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The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Shallow granular avalanches on slopes close to repose exhibit hysteretic behaviour. For instance, when a steady-uniform granular flow is brought to rest it leaves a deposit of thickness
on a rough slope inclined at an angle
to the horizontal. However, this layer will not spontaneously start to flow again until it is inclined to a higher angle
, or the thickness is increased to
. This simple phenomenology leads to a rich variety of flows with co-existing regions of solid-like and fluid-like granular behaviour that evolve in space and time. In particular, frictional hysteresis is directly responsible for the spontaneous formation of self-channelized flows with static levees, retrogressive failures as well as erosion–deposition waves that travel through the material. This paper is motivated by the experimental observation that a travelling-wave develops, when a steady uniform flow of carborundum particles on a bed of larger glass beads, runs out to leave a deposit that is approximately equal to
. Numerical simulations using the friction law originally proposed by Edwards et al. (J. Fluid Mech., vol. 823, 2017, pp. 278–315) and modified here, demonstrate that there are in fact two travelling waves. One that marks the trailing edge of the steady-uniform flow and another that rapidly deposits the particles, directly connecting the point of minimum dynamic friction (at thickness
) with the deposited layer. The first wave moves slightly faster than the second wave, and so there is a slowly expanding region between them in which the flow thins and the particles slow down. An exact inviscid solution for the second travelling wave is derived and it is shown that for a steady-uniform flow of thickness
it produces a deposit close to
for all inclination angles. Numerical simulations show that the two-wave structure deposits layers that are approximately equal to
for all initial thicknesses. This insensitivity to the initial conditions implies that
is a universal quantity, at least for carborundum particles on a bed of larger glass beads. Numerical simulations are therefore able to capture the complete experimental staircase procedure, which is commonly used to determine the
curves by progressively increasing the inclination of the chute. In general, however, the deposit thickness may depend on the depth of the flowing layer that generated it, so the most robust way to determine
is to measure the deposit thickness from a flow that was moving at the minimum steady-uniform velocity. Finally, some of the pathologies in earlier non-monotonic friction laws are discussed and it is explicitly shown that with these models either steadily travelling deposition waves do not form or they do not leave the correct deposit depth
Background: Cervical sponylotic myelopathy (CSM) may present with neck and arm pain. This study investiagtes the change in neck/arm pain post-operatively in CSM. Methods: This ambispective study llocated 402 patients through the Canadian Spine Outcomes and Research Network. Outcome measures were the visual analogue scales for neck and arm pain (VAS-NP and VAS-AP) and the neck disability index (NDI). The thresholds for minimum clinically important differences (MCIDs) for VAS-NP and VAS-AP were determined to be 2.6 and 4.1. Results: VAS-NP improved from mean of 5.6±2.9 to 3.8±2.7 at 12 months (P<0.001). VAS-AP improved from 5.8±2.9 to 3.5±3.0 at 12 months (P<0.001). The MCIDs for VAS-NP and VAS-AP were also reached at 12 months. Based on the NDI, patients were grouped into those with mild pain/no pain (33%) versus moderate/severe pain (67%). At 3 months, a significantly high proportion of patients with moderate/severe pain (45.8%) demonstrated an improvement into mild/no pain, whereas 27.2% with mild/no pain demonstrated worsening into moderate/severe pain (P <0.001). At 12 months, 17.4% with mild/no pain experienced worsening of their NDI (P<0.001). Conclusions: This study suggests that neck and arm pain responds to surgical decompression in patients with CSM and reaches the MCIDs for VAS-AP and VAS-NP at 12 months.
When a layer of static grains on a sufficiently steep slope is disturbed, an upslope-propagating erosion wave, or retrogressive failure, may form that separates the initially static material from a downslope region of flowing grains. This paper shows that a relatively simple depth-averaged avalanche model with frictional hysteresis is sufficient to capture a planar retrogressive failure that is independent of the cross-slope coordinate. The hysteresis is modelled with a non-monotonic effective basal friction law that has static, intermediate (velocity decreasing) and dynamic (velocity increasing) regimes. Both experiments and time-dependent numerical simulations show that steadily travelling retrogressive waves rapidly form in this system and a travelling wave ansatz is therefore used to derive a one-dimensional depth-averaged exact solution. The speed of the wave is determined by a critical point in the ordinary differential equation for the thickness. The critical point lies in the intermediate frictional regime, at the point where the friction exactly balances the downslope component of gravity. The retrogressive wave is therefore a sensitive test of the functional form of the friction law in this regime, where steady uniform flows are unstable and so cannot be used to determine the friction law directly. Upper and lower bounds for the existence of retrogressive waves in terms of the initial layer depth and the slope inclination are found and shown to be in good agreement with the experimentally determined phase diagram. For the friction law proposed by Edwards et al. (J. Fluid. Mech., vol. 823, 2017, pp. 278–315, J. Fluid. Mech., 2019, (submitted)) the magnitude of the wave speed is slightly under-predicted, but, for a given initial layer thickness, the exact solution accurately predicts an increase in the wave speed with higher inclinations. The model also captures the finite wave speed at the onset of retrogressive failure observed in experiments.
