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Non-spherical particles transported by turbulent flow have a rich dynamics that combines their translational and rotational motions. Here, the focus is on small, heavy, inertial particles with a spheroidal shape fully prescribed by their aspect ratio. Such particles undergo an anisotropic, orientation-dependent viscous drag with the carrier fluid flow whose associated torque is given by the Jeffery equations. Direct numerical simulations of homogeneous, isotropic turbulence are performed to study systematically how the translational motion of such spheroidal particles depends on their shape and size. It is found that the Lagrangian statistics of both velocity and acceleration can be described in terms of an effective Stokes number obtained as an isotropic average over angles of the particle's orientation. Corrections to the translational motion of particles due to their non-sphericity and rotation can hence be recast as an effective radius obtained from such a mean.
This paper empirically investigates the economic effects of environmental activities. To be specific, it investigates the interactive influence of firms' environmental management and environmental innovation on their productivity. We consider both internal and external environmental management practices of global firms observed from 41 countries between 2017 and 2019. We also consider both inputs and outputs of firms' innovation activities that aim to reduce environmental impacts. Multiple indices are constructed to comprehensively evaluate firms' environmental activities, and productivity is estimated with a semi-parametric method. We find that environmental management and environmental innovation are directly correlated to each other and both substantially promote productivity; however, they tend to substitute each other's positive effects on productivity. Other variables such as globalization, government, labor inputs, and informal competition strongly affect firm productivity too.
Wave interaction with graded metamaterials exhibits the phenomenon of rainbow reflection, in which broadband wave signals slow down and separate into their frequency components before being reflected. This phenomenon has been qualitatively understood by describing the wave field in the metamaterial using the local Bloch wave approximation (LBWA), which locally represents the wave field as a superposition of propagating wave solutions in the cognate infinite periodic media (so-called Bloch waves). We evaluate the performance of the LBWA quantitatively in the context of two-dimensional linear water-wave scattering by graded arrays of surface-piercing vertical barriers. To do this, we implement the LBWA numerically so that the Bloch waves in one region of the graded array are coupled to Bloch waves in adjacent regions. This coupling is computed by solving the scattering of Bloch waves across the interface between two semi-infinite arrays of vertical barriers, where the barriers in each semi-infinite array can have different submergence depths. Our results suggest that the LBWA accurately predicts the free surface amplitude across a wide range of frequencies, except those just above the cutoff frequencies associated with each of the vertical barriers in the array. This highlights the importance of decaying Bloch modes above the cutoff in rainbow reflection.
Levodopa-carbidopa intestinal gel (LCIG) therapy has been shown to be a safe and effective treatment for advanced Parkinson’s disease (PD). Limited data are available regarding long-term benefits and complications in Canada. Objective of the study was to review long-term experience and clinical outcomes in PD patients with LCIG therapy over 11 years in a multidisciplinary University clinic setting.
Methods:
Chart review was done on PD patients with LCIG from 2011 to 2022. Data collected: dosing, UPDRS-III motor scores, OFF times, hours with dyskinesias, MoCA, complications, discontinuation reasons, and nursing time requirements.
Results:
Thirty-three patients received LCIG therapy with a mean follow-up of 3.25±2.09 years. UPDRS-III scores showed reduction of 15% from baseline (mean 35.9) up to 4 years (mean 30.4). Daily OFF time improved from baseline (mean 7.1 ± 3.13 hours) up to 5 years (mean 3.3 ± 2.31 hours; −53.5%; p < 0.048), and dyskinesias remained stable. Nursing time averaged 22 hours per patient per year after PEG-J insertion and titration. Most common complications were PEG-J tube dislodgement and stoma site infection (0–3zero to three events/patient/year). Serious side effects were seen in four (12%) patients resulting in hospitalization and/or death. Nine patients (27.2%) discontinued the treatment due to lack of improved efficacy over oral therapy or development of dementia and 10 (30%) died of causes unrelated to LCIG infusion.
Conclusion:
Patients on LCIG showed improved motor function over 5-year follow-up. Serious complications were uncommon. Dedicated nursing time is required by LCIG-trained nurses in a multidisciplinary setting for optimum management.
