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Giant coronary artery aneurysms and myocardial fibrosis after Kawasaki disease may lead to devastating cardiovascular outcomes. We characterised the vascular and myocardial outcomes in five selected Kawasaki disease patients with a history of giant coronary artery aneurysms that completely regressed.
Methods:
Five patients were selected who had giant coronary artery aneurysm in early childhood that regressed when studied 12–33 years after Kawasaki disease onset. Coronary arteries were imaged by coronary CT angiography, and coronary artery calcium volume scores were determined. We used endocardial strain measurements from CT imaging to assess myocardial regional wall function. Calprotectin and galectin-3 (gal-3) as biomarkers of inflammation and myocardial fibrosis were measured by enzyme-linked immunosorbent assay.
Results:
The five selected patients with regressed giant coronary artery aneurysms had calcium scores of zero, normal levels of calprotectin and gal-3, and normal appearance of the coronary arteries by coronary computed tomography angiography. CT strain demonstrated normal peak systolic and diastolic strain patterns in four of five patients. In one patient with a myocardial infarction at the time of Kawasaki disease diagnosis at the age of 10 months, CT strain showed altered global longitudinal strain, reduced segmental peak strain, and reduced diastolic relaxation patterns in multiple left ventricle segments.
Conclusions:
These patients illustrate that regression of giant aneurysms after Kawasaki disease is possible with no detectable calcium, normal biomarkers of inflammation and fibrosis, and normal myocardial function. Individuals with regressed giant coronary artery aneurysm still require longitudinal surveillance to assess the durability of this favourable outcome.
Nearly all twenty-first-century readers of St. Augustine of Hippo become interested in him after reading the story of his Confessions. Yet when nonspecialists want to read more of him, they are directed to the later and more magisterial writings whose author is not immediately recognizable as the young searcher from the Confessions: City of God, On The Trinity, On Christian Doctrine, the scriptural commentaries, the anti-Pelagian tracts. The bishop of Hippo, unlike his younger self—and also unlike his philosophic predecessors, as he well knew—was obligated not to let so much as his word choice cause scandal to pious and uneducated ears.1
The COVID-19 pandemic poses challenges in maintaining global medical education partnerships, with travel restrictions and infection control concerns forcing program adaptation. The Pediatric Emergency Medicine Specialty Training and Accelerated Review (PEM-STAR) program is one such international collaboration which addresses education and training gaps in emergency care for children within Thailand. As an assessment of PEM-STAR’s ability to deliver consistent outcomes despite COVID-19 constraints, we compared program results for Cohort #1 (2018-2019, pre-pandemic) and Cohort #2 (2019-2021, spanning pandemic).
Method:
Oregon Health & Science University and Bangkok Dusit Medical Services implemented the PEM-STAR tandem physician-nurse curriculum in 2018. The cornerstone of the year-long course is a set of 22 PEM-specific topic modules, incorporating remote-accessible voiceover slide lectures, quizzes, and scholarly references to teach pediatric emergency medicine essentials. Content is reviewed via monthly teleconferences. Baseline and final assessments include written knowledge tests and high-fidelity simulation cases led by physician-nurse teams. Cohort #1 simulations were performed with evaluators in-situ using critical action checklists and validated teamwork assessment tools. Due to COVID-19 restrictions, Cohort #2 final assessments were hybrid; students completed Thailand-based simulations while Oregon leaders assessed and debriefed teams via videoconference.
Results:
Written exam scores for pre-pandemic Cohort#1 improved from 48.6% (95%CI 40.30-56.9) to 92.0% (95%CI 88.1-95.9) (p< 0.001). Cohort #2, during the pandemic, had scores improve similarly from 48.5% (95%CI 40.1-56.9) to 96.4% (95%CI 94.8-98.0) (p< 0.001). One-hundred percent of physician-nurse teams from both Cohort #1 and Cohort #2 achieved the program’s established passing score on final simulation testing: performing >85% of critical action items and scoring > 85% on the teamwork tool.
Conclusion:
The PEM-STAR design, with its emphasis on videoconferencing, web-based content, and asynchronous learning, required minimal modifications to maintain satisfactory knowledge and skill acquisition during the pandemic. Educational partnerships emphasizing these features have distinct sustainability advantages in times of global disorder.
We explore whether ageist stereotypes in job ads are detectable using machine-learning methods measuring the linguistic similarity of job-ad language to ageist stereotypes identified by industrial psychologists. We then conduct an experiment to evaluate whether this language is perceived as biased against older workers searching for jobs. We find that job-ad language classified by the machine-learning algorithm as closely related to ageist stereotypes is perceived by experimental subjects as biased against older job seekers. These methods could potentially help enforce anti-discrimination laws by using job ads to predict or identify employers more likely to be engaging in age discrimination.
