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The camber morphing of an aerofoil in ground effect was investigated using the FishBAC method and Detached Eddy Simulations with the k-omega SST turbulence model at a Reynolds number of 320,000. The aerofoil was periodically morphed at a start location of 25% chord from the leading edge with a trailing edge deflection range of 0.1% to 3% and morphing frequencies between a Strouhal number of 0.45 to 4 at a constant ground clearance of 10%. Periodically morphing the aerofoil using a sinusoidal function showed that lift and drag increased on the downstroke and decreased on the upstroke in the cycle, resulting in periodic values of lift and drag throughout the cycle. The amplitude of lift and drag increased as the morphing frequency and/or trailing edge deflection increased. It was found that the wake characteristics varied as a function of trailing edge deflection and morphing frequency. For small trailing edge deflections below 0.4% and frequencies below a 2.2 Strouhal number, Kelvin Helmholtz shedding was observed, and above this the wake became chaotic. Large trailing edge deflections showed Von-Karman shedding, where the interaction between the lower counter-clockwise vortex and the ground plane resulted in a jet-like flow that caused forward thrust. For the maximum deflection and morphing frequency tested in this study, reversed Von-Karman shedding was observed, which caused forward thrust from the interaction of the two-shedding counter-rotating vortices. Von-Karman or reversed Von-Karman shedding shows positive thrust generation, however, chaotic shedding should be avoided due to large drag gains. Varying the Reynolds number caused the Strouhal number to change as they depend on the same variables. It was found that the Strouhal number variation had a large effect on the wake, however, the Reynolds number had a minimal effect.
The acid-catalyzed reaction between methanol and isobutene to give methyl-t-butyl ether may be carried out using a cation-exchanged smectite as the catalyst. In 1,4-dioxan solvent at 60°C smectites exchanged with Al3+, Fe3+, or Cr3+ give yields of ∼60% after 4 hr, whereas smectites exchanged with Cu2+, Pb2+, Ni2+, Co2+, Ca2+, and Na+ give less than ∼8% yield. The reaction is efficient only when certain solvents are used, e.g., with Al3+-smectite the yield is ∼5% when using 1,2-dimethoxyethane, diethyleneglycol diethylether, n-pentane, tetrahydropyran, N-methylmorpholine, or tetrahydrofuran solvents compared with ∼60% using 1,4-dioxan solvent (4 hr). Moreover, the effective solvents depend somewhat on the clay interlayer cation. The use of tetrahydrofuran and tetrahydropyran gives ∼35% yields at 60°C (4 hr) with Fe3+- or Cr3+-smectites but ∼4% yield with Al3+-smectite.
The reaction of 2-methyl pent-2-ene with primary alcohols (C1-C18) at 95°C over an Al-montmorillonite gave yields of 20–90% of ethers of the type R-O-C(CH3)2C3H7. Lower yields were produced if secondary alcohols were employed, and tertiary alcohols gave only a trace of this ether. When a variety of alkenes was reacted with butan-1-ol at 95°C over a similar catalyst, no reaction occurred unless the alkene was capable of forming a tertiary carbonium ion immediately upon protonation. In this case the product was the tertiary ether t-R-O-nC4H9. However, at a reaction temperature of 150°C a variety of products were formed including (1) ether by the attack of butanol on the carbonium ions produced either directly from protonation of the alkenes or by hydride shift from such an ion, (2) alkenes by the attack of n-C4H9+ ions (derived from protonation and dehydration of butanol) on the alkene, (3) di-(but-1-yl) ether by dehydration of the butanol, and (4) small amounts of alcohol by hydration of the alkene. The differences in reactivity below and above 100°C are related directly to the amount of water present in the interlayer space of the clay and the degree of acidity found there. Although the clay behaves as an acid catalyst, the reactions are far cleaner (more selective) than comparable reactions catalyzed by sulfuric acid.
We investigated disparities in the clinical management of self-harm following hospital presentation with self-harm according to level of socio-economic deprivation (SED) in England.
