Joint programmes in paediatric cardiac surgery: an update and descriptive analysis

OBJECTIVE

Joint programmes are an alternative model that may aid in improving congenital cardiac surgery outcomes while avoiding the potential resource and accessibility challenges that could result from regionalisation. This study aims to characterise current joint programmes, identify factors that are associated with joint programme success and failure, and gauge attitudes within the profession regarding joint programmes as an alternative.

METHODS

A multiple choice survey with 23 standard questions for all programmes and additional 42 additional questions for each participant hospital in a joint programme was addressed to paediatric cardiac surgeons in the United States of America. Questions were designed to qualitatively and quantitatively characterise congenital cardiac surgery joint programmes.

RESULTS

Of the 34 unique congenital cardiac surgery programmes identified in this survey, 14 have participated in a joint programme and 50% of those joint programmes existed for more than 10 years. Most joint programmes (86%) participate or participated in a model where the hospital participants are engaged in a "mother-daughter" relationship in both perception and case volume distribution. In three out of four defunct joint programmes, there were case complexity limitations placed on partner institutions, but the now independent partner institutions operate with no limitation on complexity. Most (71%) hospital participants in a joint programme felt that the joint programme produced better outcomes than two separate programmes; however, among those who participate or have participated in a joint programme, only 18% felt that joint programmes were the optimal model for delivery of congenital cardiac surgical care.

Autochthonous Biological Resources for the Production of Regional Craft Beers: Exploring Possible Contributions of Cereals, Hops, Microbes, and Other Ingredients

Selected biological resources used as raw materials in beer production are important drivers of innovation and segmentation in the dynamic market of craft beers. Among these resources, local/regional ingredients have several benefits, such as strengthening the connection with territories, enhancing the added value of the final products, and reducing supply costs and environmental impacts. It is assumed that specific ingredients provide differences in flavours, aromas, and, more generally, sensory attributes of the final products. In particular, of interest are ingredients with features attributable and/or linked to a specific geographical origin. This review encompasses the potential contribution and exploitation of biodiversity in the main classes of beer inputs, such as cereals, hops, microbes, and adjuncts, with a specific emphasis on autochthonous biological resources, detailing the innovative paths already explored and documented in the scientific literature. This dissertation proposes an overview of the impact on beer quality for each raw material category, highlighting the benefits and limitations that influence its concrete applications and scale-up, from the field to the stain. The topics explored promote, in the sector of craft beers, trends already capitalised in the production of other alcoholic beverages, such as the preservation and revalorisation of minor and autochthonous varieties, the exploitation of yeast and bacteria strains isolated from specific sites/plant varieties, and the valorisation of the effects of peculiar terroirs on the quality of agricultural products. Finally, the examined tendencies contribute toward reducing the environmental impacts of craft beer manufacturing, and are in line with sustainable development of food systems, increasing the economic driver of biodiversity preservation.

New distributional records for ants and the evaluation of ant species richness and endemism patterns in Mexico

Background

Ants (Formicidae) in Mexico have usually been undersampled despite their ecological significance and their utility as environmental service providers and bioindicators. This study estimates the species richness and the narrow endemic species number of ants across Mexico. It also documents the presence of one species newly recorded in Mexico and 19 new state-based records of 14 species from central and north Mexico. No surveys have been performed in most of the localities where we report those records, suggesting the need for a higher sampling effort across the country.

New information

We present an ant species richness estimation and a narrow endemic ant species estimation in a grid of 0.5 degrees in Mexico. Stenammaschmitii is recorded for the first time from Mexico. Additionally, new state-based records of Aztecavelox, Dorymyrmexinsanus, Camponotuscoruscus, Camponotusstriatus, Formicapropatula, Lasiuslatipes, Neivamyrmexmelanocephalus, Neivamyrmexrugulosus, Sysciaaugustae, Attatexana, Cephalotesscutulatus, Crematogastercrinosa and Temnothoraxandrei are recorded.

