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This chapter presents a synopsis of some of the latest developments in our understanding of pyroconvective interactions, their links to fire geometrym and their role in driving dynamic fire behavior and extreme wildfire development. We highlight the need to augment traditional quasi-steady wildfire modeling paradigms with more sophisticated approaches that combine highly-instrumented, larger-scale experimental studies with state-of-the-art computational modeling. We identify the need to take maximum advantage of technical advances in remote sensing technology to provide new ways of observing extreme fire events.
The performance benefits of deploying tidal turbines in close side-by-side proximity to exploit constructive interference effects are demonstrated experimentally using two 1.2 m diameter turbines. The turbines are arrayed side-by-side at 1/4 diameter tip-to-tip spacing, and their performance compared with that of a single rotor. Tests were completed in the 25 m diameter, 2 m deep wave and current FloWave Ocean Energy Research facility. A detailed assessment of inflow conditions at different control points is used to understand the impact that rotors, designed for high blockage conditions, have on the approach flow. After accounting for global blockage, a 10.8 % uplift in the twin-turbine-averaged power coefficient, relative to that for a single turbine, is found for the turbine design speed, at the expense of a 5.2 % increase in thrust coefficient and 3.1 % increase in tip-speed-ratio. Flowfield mapping demonstrated flow effects at array and device scale including array bypass flows and jetting between turbines. Azimuthal variation of blade root flapwise and edgewise bending moments show that the turbines interact in a beneficial manner, with additional and sustained loading peaks as the blades pass in close proximity to the neighbouring rotor. Peak performance for the twin turbines occurred at a higher tip-speed-ratio than for the single turbine, which is consistent with the twin turbines exerting a higher thrust on the flow to achieve maximum power. The twin turbine performance variation with tip-speed-ratio is found to be more gradual than for the single turbine. Using differential rotor speed control we observe that array performance is robust to small differences in neighbouring rotor operating point. Through these experiments we demonstrate that there is a substantial, achievable performance benefit from closely arraying turbines for side-by-side operation and designing them for constructive interference.
The Homa Peninsula has been known to science since 1911, and fossil specimens from the area comprise many type specimens for common African mammalian paleospecies. Here we discuss the fauna and the paleoenvironmental information from the Homa Peninsula. The Homa Peninsula is a 200 km2 area in Homa Bay County, situated on the southern margin of the Winam Gulf of Lake Victoria in Kenya (Figure 29.1). Lake Victoria is estimated to be the third largest lake in the world, with a surface area of 68,900 km2 and a maximum length of approximately 616 km. Although its catchment is extensive, it is relatively shallow compared to any other lake of similar size, with a maximum depth of 84 m. Lake Victoria is located in a depression formed by the western and eastern branches of the East African Rift System (EARS), and is at an average elevation of 1135 m a.s.l. (Database for Hydrological Time Series of Inland Waters, 2017).
Little is known about the early history of the chicken (Gallus gallus domesticus), including the timing and circumstances of its introduction into new cultural environments. To evaluate its spatio-temporal spread across Eurasia and north-west Africa, the authors radiocarbon dated 23 chicken bones from presumed early contexts. Three-quarters returned dates later than those suggested by stratigraphy, indicating the importance of direct dating. The results indicate that chickens did not arrive in Europe until the first millennium BC. Moreover, a consistent time-lag between the introduction of chickens and their consumption by humans suggests that these animals were initially regarded as exotica and only several centuries later recognised as a source of ‘food’.
In March 2020, New York City (NYC) became the epicenter of the COVID-19 pandemic in the United States (US). As healthcare facilities were overwhelmed with patients, the Jacob K. Javits Convention Center was transformed into the nation’s largest alternate care site (ACS): Javits New York Medical Station (Javits). Protecting healthcare workers during a global shortage of personal protective equipment (PPE) in a non-traditional healthcare setting posed unique challenges. We describe components of the healthcare worker safety program implemented at Javits.
Setting:
Javits, a large convention center transformed into a field hospital, with clinical staff from the US Public Health Service Commissioned Corps (USPHS) and the Department of Defense (DoD).
