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We report the case of an 8-year-old boy with unrepaired cyanotic CHD who developed pheochromocytoma and presented with hypertensive heart failure. Imaging revealed a tumour in the right adrenal gland. A genetic analysis identified a somatic EPAS1 mutation. This case highlights the potential for early pheochromocytoma development in patients with unrepaired CHD and severe cyanosis. This case provides a hypothesis-generating observation suggesting that chronic hypoxia may act synergistically with a pseudohypoxia mutation, potentially leading to an earlier-than-expected presentation of pheochromocytoma.
Persistent funding shortfalls undermine protected areas (PAs) worldwide, yet few studies analyse these patterns across space and time. We examined funding deficits in 300 Brazilian federal PAs from 2014 to 2023 using spatial Durbin error models. Deficits were measured as the gap between evidence-based minimum management costs and actual spending. We analysed how PA age, size, management group, ecological region, population density and per capita GDP predict deficits, decomposing socioeconomic effects into direct and spillover components. In 2023, 72% of the PAs faced deficits totalling 958 million international dollars, despite a 30% investment increase over the decade. Larger PAs had greater shortfalls; older PAs had smaller ones. Amazon PAs averaged 79.2% deficits versus 27.6% in the Atlantic Forest. No significant difference emerged between management types. Higher population density predicted lower deficits, probably reflecting greater political visibility near urban centres. No direct local GDP effect was detected, but spillovers from neighbouring high-income regions suggest regional prosperity influences PA funding through spatial networks. Funding deteriorated in 2020–2021 amid fiscal contractions and policy shifts, then recovered in 2022–2023. These findings reveal deep structural inequities, particularly in the Amazon, highlighting the need for transparent national PA financing systems.
The drag wake of a towed inclined 6 : 1 prolate spheroid in unstratified and stratified ambients is investigated experimentally using stereoscopic particle image velocimetry. Tow speed, stratification strength and inclination angle are varied independently, resulting in a parameter space spanning Reynolds numbers $\textit{Re} = (1.25{-}20) \times 10^3$, Froude numbers $\textit{Fr}= U/\textit{ND} = 2{-}32$ and $\infty$, and inclination angles $\theta = 0^\circ$ and $20^\circ$. Measurements are repeated at each parameter combination to obtain converged wake statistics for $3 \leqslant x/D \leqslant 40$. Unstratified measurements provide a baseline experimental dataset for inclined spheroids that has not previously been reported. In the absence of stratification, inclination generates persistent wake asymmetries and a net vertical impulse that deflects the wake trajectory. Although inclined configurations exhibit larger initial wake heights than axisymmetric cases, the early wake evolution collapses when scaled by an effective body diameter, indicating that this increase is geometric in origin. Regular vertical velocity protrusions are observed in inclined wakes, with a characteristic spacing that depends on Reynolds number but shows no measurable dependence on Froude number. At sufficiently low Froude number, buoyancy influences the near-body flow, and modifies the wake trajectory and streamwise velocity profiles. For $\textit{Re} = 5000$, wake heights for both axisymmetric and inclined configurations collapse across stratification strengths when scaled by an effective diameter. In this regime, the wake trajectory exhibits oscillations with period $2\pi /N$, in agreement with previously reported stratified wake dynamics.
In 1970, Ted Williams – a medical missionary who had been running a small hospital at Kuluva in the West Nile region of Uganda for decades – was approached by the International Agency for Research on Cancer (IARC) to help establish a major study on the possible role of Epstein–Barr Virus in the aetiology of Burkitt’s lymphoma (BL). At the time, there was intense global interest in BL, as the cancer promised to be the first shown to have a viral aetiology. IARC centred its project at Kuluva Hospital and in the West Nile district because of Williams’ unusually detailed and accurate records. Williams was a meticulous record-keeper, who relied on various methods of data collection, from collecting and comparing to selecting and sorting. His paper-based archives and recording practices provide a rare window onto epidemiological knowledge production in East Africa in the decades before computing reshaped medical record-keeping. By tracing the ‘sociomaterial paper trail’ of Williams’s work, this paper examines how persona, place, and paper intersected in the making of medical knowledge, and how the researcher’s persona shapes the kinds of epidemiological data that are ultimately produced.
