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Endomyocardial biopsy remains the gold standard for cardiac cellular rejection surveillance after heart transplantation. We studied a novel non-invasive index of left ventricular relaxation to detect cardiac cellular rejection in paediatric heart transplant patients.
Methods:
This is a single-centre retrospective study of paediatric heart transplant patients who underwent endomyocardial biopsy from June 2014 to September 2021. Left ventricular relaxation index was calculated as the sum of diastolic tissue Doppler imaging velocities (E) of the left ventricular lateral, septal, and posterior walls divided by the percentage of the left ventricular posterior wall thinning by M-mode. Statistical analysis included t-tests and Mann-Whitney tests to compare means and medians between treatment and non-treatment groups. We used the cut-off with the maximum Youden index to compare the sensitivity and specificity of left ventricular relaxation index to detect rejection.
Results:
The study included 65 patients who underwent 246 cardiac catheterizations and endomyocardial biopsies. Out of 246, 192 procedures were included and 54 were excluded due to recent transplants or lack of echocardiographic data. A total of 114 demonstrated Grade 0R, 68 Grade 1R, 8 Grade 2R, and 2 Grade 3R allograft rejection. The difference in mean left ventricular relaxation index between treatment versus non-treatment groups (2R, 3R vs. 0R, 1R) was not statistically significant (p = 0.917). A left ventricular relaxation index cut-off of 0.73 had the highest Youden index with good sensitivity (100%) and poor specificity (23%) for detecting rejections with grades 2R and 3R.
Conclusion:
Left ventricular relaxation index, a novel index of left ventricular relaxation, was not a sensitive or specific predictor of cardiac cellular rejection in paediatric heart transplants.
Post-procedural antimicrobial prophylaxis is not recommended by professional guidelines but is commonly prescribed. We sought to reduce use of post-procedural antimicrobials after common endoscopic urologic procedures.
Design:
A before-after, quasi-experimental trial with a baseline (July 2020–June 2022), an implementation (July 2022), and an intervention period (August 2022–July 2023).
Setting:
Three participating medical centers.
Intervention:
We assessed the effect of a bundled intervention on excess post-procedural antimicrobial use (ie, antimicrobial use on post-procedural day 1) after three types of endoscopic urologic procedures: ureteroscopy and transurethral resection of bladder tumor or prostate. The intervention consisted of education, local champion(s), and audit-and-feedback of data on the frequency of post-procedural antimicrobial-prescribing.
Results:
1,272 procedures were performed across all 3 sites at baseline compared to 525 during the intervention period; 644 (50.6%) patients received excess post-procedural antimicrobials during the baseline period compared to 216 (41.1%) during the intervention period. There was no change in the use of post-procedural antimicrobials at sites 1 and 2 between the baseline and intervention periods. At site 3, the odds of prescribing a post-procedural antimicrobial significantly decreased during the intervention period relative to the baseline time trend (0.09; 95% CI 0.02–0.45). There was no significant increase in post-procedural unplanned visits at any of the sites.
Conclusions:
Implementation of a bundled intervention was associated with reduced post-procedural antimicrobial use at one of three sites, with no increase in complications. These findings demonstrate both the safety and challenge of guideline implementation for optimal perioperative antimicrobial prophylaxis.
This trial was registered on clinicaltrials.gov, NCT04196777.
Understanding variations in knowledge and attitudes of psychiatrists to psilocybin therapy is important for the collective discourse about the potential impact on clinical practice and public health in Ireland.
Methods:
A 28-item questionnaire was designed based on previous studies and distributed to psychiatrists in Ireland via online mailing lists and at in-person academic events.
