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Travelling wave charges lying on the insulating walls of an electrolyte-filled capillary give rise to oscillatory modes which vanish when averaged over the period of oscillation. They also give rise to a zero mode (a unidirectional, time-independent velocity component) which does not vanish. The latter is a nonlinear effect caused by continuous symmetry breaking due to the quadratic nonlinearity associated with the electric body force in the time-dependent Stokes equations. In this paper, we provide a unified view of the effects arising in boundary-driven electrokinetic flows (travelling wave electroosmosis) and establish the universal behaviour exhibited by the observables. We show that the incipient velocity profiles are self-similar implying that those obtained with a single experimental configuration can be employed again to attain further insights without the need of repeating the experiment. Certain results from the literature are recovered as special cases of our formulation and we resolve certain paradoxes having appeared in the past. We present simple theoretical expressions, depending on a single-fit parameter, that reproduce these profiles, which could thus provide a rapid test of consistency between our theory and future experiment. The effect becomes more pronounced when reducing the transverse dimension of the system, relative to the velocity direction, and increasing the excitation wavelength, and can therefore be employed for unidirectional transport of electrolytes in thin and long capillaries. General relations, expressing the zero mode velocity in terms of the electric potential and the geometry of the system only, can thus be easily adapted to alternative experimental settings.
The duration of undiagnosed or untreated bipolar disorder (DUBD) has become a focus of research interest. However, its relationship with clinical characteristics and outcomes remains poorly understood.
Aims
The objective of this systematic review and meta-analysis was to examine DUBD and explore its relationships with clinical characteristics and outcomes in bipolar disorder.
Methods
We conducted a systematic search of the literature to identify studies reporting on DUBD and its relationships with clinical characteristics and outcomes including frequency of relapse into mood episodes, severity and persistence of mood symptoms, functional and cognitive measures, suicidality, hospital admission rate, and comorbidities such as substance use disorders.
Results
Thirty articles met inclusion criteria for the systematic review, and 23 studies were included in the three different sets of meta-analyses. The pooled mean DUBD across all studies was 9.10 years. Early onset, depression as the polarity of the first mood episode, lifetime suicide attempts, comorbid anxiety and alcohol use disorders, and family history of bipolar disorder were associated with significantly longer DUBD, whereas diagnosis of bipolar I disorder and lifetime psychotic symptoms were associated with shorter DUBD. Studies that investigated outcomes subsequent to the diagnosis of bipolar disorder yielded conflicting results.
Conclusion
DUBD may be associated with certain adverse outcomes. This association indicates the importance of adopting a more comprehensive approach to assessing mood disorders, with an emphasis on prioritising early screening for bipolar disorder. The significant heterogeneity among included studies suggests a need for improved methodological rigour in future research.
Syllable integrity, the idea that the content of syllables may not be metrified separately, is often taken to be an inviolable constraint of grammar. This has been challenged in recent work, though the data are often subject to competing analyses. This article claims that syllable integrity is readily violable in Naasioi. Evidence from stress, the minimal word and metrically sensitive allomorphy supports an analysis of the metrical system operating on bimoraic feet, and in which long vowels can be metrified separately. Despite this, there is also evidence, in the form of vowel shortening and truncation, to indicate that long vowels constitute a single syllable. The net result is a stress system which systematically ignores syllables, a state of affairs which allows for syllable integrity violations to arise.
Knowledge about HIV and level of HIV-related stigma have been considered the main indicators of the community’s readiness to combat and bring the HIV epidemic to an end. Of all Serbia, the northern Kosovo province is especially vulnerable to the HIV spread because the infrastructure and the entire regulatory system had to be rebuilt after the ethnic conflict. The study objective was to examine the association between HIV-related knowledge level and attitudes towards people living with HIV (PLHIV) among university students from northern Kosovo using the quantile regression. A total of 1,017 students filled in an anonymous questionnaire. The questionnaire examined socio-demographic characteristics, HIV-related knowledge, attitudes towards PLHIV, sources of information about HIV, past experiences with PLHIV, and health behaviours. The dependent variable in the model was the attitude score (ATS) divided into quantiles (Q) in quantile regression analysis: Q0.10, Q0.25, Q0.50, Q0.75, and Q0.90. The independent variable was the knowledge score (KNS). The model was adjusted for relevant covariates. The majority of students had adequate HIV-related knowledge (89.6%) and 10.4% had lower knowledge. Most students also had a positive attitude (83.9%), while 16.1% were indecisive towards PLHIV. No students exhibiting wrong knowledge and negative attitudes were observed. The KNS and ATS significantly correlated with one another (ρ = 0.383; p = 0.001). The quantile regression model adjusted for variables associated with both KNS and ATS showed a negative association between KNS and ATS in the lowest quantile (Q0.10) of the ATS. In all other quantiles (Q0.25–Q0.90), a higher KNS was associated with having stronger positive attitudes towards PLHIV. This study confirmed that higher knowledge about HIV was associated with stronger positive attitudes towards HIV. Still, some students remain indecisive despite being knowledgeable about HIV. These students could benefit the most from continuing educational programmes to reduce the HIV-related stigma.
