The business case development process in the delivery of NHS infrastructure

There is a lack of knowledge base in relation to experiences gained and lessons learnt from previously executed National Health Service (NHS) infrastructure projects in the UK. This is in part a feature of one-off construction projects, which typify healthcare infrastructure, and in part due to the absence of a suitable method for conveying such information. The complexity of infrastructure delivery process in the NHS makes the construction of healthcare buildings a formidable task. This is particularly the case for the NHS trusts who have little or no experience of construction projects. To facilitate understanding a most important aspect of the delivery process, which is the preparation of a capital investment proposal; steps taken in developing the business case for an NHS healthcare facility are examined. The context for such examination is provided by the planning process of a healthcare project, studied retrospectively. The process is analysed using a social science based method called ‘building stories’, developed at the University of California-Berkeley. By applying this method, stories or narratives are constructed around the data captured on the case study. The findings indicate that the business case process may be used to justify, rather than identify, trusts’ requirements. The study is useful for UK public sector clients as well as consultants and professionals who aim to participate in the delivery of healthcare infrastructure projects in the UK.

Advances in upper limb stroke rehabilitation: a technology push

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

A novel satellite mission concept for upper air water vapour, aerosol and cloud observations using integrated path differential absorption LiDAR limb sounding

We propose a new satellite mission to deliver high quality measurements of upper air water vapour. The concept centres around a LiDAR in limb sounding by occultation geometry, designed to operate as a very long path system for differential absorption measurements. We present a preliminary performance analysis with a system sized to send 75 mJ pulses at 25 Hz at four wavelengths close to 935 nm, to up to 5 microsatellites in a counter-rotating orbit, carrying retroreflectors characterized by a reflected beam divergence of roughly twice the emitted laser beam divergence of 15 µrad. This provides water vapour profiles with a vertical sampling of 110 m; preliminary calculations suggest that the system could detect concentrations of less than 5 ppm. A secondary payload of a fairly conventional medium resolution multispectral radiometer allows wide-swath cloud and aerosol imaging. The total weight and power of the system are estimated at 3 tons and 2,700 W respectively. This novel concept presents significant challenges, including the performance of the lasers in space, the tracking between the main spacecraft and the retroreflectors, the refractive effects of turbulence, and the design of the telescopes to achieve a high signal-to-noise ratio for the high precision measurements. The mission concept was conceived at the Alpbach Summer School 2010.

Importance of density-compensated temperature change for deep North Atlantic Ocean heat uptake

The efficiency with which the oceans take up heat has a significant influence on the rate of global warming. Warming of the ocean above 700 m over the past few decades has been well documented. However, most of the ocean lies below 700 m. Here we analyse observations of heat uptake into the deep North Atlantic. We find that the extratropical North Atlantic as a whole warmed by 1.45±0.5×1022 J between 1955 and 2005, but Lower North Atlantic Deep Water cooled, most likely as an adjustment from an early twentieth-century warm period. In contrast, the heat content of Upper North Atlantic Deep Water exhibited strong decadal variability. We demonstrate and quantify the importance of density-compensated temperature anomalies for long-term heat uptake into the deep North Atlantic. These anomalies form in the subpolar gyre and propagate equatorwards. High salinity in the subpolar gyre is a key requirement for this mechanism. In the past 50 years, suitable conditions have occurred only twice: first during the 1960s and again during the past decade. We conclude that heat uptake through density-compensated temperature anomalies will contribute to deep ocean heat uptake in the near term. In the longer term, the importance of this mechanism will be determined by competition between the multiple processes that influence subpolar gyre salinity in a changing climate.

