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Patient- and proxy-reported outcomes (PROs) are an important indicator of healthcare quality and can be used to inform treatment. Despite the widescale use of PROs in adult cardiology, they are underutilised in paediatric cardiac care. This study describes a six-center feasibility and pilot experience implementing PROs in the paediatric and young adult ventricular assist device population.
The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) is a collaborative learning network comprised of 55 centres focused on improving clinical outcomes and the patient/family experience for children with heart failure and those supported by ventricular assist devices. The development of ACTION’s PRO programme via engagement with patient and parent stakeholders is described. Pilot feasibility, patient/parent and clinician feedback, and initial PRO findings of patients and families receiving paediatric ventricular assist support across six centres are detailed.
Thirty of the thirty-five eligible patients (85.7%) were enrolled in the PRO programme during the pilot study period. Clinicians and participating patients/parents reported positive experiences with the PRO pilot programme. The most common symptoms reported by patients/parents in the first month post-implant period included limitations in activities, dressing change distress, and post-operative pain. Poor sleep, dressing change distress, sadness, and fatigue were the most common symptoms endorsed >30 days post-implant. Parental sadness and worry were notable throughout the entirety of the post-implant experience.
This multi-center ACTION learning network-based PRO programme demonstrated initial success in this six-center pilot study experience and yields important next steps for larger-scale PRO collection, research, and clinical intervention.
Suicide risk is complex and nuanced, and how place impacts suicide risk when considered alongside detailed individual risk factors remains uncertain. We aimed to examine suicide risk in Denmark with both individual and neighbourhood level risk factors.
We used Danish register-based data to identify individuals born in Denmark from 1972, with full parental information and psychiatric diagnosis history. We fitted a two-level survival model to estimate individual and neighbourhood determinants on suicide risk.
We identified 1723 cases of suicide in Denmark during the follow-up period from 1982 to 2015. Suicide risk was explained mainly by individual determinants. Parental comorbidities, particularly maternal schizophrenia [incidence rate ratio (IRR): 2.29, 95% CI 1.56–3.16] and paternal death (2.29, 95% CI 1.31–3.72) partly explained suicide risk when adjusted for all other determinants. The general contextual effect of suicide risk across neighbourhoods showed a median incidence rate ratio (MRR) of 1.13 (1.01–1.28), which was further reduced with full adjustment. Suicide risk increased in neighbourhoods with a higher proportion of manual workers (IRR: 1.08; 1.03–1.14), and decreased with a higher population density (IRR: 0.89; 0.83–0.96).
Suicide risk varies mainly between individuals, with parental comorbidities having the largest effect on suicide risk. Suicide risk was less impacted by neighbourhood, though, albeit to a lesser extent than individual determinants, some characteristics were associated with suicide risk. Suicide prevention policies might consider targeting interventions towards individuals more vulnerable due to particular parental comorbidities, whilst taking into account that some neighbourhood characteristics might exacerbate this risk further.
The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors.
Online questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change.
Prospective symptom analyses showed small decreases in depression (PHQ-9: −0.43 points) and anxiety [generalised anxiety disorder scale – 7 items (GAD)-7: −0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status.
We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.
In this prospective study of mental health, we examine the influence of three interrelated traits — perceived stress, rumination, and daytime sleepiness — and their association with symptoms of anxiety and depression in early adolescence. Given the known associations between these traits, an important objective is to determine the extent to which they may independently predict anxiety/depression symptoms. Twin pairs from the Queensland Twin Adolescent Brain (QTAB) project were assessed on two occasions (N = 211 pairs aged 9−14 years at baseline and 152 pairs aged 10−16 years at follow-up). Linear regression models and quantitative genetic modeling were used to analyze the data. Prospectively, perceived stress, rumination, and daytime sleepiness accounted for 8−11% of the variation in later anxiety/depression; familial influences contributed strongly to these associations. However, only perceived stress significantly predicted change in anxiety/depression, accounting for 3% of variance at follow-up after adjusting for anxiety/depression at baseline, although it did not do so independently of rumination and daytime sleepiness. Bidirectional effects were found between all traits over time. These findings suggest an underlying architecture that is shared, to some degree, by all traits, while the literature points to hypothalamic–pituitary–adrenal (HPA) axis and/or circadian systems as potential sources of overlapping influence and possible avenues for intervention.