The use of whole-pattern matching techniques for phase identification provides increased confidence in the phases determined compared with d-I matching and enhances the potential for determining the existence of phases present in low concentrations. Reference patterns from a database of selected phases were compared with the experimental pattern obtained from an unknown, and the results were ranked using figures-of-merit designed to distinguish the best pattern matches. Several different figures-of-merit have been evaluated, all of which proved successful in recognizing the strongest phase but varied with respect to the other phases.
Low-concentration phases are revealed when the patterns of the more abundant phases are stripped from the experimental trace using the best-fit scaled reference traces. Pattern stripping is improved by pattern shifting and profile shape matching which are provided for in the matching program.
The affect of several aberrations on the figures of merit, FOM, used in the identification analysis of diffraction patterns has been examined by generating simulated diffraction traces with mathematically induced errors. Patterns of mixtures with random 20 shifts, intensity variations, and profile broadening were generated for analysis by MATCHDB, and the behavior of three FOMs during the search step was followed. The results have shown that the angle errors are the most serious in degrading the potential for identification of the phases in the mixtures. Intensity errors cause some degradation on the results. Broadening has little affect when using whole-pattern matching methods.
To determine which healthcare worker (HCW) roles and patient care activities are associated with acquisition of vancomycin-resistant Enterococcus (VRE) on HCW gloves or gowns after patient care, as a surrogate for transmission to other patients.
Prospective cohort study.
Medical and surgical intensive care units at a tertiary-care academic institution.
VRE-colonized patients on Contact Precautions and their HCWs.
Overall, 94 VRE-colonized patients and 469 HCW–patient interactions were observed. Research staff recorded patient care activities and cultured HCW gloves and gowns for VRE before doffing and exiting patient room.
VRE were isolated from 71 of 469 HCWs’ gloves or gowns (15%) following patient care. Occupational/physical therapists, patient care technicians, nurses, and physicians were more likely than environmental services workers and other HCWs to have contaminated gloves or gowns. Compared to touching the environment alone, the odds ratio (OR) for VRE contamination associated with touching both the patient (or objects in the immediate vicinity of the patient) and environment was 2.78 (95% confidence interval [CI], 0.99–0.77) and the OR associated with touching only the patient (or objects in the immediate vicinity) was 3.65 (95% CI, 1.17–11.41). Independent risk factors for transmission of VRE to HCWs were touching the patient’s skin (OR, 2.18; 95% CI, 1.15–4.13) and transferring the patient into or out of bed (OR, 2.66; 95% CI, 1.15–6.43).
Patient contact is a major risk factor for HCW contamination and subsequent transmission. Interventions should prioritize contact precautions and hand hygiene for HCWs whose activities involve touching the patient.
Small perturbations to a steady uniform granular chute flow can grow as the material moves downslope and develop into a series of surface waves that travel faster than the bulk flow. This roll wave instability has important implications for the mitigation of hazards due to geophysical mass flows, such as snow avalanches, debris flows and landslides, because the resulting waves tend to merge and become much deeper and more destructive than the uniform flow from which they form. Natural flows are usually highly polydisperse and their dynamics is significantly complicated by the particle size segregation that occurs within them. This study investigates the kinematics of such flows theoretically and through small-scale experiments that use a mixture of large and small glass spheres. It is shown that large particles, which segregate to the surface of the flow, are always concentrated near the crests of roll waves. There are different mechanisms for this depending on the relative speed of the waves, compared to the speed of particles at the free surface, as well as on the particle concentration. If all particles at the surface travel more slowly than the waves, the large particles become concentrated as the shock-like wavefronts pass them. This is due to a concertina-like effect in the frame of the moving wave, in which large particles move slowly backwards through the crest, but travel quickly in the troughs between the crests. If, instead, some particles on the surface travel more quickly than the wave and some move slower, then, at low concentrations, large particles can move towards the wave crest from both the forward and rearward sides. This results in isolated regions of large particles that are trapped at the crest of each wave, separated by regions where the flow is thinner and free of large particles. There is also a third regime arising when all surface particles travel faster than the waves, which has large particles present everywhere but with a sharp increase in their concentration towards the wave fronts. In all cases, the significantly enhanced large particle concentration at wave crests means that such flows in nature can be especially destructive and thus particularly hazardous.
