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Atrioventricular valve regurgitation in patients with univentricular heart is a well-known risk factor for adverse outcomes and atrioventricular valve repair remains a particular surgical challenge.
Methods:
We reviewed all surgical atrioventricular valve procedures in patients with univentricular heart and two separate atrioventricular valves who underwent surgical palliation. Endpoints of the study were reoperation-free survival and cumulative incidence of reoperation.
Results:
Between 1994 and 2021, 202 patients with univentricular heart and two separate atrioventricular valve morphology underwent surgical palliation, with 15.8% (32/202) requiring atrioventricular valve surgery. Primary diagnoses were double inlet left ventricle (n = 14, 43.8%), double outlet right ventricle (n = 7, 21.9%), and congenitally corrected transposition of the great arteries (n = 7, 21.9%). Median weight at valve surgery was 10.6 kg (interquartile range, 7.9–18.9). Isolated left or right atrioventricular valve surgery was required in nine (28.1%) and 22 patients (68.8%), respectively. Concomitant left and right atrioventricular valve surgery was performed in one patient (3.1%). Closure of the left valve was conducted in four patients (12.5%) and closure of the right valve in three (9.4%). Operative and late mortality were 3.1% and 9.7%, respectively. Reoperation-free survival and cumulative incidence of reoperation at 10 years after surgery were 62.3% (standard error of the mean: 6.9) and 30.9% (standard error of the mean: 9.6), respectively.
Conclusions:
In patients with univentricular heart and two separate atrioventricular valves, surgical intervention on these valves is required in a minority of patients and is associated with low mortality but high incidence of reoperation.
Velocity gradient tensor, $A_{ij}\equiv \partial u_i/\partial x_j$, in a turbulence flow field is modelled by separating the treatment of intermittent magnitude ($A = \sqrt {A_{ij}A_{ij}}$) from that of the more universal normalised velocity gradient tensor, $b_{ij} \equiv A_{ij}/A$. The boundedness and compactness of the $b_{ij}$-space along with its universal dynamics allow for the development of models that are reasonably insensitive to Reynolds number. The near-lognormality of the magnitude $A$ is then exploited to derive a model based on a modified Ornstein–Uhlenbeck process. These models are developed using data-driven strategies employing high-fidelity forced isotropic turbulence data sets. A posteriori model results agree well with direct numerical simulation data over a wide range of velocity-gradient features and Reynolds numbers.
Recent studies highlight the need for ethical and equitable digital health research that protects the rights and interests of racialized communities. We argue for practices in digital health that promote data self-determination for these communities, especially in data collection and management. We suggest that researchers partner with racialized communities to curate data that reflects their wellness understandings and health priorities, and respects their consent over data use for policy and other outcomes. These data governance approach honors and builds on Indigenous Data Sovereignty (IDS) decolonial scholarship by Indigenous and non-indigenous researchers and its adaptations to health research involving racialized communities from former European colonies in the global South. We discuss strategies to practice equity, diversity, inclusion, accessibility and decolonization (EDIAD) principles in digital health. We draw upon and adapt the concept of Precision Health Equity (PHE) to emphasize models of data sharing that are co-defined by racialized communities and researchers, and stress their shared governance and stewardship of data that is generated from digital health research. This paper contributes to an emerging research on equity issues in digital health and reducing health, institutional, and technological disparities. It also promotes the self-determination of racialized peoples through ethical data management.
On July 13, 2023, the International Court of Justice (ICJ) delivered its judgment in the case concerning Question of the Delimitation of the Continental Shelf Between Nicaragua and Colombia Beyond 200 Nautical Miles from the Nicaraguan Coast (Nicaragua v. Colombia) (2023 Judgment). This is the first decision addressing the question of the delimitation of the continental shelf, between states with opposite coasts, in a situation where one state asserts a continental shelf extending beyond 200 nautical miles (extended continental shelf) within the 200 miles from the baselines of another state.
The scaling universality of structure functions is studied for artificially thickened turbulent boundary-layer flows in over-tripped impacts by using hot-wire measurement datasets. The self-similarity behaviours in the inner and outer regions are examined from the viewpoint of different flow mechanisms. In the inner region, the relative ratios between structure functions for the energy-containing range of scales exhibit universality behaviour, in accordance with Townsend's attached eddy hypothesis. This universality of the energy-containing range of scales extends further away from the wall by increasing the tripping intensity. On the other hand, the impact of the external intermittency on the self-similarity of small-scale turbulence is examined through the intermittent zone in over-tripped conditions. Towards the boundary-layer edge, the structure functions exhibit a growing departure from self-similarity and analytical prediction, and it is demonstrated that the departure is primarily due to external intermittency. Moreover, based on the conditional statistics concentrated in the turbulent regimes, it is revealed that the small scales in the turbulence regime are homogenized in a self-similar behaviour, which is independent of the current tripping conditions.
