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We analysed cardiac MRI and catheterisation variables during pre-Fontan evaluations for associations with major adverse cardiac events including Fontan takedown, mechanical circulatory support, heart transplantation, or death.
Methods:
In this single-centre retrospective study, we gathered pre-operative MRI and catheterisation data for all patients who underwent Fontan operation at Children’s Medical Center, Dallas, from April 2017 to November 2022. Patients were grouped according to the presence or absence of adverse events, and MRI and catheterisation parameters were compared between groups. We used the Mann–Whitney U Test for non-parametric data, Student’s T-test for parametric continuous variables, and Fisher’s Exact Test for categorical variables.
Results:
Of the 119 combined evaluations, 81 proceeded with Fontan palliation. Adverse events were recorded in 10% of patients (n = 8). One had a Fontan takedown, one underwent transplant, one required mechanical circulatory support, and five died in a median 21-month follow-up. Factors significantly associated with adverse events included heterotaxy syndrome (p = 0.04), higher combined pulmonary vascular resistance (p = 0.03), and moderate-severe (≥30%) atrioventricular valve regurgitation (p = 0.046). While combined pulmonary vascular resistance calculated from both catheterisation and MRI data predicted outcome, pulmonary vascular resistance calculated using data solely from catheterisation showed no discriminative ability.
Conclusions:
Post-Fontan major adverse cardiac events were associated with heterotaxy syndrome, higher combined pulmonary vascular resistance, and moderate-severe atrioventricular valve regurgitation identified on pre-Fontan MRI and catheterisation. Combined pulmonary vascular resistance using transpulmonary gradient from catheterisation data and effective pulmonary blood flow from MRI data may help predict outcome.
This essay memorializes William E. Leuchtenburg (1922–2025), who over the course of his long, distinguished career made numerous significant contributions to policy history, presidential history, and the history profession in general.
This study aimed to develop and evaluate a predictive model using electronic health record (EHR) data from a large south London mental health service, in order to identify patients 3 months following first referral who are at risk of subsequent high-intensity service use over the subsequent 12 months. Early identification of such patients may support proactive and personalised care planning, reducing the need for high-cost episodes of care. Predictive models were developed using information from 18 869 patients newly referred between 2007 and 2011. High-intensity use was defined as the top 10% of estimated mental healthcare expenditure. The model was developed using demographic, clinical and service use variables, and was validated on data from the periods 2012–2017 and 2018–2023.
Results
A logistic regression model achieved an area under the receiver operating characteristic (AUROC) of 0.79 in development (sensitivity 0.82, specificity 0.54), with robust performance in validation sets (AUROC 0.81, 0.83, respectively). Key predictors included first 3 months service use, schizophrenia or eating disorder diagnoses and living alone. Natural language processing-derived features did not improve performance.
Clinical implications
Routine EHR data performed well in predicting the risk of high-cost care, potentially enabling targeted interventions and more efficient resource allocation.
Under current Dutch regulations, accurate assessment of the amount of P secreted in milk is essential, as it determines manure P output. The two main aims were: 1) to predict P content in bovine milk using a broad range of predictor variables, and 2) to obtain predicted milk P contents representative of the Dutch dairy cow population. A secondary objective was to evaluate seasonal variation in milk P content. Weekly bulk milk samples (week 14 in 2017 up until week 13 in 2018) were collected from 14 dairy plants located across the Netherlands and pooled per week as representative samples of Dutch bovine milk. Milk samples were analysed for macronutrients and mineral contents. The mean P content of milk was 101.2 mg/100 g, and significant seasonal variation was observed, with the highest values found during winter and the lowest during summer. The contents of fat, protein, casein, Ca, Mg and Mn in milk were found to be highly correlated with the milk P content. The preferred multiple regression equation to predict the milk P content (mg/100 g) included the predictor variables milk fat (g/100 g), Ca (mg/100 g) and K (mg/100 g), viz. milk P content = – 58.6 (±14.09) + 0.28 (±0.104) × Ca + 11.46 (±2.559) × fat + 0.48 (±0.094) × K, and explained 80% of the variation (R2adj) in milk P content. The contribution of milk K content to explain variation in milk P content cannot be physiologically explained.
A series of experiments comparing winter wheat, rye and triticale varieties andbreeding lines was carried out during 1981-3.
