Jacobs (United Kingdom)

AIM: The "2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease" provides recommendations to guide clinicians in the treatment of patients with lower extremity peripheral artery disease across its multiple clinical presentation subsets (ie, asymptomatic, chronic symptomatic, chronic limb-threatening ischemia, and acute limb ischemia). METHODS: A comprehensive literature search was conducted from October 2020 to June 2022, encompassing studies, reviews, and other evidence conducted on human subjects that was published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through May 2023 during the peer review process, were also considered by the writing committee and added to the evidence tables where appropriate. STRUCTURE: Recommendations from the "2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease" have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with peripheral artery disease have been developed.

A scientific statement from the American Heart Association<br/>Keywords: cardiovascular diseases; health care evaluation mechanisms; health status; health surveys; patients

This book is designed to assist the civil and geotechnical engineer, geomorphologist, forester, landscape architect or ecologist in choosing ecotechnological solutions for slopes that are prone to a variety of mass movements e.g. shallow failure or erosion. Within this book, the 'engineer' is used in the global sense to encompass all planners, designers, etc who are involved in the stabilisation of slopes. We review the types of problematic slopes that may occur and describe briefly the nature of mass movements and the causes of these movements. In this book, we focus on the use of vegetation to stabilize soil on slopes prone to mass movements. Before a plant can be chosen for a particular function, its physical and hydrological properties must be determined, thus the root architecture of grasses, shrubs and trees are described and the soil hydrological and mechanical factors which influence vegetation are discussed. Depending on the use of the slope, the engineer may wish to ascertain either the stability of the slope or the mechanical stability of the vegetation or both, therefore slope stability analysis methods are reviewed and the contribution the vegetation has to the stability of the slope are explained. Models to assess the mechanical stability of vegetation are reviewed. This book also introduces new ecotechnological methods for stabilising active rockfalls on steep slopes and slopes that are prone to soil erosion following wild fires, as well as providing user friendly information on traditional ground bio-engineering techniques and tables of plants suitable for different functions. Case studies where ground bio- and eco-engineering measures have been put into practice are also discussed.

BACKGROUND: The high overall mortality from ovarian cancer (> 60%) relates, in part, to delays in diagnosis. When ovarian cancer is detected in stage I (International Federation of Gynecology and Obstetrics staging), up to 90% of patients can be cured. Transvaginal sonography can detect early-stage disease with great sensitivity, but it is expensive and lacks specificity. Although serum marker assays could provide a less expensive and more convenient initial screening test, the sensitivity of assays varies. Measurement of serum CA 125 in conjunction with ultrasound screening as a second-line test confers high specificity but detects only about one half of early stage ovarian carcinomas. PURPOSE: The purpose of this retrospective study was to determine whether assays of multiple serum markers would improve sensitivity by detecting a higher percentage of stage I ovarian cancers than the CA 125 assay alone. METHODS: Using immunoradiometric assays, we measured preoperative serum levels of CA 125 tumor-associated antigen, macrophage colony-stimulating factor (M-CSF), and OVX1 in 46 patients with stage I ovarian cancer of different histologies and 237 patients with benign pelvic masses. We also assayed sera from 204 apparently healthy women who had participated in a screening trial and remained free from cancer at 1 year of followup. All specimens were obtained from cryopreserved aliquots. Marker levels were considered to be elevated when levels of CA 125 were greater than 30 U/mL, M-CSF levels were greater than 3.1 ng/mL, or OVX1 levels were greater than 12.1 U/mL. RESULTS: At least one of the serum markers was elevated in 98% of patients with stage I ovarian cancer; CA 125 levels were elevated in 67%. By the same criteria, 11% of healthy individuals and 51% of patients with benign pelvic masses had at least one elevated marker value. Thus, the sensitivity of the combination of assays for the three serum markers was significantly greater than the sensitivity of the CA 125 assay (P < .0005) and specificity was moderate. CONCLUSION: A panel of these three tumor markers can identify early-stage ovarian cancer with extremely high sensitivity and moderate specificity. IMPLICATIONS: Elevation of one or more serum markers should be evaluated further as an indication for transvaginal sonography in apparently healthy women. Such a strategy might substantially reduce the expense and improve the specificity of screening compared to the use of ultrasound alone. Prospective studies with a large cohort of patients at high risk for ovarian cancer will be required to confirm these findings.

