Abstract
Difficulties with tracheal intubation commonly arise and impact patient safety. This systematic review evaluates whether videolaryngoscopes reduce intubation failure and complications ...compared with direct laryngoscopy in adults. We searched CENTRAL, MEDLINE, Embase and clinicaltrials.gov up to February 2015, and conducted forward and backward citation tracking. We included randomized controlled trials that compared adult patients undergoing laryngoscopy with videolaryngoscopy or Macintosh laryngoscopy. We did not primarily intend to compare individual videolaryngoscopes. Sixty-four studies (7044 participants) were included. Moderate quality evidence showed that videolaryngoscopy reduced failed intubations (Odds Ratio (OR) 0.35, 95% Confidence Interval (CI) 0.19-0.65) including in participants with anticipated difficult airways (OR 0.28, 95% CI 0.15-0.55). There was no evidence of reduction in hypoxia or mortality, but few studies reported these outcomes. Videolaryngoscopes reduced laryngeal/airway trauma (OR 0.68, 95% CI 0.48-0.96) and hoarseness (OR 0.57, 95% CI 0.36-0.88). Videolaryngoscopy increased easy laryngeal views (OR 6.77, 95% CI 4.17-10.98) and reduced difficult views (OR 0.18, 95% CI 0.13-0.27) and intubation difficulty, typically using an 'intubation difficulty score' (OR 7.13, 95% CI 3.12-16.31). Failed intubations were reduced with experienced operators (OR 0.32, 95% CI 0.13-0.75) but not with inexperienced users. We identified no difference in number of first attempts and incidence of sore throat. Heterogeneity around time for intubation data prevented meta-analysis. We found evidence of differential performance between different videolaryngoscope designs. Lack of data prevented analysis of impact of obesity or clinical location on failed intubation rates. Videolaryngoscopes may reduce the number of failed intubations, particularly among patients presenting with a difficult airway. They improve the glottic view and may reduce laryngeal/airway trauma. Currently, no evidence indicates that use of a videolaryngoscope reduces the number of intubation attempts or the incidence of hypoxia or respiratory complications, and no evidence indicates that use of a videolaryngoscope affects time required for intubation.
To estimate the daily dietary energy intake for me to maintain a constant body weight. How hard can it be?
Very introspective study.
At home. In lockdown. (Except every Tuesday afternoon and Saturday ...morning, when I went for a run.) PARTICIPANTS: Me. n=1.
My weight, measured each day.
Sleeping, I shed about a kilogram each night (1.07 (SD 0.25) kg). Running 5 km, I shed about half a kilogram (0.57 (SD 0.15) kg). My daily equilibrium energy intake is about 10 000 kJ (10 286 (SD 201) kJ). Every kJ above (or below) 10 000 kJ adds (or subtracts) about 40 mg (35.4 (SD 3.2) mg).
Body weight data show persistent variability, even when the screws of control are tightened and tightened.
This paper presents a study comparing the wear performance of laser clad rails. A grade of martensitic stainless steel (MSS) was deposited on two substrate materials: The European standard grade rail ...steel R260, and a lower grade rail steel R200. A twin-disc method has been used to simulate the contact of wheel and rail under closely controlled conditions. Although cladding on a lesser grade of rail has an effect on the hardness and wear performance of the clad layer (due to dilution), the resulting wear performance of the clad layer assessed using this approach is still vastly improved over R260 material alone.
•A twin-disc method has been used to simulate the contact of wheel and rail under closely controlled conditions.•Twin-disc tests have been performed on both R200 and R260 rail after being laser clad with a single layer of MSS material.•MSS clad R200 is softer than MSS clad R260 and as a result has a slightly higher wear rate.•Clad R200 and R260 had wear rates 50% or less relative to the reference R260 sample without cladding.
Dementia is the leading cause of death in elderly Western populations. Preventative interventions that could delay dementia onset even modestly would provide a major public health impact. There are ...no disease-modifying treatments currently available. Lithium has been proposed as a potential treatment. We assessed the association between lithium use and the incidence of dementia and its subtypes.
