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Children with CHD develop heart failure due to increased pulmonary blood flow, cyanosis, and pulmonary hypertension. The metabolic needs of these children differ from those of healthy children, and malnutrition is common. Protein-losing enteropathy has been reported in 5 to 13% of patients after the Fontan procedure. Serum albumin and total protein levels, which are indicators of the quality of post-operative care, can be useful tools for monitoring and examining the intensive care treatment strategies of these patients. In our retrospective study, the effects of albumin and total protein values, which are two of the markers that give us an idea about diet, nutritional status, and inflammation, on the prognosis of children who underwent the Fontan procedure were investigated.
Method:
In our study, 127 patients who underwent Fontan procedure in our clinic between 2012 and 2021 were analysed retrospectively. Of the patients, 52.7% (n = 67) were male and 47.3% (n = 60) were female. The mean age is 5.83 ± 4.63 years. Patients who underwent albumin replacement were not included in the study.
Results:
Although the relationship between pre-operative albumin and total protein values and post-operative mortality was not statistically significant, the inverse correlation of post-operative albumin 1st, 2nd, and 3rd-day values and post-operative total protein 1st, 2nd, and 3rd-day values with mortality was found to be statistically significant. In addition, we found that mortality was statistically high in patients whose total protein amount was below 6.65 mg/dl in the early post-operative period.
Conclusion:
Albumin and total protein, whose blood levels can vary with diet, can be used as predictors in the early post-operative prognosis of Fontan patients. In addition, when we examined the exitus patients, it was observed that the total protein amount was below 6.65 mg/dl on the post-operative 1st day. Based on this, we think that a diet with high protein content before surgery will help reduce post-operative early mortality.
Cephalopod populations have expanded over recent decades, both numerically and geographically. These expansions are particularly noteworthy because cephalopods are a taxon of quickly reproducing, high-metabolic rate predators that can have disproportionate impacts on naïve ecosystems. We report a new occurrence of an octopus species in 11.6 m of water in Burrows Bay, Washington, USA (coastal northeast Pacific Ocean). These newly identified individuals have several characteristics that clearly differentiate them from either of the two known octopus species that occur in shallow water within the area: Octopus rubescens and Enteroctopus dofleini. Instead, specimens superficially resemble Muusoctopus leioderma, a species which is found in the geographic area, but has never been reported at depths less than 70 m. Octopuses were collected for morphological and genetic comparison to known octopus species, focusing on other nominal Muusoctopus species. Genetic comparisons were conducted using three mitochondrial loci (12S ribosomal RNA, cytochrome oxidase subunit III, and cytochrome b) sequenced for the octopus along with two M. leioderma museum specimens, including the species' neotype. Observation of octopus behaviour revealed a unique burrowing behaviour. Morphology of the octopus found in Burrows Bay largely coincides with M. leioderma, with a few notable differences. Phylogenetic analysis revealed that Burrows Bay octopus forms a monophyletic clade with the M. leioderma neotype, but also suggested that M. leioderma is more closely related to Octopus californicus than to the other members of the genus Muusoctopus. These octopuses are thus attributed to M. leioderma but the generic placement of the species should be reviewed.
In the present study, we investigate the compressibility effects in supersonic and hypersonic turbulent boundary layers under the influence of wall disturbances by exploiting direct numerical simulation databases at Mach numbers up to 6. Such wall disturbances enforce extra Reynolds shear stress on the wall and induce mean streamline curvature in rough wall turbulence that leads to the intensification of turbulent motions in the outer region. The turbulent and fluctuating Mach numbers, the density and the velocity divergence fluctuation intensities suggest that the compressibility effects are enhanced by the increment of the free-stream Mach number and the implementation of the wall disturbances. The differences between the Reynolds and Favre average due to the density fluctuations constitute approximately $9\,\%$ of the mean velocity close to the wall and $30\,\%$ of the Reynolds stress near the edge of the boundary layer, indicating their non-negligibility in turbulent modelling strategies. The comparatively strong compressive events behaving as eddy shocklets are observed at the free-stream Mach number of $6$ only in the cases with wall disturbances. By further splitting the velocity into the solenoidal and dilatational components with the Helmholtz decomposition, we found that the dilatational motions are organized as travelling wave packets in the wall-parallel planes close to the wall and as forward inclined structures in the form of radiated waves in the vertical planes. Despite their increased magnitudes and higher portion in the Reynolds normal and shear stresses, the dilatational motions show no tendency of contributing significantly to the skin friction and the production of turbulent kinetic energy due to their mitigation by the cross-correlation between the solenoidal and dilatational velocity components.
