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The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use.
Methods:
Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%.
Results:
In each survey, 28−47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%−37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%−41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%−40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60).
Conclusions:
The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.
Many patients with mental health disorders become increasingly isolated at home due to anxiety about going outside. A cognitive perspective on this difficulty is that threat cognitions lead to the safety-seeking behavioural response of agoraphobic avoidance.
Aims:
We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess a wide range of cognitions likely to lead to agoraphobic avoidance. We also included two additional subscales assessing two types of safety-seeking defensive responses: anxious avoidance and within-situation safety behaviours.
Method:
198 patients with psychosis and agoraphobic avoidance and 1947 non-clinical individuals completed the item pool and measures of agoraphobic avoidance, generalised anxiety, social anxiety, depression and paranoia. Factor analyses were used to derive the Oxford Cognitions and Defences Questionnaire (O-CDQ).
Results:
The O-CDQ consists of three subscales: threat cognitions (14 items), anxious avoidance (11 items), and within-situation safety behaviours (8 items). Separate confirmatory factor analyses demonstrated a good model fit for all subscales. The cognitions subscale was significantly associated with agoraphobic avoidance (r = .672, p < .001), social anxiety (r = .617, p < .001), generalized anxiety (r = .746, p < .001), depression (r = .619, p < .001) and paranoia (r = .655, p < .001). Additionally, both the O-CDQ avoidance (r = .867, p < .001) and within-situation safety behaviours (r = .757, p < .001) subscales were highly correlated with agoraphobic avoidance. The O-CDQ demonstrated excellent internal consistency (cognitions Cronbach’s alpha = .93, avoidance Cronbach’s alpha = .94, within-situation Cronbach’s alpha = .93) and test–re-test reliability (cognitions ICC = 0.88, avoidance ICC = 0.92, within-situation ICC = 0.89).
Conclusions:
The O-CDQ, consisting of three separate scales, has excellent psychometric properties and may prove a helpful tool for understanding agoraphobic avoidance across mental health disorders.
This paper explores the screech closure mechanism for different axisymmetric modes in shock-containing jets. While many of the discontinuities in tonal frequency exhibited by screeching jets can be associated with a change in the azimuthal mode, there has to date been no satisfactory explanation for the existence of multiple axisymmetric modes at different frequencies. This paper provides just such an explanation. As shown in previous works, specific wavenumbers arise from the interaction of waves in the flow with the shocks. This provides new paths for driving upstream-travelling waves that can potentially close the resonance loop. Predictions using locally parallel and spatially periodic linear stability analyses and the wavenumber spectrum of the shock-cell structure suggest that the A1 mode resonance is closed by a wave generated when the Kelvin–Helmholtz mode interacts with the leading wavenumber of the shock-cell structure. The A2 mode is closed by a wave that arises owing to the interaction between the Kelvin–Helmholtz wave and a secondary wavenumber peak, which arises from the spatial variation of the shock-cell wavelength. The predictions are shown to closely match experimental data, and possible justifications for the dominance of each mode are provided based on the growth rates of the absolute instability.
To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution.
Design:
Retrospective cohort study.
Setting:
Two affiliated academic medical centers in Los Angeles, California.
Patients:
Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards.
Methods:
We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation.
Results:
Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91–4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28–3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34–0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22–0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria.
Conclusions:
Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.
We present an analysis of the linear stability characteristics of shock-containing jets. The flow is linearised around a spatially periodic mean, which acts as a surrogate for a mean flow with a shock-cell structure, leading to a set of partial differential equations with periodic coefficients in space. Disturbances are written using the Floquet ansatz and Fourier modes in the streamwise direction, leading to an eigenvalue problem for the Floquet exponent. The characteristics of the solution are directly compared with the locally parallel case, and some of the features are similar. The inclusion of periodicity induces minor changes in the growth rate and phase velocity of the relevant modes for small shock amplitudes. On the other hand, the eigenfunctions are now subject to modulation related to the periodicity of the flow. Analysis of the spatio-temporal growth rates led to the identification of a saddle point between the Kelvin–Helmholtz mode and the guided jet mode, characterising an absolute instability mechanism. Frequencies and mode shapes related to the saddle points for two conditions (associated with axisymmetric and helical modes) are compared with screech frequencies and the most energetic coherent structures of screeching jets, resulting in a good agreement for both. The analysis shows that a periodic shock-cell structure has an impulse response that grows upstream, leading to oscillator behaviour. The results suggest that screech can occur in the absence of a nozzle, and that the upstream reflection condition is not essential for screech frequency selection. Connections to previous models are also discussed.
