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We perform three-dimensional numerical simulations to investigate the sedimentation of a single sphere in the absence and presence of a simple cross-shear flow in a yield stress fluid with weak inertia. In our simulations, the settling flow is considered to be the primary flow, whereas the linear cross-shear flow is a secondary flow with amplitude 10 % of the primary flow. To study the effects of elasticity and plasticity of the carrying fluid on the sphere drag as well as the flow dynamics, the fluid is modelled using the elastoviscoplastic constitutive laws proposed by Saramito (J. Non-Newtonian Fluid Mech., vol. 158 (1–3), 2009, pp. 154–161). The extra non-Newtonian stress tensor is fully coupled with the flow equation and the solid particle is represented by an immersed boundary method. Our results show that the fore–aft asymmetry in the velocity is less pronounced and the negative wake disappears when a linear cross-shear flow is applied. We find that the drag on a sphere settling in a sheared yield stress fluid is reduced significantly compared to an otherwise quiescent fluid. More importantly, the sphere drag in the presence of a secondary cross-shear flow cannot be derived from the pure sedimentation drag law owing to the nonlinear coupling between the simple shear flow and the uniform flow. Finally, we show that the drag on the sphere settling in a sheared yield stress fluid is reduced at higher material elasticity mainly due to the form and viscous drag reduction.
We use interface-resolved direct numerical simulations to study the dynamics of a single sediment particle in a turbulent open channel flow over a fixed porous bed. The relative strength of the gravitational acceleration, quantified by the Galileo number, is varied so as to reproduce the different modes of sediment transport – resuspension, saltation and rolling. The results show that the sediment dynamics at lower Galileo numbers (i.e. resuspension and saltation) are mainly governed by the mean flow. Here, the regime of motion can be predicted by the ratio between the gravity and the shear-induced boundary force. In these cases, the sediment particle rapidly takes off when exposed to the flow, and proceeds with an oscillatory motion. Increasing the Galileo number, the frequency of these oscillations increases and their amplitude decreases, until the transport mode switches from resuspension to saltation. In this case, the sediment travels by short successive collisions with the bed. Further increasing the Galileo number, the particle rolls without detaching from the bed. Differently from the previous modes, the motion is triggered by extreme turbulent events, and the particle response depends on the specific initial conditions, at fixed Reynolds number. The results reveal that close to the onset of sediment motion, only turbulent sweeps can effectively trigger the particle motion by increasing the stagnation pressure upstream. We show that for the parameters in this study, a criterion based on the streamwise flow-induced force can successfully predict the incipient movement.
At present, analysis of diet and bladder cancer (BC) is mostly based on the intake of individual foods. The examination of food combinations provides a scope to deal with the complexity and unpredictability of the diet and aims to overcome the limitations of the study of nutrients and foods in isolation. This article aims to demonstrate the usability of supervised data mining methods to extract the food groups related to BC. In order to derive key food groups associated with BC risk, we applied the data mining technique C5.0 with 10-fold cross-validation in the BLadder cancer Epidemiology and Nutritional Determinants study, including data from eighteen case–control and one nested case–cohort study, compromising 8320 BC cases out of 31 551 participants. Dietary data, on the eleven main food groups of the Eurocode 2 Core classification codebook, and relevant non-diet data (i.e. sex, age and smoking status) were available. Primarily, five key food groups were extracted; in order of importance, beverages (non-milk); grains and grain products; vegetables and vegetable products; fats, oils and their products; meats and meat products were associated with BC risk. Since these food groups are corresponded with previously proposed BC-related dietary factors, data mining seems to be a promising technique in the field of nutritional epidemiology and deserves further examination.
Suicide risk is increased in patients with a history of psychiatric hospitalization.
To explore how suicide risk varies by age during psychiatric hospitalization and in the year post-discharge.
