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Derived from the National Pediatric Cardiology Quality Improvement Collaborative registry, the NEONATE risk score predicted freedom from interstage mortality or heart transplant for patients with single ventricle CHD and aortic arch hypoplasia discharged home following Stage 1 palliation.
Objectives:
We sought to validate the score in an external, modern cohort.
Methods:
This was a retrospective cohort analysis of single ventricle CHD and aortic arch hypoplasia patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative Phase II registry from 2016 to 2020, who were discharged home after Stage 1 palliation. Points were allocated per the NEONATE score (Norwood type—Norwood/Blalock–Taussig shunt: 3, Hybrid: 12; extracorporeal membrane oxygenation post-op: 9, Opiates at discharge: 6, No Digoxin at discharge: 9, Arch Obstruction on discharge echo: 9, Tricuspid regurgitation ≥ moderate on discharge echo: 12; Extra oxygen plus ≥ moderate tricuspid regurgitation: 28). The composite primary endpoint was interstage mortality or heart transplant.
Results:
In total, 1026 patients met inclusion criteria; 61 (6%) met the primary outcome. Interstage mortality occurred in 44 (4.3%) patients at a median of 129 (IQR 62,195) days, and 17 (1.7%) were referred for heart transplant at a 167 (114,199) days of life. The median NEONATE score was 0(0,9) in those who survived to Stage 2 palliation compared to 9(0,15) in those who experienced interstage mortality or heart transplant (p < 0.001). Applying a NEONATE score cut-off of 17 points that separated patients into low- and high-risk groups in the learning cohort provided 91% specificity, negative predictive value of 95%, and overall accuracy of 87% (85.4–89.5%).
Conclusion:
In a modern cohort of patients with single ventricle CHD and aortic arch hypoplasia, the NEONATE score remains useful at discharge post-Stage 1 palliation to predict freedom from interstage mortality or heart transplant.
After unification in 1871 Germany became, for some of Greece's intellectuals, politicians, and journalists, a model for the organization and national integration of their own country. This article examines perceptions of the Second Reich between the accession of Wilhelm II and the start of the First World War. It traces the role played by the German model in public discourse within the Kingdom of Greece in relation to the importance of the monarchy, the dynasty, and the army in the realization of the Megale Idea, and in the choice of the country's political orientation between East and West.
Normative neuropsychological data are essential for interpretation of test performance in the context of demographic factors. The Mayo Normative Studies (MNS) aim to provide updated normative data for neuropsychological measures administered in the Mayo Clinic Study of Aging (MCSA), a population-based study of aging that randomly samples residents of Olmsted County, Minnesota, from age- and sex-stratified groups. We examined demographic effects on neuropsychological measures and validated the regression-based norms in comparison to existing normative data developed in a similar sample.
Method:
The MNS includes cognitively unimpaired adults ≥30 years of age (n = 4,428) participating in the MCSA. Multivariable linear regressions were used to determine demographic effects on test performance. Regression-based normative formulas were developed by first converting raw scores to normalized scaled scores and then regressing on age, age2, sex, and education. Total and sex-stratified base rates of low scores (T < 40) were examined in an older adult validation sample and compared with Mayo’s Older Americans Normative Studies (MOANS) norms.
Results:
Independent linear regressions revealed variable patterns of linear and/or quadratic effects of age (r2 = 6–27% variance explained), sex (0–13%), and education (2–10%) across measures. MNS norms improved base rates of low performance in the older adult validation sample overall and in sex-specific patterns relative to MOANS.
Conclusions:
Our results demonstrate the need for updated norms that consider complex demographic associations on test performance and that specifically exclude participants with mild cognitive impairment from the normative sample.
