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We study the deformation and dewetting of liquid films under impinging gas jets using experimental, analytical and numerical techniques. We first derive a reduced-order model (a thin-film equation) based on the long-wave assumption and on appropriate decoupling of the gas problem from that for the liquid. The model not only provides insight into relevant flow regimes, but is also used in conjunction with experimental data to guide more computationally prohibitive direct numerical simulations of the full governing equations. A unique feature of our modelling solution is the use of an efficient iterative procedure in order to update the interfacial deformation based on stresses originating from computational data. We show that both gas normal and tangential stresses are equally important for achieving accurate predictions. The interplay between these techniques allows us to study previously unreported flow features. These include finite-size effects of the host geometry, with consequences for flow and vortex formation inside the liquid, as well as the specific individual contributions from the non-trivial gas flow components on interfacial deformation. Dewetting phenomena are found to depend on either a dominant gas flow or contact line motion, with the observed behaviour (including healing effects) being explained using a bifurcation diagram of steady-state solutions in the absence of the gas flow.
Observational studies have found associations between smoking and both poorer cognitive ability and lower educational attainment; however, evaluating causality is challenging. We used two complementary methods to explore this.
We conducted observational analyses of up to 12 004 participants in a cohort study (Study One) and Mendelian randomisation (MR) analyses using summary and cohort data (Study Two). Outcome measures were cognitive ability at age 15 and educational attainment at age 16 (Study One), and educational attainment and fluid intelligence (Study Two).
Study One: heaviness of smoking at age 15 was associated with lower cognitive ability at age 15 and lower educational attainment at age 16. Adjustment for potential confounders partially attenuated findings (e.g. fully adjusted cognitive ability β −0.736, 95% CI −1.238 to −0.233, p = 0.004; fully adjusted educational attainment β −1.254, 95% CI −1.597 to −0.911, p < 0.001). Study Two: MR indicated that both smoking initiation and lifetime smoking predict lower educational attainment (e.g. smoking initiation to educational attainment inverse-variance weighted MR β −0.197, 95% CI −0.223 to −0.171, p = 1.78 × 10−49). Educational attainment results were robust to sensitivity analyses, while analyses of general cognitive ability were less so.
We find some evidence of a causal effect of smoking on lower educational attainment, but not cognitive ability. Triangulation of evidence across observational and MR methods is a strength, but the genetic variants associated with smoking initiation may be pleiotropic, suggesting caution in interpreting these results. The nature of this pleiotropy warrants further study.
Diet has a major influence on the composition and metabolic output of the gut microbiome. Higher-protein diets are often recommended for older consumers; however, the effect of high-protein diets on the gut microbiota and faecal volatile organic compounds (VOC) of elderly participants is unknown. The purpose of the study was to establish if the faecal microbiota composition and VOC in older men are different after a diet containing the recommended dietary intake (RDA) of protein compared with a diet containing twice the RDA (2RDA). Healthy males (74⋅2 (sd 3⋅6) years; n 28) were randomised to consume the RDA of protein (0⋅8 g protein/kg body weight per d) or 2RDA, for 10 weeks. Dietary protein was provided via whole foods rather than supplementation or fortification. The diets were matched for dietary fibre from fruit and vegetables. Faecal samples were collected pre- and post-intervention for microbiota profiling by 16S ribosomal RNA amplicon sequencing and VOC analysis by head space/solid-phase microextraction/GC-MS. After correcting for multiple comparisons, no significant differences in the abundance of faecal microbiota or VOC associated with protein fermentation were evident between the RDA and 2RDA diets. Therefore, in the present study, a twofold difference in dietary protein intake did not alter gut microbiota or VOC indicative of altered protein fermentation.
