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Purpose The purpose of this study is to assess the feasibility of conducting a large, multicentre randomised controlled trial (RCT) comparing needle fasciotomy with limited fasciectomy for treatment of Dupuytren’s contractures. Design The design of this study is a parallel, two-arm, multicentre, randomised feasibility trial with embedded QuinteT Recruitment Intervention. Participants Patients aged 18 years or over who were referred from primary to secondary care for treatment of a hand with Dupuytren’s contractures of one or more fingers of more than 30° at the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joints and well-defined cord(s). Patients were excluded if they had undergone previous Dupuytren’s contracture surgery on the same hand. Methods Potential participants were screened for eligibility. Recruited participants randomised (1:1) to treatment with either needle fasciotomy or limited fasciectomy and followed-up for up to 6 months after treatment. Data on recruitment rates, completion of follow-up, and procedure costs were collected. Four patient reported outcome measures (PROMs) and objective outcome measures were collected before intervention and 6 weeks and 6 months afterwards. Results One hundred and fifty-three of 267 (57%) primary-care referrals for Dupuytren’s contractures met the eligibility criteria for the study. Seventy-one of the 153 (46%) agreed to participate and were randomly allocated to treatment with needle fasciotomy or limited fasciectomy. Sixty-seven of these underwent their allocated treatment, two were crossovers from limited fasciectomy to needle fasciotomy, and two (both allocated limited fasciectomy) received no treatment. Fifty-nine participants (85%) completed 6-month follow-up PROMs. Participants felt the MYMOP, PEM and URAM PROMs allowed them to better describe how their treatment affected their hand function than the DASH PROM. The estimated costs of limited fasciectomy (in an operating theatre) and needle fasciotomy (in a clinic room) were £777 and £111 respectively. Conclusion A large RCT comparing treatment of Dupuytren’s contractures by needle fasciotomy and limited fasciectomy is feasible. Data from this study will help determine the number of sites and duration of recruitment required to complete an adequately powered RCT and will assist the selection of PROMs in future studies on the treatment of Dupuytren’s contractures. (Level 1 feasibility study). Trial registration Trial registered with ISRCTN (registration number: ISRCTN11164292 ), date assigned - 28/08/2015.

The study of climate and climate change is hindered by a lack of information on the effect of clouds on the radiation balance of the earth, referred to as the cloud-radiative forcing. Quantitative estimates of the global distributions of cloud-radiative forcing have been obtained from the spaceborne Earth Radiation Budget Experiment (ERBE) launched in 1984. For the April 1985 period, the global shortwave cloud forcing [-44.5 watts per square meter (W/m$^{2}$)] due to the enhancement of planetary albedo, exceeded in magnitude the longwave cloud forcing (31.3 W/m$^{2}$) resulting from the greenhouse effect of clouds. Thus, clouds had a net cooling effect on the earth. This cooling effect is large over the mid- and high-latitude oceans, with values reaching -100 W/m$^{2}$. The monthly averaged longwave cloud forcing reached maximum values of 50 to 100 W/m$^{2}$ over the convectively disturbed regions of the tropics. However, this heating effect is nearly canceled by a correspondingly large negative shortwave cloud forcing, which indicates the delicately balanced state of the tropics. The size of the observed net cloud forcing is about four times as large as the expected value of radiative forcing from a doubling of CO$_{2}$. The shortwave and longwave components of cloud forcing are about ten times as large as those for a CO$_{2}$ doubling. Hence, small changes in the cloud-radiative forcing fields can play a significant role as a climate feedback mechanism. For example, during past glaciations a migration toward the equator of the field of strong, negative cloud-radiative forcing, in response to a similar migration of cooler waters, could have significantly amplified oceanic cooling and continental glaciation.

Radiative flux anomalies derived from the National Aeronautics and Space Administration (NASA) spaceborne Earth Radiation Budget Experiment were used to determine the volcanic radiative forcing that followed the eruption of Mount Pinatubo in June 1991. They are the first unambiguous, direct measurements of large-scale volcanic forcing. The volcanic aerosols caused a strong cooling effect immediately; the amount of cooling increased through September 1991 as shortwave forcing increased relative to the longwave forcing. The primary effects of the aerosols were a direct increase in albedo over mostly clear areas and both direct and indirect increases in the albedo of cloudy areas.

The role of clouds in modifying the earth's radiation balance is well recognized as a key uncertainty in predicting any potential future climate change. This statement is true whether the climate change of interest is caused by changing emissions of greenhouse gases and sulfates, deforestation, ozone depletion, volcanic eruptions, or changes in the solar constant. This paper presents an overview of the role of the National Aeronautics and Space Administration's Earth Observing System (EOS) satellite data in understanding the role of clouds in the global climate system. The paper gives a brief summary of the cloud/radiation problem, and discusses the critical observations needed to support further investigations. The planned EOS data products are summarized, including the critical advances over current satellite cloud and radiation budget data. Key advances include simultaneous observation of radiation budget and cloud properties, additional information on cloud particle size and phase, improved detection of thin clouds and multilayer cloud systems, greatly reduced ambiguity in partially cloud-filled satellite fields of view, improved calibration and stability of satellite-observed radiances, and improved estimates of radiative fluxes at the top of the atmosphere, at the surface, and at levels within the atmosphere. Outstanding sampling and remote sensing issues that affect data quality are also discussed. Finally, the EOS data are placed in the context of other satellite observations as well as the critical surface, field experiment, and laboratory data needed to address the role of clouds in the climate system. It is concluded that the EOS data are a necessary but insufficient condition for solution of the scientific cloud/radiation issues. A balanced approach of satellite, field, and laboratory data will be required. These combined data can span the necessary spatial scales of global, regional, cloud cell, and cloud particle physics (i.e., from 108 to 10−7 m).

