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Background: Information is needed regarding the complex relationships between long-term functional outcomes and health-related quality of life (HRQoL) in Hirschsprung's Disease (HSCR). We describe longterm outcomes across multiple domains, completing a core outcome set through to adulthood. Methods: HSCR patients operated at a single center over a 35-year period (1978-2013) were studied. Patients completed detailed questionnaires on bowel and urologic function, and HRQOL. Patients with learning disability (LD) were excluded. Outcomes were compared to normative data. Data are reported as median [IQR] or mean (SD). Results: 186 patients (median age 28 [18-32] years; 135 males) completed surveys. Bowel function was reduced (BFS 17 [14-19] vs. 19 [19-20], p < 0.0001;eta(2) = 0.22). Prevalence and severity of fecal soiling and fecal awareness improved with age ( p < 0.05 for both). Urinary incontinence was more frequent than controls, most of all in 13-26y females (65% vs. 31%, p = 0.003). In adults, this correlated independently with constipation symptoms (OR 3.18 [1.4-7.5], p = 0.008). HRQoL outcomes strongly correlated with functional outcome: 42% of children demonstrated clinically significant reductions in overall PedsQL score, and poor bowel outcome was strongly associated with impaired QOL (B = 22.7 [12.7- 32.7], p < 0.001). In adults, GIQLI scores were more often impacted in patients with extended segment disease. SF-36 scores were reduced relative to population level data in most domains, with large effect sizes noted for females in General Health (g = 1.19) and Social Wellbeing (g = 0.8). Conclusion: Functional impairment is common after pull-through, but bowel function improves with age. Clustering of poor functional outcomes across multiple domains identifies a need for early recognition and long-term support for these patients. (C) 2021 Elsevier Inc. All rights reserved.

The solution to many engineering problems is obtained through the combination of analytical, computational and experimental methods. In many cases, cost or size constraints limit testing of full-scale articles. Similitude allows observations made in the laboratory to be used to extrapolate the behavior to full-scale system by establishing relationships between the results obtained in a scaled experiment and those anticipated for the full-scale prototype. This paper describes the application of the Buckingham Pi theorem to develop a set of non-dimensional parameters that are appropriate for describing the problem of a distributed load applied to the rostrum of the paddlefish. This problem is of interest because previous research has demonstrated that the rostrum is a very efficient structural system. The ultimate goal is to estimate the response of a complex, bio-inspired structure based on the rostrum to blast load. The derived similitude laws are verified through a series of numerical experiments having a maximum error of 3.39%.

This study describes functional and health-related quality of life (HRQoL) outcomes in patients with Hirschsprung’s disease (HSCR) with associated learning disability or neurodevelopmental delay (LD), completing a core outcome set for HSCR. This was a cross-sectional study from a tertiary pediatric surgery center. Patients treated between 1977 and 2013 were prospectively contacted to complete an outcomes survey. Children under 12 and older patients with LD were assisted to complete these by a proxy. Bowel and urologic function were assessed (Rintala’s BFS and modified DanPSS) along with HRQoL (PedsQL/GIQLI/SF-36). Thirty-two patients with LD were compared to 186 patients with normal cognition. Patients with LD had 76% survival over the follow-up period, compared to 99% in the remainder of the cohort. Poor functional outcomes were common in the patients with LD, considerably higher than cognitively normal patients: with weekly issues withholding stool, soiling and fecal accidents in over half of patients surveyed (44–60%), and urinary incontinence in 46%. Use of permanent stoma was significantly higher (22% vs. 4%; p = 0.001). HRQoL was worse in domains of physical functioning in adults and children but not for social or emotional domains in adults. Subgroup analysis of patients with Down syndrome suggested similar functional results but better QoL. Multivariate analysis demonstrated a dramatically higher incidence of poor continence outcomes in patients with LD (adjusted OR 9.6 [4.0–23]).Conclusions: We provide LD-specific outcomes showing inferior function but similar HRQoL to other patients with HSCR, this is much needed in the counselling of families of these children. What is Known:• Hirschsprung’s disease is commonly associated with syndromes or other anomalies with resultant cognitive impairments.• The outcomes for these patients specifically have been poorly described in the literature. What is New:• Objective functional and quality of life surveys demonstrate significant differences from patients without cognitive impairment.• Patients with learning disability Patients with associated LD were almost ten times more likely to have an associated poor functional outcome, with very little impact on proxy-reported quality of life.

The objective of this review was to assess the evidence on relaxation training for management of paediatric headaches. Our methodology was a rapid review of English-language peer reviewed published literature focused on studies evaluating relaxation training as a primary or adjunct management option for headache in a paediatric population (0 to 18 years of age). Seven studies involving 571 children were included in the review. The quality of evidence was very low using GRADE criteria. Headache frequency, duration, and intensity were the primary outcomes in the included studies. Results for the effects of relaxation training for paediatric headache are inconsistent. Four of the seven studies reported decreased headache frequency, two of the five studies reported decreased headache duration, and two of the six studies reported decreased headache intensity following relaxation training. No adverse events were reported. The current state of the evidence for relaxation training for management of paediatric headache is both inconsistent and of very low quality. High-quality research evaluating the effects of relaxation training for paediatric headaches is required to advance the field.