This study explores the impact that recent Bronze Age hoard finds have had on our understanding of hoarding practices across Britain and Northern Ireland. Changes to the legislation of Treasure and the onset of the Portable Antiquities Scheme in England and Wales have produced a wealth of new information on Bronze Age hoards. Beyond a handful of studies which have focused on specific groups of hoards or the distinction between dryland/wetland deposition, however, many of these more recent finds have been overlooked. Our regional understanding of hoarding practices across Britain is also largely based on studies which are now significantly out of date. This paper aims to address this problem by providing a snapshot of hoards and hoarding practices, based on a substantial dataset of 385 hoards (containing 7210 objects) that were reported on between 1997 and 2021. Broad chronological and spatial trends in the distribution are highlighted, with precedence given to characterising these enigmatic deposits based on their size and the categories of objects within them. This investigation provides fresh insights into the selection of certain object groups – particularly axes – during certain periods and within specific regions, whilst also exploring ideas so that we might better understand the scale of metalwork deposition. This research not only demonstrates how recent hoard finds fit into traditional narratives but also how they have the potential to enhance our understanding of regional hoarding practices, offering new and exciting avenues for future research.
The lift generation mechanism of leading-edge vortex (LEV) in the case of a pitching and plunging plate is studied using an experimental approach and the improved discrete vortex method in this research. A formation condition of the secondary structure is introduced into the traditional discrete vortex method to compensate for the shortcomings in the simulation of the viscous effect between LEV and plate. The simulation of the secondary structure helps the improved method perform better in flow-field reconstruction and lift prediction. Accordingly, the lift generation mechanism of the LEV and influence of the secondary structure are studied. The lift contribution of the vortex structure is isolated and linearly decomposed into two parts according to sources of flow field: the quasi-potential flow part and the vortex-induced flow part. The vortex lift is defined as the lift contribution of the vortex structure in vortex-induced flow, which gives a new insight into the production of lift of the LEV. The lift generation mechanism through the discrete vortex method is verified and extended in viscous flow through experimental measurement. In addition, a vortex lift indicator based on the reverse flow of the LEV is proposed to examine the change of vortex lift in experimental measurement. The flow mechanism for the decline of vortex lift for different maximum effective angles of attack is revealed based on the vortex lift indicator. Furthermore, for the LEV-dominating flow, the indicator can also be applied in estimating the maximum value and corresponding critical time of overall lift in experiments.
Across Western European democracies, the last 20 years have seen a growth of precarious employment and the rise of challenger parties. Both trends are especially marked in Italy, where occupational insecurity has become the norm and over half of the electorate has turned to a challenger party. In this article, I investigate the relationship between these two phenomena, addressing the question of whether and how precarity in the labor market influenced vote choice in the 2018 general election. First, I provide descriptive evidence that the Italian labor market shifted from dualism to generalized precarization. Second, I empirically investigate the relationship between precarity and voting in this context. The results show that the perception of precarity, not formal employment status, influenced voting behavior: it fostered participation, increased support for the Five Star Movement, and decreased support for the Democratic Party. These findings challenge core assumptions in the literature, first and foremost about precarious workers' low turnout rate, difficult mobilization, and consequent political irrelevance. They indicate that the electoral weight of precarious workers has increased, and their representation can be electorally beneficial.
The West African giraffe is restricted to Niger, but historically it inhabited much of the Sudano-Sahelian zone. The population is concentrated in the ‘Giraffe Zone’ (GZ), an unprotected area with a high human population density. Since the mid-1990s, the giraffe population has steadily increased mainly due to the collective social and conservation initiatives of the government, non-governmental organizations and the local community. In 2018, the first West African giraffe satellite population was established through the reintroduction of eight individuals into Gadabedji Biosphere Reserve (GBR). In this study, we aimed to describe the current state of human–giraffe coexistence, human attitudes towards giraffe and human habits of natural resources use through a questionnaire survey conducted in the GZ and GBR. Although most of the GZ respondents highlighted crop damage caused by giraffe, we also found overall positive attitudes towards the animals. Most respondents from both sites expressed positive attitudes towards giraffe, highlighting that they do not see poaching as a major current threat. However, the giraffe population continues to be directly threatened by habitat loss through firewood cutting, livestock overgrazing and agriculture expansion. Long-term conservation of the West African giraffe is dependent on better habitat protection and understanding of current human–giraffe coexistence through ensuring that giraffe presence will benefit local communities across their range.