Results:
151 psychiatrists completed the questionnaire (73.3% were under 40 years of age, 76.0% were trainees, and 49.0% were female). In the total sample, 81.5% agreed that psilocybin therapy shows promise in the treatment of psychiatric disorders and 86.8% supported funding research, 86.8% would be willing to refer a patient if it was licensed and indicated, and 78.1% would consider the treatment for themselves, if indicated. Conversely, 6.6% agreed that psilocybin therapy was unsafe even under medical supervision, and 21.9% thought it was potentially addictive. 15.9% of the total sample reported at least one concern including, lack of robust evidence, long-term effectiveness, superiority to current interventions, potential harmful effects, cost and accessibility, and impartiality. Less than half of respondents felt knowledgeable (40.0%) and 9.9% felt adequately prepared to participate in psilocybin therapy. Consultant psychiatrists trended towards less optimism for a potential role in bipolar depression and emotionally unstable personality disorder compared to trainee psychiatrists.
Conclusion:
Overall psychiatrists in Ireland held positive attitudes towards psilocybin therapy. However, there was a lack of knowledge evident. Addressing the knowledge gap and aligning with the best available evidence will be key if psychedelic therapy is to prevail in a clinical setting.
Lipids play an important role in human nutrition. Although adequate lipid consumption is necessary for an optimal functioning of the human body, overconsumption of saturated fatty acids can lead to postprandial hypertriglyceridaemia, which triggers the development of atherosclerosis. Important parameters that impact postprandial lipaemia and inflammation are related to the matrix structure and the fat-soluble micronutrient profile of ingested foods/lipids, but the specific effect of these parameters should be further studied, as most of the available studies evaluate their effect at fasting state. This review specifically explores the effects of food structure and fat-soluble micronutrients, from either micronutrient-rich foods or supplements, on postprandial hypertriglyceridaemia and inflammation. The review also highlights the potential of emerging biomarkers such as miRNAs or circulating microvesicles, as an alternative to the widely use biomarkers (e.g. low-density lipoproteins or blood concentration of pro-inflammatory cytokines), to identify inflammation associated with postprandial hypertriglyceridaemia at early stages.
How can public opinion change in a pro-immigration direction? Recent studies suggest that those who support immigration care less about it than those who oppose it, which may explain why lawmakers do not enact pro-immigration reforms even when voters are pro-immigration. To see if the personal issue importance of immigration can be changed, I conducted a probability-based, nationally representative US survey experiment (N = 3,450) exposing respondents to verifiable arguments about the broad national benefits of expanding legal immigration and the costs of not doing so. Using new measures of issue importance, my descriptive results show that only one-fifth of voters who prioritize the issue have a pro-immigration preference. Furthermore, while anti-immigration respondents prioritize policies regarding law enforcement and (reducing) future immigration, pro-immigration respondents prioritize (helping) immigrants already here. The experimental results confirm that the provided arguments raised immigration’s importance among pro-immigration voters but did not backfire by mobilizing anti-immigration voters. Contrary to expectations, the arguments increased pro-immigration policy preferences, but did not change voters’ subissue priorities within immigration or their willingness to sign a petition. Overall, the treatment was effective beyond changing minds by shifting stated issue positions and priorities in a pro-immigration direction. It can thus be used in a nontargeted information campaign to promote pro-immigration reforms.
Critical space assets require continuous monitoring to prevent potential losses. Auxiliary satellites protect these assets by observing and tracking approaching targets. Although observation satellites can make rapid autonomous onboard decisions, they face challenges due to limited computational capacity. The two mainstream command and control methods currently available do not meet the demands of onboard decision-making. Highly procedural decision-making methods require extended decision times, while rapid-response intuitive or heuristic methods carry significant error risks. To address this, this paper proposes a multi-granularity decision-making method for optical space surveillance satellites. First, multi-granularity relative orbit determination algorithm models and multi-granularity impulsive orbit manoeuver algorithm models were developed. Based on these models, a granularity selection method for sequential three-way decisions is proposed. In non-emergency situations, fine-granularity models are preferred to conserve fuel, while in emergency situations, coarse-granularity models are used to enhance decision-making speed and reduce positional deviations caused by the manoeuvering game. In random multi-scenario tests, the proposed method demonstrates lower average terminal positional deviations and fuel consumption compared to single-granularity (highly procedural or rapid-response) and random-granularity methods.
