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The cardiovascular adaptations associated with structured exercise training in Fontan patients remain unknown. We hypothesised that short-term training causes cardiac remodelling and parallel improvement in maximal exercise capacity (VO2 max) in these patients.
Methods and Results:
Five patients, median age 19.5 (17.6–21.3) years, with a history of Fontan operation meeting inclusion/exclusion criteria, participated in a 3-month training programme designed to improve endurance. Magnetic resonance images for assessment of cardiac function, fibrosis, cardiac output, and liver elastography to assess stiffness were obtained at baseline and after training. Maximal exercise capacity (VO2 max) and cardiac output Qc (effective pulmonary blood flow) at rest and during exercise were measured (C2H2 rebreathing) at the same interval. VO2 max increased from median (IQR) 27.2 (26–28.7) to 29.6 (28.5–32.2) ml/min/kg (p = 0.04). There was an improvement in cardiac output (Qc) during maximal exercise testing from median (IQR) 10.3 (10.1–12.3) to 12.3 (10.9–14.9) l/min, but this change was variable (p = 0.14). Improvement in VO2 max correlated with an increase in ventricular mass (r = 0.95, p = 0.01), and improvement in Quality-of-life inventory (PedsQL) Cardiac scale scores for patient-reported symptoms (r = 0.90, p = 0.03) and cognitive problems (r = 0.89, p = 0.04). The correlation between VO2 max and Qc showed a positive trend but was not significant (r = 0.8, p = 0.08). No adverse cardiac or liver adaptations were noted.
Conclusion:
Short-term training improved exercise capacity in this Fontan pilot without any adverse cardiac or liver adaptations. These results warrant further study in a larger population and over a longer duration of time.
Diets and dietary constituents that we consume have a considerable impact on disease risk. Intriguingly these effects may be modulated to some extent by sex. Lack of female representation in nutritional studies as well as a lack of stratification by sex has and continues to limit our understanding of these sex × diet interactions. Here we provide an overview of the current and available literature describing how exposure to certain dietary patterns (Western-style diet, Mediterranean diet, vegetarian/vegan, ketogenic diet) and dietary constituents (dietary fibre, PUFA and plant bioactive) influences disease risk in a sex-specific manner. Interestingly, these sex differences appear to be highly disease-specific. The identification of such sex differences in response to diet stresses the importance of sex stratification in nutritional research.
The confluence of rapid population aging and the overwhelming desire of older adults to age in place begs the question: Do our cities support the health and well-being of aging populations? Using a neighbourhood-by-neighbourhood approach, this macro-scale investigation explores the “double risk” that many older adults live with – the potential of being disadvantaged by socio-demographic risk factors (being older, living alone, low income) and by living in an unsupportive built environment. It is an integration of what we know about supportive built form for older adults and applies this knowledge to Canadian cities, using a spectrum approach to classifying built environments. We found that most older adults with socio-demographic risk factors are living in unsupportive built environments in Canada; however, the distribution between built environments along the spectrum and between municipalities reveals a variegated landscape of double risk. Previous research suggests that unsupportive built environments can be supplemented with services, small-scale improvements in the built environment, and larger-scale retrofitting of neighbourhoods. Since the spatial distribution of vulnerability varies greatly within the 33 Canadian cities analysed, it highlights the need for this kind of inquiry to target age-friendly policy interventions.
Wind tunnel experiments are performed in both neutral and stable boundary layers to study the effect of thermal stability on the wake of a single turbine and on the wakes of two axially aligned turbines, thereby also showing the influence of the second turbine on the impinging wake. In the undisturbed stable boundary layers, the turbulence length scales are significantly smaller in the vertical and longitudinal directions (up to 50 % and $\approx$40 %, respectively), compared with the neutral flow, while the lateral length scale is unaffected. The reductions are larger with the imposed inversion of a second stable case, except in the near-wall region. In the neutral case, the length scales in the wake flow of the single turbine are reduced both vertically and laterally (up to 50 % and nearly 40 %, respectively). While there is significant upstream influence of a second turbine (on mean and turbulence quantities), there is virtually no upstream effect on vertical length scales. However, curiously, the presence of the second turbine aids length-scale recovery in both directions. Longitudinally, each turbine contributes to successive reduction in coherence. The effect of stability on the turbulence length scales in the wake flows is non-trivial: at the top of the boundary layer, the reduction in the wall-normal length scale is dominated by the thermal effect, while closer to the wall, the wake processes strongly modulate this reduction. Laterally, the turbines’ rotation promotes asymmetry, while stability opposes this tendency. The longitudinal coherence, significantly reduced by the wake flows, is less affected by the boundary layer's thermal stability.
We present sound and complete sequent calculi for the modal mu-calculus with converse modalities, aka two-way modal mu-calculus. Notably, we introduce a cyclic proof system wherein proofs can be represented as finite trees with back-edges, i.e., finite graphs. The sequent calculi incorporate ordinal annotations and structural rules for managing them. Soundness is proved with relative ease as is the case for the modal mu-calculus with explicit ordinals. The main ingredients in the proof of completeness are isolating a class of non-wellfounded proofs with sequents of bounded size, called slim proofs, and a counter-model construction that shows slimness suffices to capture all validities. Slim proofs are further transformed into cyclic proofs by means of re-assigning ordinal annotations.
