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.
Prior reports of healthcare-associated respiratory syncytial virus (RSV) have been limited to cases diagnosed after the third day of hospitalization. The omission of other healthcare settings where RSV transmission may occur underestimates the true incidence of healthcare-associated RSV.
Design:
Retrospective cross-sectional study.
Setting:
United States RSV Hospitalization Surveillance Network (RSV-NET) during 2016–2017 through 2018–2019 seasons.
Patients:
Laboratory-confirmed RSV-related hospitalizations in an eight-county catchment area in Tennessee.
Methods:
Surveillance data from RSV-NET were used to evaluate the population-level burden of healthcare-associated RSV. The incidence of healthcare-associated RSV was determined using the traditional definition (i.e., positive RSV test after hospital day 3) in addition to often under-recognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a non-RSV illness in the preceding 7 days.
Results:
Among the 900 laboratory-confirmed RSV-related hospitalizations, 41 (4.6%) had traditionally defined healthcare-associated RSV. Including patients with a positive RSV test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a non-RSV illness in the preceding 7 days identified an additional 95 cases (10.6% of all RSV-related hospitalizations).
Conclusions:
RSV is an often under-recognized healthcare-associated infection. Capturing other healthcare exposures that may serve as the initial site of viral transmission may provide more comprehensive estimates of the burden of healthcare-associated RSV and inform improved infection prevention strategies and vaccination efforts.
The Lyman alpha (Lyα) forest in the spectra of z > 5 quasars provides a powerful probe of the late stages of the Epoch of Reionization (EoR).With the recent advent of exquisite datasets such as XQR-30, many models have struggled to reproduce the observed large-scale fluctuations in the Lyα opacity. Here we introduce a Bayesian analysis framework that forward-models large-scale lightcones of intergalactic medium (IGM) properties, and accounts for unresolved sub-structure in the Lyα opacity by calibrating to higher-resolution hydrodynamic simulations. Our models directly connect physically-intuitive galaxy properties with the corresponding IGM evolution, without having to tune “effective” parameters or calibrate out the mean transmission. The forest data, in combination with UV luminosity functions and the CMB optical depth, are able to constrain global IGM properties at percent level precision in our fiducial model. Unlike many other works, we recover the forest observations without invoking a rapid drop in the ionizing emissivity from z ∼ 7 to 5.5, which we attribute to our sub-grid model for recombinations. In this fiducial model, reionization ends at z = 5.44 ± 0.02 and the EoR mid-point is at z = 7.7 ± 0.1. The ionizing escape fraction increases towards faint galaxies, showing a mild redshift evolution at fixed UV magnitude, MUV. Half of the ionizing photons are provided by galaxies fainter than MUV ∼ –12, well below direct detection limits of optical/NIR instruments including JWST. We also show results from an alternative galaxy model that does not allow for a redshift evolution in the ionizing escape fraction. Despite being decisively disfavored by the Bayesian evidence, the posterior of this model is in qualitative agreement with that from our fiducial model. We caution however that our conclusions regarding the early stages of the EoR and which sources reionized the Universe are more model-dependent.
We study Pareto optimality in a decentralized peer-to-peer risk-sharing market where agents’ preferences are represented by robust distortion risk measures that are not necessarily convex. We obtain a characterization of Pareto-optimal allocations of the aggregate risk in the market, and we show that the shape of the allocations depends primarily on each agent’s assessment of the tail of the aggregate risk. We quantify the latter via an index of probabilistic risk aversion, and we illustrate our results using concrete examples of popular families of distortion functions. As an application of our results, we revisit the market for flood risk insurance in the United States. We present the decentralized risk sharing arrangement as an alternative to the current centralized market structure, and we characterize the optimal allocations in a numerical study with historical flood data. We conclude with an in-depth discussion of the advantages and disadvantages of a decentralized insurance scheme in this setting.
Post-traumatic stress disorder (PTSD) is characterized by severe distress and associated with cardiometabolic diseases. Studies in military and clinical populations suggest that dysregulated metabolomic processes may be a key mechanism. Prior work identified and validated a metabolite-based distress score (MDS) linked with depression and anxiety and subsequent cardiometabolic diseases. Here, we assessed whether PTSD shares metabolic alterations with depression and anxiety and if additional metabolites are related to PTSD.
Methods
We leveraged plasma metabolomics data from three subsamples nested within the Nurses’ Health Study II, including 2835 women with 2950 blood samples collected across three time points (1996–2014) and 339 known metabolites assayed by mass spectrometry-based techniques. Trauma and PTSD exposures were assessed in 2008 and characterized as follows: lifetime trauma without PTSD, lifetime PTSD in remission, and persistent PTSD symptoms. Associations between the exposures and the MDS or individual metabolites were estimated within each subsample adjusting for potential confounders and combined in random-effects meta-analyses.