Let $f\;:\; M\rightarrow \mathbb{C}P^{2}$ be an isometric immersion of a compact surface in the complex projective plane $\mathbb{C}P^{2}$. In this paper, we consider the Helfrich-type functional $\mathcal{H}_{\lambda _{1},\lambda _{2}}(f)=\int _{M}(|H|^{2}+\lambda _{1}+\lambda _{2} C^{2})\textrm{d} M$, where $\lambda _{1}, \lambda _{2}\in \mathbb{R}$ with $\lambda _{1}\geqslant 0$, $H$ and $C$ are respectively the mean curvature vector and the Kähler function of $M$ in $\mathbb{C}P^{2}$. The critical surfaces of $\mathcal{H}_{\lambda _{1},\lambda _{2}}(f)$ are called Helfrich surfaces. We compute the first variation of $\mathcal{H}_{\lambda _{1},\lambda _{2}}(f)$ and classify the homogeneous Helfrich tori in $\mathbb{C}P^{2}$. Moreover, we study the Helfrich energy of the homogeneous tori and show the lower bound of the Helfrich energy for such tori.
Identifying early predictors of dialysis requirements in earthquake-related injuries is crucial for optimal resource allocation and timely intervention. This study aimed to develop a predictive scoring system, named SAFE-QUAKE (Seismic Assessment of Kidney Function to Rule Out Dialysis Requirement), to identify patients at high risk of developing acute kidney injury (AKI) and requiring dialysis.
Methods:
A retrospective analysis was conducted on a cohort of 205 patients presenting with earthquake-related injuries. Patients were divided into two groups based on their need for dialysis: the no dialysis group (n = 170) and the dialysis group (n = 35). Demographic, clinical, and laboratory data were collected and compared between the two groups to identify significant predictors of dialysis requirements. The parameters that would form the score were determined by conducting an importance analysis using artificial neural networks (ANNs) to identify parameters that exhibited statistically significant differences in univariate analysis.
Results:
The dialysis group had a significantly longer median duration of being trapped under debris (48 hours) compared to the no dialysis group (eight hours). Blood gas and laboratory analyses revealed significant differences in pH levels, lactate values, creatinine levels, lactate dehydrogenase (LDH) levels, and aspartate transaminase (AST)-to-alanine transaminase (ALT) ratio between the two groups. Based on these findings, the SAFE-QUAKE rule-out scoring system was developed, incorporating entrapment duration (<45 hours), pH levels (>7.31), creatinine levels (<2mg/dL), LDH levels (<1600mg/dL), and the AST-to-ALT ratio (<2.4) as key predictors of dialysis requirements. This score included 139 patients, and among them, only one patient required dialysis, resulting in a negative predictive value of 99.29%.
Conclusions:
The SAFE-QUAKE scoring system demonstrated a high negative predictive value of 99.29% in ruling out the need for dialysis among earthquake-related injury cases. This scoring system offers a practical approach for health care providers to identify patients at high risk of developing AKI and requiring dialysis in earthquake-affected regions.
This article presents a first-principles model for electrosprays operating in the ion emission regime. The model considers ion emission from a Taylor cone anchored on a tubular emitter, including the fluid dynamics as well as the electrostatic interaction between the liquid, the electrodes and the ion beam. The model accounts for the self-heating of the liquid due to ohmic and viscous dissipation, and the associated variation of the viscosity and electrical conductivity with temperature. The numerical solution reproduces the experimental phenomenology of the ion emission regime (e.g. current levels, the high sensitivity to the ion solvation energy, the proportionality between the emitted current and emitter potential, etc.), and other aspects of the underlying physics such as the coupling between ion emission and self-heating of the liquid. The numerical solution is also used to validate a simpler analytical model that yields scaling laws for the emitted current, and for the characteristic length, current density and electric field of the emission region. The analytical model also provides liquid-dependent criteria for the onset of the ion emission regime.
