Hand, foot and mouth disease (HFMD) is a contagious communicable disease, with a high incidence in children aged under 10 years. It is a mainly self-limiting disease but can also cause serious neurological or cardiopulmonary complications in some cases, which can lead to death. Little is known about the burden of HMFD on primary care health care services in the UK. The aim of this work was to describe trends in general practitioner (GP) consultations for HFMD in England from January 2017 to December 2022 using a syndromic surveillance network of GPs. Daily GP consultations for HFMD in England were extracted from 1 January 2017 to 31 December 2022. Mean weekly consultation rates per 100,000 population and 95% confidence intervals (CI) were calculated. Consultation rates and rate ratios (RR) were calculated by age group and sex. During the study period, the mean weekly consultation rate for HFMD (per 100,000 registered GP patients) was 1.53 (range of 0.27 to 2.47). In England, children aged 1–4 years old accounted for the largest affected population followed by children <1 years old. We observed a seasonal pattern of HFMD incidence during the non-COVID years, with a seasonal peak of mean weekly rates between months of September and December. HFMD is typically diagnosed clinically rather than through laboratory sampling. Therefore, the ability to look at the daily HFMD consultation rates provides an excellent epidemiological overview on disease trends. The use of a novel GP-in-hours surveillance system allowed a unique epidemiological insight into the recent trends of general practitioner consultations for HFMD. We demonstrate a male predominance of cases, the impact of the non-pharmaceutical interventions during the COVID-19 pandemic, and a change in the week in which the peak number of cases happens post-pandemic.

We investigate nonlinear energy transfer for channel flows at friction Reynolds numbers $Re_{\tau }=180$ and $590$. The key feature of the analysis is that we quantify the energy transferred from a source mode to a recipient mode, with each mode characterised by a streamwise wavenumber and a spanwise wavenumber. This is achieved through an explicit examination of the triadic interactions of the nonlinear energy transfer term in the spectral turbulent kinetic energy equation. First, we quantify the nonlinear energy transfer gain and loss for individual Fourier modes. The gain and loss cannot be obtained without expanding the nonlinear triadic interactions. Second, we quantify the nonlinear energy transfer budgets for three types of modes. Each type of mode is characterised by a specific region in streamwise–spanwise wavenumber space. We find that a transverse cascade from streamwise-elongated modes to spanwise-elongated modes exists for all three types of modes. Third, we quantify the forward and inverse cascades between resolved scales and subgrid scales in the spirit of large-eddy simulations. For the cutoff wavelength range that we consider, the forward and inverse cascades between the resolved scales and subgrid scales result in a net forward cascade from the resolved scales to the subgrid scales. The shape of the net forward cascade curve with respect to the cutoff wavelength resembles the net forward cascade predicted by the Smagorinsky eddy viscosity.

The p-median offers an alternative to centroid-based clustering algorithms for identifying unobserved categories. However, existing p-median formulations typically require data aggregation into a single proximity matrix, resulting in masked respondent heterogeneity. A proposed three-way formulation of the p-median problem explicitly considers heterogeneity by identifying groups of individual respondents that perceive similar category structures. Three proposed heuristics for the heterogeneous p-median (HPM) are developed and then illustrated in a consumer psychology context using a sample of undergraduate students who performed a sorting task of major U.S. retailers, as well as a through Monte Carlo analysis.

Where and under what conditions the transfer of energy between electromagnetic fields and particles takes place in the solar wind remains an open question. We investigate the conditions that promote the growth of kinetic instabilities predicted by linear theory to infer how turbulence and temperature-anisotropy-driven instabilities are interrelated. Using a large dataset from Solar Orbiter, we introduce the radial rate of strain, a novel measure computed from single-spacecraft data, which we interpret as a proxy for the double-adiabatic strain rate. The solar wind exhibits high absolute values of the radial rate of strain at locations with large temperature anisotropy. We measure the kurtosis and skewness of the radial rate of strain from the statistical moments to show that it is non-Gaussian for unstable intervals and increasingly intermittent at smaller scales with a power-law scaling. We conclude that the velocity field fluctuations in the solar wind contribute to the presence of temperature anisotropy sufficient to create potentially unstable conditions.

