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Aims: COVID-19 affected many countries globally, including the UK, to which the UK responded by placing lockdown measures throughout the country. This meant that many people were restricted in their everyday lives, including students. This study is used to understand the impact of these measures on sixth form students.
Methods: The Warwick–Edinburgh Mental Wellbeing Scale was sent to students in a sixth-form grammar school in September 2021 to assess students’ mental well-being. A semi-structured proforma was then also sent in May 2022 to compare students’ experiences and mental health before and after the lockdown measures.
Results: On the well-being scale, 47.1% of sixth-form students scored below 44 (average to low mental well-being), while 31% of the 1st year sixth-form students and 27% of the 2nd year sixth-form students scored 40 and below (lower than average mental well-being). In the semi-structured proforma, 73.90% of students (n=69) experienced quarantine since the pandemic started. 69.10% of them felt that the quarantines negatively impacted their mental health. In response to the question ‘In your own words, what was the most difficult thing that you experienced during the COVID pandemic?’ (n=55), 5 general themes were identified: Isolation, not socialising, loneliness, loss of teenage life/youth, and online learning.
Conclusion: The study showed that the mental well-being of sixth-form grammar school students in Cumbria was mostly negatively affected by the lockdown measures. The authors concluded that more accessible and approachable support should be provided to students in case of a similar event. More research is needed to understand the long-term impacts of such measures on students’ school and social lives.
Many hypersonic flows of interest feature high free-stream stagnation enthalpies, which lead to high flow-field temperatures and thermochemical non-equilibrium (TCNE) effects, such as finite-rate chemistry and vibrational excitation. However, very few studies have considered receptivity for high-enthalpy flows. In this paper, we investigate the receptivity of a high-enthalpy Mach 5 straight-cone boundary layer to slow and fast acoustic free-stream waves using direct numerical simulation alongside linear stability theory and the linear parabolised stability equations. In addition, we investigate the TCNE effect on receptivity by comparing results between the TCNE gas model and a thermochemically frozen gas model. The dominant instability mechanism for this flow configuration is found to be Mack’s second mode, with the unstable mode being the fast mode. Second-mode receptivity coefficients are obtained for a number of frequencies. For free-stream slow acoustic waves, these receptivity coefficients are found to generally increase with frequency. For a small subset of the considered frequency range, the receptivity coefficients corresponding to free-stream fast acoustic waves are found to be several times larger than for free-stream slow acoustic waves. The TCNE effects are found to lead to higher peak $N$-factors while also reducing second-mode receptivity coefficients, indicating that TCNE effects have competing impacts on receptivity versus stability for the considered frequencies.
The presence of an intraluminal thrombus in acutely symptomatic carotid stenosis is thought to represent a high-risk lesion for short-term stroke reccurrence though evidence on natural history and treatment is lacking, leading to equipoise and much variation in practice. The objective of this study was to map these variations in practice (medical management and timing of revascularization), determine the considerations that influence clinician decision-making in this condition and gather opinions that inform the development and design of future trials in the area.
Methods:
This was a mixed-methods study using both quantitative survey methods and qualitative interview-based methods. International perspectives were gathered by distributing a case-based survey via the “Practice Current” section of Neurology: Clinical Practice and interviewing international experts using established qualitative research methods.
Results:
The presence of an intraluminal thrombus significantly increased the likelihood of using a regimen containing anticoagulation agents (p < 0.001) in acutely symptomatic carotid stenosis in the case-based survey. Themes that emerged from qualitative interview analysis were therapeutic uncertainty regarding anticoagulation, decision to reimage, revascularization choices and future trial design and anticipated challenges.
Conclusion:
Results of this study demonstrate a preference for anticoagulation and delayed revascularization after reimaging to examine for clot resolution, though much equipoise remains. While there is interest from international experts in future trials, further study is needed to understand the natural history of this condition in order to inform trial design.
