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The flow stability induced by the impingement of gas jets exiting from the intake manifold affects the in-cylinder flow characteristics of internal combustion engine. Using high-speed planar particle image velocimetry (PIV) with proper orthogonal decomposition (POD) analysis, an investigation was conducted to reveal the spatio-temporal characteristics of annular gas jets impinging in a region between the exits of two intake valves. Unique flow behaviors are identified where strong initial interaction of impinging jets appears near the valve exit as a result of fierce flow vorticity competition in both clockwise and counter-clockwise directions. This mixing zone exhibits strong fluctuations in the angle of the merged gas jet. Flow vorticity and merged jet angle are highly correlated with each other, and the quasi-periodical behavior of the jet impingement is linked to the kinetic energy dissipation. In addition, using POD, the underlying flow structures show large-scale rotating structures with translation which are responsible for the quasi-periodical behavior. In summary, three types of flow stability can be identified resulting from different levels of induced impingement: one-way interaction of single jet flow case, two-way interaction of dual impinging jets with equal flow magnitude, and transitional one-way interaction of dual impinging jets with unequal flow magnitude.

BACKGROUND Effective communication is the bedrock of quality health care, but it continues to be a major problem for patients, family caregivers, health care providers, and organizations. Although progress related to communication skills training for health care providers has been made, clinical practice and research gaps persist, particularly regarding how to best monitor, measure, and evaluate the implementation of communication skills in the actual clinical setting and provide timely feedback about communication effectiveness and quality. OBJECTIVE Our interdisciplinary team of investigators aims to develop, and pilot test, a novel sensing system and associated natural language processing algorithms (CommSense) that can (1) be used on mobile devices, such as smartwatches; (2) reliably capture patient-clinician interactions in a clinical setting; and (3) process these communications to extract key markers of communication effectiveness and quality. The long-term goal of this research is to use CommSense in a variety of health care contexts to provide real-time feedback to end users to improve communication and patient health outcomes. METHODS This is a 1-year pilot study. During Phase I (Aim 1), we will identify feasible metrics of communication to extract from conversations using CommSense. To achieve this, clinical investigators will conduct a thorough review of the recent health care communication and palliative care literature to develop an evidence-based “ideal and optimal” list of communication metrics. This list will be discussed collaboratively within the study team and consensus will be reached regarding the included items. In Phase II (Aim 2), we will develop the CommSense software by sharing the “ideal and optimal” list of communication metrics with engineering investigators to gauge technical feasibility. CommSense will build upon prior work using an existing Android smartwatch platform (SWear) and will include sensing modules that can collect (1) physiological metrics via embedded sensors to measure markers of stress (eg, heart rate variability), (2) gesture data via embedded accelerometer and gyroscope sensors, and (3) voice and ultimately textual features via the embedded microphone. In Phase III (Aim 3), we will pilot test the ability of CommSense to accurately extract identified communication metrics using simulated clinical scenarios with nurse and physician participants. RESULTS Development of the CommSense platform began in November 2021, with participant recruitment expected to begin in summer 2022. We anticipate that preliminary results will be available in fall 2022. CONCLUSIONS CommSense is poised to make a valuable contribution to communication science, ubiquitous computing technologies, and natural language processing. We are particularly eager to explore the ability of CommSense to support effective virtual and remote health care interactions and reduce disparities related to patient-clinician communication in the context of serious illness. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/37975