Spalding Gentlemen’s Society holds, among its varied collections of William Stukeley papers, a virtually unknown set of forty-four important drawings dating from 1720–64. It is an intimate collection closely connected with Stukeley and his immediate family: portraits, his houses and gardens in Lincolnshire and Kentish Town, and a few miscellaneous family history papers. Originally, the collection was bound into an album which, as the latest drawing dates from the year before Stukeley’s death, was almost certainly compiled post mortem by a family member. For many years the collection was lost, but recent investigation has revealed that c 1866–7 it was purchased by Sir Thomas Phillipps, Bart., and sold at auction in 1910. It has been in Spalding ever since, arriving at the Spalding Gentlemen's Society possibly about 1950. Cataloguing the collection was recently undertaken by this author and the enhanced significance given by this and the revealed provenance enabled the Society to apply successfully to the Heritage Lottery Fund for a grant towards conservation and storage. The great value of the collection is that it hugely increases our knowledge of Stukeley’s houses and gardens, particularly his garden works, and illuminates the evolution of Stukeley’s thoughts on garden design.
It is not clear to what extent associations between schizophrenia, cannabis use and cigarette use are due to a shared genetic etiology. We, therefore, examined whether schizophrenia genetic risk associates with longitudinal patterns of cigarette and cannabis use in adolescence and mediating pathways for any association to inform potential reduction strategies.
Associations between schizophrenia polygenic scores and longitudinal latent classes of cigarette and cannabis use from ages 14 to 19 years were investigated in up to 3925 individuals in the Avon Longitudinal Study of Parents and Children. Mediation models were estimated to assess the potential mediating effects of a range of cognitive, emotional, and behavioral phenotypes.
The schizophrenia polygenic score, based on single nucleotide polymorphisms meeting a training-set p threshold of 0.05, was associated with late-onset cannabis use (OR = 1.23; 95% CI = 1.08,1.41), but not with cigarette or early-onset cannabis use classes. This association was not mediated through lower IQ, victimization, emotional difficulties, antisocial behavior, impulsivity, or poorer social relationships during childhood. Sensitivity analyses adjusting for genetic liability to cannabis or cigarette use, using polygenic scores excluding the CHRNA5-A3-B4 gene cluster, or basing scores on a 0.5 training-set p threshold, provided results consistent with our main analyses.
Our study provides evidence that genetic risk for schizophrenia is associated with patterns of cannabis use during adolescence. Investigation of pathways other than the cognitive, emotional, and behavioral phenotypes examined here is required to identify modifiable targets to reduce the public health burden of cannabis use in the population.
Innovation Concept: Research training programs for students, especially in emergency medicine (EM), may be difficult to initiate due to lack of protected time, resources, and mentors (Chang Y, Ramnanan CJ. Academic Medicine 2015). We developed a ten-week summer program for medical students aimed at cultivating research skills through mentorship, clinical enrichment, and immersion in EM research culture through shadowing and project support. Methods: Five second year Ontario medical students were recruited to participate in the Summer Training and Research in Emergency Medicine (STAR-EM) program at University Health Network, Toronto, from June - Aug, 2019. Program design followed review of existing summer research programs and literature regarding challenges to EM research (McRae, Perry, Brehaut et al. CJEM 2018). The program had broad emergency physician (EP) engagement, with five EP research project mentors, and over ten EPs delivering academic sessions. Curriculum development was collaborative and iterative. All projects were approved by the hospital Research Ethics Board (REB). Curriculum, Tool or Material: Each weekly academic morning comprised small group teaching (topics including research methodology, manuscript preparation, health equity, quality improvement, and wellness), followed by EP-led group progress review of each student's project. Each student spent one half day per week in the emergency department (ED), shadowing an EP and identifying patients for recruitment for ongoing mentor-initiated ED research projects. Remaining time was spent on independent student project work. Presentation to faculty and program evaluation occurred in week 10. Scholarly output included one abstract submitted for publication per student. Program evaluation by students reflected a uniform impression that course material and mentorship were each excellent (100%, n = 5). Interest in pursuing academic EM as a career was identified by all students. Faculty researchers rated the program as very effective (80%, n = 4) or somewhat effective (20%, n = 1) in terms of enhancing productivity and scholarly output. Conclusion: The STAR-EM program provides a transferable model for other academic departments seeking to foster the development of future clinician investigators and enhance ED research culture. Program challenges included delays in REB approval for student projects and engaging recalcitrant staff to participate in research.
