Design and Experimental Validation of a Ducted Counter-rotating Axial-flow Fans System

An experimental study on the design of counter-rotating axial-flow fans was carried out. The fans were designed using an inverse method. In particular, the system is designed to have a pure axial discharge flow. The counter-rotating fans operate in a ducted-flow configuration and the overall performances are measured in a normalized test bench. The rotation rate of each fan is independently controlled. The relative axial spacing between fans can vary from 17% to 310%. The results show that the efficiency is strongly increased compared to a conventional rotor or to a rotor-stator stage. The effects of varying the rotation rates ratio on the overall performances are studied and show that the system has a very flexible use, with a large patch of high efficient operating points in the parameter space. The increase of axial spacing causes only a small decrease of the efficiencyComment: accepted in Journal of Fluid Engineerin

Application of the Wilson-Richmond categorisation tool on three-dimensional facial scans of a population of 12-year old Welsh children

Objective: To determine the reproducibility and reliability of the Wilson-Richmond categorisation tool in the assessment of lip morphology and to demonstrate its use in a 12-year old Welsh population. Setting and Sample Population: 50 subjects age 12 (27 male and 23 female) of Caucasian origin selected from two large comprehensive schools in South Wales (UK) as part of a growth study. Material & Methods: Images of the subjects obtained by laser stereophoto-grammetry were assessed using the Wilson-Richmond categorisation tool in order to evaluate the perioral region from a topographical perspective. Results: The Wilson-Richmond categorisation tool demonstrated high levels (70 -100%) of both intra and inter-examiner reliability. The lower double ver-million border and the philtrum width proved to be the most reliable and re-producible categories (85-100% agreement). The least reliable were the lower vermillion contour and lip-chin shape in both the intra and inter-examiner groups (70 -78% agreement). This study found that some morphological features in this 12-year old Welsh population differed in prevalence compared to previously reported Figure. Conclusion: This study has shown that the Wilson-Richmond categorisation tool is both a reproducible and reliable method of lip morphology assessment. The morphological traits of a 12-year old Welsh population have been reported and further research on this population will highlight the normal morphological changes of the lips associated with growth

Protocol for "Seal or Varnish?" (SoV) trial: a randomised controlled trial to measure the relative cost and effectiveness of pit and fissure sealants and fluoride varnish in preventing dental decay.

This is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: Dental caries remains a significant public health problem, prevalence being linked to social and economic deprivation. Occlusal surfaces of first permanent molars are the most susceptible site in the developing permanent dentition. Cochrane reviews have shown pit and fissure sealants (PFS) and fluoride varnish (FV) to be effective over no intervention in preventing caries. However, the comparative cost and effectiveness of these treatments is uncertain. The primary aim of the trial described in this protocol is to compare the clinical effectiveness of PFS and FV in preventing dental caries in first permanent molars in 6-7 year-olds. Secondary aims include: establishing the costs and the relative cost-effectiveness of PFS and FV delivered in a community/school setting; examining the impact of PFS and FV on children and their parents/carers in terms of quality of life/treatment acceptability measures; and examining the implementation of treatment in a community setting. METHODS/DESIGN: The trial design comprises a randomised, assessor-blinded, two-arm, parallel group trial in 6-7 year old schoolchildren. Clinical procedures and assessments will be performed at 66 primary schools, in deprived areas in South Wales. Treatments will be delivered via a mobile dental clinic. In total, 920 children will be recruited (460 per trial arm). At baseline and annually for 36 months dental caries will be recorded using the International Caries Detection and Assessment System (ICDAS) by trained and calibrated dentists. PFS and FV will be applied by trained dental hygienists. The FV will be applied at baseline, 6, 12, 18, 24 and 30 months. The PFS will be applied at baseline and re-examined at 6, 12, 18, 24, and 30 months, and will be re-applied if the existing sealant has become detached/is insufficient. The economic analysis will estimate the costs of providing the PFS versus FV. The process evaluation will assess implementation and acceptability through acceptability scales, a schools questionnaire and interviews with children, parents, dentists, dental nurses and school staff. The primary outcome measure will be the proportion of children developing new caries on any one of up to four treated first permanent molars. DISCUSSION: The objectives of this study have been identified by the National Institute for Health Research as one of importance to the National Health Service in the UK. The results of this trial will provide guidance on which of these technologies should be adopted for the prevention of dental decay in the most susceptible tooth-surface in the most at risk children. TRIAL REGISTRATIONS: ISRCTN ref: ISRCTN17029222 EudraCT: 2010-023476-23 UKCRN ref: 9273.This trial is funded by the National Institute for Health Research (NIHR) – Health Technology Assessment Programme (project number 08/104/04 http://www.hta.ac.uk/2202)