The spatial relationship between turbulent and particle concentration structures is investigated based on the turbulent velocity and particle concentration data obtained synchronously at the Qingtu Lake Observation Array site. In addition to the observation of particle concentration structures that contain not only large-scale coherence but also significant energy in the high-Reynolds-number atmospheric surface layer (ASL), the scale of turbulent motions that have the most significant coherence with particle concentration is found to follow a 1/2 power scaling law with the local height and ASL thickness. Moreover, large-scale turbulent velocity fluctuations have a significant amplitude modulation effect on particle concentration fluctuations, but the modulating influence is different for small dust particles and large saltating particles. Based on the interphase amplitude modulation, there exists a particle–turbulence structure phase difference that varies with height, which further makes the structure inclination angle of the particle concentration larger than that of the turbulence. In this scenario, a conceptual model reflecting the relationship between the two is proposed, and a quantitative formulation is further derived and found to be in good agreement with the experimental results. These findings and the proposed model contribute insights into particle–turbulence interactions, thereby providing theoretical support for a unified model of turbulence dynamics and particle kinematics.
Fatigue and insomnia, potentially induced by inflammation, are distressing symptoms experienced by colorectal cancer (CRC) survivors. Emerging evidence suggests that besides the nutritional quality and quantity, also the timing, frequency and regularity of dietary intake (chrono-nutrition) could be important for alleviating these symptoms. We investigated longitudinal associations of circadian eating patterns with sleep quality, fatigue and inflammation in CRC survivors. In a prospective cohort of 459 stage I-III CRC survivors, four repeated measurements were performed between 6 weeks and 24 months post-treatment. Chrono-nutrition variables included meal energy contribution, frequency (a maximum of six meals could be reported each day), irregularity and time window (TW) of energetic intake, operationalised based on 7-d dietary records. Outcomes included sleep quality, fatigue and plasma concentrations of inflammatory markers. Longitudinal associations of chrono-nutrition variables with outcomes from 6 weeks until 24 months post-treatment were analysed by confounder-adjusted linear mixed models, including hybrid models to disentangle intra-individual changes from inter-individual differences over time. An hour longer TW of energetic intake between individuals was associated with less fatigue (β: −6·1; 95 % CI (−8·8, −3·3)) and insomnia (β: −4·8; 95 % CI (−7·4, −2·1)). A higher meal frequency of on average 0·6 meals/d between individuals was associated with less fatigue (β: −3·7; 95 % CI (−6·6, −0·8)). An hour increase in TW of energetic intake within individuals was associated with less insomnia (β: −3·0; 95 % CI (−5·2, −0·8)) and inflammation (β: −0·1; 95 % CI (−0·1, 0·0)). Our results suggest that longer TWs of energetic intake and higher meal frequencies may be associated with less fatigue, insomnia and inflammation among CRC survivors. Future studies with larger contrasts in chrono-nutrition variables are needed to confirm these findings.
The COVID-19 pandemic and ensuing restrictions/lockdowns have caused significant physical and psychological consequences for people with cognitive impairment who are heavily dependent on their care-givers. However, little is known about the impact on care-givers, the factors that exacerbate their situation and what supports they need. The aims of this paper are threefold: (a) to examine the impact of COVID-19 physical restrictions on both formal and informal care-givers of people with cognitive impairment; (b) to identify attributing factors influencing this impact; and (c) to recognise their support needs. Further, this paper informs future research, policy and practice. Guided by the Joanna Briggs Institute framework, a systematic review was conducted using a mixed-methods convergent integrated approach. Eight databases were searched using keywords related to COVID-19 restriction, dementia care-givers, impacts and care settings, followed by a manual search. The study was limited to primary research published in English between January 2020 and December 2021. Of the 840 records identified, 30 met the inclusion criteria. Service withdrawal and social distancing has effectively led to the reprivatisation of care to the family, particularly women. Care-givers experienced negative impacts including reduced psychological wellbeing and physical health, increased care burden and financial difficulties. A number of clinical attributes and socio-demographic factors influenced the COVID-19 impact on care-givers. Consequently, counselling services, assistance with care and financial support were identified as support needs. Implementation of new support and the strengthening of existing services are recommended to enhance resilience, build capacity to support care-givers in any given situation and mitigate the effects of future outbreaks.
