Search

Pediatric obstructive sleep apnea poses a significant health risk, with potential long‐term consequences on cardiovascular health. This study explores the dichotomous nature of neonatal cardiac response to chronic intermittent hypoxia (CIH) between males and females, aiming to fill a critical knowledge gap in the understanding of sex‐specific cardiovascular consequences of sleep apnea in early life. Neonates were exposed to CIH until p28 and underwent comprehensive in vivo physiological assessments, including whole‐body plethysmography, treadmill stress‐tests, and echocardiography. Results indicated that male CIH rats weighed 13.7% less than age‐matched control males (p = 0.0365), while females exhibited a mild yet significant increased respiratory drive during sleep (93.94 ± 0.84 vs. 95.31 ± 0.81;p = 0.02). Transcriptomic analysis of left ventricular tissue revealed a substantial sex‐based difference in the cardiac response to CIH, with males demonstrating a more pronounced alteration in gene expression compared to females (5986 vs. 3174 genes). The dysregulated miRNAs in males target metabolic genes, potentially predisposing the heart to altered metabolism and substrate utilization. Furthermore, CIH in males was associated with thinner left ventricular walls and dysregulation of genes involved in the cardiac action potential, possibly predisposing males to CIH‐related arrhythmia. These findings emphasize the importance of considering sex‐specific responses in understanding the cardiovascular implications of pediatric sleep apnea. [ABSTRACT FROM AUTHOR]

Background: Triage is pivotal in intensive care for patient safety and resource allocation. The admission algorithm has been shown to correlate with the appropriateness of ICU admission and offer decision aid when facing challenges in times of scarce critical care resources. This study aimed to explore the development of a reference tool to support triage decisions for admission to the ICU. Methods: In this retrospective observational study, the Intensive Care Triage Score (ICTS) was generated as a reference to correlate with the triage decision made by clinical judgment. ICU admission would be advised for ICTS below 6. The primary outcome was ICU admission. The secondary outcomes included ICU, hospital, 90- day, and 1-year mortality. The receiver operating characteristic curve was used to assess the performance of ICTS. Results: A total of 1664 patients were included in the analysis. There were 1204 patients (72.4%) admitted to the ICU; 680 of 738 (92%) with ICTS below 6 were admitted to the ICU. The hospital mortality of the whole cohort was 25.1%; there was a positive correlation between ICTS and hospital mortality. The area under the receiver operating characteristic curve (AUC) of ICTS in predicting hospital mortality for all patients was 0.754 (95% CI 0.728-0.780). The correlation between ICTS and hospital mortality was observed in patients admitted and not admitted to the ICU. Conclusion: Developing a scoring system as a reference tool would be useful for ICU triage. [ABSTRACT FROM AUTHOR]

This paper reports a longitudinal investigation into the productive vocabulary development in the written Chinese of the Cantonese-speaking elementary children in Hong Kong. Data gathering took place using two vocabulary tests which selected prescriptive vocabulary from the textbooks and the 2007 Vocabulary List. The two assessment tests also included vocabulary from the two classes of words in Chinese, namely, the content and the function words. Data were collected in a senior elementary class in 2008 and 2009 respectively. The phonological, orthographical, syntactic and semantic dimensions of the children's productive vocabulary knowledge in both year four and year five were examined. The longitudinal data of these four linguistic dimensions were scored under respective conditions. The results indicate that the syntactic dimension of the function words is the weakest aspect in vocabulary growth. This may suggest that the syntactic acquisition of the function words seems to take a longer time. Furthermore, two relatively independent aspects of vocabulary knowledge, namely, the phonological-orthographical and the syntactic-semantic, emerge in the vocabulary development.

