Improving continence services for older people from the service-providers' perspective: a qualitative interview study

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.Objective To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting 3 acute and 13 primary care National Health Service Trusts in England. Participants 16 continence service leads in England actively treating and managing older people with UI. Results In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.Funding was received from the New Dynamics of Ageing Programme, led by the Economic & Social Research Council, UK (grantnumber RES-353-25-0010)

The density of critical percolation clusters touching the boundaries of strips and squares

We consider the density of two-dimensional critical percolation clusters, constrained to touch one or both boundaries, in infinite strips, half-infinite strips, and squares, as well as several related quantities for the infinite strip. Our theoretical results follow from conformal field theory, and are compared with high-precision numerical simulation. For example, we show that the density of clusters touching both boundaries of an infinite strip of unit width (i.e. crossing clusters) is proportional to $(\sin \pi y)^{-5/48}\{[\cos(\pi y/2)]^{1/3} +[\sin (\pi y/2)]^{1/3}-1\}$. We also determine numerically contours for the density of clusters crossing squares and long rectangles with open boundaries on the sides, and compare with theory for the density along an edge.Comment: 11 pages, 6 figures. Minor revision

Polymer Concrete Overlay Evaluation

The objectives of this work were to document the state-of-the-practice with respect to polymer concrete overlays, document the placement of two overlays in Iowa, monitor the field performance of the overlays over a two-year period, and relate their performance to material usage and/or workmanship. The two bridges - a Johnson County, Iowa bridge over I-80 on 12th Avenue in Coralville, and the Keg Creek Bridge on Hwy 6 in western Iowa, 10 miles east of Council Bluffs - were overlaid during the summer/fall of 2013. The process by which each bridge was overlaid was similar in many ways, although a few slight differences existed. Over time, each overlay has generally performed quite well with only a few areas of exception. It is believed that these localized areas likely underperformed due to poor deck preparation, improper polymer mixing, snowplow impact, or a combination thereof

Iowa ABC Connections

For several years the Iowa Department of Transportation (DOT), Iowa State University, the Federal Highway Administration, and several Iowa counties have been working to develop accelerated bridge construction (ABC) concepts, details, and processes. Throughout this development, much has been learned and has resulted in Iowa being viewed as a national leader in the area of ABC. However, at this time, the Office of Bridges and Structures does not have a complete set of working standards nor design examples to accompany ABC portions of the bridge design manual (now called the Load and Resistance Factor Design/LRFD Bridge Design Manual). During the fall of 2013, the Iowa DOT constructed a bridge on IA 92 in Cass County using an ABC technique known as slide-in bridge construction. During the design of the Cass County Bridge, several questions were raised about the performance of critical design and construction details: the pile-to-pile cap connection and the polytetrafluoroethylene (PTFE) coated bearing pads on which the bridge would slide. The timing of this specific need and the initiation of this project offered a unique opportunity to provide significant short- and long-term value to the Office of Bridges and Structures. Several full-scale laboratory tests, which included several variations of the pile-to-pile cap connection and bearing pad slides, were completed. These tests proved that the connection was capable of achieving the desired capacity and that the expected coefficient of friction of the bearing pads was reasonably low. Finally, a design tool was developed for the Office of Bridges and Structures to be used on future projects that might benefit from a precast pile cap

