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The resection of a subaortic membrane remains far from a curative operation. We sought to examine factors associated with reoperation and the degree of aortic valve regurgitation as a potential long-term source for reoperation.
All patients who underwent resection of an isolated subaortic membrane between 1995 and 2018 were included. Patients who underwent other procedures were excluded. Paired categorical data were compared using McNemar’s test. Univariate time-to-event analyses were performed using Kaplan–Meier methods with log-rank tests for categorical variables and univariate Cox models for continuous variables.
A total of 84 patients (median age 6.6, 31% females) underwent resection of isolated subaortic membrane. At a median follow-up of 9.3 years (interquartile range 0.6–22.5), 12 (14%) patients required one reoperation and 1 patient required two reoperations. Median time to first reoperation was 4.6 years. The degree of aortic valve regurgitation improved post-operatively from pre-operatively (p = 0.0007); however, the degree of aortic valve regurgitation worsened over the course of follow-up (p = 0.010) to equivalence with pre-operative aortic valve regurgitation (p = 0.18). Performance of a septal myectomy was associated with longer freedom from reoperation (p = 0.004).
In patients with isolated subaortic membranes, performance of a septal myectomy can minimise risk for reoperation. Patients should be serially monitored for degradation of the aortic valve, even if aortic regurgitation is not present post-operatively.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
For families of smooth complex projective varieties, we show that normal functions arising from algebraically trivial cycle classes are algebraic and defined over the field of definition of the family. In particular, the zero loci of those functions are algebraic and defined over such a field of definition. This proves a conjecture of Charles.
We show that the image of the Abel–Jacobi map admits functorially a model over the field of definition, with the property that the Abel–Jacobi map is equivariant with respect to this model. The cohomology of this abelian variety over the base field is isomorphic as a Galois representation to the deepest part of the coniveau filtration of the cohomology of the projective variety. Moreover, we show that this model over the base field is dominated by the Albanese variety of a product of components of the Hilbert scheme of the projective variety, and thus we answer a question of Mazur. We also recover a result of Deligne on complete intersections of Hodge level 1.
A conjecture of Orlov predicts that derived equivalent smooth projective varieties over a field have isomorphic Chow motives. The conjecture is known for curves, and was recently observed for surfaces by Huybrechts. In this paper we focus on threefolds over perfect fields, and unconditionally secure results, which are implied by Orlov's conjecture, concerning the geometric coniveau filtration, and abelian varieties attached to smooth projective varieties.
In this paper, motivated by a problem posed by Barry Mazur, we show that for smooth projective varieties over the rationals, the odd cohomology groups of degree less than or equal to the dimension can be modeled by the cohomology of an abelian variety, provided the geometric coniveau is maximal. This provides an affirmative answer to Mazur’s question for all uni-ruled threefolds, for instance. Concerning cohomology in degree three, we show that the image of the Abel–Jacobi map admits a distinguished model over the rationals.
In 2008 it became policy that all those on the care programme approach were assessed for sexual violence/abuse. The implementation of this policy was assessed 8 years on. The findings of a survey and data request to Health and Social Care Information Centre are disappointing. We argue that this important initiative needs to be reinvigorated.
As a result of the psychiatric hospital closure programme the use of private
sector facilities for those needing longer-term care and support has
increased. However, local rehabilitation services may be a better solution
than out of area treatment.
Coconut, Cocos nucifera L., is a tree that is cultivated to provide a large number of products, although it is mainly grown for its nutritional and medicinal values. Coconut oil, derived from the coconut fruit, has been recognised historically as containing high levels of saturated fat; however, closer scrutiny suggests that coconut should be regarded more favourably. Unlike most other dietary fats that are high in long-chain fatty acids, coconut oil comprises medium-chain fatty acids (MCFA). MCFA are unique in that they are easily absorbed and metabolised by the liver, and can be converted to ketones. Ketone bodies are an important alternative energy source in the brain, and may be beneficial to people developing or already with memory impairment, as in Alzheimer's disease (AD). Coconut is classified as a highly nutritious ‘functional food’. It is rich in dietary fibre, vitamins and minerals; however, notably, evidence is mounting to support the concept that coconut may be beneficial in the treatment of obesity, dyslipidaemia, elevated LDL, insulin resistance and hypertension – these are the risk factors for CVD and type 2 diabetes, and also for AD. In addition, phenolic compounds and hormones (cytokinins) found in coconut may assist in preventing the aggregation of amyloid-β peptide, potentially inhibiting a key step in the pathogenesis of AD. The purpose of the present review was to explore the literature related to coconut, outlining the known mechanistic physiology, and to discuss the potential role of coconut supplementation as a therapeutic option in the prevention and management of AD.
Delayed vasculopathy associated with prior brain irradiation is a known cause of stroke. Radiation is implicated in large-vessel stenosis, cavernous malformations and, rarely, small-vessel disease. There have been no reported cases of fulminant ischaemic and haemorrhagic strokes secondary to radiation vasculopathy. We present the case of a 40-year-old woman with a history of childhood leukaemia and whole-body and cranio-cervical radiation. The patient presented with recurrent acute neurological deficits over a 4-month period resulting from haemorrhagic and ischaemic strokes. Imaging revealed numerous cavernomas and small-vessel acute infarctions. No traditional stroke aetiology was identified. Delayed radiation-induced vasculopathy should be considered in patients with a history of brain irradiation and ischaemic or haemorrhagic strokes, and can present in a fulminant manner with recurrent strokes over a short period of time.
The majority of extra-solar planets have been discovered (or confirmed after follow-up) through radial-velocity (RV) surveys. Using ground-based spectrographs such as High Accuracy Radial Velocity Planetary Search (HARPS) and HARPS-North, it is now possible to detect planets that are only a few times the mass of the Earth. However, the presence of dark spots on the stellar surface produces RV signals that are very similar in amplitude to those caused by orbiting low-mass planets. Disentangling these signals has thus become the biggest challenge in the detection of Earth-mass planets using RV surveys. To do so, we use the star's lightcurve to model the RV variations produced by spots. Here we present this method and show the results of its application to CoRoT-7.
Charged dust grains in the atmospheres of exoplanets may play a key role in the formation of prebiotic molecules, necessary to the origin of life. Dust grains submerged in an atmospheric plasma become negatively charged and attract a flux of ions that are accelerated from the plasma. The energy of the ions upon reaching the grain surface may be sufficient to overcome the activation energy of particular chemical reactions that would be unattainable via ion and neutral bombardment from classical, thermal excitation. As a result, prebiotic molecules or their precursors could be synthesized on the surface of dust grains that form clouds in exoplanetary atmospheres. This paper investigates the energization of the plasma ions, and the dependence on the plasma electron temperature, in the atmospheres of substellar objects such as gas giant planets. Calculations show that modest electron temperatures of ≈1 eV (≈104 K) are enough to accelerate ions to sufficient energies that exceed the activation energies required for the formation of formaldehyde, ammonia, hydrogen cyanide and the amino acid glycine.