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Complications following the Fontan procedure include prolonged pleural drainage and readmission for effusions. To address these complications, a post-Fontan management pathway was implemented with primary goals of reducing chest tube duration/reinsertion rates and decreasing hospital length of stay and readmissions.
Methods:
Fontan patients were identified by retrospective chart review (2017–2019) to obtain baseline data for chest tube duration/reinsertion rates, hospital length of stay, and readmission rates for effusion. A post-Fontan management pathway was implemented (2020–2021) utilising post-operative vasopressin, nasal cannula oxygen until chest tube removal, and discharge regimen of three times daily diuretics, sildenafil, and afterload reducing medications. Patients were followed to evaluate primary outcomes.
Results:
The pre- and post-pathway groups were similar in single ventricle morphology, demographics, and pre-operative haemodynamics. Forty-three and 36 patients were included in the pre- and post-pathway cohorts, respectively. There were statistically significant reductions in chest tube duration (8 vs. 5 days, p ≤ 0.001), chest tube output on post-operative day 4 (20.4 vs. 9.9 mL/kg/day, p = 0.003), and hospital readmission rates for effusion (13[30%] vs. 3[8%], p = 0.02) compared to baseline. There was an absolute reduction in hospital length of stay (11 vs. 9.5 days, p = 0.052). When combining average cost savings for the Fontan hospitalisations, readmissions for effusion, and cardiac catheterisations within 6 months of Fontan completion, there was a $325,144 total cost savings for 36 patients following pathway implementation.
Conclusion:
Implementation of a post-Fontan management pathway resulted in significant reductions in chest tube duration and output, and readmission rates for effusion in the perioperative period.
Depuis Spitta-Bey (1880), une littérature riche et détaillée décrit invariablement l'inventaire vocalique de surface de l'arabe du Caire comme incluant des voyelles moyennes brèves, [e] et [o]. Une nouvelle ère s'ouvre un siècle plus tard avec l'apparition soudaine d'un consensus massif sur l'idée que les voyelles moyennes brèves ne sont pas attestées en arabe cairote. Une différence d'une telle nature et d'une telle ampleur a nécessairement des conséquences sur l'analyse du système phonologique. Certaines de ces conséquences sont mises en évidence dans le présent article. Il est montré que le déni de la présence de [e] et [o] dans la langue conduit mécaniquement à inférer l'existence de processus phonologiques fictifs, et qu'une description de la réalité impose la reconnaissance de ces voyelles. La littérature pertinente est passée en revue, des tests originaux permettant de vérifier cette affirmation sont proposés, ainsi que le témoignage de mesures instrumentales.
In this paper I examine the effect of introducing an account-based central bank digital currency (CBDC) on liquidity insurance and monetary policy implementation. An asset-exchange model is constructed with idiosyncratic liquidity risk, in which one type of agents require currency and/or CBDC to consume while the other type of agents can use any assets to trade. There arises a liquidity insurance to distribute assets efficiently by type. Since central bank reserve accounts are accessible by the public directly, the large excess reserves (LER) in a floor system can make it difficult to separate the types under private information. Therefore, raising the interest on reserves in the floor system can reduce the aggregate liquidity excessively, and the equilibrium allocation with the LER can be suboptimal.
States have long been understood to have an obligation to protect the international legal rights and interests of others, consistent with the maxim sic utere tuo ut alienum non laedas (use what is yours in such a manner as not to injure that of another). As the world's population becomes more interdependent, this no harm obligation becomes more significant. Further, as knowledge increases about the consequences of human activity for the climate and the environment, the no harm obligation takes on greater relevance vis-à-vis the interests of the Earth's future populations. Future generations’ legal interests have been recognized in the context of sustainable development and through the principle of intergenerational equity. The no harm rule requires that these interests be properly considered and addressed appropriately, commensurate with what is at stake. At a minimum, this may require avoidance of ‘manifestly excessive adverse impacts’.
The American sweet potato (Ipomoea batatas) is a globally important comestible crop that features prominently in Polynesian lore; however, the timing and mode of its Oceanic transplantation remain obscure. New research from the Māori cultivation site M24/11 in Aotearoa/New Zealand, presented here, offers a re-evaluation of evidence for the early use and distribution of the sweet potato in southern Polynesia. Consideration of plant microparticles from fourteenth-century archaeological contexts at the site indicates local cultivation of sweet potato, taro and yam. Of these, only sweet potato persisted through a post-1650 climatic downturn it seems, underscoring the enduring southern-Polynesian appeal of this hardy crop.
