We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
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 no-reply@cambridge.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.
Anomalous circumflex coronary artery origin from pulmonary artery is a very rare congenital heart disease. Misdiagnosis of this condition may lead to inadequate myocardial protection during cardiopulmonary bypass surgery.
With the national redesign of specialist mental health services and its move towards episodic care, community mental health teams in the UK face a challenge in transferring LAI patients to Primary Care. In North Bristol, anecdotal concerns had been raised about this, particularly in the absence of established shared care arrangements (SCAs), and these prompted this service evaluation.
Objective:
To characterise the use of LAIs by NBRS.
Aims:
1. To establish the prevalence of LAI prescriptions in NBRS and type of LAI prescribed.
2. To consider the resource implications and distribution of LAI patients by Primary Care surgery.
3. Using aims 1&2 to inform the development of local SCAs.
Methods:
Use of a cross-sectional caseload survey of 523 out-patients under the care of NBRS on 1 September 2012.
Results:
LAIs were prescribed for 15% of the service’s total caseload (both psychotic and non-psyhcotic diagnoses). For those diagnosed with psychosis, flupentixol, risperidone and zuclopenthixol were most commonly prescribed, at mainly fortnightly or weekly injection intervals. The highest concentration of LAI patients were registered with Primary Care surgeries in areas reported as among the 10% most deprived nationally.
Conclusions:
1. LAI prescribing practice in NBRS, for those with psychosis, was consistent with national practice.
2. Use of LAIs has particular resource implications for mental health teams.
3. Use of SCAs could facilitate the transfer of care of LAI patients to Primary Care.
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.
We present a model for the scaling of mixing in weakly rotating stratified flows characterized by their Rossby, Froude and Reynolds numbers
$Ro,Fr$
,
$Re$
. This model is based on quasi-equipartition between kinetic and potential modes, sub-dominant vertical velocity,
$w$
, and lessening of the energy transfer to small scales as measured by a dissipation efficiency
$\unicode[STIX]{x1D6FD}=\unicode[STIX]{x1D716}_{V}/\unicode[STIX]{x1D716}_{D}$
, with
$\unicode[STIX]{x1D716}_{V}$
the kinetic energy dissipation and
$\unicode[STIX]{x1D716}_{D}=u_{rms}^{3}/L_{int}$
its dimensional expression, with
$w,u_{rms}$
the vertical and root mean square velocities, and
$L_{int}$
the integral scale. We determine the domains of validity of such laws for a large numerical study of the unforced Boussinesq equations mostly on grids of
$1024^{3}$
points, with
$Ro/Fr\geqslant 2.5$
, and with
$1600\leqslant Re\approx 5.4\times 10^{4}$
; the Prandtl number is one, initial conditions are either isotropic and at large scale for the velocity and zero for the temperature
$\unicode[STIX]{x1D703}$
, or in geostrophic balance. Three regimes in Froude number, as for stratified flows, are observed: dominant waves, eddy–wave interactions and strong turbulence. A wave–turbulence balance for the transfer time
$\unicode[STIX]{x1D70F}_{tr}=N\unicode[STIX]{x1D70F}_{NL}^{2}$
, with
$\unicode[STIX]{x1D70F}_{NL}=L_{int}/u_{rms}$
the turnover time and
$N$
the Brunt–Väisälä frequency, leads to
$\unicode[STIX]{x1D6FD}$
growing linearly with
$Fr$
in the intermediate regime, with a saturation at
$\unicode[STIX]{x1D6FD}\approx 0.3$
or more, depending on initial conditions for larger Froude numbers. The Ellison scale is also found to scale linearly with
$Fr$
. The flux Richardson number
$R_{f}=B_{f}/[B_{f}+\unicode[STIX]{x1D716}_{V}]$
, with
$B_{f}=N\langle w\unicode[STIX]{x1D703}\rangle$
the buoyancy flux, transitions for approximately the same parameter values as for
$\unicode[STIX]{x1D6FD}$
. These regimes for the present study are delimited by
${\mathcal{R}}_{B}=ReFr^{2}\approx 2$
and
$R_{B}\approx 200$
. With
$\unicode[STIX]{x1D6E4}_{f}=R_{f}/[1-R_{f}]$
the mixing efficiency, putting together the three relationships of the model allows for the prediction of the scaling
$\unicode[STIX]{x1D6E4}_{f}\sim Fr^{-2}\sim {\mathcal{R}}_{B}^{-1}$
in the low and intermediate regimes for high
$Re$
, whereas for higher Froude numbers,
$\unicode[STIX]{x1D6E4}_{f}\sim {\mathcal{R}}_{B}^{-1/2}$
, a scaling already found in observations: as turbulence strengthens,
$\unicode[STIX]{x1D6FD}\sim 1$
,
$w\approx u_{rms}$
, and smaller buoyancy fluxes together correspond to a decoupling of velocity and temperature fluctuations, the latter becoming passive.
