Predictors of recurrence following laparoscopic minor hepatectomy for hepatocellular carcinoma in the UK.

AIMS: Minor hepatectomy, which is increasingly carried out laparoscopically (LLR), is a cornerstone of curative treatment for hepatocellular carcinoma (HCC). The majority of relevant publications however originate from regions with endemic viral hepatitis. Although the incidence of HCC in the UK is increasing, little is known about outcomes following LLR. METHODS: Consecutive patients undergoing minor (involving ≤2 segments) LLR or open resection (OLR) at our institute between 2014 and 2021 were compared. Selection from a plethora of factors potentially impacting on overall (OS) and disease free survival (DFS) was optimised with Lasso regression. To enable analysis of patients having repeat resection, multivariate frailty modelling was utilised to calculate hazard ratios (HR). RESULTS: The analysis of 111 liver resections included 55 LLR and 56 OLR. LLR was associated with a shorter hospital stay (5 ± 2 vs. 7 ± 2 days; p < 0.001) and a lower comprehensive complication index (4.43 vs. 9.96; p = 0.006). Mean OS (52.3 ± 2.3 vs. 49.9 ± 3.0 months) and DFS (33.9 ± 3.4 vs. 36.5 ± 3.6 months; p = 0.59) were comparable between LLR and OLR, respectively (median not reached). Presence of mixed cholangiocarcinoma/HCC, satellite lesions and AFP level predicted OS and DFS. In addition tumour size was predictive of DFS. CONCLUSIONS: In the studied population minor LLR was associated with shorter hospital stay and fewer complications while offering non-inferior long-term outcomes. A number of predictors for disease free survival have been elucidated that may aid in identifying patients with a high risk of disease recurrence and need for further treatment.

A comparative study of thermally and chemically treated dairy waste: Impacts on soil phosphorus turnover and availability using 33P isotope dilution.

Dairy processing sludge (DPS) and DPS-derived secondary products such as struvite, biochar, hydrochar and ash (collectively known as SRUBIAS) are emerging as alternatives to fertilizers produced from mined rock phosphate. However, little is known about how these products affect soil P availability and daily P turnover rates.. A lack of such information prevents precision nutrient management planning using these products out on farms. This study used a novel isotope dilution technique (IPD) with 33P as a tracer to compare P turnover in soils amended with chemically (alum-treated DPS and struvite) and thermally (biochar, hydrochar, ash) treated DPS. Results showed that thermally treated products exhibited poor agronomic performance as P fertilizers, potentially inhibiting P availability when applied to soils. For example, a P deficient soil amended with hydrochar treatment at the highest application rates did not record a build-up of available P to agronomic target values. In ash and biochar treated P deficient soils, available P increased but only with very high application rates of 150 and 80 mg P kg -1. The application of these products as fertilizers could have negative implications for both environmental and agronomic goals. Conversely, chemically treated fertilisers demonstrated better agronomic performance. The same agronomic target value was reached with application rates of only 20 mg P kg -1 soil for DPS and 50 mg P kg -1 soil for struvite. However, the techniques deployed revealed that these products exhibited slower rates of available and exchangeable P build-up when compared with chemical fertilisers. This suggests that these bio-based alternatives require higher application rates or earlier application times compared to conventional chemical fertilizers. Regulations providing advice on P use in agricultural soils need to account for slower P turnover in soils receiving recycled fertilizers. The IPD technique is transferrable to all wastes to examine their performance as fertilizers.

Impact of COVID-19 & Response Measures on HIV-HCV Prevention Services and Social Determinants in People Who Inject Drugs in 13 Sites with Recent HIV Outbreaks in Europe, North America and Israel.

