Lower Position Research Articles

Using High-Speed Videoendoscopy to Analyze Laryngeal Closure Parameters During Normal Swallow.

This pilot study was designed to test the tolerability of a lower scope position and feasibility of custom-designed MATLAB graphical user interface (GUI) used to analyze playback review of laryngeal high-speed videoendoscopy (laryngeal HSV) during healthy volitional dry swallows. We hypothesized this method would conceptually provide time resolution for glottic closure events compared with standard (30 frames per second, fps), and enable a means to measure timing, sequence, and duration of laryngeal movements during swallowing not otherwise visualized. A total of 14 healthy adults (4 male, 22-80 years) participated. We performed laryngeal HSV at 500fps. Measurements included: (i) feasibility and tolerability of the procedure; (ii) identification of a swallowing segment of interest (SOI) for the peak of the swallow; and (iii) description of laryngeal swallowing movements using a GUI. Fourteen subjects tolerated the procedure without discomfort and swallow images were able to be analyzed in 12. Using our GUI, mean SOI was 260 ms, yielding 130 frames for analysis (compared with seven in standard laryngoscopy). Vocal fold adduction, vocal fold medialization, and anterior-posterior arytenoid compression to the epiglottis prior to whiteout could be identified and sequenced. Participants tolerated a low position of the endoscope during dry volitional swallows. The output of our GUI demonstrated a novel technique for identifying, describing, and sequencing a swallowing SOI. Future studies should investigate laryngeal closure and arytenoid positioning with a bolus and in a range of ages, genders, and etiologies in both healthy and abnormal populations to better understand swallowing physiology. NA Laryngoscope, 2024.

Comparative Analysis of Aerodynamic Drag Between Long Tail and Short Tail Aero Helmets Through Wind Tunnel Testing

Aerodynamic drag is a critical factor influencing the performance of competitive cyclists, particularly in time-trial events, where reducing drag can significantly improve speed and efficiency. Helmets are an essential component of aerodynamic gear, and their design plays a vital role in minimizing air resistance. However, the effect of different helmet shapes and head positions on aerodynamic performance has not been thoroughly examined. This study aims to investigate and compare the aerodynamic performance of long-tail (LT) and short-tail (ST) aero helmets, along with the Kabuto Aero SL, under varying pitch angles and speeds. Wind tunnel testing was conducted using an adult-sized mannequin head, with helmets evaluated at pitch angles ranging from 15° to 45° and wind speeds of 5 to 15 m/s. The results showed that the LT Aero helmet achieved the best performance at lower pitch angles (15°), while the ST Aero helmet performed optimally at a 25° pitch angle. The Kabuto Aero SL helmet demonstrated superior performance at low pitch positions, particularly at 15°. These findings highlight the importance of helmet design and head positioning in optimizing aerodynamic efficiency for cyclists in competitive conditions.

CBCT Analysis of the Hyoid and Pharyngeal Airway Changes in Class III Patients With Orthognathic Surgery.

This study was designed to investigate the response of the respiratory structures to orthognathic surgery in patients with Class III malocclusion, with a specific emphasis on the vertical placement of the hyoid bone. The correlations of these changes were also analysed, followed by further subgroup analyses based on preoperative conditions. Dolphin software was used to obtain cephalometric landmarks, airway and hyoid bone measurements from pre- and postoperative CBCT scans of 31 patients. Statistical analyses included paired t-tests and Pearson's correlation analysis. Stomatological mandibular values and the nasopharynx height showed significant changes. Pearson's correlation identified significant correlations between changes in B and H horizontal coordinates (p < 0.05), as well as between changes in H longitudinal coordinates and specific airway dynamics (p < 0.05). Patients with a lower preoperative hyoid position experienced a more pronounced decrease in hypopharyngeal airway volume after surgery compared to those with a higher preoperative hyoid position, as evidenced by the significant mean differences and p values (p < 0.01). Class III patients experienced airway constriction following orthognathic surgery, particularly those with a lower preoperative hyoid bone position, who showed a more significant decrease in hypopharyngeal airway volume postsurgery compared to those with a higher preoperative hyoid position. These findings underscored the importance of individualised surgical planning and highlighted the need for further research with dynamic assessments to optimise respiratory outcomes.