In two experiments on good arable soils and in the absence of inter-plotcompetition, lodging and differential disease incidence, the greatest grain yields were obtained from the semi-dwarf winter wheat variety Norman. The best triticales gave yields similar to those of the winter wheat varieties which lacked the semi-dwarfing gene, though they were somewhat taller than the wheat. Total above-ground dry matter (biomass) yields were generally similar for the best wheat and triticale varieties. A triticale breeding line with the Rht3, dwarfing gene was considerably shorter than the others, all of which had the Rht1, allele, but it had lower grain yield and biomass than either theRht1, triticale or the winter wheat variety of comparable height.
In a third experiment on a loamy sand, the triticales gave 16% greater grain and 23% greater biomass yields than the three wheat varieties tested. However, as disease control in the wheat was not fully effective in this experiment, the yield advantage of the triticales may have been exaggerated.
In one of the experiments, in which different rates of fertilizer nitrogen were given, the rye and triticales were as responsive to the fertilizer as were the wheat varieties.
It is concluded that, given comparable selection for high yield, triticale varieties could be produced in the U.K. which would be capable of yielding as much as the highest yielding varieties of winter wheat. The triticales tested grow more rapidly during the winter and flowered earlier than the wheat varieties. Provided that improved triticales retained these characteristics they would be more likely than winter wheat to escape the effects of summer drought, and so be more suitable for light soils.
This note addresses a grammatical objection, first raised by Torstrik, to the transmitted text of Aristotle’s De anima 3.7, namely that the text contains at 431a4–7 a μέν without a corresponding δέ (or another adversative particle). Rejecting Corcilius’s suggestion that this is a μέν solitarium, the note shows that modest repunctuation reveals a responding δέ and makes better sense of this part of the text.
The aim of this article is threefold. First, it develops the premises on which the Special Issue “A Union of Crises: In Search of Constitutional Resilience” is based: that the omnipresence of diverse crises has become an inescapable reality for the EU, and that the low likelihood of Treaty change requires a reorientation in legal literature towards a more systematic exploration and conceptualisation of EU crisis law that transcends the hitherto focus on single-crisis measures. Second, the paper attempts to lay the groundwork for such a reorientation by offering a meta-view of what EU crisis law entails by outlining the constitutional contours of EU crisis law. It argues that the concept of EU crisis law is a combination of constitutional, international, hybrid, exceptional and legislative models of crisis accommodation, and demonstrates how these have interacted in the responses to past and present crises. Finally, the paper demonstrates how the remaining papers that form part of this Special Issue advance a meta-narrative of EU crisis and begin to provide answers to some of the most pressing issues that this nascent discipline is to address.
Four new species of Poecilosclerida (Porifera, Demospongiae) assigned to the genera Latrunculia and Iophon are described from South Africa and Namibia, located in the Namaqua ecoregion. The Porifera occurring along the continental shelf within this ecoregion are relatively well-known, with 76 species formally described in previous literature. Of these, 35 species belong to the Order Poecilosclerida. Additionally, Latrunculia (Aciculatrunculia) biformis is reported from the continental shelf on the west coast of South Africa, extending its range further northwards into the South Atlantic. DNA barcoding and molecular phylogenetic analyses were employed to ensure accurate taxonomic assignment and designation of new species.
There is limited research investigating advanced practice provider (APP) knowledge and perspectives on education in antimicrobial stewardship (AS).
Setting:
Large academic children’s hospital.
Participants:
APPs in Division of Pediatrics, Antimicrobial Stewardship Program (ASP) stakeholders.
Objective design:
We conducted four focus groups with APPs and one focus group with ASP stakeholders. APPs were asked eleven open questions about training, influences on prescribing practices, knowledge gaps and desired topics for education in AS as well as general barriers to learning. ASP stakeholders were asked five open-ended questions about teaching initiatives, knowledge gaps and high yield teaching topics for APPs.
Results:
20 APPs and 6 ASP stakeholders (1 medical director, 3 pharmacists and 2 pediatric infectious diseases fellows) participated in focus groups. Four domains and eight themes were generated. (1) Barriers to AS in Practice: lack of critical thinking and conflict between the ASP and APPs within the cultural context of the institution. (2) Approach to Education: logistical challenges to curriculum development and adopting APP centered approaches to teaching. (3) Education for New to Practice APPs: learning basics of microbiology, infectious diseases and utilizing resources to encourage AS in practice. (4) Education for Experienced APPs: learning approaches to common clinical scenarios and updates to improve AS in practice.
Conclusions:
Curricular content should acknowledge the cultural influences of the institution, target knowledge gaps and areas of interest of learners, and be delivered via flexible and engaging learning modalities that encourage maximal participation.
