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To summarise and describe the clinical presentations, diagnostic approaches and airway management techniques in children with laryngotracheal trauma.
The clinical data related to laryngotracheal trauma diagnosed and treated at the Beijing Children's Hospital, between January 2013 and July 2018, were retrospectively reviewed. Disease diagnosis, treatment, management and outcomes were analysed.
A total of 13 cases were enrolled, including 7 cases of penetrating laryngotracheal trauma. The six cases of blunt laryngotracheal trauma were caused by collisions with hard objects. In all cases, voice, airway and swallowing outcomes were graded as ‘good’, except for one patient who had residual paralysis of the vocal folds.
Flexible fibre-optic laryngoscopy and computed tomography can play an important role in diagnosing laryngotracheal trauma. The airway should be secured and, if necessary, opened by tracheal intubation or tracheostomy.
OBJECTIVES/GOALS: Diffusion basis spectrum imaging (DBSI) allows for detailed evaluation of white matter microstructural changes present in cervical spondylotic myelopathy (CSM). Our goal is to utilize multidimensional clinical and quantitative imaging data to characterize disease severity and predict long-term outcomes in CSM patients undergoing surgery. METHODS/STUDY POPULATION: A single-center prospective cohort study enrolled fifty CSM patients who underwent surgical decompression and twenty healthy controls from 2018-2021. All patients underwent diffusion tensor imaging (DTI), DBSI, and complete clinical evaluations at baseline and 2-years follow-up. Primary outcome measures were the modified Japanese Orthopedic Association score (mild [mJOA 15-17], moderate [mJOA 12-14], severe [mJOA 0-11]) and SF-36 Physical and Mental Component Summaries (PCS and MCS). At 2-years follow-up, improvement was assessed via established MCID thresholds. A supervised machine learning classification model was used to predict treatment outcomes. The highest-performing algorithm was a linear support vector machine. Leave-one-out cross-validation was utilized to test model performance. RESULTS/ANTICIPATED RESULTS: A total of 70 patients – 20 controls, 25 mild, and 25 moderate/severe CSM patients – were enrolled. Baseline clinical and DTI/DBSI measures were significantly different between groups. DBSI Axial and Radial Diffusivity were significantly correlated with baseline mJOA and mJOA recovery, respectively (r=-0.33, p<0.01; r=-0.36, p=0.02). When predicting baseline disease severity (mJOA classification), DTI metrics alone performed with 38.7% accuracy (AUC: 72.2), compared to 95.2% accuracy (AUC: 98.9) with DBSI metrics alone. When predicting improvement after surgery (change in mJOA), clinical variables alone performed with 33.3% accuracy (AUC: 0.40). When combining DTI or DBSI parameters with key clinical covariates, model accuracy improved to 66.7% (AUC: 0.65) and 88.1% (AUC: 0.95) accuracy, respectively. DISCUSSION/SIGNIFICANCE: DBSI metrics correlate with baseline disease severity and outcome measures at 2-years follow-up. Our results suggest that DBSI may serve as a valid non-invasive imaging biomarker for CSM disease severity and potential for postoperative improvement.
The aerodynamics of a stationary wing in a turbulent wake are investigated. Force and velocity measurements are used to describe the unsteady flow. Various wakes are studied with different dominant frequencies and length scales. In contrast to the pre-stall angles of attack, the time-averaged lift increases substantially at post-stall angles of attack as the wing interacts with the von Kármán vortex street and experiences temporal variations of the effective angle of attack. At an optimal offset distance from the wake centreline, the time-averaged lift becomes maximum despite of small amplitude oscillations in the effective angle of attack. The stall angle of attack can reach 20° and the maximum lift coefficient can reach 64 % higher than that in the freestream. Whereas large velocity fluctuations at the wake centreline cause excursions into the fully attached and separated flows during the cycle, small-amplitude oscillations at the optimal location result in periodic shedding of leading edge vortices. These vortices may produce large separation bubbles with reattachment near the trailing-edge. Vorticity roll-up, strength and size of the vortices increase with increasing wavelength and period of the von Kármán vortex street, which also coincides with an increase in the spanwise length scale of the incident wake, and all contribute to the remarkable increase in lift.
