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While echocardiographic parameters are used to quantify ventricular function in infants with single ventricle physiology, there are few data comparing these to invasive measurements. This study correlates echocardiographic measures of diastolic function with ventricular end-diastolic pressure in infants with single ventricle physiology prior to superior cavopulmonary anastomosis.
Data from 173 patients enrolled in the Pediatric Heart Network Infant Single Ventricle enalapril trial were analysed. Those with mixed ventricular types (n = 17) and one outlier (end-diastolic pressure = 32 mmHg) were excluded from the analysis, leaving a total sample size of 155 patients. Echocardiographic measurements were correlated to end-diastolic pressure using Spearman’s test.
Median age at echocardiogram was 4.6 (range 2.5–7.4) months. Median ventricular end-diastolic pressure was 7 (range 3–19) mmHg. Median time difference between the echocardiogram and catheterisation was 0 days (range −35 to 59 days). Examining the entire cohort of 155 patients, no echocardiographic diastolic function variable correlated with ventricular end-diastolic pressure. When the analysis was limited to the 86 patients who had similar sedation for both studies, the systolic:diastolic duration ratio had a significant but weak negative correlation with end-diastolic pressure (r = −0.3, p = 0.004). The remaining echocardiographic variables did not correlate with ventricular end-diastolic pressure.
In this cohort of infants with single ventricle physiology prior to superior cavopulmonary anastomosis, most conventional echocardiographic measures of diastolic function did not correlate with ventricular end-diastolic pressure at cardiac catheterisation. These limitations should be factored into the interpretation of quantitative echo data in this patient population.
The bifurcation of two-dimensional gravity–capillary waves into solitary waves when the phase velocity and group velocity are nearly equal is investigated in the presence of constant vorticity. We found that gravity–capillary solitary waves with decaying oscillatory tails exist in deep water in the presence of vorticity. Furthermore we found that the presence of vorticity influences strongly (i) the solitary wave properties and (ii) the growth rate of unstable transverse perturbations. The growth rate and bandwidth instability are given numerically and analytically as a function of the vorticity.
A nonlinear Schrödinger equation for the envelope of two-dimensional gravity–capillary waves propagating at the free surface of a vertically sheared current of constant vorticity is derived. In this paper we extend to gravity–capillary wave trains the results of Thomas et al. (Phys. Fluids, 2012, 127102) and complete the stability analysis and stability diagram of Djordjevic & Redekopp (J. Fluid Mech., vol. 79, 1977, pp. 703–714) in the presence of vorticity. The vorticity effect on the modulational instability of weakly nonlinear gravity–capillary wave packets is investigated. It is shown that the vorticity modifies significantly the modulational instability of gravity–capillary wave trains, namely the growth rate and instability bandwidth. It is found that the rate of growth of modulational instability of short gravity waves influenced by surface tension behaves like pure gravity waves: (i) in infinite depth, the growth rate is reduced in the presence of positive vorticity and amplified in the presence of negative vorticity; (ii) in finite depth, it is reduced when the vorticity is positive and amplified and finally reduced when the vorticity is negative. The combined effect of vorticity and surface tension is to increase the rate of growth of modulational instability of short gravity waves influenced by surface tension, namely when the vorticity is negative. The rate of growth of modulational instability of capillary waves is amplified by negative vorticity and attenuated by positive vorticity. Stability diagrams are plotted and it is shown that they are significantly modified by the introduction of the vorticity.
The ideal sampling method and benefit of qualitative versus quantitative culture for carbapenem-resistant Enterobacteriaceae (CRE) recovery in hospitalized patient rooms and bathrooms is unknown. Although the use of nylon-flocked swabs improved overall gram-negative organism recovery compared with cellulose sponges, they were similar for CRE recovery. Quantitative culture was inferior and unrevealing beyond the qualitative results.
As the consciousness of energy saving and carbon reduction and comfortable environment is paid increasing attention to, the common objective of various countries with decreasing energy is to develop and popularize high efficiency and low running noise blowers. This study uses CFD to calculate the flow field and performance of a blower and compare with the experimental measurement. The characteristic curve of blower shows that the simulated and experimental values are close to each other, the difference between the values is only 0.4%. This analysis result proofs the CFD package is a highly reliable tool for the future blower design improvement. In addition, this study discusses the noise distribution of blower flow field, the periodic pressure output value calculated by CFD is used in the sound source input of sound pressure field, so as to simulate and analyze the aerodynamic noise reading of the flow field around the blower. The result shows that the simulated value of flow field around the fan has as high as 80.5 dB(A) ∼ 81.5 dB(A) noise level and is agree with measurement (82 dB(A)). The noise level is low but has a sharp noise. According to the numerical results, designer of the blower modify the tongue geometry and remove the sharp noise.
