Search

Introduction Silent cerebral infarcts (SCI) are common in patients with sickle cell disease (SCD) and thought to be caused by a mismatch between oxygen delivery and consumption. The mechanism underlying insufficient oxygen utilization is related to severity of anemia, and paradoxically, to the elevated cerebral blood flow (CBF) observed in SCD patients. CBF is elevated as a compensatory mechanism to maintain oxygen delivery, but high CBF levels can result in rapid transit of blood through the brain capillaries, limiting offloading of oxygen to the tissue; a process called arteriovenous shunting. One way to assess functional arteriovenous shunting is to use noncontrast perfusion MRI techniques in which we can assess the signal intensity of an endogenous blood tracer when it reaches the sagittal sinus. This venous signal (VS) reflects the amount of labeled blood that has not exchanged with the brain parenchyma. Under normal physiological conditions, the VS intensity will increase approximately proportionally with CBF as we expect only some of the water to exchange with tissue as it flows by. However, it is unknown whether functional shunting scales with CBF only, or whether other hemodynamic processes play a role in patients with SCD. We hypothesize that, under pathophysiological conditions such as in SCD patients, more labeled blood may pass unexchanged through the capillaries, which results in higher VS. In the present study, we investigated functional shunting by quantifying VS and assessed its association with hemodynamic, demographic and laboratory parameters in both pediatric and adult SCD patients, and controls. In addition, VS-CBF relationship was studied by further increasing CBF after a vasodilatory challenge. Methods We included 28 children (mean age 12.7 ± 2.3, 9 F) and 38 adults (mean age 32.1 ± 11.2, 14 F) with SCD (HbSS and HbS), and 10 healthy race-matched adult controls (mean age 36.4 ± 15.9, 4 F). For the CBF and VS measurements, pseudo-continuous arterial spin labelling (pCASL) data were acquired using 3T MRI. We segmented the ASL blood pool in the sagittal sinus to determine a common region of interest for each group. We used these images as masks to calculate average VS. Notably, for the comparison between children and adults the ratio between VS to gray matter CBF was used (VGR) instead of the VS, to take into account higher CBF in children. To get more insight into the oxygen utilization, oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO 2) were calculated. In adult participants acetazolamide (ACZ) was used as a vasodilatory challenge. The hematologic laboratory parameters hemoglobin (Hb) and LDH were used as markers of anemia and hemolysis, respectively. Results VS as a marker of cerebral shunting was higher in both adult and pediatric patients with SCD as compared to controls (p Conclusion Our results show that the VS in the sagittal sinus on ASL images can be used to assess functional arteriovenous shunting in the brain. Given its negative association with CMRO 2 in combination with the negative association with hemoglobin and positive correlation with LDH, this functional shunting seems to reflect pathophysiologic shunting related to higher disease severity. Future studies will focus on the relation between functional shunting and the prevalence of SCI, investigating its link to aberrant capillary oxygen exchange in SCD. Figure 1 Figure 1. Disclosures Vaclavu: Philips Healthcare: Research Funding. Biemond: GBT: Honoraria, Research Funding, Speakers Bureau; Novo Nordisk: Honoraria; Novartis: Honoraria, Research Funding, Speakers Bureau; Celgene: Honoraria; Sanquin: Research Funding. more...

Congenital complete heart block (CCHB) affects 1 in 20,000 newborns. This study evaluates fetal and neonatal risk factors predictive of neonatal pacemaker placement in antibody-mediated complete heart block. The Children’s Hospital Los Angeles institutional fetal, pacemaker, and medical record databases were queried for confirmed SSA/SSB cases of CCHB between January 2004 and July 2019. Cases excluded were those with a diagnosis beyond the neonatal period, diagnosis of a channelopathy, or if maternal antibody status was unknown. We recorded the gestational age (GA), birth weight (BW), fetal heart rates (FHRs) of the last echocardiogram before delivery, specific neonatal ECG and echocardiogram findings, age at pacemaker placement, and mortality. Of 43 neonates identified with CCHB, 27 had confirmed maternal antibody exposure. Variables associated with neonatal pacemaker implantation were FHRs more...

During the midst of the Coronavirus 2019 (COVID-19) pandemic, a large Navy Working Capital Funded government laboratory transitioned from a traditional on-site/physical daily operational presence to a distributed, virtual maximum telework posture. The direction given in March 2020 was that unless performance of a specific approved tasking was required at the physical workplace, the laboratory workforce was to telework from a safe location while practicing social distancing. To this extent, a majority of the organization’s workforce continued performing the duties associated with their programs and projects in a virtual and secure distributed environment. This new norm certainly raised questions and considerations related to the effectiveness of the workforce while under maximum telework. As a result, two surveys were conducted to assess the perceived work-effectiveness of the organization. The perceived work-effectiveness was assessed at the operational (work unit) level, focusing on project impacts of telework, and from the macroorganizational perspective. The first survey was conducted on a project that was 2 weeks into this virtual maximum telework environment. The second survey was performed one layer above the project at the division level, thereby extending the aperture of the data. Both surveys provided a great deal of information and insight on how project teams perceived work performance and effectiveness during telework. The purpose of the study was to understand the impact of distributed telework in workforce productivity and project success as well as assess workforce perceptions on the effects of telework. more...

This paper examines existing management concepts and practices that make up three contemporary approaches to public policy and public administration. We attempt to understand whether municipal public administrators and public administration graduate students validate these perspectives in “reality” versus “ideally.” Addressing the extent to which practicing public administrators and students identify with theoretical frameworks, which one(s) they deem most prominent, and how closely their preferred frameworks correspond to what they see in practice, we offer an exploratory analysis of results from 176 respondents through descriptive statistics, paired-sample t-tests, and analysis of covariance (ANCOVA). We hypothesize significant differences with respect to 1) what is preferred and what is perceived in the workplace, 2) group membership (administrator, graduate student, or undergraduate student), and 3) gender (female or male). This research will help public administration educators bridge the gap between theory and practice and narrow the distance between the “is” and the “ought.” more...

Anemia is the most common blood disorder in the world. In patients with chronic anemia, such as sickle cell disease or major thalassemia, cerebral blood flow increases to compensate for decreased oxygen content. However, the effects of chronic anemia on oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2 ) are less well understood. In this study, we examined 47 sickle-cell anemia subjects (age 21.7 ± 7.1, female 45%), 27 non-sickle anemic subjects (age 25.0 ± 10.4, female 52%) and 44 healthy controls (age 26.4 ± 10.6, female 71%) using MRI metrics of brain oxygenation and flow. Phase contrast MRI was used to measure resting cerebral blood flow, while T2 -relaxation-under-spin-tagging (TRUST) MRI with disease appropriate calibrations were used to measure OEF and CMRO2 . We observed that patients with sickle cell disease and other chronic anemias have decreased OEF and CMRO2 (respectively 27.4 ± 4.1% and 3.39 ± 0.71 ml O2 /100 g/min in sickle cell disease, 30.8 ± 5.2% and 3.53 ± 0.64 ml O2 /100 g/min in other anemias) compared to controls (36.7 ± 6.0% and 4.00 ± 0.65 ml O2 /100 g/min). Impaired CMRO2 was proportional to the degree of anemia severity. We further demonstrate striking concordance of the present work with pooled historical data from patients having broad etiologies for their anemia. The reduced cerebral oxygen extraction and metabolism are consistent with emerging data demonstrating increased non-nutritive flow, or physiological shunting, in sickle cell disease patients. more...

Background To treat healthy retinal pigmented epithelium (RPE) with the 3-ns retinal rejuvenation therapy (2RT) laser and to investigate the subsequent wound-healing response of these cells. Methods Primary rat RPE cells were treated with the 2RT laser at a range of energy settings. Treated cells were fixed up to 7 days post-irradiation and assessed for expression of proteins associated with wound-healing. For in vivo treatments, eyes of Dark Agouti rats were exposed to laser and tissues collected up to 7 days post-irradiation. Isolated wholemount RPE preparations were examined for structural and protein expression changes. Results Cultured RPE cells were ablated by 2RT laser in an energy-dependent manner. In all cases, the RPE cell layer repopulated completely within 7 days. Replenishment of RPE cells was associated with expression of the heat shock protein, Hsp27, the intermediate filament proteins, vimentin and nestin, and the cell cycle-associated protein, cyclin D1. Cellular tight junctions were lost in lased regions but re-expressed when cell replenishment was complete. In vivo, 2RT treatment gave rise to both an energy-dependent localised denudation of the RPE and the subsequent repopulation of lesion sites. Cell replenishment was associated with the increased expression of cyclin D1, vimentin and the heat shock proteins Hsp27 and αB-crystallin. Conclusions The 2RT laser was able to target the RPE both in vitro and in vivo, causing debridement of the cells and the consequent stimulation of a wound-healing response leading to layer reformation. more...

Objectives This study sought to evaluate the effect of weight loss on the atrial substrate for atrial fibrillation (AF). Background Whether weight loss can reverse the atrial substrate of ...

Patients with neuropathic pain often experience innocuous cooling as excruciating pain. The cell and molecular basis of this cold allodynia is little understood. We used in vivo calcium imaging of sensory ganglia to investigate how the activity of peripheral cold-sensing neurons was altered in three mouse models of neuropathic pain: oxaliplatin-induced neuropathy, partial sciatic nerve ligation, and ciguatera poisoning. In control mice, cold-sensing neurons were few in number and small in size. In neuropathic animals with cold allodynia, a set of normally silent large diameter neurons became sensitive to cooling. Many of these silent cold-sensing neurons responded to noxious mechanical stimuli and expressed the nociceptor markers Nav1.8 and CGRPα. Ablating neurons expressing Nav1.8 resulted in diminished cold allodynia. The silent cold-sensing neurons could also be activated by cooling in control mice through blockade of Kv1 voltage-gated potassium channels. Thus, silent cold-sensing neurons are unmasked in diverse neuropathic pain states and cold allodynia results from peripheral sensitization caused by altered nociceptor excitability., MacDonald et al. show that cold allodynia—a hallmark of pain caused by cancer drugs like oxaliplatin, nerve injury or poisoning with ciguatoxin—leads to the activation of a set of large silent nociceptors in mice. Ablating these cells reverses cold allodynia, a phenomenon linked to Kv1 channel activity in these cells. more...

