Review of Experimental Work in Biomimetic Foils

Significant progress has been made in understanding some of the basic mechanisms of force production and flow manipulation in oscillating foils for underwater use. Biomimetic observations, however, show that there is a lot more to be learned, since many of the functions and details of fish fins remain unexplored. This review focuses primarily on experimental studies on some of the, at least partially understood, mechanisms, which include 1) the formation of streets of vortices around and behind two- and three-dimensional propulsive oscillating foils; 2) the formation of vortical structures around and behind two- and three-dimensional foils used for maneuvering, hovering, or fast-starting; 3) the formation of leading-edge vortices in flapping foils, under steady flapping or transient conditions; 4) the interaction of foils with oncoming, externally generated vorticity; multiple foils, or foils operating near a body or wall

Physical forcing and physical/biochemical variability of the Mediterranean Sea: a review of unresolved issues and directions for future research

This paper is the outcome of a workshop held in Rome in November 2011 on the occasion of the 25th anniversary of the POEM (Physical Oceanography of the Eastern Mediterranean) program. In the workshop discussions, a number of unresolved issues were identified for the physical and biogeochemical properties of the Mediterranean Sea as a whole, i.e., comprising the Western and Eastern sub-basins. Over the successive two years, the related ideas were discussed among the group of scientists who participated in the workshop and who have contributed to the writing of this paper. Three major topics were identified, each of them being the object of a section divided into a number of different sub-sections, each addressing a specific physical, chemical or biological issue: 1. Assessment of basin-wide physical/biochemical properties, of their variability and interactions. 2. Relative importance of external forcing functions (wind stress, heat/moisture fluxes, forcing through straits) vs. internal variability. 3. Shelf/deep sea interactions and exchanges of physical/biogeochemical properties and how they affect the sub-basin circulation and property distribution. Furthermore, a number of unresolved scientific/methodological issues were also identified and are reported in each sub-section after a short discussion of the present knowledge. They represent the collegial consensus of the scientists contributing to the paper. Naturally, the unresolved issues presented here constitute the choice of the authors and therefore they may not be exhaustive and/or complete. The overall goal is to stimulate a broader interdisciplinary discussion among the scientists of the Mediterranean oceanographic community, leading to enhanced collaborative efforts and exciting future discoveries

The mental health care system for children and adolescents in Greece: a review and structure assessment

Background: The mental health system in Greece faces challenges to complete its transition to a community-oriented model, having significant concerns for child and adolescent care due to lower coverage and service gaps. This component of the mental health system has not been comprehensively evaluated. Methods: We conducted a review of the mental health care system for children and adolescents in Greece. For a field assessment, we directly collected data from mental health services to map availability and distribution. We analyzed the needs of human resources using professional register data and the national census. Results: The National Health Care Service (ESY, Εθνικό Σύστημα Υγείας) is the public health system in Greece, characterized by public governance but significant private participation. Although ESY aims for universal care, gaps in population coverage and high user fees create barriers to access. Embedded within ESY, the mental health system is shifting towards a community-oriented structure since the psychiatric reform. For children and adolescents, there is a developing framework for regionalization and community services, including day centers, inpatient facilities, outpatient departments, and school-based psychoeducational facilities. However, services lack coordination in a stepped care model. Patient pathways are not established and primary care rarely involves child mental health, leading to direct access to specialists. Services operate in isolation due to the absence of online registers. There is no systematic performance monitoring, yet some assessments indicate that professional practices may lack evidence-based guidelines. Our mapping highlighted a scarcity of public structures, with an unbalanced regional distribution and many underserved areas. Child and adolescent psychiatrists are predominantly affiliated with the private sector, leading to professional gaps in the public system. Conclusions: Our assessment identifies an established framework for a community-oriented, universally accessible mental health system, yet several barriers impede its full realization. These include an inconsistent primary healthcare system, a shortage of specialists in the public sector, imbalanced service distribution, lack of coordination among providers, underfunding, and absence of quality monitoring. We propose interventions to promote child and adolescent mental health in primary care, coordinate patient pathways, establish standards of care, and monitor performance

