To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Trends in utilization of Emergency Medical Services (EMS) systems can be used to extrapolate future use of an EMS system, which will be valuable for the budgeting and planning of finances and resources. The best model for incorporation of seasonal and regional fluctuations in utilization to predict future utilization is unknown.
Authors aimed to trend patterns of utilization in a regional EMS system to identify the needs of a growing population and to allow for a better understanding of how the EMS system is used on a basis of call volume and frequency of EMS transportation. The authors then used a best-fitting prediction model approach to show how the studied EMS system will be used in future years.
Systems data were retrospectively extracted by using the electronic medical records of the studied EMS system and its computer-assisted dispatch (CAD) database from 2010 through 2017. All EMS dispatches entering the system’s 9-1-1 public service access point were captured. Annual utilization data were available from 2010 through 2017, while quarterly data were available only from 2013 through 2017. The 9-1-1 utilization per capita, Advanced Life Support (ALS) utilization per capita, and ALS cancel rates were calculated and trended over the study period. The methods of prediction were assessed through a best-fitting model approach, which statistically suggested that Additive Winter’s approach (SAS) was the best fit to determine future utilization and ALS cancel rates.
Total 9-1-1 call volume per capita increased by 32.46% between 2010 and 2017, with an average quarterly increase of 0.78% between 2013 and 2017. Total ALS call volume per capita increased by 1.93% between 2010 and 2017. Percent ALS cancellations (cancelled en route to scene) increased by eight percent between 2010 and 2017, with an average quarterly increase of 0.42% (2013–2017). Predictions to end of 2019 using Additive Winter’s approach demonstrated increasing trends in 9-1-1 call volume per capita (R2 = 0.47), increasing trends of ALS utilization per capita (R2 = 0.71), and increasing percent ALS cancellation (R2 = 0.93). Each prediction showed increasing future trends with a 95% confidence interval.
The authors demonstrate paramount per capita increases of 9-1-1 call volume in the studied ALS system. There are concomitant increases of ALS cancellations prior to arrival, which suggests a potential burden on this regional ALS response system.
Surface mass balance (SMB) is the net input of mass on a glacier's upper surface, composed of snow deposition, melt and erosion processes, and is a major contributor to the overall mass balance. Pine Island Glacier (PIG) in West Antarctica has been dynamically imbalanced since the early 1990s, indicating that discharge of solid ice into the oceans exceeds snow deposition. However, observations of the SMB pattern on the fast flowing regions are scarce, and are potentially affected by the firn's strain history. Here, we present new observations from radar-derived stratigraphy and a relatively dense network of firn cores, collected along a ~900 km traverse of PIG. Between 1986 and 2014, the SMB along the traverse was 0.505 m w.e. a−1 on average with a gradient of higher snow deposition in the South-West compared with the North-East of the catchment. We show that along ~80% of the traverse the strain history amounts to a misestimation of SMB below the nominal uncertainty, but can exceed it by a factor 5 in places, making it a significant correction to the SMB estimate locally. We find that the strain correction changes the basin-wide SMB by ~0.7 Gt a−1 and thus forms a negligible (1%) correction to the glacier's total SMB.
We aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.
The intensely active 2017 Atlantic basin hurricane season provided an opportunity to examine how climate drivers, including warming oceans and rising seas, exacerbated tropical cyclone hazards. The season also highlighted the unique vulnerabilities of populations residing on Small Island Developing States (SIDS) to the catastrophic potential of these storms. During 2017, 22 of the 29 Caribbean SIDS were affected by at least one named storm, and multiple SIDS experienced extreme damage. This paper aims to review the multiplicity of storm impacts on Caribbean SIDS throughout the 2017 season, to explicate the influences of climate drivers on storm formation and intensity, to explore the propensity of SIDS to sustain severe damage and prolonged disruption of essential services, to document the spectrum of public health consequences, and to delineate the daunting hurdles that challenged emergency response and recovery operations for island-based, disaster-affected populations. (Disaster Med Public Health Preparedness. 2019;13:5–17)
Mastitis is one of most frequent and costly diseases encountered on dairy farms. In 1998 mastitis costs UK dairy farmers approximately £80 million a year and this figure increases to over £100 million when further associated losses such as somatic cell count (SCC) penalties, antibiotic residue penalties and reduced cell count and bacteria count payments are accounted for. In the 1980’s and 1990’s there has been a continuing increase in the incidence of environmental mastitis and especially due to E coli (Brand, 1999),. Increasing SCC levels are set against a background of emphasis on higher milk price for low SSC milk by purchasers has led to the need to increase milk price by reducing losses from high SCC levels. The aim of the study was to monitor bulk milk SCC levels in milk supplied to a milk producer co-operative over a 12 month period and select a sub-sample of milk producers with high SCC, analyse the clinical incidence of mastitis, establish the pathogens involved and their response to antibiotics.
