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A neonate with unbalanced right-dominant atrioventricular canal defect with intact atrial septum and abnormal pulmonary venous return developed bradycardic arrest and a subsequent diagnosis of tracheal rings and left lung aplasia. This report details the fatal nature of the triad of hypoplastic left heart, pulmonary venous obstruction, and airway anomalies, along with the role of advanced imaging in prognostication.
The entorhinal cortex (EC) is the first cortical region affected by tau pathology in Alzheimer’s disease (AD), but its functions remain unclear. The EC is thought to support memory binding, which can be tested using the Visual Short-Term Memory Binding Test (VSTMBT). We aimed to test whether VSTMBT performance can identify individuals with preclinical AD before noticeable episodic memory impairment and whether these performances are related to amyloid (Aβ) pathology and/or EC tau burden.
Methods:
Ninety-four participants underwent the VSTMBT (including a shape-only condition (SOC) and a shape-color binding condition (SCBC)), standard neuropsychological assessment including the Preclinical Alzheimer Cognitive Composite (PACC5), an Aβ status examination, a 3D-T1 MRI and a [18F]-MK-6240 tau-PET scan. Participants were classified as follows: 54 Aβ-negative cognitively normal (Aβ − CN), 22 Aβ-positive CN (Aβ + CN, preclinical AD), and 18 Aβ + individuals with Mild Cognitive Impairment (Aβ + MCI, prodromal AD).
Results:
Aβ + CN individuals performed worse than Aβ-CN participants in the SCBC while the SOC only distinguished Aβ − CN from MCI participants. The SCBC performance was predicted by tau burden in the EC after adjusting for Aβ, white matter hypointensities, inferior temporal cortex (ITC) tau burden, age, sex, and education. The SCBC was more sensitive than the PACC5 in identifying CN individuals with a positive tau-PET scan.
Conclusion:
Impaired visual short-term memory binding performance was evident from the preclinical stage of sporadic AD and related to tau pathology in the EC, suggesting that SCBC performance could detect early tau pathology in the EC among CN individuals.
The doctrine that God is unlimited in power has been challenged recently by figures such as Thomas Oord and Philip Goff. This article responds to these challenges from the perspective of classical theism. It is argued that omnipotence follows from God’s being the reason why there is something rather than nothing, and that understanding God in this way is the only coherent way of fleshing out the claim that God is the creator. The relationship of creator and creature is discussed, and the point is made that God and creatures are not in metaphysical competition, defusing Oord’s worry that an omnipotent God would be controlling. The issue of evil in the world, and its claimed incompatibility with omnipotence is broached. In response to concerns about evil and omnipotence appeal is made to Brian Davies’ work on classical theism and evil, before concluding that the Christian classical theist can acknowledge there being a mystery about the presence of evil in the world whilst, without prejudice to her intellectual integrity, resting trustfully in the mysterious love of God.
Sixty uncrewed aerial vehicle (UAV) accident reports were analysed to identify causal and contributory factors leading to loss of control in flight – the most prominent category of UAV accident (36%). Design and manufacturing errors were dominant causal factors (22 events, 34%) and contributory factors (18 events, 22%). Recovery was not attempted in the majority of events (35 events, 55%). The relationship between operator age, total hours of experience, experience on type and recovery attempts were analysed. The number of accidents decreased as total hours of experience increased as well as attempted recovery. Using this data, existing accident analysis frameworks HFACS, AcciMap and Accident Route Matrix were applied to a sample of accidents and suitability compared. An adapted version of the Accident Route Matrix – Uncrewed Aerial Vehicle is proposed to assist current and future operators to understand causal and contributory factors to mitigate future loss of control in flight accidents and improve the likelihood of recovery. Using the results of the statistical analysis and the data gathered, a new definition for LOC-I for UAVs was defined by considering the different operating environment of UAVs.
Porous membranes, like nets or filters, are thin structures that allow fluid to flow through their pores. Homogenisation can be used to rigorously link the flow velocity with the stresses on the membrane via several coefficients (e.g. permeability and slip) stemming from the solution of Stokes problems at the pore level. For a periodic microstructure, the geometry of a single pore determines these coefficients for the whole membrane. However, many biological membranes are not periodic, and the porous microstructure of industrial membranes can be modified to address specific needs, resulting in non-periodic patterns of solid inclusions and pores. In this case, multiple microscopic calculations are needed to retrieve the local non-periodic membrane properties, negatively affecting the efficiency of the homogenised model. In this paper, we introduce an adjoint-based procedure that drastically reduces the computational cost of these operations by computing the pore-scale solution’s first- and second-order sensitivities to geometric modifications. This adjoint-based technique only requires the solution of a few problems on a reference geometry and allows us to find the homogenised solution on any number of modified geometries. This new adjoint-based homogenisation procedure predicts the macroscopic flow around a thin aperiodic porous membrane at a fraction of the computational cost of classical approaches while maintaining comparable accuracy.
