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This study aimed to investigate the effect of pulmonary regurgitation (PR) on left ventricular ventriculo–arterial (VA) coupling in patients with repaired tetralogy of Fallot (ToF). It was hypothesised that increasing PR severity results in a smaller forward compression wave (FCW) peak in the aortic wave intensity, because of right-to-left ventricular interactions. The use of cardiovascular magnetic resonance (CMR)-derived wave-intensity analysis provided a non-invasive comparison between patients with varying PR degrees. A total of n = 201 patients were studied and both hemodynamic and wave-intensity data were compared. Wave-intensity peaks and areas of the forward compression and forward expansion waves were calculated as surrogates of ventricular function. Any extent of PR resulted in a significant reduction in the FCW peak. A correlation was found between aortic distensibility and the FCW peak, suggesting unfavourable (VA) coupling in patients that also present stiffer ascending aortas. Data suggest that VA coupling is affected by increased impedance.

In the early 2030s, after the end of operations for the epochal Hubble Space Telescope and the long-anticipated James Webb Space Telescope, astrophysics will lose access to a general purpose high-spatial resolution space observatory to cover the UV–optical–NIR wavelength range with a variety of imaging bandpasses and high-multiplexing mid-resolution spectroscopy. This will greatly impact astrophysical “discovery space” at visible wavelengths, in stark contrast to progress at most other wavelengths enabled by groundbreaking new facilities between 2010 and 2030. This capability gap will foreseeably limit progress in a number of fundamental research directions anticipated to be pressing in the 2030’s and beyond such as: What are the histories of star formation and cosmic element production in nearby galaxies? What can we learn about the nature of dark matter from dwarf galaxies? What is the local value of the Hubble Constant? A multi-purpose optical–NIR imaging and multiplexed spectroscopy Workhorse Camera (HWC) onboard NASA’s 4m-class Habitable Exoplanet Observatory (HabEx) space mission would provide access to these required data. HabEx is currently under study by NASA for the US Decadal Survey on Astronomy and Astrophysics 2020, and if selected would launch around 2035. Aside from its direct imaging of Earth-like exoplanets, it will have a general-observatory complement of instrumentation. The versatile Workhorse Camera will provide imaging and R$\sim $ ∼ 1000 spectroscopy from 370nm to 1800nm, diffraction-limited over the whole wavelength range, with simultaneous observations of the visible and NIR. Spectroscopic multiplexing will be achieved through microshutter arrays. All necessary HWC technology is already at Technology Readiness Level 5, hence technological risks are low. HWC has a rough-order-of-magnitude (ROM) cost of 300 M€, and could be European-funded within the cost envelope of an ESA S-class mission in the Voyage 2050 program, with matching funds by national funding agencies to construct HWC by a European instrument consortium. This White Paper is intended to put a European HabEx Workhorse Camera into ESA’s considerations. If ESA shares the wide interest and if HabEx were to be selected by NASA, there would be ample time to identify interested institutes for a European instrument consortium, including MPIA, to design, finance, and build the HabEx Workhorse Camera.

Variability is a general property of accretion discs and their associated jets. We introduce a semi-analytic model for particle acceleration and radio jet/lobe evolution and explore the effect of Myr timescale jet variability on the particles accelerated by an AGN jet. Our work is motivated by the need for local powerful ultrahigh energy cosmic ray (UHECR) sources and evidence for variability in AGN and radio galaxies. Our main results are: i) UHECR and nonthermal radiative luminosities track the jet power but with a response set by the escape and cooling times, respectively; ii) jet variability produces structure in the electron, synchrotron and UHECR spectra that deviates from that produced for a constant jet power - in particular, spectral hardening features may be signatures of variability; iii) the cutoff in the integrated CR spectrum is stretched out due to the variation in jet power (and, consequently, maximum CR energy). The resulting spectrum is the convolution of the jet power distribution and the source term. We derive an approximate form for a log-normal distribution of powers; iv) we introduce the idea of $\sim 10$ GeV 'proxy electrons' that are cooling at the same rate that UHECRs of rigidity 10 EV are escaping from the source, and determine the corresponding photon frequencies that probe escaping UHECRs. Our results demonstrate the link between the history of an astrophysical particle accelerator and its particle contents, nonthermal emission and UHECR spectrum, with consequences for observations of radio galaxies and UHECR source models., 17 pages, 11 figures. Accepted to MNRAS

