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IMPORTANCE: Accurate, timely, and cost-effective methods for staging oropharyngeal cancers are crucial for patient prognosis and treatment decisions, but staging documentation is often inaccurate or incomplete. With the emergence of artificial intelligence in medicine, data abstraction may be associated with reduced costs but increased efficiency and accuracy of cancer staging. OBJECTIVE: To evaluate an algorithm using an artificial intelligence engine capable of extracting essential information from medical records of patients with oropharyngeal cancer and assigning tumor, nodal, and metastatic stages according to American Joint Committee on Cancer eighth edition guidelines. DESIGN, SETTING, AND PARTICIPANTS: This retrospective diagnostic study was conducted among a convenience sample of 806 patients with oropharyngeal squamous cell carcinoma. Medical records of patients with oropharyngeal squamous cell carcinomas who presented to a single tertiary care center between January 1, 2010, and August 1, 2020, were reviewed. A ground truth cancer stage dataset and comprehensive staging rule book consisting of 135 rules encompassing p16 status, tumor, and nodal and metastatic stage were developed. Subsequently, 4 distinct models were trained: model T (entity relationship extraction) for anatomical location and invasion state, model S (numerical extraction) for lesion size, model M (sequential classification) for metastasis detection, and a p16 model for p16 status. For validation, results were compared against ground truth established by expert reviewers, and accuracy was reported. Data were analyzed from March to November 2023. MAIN OUTCOMES AND MEASURES: The accuracy of algorithm cancer stages was compared with ground truth. RESULTS: Among 806 patients with oropharyngeal cancer (mean [SD] age, 63.6 [10.6] years; 651 males [80.8%]), 421 patients (52.2%) were positive for human papillomavirus. The artificial intelligence engine achieved accuracies of 55.9% (95% CI, 52.5%-59.3%) for tumor, 56.0% (95% CI, 52.5%-59.4%) for nodal, and 87.6% (95% CI, 85.1%-89.7%) for metastatic stages and 92.1% (95% CI, 88.5%-94.6%) for p16 status. Differentiation between localized (stages 1-2) and advanced (stages 3-4) cancers achieved 80.7% (95% CI, 77.8%-83.2%) accuracy. CONCLUSION AND RELEVANCE: This study found that tumor and nodal staging accuracies were fair to good and excellent for metastatic stage and p16 status, with clinical relevance in assigning optimal treatment and reducing toxic effect exposures. Further model refinement and external validation with electronic health records at different institutions are necessary to improve algorithm accuracy and clinical applicability.

Due to the low-volume, high-risk nature of simultaneous pancreas-kidney transplantation, the development of standardized education provided nurses the tools to support patients postoperatively. Creation of a standardized educational brochure assisted in improving nurse knowledge and confidence in the patient education process., Patient-centered discharge instructions and focused education are essential parts of the patient experience and increase patients' ability to manage their health (Luther et al., 2019). Informed patients actively participate in [...]

AbstractBackground:Venovenous collaterals are abnormal connections between the systemic and pulmonary venous systems. They are commonly seen in the Fontan circulation and may lead to significant hypoxaemia. Transcatheter closure of venovenous collaterals is a potential but controversial treatment as the long-term benefits and outcomes are not well understood.Methods:This retrospective cohort study utilised data from the Australian and New Zealand Fontan Registry. Patients who underwent transcatheter venovenous collateral occlusion for hypoxemia from the year 2000 onwards were included. Atriopulmonary and Kawashima-type Fontan circulations were excluded to reflect a more contemporary Fontan cohort.Results:Nineteen patients (age 19.3 ± 7.8 years, 53% female) underwent transcatheter venovenous collateral occlusion. Compared to baseline, mean oxygen saturation was improved at latest follow-up (90.5% vs 87.0%; p = 0.003). Nine patients achieved a clinically significant response (defined as an increase of at least 5% to 90% or greater), and this was associated with lower baseline Fontan pressures (12.9 v 15.6 mmHg; p = 0.02). No heart failure hospitalisations, arrhythmia, transplant referrals, or mortality were observed during the median follow-up period of 4 years. Two patients experienced thromboembolic events and five patients underwent re-intervention.Conclusion:Transcatheter occlusion of venovenous collaterals in Fontan patients with chronic hypoxaemia resulted in a modest increase in oxygenation over a median follow-up of 4 years and longer-term prognosis did not appear to be adversely affected. Lower Fontan pressures at baseline were associated with a greater improvement in oxygenation.

