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Background: Neck vessel imaging is often performed in hyperacute stroke to allow neurointerventionalists to estimate access complexity. This study aimed to assess clinician agreement on catheterization strategies based on imaging in these scenarios. Methods: An electronic portfolio of 60 patients with acute ischemic stroke was sent to 53 clinicians. Respondents were asked: (1) the difficulty of catheterization through femoral access with a regular Vertebral catheter, (2) whether to use a Simmons or reverse-curve catheter initially, and (3) whether to consider an alternative access site. Agreement was assessed using Fleiss’ Kappa statistics. Results: Twenty-two respondents (7 neurologists, 15 neuroradiologists) completed the survey. Overall there was slight interrater agreement (κ=0.17, 95% CI: 0.10–0.25). Clinicians with >50 cases annually had better agreement (κ=0.22) for all questions than those with fewer cases (κ=0.07). Agreement did not significantly differ by imaging modality: CTA (κ=0.18) and MRA (κ=0.14). In 40/59 cases (67.80%), at least 25% of clinicians disagreed on whether to use a Simmons or reverse-curve catheter initially. Conclusions: Agreement on catheterization strategies remains fair at best. Our results suggest that visual assessment of pre-procedural vessels imaging is not reliable for the estimation of endovascular access complexity.
Turbulent flow widely exists in the aerospace field, and it is still challenging to realise the accurate prediction in the numerical simulation. To realise the high-fidelity numerical simulation of compressible turbulent flow, a high-order accurate self-adaptive turbulence eddy simulation (SATES) method is developed on the PHengLEI-HyOrder open-source solver, combining with the high-order accurate weighted compact nonlinear schemes (WCNS). The compressible flow in the subsonic and transonic is numerically simulated, including some typical cases, such as subsonic flow past a circular cylinder and flow past a square cylinder, high-lift configuration DLR-F11, transonic flow around a circular cylinder. The results predicted by the current high-order accurate SATES are in good agreement with the available experimental and numerical data. The present numerical method can also accurately capture the interactions between shock waves and turbulence while accurately simulating flow separation, shear layer instability and large-scale vortex shedding. The results obtained show that the current high-order accurate SATES simulations based on PHengLEI-HyOrder solver can accurately simulate complex turbulent flows with high reliability.
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.
Aromatic B-series were introduced as an extension of standard Butcher-series for the study of volume-preserving integrators. It was proven with their help that the only volume-preserving B-series method is the exact flow of the differential equation. The question was raised whether there exists a volume-preserving integrator that can be expanded as an aromatic B-series. In this work, we introduce a new algebraic tool, called the aromatic bicomplex, similar to the variational bicomplex in variational calculus. We prove the exactness of this bicomplex and use it to describe explicitly the key object in the study of volume-preserving integrators: the aromatic forms of vanishing divergence. The analysis provides us with a handful of new tools to study aromatic B-series, gives insights on the process of integration by parts of trees, and allows to describe explicitly the aromatic B-series of a volume-preserving integrator. In particular, we conclude that an aromatic Runge–Kutta method cannot preserve volume.
In this paper, a super-twisting disturbance observer (STDO)-based adaptive reinforcement learning control scheme is proposed for the straight air compound missile system with aerodynamic uncertainties and unmodeled dynamics. Firstly, neural network (NN)-based adaptive reinforcement learning control scheme with actor-critic design is investigated to deal with the tracking problems for the straight gas compound system. The actor NN and the critic NN are utilised to cope with the unmodeled dynamics and approximate the cost function that are related to control input and tracking error, respectively. In other words, the actor NN is used to perform the tracking control behaviours, and the critic NN aims to evaluate the tracking performance and give feedback to actor NN. Moreover, with the aid of the STDO disturbance observer, the problem of the control signal fluctuation caused by the mismatched disturbance can be solved well. Based on the proposed adaptive law and the Lyapunov direct method, the eventually consistent boundedness of the straight gas compound system is proved. Finally, numerical simulations are carried out to demonstrate the feasibility and superiority of the proposed reinforcement learning-based STDO control algorithm.
Aneurysmal bone cysts are expansile benign lesions associated with compressive destruction and obscure pathogenesis. The most common sites of temporal bone involvement are the petrous apex, squamous portions and mastoid.
