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Heart failure induced by systemic ventricular dysfunction after the Norwood procedure may improve with medications. This study aimed to evaluate the incidence of heart failure, medication use, and subsequent improvement after the Norwood procedure.
Methods:
Among the patients undergoing the Norwood procedure between 2001 and 2024, those who demonstrated heart failure (systemic ventricular dysfunction lasting > 30 days) were identified. Medical therapy and clinical outcomes were evaluated in relation to the recovery of systemic ventricular dysfunction.
Results:
Among 380 patients after the Norwood procedure, heart failure was observed in 55 patients. Recovery of systemic ventricular function occurred in 21 patients with a median duration of 187 (interquartile range: 77–354) days. The cumulative incidence of recovery was 60.9% at 5 years. Recovery was more frequently observed in patients whose onset was between stage II and III palliation than in other periods (58% vs. 28%, p = .029). Survival after the onset of heart failure was better in patients who showed recovery than in those who did not (88.8% vs. 26.7% at 5 years, p < .001). At the onset of heart failure, zlog-N-terminal prohormone of brain natriuretic peptide (4.2 ± 1.3 vs. 4.5 ± 1.3, p = .55) was similar but differed at the last follow-up (2.2 ± 1.3 vs. 5.1 ± 1.5, p = .01) in patients with and without recovery. A phosphodiesterase type 5 inhibitor was identified as a factor that promoted the recovery (hazard ratio: 5.89, p < .01).
Conclusions:
In patients who developed heart failure after the Norwood procedure, survival was better in those with recovered function than in those with sustained dysfunction. Phosphodiesterase type 5 inhibitors were identified as a factor promoting the recovery.
In laser-produced plasma (LPP) extreme ultraviolet (EUV) sources, deformation of a tin droplet into an optimal target shape is determined by its interaction with a pre-pulse laser-generated plasma. This interaction is mediated by a transient ablation pressure, whose complex spatio-temporal evolution remains experimentally inaccessible. Existing modelling approaches are limited: empirical pressure–impulse models neglect dynamic plasma feedback, while advanced radiation hydrodynamics codes often fail to resolve late-time droplet hydrodynamics. To bridge this gap, we propose a radiation two-phase flow model based on a diffuse interface approach. The model integrates radiation hydrodynamics for the plasma with the Euler equations for a weakly compressible liquid, extending a five-equation diffuse interface formulation to incorporate radiation transport, thermal conduction, ionisation and surface tension. This formulation enforces pressure and velocity equilibrium across the diffuse interface region, with closure models constructed to ensure correct jump conditions at interfaces and asymptotically recover the pure-phase equations in bulk regions. Then we apply the model to simulate a benchmark pre-pulse scenario, where a $50\ \unicode{x03BC} \mathrm{m}$ tin droplet is irradiated by a $10\ \mathrm{ns}$ laser pulse. Our axisymmetric simulations capture the rapid plasma expansion and subsequent inertial flattening of the droplet into a thin, curved sheet over microsecond time scales. Notably, the model reproduces experimentally observed features such as an axial jet – rarely replicated in prior simulations. Quantitative agreement with experimental data for sheet dimensions and velocity validates the approach. The proposed model self-consistently couples laser–plasma physics with compressible droplet dynamics, providing a powerful tool for studying plasma–liquid interactions in LPP-EUV source optimisation.
This article investigates the polyfunctionality of the Italian adverb pure ‘also’ and its relationship with post-modal meanings. Beside its prototypical use as an additive focus adverb, pure displays secondary uses which involve categories that fall within the post-modal domain, such as concessivity, speech act marking, and illocutionary modification. Drawing on newly extracted corpus data, this article shows (i) how the additive semantics of pure lends itself to cover different discourse-pragmatic functions, (ii) describes their features and the connections between them, and (iii) highlights patterns of semantic change. The results contribute to shed light on the internal structure of the post-modal domain and on the different development paths leading to it. Special attention has been given to illocutionary modification, both in terms of the range of functions which can be subsumed under this category and its position in a layered model of grammar.