Vital signs are an essential component of the prehospital assessment of patients encountered in an emergency response system and during mass-casualty disaster events. Limited data exist to define meaningful vital sign ranges to predict need for advanced care.
Study Objectives:
The aim of this study was to identify vital sign ranges that were maximally predictive of requiring a life-saving intervention (LSI) among adults cared for by Emergency Medical Services (EMS).
Methods:
A retrospective study of adult prehospital encounters that resulted in hospital transport by an Advanced Life Support (ALS) provider in the 2022 National EMS Information System (NEMSIS) dataset was performed. The outcome was performance of an LSI, a composite measure incorporating critical airway, medication, and procedural interventions, categorized into eleven groups: tachydysrhythmia, cardiac arrest, airway, seizure/sedation, toxicologic, bradycardia, airway foreign body removal, vasoactive medication, hemorrhage control, needle decompression, and hypoglycemia. Cut point selection was performed in a training partition (75%) to identify ranges for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), oxygen saturation, and Glasgow Coma Scale (GCS) by using an approach intended to prioritize specificity, keeping sensitivity constrained to at least 25%.
Results:
Of 18,259,766 included encounters (median age 63 years; 51.8% male), 6.3% had at least one LSI, with the most common being airway interventions (2.2%). Optimal ranges for vital signs included 47-129 beats/minute for HR, 8-30 breaths/minute for RR, 96-180mmHg for SBP, >93% for oxygen saturation, and >13 for GCS. In the test partition, an abnormal vital sign had a sensitivity of 75.1%, specificity of 66.6%, and positive predictive value (PPV) of 12.5%. A multivariable model encompassing all vital signs demonstrated an area under the receiver operator characteristic curve (AUROC) of 0.78 (95% confidence interval [CI], 0.78-0.78). Vital signs were of greater accuracy (AUROC) in identifying encounters needing airway management (0.85), needle decompression (0.84), and tachydysrhythmia (0.84) and were lower for hemorrhage control (0.52), hypoglycemia management (0.68), and foreign body removal (0.69).
Conclusion:
Optimal ranges for adult vital signs in the prehospital setting were statistically derived. These may be useful in prehospital protocols and medical alert systems or may be incorporated within prediction models to identify those with critical illness and/or injury for patients with out-of-hospital emergencies.
We give a crystal structure on the set of Gelfand–Tsetlin patterns (GTPs), which parametrize bases for finite-dimensional irreducible representations of the general linear Lie algebra. The crystal data are given in closed form and are expressed using tropical polynomial functions of the entries of the patterns. We prove that with this crystal structure, the natural bijection between GTPs and semistandard Young tableaux is a crystal isomorphism.
The article considers various grounds on which lying is forbidden, even in the case of Nazis at the door searching for Jewish refugees. It discusses eight such grounds, seven philosophical (natural law) arguments, and one theological argument. It is concluded that whilst only one of the initial seven grounds appears to permit lying to the Nazis, the theological ground prohibiting lying is the strongest of all.
To understand the potential human health effects of exposure to hazardous substances among first responders from the East Palestine train derailment, an electronic self-administered Assessment of Chemical Exposures (ACE) survey was created and available to first responders between February-March 2023. Among the 339 completed responder surveys analyzed, most reported working at least 1 day during the incident between February 3-8, 2023. Most (79%) reported inhaling, touching, or swallowing potentially harmful substances and did not report using a face mask or respirator while working (75%). Nearly half reported at least 1 new or worsening physical symptom after incident response. These findings support several recommendations to mitigate exposure to hazardous substances among first responders during future incidents, including using a hierarchy of controls framework to reduce exposure to hazards, timely communication of possible hazardous substances involved in the event, and using the Emergency Responder Health Monitoring Surveillance (ERHMS) framework.
Cargo carrying by a spring connected chiral micro-swimmer in a square channel is numerical studied by the three-dimensional lattice Boltzmann method and a chiral squirmer model. The effects of the driving type (β), swimming Reynolds number (Rep), spin coefficient (ξ) and diameter ratio (S) on the changes of the cargo-carrying velocity, spring length and motion modes are investigated, respectively. Four kinds of interesting motion modes are observed. When the chirality is not considered, the optimal combination for maximising swimming velocity are the pusher–cargo and cargo–puller configurations when Rep = 0.1 ∼ 1. When Rep is enhanced, the swimming velocities of the pusher–cargo, puller–cargo and cargo–pusher are increased, while the velocity of the cargo–puller is gradually decreased. When considering the chirality, only the swimming velocity of cargo–pusher and cargo–puller keep an interesting increment, and the reverse motion mode for the pusher-cargo and puller-cargo is firstly found in the present work when ξ exceeds a certain value. The impact of S on the cargo-carrying behaviour is complex, three kinds of oscillatory trajectories will appear under different ξ and S. The swimming velocity is reduced and even zero velocity will be observed when S is large. This work reveals key factors on the movement of microorganisms, offering guidance for improving cargo-carrying capabilities.
