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Coronary artery abnormalities in children that require bypass grafting are infrequent but represent a well-recognised entity with a broad spectrum of indications beyond Kawasaki disease. Although myocardial revascularisation in children is uncommon, studies have shown that it can yield favourable short- and long-term outcomes, allowing affected children to regain health and grow up to live normal lives.
Myocardial revascularisation in children is an extremely rare intervention in Western countries, accounting for less than 1% of all paediatric cardiac surgeries in this region. It is a highly technically demanding procedure that opens a new arena in cardiac surgery, for which cardiovascular surgeons need to be trained to achieve outcomes as good as those shown in the literature.
We present the experience of paediatric coronary artery bypass grafting in a middle-income country, with a wide range of indications.
Methods:
A retrospective descriptive study was conducted on paediatric patients (under 18 years of age) who underwent coronary artery bypass grafting between 2004 and 2023 at a cardiovascular centre in Bogotá, Colombia. Data were collected from electronic medical records, including demographics, preoperative diagnoses, surgical details, and outcomes. Follow-up included clinical assessment and imaging with echocardiography. Ethical approval was obtained, and confidentiality was ensured.
Results:
Nine paediatric patients (ages 6–17) underwent coronary artery bypass grafting between 2004 and 2023. Kawasaki disease was the most common indication, but there are other aetiologies, including post-arterial switch coronary occlusion, anomalous origin of the LCA from the pulmonary artery, anomalous origin of coronary arteries from the aorta, Takayasu disease, and iatrogenic injury. The internal mammary artery was used in most cases, with successful completion of the planned revascularisation in all patients. There were no perioperative deaths or reinterventions. At a mean follow-up of 5.5 years, all patients showed clinical and biventricular improvement, and all grafts evaluated showed graft patency.
Paediatric coronary artery bypass grafting is a safe and effective treatment for selected congenital and acquired coronary pathologies, even in complex cases. Outcomes are optimised with the use of internal mammary arteries and a multidisciplinary heart team approach. In middle-income settings, favourable short- and mid-term results can be achieved despite follow-up challenges. Paediatric coronary artery bypass grafting should be considered a key component of congenital cardiac surgery training.
Excavations at the Infantas complex in Chillón Valley, Perú, revealed a U-shaped monumental centre with a central mound, clay staircase and columned atrium. Aligned with structures from the Rímac and Lurín valleys, these complexes anchored ritual-political power, serving as hubs for ideological integration and territorial organisation in early Andean societies.
Rotorcraft engines are highly complex, nonlinear thermodynamic systems operating under varying environmental and flight conditions. Simulating their dynamics is crucial for design, fault diagnostics and deterioration control, requiring robust control systems to estimate performance throughout the flight envelope. Numerical simulations provide accurate assessments in both steady and unsteady scenarios through physics-based and mathematical models, although their development is challenging due to the engine’s complex physics and strong dependencies on environmental conditions. In this context, data-driven machine-learning techniques have gained significant interest for their ability to capture nonlinear dynamics and enable online performance estimation with competitive accuracy. This work explores different neural network architectures to model the turboshaft engine of Leonardo’s AW189P4 prototype, aiming to predict engine torque. The models are trained on a large database of real flight tests, covering a variety of operational manoeuvers under different conditions, thus offering a comprehensive performance representation. Additionally, sparse identification of nonlinear dynamics (SINDy) is applied to derive a low-dimensional model from the available data, capturing the relationship between fuel flow and engine torque. The resulting model highlights SINDy’s ability to recover underlying engine physics and suggests its potential for further investigations into engine complexity. The paper details the development and prediction results of each model, demonstrating that data-driven approaches can exploit a broader range of parameters compared to standard transfer function-based methods, enabling the use of trained schemes to simulate nonlinear effects in different engines and helicopters.
The Department of Veterans Affairs (VA) does not have system-wide standardized policies or procedures for ultraviolet-C (UV-C) use. Qualitative researchers performed content analysis of VAV UV-C guidance documents. We observed that lack of specificity and uniformity across guidance documents is a potential barrier to UV-C implementation and future quality control.
