Suchergebnisse

Ninety two patients, who were registered with one general practice partnership that has a tradition of providing minor trauma services and who had attended a hospital accident and emergency department, completed a questionnaire giving their reasons for not first attending their general practitioners with their ailments. Most had not tried to contact their general practitioner, and of these, only a few were unsuitable for treatment first by the general practitioner. More than half had attended the accident and emergency department because they did not want to bother their own general practitioner or thought that their problem was unsuitable for his attention. A higher proportion had attended for reasons of perceived speed or convenience. In the light of the need to cut costs in the hospital service and of government interest in promoting a wider range of services in general practice further study of such problems is needed. Patients' perceptions of the role of the accident department need to be changed if present behaviour is to be altered.

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 these 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.

Absolute risk of cardiovascular disease (CVD) may be calculated using the Framingham equation. Since risk increases with age, a useful measure of excess risk adjusted for age is 'heart age', the age of a reference person with the same estimated risk, but based on ideal values of risk factors defined as non‐smoker, non‐diabetic, untreated SBP of 125 mmHg, total cholesterol of 180 mg/dL and HDL cholesterol of 45 mg/dL [1]. Patients attended the Bristol HIV Cohort between 2008–11. HDL and total cholesterol, SBP, CD4 count and viral load measured within a period of 6 months were available for 749/1013 (74%) patients. The median age was 42 years, 33% were female and 82% were on ART. We calculated heart‐age deviation (heart age‐actual age) by sex and age group. Smoking status was not available and therefore we did all calculations twice assuming all a) non‐smokers b) smokers. We used fractional polynomials to model change in heart‐age deviation with actual age. We used mutually adjusted multivariable linear regression to determine whether sex, age, CD4, viral load, treatment status and year of starting ART were associated with heart‐age deviation. The mean heart‐age deviation in males was 3.4 years (females 1.7) for non‐smokers, and 14.8 years (females 12.5) for smokers. The figure shows that deviation increased with age; eg for male smokers it was 9.7, 15.0, 20.4 and 23.3 years at ages 16–39, 40–49, 50–59 and ≥60 years respectively. On average a 45‐year‐old male smoker had a heart age of 60 years. Compared with males, deviation was lower in younger females, but became higher after age 48 years. Compared with treated patients (assuming non‐smoker) with viral suppression, untreated patients had similar heart age (0.33 [95% CI 1.67, 2.33]) and treated patients with unsuppressed viral replication had higher heart age (3.01 [0.61, 5.42]). Higher CD4 count was associated with higher heart age: those with CD4 between 500–750 and >750 (v.<500) had an increase of 2.25 (0.61, 3.89) and 4.39 (2.41, 6.36) years respectively.HIV+ve individuals have a considerably increased risk of CVD compared with the ideal reference values, although we do not know if estimated risk translates to CVD events. Heart‐age deviation increases with age and is greater for smokers. Deviation increases more sharply in women, possibly due to lower CVD risk at younger ages or to increased risk postmenopause. Heart age could be a useful communication tool in attempts to reduce CVD risk in HIV+ve individuals.Heart age deviation by actual age by sex and smoking status (95% CI shown shaded)image

In 2020, over 8,400 people made their way from France to the UK coast using small vessels. They did so principally in order to claim asylum in the United Kingdom (UK). Much like in other border-zones, the UK state has portrayed irregular Channel crossings as an invading threat and has deployed a militarized response. While there is burgeoning scholarship focusing on informal migrant camps in the Calais area, there has been little analysis of state responses to irregular Channel crossings. This article begins to address this gap, situating contemporary British responses to irregular Channel crossers within the context of colonial histories and maritime legacies. We focus particularly on the enduring appeal of "the offshore" as a place where undesirable racialized populations can be placed. Our aim is to offer a historicized perspective on this phenomenon which seeks to respond to calls to embed colonial histories in analyses of the present.

