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This study investigates the influence of surface wave characteristics, specifically wave steepness and directional spreading, on intermittency in deep-water gravity wave turbulence through long-term numerical simulations of three-dimensional potential fully nonlinear periodic gravity waves. We conducted this investigation by estimating the scaling exponent of the surface elevation under different sea state conditions. With our numerical methods, we were able to evaluate the scaling exponents of the structure-function up to 12th order. The observed increased intermittency in directionally narrower sea states and in higher steepness conditions aligns with known effects of quasi-resonant wave–wave interactions and wave breaking. Comparative analyses reveal that both the conventional She–Leveque model and the multifractal models, also used to represent intermittency in wave turbulence of a different nature, exhibit a strong correlation in this study. This observation underscores the universality of intermittency phenomena within wave turbulence.
Racial and ethnic variations in antibiotic utilization are well-reported in outpatient settings but little is known about inpatient settings. Our objective was to describe national inpatient antibiotic utilization among children by race and ethnicity.
Methods:
This study included hospital visit data from the Pediatric Health Information System between 01/01/2022 and 12/31/2022 for patients <20 years. Primary outcomes were the percentage of hospitalization encounters that received an antibiotic and antibiotic days of therapy (DOT) per 1000 patient days. Mixed-effect regression models were used to determine the association of race-ethnicity with outcomes, adjusting for covariates.
Results:
There were 846,530 hospitalizations. 45.2% of children were Non-Hispanic (NH) White, 27.1% were Hispanic, 19.2% were NH Black, 4.5% were NH Other, 3.5% were NH Asian, 0.3% were NH Native Hawaiian/Other Pacific Islander (NHPI) and 0.2% were NH American Indian. Adjusting for covariates, NH Black children had lower odds of receiving antibiotics compared to NH White children (aOR 0.96, 95%CI 0.94–0.97), while NH NHPI had higher odds of receiving antibiotics (aOR 1.16, 95%CI 1.05–1.29). Children who were Hispanic, NH Asian, NH American Indian, and children who were NH Other received antibiotic DOT compared to NH White children, while NH NHPI children received more antibiotic DOT.
Conclusions:
Antibiotic utilization in children’s hospitals differs by race and ethnicity. Hospitals should assess policies and practices that may contribute to disparities in treatment; antibiotic stewardship programs may play an important role in promoting inpatient pharmacoequity. Additional research is needed to examine individual diagnoses, clinical outcomes, and drivers of variation.
The depression, obstructive sleep apnea and cognitive impairment (DOC) screen assesses three post-stroke comorbidities, but additional information may be gained from the time to complete the screen. Cognitive screening completion time is rarely used as an outcome measure.
Objective:
To assess DOC screen completion time as a predictor of cognitive impairment in stroke/transient ischemic attack clinics.
Methods:
Consecutive English-speaking stroke prevention clinic patients consented to undergo screening and neuropsychological testing (n = 437). DOC screen scores and times were compared to scores on the NINDS-CSC battery using multiple linear regression (controlling for age, sex, education and stroke severity) and receiver operating characteristic (ROC) curve analysis.
Results:
Completion time for the DOC screen was 3.8 ± 1.3 minutes. After accounting for covariates, the completion time was a significant predictor of the speed of processing (p = 0.002, 95% CI: −0.016 to −0.004), verbal fluency (p < 0.001, CI: −0.012 to −0.006) and executive function (p = 0.004, CI: −0.006 to −0.001), but not memory. Completion time above 5.5 minutes was associated with a high likelihood of impairment on executive and speed of processing tasks (likelihood ratios 3.9–5.2).
Conclusions:
DOC screen completion time is easy to collect in routine care. People needing over 5.5 minutes to be screened likely have deficits in executive functioning and speed of processing – areas commonly impaired, but challenging to screen for, after stroke. DOC screen time provides a simple, feasible approach to assess these under-identified cognitive impairments.
If one were to write the history of representation from an intersectional perspective, it would read as a veritable comedy of errors. A story, in short of inclusion and exclusion, privileging and marginalization, and of good, mis-, poor, and non-representation. No facet of politics is untouched by these dynamics – whether civil society or formal political participation, political recruitment and leadership, or policy and legislation (Siow 2023).
