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The dynamic interplay between surface and subsurface flow in the presence of a permeable boundary was investigated using low and high frame-rate particle-image velocimetry measurements in a refractive-index-matching flow environment. Two idealized permeable wall models were considered. Both models contained five layers of cubically packed spheres, but one exhibited a smooth interface with the flow, while the other embodied a hemispherical surface topography. The relationship between the large-scale turbulent motions overlying the permeable walls and the small-scale turbulence just above, and within, the walls was explored using instantaneous and statistical analyses. Although previous studies have indirectly identified the potential existence of amplitude modulation in permeable-wall turbulence (a phenomenon identified in impermeable-wall turbulence whereby the outer large scales modulate the intensity of the near-wall, small-scale turbulence), the present effort provides direct evidence of its existence in flow over both permeable walls considered. The spatio-temporal signatures of amplitude modulation were also characterized using conditional averaging based on zero-crossing events. This analysis highlights the connection between large-scale regions of high/low streamwise momentum in the surface flow, downwelling/upwelling across the permeable interface and enhancement/suppression of small-scale turbulence, respectively, just above and within the permeable walls. The presence of bed roughness is found to intensify the strength and penetration of flow into the permeable bed modulated by large-scale structures in the surface flow, and linked to possible roughness-formed channelling effects and shedding of smaller-scale flow structures from the roughness elements.
Direct numerical simulations (DNS) of turbulent channel flow over hexagonally packed hemispheres were performed for friction Reynolds number
. For cases at
, the inner-scaled roughness height
was maintained while the spacing between roughness elements was varied from
to 4. Two additional rough-wall cases were performed at
were fixed to investigate the
trends. For each case, wall shear stress was extracted from DNS by integrating the stress tensor over the rough surfaces. Spherical harmonics were employed to investigate the detailed spectral behaviour of the wall shear stress. Flow visualization near roughness elements was used to assist physical interpretations of the dominant flow features observed for various roughness characteristics. Analysis of amplitude modulation was applied to investigate the interactions between the ‘cell-averaged’ wall shear stress and outer, large-scale structures. A universal signal was obtained by removing the effects of outer, large-scale motions, based on the model proposed by Mathis et al. (J. Fluid Mech., vol. 715, 2013, pp. 163–180). Pre-multiplied spectra of the universal wall shear stress showed distinct behaviours at smaller scales for the ‘k-type’ roughness (
) compared to ‘d-type’ roughness (
), whereas the spectra at larger scales appeared similar for both types of roughness. A scaling relation between the variance of universal wall shear stress and averaging cell dimensions was found for both ‘k-type’ and ‘d-type’ roughness, which can be useful in designing candidate wall models used in large-eddy simulation.
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.
Direct numerical simulations (DNS) of turbulent channel flow over rough surfaces, formed from hexagonally packed arrays of hemispheres on both walls, were performed at friction Reynolds numbers
. The inner normalized roughness height
was maintained for all Reynolds numbers, meaning all flows were classified as transitionally rough. The spacing between hemispheres was varied within
. The statistical properties of the rough-wall flows were contrasted against a complementary smooth-wall DNS at
and literature data at
revealing strong modifications of the near-wall turbulence, although the outer-layer structure was found to be qualitatively consistent with smooth-wall flow. Amplitude modulation (AM) analysis was used to explore the degree of interaction between the flow in the roughness sublayer and that of the outer layer utilizing all velocity components. This analysis revealed stronger modulation effects, compared to smooth-wall flow, on the near-wall small-scale fluctuations by the larger-scale structures residing in the outer layer irrespective of roughness arrangement and Reynolds number. A predictive inner–outer model based on these interactions, and exploiting principal component analysis (PCA), was developed to predict the statistics of higher-order moments of all velocity fluctuations, thus addressing modelling of anisotropic effects introduced by roughness. The results show excellent agreement between the predicted near-wall statistics up to fourth-order moments compared to the original statistics from the DNS, which highlights the utility of the PCA-enhanced AM model in generating physics-based predictions in both smooth- and rough-wall turbulence.
This study investigated the characteristics of subjective memory complaints (SMCs) and their association with current and future cognitive functions.
A cohort of 209 community-dwelling individuals without dementia aged 47–90 years old was recruited for this 3-year study. Participants underwent neuropsychological and clinical assessments annually. Participants were divided into SMCs and non-memory complainers (NMCs) using a single question at baseline and a memory complaints questionnaire following baseline, to evaluate differential patterns of complaints. In addition, comprehensive assessment of memory complaints was undertaken to evaluate whether severity and consistency of complaints differentially predicted cognitive function.
