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Medical advances have extended the lives of adults with CHD, but transitioning to adult healthcare remains challenging. Identifying factors related to lapses in care is crucial for adult females due to their unique healthcare needs.
Objective:
We examined the relationships among length of lapses in primary care and cardiology services with quality of life and perceived health status for adult females with CHD.
Methods:
A convergent mixed-methods design was used to examine thirty adult females with CHD, aged 21–30. Descriptive statistics and correlational analysis were used to examine perceived health status and quality of life based on lapse of care durations. Thematic analysis was used for qualitative data.
Results:
A 12-month or greater lapse in care occurred in 46.7% of participants for cardiology and 60% for primary care, and 30.0% lacked an established adult primary care provider. Participants cited healthcare system barriers, provider shortages, and difficult transitions from paediatric providers as contributing factors to lapses in care. Despite lapses, most participants reported similar or better physical health scores than the general population. However, those with either no or prolonged lapse in cardiology care had lower mental health scores. Participants with primary care lapses greater than 6 months reported better quality-of-life scores than those with uninterrupted care.
Conclusion:
Significant gaps, which contribute to lapses of care, persist in transition care for females with CHD. Findings highlight the need for structured transition planning, improved primary care access, and an integrated primary-specialty care model to improve transition.
Underactuated Cable-Driven Parallel Robots (UACDPRs) typically rely on relative internal sensors to estimate the end-effector (EE) state. Therefore, at startup, the reference values of the quantities measured by these sensors are unknown, and so is the initial pose of the EE. The problem of determining the reference values of the internal sensors is called initial-pose self-calibration. The latter is often formulated as an overdetermined system of nonlinear equations and solved using nonlinear weighted least-squares methods, minimizing the error between modeled and measured variables, and its effectiveness is highly influenced by the choice of measurement configurations, as well as the motion planning and control strategy used to reach them. This work presents two practical data acquisition methods for initial-pose self-calibration of UACDPRs, aiming to reduce the overall time required by the procedure and enhance process automation. The first method is slower but richer in data, as it relies on equilibrium poses and, therefore, can leverage cable-tension data, whereas the second method is faster and is based on geometric constraints only. The performance of the methods is evaluated in terms of acquisition time, number of measurements, and calibration accuracy on a 4-cable UACDPR prototype. The results highlight the merits and shortcomings of both methods, namely, trade-offs between the velocity of data collection and the precision of pose estimation.
How should you respond to higher-order evidence which says that you have made a mistake in the reasoning from your first-order evidence? It is highly plausible that you should reduce your confidence in your first-order reasoning. However, attempts to precisely formulate how this works have run into problems. I will argue that we should appeal to an independently motivated normative contextualism. That is, normative words like ‘ought’ and ‘reason’ have a different reference in different contexts. The result is that different answers to our question are true in different contexts.
Patients with CHD are at risk for developing necrotising enterocolitis. Currently, no standardised approaches for identification, diagnosis, and treatment of necrotising enterocolitis exists, and there are varying rates and management strategies of necrotising enterocolitis across centres. We used the Paediatric Cardiac Critical Care Consortium to identify high- and low-performing centres based on necrotising enterocolitis rates and convened a necrotising enterocolitis working group. The aims of the group were to understand why variability exists, identify risk factors, and create a foundation for a prospective improvement project.
Methods:
Nine centres participated, and collaborative learning sessions were held with multidisciplinary input. REDCap surveys were disseminated to centres to create consensus among site practices and recommendations.
Results:
The following topics were discussed: diagnosis, risk factors, and management. Diagnosis consensus suggests (1) Diagnosis would benefit from a comprehensive scoring tool, and (2) ultrasound may serve as a highly sensitive diagnostic tool for those at high risk with the absence of other radiologic findings of necrotising enterocolitis. Risk factor consensus suggests (1) those with ductal-dependent systemic blood flow are the highest risk, and (2) vasopressors with splanchnic constriction should be used with caution. Management consensus suggests (1) breastmilk be used first-line for feeding, 2) resume feeds 24–48 hours after a necrotising enterocolitis rule-out, and 3) surgical deference to physical examination and laboratory evaluation above radiographic findings.
Conclusion:
Variability exists in diagnosing necrotising enterocolitis and feeding approaches for at-risk patients. Opportunities exist for collaboration to standardise definitions, compare outcomes, identify risk factors, and create consensus on the management of necrotising enterocolitis.
Motivated by the construction of the free Banach lattice generated by a Banach space, we introduce and study several vector and Banach lattices of positively homogeneous functions defined on the dual of a Banach space E. The relations between these lattices allow us to give multiple characterizations of when the underlying Banach space E is finite-dimensional and when it is reflexive. Furthermore, we show that lattice homomorphisms between free Banach lattices are always composition operators, and study how these operators behave on the scale of lattices of positively homogeneous functions.
