Adult missing persons:a concept analysis

Missing persons incidents incur considerable societal costs but research has overwhelmingly concentrated on missing children. Understanding the phenomenon among adults is underdeveloped as a result. We conducted an evolutionary concept analysis of the ‘missing person’ in relation to adults. Evolutionary concept analysis provides a structured narrative review methodology which aims to clarify how poorly defined phenomena have been discussed in the professional/academic literature in order to promote conceptual clarity and provide building blocks for future theoretical development. A systematic literature search identified k = 73 relevant papers from which surrogate terms for, and antecedents, consequences, and attributes of the occurrence of adult missing persons were extracted and analysed. The core attributes of the adult missing person are (i) actual or perceived unexpected or unwanted absence accompanied by an absence of information and (ii) a potential adverse risk outcome as perceived by those left behind. The centrality of mental ill-health in actual adult missing persons cases is not reflected in theoretical development which largely comprises descriptive typologies of variable quality and questionable utility. There is a clear need to shift research emphasis towards clinical and psychological domains of inquiry in order to further advance the field of adult missing persons research

Quality improvement at scale: evaluation of the drivers and barriers to adoption and sustainability of an intervention to reduce late referral in chronic kidney disease

This quality improvement project aimed to drive large-scale and sustained change to reduce the burden of chronic kidney disease in the UK. The intervention is a software programme that extracts relevant biochemical data from laboratory databases which then generate graphs of estimated kidney function (eGFR) over time. Graphs showing progressive kidney disease are sent directly back to GPs to alert them to re-review patient care and if necessary, refer to renal services. The aim of this evaluation study was to explain the barriers and drivers to implementation and adoption of the eGFR graph intervention. This evaluation study involved five of the 20 renal units (sites) involved. A Developmental Evaluation approach was utilised. Methods included collection of descriptive data about graph reporting; GP surveys (n=68); focus groups (n=4) with Practices; face-to-face interviews with secondary care clinicians (n=10). Results showed the mean number of graphs reviewed per week per site was 230, taking one hour per week per site. Only 18.2 % graphs highlighted a concerning decline in kidney function. Important enablers to sustain the intervention were low cost, easy to understand, a sense of local ownership and perceived impact. Barriers included nephrologists’ perceived increase in new referrals. We concluded that developmental evaluation can explain the barriers/drivers to implementation of a national quality improvement project that involves a variety of different stakeholders. The intervention has the potential to slow down progression of kidney disease due to the eGFR prompts alerting GPs to review the patient record and take action, such as reviewing medications and referring to renal teams if progressive kidney disease had not been identified previously

Cloud-resolving model simulations with one- and two-way couplings via the weak temperature gradient approximation

A cloud-resolving model is modified to implement the weak temperature gradient approximation in order to simulate the interactions between tropical convection and the large-scale tropical circulation. The instantaneous domain-mean potential temperature is relaxed toward a reference profile obtained from a radiative–convective equilibrium simulation of the cloud-resolving model. For homogeneous surface conditions, the model state at equilibrium is a large-scale circulation with its descending branch in the simulated column. This is similar to the equilibrium state found in some other studies, but not all. For this model, the development of such a circulation is insensitive to the relaxation profile and the initial conditions. Two columns of the cloud-resolving model are fully coupled by relaxing the instantaneous domain-mean potential temperature in both columns toward each other. This configuration is energetically closed in contrast to the reference-column configuration. No mean large-scale circulation develops over homogeneous surface conditions, regardless of the relative area of the two columns. The sensitivity to nonuniform surface conditions is similar to that obtained in the reference-column configuration if the two simulated columns have very different areas, but it is markedly weaker for columns of comparable area. The weaker sensitivity can be understood as being a consequence of a formulation for which the energy budget is closed. The reference-column configuration has been used to study the convection in a local region under the influence of a large-scale circulation. The extension to a two-column configuration is proposed as a methodology for studying the influence on local convection of changes in remote convection

The impact of air–sea interactions on the representation of tropical precipitation extremes

