Leamington Spa Hospital

Summary Research has highlighted the importance of buoyancy for hydrochorous propagule dispersal, but recently the river bed has been identified as a significant store of viable propagules. Over four consecutive 4‐month periods, deposited propagules (predominantly seeds) and sediment were sampled at 78 river bed, bank face and bank top sites within three river reaches in two catchments. Species of deposited propagules were compared with the propagule bank and standing vegetation to identify ‘new’ species. Forty‐four percent of deposited propagule species were not present in the vegetation and the largest proportions were deposited in winter. New propagules showed a higher proportion of species that establish long‐term seed banks and produce light seeds, a higher proportion of R‐strategists, and a lower proportion of C‐strategists than species in the vegetation. Ordination of propagule species abundance data revealed differences in samples between reaches; bed and bank locations; and sampling periods. Within depositional samples there were significant positive correlations between average C scores and the proportion of species producing relatively heavy, short‐lived seeds and scores on an ordination axis describing a gradient from channel bed to bank top. Correlations and multiple regression models between species richness and abundance of deposited propagules (total and new), and the quantity and calibre of river‐deposited sediment, demonstrated a direct link between propagule deposition and hydraulic conditions during inundation. Synthesis . Riparian connectivity of river flows, varying hydraulic conditions and temporary storage of propagules are all complex components of hydrochorous propagule dispersal in the study reaches. Flood flows can transfer sediment particles and non‐buoyant, viable propagules from the river into the riparian zone. Propagules can pass in and out of storage within the channel bed and margins through a variety of dispersal processes and can then settle out of the water in suitable depositional environments generating distinct spatial and temporal patterns in total propagule deposition. New propagules show greatest floristic similarity to propagule bank and bed samples. They are preferentially smaller, lighter and form longer term seed banks, making them particularly suitable for long distance transport over prolonged time periods and for widespread dispersal across river margins.

This fully revised edition provides a comprehensive analysis of the relationship between business and government in Britain, including a completely updated account of business political activity at th

Dry friction between two components in rubbing contact may often be the cause of vibration. This type of behaviour was investigated by means of a model apparatus comprising a disc and a cantilever. A mathematical theory for the oscillation of the system was developed: Lagrange's equations were used and the deflections were expressed in normal co-ordinates. Numerical analysis showed that variation of the coefficient of friction with relative velocity was insufficient to cause the vibration. The instability was due to the manner in which the motions of the components were coupled. The amplitude would grow exponentially until limited by a breakdown of the continuity of contact between the components. A refinement of the theory took account of the flexibility and dissipation of the friction material with which the cantilever was tipped. The experimental work verified the existence of stable and unstable regions as predicted by the theory. The measured amplitudes were so great that continuity of contact could not be maintained, as was to be expected if the suggested mechanism of amplitude limitation was actual. A subsidiary investigation was made of the effect of tightness of the cantilever clamp. The investigation has shown that it should be possible to avoid unwanted vibration in any system merely by careful choice of dimensions in the design.

A generic inertia emulation controller (INEC) scheme for multi‐terminal voltage‐source‐converter (VSC)‐based high voltage direct current (HVDC) systems is proposed in this study. The INEC can be incorporated in any grid‐side VSC station, allowing the multi‐terminal HVDC (MTDC) terminal to contribute an inertial response to connected AC systems during system disturbances, in a fashion similar to synchronous generators. The DC‐link capacitors within the MTDC are utilised by the INEC scheme to exchange stored energy with the AC system by varying the overall DC voltage level of the MTDC network within a safe and pre‐defined range. A theoretical treatment of the INEC algorithm and its implementation and integration within a conventional VSC control system are presented, and the impact on the total DC capacitance required within the MTDC network to ensure that DC voltages vary within an acceptable range is discussed. The proposed INEC scheme is validated using a MATLAB/SIMULINK model under various changes in demand and AC network faults. The model incorporates a multi‐machine AC power system connected to a MTDC transmission system with multiple converter‐interfaced nodes. The effectiveness of the INEC in damping post‐fault oscillations and in enhancing AC grid frequency stability is also investigated.

Testosterone deficiency (TD) is an increasingly common problem with significant health implications, but its diagnosis and management can be challenging. A multi-disciplinary panel from BSSM reviewed the available literature on TD and provide evidence-based statements for clinical practice. Evidence was derived from Medline, EMBASE and Cochrane searches on hypogonadism, testosterone therapy (T Therapy) and cardiovascular safety from May 2017 to September 2022. This revealed 1,714 articles, including 52 clinical trials and 32 placebo-controlled randomised controlled trials. A total of twenty-five statements are provided, relating to five key areas: screening, diagnosis, initiating T Therapy, benefits and risks of T Therapy, and follow-up. Seven statements are supported by level 1 evidence, eight by level 2, five by level 3, and five by level 4. Recent studies have demonstrated that low levels of testosterone in men are associated with increased risk of incident type 2 diabetes mellitus, worse outcomes in chronic kidney disease and COVID 19 infection with increased all-cause mortality, along with significant quality of life implications. These guidelines should help practitioners to effectively diagnose and manage primary and age-related TD.

The characterization of livestock genetic diversity can inform breed conservation initiatives. The genetic diversity and genetic structure were assessed in 685 individual genotypes sampled from 24 British chicken breeds. A total of 239 alleles were found across 30 microsatellite loci with a mean number of 7.97 alleles per locus. The breeds were highly differentiated, with an average F(ST) of 0.25, similar to that of European chicken breeds. The genetic diversity in British chicken breeds was comparable to that found in European chicken breeds, with an average number of alleles per locus of 3.59, ranging from 2.00 in Spanish to 4.40 in Maran, and an average expected heterozygosity of 0.49, ranging from 0.20 in Spanish to 0.62 in Araucana. However, the majority of breeds were not in Hardy-Weinberg Equilibrium, as indicated by heterozygote deficiency in the majority of breeds (average F(IS) of 0.20), with an average observed heterozygote frequency of 0.39, ranging from 0.15 in Spanish to 0.49 in Cochin. Individual-based clustering analyses revealed that most individuals clustered to breed origin. However, genetic subdivisions occurred in several breeds, and this was predominantly associated with flock supplier and occasionally by morphological type. The deficit of heterozygotes was likely owing to a Wahlund effect caused by sampling from different flocks, implying structure within breeds. It is proposed that gene flow amongst flocks within breeds should be enhanced to maintain the current levels of genetic diversity. Additionally, certain breeds had low levels of both genetic diversity and uniqueness. Consideration is required for the conservation and preservation of these potentially vulnerable breeds.

Abstract This paper investigates temporal variations in the abundance, species composition and richness, and spatial distribution of plant propagules stored on river‐beds. Samples of the surface layers of river‐bed sediments were obtained from two reaches of the River Frome, Dorset, UK, and one reach of the River Tern, Shropshire, UK. Samples were taken from the same bed locations on four occasions spaced at approximately four monthly intervals. Following greenhouse germination trials, 11 384 viable propagules of 105 species were identified in 192 channel bed samples. On average, 32% of the species found in the propagule samples were not present in the channel and riparian vegetation. Most of these additional species were wetland and terrestrial rather than aquatic species. The number of species and density of propagules stored on the river‐bed varied through time and between reaches. These findings indicate that the channel bed is a dynamic store for viable propagules, including a large proportion of species that are not found locally. These propagules are available for redistribution across river‐banks and floodplains during high river flows. Propagules were preferentially stored within particular bed habitats. On the Tern, the most retentive habitats were close to the channel margins and adjacent to riparian vegetation and trees. On the Frome, stands of emergent vegetation along the channel margin were the most retentive habitat, and were also associated with trapping of finer sediment and organic matter. This habitat provides an aggrading environment at the bank toe that could potentially offer germination sites for the non‐aquatic propagules that are stored. Germination and growth of wetland and terrestrial plants during bank profile aggradation and lateral extension would provide root reinforcement and flow resistance across the changing bank profile. The preferential accumulation of sediment and species‐rich propagules around stands of marginal emergent vegetation is indicative of a subtle coupling of geomorphological and ecological systems. Copyright © 2007 John Wiley & Sons, Ltd.

In this article I explore both the name and the meaning of ‘sex addiction’ and offer a biopsychosocial view through which we might understand the complexity of cases presented before clinicians. Through published research and clinical experience, this paper looks at the biological, psychological and social influences of sex addiction in a hope that a broader understanding will increase dialogue between professionals of differing viewpoints and help develop multi-disciplinary approaches to treatment. The therapeutic dilemmas presented by this controversial and often maligned condition are also considered.

