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Most children with CHD who undergo cardiac surgery in infancy require anaesthesia for additional non-cardiac procedures early in childhood. The purpose of our study was to characterise the use of non-cardiac procedures during the first year of life among neonates requiring cardiac surgery in order to set family and care team expectations.
Materials and methods:
We conducted a retrospective descriptive study comprising data collection from the medical record since programme inception from September 1, 2018, to November 3, 2025. The records of all patients undergoing neonatal cardiac surgery were reviewed if they reached their first birthday during the study period. Infants who died during hospitalisation were excluded.
Results:
Three hundred fourteen unique neonates underwent 862 procedures (Figure 1). The typical neonate underwent 2.75 procedures during the first year of life (not including cardiac surgery). The surgical complexity STAT scores of the neonatal operation categories 1–5 had 48, 57, 92, 78, and 39 participants, respectively. The STAT category associated with the most frequent use of anaesthetics was STAT 5. The most common procedures were peripherally inserted central catheter line, cardiac catheterisation, CT with angiography, and gastrostomy tube placement.
Comment:
We conducted a retrospective descriptive study comprising data collection from the medical record since programme inception from September 1, 2018, to November 3, 2025. A requirement for non-cardiac procedures in the first year of life is common but not universal. Neonates undergoing more complex cardiac procedures (STAT 3–5) underwent more frequent non-cardiac anaesthetics compared with STAT 1–2.
Mining activities have intensive water and energy needs that require reliable infrastructure for ongoing supply. In several jurisdictions, regulations require mining companies to clear all service infrastructure as part of closure planning. This creates significant challenges for remote communities near mine sites that often rely on company-sponsored infrastructure for essential services such as energy and water. Unreliable or unaffordable services not only impact the local quality of life but can also significantly constrain post-closure economic diversification opportunities. This uncertainty in reliable access to critical public services in mining-dependent communities has received little attention in contemporary scholarship on mine closure planning.
Technical summary
Reliable and affordable access to water and energy is critical to supporting remote mining-dependent communities in planning their social and economic transition after mine closure. Traditional cost-efficiency approaches employed by service providers have consistently failed on two accounts. First, they have paid little consideration to community needs in planning supply solutions. Second, typically, a single-minded focus on cost-effectiveness has led to isolated initiatives for energy supply, without considering their interface with sustainable water management. These practices have often led to unreliable and unaffordable services, particularly in remote jurisdictions, where community capacity is low, and over-reliance on company-supported infrastructure is common. This paper proposes a novel conceptual approach to planning integrated water and energy solutions to address these shortcomings. An integrated systems design offers several advantages, including optimal resource use, system and price efficiency, and reduced risk of social and environmental consequences. These advantages, in turn, support socio-economic development needs and may build community confidence in pursuing economic diversification post-mining. The framework, rooted in the principles of stakeholder engagement and intersectoral coordination, offers a critical resource for mine closure planners, regulators, and communities to minimise negative impacts from the closure of long-established mining operations and create new pathways to transition post-mining.
The mechanisms governing generation and amplification of laser-driven electromagnetic pulses (EMPs) in the picosecond (ps) regime remain insufficiently understood. Here, we present a unified theoretical and experimental framework that demonstrates dual-picosecond laser irradiation of solid targets can synergistically enhance EMP emission. By integrating particle-in-cell simulations with three-dimensional electromagnetic modeling, we reveal that the increasing laser focal power density amplifies hot electron emission and strengthens neutralization currents, leading to giant EMP radiations. Experimentally, we validate these predictions at the XG-III and SG-II U picosecond petawatt laser facilities, achieving a record-breaking EMP field strength of 3.08 MV/m – substantially exceeding previously reported values from ps-laser–solid interactions. Furthermore, we demonstrate that EMP characteristics can be precisely tuned via laser and target parameters, enabling controllable, high-field electromagnetic sources. Our findings provide deep insight into the physics of laser-driven EMP amplification and establish a robust platform for developing next-generation high-intensity electromagnetic emitters.
