A new quality of life consultation template for patients with venous leg ulceration

OBJECTIVE: Chronic venous leg ulcers (CVLUs) are common and recurrent, however, care for patients predominantly has a focus which overlooks the impact of the condition on quality of life. The aim of this study was to develop a simple, evidence-based consultation template, with patients and practitioners, which focuses consultations on quality of life themes. METHOD: A nominal group was undertaken to develop a new consultation template for patients with CVLUs based on the findings of earlier qualitative study phases. RESULTS: A user-friendly two-sided A4 template was designed to focus nurse-patient consultations on the quality of life challenges posed by CVLUs. CONCLUSION: CVLUs impact negatively on the quality of life of the patient but this receives inadequate attention during current consultations. This new template will help to ensure that key concerns are effectively raised, explored and addressed during each consultation. DECLARATION OF INTEREST: The NHS West Midlands Strategic Health Authority funded this study. The authors have no conflicts of interest to declare.NHS West Midlands Health Authorit

Standing Practice In Rehabilitation Early after Stroke (SPIRES): a functional standing frame programme (prolonged standing and repeated sit to stand) to improve function and quality of life and reduce neuromuscular impairment in people with severe sub-acute stroke-a protocol for a feasibility randomised controlled trial.

Background: The most common physical deficit caused by a stroke is muscle weakness which limits a person's mobility. Mobility encompasses activities necessary for daily functioning: getting in and out bed, on/off toilet, sitting, standing and walking. These activities are significantly affected in people with severe stroke who typically spend most of their time in bed or a chair and are immobile. Immobility is primarily caused by neurological damage but exacerbated by secondary changes in musculoskeletal and cardiorespiratory systems. These secondary changes can theoretically be prevented or minimised by early mobilisation, in this case standing up early post-stroke.Standing up early post-stroke has been identified as an important priority for people who have suffered a severe stroke. However, trials of prolonged passive standing have not demonstrated any functional improvements. Conversely, task-specific training such as repeated sit-to-stand has demonstrated positive functional benefits. This feasibility trial combines prolonged standing and task-specific strength training with the aim of determining whether this novel combination of physiotherapy interventions is feasible for people with severe stroke as well as the overall feasibility of delivering the trial. Methods/design: This is a pragmatic multi-centre parallel single-blinded two-armed feasibility randomised controlled trial. Fifty people with a diagnosis of severe stroke will be randomly allocated to either the functional standing frame programme or usual physiotherapy. All patient participants will be assessed at baseline and followed up at 3 weeks, then 3, 6 and 12 months post-randomisation. Trial objectives are to determine the feasibility according to the following indicators:: (i) Process: recruitment and retention rate, ability to consent, eligibility criteria, willingness/ability of physiotherapists to recruit, willingness of patients to be randomised, and acceptability of the intervention; (ii) Resource: burden and potential costs; (iii) Management: treatment fidelity, participant adherence, acceptability and completeness of outcome measures, impact and management or orthostatic hypotension; and (iv) Safety: number and nature of adverse and serious adverse events. Discussion: The functional standing frame programme addresses a key concern for people who have suffered a severe stroke. However, several uncertainties exist which need to be understood prior to progressing to a full-scale trial, including acceptability and tolerance of the functional standing frame programme intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties. Trial registration: International Standard Randomised Controlled Trial Number ISRCTN15412695. Registration on 19 December 2016

Data Management: File Systems, Databases, and Metadata

Data management contributes to the growth of local data infrastructure supporting collaborative research in the natural sciences. An important first step in local data management is the process of data assembly. Providing access by a consortium of researchers to assembled data requires planning with two timeframes in mind. In the short-term, support for data aggregation and access at the local site is a high priority. For the long-term, planning toward processes and procedures that support data migration to new technologies as well as to established data repositories is critical. Differing approaches to data storage, organization, and metadata provide examples of multi-temporal planning. A comparison is made between use of file systems and relational databases for heterogeneous field data. Best practices in data management planning will be used to show the weaknesses and strengths of each method.National Science Foundation (NSF DEB, Rapid Grant# 1347077) and Institute of Museum and Library Services Data Curation Education in Research Centers (IMLS/DCERC, Award# RE-02-10-0004-10)Ope

Theory of Spontaneous Polarization of Endohedral Fullerenes

A pseudo-Jahn-Teller model describing central atom distortions is proposed for endohedral fullerenes of the form A@C$_{60}$ where A is either a rare gas or a metal atom. A critical (dimensionless) coupling $g_c$ is found, below which the symmetric configuration is stable and above which inversion symmetry is broken. Vibronic parameters are given for selected endohedral fullerenes.Comment: 4 pages, REVTEX, 1 Postscript figure. [Phys. Rev. Lett. (in press)

Dynamical Jahn-Teller Effect and Berry Phase in Positively Charged Fullerene I. Basic Considerations

