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The National Institute for Health and Care Research has enabled the integration of world-leading science with clinical practice in the UK’s National Health Service, and has saved lives and improved lives as a result. However, this integration has not extended to mental health services. The case is made for a National Institute for Mental Health Research (NIMHR) to address this inequity.
Triage is an essential process used to adequately allocate resources and thus increase chances of survival in case of mass-casualty incidents (MCIs). Several triage scales are currently used, but data regarding their performance remain scarce. The objective was to compare the performance of two prehospital triage algorithms (Sieve versus SwissPre) using a validated physiological simulator.
Methods:
This was a web-based, randomized open-label study. A real-time evolutive simulator based on a heart-lung-brain interaction model embedding functional blocks was used to simulate the evolution of vital parameters. Participants, who were randomly allocated to either algorithm, were asked to triage 30 patients in random order. The primary outcome was the triage score (each correct decision was awarded one point). The “Immediate patients” were defined as those who would die within the first hour according to the physiological model. The secondary outcome was the duration of patient triage.
Results:
Out of 71 participants, 67 (94.4%) were included in the final analysis. The Sieve group achieved a mean score of 17.1 out of 30 (95%CI, 16.3 to 17.8). The SwissPre group scored 15.5 out of 30 (95%CI, 14.5 to 16.5). The mean difference between groups was 1.6 points (95%CI, 0.4 to 2.8; P = .011) in favor of the Sieve algorithm. Triage duration did not differ significantly between the Sieve (mean 43 minutes, SD = 10) and SwissPre (mean 46 minutes, SD = 23) groups, with a mean difference of three minutes (95%CI, −12 to 6; P = .507).
Conclusions:
The simpler Sieve algorithm may slightly outperform the more complex SwissPre in accurately categorizing critically injured patients who would likely die within 60 minutes if left untreated. No significant difference was observed in triage speed. However, these exploratory findings should be interpreted cautiously, considering the mean difference was modest and the controlled simulated setting, limiting generalizability.
In the early 1980s, a group of radical African economists working at the Dakar-based Institut Africain de Développement Economique et de Planification (IDEP) were dismissed. Among them were three Ghanaian economists, Tony Obeng, Cadman Atta Mills, and Kwame Amoa, who applied a neocolonial analysis of global political economy to critique international development policies. Although the precise circumstances of their dismissal remain unclear, it was evident that their revolutionary approach to development clashed fundamentally with IDEP’s methods. Inspired by Ghanaian President Kwame Nkrumah’s theory of neocolonialism and the Latin American school of dependency theory, these Pan-African scholars refuted the dominant, anti-political, dehistorical, and simplistic Western explanation of Africa’s underdevelopment and urgently searched for better explanations. Drawing on institutional records, working papers, interviews, memos, and published and unpublished papers, this article centers Africans and African institutions engaged in development thinking in the larger history of economic thought in the 1970s and 1980s.
Fix integers $r \ge 2$ and $1\le s_1\le \cdots \le s_{r-1}\le t$ and set $s=\prod _{i=1}^{r-1}s_i$. Let $K=K(s_1, \ldots , s_{r-1}, t)$ denote the complete $r$-partite $r$-uniform hypergraph with parts of size $s_1, \ldots , s_{r-1}, t$. We prove that the Zarankiewicz number $z(n, K)= n^{r-1/s-o(1)}$ provided $t\gt 3^{s+o(s)}$. Previously this was known only for $t \gt ((r-1)(s-1))!$ due to Pohoata and Zakharov. Our novel approach, which uses Behrend’s construction of sets with no 3-term arithmetic progression, also applies for small values of $s_i$, for example, it gives $z(n, K(2,2,7))=n^{11/4-o(1)}$ where the exponent 11/4 is optimal, whereas previously this was only known with 7 replaced by 721.
We study stationary distributions in the context of stochastic reaction networks. In particular, we are interested in complex balanced reaction networks and the reduction of such networks by assuming that a set of species (called non-interacting species) are degraded fast (and therefore essentially absent from the network), implying that some reaction rates are large relative to others. Technically, we assume that these reaction rates are scaled by a common parameter N and let $N\to\infty$. The limiting stationary distribution as $N\to\infty$ is compared with the stationary distribution of the reduced reaction network obtained by elimination of the non-interacting species. In general, the limiting stationary distribution could differ from the stationary distribution of the reduced reaction network. We identify various sufficient conditions under which these two distributions are the same, including when the reaction network is detailed balanced and when the set of non-interacting species consists of intermediate species. In the latter case, the limiting stationary distribution essentially retains the form of the complex balanced distribution. This finding is particularly surprising given that the reduced reaction network could be non-weakly reversible and might exhibit unconventional kinetics.