Objectives:To assess the overall burden and outcomes of acute respiratory infections in paediatric inpatients with congenital heart disease (CHD).Methods:This is a retrospective cross-sectional study of non-neonates Results:Of the 28,696 infants with CHD in our sample, 26% had respiratory infections. Respiratory infection-associated hospitalisations accounted for $440 million in costs (32%) for all CHD patients. After adjusting for confounders including severity, mortality was higher for those with respiratory infections (OR 1.5, p = 0.003), estimated mean length of stay was longer (14.7 versus 12.2 days, p < 0.001), and estimated mean costs were higher ($53,760 versus $46,526, p < 0.001). Compared to infants with respiratory infections and non-critical CHD, infants with respiratory infections and critical CHD had higher mortality (4.5 versus 2.3%, p < 0.001), longer mean length of stay (20.1 versus 15.5 days, p < 0.001), and higher mean costs ($94,284 versus $52,585, p < 0.001).Conclusion:Acute respiratory infections are a significant burden on infant inpatients with CHD and are associated with higher mortality, costs, and longer length of stay; particularly in those with critical CHD. Future interventions should focus on reducing the burden of respiratory infections in this population. more...

Significance Age-related bioenergetic insufficiency increases the vulnerability of retinal ganglion cells to intraocular pressure during glaucoma pathogenesis. This paper addresses these relationships and provides a deeper understanding of this common neurodegeneration. We demonstrate an intraocular pressure-dependent decline in retinal pyruvate levels coupled to dysregulated glucose metabolism, and detected mTOR activation at the mechanistic nexus of neurodegeneration and metabolism. Supporting this, oral supplementation of pyruvate or mTOR inhibition by rapamycin strongly protects from neurodegeneration. Bioenergetic enhancement thus provides a readily clinically translatable strategy for neurodegenerative disease. This study provides important avenues for neuroprotection against glaucoma by targeting key metabolic pathways that may be mirrored in other neurodegenerative diseases in which metabolic dysregulation may play a key role., Intraocular pressure-sensitive retinal ganglion cell degeneration is a hallmark of glaucoma, the leading cause of irreversible blindness. Here, we used RNA-sequencing and metabolomics to examine early glaucoma in DBA/2J mice. We demonstrate gene expression changes that significantly impact pathways mediating the metabolism and transport of glucose and pyruvate. Subsequent metabolic studies characterized an intraocular pressure (IOP)-dependent decline in retinal pyruvate levels coupled to dysregulated glucose metabolism prior to detectable optic nerve degeneration. Remarkably, retinal glucose levels were elevated 50-fold, consistent with decreased glycolysis but possibly including glycogen mobilization and other metabolic changes. Oral supplementation of the glycolytic product pyruvate strongly protected from neurodegeneration in both rat and mouse models of glaucoma. Investigating further, we detected mTOR activation at the mechanistic nexus of neurodegeneration and metabolism. Rapamycin-induced inhibition of mTOR robustly prevented glaucomatous neurodegeneration, supporting a damaging role for IOP-induced mTOR activation in perturbing metabolism and promoting glaucoma. Together, these findings support the use of treatments that limit metabolic disturbances and provide bioenergetic support. Such treatments provide a readily translatable strategy that warrants investigation in clinical trials. more...

Kidney iron deposition measured by R2* (magnetic resonance imaging) MRI is posited to result from tubular reabsorption of filtered haemoglobin due to intravascular haemolysis. In chronically transfused sickle cell disease (SCD), R2* is elevated and positively correlated with lactate dehydrogenase (LDH). To account for contributions to renal iron from systemic iron overload, we evaluated kidney R2*, urinary iron and haemolysis markers in 62 non-transfused SCD patients. On multivariate analysis, kidney R2* was associated with urinary iron and LDH (R2 = 0·55, P more...

Background Increased bone resorption is driven by augmented osteoclast activity in pathological states of the bone, including osteoporosis, fracture and metastatic bone cancer. Pain is a frequent co‐morbidity in bone pathologies and adequate pain management is necessary for symptomatic relief. Bone cancer is associated with severe skeletal pain and dysregulated bone remodelling, while increased osteoclast activity and bone pain are also observed in osteoporosis and during fracture repair. However, the effects of altered osteoclast activity and bone resorption on nociceptive processing of bone afferents remain unclear. Methods This study investigates whether physiologic osteoclasts and resulting changes in bone resorption can induce skeletal pain. We first assessed correlation between changes in bone microarchitecture (through µCT) and skeletal pain using standardized behavioural phenotyping assays in a mouse model of metastatic bone cancer. We then investigated whether increased activity of physiologic osteoclasts, and the associated bone resorption, is sufficient to induce skeletal pain using mouse models of localized and widespread bone resorption following administration of exogenous receptor activator of nuclear factor kappa‐B ligand (RANKL). Results Our data demonstrates that mice with bone cancer exhibit progressive pain behaviours that correlate with increased bone resorption at the tumour site. Systemic RANKL injections enhance osteoclast activity and associated bone resorption, without producing any changes in motor function or pain behaviours at both early and late timepoints. Conclusion These findings suggest that activation of homeostatic osteoclasts alone is not sufficient to induce skeletal pain in mice. Significance statement The role of osteoclasts in peripheral sensitization of sensory neurones is not fully understood. This study reports on the direct link between oestrogen‐independent osteoclast activation and skeletal pain. Administration of exogenous receptor activator of nuclear factor kappa‐B ligand (RANKL) increases bone resorption, but does not produce pro‐nociceptive changes in behavioural pain thresholds. Our data demonstrates that physiologic osteoclasts are not essential for skeletal pain behaviours. more...

Patients with asthma typically have chronic airway inflammation, variable airflow limitation, and intermittent respiratory symptoms; patients with chronic obstructive pulmonary disease (COPD) often have fixed airflow limitation and persistent respiratory symptoms. Some patients exhibit features suggesting that they have both conditions, which is termed asthma-COPD overlap. These patients have been reported to have worse health outcomes than do those with asthma or COPD alone (1). To describe mortality among persons aged ≥25 years with asthma-COPD overlap, CDC analyzed 1999-2016 National Vital Statistics multiple-cause-of-death mortality data* extracted from the National Occupational Mortality System (NOMS), which included industry and occupation† information collected from 26 states§ for the years 1999, 2003, 2004, and 2007-2014. Age-adjusted death rates per one million persons¶ and proportionate mortality ratios (PMRs)** were calculated. During 1999-2016, 6,738 male decedents (age-adjusted rate per million = 4.30) and 12,028 female decedents (5.59) had both asthma and COPD assigned on their death certificate as the underlying or contributing cause of death. The annual age-adjusted death rate per million among decedents with asthma-COPD overlap declined from 6.70 in 1999 to 3.01 in 2016 (p more...

In sickle cell disease (SCD), oxygen delivery is impaired due to anemia, especially during times of increased metabolic demand, and cerebral blood flow (CBF) must increase to meet changing physiologic needs. But hyperemia limits cerebrovascular reserve (CVR) and ischemic risk prevails despite elevated CBF. The cerebral metabolic rate of oxygen (CMRO2) directly reflects oxygen supply and consumption and may therefore be more insightful than flow‐based CVR measures for ischemic risk in SCD. We hypothesized that adults with SCD have impaired CMRO2 at rest and that a vasodilatory challenge with acetazolamide would improve CMRO2. CMRO2 was calculated from CBF and oxygen extraction fraction (OEF), measured with arterial spin labeling and T2‐prepared tissue relaxation with inversion recovery (T2‐TRIR) MRI. We studied 36 adults with SCD without a clinical history of overt stroke, and nine healthy controls. As expected, CBF was higher in patients with SCD versus controls (mean ± SD: 74 ± 16 versus 46 ± 5 mL/100 g/min, P P = .69). OEF was lower in patients versus controls (27 ± 4 versus 35 ± 4%, P P = .002). After acetazolamide, CMRO2 declined further in patients (P P = .78), indicating that forcing higher CBF worsened oxygen utilization in SCD patients. This lower CMRO2 could reflect variation between healthy and unhealthy vascular beds in terms of dilatory capacity and resistance whereby dysfunctional vessels become more oxygen‐deprived, hence increasing the risk of localized ischemia. more...

BACKGROUND: MRI T2* and R2* mapping have gained clinical acceptance for noninvasive assessment of iron overload. Lower field MRI may offer increased measurement dynamic range in patients with high iron concentration and may potentially increase MRI accessibility, but it is compromised by lower signal-to-noise ratio that reduces measurement precision. PURPOSE: To characterize a high-performance 0.55 T MRI system for evaluating patients with liver iron overload. STUDY TYPE: Prospective. POPULATION: Forty patients with known or suspected iron overload (sickle cell anemia [n = 5], β-thalassemia [n = 3], and hereditary spherocytosis [n = 2]) and a liver iron phantom. FIELD STRENGTH/SEQUENCE: A breath-held multiecho gradient echo sequence at 0.55 T and 1.5 T. ASSESSMENT: Patients were imaged with T2*/R2* mapping 0.55 T and 1.5 T within 24 hours, and 16 patients returned for follow-up exams within 6–16 months, resulting in 56 paired studies. Liver T2* and R2* measurements and standard deviations were compared between 0.55 T and 1.5 T and used to validate a predictive model between field strengths. The model was then used to classify iron overload at 0.55 T. STATISTICAL TESTS: Linear regression and Bland–Altman analysis were used for comparisons, and measurement precision was assessed using the coefficient of variation. A P-value < 0.05 was considered statistically significant. RESULTS: R2* was significantly lower at 0.55 T in our cohort (488 ± 449 s(−1) at 1.5 T vs. 178 ± 155 s(−1) at 0.55 T, n = 56 studies) and in the patients with severe iron overload (937 ± 369 s(−1) at 1.5 T vs. 339 ± 127 s(−1) at 0.55 T, n = 23 studies). The coefficient of variation indicated reduced precision at 0.55 T (3.5 ± 2.2% at 1.5 T vs 6.9 ± 3.9% at 0.55 T). The predictive model accurately predicted 1.5 T R2* from 0.55 T R2* (Bland Altman bias = −6.6 ± 20.5%). Using this model, iron overload at 0.55 T was classified as: severe R2* > 185 s(−1), moderate 81 s(−1) < R2* < 185 s(−1), and mild 45 s(−1) < R2* < 91 s(−1). DATA CONCLUSION: We demonstrated that 0.55 T provides T2* and R2* maps that can be used for the assessment of liver iron overload in patients. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2 more...

Vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD) and occurs when deoxygenated sickled red blood cells occlude the microvasculature. Any stimulus, such as mental stress, which decreases microvascular blood flow will increase the likelihood of red cell entrapment resulting in local vaso-occlusion and progression to VOC. Neurally mediated vasoconstriction might be the physiological link between crisis triggers and vaso-occlusion. In this study, we determined the effect of mental stress on microvascular blood flow and autonomic nervous system reactivity. Sickle cell patients and controls performed mentally stressful tasks, including a memory task, conflict test and pain anticipation test. Blood flow was measured using photoplethysmography, autonomic reactivity was derived from electrocardiography and perceived stress was measured by the State-Trait Anxiety Inventory questionnaire. Stress tasks induced a significant decrease in microvascular blood flow, parasympathetic withdrawal and sympathetic activation in all subjects. Of the various tests, pain anticipation caused the highest degree of vasoconstriction. The magnitude of vasoconstriction, sympathetic activation and perceived stress was greater during the Stroop conflict test than during the N-back memory test, indicating the relationship between magnitude of experimental stress and degree of regional vasoconstriction. Baseline anxiety had a significant effect on the vasoconstrictive response in sickle cell subjects but not in controls. In conclusion, mental stress caused vasoconstriction and autonomic nervous system reactivity in all subjects. Although the pattern of responses was not significantly different between the two groups, the consequences of vasoconstriction can be quite significant in SCD because of the resultant entrapment of sickle cells in the microvasculature. This suggests that mental stress can precipitate a VOC in SCD by causing neural-mediated vasoconstriction. more...

To address the global burden of sickle cell disease (SCD) and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to: patient-reported outcomes (PROs), pain (non-PROs), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the PROs, pain, and brain panels, as well as relevant findings and recommendations from the biomarkers panel. The panels identify end points, where there were supporting data, to use in clinical trials of SCD. In addition, the panels discuss where further research is needed to support the development and validation of additional clinical trial end points. more...

The increasing use of renewables for energy production is also accompanied by an increasing need for flexible power production, while aiming at carbon free emissions. The potential solutions of energy storage of excess generation from renewables through hydrogen production and pre-combustion carbon capture are gaining momentum. Both scenarios require gas turbines capable of operation with hydrogen-based fuels. At the same time, the composition of natural gas considered for use within gas turbines is becoming significantly more variable due to increased use of liquefied natural gas and a wider range of gas sources and extraction methods. Fuel flexibility, both in terms of the amount of hydrogen and higher hydrocarbons is therefore of utmost importance in modern gas turbine development. This paper provides an overview of key steps taken in the design and development of an operation concept, leveraging the advantage of the GT36 Constant Pressure Sequential Combustion system (CPSC) – a premixed low emission reheat combustion technology, characterised by an extremely broad fuel range capability, composed of two combustion stages in series. The results presented in this paper clearly show that the complementarity behaviour of first and second combustion stages – extensively proven for fuels containing high concentrations of higher hydrocarbons – can be extended to hydrogen. Ultimately, this allows the achievement of ultra-low emissions at full combustor exit temperature maintaining the power and efficiency performance of F and H class engines. Recent validation performed at the high pressure combustion facility at DLR-Cologne, proved fuel flexibility with minimal or no de-rating with hydrogen contents from 0 to 50% in volume, without any modification of the standard GT36 hardware. Based on the current studies, the flexibility of the GT36 CPSC system is envisaged to enable a further increase in hydrogen content allowing this H class engine to be operated with 100% hydrogen. more...

Over the past decade, electronic parts have become smaller, more complex, and highly functional. This is well understood for many products within the consumer and handheld markets. Miniaturization, however, is also impacting sectors such as aerospace and automotive, pushing the limits of already harsh environments. As more power is driven through active devices, the integrity of materials used to provide the electrically conductive interfaces is becoming increasingly critical. For many applications, adhesive films have been the preferred material because they offer a variety of performance and operational advantages such high electrical and thermal conductivity, uniform bondlines, superior adhesion, and low processing temperatures. Today, as miniaturization pushes power-density limits and although devices are also being exposed to high operating temperatures, even for traditionally robust adhesive films, it is challenging to cope with these conditions. In sectors such as aerospace where high reliability is essential, material capability must evolve to deliver on fail-safe performance expectations. This study compares the performance of an established and widely used electrically conductive film adhesive with that of a newly developed film designed to provide improved mechanical performance over a higher elevated temperature range. more...

Purpose This paper aims to empirically examine the proposed framework that incorporates multiple business relational ties as components in a composite that can provide strength to relationships. Strength is conceptualized as tensile strength or an ability to withstand stress without permanent deformation of the relationship. Design/methodology/approach The study uses dyadic survey data collected by mail survey from the organizational buyers and suppliers. Analysis is through moderated multiple regression. Findings Results indicate that stressors can disrupt individual components of relationships. However, the overall relationship outcome of behavioral loyalty remains intact with tensile strength coming from other components of the relationship. Originality/value This research introduces the concept of tensile strength from the material sciences as relevant to dyadic business relationship strength. The outcomes indicate that looking at multiple components of the business relationship provides greater insight into the tensile strength of business relationships. more...

‘The Chinese People’s Liberation Army Navy [has] turned 70 … It is a time for reflecting on its beginning and how over the past seven decades it has overcome numerous difficulties to grow into a mo... more...

Background With a prevalence of up to 16.5%, depression is one of the commonest mental disorders in people with advanced cancer. Depression reduces the quality of life (QoL) of patients and those close to them. The National Institute for Health and Care Excellence (NICE) guidelines recommend treating depression using antidepressants and/or psychological treatments, such as cognitive–behavioural therapy (CBT). Although CBT has been shown to be effective for people with cancer, it is unclear whether or not this is the case for people with advanced cancer and depression. Objectives To assess the clinical effectiveness and cost-effectiveness of treatment as usual (TAU) plus manualised CBT, delivered by high-level Improving Access to Psychological Therapy (IAPT) practitioners, versus TAU for people with advanced cancer and depression, measured at baseline, 6, 12, 18 and 24 weeks. Design Parallel-group, single-blind, randomised trial, stratified by whether or not an antidepressant was prescribed, comparing TAU with CBT plus TAU. Setting Recruitment took place in oncology, hospice and primary care settings. CBT was delivered in IAPT centres or/and over the telephone. Participants Patients (N = 230; n = 115 in each arm) with advanced cancer and depression. Inclusion criteria were a diagnosis of cancer not amenable to cure, a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of depressive disorder using the Mini-International Neuropsychiatric Interview, a sufficient understanding of English and eligibility for treatment in an IAPT centre. Exclusion criteria were an estimated survival of Interventions (1) Up to 12 sessions of manualised individual CBT plus TAU delivered within 16 weeks and (2) TAU. Outcome measures The primary outcome was the Beck Depression Inventory, version 2 (BDI-II) score at 6, 12, 18 and 24 weeks. Secondary outcomes included scores on the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, satisfaction with care, EuroQol-5 Dimensions and the Client Services Receipt Inventory, at 12 and 24 weeks. Results A total of 80% of treatments (185/230) were analysed: CBT (plus TAU) (n = 93) and TAU (n = 92) for the BDI-II score at all time points using multilevel modelling. CBT was not clinically effective [treatment effect –0.84, 95% confidence interval (CI) –2.76 to 1.08; p = 0.39], nor was there any benefit for other measures. A subgroup analysis of those widowed, divorced or separated showed a significant effect of CBT on the BDI-II (treatment effect –7.21, 95% CI –11.15 to –3.28; p Limitations Although all participants satisfied a diagnosis of depression, for some, this was of less than moderate severity at baseline, which could have attenuated treatment effects. Only 64% (74/115) took up CBT, comparable to the general uptake through IAPT. Conclusions Cognitive–behavioural therapy (delivered through IAPT) does not achieve any clinical benefit in advanced cancer patients with depression. The benefit of CBT for people widowed, divorced or separated is consistent with other studies. Alternative treatment options for people with advanced cancer warrant evaluation. Screening and referring those widowed, divorced or separated to IAPT for CBT may be beneficial. Whether or not improvements in this subgroup are due to non-specific therapeutic effects needs investigation. Trial registration Current Controlled Trials ISRCTN07622709. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 19. See the NIHR Journals Library website for further project information. more...

Object tracking algorithms rely on user input to learn the object of interest. In multi-object tracking, this can be a challenge when the user has to provide a lot of locations to track. This paper presents a new approach that reduces the need for user input in multi-tracking. The approach uses density based clustering to analyse the colours in one frame and find the best separation of colours. The colours selected from the detection are learned and used in subsequent frames to track the colours through the video. With this training approach, the user interaction is limited to selecting the colours rather than selecting the multiple location to be tracked. The training algorithm also provides online training even when training on thousands of features. more...

As we become familiar with the 21st century we can see that what we are designing is changing, new technologies support the creation of new forms of product and service, and new pressures on business and society demand the design of solutions to increasingly complex problems, sometimes local, often global in nature. Customers, users and stakeholders are no longer passive recipients of design, expectations are higher, and increased participation is often essential.This book explores these issues through the work of 21 research teams. Over a twelve-month period each of these groups held a series of workshops and events to examine different facets of future design activity as part of the UK's research council supported Designing for the 21st Century Research Initiative. Each of these 21 contributions describes the context of enquiry, the journey taken by the research team and key insights generated through discourse. Editor and Initiative Director, Tom Inns, provides an introductory chapter that suggests ways that the reader might navigate these different viewpoints. more...

