The acute respiratory distress syndrome in 2013.

Acute lung injury and the acute respiratory distress syndrome are major causes of morbidity and mortality in critically ill patients. This review focuses on new developments in definitions, epidemiology, clinical and basic research, and promising new directions in treatment. There is new information about the potential contribution of environmental factors, especially exposure to cigarette smoke. Pathologic findings in ARDS have been limited to case reports of open lung biopsies and post-mortem studies but there is some new information from a recent pathology study relative to the frequency of diffuse alveolar damage and the severity of arterial hypoxemia. Further, therapy with lung-protective ventilation and fluid conservative protocol has improved outcomes, but several new trials are in progress to test several promising strategies

Factors that impact on the quality of life of intestinal failure patients treated with home parenteral nutrition: protocol for a multicentre, longitudinal observational study

\ua9 2024 BMJ Publishing Group. All rights reserved. Background: Home parenteral nutrition (HPN) refers to the intravenous administration of macronutrients, micronutrients and fluid. The aims of treatment are to increase survival and improve quality of life (QoL). However, patients struggle with physiological symptoms, time-consuming invasive therapy and an increased occurrence of depression and social isolation. Our aim is to understand how HPN impacts the QoL of patients, and the contribution played by the complications of treatment, for example, liver disease. Methods and analysis: A multicentre, longitudinal, observational study will be conducted using routinely collected clinical data. Participants will also be asked to complete three QoL questionnaires (EuroQol-5 Dimensions, Short Form 36 and HPN-QoL) at baseline and 12 months. The primary outcome is mean change in QoL scores over 12 months. Secondary outcomes include how factors including liver function, gut microbiota, number of infusions of PN per week, nutritional composition of PN and nutritional status impact on QoL scores. Ethics and dissemination: Ethical approval was obtained from HRA and Health and Care Research Wales Research Ethics Committee (21/SC/0316). The study was eligible for portfolio adoption, Central Portfolio Management System ID 50506. Results will be disseminated through peer-reviewed scientific journals and presented at national and international meetings

Particle acceleration at ultrarelativistic shocks: an eigenfunction method

We extend the eigenfunction method of computing the power-law spectrum of particles accelerated at a relativistic shock fronts to apply to shocks of arbitrarily high Lorentz factor. In agreement with the findings of Monte-Carlo simulations, we find the index of the power-law distribution of accelerated particles which undergo isotropic diffusion in angle at an ultrarelativistic, unmagnetized shock is s=4.23 (where s=-d(ln f)/dp with f the Lorentz invariant phase-space density and p the momentum). This corresponds to a synchrotron index for uncooled electrons of a=0.62 (taking cooling into account a=1.12), where a=-d(ln F)/dn, F is the radiation flux and n the frequency. We also present an approximate analytic expression for the angular distribution of accelerated particles, which displays the effect of particle trapping by the shock: compared with the non-relativistic case the angular distribution is weighted more towards the plane of the shock and away from its normal. We investigate the sensitivity of our results to the transport properties of the particles and the presence of a magnetic field. Shocks in which the ratio of Poynting to kinetic energy flux upstream is not small are less compressive and lead to larger values of $s$.Comment: Minor additions on publicatio

Implications of Variability Patterns observed in TeV Blazars on the Structure of the Inner Jet

The recent long look X-ray observations of TeV blazars have revealed many important new features concerning their time variability. In this paper, we suggest a physical interpretation for those features based on the framework of the internal and external shock scenarios. We present a simplified model applicable to TeV blazars, and investigate through simulations how each of the model parameters would affect to the observed light curve or spectrum. In particular, we show that the internal shock scenario naturally leads to all the observed variability properties including the structure function, but for it to be applicable, the fractional fluctuation of the initial bulk Lorentz factors must be small, with sigma_gamma / gamma_average < 0.01. This implies very low dynamical efficiency of the internal shock scenario. We also suggest that several observational quantities -- such as the characteristic time scale, the relative amplitude of flares as compared to the steady (``offset'') component, and the slope of the structure function -- can be used to probe the inner jet. The results are applied to the TeV blazar Mrk421, and this, within the context of the model, leads to the determination of several physical parameters: the ejection of a shell with average thickness of ~1E13 cm occurs on average every 10 minutes, and the shells collide ~1E17 cm away from the central source.Comment: 12 pages, 13 figures, to appear in Ap

Spectral evolution of non-thermal electron distributions in intense radiation fields

(abridged) Models of many astrophysical gamma-ray sources assume they contain a homogeneous distribution of electrons that are injected as a power-law in energy and evolve by interacting with radiation fields, magnetic fields and particles in the source and by escaping. This problem is particularly complicated if the radiation fields have higher energy density than the magnetic field and are sufficiently energetic that inverse Compton scattering is not limited to the Thomson regime. We present a simple, time-dependent, semi-analytical solution of the electron kinetic equation that treats both continuous and impulsive injection, cooling via synchrotron and inverse Compton radiation, (taking into account Klein-Nishina effects) and energy dependent particle escape. The kinetic equation for an arbitrary, time-dependent source function is solved by the method of Laplace transformations. Using an approximate expression for the energy loss rate that takes into account synchrotron and inverse Compton losses including Klein-Nishina effects for scattering off an isotropic photon field with either a power-law or black-body distribution, we find explicit expressions for the cooling time and escape probability of individual electrons. This enables the full, time-dependent solution to be reduced to a single quadrature. From the electron distribution, we then construct the time-dependent, multi-wavelength emission spectrum. We compare our solutions with several limiting cases and discuss the general appearance and temporal behaviour of spectral features (i.e., cooling breaks, bumps etc.). As a specific example, we model the broad-band energy spectrum of the open stellar association Westerlund-2 at different times of its evolution, and compare it with observations.Comment: 14 pages, 8 figures, acccepted for publication in A&

Removal of steroid estrogens in carbonaceous and nitrifying activated sludge processes

This is the post-print version of the final paper published in Chemosphere. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V.A carbonaceous (heterotrophic) activated sludge process (ASP), nitrifying ASP and a nitrifying/denitrifying ASP have been studied to examine the role of process type in steroid estrogen removal. Biodegradation efficiencies for total steroid estrogens (ΣEST) of 80 and 91% were recorded for the nitrifying/denitrifying ASP and nitrifying ASP respectively. Total estrogen biodegradation (ΣEST) was only 51% at the carbonaceous ASP, however, the extent of biodegradation in the absence of nitrification clearly indicates the important role of heterotrophs in steroid estrogen removal. The low removal efficiency did not correlate with biomass activity for which the ASPcarbonaceous recorded 80 μg kg−1 biomass d−1 compared to 61 and 15 μg kg−1 biomass d−1 at the ASPnitrifying and ASPnitrifying/denitrifying respectively. This finding was explained by a moderate correlation (r2 = 0.55) between total estrogen loading (ΣEST mg m−3 d−1) and biomass activity (μg ΣEST degraded kg−1 d−1) and has established the impact of loading on steroid estrogen removal at full-scale. At higher solids retention time (SRT), steroid estrogen biodegradation of >80% was observed, as has previously been reported. It is postulated that hydraulic retention time (HRT) is as important as SRT as this governs both reaction time and loading. This observation is based on the high specific estrogen activity determined at the ASPcarbonaceous plant, the significance of estrogen loading and the positive linear correlation between SRT and HRT.Public Utilities Board of Singapore, Anglian Water Ltd., Severn Trent Water Ltd., Thames Water Utilities Ltd., United Utilities Plc., and Yorkshire Water Services Ltd

