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Recent progress in understanding subcritical transition to turbulence is based on the concept of the edge, the manifold separating the basins of attraction of the laminar and the turbulent state. Originally developed in numerical studies of parallel shear flows with a linearly stable base flow, this concept is adapted here to the case of a spatially developing Blasius boundary layer. Longer time horizons fundamentally change the nature of the problem due to the loss of stability of the base flow due to Tollmien–Schlichting (TS) waves. We demonstrate, using a moving box technique, that efficient long-time tracking of edge trajectories is possible for the parameter range relevant to bypass transition, even if the asymptotic state itself remains out of reach. The flow along the edge trajectory features streak switching observed for the first time in the Blasius boundary layer. At long enough times, TS waves co-exist with the coherent structure characteristic of edge trajectories. In this situation we suggest a reinterpretation of the edge as a manifold dividing the state space between the two main types of boundary layer transition, i.e. bypass transition and classical transition.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
A right aortic arch with an isolated left innominate artery is a rare form of aortic arch anomaly. We present a case of neonatal diagnosis of this anomaly with concerning findings of global cerebral white matter atrophy at 13 months of age.
Changes in voters' behavior and in the campaign strategies that political parties pursue are likely to have increased the importance of campaigns on voters' electoral choices. As a result, scholars increasingly question the usefulness and predictive power of structural forecasting models, that use information from “fundamental” variables to make an election prediction several months before Election Day. In this paper, we empirically examine the expectation that structural forecasting models are increasingly error-prone. For doing so, we apply a structural forecasting model to predict elections in six established democracies. We then trace the predictive power of this model over time. Surprisingly, our results do not give the slightest indication of a decline in the predictive power of structural forecasting models. By showing that information on long-term factors still allows making accurate predictions of electoral outcomes, we question the assumption that campaigns matter more now than they did in the past.
Three methods are evaluated to estimate the streamwise velocity fluctuations of a zero-pressure-gradient turbulent boundary layer of momentum-thickness-based Reynolds number up to
, using as input velocity fluctuations at different wall-normal positions. A system identification approach is considered where large-eddy simulation data are used to build single and multiple-input linear and nonlinear transfer functions. Such transfer functions are then treated as convolution kernels and may be used as models for the prediction of the fluctuations. Good agreement between predicted and reference data is observed when the streamwise velocity in the near-wall region is estimated from fluctuations in the outer region. Both the unsteady behaviour of the fluctuations and the spectral content of the data are properly predicted. It is shown that approximately 45 % of the energy in the near-wall peak is linearly correlated with the outer-layer structures, for the reference case
. These identified transfer functions allow insight into the causality between the different wall-normal locations in a turbulent boundary layer along with an estimation of the tilting angle of the large-scale structures. Differences in accuracy of the methods (single- and multiple-input linear and nonlinear) are assessed by evaluating the coherence of the structures between wall-normally separated positions. It is shown that the large-scale fluctuations are coherent between the outer and inner layers, by means of an interactions which strengthens with increasing Reynolds number, whereas the finer-scale fluctuations are only coherent within the near-wall region. This enables the possibility of considering the wall-shear stress as an input measurement, which would more easily allow the implementation of these methods in experimental applications. A parametric study was also performed by evaluating the effect of the Reynolds number, wall-normal positions and input quantities considered in the model. Since the methods vary in terms of their complexity for implementation, computational expense and accuracy, the technique of choice will depend on the application under consideration. We also assessed the possibility of designing and testing the models at different Reynolds numbers, where it is shown that the prediction of the near-wall peak from wall-shear-stress measurements is practically unaffected even for a one order of magnitude change in the corresponding Reynolds number of the design and test, indicating that the interaction between the near-wall peak fluctuations and the wall is approximately Reynolds-number independent. Furthermore, given the performance of such methods in the prediction of flow features in turbulent boundary layers, they have a good potential for implementation in experiments and realistic flow control applications, where the prediction of the near-wall peak led to correlations above 0.80 when wall-shear stress was used in a multiple-input or nonlinear scheme. Errors of the order of 20 % were also observed in the determination of the near-wall spectral peak, depending on the employed method.
