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We report a case of dilated cardiomyopathy-like hypertensive cardiomyopathy (HTN-CM) with polycystic kidney disease without family history when a 3-month-old boy developed bacteraemia secondary to a urinary tract infection. He was later confirmed as having autosomal recessive inheritance due to the proven PKHD1 gene mutation. The treatment consisted mainly of antihypertensive and anti-heart failure therapies and he was discharged on the 131st day. To prevent the development of heart failure in patients with HTN-CM due to autosomal recessive polycystic kidney disease (ARPKD), it is important to improve the fetal diagnosis rate of ARPKD, detect hypertension early, and strictly control the blood pressure after birth.
It is known established that the cardiac effects of COVID-19 infection are associated with poor prognosis and high mortality rates in infected patients. The aim of this study was to evaluate the cardiac effects of COVID-19 infection in paediatric patients and identify the correlations between clinical and laboratory data and the degree of cardiac involvement.
Materials and Methods:
A retrospective data analysis was conducted on 64 paediatric patients at Gazi University Department of Pediatrics who were treated as inpatients with a diagnosis of COVID-19. Patients were classified as “COVID-19-related cardiac involvement cases” if their electrocardiogram and echocardiogram results indicated a pathology and/or if their laboratory data indicated increased cardiac enzymes. All patients were divided into subgroups based on whether they had cardiac involvement and whether they were diagnosed with multisystem inflammatory syndrome in children.
Results:
In comparison to patients who did not have cardiac involvement, those with cardiac involvement had significantly higher levels of hs-Troponin T, Pro-BNP, and D-dimer. Patients with multisystem inflammatory syndrome in children had significantly longer PR intervals than those without multisystem inflammatory syndrome in children (p = 0.0001). Patients with multisystem inflammatory syndrome in children had a significantly higher rate of pathological valve insufficiencies (68.1%) than those without multisystem inflammatory syndrome in children (14.2%) (p = 0.001).
Conclusion:
In our study, the strongest predictive biomarker of cardiac involvement in paediatric patients with COVID-19 infection was determined to be hs-Troponin T. It was observed that pathologic electrocardiogram changes could reflect cardiac involvement in the absence of any other signs. Patients with multisystem inflammatory syndrome in children exhibited significantly greater rates of pathologic echocardiogram findings and myocardial dysfunction than those without multisystem inflammatory syndrome in children. In all patients, pathologic electrocardiogram and echocardiogram findings were found to be strongly associated with the severity of inflammation.
A perennial problem for sociolinguists interested in morphosyntactic variation is that such forms are often low frequency, making quantitative analysis difficult or impossible. However, sociolinguists have been generally reluctant to adopt methodologies from syntax, such as acceptability data gleaned from speaker intuition, due to the belief that these judgments are not necessarily reliable. In this article we present data from the Scots Syntax Atlas, which employs sociolinguistic methodologies in spoken data alongside the results of acceptability judgments. We target three morphosyntactic variables and compare and contrast these across the two data types in order to assess the reliability of the judgment data at community level. The results show that reliability is variable-dependent. For some variables, there is clear correlation; with others, it appears that, as Labov (1996) phrased it, ‘intuitions fail’. We discuss how factors such as salience, social stigma and local identity combine to govern the reliability of judgment data.
The practical implementation of machine learning in flow control is limited due to its significant training expenses. In the present study the convolutional neural network (CNN) trained with the data of the restricted nonlinear (RNL) model is used to predict the normal velocity on a detection plane at $y^+=10$ in a turbulent channel flow, and the predicted velocity is used as wall blowing and suction for drag reduction. An active control test is carried out by using the well-trained CNN in direct numerical simulation (DNS). Substantial drag reduction rates up to 19 % and 16 % are obtained based on the spanwise and streamwise wall shear stresses, respectively. Furthermore, we explore the online control of wall turbulence by combining the RNL model with reinforcement learning (RL). The RL is constructed to determine the optimal wall blowing and suction based on its observation of the wall shear stresses without using the label data on the detection plane for training. The controlling and training processes are conducted synchronously in a RNL flow field. The control strategy discovered by RL has similar drag reduction rates with those obtained previously by the established method. Also, the training cost decreases by over thirty times at $Re_{\tau }=950$ compared with the DNS-RL model. The present results provide a perspective that combining the RNL model with machine learning control for drag reduction in wall turbulence can be effective and computationally economical. Also, this approach can be easily extended to flows at higher Reynolds numbers.
