Simple Scaling Research Articles

International validation of a novel PEACE scale to improve the quality of upper gastrointestinal mucosal inspection during endoscopy

Objectives: The performance of a high quality esophagogastroduodenoscopy (EGD) is dependent on the mucosal cleanliness. Recently, the PEACE scale was created to assess degree of mucosal cleanliness during EGD. The aim of this study was to validate this scoring system in a cohort of international endoscopists. Methods: 39 EGD videos, with different degrees of mucosal cleanliness were retrieved from a previously conducted prospective trial. All experts rated the cleanliness of the mucosa on each video using the PEACE scale. To evaluate agreement of all scores (0 – 3), intraclass correlation coefficient (ICC 2.1) was used. The agreement on adequate (scores 2 and 3) and inadequate (scores 0 and 1) cleanliness was assessed using kappa values. Results: Videos evaluating esophagus, stomach, and duodenum cleanliness were reviewed by 16 endoscopists. The PEACE scores demonstrated good agreement (ICC 0.82, 95% CI 0.75 – 0.89), especially for esophagus (0.84; 95%CI 0.71 – 0.95) and stomach (0.81; 95%CI 0.69 – 0.91); while agreement was moderate for the duodenum (0.69; 95%CI 0.51 – 0.87). The agreement was similar between Eastern (0.86; 95%CI 0.79 – 0.92) and Western experts (0.80; 95%CI 0.72 – 0.88). Similarly, agreement regarding adequate cleanliness was comparable between Eastern (0.70; 95%CI 0.55 – 0.85) and Western (0.74; 95%CI 0.64 – 0.84) endoscopists being overall 0.75 (95%CI 0.65 – 0.85). Conclusions: The PEACE scoring system is a simple and reliable scale to assess the cleanliness during EGD. The score is now validated among international experts with high concordance, justifying its use in clinical practice.

Liquid pinching dynamics in an inertial transitioning regime

The pinching of a liquid filament at low viscosity, whether in air or liquid, shows a rich and interesting behavior. The liquid thread thins according to a capillary-inertial regime power law at the beginning, before transitioning into other regimes when approaching the pinching moment. Here we study the pinching of a pendant drop revealing the effect of internal and external viscosity on thread thinning. We show an inertial transitioning regime in which slower thinning happens by slightly increasing not only the droplet viscosity but also the viscosity of the surrounding liquid. The viscosity is found to reduce the filament neck axial velocity leading to a slower thinning. We derive a simple universal scaling law that can predict the thinning inertial prefactor value as a function of the neck axial velocity showing excellent agreement with numerical data. Finally, the breakup of satellite droplets is characterized given the defined thinning regimes. Published by the American Physical Society 2024

Simple Scaling as a Tool to Help Assess the Closure-Free da/dN Versus ΔKeff Curve in a Range of Materials

Recent studies have proposed a simple formula, which is based on Elber’s original approach to account for R-ratio effects, for determining the crack closure-free ΔKeff versus da/dN curve from the measured R-ratio-dependent ΔK versus da/dN curves. This approach, which is termed “Simple Scaling,” has been shown to collapse the various R-ratio-dependent curves onto a single curve. Indeed, this approach has been verified for a number of tests on metals, polymers, and a medium-entropy alloy. However, it has not yet been used to help assess/determine the closure-free ΔKeff versus da/dN curve. The current paper addresses this shortcoming and illustrates how to use this methodology to assess the ΔKeff versus da/dN curves given in the open literature for tests on a number of steels, aluminum alloys, STOA Ti-6Al-4V, a magnesium alloy, and Rene 95. As such, it would appear to be a useful tool for assessing fatigue crack growth.

The Influence of Perspective on Perception: Assessing Residue Across Planes of Videofluoroscopy.