Case report
This paper reports a right temporal aneurysmal bone cyst in a 51-year-old man who presented clinically with facial palsy, and hearing loss and impaired vestibular function. Magnetic resonance imaging and computed tomography findings were consistent with a diagnosis of aneurysmal bone cyst. Inter-operative findings showed that the lesion had caused compressive damage to the internal auditory canal. Following surgical excision, the patient experienced vertigo, indicating recovery of vestibular function. Follow-up imaging revealed complete resection without clinical recurrence.
Conclusion
To our knowledge, this is the first report of aneurysmal bone cyst invasion of the inner auditory canal. Our clinical experience indicates that vestibular nerve damage recovery is relatively uncommon. This case report will hopefully inform future studies.
To summarise and describe the clinical presentations, diagnostic approaches and airway management techniques in children with laryngotracheal trauma.
Methods
The clinical data related to laryngotracheal trauma diagnosed and treated at the Beijing Children's Hospital, between January 2013 and July 2018, were retrospectively reviewed. Disease diagnosis, treatment, management and outcomes were analysed.
Results
A total of 13 cases were enrolled, including 7 cases of penetrating laryngotracheal trauma. The six cases of blunt laryngotracheal trauma were caused by collisions with hard objects. In all cases, voice, airway and swallowing outcomes were graded as ‘good’, except for one patient who had residual paralysis of the vocal folds.
Conclusion
Flexible fibre-optic laryngoscopy and computed tomography can play an important role in diagnosing laryngotracheal trauma. The airway should be secured and, if necessary, opened by tracheal intubation or tracheostomy.
Ice breaking has become one of the main problems faced by ships and other equipment operating in an ice-covered water region. New methods are always being pursued and studied to improve ice-breaking capabilities and efficiencies. Based on the strong damage capability, a high-speed water jet impact is proposed to be used to break an ice plate in contact with water. A series of experiments of water jet impacting ice were performed in a transparent water tank, where the water jets at tens of metres per second were generated by a home-made device and circular ice plates of various thicknesses and scales were produced in a cold room. The entire evolution of the water jet and ice was recorded by two high-speed cameras from the top and front views simultaneously. The focus was the responses of the ice plate, such as crack development and breakup, under the high-speed water jet loads, which involved compressible pressure ${P_1}$ and incompressible pressure ${P_2}$. According to the main cause and crack development sequence, it was found that the damage of the ice could be roughly divided into five patterns. On this basis, the effects of water jet strength, ice thickness, ice plate size and boundary conditions were also investigated. Experiments validated the ice-breaking capability of the high-speed water jet, which could be a new auxiliary ice-breaking method in the future.
In order to intercept a highly manoeuvering target with an ideal impact angle in the three-dimensional space, this paper promises to probe into the problem of three-dimensional terminal guidance. With the goal of the highly target acceleration and short terminal guidance time, a guidance law, based on the advanced fast non-singular terminal sliding mode theory, is designed to quickly converge the line-of-sight (LOS) angle and the LOS angular rate within a finite time. In the design process, the target acceleration is regarded as an unknown boundary external disturbance of the guidance system, and the RBF neural network is used to estimate it. In order to improve the estimation accuracy of RBF neural network and accelerate its convergence, the parameters of RBF neural network are adjusted online in real time. At the same time, an adaptive law is designed to compensate the estimation error of the RBF neural network, which improves the convergence speed of the guidance system. Theoretical analysis demonstrates that the state and the sliding manifold of the guidance system converge in finite time. According to Lyapunov theory, the stability of the system can be guaranteed by online adjusting the parameters of RBF neural network and adaptive parameters. The numerical simulation results verify the effectiveness and superiority of the proposed guidance law.
To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution.
Design:
Retrospective cohort study.
Setting:
Two affiliated academic medical centers in Los Angeles, California.
Patients:
Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards.
Methods:
We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation.
Results:
Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91–4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28–3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34–0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22–0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria.
Conclusions:
Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.
Multidrug-resistant organisms (MDROs) colonizing the healthcare environment have been shown to contribute to risk for healthcare-associated infections (HAIs), with adverse effects on patient morbidity and mortality. We sought to determine how bacterial contamination and persistent MDRO colonization of the healthcare environment are related to the position of patients and wastewater sites.
Methods:
We performed a prospective cohort study, enrolling 51 hospital rooms at the time of admitting a patient with an eligible MDRO in the prior 30 days. We performed systematic sampling and MDRO culture of rooms, as well as 16S rRNA sequencing to define the environmental microbiome in a subset of samples.