Insights into how biological systems respond to high- and low-dose acute environmental stressors are a fundamental aspect of exposome research. However, studying the impact of low-level environmental exposure in conventional in vitrosettings is challenging. This study employed a three-dimensional (3D) biomimetic microfluidic lung-on-chip (μLOC) platform and RNA-sequencing to examine the effects of two model anthropogenic engineered nanoparticles (NPs): zinc oxide nanoparticles (Nano-ZnO) and copier center nanoparticles (Nano-CCP). The airway epithelium exposed to these NPs exhibited dose-dependent increases in cytotoxicity and barrier dysregulation (dominance of the external exposome). Interestingly, even nontoxic and low-level exposure (10 μg/mL) of the epithelium compartment to Nano-ZnO triggered chemotaxis of lung fibroblasts toward the epithelium. An increase in α smooth muscle actin (α-SMA) expression and contractile activity was also observed in these cells, indicating a bystander-like adaptive response (dominance of internal exposome). Further bioinformatics and network analysis showed that a low-dose Nano-ZnO significantly induced a robust transcriptomic response and upregulated several hub genes associated with the development of lung fibrosis. We propose that Nano-ZnO, even at a no observable effect level (NOEL) dose according to conventional standards, can function as a potent nanostressor to disrupt airway epithelium homeostasis. This leads to a cascade of profibrotic events in a cross-tissue compartment fashion. Our findings offer new insights into the early acute events of respiratory harm associated with environmental NPs exposure, paving the way for better exposomic understanding of this emerging class of anthropogenic nanopollutants.

Measurement‐based care tools in psychiatry are useful for symptom monitoring and detecting response to treatment, but methods for quick and objective measurement are lacking especially for acute psychosis. The aim of this study was to explore potential language markers, detected by natural language processing (NLP) methods, as a means to objectively measure the severity of psychotic symptoms of schizophrenia in an acute clinical setting. Twenty‐two speech samples were collected from seven participants who were hospitalized for schizophrenia, and their symptoms were evaluated over time with SAPS/SANS and TLC scales. Linguistic features were extracted from the speech data using machine learning techniques. Spearman's correlation was performed to examine the relationship between linguistic features and symptoms. Various machine learning models were evaluated by cross‐validation methods for their ability to predict symptom severity using the linguistic markers. Reduced lexical richness and syntactic complexity were characteristic of negative symptoms, while lower content density and more repetitions in speech were predictors of positive symptoms. Machine learning models predicted severity of alogia, illogicality, poverty of speech, social inattentiveness, and TLC scores with up to 82% accuracy. Additionally, speech incoherence was quantifiable through language markers derived from NLP methods. These preliminary findings suggest that NLP may be useful in identifying clinically relevant language markers of schizophrenia, which can enhance objectivity in symptom monitoring during hospitalization. Further work is needed to replicate these findings in a larger data set and explore methods for feasible implementation in practice. Natural language processing and machine learning techniques were applied to speech transcripts from patients with schizophrenia who were admitted to hospital for psychosis.Certain linguistic features computed by natural language processing were found to correspond to the presence and severity of specific positive and negative symptoms.Natural language processing may offer an objective way to measure disorganized speech and symptom severity in schizophrenia. Natural language processing and machine learning techniques were applied to speech transcripts from patients with schizophrenia who were admitted to hospital for psychosis. Certain linguistic features computed by natural language processing were found to correspond to the presence and severity of specific positive and negative symptoms. Natural language processing may offer an objective way to measure disorganized speech and symptom severity in schizophrenia.

Family trips to the beautiful countries of Scandinavia are a hot ticket these days. The incredible vistas, easy walking cities and locals speaking fluent English all add to what make [...]