(1) To determine whether perception of pharyngeal residue severity differs by view plane on videofluoroscopy. (2) To explore whether the Bolus Clearance Ratio (BCR) can be reliably applied in the anterior-posterior (AP) plane. (3) To investigate the relationship between perception of residue severity and BCR measures across view planes. Images of the same bolus condition in lateral and AP were rated using a simple 5-point ordinal descriptive scale (none, trace, mild, moderate, severe) by 225 speech-language pathologists via electronic survey. BCR measures were obtained for the same set of images from four trained raters. Wilcoxon signed-rank tests and cumulative mixed modeling were used to compare ratings by plane. BCR reliability was calculated using intraclass correlation coefficients. Perceptual ratings were compared with BCR measures using Spearman correlations. (1) Perception of residue severity was not consistent across plane in 9/10 image pairs (p < 0.05), with a significant fixed effect of plane on severity rating (β = 0.41; z = 7.27; p < 0.001). The directionality of differences varied by case. (2) Inter-rater reliability for BCR measures was good across lateral (intraclass correlation coefficient [ICC] = 0.82) and AP (ICC = 0.87) planes, with superior intra-rater reliability in AP (lateral ICC = 0.85; AP ICC = 0.98). (3) There was a strong positive correlation between perceptual ratings and BCR measures in both planes. Perception of pharyngeal residue severity differs between lateral and AP planes with inconsistent directionality raising important questions about the clinical implications of single plane studies. The BCR shows good-excellent reliability and strong correlation with perception across planes, offering a promising method for cross-plane quantification. Level III, diagnostic study with a gold standard Laryngoscope, 2024.

Large Eddy Simulation of large-scale hydrogen deflagrations using the Thickened Flame Model with stretch sensitivity adaptation and thermo-diffusive instability modeling

Due to the high costs associated to experimental testing of hydrogen (H2) explosions, numerical simulations play an essential role in the design of safe industrial systems. In this work, we investigate the use of the Thickened Flame Model (TFM) to perform simulations of H2 deflagrations. Specific issues arise when considering hydrogen: (i) due to differential diffusion, the flame is very sensitive to stretch; (ii) instabilities of the flame front are generated and lead to an increased flame propagation speed. Both of these phenomena are affected by flame thickening. First, the flame sensitivity to stretch is artificially increased by the thickening. The recently developed Ma-TFM model proposes a correction of diffusive fluxes to reach the correct Markstein length and is selected in this work. Secondly, thermo-diffusive and hydrodynamic flame instabilities are also altered by thickening. By computing the dispersion relationship for a hydrogen/air mixture, we show that the instability scales are proportional to the thickening factor F. A simple subgrid scale (SGS) model, based on the computations of laminar unstable 2-D and 3-D flames, is then considered to take into account the effect of instabilities. The Ma-TFM and SGS instability models are applied together for the first time on a semi-industrial vented lean hydrogen deflagration, leading to promising results. In particular, it is found that considering 3-D unstable flames is necessary to accurately predict the experimental pressure peaks.

Deltopectoral approach without subscapularis detachment for reverse shoulder arthroplasty. Technique and results of a safe and reproducible subscapularis-sparing approach

AimsThe importance of the subscapularis for reverse total shoulder arthroplasty (rTSA) has been demonstrated, especially for internal rotation and stability. In a deltopectoral approach, a detachment of the subscapularis is performed (tenotomy, tuberosity peeling or osteotomy) but the tendon is not always repairable at the end. When it is repaired, healing is obtained in only 40% to 76% of the cases, with potential consequences for the outcomes. The Anterior Muscle-Sparing (AMS) approach is a deltopectoral approach with preservation of the subscapularis, providing a solution to these problems. We present the surgical technique and results. MethodsIn a retrospective study, we included our first 45 cases of rTSA performed with the AMS approach for a degenerative affection of the shoulder (massive rotator cuff tear, cuff tear arthropathy, primary glenohumeral arthritis, rheumatoid arthritis), excluding traumatic and revision cases. The subscapularis was intact in all the cases. The mean age at inclusion was 74.1 years. No patients were lost at the minimum 24-month follow-up. All the patients underwent a clinical evaluation preoperatively and at the last follow-up, including Constant score, simple shoulder value (SSV), pain scale, and range of motion. An X-ray evaluation was conducted postoperatively and at the last follow-up to assess implant positioning and evolution. ResultsThere was no intraoperative complication, and the mean operative time was 62 minutes. We observed a significant improvement in Constant score (from 36 to 70, p <.001), SSV (from 33 to 81, p <.001), pain (from 6.3 to 0.7, p <.001), strength (from 0.5 to 3.5, p <.001), and most of the active mobilities. Regarding internal rotation, 95% of the patients reached level L3 or higher. Glenoid positioning was considered optimal in more than 90% of the cases (inferior tilt and low position) without any occurrence of superior tilt or high position. The osteophytes could be totally removed in 8 out of 9 cases (88.9%). Six postoperative complications (13.3%) were reported: 1 infection (2.2%), 2 cases of traumatic glenoid loosening (4.4%), 2 acromion fractures (4.4%), and 1 hematoma (2.2%). There was no instability. Eighty percent of the patients could return home, with a mean hospital stay of 1.8 days. ConclusionThe AMS approach is a safe and reproducible technique. The preservation of the subscapularis has potential benefits regarding internal rotation and stability. In the absence of tendon suture, rehabilitation can be started immediately without motion restriction, allowing for a fast recovery and return to autonomy.

