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A 15-year-old female presented with exertional chest pain and near-syncope. Imaging revealed a large left sinus of Valsalva aneurysm compressing the left coronary artery. She underwent successful surgical repair. Intraoperative and pathologic findings confirmed Takayasu arteritis. This case highlights a rare aetiology of cardiac chest pain in adolescents and underscores the importance of evaluating for an underlying vasculitis when a sinus of Valsalva aneurysm is identified.
Since about 1960, the study of petroglyphs and pictographs has escaped the confines of anthropology, art history, and philology and established itself as a discrete field of transdisciplinary scholarship, supported by its own organizations, periodicals, and lexicon. “Rock art research” emerged as the field’s moniker, and “rock art” became the most popular term for describing anthropogenic marks in and on geological surfaces. However, this label has sparked controversy over whether “art” is an accurate, ethical, and inclusive gloss for non-Western and premodern imagery. Although some pragmatic scholars, preservationists, and descendant community representatives accept this nomenclature, others find it imprecise, distracting, and, at times, offensive. We advance this debate with results from two surveys. First, a review of article titles published since 1865 shows that “rock art” is just one of many terms used in the field, and it is one of the youngest. Second, a survey of federally recognized Tribes found strong though not universal dissatisfaction with “rock art” to characterize ancestral petroglyphs and pictographs. As a bridge between field practitioners and descendant communities, we recommend that researchers and organizations work with Tribes to develop and use terms that are respectful, useful, and of mutual benefit.
Zn and Mn are essential nutrients for fetal growth and development. Since deficiency of maternal nutrition may lead to preventable adverse pregnancy outcomes, we aimed to examine the association of maternal dietary Zn and Mn levels with low birth weight (LBW). A nested case–control study was conducted in 605 cases and 7497 controls in Lanzhou, China. Eligible participants reported on their diet and characteristics during pregnancy. The relationship between dietary Zn and Mn intake and the risk of LBW was analysed by unconditioned logistic regression and multivariate adjusted restricted cubic spline model. The receiver operating characteristic curve was used to determine the optimal cut-off values of Zn and Mn. The dietary intake below the cut-off value was defined as the low-level group, and greater than or equal to the cut-off value was defined as the high-level group. Low dietary Zn (<5·05 mg/d before pregnancy and <7·36 mg/d during pregnancy) and Mn (<2·66 mg/d before pregnancy and <3·41 mg/d during pregnancy) intake was associated with increased risk of LBW and some subtypes. Both Zn and Mn have a nonlinear relationship with the risk of LBW (P < 0·001). In addition, there was a synergistic effect of low Zn and low Mn intake on LBW risk. There were separate and interaction effects of Zn and Mn on the occurrence of LBW. An appropriate range of Zn and Mn intake may be beneficial to reduce the risk of LBW.
Submesoscale processes, typically shaped by intricate interactions between frontal dynamics and turbulence, have significant impacts on the transport of momentum, heat and biogeochemical tracers in the ocean. This study employs large-eddy simulations to investigate submesoscale frontogenesis and arrest in the ocean surface boundary layer. We compare a single-sided front with a dense filament, which can be viewed as a two-sided front. Both cases exhibit a similar life cycle, including frontogenesis driven by secondary circulation, frontal arrest due to the growth of instability and turbulence, and eventual frontal decay. One major difference is that the filament remains stationary throughout its life cycle, while the front propagates towards the denser side. Another distinction lies in the relative contributions of horizontal and vertical turbulent fluxes. In the filament case, horizontal (cross-front) turbulent flux dominates and effectively counteracts the frontogenetic tendency induced by secondary circulation, leading to frontal arrest. In contrast, both vertical and horizontal turbulent fluxes are crucial for the arrest of the single-sided front. Horizontal shear production is the primary source of turbulence in the filament, associated with the emergence of horizontal coherent eddies and consistent with the characteristics of horizontal shear instability. For the front, the development of horizontal eddies is less pronounced, and vertical shear production plays a more important role. This study reveals the similarities and differences between the dynamics of submesoscale fronts and filaments, as well as the role of turbulence in their evolution, providing insights for improved representation of these processes in ocean models.