AbstractA distinguishing feature of the modern state is the broad scope of social welfare provision. This remarkable expansion of public assistance was characterized by huge spatial and temporal disparities. What explains the uneven expansion in the reach of social welfare? We argue that social welfare expansion depends in part on the ability of the governed to compel the state to provide rewards in return for military service—and crucially, that marginalized groups faced greater barriers to obtaining those rewards. In colonial states, subjects faced a bargaining disadvantage relative to citizens living in the colony and were less likely to win concessions from the state for their wartime sacrifices. We test this argument using a difference-in-differences research design and a rich data set of local spending before and after World War I in colonial Algeria. Our results reveal that social welfare spending expanded less in communes where the French subject share of the population was greater. This paper contributes to the state-building literature by highlighting the differential ability of the governed to bargain with the state in the aftermath of conflict.

•ENTRUST is a serious game-based assessment platform for clinical decision-making.•Score performance was positively correlated to PGY-level.•Correlation between performance and prior hernia operative case experience.•Validity evidence for ENTRUST as objective assessment of surgical decision-making.•Tool for assessing American Board of Surgery Entrustable Professional Activities.

Coarctation of the aorta (CoA) is one of the most common types of congenital heart disease. Unfortunately, there is a high prevalence of hypertension and late cardiovascular mortality in patients with CoA despite successful repair. The growing impact of acquired cardiovascular disease remains a significant concern as the adult congenital heart disease population continues to rapidly expand and age. This review aims to explore (1) the determinants of vascular health and atherosclerosis including endothelial dysfunction and vascular wall abnormalities, (2) the prevalence of atherosclerosis and associated sequelae in repaired CoA including coronary artery disease, coronary artery calcium, aortic calcium, stroke, and peripheral artery disease, and (3) the contributing factors specific to CoA. This review aims to guide optimization of long-term cardiovascular health to ultimately reduce mortality and morbidity in this young high-risk population.

To the Editor: In 'Rate-Base Cleansings: Rolling Over Ratepayers' (November 2005, p.58), Michael Majoros urges state public utility commissions to recognize a refundable regulatory liability for past charges to ratepayers [...]

Postoperative evaluation of differentiated thyroid cancer requires knowledge of the clinical risk status of patients, biochemical marker abnormalities, and multimodality imaging findings to accurately diagnose disease recurrence and guide appropriate management.

IMPORTANCE: The psychological symptoms associated with having a family member admitted to the intensive care unit (ICU) during the COVID-19 pandemic are not well defined. OBJECTIVE: To examine the prevalence of symptoms of stress-related disorders, primarily posttraumatic stress disorder (PTSD), in family members of patients admitted to the ICU with COVID-19 approximately 90 days after admission. DESIGN, SETTING, AND PARTICIPANTS: This prospective, multisite, mixed-methods observational cohort study assessed 330 family members of patients admitted to the ICU (except in New York City, which had a random sample of 25% of all admitted patients per month) between February 1 and July 31, 2020, at 8 academic-affiliated and 4 community-based hospitals in 5 US states. EXPOSURE: Having a family member in the ICU with COVID-19. MAIN OUTCOMES AND MEASURES: Symptoms of PTSD at 3 months, as defined by a score of 10 or higher on the Impact of Events Scale 6 (IES-6). RESULTS: A total of 330 participants (mean [SD] age, 51.2 [15.1] years; 228 [69.1%] women; 150 [52.8%] White; 92 [29.8%] Hispanic) were surveyed at the 3-month time point. Most individuals were the patients’ child (129 [40.6%]) or spouse or partner (81 [25.5%]). The mean (SD) IES-6 score at 3 months was 11.9 (6.1), with 201 of 316 respondents (63.6%) having scores of 10 or higher, indicating significant symptoms of PTSD. Female participants had an adjusted mean IES-6 score of 2.6 points higher (95% CI, 1.4-3.8; P < .001) than male participants, whereas Hispanic participants scored a mean of 2.7 points higher compared with non-Hispanic participants (95% CI, 1.0-4.3; P = .002). Those with graduate school experience had an adjusted mean score of 3.3 points lower (95% CI, 1.5-5.1; P < .001) compared with those with up to a high school degree or equivalent. Qualitative analyses found no substantive differences in the emotional or communication-related experiences between those with high vs low PTSD scores, but those with higher scores exhibited more distrust of practitioners. CONCLUSIONS AND RELEVANCE: In this cohort study, symptoms of PTSD among family members of ICU patients with COVID-19 were high. Hispanic ethnicity and female gender were associated with higher symptoms. Those with higher scores reported more distrust of practitioners.