A public health emergency was declared for the opioid crisis in 2017 and remains in place. Between 2017-2024, there were 164 billion dollar disasters. People who use drugs (PWUDs) are highly susceptible to disasters; however adaptive capacity of opioid treatment programs (OTP) is not well understood. Identifying and addressing gaps to increase resilience and reduce morbidity and mortality among PWUDs is critical.
Methods
A semi-structured interview guide with 8 questions was developed to assess how disasters impact service provision and other aspects of OTPs. OTP leaders, government officials, community health navigators, and advocates received an email invitation to complete an interview via Zoom. Transcripts were independently hand coded to inductively identify themes.
Results
Eleven interviews were completed. Four themes were identified including client challenges securing housing and reliable transportation, disaster-related communication barriers, stigma around help seeking, and issues related to policies and practices such as regulations and insurance coverage that are inflexible during a disaster.
Conclusions
Disruptions to OTPs during disasters require preparedness planning adaptations like more flexible guest dosing. The ongoing public health emergency of the opioid epidemic and the increasing frequency and severity of climate and weather emergencies requires adaptations to a highly regulated system to address vulnerabilities.
Parvovirus B19 (PVB19) myocarditis is a life-threatening condition with high morbidity and mortality in children. While electrocardiograms are commonly used in the early assessment of myocarditis, no specific electrocardiogram pattern has been consistently linked to PVB19. The objective of this study is to identify a distinctive electrocardiogram pattern associated with PVB19 myocarditis and evaluate its diagnostic accuracy.
Methods:
This retrospective case–control study included 77 paediatric patients diagnosed with acute myocarditis at a single centre in Barcelona over 16 years (August 2008–September 2024). Twenty patients had PVB19 myocarditis, confirmed by polymerase chain reaction in blood or endomyocardial biopsy, while 57 patients had myocarditis caused by other viruses. Electrocardiogram were assessed by three cardiologists blinded to the aetiological diagnosis.
Results:
A specific electrocardiogram pattern in the limb leads, characterised by peaked P waves, low QRS complex voltages, and altered repolarisation (manifesting as negative or flat T waves, with or without QTc prolongation), was observed in 14 of 20 patients (70%) with PVB19 myocarditis. Two additional patients exhibited low voltages and altered repolarisation without peaked P waves, and all demonstrated repolarisation abnormalities. In contrast, only 1 of 57 patients with myocarditis from other viruses exhibited the full electrocardiogram pattern. The pattern demonstrated a specificity of 98% and a sensitivity of 70% for PVB19 myocarditis.
Conclusion:
The identified electrocardiogram pattern shows strong diagnostic specificity for PVB19 myocarditis in paediatric patients and may serve as a useful early diagnostic tool. Further multicentre studies are needed to confirm these findings and explore their clinical implications.
Today, two touchstones of the conservative legal movement are support for the unitary executive theory and skepticism of affirmative action policies. This article reveals a connection between these two positions, demonstrating how policy disputes over civil rights contributed to conservative efforts to increase and legitimize presidential control over the bureaucracy through the controversial claim that the president possesses the whole executive power under Article II. Specifically, I examine two intertwined controversies from 1983, which pit the Reagan White House and Department of Justice (DOJ) against the Equal Employment Opportunity Commission (EEOC) and U.S. Commission on Civil Rights (USCCR), two agencies that Reagan officials viewed as obstacles to pursuing its preferred civil rights agenda. Conflicts between the DOJ and EEOC led the administration to deploy the unitary executive theory to help centralize control over its civil rights litigation strategy, while clashes with the USCCR spurred the administration to assert the theory's tenets amid battles over that agency's reauthorization. While these episodes yielded mixed political and legal outcomes, the early articulations of the unitary executive theory that emerged helped to elaborate and advance a controversial constitutional doctrine about presidential power that has become increasingly consequential over time.
