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Since Durkheim, epidemiological studies have revealed a significant, complex association between unemployment and suicidal behaviour. The aim of this study was to analyse the relationship between parasuicide and job instability, including unemployment, French social measures against unemployment and occasional work.
Demographic data, personal and familial characteristics were collected in 541 suicide attempters.
Seventy-seven per cent were socially active, with 61.5% in regular employment, and 38.5% in precarious employment. The female-to-male ratio approached 2 in the securely employed sample, and fell to 1 for those with poor social and professional integration. Depression, parasuicide, and alcohol abuse were more common in the families of repeaters in secure employment. The impact of the familial psychiatric background was no longer significant in the job insecurity group. Fostering in childhood was a risk factor for repeat suicidal behaviour in the group with job insecurity.
Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals.
We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16–75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822.
There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25–3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI −0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42–2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function.
CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.
Unsteadiness in separated shock–boundary layer interactions have been previously analysed in order to propose a scenario of entrainment–discharge as the origin of unsteadiness. It was assumed that the fluid in the separated zone is entrained by the free shear layer formed at its edge, and that this layer follows the properties of the canonical mixing layer. This last point is addressed by reanalysing the velocity measurements in an oblique shock reflection at a nominal Mach number of 2.3 and for two cases of flow deviation (
). The rate of spatial growth of this layer is evaluated from the spatial growth of the turbulent stress profiles. Moreover, the entrainment velocity at the edge of the layer is determined from the mean velocity profiles. It is shown that the values of turbulent shear stress, spreading rate and entrainment velocity are consistent, and that they follow the classical laws for turbulent transport in compressible shear layers. Moreover, the measurements suggest that the vertical normal stress is sensitive to compressibility, so that the anisotropy of turbulence is affected by high Mach numbers. Dimensional considerations proposed by Brown & Roshko (J. Fluid Mech., vol. 64, 1974, 775–781) are reformulated to explain this observed trend.
Introduction: Poor physicians’ knowledge of health care costs has been identified as an important barrier to improving efficiency and reducing overuse in care delivery. Moreover, costs of tests and treatments estimated with traditional costing methods have been shown to be imprecise and unreliable. We estimated the cost of frequent care activities in the emergency department (ED) using the time-driven activity-based costing (TDABC) method. Methods: We conducted a TDABC study in the ED of the CHUL, Québec city (77000 visits/year). We estimated the cost of all potential care activities (e.g. triage) provided to adult patients with selected urgent (e.g. pulmonary sepsis) and non urgent (e.g. urinary tract infection) conditions frequently encountered in the ED. Following Lean management principles, process maps were developed by a group of ED care providers for each care activity to identify human resources, supplies and equipment involved, and to estimate the time required to complete each process. Resource unit cost (e.g. cost per minute of a nurse) and overhead rate were calculated using financial information from fiscal year 2015-16. Estimated cost of each care activity (e.g. chest X-ray) including physicians’ charges was calculated by summing overhead allocation and the cost of each process (e.g. disinfection of the X-ray machine) as obtained by multiplying the resource unit cost by the time for process completion. Results: Process maps were developed for 14 conditions and 68 ED care activities. We estimated the costs of activities (CAN$) related to nursing (e.g. urinalysis and culture triage ordering $14.70), clerk tasks (e.g. patient registration $3.40), physicians (e.g. FAST scan $20.90), laboratory testing (e.g. CBC $6.30), diagnostic imaging (e.g. abdominal CT scan $146.50), therapy (e.g. 5 mg of iv morphine $20.40), and resuscitation (rapid sequence intubation with ketamine and succinylcholine $146.40). Overall, emergency physicians’ charges, personnel salaries and overheads accounted for 38%, 22% and 16% of all ED care costs, respectively. Conclusion: Our results represent an important step toward increasing emergency physicians’ awareness on the real cost of their interventions and empowering them to adopt more cost-effective practice patterns.
In this contribution, we report progress in the preparation of superconducting materials made by Spark Plasma Sintering (SPS). On the one hand, the fabrication process was optimized in order to improve the texturing of Bi2Ca2Sr2CuO8 superconductor ceramics. The new process is referred to as “Spark Plasma Texturing” (SPT). During SPT, the bulk material is free to deform itself. As a result, an inter-grain preferential crystallographic orientation is generated, while materials processed by conventional SPS are usually quasi-isotropic. The crystallographic orientation causes a strong anisotropy in the magnetic properties of the Bi2Ca2Sr2CuO8 bulk.
On the other hand, superconducting MgB2 discs were consolidated using the rapid SPS process. MgB2 has not been yet been seriously considered as a superconductor that could be used for magnetic levitation. Here we present trapped field measurements as a function of the distance to the superconductor and field cooled levitation force measurements that suggests that it presents interesting characteristics for this application.
