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This study aimed to evaluate the predictive accuracy of Paediatric Risk of Mortality-III, Paediatric Index of Mortality-II, and Paediatric Logistic Organ Dysfunction scoring systems for major adverse events following congenital heart surgery.
Methods:
This prospective observational study included patients under 18 years of age who were admitted to the ICU for at least 24 hours postoperatively following congenital heart surgery. Major adverse events were defined as a composite of 30-day mortality, ICU readmission, reintubation, acute neurologic events, requirement for extracorporeal membrane oxygenation, cardiac arrest requiring cardiopulmonary resuscitation, need for a permanent pacemaker, acute kidney injury, or unplanned reoperation.
Results:
A total of 116 patients, with a median age of 17.5 months (interquartile range: 5.4–60.0) were included in the study. Major adverse events occurred in 34 patients (29.3%). Paediatric Risk of Mortality-III (11.5 [8.0–18.8] vs. 7.0 [2.3–11.0]; p = 0.001), Paediatric Index of Mortality-II (3.8 [2.8–6.6] vs. 2.2 [1.7–2.8]; p < 0.001), and Paediatric Logistic Organ Dysfunction (12.0 [10.0–21.0] vs. 1.0 [1.0-10.0]; p < 0.001) scores were significantly higher in patients with major adverse events than in those without. The Paediatric Logistic Organ Dysfunction score (area under the curve 0.83; 95% confidence interval: 0.74–0.92) demonstrated the highest discrimination capacity compared to Paediatric Risk of Mortality-III (area under the curve 0.70; 95% confidence interval: 0.60–0.81) and Paediatric Index of Mortality-II (area under the curve 0.77; 95% confidence interval: 0.66–0.88) with good calibration (Hosmer–Lemeshow p > 0.05 for all). Based on the logistic regression model evaluation metrics, Paediatric Logistic Organ Dysfunction demonstrated better performance in predicting major adverse events compared with Paediatric Risk of Mortality-III and Paediatric Index of Mortality-II.
Conclusions:
The Paediatric Logistic Organ Dysfunction score outperformed the Paediatric Index of Mortality-II and Paediatric Risk of Mortality-III scores in predicting major adverse events in paediatric patients admitted to the ICU after congenital heart surgery.
Individuals with a family history of bipolar disorder are at increased risk of developing affective psychopathology. Longitudinal imaging studies in young people with familial risk have been limited, and cortical developmental trajectories in the progression towards illness remain obscure.
Aims
To establish high-resolution longitudinal differences in cortical structure that are associated with risk of bipolar disorder.
Method
Using structural magnetic resonance imaging data from 217 unrelated ‘Bipolar Kids and Sibs study’ participants (baseline n = 217, follow-up n = 152), we examined changes over a 2-year period in cortical area, thickness and volume, measured at each vertex across the cortical surface. Groups comprised 105 ‘high-risk’ participants with a first-degree relative with bipolar disorder (female n = 64; age in years: M (mean) = 20.9, s.d. = 5.5) and 112 controls with no familial psychiatric history (females n = 60; age in years: M = 22.4, s.d. = 3.7).
Results
Accelerated thickness and volume reductions over time were observed in ‘high-risk’ individuals across multiple cortical regions, relative to controls, including right lateral orbitofrontal thickness (β = 0.033, P < 0.001) and inferior frontal volume (β = 0.021, P < 0.001). These differences were observed after controlling for age, sex, ancestry, current medication status, lifetime psychiatric diagnoses and measures of gross brain morphology.
Conclusions
Longitudinal group differences suggest the presence of thicker cortex in familial ‘high-risk’ individuals at earlier developmental stages, followed by accelerated thinning towards the typical age of bipolar disorder onset. Future examination of genetic and environmental components of familial risk and the mechanistic nature (pathological or protective) of cortical-trajectory differences over time may facilitate the identification of prodromal biomarkers and opportunities for early clinical intervention.