We perform numerical simulations of the interaction between a vortex ring and a free surface, and provide a new interpretation of the mechanism by which the vortex ring connects to the free surface. Large vorticity gradients at the free surface result in the diffusion of surface-tangential vorticity out of the fluid. This is accompanied by the diffusion of opposite-signed surface-normal vorticity away from the connection line, along the free surface, which results in the attachment of the vortex ring to the free surface. Compared to existing descriptions, this interpretation explains better how the solenoidal property that vortex lines do not end in the fluid is maintained. By including an interface vortex sheet at the free surface, the important property of vorticity conservation is maintained throughout the interaction. The upper part of the vortex ring simply diffuses out of the fluid, and into the interface vortex sheet, with the total circulation remaining constant.
The hippocampus is a complex brain structure with key roles in cognitive and emotional processing and with subregion abnormalities associated with a range of disorders and psychopathologies. Here we combine data from two large independent young adult twin/sibling cohorts to obtain the most accurate estimates to date of genetic covariation between hippocampal subfield volumes and the hippocampus as a single volume. The combined sample included 2148 individuals, comprising 1073 individuals from 627 families (mean age = 22.3 years) from the Queensland Twin IMaging (QTIM) Study, and 1075 individuals from 454 families (mean age = 28.8 years) from the Human Connectome Project (HCP). Hippocampal subfields were segmented using FreeSurfer version 6.0 (CA4 and dentate gyrus were phenotypically and genetically indistinguishable and were summed to a single volume). Multivariate twin modeling was conducted in OpenMx to decompose variance into genetic and environmental sources. Bivariate analyses of hippocampal formation and each subfield volume showed that 10%–72% of subfield genetic variance was independent of the hippocampal formation, with greatest specificity found for the smaller volumes; for example, CA2/3 with 42% of genetic variance being independent of the hippocampus; fissure (63%); fimbria (72%); hippocampus-amygdala transition area (41%); parasubiculum (62%). In terms of genetic influence, whole hippocampal volume is a good proxy for the largest hippocampal subfields, but a poor substitute for the smaller subfields. Additive genetic sources accounted for 49%–77% of total variance for each of the subfields in the combined sample multivariate analysis. In addition, the multivariate analyses were sufficiently powered to identify common environmental influences (replicated in QTIM and HCP for the molecular layer and CA4/dentate gyrus, and accounting for 7%–16% of total variance for 8 of 10 subfields in the combined sample). This provides the clearest indication yet from a twin study that factors such as home environment may influence hippocampal volumes (albeit, with caveats).
Democratic cooperation is a particularly complex type of arrangement that requires attendant institutions to ensure that the problems inherent in collective action do not subvert the public good. It is perhaps due to this complexity that historians, political scientists, and others generally associate the birth of democracy with the emergence of so-called states and center it geographically in the “West,” where it then diffused to the rest of the world. We argue that the archaeological record of the American Southeast provides a case to examine the emergence of democratic institutions and to highlight the distinctive ways in which such long-lived institutions were—and continue to be—expressed by Native Americans. Our research at the Cold Springs site in northern Georgia, USA, provides important insight into the earliest documented council houses in the American Southeast. We present new radiocarbon dating of these structures along with dates for the associated early platform mounds that place their use as early as cal AD 500. This new dating makes the institution of the Muskogean council, whose active participants have always included both men and women, at least 1,500 years old, and therefore one of the most enduring and inclusive democratic institutions in world history.
The goal for many PhD students in archaeology is tenure-track employment. Students primarily receive their training by tenure-track or tenured professors, and they are often tacitly expected—or explicitly encouraged—to follow in the footsteps of their advisor. However, the career trajectories that current and recent PhD students follow may hold little resemblance to the ones experienced by their advisors. To understand these different paths and to provide information for current PhD students considering pursuing a career in academia, we surveyed 438 archaeologists holding tenured or tenure-track positions in the United States. The survey, recorded in 2019, posed a variety of questions regarding the personal experiences of individual professors. The results are binned by the decade in which the respondent graduated. Evident patterns are discussed in terms of change over time. The resulting portraits of academic pathways through the past five decades indicate that although broad commonalities exist in the qualifications of early career academics, there is no singular pathway to obtaining tenure-track employment. We highlight the commonalities revealed in our survey to provide a set of general qualifications that might provide a baseline set of skills and experiences for an archaeologist seeking a tenure-track job in the United States.
