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This study is aimed at developing a Rural Primary Health Care (PHC) Model for delivering comprehensive PHC for dementia in rural settings and addressing the gap in knowledge about disseminating and implementing evidence-based dementia care in a rural PHC context.
Limited access to specialists and services in rural areas leads to increased responsibility for dementia diagnosis and management in PHC, yet a gap exists in evidence-based best practices for rural dementia care.
Elements of the Rural PHC Model for Dementia were based on seven principles of effective PHC for dementia identified from published research and organized into three domains: team-based care, decision support, and specialist-to-provider support. Since 2013 the researchers have collaborated with a rural PHC team in a community of 1000 people in the Canadian province of Saskatchewan to operationalize these elements in ways that were feasible in the local context. The five-step approach included: building relationships; conducting a problem analysis/needs assessment; identifying core and adaptable elements of a decision support tool embedded in the model and resolving applicability issues; implementing and adapting the intervention with local stakeholders; and sustaining the model while incrementally scaling up.
Developing and sustaining relationships at regional and PHC team levels was critical. A comprehensive needs assessment identified challenges related to all domains of the Rural PHC Model. An existing decision support tool for dementia diagnosis and management was adapted and embedded in the team’s electronic medical record. Strategies for operationalizing other model elements included integrating team-based care co-ordination into the decision support tool and family-centered case conferences. Research team specialists provided educational sessions on topics identified by the PHC team. This paper provides an example of a community-based process for adapting evidence-based practice principles to a real-world setting.
After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
Although boundary-layer flows over convex surfaces are exponentially stable, non-modal mechanisms may enable significant disturbance growth which can make the flow susceptible to secondary instabilities. A parametric investigation of the transient growth and secondary instabilities in flows over convex surfaces is performed. The optimal disturbance in the steady case corresponds to alternating streaks and streamwise vortices of opposite sign that reinforce one another due to lift-up and centrifugal forces, respectively. The process repeats with a constant (naturally appearing) streamwise wavelength which is proportional to the square root of the radius. Unsteady disturbances achieve a higher optimal gain, compared to the steady case, as a result of the opposing effects of the lift-up and centrifugal mechanisms. Linear analysis shows that the curvature has a negligible effect on secondary instabilities. Direct numerical simulations of transient growth with and without secondary instabilities confirm the predictions obtained by the local stability theory. It is found that the presence of a secondary instability is not sufficient, on its own, to ensure transition to turbulence. Only sufficiently long and energetic streaks trigger the breakdown to turbulence.
The mechanism underlying the coherent hairpin process in wall-bounded shear flows is studied. An algorithm for the identification and analysis of flow structures based on morphological operations is presented. The method distils the topology of the flow field into a discrete data set and enables the time-resolved sampling of coherent flow processes across multiple scales. Application to direct simulation data of transitional and turbulent boundary layers at moderate Reynolds number sheds light on the flow physics of the hairpin process. The analysis links the hairpin to an exponential instability which is amplified in the flow distorted by a negative perturbation in the streamwise velocity component. Linear analyses substantiate the connection to an inviscid instability mechanism of varicose type. The formation of packets of hairpins is related to a self-similar process which originates from a single patch of low-speed fluid and describes a recurrence of the dynamics that leads to the formation of an individual hairpin. Analysis of the evolution of several thousand turbulent hairpins provides a statistical characterization of the principal dynamics and yields a time-resolved average of the hairpin process. Comparisons with the transitional hairpin show qualitatively consistent trends and thus support earlier hypotheses of their equivalence. In terms of the causality of events, the results suggest that the hairpin is a manifestation of the varicose instability and as such is a consequence rather than a cause of the primary perturbations of the flow.
The Mira AB interacting binary provides an ideal laboratory for studying mass loss and accretion processes in systems containing an AGB star and a compact accretor, because its components have been resolved and can be studied individually. We present here results from our long term study of accretion processes in this system. Those include recent HST observations suggesting that the accretion rate onto Mira B is much lower than before, indicating possible disruption of the accretion disk.
Algebraic disturbance growth in spatially developing boundary-layer flows is investigated using an optimization approach. The methodology builds on the framework of the parabolized stability equations and avoids some of the limitations associated with adjoint-based schemes. In the Blasius boundary layer, non-parallel effects are shown to significantly enhance the energy gain due to algebraic growth mechanisms. In contrast to parallel flow, the most energetic perturbations have finite frequency and are generated by the simultaneous activity of the Orr and lift-up mechanisms. The highest amplification occurs in a limited region of the parameter space that is characterized by a linear relation between the wavenumber and frequency of the disturbances. The frequency of the most highly amplified perturbations decreases with Reynolds number. Adverse streamwise pressure gradient further enhances the amplification of disturbances while preserving the linear trend between the wavenumber and frequency of the most energetic perturbations.