After deep venous thrombosis (DVT), many patients have impaired quality of life (QOL). We aimed to assess whether pharmacomechanical catheter-directed thrombolysis (PCDT) improves short-term or long-term QOL in patients with proximal DVT and whether QOL is related to extent of DVT.The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial was an assessor-blinded randomized trial that compared PCDT with no PCDT in patients with DVT of the femoral, common femoral, or iliac veins. QOL was assessed at baseline and 1 month, 6 months, 12 months, 18 months, and 24 months using the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) disease-specific QOL measure and the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary general QOL measures. Change in QOL scores from baseline to assessment time were compared in the PCDT and no PCDT treatment groups overall and in the iliofemoral DVT and femoral-popliteal DVT subgroups.Of 692 ATTRACT patients, 691 were analyzed (mean age, 53 years; 62% male; 57% iliofemoral DVT). VEINES-QOL change scores were greater (ie, better) in PCDT vs no PCDT from baseline to 1 month (difference, 5.7; P = .0006) and from baseline to 6 months (5.1; P = .0029) but not for other intervals. SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 2.4; P = .01) but not for other intervals. Among iliofemoral DVT patients, VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group; this was statistically significant in the intention-to-treat analysis at 1 month (difference, 10.0; P .0001) and 6 months (8.8; P .0001) and in the per-protocol analysis at 18 months (difference, 5.8; P = .0086) and 24 months (difference, 6.6; P = .0067). SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1 month (difference, 3.2; P = .0010) but not for other intervals. In contrast, in femoral-popliteal DVT patients, change scores from baseline to all assessments were similar in the PCDT and no PCDT groups.Among patients with proximal DVT, PCDT leads to greater improvement in disease-specific QOL than no PCDT at 1 month and 6 months but not later. In patients with iliofemoral DVT, PCDT led to greater improvement in disease-specific QOL during 24 months.

Flexible layout of electric motors in battery electric vehicles (BEVs) has enabled different powertrain topologies to be used. However, these different powertrain topologies also affect the overall efficiency of energy conversion from the electrochemical form stored in the battery to the mechanical form on the driving wheels for vehicle propulsion. In this study, a methodology combining an energy-based BEV simulation model with the genetic algorithm optimization approach is applied to evaluate the energy efficiency of three different BEV powertrain topologies. The analysis is carried out assuming two different urban driving conditions, as exemplified by the New European Drive Cycle (NEDC) and the Japanese JC08 drive cycle. Each of the three BEV powertrain topologies is then optimized – in terms of its electric motor size and, where applicable, gear reduction ratio – for minimum energy consumption. The results show that among the three powertrain topologies, the wheel-hub drive without gear reducers consumes the least energy. The energy consumption of BEVs under the more aggressive JC08 drive cycle is consistently 8 % above that under NEDC for all three powertrain topologies considered.

No abstract available. Article truncated after first page. History of Present Illness: A 54-year-old Hispanic male who was incarcerated 3 days prior to hospital admission was brought into the emergency room from prison for alcohol related withdrawal seizures. Physical Examination: Upon arrival to the ER, the patient was noted to be hypoxic with copious thick secretions in his mouth. He was intubated for airway protection, started on propofol and fentanyl drips as well as intravenous thiamine and folic acid. Radiography: A chest radiograph was performed (Figure 1). Which of the following are true regarding management of this patient? 1. Phenytoin should be administered for prevention of seizures; 2. Prophylactic antibiotics for aspiration pneumonia should be administered; 3. Thiamine and folic acid should be administered; 4. 1 and 3; 5. All of the above. …

Natural language processing (NLP), utilizing computer programs to process large amounts of language data, is a key research area in artificial intelligence and computer science. Deep learning technologies have been well developed and applied in this area. However, the literature still lacks a succinct survey, which would allow readers to get a quick understanding of (1) how the deep learning technologies apply to NLP and (2) what the promising applications are. In this survey, we try to investigate the recent developments of NLP, centered around natural language understanding, to answer these two questions. First, we explore the newly developed word embedding or word representation methods. Then, we describe two powerful learning models, Recurrent Neural Networks and Convolutional Neural Networks. Next, we outline five key NLP applications, including (1) part-of-speech tagging and named entity recognition, two fundamental NLP applications; (2) machine translation and automatic English grammatical error correction, two applications with prominent commercial value; and (3) image description, an application requiring technologies of both computer vision and NLP. Moreover, we present a series of benchmark datasets which would be useful for researchers to evaluate the performance of models in the related applications.

