Successful ageing in an area of deprivation: Part 1—A qualitative exploration of the role of life experiences in good health in old age

Objectives: To determine the life histories and current circumstances of healthy and unhealthy older people who share an ecology marked by relative deprivation and generally poor health. Study design: In-depth interview study with a qualitative analysis. Methods: Matched pairs of healthy and unhealthy ‘agers’ were interviewed face-to-face. Healthy ageing was assessed in terms of hospital morbidity and self-reported health. Study participants consisted of 22 pairs (44 individuals), aged 72–89 years, matched for sex, age and deprivation category, and currently resident in the West of Scotland. All study participants were survivors of the Paisley/Renfrew (MIDSPAN) survey, a longitudinal study commenced in 1972 with continuous recording of morbidity and mortality since. Detailed life histories were obtained which focused on family, residence, employment, leisure and health. This information was supplemented by more focused data on ‘critical incidents’, financial situation and position in social hierarchies. Results: Data provided rich insights into life histories and current circumstances but no differences were found between healthy and unhealthy agers. Conclusions: It is important to understand what differentiates individuals who have lived in circumstances characterized by relative deprivation and poor health, yet have aged healthily. This study collected rich and detailed qualitative data. Yet, no important differences were detected between healthy and unhealthy agers. This is an important negative result as it suggests that the phenomenon of healthy ageing and the factors that promote healthy ageing over a lifetime are so complex that they will require even more detailed studies to disentangle

Connecting primary care patients to community-based physical activity:a qualitative study of health professional and patient views

Funding: NHS Fife Endowment Fund Grant which was awarded as part of a larger project (FIF142).Background Inconclusive evidence supporting referrals from health professionals to gym-based exercise programmes has raised concern for the roll-out of such schemes, and highlights the importance of developing links between healthcare settings and community-based opportunities to improve physical activity (PA) levels. Aim This study aimed to identify methods, and explore barriers and facilitators, of connecting primary care patients with PA opportunities from the perspectives of both health professionals (HPs) and patients, using the example of jogs cotland. Design & setting An exploratory study utilising semi-structured interviews with primary care patients (n = 14) and HPs (n = 14) from one UK NHS board was conducted. Method Patient and HP transcripts were analysed separately using thematic analysis. Potential methods of connection were identified. The Capability, Opportunity, Motivation, behavioural (COM-B) model and theoretical domains framework (TDF) were employed to facilitate identification of barriers and facilitators for connecting primary care to community jogscotland groups. Results Three methods of connecting patients to community-based groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators for patient connection fell into five TDF domains for HPs and two COM-B model components for patients. Conclusion For patients, HPs raising the topic of PA can help to justify, facilitate, and motivate action to change. The workload associated with connecting patients with community-based opportunities is central to implementation by HPs. Integrative resource solutions and social support for patients can provide a greater variety of PA options and the vital information and support for connecting with local opportunities, such as jogscotland.Publisher PDFPeer reviewe

To What Extent Can UAV Photogrammetry Replicate UAV LiDAR to Determine Forest Structure? A Test in Two Contrasting Tropical Forests

Tropical forests are complex multi-layered systems, with the height and three-dimensional (3D) structure of trees influencing the carbon and biodiversity they contain. Fine-resolution 3D data on forest structure can be collected reliably with Light Detection and Ranging (LiDAR) sensors mounted on aircraft or Unoccupied Aerial Vehicles (UAVs), however, they remain expensive to collect and process. Structure-from-Motion (SfM) Digital Aerial Photogrammetry (SfM-DAP), which relies on photographs taken of the same area from multiple angles, is a lower-cost alternative to LiDAR for generating 3D data on forest structure. Here, we evaluate how SfM-DAP compares to LiDAR data acquired concurrently using a fixed-wing UAV, over two contrasting tropical forests in Gabon and Peru. We show that SfM-DAP data cannot be used in isolation to measure key aspects of forest structure, including canopy height (%Bias: 40%–50%), fractional cover, and gap fraction, due to difficulties measuring ground elevation, even under low tree cover. However, we find even in complex forests, SfM-DAP is an effective means of measuring top-of-canopy structure, including surface heterogeneity, and is capable of producing similar measurements of vertical structure as LiDAR. Thus, in areas where ground height is known, SfM-DAP is an effective method for measuring important aspects of forest structure, including canopy height, and gaps, however, without ground data, SfM-DAP is of more limited utility. Our results support the growing evidence base pointing to photogrammetry as a viable complement, or alternative, to LiDAR, capable of providing much needed information to support the mapping and monitoring of biomass and biodiversity

Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer

The presence of systemic inflammation before surgery, as evidenced by the glasgow prognostic score (mGPS), predicts poor long-term survival in colorectal cancer. The aim was to examine the relationship between the preoperative mGPS and the development of postoperative complications in patients undergoing potentially curative resection for colorectal cancer. Patients (n=455) who underwent potentially curative resections between 2003 and 2007 were assessed consecutively, and details were recorded in a database. The majority of patients presented for elective surgery (85%) were over the age of 65 years (70%), were male (58%), were deprived (53%), and had TNM stage I/II disease (61%), had preoperative haemoglobin (56%), white cell count (87%) and mGPS 0 (58%) in the normal range. After surgery, 86 (19%) patients developed a postoperative complication; 70 (81%) of which were infectious complications. On multivariate analysis, peritoneal soiling (P<0.01), elevated preoperative white cell count (P<0.05) and mGPS (P<0.01) were independently associated with increased risk of developing a postoperative infection. In elective patients, only the mGPS (OR=1.75, 95% CI=1.17-2.63, P=0.007) was significantly associated with increased risk of developing a postoperative infection. Preoperative elevated mGPS predicts increased postoperative infectious complications in patients undergoing potentially curative resection for colorectal cancer