Lateral violence and its effects on the health of sexual minority pre-service teachers in township schools in South Africa

Research has identified teaching as a high-risk occupation for lateral violence in the form of harmful covert or overt acts of verbal or non-verbal behaviour carried out by one employee against another who holds an equal or lower position of power. The goal of this study was to explore and describe experiences of lateral violence and its impact on the health of sexual minority pre-service teachers in township schools in South Africa. There is a paucity of research on the experiences of sexual minority teachers in South African schools. A phenomenological approach was adopted, in which eight sexual minority pre-service teachers took part in in-depth interviews to capture their day-to-day experiences during teaching practice. Findings from the study revealed that sexual minority pre-service teachers experienced incidents of lateral violence, predominantly from school management and in-service teachers. These actions exist in tension with the Constitution of South Africa, which prohibits discrimination against citizens based on sexual orientation. Pre-service teachers in this study reported negative mental, physical and social health consequences arising from incidents of lateral violence in schools. Professional development for school management and both pre- and in-service teachers on issues of sexuality and gender diversity in South Africa is needed.

Hole transfer promotion on La-MOF@MXene by valence band structure regulation for the efficient photocatalytic degradation

La-MOF has excellent thermal and chemical stability. Therefore, it can be used in the field of photocatalysis. However, the sluggish hole transfer, which is caused by low valence band position hinders its application prospects in photocatalysis, especially in hole-driven processes. In this work, we have proposed a strategy to adjust the VB structure on La-MOF, by modifying the two-dimensional (2D) conductor MXene electron-withdrawing. XRD, Raman, and HRTEM analysis indicated that the three-dimensional La-MOF was uniformly encased by the 2D MXene, and the distinct interface substantiated the successful construction of the Schottky heterojunction. XPS and UPS characterization revealed that the electron transfer from La-MOF to MXene induces an upward shift in the valence band of La-MOF to promote hole transfer. As a result, the optimized La-MOF@MXene achieved a photocatalytic degradation constant of 0.00773 min−1 for tetracycline hydrochloride within 120 min, which is 5.3 and 20 times higher than that of pure La-MOF and MXene, respectively, outperforming most previously reported works. This work can expand the application of La-MOF materials in the field of photocatalysis, providing a fresh avenue to regulate the slow hole transport.

The new normal for children’s physical activity and screen viewing: a multi-perspective qualitative analysis of behaviours a year after the COVID-19 lockdowns in the UK

Abstract Background The COVID-19 pandemic significantly impacted children’s physical activity. Recent evidence indicated children’s accelerometer-measured physical activity levels have, on average, returned to near pre-pandemic levels in 2022, though sedentary behaviour remains higher. However, insufficient physical activity levels among children continues to be a critical public health issue in the UK, with only 41% meeting physical activity guidelines. This study aimed to provide in-depth analysis of how the pandemic has shaped children’s physical activity patterns beyond the short-term periods following lockdowns and identify the new challenges to engaging children in physical activity. Methods One-to-one interviews with parents (n = 22), school staff (n = 9), and six focus groups with children aged 10–11 years (n = 45) were conducted between February and July 2022. Topics explored changes to children’s physical activity and sedentary behaviour patterns, including screen-viewing, and factors influencing any changes. The framework method was used for analysis. Results Five themes were generated. Theme 1 described residual lockdown habits, including increased screen-viewing within the home, while activities outside the home continued to feel less spontaneous. Theme 2 highlighted an interrupted development of social, emotional, and physical skills among children compared to what would be expected pre-pandemic. This coincided with Theme 3 which reflected increased mental health challenges among families, creating complex barriers to children’s physical activity. A new normal for child physical activity was evoked and explored in Theme 4, with greater dependence on structured and organised activities. However, Theme 5 highlighted that girls and children with lower socio-economic position may be especially at risk of decreased physical activity. Conclusions There is a new normal for children’s physical activity that is characterised by increased dependence on structured and organised physical activities, such as active clubs, and less on unstructured and spontaneous physical activities, such as physical play. While this may suit many children, girls and children from lower socio-economic households face barriers to participating in the new normal. It is important that affordable and equitable opportunities are provided to all children to prevent physical activity and health inequalities.

Propagation, Establishment, and Early Fruit Production of Table Grape Microvines in an LED-Lit Hydroponics System: A Demonstration Case Study.

