Search

ObjectiveTo determine the postoperative attempted and completed suicide rates after subthalamic nucleus deep brain stimulation (STN-DBS) in a single-center cohort and to determine factors associated with attempted and completed suicide.MethodsWe retrospectively included all patients with Parkinson disease (PD) who underwent bilateral STN-DBS surgery at the Grenoble University Hospital between 1993 and 2016. For each patient who committed or attempted suicide, 2 patients with PD with STN-DBS without any suicidal behaviors were matched for age (±1 year), sex, and year of surgery (±2 years). Clinical data were collected from medical records. Detailed preoperative and postoperative neuropsychological evaluations, including frontal and Beck Depression Inventory (BDI) scores, were gathered.ResultsA total of 534 patients with PD were included. Completed and attempted suicide percentages were 0.75% (4 of 534) and 4.11% (22 of 534), respectively. The observed suicide rate in the first postoperative year (187.20 of 100,000 per year, 1 of 534) was higher than the expected National Observatory on Suicide Risks rate adjusted for age and sex (standardized mortality ratio 8.1). This rate remained similar over the second and third postoperative years. In a comparison of the 26 patients completing/attempting suicide and the 52 controls, the first group showed more frequent history of suicidal ideation/suicide attempts and psychotic symptoms, higher percentage of family psychiatric history, higher psychiatric medication use, and higher preoperative frontal and BDI scores on neuropsychological evaluations.ConclusionsSuicide behaviors can occur after STN-DBS, especially during the first 3 years. A careful multidisciplinary assessment and long-term follow-up are recommended to recognize and treat this potentially preventable risk for mortality.

This paper describes the application of a coupled acoustic model/large-eddy simulation approach to assess the effect of fuel split on combustion instabilities in an industrial ultra-low-NOx annular combustor. Multiphase flow LES and an analytical model (analytical tool to analyze and control azimuthal modes in annular chambers (ATACAMAC)) to predict thermoacoustic modes are combined to reveal and compare two mechanisms leading to thermoacoustic instabilities: (1) a gaseous type in the multipoint zone (MPZ) where acoustics generates vortex shedding, which then wrinkle the flame front, and (2) a multiphase flow type in the pilot zone (PZ) where acoustics can modify the liquid fuel transport and the evaporation process leading to gaseous fuel oscillations. The aim of this paper is to investigate these mechanisms by changing the fuel split (from 5% to 20%, mainly affecting the PZ and mechanism 2) to assess which mechanism controls the flame dynamics. First, the eigenmodes of the annular chamber are investigated using an analytical model validated by 3D Helmholtz simulations. Then, multiphase flow LES are forced at the eigenfrequencies of the chamber for three different fuel split values. Key features of the flow and flame dynamics are investigated. Results show that acoustic forcing generates gaseous fuel oscillations in the PZ, which strongly depend on the fuel split parameter. However, the correlation between acoustics and the global (pilot + multipoint) heat release fluctuations highlights no dependency on the fuel split staging. It suggests that vortex shedding in the MPZ, almost not depending on the fuel split, is the main feature controlling the flame dynamics for this engine.

Design of lean combustion technologies will have to face the problem of the increasing difficulty to control carbon monoxide emission. To help the designer, a 91 species and 1329 elementary reactions chemical mechanism for Jet Al kerosene is tabulated and coupled with the turbulent flow through a presumed probability density function approach. The capacities of the methodology for finite rate chemistry prediction are assessed by the computation of several operating conditions of an experimental combustor. The first case corresponds to high-power operating conditions and a good agreement is achieved between the predicted and measured carbon monoxide emissions and temperature profile at the combustor outlet. The second case corresponding to low-power operating conditions for which finite rate chemistry effects are important is focused on the study of carbon monoxide emissions variations with respect to the global fuel air ratio of the combustor, while keeping constant the inlet air mass flow rate and the airflow split. A detailed discussion is provided to carefully check the coherence of the obtained results, then the full relevance of this tabulated approach regarding the prediction of finite rate chemistry effects for turbulent combustion in aeronautical combustors with liquid injection is concluded.

International audience; This paper describes the application of a coupled acoustic model/large-eddy simulation approach to assess the effect of fuel split on combustion instabilities in an industrial ultra-low-NOx annular combustor. Multiphase flow LES and an analytical model (analytical tool to analyze and control azimuthal modes in annular chambers (ATACAMAC)) to predict thermoacoustic modes are combined to reveal and compare two mechanisms leading to thermoacoustic instabilities: (1) a gaseous type in the multipoint zone (MPZ) where acoustics generates vortex shedding, which then wrinkle the flame front, and (2) a multiphase flow type in the pilot zone (PZ) where acoustics can modify the liquid fuel transport and the evaporation process leading to gaseous fuel oscillations. The aim of this paper is to investigate these mechanisms by changing the fuel split (from 5% to 20%, mainly affecting the PZ and mechanism 2) to assess which mechanism controls the flame dynamics. First, the eigenmodes of the annular chamber are investigated using an analytical model validated by 3D Helmholtz simulations. Then, multiphase flow LES are forced at the eigenfrequencies of the chamber for three different fuel split values. Key features of the flow and flame dynamics are investigated. Results show that acoustic forcing generates gaseous fuel oscillations in the PZ, which strongly depend on the fuel split parameter. However, the correlation between acoustics and the global (pilot + multipoint) heat release fluctuations highlights no dependency on the fuel split staging. It suggests that vortex shedding in the MPZ, almost not depending on the fuel split, is the main feature controlling the flame dynamics for this engine