This paper discusses issues that are encountered in the modelling of the operational behaviour of pedestrians such as the representation of pedestrian street crossing movements and speed choice at a micro‐scale. A comprehensive literature review is undertaken for various parameters of pedestrian movement that are of fundamental importance in any pedestrian modelling approach. These parameters are pedestrian speeds, pedestrian speed--flow--density relationships, pedestrian compliance to traffic signals, and pedestrian gap acceptance while crossing the road. Based on the research evidence from the literature, a modelling framework for examining pedestrian speed choice is presented that postulates that pedestrian speed is a function of a pedestrian’s value of time, risk and capabilities.

Abstract In response to Defra's First Government Response to the Making Space for Water consultation, the Feasibility study into expanding flood warning to cover other flood risks (reference RF5) has investigated the technical feasibility of providing warning services for sources of flooding other than from rivers and the sea. Following a review of all nonfluvial and noncoastal sources of flooding perceived as significant, it was concluded that it is currently technically feasible to consider providing some form of warning service for pluvial and three forms of groundwater flooding. Although a warning service for pluvial flooding is considered less advanced than that for groundwater, a trigger rainfall forecast and a method for identifying locations most susceptible to pluvial flooding has been proposed. This form of service could provide responding organisations with more warning of possible flooding than is currently available.

Overland flow is an important component of peatland hydrology. Hydrological models of peatlands are being developed that require estimates of flow velocity and its controls. However, surprisingly little is known about overland flow velocities in peatlands. Some peatlands have also been drained using open ditches, and these need to be incorporated into flow models. This paper presents field data on the velocity of overland flow and drain flow in upland peatlands. The relationships between flow velocity, vegetation cover, slope, and water depth are explored. Sphagnum provided a significantly greater effective hydraulic roughness to overland flow than peatland grasses. In all cases, a significant break in process occurred for flows with water depths of around 1 cm so that there were two components of the roughness curve. This is consistent with partial submergence theory for very shallow flows where resistance increases with depth as the soil surface first becomes fully submerged. While each surface cover type should be considered separately, the results also suggest that a first‐order estimate of Darcy‐Weisbach roughness and mean velocity can be based on a single parameter for each surface cover. This paper presents an empirical overland flow velocity forecasting model that can be applied to peatlands. The model combines the partially submerged component for flows with water depths below 1 cm with the fully submerged component for flows with depths up to 5 cm, which are representative of the depths of flows that occur across peatlands.

Summary Understanding of the detailed mechanisms of how roots anchor in and reinforce soil is complicated by the variability and complexity of both materials. This study controlled material stiffness and architecture of root analogues, by using rubber and wood, and also employed real willow root segments, to investigate the effect on pullout resistance in wet and air‐dry sand. The architecture of model roots included either no laterals (tap‐root) or a single pair at two different locations (herringbone and dichotomous). During pullout tests, data on load and displacement were recorded. These studies were combined with Particle Image Velocimetry (PIV) image analysis of the model root‐soil system at a transparent interface during pullout to increase understanding of mechanical interactions along the root. Model rubber roots with small stiffness had increasing pullout resistance as the branching and the depth of the lateral roots increased. Similarly, with the stiff wooden root models, the models with lateral roots embedded deeper showed greatest resistance. PIV showed that rubber model roots mobilized their interface shear strength progressively whilst rigid roots mobilized it equally and more rapidly over the whole root length. Soil water suction increased the pullout resistance of the roots by increasing the effective stress and soil strength. Separate pullout tests conducted on willow root samples embedded in sand showed similar behaviour to the rigid model roots. These tests also demonstrated the effect of the root curvature and rough interface on the maximum pullout resistance.