Pregnancy and neonatal outcomes of COVID-19: co-reporting of common outcomes from PAN-COVID and AAP SONPM registries

OBJECTIVE: Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with SARS-CoV-2 infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the US American Academy of Pediatrics Section on Neonatal Perinatal Medicine (AAP SONPM) National Perinatal COVID-19 Registry. METHODS: This was an analysis of data from the PAN-COVID registry (January 1st to July 25th 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP SONPM National Perinatal COVID-19 registry (April 4th to August 8th 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented both overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. RESULTS: We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP SONPM). For obstetric outcomes, in PAN-COVID overall, those with confirmed infection in PAN-COVID and AAP SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was pre-term (<37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.2% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP SONPM. Extremely preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP SONPM. Neonatal SARS-CoV-2 infection was reported in 0.8% of all deliveries in PAN-COVID, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a SGA neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP SONPM. Mean gestational age adjusted birth-weight z-scores were -0.03 in PAN-COVID and -0.18 in AAP SONPM. CONCLUSIONS: The findings from the UK and US registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a small for gestational age infant or early neonatal death were comparable to those in historical and contemporaneous UK and US data. Although maternal death was uncommon, the rate was higher than expected based on UK and US population data, which is likely explained by under-ascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study although not in the AAP SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of women planning pregnancy. This article is protected by copyright. All rights reserved

Recruitment and retention of participants from socioeconomically deprived communities : lessons from the Awareness and Beliefs About Cancer (ABACus3) randomised controlled trial

Background Recruitment of research participants poses challenges in socioeconomically deprived areas. The Awareness and Beliefs About Cancer (ABACus) phase 3 Randomised Control Trial recruited adult participants from socioeconomically deprived areas using a combined healthcare/community engagement model. We report the strategies used to successfully recruit and retain our trial participant sample. Methods Community and healthcare settings in areas of high socioeconomic deprivation were identified by lay advisors who recruited participants opportunistically or by appointment. Follow-up was done by telephone or post at 2-weeks and 6-months after recruitment, and all participants were offered financial incentives. Qualitative interviews were conducted with lay advisors regarding their experience and reflections. Results The lay advisors identified and contacted 107 potential recruitment venues across South and West Yorkshire and South East Wales of which 41.1% (n = 42) were opened for recruitment. A total of 234 participants were recruited, with 91% (n = 212) retention at 2-weeks and 85% (n = 199) at 6-months. Community settings yielded 75% (n = 176) of participants. Participants had a mean age of 61.3 years and 63.3% (n = 148) were female, with 66% (n = 154) resident in the most deprived geographical areas. Lay advisors described recruitment as intensive, although engaging participants was easier in community settings. Conclusions The ABACus3 trial achieved recruitment and high retention with a population that is often “hard to reach” or entirely missed in health research. Strategies were specifically tailored to engage the venues and adult residents of highly deprived areas. Future studies recruiting adults living in the most deprived areas might benefit from community recruitment and from collaborating with local gatekeepers who are key to engagement. This study adheres to CONSORT guidelines. Trial registration Retrospectively registered with ISRCTN (http://www.isrctn.com/ISRCTN16872545) on 12.01.2018

Two-loop Yang-Mills diagrams from superstring amplitudes

Starting from the superstring amplitude describing interactions among D-branes with a constant world-volume field strength, we present a detailed analysis of how the open string degeneration limits reproduce the corresponding field theory Feynman diagrams. A key ingredient in the string construction is represented by the twisted (Prym) super differentials, as their periods encode the information about the background field. We provide an efficient method to calculate perturbatively the determinant of the twisted period matrix in terms of sets of super-moduli appropriate to the degeneration limits. Using this result we show that there is a precise one-to-one correspondence between the degeneration of different factors in the superstring amplitudes and one-particle irreducible Feynman diagrams capturing the gauge theory effective action at the two-loop level.Comment: 42 pages plus appendices, 10 figure

Feasibility and acceptability of a motivational interviewing breastfeeding peer support intervention

