Helicopter tail rotor orthogonal blade vortex interaction

The aerodynamic operating environment of the helicopter is particularly complex and, to some extent, dominated by the vortices trailed from the main and tail rotors. These vortices not only determine the form of the induced flow field but also interact with each other and with elements of the physical structure of the flight vehicle. Such interactions can have implications in terms of structural vibration, noise generation and flight performance. In this paper, the interaction of main rotor vortices with the helicopter tail rotor is considered and, in particular, the limiting case of the orthogonal interaction. The significance of the topic is introduced by highlighting the operational issues for helicopters arising from tail rotor interactions. The basic phenomenon is then described before experimental studies of the interaction are presented. Progress in numerical modelling is then considered and, finally, the prospects for future research in the area are discussed

Student-Led Conferences

This professional learning module is designed to lead educators through the process of successfully developing and implementing effective student-led conferences to improve student ownership in their learning and to increase family engagement. The goal is to determine what structures need to be in place in classrooms and schools, to define the key components of student-led conferences, and to explain the impact of implementing student-led conferences on the school community and overall school structure. The module presents current research and resources supporting student-led conferences in school. Resources include activities, videos, and assessments. Educators are presented potential barriers to student-led conferences and methods to overcome those barriers. View professional learning module.https://digitalcommons.gardner-webb.edu/improve/1031/thumbnail.jp

Early changes in ventricular septal defect size and ventricular geometry in the single left ventricle after volume-unloading surgery

Objectives.This study investigated the phenomenon of, and the relation between, alterations in ventricular geometry after acute surgical volume unloading of the ventricle and the development of subaortic stenosis in patients with a single ventricle and ventricular septal defect—dependent systemic flow.Background.Subaortic outflow obstruction has been observed to occur in patients with a single left ventricle after placement of a pulmonary artery band. The timing and etiology of this phenomenon are not well defined.Methods.The preoperative and postoperative echocardiograms of 18 patients 14.9 ± 22.8 months old (mean ± SD) with a diagnosis of single left ventricle who underwent pulmonary artery banding or cavopulmonary connection were reviewed. Postoperative studies were performed a mean of 7.0 ± 6.5 days after operation. The ventricular septal defect diameter was measured in two orthogonal views and the area calculated using the formula for an ellipse. Interventricular septal and posterior wall thickness and left ventricular diameter and length were also measured.Results.Mean ventricular septal defect area indexed to body surface area diminished by 36 ± 23% (3.1 ± 2.7 to 2.0 ± 1.8 cm2/m2, p < 0.01). Mean interventricular septal and posterior wall thickness increased significantly, and left ventricular diameter and length decreased significantly. A greater diminution in ventricular septal defect area was noted after cavopulmonary connection (41 ± 19%, p < 0.01) than after pulmonary artery banding (25 ± 28%, p = 0.22).Conclusions.In the single left ventricle, diminution in ventricular septal defect size occurs early and is related to an acute alteration in ventricular geometry that accompanies the decrease in ventricular volume. Ventricular septal defect diminution was greater after volume unloading of the ventricle after cavopulmonary connection than after pulmonary artery banding

The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database

ObjectiveWe sought to determine the association between pediatric cardiac surgical volume and mortality using sophisticated case-mix adjustment and a national clinical database.MethodsPatients 18 years of age or less who had a cardiac operation between 2002 and 2006 were identified in the Society of Thoracic Surgeons Congenital Heart Surgery Database (32,413 patients from 48 programs). Programs were grouped by yearly pediatric cardiac surgical volume (small, <150; medium, 150–249; large, 250–349; and very large, ≥350 cases per year). Logistic regression was used to adjust mortality rates for volume, surgical case mix (Aristotle Basic Complexity and Risk Adjustment for Congenital Heart Surgery, Version 1 categories), patient risk factors, and year of operation.ResultsWith adjustment for patient-level risk factors and surgical case mix, there was an inverse relationship between overall surgical volume as a continuous variable and mortality (P = .002). When the data were displayed graphically, there appeared to be an inflection point between 200 and 300 cases per year. When volume was analyzed as a categorical variable, the relationship was most apparent for difficult operations (Aristotle technical difficulty component score, >3.0), for which mortality decreased from 14.8% (60/406) at small programs to 8.4% (157/1858) at very large programs (P = .02). The same was true for the subgroup of patients who underwent Norwood procedures (36.5% [23/63] vs 16.9% [81/479], P < .0001). After risk adjustment, all groups performed similarly for low-difficulty operations. Conversely, for difficult procedures, small programs performed significantly worse. For Norwood procedures, very large programs outperformed all other groups.ConclusionThere was an inverse association between pediatric cardiac surgical volume and mortality that became increasingly important as case complexity increased. Although volume was not associated with mortality for low-complexity cases, lower-volume programs underperformed larger programs as case complexity increased

Coronary steal syndrome after coronary artery bypass for anomalous aortic origin of a coronary artery.

