Lecture III: There are maps and there are maps – motives, markets and users

This is the third of three lectures given on 5,6 and 8 March 2007 as the Sandars lectures for that year at Cambridge University Library. The text is as read at the time, but includes some later revisions and citations to works used within the text. The slides shown are listed in a separate document.Cambridge University Library, Sandars Readership in Bibliograph

Lecture II: Geography is better than divinity. The practitioners' story

This is the second of three lectures given on 5,6 and 8 March 2007 as the Sandars lectures for that year at Cambridge University Library. The text is as read at the time, but includes some later revisions and citations to works used within the text. The slides shown are listed in a separate document.Cambridge University Library, Sandars Readership in Bibliograph

Significant variations in nutritional supplementation amongst neonates in the UK

Aim Nutritional supplementation in neonates is common in neonatal unit. This study set out to ascertain UK adherence to ESPGHAN guidance. Methods A national cross sectional questionnaire study of neonatal units across England was completed between January and March 2014. All 174 units in the country were attempted to be contacted to complete a telephone survey. This included all level 1,2 and 3 units. They were initially contacted by phone and asking any senior member of the team about their current practice and procedures. The first ten telephone interviews were completed with two researchers present to ensure consistency of approach. If no response was received or no details were available, one further attempt was made to contact the unit. The results were recorded in a proforma and then collated and entered into a spreadsheet for analysis. Comparison to ESPGHAN guidance was completed. Results Response rate was 53%. There was variation in use of all supplements. The survey collected data from 91 neonatal units (53% response rate). It was found that 10% of neonatal units had no fixed policy on supplements. The protocols regarding supplementation involved predominantly folic acid, Vitamin A, Vitamin D and iron, with much variation in doses and regimens. The criteria for prescribing supplements was largely based on age (47%) with only 7% using a weight targets to initiate supplements. Summary data regarding the appropriateness of each nutritional supplement for a variety of different weights are presented, as well as comparison to ESPGHAN guidance which suggests issues with both underdoing of Breast Fed infants and overdosing of infants on several artificial formulas which already contain significant amounts of these nutritional elements. Conclusions There is significant heterogeneity in neonatal policies when prescribing supplements to neonates. National policies which take international guidance into account are recommended

Large eddy simulation of turbine internal cooling ducts

Large-Eddy Simulation (LES) and hybrid Reynolds-averaged Navier-Stokes-LES (RANSLES) methods are applied to a turbine blade ribbed internal duct with a 180 degree bend containing 24 pairs of ribs. Flow and heat transfer predictions are compared with experimental data and found to be in agreement. The choice of LES model is found to be of minor importance as the flow is dominated by large geometric scale structures. This is in contrast to several linear and nonlinear RANS models, which display turbulence model sensitivity. For LES, the influence of inlet turbulence is also tested and has a minor impact due to the strong turbulence generated by the ribs. Large scale turbulent motions destroy any classical boundary layer reducing near wall grid requirements. The wake-type flow structure makes this and similar flows nearly Reynolds number independent, allowing a range of flows to be studied at similar cost. Hence LES is a relatively cheap method for obtaining accurate heat transfer predictions in these types of flows.This is the accepted manuscript. The final version is available at http://www.sciencedirect.com/science/article/pii/S0045793015000663

Significant variations in nutritional supplementation amongst neonates in the United Kingdom

AIM: To ascertain United Kingdom adherence to European society of Paediatric Gastroenterology, Hepatology and Nutrition guidance (ESPGHAN). METHODS: A national cross sectional questionnaire study of neonatal units across England was completed between January and March 2014. All 174 units in the country were attempted to be contacted to complete a telephone survey. This included all level 1, 2 and 3 units. They were initially contacted by phone and asking any senior member of the team about their current practice and procedures. The first ten telephone interviews were completed with two researchers present to ensure consistency of approach. If no response was received or no details were available, one further attempt was made to contact the unit. The results were recorded in a proforma and then collated and entered into a spreadsheet for analysis. Comparison to United Kingdom adherence to ESPGHAN guidance was completed. RESULTS: Response rate was 53%. There was variation in use of all supplements. The survey collected data from 91 neonatal units (53% response rate). It was found that 10% of neonatal units had no fixed policy on supplements. The protocols regarding supplementation involved predominantly folic acid, vitamin A, vitamin D and iron, with much variation in doses and regimens. The criteria for prescribing supplements was largely based on age (47%) with only 7% using a weight targets to initiate supplements. Summary data regarding the appropriateness of each nutritional supplement for a variety of different weights are presented, as well as comparison to ESPGHAN guidance which suggests issues with both underdoing of Breast Fed infants and overdosing of infants on several artificial formulas which already contain significant amounts of these nutritional elements. CONCLUSION: There is significant heterogeneity in neonatal policies when prescribing supplements to neonates. National policies which take international guidance into account are recommended

