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This chapter offers a detailed reading of McEwan’s 2012 novel Sweet Tooth as a highly self-conscious and allusive literary spy thriller of the Cold War era, one which invites a renewed attention to the Cold War themes, ideas and literary strategies which have been important in his work since the late 1970s in which the novel is set. These flourished especially in the two novels written around the fall of the Berlin Wall, The Innocent and Black Dogs which also receive extended treatment here. In McEwan’s reworking of the Cold War spy thriller as postmodern literary fiction we find, it is argued, a recurrent fascination with misunderstandings and readjustments in emotional and political relations between the sexes as an analogy for Cold War politics and vice versa. Added to this McEwan increasingly packs his fictions with informed literary debate that constitute a profound exploration of literary genres and of the complex relationship between author and reader.
During mass gatherings, such as marathons, the provision of timely access to health care services is required for the mass gathering population as well as the local community. However, effective provision of health care during sporting mass gatherings is not well understood.
To describe the structures and processes developed for an emergency team to operate an in-event acute health care facility during one of the largest mass sporting participation events in the southern hemisphere, the Gold Coast marathon.
A pragmatic qualitative methodology was used to describe the structures and processes required to operate an in-event acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with Emergency Department (ED) clinical staff working during the two-day event was undertaken in 2016.
Structural elements that underpinned the in-event health care facility included: physical spaces such as the clinical zones in the marathon health tent, tent access, and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms. Critical processes included: clear communication pathways, interprofessional care coordination, and engagement involving shared knowledge of and access to resources. Distinct but overlapping clinical scope between nurses and doctors was also noted as important for timely care provision and appropriate case management. Staff outlined many perceived benefits and opportunities of in-event health care delivery including ED avoidance and disaster training.
This in-event model of emergency care delivery enabled acute out-of-hospital health care to be delivered in a portable and transportable facility. Clinical staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
First aid, particularly bystander cardiopulmonary resuscitation (CPR), is an important element in the chain of survival. However, little is known about what influences populations to undertake first aid/CPR training, update their training, and use of the training.
The aim of this study was to explore the characteristics of people who have first aid/CPR training, those who have updated their training, and use of these skills.
As part of the 2011 state-wide, computer-assisted telephone interviewing (CATI) survey of people over 18 years of age living in Queensland, Australia, stratified by gender and age group, three questions about first aid training, re-training, and skill uses were explored.
Of the 1,277 respondents, 73.2% reported having undertaken some first aid/CPR training and 39.5% of those respondents had used their first aid/CPR skills. The majority of respondents (56.7%) had not updated their first aid/CPR skills in the past three years, and an additional 2.5% had never updated their skills. People who did not progress beyond year 10 in school and those in lower income groups were less likely to have undertaken first aid/CPR training. Males and people in lower income groups were less likely to have recently updated their first aid/CPR training. People with chronic health problems were in a unique demographic sub-group; they were less likely to have undertaken first aid/CPR training but more likely to have administered first aid/CPR.
Training initiatives that target people on the basis of education level, income group, and the existence of chronic health problems might be one strategy for improving bystander CPR rates when cardiac arrest occurs in the home.
Franklin RC, Watt K, Aitken P, Brown LH, Leggat PA. Characteristics associated with first aid and cardiopulmonary resuscitation training and use in Queensland, Australia. Prehosp Disaster Med. 2019;34(2):155–160
Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.
The aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).
A pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.
Important structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.
This in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
JohnstonANB, WadhamJ, Polong-BrownJ, AitkenM, RanseJ, HuttonA, RichardsB, CrillyJ.Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery. Prehosp Disaster Med. 2019;34(1):62–71.
We identified a pseudo-outbreak of Mycobacterium avium in an outpatient bronchoscopy clinic following an increase in clinic procedure volume. We terminated the pseudo-outbreak by increasing the frequency of automated endoscope reprocessors (AER) filter changes from quarterly to monthly. Filter changing schedules should depend on use rather than fixed time intervals.
A cognitive–behavioural therapy in-patient treatment model for adults with severe anorexia nervosa was developed and evaluated, and outcomes were compared with the previous treatment model and other published outcomes from similar settings.
This study showed the Pathways to Recovery outcomes were positive in terms of improvements in body mass index and psychopathology.
Adults with anorexia nervosa can achieve good outcomes despite longer illness duration and comorbidities.
Declaration of interest
A.B., A.C. and L.H. work at The Retreat where the Pathways to Recovery were developed.