HIV/HCV prevention among people who inject drugs (PWID) is of key public health importance. We aimed to assess the impact of COVID-19 and associated response measures on HIV/HCV prevention services and socio-economic status of PWID in high-HIV-risk sites. Sites with recent (2011-2019) HIV outbreaks among PWID in Europe North America and Israel, that had been previously identified, were contacted early May 2020. Out of 17 sites invited to participate, 13 accepted. Semi-structured qualitative site reports were prepared covering data from March to May 2020, analyzed/coded and confirmed with a structured questionnaire, in which all sites explicitly responded to all 103 issues reported in the qualitative reports. Opioid maintenance treatment, needle/syringe programs and antiretroviral treatment /hepatitis C treatment continued, but with important reductions and operational changes. Increases in overdoses, widespread difficulties with food and hygiene needs, disruptions in drug supply, and increased homelessness were reported. Service programs rapidly reformed long established, and politically entrenched, restrictive service delivery policies. Future epidemic control measures should include mitigation of negative side-effects on service provision and socio-economic determinants in PWID.

RESUMEN: La prevención del VIH/VHC entre las personas que se inyectan drogas (PWID) es de vital importancia para la salud pública. Nuestro objetivo fue evaluar el impacto de COVID-19 y las medidas de respuesta asociadas en los servicios de prevención del VIH/VHC y el estado socioeconómico de las PWID en sitios de alto riesgo de VIH. Se contactó con sitios con brotes recientes (2011­2019) de VIH entre PWID en Europa, América del Norte e Israel, que habían sido previamente identificados, a principios de mayo de 2020. De los 17 sitios invitados a participar, 13 aceptaron. Se prepararon informes cualitativos semiestructurados del sitio que cubrían los datos de marzo a mayo de 2020, analizados/codificados y confirmados con un cuestionario estructurado, en el que todos los sitios respondieron explícitamente a los 103 asuntos reportados en los informes cualitativos. El tratamiento de mantenimiento con opiáceos, los programas de agujas/jeringas y el tratamiento antirretroviral/tratamiento de la hepatitis C continuaron, pero con importantes reducciones y cambios operativos. Se reportaron aumentos en las sobredosis, dificultades generalizadas con las necesidades alimentarias y de higiene, interrupciones en el suministro de medicamentos y aumento de personas sin hogar. Los programas de servicios reformaron rápidamente las políticas restrictivas de prestación de servicios, establecidas desde hace mucho tiempo y políticamente arraigadas. Las futuras medidas de control de epidemias deben incluir la mitigación de los efectos secundarios negativos en la prestación de servicios y los determinantes socioeconómicos en las PWID.

Predictors of Stress-Delta High-Sensitivity Troponin T in Emergency Department Patients Undergoing Stress Testing.

Background and objective Elevations in high-sensitivity troponin T (hs-TnT) are frequently observed following extreme physical exercise. In light of this, we sought to determine whether specific clinical characteristics are associated with this phenomenon in patients undergoing cardiac exercise tolerance testing (ETT). Methods We conducted a retrospective analysis of a prospectively collected biospecimen repository of 257 patients undergoing a stress echocardiogram for possible acute coronary syndrome (ACS). Ischemic electrocardiogram (ECG) changes during ETT and the presence or absence of ischemia on imaging were determined by a board-licensed cardiologist. N-terminal pro-brain natriuretic peptide (NT-proBNP) and hs-TnT assays were obtained immediately before and two hours following ETT. We developed linear regression models including several clinical characteristics to predict two-hour stress-delta hs-TnT. Variable selection was performed using the least absolute shrinkage and selection operator (LASSO). Results The mean age of the patients was 52 years [standard deviation (SD): 11.4]; 125 (48.6%) of them were men, and 88 (34.2%) were African-American. Twenty-two patients (8.6%) had ischemia evident on echocardiography, and 31 (12.1%) had ischemic ECG changes during exercise. The mean baseline hs-TnT was 5.6 ng/L (SD: 6.4) and the mean two-hour hs-TnT was 7.1 ng/L (SD: 10.2). Age and ischemic ECG changes were associated with two-hour stress-delta hs-TnT values. Conclusions Based on our findings, ischemic changes in stress ECG and age were associated with an increase in hs-TnT levels following exercise during a stress echo.