Results:
The probability of detecting resistant gram-negative organisms, including Enterobacterales, Acinetobacter spp, and Pseudomonas spp, increased with distance from the patient. In contrast, Clostridioides difficile and methicillin-resistant Staphylococcus aureus were more likely to be detected close to the patient. Resistant Pseudomonas spp and S. aureus were enriched in these hot spots despite broad deposition of 16S rRNA gene sequences assigned to the same genera, suggesting modifiable factors that permit the persistence of these MDROs.
Conclusions:
MDRO hot spots can be defined by distance from the patient and from wastewater reservoirs. Evaluating how MDROs are enriched relative to bacterial DNA deposition helps to identify healthcare micro-environments and suggests how targeted environmental cleaning or design approaches could prevent MDRO persistence and reduce infection risk.
We investigate the European call option pricing problem under the fractional stochastic volatility model. The stochastic volatility model is driven by both fractional Brownian motion and standard Brownian motion. We obtain an analytical solution of the European option price via the Itô’s formula for fractional Brownian motion, Malliavin calculus, derivative replication and the fundamental solution method. Some numerical simulations are given to illustrate the impact of parameters on option prices, and the results of comparison with other models are presented.
Coated copper sulphate (CCS) could be used as a Cu supplement in cows. To investigate the influences of copper sulphate (CS) and CCS on milk performance, nutrient digestion and rumen fermentation, fifty Holstein dairy cows were arranged in a randomised block design to five groups: control, CS addition (7·5 mg Cu/kg DM from CS) or CCS addition (5, 7·5 and 10 mg Cu/kg DM from CCS, respectively). When comparing Cu source at equal inclusion rates (7·5 mg/kg DM), cows receiving CCS addition had higher yields of fat-corrected milk, milk fat and protein; digestibility of DM, organic matter (OM) and neutral-detergent fibre (NDF); ruminal total volatile fatty acid (VFA) concentration; activities of carboxymethyl cellulase, cellobiase, pectinase and α-amylase; populations of Ruminococcus albus, Ruminococcus flavefaciens and Fibrobacter succinogenes; and liver Cu content than cows receiving CS addition. Increasing CCS addition, DM intake was unchanged, yields of milk, milk fat and protein; feed efficiency; digestibility of DM, OM, NDF and acid-detergent fibre; ruminal total VFA concentration; acetate:propionate ratio; activity of cellulolytic enzyme; populations of total bacteria, protozoa and dominant cellulolytic bacteria; and concentrations of Cu in serum and liver increased linearly, but ruminal propionate percentage, ammonia-N concentration, α-amylase activity and populations of Prevotella ruminicola and Ruminobacter amylophilus decreased linearly. The results indicated that supplement of CS could be substituted with CCS and addition of CCS improved milk performance and nutrient digestion in dairy cows.
We present the elements required to construct two devices used in an undergraduate plasma physics laboratory. The materials and construction costs of the sources, the vacuum systems and probe drives and electrical circuits are presented in detail in the text and the first appendix. We also provide the software for probe motion and data acquisition as well as the electrical schematics for key components. Experiments which have been performed are listed and two (resonance cones and whistler waves) are described in greater detail. The machines are flexible and original research is possible.
Metal additive manufacturing (AM) provides a platform for microstructure optimization via process control, but establishing a quantitative processing-microstructure linkage necessitates an efficient scheme for microstructure representation and regeneration. Here, we present a deep learning framework to quantitatively analyze the microstructural variations of metals fabricated by AM under different processing conditions. The principal microstructural descriptors are extracted directly from the electron backscatter diffraction patterns, enabling a quantitative measure of the microstructure differences in a reduced representation domain. We also demonstrate the capability of predicting new microstructures within the representation domain using a regeneration neural network, from which we are able to explore the physical insights into the implicitly expressed microstructure descriptors by mapping the regenerated microstructures as a function of principal component values. We validate the effectiveness of the framework using samples fabricated by a solid-state AM technology, additive friction stir deposition, which typically results in equiaxed microstructures.
