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.
We propose a novel time-asymptotically stable, implicit–explicit, adaptive, time integration method (denoted by the $\theta $-method) for the solution of the fractional advection–diffusion-reaction (FADR) equations. The spectral analysis of the method (involving the group velocity and the phase speed) indicates a region of favourable dispersion for a limited range of Péclet number. The numerical inversion of the coefficient matrix is avoided by exploiting the sparse structure of the matrix in the iterative solver for the Poisson equation. The accuracy and the efficacy of the method is benchmarked using (a) the two-dimensional fractional diffusion equation, originally proposed by researchers earlier, and (b) the incompressible, subdiffusive dynamics of a planar viscoelastic channel flow of the Rouse chain melts (FADR equation with fractional time-derivative of order ) and the Zimm chain solution (). Numerical simulations of the viscoelastic channel flow effectively capture the nonhomogeneous regions of high viscosity at low fluid inertia (or the so-called “spatiotemporal macrostructures”), experimentally observed in the flow-instability transition of subdiffusive flows.
Military Servicemembers and Veterans are at elevated risk for suicide, but rarely self-identify to their leaders or clinicians regarding their experience of suicidal thoughts. We developed an algorithm to identify posts containing suicide-related content on a military-specific social media platform.
Methods
Publicly-shared social media posts (n = 8449) from a military-specific social media platform were reviewed and labeled by our team for the presence/absence of suicidal thoughts and behaviors and used to train several machine learning models to identify such posts.
Results
The best performing model was a deep learning (RoBERTa) model that incorporated post text and metadata and detected the presence of suicidal posts with relatively high sensitivity (0.85), specificity (0.96), precision (0.64), F1 score (0.73), and an area under the precision-recall curve of 0.84. Compared to non-suicidal posts, suicidal posts were more likely to contain explicit mentions of suicide, descriptions of risk factors (e.g. depression, PTSD) and help-seeking, and first-person singular pronouns.
Conclusions
Our results demonstrate the feasibility and potential promise of using social media posts to identify at-risk Servicemembers and Veterans. Future work will use this approach to deliver targeted interventions to social media users at risk for suicide.
The viability of metacercariae of Fasciola gigantica was tested by in vitro and in vivo methods. In vitro testing was based upon the motility of juvenile flukes within the inner cyst as examined under the light microscope. In vivo testing was undertaken through experimental infections of rabbits (two groups) and natural definitive hosts, lambs (one group). In the first group, out of six rabbits each given 25 metacercariae, worm establishment only took place in one rabbit with a single fluke recovery on 60 days post infection. In the second group of six rabbits each given 200 metacercariae, five were infected, with two or three flukes per host. All the lambs given 250 metacercariae became infected showing prevalences of 7.2–40% in comparison with rabbits in which low prevalences (0–4%) were recorded. The results indicated that even viable metacercariae which were already tested in vitro could not readily establish in rabbits. Such variability in worm establishment suggests that immunological and chemotherapeutic studies in rabbits infected with F. gigantica are likely to be unreliable.
Pyrophyllite is the precursor to other smectite-group minerals which exhibit swelling. The mineral structure of pyrophyllite can lead to other minerals in the smectite group, including montmorillonite, through appropriate isomorphous substitutions. In this work, an atomic model of the pyrophyllite interlayer was constructed. The response of the interlayer was evaluated using steered molecular dynamics simulations. In steered molecular dynamics, external forces were applied to individual atoms to study the response of the model to applied forces. In this work, forces are applied to the surface clay atoms to evaluate the displacement vs. applied stress in the interlayer between clay layers. This paper describes the construction of the model, the simulation procedure, and the results of the simulations which show that under the applied loading, deformation occurs mainly in the interlayer. The clay layers show relatively little deformation. The results show that the relationship between applied stress and displacement of the interlayer is linear. The stress-deformation relationship for the interlayer is presented.
Psychologically faithful deep neural networks (DNNs) could be constructed by training with psychophysics data. Moreover, conventional DNNs are mostly monocular vision based, whereas the human brain relies mainly on binocular vision. DNNs developed as smaller vision agent networks associated with fundamental and less intelligent visual activities, can be combined to simulate more intelligent visual activities done by the biological brain.
Patients with unbalanced common atrioventricular canal can be difficult to manage. Surgical planning often depends on pre-operative echocardiographic measurements. We aimed to determine the added utility of cardiac MRI in predicting successful biventricular repair in common atrioventricular canal.
