The NHS Health Check programme: implementation in east London 2009-2011

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http:// creativecommons.org/licenses/by-nc/4.0/Objectives To describe implementation and results from the National Health Service (NHS) Health Check programme. Design Three-year observational open cohort study: 2009–2011. Participants People of age 40–74 years eligible for an NHS Health Check. Setting 139/143 general practices in three east London primary care trusts (PCTs) serving an ethnically diverse and socially disadvantaged population. Method Implementation was supported with education, IT support and performance reports. Tower Hamlets PCT additionally used managed practice networks and prior-stratification to call people at higher cardiovascular (CVD) risk first. Main outcomes measures Attendance, proportion of high-risk population on statins and comorbidities identified. Results Coverage 2009, 2010, 2011 was 33.9% (31 878/10 805), 60.6% (30 757/18 652) and 73.4% (21 194/28 890), respectively. Older people were more likely to attend than younger people. Attendance was similar across deprivation quintiles and was in accordance with population distributions of black African/Caribbean, South Asian and White ethnic groups. 1 in 10 attendees were at high-CVD risk (20% or more 10-year risk). In the two PCTs stratifying risk, 14.3% and 9.4% of attendees were at high-CVD risk compared to 8.6% in the PCT using an unselected invitation strategy. Statin prescription to people at high-CVD risk was higher in Tower Hamlets 48.9%, than in City and Hackney 23.1% or Newham 20.2%. In the 6 months following an NHS Health Check, 1349 new cases of hypertension, 638 new cases of diabetes and 89 new cases of chronic kidney disease (CKD) were diagnosed. This represents 1 new case of hypertension per 38 Checks, 1 new case of diabetes per 80 Checks and 1 new case of CKD per 568 Checks. Conclusions Implementation of the NHS Health Check programme in these localities demonstrates limited success. Coverage and treatment of those at high-CVD risk could be improved. Targeting invitations to people at high-CVD risk and managed practice networks in Tower Hamlets improved performanc

Enablers and constraints women en counter in advancing to senior managerial positions: Case of South African Military Health Institutions in the Western Cape

School for Defence Organisation and Resource Managemen

Tigard Walks (A Plan for Walkable Neighborhoods in Tigard)

The Walkable Neighborhoods Plan for Tigard outlines a set of strategies to help Tigard’s residents, businesses, and leaders build their city into a more walkable place. These five strategies are based on three core values gleaned from StepUP Studio’s outreach efforts to the people living and working in and for the city of Tigard. This project was conducted under the supervision of Sy Adler, Marisa A. Zapata and Gil Kelle

Two-component model of the interaction of an interstellar cloud with surrounding hot plasma

We present a two-component gasdynamic model of an interstellar cloud embedded in a hot plasma. It is assumed that the cloud consists of atomic hydrogen gas, interstellar plasma is quasineutral. Hydrogen atoms and plasma protons interact through a charge exchange process. Magnetic felds and radiative processes are ignored in the model. The influence of heat conduction within plasma on the interaction between a cloud and plasma is studied. We consider the extreme case and assume that hot plasma electrons instantly heat the plasma in the interaction region and that plasma flow can be described as isothermal. Using the two-component model of the interaction of cold neutral cloud and hot plasma, we estimate the lifetime of interstellar clouds. We focus on the clouds typical for the cluster of local interstellar clouds embedded in the hot Local Bubble and give an estimate of the lifetime of the Local interstellar cloud where the Sun currently travels. The charge transfer between highly charged plasma ions and neutral atoms generates X-ray emission. We assume typical abundance of heavy ions for the Local Bubble plasma and estimate the X-ray emissivity due to charge exchange from the interface between cold neutral cloud and hot plasma. Our results show that charge exchange X-ray emission from the neutral-plasma interfaces can be a non-negligible fraction of the observed X-ray emission.Comment: 9 pages, 7 figure

Development of haemostatic decontaminants for treatment of wounds contaminated with chemical warfare agents. 3: Evaluation of in vitro topical decontamination efficacy using damaged skin

This document is the Accepted Manuscript version of the following article: Lydon, H. L., Hall, C. A., Dalton, C. H., Chipman, J. K., Graham, J. S., and Chilcott, R. P., ‘Development of haemostatic decontaminants for treatment of wounds contaminated with chemical warfare agends. 3: Evaluation of in vitro topical decontamination efficacy using damaged skin’, Journal of Applied Toxicology, Vol. 37 (8): 976-984, February 2017. The Version of Record is available online at doi: doi: 10.1002/jat.3446. Copyright © 2017 John Wiley & Sons, Ltd.Previous studies have demonstrated that haemostatic products with an absorptive mechanism of action retain their clotting efficiency in the presence of toxic materials and are effective in decontaminating chemical warfare (CW) agents when applied to normal, intact skin. The purpose of this in vitro study was to assess three candidate haemostatic products for effectiveness in the decontamination of superficially damaged porcine skin exposed to the radiolabelled CW agents soman (GD), VX and sulphur mustard (HD). Controlled physical damage (removal of the upper 100 µm skin layer) resulted in significant enhancement of the dermal absorption of all three CW agents. Of the haemostatic products assessed, WoundStat™ was consistently the most effective, being equivalent in performance to a standard military decontaminant (fuller’s earth). These data suggest that judicious application of haemostatic products to wounds contaminated with CW agents may be a viable option for the clinical management of casualties presenting with contaminated, haemorrhaging injuries. Further studies using a relevant animal model are required to confirm the potential clinical efficacy of WoundStat™ for treating wounds contaminated with CW agents.Peer reviewe

