Outcomes after bidirectional cavopulmonary shunt with antegrade pulmonary blood flow in high-risk patients.

OBJECTIVE: We have left antegrade pulmonary blood flow (APBF) at bidirectional cavopulmonary shunt (BCPS) only for high-risk patients. This study evaluates the indication and the outcomes of patients with APBF, compared to those without APBF. METHODS: Patients with APBF after BCPS were identified among patients who underwent BCPS between 1997 and 2022. Outcomes of patients with and without APBF after BCPS were compared. RESULTS: APBF was open in 38 (8.2%) of 461 patients. Median age (7.7 versus 6.3 months, p = 0.55) and weight (5.6 versus 6.1 kg, p = 0.75) at BCPS were similar in both groups. The most frequent indication for APBF was high pulmonary artery pressure (PAP) in 14 patients, followed by hypoxaemia in 10, and hypoplastic left pulmonary artery in 8. The source of APBF was the pulmonary trunk in 10 patients and the aortopulmonary shunt in 28. Median hospital stay after BCPS was longer (22 versus 14 days, p = 0.018) and hospital mortality was higher (10.5 versus 2.1%, p = 0.003) in patients with APBF compared to those without APBF. However, 448 hospital survivors showed similar survival after discharge following BCPS (p = 0.224). Survival after total cavopulmonary connection (TCPC) was similar between the groups (p = 0.753), although patients with APBF were older at TCPC compared to those without (3.9 versus 2.2 years, p = 0.010). CONCLUSION: APBF was left in 8% following BCPS in high-risk patients, mainly due to preoperative high PAP. Hospital survivors after BCPS demonstrated comparable survival in patients with and without APBF. Adding APBF at BCPS might be a useful option for high-risk patients.

Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications.

Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of effects, plausible pathways, and in some cases a causal link between social connection and later health outcomes. Societal trends across several indicators reveal increasing rates of those who lack social connection, and a significant portion of the population reporting loneliness. The scientific study on social isolation and loneliness has substantially extended over the past two decades, particularly since 2020; however, its relevance to health and mortality remains underappreciated by the public. Despite the breadth of evidence, several challenges remain, including the need for a common language to reconcile the diverse relevant terms across scientific disciplines, consistent multi-factorial measurement to assess risk, and effective solutions to prevent and mitigate risk. The urgency for future health is underscored by the potentially longer-term consequences of the COVID-19 pandemic, and the role of digital technologies in societal shifts, that could contribute to further declines in social, mental and physical health. To reverse these trends and meet these challenges, recommendations are offered to more comprehensively address gaps in our understanding, and to foster social connection and address social isolation and loneliness.

Social Determinants of COVID-19 Pandemic Control: Participatory Learnings From Everyday Experiences in Cape Town, South Africa.

INTRODUCTION: As countries adapted their disaster responses to the COVID-19 pandemic, South Africa responded with an alert-level risk approach based on epidemiological principles that impacted all societal levels. We explored the everyday experiences of people in Cape Town whose basic needs were met and who could report on the realities of the COVID-19 pandemic control. Gaining insight into their perspectives contributes to knowledge that can inform policies and practices for managing future public health crises. METHODS: Community-Based Participatory Research principles guided the design and a series of facilitated dialogues with 18 research participants. The thematic analysis was deepened through two colloquiums with members of an overarching research consortium and a participant reflection workshop. FINDINGS: The pandemic impacted individuals, their interpersonal relationships, workplaces and communities, leading to societal processes such as stigma, virtue signalling and the subversion of mandates. The public health response had mixed reactions, with useful information about preventive measures being diluted by COVID-19 denialism and fake news. Health and other authorities were frequently perceived as out of touch with, and unresponsive to, the everyday realities of local communities. CONCLUSIONS: Our study demonstrates the connectedness of people and the need to maintain and re-establish severed connections. A holistic approach to health care and promotion from social determinants of health and a community-engaged perspective may significantly increase the outcomes of public health responses. PARTICIPANT AND PUBLIC CONTRIBUTION: People with everyday experience of the COVID-19 pandemic-including community members, healthcare workers, case managers, carers and researchers-collaborated on the study design, interview schedule, data interpretation, analysis and refinement of this article.

The Impact and Feasibility of a Student-led Program to Connect Patients and Caregivers via Synchronous Audiovisual Technology During Restricted Visitation Policies.