Addressing the challenges of regulatory systems strengthening in small states

Countries should ensure equitable access to quality medicines. Regulatory systems for medicines and other health technologies are an essential part of well-functioning health systems and are a requisite for achieving Universal Health and the Sustainable Development Goals. The Pan American Health Organization, the World health Organization (WHO) regional office for the Americas, has assessed national regulatory capacities using a precursor of WHO Global Benchmarking Tool, and conducted an analysis of the data which suggests an association of regulatory capacity with population and the size of the economy. Regulatory capacity tends to decrease as population and gross domestic product decreases. This predominantly impacts the Caribbean sub-region in the Americas, which includes many states with small populations and economies. This paper will use the World Bank’s term ‘small states’ to refer to countries with 1.5 million people or less and other larger countries that face similar challenges. The regulatory challenges of small states include small markets and limited human and financial resources. However, small states can build regulatory systems with a narrower scope that are less resource intensive and still ensure appropriate regulation and oversight. The approach should be tailored to accomplish a subset of WHO recommended essential functions, including marketing authorisation, licensing of establishments and postmarket surveillance/pharmacovigilance, depending on the need to oversee local manufacturing, which requires a comprehensive system. The approach should also include adoption of efficiencies, such as regionalisation and reliance. This model is currently being put in practice in the small states of the Caribbean Community and Pacific Islands and can inform other small states around the world.

Patterns of intracolumnar size variation inform the heterochronic mechanisms underlying extreme body shape divergence in microcephalic sea snakes

Sea snakes (Hydrophiinae) that specialize on burrowing eel prey have repeatedly evolved tiny heads and reduced forebody relative to hindbody girths. Previous research has found that these "microcephalic" forms have higher counts of precaudal vertebrae, and postnatal ontogenetic changes cause their hindbodies to reach greater girths relative to their forebodies. We examine variation in vertebral size along the precaudal axis of neonates and adults of three species. In the nonmicrocephalic Hydrophis curtus, these intracolumnar patterns take the form of symmetrical curved profiles, with longer vertebrae in the midbody (50% of body length) relative to distal regions. In contrast, intracolumnar profiles in the microcephalic H. macdowelli and H. obscurus are strongly asymmetrical curves (negative skewness) due to the presence of numerous, smaller-sized vertebrate in the forebody (anterior to the heart). Neonate and adult H. macdowelli and H. obscurus specimens all exhibit this pattern, implying an onset of fore- versus hindbody decoupling in the embryo stage. Based on this, we suggest plausible developmental mechanisms involving the presence and positioning of Hox boundaries and heterochronic changes in segmentation. Tests of our hypotheses would give new insights into the drivers of rapid convergent shifts in evolution, but will ultimately require studies of gene expression in the embryos of relevant taxa.

The neuroanatomy of autism - a developmental perspective

Autism Spectrum Disorders (ASDs) are a heterogeneous group of neurodevelopmental disorders that are diagnosed solely on the basis of behaviour. A large body of work has reported neuroanatomical differences between individuals with ASD and neurotypical controls. Despite the huge clinical and genetic heterogeneity that typifies autism, some of these anatomical features appear to be either present in most cases or so dramatically altered in some that their presence is now reasonably well replicated in a number of studies. One such finding is the tendency towards overgrowth of the frontal cortex during the early postnatal period. Although these reports have been focused primarily on the presumed pathological anatomy, they are providing us with important insights into normal brain anatomy and are stimulating new ideas and hypotheses about the normal trajectory of brain development and the function of specific anatomical brain structures. The use of model systems that include genetic model organisms such as the mouse and, more recently, human induced pluripotent stem cell‐derived brain organoids to model normal and pathological human cortical development, is proving particularly informative. Here we review some of the neuroanatomical alterations reported in autism, with a particular focus on well‐validated findings and recent advances in the field, and ask what these observations can tell us about normal and abnormal brain development.

