Physical activity education in the undergraduate curricula of all UK medical schools: are tomorrow's doctors equipped to follow clinical guidelines?

Physical activity (PA) is a cornerstone of disease prevention and treatment. There is, however, a considerable disparity between public health policy, clinical guidelines and the delivery of physical activity promotion within the National Health Service in the UK. If this is to be addressed in the battle against non-communicable diseases, it is vital that tomorrow's doctors understand the basic science and health benefits of physical activity. The aim of this study was to assess the provision of physical activity teaching content in the curricula of all medical schools in the UK. Our results, with responses from all UK medical schools, uncovered some alarming findings, showing that there is widespread omission of basic teaching elements, such as the Chief Medical Officer recommendations and guidance on physical activity. There is an urgent need for physical activity teaching to have dedicated time at medical schools, to equip tomorrow's doctors with the basic knowledge, confidence and skills to promote physical activity and follow numerous clinical guidelines that support physical activity promotion

Prevention of postoperative pulmonary complications in the hypoxaemic patient - gathering the evidence for noninvasive respiratory support

This is the accepted manuscript of article published in European Journal of Anaesthesiology. The final published version is available online at doi: 10.1097/EJA.000000000000118

The Ocean – Continent Transition Zones Along the Appalachian – Caledonian Margin of Laurentia: Examples of Large-Scale Hyperextension During the Opening of the Iapetus Ocean

A combination of deep seismic imaging and drilling has demonstrated that the ocean-continent transition (OCT) of present-day, magma-poor, rifted continental margins is a zone of hyperextension characterized by extreme thinning of the continental crust that exhumed the lowermost crust and/or serpentinized continental mantle onto the seafloor. The OCT on present-day margins is difficult to sample, and so much of our knowledge on the detailed nature of OCT sequences comes from obducted, magma-poor OCT ophiolites such as those preserved in the upper portions of the Alpine fold-and-thrust belt. Allochthonous, lens-shaped bodies of ultramafic rock are common in many other ancient orogenic belts, such as the Caledonian – Appalachian orogen, yet their origin and tectonic significance remains uncertain. We summarize the occurrences of potential ancient OCTs within this orogen, commencing with Laurentian margin sequences where an OCT has previously been inferred (the Dalradian Supergroup of Scotland and Ireland and the Birchy Complex of Newfoundland). We then speculate on the origin of isolated occurrences of Alpine-type peridotite within Laurentian margin sequences in Quebec – Vermont and Virginia – North Carolina, focusing on rift-related units of Late Neoproterozoic age (so as to eliminate a Taconic ophiolite origin). A combination of poor exposure and pervasive Taconic deformation means that origin and emplacement of many ultramafic bodies in the Appalachians will remain uncertain. Nevertheless, the common occurrence of OCT-like rocks along the whole length of the Appalachian – Caledonian margin of Laurentia suggests that the opening of the Iapetus Ocean may have been accompanied by hyperextension and the formation of magma-poor margins along many segments.SOMMAIREDes travaux d’imagerie sismique et des forages profonds ont montré que la transition océan-continent (OCT) de marges continentales de divergence pauvre en magma exposée de nos jours, correspond à une zone d’hyper-étirement tectonique caractérisée par un amincissement extrême de la croûte continentale, qui a exhumé sur le fond marin, jusqu’à la tranche la plus profonde de la croûte continentale, voire du manteau continental serpentinisé.  Parce qu’on peut difficilement échantillonner l’OCT sur les marges actuelles, une grande partie de notre compréhension des détails de la nature de l’OCT provient d’ophiolites pauvres en magma d’une OCT obduite, comme celles préservées dans les portions supérieures de la bande plissée alpine.  Des masses lenticulaires de roches ultramafiques allochtones sont communes dans de nombreuses autres bandes orogéniques anciennes, comme l’orogène Calédonienne-Appalaches, mais leur origine et signification tectonique reste incertaine.  Nous présentons un sommaire des occurrences d’OCT potentielles anciennes de cet orogène, en commençant par des séquences de la marge laurentienne, où la présence d’OCT a déjà été déduites (le Supergroupe Dalradien d’Écosse et d'Irlande, et le complexe de Birchy de Terre-Neuve).  Nous spéculons ensuite sur l'origine de cas isolés de péridotite de type alpin dans des séquences de marge des Laurentides du Québec-Vermont et de la Virginie-Caroline du Nord, en nous concentrant sur les unités de rift d'âge néoprotérozoïque tardif (pour éviter les ophiolites du Taconique).  La conjonction d’affleurements de piètre qualité et de la déformation taconique omniprésente, signifie que l'origine et la mise en place de nombreuses masses ultramafiques dans les Appalaches demeureront incertaines.  Néanmoins, la présence fréquente de roches de type OCT tout le long de la marge Calédonnienne-Appalaches de Laurentia suggère que l'ouverture de l'océan Iapetus peut avoir été accompagnée d’hyper-étirement et de la formation de marges pauvres en magma le long de nombreux segments

Magma Ascent along a Major Terrane Boundary: Crustal Contamination and Magma Mixing at the Drumadoon Intrusive Complex, Isle of Arran, Scotland