Background: Although Cognitive Behavioural Therapy (CBT) is effective for 60% of adolescents with anxiety disorders, only 36% are in remission post‐intervention. This indicates that more effective treatments are needed which should be reflected in the NICE guidelines. We hypothesised that Single‐case experimental designs (SCEDs) may provide a framework for accelerating the development of novel interventions. The primary purpose of this review was to investigate whether SCEDs are currently followed by randomised controlled trials (RCTs) of CBT intervention for adolescent anxiety disorders named in the NICE guidelines. The secondary objective was to investigate whether using SCEDs prior to RCTs could be a helpful approach. Method: For the primary search of SCEDs five databases were used (PsycINFO, PubMed, PsycArticles, Web of Science and ProQuest). Nineteen articles met eligibility criteria including a total of 107 participants. For the secondary search of RCTs named in the NICE guidelines for adolescent anxiety disorders 53 articles met inclusion criteria and were included in the systematic review. Results: The 19 SCED studies included in the review were conducted with participants with a diverse range of anxiety disorders and across a range of CBT formats. Two of the SCEDs were followed by RCTs, but neither of these were named in the NICE guidelines for anxiety disorders. All of the SCEDs identified were rated as low quality with none meeting the criteria for the highest or second highest quality rating. From the secondary searches, none of the RCTs named in the NICE guide were preceded by SCEDs. Conclusions: It was concluded that currently SCEDs were not followed by RCTs of CBT interventions named in the NICE guidelines for adolescent anxiety disorders. However, it was suggested that SCEDs may provide an important framework for the development of more effective interventions for adolescents with anxiety. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea is a prevalent and poorly treated cardiovascular disease that leads to hypertension and autonomic imbalance. Recent studies that restore cardiac parasympathetic tone using selective activation of hypothalamic oxytocin neurons have shown beneficial cardiovascular outcomes in animal models of cardiovascular disease. This study aimed to determine if chemogenetic activation of hypothalamic oxytocin neurons in animals with existing obstructive sleep apnea-induced hypertension would reverse or blunt the progression of autonomic and cardiovascular dysfunction. Methods: Two groups of rats were exposed to chronic intermittent hypoxia (CIH), a model of obstructive sleep apnea, for 4 weeks to induce hypertension. During an additional 4 weeks of exposure to CIH, 1 group was treated with selective activation of hypothalamic oxytocin neurons while the other group was untreated. Results: Hypertensive animals exposed to CIH and treated with daily hypothalamic oxytocin neuron activation had lower blood pressure, faster heart rate recovery times after exercise, and improved indices of cardiac function compared with untreated hypertensive animals. Microarray analysis suggested that, compared with treated animals, untreated animals had gene expression profiles associated with cellular stress response activation, hypoxia-inducible factor stabilization, and myocardial extracellular matrix remodeling and fibrosis. Conclusions: In animals already presenting with CIH-induced hypertension, chronic activation of hypothalamic oxytocin neurons blunted the progression of hypertension and conferred cardioprotection after an additional 4 weeks of CIH exposure. These results have significant clinical translation for the treatment of cardiovascular disease in patients with obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

Karenia mikimotoi is one of the most damaging ichthyotoxic dinoflagellate species commonly found in China. However, its growth and ichthyotoxicity responses to salinity changes are still largely unknown. In this study, the growth and ichthyotoxicity of three K. mikimotoi strains, Hong Kong strain KMHK, Japanese strain NIES2411 and New Zealand strain CAWD133, under different salinities (25 to 35 ppt), initial algal densities (5 to 40 thousand cells) and growth phases were investigated. Results indicated that the optimum salinity for all three strains was 30 ppt. The Japanese strain achieved the highest maximum cell densities (cells mL−1) and the New Zealand strain achieved the highest specific growth rate. The Hong Kong and New Zealand strains could not tolerate the low salinity at 25 ppt and the algal cells burst after 3 days of exposure. The average cell widths of all three algal strains in 35 ppt salinity were significantly larger than that in 30 ppt. The acute toxicity test performed on Oncorhynchus mykiss gill cell line RTgill-W1 revealed that the median lethal times for KMHK and NIES2411 were 66.9 and 31.3 min, respectively, and their ichthyotoxicity was significantly affected by algal cell density and growth phase. Nevertheless, CAWD133 did not pose any ichthyotoxicity. The gill cell viability levels at 30 min were reduced from 96 to 61% and 95 to 39% for KMHK and NIES2411, respectively, when the algal cell density increased from 5 × 103 to 4 × 104 algal cells mL−1. Both KMHK and NIES2411 at stationary phase also had higher toxicity than at log phase, with a 27% reduction of gill cell viability, and exerted higher toxicity to the gill cells under extremely low (28 ppt) or high (35 ppt) salinity. These findings demonstrated that the growth–ichthyotoxicity response of Karenia mikimotoi to salinity was not only strain-specific but also depended on its density and growth phase. Study on the effects of salinity on the growth and toxicity of K. mikimotoi is greatly limited. Results from the present study provide valuable insight on the growth and toxicity of different K. mikimotoi strains, which is important in understanding their occurrence of algal bloom and fish-killing action. [ABSTRACT FROM AUTHOR]

