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This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to COVID-19 with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplemental materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
Understanding the clinical risk factors for COVID-19 disease severity and outcomes requires a combination of data from electronic health records and patient reports. To facilitate the collection of patient-reported data, as well as accelerate and standardize the collection of data about host factors, we have constructed a COVID-19 survey. This survey is freely available to the scientific community to send electronically for patients to complete online. This patient survey is designed to be comprehensive, yet not overly burdensome, to gather data useful for a range of clinical investigations, and to accommodate a wide variety of implementation settings including at a COVID-19 testing site, at home during infection or after recovery, and/or for individuals while they are hospitalized. A widely adopted standardized survey that can be implemented online with minimal resources can serve as a critical tool for combining and comparing data across studies to improve our understanding of COVID-19 disease.
We aimed to investigate the heterogeneity of seasonal suicide patterns among multiple geographically, demographically and socioeconomically diverse populations.
Weekly time-series data of suicide counts for 354 communities in 12 countries during 1986–2016 were analysed. Two-stage analysis was performed. In the first stage, a generalised linear model, including cyclic splines, was used to estimate seasonal patterns of suicide for each community. In the second stage, the community-specific seasonal patterns were combined for each country using meta-regression. In addition, the community-specific seasonal patterns were regressed onto community-level socioeconomic, demographic and environmental indicators using meta-regression.
We observed seasonal patterns in suicide, with the counts peaking in spring and declining to a trough in winter in most of the countries. However, the shape of seasonal patterns varied among countries from bimodal to unimodal seasonality. The amplitude of seasonal patterns (i.e. the peak/trough relative risk) also varied from 1.47 (95% confidence interval [CI]: 1.33–1.62) to 1.05 (95% CI: 1.01–1.1) among 12 countries. The subgroup difference in the seasonal pattern also varied over countries. In some countries, larger amplitude was shown for females and for the elderly population (≥65 years of age) than for males and for younger people, respectively. The subperiod difference also varied; some countries showed increasing seasonality while others showed a decrease or little change. Finally, the amplitude was larger for communities with colder climates, higher proportions of elderly people and lower unemployment rates (p-values < 0.05).
Despite the common features of a spring peak and a winter trough, seasonal suicide patterns were largely heterogeneous in shape, amplitude, subgroup differences and temporal changes among different populations, as influenced by climate, demographic and socioeconomic conditions. Our findings may help elucidate the underlying mechanisms of seasonal suicide patterns and aid in improving the design of population-specific suicide prevention programmes based on these patterns.
The occurrence of secondary flows is investigated for three-dimensional sinusoidal roughness where the wavelength and height of the roughness elements are systematically altered. The flow spanned from the transitionally rough regime up to the fully rough regime and the solidity of the roughness ranged from a wavy, sparse roughness to a dense roughness. Analysing the time-averaged velocity, secondary flows are observed in all of the cases, reflected in the coherent stress profile which is dominant in the vicinity of the roughness elements. The roughness sublayer, defined as the region where the coherent stress is non-zero, scales with the roughness wavelength when the roughness is geometrically scaled (proportional increase in both roughness height and wavelength) and when the wavelength increases at fixed roughness height. Premultiplied energy spectra of the streamwise velocity turbulent fluctuations show that energy is reorganised from the largest streamwise wavelengths to the shorter streamwise wavelengths. The peaks in the premultiplied spectra at the streamwise and spanwise wavelengths are correlated with the roughness wavelength in the fully rough regime. Current simulations show that the spanwise scale of roughness determines the occurrence of large-scale secondary flows.
Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions.
A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation.
At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38–2.34).
Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.