Face milling is performed on aluminum alloy A96061-T6 at diverse cutting parameters proposed by the design of experiments. Surface roughness is predicted by examining the effects of cutting parameters (CP), vibrations (Vib), and sound characteristics (SC). Sound characteristics based on surface roughness estimation determine the rarity of the work. In this study, a unique ANN-TLBO hybrid model (Artificial Neural Networks: Teaching Learning Based Algorithm) is created to predict the surface roughness from CP, Vib, and SC. To ascertain their correctness and efficacy in evaluating surface roughness, the performance of these models is evaluated. First off, the CP hybrid model demonstrated an amazing accuracy of 95.1%, demonstrating its capacity to offer trustworthy forecasts of surface roughness values. The Vib hybrid model, in addition, demonstrated a respectable accuracy of 85.4%. Although it was not as accurate as the CP model, it nevertheless showed promise in forecasting surface roughness. The SC-based hybrid model outperformed the other two models in terms of accuracy with a remarkable accuracy of 96.2%, making it the most trustworthy and efficient technique for assessing surface roughness in this investigation. An analysis of error percentages revealed the exceptional performance of SC-based Model-3, exhibiting an average error percentage of 3.77%. This outperformed Vib Model-2 (14.52%) and CP-based Model-1 (4.75%). The SC model is the best option, and given its outstanding accuracy, it may end up becoming the go-to technique for industrial applications needing accurate surface roughness measurement. The SC model’s exceptional performance highlights the importance of optimization strategies in improving the prediction capacities of ANN-based models, leading to significant advancements in the field of surface roughness assessment and related fields. An IoT platform is developed to link the model’s output with other systems. The system created eliminates the need for manual, physical surface roughness measurement and allows for the display of surface roughness data on the cloud and other platforms.
Patients with disordered eating in psychiatry are considered highly complex in the acute hospital setting. In Spring 2023 a pilot for a specialised dietitian was introduced to identify and target such patients; aimed at reducing length of stay to the acute medical wards. Hospital admissions for eating disorder increased by 84% between 2015/16 and 2020/21; with increasing complexity of presentations and a demand for Specialist Eating Disorder (SEDU) beds, there are increasing numbers admitted to acute medical beds for initial treatment and management. In 2021 the Royal College of Psychiatrists published its updated guidance, Medical Emergencies in Eating Disorders (MEED). There is recognition that acute trusts must identify care pathways for the management of patients with eating disorders and severe food restriction for psychiatric reasons. This audit aims to show how these guidelines are being implemented locally and where there is a need for improvements in care pathways focusing particularly on length of stay, frequent attenders and avoiding hospital admissions.
Methods
A retrospective audit of 26 patients presenting between 01/03/2023 and 31/12/2023 was completed. Patients were identified from data collated by the specialist dietitian as having presented with an existing diagnosis of eating disorder or disordered eating in the context of psychiatry. Some patients were detained under the Mental Health Act. Some patients presented on multiple occasions to the acute hospital during this period; each inpatient episode was analysed independently. Data was collected retrospectively by analysing PICS documentation (electronic notes system) and entered into a data collection spreadsheet. A Google Form checklist was created to capture whether key points from MEED guidelines were met.
Results
Demographic data, details of initial presentation and admission events were collated including the team initially referred to and how long after the initial admission this occurred. Outcomes of admission were also recorded. Data was quantitatively analysed to understands trends in referral process, MDT working (inclusion of emergency clinicians, acute medicine, psychiatrist, specialist dieticians and nursing colleagues). Average lengths of stay, number of attendances and planned admissions were also captured.
Conclusion
An overall reduction in length of stay for detained patients with dietetic and wider MDT input was noted from 50 days prior to January 2023, to 29 in the period from March 2023 onwards. Frequent attendance for electrolyte abnormalities was significantly improved though implementing MDT working with teams in the community and planned admissions from inpatient units or SEDUs for medical management reduced overall length of stay for those patients.