SMC and NMC individuals were significantly different on various features of SMCs. Greater overall severity (but not consistency) of complaints was significantly associated with current and future cognitive functioning.
SMC individuals present distinctive features of memory complaints as compared to NMCs. Further, the severity of complaints was a significant predictor of future cognition. However, SMC did not significantly predict change over time in this sample. These findings warrant further research into the specific features of SMCs that may portend subsequent neuropathological and cognitive changes when screening individuals at increased future risk of dementia.
The current study evaluated the effect of sowing date (early, mid-August or timely, mid-September) on two winter wheat (Triticum aestivum L.) cultivars (Hereford, Mariboss) with different rates of nitrogen (N) (0–225 kg total N/ha) applied as animal manure (AM; cattle slurry) or mineral fertilizers (N: phosphorus: potassium; NPK). Overwinter plant N uptake and soil mineral N content were determined during 2014/15, while harvest yields (grain, straw, N content) were determined during 2014/15 and 2015/16. Overwinter uptake of N was 14 kg N/ha higher in early than in timely-sown wheat. Despite very different yield levels in 2015 and 2016 harvests, the advantage of early sowing on grain yields was similar (1.1 and 0.9 t/ha); straw yield benefits were greater in 2015 (1.7 t/ha more) than in 2016 (0.4 t/ha more). In 2015 and 2016, N offtake was 35 and 17 kg N/ha higher in early than in timely-sown wheat, respectively. The mineral N fertilizer value of cattle slurry averaged 50%. Early sowing increased the apparent N recovery (ANR) for wheat regardless of nutrient source. However, ANR was substantially higher for NPK (82% in 2015; 52% in 2016) than for AM (39% in 2015; 27% in 2016). Performance of the two cultivars did not differ consistently with respect to the effect of early sowing on crop yield, N concentration and offtake, or ANR. Within the north-west European climatic region, moving the sowing time of winter wheat from mid-September to mid-August provides a significant yield and N offtake benefit.
Studies of the association between pre-deployment cognitive ability and post-deployment post-traumatic stress disorder (PTSD) have shown mixed results.
To study the inflence of pre-deployment cognitive ability on PTSD symptoms 6–8 months post-deployment in a large population while controlling for pre-deployment education and deployment-related variables.
Study linking prospective pre-deployment conscription board data with post-deployment self-reported data in 9695 Danish Army personnel deployed to different war zones in 1997–2013. The association between pre-deployment cognitive ability and post-deployment PTSD was investigated using repeated-measure logistic regression models. Two models with cognitive ability score as the main exposure variable were created (model 1 and model 2). Model 1 was only adjusted for pre-deployment variables, while model 2 was adjusted for both pre-deployment and deployment-related variables.
When including only variables recorded pre-deployment (cognitive ability score and educational level) and gender (model 1), all variables predicted post-deployment PTSD. When deployment-related variables were added (model 2), this was no longer the case for cognitive ability score. However, when educational level was removed from the model adjusted for deployment-related variables, the association between cognitive ability and post-deployment PTSD became significant.
Pre-deployment lower cognitive ability did not predict post-deployment PTSD independently of educational level after adjustment for deployment-related variables.
Piglet mortality is a major problem in organic pig production affecting both farm economy and animal welfare. Knowledge is scarce on the risk factors of piglet mortality in Danish commercial organic pig production. The objectives of this study were to evaluate season, litter size, parity, sow body condition and stillborn littermates as risk factors for early piglet mortality and crushing of liveborn piglets from parturition until castration at day 3 to 5 postpartum (pp). The study was conducted over a 1-year period in nine commercial Danish organic pig herds practicing outdoor farrowing all year round. Data included recordings on 3393 farrowings with 50 284 liveborn piglets of which 14.8% died before castration. A subset of the dead piglets were collected and necropsied to identify crushed piglets. The average number of liveborn piglets per litter was 14.8 (SD=3.7) and the average time from parturition until castration was 4.1 (SD=1.7) days. A negative binomial regression analysis was used to model the effect of the predictive variables on the early piglet mortality accounting for different time periods from parturition to castration. An increase in maternal body condition score (BCS) and parity significantly increased the risk of dying between parturition and castration. Early mortality was found to be lowest during spring (March to May) and highest during summer (June to August). Being born into a litter with one or more stillborn littermates increased the risk of early mortality. The risk factors for crushing of piglets were evaluated using a logistic analysis. A significant effect of parity and litter size was found where the odds of at least one piglet in a litter with mortality was diagnosed as crushed increased with increasing parity and litter size. In conclusion, being born during summer (June to August), high parity and maternal BCS and stillborn littermates were found to be risk factors for piglet mortality between parturition and castration. In addition, parity and increasing litter size were found to be risk factors for crushing of piglets in litters with mortality.