This is a population-based case-control study of all suicides (n = 20,675; 70% male) in Sweden aged ≥18 years during 1991–2003. Each suicide was individually matched to 10 population controls by age, sex, and county of residence. Discharge diagnoses of a mental disorder (except dementia and other organic disorders) in the year prior to suicide were identified by register linkage. Odds ratios (OR) were calculated by conditional logistic regression to estimate the relative risk of suicide in those with psychiatric diagnoses compared to the general population. ORs were estimated by age group (18–34 years, 35–49 years, 50–64 years, and ≥ 65 years) and timing of the suicide in relation to discharge.
During hospitalization, the youngest age group had the greatest suicide risk elevation [OR 64 (95% CI 44-92)]. In the first month post-discharge, the oldest age group had the highest suicide risk elevation [OR 162 (95% 66–399) in the first week and OR 127 (95% 67–242) in the second to fourth weeks]. In the remaining eleven months, suicide risk elevation was lower and relatively similar in different age groups.
During the year following psychiatric hospitalization, an especially high attention should be paid to the suicide risk of the elderly patients in the first month post-discharge.
Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of how pharmacotherapy is related to suicide risk is limited.
To explore suicide risk in relation to prescription of antipsychotics and antidepressants.
Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4,000), patients who died by suicide within five years from diagnosis were defined as cases (n = 84; 54% male). Individual matching was performed with schizophrenia controls from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Odds ratios (OR) of the association between medication and suicide risk were calculated by conditional logistic regression.
No significant association was observed between suicide and having ever been prescribed any antidepressant (33 cases and 30 controls) or any antipsychotic (83 cases and 82 controls). A lower suicide risk was found in patients who had ever been prescribed a second generation antipsychotic (risperidone, ziprazidone, olanzapine or clozapine; 12 cases and 23 controls): OR 0.2 (95% confidence interval [CI], 0.1–0.7). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.1 (95% CI, 0.03–0.6).
The lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these medications, to differences in compliance, or to differences in other characteristics associated with a lower suicide risk.
Little is known of the relations between psychosis, religion and suicide. One hundred and fifteen outpatients with schizophrenia or schizo-affective disorder and 30 inpatients without psychotic symptoms were studied using a semi-structured interview assessing religiousness/spirituality. Their past suicide attempts were examined. Additionally, they were asked about the role (protective or incentive) of religion in their decision to commit suicide. Forty-three percent of the patients with psychosis had previously attempted suicide. Religiousness was not associated with the rate of patients who attempted suicide. Twenty-five percent of all subjects acknowledged a protective role of religion, mostly through ethical condemnation of suicide and religious coping. One out of ten patients reported an incentive role of religion, not only due to negatively connotated issues but also to the hope for something better after death. There were no differences between groups (i.e. psychotic vs. non-psychotic patients). Religion may play a specific role in the decisions patients make about suicide, both in psychotic and non-psychotic patients. This role may be protective, a finding particularly important for patients with psychosis who are known to be at high risk of severe suicide attempts. Interventions aiming to lower the number of suicide attempts in patients with schizophrenia should take these data into account.
Anorexia Nervosa (AN) is a serious psychiatric disorder associated with high mortality.
To examine mortality patterns in patients with anorexia nervosa and psychiatric comorbidity.
6009 women who received in-patient treatment for AN between 1973-2003 were followed up retrospectively using Swedish registers. SMR were calculated on the basis of 74 523 person-years for natural causes of death and 80 388 personyears for unnatural causes of death. SMR was calculated for the group as a whole but also for patients with comorbid inpatient-treated psychiatric disorders, defined by respective ICD-codes from the Swedish patient discharge register.
Nearly half of the patients (44.9%) received in-patient treatment for a psychiatric disorder other than AN during the follow-up time. The overall SMR for anorexia nervosa with psychiatric comorbidity was 6.5 (95% CI: 5.2–7.9) for natural causes and 17.6 (95% CI:14.3–21.4) for unnatural causes of death. Comorbid psychiatric disorders yielded very high SMR for unnatural causes of death. The highest SMR for natural causes was estimated for anorexia nervosa with comorbid alcohol use disorder (16.8; 95% CI: 11.7–23.3).
Anorexia nervosa is a disorder with high mortality for natural and unnatural causes of death, especially when psychiatric comorbidity is involved. To correctly diagnose psychiatric comorbidity, particularly alcohol use disorder, and initiate early treatment could be a way to decrease mortality.
