Coherent State Approach to Quantum Clocks

The ``problem of time'' has been a pressing issue in quantum gravity for some time. To help understand this problem, Rovelli proposed a model of a two harmonic oscillators system where one of the oscillators can be thought of as a ``clock'' for the other oscillator thus giving a natural time reference frame for the system. Recently, the author has constructed an explicit form for the coherent states on the reduced phase space of this system in terms of Klauder's projection operator approach. In this paper, by using coherent state representations and other tools from coherent state quantization, I investigate the construction of gauge invariant operators on this reduced phase space, and the ability to use a quantum oscillator as a ``clock.''Comment: 13 pages, Late

Enhancing the patient involvement in outcomes: a study protocol of personalised outcome measurement in the treatment of substance misuse

Involving patients in treatment is becoming increasingly popular in mental health [Sales & Alves: Personalized evaluation of psychological treatments: A review of tools and research designs, submitted]. However, in substance misuse treatment settings, the patient perspective about treatment tends to be overlooked. This has been cited as a key priority by Orford et al. [Addiction, 103: 875-885, 2008] who included patient feedback about treatment as one of ten areas requiring an urgent paradigm shift in addiction research and practice. This project will apply an innovative method to involve substance misuse patients in psychological therapies, by asking them to suggest topics to evaluate their treatment. These topics suggested by patients can be written as a list of personalised items, so-called as patient-generated outcome measures (PGOM). Despite its patient-friendly features, PGOM’s have never been used in this population, which is what this project aims to overcome

Political Ideology and Public Views of the Energy Transition in Australia and the UK

We explore the relationship between political ideology and public attitudes towards a range of energy technologies (namely: biomass, coal, shale (or coal seam) gas, natural gas, carbon capture and storage, hydroelectricity, nuclear, solar thermal and photovoltaic, wave and wind energy). Our empirical analysis draws on the results of two similar nationally representative public surveys that were conducted in Australia and the UK in 2017. Our findings suggest that political ideology is significantly associated with public attitudes towards energy technologies. Specifically, supporters of left-leaning political parties tend to be more supportive of renewables and opposed to biomass, shale (coal seam) gas, nuclear and fossil fuel energies compared to right-leaning individuals. We also create an alternative ideological proxy to capture the relative emphasis that parties place on the environment and economy and find that supporters of environmentally focused parties generally express similar energy preferences to left-leaning individuals and economy-focused respondents align with right-leaning attitudes. Our findings are robust to different choices of proxy

Enhanced motivational interviewing for reducing weight and increasing physical activity in adults with high cardiovascular risk: the MOVE IT three-arm RCT.

BACKGROUND: Motivational interviewing (MI) enhanced with behaviour change techniques (BCTs) and deployed by health trainers targeting multiple risk factors for cardiovascular disease (CVD) may be more effective than interventions targeting a single risk factor. OBJECTIVES: The clinical effectiveness and cost-effectiveness of an enhanced lifestyle motivational interviewing intervention for patients at high risk of CVD in group settings versus individual settings and usual care (UC) in reducing weight and increasing physical activity (PA) were tested. DESIGN: This was a three-arm, single-blind, parallel randomised controlled trial. SETTING: A total of 135 general practices across all 12 South London Clinical Commissioning Groups were recruited. PARTICIPANTS: A total of 1742 participants aged 40-74 years with a ≥ 20.0% risk of a CVD event in the following 10 years were randomised. INTERVENTIONS: The intervention was designed to integrate MI and cognitive-behavioural therapy (CBT), delivered by trained healthy lifestyle facilitators in 10 sessions over 1 year, in group or individual format. The control group received UC. RANDOMISATION: Simple randomisation was used with computer-generated randomisation blocks. In each block, 10 participants were randomised to the group, individual or UC arm in a 4 : 3 : 3 ratio. Researchers were blind to the allocation. MAIN OUTCOME MEASURES: The primary outcomes are change in weight (kg) from baseline and change in PA (average number of steps per day over 1 week) from baseline at the 24-month follow-up, with an interim follow-up at 12 months. An economic evaluation estimates the relative cost-effectiveness of each intervention. Secondary outcomes include changes in low-density lipoprotein cholesterol and CVD risk score. RESULTS: The mean age of participants was 69.75 years (standard deviation 4.11 years), 85.5% were male and 89.4% were white. At the 24-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA [mean 70.05 steps, 95% confidence interval (CI) -288 to 147.9 steps, and mean 7.24 steps, 95% CI -224.01 to 238.5 steps, respectively] or in reducing weight (mean -0.03 kg, 95% CI -0.49 to 0.44 kg, and mean -0.42 kg, 95% CI -0.93 to 0.09 kg, respectively). At the 12-month follow-up, the group and individual intervention arms were not more effective than UC in increasing PA (mean 131.1 steps, 95% CI -85.28 to 347.48 steps, and mean 210.22 steps, 95% CI -19.46 to 439.91 steps, respectively), but there were reductions in weight for the group and individual intervention arms compared with UC (mean -0.52 kg, 95% CI -0.90 to -0.13 kg, and mean -0.55 kg, 95% CI -0.95 to -0.14 kg, respectively). The group intervention arm was not more effective than the individual intervention arm in improving outcomes at either follow-up point. The group and individual interventions were not cost-effective. CONCLUSIONS: Enhanced MI, in group or individual formats, targeted at members of the general population with high CVD risk is not effective in reducing weight or increasing PA compared with UC. Future work should focus on ensuring objective evidence of high competency in BCTs, identifying those with modifiable factors for CVD risk and improving engagement of patients and primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN84864870. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 69. See the NIHR Journals Library website for further project information. This research was part-funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London