Roughness predominantly alters the near-wall region of turbulent flow while the outer layer remains similar with respect to the wall shear stress. This makes it a prime candidate for the minimal-span channel, which only captures the near-wall flow by restricting the spanwise channel width to be of the order of a few hundred viscous units. Recently, Chung et al. (J. Fluid Mech., vol. 773, 2015, pp. 418–431) showed that a minimal-span channel can accurately characterise the hydraulic behaviour of roughness. Following this, we aim to investigate the fundamental dynamics of the minimal-span channel framework with an eye towards further improving performance. The streamwise domain length of the channel is investigated with the minimum length found to be three times the spanwise width or 1000 viscous units, whichever is longer. The outer layer of the minimal channel is inherently unphysical and as such alterations to it can be performed so long as the near-wall flow, which is the same as in a full-span channel, remains unchanged. Firstly, a half-height (open) channel with slip wall is shown to reproduce the near-wall behaviour seen in a standard channel, but with half the number of grid points. Next, a forcing model is introduced into the outer layer of a half-height channel. This reduces the high streamwise velocity associated with the minimal channel and allows for a larger computational time step. Finally, an investigation is conducted to see if varying the roughness Reynolds number with time is a feasible method for obtaining the full hydraulic behaviour of a rough surface. Currently, multiple steady simulations at fixed roughness Reynolds numbers are needed to obtain this behaviour. The results indicate that the non-dimensional pressure gradient parameter must be kept below 0.03–0.07 to ensure that pressure gradient effects do not lead to an inaccurate roughness function. An empirical costing argument is developed to determine the cost in terms of CPU hours of minimal-span channel simulations a priori. This argument involves counting the number of eddy lifespans in the channel, which is then related to the statistical uncertainty of the streamwise velocity. For a given statistical uncertainty in the roughness function, this can then be used to determine the simulation run time. Following this, a finite-volume code with a body-fitted grid is used to determine the roughness function for square-based pyramids using the above insights. Comparisons to experimental studies for the same roughness geometry are made and good agreement is observed.
We investigate rough-wall turbulent flows through direct numerical simulations of flow over three-dimensional transitionally rough sinusoidal surfaces. The roughness Reynolds number is fixed at
is the sinusoidal semi-amplitude, and the sinusoidal wavelength is varied, resulting in the roughness solidity
(frontal area divided by plan area) ranging from 0.05 to 0.54. The high cost of resolving both the flow around the dense roughness elements and the bulk flow is circumvented by the use of the minimal-span channel technique, recently demonstrated by Chung et al. (J. Fluid Mech., vol. 773, 2015, pp. 418–431) to accurately determine the Hama roughness function,
. Good agreement of the second-order statistics in the near-wall roughness-affected region between minimal- and full-span rough-wall channels is observed. In the sparse regime of roughness (
) the roughness function increases with increasing solidity, while in the dense regime the roughness function decreases with increasing solidity. It was found that the dense regime begins when
, in agreement with the literature. A model is proposed for the limit of
, which is a smooth wall located at the crest of the roughness elements. This model assists with interpreting the asymptotic behaviour of the roughness, and the rough-wall data presented in this paper show that the near-wall flow is tending towards this modelled limit. The peak streamwise turbulence intensity, which is associated with the turbulent near-wall cycle, is seen to move further away from the wall with increasing solidity. In the sparse regime, increasing
reduces the streamwise turbulent energy associated with the near-wall cycle, while increasing
in the dense regime increases turbulent energy. An analysis of the difference of the integrated mean momentum balance between smooth- and rough-wall flows reveals that the roughness function decreases in the dense regime due to a reduction in the Reynolds shear stress. This is predominantly due to the near-wall cycle being pushed away from the roughness elements, which leads to a reduction in turbulent energy in the region previously occupied by these events.
This study aimed to evaluate the association of chronic rhinosinusitis with sudden sensorineural hearing loss using a population-based database.
Sampled subject data were obtained from the Taiwan Longitudinal Health Insurance Database 2000. A total of 3325 patients with sudden sensorineural hearing loss were identified and 9975 controls were randomly selected. A conditional logistic regression was used to calculate the odds ratio for having been previously diagnosed with chronic rhinosinusitis, for cases and controls.
Results and conclusion:
The adjusted odds ratio of having prior chronic rhinosinusitis among cases compared to controls was 1.36 (95 per cent confidence interval = 1.16–1.60). The significant relationship between sudden sensorineural hearing loss and chronic rhinosinusitis was most pronounced among those patients aged 44 years or less (compared to controls) (odds ratio = 2.18; 95 per cent confidence interval = 1.63–2.92). However, the significant relationship between sudden sensorineural hearing loss and prior chronic rhinosinusitis was not sustained for patients older than 60 years compared to controls.
