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For vascular trauma purposes the abdomen is divided into four retroperitoneal anatomical areas:
Zone 1: The midline retroperitoneum from the aortic hiatus to the sacral promontory is broken into supramesocolic and inframesocolic areas. The supramesocolic area contains the suprarenal aorta and its major branches (celiac artery, superior mesenteric artery, and renal arteries), the supramesocolic segment of the inferior vena cava with its major branches, and the superior mesenteric vein. The inframesocolic area contains the infrarenal aorta and infrarenal inferior vena cava.
Zone 2 (left and right): This is the paired right and left region lateral of Zone 1 containing the kidneys and renal vessels.
Zone 3: The pelvic retroperitoneum, which contains the iliac vessels.
The abdominal aorta originates between the two crura of the diaphragm at the level of T12–L1 and bifurcates into the common iliac arteries at the level of L4–5. The umbilicus is an approximate external landmark for the aortic bifurcation. The first large branch is the celiac trunk, followed by the superior mesenteric artery 1–2 cm inferiorly, and both course anteriorly and inferiorly. The renal arteries originate 1–2 cm below the origin of the superior mesenteric artery at the level of L2 and course laterally. Finally, the inferior mesenteric artery originates 2–5 cm above the aortic bifurcation on the left anterior aspect of the aorta.
Celiac artery: The main trunk originates on the anterior surface of the aorta at the level of T12–L1. It is 1–2 cm long and divides into three branches at the upper border of the pancreas—the common hepatic, left gastric, and splenic arteries. The celiac is encased in extensive fibrous, ganglionic, and lymphatic tissues, which makes surgical dissection of the celiac artery difficult. In 10–20% of patients, the left gastric artery gives off a replaced left hepatic artery that courses through the gastrohepatic omentum and can be injured while mobilizing the left lobe of the liver or lesser curve of the stomach.
Superior mesenteric artery (SMA): The SMA originates from the anterior surface of the aorta at the level of L1, 1–2 cm below the celiac artery. It courses posterior to the neck of the pancreas and anterior to the third part of the duodenum, beyond which it enters the root of the mesentery. SMA branches include the inferior pancreaticoduodenal artery, the middle colic artery, an arterial arcade with 12–18 intestinal branches, the right colic artery, and the ileocolic artery. In 10–20% of patients, the SMA gives off a replaced right hepatic artery, which courses posterior to the head of the pancreas and runs posteriorly and to the right of the portal vein.
Renal arteries: The right renal artery emerges at a slightly higher level and is longer than the left and courses posteriorly to the inferior vena cava. Approximately 30% of patients have more than one renal artery, usually an accessory artery supplying the lower pole of the kidney. Both renal veins lie anteriorly of their accompanying renal arteries. The left renal vein is significantly longer than the right and courses anteriorly to the aorta. The left renal vein drains the left gonadal vein inferiorly, the left adrenal vein superiorly, and the renolumbar vein posteriorly. The right gonadal vein drains directly into the IVC.
Inferior mesenteric artery (IMA): The IMA provides blood supply to the left colon, sigmoid, and the rectum. It communicates with the SMA through the marginal artery of Drummond and arc of Riolan.
Milrinone is a drug frequently used for hemodynamic support in children during critical illness. Although the hemodynamic changes induced by milrinone in children may appear similar to those of adults, the physiologic contributors of these changes remain vastly unknown. A systematic review was conducted to identify studies characterising the hemodynamic effects of milrinone in children during critical illness for hemodynamic support for various medical conditions. Studies were assessed for quality and those of satisfactory quality with pre- and post-operative hemodynamics for each patient were included in the final analyses. Those not limited to children and those not limited to patients with critical illness were excluded from the final analyses. A total of six studies with 791 patients were included in the final analyses. Milrinone infusion doses ranged from 0.3 to 0.75 mcg/kg/minute with the mean infusion dose being 0.5 mcg/kg/minute. Patients whom received milrinone infusion had greater cardiac output, greater left ventricle shortening fraction, lower right ventricular systolic pressure, and lower serum lactate levels. Systolic blood pressure mean arterial blood pressure and arterial oxygen concentration did not significantly change with administration of milrinone. These results were irrespective of milrinone infusion dose, infusion duration, and study size. Milrinone was found to have several beneficial hemodynamic effects in children during critical illness when used at usual clinical doses.
