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The few prethaw observations of tundra carbon fluxes suggest that there may be large spring releases, but little is known about the scale and underlying mechanisms of this phenomenon. To address these questions, we combined ecosystem eddy flux measurements from two towers near Barrow, Alaska, with mechanistic soil‐core thawing experiment. During a 2 week period prior to snowmelt in 2014, large fluxes were measured, reducing net summer uptake of CO2by 46% and adding 6% to cumulative CH4emissions. Emission pulses were linked to unique rain‐on‐snow events enhancing soil cracking. Controlled laboratory experiment revealed that as surface ice thaws, an immediate, large pulse of trapped gases is emitted. These results suggest that the Arctic CO2and CH4spring pulse is a delayed release of biogenic gas production from the previous fall and that the pulse can be large enough to offset a significant fraction of the moderate Arctic tundra carbon sink. Prethaw carbon flux pulses during thaw offset 46% of CO2summer uptake and added 6% to CH4summer fluxesLaboratory experiment linked pulse emissions to a delayed microbial production mechanismThe spring pulse may be a large underrepresented source of carbon in Arctic regions

The purpose of this article is to discuss the evolving workforce required to deliver quality healthcare in NHS acute care settings within the UK. The development and implementation of non-medical practitioner (NMP) roles, such as advanced clinical practitioners, surgical care practitioners, surgical first assistants, physician associates and physician assistants in anaesthesia are discussed in relation to training, regulation, governance and evaluation in clinical practice.

Methane hydrate formation and dissociation are buffered by salinity in a closed system. During hydrate formation, salt excluded from hydrate increases salinity, drives the system to three‐phase (gas, water, and hydrate phases) equilibrium, and limits further hydrate formation and dissociation. We developed a zero‐dimensional local thermodynamic equilibrium‐based model to explain this concept. We demonstrated this concept by forming and melting methane hydrate from a partially brine‐saturated sand sample in a controlled laboratory experiment by holding pressure constant (6.94 MPa) and changing temperature stepwise. The modeled methane gas consumptions and hydrate saturations agreed well with the experimental measurements after hydrate nucleation. Hydrate dissociation occurred synchronously with temperature increase. The exception to this behavior is that substantial subcooling (6.4°C in this study) was observed for hydrate nucleation. X‐ray computed tomography scanning images showed that core‐scale hydrate distribution was heterogeneous. This implied core‐scale water and salt transport induced by hydrate formation. Bulk resistivity increased sharply with initial hydrate formation and then decreased as the hydrate ripened. This study reproduced the salinity‐buffered hydrate behavior interpreted for natural gas‐rich hydrate systems by allowing methane gas to freely enter/leave the sample in response to volume changes associated with hydrate formation and dissociation. It provides insights into observations made at the core scale and log scale of salinity elevation to three‐phase equilibrium in natural hydrate systems. Salinity buffers methane hydrate formation and dissociation in closed systemsA thermodynamic equilibrium‐based model is developed to explain this conceptA laboratory experiment is conducted and demonstrated in this concept

Effective team working is essential to the delivery of consistent and goal-directed rehabilitation. Within the rehabilitation team, the nurse has a key role to play. This paper reports on a study which gained insight into the nursing contribution to rehabilitation.

AbstractThere is currently much interest in the potential for small producers in the speciality food and drinks industry to develop niche markets based on the regionally distinctive character of their products. One Possible tool for developing such markets lies in the use of marketing and promotional strategies which attempt to create associations between ‘regional images’ and ‘quality’. This article presents some initial findings from research into the use of regional images to promote speciality food and drink products within the English ‘West Country’. These findings suggest that, although producers are aware of regional images, their use within marketing strategies is limited. Furthermore, as both ‘regional images’ and ‘quality’ are subjective, contested and socially constructed, attempts to use one to Promote the other are fraught with complexity.