What can a Hegelian perspective contribute to addressing the ecological crisis? This paper argues that, for Hegel, a transformative yet sustainable relation with nature is a requirement for a free form of life. Drawing on both the Phenomenology of Spirit and the Philosophy of Right, it contends that Hegel’s notions of work, bad infinity and habit help us understand how societies become entrenched in unsustainable practices. At the same time, by pointing to the notion of limit, these concepts illuminate what an alternative form of life could look like. Modern subjective and objective structures that resemble a ‘bad infinity’—in the sense of an imperative of endless wealth accumulation—come at the cost of human and non-human nature. To respond to this, work must be reoriented toward social needs, mutual recognition and cooperation. However, achieving this vision requires more than individual moral commitments; it demands the transformations of sedimented habits, socio-economic relationships and their material expressions.
We investigate the motion of a thin liquid drop on a pre-stretched, highly bendable elastic sheet. Under the lubrication approximation, we derive a system of fourth-order partial differential equations, along with appropriate boundary and contact line conditions, to describe the evolution of the fluid interface and the elastic sheet. Extending the classical analysis of Cox and Voinov, we perform a four-region matched asymptotic analysis of the model in the limit of small slip length. The central result is an asymptotic relation for the contact line speed in terms of the apparent contact angles. We validate the relation through numerical simulations. A key implication of this result is that a soft substrate retards drop spreading but enhances receding, compared to the dynamics on a rigid substrate. The relation remains valid across a wide range of bending modulus, despite the distinguished limit assumed in the analysis.
At Balawat in 1956 M.E.L. Mallowan excavated a small group of 18 Neo-Assyrian documents near the Mamu Temple. These are now published here in copies by A.R. Millard and J.N. Postgate, along with four tablets from his later work at the site in 1957 which were not included in Barbara Parker’s edition of the majority of the texts from that season. They are all Neo-Assyrian utilitarian documents from the 7th century BC, mainly “legal” but in a few cases administrative. Parker observed (1963: 89) that the 1956 tablets “are a quite distinct group from the present collection” (that is, the 1957 group), and indeed there is little overlap in respect of content and prosopography between the two groups. A few of the 1956 tablets show that individuals whose private documents were kept in the town were engaged in agricultural and horticultural activities in (presumably) neighbouring villages, but they also include some rather informal conveyances of males and females.
This article discusses two imperial Roman literary descriptions of architectural space (Luc. 10.111–35 and Stat. Silv. 4.2) as responses to the real architectural space of two imperial palatial complexes in Rome, Nero’s Golden House and Domitian’s Palatine palace. Building on definitions of baroque spatiality in architecture and on concepts of literary space, it explores the interplay between the textual worlds created by these writers and the real spaces fashioned by Roman imperial architects. It considers the convergences and divergences between the architects’ ‘Baroque’ spatial strategies and the authors’ literary conceits that intimate an illusory materiality, and between the narrated memories or virtual reconstitutions of desolate imperial vastness and the physical experiences of populated space. Finally, it reflects on both differing and common perspectives towards real and literary space constructed in the ‘Baroque’ manner by considering neo-Baroque sensibilities today in both literature and the visual arts and how these might not only problematise but also allow a convergence between the spatial turn of archaeological studies and the exploration of similar spatialities in literary culture.
Quantum turbulence is characterised by the collective motion of mutually interplaying thin and discrete vortex filaments of fixed circulation which move in two mutually interacting fluid components. Despite this very peculiar nature determined by quantum-mechanical effects, turbulence in quantum fluids may exhibit very similar features to classical turbulence in terms of the vortex dynamics, energy spectrum and decay and intermittency. The recent work by Blaha et al. (2025 J. Fluid. Mech. 1015, A57) reveals an additional classical behaviour of quantum turbulence, by showing that the trajectories of starting vortices shed by accelerating airfoils in a quantum fluid are almost indistinguishable from their counterpart in classical viscous flows. These results strongly support the suggestive idea that turbulent flows, both classical and quantum, may be described by the collective dynamics of interacting, thin and discrete filaments of fixed circulation.
MacIntyrean business ethics research has focused on the concept of a practice, drawn primarily from After Virtue. MacIntyre later emphasized the need to adopt an account of human nature to provide a better grounding for his earlier social teleology. We consider three implications of incorporating the neo-Aristotelian and Thomistic account of human nature outlined in MacIntyre’s later works for MacIntyrean business ethics research: First, this account enables the MacIntyrean perspective to better ground its focus on practices as a key moral requirement for the organization of work. Second, it provides a better basis for distinguishing productive practices in good order from other business activities lacking the characteristics of a practice. Third, a theory incorporating an account of human nature, particularly MacIntyre’s notion of natural law, is better able to address broader questions in business ethics that are not directly concerned with the structure of work.
