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Paediatric cardiac electrophysiologists are essential in CHD inpatient care, but their involvement is typically limited to consultation with individual patients. In our integrated heart centre, an electrophysiologist reviews all cardiac inpatient telemetry over the preceding 24 hours and participates in daily multidisciplinary morning report. This study investigates the impact of the strategy of consistent, formalised electrophysiologist presence at multidisciplinary morning report.
Methods:
This is a single-centre, prospective, observational study of electrophysiologist participation in patient encounters during heart centre multidisciplinary morning report from 10/20/2021 to 10/31/2022. Multidisciplinary morning report includes discussion of all intensive care and non-intensive care cardiac patients. An encounter was defined as reporting on one patient for one day. Electrophysiologists were initially blinded to observations.
Results:
Two electrophysiologists were observed over 215 days encompassing 6413 patient encounters. Electrophysiologists made comments on 581(9.1%) encounters in 234 unique patients with diverse diagnoses, equating to a median of 3[interquartile range:1–4] encounters per day. These included identifications of arrhythmias and describing electrocardiographic findings. Recommendation to change management occurred in 282(48.5%) encounters, most commonly regarding medications (n = 142, 24.4%) or pacemaker management (n = 48, 8.3%). Of the 581 encounters, there were 61(10.5%) in which they corrected another physician’s interpretation of rhythm or electrocardiogram.
Conclusion:
Routine electrophysiologist involvement in multidisciplinary morning report provides significant, frequent, and timely input in patient management by identifying precise rhythm-related diagnoses and allowing nuanced, patient-specific medication and pacemaker management of all cardiac patients, not just those consulted. Electrophysiologist presence at multidisciplinary morning report is a vital resource and this practice should be considered at integrated paediatric cardiac centres.
Aquinas’s Fifth Way argues for God’s existence from the perception of goal-directed activity in nature. Its details are difficult to understand. This study interprets the premises and offers background reasoning for them, which Aquinas develops elsewhere in his writings. A major focus is clarifying the scope of finality the Fifth Way invokes. The argument leaves unspecified the kinds of purposive activity in nature Aquinas has in mind. Thus, the discussion first treats types of purposive activity in nature Aquinas recognizes. It then looks at the two reasons the argument gives for final causes in nature. Things tend to act in regular ways and tend toward what is ‘best’. Attention then turns to the key premise that goal-directed activity in nonrational beings requires direction by something with intelligence. A final section of the article explores why Aquinas seems to look to a single source of finality in nature and why, in the conclusion, he claims that we call this God. Thus, Aquinas’s larger views on finality in nature shed light on his intents in the Fifth Way.
This article reexamines the notion of voice in law and society scholarship, which has focused on journeys to complaints and claims. Using the English and Welsh National Health Service as a case study, it argues that looking at the articulation of grievances through a large number of channels across a large service sector offers new opportunities to examine a range of different political logics underpinning voicing mechanisms. Two key arguments emerge. First, it becomes clear that expressions of dissatisfaction can be collected for a variety of purposes other than dispute resolution or conflict management. Formal grievance procedures, rendered legitimate by concepts of rights and due process, not only interact with but compete with other ways of serving the collective good. The second key finding is that when looked at in isolation, the concept of voice can usefully be studied as a discrete concept rather than just a vital component of claiming.
In this paper, we study newspaper partisan behavior and content, which we measure using coverage of and commentary on partisan activities, institutions, and actors. We use this measure to describe the levels of relative partisan behavior during the period 1880 to 1900, and to describe changes over the period 1880 to 1980. We find that, on average, newspapers were initially highly partisan, but gradually became less partisan over time. Importantly, we find as much change after the 1910s as before, which contributes to the existing literature that focuses on changes in the nineteenth and early twentieth centuries. We also investigate words and phrases that had negative or positive partisan connotations in particular periods. Finally, we examine whether some of the common hypotheses offered in the literature can account for the changes. The initial findings suggest that these explanations can only account for part of the decline.
