Opportunistic assessment of hearing in elderly inpatients

Objective: To determine the prevalence of occult hearing loss in elderly inpatients, to evaluate feasibility of opportunistic hearing screening and to determine subsequent provision of hearing aids. Materials and methods: Subjects (>65 years) were recruited from five elderly care wards. Hearing loss was detected by a ward-based hearing screen comprising patient-reported assessment of hearing disability and a whisper test. Subjects failing the whisper test or reporting hearing difficulties were offered formal audiological assessment. Results: Screening was performed on 51 patients aged between 70 and 95 years. Of the patients, 21 (41%) reported hearing loss and 16 (31%) failed the whisper test. A total of 37 patients (73%) were referred for audiological assessment with 17 (33%) found to have aidable hearing loss and 11 were fitted with hearing aids (22%). Discussion: This study highlights the high prevalence of occult hearing loss in elderly inpatients. Easy two-step screening can accurately identify patients with undiagnosed deafness resulting in significant proportions receiving hearing aids

Discovering the Data of Safety: Embry-Riddle’s Aviation Safety and Security Archives

The path to the sky and beyond has not been simple or obstacle-free, but dedicated dreamers have worked to overcome obstacles, learn from mishaps, and develop new technologies to achieve their goals. As the leading university for aviation and aerospace education, Embry-Riddle Aeronautical University maintains a firm commitment to the practice and study of safety. As part of this mission, the university has established the Aviation Safety and Security Archives (ASASA) which is a national treasure of aviation safety history and information

Nutritional management for reproductive efficiency

Nutrition influences reproductive efficiency and the survival of lambs and weaners but the costs of supplementary feeding or maintaining low stocking rates are not justified by the resulting income from higher lamb weaning rates and reduced weaner mortality. The current practice of segmenting the ewe flock using ultrasound scanning to determine the number of foetuses still results in groups of ewes with a wide range of condition scores and with widely differing nutritional requirements. This report describes an approach to precision management of pregnant ewes and weaners that is based on the e-sheep platform of technologies and uses computer-directed drafting for nutritional management of individual animals and walk-through weighing to monitor changing nutritional status. It is estimated that the cost of feeding a thousand-ewe flock can be reduced from $14,000 for feeding all animals to$3300 for targeted feeding of 25% of ewes requiring additional nutrition and 20% of weaners at risk of dying. The cost of the targeted feeding strategy is more than justified by the value of additional 12-month-old animals, which is $9000. The e-sheep precision nutrition system is not attractive to industry at this stage because of the cost of the e-sheep infrastructure, the perceived complexity of the technology and the requirement for further research, but it is expected to be a commercial option within three years

Improving sheep feedlot management

This paper summarise six studies undertaken by the Sheep CRC to elucidate certain aspects of confinement feeding of sheep. A review of confinement feeding highlighted the variability of growth rate and feed conversion of sheep and revealed that little is known about the use of sorghum for feeding sheep. The review indicated that the main factors responsible for variation of growth rate and feed conversion were adaptation to grain and feeding system, including the preparation and presentation of feed. The importance of social and physiological adaptation to grain feeding was confirmed. Factors identified as responsible for safe induction and uniform growth rates included prior exposure to grain as lambs, gradual introduction of grain and, when concentrate was provided ad libitum from the first day, the use of either virginiamycin, a pelleted feed, a total mixed ration or a step-wise increase of high-starch grain components. Separate feeding of hay and grain resulted in performance comparable with that of a pelleted diet and that of a total mixed ration. Sorghum-based concentrate diets resulted in growth rates and carcase weights similar to that for winter cereal grains or pellets. Steam flaking or expanding of sorghum had no significant effect on growth rates or carcase weights. These results can be used to determine the profitability of various feedlotting options

Improving sheep feedlot management

This paper summarise six studies undertaken by the Sheep CRC to elucidate certain aspects of confinement feeding of sheep. A review of confinement feeding highlighted the variability of growth rate and feed conversion of sheep and revealed that little is known about the use of sorghum for feeding sheep. The review indicated that the main factors responsible for variation of growth rate and feed conversion were adaptation to grain and feeding system, including the preparation and presentation of feed. The importance of social and physiological adaptation to grain feeding was confirmed. Factors identified as responsible for safe induction and uniform growth rates included prior exposure to grain as lambs, gradual introduction of grain and, when concentrate was provided ad libitum from the first day, the use of either virginiamycin, a pelleted feed, a total mixed ration or a step-wise increase of high-starch grain components. Separate feeding of hay and grain resulted in performance comparable with that of a pelleted diet and that of a total mixed ration. Sorghum-based concentrate diets resulted in growth rates and carcase weights similar to that for winter cereal grains or pellets. Steam flaking or expanding of sorghum had no significant effect on growth rates or carcase weights. These results can be used to determine the profitability of various feedlotting options

Astrophysical Lasers Operating in optical Fe II Lines Lines in Stellar Ejecta of Eta Carinae