Methods:
We conducted a retrospective cohort study of children with common atrioventricular canal who underwent MRI prior to repair. Associations between MRI and echocardiographic measures and surgical outcome were tested using logistic regression, and models were compared using area under the receiver operator characteristic curve.
Results:
We included 28 patients (median age at MRI: 5.2 months). The optimal MRI model included the novel end-diastolic volume index (using the ratio of left ventricular end-diastolic volume to total end-diastolic volume) and the left ventricle–right ventricle angle in diastole (area under the curve 0.83, p = 0.041). End-diastolic volume index ≤ 0.18 and left ventricle–right ventricle angle in diastole ≤ 72° yield a sensitivity of 83% and specificity of 81% for successful biventricular repair. The optimal multimodality model included the end-diastolic volume index and the echocardiographic atrioventricular valve index with an area under the curve of 0.87 (p = 0.026).
Conclusions:
Cardiac MRI can successfully predict successful biventricular repair in patients with unbalanced common atrioventricular canal utilising the end-diastolic volume index alone or in combination with the MRI left ventricle–right ventricle angle in diastole or the echocardiographic atrioventricular valve index. A prospective cardiac MRI study is warranted to better define the multimodality characteristic predictive of successful biventricular surgery.
Drains are used post-parotidectomy to reduce seroma and haematoma formation. Tissue-derived thrombin sealant can enable a drainless procedure, allowing for an earlier discharge, less discomfort and a more cost-efficient method. This study aimed to assess whether tissue sealant improves wound-related outcomes in parotidectomy.
Method
A systematic literature review was performed using a standardised published methodology and custom database search strategy. A fixed-effect meta-analysis of the combined complications was conducted.
Results
Thirteen studies were identified relating to parotidectomy procedures using tissue sealants, of which nine were included in the quantitative synthesis. Our analysis suggested a reduction in the complication rates, including haematoma and seroma, with drainless parotidectomy procedures involving tissue sealant use when compared with conventional procedures with post-operative drain use.
Conclusion
Fibrin sealant in parotidectomy may be used to facilitate a drainless approach, expediting recovery and offering better comfort to patients.
Surgery is the recommended treatment for resectable T4a laryngeal and hypopharyngeal carcinoma. Non-surgical treatment is an option in a select few patients.
Method
This retrospective study was undertaken to assess the treatment outcomes in patients with resectable T4a carcinoma of the larynx and hypopharynx who received either surgical or non-surgical treatment at our institute and to assess factors influencing these outcomes.
Results
A total of 120 patients were included in the study. They were divided into groups A, B and C based on the presence of extralaryngeal spread through laryngeal membrane, cartilage or both. The overall survival was better among patients who received surgery than those who received non-surgical treatment in the three groups. The factor influencing overall survival was the treatment given in the form of surgical versus non-surgical treatment.
Conclusion
Surgery is the preferred treatment for T4a laryngeal and hypopharyngeal carcinoma, even in patients with extralaryngeal spread without cartilage erosion.
The impact of modern high-precision conformal techniques on rare but highly morbid late complications of head and neck radiotherapy, such as necrosis of the bone, cartilage or soft-tissues, is not well described.
Method
Medical records of head and neck cancer patients treated in prospective clinical trials of definitive high-precision radiotherapy were reviewed retrospectively to identify patients with necrosis.
Results
Twelve of 290 patients (4.1 per cent) developed radiotherapy necrosis at a median interval of 4.5 months. There was no significant difference in baseline demographic (age, gender), disease (primary site, stage) and treatment characteristics (radiotherapy technique, total dose, fractionation) of patients developing radiotherapy necrosis versus those without necrosis. Initial management included antibiotics or anti-inflammatory agents, tissue debridement and tracheostomy as appropriate followed by hyperbaric oxygen therapy and resective surgery for persistent symptoms in selected patients.
Conclusion
Multidisciplinary management is essential for the prevention, early diagnosis and successful treatment of radiotherapy necrosis of bone, cartilage or cervical soft tissues.
To correlate computed tomography findings and endoscopic localisation of the anterior ethmoidal artery during surgery, and to analyse the intranasal landmarks and abnormalities of the artery.
Method
The anterior ethmoidal artery was studied with high-resolution computed tomography and endoscopic surgery in 30 patients undergoing functional endoscopic sinus surgery (group A), and with endoscopic dissection on 30 human cadavers (group B).
