3,731 research outputs found
Apgar score and the risk of cause specific infant mortality: a population based cohort study of 1,029,207 livebirths
Background<p></p>
The Apgar score has been used worldwide as an index of early neonatal condition for more than 60 years. With advances in health-care service provision, neonatal resuscitation, and infant care, its present relevance is unclear. The aim of the study was to establish the strength of the relation between Apgar score at 5 min and the risk of neonatal and infant mortality, subdivided by specific causes.<p></p>
Methods<p></p>
We linked routine discharge and mortality data for all births in Scotland, UK between 1992 and 2010. We restricted our analyses to singleton livebirths, in women aged over 10 years, with a gestational age at delivery between 22 and 44 weeks, and excluded deaths due to congenital anomalies or isoimmunisation. We calculated the relative risks (RRs) of neonatal and infant death of neonates with low (0â3) and intermediate (4â6) Apgar scores at 5 min referent to neonates with normal Apgar score (7â10) using binomial log-linear modelling with adjustment for confounders. Analyses were stratified by gestational age at birth because it was a significant effect modifier. Missing covariate data were imputed.<p></p>
Findings<p></p>
Complete data were available for 1â029â207 eligible livebirths. Across all gestational strata, low Apgar score at 5 min was associated with an increased risk of neonatal and infant death. However, the strength of the association (adjusted RR, 95% CI referent to Apgar 7â10) was strongest at term (p<0·0001). A low Apgar (0â3) was associated with an adjusted RR of 359·4 (95% CI 277·3â465·9) for early neonatal death, 30·5 (18·0â51·6) for late neonatal death, and 50·2 (42·8â59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4â6). The strongest associations were for deaths attributed to anoxia and low Apgar (0â3) for term infants (RR 961·7, 95% CI 681·3â1357·5) and preterm infants (141·7, 90·1â222·8). No association between Apgar score at 5 min and the risk of sudden infant death syndrome was noted at any gestational age (RR 0·6, 95% CI 0·1â4·6 at term; 1·2, 0·3â4·8 at preterm).<p></p>
Interpretation<p></p>
Low Apgar score at 5 min was strongly associated with the risk of neonatal and infant death. Our findings support its continued usefulness in contemporary practice
Evaluation of an assistive technology product design using a paired comparisons method within a mixed methods approach: A case study evaluating preferences for four types of cutlery with 34 upper limb impaired participants
The purpose of the study was the assessment of preferences for 4 types of assistive
technology (AT) domestic cutlery with 24 female and 10 male participants who had a
range of upper limb impairments. A mixed-methods methodology, that included a
paired comparisons analysis, was used to inform product development. Qualitative
and quantitative data collected at the time provided triangulation of cohort
preferences and insight into the reasoning of the participants. The results indicate
that a high friction surface on AT cutlery handles is useful for all upper limb impaired
users; however, the unconventional shapes of the Caring Cutlery better match the
grip patterns generated by those with Arthritis. Conventionally shaped handles are
favoured by those who generate conventional grip patterns. Statistical analysis of the
paired comparisons results indicated a clear preference for the Caring Cutlery by
those with Arthritis. The Etan cutlery set was favoured by those using one hand that
predominantly had Hemiplegia following a Stroke. The paired comparisons method
was used as part of a mixed methodology that was considered to be cost effective.
The authors concluded that the methodology was useful to help validate a new
inclusive/universal product design when the desired attributes are not accurately known
Transport spectroscopy in a time-modulated open quantum dot
We have investigated the time-modulated coherent quantum transport phenomena
in a ballistic open quantum dot. The conductance and the electron dwell
time in the dots are calculated by a time-dependent mode-matching method. Under
high-frequency modulation, the traversing electrons are found to exhibit three
types of resonant scatterings. They are intersideband scatterings: into
quasibound states in the dots, into true bound states in the dots, and into
quasibound states just beneath the subband threshold in the leads. Dip
structures or fano structures in are their signatures. Our results show
structures due to 2 intersideband processes. At the above
scattering resonances, we have estimated, according to our dwell time
calculation, the number of round-trip scatterings that the traversing electrons
undertake between the two dot openings.Comment: 8 pages, 5 figure
The market place and the market's place in London, c. 1660 -1840
This study explores the contemporary collective significance of over seventy London markets in
the 'long' eighteenth century. Markets are loosely defined as those institutions which were
publicly recognized as places of regular trade in basic commodities: meat and livestock, fish and
corn, fruit and vegetables, hay and straw, cloth, coal and animal skins. Their characteristics and
development were shaped by a range of factors: principally 'market forces', but also political
concerns and the growth and modernization of the metropolis. This thesis represents the first
attempt to consider the markets of London during this period collectively and eclectically. One of
its principal elements, therefore, is the classification of markets according to various criteria (e.g.
