Background: Surgical delays are in common in Canada. Wait times in elective spine surgery and their impact on outcomes remain uncharacterized. Methods: This was a single-center analysis of elective spine surgery data between 2009-2020. Wait times between referral and consultation (T1), consultation and surgical booking (Ti), and booking and surgery (T2) were assessed. Results: 2041 patients were included. Longitudinal analyses were adjusted for age, sex, diagnosis, surgical volume, while outcomes analyses were age and sex-adjusted. Total T1+Ti+T2 increased 8.1% annually (p<0.001). T1 decreased 4.3% annually (p=0.032). It was not associated with adverse events (AEs) or disposition. Every 100 days of T1 was associated with 1.0% longer hospitalization (p=0.001). Ti increased 21.0% annually (p<0.001). Every 100 days of Ti was associated with 2.9% increased odds of an adverse event (p=0.002), 1.8% longer hospitalization (p<0.001), and 15.9% increased likelihood of discharge home (p<0.001). T2 increased 7.0% annually (p<0.001) and was not associated with AEs. Every 100 days of T2 was associated with 11.6% longer hospitalization (p<0.001) and 76.5% increased likelihood of discharge home (p<0.001). Conclusions: Total wait times for elective spine surgery have increased between 2009-2020. Notably, Ti increased ninefold and was associated with AEs. This study highlights areas of delay and targets for healthcare optimization.

Background: After a transient ischemic attack (TIA) or minor stroke, the long-term risk of subsequent stroke is uncertain. Methods: Electronic databases were searched for observational studies reporting subsequent stroke during a minimum follow-up of 1 year in patients with TIA or minor stroke. Unpublished data on number of stroke events and exact person-time at risk contributed by all patients during discrete time intervals of follow-up were requested from the authors of included studies. This information was used to calculate the incidence of stroke in individual studies, and results across studies were pooled using random-effects meta-analysis. Results: Fifteen independent cohorts involving 129794 patients were included in the analysis. The pooled incidence rate of subsequent stroke per 100 person-years was 6.4 events in the first year and 2.0 events in the second through tenth years, with cumulative incidences of 14% at 5 years and 21% at 10 years. Based on 10 studies with information available on fatal stroke, the pooled case fatality rate of subsequent stroke was 9.5% (95% CI, 5.9 – 13.8). Conclusions: One in five patients is expected to experience a subsequent stroke within 10 years after a TIA or minor stroke, with every tenth patient expected to die from their subsequent stroke.

To optimize flapping foil performance, in the current study we apply deep reinforcement learning (DRL) to plan foil non-parametric motion, as the traditional control techniques and simplified motions cannot fully model nonlinear, unsteady and high-dimensional foil–vortex interactions. Therefore, a DRL training framework is proposed based on the proximal policy optimization algorithm and the transformer architecture, where the policy is initialized from the sinusoidal expert display. We first demonstrate the effectiveness of the proposed DRL-training framework, learning the coherent foil flapping motion to generate thrust. Furthermore, by adjusting reward functions and action thresholds, DRL-optimized foil trajectories can gain significant enhancement in both thrust and efficiency compared with the sinusoidal motion. Last, through visualization of wake morphology and instantaneous pressure distributions, it is found that DRL-optimized foil can adaptively adjust the phases between motion and shedding vortices to improve hydrodynamic performance. Our results give a hint of how to solve complex fluid manipulation problems using the DRL method.

Let G be a finite group. A subgroup A of G is said to be S-permutable in G if A permutes with every Sylow subgroup P of G, that is, $AP=PA$. Let $A_{sG}$ be the subgroup of A generated by all S-permutable subgroups of G contained in A and $A^{sG}$ be the intersection of all S-permutable subgroups of G containing A. We prove that if G is a soluble group, then S-permutability is a transitive relation in G if and only if the nilpotent residual $G^{\mathfrak {N}}$ of G avoids the pair $(A^{s G}, A_{sG})$, that is, $G^{\mathfrak {N}}\cap A^{sG}= G^{\mathfrak {N}}\cap A_{sG}$ for every subnormal subgroup A of G.