Reducing weight and increasing physical activity in people at high risk of cardiovascular disease: a randomised controlled trial comparing the effectiveness of enhanced motivational interviewing intervention with usual care.

OBJECTIVE: The epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD. METHODS: A three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40-74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention. RESULTS: At 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI -288.00 to 147.90 and mean difference=7.24 steps, 95% CI -224.01 to 238.50, respectively), reducing weight (mean difference=-0.03 kg, 95% CI -0.49 to 0.44 and mean difference=-0.42 kg, 95% CI -0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds. CONCLUSIONS: Enhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk

The Compact Central Object in Cas A: A Neutron Star with Hot Polar Caps or a Black Hole?

The central pointlike X-ray source of the Cas A supernova remnant was discovered in the Chandra First Light Observation and found later in the archival ROSAT and Einstein images. The analysis of these data does not show statistically significant variability of the source. The power-law fit yields the photon index 2.6-4.1, and luminosity (2-60)e34 erg/s, for d=3.4 kpc. The power-law index is higher, and the luminosity lower, than those observed fromvery young pulsars. One can fit the spectrum equally well with a blackbody model with T=6-8 MK, R=0.2-0.5 km, L=(1.4-1.9)e33 erg/s. The inferred radii are too small, and the temperatures too high, for the radiationcould be interpreted as emitted from the whole surface of a uniformly heated neutron star. Fits with the neutron star atmosphere models increase the radius and reduce the temperature, but these parameters are still substantially different from those expected for a young neutron star. One cannot exclude, however, that the observed emission originates from hot spots on a cooler neutron star surface. Because of strong interstellar absorption, the possible low-temperature component gives a small contribution to the observed spectrum; an upper limit on the (gravitationally redshifted) surface temperature is < 1.9-2.3 MK. Amongst several possible interpretations, we favor a model of a strongly magnetized neutron star with magnetically confined hydrogen or helium polar caps on a cooler iron surface. Alternatively, the observed radiation may be interpreted as emitted by a compact object (more likely, a black hole) accreting from a fossil disk or from a late-type dwarf in a close binary.Comment: 12 pages, 2 figures, submitted to ApJ

Nitrogen Fixation and Seeding Rates of Common vs. Hairy Vetch for Interseeding Into Established Switchgrass Stands

Interest in alternatives to synthetic nitrogen (N) fertilizer sources for switchgrass (Panicum virgatum L.) production, such as interseeding with N- fixing legumes continues to increase. Common vetch (Vicia sativa) is a N-fixing legume that occurs naturally throughout the U.S. and has less hard seed than hairy vetch (Vicia villosa), making it potentially less invasive, and it may fix N at similar rates to that of hairy vetch. However, little data exist to substantiate this. In this study, N-fixation rates via the N-difference method were determined to be 59.3 and 43.3 kg N ha-1 for common and hairy vetch, respectively, when seeded at 6.7 kg ha-1. At these rates, neither common nor hairy vetch significantly affected switchgrass yields. Based on the N-fixation rates and vetch plant masses, we estimate that minimum seeding rates of 7.6 and 10.4 kg PLS ha-1 of common and hairy vetch, respectively are required to obtain plant stands needed to fix the current recommended rate of N for switchgrass biomass production

