Marine food-reliant subsistence systems such as those in the African Middle Stone Age (MSA) were not thought to exist in Europe until the much later Mesolithic. Whether this apparent lag reflects ...taphonomic biases or behavioral distinctions between archaic and modern humans remains much debated. Figueira Brava cave, in the Arrábida range (Portugal), provides an exceptionally well preserved record of Neandertal coastal resource exploitation on a comparable scale to the MSA and dated to ~86 to 106 thousand years ago. The breadth of the subsistence base-pine nuts, marine invertebrates, fish, marine birds and mammals, tortoises, waterfowl, and hoofed game-exceeds that of regional early Holocene sites. Fisher-hunter-gatherer economies are not the preserve of anatomically modern people; by the Last Interglacial, they were in place across the Old World in the appropriate settings.
Background
Studies on the impact of secondary lymphedema on patient-reported satisfaction and quality of life following postmastectomy breast reconstruction are limited by their heterogeneity. We ...aimed to reduce heterogeneity in study sample populations and compare BREAST-Q Reconstruction Module scores of patients with lymphedema matched to patients without lymphedema.
Methods
We identified patients who underwent postmastectomy breast reconstruction from 2009 to 2017 and performed a propensity score-matched analysis to compare patient-reported outcomes of patients who developed lymphedema with those who did not. Matched covariates included age, body mass index, race/ethnicity, smoking history, radiation or chemotherapy exposure, postoperative infection, and reconstruction modality and laterality. Outcomes of interest were pre- and postoperative BREAST-Q scores for Satisfaction with Breasts, Physical Well-being of the Chest, Sexual Well-Being, and Psychosocial Well-Being; the minimal clinically important difference (MCID) was four points.
Results
Matched cohorts included 322 patients per group. Preoperative BREAST-Q scores did not differ between lymphedema and non-lymphedema matched cohorts. Postoperative BREAST-Q scores were significantly lower in lymphedema patients: Physical Well-Being of the Chest (all time points), Satisfaction with Breast (at 1 and 2 years), Sexual Well-Being (at 2 years), and Psychosocial Well-Being (at 2 and 3 years). All significant differences in average scores were greater than the MCID.
Conclusions
Patients with breast cancer-related lymphedema reported significantly lower Physical Well-Being of the Chest, Satisfaction with Breasts, Sexual Well-Being, and Psychosocial Well-Being at various time points. Our findings may prove useful for patient counseling and justify the need for further research on the prevention and treatment of this devastating disease.
Tropospheric trace gas and aerosol pollutants have adverse effects on health, environment and climate. In order to quantify and mitigate such effects, a wide range of processes leading to the ...formation and transport of pollutants must be considered, understood and represented in numerical models. Regional scale pollution episodes result from the combination of several factors: high emissions (from anthropogenic or natural sources), stagnant meteorological conditions, kinetics and efficiency of the chemistry and the deposition. All these processes are highly variable in time and space, and their relative contribution to the pollutants budgets can be quantified with chemistry-transport models. The CHIMERE chemistry-transport model is dedicated to regional atmospheric pollution event studies. Since it has now reached a certain level a maturity, the new stable version, CHIMERE 2013, is described to provide a reference model paper. The successive developments of the model are reviewed on the basis of published investigations that are referenced in order to discuss the scientific choices and to provide an overview of the main results.
This paper presents an analytical solution of the linear buckling, free vibration and bending behavior of simple supported functionally graded sandwich plates subjected to transverse and axial ...mechanical loads. The used optimization strategy allows to express the transverse and in-plane displacement fields as a function of the n and m parameter, respectively, so the used Carrera's unified formulation (CUF) is also n and m parameters dependent. Principle of virtual displacement (PVD) is utilized to obtain the highly coupled differential equations. The solution is obtained via Navier-Type solution. Good agreements with quasi-3D solutions are found. The optimized parameters are used for solving the buckling problem of functionally graded sandwich plates with different side-to-thickness ratios. Numerical results for buckling are compared to different advanced theories since there isn’t 3D solution available in the literature. Overall, the presented results have a high accuracy to estimate the critical loads, modes and natural frequencies.
•An optimized hyperbolic unified higher order shear deformation theory is proposed.•Buckling, free vibration and bending behavior of plates is studied.•This unified theory is capable to model the thickness stretching effect.•Good accuracy is obtain compared with different solutions in the literature.•Bending and buckling results are remarkable when compared with well-known theories.•The case dependent problem of shear deformation theory is outlined.
•Three-dimensional solution of functionally graded shells is analyzed.•Differential Quadrature Method (DQM) is used.•Chebyshev-Gauss-Lobatto grid and Lagrange interpolation polynomials are ...used.•Shells are subjected to bi-sinusoidal and uniform distributed load.•Benchmark results are provided.
A numerical solution for the three-dimensional static analysis of functionally graded shells with constant curvature is presented. The solution is based on three-elasticity equations written in orthogonal curvilinear coordinates which are valid for spherical, cylindrical shell panels and rectangular plates. The equations in term of the mid-surface variables are solved using a summation of harmonics in term of Navier method which is valid only for simply supported structures. The equations in term of the thickness direction are solved numerically by the Differential Quadrature method (DQM) which permitted to easily calculate the approximate derivative of a function using a weighting sum of the functions evaluated in a certain grid. The layers of the structure are discretized separately by the Chebyshev-Gauss-Lobatto grid and Lagrange interpolation polynomials are considered as the basis functions. The inter-laminar continuity of transverse shear is imposed as part of the boundary conditions for the presented method. The boundary conditions of out-of-plane stresses at the top and the bottom due to the applied loads on the shell are also considered for the analysis, as a result this method can predict the correct behavior of through-the-thickness distribution of transverse stresses. This method permitted easily to discretize the material in term of the thickness direction and several types of single functionally graded layer and sandwich structures with functionally graded core are analyzed. Several shells subjected to bisinusoidal and uniform distributed load are analyzed. The results are compared with other three dimensional solutions proposed in the literature and accurate two dimensional models.