A numerical study of a plane wall jet with heat transfer

A direct numerical simulation (DNS) of a wall jet is performed at Re=7500. To the authors’ knowledge, this is the highest Reynolds number DNS study of a wall jet. The heat transfer process is studied with an iso-thermal boundary condition at the wall. The molecular Prandtl number is Pr=0.71. Mean flow and heat transfer parameters are contrasted with available measurements and Nusselt number coefficient correlations. The scaling parameters for heat transfer variables are investigated. The mean temperature ⟨T⟩, temperature root mean square T_rms, streamwise ⟨u′T′⟩ and wall normal 〈v′T′〉 heat flux profiles show collapse in the streamwise direction, with the inner scaling, the outer scaling and the thermal scaling parameters. The complete budgets for temperature variance ⟨T′T′⟩ and turbulent heat fluxes are also presented

The Impact of Advance Directives on the Intensity of Care Received in the Acute Care Setting in Older Adults

The proportion of older adults in the U.S. is rapidly increasing. One-third of Medicare expenditures occur in the final year of life, with nearly half resulting from acute exacerbations of chronic, progressive diseases(Riley & Lubitz, 2010). Older adults prefer comfort over life-sustaining care, and decreased intensity of care is associated with improved quality of life at the end-of-life (EOL). Advance directives (ADs) have been proposed as mechanisms to improve congruence between patient wishes and EOL care; however, the impact of ADs on care delivered in the acute care setting at the EOL for this population is unclear. A retrospective, correlation design framed by the Quality Health Outcomes Model was used to describe (a) the relationship between ADs and the intensity of care received by older adults in the acute care setting at the EOL, and (b) the congruence between patient preferences within ADs and actual care received. Four hundred and ninety-six patients, aged 65 and older who died while admitted to a large, academic medical center, were identified using electronic health records. Regression analyses, to determine the association between ADs and indicators of intensity of care, and content analysis, to describe congruence of care, were conducted. Advance directives were not independently associated with any indicators of high-intensity (i.e., high-cost, high-technology) care. While ADs were independently associated with palliative and hospice referrals, effect sizes were small, and referral timing was late. In a subset of one hundred patients with ADs, less than half received care that was congruent with documented preferences. In approximately one-fourth, patient preferences were vague, and congruence could not be determined. Advance directives may be ineffective, in their current form, to decrease aggressive care in the acute care setting. Further research is necessary to determine whether this is a function of how ADs are used within acute care or ambiguous preferences within the document. A shift in the approach of healthcare providers may be necessary to promote engagement in advanced care planning discussions, with patients and family members, with an AD serving as the product of those discussions rather than a document completed out of context

Eleanor Davies and the New Jerusalem

Eleanor Davies was a great believer in historical moments. In her first work—A Warning to the Dragon and All His Angels of 1625-she told readers that “The Lord is at the Dore.”1 This immanence of God made her watchful and purposeful, reading the signs in her daily life, counting days, weeks, and years because she believed that Christ would come again. His arrival had been predestined from the beginning of the world: “from the going forth of the Commandement, which is the beginning of the Creation to the building of the New Jerusalem, the second comming of Messiah, the Prince the Sonne of God, it shall be Seaven Weekes or Seaven Moneths.”2 For Davies, time was elastic, but history was absolute. What the biblical prophets (in this case Ezekiel) said would come to pass, really would come to pass, but their promises were oracular; they had complete authority but were also elusive. Davies accepted this. She knew that she was living in the latter days, but when it came to God’s final judgment, “the daye and houre knoweth no man.”3 God could not be known as such and what she called knowledge was a spiritual transformation that took place when “He powreth out his Spirit upon his hand-maidens,” like herself.4 This essay uses A Warning to the Dragon and Davies’ works of the 1630s and 1640s to examine her theology