Large-eddy simulation (LES) is performed to study the tip vortex flow in a ducted propulsor geometry replicating the experiments of Chesnakas & Jessup (2003, pp. 257–267), Oweis et al. (2006a J. Fluids Engng128, 751–764) and Oweis et al. (2006b J. Fluids Engng128, 751–764). Inception of cavitation in these marine propulsion systems is closely tied to the unsteady interactions between multiple vortices in the tip region. Here LES is used to shed insight into the structure of the tip vortex flow. Simulation results are able to predict experimental propeller loads and show agreement with laser Doppler velocimetry measurements in the blade wake at design advance ratio, $J=0.98$. Results show the pressure differential across the blade produces a leakage vortex which separates off the suction side blade tip upstream of the trailing edge. The separation sheet aft of the primary vortex separation point is shown to take the form of a skewed shear layer which produces a complex arrangement of unsteady vortices corotating and counter-rotating with the primary vortex. Blade tip boundary layer vortices are reoriented to align with the leakage flow and produce instantaneous low-pressure regions wrapping helically around the primary vortex core. Such low-pressure regions are seen both upstream and downstream of the propeller blade trailing edge. The trailing edge wake is found to only rarely have a low-pressure vortex core. Statistics of instantaneous low pressures below the minimum mean pressure are found to be concentrated downstream of the blade’s trailing edge wake crossing over the primary vortex core and continue in excess of 40 % chord length behind the trailing edge. The rollup of the leakage flow duct boundary layer behind the trailing edge is also seen to produce counter-rotating vortices which interact with the primary leakage vortex and contribute to strong stretching events.
We prove that the class of separably algebraically closed valued fields equipped with a distinguished Frobenius endomorphism $x \mapsto x^q$ is decidable, uniformly in q. The result is a simultaneous generalization of the work of Chatzidakis and Hrushovski (in the case of the trivial valuation) and the work of the first author and Hrushovski (in the case where the fields are algebraically closed).
The logical setting for the proof is a model completeness result for valued fields equipped with an endomorphism $\sigma $ which is locally infinitely contracting and fails to be onto. Namely, we prove the existence of a model complete theory $\widetilde {\mathrm {VFE}}$ amalgamating the theories $\mathrm {SCFE}$ and $\widetilde {\mathrm {VFA}}$ introduced in [5] and [11], respectively. In characteristic zero, we also prove that $\widetilde {\mathrm {VFE}}$ is NTP$_2$ and classify the stationary types: they are precisely those orthogonal to the fixed field and the value group.
Although B vitamins have been shown to play beneficial roles in bone health, the effects of vitamin B1 in humans are still unclear. This study aimed to investigate the effects of vitamin B1 supplementation on middle-aged and older adults. This single-armed trial study included community-dwelling adults in Japan and used a pre- and post-test design. The participants were given 28.0 mg of vitamin B1 supplementation per day for 1 month in addition to their daily usual diet. The effect of this treatment on bone turnover markers and metabolism was evaluated at baseline and after 1 month. Forty-two participants were enrolled (mean age, 58.6 ± 10.4 years; 36 women). The vitamin B1 levels in whole blood increased significantly from baseline after vitamin B1 supplementation. The level of serum tartrate-resistant acid phosphatase 5b (TRACP 5b), a bone resorption marker, reduced significantly (378 ± 135 vs. 335 ± 120 mU/dL, p < 0.001), while the level of N-terminal propeptide of type I procollagen (P1NP), a marker specific to bone formation, did not change. Moreover, the serum phosphorus and parathyroid hormone (PTH) concentrations did not change, whereas the corrected serum calcium concentrations increased and vitamin D concentrations decreased. The serum TRACP 5b levels decreased after vitamin B1 supplementation in the middle-aged and older adults. Further definitive trials are needed to determine the efficacy of vitamin B1 in improving bone health.
