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The idea behind the marine cloud-brightening (MCB) geoengineering technique is that seeding marine stratocumulus clouds with copious quantities of roughly monodisperse sub-micrometre sea water particles might significantly enhance the cloud droplet number concentration, and thereby the cloud albedo and possibly longevity. This would produce a cooling, which general circulation model (GCM) computations suggest could-subject to satisfactory resolution of technical and scientific problems identified herein-have the capacity to balance global warming up to the carbon dioxide-doubling point. We describe herein an account of our recent research on a number of critical issues associated with MCB. This involves (i) GCM studies, which are our primary tools for evaluating globally the effectiveness of MCB, and assessing its climate impacts on rainfall amounts and distribution, and also polar sea-ice cover and thickness; (ii) high-resolution modelling of the effects of seeding on marine stratocumulus, which are required to understand the complex array of interacting processes involved in cloud brightening; (iii) microphysical modelling sensitivity studies, examining the influence of seeding amount, seed-particle salt-mass, air-mass characteristics, updraught speed and other parameters on cloud-albedo change; (iv) sea water spray-production techniques; (v) computational fluid dynamics studies of possible large-scale periodicities in Flettner rotors; and (vi) the planning of a three-stage limited-area field research experiment, with the primary objectives of technology testing and determining to what extent, if any, cloud albedo might be enhanced by seeding marine stratocumulus clouds on a spatial scale of around 100×100 km. We stress that there would be no justification for deployment of MCB unless it was clearly established that no significant adverse consequences would result. There would also need to be an international agreement firmly in favour of such action.

Part of my job is to help lead the drive for continuous improvement in patient safety and the experience of being cared for at my hospital. This is important work but it risks being complicated and overwhelmed by the number of patient safety initiatives, guidance notes, alerts, recommendations and practice statements that seem to be growing at an almost exponential rate. One of the key roles of any leader is to translate and effectively communicate issues and priorities to the rest of his or her team. For me, that means communicating patient safety priorities with everyone who works at my hospital. My challenge is to make sense of this ever-expanding body of advice and ground practice change in ways that see a genuine improvement in the quality and safety of care offered to patients. Doctors in particular often seek evidence from controlled trials, numerically powered to produce statistically meaningful outcomes. The difficulty is that this can take years to complete. Feedback from patients or their carers in the shape of individual stories can provide a rich seam of opportunity to improve that can be mined much more quickly. Anecdote has its place and I frequently use patient stories to help everyone I work with see how what they do can affect safety. Every clinician wants to provide the best and most up-to-date care for patients that they can. New procedures or therapies, however, need to be introduced carefully and safely. I often tell a story to help colleagues to understand the need for controls and governance around how we introduce new treatments into my hospital.

Part of my job is to help lead the drive for continuous improvement in patient safety and the experience of being cared for at my hospital. This is important work but it risks being complicated and overwhelmed by the number of patient safety initiatives, guidance notes, alerts, recommendations and practice statements that seem to be growing at an almost exponential rate. One of the key roles of any leader is to translate and effectively communicate issues and priorities to the rest of his or her team. For me, that means communicating patient safety priorities with everyone who works at my

For years the NHS has been the most trusted of public institutions and the envy of many around the world. But today there is turmoil. Painful shortcomings in clinical care and patient experience, together with funding cuts, threaten to dig deep into service levels and standards. Seventy years of technically advanced medicine provided free to the population has produced a widespread perception of patients as passive consumers of health care. This book explores how we may renew for our times the collective compact that created our public services in the 1940s. Voices from service users and service providers show how this can be done. They offer testimony of what goes wrong and what can be put right when working together becomes the norm. Sections explore new ways of living and working with long-term conditions, more meaningful and effective approaches to service redesign, use of information technology, leadership, co-production and creating and accounting for quality. Accessible to a wide range of readers, with short, accessible contributions, this is a book to provoke and inspire.

Energy-resolved fast-neutron radiography is a powerful non-destructive technique that can be used to remotely measure the quantity and distribution of elements and isotopes in a sample. This is done by comparing the energy-dependent neutron transmission of a sample with the known cross-sections of individual isotopes. The reconstruction of the composition is possible due to the unique features (e.g. resonances) in the cross-sections of individual isotopes. At short-pulsed (  1 ns) neutron sources, such information is accessible via time-of-flight neutron imaging in principle, but requires a detector with nanosecond temporal resolution. Conventional neutron detectors can meet this requirement only by heavily compromising spatial resolution or efficiency. Here, we present a unique approach on fast neutron resonance radiography using a scintillator-based event-mode imaging detector at a short-pulsed neutron source, including first results on spatially mapped resonance profiles using MeV neutrons. The event mode approach applied in the presented detector allows recording of individual neutron interactions with nanosecond precision in time and sub-mm resolution in space. As a result, the entire available neutron energy spectrum can be measured for each pulse. At the same time, the use of a thick scintillator screen and lenses to focus the produced light results in a highly flexible field of view and a high interaction probability in the sensitive volume of the detector.

Background: In this commentary we present the findings from an international consortium on fish toxicogenomics sponsored by the U.K. Natural Environment Research Council (Fish Toxicogenomics—Moving into Regulation and Monitoring, held 21-23 April 2008 at the Pacific Environmental Science Centre, Vancouver, BC, Canada). Objectives: The consortium from government agencies, academia, and industry addressed three topics: progress in ecotoxicogenomics, regulatory perspectives on roadblocks for practical implementation of toxicogenomics into risk assessment, and dealing with variability in data sets. Discussion: Participants noted that examples of successful application of omic technologies have been identified, but critical studies are needed to relate molecular changes to ecological adverse outcome. Participants made recommendations for the management of technical and biological variation. They also stressed the need for enhanced interdisciplinary training and communication as well as considerable investment into the generation and curation of appropriate reference omic data. Conclusions: The participants concluded that, although there are hurdles to pass on the road to regulatory acceptance, omics technologies are already useful for elucidating modes of action of toxicants and can contribute to the risk assessment process as part of a weight-of-evidence approach.

Background The aetiology of bone cancers is poorly understood. This study examined geographical patterning in incidence of primary bone cancers diagnosed in 0–49 year olds in Great Britain during 1980–2005 to provide information on factors linked with disease development. We investigated putative associations with deprivation and population density. Methods Data on osteosarcoma and Ewing sarcoma were obtained from national population-based registries. Negative binomial regression was used to examine the relationship between incidence rates and the Townsend deprivation score (and its component variables) and small-area population density. Results The study analyzed 2566 osteosarcoma and 1650 Ewing sarcoma cases. For females with osteosarcoma, statistically significant decreased risk was associated with higher levels of deprivation (relative risk [RR] per unit increase in deprivation score = 0.969; 95% confidence interval [CI] 0.946–0.993). For all Ewing sarcoma combined, statistically significant decreased risk was associated with greater area-level population density and higher levels of non-car ownership (RR per person per hectare increase = 0.984; 95% CI 0.976–0.993, RR per 1% increase in non-car ownership = 0.994; 95% CI 0.991–0.998). Conclusions Higher incidence of osteosarcoma was observed for females in areas with lower deprivation levels indicating increased risk is linked to some aspect of affluent living. Higher incidence of Ewing sarcoma occurred in areas of low population density and where more people owned cars, both characteristic of rural environments. The study adds substantially to evidence associating Ewing sarcoma risk with rural environmental exposures. Putative risk factors include agricultural exposures, such as pesticides and zoonotic agents.