A medium-rise 1970s maternity hospital in the east of England: Resilience and adaptation to climate change

The late 1970s design for the Rosie Maternity Hospital on the Addenbrookes campus in Cambridge is a recurring type across the UK National Health Service, a framed three-storey courtyard configuration in brick masonry. It was selected as a case study project for the ‘Design and Delivery of Robust Hospitals in a Changing Climate’ project, pursuing the methodology developed for that research. Temperature data were collected in representative spaces within the hospital, over a two-year period. These revealed overheating in mild conditions relative to an observed 24℃ threshold for sleep but concealed within the customary 28℃ threshold marking the upper limit of acceptable conditions. The building was modelled using current climate data to predict 2010 conditions. The model was then calibrated against the observed 2010 data and used to predict the likely internal temperatures in current and 2030s. The results indicated an increase in peak temperatures. Four adaptive intervention schemes were subsequently developed: an ‘enlightened’ industry standard ‘Passivhaus’-type option providing superinsulation, sealed glazing and heat recovery; a lower technology-based scheme promoting natural cross-ventilation by providing greater opening glazing area, opening up the plan, sunshading and additional insulation; an enhanced natural ventilation scheme glazing over the courtyards to provide supply air winter gardens, and an advanced natural ventilation option pursuing passive downdraught cooling. All four schemes were modelled using the projected current and 2030s weather data and their performance was compared. The schemes were fully costed to yield relative ‘value for money’ guidance to National Health Service Trusts. Practical application: The Heat wave Plan for England 2014 warns National Health Service (NHS) organisations of the risks to patients, particularly the very young, the elderly and the seriously ill, from extreme summer heat events.1 The Chief Medical Officer in her introduction challenges each NHS locality to plan well in advance of hot spells, as appropriate. This paper describes the likely extent of overheating risk and a series of potential adaptation plans for a recurring NHS hospital building type. As a consequence, estates and facilities decision makers in NHS organisations and Public Health England officers charged with the mitigation of risk resulting from overheating of wards and clinical spaces will benefit directly in their necessary decision making from the findings. Policy makers in the Department of Health and policy advisors in the NHS Sustainable Development Unit and the Climate Change Committee Adaptation Sub-Committee will benefit from the evidence presented in advising the NHS and Department of Health. This work was undertaken at part of the UK Engineering and Physical Sciences Research Council project, ‘Design and Delivery of Robust Hospital Environments in a Changing Climate’ [grant number EP/G061327/1] through the ‘Adaptation and Resilience to a Changing Climate’ (ARCC) programme under the auspices of the ‘Living with Environmental Change’ (LWEC) initiative. The Project also received funding directly from the Department of Health.This is the final version. It was first published by Sage at http://bse.sagepub.com/content/early/2015/01/30/0143624414567544

Conducting value for money analyses for non-randomised interventional studies including service evaluations : an educational review with recommendations

This article provides an educational review covering the consideration of conducting ‘value for money’ analyses as part of non-randomised study designs including service evaluations. These evaluations represent a vehicle for producing evidence such as value for money of a care intervention or service delivery model. Decision makers including charities and local and national governing bodies often rely on evidence from non-randomised data and service evaluations to inform their resource allocation decision-making. However, as randomised data obtained from randomised controlled trials are considered the ‘gold standard’ for assessing causation, the use of this alternative vehicle for producing an evidence base requires careful consideration. We refer to value for money analyses, but reflect on methods associated with economic evaluations as a form of analysis used to inform resource allocation decision-making alongside a finite budget. Not all forms of value for money analysis are considered a full economic evaluation with implications for the information provided to decision makers. The type of value for money analysis to be conducted requires considerations such as the outcome(s) of interest, study design, statistical methods to control for confounding and bias, and how to quantify and describe uncertainty and opportunity costs to decision makers in any resulting value for money estimates. Service evaluations as vehicles for producing evidence present different challenges to analysts than what is commonly associated with research, randomised controlled trials and health technology appraisals, requiring specific study design and analytic considerations. This educational review describes and discusses these considerations, as overlooking them could affect the information provided to decision makers who may make an ‘ill-informed’ decision based on ‘poor’ or ‘inaccurate’ information with long-term implications. We make direct comparisons between randomised controlled trials relative to non-randomised data as vehicles for assessing causation; given ‘gold standard’ randomised controlled trials have limitations. Although we use UK-based decision makers as examples, we reflect on the needs of decision makers internationally for evidence-based decision-making specific to resource allocation. We make recommendations based on the experiences of the authors in the UK, reflecting on the wide variety of methods available, used as documented in the empirical literature. These methods may not have been fully considered relevant to non-randomised study designs and/or service evaluations, but could improve and aid the analysis conducted to inform the relevant value for money decision problem

