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We investigate the convergence rate of multi-marginal optimal transport costs that are regularized with the Boltzmann–Shannon entropy, as the noise parameter $\varepsilon $ tends to $0$. We establish lower and upper bounds on the difference with the unregularized cost of the form $C\varepsilon \log (1/\varepsilon )+O(\varepsilon )$ for some explicit dimensional constants C depending on the marginals and on the ground cost, but not on the optimal transport plans themselves. Upper bounds are obtained for Lipschitz costs or locally semiconcave costs for a finer estimate, and lower bounds for $\mathscr {C}^2$ costs satisfying some signature condition on the mixed second derivatives that may include degenerate costs, thus generalizing results previously in the two marginals case and for nondegenerate costs. We obtain in particular matching bounds in some typical situations where the optimal plan is deterministic.
Description of a model to improve care for patients with Medically Unexplained Symptoms (MUS) by small targeted investment and maximisation of existing resources.
Background
Treatment of MUS presents several challenges including a lack of clarity on the best models of care and limited service provision. Patients typically present with a physical complaint to physical health outlets: here limited confidence in professionals around how to address these often leads to poor patient/doctor experience, inappropriate use of resources and repeated attendance. Evidence shows that integration of care, psychological interventions and upskilling physicians in interventions such as positive communication, can significantly improve outcomes. Psychiatric Liaison Teams (PLT) are positioned at the interface of mental and physical health services and can play a crucial role for these patients, when provided with the right skill-mix.
Method
1FTE Clinical Psychologist specialising in MUS was integrated into the PLT. Pathways to triage between primary, secondary psychology and the new service were agreed, alongside channels of communication and supervision. The job plan included integrated sessions in Gastroenterology, Rheumatology and PLT. The activities included: assessments, formulations and discharges; brief psychological interventions; group sessions for patients; one-day long courses to GP trainees and physicians, and input in specialities MDTs. Clinical outcomes, numbers of patients seen and signposted, teaching sessions and simulation training delivered were collected.
Result
Over 20 months the service was able to process 237 referrals, 35 were managed over the phone. Referral sources: Gastroenterology 32%, Rheumatology 37%, Psychiatric liaison 28%.
116 patients attended 315 face to face appointments and 21 phone contacts were made. Core-10 data show reduction from moderately severe to mild psychological distress in a sample of patients. 58% of patients were referred on for continuing care. The service ran 8 patient groups including sessions on pain management and joint sessions with Rheumatology. It ran 9 one-day long courses for GP and physician trainees, training a total of 120 doctors: feedback showed increased confidence in managing and recognising MUS. Attendances to Emergency Departments covered by Barking Havering and Redbridge and Bart's Health Trusts combined (5 sites) reduced by 22%, saving an estimated £19,200, while ambulance usage in the cohort dropped by 29%, saving an estimated £9072.
Conclusion
The integration of a specialist psychologist with a mix of educational, advisory and clinical role to a PLT can provide an effective and efficient stepped-up model to increase the provision of care for patients with MUS
The reputation of the Normans is rooted in warfare, faith and mobility. They were simultaneously famed as warriors, noted for their religious devotion, and celebrated as fearless travellers. In the Middle Ages few activities offered a better conduit to combine warfare, religiosity, and movement than crusading and pilgrimage. However, while scholarship is abundant on many facets of the Norman world, it is a surprise that the Norman relationship with crusading and pilgrimage, so central in many ways to Norman identity, has hitherto not received extensive treatment. The collection here seeks to fill this gap. It aims to identify what was unique or different about the Normans and their relationship with crusading and pilgrimage, as well as how and why crusade and pilgrimage were important to the Normans. Particular focus is given to Norman participation in the First Crusade, to Norman interaction in later crusading initiatives, to the significance of pilgrimage in diverse parts of the Norman world, and finally to the ways in which crusading and pilgrimage were recorded in Norman narrative. Ultimately, this volume aims to assess, in some cases to confirm, and in others to revise the established paradigm of the Normans as crusaders par excellence and as opportunists who used religion to serve other agendas.
Dr Kathryn Hurlock is Senior Lecturer in Medieval History at Manchester Metropolitan University; Dr Paul Oldfield is Lecturer in Medieval History at the University of Manchester.
Contributors: Andrew Abram, William M. Aird, Emily Albu, Joanna Drell, Leonie Hicks, Natasha Hodgson, Kathryn Hurlock, Alan V. Murray, Paul Oldfield, David S. Spear, Lucas Villegas-Aristizábal.
Glaciers in the Alps and several other regions in the world have experienced strong negative mass balances over the past few decades. Some of them are disappearing, undergoing exceptionally negative mass balances that impact the mean regional value, and require replacement. In this study, we analyse the geomorphometric characteristics of 46 mass-balance glaciers in the Alps and the long-term mass-balance time series for a subset of nine reference glaciers. We identify regime shifts in the mass-balance time series (when non-climatic controls started impacting) and develop a glacier vulnerability index (GVI) as a proxy for their possible future development, based on criteria such as hypsometric index, breaks in slope, thickness distribution and elevation change pattern. We found that the subset of 46 mass-balance glaciers reflects the characteristics of the total glacier sample very well and identified a region-specific variability of the mass balance. As the GVI is strongly related to cumulative glacier mass balances, it can be used as a pre-selector of future mass-balance glaciers. We conclude that measurements on rapidly shrinking glaciers should be continued as long as possible to identify regime shifts in hind-cast and better understand the impacts of climatic variability on such glaciers.
The evolution of glaciers and ice sheets depends on processes in the subglacial environment. Shear seismicity along the ice–bed interface provides a window into these processes. Such seismicity requires a rapid loss of strength that is typically ascribed to rate-weakening friction, i.e., decreasing friction with sliding or sliding rate. Many friction experiments have investigated glacial materials at the temperate conditions typical of fast flowing glacier beds. To our knowledge, however, these studies have all found rate-strengthening friction. Here, we investigate the possibility that rate-weakening rock-on-rock friction between sediments frozen to the bottom of the glacier and the underlying water-saturated sediments or bedrock may be responsible for subglacial shear seismicity along temperate glacier beds. We test this ‘entrainment-seismicity hypothesis’ using targeted laboratory experiments and simple models of glacier sliding, seismicity and sediment entrainment. These models suggest that sediment entrainment may be a necessary but not sufficient condition for the occurrence of basal shear seismicity. We propose that stagnation at the Whillans Ice Stream, West Antarctica may be caused by the growth of a frozen fringe of entrained sediment in the ice stream margins. Our results suggest that basal shear seismicity may indicate geomorphic activity.
OBJECTIVES/SPECIFIC AIMS: To assess the association between probable OSA and the sudden unexpected death in epilepsy (SUDEP-7) risk profiling index in monitored adult inpatients with epilepsy. METHODS/STUDY POPULATION: We analyzed 49 consecutive adults (>18 years) with refractory epilepsy admitted to our inpatient epilepsy monitoring unit. The SUDEP-7 inventory was performed for all subjects. Probable OSA was identified using overnight oximetry, the Sleep Apnea Sleep Disorder Questionnaire (SA-SDQ), and STOP-BANG inventory. RESULTS/ANTICIPATED RESULTS: Thirty-nine percent of participants screened positive for probable sleep apnea. Patients with high SUDEP-7 scores were more likely to have a positive screen for OSA. DISCUSSION/SIGNIFICANCE OF IMPACT: OSA is an independent risk factor for sudden cardiac death. OSA may be a hitherto unrecognized contributor to sudden death risk in epilepsy. Further studies determining the relationship between OSA, neural circulatory control and SUDEP are warranted.
Few studies have examined the challenges faced by emergency medicine (EM) physicians in conducting goals of care discussions. This study is the first to describe the perceived barriers and facilitators to these discussions as reported by Canadian EM physicians and residents.
Methods
A team of EM, palliative care, and internal medicine physicians developed a survey comprising multiple choice, Likert-scale and open-ended questions to explore four domains of goals-of-care discussions: training; communication; environment; and patient beliefs.
Results
Surveys were sent to 273 EM staff and residents in six sites, and 130 (48%) responded. Staff physicians conducted goals-of-care discussions several times per month or more, 74.1% (80/108) of the time versus 35% (8/23) of residents. Most agreed that goals-of-care discussions are within their scope of practice (92%), they felt comfortable having these discussions (96%), and they are adequately trained (73%). However, 66% reported difficulty initiating goals-of-care discussions, and 54% believed that admitting services should conduct them. Main barriers were time (46%), lack of a relationship with the patient (25%), patient expectations (23%), no prior discussions (21%), and the inability to reach substitute decision-makers (17%). Fifty-four percent of respondents indicated that the availability of 24-hour palliative care consults would facilitate discussions in the emergency department (ED).
Conclusions
Important barriers to discussing goals of care in the ED were identified by respondents, including acuity and lack of prior relationship, highlighting the need for system and environmental interventions, including improved availability of palliative care services in the ED.
We use interface-resolved numerical simulations to study finite-size effects in turbulent channel flow of neutrally buoyant spheres. Two cases with particle sizes differing by a factor of two, at the same solid volume fraction of 20 % and bulk Reynolds number are considered. These are complemented with two reference single-phase flows: the unladen case, and the flow of a Newtonian fluid with the effective suspension viscosity of the same mixture in the laminar regime. As recently highlighted in Costa et al. (Phys. Rev. Lett., vol. 117, 2016, 134501), a particle–wall layer is responsible for deviations of the mesoscale-averaged statistics from what is observed in the continuum limit where the suspension is modelled as a Newtonian fluid with (higher) effective viscosity. Here we investigate in detail the fluid and particle dynamics inside this layer and in the bulk. In the particle–wall layer, the near-wall inhomogeneity has an influence on the suspension microstructure over a distance proportional to the particle size. In this layer, particles have a significant (apparent) slip velocity that is reflected in the distribution of wall shear stresses. This is characterized by extreme events (both much higher and much lower than the mean). Based on these observations we provide a scaling for the particle-to-fluid apparent slip velocity as a function of the flow parameters. We also extend the scaling laws in Costa et al. (Phys. Rev. Lett., vol. 117, 2016, 134501) to second-order Eulerian statistics in the homogeneous suspension region away from the wall. The results show that finite-size effects in the bulk of the channel become important for larger particles, while negligible for lower-order statistics and smaller particles. Finally, we study the particle dynamics along the wall-normal direction. Our results suggest that single-point dispersion is dominated by particle–turbulence (and not particle–particle) interactions, while differences in two-point dispersion and collisional dynamics are consistent with a picture of shear-driven interactions.
Nine species of the gall-associated doryctine genus Allorhogas Gahan (Hymenoptera: Braconidae) are described from Brazil (A. clidemiae Martínez and Zaldívar-Riverón new species, A. granivorus Zaldívar-Riverón and Martínez new species, A. mineiro Zaldívar-Riverón and Martínez new species, and A. vulgaris Zaldívar-Riverón and Martínez new species) and Costa Rica (A. brevithorax Zaldívar-Riverón and Martínez new species, A. pallidus Martínez and Zaldívar-Riverón new species, A. psychotria Zaldívar-Riverón and Martínez new species, A. punctatus Martínez and Zaldívar-Riverón new species, and A. tico Martínez and Zaldívar-Riverón new species). We provide host plant records for the described species, including information that reveals that at least three of them feed on seeds. Allorhogas granivorus had previously been confirmed to represent a natural enemy of the invasive weed Miconia calvescens de Candolle (Melastomataceae). Updated keys to the species of Allorhogas from Brazil and Costa Rica are provided.
The determination of the crystal structure of benleonardite (P3m1; R = 0.0321 for 1250 reflections and 102 parameters; refined formula Ag15.00Cu1.00Sb1.58As0.42S7.03Te3.97) obtained using data from a gem-quality, untwinned crystal recovered from the type material, revealed that benleonardite exhibits the structure observed for minerals of the pearceite-polybasite group. The structure consists of the stacking of [Ag6(Sb,As)2S6Te]2– A and [Ag9Cu(S,Te)2Te2]2+B layer modules in which (Sb, As) forms isolated SbS3 pyramids typically occurring in sulfosalts; Cu links two (S,Te) atoms with linear coordination, and Ag occupies sites with coordination geometries ranging from quasi-linear to almost triangular. The silver ions are found in the B layer module along two-dimensional diffusion paths and their electron densities are evidenced by means of a combination of a Gram-Charlier development of the atom displacement factors and a split model. In the structure, two S positions are completely replaced by Te (i.e. Te3 and Te4) and one is half occupied [S1: S0.514(9)Te0.486], whereas S2 is completely filled by sulfur. This distribution reflects the crystal-chemical environments of the different cations. On the basis of information gained from this characterization, the crystal-chemical formula of benleonardite was revised according to the structural results, yielding Ag15Cu(Sb,As)2S7Te4 (Z = 1) instead of Ag8(Sb,As)Te2S3(Z = 2) as previously reported. Thus, the mineral must be considered a member of the pearceite-polybasite group. A recalculation of the chemical data listed in the scientific literature for benleonardite according to the structural results obtained here leads to excellent agreement.