Research using single-word paradigms has established that forced language switching incurs processing costs for some bilinguals, yet, less research has addressed this phenomenon at the utterance level or considered real-world applications. The current study examined the impacts of forced language switching on spoken output and stress using a simulated virtual meeting. Twenty Spanish–English heritage bilinguals responded to general work-oriented questions in monolingual English (control) or language-switching (experimental) conditions. Responses were analyzed for mean length of utterance (MLU) and type-token-ratio (TTR). Multilevel modeling revealed an interaction effect of Condition (control vs. experimental) and question order on MLU, such that participants in the experimental condition produced significantly shorter utterances by the end of the task. Participants also had significantly lower lexical variation (TTR) overall in the experimental than the control condition. A 2 × 2 ANOVA revealed a significant effect of Condition and an interaction of Task (pre- vs. posttask) and Condition, such that participants in the control condition reported significantly lower stress after the activity. Results demonstrated the impact of a forced switching condition on production at the utterance level. Findings have implications for theory and scenarios in which heritage bilinguals are asked to use multiple languages in the workplace.
Congenital heart disease (CHD) occurs in approximately 8:1,000 live births and may be associated with recognizable syndromes or chromosomal abnormalities in 25% of cases. Abnormalities are often complex, affecting structure and function. Surgery may be corrective or palliative and can be staged. Over half of these operations occur in the first year of life. The timing of surgery is dictated by the severity of the lesion, the need to avoid the development of pulmonary vascular disease or the complications of cyanotic heart disease.
Psychiatric morbidity was measured in a prospective follow-up study of 51 patients admitted to hospital after minor head injury. By means of self report questionnaires (eg General Health Questionnaire (SHQ) and Impact of Event Scale), semistructured interviews and symptom-checklists, it was found that nearly half of the patients suffered considerable discomfort after 1 week. Improvement during the 3 months follow-up was generally poor. Both concussional symptoms and stress response contributed to the compromised well-being as measured by the GHQ, but outcome did not correlate to severity of injury. The GHQ-60 score of 1 week showed a strong positive correlation with outcome after 3 months. The incidence of post-traumatic stress disorder was low.
Attachment research has provided useful concepts towards an interpersonal approach to psychopathology. Although it suggests that psychological processes are defined by three relational dichotomies (self vs. other, relatedness vs. autonomy, and dependent vs. dependent-on positions), it has not yet assessed separately and simultaneously the eight components generated by the intersection of these dichotomies (e.g. self requesting relatedness, self providing relatedness etc). The aim of the present research was to investigate the validity and potential clinical usefulness of such a neglected approach.
In Study 1, thirty Cognitive Analytic Therapy outpatients at Guy's Hospital, London, were interviewed before treatment on their couple relationships and filled out the Brief Symptom Inventory (BSI) and Inventory of Interpersonal Problems (IIP). A content-analytic method was applied to the transcripts. In Study 2, a new attachment questionnaire was completed by 400 undergraduates, along with the BSI and IIP.
In Study 1, at a six-month follow-up, BSI scores were predicted by the Self Requests Autonomy [R Sq = .29, F(1,23) = 10.84, p = .003] and the Other Provides Closeness [R Sq = .23, F(1,23) = 9.72, p=.001] attachment dimensions, while IIP scores were predicted by Self Provides Support [R Sq = .11, F(1,23) = 7.87, p=.003]. In Study 2, factor analysis yielded eight components matching the theoretical expectations and correlating with BSI and IIP scores (rs ranging from .18 to.41).
The present findings provide some preliminary support for the validity and potential clinical relevance of the method.
Depression is a major public health problem in European countries, and health systems need to ensure access to effective psychological and pharmacological treatments. Research suggests that improvements in depression care require “complex interventions” that implement change in several areas simultaneously.
We describe an observational study of the implementation of a “stepped care” model to provide care for all adults presenting with a new case of depression in a mixed urban-rural area of Scotland with a population of 76,000 people.
A team of 5.2 clinicians provided care for about 1,000 new cases of depression each year. “Guided Self-Help” was the baseline intervention for all patients, supplemented where necessary with pharmacological treatment and Cognitive Behavioural or Interpersonal Therapy.