In this work we investigate the spatio-temporal nature of various coherent modes present in a wind turbine wake using a combination of new particle image velocimetry experiments and data from Biswas & Buxton (J. Fluid Mech., vol. 979, 2024, A34). A multiscale triple decomposition of the acquired velocity field is sought to extract the coherent modes and, thereafter, the energy exchanges to and from them are studied using the multiscale triple decomposed coherent kinetic energy budgets developed by Baj & Buxton (Phys. Rev. Fluids, vol. 2, 2017, 114607). Different frequencies forming the tip vortex system (such as the blade passing frequency, turbine's rotational frequency and their harmonics) are found to be energised by different sources such as production from the mean flow or nonlinear triadic interaction or both, similar to the primary, secondary or the mixed modes discussed in Biswas et al. (J. Fluid Mech., vol. 941, 2022, A36). The tip vortex system forms a complex network of nonlinear triadic energy transfers, the nature and the magnitudes of which depend on the tip speed ratio ($\lambda$). Contrastingly, the modes associated with the sheddings from the nacelle or tower and wake meandering are found to be primarily energised by the mean flow. We show that the tip vortex system exchanges energy with the mean flow primarily through the turbine's rotational frequency. In fact, the system transfers energy back to the mean flow through the turbine's rotational frequency at some distance downstream marking the onset location of wake recovery ($x_{wr}$). Here $x_{wr}$ is shown to reduce with $\lambda$ due to stronger interaction and earlier merging of the tip vortices at a higher $\lambda$.
Many paediatric studies report that patients must be established on aspirin therapy for a minimum of 5 days to achieve adequate response. This is not always practical especially in critical settings. Prospective identification of patients that are unresponsive to aspirin sooner could potentially prevent thrombotic events.
Aims:
The aim of this study was to investigate prospectively if the first dose of aspirin is effective in decreasing platelet aggregation, and thromboxane formation and if this can be measured after 2 hours in paediatric cardiology patients. A secondary aim was to identify a cut-off for a novel marker of aspirin responsiveness the maximum amplitude with arachidonic acid, which could potentially dramatically reduce the blood volume required. Third, we aimed to prospectively identify potentially non-responsive patients by spiking a sample of their blood ex vivo with aspirin.
Results:
The majority (92.3%) of patients were responsive, when measured 2 hours post first dose of aspirin. Non-response or inadequate response (7.7%) can also be identified at 2 hours after taking the first dose of aspirin. Additionally, we have shown a novel way to reduce blood sample volume requirements by measurement of the maximum amplitude with arachidonic acid as a marker of response, particularly for monitoring.
Conclusions:
These findings of rapid efficacy in the majority of patients offer assurance in a sound, practical way to attending clinicians, patients, and families.
A young child, who had a previously unsuspected aberrant right subclavian retro-oesophageal artery, swallowed a button battery complicated with recurrent life-threatening bleeding, and survived after repeated percutaneous treatment as a bridge to surgery.
This work aims to characterize and study the properties of an Algerian diatomaceous earth (Sig-Mascara) as a catalyst carrier. A commercial product of diatomite was characterized by granulometric analysis, X-ray fluorescence, X-ray diffraction, Fourier-transform infrared spectroscopy, thermogravimetric analysis/differential scanning calorimetry and scanning electron microscopy/energy-dispersive X-ray spectroscopy methods. To purify the diatomite and remove the impurities (iron oxides, clay minerals, quartz and organic matters), the <63 μm fraction of the diatomite was separated out. The 15Ni/Ds-700 catalyst has lower SiO2, Al2O3 and CaO contents compared with the original diatomite. The NiO content of the catalyst is 15 wt.%, indicating successful impregnation. According to the nitrogen sorption–desorption results, the specific surface area of the purified diatomite particles (<63 μm) increased from 26.47 to 46.33 m2 g–1 compared to crude diatomite. The 15Ni/Ds-700 catalyst was applied in the dry reforming of methane to obtain synthesis gas (CO and H2). The results showed that the catalyst was relatively stable during catalytic measurements for 6 h, although the conversion rate value was low (12%).