Bio-structures have been optimized by nature to possess remarkable resiliency and strength yet retain a light-weight composition. The hierarchical geometrical arrangements that are prevalent in bio-structures, coupled with heterogeneous constituents, present uncertainty as to what dictates the structural response. Although computational mechanics experiments give an overall distribution of stresses in the structural system, the underlying details of the stress flow patterns in the structure are hard to identify. This paper discusses the development of software that integrates the results from computational mechanics experiments with advanced mathematical algorithms to capture the stress distribution in a bio-structure subjected to an external load. A fundamental issue addressed in this work is the procedure used to prepare data in appropriate format for the seamless transition from finite element binary database files to an abstract mathematical domain. The robust, platform-independent procedure developed for this transdisciplinary strategy efficiently handles the large datasets produced by the high performance computational mechanics experiments.

Objectives The challenges of bioscience courses such as anatomy and physiology in nursing education are well documented. Virtual reality has recently become accessible and may support student engagement. The purpose of this project was to describe students’ engagement and experiences with virtual reality in a first-year nursing course on anatomy, physiology, and health assessment. Methods We used a cross-sectional design and collected both quantitative and qualitative data. The Exploratory Learning Model guided our work. Results Students perceived their engagement to be higher in virtual reality compared to other teaching methods. Their experiences were positive with students reporting that they found it easy to use, it helped their learning, and they recommended more of it. Conclusions Virtual reality is an accessible tool for supporting student engagement. The Exploratory Learning Model is a useful conceptualization for integrating virtual reality into a course. Future research on the relationship between virtual reality and learning achievements is warranted.

In this paper, we revisit the Lagrangian accumulation process that aggregates the local attribute information along integral curves for vector field visualization. Similar to the previous work, we adopt the notation of the Lagrangian accumulation field or A field for the representation of the accumulation results. In contrast to the previous work, we provide a more in-depth discussion on the properties of A fields and the meaning of the patterns exhibiting in A fields. In particular, we revisit the discontinuity in the A fields and provide a thorough explanation of its relation to the flow structure and the additional information about the flow that it may reveal. In addition, other remaining questions about the A field, such as its sensitivity to the selection of integration time, are also addressed. Based on these new insights, we demonstrate a number of enhanced flow visualizations aided by the accumulation framework and the A fields, including a new A field guided ribbon placement, an A field guided stream surface seeding and the visualization of particle-based flow data. To further demonstrate the generality of the accumulation framework, we extend it to the non-integral geometric curves (i.e., streak lines), which enable us to reveal information about the flow behavior other than those revealed by the integral curves. Finally, we introduce the Eulerian accumulation, which can reveal different flow behaviors than those revealed by Lagrangian accumulation. In summary, we believe that Lagrangian accumulation and the resulting A fields offer a valuable means to investigate flow behavior complementary to the current state-of-the-art techniques.

BACKGROUND & PURPOSE Personal support workers, licensed practical nurses, and registered nurses are the primary care providers in long-term care. Research reporting on how these professions collaborate in long-term is limited. Understanding how collaboration occurs in long-term care may support and improve the care of residents. The purpose of this paper is to describe how personal support workers, licensed practical nurses, and registered nurses enact interprofessional collaboration in long-term care. RESEARCH DESIGN & METHODS A qualitative descriptive study using individual interviews with personal support workers, licensed practical nurses, and registered nurses working in long-term care (n = 13) was conducted. Data was categorized according to competencies from the Canadian Interprofessional Health Collaborative, National Interprofessional Competency Framework and then themes were identified to describe how collaboration is enacted. FINDINGS Analysis revealed that collaboration occurs according to five competencies (interprofessional communication, collaborative leadership, role clarification, team functioning, and patient-centred care). Four themes are presented: chain of command communication, leadership based on resident condition, (mis)understanding of roles, and respect within team functioning. These themes are presented because they are organizational aspects of collaboration as opposed to individual attributes and are, therefore, more helpful for those charged with supporting or improving collaboration within an organization. CONCLUSION Personal support workers, licensed practical nurses, and registered nurses naturally enact interprofessional collaboration is a manner that closely aligns with the Canadian Interprofessional Health Collaborative, National Interprofessional Competency Framework. Strategies to support and improve collaboration in long-term care should align with these competencies and take into account the nuances between personal support workers, licensed practical nurses, and registered nurses.

The authors explore multi-domain outcomes in a cross-sectional cohort study of patients with Hirschsprung's Disease. They identify hitherto unrecognised issues affecting sexual function and fertility specifically in female patients.

This paper presents a mesh generation strategy that facilitates the numerical simulation of ice accretion on realistic aircraft configurations by automating the deformation of surface and volume meshes in response to the evolving ice shape. The discrete surface evolution algorithm is based on a face-offsetting strategy that uses an eigenvalue decomposition to determine 1) the nodal offset direction and 2) a null space in which the quality of the surface mesh is improved via point redistribution. A fast algebraic technique is then used to propagate the computed surface deformations into the surrounding volume mesh. Due to inherent limitations in the icing model employed here, there is no intent to present a tool to predict three-dimensional ice accretions but, instead, to demonstrate a meshing strategy for surface evolution and mesh deformation that is appropriate for aircraft icing applications. In this context, sample results are presented for a complex glaze-ice accretion on a rectangular-planform wing ...

