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Oral Triiodothyronine Supplementation Decreases Low Cardiac Output Syndrome After Pediatric Cardiac Surgery
The oral triiodothyronine for infants and children undergoing cardiopulmonary bypass (OTICC) trial showed that Triiodothyronine (T3) supplementation improved hemodynamic and clinical outcome parameters. We tested the validity of low cardiac output syndrome (LCOS), derived using clinical parameters and laboratory data, by comparing the LCOS diagnosis with objective parameters commonly measured in a cardiac intensive care unit (CCU) setting. OTICC, a randomized, placebo-controlled trial included children younger than 3 years with an Aristotle score between 6 and 9. We used the existing trial data set to compare the LCOS diagnosis with echocardiographic hemodynamic parameters. Additionally, we determined if LCOS, prospectively assigned during a clinical trial, served as an early predictor of clinical outcomes. All LCOS subjects at 6 and 12 h after cross-clamp release later showed significantly lower pulse pressure, stroke volume and cardiac output, and higher systemic vascular resistance. These LCOS patients also had significantly longer time to extubation (TTE) and higher mortality rate. LCOS incidence was significantly lower in the T3 treatment group [
n
= 86 vs. 66, respectively,
p
< 0.001; OR (95% CI) 0.43 (0.36–0.52)] particularly at 6 h. Also, LCOS patients in the placebo group had significantly lower FT3 serum levels over time. These analyses confirm that early clinically defined LCOS successfully predicts cardiac dysfunction determined later by objective hemodynamic echocardiographic parameters. Furthermore, early LCOS significantly impacts TTE and mortality. Finally, the data support prior clinical trial data, showing that oral T3 supplementation decreases early LCOS in concordance with reducing TTE.
Journal Article
Developing games on the Raspberry Pi : app programming with Lua and LÖVE
\"Learn to set up a Pi-based game development environment, and then develop a game with Lua, a popular scripting language used in major game frameworks like Unreal Engine (BioShock Infinite), CryEngine (Far Cry series), Diesel (Payday: The Heist), Silent Storm Engine (Heroes of Might and Magic V) and many others. More importantly, learn how to dig deeper into programming languages to find and understand new functions, frameworks, and languages to utilize in your games. You'll start by learning your way around the Raspberry Pi. Then you'll quickly dive into learning game development with an industry-standard and scalable language. After reading this book, you'll have the ability to write your own games on a Raspberry Pi, and deliver those games to Linux, Mac, Windows, iOS, and Android. And you'll learn how to publish your games to popular marketplaces for those desktop and mobile platforms. Whether you're new to programming or whether you've already published to markets like Itch.io or Steam, this book showcases compelling reasons to use the Raspberry Pi for game development. Use Developing Games on the Raspberry Pias your guide to ensure that your game plays on computers both old and new, desktop or mobile.\"--Back cover.
Book
Prophylactic use of levosimendan in pediatric patients undergoing cardiac surgery: a prospective randomized controlled trial
Background
The administration of levosimendan prophylactically to patients undergoing cardiac surgery remains a controversial practice, and few studies have specifically assessed the value of this approach in pediatric patients. This study therefore sought to explore the safety and efficacy of prophylactic levosimendan administration to pediatric patients as a means of preventing low cardiac output syndrome (LCOS) based upon hemodynamic, biomarker, and pharmacokinetic readouts.
Methods
This was a single-center, double-blind, randomized, placebo-controlled trial. Patients ≤ 48 months old were enrolled between July 2018 and April 2019 and were randomly assigned to groups that received either placebo or levosimendan infusions for 48 h post-surgery, along with all other standard methods of care. LCOS incidence was the primary outcome of this study.
Results
A total of 187 patients were enrolled, of whom 94 and 93 received levosimendan and placebo, respectively. LCOS incidence did not differ significantly between the levosimendan and placebo groups (10 [10.6%] versus 18 [19.4%] patients, respectively; 95% confidence interval [CI] 0.19–1.13;
p
= 0.090) nor did 90-day mortality (3 [3.2%] versus 4 [4.3%] patients, CI 0.14–3.69,
p
= 0.693), duration of mechanical ventilation (median, 47.5 h and 39.5 h, respectively;
p
= 0.532), ICU stay (median, 114.5 h and 118 h, respectively;
p
= 0.442), and hospital stay (median, 20 days and 20 days, respectively;
p
= 0.806). The incidence of hypotension and cardiac arrhythmia did not differ significantly between the groups. Levels of levosimendan fell rapidly without any plateau in plasma concentrations during infusion. A multiple logistic regression indicated that randomization to the levosimendan group was a predictor of LCOS.
Conclusions
Prophylactic levosimendan administration was safe in pediatric patients and had some benefit to postoperative hemodynamic parameters, but failed to provide significant benefit with respect to LCOS or 90-day mortality relative to placebo.
