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Due to limited inpatient care resources and high healthcare expenditures, understanding factors that affect lengths of stay (LOS) is highly relevant. We aimed to investigate associations between metabolic disturbances and LOS in a psychiatric hospital and to identify other clinical and sociodemographic LOS predictors.
Methods
Patients admitted to one of the units of the general psychiatric or psychogeriatric departments between January 1, 2007 and December 31, 2020, were included. Metabolic disturbances (i.e., the metabolic syndrome and its five components) were defined using the International Diabetes Federation definition. Cox frailty regression models with time-varying coefficients were used to investigate the association between metabolic disturbances and LOS. Hazard ratios (HR) >1 and HR < 1 indicated the relative likelihood of shorter and extended LOS, respectively.
Results
A total of 7,771 patients for 16,959 hospital stays throughout 14 years of follow-up were included. Central obesity (HR = 0.82; 95% confidence interval [CI] = [0.76–0.89]), hyperglycemia (HR = 0.83; 95% CI = [0.78–0.89]), hypertriglyceridemia (HR = 0.87; 95% CI = [0.80–0.92]), and the metabolic syndrome (HR = 0.76; 95% CI = [0.70–0.82]) were associated with an increased risk of extended LOS in the psychiatric hospital, while underweight (HR = 1.30, 95% CI = [1.09–1.56]) and HDL hypocholesterolemia (HR = 1.10, 95% CI = [1.03–1.18]) were associated with a higher likelihood of shorter LOS. In first-episode psychosis patients, hypertriglyceridemia (HR = 0.82; 95% CI = [0.67–0.99]) and hypertension (HR = 0.76, 95% CI = [0.58–0.99]) were associated with extended LOS when considering all stays, while no association was found when considering the first stay per patient.
Conclusion
Future studies should determine whether better metabolic monitoring and treatment of metabolic disturbances can contribute to reducing LOS.
The model eukaryotic microalgae Chlamydomonas reinhardtii is well known for its ability to generate bioconvection flows that are associated to intricate concentration patterns. Recently, it was demonstrated that the propensity of these algae to move toward a light source – a phenomenon termed phototaxis – can be exploited to locally concentrate micro-organisms and induce (photo)-bioconvection in algal suspensions by inducing a localised excess of density. In the present study we show experimentally that a cell population in a thin liquid layer self-organises in the presence of a heterogeneous light field and displays remarkable symmetry-breaking instabilities that are ruled by both the width of the light beam and the photo-bioconvection Rayleigh number. Beside circular stable states, fingers, dendrites and wave instabilities are reported, quantified and classified in a general phase diagram. Next, we use lubrication theory to develop an asymptotic model for bioconvection in a thin liquid layer, that includes the influences of both gyrotaxis and phototaxis. We obtain a single nonlinear anisotropic diffusion–drift equation describing the spatiotemporal evolution of the depth-averaged algal population. Analytical and numerical solutions are presented and show a very good agreement with the experimental results. In particular, we show that the dendrite instability arises as a result of a subtle coupling between the nonlinearity of the phototactic response, the gyrotactic effect and the self-induced bioconvective flows. Such complex flow fields might find applications in photo-bioreactors, through the efficient stirring of the harvested biomass.
Frequently associated with early psychosis, depressive and manic dimensions may play an important role in its course and outcome. While manic and depressive symptoms can alternate and co-occur, most of the studies in early intervention investigated these symptoms independently. The aim of this study was therefore to explore the co-occurrence of manic and depressive dimensions, their evolution and impact on outcomes.
Methods
We prospectively studied first-episode psychosis patients (N = 313) within an early intervention program over 3 years. Based on latent transition analysis, we identified sub-groups of patients with different mood profiles considering both manic and depressive dimensions, and studied their outcomes.
Results
Our results revealed six different mood profiles at program entry and after 1.5 years follow-up (absence of mood disturbance, co-occurrence, mild depressive, severe depressive, manic and hypomanic), and four after 3 years (absence of mood disturbance, co-occurrence, mild depressive and hypomanic). Patients with absence of mood disturbance at discharge had better outcomes. All patients with co-occurring symptoms at program entry remained symptomatic at discharge. Patients with mild depressive symptoms were less likely to return to premorbid functional level at discharge than the other subgroups. Patients displaying a depressive component had poorer quality of physical and psychological health at discharge.