Streaks have been found to be an important part of wall-turbulence dynamics. In this paper, we extend the analysis for unbounded shear flows, in particular a Mach 0.4 round jet, using measurements taken using dual-plane, time-resolved, stereoscopic particle image velocimetry (PIV) taken at pairs of jet cross-sections, allowing the evaluation of the cross-spectral density of streamwise velocity fluctuations resolved into azimuthal Fourier modes. From the streamwise velocity results, two analyses are performed: the evaluation of wavenumber spectra (assuming Taylor’s hypothesis for the streamwise coordinate) and a spectral proper orthogonal decomposition (SPOD) of the velocity field using PIV planes in several axial stations. The methods complement each other, leading to the conclusion that large-scale streaky structures are also present in turbulent jets where they experience large growth in the streamwise direction, energetic structures extending up to eight diameters from the nozzle exit. Leading SPOD modes highlight the large-scale, streaky shape of the structures, whose aspect ratio (streamwise over azimuthal length) is approximately 15. The data were further analysed using SPOD, resolvent and transient growth analyses, good agreement being observed between the models and the leading SPOD mode for the wavenumbers considered. The models also indicate that the lift-up mechanism is active in turbulent jets, with streamwise vortices leading to streaks. The results show that large-scale streaks are a relevant part of the jet dynamics.
The late Miocene is a time of strong environmental change in SW Asia. Himalayan foreland stable isotope data show a shift in the dominant vegetation of the flood plains away from trees and shrubs towards more C4 grasslands at a time when oceanic upwelling increased along the Oman margin. We present integrated geochemical and colour spectral records from International Ocean Discovery Program Site U1456 in the eastern Arabian Sea to reconstruct changing chemical weathering and erosion, as well as relative humidity during this climatic transition. Increasing hematite/goethite ratios derived from spectral data are consistent with long-term drying after c. 7.7 Ma. Times of dry conditions are largely associated with weaker chemical alteration measured by K/Rb and reduced coarse clastic flux, constrained by Si/Al and Zr/Al. A temporary phase of increased humidity from 6.3 to 5.95 Ma shows a reversal to stronger weathering and erosion. Wetter conditions can result in both more and less alteration due to the nonlinear relationship between weathering rates, precipitation and sediment transport times. Trends in relative aridity do not follow existing palaeoceanographic records and are not apparently linked to changes in Tibetan or Himalayan elevation, but more closely correlate with global cooling. An apparent opposing trend in the humidity evolution in the Indus compared to southern China, as tracked by spectrally estimated hematite/goethite, likely reflects differences in the topography in the Indus compared to the Pearl River drainage basins, as well as the generally wetter climate in southern China.