Psychometric Properties of the German Version of the Benzodiazepine Dependence Self-Report Questionnaire

AbstractTo facilitate measurement and screening of benzodiazepine/Z-drug dependence, the Dutch “Benzodiazepine Dependence Self-Report Questionnaire” was translated into German (Bendep-SRQ-GV) and psychometrically evaluated. A cross-sectional online study with 343 benzodiazepine/Z-drug users was conducted. Structural validity and reliability were assessed using confirmatory factor analysis, while convergent validity was evaluated through correlation and receiver operating characteristic analyses with the “Severity of Dependence Scale” (SDS). Furthermore, the use of simple sum subscale and total scale scores was reviewed. A model with four first-order factors and one second-order factor fitted the data best. The questionnaire showed good to excellent reliability. The scores correlated satisfactorily with the model-based factor scores and the SDS, indicating good convergent validity and supporting the use of simple sum scores. The study provided strong evidence for the validity and reliability of the Bendep-SRQ-GV as a measure of benzodiazepine/Z-drug dependence, which represents a significant step towards developing a multidimensional screening tool.

Scaling Relationships of the Structural and Rheological Behavior of Tadpole Polymer Chains in Dilute Solution Systems Using Brownian Dynamics Simulations.

Tadpole polymers, also known as lasso polymers, feature molecular structures that combine a single ring with a single linear side branch, leading to distinct conformational, dynamical, and rheological characteristics compared to their corresponding counterparts, particularly pure linear and pure ring polymers. To elucidate the mechanisms underlying these distinctive behaviors, comprehensive mesoscopic Brownian dynamics (BD) simulations of dilute solution systems of tadpole polymers were conducted using a bead-rod chain model under both equilibrium and flow conditions. Three types of tadpole polymer chains were prepared by varying the ring-to-linear ratio within the tadpole chain and comparing them with the corresponding linear and ring chains. Depending on this ratio, tadpole polymer chains exhibit entirely different structural properties and rotational dynamics, both in equilibrium and under shear flow. As the linear proportion within the tadpole chain increased, the structural, dynamic, and rheological properties of the tadpole polymer chains became more similar to those of pure linear polymers. Conversely, with an increasing ring proportion, these properties began to resemble those of pure ring polymers. Based on these observed tendencies, a simple general scaling expression is proposed for tadpole polymer properties that integrates scaling expressions for both pure linear and pure ring polymers. Our results indicate that the conformational, dynamic, and rheological properties of tadpole polymers, as predicted by these simple scaling expressions, are in good agreement with the simulated values, a result we consider statistically significant.

Estimating and Modeling Pinus contorta Transpiration in a Montane Meadow Using Sap-Flow Measurements