Previous studies suggest that influenza virus infection may provide temporary non-specific immunity and hence lower the risk of non-influenza respiratory virus infection. In a randomized controlled trial of influenza vaccination, 1 330 children were followed-up in 2009–2011. Respiratory swabs were collected when they reported acute respiratory illness and tested against influenza and other respiratory viruses. We used Poisson regression to compare the incidence of non-influenza respiratory virus infection before and after influenza virus infection. Based on 52 children with influenza B virus infection, the incidence rate ratio (IRR) of non-influenza respiratory virus infection after influenza virus infection was 0.47 (95% confidence interval: 0.27–0.82) compared with before infection. Simulation suggested that this IRR was 0.87 if the temporary protection did not exist. We identified a decreased risk of non-influenza respiratory virus infection after influenza B virus infection in children. Further investigation is needed to determine if this decreased risk could be attributed to temporary non-specific immunity acquired from influenza virus infection.

We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.

With the aim of producing a 3D representation of tumors, imaging and molecular annotation of xenografts and tumors (IMAXT) uses a large variety of modalities in order to acquire tumor samples and produce a map of every cell in the tumor and its host environment. With the large volume and variety of data produced in the project, we developed automatic data workflows and analysis pipelines. We introduce a research methodology where scientists connect to a cloud environment to perform analysis close to where data are located, instead of bringing data to their local computers. Here, we present the data and analysis infrastructure, discuss the unique computational challenges and describe the analysis chains developed and deployed to generate molecularly annotated tumor models. Registration is achieved by use of a novel technique involving spherical fiducial marks that are visible in all imaging modalities used within IMAXT. The automatic pipelines are highly optimized and allow to obtain processed datasets several times quicker than current solutions narrowing the gap between data acquisition and scientific exploitation.

Recent fossil discoveries from New Zealand have revealed a remarkably diverse assemblage of Paleocene stem group penguins. Here, we add to this growing record by describing nine new penguin specimens from the late Paleocene (upper Teurian local stage; 55.5–59.5 Ma) Moeraki Formation of the South Island, New Zealand. The largest specimen is assigned to a new species, Kumimanu fordycei n. sp., which may have been the largest penguin ever to have lived. Allometric regressions based on humerus length and humerus proximal width of extant penguins yield mean estimates of a live body mass in the range of 148.0 kg (95% CI: 132.5 kg–165.3 kg) and 159.7 kg (95% CI: 142.6 kg–178.8 kg), respectively, for Kumimanu fordycei. A second new species, Petradyptes stonehousei n. gen. n. sp., is represented by five specimens and was slightly larger than the extant emperor penguin Aptenodytes forsteri. Two small humeri represent an additional smaller unnamed penguin species. Parsimony and Bayesian phylogenetic analyses recover Kumimanu and Petradyptes crownward of the early Paleocene mainland NZ taxa Waimanu and Muriwaimanu, but stemward of the Chatham Island taxon Kupoupou. These analyses differ, however, in the placement of these two taxa relative to Sequiwaimanu, Crossvallia, and Kaiika. The massive size and placement of Kumimanu fordycei close to the root of the penguin tree provide additional support for a scenario in which penguins reached the upper limit of sphenisciform body size very early in their evolutionary history, while still retaining numerous plesiomorphic features of the flipper.