Healthcare Worker Safety Methods:
Key strategies included ensuring one-way flow of traffic on and off the patient floor; developing a matrix detailing PPE required for each work activity and location; PPE extended use and reuse protocols; personnel training; and monitoring adherence to PPE donning/doffing protocols when entering or exiting the patient floor. Javits staff who reported COVID-19 symptoms were immediately isolated, monitored, and offered a SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) test.
Conclusions:
A well-designed and implemented healthcare worker safety plan can minimize the risk of SARS-CoV-2 infection for healthcare workers. The lessons learned from operating the nation’s largest COVID-19 ACS can be adapted to other environments during public health emergencies.
Optimizing needleless connector hub disinfection practice is a key strategy in central-line–associated bloodstream infection (CLABSI) prevention. In this mixed-methods evaluation, 3 products with varying scrub times were tested for experimental disinfection followed by a qualitative nursing assessment of each.
Methods:
Needleless connectors were inoculated with varying concentrations of Staphylococcus epidermidis, Pseudomonas aeruginosa, and Staphylococcus aureus followed by disinfection with a 70% isopropyl alcohol (IPA) wipe (a 15-second scrub time and a 15-second dry time), a 70% IPA cap (a 10-second scrub time and a 5-second dry time), or a 3.15% chlorhexidine gluconate with 70% IPA (CHG/IPA) wipe (a 5-second scrub time and a 5-second dry time). Cultures of needleless connectors were obtained after disinfection to quantify bacterial reduction. This was followed by surveying a convenience sample of nursing staff with intensive care unit assignments at an academic tertiary hospital on use of each product.
Results:
All products reduced overall bacterial burden when compared to sterile water controls, however the IPA and CHG/IPA wipes were superior to the IPA caps when product efficacy was compared. Nursing staff noted improved compliance with CHG/IPA wipes compared with the IPA wipes and the IPA caps, with many preferring the lesser scrub and dry times required for disinfection.
Conclusion:
Achieving adequate bacterial disinfection of needleless connectors while maximizing healthcare staff compliance with scrub and dry times may be best achieved with a combination CHG/IPA wipe.
The storming of the US Capitol building in January 2021 was a presidential attempt at a self-coup. To make the case, this article reviews elements of the Capitol assault and the events leading up to it, in light of the key conceptual components of a self-coup, and how those compare to attributes of other kinds of attacks on governments. The Trump self-coup will then be compared and contrasted empirically to other self-coups perpetrated by leaders. It is found that what separates successful self-coups from those that fail is whether the military backs the undertaking. Thus, a section is included on US military behaviour in response to Trump's attempts to gain military adherence for his political actions.
In contrast to previous state-centric accounts, this article sheds new transnational light on the 1919 Paris peace settlement through its investigation of proposals for transnational associations’ roles in the envisaged new world order. The popularity of some of these proposals, and their perceived potential to contribute towards a more democratic, legitimate and peaceful international order, stimulated their consideration during official negotiations at the Paris Peace Conference, and subsequent League of Nations practice was also perceived to have reflected some of the ideas put forward in the proposals. This article provides a typology of these proposals, and it critically evaluates the claims made with respect to their repercussions for democracy, legitimacy and peace. The article further elucidates how, despite their limitations, these proposals helped open up diplomacy to transnational associations both at the Paris Peace Conference and in the League of Nations era.
We show that
$L_1(L_p) (1 < p < \infty )$
is primary, meaning that whenever
$L_1(L_p) = E\oplus F$
, where E and F are closed subspaces of
$L_1(L_p)$
, then either E or F is isomorphic to
$L_1(L_p)$
. More generally, we show that
$L_1(X)$
is primary for a large class of rearrangement-invariant Banach function spaces.
Variation in delineation of target volumes/organs at risk (OARs) is well recognised in radiotherapy and may be reduced by several methods including teaching. We evaluated the impact of teaching on contouring variation for thoracic/pelvic stereotactic ablative radiotherapy (SABR) during a virtual contouring workshop.