When solving a complex problem in a group, should group members always choose the best available solution that they are aware of? In this paper, I build simulation models to show that, perhaps surprisingly, a group of agents who individually randomly follow a better available solution than their own can end up outperforming a group of agents who individually always follow the best available solution. This result has implications for the feminist philosophy of science and social epistemology.
Discrimination experiences are a salient contributor to the health disparities facing Latina/x/o youth. The biopsychosocial model of minority health posits that discrimination influences health through wear and tear on the biological stress responses, including the hypothalamic-pituitary-adrenal (HPA) axis, which is a primary stress response system in the body. Emerging evidence suggests that discrimination alters the secretion of cortisol, the end product of the HPA axis, yet, whether the daily processes between discrimination and diurnal cortisol response influence mental and sleep health remains unanswered. This study integrated daily diary and post-diary survey data to examine whether daily diurnal cortisol responses to discrimination influence adolescents’ mental (depressive symptoms, anxiety) and sleep (sleep quality, duration) health in a sample of Mexican-origin youth (N = 282; Mage = 17.10; 55% female). Results showed that adolescents who experienced more discrimination across the four-day diary period exhibited steeper diurnal cortisol slopes and lower evening cortisol; however, such physiological responses tended to be associated with poorer adolescents’ mental and sleep health. The current study underscores the potential adaptation cost associated with short-term cortisol adaptation in the face of discrimination.
This article proposes a novel way to estimate consumer switching costs and uses Lithuanian credit register data and two bank closures to provide this estimate for the loan market. I show that when a distressed bank’s closure forced firms to switch, they started borrowing at lower interest rates instantly and permanently and that this drop revealed the lower bound of firms’ ex ante switching costs. A healthy bank’s closure showed no such effect. The article’s findings suggest that distressed banks hold up and overcharge firms and that by closing and resolving such banks with good-bank/bad-bank separation regulators can improve firm financing.
The description of weakly nonlinear water-wave evolution over a horizontal bottom by the integro-differential Zakharov equation, because of utilising the underlying Hamiltonian structure, has many advantages over direct use of the Euler equations. However, its application to finite-depth situations is not straightforward since, in contrast to the deep-water case, the kernels governing the four-wave interactions are singular, as well as the kernels in the canonical transformation that removes non-resonant interactions from the original equations of motion. At the singularities, these kernels are finite but not unique. The issue of how to use the Zakharov equation for finite depth and whether it is possible at all was debated intensely in the literature for decades but remains outstanding. Here we show that the absence of a limit of the kernels at the singularities is inconsequential, since in the equations of motion it is only the integral that matters. By applying the definition of the Dirac-$\delta$, we show that all the integrals involving a trivial manifold singularity are evaluated uniquely. Therefore, the Zakharov evolution equation and the nonlinear canonical transformation are only apparently singular. The findings are validated by application to examples where predictions based on the Zakharov equation are compared with known solutions obtained from the Euler equations.
This paper is concerned with the study of the fine Selmer group of an abelian variety over a $\mathbb{Z}_{p}$-extension which is not necessarily cyclotomic. It has been conjectured that these fine Selmer groups are always torsion over $\mathbb{Z}_{p}[[ \Gamma ]]$, where $\Gamma$ is the Galois group of the $\mathbb{Z}_{p}$-extension in question. In this paper, we shall provide several strong evidences towards this conjecture. Namely, we show that the conjectural torsionness is consistent with the pseudo-nullity conjecture of Coates–Sujatha. We also show that if the conjecture is known for the cyclotomic $\mathbb{Z}_{p}$-extension, then it holds for almost all $\mathbb{Z}_{p}$-extensions. We then carry out a similar study for the fine Selmer group of an elliptic modular form. When the modular forms are ordinary and come from a Hida family, we relate the torsionness of the fine Selmer groups of the specialization. This latter result allows us to show that the conjectural torsionness in certain cases is consistent with the growth number conjecture of Mazur. Finally, we end with some speculations on the torsionness of fine Selmer groups over an arbitrary p-adic Lie extension.