For the safety problems caused by the limited landing space of the deck during the arresting process of the carrier-based aircraft, a dynamic model of the carrier-based aircraft’s landing and arresting is built. Based on the batch simulation method, the lateral dynamics safety envelope of the aircraft during the arresting was defined, and the dynamic response of the key points in the envelope during the arresting process was investigated. Subsequently, the influence of engine thrust and aircraft quality on the arresting safety envelope was studied based on reasonable safety evaluation indicators, and the safety status envelope of the deck arresting was given. Then, the particular Hamilton-Jacobi partial differential equation is used to obtain the lateral dynamics safety envelope of the carrier-based aircraft in the process of landing and arresting by backward inversion. Results indicate that engine thrust and landing quality have little effect on the yaw angle in the arresting safety boundary during the arresting. Additionally, with the engine thrust and landing quality increase, the maximum safe off-centre distance gradually decreases, and the safety boundary decreases accordingly. During the phase of landing glide, the engine thrust and quality have little effect on the maximum safe eccentric distance. When the engine thrust is increased by 40%, the maximum safe yaw angle is reduced from 0.3°, and the safety boundary is reduced by 4.2%. When the aircraftquality increases by 40%, the maximum safe yaw angle is reduced by 0.4°, and the safety boundary is reduced by 2.8%. The findings of this paper can provide framework for the research on theaircraft-to-carrier dynamic matching characteristics of the carrier-based system, and is of great significance to the research on improving the safety of the carrier-based aircraft landing arresting.
The long-distance stable transport of relativistic electron beams (REBs) in plasmas is studied by full three-dimensional particle-in-cell simulations. Theoretical analysis shows that the beam transport is mainly influenced by three transverse instabilities, where the excitation of self-modulation instability, and the suppression of the filamentation instability and the hosing instability are important to realize the beam stable transport. By modulating the transport parameters such as the electron density ratio, the relativistic Lorentz factor, the beam envelopes and the density profiles, the relativistic bunches having a smooth density profile and a length of several plasma wave periods can suppress the beam-plasma instabilities and propagate in plasmas for long distances with small energy losses. The results provide a reference for the research of long-distance and stable transport of REBs, and would be helpful for new particle beam diagnosis technology and space active experiments.
The epidemic of tuberculosis has posed a serious burden in Qinghai province, it is necessary to clarify the epidemiological characteristics and spatial-temporal distribution of TB for future prevention and control measures. We used descriptive epidemiological methods and spatial statistical analysis including spatial correlation and spatial-temporal analysis in this study. Furthermore, we applied an exponential smoothing model for TB epidemiological trend forecasting. Of 43 859 TB cases, the sex ratio was 1.27:1 (M:F), and the average annual TB registered incidence was 70.00/100 000 of 2009–2019. More cases were reported in March and April, and the worst TB stricken regions were the prefectures of Golog and Yushu. High TB registered incidences were seen in males, farmers and herdsmen, Tibetans, or elderly people. 7132 cases were intractable, which were recurrent, drug resistant, or co-infected with other infections. Three likely cases clusters with significant high risk were found by spatial-temporal scan on data of 2009–2019. The exponential smoothing winters' additive model was selected as the best-fitting model to forecast monthly TB cases in the future. This research indicated that TB in Qinghai is still a serious threaten to the local residents' health. Multi-departmental collaboration and funds special for TB treatments and control are still needed, and the exponential smoothing model is promising which could be applied for forecasting of TB epidemic trend in this high-altitude province.
In order to intercept a highly manoeuvering target with an ideal impact angle in the three-dimensional space, this paper promises to probe into the problem of three-dimensional terminal guidance. With the goal of the highly target acceleration and short terminal guidance time, a guidance law, based on the advanced fast non-singular terminal sliding mode theory, is designed to quickly converge the line-of-sight (LOS) angle and the LOS angular rate within a finite time. In the design process, the target acceleration is regarded as an unknown boundary external disturbance of the guidance system, and the RBF neural network is used to estimate it. In order to improve the estimation accuracy of RBF neural network and accelerate its convergence, the parameters of RBF neural network are adjusted online in real time. At the same time, an adaptive law is designed to compensate the estimation error of the RBF neural network, which improves the convergence speed of the guidance system. Theoretical analysis demonstrates that the state and the sliding manifold of the guidance system converge in finite time. According to Lyapunov theory, the stability of the system can be guaranteed by online adjusting the parameters of RBF neural network and adaptive parameters. The numerical simulation results verify the effectiveness and superiority of the proposed guidance law.