Performance validity (PVTs) and symptom validity tests (SVTs) are necessary components of neuropsychological testing to identify suboptimal performances and response bias that may impact diagnosis and treatment. The current study examined the clinical and functional characteristics of veterans who failed PVTs and the relationship between PVT and SVT failures.
Method:
Five hundred and sixteen post-9/11 veterans participated in clinical interviews, neuropsychological testing, and several validity measures.
Results:
Veterans who failed 2+ PVTs performed significantly worse than veterans who failed one PVT in verbal memory (Cohen’s d = .60–.69), processing speed (Cohen’s d = .68), working memory (Cohen’s d = .98), and visual memory (Cohen’s d = .88–1.10). Individuals with 2+ PVT failures had greater posttraumatic stress (PTS; β = 0.16; p = .0002), and worse self-reported depression (β = 0.17; p = .0001), anxiety (β = 0.15; p = .0007), sleep (β = 0.10; p = .0233), and functional outcomes (β = 0.15; p = .0009) compared to veterans who passed PVTs. 7.8% veterans failed the SVT (Validity-10; ≥19 cutoff); Multiple PVT failures were significantly associated with Validity-10 failure at the ≥19 and ≥23 cutoffs (p’s < .0012). The Validity-10 had moderate correspondence in predicting 2+ PVTs failures (AUC = 0.83; 95% CI = 0.76, 0.91).
Conclusion:
PVT failures are associated with psychiatric factors, but not traumatic brain injury (TBI). PVT failures predict SVT failure and vice versa. Standard care should include SVTs and PVTs in all clinical assessments, not just neuropsychological assessments, particularly in clinically complex populations.
Here, we report the first validated record of the non-indigenous grouper species Epinephelus areolatus (Perciformes: Serranidae) along the Mediterranean coast of Syria. A single specimen of E. areolatus (Forsskål, 1775), was found on 29 September 2021 during a recurrent ichthyological survey, in a rocky habitat from the Mediterranean coast of Syria. This represents the first confirmed record of this species, native to the Red Sea, for the Syrian waters and the fourth for the Mediterranean Sea. The present record fills the gap with species distribution along the eastern Mediterranean and provides further evidence that the environmental alterations due to the combination of human activities and climate change render the Mediterranean waters increasingly likely to accommodate tropical species, possibly at the expense of the native ones.
In the shadow of various business scandals and societal crises, scholars and practitioners have developed a growing interest in authentic leadership. This approach to leadership assumes that leaders may access and leverage their “true selves” and “core values” and that the combination of these two elements forms the basis from which they act resolutely, lead ethically, and benefit others. Drawing on Heidegger’s work, we argue that a concern for authenticity can indeed instigate a leadership ethic, albeit one that acknowledges the unfounded openness of existence and its inherent relationality. On this basis, we propose an ethics-as-practice approach in which leaders respond to the situation at hand by being “attuned to attunement,” which cultivates an openness to otherness and a responsibility to others.
CHD is a lifelong condition with a significant burden of disease to patients and families. With increased survival, attention has shifted to longer-term outcomes, with a focus on social determinants of health. Among children with CHD, socioeconomic status is associated with disparities in outcomes. Household material hardship is a concrete measure of poverty and may serve as an intervenable measure of socioeconomic status.
Methods:
A longitudinal survey study was conducted at multiple time points (at acute hospitalisation, then 12–24 months later in the chronic phase) to determine the prevalence of household material hardship among parents of children with advanced heart disease and quality of life during long-term follow-up.
Results:
The analytic cohort was 160 children with a median patient age of 1 year (IQR 1,4) with 54% of patients <2 years. During acute hospitalisation, over one-third of families reported household material hardship (37%), with significantly lower household material hardship in the chronic phase at 16% (N = 9 of 52). For parents reporting household material hardship during acute hospitalisation, 50% had resolution of household material hardship by the chronic phase. Household material hardship-exposed children were significantly more likely to be publicly insured (56% versus 20%, p = 0.03) with lower quality of life than those without household material hardship (64% versus 82%, p = 0.013).