Interferometric synthetic aperture radar data show that Devon Ice Cap (DIC), northern Canada, is drained through a network of 11 glacier systems. More than half of all ice discharge is through broad flows that converge to the southeast of the ice cap, and these are grounded well below sea level at their termini. A calculation of the ice-cap mass budget reveals that the northwestern sector of DIC is gaining mass and that all other sectors are losing mass. We estimate that a 12 489 km2 section of the main ice cap receives 3.46±0.65 Gt of snowfall each year, and loses 3.11±0.21 Gt of water through runoff, and 1.43±0.03 Gt of ice through glacier discharge. Altogether, the net mass balance of DIC is –1.08±0.67 Gt a–1. This loss corresponds to a 0.003 mma–1 contribution to global sea levels, and is about half the magnitude of earlier estimates.
On an 11 m firn/ice core from Kongsvegen, Svalbard, we have used dielectric profiling (DEP) to measure electrical properties, and digital photography to measure a core optical stratigraphy (COS) profile. We also used a neutron-scattering probe (NP) to measure a density profile in the borehole from which the core was extracted. The NP- and DEP-derived density profiles were similar, showing large-scale (>30 cm) variation in the gravimetric densities of each core section. Fine-scale features (<10 cm) are well characterized by the COS record and are seen at a slightly lower resolution in both the DEP and NP records, which show increasing smoothing. A combination of the density accuracy of NP and the spatial resolution of COS provides a useful method of evaluating the shallow-density profile of a glacier, improving paleoclimate interpretation, mass-balance measurement and interpretation of radar returns.
Short-term ice-dynamical processes at Greenland’s Jakobshavn and Kangerdlugssuaq glaciers were studied using a 3 day time series of synthetic aperture radar data acquired during the 2011 European Remote-sensing Satellite-2 (ERS-2) 3 day repeat campaign together with modelled meteorological parameters. The time series spans the period March–July 2011 and captures the first ∼30% of the summer melting season. In both study areas, we observe velocity fluctuations at the lower ∼10 km of the glacier. At Jakobshavn Isbræ, where our dataset covers the first part of the seasonal calving-front retreat, we identify ten calving episodes, with a mean calving-front area loss of 1.29 ± 0.4 km2. Significant glacier speed-up was observed in the near-terminus area following all calving episodes. We identify changes in calving-front geometry as the dominant control on velocity fluctuations on both glaciers, apart from a <15% early-summer speed-up at Kangerdlugssuaq Glacier during a period of calving-front advance, which we attribute to enhanced surface melt-induced basal lubrication. Our 3 day velocity maps show new spatial characteristics of the ice melange flow variability in the Jakobshavn and Kangerdlugssuaq fjord systems, which are primarily controlled by calving-front dynamics and fjord geometry.
By applying Principal Components Analysis (PCA) to solar magnetic synoptic maps in cycle 21-23 obtained with Wilcox Solar Observatory we derived analytical expressions for two principal components and their summary curve of solar magnetic field oscillations defined by dipole magnetic sources. In this paper we extrapolate backwards three millennia the summary curve describing solar activity and compare it with the relevant historic data. The extrapolated summary curve shows a remarkable resemblance to the sunspot and terrestrial activity reported in the past millennia: the Maunder Minimum (1645-1715), Wolf minimum (1200), Oort minimum (1010-1050), Homer minimum (800-900 BC), the medieval warm period (900-1200), the Roman warm period (400-10BC). We note that Sporer minimum (1460-1550) derived from the increased abundance of isotope Δ14C is likely produced by a strong increase of galactic cosmic rays caused by a supernova Vela Junior occurred in the Southern hemisphere.
