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Blast injuries can occur by a multitude of mechanisms, including improvised explosive devices (IEDs), military munitions, and accidental detonation of chemical or petroleum stores. These injuries disproportionately affect people in low- and middle-income countries (LMICs), where there are often fewer resources to manage complex injuries and mass-casualty events.
Study Objective:
The aim of this systematic review is to describe the literature on the acute facility-based management of blast injuries in LMICs to aid hospitals and organizations preparing to respond to conflict- and non-conflict-related blast events.
Methods:
A search of Ovid MEDLINE, Scopus, Global Index Medicus, Web of Science, CINAHL, and Cochrane databases was used to identify relevant citations from January 1998 through July 2024. This systematic review was conducted in adherence with PRISMA guidelines. Data were extracted and analyzed descriptively. A meta-analysis calculated the pooled proportions of mortality, hospital admission, intensive care unit (ICU) admission, intubation and mechanical ventilation, and emergency surgery.
Results:
Reviewers screened 3,731 titles and abstracts and 173 full texts. Seventy-five articles from 22 countries were included for analysis. Only 14.7% of included articles came from low-income countries (LICs). Sixty percent of studies were conducted in tertiary care hospitals. The mean proportion of patients who were admitted was 52.1% (95% CI, 0.376 to 0.664). Among all in-patients, 20.0% (95% CI, 0.124 to 0.288) were admitted to an ICU. Overall, 38.0% (95% CI, 0.256 to 0.513) of in-patients underwent emergency surgery and 13.8% (95% CI, 0.023 to 0.315) were intubated. Pooled in-patient mortality was 9.5% (95% CI, 0.046 to 0.156) and total hospital mortality (including emergency department [ED] mortality) was 7.4% (95% CI, 0.034 to 0.124). There were no significant differences in mortality when stratified by country income level or hospital setting.
Conclusion:
Findings from this systematic review can be used to guide preparedness and resource allocation for acute care facilities. Pooled proportions for mortality and other outcomes described in the meta-analysis offer a metric by which future researchers can assess the impact of blast events. Under-representation of LICs and non-tertiary care medical facilities and significant heterogeneity in data reporting among published studies limited the analysis.
The jet from a model-scale, internally mixed nozzle produced a loud howling when operated at jet Mach numbers between 0.80 and 1.00. Discrete tones dominated the noise radiated to the far field and powerful oscillations were present in the jet. To explain these observations, this paper leverages a blend of experimental acoustic and flow measurements and modal analyses thereof via the spectral proper orthogonal decomposition, computational fluid dynamics simulations and local, linear stability analyses of vortex-sheet models for the flow inside the nozzle. This blend of experiments, computations and theory makes clear the cause of the howling, what sets its characteristic frequency and how it may be suppressed. The flow around a small-radius, convex bend just upstream of the final-nozzle exit led to a pocket of locally supersonic flow that was terminated by a shock. The shock was strong enough to separate the boundary layer, but neither the attached nor separated states were stable. A periodic, shock-induced separation of the boundary layer resulted, and this shock-wave/boundary-layer interaction coupled with a natural acoustic mode of the nozzle’s interior in a feedback phenomenon of sorts. Acoustic tones and large flow oscillations were produced at the associated natural frequency of the nozzle’s interior.
Ventricular tachycardia is a rare condition in the fetus and neonate with a paucity of data regarding the management and outcomes.
Methods:
We reviewed the clinical histories, associated CHD and syndromes, diagnostic investigations, management strategies, and outcomes for all fetuses and neonates with ventricular tachycardia encountered between 2005 and 2020.