The achievement of the independence of India in August 1947 was an event of epochal significance. It has meant that about four hundred million human beings have become concerned with finding a worthy place for themselves in the political and economic map of the world. The work of rehabilitation, solidification, reconstruction and development done in diverse departments of life in the country in the past nineteen years has been an eye-opener both to Indians and outsiders and is slowly revealing the tremendous energy of the Indian population, which had also expressed itself before through the hard and agonizing process of the years of struggle for freedom. India's independence has also had a pronounced intellectual and cultural consequence. 1 It has given a heightened stature to the great prophets, heroes and statesmen of India's struggle for liberation (1857-1947). It has invested the political parties and movements of this country with an Asian and even international significance. India has embarked upon the colossal task of transforming an under-developed agrarian economy and static society to the status of a modern industrialized country within the framework of parliamentary democracy, and this imparts to the political and economic experiments of this country great significance even for outsiders. The number of books on modern India is rapidly increasing. It is satisfying to note that some of these books are bound to have an influence for decades.
The transformation of a traditional society into a modern well-knit organic structure can be demonstrated in various ways. In this paper an attempt will be made to study a village in North Bihar, in the district of Saran. This village, Dharampur, is about 8 miles north-east of Chapra the chief town of the district, and some 10 miles from Khairah, the nearest station on the North Eastern Railway. The old people claim that originally their ancestors inhabited another village, Panchpatra, about a mile to the south of the present settlement. There, according to legend, ghosts used to shower bones onto the roofs the houses. The inhabitants, disturbed at their work, and terrified, decided to seek the help of a Sâdhu Ramadas who lived in a nearby monastry. The saint indicated a site which he blessed, and the construction of the new village began. Thus it is clear that the migration as well as the site of the present village were linked with traditional factors, represented in this instance by the intervention of ghosts and by the Sâdhu. This incident may have happened about 200 years ago; today the former village is known as Dīha, meaning ancient dwelling place.
This chapter, written for those who work with children and adolescents, summarizes, explains and extends psychoanalytic thinking about young people and climate change. Ambivalence, disavowal, grief, unconscious societal pressures, feelings of betrayal, regression to immature defenses, and interaction of climate concerns with other developmental issues are explored, applying the developmental frameworks of Melanie Klein, Erik Erikson, and Wilfred Bion. Climate change implications within each Eriksonian stage of psychosocial development through young adulthood are described. Specific recommendations are made to promote healthy attachment to the natural world, valuable versions of hope, and alignment with values. The importance of being a “good-enough” “flexible container” in relation to young people is emphasized. Particular considerations in addressing climate change issues with young children and with adolescents are detailed.
Obstructive sleep apnoea is a common sleep disorder, and adult congenital heart disease (CHD) is also a significant burden on the population. Early diagnosis and treatment are important for improving quality of life and reducing the risk of health complications. The limited research on obstructive sleep apnoea and adult CHD highlights the need for further investigation into the relationship between these two conditions and the mechanisms underlying this relationship.
Method:
We used NIS 2019 database to identify adult CHD admissions aged 18–44 years and assess the impact of obstructive sleep apnoea on all-cause mortality, dysrhythmia, and stroke. A propensity-matched cohort of individuals with and without obstructive sleep apnoea was obtained, and the outcomes were assessed using multivariable analysis and compared in terms of resource utilisation.
Results:
Of the 41,950 young adult CHD admissions, 6.3% (n = 2630) had obstructive sleep apnoea. The obstructive sleep apnoea+ (n = 2590) and obstructive sleep apnoea− (n = 2590) cohorts were comparable in terms of median age (35 years) and were predominantly male (63.1% versus 62.5%). The obstructive sleep apnoea+ cohort had a higher frequency of risk factors like chronic obstructive pulmonary disease, hypothyroidism, and prior venous thromboembolism than the obstructive sleep apnoea cohort. We found significant association of obstructive sleep apnoea with dysrhythmia (adjusted odds ratio 2.99, 95% confidence interval 2.13–4.19, p < 0.001), but no significant impact on the risk of all-cause mortality or stroke. The obstructive sleep apnoea+ cohort also had higher transfers to short-term facilities, prolonged stays, and higher charges (p < 0.001).
Conclusion:
Our study provides important insights into relationship between obstructive sleep apnoea and adult CHD and highlights the need for further investigation into the impact of obstructive sleep apnoea on individuals with adult CHD.