Anxiety and depression symptoms and disorders are the leading child mental health problems in western societies. This systematic review evaluated how parental emotion socialization (ES) relates to children’s internalizing problems (from birth to age 18 years). Three meta-analyses, evaluating supportive (k = 50, N = 10,698), nonsupportive ES behaviors (k = 47, N = 10,970), and elaboration (k = 6, N = 867) were conducted. Supportive ES behaviors had a very small negative association with children’s internalizing problems (r = −.06), nonsupportive ES behaviors had a medium positive association with internalizing problems (r = .18), and elaboration had a small negative association with internalizing problems (r = −.11). Very few significant moderators emerged, and no differences based on parent gender were found. The results suggest that incorporating an ES framework in intervention and preventive efforts might be beneficial for children at risk of experiencing internalizing problems.
Despite its geographic correspondence with a key fourteenth-century BC port, the tell of Yavneh-Yam has yielded only meagre evidence for Late Bronze Age occupation. The recent discovery of a sealed monumental rock-cut burial cave with hundreds of grave goods provides the first clear evidence for a significant polity.
The Occlutech Atrial Flow Regulator is a self-expandable double-disc nitinol device with a central fenestration designed to create a calibrated communication across the interatrial septum. It has been used in adult patients with heart failure and pulmonary hypertension. Its use in the paediatric population or adults with CHD has been published in several case reports and case series. This study aims to review the potential, efficacy, and safety of this device in the paediatric and adult populations living with CHD, as well as in paediatric patients with pulmonary hypertension or advanced heart failure.
Party system classifications have been central in political science, especially until Sartori's influential typology in 1976. However, recent years have seen diminished attention to such classifications. Western European party systems have significantly transformed, particularly over the last 15 years due to multiple crises, affecting their core structure, or what Sartori termed ‘patterns of interparty competition.’ This raises questions about whether these changes have undermined the very concept of systemness, making classifications irrelevant. This research note redefines party systems based on the number and composition of relevant political poles (governing alternatives) and, through a long-term analysis of Western Europe (20 countries since 1945), assesses their degree of systemness. Results indicate that many systems have become ‘non-systems,’ with fluctuating and unstable party poles. Most Western European systems have exhibited this ‘non-system’ type for at least half of legislatures since 1989, thus making classifications only short-lived snapshots and inevitably useless for long-term accounts.
Increasing interdisciplinary analysis of geoarchaeological records, including sediment and ice cores, permits finer-scale contextual interpretation of the history of anthropogenic environmental impacts. In an interdisciplinary approach to economic history, the authors examine metal pollutants in a sediment core from the Roman metal-producing centre of Aldborough, North Yorkshire, combining this record with textual and archaeological evidence from the region. Finding that fluctuations in pollution correspond with sociopolitical events, pandemics and recorded trends in British metal production c. AD 1100–1700, the authors extend the analysis to earlier periods that lack written records, providing a new post-Roman economic narrative for northern England.
How should Jewish settlers live in the new environment? This question preoccupied early Zionist professionals, seeking to employ science in the service of Jewish “acclimatization.” This article focuses on the work of a specific man of science: nutrition scholar Moshe Wilbushewich, who lived and worked in Palestine since 1924 until his death in 1952. Much of Wilbushewich’s work in the interwar period was devoted to investigating the question, how to compensate for the physical inferiority of Jewish- compared to Arab workers, through nutrition and psychotechnics. As a scholar of nutrition, he performed scientific analyses of ingredients and dishes from the Palestinian kitchen and encouraged Jewish settlers to adopt some of them to make their nutrition more adjusted to the conditions of the land, and hence more “rational.” As I show, although Zionist experts embraced an environmental approach to “revitalizing” Jewish bodies, their perceptions were nonetheless shaped by assumptions about racial difference and hierarchy– between Arabs and Jews, and between Ashkenazi and Sephardi Jews.
The ontological complexity of the twentieth-century Cold War motivates this special issue’s investigation of how social scientists conceptualize institutional novelty and change. We begin by noting the peculiar elision of the Cold War as an explanatory mechanism in mainstream sociology, even while sociologists have theoretical tools for making sense of the phenomenon: war, schema, field, world systems, and empire. All are useful; none are sufficient. We locate the explanatory problem in a tension between notions of structure and event that has organized debate in historical social science for several scholarly generations, and offer a new intellectual tool – medium durée – as a way forward. Medium durée describes phenomena that have sufficient cohesion as ideas and relationships to endure over time, yet remain sufficiently unfixed and ambiguous as to enable multifarious action and sensemaking. Our notion of medium durée is substantially informed by the articles and commentaries assembled for this special issue, which represent three years of dialogue among the authors as well as audiences in serial panels at the 2022 and 2023 annual meetings of the Social Science History Association.