In the early 1590s, the relative backwater of Hizen Nagoya in Kyushu was transformed into the launch pad for Toyotomi Hideyoshi’s East Asian War with the construction of a large castle and over 150 daimyo encampments. Hizen Nagoya was a relatively short-lived, dynamic, military-civil hybrid settlement. It thrived for a mere seven years before defeat in Korea led to its virtual abandonment. After the war, the castle was deconstructed and partly recycled, the encampments dismantled and the merchants dispersed, leaving behind few physical remnants but powerful memories. Unlike other symbolically important Toyotomi castles, it was never reconstructed. During the Edo period, Hizen Nagoya lost its strategic significance, political influence and economic dynamism. It was a melting pot that brought together cultural practices from distant Japanese regions (and beyond), before disseminating them across the archipelago via the returning soldiers. The East Asian War left not only a legacy of death and destruction, but also one of cultural creation, refinement and diffusion. The castle ruins are now a museum dedicated to historical understanding and Japan–Korea reconciliation. Its legacy has been overshadowed by that of the East Asian War and Toyotomi Hideyoshi but Hizen Nagoya’s contribution to the war and modern reconciliation efforts should not be overlooked.
Parents of adolescents facing suicidality play a crucial protective role, but often feel overwhelmed. The Partners in Parenting Plus – Suicide Prevention (PiP-SP+) programme is a co-designed, coach-supported, online parenting programme aimed to empower parents within their carer role to manage their adolescent’s suicide risk.
Aims
To evaluate PiP-SP+’s acceptability, feasibility, validity and short-term effects.
Method
Fifteen parents of adolescents aged 12–18 years, concerned about their adolescent’s suicidality, participated in an open-label, non-randomised uncontrolled trial. Parents (n = 11) completed semi-structured interviews, exploring the programme’s acceptability, feasibility and validity. Thirteen parents completed quantitative assessments of parental self-efficacy to respond to adolescent suicidality and non-suicidal self-injury, protective parenting behaviours, carer burden, parental distress, mental health support quality, family functioning, and adolescent anxiety and depressive symptoms at baseline and 120 days post baseline. Finally, nine adolescents of the participating parents self-reported anxiety symptoms, depressive symptoms and perceptions of parental support at baseline and 120 days post baseline.
Results
PiP-SP+ was an acceptable, feasible and valid intervention for parents. Significant baseline-to-post-intervention improvements were observed in parents’ self-efficacy to respond to adolescent suicidality and non-suicidal self-injury, protective parenting behaviours, carer burden, parental distress and mental health support quality. No significant differences were reported in family functioning. Adolescents perceived increased parental support; both parents and adolescents reported reductions in adolescent anxiety symptoms. Although parents reported a significant decrease in adolescent depressive symptoms, adolescents did not.
Conclusions
Findings support the value of undertaking an appropriately powered, randomised controlled trial to confirm these pilot findings.
While institutionalization is often treated as a route to legitimacy, in civil society organizations (CSOs) it can harden into donor-driven formalities that reduce responsiveness in extreme contexts. This paper advances informalization not as a rejection of structure, but as a deliberate community-anchored response to rigid institutionalization that restores local flexibility and legitimacy while retaining a minimal formal backbone. Using a single case study of Palestinian CSOs operating under prolonged occupation and shrinking civic space, we draw on 30 semi-structured interviews, a small purposive survey, and document analysis. Findings identify three mechanisms of reinstitutionalization, mainly governance decentralization, knowledge-sharing routines coupled with organized bricolage, and the operationalization of Sumud in service delivery. Together, these mechanisms constitute a process of selective formalization that recouples practice to local logics, improving responsiveness and perceived legitimacy while reallocating administrative capacity from compliance to stewardship.