Interfacial interactions between gas bubbles and the free surface are a hallmark of flows involving aqueous foams. In practice, bubble foams commonly arise from processes such as breaking waves at the ocean–atmosphere interface, plunging liquid jets and the effervescence of carbonated liquids. Once generated, bubbles within foam layers remain afloat at the free surface for finite durations before finally bursting into a fine spray of droplets. While the birth and bursting of bubble foams have received considerable attention, the understanding of floating bubbles is limited mainly to a single bubble. To build on this, in this article, we undertake numerical simulations of two or more floating bubbles in various canonical settings to examine their geometry and self-organising nature, with implications for real-world phenomena such as ocean spray production. Under lateral confinement, floating bubbles are prone to form vertically stacked layers. To this end, we analyse the geometry of coaxial pairs of floating bubbles and link geometrical differences between single and coaxial bubbles to various aspects of the ensuing bursting stage. Furthermore, we extend the existing theory of isolated floating bubbles to obtain unified analytical expressions for the shape parameters of single and coaxial bubbles of small sizes. Next, we investigate a pair of side-by-side floating bubbles, which serves as a minimal configuration to understand the formation of bubble rafts through self-organisation. We discover that Bond numbers in the range $10\leqslant \textit{Bo}\leqslant 50$ are more favourable for raft formation due to pronounced capillary attraction. The time required for two floating bubbles to assemble through capillary attraction grows exponentially with their initial separation. We also develop a linear model to capture the evolution of bubble spacing during capillary migration at low Bond numbers. Lastly, we extend the two-bubble configuration and showcase the emergent dynamics of a swarm of floating bubbles in mono- and bilayer configurations.
This work presents wavepacket models for supersonic round twin jets operating at perfectly expanded conditions, computed via plane-marching parabolised stability equations based on mean flows obtained from the compressible Reynolds-averaged Navier–Stokes (RANS) equations. High-speed schlieren visualisations and non-time-resolved PIV measurements are performed to obtain experimental datasets for validating the modelling strategy. The RANS solutions are found to be in good quantitative agreement with the particle image velocimetry (PIV) mean-flow measurements, confirming the ability of the approach to capture the interaction between jets at the mean-flow level. The obtained wavepackets consist of toroidal and flapping fluctuations of the twin-jet system, and show similarities with those of single axisymmetric jets. However, for the case of closely spaced jets, they exhibit deviations in the phase speed of structures travelling in the outer mixing layer and those travelling in the inner one, leading to different non-axisymmetric behaviours. In particular, toroidal twin-jet wavepackets feature tilted ring-like structures with respect to the jet axis, while flapping twin-jet wavepackets are distorted and lose the clean chequerboard pattern typically observed in $m = 1$ modes in axisymmetric jets. A quantitative comparison of the modelled wavepackets with experimentally educed coherent structures is performed in terms of their structural agreement measured through an alignment coefficient, providing a first validation of the modelling strategy. Alignment coefficients are found to be particularly high in the intermediate range of studied frequencies.
We prove that for bounded, divergence-free vector fields $\boldsymbol{b}$ in $L^1_{loc}((0,1];BV(\mathbb{T}^d;\mathbb{R}^d))$, there exists a unique incompressible measure on integral curves of $\boldsymbol{b}$. We recall the vector field constructed by Depauw in [8], which lies in the above class, and prove that for this vector field, the unique incompressible measure on integral curves exhibits stochasticity.
Nucleation phenomena associated with cloud cavitation about a three-dimensional (3-D) NACA$\,$16-029 hydrofoil are explored experimentally in a cavitation tunnel where susceptible free stream nuclei are absent. Microbubble nuclei are found to be intrinsically generated by cavity collapse and become sequestered in the low-momentum separated region ahead of the cavity leading edge. Nuclei dynamics upstream of a shedding sheet cavity was investigated using high-speed photography. Measurements were performed at zero incidence for cavitation numbers in the range of $0.55 \gt \sigma \gt 0.45$, and chord-based Reynolds numbers of $ \textit{Re} = 0.75\times 10^6$ and $ \textit{Re} = 1.5\times 10^6$. Nuclei are generated each shedding cycle due to cavity breakup from condensation shock-wave phenomena. These nuclei may undergo immediate activation or transport due to pressure gradients, local re-circulation and jetting. Some nuclei remain upstream of the cavity leading edge over multiple cycles. Several phenomena influence this behaviour, including cyclical variation of the boundary layer properties with each shedding cycle. A major conclusion of the work is that these nuclei are produced in a self-sustaining manner from near surface, small scale, interfacial or viscous phenomena rather than from surface or free stream nuclei. Additionally, these experiments reveal the low-momentum region upstream of the cavity to be above vapour pressure, despite the meta-stable tension developed in the boundary layer further upstream of the cavity.