Nine hundred and seventy-three white women attending an antenatal clinic completed a questionnaire on parity, social class, smoking habits, and consumption of alcohol and coffee. Forty-nine per cent said they were non-drinkers and none of their babies had a major congenital abnormalities; whereas 1.2% of the babies of the women who did consume alcohol had major abnormalities. The babies of women who said they drank more than an average of 20 ml alcohol a day had significantly smaller head circumferences than the babies of non-drinkers in some gestational age groups. Maternal serum gamma-glutamyltransferase levels predicted abnormal fetal outcome in the 3 women in whom they were raised. There is no safe level of alcohol consumption in pregnancy and even moderate 'social' drinking is associated with abnormal fetal outcome.

OBJECTIVE: To assess the variables associated with the complications of total hip replacement (THR) and report owner-assessed outcomes, through surgeon-based registration of cases via an online database, informed owner consent, and prospective outcomes assessment using a client-administered clinical metrology instrument. STUDY DESIGN: Prospective case series ANIMALS: Dogs (n = 170) METHODS: Entries into the British Veterinary Orthopaedic Association-Canine Hip Registry (BVOA-CHR) between January 2010 and August 2011 were reviewed. Variables evaluated included dog age, body weight, breed, and indication for THR and prosthesis. Associations between each variable and the incidence of complications were assessed using logistic regression. Additionally, an on-line, owner-administered outcomes assessment questionnaire (modified from the Liverpool Osteoarthritis in Dogs (LOAD) questionnaire) was used to collect data from owners. RESULTS: One hundred and seventy cases met the inclusion criteria. Surgical indications included hip dysplasia and coxofemoral osteoarthritis (n = 150), Legg-Calves-Perthes disease (7), coxofemoral luxation (6), fracture (4), slipped capital physis (2), and femoral head and neck ostectomy revision (1). Surgical implants were from 4 systems. The incidence of surgeon-reported complication was 9.4%. No significant association was identified between weight, age, sex, breed, indication for THR, surgical technique and prosthesis, and the incidence of complications. In 82% of the cases, owners described their satisfaction with the outcome of THR as "very good" and a total of 20% complication rate was reported. There was a statistically significant improvement in owner-assessed questionnaire score before and after THR (P < .001). CONCLUSIONS: The BVOA-CHR offers a novel framework for the prospective studies on THR and on a national/international scale. Initial complication rates from the BVOA-CHR are similar to previous studies.

Various improvements in the formula which was discovered by Wallis in 1669, were studied by D. K. Kazarinoff in No. 40 of these Notes (December 1956).

Cyber attacks are increasing in every aspect of daily life. There are a number of different technologies around to tackle cyber-attacks, such as Intrusion Detection Systems (IDS), Intrusion Prevention Systems (IPS), firewalls, switches, routers etc., which are active round the clock. These systems generate alerts and prevent cyber attacks. This is not a straightforward solution however, as IDSs generate a huge volume of alerts that may or may not be accurate: potentially resulting in a large number of false positives. In most cases therefore, these alerts are too many in number to handle. In addition, it is impossible to prevent cyber-attacks simply by using tools. Instead, it requires greater intelligence in order to fully understand an adversary's motive by analysing various types of Indicator of Compromise (IoC). Also, it is important for the IT employees to have enough knowledge to identify true positive attacks and act according to the incident response process. In this paper, we have proposed a new threat intelligence technique which is evaluated by analysing honeypot log data to identify behaviour of attackers to find attack patterns. To achieve this goal, we have deployed a honeypot on an AWS cloud to collect cyber incident log data. The log data is analysed by using elasticsearch technology namely an ELK (Elasticsearch, Logstash and Kibana) stack.

