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We present a deep probabilistic convolutional neural network (PCNN) model for predicting local values of small-scale mixing properties in stratified turbulent flows, namely the dissipation rates of turbulent kinetic energy and density variance, $\varepsilon$ and $\chi$. Inputs to the PCNN are vertical columns of velocity and density gradients, motivated by data typically available from microstructure profilers in the ocean. The architecture is designed to enable the model to capture several characteristic features of stratified turbulence, in particular the dependence of small-scale isotropy on the buoyancy Reynolds number $Re_b:=\varepsilon /(\nu N^2)$, where $\nu$ is the kinematic viscosity and $N$ is the background buoyancy frequency, the correlation between suitably locally averaged density gradients and turbulence intensity and the importance of capturing the tails of the probability distribution functions of values of dissipation. Empirically modified versions of commonly used isotropic models for $\varepsilon$ and $\chi$ that depend only on vertical derivatives of density and velocity are proposed based on the asymptotic regimes $Re_b\ll 1$ and $Re_b\gg 1$, and serve as an instructive benchmark for comparison with the data-driven approach. When trained and tested on a simulation of stratified decaying turbulence which accesses a range of turbulent regimes (associated with differing values of $Re_b$), the PCNN outperforms assumptions of isotropy significantly as $Re_b$ decreases, and additionally demonstrates improvements over the fitted empirical models. A differential sensitivity analysis of the PCNN facilitates a comparison with the theoretical models and provides a physical interpretation of the features enabling it to make improved predictions.
While revealing the presence of Huntington Disease (HD) within the family setting has received considerable research interest, the sources of information and the detail of which aspects of the illness are discussed remains unexplored. This study's primary aim was to identify HD information sources, both professional and family, and to describe the types of information received by members of affected families, with the hypothesis that some aspects of the disorder would be more fully addressed than others.
Method
Clients drawn from a specialist genetic unit looking after families with HD (n = 46) were engaged in structured interviews and completed standardized questionnaires, including: the psychological adjustment to genetic information scale (PAGIS); and a current psychological distress measure (K10). Participants obtained HD related information from a mean of 4.76 sources (49.3% professional).
Results
As expected, genetic and neurological symptoms were more frequently described (97.7% and 86.4% respectively) than cognitive and psychological/psychiatric (63.6%; 52.3%). Regression analyses were used to identify potential predictors of current distress, adjustment, and information satisfaction. Rated satisfaction with information received was higher among participants with a gene positive family member. Across the PAGIS sub-scales, there were differential associations with the predictors examined.
Conclusions
Given that HD is a multi-faceted condition affecting the entire family, needs would be better addressed if information provided went beyond discussion of genetic and movement disorders, and extended to the cognitive, psychological and behavioral aspects which are strongly associated with quality of life.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Loughland CM, Allen J, Gianacas L, Schofield PW, Lewin TJ, Hunter M, Carr VJ. Brief neuropsychological profiles in psychosis: a pilot study using the Audio Recorded Cognitive Screen (ARCS).
Objective:
This pilot study examines the utility of a novel, standardised brief neuropsychological assessment tool (the ARCS, Audio Recorded Cognitive Screen) in a different clinical setting to that in which it was initially developed. We hypothesised that the ARCS would be feasible to administer to individuals with a psychotic illness and that it would detect cognitive deficits similar to those identified by an established instrument (the RBANS, Repeatable Battery for the Assessment of Neuropsychological Status).
Methods:
Twenty-five people with psychosis (mean age = 43.72, SD = 9.78) and 25 age- and gender-matched controls were recruited from the Newcastle community (NSW, Australia). The ARCS and RBANS were completed about 1 week apart in a counterbalanced order.
Results:
The ARCS was well received, performed satisfactorily and both the ARCS and RBANS were sensitive to deficits typically associated with psychosis (e.g. memory and attention). After controlling for memory deficits, the largest disparity between the psychosis and control groups was on the ARCS fluency domain [p < 0.001, partial Eta-squared (ηp2) = 0.21].