This report describes the development of two photocatalytic methods for the pyridination of electron rich arenes. First, an SNAr-type reaction between aryl halides and pyridine is developed and optimized. This transformation affords selective substitution of C(sp2)–halogen over C(sp2)–OR bonds to afford arylpyridinium products under anaerobic conditions. Under complementary aerobic conditions, analogous substrates are shown to undergo oxidative C(sp2)–H pyridination.

The Internet is becoming increasingly important as a business tool and most industries, including plastics, find it essential for obtaining information and carrying out business. Research shows that around 73% of people employed in the plastics sector can access the Internet, set to rise to some 90% by end-2000. The largest category of plastics-related sites on the Internet is the general promotional site, placed online by producers, equipment manufacturers, processors and distributors. Other site categories include information providers and so-called community-builders which offer areas such as discussion forums and chat rooms.

Drilling and completing an oil/gas well is a time-sensitive and high-value operation, in which environment/system parameters change in unseen, unpredictable environments. Safety issues arise at every stage. Drilling principles can be taught using traditional methods, but safety and event response are difficult to teach in such formats. Here, in this article, we integrate a hardware-in-the-loop simulator, downhole physics, and auxiliary touchscreen interfaces (similar to a rig's add-on equipment) to develop a realistic, real-time drilling simulator for well control operation training. Realistic operational data are supplied to the simulator representative of downhole operations, including unplanned well events. The well plan accounts for drilling parameter changes, the pore-pressure fracture-gradient drilling window, mud weights, etc., which occur in response to the unplanned events. The developed simulator is used for hands-on training, human factor studies, model verification, and evaluating new auxiliary equipment and/or operational procedures. A critical research objective was evaluating the accuracy/realism of the developed system. To do so, eight petroleum engineering students and 11 certified drillers were trained and asked to complete a comprehensive (>6 h) drilling operation. System accuracy was measured by comparing how new versus experienced operators learned to operate the simulator, execute mission-critical tasks, and respond to unplanned events. The results validate the realism of the developed simulator and scenarios, since personnel with prior drilling experience took significantly less time to master the system.

As the population of adult congenital heart disease patients ages and grows, so too does the burden of heart failure in this population. Despite the advances in medical and surgical therapies over the last decades, heart failure in adult congenital heart disease remains a formidable complication with high morbidity and mortality. This review focuses on the challenges in determining the true burden and management of heart failure in adult congenital heart disease. There is a particular focus on the need for developing a common language for classifying and reporting heart failure in adult congenital heart disease, the clinical presentation and prognostication of heart failure in adult congenital heart disease, the application of hemodynamic evaluation, and advanced heart failure treatment. A common case study of heart failure in adult congenital heart disease is utilized to illustrate these key concepts.

Several plastics companies have developed in-mould decorating for presenting vehicle safety and system information in both daylight and at night. Inmould Technology is developing in-mould decorating of automotive interior parts and it is working with Bayer which has interests in PC and PBT film. Graphics are screen-printed onto a polycarbonate, PC/PBT or similar film, which is then formed into a three dimensional shape and placed in the mould. Printed graphics are effectively sandwiched between the film and the component.

The PVC profiles market was seeing strong growth in Europe until 1995, particularly in window applications, but the fall in investment in building and construction caused demand to fall. However 40% of all windows in 1995 were made of PVC and the market for replacement windows has remained fairly strong. The UK and Germany are the largest markets for PVC window profiles and the European PVC market is expected to return to growth as economies improve. There are also concerns about the use of PVC from environmental groups and some companies in the industry have responded by recycling window profiles after their natural life has finished.

Byline: Melissa E. Lee Over the last 15 or so years, many colleges have seen an influx of a certain type of student. Beneath a show of bravado, these students' [...]