In pricing insurance contracts based on the individual policyholder’s aggregate losses for non-life insurers, the literature has mainly focused on using detailed information from policies and closed claims. However, the information on open claims can reflect shifts in the distribution of the expected claim payments better than closed claims. Such shifts may be needed to be reflected in the ratemaking process earlier rather than later, especially when insurers are experiencing environmental changes. In practice, actuaries use ad hoc techniques to adjust data to current levels to determine premiums. This paper presents an intuitive ratemaking model, employing a marked Poisson process framework, which ensures that the multivariate risk analysis is done more routinely using all reported claims and makes an adjustment for Incurred But Not Reported claims. Utilizing data from the Wisconsin Local Government Property Insurance Fund, we find that by determining rates based on current data, the proposed ratemaking model leads to better alignment of premiums and provides insurers with a more financially sound portfolio.
Beginning in 2018, a quality improvement collaborative initiative in Brazil successfully reduced the baseline incidence density of healthcare-associated infections in intensive care settings after 2 years. We describe the adaptations of the quality improvement interventions as the COVID-19 pandemic emerged and how the pandemic affected the project outcomes.
In the following essay I shall propose a reading of Lordship and Bondage that follows what Robert Pippin termed a ‘practical turn’ (Pippin 2011: 28). I shall further argue that this turn ought to be qualified as Hegel's first philosophy. Starting with a reading that evinces the connection between the practical achievement of Self-Consciousness and the notion of Spirit as exhibiting a concentric relation, Spirit will be revealed to have its centre in the practical achievement of Self-Consciousness. I will then offer a commentary on the notion of a complex desideratum as a way of attaining the concept of desire at work in the Phenomenology. The commentary will show that Hegel frames the satisfaction of this desire as a distinctive problem that will in turn necessitate a proper practical solution. This leads us to the implicit critique of contractualism, that may—in the terms of Hegel's argument—function as an impediment to the proper philosophical understanding of reciprocity. To conclude I shall propose a reading within the intrasubjective family of readings. We will find that the critique of both contractualism and the apprehension of the complex desideratum offers us the rationale for interpreting the peculiar absence of fear in Hegel's allegory of life-and-death struggle. I shall offer a detailed reading of the Lord and Bondsman trope and interpret these two figures as two aspects of one self-conscious individual in the process of apprehending their practical nature, thus making explicit a tripartite structure of practical self-consciousness. This will be suggested as the solution to the initial orectic problem and the beginning of an argument towards the practical attainment of Spirit.
Our contributions examine the Norwegian Karl Evang's (1901-1981) and the Dane Halfdan Mahler's (1923-2016) participation in international health co-operation facilitated by the World Health Organization (WHO) in India in the 1950s. While Evang’s was a hectic, but relatively short visit as part of a WHO visiting team of medical scientists in 1953, Mahler’s spanned the entire decade on assignments as WHO medical officer to tuberculosis control projects. Mahler’s name should be familiar to researchers of international health as the Director-General of the WHO 1973-88, and for his promotion of primary health care through the 1978 Alma-Ata Declaration. Evang, Norway’s Director of Health 1938-72, was also a key figure in international health in the mid-twentieth century as one of the original instigators of the WHO, and a participant in much of its early work.
A core theme is the place of social medicine, both in Evang’s and Mahler’s work, and within the WHO and its navigation of complex postcolonial settings in the 1950s. Investigating cross-regional encounters and circulations of social medicine ideas between Evang and Mahler and their Indian interlocutors as well as international WHO staff members, we ask what the role of social medicine was in international health in the early post-war period. Researchers have found that social medicine had its heyday during the 1930s and 1940s, and that a technology-focused, vertical approach became dominant soon after the war. In contrast, we suggest that continued circulation of social medical ideas points towards a more complicated picture.
Polymerase chain reaction (PCR) testing for the detection of C. difficile is a highly sensitive test. Some clinical laboratories have included a 2-step testing algorithm utilizing PCR plus toxin enzyme immunoassays (EIAs) to increase specificity.
