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Women are more likely to be admitted to nursing home after stroke than men. Differences in patient characteristics and outcomes by sex after institutionalization are less understood. We examined sex differences in the characteristics and care needs of patients admitted to nursing home following stroke and their subsequent survival.
We identified patients with stroke newly admitted to nursing home between April 2011 and March 2016 in Ontario, Canada, with follow-up until March 2018 using linked administrative data. We calculated prevalence ratios and 95% confidence intervals (CIs) for the primary outcomes of dependence for activities of daily living, cognitive impairment, frailty, health instability, and symptoms of depression or pain, comparing women to men. The secondary outcome was all-cause mortality.
Among 4831 patients, 60.9% were women. Compared to men, women were older (median age [interquartile range, IQR]: 84 [78, 89] vs. 80 [71, 86]), more likely to be frail (prevalence ratio 1.14, 95% CI [1.08, 1.19]), have unstable health (1.45 [1.28, 1.66]), and experience symptoms of depression (1.25 [1.11, 1.40]) or pain (1.21 [1.13, 1.30]), and less likely to have aggressive behaviors (0.87 [0.80, 0.94]). Overall median survival was 2.9 years. In a propensity-score-matched cohort, women had lower mortality than men (hazard ratio 0.85, 95% CI [0.77, 0.94]), but in the age-stratified survival analysis, the survival advantage in women was limited to those aged 75 years and older.
Despite lower subsequent mortality, women admitted to nursing home after stroke required more care than men. Pain and depression are two treatable symptoms that disproportionately affect women.
Bennett Island stands alone in a remote part of the Arctic and information on its geology is essential to ascertain relations with other terranes in order to restore the early Palaeozoic Arctic palaeogeography. Lower Palaeozoic sedimentary rocks throughout the island were studied thoroughly for the first time. The Ordovician section (> 1.1 km thick) comprises three units: Tremadocian, lowest Floian black shale (130–140 m); Floian, lower Dapingian carbonate turbidite (> 250 m); and Dapingian, lower Darriwilian siliciclastic turbidite (> 730 m). Ordovician deposits conformably overlie Cambrian rocks deposited within the Siberian shelf, as shown earlier. Most of the Ordovician succession was formed in a deep trough that received carbonate debris from a nearby carbonate platform and silicate material from a distant landmass located to the NE (present coordinates). The Bennett Island Ordovician rocks have much in common with those of both the Central and Northern Taimyr belts. It could be tentatively suggested that both belts merged at their eastern continuation in the vicinity of De Long Islands. The whole system probably extends further eastwards. The Ordovician facies patterns and faunal assemblages in the New Siberian Islands are notably similar to those of northwestern Alaska, where the same lateral transition from turbidites to shelf limestones was reported.
Authors of this paper were educated and have spent many years in Lomonosov Moscow State University (MSU), in the Interfaculty Laboratory of Statistical Methods (ILSM). Prof. Yu. K. Belyaev was student of Kolmogorov, and for several years his deputy in the ILSM, created and led by the great A. N. Kolmogorov. Now Prof. Yuri Belyaev is Emeritus Professor at Umea University (Sweden). Asaf Hajiyev was a PhD student in Kolmogorov's ILSM. In this paper some unusual incidents about the legendary Kolmogorov, and people around him are presented. Some stories were taken from the books and the internet (see references) dedicated to the memory of Kolmogorov; some were told by his students, and some happened with authors of this paper.
Optimal stroke care requires access to resources such as neuroimaging, acute revascularization, rehabilitation, and stroke prevention services, which may not be available in rural areas. We aimed to determine geographic access to stroke care for residents of rural communities in the province of Ontario, Canada.
We used the Ontario Road Network File database linked with the 2016 Ontario Acute Stroke Care Resource Inventory to estimate the proportion of people in rural communities, defined as those with a population size <10,000, who were within 30, 60, and 240 minutes of travel time by car from stroke care services, including brain imaging, thrombolysis treatment centers, stroke units, stroke prevention clinics, inpatient rehabilitation facilities, and endovascular treatment centers.
