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As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
The resolvent formulation of McKeon & Sharma (J. Fluid Mech., vol. 658, 2010, pp. 336–382) is applied to supersonic turbulent boundary layers to study the validity of Morkovin’s hypothesis, which postulates that high-speed turbulence structures in zero-pressure-gradient turbulent boundary layers remain largely the same as their incompressible counterparts. Supersonic zero-pressure-gradient turbulent boundary layers with adiabatic wall boundary conditions at Mach numbers ranging from 2 to 4 are considered. Resolvent analysis highlights two distinct regions of the supersonic turbulent boundary layer in the wave parameter space: the relatively supersonic region and the relatively subsonic region. In the relatively supersonic region, where the flow is supersonic relative to the free-stream, resolvent modes display structures consistent with Mach wave radiation that are absent in the incompressible regime. In the relatively subsonic region, we show that the low-rank approximation of the resolvent operator is an effective approximation of the full system and that the response modes predicted by the model exhibit universal and geometrically self-similar behaviour via a transformation given by the semi-local scaling. Moreover, with the semi-local scaling, we show that the resolvent modes follow the same scaling law as their incompressible counterparts in this region, which has implications for modelling and the prediction of turbulent high-speed wall-bounded flows. We also show that the thermodynamic variables exhibit similar mode shapes to the streamwise velocity modes, supporting the strong Reynolds analogy. Finally, we demonstrate that the principal resolvent modes can be used to capture the energy distribution between momentum and thermodynamic fluctuations.
This work develops a methodology for approximating the shape of leading resolvent modes for incompressible, quasi-parallel, shear-driven turbulent flows using prescribed analytic functions. We demonstrate that these functions, which arise from the consideration of wavepacket pseudoeigenmodes of simplified linear operators (Trefethen, Proceedings of the Royal Society of London A: Mathematical, Physical and Engineering Sciences, vol. 461, 2005, pp. 3099–3122. The Royal Society), give an accurate approximation for the energetically dominant wall-normal vorticity component of a class of nominally wall-detached modes that are centred about the critical layer. We validate our method on a model operator related to the Squire equation, and show for this simplified case how wavepacket pseudomodes relate to truncated asymptotic expansions of Airy functions. Following the framework developed in McKeon & Sharma (J. Fluid Mech., vol. 658, 2010, pp. 336–382), we next apply a sequence of simplifications to the resolvent formulation of the Navier–Stokes equations to arrive at a scalar differential operator that is amenable to such analysis. The first simplification decomposes the resolvent operator into Orr–Sommerfeld and Squire suboperators, following Rosenberg & McKeon (Fluid Dyn. Res., vol. 51, 2019, 011401). The second simplification relates the leading resolvent response modes of the Orr–Sommerfeld suboperator to those of a simplified scalar differential operator – which is the Squire operator equipped with a non-standard inner product. This characterisation provides a mathematical framework for understanding the origin of leading resolvent mode shapes for the incompressible Navier–Stokes resolvent operator, and allows for rapid estimation of dominant resolvent mode characteristics without the need for operator discretisation or large numerical computations. We explore regions of validity for this method, and show that it can predict resolvent response mode shape (though not necessary the corresponding resolvent gain) over a wide range of spatial wavenumbers and temporal frequencies. In particular, we find that our method remains relatively accurate even when the modes have some amount of ‘attachment’ to the wall, and that that the region of validity contains the regions in parameter space where large-scale and very-large-scale motions typically reside. We relate these findings to classical lift-up and Orr amplification mechanisms in shear-driven flows.
Cognitive-behavioural therapy (CBT) is an effective treatment for depressed adults. CBT interventions are complex, as they include multiple content components and can be delivered in different ways. We compared the effectiveness of different types of therapy, different components and combinations of components and aspects of delivery used in CBT interventions for adult depression. We conducted a systematic review of randomised controlled trials in adults with a primary diagnosis of depression, which included a CBT intervention. Outcomes were pooled using a component-level network meta-analysis. Our primary analysis classified interventions according to the type of therapy and delivery mode. We also fitted more advanced models to examine the effectiveness of each content component or combination of components. We included 91 studies and found strong evidence that CBT interventions yielded a larger short-term decrease in depression scores compared to treatment-as-usual, with a standardised difference in mean change of −1.11 (95% credible interval −1.62 to −0.60) for face-to-face CBT, −1.06 (−2.05 to −0.08) for hybrid CBT, and −0.59 (−1.20 to 0.02) for multimedia CBT, whereas wait list control showed a detrimental effect of 0.72 (0.09 to 1.35). We found no evidence of specific effects of any content components or combinations of components. Technology is increasingly used in the context of CBT interventions for depression. Multimedia and hybrid CBT might be as effective as face-to-face CBT, although results need to be interpreted cautiously. The effectiveness of specific combinations of content components and delivery formats remain unclear. Wait list controls should be avoided if possible.
