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This paper investigates the behaviour of turbulence production in adverse pressure gradient (APG) turbulent boundary layers (TBLs), including the range of pressure gradients from zero-pressure-gradient (ZPG) to separation, moderate and high Reynolds numbers, and equilibrium and non-equilibrium flows. The main focus is on predicting the values and positions of turbulence production peaks. Based on the unique ability of turbulence production to describe energy exchange, the idea that the ratios of the mean flow length scales to the turbulence length scales are locally smallest near peaks is proposed. Thereby, the ratios of length scales are defined for the inner and outer regions, respectively, as well as the ratios of time scales for further consideration of local information. The ratios in the inner region are found to reach the same constant value in different APG TBLs. Like turbulence production in the ZPG TBL, turbulence production in APG TBLs is shown to have a certain invariance of the inner peak. The value and position of the inner peak can also be predicted quantitatively. In contrast, the ratios in the outer region cannot be determined with unique coefficients, which accounts for the different self-similarity properties of the inner and outer regions. The outer time scale ratios establish a link between mean flow and turbulence, thus participating in the discussion on half-power laws. The present results support the existence of a half-power-law region that is not immediately adjacent to the overlapping region.
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.
The Polytomous Local Independence Model (PoLIM) by Stefanutti, de Chiusole, Anselmi, and Spoto, is an extension of the Basic Local Independence Model (BLIM) to accommodate polytomous items. BLIM, a model for analyzing responses to binary items, is based on Knowledge Space Theory, a framework developed by cognitive scientists and mathematical psychologists for modeling human knowledge acquisition and representation. The purpose of this commentary is to show that PoLIM is simply a paraphrase of a DINA model in cognitive diagnosis for polytomous items. Specifically, BLIM is shown to be equivalent to the DINA model when the BLIM-items are conceived as binary single-attribute items, each with a distinct attribute; thus, PoLIM is equivalent to the DINA for polytomous single-attribute items, each with a distinct attribute.
The liver has multiple functions such as detoxification, metabolism, synthesis and storage. Folate is a water-soluble vitamin B9, which participates in one-carbon transfer reactions, maintains methylation capacity and improves oxidative stress. Folic acid is a synthetic form commonly used as a dietary supplement. The liver is the main organ for storing and metabolising folate/folic acid, and the role of folate/folic acid in liver diseases has been widely studied. Deficiency of folate results in methylation capacity dysfunction and can induce liver disorders. However, adverse effects of excessive use of folic acid on the liver have also been reported. This review aims to explore the mechanism of folate/folic acid in different liver diseases, promote further research on folate/folic acid and contribute to its rational clinical application.
This paper systematically investigated the impact mechanisms of proton irradiation, atomic oxygen irradiation and space debris collision, both individually and in combination, on the laser damage threshold and damage evolution characteristics of HfO2/SiO2 triple-band high-reflection films and fused silica substrates using a simulated near-Earth space radiation experimental system. For the high-reflection film samples, the damage thresholds decreased by 15.38%, 13.12% and 46.80% after proton, atomic oxygen and simulated space debris (penetration) irradiation, respectively. The coupling irradiation of the first two factors resulted in a decrease of 26.93%, while the combined effect of all the three factors led to a reduction of 63.19%. Similarly, the fused silica substrates exhibited the same pattern of laser damage performance degradation. Notably, the study employed high-precision fixed-point in situ measurement techniques to track in detail the microstructural changes, surface roughness and optical-thermal absorption intensity before and after proton and atomic oxygen irradiation at the same location, thus providing a more accurate and comprehensive analysis of the damage mechanisms. In addition, simulations were conducted to quantitatively analyze the transmission trajectories and concentration distribution lines of protons and atomic oxygen incident at specific angles into the target material. The research findings contribute to elucidating the laser damage performance degradation mechanism of transmissive elements in near-Earth space environments and provide technical support for the development of high-damage-threshold optical components resistant to space radiation.
Background: Receiving and managing neurosurgical consultations are central to providing quality patient care but are resource intensive processes. As part of an ongoing quality improvement initiative, we conducted a single-institution descriptive analysis of adult neurosurgical consultations. Methods: A retrospective review of prospectively collected consultation records and call schedules from a 12-month period from February 2019 to 2020 was performed. Consults were graded according to disposition (admission for surgery, non-operative admission, additional investigations recommended, opinion without further investigations, unnecessary consult). Results: There were 1916 consultations reviewed, with 52% of calls (n=991) originating outside of our hospital, and 72% (n=1387) coming from an emergency department. Cranial cases made up 64% (n=1230) of consults, while the remaining 36% (n=688) were spine cases. The mean patient age was 60.1±0.4 years. In multinomial logistic regression analysis, age, geographical distance of consulting site, and consult specific variables (neurosurgical subspecialty, inside vs. outside call, emergency department vs. inpatient ward or private office) were associated with consult disposition (p < 0.001). Conclusions: This study provides a descriptive analysis of neurosurgical consultations in Nova Scotia. Results from this study may be used to address inefficacies in the neurosurgical consultation process, including targeted education for consulting physicians.