OBJECTIVE: During the SARS-CoV-2 pandemic, hospital visitation restrictions hindered patients' access to vital social support. This study explores the impact and feasibility of a student-led program facilitating audiovisual communication between inpatient rehabilitation patients and their caregivers. METHODS: The study design employed a prospective observational approach, and convenience sampling enrolled 99 participants, including 33 patients, 33 caregivers, and 33 medical students. From September 2021 to March 2022, eligible patients admitted to an inpatient rehabilitation hospital identified a caregiver and participated in a 30-minute audiovisual call organized by a medical student. Post-visit surveys via RedCap were completed by all participants and covered limitations in video calls, program benefits, comfort levels in video conferencing, and overall program ratings. The study adopted a quantitative research paradigm for data analysis. Statistical analysis utilized pairwise McNemar's and Wilcoxon's test for inter-group comparison. RESULTS: Patients, caregivers, and medical students all reported positive outcomes in program offerings including providing social support, decreasing feelings of isolation, and providing a feeling of connection. Patients rated the program 4.82 ± 0.47 on a Likert scale, with 97% recommending it to others, even beyond visitation restrictions. The most common diagnosis among patients was stroke (30%), highlighting the program's potential applicability across diverse patient populations. Caregivers rated the program 4.59 ± 0.87 and expressed a desire for its continuation post-restrictions (80%). Medical students (81%) recommended the program, citing benefits in reducing social isolation and gaining clinical experience. No statistical differences were observed between groups in emotional and humanistic domains. CONCLUSION: This study highlights the potential for programs to utilize technology to address social isolation in the healthcare setting. When public health restrictions occur, medical educators should consider opportunities to support and foster innovation for student-led programs. Further research should explore broader impacts on healthcare outcomes and medical education.

A neural perspective on the treatment of hypertension: the neurological network excitation and inhibition (E/I) imbalance in hypertension.

Despite the increasing number of anti-hypertensive drugs have been developed and used in the clinical setting, persistent deficiencies persist, including issues such as lifelong dosage, combination therapy. Notwithstanding receiving the treatment under enduring these deficiencies, approximately 4 in 5 patients still fail to achieve reliable blood pressure (BP) control. The application of neuromodulation in the context of hypertension presents a pioneering strategy for addressing this condition, con-currently implying a potential central nervous mechanism underlying hypertension onset. We hypothesize that neurological networks, an essential component of maintaining appropriate neurological function, are involved in hypertension. Drawing on both peer-reviewed research and our laboratory investigations, we endeavor to investigate the underlying neural mechanisms involved in hypertension by identifying a close relationship between its onset of hypertension and an excitation and inhibition (E/I) imbalance. In addition to the involvement of excitatory glutamatergic and GABAergic inhibitory system, the pathogenesis of hypertension is also associated with Voltage-gated sodium channels (VGSCs, Nav)-mediated E/I balance. The overloading of glutamate or enhancement of glutamate receptors may be attributed to the E/I imbalance, ultimately triggering hypertension. GABA loss and GABA receptor dysfunction have also proven to be involved. Furthermore, we have identified that abnormalities in sodium channel expression and function alter neural excitability, thereby disturbing E/I balance and potentially serving as a mechanism underlying hypertension. These insights are expected to furnish potential strategies for the advancement of innovative anti-hypertensive therapies and a meaningful reference for the exploration of central nervous system (CNS) targets of anti-hypertensives.

National trends in loneliness and social isolation in older adults: an examination of subgroup trends over three decades in Sweden.

Introduction: Loneliness and social isolation are public health concerns. This study aimed to examine levels and trends in loneliness and social isolation among older adults (77+ years) in Sweden, assess subgroup variations, and determine associations between loneliness and social isolation. Methods: The 1992, 2002, 2004, 2011, 2014 and 2021 waves of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) were analysed through ordered logistic and linear regressions. Results: On average, 12.5 percent of the participants experienced loneliness often/nearly always, while 6 percent were categorised as severely isolated. Loneliness and social isolation were more common in women, those aged 85+, and persons with basic education, in psychological distress or with mobility limitations. Loneliness was also associated with living alone. No increases in loneliness or isolation were identified; instead, loneliness tended to decrease in groups already experiencing lower levels of loneliness. Loneliness and social isolation were moderately associated each survey year. Discussion: This study challenges perceptions of high and increasing levels of loneliness and social isolation. Given the impact on health and wellbeing and the ageing of populations, policy and practice should still address these issues and target vulnerable groups. Subgroup analyses in trends are scarce and should be explored further in future research.