Implementation of a Pilot Continuous Monitoring System: Iowa Falls Arch Bridge

The goal of this work was to move structural health monitoring (SHM) one step closer to being ready for mainstream use by the Iowa Department of Transportation (DOT) Office of Bridges and Structures. To meet this goal, the objective of this project was to implement a pilot multi-sensor continuous monitoring system on the Iowa Falls Arch Bridge such that autonomous data analysis, storage, and retrieval can be demonstrated. The challenge with this work was to develop the open channels for communication, coordination, and cooperation of various Iowa DOT offices that could make use of the data. In a way, the end product was to be something akin to a control system that would allow for real-time evaluation of the operational condition of a monitored bridge. Development and finalization of general hardware and software components for a bridge SHM system were investigated and completed. This development and finalization was framed around the demonstration installation on the Iowa Falls Arch Bridge. The hardware system focused on using off-the-shelf sensors that could be read in either “fast” or “slow” modes depending on the desired monitoring metric. As hoped, the installed system operated with very few problems. In terms of communications—in part due to the anticipated installation on the I-74 bridge over the Mississippi River—a hardline digital subscriber line (DSL) internet connection and grid power were used. During operation, this system would transmit data to a central server location where the data would be processed and then archived for future retrieval and use. The pilot monitoring system was developed for general performance evaluation purposes (construction, structural, environmental, etc.) such that it could be easily adapted to the Iowa DOT’s bridges and other monitoring needs. The system was developed allowing easy access to near real-time data in a format usable to Iowa DOT engineers

Intertwining caring science, caring practice and caring education from a lifeworld perspective—two contextual examples

This article describes how caring science can be a helpful foundation for caring practice and what kind of learning support that can enable the transformation of caring science into practice. The lifeworld approach is fundamental for both caring and learning. This will be illustrated in two examples from research that show the potential for promoting health and well-being as well as the learning process. One example is from a caring context and the other is from a learning context. In this article, learning and caring are understood as parallel processes. We emphasize that learning cannot be separated from life and thus caring and education is intertwined with caring science and life. The examples illustrate how an understanding of the intertwining can be fruitful in different contexts. The challenge is to implant a lifeworld-based approach on caring and learning that can lead to strategies that in a more profound way have the potential to strengthen the person's health and learning processes

Analyticity of layer potentials and L2L^{2} solvability of boundary value problems for divergence form elliptic equations with complex L∞L^{\infty} coefficients

We consider divergence form elliptic operators of the form L=-\dv A(x)\nabla, defined in $R^{n+1} = \{(x,t)\in R^n \times R \}$, $n \geq 2$, where the $L^{\infty}$ coefficient matrix $A$ is $(n+1)\times(n+1)$, uniformly elliptic, complex and $t$-independent. We show that for such operators, boundedness and invertibility of the corresponding layer potential operators on $L^2(\mathbb{R}^{n})=L^2(\partial\mathbb{R}_{+}^{n+1})$, is stable under complex, $L^{\infty}$ perturbations of the coefficient matrix. Using a variant of the $Tb$ Theorem, we also prove that the layer potentials are bounded and invertible on $L^2(\mathbb{R}^n)$ whenever $A(x)$ is real and symmetric (and thus, by our stability result, also when $A$ is complex, $\Vert A-A^0\Vert_{\infty}$ is small enough and $A^0$ is real, symmetric, $L^{\infty}$ and elliptic). In particular, we establish solvability of the Dirichlet and Neumann (and Regularity) problems, with $L^2$ (resp. $\dot{L}^2_1)$ data, for small complex perturbations of a real symmetric matrix. Previously, $L^2$ solvability results for complex (or even real but non-symmetric) coefficients were known to hold only for perturbations of constant matrices (and then only for the Dirichlet problem), or in the special case that the coefficients $A_{j,n+1}=0=A_{n+1,j}$, $1\leq j\leq n$, which corresponds to the Kato square root problem

Weighted maximal regularity estimates and solvability of non-smooth elliptic systems II

We continue the development, by reduction to a first order system for the conormal gradient, of $L^2$ \textit{a priori} estimates and solvability for boundary value problems of Dirichlet, regularity, Neumann type for divergence form second order, complex, elliptic systems. We work here on the unit ball and more generally its bi-Lipschitz images, assuming a Carleson condition as introduced by Dahlberg which measures the discrepancy of the coefficients to their boundary trace near the boundary. We sharpen our estimates by proving a general result concerning \textit{a priori} almost everywhere non-tangential convergence at the boundary. Also, compactness of the boundary yields more solvability results using Fredholm theory. Comparison between classes of solutions and uniqueness issues are discussed. As a consequence, we are able to solve a long standing regularity problem for real equations, which may not be true on the upper half-space, justifying \textit{a posteriori} a separate work on bounded domains.Comment: 76 pages, new abstract and few typos corrected. The second author has changed nam