Materials and methods:
Target volume/OAR contours produced by workshop participants for three cases were evaluated against reference contours using DICE similarity coefficient (DSC) and line domain error (LDE) metrics. Pre- and post-workshop DSC results were compared using Wilcoxon signed ranks test to determine the impact of teaching during the workshop.
Results:
Of 50 workshop participants, paired pre- and post-workshop contours were available for 21 (42%), 20 (40%) and 22 (44%) participants for primary lung cancer, pelvic bone metastasis and pelvic node metastasis cases, respectively. Statistically significant improvements post-workshop in median DSC and LDE results were observed for 6 (50%) and 7 (58%) of 12 structures, respectively, although the magnitude of DSC/LDE improvement was modest in most cases. An increase in median DSC post-workshop ≥0·05 was only observed for GTVbone, IGTVlung and SacralPlex, and reduction in median LDE > 1 mm was only observed for GTVbone, CTVbone and SacralPlex. Post-workshop, median DSC values were >0·7 for 75% of structures. For 92% of the structures, post-workshop contours were considered to be acceptable or within acceptable variation following review by the workshop faculty.
Conclusions:
This study has demonstrated that virtual SABR contouring training is feasible and was associated with some improvements in contouring variation for multiple target volumes/OARs.
The New Treatment Fund (NTF), launched in January 2017, aims to support the faster introduction of new medicines recommended by the National Institute for Health and Care Excellence (NICE) and the All Wales Medicines Strategy Group (AWMSG). The NTF requires seven health boards and one trust to make recommended medicines available within 60 days of any positive recommendation decision. The project goal was to develop a system for demonstrating how monitoring the NTF improves medicines access for the people of Wales.
Methods
The process was derived via a series of task and finish group meetings with relevant stakeholders. The monitoring criteria were agreed through a collaborative expert approach using a nominal group technique. This determined a minimal dataset of formulary status, which included time to formulary addition. Pre-NTF medicines data (n = 59) were available for a six-month period.
Results
By the three-year milestone of the NTF, the average time taken for newly recommended medicines (n = 219) to become available to patients across Wales had decreased by eighty-five percent from 90 to 13 days (p < 0.01).
Conclusions
An innovative and robust system has been created for accurately monitoring the formulary addition of medicines within the NTF, supporting the rapid and comprehensive uptake of medicines deemed clinically and cost effective by NICE and the AWMSG.
Research suggests that an increased risk of physical comorbidities might have a key role in the association between severe mental illness (SMI) and disability. We examined the association between physical multimorbidity and disability in individuals with SMI.
Methods
Data were extracted from the clinical record interactive search system at South London and Maudsley Biomedical Research Centre. Our sample (n = 13,933) consisted of individuals who had received a primary or secondary SMI diagnosis between 2007 and 2018 and had available data for Health of Nations Outcome Scale (HoNOS) as disability measure. Physical comorbidities were defined using Chapters II–XIV of the International Classification of Diagnoses (ICD-10).
Results
More than 60 % of the sample had complex multimorbidity. The most common organ system affected were neurological (34.7%), dermatological (15.4%), and circulatory (14.8%). All specific comorbidities (ICD-10 Chapters) were associated with higher levels of disability, HoNOS total scores. Individuals with musculoskeletal, skin/dermatological, respiratory, endocrine, neurological, hematological, or circulatory disorders were found to be associated with significant difficulties associated with more than five HoNOS domains while others had a lower number of domains affected.
Conclusions
Individuals with SMI and musculoskeletal, skin/dermatological, respiratory, endocrine, neurological, hematological, or circulatory disorders are at higher risk of disability compared to those who do not have those comorbidities. Individuals with SMI and physical comorbidities are at greater risk of reporting difficulties associated with activities of daily living, hallucinations, and cognitive functioning. Therefore, these should be targeted for prevention and intervention programs.
The topic of patients recording healthcare consultations has been previously debated in the literature, but little consideration has been given to the risks and benefits of such recordings in the context of mental health assessments and treatment. This issue is of growing importance given the increasing use of technology in healthcare and the recent increase in online healthcare services, largely accelerated by the COVID-19 pandemic. We discuss the clinical, ethical and legal considerations relevant to audio or visual recordings of mental health consultations by patients, with reference to existing UK guidance and the inclusion of a patient's perspective.