We have investigated the spectral evolutions of H2O and SiO masers associated with 12 “water fountain” sources in our FLASHING (Finest Legacy Acquisitions of SiO-/H2O-maser Ignitions by Nobeyama Generation) project. Our monitoring observations have been conducted using the Nobeyama 45 m telescope every 2 weeks–2 months since 2018 December except during summer seasons. We have found new extremely high velocity H2O maser components, breaking the records of jet speeds in this type of sources. Systematic line-of-sight velocity drifts of the H2O maser spectral peaks have also been found, indicating acceleration of the entrained material hosting the masers around the jet. Moreover, by comparing with previous spectral data, we can find decadal growths/decays of H2O maser emission. Possible periodic variations of the maser spectra are further being inspected in order to explore the periodicity of the central stellar system (a pulsating star or a binary). Thus we expect to see the real-time evolution/devolutions of the water fountains over decades.
We report new detections of SiO ν = 1 and ν = 2 J = 1 → 0 masers in the “water fountain” source IRAS 16552-3050, which was observed with the Nobeyama 45 m telescope from March 2021 to April 2023. Water fountains are evolved stars whose H2O maser spectra trace high-velocity outflows of >100 Km s−. This is the second known case of SiO masers in a water fountain, after their prototypical source, W 43A. The line-of-sight velocity of the SiO masers are blue-shifted by ∼25 km s−1 from the systemic velocity. This velocity offset imply that the SiO masers are associated with nozzle structure formed by a jet penetrating the circumstellar envelope, and that new gas blobs of the jet erupted recently. Thus, the SiO masers imply this star to be in a new evolutionary stage.
The ‘16Up’ study conducted at the QIMR Berghofer Medical Research Institute from January 2014 to December 2018 aimed to examine the physical and mental health of young Australian twins aged 16−18 years (N = 876; 371 twin pairs and 18 triplet sets). Measurements included online questionnaires covering physical and mental health as well as information and communication technology (ICT) use, actigraphy, sleep diaries and hair samples to determine cortisol concentrations. Study participants generally rated themselves as being in good physical (79%) and mental (73%) health and reported lower rates of psychological distress and exposure to alcohol, tobacco products or other substances than previously reported for this age group in the Australian population. Daily or near-daily online activity was almost universal among study participants, with no differences noted between males and females in terms of frequency or duration of internet access. Patterns of ICT use in this sample indicated that the respondents were more likely to use online information sources for researching physical health issues than for mental health or substance use issues, and that they generally reported partial levels of satisfaction with the mental health information they found online. This suggests that internet-based mental health resources can be readily accessed by adolescent Australians, and their computer literacy augurs well for future access to online health resources. In combination with other data collected as part of the ongoing Brisbane Longitudinal Twin Study, the 16Up project provides a valuable resource for the longitudinal investigation of genetic and environmental contributions to phenotypic variation in a variety of human traits.
Long before his election as Pope Benedict XVI, the young Joseph Ratzinger was known among Augustine scholars for his path-breaking studies of Augustine's ecclesiology. Later, as Cardinal Ratzinger, he was known widely for speaking out on political issues and controversies of our day, particularly those related to the future of Europe and the place of Christianity within it. Rarely has anyone connected his interest in politics with his early writings on Augustine. In the past sixty years of scholarship on Augustine's political thought, Ratzinger has received barely a mention, and as far as I am aware, Michael Bruno's valuable 2014 monograph on the past century's interpretations of Augustine's political thought was the first ever to classify Ratzinger as even having offered such an interpretation. But perhaps it would be more accurate to say that Bruno is the second, the first being Ratzinger himself. In a 1990 public lecture titled “Europe: Chances and Dangers,” he made a number of bold claims about the historical importance of the “decisive interpretation” that Augustine had given to the “Platonic tradition … [of] political philosophy” and supported those claims with a footnote to a monograph chapter he wrote in 1961 on Augustine's debate with Roman “political theology.” Drawing on that chapter, Ratzinger now made a series of claims about Augustine (in relation to controversies over the meaning of Europe today) that must be striking to any scholar of Augustine's political thought and are worth quoting at length.
What can and ought Europe really to be, for itself and for the world? We open the path to answering this question when we look somewhat more closely into … the claim that a state without justice is nothing but a robber band grown immeasurably large…. [In its pre-Augustinian form,] this claim took concrete shape on the basis of real experiences of rulers who were in point of fact robbers. But its philosophical presuppositions lie deeper. To examine them, we are led into the heart of Greek and Roman political philosophy, in which the spiritual roots of Europe lie…. [Plato's basic political teaching, which Ratzinger here spends a page summarizing] means that a state that is basically agnostic with respect to God, one that builds justice only on majority opinions, declines in and of itself into a robber band.