Our aim was to identify areas of improvement for current Opioid Maintenance Treatment (OMT) approaches, by analysing European Quality Audit of Opioid Treatment (EQUATOR) data from 8 European countries (Austria, Denmark, France, Germany, Norway, Portugal, Sweden, UK).
A standardised face-to-face survey was administered to OMT patients (OMT-P) and active opioid user (AOU). Reasons for entering and staying out of OMT, rules pertaining to OMT, and factors facilitating OMT retention were compared between countries, and between OMT-P and AOU groups. Both groups were divided into those who never had OMT before [un-experienced OMT-P (n=573) and AOU (n=360)] and those who had been maintained at least once [experienced OMT-P (n=746) and AOU (n=377)].
Motives for starting OMT vary distinctly between countries (p≤0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p≤0.05).
The major strength of this investigation was the homogenous methodology applied in all countries, which enabled new insights in variations between treatment systems and their impact on patient outcome. Treatment systems need to aim an optimal balance between flexibility and structure. Standardised approaches that still permit tailoring treatment to individual patient needs are crucial to yield maximum benefit for patients, and reduce the considerable societal economic burden of addiction.
Suicidal behaviour and deliberate self-harm are common among adults. Research indicates that maintaining contact either via letter or postcard with at-risk adults following discharge from care services can reduce reattempt risk. Feasibility trials demonstrated that intervention through text message was also acceptable to suicide attempters.
The aim of the current study is to investigate the effect of text message intervention versus traditional treatment on reducing the risk of suicide attempt repetition among adults after self-harm.
The study will be a 2-year multicentric randomized controlled trial conducted by the Brest University Hospital, France. Participants will be adults discharged after self–harm, from emergency services or after a short hospitalization. The intervention is comprised of an SMS that will be sent at h48, D7, D15 and monthly during 6 month. The text message enquires about the patients’ well-being and includes information regarding individual sources of help and evidence-based self help strategies. As primary endpoint, we will assess the number of patients who reattempt suicide in each group at 6 months. As secondary endpoints, we will assess the number of patients who reattempt suicide at 13 month, suicidal behaviour at month 6 and 13 and Medical costs at month 13.
Results will be accepted regarding the preliminary results of the study.
This paper describes the design and deployment of a trial SIAM; an easily reproducible intervention that aims to reduce suicide risk in adults after self-harm. It utilizes several characteristics of interventions that have shown a significant reduction in the number of suicide reattempts.
Functional magnetic resonance imaging (fMRI) studies in schizophrenia found altered brain activation patterns during Theory of Mind (ToM) task performance in the so-called ToM-network, recently focusing on over- rather than under-activation. Even though most fMRI-studies applied tasks that might gradually activate the ToM-network, no study so far has investigated the time-course of ToM-performance. Some of the varying activation results might thus be due to time-course of performance.
Our aim was to investigate neural activation over time in schizophrenia compared with a healthy control sample.
Using a block design in fMRI, we presented a sophisticated paradigm that depicts moving geometrical shapes interacting in social patterns. 14 patients with schizophrenia and 15 healthy controls participated in the study. Functional activation patterns were investigated for the first and second half of the videos separately.
Both groups activated brain areas related to the ToM-network during performance of ToM videos as compared to a baseline condition. Most importanly, schizophrenia patients showed activation in ToM-related brain areas only in the second part, while healthy controls activated the ToM-network in the first part of the video presentation.
Results confirm recent findings of an increased activation in ToM-related brain areas in schizophrenia. Moreover, patients activated ToM-related brain areas later than healthy controls. This delay might be due to a general cognitive slowing, symptom-related inhibition of cognition-associated processes or specific delay in task processing. As this is the first study to investigate this time-course of ToM, more research is needed to classify results.