Autonomy theories of contract are influential and have many attractions, not least their compatibility with liberal ideals. However, such theories cannot account for basic features of the common law of contract, in particular: the role of established transaction types, the doctrine of consideration and the phenomenon of contractual obligation. An exchange theory of contract can account for those features of the law. This theory’s liberal credentials can be established by connecting it to an alternative intellectual strand in the liberal tradition, sometimes known as commercial liberalism.
Gas turbine maintenance strategy relies heavily on accurate estimation of critical component life consumption of gas turbine engines during their operations. The equivalent operating hours (EOH) is a useful concept to measure the engine life consumption and support condition-based maintenance planning for gas turbine engines and their critical components. However, the current EOH calculation methods are mostly empirical and engine-specific, relying on vast operating data and experience. This paper introduces a novel physics-based method to estimate the EOH of the high-pressure turbine rotor blades of a gas turbine engine based on the damages caused by creep and low-cycle fatigue (creep-LCF) interactions. The method has been applied to a typical turbofan engine taking both 440-minute long-haul flight at one flight per day and 60-minute short-haul flight at two flights per day. A comparison of the predicted damages and life consumptions indicates that the creep EOH and also the creep damage of the engine of the short-haul aircraft is about 1.38 times that of the engine of the long-haul aircraft, the LCF equivalent operating cycles (EOC) and also the LCF damage of the engine of the short-haul aircraft is about 2.0 times that of the engine of the long-haul aircraft, and the total damages are more affected by the creep damage than the LCF damage with the creep damage being 6.78 times the LCF damage for the engine of the short-haul aircraft and 9.81 times for the engine of the long-haul aircraft. In addition, the total EOH or the total damage of the engine of the short-haul aircraft is about 1.44 times that of the engine of the long-haul aircraft. The proposed method shows a great potential to provide a quick estimate of the life consumption of gas turbine engines for condition monitoring, and it can be applied to other types of gas turbine engines.
The money exchange model is a type of agent-based model used to study how wealth distribution and inequality evolve through monetary exchanges between individuals. The primary focus of this model is to identify the limiting wealth distributions that emerge at the macroscopic level, given the microscopic rules governing the exchanges among agents. In this paper, we formulate generalized versions of the immediate exchange model, the uniform reshuffling model, and the uniform saving model, all of which are types of money exchange model, as discrete-time interacting particle systems and characterize their stationary distributions. Furthermore, we prove that, under appropriate scaling, the asymptotic wealth distribution converges to an exponential distribution for the uniform reshuffling model, and to either an exponential distribution or a gamma distribution depending on the tail behavior of the number of coins given/saved in the immediate exchange model and the random saving model, which generalizes the uniform saving model. In particular, our results provide a mathematically rigorous formulation and generalization of the assertions previously predicted in studies based on numerical simulations and heuristic arguments.
Persistent ductus venosus is an extremely rare disease that causes liver failure, hypoxaemia, and encephalopathy. We report the successful treatment of our patient with elevated transaminase and ammonia levels due to patent ductus venosus, diagnosed in the neonatal period and treated with a vascular plug device.
To compare verbal memory encoding, storage, and retrieval in patients with schizophrenia (SZ), SZ plus substance use disorder (SZ+), and substance use disorder only (SUD), testing the hypothesis that SZ + group exhibits greater impairment across all processes.
Methods:
A total of 294 male patients under treatment (SZ = 72, SZ+ = 72, SUD = 150) meeting DSM-5 criteria completed the Rey Auditory Verbal Learning Test (RAVLT). RAVLT measures assessed encoding, storage, and retrieval. ANCOVA/MANCOVA, controlling for premorbid IQ, were used to explore group differences.
Results:
Significant differences among groups were observed in all RAVLT measures (F(2,291) > 9.25, p < 0.001, ηp2 > 0.06) except retrieval. Post hoc analyses revealed that both SZ and SZ+ groups showed significant verbal memory impairments (learning trials and storage, interference, short and long-term recall and recognition) compared to the SUD group which performed within the normative range. The SZ and SZ+ groups showed altered values (Z ≥ −1.5) from the second learning trial onward and total learning, and the SZ+ group also for long-term recall and recognition.
Conclusions:
This study confirms the existence of significant verbal memory deficits in both SZ and SZ+ groups compared to SUD. Verbal memory impairment appears as a central feature of SZ spectrum disorders, irrespective of SUD comorbidity. Exacerbated memory impairment in SZ+ compared to SZ on the RAVLT is subtle without reaching significant differences, although consideration of altered Z-scores suggests worse performance in SZ+ in encoding and consolidation processes. Further research should explore clinical variables and moderators of comorbidity effects in SZ.