Children with chronic illness often experience difficulties at school, yet little is known about the impact of the child's illness on siblings’ school experiences. This study investigated parents’ perceptions of siblings’ school experiences and school support. We conducted semi-structured telephone interviews with 27 parents of children with a chronic illness who had a sibling or siblings (4–25 years), representing the experiences of 31 siblings. Interviews were audio-recorded, transcribed, and analysed using content analysis. Parents believed that 14 of 31 (45.2%) siblings had school difficulties related to the ill child, such as increased anxiety or stress at school, lack of attention from teachers, and changes in behaviour as a result of increased carer responsibilities. Parents identified increased absenteeism due to the ill child's hospitalisation and the impact of parent absences on sibling school functioning. Parents described general and psychological support from the school, and the importance of monitoring the sibling at school and focusing on their unique needs. Overall, our findings suggest the need for a school-based sibling support model that combines psycho-education for siblings and school personnel, individualised sibling psychological support, and shared school and parent responsibility in normalising the sibling experience and providing consistent support.
We briefly introduce the VLBI maser astrometric analysis of IRAS 18043–2116 and IRAS 18113–2503, two remarkable and unusual water fountains with spectacular bipolar bow shocks in their high-speed collimated jet-driven outflows. The 22 GHz H2O maser structures and velocities clearly show that the jets are formed in very short-lived, episodic outbursts, which may indicate episodic accretion in an underlying binary system.
Objectives: The aim of this study was to demonstrate the utility of an evidence-based assessment (EBA) model to establish a multimodal set of tools for identifying students at risk for perceived post-injury academic problems. Methods: Participants included 142 students diagnosed with concussion (age: M=14.95; SD=1.80; 59% male), evaluated within 4 weeks of injury (median=16 days). Demographics, pre-injury history, self- and parent-report measures assessing symptom severity and executive functions, and cognitive test performance were examined as predictors of self-reported post-injury academic problems. Results: Latent class analysis categorized participants into “high” (44%) and “low” (56%) levels of self-reported academic problems. Receiver operating characteristic analyses revealed significant discriminative validity for self- and parent-reported symptom severity and executive dysfunction and self-reported exertional response for identifying students reporting low versus high academic problems. Parent-reported symptom ratings [area under the receiver operating characteristic curve (AUC)=.79] and executive dysfunction (AUC=.74), and self-reported ratings of executive dysfunction (AUC=.84), symptoms (AUC=.80), and exertional response (AUC=.70) each classified students significantly better than chance (ps<.001). Hierarchical logistic regression indicated that, of the above, self-reported symptoms and executive dysfunction accounted for the most variance in the prediction of self-reported academic problems. Conclusions: Post-concussion symptom severity and executive dysfunction significantly predict perceived post-injury academic problems. EBA modeling identified the strongest set of predictors of academic challenges, offering an important perspective in the management of concussion by applying traditional strengths of neuropsychological assessment to clinical decision making. (JINS, 2016, 22, 1038–1049)
When discussing the preconditions of liberal Islamic politics, liberal theorists often advocate the reinterpretation of traditional religious texts in light of liberal political theory. Such an interpretive project is worth comparing to a similar project conceived by the medieval Islamic philosopher Alfarabi, whose effort to introduce Greek political philosophy into his political-religious community parallels these efforts to introduce liberal theory into Islamic communities. Alfarabi argued that traditional texts should be reinterpreted in light of a new political science, one based on Greek sources but adapted to the unique needs of a community like his. This article shows how Alfarabi conceived of these adaptations, emphasizing the flexibility that he thought students of Greek political philosophy should adopt in accommodating even Islamic doctrines that they could not fully accept.
This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.
In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1).
Zelditch's proof of the Tian–Yau–Zelditch Theorem makes use of the Boutet de Monvel–Sjöstrand results on the asymptotic properties of Szegö projectors for strictly pseudoconvex domains. However, as we will show below, the theorem is also closely related to another theorem of Boutet de Monvel's, namely his wave trace formula for Toeplitz operators. Finally, we will derive, for the pseudoconvex manifolds considered by Zelditch in his proof of the Tian–Yau–Zelditch Theorem, an analogue of another result of Boutet de Monvel's, the extendability theorem of Berndtsson for holomorphic functions on Grauert tubes.
It is not hard to find critics of how the U.S. Congress operates today. Two of the most prominent, Thomas Mann and Norman Ornstein, have bemoaned in particular Congress's failure to follow “regular order,” which in their 2006 book The Broken Branch they describe as a legislative process that incorporates “discussion, debate, negotiation, and compromise” (Mann and Ornstein 2006, 170).
A substantial amount of work has been devoted to the proof of correctness of various program analyses but much less attention has been paid to the correctness of compiler optimisations based on these analyses. In this paper we tackle the problem in the context of strictness analysis for lazy functional languages. We show that compiler optimisations based on strictness analysis can be expressed formally in the functional framework using continuations. This formal presentation has two benefits: it allows us to give a rigorous correctness proof of the optimised compiler; and it exposes the various optimisations made possible by a strictness analysis.