Transformation trajectory of wetland and suitability of migratory water bird habitat in the moribund Ganges delta.

Wetland is a suitable habitat for water birds, and it enhances cultural ecosystem services. But the rapid transformation of such habitat, especially in floodplain environments, is an emerging crisis. Wetland reclamation and fragmentation are two major issues leading to poor habitat and landscape. The present paper aimed to explore the spatio-temporal changes in the suitability of wetland bird habitat, wetland landscape pattern, and the connection between them. Two wetlands, including a wetland of national importance, were taken as cases for this study. Time series Landsat and Sentinel images were taken for developing modeling parameters and Land Use Land Cover (LULC) for the years 2016 and 2020. The first transformation of wetland was accounted from the LULC maps of both years. Machine learning algorithm-based spatial models were developed for mapping the poor landscape condition of the existing wetland parts. Finally, semi-subjective analytic hierarchy approach (AHP)-based models were developed for assessing waterbird habitat suitability. Results demarcated more than 48% area belonging primarily to edges and tiny patches of wetlands under a poor state in 2020. Although the total wetland area was reduced between 2016 and 2020, the wetland area found to be highly suitable habitat increased from 25.5 to 59.44% of the total area during that period. The suitability of edge-preferring bird habitat showed a 10% increase. The increasing poverty of the landscape was caused by declining edge-preferring bird habitat suitability. From 1990 to 2020, 27% of wetlands were converted to single-cropped lands, and 5% were converted to multi-cropped agricultural land. Since the study spatially identified the potential suitable area and trend of wetland habitat transformation, this could help policymakers define suitable planning for the restoration and conservation of such promising bird habitat.

Keeping Students with Long-term Conditions Connected with Schools: Facilitators for Sustainable Virtual Connections.

Students with Long-Term Conditions (LTCs) experience prolonged absences that can impact their school connectedness and belonging. Inclusive education policies in New Zealand advocate for equitable learning opportunities for students with disabilities. Students with LTCs are included under this purview, but responses to their unique learning and connectedness needs are not well articulated. Literature suggests the potential of technology to enable virtual connections to keep these students' continued presence and engagement in class (i.e., sustainable connections). Studies internationally and in New Zealand, argue that virtual connections with schools can enhance educational opportunities and a sense of belonging for students with LTCs. However, limited research is available on developing and nurturing such ongoing connections with schools. This article reports on a qualitative study investigating New Zealand stakeholder perspectives on the facilitators of virtual connection with schools for students with LTCs. Findings from a thematic analysis of 18 individual interviews with stakeholders highlighted six facilitators for virtually connecting these students with schools, indicating the need for a flexible approach tailored to students' needs, strong support systems and purposeful, safe and inclusive connection opportunities. The stakeholders indicated these facilitators as essential for the virtual school connections to be sustainable and enhance students with LTCs' presence, belonging and social connection in schools.

Social Isolation and Hospitalization in Community-dwelling Older Adults by Dementia Status.

BACKGROUND: Social isolation is a well-known risk factor for poor health outcomes, including incident dementia, yet its associations with outcomes among persons living with dementia is understudied. We examined the association between social isolation and hospitalization among a nationally representative sample of older adults with and without dementia. METHODS: This observational cohort study included 5,533 community-dwelling Medicare beneficiaries from the 2015 and 2016 National Health and Aging Trends Study (NHATS). Using multivariable logistic regression analyses, we examined associations between social isolation and hospitalization in the following year, examining differences by dementia status. Social isolation was measured using a 4-item typology. Dementia was identified using a pre-specified classification in NHATS. RESULTS: 20.7% of older adults were socially isolated. Social isolation was more prevalent among persons with dementia (35.4%) than among those without dementia (19.0%) (p < .001). Among persons with dementia, social isolation was associated with 1.68 greater odds of hospitalization (CI: 1.23‒2.28), translating into a 9% average increase in the predicted probability of hospitalization for persons with dementia who were socially isolated compared to those who were not (p = 0.001). In the combined sample that included persons with and without dementia, there was a significant moderation effect of dementia on the association between social isolation and hospitalization (OR: 1.70; CI: 1.19‒2.43). CONCLUSIONS: For persons with dementia, social isolation is prevalent and associated with greater odds of subsequent hospitalization. Efforts to reduce acute healthcare utilization should explore ways to bolster social connection to improve health outcomes among persons with dementia.