To develop and pilot a clinician-rated outcome scale to evaluate symptomatic outcomes in liaison psychiatry services. Three hundred and sixty patient contacts with 207 separate individuals were rated using six subscales (mood, psychosis, cognition, substance misuse, mind–body problems and behavioural disturbance) plus two additional items (side-effects of medication and capacity to consent for medical treatment). Each item was rated on a five-point scale from 0 to 5 (nil, mild, moderate, severe and very severe).
The liaison outcome measure was acceptable and easy to use. All subscales showed acceptable interrater reliability, with the exception of the mind–body subscale. Overall, the measure appears to show stability and sensitivity to change.
The measure provides a useful and robust way to determine symptomatic change in a liaison mental health setting, although the mind–body subscale requires modification.
Safety at work is a core issue for mental health staff working on
in-patient units. At present, there is a limited theoretical base
regarding which factors may affect staff perceptions of safety.
This study attempted to identify which factors affect perceived staff
safety working on in-patient mental health wards.
A cross-sectional design was employed across 101 forensic and
non-forensic mental health wards, over seven National Health Service
trusts nationally. Measures included an online staff survey, Ward
Features Checklist and recorded incident data. Data were analysed using
categorical principal components analysis and ordinal regression.
Perceptions of staff safety were increased by ward brightness, higher
number of patient beds, lower staff to patient ratios, less dayroom space
and more urban views.
The findings from this study do not represent common-sense assumptions.
Results are discussed in the context of the literature and may have
implications for current initiatives aimed at managing in-patient
violence and aggression.
Archaeological fieldwork preceding housing development revealed a Mesolithic site in a primary context. A central hearth was evident from a cluster of calcined flint and bone, the latter producing a modelled date for the start of occupation at 8220–7840 cal bc and ending at 7960–7530 cal bc (95% probability). The principal activity was the knapping of bladelets, the blanks for microlith production. Impact-damaged microliths indicated the re-tooling of hunting weaponry, while microwear analysis of other tools demonstrated hide working and butchery activity at the site. The lithics can be classified as a Honey Hill assemblage type on the basis of distinctive leaf-shaped microlithic points with inverse basal retouch.
Such assemblages have a known concentration in central England and are thought to be temporally intermediate between the conventional British Early and Late Mesolithic periods. The lithic assemblage is compared to other Honey Hill type and related Horsham type assemblages from south-eastern England. Both assemblage types are termed Middle Mesolithic and may be seen as part of wider developments in the late Preboreal and Boreal periods of north-west Europe. Rapid climatic warming at this time saw the northward expansion of deciduous woodland into north-west Europe. Emerging new ecosystems presented changes in resource patterns and the Middle Mesolithic lithic typo-technological developments reflect novel foraging strategies as adaptations to the new opportunities of Boreal forest conditions. While Honey Hill-type assemblages are seen as part of such wider processes their distinctive typological signature attests to autochthonous, regional developments of human groups infilling the landscape. Such cultural insularity may reflect changing social boundaries with reduction in mobility range and physical isolation caused by rising sea level and the creation of the British archipelago.
Many snow models have been developed for various applications such as hydrology, global atmospheric circulation models and avalanche forecasting. The degree of complexity of these models is highly variable, ranging from simple index methods to multi-layer models that simulate snow-cover stratigraphy and texture. In the framework of the Snow Model Intercomparison Project (SnowMIP), 23 models were compared using observed meteorological parameters from two mountainous alpine sites. The analysis here focuses on validation of snow energy-budget simulations. Albedo and snow surface temperature observations allow identification of the more realistic simulations and quantification of errors for two components of the energy budget: the net short- and longwave radiation. In particular, the different albedo parameterizations are evaluated for different snowpack states (in winter and spring). Analysis of results during the melting period allows an investigation of the different ways of partitioning the energy fluxes and reveals the complex feedbacks which occur when simulating the snow energy budget. Particular attention is paid to the impact of model complexity on the energy-budget components. The model complexity has a major role for the net longwave radiation calculation, whereas the albedo parameterization is the most significant factor explaining the accuracy of the net shortwave radiation simulation.
