Fruit and vegetable intakes are major modifiable determinants of risk for non-communicable disease(1), yet intake levels remain low(2) and multiple barriers (cost, access, perishability, preparation skills) exist(3,4). 100% fruit and vegetable juices contain key micronutrients and bioactive compounds (5–7) and may help circumvent these barriers to consumption(6,7). However, their role in dietary guidelines and models of healthy eating remains controversial due to their free sugars and reduced dietary fibre content, relative to whole fruits and vegetables(6,7). Therefore, we conducted a systematic umbrella review of systematic literature reviews (SLRs) with meta-analyses assessing the relationships between 100% juice consumption and human health outcomes. Four databases (Medline, Cochrane Library, EMBASE, and CINAHL) were systematically searched for SLRs with meta-analyses of human prospective cohort, case-control, and intervention studies examining the relationship between 100% juice and any health outcome through to 20th October 2022. Screening (Covidence), quality (GRADE)(8), risk of bias (ROBIS)(9) and content overlap (corrected covered area(10)) tools were applied, and extracted data were narratively synthesised. The protocol was pre-registered (PROSPERO) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists. 15 SLRs on 100% fruit juice including 51 primary meta-analyses, 6 dose-response analyses, and 87 sub-analyses were eligible for inclusion. No eligible studies on vegetable juice were found. Included studies represented data from almost 2 million subjects with a range of doses (50-1200mL/day) and timeframes (hours to years). Significant improvements in health outcomes were found in 19.6% of included meta-analyses (blood pressure, flow-mediated dilation, IL-6, c-reactive protein, and stroke mortality), and increased disease risks were found in 5.9% of included meta-analyses (CVD mortality, prostate cancer, and type II diabetes). The remainder (74.5%) found no significant difference (blood lipids, weight, liver function, metabolic markers, colorectal and breast cancers, and multiple inflammatory markers). The ROBIS quality assessment rated nine SLRs as low risk of bias, three as unclear and three as high. Using GRADE, confidence in the body of evidence ranged from very low (27 primary and 79 secondary meta-analyses) to low (19 primary and 13 secondary meta-analyses), and medium (4 primary and one secondary meta-analyses.) Findings show 100% juice consumption has limited risks of harm and some potential benefits, over a broad range of doses, including some that are relatively high, and time periods. The positive associations between 100% juice consumption and specific health outcomes relevant to population health may be explained by multiple mechanisms, including the vitamin, mineral, and bioactive contents. The balance of evidence suggests that 100% may have a neutral or beneficial place in general, population-level dietary guidelines.

Background: Massive hemorrhage protocols (MHPs) streamline the complex logistics required for prompt care of the bleeding patient, but their uptake has been variable and few regions have a system to measure outcomes from these events. Aim Statement: We aim to implement a standardized MHP with uniform quality improvement (QI) metrics to increase uptake of evidence-based MHPs across 150-hospitals in Ontario between 2017 and 2021. Measures & Design: We performed ongoing PDSA cycles; 1) stakeholder analysis by surveying the Ontario Regional Blood Coordinating Network (ORBCoN), 2) problem characterization and Ishikawa analysis for key QI metrics based on areas of MHP variability in 150 Ontario hospitals using a web-based survey, 3) creation of a consensus MHP via a modified Delphi process, 4) problem characterization at ORBCoN for the design of a freely available toolkit for provincial implementation by expert working groups, 5) design of 8 key QI metrics by a modified Delphi process, and 6) identification of process measures for QI data collection by implementation metrics. Evaluation/Results: PDSA1-2; 150-hospitals were surveyed. 33% of hospitals lacked MHPs, mostly in smaller sites. Major areas for QI were related to activation criteria, hemostatic agents, protocolized hypothermia management, variable MHP naming, QI metrics and serial blood work requirements. PDSA3; 3 Delphi rounds were held to reach 100% expert consensus for 42 statements and 8 CQI metrics. Major areas for modification were protocol name, laboratory resuscitation targets, cooler configurations, and role of factor VIIa. PDSA4; adaptable toolkit is under development by the steering committee and expert working groups. Implementation is scheduled for Spring 2020. PDSA5; the 8 CQI metrics are: TXA administration < 1 h, RBC transfusion < 15 min, call to transfer for definitive care < 60 min, temp >35°C at end of protocol, Hgb kept between 60-110g/L, transition to group-specific RBC by 90 min, appropriate activation defined by ≥6 units RBC in the first 24 hours, and any blood component wastage. Discussion/Impact: MHP uptake, content, and tracking is variable. A standardized MHP that is adaptable to diverse settings decreases complexity, improves use of evidence-based practices, and provides a platform for continuous QI. PDSA6 will occur after implementation; we will complete an implementation survey, and design a pilot and feasibility study for prospective tracking of patient outcomes using existing prospectively collected inter-hospital and provincial databases.

