The Milky Way's Fermi Bubbles: Echoes of the Last Quasar Outburst?

{\it Fermi}-LAT has recently detected two gamma ray bubbles disposed symmetrically with respect to the Galactic plane. The bubbles have been suggested to be in a quasi-steady state, inflated by ongoing star formation over the age of the Galaxy. Here we propose an alternative picture where the bubbles are the remnants of a large-scale wide-angle outflow from \sgra, the SMBH of our Galaxy. Such an outflow would be a natural consequence of a short but bright accretion event on to \sgra\ if it happened concurrently with the well known star formation event in the inner 0.5 pc of the Milky Way $\sim 6$ Myr ago. We find that the hypothesised near-spherical outflow is focussed into a pair of symmetrical lobes by the greater gas pressure along the Galactic plane. The outflow shocks against the interstellar gas in the Galaxy bulge. Gamma--ray emission could be powered by cosmic rays created by either \sgra\ directly or accelerated in the shocks with the external medium. The Galaxy disc remains unaffected, agreeing with recent observational evidence that supermassive black holes do not correlate with galaxy disc properties. We estimate that an accreted mass \sim 2 \times 10^3\msun is needed for the accretion event to power the observed {\it Fermi}--LAT lobes. Within a factor of a few this agrees with the mass of the young stars born during the star formation event. This estimate suggests that roughly 50% of the gas was turned into stars, while the rest accreted onto \sgra. One interpretation of this is a reduced star formation efficiency inside the \sgra\ accretion disc due to stellar feedback, and the other a peculiar mass deposition geometry that resulted in a significant amount of gas falling directly inside the inner $\sim 0.03$ pc of the Galaxy.Comment: 6 pages, 0 figures; accepted for publication in MNRA

Sleep positioning systems for children and adults with a neurodisability: A systematic review

This is the author's accepted version.The final version is available from SAGE via the DOI in this record.Introduction: Sleep positioning systems are often prescribed as part of a 24-hour postural management programme for children and adults with neurodisabilities. In a search for evidence of effectiveness for children with cerebral palsy a recent Cochrane review found two randomised controlled trials. This review aims to appraise a broader set of studies including any neurological diagnosis and users of all ages to inform therapists about the quality of the evidence underlying practice. Method: A comprehensive search for all peer-reviewed studies that evaluated the use of sleep positioning systems was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Library databases, BNI, HMIC, PEDro, OTSeeker and clinical trials registries. Disability organisations, manufacturers and colleagues worldwide were also contacted. Titles were screened for relevance by two reviewers. Data were extracted into bespoke quantitative or qualitative forms by one reviewer and checked by a second. Findings were analysed into simple themes. Results: A total of 14 studies were eligible for inclusion; all were small and most were of low quality. Inferences of benefits cannot be made from the literature but also no harm was found. Conclusions: The body of evidence supporting practice remains small and mostly of low quality. Therapists should remain cautious when presenting the benefits to families.This review was supported financially by the Posture and Mobility Group who had no other input into the study. We acknowledge support from the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC) and the charity Cerebra

Nanoscale β\beta-Nuclear Magnetic Resonance Depth Imaging of Topological Insulators

Considerable evidence suggests that variations in the properties of topological insulators (TIs) at the nanoscale and at interfaces can strongly affect the physics of topological materials. Therefore, a detailed understanding of surface states and interface coupling is crucial to the search for and applications of new topological phases of matter. Currently, no methods can provide depth profiling near surfaces or at interfaces of topologically inequivalent materials. Such a method could advance the study of interactions. Herein we present a non-invasive depth-profiling technique based on $\beta$-NMR spectroscopy of radioactive $^8$Li$^+$ ions that can provide "one-dimensional imaging" in films of fixed thickness and generates nanoscale views of the electronic wavefunctions and magnetic order at topological surfaces and interfaces. By mapping the $^8$Li nuclear resonance near the surface and 10 nm deep into the bulk of pure and Cr-doped bismuth antimony telluride films, we provide signatures related to the TI properties and their topological non-trivial characteristics that affect the electron-nuclear hyperfine field, the metallic shift and magnetic order. These nanoscale variations in $\beta$-NMR parameters reflect the unconventional properties of the topological materials under study, and understanding the role of heterogeneities is expected to lead to the discovery of novel phenomena involving quantum materials.Comment: 46 pages, 12 figures in Proc. Natl. Aca. Sci. USA (2015) Published online - early editio

Building Telehealth Teams of the Future Through Interprofessional Curriculum Development: A Five-Year Mixed Methodology Study