Growth rate and vertical propagation of the initial error in baroclinic models

The present study investigates the growth of error in baroclinic waves. It is found that stable or neutral waves are particularly sensitive to errors in the initial condition. Short stable waves are mainly sensitive to phase errors and the ultra long waves to amplitude errors. Analysis simulation experiments have indicated that the amplitudes of the very long waves become usually too small in the free atmosphere, due to the sparse and very irregular distribution of upper air observations. This also applies to the four-dimensional data assimilation experiments, since the amplitudes of the very long waves are usually underpredicted. The numerical experiments reported here show that if the very long waves have these kinds of amplitude errors in the upper troposphere or lower stratosphere the error is rapidly propagated (within a day or two) to the surface and to the lower troposphere.

The role of baroclinic waves in the initiation of tropical cyclones across the southern Indian Ocean

Cases where tropical storms are initiated simultaneously along one latitude are investigated. It is argued that such structure arises as part of a baroclinic wave. A case from February 2008 is examined using European Centre for Medium-Range Forecasts (ECMWF) analyses; the birth of three tropical cyclones in the low-level cyclonic regions to the east of upper-level troughs suggests that the wave was instrumental for initiation. Archived satellite imagery and storm warnings reveal that baroclinic waves over the southern Indian Ocean accompany tropical cyclogenesis twice a season on average, mainly in late summer, when breaking Rossby waves on the subtropical westerly jet are closest to the Intertropical Convergence Zone (ITCZ). Copyright © 2012 Royal Meteorological Society

Dynamical evolution of North Atlantic ridges and poleward Jet Stream displacements

The development of a particular wintertime atmospheric circulation regime over the North Atlantic, comprising a northward shift of the North Atlantic eddy-driven jet stream and an associated strong and persistent ridge in the subtropics, is investigated. Several different methods of analysis are combined to describe the temporal evolution of the events and relate it to shifts in the phase of the North Atlantic Oscillation and East Atlantic pattern. First, the authors identify a close relationship between northward shifts of the eddy-driven jet, the establishment and maintenance of strong and persistent ridges in the subtropics, and the occurrence of upper-tropospheric anticyclonic Rossby wave breaking over Iberia. Clear tropospheric precursors are evident prior to the development of the regime, suggesting a preconditioning of the Atlantic jet stream and an upstream influence via a large-scale Rossby wave train from the North Pacific. Transient (2–6 days) eddy forcing plays a dual role, contributing to both the initiation and then the maintenance of the circulation anomalies. During the regime there is enhanced occurrence of anticyclonic Rossby wave breaking, which may be described as low-latitude blocking-like events over the southeastern North Atlantic. A strong ridge is already established at the time of wave-breaking onset, suggesting that the role of wave-breaking events is to amplify the circulation anomalies rather than to initiate them. Wave breaking also seems to enhance the persistence, since it is unlikely that a persistent ridge event occurs without being also accompanied by wave breaking.

Radiative-dynamical climatology of the first-generation Canadian middle atmosphere model

The Canadian Middle Atmosphere Modelling (MAM) project is a collaboration between thé Atmospheric Environment Service (AES) of Environment Canada and several Canadian universities. Its goal is thé development of a comprehensive General Circulation Model of the troposphere-stratosphere-mesosphere System, starting from the AES/CCCma third-generation atmospheric General Circulation Model. This paper describes the basic features of the first-generation Canadian MAM and some aspects of its radiative-dynamical climatology. Standard first-order mean diagnostics are presented for monthly means and for the annual cycle of zonal-mean winds and temperatures. The mean meridional circulation is examined, and comparison is made between thé steady diabatic, downward controlled, and residual stream functions. It is found that downward control holds quite well in the monthly mean through most of the middle atmosphere, even during equinoctal periods. The relative roles of different drag processes in determining the mean downwelling over the wintertime polar middle stratosphere is examined, and the vertical structure of the drag is quantified.

