Comparison of perceived and modelled geographical access to accident and emergency departments: a cross-sectional analysis from the Caerphilly Health and Social Needs Study

BACKGROUND: Assessment of the spatial accessibility of hospital accident and emergency departments as perceived by local residents has not previously been investigated. Perceived accessibility may affect where, when, and whether potential patients attend for treatment. Using data on 11,853 respondents to a population survey in Caerphilly county borough, Wales, UK, we present an analysis comparing the accessibility of accident and emergency departments as reported by local residents and drive-time to the nearest accident and emergency department modelled using a geographical information system (GIS). RESULTS: Median drive-times were significantly shorter in the lowest perceived access category and longer in the best perceived access category (p < 0.001). The perceived access and GIS modelled drive-time variables were positively correlated (Spearman's rank correlation coefficient, r = 0.38, p < 0.01). The strongest correlation was found for respondents living in areas in which nearly all households had a car or van (r = 0.47, p < 0.01). Correlations were stronger among respondents reporting good access to public transport and among those reporting a recent accident and emergency attendance for injury treatment compared to other respondents. Correlation coefficients did not vary substantially by levels of household income. Drive-time, road distance and straight-line distance were highly inter-correlated and substituting road distance or straight-line distance as the GIS modelled spatial accessibility measure only marginally decreased the magnitude of the correlations between perceived and GIS modelled access. CONCLUSION: This study provides evidence that the accessibility of hospital-based health care services as perceived by local residents is related to measures of spatial accessibility modelled using GIS. For studies that aim to model geographical separation in a way that correlates well with the perception of local residents, there may be minimal advantage in using sophisticated measures. Straight-line distance, which can be calculated without GIS, may be as good as GIS-modelled drive-time or distance for this purpose. These findings will be of importance to health policy makers and local planners who seek to obtain local information on access to services through focussed assessments of residents' concerns over accessibility and GIS modelling

Feasibility of Manual Teach-and-Replay and Continuous Impedance Shaping for Robotic Locomotor Training Following Spinal Cord Injury

Robotic gait training is an emerging technique for retraining walking ability following spinal cord injury (SCI). A key challenge in this training is determining an appropriate stepping trajectory and level of assistance for each patient, since patients have a wide range of sizes and impairment levels. Here, we demonstrate how a lightweight yet powerful robot can record subject-specific, trainer-induced leg trajectories during manually assisted stepping, then immediately replay those trajectories. Replay of the subject-specific trajectories reduced the effort required by the trainer during manual assistance, yet still generated similar patterns of muscle activation for six subjects with a chronic SCI. We also demonstrate how the impedance of the robot can be adjusted on a step-by-step basis with an error-based, learning law. This impedance-shaping algorithm adapted the robot's impedance so that the robot assisted only in the regions of the step trajectory where the subject consistently exhibited errors. The result was that the subjects stepped with greater variability, while still maintaining a physiologic gait pattern. These results are further steps toward tailoring robotic gait training to the needs of individual patients

Human milk bile-salt stimulated lipase Sequence similarity with rat lysophospholipase and homology with the active site region of cholinesterases

AbstractTo determine the active site residue, human milk bile-salt stimulated lipase (BSSL) was labelled with [3H]diisopropyl fluorophosphate (DFP). Partial sequence analysis or cyanogen bromide fragments (a total of 146 residues from 6 peptides) revealed 84% sequence identity with a putative rat lysophospholipase. Sequence analysis of a [3H]DFP-labelled peptide indicated that the active site serine was contained in the sequence Gly-Glu-Scr-Ala-Gly. In addition to similarity with rat lysophospholipase, this sequence showed homology with regions of human butyrylcholinesterase and electric ray acetylcholinesterase (68% identity). It is concluded that these proteins are members of a new supergene family

Exploring views on satisfaction with life in young children with chronic illness: an innovative approach to the collection of self-report data from children under 11

The objective of this study was to explore young children’s views on the impact of chronic illness on their life in order to inform future development of a patient-based self-report health outcome measure. We describe an approach to facilitating self-report views from young children with chronic illness. A board game was designed in order to obtain qualitative data from 39 children with a range of chronic illness conditions and 38 healthy controls ranging in age from 3 to 11 years. The format was effective in engaging young children in a self-report process of determining satisfaction with life and identified nine domains. The board game enabled children aged 5–11 years with chronic illness to describe the effects of living with illness on home, family, friends, school and life in general. It generated direct, non-interpreted material from children who, because of their age, may have been considered unable or limited their ability to discuss and describe how they feel. Obtaining this information for children aged 4 and under continues to be a challenge

An Overview of the Semi-Span Super-Sonic Transport (S4T) Wind-Tunnel Model Program

A summary of computational and experimental aeroelastic (AE) and aeroservoelastic (ASE) results for the Semi-Span Super-Sonic Transport (S4T) wind-tunnel model is presented. A broad range of analyses and multiple AE and ASE wind-tunnel tests of the S4T wind-tunnel model have been performed in support of the ASE element in the Supersonics Program, part of the NASA Fundamental Aeronautics Program. This paper is intended to be an overview of multiple papers that comprise a special S4T technical session. Along those lines, a brief description of the design and hardware of the S4T wind-tunnel model will be presented. Computational results presented include linear and nonlinear aeroelastic analyses, and rapid aeroelastic analyses using CFD-based reduced-order models (ROMs). A brief survey of some of the experimental results from two open-loop and two closed-loop wind-tunnel tests performed at the NASA Langley Transonic Dynamics Tunnel (TDT) will be presented as well