Results:
Five fetal and 8 neonatal cases of ventricular tachycardia were encountered. Two (40%) fetal cases, compared to 5 (62%) neonatal cases had CHD (p = 0.59), and only 1 fetus had cardiomyopathy with findings suggesting restriction before ventricular tachycardia onset. The median age at ventricular tachycardia presentation was 32 (26–37) weeks for fetal and 11 (1–27) days for neonatal cases. Of the fetal cases, 2 were initially treated trans-placentally with propranolol and 2 with amiodarone. Two fetuses (40%) had ventricular tachycardia suppression prenatally that recurred during the neonatal period necessitating propranolol therapy, 2 (40%) had resolution before birth with no postnatal recurrence, and the cardiomyopathy case never achieved full control, developed hydrops and demised. Of the neonatal cases, 4 received intravenous antiarrhythmics on admission: 3 amiodarone and 1 esmolol, and 2 of these were converted to propranolol and 2 to sotalol. Three other neonates initially received propranolol, with 1 discharged on propranolol, 1 on sotalol, and 1 on mexiletine after failed propranolol and sotalol treatment. The 8th neonate was discharged on no medication.
Conclusion:
Most fetal and neonatal ventricular tachycardia is manageable with pharmacologic therapy. Given its rarity, larger studies are needed to identify optimal management strategies.
Nonlinear dynamical systems often allow for multiple statistically stationary states for the same values of the control parameters. Herein, we introduce a framework that selectively eliminates specific nonlinear triad interactions, thereby suppressing emergence of a particular state, and enabling the emergence of another. The methodology is applied to yield the multiple convection-roll states in two-dimensional planar Rayleigh–Bénard convection (e.g. Wang et al., 2020, Phys. Rev. Lett., vol. 125, 074501) in the turbulent regime. The intrusive framework presented here is based on the observation that the characteristic wavenumber associated with the mean horizontal size of the convection rolls mediates triadic scale interactions resulting in both kinetic energy and temperature variance cascades that are dominant energy transfer processes in a statistically stationary state. Suppression of these cascades mediated by a candidate wavenumber hinders the formation of the convection rolls at that wavenumber. Consequently, convection rolls are formed at another candidate wavenumber which is allowed to mediate energy to establish the cascade processes. In case no stable convection-roll states are possible, this technique does not tend to yield any convection rolls, making it a suitable method for discovering multiple states. Whereas in previous investigations the signature of different states in the initial condition in simulations yielded the multiple states, the present method alleviates such dependence of the emergence of multiple states on initial conditions. It is also demonstrated that accurate predictions of statistical quantities, such as Nusselt number and volume-averaged Reynolds numbers, can also be obtained using this method. The convection-roll states yielded using this technique may be used as initial conditions for direct simulations quickly converging to the target roll state without taking long convergence routes involving state transitions. Additionally, because only one state can possibly emerge in each simulation, this technique can empirically designate each of the multiple states with respect to their stability.
This study is the first to investigate the intra- and interspecific differences in otolith’s length (Lo), width (Wo), perimeter (Po), area (Ao), and mass asymmetry (OMA) in the pelagic Ethmalosa fimbriata, demersal Galeoides decadactylus, and benthic Cynoglossus monodi collected from the Lebe fishing site located along the Komo Estuary, central-western Gabon. The objectives were to (1) verify whether or not otolith morphometry differs in relation to living depth levels of the three species, (2) examine fluctuating asymmetry (FA) in the otolith morphometry, and (3) assess the relationship between OMA and total length (TL). A significant asymmetry was found in Lo, Wo, Po, and Ao between the left and right otoliths within and among males and females at the intraspecific level and only in Wo and Ao at the interspecific level due to FA. At the intraspecies level, a significant OMA was only observed within females of G. decadactylus and C. monodi and males and females of E. fimbriata and C. monodi. Moreover, a significant relationship between OMA and TL was detected only among males and females within the pelagic E. fimbriata and the demersal G. decadactylus, and no significant relationship was found at the interspecific level. As a result, significant differences in Wo and Ao and non-significant differences in OMA were recorded between the three species based on variations in living depth levels. These results highlight the importance of using otolith morphometry and OMA analyses to address the relationship between fish species and their living depth levels.