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Ψυχοδυναμικά και ψυχοπαθολογικά χαρακτηριστικά υποτύπων της Οριακής Διαταραχής Προσωπικότητας: συστηματική ανασκόπηση ερευνών και ανάλυση λανθάνοντος προφίλ

Η οριακή διαταραχή προσωπικότητας (ΟΔΠ), από τα πρώτα χρόνια εμφάνισης του όρου, έως και σήμερα, που η διάγνωσή της εδράζεται στα στενά καθορισμένα κριτήρια του DSM, βρίσκεται διαρκώς σε μια προσπάθεια ορισμού, επανακαθορισμού, και διερεύνησης της ετερογένειας που χαρακτηρίζει τόσο τα συμπτώματα, όσο και τα άτομα που φέρουν τη διαταραχή. Mε σκοπό τη μεγαλύτερη κατανόηση της ετερογένειας της ΟΔΠ όπως έχει μελετηθεί ως σήμερα, διενεργήθηκαν δύο συστηματικές ανασκοπήσεις, με σκοπό τον εντοπισμό και τη συγκριτική αξιολόγηση των ευρημάτων, των μελετών που διερεύνησαν τη δομή των κριτηρίων της ΟΔΠ κατά DSM, με τη χρήση μεθόδων παραγοντικής ανάλυσης (έρευνα εστιασμένη στις μεταβλητές), και των μελετών που διερεύνησαν την ύπαρξη υποτύπων της ΟΔΠ, με τη χρήση μεθόδων ανάλυσης συστάδων (έρευνα εστιασμένη στα άτομα). Όσον αφορά τις υποκείμενες διαστάσεις της ΟΔΠ, τα συγκριτικά αποτελέσματα επιβεβαιώνουν τόσο τη μονοπαραγοντική δομή της ΟΔΠ, όσο και μία δομή τριών παραγόντων (διαταραγμένες σχέσεις, συμπεριφορική απορρύθμιση και συναισθηματική απορρύθμιση). Οι έρευνες που μελέτησαν υποτύπους της ΟΔΠ, εστίασαν σε προεξέχοντα χαρακτηριστικά της διαταραχής, και φαίνεται να επιβεβαιώνουν τις θεωρητικές παρατηρήσεις ύπαρξης ενός εσωτερικευτικού και ενός εξωτερικευτικού υποτύπου της ΟΔΠ, αλλά και την ύπαρξη περισσότερο και λιγότερο επιβαρυμένων υποτύπων της διαταραχής. Με σκοπό τη διερεύνηση της ύπαρξης υποτύπων σε ελληνικό πληθυσμό, πραγματοποιήθηκε ανάλυση λανθάνοντος προφίλ, με βάση τα διαστασιακά χαρακτηριστικά διαταραχών προσωπικότητας σε άτομα με ΟΔΠ που παρακολουθούνταν στα ειδικά ιατρεία του Αιγινητείου, Αττικού, και Σισμανογλείου νοσοκομείου (Ν=160). Με συμφωνία των δεικτών AIC, BIC, CAIC, SABIC και BLRT, επιλέχθηκε ένα μοντέλο πέντε προφίλ, τα οποία ονομάστηκαν Αμιγώς οριακός, Εξωστρεφής, Ανασφαλής, Σοβαρά επιβαρυμένος και Εκκεντρικός υποτύπος. Οι υποτύποι στη συνέχεια συγκρίθηκαν ως προς τα ψυχοδυναμικά και ψυχοπαθολογικά χαρακτηριστικά τους μέσω παραμετρικών ή μη-παραμετρικών ANOVA, και post-hoc αναλύσεων κατά ζεύγη. Τα αποτελέσματα υποδεικνύουν ότι ο Αμιγώς οριακός υποτύπος (n=37), εμφανίζει λίγα χαρακτηριστικά άλλων διαταραχών προσωπικότητας, ηπιότερη ψυχοπαθολογία, και είναι καλύτερα συγκροτημένος σε ψυχοδυναμικό επίπεδο. Στον αντίποδα, ο Σοβαρά επιβαρυμένος υποτύπος (n=27), καταγράφει υψηλές τιμές στις περισσότερες διαταραχές προσωπικότητας, φέρει περισσότερα ψυχοπαθολογικά συμπτώματα και βαρύτερη ΟΔΠ, ενώ παράλληλα εμφανίζει περισσότερες ανώριμες άμυνες, υψηλότερη αβεβαιότητα στην αναστοχαστική λειτουργία και επιβαρυμένη διαπροσωπική λειτουργικότητα. Ο Εξωστρεφής υποτύπος (n=33), χαρακτηρίζεται από ιστριονικά και ναρκισσιστικά στοιχεία, φέρει συγκριτικά ηπιότερη ψυχοπαθολογία, ωστόσο εμφανίζει υψηλή χρήση ανώριμων αμυνών κι ένα διαπροσωπικό προφίλ που δομείται στη διάσταση της κυριαρχίας. Ο Ανασφαλής υποτύπος (n=27), χαρακτηρίζεται κυρίως από αποφευκτικά και εξαρτητικά στοιχεία, εμφανίζοντας συγκριτικά μεγαλύτερα ποσοστά κατάθλιψης, φοβίας και διαπροσωπικής ευαισθησίας. Η αμυντική του λειτουργία είναι σχετικά δομημένη, ωστόσο εμφανίζει περισσότερα διαπροσωπικά προβλήματα, στις διαστάσεις της υπέρμετρης ενδοτικότητας, της έλλειψης πρωτοβουλίας και της κοινωνικής συστολής. Ο Εκκεντρικός υποτύπος (n=36), φέρει συγκριτικά περισσότερα παρανοειδή και σχιζότυπα, και χαμηλότερα εξαρτητικά στοιχεία, και εμφανίζει μέση λειτουργία της