Le suicide et les conduites auto-agressives sont fréquents dans la population adulte. De précédentes études ont prouvé que le fait de maintenir le lien avec le sujet suicidant, par lettres ou cartes postales, après la prise en charge en aigu, réduit le risque de récidive. De plus, les études de faisabilité ont montré que l’intervention par SMS est acceptable pour les patients. L‘objectif principal de cette étude est de démontrer l’efficacité du dispositif de veille par SMS sur la réduction de la récidive suicidaire à 6 mois. Nous présenterons dans un premier temps l’étude de faisabilité puis l’étude multicentrique démarrée dans 8 CHU.
Matériel et méthode
Il s’agira d’un essai de supériorité, contrôlé, randomisé, multicentrique, d’une durée de 2 ans, et piloté par le CHRU de Brest. Les sujets seront des adultes ayant survécu à un passage à l’acte suicidaire, inclus après une prise en charge aux urgences ou une courte hospitalisation. Le recrutement s’étalera sur une période de 9 mois. Les SMS seront envoyés à j2, j7, j15, puis mensuellement. Ces messages se soucieront du bien-être du patient, et lui rappelleront les coordonnées d’urgence dont il dispose en cas de besoin. Les patients seront évalués à j0, puis à 6 et 13 mois. Le critère de jugement principal sera le nombre de patients récidivant à 6 mois, dans le groupe recevant les SMS et dans le groupe témoin (qui bénéficie de la prise en charge de référence). Les critères de jugement secondaires seront le nombre de patients récidivant à 13 mois, le nombre de tentatives de suicide à 6 et 13 mois, le nombre de décès par suicide à 6 et 13 mois, dans les deux groupes. Les idées suicidaires seront évaluées dans chaque groupe, à j0, à 6 mois, et à 13 mois. Enfin, les coûts médicaux et la satisfaction seront évalués à 13 mois.
La fréquence de récidive attendue à 6 mois dans le groupe témoin est de l’ordre de 18 %. Nous espérons la réduire à 9 % grâce au contact par SMS. Afin d’y parvenir, le nombre de sujets nécessaires a été évalué à 530, soit 265 dans chaque bras.
Ce dispositif de veille par SMS s’appuie sur de précédentes interventions, aux résultats significatifs dans le domaine, et est facilement reproductible. Nous proposons d’évaluer son efficacité dans la réduction du risque de récidive suicidaire au sein d’une population d’adultes ayant fait un passage à l’acte.
The purpose of this study was to estimate the general population life-time and point prevalence of visual height intolerance and acrophobia, to define their clinical characteristics and to determine their anxious and depressive comorbidities.
A case-control study was conducted within a German population-based cross-sectional telephone survey. A representative sample of 2,012 individuals aged 14 and above were selected. Defined neurological conditions (migraine, Menière's disease, motion sickness), symptom pattern, age of first manifestation, precipitating height stimuli, course of illness, psychosocial impairment, and comorbidity patterns (anxiety conditions, depressive disorders according to DSM-IV-TR) for vHI and acrophobia were assessed.
The life-time prevalence of vHI was 28.5% (women: 32.4%, men: 24.5%). Initial attacks occurred predominantly (36%) in the second decade. A rapid generalization to other height stimuli and a chronic course of illness with at least moderate impairment were observed. 22.5% of individuals with vHI experienced the intensity of panic attacks. The life-time prevalence of acrophobia was 6.4% (women: 8.6%, men: 4.1%), point prevalence was 2.0% (women: 2.8%; men: 1.1%). VHI and even more acrophobia were associated with high rates of comorbid anxious and depressive conditions. Migraine was both a significant predictor of later acrophobia and a significant consequence of previous acrophobia.
VHI affects nearly a third of the general population; in more than 20% of these persons vHI occasionally develops into panic attacks and in 6.4% it escalates to acrophobia. Symptoms and degree of social impairment form a continuum of mild to seriously distressing conditions in susceptible subjects.
There is a number of strict alcohol and drug abusers all around the world. They need in some funds for substances buying and often they do not have regular work commit a crimes. Besides frequently addicts underestimate their own condition and anosognosia happens regularly.