Enhancing Perception of Complex Sculptural Forms using Interactive Real-time Ray tracing

This paper looks at experiments into using real-time ray tracing to significantly enhance shape perception of complex three-dimensional digitally created structures. The author is a computational artist whose artistic practice explores the creation of intricate organic three-dimensional forms using simulation of morphogenesis. The generated forms are often extremely detailed, comprising tens of millions of cellular primitives. This often makes depth perception of the resulting structures difficult. His practice has explored various techniques to create presentable artefacts from the data, including high resolution prints, animated videos, stereoscopic installations, 3D printing and virtual reality. The author uses ray tracing techniques to turn the 3D data created from his morphogenetic simulations into visible artefacts. This is typically a time-consuming process, taking from seconds to minutes to create a single frame. The latest generation of graphics processing units offer dedicated hardware to accelerate ray tracing calculations. This potentially allows the generation of ray traced images, including self-shadowed complex structures and multiple levels of transparency, from new viewpoints at frame rates capable of real-time interaction. The author presents the results of his experiments using this technology with the aim of providing significantly enhanced perception of his generated three-dimensional structures by allowing user-initiated interaction to generate novel views, and utilizing depth cues such as stereopsis, depth from motion and defocus blurring. The intention is for these techniques to be usable to present new exhibitable works in a gallery context

Evidence-informed health policy: are we beginning to get there at last

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Switched On : a qualitative review of energy advice for young people

The Switched On project involved the delivery of freeenergy advice to young people aged 16–25 in theform of workshops, one-to-one individualised advicesessions and advice via text messaging. Young adultsare a demographic group recognised to be at risk of fuelpoverty, and evaluations such as this review are key inensuring that future energy advice provisions maximisetheir potential positive impact in addressing this issue.This report was produced by the Sustainable Housing andUrban Studies Unit (SHUSU), a research team based atthe University of Salford, in order to evaluate the deliveryof the project

Hepatorenal syndrome: aetiology, diagnosis, and treatment.

Acute renal impairment is common in patients with chronic liver disease, occurring in approximately 19% of hospitalised patients with cirrhosis. A variety of types of renal impairment are recognised. The most important of these is the hepatorenal syndrome, a functional renal impairment due to circulatory and neurohormonal abnormalities that underpin cirrhosis. It is one of the most severe complications of cirrhosis with survival often measured in weeks to months. A variety of treatment options exist with early diagnosis and appropriate treatment providing the best hope for cure. This paper provides a comprehensive and up-to-date review of hepatorenal syndrome and lays out the topic according to the following sections: pathophysiology, historical developments, diagnostic criteria and limitations, epidemiology, precipitating factors, predictors, clinical and laboratory findings, prognosis, treatment options, prophylaxis, and conclusion.Peer Reviewe

Estimates of Micro-, Nano-, and Picoplankton Contributions to Particle Export in the Northeast Pacific

The contributions of micro-, nano-, and picoplankton to particle export were estimated from measurements of size-fractionated particulate 234Th, organic carbon, and phytoplankton indicator pigments obtained during five cruises between 2010 and 2012 along Line P in the subarctic northeast Pacific Ocean. Sinking fluxes of particulate organic carbon (POC) and indicator pigments were calculated from 234Th–238U disequilibria and, during two cruises, measured by sediment trap at Ocean Station Papa. POC fluxes at 100 m ranged from 0.65–7.95 mmol m−2 d−1, similar in magnitude to previous results at Line P. Microplankton pigments dominate indicator pigment fluxes (averaging 69 ± 19% of total pigment flux), while nanoplankton pigments comprised the majority of pigment standing stocks (averaging 64 ± 23% of total pigment standing stock). Indicator pigment loss rates (the ratio of pigment export flux to pigment standing stock) point to preferential export of larger microplankton relative to smaller nano- and picoplankton. However, indicator pigments do not quantitatively trace particle export resulting from zooplankton grazing, which may be an important pathway for the export of small phytoplankton. These results have important implications for understanding the magnitude and mechanisms controlling the biological pump at Line P in particular, and more generally in oligotrophic gyres and high-nutrient, low-chlorophyll regions where small phytoplankton represent a major component of the autotrophic community