The development of nutritional strategies to improve microbial homeostasis and gut health of piglets post-weaning is required to mitigate the high prevalence of post-weaning diarrhea and subsequent growth checks typically observed during the weaning transition. Therefore the objective of this study was to determine the effect of supplementing piglet creep and nursery feed with a yeast-derived mannan-rich fraction (MRF) on piglet growth performance, cecal microbial profiles, and jejunal morphology and gene expression. Ten litters of piglets (n=106) were selected on postnatal day (PND) 7 and assigned to diets with or without MRF (800 mg/kg) until weaning (n=5 litters/treatment; initial weight 3.0±0.1 kg). On PND 21, 4 piglets per litter (n=40) were selected and weaned into the nursery where they remained on their respective diets until PND 42. A two-phase feeding program was used to meet nutrient requirements, and pigs were switched from phase 1 to phase 2 on PND 28. Feed intake and piglet weights were recorded on PND 7, 14, 21, 28, 35 and 42. On PND 28 and 42, ten piglets per treatment were euthanized to collect intestinal tissue and digesta. Piglets supplemented with MRF had 21.5% greater (P<0.05) average daily feed intake between PND 14-21. However, MRF supplementation did not affect piglet growth performance compared to control. On PND 28, jejunal villus height was 16.8% greater (P<0.05) in piglets consuming MRF supplemented diets. Overall microbial community structure in cecal digesta on PND 28 tended to differ in pigs supplemented with MRF (P=0.076; analysis of similarities (ANOSIM)) with increased (P<0.05) relative abundance of Paraprevotellaceae genera YRC22 and CF231, and reduced (P<0.05) relative abundance of Sutterella and Prevotella. Campylobacter also tended to reduce (P<0.10) in MRF supplemented piglets. On PND 28 differential gene expression in jejunal tissue signified an overall effect of supplementing MRF to piglets. Downstream analysis of gene expression data revealed piglets supplemented with MRF had enriched biological pathways involved in intestinal development, function and immunity, supporting the observed improvement in jejunal villus architecture on PND 28. On PND 42 there was no effect of MRF supplementation on jejunal morphology or overall cecal microbial community structure. In conclusion, supplementing Actigen™, a MRF, to piglets altered cecal microbial community structure and improved jejunal morphology early post-weaning on PND 28, which is supported by enrichment of intestinal development pathways.
An experiment was carried out to examine the effects of offering beef cattle five silage diets. These were perennial ryegrass silage (PRGS) as the sole forage, tall fescue/perennial ryegrass silage (FGS) as the sole forage, PRGS in a 50:50 ratio on a dry matter (DM) basis with lupin/triticale silage (LTS), lupin/wheat silage (LWS) and pea/oat silage (POS). Each of the five silage diets was supplemented with 4 and 7 kg of concentrates/head/day in a five silages × two concentrate intakes factorial design. A total of 90 cattle were used in the 121-day experiment. The grass silages were of medium digestibility and were well preserved. The legume/cereal silages had high ammonia N, high acetic acid, low lactic acid, low butyric acid and low digestible organic matter concentrations (542, 562 and 502 g/kg DM for LTS, LWS and POS, respectively). Silage treatment did not significantly affect liveweight gain, carcass gain, carcass characteristics, the instrumental assessment of meat quality or fatty acid composition of the M. longissimus dorsi muscle. In view of the low yields of the legume/cereal crops, it is concluded that the inclusion of spring-sown legume/cereal silages in the diets of beef cattle is unlikely to be advantageous.