Multi-layer reconstruction has become standard in endoscopic skull base surgery. The inlay component used can vary among autografts, allografts, xenografts and synthetics, primarily based on surgeon preference. The short- and long-term outcomes of collagen matrix in skull base reconstruction are described.
A case series of patients who underwent endoscopic skull base reconstruction with collagen matrix inlay were assessed. Immediate peri-operative outcomes (cerebrospinal fluid leak, meningitis, ventriculitis, intracranial bleeding, epistaxis, seizures) and delayed complications (delayed healing, meningoencephalocele, prolapse of reconstruction, delayed cerebrospinal fluid leak, ascending meningitis) were examined.
Of 120 patients (51.0 ± 17.5 years, 41.7 per cent female), peri-operative complications totalled 12.7 per cent (cerebrospinal fluid leak, 3.3 per cent; meningitis, 3.3 per cent; other intracranial infections, 2.5 per cent; intracranial bleeding, 1.7 per cent; epistaxis, 1.7 per cent; and seizures, 0 per cent). Delayed complications did not occur in any patients.
Collagen matrix is an effective inlay material. It provides robust long-term separation between sinus and cranial cavities, and avoids donor site morbidity, but carries additional cost.
Antipsychotics are associated with the polymorphic ventricular tachycardia, Torsade's de pointes, which in worst case can lead to sudden cardiac death. The QTc interval is used as a clinical proxy for Torsade's de pointes. QTc interval is prolonged by monotherapy with antipsychotic, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmacy.
To investigate the associations between QTc interval and antipsychotic mono- and polypharmaceutical treatment, respectively, in schizophrenic patients.
To learn more about the impact of antipsychotics on the QTc interval.
An observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the Region of Central Jutland, Denmark. Patients were enrolled from January 2013 through March 2015 with follow-up until June 2015. Data was collected from clinical interviews and clinical case records.
ECGs were available in 58 patients receiving antipsychotic treatment. We observed no difference in average QTc interval for the whole sample of patients receiving monotherapy or polypharmacy (P = 0.29). However, women presented longer QTc-interval on polypharmacy than on monotherapy (P = 0.01).
We recommend an increased focus on monitoring the QTc interval in woman with schizophrenia receiving antipsychotics as polypharmacy.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Both 1st and 2nd generation of antipsychotics are associated with prolonged QTc interval. Prolonged QTc can lead to ventricular tachycardia and Torsade's de pointes, ultimatime resulting to cardiac arrest and sudden death. Prolonged QTc interval due to increased DDD has not yet been investigated.
To investigate whether increased DDD of antipsychotics, causes further prolonged QTc, by patients diagnosed with schizophrenia.
To learn more about antipsychotics impact on the QTc interval in patients diagnosed with schizophrenia.
An observational study of unselected patients diagnosed with schizophrenia. Enrolled from January 2013 through March 2015 with follow-up until June 2015 in the region of central Denmark. Data was collected from ECG records and patient journals.
ECGs were available in 58 patients. We observed no relation between increased DDD of antipsychotics and prolonged QTc. There were no differences in average QTc interval for the whole sample of patients receiving different DDD of antipsychotics.
We do not recommend increased attention to patients treated with higher DDD of antipsychotics.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Danish psychiatric system has gone through several structural changes in the last four decades. The deinstitutionalization of the mental healthcare system was implemented in Denmark in the late 1970s with the intention of increasing outpatient treatment. One of the aims in the reorganization was to treat the patient in the local environment rather than during long-term hospitalization.
This study focuses on the changes in the utilization of hospital facilities for patients diagnosed with schizophrenia.
The aims of this study were to analyze the development of admission/readmission, bed days and occupancy rates over four decades (1970–2012) in Denmark in schizophrenia treatment using admission statistics for in-patients only.
Using register data from secondary healthcare treatment of patients diagnosed with schizophrenia in Denmark 1970–2012, we analyzed the development in the use of hospital facilities.
