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The shape of a free-surface slump of viscoplastic material supported by an oblique barrier on an inclined plane is investigated theoretically and experimentally. The barrier is sufficiently tall that it is not surmounted by the viscoplastic fluid, and a focus of this study is the largest volume of rigid viscoplastic fluid that can be supported upstream of it. A lubrication model is integrated numerically to determine the transient flow as the maximal rigid shape is approached. Away from the region supported by the barrier, the viscoplastic layer attains a uniform thickness in which the gravitational stresses are in balance with the yield stress of the material. However, closer to the barrier, the layer thickens and the barrier bears the additional gravitational loading. An exact solution for the rigid shape of the viscoplastic material is constructed from the steady force balance and computed by integrating Charpit’s equations along characteristics that emanate from the barrier wall. The characteristics represent the late-time streamlines of the flow as it approaches the rigid shape. The exact solution depends on a single dimensionless group, which incorporates the slope inclination, the barrier width and the fluid’s yield stress. It is shown that the shape is insensitive to the transient flow from which it originates. The force exerted by the slump is calculated for different barrier shapes. The results of new laboratory experiments are reported; these show that although convergence to the final rigid state is slow, there is good agreement with the experimental measurements at long times.
Multicenter clinical trials are essential for evaluating interventions but often face significant challenges in study design, site coordination, participant recruitment, and regulatory compliance. To address these issues, the National Institutes of Health’s National Center for Advancing Translational Sciences established the Trial Innovation Network (TIN). The TIN offers a scientific consultation process, providing access to clinical trial and disease experts who provide input and recommendations throughout the trial’s duration, at no cost to investigators. This approach aims to improve trial design, accelerate implementation, foster interdisciplinary teamwork, and spur innovations that enhance multicenter trial quality and efficiency. The TIN leverages resources of the Clinical and Translational Science Awards (CTSA) program, complementing local capabilities at the investigator’s institution. The Initial Consultation process focuses on the study’s scientific premise, design, site development, recruitment and retention strategies, funding feasibility, and other support areas. As of 6/1/2024, the TIN has provided 431 Initial Consultations to increase efficiency and accelerate trial implementation by delivering customized support and tailored recommendations. Across a range of clinical trials, the TIN has developed standardized, streamlined, and adaptable processes. We describe these processes, provide operational metrics, and include a set of lessons learned for consideration by other trial support and innovation networks.
Vitamin A deficiency (VAD) poses significant health risks and is prevalent in children and adolescents in India. This study aimed to determine the effect of seasonal variation and availability of vitamin A-rich (VA-rich) foods on serum retinol in adolescents. Data on serum retinol levels from adolescents (n 2297, mean age 14 years) from the Comprehensive National Nutrition Survey (2016–2018) in India were analysed, with VAD defined as serum retinol < 0·7 µmol/L. Five states were selected based on a comparable under-five mortality rate and the seasonal spread of the data collection period. Dietary data from adolescents and children ≤ 4 years old were used to assess VA-rich food consumption. A linear mixed model framework was employed to analyse the relationship between serum retinol, month of the year and VA-rich food consumption, with a priori ranking to control for multiple hypothesis testing. Consumption of VA-rich foods, particularly fruits and vegetables/roots and tubers, showed seasonal patterns, with higher consumption during summer and monsoon months. Significant associations were found between serum retinol concentrations and age, month of sampling, consumption of VA-rich foods and fish. VAD prevalence was lowest in August, coinciding with higher consumption of VA-rich fruits and foods. Findings highlight the importance of considering seasonality in assessing VAD prevalence and careful interpretation of survey findings. Intentional design, analysis and reporting of surveys to capture seasonal variation is crucial for accurate assessment and interpretation of VAD prevalence, including during monitoring and evaluation of programmes, and to ensure that public health strategies are appropriately informed.
