Recruiting patients with advanced malignant and non-malignant disease: lessons learned from a palliative care RCT.

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Inducer dynamics full-flow, full-admission hydraulic turbine drive Interim report for tasks 1, 2, and 3

Hydrodynamical and mechanical design layout for two-speed hydraulic turbine inducer, computer simulation of pumping system and test facility performance, and study of demonstration uni

The role of ice particle shapes and size distributions in the single scattering properties of cirrus clouds

The roles of ice particle size distributions (SDs) and particle shapes in cirrus cloud solar radiative transfer are investigated by analyzing SDs obtained from optical array probe measurements (particle sizes larger than 20–40 μm) during intensive field observations of the International Cirrus Experiment, the European Cloud and Radiation Experiment, the First ISCCP Regional Experiment, and the Central Equatorial Pacific Experiment. It is found that the cloud volume extinction coefficient is more strongly correlated with the total number density than with the effective particle size. Distribution-averaged mean single scattering properties are calculated for hexagonal columns, hexagonal plates, and polycrystals at a nonabsorbing (0.5 μm), moderately absorbing (1.6 μm), and strongly absorbing (3.0 μm) wavelength. At 0.5 μm (1.6 μm) (3.0 μm), the spread in the resulting mean asymmetry parameters due to different SDs is smaller than (comparable to) (smaller than) the difference caused by applying different particle shapes to these distributions. From a broadband solar radiative transfer point of view it appears more important to use the correct particle shapes than to average over the correct size distributions

Predicting response to holistic breathlessness services: a pooled analysis of trial data

Background: Holistic breathlessness services have been developed for people with advanced disease and chronic breathlessness, leading to improved psychological aspects of breathlessness and health. The extent to which patient characteristics influence outcomes is unclear. Aim: To identify patient characteristics predicting outcomes of mastery and distress around breathlessness following holistic breathlessness services. Design: Secondary analysis of pooled individual patient data from three clinical trials. Our primary analysis assessed predictors of clinically important improvements in Chronic Respiratory Questionnaire mastery scores (+0.5 point), and our secondary analysis predictors of improvements in Numerical Rating Scale distress due to breathlessness (-1 point). Variables significantly related to improvement in univariate models were considered in separate backwards stepwise logistic regression models. Participants: The dataset comprised 259 participants (118 female; mean (standard deviation) age 69.2(10.6) years) with primary diagnoses of chronic obstructive pulmonary disease (49.8%), cancer (34.7%) and interstitial lung disease (10.4%).Results: Controlling for age, sex, and trial, baseline mastery remained the only significant independent predictor of improvement in mastery (odds ratio 0.57, 95% confidence intervals 0.43 to 0.74; p <0001), and baseline distress remained the only significant predictor of improvement in distress (odds ratio 1.64; 95% confidence intervals 1.35 to 2.03; p<001). Baseline lung function, breathlessness severity, health status, mild anxiety and depression, and diagnosis did not predict outcomes. Conclusions: Outcomes of mastery and distress following holistic breathlessness services are influenced by baseline scores for these variables, and not by diagnosis, lung function, or health status. Stratifying patients by levels of mastery and/or distress appears appropriate for clinical trials and services

Use of observed ice crystal sizes and shapes to calculate mean-scattering properties and multispectral radiances: CEPEX April 4, 1993, case study

During the Central Equatorial Pacific Experiment, ice crystal sizes and shapes were measured in an outflow anvil. A habit (i.e., column, bullet rosette, Koch fractal polycrystal, sphere) was assigned to each particle using a self-organized neural network based on simulations of how the maximum particle dimension and area ratio varied for random orientations of these crystals. Average ice crystal size and shape distributions were calculated for 25 km long segments at six altitudes using measurements from a two-dimensional cloud probe for crystals larger than 90 μm and a parameterization for smaller crystals based on measurements from the Video Ice Particle Sampler (VIPS). Mean-scattering properties were determined by weighting the size and shape dependent single-scattering properties computed with ray-tracing algorithms according to scattering cross-section. Reflectances at 0.664, 0.875, 1.621, and 2.142 μm were then calculated using a Monte Carlo radiative transfer routine. Although these reflectances agree reasonably with those measured by the MODIS airborne simulator (MAS) above the anvil, uncertainties in cloud base and system evolution prevent a determination of whether ray-tracing or anomalous diffraction theory better predict reflectance. The calculated reflectances are as sensitive to the numbers and shapes of crystals smaller than 90 μm as to those of larger crystals. The calculated reflectances were insensitive to the classification scheme (i.e., neural network, discriminator analysis, and previously used classification scheme) for assigning particle shape to observed crystals. However, the reflectances significantly depended on assumed particle shape

