A Fatal Complication Following Hybrid Total Arch Replacement with Supra-aortic Artery Translocation and Endovascular Stenting

This case highlights the successful management of acute Type B dissection complicated by visceral malperfusion. Even though the procedure of hybrid supra-aortic translocation and endovascular stenting corrected the malperfusion, it is important for vigilant CT scan surveillance for the post operative complications which can occur with this procedure

Thinking beyond the hybrid:“actually-existing” cities “after neoliberalism” in Boyle <i>et al.</i>

In their article, ‘The spatialities of actually existing neoliberalism in Glasgow, 1977 to present’, Mark Boyle, Christopher McWilliams and Gareth Rice (2008) usefully problematise our current understanding of neoliberal urbanism. Our response is aimed at developing a sympathetic but critical approach to Boyle et al's understanding of neoliberal urbanism as illustrated by the Glasgow example. In particular, the counterposing by Boyle et al of a 'hybrid, mutant' model to a 'pure' model of neoliberalism for us misrepresents existing models of neoliberalism as a perfectly finished object rather than a roughly mottled process. That they do not identify any ‘pure’ model leads them to create a straw construct against which they can claim a more sophisticated, refined approach to the messiness of neoliberal urbanism. In contrast, we view neoliberalism as a contested and unstable response to accumulation crises at various scales of analysis

Managing healthcare budgets in times of austerity: the role of program budgeting and marginal analysis

Given limited resources, priority setting or choice making will remain a reality at all levels of publicly funded healthcare across countries for many years to come. The pressures may well be even more acute as the impact of the economic crisis of 2008 continues to play out but, even as economies begin to turn around, resources within healthcare will be limited, thus some form of rationing will be required. Over the last few decades, research on healthcare priority setting has focused on methods of implementation as well as on the development of approaches related to fairness and legitimacy and on more technical aspects of decision making including the use of multi-criteria decision analysis. Recently, research has led to better understanding of evaluating priority setting activity including defining ‘success’ and articulating key elements for high performance. This body of research, however, often goes untapped by those charged with making challenging decisions and as such, in line with prevailing public sector incentives, decisions are often reliant on historical allocation patterns and/or political negotiation. These archaic and ineffective approaches not only lead to poor decisions in terms of value for money but further do not reflect basic ethical conditions that can lead to fairness in the decision-making process. The purpose of this paper is to outline a comprehensive approach to priority setting and resource allocation that has been used in different contexts across countries. This will provide decision makers with a single point of access for a basic understanding of relevant tools when faced with having to make difficult decisions about what healthcare services to fund and what not to fund. The paper also addresses several key issues related to priority setting including how health technology assessments can be used, how performance can be improved at a practical level, and what ongoing resource management practice should look like. In terms of future research, one of the most important areas of priority setting that needs further attention is how best to engage public members

Metabolic heat loss in southern elephant seals (Mirounga leonina) differs with stage of moult and between habitats

The moult in southern elephant seals (Mirounga leonina) represents an especially energetically demanding period during which seals must maintain high skin temperature to facilitate complete replacement of body fur and upper dermis. In this study, heat flux from the body surface was measured on 18 moulting southern elephant seals to estimate metabolic heat loss in three different habitats (beach, wallow and vegetation). Temperature data loggers were also deployed on 10 southern elephant seals to monitor skin surface temperature. On average, heat loss of animals on the beach was greater than in wallows or vegetation, and greater in wallows than in vegetation. Heat loss across all habitats during the moult equated to 1.8 x resting metabolic rate (RMR). The greatest heat loss of animals was recorded in the beach habitat during the late moult, that represented 2.3 x RMR. Mass loss was 3.6 ± 0.3 kg day-1, resulting in changes in body condition as the moult progressed. As body condition declined, skin surface temperature also decreased, suggesting that as animals approached the end of the moult blood flow to the skin surface was no longer required for hair growth

Post-disturbance haulout behaviour of harbour seals

1. The impact of anthropogenic activity associated with the construction of a proposed tidal turbine on harbour seals (Phoca vitulina) was investigated using controlled disturbance trials.2. Trials were conducted by approaching hauled out seals by boat at a speed of five knots until all seals had entered the water. Trials were carried out at a frequency of once every three days when weather permitted and the post disturbance haulout behaviours of the seals were documented. The time taken for numbers to recover to pre-disturbance levels was determined by monitoring haulout sites using time-lapse photography. In addition, seals were tagged with GPS phone tags providing haulout location and at-sea movement data allowing investigation of how disturbance may influence haulout site choice and seal distribution.3. Mean post-disturbance recovery of seals was 52% (95%CI 35-69%) within 30 minutes. However, mean recovery only returned to 94% (95%CI 55-132%) of pre-disturbance levels after four hours.4. Telemetry tagged seals displayed a high degree of haulout site fidelity. Disturbance trials did not have a significant effect on the probability of seals moving to a different haulout site. 5. The results of this study suggest that increased boat activity that causes seals to enter the water at a higher than normal frequency will not cause individuals to relocate to another haulout site. Seals continued to return to the original site despite repeated disturbance trials suggesting that increased boat activity is likely to repeatedly impact on the same seals with the largest effect being to reduce the amount of time available to seals to haul out.6. This study recommends that monitoring effort to mitigate against increased levels of disturbance caused by boat activity need only be on a local scale relative to any proposed development

Optimizing the Activity of Nanoneedle Structured WO3 Photoanodes for Solar Water Splitting: Direct Synthesis via Chemical Vapor Deposition

