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Syncope is common among pediatric patients and is rarely pathologic. The mechanisms for symptoms during exercise are less well understood than the resting mechanisms. Additionally, inert gas rebreathing analysis, a non-invasive examination of haemodynamics including cardiac output, has not previously been studied in youth with neurocardiogenic syncope.
Methods:
This was a retrospective (2017–2023), single-center cohort study in pediatric patients ≤ 21 years with prior peri-exertional syncope evaluated with echocardiography and cardiopulmonary exercise testing with inert gas rebreathing analysis performed on the same day. Patients with and without symptoms during or immediately following exercise were noted.
Results:
Of the 101 patients (15.2 ± 2.3 years; 31% male), there were 22 patients with symptoms during exercise testing or recovery. Resting echocardiography stroke volume correlated with resting (r = 0.53, p < 0.0001) and peak stroke volume (r = 0.32, p = 0.009) by inert gas rebreathing and with peak oxygen pulse (r = 0.61, p < 0.0001). Patients with syncopal symptoms peri-exercise had lower left ventricular end-diastolic volume (Z-score –1.2 ± 1.3 vs. –0.36 ± 1.3, p = 0.01) and end-systolic volume (Z-score –1.0 ± 1.4 vs. −0.1 ± 1.1, p = 0.001) by echocardiography, lower percent predicted peak oxygen pulse during exercise (95.5 ± 14.0 vs. 104.6 ± 18.5%, p = 0.04), and slower post-exercise heart rate recovery (31.0 ± 12.7 vs. 37.8 ± 13.2 bpm, p = 0.03).
Discussion:
Among youth with a history of peri-exertional syncope, those who become syncopal with exercise testing have lower left ventricular volumes at rest, decreased peak oxygen pulse, and slower heart rate recovery after exercise than those who remain asymptomatic. Peak oxygen pulse and resting stroke volume on inert gas rebreathing are associated with stroke volume on echocardiogram.
We conducted a quantitative analysis of the microbial burden and prevalence of epidemiologically important pathogens (EIP) found on long-term care facilities (LTCF) environmental surfaces.
Methods:
Microbiological samples were collected using Rodac plates (25cm2/plate) from resident rooms and common areas in five LTCFs. EIP were defined as MRSA, VRE, C. difficile and multidrug-resistant (MDR) Gram-negative rods (GNRs).
Results:
Rooms of residents with reported colonization had much greater EIP counts per Rodac (8.32 CFU, 95% CI 8.05, 8.60) than rooms of non-colonized residents (0.78 CFU, 95% CI 0.70, 0.86). Sixty-five percent of the resident rooms and 50% of the common areas were positive for at least one EIP. If a resident was labeled by the facility as colonized with an EIP, we only found that EIP in 30% of the rooms. MRSA was the most common EIP recovered, followed by C. difficile and MDR-GNR.
Discussion:
We found frequent environmental contamination with EIP in LTCFs. Colonization status of a resident was a strong predictor of higher levels of EIP being recovered from his/her room.
Biomedical research on advanced cryopreservation has spillover effects on innovation in the food and agricultural sector. Advanced biopreservation technology has three key domains of impact in the food system: (1) improving efficiencies in storage and utilization of gametes and organoids for plant and animal breeding; (2) isochoric methods for preservation of fresh food products; and (3) in biorepositories for storage of genetic resources for agriculturally significant plants and livestock species.
Strong gas-mineral interactions or slow adsorption kinetics require a molecular-level understanding of both adsorption and diffusion for these interactions to be properly described in transport models. In this combined molecular simulation and experimental study, noble gas adsorption and mobility is investigated in two naturally abundant zeolites whose pores are similar in size (clinoptilolite) and greater than (mordenite) the gas diameters. Simulated adsorption isotherms obtained from grand canonical Monte Carlo simulations indicate that both zeolites can accommodate even the largest gas (Rn). However, gas mobility in clinoptilolite is significantly hindered at pore-limiting window sites, as seen from molecular dynamics simulations in both bulk and slab zeolite models. Experimental gas adsorption isotherms for clinoptilolite confirm the presence of a kinetic barrier to Xe uptake, resulting in the unusual property of reverse Kr/Xe selectivity. Finally, a kinetic model is used to fit the simulated gas loading profiles, allowing a comparison of trends in gas diffusivity in the zeolite pores.