The perception and management of risk in UK office property development

Risk is an ever-present aspect of business, and risk taking is necessary for profit and economic progress. Speculative property development is popularly perceived as a 'risky business' yet, like other entrepreneurs, developers have opportunities to manage the risks they face; techniques include phasing and joint ventures. The associated areas of investment portfolio risk, development risk analysis and construction risk management have all been addressed by research. This article presents new knowledge about how developers perceive risks and the means they subsequently adopt to manage them. The developers of office projects across the UK were sent questionnaires by post. Respondents were asked about their perceptions of risks at the first appraisal stage and currently and about the risk management techniques that they had adopted. In-depth interviews with a selection of respondents were then used to discuss and augment the findings. Developers were most concerned about market-based risks at both stages. Concern about production-orientated risks was lower and fell significantly between the two stages. A fixed price contract was the most common risk management technique. Risk management techniques were used more often outside London and the South East. Developer type affects both the perception and management of risk. While developers do manage risk, decisions are made on the basis of professional and business experience. These findings should help development companies manage risk in a more objective and analytical way

Hypertension and cardiovascular risk factor management in a multi-ethnic cohort of adults with CKD: a cross sectional study in general practice

Background: Hypertension, especially if poorly controlled, is a key determinant of chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD). Aim: To assess hypertension and risk factor management, and determinants of systolic blood pressure control in individuals with CKD and hypertension. Design and setting: Cross-sectional survey using primary care electronic health records from 47/49 general practice clinics in South London. Methods: Known effective interventions, management of hypertension and cardiovascular disease (CVD) risk in patients with CKD Stages 3–5 were investigated. Multivariable logistic regression analysis examined the association of demographic factors, comorbidities, deprivation, and CKD coding, with systolic blood pressure control status as outcome. Individuals with diabetes were excluded. Results: Adults with CKD Stages 3–5 and hypertension represented 4131/286,162 (1.4%) of the total population; 1984 (48%) of these individuals had undiagnosed CKD without a recorded CKD clinical code. Hypertension was undiagnosed in 25% of the total Lambeth population, and in patients with CKD without diagnosed hypertension, 23.0% had systolic blood pressure > 140 mmHg compared with 39.8% hypertensives, p < 0.001. Multivariable logistic regression revealed that factors associated with improved systolic blood pressure control in CKD included diastolic blood pressure control, serious mental illness, history of cardiovascular co-morbidities, CKD diagnostic coding, and age < 60 years. African ethnicity and obesity were associated with poorer systolic blood pressure control. Conclusion: We found both underdiagnosed CKD and underdiagnosed hypertension in patients with CKD. The poor systolic blood pressure control in older age groups ≥ 60 years and in Black African or obese individuals is clinically important as these groups are at increased risk of mortality for cardiovascular diseases

Hydrodynamic modeling of tidal-fluvial flows in a large river estuary

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordThe transition between riverine and estuarine environments is characterised by a change from unidirectional to bidirectional flows, in a region referred to herein as the Tidally-Influenced Fluvial Zone (TIFZ). In order to improve our understanding of the hydrodynamics and morphodynamics of this zone, we present a combined field and numerical modelling study of the Columbia River Estuary (CRE), USA, tidally-influenced fluvial zone. The CRE is large measuring 40 km in length and between 5 and 10 km wide. A shallow water model (Delft3D) was applied in both 2D and 3D configurations and model sensitivity to the key process parameterizations was investigated. Our results indicate that a 2D model constrained within the estuary can sufficiently reproduce depth-averaged flow within the TIFZ of a stratified estuary. Model results highlight the interactions between tidal-, fluvial- and topographic-forcing that result in depth dependent tidal rectification, and thus zones of residual sediment transport that: i) may be flood-directed along shallow channel margins and in the lee of bars, and simultaneously ii) is ebb-directed within deeper channel thalwegs. This condition is enhanced at lower discharges, but increased fluvial discharge reduces the number and size of regions with net flood-directed sediment transport and flow. These sediment transport patterns provide a mechanism to extend the bar/island topography downstream, and generate flood-directed, ebb-directed, and symmetrical bedforms, all within the same channel. Analysis of the model data reveals flood-directed sediment transport is due to both tidal variability and mean flow. These results highlight the need to include the mean flow component (M0) when considering the long-term morphodynamic evolution in a TIFZ. Model results highlight the interactions between tidal-, fluvial- and topographic-forcing that result in depth dependent tidal rectification, and thus zones of residual sediment transport that: i) may be flood-directed along shallow channel margins and in the lee of bars, and simultaneously ii) is ebb-directed within deeper channel thalwegs. This condition is enhanced at lower discharges, but increased fluvial discharge reduces the number and size of regions with net flood-directed sediment transport and flow. These sediment transport patterns provide a mechanism to extend the bar/island topography downstream, and generate flood-directed, ebb-directed, and symmetrical bedforms, all within the same channel. Analysis of the model data reveals flood-directed sediment transport is due to both tidal variability and mean flow. These results highlight the need to include the mean flow component (M0) when considering the long-term morphodynamic evolution in a TIFZ