size, ownership, location) over time (Chapter Two). One key trend is the apparent rise and fall of
food market retailing, which is explained by various economic and cultural factors (Chapter
Three). The economics of wholesaling demonstrate that formal market mechanisms generally
adapted to changing times and performed the task of distribution with reasonable efficiency
(Chapters Four and Five). Political influences on the geography and development of the markets -
the role of market rights and regulations - highlight the distinctive and complex political economy
of the metropolis (Chapter Six). A final dimension of inquiry concerns the relationship between
markets and the city environment, and the extent to which metropolitan growth and
'improvement' impinged on the traditionally focal and symbolic status of markets (Chapter
Seven). In general, markets' collective identity was fragmenting: some prospered whilst others
declined; wholesale-retail distinctions established themselves; the boundaries between formal
marketing and other forms of exchange became increasingly blurred. Nevertheless, the market
place was not made obsolete by the process of metropolitan modernization. The abiding
impression of the study is one of London's commercial, topographical and political complexity
and diversity
An Emerging Pattern of Declining Growth Rates in Belugas of the Beaufort Sea: 1989â2008
Standardized, hunter-based sampling of harvested beluga whales was initiated in the three main harvesting areas of the Mackenzie River delta (Shallow Bay, Kendall Island, Kugmallit Bay) in 1980 and near Paulatuk, Northwest Territories, in 1989. Standard length and sex of landed whales have been recorded for 90 to 110 belugas per year since 1980, and ages have been determined since 1988. Hunters select larger and older belugas; males outnumbered females 2.0 to 1 between 1980 and 1989, 3.0 to 1 between 1990 and 1999, and 3.6 to 1 between 2000 and 2009. Age classes younger than 10 growth layer groups (GLGs) were essentially absent from harvests both in the Delta and near Paulatuk. Asymptotic lengths, calculated using GLG counts from teeth of 839 males and 225 females sampled over 16 seasons (1989, 1993 â 2008), were 435.3 cm (SE 2.0) for males and 380.1 cm (SE 1.8) for females. Males were 14.5% longer than females. Belugas landed in the Delta and Paulatuk were mainly mature adults (by hunter selection). Mature belugas landed by Paulatuk hunters were younger and shorter than those taken in the Delta because of age and sex segregation in the hunting areas. There was no difference in the size-at-age relationships for belugas landed at Paulatuk vs the Delta. The linear trend in size-at-age indicated a decline of 0.08% (SE 0.038%) per year, or 1.75% over the 19 year time series. The 314 male belugas landed in the Delta between 2000 and 2007 showed statistically significant differences in blubber thickness among years, but only a slight downward trend over this short period. Mean blubber was thickest in 2002 and 2003 and thinnest in 2005. The thinness of belugas in 2005, and subtle changes in growth of the belugas over the time series, may reflect ecosystem changes that have reduced the availability or quality and quantity of their prey in recent years. Further research, including isotope and fatty acid profiling, would be helpful in substantiating the declining trend in growth and elucidating the causative factors.Des Ă©chantillons standardisĂ©s provenant de pĂȘcheurs ayant capturĂ© des bĂ©lugas ont Ă©tĂ© prĂ©levĂ©s dans trois lieux de capture principaux du delta du fleuve Mackenzie (baie Shallow, Ăźle Kendall et baie Kugmallit) en 1980 et prĂšs de Paulatuk, dans les Territoires du Nord-Ouest, en 1989. La longueur standard et le sexe