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Vitamin D deficiency is a common nutritional problem in exclusively breastfed infants. Dilated cardiomyopathy is a rare but potentially fatal complication of this condition. We describe a 15-month-old who presented with cardiogenic shock. Laboratory and radiographic findings were consistent with vitamin D deficiency. Metabolic parameters normalised within one week and echocardiography normalised by 19 months after supplementation. Although rare, severe vitamin D deficiency must be on the differential for young children presenting with new-onset dilated cardiomyopathy. Clinicians must maintain a high index of suspicion for vitamin D deficiency in at-risk populations to prevent potentially life-threatening complications.
Fully resolved three-dimensional simulations of planar gravity currents are conducted to investigate the influence of imposed spanwise perturbations on flow evolution and mixing at two Reynolds numbers ($ \textit{Re}=3450$ and 10 000). The initial perturbations consist of sinusoidal waves with a varying number of repeating waves, $k_y$, with simulations spanning $0 \leqslant k_y \leqslant 8$. At low-$ \textit{Re} $, cases with perturbations ($k_y \gt 0$) exhibit a more rapid breakdown of spanwise coherence compared with the unperturbed case ($k_y = 0$), although the resulting structures retain spatial periodicity and remain relatively ordered. This earlier disruption leads to greater front propagation distances beyond the self-similar inertial phase compared with the unperturbed case. Notably, imposed perturbations exhibit minimal influence on the flow transition; all cases follow the slumping velocity reported in the literature, with the transition into the inertial phase occurring at comparable times across different $k_y$ values at both $ \textit{Re} $. The increased propagation speed is accompanied by reduced mixing efficiency due to the premature disruption of coherent Kelvin–Helmholtz (K–H) billows, which play a key role in maintaining multi-scale mixing. At high-$ \textit{Re} $, the influence of initial spanwise perturbations diminishes, as three-dimensional turbulence induces a more chaotic, fine-scale breakdown of spanwise coherence across all $k_y$ cases, overriding the effects of the initial perturbations. Consequently, the dominant stirring mechanism shifts from K–H billows to vortices within the current head. Nevertheless, the unperturbed case maintains comparatively higher mixing efficiency at both low- and high-$ \textit{Re} $. This is attributed to the persistence of recognisable K–H billow structures, which, despite undergoing chaotic breakdown at high-$ \textit{Re} $, still contribute to effective stirring by stretching and folding the density interface. These results highlight the dual role of K–H billows: they promote efficient mixing, yet the enhanced mixing reduces the density difference between the current and the ambient fluid, weakening buoyancy and slowing front propagation despite stronger stirring. These findings are supported by consistent trends in streamwise density distribution and ‘local’ energy exchange analyses.
This text addresses the materiality of radio art, situating it within the theoretical frameworks of contemporary research on new materialism as well as the materiality of media and sound. The analysis employs perspectives from Christoph Cox’s sonic materialism and approaches by such writers as Salomé Voegelin, Gregory Whitehead, Allen S. Weiss and Margaret Hall, who emphasise the ontological autonomy of sound and its impact on space and listeners. A critical close reading of the relevant literature is conducted with regard to its applicability to radio art. The article analyses radio art practices structurally and phenomenologically across composition, reception, materiality and technology, aligning with practice-informed media analysis. The author’s aim is to outline and systematise diverse theoretical approaches and frameworks that capture the materiality of radio being, as well as to reveal the ways in which the radio medium co-creates artistic sound reality. The results of the literature and artistic practice analysis highlight the significance of sound’s materiality and its relational character, indicating that sound does not exist in isolation but in interaction with the environment, technology and listener. Consequently, seven dimensions of radio art materiality are delineated, which integrate existing concepts and provide a comprehensive perspective on radio artistic works.
DeGAUSS is a privacy-preserving application that ingests addresses and generates output that includes latitude, longitude, census tract, deprivation index and drive times to major hospitals. The application uses a complex command line interface and a container management platform to perform analysis. Our objective was to develop a user-friendly DeGAUSS-based application that simplifies place-based analysis. We also enabled automated geomarker generation by providing an API modality to DeGAUSS.