An increasing number of older adults require residential care. Concurrently, older adults’ alcohol use is increasing. This review explored the perspectives of all relevant stakeholders on older adults’ alcohol use within residential care settings, through a systematic review and thematic synthesis of qualitative studies. Eight databases were searched for qualitative studies focusing on older adults’ alcohol consumption (defined as aged ≥ 50) within residential care settings, sampling any involved stakeholders, published up until January 2024. Quality appraisal utilised the Critical Appraisal Skills Programme checklist and included 15 studies of mainly moderate quality across seven high-income countries, reporting data from a range of stakeholders and representing varied older adults’ alcohol histories. Three themes were identified: alcohol use by older adults is socially acceptable and purposeful in residential care settings; alcohol helps in the pursuit of an ‘ideal’ outcome; and decision-making around older adults’ alcohol use varies depending on the involvement, knowledge, skills and beliefs of the participating stakeholders, who also vary. Reports of problematic alcohol use were rare and older adults in residential care settings should be supported to exercise their own choice in determining their alcohol use. However, residential care settings face particular challenges in managing the alcohol intake of older adults with limited mental capacity and alcohol dependency; owing to a lack of guidance, front-line staff make subjective decisions. Future research should develop guidance that involves all relevant stakeholders, including family members. Limitations include lack of generalisability to low- and middle-income countries and limited availability of raw data.
Amidst the global digital transformation and the expanding IT sector, particularly in Ukraine, it is essential to examine how digitalization affects structural shifts within the national economy. This study aims to analyze the impact of digitalization on the growth of Ukraine’s IT sector, focusing on comparing the economic metrics of freelancing and outsourcing and providing strategic recommendations to enhance entrepreneurial activity in this area. During the research, the methods of expert evaluations, economic-mathematical modelling, comparative analysis, and statistical data analysis were used. The research revealed that digitalization significantly influences structural changes in the national economy, particularly through the advancement of the IT sector. It was established that outsourcing has significant advantages compared to freelancing in terms of such indicators as the share of the GDP of the IT sector and the volume of exports of IT services. By analyzing the economic indicators of freelancing and outsourcing, specific recommendations were developed for the continued growth of Ukraine’s IT sector, aimed at boosting entrepreneurial activity and creating new job opportunities. The key factors influencing IT specialists’ employment choices were summarized, which is crucial for the continued development of the national economy in the context of digitalization. The practical value of this research is that its findings can be utilized to enhance Ukraine’s IT sector, particularly by backing outsourcing businesses and promoting the expansion of freelance platforms.
Emerging wildlife pathogens often display geographic variability due to landscape heterogeneity. Modeling approaches capable of learning complex, non-linear spatial dynamics of diseases are needed to rigorously assess and mitigate the effects of pathogens on wildlife health and biodiversity. We propose a novel machine learning (ML)-guided approach that leverages prior physical knowledge of ecological systems, using partial differential equations. We present our approach, taking advantage of the universal function approximation property of neural networks for flexible representation of the underlying dynamics of the geographic spread and growth of wildlife diseases. We demonstrate the benefits of our approach by comparing its forecasting power with commonly used methods and highlighting the obtained insights on disease dynamics. Additionally, we show the theoretical guarantees for the approximation error of our model. We illustrate the implementation of our ML-guided approach using data from white-nose syndrome (WNS) outbreaks in bat populations across the US. WNS is an infectious fungal disease responsible for significant declines in bat populations. Our results on WNS are useful for disease surveillance and bat conservation efforts. Our methods can be broadly used to assess the effects of environmental and anthropogenic drivers impacting wildlife health and biodiversity.
In this study, the propagation behaviour of detonation waves in a channel filled with stratified media is analysed using a detailed chemical reaction model. Two symmetrical layers of non-reactive gas are introduced near the upper and lower walls to encapsulate a stoichiometric premixed H2–air mixture. The effects of gas temperature and molecular weight of the non-reactive layers on the detonation wave’s propagation mode and velocity are examined thoroughly. The results reveal that as the non-reactive gas temperature increases, the detonation wave front transitions from a ‘convex’ to a ‘concave’ shape, accompanied by an increase in wave velocity. Notably, the concave wave front comprises detached shocks, oblique shocks and detonation waves, with the overall wave system propagating at a velocity exceeding the theoretical Chapman–Jouguet speed, indicating the emergence of a strong detonation wave. Furthermore, when the molecular weight of non-reactive layers varies, the results qualitatively align with those obtained from temperature variations. To elucidate the formation mechanism of different detonation wave front shapes, a dimensionless parameter $\eta$ (defined as a function of the specific heat ratio and sound speed) is proposed. This parameter unifies the effects of temperature and molecular weight, confirming that the specific heat ratio and sound speed of non-reactive layers are the primary factors governing the detonation wave propagation mode. Additionally, considering the effect of mixture inhomogeneity on the detonation reaction zone, the stream tube contraction theory is proposed, successfully explaining why strong detonation waves form in stratified mixtures. Numerical results show good agreement with theoretical predictions, validating the proposed model.