Introduction: TREKK is a national knowledge mobilization network of clinicians, researchers and parents aimed at improving emergency care for children by increasing collaborations between general and pediatric emergency departments (ED). This study aimed to determine patterns of knowledge sharing within the network and identify connections, barriers and opportunities to obtaining pediatric information and training. Methods: Social network analysis (SNA) uses network theory to understand patterns of interaction. Two SNAs were conducted in 2014 and 2015 using an online network survey distributed to 37 general EDs. Data was analyzed using UCI Net and Netdraw to identify connections, knowledge sharing and knowledge brokers within the network. Building on these results, we then conducted 22 semi-structured follow-up interviews (2016) with healthcare professionals (HCPs) at General EDs across Canada, purposefully sampled to include individuals from connected and disconnected sites, as identified in the SNA. Interviews were analyzed by 2 reviewers using content and thematic analysis. Results: SNA data was analyzed for 135 participants across the network. Results from 2014 showed that the network was divided along provincial lines, with most individuals connecting with colleagues within their own institution. Results from 2015 showed more inter-site interconnectivity and a reduction in isolated sites over time from 17 to 3. Interview participants included physicians (59%) and nurses (41%) from 18 general EDs in urban (68%) and rural/remote (32%) Canada. HCPs sought information both formally and informally, by using guidelines, talking to colleagues, and attending pediatric related training sessions. Network structure and processes were felt to increase connections, support practice change, and promote standards of care. Participants identified personal, organizational and system-level barriers to information and skill acquisition, including resources and personal costs, geography, dissemination, and time. Providing easy access to information at the point of care was promoted through enhancing content visibility and by embedding resources into local systems. There remains a need to share successful methods of local dissemination and implementation across the network, and to leverage local professional champions such as clinical nurse liaisons. Conclusion: This study highlights the power of a network to increase connections between HCPs working in general and pediatric EDs. Findings reinforce the critical role of ongoing network evaluation to improve the design and delivery of knowledge mobilization initiatives.
Introduction: Online medical education resources are becoming an increasingly used modality and many studies have demonstrated their efficacy in procedural instruction. This study sought to determine whether a standardized online procedural video is as effective as a standard recorded didactic teaching session for chest tube insertion. Methods: A randomized control trial was conducted. Participants were taught how to insert a chest tube with either a recorded didactic teaching session, or a New England Journal of Medicine (NEJM) video. Participants filled out a questionnaire before and after performing the procedure on a cadaver, which was filmed and assessed by two blinded evaluators using a standardized tool. Thirty 4th year medical students from two graduating classes at the Schulich School of Medicine & Dentistry in London, ON were screened for eligibility. Two students did not complete the study, and were excluded. There were 13 students in the NEJM group, and 15 students in the ATLS group. Results: The NEJM group’s average score was 45.2% (±9.6) on the pre-questionnaire, 67.7% (±12.9) for the procedure, and 60.1% (±7.7) on the post-questionnaire. The didactic group’s average score was 42.8% (±10.9) on the pre-questionnaire, 73.7% (±9.9) for the procedure, and 46.5% (±7.5) on the post-questionnaire. There was no difference between the groups on the pre-questionnaire (Δ +2.4%; 95% CI: −5.2, 10.0), or the procedure (Δ −6.0%; 95% CI: −14.6, 2.7). The NEJM group had better scores on the post-questionnaire (Δ +11.15%; 95% CI: 3.7, 18.6). Conclusion: The NEJM video was as effective as video-recorded training for teaching the knowledge and technical skills essential for chest tube insertion. Participants expressed high satisfaction with this modality. It may prove to be a helpful adjunct to standard instruction on the topic.