Abstract. The Alpine Fault in New Zealand's South Island has not sustained a large magnitude earthquake since ca. AD 1717. The time since this rupture is close to the average inferred recurrence interval of the fault (~300 yr). The Alpine Fault is therefore expected to generate a large magnitude earthquake in the near future. Previous ruptures of this fault are inferred to have generated Mw = 8.0 or greater earthquakes and to have resulted in, amongst other geomorphic hazards, large-scale landslides and landslide dams throughout the Southern Alps. There is currently 85% probability that the Alpine Fault will cause a Mw = 8.0+ earthquake within the next 100 yr. While the seismic hazard is fairly well understood, that of the consequential geomorphic activity is less well studied, and these consequences are explored herein. They are expected to include landsliding, landslide damming, dam-break flooding, debris flows, river aggradation, liquefaction, and landslide-generated lake/fiord tsunami. Using evidence from previous events within New Zealand as well as analogous international examples, we develop first-order estimates of the likely magnitude and possible locations of the geomorphic effects associated with earthquakes. Landsliding is expected to affect an area > 30 000 km2 and involve > 1billion m3 of material. Some tens of landslide dams are expected to occur in narrow, steep-sided gorges in the affected region. Debris flows will be generated in the first long-duration rainfall after the earthquake and will continue to occur for several years as rainfall (re)mobilises landslide material. In total more than 1000 debris flows are likely to be generated at some time after the earthquake. Aggradation of up to 3 m will cover an area > 125 km2 and is likely to occur on many West Coast alluvial fans and floodplains. The impact of these effects will be felt across the entire South Island and is likely to continue for several decades.

Seasonal Snowpacks examines the processes which control the chemistry of seasonal snowcover and provides detailed information on the biogeographical distribution of snow (e.g. urban, alpine snowpacks), snow composition (e.g. micropollutants, stable isotopes) or the physical and biological processes which influence the chemical changes in snow (e.g. wind, microbiological activity). The fluxes of chemicals at the snow-atmosphere and snow-soil interfaces are examined, as are processes which modify composition within the snowcover. It is the first book in which the reader will find a comprehensive overview of the theoretical concepts, latest measurement techniques, process-oriented research methods, and models of studies in snow chemistry. The linkages between snow chemistry, atmospheric chemistry and hydrology will make this book of use to both research workers and students in the physical and biological sciences and to natural resource management personnel

Introductory chapter to the book The State of Open Data: Histories and Horizons.

In recent years, INGO legitimacy has been subject to growing scrutiny from analysts and practitioners alike. Critics have highlighted a backlash against INGOs in the Global South, a growing mismatch between INGO capacities and contemporary global challenges, and diminishing support for norms such as democracy and human rights that underpin INGOs' work. Though these problems have attracted significant attention within the academic literature, this article argues that existing explorations of INGO legitimacy have broadly conformed either to a top-down approach focused on global norms and institutions or a bottom-up approach focused on the local dynamics surrounding states and populations in the Global South. We suggest that this divide is is unhelpful for understanding the current predicament and propose a new approach, which pays closer attention to the interaction between bottom-up and top-down dimensions, and to historical context. This new approach can provide important insights into current debates about the future roles and internal structures of INGOs.

We present a spatial interaction entropy maximizing and structural dynamics model of settlements from the Middle Bronze (MBA) and Iron Ages (IA) in the Khabur Triangle (KT) region within Syria. The model addresses factors that make locations attractive for trade and settlement, affecting settlement growth and change. We explore why some sites become relatively major settlements, while others diminish in the periods discussed. We assess how political and geographic constraints affect regional settlement transformations, while also accounting for uncertainty in the archaeological data. Model outputs indicate how the MBA settlement pattern contrasts from the IA for the same region when different factors affecting settlement size importance, facility of movement, and exogenous site interactions are studied. The results suggest the importance of political and historical factors in these periods and also demonstrate the value of a quantitative model in explaining emergent settlement size distributions across landscapes affected by different socio-environmental causal elements.