A suite of Miaolingian to Furongian (i.e., traditional middle-upper Cambrian) trilobites are reported from the Abrigo Formation at exposures along Nugget Canyon and adjacent Peppersauce Canyon, Santa Catalina Mountains, Arizona, USA. These fossils are uncommon in the region because the unit predominantly comprises coarser-grained siliciclastic facies deposited near shoreface settings where fossils are not often preserved. Trilobites include Agnostidae gen. indet. sp. indet. and the ptychoparioids Ehmaniella sp. indet.; Neoblairella sp. indet.; Altiocculus sp. indet.; Arapahoia ransomei (Stoyanow, 1936); Bolaspidella sp. indet.; Bolaspididae gen. indet. sp. indet.; Brachyaspidion sp. indet.; Cedaria sp. indet.; Crepicephalus sp. indet.; Elburgia sp. indet.; Eldoradia linnarssoni (Walcott, 1884); Eldoradia prospectensis (Walcott, 1884); Iddingsia sp. indet.; Modocia centralis (Whitfield, 1877); Modocia cf. M. crassimarginata Rasetti, 1965b; Modocia oweni? (Meek and Hayden, 1861); Strigambitus cf. S. transversus Palmer, 1965; and Tricrepicephalus texanus (Shumard, 1861). The type specimens of Arapahoia ransomei and Arapahoia butleri (Stoyanow, 1936) are refigured and considered synonymous. This fauna spans the Ehmaniella to Crepicephalus biozones and the Dunderbergia Biozone; the last has not been previously reported from the Abrigo Formation. This biostratigraphy is calibrated by correlation with regional strata constrained by detrital zircon U-Pb geochronology, which provides ages that are consistent with the observed biozones. Considered together, these data help correlate the Abrigo Formation to more fossiliferous and offshore successions elsewhere in Arizona, Sonora, New Mexico, Texas, USA, and beyond.
Convective mixing in porous media is crucial in both geophysical and industrial fields, spanning applications ranging from carbon dioxide sequestration to geothermal energy extraction. Key processes are affected by convective heat transport or diffusion of chemical species in porous formations. Intense convection flow and mixing create complex, dynamic patterns that are difficult to predict and measure. The present work focuses on the use of topological data analysis, in particular, the measures emerging from the growing field of persistent homology (PH), to quantify these patterns. These measures are objective and quantify structures across all temperature or concentration values simultaneously. These techniques, when applied to classical porous media set-ups, such as one-sided and Rayleigh–Bénard flow configurations, provide new insights into a system’s structure, flow patterns and macroscopic mixing properties. Using large datasets we make publicly available, comprising original simulations as well as those presented in previous works, we correlate the behaviour of the heat transport rate (quantified by the Nusselt number) with the evolution of the flow structures (quantified by the PH measures). Finally, we provide a detailed analysis of the flow evolution over a wide range of governing parameters, namely the Rayleigh–Darcy number and the domain size.
Only six species of the genus Cylindrobulla have been described anatomically. A new species from Ghizo Island, Solomon Islands, is here described. It is the first anatomically described species from the South Pacific Ocean. The new species, Cylindrobulla ghizoensis sp. nov., has a thin, semi-transparent shell 2–6 mm long and a white head and foot, which are completely retractable inside the shell. The foot is slightly longer than the head. The uniseriate radula has numerous small (6–8 µm) teeth with a short central cusp only marginally longer than the few lateral cusps. The short penis has no stylet. A comparison of all described species of Cylindrobulla permits an emended genus diagnosis including a shell with a deep, oblique apical keel with excentric nucleus, a thickened edge of body whorl, a suctorial pharynx, and numerous (80–100+) small, uniformly sized radular teeth, including several formative teeth and a poorly defined ascus. Comparing the feeding structures of Cylindrobulla with those of other sacoglossans shows a pharynx with weaker musculature and teeth unsuitable for piercing algal cell walls, indicating a different feeding method.
How much did France pay for its colonial empire? Did colonies benefit from large transfers from French taxpayers and private investors, or were they, on the contrary, drained of their capital? This paper uses novel budgetary, private investment, and loan data to compute monetary flows between France and the colonies between 1833 and 1962. Public expenditure spent by France on the empire represented only 1.3 percent of its GDP, of which four-fifths was for the military. Trade balance deficits of French colonies were not counterbalanced by large public or private capital transfers from France to the colonies, but by military expenditure from the metropole. Overall, large sums of money were flowing from the colonies to the metropole, a “drain” representing a couple of percentage points of colonial GDP, making French colonies comparable to British India in the twentieth century.