Made available in DSpace on 2021-06-25T11:16:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Agence Nationale Des Parcs Nationaux Centre for International Forestry Research Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS) David and Lucile Packard Foundation European Space Agency Leverhulme Trust Gordon and Betty Moore Foundation Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Fundação de Amparo à Pesquisa do Estado de Goiás European Research Council Belgian Federal Science Policy Office Vlaamse Interuniversitaire Raad Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) National Science Foundation Natural Environment Research Council Royal Society National Geographic Society Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests. Resumen: Los bosques tropicales son los ecosistemas más diversos y productivos del mundo y entender su funcionamiento es crítico para nuestro futuro colectivo. Sin embargo, hasta hace muy poco, los esfuerzos para medirlos y monitorearlos han estado muy desconectados. El trabajo en redes es esencial para descubrir las respuestas a preguntas que trascienden las fronteras y los plazos de las agencias de financiamiento. Aquí mostramos cómo una comunidad global está respondiendo a los desafíos de la investigación en ecosistemas tropicales a través de diversos equipos realizando mediciones árbol por árbol en miles de parcelas permanentes de largo plazo. Revisamos los descubrimientos más importantes de este trabajo y discutimos cómo este proceso está cambiando la ciencia relacionada a los bosques tropicales. El enfoque central de nuestro esfuerzo implica la conexión de iniciativas locales de largo plazo con protocolos estandarizados y manejo de datos para producir resultados que se puedan trasladar a múltiples escalas. Conectando investigadores tropicales, elevando su posición y estatus, nuestro modelo de Red Social de Investigación reconoce el rol fundamental que tienen, para el descubrimiento científico, quienes generan o producen los datos. Concebida en 1999 con RAINFOR (Suramérica), nuestras redes de parcelas permanentes han sido adaptadas en África (AfriTRON) y el sureste asiático (T-FORCES) y ampliamente replicadas en el mundo. Actualmente todas estas iniciativas están integradas a través de la ciber-infraestructura de ForestPlots.net, conectando colegas de 54 países en 24 redes diferentes de parcelas. Colectivamente, estas redes están transformando nuestro conocimiento sobre los bosques tropicales y el rol de éstos en la biósfera. Juntos hemos descubierto cómo, dónde y porqué el carbono y la biodiversidad de los bosques tropicales está respondiendo al cambio climático y cómo se retroalimentan. Esta colaboración pan-tropical de largo plazo ha expuesto un gran sumidero de carbono y sus tendencias, mostrando claramente cuáles son los factores más importantes, qué procesos se ven afectados, dónde ocurren los cambios, los tiempos de reacción y las probables respuestas futuras mientras el clima continúa cambiando. Apalancando lo que realmente es una tecnología antigua, las redes de parcelas están generando una verdadera y moderna revolución en la ciencia tropical. En el futuro, la humanidad puede beneficiarse enormemente si se nutren y cultivan comunidades de investigadores de base, actualmente con la capacidad de generar información única y de largo plazo para entender los que probablemente son los bosques más preciados de la tierra. Resumo: Florestas tropicais são os ecossistemas mais diversos e produtivos da Terra. Embora uma boa compreensão destas florestas seja crucial para o nosso futuro coletivo, até muito recentemente os esforços de medições e monitoramento foram amplamente desconexos. É essencial formarmos redes para obtermos respostas que transcendem fronteiras e horizontes de agências financiadoras. Neste estudo nós mostramos como uma comunidade global está respondendo aos desafios da pesquisa de ecossistemas tropicais, com equipes diversas medindo florestas, árvore por árvore, em milhares de parcelas monitoradas à longo prazo. Nós revisamos as maiores descobertas científicas deste trabalho, e mostramos também como este processo está mudando a ciência de florestas tropicais. Nossa abordagem principal envolve unir iniciativas de base a protocolos padronizados e gerenciamento de dados a fim de gerar resultados robustos em escalas ampliadas. Ao conectar pesquisadores tropicais e elevar seus status, nosso modelo de Rede de Pesquisa Social reconhece o papel-chave do produtor dos dados na descoberta científica. Concebida em 1999 com o RAINFOR (América do Sul), nossa rede de parcelas permanentes foi adaptada para África (AfriTRON) e Sudeste asiático (T-FORCES), e tem sido extensamente reproduzida em todo o mundo. Agora estas múltiplas iniciativas estão integradas através de uma infraestrutura cibernética do ForestPlots.net, conectando colegas de 54 países de 24 redes de parcelas. Estas iniciativas estão transformando coletivamente o entendimento das florestas tropicais e seus papéis na biosfera. Juntos nós descobrimos como, onde e por que o carbono e a biodiversidade da floresta estão respondendo às mudanças climáticas, e seus efeitos de retroalimentação. Esta duradoura colaboração pantropical revelou um grande sumidouro de carbono persistente e suas tendências, assim como tem evidenciado quais direcionadores são mais importantes, quais processos florestais são mais afetados, onde eles estão mudando, seus atrasos no tempo de resposta, e as prováveis respostas das florestas tropicais conforme o clima continua a mudar. Dessa forma, aproveitando uma notável tecnologia antiga, redes de parcelas acendem faíscas de uma moderna revolução na ciência das florestas tropicais. No futuro a humanidade pode se beneficiar incentivando estas comunidades basais que agora são coletivamente capazes de gerar conhecimentos únicos e duradouros sobre as florestas mais preciosas da Terra. Résume: Les forêts tropicales sont les écosystèmes les plus diversifiés et les plus productifs de la planète. Si une meilleure compréhension de ces forêts est essentielle pour notre avenir collectif, jusqu'à tout récemment, les efforts déployés pour les mesurer et les surveiller ont été largement déconnectés. La mise en réseau est essentielle pour découvrir les réponses à des questions qui dépassent les frontières et les horizons des organismes de financement. Nous montrons ici comment une communauté mondiale relève les défis de la recherche sur les écosystèmes tropicaux avec diverses équipes qui mesurent les forêts arbre après arbre dans de milliers de parcelles permanentes. Nous passons en revue les principales découvertes scientifiques de ces travaux et montrons comment ce processus modifie la science des forêts tropicales. Notre approche principale consiste à relier les initiatives de base à long terme à des protocoles standardisés et une gestion de données afin de générer des résultats solides à grande échelle. En reliant les chercheurs tropicaux et en élevant leur statut, notre modèle de réseau de recherche sociale reconnaît le rôle clé de l'auteur des données dans la découverte scientifique. Conçus en 1999 avec RAINFOR (Amérique du Sud), nos réseaux de parcelles permanentes ont été adaptés à l'Afrique (AfriTRON) et à l'Asie du Sud-Est (T-FORCES) et largement imités dans le monde entier. Ces multiples initiatives sont désormais intégrées via l'infrastructure ForestPlots.net, qui relie des collègues de 54 pays à travers 24 réseaux de parcelles. Ensemble, elles transforment la compréhension des forêts tropicales et de leur rôle biosphérique. Ensemble, nous avons découvert comment, où et pourquoi le carbone forestier et la biodiversité réagissent au changement climatique, et comment ils y réagissent. Cette collaboration pan-tropicale à long terme a révélé un important puits de carbone à long terme et ses tendances, tout en mettant en évidence les facteurs les plus importants, les processus forestiers qui sont affectés, les endroits où ils changent, les décalages et les réactions futures probables des forêts tropicales à mesure que le climat continue de changer. En tirant parti d'une technologie remarquablement ancienne, les réseaux de parcelles déclenchent une révolution très moderne dans la science des forêts tropicales. À l'avenir, l'humanité pourra grandement bénéficier du soutien des communautés de base qui sont maintenant collectivement capables de générer une compréhension unique et à long terme des forêts les plus précieuses de la Terre. Abstrak: Hutan tropika adalah di antara ekosistem yang paling produktif dan mempunyai kepelbagaian biodiversiti yang tinggi di seluruh dunia. Walaupun pemahaman mengenai hutan tropika amat penting untuk masa depan kita, usaha-usaha untuk mengkaji dan mengawas hutah-hutan tersebut baru sekarang menjadi lebih diperhubungkan. Perangkaian adalah sangat penting untuk mencari jawapan kepada soalan-soalan yang menjangkaui sempadan dan batasan agensi pendanaan. Di sini kami menunjukkan bagaimana sebuah komuniti global bertindak balas terhadap cabaran penyelidikan ekosistem tropika melalui penglibatan pelbagai kumpulan yang mengukur hutan secara pokok demi pokok dalam beribu-ribu plot jangka panjang. Kami meninjau semula penemuan saintifik utama daripada kerja ini dan menunjukkan bagaimana proses ini sedang mengubah bidang sains hutan tropika. Teras pendekatan kami memberi tumpuan terhadap penghubungan inisiatif akar umbi jangka panjang dengan protokol standar serta pengurusan data untuk mendapatkan hasil skala besar yang kukuh. Dengan menghubungkan penyelidik-penyelidik tropika dan meningkatkan status mereka, model Rangkaian Penyelidikan Sosial kami mengiktiraf kepentingan peranan pengasas data dalam penemuan saintifik. Bermula dengan pengasasan RAINFOR (Amerika Selatan) pada tahun 1999, rangkaian-rangkaian plot kekal kami kemudian disesuaikan untuk Afrika (AfriTRON) dan Asia Tenggara (T-FORCES) dan selanjutnya telah banyak dicontohi di seluruh dunia. Kini, inisiatif-inisiatif tersebut disepadukan melalui infrastruktur siber ForestPlots.net yang menghubungkan rakan sekerja dari 54 negara di 24 buah rangkaian plot. Secara kolektif, rangkaian ini sedang mengubah pemahaman tentang hutan tropika dan peranannya dalam biosfera. Kami telah bekerjasama untuk menemukan bagaimana, di mana dan mengapa karbon serta biodiversiti hutan bertindak balas terhadap perubahan iklim dan juga bagaimana mereka saling bermaklum balas. Kolaborasi pan-tropika jangka panjang ini telah mendedahkan sebuah sinki karbon jangka panjang serta arah alirannya dan juga menjelaskan pemandu-pemandu perubahan yang terpenting, di mana dan bagaimana proses hutan terjejas, masa susul yang ada dan kemungkinan tindakbalas hutan tropika pada perubahan iklim secara berterusan di masa depan. Dengan memanfaatkan pendekatan lama, rangkaian plot sedang menyalakan revolusi yang amat moden dalam sains hutan tropika. Pada masa akan datang, manusia sejagat akan banyak mendapat manfaat jika memupuk komuniti-komuniti akar umbi yang kini berkemampuan secara kolektif menghasilkan pemahaman unik dan jangka panjang mengenai hutan-hutan yang paling berharga di dunia. Instituto de Ecología Regional (IER) Universidad Nacional de Tucumán (UNT) Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) Facultad de Ciencias Agrarias Universidad Nacional de Jujuy James Cook University (JCU) CSIRO (Commonwealth Scientific and Industrial Research Organisation) School of Land & Food University of Tasmania CSIRO Tropical Forest Research Centre Independent Researcher Environmental Protection Agency (EPA) Centre for Tropical Environmental and Sustainability Science (TESS) College of Marine and Environmental Sciences James Cook University Centre for Tropical Environmental and Sustainability Science College of Science and Engineering James Cook University University of the Sunshine Coast University of York Flamingo Land Ltd. Sommersbergseestrasse Ghent University CAVElab Ghent University Royal Museum for Central Africa - Service of Wood Biology Isotope Bioscience Laboratory-ISOFYS Ghent University Gembloux Agro-Bio Tech Université de Liege Landscape Ecology and Vegetal Production Systems Unit CAVElab Computational & Applied Vegetation Ecology Ghent University Tropical Forestry Forest Resources Management Gembloux Agro-Bio Tech University of Liege Université Libre de Bruxelles (ULB) Evolutionary Biology and Ecology Royal Museum for Central Africa Royal Museum for Central Africa Ghent University Department of Environment Ghent University Service Evolution Biologique et Ecologie Belize Foundation for Research and Environmental Education IBIF Museo de Historia Natural Noel Kempff Mercado Universidad Autonoma Gabriel Rene Moreno PROMAB Museo Noel Kempff Consultor Independiente Jardin Botanico Municipal de Santa Cruz Museo de Historia Natural Noel Kempff Mercado Forest Management in Bolivia Universidad Autónoma del Beni Riberalta Museo de Historia Natural Noel Kempff Herbario del Sur de Bolivia Universidad Autónoma del Beni Conservation International Instituto de Biodiversidade e Floresta Universidade Federal do Oeste do Pará Universidade Federal de Pernambuco Universidade do Estado de Mato Grosso Universidade do Estado de Mato Grosso (UNEMAT) Projeto TEAM – Manaus Universidade Federal de Juiz de Fora (UFJF) Universidade Federal do Rio de Janeiro Instituto Nacional de Pesquisas da Amazônia Projeto Dinâmica Biológica de Fragmentos Florestais Departamento de Genética Ecologia e Evolução Universidade Federal de Minas Gerais Universidade Estadual de Campinas Laboratório de Ecologia de Comunidades e Funcionamento de Ecossistemas-ECoFERP Departamento de Biologia Faculdade de Filosofia Ciências e Letras USP National Institute for Space Research (INPE) Universidade Federal de Roraima (UFRR) UNESP - São Paulo State University Carbonozero Consultoria Ambiental Departamento de Biologia Universidade Federal do Amazonas (UFAM) Centro de Energia Nuclear na Agricultura Universidade de São Paulo UERR - Campus Rorainópolis Universidade Federal do Acre Instituto Agronômico de Campinas Universidade Federal do Rio Grande do Sul Embrapa Universidade Estadual do Norte Fluminense (UENF) Universidade Federal da Bahia (UFBA) Instituto de Biologia Universidade Estadual de Campinas Universidade Federal do Piauí (UFPI) Botany and Plant Ecology Laboratory Federal University of Acre INPA- Instituto Nacional de Pesquisas da Amazônia UERR - Campus Boa Vista Universidade Federal do Ceará Universidade Federal de Campina Grande Universidade Federal do Para Núcleo de Estudos e Pesquisas Ambientais Universidade Estadual de Campinas Instituto Federal de Educação Ciência e Tecnologia do Acre Instituto de Pesquisas Jardim Botânico do Rio de Janeiro Universidade Federal do Oeste do Pará UEFS Depto. de Ciências Biológicas Universidade Federal do Agreste de Pernambuco (UFAPE) Universidade Estadual de Montes Claros FFCLRP-USP/Br UNEMAT Universidade Federal de Jataí Universidade Federal do Pará Instituto de Ciências Biológicas Universidade de Campinas Universidade Federal de Lavras (UFLA) Museu Goeldi Embrapa Amazônia Oriental Instituto Nacional de Pesquisas da Amazônia UFMG - Universidade Federal de Minas Gerais Fundação Universidade Fedral de Rondônia - UNIR INPA- Instituto Nacional de Pesquisas Amazônicas Instituto Nacional de Pesquisas da Amazônia - Coordenação de Pesquisas em Silvicultura Tropical Jardim Botânico do Rio de Janeiro National Institute for Research in Amazonia Universidade Federal de Roraima (UFRR/PRONAT) Universidade Estadual de Campinas/UNICAMP Instituto Nacional de Pesquisas da Amazônia/CPBO Universidade Federal de Santa Catarina (UFSC) INCAPER- Instituto Capixaba de Pesquisa Assistência Técnica e Extensão Rural INPE- Instituto Nacional de Pesquisas Espaciais Universidade de São Paulo Instituto de Biociências Universidade Estadual Paulista Semiarid National Institute (INSA) Universidade de Brasília Departamento de Engenharia Florestal IBAM - Instituto Bem Ambiental Universidade do Estado de Mato Grosso Campus de Nova Xavantina University in Campinas Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF) LMF Instituto Nacional de Pesquisas da Amazônia Universidade Federal do Vale do São Francisco USP - University of São Paulo Instituto Federal do Espírito Santo (IFES) INPA - Instituto Nacional de Pesquisas da Amazônia Grupo MAUA Universidade Federal de Mato Grosso Instituto de Ciências Naturais Humanas e Sociais Instituto Nacional da Mata Atlântica RAINFOR-PPBIO Universidade Federal Rural da Amazônia - UFRA/CAPES Universidade Federal do Amazonas (UFAM) INPA/Max-Planck Project EMBRAPA- Empresa Brasileira de Pesquisa Agropecuária (Amazônia Oriental) Serviço Florestal Brasileiro Museu Universitário Universidade Federal do Acre Universidade Federal Rural de Pernambuco PUCPR - Pontifícia Universidade Católica do Paraná Museu Paraense Emilio Goeldi Universiti Brunei Darussalam Environmental and Life Sciences Faculty of Science Universiti Brunei Darussalam Institute for Biodiversity and Environmental Research Universiti Brunei Darussalam Plant Systematic and Ecology Laboratory Department of Biology Higher Teachers’ Training College University of Yaounde I Faculty of Science Department of Botany and Plant Physiology University of Buea Faculty of Science Department of Plant Science University of Buea National Herbarium Plant Systematics and Ecology Laboratory Higher Teachers’ Training College University of Yaoundé I Department of Plant Biology Faculty of Sciences University of Yaounde 1 Bioversity International Faculty of Forestry University of Toronto Ministère des Eaux Forêts Chasse et Pêche (MEFCP) Universidad Católica de la Santísima Concepción Universidad de La Serena Research Institute of Tropical Forestry Chinese Academy of Forestry Kunming Institute of Botany Chinese Academy of Sciences Beijing Forestry University Universidad Nacional Abierta y a Distancia Red COL-TREE Corporación COL-TREE Nuevo Estándar Biotropical NEBIOT SAS Universidad del Tolima Asociación GAICA Universidad de Nariño – Red BST-Col Parques Nacionales Naturales Territorial Caribe – Red BST-Col Universidad del Atlantico – Red BST-Col Departamento de Ciencias Forestales Universidad Nacional de Colombia - Sede Medellín Socioecosistemas y Clima Sostenible Fundacion con Vida Parques Nacionales Naturales de Colombia – Red BST-Col Instituto de Investigación de Recursos Biológicos Alexander von Humboldt – Red BST-Col UNAL Instituto de Investigación Recursos Biologicos Alexander von Humboldt – Red BST-Col Fundación Jardín Botánico de Medellín Herbario “Joaquín Antonio Uribe” (JAUM) – Red BST-Col Universidad Nacional de Colombia sede Amazonia Coltree Facultad del Medio Ambiente y Recursos Naturales Universidad Distrital Francisco José de Caldas – Red BST-Col Universidad de Tolima Fundación Orinoquia Biodiversa – Red BST-Col Departamento de Biología Facultad de Ciencias Naturales Universidad Icesi – Red BST-Col Instituto de Ciencias Naturales Universidad Nacional de Colombia Universidad de los Llanos Servicios Ecoysistemicos y Cambio Climatico (SECC) Fundación Con Vida & Corporación COL-TREE Universidad del Rosario Fundacion Ecosistemas Secos de Colombia – Red BST-Col Universidad de los Andes - ANDES herbarium Institute of Botany Czech Academy of Sciences Palacky University Czech University of Life Sciences Mendel University World Wide Fund for Nature Wildlife Conservation Society-DR Congo Lukuru Wildlife Research Foundation Université de Kisangani Faculté des Sciences Laboratoire d'écologie et aménagement forestier Université de Kisangani Université de Kisangani Faculté des Sciences Agronomiques République Démocratique du Congo Ministère de l'Environnement et Développement Durable Aarhus University University of Copenhagen Escuela Politécnica Nacional del Ecuador Herbario Alfredo Paredes (QAP) Universidad Central del Ecuador Universidad Técnica Particular de Loja Grupo de Investigación en Biodiversidad Medio Ambiente y Salud-BIOMAS Universidad de las Américas, Campus Queri Keller Science Action Center The Field Museum, 1400 South Lake Shore Dr. Universidad Estatal Amazónica Facultad de Ingeniería Ambiental Universidad Tecnica del Norte Herbario Nacional del Ecuador Grupo de Ecosistemas Tropicales y Cambio Global Universidad Regional Amazónica ikiam Colegio de Ciencias Biológicas y Ambientales COCIBA & Extensión Galápagos Universidad San Francisco de Quito-USFQ Herbario de Botánica Económica del Ecuador QUSF Universidad San Francisco de Quito USFQ Galapagos Science Center USFQ UNC Chapel Hill University of North Carolina-UNC Chapel Hill University of Florida FindingSpecies Mekelle University Environment Climate Change and Coffee Forest Forum (ECCCFF) University of Turku Centre de coopération International en Recherche Agronomique pour le Développement (CIRAD) CNRS ONF INRAE Centre National de la Recherche Scientifique AMAP Univ Montpellier IRD CNRS CIRAD INRA Forêts et Sociétés (F&S) Centre de coopération International en Recherche Agronomique pour le Développement (CIRAD) Departement Hommes Natures Societes Museum national d'histoire naturelle INRA Cirad UMR Ecologie des Forêts de Guyane (AgroparisTech CNRS INRAE Université des Antilles Université de la Guyane) Ministry of Forests Seas Environment and Climate Rougier-Gabon Agence Nationale des Parcs Nationaux Gabon Commission of Central African Forests (COMIFAC) Agence Nationale des Parcs Nationaux Ministère des Forêts des Eaux de la Mer de l'Environnement Chargé du Plan Climat des Objectifs de Développement Durable et du Plan d'Affectation des Terres Institut de Recherche en Ecologie Tropicale (CENAREST) Gabon/Agence Nationale des Parcs Nationaux Georg-August-University Göttingen University of Freiburg Institute of Botany University of Hohenheim Max Planck Institute for Chemistry Forestry Research Institute of Ghana (FORIG) Mensuration Unit Forestry Commission of Ghana Center for International Forestry Research Iwokrama International Centre for Rainforest Conservation and Development Guyana Forestry Commission Utrecht University Centre for Sustainable Technologies Indian Institute of Science Centre for International Forestry Research (CIFOR) Herbarium Borgoriense Indonesian Institute of Sciences (LIPI) Indonesian Institute of Science Forest Research and Development Agency (FORDA) Balitek-KSDA Samboja University of Florence and MUSE - Museo delle Scienze Cirad Hokkaido University Graduate School of Agriculture Kyoto University Forestry Development Authority of the Government of Liberia (FDA) University of Liberia Sungai Wain Protection Forest South East Asia Rainforest Research Partnership Danum Valley Field Centre Malaysian Palm Oil Board Sabah Forestry Department Forest Research Centre Universiti Malaysia Sabah Sabah Forestry Department Sarawak Forestry Corporation Eduardo Mondlane University Herbarium UNAN-Leon Universidad Nacional Autónoma de Nicaragua University of Abeokuta Natural History Museum of Norway University of Oslo Norwegian University of Life Sciences Universidad Nacional de la Amazonía Peruana (UNAP) Universidad Nacional de Jaén Jardin Botanico de Missouri Andes to Amazon Biodiversity Program Universidad Nacional de San Agustín de Arequipa Facultad de Ciencias Biológicas Universidad Nacional de la Amazonía Peruana Kené - Instituto de Estudios Forestales y Ambientales Instituto de Investigaciones de la Amazonia Peruana (IIAP) Universidad Nacional Jorge Basadre de Grohmann (UNJBG) Universidad Nacional de San Antonio Abad del Cusco Centro de Conservación Investigación y Manejo CIMA Pontificia Universidad Católica del Perú Asociacion Bosques Perú Université Officielle de Bukavu Université Marien N'Gouabi Wildlife Conservation Society Ecole Nationale Supérieure d'Agronomie et de Foresterie Université Marien Ngouabi Univeriste Marien Ngouabi The Gola Rainforest National Park Department of Geography National University of Singapore Departamento de Biología y Geología Física y Química inorgánica Universidad Rey Juan Carlos Real Jardín Botánico – CSIC Departamento de Biología Área de Botánica Universidad Autónoma de Madrid Museo Nacional de Ciencias Naturales (MNCN-CSIC) Centre for Agricultural Research in Suriname (CELOS) Stockholm Environment Institute Department of Plant Ecology and Evolution Uppsala University Southern Swedish Forest Research Centre InfoFlora Conservatoire et Jardin Botanique Geneve National Chung Hsing University Sokoine University of Agriculture Naturalis Biodiversity Center Wageningen University Forest Ecology and Forest Management Group Tropenbos International Institute for Biodiversity and Ecosystem Dynamics University of Amsterdam Bureau Waardenburg BV Van Hall Larenstein University of Applied Sciences Van der Hout Forestry Consulting Utrecht University, Domplein 29 Wageningen University Plant Ecology and Nature Conservation Group Data for Sustainability Department of Zoology Entomology & Fisheries Sciences Makerere University The Institute of Tropical Forest Conservation (ITFC) Mbarara University of Science and Technology (MUST) George Washington University Makerere University Department of Forestry Biodiversity and Tourism Makerere University University of Stirling University of Kent School of Geography University of Leeds UK Centre of Ecology & Hydrology Lancaster University University of Oxford The Landscapes and Livelihoods Group (TLLG) Overseas Development Institute Manchester Metropolitan University University of Aberdeen University of Exeter School of GeoSciences University of Edinburgh University of Cambridge Department of Environment and Geography University of York Department of Geography University College London Imperial College School of Geography Earth & Environmental Sciences Birmingham Institute of Forest Research University of Birmingham University of Plymouth Geography College of Life and Environmental Sciences University of Exeter Lancaster Environment Centre Lancaster University University of Edinburgh School of Biology University of Leeds Royal Botanic Garden Edinburgh CENAREST & ANPN & Stirling University University of Bristol School of Biological Sciences Department of Plant Sciences University of Cambridge Living with Lake Centre Laurentian University Royal Botanic Gardens Kew The Royal Society for the Protection of Birds centre for Conservation Science Environmental Change Institute School of Geography and the Environment University of Oxford UK Centre for Ecology & Hydrology School of Geography and the Environment University of Oxford The Royal Botanic Gardens Department of Geography and Environmental Science University of Dundee School of Biological Sciences University of Southampton University of East Anglia Stirling University School of Earth and Environment University of Leeds Department of Plant & Soil Science School of Biological Sciences University of Aberdeen, Cruickshank Building Institute for Transport Studies University of Leeds UK Research & Innovation University of Nottingham University of Bangor Center for Tropical Research Institute of the Environment and Sustainability University of California Center for Tropical Conservation Nicholas School of the Environment Duke University Ecology and Evolutionary Biology University of Michigan Saint Louis Zoo Department of Organismic and Evolutionary Biology Harvard University Center for Global Discovery and Conservation Science Arizona State University Wildlife Conservation Society – Programme Congo Woods Hole Research Center The University of Michigan Herbarium Nicholas School of the Environment National Park Service University of California ForestGEO Smithsonian Tropical Research Institute University of Texas at Austin Smithsonian Institute Washington University in Saint Louis Center for Conservation and Sustainable Development at the Missouri Botanical Garden Smithsonian Tropical Research Institute Smithsonian Institution Forest Global Earth Observatory (ForestGEO) Forest Global Earth Observatory (ForestGEO) Smithsonian Tropical Research Institute George Mason University Missouri Botanical Garden Broward County Parks and Recreation Nova Southeastern University Science and Education The Field Museum Department of Biology Boston University Wake Forest University Department of Geographical Sciences University of Maryland San Diego Zoo Institute for Conservation Research Biology Department Washington State University Yale School of Forestry & Environmental Studies Columbia University Department of Environmental Science Policy and Management University of California Berkeley School of Earth Sciences and Environmental Sustainability Northern Arizona University Department of Geography and the Environment University of Texas at Austin UNELLEZ-Guanare Programa de Ciencias del Agro y el Mar Herbario Universitario (PORT) Ci Progress GreenLife Universidad Nacional Experimental de Guayana Instituto Venezolano de Investigaciones Científicas (IVIC) Universidad de los Andes Viet Nature Conservation Centre CIRAD School of Life Sciences University of Lincoln UNESP - São Paulo State University Instituto de Biociências Universidade Estadual Paulista Gordon and Betty Moore Foundation: 1656 FAPESP: 2012/51509-8 FAPESP: 2012/51872-5 Fundação de Amparo à Pesquisa do Estado de Goiás: 2017/10267000329 European Research Council: 291585 Gordon and Betty Moore Foundation: 5349 European Research Council: 758873 Belgian Federal Science Policy Office: BR/132/A1/AFRIFORD Belgian Federal Science Policy Office: BR/143/A3/HERBAXYLAREDD Vlaamse Interuniversitaire Raad: CD2018TEA459A103 CNPq: CNPq/PPBio/457602/2012-0 National Science Foundation: DEB 1754647 Natural Environment Research Council: E/M0022021/1 Royal Society: ICA/R1/180100 Natural Environment Research Council: NE/D005590/1 European Research Council: NE/F005806/1 Natural Environment Research Council: NE/F005806/1 FAPESP: NE/K016431/1 Natural Environment Research Council: NE/N004655/1 FAPESP: NE/N012542/1 Royal Society: NE/P008755/1 FAPESP: NE/S011811/1 National Geographic Society: NE/T01279X/1 CNPq: PELD/441244/2016-5 Belgian Federal Science Policy Office: SD/AR/01A/COBIMFO more...