Patients with lower-extremity peripheral artery disease (PAD) have greater functional impairment, faster functional decline, increased rates of mobility loss, and poorer quality of life than people without PAD. Supervised exercise therapy (SET) improves walking ability, overall functional status, and health-related quality of life in patients with symptomatic PAD. In 2017, the Centers for Medicare & Medicaid Services released a National Coverage Determination (CAG-00449N) for SET programs for patients with symptomatic PAD. This advisory provides a practical guide for delivering SET programs to patients with PAD according to Centers for Medicare & Medicaid Services criteria. It summarizes the Centers for Medicare & Medicaid Services process and requirements for referral and coverage of SET and provides guidance on how to implement SET for patients with PAD, including the SET protocol, options for outcome measurement, and transition to home-based exercise. This advisory is based on the guidelines established by the Centers for Medicare & Medicaid Services for Medicare beneficiaries in the United States and is intended to assist clinicians and administrators who are implementing SET programs for patients with PAD.

BACKGROUND: In 2008, the National Heart, Lung, and Blood Institute convened an Implementation Science Work Group to assess evidence-based strategies for effectively implementing clinical practice guidelines. This was part of a larger effort to update existing clinical practice guidelines on cholesterol, blood pressure, and overweight/obesity. OBJECTIVES: Review evidence from the published implementation science literature and identify effective or promising strategies to enhance the adoption and implementation of clinical practice guidelines. METHODS: This systematic review was conducted on 4 critical questions, each focusing on the adoption and effectiveness of 4 intervention strategies: (1) reminders, (2) educational outreach visits, (3) audit and feedback, and (4) provider incentives. A scoping review of the Rx for Change database of systematic reviews was used to identify promising guideline implementation interventions aimed at providers. Inclusion and exclusion criteria were developed a priori for each question, and the published literature was initially searched up to 2012, and then updated with a supplemental search to 2015. Two independent reviewers screened the returned citations to identify relevant reviews and rated the quality of each included review. RESULTS: Audit and feedback and educational outreach visits were generally effective in improving both process of care (15 of 21 reviews and 12 of 13 reviews, respectively) and clinical outcomes (7 of 12 reviews and 3 of 5 reviews, respectively). Provider incentives showed mixed effectiveness for improving both process of care (3 of 4 reviews) and clinical outcomes (3 reviews equally distributed between generally effective, mixed, and generally ineffective). Reminders showed mixed effectiveness for improving process of care outcomes (27 reviews with 11 mixed and 3 generally ineffective results) and were generally ineffective for clinical outcomes (18 reviews with 6 mixed and 9 generally ineffective results). Educational outreach visits (2 of 2 reviews), reminders (3 of 4 reviews), and provider incentives (1 of 1 review) were generally effective for cost reduction. Educational outreach visits (1 of 1 review) and provider incentives (1 of 1 review) were also generally effective for cost-effectiveness outcomes. Barriers to clinician adoption or adherence to guidelines included time constraints (8 reviews/overviews); limited staffing resources (2 overviews); timing (5 reviews/overviews); clinician skepticism (5 reviews/overviews); clinician knowledge of guidelines (4 reviews/overviews); and higher age of the clinician (1 overview). Facilitating factors included guideline characteristics such as format, resources, and end-user involvement (6 reviews/overviews); involving stakeholders (5 reviews/overviews); leadership support (5 reviews/overviews); scope of implementation (5 reviews/overviews); organizational culture such as multidisciplinary teams and low-baseline adherence (9 reviews/overviews); and electronic guidelines systems (3 reviews). CONCLUSION: The strategies of audit and feedback and educational outreach visits were generally effective in improving both process of care and clinical outcomes. Reminders and provider incentives showed mixed effectiveness, or were generally ineffective. No general conclusion could be reached about cost effectiveness, because of limitations in the evidence. Important gaps exist in the evidence on effectiveness of implementation interventions, especially regarding clinical outcomes, cost effectiveness and contextual issues affecting successful implementation.

