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We consider peeling of an elastic sheet away from an elastic substrate through propagation of a fluid-filled crack along the interface between the two. The peeling is driven by a bending moment applied to the sheet and is resisted by viscous flow towards the crack tip and by the toughness of any bonding between the sheet and the substrate. Travelling-wave solutions are determined using lubrication theory coupled to the full equations of elasticity and fracture. The propagation speed
is the sheet’s thickness,
its plane-strain modulus,
the fluid viscosity,
the applied bending moment and
the sheet’s curvature due to bending; and the prefactor depends on the dimensionless toughness. If the toughness is small then there is a region of dry shear failure ahead of the fluid-filled region. The expressions for the propagation speed have been used to derive new similarity solutions for the spread of an axisymmetric fluid-filled blister in a variety of regimes: constant-flux injection resisted by elastohydrodynamics in the tip leads to spread proportional to
for peeling-by-bending, gravitational spreading and peeling-by-pulling, respectively.
Cancer-related fatigue (CRF) is one of the most commonly reported disease- and treatment-related side effects that impede quality of life. This systematic review and meta-analysis describes the effects of nutrition therapy on CRF and quality of life in people with cancer and cancer survivors. Studies were identified from four electronic databases until September 2017. Eligibility criteria included randomised trials in cancer patients and survivors; any structured dietary intervention describing quantities, proportions, varieties and frequencies of food groups or energy and macronutrient consumption targets; and measures of CRF and quality of life. Standardised mean differences (SMD) were pooled using random-effects models. The American Dietetic Association’s Evidence Analysis Library Quality Checklist for Primary Research was used to evaluate the methodological quality and risk of bias. A total of sixteen papers, of fifteen interventions, were included, comprising 1290 participants. Nutrition therapy offered no definitive effect on CRF (SMD 0·18 (95 % CI –0·02, 0·39)) or quality of life (SMD 0·07 (95 % CI –0·10, 0·24)). Preliminary evidence indicates plant-based dietary pattern nutrition therapy may benefit CRF (SMD 0·62 (95 % CI 0·10, 1·15)). Interventions using the patient-generated subjective global assessment tool and prescribing hypermetabolic energy and protein requirements may improve quality of life. However, the heterogeneity seen in study design, nutrition therapies, quality-of-life measures and cancer types impede definitive dietary recommendations to improve quality of life for cancer patients. There is insufficient evidence to determine the optimal nutrition care plan to improve CRF and/or quality of life in cancer patients and survivors.
Methylation of the fragile X mental retardation 1 (FMR1) exon 1/intron 1 boundary positioned fragile X related epigenetic element 2 (FREE2), reveals skewed X-chromosome inactivation (XCI) in fragile X syndrome full mutation (FM: CGG > 200) females. XCI skewing has been also linked to abnormal X-linked gene expression with the broader clinical impact for sex chromosome aneuploidies (SCAs). In this study, 10 FREE2 CpG sites were targeted using methylation specific quantitative melt analysis (MS-QMA), including 3 sites that could not be analysed with previously used EpiTYPER system. The method was applied for detection of skewed XCI in FM females and in different types of SCA. We tested venous blood and saliva DNA collected from 107 controls (CGG < 40), and 148 FM and 90 SCA individuals. MS-QMA identified: (i) most SCAs if combined with a Y chromosome test; (ii) locus-specific XCI skewing towards the hypomethylated state in FM females; and (iii) skewed XCI towards the hypermethylated state in SCA with 3 or more X chromosomes, and in 5% of the 47,XXY individuals. MS-QMA output also showed significant correlation with the EpiTYPER reference method in FM males and females (P < 0.0001) and SCAs (P < 0.05). In conclusion, we demonstrate use of MS-QMA to quantify skewed XCI in two applications with diagnostic utility.
Teflon amorphous fluoropolymer (TAF) multi-walled carbon nanotube (MWCNT) suspensions have the potential for creating conductive coatings on insulating films for numerous applications. However, there are few studies on polymer MWCNT suspension properties and even fewer that use Teflon. To define mechanical and electrical property relationships, bilayer films of TAF-MWCNT were created with differing concentrations of MWCNTs. Nanoindentation revealed that addition of 8 wt% MWCNTs to TAF increased the elastic modulus by about 25% and hardness by about 15%. Conducting indentation showed 8 wt% MWCNT films exhibit uniform stable conductance once indentation depth exceeds several hundred nanometers. Films with lower concentrations of CNTs were insulating. The two techniques provide a unique description of structure property relationships in this suspension film system.
Outcomes following admission to residential alternatives to standard in-patient mental health services are underresearched.
To explore short-term outcomes and costs of admission to alternative and standard services.