Small unmanned aerial systems (UASs) present many potential solutions and enhancements to industry today but equally pose a significant security challenge. We only need to look at the levels of disruption caused by UASs at airports in recent years. The accuracy of UAS detection and classification systems based on radio frequency (RF) signals can be hindered by other interfering signals present in the same frequency band, such as Bluetooth and Wi-Fi devices. In this paper, we evaluate the effect of real-world interference from Bluetooth and Wi-Fi signals concurrently on convolutional neural network (CNN) feature extraction and machine learning classification of UASs. We assess multiple UASs that operate using different transmission systems: Wi-Fi, Lightbridge 2.0, OcuSync 1.0, OcuSync 2.0 and the recently released OcuSync 3.0. We consider 7 popular UASs, evaluating 2 class UAS detection, 8 class UAS type classification and 21 class UAS flight mode classification. Our results show that the process of CNN feature extraction using transfer learning and machine learning classification is fairly robust in the presence of real-world interference. We also show that UASs that are operating using the same transmission system can be distinguished. In the presence of interference from both Bluetooth and Wi-Fi signals, our results show 100% accuracy for UAV detection (2 classes), 98.1% (+/−0.4%) for UAV type classification (8 classes) and 95.4% (+/−0.3%) for UAV flight mode classification (21 classes). more...

