Acute Respiratory Distress Syndrome:The Berlin Definition

The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm HgPaO2/FIO2300 mmHg), moderate (100mmHgPaO2/FIO2200mmHg), and severe (PaO2/FIO2100mmHg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (40 mL/cm H2O), positive endexpiratory pressure (10 cm H2O), and corrected expired volume per minute(10 L/min). The draft Berlin Definition was empirically evaluated using patientlevel meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%;95%CI, 24%-30%; 32%;95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P.001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P.001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P.001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning

Family presence during resuscitation in paediatric and neonatal cardiac arrest : A systematic review

Context: Parent/family presence at pediatric resuscitations has been slow to become consistent practice in hospital settings and has not been universally implemented. A systematic review of the literature on family presence during pediatric and neonatal resuscitation has not been previously conducted. Objective: To conduct a systematic review of the published evidence related to family presence during pediatric and neonatal resuscitation. Data sources: Six major bibliographic databases was undertaken with defined search terms and including literature up to June 14, 2020. Study selection: 3200 titles were retrieved in the initial search; 36 ultimately included for review. Data extraction: Data was double extracted independently by two reviewers and confirmed with the review team. All eligible studies were either survey or interview-based and as such we turned to narrative systematic review methodology. Results: The authors identified two key sets of findings: first, parents/family members want to be offered the option to be present for their child's resuscitation. Secondly, health care provider attitudes varied widely (ranging from 15% to >85%), however, support for family presence increased with previous experience and level of seniority. Limitations: English language only; lack of randomized control trials; quality of the publications. Conclusions: Parents wish to be offered the opportunity to be present but opinions and perspectives on the family presence vary greatly among health care providers. This topic urgently needs high quality, comparative research to measure the actual impact of family presence on patient, family and staff outcomes.Peer reviewe

Observation of individual molecules trapped on a nanostructured insulator

For the first time, ordered polar molecules confined in monolayer-deep rectangular pits produced on an alkali halide surface by electron irradiation have been resolved at room temperature by non-contact atomic force microscopy. Molecules self-assemble in a specific fashion inside pits of width smaller than 15 nm. By contrast no ordered aggregates of molecules are observed on flat terraces. Conclusions regarding nucleation and ordering mechanisms are drawn. Trapping in pits as small as 2 nm opens a route to address single molecules

Resistance and resilience of social–ecological systems to recurrent typhoon disturbance on a subtropical island: Taiwan

Tropical cyclones (TCs) have major effects on ecological and social systems. However, studies integrating the effects of TCs on both social and ecological systems are rare, especially in the northwest Pacific, where the frequency of TCs (locally named typhoons) is the highest in the world. We synthesized studies of effects of recurrent typhoons on social and ecological systems in Taiwan over the last several decades. Many responses to TCs are comparable between social and ecological systems. High forest ecosystem resistance, evident from tree mortality below 2% even following multiple strong typhoons, is comparable with resistance of social systems, including the only 4% destruction of river embankments following a typhoon that brought nearly 3000 mm rainfall in three days. High resilience as reflected by quick returns of leaf area index, mostly in one year, and streamwater chemistry, one to several weeks to pre‐typhoon levels of ecosystems, are comparable to quick repair of the power grid within one to several days and returns of vegetable price within several weeks to pre‐typhoon levels of the social systems. Landslides associated with intense typhoons have buried mountain villages and transported large quantities of woody debris to the coast, affecting the coastal plains and reefs, illustrating a ridge‐to‐reef link between ecological and societal systems. Metrics of both social and ecological function showed large fluctuations in response to typhoons but quickly returned to pre‐disturbance levels, except when multiple intense typhoons occurred within a single season. Our synthesis illustrates that the social–ecological systems in Taiwan are highly dynamic and responsive to frequent typhoon disturbance, with extraordinarily high resistance and resilience. For ecosystems, the efficient responsiveness results from the selective force of TCs on ecosystem structure and processes. For social systems, it is the result of the effects of TCs on planning and decision making by individuals (e.g., farmers), management sectors, and ultimately the government. In regions with frequent TCs, the social–ecological systems are inevitably highly dynamic and rapid responses are fundamental to system resistance and resilience which in turn is key to maintaining structure and function of the social–ecological systems

Structure of unbound neutron-rich 9^{9}He studied using single-neutron transfer

The 8He(d,p) reaction was studied in inverse kinematics at 15.4A MeV using the MUST2 Si-CsI array in order to shed light on the level structure of 9He. The well known 16O(d,p)17O reaction, performed here in reverse kinematics, was used as a test to validate the experimental methods. The 9He missing mass spectrum was deduced from the kinetic energies and emission angles of the recoiling protons. Several structures were observed above the neutron-emission threshold and the angular distributions were used to deduce the multipolarity of the transitions. This work confirms that the ground state of 9He is located very close to the neutron threshold of 8He and supports the occurrence of parity inversion in 9He.Comment: Exp\'erience GANIL/SPIRAL1/MUST