We prove the compatibility of local and global Langlands correspondences for $\operatorname {GL}_n$ up to semisimplification for the Galois representations constructed by Harris-Lan-Taylor-Thorne [10] and Scholze [18]. More precisely, let $r_p(\pi )$ denote an n-dimensional p-adic representation of the Galois group of a CM field F attached to a regular algebraic cuspidal automorphic representation $\pi $ of $\operatorname {GL}_n(\mathbb {A}_F)$. We show that the restriction of $r_p(\pi )$ to the decomposition group of a place $v\nmid p$ of F corresponds up to semisimplification to $\operatorname {rec}(\pi _v)$, the image of $\pi _v$ under the local Langlands correspondence. Furthermore, we can show that the monodromy of the associated Weil-Deligne representation of $\left .r_p(\pi )\right |{}_{\operatorname {Gal}_{F_v}}$ is ‘more nilpotent’ than the monodromy of $\operatorname {rec}(\pi _v)$.
Stimulated Raman forward scattering (SRFS) of an intense X-mode laser pump in a preformed parabolic plasma density profile is investigated. The laser pump excites a plasma wave and one/two electromagnetic sideband waves. In Raman forward scattering, the growth rate of the parametric instability scales as two-third powers of the pump amplitude and increases linearly with cyclotron frequency.
Barzykowski and Moulin argue both involuntary autobiographical memories and déjà vu experiences rely on the same involuntary memory retrieval processes but their underlying neurological basis remains unclear. We propose spontaneous neural replay in the default mode network (DMN) and hippocampus as the basis for involuntary autobiographical memories, whereas for déjà vu experiences such transient activation is limited to the DMN.
To determine the effectiveness of active, upper-room, germicidal ultraviolet (GUV) devices in reducing bacterial contamination in patient rooms in air and on surfaces as a supplement to the central heating, ventilation, and air conditioning (HVAC) air handling unit (AHU) with MERV 14 filters and UV-C disinfection.
Methods:
This study was conducted in an academic medical center, burn intensive care unit (BICU), for 4 months in 2022. Room occupancy was monitored and recorded. In total, 402 preinstallation and postinstallation bacterial air and non–high-touch surface samples were obtained from 10 BICU patient rooms. Airborne particle counts were measured in the rooms, and bacterial air samples were obtained from the patient-room supply air vents and outdoor air, before and after the intervention. After preintervention samples were obtained, an active, upper-room, GUV air disinfection system was deployed in each of the patient rooms in the BICU.
Results:
The average levels of airborne bacteria of 395 CFU/m3 before GUV device installation and 37 CFU/m3 after installation indicated an 89% overall decrease (P < .0001). Levels of surface-borne bacteria were associated with a 69% decrease (P < .0001) after GUV device installation. Outdoor levels of airborne bacteria averaged 341 CFU/m3 in March before installation and 676 CFU/m3 in June after installation, but this increase was not significant (P = .517).
Conclusions:
Significant reductions in air and surface contamination occurred in all rooms and areas and were not associated with variations in outdoor air concentrations of bacteria. The significant decrease of surface bacteria is an unexpected benefit associated with in-room GUV air disinfection, which can potentially reduce overall bioburden.
From Chaucer to Shakespeare, and Virginia Woolf to Bernadine Evaristo, London as a city has always instigated the literary imagination. By the nineteenth century, it had become not just the capital of the United Kingdom, but also of a sprawling world-wide empire. This also meant that the city became host to a diverse range of stories, storytellers, and writers that have responded to both its physical and imagined dimensions. Taking a cue from Pascale Casanova’sThe World Republic of Letters, but correcting it to account for the impact of empire, this essay tracks the ways in which London emerged as the global centre of literary and aesthetic production and as a universal arbiter of taste in the early decades of the twentieth century, through the decades of decolonization in the middle of the twentieth century, and leading up to the contemporary moment in which its status as a literary capital is subject to new uncertainties that are enmeshed in the political economy of contemporary world literature.The essay focalizes this discussion through two linked tropes—the city’s “exhibitionary complex” and its “circulatory network”.