Prior to integrated circuit (IC) packaging, die performance must be verified using probe cards to screen for defective products. With the decrease in IC line width, the dimensions of the pads used for performance verification and the spacing between adjacent pads have also decreased. However, when the pad pitch is reduced to less than 30 μm, commonly used probe cards will face manufacturing problems in miniaturization. To resolve probe card manufacturing problems caused by the miniaturization of IC components, the use of an anisotropic conductive film (ACF) in probe cards was proposed in this study. Theoretical calculations and experimental testing of this probe structure were conducted to demonstrate the feasibility of this concept.
In theoretical calculations, composite material and buckling theory were utilized to evaluate the buckling behavior of the ACF. In experimental testing, photolithography and electroplating techniques were used to control the line width and spacing intervals of the micron-scale metal wires in the ACF. After the ACF was fabricated, the mechanical properties of the ACF during wafer testing were assessed. Theoretical analyses and experimental testing verified that ACFs can potentially be applied to the performance verification of IC products. In the ACF structure, multiple probes came into contact with each pad. Therefore, ACFs can potentially be applied to the performance verification of IC components with pad diameters of less than 20 μm. The results of this study directly benefit the miniaturization of ICs.
A few studies have evaluated the impact of clinical trial results on practice in paediatric cardiology. The Infant Single Ventricle (ISV) Trial results published in 2010 did not support routine use of the angiotensin-converting enzyme inhibitor enalapril in infants with single-ventricle physiology. We sought to assess the influence of these findings on clinical practice.
A web-based survey was distributed via e-mail to over 2000 paediatric cardiologists, intensivists, cardiothoracic surgeons, and cardiac advance practice nurses during three distribution periods. The results were analysed using McNemar’s test for paired data and Fisher’s exact test.
The response rate was 31.5% (69% cardiologists and 65% with >10 years of experience). Among respondents familiar with trial results, 74% reported current practice consistent with trial findings versus 48% before trial publication (p<0.001); 19% used angiotensin-converting enzyme inhibitor in this population “almost always” versus 36% in the past (p<0.001), and 72% reported a change in management or improved confidence in treatment decisions involving this therapy based on the trial results. Respondents familiar with trial results (78%) were marginally more likely to practise consistent with the trial results than those unfamiliar (74 versus 67%, p=0.16). Among all respondents, 28% reported less frequent use of angiotensin-converting enzyme inhibitor over the last 3 years.
Within 5 years of publication, the majority of respondents was familiar with the Infant Single Ventricle Trial results and reported less frequent use of angiotensin-converting enzyme inhibitor in single-ventricle infants; however, 28% reported not adjusting their clinical decisions based on the trial’s findings.
Researchers have studied psychological disorders extensively from a common cause perspective, in which symptoms are treated as independent indicators of an underlying disease. In contrast, the causal systems perspective seeks to understand the importance of individual symptoms and symptom-to-symptom relationships. In the current study, we used network analysis to examine the relationships between and among depression and anxiety symptoms from the causal systems perspective.
We utilized data from a large psychiatric sample at admission and discharge from a partial hospital program (N = 1029, mean treatment duration = 8 days). We investigated features of the depression/anxiety network including topology, network centrality, stability of the network at admission and discharge, as well as change in the network over the course of treatment.
Individual symptoms of depression and anxiety were more related to other symptoms within each disorder than to symptoms between disorders. Sad mood and worry were among the most central symptoms in the network. The network structure was stable both at admission and between admission and discharge, although the overall strength of symptom relationships increased as symptom severity decreased over the course of treatment.
Examining depression and anxiety symptoms as dynamic systems may provide novel insights into the maintenance of these mental health problems.
The effects of backward inclination angle on flow characteristics and jet dispersion properties of a stack-issued jet in crossflow were studied by means of instantaneous and long-exposure photography, particle image velocimetry (PIV), and tracer-gas concentration detections at a Reynolds number of 2,400, a jet-to-crossflow momentum flux ratio of 1.0, and the backward inclination angles θ = 0° - 60°. Three characteristic flow patterns featured by different near-wake flow structures were found within the surveyed span of the backward inclination angle: low (θ ≤ 25°), mediate (25° < θ < 50°), and high (θ ≥ 50°). In the range of low backward inclination angle, mushroom vortices appeared in the upwind shear layer. Jet fluids were entrained into the jet- and tube-wakes because the near wake region was characterized by a jet-wake vortex and a downwash flow. In the range of mediate backward inclination angle, forward-rolling vortices were formed in the upwind shear layer. Jet fluids were entrained into the jet wake but not appearing in the tube wake because the near wake was characterized by an isolated tube wake and up-going flows. In the range of high backward inclination angle, small-sized forward-rolling vortices were observed in the upwind shear layer. Jet fluids were not observed in both the jet- and tube-wakes because all flows went forward without reversal or vortex, which was similar to that in a jet in co-flow. Large turbulence intensities occurred around the jet-wake vortex and along sides of the tube wake bifurcation line, therefore the mixing at the low backward inclination angles presented better properties than those at mediate and high backward inclination angles owing to the featured flow structures and turbulence intensities.