Objectives: The Tower of London (TOL) test has probably become the most often used task to assess planning ability in clinical and experimental settings. Since its implementation, efforts were made to provide a task version with adequate psychometric properties, but extensive normative data are not publicly available until now. The computerized TOL-Freiburg Version (TOL-F) was developed based on theory-grounded task analyses, and its psychometric adequacy has been repeatedly demonstrated in several studies but often with small and selective samples. Method: In the present study, we now report reliability estimates and normative data for the TOL-F stratified for age, sex, and education from a large population-representative sample collected in the Gutenberg Health Study in Mainz, Germany (n=7703; 40–80 years). Results: The present data confirm previously reported adequate indices of reliability (>.70) of the TOL-F. We also provide normative data for the TOL-F stratified for age (5-year intervals), sex, and education (low vs. high education). Conclusions: Together, its adequate reliability and the representative age-, sex-, and education-fair normative data render the computerized TOL-F a suitable diagnostic instrument to assess planning ability. (JINS, 2019, 25, 520–529)
In several recently published phylogenetic analyses, two Lower Devonian taxa, Doliodus and Pucapampella, both fall on the chondrichthyan stem, very close to the base of ‘conventionally defined chondrichthyans’ (i.e., forms possessing tessellated mineralization of the cartilaginous endoskeleton). These two taxa nevertheless exhibit strongly discordant morphologies from each other. A summary of the anatomical data concerning these taxa is presented here, including new, as well as previously published, findings. A new family Pucapampellidae is erected, containing Pucapampella and a newly recognized genus from South Africa. Morphological evidence is summarized for the monophyly of crown elasmobranchs (sharks and rays), holocephalans (chimaeras) and other chondrichthyans. Based on these data, Doliodus and pucapampellids both fall outside the chondrichthyan crown, but their relative phylogenetic positions on the chondrichthyan stem are unclear. Pucapampellid interrelationships are particularly hard to assess because little is known beyond their cranial and visceral arch morphology and also because pucapampellids possess a suite of ontogenetically primitive (and thus potentially neotenic) features. By contrast, the phylogenetic position of Doliodus seems less elusive; it possessed an ‘acanthodian-like’ complex of dermal spines, including pectoral fin spines, prepectoral, admedian, and prepelvic spines, and possibly dorsal and pelvic fin spines, in conjunction with numerous ‘chondrichthyan-like’ endoskeletal features and a heterodont ‘sharklike’ dentition. Doliodus can be viewed as a quintessential component of the evolutionary transition between ‘acanthodians’ and ‘conventionally defined chondrichthyans’, leaving little doubt that the chondrichthyan total group includes ‘acanthodians’ (now widely perceived to be a paraphyletic group, populating the basal part of the chondrichthyan stem). Although Doliodus has been resolved as a basal member of the ‘conventionally defined chondrichthyans’, it could occupy a more basal position on the chondrichthyan stem.
This paper investigates the passive and active control strategies to provide a physical assistance and rehabilitation by a 7-DOF exoskeleton robot with nonlinear uncertain dynamics and unknown bounded external disturbances due to the robot user's physiological characteristics. An Integral backstepping controller incorporated with Time Delay Estimation (BITDE) is used, which permits the exoskeleton robot to achieve the desired performance of working under the mentioned uncertainties constraints. Time Delay Estimation (TDE) is employed to estimate the nonlinear uncertain dynamics of the robot and the unknown disturbances. To overcome the limitation of the time delay error inherent of the TDE approach, a recursive algorithm is used to further reduce its effect. The integral action is employed to decrease the impact of the unmodeled dynamics. Besides, the Damped Least Square method is introduced to estimate the desired movement intention of the subject with the objective to provide active rehabilitation. The controller scheme is to ensure that the robot system performs passive and active rehabilitation exercises with a high level of tracking accuracy and robustness, despite the unknown dynamics of the exoskeleton robot and the presence of unknown bounded disturbances. The design, stability, and convergence analysis are formulated and proven based on the Lyapunov–Krasovskii functional theory. Experimental results with healthy subjects, using a virtual environment, show the feasibility, and ease of implementation of the control scheme. Its robustness and flexibility to deal with parameter variations due to the unknown external disturbances are also shown.
Lumbar punctures (LPs) are painful for children, and analgesia is recommended by academic societies. However, less than one-third of pediatric emergency physicians (EPs) adhere to recommendations. We assessed the willingness to provide analgesia among pediatric and general EPs and explored patient and provider-specific barriers.
We surveyed physicians in the Pediatric Emergency Research Canada (PERC) or Canadian Association of Emergency Physicians (CAEP) databases from May 1 to August 1, 2016, regarding hypothetical scenarios for a 3-week-old infant, a 3-year-old child, and a 16-year-old child requiring an LP. The primary outcome was the willingness to provide analgesia. Secondary outcomes included the type of analgesia, reasons for withholding analgesia, and their perceived competence performing LPs.
For a 3-week old infant, 123/144 (85.4%) pediatric EPs and 231/262 (88.2%) general EPs reported a willingness to provide analgesia. In contrast, the willingness to provide analgesia was almost universal for a 16-year-old (144/144 [100%] of pediatric EPs and 261/262 [99.6%] of general EPs) and a 3-year-old (142/144 [98.6%] of pediatric EPs and 256/262 [97.7%] of general EPs). For an infant, the most common barrier cited by pediatric EPs was the perception that it produced additional discomfort (13/21, 61.9%). The same reason was cited by general EPs (12/31, 38.7%), along with unfamiliarity surrounding analgesic options (13/31, 41.9%).
