Greater Complexity Research Articles

In-Hospital Death and End-of-Life Status Among Patients With Adult Congenital Heart Disease - A Retrospective Study Using the JROAD-DPC Database in Japan.

The end-of-life (EOL) status, including age at death and treatment details, of patients with adult congenital heart disease (ACHD) remains unclear. This study investigated the EOL status of patients with ACHD using a nationwide Japanese database.Methods and Results: Data on the last hospitalization of 26,438 patients with ACHD aged ≥15 years, admitted between 2013 and 2017, were included. Disease complexity (simple, moderate, or great) was classified using International Classification of Diseases, 10th Revision codes. Of the 853 deaths, 831 patients with classifiable disease complexity were evaluated for EOL status. The median age at death of patients in the simple, moderate, and great disease complexity groups was 77.0, 66.5, and 39.0 years , respectively. The treatments administered before death to patients in the simple, moderate, and great complexity groups included cardiopulmonary resuscitation (30.1%, 35.7%, and 41.9%, respectively), percutaneous cardiopulmonary support (7.2%, 16.5%, and 16.3%, respectively), and mechanical ventilation (58.7%, 72.2%, and 75.6%, respectively). Overall, 70% of patients died outside of specialized facilities, with >25% dying after ≥31 days of hospitalization. Nationwide data showed that patients with ACHD with greater disease complexity died at a younger age and underwent more invasive treatments before death, with many dying after ≥1 month of hospitalization. Discussing EOL options with patients at the appropriate time is important, particularly for patients with greater disease complexity.

Dominance of transposable element-related satDNAs results in great complexity of “satDNA library” and invokes the extension towards “repetitive DNA library”

Research on bivalves is fast-growing, including genome-wide analyses and genome sequencing. Several characteristics qualify oysters as a valuable model to explore repetitive DNA sequences and their genome organization. Here we characterize the satellitomes of five species in the family Ostreidae (Crassostrea angulata, C. virginica, C. hongkongensis, C. ariakensis, Ostrea edulis), revealing a substantial number of satellite DNAs (satDNAs) per genome (ranging between 33 and 61) and peculiarities in the composition of their satellitomes. Numerous satDNAs were either associated to or derived from transposable elements, displaying a scarcity of transposable element-unrelated satDNAs in these genomes. Due to the non-conventional satellitome constitution and dominance of Helitron-associated satDNAs, comparative satellitomics demanded more in-depth analyses than standardly employed. Comparative analyses (including C. gigas, the first bivalve species with a defined satellitome) revealed that 13 satDNAs occur in all six oyster genomes, with Cg170/HindIII satDNA being the most abundant in all of them. Evaluating the “satDNA library model” highlighted the necessity to adjust this term when studying tandem repeat evolution in organisms with such satellitomes. When repetitive sequences with potential variation in the organizational form and repeat-type affiliation are examined across related species, the introduction of the terms “TE library” and “repetitive DNA library” becomes essential.

C-Reactive Protein and Long-Term Prognosis in Adult Patients with Congenital Heart Disease.

Background/Objectives: Prognostic biomarkers may provide information about the patient's cardiovascular outcomes. However, there are doubts regarding how high-sensitivity C-reactive protein (hs-CRP) impacts patients with congenital heart disease (CHD). The main objective is to evaluate whether high hs-CRP levels predict a worse prognosis in patients with CHD. Methods: Observational and prospective cohort study. Adult CHD patients and controls were matched for age and sex. Results: In total, 434 CHD patients (cases) and 820 controls were studied. The median age in the CHD patients was 30 (18-62) years and 256 (59%) were male. A total of 51%, 30%, and 19% of patients with CHD had mild, moderate, and great complexity defects, respectively. The body mass index [1.07 (1.01-1.13), p = 0.022)], diabetes mellitus [3.57 (1.07-11.97), p = 0.039], high NT-pro-BNP levels [1.00 (1.00-1.01), p = 0.021], and low serum iron concentrations [0.98 (0.97-0.99), p = 0.001] predicted high hs-CRP levels (≥0.3 mg/dL) in patients with CHD. During a follow-up time of 6.81 (1.17-10.46) years, major cardiovascular events (MACE) occurred in 40 CHD patients, showing the Kaplan-Meier test demonstrated a worse outcome among patients with hs-CRP levels above 0.3 mg/dL (p = 0.012). Also, hs-CRP showed statistical significance in the univariate Cox regression survival analysis. However, after adjusting for other variables, this significance was lost and the remaining predictors of MACE were age [HR 1.03 (1.01-1.06), p = 0.001], great complexity defects [HR 2.46 (1.07-5.69), p = 0.035], and an NT pro-BNP cutoff value for heart failure > 125 pg/mL [HR 7.73 (2.54-23.5), p < 0.001]. Conclusions: Hs-CRP obtained statistical significance in the univariate survival analysis. However, this significance was lost in the multivariate analysis in favor of age, CHD complexity, and heart failure.