PURPOSE To demonstrate the feasibility of mapping cerebral perfusion metrics with BOLD MRI during modulation of pulmonary venous oxygen saturation. METHODS A gas blender with a sequential gas delivery breathing circuit was used to implement rapid isocapnic changes in the partial pressure of oxygen of the arterial blood. Partial pressure of oxygen was initially lowered to a baseline of 40 mmHg. It was then rapidly raised to 95 mmHg for 20 s before rapidly returning to baseline. The induced cerebral changes in deoxyhemoglobin concentration were tracked over time using BOLD MRI in 6 healthy subjects and 1 patient with cerebral steno-occlusive disease. BOLD signal change, contrast-to-noise ratio, and time delay metrics were calculated. Perfusion metrics such as mean transit time, relative cerebral blood volume, and relative cerebral blood flow were calculated using a parametrized method with a mono-exponential residue function. An arterial input function from within the middle cerebral artery was used to scale relative cerebral blood volume and calculate absolute cerebral blood volume and cerebral blood flow. RESULTS In normal subjects, average gray and white matter were: BOLD change = 6.3 ± 1.2% and 2.5 ± 0.6%, contrast-to-noise ratio = 4.3 ± 1.3 and 2.6 ± 0.7, time delay = 2.3 ± 0.6 s and 3.6 ± 0.7 s, mean transit time = 3.9 ± 0.6 s and 5.5 ± 0.6 s, relative cerebral blood volume = 3.7 ± 0.9 and 1.6 ± 0.4, relative cerebral blood flow = 70.1 ± 8.3 and 20.6 ± 4.0, cerebral blood flow volume = 4.1 ± 0.9 mL/100 g and 1.8 ± 0.5 mL/100 g, and cerebral blood flow = 97.2 ± 18.7 mL/100 g/min and 28.7 ± 5.9 mL/100 g/min. CONCLUSION This study demonstrates that induced abrupt changes in deoxyhemoglobin can function as a noninvasive vascular contrast agent that may be used for cerebral perfusion imaging. more...