BOUT++ turbulence simulations were performed to investigate the impact of turbulence spreading on the edge localized mode (ELM) size and divertor heat flux width $({\lambda _q})$ broadening in small ELM regimes. This study is motivated by EAST experiments. BOUT++ linear simulations of a pedestal radial electric field (Er) scan show that the dominant toroidal number mode (n) shifts from high-n to low-n, with a narrow mode spectrum, and the maximum linear growth rate increases as the pedestal Er well deepens. The nonlinear simulations show that as the net E × B pedestal flow increases, the pressure fluctuation level and its inward penetration beyond the top of the pedestal both increase. This leads to a transition from small ELMs to large ELMs. Both inward and outward turbulence spreading are sensitive to the scrape-off-layer (SOL) plasma profiles. The inward turbulence spreading increases for the steep SOL profiles, leading to increasing pedestal energy loss in the small ELM regime. The SOL width $({\lambda _q})$ is significantly broadened progressing from the ELM-free to small ELM regime, due to the onset of strong radial turbulent transport. The extent of the SOL width $({\lambda _q})$ broadening depends strongly on outward turbulence spreading. The fluctuation energy intensity flux ${\varGamma _\varepsilon }$ at the separatrix can be enhanced by increasing either pedestal Er flow shear or local SOL pressure gradient. The ${\lambda _q}$ is broadened as the fluctuation energy intensity flux ${\varGamma _\varepsilon }$ at the last close flux surface (LCFS) increases. Local SOL E × B flow shear will restrain outward turbulence spreading and the associated heat flux width broadening. Operating in H-mode with small ELMs has the potential to solve two critical problems: reducing the ELM size and broadening the SOL width.

Spontaneous avalanche to plasma begins in the core of an ellipsoidal Rydberg gas of nitric oxide. Ambipolar expansion of NO$^+$ draws energy from avalanche-heated electrons. Then, cycles of long-range resonant electron transfer from Rydberg molecules to ions equalize their relative velocities. This sequence of steps gives rise to a remarkable mechanics of self-assembly, in which the kinetic energy of initially formed hot electrons and ions drives an observed separation of plasma volumes. These dynamics adiabatically sequester energy in a reservoir of mass transport, starting a process that anneals separating volumes to form an apparent glass of strongly coupled ions and electrons. Short-time electron spectroscopy provides experimental evidence for complete ionization. The long lifetime of this system, particularly its stability with respect to recombination and neutral dissociation, suggests that this transformation affords a robust state of arrested relaxation, far from thermal equilibrium. We see this most directly in the excitation spectrum of transitions to states in the initially selected Rydberg series, detected as the long-lived signal that survives a flight time of $500\ \mathrm {\mu }$s to reach an imaging detector. The initial density of electrons produced by prompt Penning ionization, which varies with the selected initial principal quantum number and density of the Rydberg gas, determines a balance between the rising density of ions and the falling density of Rydberg molecules. This Penning-regulated ion-Rydberg molecule balance appears necessary as a critical factor in achieving the long ultracold plasma lifetime to produce spectral features detected after very long delays.

We present the third data release from the Parkes Pulsar Timing Array (PPTA) project. The release contains observations of 32 pulsars obtained using the 64-m Parkes ‘Murriyang’ radio telescope. The data span is up to 18 yr with a typical cadence of 3 weeks. This data release is formed by combining an updated version of our second data release with $\sim$3 yr of more recent data primarily obtained using an ultra-wide-bandwidth receiver system that operates between 704 and 4032 MHz. We provide calibrated pulse profiles, flux density dynamic spectra, pulse times of arrival, and initial pulsar timing models. We describe methods for processing such wide-bandwidth observations and compare this data release with our previous release.