Conclusions
Our results confirm the major role played by mood dimensions in early psychosis, and show that profiles with co-occurring manic and depressive dimensions are at risk of poorer outcome. An accurate assessment and treatment of these dimensions in people with early psychosis is crucial.
While specialized early intervention programs represent the gold standard in terms of optimal management of first-episode psychosis (FEP), poor medication adherence remains a predominant unmet need in the treatment of psychosis. In this regard, an interaction between insight and adherence in FEP patients has been hypothesized but has been challenged by multiple pitfalls.
Methods
Latent profile analysis and trajectory modeling techniques were used to evaluate insight and adherence of 331 FEP patients engaged at the beginning, middle, and end of a 3-year specialized early psychosis program. A Bayesian model comparison approach was used to compare scores of clinical, functional, and socioeconomic outcomes at the end point of the study.
Results
Nearly one-third of the patients maintain a high level of insight and adherence during the entire program. At the end of the 3-year follow-up, more than three-quarters of patients are considered adherent to their medication. Patients with low levels of insight and adherence at the beginning of the program improve first in terms of adherence and then of insight. Furthermore, patients with high levels of insight and adherence are most likely to reach functional recovery and to experience an increase in environmental quality of life.
Conclusions
Latent FEP subpopulations can be identified based on insight and adherence. Medication adherence was the first variable to improve, but a gain in insight possibly plays a role in the reinforcement of adherence.
Models typically have actual, existing targets. However, some models are viewed as having non-actual targets. I argue that this interpretation comes at various costs and propose an alternative that fares better along two dimensions: (1) agreement with practice and (2) ontological and epistemological parsimony. My proposal is that many of these models actually have actual targets.
We develop a model of optimal land allocation in a developing economy that features three possible land uses: agriculture, primary and secondary forests. The distinction between those forest types reflects their different contributions in terms of public goods. In our model, reforestation is costly because it undermines land title security. Using the forest transition concept, we study long-term land-use change and explain important features of cumulative deforestation across countries. Our results shed light on the speed at which net deforestation ends, on the effect of tenure costs in this process, and on composition in steady state. We also present a policy analysis that emphasizes the critical role of institutional reforms addressing the costs of both deforestation and tenure in order to promote a transition. We find that focusing only on net forest losses can be misleading since late transitions may yield, upon given conditions, a higher level of environmental benefits.
Gravity-driven size segregation is important in mountain streams where a wide range of grain sizes are transported as bedload. More particularly, vertical size segregation is a multi-scale process that originates in interactions at the scale of particles with important morphological consequences for the river bed. To address this issue, a volume-averaged multi-phase flow model for immersed bi-disperse granular flows was developed based on an interparticle segregation force (Guillard et al., J. Fluid Mech., vol. 807, 2016, R1) and a granular Stokesian drag force (Tripathi & Khakhar, J. Fluid Mech., vol. 717, 2013, pp. 643–669). An advection–diffusion model was derived from this model yielding parametrisations for the advection and diffusion coefficients based on the interparticle interactions. This approach makes it possible to bridge the gap between grain-scale physics and continuum modelling. Both models were successfully tested against existing discrete element model (DEM) simulations of size segregation in bedload transport (Chassagne et al., J. Fluid Mech., vol. 895, 2020, A30). Through a detailed investigation of the granular forces, it is demonstrated that the observed scaling of the advection and diffusion coefficients with the inertial number can be explained by the granular drag force dependency on the viscosity. The drag coefficient is shown to be linearly dependent on the small particle concentration. A new scaling relationship for the segregation force including the small particle concentration and the pressure is proposed. Lastly, adding a size-ratio dependency in the segregation force fairly reproduces the DEM results for a large range of small particle concentrations and size ratios.
Grain-scale discrete element simulations of bidisperse mixtures during bedload transport are used to understand, and model, bedload transport and particle-size segregation in granular media. For an initial distribution of fine particles on top of a coarse granular bed, this paper investigates the gravity driven percolation/segregation of the fine particles down into the quasi-static part of the bed. The segregation is observed to be driven by the inertial number at the bottom of the fine particle layer, and is independent of the number of fine particles. A novel travelling wave solution for the evolving concentration distribution is constructed using the continuum particle-size segregation model of Thornton, Gray & Hogg (J. Fluid Mech., vol. 550, 2006, pp. 1–25) and Gray & Chugunov (J. Fluid Mech., vol. 569, 2006, pp. 365–398). The observed behaviour is shown to be related to a local equilibrium between the influence of the concentration and of the inertial number. The existence of the exact solution relies on the segregation flux and the diffusion coefficient having the same dependency on the inertial number. This functional dependence allows the continuum model to quantitatively reproduce the discrete simulations. These results significantly improve on our understanding of the size segregation dynamics and represent a step forward in the up-scaling process to polydisperse granular flows in the context of turbulent bedload transport.