UUID: https://zoobank.org/15b1d5b2-a5a0-4aa5-ba0a-8ef3b8461730

Unsustainable hunting, both illegal and legal, has led to the extirpation of many species. In the last 35 years giraffe Giraffa spp. populations have declined precipitously, with extinctions documented in seven African countries. Amongst the various reasons for these population declines, poaching is believed to play an important role in some areas. Giraffes are primarily hunted for consumption and for the use of their body parts as trophies and in traditional medicine. However, the socio-economic factors that correlate with the use of giraffe body parts are not well understood. We conducted our study in Tsavo Conservation Area, Kenya, which experiences high levels of poaching. We used semi-structured surveys amongst 331 households to document how giraffe body parts are typically acquired and their intended use (i.e. trophy, medicinal or consumptive). We then used logistic regression models to assess the correlations between nine socio-economic factors and the use of giraffe body parts. We found that giraffe body parts had mostly consumptive and trophy uses. One-time suppliers, opportunistic access and widely known markets were the most common means of acquiring giraffe body parts. Results from our models showed that three variables (gender: men, occupation: tourism worker, and land ownership) were correlated significantly and positively with the use of giraffe body parts. We describe the complex links between socio-economic factors and the use of giraffe body parts and highlight the importance of implementing mitigation measures adapted to local contexts to combat a challenge that many species of conservation concern are facing.

Viscoelastic flow instability, which is compelled by elastic effects rather than inertia, can be driven to a chaotic state termed elastic turbulence (ET) manifested as strong velocity fluctuations with an algebraic decay in the frequency spectrum and increased mixing. We report the first spatiotemporally complete description of ET by considering a broad volume within a novel three-dimensional ordered porous medium, reconstructing flow at a micrometre characteristic length scale ($\text {Reynolds numbers} \ll 1$) via time-resolved microtomographic particle image velocimetry. Beyond a critical Weissenberg number of 2, we observe an elastic flow instability accompanied by an enhanced pressure drop with spectral characteristics typical of ET. Polymer chains in the ET flow state are advected along increasingly curved streamlines between pores such that they accumulate strain and generate a local flow instability evaluated per an established instability criterion based on local evaluation of elastic tensile stress and streamline curvature. The onset of ET leads to increased pore-scale resistance and positive feedback on upstream streamline curvature. ET is thus characterized by a continuous evolution between states of laminar and unstable flow: pores with unstable flow flood their adjacent peers and thus encourage straightened streamlines and flow stability across the array, while positive feedback from flow resistance on streamline curvature results in the instability propagating upstream along the array. By employing a geometrically ordered medium, we permit flow state communication between pores, yielding generalized insights highlighting the significance of spatial correlation and flow history, and thus provide new avenues for explaining the mechanisms of ET.

Eating disorders have the highest mortality rate of any psychiatric condition. Since the COVID-19 pandemic, the number of patients who have required medical stabilisation on paediatric wards has increased significantly. Likewise, the number of patients who have required medical stabilisation against their will as a lifesaving intervention has increased. This paper highlights a fictional case study aiming to explore the legal, ethical and practical considerations a trainee should be aware of. By the end of this article, readers will be more aware of this complex issue and how it might be managed, as well as the impact it can have on the patient, their family and ward staff.

Viscoelastic flow through an abrupt planar contraction geometry above a certain Weissenberg number ($Wi$) is well known to become unstable upstream of the contraction plane via a central jet separating from the walls and forming vortices in the salient corners. Here, for the first time, we consider three-dimensional (3-D) viscoelastic contraction flows in a microfabricated glass square–square contraction geometry. We employ state-of-the-art microtomographic particle image velocimetry to produce time-resolved and volumetric quantification of the 3-D viscoelastic instabilities arising in a dilute polymer solution driven through the geometry over a wide range of $Wi$ but at negligible Reynolds number. Based on our observations, we describe new insights into the growth, propagation and transient dynamics of an elastic vortex formed upstream of the 3-D microcontraction due to flow jetting towards the contraction. At low $Wi$ we observe vortex growth for increasing $Wi$, followed by a previously unreported vortex growth plateau region. In the plateau region, the vortex circulates around the jet with a period that decreases with $Wi$ but an amplitude that is independent of $Wi$. In addition, we report new out-of-plane asymmetric jetting behaviour with a phase-wise dependence on $Wi$. Finally, we resolve the rate-of-strain tensor $\boldsymbol{\mathsf{D}}$ and ascribe local gradients in $\boldsymbol{\mathsf{D}}$ as the underlying driver of circulation via strain hardening of the fluid in the wake of the jet.

