Rainfall-induced differential settlements of foundations on heterogeneous unsaturated soils

This study stochastically investigates the rainfall-induced differential settlement of a centrally loaded, rigid strip foundation on an unsaturated soil with spatially varying values of either preconsolidation stress or porosity. The differential settlement (between the two foundation ends) is calculated at various times during rainfall by way of a coupled, hydro-mechanical, finite-element analysis. The Barcelona basic model describes the mechanical behaviour of the soil, and the van Genuchten relationships describe water retention and permeability. The variability of soil properties is modelled by means of random fields with spatial correlation in the framework of a Monte Carlo simulation. The study demonstrates that the occurrence of rainfall-induced differential settlements can be consistently analysed using concepts of unsaturated soil mechanics and random field theory. Results show that differential settlements can be vastly underpredicted (or even completely missed) if random heterogeneity and partial saturation are not simultaneously considered. The variation of differential settlements and their statistics during the rainfall depend on the magnitude of the applied load and the statistics of soil variability. Moreover, the transient phase of infiltration and a spatial correlation length equal to the width of the foundation pose the highest risk of differential settlement

Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison

Background: There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors’ subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy. Aim: We therefore studied the effects on patient's safety and doctors’ work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota. Methods: Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors. Results: Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0–60.0) vs. 52.4 (11.2) (30.0–77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota. Conclusions: Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety

Accretion physics at high X-ray spectral resolution: New frontiers and game-changing science

Microcalorimeters have demonstrated success in delivering high spectral resolution, and have paved the path to revolutionary new science possibilities in the coming decade of X-ray astronomy. There are several research areas in compact object science that can only be addressed with energy resolution Delta(E)<~5 eV at photon energies of a few keV, corresponding to velocity resolution of <~a few hundred km/s, to be ushered in by microcalorimeters. Here, we review some of these outstanding questions, focusing on how the research landscape is set to be transformed (i) at the interface between accreting supermassive black holes and their host galaxies, (ii) in unravelling the structures of accretion environments, (iii) in resolving long-standing issues on the origins of energy and matter feedback, and (iv) to test mass-scaled unification of accretion and feedback. The need to learn lessons from Hitomi and to make improvements in laboratory atomic data precision as well as plasma modeling are highlighted.Comment: To appear in Nature Astronomy as a review. Author version, before final editorial and style revision

Associative and Spatial Relationships in Thesaurus-based Retrieval

The OASIS (Ontologically Augmented Spatial Information System) project explores terminology systems for thematic and spatial access in digital library applications. A prototype implementation uses data from the Royal Commission on the Ancient and Historical Monuments of Scotland, together with the Getty AAT and TGN thesauri. This paper describes its integrated spatial and thematic schema and discusses novel approaches to the application of thesauri in spatial and thematic semantic distance measures. Semantic distance measures can underpin interactive and automatic query expansion techniques by ranking lists of candidate terms. We first illustrate how hierarchical spatial relationships can be used to provide more flexible retrieval for queries incorporating place names in applications employing online gazetteers and geographical thesauri. We then employ a set of experimental scenarios to investigate key issues affecting use of the associative (RT) thesaurus relationships in semantic distance measures. Previous work has noted the potential of RTs in thesaurus search aids but the problem of increased noise in result sets has been emphasised. Specialising RTs allows the possibility of dynamically linking RT type to query context. Results presented in this paper demonstrate the potential for filtering on the context of the RT link and on subtypes of RT relationships

A randomized, double-blind comparison of OROS® hydromorphone and controlled-release morphine for the control of chronic cancer pain

<p>Abstract</p> <p>Background</p> <p>Long-acting opioid formulations are advocated for maintaining pain control in chronic cancer pain. OROS^®hydromorphone is a sustained-release formulation of hydromorphone that requires dosing once daily to maintain therapeutic concentrations. The objective of this study was to demonstrate the clinical equivalence of immediate-release and sustained-release formulations of hydromorphone and morphine for chronic cancer pain.</p> <p>Methods</p> <p>200 patients with cancer pain (requiring ≤ 540 mg/d of oral morphine) participated in this double-blind, parallel-group trial. Patients were randomized to receive hydromorphone or morphine (immediate-release for 2–9 days, sustained-release for 10–15 days). Efficacy was assessed with the Brief Pain Inventory (BPI), investigator and patient global evaluations, Eastern Cooperative Oncology Group performance status, and the Mini-Mental State Examination. The primary endpoint was the 'worst pain in the past 24 hours' item of the BPI, in both the immediate-release and sustained-release study phases, with treatments deemed equivalent if the 95% confidence intervals (CI) of the between-group differences at endpoint were between -1.5 and 1.5. No equivalence limits were defined for secondary endpoints.</p> <p>Results</p> <p>Least-squares mean differences (95% CI) between groups were 0.2 (-0.4, 0.9) in the immediate-release phase and -0.8 (-1.6, -0.01) in the sustained-release phase (intent-to-treat population), indicating that the immediate-release formulations met the pre-specified equivalence criteria, but that the lower limit of the 95% CI (-1.6) was outside the boundary (-1.5) for the sustained-release formulations. BPI 'pain now PM' was significantly lower with OROS^®hydromorphone compared with controlled-release morphine (least-squares mean difference [95% CI], -0.77 [-1.49, -0.05]; <it>p </it>= 0.0372). Scores for other secondary efficacy variables were similar between the two sustained-release treatments. At endpoint, > 70% of investigators and patients rated both treatments as good to excellent. The safety profiles of hydromorphone and morphine were similar and typical of opioid analgesics.</p> <p>Conclusion</p> <p>Equivalence was demonstrated for immediate-release formulations of hydromorphone and morphine, but not for the sustained-release formulations of OROS^®hydromorphone and controlled-release morphine. The direction of the mean difference between the treatments (-0.8) and the out-of-range lower limit of the 95% CI (-1.6) were in favor of OROS^®hydromorphone.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: NCT0041054</p