The impacts of air–sea interactions on the representation of tropical precipitation extremes are investigated using an atmosphere–ocean-mixed-layer coupled model. The coupled model is compared to two atmosphere-only simulations driven by the coupled model sea-surface temperatures (SSTs): one with 31-day running means (31d), the other with a repeating mean annual cycle. This allows separation of the effects of inter-annual SST variability from those of coupled feedbacks on shorter timescales. Crucially, all simulations have a consistent mean state with very small SST biases against present-day climatology. 31d overestimates the frequency, intensity and persistence of extreme tropical precipitation relative to the coupled model, likely due to excessive SST-forced precipitation variability. This implies that atmosphere-only attribution and time-slice experiments may overestimate the strength and duration of precipitation extremes. In the coupled model, air–sea feedbacks damp extreme precipitation, through negative local thermodynamic feedbacks between convection, surface fluxes and SST

A stepped wedge cluster randomized trial of graphical surveillance of kidney function data to reduce late presentation for kidney replacement therapy.

Late presentation for kidney replacement therapy (KRT) is an important cause of avoidable morbidity and mortality. Here, we evaluated the effect of a complex intervention of graphical estimated glomerular filtration rate (eGFR) surveillance across 15% of the United Kingdom population on the rate of late presentation using data routinely collected by the United Kingdom Renal Registry. A stepped wedge cluster randomized trial was established across 19 sites with eGFR graphs generated from all routine blood tests (community and hospital) across the population served by each site. Graphs were reviewed by trained laboratory or clinical staff and high-risk graphs reported to family doctors. Due to delays outside the control of clinicians and researchers few laboratories activated the intervention in their randomly assigned time period, so the trial was converted to a quasi-experimental design. We studied 6,100 kidney failure events at 20 laboratories served by 17 main kidney units. A total of 63,981 graphs were sent out. After adjustment for calendar time there was no significant reduction in the rate of presentation during the intervention period. Therefore, implementation of eGFR graph surveillance did not reduce the rate of late presentation for KRT after adjustment for secular trends. Thus, graphical surveillance is an intervention aimed at reducing late presentation, but more evidence is required before adoption of this strategy can be recommended. [Abstract copyright: Copyright © 2024. Published by Elsevier Inc.

Impact of calcium on salivary α-amylase activity, starch paste apparent viscosity and thickness perception

Thickness perception of starch-thickened products during eating has been linked to starch viscosity and salivary amylase activity. Calcium is an essential cofactor for α-amylase and there is anecdotal evidence that adding extra calcium affects amylase activity in processes like mashing of beer. The aims of this paper were to (1) investigate the role of salivary calcium on α-amylase activity and (2) to measure the effect of calcium concentration on apparent viscosity and thickness perception when interacting with salivary α-amylase in starch-based samples. α-Amylase activity in saliva samples from 28 people was assessed using a typical starch pasting cycle (up to 95 °C). The activity of the enzyme (as measured by the change in starch apparent viscosity) was maintained by the presence of calcium, probably by protecting the enzyme from heat denaturation. Enhancement of α-amylase activity by calcium at 37 °C was also observed although to a smaller extent. Sensory analysis showed a general trend of decreased thickness perception in the presence of calcium, but the result was only significant for one pair of samples, suggesting a limited impact of calcium enhanced enzyme activity on perceived thickness

Transition from suppressed to active convection modulated by a weak-temperature gradient derived large-scale circulation

Numerical simulations are performed to assess the influence of the large-scale circulation on the transition from suppressed to active convection. As a model tool, we used a coupled-column model. It consists of two cloud-resolving models which are fully coupled via a large-scale circulation which is derived from the requirement that the instantaneous domain-mean potential temperature profiles of the two columns remain close to each other. This is known as the weak-temperature gradient approach. The simulations of the transition are initialized from coupled-column simulations over non-uniform surface forcing and the transition is forced within the dry column by changing the local and/or remote surface forcings to uniform surface forcing across the columns. As the strength of the circulation is reduced to zero, moisture is recharged into the dry column and a transition to active convection occurs once the column is sufficiently moistened to sustain deep convection. Direct effects of changing surface forcing occur over the first few days only. Afterward, it is the evolution of the large-scale circulation which systematically modulates the transition. Its contributions are approximately equally divided between the heating and moistening effects. A transition time is defined to summarize the evolution from suppressed to active convection. It is the time when the rain rate within the dry column is halfway to the mean value obtained at equilibrium over uniform surface forcing. The transition time is around twice as long for a transition that is forced remotely compared to a transition that is forced locally. Simulations in which both local and remote surface forcings are changed produce intermediate transition times