Machine learning encompasses statistical approaches such as logistic regression (LR) through to more computationally complex models such as neural networks (NN). The aim of this study is to review current published evidence for performance from studies directly comparing logistic regression, and neural network classification approaches in medicine. A literature review was carried out to identify primary research studies which provided information regarding comparative area under the curve (AUC) values for the overall performance of both LR and NN for a defined clinical healthcare-related problem. Following an initial search, articles were reviewed to remove those that did not meet the criteria and performance metrics were extracted from the included articles. Teh initial search revealed 114 articles; 21 studies were included in the study. In 13/21 (62%) of cases, NN had a greater AUC compared to LR, but in most the difference was small and unlikely to be of clinical significance; (unweighted mean difference in AUC 0.03 (95% CI 0-0.06) in favour of NN versus LR. In the majority of cases examined across a range of clinical settings, LR models provide reasonable performance that is only marginally improved using more complex methods such as NN. In many circumstances, the use of a relatively simple LR model is likely to be adequate for real-world needs but in specific circumstances in which large amounts of data are available, and where even small increases in performance would provide significant management value, the application of advanced analytic tools such as NNs may be indicated.

ObjectiveThe COVID-19 pandemic and subsequent government restrictions have had a major impact on healthcare services and disease transmission, particularly those associated with acute respiratory infection. This study examined non-identifiable routine electronic patient record data from a specialist children’s hospital in England, UK, examining the effect of pandemic mitigation measures on seasonal respiratory infection rates compared with forecasts based on open-source, transferable machine learning models.MethodsWe performed a retrospective longitudinal study of respiratory disorder diagnoses between January 2010 and February 2022. All diagnoses were extracted from routine healthcare activity data and diagnosis rates were calculated for several diagnosis groups. To study changes in diagnoses, seasonal forecast models were fit to prerestriction period data and extrapolated.ResultsBased on 144 704 diagnoses from 31 002 patients, all but two diagnosis groups saw a marked reduction in diagnosis rates during restrictions. We observed 91%, 89%, 72% and 63% reductions in peak diagnoses of ‘respiratory syncytial virus’, ‘influenza’, ‘acute nasopharyngitis’ and ‘acute bronchiolitis’, respectively. The machine learning predictive model calculated that total diagnoses were reduced by up to 73% (z-score: −26) versus expected during restrictions and increased by up to 27% (z-score: 8) postrestrictions.ConclusionsWe demonstrate the association between COVID-19 related restrictions and significant reductions in paediatric seasonal respiratory infections. Moreover, while many infection rates have returned to expected levels postrestrictions, others remain supressed or followed atypical winter trends. This study further demonstrates the applicability and efficacy of routine electronic record data and cross-domain time-series forecasting to model, monitor, analyse and address clinically important issues.

Multiwavelength observation of the gamma-ray burst, GRB 190114C, opens a new window for studying the emission mechanism of GRB afterglows. Its very high energy (VHE; ≳ 100 GeV) detection has motivated an inverse Compton interpretation for the emission, but this has not been tested. Here, we revisit the early afterglow emission from 68 to 180 s and perform the modelling likelihood analysis with the keV to TeV data sets. We compute for the first time the statistical preference in the combined synchrotron (syn) and synchrotron self-Compton (SSC) model over the syn-only model. In agreement with earlier analyses, between 68 and 110 s an unstable preference for the SSC model can be found, which can also be explained by systematic cross-calibration effect between the included instruments. We conclude that there is no stable statistical preference for one of the two models.