Salicylate plays an important role as a non-steroid, anti-inflammatory drug. In poultry, those used most commonly are sodium salicylate (SS) and acetylsalicylic acid (ASA), due to their immunomodulatory, analgesic, antipyretic, and anti-inflammatory activities. Other effects have been reported such as minimising the effects of heat stress, allostatic load, ascites, leg disorders, reducing respiratory and digestive disorders, as well as enhancing growth performance, feed utilisation, nutrient digestion and absorption, egg production and the quality of meat and eggs. Furthermore, ASA plays a key role in lowering cholesterol and triglycerides in blood, meat and eggs, and improvements in immune functions and antioxidant enzymes have been noted in birds. This paper reviews the different characteristics and beneficial applications of ASA in poultry nutrition for improving immunity, production, and safeguarding health, especially under heat stress conditions.
Having accurate data for ileal amino acid digestibility of a feed ingredient is one of the ways to enhance protein and nitrogen utilisation, improve poultry feeding efficiency, and mitigate ammonia emission and pollution in the environment. Moreover, the precise estimation of endogenous amino acid losses (EAAL) depends on formulating diets on digestible amino acid (DAA) basis. Numerous methods have been reported to determine the endogenous fractions including the regression method, the protein-free diet, and the total digestible nitrogen diet. The EAAL determined by these techniques can help in calculated corrected values for amino acid digestibility, termed true digestibility. Certain dietary components that can be called ‘specific losses’ could lead to higher losses than the basal calculation would indicate. To determine the basal plus specific losses (total endogenous losses), some researchers suggested the 15N-dilution method, which allows the determination of the actual digestibility. This method needs more studies and evaluations because there are some controversial issues about this methodology, such as the validity of the 15N-dilution technique when applied to any amino acid or to total nitrogen, the reference pool for the estimation of the labelling of endogenous fractions/secretions, anti-nutritional agents, the effect of bird age, mucin, different cereal grains, as well as the marker itself and the proper assessment. This review will be focused on the above issues, finding that the recently reported 15N isotopes single injection method could be an easy, time-saving, consistent, and reliable methodology for EAAL estimation in poultry.
Streaks in pre-transitional boundary layers are analysed and their properties are extracted from direct numerical simulation data. Streaks that induce breakdown to turbulence via secondary instability are shown to differ from the remainder of the population in various attributes. Conditionally averaged flow fields establish that they are situated farther away from the wall, and have a larger cross-sectional area and higher peak amplitude. The analysis also shows that the momentum thickness acts as a similarity parameter for the properties of the streaks. Probability density functions of the streak amplitude, area, and shear along the streaks, collapse among the various pressure gradients when plotted as a function of the momentum thickness. A prediction scheme for laminar–turbulent transition based on artificial neural networks is presented, which can identify the streaks that will eventually induce the formation of turbulent spots. In comparison to linear stability theory, the approach achieves a higher prediction accuracy at considerably lower computational cost.
Lithium in cool magnetic CP stars in still poorly studied and estimations of the Li abundance in these stars are scarce. There is some evidence of variability of the LiI 6708 Â line, but this variability has not been studied systematicaly. Even the identification of the 6708 Â line with the LiI resonance doublet is still in doubt. This problem is important in the broader context of the Li abundance in various types of stars, as well as for deeper undersfanding of the magnetic star phonomenon itself. The reason for fhis is that the Li abundance in very sensitive to evolutionary status of the stars and their properties, such as the character and intensity of mixing processes.
Prelimary results of an extended program of coordinated X-ray and optical observations of TT Ari are presented. The object was observed on August 21/22 1985 both in X-rays (EXOSAT) and optical range, about 100 days after the return to the active state. The first detailed simultaneous study of TT Ari in active state indicates the presence of strongly absorbing structure in the system.
Variations of the UV continuum have been analyzed. The observed UV continuum may be reproduced by a superposition of a Kurucz model atmosphere (log g=2), Teff ~ 8500 - 15000 K) and optically thin hydrogen bound-free and free-free emission (Te ~ 1000 K). The temperature of the Kurucz atmosphere is the lowest at the maximum of brightness. The flat minimum in the UV integrated flux was observed in May-October 1985.
We present preliminary results of the EXOSAT X-ray observations and quasisimultaneous and simultaneous optical photometry of the X-ray source EX0020528+1454.8 = 1E0205+149 found independently as an serendipitous source both with Einstein and EXOSAT satellites. The optical counterpart is a pair of dMe stars, Our results indicate that the object is variable both in X-rays and optical wavelenghts, and probably belongs to dMe flare stars.