Polycystic liver disease presenting with an exudative pleural effusion: a case report

<p>Abstract</p> <p>Introduction</p> <p>Polycystic liver disease is asymptomatic in 95% of patients. In the remaining 5% it causes symptoms due to the local mass effect of the polycystic liver. We describe the case of a patient who presented with symptoms of a pleural effusion and was also found to have polycystic liver disease. The effusion recurred despite repeated efforts at drainage and only resolved following surgical debridement of the cystic liver.</p> <p>Case presentation</p> <p>A 50-year-old Caucasian woman presented with a two-week history of increasing dyspnoea. An examination revealed a large right pleural effusion and gross hepatomegaly. An ultrasound confirmed a large polycystic liver and diagnostic thoracocentesis revealed an exudate, which was sterile to culture. The pleural effusion proved refractory to drainage and our patient underwent surgery to deroof the main hepatic cysts in an attempt to reduce the pressure on her right diaphragm. The histology was compatible with that of polycystic liver disease. No evidence of malignancy was found. After surgery, our patient had no recurrence of her effusion and, to date, has remained asymptomatic from her polycystic liver disease.</p> <p>Conclusion</p> <p>The case in this report illustrates that an exudative pleural effusion is a rare complication of polycystic liver disease. We feel that the mechanical effects of a large polycystic liver, and subsequent disruption of sub-diaphragmatic capillaries, resulted in a persistent exudative pleural effusion. Thus, surgical debulking of the hepatic cysts is required to manage these effusions.</p

Intercomparison of methods of coupling between convection and large-scale circulation. 2: comparison over non-uniform surface conditions

As part of an international intercomparison project, the weak temperature gradient (WTG) and damped gravity wave (DGW) methods are used to parameterize large-scale dynamics in a set of cloud-resolving models (CRMs) and single column models (SCMs). The WTG or DGW method is implemented using a configuration that couples a model to a reference state defined with profiles obtained from the same model in radiative-convective equilibrium. We investigated the sensitivity of each model to changes in SST, given a fixed reference state. We performed a systematic comparison of the WTG and DGW methods in different models, and a systematic comparison of the behavior of those models using the WTG method and the DGW method. The sensitivity to the SST depends on both the large-scale parameterization method and the choice of the cloud model. In general, SCMs display a wider range of behaviors than CRMs. All CRMs using either the WTG or DGW method show an increase of precipitation with SST, while SCMs show sensitivities which are not always monotonic. CRMs using either the WTG or DGW method show a similar relationship between mean precipitation rate and column-relative humidity, while SCMs exhibit a much wider range of behaviors. DGW simulations produce large-scale velocity profiles which are smoother and less top-heavy compared to those produced by the WTG simulations. These large-scale parameterization methods provide a useful tool to identify the impact of parameterization differences on model behavior in the presence of two-way feedback between convection and the large-scale circulation

Memory properties in cloud--resolving simulations of the diurnal cycle of deep convection

A series of high-resolution three{dimensional simulations of the diurnal cycle of deep convection over land are performed using the new​ Met Office NERC cloud-resolving model. This study features scattered​ convection. A memory function is defined to identify the effects of previous convection in modifying current convection. It is based on the probability of finding rain at time t0 and at an earlier time t0-Dt compared​ to the expected probability given no memory. The memory is examined as​ a function of the lag time Dt. It is strongest at grey-zone scales of 4-10 km,​ there is a change of behaviour for spatial scales between 10-15 km, and it​ is reduced substantially for spatial scales larger than 25 km. At grey-zone​ scales, there is a first phase of the memory function which represents the persistence of convection and it is maintained for about an hour. There is a second phase which represents the suppression of convection in regions which​ were raining 1 to 3 hours previously, and subsequently a third phase which​ represents a secondary enhancement of precipitation. The second and third​ phases of the memory function develop earlier for weaker forcing.​ When thermodynamic fluctuations resulting from the previous day are allowed to influence the development of convection on the next day, there are​ fewer rainfall events with relatively large sizes, which are more intense and​ thus, decay and recover more slowly, in comparison to the simulations where​ feedback from previous days is removed. Further sensitivity experiments reveal that convective memory attributed to these thermodynamic fluctuations resides in the lower troposphere