Moving towards a wave-resolved approach to forecasting mountain wave induced clear air turbulence

Mountain wave breaking in the lower stratosphere is one of the major causes of atmospheric turbulence encountered in commercial aviation, which in turn is the cause of most weather-related aircraft incidents. In the case of clear air turbulence (CAT), there are no visual clues and pilots are reliant on operational forecasts and reports from other aircraft. Traditionally mountain waves have been sub-grid-scale in global numerical weather prediction (NWP) models, but recent developments in NWP mean that some forecast centres (e.g. the UK Met Office) are now producing operational global forecasts that resolve mountain wave activity explicitly, allowing predictions of mountain wave induced turbulence with greater accuracy and confidence than previously possible. Using a bespoke turbulent kinetic energy diagnostic, the Met Office Unified Model (MetUM) is shown to produce useful forecasts of mountain CAT during three case studies over Greenland, and to outperform the current operational Met Office CAT prediction product (the World Area Forecast Centre (WAFC) London gridded CAT product) in doing so. In a long term, 17-month, verification, MetUM forecasts yield a turbulence prediction hit rate of 80% with an accompanying false alarm rate of under 40%. These skill scores are a considerable improvement on those reported for the mountain wave component of the WAFC product, although no direct comparison is available. The major implication of this work is that sophisticated global NWP models are now sufficiently advanced to provide skilful forecasts of mountain wave turbulence

Narrative Skin Repair: Bearing Witness to Mediatized Representations of Self-Harm

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Managed care and patient ratings of the quality of specialty care among patients with pain or depressive symptoms

BACKGROUND: Managed care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care among primary care patients with pain and depressive symptoms who received specialty care for those conditions. METHODS: A prospective cohort study design was conducted in the offices of 261 primary physicians in private practice in Seattle in 1997. Patients (N = 17,187) were screened in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms. Patients (n = 1,995) completed a 6-month follow-up survey. Of these, 691 patients received specialty care for pain, and 356 patients saw mental health specialists. For each patient, managed care was measured by the intensity of managed care controls in the patient's health plan and primary care office. Quality of specialty care at follow-up was measured by patient rating of care provided by the specialists. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days. RESULTS: The intensity of managed care controls in health plans and primary care offices was generally not associated with patient ratings of the quality of specialty care. However, pain patients in more-managed primary care offices had lower ratings of the quality of specialty care from physician specialists and ancillary providers. CONCLUSION: For primary care patients with pain or depressive symptoms and who see specialists, managed care controls may influence ratings of specialty care for patients with pain but not patients with depressive symptoms

Enhancing access to reports of randomized trials published world-wide – the contribution of EMBASE records to the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library

<p>Abstract</p> <p>Background</p> <p>Randomized trials are essential in assessing the effects of healthcare interventions and are a key component in systematic reviews of effectiveness. Searching for reports of randomized trials in databases is problematic due to the absence of appropriate indexing terms until the 1990s and inconsistent application of these indexing terms thereafter.</p> <p>Objectives</p> <p>The objectives of this study are to devise a search strategy for identifying reports of randomized trials in EMBASE which are not already indexed as trials in MEDLINE and to make these reports easily accessible by including them in the Cochrane Central Register of Controlled Trials (CENTRAL) in <it>The Cochrane Library</it>, with the permission of Elsevier, the publishers of EMBASE.</p> <p>Methods</p> <p>A highly sensitive search strategy was designed for EMBASE based on free-text and thesaurus terms which occurred frequently in the titles, abstracts, EMTREE terms (or some combination of these) of reports of trials indexed in EMBASE. This search strategy was run against EMBASE from 1980 to 2005 (1974 to 2005 for four of the terms) and records retrieved by the search, which were not already indexed as randomized trials in MEDLINE, were downloaded from EMBASE, printed and read. An analysis of the language of publication was conducted for the reports of trials published in 2005 (the most recent year completed at the time of this study).</p> <p>Results</p> <p>Twenty-two search terms were used (including nine which were later rejected due to poor cumulative precision). More than a third of a million records were downloaded and scanned and approximately 80,000 reports of trials were identified which were not already indexed as randomized trials in MEDLINE. These are now easily identifiable in CENTRAL, in <it>The Cochrane Library</it>. Cumulative sensitivity ranged from 0.1% to 60% and cumulative precision ranged from 8% to 61%. The truncated term 'random$' identified 60% of the total number of reports of trials but only 35% of the more than 130,000 records retrieved by this term were reports of trials. The language analysis for the sample year 2005 indicated that of the 18,427 reports indexed as randomized trials in MEDLINE, 959 (5%) were in languages other than English. The EMBASE search identified an additional 658 reports in languages other than English, of which the highest number were in Chinese (320).</p> <p>Conclusion</p> <p>The results of the search to date have greatly increased access to reports of trials in EMBASE, especially in some languages other than English. The search strategy used was subjectively derived from a small 'gold standard' set of test records and was not validated in an independent test set. We intend to design an objectively-derived validated search strategy using logistic regression based on the frequency of occurrence of terms in the approximately 80,000 reports of randomized trials identified compared with the frequency of these terms across the entire EMBASE database.</p