This paper documents the predictive capability of rotating blade-resolved unsteady Reynolds averaged Navier-Stokes (URANS) and Improved Delayed Detached Eddy Simulation (IDDES) computations for tidal stream turbine performance and intermediate wake characteristics. Ansys/Fluent and OpenFOAM simulations are performed using mixed-cell, unstructured grids consisting of up to 11 million cells. The thrust, power and intermediate wake predictions compare reasonably well within 10% of the experimental data. For the wake predictions, OpenFOAM performs better than Ansys/Fluent, and IDDES better than URANS when the resolved turbulence is triggered. The primary limitation of the simulations is under prediction of the wake diffusion towards the turbine axis, which in return is related to the prediction of turbulence in the tip-vortex shear layer. The shear-layer involves anisotropic turbulent structures, thus, hybrid RANS/LES models, such as IDDES, are preferred over URANS. Unfortunately, IDDES fails to accurately predict the resolved turbulence in the near-wake region due to the modeled stress depletion issue.

A key design factor impacting the use of electrical power to drive aircraft systems and subsystems is energy efficiency. With the design of an all-electric, hybrid ice protection system, energy consumption can be reduced to a large extent. The hybridization is achieved through an intentional partitioning of the ice at the stagnation line by melting via surface heating and ice shedding in the unheated regions of the airfoil surface via an electromechanical deicing system based on piezoelectric multilayer actuators. To further reduce energy consumption, the adhesion forces between the ice and the airfoil surface can be reduced using an ultrasmooth, nanostructured surface with water- and ice-repellent properties that encourages ice shedding. Experimental investigations, performed in a laboratory-scale icing wind tunnel for a small-scale configuration, reveal that the hybrid approach for ice protection reliably sheds the ice accreted on the airfoil surface. Compared with an all-thermoelectric system for ice p...

To study ice adhesion at the droplet scale, a strategy is presented to simulate the impact and solidification of a supercooled water droplet on a cooled substrate. Upon impact, nucleation is assumed to occur instantaneously, and properties of the droplet are chosen to account for the nucleation process. Simulations are performed in ANSYS Fluent using a coupled volume-of-fluid and level-set method to capture the air–water interface, and an enthalpy-porosity method is used to capture the liquid–solid interface. Calibration of a simulation parameter Amush is performed in order to match experimental data for different ideal surface types and surface temperatures. The simulation strategy successfully predicts the overall droplet response for several droplet impact conditions.

This study evaluates the feasibility of applying a newly developed dynamic hybrid Reynolds-averaged Navier–Stokes/large-eddy simulation modeling framework to predict the massively separated flow around a GLC-305 airfoil with a 22.5 min leading-edge glaze ice accretion. Three-dimensional numerical simulations were performed at Re=3.5×106, M=0.12, and α=6 deg. Comparisons were made between experimental data and simulation results computed using two Reynolds-averaged Navier–Stokes models (Menter’s shear stress transport k-ω and Spalart–Allmaras) and two hybrid Reynolds-averaged Navier–Stokes/large-eddy simulation models (delayed detached-eddy simulation and the dynamic hybrid Reynolds-averaged Navier–Stokes/large-eddy simulation model). All models overpredicted the mean wall static pressures on the suction surface. Wall pressure predictions obtained using the Reynolds-averaged Navier–Stokes and dynamic hybrid Reynolds-averaged Navier–Stokes/large-eddy simulation models exhibited qualitatively better agreeme...

In Computational aeroacoustics, hybrid approaches first resolve the source and nearfield regions of the flow field by employing Reynolds Averaged Navier-Stokes (RANS) equations, Large Eddy Simulations (LES) or Direct Numerical Simulations (DNS). The source region data is used to form source terms, which are, in turn, applied to either empirical models or equations linearized around a mean flow. An acoustic analogy type of model is used to propagate the acoustics to the farfield regions. The aim of this research is two-fold: to introduce and test a hybrid acoustic analogy, based on a coupling between the Navier-Stokes equations, applied in the source region, and the Non-linear Euler (NLE) equations applied in the acoustic propagation region; and to test and validate a recently derived generalized acoustic analogy theory in the framework of jet noise with acoustic source information obtained from RANS or LES. In the first part, the coupling between the Navier-Stokes and the NLE equations is accomplished via a buffer region, which is used to interpolate and penalize the flow variables of interest from the source region. The penalized flow variables are then applied as source terms in the NLE equations, to calculate the acoustic propagation. The non-linear Euler equations, discretized using high-accurate dispersion-relation preserving schemes constitute a very efficient approach for jet noise predictions in complex environments, especially for supersonic and hypersonic jets, where nonlinearities may propagate over long distances. In the second part, a RANS- or LES-informed model, which is used to provide data for Goldstein's generalized acoustic analogy, is presented. The generalized acoustic analogy of Goldstein is considered, wherein the effects of non-parallelism are taken into account and an asymptotic expansion is utilized to simplify the adjoint Green function equations. The use of the adjoint Green's function leads to a simple model for jet

Altitude training has been shown to alter blood lactate (BL) levels due to alterations resulting from acclimatization. This study aims to estimate the impact of altitude training on BL changes immediately following an incremental treadmill test and during recovery before and after 10-day altitude training at approximately 1828 meters. Eight varsity cross-country runners performed an incremental treadmill test (ITT), pre and post-altitude training. Resting and post-warm-up BL values were recorded. During ITT, heart rate (HR), oxygen saturation (SpO2), and time to exhaustion were monitored. BL was also measured post-ITT at 0, 2, 4, 6, and 8 minutes. The average of all BL values was higher following altitude intervention (8.8 ± 4.6 mmol/L) compared to pre-intervention (7.4 ± 3.3 mmol/L). These differences were statistically significant (t(6) = −2.40, p = .026). BL immediately (0 minutes) after the ITT was higher following the altitude intervention (13.6 ± 3.6 mmol/L) compared to pre-intervention (9.7 ± 3.8 mmol/L) and was statistically significant (t(7) = −3.30, p = .006). Average HR during the ITT was lower following the altitude intervention (176.9 ± 11.1 bpm) compared to pre (187 ± 9.5 bpm), these differences were statistically significant (t(28)= 18.07, p=

Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning and collaboration, (c) experiencing the importance of social connections to interprofessional collaboration and learning, and (d) realisations that interprofessional collaboration is a means of overcoming barriers in rural areas. We discuss our findings using the socio-material perspective of complexity theory. These findings may be used to inform undergraduate programs in re-defining, re-creating, developing, and fostering interprofessional learning opportunities for medical students in rural communities as well as to support clinical faculty through ongoing professional development.

This paper studies the discontinuity in the behavior of neighboring integral curves. The discontinuity is measured by a number of selected attributes of integral curves. A variety of attribute fields are defined. The attribute value at any given spatio-temporal point in these fields is assigned by the attribute of the integral curve that passes through this point. This encodes the global behavior of integral curves into a number of scalar fields in an Eulerian fashion, which differs from the previous pathline attribute approach that focuses on the discrete representation of individual pathlines. With this representation, the discontinuity of the integral curve behavior now corresponds to locations in the derived fields where the attribute values have sharp gradients. We show that based on the selected attributes, the extracted discontinuity from the corresponding attribute fields may relate to a number of flow features, such as LCS, vortices, and cusp-like seeding curves. In addition, we study the correlations among different attributes via their pairwise scatter plots. We also study the behavior of the combined attribute fields to understand the spatial correlation that cannot be revealed by the scatter plots. Finally, we integrate our attribute field computation and their discontinuity detection into an interactive system to guide the exploration of various 2D flows.

Background Nurses are increasingly expected to engage in evidence-informed decision making (EIDM); the use of research evidence with information about patient preferences, clinical context and resources, and their clinical expertise in decision making. Strategies for enhancing EIDM have been synthesized in high-quality systematic reviews, yet most relate to physicians or mixed disciplines. Existing reviews, specific to nursing, have not captured a broad range of strategies for promoting the knowledge and skills for EIDM, patient outcomes as a result of EIDM, or contextual information for why these strategies “work.” Aim To conduct a scoping review to identify and map the literature related to strategies implemented among nurses in tertiary care for promoting EIDM knowledge, skills, and behaviours, as well as patient outcomes and contextual implementation details. Methods A search strategy was developed and executed to identify relevant research evidence. Participants included registered nurses, clinical nurse specialists, nurse practitioners, and advanced practice nurses. Strategies were those enhancing nurses’ EIDM knowledge, skills, or behaviours, as well as patient outcomes. Relevant studies included systematic reviews, randomized controlled trials, cluster randomized controlled trials, non-randomized trials (including controlled before and after studies), cluster non-randomized trials, interrupted time series designs, prospective cohort studies, mixed-method studies, and qualitative studies. Two reviewers performed study selection and data extraction using standardized forms. Disagreements were resolved through discussion or third party adjudication. Results Using a narrative synthesis, the body of research was mapped by design, clinical areas, strategies, and provider and patient outcomes to determine areas appropriate for a systematic review. Conclusions There are a sufficiently high number of studies to conduct a more focused systematic review by care settings, study design, implementation strategies, or outcomes. A focused review could assist in determining which strategies can be recommended for enhancing EIDM knowledge, skills, and behaviours among nurses in tertiary care.

Robust automated vortex detection algorithms are needed to facilitate the exploration of large-scale turbulent fluid flow simulations. Unfortunately, robust non-local vortex detection algorithms are computationally intractable for large data sets and local algorithms, while computationally tractable, lack robustness. We argue that the deficiencies inherent to the local definitions occur because of two fundamental issues: the lack of a rigorous definition of a vortex and the fact that a vortex is an intrinsically non-local phenomenon. As a first step towards addressing this problem, we demonstrate the use of machine learning techniques to enhance the robustness of local vortex detection algorithms. We motivate the presence of an expert-in-the-loop using empirical results based on machine learning techniques. We employ adaptive boosting to combine a suite of widely used, local vortex detection algorithms, which we term weak classifiers, into a robust compound classifier. Fundamentally, the training phase of the algorithm, in which an expert manually labels small, spatially contiguous regions of the data, incorporates non-local information into the resulting compound classifier. We demonstrate the efficacy of our approach by applying the compound classifier to two data sets obtained from computational fluid dynamical simulations. Our results demonstrate that the compound classifier has a reduced misclassification rate relative to the component classifiers.

This work presents a transdisciplinary, integrated approach that uses computational mechanics experiments with a flow network strategy to gain fundamental insights into the stress flow of high-performance, lightweight, structured composites by investigating the rostrum of paddlefish. Although computational mechanics experiments give an overall distribution of stress in the structural systems, stress flow patterns formed at nascent stages of loading a biostructure are hard to determine. Computational mechanics experiments on a complex model will involve a high degree of freedom thereby making the extraction of finer details computationally expensive. To address this challenge, the evolution of the stress in the rostrum is formulated as a network flow problem generated by extracting the node and connectivity information from the numerical model of the rostrum. The flow network is weighted based on the parameter of interest, which is stress in the current research. The changing kinematics of the system is provided as input to the mathematical algorithm that computes the minimum cut of the flow network. The flow network approach is verified using two simple classical problems. When applied to the model of the rostrum, the flow network approach identifies strain localization in tensile regions, and buckling/crushing in compressive regions.