The use of repeated measures analysis of variance (ANOVA) options for the analysis of in vitro ruminal fermentation gas production profiles is illustrated. Because of the different variances and covariance structures among profile observations, ordinary ANOVA for more than two-time points is not recommended. To mitigate this problem, the Greenhouse–Geisser epsilon correction can be applied to reduce the degrees of freedom, inflated by violation of the sphericity assumption, for F ratio probability calculations. After this correction, the Box–Greenhouse–Geisser ANOVA (modified ANOVA) layout appears similar to the layout of a split-plot design ANOVA with whole plots divided into subplots (incubation time). Any F tests in the main plot part are valid but F tests involving the time factor from the subplot part need modification because time factor, by its very nature, cannot be allocated at random. Application of multivariate ANOVA, distance multivariate ANOVA, ante-dependence and mixed model analysis are also considered. All these options lend themselves to wide application in the applied biological sciences.
Sensory differences and anxiety disorders are highly prevalent in autistic individuals with and without ADHD. Studies have shown that sensory differences and anxiety are associated and that intolerance of uncertainty (IU) plays an important role in this relationship. However, it is unclear as to how different levels of the sensory processing pathway (i.e., perceptual, affective, or behavioral) contribute. Here, we used psychophysics to assess how alterations in tactile perception contribute to questionnaire measures of sensory reactivity, IU, and anxiety. Thirty-eight autistic children (aged 8-12 years; 27 with co-occurring ADHD) were included. Consistent with previous findings, mediation analyses showed that child-reported IU fully mediated an association between parent-reported sensory reactivity and parent-reported anxiety and that anxiety partially mediated an association between sensory reactivity and IU. Of the vibrotactile thresholds, only simultaneous frequency discrimination (SFD) thresholds correlated with sensory reactivity. Interestingly, we found that sensory reactivity fully mediated an association between SFD threshold and anxiety, and between SFD threshold and IU. Taken together, those findings suggest a mechanistic pathway whereby tactile perceptual alterations contribute to sensory reactivity at the affective level, leading in turn to increased IU and anxiety. This stepwise association can inform potential interventions for IU and anxiety in autism.
This note updates a measure of lockdown regulatory freedom for 2021 and then uses it to adjust countries' 2021 economic freedom scores to account for pandemic regulations that impact economic freedom but otherwise would go unmeasured. We directly follow Miozzi and Powell's (2023a, Journal of Institutional Economics19(2), 229–250) methods to measure lockdown regulations and adjust 2020 economic freedom scores. Thus, when paired with those findings we provide a data set that consistently measures coronavirus disease 2019 regulations and economic freedom over the course of the pandemic that can be used in other research. We find that lockdown regulatory freedom increased as countries scaled back pandemic regulations, while other areas of economic freedom continued declining. We also find that adjusting for lockdown regulatory freedom continues to significantly impact countries' relative ranking in economic freedom.
Recent studies postulated the viability of a suite of metabolic pathways in Enceladus’ ocean motivated by the detection of H2 and CO2 in the plumes – evidence for available free energy for methanogenesis driven by hydrothermal activity at the moon's seafloor. However, these have not yet been explored in detail. Here, a range of experiments were performed to investigate whether microbial iron reduction could be a viable metabolic pathway in the ocean by iron-reducing bacteria such as Geobacter sulfurreducens. This study has three main outcomes: (i) the successful reduction of a number of crystalline Fe(III)-bearing minerals predicted to be present at Enceladus was shown to take place to differing extents using acetate as an electron donor; (ii) substantial bacterial growth in a simulated Enceladus ocean medium was demonstrated using acetate and H2(g) separately as electron donors; (iii) microbial iron reduction of ferrihydrite was shown to partially occur at pH 9, the currently accepted value for Enceladus’ ocean, whilst being severely hindered at the ambient ocean temperature of 0°. This study proposes the possibilities for biogeochemical iron cycling in Enceladus’ ocean, suggesting that a strain of iron-reducing bacteria can effectively function under Enceladus-like conditions.