Results
Persistent PTSD symptoms were associated with higher levels of the previously developed MDS. Out of 339 metabolites, we identified 29 metabolites (primarily elevated glycerophospholipids and glycerolipids) associated with persistent symptoms (false discovery rate < 0.05; adjusting for technical covariates). No metabolite associations were found with the other PTSD-related exposures.
Conclusions
As the first large-scale, population-based metabolomics analysis of PTSD, our study highlighted shared and distinct metabolic differences linked to PTSD versus depression or anxiety. We identified novel metabolite markers associated with PTSD symptom persistence, suggesting further connections with metabolic dysregulation that may have downstream consequences for health.
Due to the safety threats caused by icing, the de-icing system is essential in the aviation industry. As an effective method, the electromechanical de-icing system (EDS) is a new ice-protection system based on mechanical vibration principles. For the majority of the current research on system de-icing capability estimation, the effect of impedance-matching is not considered. Impedance matching plays a very important role in improving the performance of the electromechanical system, so we must also consider the impact of impedance matching when designing the EDS. In the present study, a de-icing capability prediction method considering the impact of an impedance-matching device is established based on experimental and numerical methods. The results indicate that the impedance-matching effect has no impact on the mechanical vibration of the structure for the same load power. Meanwhile, impedance-matching devices can significantly improve the power factor and increase the interface shear stress/strain for de-icing. Eight different vibrational modes were tested, and the experimental results showed that the actual interface shear strain after impedance matching is inversely proportional to the de-icing time. The verification experiments were conducted and the accuracy of the proposed prediction method was verified.
Due to the environmental problems derived from the use of common surfactants as modifiers for clay mineral adsorbents to mitigate mycotoxin contamination of animal feeds, finding non-toxic modifiers to prepare safe and efficient adsorbents is necessary. The objective of the present study was, therefore, to modify acidified palygorskite with polyhexamethylene biguanide (PHMB) to obtain antibacterial polyhexamethylene biguanide/palygorskite (PHMB/Plg) composites for the removal of zearalenone, a common mycotoxin. The PHMB/Plg composites were characterized and analyzed by X-ray diffraction, Fourier-transform infrared spectroscopy, field-emission scanning electron microscopy, and isothermal nitrogen adsorption analysis. The adsorption properties of the composites with respect to zearalenone and their antibacterial activity with respect to Escherichia coli and Staphylococcus aureus were studied. The results indicated that the hydrophobicity of palygorskite was enhanced after modification with PHMB, which could effectively improve the adsorption property of palygorskite toward the nonpolar zearalenone molecules. The adsorption capacity of PHMB/Plg increased with increasing amounts of polyhexamethylene biguanide and increasing pH. The adsorption data were described well by pseudo-second order kinetics and by the Langmuir adsorption model. The maximum adsorption capacity was 2777 μg/g. When the amount of PHMB added increased to 15 wt.%, the composites obtained exhibited good antibacterial performance, and the minimum inhibitory concentrations for Escherichia coli and Staphylococcus aureus were both at 2.5 mg/mL.
We introduce a geometric analysis of turbulent mixing in density-stratified flows based on the alignment of the density gradient in two orthogonal bases that are locally constructed from the velocity gradient tensor. The first basis connects diapycnal mixing to rotation and shearing motions, building on the recent ‘rortex–shear decomposition’ in stratified shear layers (Jiang et al., J. Fluid Mech., vol. 947, 2022, A30), while the second basis connects mixing to the principal axes of the viscous dissipation tensor. Applying this framework to datasets taken in the stratified inclined duct laboratory experiment reveals that density gradients in locations of high shear tend to align preferentially (i) along the direction of minimum dissipation and (ii) normal to the plane spanned by the rortex and shear vectors. The analysis of the local alignment across increasingly turbulent flows offers new insights into the intricate relationship between the density gradient and dissipation, and thus diapycnal mixing.
The stratified inclined duct (SID) sustains an exchange flow in a long, gently sloping duct as a model for continuously forced density-stratified flows such as those found in estuaries. Experiments have shown that the emergence of interfacial waves and their transition to turbulence as the tilt angle is increased appears to be linked to a threshold in the exchange flow rate given by inviscid two-layer hydraulics. We uncover these hydraulic mechanisms by (i) using recent direct numerical simulations (DNS) providing full flow data in the key flow regimes (Zhu et al., J. Fluid Mech., vol. 969, 2023, A20), (ii) averaging these DNS into two layers, and (iii) using an inviscid two-layer shallow-water and instability theory to diagnose interfacial wave behaviour and provide physical insight. The laminar flow is subcritical and stable throughout the duct and hydraulically controlled at the ends of the duct. As the tilt is increased, the flow becomes supercritical everywhere and unstable to long waves. An internal jump featuring stationary waves first appears near the centre of the duct, then leads to larger-amplitude travelling waves, and to stronger jumps, wave breaking and intermittent turbulence at the largest tilt angle. Long waves described by the (nonlinear) shallow-water equation are interpreted locally as linear waves on a two-layer parallel base flow described by the Taylor–Goldstein equation. This link helps us to interpret long-wave instability and contrast it with short-wave (e.g. Kelvin–Helmholtz) instability. Our results suggest a transition to turbulence in SID through long-wave instability relying on vertical confinement by the top and bottom walls.
