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The Duke Activity Status Index is used to assess an individual patient’s perception of their fitness abilities. It has been validated and shown to predict actual fitness in adults but has been studied less in the paediatric population, specifically those with heart disease. This study aims to assess if the Duke Activity Status Index is associated with measured markers of physical fitness in adolescents and young adults with heart disease.
Methods:
This retrospective single-centre cohort study includes patients who completed a minimum of 12 weeks of cardiac rehabilitation between 2016 and 2022. Cardiac rehabilitation outcomes included physical, performance, and psychosocial measures. A comparison between serial testing was performed using a paired t-test. Univariable and multivariable analyses for Duke Activity Status Index were performed. Data are reported as median [interquartile range].
Results:
Of the 118 participants (20 years-old [13.9–22.5], 53% male), 33 (28%) completed at least 12 weeks of cardiac rehabilitation. Median peak oxygen consumption was 60.1% predicted [49–72.8%], and Duke Activity Status Index was 32.6 [21.5–48.8]. On Pearson’s correlation assessing the Duke Activity Status Index, there were significant associations with % predicted peak oxygen consumption (r = 0.49, p < 0.0001), 6-minute walk distance (r = 0.45, p < 0.0001), Duke Activity Status Index metabolic equivalents (r = 0.45, p < 0.0001), and dominant hand grip (r = 0.48, p < 0.0001). In multivariable analysis, the % predicted peak oxygen consumption (r = 0.40, p = 0.005) and dominant hand grip (r = 0.37, p = 0.005) remained statistically significant.
Conclusions:
Duke Activity Status Index is associated with measures of physical fitness in paediatric and young adults with heart disease who complete a cardiac rehabilitation program.
Background: Hyperacute stroke care demands rapid, coordinated care. Traditional metrics like Door-to-Needle time are pivotal but insufficient for capturing the complexity of endovascular stroke interventions. The SMILES collaboration aims to standardize and optimize protocols for door-to-intervention times, incorporating Crew Resource Management (CRM). Methods: The multidisciplinary initiative integrates both hospitals, ED, neurology, and QI teams. We employed a comprehensive approach: stakeholder engagement, simulation-based learning, process mapping, and literature review. Emphasis was placed on enhancing situational awareness, triage and prioritization, cognitive load management, role clarity, effective communication, and debriefing. Results: The collaboration led to PDSA cycles and development of refined stroke protocols. Interventions included: 1) A ’zero point survey’ for team pre-arrival briefings, enhancing situational awareness and role clarity; 2) Streamlined patient registration to reduce cognitive load and improve triage efficiency; 3) Direct transfer of patients to imaging. Additionally, digital tools were implemented to facilitate communication. Simulation sessions reinforced CRM principles, leading to improved team cohesion and operational performance. Conclusions: The SMILES initiative is grounded in CRM principles by standardizing protocols and emphasizing non-technical skills crucial for high-stakes environments. This improves outcomes but also fosters a culture of safety and efficiency. Future directions include an evaluation of these protocols’ impact on patient factors.
This study builds on the work by Rehman et al (2022) who argued that transcranial magnetic stimulation (TMS) treatment not only helps treat depression but also decreases sleep problems such as difficulty falling asleep,staying asleep, and waking too early. The present study further explores differences in sleep onset latency, meaning the time it takes to fall asleep, and duration of sleep per night in the pre and post treatment phases of rTMS. The information regarding major attributes of sleep is critical because recent research shows that about 90% of patients with major depressive disorder (MDD) also struggle with sleep disorders (Li et al., 2022), and sleeping for less than seven hours may eventually lead to sleep deprivation (Hirshkowitz et al., 2015), with increased risk of physical and mental health problems (Sheehan et al, 2019). Sleep onset latency estimates vary from individual to individual but typical sleep latency is considered between 10 to 20 minutes (Jung et al, 2013). As it has been shown that overall sleep problems improve with rTMS, we hypothesized that self-reported sleep onset latency will decrease, and sleep duration will increase.
Participants and Methods:
All participants met inclusion criteria for MDD diagnosis and completed a full course of TMS treatment (N=470; Mean age=53.45, SD=13.73). The sample was mostly male (81%) and ethnically diverse: 77.7% non-Hispanic White, 13.3% Black Americans, 1.9% Asian, 0.2 % Asian Indian, and 1.9% other ethnicities. Sleep problems were assessed using the following questions at the pre and post treatment stages: the number of minutes it takes to fall asleep and duration of sleep each night.