Understanding the distribution and extent of suitable habitats is critical for the conservation of endangered and endemic taxa. Such knowledge is limited for many Central African species, including the rare and globally threatened Grey-necked Picathartes Picathartes oreas, one of only two species in the family Picathartidae endemic to the forests of Central Africa. Despite growing concerns about land-use change resulting in fragmentation and loss of forest cover in the region, neither the extent of suitable habitat nor the potential species’ distribution is well known. We combine 339 (new and historical) occurrence records of Grey-necked Picathartes with environmental variables to model the potential global distribution. We used a Maximum Entropy modelling approach that accounted for sampling bias. Our model suggests that Grey-necked Picathartes distribution is strongly associated with steeper slopes and high levels of forest cover, while bioclimatic, vegetation health, and habitat condition variables were all excluded from the final model. We predicted 17,327 km2 of suitable habitat for the species, of which only 2,490 km2 (14.4%) are within protected areas where conservation designations are strictly enforced. These findings show a smaller global distribution of predicted suitable habitat forthe Grey-necked Picathartes than previously thought. This work provides evidence to inform a revision of the International Union for Conservation of Nature (IUCN) Red List status, and may warrant upgrading the status of the species from “Near Threatened” to “Vulnerable”.
Olive oil (OO) polyphenols have been shown to improve HDL anti-atherogenic function, thus demonstrating beneficial effects against cardiovascular risk factors. The aim of the present study was to investigate the effect of extra virgin high polyphenol olive oil (HPOO) v. low polyphenol olive oil (LPOO) on the capacity of HDL to promote cholesterol efflux in healthy adults. In a double-blind, randomised cross-over trial, fifty participants (aged 38·5 (sd 13·9) years, 66 % females) were supplemented with a daily dose (60 ml) of HPOO (320 mg/kg polyphenols) or LPOO (86 mg/kg polyphenols) for 3 weeks. Following a 2-week washout period, participants crossed over to the alternate treatment. Serum HDL-cholesterol efflux capacity, circulating lipids (i.e. total cholesterol, TAG, HDL, LDL) and anthropometrics were measured at baseline and follow-up. No significant between-group differences were observed. Furthermore, no significant changes in HDL-cholesterol efflux were found within either the LPOO and HPOO treatment arms; mean changes were 0·54 % (95 % CI (0·29, 1·37)) and 0·10 % (95 % CI (0·74, 0·94)), respectively. Serum HDL increased significantly after LPOO and HPOO intake by 0·13 mmol/l (95 % CI (0·04, 0·22)) and 0·10 mmol/l (95 % CI (0·02, 0·19)), respectively. A small but significant increase in LDL of 0·14 mmol/l (95 % CI (0·001, 0·28)) was observed following the HPOO intervention. Our results suggest that additional research is warranted to further understand the effect of OO with different phenolic content on mechanisms of cholesterol efflux via different pathways in multi-ethnic populations with diverse diets.
The Covid-19 pandemic in 2020 led to extensive new government regulations and lockdown policies that, according to some prominent definitions, severely reduced economic freedom. However, many of these new pandemic-related regulatory restrictions on economic freedom are largely missed by the Economic Freedom of the World Report (EFW). This paper first adjusts the Our World in Data Covid-19 Stringency Index into a measure of lockdown regulatory freedom and then merges it into the EFW index to better measure countries' 2020 cross-sectional relative economic freedom. We find significant differences in the relative ranking of economic freedom between countries once we adjust for lockdown regulatory restrictions.
Pietraszewski proposes four triadic “primitives” for representing social groups. We argue that, despite surface differences, these triads can all be reduced to similar underlying welfare trade-off ratios, which are a better candidate for social group primitives. Welfare trade-off ratios also have limitations, however, and we suggest there are multiple computational strategies by which people recognize and reason about social groups.