We study the most general class of eigenfunction expansions for abstract normal operators with pure point spectrum in a complex Hilbert space. We find sufficient conditions for such expansions to be unconditionally convergent in spaces with two norms and also estimate the degree of this convergence. Our result essentially generalizes and complements the known theorems of Krein and of Krasnosel'skiĭ and Pustyl'nik. We apply it to normal elliptic pseudodifferential operators on compact boundaryless $C^{\infty }$-manifolds. We find generic conditions for eigenfunction expansions induced by such operators to converge unconditionally in the Sobolev spaces $W^{\ell }_{p}$ with $p\gt 2$ or in the spaces $C^{\ell }$ (specifically, for the $p$-th mean or uniform convergence on the manifold). These conditions are sufficient and necessary for the indicated convergence on Sobolev or Hörmander function classes and are given in terms of parameters characterizing these classes. We also find estimates for the degree of the convergence on such function classes. These results are new even for differential operators on the circle and for multiple Fourier series.
This study presents the interplay of flow and acoustics within tandem deep cavities, focusing on the resonance mechanism occurring between turbulent shear layers and acoustic eigenmodes. The arrangement inside the tandem deep cavities includes both close and remote configurations. A combined fully coupled and decoupled aeroacoustic simulation strategy was devised. Employing an advanced high-order spectral/hp element method in conjunction with implicit large eddy simulation, the nonlinear compressible Navier–Stokes equations were solved to acquire internal flow–acoustic resonant field. In parallel, the linearized Navier–Stokes equations were tackled to determine coherent shear layer perturbations with external acoustic forcing. Based on acoustic measurements, the mainstream Reynolds number approaches approximately $R{e_{in}} = {O}({10^5})$, where we identified the presence of frequency lock-in and a resonance range. Aeroacoustic noise sources were examined by implementing spectral proper orthogonal decomposition to decompose the pressure fields into hydrodynamic and acoustic components. As feedback intensified, the flow characteristics by the acoustic forcing effect and the flow-interactive effect were categorized according to the development of concurrent turbulent shear layers. Subsequently, the alternating and synchronous behaviours of concurrent shear layers resonated with the out-of-phase and in-phase acoustic eigenmodes were identified, and the corresponding large-scale counter-rotating vortex pairs and co-rotating vortex structures at the cavity entrances were extracted. The acoustic power generated by the Coriolis force was calculated using Howe's vortex-sound analogy, and the aeroacoustic energy transfer mechanism between large-scale shear layer vortices with acoustic eigenmodes was further explored. Finally, a linear response of coherent perturbations of the concurrent shear layers by external acoustic forcing was established. The amplification of flow in the streamwise direction toward the main duct led to the formation of coherent vortex structures, accompanied by separation bubbles into the main duct.
Deep-sea hydrothermal vents host chemosynthesis-based ecosystems inhabited chiefly by specially adapted animals that do not live anywhere else, and depth has been shown to be a major driver of species composition at vents around Japan. Though the Ryukyu region in southern Japan is home to many hot vents, only two – Minami-Ensei Knoll and Yoron Hole – have been found shallower than 1000 m. Here, we report the discovery of a new vent field on the Amami Rift northwest off Amami Ōshima at 630 m deep. A total of 29 macrofaunal species were recorded from Amami Rift, including 19 vent specialists. Comparison of species composition across the three shallow Ryukyu vents revealed only three shared species, highlighting that all three display distinct community structure. Amami Rift exhibits distinct zonation patterns and is generally more similar to Minami-Ensei than Yoron Hole, but the presence of key taxa such as the sulphide worm Paralvinella and the mussel ‘Bathymodiolus’ platifrons as well as the absence of the symbiotic squat lobster Shinkaia and the limpet Lepetodrilus exemplify its difference with Minami-Ensei. Furthermore, the non-vent specific predators seen in these two sites were completely different. Overall, the Amami Rift vent field can be considered a shallow vent with a unique set of fauna, warranting future research on the mechanisms shaping disparate macrofaunal diversity between nearby shallow vents such as Amami Rift and Minami-Ensei. The unusual geological setting of Amami Rift at the converging point of Okinawa Trough and Ryukyu Arc may influence fluid chemistry to drive such differences.