There is a lack of evidence related to the prevalence of mental health symptoms as well as their heterogeneities during the coronavirus disease 2019 (COVID-19) pandemic in Latin America, a large area spanning the equator. The current study aims to provide meta-analytical evidence on mental health symptoms during COVID-19 among frontline healthcare workers, general healthcare workers, the general population and university students in Latin America.
Bibliographical databases, such as PubMed, Embase, Web of Science, PsycINFO and medRxiv, were systematically searched to identify pertinent studies up to August 13, 2021. Two coders performed the screening using predefined eligibility criteria. Studies were assigned quality scores using the Mixed Methods Appraisal Tool. The double data extraction method was used to minimise data entry errors.
A total of 62 studies with 196 950 participants in Latin America were identified. The pooled prevalence of anxiety, depression, distress and insomnia was 35%, 35%, 32% and 35%, respectively. There was a higher prevalence of mental health symptoms in South America compared to Central America (36% v. 28%, p < 0.001), in countries speaking Portuguese (40%) v. Spanish (30%). The pooled prevalence of mental health symptoms in the general population, general healthcare workers, frontline healthcare workers and students in Latin America was 37%, 34%, 33% and 45%, respectively.
The high yet heterogenous level of prevalence of mental health symptoms emphasises the need for appropriate identification of psychological interventions in Latin America.
We report on experimental observation of non-laminar proton acceleration modulated by a strong magnetic field in laser irradiating micrometer aluminum targets. The results illustrate the coexistence of ring-like and filamentation structures. We implement the knife edge method into the radiochromic film detector to map the accelerated beams, measuring a source size of 30–110 μm for protons of more than 5 MeV. The diagnosis reveals that the ring-like profile originates from low-energy protons far off the axis whereas the filamentation is from the near-axis high-energy protons, exhibiting non-laminar features. Particle-in-cell simulations reproduced the experimental results, showing that the short-term magnetic turbulence via Weibel instability and the long-term quasi-static annular magnetic field by the streaming electric current account for the measured beam profile. Our work provides direct mapping of laser-driven proton sources in the space-energy domain and reveals the non-laminar beam evolution at featured time scales.
We prospectively surveyed SARS-CoV-2 RNA contamination in staff common areas within an acute-care hospital. An increasing prevalence of surface contamination was detected over time. Adjusting for patient census or community incidence of coronavirus disease 2019 (COVID-19), the proportion of contaminated surfaces did not predict healthcare worker COVID-19 infection on study units.
Frequent freezing injury greatly influences winter wheat production; thus, effective prevention and a command of agricultural production are vital. The freezing injury monitoring method integrated with ‘3S’ (geographic information systems (GIS), global positioning system (GPS) and remote sensing (RS)) technology has an unparalleled advantage. Using HuanJing (HJ)-1A/1B satellite images of a winter wheat field in Shanxi Province, China plus a field survey, crop types and winter wheat planting area were identified through repeated visual interpretations of image information and spatial analyses conducted in GIS. Six vegetation indices were extracted from processed HJ-1A/1B satellite images to determine whether the winter wheat suffered from freezing injury and its degree of severity and recovery, using change vector analysis (CVA), the freeze injury representative vegetation index and the combination of the two methods, respectively. Accuracy of the freezing damage classification results was verified by determining the impact of freezing damage on yield and quantitative analysis. The CVA and the change of normalized difference vegetation index (ΔNDVI) monitoring results were different so a comprehensive analysis of the combination of CVA and ΔNDVI was performed. The area with serious freezing injury covered 0.9% of the total study area, followed by the area of no freezing injury (3.5%), moderate freezing injury (10.2%) and light freezing injury (85.4%). Of the moderate and serious freezing injury areas, 0.2% did not recover; 1.2% of the no freezing injury and light freezing injury areas showed optimal recovery, 15.6% of the light freezing injury and moderate freezing injury areas showed poor recovery, and the remaining areas exhibited general recovery.
