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In the last ten years, the recovery movement has significantly influenced mental health services and workers, psychiatric reform, and the advocacy movement worldwide. Within Brazil’s public mental health care system, operates a cohesive, powerful advocacy coalition empowering recovery-oriented practices. This article aims to highlight successful initiatives spearheaded by individuals with lived experience in Brazil. We will also present some challenges, and discuss possible recovery strategies to strengthen mental health services by empowering people with lived experience and promoting social justice. Efforts and initiatives to implement recovery strategies in Brazil are underway, aiming to improve population mental health and substance misuse both within and outside mental health services. These initiatives include peer support, advocacy, testimonies and empowerment, employment, and social, cultural, and artistic initiatives. Some of the challenges to greater participation of individuals with lived experience in this ongoing process of Brazilian psychiatric reform include the following aspects: barriers to the autonomy and independence of lived experience organizations; the longstanding history of racism in Brazilian society; disparities in social indicators such as education and income, between professionals and people with lived experience in mental health and substance misuse. Although progress in Brazil’s psychiatric reform has advanced through recovery initiatives, challenges remain in ensuring leadership roles for people with lived experience. Ongoing success depends on their active involvement, alongside advocacy movements and involvement of broader society.
The Stop the Bleed campaign provided civilians with tourniquet application training and increased the demand for tourniquets among the general population, which led to the development of new commercially available devices. However, most widely available tourniquets have not undergone testing by regulatory bodies and their efficacy remains unknown.
Study Objective:
This study aimed to compare the efficacy and performance of Combat Application Tourniquets (CAT) versus uncertified tourniquets.
Methods:
This study compared 25 CAT with 50 commercially available “look-alike” tourniquets (LA-TQ) resembling the CAT. The CAT and the LA-TQ were compared for cost, size, and tested during one-hour and six-hour applications on a manikin’s leg. The outcomes were force applied, force variation during the application, and tourniquet rupture rate.
Results:
The LA-TQ were cheaper (US$6.07 versus US$27.19), shorter, and had higher inter-device variability than the CAT (90.1 [SE = 0.5] cm versus 94.5 [SE = 0.1] cm; P <.001). The CAT applied a significantly greater force during the initial application when compared to the LA-TQ (65 [SE = 3] N versus 14 [SE = 1] N; P <.001). While the initial application force was maintained for up to six hours in both groups, the CAT group applied an increased force during one-hour applications (group effect: F [1,73] = 105.65; P <.001) and during six-hour applications (group effect: F [1,12] = 9.79; P = .009). The rupture rate differed between the CAT and the LA-TQ (0% versus 4%).
Conclusion:
The LA-TQ applied a significantly lower force and had a higher rupture rate compared to the CAT, potentially affecting tourniquet performance in the context of public bleeding control. These findings warrant increased layperson education within the framework of the Stop the Bleed campaign and further investigations on the effectiveness of uncertified devices in real-world applications.
O índice de volatilidade eleitoral tem sido usado como um dos principais indicadores de institucionalização dos sistemas partidários em países de democracia recente. Contudo, os estudos comparados usualmente analisam esse índice num nível de agregação dos dados muito elevado, avaliando sua variação com base nas médias nacionais. Sob tal perspectiva, nosso objetivo é analisar a volatilidade eleitoral brasileira tomando os 27 entes federativos como unidade de agregação dos dados eleitorais para a Câmara dos Deputados. Na primeira parte do artigo, mostramos que há grande variabilidade no índice entre os estados e entre as sucessivas eleições; na segunda parte, realizamos um teste estatístico do impacto explicativo de variáveis políticas, econômicas e sociais na variação da volatilidade eleitoral em duas dimensões: a temporal (entre as eleições) e a espacial (entre os estados). Os resultados mostram a importância de algumas variáveis políticas na explicação da variação da volatilidade eleitoral brasileira.
The aim of this study is to compare patient geometrical uncertainties in the treatment of breast boost three-dimensional conformal radiation therapy (3D-CRT) considering both manual alignment and automatic different registration methods in cone-beam computed tomography (CBCT).