THE COLLECTION OF STUDIES “VIOLINSCHULWERK” IN KLAUS HERTEL PUBLISHING HOUSE - ULFERT THIEMANN - METHODICAL APPROACHES TO VIOLIN TECHNIQUE

The education of technical-interpretive skills from various methodical perspectives, with disciplinary tangents, represents a topic of great importance and topicality of instrumental pedagogy. The collection of studies “Violinschulwerk” edited by the renowned pedagogues and performers Klaus Hertel and Ulfert Thiemann welcomes violin students, future teachers, with a selection of studies and caprices of great variety and technical complexity, belonging to prominent representatives of the main violin schools. The included contents guide the instrumentalist towards a complete approach in interpretation, with the inherent realization of the correlation between technique - musical theory - style.

The first degree-scale starlight-polarization-based tomography map of the magnetized interstellar medium

We present the first degree-scale tomography map of the dusty magnetized interstellar medium (ISM) from stellar polarimetry and distance measurements. We used the RoboPol polarimeter at Skinakas Observatory to conduct a survey of the polarization of starlight in a region of the sky of about four square degrees. We propose a Bayesian method to decompose the stellar-polarization source field along the distance to invert the three-dimensional (3D) volume occupied by the observed stars. We used this method to obtain the first 3D map of the dusty magnetized ISM. Specifically, we produced a tomography map of the orientation of the plane-of-sky component of the magnetic field threading the diffuse, dusty regions responsible for the stellar polarization. For the targeted region centered on Galactic coordinates (l, b) ≈ (103.3°, 22.3°), we identified several ISM clouds. Most of the lines of sight intersect more than one cloud. A very nearby component was detected in the foreground of a dominant component from which most of the polarization signal comes and which we identified as being an intersection of the wall of the Local Bubble and the Cepheus Flare. Farther clouds, with a distance of up to 2 kpc, were similarly detected. Some of them likely correspond to intermediate-velocity clouds seen in H I spectra in this region of the sky. We found that the orientation of the plane-of-sky component of the magnetic field changes along distance for most of the lines of sight. Our study demonstrates that starlight polarization data coupled to distance measures have the power to reveal the great complexity of the dusty magnetized ISM in 3D and, in particular, to provide local measurements of the plane-of-sky component of the magnetic field in dusty regions. This demonstrates that the inversion of large data volumes, as expected from the PASIPHAE survey, will provide the necessary means to move forward in the modeling of the Galactic magnetic field and of the dusty magnetized ISM as a contaminant in observations of the cosmic microwave background polarization.

Clinical Biomarkers of Acute Vaso-Occlusive Sickle Cell Crisis.