The modified technology acceptance model was used to predict actual Blackboard usage (a web-based information system) in a sample of 57 Hong Kong student teachers whose mean age was 27.8 yr. (SD = 6.9). While the general form of the model was supported, Application-specific Self-efficacy was a more powerful predictor of system use than Behavioural Intention as predicted by the theory of reasoned action. Thus in this cultural and educational context, it has been shown that the model does not fully mediate the effect of Self-efficacy on System Use. Also, users' Enjoyment exerted considerable influence on the component variables of Usefulness and Ease of Use and on Application-specific Self-efficacy, thus indirectly influencing system usage. Consequently, efforts to gain students' acceptance and, therefore, use of information systems such as Blackboard must pay adequate attention to users' Self-efficacy and motivational variables such as Enjoyment.

The recent advancements in radiotherapy technologies have made delivery of the highly conformal dose to the target volume possible. With the increasing popularity of delivering high dose per fraction in modern radiotherapy schemes such as in stereotactic body radiotherapy and stereotactic body ablative therapy, high degree of treatment precision is essential. In order to achieve this, we have to overcome the potential difficulties caused by patient instability due to immobilization problems; patient anxiety and random motion due to prolonged treatment time; tumor deformation and baseline shift during a treatment course. This is even challenging for patients receiving radiotherapy in the chest and abdominal regions because it is affected by the patient's respiration which inevitably leads to tumor motion. Therefore, monitoring of intrafractional motion has become increasingly important in modern radiotherapy. Major intrafractional motion management strategies including integration of respiratory motion in treatment planning; breath-hold technique; forced shallow breathing with abdominal compression; respiratory gating and dynamic real-time tumor tracking have been developed. Successful intrafractional motion management is able to reduce the planning target margin and ensures planned dose delivery to the target and organs at risk. Meanwhile, the emergency of MRI-linear accelerator has facilitated radiation-free real-time monitoring of soft tissue during treatment and could be the future modality in motion management. This review article summarizes the various approaches that deal with intrafractional target, organs or patient motion with discussion of their advantages and limitations. In addition, the potential future advancements including MRI-based tumor tracking are also discussed. [ABSTRACT FROM AUTHOR]

The optimal timing for renal replacement therapy initiation in septic acute kidney injury (AKI) remains controversial. This study investigates the impact of early versus late initiation of continuous renal replacement therapy (CRRT) on organ dysfunction among patients with septic shock and AKI. Patients were dichotomized into 'early' (simplified RIFLE Risk) or 'late' (simplified RIFLE Injury or Failure) CRRT initiation. Patients with chronic kidney disease stage 5 or those on long-term dialysis were excluded. Organ dysfunction was quantified by Sequential Organ Failure Assessment (SOFA) score. From January 2008 to June 2011, 120 patients fulfilled the inclusion criteria. Thirty-one (26%) underwent 'early' while 89 (74%) had 'late' CRRT. No significant difference was noted between groups on improvement of total SOFA/non-renal SOFA score or noradrenaline equivalent in the first 24 and 48 h after CRRT initiation. Dialysis requirement and mortality (at 28 days, 3 months and 6 months) did not differ. In conclusion, improvement of non-renal SOFA score 48 h after CRRT correlated with SOFA score on CRRT initiation ( P = 0.040) and APACHE IV risk of death ( P = 0.000), but not estimated glomerular filtration rate on CRRT initiation ( P = 0.377). Improvement of non-renal SOFA score correlated with SOFA score on CRRT initiation and APACHE IV risk of death. However, this retrospective review cannot identify any significant clinical benefit of early CRRT initiation in patients presenting with septic shock and AKI. [ABSTRACT FROM AUTHOR]