Results
The anterior ethmoidal artery was demonstrated on computed tomography in 25 patients and intra-operatively in 12 (group A). It was identified in 26 cadavers (group B). Dehiscence of bony canal and branching was noted in 10.53 per cent of cases. The mean (± standard deviation) intranasal length of the anterior ethmoidal artery was 7.29 (± 1.21) mm, the distance of the artery from the axilla of the middle turbinate was 16.24 (± 2.75) mm, and the mean distance from the ground lamella was 8.97 (± 1.46) mm.
Conclusion
High-resolution computed tomography scanning prior to functional endoscopic sinus surgery is mandatory to identify the anterior ethmoidal artery. Endoscopically, the axilla of the middle turbinate and the ground lamella can serve as dependable reference points to identify the artery. Cadaver dissection improves understanding of anatomy.
Camber morphing is an effective way to control the lift generated by any aerofoil and potentially improve the range (as measured by the lift-to-drag ratio) and endurance (as measured by $C_l^{3/2}/C_d$). This can be especially useful for fixed-wing Unmanned Aerial Vehicles (UAVs) undergoing different flying manoeuvres and flight phases. This work investigates the aerodynamic characteristics of the NACA0012 aerofoil morphed using a Single Corrugated Variable-Camber (SCVC) morphing approach. Structural analysis and morphed shapes are obtained based on small-deformation beam theory using chain calculations and validated using finite-element software. The aerofoil is then reconstructed from the camber line using a Radial Basis Function (RBF)-based interpolation method (J.H.S. Fincham and M.I. Friswell, “Aerodynamic optimisation of a camber morphing aerofoil,” Aerosp. Sci. Technol., 2015). The aerodynamic analysis is done by employing two different finite-volume solvers (OpenFOAM and ANSYS-Fluent) and a panel method code (XFoil). Results reveal that the aerodynamic coefficients predicted by the two finite-volume solvers using a fully turbulent flow assumption are similar but differ from those predicted by XFoil. The aerodynamic efficiency and endurance factor of morphed aerofoils indicate that morphing is beneficial at moderate to high lift requirements. Further, the optimal morphing angle increases with an increase in the required lift. Finally, it is observed for a fixed angle-of-attack that an optimum morphing angle exists for which the aerodynamic efficiency becomes maximum.
Crenidens macracanthus was originally described in 1874 based on a single specimen collected from Chennai (Madras), south-east coast of India. In 1875, the species was synonymized with C. indicus without citing any valid reason. Since then, no taxonomic studies have been attempted for the genus Crenidens, except in 2013 the species was resurrected from synonymy and redescribed as a valid species based on the holotype and non-type specimen. In view of the fact that C. macracanthus is a poorly known species, it is redescribed based on examination of 30 additional specimens of 105.8–162.2 mm SL, collected from Puri, Odisha, north-east coast of India (Bay of Bengal) from 2017–2019, using morphological and molecular examinations. Our study provides a detailed morphological description, first colour photographs and phylogenetic analysis using COI barcodes of the species. The study has expanded the range in several morpho-meristic characters in comparison with the type and non-type specimens described earlier. The species in fresh condition can be easily distinguished from its two congeners (C. crenidens and C. indicus) by the yellowish tip of the lower caudal-fin lobe. Our study has also extended the distribution range of C. indicus (previously known only from the north-eastern Arabian Sea) to the eastern Indian Ocean, based on examination of a preserved specimen collected from Tuticorin, Tamil Nadu.
Opioid use disorder is a major public health crisis, and evidence suggests ways of better serving patients who live with opioid use disorder in the emergency department (ED). A multi-disciplinary team developed a quality improvement project to implement this evidence.
Methods
The intervention was developed by an expert working group consisting of specialists and stakeholders. The group set goals of increasing prescribing of buprenorphine/naloxone and providing next day walk-in referrals to opioid use disorder treatment clinics. From May to September 2018, three Alberta ED sites and three opioid use disorder treatment clinics worked together to trial the intervention. We used administrative data to track the number of ED visits where patients were given buprenorphine/naloxone. Monthly ED prescribing rates before and after the intervention were considered and compared with eight nonintervention sites. We considered whether patients continued to fill opioid agonist treatment prescriptions at 30, 60, and 90 days after their index ED visit to measure continuity in treatment.
