We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Plasma-terminating disruptions represent a critical outstanding issue for reactor-relevant tokamaks. ITER will use shattered pellet injection (SPI) as its disruption mitigation system to reduce heat loads, vessel forces and to suppress the formation of runaway electrons. In this paper we demonstrate that reduced kinetic modelling of SPI is capable of capturing the major experimental trends in ASDEX Upgrade SPI experiments, such as dependence of the radiated energy fraction on neon content, or the current quench dynamics. Simulations are also consistent with the experimental observation of no runaway electron generation with neon and mixed deuterium–neon pellet composition. We also show that statistical variations in the fragmentation process only have a notable impact on the disruption dynamics at intermediate neon doping, as was observed in experiments.
In 2022, highly pathogenic avian influenza (HPAI) A(H5N1) virus clade 2.3.4.4b became enzootic and caused mass mortality in Sandwich Tern Thalasseus sandvicensis and other seabird species across north-western Europe. We present data on the characteristics of the spread of the virus between and within breeding colonies and the number of dead adult Sandwich Terns recorded at breeding sites throughout north-western Europe. Within two months of the first reported mortalities, 20,531 adult Sandwich Terns were found dead, which is >17% of the total north-western European breeding population. This is probably an under-representation of total mortality, as many carcasses are likely to have gone unnoticed and unreported. Within affected colonies, almost all chicks died. After the peak of the outbreak, in a colony established by late breeders, 25.7% of tested adults showed immunity to HPAI subtype H5. Removal of carcasses was associated with lower levels of mortality at affected colonies. More research on the sources and modes of transmission, incubation times, effective containment, and immunity is urgently needed to combat this major threat for colonial seabirds.
The International Psychogeriatric Association (IPA) published a provisional consensus definition of agitation in cognitive disorders in 2015. As proposed by the original work group, we summarize the use and validation of criteria in order to remove “provisional” from the definition.
Methods:
This report summarizes information from the academic literature, research resources, clinical guidelines, expert surveys, and patient and family advocates on the experience of use of the IPA definition. The information was reviewed by a working group of topic experts to create a finalized definition.
Results:
We present a final definition which closely resembles the provisional definition with modifications to address special circumstances. We also summarize the development of tools for diagnosis and assessment of agitation and propose strategies for dissemination and integration into precision diagnosis and agitation interventions.
Conclusion:
The IPA definition of agitation captures a common and important entity that is recognized by many stakeholders. Dissemination of the definition will permit broader detection and can advance research and best practices for care of patients with agitation.
To develop an agitation reduction and prevention algorithm is intended to guide implementation of the definition of agitation developed by the International Psychogeriatric Association (IPA)
Design:
Review of literature on treatment guidelines and recommended algorithms; algorithm development through reiterative integration of research information and expert opinion
Setting:
IPA Agitation Workgroup
Participants:
IPA panel of international experts on agitation
Intervention:
Integration of available information into a comprehensive algorithm
Measurements:
None
Results
The IPA Agitation Work Group recommends the Investigate, Plan, and Act (IPA) approach to agitation reduction and prevention. A thorough investigation of the behavior is followed by planning and acting with an emphasis on shared decision-making; the success of the plan is evaluated and adjusted as needed. The process is repeated until agitation is reduced to an acceptable level and prevention of recurrence is optimized. Psychosocial interventions are part of every plan and are continued throughout the process. Pharmacologic interventions are organized into panels of choices for nocturnal/circadian agitation; mild-moderate agitation or agitation with prominent mood features; moderate-severe agitation; and severe agitation with threatened harm to the patient or others. Therapeutic alternatives are presented for each panel. The occurrence of agitation in a variety of venues—home, nursing home, emergency department, hospice—and adjustments to the therapeutic approach are presented.
Conclusions
The IPA definition of agitation is operationalized into an agitation management algorithm that emphasizes the integration of psychosocial and pharmacologic interventions, reiterative assessment of response to treatment, adjustment of therapeutic approaches to reflect the clinical situation, and shared decision-making.
This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.