Exploring the neural basis related to different mood states is a critical issue for understanding the pathophysiology underlying mood switching in bipolar disorder (BD), but research has been scarce and inconsistent.
Methods
Resting-state functional magnetic resonance imaging data were acquired from 162 patients with BD: 33 (hypo)manic, 64 euthymic, and 65 depressive, and 80 healthy controls (HCs). The differences of large-scale brain network functional connectivity (FC) between the four groups were compared and correlated with clinical characteristics. To validate the generalizability of our findings, we recruited a small longitudinal independent sample of BD patients (n = 11). In addition, we examined topological nodal properties across four groups as exploratory analysis.
Results
A specific strengthened pattern of network FC, predominantly involving the default mode network (DMN), was observed in (hypo)manic patients when compared with HCs and bipolar patients in other mood states. Longitudinal observation revealed an increase in several network FCs in patients during (hypo)manic episode. Both samples evidenced an increase in the FC between the DMN and ventral attention network, and between the DMN and limbic network (LN) related to (hypo)mania. The altered network connections were correlated with mania severity and positive affect. Bipolar depressive patients exhibited decreased FC within the LN compared with HCs. The exploratory analysis also revealed an increase in degree in (hypo)manic patients.
Conclusions
Our findings identify a distributed pattern of large-scale network disturbances in the unique context of (hypo)mania and thus provide new evidence for our understanding of the neural mechanism of BD.
This paper documents the design and construction of MUSE, the world's first permanent magnet (PM) stellarator and the first quasi-axisymmetric experiment. The purpose of MUSE is to develop and assess a new way of building optimised stellarators that uses simple planar coils PMs. Our PM optimisation algorithm consists of initialising a geometry to pack dipoles densely, running the FAMUS code to minimise surface field error subject to PM constraints and applying discrete jumps to reach a physically realisable solution. FAMUS treats the PM system as a set of ideal point dipoles. From there we construct finite-volume magnet towers to be housed in 3D-printed PM holders. We describe the design of the PM holders, which were validated by laser metrology. We analyse the effects of finite permeability, sensitivity to perturbations and magnetostatic forces. An exact analytic formula for the magnetic field from a finite-volume PM tower is presented to compute PM–PM forces and stress on the PM holder. Stellarator construction is complete and experiments are underway.
The stratified inclined duct (SID) experiment consists of a zero-net-volume exchange flow in a long tilted rectangular duct, which allows the study of realistic stratified shear flows with sustained internal forcing. We present the first three-dimensional direct numerical simulations (DNS) of SID to explore the transitions between increasingly turbulent flow regimes first described by Meyer & Linden (J. Fluid Mech., vol. 753, 2014, pp. 242–253). We develop a numerical set-up that faithfully reproduces the experiments and sustains the flow for arbitrarily long times at minimal computational cost. We recover the four qualitative flow regimes found experimentally in the same regions of parameter space: laminar flow, waves, intermittent turbulence and fully developed turbulence. We find good qualitative and quantitative agreement between DNS and experiments and highlight the added value of DNS to complement experimental diagnostics and increase our understanding of the transition to turbulence, both temporally (laminar/turbulent cycles) and parametrically (as the tilt angle of the duct and the Reynolds number are increased). These results demonstrate that numerical studies of SID – and deeper integration between simulations and experiments – have the potential to lead to a better understanding of stratified turbulence.
There are many deviation sources in the assembly process of aircraft complex thin-walled structures. To get important factors that affect quality, it is crucial to diagnose the key deviation resources. The deviation transfer between deviation sources and assembly parts has the characteristics of small sample size, nonlinearity, and strong coupling, so it is difficult to diagnose the key deviation sources by constructing assembly dimension chains. Therefore, based on the deviation detection data, transfer entropy and complex network theory are introduced. Integrating the depth-first traversal algorithm with degree centrality theory, a key deviation diagnosis method for complex thin-walled structures is proposed based on weighted transfer entropy and complex networks. The application shows that key deviation sources that affect assembly quality can be accurately identified by the key deviation source diagnosis method based on complex networks and weighted transfer entropy.