While ‘hard-right’ has gained traction in scholarship and newsrooms, its conceptual vagueness and practical effects have remained underexamined. Drawing on Framing Theory and Agenda-Setting Theory, this article offers the first systematic, crosspublication study of how seven leading English-language outlets – The Guardian, the British Broadcasting Corporation (BBC), Politico, The New Statesman, The Economist, Reuters, and The Financial Times – employed the term between 2022 and 2025. A qualitative content analysis of 140 articles demonstrates that ‘hard-right’ functions as an umbrella label that conflates distinct far-right currents, while framing devices selectively highlight certain traits and agenda-setting practices that elevate the term’s prominence in headlines and summaries. Although outlets vary in their use of contextual qualifiers, all exhibit comparable patterns of misclassification, label inflation, and strategic ambiguity. It can be argued that the strategic use of vague terminology can soften the far-right’s image and bolster their electoral appeal. The findings demonstrate the urgency of adopting established political science typologies and clearer editorial guidelines to safeguard analytical precision and democratic accountability in media coverage.
Avoidant/restrictive food intake disorder (ARFID) is a condition characterised by an avoidance or restriction of food intake that has a detrimental impact on physical health, psychosocial functioning or both. ARFID has now been classified in ICD-11, alongside DSM-5; however, challenges remain for healthcare professionals in recognising ARFID in young people and identifying best practice for managing their care. This educational article aims to provide an update on the epidemiology and clinical presentation of ARFID in children and young people, with a particular focus on co-occurring neurodevelopmental conditions and psychiatric disorders. A multidisciplinary approach to assessment and management is key, working closely with the young person and the system around them. Physical and psychosocial risk assessment has been aided by the publication of the medical emergencies in eating disorders (MEED) guidelines. Crucially, there is a need for further research into ARFID in order to develop evidence-based standardised guidelines for assessment, management and transition to adult services if required.
Exploiting intergenerationally linked data from the Survey of Health, Ageing, and Retirement in Europe, we examine the association between the home-leaving ages of parents and those of their daughters and sons. We propose a framework in which intergenerational associations between nest-leaving patterns of successive generations might stem from three channels of transmission, and we rely on detailed information on three generations of individuals to establish the strength of each channel. We find that a 1-year increase in the age at which a parent left home is associated with children leaving the nest approximately 1 month later. We provide evidence supporting our claim that the bulk of this association is due to direct cultural transmission of home-leaving ages stemming from the inheritance of preferences on the optimal timing of life-course events, such as cohabitation, marriage, and parenthood.
Investigating the relationship between behavioural addictions and mental health is essential due to their impact on well-being and the significant barriers they create to achieving lasting recovery. The aim of the study was to examine the prevalence of food addiction, problematic internet use, and internet gaming disorder among 866 high school students (grades 9–12) in Turkey, Bingöl and their associated with impulsivity, emotional regulation, depression, anxiety, and stress.
Methods:
The sample was selected using a convenience sampling approach. Data were collected via online questionnaires using validated scales and analysed with SPSS package programme.
Results:
The prevalence of food addiction was 6.9%, problematic internet use 14.3%, and internet gaming disorder 0.9%. Problematic internet use relatively high prevalence likely reflects adolescents’ increased exposure to digital devices. Mental health factors were found to be significantly related to behavioural addictions: depression, anxiety, and stress predicted food addiction; depression and stress predicted problematic internet use, and anxiety was linked to internet gaming disorder.
Conclusions:
This study contributes to the literature by examining multiple behavioural addictions and their common risk factors simultaneously and provides a comprehensive perspective. It is also one of the rare studies examining food addiction with other behavioural addictions. More research is needed to develop better intervention programmes and policies in the issue.
We are in a metacrisis caused by exponential growth, extraction and entitlement. When we strive to abolish the abundant absurdities of the current system (i.e., modernity) with rehabilitative or reformist responses, we risk reproducing, even reinforcing, the very dynamics we seek to transform. The sensing seed is a visual heuristic and practice of resonant embodied ethics to aid in unravelling the machinations of modernity. The seed identifies three polarities that reflect salient patterns of modernity: separateness, linearity and abstraction. The sensing seed is designed to surface the many materialisations of modernity while elucidating ethical entrées that are decolonially discordant with dominant dispositions by enabling reflexive, visceral and committed praxes of the many adjacent alternatives available, but largely imperceptible, even unimaginable, to modern humans. Through radical acceptance, attention to aesthesis and action, we can show up, cultivate connexion, kindle kin, grow groundward, tarry with trouble, abide in aporias and wallow in wiser lifeways akin to those of our pre-modern (i.e., primal) ancestors.