Liben Lark Heteromirafra archeri is a ‘Critically Endangered’ species threatened by the loss and degradation of grassland at the Liben Plain, southern Ethiopia, one of only two known sites for the species. We use field data from nine visits between 2007 and 2019 and satellite imagery to quantify changes over time in the species’ abundance and in the extent and quality of its habitat. We estimate that the population fell from around 279 singing males (95% CL: 182–436) in 2007 to around 51 (14–144) in 2013, after which too few birds were recorded to estimate population size. Arable cultivation first appeared on the plain in the early 1990s and by 2019 more than a third of the plain had been converted to crops. Cultivation was initially confined to the fertile black soils but from 2008 began to spread into the less fertile red soils that cover most of the plain. Liben Larks strongly avoided areas with extensive bare ground or trees and bushes, but the extent of these did not change significantly over the survey period. A plausible explanation for the species’ decline is that grassland degradation, caused before 2007 by continuous high-pressure grazing by livestock, reduced its rates of reproduction or survival to a level that could not support its previous population. Since 2015, communal kalos (grazing exclosures) have been established to generate forage and other resources in the hope of also providing breeding habitat for Liben Larks. Grass height and density within four grassland kalos in 2018 greatly exceeded that in the surrounding grassland, indicating that the plain retains the potential to recover rapidly if appropriately managed. Improvement of grassland structure through the restitution of traditional and sustainable rangeland management regimes and the reversion of cereal agriculture to grassland are urgently needed to avert the species’ extinction.

Antarctica's ice shelves modulate the grounded ice flow, and weakening of ice shelves due to climate forcing will decrease their ‘buttressing’ effect, causing a response in the grounded ice. While the processes governing ice-shelf weakening are complex, uncertainties in the response of the grounded ice sheet are also difficult to assess. The Antarctic BUttressing Model Intercomparison Project (ABUMIP) compares ice-sheet model responses to decrease in buttressing by investigating the ‘end-member’ scenario of total and sustained loss of ice shelves. Although unrealistic, this scenario enables gauging the sensitivity of an ensemble of 15 ice-sheet models to a total loss of buttressing, hence exhibiting the full potential of marine ice-sheet instability. All models predict that this scenario leads to multi-metre (1–12 m) sea-level rise over 500 years from present day. West Antarctic ice sheet collapse alone leads to a 1.91–5.08 m sea-level rise due to the marine ice-sheet instability. Mass loss rates are a strong function of the sliding/friction law, with plastic laws cause a further destabilization of the Aurora and Wilkes Subglacial Basins, East Antarctica. Improvements to marine ice-sheet models have greatly reduced variability between modelled ice-sheet responses to extreme ice-shelf loss, e.g. compared to the SeaRISE assessments.

While medical nutrition therapy is an essential part of the care for critically ill patients, uncertainty exists about the right form, dosage, timing and route in relation to the phases of critical illness. As enteral nutrition (EN) is often withheld or interrupted during the intensive care unit (ICU) stay, combined EN and parenteral nutrition (PN) may represent an effective and safe option to achieve energy and protein goals as recommended by international guidelines. We hypothesise that critically ill patients at high nutritional risk may benefit from such a combined approach during their stay on the ICU. Therefore, we aim to test if an early combination of EN and high-protein PN (EN+PN) is effective in reaching energy and protein goals in patients at high nutritional risk, while avoiding overfeeding. This approach will be tested in the here-presented EFFORTcombo trial. Nutritionally high-risk ICU patients will be randomised to either high (≥2·2 g/kg per d) or low protein (≤1·2 g/kg per d). In the high protein group, the patients will receive EN+PN; in the low protein group, patients will be given EN alone. EN will be started in accordance with international guidelines in both groups. Efforts will be made to reach nutrition goals within 48–96 h. The efficacy of the proposed nutritional strategy will be tested as an innovative approach by functional outcomes at ICU and hospital discharge, as well as at a 6-month follow-up.

We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band ( ${\sim}60\%$ ), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.