Although controversial, diagnosis of luteal phase defect (LPD) includes the morphological assessment of endometrial development. This study was conducted to determine if refresher training in the histological criteria could improve the accuracy and interobserver reproducibility of endometrial dating. Seventy-eight endometrial biopsies were dated by a reference panel of two pathologists and then reviewed twice by a study panel of four pathologists. In the first review, usual practice was applied. Prior to the second review, they studied a standard document of histological criteria. Samples were dated as proliferative, secretory (post-ovulatory day, POD), menstrual, and undatable. Accuracy levels based on the reference dating and agreement levels using values were calculated per review and compared. The κ for overall dating was 0.683 in the first review and 0.696 in the second. The respective first and second review κ values were 0.736 and 0.771 for proliferative, and 0.794 and 0.764 for secretory. Amongst those dated as secretory in the first and second reviews, respectively, 31 and 28% were assigned the same POD by any two panellists, 68 and 63% were dated to within 1 day, and 77 and 71% were dated to within 2 days. Accuracy levels per panellist for overall dating were very high in both reviews but were low for individual PODs. Accuracy and interobserver reproducibility were unaffected by refresher training, suggesting the limits of histological dating have been reached.

Summary Regional food products are of contemporary interest as people are increasingly concerned to know where food comes from and how it is produced. Geographers have been slow to examine the link between product and place and this paper provides initial insights into the uptake of a European regulation designed to protect and promote high quality regional food and drink products in the United Kingdom. The early adopters of EU quality marks are shown to use them to protect their names from cheaper imitations rather than as a marketing device. Bureaucracy and costs of implementation, together with a lack of consumer knowledge, are likely to prevent rapid future adoption in the UK.

Despite the increasingly globalized nature of food production and consumption patterns, the demand for regional speciality food and drink products is also increasing. Yet little research exists that examines the link between specific products and particular places. This paper reports on an EU regulation aimed at ‘protecting’ and ‘promoting’ food and drink products with a recognizable geographical origin. Results indicate quite marked national and regional variations in patterns of uptake, reflecting differences in both the cultural significance of regional foods in Europe and the importance of producer cooperatives. There is a real danger that the regulation will benefit larger producers and retailers, rather than genuine small-scale businesses.

Candida albicansis a commensal of the urogenital tract and the predominant cause of vulvovaginal candidiasis (VVC). Factors that increase circulatory estrogen levels such as pregnancy, the use of oral contraceptives, and hormone replacement therapy predispose women to VVC, but the reasons for this are largely unknown. Here, we investigate how adaptation of C. albicansto estrogen impacts the fungal host-pathogen interaction. Estrogen promotes fungal virulence by enabling C. albicansto avoid the actions of the innate immune system. Estrogen-induced innate immune evasion is mediated via inhibition of opsonophagocytosis through enhanced acquisition of the human complement regulatory protein, Factor H, on the fungal cell surface. Estrogen-induced accumulation of Factor H is dependent on the fungal cell surface protein Gpd2. The discovery of this hormone-sensing pathway might pave the way in explaining gender biases associated with fungal infections and may provide an alternative approach to improving women's health.

Fluid flow through fractured rock systems is governed in large part by the distribution, interconnectivity, and size of fracture apertures. In‐situ stress is one of the primary factors controlling fracture aperture, and one that is altered significantly during high‐pressure fluid injections or extractions. Interactions between stress, pore pressure, aperture, and fluid flow can result in complex and evolving poroelastic behavior with significant implications regarding the predictability and risk involved with developing and managing deep subsurface reservoirs (geothermal, fossil energy, and geologic carbon sequestration). In saturated rocks, bulk electrical conductivity is sensitive to both primary and secondary porosity (i.e., matrix porosity and fractures), and therefore to fracture aperture size and distribution. We demonstrate the use of time‐lapse 3D electrical resistivity tomography for remotely monitoring stress induced changes in aperture distribution during high pressure injections into a dense fractured rock system at a scale of tens of meters. Results reveal a complex and continuously evolving stress field involving aperture dilations in the natural fracture system and aperture contractions in adjacent zones of shadow stress. Results provide information about the spatiotemporal changes in the system behavior and point to the potential of electrical imaging for autonomously and remotely monitoring evolving stress conditions by proxy through changes in bulk electrical conductivity. The state and evolution of the stress exerted on rocks has a governing influence on how fluids migrate through deep, fractured rock systems. Dynamic changes in stress during subsurface fluid injections and extractions are difficult to observe, which limits the ability to optimize the management of subsurface reservoirs. We demonstrate how time‐lapse 3D (i.e., 4D) electrical geophysical imaging can be used to monitor how fractures expand and contract in response to stresses induced during high‐pressure injections into a deep fractured rock formation. Results point to the potential of autonomous electrical imaging for providing actionable feedback information during reservoir operations, enabling enhanced understanding and control. Time‐Lapse 3D ERT imaging is used to monitor stress‐induced fracture dilation and contraction during high pressure injectionsHigh temporal resolution reveals fine details of complex dynamic poroelastic system behavior during and after high pressure injectionsResults demonstrate the potential of ERT for remote, proxy monitoring of changes in stress and fracture aperture in fractured‐rock systems Time‐Lapse 3D ERT imaging is used to monitor stress‐induced fracture dilation and contraction during high pressure injections High temporal resolution reveals fine details of complex dynamic poroelastic system behavior during and after high pressure injections Results demonstrate the potential of ERT for remote, proxy monitoring of changes in stress and fracture aperture in fractured‐rock systems