Unmanned Aerial Vehicle (UAV) detection and classification methods include the use of audio, video, thermal, RADAR and radio frequency (RF) signals. RF signals have the ability to detect UAVs at longer ranges but interference from other signals in the same frequency band such as Bluetooth and Wi-Fi at 2.4GHz is a known limitation. The experiments in this paper evaluate the effect of real world Bluetooth and Wi-Fi signal interference on UAV detection and classification, using transfer learning via Convolutional Neural Network (CNN) feature extraction and machine learning classifiers Logistic Regression (LR) and k Nearest Neighbour (kNN). 2 class UAV detection, 4 class UAV type and 10 class flight mode classification are evaluated with graphical representation from the time and frequency domain. Flight modes evaluated included mode 1 - switched on and connected to the controller, mode 2 - hovering and mode 3 - flying. Results show that Bluetooth signals are more likely to interfere with detection and classification accuracy than Wi-Fi signals but that accuracy can be maintained at over 96% by using frequency domain features with LR as the classifier. Time domain features were shown to be less robust than frequency domain features when interefence signals were introduced. In the presence of Bluetooth or Wi-Fi signals, 2 class UAV detection produced 100% accuracy, 4 class UAV type classification produced 99.9% (+/- 0.1%) and 10 class UAV flight mode classification produced 96.4% (+/- 0.5%) accuracy. Overall we have shown frequency domain features extracted from a CNN to be more robust than time domain features in the presence of interference and that high accuracy can be maintained using LR as a classifier with CNN derived features. more...

RF connectivity is pervasive in many systems to- day and can underpin fundamental services. Intentional Global Navigation Satellite System (GNSS) jamming activities are increasing across the globe, causing significant threats to real life applications from power distribution to finance and even 5G performance. The first step towards its mitigation is the detection and classification of the signal. Classification could inform an attribution picture. For example, connecting a perpetrator through the jamming signal type from a device found in their possession. This paper introduces a novel approach which utilises transfer learning from the imagery domain and considers the jamming signal power spectral density (PSD), spectrogram, raw constellation, and histogram signal representations as images. Collecting datasets large enough to train a neural network from scratch is a common problem. The use of Transfer Learning overcomes this issue. Transfer learning is applied through feature extraction using a Convolutional Neural Network (CNN) VGG16 pretrained on the ImageNet dataset. Various Machine Learning classifiers are evaluated including Support Vector Machine (SVM), Logistic Regression (LR), and Random Forest (RF). To date, prior research in this field has concentrated on spectrogram representation but our evidence shows that the novel concatenation of signal representations (PSD, spectrogram, raw constellation and histogram) is more effective, allowing the CNN to benefit from the strengths of each individual representation. The image concatenation dataset produced 98% (+/- 0.5%) classification accuracy with LR and SVM models and 96.3% (+/- 0.6%) with RF. The results, validated through 10-fold cross validation, showed that transfer learning using CNN VGG16 in conjunction with ML models LR, SVM, and RF and the concatenation of signal representations, produces high accuracy for the classification of GNSS jamming signals and outperforms previous work in the field. more...

Previous research indicates that patient self-measured blood pressure (SMBP) is a cost-effective strategy for improving hypertension (HTN) diagnosis and control. However, it is unknown which specific uses of SMBP produce the most value. Our goal is to estimate, from an insurance perspective, the return-on-investment (ROI) and net present value associated with coverage of SMBP devices when used (a) only to diagnose HTN, (b) only to select and titrate medication, (c) only to monitor HTN treatment, or (d) as a bundle with all three uses combined. We employed national sample of claims data, Framingham risk predictions, and published sensitivity-specificity values of SMBP and clinic blood-pressure measurement to extend a previously-developed local decision-analytic simulation model. We then used the extended model to determine which uses of SMBP produce the most economic value when scaled to the U.S. adult population. We found that coverage of SMBP devices yielded positive ROIs for insurers in the short-run and at lifetime horizon when the three uses of SMBP were considered together. When each use was evaluated separately, positive returns were seen when SMBP was used for diagnosis or for medication selection and titration. However, returns were negative when SMBP was used exclusively to monitor HTN treatment. When scaled to the U.S. population, adoption of SMBP would prevent nearly 16.5 million false positive HTN diagnoses, thereby improving quality of care while saving insurance plans $254 per member. A strong economic case exists for insurers to cover the cost of SMBP devices, but it matters how devices are used. more...

Purpose: To evaluate six cerebral arterial segmentation algorithms in a set of patients with a wide range of hemodynamic characteristics to determine real-world performance. Approach: Time-of-flight magnetic resonance angiograms were acquired from 33 subjects: normal controls ([Formula: see text]), sickle cell disease ([Formula: see text]), and non-sickle anemia ([Formula: see text]) using a 3 Tesla Philips Achieva scanner. Six segmentation algorithms were tested: (1) Otsu’s method, (2) K-means, (3) region growing, (4) active contours, (5) minimum cost path, and (6) U-net machine learning. Segmentation algorithms were tested with two region-selection methods: global, which selects the entire volume; and local, which iteratively tracks the arteries. Five slices were manually segmented from each patient by two readers. Agreement between manual and automatic segmentation was measured using Matthew’s correlation coefficient (MCC). Results: Median algorithm segmentation times ranged from 0.1 to 172.9 s for a single angiogram versus 10 h for manual segmentation. Algorithms had inferior performance to inter-observer vessel-based ([Formula: see text] , [Formula: see text]) and voxel-based ([Formula: see text] , [Formula: see text]) measurements. There were significant differences between algorithms ([Formula: see text]) and between patients ([Formula: see text]). Post-hoc analyses indicated (1) local minimum cost path performed best with vessel-based ([Formula: see text] , [Formula: see text]) and voxel-based ([Formula: see text] , [Formula: see text]) analyses; and (2) higher vessel-based performance in non-sickle anemia ([Formula: see text]) and lower voxel-based performance in sickle cell ([Formula: see text]) compared with normal controls. All reported MCCs are medians. Conclusions: The best-performing algorithm (local minimum cost path, voxel-based) had 9.59% worse performance than inter-observer agreement but was 3 orders of magnitude faster. Automatic segmentation was non-inferior in patients with sickle cell disease and superior in non-sickle anemia. more...

In patients with sickle cell disease (SCD), cerebral blood flow (CBF) is elevated to counteract anemia and maintain oxygen supply to the brain. This may exhaust the vasodilating capacity of the vessels, possibly increasing the risk of silent cerebral infarctions (SCI). To further investigate cerebrovascular hemodynamics in SCD patients, we assessed CBF, arterial transit time (ATT), cerebrovascular reactivity of CBF and ATT (CVRCBF and CVRATT) and oxygen delivery in patients with different forms of SCD and matched healthy controls. We analyzed data of 52 patients with severe SCD (HbSS and HbSβ0-thal), 20 patients with mild SCD (HbSC and HbSβ+-thal) and 10 healthy matched controls (HbAA and HbAS). Time-encoded arterial spin labeling (ASL) scans were performed before and after a vasodilatory challenge using acetazolamide (ACZ). To identify predictors of CBF and ATT after vasodilation, regression analyses were performed. Oxygen delivery was calculated and associated with hemoglobin and fetal hemoglobin (HbF) levels. At baseline, severe SCD patients showed significantly higher CBF and lower ATT compared to both the mild SCD patients and healthy controls. As CBFpostACZ was linearly related to CBFpreACZ, CVRCBF decreased with disease severity. CVRATT was also significantly affected in severe SCD patients compared to mild SCD patients and healthy controls. Considering all groups, women showed higher CBFpostACZ than men (p < 0.01) independent of baseline CBF. Subsequently, post ACZ oxygen delivery was also higher in women (p < 0.05). Baseline, but not post ACZ, GM oxygen delivery increased with HbF levels. Our data showed that baseline CBF and ATT and CVRCBF and CVRATT are most affected in severe SCD patients and to a lesser extent in patients with milder forms of SCD compared to healthy controls. Cerebrovascular vasoreactivity was mainly determined by baseline CBF, sex and HbF levels. The higher vascular reactivity observed in women could be related to their lower SCI prevalence, which remains an area of future work. Beneficial effects of HbF on oxygen delivery reflect changes in oxygen dissociation affinity from hemoglobin and were limited to baseline conditions suggesting that high HbF levels do not protect the brain upon a hemodynamic challenge, despite its positive effect on hemolysis. more...

The story of purinergic neurotransmission and regulation is intimately linked to studies of the somatosensory system. Burnstock's contributions to the discovery of ATP as a primary afferent neurotransmitter, as well as a signal of peripheral tissue damage that depolarised sensory neurons initiated a new period of pain research. The neuro-immune interactions that occur after tissue damage and are important for pain have now also been found to involve purinergic signalling, and adenosine has been demonstrated to have significant analgesic effects. In the pain field as in so many other areas of neuroscience and physiology, Burnstock's contributions have been critical to the expansion of our knowledge about the significance of purines. His mechanistic insights have profound significance for understanding the pain system and further underscore his stature as a pioneer and force for progress in biomedicine. more...

Fibromuscular dysplasia (FMD) is predominantly diagnosed in women and is a congenital malformation damaging the arterial cell walls of numerous arteries, most prominently impacting the renal arteries. Although previously believed to be a disease of young women, older patients have been shown to make up a large percentage of this patient population as well. FMD is underdiagnosed, and the misdiagnosis of this disease has life-threatening consequences. Here, we present the case of a 24-year-old woman with hypertension who did not receive adequate workup until her symptoms were unrelenting. Her hypertension was presumed to be a result of her generalised anxiety disorder. However, once she began to experience vision changes and significant headaches, further workup ensued. This case exemplifies the importance of performing a thorough evaluation of all patients that present with hypertension of unknown origin, especially young women. To decrease the risk of permanent consequences such as strokes, renal failure and even death, the correct diagnosis of FMD is vital. more...

Background and Aims: Despite known Indigenous health and socioeconomic disadvantage in countries with a Very High Human Development Index, data on the incidence of stroke in these populations are sparse. With oversight from an Indigenous Advisory Board, we will undertake a systematic review of the incidence of stroke in Indigenous populations of developed countries or regions, with comparisons between Indigenous and non-Indigenous populations of the same region, though not between different Indigenous populations.Methods: Using PubMed, OVID-EMBASE, and Global Health databases, we will examine population-based incidence studies of stroke in Indigenous adult populations of developed countries published 1990-current, without language restriction. Non-peer-reviewed sources, studies including Results: Primary outcomes include crude, age-specific and/or age-standardized incidence of stroke. Secondary outcomes include overall stroke rates, incidence rate ratio and case-fatality. Results will be synthesized in figures and tables, describing data sources, populations, methodology, and findings. Within-population meta-analysis will be performed if, and where, methodologically sound and comparable studies allow this.Conclusion: We will undertake the first systematic review assessing disparities in stroke incidence in Indigenous populations of developed countries. Data outputs will be disseminated to relevant Indigenous stakeholders to inform public health and policy research. more...