This paper investigates a recently proposed dynamic hybrid RANS-LES framework using a general-purpose finite-volume flow solver. The new method is highly generalized, allowing coupling of any selected RANS model with any selected LES model and containing no explicit grid dependence in its formulation. Selected results are presented for three test cases: two-dimensional channel flow, backward facing step, and a nozzle flow relevant to biomedical applications. Comparison with experimental and DNS data, and with other hybrid RANS-LES approaches, highlights the advantages of the new method and suggests that further investigation is warranted.

Feature-based solution-adaptive mesh refinement is an attractive strategy when it is known a priori that the resolution of certain key features is critical to achieving the objectives of a simulation. In this paper, we apply vortex characterization techniques, which are typically employed to visualize vortices, to identify regions of the computational domain for mesh refinement. We investigate different refinement strategies that are facilitated by these vortex characterization techniques to simulate the flow past a wing in a wind tunnel. Our results, which we compare with experimental data, indicate that it is necessary to refine the region within and near the vortex extent surface to obtain an accurate prediction. Application of the identified mesh refinement strategy also produced observed improvement in the results predicted for a spinning missile with deflected canards.

In this paper, we present a technique for generating solution adaptive meshes that uses feature-aligned surfaces embedded in the computational domain. A feature-detection algorithm is first employed to identify features of interest. Surfaces associated with these features are then meshed, and a volume mesh that respects these embedded surface meshes is then generated. This approach is promising because it provides a mechanism for controlling local grid quality as well as automatically aligning cell faces with the feature. For flows that include topologically and/or geometrically complex features, we describe a mesh refinement technique that can be used in tandem with the embedded surface meshes to provide a mechanism for refining throughout the computational domain. We include results from two cases to illustrate how the method works.

A 68 year old man presented with a two month history of progressive shortness of breath. He had previously been able to swim three times a week, but was now becoming short of breath on climbing stairs. His associated symptoms included orthopnoea, swollen ankles, weight gain, and anorexia. He was being treated with simvastatin for hypercholesterolaemia and diltiazem for hypertension and had never smoked. On examination, he was plethoric, his pulse was regular at 84 beats/min, and his blood pressure was 138/72 mm Hg. Heart sounds were normal and his jugular venous pressure was not raised, although he had pitting oedema to the mid thighs. Findings on respiratory examination included a respiratory rate of 20 breaths/min, with dullness to percussion and associated reduced breath sounds over the right lung base. His abdominal examination was unremarkable. Laboratory tests showed haemoglobin 129 g/L (reference range 130-170), mean cell volume 79.4 fL (80-100), and creatinine 127 μmol/L (80-115). All other blood test results, and an electrocardiogram, were unremarkable. Chest radiography showed mild cardiomegaly and echocardiography showed well preserved left ventricular size and function. As a result, computed tomography with contrast of his chest, abdomen, and pelvis was performed (figure⇓). Reformatted curved coronal section through the abdomen ### 1. What abnormalities can be seen on the computed tomogram? #### Short answer The computed tomogram shows a small renal mass in the right kidney (A) and a large filling defect within a grossly dilated suprarenal inferior vena cava (B). #### Long answer The computed tomogram shows a small renal mass in the right kidney that probably represents a renal cell carcinoma (RCC), and a grossly dilated suprarenal inferior vena cava containing a large heterogeneous mass (tumour thrombus) …

A novel method for efficient and accurate jet noise prediction is developed and tested in the framework of coupled LES and stochastic noise modeling. In the proposed method, the low frequency range of the acoustic spectrum, which corresponds to large turbulent structures, is resolved with an implicit LES model by employing higher-order spatial and temporal discretizations. The high frequency range, which corresponds to the fine-scale turbulence, is modeled via a stochastic broadband noise generation model. The inputs to the stochastic model are represented by statistics from an axisymmetric RANS jet simulation. The smaller synthetic scales are convected by larger scales, accounting for the effects of sweeping from the larger LES-resolved turbulent scales. The farfield acoustic data is obtained using either the Linearized Euler Equations, or an acoustic analogy based on the Ffowcs-Williams Hawkings method. The method is evaluated on cold and heated jets at different Reynolds numbers.

Summary Objectives To estimate trends in infection/colonisation with meticillin-resistant Staphylococcus aureus (MRSA) in an intensive care unit (ICU). Design Observational study of results of ICU admission and weekly screens for MRSA. Setting and Participants All ICU admissions in 2001–2012. Interventions ICU admissions were screened for MRSA throughout. In late 2006, screening was extended to the whole hospital and extra measures taken in ICU. Main outcome measures Prevalence of MRSA in ICU admissions and number acquiring MRSA therein. Results In all, 366 of 6565 admissions to ICU were MRSA positive, including 270 of 4466 coming from within the hospital in which prevalence increased with time prior to transfer to ICU. Prevalence in this group was 9.4% (8.2–10.6) in 2001–2006, decreasing to 3.4% (2.3–4.5) in 2007–2009 and 1.3% (0.6–2.0) in 2010–2012, p 5 days on wards before ICU admission: 18.9% (15.6–22.2) in 2001–2006, 7.1% (4.0–10.2) in 2007–2009 and 1.6% (0.1–3.1) in 2010–2012, p Conclusions Following better hospital-wide infection control, fewer MRSA-positive patients were admitted to ICU with a parallel decrease in acquisition therein. Better practice there reduced the risk of bacteraemia.