Seabirds are highly threatened, including by fisheries bycatch. Accurate understanding of offshore distribution of seabirds is crucial to address this threat. Tracking technologies revolutionised insights into seabird distributions but tracking data may contain a variety of biases. We tracked two threatened seabirds (Salvin’s Albatross Thalassarche salvini n = 60 and Black Petrel Procellaria parkinsoni n = 46) from their breeding colonies in Aotearoa (New Zealand) to their non-breeding grounds in South America, including Peru, while simultaneously completing seven surveys in Peruvian waters. We then used species distribution models to predict occurrence and distribution using either data source alone, and both data sources combined. Results showed seasonal differences between estimates of occurrence and distribution when using data sources independently. Combining data resulted in more balanced insights into occurrence and distributions, and reduced uncertainty. Most notably, both species were predicted to occur in Peruvian waters during all four annual quarters: the northern Humboldt upwelling system for Salvin’s Albatross and northern continental shelf waters for Black Petrels. Our results highlighted that relying on a single data source may introduce biases into distribution estimates. Our tracking data might have contained ontological and/or colony-related biases (e.g. only breeding adults from one colony were tracked), while our survey data might have contained spatiotemporal biases (e.g. surveys were limited to waters <200 nm from the coast). We recommend combining data sources wherever possible to refine predictions of species distributions, which ultimately will improve fisheries bycatch management through better spatiotemporal understanding of risks.
Swayne's hartebeest Alcelaphus buselaphus swaynei was once widely distributed in the Horn of Africa. By the early 20th century, however, it was extirpated across most of its range and is now limited to two relict populations in the Ethiopian Rift Valley and categorized as Endangered on the IUCN Red List. In this study, we estimated the size and genetic diversity of these two remaining populations, with a particular focus on competition with livestock. We used a total block count method for both Swayne's hartebeest and livestock population counts, and faecal samples for a population genetic analysis. We estimated the total population of Swayne's hartebeest to be 1,528, with 518 individuals in Senkele Swayne's Hartebeest Sanctuary and 1,010 individuals in Maze National Park. Livestock densities were 212 and 153 times those of Swayne's hartebeest in Senkele Swayne's Hartebeest Sanctuary and Maze National Park, respectively. Among 73 mitochondrial D-loop sequences (34 from Senkele Swayne's Hartebeest Sanctuary and 39 from Maze National Park), we found 22 haplotypes (Senkele 12, Maze 16, shared 6). Population genetic parameters suggest only weak sub-structuring between the two populations (FST = 0.164). Despite the positive population trends in both protected areas, the spatial overlap with livestock may lead to future population decline as a result of resource competition and disease transmission. We therefore recommend further translocation to other protected areas within the species’ former range.
Direct numerical simulations of oscillatory boundary-layer flows in the transitional regime were performed to explain discrepancies in the literature regarding the phase difference ${\rm \Delta} \phi$ between the bed-shear stress and free-stream velocity maxima. Recent experimental observations in smooth bed oscillatory boundary-layer (OBL) flows, showed a significant change in the widely used ${\rm \Delta} \phi$ diagram (Mier et al., J. Fluid Mech., vol. 922, 2021, A29). However, the limitations of the point-wise measurement technique did not allow us to associate this finding with the turbulent kinetic energy budget and to detect the approach to a ‘near-equilibrium’ condition, defined in a narrow sense herein. Direct numerical simulation results suggest that a phase lag occurs as the result of a delayed and incomplete transition of OBL flows to a stage that mimics the fully turbulent regime. Data from the literature were also used to support the presence of the phase lag and propose a new ${\rm \Delta} \phi$ diagram. Simulations performed for ${\textit {Re}}_{\delta }=671$ confirmed the sensitivity in the development of self-sustained turbulence on the background disturbances ($\textit{Re}_{\delta}=U_{o}\delta/\nu$, where $\delta=[2\nu/\omega]^{1/2}$ is the Stokes' length, $U_{o}$ is the maximum free stream velocity of the oscillation, $\nu$ is the kinematic viscosity and $\omega=2{\rm \pi}/T$ is the angular velocity based on the period of the oscillation T). Variations of the mean velocity slope and intersect values for oscillatory flows are also explained in terms of the proximity to near-equilibrium conditions. Relaminarization and transition effects can significantly delay the development of OBL flows, resulting in an incomplete transition. The shape and defect factors are examined as diagnostic parameters for conditions that allow the formation of a logarithmic profile with the universal von Kármán constant and intersect. These findings are of relevance for environmental fluid mechanics and coastal morphodynamics/engineering applications.
Barriers to research participation by racial and ethnic minority group members are multi-factorial, stem from historical social injustices and occur at participant, research team, and research process levels. The informed consent procedure is a key component of the research process and represents an opportunity to address these barriers. This manuscript describes the development of the Strengthening Translational Research in Diverse Enrollment (STRIDE) intervention, which aims to improve research participation by individuals from underrepresented groups.