The target backsheath field acceleration mechanism is one of the main mechanisms of laser-driven proton acceleration (LDPA) and strongly depends on the comprehensive performance of the ultrashort ultra-intense lasers used as the driving sources. The successful use of the SG-II Peta-watt (SG-II PW) laser facility for LDPA and its applications in radiographic diagnoses have been manifested by the good performance of the SG-II PW facility. Recently, the SG-II PW laser facility has undergone extensive maintenance and a comprehensive technical upgrade in terms of the seed source, laser contrast and terminal focus. LDPA experiments were performed using the maintained SG-II PW laser beam, and the highest cutoff energy of the proton beam was obviously increased. Accordingly, a double-film target structure was used, and the maximum cutoff energy of the proton beam was up to 70 MeV. These results demonstrate that the comprehensive performance of the SG-II PW laser facility was improved significantly.

Attaching a wireless transmission system comprising a radio frequency (RF)-chip and a dipole antenna to dielectric material of largely different permittivity leads to strong variation of the antenna feed impedance. Due to the severe impedance mismatch between the RF-chip and the antenna, the performance of the system may deteriorate drastically. The proposed antenna provides three feed points, which show respective feed-point match to 100 Ohm balanced feeds for three different dielectric environments (free-space and half-spaces of permittivity 4 and 42, respectively). Thereby, the RF-chip incorporates three 100 Ohm balanced output ports that are connected to the antenna from whom only one can be selected to provide the output signal. The respective other two output ports are shorted by an internal switching circuit that is controlled by external DC voltages. The measurement of the reflection coefficient of the stand-alone antenna and the chip agree well with the simulations, allowing to interconnect these two components. Further, the radiation pattern of the whole system is measured for two different scenarios showing good functionalities.

For 147 hospital-onset bloodstream infections, we assessed the sensitivity, specificity, positive predictive value, and negative predictive value of the National Healthcare Safety Network surveillance definitions of central-line–associated bloodstream infections against the gold standard of physician review, examining the drivers of discrepancies and related implications for reporting and infection prevention.

We investigate the diversity in the sizes and average surface densities of the neutral atomic hydrogen (H i) gas discs in $\sim$280 nearby galaxies detected by the Widefield ASKAP L-band Legacy All-sky Blind Survey (WALLABY). We combine the uniformly observed, interferometric H i data from pilot observations of the Hydra cluster and NGC 4636 group fields with photometry measured from ultraviolet, optical, and near-infrared imaging surveys to investigate the interplay between stellar structure, star formation, and H i structural parameters. We quantify the H i structure by the size of the H i relative to the optical disc and the average H i surface density measured using effective and isodensity radii. For galaxies resolved by $>$$1.3$ beams, we find that galaxies with higher stellar masses and stellar surface densities tend to have less extended H i discs and lower H i surface densities: the isodensity H i structural parameters show a weak negative dependence on stellar mass and stellar mass surface density. These trends strengthen when we limit our sample to galaxies resolved by $>$2 beams. We find that galaxies with higher H i surface densities and more extended H i discs tend to be more star forming: the isodensity H i structural parameters have stronger correlations with star formation. Normalising the H i disc size by the optical effective radius (instead of the isophotal radius) produces positive correlations with stellar masses and stellar surface densities and removes the correlations with star formation. This is due to the effective and isodensity H i radii increasing with mass at similar rates while, in the optical, the effective radius increases slower than the isophotal radius. Our results are in qualitative agreement with previous studies and demonstrate that with WALLABY we can begin to bridge the gap between small galaxy samples with high spatial resolution H i data and large, statistical studies using spatially unresolved, single-dish data.

Effects of plasma non-uniformities and kinetic dispersiveness on the spontaneous excitation of geodesic acoustic mode (GAM) by reversed shear Alfvén eigenmode (RSAE) are investigated numerically. It is found that, due to the turning points induced by the shear Alfvén continuum structure, the nonlinear excitation of GAM is a quasiexponentially growing absolute instability. As the radial dependence of GAM frequency and pump RSAE mode structure are accounted for, the radially inward propagating GAM is preferentially excited, leading to core localized thermal plasma heating by GAM collisionless damping. Our work, thus, suggests that GAM excitation plays a crucial role in not only RSAE nonlinear saturation, but also anomalous fuel ion heating in future reactors.