During pressure testing of a downhole plugging tool manufactured from a duplex stainless steel forging, a failure occurred that had not been observed in similar development projects. The failure was characterised by surface pinhole formation and cracking associated with a region of high plastic strain. Examination revealed that the defects were associated with areas of σ-phase at the ferrite/austenite phase boundaries local to the centre of the 250 mm diameter forging. Estimation of the cooling rates of the forging during oil quenching showed that the centre region of the forging would not cool at a rate sufficient to exceed the critical cooling rate for σ-phase formation. The material was shown to be capable of withstanding greater levels of plastic strain in regions where no σ-phase existed.

Solution adaptive grid strategies based on the redistribution of a fixed number of points are described in this paper. The redistribution is performed using weight functions that vary based on significant flow features. The weight functions are evaluated using an equidistribution principle. In this paper, emphasis is placed on the development of weight functions applicable to compressible flows exhibiting large scale separated vortical flows, vortex‐vortex and vortex‐surface interactions, separated shear layers and multiple shocks of diAerent intensities. Algebraic, elliptic and parabolic methods of grid generation have been utilized for structured grid redistribution. Additionally, a point movement scheme is presented for generalized (structured/unstructured/hybrid) grid adaptation. Computer Aided Geometry Design (CAGD) techniques are combined with redistribution schemes to maintain the fidelity of solid boundaries. In particular, solid boundaries are represented using Non-Uniform Rational B-Splines (NURBS). A grid generation software system ‐ Parallel Multiblock Adaptive Grid generation (PMAG) ‐ using an elliptic redistribution scheme is also described with emphasis placed on the parallel implementation for multiblock structured grids with unstructured blocking topologies and on interpolation issues. Computational examples demonstrating the influence of diAerent weight functions and grid redistribution strategies are presented. ” 2000 Elsevier Science S.A. All rights reserved.

Robust, automated mesh generation for problems with deforming geometries, such as ice accreting on aerodynamic surfaces, remains a challenging problem. Here we describe a technique to deform a discrete surface as it evolves due to the accretion of ice. The surface evolution algorithm is based on a smoothed, face-offsetting approach. We also describe a fast algebraic technique to propagate the computed surface deformations into the surrounding volume mesh while maintaining geometric mesh quality. Preliminary results presented here demonstrate the ecacy of the approach for a sphere with a prescribed accretion rate, a rime ice accretion, and a more complex glaze ice accretion.

Background Knowledge translation (KT) aims to close the research-practice gap in order to realize and maximize the benefits of research within the practice setting. Previous studies have investigated KT strategies in nursing and medicine; however, the present study is the first systematic review of the effectiveness of a variety of KT interventions in five allied health disciplines: dietetics, occupational therapy, pharmacy, physiotherapy, and speech-language pathology. Methods A health research librarian developed and implemented search strategies in eight electronic databases (MEDLINE, CINAHL, ERIC, PASCAL, EMBASE, IPA, Scopus, CENTRAL) using language (English) and date restrictions (1985 to March 2010). Other relevant sources were manually searched. Two reviewers independently screened the titles and abstracts, reviewed full-text articles, performed data extraction, and performed quality assessment. Within each profession, evidence tables were created, grouping and analyzing data by research design, KT strategy, targeted behaviour, and primary outcome. The published descriptions of the KT interventions were compared to the Workgroup for Intervention Development and Evaluation Research (WIDER) Recommendations to Improve the Reporting of the Content of Behaviour Change Interventions. Results A total of 2,638 articles were located and the titles and abstracts were screened. Of those, 1,172 full-text articles were reviewed and subsequently 32 studies were included in the systematic review. A variety of single (n = 15) and multiple (n = 17) KT interventions were identified, with educational meetings being the predominant KT strategy (n = 11). The majority of primary outcomes were identified as professional/process outcomes (n = 25); however, patient outcomes (n = 4), economic outcomes (n = 2), and multiple primary outcomes (n = 1) were also represented. Generally, the studies were of low methodological quality. Outcome reporting bias was common and precluded clear determination of intervention effectiveness. In the majority of studies, the interventions demonstrated mixed effects on primary outcomes, and only four studies demonstrated statistically significant, positive effects on primary outcomes. None of the studies satisfied the four WIDER Recommendations. Conclusions Across five allied health professions, equivocal results, low methodological quality, and outcome reporting bias limited our ability to recommend one KT strategy over another. Further research employing the WIDER Recommendations is needed to inform the development and implementation of effective KT interventions in allied health.