•3D exact solution for the static analysis of magneto-electro-elastic of shells is presented.•The shell unknowns are modelled analytically by the Navier technique.•The continuity conditions is ...warranted.•The correct load traction condition is considered at the top and bottom of the shell.•Benchmark problem for shell is proposed.
This paper presents an exact solution for the static analysis of magneto-electro-elastic simply supported shallow shells panels. The mechanical equations are derived via equilibrium elasticity relations. The electrical and magnetic governing equations are obtained by electrostatic and magnetostatic equilibrium relations. The shell displacements, electrical and magnetic potential functions are solved analytically by the Navier closed form solutions. The governing equations formulated in terms of thickness coordinate are solved semi-analytically by using the differential quadrature method. The Lagrange polynomials are employed as basis functions. The equations are discretized per each layer by the Chebyshev-Gauss-Lobatto grid distribution. The continuity conditions in the adjacent layers for mechanical displacement, transverse dielectric displacement, electric and magnetic scalar function and transverse magnetic induction are complied. The correct load traction condition is considered at the top and bottom of the shell. Numerical results for spherical, cylindrical and rectangular panels are reported. The results are in excellent agreement with other 3D elasticity solutions reported in the literature so a new benchmark problem for shell is proposed.
•3D solution for single skin and sandwich shell composites.•Differential Quadrature Method (DQM).•A New 2D trigonometrical theory is introduced.•Several interpolation polynomials are ...used.•Bi-sinusoidal and uniform distributed load subjected to composite shells are studied.•Benchmark results are provided.
In this paper, a three-dimensional numerical solution for the bending study of laminated composite doubly-curved shells is presented. The partial differential equations are solved analytically by the Navier summation for the midsurface variables; this method is only valid for shells with constant curvature where boundary conditions are considered simply supported. The partial differential equations present different coefficients, which depend on the thickness coordinates. A semi-analytical solution and the so-called Differential Quadrature Method are used to calculate an approximated derivative of a certain function by a weighted summation of the function evaluated in a certain grin domain. Each layer is discretized by a grid point distribution such as: Chebyshev-Gauss-Lobatto, Legendre, Ding and Uniform. As part of the formulation, the inter-laminar continuity conditions of displacements and transverse shear stresses between the interfaces of two layers are imposed. The proper traction conditions at the top and bottom of the shell due to applied transverse loadings are also considered. The present results are compared with other 3D solutions available in the literature, classical 2D models, Layer-wise models, etc. Comparison of the results show that the present formulation correctly predicts through-the-thickness distributions for stresses and displacements while maintaining a low computational cost.
An international team of experts in the field of fluid resuscitation was invited by the ESICM to form a task force to systematically review the evidence concerning fluid administration using basic ...monitoring. The work included a particular emphasis on pre-ICU hospital settings and resource-limited settings. The work focused on four main questions: (1) What is the role of clinical assessment to guide fluid resuscitation in shock? (2) What basic monitoring is required to perform and interpret a fluid challenge? (3) What defines a fluid challenge in terms of fluid type, ranges of volume, and rate of administration? (4) What are the safety endpoints during a fluid challenge? The expert panel found insufficient evidence to provide recommendations according to the GRADE system, and was only able to make recommendations for basic interventions, based on the available evidence and expert opinion. The panel identified significant gaps in the scientific evidence on fluid administration outside the ICU (excluding the operating theater). Globally, scientific communities and health care systems should address these critical gaps in evidence through research on how basic fluid administration in resource-rich and resource-limited settings can be improved for the benefit of patients and societies worldwide.
•3D exact solution of hygro-thermo-mechanical doubly-curved shells is introduced.•The shell unknowns are modelled semi-analytically by the Navier technique.•The continuity conditions is ...warranted.•The correct load traction condition is considered at the top and bottom of the shell.•Benchmark problem of a shell is proposed.
In this paper, a three-dimensional bending solution of doubly-curved shells subjected to mechanical, thermal and hygrothermal load is studied. Through-the-thickness temperature of the shell is modeled by Fourier’s heat conduction equation. Fick’s moisture diffusion law equation is used to determine the hygro-thermal profile through-the-thickness. The partial differential equations are solved by using the Navier closed form summations which are valid only for shells with constant radii of curvature among the midsurface and with simply supported boundary conditions on its shell’s edges. The shell governing equations are solved by discretizing the thickness profile via Legendre’s grid distribution and by using the Differential Quadrature Method (DQM). The Layerwise capabilities of the method is guaranteed by imposing the inter-laminar continuity of out-of-the-plane stresses, displacements, temperature and hygrothermal load thickness profile. The zero-stress condition for the transverse shear stresses is imposed due to the fact that no mechanical loads are applied in those directions. Results for cylindrical, spherical panels and rectangular plates are presented. Comparisons are made with Layerwise and three-dimensional solutions available in literature. The results have strong accuracy and a benchmark problem is delivered.
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