The use of explosive weapons in populated areas (EWIPA) has a disproportionate impact on civilians. Many humanitarian organizations utilize varying sheltering guidelines to recommend safe positions for civilians affected by explosive threats. It is not known whether these recommendations are standardized or derived from evidence. This study aimed to identify existing recommendations and potential gaps in literature relevant to sheltering guidelines for civilians during explosive events.
Methods
A scoping review was conducted of the literature including indexed databases and grey literature to identify reports that described sheltering guidelines for civilians during explosive events. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology was followed.
Results
The search identified 3582 peer-reviewed records. After title/abstract and full text screening, only 2 peer-reviewed reports remained eligible. These were combined with 13 gray literature reports obtained from humanitarian organizations and internet searches. The peer-reviewed reports included mine and unexploded ordnance guidelines, not guidelines for EWIPA or aerial bombardments. There is a substantial knowledge gap and heterogeneity in existing sheltering guidelines from explosive events, particularly those appropriate for protection from EWIPA.
Conclusions
Findings from this scoping review demonstrate a need for the creation and standardization of evidence-based civilian sheltering guidelines to mitigate the threat of explosive weapons to civilians in conflict.
Studies conducted during the COVID-19 pandemic found high occurrence of suicidal thoughts and behaviours (STBs) among healthcare workers (HCWs). The current study aimed to (1) develop a machine learning-based prediction model for future STBs using data from a large prospective cohort of Spanish HCWs and (2) identify the most important variables in terms of contribution to the model’s predictive accuracy.
Methods
This is a prospective, multicentre cohort study of Spanish HCWs active during the COVID-19 pandemic. A total of 8,996 HCWs participated in the web-based baseline survey (May–July 2020) and 4,809 in the 4-month follow-up survey. A total of 219 predictor variables were derived from the baseline survey. The outcome variable was any STB at the 4-month follow-up. Variable selection was done using an L1 regularized linear Support Vector Classifier (SVC). A random forest model with 5-fold cross-validation was developed, in which the Synthetic Minority Oversampling Technique (SMOTE) and undersampling of the majority class balancing techniques were tested. The model was evaluated by the area under the Receiver Operating Characteristic (AUROC) curve and the area under the precision–recall curve. Shapley’s additive explanatory values (SHAP values) were used to evaluate the overall contribution of each variable to the prediction of future STBs. Results were obtained separately by gender.
Results
The prevalence of STBs in HCWs at the 4-month follow-up was 7.9% (women = 7.8%, men = 8.2%). Thirty-four variables were selected by the L1 regularized linear SVC. The best results were obtained without data balancing techniques: AUROC = 0.87 (0.86 for women and 0.87 for men) and area under the precision–recall curve = 0.50 (0.55 for women and 0.45 for men). Based on SHAP values, the most important baseline predictors for any STB at the 4-month follow-up were the presence of passive suicidal ideation, the number of days in the past 30 days with passive or active suicidal ideation, the number of days in the past 30 days with binge eating episodes, the number of panic attacks (women only) and the frequency of intrusive thoughts (men only).
Conclusions
Machine learning-based prediction models for STBs in HCWs during the COVID-19 pandemic trained on web-based survey data present high discrimination and classification capacity. Future clinical implementations of this model could enable the early detection of HCWs at the highest risk for developing adverse mental health outcomes.
This cross-sectional study aimed to investigate the correlation between magnesium consumption and periodontitis in different body mass index (BMI) and waist circumference (WC) groups. 8385 adults who participated in the National Health and Nutrition Examination Survey during 2009–2014 were included. The correlation between dietary magnesium intake and periodontitis was first tested for statistical significance by descriptive statistics and weighted binary logistic regression. Subgroup analysis and interaction tests were performed to investigate whether the association was stable in different BMI and WC groups. There was a statistical difference in magnesium intake between periodontitis and non-periodontitis populations. In model 3, participants with the highest magnesium consumption had an odds ratio of 0.72 (0.57-0.92) for periodontitis compared to those with the lowest magnesium consumption. However, in subgroup analysis, the relationship between magnesium intake and periodontitis remained significant only in the non-general obese (BMI ≤ 30 kg/m2) and non-abdominal obese populations (WC ≤ 102 cm in men and ≤ 88 cm in women). Dietary magnesium intake might decrease the periodontitis prevalence in the American population, and this beneficial periodontal health role of magnesium consumption might only be evident in non-general obese and non-abdominal obese populations.