OBJECTIVES/SPECIFIC AIMS: Little is known about potentially obesogenic endocrine-disruptors’ effects on excessive gestational weight gain (GWG) and postpartum weight retention (PPWR), which increase risk of adverse pregnancy and postnatal outcomes. We explored associations between prenatal organophosphate (OP) pesticide exposure and increased weight both during and after pregnancy. METHODS/STUDY POPULATION: Three dimethyl (DM) and three diethyl (DE) OP metabolites were measured in spot urine samples collected at <18, 18-25, and >25 gestational weeks among 688 participants in the Generation R Study. Metabolite levels were expressed as molar concentration/gram creatinine and log10-transformed. GWG and PPWR were calculated as the difference between weight at each prenatal/postnatal visit or maximum gestational weight and pre-pregnancy weight. In covariate-adjusted regression models we assessed associations of metabolite concentrations at each prenatal visit and, where appropriate, averaged across pregnancy with early-to-mid pregnancy, mid-to-late pregnancy, late pregnancy-to-maximum, and total GWG; insufficient and excessive GWG according to Institute of Medicine guidelines; and long-term PPWR at 6 and 10 years postpartum. Based on OP pesticides’ lipophilicity and association with hypomethylation, we investigated interactions with pre-pregnancy body mass index, periconceptional folic acid supplementation, and breastfeeding duration. RESULTS/ANTICIPATED RESULTS: A 10-fold increase in late pregnancy DE metabolite concentration was associated with 1.34 kg [95% confidence interval: 0.55, 2.12] higher late pregnancy-to-maximum GWG. A 10-fold increase in mean DE metabolite concentration across pregnancy was associated with 2.41 kg [0.62, 4.20] lower PPWR at 6 years. Stratified analysis suggested that the prenatal finding was driven by women with pre-pregnancy BMI ≥25 kg/m2, while the postnatal finding was driven by women with pre-pregnancy BMI <25 kg/m2 and with inadequate folic acid supplementation. We found no associations between OP pesticide metabolites and insufficient or excessive weight gain and no interaction with breastfeeding. DISCUSSION/SIGNIFICANCE OF IMPACT: In this longitudinal analysis, we observed a positive association of OP pesticide metabolites with GWG in late pregnancy among overweight/obese women, potentially reflecting inhibition of OP pesticide detoxification by oxidative stress. Postnatally, under/normal weight women with higher OP pesticide metabolites had lower PPWR, possibly due to better metabolic function and a more healthful diet. These results suggest that there may be a critical period during the late phase of pregnancy when OP pesticide exposure may increase GWG, and this association may be amplified in overweight/obese women. Areas for future research include examination of how the interaction between OP pesticides and polymorphisms of the paraoxonase (PON1) gene, which detoxifies OP pesticides, affect GWG/PPWR; exploration of the interplay among maternal pre-pregnancy BMI, oxidative stress, and PON1 levels; and characterization of the variability of OP pesticides exposure across pregnancy using more frequent repeated urine samples.
Child maltreatment has been associated with various cumulative risk factors. However, little is known about the extent to which genetic and environmental factors contribute to individual differences between parents in perpetrating child maltreatment. To estimate the relative contribution of genetic and environmental factors to perpetrating maltreatment we used a parent-based extended family design. Child-reported perpetrated maltreatment was available for 556 parents (283 women) from 63 families. To explore reporter effects (i.e., child perspective on maltreatment), child reports were compared to multi-informant reports. Based on polygenic model analyses, most of the variance related to the perpetration of physical abuse and emotional neglect was explained by common environmental factors (physical abuse: c2 = 59%, SE = 12%, p = .006; emotional neglect: c2 = 47%, SE = 8%, p < .001) whereas genetic factors did not significantly contribute to the model. For perpetrated emotional abuse, in contrast, genetic factors did significantly contribute to perpetrated emotional abuse (h2 = 33%, SE = 8%, p < .001), whereas common environment factors did not. Multi-informant reports led to similar estimates of genetic and common environmental effects on all measures except for emotional abuse, where a multi-informant approach yielded higher estimates of the common environmental effects. Overall, estimates of unique environment, including measurement error, were lower using multi-informant reports. In conclusion, our findings suggest that genetic pathways play a significant role in perpetrating emotional abuse, while physical abuse and emotional neglect are transmitted primarily through common environmental factors. These findings imply that interventions may need to target different mechanisms dependings on maltreatment type.
Traditional synthesis of high-performance bulk ferrites include complex sintering procedures where temperature and soak times to obtain high densities and excellent magnetic properties. Most ferrites must be sintered at hundreds degree centigrade approaching or surpassing 1000oC, and for YIG (yttrium iron garnet), the sintering temperature should be approximately 1450°C. The high sintering temperatures limit the applications of ferrites, for example, the low temperature co-sintering of ceramics with silver electrodes and/or ground planes. For decades, researchers have explored the use of ion-doping, sintering aids, and microstructural refinement. Here, we study the optimization of the sintering profile including multiples temperature and soak times for doped Bi-YIG simples. The results show an improvement in soft magnetic and gyromagnetic properties attributed to the homogenization of grain size and morphology.
Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated.
We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods.
Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%–14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change.
Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.