This article addresses the question of experiential dimensions of space in sound, in electroacoustic music and sound arts practices in particular. We suggest that these practices are limited by the generalised way that spatial audio techniques are communicated, and we attempt to develop a tentative method that would enable discussion and sharing of spatial aspects in sonic environments. These modes of articulation would permit a translation of the experience of space in sound into other modalities. Reporting from a series of workshops, we outline a three-phase method that moves through the stages of listening, describing, recreating and imagining the sonic spaces. In the final stage, a speculative design approach shows that shared sonic spatial experiences are essentially relational. Topics relating to expectations, biases and language – such as memory and imagination – and the methods of mapping and speculative design are addressed in the discussion. Through the explorations presented in this article it becomes evident that different artistic musical practices still show the same need to develop articulations that enable the integration and communication of spatial relationships. The divide between the development of new technologies for spatial audio and the conceptual frameworks for understanding and communicating spatial sonic knowledge can be bridged, and eventually the development of spatial audio should be fuelled by the dynamics between these two poles.
To investigate the advantages and disadvantages of two multi-swirl fuel-rich dome configurations, namely the triple-swirler and double-swirler, for a novel high-temperature rise centre-staged combustor, this study employed ANSYS Fluent software. Utilising the Reynolds-averaged Navier-Stokes (RANS) equation as the governing equation, three-dimensional numerical simulations were conducted using the Realisable k-ε turbulence model and non-premixed probability density function (PDF) combustion model to analyse the flow and combustion characteristics of both configurations. A comparative study was then performed to evaluate the performance differences between the two dome configurations under take-off and idle conditions. The results demonstrate that, under both conditions, the fuel-air mixing in the triple-swirler combustor occurs faster and more uniformly. Specifically, during takeoff, the primary zone temperature distribution in the triple-swirler combustor is more uniform, while during idle, the fuel-rich combustion region is more symmetrical. Furthermore, across both conditions, the outlet temperature distribution of the triple-swirler combustor is of superior quality, albeit with equivalent combustion efficiency. Notably, the formation of NOx and soot in the triple-swirler combustor, during takeoff conditions, exceeds that of the double-stage combustor along the flow path, whereas the generation of CO and UHC, during idle conditions, is lower in the former.
Maritime safety faces growing challenges due to an expanding global fleet, tighter schedules, and increasingly complex stakeholder interactions. This study integrates multiple data sources to determine a more accurate representation of major marine accident causative factors in the United Kingdom. Logistic regression and data modelling are applied to Automatic Identification System data (2011–2017) and reported accidents from the Marine Accident Investigation Branch (2013–2019). Results show that larger vessels, daytime transits, service ships, winter conditions, and confined high-density areas such as ports impact accident likelihood. Interviews validate the data and emphasize the influence of port geometry and channel complexity. Among major UK ports, London, Plymouth and Milford Haven exhibit the highest accident-to-traffic densities. While maritime regulations and safety management systems in ports and vessels are seen as adequate by industry professionals, human factors require the greatest attention to improve maritime safety.
Spatial neglect is a heterogeneous post-stroke disorder with subtypes differing in reference frames, processing stages, and spatial domains. While egocentric peri-personal neglect recovery has been studied, recovery trajectories of allocentric peri-personal visuospatial and personal neglect remain unclear. This study investigated recovery time courses of egocentric and allocentric peri-personal visuospatial and personal neglect during the first 12 weeks post-stroke; whether initial severity predicts recovery and defines distinct patient clusters; and how subtypes interrelate over time.
Method:
Forty-one first-ever stroke patients were evaluated at weeks 3, 5, 8, and 12 post-stroke using the Broken Hearts Test, Line Bisection Test, Visuospatial Search Time Test, and Fluff Test. Recovery was analyzed using linear mixed models, clustering with Gaussian finite mixture models, and interrelationships using Spearman correlations.
Results:
Significant improvements occurred in egocentric and allocentric peri-personal visuospatial and personal neglect, primarily between weeks 3 and 5, followed by a plateau. The Line Bisection Test detected no changes. Higher initial severity predicted greater residual impairment. Cluster analysis identified near-normal, mild, and moderate-to-severe baseline subgroups with distinct recovery trajectories. Moderate-to-good correlations (ρ = 0.33 – 0.55) emerged between egocentric and allocentric neglect at week 3 and when timepoints were pooled.
Conclusion:
Neglect improved mainly between weeks 3 and 5 after which recovery plateaued, mirroring motor and language recovery and suggesting a shared time-limited window. Initial severity was a determinant of recovery, highlighting the value of early severity stratification to monitor and support recovery potential after stroke. As subtypes are distinctive, assessment should include multiple neglect tests.