The black hole X-ray transient Swift J1357.2-0933 as seen with Swift and NuSTAR during its 2017 outburst

We report on observations of black hole Swift J1357.2–0933, a member of the modest population of very faint X-ray transients. This source has previously shown intense dips in the optical light curve, a phenomena that has been linked to the existence of a ‘unique toroidal structure’ in the inner region of the disc, seen at a high inclination. Our observations, carried out by the Neil Gehrels Swift and NuSTAR X-ray observatories, do not show the presence of intense dips in the optical light curves. We find that the X-ray light curves do not show any features that would straightforwardly support an edge-on configuration or high inclination configuration of the orbit. This is similar to what was seen in the X-ray observations of the source during its 2011 outburst. Moreover, the broad-band spectra were well described with an absorbed power-law model without any signatures of cut-off at energies above 10 keV, or any reflection from the disc or the putative torus. Thus, the X-ray data do not support the unique ‘obscuring torus’ scenario proposed for J1357. We also performed a multiwavelength study using the data of X-ray telescope and Ultraviolet/Optical Telescope aboard Swift, taken during the ∼4.5 months duration of the 2017 outburst. This is consistent with what was previously inferred for this source. We found a correlation between the simultaneous X-ray and ultraviolet/optical data and our study suggests that most of the reprocessed flux must be coming out in the ultraviolet.Publisher PDFPeer reviewe

Is gynaecological surgical training a cause for concern? A questionnaire survey of trainees and trainers

<p>Astract</p> <p>Background</p> <p>Concerns have been raised as to whether the current postgraduate training programme for gynaecological surgery is being detrimentally affected by changes in working practices, in particular the European Working Time Directive (EWTD). The purpose of this study was to investigate the surgical activity of obstetrics and gynaecology trainees and to explore trainees' and trainers' opinions on the current barriers and potential solutions to surgical training.</p> <p>Methods</p> <p>Two questionnaire surveys were conducted, one to obstetrics and gynaecology trainees working within the West Midlands Deanery and a second to consultant gynaecologists in the West Midlands region.</p> <p>Results</p> <p>One hundred and four trainees (64.3%) and 66 consultant gynaecologists (55.0%) responded. Sixty-six trainees (66.7%) reported attending up to one operating list per week. However, 28.1% reported attending up to one list every two weeks or less and 5 trainees stated that they had not attended a list at all over the preceding 8 weeks. Trainees working in a unit with less than 3999 deliveries attended significantly more theatre sessions compared to trainees in units with over 4000 deliveries (p = 0.007), as did senior trainees (p = 0.032) and trainees attached to consultants performing major gynaecological surgery (p = 0.022). In the previous 8 weeks, only 6 trainees reported performing a total abdominal hysterectomy independently, all were senior trainees (ST6 and above). In the trainers' survey, only two respondents (3.0%) agreed that the current program produces doctors competent in general gynaecological surgery by the end of training, compared to 48 (73.8%) respondents who disagreed.</p> <p>Conclusions</p> <p>Trainees' concerns over a lack of surgical training appear to be justified. The main barriers to training are perceived to be a lack of team structure and a lack of theatre time.</p

Does patient-physiotherapist agreement influence the outcome of low back pain? A prospective cohort study

BACKGROUND: Recent research suggests that agreement between patients' and health professionals' perceptions may influence the outcome of various painful conditions. This issue has received little attention in the context of low back pain and physiotherapy interventions. The current study aimed at exploring the relationship between patient-physiotherapist agreement on baseline low back pain intensity and related functional limitations, and changes in patient outcomes four weeks later. METHODS: Seventy-eight patient-physiotherapist dyads were included in the study. At baseline, patients and physiotherapists completed a Numerical Rating Scale and the Roland-Morris Disability Questionnaire. Patients' perceptions were reassessed over the phone at follow-up. RESULTS: Using multiple regression, baseline level of patient-physiotherapist agreement on pain intensity was associated with both outcome measures at follow-up. Agreement on functional limitations had no impact on outcomes. CONCLUSION: The results of this study indicate that patient-physiotherapist agreement has some impacts on the short-term outcomes of low back pain. Further research is needed to confirm these findings