BACKGROUND: Telerehabilitation is a feasible and potentially effective alternative to face-to-face rehabilitation. However, specific guidance, training, and support for practitioners who undertake remote assessments in people with physical disabilities and movement impairment are limited. OBJECTIVE: The aims of this survey of United Kingdom-based health and social care practitioners were to explore experiences, assess training needs, and collate ideas on best practices in telerehabilitation for physical disabilities and movement impairment. The aim will be to use the findings to inform a practical tool kit and training package for telerehabilitation use. METHODS: UK rehabilitation practitioners were invited to complete an online questionnaire from November to December 2020. Opportunity and snowball sampling were used to recruit participants from professional and educational networks, special interest groups, and via social media. Closed questionnaire items were analyzed using descriptive statistics. Qualitative inductive analysis using NVivo was used for open responses. RESULTS: There were 247 respondents, of which 177 (72%) were physiotherapists and occupational therapists. Most (n=207, 84%) had used video-based consultations (typically supported by telephone and email), and the use of this method had increased in frequency since the COVID-19 pandemic. Practitioners perceived telerehabilitation positively overall and recognized benefits for patients including a reduced infection risk, convenience and flexibility, and reduced travel and fatigue. Common obstacles were technology related (eg, internet connection), practical (eg, difficulty positioning the camera), patient related (eg, health status), practitioner related (eg, lack of technical skills), and organizational (eg, lack of access to technology). Support from family members or carers was a major facilitator for successful remote consultations. Of the 207 respondents who had used video-based consultations, 103 (50%) had assessed physical impairments using this method, 107 (52%) had assessed physical function, and 121 (59%) had used patient-reported outcome measures. Although practitioners generally felt confident in delivering video-based consultations, they felt less proficient in undertaking remote physical assessments, expressing concerns about validity, reliability, and safety. Only 46 of the 247 (19%) respondents had received any training in telerehabilitation or video consultations, and some felt they were "feeling their way in the dark." Practitioners desired training and guidance on physical assessment tools suitable for remote use, when to use video-based consultations or alternative methods, governance issues, digital platforms, and signposting to digital skills training for themselves and their patients. CONCLUSIONS: In response to the COVID-19 pandemic, practitioners rapidly adopted telerehabilitation for people with physical disabilities and movement impairment. However, there are technical, practical, and organizational obstacles to overcome, and a clear need for improved guidance and training in remote physical assessments. The findings of this survey will inform the development of a tool kit of resources and a training package for the current and future workforce in telerehabilitation.

The relation between fetal malnutrition and chronic disease in later lifeGood nutrition and lifestyle matter from womb to tomb

This paper investigates the effects power oscillation damping (POD) controller could have on a wind turbine structural system. Most of the published work in this area has been done using relatively simple aerodynamic and structural models of a wind turbine which cannot be used to investigate the detailed interactions between electrical and mechanical components of the wind turbine. Therefore, a detailed model that combines electrical, structural and aerodynamic characteristics of a grid-connected Doubly Fed Induction Generator (DFIG) based wind turbine has been developed by adapting the NREL (National Renewable Energy Laboratory) 5 MW wind turbine model within FAST (Fatigue, Aerodynamics, Structures, and Turbulence) code. This detailed model is used to evaluate the effects of POD controller on the wind turbine system. The results appear to indicate that the effects of POD control on the WT structural system are comparable or less significant as those caused by wind speed variations. Furthermore, the results also reveal that the effects of a transient three-phase short circuit fault on the WT structural system are much larger than those caused by the POD controller.

BACKGROUND: Limited evidence about mental health finances in low and middle-income countries is a key challenge to mental health care policy initiatives. This study aimed to map mental health finances in Ghana, Uganda, India (Kerala state), Sri Lanka and Lao PDR focusing on how much money is available for mental health, how it is spent, and how this impacts mental health services. METHODS: A researcher in each region reviewed public mental health-related budgets and interviewed key informants on government mental health financing. A total of 43 key informant interviews were conducted. Quantitative data was analyzed in an excel matrix using descriptive statistics. Key informant interviews were coded a priori against research questions. RESULTS: National ring-fenced budgets for mental health as a percentage of national health spending for 2007-08 is 1.7% in Sri Lanka, 3.7% in Ghana, 2.0% in Kerala (India) and 6.6% in Uganda. Budgets were not available in Lao PDR. The majority of ring-fenced budgets (76% to 100%) is spent on psychiatric hospitals. Mental health spending could not be tracked beyond the psychiatric hospital level due to limited information at the health centre and community levels. CONCLUSIONS: Mental health budget information should be tracked and made publically accessible. Governments can adapt WHO AIMS indicators for reviewing national mental health finances. Funding allocations work more effectively through decentralization. Mental health financing should reflect new ideas emerging from community based practice in LMICs.