Patients with developmental breast abnormalities often present to the plastic surgeon at a young age. We report our experience with 4 cases of unilateral breast abnormality (3 hypoplastic and 1 tuberous) treated with a Becker permanent expander/implant. Our approach is to insert the expander/implant, expand intermittently to keep pace with growth of the other breast and remove the filling valve under local anaesthesia on maturity. The techniques and advantages of this approach are illustrated and discussed.

Since the paramilitary cease-fire in Northern Ireland in August 1994 we have seen a change in the pattern of so called 'punishment attacks'. Shootings with low velocity handguns have been replaced by severe beatings to the extremities from multiple assailants using iron bars or similar weapons. In the 18 months prior to the cease-fire there were 177 punishment shootings, which were usually relatively minor and did not require any plastic surgical expertise. Between August 1994 and November 1996, however, there were 461 punishment beatings. These beatings result in much greater morbidity and require considerable orthopaedic and plastic surgical input. In the Northern Ireland Plastic and Maxillofacial Unit we have treated 18 patients with a mean age of 22.9 years (range 16-32 years) who have been the victims of punishment beatings. These patients sustained multiple injuries, all with severe soft tissue involvement; 70% had compound fractures. The majority of patients had multiple wounds. Four patients with compartment syndrome as a result of their injuries required fasciotomies. Soft tissue reconstruction included split skin grafting (4 patients), fasciocutaneous flaps (4 patients), adipofascial flaps (2 patients), local muscle flaps (2 patients) and free muscle transfers (2 patients). Six patients required more than one procedure for soft tissue reconstruction because of multiple injuries. Each patient had a cumulative mean time in theatre of 6.7 hours. The mean hospital stay was 22.2 days (range 2-52 days). This change in the pattern of injury has led to an increased use of plastic surgical resources. Patient morbidity is significantly greater than when guns are used, and permanent disability is often the result.

The capsule of the proximal interphalangeal joint consists of the central slip of the extensor tendon dorsally, the collateral ligaments at the sides and the palmar ligament ventrally. Fibrocartilaginous menisci have been reported extending into the joint cavity and the central slip has a sesamoid fibrocartilage articulating with the proximal phalanx. This study relates ECM composition in the joint capsule to function. Each part of the capsule from 24 fingers amputated because of trauma, carcinoma, isthaemia, fixed-flexion deformities or Dupuytren's contracture, was dissected out. Sections were prepared for routine histology or immunolabelled with a panel of monoclonal and polyclonal antibodies against collagens and glycosaminoglycans using the avidin/biotin/peroxidase procedure. All parts of the capsule consistently labelled for types I, III and VI collagens and for dermatan and keratan sulphate, though labelling was more pericellular in fibrocartilaginous regions. In contrast, only certain regions of the capsule in some fingers labelled for type II collagen, chondroitin 4 or 6 sulphate. The sesamoid fibrocartilage in the central slip showed the greatest degree of fibrocartilage differentiation, especially in fixed-flexion deformity fingers, and the palmar ligament the least. The immunolabelling patterns suggest that there is an ordered sequence of matrix changes accompanying fibrocartilage differentiation. Chondroitin sulphate-containing proteoglycans accumulate first, and type II collagen appears later. The presence or absence of type II collagen probably relates to different levels of compressive loading. No fibrocartilaginous menisci were found in normal joints and those described previously are regarded as synovial folds. Anat. Rec. 250:281–291, 1998. © 1998 Wiley-Liss, Inc.