Crystal cells in echinoderms have been described in the literature as a type of coelomocyte (immune cell) containing a crystalline structure. Their putative function has been widely ascribed to osmoregulation but this assertion was never robustly tested. In the present paper, a review of crystal cells and crystalline structures provides evidence supporting a different identity and function. First, the same microcrystals can be found either free or encapsulated by a cell membrane (with or without a structure resembling a nucleus). Specifically, they are typically non-encapsulated when found inside tissues of internal organs and encapsulated when free floating in the hydrovascular or perivisceral fluids. Although usually individually packaged, microcrystals were also observed encapsulated in groups of up to four, with or without other particles. Their morphological features, coupled with their chemical and optical properties, match that of microcrystals of uric acid, described in other phyla, including chordates. Two pathways of excretion of these crystallised by-products were evidenced: rejected with sea water out of the respiratory tree and expelled via transrectal coelomoducts among coelomocyte aggregates. Overall, the present synthesis strongly supports that ‘crystal cells’ historically described as a distinct type of coelomocyte in holothuroids are phagocytes that have engulfed uric acid microcrystals generated as waste by metabolic activities.
Cognitive fatigability (CF), which refers to a decline in performance during sustained cognitive effort, can significantly impact people with multiple sclerosis (PwMS). This study examined the unmet needs related to perceived CF in PwMS.
Methods:
One hundred PwMS completed a survey assessing factors known to contribute to CF. Participants indicated whether each factor, including CF itself, was disruptive and whether adequate support was available to address these concerns. A factor identified as disruptive and insufficiently addressed was considered an unmet need (Need Index [NI] ≥50%).
Results:
Group-level analysis revealed no significant unmet needs, although fatigue (NI = 30.23), CF (NI = 22.96) and physical activity (NI = 19.55) were more frequently reported. Individual-level analyses revealed that unmet needs varied by community setting (rural vs urban) and socioeconomic status (SES) (lower vs higher SES), with rural participants and those with lower SES reporting higher rates of unmet needs. In addition, PwMS who indicated CF was an unmet need reported more difficulties across most contributory factors, including sleep quality, fatigue, cognitive impairment, depression and contextual factors. The presence of fatigue and CF combined contributed to greater unmet needs across various domains, especially fatigue, CF and cognitive impairment, compared to fatigue alone.
Conclusions:
Participants from rural and low socioeconomic backgrounds were more likely to have unmet needs. Notably, 36% of participants (N = 33) reported unmet needs related to perceived CF. The findings highlight the importance of tailoring future interventions to address identified needs more adequately.
Parental prenatal mood and anxiety disorders (PMADs) are linked to child neurodevelopmental disorders (NDDs), but evaluations of the magnitude and mechanisms of this association are limited. This study estimates the strength of the association and whether it is impacted by genetic and environmental factors.
Methods
A systematic search of PubMed, CENTRAL, PsycINFO, OVID, and Google Scholar was performed for articles published from January 1988 to September 2025. Of 2,420 articles screened, 74 met the inclusion criteria. Meta-analyses were conducted on 21 studies, and 53 were included in the narrative synthesis. We conducted random-effects meta-analyses, along with tests for heterogeneity (I2) and publication bias (Egger’s test). The review followed PRISMA and MOOSE guidelines.
Results
Maternal PMADs were associated with a significantly increased risk of attention-deficit/hyperactivity disorder (ADHD; odds ratio [OR] 1.91, 95% confidence interval [CI] 1.45–2.52) and autism spectrum disorder (ASD; OR 1.75, 95% CI 1.43–2.14) in children. Paternal PMADs were also associated with the risk of NDDs, with combined odds for ASD and ADHD (OR = 1.23, 95% CI 1.14–1.33). Several studies suggested that the link between parental PMADs and offspring NDDs might be impacted by both genetic and environmental factors, including the impact of ongoing parental depression on child behavior.
Conclusions
Parental PMADs are associated with increased risk of NDDs in children. These findings likely reflect a combination of inherited liability and environmental processes; clarifying mechanisms will require genetically informed designs. Regardless of mechanism, offering optional, family-centered developmental support may help promote child well-being in families where a parent is experiencing PMADs.