Methods
108 092 presentations to hospitals (by 57 306 individuals) after self-harm in the Multicenter Study of Self-harm spanning 17 years. Area-level SED was based on the English Index of Multiple Deprivation. Information about indicators of clinical care was obtained from each hospital's self-harm monitoring systems. We assessed the associations of SED with indicators of care using mixed effect models.
Results
Controlling for confounders, psychosocial assessment and admission to a general medical ward were less likely for presentations by patients living in more deprived areas relative to presentations by patients from the least deprived areas. Referral for outpatient mental health care was less likely for presentations by patients from the two most deprived localities (most deprived: adjusted odd ratio [aOR] 0.77, 95% CI 0.71–0.83, p < 0.0001; 2nd most deprived: aOR 0.80, 95% CI 0.74–0.87, p < 0.0001). Referral to substance use services and ‘other’ services increased with increased SED. Overall, referral for aftercare was less likely following presentations by patients living in the two most deprived areas (most deprived: aOR 0.85, 95% CI 0.78–0.92, p < 0.0001; 2nd most deprived: aOR 0.86, 95% CI 0.79–0.94, p = 0.001).
Conclusions
SED is associated with differential care for patients who self-harm in England. Inequalities in care may exacerbate the risk of adverse outcomes in this disadvantaged population. Further work is needed to understand the reasons for these differences and ways of providing more equitable care.
The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.
Sesame is an oilseed crop and source of income for small-scale farmers, particularly in developing countries. In Benin, sesame production is poorly developed and the underlying reasons are still unknown. In this study, we investigated the sesame management practices, socio-demographic factors and ethnobotanical knowledge associated with sesame production, as well as the production constraints across four agroecological zones in Benin. In total, 370 farmers were surveyed based on a structured interview. Qualitative and quantitative data including socio-demographic parameters, management practices and knowledge associated with the crop, were recorded. A binary logistic regression was performed to explain the effects of socio-demographic parameters on management practices. The farm typology was generated through a principal component analysis followed by a cluster analysis. Cultivars were classified based on the seed coat colour and size. To assess the ethnobotanical knowledge related to sesame, use value, plant part used value and fidelity level were calculated. Our results showed that older farmers were more likely to practice intercropping than young farmers. In addition, male farmers applied more fertilisers and used more pesticide than female. Five distinct farm typologies were recorded in the four agroecological zones. Five different cultivars were recorded across the four agroecological zones. Sesame is mostly produced for local consumption as sauce and seed appetiser (mentioned by at least 73.23% of respondents). The seeds were the most used part of the crop. The lack of improved seeds, road impassability to the field, rarity of rain, non-availability of cultivable land for sesame production, lack of cash for farm operations were the main constraints to wide sesame production. We discussed the differences among farm typology and their productivity and proposed future research actions for expanding sesame production in Benin.
A conceptual model, based on field observations and assumed physics of a perennial firn aquifer near Helheim Glacier (southeast Greenland), is evaluated via steady-state 2-D simulation of liquid water flow and energy transport with phase change. The simulation approach allows natural representation of flow and energy advection and conduction that occur in vertical meltwater recharge through the unsaturated zone and in lateral flow within the saturated aquifer. Agreement between measured and simulated aquifer geometry, temperature, and recharge and discharge rates confirms that the conceptual field-data-based description of the aquifer is consistent with the primary physical processes of groundwater flow, energy transport and phase change. Factors that are found to control simulated aquifer configuration include surface temperature, meltwater recharge rate, residual total-water saturation and capillary fringe thickness. Simulation analyses indicate that the size of perennial firn aquifers depends primarily on recharge rates from surface snowmelt. Results also imply that the recent aquifer expansion, likely due to a warming climate, may eventually produce lakes on the ice-sheet surface that would affect the surface energy balance.
Among patients diagnosed with COVID-19, a substantial proportion are experiencing ongoing symptoms for months after infection, known as ‘long COVID’. Long COVID is associated with a wide range of physical and neuropsychological symptoms, including impacts on mental health, cognition, and psychological wellbeing. However, intervention research is only beginning to emerge. This systematic review synthesizes currently registered trials examining interventions for mental health, cognition, and psychological wellbeing in patients with long COVID.