The interaction between acoustic waves and turbulent grazing flow over an acoustic liner is investigated using lattice-Boltzmann very-large-eddy simulations. A single-degree-of-freedom liner with 11 streamwise-aligned cavities is studied in a grazing flow impedance tube. The conditions replicate reference experiments from the Federal University of Santa Catarina. The influence of grazing flow (with a centreline Mach number of 0.32), acoustic wave amplitude, frequency and propagation direction relative to the mean flow is analysed. Impedance is computed using both direct (i.e. the in situ method) and model-fitting inference (i.e. the mode-matching) methods. The former reveals strong spatial variations; however, averaged values throughout the sample show minimal differences between upstream- and downstream-propagating waves, in contrast to what is obtained with the latter method. Flow analyses reveal that the orifices displace the flow away from the face sheet, with this effect amplified by acoustic waves and dependent on the wave propagation direction. Consequently, the boundary layer displacement thickness ($\delta ^*$) increases along the streamwise direction compared with a smooth wall and exhibits localised humps downstream of each orifice. The growth of $\delta ^*$ alters the flow dynamics within the orifices by weakening the shear layer at downstream positions. This influences the acoustic-induced mass flow rate through the orifices at equal sound pressure level, suggesting that acoustic energy is dissipated differently along the liner. The asymmetry of the flow field experienced by the acoustic wave, depending on its propagation direction, highlights the need to consider a spatially evolving turbulent flow when studying the acoustic–flow interaction and measuring impedance.
Kant frequently states that ‘appearances’ (Erscheinungen) are mere ‘representations’ (Vorstellungen), a claim we can call AR. AR is typically understood as a substantive thesis. This paper argues for a claim that has not been explored at length elsewhere: that AR is an analytic truth, so it does not imply phenomenalism and can be affirmed by a moderate realist reader. I argue that appearances are mental contents directed towards things. Hence, appearances are not themselves the things our minds represent, which exist outside of minds. This reading permits us to accept insights from phenomenalists about Kant’s philosophy of mind, while saving the realists’ metaphysics.
Schizophrenia trials have been too small, short and exclusionary, leaving the most disabled patients under-represented and key outcomes neglected. Future research should match the illness burden through sustained funding, representative recruitment, multidomain assessment, and adaptive, platform and SMART designs that test treatments efficiently and produce evidence relevant to patients’ lives.
This article contributes to ongoing attempts to move historical understanding of Christian attitudes to Jews beyond a dichotomy between philo- and antisemitism. Employing the history of emotions, it examines how ‘love’ was understood in the specific religious, social and historical contexts in which it was advocated. Focusing on the Church of Scotland’s 1839 ‘Mission of Enquiry to the Jews’, it shows how the Church advocated a system of shared feeling towards Jews among believers. This ‘love’ engaged a variety of different emotional states linked to contemporary internal tensions within the Church of Scotland, and prophetic hopes for their resolution.
Expanded multiplex PCR gastrointestinal panels (GIPs) are routinely ordered to diagnose infectious diarrhea. However, recommendations for repeat GIP testing are limited, resulting in variable testing practices. We evaluated the diagnostic yield of repeat GIP testing within 14 days.
Methods:
We conducted a retrospective cohort study of adults (age ≥ 18 years) tested with GIPs across 12 hospitals and outpatient centers (2019–2024). We analyzed the first diarrheal episode per patient, excluding cases with invalid/missing results and C. difficile results. Repeat testing was defined as a GIP completed within 14 days of an index GIP, excluding confirmatory testing using the same stool sample. The primary outcome was diagnostic yield (new pathogen detection), and the secondary outcome was pathogen persistence (same pathogen detection).