Trial registration
Name of the registry: Safety evaluation and therapeutic effect of levosimendan on the low cardiac output syndrome in patients after cardiopulmonary bypass. Trial registration number: ChiCTR1800016594. Date of registration: 11 June 2018. URL of trial registry record:
http://www.chictr.org.cn/index.aspx
Journal Article
Robot Operating System (ROS) for Absolute Beginners : Robotics Programming Made Easy
Learn how to get started with robotics programming using Robot Operation System (ROS). Targeted for absolute beginners in ROS, Linux, and Python, this short guide shows you how to build your own robotics projects. ROS is an open-source and flexible framework for writing robotics software. With a hands-on approach and sample projects, Robot Operating System for Absolute Beginners will enable you to begin your first robot project. You will learn the basic concepts of working with ROS and begin coding with ROS APIs in both C++ and Python.
Book
THE NETWORK ORIGINS OF AGGREGATE FLUCTUATIONS
This paper argues that, in the presence of intersectoral input—output linkages, microeconomic idiosyncratic shocks may lead to aggregate fluctuations. We show that, as the economy becomes more disaggregated, the rate at which aggregate volatility decays is determined by the structure of the network capturing such linkages. Our main results provide a characterization of this relationship in terms of the importance of different sectors as suppliers to their immediate customers, as well as their role as indirect suppliers to chains of downstream sectors. Such higher-order interconnections capture the possibility of \"cascade effects\" whereby productivity shocks to a sector propagate not only to its immediate downstream customers, but also to the rest of the economy. Our results highlight that sizable aggregate volatility is obtained from sectoral idiosyncratic shocks only if there exists significant asymmetry in the roles that sectors play as suppliers to others, and that the \"sparseness\" of the input—output matrix is unrelated to the nature of aggregate fluctuations.
Journal Article
Make : family projects for smart objects : tabletop projects that respond to your world
\"'The Internet of Things' is the new buzzphrase, but what is it? A toaster that texts? The fitness band on your wrist? The camera in an infant's room? Sure, it's all of those things. But it's also your phone: an ultra-sophisticated sensor and communications system in your pocket or purse--capable of tracking your steps, capturing an image, or calling an Uber. And it is actually not hard or expensive to make a sensing, communicating object yourself. Doing so can be rewarding, fun, and even useful. This book teaches the basics of building sensors and communicating objects through a series of practical, demonstrative, and fun activities\"--Amazon.com.
Book
ORGANIZING THE GLOBAL VALUE CHAIN
We develop a property-rights model of the firm in which production entails a continuum of uniquely sequenced stages. In each stage, a final-good producer contracts with a distinct supplier for the procurement of a customized stage-specific component. Our model yields a sharp characterization for the optimal allocation of ownership rights along the value chain. We show that the incentive to integrate suppliers varies system-atically with the relative position (upstream versus downstream) at which the supplier enters the production line. Furthermore, the nature of the relationship between integration and \"downstreamness\" depends crucially on the elasticity of demand faced by the final-good producer. Our model readily accommodates various sources of asymmetry across final-good producers and across suppliers within a production line, and we show how it can be taken to the data with international trade statistics. Combining data from the U.S. Census Bureau's Related Party Trade database and estimates of U.S. import demand elasticities from Broda and Weinstein (2006), we find empirical evidence broadly supportive of our key predictions. In the the process, we develop two novel measures of the average position of an industry in the value chain, which we construct using U.S. Input—Output Tables.
Journal Article
Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial
Chronic heart failure (CHF) is an important cause of hospital admission and death. Poor adherence to medication is common in some chronic illnesses and might reduce the population effectiveness of proven treatments. Because little is known about adherence in patients with CHF and about the consequences of non-adherence, we assessed the association between adherence and clinical outcome in the CHARM (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity) programme.
CHARM was a double-blind, randomised, controlled clinical trial, comparing the effects of the angiotensin receptor blocker candesartan with placebo in 7599 patients with CHF. Median follow-up was 38 months. The proportion of time patients took more than 80% of their study medication was defined as good adherence and 80% or less as poor adherence. We used a Cox proportional hazards regression model, with adherence as a time-dependent covariate in the model, to examine the association between adherence and mortality in the candesartan and placebo groups.
We excluded 187 patients because of missing information on adherence. In the time-dependent Cox regression model, after adjustment for predictive factors (demographics, physiological and severity-of-illness variables, smoking history, and number of concomitant medications), good adherence was associated with lower all-cause mortality in all patients (hazard ratio [HR] 0·65, 95% CI 0·57–0·75, p<0·0001). The adjusted HR for good adherence was similar in the candesartan (0·66, 0·55–0·81, p<0·0001) and placebo (0·64, 0·53–0·78, p<0·0001) groups.
Good adherence to medication is associated with a lower risk of death than poor adherence in patients with CHF, irrespective of assigned treatment. This finding suggests that adherence is a marker for adherence to effective treatments other than study medications, or to other adherence behaviours that affect outcome. Understanding these factors could provide an opportunity for new interventions, including those aimed at improving adherence.
Journal Article