The First Large Absorption Survey in H i (FLASH) is a large-area radio survey for neutral hydrogen in and around galaxies in the intermediate redshift range $0.4\lt z\lt1.0$, using the 21-cm H i absorption line as a probe of cold neutral gas. The survey uses the ASKAP radio telescope and will cover 24,000 deg$^2$ of sky over the next five years. FLASH breaks new ground in two ways – it is the first large H i absorption survey to be carried out without any optical preselection of targets, and we use an automated Bayesian line-finding tool to search through large datasets and assign a statistical significance to potential line detections. Two Pilot Surveys, covering around 3000 deg$^2$ of sky, were carried out in 2019-22 to test and verify the strategy for the full FLASH survey. The processed data products from these Pilot Surveys (spectral-line cubes, continuum images, and catalogues) are public and available online. In this paper, we describe the FLASH spectral-line and continuum data products and discuss the quality of the H i spectra and the completeness of our automated line search. Finally, we present a set of 30 new H i absorption lines that were robustly detected in the Pilot Surveys, almost doubling the number of known H i absorption systems at $0.4\lt z\lt1$. The detected lines span a wide range in H i optical depth, including three lines with a peak optical depth $\tau\gt1$, and appear to be a mixture of intervening and associated systems. Interestingly, around two-thirds of the lines found in this untargeted sample are detected against sources with a peaked-spectrum radio continuum, which are only a minor (5–20%) fraction of the overall radio-source population. The detection rate for H i absorption lines in the Pilot Surveys (0.3 to 0.5 lines per 40 deg$^2$ ASKAP field) is a factor of two below the expected value. One possible reason for this is the presence of a range of spectral-line artefacts in the Pilot Survey data that have now been mitigated and are not expected to recur in the full FLASH survey. A future paper in this series will discuss the host galaxies of the H i absorption systems identified here.
Aerosol-cloud interactions contribute significant uncertainty to modern climate model predictions. Analysis of complex observed aerosol-cloud parameter relationships is a crucial piece of reducing this uncertainty. Here, we apply two machine learning methods to explore variability in in-situ observations from the NASA ACTIVATE mission. These observations consist of flights over the Western North Atlantic Ocean, providing a large repository of data including aerosol, meteorological, and microphysical conditions in and out of clouds. We investigate this dataset using principal component analysis (PCA), a linear dimensionality reduction technique, and an autoencoder, a deep learning non-linear dimensionality reduction technique. We find that we can reduce the dimensionality of the parameter space by more than a factor of 2 and verify that the deep learning method outperforms a PCA baseline by two orders of magnitude. Analysis in the low dimensional space of both these techniques reveals two consistent physically interpretable regimes—a low pollution regime and an in-cloud regime. Through this work, we show that unsupervised machine learning techniques can learn useful information from in-situ atmospheric observations and provide interpretable results of low-dimensional variability.
Inflammation and infections such as malaria affect concentrations of many micronutrient biomarkers and hence estimates of nutritional status. We aimed to assess the relationship between malaria infection and micronutrient biomarker concentrations in pre-school children (PSC), school-age children (SAC) and women of reproductive age (WRA) in Malawi and examine the potential role of malarial immunity on the relationship between malaria and micronutrient biomarkers. Data from the 2015/2016 Malawi micronutrient survey were used. The associations between current or recent malaria infection, detected by rapid diagnostic test and concentration of serum ferritin, soluble transferrin receptor (sTfR), zinc, serum folate, red blood cell folate and vitamin B12 were estimated using multivariable linear regression. Factors related to malarial immunity including age, altitude and presence of hemoglobinopathies were examined as effect modifiers. Serum ferritin, sTfR and zinc were adjusted for inflammation using the BRINDA method. Malaria infection was associated with 68 % (95 % CI 51, 86), 28 % (18, 40) and 34 % (13, 45) greater inflammation-adjusted ferritin in PSC, SAC and WRA, respectively (P < 0·001 for each). In PSC, the positive association was stronger in younger children, high altitude and children who were not carriers of the sickle cell trait. In PSC and SAC, sTfR was elevated (+ 25 % (16, 29) and + 15 % (9, 22) respectively, P < 0·001). Serum folate and erythrocyte folate were elevated in WRA with malaria (+ 18 % (3, 35) and + 11 % (1, 23), P = 0·01 and P = 0·003 respectively). Malaria affects the interpretation of micronutrient biomarker concentrations, and examining factors related to malarial immunity may be informative.