Communicating bad news to patients and their families is a difficult but routine responsibility for hospitalists. Most practitioners have little or no formal training for this task. Preparation for, delivery of, and follow-up to these conversations should be deliberately planned in order to meet patients' needs. In this article, we review the literature that guides this process and, with a case example, describe steps practitioners can take to effectively deliver bad news and pitfalls that should be avoided. As competency in this skill set is necessary for effective patient care, hands-on training should be part of the core curriculum for all health care practitioners. Hospitalists should be proficient in this area and may serve as role models and instructors for colleagues and trainees. Journal of Hospital Medicine 2007;2:415–421. © 2007 Society of Hospital Medicine

The structure of in-cylinder flow field makes significant impacts on the processes of fuel injection, air–fuel interactions, and flame development in internal combustion engines. In this study, the implementation of time-resolved particle image velocimetry (PIV) in an optical engine is presented. Flow field PIV images at different crank angles have been taken using a high-speed double-pulsed laser and a high-speed camera with seeding particles mixed with the intake air. This study is focused on measuring the flow fields on the swirl plane at 30 mm below the injector tip under various intake air swirl ratios. A simple algorithm is developed to identify the vortex structure and to track the location and motion of vortex center at different crank angles. Proper orthogonal decomposition (POD) has been used to extract the ensemble and variation information of the vortex structure. Experimental results reveal that strong cycle-to-cycle variations exist in almost all test conditions. The vortex center is difficult to identify since multiple, but small scale, vortices exist during the early stage of the intake stroke. However, during the compression stroke when only one vortex center exists in most cycles, the motion of vortex center is found to be quite similar at different intake swirl ratios and engine speeds. This is due to the dominant driving force exerted by the piston’s upward motion on the in-cylinder air.

BACKGROUND Computerized physician order entry (CPOE) is a widely advocated patient safety intervention, yet little is known about its adoption by attending physicians or community hospitals. METHODS We calculated the order entry rates of attending physicians at 2 hospitals by measuring the number of orders entered directly and dividing this by the sum of orders entered directly and those written by hand. These findings were paired with the results of a survey that assessed attitudes concerning the impact of CPOE on personal efficiency, quality of care, and patient safety. RESULTS Three hundred and fifty-six (71%) of the 502 surveys were returned by physicians, whose median order entry rate was 66%. Forty-two percent of respondents placed at least 80% of their orders electronically (high use), 26% placed 21%-79% of their orders electronically (intermediate use), and 32% placed 20% or less of their orders electronically (low use). Sex, years since medical school graduation, years in practice at the study institution, and use of computers in the outpatient arena were not meaningfully different among the 3 groups. However, use of the system to place orders varied by specialty, and those with intermediate or high use of the system were more likely than low users to have used CPOE during training and to be regular users of computers for personal activities. These physicians were more likely to believe that CPOE enabled orders to be placed efficiently, that directly entered orders were carried out more rapidly, and that such orders were associated with fewer errors. CONCLUSIONS The adoption of CPOE by attending physicians at community hospitals varies widely. In addition to purchasing systems that support physician work flow, hospitals intent on successfully implementing CPOE should emphasize the benefits in safety and quality of this new technology. Journal of Hospital Medicine 2006;1:221–230. © 2006 Society of Hospital Medicine.

Forming simulation technologies continues to develop at a rapid pace, to address formability, tolerance control, and product performance issues in an increasing range of processes, and in ever more detail. Springback prediction and compensation continue to evolve, with new concepts for improving the accuracy of the springback prediction for example by the incorporation of geometric drawbeads, and further refinement in compensation techniques. The paper highlights how the integration of simulation and geometry plays an ever more important role, in improving accuracy and reducing time.Other techniques which can help speed‐up and improve simulation results for hydroforming, and tube bending are ‘classical’ and more recently ‘in‐process’ optimization techniques. The paper will show the advantages on an industrial case, and the potential for the future.The paper will discuss how the PAM‐STAMP 2G™ and PAM‐TUBE 2G™ integrated solutions are successfully implemented to deliver a positive business impact, by provid...