There has been a long history of unexplained anomalous absorption of solar radiation by clouds. Collocated satellite and surface measurements of solar radiation at five geographically diverse locations showed significant solar absorption by clouds, resulting in about 25 watts per square meter more global-mean absorption by the cloudy atmosphere than predicted by theoretical models. It has often been suggested that tropospheric aerosols could increase cloud absorption. But these aerosols are temporally and spatially heterogeneous, whereas the observed cloud absorption is remarkably invariant with respect to season and location. Although its physical cause is unknown, enhanced cloud absorption substantially alters our understanding of the atmosphere's energy budget.

Clouds and the Earth's Radiant Energy System (CERES) is an investigation to examine the role of cloud/radiation feedback in the Earth's climate system. The CERES broadband scanning radiometers are an improved version of the Earth Radiation Budget Experiment (ERBE) radiometers. The CERES instruments will fly on several National Aeronautics and Space Administration Earth Observing System (EOS) satellites starting in 1998 and extending over at least 15 years. The CERES science investigations will provide data to extend the ERBE climate record of top-of-atmosphere shortwave (SW) and longwave (LW) radiative fluxes. CERES will also combine simultaneous cloud property data derived using EOS narrowband imagers to provide a consistent set of cloud/radiation data, including SW and LW radiative fluxes at the surface and at several selected levels within the atmosphere. CERES data are expected to provide top-of-atmosphere radiative fluxes with a factor of 2 to 3 less error than the ERBE data. Estimates of radiative fluxes at the surface and especially within the atmosphere will be a much greater challenge but should also show significant improvements over current capabilities.

Gregory of Nyssa's commentary on the Song of Songs, in which he argues that there is no gender in the eternal Godhead, is discussed. How two other Cappadocians, Basil of Caesarea and Gregory Nazianzen, understand male and female is explored.

First results for diurnal cycles derived from the Earth Radiation Budget Experiment (ERBE) are presented for the combined Earth Radiation Budget Satellite (ERBS) and NOAA-9 spacecraft for April 1985. Regional scale longwave (LW) radiation data are analyzed to determine diurnal variations for the total scene (including clouds) and for clearsky conditions. The LW diurnal range was found to be greatest for clear desert regions (up to about 70 W · m−2) and smallest for clear oceans (less than 5 W · m−2). Local time of maximum longwave radiation occurs at a wide range of times throughout the day and night over oceans, but generally occurs from noon to early afternoon over land and desert regions.

The role of clothing in the management of eczema (also called atopic dermatitis or atopic eczema) is poorly understood. This trial evaluated the effectiveness and cost-effectiveness of silk garments (in addition to standard care) for the management of eczema in children with moderate to severe disease. This was a parallel-group, randomised, controlled, observer-blind trial. Children aged 1 to 15 y with moderate to severe eczema were recruited from secondary care and the community at five UK medical centres. Participants were allocated using online randomisation (1:1) to standard care or to standard care plus silk garments, stratified by age and recruiting centre. Silk garments were worn for 6 mo. Primary outcome (eczema severity) was assessed at baseline, 2, 4, and 6 mo, by nurses blinded to treatment allocation, using the Eczema Area and Severity Index (EASI), which was log-transformed for analysis (intention-to-treat analysis). A safety outcome was number of skin infections. Three hundred children were randomised (26 November 2013 to 5 May 2015): 42% girls, 79% white, mean age 5 y. Primary analysis included 282/300 (94%) children (n = 141 in each group). The garments were worn more often at night than in the day (median of 81% of nights [25th to 75th centile 57% to 96%] and 34% of days [25th to 75th centile 10% to 76%]). Geometric mean EASI scores at baseline, 2, 4, and 6 mo were, respectively, 9.2, 6.4, 5.8, and 5.4 for silk clothing and 8.4, 6.6, 6.0, and 5.4 for standard care. There was no evidence of any difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age, and centre: adjusted ratio of geometric means 0.95, 95% CI 0.85 to 1.07, (p = 0.43). This confidence interval is equivalent to a difference of -1.5 to 0.5 in the original EASI units, which is not clinically important. Skin infections occurred in 36/142 (25%) and 39/141 (28%) of children in the silk clothing and standard care groups, respectively. Even if the small observed treatment effect was genuine, the incremental cost per quality-adjusted life year was £56,811 in the base case analysis from a National Health Service perspective, suggesting that silk garments are unlikely to be cost-effective using currently accepted thresholds. The main limitation of the study is that use of an objective primary outcome, whilst minimising detection bias, may have underestimated treatment effects. Silk clothing is unlikely to provide additional benefit over standard care in children with moderate to severe eczema. Current Controlled Trials ISRCTN77261365.