It is inconclusive whether trimethylamine N-oxide (TMAO) and choline and related metabolites, namely trimethylamine (TMA), l-carnitine, betaine and dimethylglycine (DMG), are associated with non-alcoholic fatty liver disease (NAFLD). Our objective was to investigate these potential associations. Additionally, we sought to determine the mediating role of TMAO. In this 1:1 age- and sex-matched case–control study, a total of 150 pairs comprising NAFLD cases and healthy controls were identified. According to the fully adjusted model, after the highest tertile was compared with the lowest tertile, the plasma TMAO concentration (OR = 2·02 (95 % CI 1·04, 3·92); P trend = 0·003), l-carnitine concentration (OR = 1·79 (1·01, 3·17); P trend = 0·020) and DMG concentration (OR = 1·81 (1·00, 3·28); P trend = 0·014) were significantly positively associated with NAFLD incidence. However, a significantly negative association was found for plasma betaine (OR = 0. 50 (0·28, 0·88); P trend = 0·001). The restricted cubic splines model consistently indicated positive dose–response relationships between exposure to TMAO, l-carnitine, and DMG and NAFLD risk, with a negative association being observed for betaine. The corresponding AUC increased significantly from 0·685 (0·626, 0·745) in the traditional risk factor model to 0·769 (0·716, 0·822) when TMAO and its precursors were included (l-carnitine, betaine and choline) (P = 0·032). Mediation analyses revealed that 14·7 and 18·6 % of the excess NAFLD risk associated with l-carnitine and DMG, respectively, was mediated by TMAO (the P values for the mediating effects were 0·021 and 0·036, respectively). These results suggest that a higher concentration of TMAO is associated with increased NAFLD risk among Chinese adults and provide evidence of the possible mediating role of TMAO.
Under adverse pressure gradient (APG) conditions, the outer regions of turbulent boundary layers (TBLs) are characterized by an increased velocity defect $U_{e}-U$, an outwards shift of the peak value of the Reynolds shear stress $-\langle uv\rangle$ and an appearance of the outer peak value of the Reynolds normal stress $\langle uu\rangle$. Here $U_{e}$ is the TBL edge velocity. Scaling APG TBLs is challenging due to the non-equilibrium effects caused by changes in the APG. To address this, the response distance of TBLs to non-equilibrium conditions is utilized to extend the Zagarola–Smits scaling $U_{zs} = U_{e}({\delta ^{*} }/{\delta })$ and ensure that the original properties of the Zagarola–Smits scaling are maintained as $Re \to \infty$. Here $\delta ^{*}$ is the displacement thickness and $\delta$ is the boundary layer thickness. Based on the established correlation between $U_{e}-U$ and $-\langle uv\rangle$, the scaling is extended to $-\langle uv\rangle$. Furthermore, considering the coupling relationship between Reynolds stress components, the scaling is extended to encompass each Reynolds stress component. The proposed consistent scaling is verified using five non-equilibrium databases and five near-equilibrium databases, successfully collapsing the data of the TBL outer region. The pressure gradient parameter $\beta =({\delta ^{*} }/{\rho u_{\tau }^{2} }) ({\mathrm {d} P_{e} }/{\mathrm {d}\kern0.7pt x})$ of these databases spans two orders of magnitude. Here $P_{e}$ is the boundary layer edge pressure, $u_{\tau }$ is the friction velocity and $\rho$ is the density. Finally, the influence of the APG on the inner and outer regions of TBLs is analysed using the mean momentum balance equation. The analysis suggests that the shift of the $-\langle uv\rangle$ peak to the outer region under APG conditions is due to an insufficient inertia term near the inner region to balance the APG. It is observed that the APG promotes interaction between the inner and outer regions of TBLs, but the inner and outer regions still retain distinctive properties.