An experiment was carried out to examine the effects of offering beef steers grass silage (GS) as the sole forage, lupins/triticale silage (LTS) as the sole forage, a mixture of LTS and GS at a ratio of 70:30 on a dry matter (DM) basis, vetch/barley silage (VBS) as the sole forage, a mixture of VBS and GS at a ratio of 70:30 on a DM basis, giving a total of five silage diets. Each of the five silage diets was supplemented with 2 and 5 kg of concentrates/head/day in a 5 × 2 factorial design to evaluate the five silages at two levels of concentrate intake and to examine possible interactions between silage type and concentrate intake. A total of 80 beef steers were used in the 122-day experiment. The GS was well preserved while the whole crop cereal/legume silages had high ammonia-nitrogen (N) concentrations, low lactic acid concentrations and low butyric acid concentrations For GS, LTS, LTS/GS, VBS and VBS/GS, respectively, silage DM intakes were 6.5, 7.0, 7.2, 6.1 and 6.6 (s.e.d. 0.55) kg/day and live weight gains were 0.94, 0.72, 0.63, 0.65 and 0.73 (s.e.d. 0.076) kg/day. Silage type did not affect carcass fatness, the colour or tenderness of meat or the fatty acid composition of the intramuscular fat in the longissimus dorsi muscle.
The study objective was to determine the prevalence of Staphylococcus aureus colonisation in the nares and oropharynx of healthy persons and identify any risk factors associated with such S. aureus colonisation. In total 263 participants (177 adults and 86 minors) comprising 95 families were enrolled in a year-long prospective cohort study from one urban and one rural county in eastern Iowa, USA, through local newspaper advertisements and email lists and through the Keokuk Rural Health Study. Potential risk factors including demographic factors, medical history, farming and healthcare exposure were assessed. Among the participants, 25.4% of adults and 36.1% minors carried S. aureus in their nares and 37.9% of adults carried it in their oropharynx. The overall prevalence was 44.1% among adults and 36.1% for minors. Having at least one positive environmental site for S. aureus in the family home was associated with colonisation (prevalence ratio: 1.34, 95% CI: 1.07–1.66). The sensitivity of the oropharyngeal cultures was greater than that of the nares cultures (86.1% compared with 58.2%, respectively). In conclusion, the nares and oropharynx are both important colonisation sites for healthy community members and the presence of S. aureus in the home environment is associated with an increased probability of colonisation.
Vaccination remains a mainstay of companion animal population health. However, how vaccine use at a population level complies with existing guidelines is unknown. Here we use electronic health records to describe vaccination in dogs, cats and rabbits attending a large sentinel network of UK veterinary practices. In total, 77.9% (95% CI: 77.6–78.1) of animals had recorded vaccinations. The percentage of animals with recorded vaccinations was higher in dogs, neutered animals, in insured dogs and cats and in purebred dogs. Vaccination rates varied in different regions of Great Britain in all species. Dogs and cats belonging to owners living in less deprived areas of England and Scotland were more likely to be recorded as vaccinated. In the vaccinated population, cats received more core vaccines per year of life (0.86) than dogs (0.75), with feline leukaemia vaccines almost as frequent as core vaccines. In dogs, leptospira vaccines were more frequent than core vaccines. This descriptive study suggests a substantial proportion of animals are not benefiting from vaccine protection. For the first time, we identify potential factors associated with variations in recorded vaccination frequency, providing a critical baseline against which to monitor future changes in companion animal vaccination and evidence to inform future targeted health interventions.
This study aimed to evaluate levels of beef cow fertility using calving interval (CI; measured in days) as a measure, and investigate the effects of breed, season, year and progeny gender on CI. The CI data included 273 764 records collected between 1997 and 2012 and included the seven most common breeds (and their crosses) in Northern Ireland (Charolais, Limousin, Belgian Blue, Simmental, Blonde d’Aquitaine, Aberdeen Angus and Hereford), accounting for 94.1% of beef dams recorded. Mean CI for all cows was 395 days, 30 days longer than the optimum 365 days. Charolais and Belgian Blue dams had the longest CI (P<0.05). Cows older than 144 months had a longer CI (P<0.05) compared with cows younger than 144 months. Charolais sires had a shorter subsequent CI of 392 days (P<0.05) compared with the other breeds. Cows calving in June had the shortest subsequent CI (376 days; P<0.05), whereas cows calving in November had the longest subsequent CI (410 days). Progeny gender did not significantly affect CI. This study establishes the level of beef cow fertility using CI as a measure in Northern Ireland is sub optimal and there are opportunities for improvement. Factors identified as influencing CI included dam breed, sire breed and month of parturition. This knowledge can be used to direct breeding programmes and inform knowledge transfer protocol to improve sustainability of beef production.