Controlled environment farming (CEF) systems, including tunnel houses, glasshouses, and vertical farms, are expanding worldwide. As the industry scales, growers need a broader range of crops that are adapted to CEF systems to take full advantage of the potential to increase yields and decrease weather-related risks. Dwarf grapevines (microvines) are ideal candidates for CEF due to their high economic value, phenotype, and phenology. This study aimed to develop propagation protocols, a critical first step for the successful integration of microvines in the CEF market, and to demonstrate the establishment, early growth, first flowering, and fruiting of table grape microvines in a fully indoor, LED-lit, CEF system. An experiment was conducted to investigate the efficiency of clonal propagation of a newly developed microvine variety, which had been bred for the production of seedless table grapes in response to two variables: (a) shoot position of cutting, and (b) length of time of misting exposure (from 3 to 7 weeks). A subset of successfully established plantlets were then transplanted into a hydroponic, CEF system, where their establishment, early growth, flowering, and fruit formation were assessed. Three weeks after cuttings were taken, 83.7% of the cuttings had formed roots, regardless of cutting section or misting treatment, while the remaining 16.7% of cuttings died. The sprouting success was lower with 49.3% of plants forming new leaves after 7 weeks. The highest level of sprouting was observed with cuttings taken from mid-shoot and lower shoot positions and the 5-week misting duration. While the rooting efficiency and survival of green shoot microvine cuttings are very high, further research is needed to increase the frequency of sprouting in the required timeframes to levels that are more acceptable for commercial production. The establishment success of sprouted cuttings after transplanting to hydroponics was 100% and their production and fruit quality were similar regardless of cutting tissue source. The crop cycle from planting to first harvest was 208 days (63 days for plantlet production and 145 days from transplanting to first harvest). The vines began flowering after an average of 33.9 days and the berries went through veraison (i.e., commencement of ripening) after an average of 116 days under the conditions tested. Microvine fruit grown under these conditions contained greater than the minimum total soluble solids content required for the Australian market. We have demonstrated that table grape microvines have potential as a novel crop for CEF systems.

Image of Triple Oppressed Women in Bama’s Sangati

Bama’s Sangati is a unique work that delves into the consequences of multiple discriminations suffered by Dalit Christian women, without having clear narrative or protagonist. The present research paper does a thorough analysis of the novel in order to identify instances of prejudice that result in women being marginalized and subjugated. It is believed that women are the most marginalized group and Dalit women face triple oppression. These women face traumatizing treatment at every turn in their difficult lives. Initially, they face discrimination due to their caste and lower position than men. Afterward, they face exploitation by male family members inside their own society. They are reduced to the position of domestic helpers during the harsh daylight hours and transformed into objects of sex during the night. Women are routinely treated as lesser animals- meant only objects of male gratification and subjugation and are branded as illegitimate. Men have the natural right to take advantage of, mistreat and even kill women. This includes setting them on fire. With the novel, the paper explores these deep topics, illuminating the widespread discrimination that results in Dalit Christian women’s misery and disempowerment.

Evaluating factors influencing visit intention towards birding tourism: an extended theory of planned behaviour perspective

ABSTRACT Birdwatching, also known as avitourism, has become the fastest-growing segment of ecotourism, which contributes significantly to socio-economic development as well as the protection and development of threatened natural areas around the world. Despite the potential benefits of avitourism, only a few countries have fully exploited such opportunities. Hence, this study aims to understand the factors influencing the intentions to visit avitourism destinations. To improve the conceptual model, this study extended the Theory of Planned Behaviour (TPB) by integrating environmental awareness, concern, knowledge and the Big-Five personality traits. A quantitative methodology via questionnaire was employed to gather data from 389 respondents across Malaysia. The results reveal that environmental awareness, environmental knowledge, openness to experience, introversion, and emotional stability significantly influence Malaysians’ intention to visit avitourism destinations. Notably, this study also highlights the demographic profile as a crucial factor influencing the visit intention towards avitourism. Older males with lower education and job positions are more likely to visit avitourism destinations than younger females with higher education and job positions. These insights are anticipated to assist tourism organisations, educators, and policymakers in devising strategies to foster avitourism amongst the Malaysian population. The limitations and future studies were also discussed in this study.