Temporal dynamics have been increasingly recognized as an important component of facial expressions. With the need for appropriate stimuli in research and application, a range of databases of dynamic facial stimuli has been developed. The present article reviews the existing corpora and describes the key dimensions and properties of the available sets. This includes a discussion of conceptual features in terms of thematic issues in dataset construction as well as practical features which are of applied interest to stimulus usage. To identify the most influential sets, we further examine their citation rates and usage frequencies in existing studies. General limitations and implications for emotion research are noted and future directions for stimulus generation are outlined.

Chemotaxing Dictyostelium discoideum cells adapt their morphology and migration speed in response to intrinsic and extrinsic cues. Using Fourier traction force microscopy, we measured the spatiotemporal evolution of shape and traction stresses and constructed traction tension kymographs to analyze cell motility as a function of the dynamics of the cell's mechanically active traction adhesions. We show that wild-type cells migrate in a step-wise fashion, mainly forming stationary traction adhesions along their anterior-posterior axes and exerting strong contractile axial forces. We demonstrate that lateral forces are also important for motility, especially for migration on highly adhesive substrates. Analysis of two mutant strains lacking distinct actin cross-linkers (mhcA(-) and abp120(-) cells) on normal and highly adhesive substrates supports a key role for lateral contractions in amoeboid cell motility, whereas the differences in their traction adhesion dynamics suggest that these two strains use distinct mechanisms to achieve migration. Finally, we provide evidence that the above patterns of migration may be conserved in mammalian amoeboid cells.

The combustion of fossil fuels for energy generation has contributed considerably to the effects of climate change. In order to reduce fossil fuel consumption, designers are increasingly seeking to reduce the energy consumption of products over their life cycle. To achieve a significant reduction in energy consumption, it is essential that energy considerations are incorporated within the design phase of a product, since the majority a product's environmental impact is determined during this phase. This work proposes a new ‘Design for Energy Minimization’ (DfEM) approach, which is intended to provide increased transparency with respect to the energy consumed during manufacture in order to help inform design decisions. An energy simulation model based on this approach is then presented to aid designers during the design phase. The application of this novel design tool is demonstrated in two cases: That of a simple product (designed by a single Original Equipment Manufacturer (OEM) through a centralized approach); and a complex product (designed by a number of designers within a supply chain using a distributed approach). The subsequent benefits to energy minimization are then discussed and conclusions drawn.

Using an autoencoder for dimensionality reduction, this paper presents a novel projection-based reduced-order model for eigenvalue problems. Reduced-order modelling relies on finding suitable basis functions which define a low-dimensional space in which a high-dimensional system is approximated. Proper orthogonal decomposition (POD) and singular value decomposition (SVD) are often used for this purpose and yield an optimal linear subspace. Autoencoders provide a nonlinear alternative to POD/SVD, that may capture, more efficiently, features or patterns in the high-fidelity model results. Reduced-order models based on an autoencoder and a novel hybrid SVD-autoencoder are developed. These methods are compared with the standard POD-Galerkin approach and are applied to two test cases taken from the field of nuclear reactor physics.