The biodiversity of tropical rainforest is difficult to assess. Yet, its estimation is necessary for conservation purposes, to evaluate our level of knowledge and the risks faced by the forest in relation to global change. Our contribution is to estimate the regional richness of tree species from local but widely spread inventories. We reviewed the methods available, which are nonparametric estimators based on abundance or occurrence data, log-series extrapolation and the universal species–area relationship based on maximum entropy. Appropriate methods depend on the scale considered. Harte’s self-similarity model is suitable at the regional scale, while the log-series extrapolation is not. GuyaDiv is a network of forest plots installed over the whole territory of French Guiana, where trees over 10 cm DBH are identified. We used its information (1315 species censused in 68 one-hectare plots) to estimate the exponent of the species–area relationship, assuming Arrhenius’s power law. We could then extrapolate the number of species from three local, wide inventories (over 2.5 km2). We evaluated the number of tree species around 2200 over the territory.
Global music history projects have become increasingly popular in recent years. Going global has its advantages: it develops conversations between researchers working on disparate regions; it sheds light on larger frameworks that are less evident on smaller scales of analysis; it decentres how we teach music history; and it retraces a global hinterland for music systems that have conventionally been called ‘Western’. At the same time, the global history approach raises challenges for researchers working on the world beyond Europe. In particular, there is the danger of unintentionally reinstating Eurocentrism, either by uncritically exporting research questions based on the European experience to the wider world, or by narrowing our focus onto those musicians and scholars who engaged with European ideas and practices, especially in colonial settings. This work is valuable, but it also comes with risks. This essay considers these problems through a case study: a largely forgotten music scholar, Goswami Pannalal, who travelled and taught across north India in the late nineteenth century. Examining his musicological study in Hindi, the Nād Binod (‘Sonic Delight’, 1896), I consider how far asking ‘global’ questions might shed light on his work, and offer an alternative reading based on a ‘significant geographies’ approach.
Infants with congenital heart disease and increased pulmonary blood flow frequently suffer from feeding difficulties and growth failure. Providing expressed breast milk by spoon has been hypothesised to decrease energy expenditure in these infants as compared to breastfeeding. This study assessed the effect of supplemental feeding of expressed breast milk on weight gain in infants with unoperated congenital heart disease.
Method:
This was a prospective open-label randomised control trial. In total, 50 infants with post tricuspid left to right shunt were enrolled in the study. In the intervention group, apart from breastfeeding, a minimum predetermined volume of expressed breast milk was targeted to be given by spoon. 30-50 kcal/kg/day was given by expressed breast milk by spoon-feeding. In the control group, the infants were given at least 8 feeds per 24 hours by direct breastfeeding. Both groups were followed up for 1 month and assessed for weight gain.
Result:
Despite a high rate of protocol breach in both groups (30% overall), infants in the intervention group had better weight gain at one-month follow-up compared to those in the control group, 780 ± 300 versus 530 ± 250 gm (p = 0.01).
Conclusion:
In infants with left to right shunts, supplemental feeding of expressed breast milk by spoon along with breastfeeding resulted in significantly higher average weight gain at 30 days compared to the control group who received breastfeeding alone. Future studies with larger sample sizes and longer follow-ups need to be done to confirm the findings of this study.
Gregory of Nyssa’s critiques of various forms of social injustice hinge on his rigorous theological anthropology. For Gregory, slavery, the accumulation of wealth, and the mistreatment of the poor are evil because they deny the freedom proper to human creatures created according to the divine Image. However, Gregory’s anthropology also contains, we will argue, a distinct account of the ways in which humanity’s difference from God – particularly its poverty and limitation – reveals important aspects of the particular and ultimately Christological mode in which finite humans imitate the infinitude God. The aim of this present essay is to articulate how both likeness and unlikeness to God – mirrors of God and mirrors of death – are integral to Gregory’s theological anthropology as it pertains to various forms of social critique.