The origin of the Fermi bubbles, which constitute two gamma-ray emitting lobes above and below the Galactic plane, remains unclear. The possibility that this Fermi bubbles gamma-ray emission originates from hadronic cosmic rays advected by a subsonic Galactic outflow, or breeze, is here explored. The simulation of a breeze solution and subsequent cosmic ray transport is carried out using the hydrodynamical code, PLUTO, in combination with a cosmic ray transport code. The Galactic outflow model obtained is found to be compatible with both inferences of the decelerating outflow velocity profile of the gas in the Fermi bubbles region, and evidence for the presence of a large amount of hot ionized gas out in the Galactic halo region. Although simple, this model is found to be able to reproduce the observed Fermi-LAT energy flux at high Galactic latitudes. Following these results a prediction concerning the gamma-ray emission for 1–3 TeV photons is made for future comparison with CTA/SWGO measurements.

Monthly notices of the Royal Astronomical Society 517(2), 2534 - 2545 (2022). doi:10.1093/mnras/stac2778, We consider the synchrotron emission from electrons out in the Galactic halo bubble region where the Fermi bubble structures reside. Utilising a simple analytical expression for the non-thermal electron distribution and a toy magnetic field model, we simulate polarised synchrotron emission maps at a frequency of 30~GHz. Comparing these maps with observational data, we obtain constraints on the parameters of our toy Galactic halo bubble magnetic field model. Utilising this parameter value range for the toy magnetic field model, we determine the corresponding range of arrival directions and suppression factors of ultra high energy cosmic rays (UHECRs) from potential local source locations. We find that high levels of flux suppression (down to 2\%) and large deflection angles ($\geq 80^{\circ}$) are possible for source locations whose line-of-sight pass through the Galactic halo bubble region. We conclude that the magnetic field out in the Galactic halo bubble region can strongly dominate the level of deflection UHECRs experience whilst propagating from local sources to Earth., Published by Oxford Univ. Press, Oxford

Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). Findings We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9–6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40–59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. Interpretation We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. Funding UK Research and Innovation and National Institute for Health Research.

ObjectivesPatient-specific multiscale modeling simulates virtual surgeries of the Fontan procedure using three different graft options. Predictive modeling details post-operative outcomes that can help inform clinical decision support.MethodsSix patients underwent preoperative cardiac magnetic resonance imaging and catheterization. Virtual surgery is carried out for each patient to test the resulting hemodynamics of three Fontan graft options: ECC, 9mm Y-graft, and 12mm Y-graft.Results1) one-way ANOVA p>0.998 in all systemic pressures and flows between graft options, 2) p=0.706 for hepatic flow distribution between graft options, 3) local power loss differences do not affect the systemic circulation, 4) anastomosis positioning modification of the same Y-graft in the same patient changed left PA hepatic distribution from 0.66 to 0.49ConclusionsSystemic pressures and blood flow after the Fontan procedure are not affected by graft selection but are well influenced by patient pulmonary vascular impedance. The hepatic distribution can be affected by anastomosis placement.Ultra-mini abstractWe present the first case series of patient-specific multiscale modeling of the Fontan procedure. Despite noticeable local power loss differences, graft selection does not affect systemic pressure and flow rates or other clinically relevant quantities. Anastomosis placement can affect hepatic distribution.

A semi-analytical, fast and robust method for the propagation of ultra-high-energy cosmic rays (UHECR) under extra-galactic turbulent magnetic fields presented by the authors in previous works is described in detail. Under the assumption of dominant turbulent fields, it is possible to obtain the energy spectrum, as well as the relative contribution from each source, and the angular distribution of arrival directions without the need for 4-D simulations. This method provides an important tool in the quest for the origin of UHECR. A brief overview of the results already obtained with it is presented. The relative contribution to the energy spectrum from sources in different distance shells is elucidated and constraints of a few tens of Mpc, depending on composition, are imposed to the distance to the nearest source. A solid understanding of the arising of the dipole as well as its evolution with energy is built. The importance of a power spectrum analysis in energies detected by experiments is discussed.