Methods
Standard systematic review guidelines were followed. Trials registered in two large trial registries in 2020 to May 2022 were reviewed. Included studies were narratively synthesized by type of intervention and a risk-of-bias assessment was conducted.
Results
Forty-two registered trials were included, with a total target sample size of 5814 participants. These include 11 psychological interventions, five pharmacological and other medical interventions, and five evaluating herbal, nutritional, or natural supplement interventions. An additional nine trials are examining cognitive and neurorehabilitation interventions and 12 are examining physiotherapy or physical rehabilitation. Most trials are randomized, but many are feasibility trials; trials are evaluating a wide spectrum of outcomes.
Conclusions
While there is a newly emerging body of research testing interventions for mental health, cognition, and psychological wellbeing in long COVID, the breadth and scope of the research remains limited. It is urgently incumbent on researchers to expand upon the intervention research currently under way, in order to generate high-quality evidence on a wide range of candidate interventions for diverse long COVID patient populations.
As practitioners of a historical science, paleontologists and geoscientists are well versed in the idea that the ability to understand and to anticipate the future relies upon our collective knowledge of the past. Despite this understanding, the fundamental role that the history of paleontology and the geosciences plays in shaping the structure and culture of our disciplines is seldom recognized and therefore not acted upon sufficiently. Here, we present a brief review of the history of paleontology and geology in Western countries, with a particular focus on North America since the 1800s. Western paleontology and geology are intertwined with systematic practices of exclusion, oppression, and erasure that arose from their direct participation in the extraction of geological and biological resources at the expense of Black, Indigenous, and People of Color (BIPOC). Our collective failure to acknowledge this history hinders our ability to address these issues meaningfully and systemically in present-day educational, academic, and professional settings. By discussing these issues and suggesting some ways forward, we intend to promote a deeper reflection upon our collective history and a broader conversation surrounding racism, colonialism, and exclusion within our scientific communities. Ultimately, it is necessary to listen to members of the communities most impacted by these issues to create actionable steps forward while holding ourselves accountable for the past.
The burden of depression and anxiety is poorly documented in Central African populations.
Objectives
To present the epidemiology of depressive and anxiety disorders among older people in two Central African countries.
Methods
A cross-sectional population-based study was carried out in Republic of Congo (ROC) and Central African Republic (CAR) between 2011 - 2012 among people aged ≥ 65 years (EPIDEMCA study). Data were collected using a standardized questionnaire and participants underwent a brief physical examination. Depression and anxiety symptoms were ascertained using a community version of the Geriatric Mental State (GMS-B3). Probable cases were defined as having a GMS-AGECAT score ≥ 3. Logistic regression models were used to investigate the association between potential risk factors collected and presence of at least one of both symptoms.
Results
Overall 2002 participants were included in the EPIDEMCA study. Median age of the participants was 72 years [interquartile range: 68 – 78 years] and 61.8% were females. Prevalence was 38.1% (95% Confidence Interval: 35.9% - 40.2%) for depression, 7.7% (95% CI: 6.5% - 8.9%) for anxiety. In total 40.1% had least one of both symptoms. In multivariable models, the following factors were associated with the presence of at least one of both symptoms: female sex, residence area, frailty, cognitive disorders, a high happiness score (protective) and hypertension (adjusted Odds Ratios from 1.3 to 1.7; p<0.01).
Conclusions
In light of the high prevalence of both psychiatric symptoms among Central African older people, evidence on their epidemiology is important for better management and policy planning.
During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient’s lifetime.
Methods:
Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis.
Results:
The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (−$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care.
Conclusions:
Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient’s lifetime.
Air pollution is linked to mortality and morbidity. Since humans spend nearly all their time indoors, improving indoor air quality (IAQ) is a compelling approach to mitigate air pollutant exposure. To assess interventions, relying on clinical outcomes may require prolonged follow-up, which hinders feasibility. Thus, identifying biomarkers that respond to changes in IAQ may be useful to assess the effectiveness of interventions.
