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In this study, we developed an adaptive gain-scheduling algorithm for hypersonic flight vehicles operating across wide altitude-Mach number envelopes. First, we employed a gap metric-based nominal point selection algorithm to establish a linear parameter-varying (LPV) model more accurate than the traditional Jacobian linearisation method. Active disturbance rejection control (ADRC) was then applied to cope with disturbances and uncertainties, and control gains were scheduled using the Guardian maps (GM) method to adapt to the wide envelope of velocity and altitude. The simulation results demonstrate that under all operating conditions, the proposed algorithm can automatically iterate to obtain a gain-scheduling strategy that meets the flying qualities requirements. Notably, the proposed algorithm exhibited an integral of the time absolute error approximately half of that of the traditional ADRC and significantly lower than that of the GM-LQR method in the ascent phase, demonstrating its excellent control performance and robustness.
The primary purpose of this study was to assess perceived burdens and benefits of participating in implementation research among staff employed in resource-constrained healthcare settings. Another objective was to use findings to generate considerations for engaging staff in research across different phases of implementation research.
Methods:
This qualitative focus group and consensus building study involved researchers affiliated with the National Cancer Institute Implementation Science Centers in Cancer Control program and nine Community Health Centers (CHCs) in Massachusetts. Six focus groups (n = 3 with CHC staff; n = 3 with researchers) assessed barriers and facilitators to staff participation in implementation research. During consensus discussions, we used findings to develop considerations for engaging staff as participants and partners throughout phases of implementation research.
Results:
Sixteen researchers and 14 staff participated in separate focus groups; nine researchers and seven staff participated in separate consensus discussions. Themes emerged across participant groups in three domains: (1) influences on research participation; (2) research burdens and benefits; and (3) ways to facilitate staff participation in research. Practical considerations included: (a) aligning research with organizational and staff values and priorities; (b) applying user-centered design to research methods; (c) building organizational and individual research capacity; and (d) offering equitable incentives for staff participation.
Conclusions:
Engaging staff as participants and partners across different phases of implementation research requires knowledge about what contributes to research burden and benefits and addressing context-specific burdens and benefits.
This article describes lessons learned from the incorporation of language justice as an antiracism praxis for an academic Center addressing cardiometabolic inequities. Drawing from a thematic analysis of notes and discussions from the Center’s community engagement core, we present lessons learned from three examples of language justice: inclusion of bilingual team members, community mini-grants, and centering community in community-academic meetings. Facilitating strategies included preparing and reviewing materials in advance for interpretation/translation, live simultaneous interpretation for bilingual spaces, and in-language documents. Barriers included: time commitment and expenses, slow organizational shifts to collectively practice language justice, and institutional-level administrative hurdles beyond the community engagement core’s influence. Strengthening language justice means integrating language justice institutionally and into all research processes; dedicating time and processes to learn about and practice language justice; equitably funding language justice within research budgets; equitably engaging bilingual, bicultural staff and language justice practitioners; and creating processes for language justice in written and oral research and collaborative activities. Language justice is not optional and necessitates buy-in, leadership, and support of community engagement cores, Center leadership, university administrators, and funders. We discuss implications for systems and policy change to advance language justice in research to promote health equity.
The relationship between psychosis and violence is often construed focusing on a narrow panel of factors; however, recent evidence suggests violence might be linked to a complex interplay of biopsychosocial factors among forensic psychiatric patients with psychosis (FPPP). This review describes violence incidents in FPPP, the factors associated with violence, and relevant implications.
Methods
This review was conducted following the preferred reporting items for systematic reviews and meta-analyses guideline. Databases, including CINAHL, EMBASE, Medline/PubMed, PsycINFO, and Web of Science, were searched for eligible studies that examined violence among adult FPPP. Screening of reports and data extraction were completed by at least two independent reviewers.
Results
Across the 29 included studies, violence was consistently related to prior contact with psychiatric services, active psychotic symptoms, impulsivity, adverse experiences, and low social support. However, FPPP who reported violence varied in most other biopsychosocial domains, suggesting the underlying combinatorial effects of multiple risk factors for violence rather than individual factors. Variability in violence was addressed by stratifying FPPP into subgroups using composite/aggregate of identifiable factors (including gender, onset/course of illness, system-related, and other biopsychosocial factors) to identify FPPP with similar risk profiles.
Conclusions
There are multiple explanatory pathways to violence in FPPP. Recent studies identify subgroups with underlying similarities or risk profiles for violence. There is a need for future prospective studies to replicate the clinical utility of stratifying FPPP into subgroups and integrate emerging evidence using recent advancements in technology and data mining to improve risk assessment, prediction, and management.
Digital methods in healthcare research have been steadily gaining ground but, until recently, were superseded by conventional face-to-face approaches wherever possible. However, the COVID-19 pandemic rendered in-person forms of data collection largely impossible, propelling digital approaches to the forefront. This book offers a digital lens in the participatory perspective of ethnography, a qualitative methodology. A series of chapters from internationally distinguished and rising authors present digital platforms and techniques and apply these to a wide range of healthcare studies. The authors highlight the different aspects of digital research approaches as well as reflecting on and proffering digital approaches to qualitative research for the future. Will these new digital health techniques be embraced, or will researchers be keen to revert to the traditional methods? With its unique approach, this is an invaluable resource for both prospective and experienced qualitative researchers in a broad array of medical and health disciplines.