Proglacial outwash plains, or “sandar,” can be recognized to be a part of a geomorphic, sedimentary, and hydrological system. At a global scale, glacial meltwater regimes and hence proglacial fluvial systems are strongly determined by glacier basal water conditions and glacier behavior. At a catchment scale it is necessary to consider that proglacial fluvial sedimentation can have a range of frequency and magnitude regimes. This paper presents geomorphological and sedimentological data from Franz Josef Glacier and Fox Glacier sandar, which have adjacent catchments. We determine that glaciofluvial facies are the most abundant sediment-landform association at both sites. However, we also observe considerable intra-catchment variability with respect to the magnitude-frequency regime of fluvial deposition and the relative importance of fluvial processes for sandur character. Franz Josef Glacier sandur is relatively high relief and superficially composed of boulder bedforms that are laterally and longitudinally extensive. It has a sedimentology dominated by massive, poorly sorted sediments containing outsized clasts. Franz Josef Glacier sandur thus has a character consistent with formation by episodic high-magnitude fluvial flows, i.e. jökulhlaups. In contrast, Fox Glacier sandur is of low cross-section relief and comprises two distinct components: an aggrading braided river and paraglacial debris fan deposits. With the exception of the contemporary ice margin, Fox Glacier sandur is of significantly finer-grained material than that at Franz Josef Glacier. We suggest that the contemporary Fox Glacier sandur contains widespread evidence that refutes a hypothesis of high-magnitude episodic events. Additionally, contemporary paraglacial inputs from recently deglaciated valley walls at Fox Glacier are far more important to sandur sedimentation than water or sediment from Fox Glacier. These results present a conceptual model of the predominant contemporary land-forming processes within a glaciated tectonically active region with exceptionally high denudation rates. Intra-catchment variability has important implications for predicting sediment fluxes in response to hydro-climatic forcing.

Background Middle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation. Methods Data for consecutive patients who underwent transradial MMA embolization for CSDH during a 2-year period (2018–2019) were analyzed from a single-center, prospectively-maintained database. Patient demographics, comorbidities, ambulatory times, subdural hematoma resorption status, and guide catheter type were recorded. Conversion to femoral access and complication rates were also recorded. Univariate and multivariate analyses were performed. Results Forty-six patients (mean age, 71.7±14.4 years) were included in this study. Mean CSDH size was 14±5.5 mm. Most (91.3%) TRA embolizations were performed with 6-French 0.071-inch Benchmark guide catheters (Penumbra). MMA embolization was successful in 44 patients (95.7%) (including two cases of TRA conversion). Twenty-one (48%) patients had a severe Charlson Comorbidity Index ( &gt; 5). Symptomatic improvement was noted in 39 of 44 patients (88.6%). Mean length of stay was 4±3 days. Patients were ambulated immediately postprocedure. At mean follow-up (8±4 weeks), 86.4% of patients had complete or partial CSDH resolution. Persistent use of antiplatelet agents after the procedure was associated with failed or minimal CSDH resorption (5 of 6, 83.3% vs 9 of 38 23.7% with complete or near-complete resolution; P=0.009). Conclusion Transradial Onyx MMA embolization under conscious sedation is safe and effective for CSDH treatment. TRA may be especially useful in elderly patients with numerous comorbidities.

Abstract With increased commitment from the international community to reduce greenhouse gas (GHG) emissions from all sectors in accordance with the Paris Agreement, the water sector has never felt the pressure it is now under to transition to a low-carbon water management model. This requires reducing GHG emissions from grid-energy consumption (Scope 2 emissions), which is straightforward; however, it also requires reducing Scope 1 emissions, which include nitrous oxide and methane emissions, predominantly from wastewater handling and treatment. The pathways and factors leading to biological nitrous oxide and methane formation and emissions from wastewater are highly complex and site-specific. Good emission factors for estimating the Scope 1 emissions are lacking, water utilities have little experience in directly measuring these emissions, and the mathematical modelling of these emissions is challenging. Therefore, this book aims to help the water sector address the Scope 1 emissions by breaking down their pathways and influencing factors, and providing guidance on both the use of emission factors, and performing direct measurements of nitrous oxide and methane emissions from sewers and wastewater treatment plants. The book also dives into the mathematical modelling for predicting these emissions and provides guidance on the use of different mathematical models based upon your conditions, as well as an introduction to alternative modelling methods, including metabolic, data-driven, and AI methods. Finally, the book includes guidance on using the modelling tools for assessing different operating strategies and identifying promising mitigation actions. A must-have book for anyone needing to understand, account for, and reduce water utility Scope 1 emissions. ISBN: 9781789060454 (Paperback) ISBN: 9781789060461 (eBook) ISBN: 9781789060478 (ePub)