Selected regions of the ultraviolet spectrum of Beta Lyrae were observed in 1973 and 1974 at the epochs of the two eclipses and of the two quadratures with the Copernicus Princeton University spectrometer. The results were published in the Astrophysical Journal (Hack et al. 1975, 1976). Here we summarize the results of a third series of observations with the same instrument covering the whole period of 12.93 days. The following spectral regions were observed in June 1975 during 13 consecutive days: λ 1036–1060; 1300–1326; 1398–1416; 2050–2098; 2580–2632; 2777–2812 in the low resolution mode; λ 1172–1177 and 2795–2799 in the high resolution mode. The main results are the following: 1) The radial velocity curve for λ 1175 C III is almost 180° out of phase with the orbital velocity curve of the primary star and the mean velocity is - 240 km s−1; K = 70 km s−1. This suggests that λ 1175 C III is formed in an expanding envelope associated with the secondary. The mass ratio can be determined: m2 /m1 = 2.7 −1.1/+0.2 .2) The continuum variation confirms the results obtained with 0A0-2. At λ 2100 we observe the light of a continuum indicating that the temperature of the body eclipsing the primary star is lower than that of the primary and of about 9000 K. The light curves at λ 1900, 2100 can be explained with the contribution of Fe III emission in the circumbinary plasma. On the contrary, the depth of the secondary minimum at λ 1311–1326 and at λ 1410 cannot be explained with the Si III and Si IV emissions. A possible explanation is the presence of a hot spot in the region of the eclipsing body (probably a disk surrounding the companion) where the stream from the primary impinges on the disk. The hot spot can also explain the behavior of the infrared light curves observed by Jameson and Longmore (1976).
Modal and non-modal perturbation growth in boundary layers subjected to time-harmonic spanwise wall motion are examined. The superposition of the streamwise Blasius flow and the spanwise Stokes layer can lead to strong modal amplification during intervals of the base-flow period. Linear stability analysis of frozen phases of the base state demonstrates that this growth is due to an inviscid instability, which is related to the inflection points of the spanwise Stokes layer. The generation of new inflection points at the wall and their propagation towards the free stream leads to mode crossing when tracing the most unstable mode as a function of phase. The fundamental mode computed in Floquet analysis has a considerably lower growth rate than the instantaneous eigenfunctions. Furthermore, the algebraic lift-up mechanism that causes the formation of Klebanoff streaks is examined in transient growth analyses. The wall forcing significantly weakens the wall-normal velocity perturbations associated with lift-up. This effect is attributed to the formation of a pressure field which redistributes energy from the wall-normal to the spanwise velocity perturbations. The results from linear theory explain observations from direct numerical simulations of breakdown to turbulence in the same flow configuration by Hack & Zaki (J. Fluid Mech., vol. 760, 2014a, pp. 63–94). When bypass mechanisms are dominant, the flow is stabilized due to the weaker non-modal growth. However, at high amplitudes of wall oscillation, transition is promoted due to fast growth of the modal instability.
The influence of harmonic spanwise wall motion on bypass transition in boundary layers is investigated using direct numerical simulations. It is shown that the appropriate choice of the forcing parameters can achieve a substantial stabilization of the laminar flow regime. However, an increase of the forcing amplitude or period beyond their optimal values diminishes the stabilizing effect, and leads to breakdown upstream of the unforced case. For the optimal wall-oscillation parameters, the reduction in propulsion power substantially outweighs the power requirement of the forcing. The mechanism of transition delay is examined in detail. Analysis of the pre-transitional streaks shows that the wall oscillation substantially reduces their average amplitude, and eliminates the most energetic streaks. As a result, the secondary instabilities that precede breakdown to turbulence are substantially weakened – an effect demonstrated by linear stability analyses of flow fields from direct numerical simulations. The outcome is transition delay owing to a significant reduction in the frequency of occurrence of turbulent spots and a downstream shift in their average inception location. Finally, it is shown that the efficiency of the forcing can be further improved by replacing the sinusoidal time dependence of the wall oscillation with a square wave.
The secondary instability of boundary layer streaks is investigated by means of direct stability analysis. The base flow is computed in direct simulations of bypass transition. The random nature of the free-stream perturbations causes the formation of a spectrum of streaks inside the boundary layer, with breakdown to turbulence initiated by the amplification of localized instabilities of individual streaks. The capability of the instability analysis to predict the instabilities which are observed in the direct numerical simulation is established. Furthermore, the analysis is shown to identify the particular streaks that break down to turbulence farther downstream. Two particular configurations of streaks regularly induce the growth of these localized instabilities: low-speed streaks that are lifted towards the edge of the boundary layer, and the local overlap between high-speed and low-speed streaks inside the boundary layer. It is established that the underlying modes can be ascribed to the general classification of inner and outer modes which was introduced by Vaughan & Zaki (J. Fluid Mech., vol. 681, 2011, pp. 116–153). Statistical evaluations show that Blasius boundary layers favour the amplification of outer instabilities. Adverse pressure gradient promotes breakdown to turbulence via the inner mode.