Pneumatic launch systems for Unmanned Aerial Vehicles (UAVs), including mechanical and pneumatic systems, are complex and non-linear. They are subjected to system parameters during launch, which leads to difficulty in engineering research analysis. For example, the mismatch between the UAV parameters and the parameter design indices of the launch system as well as the unclear design indices of the launching speed and overload of UAVs have a great impact on launch safety. Considering this situation, some studies are presented in this paper. Taking the pneumatic launch system as a research object, a pneumatic launcher dynamic simulation model is built based on co-simulation considering the coupling characteristics of the mechanical structure and transmission system. Its accuracy was verified by laboratory test results. Based on this model, the paper shows the effects of the key parameters, including the mass of the UAV, cylinder volume, pressure and moment of inertia of the pulley block, on the performance of the dynamic characteristics of the launch process. Then, a method for matching the parameter characteristics between the UAV and launch system based on batch simulation is proposed. The set of matching parameter values of the UAV and launch system that satisfy the launch take-off safety criteria are calculated. Finally, the influence of the system parameters of the launch process on the launch performance was analysed in detail, and the design optimised. Meaningful conclusions were obtained. The analysis method and its results can provide a reference for engineering and theoretical research and development of pneumatic launch systems.
There is a limited literature available showing mental health burden among adolescents following cyberbullying.
Aim is to evaluate the association of low mood and suicidality amongst cyberbullied adolescents.
A study on CDC National Youth Risk Behavior Surveillance (YRBS) (1991-2017). Responses from adolescence related to cyberbullying and suicidality were evaluated. Chi-square and mix-effect multivariable logistic regression analysis was performed to find out the association of cyberbullying with sadness/hopelessness, suicide consideration, plan, and attempts.
A total of 10,463 adolescents, 14.8% of adolescents faced cyberbullying a past year. There was a higher prevalence of cyberbullying in youths aged 15-17 years (25 vs 26 vs 23%), which included more females to males (68 vs 32%).(p<0.0001) Caucasians (53%) had the highest number of responses to being cyberbullied compared to Hispanics (24%), African Americans (11%).(p<0.0001) There was an increased prevalence of cyberbullied youths with feelings of sadness/hopelessness (59.6 vs 25.8%), higher numbers considering suicide (40.4 vs 13.2%), suicide plan (33.2 vs 10.8%), and multiple suicidal attempts in comparison to non-cyberbullied.(p<0.0001) On regression analysis, cyberbullied adolescence had a 155% higher chance of feeling sad and hopeless [aOR=2.55; 95%CI=2.39-2.72], considered suicide [1.52 (1.39-1.66)], and suicide plan [1.24 (1.13-1.36)].
In our study, cyberbullying was associated with negative mental health outcomes. Further research is warranted to examine the impact and outcomes of cyberbullying amongst adolescents and guiding the policies to mitigate the consequences.
The degree to which suicide risk aggregates in US families is unknown. The authors aimed to determine the familial risk of suicide in Utah, and tested whether familial risk varies based on the characteristics of the suicides and their relatives.
A population-based sample of 12 160 suicides from 1904 to 2014 were identified from the Utah Population Database and matched 1:5 to controls based on sex and age using at-risk sampling. All first through third- and fifth-degree relatives of suicide probands and controls were identified (N = 13 480 122). The familial risk of suicide was estimated based on hazard ratios (HR) from an unsupervised Cox regression model in a unified framework. Moderation by sex of the proband or relative and age of the proband at time of suicide (<25 v. ⩾25 years) was examined.
Significantly elevated HRs were observed in first- (HR 3.45; 95% CI 3.12–3.82) through fifth-degree relatives (HR 1.07; 95% CI 1.02–1.12) of suicide probands. Among first-degree relatives of female suicide probands, the HR of suicide was 6.99 (95% CI 3.99–12.25) in mothers, 6.39 in sisters (95% CI 3.78–10.82), and 5.65 (95% CI 3.38–9.44) in daughters. The HR in first-degree relatives of suicide probands under 25 years at death was 4.29 (95% CI 3.49–5.26).
Elevated familial suicide risk in relatives of female and younger suicide probands suggests that there are unique risk groups to which prevention efforts should be directed – namely suicidal young adults and women with a strong family history of suicide.