Computed tomography (CT) has a well-established diagnostic role in the assessment of coronary arteries in adults. However, its application in a pediatric setting is still limited and often impaired by several technical issues, such as high heart rates, poor patient cooperation, and radiation dose exposure. Nonetheless, CT is becoming crucial in the noninvasive approach of children affected by coronary abnormalities and congenital heart disease. In some circumstances, CT might be preferred to other noninvasive techniques such as echocardiography and MRI for its lack of acoustic window influence, shorter acquisition time, and high spatial resolution. The introduction of dual-source CT has expanded the role of CT in the evaluation of pediatric cardiovascular anatomy and pathology. Furthermore, technical advances in the optimization of low-dose protocols represent an attractive innovation. Dual-source CT can play a key role in several clinical settings in children, namely in the evaluation of children with suspected congenital coronary artery anomalies, both isolated and in association with congenital heart disease. Moreover, it can be used to assess acquired coronary artery abnormalities, as in children with Kawasaki disease and after surgical manipulation, especially in case of transposition of the great arteries treated with arterial switch operation and in case of coronary re-implantation.

Objective: Habitual diet impacts mood and the human gastrointestinal (GI) microbiota. Yet, studies infrequently control for diet when evaluating associations between mood and GI microbiota. Accordingly, we aimed to investigate relationships among diet, GI microbiota, and mood in adults without mood disorders by conducting a cross-sectional examination of dietary intake, subjective emotional state, and fecal microbial taxa abundances.Methods: Adults (N = 133; 25–45 years of age) without physician-diagnosed mood disorders were studied. Fecal DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced. Sequences were analyzed using QIIME2. Subjective mood state was assessed using the 42-item Depression, Anxiety, and Stress Scale (DASS-42). Habitual dietary intake was measured with the National Cancer Institute's Diet History Questionnaire II, and diet quality was evaluated with the 2010 Healthy Eating Index (HEI).Results: Relationships were observed between 28 bacterial taxa and DASS-42 s...

Artificial intelligence (AI) offers the potential to change many aspects of paediatric cardiac imaging. At present, there are only a few clinically validated examples of AI applications in this field. This review focuses on the use of AI in paediatric cardiovascular MRI, using examples from paediatric cardiovascular MRI, adult cardiovascular MRI and other radiologic experience.

Energetic particles, such as stellar cosmic rays, produced at a heightened rate by active stars (like the young Sun) may have been important for the origin of life on Earth and other exoplanets. Here we compare, as a function of stellar rotation rate ($\Omega$), contributions from two distinct populations of energetic particles: stellar cosmic rays accelerated by impulsive flare events and Galactic cosmic rays. We use a 1.5D stellar wind model combined with a spatially 1D cosmic ray transport model. We formulate the evolution of the stellar cosmic ray spectrum as a function of stellar rotation. The maximum stellar cosmic ray energy increases with increasing rotation i.e., towards more active/younger stars. We find that stellar cosmic rays dominate over Galactic cosmic rays in the habitable zone at the pion threshold energy for all stellar ages considered ($t_*=0.6-2.9\,$Gyr). However, even at the youngest age, $t_*=0.6\,$Gyr, we estimate that $\gtrsim\,80$MeV stellar cosmic ray fluxes may still be transient in time. At $\sim1\,$Gyr when life is thought to have emerged on Earth, we demonstrate that stellar cosmic rays dominate over Galactic cosmic rays up to $\sim$4$\,$GeV energies during flare events. Our results for $t_*=0.6\,$Gyr ($\Omega = 4\Omega_\odot$) indicate that $\lesssim$GeV stellar cosmic rays are advected from the star to 1$\,$au and are impacted by adiabatic losses in this region. The properties of the inner solar wind, currently being investigated by the Parker Solar Probe and Solar Orbiter, are thus important for accurate calculations of stellar cosmic rays around young Sun-like stars., Comment: 14 pages, 8 figures, accepted for publication in MNRAS

37th International Cosmic Ray Conference, ICRC 2021, Berlin, online, Germany, 12 Jul 2021 - 23 Jul 2021; Proceedings of Science / International School for Advanced Studies (ICRC2021), 1391 (2021). doi:10.22323/1.395.1391, In a collaboration between astroparticle physicists, animation artists from the award-winning Science Communication Lab, and musician Carsten Nicolai (a.k.a. Alva Noto), two cosmic particle accelerators have been brought to life: the massive binary star Eta Carinae, and the exploding star, which resulted in the gamma-ray burst GRB190829A. For Eta Carinae, the computer-generated images are close to reality because the measured orbital, stellar, and wind parameters were used for this purpose. Particle acceleration in the jet of GRB190829A has also been animated at a level of detail not seen before. The internationally acclaimed multimedia artist Carsten Nicolai, who uses the pseudonym Alva Noto for his musical works, exclusively composed the sound for the animations. The multimedia projects aim at making the discoveries more accessible to the general public, and to mediate scientific results and their reference to reality from an artistic point of view., Published by SISSA, Trieste

