Estimation of Scottish pluvial flooding Expected Annual Damages using interpolation techniques

Flood modelling and mapping, underpinned by hydraulic modelling, are typically used to define flood hazard and allow a quantification of risk and associated Expected Annual Damages (EAD). At a regional or national scale, such modelling is often a lengthy process, which does not allow changes in risk resulting from new science such as revised rainfall frequency estimates or climate projections to be readily quantified by policy makers. A framework of interpolation and extrapolation methods has been developed in the R language via practical application to the city of Perth in central Scotland. These methods allow existing flood mapping, design rainfall estimates and property receptor datasets combined with revised design rainfall estimates to be used to rapidly assess the consequences of change in risk and EAD. The results are evaluated against detailed hydraulic modelling and are shown to provide a good approximation of changes in flood depth and EAD for properties previously modelled as at risk of flooding, particularly residential properties, with lower confidence for non-residential properties. In the Scottish context, the methods are considered to be robust for regional and national scale application and would allow policy makers with a means to rapidly determine the consequence of changes in design rainfall estimates without the immediate requirement to undertake complex hydraulic modelling

Limits on the Boron Isotopic Ratio in HD 76932

Data in the 2090 A B region of HD 76932 have been obtained at high S/N using the HST GHRS echelle at a resolution of 90,000. This wavelength region has been previously identified as a likely candidate for observing the B11/B10 isotopic splitting. The observations do not match a calculated line profile extremely well at any abundance for any isotopic ratio. If the B abundance previously determined from observations at 2500 A is assumed, the calculated line profile is too weak, indicating a possible blending line. Assuming that the absorption at 2090 A is entirely due to boron, the best-fit total B abundance is higher than but consistent with that obtained at 2500 A, and the best-fit isotopic ratio (B11/B10) is in the range ~10:1 to ~4:1. If the absorption is not entirely due to B and there is an unknown blend, the best-fit isotopic ratio may be closer to 1:1. Future observations of a similar metal-poor star known to have unusually low B should allow us to distinguish between these two possibilities. The constraints that can be placed on the isotopic ratio based on comparisons with similar observations of HD 102870 and HD 61421 (Procyon) are also discussed.Comment: Accepted for Nov 1998 Ap

Advanced chronic liver disease in the last year of life: a mixed methods study to understand how care in a specialist liver unit could be improved

Objective: To identify the limitations in palliative care provision in the last year of life for people with liver cirrhosis and potential barriers to and enablers of palliative care. / Design: Mixed methods, including a retrospective case note review, qualitative focus groups and individual interviews. / Setting: A tertiary referral liver centre in the south of England (UK). / Participants: Purposively selected case notes of 30 people with cirrhosis who attended the tertiary referral liver centre and died during an 18-month period; a purposive sample of 22 liver health professionals who participated in either focus groups or individual interviews. / Primary and secondary outcomes: Data collected from case notes included hospital admissions, documented discussions of prognosis and palliative care provision. Qualitative methods explored management of people with cirrhosis, and barriers to and enablers of palliative care. / Results: Participants had high rates of hospital admissions and symptom burden. Clinicians rarely discussed prognosis or future care preferences; they lacked the skills and confidence to initiate discussions. Palliative care provision occurred late because clinicians were reluctant to refer due to their perception that reduced liver function is reversible, poor understanding of the potential of a palliative approach; palliative care was perceived negatively by patients and families. / Conclusions: People dying with cirrhosis have unpredictable trajectories, but share a common pathway of frequent admissions and worsening symptoms as death approaches. The use of clinical tools to identify the point of irreversible deterioration and joint working between liver services and palliative care may improve care for people with cirrhosis

Palliative care for cirrhosis: a UK survey of health professionals' perceptions, current practice and future needs

Objective: To determine the knowledge and practice patterns of a UK cohort of relevant healthcare professionals (HCPs) about delivering palliative care in cirrhosis, and to inform priorities for future research. / Design: An on-line questionnaire survey with closed and open responses. / Setting: HCPs identified from the mailing list of special interest groups in hepatology and gastroenterology (liver), general practice and specialist palliative care (SPC) across the UK. / Results: Of the 6181 potential contacts identified, 517 HCPs responded. Most believed a role exists for SPC in caring for people with cirrhosis, but many SPC HCPs felt ill prepared to provide good care to those facing death. Further training was needed in managing liver-related symptoms, symptom control and end of life issues. All HCP groups wished to increase community provision of palliative care support, but many general practitioners felt unable to manage advanced cirrhosis in the community. There were differences in the optimal trigger for SPC referral with liver HCPs less likely to refer at symptom deterioration. Prognostication, symptom management and service configuration were key areas identified for future research. / Conclusions: All who responded acknowledged the role of SPC in caring for those dying with cirrhosis and need for further training to improve confidence and enable joint working between SPC, general practice and liver teams. Low response rates make it difficult to generalise these findings, which require further validation

Establishing and augmenting acceptability of the Fever trial: a mixed methods feasibility study