Evolution of the Yigong river channel on the Eastern edge of the Qinghai-Tibet Plateau: insights from hydrodynamic geological hazards shaping topography

Geological action is one of the main forces in the formation of topography, especially in the southeastern part of the Qinghai-Tibet Plateau. Collapse, landslide, mud-rock flow and other geological actions are the main factors affecting the evolution of river valley landforms. However, existing inference methods primarily rely on theoretical calculations and multi-temporal remote sensing image interpretation, lacking direct analysis and validation through geological exploration techniques. In response, this study employed geological engineering and geotechnical exploration techniques to investigate the impact of debris flows, landslides, and collapses on the evolution of topography and geomorphology in a 5.0 km section of the Yigong Zangbo Basin. Through drilling and geophysical exploration, 6 geological profiles were constructed, identifying the distribution range and development characteristics of the geological phenomena within this section of the river valley, revealing the distribution positions of both the new and old river channels, and inferring the evolution of the river bedrock based on the original topography. The study found that when geological phenomena occur, substantial material is transported into the river channel, altering its original shape and influencing the river’s erosion process. Additionally, the occurrence of geological phenomena is closely correlated with the evolution of river valley morphology. When the river valley is wide, material accumulation on one side causes the river to flow along a lower position on the opposite side, primarily resulting in the river’s bending on the plane. In contrast, in narrow river valleys, material accumulation on the sides can fill the entire river channel, leading to a rise in the riverbed. These research findings provide a critical theoretical basis for understanding river valley morphological evolution and informing basin engineering construction.

Movement Mediates the Relationship Between Socioeconomic Position and Socioemotional Outcomes in Youth.

Youth from lower socioeconomic positions tend to have poorer socioemotional outcomes, be less physically active, have poorer sleep, and engage in more screen time than their peers from higher socioeconomic positions. The objective of this study was to test the hypothesis that movement behaviors (ie,physical activity, sedentary behavior, and sleep) and changes in combinations of movement behaviors over time (movement trajectories) mediate the relationship between socioeconomic position and socioemotional outcomes in youth. This study used socioeconomic position data, scores from Strengths and Difficulties Questionnaires, and time-use diaries from 980 females and 1014 males (2% Australian Indigenous) aged 10-14 from the Longitudinal Study of Australian Children from 2014 to 2018. Movement trajectories did not mediate the relationship between socioeconomic position and socioemotional outcomes. Least absolute shrinkage and selection operator-based mediation analyses found males from lower socioeconomic positions participated in less moderate- to vigorous-intensity physical activity than their peers from high socioeconomic positions, partially explaining (7%) more peer problems. Youth from lower socioeconomic positions participated in more recreational screen activities than their peers from higher socioeconomic positions, partially explaining (1%-3%) worse total socioemotional outcomes and conduct (females) and emotional problems (males). Future qualitative research should be considered to identify the best ways for youth from lower socioeconomic positions to decrease screen time and increase opportunities to participate in moderate- to vigorous-intensity physical activity in the community, at school, and at home. Other mediators explaining differences in socioemotional outcomes should be explored.

Does vertical integration reduce the cost of equity?

Faced with the increasing risk of supply chain disruption, more firms are using mergers and acquisitions or investments to expand their core business's upstream and downstream supply chain and improve their vertical integration. In this vertical integration trend, the cost of capital for core firms is crucial to coordinating the entire supply chain. We manually collected input-output matrix data of segmented departments and supply chain value-added data to explore how vertical integration impacts the cost of equity. Using A-share listed firms from 2008 to 2021 as our sample, the results of our regression analyses show that vertical integration plays a significant role in reducing the cost of equity. These results remain consistent throughout a series of robustness tests. The channel tests indicate that vertical integration can reduce the cost of equity by reducing operating risk and mitigating information asymmetry. Additional analyses show that vertical integration's impact on the cost of equity is more pronounced for firms with more intense industry competition, lower product market positions, lower supply chain concentration, weaker corporate governance, and more aggressive strategies, as well as firms in regions with lower marketization processes and weaker trust environment. Our findings contribute to the literature on the economic consequences of vertical integration from the perspective of corporate financing behavior and extend the literature on cost of equity determinants to the field of supply chains.

