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Sepsis, a life-threatening organ dysfunction resulting from a dysregulated host response to infections, poses a critical threat. Cardiac surgery itself induces a robust inflammatory response, further exacerbated by cardiopulmonary bypass, causing notable clinical and physiological changes. Identifying sepsis early in the post-operative period with elevated septic markers becomes challenging, with delayed antibiotic intervention ultimately posing a fatal risk for the patient.
Methods:
We performed a prospective observational cross-sectional study aimed at identifying sepsis markers that include total leucocyte count, absolute neutrophil count, platelet count, serum albumin, chest X-ray, blood, urine, and tracheal cultures, procalcitonin, c-reactive protein, serum lactate >2.5 mmol/l along with clinical parameters (fever, hypotension, tachycardia) on post-operative days 1, 3, 5, and 10 in paediatric patients undergoing cardiac surgery with prolonged cardiopulmonary bypass time >100 min.
Results:
Total leucocyte count, absolute neutrophil count, and platelet counts were not significant enough to detect early sepsis, especially in patients with prolonged cardiopulmonary bypass time. Chest X-ray was significant from post-operative day 3 onwards. Procalcitonin was significant from day 5, and C-reactive protein was significant only from day 10. Among the clinical parameters, fever, hypotension, tachycardia, and elevated lactate levels were significant from post-operative day 1 in the patients developing sepsis.
Conclusion:
Neonates and infants faced a higher sepsis risk than older children. Longer cardiopulmonary bypass and aortic clamp times correlated with increased sepsis likelihood. Clinical factors outweighed laboratory indicators for early sepsis detection post-cardiac surgery, prompting prompt investigation and intervention.
The COVID-19 pandemic brought the EU health mandate under unprecedented scrutiny, providing a new impetus for action. The European Commission launched the ‘European Health Union’ (EHU), bringing a number of pre-existing and newer policy initiatives under a common umbrella. This contribution looks back at the recent developments in EU health law and policy, taking the 2019–2024 parliamentary term as a boundary. It offers an overview of what the EHU currently is, and what it could become. Despite its potential, the EHU is not yet a game changer. This can only happen if changes are brought to the EU’s competence and budgetary frameworks. The contribution provides first a brief introduction to the EU’s complex health competence framework and its general policy orientations in the field. We turn next to COVID-19, offering a condensed overview of the EU’s response and of the subsequent changes brought to the legal framework applicable to health emergencies. We finish by casting a closer look at the EHU, examining the descriptive and normative aspects of this concept, and making recommendations to increase the clarity, quality and legitimacy of EU action in the field.
This study investigated the cylindrically divergent Rayleigh–Taylor instability (RTI) on a liquid–gas interface and its dependence on initial conditions. A novel hydrophobic technique was developed to generate a two-dimensional water–air interface with controlled initial conditions. The experimental configuration utilised high-pressure air injection to produce uniform circumferential acceleration. Amplitude measurements over time revealed that the cylindrical RTI growth depends strongly on the azimuthal wavenumber. Experimental results demonstrated that surface tension significantly suppresses the liquid–gas cylindrical RTI, even inducing a freeze-out and oscillatory perturbation growth – a phenomenon observed for the first time. Spectrum analysis of the interface contours demonstrated that the cylindrical RTI evolves in a weakly nonlinear regime. Linear and weakly nonlinear models were derived to accurately predict the time-varying interface amplitudes and high-order modes. The linear model was further used to determine conditions for unstable, freeze-out and oscillatory solutions of the cylindrically divergent RTI. These findings offer valuable insights into manipulating hydrodynamic instabilities in contracting/expanding geometries using surface tension.
