Evolution of solitary waves and an undular bore intruding through an abrupt transition from a wide basin into a narrow channel with opposing current is investigated. The laboratory experiments are performed in a wave tank that is crafted to achieve a steady and symmetrical shallow-water jet in the basin. The channel has a breadth comparable to the wave lengths, and the flow has Froude number approximately 0.1. The opposing current amplifies and slows the incoming waves on the jet in the basin, but the propagation speed is faster than the local Doppler effect of the current due to the influence of the wave propagating in the flank of the jet. At the channel mouth, the wave amplitude is enhanced due to the waveform altered by the current in the basin, although the amplification in the upstream channel is similar with and without the current. The longer incident waves have greater amplification into the channel. The leading wave of the undular bore is impacted by the opposing flow and transition similarly to the solitary waves. In contrast, the subsequent waves of the undular bore have a complex phase interference on the jet that causes disconnection in the lateral wave formation across the breadth of the jet. At the transition, the subsequent waves exhibit greater amplification than the leading one due to accumulated wave energy at the channel mouth. The intrusion of the undular bore against the current further enhances a rise in mean water level in the channel.

Long-term sequelae of severe acute respiratory coronavirus-2 (SARS-CoV-2) infection may include increased incidence of diabetes. Here we describe the temporal relationship between new type 2 diabetes and SARS-CoV-2 infection in a nationwide database. We found that while the proportion of newly diagnosed type 2 diabetes increased during the acute period of SARS-CoV-2 infection, the mean proportion of new diabetes cases in the 6 months post-infection was about 83% lower than the 6 months preinfection. These results underscore the need for further investigation to understand the timing of new diabetes after COVID-19, etiology, screening, and treatment strategies.

In 2018, the Tibet Autonomous Region began resettling pastoralists from high-altitude areas to newly built settlements in distant, lower-altitude farming locations under the “extremely high-altitude ecological resettlement” programme, with a stated dual purpose of environmental protection and improving pastoralist well-being. The programme is said to be based on a principle of “government guidance and voluntary participation.” However, despite its stated “voluntary” nature, the government reports a 100 per cent rate of agreement to participate. After examining the ecological rationales for resettlement and pastoralists’ reluctance to move owing to livelihood concerns and attachment to homeland, the article examines how consent is achieved. Based on official documents and reports as well as semi-structured interviews with officials and pastoralists in Nagchu Municipality, the core target area for the programme, the article identifies a three-step “thought-work” oriented process – beginning with an initial survey, followed by group incentives and warnings and then individual incentives and warnings – which is deployed until pastoralists sign a resettlement agreement. The process illustrates the dialectical relationship between coercion and consent.

Campaign-style environmental enforcement that involves the destruction of infrastructure has become increasingly common. Scholars have theorized such crackdowns as a form of bureaucratic control. These explanations are compelling, yet incomplete. This paper adopts an infrastructural lens to call attention to the fact of infrastructural demolition. I argue that the reduction of existing infrastructure to rubble is a way of clearing space for other kinds of infrastructure, specifically natural infrastructure, which has become central in the pursuit of ecological civilization. The creation of natural infrastructure requires calculative tools, which work to obscure the profoundly political nature of the natural infrastructure that they create through spatial zoning, ecological functional zoning and ecological conservation red lines (ECRLs). The article then scales down to two case studies of villages in post-earthquake Sichuan that are within ECRLs and designated for the function of providing ecosystem services. In both, infrastructure within scenic areas that was previously encouraged by the state and central to village livelihoods was suddenly destroyed following ecological civilization enforcement campaigns. The arrival of natural infrastructure marks a national-scale infrastructural time that promises a new future in which village-controlled scenic areas have no part, leading to a ruination of their imagined futures.

Background: Massive hemorrhage protocols (MHPs) streamline the complex logistics required for prompt care of the bleeding patient, but their uptake has been variable and few regions have a system to measure outcomes from these events. Aim Statement: We aim to implement a standardized MHP with uniform quality improvement (QI) metrics to increase uptake of evidence-based MHPs across 150-hospitals in Ontario between 2017 and 2021. Measures & Design: We performed ongoing PDSA cycles; 1) stakeholder analysis by surveying the Ontario Regional Blood Coordinating Network (ORBCoN), 2) problem characterization and Ishikawa analysis for key QI metrics based on areas of MHP variability in 150 Ontario hospitals using a web-based survey, 3) creation of a consensus MHP via a modified Delphi process, 4) problem characterization at ORBCoN for the design of a freely available toolkit for provincial implementation by expert working groups, 5) design of 8 key QI metrics by a modified Delphi process, and 6) identification of process measures for QI data collection by implementation metrics. Evaluation/Results: PDSA1-2; 150-hospitals were surveyed. 33% of hospitals lacked MHPs, mostly in smaller sites. Major areas for QI were related to activation criteria, hemostatic agents, protocolized hypothermia management, variable MHP naming, QI metrics and serial blood work requirements. PDSA3; 3 Delphi rounds were held to reach 100% expert consensus for 42 statements and 8 CQI metrics. Major areas for modification were protocol name, laboratory resuscitation targets, cooler configurations, and role of factor VIIa. PDSA4; adaptable toolkit is under development by the steering committee and expert working groups. Implementation is scheduled for Spring 2020. PDSA5; the 8 CQI metrics are: TXA administration < 1 h, RBC transfusion < 15 min, call to transfer for definitive care < 60 min, temp >35°C at end of protocol, Hgb kept between 60-110g/L, transition to group-specific RBC by 90 min, appropriate activation defined by ≥6 units RBC in the first 24 hours, and any blood component wastage. Discussion/Impact: MHP uptake, content, and tracking is variable. A standardized MHP that is adaptable to diverse settings decreases complexity, improves use of evidence-based practices, and provides a platform for continuous QI. PDSA6 will occur after implementation; we will complete an implementation survey, and design a pilot and feasibility study for prospective tracking of patient outcomes using existing prospectively collected inter-hospital and provincial databases.

