Thermally induced convective circulation and precipitation over an isolated volcano

Intense rainfall over active volcanoes is known to trigger dangerous volcanic hazards, from remobilizing loose volcanic surface material into lahars or mudflows to initiating explosive activity including pyroclastic flows at certain dome-forming volcanoes. However, the effect of the heated volcanic surface on the atmospheric circulation, including any feedback with precipitation, is unknown. This is investigated here, using the Weather Research and Forecasting (WRF) Model. The recent activity at the Soufrière Hills Volcano (SHV), Montserrat, is a well-documented case of such rainfall–volcano interaction and is used as a template for these experiments. The volcano is represented in the model by an idealized Gaussian mountain, with an imposed realistic surface temperature anomaly on the volcano summit. A robust increase in precipitation over the volcano is simulated for surface temperature anomalies above approximately 40°C, an area-average value that is exceeded at the SHV. For wind speeds less than 4 m s−1 and a range of realistic atmospheric conditions, the precipitation increase is well above the threshold required to trigger volcanic hazards (5–10 mm h−1). Hence, the thermal atmospheric forcing due to an active, but nonerupting, volcano appears to be an important factor in rainfall–volcano interactions and should be taken account of in future hazard studies

A cyber-security framework for development, defense and innovation at NATO

The article is of strategic nature. It projects the importance of cyber-security as policy, while reflecting the need for enhancing constantly NATO’s (North Atlantic Treaty Organization) cyber-dimensional strategy, management, and operations. There is a policy need for constant innovation and entrepreneurship in security, one that reflects also NATO’s practical needs; its security resilience and business continuity. At a time of strategic challenges and policy recommendations, the production of this article is timely. It examines NATOs Heads of States and Governments decision of the Brussels Summit meeting on Cyber Security that was held in July 2018. The article proposes a framework of strategic re-alignment, with a stronger eye toward practical innovation and entrepreneurship; practicality in operational management, while enhancing political cooperation and tactical/strategic preparation for field operations. The aim, design, and setting of this article explicitly and methodologically evaluates NATO’s security and cyber-security options to come for the near future. The article integrates and proposes a new design for a new format of collective defense. The article considers cyber-defense as key tool for current and future operational and network centric operations. The article enables us to comprehend better the Alliance’ global and regional needs the framework of current and future defense, requesting at the same time for a holistic approach to innovation and entrepreneurship, while new geostrategic and geo-economic challenges emerge

Medical and Legal Aspects of Child Sexual Abuse: a Population-Based Study in a Hungarian County

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GPs' perceptions of resilience training: a qualitative study.

BACKGROUND: GPs are reporting increasing levels of burnout, stress, and job dissatisfaction, and there is a looming GP shortage. Promoting resilience is a key strategy for enhancing the sustainability of the healthcare workforce and improving patient care. AIM: To explore GPs' perspectives on the content, context, and acceptability of resilience training programmes in general practice, in order to build more effective GP resilience programmes. DESIGN AND SETTING: This was a qualitative study of the perspectives of GPs currently practising in England. METHOD: GPs were recruited through convenience sampling, and data were collected from two focus groups (n = 15) and one-to-one telephone interviews (n = 7). A semi-structured interview approach was used and data were analysed using thematic analysis. RESULTS: Participants perceived resilience training to be potentially of value in ameliorating workplace stresses. Nevertheless, uncertainty was expressed regarding how best to provide training for stressed GPs who have limited time. Participants suspected that GPs most likely to benefit from resilience training were the least likely to engage, as stress and being busy worked against engagement. Conflicting views were expressed about the most suitable training delivery method for promoting better engagement. Participants also emphasised that training should not only place the focus on the individual, but also focus on organisation issues. CONCLUSION: A multimodal, flexible approach based on individual needs and learning aims, including resilience workshops within undergraduate training and in individual practices, is likely to be the optimal way to promote resilience

Hearing health geography in England:findings from the English longitudinal study of ageing (ELSA) and evidence of a north-south divide

Objective:To explore regional patterns and trends of hearing loss (HL) in a representative longitudinal prospective cohort study of the English population aged 50 years and above.Method:We used the full dataset (74,699 person-years) of the English Longitudinal Study of Ageing (ELSA). We examined the geographical identifiers of the participants at Geographical Office Regions (GOR) level, and the geographically based Index of Multiple Deprivation (IMD). We computed Adjusted Predictions at the Means (APMs) and the Marginal Effects at the Means (MEMs) of the HL prevalence in each ELSA Wave, with age, gender, education, occupation, income, wealth, IMD and alcohol consumption as the factor variables.Results:Between 2002-2017 there was an estimated increase of 10.2% in the total HL prevalence in the English older population: 38.50 (95%CI 37.37-39.14) in Wave 1, to 48.66 (95%CI 47.11-49.54) in Wave 8. The Hot Spot and Cold Spot analyses showed marked regional variability and evidence of a North-South divide. There was a wide variation in HL prevalence in representative samples from different regions in England that had similar age profiles, and the increase rate of HL ranged from 3.2% to 45%.Implications:These results provided evidence that the increasing trend in HL prevalence is not related to the ageing of the population, as widely believed, as the samples had significantly equal age but differed markedly on their HL outcomes, both regionally and chronically. A socio-spatial approach is crucial for planning sustainable models of hearing care based on actual needs and reducing hearing health inequalities

Interventions to Improve the Breaking of Bad or Difficult News by Physicians, Medical Students, and Interns/Residents: A Systematic Review and Meta-Analysis

Purpose: To assess the effectiveness of news delivery interventions to improve observer-rated skills, physician confidence, and patient-reported depression/anxiety. Method: MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Register of Controlled Trials databases were searched from inception to September 5, 2016 (updated February 2017). Eligible studies included randomized controlled trials (RCTs), non-RCTs, and controlled before–after studies of interventions to improve the communication of bad or difficult news by physicians, medical students, and residents/interns. The EPOC risk of bias tool was used to conduct a risk of bias assessment. Main and secondary meta-analyses examined the effectiveness of the identified interventions for improving observer-rated news delivery skills and improving physician confidence in delivering news and patient-reported depression/anxiety, respectively. Results: Seventeen studies were included in the systematic review and meta-analysis, including 19 independent comparisons on 1,322 participants and 9 independent comparisons on 985 participants for the main and secondary (physician confidence) analyses (mean [SD] age = 35 [7] years; 46% male), respectively. Interventions were associated with large, significant improvements in observer-rated news delivery skills (19 comparisons: standardized mean difference [SMD] = 0.74; 95% CI = 0.47–1.01) and moderate, significant improvements in physician confidence (9 comparisons: SMD = 0.60; 95% CI = 0.26–0.95). One study reported intervention effects on patient-reported depression/anxiety. The risk of bias findings did not influence the significance of the results. Conclusions: Interventions are effective for improving news delivery and physician confidence. Further research is needed to test the impact of interventions on patient outcomes and determine optimal components and length

Cruel and Usual

A transcription of the Footnote Forum Podcast, a CUNY Law Review Productio