This study quantifies the transpiration of encroached lodgepole pine (Pinus contorta var. murryana (Grev. &amp; Balf.) Engelm.) in a montane meadow using pre-restoration sap-flow measurements. Lodgepole pine transpiration and its response to environmental variables were examined in Rock Creek Meadow (RCM), Southern Cascade Range, CA, USA. Sap-flow data from lodgepole pines were scaled to the meadow using tree survey data and then validated with MODIS evapotranspiration estimates for the 2019 and 2020 growing seasons. A modified Jarvis–Stewart model calibrated to 2020 sap-flow data analyzed lodgepole pine transpiration’s correlation with solar radiation, air temperature, vapor pressure deficit, and soil volumetric water content. Model validation utilized 2021 growing season sap-flow data. Calibration and validation employed a Markov Chain Monte Carlo (MCMC) approach through the DREAM(ZS) algorithm with a generalized likelihood (GL) function, enabling parameter and total uncertainty assessment. The model’s scaling was compared with simple scaling estimates. Average lodgepole pine transpiration at RCM ranged between 220.6 ± 25.3 and 393.4 ± 45.7 mm for the campaign (mid-July 2019 to mid-August 2020) and 100.2 ± 11.5 to 178.8 ± 20.7 mm for the 2020 partial growing season (April to mid-August), akin to MODIS ET. The model aligned well with observed normalized sap-velocity during the 2020 growing season (RMSE = 0.087). However, sap-velocity, on average, was underpredicted by the model (PBIAS = −6.579%). Model validation mirrored calibration in performance metrics (RMSE = 0.1233; PBIAS = −2.873%). The 95% total predictive uncertainty confidence intervals generated by GL-DREAM(ZS) enveloped close to the theoretically expected 95% of total observations for the calibration (94.5%) and validation (81.8%) periods. The performance of the GL-DREAM(ZS) approach and uncertainty assessment in this study shows promise for future MJS model applications, and the model-derived 2020 transpiration estimates highlight the MJS model utility for scaling sap-flow measurements from individual trees to stands of trees.

The Impact of Parenting Styles of University Students' Parents on Parent-Child Relationships, and The Mediating Role of Neurotic Personality Traits

This paper aims to explore the influence of college students' parenting style on parent-child relationship and neurotic peopleWhether the lattice plays an intermediary role in it. Methods: Simple parenting style scale and parent-child relationship quantity were used. The questionnaire and the Big Five Personality Scale were used to investigate college students. Results: (1) Parental rearing of college students. There was a significant positive correlation between style and parent-child relationship (p&lt;0.01). Neurotic personality and parent-child relationship There was a significant positive correlation (p&lt;0.01) .Neurotic personality and parenting style existed A significant positive correlation. (4) There were gender differences in college students' parenting styles (t=2.351, p&lt;0.05). The score of male students' parenting style is slightly higher than that of college students' (5) Parenting style does not exist in the grade (6) The neurotic personality of college students is partly related to the parenting style and personal relationship Mediating effect.

Sedative effects of intramuscular alfaxalone–methadone–midazolam versus ketamine–methadone–midazolam in cats

ObjectiveTo assess depth and quality of sedation and the ability to place an intravenous catheter in cats after intramuscular (IM) injection with alfaxalone–methadone–midazolam (AMM) or ketamine–methadone–midazolam (KMM). Study designBlinded randomized clinical trial. AnimalsA group of 46 healthy Domestic Short Hair cats. MethodsCats were randomly assigned to be administered IM methadone 0.3 mg kg–1 and midazolam 0.3 mg kg–1 with either alfaxalone 2 mg kg–1 (AMM group, n = 23) or ketamine 3 mg kg–1 (KMM group, n = 23). Before IM injection, a temperament score was assigned. The reaction to injection was scored. After 15 minutes, the depth of sedation was scored using a simple descriptive scale (SDS) and multidimensional sedation score. Success or failure to place an intravenous catheter at first attempt was recorded; p < 0.05. ResultsCats in the AMM group had a significantly higher median temperament score (p = 0.026). Behavioural reaction to injection with AMM was significantly less compared with KMM (p = 0.016). Median sedation scores were significantly higher in the AMM group than in the KMM group: SDS 4 (0–4) versus 2 (0–4), p = 0.01, respectively; multidimensional sedation score AMM 13 (0–13) versus 3 (0–10), indicating superior sedative effect in the AMM group, p = 0.01. Success rate of catheter placement was significantly higher in the AMM group (18/23) than in the KMM group (10/23), p = 0.033. Conclusionsand clinical relevance Addition of 2 mg kg–1 alfaxalone to 0.3 mg kg–1 methadone and 0.3 mg kg–1 midazolam provided better sedation after IM injection than ketamine 3 mg kg–1 combined with the same doses of methadone and midazolam. This combination of drugs may be particularly desirable as an alternative to α-2 adrenoceptor agonist-based protocols for cats requiring IM sedation.

