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The Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) trial demonstrated that minimally invasive surgery to treat spontaneous lobar intracerebral hemorrhage (ICH) improved functional outcomes. We aimed to explore current management trends for spontaneous lobar ICH in Canada to assess practice patterns and determine whether further randomized controlled trials are needed to clarify the role of surgical intervention.
Methods:
Neurologists, neurosurgeons, physiatrists and trainees in these specialties were invited to complete a 16-question survey exploring three areas: (1) current management for spontaneous lobar ICH at their institution, (2) perceived influence of ENRICH on their practice and (3) perceived need for additional clinical trial data. Standard descriptive statistics were used to report categorical variables. The χ2 test was used to compare responses across specialties and career stages.
Results:
The survey was sent to 433 physicians, and 101 (23.3%) responded. Sixty-eight percent of participants reported that prior to publication of the ENRICH trial, spontaneous lobar ICH was primarily managed conservatively, with surgery reserved for life-threatening situations. Forty-three percent of participants did not foresee a significant increase in surgical intervention at their institution. Of neurosurgical respondents, 33% remained hesitant to offer surgical intervention beyond lifesaving operations. Only 5% reported routinely using specifically designed technologies to evacuate ICH. Seventy percent reported that another randomized controlled trial comparing nonsurgical to surgical management for spontaneous lobar ICH is needed.
Conclusions:
There is significant practice variability in the management of spontaneous lobar ICH across Canadian institutions, stressing the need for additional clinical trial data to determine the role of surgical intervention.
An analytical theory is developed that describes acoustic microstreaming produced by the interaction of an oscillating gas bubble with a viscoelastic particle. The bubble is assumed to undergo axisymmetric oscillation modes, which can include radial oscillation, translation and shape modes. The oscillations of the particle are excited by the oscillations of the bubble. No restrictions are imposed on the ratio of the bubble and the particle radii to the viscous penetration depth and the separation distance, as well as on the ratio of the viscous penetration depth to the separation distance. Capabilities of the developed theory are illustrated by computational examples. The shear stress produced by the acoustic microstreaming on the particle’s surface is calculated. It is shown that this stress is much higher than the stress predicted by Nyborg’s formula (1958 J. Acoust. Soc. Am.30, 329–339), which is commonly used to evaluate the time-averaged shear stress produced by a bubble on a rigid wall.
This article is part of Religious Studies’ new initiative to publish a series of interviews with distinguished philosophers of religion. Each interview explores the personal and academic background of the interviewee and discusses their core philosophical views. The aim is to inspire students and scholars and to provide an overview of some of the most important works developed by contemporary philosophers of religion. In this interview, Kirk Lougheed interviews John Leslie, covering such topics as working in advertising after finishing his BA at Oxford, returning to graduate school, and developing and defending Axiarchism throughout his philosophical career.
It is proven that a matched pair of actions on a Hopf algebra H is equivalent to the datum of a Yetter–Drinfeld brace, which is a novel structure generalizing Hopf braces. This [-30pt] improves a theorem by Angiono, Galindo, and Vendramin, originally stated for cocommutative Hopf braces. These Yetter–Drinfeld braces produce Hopf algebras in the category of Yetter–Drinfeld modules over H, through an operation that generalizes Majid’s transmutation. A characterization of Yetter–Drinfeld braces via 1-cocycles, in analogy to the one for Hopf braces, is given.
Every coquasitriangular Hopf algebra H will be seen to yield a Yetter–Drinfeld brace, where the additional structure on H is given by the transmutation. We compute explicit examples of Yetter–Drinfeld braces on the Sweedler’s Hopf algebra, on the algebras $E(n)$, on $\mathrm {SL}_{q}(2)$, and an example in the class of Suzuki algebras.
This paper presents detailed analyses of the Reynolds stresses and their budgets in temporally evolving stratified wakes using direct numerical simulation. Ensemble averaging is employed to mitigate statistical errors in the data, and the results are presented as functions of both the transverse and vertical coordinates – at time instants across the near-wake, non-equilibrium, and quasi-two-dimensional regimes for wakes in weakly and strongly stratified environments. Key findings include the identification of dominant terms in the Reynolds stress transport equations and their spatial structures, the generation and destruction processes of the Reynolds stresses, and the energy transfer between the Reynolds stress and the mean flow. The study also clarifies the effects of the Reynolds number and the Froude number. Additionally, we assess the validity of the eddy-viscosity type models and some existing closures for the Reynolds stress model, highlighting the limitations of isotropy and return-to-isotropy hypotheses in stratified flows.
Latin America continues to provide a fertile hunting ground for students of comparative politics. There is plentiful variation between, within, and across countries and subsectors. Yet, there are also shared scope conditions, cultural and institutional commonalities, and region-wide interactions and demonstration effects. There are some areas where comparisons can be based on either the “most similar” or the “most different” system design, but most causal variables of real interest are imprecise, unstable, and mutually interactive. They often operate within discontinuous and unstable political systems that evade mechanistic modeling. Temporal discontinuities and compartmentalized sectors can be so prevalent that “kaleidoscopic” patterns may seem more typical than smoothly institutionalized regularities or predictable convergences.