Conclusion:
The burden of heart disease during the chronic phase of illness is high. Household material hardship may serve as a target to ensure equity in the care and outcomes of CHD patients and their families.
L’éviction d’Alioune Diop du Deuxième Festival Mondial des Arts Négro-Africains (FESTAC), qui constitue l’un des événements les plus importants ayant marqué ce festival, ne se comprend que si l’on en étend le contexte au-delà du Nigéria. Pour cela, il faut aussi élargir le champ d’investigation de la recherche archivistique. C’est dans cette mesure que se révèle l’importance des archives de l’UNESCO et de Présence Africaine, et qu’il apparaît que cette éviction est d’abord un événement indépendant qui a ses propres conséquences sur le plan historique.
This special issue draws on new research conducted by the PUblic REnaissance: Urban Cultures of Public Space between Early Modern Europe and the Present project, funded by the Humanities in the European Research Area (see: www.hiddencities.eu). The project considers how public spaces, from street corners to major city squares, were shaped by the everyday activities of ordinary city dwellers between 1450 and 1700. We have focused on the urban fabric, and the ways in which meanings are attached to specific sites in the city (and objects in museum collections) that are often overlooked – the material culture of public space. Our themes are familiar to urban historians – sociability, the circulation of knowledge, information or gossip, authority and its contestation – although by moving between textual sources, maps, the built fabric and museum artefacts, our interdisciplinary and cross-Europe approach is structured around material objects in the early modern period.
The link between school feeding programmes (SFP) and the promotion of healthy eating and health is being explored in studies performed in different countries. The coronavirus disease-19 pandemic has revealed flaws and weaknesses in contemporary food systems, with many school-age children experiencing food insecurity and hunger. There is intense debate among policymakers regarding whether government SFP should be universal or targeted. Countries such as Brazil and India, which have two of the most comprehensive universal free-of-charge programmes, have shown the benefits of SFP, including improved nutritional status, support for more sustainable food systems, attendance and academic performance. Evidence shows and supports actions advocating that it is time to offer healthy and free school meals for all students.
The Developmental Origins of Health and Disease (DOHaD) approach supports that nutritional exposures in early life affect an individual’s later health and risk of disease. Dietary exposure during the preconception period may also influence individual, and inter- and transgenerational health and disease risk, in both men and women. This study aimed to describe knowledge of the DOHaD approach (DOHaDKNOWLEDGE) and diet quality in preconception young adults in Norway, to assess associations between DOHaDKNOWLEDGE and a Diet Quality Score (DQS), and to assess gender differences in those above. Data from 1362 preconception young adults was obtained from the PREPARED study baseline dataset. The sample had 88% women participants, a mean age of 27 years, 36% had overweight or obesity, and 77% had higher level of education. DOHaDKNOWLEDGE was assessed by the participants’ agreement to five statements using a Likert scale. Diet quality was assessed using aspects of diet quality and a DQS derived from a dietary screener. We found moderate level of both DOHaDKNOWLEDGE (12/20 points) and diet quality (DQS: 60/100 points), indicating potential for improvements. Specifically, the greatest potential for diet quality improvements were observed for sugary foods, red and processed meats, legumes, and unsalted nuts and seeds. Gender differences were observed for both DOHaDKNOWLEDGE and diet quality. DOHaDKNOWLEDGE was positively associated with DQS, adjusted for sociodemographic factors, with little evidence of an interaction effect by gender. This study indicates that knowledge of the DOHaD approach is positively associated with diet quality in preconception young men and women. Future studies should consider incorporating pregnancy intentions, relationship status, and health literacy.