The last few years have seen the use of stamping simulation evolve to the extent that it is now a mainstream activity; a core part of the press tool engineering process. Now, new requirements for the use of challenging materials like Dual phase / Complex phase steel, VHSS, and aluminum, together with more stringent quality expectations, and shorter development cycles, there is a need to assess the panel quality in a wider context, before committing to tool manufacture.The integrated approach from ESI Group allows early up‐front feasibility assessment, geometry and process optimization, and detailed process validation all within one system. Rapid die design and quick forming simulation modules play an essential role in the early stages of the process. A seamless connection between simulation and geometry is a vital characteristic, with the accurate simulation being used to validate and fine tune the process in order to assess final component quality in unprecedented detail, utilizing some of the most accur...

This paper focuses on the National College for School Leadership's 'Community Leadership Network' which comprises ten areas in England (rural and urban). The paper argues that models of school leadership should aim to service and build capacity for interdependent relationships between institutions and communities beyond the school gates. Through a case study of Winsford Networked Learning Community (North of England) and its use of facilitation tools it will lay out the problems and possibilities of building this capacity

Tracheoesophageal fistula (TEF) is a devastating complication of malignancies; however, those associated with Hodgkin's Disease (HD) may carry a better prognosis. We present a patient with recurrent HD and TEF.

The post-buckling behavior of short towers, supported by a single set of guy wires is investigated. Using the principle of stationary potential energy, a set of non-linear algebraic equations are obtained for both fixed and hinged-base towers. The equations are solved numerically for several actual systems. The results of the investigation include the shape of the post-buckling curves for towers subjected to vertical loads, the effect of cable pretension on the post-buckling behavior and the effect of horizontal forces on the capacity of the towers to supprot vertical loads.

McClennan BL, Ling D, Rholl KS, James M. Urography with a low osmolality contrast agent: comparison of Hexabrix with Conray 325. Invest Radiol 1986;21:144–150.A double-blind, parallel group comparison study of Hexabrix and Conray 325 for adult intravenous urography was performed. Sixty patients with a mean age of 54 years were included. Doses of contrast ranged from 0.5–1.1 ml/kg for both groups with a mean of 0.7 ml/kg. Hematology, urinary and biochemical laboratory tests were performed prior to the study in all patients and at 24 hours afterward in nearly half the group. Biochemical laboratory tests were done at 72 to 96 hours in approximately one third of the patients. Hexabrix proved satisfactory for standard urography at a chosen dose of 16 g of iodine (50 ml). There were no statistically significant differences in the diagnostic quality of the urogram in the two groups except for bladder filling. The decreased osmotic diuresis associated with Hexabrix necessitated delayed bladder filming for optimal evaluation. Excellent patient tolerance was achieved with less pain on injection with Hexabrix. There was one death in the Hexabrix group in a patient with multiple medical problems. Although the patient's medical problems appeared well controlled and did not meet specific rejection criteria, they almost certainly played a role in his death. Hexabrix may be useful for adult urography at a lower dose range, eg, 16 g iodine, than is typically used, which also may be cost effective (competitive) given the higher projected cost of the new low osmolar agents.

(1981). A debate judge certification test: Development and operation on a state‐wide scale. Communication Education: Vol. 30, No. 4, pp. 414-420.

Computed tomography (CT) has dramatically changed the imaging of pediatric oncologic disease. CT precisely displays and characterizes cross-sectional anatomic pathology. This provides important information for diagnosing and staging tumors in infants and children. The principles, techniques, and indications for computed tomography in the evaluation of pediatric extracranial tumors are reviewed in this article. Selected applications of computed tomography for pediatric tumors of the mediastinum, chest wall, lung parenchyma, abdomen, pelvis, and extremities are discussed and illustrated.

The preoperative assessment of many renal and adrenal tumors includes evaluation for tumor extension into the inferior vena cava. Computed tomography (CT) can allow the noninvasive diagnosis of tumor thrombus but specific pitfalls related to incomplete mixing of opacified and unopacified blood limit its utility. We report another pitfall, that of retrocaval lymphadenopathy mimicking tumor thrombus in the inferior vena cava.