Machine learning (ML) holds great potential for predicting clinical outcomes in heterogeneous chronic respiratory diseases (CRD) affecting children, where timely individualised treatments offer opportunities for health optimisation. This paper identifies rate-limiting steps in ML prediction model development that impair clinical translation and discusses regulatory, clinical and ethical considerations for ML implementation. A scoping review of ML prediction models in paediatric CRDs was undertaken using the PRISMA extension scoping review guidelines. From 1209 results, 25 articles published between 2013 and 2021 were evaluated for features of a good clinical prediction model using the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) guidelines.Most of the studies were in asthma (80%), with few in cystic fibrosis (12%), bronchiolitis (4%) and childhood wheeze (4%). There were inconsistencies in model reporting and studies were limited by a lack of validation, and absence of equations or code for replication. Clinician involvement during ML model development is essential and diversity, equity and inclusion should be assessed at each step of the ML pipeline to ensure algorithms do not promote or amplify health disparities among marginalised groups. As ML prediction studies become more frequent, it is important that models are rigorously developed using published guidelines and take account of regulatory frameworks which depend on model complexity, patient safety, accountability and liability.

In univentricular (Fontan) physiology, peripheral and splanchnic vascular tone may be raised to counteract reduced cardiac output (CO) and elevated central venous pressure and thus maintain vital organ perfusion. This could negatively affect the normal cardiovascular response to food ingestion, where mesenteric vasodilation and a concurrent rise in CO are central. We sought to elucidate this using rapid cardiovascular MRI. Thirty fasting subjects (50% controls, 40% women and 60% men) ingested a standardized meal. Responses over ~50 min in mean arterial pressure (MAP), CO, and blood flow in all major aortic branches were measured, and regional vascular impedance (Z(0)) was calculated. Differences from baseline and between groups were assessed by repeated-measures mixed models. Compared with the control group, the Fontan patient group had greater fasting Z(0) of the legs and kidneys, resulting in greater systemic Z(0) and similar MAP. They further had similar blood flow to the digestive organs at baseline, despite larger variation in mesenteric resistance. Postprandially, blood flow to the legs decreased in the control group but not in the Fontan patient group. Increases in CO and superior mesenteric blood flow were similar in both groups, but the celiac response was blunted in the Fontan patient group. No significant differences in MAP responses were observed. In conclusion, alterations in vascular tone to counteract adverse hemodynamics and raised hepatic afterload may blunt vasoreactivity in the legs and the celiac axis in Fontan physiology. Further study is needed to determine whether blunted celiac or mesenteric vasoreactivity is linked to deteriorating hemodynamics and poor prognosis in Fontan patients. NEW & NOTEWORTHY Novel data on cardiovascular physiology in response to a meal in Fontan patients are presented. Using a previously validated dynamic MRI protocol, we demonstrated that the usual increase in cardiac output and the dilation of the superior mesenteric artery are preserved in clinically well Fontan patients. In contrast, vasoconstriction of the legs may have prevented redistribution of blood flow from this region in response to the meal. This may also affect responses to other types of stress. Celiac vasodilation was also absent in Fontan patients. This may be due to abnormal hepatic circulation. The proposed protocol may be used to study Fontan complications secondary to abnormal regional hemodynamics.