Physiological response to parachute jumpingThe metabolic and hormonal responses to stress in racing drivers, airline pilots, rock climbers, public speakers, and parachutists have been reported.'Most studies have concentrated on catecholamine concentrations and their effects on heart rate; little information is available about changes in the concentrations of other hormones and intermediary metabolites. Subjects, methods, and resultsEight healthy subjects (two women, six men) took part in the study.None had made a parachute jump before.Their ages ranged from 23 to 29, and all were within 10% of their ideal body weight.All subjects fasted from 1300 and jumped between 1900 and 2100.Venous blood was taken through an indwelling cannula before they left for the airfield (basal values); on arrival; after 30 minutes' exercise training on the ground; in the aircraft at 610 m immediately before they jumped from a static line; within 30 seconds after landing; and at 10, 20, and 30 minutes after landing.A Tracker Holter monitor was attached to each subject to give a continuous electrocardiogram, and the tapes were analysed on a Pathfinder 3 analyser.Concentrations of intermediary metabolites were measured fluorimetrically and spectrophotometrically (acetoacetate).Non-esterified fatty acid concentrations were measured by a radiocobalt soap method, potassium concentrations by flame photometry, and hormone concentrations by radioimmunoassay or high performance liquid chromatography (catecholamines).2Data were classified by subject and time and analysed by two way analysis ofvariance.When the variance ratio for a time effect was significant the change from basal values was assessed by Student's t test for paired samples.All eight subjects showed three clear peaks in heart rate: on arriving at the airfield, during ground training, and on jumping out ofthe aeroplane (the greatest increase).Heart rates increased from a basal mean of 78 (range 62-91) beats/min to a peak of 160 (150-183).No ventricular arrhythmias or ST segment abnormalities were recorded.The table shows the changes in concentrations of intermediary metabolites and hormones.In six subjects peak concentrations of non-esterified fatty acids were greater than 1-4 mmolIl, and three had lactate concentrations greater than 5 mmol/l.Concentrations of adrenaline and noradrenaline rose in parallel, reaching peak values when the subjects were in the aeroplane and on landing, respectively.After landing the concentration of adrenaline fell to basal values within 10 minutes but the concentration of noradrenaline was still significantly raised 30 minutes later (p<005).

The case of a person with severe mental handicap whose pica became uncontrollable during episodes of depressive illness is described. Treatment of the depression with lofepramine markedly reduced the pica, and withdrawal of lofepramine led to recurrence. It is suggested that biological symptoms of depression should be monitored in people with severe mental handicap who show significant episodic worsening of long-standing repetitive behaviour.

OBJECTIVE: Our aim was to review all the evidence of lamotrigine's effectiveness in treatment resistant depression after at least one failed antidepressant trial. METHOD: We used a systematic search strategy to identify studies that included adults aged 18-65 years with a diagnosis of unipolar depression who had not responded to at least a 4-week course of a recommended dose of an antidepressant. RESULTS: We found only one randomized, double blind study that has been published, showing its effectiveness for treatment-resistant depression. In this study, lamotrigine was found statistically superior to placebo on the CGI scale for severity and improvement; however, it was not on the HAM-D (primary end point) and MADRS scales. There were a number of smaller non RCT's which are included. CONCLUSIONS: There is little evidence to guide the use of lamotrigine for depression that has not responded to a course of antidepressants. Treatment-refractory depression continues to be significant mental health problem and large RCT trials are needed to inform clinical practice.

PRIMARY OBJECTIVE: Given that poor effort may have a profound impact upon the results of neuropsychological assessment, it is of critical importance that assessment of effort is incorporated into the interpretation of a patient's neuropsychological profile. The current study examines the relationship between head injury severity (as measured by length of post-traumatic amnesia) and level of cognitive functioning in patients passing or failing a test of effort (Test of Malingered Memory). RESEARCH DESIGN: A cross-sectional correlational design was employed in a consecutive cohort of 78 persons with ongoing compensation claims. METHODS AND PROCEDURES: Head injury severity was assessed by duration of post-traumatic amnesia. All participants received a clinical interview followed by neuropsychological assessment. MAIN OUTCOMES AND RESULTS: A systematic and interpretable negative correlation between head injury severity and intellectual and memory functioning was demonstrated in persons passing the test of effort. However, in persons failing the test of effort no such relationships were demonstrated. CONCLUSIONS: The implications for the interpretation of neuropsychological test data are discussed. It is strongly recommend that valid interpretation of neuropsychological assessment data should include consideration of at least one test of effort.