The Anda manuscript and Haihun slips have revealed that there were several different stanza permutations for poems in the “Guo feng” 國風 in early China. As most repetitive stanzas are essentially nonlinear, there is no intrinsic sequence for many poems. Rather than finding a “superior” stanza order, I would like to consider how the various stanza orders might challenge traditional interpretations of references to stanza numbers in the Zuozhuan 左傳 and the hermeneutical rule of “orderly progression” in the Shijing. Just as establishing the order of stanzas took a long time, the development of this rule was gradual. The belief in there being an unalterable stanza order not only influences how rhymes are interpreted but also shapes how lines and verses are annotated. Therefore, reconsidering the theory of orderly progression is a step towards re-evaluating the tradition of Shijing interpretation.
Autism spectrum disorder (ASD) is a neurodevelopmental condition. Omega-3 fatty acid insufficiency has been linked to ASD. This umbrella meta-analysis was performed to investigate the effects of omega-3 supplementation on clinical manifestations in participants with ASD. Based on the PRISMA statement, databases including Web of Science, PubMed and Scopus were systematically searched for published meta-analyses on the effect of omega-3 supplementation on ASD up to December 2023. To assess the risk of bias, the assessment of multiple systematic reviews (AMSTAR)-2 was utilised. The outcomes were core and non-core symptoms of ASD including social withdrawal/lethargy, cluttering speech, hyperactivity, irritability and stereotypy. Seven meta-analyses eventually remained in the umbrella review. The results revealed that omega-3 fatty acid supplementation caused a significant reduction in cluttering speech in studies conducted on age ≤8 years (effect size (ES) −0·30; 95% confidence interval (CI) −0·55, −0·06; P = 0·02). Omega-3 supplementation caused a significant reduction in hyperactivity in participants ≤8 years (ES −0·30; 95% CI −0·55, −0·06; P = 0·02) and in participants who received the supplements for more than 14 weeks (ES −0·30; 95% CI −0·55, −0·06; P = 0·02). A dosage of ≤1000 mg/d of omega-3 supplementation led to a significant increase in the stereotypy/restricted and repetitive interests and behaviours (ES 0·19; 95% CI 0·03, 0·35; P = 0·02). This umbrella review revealed that omega-3 fatty acid may be a beneficial supplement to control cluttering speech and hyperactivity in children with ASD who are 8 years old or younger.
In order to improve the regional applicability of existing evaporative misting systems, a new evaporative misting system based on photovoltaic/thermal and ventilation heat exchange is proposed for sow farms. Compared to traditional systems, the proposed system can help to improve their regional applicability and reduce their energy consumption. Meanwhile, its simulation model is constructed and the reliability is verified for its core equipment. The maximum error is less than 14.5% for the above models. Through simulation, the optimal regulation variable ranges in the proposed system are determined for mass flow rate of working fluid (MFWF) and misting power by analysing its operating characteristics. The results show that its optimal ranges of MFWF and misting power are 7245–9245 kg/h and 40–45 kW, respectively. The annual performance is further quantified and analysed under different load ratios for the proposed system in Guangzhou. It can be found that the annual exergy loss, heat exchange coefficient and solar energy benefits of the proposed system in Guangzhou are negatively correlated with load ratio, but its annual energy consumption and energy efficiency ratio are positively correlated. Meanwhile, the system performance and benefits are not significantly improved by increasing device investment and sow density when load ratio exceeds 120% in sow farms. The above conclusion can contribute to improving the existing evaporative misting systems in sow farms and guiding the operating regulation of the proposed system.
Godwin Mbikusita-Lewanika, the founding president of Zambia’s first nationalist organisation, is now remembered as a staunch supporter of colonial rule. Such figures are not uncommon and are often termed “loyalists,” a term that is usually understood in the literature as a fixed category that either dwindled in the face of racial oppression or was a choice shaped and hardened by conflict. Lewanika, however, moved easily between different sides, reinventing himself as an anticolonial nationalist, trade unionist, colonial loyalist, and Lozi traditional monarchist as circumstances warranted. The tumult of the mid-twentieth century opened up new opportunities and Lewanika seized roles that were not previously available. Biographies of anticolonial nationalists often argue they turned to political action when their education and ambitions clashed with the highly-circumscribed roles available under colonialism. Lewanika’s life was the opposite. He carved out a prominent place for himself in the colonial order and then in independent Zambia.