Introduction: When presenting to the Emergency Department (ED), the care of elderly patients residing in Long Term Care (LTC) can be complicated by threats to patient safety created by ineffective transitions of care. Though standardized inpatient handover tools exist, there has yet to be a universal tool adopted for transfers to the ED. In this study, we surveyed relevant stakeholders and identified what information is essential in the transitions of care for this vulnerable population. Methods: We performed a descriptive, cross sectional electronic survey that was distributed to physicians and nurses in ED and LTC settings, paramedics, and patient advocates in two Canadian cities. The survey was kept open for a one month period with weekly formal reminders sent. Questions were generated after performing a literature review which sought to assess the current landscape of transitional care in this population. These were either multiple choice or free text entry questions aimed at identifying what information is essential in transitional periods. Results: A total of 191 health care providers (HCP) and 22 patient advocates (PA) responded to the survey. Within the HCPs, 38% were paramedics, 38% worked in the ED, and 24% were in LTC. In this group, only 41% of respondents were aware of existing handover protocols. Of the proposed informational items in transitional care, 100% of the respondents within both groups indicated that items including reason for transfer and advanced care directives were essential. Other areas identified as necessary were past medical history and baseline functional status. Furthermore, the majority of PAs identified that items such as primary language, bowel and bladder incontinence and spiritual beliefs should be included. Conclusion: This survey demonstrated that there is a need for an improved handover culture to be established when caring for LTC patients in the ED. Education needs to be provided surrounding existing protocols to ensure that health care providers are aware of their existence. Furthermore, we identified what information is essential to transitional care of these patients according to HCPs and PAs. These findings will be used to generate a simple, one page handover form. The next iteration of this project will pilot this handover form in an attempt to create safer transitions to the ED in this at-risk population.

We present an experimental study of a buoyancy-driven, low-Reynolds-number (Re < 1) exchange flow of two Newtonian fluids in a vertical cylindrical pipe (length 1 m and diameter 38.4 mm) connecting two fluid reservoirs. The denser, more viscous fluid was golden syrup and the less dense, less viscous fluid was a golden syrup–water solution; the ratio of the viscosities of the two fluids (β) ranged from 2 to 1180. Flows were initiated by removing a bung in the base of the upper reservoir or sliding out a gate positioned at the top, middle or bottom of the pipe. We observe the flows over long time durations (up to 356 h), and define the development of the flow with reference to a non-dimensional time (τ). The initial transient development of the flow was dependent on which of the two fluids initially filled the pipe, but this did not systematically affect the flow regime observed at τ ≫ 1. Two distinct flow regimes were observed: axisymmetric core-annular flow (CAF), in which the less viscous fluid occupies a cylindrical core and the denser fluid flows downwards in an annulus, and side-by-side (SBS) flow where both fluids are in contact with the pipe and there is a single interface between them. CAF formed at β ≥ 75 and SBS flow at β ≤ 117. In several experiments, for 5 ≤ β ≤ 59, a slowly developing transitional SBS (TSBS) flow was observed where SBS flow and CAF occurred simultaneously with SBS in the lower portion of the pipe; SBS existed throughout most of the pipe and in one case grew with time to entirely fill the pipe. Velocity profiles determined by tracking tracer particles show that the observed CAFs are adequately described by the formulation of Huppert & Hallworth (J. Fluid Mech., vol. 578, 2007, pp. 95–112). Experimental SBS velocity profiles are not well produced by the formulation of Kerswell (J. Fluid Mech., 10.1017/jfm.2011.190), possibly because the latter is restricted to flows whose cross-section has an interface of constant curvature. Despite the variations in flow regime, volume fluxes can be described by a power-law function of β, Q1 = 0.059 β−0.74. A comparison of experimental data with the theoretical approaches of Huppert Hallworth (2007) and Kerswell (2011) indicates that fluids are not arranged in the regime that maximises volume flux (e.g. SBS or CAF), nor do they adopt the geometry that maximises volume flux within that particular regime.