shock impingement point, it was observed that a reduction in  ow separation behind the shock ensued as a result of weakened shock strength. Conclusions The  owŽ eld inside transonic compressors involves high-level  ow physics and is very sensitive to changes in blade geometry. Therefore, the design of an axial compressor blade requires careful maneuvering through complex nonlinear design space. Numerical optimization is attractive in that constraints can be imposed to prevent ill effectsof a design.Constraints,however, limits designspace, and in the case of an axial compressor blade design, a constraint on inletmass  ow rate takes toomuchspaceaway,makingoptimization extremely difŽ cult to perform. This Note shows that incorporating the constraint into an objective function can improve the design results. Also if needed constraints are related to the objective function in someways, it would be possiblethat they all becomea part of the objective function while discouraging the design process from moving into certain directions. The study also shows that the developed design method can improve the adiabatic efŽ ciency of a blade section signiŽ cantly by reducing the losses from the passage shock and the  ow separation. The design method, however, cannot handle three-dimensional effects because it employs quasi-three-dimensional  ow physics and did not produce desired design results for the blade section near the hub region. To ascertain the signiŽ cance of the quasi-threedimensional design results, constructing and evaluating the performance of three-dimensionalblades based on the designed sections will be conducted in the future. References 1Damle, S., Dang, T., Stringham, J., and Razinsky, E., “Practical Use of 3D Inverse Method for Compressor Blade Design,” American Society of Mechanical Engineers, ASME Paper 98-GT-115, June 1998. 2Wang,Z., Cai, R., Chen, H., and Zhang,D., “A FullyThree-Dimensional Inverse Method for Turbomachinery Blading with Navier–Stokes Equations,” American Society of Mechanical Engineers, ASME Paper 98-GT126, June 1998. 3Sorenson, R. L., “A Computer Program to Generate Two-Dimensional Grids About Airfoils and Other Shapes by Use of Poisson’s Equation,” NASA TM-81198, 1980. 4Chima, R. V., “Explicit Multigrid Algorithm for Quasi-ThreeDimensionalViscous Flows in Turbomachinery,”Journalof Propulsion and Power, Vol. 3, No. 5, 1987, pp. 397–405. 5Wilcox, D. C., “Comparison of Two-Equation Turbulence Models for Boundary Layers with Pressure Gradient,” AIAA Journal, Vol. 31, No. 8, 1993, pp. 1414–1421. 6Katsanis, T., andMcNally,W.D., “Revised FORTRANProgramforCalculating Velocities and Streamlines on the Hub-ShroudMidchannel Stream Surface of an Axial-, Radial-, and Mixed-Flow Turbomachine or Annular Duct, Part I—User’s Manual,” NASA TN D-8430, 1977. 7“DOT User’s Manual,” Ver. 3.00, VMA Engineering,Goleta, CA, 1992. 8Hicks, R. M., and Henne, P. A., “Wing Design by Numerical Optimization,” Journal of Aircraft, Vol. 15, No. 7, 1978, pp. 407–412.

One of the key challenges for computational fluid dynamics (CFD) simulations of human lung airflow is the sheer size and complexity of the complete, multiscale geometry of the bronchopulmonary tree. Since 3-D CFD simulations of the full airway tree are currently intractable, researchers have proposed reduced geometry models in which multiple airway paths are truncated downstream of the first few generations. This paper investigates a recently proposed method for closing the CFD model by application of physiologically correct boundary conditions at truncated outlets. A realistic, reduced geometry model of the lung airway based on CT data has been constructed up to generation 18, including extrathoracic, bronchi, and bronchiole regions. Results indicate that the new method yields reasonable results for pressure drop through the airway, at a small fraction of the cost of fully resolved simulations.

Background Knowledge translation (KT) aims to close the gap between knowledge and practice in order to realize the benefits of research through (a) improved health outcomes, (b) more effective health services and products, and (c) strengthened healthcare systems. While there is some understanding of strategies to put research findings into practice within nursing and medicine, we have limited knowledge of KT strategies in allied health professions. Given the interprofessional nature of healthcare, a lack of guidance for supporting KT strategies in the allied health professions is concerning. Our objective in this study is to systematically review published research on KT strategies in five allied health disciplines. Methods A medical research librarian will develop and implement search strategies designed to identify evidence that is relevant to each question of the review. Two reviewers will perform study selection and quality assessment using standard forms. For study selection, data will be extracted by two reviewers. For quality assessment, data will be extracted by one reviewer and verified by a second. Disagreements will be resolved through discussion or third party adjudication. Within each profession, data will be grouped and analyzed by research design and KT strategies using the Effective Practice and Organisation of Care Review Group classification scheme. An overall synthesis across professions will be conducted. Significance A uniprofessional approach to KT does not represent the interprofessional context it targets. Our findings will provide the first systematic overview of KT strategies used in allied health professionals' clinical practice, as well as a foundation to inform future KT interventions in allied healthcare settings.

We propose a technique for locating swirling regions of a flowfield. The technique is based on the eigenvalues of the velocity gradient tensor. We show that regions of swirling flow are characterized by complex eigenvalues for a constant velocity gradient tensor. Using results obtained in this analysis, we define an approximate parameter to indicate the tendency for the fluid to swirl about the point in question. The technique is illustrated by application to several two- and three-dimensional flowfields. In addition, the basic ideas contained here suggest the existence of a fluid property that we have termed intrinsic swirl

The visualization community is currently witnessing strong advances in topology-based flow visualization research. Numerous algorithms have been pro posed since the introduction of this class of approaches in 1989. Yet despite the many advances in the field, topology-based flow visualization methods have, until now, failed to penetrate industry. Application domain experts are still, in general, not using topological analysis and visualization in daily practice. We present a range of state-of-the art topology-based flow visualization methods such as vortex core line extraction, singularity and separatrix extraction, and periodic orbit extraction techniques, and apply them to real-world data sets. Applications include the visual ization of engine simulation data such as in-cylinder flow, cooling jacket flow, as well as flow around a spinning missile. The novel application of periodic orbit extraction to the boundary surface of a cooling jacket is presented. Based on our experiences, we then describe what we believe needs to be done in order to bring topological flow visualization methods to industry-level software applications. We believe this discussion will inspire useful directions for future work.