It is known that an inherited blood condition called sickle cell disease (SCD) is a result of one gene. A number of blood and urine biomarkers have been determined in association with lab and clinical history for SCD patients. SCD has numerous interacting pathways associated with it, which have been identified by biomarkers. These mechanisms consist of some examples, such as endothelial vasodilation response, hypercoagulability, hemolysis, inflammation, oxidative stress, vascular dysfunction, and reperfusion injury among others. To effectively manage SCD, a comprehensive panel of validated blood and urine biomarkers must be established. Despite its monogenic inheritance, the complex nature of the SCD phenotype has impeded progress in its treatment. However, significant strides have been made in clinical biotechnology, paving the way for potential breakthroughs. In SCD, a panel of verified blood and urine biomarkers must be established, however. Despite monogenic inheritance, the great complexity of the SCD phenotype has hindered progress in its management. With few exceptions, clinical biomarkers of illness severity have been found through epidemiological investigations; nevertheless, systematic integration of these biomarkers into clinical treatment algorithms has not occurred. Furthermore, sickle cell crisis, the primary acute consequence of SCD, has been difficult to diagnose with the biomarkers now in use. Inadequate care and a lack of appropriate outcome measures for clinical research are the consequences of these diagnostic constraints. A new chapter in SCD customized treatment has begun with recent advancements in molecular and imaging diagnostics. Strategies in precision medicine are especially relevant now that molecular therapies are within reach. The significance of biochemical indicators linked to clinical manifestation and sub-phenotype identification in SCD is reviewed in this research.

Dynamic re-sedimentation of lacustrine carbonates in the Búzios Field, pre-salt section of Santos Basin, Brazil

The huge oil accumulations in the South Atlantic Pre-Salt section have driven studies that seek a greater understanding of the origin and evolution of these important reservoirs. Lacustrine carbonate intraclastic deposits correspond to the main reservoirs in the Búzios Field, currently with the highest daily production wells in the world, and in other Santos Basin fields. However, few studies were dedicated to these deposits due to the great complexity of Pre-Salt deposits and the lack of analogs. These factors have generated intense controversies in the interpretation of their depositional models. A systematic petrographic characterization allowed detailed characterization of the textures and primary constituents in the rift and sag sections of a well in the Búzios Field. The bioclastic accumulations of the rift Itapema Formation, show features indicative of reworking, such as abrasion, fragmentation and disarticulation of the bivalve bioclasts. Moreover, the bioclasts occur mainly within intraclasts and as nuclei of ooids, characteristics of multicycle redeposition. The massive structure of these deposits, the lack of characteristic wave structures, their distribution in lows and conspicuous mixing with stevensitic grains indicate their gravitational redeposition, as result of the intense tectonic activity during the rift phase. The sag phase Barra Velha Formation deposits are composed of intraclasts eroded from the in situ spherulites and shrubs. These rocks are predominantly massive, lack subaerial exposure features, and display features that point to dynamic and multicyclic reworking. Furthermore, they occur intercalated with in situ deposits in high frequency, even at a thin section scale. These aspects, along with the consistency of isotope values, the widespread spatial distribution and preservation of stevensite across diverse Pre-Salt areas, suggest that gravitational, waves and currents redeposition models should be reevaluated. We propose that internal waves, generated by perturbations of the chemocline of a meromictic, stratified lacustrine system promoted recurrent reworking of the in situ deposits. This generated intraclastic levels with multicycle redeposition aspects, often interlayered with the characteristic in situ deposits. Understanding the processes that generated these deposits will contribute to reduce exploration risks and optimize hydrocarbon production from the intraclastic reservoirs.

Psychometric Properties of the Gastrointestinal Symptom Severity Scale in a Sample of Adolescents and Young Adults.

Background: Functional gastrointestinal disorders (FGIDs) are a set of chronic or recurrent gastrointestinal symptoms (GS) with great psychobiological complexity. The appearance of FGIDs harms quality of life and drains medical resources. Methods: Psychometric properties of the Gastrointestinal Symptom Severity Scale (GSSS) based on Rome IV criteria were examined in a sample of 1247 individuals with typical development. Observations were randomly divided into two subsets, namely, subsample 1 (n = 624) and subsample 2 (n = 623). Exploratory factor analysis (EFA) was performed with data from subsample 1, whilst confirmatory factor analysis (CFA) was performed with data from subsample 2. Internal consistency of the scale was assessed for the whole dataset according to ordinal alpha, whilst four-week reliability was measured according to the intraclass correlation coefficient (ICC). Measurement invariance as a function of sex was also examined, and discriminant-convergent validity of the GSSS was examined through hypothesis testing. Results: EFA revealed a two-factor structure with a moderate percentage of explained variance (51.3%), whilst CFA exhibited an excellent fit of the data to the model. A one-factor CFA model demonstrated an acceptable but slightly lower fit. Internal consistency was moderate and test-retest reliability was deemed adequate. Metric invariance was demonstrated as a function of sex. Hypothesis testing demonstrated strong convergent-discriminant validity with measures of sensory sensitivity, obsessive-compulsive symptoms, and pain. Conclusions: The GSSS is a tool with acceptable and promising psychometric properties when administered to neurotypical adolescents and young adults. The self-report GSSS may promote better understanding of GS involvement in the gut microbiota-brain axis in the general population.

