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We describe caudal analgesia agent, dose, reported adverse events, and outcomes in a single-centre, retrospective cohort study of 200 patients undergoing cardiac surgery from October 2020 to April 2023. Median (interquartile range) doses of clonidine and morphine were 2.7 (2.1–3) mCg/kg and 0.12 (0.1–1.12) mg/kg, respectively. Our findings suggest that a clonidine/morphine caudal was tolerated in cardiac surgical patients.
The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
We present a study of subcritical shocks in a highly collisional laboratory plasma with a dynamically significant magnetic field. Shocks were produced by placing cylindrical obstacles into the supermagnetosonic ($M_{{\rm MS}} \sim 1.9$) outflow from an inverse wire array z-pinch at the MAGPIE pulsed power facility ($n_{e} \sim 8.5 \times 10^{17}\,{\rm cm}^{-3}$, $v \sim 45\,{\rm km}\,{\rm s}^{-1}$). We demonstrate the existence of subcritical shocks in this regime and find that secondary stagnation shocks form in the downstream which we infer from interferometry and optical Thomson scattering measurements are hydrodynamic in nature. The subcritical shock width is found to be approximately equal to the resistive diffusion length and we demonstrate the absence of a jump in hydrodynamic parameters. Temperature measurements by collective optical Thomson scattering showed little temperature change across the subcritical shock (${<}10\,\%$ of the ion kinetic energy) which is consistent with a balance between adiabatic and Ohmic heating and radiative cooling. We demonstrate the absence of subcritical shocks when the obstacle diameter is less than the resistive diffusion length due to decoupling of the magnetic field from the plasma. These findings are supported by magnetohydrodynamic simulations using the Gorgon and AstroBEAR codes and discrepancies between the simulations and experiment are discussed.
Prior research finds that liberals and conservatives process information differently. Predispositions toward intuitive versus reflective thinking may help explain this individual level variation. There have been few direct tests of this hypothesis and the results from the handful of studies that do exist are contradictory. Here we report the results of a series of studies using the Cognitive Reflection Test (CRT) to investigate inclinations to be reflective and political orientation. We find a relationship between thinking style and political orientation and that these effects are particularly concentrated on social attitudes. We also find it harder to manipulate intuitive and reflective thinking than a number of prominent studies suggest. Priming manipulations used to induce reflection and intuition in published articles repeatedly fail in our studies. We conclude that conservatives—more specifically, social conservatives—tend to be dispositionally less reflective, social liberals tend to be dispositionally more reflective, and that the relationship between reflection and intuition and political attitudes may be more resistant to easy manipulation than existing research would suggest.
This study addresses the question of whether a thin, relatively heavy solid body with a smooth under-surface can skim on a shallow layer of liquid (for example water), i.e. impact on the layer and rebound from it. The body impacts obliquely onto the liquid layer with the trailing edge of the underbody making the initial contact. The wetted region then spreads along the underbody and eventually either retracts, generating a rebound, or continues to the leading edge of the body and possibly leads to the body sinking. The present inviscid study involves numerical investigations for increased mass ($M$, in scaled terms) and moment of inertia ($I$, proportional to the mass) together with an asymptotic analysis of the influential parameters and dynamics at different stages of the skimming motion. Comparisons between the asymptotic analysis and numerical results show close agreement as the body mass becomes large. A major finding is that, for a given impact angle of the underbody relative to the liquid surface, only a narrow band of initial conditions is found to allow the heavy-body skim to take place. This band includes reduced impact velocities of the body vertically and rotationally, both decreasing like $M^{-2/3}$, while the associated total time of the skim from entry to exit is found to increase like $M^{1/3}$ typically. Increased mass thereby enhances the super-elastic behaviour of the skim.
Dietary patterns characterised by high intake of red and processed meat are associated with detrimental health and environmental outcomes. To better understand how Americans consume red and processed meat, this study examined the food groups that are the greatest contributors to red and processed meat intake in US diets.
Design:
Cross-sectional analysis of total red and processed meat, unprocessed red meat and processed meat using data from the National Health and Nutrition Examination Survey (2015–2016 and 2017–2018). Items containing red or processed meat were classified into thirteen mutually exclusive food groups. For highly consumed food groups (≥10 % of meat intake), contribution to meat intake was further assessed by source, sex, income and education.
