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Shock–turbulence interactions are investigated using well-resolved direct numerical simulations (DNS) and analysis at a range of Reynolds, mean and turbulent Mach numbers (
, respectively). The simulations are shock and turbulence resolving with
up to 65,
up to 0.54 and
up to 1.4. The focus is on the effect of strong turbulence on the jumps of mean thermodynamic variables across the shock, the shock structure and the amplification of turbulence as it moves through the shock. Theoretical results under the so-called quasi-equilibrium (QE) assumption provide explicit laws for a number of statistics of interests which are in agreement with the new DNS data presented here as well as all the data available in the literature. While in previous studies turbulence was found to weaken jumps, it is shown here that stronger jumps are also observed depending on the regime of the interaction. Statistics of the dilatation at the shock are also investigated and found to be well represented by QE for weak turbulence but saturate at high turbulence intensities with a Reynolds number dependence also captured by the analysis. Finally, amplification factors are found to present a universal behaviour with two limiting asymptotic regimes governed by
, for weak and strong turbulence, respectively. Effect of anisotropy in the incoming flow is also assessed by utilizing two different forcing mechanisms to generate turbulence.
Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.
In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.
Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.
During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.
Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
The purpose of the study was to determine the incidence of cardiovascular disease (CVD) among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (PLWHA) in Taiwan. PLWHA were identified from the Taiwan Centers for Disease Control HIV Surveillance System between 2000 and 2014. To examine the effect of active antiretroviral therapy (HAART) on CVD incidence, incidence densities and standardised incidence rates (SIRs) of CVD were calculated after stratifying PLWHA by HAART. Of 26 272 PLWHA (mean age, 32.3 years) identified, 73.4% received HAART. Compared with general population, SIRs (95% confidence interval) were higher for incident coronary artery disease (1.11 (1.04–1.19)), percutaneous coronary intervention (1.32 (1.18–1.47)), coronary artery bypass surgery (1.47 (1.29–1.66)), sudden cardiac death (3.01 (2.39–3.73)), heart failure (1.50 (1.31–1.70)) and chronic kidney disease (1.95 (1.81–2.10)), but was lower for incident atrial fibrillation (0.53 (0.37–0.73)). Considering the effect of HAART on incident CVD, the SIRs for all-cause, ischaemic and haemorrhagic stroke were higher in PLWHA who did not receive HAART, but were lower in PLWHA who received HAART. PLWHA had higher risks of incident coronary artery disease, percutaneous coronary intervention, coronary artery bypass surgery, sudden cardiac death, heart failure and chronic kidney disease. HAART reduces risks of incident CVD in PLWHA.
We report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.
A 2,000-bed tertiary-care psychiatric hospital.
Active surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)–based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.
The study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1–C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0–5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21–45 and 26–58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology.
WGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.
Precise control is a key factor in enabling Unmanned Underwater Vehicles (UUVs) to complete various underwater activities. The development of UUV control rules is mostly based on UUV dynamic models. However, such dynamic models contain unknown hydrodynamic parameters that need to be identified. This paper presents a new method, Laser Line Scanning for Hydrodynamic Parameter Identification (LSHPI), which integrates laser line scanning, decoupled dynamics, and evolutionary optimisation to identify the hydrodynamic parameters of an Autonomous Underwater Vehicle (AUV). In this research, laser images, seen from an on board camera's perspective and created using Open Graphics Library (OpenGL), were used to validate LSHPI's feasibility. The accuracy of the AUV positions and Euler angles obtained by the laser image-based methods were investigated for each decoupled One-Dimensional (1D) motion and the influence of other motion disturbances on the accuracy of the obtained AUV positions or Euler angles was also evaluated. In addition, the accuracy of the surge-related hydrodynamic parameters obtained by LSHPI was investigated under different motion disturbances. Based on the hydrodynamic parameter identification results under different motion disturbances, LSHPI's feasibility was successfully validated.
Objective: To examine whether elbow coordination training can improve elbow coordination in cerebral palsy and whether any benefit carries over to upper limb activity.