This study aimed to assess head and neck cancer patient satisfaction with the use of a touch-screen computer patient-completed questionnaire for assessing Adult Co-morbidity Evaluation 27 co-morbidity scores prior to treatment, along with its clinical reliability.
A total of 96 head and neck cancer patients were included in the audit. An accurate Adult Co-morbidity Evaluation 27 co-morbidity score was achieved via patient-completed questionnaire assessment for 97 per cent of participants.
In all, 96 per cent of patients found the use of a touch-screen computer acceptable and would be willing to use one again, and 62 per cent would be willing to do so without help. Patients were more likely to be willing to use the computer again without help if they were aged 65 years or younger (χ2 test; p = 0.0054) or had a performance status of 0 or 1 (χ2 test; p = 0.00034).
Use of a touch-screen computer is an acceptable approach for assessing Adult Co-morbidity Evaluation 27 scores at pre-treatment assessment in a multidisciplinary joint surgical–oncology clinic.
Accurate forecasting of seasonal influenza epidemics is of great concern to healthcare providers in temperate climates, since these epidemics vary substantially in their size, timing and duration from year to year, making it a challenge to deliver timely and proportionate responses. Previous studies have shown that Bayesian estimation techniques can accurately predict when an influenza epidemic will peak many weeks in advance, and we have previously tailored these methods for metropolitan Melbourne (Australia) and Google Flu Trends data. Here we extend these methods to clinical observation and laboratory-confirmation data for Melbourne, on the grounds that these data sources provide more accurate characterizations of influenza activity. We show that from each of these data sources we can accurately predict the timing of the epidemic peak 4–6 weeks in advance. We also show that making simultaneous use of multiple surveillance systems to improve forecast skill remains a fundamental challenge. Disparate systems provide complementary characterizations of disease activity, which may or may not be comparable, and it is unclear how a ‘ground truth’ for evaluating forecasts against these multiple characterizations might be defined. These findings are a significant step towards making optimal use of routine surveillance data for outbreak forecasting.
Ground-state OH masers identified in the Southern Parkes Large-Area Survey in Hydroxyl were observed with the Australia Telescope Compact Array to obtain positions with high accuracy (~1 arcsec). We classified these OH masers into evolved star OH maser sites, star formation OH maser sites, supernova remnant OH maser sites, planetary nebula OH maser sites and unknown maser sites using their accurate positions. Evolved star and star formation OH maser sites in the Galactic Centre region (between Galactic longitudes of −5° to +5° and Galactic latitudes of −2° and +2°) were studied in detail to understand their distributions.
The statistics of the velocity gradient tensor
, which embody the fine scales of turbulence, are influenced by turbulent ‘structure’. Whilst velocity gradient statistics and dynamics have been well characterised, the connection between structure and dynamics has largely focused on rotation-dominated flow and relied upon data from numerical simulation alone. Using numerical and spatially resolved experimental datasets of homogeneous turbulence, the role of structure is examined for all local (incompressible) flow topologies characterisable by
. Structures are studied through the footprints they leave in conditional averages of the
field, pertinent to non-local strain production, obtained using two complementary conditional averaging techniques. The first, stochastic estimation, approximates the
field conditioned upon
and educes quantitatively similar structure in both datasets, dissimilar to that of random Gaussian velocity fields. Moreover, it strongly resembles a promising model for velocity gradient dynamics recently proposed by Wilczek & Meneveau (J. Fluid Mech., vol. 756, 2014, pp. 191–225), but is derived under a less restrictive premise, with explicitly determined closure coefficients. The second technique examines true conditional averages of the
field, which is used to validate the stochastic estimation and provide insights towards the model’s refinement. Jointly, these approaches confirm that vortex tubes are the predominant feature of rotation-dominated regions and additionally show that shear layer structures are active in strain-dominated regions. In both cases, kinematic features of these structures explain alignment statistics of the pressure Hessian eigenvectors and why local and non-local strain production act in opposition to each other.