Our major finding was a 220% increase between 1970 and 2012 in the total number of hospital admissions due to schizophrenia each year, while at the same time the number of annual schizophrenia bed days was reduced by 76%. Furthermore, the readmission rate within a year after discharge with a diagnosis of schizophrenia reached 70% in 2012 compared to 51% in 1970. Finally, the total bed occupancy continued to rise over the four decades and has exceeded 100% in several years since 1999.
The findings indicate that the reorganization of the Danish mental healthcare system has created a problem of “revolving door” schizophrenia patients’ who since the 1970s have been increasingly hospitalized but for shorter periods.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A turbulent boundary layer developed over a herringbone patterned riblet surface is investigated using stereoscopic particle image velocimetry in the cross-stream plane at
. The three velocity components resulting from this experiment reveal a pronounced spanwise periodicity in all single-point velocity statistics. Consistent with previous hot-wire studies over similar-type riblets, we observe a weak time-average secondary flow in the form of
-filling streamwise vortices. The observed differences in the surface and secondary flow characteristics, compared to other heterogeneous-roughness studies, may suggest that different mechanisms are responsible for the flow modifications in this case. Observations of instantaneous velocity fields reveal modified and rearranged turbulence structures. The instantaneous snapshots also suggest that the time-average secondary flow may be an artefact arising from superpositions of much stronger instantaneous turbulent events enhanced by the surface texture. In addition, the observed instantaneous secondary motions seem to have promoted a free-stream-engulfing behaviour in the outer layer, which would indicate an increase turbulent/non-turbulent flow mixing. It is overall demonstrated that the presence of large-scale directionality in transitional surface roughness can cause a modification throughout the entire boundary layer, even when the roughness height is 0.5 % of the layer thickness.
In Danish organic pig production, one-third of total born piglets die before weaning, and stillbirth has previously crudely been estimated to account for 27% of the total preweaning mortality. The objective of this study was to evaluate season, litter size, parity and body condition of the sow as risk factors for stillbirth in nine commercial Danish organic pig herds. The study was conducted over a 1-year period, and the data included registrations on 5170 farrowings with 82 906 total born piglets. The average number of total born piglets per litter was 16.0, and the number of stillborn piglets per litter was 1.1. A significant effect of season was seen with an odds ratio for stillbirth of 1.15 during summer (May to August) compared with the remaining part of the year. A non-linear effect of litter size was seen where an increase in litter size from 11 to 16 resulted in an odds ratio of stillbirth of 1.11. An increase in litter size from 16 to 21 resulted in an odds ratio of stillbirth of 1.45. A significant interaction between body condition and parity was present. In first parity sows, an increase in body condition score from 2 (thin) to 3 (moderate) and from 3 to 4 (fat) increased the probability of stillbirth with an odds ratio of 1.23 and 1.36, respectively. In sows with parity above 4, an increase in body condition score from 2 to 3 and from 3 to 4 decreases the probability of stillbirth with an odds ratio of 0.68 and 0.79, respectively. In conclusion, increasing litter size and being born during the summer months of May to August were found to be risk factors for stillbirth. Furthermore, an interaction between body condition and parity showed that thin sows with parity above 4 had a substantially increased risk of stillbirth compared with normal and fat sows with parity above 4. In contrast, for parity 1 sows risk of stillbirth was increased in fat sows.
High-resolution (or “cross-correlation”) electron backscatter diffraction analysis (HR-EBSD) utilizes cross-correlation techniques to determine relative orientation and distortion of an experimental electron backscatter diffraction pattern with respect to a reference pattern. The integrity of absolute strain and tetragonality measurements of a standard Si/SiGe material have previously been analyzed using reference patterns produced by kinematical simulation. Although the results were promising, the noise levels were significantly higher for kinematically produced patterns, compared with real patterns taken from the Si region of the sample. This paper applies HR-EBSD techniques to analyze lattice distortion in an Si/SiGe sample, using recently developed dynamically simulated patterns. The results are compared with those from experimental and kinematically simulated patterns. Dynamical patterns provide significantly more precision than kinematical patterns. Dynamical patterns also provide better estimates of tetragonality at low levels of distortion relative to the reference pattern; kinematical patterns can perform better at large values of relative tetragonality due to the ability to rapidly generate patterns relating to a distorted lattice. A library of dynamically generated patterns with different lattice parameters might be used to achieve a similar advantage. The convergence of the cross-correlation approach is also assessed for the different reference pattern types.