Snap-through eversion of axisymmetric shells under contact indentation

In this paper, we systematically investigate the stability of an axisymmetric shell and the snap-through eversion induced by indentation through a discrete numerical approach. To capture the intricate interplay between the geometric and boundary nonlinearities during contact actuation, we employ the discrete axisymmetric shell model accompanied by the incremental potential formulation for our analysis. Our results reveal that the indentation response of a spherical shell can be classified into three groups, i.e. monotonous, monostable and bistable behaviours, whose boundaries can be characterized by a simple scaling law. We further discover that, for bistable shells, the snap-through eversion happens at a critical state where the configurations are universal, which is independent of the indenter size and can be captured by a simple geometric model. One interesting prediction of our model is that, with increasing indenter size, the contact state between the shell and indenter changes from conformal contact to partial separation, which is validated by a finite element method simulation. Our findings may provide explanations for some biophysical phenomena (e.g. cell fusion) and can also guide optimal designs of intelligent structures (e.g. soft actuators and soft robots).

Prevalence of restless legs and association with patient-reported outcome measures in myasthenia gravis.

Inflammatory and immune mechanisms are considered in restless legs syndrome (RLS) pathophysiology with several autoimmune diseases associated with RLS. There is a paucity of studies examining RLS prevalence in myasthenia gravis (MG), an autoimmune neuromuscular disease. This study investigated RLS prevalence and association with patient-reported measures in a large registry of participants with MG using a validated RLS diagnostic questionnaire. The Myasthenia Gravis Foundation of America MG Patient Registry is used on a semi-annual basis to survey participants with MG. Patients aged ≥18 years, living in the United States, and answering "Yes" to physician diagnosed MG were invited by email to enroll in an RLS-customized web-based survey. Collection of data included demographics, disease variables, patient-reported measures with a simple depression scale, MG 15-item Quality of Life (MG-QOL15r), MG-Activities of Daily Living (MG-ADL) instruments, and 13-item short-form Cambridge-Hopkins diagnostic questionnaire for RLS (CH-RLSq13). Multivariable logistic regression models explored the association between RLS and MG variables of interest. 630 eligible participants with MG (age: 62.8±13.2; 54.9% female; 91.6% White) completed the survey. The overall prevalence of RLS was 14.8%. The prevalence of clinically significant RLS was 8.4%. The odds of having RLS were increased with higher (worse) MG-ADL, MG-QOL15r, and depression scores. History of "Thymic tumor with thymectomy" and "CPAP therapy" were also independent predictors of RLS. RLS is common in patients with MG and is associated with worse functional status, quality of life, and depression. The thymus could play a key role in an autoimmune process associating MG with RLS.

Host Material Viscoelasticity Determines Wrinkling of Fungal Films.

Microbial organisms react to their environment and are able to change it through biological and physical processes. For example, fungi exhibit various growth morphologies depending on their host material. Here, we show how the rheological properties of the host material influence the fungal wrinkling morphology. Rheological data of the host material was set in relation to the growth morphology. On host material with high storage modulus, the fungal film was flat, whereas on host material with low storage modulus, the fungus showed a morphology made of folds and wrinkles. We combined our findings with mechanical instability theories and found that the formation of wrinkles and folds is dependent on the storage modulus of the host material. The connection between the wrinkling morphology and the storage modulus of the host material is shown with simple scaling theories. The amplitude, number of wrinkles, and wrinkle length follow geometrical laws, and the mechanical properties of the fungal film are expected to increase with increasing host material elasticity. The obtained results show the connection between living biological films, how they react to their surroundings, and the underlying physical mechanisms. They can provide a framework to further design fungal materials with specific surface morphologies.