This manuscript presents a novel design for an absorptive bandpass filter for mm-wave applications, specifically the commercial FR2 spectrum. Three bands have been selected to be properly input matched with only one of them being the passband, where the insertion loss is minimized. The proposed approach relies on a multiplexer topology implemented through microstrip lines and on thin-film manufacturing process on alumina to shrink the footprint. Cascades of half-wavelength C-shape open-ended resonators are exploited to create the matched bands and define the filter’s selectivity. The selected passband spans from 26.5 to 28.5 GHz, with a measured maximum insertion loss of 3.05 dB for a −3 dB fractional bandwidth of 7.3%. Two absorptive bands are realized to match signals at 24 and 32.25 GHz. The alumina die footprint is 5500 × 3440 µm2, compatible with immediate integration within a mm-wave lineup.
This article presents an innovative design for a low-profile, high-gain circularly polarized (CP) antenna using a single-layer metasurface (MTS). The proposed design incorporates an MTS layer, comprising a 4 × 4 array of hexagonal-shaped patches, printed on the top layer of the substrate. The bottom layer features a coplanar waveguide-fed slotted ground. Circular polarization and broadside radiation are achieved through the application of characteristic mode analysis (CMA). CMA is employed to simultaneously excite desired modes, aiming for wideband circular polarization and gain enhancement. Experimental results validate the effectiveness of the design, with compact dimensions of 0.67λ0 × 0.67λ0 × 0.04λ0. The measurements demonstrate an impressive impedance bandwidth of 84.3% within the 3.7–9.1 GHz. Additionally, a 3-dB axial ratio bandwidth of 18.6% is observed between 4.96 and 5.98 GHz and 3.74% between 8.38 and 8.7 GHz. The antenna exhibits excellent radiation pattern characteristics, featuring a maximum gain of 10.08 dBi at 7.1 GHz. The radiation pattern is symmetrical with broadside directionality, making the antenna well-suited for sensing applications.
We consider the super-replication problem for a class of exotic options known as life-contingent options within the framework of the Black–Scholes market model. The option is allowed to be exercised if the death of the option holder occurs before the expiry date, otherwise there is a compensation payoff at the expiry date. We show that there exists a minimal super-replication portfolio and determine the associated initial investment. We then give a characterisation of when replication of the option is possible. Finally, we give an example of an explicit super-replicating hedge for a simple life-contingent option.
Antimicrobial-resistant bacteria pose serious public health risks, necessitating bioprospecting for novel antimicrobial drugs. The endophytic fungi of the mangrove ecosystem are hotspots for discovering new bioactive chemical compounds. In this context, an investigation was designed to determine the isolation of the major endophytic fungi inhabiting the leaves of Acanthus ilicifolius, a mangrove plant with a long history of traditional use in the Chinese and Indian medical systems. Based on the morphological characterizations and molecular analysis of internal transcribed spacer rDNA sequence data, the study identified three unique endophytic fungal species, namely, Periconia macrospinosa, Coprinopsis cinerea, and Alternaria sp. Of these, P. macrospinosa was identified as the most dominant one, with the highest relative frequency (35.22%). The antibacterial activity of P. macrospinosa isolate (CMFRI/fPM-01) was evaluated by the well and diffusion method against six human pathogens, viz., Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Vibrio cholerae, Vibrio parahaemolyticus, and Vibrio vulnificus. The results demonstrated a high and wide spectrum of antimicrobial action of the isolate against all the tested human pathogens, with no significant difference (P > 0.05) in the activity between the pathogens. The antibacterial activity was further confirmed by determining the fungal culture supernatant's minimum inhibitory concentration and minimum bactericidal concentration. Although the studied fungi are known from other sources, this is the first report of P. macrospinosa and C. cinerea as endophytes in A. ilicifolius leaves. The outcomes also showed that the P. macrospinosa isolate could be used to discover effective antibacterial drugs against various human diseases.