Childhood maltreatment is an established risk factor for psychopathology. However, it remains unclear how childhood traumatic events relate to mental health problems and how the brain is involved. This study examined the serial mediation effect of brain morphological alterations and emotion-/reward-related functions on linking the relationship from maltreatment to depression. We recruited 156 healthy adolescents and young adults and an additional sample of 31 adolescents with major depressive disorder for assessment of childhood maltreatment, depressive symptoms, cognitive reappraisal and anticipatory/consummatory pleasure. Structural MRI data were acquired to identify maltreatment-related cortical and subcortical morphological differences. The mediation models suggested that emotional maltreatment of abuse and neglect, was respectively associated with increased gray matter volume in the ventral striatum and greater thickness in the middle cingulate cortex. These structural alterations were further related to reduced anticipatory pleasure and disrupted cognitive reappraisal, which contributed to more severe depressive symptoms among healthy individuals. The above mediating effects were not replicated in our clinical group partly due to the small sample size. Preventative interventions can target emotional and reward systems to foster resilience and reduce the likelihood of future psychiatric disorders among individuals with a history of maltreatment.
This study assesses the difference in professional attitudes among medical students, both before and after coronavirus disease 2019 (COVID-19), and identifies the determinants closely associated with it, while providing precise and scientific evidence for implementing precision education on such professional attitudes.
Methods:
A pre-post-like study was conducted among medical students in 31 provinces in mainland China, from March 23, to April 19, 2021.
Results:
The proportion of medical students whose professional attitudes were disturbed after the COVID-19 pandemic, was significantly lower than before the COVID-19 pandemic (χ2 = 15.6216; P < 0.0001). Compared with the “undisturbed -undisturbed” group, the “undisturbed-disturbed” group showed that there was a 1.664-fold risk of professional attitudes disturbed as grade increased, 3.269-fold risk when others suggested they choose a medical career rather than their own desire, and 7.557-fold risk for students with COVID-19 in their family, relatives, or friends; while the “disturbed-undisturbed” group showed that students with internship experience for professional attitudes strengthened was 2.933-fold than those without internship experience.
Conclusions:
The professional attitudes of medical students have been strengthened during the COVID-19 pandemic. The results provide evidence of the importance of education on professional attitudes among medical students during public health emergencies.
The Sichuan Basin was a part of the Yangtze Carbonate Platform (YCP) during the Cambrian–Ordovician, and marine carbonates were deposited in the basin during this interval. Although previous studies have evaluated the paleogeography, paleoclimate and paleoecology of this basin, they have primarily focused on the paleoecology and biological evolution in the basin; however, analysis of paleogeography and paleoclimate is lacking. This study integrated outcrop sedimentological and magnetic fabric data to document sedimentary differentiation and anisotropy of magnetic susceptibility (AMS) within the YCP. The aims of this study were to infer paleowind directions during each epoch of the Cambrian–Ordovician and to constrain the paleogeographic location of the YCP. The northwestern, central and southeastern sides of the YCP were characterized by high-energy deposition (e.g. sub-angular to rounded intraclasts), medium-energy deposition (e.g. sub-angular to sub-rounded intraclasts) and low-energy deposition (e.g. angular to sub-angular intraclasts), respectively. The centroid D-Kmax values for the Early, Middle and Late Cambrian were 116° ± 52°, 145° ± 57° and 159° ± 62° from the present north, respectively; corresponding values for the Early, Middle and Late Ordovician were 169° ± 70°, 139° ± 73° and 91° ± 68° from the present north, respectively. Sedimentary differentiation and AMS results indicated that the prevailing wind directions during the Early Cambrian, Middle Cambrian, Late Cambrian, Early Ordovician, Middle Ordovician and Late Ordovician were 296° ± 52°, 325° ± 57°, 339° ± 62°, 349° ± 70°, 319° ± 73° and 271° ± 68° from the present north, respectively. The present study provides evidence for the location of the YCP during the Cambrian–Ordovician via the correspondence between the paleowind directions over the YCP and the trade winds in the Northern and Southern hemispheres. The novelty of this study lies in the following aspects: (1) it integrates microfacies and AMS analyses to establish paleowind patterns; (2) it constrains the paleo-hemispheric location of the YCP during the Cambrian–Ordovician; and (3) it provides a reference for further studies of the paleoclimate and paleogeography of the YCP during the Cambrian–Ordovician.
