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Congenital heart patients undergoing congenital heart surgery in the first year of life are at high risk of having a neurodevelopmental disorder. The most common difficulties are related to executive functioning. The following questions were assessed in the current project: Are patients having congenital heart surgery after one year of life at lower risk for neurodevelopmental disorders? At what age do executive function deficits manifest?
Methods:
We evaluated executive function in four groups of congenital heart patients who had undergone congenital heart surgery. These groups were high-risk patients with and without a genetic syndrome associated with a neurodevelopmental disorder and low-risk patients with and without a genetic syndrome associated with a neurodevelopmental disorder. We evaluated executive function using the Behavior Rating Inventory of Executive Function – Preschool Version, Behavior Rating Inventory of Executive Function-2, and Minnesota Executive Function Scale at various ages. We compared the rates of executive function deficits in the high- and low-risk groups as well as compared that to the published norms for age. We also assessed at what age these deficits become apparent.
Conclusion:
We found that both high- and low-risk groups had higher levels of executive functioning deficits compared to the norms for age. The low-risk group’s degree of executive function deficits appeared a little lower than the high-risk group. However, it was difficult to comment on the statistical significance. We also saw that executive function deficits often do not become apparent for many years after surgery. This finding highlights the need for continued evaluation of functioning as these kids mature.
This study aimed to delineate profiles of self-regulation among sexually abused children and their association with behavior problems using a person-centered approach. A sample of 223 children aged six to 12, their parents, and teachers were recruited in specialized intervention centers. Latent profile analysis revealed four profiles: (1) Dysregulated, (2) Inhibited, (3) Flexibly Regulated, and (4) Parent Perceived Self-Regulation. Children from the Flexibly Regulated profile showed relatively low behavior problems, and those from the Dysregulated profile were characterized by high behavior problems. Children from the Parent Perceived Self-Regulation profile showed overall good adaptation, although teachers reported higher behavior problems than parents. Children from the Inhibited profile, characterized by the highest level of inhibition but low parent-rated emotion regulation competencies and executive functions, showed the highest level of internalizing behavior problems, indicating that high inhibition does not necessarily translate to better adaptation. Results also show a moderation effect of sex. Being assigned to the Inhibited profile was associated with decreased externalizing behaviors in boys and increased internalizing behaviors in girls. This study underscores the complexity of self-regulation in sexually abused children and supports the need to adopt a multi-method and multi-informant approach when assessing these children.
Territory and territoriality lie at the heart of both world politics and International Relations (IR) theory. In terms of IR theory’s geographical assumptions, one of the most influential studies to date has been political geographer John Agnew’s 1994 article on the ‘the territorial trap’ (TTT). While Agnew’s original insights and subsequent research has reached canonical status in political geography, mainstream IR scholarship has yet to fully engage TTT. Political geographers, in turn, have largely dealt with the consequences of TTT for our understanding of world politics. This study offers the first detailed account of the origins of TTT, which are hidden in broad daylight in IR’s own history. The origins of TTT and mainstream IR are intertwined in terms of two dynamics: the racist and colonial origins of IR, and the selective nationalistic ontology that dominated IR especially in the first half of the 20th century. The arguments offered in this study have a wide variety of implications for problematising the ways in which IR-as-epistemological-community approaches territory and territoriality as well as our understanding of the origins and evolution of the present-day global territorial order.
This study aims to provide insights into the values entrenchment strategies that indigenous Black founders and next-generation (NextGen) leaders use in their efforts to entrench values into their family businesses. The study uses a qualitative methodology and an inductive approach, and draws on seven indigenous African family business cases operating in various industries within the services sector. Our findings show that founders and NextGen leaders use explicit and implicit carriers as they strive to entrench values in their family businesses. It was established that these leaders are influential institutional constituents who contribute to entrenching values into the family business and, by doing so, shape institutional knowledge. Our study contributes to family business literature by extending the founder centrality to include that of the NextGen leaders in values entrenchment, explaining how these leaders articulate their personal and family values and how they seek to translate them into family business values.
We present a new version of a generalisation to elliptic nets of a theorem of Ward [‘Memoir on elliptic divisibility sequences’, Amer. J. Math.70 (1948), 31–74] on symmetry of elliptic divisibility sequences. Our results cover all that is known today.