The concept of Developmental Origins of Health and Disease initially stemmed from the developmental programming of metabolic diseases. Reproductive functions and fertility in adulthood may also be programmed during foetal development. We studied the impact of dietary-induced maternal hyperlipidaemia and hypercholesterolaemia (HH), administered at 10 weeks of age and throughout the gestation and lactation, on male reproductive functions of rabbit offspring. Male rabbits born to HH dams and fed a control diet had significantly lighter testes and epididymes compared with rabbits born to control dams at adulthood. No significant changes in sperm concentration, sperm DNA integrity and sperm membrane composition were observed, but serum-free testosterone concentrations were decreased in HH males. This study confirms the importance of maternal metabolic status for the development of male reproductive organs.
A model based on mass conservation properties is developed for shock-wave/boundary-layer interactions (SWBLIs), aimed at reconciling the observed great diversity in flow organization documented in the literature, induced by variations in interaction geometry and aerodynamic conditions. It is the basis for a scaling approach for the interaction length that is valid independent of the geometry of the flow (considering compression corners and incident-reflecting shock interactions). As part of the analysis, a scaling argument is proposed for the imposed pressure jump that depends principally on the free-stream Mach number and the flow deflection angle. Its interpretation as a separation criterion leads to a successful classification of the separation states for turbulent SWBLIs (attached, incipient or separated). In addition, the dependence of the interaction length on the Reynolds number and the Mach numbers is accounted for. A large compilation of available data provides support for the validity of the model. Some general properties on the state of the flow are derived, independent of the geometry of the flow and for a wide range of Mach numbers and Reynolds numbers.
Improvement of reproduction in dairy cows has become a major challenge in dairy production. We have recently shown that dairy cows carrying the ‘fertil−’ haplotype for one quantitative trait locus (QTL), affecting female fertility and located on the bovine chromosome 3, had a significantly lower conception rate after the first artificial insemination than cows carrying the ‘fertil+’ haplotype. The objective of this paper was to study other phenotypic modifications linked to this QTL. In the present study, 23 ‘fertil+’ and 18 ‘fertil−’ cows were characterized for live weight, milk production, food intake, eating behaviour and plasma metabolites. These parameters were measured during the first lactation, from calving to 40 weeks postpartum (wkpp). In the first 7 weeks of lactation, ‘fertil+’ primiparous cows had a significantly higher live BW and milk production than ‘fertil−’ cows. Dry matter intake tended to be slightly higher for ‘fertil+’ than for ‘fertil−’ primiparous cows in this period. However, energy balance was similar for the two haplotypes in the whole lactation, except in the first wkpp, and consequently, could not explain their different fertility. The major observation concerned the eating behaviour. ‘Fertil+’ primiparous cows had a significantly lower eating rate than ‘fertil−’ cows during the 40 weeks of lactation. In parallel, ‘fertil+’ cows spent significantly more time at the feeder for a similar number of visits than ‘fertil−’ cows. Furthermore, no differences in plasma concentrations of non-esterified fatty acids and insulin were observed between the two haplotypes. Plasma glucose was significantly lower in ‘fertil+’ than in ‘fertil−’ cows in the second wkpp. Taken together, our results show that ‘fertil+’ and ‘fertil−’ dairy cows, with different fertility, have also different eating behaviour without any variation in energy balance, except in the first week of lactation.
The diagnosis of cows' milk protein allergy (CMPA) requires first the suspicion of diagnosis based on symptoms described in the medical history, and, second, the elimination of cows' milk proteins (CMP) from the infant's diet. Without such rigorous analysis, the elimination of CMP is unjustified, and sometimes harmful. The elimination diet should be strictly followed, at least until 9–12 months of age. If the child is not breast fed or the mother cannot or no longer wishes to breast feed, the first choice is an extensively hydrolysed formula (eHF) of CMP, the efficacy of which has been demonstrated by scientifically sound studies. If it is not tolerated, an amino acid-based formula is warranted. A rice protein-based eHF can be an alternative to a CMP-based eHF. Soya protein-based infant formulae are also a suitable alternative for infants >6 months, after establishing tolerance to soya protein by clinical challenge. CMPA usually resolves during the first 2–3 years. However, the age of recovery varies depending on the child and the type of CMPA, especially whether it is IgE-mediated or not, with the former being more persistent. Once the child reaches the age of 9–12 months, an oral food challenge is carried out in the hospital ward to assess the development of tolerance and, if possible, to allow for the continued reintroduction of CMP at home. Some children with CMPA will tolerate only a limited daily amount of CMP. The current therapeutic options are designed to accelerate the acquisition of tolerance thereof, which seems to be facilitated by repeated exposure to CMP.
If the shock wave associated with a shock wave–boundary-layer interaction (SBLI) is intense enough to cause separation, flow unsteadiness appears to be the almost-inevitable outcome. This often leads to strong flow oscillations that are experienced far downstream of the interaction and can be so severe in some instances as to inflict damage on an airframe or an engine. This is generally referred to as “breathing” or, simply, “unsteadiness” because it involves very low frequencies, typically at least two orders of magnitude below the energetic eddies in the incoming boundary layer. The existence of these oscillations raises two questions: “What is their cause?” and “Is there a general way in which they can be understood?”