Role of intergenerational connections in cognitive aging: Evidence from a Chinese longitudinal study.

Objective: To explore the impact of intergenerational connections on cognitive function in middle-aged and older adults (45-60 years and over 60 years, respectively) and analyze the urban-rural and sex differences in the effects of intergenerational connections on cognitive function. Method: Based on China Health and Retirement Longitudinal Study data (CHARLS), this study conducted ID matching for four waves of data from 2011, 2013, 2015, and 2018. Cognitive function was measured via Telephone Interview for Cognitive Status-modified (TICS-m), word recall, and imitation drawing. Using a combination of cross-sectional and longitudinal research, we constructed the cross-lagged panel model (CLPM) with a sample of 1,480 participants to explore the relationship between intergenerational connections and cognitive function. Results: This study examines the impact of intergenerational connections on cognitive function in middle-aged (45-60 years) and older adults (over 60 years) using data from the CHARLS. It identifies urban-rural and sex differences, with notable effects among rural female participants. The frequency of meeting with one child negatively predicts cognitive function (ß = -0.040, p = 0.041), and the frequency of communication with one child positively predicts cognitive function (ß = 0.102, 0.068, 0.041, p < 0.001, p = 0.001, 0.045). Meanwhile, intergenerational connections with multiple children positively predicts cognitive function (ß = 0.044, p = 0.031), (ß = 0.128, 0.084, and 0.056, p < 0.001, 0.001, p = 0.008). There are urban-rural and sex differences in the effects of intergenerational connections on cognitive function; additionally, the effects of intergenerational connections on cognitive function are significant in rural female middle-aged and older adults. Discussion: This study proposes the theory of skewed intergenerational support, which suggests that as middle-aged and older adults age, the responsibility for intergenerational support is skewed toward one child. This leads to conflicts between middle-aged and older parents and the child, which further affects cognitive function. In addition, this study put forward the boat-carrying theory of intergenerational relations and "to hold a bowl of water level" is the art of dealing with intergenerational relationships.

Commensal bacteria exacerbate seizure-like phenotypes in Drosophila voltage-gated sodium channel mutants.

Mutations in voltage-gated sodium (Nav) channels, which are essential for generating and propagating action potentials, can lead to serious neurological disorders, such as epilepsy. However, disease-causing Nav channel mutations do not always result in severe symptoms, suggesting that the disease conditions are significantly affected by other genetic factors and various environmental exposures, collectively known as the "exposome". Notably, recent research emphasizes the pivotal role of commensal bacteria in neural development and function. Although these bacteria typically benefit the nervous system under normal conditions, their impact during pathological states remains largely unknown. Here, we investigated the influence of commensal microbes on seizure-like phenotypes exhibited by paraShu-a gain-of-function mutant of the Drosophila Nav channel gene, paralytic. Remarkably, the elimination of endogenous bacteria considerably ameliorated neurological impairments in paraShu. Consistently, reintroducing bacteria, specifically from the Lactobacillus or Acetobacter genera, heightened the phenotypic severity in the bacteria-deprived mutants. These findings posit that particular native bacteria contribute to the severity of seizure-like phenotypes in paraShu. We further uncovered that treating paraShu with antibiotics boosted Nrf2 signaling in the gut, and that global Nrf2 activation mirrored the effects of removing bacteria from paraShu. This raises the possibility that the removal of commensal bacteria suppresses the seizure-like manifestations through augmented antioxidant responses. Since bacterial removal during development was critical for suppression of adult paraShu phenotypes, our research sets the stage for subsequent studies, aiming to elucidate the interplay between commensal bacteria and the developing nervous system in conditions predisposed to the hyperexcitable nervous system.

Hybrid stage 1 Norwood combined with reverse Blalock-Taussig shunt and sutureless repair of total anomalous pulmonary venous connections.