We study the effect of gas rarefaction on the interaction of small thermodynamic non-uniformities with a finite body. Considering a two-dimensional set-up, the initial system state is modelled as slight perturbations over its uniform density and temperature fields, prescribed in the vicinity of a thin plate. The problem is analysed in the collisionless limit and complemented by direct simulation Monte Carlo computations to cover the entire range of gas rarefaction rates. The high-Knudsen ‘sink-like’ and ‘source-like’ propagation patterns observed in the density- and temperature-driven set-ups, respectively, are discussed, together with the impact of specular (smooth) and diffuse (isothermal) wall reflections. At highly rarefied conditions, the solid body obstructs part of the gas domain, preventing the propagation of acoustic disturbances therein. With decreasing gas rarefaction, the acoustic field penetrates the obscured area via the effect of molecular collisions. Inspecting the near-field description, the propagation of flow disturbances along the plate surface is examined, and the acoustic force on the body is computed. In the thermally excited case, both normal- and shear-force components change sign at late times, attracting the plate towards the initial perturbation location. With reducing gas rarefaction, the shear force diminishes while the normal force sharply increases due to the decrease in signal decay. Finally, we apply the analysis to study the impact of gas rarefaction on acoustic reciprocity. Notably, acoustic reciprocity does not hold at non-continuum conditions over non-specular surfaces, where boundary reflections propagate in the presence of few molecular collisions, insufficient to retain reciprocal symmetry.
Risk stratification is recommended for patients with ventricular pre-excitation, particularly when sports eligibility is required. Few studies have examined the changes in the electrophysiological properties of the accessory pathway during growth. This study investigates the evolution of electrophysiological properties of the ventricular pre-excitation in young athletes referred for sports eligibility.
Methods:
Between January 2011 and July 2022, 44 paediatric patients (32 males; mean age, 10 ± 2.42) with ventricular pre-excitation underwent an electrophysiological study, both at rest and during adrenergic stress at two different times (T0 and T1) within a minimal interval of 2 years. Transcatheter ablation was not performed between the two electrophysiological studies. Electrophysiological data were collected and compared.
Results:
Electrophysiological study under basal conditions showed a significant decrease in the anterograde accessory pathway effective refractory period and 1:1 conduction over the accessory pathway from T0 to T1. The shortest pre-excited R-R interval during atrial fibrillation did not significantly change at the basal condition; however, it decreased during the stress test. Furthermore, six patients (13.6%) changed the risk profile of their accessory pathway: two “high-risk” patients at T0 became “low-risk” and four “low-risk” patients became “high-risk” at T1. Atrioventricular re-entry tachycardia inducibility did not differ significantly between the two electrophysiological studies.
Conclusions:
This study highlights the importance of repeating electrophysiological study (transesophageal or intracardiac) in paediatric athletes with ventricular pre-excitation because significant and clinically relevant changes in the conduction and refractoriness of accessory pathway can occur. This could influence risk stratification for sports eligibility and the correct indication and timing for accessory pathway ablation.
Left ventricular diastolic dysfunction is associated with poor prognosis in patients with hypertrophic cardiomyopathy and CHD. We report the case of an infant concomitant with hypertrophic cardiomyopathy, an atrial septal defect, and left ventricular diastolic dysfunction, who was successfully managed with fenestrated closure of the atrial septal defect.
Although evidence supports the improved safety profile of direct oral anticoagulants (DOACs) over warfarin (WF), outcomes among elderly traumatic brain injury (TBI) patients on this regimen remain unclear. This study describes the association between anticoagulation status (DOAC vs. WF use) and the rates of occurrence of intracranial hemorrhage (ICH), hematoma progression, need for surgical intervention and mortality in elderly TBI cases.
Methods:
This retrospective cohort study from 2014 to 2019 included all trauma patients > 65 years on either WF or DOACs at the time of injury. The primary outcome was the rate of ICH after TBI. Multivariable regression analysis identified independent predictors of functional dependency and mortality.
Results:
A total of 501 elderly TBI patients (mean age = 82 years old) were included. WF users had higher CT Marshall scores (p = 0.007), more severe TBI (GCS < 8) (p = 0.003) and higher rates of subdural hematomas compared to the DOAC group (p = 0.003). Patients on DOACs had lower rates of ICH (42% vs. 57%, p = 0.001) and hospitalization (30% vs. 41%, p = 0.013) and better Glasgow outcome scale-extended scores at hospital discharge (mean 6.98 vs. 6.41, p = 0.005). Multicompartment ICH (OR 2.30, p = 0.027) and longer hospitalization (OR 0.04, p < 0.001) were associated with higher functional dependency rates, while higher CT Marshall scores (OR 1.09, p < 0.001) and poorer baseline frailty status (OR 0.62, p = 0.026) predicted increased mortality risk.
Conclusion:
Elderly TBI patients on DOACs have lower rates of ICH, lower need for hospitalization and better functional outcomes at discharge compared to those taking WF. These findings need further confirmation using prospective multicenter studies.