Results
The intervention sites increased their prescribing of buprenorphine/naloxone during the intervention period and prescribed more buprenorphine/naloxone than the controls. Thirty-five of 47 patients (74.4%) discharged from the ED with buprenorphine/naloxone continued to fill opioid agonist treatment prescriptions 30 days and 60 days after their index ED visit. Thirty-four patients (72.3%) filled prescriptions at 90 days.
Conclusions
Emergency clinicians can effectively initiate patients on buprenorphine/naloxone when supports for this standardized evidence-based care are in place within their practice setting and timely follow-up in community is available.
Background: Since January 1, 2016 2358 people have died from opioid poisoning in Alberta. Buprenorphine/naloxone (bup/nal) is the recommended first line treatment for opioid use disorder (OUD) and this treatment can be initiated in emergency departments and urgent care centres (EDs). Aim Statement: This project aims to spread a quality improvement intervention to all 107 adult EDs in Alberta by March 31, 2020. The intervention supports clinicians to initiate bup/nal for eligible individuals and provide rapid referrals to OUD treatment clinics. Measures & Design: Local ED teams were identified (administrators, clinical nurse educators, physicians and, where available, pharmacists and social workers). Local teams were supported by a provincial project team (project manager, consultant, and five physician leads) through a multi-faceted implementation process using provincial order sets, clinician education products, and patient-facing information. We used administrative ED and pharmacy data to track the number of visits where bup/nal was given in ED, and whether discharged patients continued to fill any opioid agonist treatment (OAT) prescription 30 days after their index ED visit. OUD clinics reported the number of referrals received from EDs and the number attending their first appointment. Patient safety event reports were tracked to identify any unintended negative impacts. Evaluation/Results: We report data from May 15, 2018 (program start) to September 31, 2019. Forty-nine EDs (46% of 107) implemented the program and 22 (45% of 49) reported evaluation data. There were 5385 opioid-related visits to reporting ED sites after program adoption. Bup/nal was given during 832 ED visits (663 unique patients): 7 visits in the 1st quarter the program operated, 55 in the 2nd, 74 in the 3rd, 143 in the 4th, 294 in the 5th, and 255 in the 6th. Among 505 unique discharged patients with 30 day follow up data available 319 (63%) continued to fill any OAT prescription after receiving bup/nal in ED. 16 (70%) of 23 community clinics provided data. EDs referred patients to these clinics 440 times, and 236 referrals (54%) attended their first follow-up appointment. Available data may under-report program impact. 5 patient safety events have been reported, with no harm or minimal harm to the patient. Discussion/Impact: Results demonstrate effective spread and uptake of a standardized provincial ED based early medical intervention program for patients who live with OUD.
The aim of this study was to audit the practise of Lithium monitoring on all patients over the age of 65 years, over a one-year period in North Tyneside General Hospital, against the recommended standards, and re-auditing the following year.
Methods:
During the audit; data was collected from the medical notes of all patients prescribed Lithium, over 65 years in North Tyneside General Hospital. This was from January 2004 - January 2005. The standards used were the recommendations of The British National Formulary. The monitoring of urea, electrolytes, TSH and Lithium were recorded. The presence of an ECG, documentation of side effects, information leaflets’ distribution and patients lost to follow up were noted. Following the audit, recommendations were made and prescribing Consultants were informed. A re-audit was conducted on all patients on Lithium the next year from January 2006 - June 2006, using the same designed tool.
Results:
22 patient's notes were audited and 29 notes re-audited. 41% were males and 59% females in the audit, with similar distribution in the re-audit. 54% were between 65-75 years and 45% over the age of 75years in the audit. 41% and 59% respectively in the re-audit. Blood monitoring followed the standards in 86% in the audit and 95% in the re-audit. 32% had documentation of side effects in the audit, increasing to 72% in the re-audit. While 23% patients were lost to follow up in the audit, all were followed up in the re-audit.
Conclusions:
The re-audit encouragingly showed significant improvement in practise.