The mechanical properties and stress corrosion cracking (SCC) resistance of 7xxx series aluminium alloys are significantly affected by the composition and distribution of precipitates formed during heat treatment. In particular, their quench sensitivity is related to the formation of η-phase precipitates that nucleate heterogeneously on grain boundaries at lower cooling rates after solution treatment, which has been a key factor restricting the gauge of hot rolled plates in the aerospace industry. To better understand the effects of slower cooling rates on the composition of quench-induced grain boundary precipitates (Q-GBPs) found in thick plate 7xxx alloys, plasma focused ion beam and high-resolution scanning transmission electron microscopy were used to obtain accurate composition data. The η-phase Q-GBPs have a complex- branched morphology, which develops higher aspect ratios and secondary arms as the cooling rate is reduced. Only a small change in average composition of Q-GBPs was found with cooling rate; but a large scatter was observed. This is caused by significant Zn/Cu/Al composition gradients developing along their principal growth directions in both AA7050 and AA7085 alloys. This concentration gradient did not reduce significantly after a T76 treatment. Simulations of Q-GBP growth with different cooling rates using a CALPHAD-informed phase-field model, with the η-phase represented by a two-sublattice model, gave results consistent with experimental observations. Chemical gradients were predicted to develop in the Q-GBPs due to the changing local equilibrium at the growth front during the cooling. The influence of this non-homogeneous microchemistry on the SCC behaviour of 7xxx alloys is briefly discussed.

OBJECTIVE: Excessive delay discounting, the rapid devaluation of future rewards, is often demonstrated by individuals suffering from substance use disorders, including chronic cigarette smokers. This constricted temporal window not only produces increased valuation of immediate unhealthy rewards (e.g., cigarettes) but also a decreased valuation of both future healthy rewards (e.g., increased energy) and future consequences (e.g., lung cancer). Moreover, in addition to cigarettes, smokers tend to engage in other behaviors that elicit immediate rewards and negative future consequences such as overconsuming alcohol, unhealthy eating, physical inactivity, and/or irresponsible spending. The present study sought to determine whether smokers' discounting rate would predict the frequency of engagement in other poor health and financial behaviors, independent of cigarette smoking. METHOD: A total of 303 daily smokers were asked to complete a delay discounting task and then answer how frequently they typically engaged in health and finance related behaviors. RESULTS: A structural equation model was used to group the questions into highly significantly latent factors of "Drug Use," "Finances," "Fitness," "Food," "Health," "Household Savings," "Personal Development," and "Safe Driving." When regressed on the model, delay discounting significantly predicted engagement all of the factors, except "Safe Driving," independent of smoking status. CONCLUSION: In sum, these findings highlight delay discounting as a useful metric for predicting whether individuals' engagement in variety of healthy physical and financial behaviors, as a function of their temporal window. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Abstract Identifying areas that may be susceptible to groundwater flooding through both hazard and risk maps is a requirement of the EU Floods Directive. For groundwater flooding, hazard maps could show flood extent and depth or water level (velocity would not generally be appropriate) with risk maps additionally showing the potential adverse consequences. The EU Floods Directive allows Member States to limit groundwater flood maps to floods with a low probability, or extreme events. This paper focuses on feasible techniques, available data and current limitations for producing groundwater flood maps that could meet the requirements of the Floods Directive. In addition, to set mapping in the wider context of groundwater flood risk management, advances in data collection and flood warning are also reviewed. Specifically, determining the likelihood and the likely depth of groundwater flooding will be particular challenges where further work will have to build on the advances already made.