Barriers-enablers-ownership approach: A mixed methods analysis of a social intervention to improve surgical antibiotic prescribing in hospitals

Objectives To assess an intervention for surgical antibiotic prophylaxis (SAP) improvement within surgical teams focused on addressing barriers and fostering enablers and ownership of guideline compliance. Design The Queensland Surgical Antibiotic Prophylaxis (QSAP) study was a multicentre, mixed methods study designed to address barriers and enablers to SAP compliance and facilitate engagement in self-directed audit/feedback and assess the efficacy of the intervention in improving compliance with SAP guidelines. The implementation was assessed using a 24-month interrupted time series design coupled with a qualitative evaluation. Setting The study was undertaken at three hospitals (one regional, two metropolitan) in Australia. Participants SAP-prescribing decisions for 1757 patients undergoing general surgical procedures from three health services were included. Six bimonthly time points, pre-implementation and post implementation of the intervention, were measured. Qualitative interviews were performed with 29 clinical team members. SAP improvements varied across site and time periods. Intervention QSAP embedded ownership of quality improvement in SAP within surgical teams and used known social influences to address barriers to and enablers of optimal SAP prescribing. Results The site that reported senior surgeon engagement showed steady and consistent improvement in prescribing over 24 months (prestudy and poststudy). Multiple factors, including resource issues, influenced engagement and sites/time points where these were present had no improvement in guideline compliance. Conclusions The barriers-enablers-ownership model shows promise in its ability to facilitate prescribing improvements and could be expanded into other areas of antimicrobial stewardship. Senior ownership was a predictor of success (or failure) of the intervention across sites and time periods. The key role of senior leaders in change leadership indicates the critical need to engage other specialties in the stewardship agenda. The influence of contextual factors in limiting engagement clearly identifies issues of resource distributions/inequalities within health systems as limiting antimicrobial optimisation potential

Transposing tirtha: Understanding religious reforms and locative piety in early modern Hinduism

The paper deals with a historical and hitherto obscure case of de-commercialisation of sacred geography of India. Sahajanand Swami, an eighteenth century religious leader from Gujarat who became popular as Bhagwan Swaminarayan took an initiative to eliminate corruption in Dwarka, one of the most sacred destination in Hindu imagination. He also attempted to transpose the piety of Dwarka and recreate a parallel religious experience at Vadtal, an important site in Swaminarayan Hinduism. This process of making sacred sites more egalitarian is classified here as a 'religious reform'. The paper assesses this bivalent pursuit as an institutional reform within religion as well as a religious process in the context of piety, authority and orthodoxy. Through the example of Sahajanand Swami, it is argued to calibrate the colonial paradigm of reform that was largely contextual to social issues and western thought and failed to appreciate the religious reforms of that era. By constructing a nuanced typology of 'religious reform' distinct from 'social reforms', the paper eventually calls for a reassessment of religious figures who have significantly contributed in reforming the Hindu tradition in the medieval and modern era

Regional disparities in the beneficial effects of rising CO2 concentrations on crop water productivity

Rising atmospheric CO2 concentrations ([CO2]) are expected to enhance photosynthesis and reduce crop water use1. However, there is high uncertainty about the global implications of these effects for future crop production and agricultural water requirements under climate change. Here we combine results from networks of field experiments1, 2 and global crop models3 to present a spatially explicit global perspective on crop water productivity (CWP, the ratio of crop yield to evapotranspiration) for wheat, maize, rice and soybean under elevated [CO2] and associated climate change projected for a high-end greenhouse gas emissions scenario. We find CO2 effects increase global CWP by 10[0;47]%–27[7;37]% (median[interquartile range] across the model ensemble) by the 2080s depending on crop types, with particularly large increases in arid regions (by up to 48[25;56]% for rainfed wheat). If realized in the fields, the effects of elevated [CO2] could considerably mitigate global yield losses whilst reducing agricultural consumptive water use (4–17%). We identify regional disparities driven by differences in growing conditions across agro-ecosystems that could have implications for increasing food production without compromising water security. Finally, our results demonstrate the need to expand field experiments and encourage greater consistency in modelling the effects of rising [CO2] across crop and hydrological modelling communities