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We use interface-resolved simulations to study near-wall turbulence modulation by small inertial particles, much denser than the fluid, in dilute/semi-dilute conditions. We considered three bulk solid mass fractions, $\varPsi =0.34\,\%$, $3.37\,\%$ and $33.7\,\%$, with only the latter two showing turbulence modulation. The increase of the drag is strong at $\varPsi =3.37\,\%$, but mild in the densest case. Two distinct regimes of turbulence modulation emerge: for smaller mass fractions, the turbulence statistics are weakly affected and the near-wall particle accumulation increases the drag so the flow appears as a single-phase flow at slightly higher Reynolds number. Conversely, at higher mass fractions, the particles modulate the turbulent dynamics over the entire flow, and the interphase coupling becomes more complex. In this case, fluid Reynolds stresses are attenuated, but the inertial particle dynamics near the wall increases the drag via correlated velocity fluctuations, leading to an overall drag increase. Hence, we conclude that, although particles at high mass fractions reduce the fluid turbulent drag, the solid phase inertial dynamics still increases the overall drag. However, inspection of the streamwise momentum budget in the two-way coupling limit of vanishing volume fraction, but finite mass fraction, indicates that this trend could reverse at even higher particle load.
This study aimed to establish rates and gender patterns of 25 comorbidities in 1912 children (72% male) with a neurological disorder and a comparison group (n = 40 718, 45% male) from a large clinical records data-set in child mental health services in the UK with clinician-recorded data on neurological and psychological conditions. Obsessive–compulsive disorder, oppositional defiant/conduct disorders, autism spectrum disorders and intellectual disabilities (also known in UK health services as learning disabilities) occurred significantly more often in both boys and girls with neurological disorders than in the comparison group. Girls with neurological disorders showed a ‘male-typic’ comorbidity profile.
Pareiasaurs were globally distributed, abundant, herbivorous parareptiles with the basal-most members found only in the mid-Permian of South Africa. These basal forms form a monophyletic group and were locally abundant and became extinct at the top of the Tapinocephalus Assemblage Zone at the end of the Guadalupian. Four species of basal pareiasaurs are currently recognised: Bradysaurus baini, B. seeleyi, Embrithosaurus schwarzi and Nochelesaurus alexanderi, but they are all poorly understood and there remains historic uncertainty as to their validity. In this paper, our second contribution designed to improve understanding of the basal group, we present the first detailed cranial description and updated diagnosis for Nochelesaurus alexanderi and demonstrate that it is a distinct taxon based on one cranial autapomorphy, a large transversely wide postparietal, and a combination of cranial characters. Within the local group of mid-Permian pareiasaurs, we recognise new dental features of Nochelesaurus alexanderi: non-symmetrical marginal cusp arrangements on upper and lower teeth resulting from an extra basal mesial cusp; an incipient horizontal cingulum on lower jaw teeth, sometimes with one or two tiny medial cingular cusps; and up to ten marginal cusps. Our study demonstrates that tooth morphology and orientation, cranial ornamentation, morphology of the cheek bosses, shape of the postfrontal and postparietal, and morphology of the distal paroccipital process of the opisthotic are the most useful to identify South African mid-Permian pareiasaurs.
We analysed both structural and functional aspects of sentences containing the four adverbials “after”, “before”, “because”, and “if” in two dense corpora of parent-child interactions from two British English-acquiring children (2;00–4;07). In comparing mothers’ and children's usage we separate out the effects of frequency, cognitive complexity and pragmatics in explaining the course of acquisition of adverbial sentences. We also compare these usage patterns to stimuli used in a range of experimental studies and show how differences may account for some of the difficulties that children have shown in experiments. In addition, we report descriptive data on various aspects of adverbial sentences that have not yet been studied as a resource for future investigations.