High ions towards white dwarfs: circumstellar line shifts and stellar temperature

Based on a compilation of OVI, CIV, SiIV and NV data from IUE, FUSE, GHRS, STIS, and COS, we derive an anti- correlation between the stellar temperature and the high ion velocity shift w.r.t. to the photosphere, with positive (resp. negative) velocity shifts for the cooler (resp. hotter) white dwarfs. This trend probably reflects more than a single process, however such a dependence on the WD's temperature again favors a CS origin for a very large fraction of those ion absorptions, previously observed with IUE, HST-STIS, HST-GHRS, FUSE, and now COS, selecting objects for which absorption line radial velocities, stellar effective temperature and photospheric velocity can be found in the literature. Interestingly, and gas in near-equilibrium in the star vicinity. It is also probably significant that the temperature that corresponds to a null radial velocity, i.e. \simeq 50,000K, also corresponds to the threshold below which there is a dichotomy between pure or heavy elements atmospheres as well as some temperature estimates for and a form of balance between radiation pressure and gravitation. This is consistent with ubiquitous evaporation of orbiting dusty material. Together with the fact that the fraction of stars with (red-or blue-) shifted lines and the fraction of stars known to possess heavy species in their atmosphere are of the same order, such a velocity-temperature relationship is consistent with quasi-continuous evaporation of orbiting CS dusty material, followed by accretion and settling down in the photosphere. In view of these results, ion measurements close to the photospheric or the IS velocity should be interpreted with caution, especially for stars at intermediate temperatures. While tracing CS gas, they may be erroneously attributed to photospheric material or to the ISM, explaining the difficulty of finding a coherent pattern of the high ions in the local IS 3D distribution.Comment: Accepted by A&A. Body of paper identical to v1. This submission has a more appropriate truncation of the original abstrac

A systematic review of studies measuring and reporting hearing aid usage in older adults since 1999: a descriptive summary of measurement tools

Objective: A systematic review was conducted to identify and quality assess how studies published since 1999 have measured and reported the usage of hearing aids in older adults. The relationship between usage and other dimensions of hearing aid outcome, age and hearing loss are summarised. Data sources: Articles were identified through systematic searches in PubMed/MEDLINE, The University of Nottingham Online Catalogue, Web of Science and through reference checking. Study eligibility criteria: (1) participants aged fifty years or over with sensori-neural hearing loss, (2) provision of an air conduction hearing aid, (3) inclusion of hearing aid usage measure(s) and (4) published between 1999 and 2011. Results: Of the initial 1933 papers obtained from the searches, a total of 64 were found eligible for review and were quality assessed on six dimensions: study design, choice of outcome instruments, level of reporting (usage, age, and audiometry) and cross validation of usage measures. Five papers were rated as being of high quality (scoring 10–12), 35 papers were rated as being of moderate quality (scoring 7–9), 22 as low quality (scoring 4–6) and two as very low quality (scoring 0–2). Fifteen different methods were identified for assessing the usage of hearing aids. Conclusions: Generally, the usage data reviewed was not well specified. There was a lack of consistency and robustness in the way that usage of hearing aids was assessed and categorised. There is a need for more standardised level of reporting of hearing aid usage data to further understand the relationship between usage and hearing aid outcomes

Looking for the party? The effects of partisan change on issue attention in UK Acts of Parliament

Political parties matter for government outcomes. Despite this general finding for political science research, recent work on public policy and agenda-setting has found just the opposite; parties generally do not matter when it comes to explaining government attention. While the common explanation for this finding is that issue attention is different than the location of policy, this explanation has never truly been tested. Through the use of data on nearly 65 years of UK Acts of Parliament, this paper presents a detailed investigation of the effect parties have on issue attention in UK Acts of Parliament. It demonstrates that elections alone do not explain changes in the distribution of policies across issues. Instead, the parties’ organizations, responses to economic conditions, and size of the parliamentary delegation influence the stability of issue attention following a party transition

Further investigation of white dwarfs in the open clusters NGC2287 and NGC3532

We report the results of a CCD imaging survey, complimented by astrometric and spectroscopic follow-up studies, that aims to probe the fate of heavy-weight intermediate mass stars by unearthing new, faint, white dwarf members of the rich, nearby, intermediate age open clusters NGC3532 and NGC2287. We identify a total of four white dwarfs with distances, proper motions and cooling times which can be reconciled with membership of these populations. We find that WDJ0643-203 in NGC2287, with an estimated mass of M=1.02-1.16Msun, is potentially the most massive white dwarf so far identified within an open cluster. Guided by the predictions of modern theoretical models of the late-stage evolution of heavy-weight intermediate mass stars, we conclude that there is a distinct possibility it has a core composed of O and Ne. We also determine that despite the cooling times of the three new white dwarfs in NGC3532 and the previously known degenerate member NGC3532-10 spanning ~90Myr, they all have remarkably similar masses (M~0.9-1Msun). This is fully consistent with the results from our prior work on a heterogeneous sample of ~50 white dwarfs from 12 stellar populations, on the basis of which we argued that the stellar initial mass-final mass relation is less steep at Minit>4Msun than in the adjacent lower initial mass regime. This change in the gradient of the relation could account for the secondary peak observed in the mass distribution of the field white dwarf population and mitigate the need to invoke close binary evolution to explain its existence. Spectroscopic investigation of numerous additional candidate white dwarf members of NGC3532 unearthed by a recent independent study would be useful to confirm (or otherwise) these conclusions.Comment: 8 Figures, 8 tables. Accepted for publication in MNRA