Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: The CDH EURO consortium consensus

Congenital diaphragmatic hernia (CDH) is associated with high mortality and morbidity. To date, there are no standardized protocols for the treatment of infants with this anomaly. However, protocols based on the literature and expert opinion might improve outcome. This paper is a consensus statement from the CDH EURO Consortium prepared with the aim of achieving standardized postnatal treatment in European countries. During a consensus meeting between high-volume centers with expertise in the treatment of CDH in Europe (CDH EURO Consortium), the most recent literature on CDH was discussed. Thereafter, 5 experts graded the studies according to the Scottish Intercollegiate Guidelines Network (SIGN) Criteria. Differences in opinion were discussed until full consensus was reached. The final consensus statement, therefore, represents the opinion of all consortium members. Multicenter randomized controlled trials on CDH are lacking. Use of a standardized protocol, however, may contribute to more valid comparisons of patient data in multicenter studies and identification of areas for further research

Dutch guidelines on care for extremely premature infants:Navigating between personalisation and standardization

OBJECTIVE: There is no international consensus on what type of guideline is preferred for care at the limit of viability. We aimed to conceptualize what type of guideline is preferred by Dutch healthcare professionals: 1) none; 2) gestational-age-based; 3) gestational-age-based-plus; or 4) prognosis-based via a survey instrument. Additional questions were asked to explore the grey zone and attitudes towards treatment variation. FINDING: 769 surveys were received. Most of the respondents (72.8%) preferred a gestational-age-based-plus guideline. Around 50% preferred 24+0/7 weeks gestational age as the lower limit of the grey zone, whereas 26+0/7 weeks was the most preferred upper limit. Professionals considered treatment variation acceptable when it is based upon parental values, but unacceptable when it is based upon the hospital's policy or the physician's opinion. CONCLUSION: In contrast to the current Dutch guideline, our results suggest that there is a preference to take into account individual factors besides gestational age

Systematic variation in food web body-size structure linked to external subsidies.

The relationship between body mass (M) and size class abundance (N) depicts patterns of community structure and energy flow through food webs. While the general assumption is that M and N scale linearly (on log-log axes), nonlinearity is regularly observed in natural systems, and is theorized to be driven by nonlinear scaling of trophic level (TL) with M resulting in the rapid transfer of energy to consumers in certain size classes. We tested this hypothesis with data from 31 stream food webs. We predicted that allochthonous subsidies higher in the web results in nonlinear M-TL relationships and systematic abundance peaks in macroinvertebrate and fish size classes (latter containing salmonids), that exploit terrestrial plant material and terrestrial invertebrates, respectively. Indeed, both M-N and M-TL significantly deviated from linear relationships and the observed curvature in M-TL scaling was inversely related to that observed in M-N relationships. Systemic peaks in M-N, and troughs in M-TL occurred in size classes dominated by generalist invertebrates, and brown trout. Our study reveals how allochthonous resources entering high in the web systematically shape community size structure and demonstrates the relevance of a generalized metabolic scaling model for understanding patterns of energy transfer in energetically 'open' food webs

An open and parallel multiresolution framework using block-based adaptive grids

A numerical approach for solving evolutionary partial differential equations in two and three space dimensions on block-based adaptive grids is presented. The numerical discretization is based on high-order, central finite-differences and explicit time integration. Grid refinement and coarsening are triggered by multiresolution analysis, i.e. thresholding of wavelet coefficients, which allow controlling the precision of the adaptive approximation of the solution with respect to uniform grid computations. The implementation of the scheme is fully parallel using MPI with a hybrid data structure. Load balancing relies on space filling curves techniques. Validation tests for 2D advection equations allow to assess the precision and performance of the developed code. Computations of the compressible Navier-Stokes equations for a temporally developing 2D mixing layer illustrate the properties of the code for nonlinear multi-scale problems. The code is open source

Multiphoton Ionization as Time-Dependent Tunneling

A new semiclassical approach to ionization by an oscillating field is presented. For a delta-function atom, an asymptotic analysis is performed with respect to a quantity h, defined as the ratio of photon energy to ponderomotive energy. This h appears formally equivalent to Planck's constant in a suitably transformed Schroedinger equation and allows semiclassical methods to be applicable. Systematically, a picture of tunneling wave packets in complex time is developped, which by interference account for the typical ponderomotive features of ionization curves. These analytical results are then compared to numerical simulations and are shown to be in good agreement.Comment: 36 pages (also printable half size), uuencoded compressed tarred Latex file with 9 Postscript figures included automaticall