Objective This study evaluated the craniofacial form of a sample of Northern Irish children with unilateral cleft lip and palate (UCLP). The quality of the outcomes achieved was compared with the outcomes reported for the six centers involved in the European multicenter study (Mars et al., 1992; Mølsted et al, 1992).Design Retrospective analysis.Patients All children born with complete skeletal UCLP in Northern Ireland during the years 1983 to 1987.Main outcome Measures Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system.Results The sample comprised 25 children with complete skeletal UCLP who had cephalometric radiographs and study casts recorded at a mean age of 9.4 years (range, 8 to 11 years). Cephalometric analysis revealed no important skeletal differences between the Northern Irish UCLP children and the published results from the six Eurocleft centers. The soft tissue profile of the Northern Irish UCLP children was significantly more convex than the soft tissue profile recorded for center D in the Eurocleft study. The Goslon ranking system revealed that 18 (72%) of the Northern Irish UCLP children had good or satisfactory dental arch relationships.Conclusions No clinically important differences were detected between the mean cephalometric skeletal parameters of the Northern Irish UCLP children and those published for the six cleft centers involved in the Eurocleft study. On average, the Northern Irish UCLP children were found to differ significantly from Eurocleft's center D in their soft tissue facial contour and sagittal lip profile. The quality of the dental arch relationships of the Northern Irish sample was between the best and the less good Eurocleft centers.

Quality products and services (niche markets) could be an important instrument of rural development in the lagging regions of the European Union. However, there is little research which relates product to place in a rural context. After providing a brief insight into aspects of agricultural and rural restructuring, the article reviews existing literature and relevant concepts under the separate headings of 'Constructing quality' and 'Constructing regional images: linking product to place'. Many of these ideas are being applied in an interdisciplinary and international (EU) research project which attempts to link specific quality products and services to specific regions. The aims of RIPPLE are outlined in the hope of encouraging more research into the links between quality products and rural places.

Geological carbon storage (GCS) involves unstable drainage processes, the formation of patterns in a morphologically unstable interface between two fluids in a porous medium during drainage. The unstable drainage processes affect CO2storage efficiency and plume distribution and can be greatly complicated by the mixed‐wet nature of rock surfaces common in hydrocarbon reservoirs where supercritical CO2(scCO2) is used in enhanced oil recovery. We performed scCO2injection (brine drainage) experiments at 8.5 MPa and 45°C in heterogeneous micromodels, two mixed‐wet with varying water‐ and intermediate‐wet patches, and one water‐wet. The flow regime changes from capillary fingering through crossover to viscous fingering in the micromodels of the same pore geometry but different wetting surfaces at displacement rates with logCa(capillary number) increasing from −8.1 to −4.4. While the mixed‐wet micromodel with uniformly distributed intermediate‐wet patches yields ~0.15 scCO2saturation increase at both capillary fingering and crossover flow regimes (−8.1 ≤ logCa≤  − 6.1), the one heterogeneous wetting to scCO2results in ~0.09 saturation increase only at the crossover flow regime (−7.1 ≤ logCa≤  − 6.1). The interconnected flow paths in the former are quantified and compared to the channelized scCO2flow through intermediate‐wet patches in the latter by topological analysis. At logCa>  − 6.1(near well), the effects of wettability and pore geometry are suppressed by strong viscous force. Both scCO2saturation and distribution suggest the importance of wettability on CO2storage efficiency and plume shape in reservoirs and capillary leakage through caprock at GCS conditions. We created two mixed‐wet systems with varying water‐ and intermediate‐wet patches in a 2.5‐D heterogeneous micromodelThe uniformly distributed intermediate‐wet patches yield bridging flow topology and highest storage efficiency after drainageThe heterogeneously distributed intermediate‐wet patches enhance channelized CO2flow and hinder storage efficiency after drainage

High-pressure injection injuries to the hand are uncommon, but often result in poor outcome or even amputation. We report a review of the 28 cases treated surgically in our department over the last 10 years and have examined the factors leading to increased morbidity. The severity of these injuries was related to the nature of the injected material, involvement of the tendon sheath and proximal spread of the injected substance. All cases in which the digit was noted to be poorly perfused from the outset resulted in amputation. We conclude that early amputation should be considered in cases in which the affected digit is initially cool or poorly perfused.