Non-isotopic splitting spheres for a split link in S4S^4

We show that there exist split, orientable, 2-component surface-links in $S^4$ with non-isotopic splitting spheres in their complements. In particular, for non-negative integers $m,n$ with $m\ge 4$, the unlink $L_{m,n}$ consisting of one component of genus $m$ and one component of genus $n$ contains in its complement two smooth splitting spheres that are not topologically isotopic in $S^4\setminus L_{m,n}$. This contrasts with link theory in the classical dimension, as any two splitting spheres in the complement of a 2-component split link $L\subset S^3$ are isotopic in $S^3\setminus L$.Comment: 14 pages with 7 figures. Comments welcome

The status of Habitats Directive Annex I saltmarsh habitats, transition zones and spartina species in England

On unmodified soft sediment coastlines, of which there are long lengths especially on the English east and south coasts, there should be a wide transitional zone between tidal areas and full terrestrial land. The conditions in this zone result in a rich and distinctive range of habitats. There are two saltmarsh habitats listed in Annex I of the Habitats Directive within this zone (H1420 Mediterranean and thermo-Atlantic halophilous scrubs and H1320 Spartina swards,Spartinion maritimae) reflecting its importance for nature conservation. At the time work for this project was started in 2012, the conservation status of these habitats was reported as ‘unfavourable, bad and deteriorating’. Due to construction of artificial sea defences, these zones are now much reduced in extent and distribution and are under threat from a range of factors. This project aims to provide an inventory and description of Annex I saltmarsh habitats and transitional vegetation in England. This will help to update future reporting on conservation status. The outcomes will also help improve understanding of the underpinning processes which can be used in design to improve the potential for recreating these elements of saltmarshes as part of intertidal restoration schemes. The project also provides an up to date assessment of Spartina alterniflora stands in the Solent SAC through review and field survey for 2012

“Who does this patient belong to?” Boundary work and the re/making of (NSTEMI) heart attack patients

This ethnography within ten English and Welsh hospitals explores the significance of boundary work and the impacts of this work on the quality of care experienced by heart attack patients who have suspected non–ST segment elevation myocardial infarction (NSTEMI) /non-ST elevation acute coronary syndrome. Beginning with the initial identification and prioritisation of patients, boundary work informed negotiations over responsibility for patients, their transfer and admission to different wards, and their access to specific domains in order to receive diagnostic tests and treatment. In order to navigate boundaries successfully and for their clinical needs to be more easily recognised by staff, a patient needed to become a stable boundary object. Ongoing uncertainty in fixing their clinical classification, was a key reason why many NSTEMI patients faltered as boundary objects. Viewing NSTEMI patients as boundary objects helps to articulate the critical and ongoing process of classification and categorisation in the creation and maintenance of boundary objects. We show the essential, but hidden, role of boundary actors in making and re-making patients into boundary objects. Physical location was critical and the parallel processes of exclusion and restriction of boundary object status can lead to marginalisation of some patients and inequalities of care.NIHR Research for Patient Benefi

Understanding variation in patient care: A qualitative study of hospital (non-ST elevation myocardial infarction) practices [version 1; peer review: awaiting peer review].

Background Variation in care is often poorly understood but has a big impact on patients. Non-ST segment elevation myocardial infarction (NSTEMI, also known as non-ST elevation acute coronary syndrome or NSTE-ACS) is the most common form of heart attack. NSTEMI is frequently hard to diagnose, its management pathway poorly defined and there is considerable variation in clinical practice. Methods A qualitative study based on site visits, observation, and interviews with managers, clinicians and patients. The setting was 10 hospitals in England and Wales selected to represent variation in 30-day mortality. 199 hospital staff and 68 patients were observed; 142 staff and 53 patients were interviewed. Analysis was thematic and guided by the principles of grounded theory. We triangulated interviews, observational data and medical records and interpreted these findings with reference to national guidelines. Results While the majority of hospitals in our sample had specialist cardiac roles, variation in their remits, specifically their involvement in close monitoring, significantly affected patient management. Close monitoring was important in the identification and prioritisation of patients. Rapid responses with diagnostic and treatment procedures were facilitated by close monitoring but also heavily dependent on effective and flexible bed and catheter laboratory management. Conclusions Close monitoring was a key area of variation. Guidelines for NSTEMI care specify what to do, but not how to do it. These findings are especially relevant for acute conditions with diagnostic and treatment uncertainty. Detailed examples of variation in care can inform quality improvement and potentially help improve patient outcomes

Aerobiology over Antarctica – a new initiative for atmospheric ecology

The role of aerial dispersal in shaping patterns of biodiversity remains poorly understood, mainly due to a lack of coordinated efforts in gathering data at appropriate temporal and spatial scales. It has been long known that the rate of dispersal to an ecosystem can significantly influence ecosystem dynamics, and that aerial transport has been identified as an important source of biological input to remote locations. With the considerable effort devoted in recent decades to understanding atmospheric circulation in the south-polar region, a unique opportunity has emerged to investigate the atmospheric ecology of Antarctica, from regional to continental scales. This concept note identifies key questions in Antarctic microbial biogeography and the need for standardized sampling and analysis protocols to address such questions. A consortium of polar aerobiologists is established to bring together researchers with a common interest in the airborne dispersion of microbes and other propagules in the Antarctic, with opportunities for comparative studies in the Arctic

Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor