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In times of repeated disaster events, including natural disasters and pandemics, public health workers must recover rapidly to respond to subsequent events. Understanding predictors of time to recovery and developing predictive models of time to recovery can aid planning and management.
We examined 681 public health workers (21-72 y, M(standard deviation [SD]) = 48.25(10.15); 79% female) 1 mo before (T1) and 9 mo after (T2) the 2005 hurricane season. Demographics, trauma history, social support, time to recover from previous hurricane season, and predisaster work productivity were assessed at T1. T2 assessed previous disaster work, initial emotional response, and personal hurricane injury/damage. The primary outcome was time to recover from the most recent hurricane event.
Multivariate analyses found that less support (T1; odds ratio [OR] = .74[95% confidence interval [CI] = .60-.92]), longer previous recovery time (T1; OR = 5.22[95%CI = 3.01-9.08]), lower predisaster work productivity (T1; OR = 1.98[95%CI = 1.08-3.61]), disaster-related personal injury/damage (T2; OR = 3.08[95%CI = 1.70-5.58]), and initial emotional response (T2; OR = 1.71[95%CI = 1.34-2.19]) were associated with longer recovery time (T2).
Recovery time was adversely affected in disaster responders with a history of longer recovery time, personal injury/damage, lower work productivity following prior hurricanes, and initial emotional response, whereas responders with social support had shorter recovery time. Predictors of recovery time should be a focus for disaster preparedness planners.
The COVID-19 pandemic resulted in millions of deaths worldwide and is considered a significant mass-casualty disaster (MCD). The surge of patients and scarcity of resources negatively impacted hospitals, patients, and medical practice. We hypothesized ICUs during this MCD had a higher acuity of illness and subsequently had increased lengths of stay (LOS), complication rates, death rates, and costs of care. The purpose of this study was to investigate those outcomes.
This was a multicenter, retrospective study that compared intensive care admissions in 2020 to those in 2019 to evaluate patient outcomes and cost of care. Data were obtained from the Vizient Clinical Data Base/Resource Manager.
Data included the number of ICU admissions, patient outcomes, case mix index, and summary of cost reports. Quality outcomes were also collected. 1,304,981 patients from 333 hospitals were included. For all medical centers, there was a significant increase in LOS index, ICU LOS, complication rate, case mix index, total cost, and direct cost index.
The MCD caused by COVID-19 was associated with increased adverse outcomes and cost-of-care for ICU patients.
In order to improve the resiliency of the grid and to enable integration of renewable energy sources into the grid, the utilization of battery systems to store energy for later demand is of the utmost importance. The implementation of grid-scale electrical energy storage systems can aid in peak shaving and load leveling, voltage and frequency regulation, as well as emergency power supply. Although the predominant battery chemistry currently used is Li-ion; due to cost, safety and sourcing concerns, incorporation of other battery technologies is of interest for expanding the breadth and depth of battery storage system installations. This Element discusses existing technologies beyond Li-ion battery storage chemistries that have seen grid-scale deployment, as well as several other promising battery technologies, and analyzes their chemistry mechanisms, battery construction and design, and corresponding advantages and disadvantages.
Fatigue is frequently co-existing with other symptoms and is highly prevalent among patients with cancer and geriatric population. There was a lack of knowledge that focus on fatigue clusters in older adults with cancer in hospice care.
To identify fatigue-related symptom clusters in older adult hospice patients and discover to what extent fatigue-related symptom clusters predict functional status while controlling for depression.
This was a cross-sectional study in a sample of 519 older adult hospice patients with cancer, who completed the Memorial Symptom Assessment Scale, the Center for Epidemiological Studies Depression, Boston Short Form Scale, and the Palliative Performance Scale. Data from a multi-center symptom trial were extracted for this secondary analysis using exploratory factor analysis and hierarchical multiple regression analysis.
Data from 519 patients (78 ± 7 years) with terminal cancer who received hospice care under home healthcare services revealed that 39% of the participants experienced fatigue-related symptom clusters (lack of energy, feeling drowsy, and lack of appetite). The fatigue cluster was significantly associated positively with depression (r = 0.253, p < 0.01), and negatively with functional status (r = −0.117, p < 0.01) and was a strong predictor of participants’ low functional status. Furthermore, depression made a significant contribution to this predictive relationship.
Older adult hospice patients with cancer experienced various concurrent symptoms. The fatigue-specific symptom cluster was identified significantly associated with depression and predicted functional status. Fatigue should be routinely monitored in older adults, especially among hospice cancer patients, to help reduce psychological distress and prevent functional decline.
Opposition control of artificially initiated turbulent spots in a laminar boundary layer was carried out in a low-turbulence wind tunnel with the aim to delay transition to turbulence by modifying the turbulent structure within the turbulent spots. The timing and duration of control, which was carried out using wall-normal jets from a spanwise slot, were pre-determined based on the baseline measurements of the transitional boundary layer. The results indicated that the high-speed region of the turbulent spots was cancelled by opposition control, which was replaced by a carpet of low-speed fluid. The application of the variable-interval time-averaging technique on the velocity fluctuation signals demonstrated a reduction in both the burst duration and intensity within the turbulent spots, but the burst frequency was increased.
Background: Despite a higher prevalence of traumatic spinal cord injury (TSCI) amongst Canadian Indigenous peoples, there is a paucity of studies focused on Indigenous TSCI. We present the first Canada-wide study comparing TSCI amongst Canadian Indigenous and non-Indigenous peoples. Methods: This study is a retrospective analysis of prospectively-collected TSCI data from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2004-2019. We divided participants into Indigenous and non-Indigenous cohorts and compared them with respect to demographics, injury mechanism, level, severity, and outcomes. Results: Compared with non-Indigenous patients, Indigenous patients were younger, more female, less likely to have higher education, and less likely to be employed. The mechanism of injury was more likely due to assault or transportation-related trauma in the Indigenous group. The length of stay for Indigenous patients was longer. Indigenous patients were more likely to be discharged to a rural setting, less likely to be discharged home, and more likely to be unemployed following injury. Conclusions: Our results suggest that more resources need to be dedicated for transitioning Indigenous patients sustaining a TSCI to community living and for supporting these patients in their home communities. A focus on resources and infrastructure for Indigenous patients by engagement with Indigenous communities is needed.
The increasing availability of smart products creates a more pronounced need for designers to prototype and communicate interactive and environmental qualities of product during their design process. This paper explores which elements of User journey, Storyboards and Wireframes contribute to communicating these qualities, and how they might integrate with sketching. Results show depictions of user and temporal elements alongside low fidelity sketches are deemed most important. Our findings form the basis to propose and subsequently test combined prototyping approaches in future research.
Pre-pandemic psychological distress is associated with increased susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but associations with the coronavirus disease 2019 (COVID-19) severity are not established. The authors examined the associations between distress prior to SARS-CoV-2 infection and subsequent risk of hospitalization.
Between April 2020 (baseline) and April 2021, we followed 54 781 participants from three ongoing cohorts: Nurses' Health Study II (NHSII), Nurses' Health Study 3 (NHS3), and the Growing Up Today Study (GUTS) who reported no current or prior SARS-CoV-2 infection at baseline. Chronic depression was assessed during 2010–2019. Depression, anxiety, worry about COVID-19, perceived stress, and loneliness were measured at baseline. SARS-CoV-2 infection and hospitalization due to COVID-19 was self-reported. Relative risks (RRs) were calculated by Poisson regression.
3663 participants reported a positive SARS-CoV-2 test (mean age = 55.0 years, standard deviation = 13.8) during follow-up. Among these participants, chronic depression prior to the pandemic [RR = 1.72; 95% confidence interval (CI) 1.20–2.46], and probable depression (RR = 1.81, 95% CI 1.08–3.03), being very worried about COVID-19 (RR = 1.79; 95% CI 1.12–2.86), and loneliness (RR = 1.81, 95% CI 1.02–3.20) reported at baseline were each associated with subsequent COVID-19 hospitalization, adjusting for demographic factors and healthcare worker status. Anxiety and perceived stress were not associated with hospitalization. Depression, worry about COVID-19, and loneliness were as strongly associated with hospitalization as were high cholesterol and hypertension, established risk factors for COVID-19 severity.
Psychological distress may be a risk factor for hospitalization in patients with SARS-CoV-2 infection. Assessment of psychological distress may identify patients at greater risk of hospitalization. Future work should examine whether addressing distress improves physical health outcomes.
We perform a direct numerical simulation (DNS) of interacting Kelvin–Helmholtz instabilities (KHI) that arise at a stratified shear layer where KH billow cores are misaligned or exhibit varying phases along their axes. Significant evidence of these dynamics in early laboratory shear-flow studies by Thorpe (Geophys. Astrophys. Fluid Dyn., vol. 34, 1985, pp. 175–199) and Thorpe (J. Geophys. Res., vol. 92, 1987, pp. 5231–5248), in observations of KH billow misalignments in tropospheric clouds (Thorpe, Q. J. R. Meteorol. Soc., vol. 128, 2002, pp. 1529–1542) and in recent direct observations of such events in airglow and polar mesospheric cloud imaging in the upper mesosphere reveals that these dynamics are common. More importantly, the laboratory and mesospheric observations suggest that these dynamics lead to more rapid and more intense instabilities and turbulence than secondary convective instabilities in billow cores and secondary KHI in stratified braids between and around adjacent billows. To date, however, no simulations exploring the dynamics and energetics of interacting KH billows (apart from pairing) have been performed. Our DNS performed for Richardson number $Ri=0.10$ and Reynolds number $Re=5000$ demonstrates that KHI tubes and knots (i) comprise strong and complex vortex interactions accompanying misaligned KH billows, (ii) accelerate the transition to turbulence relative to secondary instabilities of individual KH billows, (iii) yield significantly stronger turbulence than secondary KHI in billow braids and secondary convective instabilities in KHI billow cores and (iv) expand the suite of secondary instabilities previously recognized to contribute to KHI dynamics and breakdown to turbulence in realistic geophysical environments.
Fritts et al. (J. Fluid Mech., vol. xx, 2022, xx) describe a direct numerical simulation of interacting Kelvin–Helmholtz instability (KHI) billows arising due to initial billow cores that exhibit variable phases along their axes. Such KHI exhibit strong ‘tube and knot’ dynamics identified in early laboratory studies by Thorpe (Geophys. Astrophys. Fluid Dyn., vol. 34, 1985, pp. 175–199). Thorpe (Q.J.R. Meteorol. Soc., vol. 128, 2002, pp. 1529–1542) noted that these dynamics may be prevalent in the atmosphere, and they were recently identified in atmospheric observations at high altitudes. Tube and knot dynamics were found by Fritts et al. (J. Fluid. Mech., 2022) to drive stronger and faster turbulence transitions than secondary instabilities of individual KH billows. Results presented here reveal that KHI tube and knot dynamics also yield energy dissipation rates $\sim$2–4 times larger as turbulence arises and that remain $\sim$2–3 times larger to later stages of the flow evolution, compared with those of secondary convective instabilities (CI) and secondary KHI accompanying KH billows without tube and knot influences. Elevated energy dissipation rates occur due to turbulence transitions by tube and knot dynamics arising on much larger scales than secondary CI and KHI where initial KH billows are misaligned. Tube and knot dynamics also excite large-scale Kelvin ‘twist waves’ that cause vortex tube and billow core fragmentation, more energetic cascades of similar interactions to smaller scales and account for the strongest energy dissipation events accompanying such KH billow evolutions.
The incidence of scarlet fever has increased dramatically in recent years in Chongqing, China, but there has no effective method to forecast it. This study aimed to develop a forecasting model of the incidence of scarlet fever using a seasonal autoregressive integrated moving average (SARIMA) model. Monthly scarlet fever data between 2011 and 2019 in Chongqing, China were retrieved from the Notifiable Infectious Disease Surveillance System. From 2011 to 2019, a total of 5073 scarlet fever cases were reported in Chongqing, the male-to-female ratio was 1.44:1, children aged 3–9 years old accounted for 81.86% of the cases, while 42.70 and 42.58% of the reported cases were students and kindergarten children, respectively. The data from 2011 to 2018 were used to fit a SARIMA model and data in 2019 were used to validate the model. The normalised Bayesian information criterion (BIC), the coefficient of determination (R2) and the root mean squared error (RMSE) were used to evaluate the goodness-of-fit of the fitted model. The optimal SARIMA model was identified as (3, 1, 3) (3, 1, 0)12. The RMSE and mean absolute per cent error (MAPE) were used to assess the accuracy of the model. The RMSE and MAPE of the predicted values were 19.40 and 0.25 respectively, indicating that the predicted values matched the observed values reasonably well. Taken together, the SARIMA model could be employed to forecast scarlet fever incidence trend, providing support for scarlet fever control and prevention.
In centrifugal compressors, the identification of flow instability signals from experiments is a difficult problem owing to the nonlinear and non-stationary characteristics. Otherwise, the complicated asymmetric structure of the volute brings a huge challenge to the evolution and circumferential nonuniformity characteristics of the flow instabilities. This paper presents experimental and numerical investigations on internal flow field to understand the flow instability characteristics in a centrifugal compressor. Considering nonlinear and non-stationary signals, a method based on Fourier-transform and variational mode decomposition was introduced to analyse the flow instability characteristics. The Fourier spectrum results show that at 0.21kg/s of 80krpm, the pressure signal has a noticeable high-frequency fluctuation, which indicates that the compressor enters the flow instability state. The variational mode decomposition results show that before a surge, the compressor experiences different flow instability stages: the RI stage, the coexistence stage of RI and stall, and the stall stage. Moreover, obvious circumferential nonuniformity characteristics of flow instabilities were observed during the throttling process. RI first occurred at the 180° circumferential position and then the stall first appeared in the circumferential range of 60° to 240°. The simulation results that it is because that the asymmetric volute causes the adverse pressure gradient inside the impeller passage and a high-pressure region (120°–240°) at the upstream of the impeller inlet. Under this combined action of the two, the effect region of tip leakage vortex expands the upstream of the impeller inlet. Meanwhile, the tip leakage vortex core migrates to a lower span of blades. This study demonstrates the ability to analyse nonlinear and non-stationary signals from a centrifugal compressor via variational mode decomposition, and provides a useful guidance for the identification of flow instability signals.
To examine the association between adherence to plant-based diets and mortality.
Prospective study. We calculated a plant-based diet index (PDI) by assigning positive scores to plant foods and reverse scores to animal foods. We also created a healthful PDI (hPDI) and an unhealthful PDI (uPDI) by further separating the healthy plant foods from less-healthy plant foods.
The VA Million Veteran Program.
315 919 men and women aged 19–104 years who completed a FFQ at the baseline.
We documented 31 136 deaths during the follow-up. A higher PDI was significantly associated with lower total mortality (hazard ratio (HR) comparing extreme deciles = 0·75, 95 % CI: 0·71, 0·79, Ptrend < 0·001]. We observed an inverse association between hPDI and total mortality (HR comparing extreme deciles = 0·64, 95 % CI: 0·61, 0·68, Ptrend < 0·001), whereas uPDI was positively associated with total mortality (HR comparing extreme deciles = 1·41, 95 % CI: 1·33, 1·49, Ptrend < 0·001). Similar significant associations of PDI, hPDI and uPDI were also observed for CVD and cancer mortality. The associations between the PDI and total mortality were consistent among African and European American participants, and participants free from CVD and cancer and those who were diagnosed with major chronic disease at baseline.
A greater adherence to a plant-based diet was associated with substantially lower total mortality in this large population of veterans. These findings support recommending plant-rich dietary patterns for the prevention of major chronic diseases.
Digital biomarkers of mental health, created using data extracted from everyday technologies including smartphones, wearable devices, social media and computer interactions, have the opportunity to revolutionise mental health diagnosis and treatment by providing near-continuous unobtrusive and remote measures of behaviours associated with mental health symptoms. Machine learning models process data traces from these technologies to identify digital biomarkers. In this editorial, we caution clinicians against using digital biomarkers in practice until models are assessed for equitable predictions (‘model equity’) across demographically diverse patients at scale, behaviours over time, and data types extracted from different devices and platforms. We posit that it will be difficult for any individual clinic or large-scale study to assess and ensure model equity and alternatively call for the creation of a repository of open de-identified data for digital biomarker development.
This study aimed to examine the intrapersonal, interpersonal, environmental and macrosystem influences on dietary behaviours among primary school children in Singapore.
A qualitative interpretive approach was used in this study. Focus group discussions guided by the socio-ecological model (sem), of which transcripts were analysed deductively using the sem and inductively using thematic analysis to identify themes at each sem level.
Two co-educational public primary schools in Singapore.
A total of 48 children (n 26 girls) took part in the semi-structured focus group discussions. Their mean age was 10·8 years (sd = 0·9, range 9–12 years), and the majority of the children were Chinese (n 36), along with some Indians (n 8) and Malays (n 4).
Children’s knowledge of healthy eating did not necessarily translate into healthy dietary practices and concern for health was a low priority. Instead, food and taste preferences were pivotal influences in their food choices. Parents had a large influence on children with regards to their accessibility to food, their attitudes and values towards food. Parental food restriction led to some children eating in secrecy. Peer influence was not frequently reported by children. Competitions in school incentivised children to consume fruits and vegetables, but reinforcements from teachers were inconsistent. The proximity of fast-food chains in the neighbourhood provided children easy access to less healthy foods. Health advertisements on social media rather than posters worked better in drawing children’s attention.
Findings highlighted important factors that should be considered in future nutrition interventions targeting children.
Subthreshold depression could be a significant precursor to and a risk factor for major depression. However, reliable estimates of the prevalence and its contribution to developing major depression under different terminologies depicting subthreshold depression have to be established.
By searching PubMed and Web of Science using predefined inclusion criteria, we included 1 129 969 individuals from 113 studies conducted. The prevalence estimates were calculated using the random effect model. The incidence risk ratio (IRR) was estimated by measuring the ratio of individuals with subthreshold depression who developed major depression compared to that of non-depressed individuals from 19 studies (88, 882 individuals).
No significant difference in the prevalence among the different terminologies depicting subthreshold depression (Q = 1.96, p = 0.5801) was found. By pooling the prevalence estimates of subthreshold depression in 113 studies, we obtained a summary prevalence of 11.02% [95% confidence interval (CI) 9.78–12.33%]. The youth group had the highest prevalence (14.17%, 95% CI 8.82–20.55%), followed by the elderly group (12.95%, 95% CI 11.41-14.58%) and the adult group (8.92%, 95% CI 7.51–10.45%). Further analysis of 19 studies' incidence rates showed individuals with subthreshold depression had an increased risk of developing major depression (IRR = 2.95, 95% CI 2.33–3.73), and the term minor depression showed the highest IRR compared with other terms (IRR = 3.97, 95% CI 3.17–4.96).
Depression could be a spectrum disorder, with subthreshold depression being a significant precursor to and a risk factor for major depression. Proactive management of subthreshold depression could be effective for managing the increasing prevalence of major depression.
Although, biological evidence suggests that tea consumption may protect against non-Hodgkin lymphoma (NHL), epidemiologic evidence has been unclear. The aim of this study was to examine the association between tea-drinking habits and the risk of NHL in a large nationwide prospective cohort of postmenopausal US women. 68,854 women who were enrolled from 1993 through 1998 in the Women’s Health Initiative Observational Study (WHI-OS) and responded to year 3 annual follow-up questionnaire comprised the analytic cohort. Newly diagnosed NHL cases after the year 3 visit were confirmed by medical and pathology reports. Multivariable-adjusted Cox proportional hazards models were performed to assess the associations of tea-drinking habits (specifically, the amounts of caffeinated/herbal/decaffeinated tea intake) with the overall risk of NHL and 3 major subtypes (Diffuse large B-cell lymphoma, DLBCL, (n=195, 0.3%), follicular lymphoma, FL, (n=128, 0.2%), and chronic lymphocytic leukemia/small lymphocytic lymphoma, CLL/SLL, (n=51, 0.1%)). Among 62,622 participants, a total of 663 (1.1%) women developed NHL during a median follow-up of 16.51(SD±6.20) years. Overall, different amounts of type-specific tea intake were not associated with the risk of NHL regardless of its histologic subtypes after adjustment for confounders. Our findings suggest that tea intake at the current consumption level does not influence the risk of NHL, regardless of its histologic types.
Erikson asked what makes some people care for the future of the species and others not, calling this ‘generativity vs. stagnation’. In three studies, we addressed structure of this trait and its heritability. Study 1 (N = 1570), using structural models of the Loyola Generativity Scale , revealed three correlated factors consisting of (1) Establishing and aiding the next generation; (2) Maintaining the world; and (3) Symbolic immortality through a positive legacy. Study 2 (N = 311) successfully replicated this structure in an independent UK sample. Study 3 tested genetic and environmental influences on generativity. All three factors showed significant and substantial heritable influence. A general factor was required, which was also heritable. In resolving previous uncertainty over the transmission of generativity across generations, shared environmental transmission models fit poorly. Substantial unique environmental effects suggest strong cultural impacts on concern for the species. Generativity researchers may usefully adopt this three-factor scoring system, allowing research on the predictive power of each component of generativity as well as molecular genetic or biological studies.
This study aimed to elucidate whether molecular signalling involved in upper airway remodelling is enhanced in patients with obstructive sleep apnoea.
Twenty patients with mild obstructive sleep apnoea (control group) and 40 patients with moderate to severe obstructive sleep apnoea (obstructive sleep apnoea group) who desired uvulopalatopharyngoplasty were recruited for the study. After uvulopalatopharyngoplasty, surgical specimens of the uvula were subjected to haematoxylin and eosin, Masson's trichrome and immunohistochemical staining. Western blot and reverse transcriptase-polymerase chain reaction were used to evaluate the protein and messenger RNA expressions.
The obstructive sleep apnoea group showed more severe inflammation, increased collagen deposition and higher immunohistochemical staining intensity for TGF-ß and MMP-9 as well as higher protein and messenger RNA expression of MMP-9, VEGF, TGF-ß, p38 MAPK, SMAD 2/3, AKT and JNK in the uvula than control group.
Patients with obstructive sleep apnoea demonstrated more severe inflammation, increased airway remodelling, and increased protein and messenger RNA expression of pro-inflammatory and pro-fibrotic cytokines in the uvula than control participants.