The nature and behaviour of the drag coefficient $C_D$ of irregularly shaped grains within a wide range of Reynolds numbers $Re$ is discussed. The morphology of the grains is controlled by their fractal description, and they differ in shape. Using computational fluid dynamics tools, the characteristics of the boundary layer at high $Re$ has been determined by applying the Reynolds-averaged Navier–Stokes turbulence model. Both grid resolution and mesh size dependence are validated with well-reported previous experimental results applied in flow around isolated smooth spheres. The drag coefficient for irregularly shaped grains is shown to be higher than that for spherical shapes, also showing a strong drop in its value at high $Re$. This drag crisis is reported at lower $Re$ compared to the smooth sphere, but higher critical $C_D$, demonstrating that the morphology of the particle accelerates this crisis. Furthermore, the dependence of $C_D$ on $Re$ in this type of geometry can be represented qualitatively by four defined zones: subcritical, critical, supercritical and transcritical. The orientational dependence for both particles with respect to the fluid flow is analysed, where our findings show an interesting oscillatory behaviour of $C_D$ as a function of the angle of incidence, fitting the results to a sine-squared interpolation, predicted for particles within the Stokes laminar regime ($Re\ll 1$) and for elongated/flattened spheroids up to $Re=2000$. A statistical analysis shows that this system satisfies a Weibullian behaviour of the drag coefficient when random azimuthal and polar rotation angles are considered.
In order to solve the problem of the insufficient adaptability of the current small- and medium-sized casting sorting robot gripper, we have designed a casting sorting robot bionic gripper with rigid–flexible coupling structures based on the robot topology theory. The second-order Yeoh model was used to statically model the clamping belt in the gripper to derive the relationship between the external input air pressure and the bending angle of the driving layer, and the feasibility of multiangle bending of the driving layer was verified by finite element analysis. The maximum gripping diameter of the gripper is 140 mm, and in order to test the adaptive gripping ability of the gripper, a prototype of the casting sorting robot gripper is prepared, and the pneumatic control system and human–machine interface of the gripper are designed. After several experimental analyses, the designed casting sorting robot gripper is characterized by strong adaptability and high robustness, with a maximum load capacity of 930 g and a maximum wrap angle of 296°, which can complete the gripping operation within 1 s, and the comprehensive gripping success rate reaches 96.4%. The casting sorting robot gripper designed in the paper can provide a reference for the design and optimization of various types of shaped workpiece gripping manipulators.
Physical vapor deposited (PVD) molybdenum disulfide (nominal composition MoS2) is employed as a thin film solid lubricant for extreme environments where liquid lubricants are not viable. The tribological properties of MoS2 are highly dependent on morphological attributes such as film thickness, orientation, crystallinity, film density, and stoichiometry. These structural characteristics are controlled by tuning the PVD process parameters, yet undesirable alterations in the structure often occur due to process variations between deposition runs. Nondestructive film diagnostics can enable improved yield and serve as a means of tuning a deposition process, thus enabling quality control and materials exploration. Grazing incidence X-ray diffraction (GIXRD) for MoS2 film characterization provides valuable information about film density and grain orientation (texture). However, the determination of film stoichiometry can only be indirectly inferred via GIXRD. The combination of density and microstructure via GIXRD with chemical composition via grazing incidence X-ray fluorescence (GIXRF) enables the isolation and decoupling of film density, composition, and microstructure and their ultimate impact on film layer thickness, thereby improving coating thickness predictions via X-ray fluorescence. We have augmented an existing GIXRD instrument with an additional X-ray detector for the simultaneous measurement of energy-dispersive X-ray fluorescence spectra during the GIXRD analysis. This combined GIXRD/GIXRF analysis has proven synergetic for correlating chemical composition to the structural aspects of MoS2 films provided by GIXRD. We present the usefulness of the combined diagnostic technique via exemplar MoS2 film samples and provide a discussion regarding data extraction techniques of grazing angle series measurements.