This paper estimates the scarring effect of recessions on corporates’ investment and how it is amplified by the level of corporate debt. Our results suggest that the effect of firms’ debt in shaping the response of investment to recessions is statistically significant and economically sizeable, with high-debt firms seeing a larger decline in investment. Back-of-the-envelope calculations suggest that firms’ debt accounts for at least 28% of the average medium-term decline of investment. This effect is especially larger for: (i) countries with less efficient bankruptcy systems; (ii) during global recessions and firms operating in sectors with higher export dependences; and (iii) firms that are credit-constrained—small and less profitable firms, and those with high share of short-term debt.
This study aimed to report a 10-year single-centre experience of cochlear implantation in children with CHARGE syndrome (manifests as coloboma, heart defects, atresia of the choanae, growth retardation and genital and ear anomalies) and evaluate surgical strategies and outcomes.
Methods
Children with CHARGE syndrome who underwent cochlear implantation between 2014 and 2024 were retrospectively reviewed. Patient characteristics and post-operative auditory outcomes were analysed.
Results
Six patients (nine ears) were included. Most had airway anomalies, one-third required post-operative intensive care. Temporal bone malformations were present in 78 per cent of ears. Standard posterior tympanotomy was feasible in one-third; the remainder required transcanal or combined approaches. Full-electrode insertion was achieved in all ears. Median follow-up was 3.4 years; aided thresholds ranged 25 to 50 dB hearing level. Three patients developed reliable open-set speech perception, two achieved closed-set recognition and one demonstrated environmental sound awareness.
Conclusion
Cochlear implantation provides meaningful auditory benefit in selected children with CHARGE syndrome. Pre-operative cochlear nerve imaging, flexible surgical planning and coordinated peri-operative airway management are essential.
Oxidative stress is an important pathomechanism in psoriasis, and the oxidative balance score (OBS) serves as a standardised metric for assessing systemic oxidative status, but its association with psoriasis is unclear. This study included 18 023 adults from the National Health and Nutrition Examination Survey to investigate the relationship between OBS and psoriasis. After using a complex sampling weighting method, we performed multi-model logistic regression and stratified analysis with OBS as the exposure and psoriasis as the outcome for the primary analysis. Restricted cubic spline (RCS) plots were used to evaluate potential non-linear associations between OBS and psoriasis. In addition, we performed replication analyses using two 24-h dietary records data as a sensitivity test to ensure robustness of the results. Multi-model logistic regression analyses revealed no statistically meaningful link between OBS and psoriasis prevalence when accounting for all confounders (P > 0·05), but in stratified analyses, OBS demonstrated a significant association with reduced risk of psoriasis in individuals aged 60–80 years (OR = 0·27–0·35, P < 0·05). As part of the overall OBS, moderate dietary OBS demonstrated an association with reduced psoriasis risk in 60- to 80-year-olds (OR = 0·39–0·43, P < 0·05). Lifestyle OBS (LOBS) indicates a significant negative correlation with psoriasis risk among the ‘Other Hispanic’ group. (Q3 OR = 0·23, P < 0·05). The RCS showed a non-linear relationship between LOBS and psoriasis (non-linear P = 0·013). This study provides the first systematic confirmation of an association between OBS and a reduced risk of psoriasis in elderly populations and specific ethnic groups. These findings offer new insights and directions for the prevention and treatment of psoriasis.
Strategic trajectory planning (STP) is critical for improving flight efficiency and ensuring operational safety, particularly in large-scale flight operations. Given the long lead time of STP, accurately analysing wind forecast uncertainty is essential to enhancing the quality of planned trajectories. However, most existing research overlooks the time-variant nature of wind forecast uncertainty. This may lead to significant discrepancies between planned and actual flight trajectories, increasing operational costs and conflict risks. Therefore, this paper proposes a novel bilevel STP framework for large-scale flights that explicitly accounts for time-variant wind forecast uncertainty. The upper-level model optimises trajectories across multiple flights to minimise total flight time, based on the departure times determined by the lower-level model. The lower-level model mitigates potential conflicts by adjusting the departure times according to the trajectories selected by the upper level. To solve this problem efficiently, a time-variant A* algorithm (TVA*) and a multi-objective cooperative co-evolution algorithm (MOCCEA) are developed, supported by static expectation (SE) and dynamic equilibrium grouping (DEG) strategies to accelerate computation. Experimental results confirm that the proposed method yields consistently dominant Pareto fronts, significantly enhancing flight efficiency while ensuring operational safety and fairness.