Objective:
To determine the risk factors and outcomes of C. difficile PCR-positive/toxin-positive encounters compared to PCR-positive/toxin-negative encounters.
Design:
Retrospective study.
Setting:
A Veterans’ Affairs hospital.
Methods:
A retrospective case–control study of patient encounters with a positive C. difficile test by PCR and either a toxin EIA–positive assay (ie, cases) or toxin EIA–negative assay (ie, controls). Clinically relevant exposures and risk factors were determined to assess CDI recurrence at 30 days. Available encounter stool specimens were cultured for C. difficile and were subjected to restriction endonuclease analysis (REA) strain typing.
Results:
Among 130 C. difficile PCR-positive patient encounters, 80 (61.5%) were toxin EIA negative and 50 (38.5%) were toxin EIA positive. Encounters that were toxin positive were more frequently treated (96.0%) compared to toxin-negative encounters (71.3%; P < .01). A multivariable logistic regression model revealed that toxin-negative encounters were less likely to suffer a recurrent CDI episode within 30 days (odds ratio [OR], 0.20, 95% confidence interval [CI], 0.05–0.83). Additionally, a higher C. difficile PCR cycle threshold predicted a lower risk of CDI recurrence at 30 days. (OR, 0.82; 95% CI, 0.68–0.98). During the study period, the REA group Y strain accounted for most toxin-negative encounters (32.5%; P = .05), whereas REA group BI strain accounted for most toxin-positive encounters (24.3%; P = .02).
Conclusions:
A testing strategy of PCR plus toxin EIA helped predict recurrent CDI.
To examine differences in risk factors and outcomes of patients undergoing colon surgery in level 1 trauma centers versus other hospitals and to investigate the potential financial impact of these reportable infections.
Design:
Retrospective cohort study between 2015 and 2022.
Setting:
Large public healthcare system in New York City.
Participants:
All patients undergoing colon surgery; comparisons were made between (1) all patients undergoing colon surgery at the level 1 trauma centers versus patients at the other hospitals and (2) the nontrauma and trauma patients at the level 1 trauma centers versus the nontrauma patients at other hospitals.
Results:
Of 5,217 colon surgeries reported, 3,531 were at level 1 trauma centers and 1686 at other hospitals. Patients at level 1 trauma centers had significantly increased American Society of Anesthesiology (ASA) scores, durations of surgery, rates of delayed wound closure, and rates of class 4 wounds, resulting in higher SIRs (1.1 ± 0.15 vs 0.75 ± 0.18; P = .0007) compared to the other hospitals. Compared to the nontrauma patients at the other hospitals, both the nontrauma and trauma patients at the level 1 trauma centers had higher ASA scores, rates of delayed wound closure, and of class 4 wounds. The SIRs of the nontrauma patients (1.16 ± 1.29; P = .008) and trauma patients (1.26 ± 2.69; P = .066) at the level 1 trauma center were higher than the SIRs of nontrauma patients in the other hospitals (0.65 ± 1.18).
Conclusions:
Patients undergoing colon surgery at level 1 trauma centers had increased complexity of surgery compared to the patients in other hospitals. Until there is appropriate adjustment for these risk factors, the use of infections following colon surgery as a reportable quality measure should be re-evaluated.
We study the onset of the three-dimensional mode A instability in the near wake behind a circular cylinder. We show that long-wavelength perturbations organise in a time-shifting pattern such that the in-plane velocity in each streamwise slice corresponds to the base flow solution at shifted times. This observation introduces an additional unifying characteristic for certain mode A type instabilities. We then analyse the mechanisms which control the growth or decay of these perturbations and highlight the crucial role played by the tilting mechanism which operates via non-local interactions in a manner similar to Biot–Savart induction. We characterise its domain of influence using a Green's function-based approach which allows us to rationalise the non-trivial dependence of the growth rate on the spanwise wavenumber. We connect this behaviour to the subtle balance between the local growth of the perturbations as they are swept along by the flow and the feedback on the perturbations that are generated during the next period of the time-periodic base flow. Finally, we discuss generalisations of our findings to other types of flows.