The equilibration time
$\unicode[STIX]{x1D70F}$
in response to a change in flux from
$Q$
to
$\unicode[STIX]{x1D6EC}Q$
after an injection period
$T$
applied to either a low-Reynolds-number gravity current or one propagating through a porous medium, in both axisymmetric and one-dimensional geometries, is shown to be of the form
$\unicode[STIX]{x1D70F}=Tf(\unicode[STIX]{x1D6EC})$
, independent of all the remaining physical parameters. Numerical solutions are used to investigate
$f(\unicode[STIX]{x1D6EC})$
for each of these situations and compare very well with experimental results in the case of an axisymmetric current propagating over a rigid horizontal boundary. Analysis of the relaxation towards self-similarity provides an illuminating connection between the excess (deficit) volume from early times and an asymptotically equivalent shift in time origin, and hence a good quantitative estimate of
$\unicode[STIX]{x1D70F}$
. The case
$\unicode[STIX]{x1D6EC}=0$
of equilibration after ceasing injection at time
$T$
is a singular limit. Extensions to high-Reynolds-number currents and to the case of a constant-volume release followed by constant-flux injection are discussed briefly.
Transport of dense fluid by an inclined gravity current can control the vertical density structure of the receiving basin in many natural and industrial settings. A case familiar to many is a lake fed by river water that is dense relative to the lake water. In laboratory experiments, we pulsed dye into the basin inflow to visualise the transport pathway of the inflow fluid through the basin. We also measured the evolving density profile as the basin filled. The experiments confirmed previous observations that when the turbulent gravity current travelled through ambient fluid of uniform density, only entrainment into the dense current occurred. When the gravity current travelled through the stratified part of the ambient fluid, however, the outer layers of the gravity current outflowed from the current by a peeling detrainment mechanism and moved directly into the ambient fluid over a large range of depths. The prevailing model of a filling box flow assumes that a persistently entraining gravity current entrains fluid from the basin as the current descends to the deepest point in the basin. This model, however, is inconsistent with the transport pathway observed in visualisations and poorly matches the stratifications measured in basin experiments. The main contribution of the present work is to extend the prevailing filling box model by incorporating the observed peeling detrainment. The analytical expressions given by the peeling detrainment model match the experimental observations of the density profiles more closely than the persistently entraining model. Incorporating peeling detrainment into multiprocess models of geophysical systems, such as lakes, will lead to models that better describe inflow behaviour.
Leishmaniasis are diseases caused by parasites of the genus Leishmania and transmitted to humans by the bite of infected insects of the subfamily Phlebotominae. Current drug therapy shows high toxicity and severe adverse effects. Recently, two oligopeptidases (OPBs) were identified in Leishmania amazonensis, namely oligopeptidase B (OPB) and oligopeptidase B2 (OPB2). These OPBs could be ideal targets, since both enzymes are expressed in all parasite lifecycle and were not identified in human. This work aimed to identify possible dual inhibitors of OPB and OPB2 from L. amazonensis. The three-dimensional structures of both enzymes were built by comparative modelling and used to perform a virtual screening of ZINC database by DOCK Blaster server. It is the first time that OPB models from L. amazonensis are used to virtual screening approach. Four hundred compounds were identified as possible inhibitors to each enzyme. The top scored compounds were submitted to refinement by AutoDock program. The best results suggest that compounds interact with important residues, as Tyr490, Glu612 and Arg655 (OPB numbers). The identified compounds showed better results than antipain and drugs currently used against leishmaniasis when ADMET in silico were performed. These compounds could be explored in order to find dual inhibitors of OPB and OPB2 from L. amazonensis.
