Regionalized state training academies: a better use of law enforcement training resources

Examines the costs associated with different training academy models, single jurisdiction or regional

Validating an Operational Flood Forecast Model Using Citizen Science in Hampton Roads, VA, USA

Changes in the eustatic sea level have enhanced the impact of inundation events in the coastal zone, ranging in significance from tropical storm surges to pervasive nuisance flooding events. The increased frequency of these inundation events has stimulated the production of interactive web-map tracking tools to cope with changes in our changing coastal environment. Tidewatch Maps, developed by the Virginia Institute of Marine Science (VIMS), is an effective example of an emerging street-level inundation mapping tool. Leveraging the Semi-implicit Cross-scale Hydro-science Integrated System Model (SCHISM) as the engine, Tidewatch operationally disseminates 36-h inundation forecast maps with a 12-h update frequency. SCHISM’s storm tide forecasts provide surge guidance for the legacy VIMS Tidewatch Charts sensor-based tidal prediction platform, while simultaneously providing an interactive and operationally functional forecast mapping tool with hourly temporal resolution and a 5 m spatial resolution throughout the coastal plain of Virginia, USA. This manuscript delves into the hydrodynamic modeling and geospatial methods used at VIMS to automate the 36-h street-level flood forecasts currently available via Tidewatch Maps, and the paradigm-altering efforts involved in validating the spatial, vertical, and temporal accuracy of the model. Supplementary material: Catch the King Tide GPS data points were collected by volunteers to effectively breadcrumb their path tracing the tidal high water contour lines by pressing the \u27Save Data\u27 button in the free Sea Level Rise Mobile App every few steps along the water\u27s edge during the high tide on the morning of November 5th, 2017. https://doi.org/10.25773/276h-2b4

A prospective, multicentre, observational cohort study of analgesia and outcome after pneumonectomy

Background Meta-analysis and systematic reviews of epidural compared with paravertebral blockade analgesia techniques for thoracotomy conclude that although the analgesia is comparable, paravertebral blockade has a better short-term side-effect profile. However, reduction in major complications including mortality has not been proven. Methods The UK pneumonectomy study was a prospective observational cohort study in which all UK thoracic surgical centres were invited to participate. Data presented here relate to the mode of analgesia and outcome. Data were analysed for 312 patients having pneumonectomy at 24 UK thoracic surgical centres in 2005. The primary endpoint was a major complication. Results The most common type of analgesia used was epidural (61.1%) followed by paravertebral infusion (31%). Epidural catheter use was associated with major complications (odds ratio 2.2, 95% confidence interval 1.1–3.8; P=0.02) by stepwise logistic regression analysis. Conclusions An increased incidence of clinically important major post-pneumonectomy complications was associated with thoracic epidural compared with paravertebral blockade analgesia. However, this study is unable to provide robust evidence to change clinical practice for a better clinical outcome. A large multicentre randomized controlled trial is now needed to compare the efficacy, complications, and cost-effectiveness of epidural and paravertebral blockade analgesia after major lung resection with the primary outcome of clinically important major morbidity

The Growing Block’s past problems

The Growing-Block view of time has some problems with the past. It is committed to the existence of the past, but needs to say something about the difference between the past and present. I argue that we should resist Correia and Rosenkranz’ (Oxford studies in metaphysics, vol 8, pp 333–350, 2013) response to Braddon-Mitchell’s (Analysis 64:199–203, 2004) argument that the Growing-Block leads to scepticism about whether we are present. I consider an approach, similar to Peter Forrest (Analysis 64:358–362, 2004), and show it is not so counter-intuitive as Braddon-Mitchell suggests and further show that it requires no ‘semantic and metaphysical gymnastics’, as Chris Heathwood (Analysis 65:249–251, 2005) has suggested. In doing these things I make the problem of the past on the Growing-Block view a problem in its history, not its present

The "Artificial Mathematician" Objection: Exploring the (Im)possibility of Automating Mathematical Understanding

Reuben Hersh confided to us that, about forty years ago, the late Paul Cohen predicted to him that at some unspecified point in the future, mathematicians would be replaced by computers. Rather than focus on computers replacing mathematicians, however, our aim is to consider the (im)possibility of human mathematicians being joined by “artificial mathematicians” in the proving practice—not just as a method of inquiry but as a fellow inquirer

Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study

BACKGROUND: The NHS Cancer Plan for England set waiting time targets for cancer referral (14 days from GP referral to first hospital appointment) and treatment (31 days from diagnosis, 62 days from urgent GP referral). Interim diagnostic intervals can also be calculated. The factors that influence timely post-primary care referral, diagnosis and treatment for lung cancer are not known. METHODS: Northern and Yorkshire Cancer Registry, Hospital Episode Statistics and lung cancer audit data sets were linked. Logistic regression was used to investigate the factors (socioeconomic position, age, sex, histology, co-morbidity, year of diagnosis, stage and performance status (PS)) that may influence the likelihood of referral, diagnosis and treatment within target, for 28 733 lung cancer patients diagnosed in 2006–2010. RESULTS: Late-stage, poor PS and small-cell histology were associated with a higher likelihood of post-primary care referral, diagnosis and treatment within target. Older patients were significantly less likely to receive treatment within the 31-day (odds ratio (OR)=0.79, 95% confidence interval (CI) 0.69–0.91) and 62-day target (OR=0.80, 95% CI 0.67–0.95) compared with younger patients. CONCLUSIONS: Older patients waited longer for treatment and this may be unjustified. Patients who appeared ill were referred, diagnosed and treated more quickly and this ‘sicker quicker’ effect may cancel out system socioeconomic inequalities that might result in longer time intervals for more deprived patients