Deficiency in vitamin D can increase the risk of type 2 diabetes (T2D). Yet, the association between 25-hydroxyvitamin D (25(OH)D) levels and the serum proteome in subjects at risk of T2D remains unknown This proteomic analysis aimed to examine the correlations between serum proteins and 25(OH)D levels stratified as insufficient (<50 nmol/L), adequate (50–74.9 nmol/L), and optimal (≥75 nmol/L); and (2) to identify biological pathways linked to these proteins that may reduce T2D risk. In this crossover study, 25 hyperinsulinemic French-Canadian adults from the Quebec City metropolitan area (Canada) were evaluated at four timepoints: before and after 6 weeks of either adequate dairy intake (∼2 servings/day) or high dairy intake (≥4 servings/day). Serum 25(OH)D concentrations were measured using an immunoassay and serum protein profiling was performed using liquid chromatography–tandem mass spectrometry. Gene ontology analysis identified biological pathways. Dairy intake did not significantly change 25(OH)D serum levels. Nevertheless, in ten subjects with optimal 25(OH)D levels, positively correlated proteins were mainly involved in immunoglobulin-mediated immune response, regulation of blood coagulation, acute-phase response, and adaptive immunity. Negatively correlated proteins were enriched in classical complement activation, innate immune response, acute-phase response, and proteolysis. In six subjects with adequate 25(OH)D levels, correlated proteins were associated mainly with innate immune responses. No significant biological pathway enrichment was observed in subjects with insufficient 25(OH)D. Overall, individuals with higher or optimal serum 25(OH)D levels exhibit a greater number of proteins enriched in various immune system response pathways, processes known to influence T2D development.
Dispatcher-guided cardiopulmonary resuscitation (CPR) via video calls represents an important shift from purely verbal instruction to real-time visual modeling for untrained bystanders during out-of-hospital cardiac arrest. This approach may improve compression depth, rhythm, overall CPR quality, and reduce interruptions.
Problems:
Its implementation remains challenging because voice calls may be faster, whereas video guidance requires stable connectivity, smartphone access, digital literacy, appropriate camera positioning, and trained dispatchers. Moreover, simulation findings among young university students may not reflect real emergency conditions.
Conclusion:
Video-assisted CPR should be developed as a hybrid, equitable, low-bandwidth intervention and tested pragmatically across diverse emergency systems.
An $[s,t]$-graph is a graph in which every induced subgraph on s vertices contains at least t edges. Li and Wang [‘Hamilton cycles in $2$-connected $[5,3]$-graphs’, J. Inn. Mong. Norm. Univ. Nat. Sci.35(3) (2006), 285–287] investigated the Hamiltonicity of $[5,3]$-graphs, and more recently, Liu and Liu [‘On the pancyclicity of $2$-connected $[5,3]$-graphs’, Discrete Applied Mathematics389 (2026), 323–334] studied their pancyclicity. In this note, we continue this line of research by studying the Hamiltonian-connectedness of $[5,3]$-graphs.
The nonlinear behaviour and parameter coupling inherent in gas turbine engines pose persistent challenges in the development of accurate thrust prediction models for unmanned aerial vehicle (UAV) propulsion systems. This study investigates the application of ensemble regression methods to address these complexities and enhance predictive accuracy using experimental data obtained under controlled test conditions. The evaluated models include bootstrap aggregating (bagging), adaptive boosting (AdaBoost), light gradient boosting machine (LightGBM), CatBoost, stacked generalisation (stacking) and a voting regressor ensemble. Each model was trained and evaluated using experimentally measured thermodynamic and operational parameters across a range of engine operating conditions. Cross-validation results revealed that stacking achieved the lowest prediction errors with a root mean square error (RMSE) of 0.0635 and a mean absolute error (MAE) of 0.0442, while AdaBoost demonstrated a very high cross-validated coefficient of determination (${R^2}$) of 0.9998. CatBoost achieved ${R^2}$ values above 0.99, and voting produced ${R^2}$ values close to 0.99. LightGBM exhibited comparatively higher prediction errors and greater variability across folds. These results indicate the potential effectiveness of stacking and adaptive boosting approaches for thrust estimation in UAV gas turbine propulsion systems, while also demonstrating that ensemble performance depends strongly on algorithm selection and dataset characteristics.
