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.
Objective The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting 76 general practices in the United Kingdom. Participants 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration ISRCTN13790648 .
Introduction: Cognitive biases in attention, interpretation and less consistently memory have been observed in individuals with chronic pain and play a critical role in the onset and maintenance of chronic pain. Despite operating in combination cognitive biases are typically explored in isolation. Aim: The primary aim of this study was to explore attentional, interpretation and memory biases and their interrelationship in individuals with chronic headache. Methods: Twenty-eight participants with chronic headache and 34 healthy controls completed paradigms assessing attentional, interpretation and memory biases with ambiguous sensory-pain and neutral words. Results: Individuals with chronic pain showed significantly greater pain-related attentional and interpretation biases relative to controls, with no differences in memory bias. No significant correlation was found between any of the three forms of cognitive bias assessed. Discussion and conclusion: The clinical implications of cognitive biases in individuals with chronic pain remain to be fully explored, although one avenue for future research would be specific investigation of the implications of biased interpretations considering the consistency of results found across the literature for this form of bias.
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