The target backsheath field acceleration mechanism is one of the main mechanisms of laser-driven proton acceleration (LDPA) and strongly depends on the comprehensive performance of the ultrashort ultra-intense lasers used as the driving sources. The successful use of the SG-II Peta-watt (SG-II PW) laser facility for LDPA and its applications in radiographic diagnoses have been manifested by the good performance of the SG-II PW facility. Recently, the SG-II PW laser facility has undergone extensive maintenance and a comprehensive technical upgrade in terms of the seed source, laser contrast and terminal focus. LDPA experiments were performed using the maintained SG-II PW laser beam, and the highest cutoff energy of the proton beam was obviously increased. Accordingly, a double-film target structure was used, and the maximum cutoff energy of the proton beam was up to 70 MeV. These results demonstrate that the comprehensive performance of the SG-II PW laser facility was improved significantly.
To provide comprehensive population-level estimates of the burden of healthcare-associated influenza.
Design:
Retrospective cross-sectional study.
Setting:
US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2012–2013 through 2018–2019 influenza seasons.
Patients:
Laboratory-confirmed influenza-related hospitalizations in an 8-county catchment area in Tennessee.
Methods:
The incidence of healthcare-associated influenza was determined using the traditional definition (ie, positive influenza test after hospital day 3) in addition to often underrecognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a noninfluenza illness in the preceding 7 days.
Results:
Among the 5,904 laboratory-confirmed influenza-related hospitalizations, 147 (2.5%) had traditionally defined healthcare-associated influenza. When we included patients with a positive influenza test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a noninfluenza illness in the preceding 7 days, we identified an additional 1,031 cases (17.5% of all influenza-related hospitalizations).
Conclusions:
Including influenza cases associated with preadmission healthcare exposures with traditionally defined cases resulted in an 8-fold higher incidence of healthcare-associated influenza. These results emphasize the importance of capturing other healthcare exposures that may serve as the initial site of viral transmission to provide more comprehensive estimates of the burden of healthcare-associated influenza and to inform improved infection prevention strategies.
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.
As a typical plasma-based optical element that can sustain ultra-high light intensity, plasma density gratings driven by intense laser pulses have been extensively studied for wide applications. Here, we show that the plasma density grating driven by two intersecting driver laser pulses is not only nonuniform in space but also varies over time. Consequently, the probe laser pulse that passes through such a dynamic plasma density grating will be depolarized, that is, its polarization becomes spatially and temporally variable. More importantly, the laser depolarization may spontaneously take place for crossed laser beams if their polarization angles are arranged properly. The laser depolarization by a dynamic plasma density grating may find application in mitigating parametric instabilities in laser-driven inertial confinement fusion.
In the present study, we investigated the influence of different mid-stage N compensation timings on agronomic and physiological traits associated with grain yield and quality in field experiments. Two japonica rice cultivars with a good tasting quality (Nangeng 9108 and Nangeng 5055) were examined under eight N compensation timings (N1–N6: one-time N compensation at 7-2 weeks before heading; N7: split N compensation at 5 and 3 weeks before heading; N8: split N compensation at 4 and 2 weeks before heading) and a control with no N compensation. The highest yield was obtained with N7, followed by N3. The yield advantage is mainly attributable to the improved population structure (higher productive tiller rate with a stable number of effective panicles), higher total number of spikelets per unit area (large panicles with more grains per panicle), larger leaf area index in the late period and higher photosynthetic production capacity (more dry matter accumulation and transportation in the middle and late periods). Delaying N compensation timing improved the processing and nutritional quality of rice, but decreased the quality of appearance and cooking/eating traits. Our results suggest that, from the perspective of achieving relative coordination between high yield and high quality of japonica rice, the optimal N compensation should be divided equally at 5 and 3 weeks before heading. However, if simplifying the number of operations and the pursuit of eating quality were considered, one-time N compensation should be conducted at 5 weeks before heading.
Biomarkers may be useful endophenotypes for genetic studies if they share genetic sources of variation with the outcome, for example, with all-cause mortality. Australian adult study participants who had reported their parental survival information were included in the study: 14,169 participants had polygenic risk scores (PRS) from genotyping and up to 13,365 had biomarker results. We assessed associations between participants’ biomarker results and parental survival, and between biomarker results and eight parental survival PRS at varying p-value cut-offs. Survival in parents was associated with participants’ serum bilirubin, C-reactive protein, HDL cholesterol, triglycerides and uric acid, and with LDL cholesterol for participants’ fathers but not for their mothers. PRS for all-cause mortality were associated with liver function tests (alkaline phosphatase, butyrylcholinesterase, gamma-glutamyl transferase), metabolic tests (LDL and HDL cholesterol, triglycerides, uric acid), and acute-phase reactants (C-reactive protein, globulins). Association between offspring biomarker results and parental survival demonstrates the existence of familial effects common to both, while associations between biomarker results and PRS for mortality favor at least a partial genetic cause of this covariation. Identification of genetic loci affecting mortality-associated biomarkers offers a route to the identification of additional loci affecting mortality.