High-order accurate positivity-preserving and well-balanced discontinuous Galerkin schemes for ten-moment Gaussian closure equations with source terms

This paper proposes novel high-order accurate discontinuous Galerkin (DG) schemes for the one- and two-dimensional ten-moment Gaussian closure equations with source terms defined by a known potential function. Our DG schemes exhibit the desirable capability of being well-balanced (WB) for a known hydrostatic equilibrium state while simultaneously preserving positive density and positive-definite anisotropic pressure tensor. The well-balancedness is built on carefully modifying the solution states in the Harten–Lax–van Leer–contact (HLLC) flux, and appropriate reformulation and discretization of the source terms. Our novel modification technique overcomes the difficulties posed by the anisotropic effects, maintains the high-order accuracy, and ensures that the modified solution state remains within the physically admissible state set. We provide the rigorous positivity-preserving analyses of our WB DG schemes, based on several key properties of the admissible state set, the HLLC flux and the HLLC solver, as well as the geometric quasilinearization (GQL) approach in Wu and Shu (2023) [52], which was originally applied to analyze the admissible state set and the physical-constraints-preserving schemes for the relativistic magnetohydrodynamic equations in Wu and Tang (2017) [54], to address the difficulties arising from the nonlinear constraints on the pressure tensor. Moreover, the proposed WB DG schemes satisfy the weak positivity for the cell averages, implying the use of a simple scaling limiter to enforce the physical admissibility of the DG solution polynomials at certain points of interest. Extensive numerical experiments are conducted to validate the preservation of equilibrium states, accuracy in capturing small perturbations to such states, robustness in solving problems involving low density or low pressure, and high resolution for both smooth and discontinuous solutions.

A Simple Score Scale Composed of Serum Inflammatory Factors Assists in Psoriasis Arthritis Prediction among Patients with Psoriasis Vulgaris.

Aim: To compare the levels of serum inflammatory indicators in psoriasis vulgaris patients who progress to PsA and those not, as well as to establish and validate a simple score scale for predicting PsA for psoriasis vulgaris patients. Methods: A cross-sectional study was performed at a university hospital in China to recruit five hundred and seventy-seven patients who had been diagnosed with psoriasis vulgaris for at least 10 years. After evaluation, 86 were enrolled in the PsA group, and the others were selected as the control group. Eight serum inflammatory factors were detected and compared between the two groups. A simple score scale for PsA prediction was established and validated. Results: Serum CRP, IL-6, and TNF-α levels were significantly higher in the PsA group than in the control group. A simple score scale composed of CRP, IL-6, and TNF-α was established. The sensitivity was 59.30% and the specificity was 83.50% for predicting PsA among all psoriasis vulgaris patients when the cut-off value of the total score was set as 1.8 points. The simple score scale presented a predictive value for progressing to PsA among all psoriasis vulgaris patients internally (AUC = 0.788), and the performance was also conformed in psoriasis vulgaris patients receiving topical treatment (AUC = 0.746), systemic treatment (AUC = 0.747) and biological treatment (AUC = 0.808), respectively. The predictive performance of this scale was also validated by an external retrospective cohort (AUC = 0.686). Conclusions: CRP, IL-6, and TNF-α were potential indicators to recognize PsA risk in patients with psoriasis vulgaris. A simple score scale may provide new insights for early prediction of PsA among psoriasis vulgaris patients.

Spatial variations of annual net ecosystem productivity and its trend over Chinese terrestrial ecosystems based on spatial downscaling.

Annual net ecosystem productivity (NEP), the amount of net carbon sequestration during a year, serves as the basis of terrestrial carbon sink. Quantifying the spatial variations of NEP and its trend would enhance our understandings on the response and adaption of ecosystems to environmental change, which also serves for the regional carbon management targeting at carbon neutrality. Based on process-based model and data-driven model simulating NEP, we selected the optimal simulating NEP mostly representing NEP spatial variations with multiple site eddy covariance measurements to develop the spatial downscaling method and generate high resolution NEP data of China, which was used to examine the spatial variations of NEP and its trend and driving factors during 2000-2017. Compared with process-based model results, data-driven model simulating NEP could mostly represent the spatial variation of site measurements. The random forest regression based on climate, soil, and biological data combining with the simple scaling could successfully downscale NEP to a high spatial resolution. From 2000 to 2017, the total amount of NEP in China was (1.30±0.03) Pg C·a-1, showing a decreasing-increasing pattern with the inflection point in 2009. Chinese NEP decreased from southeast to northwest, showing a descending latitudinal distribution and an ascending longitudinal distribution, with the combined effects of climate and biotic factors. NEP trend decreased from east towards west, which was only accompanied with a slightly ascending longitudinal distribution, while photosynthetically active radiation and soil organic carbon content dominated the spatial variations of NEP trend. Therefore, the spatial patterns of generated NEP obviously differed from those of NEP trend, suggesting the obvious difference between the responses and adaptions of ecosystems to environmental changes.