προσωπικότητας, με σχετικά υψηλή ψυχοπαθολογική επιβάρυνση. Η έρευνα υποτύπων της ΟΔΠ, αναμένεται να διευρύνει την κατανόηση των κλινικών για τη διαταραχή, και να συνεισφέρει στην εξατομικευμένη αντιμετώπιση των ασθενών.Borderline personality disorder (BPD), from its first appearance as a psychoanalytic or a psychiatric construct, and up to the current understanding of the disorder within the well-circumscibed boundaries of the DSM diagnosis, continues to be the subject of re-definition and exploration of the marked heterogeneity that underlies the symptoms and separates the individuals with the disorder. To further the understanding of BPD heterogeneity, two systematic reviews were conducted to identify and critically appraise studies that either investigated the structure of BPD criteria, using factor analytic methods, or the possible existence of BPD subtypes, using cluster analytic methods. In terms of the underlying BPD dimensions, the comparative results provide support for both the unidimensional and a three-dimensional structure of the DSM criteria, the latter consisting of the Disturbed relationships, Emotional dysregulation, and Behavioral dysregulation dimensions. Studies examining BPD subtypes, have focused on salient features of the disorder, and appear to confirm the theoretical observations regarding the existence of an internalizing and an externalizing BPD subtype, as well as the existence of more adaptive and more disruptive subtypes of the disorder. With the aim of exploring the possible existence of BPD subtypes in a Greek adult population, a latent profile analysis based on the dimensional characteristics of personality disorders, was conducted in outpatients with a BPD diagnosis, being treated at the Aiginiteio, Attiko, and Sismanogleio Hospital (N=160). AIC, BIC, CAIC, SABIC and BLRT values favoured a five-profile model, with the profiles named Pure borderline, Externalizing, Insecure, Severely burdened and Eccentric subtype. The subtypes were then compared on psychopathological and psychodynamic variables using parametric or non-parametric ANOVAS, followed by post-hoc pairwise analyses. The Pure borderline subtype (n=37), displays fewer traits of other personality disorders, experiences less psychopathology and appears to be better adjusted on a psychodynamic level. On the other hand, the Severely burdened subtype (n=27), displays a variety of other personality disorder traits, comparatively more psychopathology, including severe BPD symptoms, uses more immature defenses, faces more interpersonal problems and is characterized by greater reflective functioning uncertainty. The Externalizing subtype (n=33), is characterized by more histrionic and narcissistic features, experiences comparatively less psychopathology, uses more immature defenses and has a dominant interpersonal profile. The Insecure subtype (n=27), shows more avoidant and dependent characteristics, while experiencing comparatively more depressive and phobic symptoms. While its defense structure is relatively neurotic, the Insecure subtype experiences more interpersonal problems, being overly accommodating, non-assertive and socially inhibited. The Eccentric subtype (n=36), exhibits more paranoid and schizotypal traits, less dependent traits, and is placed in-between the more and less adapted subtypes in terms of personality organization, while experiencing relatively more psychopathology. Studies exploring BPD subtypes, are expected to broaden the clinicians’ perceptions of the disorder, and contribute to the individualized treatment of people with BPD