Catalytic valorisation of biomass levulinic acid into gamma valerolactone using formic acid as a H2 donor: a critical review.

This review sheds light on the catalytic valorisation of agroforestry biomass through levulinic acid and formic acid towards γ-valerolactone and other higher-value chemicals. γ-Valerolactone is produced by the hydrogenation of levulinic acid, which can be achieved through an internal hydrogen transfer reaction with formic acid in the presence of catalyst. By reviewing corresponding catalysts, the paper underlines the most efficient steps constituting an integrated sustainable process that eliminates the need for external H2 sources while producing biofuels as an alternative energy source. Furthermore, the review emphasizes the role of catalysts in the hydrogenation of levulinic acid, with special focus on heterogeneous catalysts. The authors highlighted the dual role of different catalysts by comparing their activity, morphology, electronic structure, synergetic relation between support and doped species, as well as their deactivation and recyclability. Acknowledging the need for green and sustainable H2 production, the review extends to cover the role of photo catalysis in dissociating H2-donor solvents for reducing levulinic acid into γ-valerolactone under mild temperatures. To wrap up, the critical discussion presented enables readers to hone their knowledge about different schools and emphasizes research gaps emerging from experimental work. The review concludes with a comprehensive table summarizing the recent catalysts reported between the years 2017-2021.

Stress-Delta B-Type Natriuretic Peptide Does Not Exclude ACS in the ED.

BACKGROUND: There are many detectable changes in circulating biomarkers in the setting of myocardial ischemia. We hypothesize that there are associated changes in circulating B-type natriuretic peptide (BNP) level after stress-induced myocardial ischemia, which can be used for emergency department (ED) acute coronary syndrome (ACS) risk stratification. METHODS: In a prospective study, we enrolled 340 patients over the age of 30 receiving an exercise echocardiography stress test in an ED observational unit for suspected ACS. We collected blood samples at baseline and at 2 and 4 h post-stress test, measuring the relative and absolute changes (stress-delta) in plasma BNP concentrations. In addition, patients were contacted at 90 days and at 1 year posttest for a follow-up. We calculated the diagnostic test characteristics of stress-delta BNP for a composite outcome of ischemic imaging on stress echocardiogram, nonelective percutaneous coronary intervention, coronary artery bypass graft surgery, subsequent acute myocardial infarction, or cardiac death at 1 year via a logistic regression. We analyzed the 2-h BNP concentrations using an ANOVA model to adjust for the baseline BNP level. RESULTS: Baseline and 2-h post-stress BNP were both higher in the positive outcome group, but the stress-delta BNP was not. Stress-delta BNP had a sensitivity and specificity, respectively, of 53% and 76% at 2 h and 67% and 68% at 4 h. It was noted that patients with the composite outcome had a higher baseline BNP level. CONCLUSIONS: BNP stress-deltas are poor diagnostic means for ACS risk stratification, but resting BNP remains a promising prognostic tool for ED patients with suspected ACS.

Hydrothermal carbonization (HTC) of dairy waste: effect of temperature and initial acidity on the composition and quality of solid and liquid products.

