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As part of the SIIBED program, a subsea risk model for the Grand Banks was updated to reflect observed changes in the iceberg regime on the Grand Banks since the 1980s. This risk model is used to calculate interaction rates between free-floating and scouring icebergs and subsea infrastructure. The changes to the iceberg regime are described, along with the updates to the subsea risk model and changes in previously calculated iceberg interaction rates for a proposed facility. A methodology for integrating output from other SIIBED tasks into the risk analysis is outlined. Components of a source-to-sink model for understanding past changes in the iceberg regime, as well as future anticipated changes, are discussed.

The move to reduce greenhouse gas emissions in the offshore hydrocarbons production industry has resulted in a growing interest in the possibility of using offshore wind to reduce on-platform power generation. While some offshore areas are progressing towards or planning for the use of offshore wind to electrify hydrocarbon producing platforms, they do not have the challenges associated with Newfoundland & Labrador's offshore environment.This region is prone to incursions by icebergs and pack ice, which would present a risk to offshore wind turbines. Analysis approachesto assess these risks, along with preliminary results, are presented herefor floating offshore wind turbines (FOWT).An area of interest (AOI), covering 45°N to 51°N and 45°W to 51°W, was defined covering all development licenses on the Grand Banks, Flemish Pass and Orphan Basin. Iceberg and pack ice contact rates and loads were calculated using data from the Nalcor NESS Metocean database, Canadian Ice Service (CIS) ice charts and satellite imagery. Ice loads corresponding to 50-year return periods levels were assessed, with and without ice management, giving a basis for determining whether ice management and/or disconnection capabilities are required. The frequency and severity of atmospheric icing of turbines was also modelled using available data and models.

Variability in sea ice conditions, combined with strong couplings to the atmosphere and the ocean, lead to a broad range of complex sea ice dynamics. More in-situ measurements are needed to better identify the phenomena and mechanisms that govern sea ice growth, drift, and breakup. To this end, we have gathered a dataset of in-situ observations of sea ice drift and waves in ice. A total of 15 deployments were performed over a period of 5 years in both the Arctic and Antarctic, involving 72 instruments. These provide both GPS drift tracks, and measurements of waves in ice. The data can, in turn, be used for tuning sea ice drift models, investigating waves damping by sea ice, and helping calibrate other sea ice measurement techniques, such as satellite based observations.

The motivation for this chapter stems from a 15-year collaboration between the California Department of Transportation (Caltrans) and the Western Transportation Institute, and now Utah State University. Ian Turnbull, recently retired from Caltrans, set the standard of “accurate, timely and reliable” for all projects he was involved with, particularly those in remote, rural areas of California, and related collaborations. Ian’s team, now headed by Jeremiah Pearce, is responsible for the operation of a vast field sensor network and the provision of weather sensor data, CCTV images, chain control messages, changeable message sign (CMS) messages, and just about every other type of traveler information related to Caltrans District 2, particularly in remote, rural areas of Northeastern California. In turn, Sean Campbell, also from Caltrans, makes this and similar data from the rest of the state available to third-party providers of traveler information and other related applications. The experience gained in working with Ian, Sean, Jeremiah and others on the provision of traveler information and the development of systems for DOT operations and maintenance personal has been invaluable for recognizing the need for and the challenges of providing quality spatio-temporal data.

In this paper, we demonstrate the difficulty of conducting spatio-temporal data quality control for sensor data. Our motivation is the provision of quality traveler information by departments of transportation. We show that assessment of accuracy of air temperature requires robust methods that go beyond the identification of outliers and inliers to mitigate the impact of bad data and bad metadata. We give a representative approach and demonstrate the challenges of assessment, particularly in the presence of incorrect data quality labels and the absence of ground truth for this air temperature data. Our approach is model-based and can be used to estimate not only outliers versus inliers, but also degree of outlyingness. It can not only be used to identify bad data in general as well as bad metadata. We evaluate our approach against other methods that use interpolation to model the data. We use an Area Under the ROC (AUROC) analysis to compare methods when data quality labels are provided. We use mean-squared-error and t-tests to compare methods both when labels are provided and when not. We measure scalability using computation time.

Icy pavements can impair the ability of drivers to operate their vehicles safely. The California Department of Transportation has deployed an icy curve warning system (ICWS) on a five-mile segment of SR 36 in Lassen County. This section of roadway has a history as a high-crash location with fatal crashes, the vast majority of which occurred during icy pavement. The objective of this study was to evaluate operational effects of the ICWS, specifically on speeds during various conditions. The results of statistical analysis found that mean speeds were significantly different by greater than 5 mph when the system was on against off in general, as well as when examined by day and night. Mean speeds were significantly reduced by greater than 5 mph during wet weather (during day and night). The real interest of the evaluation was the system's impacts on reducing speeds during conditions when ice was present but unexpected (called clear, cold and not dry in this work). Statistical analysis found that mean speed reductions were significant by greater than 3 mph (but less than 5 mph) when the system was on both during the day and at night. Consequently, the ICWS appears to reduce speeds by approximately 3 mph in conditions where icy roads are unexpected.