In the early days after the revolutions in Egypt and Tunisia, Islamist movements and parties appeared to be the winners of the political transformation. This opened new opportunities for activism and political participation for Islamist men and women. The political organizing of the Egyptian Muslim Sisterhood and Ennahda women in Tunisia before, during, and after the Arab Spring provides a significant case for addressing the gap in the literature on Islamist women's political organizing and agency. Moreover, it addresses the lack of scholarly attention to the Muslim Sisterhood and Ennahda women and the agency they manifest in their sociopolitical activism. Relying on primary and secondary interviews with these activists, this article traces the framing strategies, activism, and roles of Islamist women in Egypt and Tunisia. In both cases, we argue that government repression and backlash against Islamist movements is a shared experience and a central topic of identification for Islamist women. Islamist women in Tunisia and Egypt became more visible in the aftermath of the uprisings and reached into decision-making bodies such as a parliament when their countries were on the path toward democracy. Women from the two groups highlight democracy, freedom, human rights, and women's rights to frame their activism.
This study aimed to describe the person-centered experience of symptoms and impact of dementia-related psychosis (DRP) from a patient and care partner (CP) perspective.
This observational, non-interventional, prospective study collected patient experience data to understand the impact of DRP in persons with various dementia subtypes. Qualitative interviews were conducted with persons or their CP who have a clinical diagnosis of all-cause dementia with psychotic symptoms, recruited through physician referrals. The quantitative online survey was completed by persons with self-reported DRP or their CP recruited by advocacy groups: UsAgainstAlzheimer’s and the Lewy Body Dementia Association. CP burden was beyond the scope of this study.
Sixteen individuals (1 patient, 15 CP) participated in the qualitative interview. The most commonly reported symptoms of DRP were visual hallucinations (88%), auditory hallucinations (69%), and persecutory delusions (56%). Participants described an impact of DRP on activities of daily living (75%), sleep (63%), family life (56%), and safety concerns (56%).
The quantitative portion was completed by 212 participants (26 patients, 186 CP). DRP symptoms most frequently reported by patients were visual hallucinations (89%), auditory hallucinations (54%), and distortion of senses (54%); those reported by CP were paranoid delusions (76%), visual hallucinations (75%), and lack of trust for loved ones (52%). For patients with recent visual hallucinations, 61% of patients and 70% of CP reported experiencing this symptom on a weekly basis. When asked to rank the impact on the patient’s life, patients reported that visual hallucinations were the most impactful symptom whereas CP reported paranoid delusions/false beliefs as most impactful, followed by visual hallucinations. Difficulty differentiating what is real from what is not real, increased anxiety, and effects on personal relationships were the most common types of impacts reported by both patients and CP. Most patients (>40%) were not receiving medications for DRP.
Persons with DRP experience hallucinations and delusions that have a substantial impact on their lives. Here, patient experience data demonstrate that there is a need for treatments to reduce the symptoms and impacts of DRP.
Study Sponsored By: ACADIA Pharmaceuticals Inc.
TF is a consultant with Frangiosa & Associates, LLC.
VB and AT have no relevant financial relationships to disclose.
TB, BK, and VA are employees of and may hold stock and/or stock options with ACADIA Pharmaceuticals Inc.
We aimed to describe current treatment patterns and unmet needs of persons with DRP from a patient and care partner (CP) perspective.
This observational, non-interventional, prospective study used a mixed-methods approach with qualitative interviews and a quantitative online survey. Persons with DRP and CP of persons with DRP reported the effectiveness of current treatments using a visual analog scale (VAS) of 0 (“not at all well”) to 5 (“extremely well”) and ranked benefits of an ideal treatment. CP burden was outside the scope of this study.
The qualitative interview was completed by 1 patient and 15 CP. Current treatments included atypical antipsychotics, antidepressants, anxiolytics, and benzodiazepines. Participants commonly indicated a need to improve patients’ ability to know what is real vs not real.
The online survey was completed by 26 patients and 186 CP on behalf of patients under their care. Common treatments used included atypical antipsychotics (27% of patients, 41% of CP) and psychological/ behavioral therapy (23% of patients, 8% of CP). Many participants reported no current treatment (42% of patients, 42% of CP). Participants reported that current treatment methods were less than moderately helpful in treating patients’ most impactful symptoms with a median VAS score of 2.0/5 reported by patients and CP (mean VAS score [standard deviation] = 2.33 [1.0] for patients [n=15], mean [standard deviation] VAS score = 2.4 [1.3] for CP [n=104]). Discontinuation of a treatment was reported by 11 patients and 115 CP, most commonly due to a side effect (27% of patients, 31% of CP), doctor’s recommendation (27% of patients, 14% of CP), or lack of symptom improvement (9% of patients, 28% of CP). Participants ranked the ability to distinguish what is real vs not real (35% of patients, 49% of CP) and overall symptom improvement (42% of patients, 23% of CP) as the most important benefits of an ideal treatment.