The coronavirus disease 2019 (COVID-19) pandemic requires urgent implementation of effective community-engaged strategies to enhance education, awareness, and inclusion of underserved communities in prevention, mitigation, and treatment efforts. The Texas Community-Engagement Alliance Consortium was established with support from the United States’ National Institutes of Health (NIH) to conduct community-engaged projects in selected geographic locations with a high proportion of medically underserved minority groups with a disproportionate burden of COVID-19 disease and hospitalizations. The purpose of this paper is to describe the development of the Consortium. The Consortium organized seven projects with focused activities to address COVID-19 clinical and vaccine trials in highly affected counties, as well as critical statewide efforts. Five Texas counties (Bexar, Dallas, Harris, Hidalgo, and Tarrant) were chosen by NIH because of high concentrations of underserved minority communities, existing community infrastructure, ongoing efforts against COVID-19, and disproportionate burden of COVID-19. Policies and practices can contribute to disparities in COVID-19 risk, morbidity, and mortality. Community engagement is an essential element for effective public health strategies in medically underserved minority areas. Working with partners, the Consortium will use community engagement strategies to address COVID-19 disparities.
This article presents a three-dimensional theory of vorticity creation on generalised interfaces, including both non-slip and free-slip boundaries, which generalises a previous two-dimensional formulation (Terrington et al., J. Fluid Mech., vol. 890, 2020, p. A5). Under this description, vorticity may be created on a boundary by the inviscid relative acceleration between fluid elements on each side of the boundary, driven by either tangential pressure gradients or body forces. Viscosity acts to transfer circulation between the vortex sheet representing the slip velocity on the interface, and the fluid interior, but is not responsible for the creation of vorticity on the interface. This formulation also describes a principle of vorticity conservation for interfacial and free-surface flows: in many flow configurations, the net generation of vorticity on the interface is zero, and the total circulation remains constant throughout flow evolution.
The coronavirus disease 2019 (COVID-19) pandemic has significantly increased depression rates, particularly in emerging adults. The aim of this study was to examine longitudinal changes in depression risk before and during COVID-19 in a cohort of emerging adults in the U.S. and to determine whether prior drinking or sleep habits could predict the severity of depressive symptoms during the pandemic.
Participants were 525 emerging adults from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a five-site community sample including moderate-to-heavy drinkers. Poisson mixed-effect models evaluated changes in the Center for Epidemiological Studies Depression Scale (CES-D-10) from before to during COVID-19, also testing for sex and age interactions. Additional analyses examined whether alcohol use frequency or sleep duration measured in the last pre-COVID assessment predicted pandemic-related increase in depressive symptoms.
The prevalence of risk for clinical depression tripled due to a substantial and sustained increase in depressive symptoms during COVID-19 relative to pre-COVID years. Effects were strongest for younger women. Frequent alcohol use and short sleep duration during the closest pre-COVID visit predicted a greater increase in COVID-19 depressive symptoms.
The sharp increase in depression risk among emerging adults heralds a public health crisis with alarming implications for their social and emotional functioning as this generation matures. In addition to the heightened risk for younger women, the role of alcohol use and sleep behavior should be tracked through preventive care aiming to mitigate this looming mental health crisis.