In children with tetralogy of Fallot and associated right ventricular outflow tract obstruction, right ventricular outflow tract stenting has emerged as a viable alternative to surgical shunting, particularly in high-risk patients who are unsuitable for early definitive repair.
Methods:
This prospective and retrospective observational study involved 55 symptomatic children with Fallot-type physiology who underwent right ventricular outflow tract stenting over a 30-month period at a tertiary-care centre in India. Data from pre-procedural imaging, intraoperative parameters, and post-procedural outcomes were analysed. The primary endpoints were improvement in systemic oxygen saturation and pulmonary artery growth. Secondary endpoints included complication rates, ICU stay duration, and factors associated with procedural failure.
Results:
The median age at intervention was 11 months. All patients presented with cyanosis, and 80% had documented cyanotic spells. The right internal jugular vein was used for vascular access in 75% of cases. A significant improvement was observed in systemic oxygen saturation (from 67.8 to 87.1%, p < 0.001), along with an increase in pulmonary artery Z-scores. Complications included pulmonary oedema (47%), stent migration (7.2%), and new-onset tricuspid regurgitation (26.9%). The procedure had a success rate of 83.6%. Although no significant predictors of failure or prolonged ICU stay were identified, furosemide use was associated with a longer recovery time.
Conclusion:
Right ventricular outflow tract stenting serves as a safe, effective, and reproducible palliative option in selected neonates with Fallot physiology. It facilitates improved systemic oxygenation and promotes pulmonary artery development, thereby serving as a bridge to definitive surgical repair.
As breeding has become increasingly specialized over the last decades, modern dairy breeds have mainly been focusing on milk production, producing bull and surplus female calves with low economic value. To address this dilemma, the present study evaluates how crossbreeding with the specialized beef breed Belgian Blue and pure breeding with Holstein-Friesian bulls affect calving ease and subsequent fattening performance, and carcass quality in Holstein-Friesian herds. For the study, pedigree information, calving information, as well as fattening performance and carcass quality parameters of 5,162 fattening bulls sired by either Holstein-Friesian (n = 4,607) or Belgian Blue (n = 555) sires from Holstein-Friesian cows in northern Germany were considered. Crossbred calves had higher birth weights and better carcass conformation ratings but also higher age at slaughter, carcass weight and average daily weight gain than purebred dairy calves, reflecting beef breeds’ superior muscle development. However, crossbreeding with Belgian Blue sires also increased the frequency of difficult births (dystocia), which has previously been shown to negatively impact calf health. The effect of parity was not relevant for fattening and carcass quality parameters but highlighted the present breeding practice of using beef sires in multiparous rather than in primiparous cows. Seasonal variations were also observed, with spring and summer-born bulls exhibiting faster weight gain.
The study aims to explain the challenges experienced by Emergency Medical Services workers in a massive disaster due to resource scarcity.
Methods
In this qualitative study, in-depth interviews were conducted with 14 Emergency Medical Services workers in the region within the first 72 hours of the Kahramanmaraş Earthquakes. Participants were determined by snowball sampling method, and data were collected using a semi-structured interview form. Collected data were evaluated using descriptive and content analysis methods.
Results
When the data were analyzed, the difficulties experienced by the participants were covered in two main themes and eight sub-themes. The main themes were physical and managerial challenges, and the sub-themes were nutrition, shelter and adverse weather conditions, hygiene, safety, sleep shortage and exhaustion, operational, logistics and transportation, communication and coordination.
Conclusion
The findings suggest that challenges in meeting the basic physical needs of Emergency Medical Services workers during massive disasters may reduce the overall effectiveness of response efforts. Ensuring their physical safety, particularly in large-scale earthquakes that cause severe structural damage, emerges as a persistent concern. Disaster preparedness efforts should more carefully consider the fragility and vulnerability of high-risk zones when developing national response plans.