Conclusion:
The ARCS uses audio administration (approximately 34 min) to reduce clinician time (to 3–5 min for scoring) and appears to be a useful brief assessment tool for examining the cognitive deficits associated with psychosis. However, the potential clinical utility of the ARCS needs to be investigated further in larger samples drawn from a wider variety of specialist and non-specialist settings.
We investigated a possible outbreak of H. pylori in a rural Northern Plains community. In a cross-sectional survey, we randomly sampled 244 households from a geocoded emergency medical system database. We used a complex survey design and global positioning system units to locate houses and randomly selected one eligible household member to administer a questionnaire and a 13C-urea breath test for active H. pylori infection (n = 166). In weighted analyses, active H. pylori infection was detected in 55·0% of the sample. Factors associated with infection on multivariate analysis included using a public drinking-water supply [odds ratio (OR) 12·2, 95% confidence interval (CI) 2·9–50·7] and current cigarette smoking (OR 4·1, 95% CI 1·7–9·6). People who lived in houses with more rooms, a possible indicator of decreased crowding in the home, were less likely to have active H. pylori infections (OR 0·7, 95% CI 0·5–0·9 for each additional room).
Developmental cascades are links across the life span among heterotypic (qualitatively distinct) variables associated with one or more levels of organization within the ecology of human development. Using data from the longitudinal, 4-H Study of Positive Youth Development (PYD), we illustrate a developmental systems theory predicated model of cascades in the relations between individuals and contexts that promote positive development among adolescents. Consistent with expectations about the bases of PYD and the role in such development on person and context, ecological resources associated with parenting are linked to individual self-regulatory behaviors that in turn impact PYD, which is then associated with youth community contributions. We discuss the limitations and future directions of this research and the implications of developmental cascades for applications to policies and programs.
Conductive ceramics have widespread use in many industrial applications. One important application for such materials is electrical contact technology. Over the last few years, a new class of nanocomposite ceramic thin film materials has been developed with contact coatings as one key objective. This family of materials has proven to combine the favorable contact properties of metals, such as low electrical and thermal resistivity, and high ductility, with those of ceramics such as low friction and wear rate, high chemical integrity and good high-temperature properties. Furthermore, it is also found that the tribological properties of such materials can be tailored by alloying thus creating a triboactive system. The technology is now industrialized, and a practical example of a contact system utilizing a nanocomposite coating for improved performance is given.
This paper describes the construction, refinement and implementation of a self-administered measure of personal hopefulness, the Hunter Opinions and Personal Expectations Scale (HOPES). Initial state and trait versions of the HOPES instrument were utilized in three separate studies, comprising a medical student sample (N = 211), an adolescent male sample (N = 280) and a psychiatric hospital staff sample (N = 318). A revised 20-item, two factor, trait version of the scale was then utilized in a prospective, longitudinal investigation (N = 753) of the psychosocial sequelae of the earthquake which struck Newcastle (Australia) in December, 1989. Data from all four studies provide strong support for the HOPES instrument's construct, concurrent and predictive validity. Global personal hopefulness (GPH) was shown to be an enduring characteristic of individuals, with a test–retest correlation of r = +0·71 (over 64 weeks). The association between GPH and trait anxiety (r = −0·64) raised the possibility of redefining anxiety as hope under threat. The hope subscale (HS) and the despair subscale (DS) were moderately negatively correlated (r = −0·32), suggesting that hope and despair are not simply polar opposites. There were no gender differences in GPH scores, however, there were relatively clear age effects, with those aged 70 years and over reporting the lowest levels of personal hopefulness. GPH was negatively correlated with post-earthquake scores on the General Health Questionnaire (r = −0·33), the Impact of Event Scale (r = −0·33), the Beck Depression Inventory (r = −0·54) and the global symptom index from the SCL-90-R (r = −0·43). Overall, the contribution made by personal hopefulness to post-earthquake morbidity was equal to the contributions made by initial exposure to disruption and threat experiences.
