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The impact of internal lee wave closure in an idealised global model
Full text linkInternal lee waves, with scales typically ranging from 1 to 10 km, play an important role in modulating ocean energy budget and deep ocean stratification. However, these small-scale motions have not yet been resolved in global ocean circulation models. Here we conduct a suite of numerical experiments using an idealised global model that incorporates an energetically and dynamically consistent lee wave closure. The effects of mean-wave interaction, wave drag and wave-driven mixing are considered separately through different experiments. The results show that wave drag plays a dominant role in modulating ocean energy and overturning circulation, while the effects of mean-wave interaction and wave-driven mixing are secondary. In the presence of wave drag, the (eddy) kinetic energy is significantly reduced by ~30%. In the Southern Ocean, enhanced eddy dissipation due to wave drag weakens eddy-induced meridional overturning circulation and reduces meridional eddy heat transport, leading to greater ocean heat uptake. To compensate for the enhanced eddy dissipation, isopycnals in the Southern Ocean steepen, which results in a deepening of the Atlantic pycnocline and a strengthening and deepening of the upper cell of the Atlantic meridional overturning circulation. Our study highlights the role of lee waves in modulating overturning circulation which could have important implications for global heat storage and climate change
Reexamining Person-Centered Care Frameworks in Long-Term Care: A Cross-Cultural Perspective on Core Elements and Implementation Challenges
No full textThe state of the art of environmental impact assessment (EIA)
No full textEnvironmental impact assessment (EIA) continues to evolve in response to new environmental, social, and regulatory challenges. The aim of this paper is to provide a current perspective on the state of the art of EIA in terms of practice and effectiveness. This is achieved through a literature review and SWOT analysis (strengths, weaknesses, opportunities, and threats). Results show that EIA practice is globally established, with over 190 countries maintaining some form of EIA legislation, supported by growing numbers of professional networks and best practice guidelines. On effectiveness, while strengths include legal frameworks and institutional maturity, weaknesses, such as poor follow-up, limited stakeholder engagement, and political interference persist. Opportunities lie in leveraging technology, enhancing communication, and strengthening participatory approaches. However, streamlining pressures, political and development agendas, and substitution by other instruments remain significant threats
Relative Disposition of PCDD/Fs and PCBs in Paired Liver and Muscle Tissues from Different Species of Farm Animals and Different Contamination Scenarios
No full textPolychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) and polychlorinated biphenyls (PCBs) are preferentially retained in animal liver and adipose. Distribution between these tissues is of particular interest in species raised for food but is difficult to ascertain because of limited study numbers, most of which use tissues sourced from different animals. This report overcame such limitations by using paired liver/muscle from the same animals. It combined data from seven independent studies on four species and variable (low, moderate, high) levels of pasture/housing contamination. In >150 animals sampled in the UK and Italy, PCDD/F and PCB toxic equivalence (TEQ) occurred to a significantly (P15:1, liver:muscle), reducing to 4:1 for cattle, but chicken tissues showed similar distribution. Occurrence levels were consistent with pasture contamination. Congener patterns in muscle and liver were similar for chickens and pigs but were notable different for PCDD/Fs in sheep. Remarkably, PCDD/Fs consistently dominated the TEQ in UK cattle and sheep (average, 69% - liver and 52% - muscle), rising to 69% (chickens) and 81-95% (pigs). Conversely, PCBs dominated TEQ (average, 65-95% and 80-98% in liver and muscle respectively) in Italian cattle and sheep. This divergence may arise from differences in feed, husbandry and geography but elevated PCB contamination has been reported in some Southern Italian locations. The higher liver contamination corresponds to the ability of these contaminants to induce and bind to the hepatic CYP1A2 enzyme, restricting CYP-mediated metabolism with resulting liver retention or sequestration
The feasibility of implementing a hospital deprescribing behaviour change intervention and undertaking trial processes: A mixed methods evaluation
