Estimating a sub-mesoscale diffusivity using a roughness measure applied to a tracer release experiment in the Southern Ocean

We test the use of a measure to diagnose a sub-mesoscale isopycnal diffusivity by determining the best match between observations of a tracer and simulations with varying small-scale diffusivities. Specifically, the robustness of a ‘roughness’ measure to discriminate between tracer fields experiencing different sub-mesoscale isopycnal diffusivities and advected by scaled altimetric velocity fields is investigated. We use the measure to compare numerical simulations of the tracer released at a depth of about 1.5 km in the Pacific sector of the Southern Ocean during the Diapycnal and Isopycnal Mixing Experiment in the Southern Ocean (DIMES) field campaign with observations of the tracer taken on DIMES cruises. We find that simulations with an isopycnal diffusivity of ~20 m2s−1 best match observations in the Pacific sector of the ACC, rising to ~20-50 m2s−1 through Drake Passage, representing sub-mesoscale processes and any mesoscale processes unresolved by the advecting altimetry fields. The roughness measure is demonstrated to be a statistically robust way to estimate a small-scale diffusivity when measurements are relatively sparse in space and time, although it does not work if there are too few measurements overall. The planning of tracer measurements during a cruise in order to maximise the robustness of the roughness measure is also considered. It is found that the robustness is increased if the spatial resolution of tracer measurements is increased with the time since tracer release

Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

Introduction. Self-monitoring of blood pressure (BP) is an increasingly common part of hypertension management. The objectives of this systematic review were to evaluate the systolic and diastolic BP reduction, and achievement of target BP, associated with self-monitoring. Methods. MEDLINE, Embase, Cochrane database of systematic reviews, database of abstracts of clinical effectiveness, the health technology assessment database, the NHS economic evaluation database, and the TRIP database were searched for studies where the intervention included self-monitoring of BP and the outcome was change in office/ambulatory BP or proportion with controlled BP. Two reviewers independently extracted data. Meta-analysis using a random effects model was combined with meta-regression to investigate heterogeneity in effect sizes. Results. A total of 25 eligible randomized controlled trials (RCTs) (27 comparisons) were identified. Office systolic BP (20 RCTs, 21 comparisons, 5,898 patients) and diastolic BP (23 RCTs, 25 comparisons, 6,038 patients) were significantly reduced in those who self-monitored compared to usual care (weighted mean difference (WMD) systolic −3.82 mmHg (95% confidence interval −5.61 to −2.03), diastolic −1.45 mmHg (−1.95 to −0.94)). Self-monitoring increased the chance of meeting office BP targets (12 RCTs, 13 comparisons, 2,260 patients, relative risk = 1.09 (1.02 to 1.16)). There was significant heterogeneity between studies for all three comparisons, which could be partially accounted for by the use of additional co-interventions. Conclusion. Self-monitoring reduces blood pressure by a small but significant amount. Meta-regression could only account for part of the observed heterogeneity

PRAXIS: low thermal emission high efficiency OH suppressed fibre spectrograph

PRAXIS is a second generation instrument that follows on from GNOSIS, which was the first instrument using fibre Bragg gratings for OH background suppression. The Bragg gratings reflect the NIR OH lines while being transparent to light between the lines. This gives a much higher signal-noise ratio at low resolution but also at higher resolutions by removing the scattered wings of the OH lines. The specifications call for high throughput and very low thermal and detector noise so that PRAXIS will remain sky noise limited. The optical train is made of fore-optics, an IFU, a fibre bundle, the Bragg grating unit, a second fibre bundle and a spectrograph. GNOSIS used the pre-existing IRIS2 spectrograph while PRAXIS will use a new spectrograph specifically designed for the fibre Bragg grating OH suppression and optimised for 1470 nm to 1700 nm (it can also be used in the 1090 nm to 1260 nm band by changing the grating and refocussing). This results in a significantly higher transmission due to high efficiency coatings, a VPH grating at low incident angle and low absorption glasses. The detector noise will also be lower. Throughout the PRAXIS design special care was taken at every step along the optical path to reduce thermal emission or stop it leaking into the system. This made the spectrograph design challenging because practical constraints required that the detector and the spectrograph enclosures be physically separate by air at ambient temperature. At present, the instrument uses the GNOSIS fibre Bragg grating OH suppression unit. We intend to soon use a new OH suppression unit based on multicore fibre Bragg gratings which will allow increased field of view per fibre. Theoretical calculations show that the gain in interline sky background signal-noise ratio over GNOSIS may very well be as high as 9 with the GNOSIS OH suppression unit and 17 with the multicore fibre OH suppression unit.Comment: SPIE conference proceedings 915

Dissemination of clinical practice guidelines: A content analysis of patient versions