We report experimental results on the low-frequency dynamics in the wake of a stationary sphere and the corresponding bifurcation. This low frequency is the second frequency appearing past a sphere when the Reynolds number is increased. We measure the velocity field using particle image velocimetry in transverse planes past a sphere placed in a water channel, and obtain the streamwise vorticity. We compute the position of the barycentre of the absolute value of the vorticity and projected the vorticity on azimuthal mode 1. We deduce from periodograms of these signals the Strouhal numbers $\mathit{St}_1$ and ${{\textit{St}}_2}$ associated with the first ($f_1$) and second ($f_2$) frequencies. The frequency ratio $f_2/f_1$ decreases with the Reynolds number, and is close to $2/7$ near the threshold. The two frequencies are generally incommensurate. In the periodograms, many combinations of $f_1$ and $f_2$ are present, in particular $f_1+f_2$ and $f_1-f_2$, consistent with a $T^2$ torus dynamics. We also obtain the squared magnitude associated with $f_1$ and $f_2$. The linear variation of this squared magnitude above the threshold ${\textit{Re}}_{1}$ and the variation of the frequency $f_1$ confirm that this first oscillatory bifurcation is a supercritical Hopf bifurcation. Similar variations for $f_2$ above the corresponding threshold ${\textit{Re}}_{2}$ show that the second oscillatory bifurcation is a supercritical secondary Hopf bifurcation (supercritical Neimark–Sacker bifurcation). The component at $f_2$ of the vorticity field remains significant even $9$ diameters downstream of the sphere.
Research shows that quotas and feminist movements impose gender mandates on congresswomen, shaping their legislative outputs. However, this scholarship treats women as a homogeneous collective, rendering invisible intragroup differences. This article addresses this gap by asking how gender quotas shape the representation of marginalized women’s interests in contexts characterized by strong gender mandates. Analyzing the Chilean case, I compared the legislative terms pre (2014–18) and post (2018–22) quota. First, I examined how many marginalized women entered Congress in each cycle. Then, I reviewed the contents of all laws and bills on gender issues and marginalized groups sponsored by the congresswomen, to determine how well they represented marginalized women’s needs. Finally, I analyzed who were the main sponsors of intersectional legislation. The findings indicate that marginalized women’s interests, though better represented after the quota implementation, remained a marginal portion of congresswomen’s legislative output.
People who seek advice about their mental health or help with their psychological distress may use complex metaphors to communicate. It can be helpful for psychiatrists to be attuned to the details of people’s language. In this brief article, we offer two vignettes to illustrate how metaphors can open up understanding in psychiatric practice.
Despite being common and linked to significant morbidity and mortality, personality disorders (PD) are underdiagnosed. Stigma, professionals’ therapeutic nihilism and lack of effective treatments are contributing factors. This survey aimed to explore the experiences of a service user group of being assessed for and receiving a diagnosis of personality disorder and to examine the impact of the diagnosis and the disorder on their life.
Methods:
Patients under the care of two consultant-led teams who had received a diagnosis of personality disorder using Structured Clinical Interview for DSM-5 PD (SCID-5-PD) in 2019 and 2020 were invited by email to complete a qualitative survey. Responses were analysed using thematic analysis.
Results:
Participants were predominantly aged 41–50 years, with most discharged over three years previously. Borderline personality disorder was most commonly reported. Thematic analysis identified three themes: Understanding and Being Understood – highlighting variable levels of comprehension and agreement with the diagnosis; A turning point – describing both abandonment and access to targeted treatment; and Restriction – capturing stigma, secrecy, and perceived negative impacts on care, relationships, and functioning.
Discussion:
Findings highlight the complexity of delivering diagnoses in a meaningful and therapeutic way. Participants reported limited understanding, underscoring the need for clear, repeated psychoeducation and collaborative formulation while others described positive experiences leading to self understanding and recovery. Many were relieved to get the diagnosis after significant delays and lack of appropriate treatment. Revisiting formulation over time and linking diagnosis to treatment pathways appear crucial for acceptance, empowerment, and positive outcomes.
More than a million fish bones have been analyzed from the faunal assemblages in shell middens that mark the location of ancestral Indigenous settlements on the shores of the central reaches of the Salish Sea. Salmon bones, which account for 38% of the identifiable fish remains, are most abundant close to the main migration route of Fraser River sockeye and pink salmon. Salmon bone abundance in the “Marpole” cultural phase from 2400 to 1200 cal BP varies in concert with activity levels at salmon-fishing locations upstream on the Thompson River, peaking in the interval of maximal local marine productivity from about 1650 to 1350 cal BP. Summed probability distributions (SPDs) derived from the radiocarbon catalogs of coastal sites either echo the Thompson River pattern or are contrapuntal. The concordant SPDs suggest that Salishan population dynamics on the sockeye migration route reflect the relative success of the salmon fishery. The contrapuntal patterns are restricted to bays and inlets off the main sockeye and pink salmon migration route and may reflect the movements of Salishan people responding to a dearth of salmon by resettling in locales with a less volatile resource base.