We describe a fast direct numerical simulation (DNS) method that promises to directly characterise the hydraulic roughness of any given rough surface, from the hydraulically smooth to the fully rough regime. The method circumvents the unfavourable computational cost associated with simulating high-Reynolds-number flows by employing minimal-span channels (Jiménez & Moin, J. Fluid Mech., vol. 225, 1991, pp. 213–240). Proof-of-concept simulations demonstrate that flows in minimal-span channels are sufficient for capturing the downward velocity shift, that is, the Hama roughness function, predicted by flows in full-span channels. We consider two sets of simulations, first with modelled roughness imposed by body forces, and second with explicit roughness described by roughness-conforming grids. Owing to the minimal cost, we are able to conduct direct numerical simulations with increasing roughness Reynolds numbers while maintaining a fixed blockage ratio, as is typical in full-scale applications. The present method promises a practical, fast and accurate tool for characterising hydraulic resistance directly from profilometry data of rough surfaces.
Direct numerical simulations (DNS) are conducted for turbulent flow through pipes with three-dimensional sinusoidal roughnesses explicitly represented by body-conforming grids. The same viscous-scaled roughness geometry is first simulated at a range of different Reynolds numbers to investigate the effects of low Reynolds numbers and low
is the pipe radius and
is the roughness height. Results for the present class of surfaces show that the Hama roughness function
is only marginally affected by low Reynolds numbers (or low
), and observations of outer-layer similarity (or lack thereof) show no signs of sensitivity to Reynolds number. Then, building on this, a systematic approach is taken to isolate the effects of roughness height
in a turbulent wall-bounded flow in both transitionally rough and fully rough regimes. Current findings show that while the effective slope
(which for the present sinusoidal surfaces is proportional to
) is an important roughness parameter, the roughness function
must also depend on some measure of the viscous roughness height. A simplistic linear–log fit clearly illustrates the strong correlation between
and both the roughness average height
(which is related to
for the surfaces simulated here, consistent with published literature. Various definitions of the virtual origin for rough-wall turbulent pipe flow are investigated and, for the surfaces simulated here, the hydraulic radius of the pipe appears to be the most suitable parameter, and indeed is the only virtual origin that can ever lead to collapse in the total stress. First- and second-order statistics are also analysed and collapses in the outer layer are observed for all cases, including those where the largest roughness height is a substantial proportion of the reference radius (low
). These results provide evidence that turbulent pipe flow over the present sinusoidal surfaces adheres to Townsend’s notion of outer-layer similarity, which pertains to statistics of relative motion.
This paper describes the system architecture of a newly constructed radio telescope – the Boolardy engineering test array, which is a prototype of the Australian square kilometre array pathfinder telescope. Phased array feed technology is used to form multiple simultaneous beams per antenna, providing astronomers with unprecedented survey speed. The test array described here is a six-antenna interferometer, fitted with prototype signal processing hardware capable of forming at least nine dual-polarisation beams simultaneously, allowing several square degrees to be imaged in a single pointed observation. The main purpose of the test array is to develop beamforming and wide-field calibration methods for use with the full telescope, but it will also be capable of limited early science demonstrations.
Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design.
Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed.
Results suggested that EI patients had reduced suicide rate (χ2(1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR −0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery.
The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service.
Dental remineralization may be achieved by mediating the interactions between tooth surfaces with free ions and biomimetic peptides. We recently developed octuplet repeats of aspartate-serine-serine (DSS-8) peptide, which occurs in high abundance in naturally occurring proteins that are critical for tooth remineralization. In this paper, we evaluated the possible role of DSS-8 in dentin remineralization. Human dentin specimens were demineralized, exposed briefly to DSS-8 solution, and then exposed to concentrated ionic solutions that favor remineralization. Dentin nano-mechanical behaviors, hardness and elastic modulus, at various stages of treatment were determined by nanoindentation. The phase, microstructure and morphology of the resultant surfaces were characterized using grazing incidence X-ray diffraction, variable pressure scanning electron microscopy, and atomic force microscopy, respectively. Nanoindentation results show that DSS-8 remineralization effectively improves the mechanical and elastic properties of native dentin. Moreover, the hardness and elastic modulus for the DSS-8 treated dentin were significantly higher than surfaces remineralized without DSS-8.