Intensive care for extreme prematurity--moving beyond gestational age.

BACKGROUND: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients. METHODS: We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks\u27 gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to 22 months. RESULTS: Among study infants, 3702 (83%) received intensive care in the form of mechanical ventilation. Among the 4192 study infants (94%) for whom outcomes were determined at 18 to 22 months, 49% died, 61% died or had profound impairment, and 73% died or had impairment. In multivariable analyses of infants who received intensive care, exposure to antenatal corticosteroids, female sex, singleton birth, and higher birth weight (per each 100-g increment) were each associated with reductions in the risk of death and the risk of death or profound or any neurodevelopmental impairment; these reductions were similar to those associated with a 1-week increase in gestational age. At the same estimated likelihood of a favorable outcome, girls were less likely than boys to receive intensive care. The outcomes for infants who underwent ventilation were better predicted with the use of the above factors than with use of gestational age alone. CONCLUSIONS: The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: sex, exposure or nonexposure to antenatal corticosteroids, whether single or multiple birth, and birth weight. (ClinicalTrials.gov numbers, NCT00063063 [ClinicalTrials.gov] and NCT00009633 [ClinicalTrials.gov].)

Wolf Management In The Northwestern United States

Gray wolves (Canis lupus) were deliberately eliminated from the northern Rocky Mountains (NRM) by 1930. Restoration began in 1986. There are currently nearly 120 breeding pair and 1800 wolves. Wolf restoration initially proceeded with more benefits and fewer problems than predicted. However, conflicts have steadily increased since 2002 when the population first met its minimum recovery goal. About 40 million has been spent since 1974 and the management program currently costs >4 million/yr. Wolves were delisted in 2008 and 2009 but relisted by federal court order in 2009 and 2010. While the NRM wolf population is biologically recovered, public opinion remains divisive and the legal, political, and policy decisions will continue to be litigated by a diversity of interests. Science is a poor tool to resolve the differing human values that continue to be debated with great passion through wolf symbolism

Combined bezafibrate and medroxyprogesterone acetate: potential novel therapy for acute myeloid leukaemia

Background: The majority of acute myeloid leukaemia (AML) patients are over sixty years of age. With current treatment regimens, survival rates amongst these, and also those younger patients who relapse, remain dismal and novel therapies are urgently required. In particular, therapies that have anti-leukaemic activity but that, unlike conventional chemotherapy, do not impair normal haemopoiesis. Principal Findings: Here we demonstrate the potent anti-leukaemic activity of the combination of the lipid-regulating drug bezafibrate (BEZ) and the sex hormone medroxyprogesterone acetate (MPA) against AML cell lines and primary AML cells. The combined activity of BEZ and MPA (B/M) converged upon the increased synthesis and reduced metabolism of prostaglandin D2 (PGD2) resulting in elevated levels of the downstream highly bioactive, anti-neoplastic prostaglandin 15-deoxy Δ12,14 PGJ2 (15d-PGJ2). BEZ increased PGD2 synthesis via the generation of reactive oxygen species (ROS) and activation of the lipid peroxidation pathway. MPA directed prostaglandin synthesis towards 15d-PGJ2 by inhibiting the PGD2 11β -ketoreductase activity of the aldo-keto reductase AKR1C3, which metabolises PGD2 to 9α11β-PGF2α. B/M treatment resulted in growth arrest, apoptosis and cell differentiation in both AML cell lines and primary AML cells and these actions were recapitulated by treatment with 15d-PGJ2. Importantly, the actions of B/M had little effect on the survival of normal adult myeloid progenitors. Significance: Collectively our data demonstrate that B/M treatment of AML cells elevated ROS and delivered the anti-neoplastic actions of 15d-PGJ2. These observations provide the mechanistic rationale for the redeployment of B/M in elderly and relapsed AML

The Role of Physical, Chemical, and Microbial Heterogeneity on the Field-Scale Transport and Attachment of Bacteria

A field-scale bacterial transport experiment was conducted at the Narrow Channel Focus Area of the South Oyster field site located in Oyster, Virginia. The goal of the field experiment was to determine the relative influence of subsurface heterogeneity and microbial population parameters on flow direction, velocity, and attachment of bacteria at the field scale. The field results were compared with results from laboratory-scale column experiments to develop a method for predicting field-scale bacterial transport. The field site is a shallow, sandy, unconfined, aerobic aquifer that has been characterized by geophysical, sedimentological, and hydrogeological methods. Comamonas sp. strain DA001 and a conservative tracer, bromide (Br), were injected into an area of high permeability for 12 hours. The Br and bacterial concentrations in the groundwater were monitored for 1 week at 192 sampling ports spaced over a 2-m vertical zone located from 0.5 to 7 m down-gradient of the injection well. The bacterial and Br plume was observed to move past 95 sampling ports. The densely characterized field site enabled the comparison of variations in DA001 transport to the aquifer properties. The velocity of the injected plume was correlated with geophysical estimates of hydraulic conductivity. The bacterial and Br plume appeared to follow flow paths not coincident with the hydraulic gradient but through a zone of higher permeability located off the flow axis. The amount of breakthrough of the bacteria was similar in both the high and low permeability layers with only a weak correlation between the observed hydraulic conductivity and amount of bacterial breakthrough. The uniformity in the observed attachment rates across varying grain sizes could be explained by heterogeneity of microbial properties within the single strain of injected bacteria. Application of colloid filtration theory to the field data indicated that variations in the microbial population were described by a lognormal distribution of the collision efficiency (a). Core-scale studies were used to predict the a distribution and field-scale transport distances of DA001. In sandy aquifers, physical heterogeneity may play a secondary role in controlling field-scale bacterial transport, and future research should focus on the microbial factors affecting transport