Psychosynthesis: A Foundational Bridge Between Psychology and Spirituality

Pastoral psychologists have long tried to establish a working model that encompasses the seemingly conflicting disciplines of science and religion. Psychosynthesis, a transpersonal psychology and therapeutic approach, offers such a model of the human personality, in which the psychological and spiritual perspectives can converge. This article explores psychosynthesis psychology and therapy as a theoretical framework for pastoral psychology. Although psychosynthesis psychotherapy relies on an array of techniques, it fundamentally works with the clients’ will while emphasizing, exploring, and cultivating their relationships on all levels—intrapersonal, interpersonal, and with the Higher Self. In addition to the subconscious, psychosynthesis includes a higher psychological plane, called the superconscious, from which our higher ethical, aesthetic, scientific, and spiritual values are derived. This article begins by introducing psychosynthesis concepts and techniques. It then provides qualitative findings showing that psychosynthesis counseling helped to awaken spirituality in three out of eleven clients who had formerly identified themselves as atheists. In addition, testimonies are included that show that psychosynthesis counseling also helped all eleven clients to attain personal growth. Finally, the counselor describes her experience of psychosynthesis as a Christian in the therapeutic setting. The framework of psychosynthesis psychology and its techniques are viable methodologies for anyone searching to incorporate spiritual growth into a psychological working mode

What about reservoirs? Questioning anthropogenic and climatic interferences on water availability

Water resources in semi-arid regions like the Mediterranean Basin are highly vulnerable because of the high variability of weather systems. Additionally, climate change is altering the timing and pattern of water availability in a region where growing populations are placing extra demands on water supplies. Importantly, how reservoirs and dams have an influence on the amount of water resources available is poorly quantified. Therefore, we examine the impact of reservoirs on water resources together with the impact of climate change in a semi-arid Mediterranean catchment. We simulated the Susurluk basin (23.779-km(2)) using the Soil and Water Assessment Tool (SWAT) model. We generate results for with (RSV) and without reservoirs (WRSV) scenarios. We run simulations for current and future conditions using dynamically downscaled outputs of the MPI-ESM-MR general circulation model under two greenhouse gas relative concentration pathways (RCPs) in order to reveal the coupled effect of reservoir and climate impacts. Water resources were then converted to their usages - blue water (water in aquifers and rivers), green water storage (water in the soil) and green water flow (water losses by evaporation and transpiration). The results demonstrate that all water resources except green water flow are projected to decrease under all RCPs compared to the reference period, both long-term and at seasonal scales. However, while water scarcity is expected in the future, reservoir storage is shown to be adequate to overcome this problem. Nevertheless, reservoirs reduce the availability of water, particularly in soil moisture stores, which increases the potential for drought by reducing streamflow. Furthermore, reservoirs cause water losses through evaporation from their open surfaces. We conclude that pressures to protect society from economic damage by building reservoirs have a strong impact on the fluxes of watersheds. This is additional to the effect of climate change on water resources.İstanbul Üniversitesi Bilimsel Araştırma Projeleri Birimi (57515, 39111, 38985

Reliability and Validity of the Diagnostic Criteria for Temporomandibular Disorders Axis I in Clinical and Research Settings: A Critical Appraisal

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