Studying phenotypic and genetic characteristics of age at onset (AAO) and polarity at onset (PAO) in bipolar disorder can provide new insights into disease pathology and facilitate the development of screening tools.
Aims
To examine the genetic architecture of AAO and PAO and their association with bipolar disorder disease characteristics.
Method
Genome-wide association studies (GWASs) and polygenic score (PGS) analyses of AAO (n = 12 977) and PAO (n = 6773) were conducted in patients with bipolar disorder from 34 cohorts and a replication sample (n = 2237). The association of onset with disease characteristics was investigated in two of these cohorts.
Results
Earlier AAO was associated with a higher probability of psychotic symptoms, suicidality, lower educational attainment, not living together and fewer episodes. Depressive onset correlated with suicidality and manic onset correlated with delusions and manic episodes. Systematic differences in AAO between cohorts and continents of origin were observed. This was also reflected in single-nucleotide variant-based heritability estimates, with higher heritabilities for stricter onset definitions. Increased PGS for autism spectrum disorder (β = −0.34 years, s.e. = 0.08), major depression (β = −0.34 years, s.e. = 0.08), schizophrenia (β = −0.39 years, s.e. = 0.08), and educational attainment (β = −0.31 years, s.e. = 0.08) were associated with an earlier AAO. The AAO GWAS identified one significant locus, but this finding did not replicate. Neither GWAS nor PGS analyses yielded significant associations with PAO.
Conclusions
AAO and PAO are associated with indicators of bipolar disorder severity. Individuals with an earlier onset show an increased polygenic liability for a broad spectrum of psychiatric traits. Systematic differences in AAO across cohorts, continents and phenotype definitions introduce significant heterogeneity, affecting analyses.
The protected Tel-Dor coastal embayment in the eastern Mediterranean preserves an unusually complete stratigraphic record that reveals human–environmental interactions throughout the Holocene. Interpretation of new seismic profiles collected from shallow marine geophysical transects across the bay show five seismic units were correlated with stratigraphy and age dates obtained from coastal and shallow-marine sediment cores. This stratigraphic framework permits a detailed reconstruction of the coastal system over the last ca. 77 ka as well as an assessment of environmental factors that influenced some dimensions of past coastal societies. The base of the boreholes records lowstand aeolian deposits overlain by wetland sediments that were subsequently flooded by the mid-Holocene transgression. The earliest human settlements are submerged Pottery Neolithic (8.25–7 ka) structures and tools, found immediately above the wetland deposits landward of a submerged aeolianite ridge at the mouth of the bay. The wetland deposits and Pottery Neolithic settlement remains are buried by coastal sand that records a middle Holocene sea-level rise ca. 7.6–6.5 ka. Stratigraphic and geographic relationships suggest that these coastal communities were displaced by sea-level transgression. These findings demonstrate how robust integration of different data sets can be used to reconstruct the geomorphic evolution of coastal settings as well as provide an important addition to the nature of human–landscape interaction and cultural development.
This article examines large-scale spatial and temporal patterns in the agricultural demographic transition (ADT) of Mesoamerica and southwestern North America (“the Southwest”). An analysis of published settlement and subsistence data suggests that the prolonged ADTs of these regions involved two successive eras of rapid population growth. Although both periods of growth were fueled by the introduction or development of more productive domesticates, they had distinctive demographic and social consequences. The first phase of the ADT occurred only in a scattering of favorable regions, between 1900 and 1000 BC in Mesoamerica and 1200 BC–AD 400 in the Southwest. Its demographic consequences were modest because it was underwritten by still rather unproductive maize. During this phase, increased population was confined mainly to a few agricultural heartlands, whereas surrounding regions remained sparsely populated. The second phase of the ADT was more dramatic in the spatial scale of its impact. This “high productivity” phase unfolded between 1000 and 200 BC in Mesoamerica and AD 500–1300 in the Southwest, and it was fueled by more productive maize varieties and improving agricultural technologies. It was accompanied by sweeping social, economic, and political changes in both regions.