The California Department of Transportation (Caltrans) deployed an icy-curve warning system (ICWS) on a 5-mi section of SR-36 in Lassen County, California, over Fredonyer Pass. This section of roadway had a history as a high-crash location, with multiple fatal crashes. The vast majority of these accidents occurred when the pavement was icy, despite static signage that Caltrans had installed to increase motorist awareness. This study presents the results of research that investigated safety effects of the ICWS. An observational before–after study method with the empirical Bayes technique was used to determine the effects of ICWS on crash frequencies. The results showed that the ICWS reduced annual crashes by 18%. Moreover, analysis of ice-related accidents during winters found that the ICWS had reduced crash severities on this roadway section. On the basis of these results, a benefit analysis revealed that the ICWS provided an estimated monetary benefit of $1.7 million per winter season to motorists through reduced crashes. The study results are anticipated to contribute to a better understanding of safety effects of ice (or icy-curve) warning systems and increase the knowledge base of weather-specific treatments and their associated effects.

Objectives: To report the neuropathological findings of a patient with immune reconstitution syndrome associated with progressive multifocal leukoencephalopathy (PML) in human immunodeficiency virus (HIV) and to review the literature. Methods: A 38-year-old man was presented with a rapidly evolving brainstem syndrome. Serology for HIV was positive with an initial CD4 count of 130 cells/mL3. Magnetic resonance imaging showed widespread high signal changes within the brainstem bilaterally, the cerebellum, inferior cerebellar peduncle, and the frontal lobe on the right. Opportunistic infections were excluded from blood and cerebrospinal fluid samples. Despite treatment with antiretrovirals, he continued to deteriorate neurologically, and a repeat magnetic resonance imaging scan showed progression of his lesions. Cortical wedge frontal lobe brain biopsy showed features characteristic of PML, but was associated with an exaggerated inflammatory response. Polymerase chain reaction analysis of the specimen demonstrated the presence of JC virus (JCV) DNA, confirming the pathologic impression of PML. Results: The patient made a rapid (within 24 hours) improvement with pulsed methylprednisolone and has maintained a clinical response 7 months later. These features clinically, radiologically, and histopathologically suggest an added component in the form of immune reconstitution syndrome to PML. Conclusion: This report highlights the need to carefully evaluate the clinical syndrome in patients with HIV-associated leukoencephalopathy. It also substantiates the role of corticosteroids in carefully considered cases of HIV with leukoencephalopathy secondary to immune reconstitution.

Computed tomography imaging of the head is commonly used in the investigation of traumatic brain injury. Emergency department personnel often need to interpret these images without expert radiological assistance. This article reviews the common computed tomography appearances of the head following traumatic brain injury.

Supply vessels for the Grand Banks oil and gas industry have faced 25 ice blockage events entering St. John’s Harbour, Newfoundland from 1979-2005. We propose an empirical approach to forecasting the occurrence of 8-10/10ths total ice concentration at the harbour, and tables for alerting and advising ship personnel on the likelihood of such an event based on offshore winds, surface ocean currents, and ice conditions. These events are primarily controlled by the strength and character of an ocean current gyre and the ice conditions over a large area offshore St. John’s Harbour.

Introduction In March 2012 Willowbrook started to support the rehabilitation of currently serving offenders by offering volunteer placements in our Warehouse. This was a very bold move by the Hospice which had previously relied on traditional volunteering methods. Aims The Hospice’s Strategic Business plan is to broaden the diversity of its volunteering by giving volunteer opportunities to young people who may not have come across the Hospice movement in their lives. Willowbrook could provide work experience to prisoner’s approaching the end of their sentence supporting the Prisons Outreach Placement programme and raise extra funds to provide for patient care. Methods The views of all the participants needed to be taken into account - a visit to the prison arranged meeting with the Prison Placement Officer, a business case was proposed to the Hospice Trustees, Senior Managers and Warehouse Staff. In May 2012 the first prisoners arrived at the warehouse. Results For the Hospice - over the 18 months the 10 prisoners have made a fantastic contribution with over 5000 hours of support the warehouse has been able to increase its contribution to patient care by 12%, all the prisoners have settled in quickly with both Hospice staff and existing volunteers. For the Prison Service - Willowbrook is a highly reputable organisation, they know the prisoners will be supervised and provided with training. For the Prisoner - they feel more fulfilled and have more skills to take them back into ‘normal’ life. Conclusions The Hospice Prison Volunteer Placement programme continues to be a highly successful partnership between the Prison Service, prisoners and the Hospice. The hospice gains more volunteering time and funds, the prisoners have gained confidence, team working and independence skills that they can utilise outside the prison and the Prison Service has a professional, reliable organisation to work with.