Service delivery systems were reformed to provide: specialist treatment in primary care settings using primarily non-medical clinicians, comprehensive electronic clinical records, continuous outcome monitoring and intensive investment in staff training and support.
Clinical outcomes (measured by the Personal Health Questionnaire, Social and Work Adjustment Scale and EQ-5D) showed significant improvement despite relatively brief clinician contact (2.5 hours over 4.6 contacts). Savings of more than 50% were made on the antidepressant drug budget. Service user satisfaction ratings were high.
Population needs for depression care can be met using “stepped care” models such as that described above. A randomised controlled study of this approach would be required to fully test the model.
There are no evidence-based treatments for severe and enduring anorexia nervosa.
To evaluate the relative efficacy of Cognitive Behavioral Therapy (CBT) and Specialist Supportive Clinical Management (SSCM) for adults with severe and enduring anorexia nervosa.
Randomised controlled trial.
Sixty-three participants aged 18 and over (range 20-62) with a DSM-IV diagnosis of anorexia nervosa with at least a seven year illness history.
Thirty outpatient visits over 8 months. Participants were assessed at baseline, end of treatment (EOT), and 6-month and 12-month post-treatment follow-up. At EOP and follow-up, both groups improved significantly on the majority of outcome measures. However, there were no differences between treatment groups at EOT. At 6- and 12-month follow-up, analyses indicate greater improvement for those in CBT compared to SSCM. At 6-month follow-up, CBT participants had higher scores on the social adjustment scale (p = .038), and at 12-month they reported lower eating disorder examination global score (p = .004), and higher readiness for recovery (p = .013) compared to SSCM.
Patients with severe and enduring anorexia nervosa can make significant and meaningful improvements with therapy. CBT shows significant advantage over SSCM in terms of social adjustment, core eating pathology, and readiness for change over time.
Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time.
FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n = 69), 3 months (n = 29) and 12 months (n = 36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point.
Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed ‘enhancement’ followed by ‘coping with unpleasant affect’ and ‘social motive’ more highly for their cannabis use than any other reason. ‘Conformity and acceptance’ followed closely. ‘Relief of positive symptoms and side effects’ was the least endorsed motive.
Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated ‘enhancement’ most highly for their cannabis use.
This paper presents a case of an isolated pituitary fossa metastasis on a background of a previously treated tonsillar squamous cell carcinoma.
A 64-year-old male, diagnosed with a primary p16-negative squamous cell carcinoma in the right tonsil, was treated with a course of chemoradiotherapy with curative intent. Positron emission tomography/computed tomography, performed at six months post-treatment, revealed a good local response and no distant metastases. The patient was placed on routine follow up at two-monthly intervals. Two months into follow up, he presented with a right-sided oculomotor nerve palsy and partial Horner's syndrome. Imaging and biopsy revealed a pituitary fossa metastasis (p16-negative squamous cell carcinoma), and a further positron emission tomography/computed tomography visualised this lesion. He was deemed unsuitable for further intervention and underwent palliative radiotherapy for symptom control.
This case represents the first reported isolated pituitary fossa metastasis from a tonsillar squamous cell carcinoma. A high degree of clinical suspicion is recommended, along with a low threshold for biopsy and a cautioned use of positron emission tomography/computed tomography, when investigating such patients.
The stiffness of conjugated polymers should lead to chain alignment near buried interfaces, even if the polymer film is nominally amorphous. Although simulations predict that this alignment layer is approximately 1.5 times the persistence length, chain alignment at buried interfaces of amorphous polymers has not been experimentally measured. Using Mueller matrix spectroscopy, the optical response of regiorandom poly(3-hexylthiophene-2,5-diyl) (P3HT) was modeled in order to extract the aligned layer thickness. By approximating the optical properties of the aligned layer as that of regioregular P3HT, the data can be effectively modeled. When the film is thicker than 150 nm, optical properties are best described with a 4-nm aligned layer, which is quantitatively consistent with previous predictions.