The potential safety hazards associated with the Mizoroki–Heck cross-coupling of bromobenzenes with styrenes were evaluated. The heat output from the reaction in various solvents was comparable in a variety of solvents; however, the rate of reaction was significantly faster in the presence of water. Thermal stability evaluation of the postreaction mixtures in DMSO and 3:1 DMSO/water by differential scanning calorimetry indicated that the onset temperatures of thermal decomposition were significantly lower than that of neat DMSO. Evaluation of the substrate scope revealed that the substitution pattern on the bromobenzene did not affect the heat output. The reaction rate of electron-deficient bromobenzenes was slower than that of the electron-rich bromobenzenes. In general, substituted styrenes afforded similar magnitudes of exotherms; however, the reaction rate of bromobenzene with 2-methylstyrene was significantly slower than the other studied styrenes. The predicted heat of reaction using the density functional theory method, B3LYP, was in good agreement with the experimental data. Such excellent agreement suggests that this calculation method can be used as a preliminary tool to predict heat of reaction and avoid exothermic reaction conditions. In many of the studied cases, the maximum temperature of a synthesis reaction was considerably higher than the solvent boiling point and thermal decomposition onset temperatures when the reaction was performed in DMSO or 3:1 DMSO/water. It is crucial to understand the thermal stability of the reaction mixture to design the process accordingly and ensure the reaction temperature is maintained below the onset temperature of decomposition to avoid potential runaway reactions.

AbstractBackground:Paediatric heart transplantation in Australia is centralised at The Royal Children’s Hospital, Melbourne. Survival to adulthood is improving but the ongoing need for complex medical therapy, surveillance, and potential for late complications continues to impact on quality of life. Quality of life in adults who underwent heart transplantation in childhood in Australia has not been assessed.Methods:Cross-sectional quality of life data were collected from paediatric heart transplant survivors >18 years of age using Rand 36-Item Health Survey. Self-reported raw scores were transformed to a 0–100 scale with higher scores indicating better quality of life. Mean scores were compared to National Health Survey Short Form-36 Population Norms data using the independent sample t-test.Results:A total of 64 patients (64/151) who underwent transplantation at The Royal Children’s Hospital between 1988 and 2016 survived to adulthood. In total 51 patients (51/64, 80%) were alive at the time of the study and 27 (53%) responded with a mean age of 25 ± 6 years, being a median of 11 years (interquartile range 7–19) post-transplantation. Most self-reported quality of life subscale scores were not significantly different from the Australian normative population data. However, self-reported ‘General Health’ was significantly worse than normative data (p = 0.02). Overall, 93% (25/27) reported their general health as being the same or better compared to 1-year ago.Conclusion:Adult survivors after paediatric heart transplantation in Australia report good quality of life in multiple domains and demonstrate independence in activities of daily living and employment. However, lifelong medical treatment may affect perceptions of general health.

Tumor stromal residing cancer-associated fibroblasts (CAFs) are significant accomplices in the growth and development of malignant neoplasms. As cancer progresses, the stroma undergoes a dramatic remodeling and stiffening of its extracellular matrix (ECM). However, exactly how these biomechanical changes influence the CAF behavior and the functional paracrine crosstalk with the neighboring tumor cells in a 3-dimensional (3D) microenvironment remains elusive. Herein, a collagen and alginate interpenetrating network (CoAl-IPN) hydrogel system was employed as a 3D in vitro surrogate of the cancerous breast tissue stromal niche. In this study, the mechanical properties of CoAl-IPN were precisely fine-tuned with Young’s modulus (E) values of ∼108 and 898 Pa. The results revealed that the 3D polymeric network mechanics and microstructure are critical biophysical determinants of the human breast CAF (b-CAF) morphology, phenotype, and paracrine dialogue with MDA-MB-231 tumoroids. A compliant hydrogel network favors b-CAF spreading, nuclear translocation of the YAP/TAZ mechanosignaling protein, and upregulation of CAF hallmark transcripts. Conversely, a rigid and highly cross-linked hydrogel network imposed a physical entrapment effect on the b-CAFs that limited their spreading and phenotype in a manner that effectively muted their pro-tumorigenic paracrine activity. Collectively, the CoAl-IPN 3D culture system has proven to be a versatile platform in defining the 3D biophysical parameters that could either promote or restrain the protumorigenic activity of b-CAFs and sheds critical mechano-mediated light onto the phenotypic plasticity and corresponding specific bioactivity of b-CAFs in the 3D microenvironment.