Numerous references to ‘new’ literacies have been added to the discourse of various academic and public domains, resulting in a multiplication of literacies. Among them is the term ‘language assessment literacy’ (LAL), which has been used as a subset of Assessment Literacy (AL) (Gan & Lam, 2022) in the field of language testing and assessment and has not been uncontested. LAL refers to the skills, knowledge, methods, techniques and principles needed by various stakeholders in language assessment to design and carry out effective assessment tasks and to make informed decisions based on assessment data (e.g., Fulcher, 2012*; Inbar-Lourie, 2008*[1]; 2013; Taylor, 2009*, 2013*).
The US has experienced runaway economic inequality since the 1970s, yet there is no strong public support for government efforts that serve to narrow the growing disparities between citizens. Why? I point to the role of rising racial diversity. I argue Americans believe in conditional equality, where they support equalizing policies as long as they perceive the beneficiaries as people like themselves. However, as the country grows more diverse, citizens are less likely to perceive those around them as people like themselves. Using time-series cross-sectional data of the American states, I demonstrate that as racial diversity increases, the likelihood the public will respond to increasing inequality by supporting bigger government declines. This study provides evidence for the mechanism usually implied but rarely tested by studies of diversity and policy: mass preferences.
Heated supersonic rectangular twin jets (SRTJ) with a total temperature ratio of 2, using nozzles of design Mach number 1.5 and aspect ratio 2, were investigated in flow regimes from overexpanded to the design condition (Mj = 1.3–1.5). This work complements our recently published work in unheated SRTJ using the same experimental facility (Samimy et al., J. Fluid Mech, vol. 959, 2023, A13). Localized arc filament plasma actuators (LAFPAs) were used to excite the natural instabilities in the jets, thereby controlling the flow and acoustics. The results show that the jets were coupled primarily out-of-phase in overexpanded cases, that the coupling had significant effects on the near-field (NF) pressure fluctuations, and that these fluctuations were considerably higher for in-phase than for out-of-phase coupled cases. The results also revealed that the far-field (FF) overall sound pressure level is significantly higher on the minor axis plane of the SRTJ and that the onset of Mach wave radiation contributes to the increased acoustic radiation at the peak noise direction. The LAFPAs successfully controlled the coupling and were able to reduce the NF pressure fluctuations by 10 dB. However, only 1 to 2 dB FF noise reduction at the peak noise radiation direction was achieved. The overall trends of the baseline results and response of the flow to excitation are qualitatively similar in unheated and heated cases, but the details are significantly different.
A tension between freedom and constraint is characteristic of improvisation practice and pedagogy, presenting challenges for teachers/workshop leaders. To create musical focus in ensemble improvisation, some sounds are encouraged, whilst others are edited out, ignored or marginalised. This article investigates improvised sounds as central or subaltern, asking how marginal sounds such as musical ‘heckles’ and off-task sounds can be accepted meaningfully into musical frameworks. I question what can be learned from subaltern sounds. How can power structures within the improvisation workshop be subverted by listening to sounds outside teacher-defined frames, and how can listening become inclusive without sessions descending into chaos?
Hexamermis zirabi sp. n., recovered from a natural habitat of Mazandaran province, north of Iran, is described based on morphological and molecular data. The new species is characterized by its six cephalic papillae; cuticle with distinct cross fibers; conoid or sharply tapered head; mouth terminal; six hypodermal cords; J-shaped vagina oriented to the anterior end of body; uterus with Z-organs or sclerotized bodies; tail similar in both sexes and bluntly rounded; spicules paired, separate, slightly curved, shorter than body width at cloaca, with rounded tip; and male genital papillae arranged in five rows. In addition to the morphological study, molecular phylogenetic analyses using a partial large subunit (28S D2-D3) were also performed, and the new species formed a highly supported (1.00% Bayesian posterior probability (BPP)) clade with Hexamermis popilliae.
Let $\Omega $ be a complex lattice which does not have complex multiplication and $\wp =\wp _\Omega $ the Weierstrass $\wp $-function associated with it. Let $D\subseteq \mathbb {C}$ be a disc and $I\subseteq \mathbb {R}$ be a bounded closed interval such that $I\cap \Omega =\varnothing $. Let $f:D\rightarrow \mathbb {C}$ be a function definable in $(\overline {\mathbb {R}},\wp |_I)$. We show that if f is holomorphic on D then f is definable in $\overline {\mathbb {R}}$. The proof of this result is an adaptation of the proof of Bianconi for the $\mathbb {R}_{\exp }$ case. We also give a characterization of lattices with complex multiplication in terms of definability and a nondefinability result for the modular j-function using similar methods.