THE ENTROPIC EFFECT OF GLOBALIZATION AND THE SUSTAINABILITY CHALLENGE: TOWARDS A BIFURCATION

The entropic effect of globalisation and the challenge of sustainability provide an opportunity for a critical exploration of the interplay between life, order and social change. Drawing on the principles of self-organisation observed in living beings, we delve into the continuous exchange of energy and resources, the general connectedness of all that is alive. Organisms, through their interaction with the environment, renew themselves by dissipating entropy, a process essential to maintaining internal order. Life (physical, biological, psychic or social) is a (dynamic) balance between entropic and neghentropic forces and tends towards greater complexity and organisation. Conversely, when entropy grows and prevails, life moves towards disorganisation, fragmentation, de-differentiation, chaos and death. Human beings are able to extend their reach through technology and socio-political institutions. These exosomatic extensions redefine their relationship with the environment, expanding the possibilities of life. Industrialisation has further catalysed this process, liberating individual desire and increasing productive capacity. As a result, billions of people have witnessed unprecedented improvements in their life possibilities. But all this has greatly increased entropy. To improve neghentropy beyond the individualisation/totalisation model favoured by digitisation, towards true sustainability, a paradigm shift from individualism to interdependence (based on scientific, rather than ethical, evidence) is required. In sum, our exploration reveals how the inherent interconnectedness of life can be a starting point for addressing the unexpected consequences of globalisation, challenging entropy and promoting resilience in the face of new global challenges.

Forks in the road: decisions that have shaped and will shape the teaching and practice of geotechnical engineering

Geotechnical engineering spans a wide range of applications, including tunnels, foundations, dams, and retaining structures. It deals with a material known to be difficult to model: a particulate material whose mechanical response is affected by all three invariants of the stress tensor, by loading rate, by density and by fabric. New problems and greater complexity in old problems have come about with the effects of climate change. Progress in certain technologies—notably artificial intelligence—also defines the new landscape in which geotechnical engineers must operate. This paper focuses on mechanics-based geotechnical engineering applications. The paper reviews some of the major decisions that were made by the engineers and researchers who developed geotechnical engineering to the point at which it was an identifiable separate discipline and the consequences that these decisions have had on the development of the discipline and on its teaching. The paper identifies some key modelling choices that were made that have had an undeservedly disproportionate impact on the teaching and practice of geotechnical engineering. The focus of the paper is therefore on these decisions and choices, and what should be taught in their place today. Challenges that future geotechnical engineers may face, as well tools that will be available to them, are also discussed in the context of what should be taught in undergraduate and graduate courses.

Stimuli-Responsive Polymers for Engineered Emulsions.

Emulsions are complex. Dispersing two immiscible phases, thus expanding an interface, requires effort to achieve and the resultant dispersion is thermodynamically unstable, driving the system toward coalescence. Furthermore, physical instabilities, including creaming, arise due to presence of dispersed droplets of different densities to a continuous phase. Emulsions allow the formulation of oils, can act as vehicles to solubilize both hydrophilic and lipophilic molecules, and can be tailored to desirable rheological profiles, including "gel-like" behavior and shear thinning. The usefulness of emulsions can be further expanded by imparting stimuli-responsive or "smart" behaviors by inclusion of a stimuli-responsive emulsifier, polymer or surfactant. This enables manipulation like gelation, breaking, or aggregation, by external triggers such as pH, temperature, or salt concentration changes. This platform generates functional materials for pharmaceuticals, cosmetics, oil recovery, and colloid engineering, combining both smart behaviors and intrinsic benefit of emulsions. However, with increased functionality comes greater complexity. This review focuses on the use of stimuli-responsive polymers for the generation of smart emulsions, motivated by the great adaptability of polymers for this application and their efficacy as steric stabilizers. Stimuli-responsive emulsions are described according to the trigger used to provide the reader with an overview of progress in this field.