We conducted a retrospective cohort study comparing patients treated between January 1, 2005 and December 31, 2019, using data from electronic clinical records of secondary care mental health (MH) services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), United Kingdom (catchment area population approximately 0.86 million). Eligible patients were those aged 50 years or over at baseline and who had at least 1 year follow-up, excluding patients with a diagnosis of mild cognitive impairment (MCI) or dementia before, or less than 1 year after, their start date. The intervention was the use of lithium. The main outcomes were dementia and its subtypes, diagnosed and classified according to the International Classification of Diseases-10th Revision (ICD-10). In this cohort, 29,618 patients (of whom 548 were exposed to lithium) were included. Their mean age was 73.9 years. A total of 40.2% were male, 33.3% were married or in a civil partnership, and 71.0% were of white ethnicity. Lithium-exposed patients were more likely to be married, cohabiting or in a civil partnership, to be a current/former smoker, to have used antipsychotics, and to have comorbid depression, mania/bipolar affective disorder (BPAD), hypertension, central vascular disease, diabetes mellitus, or hyperlipidemias. No significant difference between the 2 groups was observed for other characteristics, including age, sex, and alcohol-related disorders. In the exposed cohort, 53 (9.7%) patients were diagnosed with dementia, including 36 (6.8%) with Alzheimer disease (AD) and 13 (2.6%) with vascular dementia (VD). In the unexposed cohort, corresponding numbers were the following: dementia 3,244 (11.2%), AD 2,276 (8.1%), and VD 698 (2.6%). After controlling for sociodemographic factors, smoking status, other medications, other mental comorbidities, and physical comorbidities, lithium use was associated with a lower risk of dementia (hazard ratio HR 0.56, 95% confidence interval CI 0.40 to 0.78), including AD (HR 0.55, 95% CI 0.37 to 0.82) and VD (HR 0.36, 95% CI 0.19 to 0.69). Lithium appeared protective in short-term (≤1-year exposure) and long-term lithium users (>5-year exposure); a lack of difference for intermediate durations was likely due to lack of power, but there was some evidence for additional benefit with longer exposure durations. The main limitation was the handling of BPAD, the most common reason for lithium prescription but also a risk factor for dementia. This potential confounder would most likely cause an increase in dementia in the exposed group, whereas we found the opposite, and the sensitivity analysis confirmed the primary results. However, the specific nature of the group of patients exposed to lithium means that caution is needed in extending these findings to the general population. Another limitation is that our sample size of patients using lithium was small, reflected in the wide CIs for results relating to some durations of lithium exposure, although again sensitivity analyses remained consistent with our primary findings.
We observed an association between lithium use and a decreased risk of developing dementia. This lends further support to the idea that lithium may be a disease-modifying treatment for dementia and that this is a promising treatment to take forwards to larger randomised controlled trials (RCTs) for this indication.
Great potential exists to reverse the loss of mangrove forests worldwide through the application of basic principles of ecological restoration using ecological engineering approaches, including ...careful cost evaluations prior to design and construction. Previous documented attempts to restore mangroves, where successful, have largely concentrated on creation of plantations of mangroves consisting of just a few species, and targeted for harvesting as wood products, or temporarily used to collect eroded soil and raise intertidal areas to usable terrestrial agricultural uses. I document here the importance of assessing the existing hydrology of natural extant mangrove ecosystems, and applying this knowledge to first protect existing mangroves, and second to achieve successful and cost-effective ecological restoration, if needed. Previous research has documented the general principle that mangrove forests worldwide exist largely in a raised and sloped platform above mean sea level, and inundated at approximately 30%, or less of the time by tidal waters. More frequent flooding causes stress and death of these tree species. Prevention of such damage requires application of the same understanding of mangrove hydrology.
Background & Aims
Hepatocellular carcinoma (HCC) is the second most common cause of cancer deaths worldwide. The global HCC BRIDGE study was a multiregional, large‐scale, longitudinal cohort study ...undertaken to improve understanding of real‐life management of patients with HCC, from diagnosis to death.
Methods
Data were collected retrospectively from January 2005 to September 2012 by chart reviews of eligible patients newly diagnosed with HCC at participating institutions.
Results
Forty‐two sites in 14 countries contributed final data for 18 031 patients. Asia accounted for 67% of patients, Europe for 20% and North America for 13%. As expected, the most common risk factor was hepatitis C virus in North America, Europe and Japan, and hepatitis B virus in China, South Korea and Taiwan. The most common Barcelona Clinic Liver Cancer stage at diagnosis was C in North America, Europe, China and South Korea, and A in Taiwan and Japan. Across all stages, first HCC treatment was most frequently transarterial chemoembolization in North America, Europe, China and South Korea, percutaneous ethanol injection or radiofrequency ablation in Japan and resection in Taiwan. Survival from first HCC treatment varied significantly by region, with median overall survival not reached for Taiwan and 60, 33, 31, 24 and 23 months for Japan, North America, South Korea, Europe and China respectively (P < 0.0001).
Conclusions
Initial results from the BRIDGE study confirm previously reported regional trends in patient demographic characteristics and HCC risk factors, document the heterogeneity of treatment approaches across regions/countries and underscore the need for earlier HCC diagnosis worldwide.
We propose a new dynamical method to connect equilibrium quantum phase transitions and quantum coherence using out-of-time-order correlations (OTOCs). Adopting the iconic Lipkin-Meshkov-Glick and ...transverse-field Ising models as illustrative examples, we show that an abrupt change in coherence and entanglement of the ground state across a quantum phase transition is observable in the spectrum of multiple quantum coherence intensities, which are a special type of OTOC. We also develop a robust protocol to obtain the relevant OTOCs using quasi-adiabatic quenches through the ground state phase diagram. Our scheme allows for the detection of OTOCs without time reversal of coherent dynamics, making it applicable and important for a broad range of current experiments where time reversal cannot be achieved by inverting the sign of the underlying Hamiltonian.
Evidence suggests that living near blue spaces such as the coast, lakes and rivers may be good for health and wellbeing. Although greater levels of physical activity (PA) may be a potential ...mechanism, we know little about the types of PA that might account for this.