This paper presents the design and experimental validation of a robust flight control strategy for quadrotor unmanned aerial vehicles (UAVs) based on the Interconnection and Damping Assignment Passivity-Based Control (IDA-PBC) methodology. The proposed approach is specifically tailored to the Parrot Bebop 2, a commercial UAV. The IDA-PBC control law is derived using the Hamiltonian model of the UAV dynamics obtained from experimental data to represent the dynamics of all six degrees of freedom, including translational and rotational motions. The control strategy was validated through numerical simulations and experimental tests conducted in an indoor flight setup using MATLAB, Robot Operating System, and an OptiTrack motion capture system. Numerical and experimental results demonstrate that the controller effectively tracks desired flight trajectories, ensuring stable and robust performance.
Brittle stars undergo remarkable morphological changes during their transition to adulthood, extending beyond metamorphosis. Members of the genus Ophioderma exhibit particularly noteworthy morphological changes between the juvenile and adult stages. These growth changes have been a persistent source of misidentification in Ophioderma, even leading to the misclassification of juveniles to a different genus. In this study, the growth changes of three common eastern Pacific Ophioderma species were characterised: Ophioderma aija, Ophioderma occultum, and Ophioderma panamense. Their growth series, ranging from 2.5 to 26.7 mm disc diameter, were analysed by combining morphology, morphometrics, and DNA barcoding. Three size groups within the species were identified. In general, the morphological changes shown by the three species were highly similar and occurred at comparable sizes, allowing a pattern to be identified and reconstructed. However, differences between the species were observed throughout the series in quantitative (arm length, dorsal arm plates, number of arm spines) and qualitative (radial shields, colouration) characters. This work represents one of the few available contributions on the growth changes of Ophiuroidea from the eastern Pacific and so far in the genus Ophioderma.
The United States Department of Defense is planning a massive military build-up on Guahan (Guam) that threatens to change the entire make-up of the island. Guahan, nestled at the southern-most tip of the Marianas Archipelago in the Micronesian region of Oceania, is a mere 212 square miles in area, barely bigger than a dot in most world maps. The island is similarly small in the consciousness of most American and Japanese taxpayers, who will be funding the military expansion. Guahan, however, has a large and rich history. While the island and her people remained in relative isolation from the Western world for over 3,500 years from the earliest indications of settlement, its strategic location as a crossroad between East and West has resulted in colonization by successive maritime powers over the last six centuries.
This investigation examines the dynamic response of an accelerating turbulent pipe flow using direct numerical simulation data sets. A low/high-pass Fourier filter is used to investigate the contribution and time dependence of the large-scale motions (LSM) and the small-scale motions (SSM) into the transient Reynolds shear stress. Additionally, it analyses how the LSM and SSM influence the mean wall shear stress using the Fukagata–Iwamoto–Kasagi identity. The results reveal that turbulence is frozen during the early flow excursion. During the pretransition stage, energy growth of the LSM and a subtle decay in the SSM is observed, suggesting a laminarescent trend of SSM. The transition period exhibits rapid energy growth in the SSM energy spectrum at the near-wall region, implying a shift in the dominant contribution from LSM to SSM to the frictional drag. The core-relaxation stage shows a quasisteady behaviour in large- and small-scale turbulence at the near-wall region and progressive growth of small- and large-scale turbulence within the wake region. The wall-normal gradient of the Reynolds shear stress premultiplied energy cospectra was analysed to understand how LSM and SSM influence the mean momentum balance across the different transient stages. A relevant observation is the creation of a momentum sink produced at the buffer region in large- and very large-scale (VLSM) wavelengths during the pretransition. This sink region annihilates a momentum source located in the VLSM spectrum and at the onset of the logarithmic region of the net-force spectra. This region is a source term in steady wall-bounded turbulence.
Integrating scientific research across multiple disciplines to advance breakthroughs is at the heart of clinical-translational science (CTS); among competencies that have been identified as essential for progress, skillful communication is critical. Few tools are available to address the social dynamics of the multidimensional diversity characteristics of CTS. We created the “Building a Diverse Biomedical Workforce Through Communication Across Difference (CAD)” workshop intervention. Based on principles of intercultural communication, CAD taught novel situationally-based communication skills to dyads of near-peer mentors and their undergraduate mentees. This study reports on the effectiveness of the operative mechanisms employed in CAD workshops for helping participants navigate highly diverse research environments.
Methods:
Participant data were collected from multiple sources, including workshop artifacts as well as focus groups conducted post-workshop. Data were organized, individually coded, and then iteratively and collectively into pre-defined and emergent themes.
Results:
Responses indicated that the content and activities resonated strongly with participants and illuminated their understanding of challenges (both their own and others’) related to belonging, confidence, and connectedness to the research environment; several participants shared that they planned to use or had successfully used the skills. Focus group comments revealed that participants recognized the potential of the skills to include significant opportunities for non-instrumental interaction, contributing to a psychologically healthier workplace.
