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Bicuspid aortic valve is the most common CHD and commonly associated with activity restrictions that may lead to a sedentary lifestyle known to increase obesity risk. It is unknown whether obesity is associated with changes in aortic dimensions or aortic valve function in young people with bicuspid aortic valve. This study investigates whether overweight and obese children with bicuspid aortic valve have worse aortic valve function or increased aortic dimensions compared to healthy weight children with bicuspid aortic valve.
Methods:
This was a single centre retrospective cohort study comprised of patients 5 to 25 years old with a diagnosis of bicuspid aortic valve between 1 January, 2019 and 31 December, 2020. Patients were classified as healthy weight or overweight/obese. Values for aortic dimensions as well as peak and mean aortic valve gradients were obtained from echocardiogram reports.
Results:
About 251 patients were analysed. Demographics were similar between groups. When indexed to height, the aortic valve annulus (1.28 ± 0.14 vs. 1.34 ± 0.15, p = 0.001) and sinotubular junctions (1.44 ± 0.21 vs. 1.49 ± 0.24, p = 0.038) were larger in the overweight/obese group, with no differences in aortic root or ascending aorta sizes. The obese/overweight group had a higher peak aortic valve gradient (23.03 ± 1.64 mmHg vs. 16.17 ± 1.55 mmHg, p = 0.003) compared to the healthy weight group.
Conclusion:
Healthy weight patients did not have larger aortic dimensions compared to the overweight/obese patients. There was evidence of worsening aortic valve stenosis in overweight/obese patients compared to those at a healthy weight.
Biofortification – the process of increasing the concentrations of essential nutrients in staple crops – is a means of addressing the burden of micronutrient deficiencies at a population level via existing food systems, such as smallholder farms. To realise its potential for global impact, we need to understand the factors that are associated with decisions to adopt biofortified crops and food products. We searched the literature to identify adoption determinants, i.e. barriers to (factors negatively associated) or facilitators of (factors positively associated) adoption, of biofortified crops and food products. We found 41 studies reporting facilitator(s) and/or barrier(s) of adoption. We categorised the factors using the Consolidated Framework of Implementation Research 2.0, resulting in a set of factors that enable or constrain adoption of biofortified foods across twenty-four constructs and five domains of this meta-theoretical determinant framework from implementation science. Facilitators of orange sweet potato adoption included knowledge about importance, relative advantage, efficient production and management practices; barriers included lacking timely access to quality vines and market remoteness (28 studies total). Facilitators of vitamin A cassava adoption included awareness of its benefits and access to information; barriers included poor road networks and scarcity of improved technology including inadequate processing/storage facilities (8). Facilitators of high-iron bean adoption included farmers’ networking and high farming experience; barriers included low knowledge of bean biofortification (8). Barriers to vitamin A maize adoption included low awareness and concerns regarding yield, texture and aflatoxin contamination (1). These barriers and facilitators may be a starting point for researchers to move towards testing implementation strategies and/or for policymakers to consider before planning scale-up and continuous optimisation of ongoing projects promoting adoption of biofortified crops and food products.
This article analyses a selection of archival material written by Paul Tillich, particularly his early parish sermons and sermons from World War I. Although the themes of ‘eternity’ and ‘the soul’ are rare in the early parish sermons and only appear in the context of death or suffering, they play a predominant role in the World War I sermons. This article suggests that this is because, for Tillich, suffering became the interpretative key. Through his sermons amidst the suffering and devastation of war Tillich employed what he called the immanent way of theology.
This survey of 66 specialist mental health services aimed to provide an up-to-date description of pathways of care and interventions available to children with an intellectual disability referred for behaviours that challenge or with suspected mental health problems.
Results
Overall, 24% of services made contact with a family at referral stage, whereas 29% contacted families at least once during the waiting list phase. Only two in ten services offered any therapeutic input during the referral or waiting list stages. During the active caseload phase, services offered mostly psychoeducation (52–59%), followed by applied behaviour analytic approaches for behaviours that challenge (52%) and cognitive–behavioural therapy (41%). Thirty-six per cent of services had not offered any packaged or named intervention in the past 12 months.