Results:
A Wilcoxon matched-pairs signed-rank test was conducted to determine whether there was a difference in sleep onset latency and hours of sleep per night between pre and post intervention. The results indicated a significant difference in time to fall asleep between pre and post treatment (pre-treatment M = 1.19, SD = 0.99, post-treatment M = 0.93, SD = 0.91; z = -5.01, p < .001. In addition, there was a significant increase in the minutes of sleep per night in pre (M = 6.11, SD = 2.07) compared to the post treatment (M = 6.32, SD = 1.77), z = -2.56, p = .010.
Conclusions:
Reduced sleep is known to negatively impact mood, cognitive ability, work performance, and immune function (Besedovsky et al., 2012; Killgore, 2010; Massar et al, 2019; Vandekerckhove & Wang, 2018). Similarly, longer sleep onset latency can cause an individual to enter the first sleep stage later than expected and complete fewer sleep cycles. The results of the present study show the effectiveness of rTMS in decreasing sleep onset latency and increasing the duration of sleep. Given the comorbidity and bidirectionality between sleep disturbances and mood disorders (Fang et al., 2019; Palagini et al., 2019), further researching treatments such as rTMS to improve sleep as a means to also improve mood is crucial. We propose acquiring knowledge about sleep attributes as an essential part of clinicians’ work early on in the rTMS treatment in order to monitor an individual’s global functioning level in light of improved sleep.
Repetitive transcranial magnetic stimulation (TMS) is an evidenced based treatment for adults with treatment resistant depression (TRD). The standard clinical protocol for TMS is to stimulate the left dorsolateral prefrontal cortex (DLPFC). Although the DLPFC is a defining region in the cognitive control network of the brain and implicated in executive functions such as attention and working memory, we lack knowledge about whether TMS improves cognitive function independent of depression symptoms. This exploratory analysis sought to address this gap in knowledge by assessing changes in attention before and after completion of a standard treatment with TMS in Veterans with TRD.
Participants and Methods:
Participants consisted of 7 Veterans (14.3% female; age M = 46.14, SD = 7.15; years education M = 16.86, SD = 3.02) who completed a full 30-session course of TMS treatment and had significant depressive symptoms at baseline (Patient Health Questionnaire-9; PHQ-9 score >5). Participants were given neurocognitive assessments measuring aspects of attention [Wechsler Adult Intelligence Scale 4th Edition (WAIS-IV) subtests: Digits Forward, Digits Backward, and Number Sequencing) at baseline and again after completion of TMS treatment. The relationship between pre and post scores were examined using paired-samples t-test for continuous variables and a linear regression to covary for depression and posttraumatic stress disorder (PTSD), which is often comorbid with depression in Veteran populations.
Results:
There was a significant improvement in Digit Span Forward (p=.01, d=-.53), but not Digit Span Backward (p=.06) and Number Sequencing (p=.54) post-TMS treatment. Depression severity was not a significant predictor of performance on Digit Span Forward (f(1,5)=.29, p=.61) after TMS treatment. PTSD severity was also not a significant predictor of performance on Digit Span Forward (f(1,5)=1.31, p=.32).
Conclusions:
Findings suggested that a standard course of TMS improves less demanding measures of working memory after a full course of TMS, but possibly not the more demanding aspects of working memory. This improvement in cognitive function was independent of improvements in depression and PTSD symptoms. Further investigation in a larger sample and with direct neuroimaging measures of cognitive function is warranted.
This investigation characterises the time response and the transient turbulence dynamics undergone by rapidly decelerating turbulent pipe flows. A series of direct numerical simulations of decelerating flows between two steady Reynolds numbers were conducted for this purpose. The statistical analyses reveal that rapidly decelerating turbulent flows undergo four coherent, unambiguous transitional stages: inertial (stage I), a dramatic change of sign in the viscous force associated with the decay of the viscous shear stress at the wall together with a mild turbulence decay in the viscous sublayer; friction recovery (stage II), a recovery in viscous force and progressive decay in the turbulent inertia at the near-wall region; turbulence decay (stage III), a balanced decay in both turbulent inertia and viscous force at the near-wall and overlap regions; core relaxation (stage IV), slow turbulence decay at the core region. The FIK identity derived by Fukagata, Iwamoto and Kasagi (Phys. Fluids, vol. 14, 2002, L73–L76) was used to understand further how the flow dynamics influence the time response of the skin friction coefficient ($C_f$). The results show that although $C_f$ plateaus during the fourth stage, the turbulent contribution keeps decaying, undershoots and finally recovers to attain its final steady value. The time evolution of the azimuthal vorticity ($\omega _\theta$) flux reveals that as the flow is decelerated, a layer of negative $\omega _\theta$ is produced at the wall during the flow excursion. As time progresses, this negative vorticity propagates in the wall-normal direction, attenuating the pre-existing vorticity and producing a decay in the turbulence levels.