Methods:
We conducted a narrative review by searching several databases to identify studies published over the last decade that measured the response of blood, urine, and/or salivary biomarkers to variations (natural and intervention-induced) of changes in indoor air pollutant exposure.
Results:
Numerous studies reported on associations between IAQ exposures and biomarkers with heterogeneity across study designs and methods. This review summarizes the responses of 113 biomarkers described in 30 articles. The biomarkers which most frequently responded to variations in indoor air pollutant exposures were high sensitivity C-reactive protein (hsCRP), von Willebrand Factor (vWF), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and 1-hydroxypyrene (1-OHP).
Conclusions:
This review will guide the selection of biomarkers for translational studies evaluating the impact of indoor air pollutants on human health.
Introduction: For rhythm control of acute atrial flutter (AAFL) in the emergency department (ED), choices include initial drug therapy or initial electrical cardioversion (ECV). We compared the strategies of pharmacological cardioversion followed by ECV if necessary (Drug-Shock), and ECV alone (Shock Only). Methods: We conducted a randomized, blinded, placebo-controlled trial (1:1 allocation) comparing two rhythm control strategies at 11 academic EDs. We included stable adult patients with AAFL, where onset of symptoms was <48 hours. Patients underwent central web-based randomization stratified by site. The Drug-Shock group received an infusion of procainamide (15mg/kg over 30 minutes) followed 30 minutes later, if necessary, by ECV at 200 joules x 3 shocks. The Shock Only group received an infusion of saline followed, if necessary, by ECV x 3 shocks. The primary outcome was conversion to sinus rhythm for ≥30 minutes at any time following onset of infusion. Patients were followed for 14 days. The primary outcome was evaluated on an intention-to-treat basis. Statistical significance was assessed using chi-squared tests and multivariable logistic regression. Results: We randomized 76 patients, and none was lost to follow-up. The Drug-Shock (N = 33) and Shock Only (N = 43) groups were similar for all characteristics including mean age (66.3 vs 63.4 yrs), duration of AAFL (30.1 vs 24.5 hrs), previous AAFL (72.7% vs 69.8%), median CHADS2 score (1 vs 1), and mean initial heart rate (128.9 vs 126.0 bpm). The Drug-Shock and Shock only groups were similar for the primary outcome of conversion (100% vs 93%; absolute difference 7.0%, 95% CI -0.6;14.6; P = 0.25). The multivariable analyses confirmed the similarity of the two strategies (P = 0.19). In the Drug-Shock group 21.2% of patients converted with the infusion. There were no statistically significant differences for time to conversion (84.2 vs 97.6 minutes), total ED length of stay (9.4 vs 7.5 hours), disposition home (100% vs 95.3%), and stroke within 14 days (0 vs 0). Premature discontinuation of infusion (usually for transient hypotension) was more common in the Drug-Shock group (9.1% vs 0.0%) but there were no serious adverse events. Conclusion: Both the Drug-Shock and Shock Only strategies were highly effective and safe in allowing AAFL patients to go home in sinus rhythm. IV procainamide alone was effective in only one fifth of patients, much less than for acute AF.
Psychoanalytic psychotherapy was found superior to usual treatment among borderline patients and should be further investigated in subject samples with adequate adherence to effective treatment and careful evaluation of psychotherapy process and its relationship to outcome. According to this rationale we tested the comparative cost-effectiveness of an innovative model of time limited psychoanalytic psychotherapy aimed at working-out conflicting mourning process associated with traumatic abandonment from a romantic partner.
Methods:
Eighty patients aged 18-60, who had been referred to medical emergency room with self-intoxication, DSMIV-R major depression and DSMIV-R borderline personality disorder were investigated in a 3-month randomized clinical trial. At general hospital discharge consecutive subjects were allocated to time-limited mourning focused psychoanalytic psychotherapy and venlafaxine and psychodynamic crisis intervention and venlafaxine. Reliable evaluations were conducted at intake, treatment discharge and 6-month follow-up on a battery of standardized instruments. Service consume was assessed via the computerized case register of the Geneva state health services system.