We study the Jahn-Teller effect of positive fullerene ions $^2$C$_{60}^{+}$ and $^1$C$_{60}^{2+}$. The aim is to discover if this case, in analogy with the negative ion, possesses a Berry phase or not, and what are the consequences on dynamical Jahn-Teller quantization. Working in the linear and spherical approximation, we find no Berry phase in $^1$C$_{60}^{2+}$, and presence/absence of Berry phase for coupling of one $L=2$ hole to an $L=4$/$L=2$ vibration. We study in particular the special equal-coupling case ($g_2=g_4$), which is reduced to the motion of a particle on a 5-dimensional sphere. In the icosahedral molecule, the final outcome assesses the presence/absence of a Berry phase of $\pi$ for the $h_u$ hole coupled to $G_g$/$H_h$ vibrations. Some qualitative consequences on ground-state symmetry, low-lying excitations, and electron emission from C$_{60}$ are spelled out.Comment: 31 pages (RevTeX), 3 Postscript figures (uuencoded

Fixed-bed gasification research using US coals. Volume 7. Gasification of Piney Tipple bituminous coal

A single-staged, fixed-bed Wellman-Galusha gasifier coupled with a hot, raw gas combustion system and scrubber has been used to gasify numerous coals from throughout the United States. The gasification test program is organized as a cooperative effort by private industrial participants and governmental agencies. The consortium of participants is organized under the Mining and Industrial Fuel Gas (MIFGa) Group. This report is the seventh volume in a series of reports describing the atmospheric pressure, fixed-bed gasification of US coals. This specific report describes the gasification of Piney Tipple bituminous coal. The period of the gasification test was July 18-24, 1983. 6 refs., 20 figs., 17 tabs

Fixed-bed gasification research using US coals. Volume 12. Gasification of Absaloka/Robinson subbituminous coal

A single-staged, fixed-bed Wellman-Galusha gasifier coupled with a hot, raw gas combustion system and scrubber has been used to gasify numerous coals from throughout the United States. The gasification test program is organized as a cooperative effort by private industrial particpants and governmental agencies. The consortium of participants is organized under the Mining and Industrial Fuel Gas (MIFGa) Group. This report is the twelfth volume in a series of reports describing the atmospheric pressure, fixed-bed gasification of US coals. this specific reports describes the gasification of Absaloka/Robinson subbituminous coal. This volume covers the test period June 18, 1984 to June 30, 1984. 4 refs., 20 figs., 18 tabs

Functional standing frame programme early after severe sub-acute stroke (SPIRES): a randomised controlled feasibility trial

Abstract Background Early mobilisation (&gt; 24 h post-stroke) is recommended for people with stroke. However, there is a paucity of evidence about how to implement early mobilisation for people who have had a severe stroke. Prolonged standing and task-specific training (sit-to-stand repetitions) have separately been evaluated in the literature; however, these functionally linked tasks have not been evaluated in combination for people with severe sub-acute stroke. Methods The objective was to determine the feasibility of conducting a randomised controlled trial (RCT) of a functional standing frame programme compared with usual physiotherapy for people with severe sub-acute stroke. An assessor-blinded feasibility RCT with nested qualitative component (interviews and focus group) and process evaluation was adopted. Participants were aged ≥ 18 years with new diagnosis of severe sub-acute stroke (modified Rankin Scale (mRS) 4/5) from four Stroke Rehabilitation Units across South West England. Participants were randomised to receive either: (1) functional standing frame programme (30 min. standing plus sit-to-stand repetitions) plus 15 min of usual physiotherapy daily (intervention); (2) usual physiotherapy (45 min) daily (control). Both programmes were protocolised to be undertaken a minimum of five sessions per week for 3 weeks. Feasibility indicators included process, resource, management, and safety. Adherence, fidelity, and acceptability of the trial and intervention were evaluated using data recorded by therapists, observation of intervention and control sessions, interviews and one focus group. Patient measures of motor impairment, activities/participation, and quality of life were carried out by blinded assessors at baseline, 3, 15, 29, and 55 weeks post-randomisation. Results Forty-five participants (51–96 years; 42% male, mRS 4 = 80% 5 = 20%) were randomised (n = 22 to intervention). Twenty-seven (60%) participants were followed-up at all time points. Twelve participants (27%) died during the trial; no deaths were related to the trial. Adherence to the minimum number of sessions was low: none of the participants completed all 21 sessions, and only 8 participants (18%) across both groups completed ≥ 15 sessions, over the 3 weeks; 39% intervention; 51% control sessions were completed; mean session duration 39 min (SD 19) control, 37 min intervention (SD 11). Intervention group: mean standing time 13 min (SD 9); mean sit-to-stand repetitions/session 5 (SD 4). Interviews were conducted with 10 participants, four relatives and six physiotherapists. Five physiotherapists attended a focus group. Conclusions The majority of progression criteria for this feasibility trial were met. However, adherence to the interventions was unacceptably low. This aspect of the trial design needs to be addressed prior to moving to a definitive RCT of this standing frame intervention in people with severe sub-acute stroke. Solutions have been identified to address these concerns. Trial registration International Standard Randomised Controlled Trial Number ISRCTN15412695. Registration 19 December 2016. </jats:sec

Education, Job Requirements, and Commuting: An Analysis of Network Flows

By now measures of employment "access" and "potential" have been widely diffused in the literature on regional economics and transport planning. Pooler (1995) gives a brief review of accessibility measures, indicating that these concepts date back to the 1930s. According to standard economic intuition, the employment access of a residential area increases with its proximity to concentrations of employment opportunities. The various indices of accessibility which have been proposed merely formalize and quantify this notion