Few studies examined the association of energy, macronutrients and food consumption at dinner v. breakfast with hypercholesterolaemia. A total of 27 911 participants from the National Health and Nutrition Examination Survey (2003–2016) were included in the cross-sectional study. Energy, macronutrients and food consumption at breakfast, dinner and the difference at dinner v. breakfast (Δratio) were calculated. Multiple logistic regression models and substitution effects of foods at dinner with breakfast were also performed. After adjustment for potential covariates, compared with the lowest quintile, participants in the highest quintile of Δratio in terms of energy had a higher risk of prevalent hypercholesterolaemia (ORΔratio of energy 1·16, 95 % CI (1·01, 1·33)) mainly due to Δratio of low-quality carbohydrates and plant protein (ORΔratio of low-quality carbohydrates 1·19; 95 % CI (1·05, 1·35)); ORΔratio of plant protein 1·13; 95 % CI (1·01, 1·28)). ΔAdded sugars and Δnuts were associated with hypercholesterolaemia (ORΔadded sugars 1·01; 95 % CI (1·00, 1·02)); ORΔnuts 1·08; 95 % CI (1·01, 1·16)). Furthermore, the substitution of added sugars, nuts and processed meat at dinner with breakfast could reduce the OR of hypercholesterolaemia. This study indicated that among US adults, overconsumption of energy, macronutrients including low-quality carbohydrates and plant protein at dinner than breakfast was significantly associated with a higher risk of prevalent hypercholesterolaemia. The replacing of added sugar, nuts and processed meat at dinner with breakfast reduced the risk of prevalent hypercholesterolaemia. This study emphasised the importance of meal timing in the prevention of hypercholesterolaemia.
Financial inclusion depends on providing adjusted services for citizens with disclosed vulnerabilities. At the same time, the financial industry needs to adhere to a strict regulatory framework, which is often in conflict with the desire for inclusive, adaptive, and privacy-preserving services. In this article we study how this tension impacts the deployment of privacy-sensitive technologies aimed at financial inclusion. We conduct a qualitative study with banking experts to understand their perspectives on service development for financial inclusion. We build and demonstrate a prototype solution based on open source decentralized identifiers and verifiable credentials software and report on feedback from the banking experts on this system. The technology is promising thanks to its selective disclosure of vulnerabilities to the full control of the individual. This supports GDPR requirements, but at the same time, there is a clear tension between introducing these technologies and fulfilling other regulatory requirements, particularly with respect to “Know Your Customer.” We consider the policy implications stemming from these tensions and provide guidelines for the further design of related technologies.
Background: Despite efforts toward gender equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is often unavailable. The purpose of this study was to determine if gender equality exists in the management of degenerative lumbar disease. Methods: Part 1: A systematic scoping review was conducted according to PRISMA guidelines, in order to synthesize the adult surgical literature regarding gender differences in pre- and post-operative clinical assessment scores for patients diagnosed with degenerative lumbar disease.
Part 2: An ambispective cohort analysis (multi-variate logistic regression) of the Canadian Spine Outcomes Research Network registry was performed to address knowledge gaps identified in “Part 1”. Results: Part 1: Thirty articles were identified, accounting for 32,951 patients. Female patients have worse absolute pre-operative pain, disability and health-related quality-of-life (HRQoL). Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males.
Part 2: Data was analyzed for 5,039 patients. Significant gender differences in pre-operative utilization of healthcare resources (medication use, diagnostic testing, medical and allied healthcare professional visits) were identified. Conclusions: Significant gender disparities in clinical assessment scores and the pre-operative utilization of healthcare resources were identified for patients undergoing surgery for degenerative lumbar disease.
Background: Despite efforts toward gender equality in clinical trial enrollment, females are frequently underrepresented and gender-specific data analysis is often unavailable. The purpose of this study was to determine if gender equality exists in the management of degenerative lumbar disease. Methods: Part 1: A systematic scoping review was conducted according to PRISMA guidelines, in order to synthesize the adult surgical literature regarding gender differences in pre- and post-operative clinical assessment scores for patients diagnosed with degenerative lumbar disease.
Part 2: An ambispective cohort analysis (multi-variate logistic regression) of the Canadian Spine Outcomes Research Network registry was performed to address knowledge gaps identified in “Part 1”. Results: Part 1: Thirty articles were identified, accounting for 32,951 patients. Female patients have worse absolute pre-operative pain, disability and health-related quality-of-life (HRQoL). Following surgery, females have worse absolute pain, disability, and HRQoL, but demonstrate an equal or greater interval change compared to males.
Part 2: Data was analyzed for 5,039 patients. Significant gender differences in pre-operative utilization of healthcare resources (medication use, diagnostic testing, medical and allied healthcare professional visits) were identified. Conclusions: Significant gender disparities in clinical assessment scores and the pre-operative utilization of healthcare resources were identified for patients undergoing surgery for degenerative lumbar disease.
Optimal preoperative therapy regimen in the treatment of resectable retroperitoneal sarcoma (RPS) remains unclear. This study compares the impact of preoperative radiation, chemoradiation and chemotherapy on overall survival (OS) in RPS patients.