No full textBackground: CompreHensive geriAtRician-led MEdication Review (CHARMER) is a behaviour change intervention designed to address the determinants of geriatricians and pharmacists deprescribing in hospital. CHARMER comprises a deprescribing action plan, deprescribing briefings, videos of successful deprescribing consultations, deprescribing case studies workshop and a deprescribing performance dashboard. This study aimed to evaluate the feasibility of undertaking a CHARMER definitive trial and inform primary outcome measure selection (90-day hospital readmission or patient quality of life (QoL)). Methods: A two-arm purposive allocation feasibility study was undertaken in four hospitals (three intervention, one control). Intervention fidelity and acceptability, outcome data completeness and quality were evaluated alongside acceptability of data collection methods. The process evaluation explored these via interviews with staff and patients. Data were used to inform primary outcome measure selection. Results: Eighteen geriatricians and pharmacists received the CHARMER intervention and 318 patients admitted to study wards were enrolled. 90-day hospital readmission data were available for 290 (91.2 %) patients. Sixty-six (20.8 %) were approached for consent to complete QoL measures; 25 (37.9 %) consented and 13 (52 %) completed at baseline and 90-day follow up. All intervention components were implemented with acceptable fidelity; hospitals were unfamiliar with implementing action plans and unclear who should be involved with implementing the dashboard, leading to delays. Conclusions: The CHARMER intervention is feasible to implement and given the low patient consent rate, 90-day readmission rate is the most appropriate primary outcome measure. Minor refinements to guidance will facilitate hospitals to undertake activities for implementation that are unfamiliar. Clinical trial registration The study was registered on ISRCTN ( ISRCTN11899506 )
Landmark Cases in International Refugee Protection: International Jurisprudence on the Rights of Refugees
No full textAn edited collection profiling leading cases in international refugee protection. Each chapter analyses a single judicial decision and locates it in a wider legal, political and policy context, tracing its subsequent impact on refugee law and policy. Some of the decisions analysed in this collection were foundational in establishing the reach of refugee law, particularly in defining the scope of the refugee definition. Others engage with key areas of refugee rights in contexts which indicate a critical turning point in state refugee policy, such as interdiction of boats at sea, encampment and extraterritorial asylum processing mechanisms. The contributions demonstrate how refugee protection is shaped by the intersection of different fields of law, including refugee law, human rights law, and domestic constitutional provisions. Reflecting this complexity, the collection explores decisions from the UK, Canada, USA, Kenya, Australia and Papua New Guinea, as well as regional courts including the European Court of Human Rights, Inter-American Court of Human Rights, the Court of Justice of the European Union, and decisions of the United Nations Human Rights treaty bodies. Authors include leading academics and practitioners in refugee and human rights law from a range of jurisdictions. This book offers compelling insights for anyone with an interest in international refugee protection, human rights, and the development of international refugee law
Exploring spillover effects following surgical de-implementation: An observational evaluation of primary care, referrals, and time to surgical intervention following reductions in the use of tonsillectomy and Dupuytren’s contracture
No full textBackground: Reducing the use of low-value surgery is important to maintain effective, safe and financially sustainable health systems. However, following de-implementation there are inevitably wider impacts for health systems beyond the targeted reduction in surgery, which have hitherto not been explored. Here we describe the spillover effects following the reduction in the use of two surgical procedures; tonsillectomy and Dupuytren’s contracture release (DCR) identified in 2019 by the Evidence Based Interventions (EBI) programme a de-implementation initiative in England. Methods: This longitudinal observational study used linked primary (Clinical Practice Research Datalink) and secondary (hospital episode statistics) care electronic health records from 1st April 2016 to 29th February 2020 to identify care for patients presenting with symptoms of tonsillitis or Dupuytren’s contracture (DC). Outcome measures include GP visits; related prescriptions; outpatient appointments, referral to secondary care and surgery. Differences were explored between cohorts of patients seeking care for tonsillitis or DC before and after EBI guidelines. Using a two-part Generalised Linear Model (GLM), we explored changes in likelihood of surgery and the time-to-surgery (if it occurred) before and after EBI guidelines. Results: Repeat GP visits for tonsillitis increased by 540 per 10,000 patients-per-year post-EBI, but remained stable for DC. Antibiotic prescriptions for tonsillitis fell, and outpatient appointments remained stable for both conditions. The likelihood of surgery reduced for both conditions post-EBI with an odds ratio of 0.75 {95%CI 0.71, 0.79} and 0.88 {95%CI 0.81, 0.95}), with a shorter time-to-tonsillectomy of -5.2 days (95%CI {-9.5 days to -1 day}). Reduction in time-to-DCR was less evident (-2.2 days CI {95%-7.1 to + 3}) but should be considered in the context of nationally increasing elective waiting time trends. Conclusions: Reductions in both surgical procedures were associated with small, but potentially important, changes to primary care utilisation and specialist treatment. Policy makers should identify potential spillovers from de-implementation, design policies to mitigate negative effects, and monitor these wider impacts alongside the direct influence on the targeted procedure rates
Mapping developmental transitions in mental health from mid- to late-adolescence:Concurrent and longitudinal links to cognition
No full textBackground: Developmental changes in mental health are mostly mapped between childhood and adolescence or childhood and adulthood. This study maps developmental transitions in mental health profiles from mid- to late-adolescence, exploring how these transitions relate to cognitive function in mid-adolescence. Method: Participants from the IMAGEN cohort (N = 1304) were followed from mid- (14 years) to late (22 years) adolescence. K-means clustering was applied to data from those with elevated mental health problems to identify common profiles of mental health symptoms at each timepoint (n = 784 at 14 years, n = 655 at 22 years). Those with no mental health symptoms formed a comparison group (n = 520 at 14 years, n = 649 at 22 years). Transitions between the groups were mapped across time and related to cognitive function at age 14. Results: Three distinct mental health profiles were identified: presentations of externalising, internalising, or social problems. These were similar in mid- and late adolescence. Externalising problems were more common in mid-adolescence. Persistent externalising and social problems were related to cognitive function in mid-adolescence, but problems that emerged or resolved in late adolescence were not. Conclusions: These data highlight the importance of understanding the developmental context in which mental health symptoms occur, and the cognitive factors linked to their persistence
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No full textClimate Record: Surface Temperature Trends
No full textSurface temperatures rose by 0.7–0.8°C during the 20th century, and have continued to warm during the first 23 years of the 21st century. This article addresses the quality of the basic temperature data over the terrestrial and marine domains. The warming since the 19th century did not occur in a linear fashion but in two periods, from about 1920 to 1945 and since about 1975. Spatial patterns of the change over the last 100 years indicate most regions have had statistically significant warming, except for some high latitudes of the Atlantic and Southern Oceans. Changes in temperature are also assessed in greater detail: showing that the warming occurred more by reductions in cold extremes compared to increases in warm extremes and more at night than during the daytime. The 20th and early 21st century warming is finally placed in a longer context by considering millennial-length paleoclimatic information from many diverse proxies. The latest evidence shows that the 20th century was likely the warmest of the last two millennia and the warming rate during it has been unprecedented during this period. The 1990s (1991–2000) was the warmest decade of the 20th century (0.32°C above the 1961–90 period) and 1998 the warmest year 0.58°C. The first decade of the 21st century (2001–10) was warmer again, 0.24°C above the 1990s, and the last complete decade (2011–20) was warmer again, 0.20°C above the 2000s. The 23 warmest years are all the years from 2001 to 2023, except 2008 was cooler than 1998. The four warmest years are: 2023 (1.06°C above 1961–90), 2016 (0.93°C), 2020 (0.92°C) and 2019 (0.89°C)