Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults.In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial.In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463).Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021.The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial.International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980.DERR1-10.2196/18929.
The effects of eddies on the mixed layer and on the transfer of properties between the mixed layer and thermocline are studied in a high‐resolution model of an unstable front. A spring scenario is considered, with a mixed layer maintained against surface warming by wind mixing. Tilting of the buoyancy gradients by ageostrophic flow is found to shallow the mixed layer over the front, giving a mixed layer as shallow as 10 m in some places, compared with the equilibrium Monin‐Obukhov depth of ∼30 m away from the front. Variations of mixed layer depth with time and lateral advection lead to a subduction field that is substantially different from the vertical velocity field. Vertical velocities associated with the growing instabilities push tongues of a ventilation tracer, initially only present within the surface layer, down to depths of up to 100 m. After 24 days a quarter of this ventilation tracer has been deposited in the thermocline. Conversely, the vertical motions pull nutrients from the thermocline up into the mixed layer, giving enhanced surface values along the front. In the basin average the geostrophic eddies give vertical eddy diffusivities for a ventilation tracer of O(3 ‐ 10×10 −4 m 2 s −1 ).
This paper is a review of the observational, experimental, theoretical, and numerical studies of mesoscale shallow convection (MSC) in the atmosphere. Typically, MSC is 1 to 2 km deep, has a horizontal length scale of a few to a few tens of kilometers, and takes distinctive planforms: linear and hexagonal. The former is called a cloud street, roll, or band, while the latter is called mesoscale cellular convection (MCC), comprising three‐dimensional cells. MSC is characterized by its shape, horizontal extent, convective depth, and aspect ratio. The latter is the ratio of the horizontal extent to that in the vertical. For cells the horizontal extent is their diameter, whereas for rolls it is their spacing. Rolls usually align along or at angles of up to 10° from the mean horizontal wind of the convective layer, with lengths from 20 to 200 km, widths from 2 to 10 km, and convective depths from 2 to 3 km. The typical value of aspect ratio ranges from 2 to 20. Rolls may occur over both water surface and land surfaces. Mesoscale convective cells may be divided into two types: open and closed. Open‐cell circulation has downward motion and clear sky in the cell center, surrounded by cloud associated with upward motion. Closed cells have the opposite circulation. Both types of cell have diameters ranging from 10 to 40 km and aspect ratios of 5 to 50, and both occur in a convective layer with a depth of about 1 to 3 km. Both the magnitude and direction of horizontal wind in the convective layer change little with height. MSC results from a complex and incompletely understood mix of processes. These processes are outlined, and their interplay is examined through a review of theoretical and laboratory analyses and numerical modeling of MSC.
The effects of eddies on the mixed layer and on the transfer of properties between the mixed layer and thermocline are studied in a high-resolution model of an unstable front.A spring scenario is considered, with a mixed layer maintained against surface warming by wind mixing.Tilting of the buoyancy gradients by ageostrophic flow is found to shallow the mixed layer over the front, giving a mixed layer as shallow as 10 m in some places, compared with the equilibrium Monin-Obukhov depth of-30 m away from the front.Variations of mixed layer depth with time and lateral advection lead to a subduction field that is substantially different from the vertical velocity field.Vertical velocities associated with the growing instabilities push tongues of a ventilation tracer, initially only present within the surface layer, down to depths of up to 100 m.After 24 days a quarter of this ventilation tracer has been deposited in the thermocline.Conversely, the vertical motions pull nutrients from the thermocline up into the mixed layer, giving enhanced surface values along the front.In the basin average the geostrophic eddies give vertical eddy diffusivities for a ventilation tracer of O(3-10x 10 -4 m 2 s-l).1. Introduction Mesoscale eddies (with radii 5-50 kin) can drive strong vertical circulations, such as the vertical velocities of up to 17 m d-l in the Azores front [Rudnick, 1996] and 25 m d-l, diagnosed by Pollard and Regier [1992] within frontal regions along the southern flank of the subtropical gyre of the North Atlantic during the Frontal Air-Sea Interaction Experiment (FASINEX) [Weller, 1991].Strong vertical motions have also been diagnosed by Allen and Smeed [1996]; Viudez et al. [1996a, b].These eddy-induced motions must be important in transporting properties between the surface mixed layer and thermocline and hence in influencing the biology [Woods, 1988].An analogy [Follows and Marshall, 1994] may be drawn between oceanic mixed layer/thermocline exchange and atmospheric stratosphere/troposphere exchange, much of which is associated with depressions striking the tropopause [Follows and Austin, 1992].Indeed, there is much evidence of chlorophyll patchiness near fronts [Strass, 1992], presumably driven by eddy-induced upwelling of nutrient.Highresolution time series of nitrate have shown [McGillicuddy and Robinson, 1997] injections of nutrient into the surface zone with timescales and space scales consistent with upwelling by mesoscale eddies.Jenkins [1988] has set out observations of excess He 3 and nitrate in the upper ocean near Bermuda that imply recent upwelling in that region.Conversely, the filaments of chlorophyll observed at depths down to 400 m in the eastern North Atlantic, (Plate 1) show the drawing down of fluid from the mixed layer into the thermocline (subduction).Subduction of mixed layer waters
Professor ZHANG Ren's clinical experience of acupuncture for glaucoma is summarized. Professor ZHANG believes that key pathogenesis of glaucoma is stagnation of qi and blood in the eyes, obstruction of xuanfu in the eyes, and obstruction of meridians. The treatment should focus on the eye, with smoothing the liver and keeping functional state of six-fu as priority; he also emphasizes the acupoint selection based on the combination of disease differentiation and syndrome differentiation, and pays attention to the application of acupuncture method of promoting qi circulation and inducting qi movement. Professor ZHANG proposes that the patients should be treated according to different types, and stresses the importance of using comprehensive treatment and emotional adjustment method, as well as early intervention, long-term adherence and regular treatment.
Introduction Chronic musculoskeletal pain is a complex medical condition that can significantly impact quality of life. Patients with chronic pain demonstrate attentional biases towards pain-related information. The therapeutic benefits of modifying attentional biases by implicitly training attention away from pain-related information towards neutral information have been supported in a small number of published studies. Limited research however has explored the efficacy of modifying pain-related biases via the internet. This protocol describes a randomised, double-blind, internet-delivered attentional bias modification intervention, aimed to evaluate the efficacy of the intervention on reducing pain interference. Secondary outcomes are pain intensity, state and trait anxiety, depression, pain-related fear, and sleep impairment. This study will also explore the effects of training intensity on these outcomes, along with participants’ perceptions about the therapy. Methods and analysis The study is a double-blind, randomised controlled trial with four arms exploring the efficacy of online attentional bias modification training versus placebo training theorised to offer no specific therapeutic benefit. Participants with chronic musculoskeletal pain will be randomised to one of four groups: (1) 10-session attentional modification group; (2) 10-session placebo training group; (3) 18-session attentional modification group; or (4) 18-session placebo training group. In the attentional modification groups, the probe-classification version of the visual-probe task will be used to implicitly train attention away from threatening information towards neutral information. Following the intervention, participants will complete a short interview exploring their perceptions about the online training. In addition, a subgroup analysis for participants aged 16–24 and 25–60 will be undertaken. Ethics and dissemination This study has been approved by the University of Southampton Research Ethics Committee. Results will be published in peer-reviewed journals, academic conferences, and in lay reports for pain charities and patient support groups. Trial registration number NCT02232100 .
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