Maize is the most important staple food in sub-Saharan Africa. Yet, smallholders produce on average about 20% of what is possible with best agronomic practices. On-farm experiments were conducted over two consecutive cropping seasons in Central Mozambique to investigate the contribution of genotype-by-environment-by-management interactions to maize yields in relation to improved cultivars, sowing time, and fertilization regimes across soil fertility conditions. In 2022–2023, maize yield variability on high-fertility fields was explained by a three-way interaction between fertilizer regime, sowing date, and cultivar, whereas on low-fertility fields, it was explained by fertilizer regime only. The highest yields were observed with early sowing of an intermediate (3.6 t ha−1) or early (3.1 t ha−1) maturity cultivar, whereas late sowing yielded the least (1.6 t ha−1). In 2023–2024, characterized by a severe El Niño drought, yield variability was explained by cultivar on high-fertility fields (with the intermediate maturity cultivar yielding highest) and by fertilizer regime on low-fertility fields. Results from farmer-managed experiments conducted in the same season confirmed the importance of cultivar choice and fertilizer use. Profitability with improved maize cultivars and mineral fertilizers depended on soil fertility and on the extent of water limitations to maize growth, with trade-offs arising between food security and return on investment when improved genetics and agronomic management were used. Targeting intermediate maturity maize cultivars with early sowing and fertilizer inputs was found to be critical to improve food security amid climate change.
The Fontan procedure, a palliative surgical approach for single-ventricle physiology, has significantly improved long-term survival. However, it is frequently associated with reduced exercise capacity and multiorgan dysfunction. In this context, peripheral muscle function and body composition may influence functional outcomes.
Objective:
The aim of the study was to evaluate the relationships among body composition, handgrip strength, and functional capacity in Fontan patients, as well as to investigate the impact of Fontan-related variables on these parameters.
Methods:
This single-centre study included 30 clinically stable patients (age range: 7.0–33.0 years) with Fontan circulation. Data collected included pre-operative primary diagnosis, pre-Fontan mean pulmonary artery pressure, and laboratory parameters such as B-type natriuretic peptide, haemoglobin, creatinine, alanine aminotransferase, aspartate aminotransferase, albumin, and uric acid levels. 6-minute walk test (6MWT), handgrip strength, and body composition via bioelectrical impedance were assessed. Correlation and subgroup analyses were performed according to pre-Fontan surgery history, Bidirectional Glenn, Fontan type, fenestration, and other clinical factors.
Results:
The median 6MWT distance was 564 m, handgrip strength was 28.3 ± 11.1 kg, and ΔSpO2 was 4% (IQR: 2–5). Patients with intra-extracardiac Fontan and fenestration exhibited significantly higher ΔSpO2 (p = 0.03 and p = 0.003, respectively). ΔSpO2 was inversely correlated with 6MWT distance (r = −0.531, p = 0.008) and handgrip strength (r = −0.472, p = 0.017). Fat-free mass was positively correlated with both 6MWT distance (r = 0.598, p < 0.001) and handgrip strength (r = 0.537, p = 0.002). Red cell distribution width was negatively correlated with 6MWT (r = −0.631, p < 0.001) and grip strength (r = −0.413, p = 0.029).
Conclusion:
In Fontan patients, reduced handgrip strength, lower fat-free mass, and greater post-exercise oxygen desaturation were associated with impaired exercise capacity, supporting the clinical value of simple functional and muscle strength assessments in routine follow-up.
This paper concerns the isentropic compressible Navier–Stokes equations in a three-dimensional (3D) bounded domain with slip boundary conditions and vacuum. It is shown that the classical solutions to the initial-boundary-value problem of this system with large initial energy and vacuum exist globally in time and have an exponential decay rate, which is decreasing with respect to the adiabatic exponent $\gamma \gt 1$ provided that the fluid is nearly isothermal (namely, the adiabatic exponent is close enough to 1). This constitutes an extension of the celebrated result for the one-dimensional Cauchy problem of the isentropic Euler equations that has been established in 1973 by Nishida and Smoller (Comm. Pure Appl. Math. 26 (1973), 183–200). In addition, it is also shown that the gradient of the density will grow unboundedly with an exponential rate when the initial vacuum appears (even at a point). In contrast to previous related works, where either small initial energy is required or boundary effects are absent, this establishes the first result on the global existence and exponential growth of large-energy solutions with vacuum to the 3D isentropic compressible Navier–Stokes equations with slip boundary conditions.
