A microtonal wind controller building on Yamaha’s technology to facilitate the performance of music based on the “19-EDO” scale

We describe a project in which several collaborators adapted an existing instrument to make it capable of playing expressively in music based on the microtonal scale characterised by equal divsion of the octave into 19 tones (“19-EDO”). Our objective was not just to build this instrument, however, but also to produce a well-formed piece of music which would exploit it idiomatically, in a performance which would provide listeners with a pleasurable and satisfying musical experience. Hence, consideration of the extent and limits of the playing-techniques of the resulting instrument (a “Wind-Controller”) and of appropriate approaches to the composition of music for it were an integral part of the project from the start. Moreover, the intention was also that the piece, though grounded in the musical characteristics of the 19-EDO scale, would nevertheless have a recognisable relationship with what Dimitri Tymoczko (2010) has called the “Extended Common Practice” of the last millennium. So the article goes on to consider these matters, and to present a score of the resulting new piece, annotated with comments documenting some of the performance issues which it raises. Thus, bringing the project to fruition involved elements of composition, performance, engineering and computing, and the article describes how such an inter-disciplinary, multi-disciplinary and cross-disciplinary collaboration was co-ordinated in a unified manner to achieve the envisaged outcome. Finally, we consider why the building of microtonal instruments is such a problematic issue in a contemporary (“high-tech”) society like ours

Achieving Universal Coverage Through Comprehensive Health Reform: The Vermont Experience -- Report of Findings

Presents findings on the role of Vermont's health reform programs in increasing insurance coverage between 2005 and 2009. Examines changes by insurance type, contributing factors such as outreach campaigns, financial sustainability, and implications

The evolution of climate change guidance for fluvial flood risk management in England

Floods are one of the biggest natural hazards to society, and there is increasing concern about the potential impacts of climate change on flood occurrence and magnitude. Furthermore, flood risk is likely to increase in the future not just through increased flood occurrence, but also through socio-economic changes, such as increasing population. The extent to which adaptation measures can offset this increased risk will depend on the level of future climate change, but there exists an urgent need for information on the potential impacts of climate change on floods, so that these can be accounted for by flood management authorities and local planners aiming to reduce flood risk. Agencies across the UK have been pro-active in providing such guidance for many years and in refining it as the science of climate change and hydrological impacts has developed. The history of this guidance for fluvial flood risk in England is presented and discussed here, including the recent adoption of a regional risk-based approach. Such an approach could be developed and applied to flood risk management in other countries, and to other sectors affected by climate change

Web tools for large-scale 3D biological images and atlases

<p>Abstract</p> <p>Background</p> <p>Large-scale volumetric biomedical image data of three or more dimensions are a significant challenge for distributed browsing and visualisation. Many images now exceed 10GB which for most users is too large to handle in terms of computer RAM and network bandwidth. This is aggravated when users need to access tens or hundreds of such images from an archive. Here we solve the problem for 2D section views through archive data delivering compressed tiled images enabling users to browse through very-large volume data in the context of a standard web-browser. The system provides an interactive visualisation for grey-level and colour 3D images including multiple image layers and spatial-data overlay.</p> <p>Results</p> <p>The standard Internet Imaging Protocol (IIP) has been extended to enable arbitrary 2D sectioning of 3D data as well a multi-layered images and indexed overlays. The extended protocol is termed IIP3D and we have implemented a matching server to deliver the protocol and a series of Ajax/Javascript client codes that will run in an Internet browser. We have tested the server software on a low-cost linux-based server for image volumes up to 135GB and 64 simultaneous users. The section views are delivered with response times independent of scale and orientation. The exemplar client provided multi-layer image views with user-controlled colour-filtering and overlays.</p> <p>Conclusions</p> <p>Interactive browsing of arbitrary sections through large biomedical-image volumes is made possible by use of an extended internet protocol and efficient server-based image tiling. The tools open the possibility of enabling fast access to large image archives without the requirement of whole image download and client computers with very large memory configurations. The system was demonstrated using a range of medical and biomedical image data extending up to 135GB for a single image volume.</p

Mortality benefits of population-wide adherence to national physical activity guidelines: a prospective cohort study.

We quantified the mortality benefits and attributable fractions associated with engaging in physical activity across a range of levels, including those recommended by national guidelines. Data were from the Allied Dunbar National Fitness Survey, a population-based prospective cohort comprising 1,796 male and 2,122 female participants aged 16-96 years, randomly selected from 30 English constituencies in 1990. Participants were tagged for mortality at the Office for National Statistics. Cox multivariable regression quantified the association between self-reported achievement of activity guidelines--150 min of at least moderate activity per week, equivalent here to 30 or more 20-min episodes of at least moderate activity per month--and mortality adjusting for age, sex, smoking status, social class, geographical area, anxiety/depression and interview season. There were 1,175 deaths over a median (IQR) of 22.9 (3.9) years follow-up; a mortality rate of 15.2, 95% confidence interval (CI) 14.4-16.1 per 1,000 person years. Compared with being inactive (no 20-min bouts per month), meeting activity guidelines (30+ bouts) was associated with a 25% lower mortality rate, adjusting for measured confounders. If everyone adhered to recommended-, or even low-activity levels, a substantial proportion of premature mortality might be avoided (PAF, 95% CI 20.6, 6.9-32.3 and 8.9, 4.2-13.4%, respectively). Among a representative English population, adherence to activity guidelines was associated with significantly reduced mortality. Efforts to increase population-wide activity levels could produce large public health benefits and should remain a focus of health promotion efforts.The Allied Dunbar National Fitness Survey was funded by the Department of Health, Health Education Authority, The Sports Council and Allied Dunbar Assurance plc. This work was supported by the Medical Research Council (MC_UU_12015/1, MC_UU_12015/3 and MC_UU_12015/4). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the UK Department of Health.This is the final published version. It first appeared at http://link.springer.com/article/10.1007%2Fs10654-014-9965-5