Responding to Kenneth Smith’s recent essay, I theorize that Lisztian two-dimensional sonata form and Stravinskian ‘block’ structure exhibit a tightly bound relationship in Alexander Scriabin’s late sonatas. Such analysis stitches Scriabin both backwards in time towards Liszt, through the latter’s disciple Alexander Siloti, and forwards in time towards Stravinsky and the fragmented aesthetic of much twentieth-century musical modernism. Thus Scriabin’s late works, often thought to be hermetically sealed from traditions before and after him, are situated in direct contact with two practices. Though of little note in isolation, biographical connections to Liszt and Stravinsky are also compelling from a sonata-specific perspective. I examine not just how Scriabin’s mature sonatas are Lisztian-Stravinskian, but why.
This article investigates how Black voters choose candidates in majority-Black congressional districts. Partisanship often drives Black vote choice, but the lack of competition in general elections reduces its relevance and highlights the importance of primary elections. Racial cues are also referenced in literature, but the electoral setting reduces the relevance of race. Majority-Black congressional districts are racially homogeneous, and all emerging candidates are Black. Race cannot be used to distinguish between candidates. Congressional primary elections are also considered low-information environments, and voters have limited knowledge about the emerging candidates. In these settings, Black voters turn to cues to choose candidates. Since partisan and racial cues are not viable options, I argue that Black voters seek cues that signal group consensus. I highlight the role of endorsements and public opinion data. I utilize a mixed methodological approach incorporating a randomized survey experiment and focus group discussions with Black primary voters. Results from both methods suggest consensus cues are essential. Experimental results found no significant difference between racial and partisan endorsements, but they found a positive and significant effect for high polling. Focus group respondents had sincere preferences but were willing to abandon them if they differed from the group consensus. They also pointed to the importance of the media. I conducted an exploratory analysis of my experimental results, and I found that those with higher levels of media attention are more likely to rely on consensus cues. These results provide important insight into Black vote choice in majority-Black congressional districts.
Turbulent mixing in a supercritical CO$_2$ shear layer is examined using both experimental and numerical methods. Boundary conditions are selected to focus on the rarely studied near-critical regime, where thermophysical properties vary nonlinearly with respect to temperature and pressure. Experimental results are obtained via Raman spectroscopy and shadowgraphy, while numerical results are obtained via direct numerical simulation. The shear layer growth rate is found to be 0.2. Additionally, density profiles indicate a relaxation of density gradients between the mixed fluid and heavy fluid as the flow evolves downstream, which runs counter to existing supercritical shear layer data in the literature. The computational results identify significant anisotropy in the turbulence in the shear layer, which is discussed in terms of the development of regions of high density gradient magnitude. The Reynolds-averaged enstrophy budget at various streamwise locations indicates no significant dilatational or baroclinic contribution within the shear layer.
An important parameter characterising the synchronisation of turbulent flows is the threshold coupling wavenumber. This study investigates the relationship between the threshold coupling wavenumber and the leading Lyapunov vector using large eddy simulations and the SABRA model. Various subgrid-scale stress models, Reynolds numbers and different coupling methods are examined. A new scaling relation is identified for the leading Lyapunov exponents in large eddy simulations, showing that they approximate those of filtered direct numerical simulations. This interpretation provides a physical basis for results related to the Lyapunov exponents of large eddy simulations, including those related to synchronisation. Synchronisation experiments show that the peak wavenumber of the energy spectrum of the leading Lyapunov vector coincides with the threshold coupling wavenumber, in large eddy simulations of box turbulence with standard Smagorinsky or dynamic mixed models as well as in the SABRA model, replicating results from direct numerical simulations of box turbulence. Although the dynamic Smagorinsky model exhibits different behaviour, the totality of the results suggests that the relationship is an intrinsic property of a certain class of chaotic systems. We also confirm that conditional Lyapunov exponents characterise the synchronisation process in indirectly coupled systems as they do in directly coupled ones, with their values insensitive to the nature of the master flow. These findings advance the understanding of the role of the Lyapunov vector in the synchronisation of turbulence.
We audited family caregivers’ hand hygiene (HH) and masking practices at a pediatric tertiary care center during a period of increased community viral circulation and an enteric outbreak. Observed HH rates were below 5%, whereas masking was above 90%. Awareness of practices can inform strategies in caregiver infection prevention education.