Methods:
We developed a self-service platform based on the DeGAUSS application. The application was linked to user authentication platforms. The self-service application can be implemented as an API, enabling high-volume geocoding transactions. We surveyed active users for feedback.
Results:
The self-service geomarker application was deployed at Children’s Mercy and the University of Kansas Medical Center. During the period evaluated, more than 2 million addresses were geocoded for 24 users through the user interface and more than 15 million addresses through the API. Users expressed high satisfaction with the system. All respondents used the census block group feature and the core geocoding. Most respondents, 60%, used the deprivation index and 30% used the drive time feature. Population health and social determinants of health were the most common uses (80% each) followed by health equity analyses (70%).
Conclusion:
Population health and social determinants of health research require access to precise geographic information about patients or research subjects. The self-service geomarker capability enables users who may not be comfortable with a command line interface to generate geocoded addresses in support of their research and analysis.
Discussions of social organisation in early complex societies often rely on traditional narratives of a linear progression to hierarchy, but archaeological evidence is increasingly showcasing a spectrum of social structures. Here, examination of burial practices in 50 tombs from Kedurma, Sudan, helps illustrate social stratification and identity negotiation beyond the binary rendering of elite/non-elite during the Meroitic period (third century BC to fourth century AD). The diversity of architectural forms and grave goods highlights the importance of inter-regional exchange networks and a more fluid social dynamic, contributing to our understanding of early African state formation.
We explore the effects of fiscal policy shocks on aggregate output and inflation. We use the Bayesian econometric methodology of Baumeister and Hamilton applied to the fiscal structural vector autoregressive model to evaluate key elasticities and fiscal multipliers using U.S. data. In our baseline specification that ends before Covid pandemic, the government spending multiplier is equal to approximately $0.57$ and tax multiplier is approximately $-0.35$ after one year. The short-term output elasticity of government spending is statistically insignificant and the output elasticity of taxes is approximately equal to $2.26$.
Previous research has highlighted that supplementing standard group-level event-related potential analyses with assessments of individual variation can enhance our understanding of language-related brain activity. The present study pursues this approach by examining bilingual speakers’ brain responses to morphologically complex word forms in both their native (German, L1) and their second language (English, L2). We tested 108 bilingual speakers using an ERP violation paradigm examining overapplications of regular verb inflections (‘regularizations’) and of irregular ones (‘irregularizations’). We found a striking L1/L2 contrast within the same bilingual speakers, a left-anterior negativity for regularizations in the L1 and a positivity (P600) for both violation types in the L2. Consistent with previous research, individuals’ brain responses were found to vary along negativity-/positivity-dominant effects. However, the crucial L1/L2 contrast in participants’ brain responses to regularizations was stable across individual differences. We conclude that linguistic constraints, that is, violation type and language status (L1 vs. L2), limit individual variability.
The marked Hawkes risk process is a compound point process where the occurrence and amplitude of past events impact the future. Since data in real life are acquired over a discrete time grid, we propose a strong discrete-time approximation of the continuous-time risk process obtained by embedding from the same Poisson measure. We then prove trajectorial convergence results in both fractional Sobolev spaces and the Skorokhod space, hence extending the theorems proven in Huang and Khabou ((2023). Stoch. Process. Appl.161, 201–241) and Kirchner ((2016). Stoch. Process. Appl.126(8), 2494–2525). We also provide upper bounds on the convergence speed with explicit dependence on the size of the discretization step, the time horizon, and the regularity of the kernel.
We provide a first-order homogenization result for quadratic functionals. In particular, we identify the scaling of the energy and the explicit form of the limiting functional in terms of the first-order correctors. The main novelty of the paper is the use of the dual correspondence between quadratic functionals and PDEs, combined with a refinement of the classical Riemann–Lebesgue lemma.
This study aimed to explore the end-of-life decision-making experiences of bereaved family caregivers of Alzheimer’s disease (AD) patients, focusing on do-not-resuscitate orders. Given the high emotional and ethical burden on caregivers, understanding their challenges and needs is crucial to enhancing palliative care for AD patients.
Methods
A qualitative, exploratory study was conducted using semi-structured interviews with 22 family caregivers recruited through purposive sampling in central Taiwan. Participants were primary caregivers for AD patients who had been bedridden for at least a year before death. Analysis employed inductive thematic coding to identify key themes, with rigor ensured through multiple coding, member checking, and reflective journaling.