The coalescence and breakup of drops are classic examples of flows that feature singularities. The behaviour of viscoelastic fluids near these singularities is particularly intriguing – not only because of their added complexity, but also due to the unexpected responses they often exhibit. In particular, experiments have shown that the coalescence of viscoelastic sessile drops can differ significantly from that of their Newtonian counterparts, sometimes resulting in a sharply distorted interface. However, the mechanisms driving these differences in dynamics, as well as the potential influence of the contact angle are not fully known. Here, we study two different flow regimes effectively induced by varying the contact angle and demonstrate how that leads to markedly different coalescence behaviours. We show that the coalescence dynamics is effectively unaltered by viscoelasticity at small contact angles. The Deborah number, which is the ratio of the relaxation time of the polymer to the time scale of the background flow, scales as $\theta ^3$ for $\theta \ll 1$, thus rationalising the near-Newtonian response. On the other hand, it has been shown previously that viscoelasticity dramatically alters the shape of the interface during coalescence at large contact angles. We study this large contact angle limit using two-dimensional numerical simulations of the equation of motion. We show that the departure of the coalescence dynamics from the Newtonian case is a function of the Deborah number and the elastocapillary number, which is the ratio between the shear modulus of the polymer solution and the characteristic stress in the fluid.
Boundary-layer instability and transition control have drawn extensive attention from the hypersonic community. The acoustic metasurface has become a promising passive control method, owing to its straightforward implementation and lack of requirement for external energy input. Currently, the effects of the acoustic metasurface on the early and late transitional stages remain evidently less understood than the linear instability stage. In this study, the transitional stage of a flat-plate boundary layer at Mach 6 is investigated, with a particular emphasis on the nonlinear mode–mode interaction. The acoustic metasurface is modelled by the well-validated time-domain impedance boundary condition. First, the resolvent analysis is performed to obtain the optimal disturbances, which reports two peaks corresponding to the oblique first mode and the planar Mack second mode. These two most amplified responses are regarded as the dominant primary instabilities that trigger the transition. Subsequently, both optimal forcings are introduced upstream in the direct numerical simulation, which leads to pronounced detuned modes before breakdown. The takeaway is that the location of the acoustic metasurface is significant in minimising skin friction and delaying transition onset simultaneously. The bispectral mode decomposition results reveal the dominant energy-transfer routine along the streamwise direction – from primary modes to low-frequency detuned modes. By employing the acoustic metasurface, the nonlinear triadic interaction between high- and low-frequency primary modes is effectively suppressed, ultimately delaying transition onset, whereas the late interaction related to lower-frequency detuned modes is reinforced, promoting the late skin friction. The placement of the metasurface in the linearly unstable region of the second mode delays the transition, which is due to the suppressed streak in the oblique breakdown scenario. However, in the late stage of the transition, the acoustic metasurface induces an undesirable increment of skin friction overshoot due to the augmented shear-induced dissipation work, which mainly arises from reinforced detuned modes related to the combination resonance. Meanwhile, by restricting the location of the metasurface upstream of the overshoot region, this undesirable augmentation of skin friction can be eliminated. As a result, the reasonable placement of the metasurface is crucial to damping the early instability while causing less negative impacts on the late transitional stage.
Path planning, as a critical component of mobile robotic systems, significantly impacts operational efficiency and energy consumption ratios. State-of-the-art algorithms often suffer from inadequate real-time adjustment capability, insufficient dynamic environment adaptation, and suboptimal computational efficiency. To resolve these limitations, we propose a bidirectionally optimized path planning algorithm named Bidirectional Q-learning LPA* (BQ-LPA*), which incorporates three key innovations. Specifically, to enhance the global search capability of the LPA* framework, we replace fixed heuristic functions with a Q-learning-driven adaptive heuristic mechanism, which improves path quality through dynamic heuristic weighting and update strategies. Additionally, to improve the convergence rate and sample efficiency of Q-learning in complex environments, we propose integrating the LPA* framework to provide prior knowledge guidance, which can effectively minimize redundant exploration attempts by informed pathfinding initialization. Moreover, the Q-learning method inherently faces dimensionality challenges in high-dimensional continuous spaces, which manifest as action space congestion, storage bottlenecks, and computational inefficiency. To mitigate these risks, we devise an LPA*-based space discretization strategy that can reduce action space dimensionality and preserve the path feasibility. Experimental results show that, compared with mainstream path planning algorithms, BQ-LPA* achieves higher accuracy and faster convergence in mobile robot path planning.