We aimed to describe the incidence, pathogens, and antimicrobial susceptibility of central line-associated bloodstream infections (CLABSI) in adult intensive care units (ICU).
Design:
State surveillance data from 2011 to 2022 were analyzed to identify patient and device days and CLABSI events. Pathogen data were analyzed to determine the most common organisms and patterns of antimicrobial resistance grouped into 3-year time epochs.
Setting:
Adult ICU in Victoria, Australia.
Participants:
Healthcare organizations participating in CLABSI state surveillance.
Results:
608 events were reported over 751,350 device days. Overall, CLABSI incidence was 0.81 per 1,000 central-line days, with a 49.3% rate reduction from 2011 to 2022 (1.39 to 0.70 per 1,000 central-line days). Overall device utilization ratio was 0.57, with a 15.4% reduction from 2011 to 2022 (0.67 vs 0.56). Of 690 pathogens, the most common by rank order were coagulase-negative Staphylococci (CNS), Candida species, Staphylococcus aureus, and Enterococcus faecalis. The proportion of CNS-causing events increased by 69.0% from 2011 to 2022; this trend was not observed for other organisms. For every increase in epoch, a 33% decrease in methicillin-resistant S. aureus (MRSA), 4% increase in vancomycin-resistant Enterococcus faecium, and 12% increase in ceftriaxone-resistant Escherichia coli pathogens were observed.
Conclusions:
We demonstrate a decreasing incidence of CLABSI in Victorian adult ICU and an increasing burden of infections due to CNS. No significant time trend increases in antimicrobial-resistant organisms, including MRSA, vancomycin-resistant E. faecium, and ceftriaxone-resistant E. coli were observed. These findings are relevant for identifying priorities for CLABSI prevention in Victorian adult ICU.
Deaf signers are typically multilingual, often exposed to a signed language and a spoken and/or written language. One outcome of this type of contact is ‘mouthing’—the silent articulation of spoken/written words with the simultaneous production of a sign. This article focuses on mouthing patterns in the Kufr Qassem deaf community, in which there is contact between Kufr Qassem Sign Language (KQSL), Israeli Sign Language (ISL), as well as Hebrew, and Arabic, which exists as a diglossia. The findings show that mouthing is constrained by the interlocutor and sign language used, with more mouthing with an ISL interlocutor than KQSL interlocutor, and when using ISL signs than KQSL signs. Contact with a diglossic spoken language shows that signers mouth in Palestinian Arabic rather than in Modern Standard Arabic. Furthermore, evidence of diachronic changes in mouthing was found, reflecting changes in education and mobility. (Mouthing, sign language, language contact, Kufr Qassem Sign Language, Israeli Sign Language, Arabic, diglossia)*
We assessed the effect of anomalous aortic origin of a coronary artery on the risk of early and late postoperative events after aortic or mitral valve replacement in adults.
Methods:
Between 2005 and 2022, 29,579 adults underwent surgical aortic or mitral valve replacement at Cleveland Clinic. Among these, 29 had an unrepaired coronary artery rising anomalously from the aorta that was not intervened upon during valve surgery, 19 (65%) an anomalous circumflex, and 9 (31%) an anomalous right. Operative outcomes were compared between the 29 patients with anomalous coronary arteries and 87 balancing score (1:3) matched patients with normal coronary origin. Median follow-up was 6.5 years.
Results:
Among matched groups, major morbidity and mortality 24% (n = 7) in patients with anomalous coronaries and 20% (n = 17) among patients with normal coronary origin (P = .7). Ten-year freedom from coronary reintervention was 83% versus 100% (P[log-rank] = .005), and 10-year survival was 59% versus 53% (P[log-rank] = .8). One patient experienced a coronary injury from valve surgery, in which the incidentally found anomalous retroaortic circumflex was immediately repaired without further complication. There was no coronary reintervention after discharge in the normal coronary origin group and three in the anomalous coronary group; however, only one of these patients required intervention on the anomalous coronary.