Methods: A case series A–B–C multiple baseline study was carried out. Two weeks of no intervention (A) was followed by 2 weeks of computerised tracking (B), which was followed by 2 weeks of no intervention (C). Six children (age range 7–12 years) with hemiplegic cerebral palsy (Level I–III of the Manual Ability Classification System) participated. Coordination training consisted of 10 × 1-min trials of computerised tracking each session for 10 sessions over a 2-week period. Coordination was measured as tracking performance using a different target from the training target. Upper limb activity was measured using the 9-Hole Peg Test. Data were analysed using the 2-SD band method.
Results: None of the participants appeared to improve tracking performance or 9-Hole Peg Test (9HPT) scores (p > 0.05) after the 2 weeks of intervention. On withdrawal of the intervention, visual analysis showed that tracking performance and 9HPT scores remained at the same level as the intervention phase.
Conclusions: Ten minutes of computerised elbow tracking daily for 10 sessions did not improve coordination in six children with cerebral palsy.
Genetic variants and medication adherence have been identified to be the main factors contributing to lithium treatment response in bipolar disorders.
To simultaneously examine effects of variant glutamate decarboxylase-like protein 1 (GADL1) and medication adherence on response to lithium maintenance treatment in Han Chinese patients with bipolar I (BPI) disorder.
Frequencies of manic and depressive episodes between carriers and non-carriers of the effective GADL1 rs17026688 T allele during the cumulative periods of off-lithium, poor adherence to lithium treatment and good adherence to lithium treatment were compared in Han Chinese patients with BPI disorder (n = 215).
GADL1 rs17026688 T carriers had significantly lower frequencies of recurrent affective episodes than non-T carriers during the cumulative period of good adherence, but not during those of poor adherence.
GADL1 rs17026688 and medication adherence jointly predict response to lithium maintenance treatment in Han Chinese BPI patients.
In this paper, we introduce a lower extremity exoskeleton CUHK-EXO that is developed to help paraplegic patients, who have lost the motor and sensory functions of their lower limbs to perform basic daily life motions. Since the sit-to-stand and stand-to-sit (STS) motion is the first step for paraplegic patients toward walking, analysis of the exoskeleton's applicability to the STS motion assistance is performed. First, the human-exoskeleton system (HES) is modeled as a five-link model during the STS motion, and the center of pressure (COP) on the ground and center of gravity of the whole system are calculated. Then, a description of the CUHK-EXO hardware design is presented, including the mechatronics design and actuator selection. The COP position is an important factor indicating system balance and wearer's comfort. Based on the COP position, a trajectory online modification algorithm (TOMA) is proposed for CUHK-EXO to counteract disturbances, stabilize system balance, and improve the wearer's comfort in the STS motion. The results of STS motion tests conducted with a paraplegic patient demonstrate that CUHK-EXO can provide a normal reference pattern and proper assistive torque to support the patient's STS motion. In addition, a pilot study is conducted with a healthy subject to verify the effectiveness of the proposed TOMA under external disturbances before future clinical trials. The testing results verify that CUHK-EXO can counteract disturbances, and help the wearer perform the STS motion safely and comfortably.
Apathy is a condition characterized by a lack of motivation that manifests in emotional, behavioral, and cognitive domains. Although previous studies have indicated that apathy is associated with frontal lesions, few studies have focused on the different subdomains of apathy, and no in vivo human biochemical data have been obtained to examine the neurochemical changes related to apathy in patients with Alzheimer's disease (AD). Thus, we investigated the frontal neurochemical alterations related to apathy among patients with AD using proton magnetic resonance spectroscopy (1H MRS).
Apathy was assessed through the Apathy Evaluation Scale (AES). 1H MRS was performed to measure neurochemical metabolite levels in the anterior cingulate region and right orbitofrontal region. Associations between neurochemical metabolites and the total score and subscores of each domain of the AES were analyzed.