Anomalous aortic origin of a coronary artery found in a symptomatic 9-year-old boy was initially treated with coronary artery bypass grafting using a left internal mammary artery anastomoses to the left anterior descending coronary artery, but resulted in coronary ischemia, likely from a steal phenomenon. Subsequent transection of the proximal left internal mammary artery with anastomosis to the ascending aorta, and coronary ostial enlargement, resulted in a durable treatment. We recommend caution in choosing coronary artery bypass grafting using a left internal mammary artery pedicle graft for the treatment of anomalous aortic origin of a coronary artery

Tracheostomy after Surgery for Congenital Heart Disease: An Analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

Background Information concerning tracheostomy after operations for congenital heart disease has come primarily from single-center reports. We aimed to describe the epidemiology and outcomes associated with postoperative tracheostomy in a multi-institutional registry. Methods The Society of Thoracic Surgeons Congenital Heart Database (2000 to 2014) was queried for all index operations with the adverse event “postoperative tracheostomy” or “respiratory failure, requiring tracheostomy.” Patients with preoperative tracheostomy or weighing less than 2.5 kg undergoing isolated closure of patent ductus arteriosus were excluded. Trends in tracheostomy incidence over time from January 2000 to June 2014 were analyzed with a Cochran-Armitage test. The patient characteristics associated with operative mortality were analyzed for January 2010 to June 2014, including deaths occurring up to 6 months after transfer of patients to long-term care facilities. Results From 2000 to 2014, the incidence of tracheostomy after operations for congenital heart disease increased from 0.11% in 2000 to a high of 0.76% in 2012 (p < 0.0001). From 2010 to 2014, 648 patients underwent tracheostomy. The median age at operation was 2.5 months (25th, 75th percentile: 0.4, 7). Prematurity (n = 165, 26%), genetic abnormalities (n = 298, 46%), and preoperative mechanical ventilation (n = 275, 43%) were common. Postoperative adverse events were also common, including cardiac arrest (n = 131, 20%), extracorporeal support (n = 87, 13%), phrenic or laryngeal nerve injury (n = 114, 18%), and neurologic deficit (n = 51, 8%). The operative mortality was 25% (n = 153). Conclusions Tracheostomy as an adverse event of operations for congenital heart disease remains rare but has been increasingly used over the past 15 years. This trend and the considerable mortality risk among patients requiring postoperative tracheostomy support the need for further research in this complex population

Neuroanatomical and prognostic associations of depression in Parkinson's disease.

BACKGROUND: Depression is reported as a risk factor, prodromal feature and late consequence of Parkinson's disease (PD). We aimed to evaluate the timing, neuroanatomy and prognostic implications of depression in PD. METHODS: We used data from 434 023 participants from UK Biobank with 14.1 years of follow-up. Multivariable regression models established associations of depression with incident PD and regional brain volumes. Cox proportional hazards models assessed prognostic associations of depression in PD with incident dementia and all-cause mortality. RESULTS: Of 2632 individuals with incident PD, 539 (20.5%) were diagnosed with depression at some point. Depression was associated with an increased risk of subsequent PD (risk ratio 1.53, 95% CI 1.37 to 1.72). Among incident PD cases, depression prevalence rose progressively from 10 years pre-PD diagnosis (OR 2.10, 95% CI 1.57 to 2.83) to 10 years postdiagnosis (OR 3.51, 95% CI 1.33 to 9.22). Depression severity in PD was associated with reduced grey matter volume in structures including the thalamus and amygdala. Depression prior to PD diagnosis increased risk of dementia (HR 1.47, 95% CI 1.05 to 2.07) and mortality (HR 1.30, 95% CI 1.07 to 1.58). CONCLUSIONS: This large-scale prospective study demonstrated that depression prevalence increases from 10 years before PD diagnosis and is a marker of cortical and subcortical volume loss. Depression before PD diagnosis signals a worse prognosis in terms of dementia and mortality. This has clinical implications in stratifying people with poorer cognitive and prognostic trajectory in PD