Field experiments were carried out in order to investigate if brown manuring (BM) using Sesbania plants can be used to control weeds in maize, especially Cyperus rotundus (Experiment I), and further to optimize the BM technology through appropriate Sesbania seed rate (S), 2,4-D application time (T) and dose (D) (Experiment II). Each BM treatment received a pre-emergence application of pendimethalin 1.0 kg a.i./ha. Experiment I showed that the BM practice using 15 kg/ha Sesbania seed and 2,4-D 0.50 kg a.i./ha applied at 25 DAS led to better control of weeds, especially C. rotundus and higher maize grain yield. Further optimization studies (Experiment II) indicated that among the factors S, T and D, the BM combination S~25 kg/ha, D~0.50 kg a.i./ha and T~25 DAS (i.e. S25T25D0.50) resulted in lowest weed density (3.1/m2) and dry weight (3.8 g/m2) and highest weed control index (89.2%) at 60 days after sowing (DAS) which was at par with another BM practice S15T25D0.50. However, the later BM combination led to significantly higher maize productivity (5.25 t/ha) and profitability (net returns (NR) $878/ha), which were 103 and 280% higher, respectively, than the weedy check (WC). The Sesbania seed rate S~15 kg/ha gave 7% higher maize grain yield and 12% higher NR than its corresponding level S~25 kg/ha. Therefore, Sesbania BM with 15 kg seeds/ha and 2,4-D at 0.50 kg a.i/ha applied at 25 DAS can be recommended for effective and eco-friendly weed management in maize, which would provide higher maize grain yield and enhance farmers' profitability.
The theoretical investigation of shocks and solitary structures in a dense quantum plasma containing electrons at finite temperature, nondegenerate cold electrons, and stationary ions has been carried out. A linear dispersion relation is derived for the corresponding electron acoustic waves. The solitary structures of small nonlinearity have been studied by using the standard reductive perturbation method. We have considered collisions to be absent, and the shocks arise out of viscous force. Furthermore, with the help of a standard reductive perturbation technique, a KdV–Burger equation has been derived and analyzed numerically. Under limiting cases, we have also obtained the KdV solitary profiles and studied the parametric dependence. The results are important in explaining the many phenomena of the laser–plasma interaction of dense plasma showing quantum effects.
Terminal heat stress leads to sizeable yield loss in late-sown wheat in tropical environments. Several synthetic compounds are known to counteract plant stress emanating from abiotic factors. A field experiment was conducted in Sabour (eastern India) during 2013–2016 to investigate the field efficacy of two synthetic compounds, calcium chloride (CaCl2) and arginine, for improving grain yield of two contrasting wheat cultivars (DBW 14 and K 307) facing terminal heat stress. For this, foliar spray of 18.0 mM CaCl2 at booting (CCB) or anthesis (CCA), 9.0 mM CaCl2 at both booting and anthesis (CCB+A), 2.5 mM arginine at booting (ARGB) or anthesis (ARGA) and 1.25 mM arginine at both booting and anthesis (ARGB+A) treatments along with no-spray and water-spray treatments were evaluated in late-sown wheat. The highest grain yield was recorded in treatment CCB+A, followed by CCA and ARGB+A. However, the effect of these compounds was marginal on grain yield when applied only at the booting stage. Grains/ear and thousand-grain weight were found to be the critical determinants for yield in late-sown wheat. During the anthesis to grain filling period, flag-leaf chlorophyll degradation and increase in relative permeability in no-spray treatment were 34–36% and 29–52%, respectively, but these values were reduced considerably in CCB+A treatment followed CCA. Thus, foliar spray of 9.0 mM CaCl2 both at booting and anthesis stages may be recommended for alleviating the negative impacts of terminal heat stress in late-sown wheat and improving its productivity (>13%).
To assess the effect of tranexamic acid on intra-operative bleeding and surgical field visualisation.
Methods
Fifty patients undergoing various endoscopic ear surgical procedures, including endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy, endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly assigned to: a study group that received tranexamic acid or a control group which received normal saline. The intra-operative bleeding and operative field visualisation was graded using the Das and Mitra endoscopic ear surgery bleeding and field visibility score, which was separately analysed for the external auditory canal and the middle ear.
Results
The Das and Mitra score was better (p < 0.05) in the group that received tranexamic acid as a haemostat when working in the external auditory canal; with respect to the middle ear, no statistically significant difference was found between the two agents. Mean values for mean arterial pressure, heart rate and surgical time were comparable in both groups, with no statistically significant differences.
Conclusion
Tranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues.
This chapter reviews the systematics of partial melting of mantle lithologies – like peridotite and eclogite – in the presence of carbon dioxide. It discusses the composition of mantle-derived magmas generated in the presence of carbon dioxide and whether magmas erupted on Earth’s surface resemble carbonated magmas from the mantle. It reviews how the production of carbon dioxide-rich magma in the mantle varies as a function of tectonic settings – beneath continents and oceans and in subduction zones – and time.