Measuring Accountable Information in CSR Reports: A New Operationalization and Analysis Applied to Greenhouse Gas Disclosures

ABSTRACT We develop a novel and generic text-based measure to classify and evaluate greenhouse gas (GHG) disclosures. We construct the measure using collocation analysis of GHG-related words and regular expressions. Automated implementation achieved high concordance compared to manual investigations. We move beyond the “bag-of-words” approach in classifying voluminous nonfinancial corporate disclosure. We also outline a methodology that is manyfold scalable and makes replicability straightforward. Compared to past studies, we work with a significantly larger sample of 5,017 reports across 80 countries, thereby dealing with greater complexity and leading to better generalizability. We also contribute to the debate on whether nonfinancial disclosures exhibit accountability or are merely greenwashing. We find a negative trend in accountability worldwide, and firm-level accountability in GHG disclosures is not detectable in a country-level reduction of GHG emissions. Moreover, firms disclose significantly higher accountable information in a civil-law legal environment compared to those in a common-law legal environment. JEL Classifications: M14; M40.

Handling Sudoku puzzles with irregular learning cellular automata

The use of Cellular Automata (CA) in combination with Learning Automata (LA) has demonstrated effectiveness in handling hard-to-be-solved problems. Due to their capacity to learn and adapt, as well as their inherent parallelism, they can expedite the problem-solving process for a range of problems, such as challenging logic puzzles. One such puzzle is Sudoku, which poses a combinatorial optimization challenge of great difficulty and complexity. In this study, a Sudoku puzzle was represented as an Irregular Learning Cellular Automaton (ILCA), using a reward and penalty algorithm to resolve it. Simulations for an amount of 400 puzzles were performed, while the results demonstrate that the proposed algorithm operates effectively, highlighting the concurrent and learning capabilities of the ILCA structure. Furthermore, two different performance enhancement methods are investigated, namely learning rates method and selective probability reset rule, which are able to increase the initial performance by 26.8%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$26.8\\%$$\\end{document} and to achieve an overall 99.3%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$99.3\\%$$\\end{document} resolution rate.

Reframing Different Layers of Morphological Dimension - A Context of Urban Spaces w.r.t Net Zero Energy to Achieve Zero Carbon Emissions

Abstract: The contemporary city presents itself as an urban organism of great complexity, consisting of an increasingly number of elements, systems, dynamics and extracts, which makes their reading an equally complex task. the method of morphological analysis, it is assumed in this context, as an important reading tool of the city, giving order to what is naturally disordered through a classification process of the different elements that structure it –streets,squares, urban blocks,building , plots among others .Specifically, the paper discusses the morphological component of urban design, concentrating on the forms along with configurations of urban centers, as well as current preferences for urban blocks and interconnecting street patterns. Overall, it is concerned with the network of public spaces as well as actual public realm, which is the physical setting or stage for public activity. An important factor in this is one of the key tensions at the core of modern urban design: complexity, conflicts, andsynergies between the requirement for space and movement necessary for economic and social interaction and everyday living. Urban design goals, according to Jan Gehl, should be prioritized in the following order: first it islife, second it isspace, and third it isbuilding.

The Mapping of Alpha-Emitting Radionuclides in the Environment Using an Unmanned Aircraft System

The protection of first responders from radioactive contamination with alpha emitters that may result from a radiological accident is of great complexity due to the short range of alpha particles in the air of a few centimeters. To overcome this issue, for the first time, a system mounted on a UAS for the near-real-time remote measurement of alpha particles has been developed, tested, and calibrated. The new system, based on an optical system adapted to be installed on a UAS in order to measure the UV-C fluorescence emitted by alpha particles in the air, has been tested and calibrated, carried out in the laboratory and in field experiments using UV-C LEDs and 241Am sources. In experimental flights, the probability of detecting a point source was determined to be approximately 60%. In the case of a surface extended source, a detection efficiency per unit surface activity of 10 counts per second per MBq cm−2 was calculated. A background count rate of UV-C of around 26 ± 28 s−1 for an integration time of 0.1 s was measured during flights, which led to a decision threshold surface activity of 5 MBq cm−2.