Clinical implications
With increasing waiting times for specialist mental health support, services need to consider increasing the amount of contact and therapeutic input on offer throughout all stages of a child's journey with the service.
Feature-based models of sign language use distinctive features to describe the phonological structure of signs. We use near-minimal pairs and phonological phenomena like productivity and neutralisation in French Sign Language to show that the feature [web], which refers to the webbing part of the fingers, should be (re)introduced into the list of phonologically active features. In discussing potential cases of [web] in other sign languages and the impact on the shape of phonological inventories, we first offer an account of [web] in terms of a location feature in line with most traditional feature-geometry models. We then offer some speculations on why a more uniform characterisation of [web] and the features in the same subclass in terms of the orientation type results in more economical models.
Lunatic Asylums, published 130 years ago, is a fascinating insight into how these institutions were managed in the late Victorian era. This brief article considers what it reveals about the zeitgeist of the time and the book's author, the remarkable Charles Mercier.
It has long been said that legislation ought to be knowable: accessible, comprehensible, and so forth. This is often described as an essential element of the rule of law. But in many legal systems, legislation has become so voluminous and complex that few people know its content. Rather than admit that the rule of law has been compromised, some scholars take legislative complexity as a provocation to rethink what the rule of law requires—and conclude that, for various reasons, the rule of law can prevail even if legislation is not reasonably knowable to the people. This article responds to this line of scholarship and defends the orthodox position that the public ought to be able to understand legislation, or at least reasonably so. That is necessary to enable people to plan their lives in a way that properly reflects the role of legislation in contemporary administrative states.
Based on a linguistic ethnographic study of student–teacher classroom interactions, this article sheds light on language norms in a contemporary Danish STX school (upper secondary education, also known as gymnasiums). The analysis reveals that neither classrooms with the explicit teaching of an ‘academic register’ nor classrooms where teachers orient towards a youth norm constitute spaces where students have equal access to perform as good students. Even when students can decode and reproduce the language preferred by the teachers, they do not experience an equal opportunity to conform to this. It is argued that performing linguistically as good and competent students is more complex than just adapting to a specific school norm, as the students have to navigate different teacher’s norms as well as peer norms emphasising authenticity.
This manuscript mainly explores the characteristics of turbulence quantities in the wake of tall building clusters of different array size ($N$) and building spacing ($W_S$) arranged in an aligned and regular grid in the flow direction. Velocity fields are measured in a wind tunnel using three-dimensional laser Doppler anemometry. Results show a delayed recovery of $u_{rms}$ and $v_{rms}$ (defined as the root-mean-square of the streamwise and lateral velocities, respectively) in the wake flow compared with the mean flow. Based on the turbulent fluctuations, the extents of the near-, transition- and far-wake regions in Mishra et al. (Boundary-Layer Meteorol., vol. 189, 2023, pp. 1–25) are revisited. In the near wake, we observe a significant reduction in $u_{rms}$ and $v_{rms}$ in the wake of a $4\times 4$ cluster compared with that of a single building. In the transition region, the turbulence intensity magnitudes within the cluster reduce to below their free-stream counterpart; this reduction is associated with the slowly varying nature of the normalised wake deficit in the streamwise direction. The recovery of the root mean square in the far-wake region is observed for $x \geq 2.5W_A$ (where $W_A$ is the width of the cluster), with the mutual interaction of the wakes formed behind the individual buildings reducing with an increase in $W_S$, resulting in a faster recovery of the turbulent fluctuations. Finally, wavelet analysis suggests the existence of multi-scale vortex-shedding frequencies downwind of tall building clusters.
In a cross-sectional study of 20 Massachusetts long-term care (LTC) facilities, 19% (n = 449) of residents received antibiotics, with approximately one-third having a documented penicillin allergy. This documented allergy decreased the likelihood of prescribing beta-lactam antibiotics for infections. Improved penicillin allergy assessments and delabeling could optimize antibiotic prescribing in LTC settings.