Objectives/Goals: Manual skin assessment in chronic graft-versus-host disease (cGVHD) can be time consuming and inconsistent (>20% affected area) even for experts. Building on previous work we explore methods to use unmarked photos to train artificial intelligence (AI) models, aiming to improve performance by expanding and diversifying the training data without additional burden on experts. Methods/Study Population: Common to many medical imaging projects, we have a small number of expert-marked patient photos (N = 36, n = 360), and many unmarked photos (N = 337, n = 25,842). Dark skin (Fitzpatrick type 4+) is underrepresented in both sets; 11% of patients in the marked set and 9% in the unmarked set. In addition, a set of 20 expert-marked photos from 20 patients were withheld from training to assess model performance, with 20% dark skin type. Our gold standard markings were manual contours around affected skin by a trained expert. Three AI training methods were tested. Our established baseline uses only the small number of marked photos (supervised method). The semi-supervised method uses a mix of marked and unmarked photos with human feedback. The self-supervised method uses only unmarked photos without any human feedback. Results/Anticipated Results: We evaluated performance by comparing predicted skin areas with expert markings. The error was given by the absolute difference between the percentage areas marked by the AI model and expert, where lower is better. Across all test patients, the median error was 19% (interquartile range 6 – 34) for the supervised method and 10% (5 – 23) for the semi-supervised method, which incorporated unmarked photos from 83 patients. On dark skin types, the median error was 36% (18 – 62) for supervised and 28% (14 – 52) for semi-supervised, compared to a median error on light skin of 18% (5 – 26) for supervised and 7% (4 – 17) for semi-supervised. Self-supervised, using all 337 unmarked patients, is expected to further improve performance and consistency due to increased data diversity. Full results will be presented at the meeting. Discussion/Significance of Impact: By automating skin assessment for cGVHD, AI could improve accuracy and consistency compared to manual methods. If translated to clinical use, this would ease clinical burden and scale to large patient cohorts. Future work will focus on ensuring equitable performance across all skin types, providing fair and accurate assessments for every patient.
Are you or someone you know struggling with hoarding disorder, feeling ashamed or guilty about your belongings, and afraid to let them go? It's more common than you might think, affecting up to 6% of the general population. But despite its prevalence, seeking help can be challenging. This new book provides a clear description of hoarding, exploring it as a symptom of other issues as well as a condition in its own right. You'll learn about different treatment options and find step-by-step guidance and tools for recovery in the self-help section. Personal narratives and case studies make this guide accessible and relatable for those affected by hoarding, as well as their loved ones and health professionals. Don't let hoarding disorder control your life - take the first step towards recovery today with this invaluable resource.
In this chapter we examine the idea of Hoarding Disorder. This relatively new diagnosis was first described in the American Psychiatric Association’s Diagnostic and Statistical Manual which was published in 2013. Hoarding Disorder is used to describe hoarding which is associated with an extreme attachment to items which are hoarded. Although people with Hoarding Disorder may suffer from other problems such as depression and anxiety, in Hoarding Disorder it is thought that the hoarding is not due to another diagnosis or problem. However, how Hoarding Disorder can present with other diagnoses, as well as the concept of conditions with increased risk taking and impulsivity and how they can be linked, even in the same person with increased compulsivity and avoidance of risk. Because the concept of Hoarding Disorder has only been described relatively recently, there is a lack of research in this area. Whereas Hoarding Disorder is often described in the elderly or late middle-aged, it is thought to have its roots in childhood. In this chapter we will examine the presentation of Hoarding Disorder in all age groups.
As well as examining the description and diagnosis of Hoarding Disorder, in this chapter we will also look at the risks inherent in the hoarding itself as well as the risk of suicide. Theories and research about the possible causes of Hoarding Disorder will be discussed.