Solar water splitting is a promising solution for the renewable production of hydrogen as an energy vector. To date, complex or patterned photoelectrodes have shown the highest water splitting efficiencies, but lack scalable routes for commercial scale-up. In this article, we report a direct and scalable chemical vapor deposition (CVD) route at atmospheric pressure, for a single step fabrication of complex nanoneedle structured WO3 photoanodes. Using a systematic approach, the nanostructure was engineered to find the conditions that result in optimal water splitting. The nanostructured materials adopted a monoclinic γ-WO3 structure and were highly oriented in the (002) plane, with the nanoneedle structures stacking perpendicular to the FTO substrate. The WO3 photoanode that showed the highest water splitting activity was composed of a ∼300 nm seed layer of flat WO3 with a ∼5 μm thick top layer of WO3 nanoneedles. At 1.23 VRHE, this material showed incident photon-to-current efficiencies in the range ∼35–45% in the UV region (250–375 nm) and an overall solar predicted photocurrent of 1.24 mA·cm–2 (∼25% of the theoretical maximum for WO3). When coupled in tandem with a photovoltaic device containing a methylammonium lead iodide perovskite, a solar-to-hydrogen efficiency of ca. 1% for a complete unassisted water splitting device is predicted

A high-performance electron beam ion source

At Brookhaven National Laboratory, a high current Electron Beam Ion Source (EBIS) has been developed as part of a new preinjector that is under construction to replace the Tandem Van de Graaffs as the heavy ion preinjector for the RHIC and NASA experimental programs. This preinjector will produce milliampere-level currents of essentially any ion species, with q/A {ge} 1/6, in short pulses, for injection into the Booster synchrotron. In order to produce the required intensities, this EBIS uses a 10A electron gun, and an electron collector designed to handle 300 kW of pulsed electron beam power. The EBIS trap region is 1.5 m long, inside a 5T, 2m long, 8-inch bore superconducting solenoid. The source is designed to switch ion species on a pulse-to-pulse basis, at a 5 Hz repetition rate. Singly-charged ions of the appropriate species, produced external to the EBIS, are injected into the trap and confined until the desired charge state is reached via stepwise ionization by the electron beam. Ions are then extracted and matched into an RFQ, followed by a short IH Linac, for acceleration to 2 MeV/A, prior to injection into the Booster synchrotron. An overview of the preinjector is presented, along with experimental results from the prototype EBIS, where all essential requirements have already been demonstrated. Design features and status of construction of the final high intensity EBIS is also be presented

Semi-automated Magnetic Bead-Based Antibody Selection from Phage Display Libraries

Phage display of combinatorial antibody libraries is a very efficient method for selecting recombinant antibodies against a wide range of molecules. It has been applied very successfully for the generation of therapeutic antibodies for more than a decade. To increase robustness and reproducibility of the selection procedure, we developed a semi-automated selection method for the generation of recombinant antibodies from phage display libraries. In this procedure, the selection targets are specifically immobilised to magnetic particles which can then by automatically handled by a magnetic particle processor. At present up to 96 samples can be handled simultaneously. Applying the processor allows standardisation of panning parameters such as washing conditions, incubation times, or to perform parallel selections on same targets under different buffer conditions. Additionally, the whole protocol has been streamlined to carry out bead loading, phage selection, phage amplification between selection rounds and magnetic particle ELISA for confirmation of binding activity in microtiter plate formats. Until now, this method has been successfully applied to select antibody fragments against different types of target, such as peptides, recombinant or homologous proteins, or chemical compounds

The INNs and outs of antibody nonproprietary names

An important step in drug development is the assignment of an International Nonproprietary Name (INN) by the World Health Organization (WHO) that provides healthcare professionals with a unique and universally available designated name to identify each pharmaceutical substance. Monoclonal antibody INNs comprise a –mab suffix preceded by a substem indicating the antibody type, e.g., chimeric (-xi-), humanized (-zu-), or human (-u-). The WHO publishes INN definitions that specify how new monoclonal antibody therapeutics are categorized and adapts the definitions to new technologies. However, rapid progress in antibody technologies has blurred the boundaries between existing antibody categories and created a burgeoning array of new antibody formats. Thus, revising the INN system for antibodies is akin to aiming for a rapidly moving target. The WHO recently revised INN definitions for antibodies now to be based on amino acid sequence identity. These new definitions, however, are critically flawed as they are ambiguous and go against decades of scientific literature. A key concern is the imposition of an arbitrary threshold for identity against human germline antibody variable region sequences. This leads to inconsistent classification of somatically mutated human antibodies, humanized antibodies as well as antibodies derived from semi-synthetic/synthetic libraries and transgenic animals. Such sequence-based classification implies clear functional distinction between categories (e.g., immunogenicity). However, there is no scientific evidence to support this. Dialog between the WHO INN Expert Group and key stakeholders is needed to develop a new INN system for antibodies and to avoid confusion and miscommunication between researchers and clinicians prescribing antibodies

Factors influencing access to early intervention for families of children with developmental disabilities: A narrative review

Background Early intervention (EI) can improve a range of outcomes for families of children with developmental disabilities. However, research indicates the level of access does not always match the level of need. To address disparities, it is essential to identify factors influencing access. Method We propose a framework where access to EI is conceptualised as a process that includes three main phases. A narrative review examined potential barriers, facilitators and modifiers of access for each phase. Results The process of access to EI includes the following: 1) recognition of need, 2) identification or diagnosis and 3) EI provision or receipt. Several factors affecting access to EI for each phase were identified, related to the family, services, the intersection between family and services, and the context. Conclusion A broad range of factors appear to influence the process of access to EI for this population. Our framework can be used in future research investigating access. Broad implications for policy, practice and future research to improve access to EI are discussed