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 (0–3) and intermediate (4–6) Apgar scores at 5 min referent to neonates with normal Apgar score (7–10) 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 1 029 207 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 7–10) was strongest at term (p<0·0001). A low Apgar (0–3) was associated with an adjusted RR of 359·4 (95% CI 277·3–465·9) for early neonatal death, 30·5 (18·0–51·6) for late neonatal death, and 50·2 (42·8–59·0) for infant death. We noted similar associations of a lower magnitude for intermediate Apgar (4–6). The strongest associations were for deaths attributed to anoxia and low Apgar (0–3) for term infants (RR 961·7, 95% CI 681·3–1357·5) and preterm infants (141·7, 90·1–222·8). 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 0·1–4·6 at term; 1·2, 0·3–4·8 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 $G$ 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 $G$ are their signatures. Our results show structures due to 2$\hbar\omega$ 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: 1989–2008

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 – 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 échantillons standardisés provenant de pêcheurs ayant capturé des bélugas ont été prélevés dans trois lieux de capture principaux du delta du fleuve Mackenzie (baie Shallow, île Kendall et baie Kugmallit) en 1980 et près de Paulatuk, dans les Territoires du Nord-Ouest, en 1989. La longueur standard et le sexe des baleines débarquées ont été enregistrés dans le cas de 90 à 110 bélugas par année depuis 1980, et les âges ont été déterminés depuis 1988. Les pêcheurs choisissent les bélugas qui sont plus gros et plus âgés. Le nombre de mâles a dépassé 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 d’âge plus jeunes que dix groupes de couches d’accroissement (GCA) étaient pour ainsi dire absentes des récoltes du delta et de la proximité de Paulatuk. Les longueurs asymptotiques, calculées au moyen des dénombrements de GCA à partir des dents de 839 mâles et de 225 femelles échantillonnés au cours de 16 saisons (1989, 1993-2008) étaient de 435,3 cm (ET de 2,0) chez les mâles et de 380,1 cm (ET de 1,8) chez les femelles. Les mâles étaient plus longs que les femelles dans une mesure de 14,5 %. Les bélugas débarqués dans le delta et à Paulatuk étaient surtout des adultes en pleine maturité (en raison du choix des pêcheurs). Les bélugas adultes débarqués par les pêcheurs de Paulatuk étaient plus jeunes et moins longs que ceux capturés dans le delta en raison de la ségrégation entre les sexes et de l’âge dans les zones de pêche. Il n’y avait pas de différence dans les relations en fonction de la taille selon l’âge pour les bélugas débarqués à Paulatuk par rapport à ceux débarqués au delta. La tendance linéaire dans la taille selon l’âge a fait ressortir un déclin de 0,08 % (ET de 0,038 %) par année, soit 1,75 % pour la série temporelle de 19 ans. Les 314 bélugas mâles débarqués dans le delta entre 2000 et 2007 ont affiché d’importantes différences statistiques sur le plan de l’épaisseur du lard au fil des ans, mais seulement une faible tendance à la baisse pendant cette courte période. L’épaisseur moyenne du lard était à son point le plus élevé en 2002 et en 2003, et à son point le plus faible en 2005. La maigreur des bélugas en 2005 et les changements mineurs sur le plan de la croissance des bélugas au cours de la série temporelle pourraient être le reflet de changements caractérisant l’écosystème, changements qui ont eu pour effet de réduire la disponibilité ou la qualité et la quantité des proies des baleines ces dernières années. Des recherches plus poussées, prenant notamment la forme du profilage des isotopes et des acides gras, aideraient à valider la tendance à la baisse en matière de croissance et à élucider 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 Canada’s Western Arctic: Harvest-Based Monitoring 1992–2011

We examined the relationship between ringed seal body condition and reproduction and spring sea ice conditions in prime ringed seal habitat in Canada’s western Arctic during 1992 – 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 – 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 – based sample of 2281 ringed seals was obtained during 1992 – 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 – 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 examiné le lien qui existe entre l’état corporel du phoque annelé, l’état de reproduction de ce phoque et l’état de la glace de mer printanière dans son habitat d’élection de l’ouest de l’Arctique canadien et ce, entre 1992 et 2011. Depuis 1970, l’état de la glace dans l’est du golfe Amundsen et dans l’ouest du détroit de Prince-Albert n’a affiché qu’une petite tendance vers une débâcle printanière plus hâtive (de 3 à 7 jours par décennie) (p < 0,10) et aucune tendance vers un englacement plus tardif ou une variabilité accrue caractérisant la période de la débâcle du printemps. Un échantillon recueilli à partir de 2 281 phoques annelés ayant fait l’objet d’une récolte de subsistance a été obtenu entre 1992 et 2011 à Masoyak, un camp de chasse traditionnel situé sur la côte nord-ouest de l’ouest du détroit de Prince-Albert et à moins de cinq kilomètres de l’est du golfe Amundsen. Les résultats ont permis de constater une tendance statistiquement significative sur le plan de la décroissance de l’état corporel annuel moyen des phoques annelés (en fonction d’un indice de la profondeur et de la longueur de la masse du petit lard [LMD] : reproducteurs, 0,14 m1,5/kg0,5/a; préreproducteurs, 0,24 m1,5/kg0,5/a) au cours des deux dernières décennies. Un résultat parallèle a permis de corréler l’état corporel annuel moyen des reproducteurs et des préreproducteurs à la période d’une débâcle printanière rapide (débâcle tardive = pire état). Cette corrélation était plus évidente au cours des années où la glace était extrême chez tous les groupements en fonction du sexe ou de l’âge, et elle était statistiquement significative chez les préreproducteurs. Parmi les femelles matures échantillonnées depuis 1992, les taux d’ovulation annuels atteignaient 92,4 ± 16,3 % (DS) en moyenne, et étaient plus grands que 80 %, et à près de 100 % au cours de toutes les années, sauf deux. L’anovulation était évidente en 2005, ce qui correspondait à l’année de notre série où la débâcle a été la plus tardive, lorsque seulement 30,0 % des femelles adultes et matures qui avaient été échantillonnées ont ovulé. En même temps, les valeurs relatives aux indices de l’état corporel des phoques (femelles adultes, LMD = 11,3; mâles adultes, LMD = 12,4) et au pourcentage de petits faisant partie de la récolte (3,3 %) figuraient parmi les valeurs les plus basses à n’avoir jamais été enregistrées, et la débâcle printanière était plus tardive de 38 jours par rapport à la moyenne de 1992-2011. Bien que cette étude et des études antérieures laissent croire que la population de phoques de cet habitat important a réussi à se remettre des fluctuations naturelles et extrêmes des conditions de glace des quatre dernières décennies, l’effet potentiellement grossissant de plusieurs années consécutives de glace extrême, allié au déclin concurrent de l’état corporel des phoques que nous avons décelé au cours des 20 dernières années, présente une source d’inquiétude particulière

Avoiding skull radiographs in infants with suspected inflicted injury who also undergo head CT : “a no-brainer?”

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) 48–82% and 85–100%; reviewer 2, 67–98% and 82–100%; and NPV reviewer 1, 95%, CI 88–98% and 96–100%; reviewer 2, 88–97% and 88–98%. Inter- and intra-observer reliability were respectively the following: SXR, excellent (kappa = 0.831) and good (kappa = 0.694); CT, excellent (kappa = 0.831) and perfect (kappa = 1). All results were statistically significant (p < 0.001). 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