Conclusions:
Anomalous coronaries were uncommon in surgical valve replacement patients at a high-volume centre. The origin and course of each coronary should be assessed before valve replacement. With careful planning, valve replacement does not result in a significantly higher prevalence of postoperative ischaemia, mortality, or reintervention.
Functional linear regression has gained popularity as a statistical tool for studying the relationship between function-valued variables. However, in practice, it is hard to expect that the explanatory variables of interest are strictly exogenous, due to, for example, the presence of omitted variables and measurement error. This issue of endogeneity remains insufficiently explored, in spite of its empirical importance. To fill this gap, this article proposes new consistent FPCA-based instrumental variable estimators and develops their asymptotic properties in detail. Simulation experiments under a wide range of settings show that the proposed estimators perform considerably well. We apply our methodology to estimate the impact of immigration on native labor market outcomes in the US.
Previous studies in rodents suggest that mismatch between fetal and postnatal nutrition predisposes individuals to metabolic diseases. We hypothesized that in nonhuman primates (NHP), fetal programming of maternal undernutrition (MUN) persists postnatally with a dietary mismatch altering metabolic molecular systems that precede standard clinical measures. We used unbiased molecular approaches to examine response to a high fat, high-carbohydrate diet plus sugar drink (HFCS) challenge in NHP juvenile offspring of MUN pregnancies compared with controls (CON). Pregnant baboons were fed ad libitum (CON) or 30% calorie reduction from 0.16 gestation through lactation; weaned offspring were fed chow ad libitum. MUN offspring were growth restricted at birth. Liver, omental fat, and skeletal muscle gene expression, and liver glycogen, muscle mitochondria, and fat cell size were quantified. Before challenge, MUN offspring had lower body mass index (BMI) and liver glycogen, and consumed more sugar drink than CON. After HFCS challenge, MUN and CON BMIs were similar. Molecular analyses showed HFCS response differences between CON and MUN for muscle and liver, including hepatic splicing and unfolded protein response. Altered liver signaling pathways and glycogen content between MUN and CON at baseline indicate in utero programming persists in MUN juveniles. MUN catchup growth during consumption of HFCS suggests increased risk of obesity, diabetes, and cardiovascular disease. Greater sugar drink consumption in MUN demonstrates altered appetitive drive due to programming. Differences in blood leptin, liver glycogen, and tissue-specific molecular response to HFCS suggest MUN significantly impacts juvenile offspring ability to manage an energy rich diet.
While scholars have long been interested in the formation, meaning, and uses of diminutive morphology across languages, the present study illustrates a novel approach to their examination. Drawing upon a corpus of recordings of Brazilian obstetric and gynecological consultations conducted in Portuguese, our analytic points of departure are action and the sequential progression of interaction. We address these by investigating moments where diminutive forms and base forms of a lexical item are used in close proximity. This approach allows us to unpack and particularize the generic, overarching function of ‘mitigation’ in terms of the specific actions being constituted by the participants—here, offering reassurance, attenuating intrusiveness, pursuing acquiescence, and launching activity transitions. We conclude by discussing some of the implications of this analysis and suggesting some potential avenues for future comparative research. (Portuguese, Brazil, gynecology, obstetrics, healthcare, morphology, pragmatics, granularity, methodology, conversation analysis)*
From less than three dozen in 1949, the number of small hydropower stations in the People’s Republic of China grew to nearly ninety thousand by 1979. By the early 1980s, these stations were distributed across nearly 1,600 of China’s 2,300 counties. In 770 counties, small hydropower was the primary source of rural electricity generation. This article offers a history and assessment of these developments, unsettling our traditional emphasis on large-scale hydroelectricity. The article begins by reconstructing the PRC’s enormous investments in small hydropower from the 1950s to the early 1980s. This reconstruction, the first of its kind in the English language, not only helps reassess key periods and events in the history of the PRC but also establishes the position of small hydropower in the hydraulic history of the twentieth century. The article then turns to a discussion of the claimed impacts of small hydropower. As electricity became available for the first time in many parts of the Chinese countryside, it affected patterns of economic and social activity for hundreds of millions of people. Finally, the paper explores what the case of small hydropower can offer to conceptual and theoretical problems surrounding development, innovation, and the environment. Returning to the long-standing debate over scale and development, China’s experience with small hydropower reminds us of the important role played by smaller-scale, appropriate, and self-reliant technologies in global energy history.