There are several distinct types of SBLIs, depending on the geometry and whether the flow separates, and it is possible that these create fundamentally different types of unsteadiness. An interpretation was proposed by Dussauge  and Dussauge and Piponniau  using the diagram reproduced in Fig. 9.1. The organization of the diagram requires comment: In the upper branch, unseparated flows are depicted; those that separate are restricted to the lower branch. In both cases, the shock wave divides the flow into two half spaces: the upstream and the downstream layers. Hence, the shock wave can be considered an interface between the two conditions and its position and motion vary accordingly. With these various elements in mind, the shock motion can be analyzed from the perspective of the upstream and downstream conditions. The discussion in this chapter is a commentary about flow organization and other phenomena related to the two branches of the diagram.
In order to investigate the possibility of modelling plant motion at the landscape scale, an equation for crop plant motion, forced by an instantaneous velocity field, is introduced in a large-eddy simulation (LES) airflow model, previously validated over homogeneous and heterogeneous canopies. The canopy is simply represented as a poroelastic continuous medium, which is similar in its discrete form to an infinite row of identical oscillating stems. Only one linear mode of plant vibration is considered. Two-way coupling between plant motion and the wind flow is insured through the drag force term. The coupled model is validated on the basis of a comparison with measured movements of an alfalfa crop canopy. It is also compared with the outputs of a linear stability analysis. The model is shown to reproduce the well-known phenomenon of ‘honami’ which is typical of wave-like crop motions on windy days. The wavelength of the main coherent waving patches, extracted using a bi-orthogonal decomposition (BOD) of the crop velocity fields, is in agreement with that deduced from video recordings. The main spatial and temporal characteristics of these waving patches exhibit the same variation with mean wind velocity as that observed with the measurements. However they differ from the coherent eddy structures of the wind flow at canopy top, so that coherent waving patches cannot be seen as direct signatures of coherent eddy structures. Finally, it is shown that the impact of crop motion on the wind dynamics is negligible for current wind speed values. No lock-in mechanism of coherent eddy structures on plant motion is observed, in contradiction with the linear stability analysis. This discrepancy may be attributed to the presence of a nonlinear saturation mechanism in LES.
A model to explain the low-frequency unsteadiness found in shock-induced separation is proposed for cases in which the flow is reattaching downstream. It is based on the properties of fluid entrainment in the mixing layer generated downstream of the separation shock whose low-frequency motions are related to successive contractions and dilatations of the separated bubble. The main aerodynamic parameters on which the process depends are presented. This model is consistent with experimental observations obtained by particle image velocimetry (PIV) in a Mach 2.3 oblique shock wave/turbulent boundary layer interaction, as well as with several different configurations reported in the literature for Mach numbers ranging from 0 to 5.
The work presented here focuses on the analysis of a turbulent boundary layer saturated with saltating particles. Experiments were carried out in a wind tunnel 15m long and 0.6m wide at the University of Aarhus in Denmark with sand grains 242 μm in size for wind speeds ranging from the threshold speed to twice its value. The saltating particles were analysed using particle image velocimetry (PIV) and particle-tracking velocimetry (PTV), and vertical profiles of particle concentration and velocity were extracted. The particle concentration was found to decrease exponentially with the height above the bed, and the characteristic decay height was independent of the wind speed. In contrast with the logarithmic profile of the wind speed, the grain velocity was found to vary linearly with the height. In addition, the measurements indicated that the grain velocity profile depended only slightly on the wind speed. These results are shown to be closely related to the features of the splash function that characterizes the impact of the saltating particles on a sandbed. A numerical simulation is developed that explicitly incorporates low-velocity moments of the splash function in a calculation of the boundary conditions that apply at the bed. The overall features of the experimental measurements are reproduced by simulation.
The still ever increasing demand for sedation and/or analgesia for diagnostic and therapeutic procedures puts high pressure on anaesthesia care providers all over Europe. Since the capacity to provide that service by anaesthetists is limited in most European countries, guidelines for non-anaesthetist doctors who want to sedate patients on a high-quality level and especially in a safe way are mandatory. This paper, produced by a working party of the European Board of Anaesthesiology of the European Union of Medical Specialists (EUMS/UEMS), gives direction to those practitioners who feel responsibilities in this area of medicine. Close cooperation with anaesthesiologists seems mandatory to achieve and sustain a high-quality standard for our patients undergoing medical or surgical procedures under sedation.
The interaction of an oblique shock wave impinging on a turbulent boundary layer at Mach number 2.3 is experimentally investigated for a wide range of shock intensities. Characteristic time and length scales of the unsteady reflected shock and inside the downstream interaction region are obtained and compared with already existing results obtained in compression ramp experiments as well as in subsonic detached flows. Dimensionless characteristic frequencies are highlighted to characterize low-frequency shock unsteadiness as well as the different large scales which develop inside the initial part of the interaction. The possibility of describing the spatial development of the large scales inside the interaction zone using a mixing-layer scheme including compressibility effects is tested for a wide range of Mach numbers, shock intensities and geometrical configurations. Moreover, strong evidence of a statistical link between low-frequency shock movements and the downstream interaction is given. Finally, the downstream evolution of the structures shed into the boundary layer is characterized and shows features specific of our configuration.