A total of 882 samples of settled sewage, sewage sludges and final effluents from eight sewage treatment plants were examined for the presence of salmonellas. Of these samples 68% were positive, isolations being made most frequently from settled sewage (85%), raw sludge (87%) and anaerobically digested sludge (96%). Fewer isolations were made from final effluent (24%) and processed sludges (58%). Samples usually contained less than 200 salmonellas/100 ml and arguments are presented that such concentrations should not lead to disease in animals if suitable grazing restrictions are followed.
Laparoscopy has been used for second-look assessments in ovarian cancer since first described in 1973 by Bagley et al. However, it was new developments in equipment and instrumentation, such as videolaparoscopy, high pressure insufflators, and energy sources, in the late 1980s to early 1990s — combined with the work of some of the pioneers of laparoscopic surgery — that made the use of operative laparoscopy in gynecologic oncology feasible. Dargent and Salvat, Querleu et al., and Nezhat et al. first established the safety and practicability of laparoscopic retroperitoneal and intraperitoneal lymphadenectomy and radical hysterectomy. An increasing number of surgeons have since used advanced operative techniques for evaluation and surgical management of gynecologic cancers.
Laparoscopy has the benefit of image magnification to aid in identification of metastatic or recurrent disease, especially in areas such as the upper abdomen, liver and diaphragm surfaces, posterior cul-de-sac, bowel, and mesenteric surfaces. In addition, challenging retroperitoneal spaces of the pelvis, such as the paravesical, pararectal, vesicovaginal, and especially the rectovaginal space, can be accessed laparoscopically. Additional benefits of laparoscopy in gynecologic oncology surgery include limited bleeding from small vessels due to the pressure established by pneumoperitoneum, elimination of large abdominal incisions, shortened hospital stay, and rapid recovery.
By
Jan M. Shoenberger, Assistant Professor of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California; Associate Residency Director, Los Angeles County–USC Medical Center, Los Angeles, CA,
William Mallon, Associate Professor of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles County–USC Medical Center, Los Angeles, CA,
Matthew Lewin, Assistant Clinical Professor of Emergency Medicine, University of California, San Francisco School of Medicine, San Francisco, CA
Edited by
Rachel L. Chin, University of California, San Francisco
Ectoparasitosis includes all infestations where parasites live in or on human skin. Most human ectoparasites are arthropods, primarily insects and arachnids, including ticks. Many ectoparasite infestations result in significant morbidity and yet go unrecognized in the acute care setting. Failure to treat affected patients leads to spread of ectoparasites through vulnerable populations both inside and outside the hospital. Recognition and treatment of ectoparasitosis (including resistant strains of pediculosis and scabies) is particularly important because these infestations are increasing geographically and within traditionally less vulnerable populations.
GENERAL ECTOPARASITE EPIDEMIOLOGY
Ectoparisitoses are most prevalent in resource-poor populations, including the homeless, immigrants, refugees, the incarcerated, the malnourished, and those who are underinsured and uninsured. The worldwide prevalence of scabies has been estimated at 300 million cases and is expanding. Crusted (or Norwegian) scabies are now an important nosocomial disease resulting in a large number of bed closures in intensive care units (ICUs) and wards across the United States. Head lice result in the loss of 12 to 24 million school days for U.S. children annually. Emerging resistance makes control more difficult, and incidence is also increasing due to the expanded use of steroids for asthma, arthritis, lupus, and other inflammatory diseases. (See Table 52.1.)
SCABIES
Clinical Features
Scabies is a common ectoparasitic infestation caused by the mite Sarcoptes scabiei. They are also known as “human itch mites.”
The place of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression remains unclear. In this sham-controlled study we determined the efficacy and acceptability of fast, left frontal rTMS given three times a week over 4–6 weeks to 29 patients with depression (79% treatment-resistant). The procedure was generally well tolerated and more effective than sham treatment (55 v. 7% responding, P<0.05), with improvement maintained to 12 weeks. This therapy could be a useful addition to available treatments but further research is needed to determine the optimum treatment parameters.