Microfluidic paper-based analytical devices (${\unicode{x03BC}}$PADs) have gained considerable attention due to their ability to transport fluids without external pumps. Fluid motion in ${\unicode{x03BC}}$PADs is driven by capillary forces through the network of pores within paper substrates. However, the inherently low flow speeds resulting from the small pore sizes in paper often limit the performance of ${\unicode{x03BC}}$PADs. Recent studies have introduced multilayered ${\unicode{x03BC}}$PADs composed of stacked paper sheets, which enable significantly faster fluid transport through inter-layer channels. In this study, we present a combined theoretical and experimental investigation of water imbibition dynamics through channels formed by multiple paper layers. Upon contact with water, the paper layers absorb water and undergo swelling, altering channel geometry and consequently affecting flow dynamics. We develop a mathematical model that extends the classical Washburn equation to incorporate the effects of water absorption and swelling. The model predictions show excellent agreement with experimental observations of water flow through multilayered paper channels. The results elucidate how water absorption and swelling influence capillary imbibition, and suggest potential strategies for regulating flow rates in multilayered ${\unicode{x03BC}}$PADs.
The pursuit of social justice in penal matters has regained momentum in Anglo-American criminal law debates. Among the various areas of discussion, a contentious issue is whether the social hardships that contribute to much criminal offending should be considered in the adjudication of criminal responsibility. Against this backdrop, this paper defends the position that chronic – ie long-lasting and ongoing – situations of social adversity can, in principle, warrant consideration in determinations of guilt. It therefore advances a proposal for a situational partial excuse (SPE) applicable to cases where criminal conduct is precipitated by conditions of chronic social adversity that unfairly diminish a person’s opportunity to do otherwise. Importantly, the proposed excuse also accounts for the compounding role of both state and societal neglect in diminishing an individual’s opportunities and resources to avoid wrongdoing. To this end, the paper integrates normative analysis with modern empirical insights into the relationship between adverse social contexts and crime, including through mechanisms of traumatic stress. It then elaborates the theoretical and doctrinal foundations of the SPE, articulates its statutory and evidentiary requirements, and discusses its coherence with core sentencing considerations.
The European red spider mite, Panonychus ulmi Koch (Acari: Tetranychidae), is a major mite pest affecting a wide range of crops globally. Its rapid development and extensive dispersal enable P. ulmi to form large colonies through arrhenotokous reproduction, which subsequently produces bisexual offspring following oedipal phase mating. In this study, life tables for arrhenotokous and bisexual P. ulmi populations were constructed and assessed using the age-stage two-sex life table theory. To assess whether maternal age affects the offspring sex ratio, 3D life table analysis was conducted for both groups. Population projection for P. ulmi bisexual and arrhenotokous was based on life table data to evaluate the effect of arrhenotokous reproduction on population growth. Bisexual population parameters were r = 0.1828 d−1, λ = 1.2006 d−1, R0 = 44.80 offspring, and T = 20.79 d. The theoretical calculation of these parameters cannot be performed solely based on the survival rate and female fecundity of the P. ulmi arrhenotokous population, as only male offspring were produced during the first seven days before the arrival of the bisexual population. Although arrhenotokous parthenogenesis yields fewer offspring than bisexual reproduction, it significantly influences population dynamics by enabling a single virgin female to establish a bisexual population. Controlling offspring sex ratios enables rapid population growth and colonisation of new habitats. A comprehensive understanding of arrhenotokous reproduction is crucial for developing effective management strategies for P. ulmi. Future research should integrate genomic, ecological, and evolutionary perspectives to bridge the gap between laboratory and field conditions.
This article explores the complex professional and personal relationship between Edward Hume, an American missionary physician, and Fu-ch’ing Yen, a Chinese physician trained in the United States, during their work at the Yale University medical mission in Changsha, Hunan, from 1906 to 1926. The partnership between Hume and Yen exemplifies the collaboration and compromise required to sustain and develop a major medical institution in provincial China, highlighting broader tensions in early twentieth-century Sino-American medical education and professional identity. Their differing priorities led to a temporary rift over the purpose of their work at the Yale mission, reflecting deeper debates about professional identity, Sino-foreign cooperation, and the evolving dynamics of Western medicine in China. Drawing on correspondence, institutional records, and contemporary reports, this study situates their partnership within broader trends of professionalisation and the localisation of scientific medicine in Republican China. It argues that the negotiation of professional status was pivotal in shaping the trajectory of their collaboration and offers insights into the local, structural, and personal dimensions of Sino-foreign cooperation in medical work.