Optimising the FAMOUS climate model: inclusion of global carbon cycling

FAMOUS fills an important role in the hierarchy of climate models, both explicitly resolving atmospheric and oceanic dynamics yet being sufficiently computationally efficient that either very long simulations or large ensembles are possible. An improved set of carbon cycle parameters for this model has been found using a perturbed physics ensemble technique. This is an important step towards building the "Earth System" modelling capability of FAMOUS, which is a reduced resolution, and hence faster running, version of the Hadley Centre Climate model, HadCM3. Two separate 100 member perturbed parameter ensembles were performed; one for the land surface and one for the ocean. The land surface scheme was tested against present-day and past representations of vegetation and the ocean ensemble was tested against observations of nitrate. An advantage of using a relatively fast climate model is that a large number of simulations can be run and hence the model parameter space (a large source of climate model uncertainty) can be more thoroughly sampled. This has the associated benefit of being able to assess the sensitivity of model results to changes in each parameter. The climatologies of surface and tropospheric air temperature and precipitation are improved relative to previous versions of FAMOUS. The improved representation of upper atmosphere temperatures is driven by improved ozone concentrations near the tropopause and better upper level winds.

Jet characterization in the upper troposphere/lower stratosphere (UTLS): applications to climatology and transport studies

A method of classifying the upper tropospheric/lower stratospheric (UTLS) jets has been developed that allows satellite and aircraft trace gas data and meteorological fields to be efficiently mapped in a jet coordinate view. A detailed characterization of multiple tropopauses accompanies the jet characterization. Jet climatologies show the well-known high altitude subtropical and lower altitude polar jets in the upper troposphere, as well as a pattern of concentric polar and subtropical jets in the Southern Hemisphere, and shifts of the primary jet to high latitudes associated with blocking ridges in Northern Hemisphere winter. The jet-coordinate view segregates air masses differently than the commonly-used equivalent latitude (EqL) coordinate throughout the lowermost stratosphere and in the upper troposphere. Mapping O3 data from the Aura Microwave Limb Sounder (MLS) satellite and the Winter Storms aircraft datasets in jet coordinates thus emphasizes different aspects of the circulation compared to an EqL-coordinate framework: the jet coordinate reorders the data geometrically, thus highlighting the strong PV, tropopause height and trace gas gradients across the subtropical jet, whereas EqL is a dynamical coordinate that may blur these spatial relationships but provides information on irreversible transport. The jet coordinate view identifies the concentration of stratospheric ozone well below the tropopause in the region poleward of and below the jet core, as well as other transport features associated with the upper tropospheric jets. Using the jet information in EqL coordinates allows us to study trace gas distributions in regions of weak versus strong jets, and demonstrates weaker transport barriers in regions with less jet influence. MLS and Atmospheric Chemistry Experiment-Fourier Transform Spectrometer trace gas fields for spring 2008 in jet coordinates show very strong, closely correlated, PV, tropopause height and trace gas gradients across the jet, and evidence of intrusions of stratospheric air below the tropopause below and poleward of the subtropical jet; these features are consistent between instruments and among multiple trace gases. Our characterization of the jets is facilitating studies that will improve our understanding of upper tropospheric trace gas evolution.

[Global climate] global aerosols [in state of the climate in 2008]