Methods:
A total of 85 patients were chosen for this study. A total of 254 registrations of CBCT vs planning computed tomography (CT) were retrospectively performed using automatic registration algorithms from Elekta XVI system (Clipbox and Mask) to detect patient setup uncertainties. All CBCTs were also matched manually by three health professionals. Mean shift values obtained with manual registration performed by health professionals were used as reference. Absolute value of difference between automatic algorithm shifts and reference values shifts was collected for each enrolled patient considering the three different spatial directions (x,y,z), and the magnitude was calculated (δm for Mask and δc for Clipbox).
Results:
Data analysis showed a significant difference in δm and δc. t-Test statistics showed a high difference between Mask and Clipbox, in particular mean δm = (1.3 ± 0.1) mm and δc = (3.3 ± 1.2) mm (p-value <0.0001). Mask algorithm was performed in a very similar way with respect to the reference alignment, and the differences between these two procedures were of the order of 1 mm. Clipbox algorithm showed larger differences with manual registration.
Conclusions:
These results suggest that the Mask algorithm may be the optimal choice for patient setup verification in clinical practice for breast boost treatment in 3D-CRT.
The derivation and numerical implementation of a linearized version of the gyrokinetic (GK) Coulomb collision operator (Jorge et al., J. Plasma Phys., vol. 85, 2019, 905850604) and of the widely used linearized GK Sugama collision operator (Sugama et al., Phys. Plasmas, vol. 16, 2009, 112503) is reported. An approach based on a Hermite–Laguerre moment expansion of the perturbed gyrocentre distribution function is used, referred to as gyromoment expansion. This approach allows the considering of arbitrary perpendicular wavenumber and expressing the two linearized GK operators as a linear combination of gyromoments where the expansion coefficients are given by closed analytical expressions that depend on the perpendicular wavenumber and on the temperature and mass ratios of the colliding species. The drift-kinetic (DK) limits of the GK linearized Coulomb and Sugama operators are also obtained. Comparisons between the gyromoment approach and the DK Coulomb and GK Sugama operators in the continuum GK code GENE are reported, focusing on the ion-temperature-gradient instability and zonal flow damping, finding an excellent agreement. It is confirmed that stronger collisional damping of the zonal flow residual by the Sugama GK model compared with the GK linearized Coulomb (Pan et al., Phys. Plasmas, vol. 27, 2020, 042307) persists at higher collisionality. Finally, we show that the numerical efficiency of the gyromoment approach increases with collisionality, a desired property for boundary plasma applications.
Severe acute malnutrition (SAM) is associated with a complex pattern of various clinical conditions. We investigated how risk factors cluster in children with SAM, the relationship between clusters of risk factors and mortality as well as length of stay in children with SAM. A prospective observational study design was used. Data were extracted from medical records of 601 infants and children aged 0–59 months admitted and treated for SAM in three Ghanaian referral hospital between June 2013 and June 2018. Among the 601 medical records extracted, ninety-nine died. Three clusters of medical features clearly emerged from data analyses. Firstly, an association was defined by eye signs, pallor, diarrhoea and vomiting with gastrointestinal infections and malaria. In this cluster, pallor and eye signs were related to 2- to 5-fold increased mortality risk. Secondly, HIV, oedema, fast pulse, respiratory infections and tuberculosis; among those features, HIV increased child mortality risk by 2-fold. Thirdly, shock, convulsions, dermatitis, cold hands and feet, weak pulse, urinary tract infections and irritability were clustered. Among those features, cold hands and feet, dermatitis, convulsions and shock increased child mortality risk in a range of 2- to 9-fold. Medical conditions and clinical signs in children diagnosed with SAM associate in patterns and are related to clinical outcomes.
The paper describes the rigorous implementation of a validated methodological experimental protocol to divergent and convergent thinking tasks occurring in Design by neurophysiological means (EEG and eye-tracking). EEG evidence confirms the findings coherently to the literature. Interesting is the confirmation of such results through eye-tracking ones, and further evidence emerged. In particular, neurophysiological results in idea generation differ between designers and engineers. This study was supported by a multidisciplinary team, both for the neuropsychological and data analysis aspects.