Background/context Fostering good first impressions of a care setting are an important component of building confidence and providing reassurance for patient’s, carers, relatives and visitors. The 15 Steps Challenge is a toolkit devised by the NHS Institute for Innovation and Improvement in 2012 to help staff, patients and others to identify improvements that enhance the patient experience and environment. Initially 15 Steps was developed for use in Hospital wards but we adapted it for the whole Hospice environment. Aims To use an accredited quality improvement tool and clear framework to facilitate in depth observations of quality care across four domains: Welcoming Safe Caring and Involvement Well organised and calm Approach used Readily available easy to use literature to guide implementation PowerPoint slides for awareness sessions and training Small team to undertake the review (included 1 patient/carer representative, 1 non-clinical staff and 2 clinical staff) Dedicated toolkit Engagement with internal stakeholders A structured walk around the entirety of the Hospice environment Presentations to different staff groups on findings Focus on positive feedback and sharing good practice Repeated at 6 months to show achievements and improvements Outcomes Explicit patient/carer perspectives were taken into account. Detailed action plans with key positive impacts on the working environment. Supports the Care Quality Commission’s Essential Standards Case study for evaluation (IES) by telephone survey. Application to Hospice Practice Use of the 15 Steps toolkit clearly effective as a quality improvement initiative Re-audit has shown improvements in all domains Heightened staff awareness; quality is everyone’s business Strengthened communication across services Adaptable for use in Fundraising/Trading Company improving quality across the organisation. The Challenge can be repeated on a regular basis to cover all areas and to ensure that improvements are being progressed and maintained.

A series of 107 lymph node-negative (LNN) breast cancers was stained immunohistochemically with a combination of p53 and c-erb B-2. The immunohistochemical results were semiquantitated using a previously described system by Allred et al. p53 immunopositive cases were further screened for DNA mutations by the polymerase chain reaction-single-strand conformation polymorphism method (PCR-SSCP). Three representative cases showing mobility shifts were directly sequenced. One hundred of 103 invasive carcinomas were of no special type (infiltrating ductal carcinomas not otherwise specified). The three special type carcinomas included a tubular carcinoma, a classic infiltrating lobular carcinoma, and a mucinous carcinoma. Twenty-six patients (25.2%) had grade I carcinomas, and 77 patients (75%) had grade 2 or 3 carcinomas. There were four cases composed predominantly of ductal carcinoma in situ (DCIS) with foci of microinvasion. Twenty-seven of 107 patients (25%) died of disease. All those who died had grade 2 or 3 tumors. Univariate analysis showed that p53 and c-erb B-2 positivity (score > 6) were associated with a decreased overall survival (OS) (P = .0012 and P = .010, respectively), and a decreased disease-free survival (DFS) (P = .0009 and P = .027, respectively). The multivariate model selected these two variables as the best predictors of both OS and DFS (all P = or < .01). These results suggest that semiquantitative immunohistochemical analysis of p53 and c-erb B-2 provides prognostic information in LNN disease.

Motivations, Challenges and Rewards Introduction Hospice volunteers have been credited with bringing a unique human dimension to an otherwise clinical setting and are considered to be core members of interdisciplinary palliative care teams. This study looks at volunteers who have a mainly patient contact role within the Hospice. Over 100 000 volunteers are currently within the hospice movement – contributing more than 18 million hours of work to their services each year yet they remain a largely under-researched group. Aims ▶This study hopes to give this under researched group the opportunity to share their experiences with the Hospice and prospective volunteers ▶To understand the motivating factors for patient contact volunteers ▶To explore the experiences of those volunteers ▶To understand the profile of the volunteers, to aid future recruitment of new volunteers and target training and support. Methods ▶Qualitative study of the experiences of patient contact volunteers using semi structured interviews ▶Ethics approval granted from Edge Hill University Ethics committee and the Integrated Hospice Governance Group ▶Interpretative Phenomenological Analysis was used. Results ▶8 semi structured interviews conducted ▶Volunteers are drawn to hospice work to make a difference ▶Primary motivation is to discover more about themselves and others ▶Relatively few negative challenges encountered ▶Any negatives are cancelled out by the positive benefits gained ▶Capacity for personal growth is strengthened ▶Generic knowledge of symptoms would benefit the support they give. Conclusions ▶Volunteering is a two way process ▶The ‘Psychological Contract’ between the Hospice and its volunteers is very healthy ▶The organisation has good role deployment, shared values and good level9s of communication. Further developments ▶Volunteer inductions adapted to meet the training needs of individuals (eg, boundaries of care, consideration of first aid training for drivers) ▶Development of individual ‘Psychological Contracts’ between the hospice and volunteers.

A case in which unusually large deposits of Tamm-Horsfall protein were identified in perinephric adipose tissue is presented. The deposition around the kidney in this case was most likely due to calyceal rupture, secondary to distal ureteric obstruction. The peculiar gross and microscopic appearance of these deposits, their intense staining with the periodic acid--Schiff technique, and their association microscopically with epithelial fragments raised the possibility of infiltration by mucin-producing adenocarcinoma. The localization of Tamm-Horsfall protein in the deposits by the immunoperoxidase technique helped to confirm their true nature.