Primary physical education, coaches and continuing professional development

This is an Author's Accepted Manuscript of an article published in Sport, Education and Society, 16(4), 485 - 505, 2011, copyright @ Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/13573322.2011.589645.Physical education (PE) in primary schools has traditionally been taught by qualified primary teachers. More recently, some teaching of PE in primary schools has been undertaken by coaches (mostly football coaches). These coaches hold national governing body awards but do not hold teaching qualifications. Thus, coaches may not be adequately prepared to teach PE in curriculum time. The purpose of this study was to evaluate the perceptions of a group of community-based football coaches working in primary schools for the impact of a Continuing Professional Development (CPD) programme on their ability to undertake ‘specified work’ to cover PE in primary schools. The programme focused on four areas identified as important to enable coaches to cover specified work: short- and medium-term planning, pedagogy, knowledge of the curriculum and reflection. Results showed that for the majority of coaches the CPD programme had made them more aware of the importance of these four areas and had helped to develop their knowledge and ability to put this into practice in covering planning, preparation and assessment time. However, further input is still required to develop coaches’ knowledge and understanding in all four areas, but especially their curriculum knowledge, as well as their ability to put these into practice consistently. These findings are discussed in relation to the implications of employing coaches to cover the teaching of PE in primary schools and, if employed, what CPD coaches need to develop the necessary knowledge, skill and understanding for covering specified work in schools

Optical and submillimetre observations of Bok globules -- tracing the magnetic field from low to high density

We present optical and submillimetre polarimetry data of the Bok globule CB3 and optical polarimetry data of the Bok globule CB246. We use each set of polarimetry data to infer the B-field orientation in each of the clouds. The optical data can only be used in the low density, low extinction edge regions of clouds. The submillimetre data can only be used in the high column-density, central regions of the clouds. It has previously been found that near-infrared polarisation mapping of background stars does not accurately trace the magnetic field in dense cloud regions. This may be due to a lack of aligned grains in dense regions. We test this by comparing the field orientations measured by our two independent polarimetry methods. We find that the field orientation deduced from the optical data matches up well with the orientation estimated from the submillimetre data. We therefore claim that both methods are accurately tracing the same magnetic field in CB3. Hence, in this case, there must be significant numbers of aligned dust grains in the high density region, and they do indeed trace the magnetic field in the submillimetre. We find an offset of 40$\pm$14 degrees between the magnetic field orientation and the short axis of the globule. This is consistent with the mean value of 31$\pm$3 degrees found in our previous work on prestellar cores, even though CB3 is a protostellar core. Taken together, the six prestellar cores that we have now studied in this way show a mean offset between magnetic field orientation and core short axis of $\sim30\pm$3 degrees, in apparent contradiction with some models of magnetically dominated star formation.Comment: 8 pages, 3 figures, accepted for publication in MNRA

On misunderstanding Heraclitus: The justice of organisation structure

Writers on organisational change often refer to the cosmology of Heraclitus in their work. Some use these references to support arguments for the constancy and universality of organisational change and the consignment to history of organisational continuity and stability. These writers misunderstand the scope of what Heraclitus said. Other writers focus exclusively on the idea that originated with Heraclitus that the universe is composed of processes and not of things. This idea, which has been particularly associated with Heraclitus’s thought from the time of Plato, does indeed provide a rich source of insights into organisational analysis, not least the current trends towards giving proper attention to processual studies of organisational change. Yet there is some uncertainty as to whether Heraclitus actually said that the universe was composed exclusively of processes rather than things, and even if that was what he thought, he intended his ideas on flux to be understood not in isolation but in the context of other aspects of his cosmology. Writers on organisational change seldom make reference to this wider context. Heraclitus was a rational but also a religious thinker. A central element in his thought was the notion of divine Justice, which to a Greek of his era meant the order of the universe. Remote as his Olympian theology may seem today, it sets a crucial and entirely rational context for understanding his ideas about flux. It means that ideas about continuity and stability were quite as important in Heraclitus’s cosmology as his more commonly quoted ideas about change. This paper sets out an overview of Heraclitus’s philosophy, insofar as it appears to have potential relevance to organisational analysis, and discusses how far it supports or contradicts the ideas that organisational change scholars have drawn from it