Between 1903 and 1952, there was a Jesuit and French university in Shanghai called l’Aurore. This article focuses on its medical faculty, which operated from 1912 to 1952. It shows that, in a precarious political and military context, l’Aurore simultaneously benefited from Jesuit missionary activity and the French quest for imperial influence, without fully identifying with either. The faculty was not an official missionary institution, and most of its hundreds of students were not Christians. However, the Jesuit administration kept a record of baptisms among the students and, based on Catholic principles, encouraged opposition to birth control through courses on ‘medical ethics’ and a special oath that medical graduates had to take. Nor was the medical faculty an overtly imperial institution. It was part of a concession and the result of an alliance between Jesuit missionaries and anti-clerical diplomats of the French Third Republic. Yet, the faculty was key to a French policy of imperial influence designed to compete with other imperial, religious, and private foreign powers active in medical education in China. During the years of war between China and Japan (1937–1945), the faculty consolidated its influence by increasing student numbers and building new infrastructure, whereas its Chinese staff assumed a more prominent role, reinforcing the importance of Chinese medicine in teaching and research. Doctors trained at l’Aurore who stayed in China remained active in public health until well into the second half of the twentieth century, even after the medical faculty was abolished by the Communist regime.
Dante Cicchetti’s earliest work, his studies of social-emotional development in infants and children with Down syndrome, set the stage for the emergence of the larger field of developmental psychopathology. By applying basic developmental principles, methodologies, and questions to the study of persons with Down syndrome, Dante took on the challenge of searching for patterns in atypical development. In doing so, he extended traditional developmental theory and introduced a more “liberal” approach that both continues to guide developmentally based research with persons with neurodevelopmental conditions (NDCs), including Down syndrome. We highlight five themes from Dante’s work: (1) appreciating the importance of developmental level; (2) prioritizing the organization of development; (3) examining whether developmental factors work similarly in those with known genetic conditions; (4) rethinking narratives about ways of being; and (5) examining the influence of multiple levels of the environment on the individual’s functioning. We highlight ways that these essential lessons anticipated present-day research with persons with a variety of NDCs, including Down syndrome, other genetic syndromes associated with intellectual disability, and autism. We conclude with visions to the future for research with these populations as well as for the field of developmental psychopathology more generally.
Dante Cicchetti propelled forward the field of developmental psychopathology by advancing this framework and championing new methods, including emphasizing the central role that multilevel analysis holds for explicating pathways of risk and resilience. His work continues to change the face of existing science. It has also paved the way for the formation of new projects, like the Research Domain Criteria initiative. This paper uses our laboratory’s work on multilevel approaches to studying adolescent depression, non-suicidal self-injury, and suicidal thoughts and behaviors to shine a spotlight on Dr Cicchetti’s contributions. In addition, we review recent developments, ongoing challenges, and promising future directions within developmental psychopathology as we endeavor to carry on the tradition of growth in the field.
We study a system consisting of n particles, moving forward in jumps on the real line. Each particle can make both independent jumps, whose sizes have some distribution, and ‘synchronization’ jumps, which allow it to join a randomly chosen other particle if the latter happens to be ahead of it. The system state is the empirical distribution of particle locations. We consider the mean-field asymptotic regime where $n\to\infty$. We prove that $v_n$, the steady-state speed of advance of the particle system, converges, as $n\to\infty$, to a limit $v_{**}$ which can easily be found from a minimum speed selection principle. Also we prove that as $n\to\infty$, the system dynamics converges to that of a deterministic mean-field limit (MFL). We show that the average speed of advance of any MFL is lower-bounded by $v_{**}$, and the speed of a ‘benchmark’ MFL, resulting from all particles initially being co-located, is equal to $v_{**}$. In the special case of exponentially distributed independent jump sizes, we prove that a traveling-wave MFL with speed v exists if and only if $v\ge v_{**}$, with $v_{**}$ having a simple explicit form; we also show the existence of traveling waves for the modified systems with a left or right boundary moving at a constant speed v. We provide bounds on an MFL’s average speed of advance, depending on the right tail exponent of its initial state. We conjecture that these results for exponential jump sizes extend to general jump sizes.
It is unclear how extracorporeal membrane oxygenation use varies across paediatric cardiac surgical programmes and how it relates to post-operative mortality. We aimed to determine hospital-level variation in post-operative extracorporeal membrane oxygenation use and its association with case-mix adjusted mortality.
Methods:
Retrospective analysis of 37 hospitals contributing to the Pediatric Cardiac Critical Care Consortium clinical registry from 1 August 2014 to 31 December 2019. Hospitalisations including cardiothoracic surgery and post-operative admission to paediatric cardiac ICUs were included. Two-level multivariable logistic regression with hospital random effect was used to determine case-mix adjusted post-operative extracorporeal membrane oxygenation use rates and in-hospital mortality. Hospitals were grouped into extracorporeal membrane oxygenation use tertiles, and mortality was compared across tertiles.