BackgroundThere is evolving evidence of significant differences in severity and outcomes of coronavirus disease 2019 (COVID-19) in children compared to adults. Underlying medical conditions associated with increased risk of severe disease are based on adult data, but have been applied across all ages resulting in large numbers of families undertaking social ‘shielding’ (vulnerable group). We conducted a retrospective analysis of children with suspected COVID-19 at a Specialist Children’s Hospital to determine outcomes based on COVID-19 testing status and underlying health vulnerabilities.MethodsRoutine clinical data were extracted retrospectively from the Institution’s Electronic Health Record system and Digital Research Environment for patients with suspected and confirmed COVID-19 diagnoses. Data were compared between Sars-CoV-2 positive and negative patients (CoVPos / CoVNeg respectively), and in relation to presence of underlying health vulnerabilities based on Public Health England guidance.FindingsBetween 1st March and 15th May 2020, 166 children (pp=0.002), but no difference in proportion of vulnerable patients requiring ventilation (61% vs 64.3%, p = 0.84) between CoVPos and CoVNeg groups. However, a significantly lower proportion of CoVPos patients required mechanical ventilation support compared to CoVNeg patients (27.7 vs 57.4%, pp=0.67) although there were no direct COVID-19 related deaths in this highly preselected paediatric population.InterpretationCOVID-19 infection may be associated with severe disease in childhood presenting to a specialist hospital, but does not appear significantly different in severity to other causes of similar clinical presentations. In children presenting with pre-existing ‘COVID-19 vulnerable’ medical conditions at a specialist centre, there does not appear to be significantly increased risk of either contracting COVID-19 or severe complications, apart from those undergoing chemotherapy, who are over-represented.

Neonates with CHD are at increased risk of developing necrotising enterocolitis due to mesenteric hypoperfusion. Necrotising enterocolitis results in repeated feed interruptions contributing to poor growth during the early post-operative phase. Poor weight gain and longer hospital stay are risk factors for death in neonates with CHD. Abdominal radiography is used as a diagnostic tool for necrotising enterocolitis; however, its utility is limited in the early stages of necrotising enterocolitis when pneumatosis intestinalis is absent. Calprotectin is a neutrophil activation biomarker, and elevated levels are evident in inflammatory diseases such as necrotising enterocolitis. The aim of this study was to determine whether there is a correlation between faecal calprotectin concentration and gut inflammation in neonates with CHD. This prospective single-centre study recruited newly diagnosed term patients with duct-dependent CHD between March 2018 and March 2019. Faecal calprotectin concentrations were measured in post-surgical patients using enzyme-linked immunosorbent assay methods. A total of 30 patients were included in the analysis. Calprotectin concentration for patients who developed necrotising enterocolitis was 3528 µg/g compared with 390 µg/g without, compared with 1339 µg/g in patients with suspected necrotising enterocolitis (p = 0.0001). Patients with suspected necrotising enterocolitis had a significantly longer length of hospital stay, on average 18 days longer compared to patients without necrotising enterocolitis (p = 0.03). Faecal calprotectin concentrations may reflect severity of gut inflammation in neonates with CHD. Suspected necrotising enterocolitis contributes to longer days nil by mouth and an increase in length of hospital stay.

Transcatheter aortic valve implantation (TAVI) still presents complications: paravalvular leakage (PVL) and onset of conduction abnormalities leading to permanent pacemaker implantation. Our aim was testing a validated patient-specific computational framework for prediction of TAVI outcomes and possible complications. Twenty-eight TAVI patients (14 SapienXT and 14 CoreValve) were retrospectively selected. Pre-procedural CT images were post-processed to create 3D patient-specific implantation sites. The procedures were simulated with finite element analysis. Simulations’ results were compared against post-procedural clinical fluoroscopy and echocardiography images. The computational model was in good agreement with clinical findings: the overall stent diameter difference was 2.6% and PVL was correctly identified with a post-processing algorithm in 83% of cases. Strains in the implantation site were studied to assess the risk of conduction system disturbance and were found highest in the patient who required pacemaker implantation. This study suggests that computational tool could support safe planning and broadening of TAVI.