Background: The presence of intraluminal thrombi (ILT) in acutely symptomatic carotid stenosis (“hot carotid”) represents a therapeutic dilemma for physicians. With little evidence to guide treatment, current ILT management approaches rely on individual or institutional preferences. Methods: This mixed methods study analyzed themes from semi-structured interviews with 22 stroke physicians from 16 centers, paired with a worldwide case-based survey of 628 stroke physicians conducted through the “Practice Current” section of Neurology: Clinical Practice. Results: In the thematic analysis of the interviews and quantitative analysis of the survey, participants favoured using anticoagulation with or without antiplatelet agents in patients with ILT (463/628, 74%). Despite a preference for anticoagulation, uncertainty regarding optimal antithrombotic management was noted in the thematic analysis. Additional themes identified included a preference for re-imaging patients in 3-5 days after initiating treatment to look for complete or partial clot resolution, at which point most experts would then be comfortable proceeding with revascularization if indicated, though uncertainty regarding the optimal timing of revascularization was noted. Conclusions: In cases of ILT in the “hot carotid” practice patterns of global experts show a preference for using anticoagulation and reimaging patients in 3-5 days, though there is considerable equipoise regarding the most appropriate management of these patients.
Background: Little evidence exists to guide the management of symptomatic non-stenotic carotid disease (SyNC). SyNC, which refers to carotid lesions with less than 50% artery stenosis, has been increasingly implicated as a cause of stroke and TIA. Methods: Semi-structured interviews with 22 stroke physicians from 16 centers were conducted as part of the Hot Carotid Qualitative Study. This study explored decision-making approaches, opinions and attitudes regarding the management of symptomatic carotid disease. Presented here are a subset of results related to the decision to revascularize patients with SyNC. Results: Thematic analysis revealed equipoise in the decision to revascularize patients with SyNC. Participants discussed a desire to use imaging features (e.g plaque rupture and plaque morphology) to inform the decision to revascularize, though significant uncertainty remains in appraising the risk conferred by certain features. Experts support further study to better understand the use of these features in risk appraisal for patients with SyNC. Conclusions: The decision to revascularize patients with SyNC is an area with significant equipoise. Experts identify the use of imaging features as an important tool in informing the decision to pursue revascularization in patients with SyNC though more study is required in this area to better inform practice.
Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention has been well established, uncertainties remain regarding the optimal antithrombotic regimen for recently symptomatic carotid stenosis. We sought to explore the approaches of stroke physicians to antithrombotic management of patients with symptomatic carotid stenosis.
Methods:
We employed a qualitative descriptive methodology to explore the decision-making approaches and opinions of physicians regarding antithrombotic regimens for symptomatic carotid stenosis. We conducted semi-structured interviews with a purposive sample of 22 stroke physicians (11 neurologists, 3 geriatricians, 5 interventional-neuroradiologists, and 3 neurosurgeons) from 16 centers on four continents to discuss symptomatic carotid stenosis management. We then conducted thematic analysis on the transcripts.
Results:
Important themes revealed from our analysis included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and the choice of antiplatelet therapy while awaiting revascularization. There was a greater concern for adverse events while using multiple antiplatelet agents (e.g., dual-antiplatelet therapy (DAPT)) in patients undergoing carotid endarterectomy compared to carotid artery stenting. Regional variations included more frequent use of single antiplatelet agents among European participants. Areas of uncertainty included antithrombotic management if already on an antiplatelet agent, implications of nonstenotic features of carotid disease, the role of newer antiplatelet agents or anticoagulants, platelet aggregation testing, and timing of DAPT.
Conclusion:
Our qualitative findings can help physicians critically examine the rationale underlying their own antithrombotic approaches to symptomatic carotid stenosis. Future clinical trials may wish to accommodate identified variations in practice patterns and areas of uncertainty to better inform clinical practice.
We evaluated the appropriateness of antibiotic prescriptions at discharge from a tertiary-care hospital in India. Of the 790 adult patients included, 84.4% received antibiotics. Microbiological specimens were taken from 67.3% of these patients, and pathogens were identified in 28.8% of cases. Overuse of antimicrobials at hospital discharge should be curtailed.