In this chapter we will examine the substantial overlap, similarities, and also connections between people with Hoarding Disorder, Obsessive Compulsive Personality, Attention Deficit Hyperactivity Disorder, and Autism. The importance of ADHD in many people with hoarding will be examined along with a discussion about how the increasing recognition of a link between the two conditions has led to research into new ways of treating Hoarding Disorder. It is also recognised that autism interacts with hoarding as well as ADHD in a number of ways. Some people with autism are unable to tolerate any clutter at all whilst others hoard huge numbers of items due difficulty in decision-making. In addition, a substantial proportion of people with autism also have a diagnosis of OCD. As has already been discussed (Chapter 5), OCD may present with hoarding symptoms due to the nature of obsessive thoughts as well as Hoarding Disorder also.
Different countries, states and provinces have different laws and legal systems. Laws also change with time. There are nevertheless some common threads regarding laws which affect hoarding and what may be your legal rights. In this chapter we will start by examining the various laws which may be relevant for people who hoard in England, Wales and much of the UK. We will then outline the differences from these laws in Scotland and Northern Ireland. Finally, we will mention how hoarding laws vary in Europe and the European Union, Australia, Canada, India, New Zealand and the United States of America
Please note that we are not lawyers and this chapter is meant to be an overview of our understanding of the law as it currently stands. It is aimed at providing a very approximate view of a person’s rights. With any legal issues you or your family may experience, you are strongly advised to consult a solicitor for any legal advice.
In this chapter we discuss that, as well as being the main feature necessary for the diagnosis of Hoarding Disorder, hoarding can also occur as a symptom in many other physical and mental conditions. We will discuss clinical stories of people who have had difficulties with hoarding but will demonstrate how a different type of approach is needed to help them overcome their problems from that described from pure Hoarding disorder. There will then be a brief examination of the overlap between trauma and neurodiversity and hoarding as well as a brief description and discussion of the validity of the concept of Diogenes Syndrome in the elderly.
Examines the concept of hoarding, what it is and how some animals and most people have a tendency to collect items beyond their immediate requirements. The distinction is made between a hoard and a collection. The types of items which are hoarded are discussed along with a description of animal hoarding.
Social aspects of hoarding. We address the stigma of hoarding and how this can be treated by society, along with discussion of the shame and humiliation which prevents many people with hoarding problems from seeking help. This stigma can be reinforced by “helping” agencies who may view it as a “lifestyle choice” rather than a condition which requires help. Then looking at the role the media has played in perpetuating the myth that hoarders should be able to deal with it themselves.
Hoarding is a symptom rather than a distinct diagnosis and may be found in many conditions but there is a specific condition with characteristic features known as Hoarding Disorder. Some possible causes of hoarding are then described followed by a more detailed examination of the diagnosis of Hoarding Disorder
Finally, the chapter examines t what age hoarding arises and introduces the idea of hoarding in childhood.
In this chapter we will examine the psychological treatments that have been found to be helpful for people with Hoarding Disorder. The main approach used is Cognitive Behaviour Therapy (CBT). This may be with an individual or in a group setting. Although, as with much of the research into Hoarding Disorder, the number of studies of high quality are limited, we have good evidence that CBT does work and can have life-changing impacts both on the hoarding and also the depressive symptoms which often accompany Hoarding Disorder. One of the major issues, however, can be the reluctance of people with Hoarding disorder to enter into treatment programmes and then to stick with the programme. There may be many reasons for this reluctance. One recent development which may be hopeful for the future has been using an approach known as Compassion Focussed Therapy in addition to the standard CBT.
In this chapter we will we examine how Obsessive-Compulsive Disorder (OCD) or Obsessive-Compulsive Personality (OCPD) may interact with Hoarding Disorder. It has already been noted that prior to 2013 and the inclusion of a separate diagnosis of Hoarding Disorder in the Diagnostic and Statistical Manual Volume 5 (DSM5-TR) *1 was described and included under the new category of Obsessive-Compulsive and related disorders, people with Hoarding Disorder were included as either having OCD or OCPD. In reality, whereas Hoarding Disorder and symptoms of hoarding are common in both OCD and OCPD, not everyone who has Hoarding Disorder also has one of these conditions. On the other hand, hoarding symptoms may be present in both OCD and OCPD without displaying all of the characteristics of Hoarding Disorder. These distinctions can have an effect on what treatments may work for the individual.