An Arabic-language tract crafted in in Makhachkala in 1949 offered an abrasive critique of ‘Alī al-Ghumuqī (1878–1943), ostensibly the father of the Dagestani modernist milieu (al-firqa al-jadidiyya). Who was ‘Alī al-Ghumuqī, what was his oeuvre, and why did the most prominent ulama of Dagestan despise him to the extent of publishing an original pamphlet cursing his legacy? In this article we set out to answer these questions and attempt to show that at the beginning of the Soviet century, the North Caucasus represented an important conduit for the circulation and further refinement of Islamic scholarship. We contend that the absorption and reproduction of modernist thinking among Dagestani ulama was not halted by the October Revolution and the Bolsheviks’ takeover. Indeed, we set out to show that in the North Caucasus between the 1920s and the 1960s, scholars continued to cultivate interest in Islamic jurisprudence, in fact unencumbered by the secularist policies adopted by the Soviet state. As we shall see, in this environment ‘Alī al-Ghumuqī morphed into what could be termed an epic figure and became so popular as to personify either the virtues or the evil aspects of modernist Islam.
Auditory-based illusions and effects are fascinating fields for both psychoacoustic research and sound installations. While such illusions and effects are usually researched in isolated scientific studies, they can also be applied as compositional tools in sound installations. This article addresses the suspenseful connection between psychoacoustic research and sound installations. After defining terms relevant to auditory-based illusions and effects, various aspects of sound installations are described. In that light, auditory-based illusions and effects are described and categorised and examples are provided for their scientific investigation by means of references to key experiments. Further, examples of applications are included that showcase the use of auditory-based illusions and effects in compositions and sound installations. Finally, in order to foster future artistic applications, the connections between illusions and effects are visualised, and sound-installation aspects are provided in a table. Such a combined consideration of psychoacoustic fundamentals and sound-installation aspects aims not only at deepening the methodological knowledge of sound artists, but also inspiring innovative compositional perspectives.
We study monitoring and enforcement for environmental compliance in the context of a transitional economy. We estimate the factors correlated with inspections carried out by the Chilean Superintendence of Environment, the imposition of fines to detected violators and the compliance behaviour of regulated facilities. The analysis considers 6,670 facilities from different economic sectors between 2013 and 2019. We find evidence of targeted monitoring and enforcement actions based on past facilities’ behaviour and individual specific characteristics. The size of the implemented fines on detected violators correlates positively with the severity and recurrence of the violation and larger fines are imposed on facilities in the energy and mining sector. We also find that the imposition of fines is transmitted as a spillover effect on the compliance behaviour of facilities sharing the same firm owner. We discuss the policy implications for improving monitoring and enforcement strategies under budget constraints.
The moderating roles of friendship and contextual variables on associations between social withdrawal and peer exclusion and growth curves of depressed affect were studied with a three-wave multilevel longitudinal design. Participants were 313 boys and girls aged 10–12 from Canada (n = 139), mostly of European and North African descent, and Colombia (n = 174), mostly mestizo, afrocolombian, and European descent. Depressed affect, peer exclusion, social withdrawal and friendship were assessed with peer-reports, and collectivism and individualism with self-reports. Group-level scores included gender, place and means of social withdrawal, peer exclusion, friendship, collectivism and individualism for each child’s same-gender classroom peer-group. Results indicated that being friended weakened associations between peer exclusion and social withdrawal and depressed affect. The strength of this effect varied across peer-group contexts.
We initiate a study of large deviations for block model random graphs in the dense regime. Following [14], we establish an LDP for dense block models, viewed as random graphons. As an application of our result, we study upper tail large deviations for homomorphism densities of regular graphs. We identify the existence of a ‘symmetric’ phase, where the graph, conditioned on the rare event, looks like a block model with the same block sizes as the generating graphon. In specific examples, we also identify the existence of a ‘symmetry breaking’ regime, where the conditional structure is not a block model with compatible dimensions. This identifies a ‘reentrant phase transition’ phenomenon for this problem – analogous to one established for Erdős–Rényi random graphs [13, 14]. Finally, extending the analysis of [34], we identify the precise boundary between the symmetry and symmetry breaking regimes for homomorphism densities of regular graphs and the operator norm on Erdős–Rényi bipartite graphs.