Background: Hydrothermal carbonization (HTC) of dairy processing waste was performed to investigate the effect of temperature and initial pH on the yield and composition of the solid (hydrochar) and liquor produced. All hydrochars met the EU requirements of organo-mineral solid fertilizers defined in the Fertilizing Products Regulation in terms of phosphorus (P) and mineral content. Methods: Laboratory scale HTC was performed using pressurized reactors, and the products (solid and liquid) were collected, stored and analyzed for elemental composition and nutrient content using Inductively coupled plasma optical emission spectroscopy (ICP-OES), ultraviolet-visible spectrophotometry (UV-Vis) and other analytic techniques. Results: Maximum hydrochar yield (60.67%) was observed at T=180℃ and pH=2.25, whereas the maximum P-recovery was 80.38% at T=220℃ and pH=4.6. The heavy metal content of the hydrochars was mostly compliant with EU limitations, except for Ni at T=220℃ and pH=8.32. Meanwhile, further study of Chromium (Cr) species is essential to assess the fertilizer quality of the hydrochars. For the liquid product, the increase in temperature beyond 200℃, coupled with an increase in initial acidity (pH=2.25) drove P into the liquor. Simultaneously, increasing HTC temperature and acidity increased the concentration of NO 3 - and NH 4 + in the liquid products to a maximum of 278 and 148 mg/L, respectively, at T=180℃ and pH=4.6. Furthermore, no direct relation between final pH of liquor and NH 4 + concentration was observed. Conclusions: HTC allows for the production of hydrochar as a potential fertilizer material that requires further processing. Adjusting HTC conditions enhanced P-recovery in the hydrochar, while retrieving higher nitrate concentrations in the liquid product. Optimizing HTC for the production of qualified hydrochars requires further treatment of Cr content, studying the availability of P in the products and enhancing the hydrochar yield for economic feasibility.

An examination of maximum legal application rates of dairy processing and associated STRUBIAS fertilising products in agriculture.

The dairy industry produces vast quantities of dairy processing sludge (DPS), which can be processed further to develop second generation products such as struvite, biochars and ashes (collectively known as STRUBIAS). These bio-based fertilizers have heterogeneous nutrient and metal contents, resulting in a range of possible application rates. To avoid nutrient losses to water or bioaccumulation of metals in soil or crops, it is important that rates applied to land are safe and adhere to the maximum legal application rates similar to inorganic fertilizers. This study collected and analysed nutrient and metal content of all major DPS (n = 84) and DPS-derived STRUBIAS products (n = 10), and created an application calculator in MS Excel™ to provide guidance on maximum legal application rates for ryegrass and spring wheat across plant available phosphorus (P) deficient soil to P-excess soil. The sample analysis showed that raw DPS and DPS-derived STRUBIAS have high P contents ranging from 10.1 to 122 g kg-1. Nitrogen (N) in DPS was high, whereas N concentrations decreased in thermo-chemical STRUBIAS products (chars and ash) due to the high temperatures used in their formation. The heavy metal content of DPS and DPS-derived STRUBIAS was significantly lower than the EU imposed limits. Using the calculator, application rates of DPS and DPS-derived STRUBIAS materials (dry weight) ranged from 0 to 4.0 tonnes ha-1 y-1 for ryegrass and 0-4.5 tonnes ha-1 y-1 for spring wheat. The estimated heavy metal ingestion to soil annually by the application of the DPS and DPS-derived STRUBIAS products was lower than the EU guideline on soil metal accumulation. The calculator is adaptable for any bio-based fertilizer, soil and crop type, and future work should continue to characterise and incorporate new DPS and DPS-derived STRUBIAS products into the database presented in this paper. In addition, safe application rates pertaining to other regulated pollutants or emerging contaminants that may be identified in these products should be included. The fertilizer replacement value of these products, taken from long-term field studies, should be factored into application rates.

Study of Emissions from Domestic Solid-Fuel Stove Combustion in Ireland.

Solid-fuel stoves are at the heart of many homes not only in developing nations, but also in developed regions where there is significant deployment of such heating appliances. They are often operated inefficiently and in association with high emission fuels like wood. This leads to disproportionate air pollution contributions. Despite the proliferation of these appliances, an understanding of particulate matter (PM) emissions from these sources remains relatively low. Emissions from five solid fuels are quantified using a "conventional" and an Ecodesign stove. PM measurements are obtained using both "hot filter" sampling of the raw flue gas, and sampling of cooled, diluted flue gas using an Aerosol Chemical Speciation Monitor and AE33 aethalometer. PM emissions factors (EF) derived from diluted flue gas incorporate light condensable organic compounds; hence they are generally higher than those obtained with "hot filter" sampling, which do not. Overall, the PM EFs ranged from 0.2 to 108.2 g GJ-1 for solid fuels. The PM EF determined for a solid fuel depends strongly on the measurement method employed and on user behavior, and less strongly on secondary air supply and stove type. Kerosene-based firelighters were found to make a disproportionately high contribution to PM emissions. Organic aerosol dominated PM composition for all fuels, constituting 50-65% of PM from bituminous and low-smoke ovoids, and 85-95% from torrefied olive stone (TOS) briquettes, sod peat, and wood logs. Torrefied biomass and low-smoke ovoids were found to yield the lowest PM emissions. Substituting these fuels for smoky coal, peat, and wood could reduce PM2.5 emissions by approximately 63%.