Background: Despite significant morbidity and mortality, estimates of the burden of healthcare-associated viral respiratory infections (HA-VRI) for noninfluenza infections are limited. Of the studies assessing the burden of respiratory syncytial virus (RSV), cases are typically classified as healthcare associated if a positive test result occurred after the first 3 days following admission, which may miss healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated RSV, we assessed the estimates of disease prevalence. Methods: This study included laboratory-confirmed cases of RSV in adult and pediatric patients admitted to acute-care hospitals in a catchment area of 8 counties in Tennessee identified between October 1, 2016, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network by the Emerging Infections Program. Cases were defined as healthcare-associated RSV if laboratory confirmation of infection occurred (1) on or after hospital day 4 (ie, “traditional definition”) or (2) between hospital day 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, “enhanced definition”). The proportion of laboratory-confirmed RSV designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Results: We identified 900 cases of RSV in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 41 (4.6%) were deemed healthcare associated. Adding the cases identified using the enhanced definition, an additional 12 cases (1.3%) were noted in patients transferred from a chronic care facility for the current acute-care admission and 17 cases (1.9%) were noted in patients with a prior acute-care admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated RSV in this cohort was 69 (7.7%) of 900 compared to 13.1% of cases for influenza (Figure 1). Although the burden of HA-VRI due to RSV was less than that of influenza, when stratified by age, the rate increased to 11.7% for those aged 50–64 years and to 10.1% for those aged ≥65 years (Figure 2). Conclusions: RSV infections are often not included in estimates of HA-VRI, but the proportion of cases that are healthcare associated are substantial. Typical surveillance methods likely underestimate the burden of disease related to RSV, especially for those aged ≥50 years.
Background: Healthcare-associated transmission of influenza leads to significant morbidity, mortality, and cost. Most studies classify healthcare-associated viral respiratory infections (HA-VRI) as those with a positive test result after the first 3 days following admission, which does not account for healthcare exposures prior to admission. Utilizing an expanded definition of healthcare-associated influenza, we aimed to improve the estimates of disease prevalence on a population level. Methods: This study included laboratory-confirmed cases of influenza in adult and pediatric patients admitted to any acute-care hospital in a catchment area of 8 counties Tennessee identified between October 1, 2012, and April 30, 2019. Surveillance information was abstracted from hospital and state laboratory databases, hospital infection control practitioner databases, reportable condition databases, and electronic health records as a part of the Influenza Hospitalization Surveillance Network (FluSurv-NET) by the Centers for Disease Control and Prevention (CDC) Emerging Infections Program (EIP). Cases were defined as healthcare-associated influenza laboratory confirmation of infection occurred (1) on or after hospital day 4 (“traditional definition”), or (2) between hospital days 0 and 3 in patients transferred from a chronic care facility or with a recent discharge from another acute-care facility in the 7 days preceding the current index admission (ie, enhanced definition). The proportion of laboratory-confirmed influenza designated as HA-VRI using both the traditional definition as well as with the added enhanced definition were compared. Data were imported into Stata software for analysis. Results: We identified 5,904 cases of laboratory-confirmed influenza in hospitalized patients over the study period. Using the traditional definition for HA-VRI, only 147 (2.5%, seasonal range 1.3%–3.4%) were deemed healthcare associated (Figure 1). Adding the cases identified using the enhanced definition, an additional 317 (5.4%, range 2.3%–6.7%) cases were noted in patients transferred from a chronic care facility for the current acute-care admission and 336 cases (5.7%; range, 4.1%–7.4%) were noted in patients with a prior acute-care facility admission in the preceding 7 days. Using our expanded definition, the total proportion of healthcare-associated influenza in this cohort was 772 of 5,904 (13.1%; range, 10.6%–14.8%). Conclusion: HA-VRI due to influenza is an underrecognized infection in hospitalized patients. Limiting surveillance assessment of this important outcome to just those patients with a positive influenza test after hospital day 3 captured only 19% of possible healthcare-associated influenza infections across 7 influenza seasons. These results suggest that the traditionally used definitions of healthcare-associated influenza underestimate the true burden of cases.