The magnetohydrodynamic (MHD) equations, as a collisional fluid model that remains in local thermodynamic equilibrium (LTE), have long been used to describe turbulence in myriad space and astrophysical plasmas. Yet, the vast majority of these plasmas, from the solar wind to the intracluster medium (ICM) of galaxy clusters, are only weakly collisional at best, meaning that significant deviations from LTE are not only possible but common. Recent studies have demonstrated that the kinetic physics inherent to this weakly collisional regime can fundamentally transform the evolution of such plasmas across a wide range of scales. Here, we explore the consequences of pressure anisotropy and Larmor-scale instabilities for collisionless, $\beta \gg 1$, turbulence, focusing on the role of a self-organizational effect known as ‘magneto-immutability’. We describe this self-organization analytically through a high-$\beta$, reduced ordering of the Chew–Goldberger–Low-MHD (CGL-MHD) equations, finding that it is a robust inertial-range effect that dynamically suppresses magnetic-field-strength fluctuations, anisotropic-pressure stresses and dissipation due to heat fluxes. As a result, the turbulent cascade of Alfvénic fluctuations continues below the putative viscous scale to form a robust, nearly conservative, MHD-like inertial range. These findings are confirmed numerically via Landau-fluid CGL-MHD turbulence simulations that employ a collisional closure to mimic the effects of microinstabilities. We find that microinstabilities occupy a small (${\sim }5\,\%$) volume-filling fraction of the plasma, even when the pressure anisotropy is driven strongly towards its instability thresholds. We discuss these results in the context of recent predictions for ion-vs-electron heating in low-luminosity accretion flows and observations implying suppressed viscosity in ICM turbulence.
We describe the interaction of parallel-propagating Alfvén waves with ion-acoustic waves and other Alfvén waves, in magnetized, high-$\beta$ collisionless plasmas. This is accomplished through a combination of analytical theory and numerical fluid simulations of the Chew–Goldberger–Low (CGL) magnetohydrodynamic (MHD) equations closed by Landau-fluid heat fluxes. An asymptotic ordering is employed to simplify the CGL-MHD equations and derive solutions for the deformation of an Alfvén wave that results from its interaction with the pressure anisotropy generated either by an ion-acoustic wave or another, larger-amplitude Alfvén wave. The difference in time scales of acoustic and Alfvénic fluctuations at high-$\beta$ means that interactions that are local in wavenumber space yield little modification to either mode within the time it takes the acoustic wave to Landau damp away. Instead, order-unity changes in the amplitude of Alfvénic fluctuations can result after interacting with frequency-matched acoustic waves. Additionally, we show that the propagation speed of an Alfvén-wave packet in an otherwise homogeneous background is a function of its self-generated pressure anisotropy. This allows for the eventual interaction of separate co-propagating Alfvén-wave packets of differing amplitudes. The results of the CGL-MHD simulations agree well with these predictions, suggesting that theoretical models relying on the interaction of these modes should be reconsidered in certain astrophysical environments. Applications of these results to weak Alfvénic turbulence and to the interaction between the compressive and Alfvénic cascades in strong, collisionless turbulence are also discussed.
Pressure anisotropy can strongly influence the dynamics of weakly collisional, high-beta plasmas, but its effects are missed by standard magnetohydrodynamics (MHD). Small changes to the magnetic-field strength generate large pressure-anisotropy forces, heating the plasma, driving instabilities and rearranging flows, even on scales far above the particles’ gyroscales where kinetic effects are traditionally considered most important. Here, we study the influence of pressure anisotropy on turbulent plasmas threaded by a mean magnetic field (Alfvénic turbulence). Extending previous results that were concerned with Braginskii MHD, we consider a wide range of regimes and parameters using a simplified fluid model based on drift kinetics with heat fluxes calculated using a Landau-fluid closure. We show that viscous (pressure-anisotropy) heating dissipates between a quarter (in collisionless regimes) and half (in collisional regimes) of the turbulent-cascade power injected at large scales; this does not depend strongly on either plasma beta or the ion-to-electron temperature ratio. This will in turn influence the plasma's thermodynamics by regulating energy partition between different dissipation channels (e.g. electron and ion heat). Due to the pressure anisotropy's rapid dynamic feedback onto the flows that create it – an effect we term ‘magneto-immutability’ – the viscous heating is confined to a narrow range of scales near the forcing scale, supporting a nearly conservative, MHD-like inertial-range cascade, via which the rest of the energy is transferred to small scales. Despite the simplified model, our results – including the viscous heating rate, distributions and turbulent spectra – compare favourably with recent hybrid-kinetic simulations. This is promising for the more general use of extended-fluid (or even MHD) approaches to model weakly collisional plasmas such as the intracluster medium, hot accretion flows and the solar wind.