Prevalence of Dental Pain in Schoolchildren Aged 6 to 12 Years and Clinical, Sociodemographic, and Socioeconomic Risk Indicators: A Multicenter Study of Four Mexican Cities.

Background: Dental pain is a significant public health issue globally and in Mexico, with substantial negative impacts on affected individuals. Objective: The objective of this study was to evaluate the prevalence of dental pain and its association with clinical, sociodemographic, and socioeconomic risk indicators in schoolchildren aged 6 to 12 years in four cities in Mexico. Material and Methods: A cross-sectional study was conducted on 500 children attending public schools in the cities of Pachuca, Tepatitlán, Toluca, and San Luis Potosí. A questionnaire was applied, and a clinical examination was performed on the schoolchildren. Self-reported dental pain within the 12 months preceding the study, categorized as 0 (no pain) and 1 (pain), was used as the dependent variable. For the statistical analysis, the Stata program was used, where a multivariate binary logistic regression model was applied. Results: The mean age was 8.92 ± 1.99 years; 50% were girls. The prevalence of dental pain was 34.0%. Independent variables associated (p < 0.05) with the experience of dental pain were as follows: age (OR = 0.81), having a car at home (OR = 0.77), a lower socioeconomic position (OR = 2.03), curative or specialized dental care (OR = 8.40), and self-reported dental and/or gingival disease (OR = 5.39). Conclusions: Dental pain is a significant health problem in schoolchildren aged 6 to 12 years in Mexico, with a prevalence of 34% in this study. Sociodemographic and socioeconomic factors, as well as clinical indicators, play an important role in the experience of dental pain. Inequalities in oral health were observed. There is a need for public health interventions to reduce this problem in vulnerable populations.

Efficiency Analysis (Debit &amp; Head Losses) of Centrifugal Pumps at PDAM Tirta Terubuk Bengkalis

A pump is a device used to raise liquid from a lower position to a higher position. This study analyzes the efficiency of the centrifugal pump used in the air supply system at the Tirta Terukalis Bengkalis Water Supply Company (PDAM). The main focus of the analysis is on the parameters of water discharge, head losses, and centrifugal pump efficiency. This analysis was carried out at PDAM Tirta Terubuk Bengkalis. The data used in this study include the results of an airflow rate of 0.0073 m3/s, a pressure loss of 11 m, and a pump efficiency of 73%. The results of the study revealed that the water discharge was 0.0073 m3/s and the loss stress was 11 m, the pump efficiency reached 73%. This study provides insight into the performance of centrifugal pumps in certain situations in PDAM Bengkalis.

Using Artificial Intelligence to Identify Three Presenting Phenotypes of Chiari Type-1 Malformation and Syringomyelia

BACKGROUND AND OBJECTIVES: Chiari type-1 malformation (CM1) and syringomyelia (SM) are common related pediatric neurosurgical conditions with heterogeneous clinical and radiological presentations that offer challenges related to diagnosis and management. Artificial intelligence (AI) techniques have been used in other fields of medicine to identify different phenotypic clusters that guide clinical care. In this study, we use a novel, combined data-driven and clinician input feature selection process and AI clustering to differentiate presenting phenotypes of CM1 + SM. METHODS: A total of 1340 patients with CM1 + SM in the Park Reeves Syringomyelia Research Consortium registry were split a priori into internal and external cohorts by site of enrollment. The internal cohort was used for feature selection and clustering. Features with high Laplacian scores were identified from preselected groups of clinically relevant variables. An expert clinician survey further identified features for inclusion that were not selected by the data-driven process. RESULTS: The feature selection process identified 33 features (28 from the data-driven process and 5 from the clinician survey) from an initial pool of 582 variables that were incorporated into the final model. A K-modes clustering algorithm was used to identify an optimum of 3 clusters in the internal cohort. An identical process was performed independently in the external cohort with similar results. Cluster 1 was defined by older CM1 diagnosis age, small syringes, lower tonsil position, more headaches, and fewer other comorbidities. Cluster 2 was defined by younger CM1 diagnosis age, more bulbar symptoms and hydrocephalus, small syringes, more congenital medical issues, and more previous neurosurgical procedures. Cluster 3 was defined by largest syringes, highest prevalence of spine deformity, fewer headaches, less tonsillar ectopia, and more motor deficits. CONCLUSION: This is the first study that uses an AI clustering algorithm combining a data-driven feature selection process with clinical expertise to identify different presenting phenotypes of CM1 + SM.