Age-specific effects of childhood body mass index on multiple sclerosis risk

OBJECTIVE: Higher body mass index (BMI) during early life is thought to be a causal risk factor for multiple sclerosis (MS). We used longitudinal Mendelian randomisation (MR) to determine whether there is a critical window during which BMI influences MS risk. METHODS: Summary statistics for childhood BMI (n ~ 28,000 children) and for MS susceptibility were obtained from recent large genome-wide association studies (GWAS) (n = 14,802 MS, 26,703 controls). We generated exposure instruments for BMI during four non-overlapping age epochs (< 3 months, 3 months–1.5 years, 2–5 years, and 7–8 years) and performed MR using the inverse variance weighted method with standard sensitivity analyses. Multivariable MR was used to account for effects mediated via later-life BMI. RESULTS: For all age epochs other than birth, genetically determined higher BMI was associated with an increased liability to MS: Birth [Odds Ratio (OR) 0.81, 95% Confidence Interval (CI) 0.50–1.31, Number of Single-Nucleotide Polymorphisms (N(SNPs)) = 7, p = 0.39], Infancy (OR 1.18, 95% CI 1.04–1.33, N(SNPs) = 18, p = 0.01), Early childhood (OR 1.31, 95% CI 1.03–1.66, N(SNPs) = 4, p = 0.03), Later childhood (OR 1.34, 95% CI 1.08–1.66, N(SNPs) = 4, p = 0.01). Multivariable MR suggested that these effects may be mediated by effects on adult BMI. CONCLUSION: We provide evidence using MR that genetically determined higher BMI during early life is associated with increased MS risk. This effect may be driven by shared genetic architecture with later-life BMI. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-022-11161-4

Remedying contact dermatitis in broiler chickens with novel flooring treatments

Simple Summary Contact dermatitis is an overarching term for inflamed or necrotic lesions after contact with an allergen or irritant. Broiler chickens commonly experience these lesions due to prolonged contact with moisture, feces, and ammonia within litter. This study aimed to find methods to prevent and remedy lesions on broilers' feet, hocks, and breast. Furthermore, the impact of treatments on plumage cleanliness, gait, and body weight was investigated. We applied novel flooring treatments consisting of plastic slats and disinfectant mats containing povidone-iodine, which we compared to the industry control (used litter) and a positive control (clean litter). Weekly measurements on a sample of birds in each pen showed us the impact of both flooring treatments and age (weeks) on animal welfare outcomes. Contrary to expectations, the novel flooring treatments did not prevent or remedy contact dermatitis. In fact, the positive control, consisting of replacing litter every four days, resulted in the best welfare condition, with limited to no contact dermatitis at week seven of age. Contact dermatitis (footpad dermatitis (FPD), hock burns, and breast dermatitis) is a welfare issue for broiler chickens, causing pain and behavioral restrictions. Once lesions develop, often nothing is done to remedy the issue for the affected flock. Our objective was to evaluate novel flooring treatments at the flock level by providing preventative and remedial treatments against contact dermatitis, plumage soiling, and gait impairment. Broilers (n = 546) were housed in 42 pens, with 13 birds/pen. The flooring treatments (four) included used litter (NEG), new pine shavings replaced regularly (POS), a mat filled with 1% povidone-iodine solution (MAT), and the iodine mat placed on a slatted floor (SLAT). Flooring treatments were provided from day one of age (preventative approach; PREV) or day 29 (remedial approach; REM). Contact dermatitis, soiling, gait, and weight were recorded weekly (seven birds/pen). Results showed a treatment effect for all measures, dependent on bird age. Overall, the POS treatment resulted in the best welfare outcomes (FPD, hock burns, and gait). The worst contact dermatitis was found in the MAT and SLAT groups. NEG birds showed little contact dermatitis, opposite to expectations. Weights were lower for PREV-POS in week seven only. The treatments with povidone-iodine were deemed ineffective against contact dermatitis. Access to clean litter prevented and remedied contact dermatitis, and a comparable approach may be commercially feasible