Despite previous observational studies suggesting that malnutrition could be involved in venous thromboembolism (VTE), definitive causality still lacks high-quality research evidence. This study aims to explore the genetic causal association between malnutrition and VTE. The study was performed using summary statistics from genome-wide association studies for VTE (cases = 23 367; controls = 430 366). SNP associated with exposure was selected based on quality control steps. The primary analysis employed the inverse variance weighted (IVW) method, with additional support from Mendelian randomisation (MR)-Egger, weighted median and weighted mode approaches. MR-Egger, leave-one-SNP-out analysis and MR pleiotropy residual sum and outlier (MR-PRESSO) were used for sensitivity analysis. Cochran’s Q test was used to assess heterogeneity between instrumental variables (IV). IVW suggested that overweight has a positive genetic causal effect on VTE (OR = 1·1344, 95 % CI = 1·056, 1·2186, P < 0·001). No genetic causal effect of malnutrition (IVW: OR = 0·9983, 95 % CI = 0·9593, 1·0388, P = 0·9333) was found on VTE. Cochran’s Q test suggests no possible heterogeneity in both related exposures. The results of the MR-Egger regression suggest that the analysis is not affected by horizontal pleiotropy. The results of the MR-PRESSO suggest that there are no outliers. The results revealed a statistical genetic association where overweight correlates with an increased risk of VTE. Meanwhile, no genetic causal link was observed between malnutrition and VTE. Further research is warranted to deepen our understanding of these associations.
Estimation of near-wall turbulence in channel flow from outer observations is investigated using adjoint-variational data assimilation. We first consider fully resolved velocity data, starting at a distance from the wall. By enforcing the estimated flow to exactly satisfy the Navier–Stokes equations, we seek a statistically stationary turbulent state that reproduces the instantaneous outer measurements. Such an estimated state provides full access to the unknown near-wall turbulence, including the wall shear stresses and pressure. When the first observation is within 50 viscous units from the wall, the correlation coefficient between the true and estimated state exceeds 95 %. As the observations are further separated from the wall, at 90 viscous units, the accuracy of the assimilated wall stresses decreases to 40 % at the wall. This trend is nearly independent of the Reynolds number. The Fourier spectrum of the estimation error is qualitatively consistent with the coherence spectrum between the outer and the inner state variables: observed long wavelength structures in the outer flow have deeper coherence into the unobserved near-wall region and, therefore, the error is lowest at large scales. Nevertheless, the adjoint-variational approach provides a more rigorous quantification of the capacity to accurately predict the instantaneous near-wall turbulence from outer measurements. Lastly, we demonstrate the robustness of the estimation accuracy using filtered and sub-sampled outer observations.
When turbulent convection interacts with a turbulent shear flow, the cores of convective cells become aligned with the mean current, and these cells (which span the height of the domain) may interact with motions closer to the solid boundary. In this work, we use coupled Eulerian–Lagrangian direct numerical simulations of a turbulent channel flow to demonstrate that, under conditions of turbulent mixed convection, interactions between motions associated with ejections and low-speed streaks near the solid boundary and coherent superstructures in the interior of the flow interact and lead to significant vertical transport of strongly settling Lagrangian particles. We show that the primary suspension mechanism is associated with strong ejection events (canonical low-speed streaks and hairpin vortices characterised by $u'\lt 0$ and $w'\gt 0$, where $u'$ and $w'$ are the streamwise and vertical turbulent velocity fluctuations), whereas secondary suspension is strongly associated with large-scale plume structures aligned with the mean shear (characterised by $w'\gt 0$ and $\theta '\gt 0$, where $\theta$ represents temperature fluctuations). This coupling, which is absent in the limiting cases (pure channel flow or free convection) is shown to lead to a sudden increase in the interior concentration profiles as ${Ri}_\tau$, the friction Richardson number, increases, resulting in concentrations that are larger by roughly an order of magnitude at the channel midplane.
It is generally accepted that the evolution of the deep-water surface gravity wave spectrum is governed by quartet resonant and quasi-resonant interactions. However, it has also been reported in both experimental and computational studies that non-resonant triad interactions can play a role, e.g. generation of bound waves. In this study, we investigate the effects of triad and quartet interactions on the spectral evolution, by numerically tracking the contributions from quadratic and cubic terms in the dynamical equation. In a finite time interval, we find that the contribution from triad interactions follows the trend of that from quartet resonances (with comparable magnitude) for most wavenumbers, except that it peaks at low wavenumbers with very low initial energy. This result reveals two effects of triad interactions. (1) The non-resonant triad interactions can be connected to form quartet resonant interactions (hence exhibiting the comparable trend), which is a reflection of the normal form transformation applied in wave turbulence theory of surface gravity waves. (2) The triad interactions can fill energy into the low-energy portion of the spectrum (low wavenumber part in this case) on a very fast time scale, with energy distributed in both bound and free modes at the same wavenumber. We further analyse the latter mechanism using a simple model with two initially active modes in the wavenumber domain. Analytical formulae describing the distribution of energy in free and bound modes are provided, along with numerical validations.