Background. Clinical practice guidelines (CPGs) are typically written for health care professionals but are meant to assist patients with health care decisions. A number of guideline producers have started to develop patient versions of CPGs to reach this audience. Objective. To describe the content and purpose of patient versions of CPGs and compare with patient and public views of CPGs. Design. A descriptive qualitative study with a directed content analysis of a sample of patient versions of CPGs published and freely available in English from 2012 to 2014. Results. We included 34 patient versions of CPGs from 17 guideline producers. Over half of the patient versions were in dedicated patient sections of national/professional agency websites. There was essentially no information about how to manage care in the health care system. The most common purpose was to equip people with information about disease, tests or treatments, and recommendations, but few provided quantitative data about benefits and harms of treatments. Information about beliefs, values and preferences, accessibility, costs, or feasibility of the interventions was rarely addressed. Few provided personal stories or scenarios to personalize the information. Three versions described the strength of the recommendation or the level of evidence. Limitations. Our search for key institutions that produce patient versions of guidelines was comprehensive, but we only included English and freely available versions. Future work will include other languages. Conclusions. This review describes the current landscape of patient versions of CPGs and suggests that these versions may not address the needs of their targeted audience. Research is needed about how to personalize information, provide information about factors contributing to the recommendations, and provide access

Consultant-led UK paediatric palliative care services: Professional configuration, services, funding

Objectives: To systematically gather information on the professional team members, services provided, funding sources and population served for all consultant-led specialised paediatric palliative care (SPPC) teams in the UK. Methods: Two-part online survey. Results: Survey 1: All 17 medical leads from hospital-based or hospice-based SPPC teams responded to the survey (100% response rate). Only six services met the NICE guidance for minimum SPPC team. All services reported providing symptom management, specialist nursing care, end-of-life planning and care, and supporting discharges and transfers to home or hospice for the child's final days-hours. Most services also provided care coordination (n=14), bereavement support (n=13), clinical psychology (n=10) and social work-welfare support (n=9). Thirteen had one or more posts partially or fully funded by a charity. Survey 2: Nine finance leads provided detailed resource/funding information, finding a range of statutory and charity funding sources. Only one of the National Health Service (NHS)-based services fully funded by the NHS. Conclusions: One-third of services met the minimum criteria of professional team as defined by NICE. Most services relied on charity funding to fund part or all of one professional post and only one NHS-based service received all its funding directly from the NHS

Creating a positive casual academic identity through change and loss

Neoliberalism has significantly impacted higher education institutes across the globe by increasing the number of casual and non-continuing academic positions. Insecure employments conditions have not only affected the well-being of contingent staff, but it has also weakened the democratic, intellectual and moral standing of academic institutions. This chapter provides one practitioner’s account of the challenges of casual work, but rather than dwelling on the negativities, it outlines the potential richness of an identity based on insecurity and uncertainty. This exploration draws on the literature of retired academics and identity theory to illustrate the potential generative spaces within an undefined and incoherent identity

The distribution of lung cancer across sectors of society in the United Kingdom: a study using national primary care data

<p>Abstract</p> <p>Background</p> <p>There is pressing need to diagnose lung cancer earlier in the United Kingdom (UK) and it is likely that research using computerised general practice records will help this process. Linkage of these records to area-level geo-demographic classifications may also facilitate case ascertainment for public health programmes, however, there have as yet been no extensive studies of data validity for such purposes.</p> <p>Methods</p> <p>To first address the need for validation, we assessed the completeness and representativeness of lung cancer data from The Health Improvement Network (THIN) national primary care database by comparing incidence and survival between 2000 and 2009 with the UK National Cancer Registry and the National Lung Cancer Audit Database. Secondly, we explored the potential of a geo-demographic social marketing tool to facilitate disease ascertainment by using Experian's Mosaic Public Sector ™ classification, to identify detailed profiles of the sectors of society where lung cancer incidence was highest.</p> <p>Results</p> <p>Overall incidence of lung cancer (41.4/100, 000 person-years, 95% confidence interval 40.6-42.1) and median survival (232 days) were similar to other national data; The incidence rate in THIN from 2003-2006 was found to be just over 93% of the national cancer registry rate. Incidence increased considerably with area-level deprivation measured by the Townsend Index and was highest in the North-West of England (65.1/100, 000 person-years). Wider variations in incidence were however identified using Mosaic classifications with the highest incidence in Mosaic Public Sector ™types 'Cared-for pensioners, ' 'Old people in flats' and 'Dignified dependency' (191.7, 174.2 and 117.1 per 100, 000 person-years respectively).</p> <p>Conclusions</p> <p>Routine electronic data in THIN are a valid source of lung cancer information. Mosaic ™ identified greater incidence differentials than standard area-level measures and as such could be used as a tool for public health programmes to ascertain future cases more effectively.</p