Newton X-ray temperature of kT_x=7.9+/-1.0 keV and combined mass of M_200a=8.2(-2.5,+3.3)x10^14 M_sun/h70 placing it among the most massive and X-ray-hot clusters known at redshifts beyond z=1. We also highlight the optically-rich cluster ACT-CL J2327.4-0204 (RCS2 2327) at z=0.705 (spectroscopic) as the most significant detection of the whole equatorial sample with a Chandra-derived mass of M_200a=1.9(-0.4,+0.6)x10^15 M_sun/h70, comparable to some of the most massive known clusters like "El Gordo" and the Bullet Cluster.Comment: 18 pages, 12 figures. Accepted to the Astrophysical Journal. New version includes minor changes in the accepted pape

Methodological overview of systematic reviews to establish the evidence base for emergency general surgery

BACKGROUND: The evidence for treatment decision‐making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions. METHODS: Systematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non‐randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non‐surgical invasive or non‐invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist. RESULTS: The 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty‐one (48·1 per cent) included RCTs alone, 79 (74·5 per cent) included at least one RCT and 25 (23·6 per cent) summarized non‐randomized evidence alone. Reviews included 727 unique studies, of which 30·3 per cent were RCTs. Sixty‐five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non‐surgical interventions. Fifty‐seven reviews (53·8 per cent) were rated as low risk of bias. CONCLUSION: This overview of reviews highlights the need for more and better research in this field

“We’re just like Gok, but in reverse”: Ana Girls – empowerment and resistance in digital communities

‘Pro-Ana’ Internet sites can foster or celebrate anorexia and bulimia nervosa in young women. Clinical discourse portrays anorexia as a problematic and deviant ‘condition’, while Pro-Ana/-Mia spaces offer an arena that appeals to control over how bodies are represented. We draw on data from a seven-year ethnographic study of young people’s online worlds, from forums, postings on Pro-Ana sites and online interviews with Pro-Ana users, to illustrate and illuminate young women’s perspectives and the extent to which this transgressive movement strives for voice. We argue that ‘being’ Pro-Ana offers ‘practitioners’ liberation from cultural critiques of the body. The websites suggest that famously thin women, whose ‘beauty’ has already been culturally validated, have overcome similar problems to Pro-Ana readers, and offer a re-formulation of cultural identities to provide legitimate (and validated) means to reach this ‘perfection’. In this respect, they represent important sites of agency and resistance

Late Neogene evolution of modern deep-dwelling plankton

The fossil record of marine microplankton provides insights into the evolutionary drivers which led to the origin of modern deep-water plankton, one of the largest components of ocean biomass. We use global abundance and biogeographic data, combined with depth habitat reconstructions, to determine the environmental mechanisms behind speciation in two groups of pelagic microfossils over the past 15 Myr. We compare our microfossil datasets with water column profiles simulated in an Earth system model. We show that deep-living planktonic foraminiferal (zooplankton) and calcareous nannofossil (mixotroph phytoplankton) species were virtually absent globally during the peak of the middle Miocene warmth. The evolution of deep-dwelling planktonic foraminifera started from subpolar–mid-latitude species, during late Miocene cooling, via allopatry. Deep-dwelling species subsequently spread towards lower latitudes and further diversified via depth sympatry, establishing modern communities stratified hundreds of metres down the water column. Similarly, sub-euphotic zone specialist calcareous nannofossils become a major component of tropical and sub-tropical assemblages during the latest Miocene to early Pliocene. Our model simulations suggest that increased organic matter and oxygen availability for planktonic foraminifera, and increased nutrients and light penetration for nannoplankton, favoured the evolution of new deep-water niches. These conditions resulted from global cooling and the associated increase in the efficiency of the biological pump over the last 15 Myr