With the support of hybrid-kinetic simulations and analytic theory, we describe the nonlinear behaviour of long-wavelength non-propagating (NP) modes and fast magnetosonic waves in high-$\beta$ collisionless plasmas, with particular attention to their excitation of and reaction to kinetic micro-instabilities. The perpendicularly pressure balanced polarization of NP modes produces an excess of perpendicular pressure over parallel pressure in regions where the plasma $\beta$ is increased. For mode amplitudes $|\delta B/B_0| \gtrsim 0.3$, this excess excites the mirror instability. Particle scattering off these micro-scale mirrors frustrates the nonlinear saturation of transit-time damping, ensuring that large-amplitude NP modes continue their decay to small amplitudes. At asymptotically large wavelengths, we predict that the mirror-induced scattering will be large enough to interrupt transit-time damping entirely, isotropizing the pressure perturbations and morphing the collisionless NP mode into the magnetohydrodynamic (MHD) entropy mode. In fast waves, a fluctuating pressure anisotropy drives both mirror and firehose instabilities when the wave amplitude satisfies $|\delta B/B_0| \gtrsim 2\beta ^{-1}$. The induced particle scattering leads to delayed shock formation and MHD-like wave dynamics. Taken alongside prior work on self-interrupting Alfvén waves and self-sustaining ion-acoustic waves, our results establish a foundation for new theories of electromagnetic turbulence in low-collisionality, high-$\beta$ plasmas such as the intracluster medium, radiatively inefficient accretion flows and the near-Earth solar wind.
Patients treated with immunotherapy are divided into two subgroups: (i) long-term survivors (LTS) and (ii) moderate survivors. Nevertheless, clinical trials (RCTs) report only average treatment effects such as hazard rate (HRs). Health economic-models often only input average treatment effects, even though it has been shown that accounting for the LTS subgroup is crucial for accurate projection of long-term survival under immunotherapy. We investigated the incorporation of a statistical mixture cure model (MCM) in a health-economic model for lung cancer as a way to account for LTS while incorporating reported average RCT-based treatment effects.
Methods
We developed a microsimulation model describing disease progression under three treatment lines in advanced lung cancer using Dutch real-world data of chemotherapies treated patients. Here we focus on first-line treatment, for which we used gompertz distribution to simulate time-to-progression. To simulate the impact of immunotherapy, we adjusted base-model assuming MCM for first-line treatment, where the LTS subgroup was not at risk to progress, but instead die from background mortality. The subgroup of moderate survivors on the other hand are at risk to progress with adjusted progression-free HR (PF-HR). We simulated the model with size of LTS (prop_LTS) ranging from 14-34 percent (keynote-001 five-year overall survival [OS], 95% confidence interval) while fixing average RCT PF-HR at 0.5. Model predictions under the different prop_LTS were compared to real-world Dutch OS as well as the long-term RCT five-year OS.
Results
With respect to observed short-term survival outcomes, model predictions were insensitive to assumptions regarding the size of the LTS subgroup. However, to match the five-year RCT OS rate reported (32%), the prop_LTS had to be equal to 34 percent. Under this latter setting for the prop_LTS, the progression HR in the subgroup of moderate survivors was calibrated to be 1.1.
Conclusions
The use of a mixture cure model improves long-term model-based projections with the implicit assumption that moderate survivors have little or no treatment benefit.
Eclogite-facies mineral assemblages are commonly preserved in mafic protoliths within continental terranes. It is widely accepted that the entirety of these continental terrains must also have been subducted to eclogite-facies conditions. However, evidence that the felsic material transformed at eclogite-facies conditions is lacking. Low-strain metagranites of the ultrahigh-pressure metamorphic Tso Morari Complex in Ladakh, Himalaya, are host to eclogite-facies mafic sills and preserve evidence of subduction to eclogite-facies conditions. Following the eclogite-facies metamorphism, the granites and their gneissic equivalents were overprinted by amphibolite-facies Barrovian metamorphism, obscuring their earlier metamorphic history. We present evidence that the Tso Morari metagranites preserve a complex magmatic, hydrothermal and polymetamorphic history that involved four stages. Stage 1 was magmatic crystallisation, a record of which is preserved in the primary igneous mineralogy and relict igneous microstructures. Monazite grains record a U–Pb age of 474.0 ± 11.6 Ma, concurrent with a published zircon crystallisation age. Stage 2 represents pervasive late-magmatic hydrothermal alteration of the granite during emplacement and is evident in the mineral composition, particularly in the white micas preserved in the igneous domains. Stage 3 involved the (ultra)high-pressure metamorphism of these granite bodies during the Himalayan subduction of continental material. The high-pressure stage of the metamorphic history (>25 kbar at 550–650°C) is preserved as thin coronas of garnet and phengite around igneous biotite, garnet with kyanite inclusions in pseudomorphs after cordierite, and rare palisade quartz textures after coesite. Stage 4 was a result of Barrovian metamorphism of the Tso Morari Complex and is evident in the replacement of garnet by biotite. Many of these features are preserved in localised textural domains in the rock, where local equilibrium was important and the anhydrous conditions limited reaction progress, though aided preservation potential. Collectively, these four stages record a 480 Myr history of metamorphism and reworking of the northernmost Indian plate.