We consider the steady flow of a viscous compressible gas through an axisymmetric or two-dimensional porous medium whose properties in the direction of the flow are sufficiently slowly varying. The study is partly motivated by a number of different applications in the Earth sciences, including the release of magmatic volatiles from a magma chamber beneath an active volcano and the discharge of geothermal fluids. The results are also relevant to evaluating the consequences of an accidental release of carbon dioxide from a storage reservoir within the Earth, as might happen at a carbon capture and storage (CCS) site. We consider both slow, thermally equilibrated, flows and fast, adiabatic flows. Because the flow is compressible, it is the mass (and not the volume) flux which is conserved along the flow. We determine this constant mass flux and the velocity and pressure fields, both of which vary with position along the flow, as a function of all the physical parameters. We find that the resultant pressure gradient in the medium is largest at the far, low-pressure end of the conduit because the velocity is largest at that end due to the smallest density being associated with the smallest pressures. This means that the pressure in the permeable conduit is always larger than the linear pressure distribution which joins the given pressures at depth and at the surface, as would be the situation if the flow were incompressible. The detailed pressure distribution is shown to depend on the variation with depth of the quantity
$\unicode[STIX]{x1D707}T/(ka^{2})$
, where
$\unicode[STIX]{x1D707}$
is the dynamic viscosity of the vapour,
$T$
is the external temperature,
$k$
the permeability and
$\unicode[STIX]{x03C0}a^{2}$
the cross-sectional area of the conduit. The resultant mass flux is determined to be proportional to the mean along the flow of
$\unicode[STIX]{x1D707}T/(ka^{2})$
. We present two numerical illustrations of the results.
Pulmonary sequestration is a rare congenital anomaly that can be asymptomatic or present with recurrent infections, respiratory symptoms, or rarely heart failure. Sequestration is classified as intralobar or extralobar on the basis of whether there is separation from normal lung tissue by its own visceral pleura. Classically, patients are treated with surgical resection. We present a case of multivessel, combined intralobar and extralobar pulmonary sequestration treated with transcatheter embolisation.
Volcanic eruptions commonly produce buoyant ash-laden plumes that rise through the stratified atmosphere. On reaching their level of neutral buoyancy, these plumes cease rising and transition to horizontally spreading intrusions. Such intrusions occur widely in density-stratified fluid environments, and in this paper we develop a shallow-layer model that governs their motion. We couple this dynamical model to a model for particle transport and sedimentation, to predict both the time-dependent distribution of ash within volcanic intrusions and the flux of ash that falls towards the ground. In an otherwise quiescent atmosphere, the intrusions spread axisymmetrically. We find that the buoyancy-inertial scalings previously identified for continuously supplied axisymmetric intrusions are not realised by solutions of the governing equations. By calculating asymptotic solutions to our model we show that the flow is not self-similar, but is instead time-dependent only in a narrow region at the front of the intrusion. This non-self-similar behaviour results in the radius of the intrusion growing with time
$t$
as
$t^{3/4}$
, rather than
$t^{2/3}$
as suggested previously. We also identify a transition to drag-dominated flow, which is described by a similarity solution with radial growth now proportional to
$t^{5/9}$
. In the presence of an ambient wind, intrusions are not axisymmetric. Instead, they are predominantly advected downstream, while at the same time spreading laterally and thinning vertically due to persistent buoyancy forces. We show that close to the source, this lateral spreading is in a buoyancy-inertial regime, whereas far downwind, the horizontal buoyancy forces that drive the spreading are balanced by drag. Our results emphasise the important role of buoyancy-driven spreading, even at large distances from the source, in the formation of the flowing thin horizontally extensive layers of ash that form in the atmosphere as a result of volcanic eruptions.