The ageing population is anticipated to encounter several challenges related to sustainability. While policies such as ageing in place can benefit older adults in terms of familiarity and independence, these policies can also lead to increased social isolation. To facilitate ageing in the right place, it is crucial to understand how the design of environments promotes social sustainability. This article presents a scoping review of empirical research focused on the characteristics of housing and surrounding environments that support social integration, cohesion and participation of older adults. The search strategy was conducted in five databases, resulting in 20,477 articles. After screening 7,550 titles and abstracts based on predetermined inclusion and exclusion criteria, 19 articles were selected. The findings of these articles are presented across three themes: (1) housing environments, (2) environments beyond the home and (3) the social environment. Although there is no one-size-fits-all housing model for older adults, the authors suggest that ageing in place policies should be reconceptualized as ageing in ‘places’ and ‘spaces’, emphasizing the diversity of social needs of older adults. Understanding the environmental characteristics, the role of accessible and safe environments beyond the home, and how people and culture support a sense of belonging provides a policy direction for how to design socially sustainable environments for older adults in the future.
For an even positive integer n, we study rank-one Eisenstein cohomology of the split orthogonal group $\mathrm {O}(2n+2)$ over a totally real number field $F.$ This is used to prove a rationality result for the ratios of successive critical values of degree-$2n$ Langlands L-functions associated to the group $\mathrm {GL}_1 \times \mathrm {O}(2n)$ over F. The case $n=2$ specializes to classical results of Shimura on the special values of Rankin–Selberg L-functions attached to a pair of Hilbert modular forms.
Progressive ventricular remodelling in children with repaired tetralogy of Fallot may or may not result in the need for pulmonary valve replacement. We aimed to model and compare the rates of right and left ventricular adaptation over time, as assessed by cardiac MRI after surgical repair of tetralogy of Fallot, in children who did or did not require pulmonary valve replacement later in adolescence.
Methods:
Single-centre, retrospective cohort study from 2000 to 2020 including patients with tetralogy of Fallot who had complete surgical repair before 24 months.
Results:
From 214 patients included in this analysis, 142 (66.3%) had pulmonary valve replacement at a median age of 12 years (interquartile range 9–15.5) during follow-up. Assessing 323 cardiac MRI studies from 201 patients commencing from a median age of 9.4 years (interquartile range 5.9–12.3), the group that required pulmonary valve replacement later during the follow-up had a steeper time-related right ventricular dilation trajectory than non-pulmonary valve replacement patients: the increment in right ventricular end-diastolic volume index was 19.4 versus 2.8 ml/m2/log2year, P < 0.001; also, right ventricular end-systolic volume index incremented more quickly, at 11.9 versus 0.8 ml/m2/log2year, P < 0.001. Left ventricular end-diastolic volume index increased more quickly in patients who eventually had pulmonary valve replacement, at 7.2 versus 1.5 ml/m2/log2year, P = 0.005; the same occurred for indexed left ventricular end-systolic volume at 3.2 versus –0.4 ml/m2/log2year, P = 0.001.
Conclusion:
Early right and left ventricular dilation over time are identifiable by cardiac MRI in patients destined to require pulmonary valve replacement following tetralogy of Fallot repair.
The adoption of the main text of the Pandemic Agreement at the 2025 World Health Assembly is a milestone in global health law. The adopted text makes several key contributions, but there were several missed opportunities in the negotiating process, and key roadblocks remain for the future of the Pandemic Agreement.
This paper examines the legal implications of the explicit mentioning of automation bias (AB) in the Artificial Intelligence Act (AIA). The AIA mandates human oversight for high-risk AI systems and requires providers to enable awareness of AB, i.e., the human tendency to over-rely on AI outputs. The paper analyses the embedding of this extra-juridical concept in the AIA, the asymmetric division of responsibility between AI providers and deployers for mitigating AB, and the challenges of legally enforcing this novel awareness requirement. The analysis shows that the AIA’s focus on providers does not adequately address design and context as causes of AB, and questions whether the AIA should directly regulate the risk of AB rather than just mandating awareness. As the AIA’s approach requires a balance between legal mandates and behavioural science, the paper proposes that harmonised standards should reference the state of research on AB and human-AI interaction, holding both providers and deployers accountable. Ultimately, further empirical research on human-AI interaction will be essential for effective safeguards.