Of the 1,496,262 people residing in rural communities, the majority resided within 60 minutes of driving time to a center with computed tomography (85%), thrombolysis (81%), a stroke unit (68%), a stroke prevention clinic (74%), or inpatient rehabilitation (77.0%), but a much lower proportion (32%) were within 60 minutes of driving time to a center capable of providing endovascular thrombectomy (EVT).
Most rural Ontario residents have appropriate geographic access to stroke services, with the exception of EVT. This information may be useful for jurisdictions seeking to optimize the regional organization of stroke care services.
Nanostructures of plasmonic metals naturally combine strong light–matter interactions with catalytic activity, enabling new opportunities for light harvesting, catalytic chemistry, and artificial photosynthesis. Numerous studies have demonstrated that the optical excitation of localized surface plasmons generates hot electrons that can activate adsorbates triggering or facilitating chemical reactions on the surface of the nanoparticle. Going beyond such hot-electron-activated chemistry, a body of studies has shown that electron and hole carriers can be harvested from a plasmonically excited nanoparticle and utilized as redox equivalents for driving chemical reactions involving charge transfer. This article reviews such photoredox chemistry driven by plasmonic excitation of metal nanoparticles. Under certain conditions, a plasmonically excited nanoparticle can catalyze multielectron, multiproton transformations such as the photosynthesis of CO2 to hydrocarbons. We describe how the free energy of plasmonically generated charge carriers can be harvested and utilized for thermodynamically uphill reactions involving the formation of energy-rich chemical bonds or the development of molecular complexity. We end with a discussion of future opportunities in plasmon-excitation-driven photoredox chemistry.
We consider the size spectrum of entrained bubbles under strong free-surface turbulence (SFST). We investigate the entrainment bubble-size spectrum per unit (mean) interface area,
, with dimension length
, and develop a physical/mechanistic model for
through energy arguments. The model obtains two distinct regimes of
, separated by bubble-size scale
. For bubble radius
, the effects of gravity
dominate those of the surface tension force
is the turbulence dissipation rate. For
, surface tension is more important and
. From the model, we show that
, the capillary length scale, and not the generally assumed Hinze scale
. For an air–water interface and Earth gravity,
1.5 mm. The model provides an
entrainment regime map that identifies a critical dissipation rate
(constant for given
) above which there is appreciable air entrainment, thus separating SFST and weak FST. We confirm the theoretical model and its predictions using two-phase, high-fidelity direct numerical simulations of a canonical FST flow using the conservative volume-of-fluid method: the respective power laws of
; the value
; the scaling
; and the predictions of the
entrainment regime map.
Patients with severe mental disorders in low-resource settings have limited access to services, resulting in overwhelming caregiving burden for families. In extreme cases, this has led to the long-term restraining of patients in their homes. China underwent a nationwide initiative to unlock patients and provide continued treatment. This study aims to quantify household economic burden in families after unlocking and treatment, and to identify factors associated with increased burden due to schizophrenia.
A total of 264 subjects were enrolled from three geographically diverse provinces in 2012. Subjects were patients with schizophrenia who were previously put under restraints and had participated in the ‘unlocking and treatment’ intervention. The primary outcome was the current household economic burden, obtained from past year financial information collected through on-site interview. Patient disease characteristics, treatment, outcomes and family caregiving burden were collected as well. Univariate and multivariate linear regression were used to construct risk factor models for indirect economic burden.
After participating in the intervention, 85% of patients continued to receive mental health services, 70% used medication as prescribed and 80% were never relocked. Family members reported significantly decreased caregiving burden after receiving the intervention. Mean direct and indirect household economic burdens were CNY963 (US$31.7) and CNY11 724 (US$1670) per year, respectively, while family total income was on average CNY12 108 (US$1913) per year. Greater disease severity and poorer patient psychosocial function at time of study were found to be independent factors related to increased indirect burden.