The European Resuscitation Council (ERC) establishes guidelines for cardiopulmonary resuscitation (CPR) under standard conditions and special circumstances but without specific instructions for nighttime situations with reduced visibility. The aim of this study was to evaluate the feasibility of performing CPR at night under two different conditions, in darkness with ambient light and with the additional illumination of a headlamp, as well as to determine the quality of the maneuver.
Methods:
A crossover, randomized pilot study involving nineteen lifeguards was conducted, with each participant performing two five-minute CPR tests: complete darkness with headlamp and natural night environment at the beach without additional lighting. Both tests were conducted with a 30:2 ratio of chest compression (CC) to ventilations using mouth-to-pocket mask technique in the darkness of the night with a 30-minute break between them. Outcome measures included quality of CPR, number of CCs, mean depth of CCs, mean rate of CCs, and number of effective ventilations. Results were reported as the mean or median difference (MD) between the two groups with 95% confidence interval (CI) using techniques for paired data.
Results:
There were no statistically significant differences between the two lighting conditions for the outcomes of CPR quality, mean depth of CCs, or number of effective ventilations. The number of CCs was lower when performed without the headlamp (MD: -8; 95%CI, -15 to 0). In addition, the mean rate of CCs was lower when performed without the headlamp (MD: -3; 95%CI, -5 to -1).
Conclusions:
The rescuers performed CPR at night with good quality, both in darkness and with the illumination of a headlamp. The use of additional lighting with a headlamp does not appear to be essential for conducting resuscitation.
To document the evolution of subjective cognitive functioning over four years in adults hospitalized after traumatic brain injury (TBI), comparing mild and moderate-severe TBI, and accounting for sociodemographic and clinical factors.
Method:
This secondary analysis of a longitudinal observational cohort study includes 222 adult participants hospitalized following a TBI (mean age = 41 ± 15 years; 29% women; 65% mild, 35% moderate-severe TBI). Data were collected via in-person/telephone interview and self-report questionnaires administered 4, 8, 12, 24, 36, and 48 months post-TBI. The primary outcome measure for subjective cognitive functioning was the Medical Outcomes Study Cognitive Functioning Scale (MOS-COG).
Results:
Mixed model analyses revealed a significant Time effect, with post hoc tests showing a better perceived cognitive functioning on the MOS-COG at 4 months than at 24 and 36 months after TBI. The TBI severity effect and TBI severity*Time interaction were not significant. Secondary effects revealed that poorer subjective cognitive functioning was associated with higher levels of symptoms of depression, anxiety, insomnia, and fatigue, and lower quality of life. Overall, the MOS-Cog score was about one standard deviation below the normative mean, suggesting greater cognitive complaints than in the general population, regardless of injury severity.
Conclusions:
The results suggest that subjective cognitive functioning is poorer than normative values and fairly stable over four years after TBI, with a slight decrease between 4 and 24–36 months, and is similar between mild and moderate-severe TBI.
This paper discusses the need for public policy limitation on two issues that the Nigerian Same-Sex Marriage (Prohibition) Act (SSMPA) regulates. First, the paper argues that the blanket non-recognition of the benefit(s) of same-sex marriage may breach Nigeria’s conflict of laws norms in certain transnational contexts. Second, it finds the prohibition of registration of gay clubs and organizations under the SSMPA a violation of the right to freedom of expression and association which both the Nigerian Constitution and the African Charter on Human and Peoples’ Rights guarantee. The paper therefore recommends an approach that Nigerian courts might adopt in determining whether the conferral of a specific benefit of same-sex marriage conflicts with Nigerian public policy in light of recent jurisprudence.
We build a two-country DSGE model of a monetary union to compare systematically the economic impact of a fiscal stimulus according to different features: domestic or European, public investment or public consumption, unfunded (thanks to grants) or debt-funded, on the core or periphery, and in normal or abnormal (post-ZLB) times. We highlight the importance of spillover wealth effects. Grants play a more important role when it comes to funding public consumption rather than investment, in contrast with the actual use of collective EU funds. A side result permits to assess the opportunity cost of accepting loans.