Introduction: Paediatric clinical trials in critical care settings are challenging to conduct. Establishing trial acceptability can help inform trial design and avoid research waste. This paper reports on how research with parents and staff established and augmented perspectives and the design of a trial investigating temperature thresholds in critically ill children with fever and infection (Fever trial). // Methods: We used a mixed methods approach to explore perspectives at three time points: 1) before, 2) during and 3) after a pilot trial. This included: 1) pre-trial focus groups with staff and interviews with parents; 2) questionnaires with parents of randomised children following trial recruitment; 3) post-trial interviews with parents and focus groups and a survey with staff. Data analysis drew on Sekhon et al (2017) theoretical framework of acceptability. // Results: 1) 25 parents were interviewed and 56 staff took part focus groups, 2) 60 parents of 57 randomised children took part in questionnaires, 3) 19 parents were interviewed and 50 staff took part in focus group and 48 in a survey. There was initial support for the trial, although both groups raised concerns regarding proposed thresholds and not using paracetamol for pain or discomfort. Pre-trial findings informed pilot trial protocol changes and training, which assisted practitioner ‘buy in’. However, concerns about children being in pain or discomfort when weaned from ventilation led to cases of withdrawal and protocol non-adherence. Nevertheless, 95% of parents provided consent and all supported the trial. Those trained by the Fever team found the trial more acceptable than those trained by colleagues. Trusting parent and staff relationships were linked to trial acceptability. // Conclusions: Pre-trial findings and pilot trial experience augmented perspectives, providing insight into how challenges may be overcome. The proposed trial was deemed feasible. We present an adapted theoretical framework of acceptability to inform the design of future trial feasibility studies

The Los Alamos Trapped Ion Quantum Computer Experiment

The development and theory of an experiment to investigate quantum computation with trapped calcium ions is described. The ion trap, laser and ion requirements are determined, and the parameters required for quantum logic operations as well as simple quantum factoring are described.Comment: 41 pages, 16 figures, submitted to Fortschritte der Physi

National survey of feasibility of NIV trials for management of children with bronchiolitis.

Background: Bronchiolitis is a major cause of admission to hospital in children. Non-invasive ventilation (NIV) support with continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) oxygen is routinely used for infants in the UK with bronchiolitis. Objective: To establish UK paediatric practice regarding management of bronchiolitis, and to explore issues pertinent to the design of a potential future randomised controlled trial of NIV. Design: Screening logs were completed in hospitals in England capturing information on paediatric bronchiolitis admissions. An online national survey of clinical practice was disseminated to healthcare professionals (HCPs) across the UK to ascertain current management strategies. Results: Screening logs captured data on 393 infants from 8 hospitals. Reasons for admission were most commonly respiratory distress and/or poor fluid intake. Oxygen was administered for 54% of admissions. Respiratory (CPAP and HFNC) and non-respiratory support administered varied considerably. The national survey was completed by 111 HCPs from 76 hospitals. Data were obtained on criteria used to commence and wean NIV, responsibilities for altering NIV settings, minimum training requirements for staff managing a child on NIV, and numbers of trained staff. Most centres were interested in and capable of running a trial of NIV, even out of normal office hours. Conclusions: Respiratory and non-respiratory management of bronchiolitis in UK centres varies widely. A trial of HFNC oxygen therapy in this group of patients is feasible and HCPs would be willing to randomise patients into such a trial. Future work should focus on defining trial eligibility criteria

Establishing and augmenting views on the acceptability of a paediatric critical care randomised controlled trial (the FEVER trial): a mixed methods study

OBJECTIVE: To explore parent and staff views on the acceptability of a randomised controlled trial investigating temperature thresholds for antipyretic intervention in critically ill children with fever and infection (the FEVER trial) during a multi-phase pilot study. DESIGN: Mixed methods study with data collected at three time points: (1) before, (2) during and (3) after a pilot trial. SETTING: English, Paediatric Intensive Care Units (PICUs). PARTICIPANTS: (1) Pre-pilot trial focus groups with pilot site staff (n=56) and interviews with parents (n=25) whose child had been admitted to PICU in the last 3 years with a fever and suspected infection, (2) Questionnaires with parents of randomised children following pilot trial recruitment (n=48 from 47 families) and (3) post-pilot trial interviews with parents (n=19), focus groups (n=50) and a survey (n=48) with site staff. Analysis drew on Sekhon et al's theoretical framework of acceptability. RESULTS: There was initial support for the trial, yet some held concerns regarding the proposed temperature thresholds and not using paracetamol for pain or discomfort. Pre-trial findings informed protocol changes and training, which influenced views on trial acceptability. Staff trained by the FEVER team found the trial more acceptable than those trained by colleagues. Parents and staff found the trial acceptable. Some concerns about pain or discomfort during weaning from ventilation remained. CONCLUSIONS: Pre-trial findings and pilot trial experience influenced acceptability, providing insight into how challenges may be overcome. We present an adapted theoretical framework of acceptability to inform future trial feasibility studies. TRIAL REGISTRATION NUMBERS: ISRCTN16022198 and NCT03028818