This article provides a brief introduction (or recapitulation) of what variable types are and how the choice of the variable type may affect which research questions can be answered and the data analysis. The nine-item Patient Health Questionnaire and a simulated data-set are used as an illustration throughout.
A graph $H$ is said to be common if the number of monochromatic labelled copies of $H$ in a red/blue edge colouring of a large complete graph is asymptotically minimised by a random colouring in which each edge is equally likely to be red or blue. We extend this notion to an off-diagonal setting. That is, we define a pair $(H_1,H_2)$ of graphs to be $(p,1-p)$-common if a particular linear combination of the density of $H_1$ in red and $H_2$ in blue is asymptotically minimised by a random colouring in which each edge is coloured red with probability $p$ and blue with probability $1-p$. Our results include off-diagonal extensions of several standard theorems on common graphs and novel results for common pairs of graphs with no natural analogue in the classical setting.
During World War II, Disney films on Nazism, health, and United States–Latin American friendship flickered across screens throughout Latin America. They were the centerpiece of an unprecedented propaganda program by the United States, and they were shown to Latin Americans both in theaters and through mobile projectors by the Office of Inter-American Affairs (OIAA). While the OIAA and the Disney films have received considerable scholarly attention, the complex collaboration between the government organization, communication scientists, the animation film studio, and local actors in creating, distributing, and measuring propaganda has not. With the goal of creating favorable attitudes toward the United States in the minds of individual Latin Americans, the OIAA and Disney developed a novel propaganda approach based on entertainment and education. They coupled it with a comprehensive distribution system based on local projectionists who showed the films to millions of Latin Americans and measured their reactions. Local governments allowed and supported these free screenings to bolster their own popularity. Latin American voices to criticize the US instrumentalization of Disney were few, and the overall reception of the films was very positive. On the basis of an inadequate evaluation that equated popularity and reach with effect, the Disney films were considered successful propaganda by the OIAA, paving the way for a global application of the new propaganda approach. Disney propaganda for Latin America was driven by the involved actor’s unbounded faith in film’s suitability for propaganda and must thus be understood as a hype around the untapped potential of a relatively new medium.
This article raises some questions about the intuitionist response to skepticism developed by Michael Bergmann in Radical Skepticism and Epistemic Intuition, with a focus on Bergmann’s contention that epistemic intuitions serve as justifying evidence in support of anti-skepticism. It raises three main concerns: that an intuitionist conception of evidence is overly narrow, that it has undesirable implications for cases of disagreement, and that the evidential role that epistemic intuitions play in Bergmann’s version of anti-skepticism undercuts his claim that an intuitionist particularist response to skepticism is superior to disjunctivist responses.
The rise of judicial populism in various national jurisdictions is usually explained through the vicissitudes of power conflicts between the judiciary and other governmental organs. In this article, I try to locate the origins of India’s well-known judicial populism in the peculiarities of Indian constitutional design itself. I argue that the heavily statist nature of India’s transformative constitutionalism, specifically its “Directive Principles of State Policy,” has made the practice of classical judicial review increasingly untenable and provided the grammar for its judicial populism. Directive Principles add another layer of complexity to the “counter-majoritarian difficulty” in India, forcing the constitutional courts to traverse increasingly unconventional territory to legitimise their role. It helps explain why the famously powerful Indian judiciary has failed to act as an institutional check to the crisis of constitutionalism well underway in India. The article provides a stark example of the normative challenges faced by a constitutional court in a transformative constitution.
We prove the coherence of multiplier submodule sheaves associated with Griffiths semi-positive singular hermitian metrics over holomorphic vector bundles on complex manifolds which have no nontrivial subvarieties, such as generic complex tori.