Pressure distributions and oil-flow patterns for a swept circulation-control wing

Pressure distributions and photographs of oil flow patterns are presented for a circulation control wing. The model was an aspect ratio four semispan wing mounted on the side wall of the NASA Ames Transonic Wind Tunnel. The airfoil was a 20 percent thick ellipse, modified with circular leading and trailing edges of 4 percent radius, and had a 25.4 cm constant chord. This configuration does not represent a specific wing design, but is generic. A full span, tangetial, rearward blowing, circulation control slot was incorporated ahead of the trailing edge on the upper surface. The wing was tested at Mach numbers from 0.3 to 0.75 at sweep angle of 0 to 45 deg with internal to external pressure ratios of 1.0 to 3.0. Lift and pitching momemt coefficients were obtained from measured pressure distributions at five span stations. When the conventional corrections resulting from sweep angle are applied to the lift and moment of circulation control sections, no additional corrections are necessary to account for changes in blowing efficiency. This is demonstrated for an aft sweep angle of 45 deg. An empirical technique for estimating the downwash distribution of a swept wing was validated

Targeting metastatic colorectal cancer with immune oncological therapies

Metastatic colorectal cancer carries poor prognosis, and current therapeutic regimes convey limited improvements in survival and high rates of detrimental side effects in patients that may not stand to benefit. Immunotherapy has revolutionised cancer treatment by restoring antitumoural mechanisms. However, the efficacy in metastatic colorectal cancer, is limited. A literature search was performed using Pubmed (Medline), Web of Knowledge, and Embase. Search terms included combinations of immunotherapy and metastatic colorectal cancer, primarily focusing on clinical trials in humans. Analysis of these studies included status of MMR/MSS, presence of combination strategies, and disease control rate and median overall survival. Evidence shows that immune checkpoint inhibitors, such as anti-PD1 and anti-PD-L1, show efficacy in less than 10% of patients with microsatellite stable, MMR proficient colorectal cancer. In the small subset of patients with microsatellite unstable, MMR deficient cancers, response rates were 40–50%. Combination strategies with immunotherapy are under investigation but have not yet restored antitumoural mechanisms to permit durable disease regression. Immunotherapy provides the potential to offer additional strategies to established chemotherapeutic regimes in metastatic colorectal cancer. Further research needs to establish which adjuncts to immune checkpoint inhibition can unpick resistance, and better predict which patients are likely to respond to individualised therapies to not just improve response rates but to temper unwarranted side effects

Extended scope of nursing practice: a multicentre randomised controlled trial of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery

Aim/ Principal Research Question:1) To determine whether pre-operative assessment carried out by an appropriately trained nurse (ATN) is equivalent in quality to that carried out by a pre-registration house officer (PRHO).2) To assess whether pre-assessments carried out by ATNs and PRHOs are equivalent in terms of cost.3) To determine whether assessments carried out by ATNs are acceptable to patients.4) To investigate the quality of communication between senior medical staff and ATNs.Factors of Interest:The extended role of appropriately trained nurses and pre-registration house officers in pre-operative assessment in elective general surgery.Methods:The study design was principally a prospective randomised equivalence trial but was accompanied by additional qualitative assessment of patient and staff perceptions, and an economic evaluation.The intervention consisted of a pre-operative assessment carried out by either an ATN or a PRHO. Of the patients who completed the study with a full evaluation, 926 patients were randomised to the PRHO arm of the trial and 948 to the ATN arm. Three ATNs took part in the study, one from each centre, together with a total of 87 PRHOs.Immediately following the initial assessment of a patient by a PRHO or an ATN, one of a number of clinical research fellows, all specialist registrars in anaesthetics, repeated the assessment and recorded it on a study form, together with a list of investigations required. The clinical research fellow then evaluated the competency of the initial assessor by comparing the quality of their assessment with their own. Any deficiencies in ordering of investigations and referral to other specialities were met in order to maximise patient care.Sample groups:All patients attending at one site for assessment prior to general anaesthetic for elective general, vascular, urological or breast surgery were potentially included in the study. Of 1907 patients who were randomised, 1874 completed the study with a full evaluation.The study was carried out at four NHS hospitals, three of which were teaching hospitals, in three NHS Trusts in Southampton, Sheffield and Doncaster.Outcome measures:Three areas of ATN and PRHO performance were judged separately, history taking, examination and ordering of tests, and each was graded into one of four categories, the most important of which was under-assessment, which would possibly have affected peri-operative management. In the case of ordering of tests, it was possible to have both over- and under-assessed a patient on different tests.Findings:The pre-operative assessments carried out by the ATNs were essentially equivalent to those performed by the PRHOs in terms of under-assessment that might possibly have affected peri-operative management, although there was variation between the ATNs in terms of the quality of history taking. This may be related to the low number of patients seen at one study site.PRHOs ordered significantly more unnecessary tests than the ATNs. The substitution of ATNs for PRHOs was calculated to be cost neutral.The results of the qualitative assessment showed that the use of ATNs for pre-operative assessment was acceptable to patients; however, there was no evidence that communication between senior medical staff and those carrying out pre-operative assessments was improved by their introduction.Conclusions:This study demonstrated no reason to inhibit the development of fully nurse-led pre-operative assessment, provided that the nurses are appropriately trained and maintain sufficient workload to retain skills.Implications for Further Research:Further research is needed in the following areas:1) the extent and type of training needed for nurses undertaking the pre-operative assessment role2) the use, costs and benefits of routine pre-operative testing.<br/