Elements of regional beetle faunas: faunal variation and compositional breakpoints along climate, land cover and geographical gradients

Regional faunas are structured by historical, spatial and environmental factors. We studied large-scale variation in four ecologically different beetle groups (Coleoptera: Dytiscidae, Carabidae, Hydrophiloidea, Cerambycidae) along climate, land cover and geographical gradients, examined faunal breakpoints in relation to environmental variables, and investigated the best fit pattern of assemblage variation (i.e. randomness, checkerboards, nestedness, evenly spaced, Gleasonian, Clementsian). We applied statistical methods typically used in the analysis of local ecological communities to provide novel insights into faunal compositional patterns at large spatial grain and geographical extent. We found that spatially structured variation in climate and land cover accounted for most variation in each beetle group in partial redundancy analyses, whereas the individual effect of each explanatory variable group was generally much less important in accounting for variation in provincial species composition. We also found that climate variables were most strongly associated with faunal breakpoints, with temperature-related variables alone accounting for about 20% of variation at the first node of multivariate regression tree for each beetle group. The existence of faunal breakpoints was also shown by the 'elements of faunal structure' analyses, which suggested Clementsian gradients across the provinces, that is, that there were two or more clear groups of species responding similarly to the underlying ecological gradients. The four beetle groups showed highly similar biogeographical patterns across our study area. The fact that temperature was related to faunal breakpoints in the species composition of each beetle group suggests that climate sets a strong filter to the distributions of species at this combination of spatial grain and spatial extent. This finding held true despite the ecological differences among the four beetle groups, ranging from fully aquatic to fully terrestrial and from herbivorous to predaceous species. The existence of Clementsian gradients may be a common phenomenon at large scales, and it is likely to be caused by crossing multiple species pools determined by climatic and historical factors on the distributions of species.

Evolution of vertebrate forebrain development: how many different mechanisms?

Over the past 50 years and more, many models have been proposed to explain how the nervous system is initially induced and how it becomes subdivided into gross regions such as forebrain, midbrain, hindbrain and spinal cord. Among these models is the 2-signal model of Nieuwkoop & Nigtevecht (1954), who suggested that an initial signal ('activation') from the organiser both neuralises and specifies the forebrain, while later signals ('transformation') from the same region progressively caudalise portions of this initial territory. An opposing idea emerged from the work of Otto Mangold (1933) and other members of the Spemann laboratory: 2 or more distinct organisers, emitting different signals, were proposed to be responsible for inducing the head, trunk and tail regions. Since then, evidence has accumulated that supports one or the other model, but it has been very difficult to distinguish between them. Recently, a considerable body of work from mouse embryos has been interpreted as favouring the latter model, and as suggesting that a 'head organiser', required for the induction of the forebrain, is spatially separate from the classic organiser (Hensen's node). An extraembryonic tissue, the 'anterior visceral endoderm' (AVE), was proposed to be the source of forebrain-inducing signals. It is difficult to find tissues that are directly equivalent embryologically or functionally to the AVE in other vertebrates, which led some (e.g. Kessel, 1998) to propose that mammals have evolved a new way of patterning the head. We will present evidence from the chick embryo showing that the hypoblast is embryologically and functionally equivalent to the mouse AVE. Like the latter, the hypoblast also plays a role in head development. However, it does not act like a true organiser. It induces pre-neural and pre-forebrain markers, but only transiently. Further development of neural and forebrain phenotypes requires additional signals not provided by the hypoblast. In addition, the hypoblast plays a role in directing cell movements in the adjacent epiblast. These movements distance the future forebrain territory from the developing organiser (Hensen's node), and we suggest that this is a mechanism to protect the forebrain from caudalising signals from the node. These mechanisms are consistent with all the findings obtained from the mouse to date. We conclude that the mechanisms responsible for setting up the forebrain and more caudal regions of the nervous system are probably similar among different classes of higher vertebrates. Moreover, while reconciling the two main models, our findings provide stronger support for Nieuwkoop's ideas than for the concept of multiple organisers, each inducing a distinct region of the CNS.