Tuberculosis (TB) is generally considered a disease that principally afflicts the low-income segments of a population. In the Nanshan District of Shenzhen, China, with the economic transformation and a new Headquarters Economy (HE) emerging, there are now more cases in office workers than in manufacturing workers. To illustrate this trend, we describe a small TB outbreak in an office building located in the centre of the rapidly growing HE district. Two active pulmonary tuberculosis cases were found in workers who shared an office, and whole genome sequencing showed that the genetic distance between the strains of the two cases was just one single nucleotide polymorphism, consistent with intra-office transmission. Investigation of 30 other workers in the same or adjacent offices with interviews, interferon-gamma release assays (IGRAs) and chest X-rays, identified one new TB case and latent tuberculosis infection (LTBI) in 40.0% (12/30) of the contacts. The offices were under-ventilated. None of the IGRA positive, asymptomatic contacts agreed to receive treatment for LTBI, presumably due to TB stigma, and over the next 2 years 69.0% (20/29) of the contacts were lost to follow-up. Treatment for LTBI and stigma of TB remain challenges here. Office workers in the HE of rapidly economic developing areas should be targeted with increased vigilance by TB control programmes.
By considering a modified version of the evolutionary population synthesis (EPS) model for stellar populations (SPs) comprising binary stars, the retrieved galaxy and HII-region parameters/properties differ from the case of neglecting binary stars. The retrieved age, stellar metallicity and mass of galaxies increase (e.g. ∼ 0.2 dex when using spectral fitting algorithm), whilst the star formation rate decreases (∼0.2 dex). The radiation fields from intermediate-age SPs with binary stars could be potentially important ionizing sources in HII regions. Under this possibility, the theoretical division between star forming galaxy and AGN on the diagnostic diagrams would move towards the up-right corner and the retrieved gaseous metallicity would decrease.
Our prediction for the birth rate of binary neutron stars in SPs ranges from 10−9 to 10−6${\M {^\minus 1_\odot}} $ yr−1 when the kick velocity is from 0 to 190 km s−1.
The effect of hot streaks from a gas turbine combustor on the thermodynamic load of internally air-cooled nozzle guide vanes (NGVs) and shrouds has been numerically investigated under flight conditions. The study follows two steps: one for the high-fidelity 60° combustor sector with simplified ten NGVs and three thermocouples attached; and the other for the NGV sectors where each sector consists of one high-fidelity NGV (probe NGV) and nine dummy NGVs. The first step identifies which NGV has the highest thermal load and provides the inlet flow boundary conditions for the second step. In the second step, the flow fields and thermal loads of the probe NGVs are resolved in detail.
With the systematically validated physical models, the two-phase flowfield of the combustor-NGVs sector has been successfully simulated. The predicted mean and maximum temperature at the combustor sector exit are in excellent agreement with the experimental data, which provides a solid basis for the hot-streak effect investigation. The results indicate that the second NGV, looking upstream from left, has the highest thermal load. Its maximum surface temperature is 8.4% higher than that for the same NGV but with the mean inlet boundary conditions, and 14.1% higher than the ninth NGV. The finding is consistent with the field-observed NGV damage pattern. To extend the service life of these vulnerable NGVs, some protection methods should be considered.
Childhood maltreatment (CM) plays an important role in the development of major depressive disorder (MDD). The aim of this study was to examine whether CM severity and type are associated with MDD-related brain alterations, and how they interact with sex and age.
Methods
Within the ENIGMA-MDD network, severity and subtypes of CM using the Childhood Trauma Questionnaire were assessed and structural magnetic resonance imaging data from patients with MDD and healthy controls were analyzed in a mega-analysis comprising a total of 3872 participants aged between 13 and 89 years. Cortical thickness and surface area were extracted at each site using FreeSurfer.
Results
CM severity was associated with reduced cortical thickness in the banks of the superior temporal sulcus and supramarginal gyrus as well as with reduced surface area of the middle temporal lobe. Participants reporting both childhood neglect and abuse had a lower cortical thickness in the inferior parietal lobe, middle temporal lobe, and precuneus compared to participants not exposed to CM. In males only, regardless of diagnosis, CM severity was associated with higher cortical thickness of the rostral anterior cingulate cortex. Finally, a significant interaction between CM and age in predicting thickness was seen across several prefrontal, temporal, and temporo-parietal regions.
Conclusions
Severity and type of CM may impact cortical thickness and surface area. Importantly, CM may influence age-dependent brain maturation, particularly in regions related to the default mode network, perception, and theory of mind.