Results
Three major themes emerged: (1) Decision-making difficulties, where caregivers felt pressure and conflict when making urgent decisions; (2) Willingness to let go, which involved accepting the inevitability of death when recovery was no longer possible; and (3) Embracing the consequences of the decision, reflecting caregivers’ sense of relief and acceptance post-decision. Cultural factors, such as filial piety, were found to influence decision-making processes, often intensifying emotional conflicts.
Conclusions
Findings underscore the importance of early, culturally sensitive discussions around end-of-life care in palliative settings for AD patients. Healthcare providers are encouraged to initiate these discussions, offering clear explanations and emotional support to assist caregivers through decision-making. This study highlights the need for a family-centered approach that respects cultural nuances, helping to reduce caregiver stress and enhance the quality of palliative care in AD contexts.
We introduce a notion of stratification for rigidly-compactly generated tensor-triangulated categories relative to the homological spectrum and develop the fundamental features of this theory. In particular, we demonstrate that it exhibits excellent descent properties. In conjunction with Balmer’s Nerves of Steel conjecture, we conclude that classical stratification also admits a general form of descent. This gives a uniform treatment of several recent stratification results and provides a complete answer to the question: When does stratification descend? As a new application, we extend earlier work on the tensor triangular geometry of equivariant module spectra from finite groups to compact Lie groups.
This article examines how Miskitu King Robert Charles Frederic (1824–42) used colonial contracts with foreign merchants to advance his political agenda in Moskitia, on Central America’s Caribbean coast. Drawing on European and Central American archives, this study challenges narratives that portray Indigenous leaders as passive actors in colonial expansion, highlighting how the king strategically wielded contracts to facilitate the import of foreign capital through concessions and loans. His mastery of international finance enabled resistance to imperial domination while allowing him to consolidate power, maintain independence, and participate in nineteenth-century Atlantic political transformations. However, this strategy compelled him to facilitate the entry of financial capitalism into Moskitia, subsequently defining his kingdom’s fiscal governance and external relations. By examining Robert Charles Frederic’s learning process in navigating Caribbean political and Atlantic financial systems, this article contributes to scholarship on Indigenous agency in colonial encounters and reveals how peripheral actors mediated the global spread of economic institutions.
While the growing representation of women in diplomacy is often celebrated, scholarship on occupational feminisation warns that feminisation can trigger a devaluation of professional work. This article focuses on two conditions identified as inhibitors of such devaluation – the overall status of the occupation and the value accorded to female labour within the occupation – and traces how these two conditions have varied over time and interacted with feminisation in diplomatic work. We contend that in the transition from a classical to a polylateral mode of diplomacy, feminisation has not led to devaluation, as it coincided with an increase in the status of diplomatic work and reinforced the salience of ‘feminine’ skills. However, currently, the rise of populism is undermining these safeguards against devaluation in diplomatic work by constraining the autonomy of diplomats and delegitimising their expert knowledge. To illustrate these dynamics, the article examines the Turkish Ministry of Foreign Affairs (TMFA). We show that the growing diversification and ambition of Turkish foreign policy in the 2000s enhanced the status of diplomatic work and the value of female labour in it. However, by the mid-2010s, these safeguards against devaluation for a more gender-equal TMFA have weakened in the populist–authoritarian political context. Thus, in the context of rising populism in Turkey as well as globally, it is imperative for initiatives to increase women’s representation to be accompanied by strategies that preserve and elevate the status of diplomatic work.
Menopausal transition is a period of psychological vulnerability, yet suicidality remains underassessed. Hormone replacement therapy (HRT) may influence mood symptoms, but its mental health effects – particularly regarding suicidality – are poorly understood.
Aims
To evaluate changes in depressive symptoms, menopause-related distress and suicidality among menopausal women attending a specialist clinic, and explore whether outcomes differed across HRT regimens and baseline risk factors.
Method
We analysed routinely collected data from 957 women attending a UK menopause clinic. All participants received some form of treatment following their initial consultation. Participants completed the Patient Health Questionnaire-9 (PHQ-9) and Menopause Depression Rating Scale (MENO-D) at baseline and follow-up (2–6 months later). Mixed-design analyses of variance assessed changes over time, including interaction effects for HRT type and baseline risk factors (body mass index (BMI), smoking, suicidality, antidepressant use).