A TÁJHASZNÁLAT ÉS TÁJGAZDÁLKODÁS VÁLTOZÁSA A MAROSSZÖGBEN (18– 19. SZÁZAD)

Nowadays, 35 independent settlements are located on the Marosszög floodplain, exploiting the opportunities provided by the microrelief. The region’s ecological properties and resources available to society, which change over time, and its natural and landscape characteristics were markedly different from the historical counties of Csongrád and Csanád, and in certain elements the Bánság and also from other regions of the former Torontál county. Marosszö can be divided into several parts from a landscape-geographical point of view, and as a result of the surface development, it has a threefold geomorphological division. The highest areas (88–96 m) are late pleistocene loess-sand free areas. The old holocene high flood plain is located in a lower surface position (82–87 m), while the new holocene low flood plain is located at the deepest level (77–81 m). Starting from the 18th century, in the reorganization process of economic life, mixed (polyculture) farming became dominant, characteristic of the settlement group as a whole. Until the start of the integrated environmental transformation works, society adapted, and its landscape-shaping and environment-transforming activities were only at the local level. The integrated environmental transformation works strongly changed the geographical foundations of social production and the ecological conditions, the former floodplain habitats, floodplain landscapes and habitats, which corresponded to the way of life of livestock keepers and farmers, disappeared. The use of landscape and resources changed and developed significantly, arable farming became dominant. The nature of agricultural activity has shifted towards crop production in fields and animal husbandry in stables.

An eHealth intervention for patients with a low socioeconomic position during their waiting period preceding cardiac rehabilitation: a randomized feasibility study

Abstract Aims Cardiac rehabilitation (CR) shows lower effectiveness and higher dropouts among people with a low socioeconomic position (SEP) compared to those with a high SEP. This study evaluated an eHealth intervention aimed at supporting patients with a low SEP during their waiting period preceding CR. Methods and results Participants with a low SEP in their waiting period before CR were randomized into an intervention group, receiving guidance videos, patient narratives, and practical tips, or into a control group. We evaluated adherence (usage metrics), acceptance (modified Usefulness, Satisfaction, and Ease of use questionnaire), and changes in feelings of certainty and guidance between the waiting period’s start and end. Semi-structured interviews provided complementary insights. The study involved 41 participants [median interquartile range (IQR) age 62 (14) years; 33 males], with 21 participants allocated to the intervention group, using the eHealth intervention for a median (IQR) duration of 16 (10) days, using it on a median (IQR) of 100% (25) of these days, and viewing 88% of the available messages. Key adherence themes were daily routine compatibility and curiosity. Acceptance rates were 86% for usability, 67% for satisfaction, and 43% for usefulness. No significant effects on certainty and guidance were observed, but qualitative data suggested that the intervention helped to inform and set expectations. Conclusion The study found the eHealth intervention feasible for cardiac patients with a low SEP, with good adherence, usability, and satisfaction. However, it showed no effect on feelings of certainty and guidance. Through further optimization of its content, the intervention holds promise to improve emotional resilience during the waiting period. Registration This trial is registered as follows: ‘Evaluation of a Preparatory eHealth Intervention to Support Cardiac Patients During Their Waiting Period (PReCARE)’ at ClinicalTrials.gov (NCT05698121, https://clinicaltrials.gov/study/NCT05698121).

Childhood socioeconomic position relates to adult decision-making: Evidence from a large cross-cultural investigation.