Background Avocados are rich in dietary fiber and monounsaturated fatty acids (MUFAs), nutrients that have been independently connected to metabolic health benefits and the gastrointestinal microbiota. Objectives We aimed to evaluate the impact of avocado consumption on the gastrointestinal microbiota and microbial metabolites, secondary outcomes of the Persea americana for Total Health (PATH) study, and conduct exploratory analyses to assess relations between the fecal microbiota, fecal metabolites, and health markers. Methods Adults [n = 163, 25-45 y, BMI (kg/m2) ≥ 25.0] were enrolled in the PATH study, a 12-wk investigator-blinded trial where participants were batch randomized to match the 2 groups by age, sex, visceral adiposity, and fasting glucose concentrations. Participants consumed isocaloric meals with or without avocado (175 g, men; 140 g, women) once daily for 12 wk. The fecal microbiota was assessed with 16S ribosomal RNA gene (V4 region) sequencing and analysis using DADA2 and QIIME2. Fecal fatty acid and bile acid concentrations were quantified using GC and LC-MS. Per-protocol (≥80% meal consumption) and intent-to-treat analyses were conducted using univariate ANOVA and Mann-Whitney U tests. Bivariate correlations were conducted between fecal microbiota, fecal metabolites, and health measures. Results The avocado treatment increased ɑ diversity and enriched Faecalibacterium, Lachnospira, and Alistipes between 26% and 65% compared with the control group. The avocado group had 18% greater fecal acetate, 70% greater stearic acid, and 98% greater palmitic acid concentrations than the control group, while the concentrations of the bile acids cholic and chenodeoxycholic acid were 91% and 57% lower, respectively. Conclusions Daily avocado consumption resulted in lower fecal bile acid concentrations, greater fecal fatty acid and SCFAs, and greater relative abundances of bacteria capable of fiber fermentation, providing evidence that this nutrient-dense food affects digestive physiology, as well as the composition and metabolic functions of the intestinal microbiota. This trial was registered at www.clinicaltrials.gov as NCT02740439.

The most powerful persistent accelerators in the Universe are jetted active galaxies. Blazars, galaxies whose jets are directed towards Earth, dominate the extragalactic gamma-ray sky. Still, most of the highest-energy particle accelerators likely elude detection. These extreme blazars, whose radiated energy can peak beyond 10 TeV, are ideal targets to study particle acceleration and radiative processes, and may provide links to cosmic rays and astrophysical neutrinos. The growing number of extreme blazars observed at TeV energies has been critical for the emergence of gamma-ray cosmology, including measurements of the extragalactic background light, tight bounds on the intergalactic magnetic field, and constraints on exotic physics at energies inaccessible with human-made accelerators. Tremendous progress has been achieved over the past decade, which bodes well for the future, particularly with the deployment of the Cherenkov Telescope Array., Comment: 8 pages, 4 figures, 1 table. Accepted version (posted 6 months after publication)

The astrophysical journal / 2 902(1), L7 (2020). doi:10.3847/2041-8213/abb8e1, We report the identification of the polarization of ground state absorption lines from post-AGB 89~Hercules. Two ground state neutral iron lines are found to have counterintuitive high-amplitude polarizations and an unchanged polarization direction through the orbital period, as opposed to the pattern of polarizations of absorption lines from excited states, which are synchronized with the orbital phase owing to optical pumping. This can be explained with magnetic realignment on the ground state. The 3D mean magnetic field is thereby unveiled from the degree and direction of the polarizations of the two iron lines. The field strength is also constrained to be $\lesssim 100\,{\rm mG}$. Our result has thus improved the accuracy by orders of magnitude compared to the previous $10\,{\rm G}$ upper limit set by non-detection of the Zeeman effect., Published by Institute of Physics Publ., London