Premodern medicine used a variety of mineral substances for therapeutic purposes. The present article deals with pitch-asphalt, and, in particular, a precious kind of it called mūmiyāʾ originating in Persia. It was first described in detail in the Arabic pharmacological tradition, and its fame spread throughout the medieval Mediterranean, including Byzantium. By editing and examining for the first time a previously unexplored medieval Greek text on mūmiyāʾ, this study offers new insights into the medicinal uses of this substance. It also significantly increases our understanding of the intense cross-cultural transfer of medical knowledge from the Islamicate world to Byzantium by showing that this was not merely based on the translation of a few Arabic medical works into Greek, but was a multifaceted phenomenon involving a complex nexus of sources that require further investigation.
where $\Omega \subset \mathbb {R}^{n}$ is a bounded domain of class $C^{1,1}$, $1<p<({n+s})/({n-s}),\,n>\max \{1, 2s \}, 0<s<1, d>0$ and $\mathcal {N}_{s}u$ is the nonlocal Neumann derivative. We show that for small $d,$ the least energy solutions $u_d$ of the above problem achieve an $L^{\infty }$-bound independent of $d.$ Using this together with suitable $L^{r}$-estimates on $u_d,$ we show that the least energy solution $u_d$ achieves a maximum on the boundary of $\Omega $ for d sufficiently small.
This study proposes a new mechanism that can lead to layering or convection from the finite amplitude perturbation acting on the double diffusive convection with uniform background shear. We focus on the double diffusive convection in the diffusive regime with the cold fresh water laying above the warm salty water. We demonstrate that, although the unperturbed system is linearly stable, the finite amplitude perturbation can trigger the initial flow motions which subsequently obtain energy from the gravitational potential energy and from the uniform background shear, and evolve to layering or convection. By using the linear stability analysis for the initial growth stage and the energy analysis for the following transitional stage, the critical Richardson number can be predicted theoretically. Here the Richardson number measures the relative strength of stratification to the background shear. The dominant wavenumbers and the growth rates of the corresponding modes given by linear theory agree well with the two-dimensional direct numerical simulations, and so does the critical Richardson number predicted by the theoretical model. The layering state is dominated by the double diffusion process, while the convection state at smaller Richardson number exhibits stronger influences from shear and generates smaller heat and salinity fluxes. The theoretical model is further applied to the parameter range which is relevant to the real oceanic environments and reveals that for the typical density ratio observed in the staircase regions in the Arctic Ocean, the current mechanism can lead to layering for relatively weak shear.
Animal experimentation raises value conflicts between animal protection and other goods, such as freedom of inquiry or health and safety. If governments can phase out the practice by non-prohibitive incentive-setting, the pro tanto moral rationale for doing so is obvious. So why should they not? This article first sketches a fictional scenario in which a government adopts a phase-out plan for animal experimentation. It then considers two moral objections to this plan: First, the plan unduly restricts freedom of inquiry, and second, it merely displaces animal experimentation across borders and thus fails to reduce animal suffering. Both arguments are refined premise by premise to articulate their strongest versions. The two objections can help to narrow down desiderata for good phase-out plans. However, they do not provide a compelling case against phase-out planning as such because they miss its incremental and constructive nature. Unless better arguments can be provided, it appears that government inaction on phasing out animal experimentation lacks moral justification.
To quantify the proportion of referrals sent to Crumlin Cardiology Department for cardiac screening prior to commencement or modifying attention deficit hyperactivity disorder medication and assess the number detected with a clinically significant abnormality.