Health of the Nation Outcome Scales (HoNOS), Threshold Assessment Grid (TAG), Global Assessment of Functioning (GAF) and admission cost data were collected for six alternative services and six standard services.
All outcomes improved during admission for both types of service (n = 433). Adjusted improvement was greater for standard services in scores on HoNOS (difference 1.99, 95% CI 1.12–2.86), TAG (difference 1.40, 95% CI 0.39–2.51) and GAF functioning (difference 4.15, 95% CI 1.08–7.22) but not GAF symptoms. Admissions to alternatives were 20.6 days shorter, and hence cheaper (UK£3832 v. £9850). Standard services cost an additional £2939 per unit HoNOS improvement.
The absence of clear-cut advantage for either type of service highlights the importance of the subjective experience and longer-term costs.
Differences in the content of care provided by acute in-patient mental health wards and residential crisis services such as crisis houses have not been researched.
To compare planned and actual care provided at alternative and standard acute wards and to investigate the relationship between care received and patient satisfaction.
Perspectives of stakeholders, including local service managers, clinicians and commissioners, were obtained from 23 qualitative interviews. Quantitative investigation of the care provided at four alternative and four standard services was undertaken using three instruments developed for this study. The relationship of care received to patient satisfaction was explored.
No significant difference was found in intensity of staff– patient contact between alternative and standard services. Alternative services provided more psychological and less physical and pharmacological care than standard wards. Care provision may be more collaborative and informal in alternative services. All measured types of care were positively associated with patient satisfaction. Measured differences in the care provided did not explain the greater acceptability of community alternatives.
Similarities in care may be more marked than differences at alternative and standard services. Staff–patient contact is an important determinant of patient satisfaction, so increasing it should be a priority for all acute in-patient services.
Co-cultivation of Legionella pneumophila serogroup I and Acanthamoeba palestinensis in Neff's medium at 35 °C resulted in the intracellular multiplication of the bacteria as demonstrated by electron microscopy and immunofluorescence. In the closed experimental system used, the number of legionellae rose from 107 colony forming units (c. f. u.)/ml initially to a maximum of 1010 c. f. u. /ml on day 5. Legionellae were seen in expelled phagosomes, in some amoebae filling the cytoplasm and in others in which the process of encystment appeared to have commenced.
For some while there has been a growing awareness from both internal and external stakeholders that the governance and risk management in United Kingdom (U.K.) insurance companies needed to be enhanced. The proposed European Union Solvency II Directive makes this very explicit and the current economic turmoil has put a much stronger emphasis on the whole process: it is being seen as the right thing to do, rather than simply a regulatory requirement. In this paper, we set out the background to and recent history of governance for U.K. insurance companies, and consider how enterprise risk management can bring together the various control frameworks needed to support that governance. Whilst no two companies are the same, and hence the solutions to these issues will vary, there are several common themes linked to successful implementation. Similarly, various barriers to success are identified, together with solutions to resolve them.
The draft paper sets out the authors' views of what good practice for the actuarial aspects of internal models will look like in 2012, the year Solvency II is expected to be implemented. Actuaries working on internal models can expect to have to follow such practices if their internal models are to be approved for use in calculating regulatory capital. The paper is therefore relevant for actuaries who plan to work on internal model implementation for Solvency II.
Moreover, the risk quantification techniques discussed in the paper can also be used in the Own Risk Solvency Assessment (ORSA) process also required by Solvency II. The paper is therefore relevant to actuaries working in companies that are not planning to apply to use an internal model.
The paper covers both life and non-life insurance and reinsurance, and reviews current practice as well as setting out possible future practice. This leads to identification of areas for research by the Profession to prepare for 2012 and an indication of the directions this work might take.
The paper is effectively a work in progress, and readers should ask themselves what they should do in response to the ideas discussed.
Pilot studies to test methods to determine the incidence, agents, risk factors and socioeconomic costs of infectious intestinal disease (IID) in England were carried out as recommended by the Committee on the Microbiological Safety of Food (the Richmond Committee) by eight general practices. There were case control and enumeration studies of patients presenting to general practice with IID, a population-based prospective cohort study, and a survey of socioeconomic costs of cases of IID. Information on risk factors was obtained by questionnaire (self-administered compared with interview) and a stool sample was requested on all cases and controls. Response rates in the GP case control study were 75% for case questionnaires and 74% for stools; for controls the figures were 70% and 68% respectively. The acceptance rate into the cohort study was 49%; this was significantly higher where phone contact was made. The rate was similar if recruitment was by individual or household. Follow-up of the cohort by negative reporting was complete for up to 6 months. Direct postage by subject was required to obtain fresh stool specimens. Estimates were obtained of presentation rates of IID and the distribution of risk factors which were used to plan the main study. The pilot study demonstrated that it is possible to undertake a national study based in general practice to determine the incidence of IID in the population and presenting to GPs and its agents, risk factors and costs.