Magnetic resonance imaging (MRI) images acquired as multislice two-dimensional (2D) images present challenges when reformatted in orthogonal planes due to sparser sampling in the through-plane direction. Restoring the “missing” through-plane slices, or regions of an MRI image damaged by acquisition artifacts can be modeled as an image imputation task. In this work, we consider the damaged image data or missing through-plane slices as image masks and proposed an edge-guided generative adversarial network to restore brain MRI images. Inspired by the procedure of image inpainting, our proposed method decouples image repair into two stages: edge connection and contrast completion, both of which used general adversarial networks (GAN). We trained and tested on a dataset from the Human Connectome Project to test the application of our method for thick slice imputation, while we tested the artifact correction on clinical data and simulated datasets. Our Edge-Guided GAN had superior PSNR, SSIM, conspicuity and signal texture compared to traditional imputation tools, the Context Encoder and the Densely Connected Super Resolution Network with GAN (DCSRN-GAN). The proposed network may improve utilization of clinical 2D scans for 3D atlas generation and big-data comparative studies of brain morphometry. more...

PURPOSE: Cerebral T(2) oximetry is a non-invasive imaging method to measure blood T(2) and cerebral venous oxygenation. Measured T(2) values are converted to oximetry estimates using carefully validated and potentially disease-specific calibrations. In sickle cell disease, red blood cells have abnormal cell shape and membrane properties that alter T(2) oximetry calibration relationships in clinically meaningful ways. Previous in vitro works by two independent groups established potentially competing calibration models. METHODS: This study analyzed pooled datasets from these two studies to establish a unified and more robust sickle-specific calibration to serve as a reference standard in the field. RESULTS: Even though the combined calibration did not demonstrate statistical superiority compared to previous models, the calibration was unbiased compared to blood-gas co-oximetry and yielded limits of agreement of (−10.1%, 11.6%) in non-transfused subjects with sickle cell disease. In transfused patients, this study proposed a simple correction method based on individual hemoglobin S percentage that demonstrated reduced bias in saturation measurement compared to previous uncorrected sickle calibrations. CONCLUSION: The combined calibration is based on a larger range of hematocrit, providing greater confidence in the hematocrit-dependent model parameters, and yielded unbiased estimates to blood-gas co-oximetry measurements from both sites. Additionally, this work also demonstrated the need to correct for transfusion in T(2) oximetry measurements for hyper-transfused sickle cell disease patients and proposes a correction method based on patient-specific hemoglobin S concentration. more...

ObjectivesAnticipation and prompt relief of symptoms among patients with a life-limiting illness is a core element of palliative care. Indigenous Australians commonly encounter cultural barriers in healthcare that may impair outcomes. The Palliative Care Outcomes Collaboration collects patient care data for the purposes of continuous quality improvement and benchmarking, with each recorded care episode divided into phases that reflect a patient’s condition. We aimed to investigate differences between Indigenous and non-Indigenous patients in the occurrence and duration of ‘unstable’ phases (which indicate unanticipated deterioration in a patient’s condition or circumstances), and determine attainment of the relevant benchmark (resolution of unstable phases in ≤3 days in 90% of cases) for both groups.DesignCohort study.SettingAustralia-wide hospital-based and community-based specialist palliative care (1 January 2010 to 30 June 2015).Participants139 556 (1502 Indigenous and 138 054 non-Indigenous) adult patients.Outcome measuresIndigenous and non-Indigenous patients were compared on (1) the risk of a phase being categorised as unstable, (2) the duration of unstable phases, and (3) the risk of unstable phases being prolonged (>3 days). Crude and adjusted estimates were produced from three-level robust Poisson regression and complementary log-log discrete time survival models.ResultsUnstable phases occurred with similar frequency overall among Indigenous and non-Indigenous patients (adjusted relative risks 1.06; 95% CI 1.00 to 1.11; not significant after correction for multiple comparisons). The duration and risk of prolongation of unstable phases were similar in both patient groups, with no significant differences evident among subgroups. The benchmark was not met for either Indigenous or non-Indigenous patients (unstable phase duration >3 days in 24.3% vs 25.5%; p=0.398).ConclusionsDespite well-documented shortcomings of healthcare for Indigenous Australians, there is no clear evidence of greater occurrence or prolongation of unanticipated problems among Indigenous patients accessing specialist palliative care services in hospital or the community. more...

Background An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support. Objectives Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted. Design A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect. Setting Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7). Participants We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting. Intervention This ran from February to July 2018. Data sources Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed. Results The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, background, assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was Limitations The study homes may already have had effective approaches to early detection, assessment and treatment for acute health changes; consistent with government policy emphasising the need for enhanced health care in homes. Alternatively, the implementation support may not have been sufficiently potent. Conclusion A definitive trial is feasible, but the intervention is unlikely to be effective. Participant recruitment, retention, data collection and engagement with family carers can guide subsequent studies, including service evaluation and quality improvement methodologies. Future work Intervention research should be conducted in homes which need to enhance early detection, assessment and treatment. Interventions to reduce avoidable hospital admissions may be beneficial in residential care homes, as they are not required to employ nurses. Trial registration Current Controlled Trials ISRCTN74109734 and ISRCTN86811077. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information. more...

Introduction Sickle cell disease (SCD) is a hereditary blood disorder in which the oxygen‐carrying hemoglobin molecule in red blood cells is abnormal. SCD patients are at increased risks for strokes and neurocognitive deficit, even though neurovascular screening and treatments have lowered the rate of overt strokes. Tract‐specific analysis (TSA) is a statistical method to evaluate microstructural WM damage in neurodegenerative disorders, using diffusion tensor imaging (DTI). Methods We utilized TSA and compared 11 major brain WM tracts between SCD patients with no history of overt stroke, anemic controls, and healthy controls. We additionally examined the relationship between the most commonly used DTI metric of WM tracts and neurocognitive performance in the SCD patients and healthy controls. Results Disruption of WM microstructure orientation‐dependent metrics for the SCD patients was found in the genu of the corpus callosum (CC), cortico‐spinal tract, inferior fronto‐occipital fasciculus, right inferior longitudinal fasciculus, superior longitudinal fasciculus, and left uncinate fasciculus. Neurocognitive performance indicated slower processing speed and lower response inhibition skills in SCD patients compared to controls. TSA abnormalities in the CC were significantly associated with measures of processing speed, working memory, and executive functions. Conclusion Decreased DTI‐derived metrics were observed on six tracts in chronically anemic patients, regardless of anemia subtype, while two tracks with decreased measures were unique to SCD patients. Patients with WMHs had more significant FA abnormalities. Decreased FA values in the CC significantly correlated with all nine neurocognitive tests, suggesting a critical importance for CC in core neurocognitive processes., Sickle cell disease (SCD) is a genetic blood disorder with high prevalence of silent stroke and white matter damage. We utilized tract‐specific analysis and compared 11 major brain WM tracts between SCD patients and healthy controls, in correlation processing speed and response inhibition. Our results implicate a relationship between microscopic damage to WM structural damage and neurocognitive function in SCD patients. more...

International audience; Purpose: Gadolinium-based dynamic susceptibility contrast (DSC) is commonly used to characterize blood flow in patients with stroke and brain tumors. Unfortunately, gadolinium contrast administration has been associated with adverse reactions and long-term accumulation in tissues. In this work, we propose an alternative deoxygenation-based DSC (dDSC) method that uses a transient hypoxia gas paradigm to deliver a bolus of paramagnetic deoxygenated hemoglobin to the cerebral vasculature for perfusion imaging.Methods: Through traditional DSC tracer kinetic modeling, the MR signal change induced by this hypoxic bolus can be used to generate regional perfusion maps of cerebral blood flow, cerebral blood volume, and mean transit time. This gas paradigm and blood-oxygen-level-dependent (BOLD)-MRI were performed concurrently on a cohort of 66 healthy and chronically anemic subjects (age 23.5 ± 9.7, female 64%).Results: Our results showed reasonable global and regional agreement between dDSC and other flow techniques, such as phase contrast and arterial spin labeling.Conclusion: In this proof-of-concept study, we demonstrated the feasibility of using transient hypoxia to generate a contrast bolus that mimics the effect of gadolinium and yields reasonable perfusion estimates. Looking forward, optimization of the hypoxia boluses and measurement of the arterial-input function is necessary to improve the accuracy of dDSC. Additionally, a cross-validation study of dDSC and DSC in brain tumor and ischemic stroke subjects is warranted to evaluate the clinical diagnostic utility of this approach. more...

Objective Infants with Congenital Heart Disease (CHD) are at risk for developmental delays, though the mechanisms of brain injury that impair development are unknown. Potential causes could include cerebral hypoxia and cerebrovascular instability. We hypothesized that we would detect significantly reduced cerebral oxygen saturation and greater cerebrovascular instability in CHD infants compared to the healthy controls. Methods We performed a secondary analysis on a sample of 43 term infants (28 CHD, 15 healthy controls) that assessed prospectively in temporal cross-section before or at 12 days of age. CHD infants were assessed prior to open-heart surgery. Cerebral oxygen saturation levels were estimated using Near-Infrared Spectroscopy, and cerebrovascular stability was assessed with the response of cerebral oxygen saturation after a postural change (supine to sitting). Results Cerebral oxygen saturation was 9 points lower in CHD than control infants in both postures (β = -9.3; 95%CI = -17.68, -1.00; p = 0.028), even after controlling for differences in peripheral oxygen saturation. Cerebrovascular stability was significantly impaired in CHD compared to healthy infants (β = -2.4; 95%CI = -4.12, -.61; p = 0.008), and in CHD infants with single ventricle compared with biventricular defects (β = -1.5; 95%CI = -2.95, -0.05; p = 0.04). Conclusion CHD infants had cerebral hypoxia and decreased cerebral oxygen saturation values following a postural change, suggesting cerebrovascular instability. Future longitudinal studies should assess the associations of cerebral hypoxia and cerebrovascular instability with long-term neurodevelopmental outcomes in CHD infants. more...