To assess the effect of the coronavirus disease 2019 pandemic on paediatric bilateral myringotomy and tube insertion rates in New Brunswick, Canada.
Methods
All paediatric bilateral myringotomy and tube insertion cases from 1 July 2015 through 30 June 2021 were provided by New Brunswick Medicare. The numbers of otolaryngologists, cataract surgical procedures, total hip arthroplasties and thyroidectomies were collected to assess the availability of operating theatres and otolaryngologists. Negative binomial logarithmic regressions were used for analyses.
Results
Of the 5175 paediatric bilateral myringotomy and tube insertion cases that were included, the bilateral myringotomy and tube insertion rate significantly decreased by 2.9 times (p < 0.001) during the pandemic. Thyroidectomies, cataract surgical procedures and total hip arthroplasties did not significantly decrease. The number of otolaryngologists increased (20 vs 16–17).
Conclusion
Paediatric bilateral myringotomy and tube insertion rates significantly decreased during the pandemic. This cannot be accounted for by reduced otolaryngologists or operating theatre availability. The paediatric bilateral myringotomy and tube insertion rate decrease is likely due to public health measures reducing the transmission of upper respiratory tract infections, resulting in fewer indications for paediatric bilateral myringotomy and tube insertion.
How do failed coups influence power personalization in dictatorships? While scholars have studied the mechanisms of personalism in dictatorships in detail, little attention has been paid to the timing and determinants of surges in personalism levels. In this article, we propose that personalism can evolve non-linearly, and show that large, quite rapid increases in personalization by dictators occur after a failed coup attempt. The logic is that failed coups are information-revealing events that provide the dictator with strong motives and ample opportunities to accumulate power. The leader uses this window of opportunity to rapidly consolidate his power at the expense of the ruling coalition. We test the theory using time-series, cross-sectional data on dictatorships in 114 countries in the period between 1946 and 2010. Two placebo tests indicate that disruptive events by regime outsiders – failed assassination attempts and civil war onsets – do not promote the rush to personalize.
Helminth species of Neotropical bats are poorly known. In Mexico, few studies have been conducted on helminths of bats, especially in regions such as the Yucatan Peninsula where Chiroptera is the mammalian order with the greatest number of species. In this study, we characterized morphologically and molecularly the helminth species of bats and explored their infection levels and parasite–host interactions in the Yucatan Peninsula, Mexico. One hundred and sixty-three bats (representing 21 species) were captured between 2017 and 2022 in 15 sites throughout the Yucatan Peninsula. Conventional morphological techniques and molecular tools were used with the 28S gene to identify the collected helminths. Host–parasite network analyses were carried out to explore interactions by focusing on the level of host species. Helminths were found in 44 (26.9%) bats of 12 species. Twenty helminth taxa were recorded (7 trematodes, 3 cestodes and 10 nematodes), including 4 new host records for the Americas. Prevalence and mean intensity of infection values ranged from 7.1 to 100% and from 1 to 56, respectively. Molecular analyses confirmed the identity of some helminths at species and genus levels; however, some sequences did not correspond to any of the species available on GenBank. The parasite–host network suggests that most of the helminths recorded in bats were host-specific. The highest helminth richness was found in insectivorous bats. This study increases our knowledge of helminths parasitizing Neotropical bats, adding new records and nucleotide sequences.
Numerical simulations have been conducted to identify the dominant mechanism responsible for driving secondary flow motions in horizontal particle-laden pipe flows, based on an analysis of the forces acting on each phase. A four-way coupling Euler–Lagrangian approach was employed, using direct numerical simulations for the gas phase and Lagrangian particle tracking to account for the drag, gravitational and lift forces, together with the interactions that occur for both particle–wall and inter-particle collisions. The four different flow regimes, which had been identified previously as depending on various combinations of flow parameters and are characterised by the secondary flow structures of both the fluid and particle phases, were identified via varying the mass loading alone from $\varPhi _m=0.4$ to $\varPhi _m=1.8$. The distribution of the divergence of Reynolds stresses was used to help characterise the classes of the secondary fluid flow. This shows that secondary fluid flows of both the first and second kinds can either exist separately or co-exist in such flows. The forces exerted on the fluid phase by the pressure gradient and fluid–particle interactions were examined qualitatively and quantitatively to identify their contribution to the secondary fluid flow motions. A similar study was also applied to the drag, lift and gravitational forces exerted on the particle phase for the secondary particle flow motions. These were found to explain the secondary flows of both the fluid and particle phases with regard to both the flow direction and magnitude, together with the interaction between the two phases.