Manure is a primary source of methane (CH4) emissions into the atmosphere. A large proportion of CH4 from manure is emitted during storage, but this varies with storage methods. In this research, we tested whether covering a manure heap with plastic reduces CH4 emission during a short-term composting process. A static chamber method was used to detect the CH4 emission rate and the change of the physicochemical properties of cattle manure which was stored either uncovered (treatment UNCOVERED) or covered with plastic (treatment COVERED) for 30-day periods during the four seasons? The dry matter content of the COVERED treatment was significantly less than the UNCOVERED treatment (P < 0.01), and the C/N ratio of the COVERED treatment significantly greater than the UNCOVERED treatment (P > 0.05) under high temperature. In the UNCOVERED treatment, average daily methane (CH4) emissions were in the order summer > spring > autumn > winter. CH4 emissions were positively correlated with the temperature (R2 = 0.52, P < 0.01). Compared to the UNCOVERED treatment, the daily average CH4 emission rates from COVERED treatment manure were less in the first 19 days of spring, 13 days of summer, 10 days of autumn and 30 days of winter. In summary, covering the manure pile with plastic reduces the evaporation of water during storage; and in winter, long-term covering with plastic film reduces the CH4 emissions during the storage of manure.
Dry wind-tunnel (DWT) flutter test systems model the unsteady distributed aerodynamic force using various electromagnetic exciters. They can be used to test the aeroelastic and aeroservoelastic stability of smart aircraft or high-speed flight vehicles. A new parameterised modelling method at the full system level based on the generalised force equivalence for DWT flutter systems is proposed herein. The full system model includes the structural dynamic model, electromechanical coupling model and fast aerodynamic computation model. An optimisation search method is applied to determine the best locations for measurement and excitation by introducing Fisher’s information matrix. The feasibility and accuracy of the proposed system-level numerical DWT modelling method have been validated for a plate aeroelastic model with four exciters/transducers. The effects of key parameters including the number of exciters, the control time delay, the noise interference and the electrical parameters of the electromagnetic exciter model have also been investigated. The numerical and experimental results indicate that the proposed modelling method achieves good accuracy (with deviations of less than 1.5% from simulations and 4.5% from experimental test results for the flutter speed) and robust performance even in uncertain environments with a 10% noise level.
Carrier-based unmanned aerial aircraft (UAV) structure is subjected to severe tensile load during takeoff, especially the drawbar, which affects its fatigue performance and structural safety. However, the complex structural features pose great challenges for the engineering design. Considering this situation, a structural design, fatigue analysis, and parameters optimisation joint working platform are urgently needed to solve this problem. In this study, numerical analysis of strain fatigue is carried out based on the laboratory fatigue failure of the carrier-based aircraft drawbar. Taking the sensitivity of drawbar parameters to stress and life into account and optimum design of drawbar with fatigue life as a target using the parametric method, this study also includes cutting-edge parameters of milling cutters, structural details of the drawbar and so on. Then an experimental design is applied using the Latin hypercube sampling method, and a surrogate model based on RBF neural network is established. Lastly, a multi-island genetic algorithm is introduced for optimisation. The results show that the error between the obtained optimal solution and simulation is 0.26%, while the optimised stress level is reduced by 15.7%, and the life of the drawbar is increased by 122%.
The rotating instability in a contra-rotating axial flow compressor is investigated by experiments. Twenty-four pressure sensors were installed on the casing to capture the unsteady flow in the rotor tip region simultaneously. A double-phase-locking technique suitable for the contra-rotating compressor was proposed to characterise the static pressure contours of the rotor tip. The mean and root-mean-square pressure contours indicate that rotating instability occurs before the rotating stall happened, and the rotor tip clearance vortex is located upstream of the rear rotor leading edge plane before stall. Fourier spectrum shows that rotating instability and rotating stall both happened under the stall condition, and the frequency band of rotating instability does not change with the flow rate. In the front rotor, the frequency of rotating instability is half of the blade passing frequency. It is verified that the modal estimation method can be implemented by using the average azimuthal phase velocity, which significantly reduced the number of pressure sensors required. Modal estimation results show that each peak of the rotating instability frequency band corresponds to a unique dominant circumferential mode. By optimising average azimuthal phase velocity, an improved modal estimation method is obtained, which can further improve the reliability of the modal estimation results.