We prove Wiener Tauberian theorem type results for various spaces of radial functions, which are Banach algebras on a real-rank-one semisimple Lie group G. These are natural generalizations of the Wiener Tauberian theorem for the commutative Banach algebra of the integrable radial functions on G.
Nothing in William Fraser's life in India is better known than his leaving of it. In March 1835, after 30 years in India, Fraser, then the East India Company's chief representative in Delhi, was gunned down by an assassin. The story of Fraser's murder is well covered in history. However, far more of Fraser's life in India—and that of his brothers—is discernible through their letters home to their family in Reelig, outside Inverness in Scotland.
The Frasers sent five sons to India: William, his older brother James, and their three younger siblings, Edward, Alexander, and George. Only James ultimately returned home. If service in the East India Company in the time of Clive had offered the chance of making a killing, so too was it possible to die young of disease or in battle. By the early nineteenth century, after a series of Company reforms, it was no longer as possible to make a huge fortune in India, though early death was still a probability. Nevertheless, salaries were respectable, and one could live well and maybe even send money home. There is a great deal more than these material considerations in the Frasers’ correspondence. Among the topics covered are the brothers’ impressions of India, descriptions of travel and working life, their professional and social interactions with the British and Indians, and reflections on the contemporary state of medical care. This article will discuss the lives and travails of the Fraser brothers as exemplars of their generation of East India Company officialdom.
Recall that a group G has finitely satisfiable generics (fsg) or definable f-generics (dfg) if there is a global type p on G and a small model $M_0$ such that every left translate of p is finitely satisfiable in $M_0$ or definable over $M_0$, respectively. We show that any abelian group definable in a p-adically closed field is an extension of a definably compact fsg definable group by a dfg definable group. We discuss an approach which might prove a similar statement for interpretable abelian groups. In the case where G is an abelian group definable in the standard model $\mathbb {Q}_p$, we show that $G^0 = G^{00}$, and that G is an open subgroup of an algebraic group, up to finite factors. This latter result can be seen as a rough classification of abelian definable groups in $\mathbb {Q}_p$.
This essay aims to situate the emergence of Siddha medicine as a separate medical system in the erstwhile Madras Presidency of colonial India within a broader socio-economic context. Scholars who have worked on Siddha medicine have stressed more on political dimensions like nationalism and sub-nationalism with inadequate attention to the interplay of various (other) factors including contemporary global developments, changes in the attitude of the colonial State and especially to the new promises held by the greater deference shown to indigenous medical systems from the 1920s. If the construction of ‘national medicine’ based on the Sanskrit texts and the accompanying marginalisation of regional texts and practices were the only reasons for the emergence of Siddha medicine as presented by scholars, it leaves open the question as to why this emergence happened only during the third decade of the twentieth century, though the marginalisation processes started during the first decade itself. This paper seeks to find an answer by analysing the formation of Siddha medical identity beyond the frameworks of nationalism and sub-nationalism. Further, it explicates how material factors served as immediate cause along with the other, and more ideational factors related to the rise of the Dravidian political and cultural movement.
Let $\mathcal {M}$ be an Ahlfors $n$-regular Riemannian manifold such that either the Ricci curvature is non-negative or the Ricci curvature is bounded from below together with a bound on the gradient of the heat kernel. In the paper [IMRN, 2022, no. 2, 1245-1269] of Brazke–Schikorra–Sire, the authors characterised the BMO function $u : \mathcal {M} \to \mathbb {R}$ by a Carleson measure condition of its $\sigma$-harmonic extension $U:\mathcal {M}\times \mathbb {R}_+ \to \mathbb {R}$. This paper is concerned with the similar problem under a more general Dirichlet metric measure space setting, and the limiting behaviours of BMO & Carleson measure, where the heat kernel admits only the so-called diagonal upper estimate. More significantly, without the Ricci curvature condition, we relax the Ahlfors regularity to a doubling property, and remove the pointwise bound on the gradient of the heat kernel. Some similar results for the Lipschitz function are also given, and two open problems related to our main result are considered.