The C-Band All-Sky Survey (C-BASS): Simulated parametric fitting in single pixels in total intensity and polarization.

The cosmic microwave background (CMB) B-mode signal is potentially weaker than the diffuse Galactic foregrounds over most of the sky at any frequency. A common method of separating the CMB from these foregrounds is via pixel-based parametric-model fitting. There are not currently enough all-sky maps to fit anything more than the most simple models of the sky. By simulating the emission in seven representative pixels, we demonstrate that the inclusion of a 5 GHz data point allows for more complex models of low-frequency foregrounds to be fitted than at present. It is shown that the inclusion of the C-BASS data will significantly reduce the uncertainties in a number of key parameters in the modelling of both the galactic foregrounds and the CMB. The extra data allow estimates of the synchrotron spectral index to be constrained much more strongly than is presently possible, with corresponding improvements in the accuracy of the recovery of the CMB amplitude. However, we show that to place good limits on models of the synchrotron spectral curvature will require additional low-frequency data.

Provocative biomarker stress test: stress-delta N-terminal pro-B type natriuretic peptide.

Objective: Stress testing is commonly performed in emergency department (ED) patients with suspected acute coronary syndrome (ACS). We hypothesised that changes in N-terminal pro-B type natriuretic peptide (NT-proBNP) concentrations from baseline to post-stress testing (stress-delta values) differentiate patients with ischaemic stress tests from controls. Methods: We prospectively enrolled 320 adult patients with suspected ACS in an ED-based observation unit who were undergoing exercise stress echocardiography. We measured plasma NT-proBNP concentrations at baseline and at 2 and 4 hours post-stress and compared stress-delta NT-proBNP between patients with abnormal stress tests versus controls using non-parametric statistics (Wilcoxon test) due to skew. We calculated the diagnostic test characteristics of stress-delta NT-proBNP for myocardial ischaemia on imaging. Results: Among 320 participants, the median age was 51 (IQR 44-59) years, 147 (45.9%) were men, and 122 (38.1%) were African-American. Twenty-six (8.1%) had myocardial ischaemia. Static and stress-deltas NT-proBNP differed at all time points between groups. The median stress-deltas at 2 hours were 10.4 (IQR 6.0-51.7) ng/L vs 1.7 (IQR -0.4 to 8.7) ng/L, and at 4 hours were 14.8 (IQR 5.0-22.3) ng/L vs 1.0 (-2.0 to 10.3) ng/L for patients with ischaemia versus those without. Areas under the receiver operating curves were 0.716 and 0.719 for 2-hour and 4-hour stress-deltas, respectively. After adjusting for baseline NT-proBNP levels, the 4-hour stress-delta NT-proBNP remained significantly different between the groups (p=0.009). Conclusion: Among patients with ischaemic stress tests, static and 4-hour stress-delta NT-proBNP values were significantly higher. Further study is needed to determine if stress-delta NT-proBNP is a useful adjunct to stress testing.

Use of near infrared spectroscopy for the rapid low-cost analysis of waste papers and cardboards.