Conclusion:
A brief intervention to develop communication skills across a variety of differences characteristic of clinical-translational settings improves communication between mentors and mentees and with peers and increases sense of belonging in the workplace, with potential benefits to wellbeing.
Previous research has investigated the effect of planning time (PT) on L2 learners’ production regarding fluency, complexity, and accuracy, but its influence at the discourse level has been overlooked. Thus, this study explores the influence of PT on learners’ written performance regarding anaphora resolution (AR) and their pragmatically (in)felicitous choices of referring expressions (REs) in discourse since PT may reduce learners’ cognitive load and facilitate the production of pragmatically felicitous REs.
Two film-retelling tasks were completed by intermediate L1 Spanish–L2 English learners and English natives, further divided into a planning and a non-planning subgroup. Their compositions were analysed focusing on the REs produced, taking into consideration the pragmatic context. Results showed a PT effect on learners’ RE choices, although not all pragmatic contexts were equally affected. Planning time exerted a positive influence on topic continuity contexts, where learners produced more economical forms, but no effect was observed in topic shift scenarios.
Underrepresentation of diverse populations in medical research undermines generalizability, exacerbates health disparities, and erodes trust in research institutions. This study aimed to identify a suitable survey instrument to measure trust in medical research among Black and Latino communities in Baltimore, Maryland.
Methods:
Based on a literature review, a committee selected two validated instruments for community evaluation: Perceptions of Research Trustworthiness (PoRT) and Trust in Medical Researchers (TiMRs). Both were translated into Spanish through a standardized process. Thirty-four individuals participated in four focus groups (two in English, two in Spanish). Participants reviewed and provided feedback on the instruments’ relevance and clarity. Discussions were recorded, transcribed, and analyzed thematically.
Results:
Initial reactions to the instruments were mixed. While 68% found TiMR easier to complete, 74% preferred PoRT. Key discussion themes included the relevance of the instrument for measuring trust, clarity of the questions, and concerns about reinforcing negative perceptions of research. Participants felt that PoRT better aligned with the research goal of measuring community trust in research, though TiMR was seen as easier to understand. Despite PoRT’s lower reading level, some items were found to be more confusing than TiMR items.
Conclusion:
Community feedback highlighted the need to differentiate trust in medical research, researchers, and institutions. While PoRT and TiMR are acceptable instruments for measuring trust in medical research, refinement of both may be beneficial. Development and validation of instruments in multiple languages is needed to assess community trust in research and inform strategies to improve diverse participation in research.
The wide adoption of occupational shoulder exoskeletons in industrial settings remains limited. Passive exoskeletons were proved effective in a limited amount of application scenarios, such as (quasi-)static overhead handling tasks. Quasi-active devices, albeit representing an improved version of their passive predecessors, do not allow full modulation of the amount of assistance delivered to the user, lacking versatility and adaptability in assisting various dynamic tasks. Active occupational shoulder exoskeletons could overcome these limitations by controlling the shape of the delivered torque profile according to the task they aim to assist. However, most existing active devices lack compactness and wearability. This prevents their implementation in working environments. In this work, we present a new active shoulder exoskeleton, named Active Exo4Work (AE4W). It features a new flexible shaft-driven remote actuation unit that allows the positioning of the motors close to the wearer’s center of mass while it maintains a kinematic structure that is compatible with the biological motion of the shoulder joint. in vitro and in vivo experiments have been conducted to investigate the performance of AE4W. Experimental results show that the exoskeleton is kinematically compatible with the user’s workspace since it does not constrain the natural range of motion of the shoulder joint. Moreover, this device can effectively provide different types of assistance while the user executes various dynamic tasks, without altering perceived comfort.
The Mountain West Clinical and Translational Infrastructure Network Community Engagement and Outreach (CEO) Core has fostered academic-community engagement since 2018. States historically receiving lower levels of NIH funding are characterized by significantly higher proportions of rural and remote populations, as well as uniquely elevated percentages of Native American/Alaska Native and Native Hawaiian/Pacific Islander populations compared to most other states. This case study highlights the Core’s efforts in advancing community-engaged research. Key initiatives included forming a CEO Core Steering Committee to recruit interdisciplinary investigators, establishing regional community advisory boards to identify research priorities, and creating a Resource Library and Training Portal for stakeholders. The Core also collaborated with other Cores to provide training, mentorship, and funding for community-engaged research. Despite these achievements, geographical and cultural diversity presented engagement challenges. Regular meetings between investigators and stakeholders ensured bidirectional communication and aligned goals. The Core transformed transactional engagement into meaningful collaboration, emphasizing the need for interdisciplinary teams who understand community needs. Future goals include training academic teams, clinical providers, and community members, empowering early-stage investigators to share findings with partners, leveraging health records for research, and developing strategies to protect investigators’ time.