Functional capacity (FC) has been identified as a key outcome to improve real-world functioning in schizophrenia. FC is influenced by cognitive impairments, negative symptoms, self-stigma and reduced physical activity (PA). Psychosocial interventions targeting FC are still under-developed.
Methods.
we conducted a quasi-experimental study evaluating the effects of an exercise-enriched integrated social cognitive remediation (SCR) intervention (RemedRugby [RR]) compared with an active control group practicing Touch Rugby (TR). To our knowledge, this is the first trial to date evaluating the effectiveness of such a program provided in a real-life environment.
Results.
Eighty-seven people with schizophrenia were included and allocated to either the RR group (n = 57) or the TR group (n = 30) according to the routine clinical practice of the recruiting center. Outcomes were evaluated at baseline and post-treatment in both groups and after 6 months of follow-up in the RR group using standardized scales for symptom severity, social functioning, self-stigma, and a large cognitive battery. After treatment we observed moderate to large improvements in social function (Personal and Social Performance Scale [PSP], p < 0.001, d = 1.255), symptom severity (Positive and Negative Syndrome Scale [PANSS] negative, p < 0.001, d = 0.827; PANSS GP, p < 0.001, d = 0.991; PANSS positive, p = 0.009, d = 0.594), verbal abstraction (p = 0.008, d = 0.554), aggression bias (p = 0.008, d = 0.627), and self-stigma (stereotype endorsement, p = 0.019, d = 0.495; discrimination experiences, p = 0.047; d = 0.389) that were specific to the RR group and were not observed in participants playing only TR. Effects were persistent over time and even larger between post-treatment and follow-up.
Conclusions.
Exercise-enriched integrated SCR appears promising to improve real-life functioning in schizophrenia. Future research should investigate the potential effects of this intervention on neuroplasticity and physical fitness.
The interpersonal dependency inventory comprised three subscales called Emotional reliance of another person (ER), lack of social self confidence (LSS) and Assertion of autonomy (AUT). Several formula have been developed for deriving whole-scale scores.
The aim of the study on 621 addictive subjects was to determine the best formula using the DSM-IV dependent personality disorder as gold standard. The formula 3 ER + LSS – AUT yielded the best values of sensitivity and specificity.
Brannerite (UTi2O6) is among the major uranium-bearing minerals found in ore deposits, however as it has been long considered as a refractory mineral for leaching it is currently disregarded in ore deposits. Brannerite is found in a variety of geological environments with the most common occurrences being hydrothermal and pegmatitic. On the basis of scanning electron microscopy observations coupled with electron probe micro-analyses and laser ablation inductively-coupled plasma mass spectrometer analyses, this study describes the morphological features and the major- and trace-element abundances of brannerite samples from five hydrothermal and five pegmatitic localities across the world. Mineral compositions are also compared with observations from transmission electron microscopy and Raman spectrometry showing that brannerite is amorphous. Significant results include the definition of substitution trends and REE patterns, which are characteristics of either an occurrence or genetic type (hydrothermal and pegmatitic). Hence, in combination, it is possible to obtain reliable constraints for establishing a geochemical classification of brannerite. Inferred fingerprints have direct implications for forensic science and the exploration industry; they also contribute to a better understanding of metallogenic processes and to optimising the extraction of uranium.
Numerical simulations of quasi-static magnetoconvection with a vertical magnetic field are carried out up to a Chandrasekhar number of $Q=10^{8}$ over a broad range of Rayleigh numbers $Ra$. Three magnetoconvection regimes are identified: two of the regimes are magnetically constrained in the sense that a leading-order balance exists between the Lorentz and buoyancy forces, whereas the third regime is characterized by unbalanced dynamics that is similar to non-magnetic convection. Each regime is distinguished by flow morphology, momentum and heat equation balances, and heat transport behaviour. One of the magnetically constrained regimes appears to represent an ‘ultimate’ magnetoconvection regime in the dual limit of asymptotically large buoyancy forcing and magnetic field strength; this regime is characterized by an interconnected network of anisotropic, spatially localized fluid columns aligned with the direction of the imposed magnetic field that remain quasi-laminar despite having large flow speeds. As for non-magnetic convection, heat transport is controlled primarily by the thermal boundary layer. Empirically, the scaling of the heat transport and flow speeds with $Ra$ appear to be independent of the thermal Prandtl number within the magnetically constrained, high-$Q$ regimes.