Methods:
We used a community-engaged approach to develop an integrated, culturally, and literacy-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. This approach involved having Community Investigators participate in intervention development activities and using community engagement studios and other methods to get feedback from community members on intervention components.
Results:
The STRIDE intervention has three components: a simulation-based training program directed toward clinical study research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process, an electronic consent (eConsent) framework designed to improve health-related research material comprehension and relevance, and a “storytelling” intervention in which prior research participants from diverse backgrounds share their experiences delivered via video vignettes during the consent process.
Conclusions:
The community engaged development approach resulted in a multi-component intervention that addresses known barriers to research participation and can be integrated into the consent process of research studies. Results of an ongoing study will determine its effectiveness at increasing diversity among research participants.
The updated common rule, for human subjects research, requires that consents “begin with a ‘concise and focused’ presentation of the key information that will most likely help someone make a decision about whether to participate in a study” (Menikoff, Kaneshiro, Pritchard. The New England Journal of Medicine. 2017; 376(7): 613–615.). We utilized a community-engaged technology development approach to inform feature options within the REDCap software platform centered around collection and storage of electronic consent (eConsent) to address issues of transparency, clinical trial efficiency, and regulatory compliance for informed consent (Harris, et al. Journal of Biomedical Informatics 2009; 42(2): 377–381.). eConsent may also improve recruitment and retention in clinical research studies by addressing: (1) barriers for accessing rural populations by facilitating remote consent and (2) cultural and literacy barriers by including optional explanatory material (e.g., defining terms by hovering over them with the cursor) or the choice of displaying different videos/images based on participant’s race, ethnicity, or educational level (Phillippi, et al. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2018; 47(4): 529–534.).
Methods:
We developed and pilot tested our eConsent framework to provide a personalized consent experience whereby users are guided through a consent document that utilizes avatars, contextual glossary information supplements, and videos, to facilitate communication of information.
Results:
The eConsent framework includes a portfolio of eight features, reviewed by community stakeholders, and tested at two academic medical centers.
Conclusions:
Early adoption and utilization of this eConsent framework have demonstrated acceptability. Next steps will emphasize testing efficacy of features to improve participant engagement with the consent process.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
Aims
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Method
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
Results
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
Conclusions
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Observations show that glaciers around the world are in retreat and losing mass. Internationally coordinated for over a century, glacier monitoring activities provide an unprecedented dataset of glacier observations from ground, air and space. Glacier studies generally select specific parts of these datasets to obtain optimal assessments of the mass-balance data relating to the impact that glaciers exercise on global sea-level fluctuations or on regional runoff. In this study we provide an overview and analysis of the main observational datasets compiled by the World Glacier Monitoring Service (WGMS). The dataset on glacier front variations (∼42 000 since 1600) delivers clear evidence that centennial glacier retreat is a global phenomenon. Intermittent readvance periods at regional and decadal scale are normally restricted to a subsample of glaciers and have not come close to achieving the maximum positions of the Little Ice Age (or Holocene). Glaciological and geodetic observations (∼5200 since 1850) show that the rates of early 21st-century mass loss are without precedent on a global scale, at least for the time period observed and probably also for recorded history, as indicated also in reconstructions from written and illustrated documents. This strong imbalance implies that glaciers in many regions will very likely suffer further ice loss, even if climate remains stable.
A direct numerical simulation (DNS) of turbulent flow in a three-dimensional diffuser at Re = 10000 (based on bulk velocity and inflow-duct height) was performed with a massively parallel high-order spectral element method running on up to 32768 processors. Accurate inflow condition is ensured through unsteady trip forcing and a long development section. Mean flow results are in good agreement with experimental data by Cherry et al. (Intl J. Heat Fluid Flow, vol. 29, 2008, pp. 803–811), in particular the separated region starting from one corner and gradually spreading to the top expanding diffuser wall. It is found that the corner vortices induced by the secondary flow in the duct persist into the diffuser, where they give rise to a dominant low-speed streak, due to a similar mechanism as the ‘lift-up effect’ in transitional shear flows, thus governing the separation behaviour. Well-resolved simulations of complex turbulent flows are thus possible even at realistic Reynolds numbers, providing accurate and detailed information about the flow physics. The available Reynolds stress budgets provide valuable references for future development of turbulence models.