Results:
Among 16,502 patients, 507 (3.1%) underwent repeat GIP testing within 14 days (median interval: 6.3 days; IQR: 2.7–9.8). Only 4.6% [19/415] index-negative patients and 2.2% [2/92] index-positive patients detected new pathogens on repeat testing, with 51% [47/92] index-positive patients demonstrating persistence of at least one pathogen from their initial test. The number needed to test (NNT) to identify one new pathogen was 24 (95% CI: 16–39) tests overall, and 127 (95% CI: 50–455) tests to identify one new pathogen warranting antimicrobial treatment. Most repeat testing (86% [436/507]) was ordered by a different clinician.
Discussion:
Repeat GIP testing within 14 days rarely provided new diagnostic information, highlighting the limited utility of early repeat testing. Institutional policies discouraging repeat GIPs within 14 days may improve diagnostic stewardship.
This work proposes a band-switchable electrically small antenna (ESA) system for a wearable health monitoring device. The system operates at multiple 5G-NR bands (875–934 MHz and 1.72–2.2 GHz) using a switchable configuration. The antenna consists of multi-resonant shorted strips that have been miniaturized to fit in meandered form into an area of 63.2$\times$25 mm$^2$ (0.19$\times$0.08$\lambda^2$) available in the intended health monitoring device. To enable operation at two distinct modes, the antenna feedline has been integrated with a switch, which is then matched using lumped matching components. Results indicate that the ESA system operates at 875–900 MHz in Configuration 1, and at 898–934 MHz and at 1.72–2.2 GHz in Configuration 2. The device has been fabricated and integrated into a compact 3D printed casing prior to experimental evaluations. In addition to studying the switchable reflection and radiation performance, the ESA is also evaluated in the presence of a human body phantom. Simulated specific absorption rate levels are less than 0.47 W/kg averaged over 1 g of tissue, which complies with international standards.
We investigate the influence of side-wall wetting on the linear stability of falling liquid films confined in the spanwise direction. A biglobal stability framework is developed, capturing inertia, viscosity, gravity, capillarity and geometric confinement. The base flow exhibits a curved meniscus and a streamwise velocity overshoot near the side walls. Linear stability analysis based on the Navier–Stokes equations is performed in two limiting regimes. In confined channels, where spanwise confinement stabilises moderate-wavenumber perturbations via side-wall boundary layers, wetting weakens this stabilisation; as the contact angle decreases, the neutral curves shift towards the unconfined one-dimensional limit, thus wetting acts as a relative destabilising mechanism. In contrast, in weakly confined channels where side-wall boundary layers do not provide confinement-induced stabilisation, wetting produces a net long-wave stabilisation ($k \rightarrow 0$), significantly increasing the critical Reynolds number. This effect strengthens as the contact angle decreases, indicating a competition between destabilising inertia and stabilising wetting-induced capillary forces. The predicted long-wave stabilisation effect is compared quantitatively with available experimental measurements, showing consistent trends and comparable magnitudes within the accessible parameter range. Perturbation eigenmode structures show that, in confined channels, the relative destabilisation is associated with near-wall vortical structures induced by the meniscus elevation and velocity overshoot, which reduce effective viscous damping. In contrast, in weakly confined channels, stabilisation is consistent with interface tensioning through strong anchoring of the perturbations at the side walls.
Attached cavitation is likely the most common form of developed hydrodynamic cavitation, yet the reason for its dominance remains unclear. From the experimental side, a natural approach is to seed controllable nuclei and observe their evolution. We propose a laser-based on-demand nucleation method that generates micro- and nanobubbles as nuclei in Venturi flows, enabling unprecedented spatio-temporal control of hydrodynamic cavitation inception. For single-bubble cases, we find that attached cavitation occurs when the bubble surface enters the boundary layer of the channel where the pressure is below the vapour pressure. Based on it, we construct a phase diagram of cavitation regimes as a function of cavitation number and non-dimensional wall distance. Extending to multiple bubbles, assuming a random spatial distribution of nuclei within the laser-illuminated region, we develop a simple model to estimate the probability of attached cavitation. Results show that, at typical cavitation numbers, only a few bubbles suffice for attached cavitation to occur with nearly 100 % probability. Our finding provides new insights into why nuclei in hydrodynamic processes tend to develop into attached cavitation.