des baleines dĂ©barquĂ©es ont Ă©tĂ© enregistrĂ©s dans le cas de 90 Ă 110 bĂ©lugas par annĂ©e depuis 1980, et les Ăąges ont Ă©tĂ© dĂ©terminĂ©s depuis 1988. Les pĂȘcheurs choisissent les bĂ©lugas qui sont plus gros et plus ĂągĂ©s. Le nombre de mĂąles a dĂ©passĂ© le nombre de femelles dans une mesure de 2,0 contre 1 entre 1980 et 1989, de 3,0 contre 1 entre 1990 et 1999, et de 3,6 contre 1 entre 2000 et 2009. Les classes dâĂąge plus jeunes que dix groupes de couches dâaccroissement (GCA) Ă©taient pour ainsi dire absentes des rĂ©coltes du delta et de la proximitĂ© de Paulatuk. Les longueurs asymptotiques, calculĂ©es au moyen des dĂ©nombrements de GCA Ă partir des dents de 839 mĂąles et de 225 femelles Ă©chantillonnĂ©s au cours de 16 saisons (1989, 1993-2008) Ă©taient de 435,3 cm (ET de 2,0) chez les mĂąles et de 380,1 cm (ET de 1,8) chez les femelles. Les mĂąles Ă©taient plus longs que les femelles dans une mesure de 14,5 %. Les bĂ©lugas dĂ©barquĂ©s dans le delta et Ă Paulatuk Ă©taient surtout des adultes en pleine maturitĂ© (en raison du choix des pĂȘcheurs). Les bĂ©lugas adultes dĂ©barquĂ©s par les pĂȘcheurs de Paulatuk Ă©taient plus jeunes et moins longs que ceux capturĂ©s dans le delta en raison de la sĂ©grĂ©gation entre les sexes et de lâĂąge dans les zones de pĂȘche. Il nây avait pas de diffĂ©rence dans les relations en fonction de la taille selon lâĂąge pour les bĂ©lugas dĂ©barquĂ©s Ă Paulatuk par rapport Ă ceux dĂ©barquĂ©s au delta. La tendance linĂ©aire dans la taille selon lâĂąge a fait ressortir un dĂ©clin de 0,08 % (ET de 0,038 %) par annĂ©e, soit 1,75 % pour la sĂ©rie temporelle de 19 ans. Les 314 bĂ©lugas mĂąles dĂ©barquĂ©s dans le delta entre 2000 et 2007 ont affichĂ© dâimportantes diffĂ©rences statistiques sur le plan de lâĂ©paisseur du lard au fil des ans, mais seulement une faible tendance Ă la baisse pendant cette courte pĂ©riode. LâĂ©paisseur moyenne du lard Ă©tait Ă son point le plus Ă©levĂ© en 2002 et en 2003, et Ă son point le plus faible en 2005. La maigreur des bĂ©lugas en 2005 et les changements mineurs sur le plan de la croissance des bĂ©lugas au cours de la sĂ©rie temporelle pourraient ĂȘtre le reflet de changements caractĂ©risant lâĂ©cosystĂšme, changements qui ont eu pour effet de rĂ©duire la disponibilitĂ© ou la qualitĂ© et la quantitĂ© des proies des baleines ces derniĂšres annĂ©es. Des recherches plus poussĂ©es, prenant notamment la forme du profilage des isotopes et des acides gras, aideraient Ă valider la tendance Ă la baisse en matiĂšre de croissance et Ă Ă©lucider les facteurs causals
Radio Source Heating in the ICM: The Example of Cygnus A
One of the most promising solutions for the cooling flow problem involves
energy injection from the central AGN. However it is still not clear how
collimated jets can heat the ICM at large scale, and very little is known
concerning the effect of radio lobe expansion as they enter into pressure
equilibrium with the surrounding cluster gas. Cygnus A is one of the best
examples of a nearby powerful radio galaxy for which the synchrotron emitting
plasma and thermal emitting intra-cluster medium can be mapped in fine detail,
and previous observations have inferred possible shock structure at the
location of the cocoon. We use new XMM-Newton observations of Cygnus A, in
combination with deep Chandra observations, to measure the temperature of the
intra-cluster medium around the expanding radio cavities. We investigate how
inflation of the cavities may relate to shock heating of the intra-cluster gas,
and whether such a mechanism is sufficient to provide enough energy to offset
cooling to the extent observed.Comment: To appear in the Proceedings of "Heating vs. Cooling in Galaxies and
Clusters of Galaxies", August 2006, Garching (Germany), Eds. H. Boehringer,