Gravity-driven turbulent bedload transport has been extensively studied over the past century in regard to its importance for Earth surface processes such as natural riverbed morphological evolution. In the present contribution, the influence of the longitudinal channel inclination angle on gravity-driven turbulent bedload transport is studied in an idealised framework considering steady and uniform flow conditions. From an analytical analysis based on the two-phase continuous equations, it is shown that: (i) the classical slope correction of the critical Shields number is based on an erroneous formulation of the buoyancy force, (ii) the influence of the slope is not restricted to the critical Shields number but affects the whole transport formula and (iii) pressure-driven and gravity-driven turbulent bedload transport are not equivalent from the slope influence standpoint. Analysing further the granular flow driving mechanisms, the longitudinal slope is shown to not only influence the fluid bed shear stress and the resistance of the granular bed, but also to affect the fluid flow inside the granular bed – responsible for the transition from bedload transport to debris flow. The relative influence of these coupled mechanisms allows us to understand the evolution of the vertical structure of the granular flow and to predict the transport rate scaling law as a function of a rescaled Shields number. The theoretical analysis is validated with coupled fluid–discrete element simulations of idealised gravity-driven turbulent bedload transport, performed over a wide range of Shields number values, density ratios and channel inclination angles. In particular, all the data are shown to collapse onto a master curve when considering the sediment transport rate as a function of the proposed rescaled Shields number.
The local granular rheology is investigated numerically in turbulent bedload transport. Considering spherical particles, steady uniform configurations are simulated using a coupled fluid–discrete-element model. The stress tensor is computed as a function of the depth for a series of simulations varying the Shields number, the specific density and the particle diameter. The results are analysed in the framework of the $\unicode[STIX]{x1D707}(I)$ rheology and exhibit a collapse of both the shear to normal stress ratio and the solid volume fraction over a wide range of inertial numbers. Contrary to expectations, the effect of the interstitial fluid on the granular rheology is shown to be negligible, supporting recent work suggesting the absence of a clear transition between the free-fall and turbulent regimes. In addition, data collapse is observed up to unexpectedly high inertial numbers $I\sim 2$, challenging the existing conceptions and parametrisation of the $\unicode[STIX]{x1D707}(I)$ rheology. Focusing upon bedload transport modelling, the results are pragmatically analysed in the $\unicode[STIX]{x1D707}(I)$ framework in order to propose a granular rheology for bedload transport. The proposed rheology is tested using a 1D volume-averaged two-phase continuous model, and is shown to accurately reproduce the dense granular flow profiles and the sediment transport rate over a wide range of Shields numbers. The present contribution represents a step in the upscaling process from particle-scale simulations towards large-scale applications involving complex flow geometry.
Numerical simulations of three-dimensional rapidly rotating Rayleigh–Bénard convection are performed by employing an asymptotic quasi-geostrophic model that incorporates the effects of no-slip boundaries through (i) parametrized Ekman pumping boundary conditions and (ii) a thermal wind boundary layer that regularizes the enhanced thermal fluctuations induced by pumping. The fidelity of the model, obtained by an asymptotic reduction of the Navier–Stokes equations that implicitly enforces a pointwise geostrophic balance, is explored for the first time by comparisons of simulations against the findings of direct numerical simulations (DNS) and laboratory experiments. Results from these methods have established Ekman pumping as the mechanism responsible for significantly enhancing the vertical heat transport. This asymptotic model demonstrates excellent agreement over a range of thermal forcing for Prandtl number $Pr\approx 1$ when compared with results from experiments and DNS at maximal values of their attainable rotation rates, as measured by the Ekman number ($E\approx 10^{-7}$); good qualitative agreement is achieved for $Pr>1$. Similar to studies with stress-free boundaries, four spatially distinct flow morphologies exists. Despite the presence of frictional drag at the upper and/or lower boundaries, a strong non-local inverse cascade of barotropic (i.e. depth-independent) kinetic energy persists in the final regime of geostrophic turbulence and is dominant at large scales. For mixed no-slip/stress-free and no-slip/no-slip boundaries, Ekman friction is found to attenuate the efficiency of the upscale energy transport and, unlike the case of stress-free boundaries, rapidly saturates the barotropic kinetic energy. For no-slip/no-slip boundaries, Ekman friction is strong enough to prevent the development of a coherent dipole vortex condensate. Instead, vortex pairs are found to be intermittent, varying in both time and strength. For all combinations of boundary conditions, a Nastrom–Gage type of spectrum of kinetic energy is found, where the power-law exponent changes from ${\approx}-3$ to ${\approx}-5/3$, i.e. from steep to shallow, as the spectral wavenumber increases.