Early exposure to poverty may have profound and enduring impacts on developmental trajectories over the lifespan. This study investigated potential links between childhood socioeconomic position, recent economic change, and temporal discounting in a large international cohort (N = 12,951 adults from 61 countries). Temporal discounting refers to the tendency to prefer smaller immediate rewards over larger rewards delivered after a delay, and connects to consequential outcomes including academic achievement, occupational success, and risk-taking behaviors. Consistent with multiple theories about the impacts of stress exposure, individuals who reported lower socioeconomic positions in childhood exhibited greater temporal discounting in adulthood compared to peers who did not. Furthermore, an interaction emerged between childhood socioeconomic position and recent economic change, such that the steepest temporal discounting was found among those from lower childhood socioeconomic positions who also recently experienced negative economic change as a result of the COVID pandemic. These associations remained significant even when accounting for potentially confounding factors like education level and current employment. Findings provide new evidence that childhood socioeconomic position relates to greater temporal discounting and steeper devaluation of future rewards later in adulthood, particularly in response to contemporaneous economic change. This suggests childhood socioeconomic position may have longer-term impacts on developmental trajectories. Speculatively, childhood socioeconomic position may shape adult behavior through increased life stress, diminished access to resources, and lower perceived trust and reliability in social systems. These findings underscore the long-term implications of socioeconomic gaps, cycles of disadvantage and economic marginalization.

Abstract 4113301: A Rare Cause of Recurrent Heart Failure Exacerbations After Transcatheter Aortic Valve Replacement: Ventricular Septal Defect and Significant Paravalvular Leak

Introduction: Ventricular septal defects (VSD) have been reported in &lt;1% of cases following transcatheter aortic valve replacement (TAVR). A retrospective record review of VSD cases occurring after all TAVRs performed between January 2012 and September 2020 at one urban US tertiary hospital showed 0.37% incidence of these complications, mostly with small and restrictive VSD. Case Description: An 80-year-old woman with history of hypertension, HFpEF, and TAVR 8 months prior for severe aortic stenosis (AS) at an outside hospital presented with worsening dyspnea and peripheral edema over the past month. Blood pressure was 148/53mmHg, heartrate 83bpm, oxygen saturation 98% and auscultation revealed a harsh holosystolic murmur 4/6 loudest at left sternal border and bibasilar rales. Chest X-ray showed pulmonary edema and bilateral pleural effusions. NT-proBNP was 17,000pg/ml and troponin-I was negative. Echocardiogram showed EF55-60%, a membranous VSD, severe pulmonary hypertension, and moderate paravalvular leak (PVL). Coronary angiogram showed non-obstructive disease. Right heart catheterization confirmed significant left to right shunting. Treatment/Outcomes: Cardiothoracic surgery was consulted for multidisciplinary evaluation, and joint recommendation was for surgical aortic valve replacement and VSD closure which was successfully performed. One month follow-up echocardiogram showed normal aortic valve gradient without PVL and normal right ventricular pressure. Discussion/Conclusion: Numerous potential risks such as severe and uneven calcification of the native valve, an elliptic aortic annulus, excessive valve sizing, or elevated valve placement can lead to VSD. A recurrent element in many of these instances involves direct trauma to the septum caused by the implanted valve, exacerbated by subsequent annulus dilation. The presence of PVL is common post-TAVR and is an established independent prognostic factor, while VSD post-TAVR is uncommon, but may be associated with low implantation position relative to the aortic annulus or post-implantation balloon dilatation. Rarely, worsening VSD may require operative management. In this case, the improvement of heart failure symptoms and echocardiogram parameters after transthoracic surgery confirmed successful repair.

Tooth-loss related masticatory and aesthetic experiences among middle-aged and older adult Danes.

To determine whether tooth loss relates to patient experiences of masticatory or aesthetic problems and is a useful measure of oral health and treatment needs and to compare experiences of tooth loss among middle-aged and older Danes. Cross sectional online- and telephone interview questionnaire study. 1,060 Danish citizens aged 40 years or older. Experiences of difficulties eating/enjoying food or smiling/showing of teeth due to tooth related problems within the last 6 months. Data analysis used tests of proportions and ordinal logistic regression. Half the participants had a full or almost full dentition. Among those with tooth loss, 21-44% reported difficulties eating/enjoying food. In ordinal logistic regression, difficulties eating were associated with being younger, having fewer teeth and having visibly missing teeth. Being unwilling to smile or show one's teeth was associated with being younger, having fewer teeth, having lower socioeconomic position and having visibly missing teeth. Wearing a prosthesis did not ameliorate eating difficulties or unwillingness to smile. Tooth loss is a meaningful measure of oral health but cannot stand alone. Many adults with even substantial tooth loss did not experience functional or aesthetic problems. Tooth loss is associated with negative masticatory and aesthetic experiences among middle-aged than older adults. Removable prostheses were not associated with better functional or esthetic outcomes.