Patients and CPs reported either not taking any DRP treatments or that current treatments were associated with side effects along with limited efficacy. There is an unmet need for safe and effective treatments for DRP.
Study Sponsored By:
ACADIA Pharmaceuticals Inc.
TF is a consultant with Frangiosa & Associates, LLC.
VB and AT have no relevant financial relationships to disclose.
TB, BK, and VA are employees of and may hold stock and/or stock options with ACADIA Pharmaceuticals Inc.
Research of the Pontificio Istituto di Archeologia Cristiana on the Lateran Baptistery during the last two decades has resolved some of the many questions left open by the excavations inside the Baptistery in the 1920s and around it in the 1960s. This research has been coordinated by the author and Federico Guidobaldi and has involved the PIAC, the Swedish Institute of Classical Studies in Rome, the Vatican Museums and the Swedish National Heritage board. As a result it has been possible to determine the octagonal plan of the first (Constantinian) phase of the Baptistery, identify the foundations of the Oratory of Santa Croce, ascertain the height to which walls of the Constantinian phase are preserved, and deduce that the reconstructions attributed to the fifth-century Popes Sixtus III and Hilarus must be part of the same project. Laser scanned models and 3D documentation has been created as an instrument for research and for reconstructions. There remain, however, important, unresolved questions and these are also explored int his chapter. How was the building covered? Did it have an inner colonnade? What was the place of the first phase of this structure in the development of Late Antique architecture?
We perform interface-resolved simulations to study the modulation of statistically steady-state homogeneous shear turbulence by neutrally buoyant finite-size particles. We consider two shapes, spheres and oblates, and various solid volume fractions, up to 20%. The results show that a statistically steady state is not exclusive to single-phase homogeneous shear turbulence as the production and dissipation rates of the turbulent kinetic energy are also statistically in balance in particle-laden cases. The turbulent kinetic energy shows a non-monotonic behaviour with increasing solid volume fraction: increasing turbulence attenuation up to a certain concentration of solid particles and then enhancement of the turbulent kinetic energy at higher concentrations. This behaviour is observed at lower volume fractions for oblate particles than for spheres. The attenuation of the turbulence activity at lower volume fractions is explained through the enhancement of the dissipation rate close to the surface of particles. At higher volume fractions, however, particle pair interactions induce regions of high Reynolds shear stress, resulting in the enhancement of the turbulence activity. We show that the oblate particles of the considered size have larger rotational rates than spheres with no preferential orientation. This is in contrast to previous studies in wall-bounded flows where preferential orientation close to the wall and reduced rotation rates result in turbulence attenuation and thus drag reduction. Our results shed some light on the effect of rigid particles, smaller than the near-wall turbulent structures but still comparable to the viscous length scale, on the dynamics of the equilibrium logarithmic layer in wall-bounded flows.
We perform three-dimensional numerical simulations to investigate the sedimentation of a single sphere in the absence and presence of a simple cross-shear flow in a yield stress fluid with weak inertia. In our simulations, the settling flow is considered to be the primary flow, whereas the linear cross-shear flow is a secondary flow with amplitude 10 % of the primary flow. To study the effects of elasticity and plasticity of the carrying fluid on the sphere drag as well as the flow dynamics, the fluid is modelled using the elastoviscoplastic constitutive laws proposed by Saramito (J. Non-Newtonian Fluid Mech., vol. 158 (1–3), 2009, pp. 154–161). The extra non-Newtonian stress tensor is fully coupled with the flow equation and the solid particle is represented by an immersed boundary method. Our results show that the fore–aft asymmetry in the velocity is less pronounced and the negative wake disappears when a linear cross-shear flow is applied. We find that the drag on a sphere settling in a sheared yield stress fluid is reduced significantly compared to an otherwise quiescent fluid. More importantly, the sphere drag in the presence of a secondary cross-shear flow cannot be derived from the pure sedimentation drag law owing to the nonlinear coupling between the simple shear flow and the uniform flow. Finally, we show that the drag on the sphere settling in a sheared yield stress fluid is reduced at higher material elasticity mainly due to the form and viscous drag reduction.