The present work focuses on the study of the resonance and coupling of an underexpanded circular twin-jet system operating at a nozzle pressure ratio of $5.0$. Particle image velocimetry data from previous work were revisited, and a symmetry-imposed proper orthogonal decomposition (POD) was performed. It is shown that the system is dominated by a single POD mode pair symmetric about the internozzle plane, and the resonance loop is modulated by a third POD mode related to shear thickness modulation. A spatial Fourier transform of the leading POD mode pair leads to the identification of the peak wavenumbers and radial shapes of the different waves at play in the screech phenomenon. Locally parallel linear stability analysis around the experimental mean flow is also performed, in order to provide clarification of the mode ‘locking’ mechanism, i.e. the selection of the global mode associated with screech. It is shown that the characteristics of the Kelvin–Helmholtz wavepackets alone are not sufficient to explain the coupling observed in the experimental data. A consideration of the upstream-travelling guided jet mode offers an explanation; only specific symmetries of upstream modes can be supported in the frequency range at which resonance occurs. Results from stability analysis point to structures at frequencies and wavenumbers close to those found experimentally, and their spatial structures show excellent agreement with the POD modes. The present results suggest that the resonance loop is closed by an upstream-travelling guided jet mode for the twin-jet system at high nozzle pressure ratio.
Discrepancies exist in reports of social cognition deficits in individuals with premanifest Huntington’s disease (HD); however, the reason for this variability has not been investigated. The aims of this study were to (1) evaluate group- and individual-level social cognitive performance and (2) examine intra-individual variability (dispersion) across social cognitive domains in individuals with premanifest HD.
Method:
Theory of mind (ToM), social perception, empathy, and social connectedness were evaluated in 35 individuals with premanifest HD and 29 healthy controls. Cut-off values beneath the median and 1.5 × the interquartile range below the 25th percentile (P25 – 1.5 × IQR) of healthy controls for each variable were established for a profiling method. Dispersion between social cognitive domains was also calculated.
Results:
Compared to healthy controls, individuals with premanifest HD performed worse on all social cognitive domains except empathy. Application of the profiling method revealed a large proportion of people with premanifest HD fell below healthy control median values across ToM (>80%), social perception (>57%), empathy (>54%), and social behaviour (>40%), with a percentage of these individuals displaying more pronounced impairments in empathy (20%) and ToM (22%). Social cognition dispersion did not differ between groups. No significant correlations were found between social cognitive domains and mood, sleep, and neurocognitive outcomes.
Conclusions:
Significant group-level social cognition deficits were observed in the premanifest HD cohort. However, our profiling method showed that only a small percentage of these individuals experienced marked difficulties in social cognition, indicating the importance of individual-level assessments, particularly regarding future personalised treatments.