Methods:
A prospective audit was performed over a 6-month period, from November 2021 to April 2022 inclusive. Referrals sent via outpatient department triage letters, electrocardiogram dept. email, and walk-in electrocardiogram service were screened for those pertaining to commencing or modifying medication for children with attention deficit hyperactivity disorder. Each referral was coded against National Institute for Health and Care Excellence guidelines to determine the degree of clinical details given. Reported abnormalities, recommended management, and correspondence were recorded.
Results:
Ninety-one referrals were received during the 6-month audit period. More than half lacked a clinical indication for referral (53/91, 58.2%), with fewer than one third (26/91, 28.5%) meeting National Institute for Health and Care Excellence criteria for referral for cardiology. Eighty (80/91) referrals had clinical outcomes available for review (missing outpatient department information and age outside of service range accounted for eleven referrals with unavailable clinical outcomes). Of the eighty clinically reviewed referrals, seventy-two (72/80, 90%) were reported as normal with no cardiology follow up required. Eight referrals (8/80, 10%) were reviewed in the Cardiology Outpatient Department prior to commencement or modifying attention deficit hyperactivity disorder medication. Of these, only one (1/80 1%) had a clinically significant abnormality which was a potential contraindication to attention deficit hyperactivity disorder medication use, and this referral was appropriate as per National Institute for Health and Care Excellence guidelines.
Conclusion:
Routine screening prior to attention deficit hyperactivity disorder medication prescription in the absence of clinical indications (as per National Institute for Health and Care Excellence) contributed to delays in medication initiation among young people with attention deficit hyperactivity disorder. Unnecessary referrals have resource implications for cardiology clinical team. Improved adherence to National Institute for Health and Care Excellence guidelines would provide benefits for patients and clinicians.
Congenital mitral stenosis is a rare anomaly. We report successful surgical management of congenital mitral stenosis in a patient with Kabuki syndrome. A 15-month-old male with Kabuki syndrome was referred and echocardiography showed isolated congenital mitral stenosis. The valve was not repairable as it was showing severe stenotic features in multilevel fashion. Valve was replaced with mechanical valve. Postoperative course was uneventful without any rhythm problem and he has been doing well clinically during the 25 months follow-up with regular international normalized ratio checks.
The field of International Studies has often been concerned with either negative conceptualisations of freedom and liberty (i.e. freedom from obstacles and interference) or positive notions of freedom (i.e. the possibility to act and develop). Further, these two notions of freedom have been conceived of as rival and incompatible. Drawing upon Simone de Beauvoir’s ethics of ambiguity (1947), this article rejects such a binary conceptualisation of freedom and instead puts forward a relational understanding of freedom. This article also begins to sketch the possibilities offered by such an understanding of freedom via a nascent dialogue between this relational freedom and the ethics of care. Specifically, it is posited that care and freedom weave together to form the very ethical space and conditions in and through which in becomes possible to pursue various life projects in the first place. Care and freedom, it is suggested, may thus provide one orientation for studying and practising international relations in a manner that moves towards building, amending, and maintaining relations that better support everyone (where this, crucially, also entails the ending of relations which oppress, harm, and cause suffering).
This article highlights CSR disclosure as a strategic response of Chinese multinational enterprises (MNEs) to the social risk they face in host countries. Deviating from prior research that aims to directly measure social risk, we offer a new approach to isolate the effect of social risk by leveraging China's Belt & Road Initiative (BRI) as the research context, under which Chinese MNEs are largely protected from political risk in membership countries but are exposed to substantial social risk from local nongovernment stakeholders. Results from difference-in-differences analyses show that after the enactment of the BRI, Chinese MNEs investing in BRI countries significantly increases their likelihood of CSR disclosure than that of their counterparts investing in non-BRI countries. Further, such effects are more pronounced for state-owned MNEs and MNEs in natural resource industries. This research enriches the international business literature on the relationship between political risk and social risk, and that between corporate political actions and corporate social responsibility.