Ice types, albedos and impurity content are characterized for the ablation zone of the Greenland ice sheet in Kronprinz Christians Land (80° N, 24° W). Along this ice margin the width of the ablation zone is only about 8 km. The emergence and melting of old ice in the ablation zone creates a surface layer of dust that was originally deposited with snowfall high on the ice sheet. This debris cover is augmented by locally derived wind-blown sediment. Subsequently, the surface dust particles often aggregate together to form centimetre-scale clumps that melt into the ice, creating cryoconite holes. The debris in the cryoconite holes becomes hidden from sunlight, raising the area-averaged albedo relative to surfaces with uniform debris cover. Spectral and broadband albedos were obtained for snow, ice hummocks, debris-covered ice, cryoconite-studded ice and barren tundra surfaces. Broadband ice albedos varied from 0.2 (for ice with heavy loading of uniform debris) to 0.6 (for ice hummocks with cryoconite holes). The cryoconite material itself has albedo 0.1 when wet. Areal distribution of the major surface types was estimated visually from a transect video as a function of distance from the ice edge (330 m a.s.l.). Ablation rates were measured along a transect from the ice margin to the slush zone 8 km from the margin (550 m a.s.l.), traversing both Pleistocene and Holocene ice. Ablation rates in early August averaged 2 cm d−1. Impurity concentrations were typically 4.3 mg L−1 in the subsurface ice. Surface concentrations were about 16 g m−2 on surfaces with low impurity loading, and heavily loaded surfaces had concentrations as high as 1.4 kg m−2. The mineralogical composition of the cryoconite material is comparable with that of the surrounding soils and with dust on a snowdrift in front of the ice margin, implying that much of the material is derived from local sources. A fine mode (clay) is present in the oldest ice but not in the nearby soil, suggesting that its origin is from wind deposition during Pleistocene glaciation.
The northern New England region includes the states of Vermont, New Hampshire, and Maine and encompasses a large degree of climate and edaphic variation across a relatively small spatial area, making it ideal for studying climate change impacts on agricultural weed communities. We sampled weed seedbanks and measured soil physical and chemical characteristics on 77 organic farms across the region and analyzed the relationships between weed community parameters and select geographic, climatic, and edaphic variables using multivariate procedures. Temperature-related variables (latitude, longitude, mean maximum and minimum temperature) were the strongest and most consistent correlates with weed seedbank composition. Edaphic variables were, for the most part, relatively weaker and inconsistent correlates with weed seedbanks. Our analyses also indicate that a number of agriculturally important weed species are associated with specific U.S. Department of Agriculture plant hardiness zones, implying that future changes in climate factors that result in geographic shifts in these zones will likely be accompanied by changes in the composition of weed communities and therefore new management challenges for farmers.
Tillage is a foundational management practice in many cropping systems. Although effective at reducing weed populations and preparing a crop seedbed, tillage and cultivation can also dramatically alter weed community composition. We examined the impact of soil tillage timing on weed community structure at four sites across the northeastern United States. Soil was tilled every 2 wk throughout the growing season (late April to late September 2013), and weed seedling density was quantified by species 6 wk after each tillage event. We used a randomized complete block design with four replicates for each tillage-timing treatment; a total of 196 plots were sampled. The timing of tillage was an important factor in shaping weed community composition and structure at all sites. We identified three main periods of tillage timing that resulted in similar communities. Across all sites, total weed density tended to be greatest and weed evenness tended to be lowest when soils were tilled early in the growing season. From the earliest to latest group of timings, total abundance decreased on average from 428±393 to 159±189 plants m−2, and evenness increased from 0.53±0.25 to 0.72±0.20. The effect of tillage timing on weed species richness varied by site. Our results show that tillage timing affects weed community structure, suggesting that farmers can manage weed communities and the potential for weed interference by adjusting the timing of their tillage and cropping practices.
We present a model to map the 3D distribution of dust in the Milky Way. Although dust is just a tiny fraction of what comprises the Galaxy, it plays an important role in various processes. In recent years various maps of dust extinction have been produced, but we still lack a good knowledge of the dust distribution. Our presented approach leverages line-of-sight extinctions towards stars in the Galaxy at measured distances. Since extinction is proportional to the integral of the dust density towards a given star, it is possible to reconstruct the 3D distribution of dust by combining many lines-of-sight in a model accounting for the spatial correlation of the dust. Such a technique can be used to infer the most probable 3D distribution of dust in the Galaxy even in regions which have not been observed. This contribution provides one of the first maps which does not show the “fingers of God” effect. Furthermore, we show that expected high precision measurements of distances and extinctions offer the possibility of mapping the spiral arms in the Galaxy.
We use methods of differential astrometry to construct a small field inertial reference frame stable at the micro-arcsecond level. Using Gaia measurements of field angles we look at the influence of the number of reference stars and the stars magnitude as well as astrometric systematics on the total error budget with the help of Gaia-like simulations around the Ecliptic Pole in a differential astrometric scenario. We find that the systematic errors are modeled and reliably estimated to the μas level even in fields with a modest number of 37 stars with G <13 mag over a 0.24 sq. degrees field of view for short timescales of the order of a day for a perfect instrument and with high-cadence observations. Accounting for large-scale calibrations by including the geometric instrument model over such short timescales requires fainter stars down to G=14 mag without diminishing the accuracy of the reference frame.
The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.