Analytical data and quantitative near infrared (NIR) spectroscopy models for various lignocellulosic components (including Klason lignin and the constituent sugars glucose, xylose, mannose, arabinose, galactose, and rhamnose), ash, and ethanol-soluble extractives were obtained for 53 samples of paper and cardboard. These samples were mostly the type of materials typically found in domestic wastes (e.g. newspapers, printing paper, glossy papers, food packaging). A number of the samples (48) were obtained by separating a sample, after milling, into two particle size fractions. It was found that the fractions containing the smaller particles typically had higher ash and Klason lignin contents and lower glucose and xylose contents than the larger particle size fractions. Nevertheless, all of the sample types had attractive total sugars contents (>50%), indicating that these could be suitable feedstocks for the production of biofuels and chemicals in hydrolysis-based biorefining technologies. NIR models of a high predictive accuracy (R2 of >0.9 for the independent validation set) were obtained for total sugars, glucose, xylose, Klason lignin, and ash, with values for the Root Mean Square Error of Prediction (RMSEP) of 2.36%, 2.64%, 0.56%, 1.98%, and 4.87%, respectively. Good NIR models (R2 of >0.8) were also obtained for mannose, arabinose, and galactose. These results suggest that NIR spectroscopy is a suitable method for the rapid, low-cost, analysis of the major lignocellulosic components of waste paper/cardboard samples.

Updraft gasification of poultry litter at farm-scale--A case study.

Farm and animal wastes are increasingly being investigated for thermochemical conversion, such as gasification, due to the urgent necessity of finding new waste treatment options. We report on an investigation of the use of a farm-scale, auto-thermal gasification system for the production of a heating gas using poultry litter (PL) as a feedstock. The gasification process was robust and reliable. The PL's ash melting temperature was 639°C, therefore the reactor temperature was kept around this value. As a result of the low reactor temperature the process performance parameters were low, with a cold gas efficiency (CGE) of 0.26 and a carbon conversion efficiency (CCE) of 0.44. The calorific value of the clean product gas was 3.39 MJ m(-3)N (LHV). The tar was collected as an emulsion containing 87 wt.% water and the extracted organic compounds were identified. The residual char exceeds thresholds for Zn and Cu to obtain European biochar certification; however, has potential to be classified as a pyrogenic carbonaceous material (PCM), which resembles a high nutrient biochar.

Chemically and biologically-mediated fertilizing value of manure-derived biochar.

This study evaluates the potential of manure-derived biochars in promoting plant growth and enhancing soil chemical and biological properties during a 150day pot experiment. Biochars from pyrolysis of poultry litter (PL) and swine manure (SM) at 400 and 600°C, and a commonly available wood chip (WC) biochar produced at high temperature (1000°C) were incorporated to silt-loam (SL) and sandy (SY) soils on a 2% dry soil weight basis. Ryegrass was sown and moisture was adjusted to 60% water filled pore space (WFPS). The PL400 and SM400 biochars significantly increased (p<0.05) shoot dry matter (DM) yields (SL soil) and enhanced nitrogen (N), phosphorus (P) and potassium (K) uptake by the plants in both soils, compared to the Control. All biochars significantly increased the soil carbon (C) contents compared to the Control. Total N contents were significantly greater for PL400 and PL600 treatments in both soils. The dehydrogenase activity (DA) significantly increased for PL400 and SM400 treatments and was positively correlated with the volatile matter (VM) contents of the biochars, while ß-glucosidase activity (GA) decreased for the same treatments in both soils. All biochars significantly shifted (p≤0.05) the bacterial community structure compared to the Control. This study suggests that pyrolysis of animal manures can produce a biochar that acts as both soil amendment and an organic fertilizer as proven by increased NPK uptake, positive liming effect and high soil nutrient availability, while WC biochar could work only in combination with fertilizers (organic as well as mineral).

The effect of hydrogen peroxide concentration and solid loading on the fractionation of biomass in formic acid.