Let $(\phi _t)$ be a continuous semigroup of holomorphic functions in the unit disk. We prove that all its orbits are rectifiable and that its forward orbits are Lipschitz curves. Moreover, we find a necessary and sufficient condition in terms of hyperbolic geometry so that a backward orbit is a Lipschitz curve. We further explore the Lipschitz condition for forward orbits lying on the unit circle and then for semigroups of holomorphic functions in general simply connected domains.
The paper presents a simulation of the turbulent flow over and through a submerged aquatic canopy composed of 672 long, slender ribbons modelled as Cosserat rods. It is characterized by a bulk Reynolds number of 20 000, and a friction Reynolds number of 2638. Compared with a smooth turbulent channel at the same bulk Reynolds number, the canopy increases drag by a factor of 12. The ribbons are highly flexible, with a Cauchy number of 25 000, slightly buoyant, and densely packed. Their length exceeds the channel height by a factor of 1.6, while their average reconfigured height is only a quarter of the channel height. Different from lower-Cauchy-number cases, the movement of the ribbons, characterized by the motion of their tips, is very pronounced in the vertical direction, and even more in the spanwise direction, with root-mean-square fluctuations of the spanwise tip position 1.5 times the vertical ones. A canopy hull is defined to analyse the collective motion of the canopy and its interaction with the outer flow. Dominant spanwise wavelengths at this interface measure approximately one channel height, corresponding to twice the spacing of adjacent high- and low-speed streaks identified in two-point correlations of fluid velocity fluctuations. Conditional averages associated with troughs and ridges in the topography of the hull reveal streamwise-oriented counter-rotating vortices. They are reminiscent of the head-down structures related to the monami phenomenon in lower-Cauchy-number cases.
The lattice walks in the plane starting at the origin $\mathbf {0}$ with steps in $\{-1,0,1\}^{2}\setminus \{\mathbf {0}\}$ are called king walks. We investigate enumeration and divisibility for higher dimensional king walks confined to certain regions. Specifically, we establish an explicit formula for the number of $(r+s)$-dimensional king walks of length n ending at $(a_1,\ldots ,a_r,b_1,\ldots ,b_s)$ which never dip below $x_i=0$ for $i=1,\ldots ,r$. We also derive divisibility properties for the number of $(r+s)$-dimensional king walks of length p (an odd prime) through group actions.
This study analyses the evolution of body mass index (BMI) as income increases across the population, controlling for age, sex, educational level, marital status and some lifestyle habits. To this end, a quantile regression, an econometric technique that readjusts the weights of the variables in each quantile to minimize deviations, has been carried out, where the variable that orders the sample is income. We use 316,777 observations from the European Health Interview Survey (EHIS) for these regressions. This approach allows us to separate the regression analyses for low-, middle-, and high-income groups, evidence that as individual income increases, BMI tends to rise. Consequently, individuals with higher incomes exhibit higher BMI levels. Additionally, the estimated parameters for explanatory variables increase with income, signifying that wealthier individuals not only have a greater likelihood of increased BMI but also that socio-economic factors influencing BMI – whether positively or negatively – evince a stronger impact as income levels rise.
Early language development has rarely been studied in hearing children with deaf parents who are exposed to both a spoken and a signed language (bimodal bilinguals). This study presents longitudinal data of early communication and vocabulary development in a group of 31 hearing infants exposed to British Sign Language (BSL) and spoken English, at 6 months, 15 months, 24 months and 7 years, in comparison with monolinguals (exposed to English) and unimodal bilinguals (exposed to two spoken languages). No differences were observed in early communication or vocabulary development between bimodal bilinguals and monolinguals, but greater early communicative skills in infancy were found in bimodal bilinguals compared to unimodal bilinguals. Within the bimodal bilingual group, BSL and English vocabulary sizes were positively related. These data provide a healthy picture of early language acquisition in those learning a spoken and signed language simultaneously from birth.