Sometimes they fear to attend state health institutions even on ambulant and anonymous basis, because it might lead to restriction of their work and life opportunities in consequence in Russia (taking away of drive license etc.). The last one is a way for risks reducing in society to eliminate of dangerous drivers, but it declines of addicts opportunities to get professional medical support from medical specialists. All of these factors lead to pushing out of alcohol and drug users from the society, and as a result lead to increasing of their unhealthy behavior and crime activity.
There is developed system in Germany for incorporation of patients with addiction disorders into the society. It includes some social benefits for patients, encouraging their attending to outpatient departments, facilitating employers to adopt these patients for work.
On the one hand, this approach increases risks for society and patient, because a person with addiction disorder get permission for potential dangerous activity (eg. driving). But ultimately it facilitates for developing of the health behavior by individuals, decreasing of social risks through incorporation of the person to the society and improving of social environment.
Stop the Bleed (STB) is a national initiative that provides lifesaving hemorrhagic control education. In 2019, pharmacists were added as health-care personnel eligible to become STB instructors. This study was conducted to evaluate the efficacy of pharmacist-led STB trainings for school employees in South Texas.
Pharmacist-led STB trainings were provided to teachers and staff in Laredo, Texas. The 60-min trainings included a presentation followed by hands-on practice of tourniquet application, wound-packing, and direct pressure application. Training efficacy was assessed through anonymous pre- and postevent surveys, which evaluated changes in knowledge, comfort level, and willingness to assist in hemorrhage control interventions. Student volunteers (predominantly pharmacy and medical students) assisted in leading the hands-on portion, providing a unique interprofessional learning opportunity.
Participants with previous training (N = 98) were excluded, resulting in a final cohort of 437 (response rate 87.4%). Compared with baseline, comfort level using tourniquets (mean, 3.17/5 vs 4.20/5; P < 0.0001), opinion regarding tourniquet safety (2.59/3 vs 2.94/3; P < 0.0001), and knowledge regarding tourniquets (70.86/100 vs 75.84/100; P < 0.0001) and proper tourniquet placement (2.40/4 vs 3.15/4; P < 0.0001) significantly improved.
Pharmacist-led STB trainings are efficacious in increasing school worker knowledge and willingness to respond in an emergency hemorrhagic situation.
A large body of literature reported widespread structural and functional abnormalities throughout the brain in schizophrenia spectrum disorders (SZ). Corresponding with the typical symptomatology in SZ where sensory dysfunctions contribute to the core social and cognitive impairment, converging evidence suggests a disturbed interplay between higher-order (cognitive) and lower-order (sensory) regions. This talk will discuss the results of several recent studies, investigating brain connectivity in SZ using functional magnetic resonance imaging data from large samples. Within-network sensorimotor as well as sensorimotor-thalamic aberrations in SZ robustly appear among the core findings across studies, both during performance of cognitive tasks and during rest. We utilized machine learning to distinguish SZ from healthy controls based on connectivity profiles. When classifying on sensorimotor connections alone, not only can we reach accuracies largely above chance but also, these accuracies are as good as when incorporating whole brain connectivity in the classification. Whereas the overall accuracy levels in distinguishing SZ from controls are not useful in a clinical context, these results underline the robustness of the sensorimotor findings on the individual subject level. Targeting the sensory and perceptual domains may thus be key for future research to get a better understanding of the heterogeneity of clinical manifestations in severe mental disorders and to map clinical symptoms to imaging phenotypes.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This article presents the findings of the minimally destructive biomolecular species identification method known as ZooMS (zooarchaeology by mass spectrometry) to identify the use and choices of resources for manufacturing leather shoes in urban contexts in Viking and medieval Denmark. Whereas parchment and historical skin samples have been previously analysed by ZooMS, the potential of the method is demonstrated here for archaeological, vegetable-tanned, and waterlogged leather from the eleventh to thirteenth-century Danish cities of Ribe, Odense, and Viborg. Sheep, goat, and cattle were used to produce shoes, with explicit choices of species for specific purposes. The selection seems to be largely based on the skins’ material properties, suggesting that functionality was more important than signalling. The urban environment is seen as promoting synergy among providers of resources, crafts, and customers.