Pediatric obstructive sleep apnea has significant negative effects on health and behavior in childhood including depression, failure to thrive, neurocognitive impairment, and behavioral issues. It is strongly associated with an increased risk for chronic adult disease such as obesity and diabetes, accelerated atherosclerosis, and endothelial dysfunction. Accumulating evidence suggests that adult-onset non-communicable diseases may originate from early life through a process by which an insult applied at a critical developmental window causes long-term effects on the structure or function of an organism. In recent years, there has been increased interest in the role of epigenetic mechanisms in the pathogenesis of adult disease susceptibility. Epigenetic mechanisms that influence adaptive variability include histone modifications, non-coding RNAs, and DNA methylation. This review will highlight what is currently known about the phenotypic associations of epigenetic modifications in pediatric obstructive sleep apnea and will emphasize the importance of epigenetic changes as both modulators of chronic disease and potential therapeutic targets. [ABSTRACT FROM AUTHOR]

Water exposure of layered nickel-rich transition metal oxide electrodes, widely used in high-energy lithium-ion batteries, has detrimental effects on the electrochemical performance, which complicates electrode handling and prevents implementation of environmentally benign aqueous processing procedures. Elucidating the degradation mechanisms in play may help rationally mitigate/circumvent key challenges. Here, the bulk structural consequences of long-term (>2.5 years) deuterated water (D 2 O) exposure of intercalation materials with compositions Li x Ni 0.5 Co 0. 2 Mn 0. 3 O 2 (NCM523) and Li x Ni 0.8 Co 0. 1 Mn 0. 1 O 2 (NCM811) are studied by neutron powder diffraction (NPD). Detailed inspection of the NPD data reveals gradual formation of a secondary crystalline phase in all exposed samples, not previously reported for this system. This unknown phase forms faster in liquid- compared to vapor-exposed compounds. Structural modelling of the NPD data shows a stable level of Li/Ni anti-site defects and does not indicate any significant changes in lattice parameters or hydrogen-lithium (D+/Li+) exchange in the structure. Consequently, the secondary phase formation must take place via transformation rather than modification of the parent material. X-ray photoelectron spectroscopy data indicate formation of LiHCO 3 /Li 2 CO 3 at the surface and a Li-deficient oxide in the sub-surface region of the pristine compounds, and the presence of adsorbed water and transition metal hydroxides at the exposed sample surfaces. • Deuterated water (D 2 O) exposure of NCM523 and NCM811 electrodes (>2.5 years). • Bulk structural evolution investigated by modeling of neutron powder diffraction data. • Gradual formation of new secondary crystalline phase observed. • Examination of Li/Ni anti-site defects and proton-lithium exchange concentrations. • Composition and chemistry of surface and sub-surface regions examined by XPS. Image 1 [ABSTRACT FROM AUTHOR]