We present a two-point model to investigate the underlying source mechanisms for broadband shock-associated noise (BBSAN) in shock-containing supersonic jets. In the model presented, the generation of BBSAN is assumed to arise from the nonlinear interaction between downstream-propagating coherent structures with the quasi-periodic shock cells in the jet plume. The turbulent perturbations are represented as axially extended wavepackets and the shock cells are modelled as a set of stationary waveguide modes. Unlike previous BBSAN models, the physical parameters describing the hydrodynamic components are not scaled using the acoustic field. Instead, the source characteristics of both the turbulent and shock components are extracted from the hydrodynamic region of large-eddy simulation and particle image velocimetry datasets. Apart from using extracted data, a reduced-order description of the wavepacket structure is obtained using parabolised stability equations. The validity of the model is tested by comparing far-field sound pressure level predictions to azimuthally decomposed experimental acoustic data from a cold Mach 1.5 underexpanded jet. At polar angles and frequencies where BBSAN dominates, encouraging comparisons of the radiated noise spectra for the first three azimuthal modes, in both frequency and amplitude (${\pm }2\ \textrm {dB}\,\textrm {St}^{-1}$ at peak frequency), reinforce the suitability of using reduced-order wavepacket sources for predicting BBSAN peaks. On the other hand, wavepacket jitter is found to have a critical role in recovering sound amplitude at interpeak frequencies. The paper presents a quantitative demonstration that the wavepacket–shock interaction, carefully reconstructed by extracting components from data or linearised models, contains the correct essential flow physics that accounts for most features of the far-field BBSAN spectra.
The interaction between various wave-like structures in screeching jets is considered via both experimental measurements and linear stability theory. Velocity snapshots of screeching jets are used to produce a reduced-order model of the screech cycle via proper orthogonal decomposition. Streamwise Fourier filtering is then applied to isolate the negative and positive wavenumber components, which for the waves of interest in this jet correspond to upstream- and downstream-travelling waves. A global stability analysis on an experimentally derived base flow is conducted, demonstrating a close match to the results obtained via experiment, indicating that the mechanisms considered here are well represented in a linear framework. In both the global stability analysis and the experimental decomposition, three distinct wave-like structures are evident; these waves are also solutions to the cylindrical vortex-sheet dispersion relation. One of the waves is the well-known downstream-travelling Kelvin–Helmholtz mode. Another is the upstream-travelling guided jet mode that has been a topic of recent discussion by a number of authors. The third component, with positive phase velocity, has not previously been identified in screeching jets. Via a local stability analysis, we provide evidence that this downstream-travelling wave is a duct-like mode similar to that recently identified in high-subsonic jets. We further demonstrate that both of the latter two waves are generated by the interaction between the Kelvin–Helmholtz wavepacket and the shock cells in the flow. Finally, we consider the periodic spatial modulation of the coherent velocity fluctuation evident in screeching jets, and show that this modulation can be at least partially explained by the superposition of the three wave-like structures, in addition to any possible modulation of the Kelvin–Helmholtz wavepacket by the shocks themselves.
The mechanism underpinning the generation of screech tones has remained an open question for many years. In this paper, direct experimental observations of the shock-leakage mechanism first proposed by Manning & Lele (AIAA Paper 1998, p. 282) are presented. Ultra-high-speed schlieren images are filtered to preserve only upstream-propagating components, with the upstream motion of the shock tip and subsequent emission of an acoustic wave visible for a number of operating conditions. The flow visualizations are supported by the ray-tracing model for shock leakage of Shariff & Manning (Phys. Fluids., vol. 25, issue 7, 2013, 076103), applied to velocity fields corresponding to a reconstructed screech cycle. The predictions of the model, when applied to real data, are in close agreement with the phenomena observed in the flow visualizations. It is demonstrated that shock leakage does not necessarily occur either at the point of maximum wave amplitude or maximum vorticity fluctuation. While the first point of shock leakage is shown to vary between cases, sound emission from multiple sources is observed for most cases considered. Finally, it is shown that variations in vortex strength captured in the velocity data are sufficient to explain variation in shock-leakage location observed in the flow visualization data.
The ‘16Up’ study conducted at the QIMR Berghofer Medical Research Institute from January 2014 to December 2018 aimed to examine the physical and mental health of young Australian twins aged 16−18 years (N = 876; 371 twin pairs and 18 triplet sets). Measurements included online questionnaires covering physical and mental health as well as information and communication technology (ICT) use, actigraphy, sleep diaries and hair samples to determine cortisol concentrations. Study participants generally rated themselves as being in good physical (79%) and mental (73%) health and reported lower rates of psychological distress and exposure to alcohol, tobacco products or other substances than previously reported for this age group in the Australian population. Daily or near-daily online activity was almost universal among study participants, with no differences noted between males and females in terms of frequency or duration of internet access. Patterns of ICT use in this sample indicated that the respondents were more likely to use online information sources for researching physical health issues than for mental health or substance use issues, and that they generally reported partial levels of satisfaction with the mental health information they found online. This suggests that internet-based mental health resources can be readily accessed by adolescent Australians, and their computer literacy augurs well for future access to online health resources. In combination with other data collected as part of the ongoing Brisbane Longitudinal Twin Study, the 16Up project provides a valuable resource for the longitudinal investigation of genetic and environmental contributions to phenotypic variation in a variety of human traits.