The global mean temperature in 2008 was slightly cooler than that in 2007; however, it still ranks within the 10 warmest years on record. Annual mean temperatures were generally well above average in South America, northern and southern Africa, Iceland, Europe, Russia, South Asia, and Australia. In contrast, an exceptional cold outbreak occurred during January across Eurasia and over southern European Russia and southern western Siberia. There has been a general increase in land-surface temperatures and in permafrost temperatures during the last several decades throughout the Arctic region, including increases of 1° to 2°C in the last 30 to 35 years in Russia. Record setting warm summer (JJA) air temperatures were observed throughout Greenland. The year 2008 was also characterized by heavy precipitation in a number of regions of northern South America, Africa, and South Asia. In contrast, a prolonged and intense drought occurred during most of 2008 in northern Argentina, Paraguay, Uruguay, and southern Brazil, causing severe impacts to agriculture and affecting many communities. The year began with a strong La Niña episode that ended in June. Eastward surface current anomalies in the tropical Pacific Ocean in early 2008 played a major role in adjusting the basin from strong La Niña conditions to ENSO-neutral conditions by July–August, followed by a return to La Niña conditions late in December. The La Niña conditions resulted in far-reaching anomalies such as a cooling in the central tropical Pacific, Arctic Ocean, and the regions extending from the Gulf of Alaska to the west coast of North America; changes in the sea surface salinity and heat content anomalies in the tropics; and total column water vapor, cloud cover, tropospheric temperature, and precipitation patterns typical of a La Niña. Anomalously salty ocean surface salinity values in climatologically drier locations and anomalously fresh values in rainier locations observed in recent years generally persisted in 2008, suggesting an increase in the hydrological cycle. The 2008 Atlantic hurricane season was the 14th busiest on record and the only season ever recorded with major hurricanes each month from July through November. Conversely, activity in the northwest Pacific was considerably below normal during 2008. While activity in the north Indian Ocean was only slightly above average, the season was punctuated by Cyclone Nargis, which killed over 145,000 people; in addition, it was the seventh-strongest cyclone ever in the basin and the most devastating to hit Asia since 1991. Greenhouse gas concentrations continued to rise, increasing by more than expected based on with CO2 the 1979 to 2007 trend. In the oceans, the global mean uptake for 2007 is estimated to be 1.67 Pg-C, about CO2 0.07 Pg-C lower than the long-term average, making it the third-largest anomaly determined with this method since 1983, with the largest uptake of carbon over the past decade coming from the eastern Indian Ocean. Global phytoplankton chlorophyll concentrations were slightly elevated in 2008 relative to 2007, but regional changes were substantial (ranging to about 50%) and followed long-term patterns of net decreases in chlorophyll with increasing sea surface temperature. Ozone-depleting gas concentrations continued to fall globally to about 4% below the peak levels of the 2000–02 period. Total column ozone concentrations remain well below pre-1980, levels and the 2008 ozone hole was unusually large (sixth worst on record) and persistent, with low ozone values extending into the late December period. In fact the polar vortex in 2008 persisted longer than for any previous year since 1979. Northern Hemisphere snow cover extent for the year was well below average due in large part to the record-low ice extent in March and despite the record-maximum coverage in January and the shortest snow cover duration on record (which started in 1966) in the North American Arctic. Limited preliminary data imply that in 2008 glaciers continued to lose mass, and full data for 2007 show it was the 17th consecutive year of loss. The northern region of Greenland and adjacent areas of Arctic Canada experienced a particularly intense melt season, even though there was an abnormally cold winter across Greenland's southern half. One of the most dramatic signals of the general warming trend was the continued significant reduction in the extent of the summer sea-ice cover and, importantly, the decrease in the amount of relatively older, thicker ice. The extent of the 2008 summer sea-ice cover was the second-lowest value of the satellite record (which started in 1979) and 36% below the 1979–2000 average. Significant losses in the mass of ice sheets and the area of ice shelves continued, with several fjords on the northern coast of Ellesmere Island being ice free for the first time in 3,000–5,500 years. In Antarctica, the positive phase of the SAM led to record-high total sea ice extent for much of early 2008 through enhanced equatorward Ekman transport. With colder continental temperatures at this time, the 2007–08 austral summer snowmelt season was dramatically weakened, making it the second shortest melt season since 1978 (when the record began). There was strong warming and increased precipitation along the Antarctic Peninsula and west Antarctica in 2008, and also pockets of warming along coastal east Antarctica, in concert with continued declines in sea-ice concentration in the Amundsen/Bellingshausen Seas. One significant event indicative of this warming was the disintegration and retreat of the Wilkins Ice Shelf in the southwest peninsula area of Antarctica.