Ageing is an inevitable biological process accompanied by various physiological changes, and researchers have long sought interventions to promote healthy ageing. This article explores the effects of four natural compounds – omega-3 fatty acids, coenzyme Q10, gingerol and curcumin – on the ageing process. We delve into the scientific literature to examine the potential benefits and mechanisms behind these substances in mitigating age-related conditions. Omega-3’s anti-inflammatory properties, coenzyme Q10’s cellular energy support, gingerol’s antioxidant effects and curcumin’s anti-ageing properties are discussed. By shedding light on the impact of these compounds, this review aims to contribute to a better understanding of how natural substances may play a role in promoting longevity and enhancing the quality of life during the ageing journey.
We investigate a turbulent stratified plane Poiseuille flow using linear models and nonlinear simulations. We propose the first complete explanation for the prolific and coherent backward (BWs)- and forward-propagating waves (FWs), which have been observed in these flows. We demonstrate a significant presence of oblique waves in the channel core, particularly for the FWs. Critically, we show that neglect of spanwise structure leads to a distorted dispersion relation due to its strong dependence on the angle of obliquity. Interestingly, solutions to the Taylor–Goldstein equations show that wave dynamics is strongly dependent on shear, with only a weak dependence on buoyancy for the BWs at low and order-one wavenumbers, when the wavenumber is scaled by the channel half-height. As the wavenumber increases, waves transition from a shear-dominated regime to a buoyancy-dominated regime, with their dispersion relation tending towards that of idealised internal waves subject to a shear-free and constant-buoyancy-gradient flow, with a characteristic velocity and buoyancy frequency corresponding to respective centreline values in the channel. Finally, we show that the dominance of the BWs arises due to the external forcing of the system, whereby turbulent fluid ejected into the core has a lower momentum when compared with the local flow, therefore preferentially generating BWs in the channel. Qualitatively, channel-core dynamics can be reproduced with low-momentum forcing to a velocity profile with a velocity maximum and a corresponding negative second derivative intersecting a region of strong buoyancy gradient. This structure is inherent to a wide variety of jet-like environmental, atmospheric and industrial flows, suggesting that BWs are a critical control on dynamics of such flows.
We present the results of a combined experimental and theoretical investigation of different fluid sheet structures formed during the impingement of a laminar liquid jet on a vial, with a slightly larger diameter than the jet and filled with the same liquid. The present set-up produces all diverse fluid sheet structures, unlike previous experiments that required a deflector disk resulting in no-slip and no-penetration boundary conditions. The water sheet structures are classified into four regimes; regime I: pre-sheet; regime II: puffing, characterized by the periodic formation and destruction of the upward-rising water sheet, an interesting observation not reported earlier; regime III, steady upward, inverted umbrella-like sheet structures; and regime IV, the formation of downward, umbrella-like sheet structures, which can be either open or closed, classically referred to as ‘water bells’. The water sheet structures observed are governed by the non-dimensional parameters: the ratio of vial diameter to the jet diameter at impact ($X$), the capillary number ($Ca$), the Weber number ($We$) and the Froude number ($Fr$). The parametric spaces $X-Ca$, $X-We$ and $X-Fr$ exhibit the demarcation of the four regimes. A semi-empirical expression for the ejection angle of the liquid sheet, primarily responsible for different shapes, is derived in a control volume that provides a theoretical basis for the identified regime diagrams. The puffing water bells in regime II are found to be quasi-steady as the experimental trajectories are in good agreement with the steady-state theory. The rise time of puffing water bells that determines the puffing frequency has been modelled.
Radiologic imaging has become integral in not only the detection and diagnosis of subdural hematoma (SDH) but also in guiding potential treatment options. This is especially true for chronic SDH, which has conventionally been managed via surgical drainage, but can now be treated with embolization of the middle meningeal artery (MMA). We review the imaging manifestations of SDH as a function of chronicity and standardized methods of measurement and identify the MMA and its clinically significant variant anatomy as it pertains to embolization planning. Equipped with a more comprehensive approach to characterizing SDH, the radiologist will be able to curate findings of greater utility to the clinician.
The apartheid experience in South Africa was a horrendous one for mankind, in which humans unleashed all sorts of evil on one another due to unfounded categorization based on color. This led to a superiority complex where a class saw another as not worth the treatment their dogs received. The fact is that black color was an adaptive one, given the environment of the possessors; the melanin which is the pigmentation that makes the skin black is meant to prevent the skin from cancer emanating from radiations from the sun. It shouldn’t be a thing of social disequilibrium. Following the release of Nelson Mandela from jail in 1990 and the demise of the apartheid system of rule, South Africa became a free country, which provided the ground for South Africans and others to embark on penning books of personal histories of these painful experiences under apartheid.