The ‘unlocking and treatment’ intervention has improved the lives of patients and families. Indirect burden due to disease is still a major economic issue that needs to be addressed, potentially through improving treatment and patient functioning. Our findings contribute to the unravelling and eventual elimination of chronic restraining of mentally ill patients in low-resource settings.
We investigate two-phase free-surface turbulence (FST) associated with an underlying shear flow under the condition of strong turbulence (SFST) characterized by large Froude (
) and Weber (
) numbers. We perform direct numerical simulations of three-dimensional viscous flows with air and water phases. In contrast to weak FST (WFST) with small free-surface distortions and anisotropic underlying turbulence with distinct inner/outer surface layers, we find SFST to be characterized by large surface deformation and breaking accompanied by substantial air entrainment. The interface inner/outer surface layers disappear under SFST, resulting in nearly isotropic turbulence with
scaling of turbulence kinetic energy near the interface (where
is wavenumber). The SFST air entrainment is observed to occur over a range of scales following a power law of slope
. We derive this using a simple energy argument. The bubble size spectrum in the volume follows this power law (and slope) initially, but deviates from this in time due to a combination of ongoing broad-scale entrainment and bubble fragmentation by turbulence. For varying
, we find that air entrainment is suppressed below critical values
, the entrainment rate scales as
when gravity dominates surface tension in the bubble formation process, while the entrainment rate scales linearly with
when surface tension dominates.
In self-excited combustion systems, the application of open-loop forcing is known to be an effective strategy for controlling periodic thermoacoustic oscillations, but it is not known whether and under what conditions such a strategy would work on thermoacoustic oscillations that are not simply periodic. In this study, we experimentally examine the effect of periodic acoustic forcing on a prototypical thermoacoustic system consisting of a ducted laminar premixed flame oscillating quasiperiodically on an ergodic
torus at two incommensurate natural frequencies,
. Compared with that of a classical period-1 system, complete synchronization of this
system is found to occur via a more intricate route involving three sequential steps: as the forcing amplitude,
, increases at a fixed forcing frequency,
, the system transitions first (i) to ergodic
quasiperiodicity; then (ii) to resonant
quasiperiodicity as the weaker of the two natural modes,
, synchronizes first, leading to partial synchronization; and finally (iii) to a
limit cycle as the remaining natural mode,
, also synchronizes, leading to complete synchronization. The minimum
required for partial and complete synchronization decreases as
, resulting in two primary Arnold tongues. However, when forced at an amplitude above that required for complete synchronization, the system can transition out of
. The optimal control strategy is to apply off-resonance forcing at a frequency around the weaker natural mode (
) and at an amplitude just sufficient to cause
, because this produces the largest reduction in thermoacoustic amplitude via asynchronous quenching. Analysis of the Rayleigh index shows that this reduction is physically caused by a disruption of the positive coupling between the unsteady heat release rate of the flame and the
acoustic modes. If the forcing is applied near the stronger natural mode (
), however, resonant amplification can occur. We then phenomenologically model this
thermoacoustic system as two reactively coupled van der Pol oscillators subjected to external sinusoidal forcing, and find that many of its synchronization features – such as the three-step route to
, the double Arnold tongues, asynchronous quenching and resonant amplification – can be qualitatively reproduced. This shows that these features are not limited to our particular system, but are universal features of forced self-excited oscillators. This study extends the applicability of open-loop control from classical period-1 systems with just a single time scale to ergodic
quasiperiodic systems with two incommensurate time scales.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
We present high-resolution implicit large eddy simulation (iLES) of the turbulent air-entraining flow in the wake of three-dimensional rectangular dry transom sterns with varying speeds and half-beam-to-draft ratios
. We employ two-phase (air/water), time-dependent simulations utilizing conservative volume-of-fluid (cVOF) and boundary data immersion (BDIM) methods to obtain the flow structure and large-scale air entrainment in the wake. We confirm that the convergent-corner-wave region that forms immediately aft of the stern wake is ballistic, thus predictable only by the speed and (rectangular) geometry of the ship. We show that the flow structure in the air–water mixed region contains a shear layer with a streamwise jet and secondary vortex structures due to the presence of the quasi-steady, three-dimensional breaking waves. We apply a Lagrangian cavity identification technique to quantify the air entrainment in the wake and show that the strongest entrainment is where wave breaking occurs. We identify an inverse dependence of the maximum average void fraction and total volume entrained with
. We determine that the average surface entrainment rate initially peaks at a location that scales with draft Froude number and that the normalized average air cavity density spectrum has a consistent value providing there is active air entrainment. A small parametric study of the rectangular geometry and stern speed establishes and confirms the scaling of the interface characteristics with draft Froude number and geometry. In Part 2 (Hendrikson & Yue, J. Fluid Mech., vol. 875, 2019, pp. 884–913) we examine the incompressible highly variable density turbulence characteristics and turbulence closure modelling.