Sarcopenic obesity is associated with higher risk of falls, hospitalizations, mortality, and a wide range of poor health outcomes(1). However, its relationship with multimorbidity is less explored. This study aimed to investigate the association between sarcopenic obesity and multimorbidity across sexes.
In this cross-sectional analysis of the UK Biobank, we included 171,448 participants (53.1% women, mean age 55 years). Sarcopenic obesity, defined according to the EWGSOP2 classification(2), was analysed as the outcome. Multimorbidity was the predictor, determined by self-reported chronic conditions and categorized into none, 1, 2, 3, 4, and 5+ diseases. Poisson regression with robust error was used to estimate the risk ratio and its 95% confidence intervals (RR, 95%CI). Analyses were adjusted for sociodemographic and lifestyle factors.
The prevalence of sarcopenic obesity increased with the number of chronic diseases in both men and women but varied significantly by sex (p-interaction= 0.030). Compared to individuals without chronic diseases, those with 5+ diseases exhibited prevalences of 55.7% in men and 51.2% in women. The prevalence of sarcopenic obesity increased by 94% (95% CI: 1.89, 2.00) for each additional chronic disease in women and 117% (95% CI: 2.09, 2.25) in men. Relative to those with no chronic conditions, individuals with 5+ diseases had 41.5 and 68.7-times higher prevalence of sarcopenic obesity in women and men, respectively.
Our findings showed a robust association between sarcopenic obesity and multimorbidity, which varies by sex, further studies is needed to examine the predictive utility of using multimorbidity to identify sarcopenia.
There is strong evidence that low muscle strength and muscle mass are associated with an increased the risk of mortality and morbidity.⟨1⟩ Muscle mass and strength progressively decline from around the fourth decade⟨2⟩, a process known as sarcopenia, for which there is no effective pharmacological treatment.⟨3⟩ Current literature indicates that resistance exercise and/or supplementation with n-3 fatty acids can be beneficial for muscle strength and mass in older adults.⟨4⟩ However, the sample sizes in these studies are relatively small and are restricted to only resistance exercise. The relationship between dietary n-3 fatty acid intake, rather than supplements, and general physical activity, rather than resistance exercise, and muscle strength and mass remain unknown. The aim of the current study, therefore, was to investigate the associations of n-3 fatty acid intake with handgrip strength and muscle mass indices in older adults. A secondary aim was to investigate whether these associations differed by physical activity status.
Analyses included 53,994 participants from the UK biobank study (25,773 men and 28,221 women). Participants were aged 60 years or older with complete data for outcome, predictor and covariate variables. Multivariable linear regression analyses were performed to explore the associations between n-3 fatty acid intake and grip strength index (kg/m²) and muscle mass index (kg/m²) in three separate models. All analysis were performed stratified by sex and physical activity status (active/inactive). Model 1 was adjusted for age, ethnicity, deprivation index and month of assessment. Model 2 was also adjusted for total energy intake and model 3 was also adjusted for multimorbidity count.
In model 3 there were positive associations between n-3 fatty acid intake and grip strength index in women with a 0.03 kg/m² (95% CI 0.00 to 0.06 kg/m²) higher grip strength index seen in those who were active and a 0.04 kg/m² (95% CI 0.00 to 0.08 kg/m²) higher grip strength index in those who were inactive for each additional gram of n-3 fatty consumed per day, with no associations in active (p = 0.355) or inactive (p = 0.186) men. In model 3, no association between n-3 fatty acid and muscle mass index were seen in men who were active (p = 0.981) or inactive (p = 0.331) and in women who were active (p = 0.843) or inactive (p = 0.058).
Although n-3 fatty acid intake was significantly associated with grip strength index in older women, regardless of their activity status, the magnitude of this association was very small and unlikely to be clinically relevant. Additionally, n-3 fatty acid was not associated with muscle mass index. Therefore, manipulation of n-3 fatty acid intake within the normal dietary range is unlikely to be an effective strategy to prevent and/or treat sarcopenia and n-3 fatty acid supplements are likely required.