Exploring the aromatic typicity of blended red wines from geographically close sub-regions in AOC Corbières: a sensory and chemical approach

Several studies have reported a terroir effect on monovarietal wines originating from geographically close areas, using both aromatic and sensory analyses. However, few studies have evaluated this effect on blended wines, a widespread practice that is recognised as adding great complexity to wines. This study aimed to discriminate blended wines produced in five sub-regions of the Corbières AOC according to their aromatic and sensory profiles and across two vintages: 2018 and 2019. The wines’ aromatic profiles were semi-quantified using HS-SPME-GC-MS, and the sensory descriptors enabling the differentiation of the wines were identified by QDA analysis. Although blending is a frequently used process adapted for the production of homogeneous wines within an appellation, the sensory and chemical profiles enabled us to differentiate wines of the Lagrasse and Lézignan sub-regions from those of the Maritime and Durban sub-regions. The variation in intensity of red fruit jam notes may be linked to terroir factors relating to the micro-climatic conditions. Wines from vineyards in coastal regions or at higher elevations were discriminated by lower intensities of this descriptor. However, other discriminating descriptors, such as amyl, earthy or cooked vegetables, could be related to the winemaking process. Correlations were found between the tendencies observed regarding the sensory markers (such as red fruit jam, butter/lactic, amylic, cooked vegetable) and those regarding the chemical families of aroma or specific aroma compounds (such as ethyl esters, higher alcohols and sulphur compounds), whose production is particularly affected by the winemaking processes. Finally, this study shows that it is possible to discriminate blended wines from different geographically close regions, and that the terroir factor with the greatest influence on this discrimination seems to be linked to winemaking processes, including the type of blending carried out.

Diversity, origin, and evolution of the ESCRT systems.

Endosomal sorting complexes required for transport (ESCRT) play key roles in protein sorting between membrane-bounded compartments of eukaryotic cells. Homologs of many ESCRT components are identifiable in various groups of archaea, especially in Asgardarchaeota, the archaeal phylum that is currently considered to include the closest relatives of eukaryotes, but not in bacteria. We performed a comprehensive search for ESCRT protein homologs in archaea and reconstructed ESCRT evolution using the phylogenetic tree of Vps4 ATPase (ESCRT IV) as a scaffold and using sensitive protein sequence analysis and comparison of structural models to identify previously unknown ESCRT proteins. Several distinct groups of ESCRT systems in archaea outside of Asgard were identified, including proteins structurally similar to ESCRT-I and ESCRT-II, and several other domains involved in protein sorting in eukaryotes, suggesting an early origin of these components. Additionally, distant homologs of CdvA proteins were identified in Thermoproteales which are likely components of the uncharacterized cell division system in these archaea. We propose an evolutionary scenario for the origin of eukaryotic and Asgard ESCRT complexes from ancestral building blocks, namely, the Vps4 ATPase, ESCRT-III components, wH (winged helix-turn-helix fold) and possibly also coiled-coil, and Vps28-like domains. The last archaeal common ancestor likely encompassed a complex ESCRT system that was involved in protein sorting. Subsequent evolution involved either simplification, as in the TACK superphylum, where ESCRT was co-opted for cell division, or complexification as in Asgardarchaeota. In Asgardarchaeota, the connection between ESCRT and the ubiquitin system that was previously considered a eukaryotic signature was already established.IMPORTANCEAll eukaryotic cells possess complex intracellular membrane organization. Endosomal sorting complexes required for transport (ESCRT) play a central role in membrane remodeling which is essential for cellular functionality in eukaryotes. Recently, it has been shown that Asgard archaea, the archaeal phylum that includes the closest known relatives of eukaryotes, encode homologs of many components of the ESCRT systems. We employed protein sequence and structure comparisons to reconstruct the evolution of ESCRT systems in archaea and identified several previously unknown homologs of ESCRT subunits, some of which can be predicted to participate in cell division. The results of this reconstruction indicate that the last archaeal common ancestor already encoded a complex ESCRT system that was involved in protein sorting. In Asgard archaea, ESCRT systems evolved toward greater complexity, and in particular, the connection between ESCRT and the ubiquitin system that was previously considered a eukaryotic signature was established.