BASF Corp. has developed p-hydroxyphenylpyruvate dioxygenase (HPPD) inhibitor–resistant cotton and soybean that will allow growers to use isoxaflutole in future weed management programs. In 2019 and 2020, a multi-state non-crop research project was conducted to examine weed control following isoxaflutole applied preemergence alone and with several tank-mix partners at high and low labeled rates. At 28 d after treatment (DAT), Palmer amaranth was controlled ≥95% at six of seven locations with isoxaflutole plus the high rate of diuron or fluridone. These same combinations provided the greatest control 42 DAT at four of seven locations. Where large crabgrass was present, isoxaflutole plus the high rate of diuron, fluridone, pendimethalin, or S-metolachlor or isoxaflutole plus the low rate of fluometuron controlled large crabgrass ≥95% in two of three locations 28 DAT. In two of three locations, isoxaflutole plus the high rate of pendimethalin or S-metolachlor improved large crabgrass control 42 DAT when compared to isoxaflutole alone. At 21 DAT, morningglory was controlled ≥95% at all locations with isoxaflutole plus the high rate of diuron and at three of four locations with isoxaflutole plus the high rate of fluometuron. At 42 DAT at all locations, isoxaflutole plus diuron or fluridone and isoxaflutole plus the high rate of fluometuron improved morningglory control compared to isoxaflutole alone. These results suggest that isoxaflutole applied preemergence alone or in tank mixture is efficacious on a number of cross-spectrum annual weeds in cotton, and extended weed control may be achieved when isoxaflutole is tank-mixed with several soil-residual herbicides.
Children born very preterm (VP) display altered growth in corticolimbic structures compared with full-term peers. Given the association between the cortiocolimbic system and anxiety, this study aimed to compare developmental trajectories of corticolimbic regions in VP children with and without anxiety diagnosis at 13 years.
MRI data from 124 VP children were used to calculate whole brain and corticolimbic region volumes at term-equivalent age (TEA), 7 and 13 years. The presence of an anxiety disorder was assessed at 13 years using a structured clinical interview.
VP children who met criteria for an anxiety disorder at 13 years (n = 16) displayed altered trajectories for intracranial volume (ICV, p < 0.0001), total brain volume (TBV, p = 0.029), the right amygdala (p = 0.0009) and left hippocampus (p = 0.029) compared with VP children without anxiety (n = 108), with trends in the right hippocampus (p = 0.062) and left medial orbitofrontal cortex (p = 0.079). Altered trajectories predominantly reflected slower growth in early childhood (0–7 years) for ICV (β = −0.461, p = 0.020), TBV (β = −0.503, p = 0.021), left (β = −0.518, p = 0.020) and right hippocampi (β = −0.469, p = 0.020) and left medial orbitofrontal cortex (β = −0.761, p = 0.020) and did not persist after adjusting for TBV and social risk.
Region- and time-specific alterations in the development of the corticolimbic system in children born VP may help to explain an increase in anxiety disorders observed in this population.
We examine Lyman's (Appl. Mech. Rev., vol. 43, issue 8, 1990, pp. 157–158) proposed definition of the boundary vorticity flux, as an alternative to the traditional definition provided by Lighthill (Introduction: boundary layer theory. In Laminar Boundary Layers (ed. L. Rosenhead), chap. 2, 1963, pp. 46–109. Oxford University Press). While either definition may be used to describe the generation and diffusion of vorticity, Lyman's definition offers several conceptual benefits. First, Lyman's definition can be interpreted as the transfer of circulation across a boundary, due to the acceleration of that boundary, and is therefore closely tied to the dynamics of linear momentum. Second, Lyman's definition allows the vorticity creation process on a solid boundary to be considered essentially inviscid, effectively extending Morton's (Geophys. Astrophys. Fluid Dyn., vol. 28, 1984, pp. 277–308) two-dimensional description to three-dimensional flows. Third, Lyman's definition describes the fluxes of circulation acting in any two-dimensional reference surface, enabling a control-surface analysis of three-dimensional vortical flows. Finally, Lyman's definition more clearly illustrates how the kinematic condition that vortex lines do not end in the fluid is maintained, providing an elegant description of viscous processes such as vortex reconnection. The flow over a sphere, in either translational or rotational motion, is examined using Lyman's definition of the vorticity flux, demonstrating the benefits of the proposed framework in understanding the dynamics of vortical flows.
To identify attention profiles at 7 and 13 years, and transitions in attention profiles over time in children born very preterm (VP; <30 weeks’ gestation) and full term (FT), and examine predictors of attention profiles and transitions.
Participants were 167 VP and 60 FT children, evaluated on profiles across five attention domains (selective, shifting and divided attention, processing speed, and behavioral attention) at 7 and 13 years using latent profile analyses. Transitions in profiles were assessed with contingency tables. For VP children, biological and social risk factors were tested as predictors with a multinomial logistic regression.