We use interface-resolved direct numerical simulations to study the dynamics of a single sediment particle in a turbulent open channel flow over a fixed porous bed. The relative strength of the gravitational acceleration, quantified by the Galileo number, is varied so as to reproduce the different modes of sediment transport – resuspension, saltation and rolling. The results show that the sediment dynamics at lower Galileo numbers (i.e. resuspension and saltation) are mainly governed by the mean flow. Here, the regime of motion can be predicted by the ratio between the gravity and the shear-induced boundary force. In these cases, the sediment particle rapidly takes off when exposed to the flow, and proceeds with an oscillatory motion. Increasing the Galileo number, the frequency of these oscillations increases and their amplitude decreases, until the transport mode switches from resuspension to saltation. In this case, the sediment travels by short successive collisions with the bed. Further increasing the Galileo number, the particle rolls without detaching from the bed. Differently from the previous modes, the motion is triggered by extreme turbulent events, and the particle response depends on the specific initial conditions, at fixed Reynolds number. The results reveal that close to the onset of sediment motion, only turbulent sweeps can effectively trigger the particle motion by increasing the stagnation pressure upstream. We show that for the parameters in this study, a criterion based on the streamwise flow-induced force can successfully predict the incipient movement.
At present, analysis of diet and bladder cancer (BC) is mostly based on the intake of individual foods. The examination of food combinations provides a scope to deal with the complexity and unpredictability of the diet and aims to overcome the limitations of the study of nutrients and foods in isolation. This article aims to demonstrate the usability of supervised data mining methods to extract the food groups related to BC. In order to derive key food groups associated with BC risk, we applied the data mining technique C5.0 with 10-fold cross-validation in the BLadder cancer Epidemiology and Nutritional Determinants study, including data from eighteen case–control and one nested case–cohort study, compromising 8320 BC cases out of 31 551 participants. Dietary data, on the eleven main food groups of the Eurocode 2 Core classification codebook, and relevant non-diet data (i.e. sex, age and smoking status) were available. Primarily, five key food groups were extracted; in order of importance, beverages (non-milk); grains and grain products; vegetables and vegetable products; fats, oils and their products; meats and meat products were associated with BC risk. Since these food groups are corresponded with previously proposed BC-related dietary factors, data mining seems to be a promising technique in the field of nutritional epidemiology and deserves further examination.
Little is known of the relations between psychosis, religion and suicide. One hundred and fifteen outpatients with schizophrenia or schizo-affective disorder and 30 inpatients without psychotic symptoms were studied using a semi-structured interview assessing religiousness/spirituality. Their past suicide attempts were examined. Additionally, they were asked about the role (protective or incentive) of religion in their decision to commit suicide. Forty-three percent of the patients with psychosis had previously attempted suicide. Religiousness was not associated with the rate of patients who attempted suicide. Twenty-five percent of all subjects acknowledged a protective role of religion, mostly through ethical condemnation of suicide and religious coping. One out of ten patients reported an incentive role of religion, not only due to negatively connotated issues but also to the hope for something better after death. There were no differences between groups (i.e. psychotic vs. non-psychotic patients). Religion may play a specific role in the decisions patients make about suicide, both in psychotic and non-psychotic patients. This role may be protective, a finding particularly important for patients with psychosis who are known to be at high risk of severe suicide attempts. Interventions aiming to lower the number of suicide attempts in patients with schizophrenia should take these data into account.
Suicide risk is increased in patients with a history of psychiatric hospitalization.
To explore how suicide risk varies by age during psychiatric hospitalization and in the year post-discharge.
This is a population-based case-control study of all suicides (n = 20,675; 70% male) in Sweden aged ≥18 years during 1991–2003. Each suicide was individually matched to 10 population controls by age, sex, and county of residence. Discharge diagnoses of a mental disorder (except dementia and other organic disorders) in the year prior to suicide were identified by register linkage. Odds ratios (OR) were calculated by conditional logistic regression to estimate the relative risk of suicide in those with psychiatric diagnoses compared to the general population. ORs were estimated by age group (18–34 years, 35–49 years, 50–64 years, and ≥ 65 years) and timing of the suicide in relation to discharge.