Results:
Intensive psychoanalytic psychotherapy was found a cost-effective treatment choice among borderline patients in a suicidal crisis.
Comment:
A combination of ambulatory psychoanalytic psychotherapy and venlafaxine protocol is a feasible, safe and cost-effective treatment for acutely suicidal borderline patients.
Over the last few years, a new comprehensive program for acutely suicidal borderline patients has been developed in the Geneva area (careful description is provided in a distinct section of this workshop). The present work will report the results of a service research oriented study aimed at evaluating the impact of the implementation of such multidimensional intervention on a system of psychiatric services in a 500.000 inhabitant catchment area. Specifically, a pre-post design has been utilized to compare two distinct patient cohorts meeting criteria for borderline personality disorder who had bee referred to medical emergency room with suicidal attempt. Both cohorts had follow-up at 3-month and 1 year to assess treatment failure, repetition, hospitalization and direct costs. The results indicate that the program is feasible and may be associated with improved outcome and substantial costs savings among acutely suicidal borderline patients.
There is wide acknowledgement that apathy is an important behavioural syndrome in Alzheimer’s disease and in various neuropsychiatric disorders. In light of recent research and the renewed interest in the correlates and impacts of apathy, and in its treatments, it is important to develop criteria for apathy that will be widely accepted, have clear operational steps, and that will be easily applied in practice and research settings. Meeting these needs is the focus of the task force work reported here.
The task force includes members of the Association Française de Psychiatrie Biologique, the European Psychiatric Association, the European Alzheimer’s Disease Consortium and experts from Europe, Australia and North America. An advanced draft was discussed at the consensus meeting (during the EPA conference in April 7th 2008) and a final agreement reached concerning operational definitions and hierarchy of the criteria.
Apathy is defined as a disorder of motivation that persists over time and should meet the following requirements. Firstly, the core feature of apathy, diminished motivation, must be present for at least four weeks; secondly two of the three dimensions of apathy (reduced goal-directed behaviour, goal-directed cognitive activity, and emotions) must also be present; thirdly there should be identifiable functional impairments attributable to the apathy. Finally, exclusion criteria are specified to exclude symptoms and states that mimic apathy.
Consideration of ethical, legal, and social issues plus patient values (ELSI+) in health technology assessment (HTA) is challenging because of a lack of conceptual clarity and the multi-disciplinary nature of ELSI+. We used concept mapping to identify key concepts and inter-relationships in the ELSI+ domain and provide a conceptual framework for consideration of ELSI+ in HTA.
Methods
We conducted a scoping review (Medline and EMBASE, 2000–2016) to identify ELSI+ issues in the HTA literature. Items from the scoping review and an expert brainstorming session were consolidated into eighty ELSI+-related statements, which were entered into Concept Systems® Global MAX™ software. Participants (N = 38; 36 percent worked as researchers, 21 percent as academics; 42 percent self-identified as HTA experts) sorted the statements into thematic groups, and rated them on importance in making decisions about adopting technologies in Canada, from 1 (not at all important) to 5 (extremely important). We used Concept Systems® Global MAX™ software to create and analyze concept maps with four to sixteen clusters.
Results
Our final ELSI+ map consisted of five clusters, with each cluster representing a different concept and the statements within each cluster representing the same concept. Based on the concepts, we named these clusters: patient preferences/experiences, patient quality of life/function, patient burden/harm, fairness, and organizational. The highest mean importance ratings were for the statements in the patient burden/harm (3.82) and organizational (3.92) clusters.
Conclusions
This study suggests an alternative approach to ELSI+, based on conceptual coherence rather than academic disciplines. This will provide a foundation for incorporating ELSI+ into HTA.
The self-report of some autistic individuals that they experience social motivation should not be interpreted as a refutation of neuroimaging evidence supporting the social motivation hypothesis of autism. Neuroimaging evidence supports subtle differences in unconscious reward processing, which emerge at the group level and which may not be perceptible to individuals, but which may nonetheless impact an individual's behavior.