X-ray Spectroscopy of Cooling Clusters

We review the X-ray spectra of the cores of clusters of galaxies. Recent high resolution X-ray spectroscopic observations have demonstrated a severe deficit of emission at the lowest X-ray temperatures as compared to that expected from simple radiative cooling models. The same observations have provided compelling evidence that the gas in the cores is cooling below half the maximum temperature. We review these results, discuss physical models of cooling clusters, and describe the X-ray instrumentation and analysis techniques used to make these observations. We discuss several viable mechanisms designed to cancel or distort the expected process of X-ray cluster cooling.Comment: To appear in Physics Reports, 71 pages, 20 figure

The New Emerging Model for the Structure of Cooling Cores in Clusters of Galaxies

New X-ray observations with XMM-Newton show a lack of spectral evidence for large amounts of cooling and condensing gas in the centers of galaxy clusters believed to harbour strong cooling flows. The paper reexplores the cooling flow scenario in the light of the new observations. We explore the diagnostics of the temperature structure of cooling cores with XMM-spectroscopy, tests for intracluster X-ray absorption towards central AGN, the effect of metal abundance inhomogeneities, and the implications of high resolution images in the centers of clusters. We find no evidence of intrinsic absorption in the center of the cooling flows of M87 and the Perseus cluster. We further consider the effect of cluster rotation in cooling flow regions in the frame of cosmic structure evolution models. Also the heating of the core regions of clusters by jets from a central AGN is reconsidered. We find that the power of the AGN jets as estimated by their interaction effects with the intracluster medium in several examples is more then sufficient to heat the cooling flows and to reduce the mass deposition rates. We explore in more detail which requirements such a heating model has to fulfill to be consistent with all observations, point out the way such a model could be constructed, and argue that such model building seems to be successful. In summary it is argued that most observational evidence points towards much lower mass deposition rates than previously inferred in the central region of clusters thought to contain strong cooling flows.Comment: 19 pages, 14 figures, submitted to Astronomy and Astrophysic

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Partner- and planning-based interventions to reduce fat consumption: randomized controlled trial.

OBJECTIVE: The research tested the efficacy of partner- and planning-based interventions to reduce dietary fat intake over a 6-month period. DESIGN: Randomized controlled, blinded, parallel trial. METHODS: A computer randomization feature was used to allocate council employees (N = 427, of which 393 completed baseline measures) to one of four conditions (partner + implementation intentions, partner-only, implementation intentions, and control group) before they completed measures at baseline and follow-ups at 1, 3, and 6 months post-baseline. Outcome measures were comprised of validated self-report measures of dietary fat intake (saturated fat intake, fat intake, ratio of 'good' fats to 'bad' fats); psychosocial mediators (enjoyment, intention, self-efficacy, social influence, partner support); weight and waist size (baseline and 6 months only). RESULTS: Data from 393 participants were analysed in accordance with intention-to-treat analyses. All intervention groups reported greater reductions in fat intake than the control group at 3 months. The partner-based groups increased the ratio of 'good' fats to 'bad' fats at 3 and 6 months and lost more inches on their waist, versus the non-partner groups. The impacts of the partner-based manipulations on outcomes were partially mediated by greater perceived social influences, partner support, and enjoyment of avoiding high-fat foods. The partner-based interventions also increased intention and self-efficacy. However, the effects in this study were typically small and generally marginally significant. CONCLUSIONS: Partner-based interventions had some positive benefits on dietary-related outcomes at 3 and 6 months. Support for implementation intentions was more limited

The geological history of the Isle of Wight : an overview of the ‘diamond in Britain's geological crown’

The geology of the Isle of Wight has attracted both the amateur and professional geologist alike for well over two centuries. It presents a cornucopia of things geological and offers a window into the fascinating story of the geological history and landscape development of southern England, as well as an important teaching resource for all levels of study from primary education through to academic research. This paper provides a geological framework and a summary of the history of research as context for the papers in this issue can be placed. Inevitably, it can only offer a précis of the huge amount of information available, but it is hoped will also give added impetus to further investigation of the literature or, indeed, new research. The island offers a field workshop for topics such as lithostratigraphy, sequence stratigraphy, tectonics and climate change; studies that are becoming ever more international in their influence. There are 15 Sites of Special Scientific Interest designated because of their geological importance and a number of these are internationally significant. After a brief discussion on the concealed geology, this paper concentrates on an outline of the near-surface geology on the coast and inland, and introduces a different view on the structure of the Cretaceous and Palaeogene strata. The enigmatic Quaternary deposits are discussed particularly with reference to the development of the Solent River, human occupation and climate change