Precise instrumental calibration is of crucial importance to 21-cm cosmology experiments. The Murchison Widefield Array’s (MWA) Phase II compact configuration offers us opportunities for both redundant calibration and sky-based calibration algorithms; using the two in tandem is a potential approach to mitigate calibration errors caused by inaccurate sky models. The MWA Epoch of Reionization (EoR) experiment targets three patches of the sky (dubbed EoR0, EoR1, and EoR2) with deep observations. Previous work in Li et al. (2018) and (2019) studied the effect of tandem calibration on the EoR0 field and found that it yielded no significant improvement in the power spectrum (PS) over sky-based calibration alone. In this work, we apply similar techniques to the EoR1 field and find a distinct result: the improvements in the PS from tandem calibration are significant. To understand this result, we analyse both the calibration solutions themselves and the effects on the PS over three nights of EoR1 observations. We conclude that the presence of the bright radio galaxy Fornax A in EoR1 degrades the performance of sky-based calibration, which in turn enables redundant calibration to have a larger impact. These results suggest that redundant calibration can indeed mitigate some level of model incompleteness error.
In this study large-eddy simulations of under-expanded supersonic impinging jets are performed to develop a better understanding of the characteristics of the acoustic and hydrodynamic waves. Time history, dispersion relation and autocorrelation of the velocity and pressure fluctuations are used to investigate the propagation velocity, time and length scales of the dominant flow structures in the shear layer and near field. The mechanism by which the initial high-frequency instabilities change to low-frequency coherent structures within a short distance is investigated utilising Mach energy norm and linear spatial instability analysis with streamwise varying mean flow profiles. It is shown that the hydrodynamic and acoustic wavepackets have different propagation velocities and length scales while having a similar dominant frequency. It is also observed that the hydrodynamic wavepackets form approximately one jet diameter downstream of the nozzle lip. No evidence has been found to support the ‘collective interactive’ mechanism proposed by Ho & Nosseir (J. Fluid Mech., vol. 105, 1981, pp. 119–142). The ‘vortex pairing’ proposed by Winant & Browand (J. Fluid Mech., vol. 63, 1974, pp. 237–255) is observed near the nozzle; however, it has an insignificant role in the sharp reduction of the most unstable frequency of disturbances. Nonetheless, both Mach energy norm and linear spatial instability analyses show that the most unstable frequency of disturbances decreases rapidly in a very short distance from the nozzle lip in the near-nozzle region through the spatial growth of instabilities where the linear instability analysis overpredicts the frequency of the most unstable instabilities downstream of the nozzle.
Motivated by the success of wavepackets in modelling the noise from subsonic and perfectly expanded supersonic jets, we apply the wavepacket model to imperfectly expanded supersonic jets. Recent studies with subsonic jets have demonstrated the importance of capturing the ‘jitter’ of wavepackets in order to correctly predict the intensity of far-field sound. Wavepacket jitter may be statistically represented using a two-point coherence function; accurate prediction of noise requires identification of this coherence function. Following the analysis of Cavalieri & Agarwal (J. Fluid Mech., vol. 748, 2014. pp. 399–415), we extend their methodology to model the acoustic sources of broadband shock-associated noise in imperfectly expanded supersonic jets using cross-spectral densities of the turbulent and shock-cell quantities. The aim is to determine the relationship between wavepacket coherence-decay and far-field broadband shock-associated noise, using the model as a vehicle to explore the flow mechanisms at work. Unlike the subsonic case where inclusion of coherence decay amplifies the sound pressure level over the whole acoustic spectrum, we find that it does not play such a critical role in determining the peak sound amplitude for shock-cell noise. When higher-order shock-cell modes are used to reconstruct the acoustic spectrum at higher frequencies, however, the inclusion of a jittering wavepacket is necessary. These results suggest that the requirement for coherence decay identified in prior broadband shock-associated noise (BBSAN) models is in reality the statistical signature of jittering wavepackets. The results from this modelling approach suggest that nonlinear jittering effects of wavepackets need to be included in dynamic models for broadband shock-associated noise.