Simulations of the impact of orbital forcing and ocean on the Asian summer monsoon during the Holocene

The importance of orbital forcing and ocean impact on the Asian summer monsoon in the Holocene is investigated by comparing simulations with a fully coupled ocean–atmosphere general circulation model (FOAM) and with the atmospheric component of this model (FSSTAM) forced with prescribed modern sea-surface temperatures (SSTs). The results show: (1) the ocean amplifies the orbitally-induced increase in African monsoon precipitation, makes somewhat increase in southern India and damps the increase over the southeastern China. (2) The ocean could change the spatial distribution and local intensity of the orbitally-induced latitudinal atmospheric oscillation over the southeastern China and the subtropical western Pacific Ocean. (3) The orbital forcing mostly enhances the Asian summer precipitation in the FOAM and FSSTAM simulations. However, the ocean reduces the orbitally-induced summer precipitation and postpones the time of summer monsoon onset over the Asian monsoon region. (4) The orbital forcing considerably enhances the intensity of upper divergence, which is amplified by ocean further, over the eastern hemisphere. But the divergence is weaker in the FOAM simulations than in the FSSTAM simulations when the orbital forcing is fixed. (5) The orbital forcing can enhance the amplitude of precipitation variability over the subtropical Africa, the southeastern China and northwestern China, inversely, reduce it over central India and North China in the FOAM and FSSTAM simulations. The ocean obviously reduces the amplitude of precipitation variability over most of the Asian monsoon regions in the fixed orbital forcing simulations. (6) The areas characterized by increased summer precipitation in the long-term mean are mostly characterized by increased amplitude of short-term variability, whereas regions characterized by decreased precipitation are primarily characterized by decreased amplitude of short-term variability. However, the influences of orbital forcing or dynamical ocean on regional climate depend on the model.

A route to systematic error in forecasts of Rossby waves

Recent work has shown that both the amplitude of upper-level Rossby waves and the tropopause sharpness decrease with forecast lead time for several days in some operational weather forecast systems. In this contribution, the evolution of error growth in a case study of this forecast error type is diagnosed through analysis of operational forecasts and hindcast simulations. Potential vorticity (PV) on the 320-K isentropic surface is used to diagnose Rossby waves. The Rossby-wave forecast error in the operational ECMWF high-resolution forecast is shown to be associated with errors in the forecast of a warm conveyor belt (WCB) through trajectory analysis and an error metric for WCB outflows. The WCB forecast error is characterised by an overestimation of WCB amplitude, a location of the WCB outflow regions that is too far to the southeast, and a resulting underestimation of the magnitude of the negative PV anomaly in the outflow. Essentially the same forecast error development also occurred in all members of the ECMWF Ensemble Prediction System and the Met Office MOGREPS-15 suggesting that in this case model error made an important contribution to the development of forecast error in addition to initial condition error. Exploiting this forecast error robustness, a comparison was performed between the realised flow evolution, proxied by a sequence of short-range simulations, and a contemporaneous forecast. Both the proxy to the realised flow and the contemporaneous forecast a were produced with the Met Office Unified Model enhanced with tracers of diabatic processes modifying potential temperature and PV. Clear differences were found in the way potential temperature and PV are modified in the WCB between proxy and forecast. These results demonstrate that differences in potential temperature and PV modification in the WCB can be responsible for forecast errors in Rossby waves.

Visual processing of optic flow and motor control in the human posterior cingulate sulcus

Previous studies have shown that the human posterior cingulate contains a visual processing area selective for optic flow (CSv). However, other studies performed in both humans and monkeys have identified a somatotopic motor region at the same location (CMA). Taken together, these findings suggested the possibility that the posterior cingulate contains a single visuomotor integration region. To test this idea we used fMRI to identify both visual and motor areas of the posterior cingulate in the same brains and to test the activity of those regions during a visuomotor task. Results indicated that rather than a single visuomotor region the posterior cingulate contains adjacent but separate motor and visual regions. CSv lies in the fundus of the cingulate sulcus, while CMA lies in the dorsal bank of the sulcus, slightly superior in terms of stereotaxic coordinates. A surprising and novel finding was that activity in CSv was suppressed during the visuomotor task, despite the visual stimulus being identical to that used to localize the region. This may provide an important clue to the specific role played by this region in the utilization of optic flow to control self-motion.