To explore the mediating role of: a) ‘watersports’ (e.g. sailing/canoeing); b) ‘on-land outdoor PA’ in natural/mixed settings (e.g. walking/running/cycling); and, c) ‘indoor/other PA’ (e.g. gym/squash) in the relationships between residential blue space availability and health outcomes.
Using data from the Health Survey for England (n = 21,097), we constructed a path model to explore whether weekly volumes of each PA type mediate any of the relationships between residential blue space availability (coastal proximity and presence of freshwater) and self-reported general and mental health, controlling for green space density and a range of socio-economic factors at the individual- and area-level.
Supporting predictions, living nearer the coast was associated with better self-reported general and mental health and this was partially mediated by on-land outdoor PA (primarily walking). Watersports were more common among those living within 5kms of the coast, but did not mediate associations between coastal proximity and health. Presence of freshwater in the neighbourhood was associated with better mental health, but this effect was not mediated by PA.
Although nearby blue spaces offer potentially easier access to watersports, relatively few individuals in England engage in them and thus they do not account for positive population health associations. Rather, the benefits to health from coastal living seem, at least in part, due to participation in land-based outdoor activities (especially walking). Further research is needed to explore the mechanisms behind the relationship between freshwater presence and mental health.
•Living near blue space is positively associated with health and wellbeing.•We explored the role of different types of physical activity in this association.•Path modelling was used to analyse Health Survey for England data.•Positive associations were found for both coastal proximity and inland waters.•Walking was a key mediator for coastal findings.
AIM: We developed a set of statistical models to improve spatial estimates of mangrove aboveground biomass (AGB) based on the environmental signature hypothesis (ESH). We hypothesized that higher ...tidal amplitudes, river discharge, temperature, direct rainfall and decreased potential evapotranspiration explain observed high mangrove AGB. LOCATION: Neotropics and a small portion of the Nearctic region. METHODS: A universal forest model based on site‐level forest structure statistics was validated to spatially interpolate estimates of mangrove biomass at different locations. Linear models were then used to predict mangrove AGB across the Neotropics. RESULTS: The universal forest site‐level model was effective in estimating mangrove AGB using pre‐existing mangrove forest structure inventories to validate the model. We confirmed our hypothesis that at continental scales higher tidal amplitudes contributed to high forest biomass associated with high temperature and rainfall, and low potential evapotranspiration. Our model explained 20% of the spatial variability in mangrove AGB, with values ranging from 16.6 to 627.0 t ha⁻¹ (mean, 88.7 t ha⁻¹). Our findings show that mangrove AGB has been overestimated by 25–50% in the Neotropics, underscoring a commensurate bias in current published global estimates using site‐level information. MAIN CONCLUSIONS: Our analysis show how the ESH significantly explains spatial variability in mangrove AGB at hemispheric scales. This finding is critical to improve and explain site‐level estimates of mangrove AGB that are currently used to determine the relative contribution of mangrove wetlands to global carbon budgets. Due to the lack of a conceptual framework explicitly linking environmental drivers and mangrove AGB values during model validation, previous works have significantly overestimated mangrove AGB; our novel approach improved these assessments. In addition, our framework can potentially be applied to other forest‐dominated ecosystems by allowing the retrieval of extensive databases at local levels to generate more robust statistical predictive models to estimate continental‐scale biomass values.
The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe ...relative to the infarct volume may benefit from late thrombectomy.
We enrolled patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume, with mismatch criteria defined according to age (<80 years or ≥80 years). Patients were randomly assigned to thrombectomy plus standard care (the thrombectomy group) or to standard care alone (the control group). The coprimary end points were the mean score for disability on the utility-weighted modified Rankin scale (which ranges from 0 death to 10 no symptoms or disability) and the rate of functional independence (a score of 0, 1, or 2 on the modified Rankin scale, which ranges from 0 to 6, with higher scores indicating more severe disability) at 90 days.
A total of 206 patients were enrolled; 107 were assigned to the thrombectomy group and 99 to the control group. At 31 months, enrollment in the trial was stopped because of the results of a prespecified interim analysis. The mean score on the utility-weighted modified Rankin scale at 90 days was 5.5 in the thrombectomy group as compared with 3.4 in the control group (adjusted difference Bayesian analysis, 2.0 points; 95% credible interval, 1.1 to 3.0; posterior probability of superiority, >0.999), and the rate of functional independence at 90 days was 49% in the thrombectomy group as compared with 13% in the control group (adjusted difference, 33 percentage points; 95% credible interval, 24 to 44; posterior probability of superiority, >0.999). The rate of symptomatic intracranial hemorrhage did not differ significantly between the two groups (6% in the thrombectomy group and 3% in the control group, P=0.50), nor did 90-day mortality (19% and 18%, respectively; P=1.00).
Among patients with acute stroke who had last been known to be well 6 to 24 hours earlier and who had a mismatch between clinical deficit and infarct, outcomes for disability at 90 days were better with thrombectomy plus standard care than with standard care alone. (Funded by Stryker Neurovascular; DAWN ClinicalTrials.gov number, NCT02142283 .).
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