Safety of SGLT-2 inhibitors in the management of heart failure in the adult congenital heart disease patient population

BackgroundSodium glucose transporter 2 inhibitors (SGLT-2i) have shown safety and efficacy in patients with heart failure (HF). However, evidence for the use of SGLT-2i in adult congenital heart disease (ACHD) patients with HF is limited. MethodsWe performed a retrospective, single center analysis of 18 patients (>18 years of age) with ACHD and a diagnosis of HF who were initiated on an SGLT-2i. Patient characteristics, including vital signs, laboratory values, concomitant medications, clinical outcomes, and echocardiograms, were obtained as part of standardized clinical care at our ACHD program before and 2–6 months after initiation of SGLT-2i. The primary outcome was to demonstrate safety of SGLT-2i initiation via potential changes in systolic blood pressure, serum sodium, and serum creatinine. ResultsOf the 18 patients, 11 (61%) had moderate complexity congenital heart disease while 7 (39%) had great complexity congenital heart disease. Post initiation, there were no significant differences in systolic blood pressure (121.8 ± 20.8 mmHg to 114.4 ± 14.9 mmHg, p = 0.06), sodium level (138.7 ± 2.9 mMol/L to 138.0 ± 2.2 mMol/L, p = 0.75), and creatinine level (0.85 ± 0.18 mg/dL to 0.89 ± 0.18 mg/dL, p = 0.07). There was a statistically significant decline in weight (78.9 ± 22.9 kg to 76.0 ± 23.0 kg, p = 0.0039) but without a statistically significant change in NT-pro NBP (1358.2 ± 2735.0 pg/mL to 601.6 ± 786.1 pg/mL, p = 0.36). ConclusionsWe demonstrated the use of SGLT-2i in a small cohort of ACHD population, including patients with complex congenital heart disease, appears safe and well tolerated. The safety and potential efficacy of SGLT-2i in patients with ACHD will require further evaluation in prospective multicenter studies.

Heuristic Strategies in Mathematical Problem-Solving Skills

Solving math problems is one of the main challenges faced by students at all levels of education, for some, it is an exciting challenge, but for others, it can be a situation of great complexity and emotional stress. In this way, in this work the resolution of mathematical problems using heuristic strategies has been proposed, so that the student can face calculation situations with a general and broad vision, approaching the problem with multiple approaches and without getting stuck in the attempt to find a single solution. We worked with a group of 30 students so that it was possible to validate a contrast between the procedures used before and after the strategies. The main results show that heuristic strategies are a significant contribution to the visualization and resolution of mathematical problems, but they require their implementation and development permanently.

Evolution of the Microrobots: Stimuli-Responsive Materials and Additive Manufacturing Technologies Turn Small Structures into Microscale Robots.

The development of functional microsystems and microrobots that have characterized the last decade is the result of a synergistic and effective interaction between the progress of fabrication techniques and the increased availability of smart and responsive materials to be employed in the latter. Functional structures on the microscale have been relevant for a vast plethora of technologies that find application in different sectors including automotive, sensing devices, and consumer electronics, but are now also entering medical clinics. Working on or inside the human body requires increasing complexity and functionality on an ever-smaller scale, which is becoming possible as a result of emerging technology and smart materials over the past decades. In recent years, additive manufacturing has risen to the forefront of this evolution as the most prominent method to fabricate complex 3D structures. In this review, we discuss the rapid 3D manufacturing techniques that have emerged and how they have enabled a great leap in microrobotic applications. The arrival of smart materials with inherent functionalities has propelled microrobots to great complexity and complex applications. We focus on which materials are important for actuation and what the possibilities are for supplying the required energy. Furthermore, we provide an updated view of a new generation of microrobots in terms of both materials and fabrication technology. While two-photon lithography may be the state-of-the-art technology at the moment, in terms of resolution and design freedom, new methods such as two-step are on the horizon. In the more distant future, innovations like molecular motors could make microscale robots redundant and bring about nanofabrication.