Recent proposals that the substrate of memory is molecular raise questions about where this molecular model stands in relation to the dominant synaptic model of memory. In this article, we address the perceived rivalry between these models and ask whether they can be integrated. We argue that addressing rivalry or integration requires delineating the explananda of synaptic and molecular models, as well as revisiting assumptions about how these models account for their explananda. The perceived rivalry between these models exemplifies epistemic costs that arise when we try to pit explanatory models as rivals or integrate them.
For turbulent bubbly flows, multi-phase simulations resolving both the liquid and bubbles are prohibitively expensive in the context of different natural phenomena. One example is breaking waves, where bubbles strongly influence wave impact loads, acoustic emissions and atmospheric-ocean transfer, but detailed simulations in all but the simplest settings are infeasible. An alternative approach is to resolve only large scales, and model small-scale bubbles adopting sub-resolution closures. Here, we introduce a large eddy simulation smoothed particle hydrodynamics (SPH) scheme for simulations of bubbly flows. The continuous liquid phase is resolved with a semi-implicit isothermally compressible SPH framework. This is coupled with a discrete Lagrangian bubble model. Bubbles and liquid interact via exchanges of volume and momentum, through turbulent closures, bubble breakup and entrainment, and free-surface interaction models. By representing bubbles as individual particles, they can be tracked over their lifetimes, allowing closure models for sub-resolution fluctuations, bubble deformation, breakup and free-surface interaction in integral form, accounting for the finite time scales over which these events occur. We investigate two flows: bubble plumes and breaking waves, and find close quantitative agreement with published experimental and numerical data. In particular, for plunging breaking waves, our framework accurately predicts the Hinze scale, bubble size distribution, and growth rate of the entrained bubble population. This is the first coupling of an SPH framework with a discrete bubble model, with potential for cost-effective simulations of wave–structure interactions and more accurate predictions of wave impact loads.
The family Syngnathidae contains 52 seahorse species, which inhabit a range of habitats including coral reefs, seagrass beds and coastal estuaries. The seahorse Hippocampus kelloggi is among the most widely distributed species, occurring from Indo-West Pacific to East Africa. This species was included in the IUCN Red List in 2017 and is classified as vulnerable according to A2cd criteria. In this study, three specimens collected from the central coast of Mozambique were investigated and based on morphology and mitochondrial subunit of cytochrome oxidase I (COI) were identified as H. kelloggi. These results confirmed for the first time the extensive range of occurrence of H. kelloggi on the central coast of Mozambique.
Microfluidic flow focusing is a versatile method for the production of monodisperse microbubbles for biomedical applications involving ultrasound. Existing studies propose several theoretical models to predict bubble size and production rate as a function of the liquid and gas flow rate. Yet, they typically do not include physical fluid parameters such as density, viscosity and surface tension. Here, we present an exhaustive experimental and numerical investigation of the influence of physical properties of the gas and liquid, and of the channel geometry on bubble size and production rate. We find a particularly strong effect of (i) gas density on the production rate and (ii) liquid viscosity on the bubble size. We further discuss our findings within the context of existing theoretical models to reflect on gaps in our current understanding of the fluid mechanics of bubble formation by flow focusing.
Aerobreakup of drops is a fundamental two-phase flow problem that is essential to many spray applications. A parametric numerical study was performed by varying the gas stream velocity, focusing on the regime of moderate Weber numbers, in which the drop deforms to a forward bag. When the bag is unstable, it inflates and disintegrates into small droplets. Detailed numerical simulations were conducted using the volume-of-fluid method on an adaptive octree mesh to investigate the aerobreakup dynamics. Grid-refinement studies show that converged three-dimensional simulation results for drop deformation and bag formation are achieved by the refinement level equivalent to 512 cells across the initial drop diameter. To resolve the thin liquid sheet when the bag inflates, the mesh is refined further to 2048 cells across the initial drop diameter. The simulation results for the drop length and radius were validated against previous experiments, and good agreement was achieved. The high-resolution results of drop morphological evolution were used to identify the different phases in the aerobreakup process, and to characterize the distinct flow features and dominant mechanisms in each phase. In the early time, the drop deformation and velocity are independent of the Weber number, and a new internal-flow deformation model, which respects this asymptotic limit, has been developed. The pressure and velocity fields around the drop were shown to better understand the internal flow and interfacial instability that dictate the drop deformation. Finally, the impact of drop deformation on the drop dynamics was discussed.