Background: Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods: A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ($\kappa$\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\kappa$$\end{document}) value > 0.61. Results: After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion: This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract:

AbstractObjective:The Systematic Classic/Zhen Jiu Jia Yi Jing(ZJJYJ, 鍼灸甲乙經) is considered to be the first complete acupuncture manual to detail the location and meridian assignations of 349 acupuncture points. Despite numerous transcriptions and editing changes, many traditional acupuncturists adhere to the classics and rarely question their validity. However, ushering the use of acupuncture into the modern era requires examining acupuncture point locations objectively by comparing contemporary anatomical knowledge with classical texts. The aim of this research was to examine distinct neuroanatomical targets associated with acupuncture points to: (1) standardize the precise neuroanatomical target of each acupuncture point; and (2) crossreference neuroanatomical targets with classical point locations. This was done to demonstrate ancient authors' intentions when describing acupuncture points as coordinates used to stimulate the peripheral nervous system.Materials and Methods:The unique neuroanatomical targets associated with acupuncture points on the Foot Shao YinKidney meridian were defined. Specifically, KI 1 through KI 8 were examined by comparing classical point locations from the ZJJYJwith modern standardized textbook locations from Chinese Acupuncture and Moxibustion, current anatomical literature, the current authors' cadaver dissection research, and electrostimulation of acupuncture points in healthy volunteers.Results:KI 1–KI 8 correlated with motor entry points as well as with nerve branches and vessels derived from the posterior tibial neurovascular bundle.Conclusions:This research demonstrated a procedure to verify and standardize the distinct neuroanatomical structures of acupuncture points. Standardization of neuroanatomical targets of acupuncture points will enable researchers and clinicians to obtain reproducible results in clinical treatments and research protocols.

ObjectiveTo examine the contemporary long-term outcome after coarctation repair.MethodsThis is a retrospective cohort study of 834 patients aged ≥16 years who underwent coarctation repair under single-centre follow-up. Repair was performed at a median age of 3 years (lower-upper quartile: 1 month to 15 years) by surgery in 83% (690/834) and angioplasty/stenting in 17% (144/834). Survival was compared with an age- and gender matched normal population. Other outcomes included arch reintervention, aortic valve intervention, ascending aortic intervention, and residual/re-coarctation and resting hypertension at latest follow-up.ResultsAfter a median follow-up of 27 years (lower-upper quartile: 18–36), there were 38 late deaths (5%, 38/834). Overall survival was 99%, 88% and 65% at 30, 50 and 70 years of age, respectively, significantly reduced compared with a matched normal population (standardised mortality ratio: 3.20, log-rank: p<0.001). Thirty per cent (246/834) required ≥1 arch reintervention, 13% (111/834) an aortic valve intervention and 5% (43/834) an ascending aortic intervention. Freedom from aortic valve and ascending aortic intervention was 83% and 92% at 50 years and 53% and 81% at 70 years of age, respectively. Residual/re-coarctation (gradient ≥25 mm Hg or repair site/diaphragm ratio ≤70%) at latest follow-up was present in 60% (282/474) and resting hypertension in 57% (379/661).ConclusionsLong-term survival in contemporary adult survivors of coarctation repair is significantly lower than a matched normal population with accelerated decline after the third decade. Nearly 60% of patients eventually develop hypertension, whereas approximately 50% require further invasive cardiovascular treatment by 50 years of age. Our risk-stratifying data may enable personalised follow-up strategies for this common congenital heart condition.

AbstractWhy do some countries fail to govern their territory? Incomplete domestic sovereignty, defined as the absence of effective state authority over territory, has severe consequences in terms of security, order, economic growth, and human well-being. These negative consequences raise the question of why such spaces remain without effective authority. While the international relations literature suggests that state weakness persists because of an absence of war and the comparative politics literature treats political underdevelopment as the consequence of domestic factors that raise the costs of exercising authority, these views are incomplete. I argue that hostile neighbors weaken state authority over territory through a strategy of foreign interference. Foreign interference in domestic sovereignty is a powerful instrument of statecraft that can yield domestic and foreign policy benefits. I investigate the effects of hostile neighboring states through a cross-national, within-country statistical analysis utilizing a novel indicator of state authority, and pair this analysis with a qualitative case study of Malaysian subversion of the Philippines in the 1970s. Together, this evidence shows how this international factor is an underappreciated yet important contributor to weak state authority even after accounting for domestic factors. The study's conclusions challenge our understanding of the effects of international politics on internal political development.