Results:
There were 43,640 eligible surgical hospitalisations; 1397 (3.2%) included at least one post-operative extracorporeal membrane oxygenation run. Case-mix adjusted extracorporeal membrane oxygenation rates varied more than sevenfold (0.9–6.9%) across hospitals, and adjusted mortality varied 10-fold (0–5.5%). Extracorporeal membrane oxygenation rates were 2.0%, 3.5%, and 5.2%, respectively, for low, middle, and high extracorporeal membrane oxygenation use tertiles (P < 0.0001), and mortality rates were 1.9%, 3.0%, and 3.1% (p < 0.0001), respectively. High extracorporeal membrane oxygenation use hospitals were more likely to initiate extracorporeal membrane oxygenation support intraoperatively (1.6% vs. 0.6% low and 1.1% middle, p < 0.0001). Extracorporeal membrane oxygenation indications were similar across hospital tertiles. When extracorporeal cardiopulmonary resuscitation was excluded, variation in extracorporeal membrane oxygenation use rates persisted (1.5%, 2.6%, 3.8%, p < 0.001).
Conclusions:
There is hospital variation in adjusted post-operative extracorporeal membrane oxygenation use after paediatric cardiac surgery and a significant association with adjusted post-operative mortality. These findings suggest that post-operative extracorporeal membrane oxygenation use could be a complementary quality metric to mortality to assess performance of cardiac surgical programmes.
Many questions remain about the hieroglyphic stair dedicated in a.d. 642 by K'an II, the great king of Caracol. Constituent panels have been found at Caracol, Ucanal, Naranjo, and Xunantunich—archaeological sites spread between Guatemala and Belize. The most recently discovered Panels 3 and 4 at Xunantunich shed light on the tumultuous decades of the seventh century. Panel 4, which opened the hieroglyphic stair, makes a surprising statement from the outset, clarifying that Kanu'l political authority was irrevocably established at Calakmul. This bold statement serves as a synoptic précis for the entire narrative and explains why the deeds of K'an II are related, but only to the extent that these could be interwoven with the history of the Kanu'l. This makes the hieroglyphic stair such an important source, because it tracks the rulers of the Kanu'l dynasty from the vantage of a close ally. These monuments attest to the fissioning of the Kanu'l dynasty and its eventual restoration at Calakmul, from whence Classic Maya politics would be overseen for the remainder of the seventh century. In this article, we build on earlier studies and add our most recent observations and new readings based on renewed inspections of the existing panels.
Clostridioides difficile infection (CDI) is a common nosocomial infection and is associated with a high healthcare burden due to high rates of recurrence. In 2021 the IDSA/SHEA guideline update recommended fidaxomicin (FDX) as first-line therapy. Our medical center updated our institutional guidelines to follow these recommendations, prioritizing FDX use among patients at high risk for recurrent CDI (rCDI).
Methods:
This pre- post- quasi-experimental study included patients with a presumptive diagnosis of CDI at risk for recurrence (age >/= 65 years, immunocompromised, severe CDI) that received vancomycin (VAN) or FDX between October 2019 to October 2022. Patients who received bezlotoxumab, had fulminant CDI, or received <10 days of the same antibiotic for their full treatment course were excluded. Patients were evaluated for rCDI within 8 weeks of completion of therapy, subsequent episodes of CDI within 12 months, and CDI-related admissions within 30 days.
Results:
Of 397 CDI regimens evaluated, 196 received VAN and 201 received FDX. Rates of rCDI (9.2% vs 10%, P = 0.86), subsequent CDI within 12 months of therapy completion of therapy (19.4% vs 26%, P = 0.12) and 30-day CDI-related readmissions (3% vs 4.5%, P = 0.6) were similar between patients who received VAN versus FDX.
Conclusion:
Outcomes were similar between patients treated with FDX and VAN for the treatment of CDI among those at high risk for rCDI, using our outlined criteria. Although we observed a trend toward lower rates of rCDI among immunocompromised patients, this finding was not significant. Further investigation is needed to determine which patients with CDI may benefit from FDX.
Transcatheter patent ductus arteriosus closure in premature infants is gaining attention with rapidly growing experience. The KA micro plug device poses many favourable features for ductus arteriosus closure in premature infants. The study aimed to describe the technique and outcomes of a KA micro plug in closing the ductus arteriosus in premature infants weighing less than 1500 g.
Methods:
This is a single-centre retrospective study in premature infants with patent ductus arteriosus weighing less than 1500 g who underwent off-label use of a KA micro plug at the Stead Family Children’s Hospital from February 2022 to December 2023.
Results:
Eighteen premature infants weighing less than 1500 g underwent attempted transcatheter ductus arteriosus closure using a KA micro plug device. Median weight, age, and corrected gestational age at the procedure were 943 g (682–1225), 26 days (9–79), and 28.5 weeks (25.6–32), respectively. The procedure was successful with complete closure achieved in all patients. No major haemodynamic instabilities were encountered. No catheterization-related complications were encountered. On a median follow-up of 10.9 months (0.1–19), all patients are alive with the device in a good position without residual shunt or abnormal findings.
Conclusion:
KA micro plug device for patent ductus arteriosus in infants weighing less than 1500 g is feasible, safe, and effective. We recommend that manufacturers of devices used to close the ductus arteriosus in small infants enhance both the devices and their delivery systems to simplify the procedure and mitigate the risk of haemodynamic instability.