An uncontrolled study with process evaluation was conducted in three U.K. community maternity sites to establish the feasibility and acceptability of delivering a novel breastfeeding peer-support intervention informed by motivational interviewing (MI; Mam-Kind). Peer-supporters were trained to deliver the Mam-Kind intervention that provided intensive one-to-one peer-support, including (a) antenatal contact, (b) face-to-face contact within 48 hr of birth, (c) proactive (peer-supporter led) alternate day contact for 2 weeks after birth, and (d) mother-led contact for a further 6 weeks. Peer-supporters completed structured diaries and audio-recorded face-to-face sessions with mothers. Semistructured interviews were conducted with a purposive sample of mothers, health professionals, and all peer-supporters. Interview data were analysed thematically to assess intervention acceptability. Audio-recorded peer-support sessions were assessed for intervention fidelity and the use of MI techniques, using the MITI 4.2 tool. Eight peer-supporters delivered the Mam-Kind intervention to 70 mothers in three National Health Service maternity services. Qualitative interviews with mothers (n = 28), peer-supporters (n = 8), and health professionals (n = 12) indicated that the intervention was acceptable, and health professionals felt it could be integrated with existing services. There was high fidelity to intervention content; 93% of intervention objectives were met during sessions. However, peer-supporters reported difficulties in adapting from an expert-by-experience role to a collaborative role. We have established the feasibility and acceptability of providing breastfeeding peer-support using a MI-informed approach. Refinement of the intervention is needed to further develop peer-supporters' skills in providing mother-centred support. The refined intervention should be tested for effectiveness in a randomised controlled trial

A web-based life-style, exercise and activity intervention for people with progressive multiple sclerosis: Results of a single-arm feasibility study.

BACKGROUND: People with progressive Multiple Sclerosis often struggle to access appropriate and inclusive support for regular physical activity. The Lifestyle, Exercise and Activity Package (LEAP-MS) intervention, is a co-designed web-based physical activity intervention for people with progressive Multiple Sclerosis (MS). It consists of two key components; (1) web-based physical activity coaching with physiotherapists using self-management support strategies and 2) an interactive web-based platform including a physical activity information suite, an activity selection and planning tool and a participant-physiotherapist messaging system. We aimed to evaluate recruitment, retention and uptake, in a single arm feasibility study. METHODS: Participants with primary or secondary progressive MS with an Expanded Disability Status Scale score of 6 to 8 were recruited. Assessments included the MS Impact Scale (MSIS-29) and measures of participation at baseline, three and six months. All participants received the intervention which consisted of up to six web-based physiotherapy- led physical activity coaching sessions alongside access to web-based education and activity suites. Recruitment, retention and uptake data were summarised. Pre-defined progression criteria were used to guide feasibility assessment. Clinical outcome data were analysed descriptively. RESULTS: Fifty-eight percent (21/36) of those submitting expressions of interest were recruited; 76% completed follow-up. Pre-specified progression criteria for retention were met but recruitment did not meet progression criteria. The intervention achieved set fidelity criteria. At three months, 12 participants (75%) reported improvements in routine activities after the intervention. MSIS-29 physical scores improved by an average of eight points (95% CI -12.6 to -3.3). Improvements were also seen in MSIS-29 psychological scores and fatigue. Some improvements were maintained at six months. CONCLUSIONS: The LEAP-MS intervention is feasible and associated with improvements in MSIS-29 scores. The intervention facilitated partnership working between physiotherapists and people with progressive MS. Users developed valuable skills in supported self-management by focussing on enhancing physical activity to support overall wellbeing. This work has laid the foundations for a large-scale evaluation of a co-designed intervention with potential for far reaching impact on the lives of people with progressive MS

Detailing patient specific modelling to aid clinical decision-making

The anatomy of the craniofacial skeleton has been described through the aid of dissection identifying hard and soft tissue structures. Although the macro and microscopic investigation of internal facial tissues have provided invaluable information on constitution of the tissues it is important to inspect and model facial tissues in the living individual. Detailing the form and function of facial tissues will be invaluable in clinical diagnoses and planned corrective surgical interventions such as management of facial palsies and craniofacial disharmony/anomalies. Recent advances in lower-cost, non-invasive imaging and computing power (surface scanning, Cone Beam Computerized Tomography (CBCT) and Magnetic Resonance (MRI)) has enabled the ability to capture and process surface and internal structures to a high resolution. The three-dimensional surface facial capture has enabled characterization of facial features all of which will influence subtleties in facial movement and surgical planning. This chapter will describe the factors that influence facial morphology in terms of gender and age differences, facial movement—surface and underlying structures, modeling based on average structures, orientation of facial muscle fibers, biomechanics of movement—proof of principle and surgical intervention