Gender, age and the MBA: An analysis of extrinsic and intrinsic career benefits

Against the background of an earlier UK study, this paper presents the findings of a Canadian based survey of career benefits from the MBA. Results indicate firstly that gender and age interact to influence perceptions of career outcomes (young men gain most in terms of extrinsic benefits of career change and pay), and secondly that both men and women gain intrinsic benefits from the MBA. However, intrinsic benefits vary by gender: men in the study were more likely to say they gained confidence from having a fuller skill set while women were more likely to say they gained confidence from feelings of self worth; men emphasised how they had learned to give up control while women argued that they had gained a ‘voice’ in the organization. The role of the MBA in career self- management and the acquisition of key skills are examined as well as the implications for the design of programmes in meeting the varied need of men and women in different age groups

The OHStat Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: Explanation and Elaboration

Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research—statisticians and trialists from academia and industry—empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the OHstat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the Task Force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in JDR Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research

Labour supply and skills demands in fashion retailing

If, as Adam Smith once famously suggested, Britain was a nation of shopkeepers then it is now a nation of shopworkers. Retail is now a significant part of the UK economy, accounting for £256 billion in sales and one-third of all consumer spending (Skillsmart, 2007). It is the largest private sector employer in the UK, employing 3m workers, or 1 in 10 of the working population. For future job creation in the UK economy retail is also similarly prominent and the sector is expected to create a further 250,000 jobs to 2014 (Skillsmart, 2007). The centrality of retail to economic success and job creation is apparent in other advanced economies. For example, within the US, retail sales is the occupation with the largest projected job growth in the period 2004-2014 (Gatta et al., 2009) and in Australia retail accounts for 1 in 6 workers (Buchanan et al., 2003). Within the UK these workers are employed in approximately 290,000 businesses, encompassing large and small organizations and also a number of sub-sectors. This variance suggests that retail should not be regarded as homogenous in its labour demands. Hart et al. (2007) note how skill requirements and the types of workers employed may differ across the sector. This chapter further opens up this point, providing an analysis of the labour supply and skills demands for the sub-sectors of clothing, footwear and leather goods, which are described by Skillsmart (2007: 48) as being 'significant categories in UK retailing'

Constructing female entrepreneurship policy in the UK : is the US a relevant benchmark?

Successive UK governments have introduced a range of policy initiatives designed to encourage more women to start new firms. Underpinning these policies has been an explicit ambition for the UK to achieve similar participation rates as those in the US where it is widely reported that women own nearly half the stock of businesses. The data underlying these objectives are critically evaluated and it is argued that the definitions and measures of female enterprise used in the UK and the US restrict meaningful comparisons between the two. It is suggested that the expansion of female entrepreneurship in the US is historically and culturally specific to that country. UK policy goals should reflect the national socioeconomic context, while drawing upon good practice examples from a range of other countries. The paper concludes by discussing the economic and social viability of encouraging more women in the UK to enter self-employment without fully recognising the intensely competitive sectors in which they are often located

Density-Dependence Mediates the Effects of Temperature on Growth of Juvenile Blue Catfish in Nonnative Habitats

The combined effects of conspecific density and climate warming on the vital rates of invasive fish species have not been well studied, but may be important in predicting how successful they will be in the future. We evaluated the effects of temperature and population density on monthly time series of sizes of age-0 Blue Catfish Ictalurus furcatus in the James, York, and Rappahannock River subestuaries (defined here as tidally influenced bodies of water that feed into the Chesapeake Bay) from 1996 to 2017, using growing degree-days (GDDs, °C day) as a measure of thermal time. Our pre- dictive linear mixed-effects model explained 86% of the variation in the length of age-0 Blue Catfish. In addition, it indi- cated a strong positive effect of temperature on the growth rate of age-0 Blue Catfish, with individual fish biomass during warm years up to 63% higher than during cool years. Growth rate was influenced negatively by the abundance of age-0 and older fish, resulting in at least fourfold differences in the predicted biomass of Blue Catfish by the end of the first year of life depending on conspecific density. We also observed regional differences in the growth rates of Blue Catfish in the three subestuaries we examined; although growth occurred in all subestuaries, growth was highest for the Rappahannock River population even though this river accumulated the fewest GDDs. Rising water temperatures due to global climate change will likely increase the growth rate of age-0 Blue Catfish in the Chesapeake Bay region, potentially intensifying the negative impacts of this invasive species on the ecology of Chesapeake Bay. However, individual populations respond differently to warming temperatures, and thus, potential increases in the growth rate of age-0 Blue Catfish may be par- tially offset by local conditions that may serve to limit growth