Thermal imaging diagnostics was used as a surface temperature mapping tool to characterize the energy density distribution of a high-intensity pulsed ion beam. This approach was tested on the TEMP-6 accelerator (200–250 kV, 150 ns). The beam composition included carbon ions (85%) and protons, and the energy density in the focus was 5–12 J/cm2. Targets of stainless steel, titanium, brass, copper, and tungsten were examined. Our observations show that the maximum energy density measured with the thermal imaging diagnostics considerably exceeds the ablation threshold of the targets. An analysis of the overheating mechanisms of each target was carried out, including metastable overheating of the target to above its boiling temperature during rapid heating; formation, migration, and the subsequent annealing of fast radiation-induced defects in the target under ion beam irradiation. This expands the range of energy density measurement for this thermal imaging diagnostics from 2–3 J/cm2 up to 10–12 J/cm2 but introduces error into the results of measurement. For a stainless steel target, this error exceeds 15% at an energy density of more than 4 J/cm2. A method of correcting the results of the thermal imaging diagnostics is developed for a pulsed ion beam under conditions of intense ablation of the target material.
Little is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services.
We compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored.
Patients with FES (N = 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups.
There were significantly more patients who received the early intervention service in the good employment cluster (early intervention: N = 98 [67.6%]; standard care: N = 76 [52.4%]; P = 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1–5 (P < 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group.
Results suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.
Declaration of interests
No relevant conflicts of interests reported by C.L.M.H., Y.N.S., P.S., H.H.P. and K.K.Y. S.K.W.C., W.C.C. and E.H.M.L. report that they are members of the working group of the Early Assessment Service for Young People with Psychosis (EASY) programme of the Hospital Authority in Hong Kong. E.Y.H.C. is the convener of the working group of the EASY programme of the Hospital Authority in Hong Kong.
For a large part of the past century, the cold war between the Soviet Union and the United States and Russia’s continued refusal to join the Berne Convention for the Protection of Literary and Artistic Works (Berne Convention), the predominant international copyright agreement, have raised complicated questions concerning the protection of Russian authors in the United States.1 The case that has received considerable attention in intellectual property literature is Itar-Tass Russian News Agency v. Russian Kurier, Inc (Itar-Tass).2 Filed in the mid-1990s, shortly after Russia’s accession to the Berne Convention but before its admission to the World Trade Organization (WTO), this case covered not only choice-of-law questions in the intellectual property field but also the interrelationship between domestic law and international treaties. Less frequently explored, however, are the rich comparative lessons that the case has provided on the development of intellectual property law and policy in Central and Eastern Europe.