Correlation of Velopharyngeal Score in Nasoendoscopy with Perceptual Speech Intelligibility of Patients with Cleft Palate

Background and Objective: One of the challenges patients with cleft palate face is the production of intelligible speech. Though instrumental assessment of velopharyngeal function is required, there is a need to correlate the results obtained with speech outcome. The objective of this study is to correlate the Golding-Kushner scale scoring system for velopharyngeal defects as observed on nasoendoscopy with patients’ speech intelligibility. Method: The design is an observational cross-sectional study conducted from December 2022 to May 2023. This study was carried out at the orofacial cleft clinic of a tertiary hospital. Participants: The study included English-speaking patients with cleft palate who had palatorrhaphy done at least 6 months before recruitment. Intervention: Speech intelligibility was measured using a simple analog scale that ranged from 0 to 5 (0—worst speech intelligibility possible, 5—best speech intelligibility). The Golding-Kushner scale is used to measure gap size (defect) in nasoendoscopy. Main outcome measures: The primary outcome is to correlate the score of speech intelligibility with the Golding-Kushner score during nasoendoscopy. Results: A total of 40 people participated in the study, with a median age of 11 years (IQR: 6.25-21.75 years). There is a moderately negative correlation between velopharyngeal gap size and speech intelligibility (correlation coefficient = −0.6, P &lt; .01). Only the size of the size of the gap is a significant predictor of speech intelligibility after cleft palate repair. Conclusion: There is a significant, moderate correlation between velopharyngeal gap size and speech intelligibility.

Scaling the Diurnal Mixing/Mixed Layer Depth in the Tropical Ocean: A Case Study in the South China Sea

AbstractThe diurnal cycling of the surface mixing/mixed layer (ML) depth, air‐sea heat flux, and vertical profiles of the temperature and turbulent kinetic energy dissipation rate in the tropical central South China Sea was observed in summer (June 2017) and winter (January 2018). In the daytime, solar heating warmed and stabilized the ML, and the thickness of the ML can be well characterized by the Zilitinkevich scale as noted in previous studies. By contrast, in the nighttime the ML was deepened by convective turbulence generated by surface cooling. Guided by these observations, we have derived a simple scaling for the nighttime deepening of the ML by simplifying the classic Kraus‐Turner type model. We show that the variation of the ML depth can be scaled by a function of the wind speed, air‐sea heat flux and the temporal variation of the sea surface temperature, all of which are observable variables at the sea surface. It is found that the scaling works well in reproducing observed variations of the ML depth from hydrographic data. As such, this study advances our understanding of the response of the upper ocean to atmospheric forcing and provides a simple way for predicting the ML depth with solely surface observations.

Analysis of the current status and associated risk factors of cognitive function in Tibetan hypertensive patients at various altitudes

ABSTRACT Objective This study aims to explore the current cognitive status and identify risk factors associated with cognitive function in Tibetan hypertensive patients living at various altitudes. Methods The Simple Mental Status Scale (MMSE) was used to evaluate the cognitive function of 611 Tibetan hypertensive patients at various altitudes in Gannan Tibetan Autonomous Prefecture. Afterward, we conducted an analysis to identify the factors influencing their cognitive function. Results The study found that the prevalence of cognitive dysfunction was 22.3%, with a higher incidence at high altitude (group D 29.0%) compared to low altitude (group A 16.0%). The study conducted a binary logistic regression analysis to identify the risk factors for cognitive dysfunction. The analysis revealed that altitude, age, body mass index, marital status, education, income level, and blood pressure control level were all significant risk factors. After controlling for age, body mass index, marital status, educational level, income level, and blood pressure control level, the risk of developing cognitive dysfunction was 2.773 times higher (p < .05) for individuals in group C at high altitude and 2.381 times higher (p < .05) for individuals in group D at high altitude compared to those in group A at low altitude. Conclusions Altitude plays a role in the development of cognitive dysfunction in hypertensive patients. Tibetan hypertensive patients living at high altitudes may be at a higher risk of cognitive dysfunction compared to those living at lower altitudes. Therefore, interventions should be targeted to prevent or mitigate potential cognitive impairment.