Enhancement of individual and community competence: The older adult as community worker

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44012/1/10464_2004_Article_BF00896496.pd

A Spitzer Census of Transitional Protoplanetary Disks with AU-Scale Inner Holes

[abridged] Protoplanetary disks with AU-scale inner clearings, often referred to as transitional disks, provide a unique sample for understanding disk dissipation mechanisms and possible connections to planet formation. Observations of young stellar clusters with the Spitzer Space Telescope have amassed mid-infrared spectral energy distributions for thousands of star-disk systems from which transition disks can be identified. From a sample of 8 relatively nearby young regions (d <= 400 pc), we have identified about 20 such objects, which we term "classical" transition disks, spanning a wide range of stellar age and mass. We also identified two additional categories representing more ambiguous cases: "warm excess" objects with transition-like spectral energy distributions but moderate excess at 5.8 microns, and "weak excess" objects with smaller 24 micron excess that may be optically thin or exhibit advanced dust grain growth and settling. From existing Halpha emission measurements, we find evidence for different accretion activity among the three categories, with a majority of the classical and warm excess transition objects still accreting gas through their inner holes and onto the central stars, while a smaller fraction of the weak transition objects are accreting at detectable rates. We find a possible age dependence to the frequency of classical transition objects, with fractions relative to the total population of disks in a given region of a few percent at 1-2 Myr rising to 10-20% at 3-10 Myr. The trend is even stronger if the weak and warm excess objects are included. Classical transition disks appear to be less common, and weak transition disks more common, around lower-mass stars (M <= 0.3 Msun).Comment: 34 pages, 7 figures; accepted to Ap

Protocol for a Randomised controlled trial to Evaluate the effectiveness and cost benefit of prescribing high dose FLuoride toothpaste in preventing and treating dEntal Caries in high-risk older adulTs (reflect trial)

Background Dental caries in the expanding elderly, predominantly-dentate population is an emerging public health concern. Elderly individuals with heavily restored dentitions represent a clinical challenge and significant financial burden for healthcare systems, especially when their physical and cognitive abilities are in decline. Prescription of higher concentration fluoride toothpaste to prevent caries in older populations is expanding in the UK, significantly increasing costs for the National Health Services (NHS) but the effectiveness and cost benefit of this intervention are uncertain. The Reflect trial will evaluate the effectiveness and cost benefit of General Dental Practitioner (GDP) prescribing of 5000ppm fluoride toothpaste and usual care compared to usual care alone in individuals 50years and over with high-risk of caries.Methods/designA pragmatic, open-label, randomised controlled trial involving adults aged 50years and above attending NHS dental practices identified by their dentist as having high risk of dental caries. Participants will be randomised to prescription of 5000ppm fluoride toothpaste (frequency, amount and duration decided by GDP) and usual care only. 1200 participants will be recruited from approximately 60 dental practices in England, Scotland and Northern Ireland and followed up for 3years. The primary outcome will be the proportion of participants receiving any dental treatment due to caries. Secondary outcomes will include coronal and root caries increments measured by independent, blinded examiners, patient reported quality of life measures, and economic outcomes; NHS and patient perspective costs, willingness to pay, net benefit (analysed over the trial follow-up period and modelled lifetime horizon). A parallel qualitative study will investigate GDPs' practises of and beliefs about prescribing the toothpaste and patients' beliefs and experiences of the toothpaste and perceived impacts on their oral health-related behaviours.DiscussionThe Reflect trial will provide valuable information to patients, policy makers and clinicians on the costs and benefits of an expensive, but evidence-deficient caries prevention intervention delivered to older adults in general dental practice.Trial registrationISRCTN: 2017-002402-13 registered 02/06/2017, first participant recruited 03/05/2018.Ethics Reference No: 17/NE/0329/233335.Funding Body: Health Technology Assessment funding stream of National Institute for Health Research.Funder number: HTA project 16/23/01.Trial Sponsor: Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL.The Trial was prospectively registered

Spitzer IRS Spectra and Envelope Models of Class I Protostars in Taurus

We present Spitzer Infrared Spectrograph spectra of 28 Class I protostars in the Taurus star-forming region. The 5 to 36 micron spectra reveal excess emission from the inner regions of the envelope and accretion disk surrounding these predecessors of low-mass stars, as well as absorption features due to silicates and ices. Together with shorter- and longer-wavelength data from the literature, we construct spectral energy distributions and fit envelope models to 22 protostars of our sample, most of which are well-constrained due to the availability of the IRS spectra. We infer that the envelopes of the Class I objects in our sample cover a wide range in parameter space, particularly in density and centrifugal radius, implying different initial conditions for the collapse of protostellar cores.Comment: 46 pages, 29 figures; accepted for publication in ApJ