The intensity of turbidite sedimentation over long timescales is driven by sea-level change, tectonically driven rock uplift and climatically modulated sediment delivery rates. This study focuses on understanding the effect of sea-level fluctuations and climatic variability on grain-size variations. The grain size and environmental magnetic parameters of Arabian Sea sediments have been documented using 203 samples, spanning the last 200 ka, obtained from International Ocean Discovery Program (IODP) Site U1457. Grain-size end-member modelling suggests that between ~200 and 130 ka there was an increase in the coarse silt fraction caused by sediment transport following reworking of the Indus Fan and development of deep-sea canyons. The sediment size and enhanced magnetic susceptibility indicate a dominant flux of terrestrial sediments. Sedimentation in the distal Indus Fan at c. 200–130 ka was driven by a drop in sea level that lowered the base level in the Indus and Narmada river systems. The low sea-stand caused incision in the Indus delta, canyons and fan area, which resulted in the transportation of coarser sediment at the drilling site. Magnetic susceptibility and other associated magnetic parameters suggest a large fraction of the sediment was supplied by the Narmada River during ~200–130 ka. Since ~130 ka, clay-dominated sedimentation is attributed to the rise in sea level due to warm and wet climate.
Background: Canadian Stroke Guidelines recommend that Transient Ischemic Attack (TIA) patients at highest risk of stroke recurrence should undergo immediate vascular imaging. Computed tomography angiography (CTA) of the head and neck is recommended over carotid doppler because it allows for enhanced visualization of the intracranial and posterior circulation vasculature. Imaging while patients are in the emergency department (ED) is optimal for high-risk patients because the risk of stroke recurrence is highest in the first 48 hours. Aim Statement: At our hospital, a designated stroke centre, less than 5% of TIA patients meet national recommendations by undergoing CTA in the ED. We sought to increase the rate of CTA in high risk ED TIA patients from less than 5% to at least 80% in 10 months. Measures & Design: We used a multi-faceted approach to improve our adherence to guidelines including: 1) education for staff ED physicians; 2) agreements between ED and radiology to facilitate rapid access to CTA; 3) agreements between ED and neurology for consultations regarding patients with abnormal CTA; and 4) the creation of an electronic decision support tool to guide ED physicians as to which patients require CTA. We measured the rate of CTA in high risk patients biweekly using retrospective chart review of patients referred to the TIA clinic from the ED on a biweekly basis. As a balancing measure, we also measured the rate of CTA in non-high risk patients. Evaluation/Results: Data collection is ongoing. An interim run chart at 19 weeks shows a complete shift above the median after implementation, with CTA rates between 70 and 100%. At the time of submission, we had no downward trends below 80%, showing sustained improvement. The CTA rate in non-high risk patients did also increase. Disucssion/Impact: After 19 weeks of our intervention, 112 (78.9%) of high risk TIA patients had a CTA, compared to 10 (9.8%) in the 19 weeks prior to our intervention. On average, 10-15% of high risk patients will have an identifiable lesion on CTA, leading to immediate change in management (at minimum, an inpatient consultation with neurology). Our multi-faceted approach could be replicated in any ED with the engagement and availability of the same multi-disciplinary team (ED, radiology, and neurology), access to CTA, and electronic orders.
Research results of luminescence spectra of noble gases and Ar–Xe, Ar–Kr, and Kr–Xe mixtures under the excitation by products of nuclear reaction in the core of a stationary nuclear reactor with 0.87 × 1014 n/cm2s thermal neutron flux are described in the article. The emission spectra of noble gases are similar to the obtained spectrum under the excitation by the 40Ar+7 ion beam from the DC-60 accelerator. Bands in spectra of the binary mixtures of noble gases are connected with the radiation on heteronuclear ion molecule transitions. The appearance of the lines of alkali metal atoms at the temperature increase of gas chamber is explained by sputtering of the lithium layer via nuclear reaction products as well as ionized and excited particles of the buffer gas.
A new generation of high power laser facilities will provide laser pulses with extremely high powers of 10 petawatt (PW) and even 100 PW, capable of reaching intensities of
in the laser focus. These ultra-high intensities are nevertheless lower than the Schwinger intensity
at which the theory of quantum electrodynamics (QED) predicts that a large part of the energy of the laser photons will be transformed to hard Gamma-ray photons and even to matter, via electron–positron pair production. To enable the investigation of this physics at the intensities achievable with the next generation of high power laser facilities, an approach involving the interaction of two colliding PW laser pulses is being adopted. Theoretical simulations predict strong QED effects with colliding laser pulses of
focused to intensities