Black and Latino individuals are underrepresented in COVID-19 treatment and vaccine clinical trials, calling for an examination of factors that may predict willingness to participate in trials.
Methods:
We administered the Common Survey 2.0 developed by the Community Engagement Alliance (CEAL) Against COVID-19 Disparities to 600 Black and Latino adults in Baltimore City, Prince George’s County, Maryland, Montgomery County, Maryland, and Washington, DC, between October and December 2021. We examined the relationship between awareness of clinical trials, social determinants of health challenges, trust in COVID-19 clinical trial information sources, and willingness to participate in COVID-19 treatment and vaccine trials using multinomial regression analysis.
Results:
Approximately half of Black and Latino respondents were unwilling to participate in COVID-19 treatment or vaccine clinical trials. Results showed that increased trust in COVID-19 clinical trial information sources and trial awareness were associated with greater willingness to participate in COVID-19 treatment and vaccine trials among Black and Latino individuals. For Latino respondents, having recently experienced more challenges related to social determinants of health was associated with a decreased likelihood of willingness to participate in COVID-19 vaccine trials.
Conclusions:
The willingness of Black and Latino adults to participate in COVID-19 treatment and vaccine clinical trials is influenced by trial awareness and trust in trial information sources. Ensuring the inclusion of these communities in clinical trials will require approaches that build greater awareness and trust.
Evidence is scarce in terms of tracking the progress of implementation of mental healthcare plans and policies (MHPPs) in Europe, we aimed to map and analyze the content of MHPPs across the WHO European region.
We collected data from the WHO Mental Health Atlas 2011, 2017 and 2020 to map the development of MHPPs in the region. We contacted 53 key informants from each country in the European region to triangulate the data from WHO Mental Health Atlases and to obtain access to the national mental health plans and policies. We analyzed the content of MHPPs against the four major objectives of the WHO Comprehensive Mental Health Action Plan, and we also focused on the specificity and measurability of their targets.
The number and proportion of countries which have their own MHPPs has increased from 30 (52%) to 43 (91%) between 2011 and 2020. MHPPs are generally in line with the WHO policy, aiming to strengthen care in the community, expand mental health promotion and illness prevention activities, improve quality of care, increase intersectoral collaboration, build workforce and system capacity, and improve adherence to human rights. However, specific, and measurable targets as well as a description of concrete steps, responsibilities and funding sources are mostly missing. They often contain very little information systems, evidence and research, and mostly lack information on evaluating the implementation of MHPPs.
Progress has been made in terms of the development of MHPPs in the WHO Europe. However, MHPPs are often lacking operationalization and appropriate data collection for evaluation. This is then reflected in missing evaluation plans, which in turn leads to lessons not being learned. To enhance the potential for knowledge generation and demonstration of impact, MHPPs should be more specific and contain measurable targets with allocated responsibilities and funding as well as evaluation plans.
To investigate COVID-19 disparities between Hispanic/Latino persons (H/L) and non-H/L persons in an agricultural community by examining behavioral and demographic differences.
Methods
In September 2020, we conducted Community Assessments for Public Health Emergency Response in Wenatchee and East Wenatchee, Washington, to evaluate differences between H/L and non-H/L populations in COVID-19 risk beliefs, prevention practices, household needs, and vaccine acceptability. We produced weighted sample frequencies.
Results
More households from predominately H/L census blocks (H/L-CBHs) versus households from predominately non-H/L census blocks (non-H/L-CBHs) worked in essential services (79% versus 57%), could not telework (70% versus 46%), and reported more COVID-19 cases (19% versus 4%). More H/L-CBHs versus non-H/L-CBHs practiced prevention strategies: avoiding gatherings (81% versus 61%), avoiding visiting friends/family (73% versus 36%), and less restaurant dining (indoor 24% versus 39%). More H/L-CBHs versus non-H/L-CBHs needed housing (16% versus 4%) and food assistance (19% versus 6%). COVID-19 vaccine acceptance in H/L-CBHs and non-H/L-CBHs was 42% versus 46%, respectively.
Conclusions
Despite practicing prevention measures with greater frequency, H/L-CBHs had more COVID-19 cases. H/L-CBHs worked in conditions with a higher likelihood of exposure. H/L-CBHs had increased housing and food assistance needs due to the pandemic. COVID-19 vaccine acceptability was similarly low (<50%) between groups.