Compared to a preschool child and adolescent, the willingness to provide analgesia for an LP in a young infant is suboptimal among pediatric and general EPs. Misconceptions and the lack of awareness of analgesic options should be targets for practice-changing strategies.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
To examine the relationships between objectively measured sleep patterns
(sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage
(SSB) consumption (regular soft drinks, energy drinks, sports drinks and
fruit juice) among children from all inhabited continents of the world.
Multinational, cross-sectional study.
The International Study of Childhood Obesity, Lifestyle and the Environment
Children (n 5873) 9–11 years of age.
Sleep duration was 12 min per night shorter in children who reported
consuming regular soft drinks ‘at least once a day’
compared with those who reported consuming ‘never’ or
‘less than once a week’. Children were more likely to
sleep the recommended 9–11 h/night if they reported
lower regular soft drink consumption or higher sports drinks consumption.
Children who reported consuming energy drinks ‘once a week or
more’ reported a 25-min earlier bedtime than those who reported
never consuming energy drinks. Children who reported consuming sports drinks
‘2–4 d a week or more’ also reported a
25-min earlier bedtime compared with those who reported never consuming
sports drinks. The associations between sleep efficiency and SSB consumption
were not significant. Similar associations between sleep patterns and SSB
consumption were observed across all twelve study sites.
Shorter sleep duration was associated with higher intake of regular soft
drinks, while earlier bedtimes were associated with lower intake of regular
soft drinks and higher intake of energy drinks and sports drinks in this
international study of children. Future work is needed to establish
causality and to investigate underlying mechanisms.
We present a specimen preparation procedure for atom-probe tomography using SemGlu from Kleindiek Nanotechnik, an adhesive that hardens under electron beam irradiation. The SemGlu adhesive is used in place of focused-ion-beam-induced deposition of organo-metallic Pt, W, or C to form a bond between the sample and the substrate during the specimen preparation procedure. We demonstrate the utility of this adhesive-based specimen preparation technique with a correlated atom-probe tomography-scanning transmission electron microscopy study of the iron-nickel alloy kamacite (ferrite, ɑ-iron) in the Bristol iron meteorite and two steel specimens.
An unprecedented outbreak of Ebola virus diseases (EVD) occurred in West Africa from March 2014 to January 2016. The French Institute for Public Health implemented strengthened surveillance to early identify any imported case and avoid secondary cases.
Febrile travellers returning from an affected country had to report to the national emergency healthcare hotline. Patients reporting at-risk exposures and fever during the 21st following day from the last at-risk exposure were defined as possible cases, hospitalised in isolation and tested by real-time polymerase chain reaction. Asymptomatic travellers reporting at-risk exposures were considered as contact and included in a follow-up protocol until the 21st day after the last at-risk exposure.
From March 2014 to January 2016, 1087 patients were notified: 1053 were immediately excluded because they did not match the notification criteria or did not have at-risk exposures; 34 possible cases were tested and excluded following a reliable negative result. Two confirmed cases diagnosed in West Africa were evacuated to France under stringent isolation conditions. Patients returning from Guinea (n = 531; 49%) and Mali (n = 113; 10%) accounted for the highest number of notifications.
No imported case of EVD was detected in France. We are confident that our surveillance system was able to classify patients properly during the outbreak period.
Mortality associated with infections caused by carbapenem-resistant Enterobacteriaceae (CRE) is higher than mortality due to carbapenem-sensitive pathogens.
To examine the association between mortality from bacteremia caused by carbapenem-resistant (CRKP) and carbapenem-sensitive Klebsiella pneumoniae (CSKP) and to assess the impact of appropriate initial antibiotic therapy (IAT) on mortality.
Systematic review and meta-analysis
We searched MEDLINE, EMBASE, CINAHL, and Wiley Cochrane databases through August 31, 2016, for observational studies reporting mortality among adult patients with CRKP and CSKP bacteremia. Search terms were related to Klebsiella, carbapenem-resistance, and infection. Studies including fewer than 10 patients per group were excluded. A random-effects model and meta-regression were used to assess the relationship between carbapenem-resistance, appropriateness of IAT, and mortality.
Mortality was higher in patients who had CRKP bacteremia than in patients with CSKP bacteremia (15 studies; 1,019 CRKP and 1,148 CSKP patients; unadjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.8–2.6; I2=0). Mortality was lower in patients with appropriate IAT than in those without appropriate IAT (7 studies; 658 patients; unadjusted OR, 0.5; 95% CI, 0.3–0.8; I2=36%). CRKP patients (11 studies; 1,326 patients; 8-year period) were consistently less likely to receive appropriate IAT (unadjusted OR, 0.5; 95% CI, 0.3–0.7; I2=43%). Our meta-regression analysis identified a significant association between the difference in appropriate IAT and mortality (OR per 10% difference in IAT, 1.3; 95% CI, 1.0–1.6).
Appropriateness of IAT is an important contributor to the observed difference in mortality between patients with CRKP bacteremia and patients with CSKP bacteremia.