The principle of proportionality under international humanitarian law prohibits an attack if the expected harm to civilian persons and objects is excessive in relation to the anticipated concrete and direct military advantage. In this article we argue that, when applying the principle of proportionality, the incidental harm to a child must be given a higher value as compared to incidental harm to an adult. This reflects the broader framework of international humanitarian law, which creates stratifications amongst different groups of civilians and provides special protection for children in times of war. This aligns with the practice of many militaries, which tends to implicitly assign a heightened worth to the lives of children due to moral and political considerations. Such reasons stem from the perceived vulnerability of children as well as their moral innocence reflecting harmlessness and blamelessness. Indeed, harm to children’s lives tends to generate a greater backlash among the community to which they belong and, as a result, a military disadvantage. We argue that the greater weight assigned to the lives of children in proportionality assessments is not simply a matter of morality or strategic calculations, but in fact a requirement from a more wholistic interpretation of international humanitarian law.
To assess changes in caregiver practices for young children after integrating the Responsive Care and Early Learning (RCEL) Addendum package into nutrition services after 10 months of implementation.
Design:
We measured changes in RCEL practices through a pre- and post-intervention assessment comprising a household survey and observations. To implement the intervention, we trained health service staff and community volunteers to deliver RCEL counselling to caregivers of children 0–23 months of age through existing community and facility-level platforms.
Setting:
Jalal-Abad and Batken regions in the Kyrgyz Republic.
Participants:
Caregivers of children aged 0–23 months at baseline.
Results:
We found statistically significant increases in RCEL practices, availability of early learning opportunities in the home, decreases in parenting stress and improvements in complementary feeding practices after the intervention implementation period.
Conclusions:
Findings show that delivery of RCEL counselling using the RCEL Addendum was associated with improved responsive care practices and early learning opportunities. We also found that integration of RCEL with infant and young child feeding counselling did not disrupt nutrition service delivery or negatively affect complementary feeding outcomes, but rather suggest synergistic benefits. Given the importance of providing holistic care to support optimal early childhood development, these findings provide new evidence on how to strengthen the delivery of nurturing care services in the Kyrgyz Republic.
Repulsive guidance molecule b (RGMb), a glycosylphosphatidylinositol-anchored member of the RGM family, is initially identified as a co-receptor of bone morphogenetic protein (BMP) in the nervous system. The expression of RGMb is transcriptionally regulated by dorsal root ganglion 11 (DRG11), which is a transcription factor expressed in embryonic DRG and dorsal horn neurons and plays an important role in the development of sensory circuits. RGMb is involved in important physiological processes such as embryonic development, immune response, intercellular adhesion and tumorigenesis. Furthermore, RGMb is mainly involved in the regulation of RGMb–neogenin–Rho and BMP signalling pathways. The recent discovery of programmed death-ligand 2 (PD-L2)–RGMb binding reveals that the cell signalling network and functional regulation centred on RGMb are extremely complex. The latest report suggests that down-regulation of the PD-L2–RGMb pathway in the gut microbiota promotes an anti-tumour immune response, which defines a potentially effective immune strategy. However, the biological function of RGMb in a variety of human diseases has not been fully determined, and will remain an active research field. This article reviews the properties and functions of RGMb, focusing on its role under various physiological and pathological conditions.
Vitamin B12, cobalamin, is indispensable for humans owing to its participation in two biochemical reactions: the conversion of l-methylmalonyl coenzyme A to succinyl coenzyme A, and the formation of methionine by methylation of homocysteine. Eukaryotes, encompassing plants, fungi, animals and humans, do not synthesise vitamin B12, in contrast to prokaryotes. Humans must consume it in their diet. The most important sources include meat, milk and dairy products, fish, shellfish and eggs. Due to this, vegetarians are at risk to develop a vitamin B12 deficiency and it is recommended that they consume fortified food. Vitamin B12 behaves differently to most vitamins of the B complex in several aspects, e.g. it is more stable, has a very specific mechanism of absorption and is stored in large amounts in the organism. This review summarises all its biological aspects (including its structure and natural sources as well as its stability in food, pharmacokinetics and physiological function) as well as causes, symptoms, diagnosis (with a summary of analytical methods for its measurement), prevention and treatment of its deficiency, and its pharmacological use and potential toxicity.