The composite intrusions of Drumadoon and An Cumhann crop out on the SE coast of the Isle of Arran, Scotland and form part of the larger British and Irish Palaeogene Igneous Province, a subset of the North Atlantic Igneous Province. The intrusions (shallow-level dykes and sills) comprise a central quartz-feldspar-phyric rhyolite flanked by xenocryst-bearing basaltic andesite, with an intermediate zone of dark quartz-feldspar-phyric dacite. New geochemical data provide information on the evolution of the component magmas and their relationships with each other, as well as their interaction with the crust through which they travelled. During shallow-crustal emplacement, the end-member magmas mixed. Isotopic evidence shows that both magmas were contaminated by the crust prior to mixing; the basaltic andesite magma preserves some evidence of contamination within the lower crust, whereas the rhyolite mainly records upper-crustal contamination. The Highland Boundary Fault divides Arran into two distinct terranes, the Neoproterozoic to Early Palaeozoic Grampian Terrane to the north and the Palaeozoic Midland Valley Terrane to the south. The Drumadoon Complex lies within the Midland Valley Terrane but its isotopic signatures indicate almost exclusive involvement of Grampian Terrane crust. Therefore, although the magmas originated at depth on the northern side of the Highland Boundary Fault, they have crossed this boundary during their evolution, probably just prior to emplacemen

Quasifree pion photoproduction on the deuteron in the Δ\Delta region

Photo production of pions on the deuteron is studied in the spectator nucleon model. The Born terms of the elementary production amplitude are determined in pseudovector $\pi$N coupling and supplied with a form factor. The $\Delta$ resonance is considered both in the $s$ and the $u$ channel. The parameters of the $\Delta$ resonance and the cutoff of the form factors are fixed on the leading photoproduction multipoles. Results for total and differential cross sections are compared with experimental data. Particular attention is paid to the role of Pauli correlations of the final state nucleons in the quasifree case. The results are compared with those for pion photoproduction on the nucleon.Comment: 17 pages LateX2e including 5 postscript figure

Multipole analysis of spin observables in vector meson photoproduction

A multipole analysis of vector meson photoproduction is formulated as a generalization of the pseudoscalar meson case. Expansion of spin observables in the multipole basis and behavior of these observables near threshold and resonances are examined.Comment: 15 pages, latex, 2 figure

Orange juice ultrafiltration:Characterisation of deposit layers and membrane surfaces after fouling and cleaning

The influence of feed condition and membrane cleaning during the ultrafiltration (UF) of orange juice for phytosterol separation was investigated. UF was performed using regenerated cellulose acetate (RCA) membranes at different molecular weight cut-off (MWCO) values with a 336 cm2 membrane area and a range of temperatures (10-40 °C) and different feed volumes (3-9 L). Fluid dynamic gauging (FDG) was applied to assess the fouling and cleaning behaviours of RCA membranes fouled by orange juice and cleaned using P3-Ultrasil 11 over two complete cycles. During the FDG testing, fouling layers were removed by fluid shear stress caused by suction flow. The cleanability was characterised by using ImageJ software analysis. A Liebermann-Buchard-based method was used to quantify the phytosterol content. The results show that RCA 10 kDa filters exhibited the best separation of phytosterols from protein in orange juice at 20 °C using 3 L feed with a selectivity factor of 17. Membranes that were fouled after two cycles showed higher surface coverage compared to one fouling cycle. The surface coverage decreased with increasing fluid shear stress from 0 to 3.9 Pa. FDG achieved 80-95% removal at 3.9 Pa for all RCA membranes. Chemical cleaning using P3-Ultrasil 11 altered both the membrane surface hydrophobicity and roughness. These results show that the fouling layer on RCA membranes can be removed by fluid shear stress without affecting the membrane surface modification caused by chemical cleaning.</p

Refining the scalar and tensor contributions in τ→πππντ\tau\to \pi\pi\pi\nu_\tau decays

In this article we analyze the contribution from intermediate spin-0 and spin-2 resonances to the $\tau\to\nu \pi\pi\pi$ decay by means of a chiral invariant Lagrangian incorporating these mesons. In particular, we study the corresponding axial-vector form-factors. The advantage of this procedure with respect to previous analyses is that it incorporates chiral (and isospin) invariance and, hence, the partial conservation of the axial-vector current. This ensures the recovery of the right low-energy limit, described by chiral perturbation theory, and the transversality of the current in the chiral limit at all energies. Furthermore, the meson form-factors are further improved by requiring appropriate QCD high-energy conditions. We end up with a brief discussion on its implementation in the Tauola Monte Carlo and the prospects for future analyses of Belle's data.Comment: 32 pages, 13 figures. Extended discussion on the numerical importance of the tensor and scalar resonances and the parametrization of the scalar propagator. Version published in JHE

‘Treading water but drowning slowly’: what are GPs’ experiences of living and working with mental illness and distress in England? A qualitative study

Objectives This paper provides an in-depth account of general practitioners’ (GPs) experiences of living and working with mental illness and distress, as part of a wider study reporting the barriers and facilitators to help-seeking for mental illness and burn-out, and sources of stress/distress for GP participants. Design Qualitative study using in-depth interviews with 47 GP participants. The interviews were audio recorded, transcribed, anonymised and imported into NVivo V.11 to facilitate data management. Data were analysed using a thematic analysis employing the constant comparative method. Setting England. Participants A purposive sample of GP participants who self-identified as: (1) currently living with mental distress, (2) returning to work following treatment, (3) off sick or retired early as a result of mental distress or (4) without experience of mental distress. Interviews were conducted face to face or over the telephone. Results The findings report GP participants’ in-depth experiences of distress and mental illness with many recollecting their distressing experiences and significant psychological and physical symptoms relating to chronic stress, anxiety, depression and/or burn-out, and a quarter articulating thoughts of suicide. Many talked about their shame, humiliation and embarrassment at their perceived inability to cope with the stresses of their job and/or their symptoms of mental illness. Conclusions These findings paint a concerning picture of the situation affecting primary care doctors, with participants’ accounts suggesting there is a considerable degree of mental ill health and reduced well-being among GPs. The solutions are complex and lie in prevention and provision. There needs to be greater recognition of the components and cumulative effect of occupational stressors for doctors, such as the increasing workload and the clinical and emotional demands of the job, as well as the need for a culture shift within medicine to more supportive and compassionate work environments