The role of the external boundary conditions of the nozzle surface on the azimuthal mode selection of impinging supersonic jets is demonstrated for the first time. Jets emanating from thin- and infinite-lipped nozzles at a nozzle pressure ratio of $3.4$ and plate spacing of $5.0D$, where $D$ is the nozzle exit diameter, are investigated using high resolution particle image velocimetry (PIV) and acoustic measurements. Proper orthogonal decomposition is applied to the PIV fields and a difference in dominant instability mode is found. To investigate possible explanations for the change in instability mode, additional nozzle external boundary conditions are investigated, including the addition of acoustic dampening foam. A difference in acoustic feedback path is suggested to be the cause for the change in dominant azimuthal modes between the flows. This is due to the thin-lip case containing a feedback path that is concluded to be closed exclusively by a reflection from the nozzle base surface, rather than directly to the nozzle lip. The ability of the flow to form a feedback path that maximises the impingement tone gain is discussed with consideration of the numerous acoustic feedback paths possible for the given nozzle external boundary conditions.
Increasing evidence indicates that gut microbiota may influence colorectal cancer risk. Diet, particularly fibre intake, may modify gut microbiota composition, which may affect cancer risk. We investigated the relationship between dietary fibre intake and gut microbiota in adults. Using 16S rRNA gene sequencing, we assessed gut microbiota in faecal samples from 151 adults in two independent study populations: National Cancer Institute (NCI), n 75, and New York University (NYU), n 76. We calculated energy-adjusted fibre intake based on FFQ. For each study population with adjustment for age, sex, race, BMI and smoking, we evaluated the relationship between fibre intake and gut microbiota community composition and taxon abundance. Total fibre intake was significantly associated with overall microbial community composition in NYU (P=0·008) but not in NCI (P=0·81). In a meta-analysis of both study populations, higher fibre intake tended to be associated with genera of class Clostridia, including higher abundance of SMB53 (fold change (FC)=1·04, P=0·04), Lachnospira (FC=1·03, P=0·05) and Faecalibacterium (FC=1·03, P=0·06), and lower abundance of Actinomyces (FC=0·95, P=0·002), Odoribacter (FC=0·95, P=0·03) and Oscillospira (FC=0·96, P=0·06). A species-level meta-analysis showed that higher fibre intake was marginally associated with greater abundance of Faecalibacterium prausnitzii (FC=1·03, P=0·07) and lower abundance of Eubacterium dolichum (FC=0·96, P=0·04) and Bacteroides uniformis (FC=0·97, P=0·05). Thus, dietary fibre intake may impact gut microbiota composition, particularly class Clostridia, and may favour putatively beneficial bacteria such as F. prausnitzii. These findings warrant further understanding of diet–microbiota relationships for future development of colorectal cancer prevention strategies.
Experimental evidence is provided to demonstrate that the upstream-travelling waves in two jets screeching in the A1 and A2 modes are not free-stream acoustic waves, but rather waves with support within the jet. Proper orthogonal decomposition is used to educe the coherent fluctuations associated with jet screech from a set of randomly sampled velocity fields. A streamwise Fourier transform is then used to isolate components with positive and negative phase speeds. The component with negative phase speed is shown, by comparison with a vortex-sheet model, to resemble the upstream-travelling jet wave first studied by Tam & Hu (J. Fluid Mech., vol. 201, 1989, pp. 447–483). It is further demonstrated that screech tones are only observed over the frequency range where this upstream-travelling wave is propagative.