Materials and Methods:
The National Cancer Database (NCDB) was queried for patients with non-metastatic, resectable RPS (2006–15). The primary endpoint was OS, evaluated by Kaplan–Meier method, log-rank test, Cox multivariable analysis and propensity score matching.
Results:
A total of 1,253 patients met the inclusion criteria, with 210 patients (17%) receiving chemoradiation, 850 patients (68%) receiving radiation and 193 patients (15%) receiving chemotherapy. On Cox multivariable analysis, when compared to preoperative chemoradiation, preoperative radiation was not associated with improved OS (hazards ratio [HR] 0·98, 95% CI 0·76–1·25, p = 0·84), while preoperative chemotherapy was associated with worse OS (HR 1·64, 95% CI 1·24–2·18, p < 0·001). Similar findings were observed in 199 and 128 matched pairs for preoperative radiation and chemotherapy, respectively, when compared to preoperative chemoradiation.
Findings:
Our study suggested an OS benefit in using preoperative chemoradiation compared to chemotherapy alone, but OS outcomes were comparable between preoperative chemoradiation and radiation alone.
Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been discovered in Wuhan and spread rapidly across China and worldwide. Characteristics of infected patients are needed to get insight into the full spectrum of the disease.
Methods:
Epidemiological and clinical information of 1738 diagnosed patients during February 7-26, 2020 in Wuhan Dongxihu Fangcang Hospital were analyzed. A total of 709 patients were followed up on symptom, mental health, isolation site, and medication after discharge.
Results:
There were 852 males and 886 females in the cohort. The average age of the patients was 48.8 y. A total of 79.98% of the patients were from Wuhan, Hubei Province. The most common initial symptoms were fever, cough, and shortness of breath. Among all the patients, 1463 had complications, with respiratory distress as the most common complication. The average duration of hospitalization was 15.95 ± 14.69 d. The most common postdischarge symptom is cough. After discharge, most patients were full of energy and chose hotel as their self-isolation site. Coronavirus disease 2019 (COVID-19) Chinese medicine No.2 prescription is the medication used most commonly by the patients after discharge.
Conclusions:
The population is generally susceptible to SARS-CoV-2. After receiving aggressive treatment of combined Chinese and Western medicine, most patients had a good prognosis and mental health after discharge.
Induction chemotherapy (iC) followed by concurrent chemoradiation has been shown to improve overall survival (OS) for locally advanced pancreatic cancer (LAPC). However, the survival benefit of stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation therapy (CFRT) following iC remains unclear.
Materials and methods:
The National Cancer Database (NCDB) was queried for primary stage III, cT4N0-1M0 LAPC (2004–15). Kaplan–Meier analysis, Cox proportional hazards method and propensity score matching were used.
Results:
Among 872 patients, 738 patients underwent CFRT and 134 patients received SBRT. Median follow-up was 24·3 and 22·9 months for the CFRT and SBRT cohorts, respectively. The use of SBRT showed improved survival in both the multivariate analysis (hazards ratio 0·78, p = 0·025) and 120 propensity-matched pairs (median OS 18·1 versus 15·9 months, p = 0·004) compared to the CFRT.
Findings:
This NCDB analysis suggests survival benefit with the use of SBRT versus CFRT following iC for the LAPC.
This National Cancer Database (NCDB) analysis was performed to evaluate the outcomes of adjuvant chemotherapy (AC) versus observation for resected pancreatic adenocarcinoma treated with neoadjuvant therapy (NT).
Materials and methods:
The NCDB was queried for primary stages I–II cT1-3N0-1M0 resected pancreatic adenocarcinoma treated with NT (2004–2015). Baseline patient, tumour and treatment characteristics were extracted. The primary end point was overall survival (OS). With a 6-month conditional landmark, Kaplan–Meier analysis, multivariable Cox proportional hazards method and 1:1 propensity score matching was used to analyse the data.
Results:
A total of 1,737 eligible patients were identified, of which 1,247 underwent post-operative observation compared to 490 with AC. The overall median follow-up was 34·7 months. The addition of AC showed improved survival on the multivariate analysis (HR 0·78, p < 0·001). AC remained statistically significant for improved OS, with a median OS of 26·3 months versus 22·3 months and 2-year OS of 63·9% versus 52·9% for the observation cohort (p < 0·001). Treatment interaction analysis showed OS benefit of AC for patients with smaller tumours.
Findings:
Our findings suggest a survival benefit for AC compared to observation following NT and surgery for resectable pancreatic adenocarcinoma, especially in patients with smaller tumours.