Sport climbing requires a combination of physical and cognitive skills, with working memory (WM) playing a crucial role in performance. This study aimed to investigate the association between WM capacity and climbing ability, while considering potential confounding factors including sex, age, education level, and climbing experience. Additionally, the study compared prefrontal cortex (PFC) hemodynamic responses among different climbing ability groups and sex during WM performance. Twenty-eight climbers participated, with WM assessed using the eCorsi task and PFC hemodynamic responses measured with near infrared spectroscopy (NIRS). Initial linear regression analyses revealed no association between WM and climbing ability. However, significant associations were found after adjustment for covariates. Specifically, sex (p = .014), sex in conjunction with age (p = .026), sex combined with climbing experience (p = .022), and sex along with education level (p = .038) were identified as significant predictors of differences in WM between Expert and Elite climbers. Additionally, notable differences in PFC hemodynamic responses were observed between Expert and Elite climbers, as well as between sexes during the WM task, providing support for differences in WM capacity. This study contributes to understanding the complex relationship between WM capacity and climbing performance, emphasizing the need to account for influencing factors in assessments.
Dynamic stall at low Reynolds numbers, $Re \sim O(10^4)$, exhibits complex flow physics with co-existing laminar, transitional and turbulent flow regions. Current state-of-the-art stall onset criteria use parameters that rely on flow properties integrated around the leading edge. These include the leading edge suction parameter or $LESP$ (Ramesh et al., J. Fluid Mech., vol. 751, 2014, pp. 500–538) and boundary enstrophy flux or $BEF$ (Sudharsan et al., J. Fluid Mech., vol. 935, 2022, A10), which have been found to be effective for predicting stall onset at moderate to high $Re$. However, low-$Re$ flows feature strong vortex-shedding events occurring across the entire airfoil surface, including regions away from the leading edge, altering the flow field and influencing the onset of stall. In the present work, the ability of these stall criteria to effectively capture and localize these vortex shedding events in space and time is investigated. High-resolution large-eddy simulations for an SD7003 airfoil undergoing a constant-rate, pitch-up motion at two $Re$ (10 000 and 60 000) and two pitch rates reveal a rich variety of unsteady flow phenomena, including instabilities, transition, vortex formation, merging and shedding, which are described in detail. While stall onset is reflected in both $LESP$ and $BEF$, local vortex-shedding events are identified only by the $BEF$. Therefore, $BEF$ can be used to identify both dynamic stall onset and local vortex-shedding events in space and time.
Frank H. Knight is rightly regarded as having identified the distinction between risk and uncertainty and their respective roles in the entrepreneurial process in his 1921 Risk, Uncertainty, and Profit. Less well appreciated is his recognition of the work of Fred Manville Taylor in this work, even though throughout Knight made several laudatory references to Taylor’s Principles. This article will examine through the various editions of Taylor’s textbook parallels between Taylor and Knight in their respective understandings of the risk-uncertainty distinction and the emphasis each placed on the role of the entrepreneur.
The Personal Need for Structure (PNS) scale assesses individuals’ tendency to seek out clarity and structured ways of understanding and interacting with their environment. The main aim of this study was to adapt the PNS scale to Spanish and assess its psychometric properties. There are two versions of the PNS scale being used, which vary in the number of dimensions (1 vs. 2), and in the number of items (12 vs. 11; because one version excludes Item 5). Therefore, an additional aim of this study was to compare the two existing versions of the PNS scale. This comparison aimed to address the debate regarding the inclusion of Item 5, and the number of dimensions that comprise the PNS scale. A sample of 735 individuals was collected. First, through an approach combining exploratory and confirmatory analyses, evidence was found in favor of the scale being composed of two related but distinguishable factors: Desire for Structure and Response to the Lack of Structure. Scores on these subscales showed acceptable internal consistency and test-retest reliability. Evidence supporting the invariance of the internal structure across sociodemographic variables such as gender and age was found. Validity evidence was also analyzed by examining the relationships with other relevant measures. The results indicated that Item 5 can be excluded without reducing scores validity or reliability, which supports preceding research in the literature. In conclusion, the PNS scale was satisfactorily adapted to and validated in Spanish and its use in this context is recommended.