We present an overview of recent multidisciplinary, multi-institutional efforts to identify and date major sources of combustion aerosol in the current and paleoatmospheres. The work was stimulated, in part, by an atmospheric particle “sample of opportunity” collected at Summit, Greenland in August 1994, that bore the 14C imprint of biomass burning. During the summer field seasons of 1995 and 1996, we collected air filter, surface snow and snowpit samples to investigate chemical and isotopic evidence of combustion particles that had been transported from distant fires. Among the chemical tracers employed for source identification are organic acids, potassium and ammonium ions, and elemental and organic components of carbonaceous particles. Ion chromatography, performed by members of the Climate Change Research Center (University of New Hampshire), has been especially valuable in indicating periods at Summit that were likely to have been affected by the long range transport of biomass burning aerosol. Univariate and multivariate patterns of the ion concentrations in the snow and ice pinpointed surface and snowpit samples for the direct analysis of particulate (soot) carbon and carbon isotopes. The research at NIST is focusing on graphitic and polycyclic aromatic carbon, which serve as almost certain indicators of fire, and measurements of carbon isotopes, especially 14C, to distinguish fossil and biomass combustion sources.
Complementing the chemical and isotopic record, are direct “visual” (satellite imagery) records and less direct backtrajectory records, to indicate geographic source regions and transport paths. In this paper we illustrate the unique way in which the synthesis of the chemical, isotopic, satellite and trajectory data enhances our ability to develop the recent history of the formation and transport of soot deposited in the polar snow and ice.
Major questions remain regarding the dysfunctional neural circuitry underlying the pathophysiology of bipolar disorder (BD) in both youths and adults. In both age groups, studies implicate abnormal intrinsic functional connectivity among prefrontal, limbic and striatal areas.
We collected resting-state functional magnetic resonance imaging (fMRI) data from youths and adults (ages 10–50 years) with BD (n = 39) and healthy volunteers (HV; n = 78). We identified brain regions with aberrant intrinsic functional connectivity in BD by first comparing voxel-wise mean global connectivity and then conducting correlation analyses. We used k-means clustering and multidimensional scaling to organize all detected regions into networks.
Across the brain, we detected areas of dysconnectivity in both youths and adults with BD relative to HV. There were no significant age-group × diagnosis interactions. When organized by interregional connectivity, the areas of dysconnectivity in patients with BD comprised two networks: one of temporal and parietal areas involved in late stages of visual processing, and one of corticostriatal areas involved in attention, cognitive control and response generation.
These data suggest that two networks show abnormal intrinsic functional connectivity in BD. Regions in these networks have been implicated previously in BD. We observed similar dysconnectivity in youths and adults with BD. These findings provide guidance for refining models of network-based dysfunction in BD.
Recent meta-analyses of resting-state networks in major depressive disorder (MDD) implicate network disruptions underlying cognitive and affective features of illness. Heterogeneity of findings to date may stem from the relative lack of data parsing clinical features of MDD such as phase of illness and the burden of multiple episodes.
Resting-state functional magnetic resonance imaging data were collected from 17 active MDD and 34 remitted MDD patients, and 26 healthy controls (HCs) across two sites. Participants were medication-free and further subdivided into those with single v. multiple episodes to examine disease burden. Seed-based connectivity using the posterior cingulate cortex (PCC) seed to probe the default mode network as well as the amygdala and subgenual anterior cingulate cortex (sgACC) seeds to probe the salience network (SN) were conducted.
Young adults with remitted MDD demonstrated hyperconnectivity of the left PCC to the left inferior frontal gyrus and of the left sgACC to the right ventromedial prefrontal cortex (PFC) and left hippocampus compared with HCs. Episode-independent effects were observed between the left PCC and the right dorsolateral PFC, as well as between the left amygdala and right insula and caudate, whereas the burden of multiple episodes was associated with hypoconnectivity of the left PCC to multiple cognitive control regions as well as hypoconnectivity of the amygdala to large portions of the SN.
This is the first study of a homogeneous sample of unmedicated young adults with a history of adolescent-onset MDD illustrating brain-based episodic features of illness.
Combination antibiograms can be used to evaluate organism cross-resistance among multiple antibiotics. As combination therapy is generally favored for the treatment of carbapenemase-producing Enterobacteriaceae (CPE), combination antibiograms provide valuable information about the combination of antibiotics that achieve the highest likelihood of adequate antibiotic coverage against CPE.