The patient is a 35-week-old, 2.6-kg neonate who was diagnosed prenatally with hypoplastic left heart syndrome and a supracardiac variant of total anomalous pulmonary venous connection. We present the technique of stage 1 hybrid palliation combined with repair of total anomalous pulmonary venous connection. Due to the risk of retrograde aortic arch obstruction from the ductal stents, a reverse Blalock-Taussig shunt was performed as well.

Management of Fallot's Uncorrected Tetralogy in Adulthood: A Narrative Review.

The majority of cyanotic congenital cardiac defects are caused by the tetralogy of Fallot. Some symptoms include a biventricular connection of the aortic root, right ventricular hypertrophy, blockage of the right ventricular outflow tract, and a ventricular septal defect. Our understanding of tetralogy of Fallot (TOF) has significantly advanced since it was first described in 1888, and early diagnosis has led to improved surgical management and increased life expectancy. Adults with unrepaired and repaired TOF present with a range of late complications, including heart failure, the need for re-interventions, and late arrhythmias. Right ventricular (RV) failure, often caused by chronic pulmonary regurgitation, is a significant cause of heart failure in patients with TOF. Current treatment options are limited, and mainstay surgical procedures such as pulmonary-valve replacement (PVR), trans-annular repair (TAR), or infundibular widening repair have not shown a significant reduction in preventing right ventricular (RV) failure or death. Here, we explain the mechanisms of RV failure in ToF, chronic pulmonary regurgitation, heart failure, and secondary polycythemia. HF management in untreated adults is discussed. The progression of the disease, as well as complications, are also discussed. The treatment plan and the need to investigate the best management approach for this unsolved problem are included. This review aims to fill the knowledge gaps and supply valuable information regarding mechanisms of RV failure, chronic pulmonary regurgitation, and secondary polycythemia. To summarize, a new combat strategy must be found to battle RVF, and a more profound vision of these mechanisms is required. If it is not corrected, it will be one of the future research lines that will contribute to designing more efficacious treatment techniques for adults with TOF.

Embodied earth kinship: interoceptive awareness and relational attachment personal factors predict nature connectedness in a structural model of nature connection.

Previous research has found that nature connectedness, an experiential close connection to nature with cognitive, affective and physical benefits, profoundly impacts individual wellbeing and subsequently increases pro-environmental behaviors. However, little is known about the personal and contextual factors that predict nature connectedness. Testing theory derived from a qualitative interpretative phenomenological analysis study, this research addresses the lacuna in the literature. A structural equation model analysis finds that interoceptive awareness significantly predicts nature connection, that secure attachment to nature significantly explains this relationship, and that these inter-related constructs predict both pro-environmental behavior and wellbeing. This revised model of nature connection indicates important antecedents for the human-nature bond, illuminating in particular that the interpersonal relational processes foundational for close bonding with humans also occur in bonding with nature. Structural equation modeling indicates that emotional awareness is the dimension of interoceptive awareness that most significantly predicts nature connection, suggesting that the more aware a person is of the connection between inner bodily sensations and emotions, the more likely they can bond with nature. Given that interoceptive awareness indicates a coherent relationship with the self, including effective communication between body, mind and feelings, this process is therefore implicated in the capacity for humans to bond with nature. In sum, this present research points to the efficacy of an embodied, secure attachment with nature to help close both the human-nature disconnection chasm, and the environmental value-action gap. Theoretical and methodological implications for research and policy are discussed.

Rapid Forming, Robust Adhesive Fungal-Sourced Chitosan Hydrogels Loaded with Deferoxamine for Sutureless Short-Gap Peripheral Nerve Repair.

Clinically, conventional sutures for repair of short-distance nerve injuries (< 5 mm) may contribute to uncontrolled inflammation and scar formation, thus negatively impacting nerve regeneration. To repair transected peripheral nerves with short distances, a rapid-forming, robust adhesive chitosan hydrogel is prepared by synthesizing maleic and dopamine bi-functionalized fungal-sourced chitosan (DM) and subsequently photopolymerizing DM precursor solution. The hydrogel rapidly polymerized under UV light irradiation (≈2 s) and possessed a strong adhesive strength (273.33 ± 55.07 kPa), facilitating a fast bonding of nerve stump. Especially, its tailored degradation profile over 28 days supported both early gap bridging and subsequent nerve regeneration. Furthermore, deferoxamine (DFO), a pro-angiogenic drug, is loaded into the hydrogel to reach sustainable release, accelerating axonal growth synergistically. A 3 mm long sciatic nerve defects model in rats is used to investigate the efficacy of DM@DFO hydrogel for repairing peripheral nerve defects. After 60 days, the DM@DFO hydrogel significantly outperformed conventional sutures and fibrin glue, improving motor and sensory recovery by reducing inflammation, inhibiting scar formation, and accelerating vascular regeneration within 14 days post-repair. This work highlights the DM@DFO hydrogel as a promising tissue adhesive for effective short-distance peripheral nerve repair.