Altogether, 36 patients completed the study. Patients with lower N-acetylaspartate/creatine ratios (NAA/Cr) in the anterior cingulate region demonstrated higher total apathy scores (β = −0.56, p = 0.003) with adjustments for age, gender, educational level, dementia severity, and depression severity. In a further analysis, a lower NAA/Cr in the anterior cingulate region was associated with all subdomains of apathy, including cognition (β = −0.43, p = 0.028), behavior (β = −0.55, p = 0.002), and emotion (β = −0.50, p = 0.005). No statistically significant associations were discovered in the right orbitofrontal region.
Our results suggest that apathy, in each of its cognitive, behavioral, or emotional subdomains is associated with brain neurochemical alterations in the anterior cingulate region. Abnormal neuronal integrity over the anterior cingulate cortex may exhibit a central role in causing all aspects of apathy in patients with AD.
Sexual offenses cause harm to the victims’ physical and psychological functions. This study was conducted to evaluate the risk of incident psychiatric disorders in sexual assault victims. Taiwan’s National Health Insurance Research Database was used to conduct a nationwide population-based cohort study to assess the risk of incident psychiatric disorders in sexual assault victims and to further evaluate the respective risk estimates on the basis of diagnostic patterns. A total of 81 sexual assault victims and 324 controls matched by sex, age and residential area were included. The mean age of the sexual assault victims was 18.39 (sd 10.23) years, and 93.83% (76/81) of the sample were females. Sexual assault victims had a higher incidence density of psychiatric disorders than did the control group (9.2% per year, 95% confidence interval [CI] 1.1–33.2% per year v. 1.1% per year, 95% CI .4–15.7% per year; p=.037). Sexual assault was an independent risk factor for incident psychiatric disorders, with an incidence rate ratio of 3.40 (95% CI 1.04–26.41) after adjustment for potential confounding factors. Assessment of psychiatric disorders should be implemented in the integrative care of sexual assault victims. Physicians providing clinical care to the sexual assault victims should receive more all-round training to understand and manage this type of violence.
To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.
A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.
One core theme emerged: “protective preparation.” This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.
Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI.
To (i) identify the major temporal patterns of energy intake among adults; (ii) examine the association between employment status and the patterns; and (iii) examine the association between dietary quality and the patterns.
Secondary analysis based on the cross-sectional population-based nutrition survey in Taiwan, 2005–2008. Based on energy intake levels at six time intervals of a day derived from 24 h recall data, we applied cluster analysis to identify major temporal patterns of energy intake. Self-reported employment status was categorized into six groups: full-time, part-time, no job, student, homemaker and retired. Multinomial logistic regression models were fitted to test the association between temporal patterns of energy intake and employment groups.
Non-institutionalized community dwellers.
Non-pregnant adults (≥19 years old) with total energy intake between 2092 and 20920 kJ/d (500 and 5000 kcal/d; n 4508).
Five major patterns were identified, which can be seen as the traditional meal pattern and its variants. About 20 % of adults had the traditional pattern. The most prevalent pattern was the delayed morning meal pattern (33 %), which had lower Ca and P intakes than the traditional pattern. About 14 % of adults had the delayed lunchtime pattern, which had lower protein, PUFA, fibre, Ca, P, vitamin D and vitamin E intakes than the traditional. Adjusted prevalence of the delayed lunchtime pattern was highest among full-time students (34 %), followed by part-time workers (24 %), and was lower in retired (8 %), homemakers (11 %) and full-time employed adults (12 %).
Adults’ temporal patterns of energy intake, which varied with their employment status, affected their dietary quality.
This study examined whether training in translation/interpretation leads to a reliance on a ‘vertical’ translation strategy in which the source language text is comprehended before the message is reformulated. Students of translation/interpreting and untrained bilinguals were given an idiom translation judgment task with literal (form and meaning) or figurative equivalents (meaning only). Dependent measures included the time taken to comprehend the first presented sentence and the accuracy and speed of judging if the second presented sentence was a translation of the first sentence. The groups did not differ in their speed of reading the first presented sentence but translation verification times differed by group and translation type: untrained bilinguals were significantly faster at verifying literal than figurative translations while trained bilinguals were equally fast for the two types. The pattern of findings is consistent with the view that training in translation fosters a processing-for-meaning-before reformulating, or vertical, translation strategy.