A child's diet is an important determinant for later health, growth and development. In Denmark, most children in primary school bring their own packed lunch from home and attend an after-school care institution. The aim of the present study was to evaluate the food, energy and nutrient intake of Danish school children in relation to dietary guidelines and nutrient recommendations, and to assess the food intake during and outside school hours. In total, 834 children from nine public schools located in the eastern part of Denmark were included in this cross-sectional study and 798 children (95·7 %) completed the dietary assessment sufficiently (August–November 2011). The whole diet was recorded during seven consecutive days using the Web-based Dietary Assessment Software for Children (WebDASC). Compared with the food-based dietary guidelines and nutrient recommendations, 85 % of the children consumed excess amounts of red meat, 89 % consumed too much saturated fat, and 56 % consumed too much added sugar. Additionally 35 or 91 % of the children (depending on age group) consumed insufficient amounts of fruits and vegetables, 85 % consumed insufficient amounts of fish, 86 % consumed insufficient amounts of dietary fibre, 60 or 84 % had an insufficient Fe intake (depending on age group), and 96 % had an insufficient vitamin D intake. The study also showed that there is a higher intake of fruits and bread during school hours than outside school hours; this is not the case with, for example, fish and vegetables, and future studies should investigate strategies to increase fish and vegetable intake during school hours.
Conflicting reports have been published on the association between Clostridium difficile ribotypes and severe disease outcomes in patients with C. difficile infection (CDI); several so-called hypervirulent ribotypes have been described. We performed a multicenter study to assess severe disease presentation and severe outcomes among CDI patients infected with different ribotypes.
Stool samples that tested positive for C. difficile toxin were collected and cultured from patients who presented to any of 7 different hospitals in Houston, Texas (2011–2013). C. difficile was characterized using a fluorescent PCR ribotyping method. Medical records were reviewed to determine clinical characteristics and ribotype association with severe CDI presentation (ie, leukocytosis and/or hypoalbuminemia) and severe CDI outcomes (ie, ICU admission, ileus, toxic megacolon, colectomy, and/or in-hospital death).
Our study included 715 patients aged 61±18 years (female: 63%; median Charlson comorbidity index: 2.5±2.4; hospital-onset CDI: 45%; severe CDI: 36.7%; severe CDI outcomes: 12.3%). The most common ribotypes were 027, 014-020, FP311, 002, 078-126, and 001. Ribotype 027 was a significant independent predictor of severe disease (adjusted odds ratio [aOR], 2.24; 95% confidence interval [CI], 1.53–3.29; P<.001) and severe CDI outcomes (aOR, 1.71; 95% CI, 1.02–2.85; P=.041) compared with all other ribotypes in aggregate. However, in an analysis using all common ribotypes as individual variables, ribotype 027 was not associated with severe CDI outcomes more often than other ribotypes.
Ribotype 027 showed virulence equal to that of other ribotypes identified in this endemic setting. Clinical severity markers of CDI may be more predictive of severe CDI outcomes than a particular ribotype.
Infect. Control Hosp. Epidemiol. 2015;36(11):1318–1323
Internet interventions are assumed to be cost-effective. However, it is unclear how strong this evidence is, and what the quality of this evidence is.
A comprehensive literature search (1990–2014) in Medline, EMBASE, the Cochrane Central Register of Controlled Trials, NHS Economic Evaluations Database, NHS Health Technology Assessment Database, Office of Health Economics Evaluations Database, Compendex and Inspec was conducted. We included economic evaluations alongside randomized controlled trials of Internet interventions for a range of mental health symptoms compared to a control group, consisting of a psychological or pharmaceutical intervention, treatment-as-usual (TAU), wait-list or an attention control group.
Of the 6587 abstracts identified, 16 papers met the inclusion criteria. Nine studies featured a societal perspective. Results demonstrated that guided Internet interventions for depression, anxiety, smoking cessation and alcohol consumption had favourable probabilities of being more cost-effective when compared to wait-list, TAU, group cognitive behaviour therapy (CBGT), attention control, telephone counselling or unguided Internet CBT. Unguided Internet interventions for suicide prevention, depression and smoking cessation demonstrated cost-effectiveness compared to TAU or attention control. In general, results from cost-utility analyses using more generic health outcomes (quality of life) were less favourable for unguided Internet interventions. Most studies adhered reasonably to economic guidelines.
Results of guided Internet interventions being cost-effective are promising with most studies adhering to publication standards, but more economic evaluations are needed in order to determine cost-effectiveness of Internet interventions compared to the most cost-effective treatment currently available.