Results
Depressive symptoms and menopause-related psychological distress significantly declined over time (around 46% reduction on average). The largest improvements were observed among women receiving oestrogen–progesterone–testosterone combinations, although similar gains were also seen in oestrogen–progesterone and oestrogen–testosterone groups. Suicidality (PHQ-9 item 9) decreased by 92% among those with baseline ideation, but this was not moderated by HRT type. Self-worth (MENO-D item 4) also improved, but similarly showed no significant moderation by HRT regimen. Higher BMI was associated with worse baseline mental health, but did not moderate treatment outcomes.
Conclusions
Combined HRT, including formulations with testosterone, was associated with substantial improvements in mental health outcomes. Suicidality was a distinct symptom profile, often underdetected by general depression scores. However, findings are exploratory and should be interpreted cautiously because of the lack of a control group, observational design and small sample sizes in some subgroups. These results highlight the need for menopause-sensitive mental health assessments and integration of psychological screening into routine menopausal care.
The development of electroacoustic music in China over the past four decades has been shaped not only by the nation’s modernisation strategies but also by the interplay of historical contexts, temporal frameworks and cultural connotations. While certain achievements have been made in the current phase, the entrenched dualistic framework of ‘China versus the West’ and a lack of critical inquiry fundamentally constrain the potential for further advancement in China’s electroacoustic music. Positioning ‘Chineseness’ as a central strategy in electroacoustic music composition has proven effective in specific historical contexts. However, with the evolution of the times, this strategy requires re-examination and reassessment within contemporary contexts. This paper seeks to trace the developmental trajectory of electroacoustic music in China and analyse existing academic research to identify and unpack its deeper, underlying issues. By introducing a broader ecological perspective, the paper aims to transcend the rigid, dichotomous framework dominated by Chinese-Western dualism, deconstruct cultural essentialism and critically reassess the positioning of Chinese electroacoustic music within these constructs. Finally, it will explore the potential possibilities and responses of an ecological perspective in practice, based on a selection of compositional practices, including my own work Mixobloodify.
Left ventricular assist devices are increasingly used in paediatric patients with end-stage heart failure. Although they improve survival and functional capacity, serious complications can occur.
Case:
We report an 11-year-old girl with dilated cardiomyopathy supported by a left ventricular assist device (HeartMate 3) as a bridge to transplant. Despite periodic education about the use of a left ventricular assist device, she entered the sea, leading to driveline and battery seawater exposure. She presented with device alarms but was initially stable. Given the risk of corrosion, emergent battery and lead replacement were performed under intensive monitoring with inotropic support. She experienced transient hypotension during left ventricular assist device cessation but recovered uneventfully.
Conclusion:
This is the first paediatric case describing left ventricular assist device seawater exposure. The case highlights the importance of repeated education, psychological support, and preparedness for high-risk interventions. This case also underlines potential infectious and corrosive risks following seawater exposure.
An increasing number of reports highlight the potential of machine learning (ML) methodologies over the conventional generalised linear model (GLM) for non-life insurance pricing. In parallel, national and international regulatory institutions are accentuating their focus on pricing fairness to quantify and mitigate algorithmic differences and discrimination. However, comprehensive studies that assess both pricing accuracy and fairness remain scarce. We propose a benchmark of the GLM against mainstream regularised linear models and tree-based ensemble models under two popular distribution modelling strategies (Poisson-gamma and Tweedie), with respect to key criteria including estimation bias, deviance, risk differentiation, competitiveness, loss ratios, discrimination and fairness. Pricing performance and fairness were assessed simultaneously on the same samples of premium estimates for GLM and ML models. The models were compared on two open-access motor insurance datasets, each with a different type of cover (fully comprehensive and third-party liability). While no single ML model outperformed across both pricing and discrimination metrics, the GLM significantly underperformed for most. The results indicate that ML may be considered a realistic and reasonable alternative to current practices. We advocate that benchmarking exercises for risk prediction models should be carried out to assess both pricing accuracy and fairness for any given portfolio.