The Edge of Perinatal Viability:Understanding the Dutch Position

Contains fulltext : 231104.pdf (publisher's version ) (Open Access

Building better Sex Robots: Lessons from Feminist Pornography

How should we react to the development of sexbot technology? Taking their cue from anti-porn feminism, several academic critics lament the development of sexbot technology, arguing that it objectifies and subordinates women, is likely to promote misogynistic attitudes toward sex, and may need to be banned or restricted. In this chapter I argue for an alternative response. Taking my cue from the sex positive ‘feminist porn’ movement, I argue that the best response to the development of ‘bad’ sexbots is to make better ones. This will require changes to the content, process and context of sexbot development. Doing so will acknowledge the valuable role that technology can play in human sexuality, and allow us to challenge gendered norms and assumptions about male and female sexual desire. This will not be a panacea to the social problems that could arise from sexbot development, but it offers a more realistic and hopeful vision for the future of this technology in a pluralistic and progressive society

Cosmology with a long range repulsive force

We consider a class of cosmological models in which the universe is filled with a (non-electric) charge density that repels itself by means of a force carried by a vector boson with a tiny mass. When the vector's mass depends upon other fields, the repulsive interaction gives rise to an electromagnetic barrier which prevents these fields from driving the mass to zero. This can modify the cosmology dramatically. We present a very simple realization of this idea in which the vector's mass arises from a scalar field. The electromagnetic barrier prevents this field from rolling down its potential and thereby leads to accelerated expansion.Comment: 15 pages, 8 figures, LaTeX (version accepted for publication in PRD). 3 new figures, extended discussion of observational consequence

Tomato protoplast DNA transformation: physical linkage and recombination of exogenous DNA sequences

Tomato protoplasts have been transformed with plasmid DNA's, containing a chimeric kanamycin resistance gene and putative tomato origins of replication. A calcium phosphate-DNA mediated transformation procedure was employed in combination with either polyethylene glycol or polyvinyl alcohol. There were no indications that the tomato DNA inserts conferred autonomous replication on the plasmids. Instead, Southern blot hybridization analysis of seven kanamycin resistant calli revealed the presence of at least one kanamycin resistance locus per transformant integrated in the tomato nuclear DNA. Generally one to three truncated plasmid copies were found integrated into the tomato nuclear DNA, often physically linked to each other. For one transformant we have been able to use the bacterial ampicillin resistance marker of the vector plasmid pUC9 to 'rescue' a recombinant plasmid from the tomato genome. Analysis of the foreign sequences included in the rescued plasmid showed that integration had occurred in a non-repetitive DNA region. Calf-thymus DNA, used as a carrier in transformation procedure, was found to be covalently linked to plasmid DNA sequences in the genomic DNA of one transformant. A model is presented describing the fate of exogenously added DNA during the transformation of a plant cell. The results are discussed in reference to the possibility of isolating DNA sequences responsible for autonomous replication in tomato.

How to keep health risks from drinking alcohol to a low level. Government response to the public consultation.

Incident dark field imaging (IDF) is a new generation handheld microscope for bedside visualization and quantification of microcirculatory alterations. IDF is the technical successor of sidestream dark field imaging (SDF), currently the most used device for microcirculatory measurements. In (pre)term neonates the reduced thickness of the skin allows non-invasive transcutaneous measurements. The goal of this study was to compare the existing device (SDF) and its technical successor (IDF) in preterm neonates. We hypothesized that IDF imaging produces higher quality images resulting in a higher vessel density. After written informed consent was given by the parents, skin microcirculation was consecutively measured on the inner upper arm with de SDF and IDF device. Images were exported and analyzed offline using existing software (AVA 3.0). Vessel density and perfusion were calculated using the total vessel density (TVD) proportion of perfused vessels (PPV) and perfused vessel density. The microcirculation images quality score was used to evaluate the quality of the video images. In a heterogeneous group of twenty preterm neonates (median GA 27.6 weeks, range 24-33.4) IDF imaging visualized 19.9 % more vessels resulting in a significantly higher vessel density (TVD 16.9 vs. 14.1/mm, p value <0.001). The perfusion of vessels could be determined more accurately in the IDF images, resulting in a significant lower PPV (88.7 vs. 93.9 %, p value 0.002). The IDF video images scored optimal in a higher percentage compared to the SDF video images. IDF imaging of the cutaneous microcirculation in preterm neonates resulted in a higher vessel density and lower perfusion compared to the existing SDF devic