Stability of a solitary wave disturbed by a submerged flat sill is investigated experimentally. For sills narrow compared with the solitary wave, the transmitted waves are found to be unaffected in waveform and amplitude. A wider sill disturbs the solitary wave resulting in the formation of a dispersive wavetrain following the transmitted wave. In some cases, the wave amplitude recovers, despite being perturbed, to the state of an unobstructed solitary-wave state at a certain distance beyond the sill. Wider sills cause wave breaking that occurs over the sill or, in some cases, after the wave passes through the sill. Details of waveform transformation leading toward the breaking and subsequent energy dissipation are discussed.

Growth in the immediate postnatal period for extremely low birth weight (ELBW, birth weight < 1000 g) infants is an important topic in neonatal medicine. The goal is to ensure adequate postnatal growth and to minimize complications resulting from suboptimal growth. Past efforts have focused on postnatal nutrition as well as on minimizing comorbidities. It has not been systematically assessed whether antenatal factors play a role in postnatal growth. In this report, we conducted a retrospective study on 91 maternal–neonatal pairs. We prospectively collected maternal and neonatal demographic data, neonatal nutrition in the first 7 days of life and after enteral nutrition is fully established, comorbidity data, as well as weight data from birth to 50 weeks corrected gestational age. We developed a linear mixed-effects model to examine the role of placental insufficiency, as defined by fetal Doppler studies, in postnatal weight z-score trajectory over time in the ELBW population. We relied on Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) for model selection. Interestingly, the selected model included a quadratic term of time and a placental insufficiency-by-time interaction term. In a covariate analysis, AIC and BIC both favored a model that included calories intake in the first 7 days of life and the total duration of antibiotics as fixed-effects, but not their interaction terms with time. Overall, we demonstrated for the first time that placental insufficiency, an antenatal factor, is a major determinant of postnatal weight trajectory in the ELBW population. Prospective studies are warranted to confirm our findings.

Introduction: With the increasing volume of medical literature published each year, it is difficult for clinicians to translate the latest research into practice. Awareness is the first step of knowledge translation and journals have begun using social media to increase the dissemination and awareness of their publications. Infographics can describe research findings visually, are shared broadly on social media, and may be a more effective way to convey information. We hypothesized that infographic abstracts would increase the social media dissemination and online readership of research articles relative to traditional abstracts. Methods: In this randomized controlled trial, 24 original research articles were chosen from the six issues of the Canadian Journal of Emergency Medicine (CJEM) published between July 2016 and May 2017 (4 articles per issue). Half were randomized to the infographic and control groups within each issue. Infographic articles were promoted using a visual infographic outlining the findings of the article. Control articles were promoted using a screen capture image of each articles abstract. Both were disseminated through the journals social media accounts (Twitter and Facebook) along with the link to the selected article. Infographics were also published on CanadiEM.org. Abstract views, full text views, and the change in Altmetric score were tracked for 30 days and compared between groups. Unpaired two-tailed t-tests were used to detect significant differences. Results: Abstract views (mean, SD) were significantly higher for infographic articles (378.9, 162.0) than control articles (175.5, 69.2, p<0.001). Mean Altmetric scores were significantly higher for infographic articles (26.4, 13.8) than control articles (3.4, 1.7, p<0.0001). There was no statistically significant difference in full-text views between infographic (49.7, 90.4) and control articles (25.3, 12.3). Conclusion: CJEM articles promoted on social media using infographics had higher abstract viewership and Altmetric scores than those promoted with traditional abstracts. Although there was no difference in full-text readership, our results suggest that infographic abstracts may have a role in increasing the dissemination of medical literature.

In rock engineering, evaluating the post-peak strength and deformation of rock is necessary. To explore the elasto-plastic behavior of sandstone in the post-peak stage, a series of strain-controlled triaxial tests were conducted under different confining pressures. According to the post-peak characteristics, a constitutive model based on nonlinear elasticity and generalized plasticity is proposed. This proposed model is characterized by the following features: (1) Nonlinear elasticity is observed under hydrostatic and shear loading; (2) the associated flow rule is followed; (3) substantial plastic deformation occurs during shear loading; and (4) post-peak softening behavior is accurately predicted. This model requires twelve material parameters, three for elasticity and nine for plasticity. The proposed model was validated by comparing the triaxial test results of Mushan sandstone at different hydrostatic pressures under dry and saturated conditions. In addition, the model is versatile; it can simulate the deformational behavior of two other sandstones. In summary, the proposed model can reasonably predict the complete stress–strain curve of sandstone.

In long-term care facilities (LTCFs), the elderly are apt to be infected because those with latent tuberculosis infections (LTBIs) are at an increased risk for reactivation and post-primary TB disease. We report an outbreak of TB in staff and residents in a LTCF. An outbreak investigation was conducted after two TB cases were reported from the LTCF. A tuberculin skin test (TST), bacteriological examination and chest radiograph were administered to all facility staff and residents. An outbreak is defined as at least two epidemiologically linked cases that have identical Mycobacterium tuberculosis genotype isolates. This outbreak infected eight residents and one staff member, who were confirmed to have TB in a LTCF between September 2011 and October 2012. Based on the Becker method, the latent and infectious periods were estimated at 223·6 and 55·9 days. Two initial TST-negative resident contacts were diagnosed as TB cases through comprehensive TB screening. Observing elderly people who have a negative TST after TB screening appears to be necessary, given the long latent period for controlling a TB outbreak in a LTCF. It is important to consider providing LTBI treatment for elderly contacts.