Introduction: Data regarding adverse events (AEs) (unintended harm to the patient from health care provided) among children seen in the emergency department (ED) are scarce despite the high risk setting and population. The objective of our study was to estimate the risk and type of AEs, and their preventability and severity, among children treated in pediatric EDs. Methods: Our prospective cohort study enrolled children <18 years of age presenting for care during 21 randomized 8 hr-shifts at 9 pediatric EDs from Nov 2014 to October 2015. Exclusion criteria included unavailability for follow-up or insurmountable language barrier. RAs collected demographic, medical history, ED course, and systems level data. At day 7, 14, and 21 a RA administered a structured telephone interview to all patients to identify flagged outcomes (e.g. repeat ED visits, worsening/new symptoms, etc). A validated trigger tool was used to screen admitted patients’ health records. For any patients with a flagged outcome or trigger, 3 ED physicians independently determined if an AE occurred. Primary outcome was the proportion of patients with an AE related to ED care within 3 weeks of their ED visit. Results: We enrolled 6377 (72.0%) of 8855 eligible patients; 545 (8.5%) were lost to follow-up. Median age was 4.4 years (range 3 months to 17.9 yrs). Eight hundred and seventy seven (13.8%) were triaged as CTAS 1 or 2, 2638 (41.4%) as CTAS 3, and 2839 (44.7%) as CTAS 4 or 5. Top entrance complaints were fever (11.2%) and cough (8.8%). Flagged outcomes/triggers were identified for 2047 (32.1%) patients. While 252 (4.0%) patients suffered at least one AE within 3 weeks of ED visit, 163 (2.6%) suffered an AE related to ED care. In total, patients suffered 286 AEs, most (67.9%) being preventable. The most common AE types were management issues (32.5%) and procedural complications (21.9%). The need for a medical intervention (33.9%) and another ED visit (33.9%) were the most frequent clinical consequences. In univariate analysis, older age, chronic conditions, hospital admission, initial location in high acuity area of the ED, having >1 ED MD or a consultant involved in care, (all p<0.001) and longer length of stay (p<0.01) were associated with AEs. Conclusion: While our multicentre study found a lower risk of AEs among pediatric ED patients than reported among pediatric inpatients and adult ED patients, a high proportion of these AEs were preventable.
Geophysical granular flows, such as avalanches, debris flows, lahars and pyroclastic flows, are always strongly influenced by the basal topography that they flow over. In particular, localised bumps or obstacles can generate rapid changes in the flow thickness and velocity, or shock waves, which dissipate significant amounts of energy. Understanding how a granular material is affected by the underlying topography is therefore crucial for hazard mitigation purposes, for example to improve the design of deflecting or catching dams for snow avalanches. Moreover, the interactions with solid boundaries can also have important applications in industrial processes. In this paper, small-scale experiments are performed to investigate the flow of a granular avalanche over a two-dimensional smooth symmetrical bump. The experiments show that, depending on the initial conditions, two different steady-state regimes can be observed: either the formation of a detached jet downstream of the bump, or a shock upstream of it. The transition between the two cases can be controlled by adding varying amounts of erodible particles in front of the obstacle. A depth-averaged terrain-following avalanche theory that is formulated in curvilinear coordinates is used to model the system. The results show good agreement with the experiments for both regimes. For the case of a shock, time-dependent numerical simulations of the full system show the evolution to the equilibrium state, as well as the deposition of particles upstream of the bump when the inflow ceases. The terrain-following theory is compared to a standard depth-averaged avalanche model in an aligned Cartesian coordinate system. For this very sensitive problem, it is shown that the steady-shock regime is captured significantly better by the terrain-following avalanche model, and that the standard theory is unable to predict the take-off point of the jet. To retain the practical simplicity of using Cartesian coordinates, but have the improved predictive power of the terrain-following model, a coordinate mapping is used to transform the terrain-following equations from curvilinear to Cartesian coordinates. The terrain-following model, in Cartesian coordinates, makes identical predictions to the original curvilinear formulation, but is much simpler to implement.
Level-line surveys at a number of sites on the Antarctic Peninsula since the early 1970s have shown a lowering of the ice surface elevation in areas where the climate is warm enough for melting to occur during summer. Results are presented here from annual surveys on the ice ramp at Rothcra Point. Over an 8 year period, a large proportion of the ramp shows a generally steady reduction in surface elevation. The uppermost part of the ramp shows no clear trend. The ice ramp has suffered a mean rate ofsurfaee lowering of 0.32 ma−1 w.e. over the period of the surveys, which is similar to that seen at other sites on the Antarctic Peninsula. Measured ice velocities on the ramp are low, so the surface lowering can be attributed directly to changes in surface mass balance. The Surveys coincide with a period of long-term increase in temperature and ablation seen in meteorological records. Comparison of the observed surface lowering with temperature data shows a good agreement, and we conclude that increasing air temperatures in the region will raise ablation and increase the recession rate of the ice ramp.
The following list of dates contains all measurements made during 1973, ie, since our last list (R, 1973, v 15, p 451–468). We have installed this year a Nuclear Enterprises NIM system to be used with our 2.5L Oeschger-type proportional counter (Philips), in addition to our 6L and 1L proportional counters which have worked consistently with Beckman Lowbeta electronics. The Philips counter has been calibrated relative to the Beckman electronics and we are now calibrating it relative to the NIM system.