Infect. Control Hosp. Epidemiol. 2015;36(12):1458–1460
We describe a laboratory plasma physics experiment at Los Alamos National Laboratory that uses two merging supersonic plasma jets formed and launched by pulsed-power-driven railguns. The jets can be formed using any atomic species or mixture available in a compressed-gas bottle and have the following nominal initial parameters at the railgun nozzle exit: ne ≈ ni ~ 1016 cm−3, Te ≈ Ti ≈ 1.4 eV, Vjet ≈ 30–100 km/s, mean charge
≈ 1, sonic Mach number Ms ≡ Vjet/Cs > 10, jet diameter = 5 cm, and jet length ≈20 cm. Experiments to date have focused on the study of merging-jet dynamics and the shocks that form as a result of the interaction, in both collisional and collisionless regimes with respect to the inter-jet classical ion mean free path, and with and without an applied magnetic field. However, many other studies are also possible, as discussed in this paper.
The Helicon-Cathode(HelCat) device is a medium-size linear experiment suitable for a wide range of basic plasma science experiments in areas such as electrostatic turbulence and transport, magnetic relaxation, and high power microwave (HPM)-plasma interactions. The HelCat device is based on dual plasma sources located at opposite ends of the 4 m long vacuum chamber – an RF helicon source at one end and a thermionic cathode at the other. Thirteen coils provide an axial magnetic field B ⩾ 0.220 T that can be configured individually to give various magnetic configurations (e.g. solenoid, mirror, cusp). Additional plasma sources, such as a compact coaxial plasma gun, are also utilized in some experiments, and can be located either along the chamber for perpendicular (to the background magnetic field) plasma injection, or at one of the ends for parallel injection. Using the multiple plasma sources, a wide range of plasma parameters can be obtained. Here, the HelCat device is described in detail and some examples of results from previous and ongoing experiments are given. Additionally, examples of planned experiments and device modifications are also discussed.
Prevalence of multidrug-resistant (MDR) gram-negative (GN) bacteria is increasing globally and is complicated by patient movement between acute and long-term care facilities (LTCFs). In Asia, the contribution of LTCFs as a source of MDR GN infections is poorly described. We aimed to define the association between residence in LTCFs and MDR GN bloodstream infections (BSIs).
Secondary analysis of data from an observational cohort.
Two tertiary referral hospitals in Singapore, including the 1,400-bed Tan Tock Seng Hospital and the 1,600-bed Singapore General Hospital.
Adult patients with healthcare-onset (HCO) or hospital-onset (HO) GN BSI.
Patients were identified from hospital databases using standard definitions. Risk factors for both MDR GN HCO and HO BSI were analyzed using a multivariable logistic regression model.
A total of 675 episodes of GN BSI occurred over a 31-month period. Residence in a LTCF was an independent risk factor for developing MDR GN BSI (odds ratio [OR], 5.1 [95% confidence interval (CI), 2.2–11.9]; P < .01) when antibiotics were not used within the preceding 30 days. This risk persisted beyond the first 48 hours of hospitalization (OR, 3.4 [95% CI, 1.3–9.0]; P = .01). Previous culture growing an MDR organism (OR, 1.8 [95% CI, 1.3–2.7]; P < .01), previous antibiotic use (OR, 1.8 [95% CI, 1.2–2.6]; P < .01), and intensive care unit stay (OR, 2.2 [95% CI, 1.2–3.9]; P = .01), increased the risk of MDR GN BSI.
Residence in a LTCF is an independent risk factor for MDR GN BSI. Attempts to contain MDR GN bacteria in large Asian cities, where the proportion of the population that is elderly is projected to increase, should include infection prevention strategies that engage LTCFs.
The influences of acoustic excitation on the velocity field and mixing characteristic of a jet in cross-flow were investigated in a wind tunnel. The acoustic excitation waves at resonance Strouhal number were generated by a loudspeaker. The time-averaged velocity field and streamlines of the excited elevated transverse jet in the symmetry plane were measured by a high-speed particle image velocimetry. The visual penetration height and spread width were obtained by using an image processing technique. The dispersion characteristics were obtained from the tracer-gas concentration measurement. The results showed that the streamline pattern of the non-excited transverse jet was significantly modified by the acoustic excitation—the bent streamlines evolved from the jet exit escalated and the vortex rings in the jet and tube wakes and the recirculation bubble in the jet wake disappeared. The time-averaged velocity distributions revealed that the excited transverse jet produces large momentum in the up-shooting direction so that the velocity trajectories were located at levels higher than those of the non-excited one. The mixing characteristics, which include the visual penetration height, spread width, and dispersion, were drastically improved by the acoustic excitation due to the changes in the flow structures. The excited transverse jet characterized at larger jet-to-crossflow momentum flux ratios presented larger improvement in the mixing characteristics than at lower jet-to-crossflow momentum flux ratios.