The Shaugh Moor project is concerned with an area of moorland in south Dartmoor north-east and north respectively of the villages of Shaugh Prior and Wotter (fig. 1). The physical threat to the evidence for settlement and land-use caused by the operations of the China Clay industry involved the Central Excavation Unit of the Department of the Environment from 1976 in a programme of survey, excavation and environmental studies related to the settlements, land boundaries, burial mounds and ceremonial structures that are to be found on this piece of moorland. The background to the project and its preliminary research strategy have been outlined in Paper I (Wainwright et al. 1979) and this publication describes the investigation of a stone-walled enclosure surrounding houses and other structures that was totally excavated in 1977 and 1978. Subsequent papers will describe the related archaeological and scientific investigations into the past environment and land-use of this block of moorland and its adjacent region.

The prehistoric structure described in this paper is only one of a large series of wooden roads and trackways that run into and across the Somerset Levels. The Levels themselves consist of a number of wide expanses of moorland separated by ‘islands’ of rock and sand, the whole covering a region in Somerset of about 200 square miles. In the northern part of the Levels, the peats of the valley of the River Brue have for long been subjected to hand-cutting and machine-cutting by a number of individuals and peat-companies. Through their activities, many prehistoric discoveries have been made and these have been reported at intervals in these Proceedings and elsewhere. In 1973, the Somerset Levels Project was formed to organize and conduct fieldwork and excavations in the Levels, and, through co-operation with both the Department of the Environment and the many peat interests in the Levels, the Project has been able to undertake many more investigations of prehistoric remains than had previously been possible; about 15 reports relating to recent works have been published, and those relevant to the present paper are listed in the References.

The wooden trackway described here has been known to exist for almost 90 years, but so far as we are aware it has never before been fully examined, nor has it had the benefit of specialist studies dealing with dendrochronology and with fossil coleoptera associated with the trackway. These, allied to extensive wood identifications and pollen analyses, allow a more closely defined description and interpretation of the trackway which appear to us to alter the original concepts as published previously.

In 1660 someone transcribed into the ‘Town Book’ of Belfast a copy of ‘Verses presented to General Monck’:

Advance, George Monck, and Monck St George shall be,

England's restorer to its liberty,

Scotland's protector, Ireland's president,

Reducing all to a free parliament;

And if thou dost intend the other thing,

Go on, and all shall cry God save the king.

The see of Derry was (until the disestablishment of the church) one of the richest in Ireland, and the success of King William's forces in the north not unnaturally aroused some speculation about the next occupant. It is true that when the siege of Derry was raised Bishop Hopkins was still alive, but his unpopular action in opposing resistance to James's army no doubt helped to persuade the king's ecclesiastical advisers that his health was unequal to the continued discharge of his duties. At any rate, by September 1689, at least nine months before Hopkins died, it was generally known that George Walker was to have the appointment.

The difficulties and problems which the revolution of 1688 presented to people of tender conscience were, in England, smoothed over and covered by circumstances. The king’s flight left the tories free to frame, at least for their own consumption, a theory which secured to them the benefits of revolution without the sin of rebellion. The anglican church itself, than which no institution had more openly maintained the doctrine of non-resistance, found that the accomplished fact could be accepted with a face-saving show of consistency; even the moral and intellectual eminence of the non-jurors failed to secure more than a handful of followers for their schism.