Sticking under wet conditions: the remarkable attachment abilities of the torrent frog, staurois guttatus

Tree frogs climb smooth surfaces utilising capillary forces arising from an air-fluid interface around their toe pads, whereas torrent frogs are able to climb in wet environments near waterfalls where the integrity of the meniscus is at risk. This study compares the adhesive capabilities of a torrent frog to a tree frog, investigating possible adaptations for adhesion under wet conditions. We challenged both frog species to cling to a platform which could be tilted from the horizontal to an upside-down orientation, testing the frogs on different levels of roughness and water flow. On dry, smooth surfaces, both frog species stayed attached to overhanging slopes equally well. In contrast, under both low and high flow rate conditions, the torrent frogs performed significantly better, even adhering under conditions where their toe pads were submerged in water, abolishing the meniscus that underlies capillarity. Using a transparent platform where areas of contact are illuminated, we measured the contact area of frogs during platform rotation under dry conditions. Both frog species not only used the contact area of their pads to adhere, but also large parts of their belly and thigh skin. In the tree frogs, the belly and thighs often detached on steeper slopes, whereas the torrent frogs increased the use of these areas as the slope angle increased. Probing small areas of the different skin parts with a force transducer revealed that forces declined significantly in wet conditions, with only minor differences between the frog species. The superior abilities of the torrent frogs were thus due to the large contact area they used on steep, overhanging surfaces. SEM images revealed slightly elongated cells in the periphery of the toe pads in the torrent frogs, with straightened channels in between them which could facilitate drainage of excess fluid underneath the pad

Perioperative nursing: maintaining momentum and staying safe.

Perioperative practice underpins one of the key activities of many healthcare services but the work of perioperative nurses is little known. A better understanding of their work is important to enable articulation of their contribution to clinical practice. This study observed the practice of perioperative nurses and explored how they described their role. Using ethnographic observation and interview, eighty-five hours observation of eleven nurses were undertaken and eight nurses were interviewed. Thematic analysis was undertaken enabling themes to emerge with two being identified. The first, 'maintaining momentum', described the need to keep people and equipment moving. The second, ‘accounting for safety’, referred to the need to keep the patient safe during this dangerous period. Tension between these two phenomena was apparent. Perioperative nurses describe one of their key roles as maintaining the momentum of the patient’s journey through the operating theatre but having to balance this with the need to ensure the patient’s safety. A core component of the perioperative nurse’s work is thus management of the tension between these. This study illuminated how these nurses understand their practice

Managing macropods without poisoning ecosystems

A recent review of the management of hyperabundant macropods in Australia proposed that expanded professional shooting is likely to lead to better biodiversity and animal welfare outcomes. While the tenets of this general argument are sound, it overlooks one important issue for biodiversity and animal health and welfare: reliance on toxic lead-based ammunition. Lead poisoning poses a major threat to Australia's wildlife scavengers. Current proposals to expand professional macropod shooting would see tons of an extremely toxic and persistent heavy metal continue to be introduced into Australian environments. This contrasts with trends in many other countries, where lead ammunition is, through legislation or voluntary programs, being phased out. Fortunately, there are alternatives to lead ammunition that could be investigated and adopted for improved macropod management. A transition to lead-free ammunition would allow the broad environmental and animal welfare goals desired from macropod management to be pursued without secondarily and unintentionally poisoning scavengers. Through this article, we hope to increase awareness of this issue and encourage discussion of this potential change.publishedVersio

Systems, interactions and macrotheory

A significant proportion of early HCI research was guided by one very clear vision: that the existing theory base in psychology and cognitive science could be developed to yield engineering tools for use in the interdisciplinary context of HCI design. While interface technologies and heuristic methods for behavioral evaluation have rapidly advanced in both capability and breadth of application, progress toward deeper theory has been modest, and some now believe it to be unnecessary. A case is presented for developing new forms of theory, based around generic “systems of interactors.” An overlapping, layered structure of macro- and microtheories could then serve an explanatory role, and could also bind together contributions from the different disciplines. Novel routes to formalizing and applying such theories provide a host of interesting and tractable problems for future basic research in HCI