Understanding the climate response of the Antarctic Peninsula ice sheet is vital for accurate predictions of sea-level rise. However, since climate models are typically too coarse to capture spatial variability in local scale meteorological processes, our ability to study specific sectors has been limited by the local fidelity of such models and the (often sparse) availability of observations. We show that a high-resolution (5.5 km × 5.5 km) version of a regional climate model (RACMO2.3) can reproduce observed interannual variability in the Larsen B embayment sufficiently to enable its use in investigating long-term changes in this sector. Using the model, together with automatic weather station data, we confirm previous findings that the year of the Larsen B ice shelf collapse (2001/02) was a strong melt year, but discover that total annual melt production was in fact ~30% lower than 2 years prior. While the year before collapse exhibited the lowest melting and highest snowfall during 1980–2014, the ice shelf was likely pre-conditioned for collapse by a series of strong melt years in the 1990s. Melt energy has since returned to pre-1990s levels, which likely explains the lack of further significant collapse in the region (e.g. of SCAR Inlet).
Post-traumatic stress disorder (PTSD) is often associated with attention allocation and emotional regulation difficulties, but the brain dynamics underlying these deficits are unknown. The emotional Stroop task (EST) is an ideal means to monitor these difficulties, because participants are asked to attend to non-emotional aspects of the stimuli. In this study, we used magnetoencephalography (MEG) and the EST to monitor attention allocation and emotional regulation during the processing of emotionally charged stimuli in combat veterans with and without PTSD.
A total of 31 veterans with PTSD and 20 without PTSD performed the EST during MEG. Three categories of stimuli were used, including combat-related, generally threatening and neutral words. MEG data were imaged in the time-frequency domain and the network dynamics were probed for differences in processing threatening and non-threatening words.
Behaviorally, veterans with PTSD were significantly slower in responding to combat-related relative to neutral and generally threatening words. Veterans without PTSD exhibited no significant differences in responding to the three different word types. Neurophysiologically, we found a significant three-way interaction between group, word type and time period across multiple brain regions. Follow-up testing indicated stronger theta-frequency (4–8 Hz) responses in the right ventral prefrontal (0.4–0.8 s) and superior temporal cortices (0.6–0.8 s) of veterans without PTSD compared with those with PTSD during the processing of combat-related words.
Our data indicated that veterans with PTSD exhibited deficits in attention allocation and emotional regulation when processing trauma cues, while those without PTSD were able to regulate emotion by directing attention away from threat.
The glaciological work of six expeditions from Makerere University College to the Ruwenzori between December 1957 and July 1961 is described and some results are given.
The history of glaciological research in the Ruwenzori mountain range is outlined and the present ice distribution is described. A variety of evidence is presented to illustrate the pattern of change over the last 50 years, and all the glaciers examined are shown to have been drastically reduced in size, with an apparent acceleration in melting since the 1940’s. Six glaciers are known to have disappeared completely, whilst several others have split into smaller units.
A detailed survey of the Speke Glacier on Mount Speke was made, and calculations show that if the present trends continue all the ice below 4,573 in. on Mount Speke can he expected to disappear within the next 40 years.
The Elena and Savoia Glaciers on Mount Stanley and the Moore Glacier on Mount Baker are described, and recessional rates for each glacier are calculated. Measurements of the ice movement of the Elena Glacier demonstrate that it is still a fairly active glacier, although the Moore Glacier is thought to be completely stagnant. Other scientific measurements of glaciological significance include subglacial temperatures for the Elena Glacier, melt-water flow rates from the Speke Glacier and solar radiation measurements for several stations near the Ruwenzori ice margins.
The Cosmic Background Imager (CBI) is an instrument designed to make images of the cosmic microwave background radiation and to measure its statistical properties on angular scales from about 3 arc minutes to one degree (spherical harmonic scales from l ˜ 4250 down to l ˜ 400). The CBI is a 13-element interferometer mounted on a 6 meter platform operating in ten 1-GHz frequency bands from 26 GHz to 36 GHz. The instantaneous field of view of the instrument is 45 arcmin (FWHM) and its resolution ranges from 3 to 10 arcmin; larger fields can be imaged by mosaicing. At this frequency and resolution, the primary foreground is due to discrete extragalactic sources, which are monitored at the Owens Valley Radio Observatory and subtracted from the CBI visibility measurements.
The instrument has been making observations since late 1999 of both primordial CMB fluctuations and the Sunyaev-Zeldovich effect in clusters of galaxies from its site at an altitude of 5080 meters near San Pedro de Atacama, in northern Chile. Observations will continue until August 2001 or later. We present preliminary results from the first few months of observations.