At 7 and 13 years, three distinct profiles of attentional functioning were identified. VP children were 2–3 times more likely to show poorer attention profiles compared with FT children. Transition patterns between 7 and 13 years were stable average, stable low, improving, and declining attention. VP children were two times less likely to have a stable average attention pattern and three times more likely to have stable low or improving attention patterns compared with FT children. Groups did not differ in declining attention patterns. For VP children, brain abnormalities on neonatal MRI and greater social risk at 7 years predicted stable low or changing attention patterns over time.
VP children show greater variability in attention profiles and transition patterns than FT children, with almost half of the VP children showing adverse attention patterns over time. Early brain pathology and social environment are markers for attentional functioning.
To determine the prevalence of cochlear nerve anomalies on magnetic resonance imaging in patients with unilateral or bilateral sensorineural hearing loss.
A retrospective case series was conducted at a tertiary referral centre. The inclusion criteria were paediatric patients with bilateral or unilateral sensorineural hearing loss, investigated with magnetic resonance imaging. The primary outcome measure was the rate of cochlear nerve hypoplasia or aplasia.
Of the 72 patients with unilateral sensorineural hearing loss, 39 per cent (28 cases) had absent or hypoplastic cochlear nerves on the affected side. Fifteen per cent (11 cases) had other abnormal findings on magnetic resonance imaging. Eighty-four patients had bilateral sensorineural hearing loss, of which cochlear nerve hypoplasia or aplasia was identified only in 5 per cent (four cases). Other abnormal findings were identified in 14 per cent (12 cases).
Paediatric patients with unilateral sensorineural hearing loss are more likely to have cochlear nerve anomalies than those patients with bilateral sensorineural hearing loss. This has important implications regarding cochlear implantation for patients with single-sided deafness.
This article examines numerically the two-dimensional fluid–structure interaction problem of a circular cylinder rolling under gravity along an inclined surface under the assumption of a fixed but small gap. The motion of the cylinder is governed by the ratio of cylinder and fluid densities and the Reynolds number based on a velocity scale derived from the momentum balance in the asymptotic regime. For increasing Reynolds number, the cylinder wake undergoes a transition from steady to periodic flow, causing oscillations of the cylinder motion. The critical Reynolds number increases for light cylinders. Whereas the time-averaged characteristics of the asymptotic rolling states depend only on the Reynolds number, the density ratio has an additional influence on the vibration amplitude and on the cylinder motion during a start-up transient from rest. Light cylinders reach their final state quickly after the initial acceleration; heavier cylinders traverse a series of quasi-steady states, including a temporary velocity overshoot, before settling in the asymptotic regime. The amplitudes of the flow-induced vibrations remain small over the entire parameter range, which can be attributed to the value of the added-mass force associated with a rolling cylinder. Special attention is paid to the influence of the small but finite gap between cylinder and wall, since lubrication theory predicts a diverging pressure drag for a vanishing gap. The variations with gap size of the forces, torque and added mass are explored. The gap also influences the characteristics of the cylinder vibrations in the unsteady wake regime, in particular their amplitude.
This article argues that the politics of extraterritorial jurisdiction in the 1920s reshaped relations between ethnicity and territorial sovereignty in Ethiopia's eastern borderlands. A 1925 criminal trial involving Gadabursi Somalis began as what Britons deemed a ‘tribal matter’ to be settled through customary means, but became a struggle for Ethiopia's regent, Ras Tafari, to assert Ethiopia's territorial authority and imperial sovereignty. British claims of extraterritorial jurisdiction over Somalis amidst 1920s global geopolitical shifts disrupted existing practices of governance in Ethiopia's eastern borderlands and created a dilemma for Ethiopian authorities. In order to uphold international obligations, Ethiopian officials effectively had to revoke their sovereignty over some Somalis indigenous to Ethiopia. Yet Britons’ practical application of extraterritoriality to Somalis was predicated on assumed racial differences between Somalis and highland Ethiopians (‘Abyssinians’). Thus, Ethiopia's recognition of British extraterritorial jurisdiction would lend legitimacy to claims exempting Somalis from Ethiopian sovereignty due to differences in identity. The case reveals how assertions about race, nationality and ‘tribal’ identity articulated to subordinate Ethiopian rule to British interests and, in the longer term, to delegitimize Ethiopian governance over Somalis.