A gyrokinetic model is presented that can properly describe large and small amplitude electromagnetic fluctuations occurring on scale lengths ranging from the electron Larmor radius to the equilibrium perpendicular pressure gradient scale length, and the arbitrarily large deviations from thermal equilibrium that are present in the plasma periphery of tokamak devices. The formulation of the gyrokinetic model is based on a second-order accurate description of the single charged particle dynamics, derived from Lie perturbation theory, where the fast particle gyromotion is decoupled from the slow drifts assuming that the ratio of the ion sound Larmor radius to the perpendicular equilibrium pressure scale length is small. The collective behaviour of the plasma is obtained by a gyrokinetic Boltzmann equation that describes the evolution of the gyroaveraged distribution function. The collisional effects are included by a nonlinear gyrokinetic Dougherty collision operator. The gyrokinetic model is then developed into a set of coupled fluid equations referred to as the gyrokinetic moment hierarchy. To obtain this hierarchy, the gyroaveraged distribution function is expanded onto a Hermite–Laguerre velocity-space polynomial basis. Then, the gyrokinetic equation is projected onto the same basis yielding the spatial and temporal evolution of the Hermite–Laguerre expansion coefficients. A closed set of fluid equations for the lowest-order coefficients is presented. The Hermite–Laguerre projection is performed accurately at arbitrary perpendicular wavenumber values. Finally, the self-consistent evolution of the electromagnetic fields is described by a set of gyrokinetic Maxwell equations derived from a variational principle where the velocity integrals are explicitly evaluated.
A gyrokinetic Coulomb collision operator is derived, which is particularly useful to describe the plasma dynamics at the periphery region of magnetic confinement fusion devices. The derived operator is able to describe collisions occurring in distribution functions arbitrarily far from equilibrium with variations on spatial scales at and below the particle Larmor radius. A multipole expansion of the Rosenbluth potentials is used in order to derive the dependence of the full Coulomb collision operator on the particle gyroangle. The full Coulomb collision operator is then expressed in gyrocentre phase-space coordinates, and a closed formula for its gyroaverage in terms of the moments of the gyrocentre distribution function in a form ready to be numerically implemented is provided. Furthermore, the collision operator is projected onto a Hermite–Laguerre velocity space polynomial basis and expansions in the small electron-to-ion mass ratio are provided.
The dynamics of electron-plasma waves is described at arbitrary collisionality by considering the full Coulomb collision operator. The description is based on a Hermite–Laguerre decomposition of the velocity dependence of the electron distribution function. The damping rate, frequency and eigenmode spectrum of electron-plasma waves are found as functions of the collision frequency and wavelength. A comparison is made between the collisionless Landau damping limit, the Lenard–Bernstein and Dougherty collision operators and the electron–ion collision operator, finding large deviations in the damping rates and eigenmode spectra. A purely damped entropy mode, characteristic of a plasma where pitch-angle scattering effects are dominant with respect to collisionless effects, is shown to emerge numerically, and its dispersion relation is analytically derived. It is shown that such a mode is absent when simplified collision operators are used, and that like-particle collisions strongly influence the damping rate of the entropy mode.
The DIVING3D Survey (Deep Integral Field Spectrograph View of Nuclei of Galaxies) aims to observe, with high signal/noise and high spatial resolution, a statistically complete sample of southern galaxies brighter than B = 12.0 The main objectives of this survey are to study: 1) the nuclear emission line properties; 2) the circumnuclear emission line properties; 3) the central stellar kinematics and 4) the central stellar archaeology. Preliminary results of individual or small groups of galaxies have been published in 18 papers.
We analyzed the inner 320 × 535 pc2 of the elliptical galaxy NGC 1052 with integral field spectroscopy, both in the optical and in the near-infrared (NIR). The stellar population analysis revealed a dominance of old stellar populations from the optical data, and an intermediate-age ring from NIR data. When combining optical+NIR data, optical results were favoured. The emission-line analysis revealed five kinematic components, where two of them are unresolved and probably associated with the active galactic nucleus (AGN), one is associated with large-scale shocks, one with the radio jets, and the last could be explained by either a bipolar outflow, rotation in an eccentric disc or a combination of a disc and large-scale gas bubbles. Our results also indicate that the emission within the galaxy is caused by a combination of shocks and photoionization by the AGN.