In Staphylococcus aureus the qacA/B and smr genes have been associated with elevated MICs to antiseptics with such organisms often termed antiseptic tolerant S. aureus (ATSA). The impact of repeated healthcare or antiseptic exposure on colonization with ATSA is uncertain.
Design:
Prospective longitudinal cohort study.
Setting/Participants:
The high-risk cohort included children with a new diagnosis of malignancy recruited from a pediatric oncology clinic. The low-risk cohort were otherwise healthy children enrolled from general pediatrics clinics.
Methods:
Subjects had anterior nares and axillary cultures collected at 3-month intervals for one year. Identified S. aureus isolates underwent PCR for qacA/B and smr. The primary outcome was colonization with ATSA at least once during study follow-up. Logistic regression models were utilized to adjust for confounding across cohorts.
Results:
226 subjects were evaluable for the primary outcome. It was noted that 93.5% of high-risk subjects reported regularly using chlorhexidine gluconate (CHG) antiseptic products. Colonization with ATSA was found in 15.5% of subjects. In univariable analyses, subjects in the low-risk cohort more frequently had ATSA colonization; following adjustment for confounders, the rates of overall ATSA colonization were similar in the high- and low-risk cohorts. Only 2 subjects had colonization with an ATSA strain at more than one encounter.
Conclusions:
Pediatric oncology patients do not experience higher rates of ATSA colonization than healthy children. In addition, ATSA colonization is transient relative to strains negative for smr/qacA/B. These findings suggest that repeated use of infection prevention strategies including CHG do not predispose to colonization with ATSA in the ambulatory setting.
In recent years, the question of naturalism in the study of religions has been increasingly debated. Primarily, these discussions converge in the widely held view that naturalism is the only way for religious studies as an academic enterprise to exclude supernaturalist assumptions from its methodology. While I fully agree with this view, I argue that naturalism is usually formulated with the help of metaphysical assumptions, which are problematically embodied in the location problem, that is, the problem of how to locate certain phenomena, such as meanings and values, in the order of nature. By unfolding the dynamic between the elements of the location problem, I show that the kind of naturalism based on Wittgenstein’s thought prevents the location problem from arising and can serve as a balanced version of naturalism for use in the study of religion. While metaphysical naturalism often leads to dilemmas, within Wittgenstein’s kind of naturalism, it seems possible both to maintain anti-supernaturalism in the study of religion and to resist the metaphysical temptations hidden in our assumptions about language. These two features make Wittgenstein’s naturalism truly methodological.
Reducing crude protein in amino acid-adequate diets for broiler chickens is effective in reducing nitrogenous emissions and competition for resources between the food and feed sectors. This review provides a comprehensive analysis of the literature on the relevance of nonessential amino acids in low protein diets for broiler chickens. Glycine and serine, owing to their interconvertibility summarised as glycine equivalents (Glyequi), limit growth when dietary crude protein is reduced below 19% in up to 3-week-old birds. Considering essential amino acids and the variable Glyequi requirements enables the reduction of dietary crude protein to ∼16% without compromising growth. Variation in Glyequi requirements likely occurs predominantly from the varying amounts of uric acid formed. Other influences seem to exert lower impacts on dietary Glyequi requirements. Asparagine or glutamine is probably the growth-limiting amino acid when crude protein is reduced below 16%. Alternatively, nonspecific amino-nitrogen may be lacking in such diets. The current potential to reduce dietary crude protein when using free essential and nonessential amino acids enables to increase the efficiency of nitrogen utilisation to a value above 80%. This coincides with reduced uric acid synthesis and energy expenditure for nitrogen excretion. The lower nitrogen excretion via the urine results in a lower energy expenditure. Hence, dietary energy may prospectively be reduced once the energy-sparing effect is quantified, thereby further reducing the competition for resources between food and feed.