G.W. Pratt, A. Finoguenov, P. Schuecker, Springer-Verlag series "ESO
Astrophysics Symposia", p.101, in press. 8 pages, 3 multiple figure
Ringed Seals and Sea Ice in Canadaâs Western Arctic: Harvest-Based Monitoring 1992â2011
We examined the relationship between ringed seal body condition and reproduction and spring sea ice conditions in prime ringed seal habitat in Canadaâs western Arctic during 1992 â 2011. Since 1970, ice conditions in east Amundsen Gulf and west Prince Albert Sound have shown only a slight trend toward earlier ice clearance (breakup) in spring (3 â 7 days per decade) (p < 0.10) and no trend toward later freeze-up or increased variability in timing of spring ice clearance. A subsistence harvest â based sample of 2281 ringed seals was obtained during 1992 â 2011 from Masoyak, a traditional hunting camp located on the northwest shore of west Prince Albert Sound and less than 5 km from east Amundsen Gulf. The results revealed a statistically significant trend of decreasing mean annual body condition of ringed seals (using an index of length-mass-blubber depth [LMD]: adults, 0.14 m1.5/kg0.5/y; subadults, 0.24 m1.5/kg0.5/y) over the past two decades. A parallel result was that mean annual body condition of adults and subadults was correlated with the timing of fast ice clearance in spring (later ice clearance = worse condition). This correlation was most obvious in the extreme ice years in all sex/age groupings and was statistically significant for subadults. In mature females sampled since 1992, annual ovulation rates averaged 92.4 ± 16.3% (SD) and were greater than 80%, and mostly at 100%, in all years but two. Failure to ovulate was obvious in 2005, the most extreme late ice clearance year in our series, when only 30.0% of the mature adult females sampled ovulated. At the same time, values for seal body condition indices (adult females, LMD = 11.3; adult males, LMD = 12.4) and percent pups in the harvest (3.3%) were among the lowest recorded, and spring ice clearance was 38 d later than the 1992 â 2011 average. While this and previous studies indicate that the seal population in this core habitat has recovered from natural and extreme-year sea ice fluctuations over the past four decades, the potentially magnified effect of several consecutive extreme ice years, compounded by the concurrent decline in seal body condition that we have now detected over the past 20 years, is of particular concern.Nous avons examinĂ© le lien qui existe entre lâĂ©tat corporel du phoque annelĂ©, lâĂ©tat de reproduction de ce phoque et lâĂ©tat de la glace de mer printaniĂšre dans son habitat dâĂ©lection de lâouest de lâArctique canadien et ce, entre 1992 et 2011. Depuis 1970, lâĂ©tat de la glace dans lâest du golfe Amundsen et dans lâouest du dĂ©troit de Prince-Albert nâa affichĂ© quâune petite tendance vers une dĂ©bĂącle printaniĂšre plus hĂątive (de 3 Ă 7 jours par dĂ©cennie) (p < 0,10) et aucune tendance vers un englacement plus tardif ou une variabilitĂ© accrue caractĂ©risant la pĂ©riode de la dĂ©bĂącle du printemps. Un Ă©chantillon recueilli Ă partir de 2 281 phoques annelĂ©s ayant fait lâobjet dâune rĂ©colte de subsistance a Ă©tĂ© obtenu entre 1992 et 2011 Ă Masoyak, un camp de chasse traditionnel situĂ© sur la cĂŽte nord-ouest de lâouest du dĂ©troit de Prince-Albert et Ă moins de cinq kilomĂštres de lâest du golfe Amundsen. Les rĂ©sultats ont permis de constater une tendance statistiquement significative sur le plan de la dĂ©croissance de lâĂ©tat corporel annuel moyen des phoques annelĂ©s (en fonction dâun indice de la profondeur et de la longueur de la masse du petit lard [LMD] : reproducteurs, 0,14 m1,5/kg0,5/a; prĂ©reproducteurs, 0,24 m1,5/kg0,5/a) au cours des deux derniĂšres