We present the first results of the Deep Integral Field Spectroscopy View of Nuclei of Galaxies (DIVING3D) survey, obtained from the analysis of the nuclear emission-line spectra of a sub-sample we call mini-DIVING3D, including all southern galaxies with B < 11.2 and |b| >15°. In comparison with previous studies, very few galaxies were classified as Transition objects. A possible explanation is that at least part of the Transition objects are composite systems, with a central low-ionization nuclear emission-line region (LINER) contaminated by the emission from circumnuclear H II regions. The high spatial resolution of the DIVING3D survey allowed us to isolate the nuclear emission from circumnuclear contaminations, reducing the number of Transition objects.
In this work, we present preliminary results regarding the nuclear emission lines of a statistically complete sample of 56 early-type galaxies that are part of the Deep Integral Field Spectroscopy View of Nuclei of Galaxies (DIVING3D) Project. All early type galaxies (ETGs) were observed with the Gemini Multi-Object Spectrograph Integral Field Unit (GMOS-IFU) installed on the Gemini South Telescope. We detected emission lines in 93% of the sample, mostly low-ionization nuclear emission-line region galaxies (LINERs). We did not find Transition Objects nor H II regions in the sample. Type 1 objects are seen in ∼23% of the galaxies.
Understanding the interplay between the phenomena of active galactic nuclei (AGN) and starbursts remains an open issue in studies of galaxy evolution. The galaxy NGC 34 is the remnant of the merger of two former gas-rich disc galaxies and it also hosts a strong nuclear starburst. In this work, we map the ionized and molecular gas present in the nuclear regions of the galaxy NGC 34 using adaptive optics (AO) assisted near infrared (NIR) integral field unity (IFU) observations. Our main goals are to better constrain the energy source of this object and to use NGC 34 as a laboratory to probe the AGN-starburst connection in the context of galaxy evolution and AGN feeding and feedback processes.
In a reactor plasma like demonstration power station (DEMO), when using the radio frequency (RF) for heating or current drive in the lower hybrid (LH) frequency range (Franke et al., Fusion Engng Des., vol. 96–97, 2015, p. 46; Cardinali et al., Plasma Phys. Control. Fusion, vol. 59, 2017, 074002), a large fraction of the ion population (the continuously born $\unicode[STIX]{x1D6FC}$-particle, and/or the neutral beam injection (NBI) injected ions) is characterized by a non-thermal distribution function. The interaction (propagation and absorption) of the LH wave must be reformulated by considering the quasi-linear approach for each species separately. The collisional slowing down of such an ion population in a background of an electron and ion plasma is balanced by a quasi-linear diffusion in velocity space due to the propagating electromagnetic wave. In this paper, both propagations are considered by including the ion distribution function, solution of the Fokker–Planck equation, which describes the collisional dynamics of the $\unicode[STIX]{x1D6FC}$-particles including the effects of frictional slowing down, energy diffusion and pitch-angle scattering. Analytical solutions of the Fokker–Planck equation for the distribution function of $\unicode[STIX]{x1D6FC}$-particles with a background of ions and electrons at steady state are included in the calculation of the dielectric tensor. In the LH frequency domain, ray tracing (including quasi-linear damping), can be analytically solved by iterating with the Fokker–Planck solution, and the interaction of the LH wave with $\unicode[STIX]{x1D6FC}$-particles, thermal ions and electrons can be accounted self-consistently and the current drive efficiency can be evaluated in this more general scenario.