An Effective Method for InSAR Mapping of Tropical Forest Degradation in Hilly Areas

Current satellite remote sensing methods struggle to detect and map forest degradation, which is a critical issue as it is likely a major and growing source of carbon emissions and biodiveristy loss. TanDEM-X InSAR phase height (hϕ) is a promising variable for measuring forest disturbances, as it is closely related to the mean canopy height, and thus should decrease if canopy trees are removed. However, previous research has focused on relatively flat terrains, despite the fact that much of the world’s remaining tropical forests are found in hilly areas, and this inevitably introduces artifacts in sideways imaging systems. In this paper, we find a relationship between hϕ and aboveground biomass change in four selectively logged plots in a hilly region of central Gabon. We show that minimising multilooking prior to the calculation of hϕ strengthens this relationship, and that degradation estimates across steep slopes in the surrounding region are improved by selecting data from the most appropriate pass directions on a pixel-by-pixel basis. This shows that TanDEM-X InSAR can measure the magnitude of degradation, and that topographic effects can be mitigated if data from multiple SAR viewing geometries are available

Relationship between emergency presentation, systemic inflammatory response, and cancer-specific survival in patients undergoing potentially curative surgery for colon cancer

Background Emergency presentation is recognized to be associated with poorer cancer-specific survival following curative resection for colorectal cancer. The present study examined the hypothesis that an enhanced systemic inflammatory response, prior to surgery, might explain the impact of emergency presentation on survival. Methods In all, 188 patients undergoing potentially curative resection for colorectal cancer were studied. Of these, 55 (29%) presented as emergencies. The systemic inflammatory response was assessed using the Glasgow Prognostic Score (mGPS), which is the combination of an elevated C-reactive protein (>10 mg/L) and hypoalbuminemia (<35 g/L). Results In the emergency group, tumor stage was greater (P < 0.01), more patients received adjuvant therapy (P < 0.01) more patients had an elevated mGPS (P < 0.01), and more patients died of their disease (P < 0.05). The minimum follow-up was 12 months; the median follow-up of the survivors was 48 months. Emergency presentation was associated with poorer 3-year cancer-specific survival in those patients aged 65 to 74 years (P < 0.01), in both males and females (P < 0.05), in the deprived (P < 0.01), in patients with tumor-node-metastasis (TNM) stage II disease (P < 0.01), in those who received no adjuvant therapy (P < 0.01), and in the mGPS 0 and 1 groups (P < 0.05) groups. On multivariate survival analysis of patients undergoing potentially curative surgery for TNM stage II colon cancer, emergency presentation (P < 0.05) and mGPS (P < 0.05) were independently associated with cancer-specific survival. Conclusions These results suggest that emergency presentation and the presence of systemic inflammatory response prior to surgery are linked and account for poorer cancer-specific survival in patients undergoing potentially curative surgery for colon cancer. Both emergency presentation and an elevated mGPS should be taken into account when assessing the likely outcome of these patients

Computed tomographic angiography for the evaluation of aneurysmal subarachnoid hemorrhage.

OBJECTIVES: Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH. METHODS: Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient\u27s history. RESULTS: A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false-positive CTA. Follow-up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm. CONCLUSIONS: In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results

Statistical Classification Techniques for Photometric Supernova Typing

Future photometric supernova surveys will produce vastly more candidates than can be followed up spectroscopically, highlighting the need for effective classification methods based on lightcurves alone. Here we introduce boosting and kernel density estimation techniques which have minimal astrophysical input, and compare their performance on 20,000 simulated Dark Energy Survey lightcurves. We demonstrate that these methods are comparable to the best template fitting methods currently used, and in particular do not require the redshift of the host galaxy or candidate. However both methods require a training sample that is representative of the full population, so typical spectroscopic supernova subsamples will lead to poor performance. To enable the full potential of such blind methods, we recommend that representative training samples should be used and so specific attention should be given to their creation in the design phase of future photometric surveys.Comment: 19 pages, 41 figures. No changes. Additional material and summary video available at http://cosmoaims.wordpress.com/2010/09/30/boosting-for-supernova-classification

Cancer survival in England and Wales at the end of the 20th century

Survival has risen steadily since the 1970s for most cancers in adults in England and Wales, but persistent inequalities exist between those living in affluent and deprived areas. These differences are not seen for children. For many of the common adult cancers, these inequalities in survival (the 'deprivation gap') became more marked in the 1990s. This volume presents extended analyses of survival for adults diagnosed during the 14 years 1986-1999 and followed up to 2001, including trends in overall survival in England and Wales and trends in the deprivation gap in survival. The analyses include individual tumour data for 2.2 million cancer patients. This article outlines the structure of the supplement - an article for each of the 20 most common cancers in adults, followed by an expert commentary from one of the leading UK clinicians specialising in malignancies of that organ or system. The available data, quality control and methods of analysis are described here, rather than repeated in each of the 20 articles. We open the discussion between clinicians and epidemiologists on how to interpret the observed trends and inequalities in cancer survival, and we highlight some of the most important contrasts in these very different points of view. Survival improved substantially for adult cancer patients in England and Wales up to the end of the 20th century. Although socioeconomic inequalities in survival are remarkably persistent, the overall patterns suggest that these inequalities are largely avoidable