The intensity ratios of HCO+/HCN and HNC/HCN (1-0) reveal the relative influence of star formation and active galactic nuclei (AGN) or black holes on the circum-nuclear gas of a galaxy, allowing the identification of X-ray dominated regions (XDRs) and Photon-dominated regions (PDRs). It is not always clear in the literature how this intensity ratio calculation has been, or should be performed. This paper discusses ratio calculation methods for interferometric data.
To determine what factors are associated with parental motivation to change body weight in overweight children.
Dunedin, New Zealand.
Two hundred and seventy-one children aged 4–8 years, recruited in primary and secondary care, were identified as overweight (BMI≥85th percentile) after screening. Parents completed questionnaires on demographics; motivation to improve diet, physical activity and weight; perception and concern about weight; parenting; and social desirability, prior to being informed that their child was overweight. Additional measures of physical activity (accelerometry), dietary intake and child behaviour (questionnaire) were obtained after feedback.
Although all children were overweight, only 42 % of parents perceived their child to be so, with 36 % indicating any concern. Very few parents (n 25, 8 %) were actively trying to change the child’s weight. Greater motivation to change weight was observed for girls compared with boys (P=0·001), despite no sex difference in BMI Z-score (P=0·374). Motivation was not associated with most demographic variables, social desirability, dietary intake, parenting or child behaviour. Increased motivation to change the child’s weight was observed for heavier children (P<0·001), those who were less physically active (P=0·002) and more sedentary (P<0·001), and in parents who were more concerned about their child’s weight (P<0·001) or who used greater food restriction (P<0·001).
Low levels of parental motivation to change overweight in young children highlight the urgent need to determine how best to improve motivation to initiate change.
A retrospective cohort study was conducted to identify risk factors for bovine tuberculosis (bTB) recurrence in New Zealand cattle and deer herds identified as bTB-infected from 1 June 2006 to 1 November 2010. A Cox proportional hazards model identified a positive relationship between the daily hazard of bTB recurrence and: (1) the number of prior bTB episodes for two episodes [hazard ratio (HR) 3·22, 95% confidence interval (CI) 1·21–8·60], and for five episodes (HR 89·5, 95% CI 13·8–580), (2) more than one positive bTB case animal at the index episode (HR 2·25, 95% CI 1·19–4·25) and (3) the presence of cleared test-positives at the final test of the index episode. The proportional hazards assumption was violated for the latter variable so a time-dependent covariate was introduced. Up to 2 years post-clearance, the daily hazard of bTB recurrence was greater in herds with test-positives at the final test (HR 2·59, 95% CI 1·30–5·13), but this effect was not observed more than 2 years' post-clearance (HR 1·05, 95% CI 0·28–3·91). We conclude that unresolved infection contributes to further bTB episodes in the first 2 years after herd clearance.
A cloud monitor has been developed for use with cosmic ray air shower fluorescence detectors, the High Resolution Fly's Eye and the Pierre Auger Observatory. This is based on an infrared thermopile device which, unlike previous such monitors, requires no moving chopper and is suitable for unattended operation over long periods of time.
A survey of the Milky Way disk and the Magellanic System at the wavelengths of the 21-cm atomic hydrogen (H i) line and three 18-cm lines of the OH molecule will be carried out with the Australian Square Kilometre Array Pathfinder telescope. The survey will study the distribution of H i emission and absorption with unprecedented angular and velocity resolution, as well as molecular line thermal emission, absorption, and maser lines. The area to be covered includes the Galactic plane (|b| < 10°) at all declinations south of δ = +40°, spanning longitudes 167° through 360°to 79° at b = 0°, plus the entire area of the Magellanic Stream and Clouds, a total of 13 020 deg2. The brightness temperature sensitivity will be very good, typically σT≃ 1 K at resolution 30 arcsec and 1 km s−1. The survey has a wide spectrum of scientific goals, from studies of galaxy evolution to star formation, with particular contributions to understanding stellar wind kinematics, the thermal phases of the interstellar medium, the interaction between gas in the disk and halo, and the dynamical and thermal states of gas at various positions along the Magellanic Stream.