Excessive consumption of energy drinks poses significant risks, including the development of various non-communicable diseases. This trend is driven by a combination of the desire to remain alert and the strategic use of catchy advertising slogans by manufacturers, particularly targeting young adolescents. Unlike tobacco products, which are similarly linked to such diseases, Nigeria lacks legislation requiring energy drink manufacturers to warn consumers about potential adverse health effects. This paper argues that the absence of such regulation constitutes a violation of the right to health in Nigeria. It concludes by advocating for the Nigerian government to enact laws mandating energy drink manufacturers to include clear health warnings on their products.
At the end of the last glaciation aeolian processes promoted the development of the European Sand Belt, generating one of the largest areas of cold-climate dune fields in the world. Specific processes that led to the development and stabilization of these dunes remain poorly understood because there have been limited attempts to reconstruct the Belt’s past aeolian environments. New paleoenvironmental information can now be provided through an assessment of residual dune ridges (RDRs), landforms that are characteristic of wet dune systems. We recently identified almost 2,000 RDRs within the Kampinos Forest dune field (central Poland) and examined them through detailed morphometric analysis. That search showed that the development of the RDRs was driven by seasonally increased fluvial runoff and, in the longer term, by climate amelioration—apparently during the Bølling–Allerød interstadial. The high density of dunes protected ridges from deflation, so was crucial towards RDR preservation. The study proved that the RDRs can exist for more than 10 ka years, thus they can be used as environmental proxies. Additionally, they can be used as an indicator of past flood-event frequency and magnitude, as well as act as repositories of information on past-dune transformation.
Foods in squeeze pouches are widely available and are marketed as practical, convenient, and healthy food options for infants and children. However, these products do not provide adequate nutrition for growth(1) or align with the front-of-pack health claims. To develop effective strategies and guidance for squeeze pouch consumption, we need to understand which squeeze pouches are used, by whom, and why. A cross-sectional online survey of Tasmanian residents was conducted and included questions about the frequency and types of squeeze pouches consumed by infants and children (aged 0–18 years), the demographics of families who use squeeze pouches frequently and an open-ended question to explore parental motivations for using these products. Data were analysed using descriptive statistics and logistic regression identified demographic predictors of frequent squeeze pouch use (weekly or more). Thematic analysis of qualitative survey responses explored parental experiences. Parents (n = 179; 78% female, 37% aged 35–45 years, 84% born in Australia; 73% university educated) reported on the squeeze pouch use of n = 248 children. Most infants (0–2 years; 71.4%) used squeeze pouches weekly (85.7% consumed in past year), favouring fruit-based (57%), dairy-based (57%), vegetable-based (50%), and meal-based (36%) pouches. Over half of children aged 2–5 years (62.5%) consumed pouches weekly (81.3% consumed in past year), preferring dairy-based (73%) and fruit-based (19%) pouches. Over a third of 6–12-year-olds (35.2%) consume pouches weekly (69.3% consumed in past year), including dairy-based (66%) and fruit-based pouches (20%). A smaller proportion (13.1%) of teenagers (13–17 years) consume pouches weekly (33.3% consumed in past year), primarily choosing dairy-based (26%) and fruit-based (6%) pouches. Younger parents were over 5 times more likely to be frequent users than parents aged over 46 years (18–34 years OR: 5.3, 95% CI 1.8–15.7; 35–45 years OR: 6.0, 95% CI 2.8–12.8). Speaking a language other than English (OR: 4.8; 95% CI 1.5–14.6) also significantly predicted frequent squeeze pouch use, while gender, education, employment status, income, and food security were not associated. Key themes from parents who identified as frequent squeeze pouch users centred around convenience, on-the-go feeding, and managing fussy eating or sensory needs. Parents discussed the societal paradox they experienced, with parents expressing a dislike for squeeze pouches yet using them for behaviour modification as a food reward or buying in bulk when discounted. An understanding of commercial food influences, and greater environmental consciousness were the most common themes described by parents who identified as non-users. This study highlights the widespread use of squeeze pouches among children, particularly in younger age groups but also into middle childhood and adolescence. Comprehensive national data is needed to inform public health strategies that minimise the use of squeeze pouches in children of all ages.
In this paper, we demonstrate that the federal enforcement of the 15th Amendment is necessary for Black representation in the U.S. South. Using novel data on Black officeholders in the South from 1866 to 1912 and from 1969 to 1993, we examine Black representation during Reconstruction and after the passage of the 1965 Voting Rights Act. In both political periods, we find that policies aimed to enforce the 15th Amendment and active Black political participation are necessary preconditions for Black officeholding. This paper helps contextualize scholarship on descriptive representation by identifying this critical link between democracy and representation in the American South. By analyzing broad periods of history, we demonstrate the enduring necessity of active policymaking to ensure fair elections as a precondition of democracy in the American South. Our findings carry significant consequences for understanding the health of American democracy in the twenty-first century.