Accurate measurement of transcutaneous oxygen saturation is important for the assessment of cyanosis in CHD. Aim of this study was the evaluation of a supplementary transcutaneous oxygen saturation measurement with an Apple watch® in children with cyanotic heart disease.
Material and methods:
During a six-minute walk test, measurement of transcutaneous oxygen saturation was performed simultaneously with an Oximeter (Nellcor, Medtronic, USA) and an Apple watch® Series 7 (Apple inc, USA) in 36 children with cyanotic heart disease.
Results:
Median age was 9.2 (IQR 5.7–13.8) years. Transcutaneous oxygen saturation measurement with the Apple watch® was possible in 35/36 and 34/36 subjects before and after six-minute walk test. Children, in whom Apple watch® measurement was not possible, had a transcutaneous oxygen saturation < 85% on oximeter. Before six-minute walk test, median transcutaneous oxygen saturation was 93 (IQR 91–97) % measured by oximeter and 95 (IQR 93–96) % by the Apple watch®. After a median walking distance of 437 (IQR 360–487) m, transcutaneous oxygen saturation dropped to 92 (IQR 88–95, p < 0.001) % by oximeter and to 94 (IQR 90–96, p = 0.013) % measured with the Apple watch®.
Conclusion:
In children with mild cyanosis measurement of transcutaneous oxygen saturation with an Apple watch® showed only valid results if transcutaneous oxygen saturation was > 85%, with higher values being measured with the smart watch. In children with moderate or severe cyanosis transcutaneous oxygen saturation, measurement with the Apple watch® was not reliable and cannot be recommended to monitor oxygen saturation at home.
Large-scale coherent structures in incompressible turbulent pipe flow are studied for a wide range of Reynolds numbers ($Re_\tau =180, 550, 1000, 2000$ and $5200$). Employing the Karhunen–Loève decomposition and a novel approach based on the Voronoi diagram, we identify and classify statistically coherent structures based on their location, dimensions and $Re_{\tau }$. With increasing $Re_{\tau }$, two distinct classes of structures become more energetic, namely wall-attached and detached eddies. The Voronoi methodology is shown to delineate these two classes without the need for specific criteria or thresholds. At the highest $Re_{\tau }$, the attached eddies scale linearly with the wall-normal distance with a slope of approximately $l_y\sim 1.2y/R$, while the detached eddies remain constant at the size of $l_y \approx 0.26R$, with a progressive shift towards the pipe centre. We extract these two classes of structures and describe their spatial characteristics, including radial size, helix angle and azimuthal self-similarity. The spatial distribution could help explain the differences in mean velocity between pipe and channel flows, as well as in modelling large and very-large-scale motions (LSM and VLSM). In addition, a comprehensive description is provided for both wall-attached and detached structures in terms of LSM and VLSM.
Objective: This study aimed to assess and comparatively analyse two menus from a Young Offenders Institution (YOI). One menu from 2019, and one from 2022, with the objective of identifying any improvements in meeting dietary guidelines. Design: Cross-sectional and comparative analysis. Setting: United Kingdom, a YOI in Northern England. Participants: YOI Menus. Results: Analysis of 30 dietary components identified that 25 exceeded the dietary guidelines (P < 0.05) for the 2022 menu, with five failing to meet the guidelines (P < 0.05). When compared to the 2019 menu, the 2022 menu showed improvements in saturated fat, sodium, and vitamin D. Despite the improvement, vitamin D levels remained below dietary guidelines (P < 0.01). Salt and energy content were reduced in the 2022 menu (P < 0.05); however, they were still above the dietary guidelines (P < 0.01). Free sugars were significantly above dietary guidelines for both menus, with no significant change between the 2019 and 2022 menu (P = 0.12). Conclusion: The 2022 menu has demonstrated progress in alignment with meeting dietary guidelines, particularly in reducing calories, fat, saturated fat, salt, sodium, and chloride, as well as increasing vitamin D. Despite improvements, calories, free sugars, salt, saturated fat, sodium, and chloride are still exceeding dietary guidelines, posing as potential health risks.