This study investigated the fractionation of biomass using a decomposing mixture of hydrogen peroxide-formic acid as a pretreatment for the biorefining of Miscanthus × giganteus and of sugarcane bagasse. The main parameters investigated were the hydrogen peroxide concentration (2.5, 5.0 and 7.5 wt%) and biomass loading (5.0 and 10.0 wt%). At the highest hydrogen peroxide concentration used (7.5 wt%), the energy released by the decomposition of the H2O2 could heat the reaction mixture up to 180 °C in a short time (6-16 min). As a result, highly delignified pulps, with lignin removal as high as 92 wt%, were obtained. This delignification process also solubilised a significant amount of pentosan (82-98 wt%) from the initial biomass feedstock, and the resulting pulp had a high cellulosic content (92 wt%). The biomass loading only affected the reaction rate of hydrogen peroxide decomposition. Various analytical methods, including Fourier transform infrared spectroscopy, and thermogravimetric and elemental analyses, characterized the lignin obtained.

Gasification of torrefied Miscanthus × giganteus in an air-blown bubbling fluidized bed gasifier.

Torrefaction is suggested to be an effective method to improve the fuel properties of biomass and gasification of torrefied biomass should provide a higher quality product gas than that from unprocessed biomass. In this study, both raw and torrefied Miscanthus × giganteus (M×G) were gasified in an air-blown bubbling fluidized bed (BFB) gasifier using olivine as the bed material. The effects of equivalence ratio (ER) (0.18-0.32) and bed temperature (660-850°C) on the gasification performance were investigated. The results obtained suggest the optimum gasification conditions for the torrefied M × G are ER 0.21 and 800°C. The product gas from these process conditions had a higher heating value (HHV) of 6.70 MJ/m(3), gas yield 2m(3)/kg biomass (H2 8.6%, CO 16.4% and CH4 4.4%) and cold gas efficiency 62.7%. The comparison between raw and torrefied M × G indicates that the torrefied M × G is more suitable BFB gasification.

The maturation of cortical sleep rhythms and networks over early development.

OBJECTIVE: Although neuronal activity drives all aspects of cortical development, how human brain rhythms spontaneously mature remains an active area of research. We sought to systematically evaluate the emergence of human brain rhythms and functional cortical networks over early development. METHODS: We examined cortical rhythms and coupling patterns from birth through adolescence in a large cohort of healthy children (n=384) using scalp electroencephalogram (EEG) in the sleep state. RESULTS: We found that the emergence of brain rhythms follows a stereotyped sequence over early development. In general, higher frequencies increase in prominence with striking regional specificity throughout development. The coordination of these rhythmic activities across brain regions follows a general pattern of maturation in which broadly distributed networks of low-frequency oscillations increase in density while networks of high frequency oscillations become sparser and more highly clustered. CONCLUSION: Our results indicate that a predictable program directs the development of key rhythmic components and physiological brain networks over early development. SIGNIFICANCE: This work expands our knowledge of normal cortical development. The stereotyped neurophysiological processes observed at the level of rhythms and networks may provide a scaffolding to support critical periods of cognitive growth. Furthermore, these conserved patterns could provide a sensitive biomarker for cortical health across development.

Options for prandial glucose management in type 2 diabetes patients using basal insulin: addition of a short-acting GLP-1 analogue versus progression to basal-bolus therapy.

Integrating patient-centered diabetes care and algorithmic medicine poses particular challenges when optimized basal insulin fails to maintain glycaemic control in patients with type 2 diabetes. Multiple entwined physiological, psychosocial and systems barriers to insulin adherence are not easily studied and are not adequately considered in most treatment algorithms. Moreover, the limited number of alternatives to add-on prandial insulin therapy has hindered shared decision-making, a central feature of patient-centered care. This article considers how the addition of a glucagon-like peptide 1 (GLP-1) analogue to basal insulin may provide new opportunities at this stage of treatment, especially for patients concerned about weight gain and risk of hypoglycaemia. A flexible framework for patient-clinician discussions is presented to encourage development of decision-support tools applicable to both specialty and primary care practice.