Setting:
Nationally representative sample of the US population.
Participants:
Teens (aged 12–19 years) and adults (aged ≥20 years) who reported meat consumption (n 8178).
Results:
Meat mixed dishes (18·6 % (95 % CI 16·2, 20·9)), burgers (17·3 % (95 % CI 15·3, 19·3)) and beef excluding ground (17·0 % (95 % CI 13·8, 20·1)) were the top contributors to unprocessed red meat intake. For processed meat, four food groups made up about four-fifths of total intake: cold cuts and cured meats (37·7 % (95 % CI 34·6, 40·8)), sausages and frankfurters (20·3 % (95 % CI 18·6, 22·0)), bacon (14·0 % (95 % CI 12·3, 15·6)) and pizza (10·1 % (95 % CI 8·7, 11·5)). Fast-food restaurants were the top source for burgers and pizza, whereas stores were the top source for all other highly consumed food groups. Few differences were seen in patterns of intake by sociodemographic characteristics.
Conclusions:
No single food group accounts for a majority of meat intake in the USA. Many behaviour change opportunities for healthier, more sustainable substitutions exist.
The study concerns a slender, heavy body moving with streamwise velocity in a boundary layer. Modelling assumptions on body size reduce the governing equations for the body motion to a pair of nonlinear integro-differential equations (IDEs) which displays a wide range of distinguished behaviours, including eventual collision with the wall (‘crash’), escape to infinity (‘fly away’) and repeatedly travelling far from the wall and back again without ever colliding or escaping (‘bouncing’). The paper gives a survey of the variety of behaviour, as well as asymptotic analysis and insight into each category of fluid/body interaction and the conditions under which crash, fly away and bouncing occur.
Obesity increases the risk of post-operative arrhythmias in adults undergoing cardiac surgery, but little is known regarding the impact of obesity on post-operative arrhythmias after CHD surgery.
Methods:
Patients undergoing CHD surgery from 2007 to 2019 were prospectively enrolled in the parent study. Telemetry was assessed daily, with documentation of all arrhythmias. Patients aged 2–20 years were categorised by body mass index percentile for age and sex (underweight <5, normal 5–85, overweight 85–95, and obese >95). Patients aged >20 years were categorised using absolute body mass index. We investigated the impact of body mass index category on arrhythmias using univariate and multivariate analysis.
Results:
There were 1250 operative cases: 12% underweight, 65% normal weight, 12% overweight, and 11% obese. Post-operative arrhythmias were observed in 38%. Body mass index was significantly higher in those with arrhythmias (18.8 versus 17.8, p = 0.003). There was a linear relationship between body mass index category and incidence of arrhythmias: underweight 33%, normal 38%, overweight 42%, and obese 45% (p = 0.017 for trend). In multivariate analysis, body mass index category was independently associated with post-operative arrhythmias (p = 0.021), with odds ratio 1.64 in obese patients as compared to normal-weight patients (p = 0.036). In addition, aortic cross-clamp time (OR 1.007, p = 0.002) and maximal vasoactive–inotropic score in the first 48 hours (OR 1.03, p = 0.04) were associated with post-operative arrhythmias.
Conclusion:
Body mass index is independently associated with incidence of post-operative arrhythmias in children after CHD surgery.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic.
Objectives:
To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children.
Methods:
Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher’s exact, and Wilcoxon rank sum.
Results:
Thirty-nine children with median (interquartile range) age 7.8 (3.6–12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26–61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04).
Conclusion:
Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.
Direct numerical solutions are described for flow past a body placed in an otherwise uniform shear layer adjoining a wall. The study is associated with potential impact of the body onto the wall. Steady two-dimensional flow solutions are calculated for an inclined flat plate in particular, covering cases of zero wall velocity, positive wall velocity and negative wall velocity, with the plate being at varying orientations and distances from the wall. Substantial flow separation is found with reduced proximity to the wall or increased plate incidence, caused partly by the cutting off of the mass flux in the gap between the body and the wall as impact is neared. Other distinct flow characteristics that emerge with increased local Reynolds number are the extent of the enhanced wake responses, greatly condensed upstream influence near the leading edge, increased sensitivity to body orientation, the pressure dominance in the total lift and moment on the body, new insight into the complex flow structure and quantitative agreement with a recent viscous–inviscid interaction analysis on scales.
