The arithmetical hierarchy in the setting of ω1\omega_1

We continue work from (Greenberg and Knight) on computable structure theory in the setting of $\omega_1$, where the countable ordinals play the role of natural numbers, and countable sets play the role of finite sets. In the present paper, we define the arithmetical hierarchy through all countable levels (not just the finite levels). We consider two different ways of doing this—one based on the standard definition of the hyperarithmetical hierarchy, and the other based on the standard definition of the effective Borel hierarchy. For each definition, we define computable infinitary formulas through all countable levels, and we obtain analogues of the well-known results from (Ash and Knight, 1989) and (Chisholm, 1990) saying that a relation is relatively intrinsically $\Sigma^0_\alpha$ just in case it is definable by a computable $\Sigma_\alpha$ formula. Although we obtain the same results for the two definitions of the arithmetical hierarchy, we conclude that the definition resembling the standard definition of the hyperarithmetical hierarchy seems preferable

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Phytoplankton responses to marine climate change – an introduction

Phytoplankton are one of the key players in the ocean and contribute approximately 50% to global primary production. They serve as the basis for marine food webs, drive chemical composition of the global atmosphere and thereby climate. Seasonal environmental changes and nutrient availability naturally influence phytoplankton species composition. Since the industrial era, anthropogenic climatic influences have increased noticeably – also within the ocean. Our changing climate, however, affects the composition of phytoplankton species composition on a long-term basis and requires the organisms to adapt to this changing environment, influencing micronutrient bioavailability and other biogeochemical parameters. At the same time, phytoplankton themselves can influence the climate with their responses to environmental changes. Due to its key role, phytoplankton has been of interest in marine sciences for quite some time and there are several methodical approaches implemented in oceanographic sciences. There are ongoing attempts to improve predictions and to close gaps in the understanding of this sensitive ecological system and its responses

Urban geochemical mapping studies : how and why we do them

Geochemical mapping is a technique rooted in mineral exploration but has now found worldwide application in studies of the urban environment. Such studies, involving multidisciplinary teams including geochemists, have to present their results in a way that nongeochemists can comprehend. A legislatively driven demand for urban geochemical data in connection with the need to identify contaminated land and subsequent health risk assessments has given rise to a greater worldwide interest in the urban geochemical environment. Herein, the aims and objectives of some urban studies are reviewed and commonly used terms such as baseline and background are defined. Geochemists need to better consider what is meant by the term urban. Whilst the unique make up of every city precludes a single recommended approach to a geochemical mapping strategy, more should be done to standardise the sampling and analytical methods. How (from a strategic and presentational point of view) and why we do geochemical mapping studies is discussed. Keywords Background - Baseline - Geochemical mapping - Heavy metals - Pollution - Soil - Urba

Acute Lung Injury: Epidemiology, Pathogenesis, and Treatment

Acute lung injury (ALI) remains a significant source of morbidity and mortality in the critically ill patient population. Defined by a constellation of clinical criteria (acute onset of bilateral pulmonary infiltrates with hypoxemia without evidence of hydrostatic pulmonary edema), ALI has a high incidence (200,000 per year in the US) and overall mortality remains high. Pathogenesis of ALI is explained by injury to both the vascular endothelium and alveolar epithelium. Recent advances in the understanding of pathophysiology have identified several biologic markers that are associated with worse clinical outcomes. Phase III clinical trials by the NHLBI ARDS Network have resulted in improvement in survival and a reduction in the duration of mechanical ventilation with a lung-protective ventilation strategy and fluid conservative protocol. Potential areas of future treatments include nutritional strategies, statin therapy, and mesenchymal stem cells

Group Random Call Can Positively Affect Student In-Class Clicker Discussions

Understanding how instructional techniques and classroom norms influence in-class student interactions has the potential to positively impact student learning. Many previous studies have shown that students benefit from discussing their ideas with one another in class. In this study of introductory biology students, we explored how using an in-class accountability system might affect the nature of clicker-question discussions. Clicker-question discussions in which student groups were asked to report their ideas voluntarily (volunteer call) were compared with discussions in which student groups were randomly selected to report their ideas (random call). We hypothesized that the higher-accountability condition (random call) would impress upon students the importance of their discussions and thus positively influence how they interacted. Our results suggest that a higher proportion of discussions in the random call condition contained exchanges of reasoning, some forms of questioning, and both on- and off-topic comments compared with discussion in the volunteer call condition. Although group random call does not impact student performance on clicker questions, the positive impact of this instructional approach on exchanges of reasoning and other features suggests it may encourage some types of student interactions that support learning