During hospitalization, the youngest age group had the greatest suicide risk elevation [OR 64 (95% CI 44-92)]. In the first month post-discharge, the oldest age group had the highest suicide risk elevation [OR 162 (95% 66–399) in the first week and OR 127 (95% 67–242) in the second to fourth weeks]. In the remaining eleven months, suicide risk elevation was lower and relatively similar in different age groups.
During the year following psychiatric hospitalization, an especially high attention should be paid to the suicide risk of the elderly patients in the first month post-discharge.
Patients with schizophrenia are at increased risk of suicide, but data from controlled studies of how pharmacotherapy is related to suicide risk is limited.
To explore suicide risk in relation to prescription of antipsychotics and antidepressants.
Of all patients with a first clinical discharge diagnosis of schizophrenia or schizoaffective disorder in Stockholm County between 1984 and 2000 (n = 4,000), patients who died by suicide within five years from diagnosis were defined as cases (n = 84; 54% male). Individual matching was performed with schizophrenia controls from the same population. Information on prescribed medication was retrieved from psychiatric records in a blinded way. Odds ratios (OR) of the association between medication and suicide risk were calculated by conditional logistic regression.
No significant association was observed between suicide and having ever been prescribed any antidepressant (33 cases and 30 controls) or any antipsychotic (83 cases and 82 controls). A lower suicide risk was found in patients who had ever been prescribed a second generation antipsychotic (risperidone, ziprazidone, olanzapine or clozapine; 12 cases and 23 controls): OR 0.2 (95% confidence interval [CI], 0.1–0.7). When the 6 cases and 8 controls who had been prescribed clozapine were excluded, the OR was 0.1 (95% CI, 0.03–0.6).
The lower suicide risk for patients who had been prescribed second generation antipsychotics may be related to a pharmacological effect of these medications, to differences in compliance, or to differences in other characteristics associated with a lower suicide risk.
Le suicide et les conduites auto-agressives sont fréquents dans la population adulte. De précédentes études ont prouvé que le fait de maintenir le lien avec le sujet suicidant, par lettres ou cartes postales, après la prise en charge en aigu, réduit le risque de récidive. De plus, les études de faisabilité ont montré que l’intervention par SMS est acceptable pour les patients. L‘objectif principal de cette étude est de démontrer l’efficacité du dispositif de veille par SMS sur la réduction de la récidive suicidaire à 6 mois. Nous présenterons dans un premier temps l’étude de faisabilité puis l’étude multicentrique démarrée dans 8 CHU.
Matériel et méthode
Il s’agira d’un essai de supériorité, contrôlé, randomisé, multicentrique, d’une durée de 2 ans, et piloté par le CHRU de Brest. Les sujets seront des adultes ayant survécu à un passage à l’acte suicidaire, inclus après une prise en charge aux urgences ou une courte hospitalisation. Le recrutement s’étalera sur une période de 9 mois. Les SMS seront envoyés à j2, j7, j15, puis mensuellement. Ces messages se soucieront du bien-être du patient, et lui rappelleront les coordonnées d’urgence dont il dispose en cas de besoin. Les patients seront évalués à j0, puis à 6 et 13 mois. Le critère de jugement principal sera le nombre de patients récidivant à 6 mois, dans le groupe recevant les SMS et dans le groupe témoin (qui bénéficie de la prise en charge de référence). Les critères de jugement secondaires seront le nombre de patients récidivant à 13 mois, le nombre de tentatives de suicide à 6 et 13 mois, le nombre de décès par suicide à 6 et 13 mois, dans les deux groupes. Les idées suicidaires seront évaluées dans chaque groupe, à j0, à 6 mois, et à 13 mois. Enfin, les coûts médicaux et la satisfaction seront évalués à 13 mois.
La fréquence de récidive attendue à 6 mois dans le groupe témoin est de l’ordre de 18 %. Nous espérons la réduire à 9 % grâce au contact par SMS. Afin d’y parvenir, le nombre de sujets nécessaires a été évalué à 530, soit 265 dans chaque bras.
Ce dispositif de veille par SMS s’appuie sur de précédentes interventions, aux résultats significatifs dans le domaine, et est facilement reproductible. Nous proposons d’évaluer son efficacité dans la réduction du risque de récidive suicidaire au sein d’une population d’adultes ayant fait un passage à l’acte.