Current debates about surveillance demonstrate the complexity of political controversies whose uncertainty and moral ambiguities render normative consensus difficult to achieve. The question of how to study political controversies remains a challenge for IR scholars. Critical security studies scholars have begun to examine political controversies around surveillance by exploring changing security practices in the everyday. Yet, (de)legitimation practices have hitherto not been the focus of analysis. Following recent practice-oriented research, we develop a conceptual framework based on the notion of ‘narrative legitimation politics’. We first introduce the concept of ‘tests’ from Boltanski's pragmatic sociology to categorise the discursive context and different moral reference points (truth, reality, existence). Second, we combine pragmatic sociology with narrative analysis to enable the study of dominant justificatory practices. Third, we develop the framework through a practice-oriented exploration of the Snowden controversy with a focus on the US and Germany. We identify distinct justificatory practices in each test format linked to narrative devices (for example, plots, roles, metaphors) whose fluid, contested dynamics have the potential to effect change. The framework is particularly relevant for IR scholars interested in legitimacy issues, the normativity of practices, and the power of narratives.
Interaction between body motion and fluid motion is considered inside a nonlinear viscous wall layer, with this unsteady two-way coupling leading to impact of the body on the wall. The present paper involves a reduced system analysis which is shown to be consistent with computational solutions from direct numerical simulations for a basic flat-plate shape presented in an allied paper (Palmer & Smith, J. Fluid Mech., 2020). The occurrence of impact depends mainly on fluid parameters and initial conditions. The body considered is translating upstream or downstream relative to the wall. Subsequent analysis focusses on the unusual nature of the impact at the leading edge. The impacting flow structure is found to have two nonlinear viscous–inviscid regions lying on either side of a small viscous region. The flow properties in the regions dictate the lift and torque which drive the body towards the wall. Pronounced flow separations are common as the impact then cuts off the mass flux in the gap between the body and the wall; here, a nonlinear similarity solution sheds extra light on the separations. Comparisons are made between results from direct simulations and asymptotics at increased flow rate.
Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium.
Methods:
A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing.
Results:
Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects.
Conclusions:
In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
Effects of bearded sprangletop interference durations on Lemont and Newbonnet rice cultivars were studied. Interference durations of 63, 70, and 130 d after rice emergence reduced Lemont grain yields 11, 21, and 50%, respectively, and lowered Newbonnet grain yields 11, 13, and 37%, respectively. Interference durations of 21 to 56 d after emergence did not reduce grain yields of either cultivar. Bearded sprangletop grown in Lemont rice produced more biomass than that in Newbonnet. Season-long interference reduced plant height and straw dry weight of Lemont more than that of Newbonnet.
To develop consensus recommendations for training future clinician educators (CEs) in emergency medicine (EM).
Methods
A panel of EM education leaders was assembled from across Canada and met regularly by teleconference over the course of 1 year. Recommendations for CE training were drafted based on the panel’s experience, a literature review, and a survey of current and past EM education leaders in Canada. Feedback was sought from attendees at the Canadian Association of Emergency Physicians (CAEP) annual academic symposium. Recommendations were distributed to the society’s Academic Section for further feedback and updated by a consensus of the expert panel.
Results
Recommendations were categorized for one of three audiences: 1) Future CEs; 2) Academic departments and divisions (AD&D) that support training to fulfill their education leadership goals; and 3) The CAEP Academic Section. Advanced medical education training is recommended for any emergency physician or resident who pursues an education leadership role. Individuals should seek out mentorship in making decisions about career opportunities and training options. AD&D should regularly perform a needs assessment of their future CE needs and identify and encourage potential individuals who fulfill education leadership roles. AD&D should develop training opportunities at their institution, provide support to complete this training, and advocate for the recognition of education scholarship in their institutional promotions process. The CAEP Academic Section should support mentorship of future CEs on a national scale.
Conclusion
These recommendations serve as a framework for training and supporting the next generation of Canadian EM medical educators.