Building the next generation of telehealth enabled professionals requires a mixture of team-based, interprofessional practice with novel technologies that connect providers and patients. Effective telehealth education is critical for the development of multidisciplinary training curricula to ensure workforce preparedness. In this study, we evaluated the impact of a formal telehealth education curriculum for interprofessional students through an online elective. Over 12 semesters, 170 students self-selected to enroll in the 3-credit hour interprofessional elective and took part in structured didactic, experiential and interprofessional learning opportunities. Mixed-method assessments show significant knowledge and confidence gains with students reflecting on their roles as future healthcare providers. The results from five years’ worth of course data shows not only an opportunity to advance the individual knowledge of trainees, but a larger movement to facilitate changes in practice toward population health goals. Recent global health events have further highlighted the need for a rapid response to public health emergencies by highly trained provider teams who are able to utilize technology as the cornerstone for the continuity of care

Gangs and guilt: Towards a new theory of horror film

The most basic and unanimous statement made in scholarship on horror films is that horror films are ‘about’ fear: the primary purpose of horror films is to scare viewers. Based on horror films from the 1970s until the present in which child gangs play a significant part, this essay advances a new theory of horror film, namely that horror films primarily seek to elicit not fear but guilt. The analysis focuses on four topics: themes, camera angles, horror’s cinematic casting of ‘abnormality,’ and the rift, unique to the horror genre, between audience ‘alignment’ and ‘allegiance.

Participation in physical play and leisure : developing a theory- and evidence-based intervention for children with motor impairments

Peer reviewedPublisher PD

DRAFT 03

DRAFT 03, a magazine published about work and thoughts of students and staff of Interiors

Healthcare utilization and monetary costs associated with agitation in UK care home residents with advanced dementia: a prospective cohort study

OBJECTIVE: Nearly half of care home residents with advanced dementia have clinically significant agitation. Little is known about costs associated with these symptoms toward the end of life. We calculated monetary costs associated with agitation from UK National Health Service, personal social services, and societal perspectives. DESIGN: Prospective cohort study. SETTING: Thirteen nursing homes in London and the southeast of England. PARTICIPANTS: Seventy-nine people with advanced dementia (Functional Assessment Staging Tool grade 6e and above) residing in nursing homes, and thirty-five of their informal carers. MEASUREMENTS: Data collected at study entry and monthly for up to 9 months, extrapolated for expression per annum. Agitation was assessed using the Cohen-Mansfield Agitation Inventory (CMAI). Health and social care costs of residing in care homes, and costs of contacts with health and social care services were calculated from national unit costs; for a societal perspective, costs of providing informal care were estimated using the resource utilization in dementia (RUD)-Lite scale. RESULTS: After adjustment, health and social care costs, and costs of providing informal care varied significantly by level of agitation as death approached, from £23,000 over a 1-year period with no agitation symptoms (CMAI agitation score 0–10) to £45,000 at the most severe level (CMAI agitation score >100). On average, agitation accounted for 30% of health and social care costs. Informal care costs were substantial, constituting 29% of total costs. CONCLUSIONS: With the increasing prevalence of dementia, costs of care will impact on healthcare and social services systems, as well as informal carers. Agitation is a key driver of these costs in people with advanced dementia presenting complex challenges for symptom management, service planners, and providers

The influence of 'significant others' on persistent back pain and work participation: a qualitative exploration of illness perceptions

Background Individual illness perceptions have been highlighted as important influences on clinical outcomes for back pain. However, the illness perceptions of 'significant others' (spouse/partner/close family member) are rarely explored, particularly in relation to persistent back pain and work participation. The aim of this study was to initiate qualitative research in this area in order to further understand these wider influences on outcome. Methods Semi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with a convenience sample of UK disability benefit claimants, along with their significant others (n=5 dyads). Data were analysed using template analysis. Results Significant others shared, and perhaps further reinforced, claimants' unhelpful illness beliefs including fear of pain/re-injury associated with certain types of work and activity, and pessimism about the likelihood of return to work. In some cases, significant others appeared more resigned to the permanence and negative inevitable consequences of the claimant's back pain condition on work participation, and were more sceptical about the availability of suitable work and sympathy from employers. In their pursuit of authenticity, claimants were keen to stress their desire to work whilst emphasising how the severity and physical limitations of their condition prevented them from doing so. In this vein, and seemingly based on their perceptions of what makes a 'good' significant other, significant others acted as a 'witness to pain', supporting claimants' self-limiting behaviour and statements of incapacity, often responding with empathy and assistance. The beliefs and responses of significant others may also have been influenced by their own experience of chronic illness, thus participants lives were often intertwined and defined by illness. Conclusions The findings from this exploratory study reveal how others and wider social circumstances might contribute both to the propensity of persistent back pain and to its consequences. This is an area that has received little attention to date, and wider support of these findings may usefully inform the design of future intervention programmes aimed at restoring work participation