Continuum robots offer unique advantages in performing tasks within extremely confined environments due to their exceptional dexterity and adaptability. However, their soft materials and elastic structures inherently introduce nonlinearity and shape instability, especially when the robot encounters external contact forces. To address these challenges, this paper presents a comprehensive model and experimental study to estimate the shape deformation of a switchable rigid-continuum robot (SRC-Bot). The kinematic analysis is first conducted to specify the degrees of freedom (DoF) and basic motions of SRC-Bot, including motion of bending, rotating, and elongating. This analysis assumes that the curvature varies along the central axis and maps the relationship between joint space and driven space. Subsequently, an equivalence concept is proposed to unify the stiffness addressing each DoF, which is then utilized in the establishment of the dynamic model. According to the mechanical structural design, the deformed posture of SRC-Bot is discretized into five segments, corresponding to the distribution of the guiders. The dynamics model is then derived using Newton’s second law and Euler’s method to simulate the deformation under gravity, friction, and external forces. Additionally, the stiffness in three directions is quantified through an identification process to complete the theoretical model. Furthermore, a series of experiments are conducted and compared with simulated results to validate the response and deformed behavior of SRC-Bot. The comparative results demonstrate that the proposed model-based simulation accurately captures the deformable characteristics of the robot, encompassing both static deformed postures and dynamic time-domain responses induced by external and actuation forces.
Narratives of the making of the international have a specific configuration of past–present–future that constitutes the unitary character of historical time and continues to reproduce spatio-temporal hierarchies. The article argues that the historical turn in IR has addressed spatio-temporal hierarchies through different timing strategies but has not sufficiently problematised the concept of History specifically with respect to unitary historical time. The article focuses on the problem of a unitary historical time; building on works that have underlined how the past, the present, and the future are not fixed entities given to us by an objective ‘truth’ but rather performatively constructed through different politics of time, it aims to develop an analytical vocabulary to further explore how to write history in the plural. How to write history in the plural will be explored through three different readings of the Haitian Revolution, underlining ‘timeliness/untimeliness’, dialogues between presents and pasts and futures, and past and multiple presents aiming to expand our analytical vocabulary in discussing the historical time of the international.
The role of social movements and civil society actors in rights advancement has been frequently emphasised. The assumption is that legal mobilisation by civil society actors works towards the extension of rights and the emancipation and advancement of justice for distinctive (minority) groups in society. While traditionally, socio-legal attention on social movement and civil society actions around rights promotion was particularly prominent in the US, for some time now the European context has also been approached from such a socio-legal lens. However, a one-sided, liberal–progressive understanding of social mobilisation around rights has, importantly, been put to the test by recent manifestations of societal actors. Conservative actors tend to (1) promote a restrictive interpretation or a radical reinterpretation of existing rights (e.g. abortion, free speech), (2) limit the diffusion of new rights (e.g. the rights to euthanasia or legalizing surrogate maternity) and/or (3) call for the interruption of the further extensions of rights (e.g. with regard to same-sex marriage, LGBTIQ issues). The analysis of legal mobilisation by such conservative right-wing actors indicates that mobilisational repertoires are strikingly similar to those of liberal actors. This article will discuss the notions of civil society and legal mobilisation and call for a rethinking of these concepts, in part because of the increasing manifestation of societal actors that are in contrast to the traditional liberal paradigm. The article will subsequently engage in a detailed study of one such actor – the Polish legal think tank Ordo Iuris (OI) – with regard to its third-party or amicus curiae interventions at the European Court of Human Rights (ECtHR), stressing the difference of orientation of such interventions from those of liberal actors and also indicating dimensions of ambivalence and similarity in their approaches.