The article discusses need of caring for the well-being of early childhood professional (ECE) professionals. It mentions importance of early childhood care and education professionals on healthy growth and development of children. It mentions elements of ECE professional like affinity, self-respect, engagement, and communication.

Guidelines recommend daily delirium monitoring of hospitalized patients. Available delirium-screening tools have not been validated for use by nurses among diverse inpatients.

A guideline identifying when inpatients with penicillin or cephalosporin antibiotic allergy labels (PCAAL) can receive β-lactam antibiotics increased β-lactam receipt at a large northeastern US health care system.

Patients with single ventricle (SV) without Fontan palliation are uncommon, and their long-term outcomes remain unclear.

Dow Chemical is hoping Covelle, a polyolefin film manufactured using metallocene technology, will find uses in such medical applications as blood bags and packaging.

Innovations within the polyamide industry are discussed, with examples of new technologies and end-uses.

In the past the electronics industry has used inorganic chemicals for a large number of its products, but now the larger electronics companies are turning to polymers particularly for light-emitting diodes. The benefits of polymers include the ease of manufacture using light weight materials, high brightness, and lower financial and environmental costs.

Blatchford uses a range of plastics technologies to ensure optimum performance and cost effectiveness for its artificial legs. The company has two systems for making carbon fibre shins. The sockets attaching the limb to patient are thermoformed using a drape thermoforming method, while feet are produced in shoe sole-type polyurethane and have a structural element linking them to the leg.

The global engineering compound market relies on the production of over 4.5 million tones of polymer compounds. There are about 1,200 compounders throughout the world, with 200 in the US. Dow Plastics produces 60,000 tonnes of compounded polymers in its several European subsidiaries, with the company focusing on the changing needs of consumers throughout the industry. The aim is to produce polymers which are cheap but meet technical and consumer requirements.

The demand for anti-microbial and biocide additives in plastics is established in the US and Japan, and growing in Europe. The most widely-used anti-microbial is the highly-effective oxybisphenoxarsine, but manufacturers cannot use this in food-related applications as it contains arsenic. Trichlorophenoxy phenol, also known as triclosan, is suitable for these applications but is not effective against fungi. Major players in the triclosan market include Microban International and Clariant. Zeneca Biocides has launched a new anti-microbial range based on N-butyl BIT.

German chemical giant BASF split its styrenics and engineering plastics operations into two separate divisions in May 1997, with both units focusing on developing existing products. The engineering plastics division is researching improved grades of polyamides and PBT, while the development of new plastic grades for use in car body panels is being carried out in conjunction with GE Plastics. The styrene unit is developing new grades of styrene copolymers and polystyrene and is experimenting with a sheet extrusion grade of its Styroflex styrene/butadiene copolymer.

German engineering plastics company Ticona was spun-off from parent Hoechst in June 1997. The company's main product is acetal (POM), representing around half of its sales, with polyester (PBT/PEM) being developed as a second line. Ticona also claims around one third of the PPS market, with particular growth in under-the-bonnet automotive applications. The company aims to be the leading producer in all the sectors in which it operates. President Bernd Sassenrath is seeking new partners in engineering plastics to expand the company's portfolio.

Plastics manufacturer Fina Chemicals' has developed a new metallocene catalysed polyethylene for the blown film sector. The product, Finacene PE, is undergoing tests at its facilities in Antwerp, Belgium. It will probably be combined with other products to reduce costs, according to Fina Chemicals representatives. The organisation is also researching other product mixtures to take advantage of mechanical and optical properties not already available in pure metallocene products.

Dutch custom injection moulder company Tradimex Precision Products (TPP) Axxicon started to specialise in the production of gear wheels, helixes and pulleys when it became part of mould-maker Axxicon in 1990. The Axxicon group bought TPP to gather mould making expertise for future business operations. TPP makes around one quarter of group turnover and is expected to grow by between 15-20% per annum until the year 2000.

BP Chemicals Speciality Polymers Group introduced its Ketonex aliphatic polyketones at the New Plastics '96 conference, for use in barrier packaging applications. Ketonex could replace the expensive EVOH in coextruded multilayer structures. There are also new applications for Barex resins in packaging fruit juices, as tests have shown than Barex resins can reduce oxygen transmission by around 90%.