This article reconstructs the first outbreak of epidemic dropsy recorded in documentary evidence, which occurred in Calcutta, Mauritius, and northeastern India and Bengal in 1877–80. It uses current medical knowledge and investigations into the wider historical contexts in which the epidemic occurred to re-read the colonial medical literature of the period. It shows that colonial policies and structures in the context of variable enviro-climatic conditions increased the likelihood that an epidemic would break out, while also increasing the vulnerability of certain populations to infection and mortality. Additionally, it shows how the trans-regional nature of the epidemic contributed to varying understandings of the disease between two colonial medical establishments, which influenced each other in contradictory ways. The article’s core contributions are to recent trans-regional perspectives on disease transmission and colonial medical knowledge production in the Indian Ocean World.
The scaling relations mapping the turbulence statistics in compressible turbulent boundary layers (TBLs) onto their incompressible counterparts are of fundamental significance for turbulence modelling, such as the Morkovin scaling for velocity fields, while for pressure fluctuation fields, a corresponding scaling relation is currently absent. In this work, the underlying scaling relations of pressure fluctuations about Mach number ($M$) contained in their generation mechanisms are explored by analysing a series of direct numerical simulation data of compressible TBLs over a wide Mach number range $(0.5\leq M \leq 8.0)$. Based on the governing equation of pressure fluctuations, they are decomposed into components according to the properties of source terms. It is notable that the intensity of the compressible component, predominantly originating from the acoustic mode, obeys a monotonic distribution about the Mach number and wall distance; further, the intensity of the rest of the pressure components, which are mainly generated by the vorticity mode, demonstrates a uniform distribution consistent with its incompressible counterpart. Moreover, the coupling between the two components is negligibly weak. Based on the scaling relations, semiempirical models for the fluctuation intensity of both pressure and its components are constructed. Hence, a mapping relation is obtained that the profiles of pressure fluctuation intensities in compressible TBLs can be mapped onto their incompressible counterparts by removing the contribution from the acoustic mode, which can be provided by the model. The intrinsic scaling relation can provide some basic insight for pressure fluctuation modelling.
COVID-19, caused by the SARS-CoV-2 virus, has generated a global pandemic with a wide range of clinical manifestations. Cardiovascular complications are frequently observed in individuals with COVID-19, particularly those with preexisting cardiovascular risk factors or diseases. Cardiac biomarkers, including troponin, natriuretic peptides, and inflammatory markers, play a vital role in risk stratification, diagnosis, monitoring, and prognosis in COVID-19 patients. These biomarkers provide valuable insights into cardiac injury, myocardial stress, inflammation, and the prediction of adverse cardiovascular outcomes. This review aims to provide better understanding of how Cardiac biomarkers correlate to clinical manifestation of COVID-19.
Methods:
We retrieved studies from PubMed, Medline, and Google Scholars that included results on cardiac biomarkers in COVID-19. Total of 14 studies were reviewed.
Results:
8 studies showed evidence of poor progression of the disease when there is increased troponin. 6 studies out of the 14 mentioned in this review showed positive correlation between mortality and elevation in cardiac biomarkers. This shows the significance of cardiac biomarkers in predicting the mortality in patients with COVID-19.
Conclusion:
It was shown that elevated cardiac biomarkers were associated significantly to poor outcome of covid-19 infection. The outcomes that were linked to increased cardiac biomarkers included increased length of hospitalization, need of life sustaining treatment, myocarditis, invasive and non-invasive respiratory support, and even death were linked to elevated cardiac biomarkers levels.
We study analogues of Kronecker coefficients for symmetric inverse semigroups, for dual symmetric inverse semigroups and for the inverse semigroups of bijections between subquotients of finite sets. In all cases, we reduce the problem of determination of such coefficients to some group-theoretic and combinatorial problems. For symmetric inverse semigroups, we provide an explicit formula in terms of the classical Kronecker and Littlewood–Richardson coefficients for symmetric groups.