An Overview of Preliminary Computational and Experimental Results for the Semi-Span Super-Sonic Transport (S4T) Wind-Tunnel Model

A summary of computational and experimental aeroelastic and aeroservoelastic (ASE) results for the Semi-Span Super-Sonic Transport (S4T) wind-tunnel model is presented. A broad range of analyses and multiple ASE wind-tunnel tests of the S4T have been performed in support of the ASE element in the Supersonics Program, part of NASA's Fundamental Aeronautics Program. The computational results to be presented include linear aeroelastic and ASE analyses, nonlinear aeroelastic analyses using an aeroelastic CFD code, and rapid aeroelastic analyses using CFD-based reduced-order models (ROMs). Experimental results from two closed-loop wind-tunnel tests performed at NASA Langley's Transonic Dynamics Tunnel (TDT) will be presented as well

The TREAT-NMD DMD global database: Analysis of more than 7,000 duchenne muscular dystrophy mutations

Analyzing the type and frequency of patient-specific mutations that give rise to Duchenne muscular dystrophy (DMD) is an invaluable tool for diagnostics, basic scientific research, trial planning, and improved clinical care. Locus-specific databases allow for the collection, organization, storage, and analysis of genetic variants of disease. Here, we describe the development and analysis of the TREAT-NMD DMD Global database (http://umd.be/TREAT_DMD/). We analyzed genetic data for 7,149 DMD mutations held within the database. A total of 5,682 large mutations were observed (80% of total mutations), of which 4,894 (86%) were deletions (1 exon or larger) and 784 (14%) were duplications (1 exon or larger). There were 1,445 small mutations (smaller than 1 exon, 20% of all mutations), of which 358 (25%) were small deletions and 132 (9%) small insertions and 199 (14%) affected the splice sites. Point mutations totalled 756 (52% of small mutations) with 726 (50%) nonsense mutations and 30 (2%) missense mutations. Finally, 22 (0.3%) mid-intronic mutations were observed. In addition, mutations were identified within the database that would potentially benefit from novel genetic therapies for DMD including stop codon read-through therapies (10% of total mutations) and exon skipping therapy (80% of deletions and 55% of total mutations)

Time-to-response toxicity analysis as a method for drug susceptibility assessment in salmon lice

The salmon louse Lepeophtheirus salmonis (Kr&oslash;yer, 1837) is an ectoparasite causing infections ofwild and farmed Atlantic salmon (Salmo salar L.) in the Northern hemisphere.While L. salmonis control at commercial mariculture sites increasingly employs non-medicinal approaches, such as cage designs reducing infection rates and biological control through cleaner fish, anti-parasitic drugs are still a requirement for effective fish health care. With only a limited range of salmon delousing agents available, all of which have been in use for more than a decade, drug resistance formation has been reported for different products. Successful resistance management requires reliable susceptibility assessment, which is usually achieved through L. salmonis bioassays. These tests involve the exposure of parasites to different drug concentrations and require significant numbers of suitable L. salmonis stages. The present study reports an alternative bioassay that is based on time-to-response toxicity analyses and can be carried outwith limited parasite numbers. The assay determines the median effective time (ET50), i.e., the time required until impaired swimming and/or attachment behaviour becomes apparent in 50% of parasites, by conducting repeated examinations of test animals starting at the timepointwhere exposure to a set drug concentration commences. This experimental approach further allows the estimation of the apparent drug susceptibility of individual L. salmonis by determining their time to response, which may prove useful in experiments designed to elucidate associations between genetic factors and the drug susceptibility phenotype of parasites. Three laboratory strains of L. salmonis differing in susceptibility to emamectin benzoate were characterised using standard 24 h bioassays and time-to-response toxicity assays. While both the median effective concentration (EC50) and the ET50 showed variability between experimental repeats, both types of bioassay consistently discriminated susceptible and drug-resistant L. salmonis laboratory strains. Statement of relevance: Infections by sea lice cause significant costs to the global salmon farming industry, which have been estimated to exceed &euro;300 million per year worldwide. Control of sea lice still relies to a significant extent on chemical delousing; however, chemical control is threatened by resistance formation. Resistance can be combated by rotation between different drugs and strategic implementation of non-medicinal strategies. However, resistance management requires reliable and feasible methods of susceptibility assessment. The present study is a technical note introducing a novel approach to susceptibility assessments in sea lice. The method can be applied in susceptibility assessments on farms,where it offers the advantage of a reduced requirement of parasites for testing. In addition, the novel method allows deriving the times of parasite require to showa response after drug treatment has started, thus providing a variable characterizing the drug susceptibility phenotype of individual parasites. Accordingly, the bioassay approach presented here will be useful for studies aiming at unravelling the genetic determinants of drug resistance