Revolutionizing health monitoring: Integrating transformer models with multi-head attention for precise human activity recognition using wearable devices.

BACKGROUND: A daily activity routine is vital for overall health and well-being, supporting physical and mental fitness. Consistent physical activity is linked to a multitude of benefits for the body, mind, and emotions, playing a key role in raising a healthy lifestyle. The use of wearable devices has become essential in the realm of health and fitness, facilitating the monitoring of daily activities. While convolutional neural networks (CNN) have proven effective, challenges remain in quickly adapting to a variety of activities. OBJECTIVE: This study aimed to develop a model for precise recognition of human activities to revolutionize health monitoring by integrating transformer models with multi-head attention for precise human activity recognition using wearable devices. METHODS: The Human Activity Recognition (HAR) algorithm uses deep learning to classify human activities using spectrogram data. It uses a pretrained convolution neural network (CNN) with a MobileNetV2 model to extract features, a dense residual transformer network (DRTN), and a multi-head multi-level attention architecture (MH-MLA) to capture time-related patterns. The model then blends information from both layers through an adaptive attention mechanism and uses a SoftMax function to provide classification probabilities for various human activities. RESULTS: The integrated approach, combining pretrained CNN with transformer models to create a thorough and effective system for recognizing human activities from spectrogram data, outperformed these methods in various datasets - HARTH, KU-HAR, and HuGaDB produced accuracies of 92.81%, 97.98%, and 95.32%, respectively. This suggests that the integration of diverse methodologies yields good results in capturing nuanced human activities across different activities. The comparison analysis showed that the integrated system consistently performs better for dynamic human activity recognition datasets. CONCLUSION: In conclusion, maintaining a routine of daily activities is crucial for overall health and well-being. Regular physical activity contributes substantially to a healthy lifestyle, benefiting both the body and the mind. The integration of wearable devices has simplified the monitoring of daily routines. This research introduces an innovative approach to human activity recognition, combining the CNN model with a dense residual transformer network (DRTN) with multi-head multi-level attention (MH-MLA) within the transformer architecture to enhance its capability.

Influence of connection design and material properties on stress distribution and fatigue lifetime of zygomatic implants: A finite element analysis.

Zygomatic implants (ZIs) were developed as a graftless alternative to rehabilitate severely reabsorbed maxillae. This study aims to employ three-dimensional finite element analysis (FEA) to simulate the impact of external hexagonal implant connection (EHC) and internal hexagonal implant connection (IHC) on the stress distribution and fatigue lifetime within the ZI systems using parameters defined in ISO 14801:2016. Two ZI assemblies (Nobel Biocare and Noris Medical) were scanned in a micro-CT scanner and reconstructed using Nrecon software. Three-dimensional models were generated by Simpleware ScanIP Medical software. All models were exported to FEA software (ABAQUS) and subsequently to a fatigue analysis software (Fe-safe). A compressive 150 N load was applied at a 40° angle on the cap surface. A 15 Hz frequency was applied in the in silico cyclic test. The implant components had material properties of commercially pure grade 4 titanium (CPTi) and Titanium-6Aluminum-4Vanadium alloy (Ti64). Von Mises stress data, contour plots, and fatigue limits were collected and analyzed. EHC models exhibited higher peak stresses in implant components for both materials compared to IHC models. However, simulated bone support results showed the opposite trend, with higher stresses on IHCthan EHC models. The fatigue analysis revealed that assemblies with both designs exceeded ISO 14801:2016 number of cycles limits using Ti64, while CPTi groups exhibited comparatively lower worst life-repeats. In conclusion, ZIs with IHC were found to have a more homogeneous and advantageous stress distribution within both materials tested. Ti64 demonstrates a prolonged service life for both design connections.