Much of the global agricultural by products go waste, especially in developing nations where much of their revenues depend on the exports of raw agricultural products. Such waste streams, if converted to “value added” products could serve as additional source of revenue while simultaneously having a positive impact on the socio-economic well being of the people. We present a preliminary investigation on utilizing chemical activation technique and ball milling to convert agricultural waste streams such as cocoa pod, coconut husk, palm midrib and calabash commonly found in Ghana into ultra-high surface area activated carbon. Such activated carbons are suitable for myriads of applications in environmental remediation, climate management, energy storage and conversion systems (batteries and supercapacitors), and improving crop productivity. We achieved BET surface area as high as ∼ 3000 m2/g.
We study turbulent channel flow of a binary mixture of finite-sized neutrally buoyant rigid particles by means of interface-resolved direct numerical simulations. We fix the bulk Reynolds number and total solid volume fraction, $Re_{b}=5600$ and $\unicode[STIX]{x1D6F7}=20\,\%$, and vary the relative fraction of small and large particles. The binary mixture consists of particles of two different sizes, $2h/d_{l}=20$ and $2h/d_{s}=30$ where $h$ is the half-channel height and $d_{l}$ and $d_{s}$ the diameters of the large and small particles. While the particulate flow statistics exhibit a significant alteration of the mean velocity profile and turbulent fluctuations with respect to the unladen flow, the differences between the mono-disperse and bi-disperse cases are small. However, we observe a clear segregation of small particles at the wall in binary mixtures, which affects the dynamics of the near-wall region and thus the overall drag. This results in a higher drag in suspensions with a larger number of large particles. As regards bi-disperse effects on the particle dynamics, a non-monotonic variation of the particle dispersion in the spanwise (homogeneous) direction is observed when increasing the percentage of small/large particles. Finally, we note that particles of the same size tend to cluster more at contact whereas the dynamics of the large particles gives the highest collision kernels due to a higher approaching speed.
The collective response of electrons in an ultrathin foil target irradiated by an ultraintense (${\sim}6\times 10^{20}~\text{W}~\text{cm}^{-2}$) laser pulse is investigated experimentally and via 3D particle-in-cell simulations. It is shown that if the target is sufficiently thin that the laser induces significant radiation pressure, but not thin enough to become relativistically transparent to the laser light, the resulting relativistic electron beam is elliptical, with the major axis of the ellipse directed along the laser polarization axis. When the target thickness is decreased such that it becomes relativistically transparent early in the interaction with the laser pulse, diffraction of the transmitted laser light occurs through a so called ‘relativistic plasma aperture’, inducing structure in the spatial-intensity profile of the beam of energetic electrons. It is shown that the electron beam profile can be modified by variation of the target thickness and degree of ellipticity in the laser polarization.
Edited by
Kathryn Hurlock, Senior Lecturer in Medieval History, Manchester Metropolitan University,Paul Oldfield, Lecturer in Medieval History, University of Manchester
Edited by
Kathryn Hurlock, Senior Lecturer in Medieval History, Manchester Metropolitan University,Paul Oldfield, Lecturer in Medieval History, University of Manchester
Edited by
Kathryn Hurlock, Senior Lecturer in Medieval History, Manchester Metropolitan University,Paul Oldfield, Lecturer in Medieval History, University of Manchester
Edited by
Kathryn Hurlock, Senior Lecturer in Medieval History, Manchester Metropolitan University,Paul Oldfield, Lecturer in Medieval History, University of Manchester
Edited by
Kathryn Hurlock, Senior Lecturer in Medieval History, Manchester Metropolitan University,Paul Oldfield, Lecturer in Medieval History, University of Manchester
Edited by
Kathryn Hurlock, Senior Lecturer in Medieval History, Manchester Metropolitan University,Paul Oldfield, Lecturer in Medieval History, University of Manchester
Edited by
Kathryn Hurlock, Senior Lecturer in Medieval History, Manchester Metropolitan University,Paul Oldfield, Lecturer in Medieval History, University of Manchester