Observation of confined current ribbon in JET plasmas

we report the identification of a localised current structure inside the JET plasma. It is a field aligned closed helical ribbon, carrying current in the same direction as the background current profile (co-current), rotating toroidally with the ion velocity (co-rotating). It appears to be located at a flat spot in the plasma pressure profile, at the top of the pedestal. The structure appears spontaneously in low density, high rotation plasmas, and can last up to 1.4 s, a time comparable to a local resistive time. It considerably delays the appearance of the first ELM.Comment: 10 pages, 6 figure

Pico without public keys

This document is the Accepted Manuscript version of the following paper: Frank Stajano, Bruce Christianson, Mark Lomas, Graeme Jenkinson, Jeunese Payne, Max Spencer, and Quentin Stafford Fraser, 'Pico without Public Keys', Security Protocols XXIII, 23rd International Workshop Cambridge, March 31- April 2, 2015, Revised Selected Papers, pp. 195-211, part of the Lecture Notes in Computer Science book series (LNCS, Vol. 9379), first online 25 November 2015, ISBN: 978-3-319-26095-2. The final publication is available at Springer via: https://link.springer.com/chapter/10.1007%2F978-3-319-26096-9_21v.Pico is a user authentication system that does not require remembering secrets. It is based on a personal handheld token that holds the user’s credentials and that is unlocked by a “personal aura” generated by digital accessories worn by the owner. The token, acting as prover, engages in a public-key-based authentication protocol with the verifier. What would happen to Pico if success of the mythical quantum computer meant secure public key primitives were no longer available, or if for other reasons such as energy consumption we preferred not to deploy them? More generally, what would happen under those circumstances to user authentication on the web, which relies heavily on public key cryptography through HTTPS/TLS? Although the symmetric-key-vs-public-key debate dates back to the 1990s, we note that the problematic aspects of public key deployment that were identified back then are still ubiquitous today. In particular, although public key cryptography is widely deployed on the web, revocation still doesn’t work. We discuss ways of providing desirable properties of public-key-based user authentication systems using symmetric-key primitives and tamperevident tokens. In particular, we present a protocol through which a compromise of the user credentials file at one website does not require users to change their credentials at that website or any other. We also note that the current prototype of Pico, when working in compatibility mode through the Pico Lens (i.e. with websites that are unaware of the Pico protocols), doesn’t actually use public key cryptography, other than that implicit in TLS. With minor tweaks we adopt this as the native mode for Pico, dropping public key cryptography and achieving much greater deployability without any noteworthy loss in security

Population Size, Sex and Purifying Selection: Comparative Genomics of Two Sister Taxa of the Wild Yeast Saccharomyces paradoxus

This study uses population genomic data to estimate demographic and selection parameters in two sister lineages of the wild yeast Saccharomyces paradoxus and compare their evolution. We first estimate nucleotide and recombinational diversities in each of the two lineages to infer their population size and frequency of sex and then analyze the rate of mutation accumulation since divergence from their inferred common ancestor to estimate the generation time and efficacy of selection. We find that one of the lineages has significantly higher silent nucleotide diversity and lower linkage disequilibrium, indicating a larger population with more frequent sexual generations. The same lineage also shows shorter generation time and higher efficacy of purifying selection, the latter consistent with the finding of larger population size and more frequent sex. Similar analyses are also performed on the ancestries of individual strains within lineages and we find significant differences between strains implying variation in rates of mitotic cell divisions. Our sample includes some strains originating in the Chernobyl nuclear-accident exclusion zone, which has been subjected to high levels of radiation for nearly 30 years now. We find no evidence, however, for increased rates of mutation. Finally, there is a positive correlation between rates of mutation accumulation and length of growing period, as measured by latitude of the place of origin of strains. Our study illustrates the power of genomic analyses in estimating population and life history parameters and testing predictions based on population genetic theory