Ours is a collaborative approach to managing the delivery of short term mental health services for targeted populations. Implementing the Whānau Tahi Connected Care Management System (WTCC) to support the management of the Psychological Support Services Programme (PSS) has enabled Central & Eastern Sydney Primary Health Network (CESPHN) to attempt to address some key challenges. Coordination between health professionals involved in managing and delivering the Psychological Support Services (PSS) programme is key to successfully supporting clients to ensure the y do not succumb to falling through the gaps, delays in delivering services, funding and compliance gaps. Stakeholders from CESPHN and service provider organisations worked with Whānau Tahi to develop and implement coordinated processes and a technical solution for managing the seamless delivery of the PSS programme from client referral, admission, delivery of services and discharge. The aim of this change was to have a single point of assessment, centrally manage the referral and admission process, allocate clients to providers from external organisations and standardise processes and data collection. This enabled better access to and timely provision of services to clients, accurate funding and compliance with governance frameworks. The targeted population are those with a diagnosable mild to moderate mental illness who fit into one of the following underserviced populations: Children and Young People (0-25 years); Women experiencing prenatal/postnatal depression; People who identify as Aboriginal and/or Torres Strait Islander; People from Culturally or Linguistically Diverse (CALD) backgrounds; and People who are at risk of suicide or self harm. Stakeholders involved in the delivery of this programme include GPs and community providers who refer clients, CESPHN who triage and allocate clients to mental health providers for service delivery and Department of Health (DOH) for compliance reporting. Timeline: Implementation of standardised processes and a single technical solution for managing the programme went live in early 2013. CESPHN continue to work closely with Whānau Tahi to implement further enhancements. Highlights: The centrally coordinated single point of assessment referral process allows for clients' eligibility to be reviewed in a timely manner and to be allocated to mental health professionals by the contracted organisations. The ability for mental health professionals from external organisations to enter details of services provided as they are completed allow CESPHN to track the services delivered near real time and better re-allocate funding where a client no longer needs it. The solution has also provided the ability to report on some PSS data from a single source. Sustainability and transferability: The approach to coordinating the connected care for the PSS programme presented here is being trialled, with further development required by the CESPHN and Whau tahi. Conclusion: A centrally coordinated referral process supported by technology enables programme coordinators to easily review client eligibility, allocate funding which results in timely service provision to the hard to reach and/or underserviced clients of the PSS programme. It is hoped this approach will be applied in additional settings to facilitate the coordination and delivery of services in similar programmes. [ABSTRACT FROM AUTHOR]

Objective: To study large check central and peripheral hemisurround stimulus with the more commonly used full and half field stimulus, in the detection of abnormalities in optic neuritis in 21 subjects with multiple sclerosis, and in comparison with 35 control subjects. Methods: Black-and-white large (65’) checkerboard PRVEPs were recorded for full field, central field, half field and hemisurround stimulation. Results: Of the 19 female and 16 male healthy participants studied, females had shorter P100 latencies and larger amplitudes than males. In 9 of the 18 patients with VER abnormalities, central fields showed more marked abnormalities than was recorded in the full field response. It was difficult to reliably elicit responses from hemisurround stimulus in patients. Conclusion: In optic neuritis, large check central field stimulation can show a greater extent of abnormality than can be appreciated in full field stimulation alone. Previously reported sex differences with smaller check size were also noted with this method. Significance: Our findings show that central fields, even with large check sizes, are a useful adjunct to stimulation protocols in the investigation of optic neuritis and that it is best to use separate normative values for males and females. [Copyright &y& Elsevier]

In parallel with advances in the synthesis of solid-state ionic conductors, there is a need to understand the underlying mechanisms behind their improved ionic conductivities. This can be achieved by obtaining an atomic level picture of the interplay between the structure of materials and the resultant ionic diffusion processes. To this end, the structure and dynamics of Mg 2+ -stabilized rotor phase material γ-Na 3 PO 4 , characterized by neutron scattering, are detailed in this work. The Mg 2+ -stabilized rotor phase is found to be thermally stable from 4 to 650 K. However, signatures of orientational disorder of the phosphate anions are also evident in the average structure. Long-range Na + self-diffusion was probed by quasi-elastic neutron scattering and subsequently modeled via a jump diffusion matrix with consideration of the phosphate anion rotations. The resultant diffusion model points directly to coupled anion-cation dynamics. Our approach highlights the importance of considering the whole system when developing an atomic level picture of structure and dynamics, which is critical in the rational design and optimization of energy materials.