Nonunions are a relevant economic burden affecting about 1.9% of all fractures. Rather than specifying a certain time frame, a nonunion is better defined as a fracture that will not heal without further intervention. Successful fracture healing depends on local biology, biomechanics and a variety of systemic factors. All components can principally be decisive and determine the classification of atrophic, oligotrophic or hypertrophic nonunions. Treatment prioritizes mechanics before biology. The degree of motion between fracture parts is the key for healing and is described by strain theory. If the change of length at a given load is > 10%, fibrous tissue and not bone is formed. Therefore, simple fractures require absolute and complex fractures relative stability. The main characteristics of a nonunion are pain while weight bearing, and persistent fracture lines on X-ray. Treatment concepts such as ‘mechanobiology’ or the ‘diamond concept’ determine the applied osteosynthesis considering soft tissue, local biology and stability. Fine wire circular external fixation is considered the only form of true biologic fixation due to its ability to eliminate parasitic motions while maintaining load-dependent axial stiffness. Nailing provides intramedullary stability and biology via reaming. Plates are successful when complex fractures turn into simple nonunions demanding absolute stability. Despite available alternatives, autograft is the gold standard for providing osteoinductive and osteoconductive stimuli. The infected nonunion remains a challenge. Bacteria, especially staphylococcus species, have developed mechanisms to survive such as biofilm formation, inactive forms and internalization. Therefore, radical debridement and specific antibiotics are necessary prior to reconstruction. Cite this article: EFORT Open Rev 2020;5:46-57. DOI: 10.1302/2058-5241.5.190037

We update the constraints on the location of the nearest ultrahigh energy cosmic ray (UHECR) source. By analyzing recent data from the Pierre Auger Observatory using state-of-the-art CR propagation models, we reaffirm the need of local sources with a distance less than 25-100 Mpc, depending on mass composition. A new fast semianalytical method for the propagation of UHECR in environments with turbulent magnetic fields is developed. The onset of an enhancement and a low-energy magnetic horizon of cosmic rays from sources located within a particular distance range is demonstrated. We investigate the distance to the nearest source, taking into account these magnetic field effects. The results obtained highlight the robustness of our constrained distances to the nearest source.

In this chapter, we present an overview of the most common computational and physical 3D modeling methodologies that have evolved in the past 50 years to help solve clinical cardiac problems and ultimately answer the question: what is the best treatment for my patient? We highlight the most significant advances of these engineering techniques from the earliest attempts to the most recent results, boosted by the ever-growing medical imaging field and computer power. Examples and applications are from congenital and structural acquired heart disease, relevant to pathophysiological understanding of the cardiovascular system, clinical decision-making, surgical planning, device design, and education.

Fluvial strata of the Lower Cretaceous Ghaggar-Hakra Formation are exposed in fault blocks on the central-eastern margin of the Barmer Basin, Rajasthan. The sedimentology of these outcrops is described from 114 logs (thicknesses up to 100 m) and 53 two-dimensional correlation panels. The formation comprises three distinct channel-belt sandstone packages defined as the Darjaniyon-ki Dhani, Sarnoo and Nosar sandstones separated by thick siltstone-dominated floodplain successions. The sediments were deposited in a sub-tropical, low sinuosity fluvial system that matures into a highly sinuous fluvial system. The Nosar Sandstone, the youngest of the three packages, exhibits a significant increase in energy and erosive power compared to those underlying it. This distinct change in fluvial style is interpreted to be rejuvenation due to an actively developing rift network forming accommodation space, rather than climatic controls acting on part of the depositional system. Consequently, the Ghaggar-Hakra Formation at outcrop represents Lower Cretaceous syn-rift deposition within the Barmer Basin with active localised fault movement The Depositional Record 2 from Nosar Sandstone times onward. These findings provide sedimentological evidence in support of pre-Palaeogene northwest-southeast extension in the Barmer Basin. Moreover, they imply Cretaceous extension took place widely along the northern extremity of the West Indian Rift System consistent with plate tectonic models of the break-up of Gondwana and evolution of the Indian Ocean. Outcrops of Lower Cretaceous strata are patchy across India and Pakistan. This study provides valuable material which, when combined with the available published data, facilitates a re-evaluation of Lower Cretaceous palaeogeography for the northwest Indian Plate. The reconstruction demonstrates a complex fluvial system, where the sediments are preserved sporadically as early syn-rift strata. The findings imply a high preservation potential for early Cretaceous fluvial successions within rifted fault blocks near Saraswati and Ashiwarya of the Barmer Basin beneath the Palaeogene fill that likely have significant potential for further hydrocarbon exploration.

Objective: Pre-clinical evidence suggests that the gastrointestinal microbiota contributes to mood and behavior disorders. Among humans, diet quality and patterns, which also impact the gastrointes...