Motivated by the problem of jet–flap interaction noise, we study the tonal dynamics that occurs when an isothermal turbulent jet grazes a sharp edge. We perform hydrodynamic and acoustic pressure measurements to characterise the tones as a function of Mach number and streamwise edge position. The observed distribution of spectral peaks cannot be explained using the usual edge-tone model, in which resonance is underpinned by coupling between downstream-travelling Kelvin–Helmholtz wavepackets and upstream-travelling sound waves. We show, rather, that the strongest tones are due to coupling between Kelvin–Helmholtz wavepackets and a family of trapped, upstream-travelling acoustic modes in the potential core, recently studied by Towne et al. (J. Fluid Mech. vol. 825, 2017) and Schmidt et al. (J. Fluid Mech. vol. 825, 2017). We also study the band-limited nature of the resonance, showing the high-frequency cutoff to be due to the frequency dependence of the upstream-travelling waves. Specifically, at high Mach number, these modes become evanescent above a certain frequency, whereas at low Mach number they become progressively trapped with increasing frequency, which inhibits their reflection in the nozzle plane.
To investigate the effects of the nozzle-exit conditions on jet flow and sound fields, large-eddy simulations of an isothermal Mach 0.9 jet issued from a convergent-straight nozzle are performed at a diameter-based Reynolds number of
. The simulations feature near-wall adaptive mesh refinement, synthetic turbulence and wall modelling inside the nozzle. This leads to fully turbulent nozzle-exit boundary layers and results in significant improvements for the flow field and sound predictions compared with those obtained from the typical approach based on laminar flow in the nozzle. The far-field pressure spectra for the turbulent jet match companion experimental measurements, which use a boundary-layer trip to ensure a turbulent nozzle-exit boundary layer to within 0.5 dB for all relevant angles and frequencies. By contrast, the initially laminar jet results in greater high-frequency noise. For both initially laminar and turbulent jets, decomposition of the radiated noise into azimuthal Fourier modes is performed, and the results show similar azimuthal characteristics for the two jets. The axisymmetric mode is the dominant source of sound at the peak radiation angles and frequencies. The first three azimuthal modes recover more than 97 % of the total acoustic energy at these angles and more than 65 % (i.e. error less than 2 dB) for all angles. For the main azimuthal modes, linear stability analysis of the near-nozzle mean-velocity profiles is conducted in both jets. The analysis suggests that the differences in radiated noise between the initially laminar and turbulent jets are related to the differences in growth rate of the Kelvin–Helmholtz mode in the near-nozzle region.
Early childhood aggressive behaviour is a predictor of future violence. Therefore, identifying risk factors for children’s aggressive behaviour is important in understanding underlying mechanisms. Maternal postpartum depression is a known risk factor. However, little research has focused on the influence of paternal behaviour on early childhood aggression and its interaction with maternal postpartum depression.
This study was performed in two cohorts: the Fathers Project, in the United Kingdom (n = 143) and the Generation R Study, in The Netherlands (n = 549). In both cohorts, we related paternal antisocial personality (ASP) traits and maternal postpartum depressive (PPD) symptoms to childhood aggressive behaviour at age two (Fathers Project) and age three (Generation R Study). We additionally tested whether the presence of paternal ASP traits increased the association between maternal PPD–symptoms and early childhood aggression.
The association between paternal ASP traits and early childhood aggressive behaviour, corrected for maternal PPD-symptoms, was similar in magnitude between the cohorts (Fathers Project: standardized β = 0.12, p = 0.146; Generation R: β = 0.14, p = 0.001), although the association was not statistically significant in the Fathers Project. Strikingly, and in contrast to our expectations, there was evidence of a negative interaction between paternal ASP traits and maternal PPD-symptoms on childhood aggressive behaviour (Fathers Project: β = −0.20, p = 0.020; Generation R: β = −0.09, p = 0.043) in both studies. This meant that with higher levels of paternal ASP traits the association between maternal PPD-symptoms and childhood aggressive behaviour was less and vice versa.
Our findings stress the importance of including both maternal and paternal psychopathology in future studies and interventions focusing on early childhood aggressive behaviour.