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial

Background: Only one-third of patients with depression respond fully to treatment with antidepressant medication. However, there is little robust evidence to guide the management of those whose symptoms are 'treatment resistant'.&lt;p&gt;&lt;/p&gt; Objective: The CoBalT trial examined the clinical effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment-resistant depression (TRD) compared with usual care alone.&lt;p&gt;&lt;/p&gt; Design: Pragmatic, multicentre individually randomised controlled trial with follow-up at 3, 6, 9 and 12 months. A subset took part in a qualitative study investigating views and experiences of CBT, reasons for completing/not completing therapy, and usual care for TRD.&lt;p&gt;&lt;/p&gt; Setting: General practices in Bristol, Exeter and Glasgow, and surrounding areas.&lt;p&gt;&lt;/p&gt; Participants: Patients aged 18-75 years who had TRD [on antidepressants for 6 weeks, had adhered to medication, Beck Depression Inventory, 2nd version (BDI-II) score of 14 and fulfilled the International Classification of Diseases and Related Health Problems, Tenth edition criteria for depression]. Individuals were excluded who (1) had bipolar disorder/psychosis or major alcohol/substance abuse problems; (2) were unable to complete the questionnaires; or (3) were pregnant, as were those currently receiving CBT/other psychotherapy/secondary care for depression, or who had received CBT in the past 3 years.&lt;p&gt;&lt;/p&gt; Interventions: Participants were randomised, using a computer-generated code, to usual care or CBT (12-18 sessions) in addition to usual care.&lt;p&gt;&lt;/p&gt; Main outcome measures: The primary outcome was 'response', defined as 50% reduction in depressive symptoms (BDI-II score) at 6 months compared with baseline. Secondary outcomes included BDI-II score as a continuous variable, remission of symptoms (BDI-II score of &lt; 10), quality of life, anxiety and antidepressant use at 6 and 12 months. Data on health and social care use, personal costs, and time off work were collected at 6 and 12 months. Costs from these three perspectives were reported using a cost-consequence analysis. A cost-utility analysis compared health and social care costs with quality adjusted life-years.&lt;p&gt;&lt;/p&gt; Results: A total of 469 patients were randomised (intervention: n = 234; usual care: n = 235), with 422 participants (90%) and 396 (84%) followed up at 6 and 12 months. Ninety-five participants (46.1%) in the intervention group met criteria for 'response' at 6 months compared with 46 (21.6%) in the usual-care group {odds ratio [OR] 3.26 [95% confidence interval (CI) 2.10 to 5.06], p &lt; 0.001}. In repeated measures analyses using data from 6 and 12 months, the OR for 'response' was 2.89 (95% CI 2.03 to 4.10, p &lt; 0.001) and for a secondary 'remission' outcome (BDI-II score of &lt; 10) 2.74 (95% CI 1.82 to 4.13, p &lt; 0.001). The mean cost of CBT per participant was £910, the incremental health and social care cost £850, the incremental QALY gain 0.057 and incremental cost-effectiveness ratio £14,911. Forty participants were interviewed. Patients described CBT as challenging but helping them to manage their depression; listed social, emotional and practical reasons for not completing treatment; and described usual care as mainly taking medication.&lt;p&gt;&lt;/p&gt; Conclusions: Among patients who have not responded to antidepressants, augmenting usual care with CBT is effective in reducing depressive symptoms, and these effects, including outcomes reflecting remission, are maintained over 12 months. The intervention was cost-effective based on the National Institute for Health and Care Excellence threshold. Patients may experience CBT as difficult but effective. Further research should evaluate long-term effectiveness, as this would have major implications for the recommended treatment of depression.&lt;p&gt;&lt;/p&gt

A Virtual Look at Epstein–Barr Virus Infection: Biological Interpretations

The possibility of using computer simulation and mathematical modeling to gain insight into biological and other complex systems is receiving increased attention. However, it is as yet unclear to what extent these techniques will provide useful biological insights or even what the best approach is. Epstein–Barr virus (EBV) provides a good candidate to address these issues. It persistently infects most humans and is associated with several important diseases. In addition, a detailed biological model has been developed that provides an intricate understanding of EBV infection in the naturally infected human host and accounts for most of the virus' diverse and peculiar properties. We have developed an agent-based computer model/simulation (PathSim, Pathogen Simulation) of this biological model. The simulation is performed on a virtual grid that represents the anatomy of the tonsils of the nasopharyngeal cavity (Waldeyer ring) and the peripheral circulation—the sites of EBV infection and persistence. The simulation is presented via a user friendly visual interface and reproduces quantitative and qualitative aspects of acute and persistent EBV infection. The simulation also had predictive power in validation experiments involving certain aspects of viral infection dynamics. Moreover, it allows us to identify switch points in the infection process that direct the disease course towards the end points of persistence, clearance, or death. Lastly, we were able to identify parameter sets that reproduced aspects of EBV-associated diseases. These investigations indicate that such simulations, combined with laboratory and clinical studies and animal models, will provide a powerful approach to investigating and controlling EBV infection, including the design of targeted anti-viral therapies