In this article, we study the behaviour of the Abels–Garcke–Grün Navier–Stokes–Cahn– Hilliard diffuse-interface model for binary-fluid flows, as the diffuse-interface thickness passes to zero. For the diffuse-interface model to approach a classical sharp-interface model in the limit $\varepsilon \to +0$, the so-called mobility parameter $m$ in the diffuse-interface model must scale appropriately with the interface-thickness parameter $\varepsilon$. In the literature various scaling relations in the range $o(1)$ to $O(\varepsilon ^3)$ have been proposed, but the optimal order to pass to the limit has not been explored previously. Our primary objective is to elucidate this optimal order of the $m$–$\varepsilon$ scaling relation in terms of the rate of convergence of the diffuse-interface solution to the sharp-interface solution. Additionally, we examine how the convergence rate is affected by a sub-optimal parameter scaling. We centre our investigation around the case of an oscillating droplet. To provide reference limit solutions, we derive new analytical expressions for small-amplitude oscillations of a viscous droplet in a viscous ambient fluid in two dimensions. For two distinct modes of oscillation, we probe the sharp-interface limit of the Navier–Stokes–Cahn–Hilliard equations by means of an adaptive finite-element method. The adaptive-refinement procedure enables us to consider diffuse-interface thicknesses that are significantly smaller than other relevant length scales in the droplet-oscillation problem, allowing an exploration of the asymptotic regime.
This paper investigates the effect of anisotropic turbulence on generating leading-edge aerofoil–turbulence interaction noise. Thin aerofoil theory is used to model an aerofoil as a semi-infinite plate, and the scattering of incoming turbulence is solved via the Wiener–Hopf technique. This theoretical solution encapsulates the diffraction problem for gust–aerofoil interaction and is integrated over a wavenumber–frequency spectrum to account for general incoming anisotropic turbulence. We develop a novel axisymmetric wavenumber–frequency model that captures the wall-normal variation in turbulence characteristics, differing from previous approaches. Then, the method of Gaussian decomposition, in which the generalised spectra are approximated through the weighted sum of individual Gaussian eddy models, is applied to fit the turbulence model to experimental data. Comparisons with experimental data show good agreement for a range of anisotropic ratios.
Do lower court judges influence the content of Supreme Court opinions in the United Kingdom? Leveraging original data, we analyze opinion language adoption practices of the UK Supreme Court. We advance a theory where the justices’ choices to adopt language from lower court opinions are influenced by Supreme Court-level attributes and Court of Appeal case characteristics. We uncover compelling evidence that UK Supreme Court justices incorporate language extensively from the written opinions of the Court of Appeal of England and Wales. Our findings have significant implications for opinion formulation, doctrinal development, and higher and lower court interactions within comparative courts.
Anti-work philosophy holds that work, in and of itself, tends to be harmful for most people. Some anti-work theorists even advocate for the abolition of paid employment altogether. We argue that, while endorsement of the radical ideology of anti-work is in no way necessary for I/O psychologists, considering the thinking behind these ideas can be beneficial. In fact, reviewing the tenets of anti-work may prompt some to a broad reconsideration of the nature and purpose of the I/O field and its role, nested as it is in potentially problematic power dynamics both within organizations and in broader society. In this article, after describing anti-work’s core tenets, we outline a number of research directions and practical applications inspired by this perspective. While in some cases these may involve the creation of new theory, constructs, and interventions, they often simply entail the repurposing or refocusing of existing ones that are more attuned to the problematic nature of work. Possibilities for research include, but are not limited to, the examination of the prevalence and nature of “managerialism,” how we might better understand the psychological character of organized labor and its outcomes, and how to encourage healthier manifestations of employee engagement. In terms of practice, we bring to the reader’s attention how anti-work might inspire extensions or adjustments in how we recruit and onboard, train managers, improve job characteristics, measure performance and work with unions and other political advocates. Ultimately, consideration of anti-work’s assertion of the inevitable authoritarian character of employment, combined with I/O psychology’s emphases on objectivity and the translation of science into practice, can spark inquiry and innovation.
An unusual worm, previously interpreted as the earliest leech, is described from the early Silurian (Llandovery, Telychian) Brandon Bridge Formation Lagerstätte (Waukesha Biota) of Wisconsin (~437 Ma). Lacking preserved internal organs, it is up to ~16 cm long, 8.2 mm wide, with ~250 annulations and a circular structure at one end, interpreted here as the broken end of a molt. It is therefore referred to Cycloneuralia incertae sedis.
The legal evidentiary approach to “solving” statelessness can sometimes lead to the issue being framed in terms of certain groups of people not meeting objective citizenship criteria or lacking required legal documents. Building on critical interdisciplinary scholarship in anthropology, history and legal studies, this article demonstrates the “constructedness” of citizenship and statelessness through the lens of the politics of recognition and documentation. Using Thailand as a case study, I highlight how global economic, political and social contexts play a significant and dynamic role in delineating the legal line of membership. By tracing how Thai nationality has been instrumentalised by the state throughout the twentieth century, this article contextualises statelessness as a legal and social by-product of statemaking. As such, it challenges the framing of nationality as a non-discriminatory mode of recognition founded in legal objectivity and reiterates the politics of statelessness. In emphasising the fragility of citizenship when granted without genuine social, political and moral recognition, I argue that the objective of statelessness advocacy should not simply be about turning stateless persons into citizens, but rather about creating a more equitable society wherein one's rights are upheld regardless of legal status.