dĂ©cennies. Un rĂ©sultat parallĂšle a permis de corrĂ©ler lâĂ©tat corporel annuel moyen des reproducteurs et des prĂ©reproducteurs Ă la pĂ©riode dâune dĂ©bĂącle printaniĂšre rapide (dĂ©bĂącle tardive = pire Ă©tat). Cette corrĂ©lation Ă©tait plus Ă©vidente au cours des annĂ©es oĂč la glace Ă©tait extrĂȘme chez tous les groupements en fonction du sexe ou de lâĂąge, et elle Ă©tait statistiquement significative chez les prĂ©reproducteurs. Parmi les femelles matures Ă©chantillonnĂ©es depuis 1992, les taux dâovulation annuels atteignaient 92,4 ± 16,3 % (DS) en moyenne, et Ă©taient plus grands que 80 %, et Ă prĂšs de 100 % au cours de toutes les annĂ©es, sauf deux. Lâanovulation Ă©tait Ă©vidente en 2005, ce qui correspondait Ă lâannĂ©e de notre sĂ©rie oĂč la dĂ©bĂącle a Ă©tĂ© la plus tardive, lorsque seulement 30,0 % des femelles adultes et matures qui avaient Ă©tĂ© Ă©chantillonnĂ©es ont ovulĂ©. En mĂȘme temps, les valeurs relatives aux indices de lâĂ©tat corporel des phoques (femelles adultes, LMD = 11,3; mĂąles adultes, LMD = 12,4) et au pourcentage de petits faisant partie de la rĂ©colte (3,3 %) figuraient parmi les valeurs les plus basses Ă nâavoir jamais Ă©tĂ© enregistrĂ©es, et la dĂ©bĂącle printaniĂšre Ă©tait plus tardive de 38 jours par rapport Ă la moyenne de 1992-2011. Bien que cette Ă©tude et des Ă©tudes antĂ©rieures laissent croire que la population de phoques de cet habitat important a rĂ©ussi Ă se remettre des fluctuations naturelles et extrĂȘmes des conditions de glace des quatre derniĂšres dĂ©cennies, lâeffet potentiellement grossissant de plusieurs annĂ©es consĂ©cutives de glace extrĂȘme, alliĂ© au dĂ©clin concurrent de lâĂ©tat corporel des phoques que nous avons dĂ©celĂ© au cours des 20 derniĂšres annĂ©es, prĂ©sente une source dâinquiĂ©tude particuliĂšre
Using the opinions of coronary heart disease patients in designing a health education booklet for use in general practice consultations
Avoiding skull radiographs in infants with suspected inflicted injury who also undergo head CT : âa no-brainer?â
Objectives
To assess whether head CT with 3D reconstruction can replace skull radiographs (SXR) in the imaging investigation of suspected physical abuse (SPA)/abusive head trauma (AHT).
Methods
PACS was interrogated for antemortem skeletal surveys performed for SPA, patients younger than 2 years, SXR and CT performed within 4 days of each other. Paired SXR and CT were independently reviewed. One reviewer analysed CT without and (3 months later) with 3D reconstructions. SXR and CT expert consensus review formed the gold standard. Observer reliability was calculated.
Results
A total of 104 SXR/CT examination pairs were identified, mean age 6.75 months (range 4 days to 2 years); 21 (20%) had skull fractures; two fractures on CT were missed on SXR. There were no fractures on SXR that were not seen on CT. For SXR and CT, respectively: PPV reviewer 1, 95% confidence interval (CI) 48â82% and 85â100%; reviewer 2, 67â98% and 82â100%; and NPV reviewer 1, 95%, CI 88â98% and 96â100%; reviewer 2, 88â97% and 88â98%. Inter- and intra-observer reliability were respectively the following: SXR, excellent (kappaâ=â0.831) and good (kappaâ=â0.694); CT, excellent (kappaâ=â0.831) and perfect (kappaâ=â1). All results were statistically significant (pâ<â0.001).
Conclusions
CT has greater diagnostic accuracy than SXR in detecting skull fractures which is increased on concurrent review of 3D reconstructions and should be performed in every case of SPA/AHT. SXR does not add further diagnostic information and can be omitted from the skeletal survey when CT with 3D reconstruction is going to be, or has been, performed
Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care.
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