A reduced model is developed for low-Rossby-number convection in a plane layer geometry with no-slip upper and lower boundaries held at fixed temperatures. A complete description of the dynamics requires the existence of three distinct regions within the fluid layer: a geostrophically balanced interior where fluid motions are predominantly aligned with the axis of rotation, Ekman boundary layers immediately adjacent to the bounding plates, and thermal wind layers driven by Ekman pumping in between. The reduced model uses a classical Ekman pumping parameterization to alleviate the need to resolve the Ekman boundary layers. Results are presented for both linear stability theory and a special class of nonlinear solutions described by a single horizontal spatial wavenumber. It is shown that Ekman pumping (which correlates positively with interior convection) allows for significant enhancement in the heat transport relative to that observed in simulations with stress-free boundaries. Without the intermediate thermal wind layer, the nonlinear feedback from Ekman pumping would be able to generate heat transport that diverges to infinity at finite Rayleigh number. This layer arrests this blowup, resulting in finite heat transport at a significantly enhanced value. With increasing buoyancy forcing, the heat transport transitions to a more efficient regime, a transition that is always achieved within the regime of asymptotic validity of the theory, suggesting that this behaviour may be prevalent in geophysical and astrophysical settings. As the rotation rate increases, the slope of the heat transport curve below this transition steepens, a result that is in agreement with observations from laboratory experiments and direct numerical simulations.
The influence of fixed temperature and fixed heat flux thermal boundary conditions on rapidly rotating convection in the plane layer geometry is investigated for the case of stress-free mechanical boundary conditions. It is shown that whereas the leading-order system satisfies fixed temperature boundary conditions implicitly, a double boundary layer structure is necessary to satisfy the fixed heat flux thermal boundary conditions. The boundary layers consist of a classical Ekman layer adjacent to the solid boundaries that adjust viscous stresses to zero, and a layer in thermal wind balance just outside the Ekman layers that adjusts the normal derivative of the temperature fluctuation to zero. The influence of these boundary layers on the interior geostrophically balanced convection is shown to be asymptotically weak, however. Upon defining a simple rescaling of the thermal variables, the leading-order reduced system of governing equations is therefore equivalent for both boundary conditions. These results imply that any horizontal thermal variation along the boundaries that varies on the scale of the convection has no leading-order influence on the interior convection, thus providing insight into geophysical and astrophysical flows where stress-free mechanical boundary conditions are often assumed.
Storage cabinets for heat-sensitive endoscopes (SCHEs) are designed to store gastrointestinal (GI) endoscopes in a clean, dry and well-ventilated cupboard to prevent microbiological proliferation. The use of SCHEs in a GI endoscopy unit has significally reduced the rate of contaminated endoscopes (13.0% vs 45.0%, P<.001).
Infect. Control Hosp. Epidemiol. 2015;36(9):1100–1102
In the field of high data rate wireless communications, localization issues play a key role in achieving energy-efficient communication and geographic routing. time-difference of arrival (TDOA)-based localization methods present numerous advantages. In this paper, a new method of TDOA estimation is proposed. With this method, unlike conventional TDOA measurements, it is possible to perform communication and localization at the same time by using a multi-input single-output system. By transmitting ultra-wide-band orthogonal frequency-division multiplexing signals using spatial diversity, it is possible to extract TDOA from interference patterns in spectral domain. In addition, increasing the precision of localization is also studied using a multi-band approach. This whole study is made within the framework of the WiGig alliance specifications; however, it is compatible with other standards.