The increasing demand for high-data rate communications in the connected world imposes various challenges in analog and radio frequency (RF) circuits. Although continued scaling in advanced processes offers faster devices, it is accompanied by increasing complexity in circuit design and layout strategy, resulting in diminishing benefits for analog/RF circuits. In order to enable new breakthroughs in speed, cost, and power efficiency, simplifying analog/RF circuits with the assistance of signal processing is becoming a clear trend. This paper provides an overview of this trend by reviewing the signal processing algorithms commonly deployed in wireless communications, data converters, and wired data links. The discussion covers design considerations, as well as algorithms used to compensate for circuit imperfections, so as to demonstrate the cross-discipline interactions between signal processing and analog/RF circuit design.
Following the pioneering experiments on the glass transition in PMMA, which gave a good approximation to monodisperse hard-sphere systems, Pusey and van Megen (1989) and coworkers started a series of experiments with the aim of characterising the transition. Most of the experiments were performed through laser light scattered by density fluctuations characterising the transition from liquid to supercooled liquid and eventually to an amorphous solid. An efficient method was also used to measure the time average in a non-ergodic system using averages over different scattering volumes and wave vectors. The comparison with the predictions of MCT was performed in an extended fashion, showing a relatively good agreement with the experimental findings, to a 20% level of accuracy. The most relevant result of this important set of measurements was the detection of the structural arrest point, a result that is not easy to obtain in normal liquids due to the existence of activated dynamics or hopping effects. The latter are supposedly responsible for the crossing of the barriers that confine the system in a potential well.
MCT was subsequently applied to potentials with an attractive tail following the short-range repulsion, and lead to the behaviour described in the previous chapter on the the theory of supercooled liquids. The most relevant finding was the evidence of the existence of higher-order singularities, which were already defined and studied within MCT, in systems with short-range attractive interactions. Shortly after the predictions of MCT on the consequences of an attractive interaction in hard-sphere systems obtained, many attempts were made to experimentally demonstrate their validity. In particular, first the re-entrant glass line was detected, then the effect of the A3 singularity was shown and finally the higher singularity of type A4 was identified. The experiments on these various aspects of the behaviour of supercooled liquids are illustrated in the following sections.
Interactions between particles, both in molecular fluids and colloidal systems, are generally characterised by a strong short-range repulsion, which is responsible for excluded volume effects, followed by an attraction of variable strength. The latter is at the origin of cluster formation, a process that produces many different physical phenomena of great importance in the physics of simple and complex fluids. In atomic and molecular systems the most relevant effect of attraction is the appearance of critical points accompanying phase transitions, while in complex fluids, besides critical effects, peculiar phenomena develop such as aggregation, percolation, glass and sol–gel transitions. Recently the latter have been collectively named arrest phenomena, since their common feature is the pronounced slowing down of the dynamics. We first outline briefly the phenomenology and the approaches based on aggregation and percolation, which describe situations in which the attractive interaction is so strong that the colloidal particles adhere, leading to the formation of macroscopic clusters that eventually invade the physical sample. In the case of reversible aggregation the particles form the so-called physical gels. When the aggregation is irreversible, chemical gels are formed.
Thanks to the possibility of forming reversible or irreversible reactive links, during aggregation clusters of particles tend to coalesce and form larger aggregates. In the case of reversible bond formation a fragmentation process is also present. Aggregation is an ubiquitous process that can be observed in disparate situations at various length and time scales. Examples are polymer chemistry, aerosol systems, cloud physics, clusters of galaxies in astrophysics, etc. Although aggregation in colloidal suspensions has long been studied, it has become a subject of renewed interest in recent years because it is a non-equilibrium phenomenon, the final stage of which may lead, among other things, to the formation of a gel. We briefly summarise various aspects of clustering by introducing the Smoluchowski aggregation formalism, which is used in many different physical approaches to aggregation, and a brief summary of the salient aspects of percolation that are important for the physical phenomena we describe.