This study investigated the effects of enzyme and/or sodium butyrate supplementation on the performance, eggshell quality, pancreatic enzyme activities and jejunum histology of laying quails-fed diets containing sunflower meal (SFM). A total of 140 24-week-old quails were randomly allocated into five experimental groups with 14 replicates each. The treatment diets were: NC (negative control without SFM), PC (positive control with 25% SFM), PC+E (PC + 500 g/tonne multi-enzyme), PC+B (PC + 1000 g/tonne sodium butyrate) and PC+EB (PC + 500 g/tonne multi-enzyme + 1000 g/tonne sodium butyrate).
As a result of this study, egg production was significantly higher in PC, PC+E and PC+EB groups compared to NC, while feed intake increased in PC but decreased with enzyme and/or sodium butyrate supplementation. Eggshell-breaking strength was highest in PC+B, whereas eggshell ratio and thickness increased across all groups compared to NC. Pancreatic lipase activity increased in PC+E and PC+B, but pancreatic amylase and protease activities decreased in all treatments compared to NC. Villus height (VH) and crypt depth (CD) improved with enzyme and/or sodium butyrate supplementation, with villus width and surface area significantly greater in PC+E and PC+EB. However, the VH/CD ratio decreased in all groups except PC+EB. In conclusion, diets containing 25% SFM did not impair performance or egg quality and improved eggshell thickness and ratio. Enzyme and/or sodium butyrate supplementation reduced feed intake enhanced pancreatic lipase activity, decreased amylase and protease activities and improved jejunum histology, with sodium butyrate notably increasing eggshell-breaking strength.
This paper reconsiders the term ‘Generation of the Thirties’ in modern Greek art, arguing that the artists retrospectively grouped under this label emerged mainly after the Second World War and were united by a time-specific pursuit of ‘Greekness’. It examines how their synthesis of local tradition and European modernism reflected post-war quests for national identity and was shaped by Cold War cultural politics and mass media stereotypes. It traces the history of the term ‘Generation of the Thirties’ in art, explores its academic and curatorial consolidation in the late 1970s, and examines why it became attractive during the Metapolitefsi era.
This paper documents how administrative geography functioned as a strategic political instrument during post–Civil War Reconstruction. I document sixty-seven counties established by Republican-controlled state legislatures across the South that concentrated Republican and African American voters. Historical boundary data and election returns show that Republicans created new counties in areas where they held strong support, added legislative seats that strengthened their majorities, and expanded opportunities for African American political representation at the state and local level. This partisan model of administrative unit proliferation advances our understanding of institutional design during contested democratization. The findings contribute to research on American political development, democratization, redistricting, and administrative design politics—showing that county creation functioned not merely as administrative policy but as a tool in partisan competition with lasting consequences for American political geography.
The Balkan Peninsula is considered to have acted as a glacial refugium as well as a biogeographic crossroads during the Pleistocene, playing an important role in the survival of biota and population dynamics through time. Furthermore, rather than being a homogeneous habitat, it is thought to have hosted a number of diverse, isolated “refugia within refugia,” providing suitable conditions for the persistence of different plant and animal species, as well as, potentially, Pleistocene hominins. We present the first palynological and charcoal record, although discontinuous, from the middle Pleistocene archaeological site Marathousa 1 (MAR-1; Megalopolis Basin) to reconstruct the local environment along with the first multispecies record of coprophilous fungal spores from Greece to track herbivore activity during the Marine Isotope Stage (MIS) 12. Our data show that during the early and late MIS 12, when the forest cover substantially decreased, mesophilous trees and aquatic vegetation persisted, reflecting wetter and milder conditions at MAR-1. Herbivore presence is documented by ∼473 ka, while its intensification coincides with increased vegetation biomass and local fire activity during the late MIS 12. Our findings suggest that MAR-1 likely served as a glacial refugium for middle Pleistocene hominins, providing essential resources for their survival during MIS 12.