Unveiling the Layers of Borderline Personality Disorder: A Systematic Review of Clinical Subtypes

Background: Borderline personality disorder (BPD) is characterised by significant clinical heterogeneity. Classifying subtypes of BPD may offer deeper insights into the disorder’s complexity and inform more tailored therapeutic strategies. The exploration of data-driven subtyping using cluster-analytic approaches represents a promising avenue for capturing variability in symptomatology and comorbidity profiles. Aim: This systematic review aims to synthesise and critically evaluate the empirical studies that have applied cluster-analytic methods to identify subtypes of BPD in adult populations. It further assesses the consistency of findings and their alignment with theoretical models of the disorder. Methods: A comprehensive search of PubMed, Scopus, and PsycNet was conducted in accordance with the PRISMA guidelines. Eligible studies employed either traditional or probabilistic clustering techniques to classify adult individuals diagnosed with BPD based on the DSM criteria. A total of 29 studies, encompassing 24,345 participants, met the inclusion criteria. The study quality and risk of bias were assessed using the AXIS tool. Results: Most studies identified clinically meaningful BPD subtypes based on dimensions such as affective regulation, effortful control, interpersonal style, and impulsivity or aggression. Several findings supported the existence of internalizing and externalizing profiles, which converge with long-standing theoretical conceptualisations of BPD. However, substantial heterogeneity was observed in subtyping bases, sample characteristics, and analytic procedures. Discussion: Although this review highlights the recurring subtype patterns, the methodological inconsistencies and a lack of longitudinal and treatment-outcome data limit the strength of the conclusions. The future research should prioritise standardised subtyping frameworks and explore the prognostic and therapeutic utility of BPD subtypes in clinical settings

Hip Injuries in Dancer Athletes Due to Biomechanical Loading: A Systematic Review

Professional dancers are susceptible to lower limb pathologies, particularly in the hip joint, due to biomechanical stress. Multiple factors contribute to this, requiring a particular therapeutic approach to address them. This review aims to document these injuries, identify the contributing causes, and propose appropriate treatment modalities. This research was conducted by searching the PubMed, ScienceDirect, and Google Scholar databases using relevant keywords and phrases, and in accordance with the PRISMA guidelines. The major findings suggest that the most prevalent conditions include snapping hip syndrome, femoroacetabular impingement syndrome, acetabular labral tears, bursitis, and fatigue fractures. The main factors contributing to these results include excessive joint range of motion, increased training loads, hyperactivity, gender, and BMI. Dancers are susceptible to injuries; nevertheless, studies on this topic are limited, necessitating further research to strengthen their methodological level and establish their results