State formation in East Asia developed a thousand years before it did in Europe, and it occurred for reasons of emulation, not competition. China, Japan, Vietnam, and Korea emerged as states beginning in the second century BCE, and existed for centuries thereafter with centralized bureaucratic control defined over territory and administrative capacity to tax their populations, field large militaries, and provide extensive public goods. They created these institutions not to wage war. Rather, these countries developed states through emulation of China. State formation in historical East Asia occurred under a hegemonic system in which war was relatively rare, not under a balance of power system with regular existential threats. Rather, domestic elites copied Chinese civilization for reasons of prestige and domestic legitimacy. Our research challenges the universality of the bellicentric thesis of state formation. The willingness to acknowledge the Eurocentric origins of much of IR theory is not new; what is new in this book is the empirical evidence we bring that shows this explicitly, and a positive theoretical contribution about the causes of state formation.
As far back as the rise of unified Qin dynasty in 221 BCE, Asia’s predominant pattern has been concentrated power, not balance of power. Although Chinese power has waxed and waned over the centuries, what is perhaps most enduring was the centrality of China. Every other political actor that emerged in the past two thousand years emerged within the reality or idea of Chinese power. Regarding state formation, although the initial ideas for the subsequent bureaucratic Chinese state emerged at that time, it was neither pervasive, nor did the ideas result from war. Rather, the Qin state (221 to 206 BC) emerged as a result of hegemony, not about conquest or fighting or war. State formation was a result of unification and the need to administer a massive territory and also consolidate political rule beyond the aristocracy in the state and royal court itself. Indeed, what scant proto-bureaucratic innovations that did arise in Phase I were nascent and superficial in scope, and even in China the full Chinese state is usually seen to have emerged in the 7th and 8th centuries AD, not 800 years earlier during the Qin.
Why do some societies emulate a hegemon, while others do not? Why did most societies accept Chinese civilization while some resisted it, and why do some societies in general emulate a hegemon while other societies resist? Conversely, more rare were societies that rejected Chinese civilization. Located mostly on the sparsely-populated northern and central Asian steppe, some semi-nomadic societies did not see as appropriate or desirable almost anything about Chinese civilization: settled agriculture, written language, and territorial states. The contrast with Korea and Japan – and later, Vietnam – is clear. Culture, not geographic or material interests, explains why some societies did not emulate China.
There was an extensive epistemic community in historical East Asia that was central to the creation and dissemination of regional civilization that flowed mainly from China outwards, from core to periphery. This epistemic community was composed of Buddhist monks and Confucian scholars. They studied at Buddhist temples and Confucian academies, wrote in a common Chinese language using common styles, and made up the bulk of government officials in each country. These scholar-officials were also the ones who staffed diplomatic missions to other countries. This chapter will discuss in detail the flows of monks and literati between the various countries, and trace the influence of this transnational scholarly and religious community on the evolution of societies – as well as state formation – throughout the region.
Vietnam’s experience in the tenth and eleventh centuries was remarkably similar to that of Korea and Japan. The adoption of Confucian traditions as preferred modes of governance, in particular, reflected strong state bureaucratic practices that made Vietnam stand out from its neighbors in continental Southeast Asia. By 973 the Vietnamese state had been recognized as a Song tributary, and within a century, the Vietnamese state had created centralized provinces, founded a Royal Confucian Academy, used Chinese in all its writings, implemented a national tax, and created a national military based on universal conscription. By 1075, the Vietnamese court had instituted civil service examinations based on Chinese Confucian classics. The civil service examination would be used for the next nine hundred years, and it was only the arrival of French imperialists that transformed the government. Confucianism penetrated to the level of economic and family organization at the village level, affecting patrilineal inheritance and even dress. Vietnamese retained their indigenous language for unofficial uses, and indigenous social and religious customs, chief among them Buddhism.