Objective: To assess a novel method for assessing risk and providing advice about activity to children and young people with congenital cardiac disease and their parents. Design and setting: Questionnaire survey in outpatient clinics at a tertiary centre dealing with congenital cardiac disease, and 6 peripheral clinics. Interventions: Children or their parents completed a brief questionnaire. If this indicated a desire for help, or a serious mismatch between advised and real level of activity, they were telephoned by a physiotherapist. Main measures of outcome: Knowledge about appropriate levels of activity, and identification of the number exercising at an unsafe level, the number seeking help, and the type of help required. Results: 253/258 (98.0%) questionnaires were returned, with 119/253 (47.0%) showing incorrect responses in their belief about their advised level of exercise; 17/253 (6.7%) had potentially dangerous overestimation of exercise. Asked if they wanted advice 93/253 (36.8%) said “yes”, 43/253 (17.0%) “maybe”, and 117/253 (46.2%) “no”. Of those contacted by phone to give advice, 72.7% (56/77) required a single contact and 14.3% (11/77) required an intervention that required more intensive contact lasting from 2 up to 12 weeks. Of the cohort, 3.9% (3/77) were taking part in activities that put them at significant risk. Conclusions: There is a significant lack of knowledge about appropriate levels of activity, and a desire for further advice, in children and young people with congenital cardiac disease. A few children may be at very significant risk. These needs can be identified, and clinical risk reduced, using a brief self-completed questionnaire combined with telephone follow-up from a suitably knowledgeable physiotherapist.
The purpose of our study was to determine the ways in which adolescents with congenital cardiac disease believed that the condition had affected their life, and how these views were related to their perceived health. Interviews were conducted with a series of 37 adolescents, 17 girls and 20 boys, aged from 11 to 18, as they attended the clinics of 4 paediatric cardiologists in a teaching hospital in the United Kingdom. Transcripts of the interviews were analysed for recurring themes. A questionnaire was formed consisting of a set of questions for each theme, and additional items eliciting “perceived health”, and administered to a second series of 74 adolescents, 40 boys and 34 girls, who were again aged from 11 to 18 years. Slightly less than half (46%) perceived their health as either “good” or “very good”, and one-third (33%) rated it as “average”. The majority (66%) felt themselves to be “the same” as, or only very slightly “different” from, their peers. The assessment of the seriousness of their condition by the adolescents, the degree to which they saw themselves as different from others, and their perceived health, were not related to the “complexity of the underlying medical condition” as rated by their physician. It was the psychosocial themes, such as exclusion from activities or the effect of the condition on relationships, that were most strongly related to the perception of their health by the adolescents. Improved education of parents, teachers and peers, and attendance at classes for cardiac rehabilitation, might help to ameliorate some of these problems.
Few randomised controlled trials have been aimed specifically at substance use reduction among people with psychotic disorders.
Aims
To investigate whether a 10-session intervention consisting of motivational interviewing and cognitive-behavioural therapy (CBT) was more efficacious than routine treatment in reducing substance use and improving symptomatology and general functioning.
Method
A community sample of people with a psychotic disorder and who reported hazardous alcohol, cannabis and/or amphetamine use during the preceding month was recruited. Participants were randomly allocated to motivational interviewing/CBT (n=65) or treatment as usual (n=65), and were assessed on multiple outcomes at baseline, 15 weeks, 6 months and 12 months.
Results
There was a short-term improvement in depression and a similar trend with regard to cannabis use among participants who received the motivational interviewing/CBT intervention, together with effects on general functioning at 12 months. There was no differential benefit of the intervention on substance use at 12 months, except for a potentially clinically important effect on amphetamine use.
Conclusions
The motivational interviewing/CBT intervention was associated with modest improvements.