This article analyses burnout in governmental psychosocial and community programmes considering training/knowledge, the technical-professional field, the institutional framework, and networking, based on the experience of the intervention teams of three Chilean programmes. A qualitative methodology was used. Fifty people, most of them psychologists, participated in interviews and focus groups. The data were analysed according to Grounded Theory. Results indicate that burnout is a corrosive process in governmental psychosocial and community programmes. The causes of burnout are related to three gaps: between academic training and professional performance, between formulation and implementation, and between the obligation to work as part of a network and the limitations of this approach. Furthermore, we observed manifestations consequences and effects of burnout, and guidelines for improving the programmes. We discuss the institutional dimension of burnout in governmental psychosocial and community programmes and reflect on aspects that may improve team well-being and the quality of social policies.
Airway problems emerging after congenital cardiac surgery operations may have an impact on mortality and morbidity. Recently, to improve alveolar gas exchange and reduce respiratory effort, high-flow nasal cannula (HFNC) has started to be used in paediatric cases. This study aimed to evaluate the potential effects of high-flow nasal oxygen therapy on postoperative atelectasis development and reintubation rate in paediatric cardiac surgery patients.
Methods:
This study was conducted retrospectively in term newborns and infants younger than six months of age who underwent congenital cardiac surgery operation from 1 November 2022 to 1 November 2023 and were followed in the paediatric cardiac ICU. Patients who were receiving mechanical ventilator support at least 12 hours postoperatively were evaluated for the development of postoperative atelectasis and reintubation in the first 3 days of extubation. The patients were grouped as HFNC and non-HFNC users. Demographic characteristics, surgery type, and ICU clinical follow-up data were obtained from medical records. The results were statistically evaluated.
Results:
A total of 40 patients who did not use HFNC in the early postoperative period and 40 patients with HFNC in the late period during the study period were included in the study. The median age was 1 month (IQR 15 days–2 months) with equal gender distribution. Among patients, 70% of them were in the neonatal age group. Reintubation rates in the first 72 hours in HFNC users and non-HFNC users were 2.5% and 12.5%, respectively (p < 0.05). The median postoperative atelectasis scores at 24, 48, and 72 hours of extubation were 2 versus 2.5 (p > 0.05), 1.5 versus 3.5 (p < 0.05), and 1 versus 3 (p < 0.05) in HFNC users and non-HFNC users, respectively.
Conclusion:
HFNC therapy may have a positive effect on preventing atelectasis and reducing the reintubation rate in the early postoperative period.
Alexithymia (difficulties identifying and describing feelings) predicts increased risks for psychopathology, especially during the transition from childhood to adolescence. However, little is known of the early contributors to alexithymia. The language hypothesis of alexithymia suggests that language deficits play a primary role in predisposing language-impaired groups to developing alexithymia; yet longitudinal data tracking prospective relationship between language function and alexithymia are scarce. Leveraging data from the Surrey Communication and Language in Education cohort (N = 229, mean age at time point 1 = 5.32 years, SD = 0.29, 51.1% female), we investigated the prospective link between childhood language development and alexithymic traits in adolescence. Results indicated that boys with low language function at ages 4–5 years, and those who later met the diagnostic criteria for language disorders at ages 5–6 years, reported elevated alexithymic traits when they reached adolescence. Parent-reported child syntax abilities at ages 5–6 years revealed a dimensional relationship with alexithymic traits, and this was consistent with behavioral assessments on related structural language abilities. Empirically derived language groups and latent language trajectories did not predict alexithymic traits in adolescence. While findings support the language hypothesis of alexithymia, greater specificity of the alexithymia construct in developmental populations is needed to guide clinical interventions.
Due to a result by Glasner and Downarowicz [Isomorphic extensions and applications. Topol. Methods Nonlinear Anal.48(1) (2016), 321–338], it is known that a minimal system is mean equicontinuous if and only if it is an isomorphic extension of its maximal equicontinuous factor. The majority of known examples of this type are almost automorphic, that is, the factor map to the maximal equicontinuous factor is almost one-to-one. The only cases of isomorphic extensions which are not almost automorphic are again due to Glasner and Downarowicz, who in the same article provide a construction of such systems in a rather general topological setting. Here, we use the Anosov–Katok method to provide an alternative route to such examples and to show that these may be realized as smooth skew product diffeomorphisms of the two-torus with an irrational rotation on the base. Moreover – and more importantly – a modification of the construction allows to ensure that lifts of these diffeomorphisms to finite covering spaces provide novel examples of finite-to-one topomorphic extensions of irrational rotations. These are still strictly ergodic and share the same dynamical eigenvalues as the original system, but show an additional singular continuous component of the dynamical spectrum.