The success of efforts to re-establish mammalian carnivores within their former range is dependent on three key factors: methodological considerations, the biological requirements of the target species, and the involvement of local human communities for whom large carnivores pose a threat. We consider the role of these factors in the first 13 years of an effort to re-establish wild lions in northern KwaZulu-Natal Province, South Africa. We employed soft-release methods to mitigate the characteristic problems associated with restoration of large carnivores. A pre-release captivity period facilitated acclimatization of reintroduced lions and promoted long-term bonding of unfamiliar individuals into cohesive groups. All individuals remained in the release area and established enduring, stable home ranges. Reintroduced lions successfully reproduced and raised 78% of their cubs to independence. Human activity was the cause of all post-release mortality. Despite rapid population growth and the re-establishment of the species at Phinda Private Game Reserve, the population is small and isolated with little prospect for re-colonizing additional areas where the species has been extirpated, or for connecting with other isolated lion populations in the region. Accordingly, although we essentially overcame the short-term technical and biological challenges facing lion reintroduction, the long-term value of the Phinda population for addressing the conservation issues facing the species remains equivocal.
The alpha elements O, Ne, Mg, Si, S, Cl, and Ar are produced together in massive stars and their abundances are expected to evolve in lockstep. Both H II regions and planetary nebulae serve as interstellar probes of alpha element abundances. We have measured abundances for the alpha elements O, Ne, S, Cl, and Ar in over 130 Galactic Types I and II and halo PNe in a consistent manner from our own optical (3600–9600Å) spectra (Henry, Kwitter, & Balick 2004). Figure 1 is a plot of Ne vs. O for a combined dataset containing H II regions, blue compact galaxies, and our sample of planetary nebulae. All object types appear to be consistent with the expected linear relation between Ne and O. Similar plots of Cl and Ar vs. O show the same behavior. However, S vs. O is an exception.
Aims: To determine the accuracy of data relating to pulmonary vascular resistance data in patients with a bidirectional Glenn anastomosis as calculated using predicted versus measured uptake of oxygen. Methods: We studied retrospectively the data from 33 patients with a bidirectional Glenn anastomosis who underwent cardiac catheterisation prior to surgery to complete the Fontan circulation. Their weight ranged from 5.4 to 51.7 kg, and they were aged up to 12 years. Uptake of oxygen was measured using the Deltatrac II metabolic monitor. From the calculated indexed pulmonary vascular resistance, cases were stratified according to the risk of failure of the subsequent Fontan circulation. The six patients with a resistance of greater than 4 Um2 were deemed at high risk, the six with a resistance from 3 to 4 Um2 at moderate risk, and the 21 patients with a resistance less than 3 Um2 at low risk. Uptake of oxygen was also estimated from the predictive formulas of Lindahl, Lundell et al. and LaFarge and Miettinen. The indexed resistance was similarly calculated using these formulas and a comparable stratification of risk made from this data. Results: The predicted values for uptake of oxygen were consistently higher than those measured, leading to an underestimation of indexed resistance, with mean difference between −0.62 and −1.57 Um2. This difference resulted in misclassification of between five and nine of the 12 patients considered at moderate or high risk as being at low-risk. No other haemodynamic data could reliably separate the subjects deemed at low-risk from those considered to be at high-risk. A transpulmonary gradient of greater than 7 mm of mercury was found to be 100 percent specific for elevated indexed resistance, but only 60 percent sensitive. Conclusions: In patients with bidirectional Glenn anastomoses, all formulas based on predictive uptake of oxygen lead to underestimation of the true indexed pulmonary vascular resistance, to an extent that could significantly influence clinical decision-making. The transpulmonary gradient is not a reliable surrogate for indexed pulmonary vascular resistance.
Using a porthole camera the architecture of the warrens of the southern hairy-nosed wombat Lasiorhinus latifrons was examined at two sites in southern Australia. The complexity of warrens varied from simple, single-entrance warrens to a system 89 m long with 28 entrances. Logging of deep tunnel temperatures showed daily ranges of < 1 °C over periods in which surface temperatures ranged up to 24 °C, but mean tunnel temperatures varied 15.9 °C between winter and summer. Humidity gradients were maintained between the tunnel and the surface and depended on the length and depth of the tunnel. Oxygen and carbon dioxide levels were similar to those in free atmospheric air in unoccupied tunnels, but in occupied tunnels reached 16.3% and 3%, respectively. There is no specific orientation of tunnel entrances or defined mound shape. Wombat warrens ameliorate surface conditions in habitats of low humidity and high temperatures while humidity advantages promote the construction of warrens beyond the requirements for temperature modulation.