Functional abilities are needed for activities of daily living. In general, these skills expand with age. We hypothesised that, in contrast to what is normally expected, children surviving the Fontan may have deterioration of functional abilities, and that peri-Fontan stroke is associated with this deterioration. All children registered in the Western Canadian Complex Pediatric Therapies Follow-up Program who survived a Fontan operation in the period 1999–2016 were eligible for inclusion. At the age of 2 years (pre-Fontan) and 4.5 years (post-Fontan), the Adaptive Behavior Assessment System-II general adaptive composite score was determined (population mean: 100, standard deviation: 15). Deterioration of functional abilities was defined as ⩾1 standard deviation decrease in pre- to post-Fontan scores. Perioperative strokes were identified through chart review. Multivariable logistic regression analysis determined predictors of deterioration of functional abilities. Of 133 children, with a mean age at Fontan of 3.3 years (standard deviation 0.8) and 65% male, the mean (standard deviation) general adaptive composite score was 90.6 (17.5) at 2 years and 88.3 (19.1) at 4.5 years. After Fontan, deterioration of functional abilities occurred in 34 (26%) children, with a mean decline of 21.8 (7.1) points. Evidence of peri-Fontan stroke was found in 10 (29%) children who had deterioration of functional abilities. Peri-Fontan stroke (odds ratio 5.00 (95% CI 1.74, 14.36)) and older age at Fontan (odds ratio 1.67 (95% CI 1.02, 2.73)) predicted functional deterioration. The trajectory of functional abilities should be assessed in this population, as more than 25% experience deterioration. Efforts to prevent peri-Fontan stroke, and to complete the Fontan operation at an earlier age, may lead to reduction of this deterioration.
A drift-kinetic model to describe the plasma dynamics in the scrape-off layer region of tokamak devices at arbitrary collisionality is derived. Our formulation is based on a gyroaveraged Lagrangian description of the charged particle motion, and the corresponding drift-kinetic Boltzmann equation that includes a full Coulomb collision operator. Using a Hermite–Laguerre velocity space decomposition of the gyroaveraged distribution function, a set of equations to evolve the coefficients of the expansion is presented. By evaluating explicitly the moments of the Coulomb collision operator, distribution functions arbitrarily far from equilibrium can be studied at arbitrary collisionalities. A fluid closure in the high-collisionality limit is presented, and the corresponding fluid equations are compared with previously derived fluid models.
In the framework of the Astronomical Validation and Early Science activities of the Sardinia Radio Telescope (SRT, www.srt.inaf.it), we performed 22 GHz imaging observations of SNR W44 and IC443. Thanks to the single-dish imaging performances of SRT and innovative ad hoc imaging techniques, we obtained maps that provide a detailed view of the structure of the remnants. We are planning to exploit the high-frequency radio data of SNRs to better characterize the spatially-resolved spectra and search for possible spectral steepening or breaks in selected SNR regions, assessing the high-energy tail of the region-dependent electron distribution.
The aim of this study was to compare a fully slatted concrete floor (concrete slatted (CS)) with the same floor on which synthetic rubber slats were placed on the concrete slats (rubber slatted (RS)) as housing solution for finishing beef cattle. The present study involved five commercial beef cattle farms in which the floor of at least three pens was kept as fully slatted, and in an equal number of pens a rubber cover was placed on the floor, tightly matching the gap profile of the concrete slats to allow the drainage of manure. A total of 326 finishing beef bulls were used (153 on CS and 173 on RS), and regardless of the floor treatment animals were housed in groups of 6 to 12 bulls/pen with a space allowance of 3.1±0.2 m2/bull. Bulls had similar initial live weights (422.3 kg on CS and 425.0 kg on RS), but bulls on RS were heavier at the end of the finishing period with a higher average daily gain than bulls kept on CS (1.53 v. 1.46 kg/day; P<0.05). The proportion of bulls treated for locomotor problems was lower in RS pens compared with CS. Rubber covering prevented the occurrence of bursitis, but it increased the odds for hoof overgrowth at end of the finishing period. Hoof overgrowth detected in vivo in bulls on RS was confirmed at the slaughterhouse by the longer dorsal wall and diagonal lengths of the hoof as well as by a more acute toe angle. Compared with bulls on CS, bulls on RS showed less inactivity and resting time, increased social interactions, decreased abnormal lying down and unsuccessful attempts to lie down, as well as shortened the time for lying down. Bulls in RS pens were dirtier compared with those in CS pens, likely due to the draining gaps being reduced to 11.6±1.2% of the total pen surface compared with the 16.9±1.7% in CS pens. This study gave further evidence about the positive effects of the RS floor on growth performance and welfare of finishing beef cattle, although compromising cleanliness and hoof overgrowth.