Band ogives are a striking and enigmatic feature of Mer de Glace glacier flow. The surface mass balances (SMBs) of these ogives have been thoroughly investigated over a period of 12 years. We find similar cumulative SMBs over this period, ranging between −64.1 and −66.2 m w.e., on the dark and light ogives even though the dark ogive albedo is ~40% lower than that of the light ogives. We, therefore, looked for another process that could compensate for the large difference of absorbed short-wave radiation between dark and light ogives. Based on in situ roughness measurements, our numerical modeling experiments demonstrate that a significant difference in turbulent flux over the dark and light ogives due to different surface roughnesses could compensate for the difference in radiative forcing. Our results discard theories for the genesis of band ogives that are based on the assumption of a strong ice ablation contrast between dark and light ogives. More generally, our study demonstrates that future roughness changes are as important to analyze as the radiative impacts of a potential increase of aerosols or debris at the surface of glaciers.
Recent helioseismic estimates of the deep solar meridional flow have been contradictory. Using two years worth of GONG data, I show here that the detection of the meridional flow is ambiguous below about 0.85 solar radii.
Symptoms of anxiety and depression are prevalent in older adults.
To compare clinician-guided and self-guided versions of a transdiagnostic
internet-delivered cognitive–behavioural therapy (iCBT) intervention for
adults aged 60 years and above.
Adults (n=433) with symptoms of anxiety and depression
were randomly allocated to: (1) clinician-guided treatment
(n=153); (2) initial clinician interview followed by
self-guided treatment (n=140); or (3) self-guided
treatment without interview (n=140).
Large reductions (d ≥1.00) in symptoms of depression and
anxiety were observed across groups, and sustained at follow-up. No
differences were observed in clinical outcomes or satisfaction ratings.
Age did not affect outcomes.
Carefully developed iCBT interventions may significantly reduce symptoms
of anxiety and depression in older adults when delivered in either
clinician-guided or self-guided formats.
The Wellbeing Plus Course is an internet-delivered psychological intervention for older adults with anxiety or depression.
To compare the effectiveness of the Wellbeing Plus Course in a public health setting (clinic group) with its efficacy in a randomised controlled trial (research group).
Participants (n = 949) were Australian adults aged 60 and above. Primary outcome measures were the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder scale (GAD-7).
Initial symptom severity was higher in the clinic group and course completion was lower. Both groups showed significant symptom reductions at post-treatment and were satisfied with the treatment. Results were maintained at 3-month follow-up. Within-group symptom changes were comparable between settings; there were no between-group differences on primary outcomes or satisfaction.
The Wellbeing Plus Course is as effective and acceptable in routine clinical care, as it is in controlled research trials.
The purpose of this paper is to characterize and model waves that are observed within the potential core of subsonic jets and relate them to previously observed tones in the near-nozzle region. The waves are detected in data from a large-eddy simulation of a Mach 0.9 isothermal jet and modelled using parallel and weakly non-parallel linear modal analysis of the Euler equations linearized about the turbulent mean flow, as well as simplified models based on a cylindrical vortex sheet and the acoustic modes of a cylindrical soft duct. In addition to the Kelvin–Helmholtz instability waves, three types of waves with negative phase velocities are identified in the potential core: upstream- and downstream-propagating duct-like acoustic modes that experience the shear layer as a pressure-release surface and are therefore radially confined to the potential core, and upstream-propagating acoustic modes that represent a weak coupling between the jet core and the free stream. The slow streamwise contraction of the potential core imposes a frequency-dependent end condition on the waves that is modelled as the turning points of a weakly non-parallel approximation of the waves. These turning points provide a mechanism by which the upstream- and downstream-travelling waves can interact and exchange energy through reflection and transmission processes. Paired with a second end condition provided by the nozzle, this leads to the possibility of resonance in limited frequency bands that are bound by two saddle points in the complex wavenumber plane. The predicted frequencies closely match the observed tones detected outside of the jet. The vortex-sheet model is then used to systematically explore the Mach number and temperature ratio dependence of the phenomenon. For isothermal jets, the model suggests that resonance is likely to occur in a narrow range of Mach number,