Realistic engineering simulation data often have features that are not optimally resolved due to practical limitations on mesh resolution. To be useful to application engineers, vortex characterization techniques must be sufficiently robust to handle realistic data with complex vortex topologies. In this paper, we present enhancements to the vortex topology identification component of an existing vortex characterization algorithm. The modified techniques are demonstrated by application to three realistic data sets that illustrate the strengths and weaknesses of our approach.

Background There has been considerable interest recently in developing and evaluating interventions to increase research use by clinicians. However, most work has focused on medical practices; and nursing is not well represented in existing systematic reviews. The purpose of this article is to report findings from a systematic review of interventions aimed at increasing research use in nursing. Objective To assess the evidence on interventions aimed at increasing research use in nursing. Methods A systematic review of research use in nursing was conducted using databases (Medline, CINAHL, Healthstar, ERIC, Cochrane Central Register of Controlled Trials, and Psychinfo), grey literature, ancestry searching (Cochrane Database of Systematic Reviews), key informants, and manual searching of journals. Randomized controlled trials and controlled before- and after-studies were included if they included nurses, if the intervention was explicitly aimed at increasing research use or evidence-based practice, and if there was an explicit outcome to research use. Methodological quality was assessed using pre-existing tools. Data on interventions and outcomes were extracted and categorized using a pre-established taxonomy. Results Over 8,000 titles were screened. Three randomized controlled trials and one controlled before- and after-study met the inclusion criteria. The methodological quality of included studies was generally low. Three investigators evaluated single interventions. The most common intervention was education. Investigators measured research use using a combination of surveys (three studies) and compliance with guidelines (one study). Researcher-led educational meetings were ineffective in two studies. Educational meetings led by a local opinion leader (one study) and the formation of multidisciplinary committees (one study) were both effective at increasing research use. Conclusion Little is known about how to increase research use in nursing, and the evidence to support or refute specific interventions is inconclusive. To advance the field, we recommend that investigators: (1) use theoretically informed interventions to increase research use, (2) measure research use longitudinally using theoretically informed and psychometrically sound measures of research use, as well as, measuring patient outcomes relevant to the intervention, and (3) use more robust and methodologically sound study designs to evaluate interventions. If investigators aim to establish a link between using research and improved patient outcomes they must first identify those interventions that are effective at increasing research use.

A computational investigation was performed to assess the effectiveness of Detached Eddy Simulation (DES) as a tool for predicting icing effects. The AVUS code, a public domain flow solver, was employed to compute solutions for an iced wing configuration using DES and steady Reynolds Averaged Navier-Stokes (RANS) equation methodologies. The wing section considered here was a business jet airfoil (GLC305) with a 22.5-minute glaze ice accretion (944-ice shape). The section was extruded to form a rectangular planform. The model was mounted between two walls so no tip effects were considered. The numerical results were validated by comparison with experimental data for the same configuration. The time-averaged DES computations showed some improvement in lift and drag results near stall when compared to steady RANS results. However, comparisons of the flow field details did not show the level of agreement suggested by the integrated quantities. More validation is needed to determine what role DES can play as part of an overall icing effects prediction strategy.

In this paper, we present our vision for a framework to facilitate computationally-based aerospace vehicle design by improving the quality of the response surfaces that can be developed for a given cost. The response surfaces are developed using computational fluid dynamics (CFD) techniques of varying fidelity. We propose to improve the quality of a given response surface by exploiting the relationships between the response surface and the flow features that evolve in response to changes in the design parameters. The underlying technology, generalized feature mining, is employed to locate and characterize features as well as provide explanations for feature-feature and feature-vehicle interactions. We briefly describe the components of our framework and outline two different strategies to improve the quality of a response surface. We also highlight ongoing efforts.

A mathematical model is developed to investigate blood flow in arterial stenoses up to Reynolds numbers of 1000. The approach is based on Thwaites' method, normally used to treat laminar boundary layer development over a body in a freestream. The model is applicable to any axisymmetric stenosis geometry in all laminar physiological flow regimes, has a minimum of externally input parameters and is implemented as a short program on a personal computer. Maximum bounds on the expected errors are derived by comparison with known results from Poiseuille flow in a pipe. Agreement with shear stresses reported by other researchers using computational fluid dynamics is within 13% rms. The method has been specifically designed to be a useful predictive tool for biomedical investigators.

As part of an overall effort to place acoustic sensors on airborne platforms for surveillance applications, analysis studies were performed of acoustic probe windscreens that could minimize wind noise and be made relatively insensitive to small angle of attack and sideslip excursions. Through a collaborative effort between Miltec Research & Technology, Mississippi State University Department of Aerospace Engineering, Raspet Flight Research Laboratory, and the Engineering Research Center several probe designs were developed and analyzed using inviscid and viscous simulations with the objective of characterizing their flow fields and identifying potential modifications that could improve suitability for use as acoustic measurement probes. Several of the recommended probe shapes were fabricated and tested under real world conditions on an acoustically optimized 1/3 scale Schleicher ASH26 glider test bed.