After the discovery of space masers based on OH radicals (Weaver et al, 1965) and H2O (Cheung et al, 1969) such microwave lasers have been found to work in more than 100 molecular species (Elitzur, 1992; Townes, 1997), as well as in highly excited H atoms (Strelnitski et al,1996). In the IR region (10 microns), the effect of stimulated emission of radiation in the CO2 molecule has been discovered in the Martian and Venus' atmospheres (Betz et al, 1976; Mumma et al, 1981). We report here on the discovery of laser action in the range 0.9-2 micr. in several spectral lines of Fe II, which are associated with transitions from "pseudo-metastable" states populated by spontaneous transitions from Ly-alpha pumped Fe II levels. The intense Ly-alpha radiation is formed in the HII region of gas condensations close to the star Eta Carinae. The laser transitions form together with spontaneous transitions closed radiative cycles, one of which includes the extremely bright 2507/09 A lines. Closed radiative cycles, together with an accidental mixing of energy levels, may provide an explanation of the abnormal intensities of these UV non-lasing lines. Using the complicated energy level diagram of Fe II we present those peculiar features, which are essential for the inverted population and laser effect: the pumping, the level mixing, and the "bottle neck" for spontaneous decay. The laser action is a new indicator of non-equilibrium and spatially non-homogeneous physical conditions as well as a high brightness temperature of Ly-alpha in ejecta from eruptive stars. Such conditions are very difficult to probe by existing methods, and we propose some future experiments. The fact, that the lasing near-IR lines appear in the spectrum with about the same inten- sity as non-lasing lines is discussed and compared with the situation in masers.Comment: 27 pages, 11 figures; to be published in A&A; also available at http://130.235.102.158/blackhole/astrolaser.pd

Phase transitions for suspension flows

This paper is devoted to study thermodynamic formalism for suspension flows defined over countable alphabets. We are mostly interested in the regularity properties of the pressure function. We establish conditions for the pressure function to be real analytic or to exhibit a phase transition. We also construct an example of a potential for which the pressure has countably many phase transitions.Comment: Example 5.2 expanded. Typos corrected. Section 6.1 superced the note "Thermodynamic formalism for the positive geodesic flow on the modular surface" arXiv:1009.462

Sepsis recognition tools in acute ambulatory care::associations with process of care and clinical outcomes in a service evaluation of an Emergency Multidisciplinary Unit in Oxfordshire

To assess the performance of currently available sepsis recognition tools in patients referred to a community-based acute ambulatory care unit.Service evaluation of consecutive patients over a 4-month period.Community-based acute ambulatory care unit.Observations, blood results and outcome data were analysed from patients with a suspected infection. Clinical features at first assessment were used to populate sepsis recognition tools including: systemic inflammatory response syndrome (SIRS) criteria, National Early Warning Score (NEWS), quick Sequential Organ Failure Assessment (qSOFA) and National Institute for Health and Care Excellence (NICE) criteria. Scores were assessed against the clinical need for escalated care (use of intravenous antibiotics, fluids, ongoing ambulatory care or hospital treatment) and poor clinical outcome (all-cause mortality and readmission at 30 days after index assessment).Of 533 patients (median age 81 years), 316 had suspected infection with 120 patients requiring care escalated beyond simple community care. SIRS had the highest positive predictive value (50.9%, 95% CI 41.6% to 60.3%) and negative predictive value (68.9%, 95% CI 62.6% to 75.3%) for the need for escalated care. Both NEWS and SIRS were better at predicting the need for escalated care than qSOFA and NICE criteria in patients with suspected infection (all P<0.001). While new-onset confusion predicted the need for escalated care for infection in patients ≥85 years old (n=114), 23.7% of patients ≥85 years had new-onset confusion without evidence for infection.Acute ambulatory care clinicians should use caution in applying the new NICE endorsed criteria for determining the need for intravenous therapy and hospital-based location of care. NICE criteria have poorer performance when compared against NEWS and SIRS and new-onset confusion was prevalent in patients aged ≥85 years without infection

Dust Formation Above Cool Magnetic Spots in Evolved Stars

We examine the structure of cool magnetic spots in the photospheres of evolved stars, specifically asymptotic giant branch (AGB) stars and R Coronae Borealis stars. We find that the photosphere of a cool magnetic spot will be above the surrounding photosphere of AGB stars, opposite to the situation in the sun. This results from the behavior of the opacity, which increases with decreasing temperature, opposite to the behavior of the opacity near the effective temperature of the sun. We analyze the formation of dust above the cool magnetic spots, and suggest that the dust formation is facilitated by strong shocks, driven by stellar pulsations, which run through and around the spots. The presence of both the magnetic field and cooler temperatures make dust formation easier as the shock passes above the spot. We review some observations supporting the proposed mechanism, and suggest further observations to check the model.Comment: 22 pages, uses aasms4.sty, preprin