Left pulmonary vein anatomical variation in Turner syndrome. Benefits of three-dimensional visualization for surgical planning.

A 41 year-old female with a medical history of Turner syndrome underwent a chest computed tomography (CT) scan which revealed a varicose left pulmonary vein and an endobronchial tumor of the left lower lobe. As venous drainage of each lobe seemed to be respected, surgical resection was considered. During surgical exploration, the absence of fissure and a unique venous trunk was observed. Surgical resection was aborted as only pneumonectomy was possible in this context. Endobronchial resection was performed. To better understand this particular anatomy, a three-dimensional (3D) reconstruction was performed a posteriori. This technique is already commonly used in the preoperative planning of pulmonary segmentectomy. Here, we have shown its interest in a lung malformative context.

Impact of the pulmonary venous entry site morphology on postoperative pulmonary vein stenosis in total anomalous pulmonary venous connection patients.

BACKGROUND: To evaluate the association between the pulmonary vein (PV) entry site morphology after total anomalous pulmonary vein repair (TAPVC) and postoperative pulmonary vein stenosis (PVS). METHODS: Computed tomography (CT) examination was performed to determine the PV entry site morphology. The width of the PV confluence was divided by the width of the left atrium (LA) to obtain the cPV/LA index. The cPV/LA index was compared between patients with and without postoperative PVS. RESULTS: Fifty-one patients who had undergone CT after TAPVC repair were included, with a median cPV/LA index of 0.5 (interquartile range (IQR) = 0.349-0.654). Among them, 27 patients developed postoperative PVS. The median cPV/LA index after primary TAPVC repair was significantly lower in patients with PVS compared to those without PVS (0.367, IQR = 0.308-0.433 vs. 0.657, IQR = 0.571-0.783, P < 0.0001). Additionally, the cPV/LA index after surgical re-intervention for PVS was significantly smaller in patients who developed recurrent stenosis compared to those who remained free-from re-stenosis after surgical relief (0.459, IQR = 0.349-0.556; vs. 0.706, IQR = 0.628-0.810, P = 0.0045). CONCLUSION: A small PV confluence width is associated with the development of postoperative PVS and recurrent stenosis after surgical relief of PVS. Our results suggest that adequate bilateral pulmonary vein lateralization during TAPVC surgery is crucial.

Children in out-of-home care's right to family and cultural connection: Aboriginal and/or Torres Strait Islander and non-Indigenous Australian children's perspectives.

BACKGROUND: Children have a right to participate in decisions about their lives. They also have the right to family and cultural connection, including when they are removed due to child protection concerns. However, the literature highlights barriers children in out-of-home care experience connecting to family-of-origin and culture. Moreover, this literature is predominantly from the perspective of practitioners and carers, with children's perspectives notably absent. OBJECTIVE: This qualitative study addresses this gap by exploring Aboriginal and/or Torres Strait Islander and non-Indigenous Australian children's perspectives and experiences of family and cultural connection while in out-of-home care. It seeks to uphold children's right to express their views on matters that impact their lives. PARTICIPANTS AND SETTING: The participants were 62 children aged 4-15 years (x̄=9 years), who were in out-of-home care in Queensland (Australia). Forty-two of the children were non-Indigenous and 20 identified as Aboriginal and/or Torres Strait Islander children. METHODS: Lundy's (2007) model of participation guided the data collection approach. Art-based graphic-elicitation interviews were conducted. Verbatim transcripts were analysed thematically. RESULTS: Children had differing levels of understanding as to why they could not reside with their family. Most children referred to a family-of-origin member not living with them as important in their lives, but it was not always their parent/s. Siblings were mentioned frequently. Barriers to connections with family included distance and cost of travel, parents not attending visits and being uncontactable, incarcerated or deceased. Whilst most children desired increased connection with family, a few wished for reduction or cessation. Aboriginal and/or Torres Strait Islander children showed varying levels of connection to culture with both siblings and carers playing key roles in enabling greater connection. CONCLUSIONS: Graphic-elicitation interviews provided an important opportunity for children to voice their experiences of and preferences regarding family and cultural connection. The inclusion of children's voices is needed to inform responsive policies and practices that safely support their rights to family and culture when in out-of-home care.