Risk exposure trade-offs in the ontogeny of sexual segregation in Antarctic fur seal pups

Sexual segregation has important ecological implications, but its initial development in early life stages is poorly understood. We investigated the roles of size dimorphism, social behavior, and predation risk on the ontogeny of sexual segregation in Antarctic fur seal, Arctocephalus gazella, pups at South Georgia. Beaches and water provide opportunities for pup social interaction and learning (through play and swimming) but increased risk of injury and death (from other seals, predatory birds, and harsh weather), whereas tussock grass provides shelter from these risks but less developmental opportunities. One hundred pups were sexed and weighed, 50 on the beach and 50 in tussock grass, in January, February, and March annually from 1989 to 2018. Additionally, 19 male and 16 female pups were GPS-tracked during lactation from December 2012. Analysis of pup counts and habitat use of GPS-tracked pups suggested that females had a slightly higher association with tussock grass habitats and males with beach habitats. GPS-tracked pups traveled progressively further at sea as they developed, and males traveled further than females toward the end of lactation. These sex differences may reflect contrasting drivers of pup behavior: males being more risk prone to gain social skills and lean muscle mass and females being more risk averse to improve chances of survival, ultimately driven by their different reproductive roles. We conclude that sex differences in habitat use can develop in a highly polygynous species prior to the onset of major sexual size dimorphism, which hints that these sex differences will increasingly diverge in later life

Diurnal excretion of urinary cortisol, cortisone, and cortisol metabolites in chronic fatigue syndrome

Abstract Objective: The aim of this study was to obtain comprehensive information on basal hypothalamic-pituitary-adrenal (HPA) axis activity in chronic fatigue syndrome (CFS) patients who were not affected by medication or comorbid psychiatric disorder likely to influence the HPA axis. Method: Steroid analysis of urine collections from 0600 to 2100 h at 3-h intervals in CFS patients and in controls. Results: Urinary free cortisol and cortisone concentrations showed a significant normal diurnal rhythm, but levels were lower across the cycle in CFS. In contrast, while urinary cortisol metabolites also showed a normal diurnal rhythm, levels were not significantly different between the CFS and controls at any time. Derived metabolite ratios were similar in both groups. Conclusion: This study provides further evidence for reduced basal HPA axis function in patients with CFS, based on lower free cortisol and cortisone levels, but this is not corroborated by cortisol metabolite data. The difference between these measures cannot be explained by an altered timing of the diurnal rhythm.

Diurnal excretion of urinary cortisol, cortisone, and cortisol metabolites in chronic fatigue syndrome

Abstract Objective: The aim of this study was to obtain comprehensive information on basal hypothalamic-pituitary-adrenal (HPA) axis activity in chronic fatigue syndrome (CFS) patients who were not affected by medication or comorbid psychiatric disorder likely to influence the HPA axis. Method: Steroid analysis of urine collections from 0600 to 2100 h at 3-h intervals in CFS patients and in controls. Results: Urinary free cortisol and cortisone concentrations showed a significant normal diurnal rhythm, but levels were lower across the cycle in CFS. In contrast, while urinary cortisol metabolites also showed a normal diurnal rhythm, levels were not significantly different between the CFS and controls at any time. Derived metabolite ratios were similar in both groups. Conclusion: This study provides further evidence for reduced basal HPA axis function in patients with CFS, based on lower free cortisol and cortisone levels, but this is not corroborated by cortisol metabolite data. The difference between these measures cannot be explained by an altered timing of the diurnal rhythm.

Phase fluctuations, dissipation and superfluid stiffness in d-wave superconductors

We study the effect of dissipation on quantum phase fluctuations in d-wave superconductors. Dissipation, arising from a nonzero low frequency optical conductivity which has been measured in experiments below $T_c$, has two effects: (1) a reduction of zero point phase fluctuations, and (2) a reduction of the temperature at which one crosses over to classical thermal fluctuations. For parameter values relevant to the cuprates, we show that the crossover temperature is still too large for classical phase fluctuations to play a significant role at low temperature. Quasiparticles are thus crucial in determining the linear temperature dependence of the in-plane superfluid stiffness. Thermal phase fluctuations become important at higher temperatures and play a role near $T_c$.Comment: Presentation improved, new references added (10 latex pages, 3 eps figures). submitted to PR

Newsprint coverage of smoking in cars carrying children : a case study of public and scientific opinion driving the policy debate

Acknowledgements Date of Acceptance:17/10/2014 Acknowledgements: This project was funded by Cancer Research UK (MC_U130085862) and the Scottish School of Public Health Research. Cancer Research UK and the Scottish School of Public Health Research was not involved in the collection, analysis, and interpretation of data, writing of the manuscript or the decision to submit the manuscript for publication. Shona Hilton, Karen Wood, Josh Bain and Chris Patterson are funded by the UK Medical Research Council as part of the Understandings and Uses of Public Health Research programme (MC_UU_12017/6) at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. We thank Alan Pollock who provided assistance with coding.Peer reviewedPublisher PD