The introduction of the Manila clam into British coastal waters in the 1980s was contested by conservation agencies. While recognizing the value of the clam for aquaculture, the government decided that it posed no invasive risk, as British sea temperatures would prevent naturalization. This proved incorrect. Here we establish the pattern of introduction and spread of the species over the first 30 years of its presence in Britain. We report archival research on the sequence of licensed introductions and examine their relationship in time and space to the appearance of wild populations as revealed in the literature and by field surveys. By 2010 the species had naturalized in at least 11 estuaries in southern England. These included estuaries with no history of licensed introduction. In these cases activities such as storage of catch before market or deliberate unlicensed introduction represent the probable mechanisms of dispersal. In any event naturalization is not an inevitable consequence of introduction and the chances of establishment over the period in question were finely balanced. Consequently in Britain the species is not currently aggressively invasive and appears not to present significant risk to indigenous diversity or ecosystem function. However it is likely to gradually continue its spread should sea surface temperatures rise as predicted.
Previous research suggests that many people receiving mental health
treatment do not meet criteria for a mental disorder but are rather ‘the
worried well’.
Aims
To examine the association of past-year mental health treatment with
DSM-IV disorders.
Method
The World Health Organization's World Mental Health (WMH) Surveys
interviewed community samples of adults in 23 countries
(n = 62 305) about DSM-IV disorders and treatment in
the past 12 months for problems with emotions, alcohol or drugs.
Results
Roughly half (52%) of people who received treatment met criteria for a
past-year DSM-IV disorder, an additional 18% for a lifetime disorder and
an additional 13% for other indicators of need (multiple subthreshold
disorders, recent stressors or suicidal behaviours). Dose–response
associations were found between number of indicators of need and
treatment.
Conclusions
The vast majority of treatment in the WMH countries goes to patients with
mental disorders or other problems expected to benefit from
treatment.
This article represents a systematic effort to answer the question, What are archaeology’s most important scientific challenges? Starting with a crowd-sourced query directed broadly to the professional community of archaeologists, the authors augmented, prioritized, and refined the responses during a two-day workshop focused specifically on this question. The resulting 25 “grand challenges” focus on dynamic cultural processes and the operation of coupled human and natural systems. We organize these challenges into five topics: (1) emergence, communities, and complexity; (2) resilience, persistence, transformation, and collapse; (3) movement, mobility, and migration; (4) cognition, behavior, and identity; and (5) human-environment interactions. A discussion and a brief list of references accompany each question. An important goal in identifying these challenges is to inform decisions on infrastructure investments for archaeology. Our premise is that the highest priority investments should enable us to address the most important questions. Addressing many of these challenges will require both sophisticated modeling and large-scale synthetic research that are only now becoming possible. Although new archaeological fieldwork will be essential, the greatest pay off will derive from investments that provide sophisticated research access to the explosion in systematically collected archaeological data that has occurred over the last several decades.
Post-traumatic stress disorder (PTSD) in response to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) is one of the most prevalent and persistent health conditions among both professional (e.g. police) and non-traditional (e.g. construction worker) WTC responders, even several years after 9/11. However, little is known about the dimensionality and natural course of WTC-related PTSD symptomatology in these populations.
Method
Data were analysed from 10 835 WTC responders, including 4035 police and 6800 non-traditional responders who were evaluated as part of the WTC Health Program, a clinic network in the New York area established by the National Institute for Occupational Safety and Health. Confirmatory factor analyses (CFAs) were used to evaluate structural models of PTSD symptom dimensionality; and autoregressive cross-lagged (ARCL) panel regressions were used to examine the prospective interrelationships among PTSD symptom clusters at 3, 6 and 8 years after 9/11.
Results
CFAs suggested that five stable symptom clusters best represent PTSD symptom dimensionality in both police and non-traditional WTC responders. This five-factor model was also invariant over time with respect to factor loadings and structural parameters, thereby demonstrating its longitudinal stability. ARCL panel regression analyses revealed that hyperarousal symptoms had a prominent role in predicting other symptom clusters of PTSD, with anxious arousal symptoms primarily driving re-experiencing symptoms, and dysphoric arousal symptoms primarily driving emotional numbing symptoms over time.
Conclusions
Results of this study suggest that disaster-related PTSD symptomatology in WTC responders is best represented by five symptom dimensions. Anxious arousal symptoms, which are characterized by hypervigilance and exaggerated startle, may primarily drive re-experiencing symptoms, while dysphoric arousal symptoms, which are characterized by sleep disturbance, irritability/anger and concentration difficulties, may primarily drive emotional numbing symptoms over time. These results underscore the importance of assessment, monitoring and early intervention of hyperarousal symptoms in WTC and other disaster responders.