An assemblage of 34 chiton valves collected from rocks of the “Imperial” Formation sensu lato at Super Creek near Palm Springs, California, is described here. The sedimentary rocks exposed at Super Creek were deposited in the proto-Gulf of California during the Late Miocene. This chiton assemblage represents the first reported Miocene chitons from western North America. The chiton valves are classified as Callistochiton cf. C. elenensis, Chaetopleura cf. C. lanuginosa mixta, Calloplax roederi n. sp., Chiton solaris n. sp., Callistoplacidae sp. indet., and Chaetopleuridae sp. indet. Thick valves dominate the assemblage. The chiton fossils reflect the overall faunal pattern from the “Imperial” Formation s.l. of a strong similarity to taxa in the modern Gulf of California, with a Caribbean component as well. This assemblage fills a gap in the chiton fossil record and preserves details of the adaptive radiation of the Polyplacophora that occurred at the time in concert with the onset of an upwelling regime.
Reforming Healthcare: What's the Evidence? is the first major critical overview of the research published on healthcare reform in England from 1990 onwards by a team of leading UK health policy academics.
There is limited understanding of treatment pathways for paediatric sleep-disordered breathing. This study explored current UK pathways and what is important to well-being for parents and children.
Method
The study comprised in-depth qualitative interviews (n = 22) with parents of children (2–9 years) with symptoms of sleep-disordered breathing referred to a regional ENT clinic (n = 11), general practitioners who might refer these children to ENT (n = 5) and hospital doctors involved in treating these children (n = 6). Interviews were audio recorded, transcribed verbatim, anonymised and analysed thematically.
Results
General practitioners rarely identify seeing children with sleep-disordered breathing; conversely hospital doctors identify unsuspected issues. Parents are worried their child will stop breathing, but routes to referral and diagnosis are not straightforward. Modern technology can aid investigation and diagnosis. Patient weight is an issue for general practitioners and hospital doctors. Adenotonsillectomy is the treatment of choice, and information on paediatric sleep-disordered breathing is needed.
Conclusion
Guidelines for the management of paediatric sleep-disordered breathing are needed.
In this paper we propose the concept of ‘becoming-with’ in relation to the experience of the catastrophic fires in the summer of 2019–2020 in Australia, and their implications for research into young children’s response to bushfires, and their learning about bushfire recovery, which resulted in the development of an arts-based project to explore emergent curriculum and pedagogies for planetary wellbeing. We draw on Deleuze and Guattari’s theorising that ‘the self is only a threshold, a door, a becoming between two multiplicities’; and ‘Spatio-temporal relations’ as ‘not predicates of the thing but dimensions of multiplicities of events as encounters’ to theorise how ‘becoming-with’ fires enabled the development of emergent curriculum and pedagogies in an early learning centre, which can ultimately contribute to planetary wellbeing.
As countries adopt strict quarantines and lockdowns, increasing attention has been given to the impact on mental wellbeing. The influence of this on perinatal mental health and service provision is important to consider, as these women may be particularly vulnerable to the negative effects already seen in general and psychiatric populations.
Objectives
The impact on global mental health of Covid-19, and the isolation measures used to combat it’s spread, is increasingly acknowledged. We were interested in the effect the pandemic has had specifically on the mental health of women in the peripartum period. By reflecting on our experiences, we hope to generate ideas to improve services.
Methods
We considered the effects of the pandemic in this high-risk population during each stage of contact with services. This included pre-conception, antenatal and postnatal periods, as well as the potential longitudinal and service effects. Recent case examples were identified and described from our busy and diverse South London perinatal psychiatry service.
Results
Recent referrals to our service suggest the current crisis has been a key trigger for the deterioration of many women’s mental health. This includes women who have been impacted by various factors related to the pandemic, at all stages of the perinatal period.
Conclusions
It is vital to maintain equality of access to perinatal services and to continue to consider how to deliver best care. This will involve adapting to the new working environment, and optimising care delivery using remote technologies where appropriate, in a way that is safe, accessible and acceptable to service users.