This work describes the design and validation of a one-size-fits-all assistive exoskeleton for the upper limb that is self-adjustable to the wearer subject. The assistance function is performed even if the joints of the exoskeleton are not aligned with the joints of the subject; therefore, it does not require personalized adjustments during the wearing phase. The device is composed of a distal articulated system with a prismatic interface towards the body segment and a flexible proximal architecture that shifts the actuation towards the pelvis to limit the alteration of the subject’s center of gravity. In vivo experiments in the laboratory demonstrate the ability to alleviate muscular effort, and home-based experiments in performing daily activities show excellent perceived usability and acceptability in an elderly population. Furthermore, a proposed biomechanical model estimates the ability of the exoskeleton to contain the joint constraint reactions in the subject during the assistance phase.
In this paper, we study the relation between the property of detailed balance and the ability of discriminating between different ligands for a class of stochastic models of kinetic proofreading. We prove the existence of a critical amount of lack of detailed balance that the kinetic proofreading models must have in order to have strong specificity for a value of the binding energy $\sigma$. We also prove that the fact that a kinetic proofreading model has a lack of detailed balance that is larger than the critical one does not necessarily yield strong discrimination properties. Indeed, there exist different sets of chemical rates, leading to the same amount of lack of detailed balance, that have strong discrimination property in some cases and not in others.
Conciliatory views of peer disagreement (aka Conciliationism) have repeatedly been challenged on the grounds that they are epistemically self-undermining. Recently, Dixon (2024) argues that this challenge is worse than previously thought: it is (almost certainly) permanent, and this provides strong reason to abandon Conciliationism as (almost certainly) hopeless. In response, Justin (2025) argues that the self-undermining challenge and Dixon’s arguments, at best, only apply to the belief suspension versions of Conciliationism but not to degree-of-belief (aka credal) versions of Conciliationism. Thus, not only can Conciliationists largely avoid the self-undermining challenge but, contra Dixon, this challenge also does not provide adequate reason to abandon Conciliationism as hopeless. This paper argues that not only can the self-undermining challenge be reformulated to apply to credal versions of Conciliationism but this reformulated challenge also extends and further supports Dixon’s pessimism: because there (almost certainly) is or will be peer disagreement on any way of responding to this reformulated challenge, any response (almost certainly) be defeated by the very view it is attempting to defend. Thus, credal Conciliationism is also (almost certainly) permanently self-undermining and there is (almost certainly) still no hope for Conciliationism.
‘The Castles’ project was completed in late 2025 (https://castles.unisi.it) and its innovative, multidisciplinary approach is revealing a revised chronological and typological sequence for the phenomenon of incastellamento in Italy. The results show an earlier appearance of large stone structures and a much later appearance of fortified stone-built villages around seigneurial centres than previously thought.
We study saturation properties of $\sigma $-complete measures on $P_\kappa (\lambda )$, where $\lambda $ can be either regular or singular. In particular, we prove that in contrast to Galvin’s theorem, the Galvin property from [6] fails for normal, fine ultrafilters on $P_\kappa (\lambda )$, answering a question of the first author and Goldberg from [10]. We then provide several applications of our results: to ultrafilters on successors under $UA$, we generalize a result of Gitik regarding density of ground model sets in supercompact Prikry extensions, and to generating sets of $P_\kappa (\lambda )$ measures. In the second part of the article, we study variations of the Galvin property suitable for ultrafilters over $P_\kappa (\lambda )$, and generalize a result of Foreman–Magidor–Zeman [17, Theorem 1.2] on determinacy of filter games to the two-cardinal setting, answering a question of the first author and Gitman from [9].
We consider random lower triangular matrices such that the entries on and below the diagonal are i.i.d. copies of some $\mathbb{Z}$-valued random variable. We prove that the Sylow $p$-subgroups of the cokernels of these matrices have the same constant order fluctuations as those of the matrix products studied by Nguyen and Van Peski. Unlike for matrix products, for triangular matrices, the law of the limiting fluctuations depends slightly on the distribution of the entries. As a special case, we can describe the limiting fluctuations of the rank of lower triangular matrices over $\mathbb{F}_p$ with i.i.d. random entries on and below the diagonal.
A discussion is provided of several issues related to behavioral measurement that arise from Pfadt et al. (2026, Psychometrika, 2026, 1–35). The note may be viewed in part as a complement to their developments regarding precision estimation for individual test scores.