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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Benefits and harms of Risperidone and Paliperidone for treatment of patients with schizophrenia or bipolar disorder: a meta-analysis involving individual participant data and clinical study reports

Background Schizophrenia and bipolar disorder are severe mental illnesses which are highly prevalent worldwide. Risperidone and Paliperidone are treatments for either illnesses, but their efficacy compared to other antipsychotics and growing reports of hormonal imbalances continue to raise concerns. As existing evidence on both antipsychotics are solely based on aggregate data, we aimed to assess the benefits and harms of Risperidone and Paliperidone in the treatment of patients with schizophrenia or bipolar disorder, using individual participant data (IPD), clinical study reports (CSRs) and publicly available sources (journal publications and trial registries). Methods We searched MEDLINE, Central, EMBASE and PsycINFO until December 2020 for randomised placebo-controlled trials of Risperidone, Paliperidone or Paliperidone palmitate in patients with schizophrenia or bipolar disorder. We obtained IPD and CSRs from the Yale University Open Data Access project. The primary outcome Positive and Negative Syndrome Scale (PANSS) score was analysed using one-stage IPD meta-analysis. Random-effect meta-analysis of harm outcomes involved methods for coping with rare events. Effect-sizes were compared across all available data sources using the ratio of means or relative risk. We registered our review on PROSPERO, CRD42019140556. Results Of the 35 studies, IPD meta-analysis involving 22 (63%) studies showed a significant clinical reduction in the PANSS in patients receiving Risperidone (mean difference − 5.83, 95% CI − 10.79 to − 0.87, I2 = 8.5%, n = 4 studies, 1131 participants), Paliperidone (− 6.01, 95% CI − 8.7 to − 3.32, I2 = 4.3%, n = 13, 3821) and Paliperidone palmitate (− 7.89, 95% CI − 12.1 to − 3.69, I2 = 2.9%, n = 5, 2209). CSRs reported nearly two times more adverse events (4434 vs. 2296 publication, relative difference (RD) = 1.93, 95% CI 1.86 to 2.00) and almost 8 times more serious adverse events (650 vs. 82; RD = 7.93, 95% CI 6.32 to 9.95) than the journal publications. Meta-analyses of individual harms from CSRs revealed a significant increased risk among several outcomes including extrapyramidal disorder, tardive dyskinesia and increased weight. But the ratio of relative risk between the different data sources was not significant. Three treatment-related gynecomastia events occurred, and these were considered mild to moderate in severity. Conclusion IPD meta-analysis conclude that Risperidone and Paliperidone antipsychotics had a small beneficial effect on reducing PANSS score over 9 weeks, which is more conservative than estimates from reviews based on journal publications. CSRs also contained significantly more data on harms that were unavailable in journal publications or trial registries. Sharing of IPD and CSRs are necessary when performing meta-analysis on the efficacy and safety of antipsychotics

Global burden of preventable medication-related harm in health care: a systematic review

A series of WHO initiatives, such as the Global Patient Safety Challenge: Medication Without Harm and the Global Patient Safety Action Plan 2021-2030, address patient harm associated with use of medications. Medication-related harm is considered preventable if it occurs as a result of an identifiable,modifiable cause and its recurrence can be avoided by appropriate adaptation to a process or adherence to guidelines. Understanding the prevalence, natureand severity of preventable medication-related harm is critical for setting targets for clinically relevant, implementable improvements in patient safety. This report presents an updated systematic review and meta-analysis of studies of the prevalence, nature and severity of preventable medication-related harm in theinternational literature including in low- and middle-income countries (LMICs). A total of 100 studies were included in the review, involving 487 162 patients. Ofthese reports, 70 were from high-income countries (HICs) and 30 from LMICs. The results were as follows. Global prevalence and severity of preventablemedication-related harm: The pooled prevalence of preventable medication-related harm in all 100 studies was 5% (1 in 20 patients). One fourth of the harm was severe or potentially life-threatening. Geographical distribution of preventable medication-related harm: The prevalence of preventable medication-related harm was 7% in 30 studies in LMICs and 4% (3–5%, one in 25 patients) in 70 studies in HICs. The highest prevalence rates of preventable medication-related harm were in the African (9%) and South-East Asian regions (9%). Health care settings in which the most vulnerable patients are managed for preventable medication-related harm: Globally, the highest prevalence ratesfor preventable medication-related harm are for patients managed in geriatric care units (17%) and among patients in highly specialized or surgical care (9%).Stages of medication at which most preventable medication-related harm occurs: Globally about half (53%) of all preventable medication-related harmoccurred at the “ordering/prescribing” stage and 36% at the monitoring/reporting” stage. In LMICs, almost 80% of preventable medication-related harm occurred during the “ordering/prescribing” stage. Medicines that contribute most to medication- related harm: Antibacterials, antipsychotics,cardiovascular medications, drugs for functional gastrointestinal disorders, endocrine therapy, hypnotics, sedatives and non-steroidal anti-inflammatory products contributed most to medication-related harm globally.Way forward: The analysis showed that at least one in 20 patients are affected by preventable medication-related harm globally and that more than one fourthof preventable harm is severe or life-threatening. The prevalence of preventable medication-related harm in LMICs was almost twice as high as in HICs;however, few data were available on the severity and nature of medication-related harm in LMICs. A prerequisite for the success of future strategiesto mitigate preventable medication-related harm in LMICs would be to encourage reporting of any preventable medication-related harm and commission high-quality studies with standard methods for assessing and reporting such harm and also studies of the underlying causes for designing interventions that are most likely to work in LMICs. There is also an urgent need to implement improvement strategies in settings in which patients are managed, especially those who are vulnerable to preventable medication related harm, such as geriatric care and surgical care settings. Finally, most of the evidence summarized in this report was produced in hospitals and should be strengthened with more research in major specialties, including primary care, and mental health

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

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