The wake behind a circular cylinder in Mach 4 flow is examined experimentally in the Reynolds number range
. Periodic oscillations of the sliplines in the wake are observed. The Strouhal number of the oscillations based on the diameter of the cylinder is found to increase monotonically from 0.30 to 0.50 with increasing Reynolds number. If the Strouhal number is formed using the length of the sliplines, however, it has a constant value of approximately 0.48 for all Reynolds numbers studied. This scaling indicates that the oscillations in supersonic flow are likely driven by acoustic signals propagating back and forth through the subsonic region between the separation points on the cylinder and the neck where the sliplines converge, unlike in subsonic flow where oscillations are caused by vortices shed from the cylinder surface.
A novel optical method is used to measure the high-frequency (up to 3 MHz) density fluctuations that precede transition to turbulence within a laminar boundary layer in a hypervelocity flow. This optical method, focused laser differential interferometry, enables measurements of short-wavelength, high-frequency disturbances that are impossible with conventional instrumentation such as pressure transducers or hot wires. In this work, the T5 reflected-shock tunnel is used to generate flows in air, nitrogen and carbon dioxide with speeds between 3.5 and
(Mach numbers between 4 and 6) over a 5° half-angle cone at zero angle of attack. Simultaneous measurements are made at two locations approximately midway along a generator of the 1-m-long cone. With increasing Reynolds number (unit values were between 2 and
), density fluctuations are observed to grow in amplitude and transition from a single narrow band of frequencies consistent with the Mack or second mode of boundary-layer instability to bursts of large-amplitude and spectrally broad disturbances that appear to be precursors of turbulent spots. Disturbances that are sufficiently small in initial amplitude have a wavepacket-like signature and are observed to grow in amplitude between the upstream and downstream measurement locations. A cross-correlation analysis indicates propagation of wavepackets at speeds close to the edge velocity. The free stream flow created by the shock tunnel and the resulting boundary layer on the cone are computed, accounting for chemical and vibrational non-equilibrium processes. Using this base flow, local linear and parabolized stability (PSE) analyses are carried out and compared with the experimental results. Reasonable agreement is found between measured and predicted most unstable frequencies, with the greatest differences being approximately 15 %. The scaling of the observed frequency with the inverse of boundary-layer thickness and directly with the flow velocity are consistent with the characteristics of Mack’s second mode, as well as results of previous researchers on hypersonic boundary layers.
The influence of high levels of wall cooling on the stability of hypervelocity boundary layers is investigated. Such conditions are relevant to experiments in high-enthalpy impulse facilities, where the wall temperature is much smaller than the free-stream temperature, as well as to some real flight scenarios. Some effects of wall cooling are well known, for instance, the stabilization of the first mode and destabilization of the second mode. In this paper, several new instability phenomena are investigated that arise only for high Mach numbers and high levels of wall cooling. In particular, certain unstable modes can travel supersonically with respect to the free stream, which changes the nature of the dispersion curve and leads to instability over a much wider band of frequencies. The cause of this phenomenon, the range of parameters for which it occurs and its implications for boundary layer stability are examined. Additionally, growth rates are systematically reported for a wide range of conditions relevant to high-enthalpy impulse facilities, and the stability trends in terms of Mach number and wall temperature are mapped out. Thermal non-equilibrium is included in the analysis and its influence on the stability characteristics of flows in impulse facilities is assessed.
Persons who develop tuberculosis (TB) may have subtle immune defects that could predispose to other intracellular bacterial infections (ICBIs). We obtained data on TB and five ICBIs (Chlamydia trachomatis, Salmonella spp., Shigella spp., Yersinia spp., Listeria monocytogenes) reported to the Tennessee Department of Health, USA, 2000–2011. Incidence rate ratios (IRRs) comparing ICBIs in persons who developed TB and ICBIs in the Tennessee population, adjusted for age, sex, race and ethnicity were estimated. IRRs were not significantly elevated for all ICBIs combined [IRR 0·87, 95% confidence interval (CI) 0·71–1·06]. C. trachomatis rate was lowest in the year post-TB diagnosis (IRR 0·17, 95% CI 0·04–0·70). More Salmonella infections occurred in extrapulmonary TB compared to pulmonary TB patients (IRR 14·3, 95% CI 1·67–122); however, this appeared to be related to HIV co-infection. TB was not associated with an increased risk of other ICBIs. In fact, fewer C. trachomatis infections occurred after recent TB diagnosis. Reasons for this association, including reduced exposure, protection conferred by anti-TB drugs or macrophage activation by Mycobacterium tuberculosis infection warrant further investigation.