This article argues that Thomas Kuhn's landmark work, The Structure of Scientific Revolutions, has not been adequately explored by theologians and scholars in the field of science and religion. While many cite Kuhn to suggest that science and religion share structural similarities, I contend that his work is crucial in addressing current debates about the definitions of ‘science’ and ‘religion’ and the potential for intellectual progress between them. Kuhn's framework provides more than a justification for adhering to incommensurable worldviews; it offers a nuanced understanding of how science and religion interact and the significance of tacit knowledge in scientific practice. This article explains Kuhn's focus on exemplars in his philosophy of science, which underpin his argument for key differences between science and theological inquiry. The article concludes that Kuhn's pluralistic view of truth offers theologians an opportunity to engage more deeply with science, rather than sidestepping it entirely.
We explore electoral explanations for U.S. governors’ willingness to commute death sentences in their state. Across descriptive tests and pre-registered regression specifications, we find little evidence that election timing or term limits affect either the probability of commuting death sentences or the proportion of such sentences governors might commute. However, we do find evidence that governors are more likely to commute sentences – and commute sentences for a higher proportion of defendants – during the “lame duck” period after their successor’s election but before their inauguration.
The weight, urine colour and thirst (WUT) Venn diagram is a practical hydration assessment tool; however, it has only been investigated during first-morning. This study investigated accuracy of the WUT Venn diagram at morning and afternoon timepoints compared with blood and urine markers. Twelve men (21 ± 2 years; 81·0 ± 15·9 kg) and twelve women (22 ± 3 years; 68·8 ± 15·2 kg) completed the study. Body mass, urine colour, urine specific gravity (USG), urine osmolality (UOSM), thirst and plasma osmolality (POSM) were collected at first-morning and afternoon for 3 consecutive days in free-living (FL) and euhydrated states. Number of markers indicating dehydration levels were categorised into either 3, 2, 1 or 0 WUT markers. Receiver operating characteristics analysis calculated the sensitivity and specificity of 1, 2 or 3 hydration markers in detecting dehydration or euhydration. Specificity values across morning and afternoon exhibited high diagnostic accuracy for USG (0·890–1·000), UOSM (0·869–1·000) and POSM (0·787–0·990) when 2 and 3 WUT markers were met. Sensitivity values across both timepoints exhibited high diagnostic accuracy for USG (0·826–0·941) and UOSM (0·826–0·941), but not POSM in the afternoon (0·324) when 0 and 1 WUT markers were met. The WUT Venn diagram is accurate in detecting dehydration for WUT2 and WUT3 based off USG, UOSM and POSM during first-morning and afternoon. Applied medical, sport and occupational practitioners can use this tool in field settings for hydration assessment not only at various timepoints throughout the day but also in FL individuals.
We develop a high-fidelity multi-physics model and, by using it, study the energy conversion process of a piezohydroelastic flag. Instead of a regular flag with a clamped upstream leading edge, we use an inverted flag so as to make the best of fluid elastic instability for energy harvesting. Moreover, different from many previous studies where a resistor–capacitor (RC) circuit is usually used, we adopt a resistor–inductor–capacitor (RLC) circuit for electricity generation. The influences of several key parameters associated with fluid, structure and electric dynamics are studied. Significantly different response modes are identified, among which the symmetric- and asymmetric-flutter modes are most suitable for sustainable energy harvesting, both emerging with moderate bending stiffness. If only deploying the RC circuit, increasing the resistance makes the flag more stable. By adding an inductor to turn the RC circuit into an RLC one, we observe the occurrence of ‘lock-in’ between the flag frequency and the circuit frequency as first reported on a regular flag by Xia et al. (Phys. Rev. Appl., vol. 3, 2015, 014009). This phenomenon can significantly enhance the energy output, but it only happens when the circuit resistance is sufficiently large. From a derivation based on dynamic mode decomposition analysis, we further identify an optimal condition for maximizing the energy output, which can serve as a guideline to determine whether deploying an inductor can boost the performance, and, if yes, the required inductance. The findings from this study can better guide the design of flow-induced-vibration-based piezoelectric energy harvesters for microelectronic devices.