Access to interpreting services in England: secondary analysis of national data

Background: Overcoming language barriers to health care is a global challenge. There is great linguistic diversity in the major cities in the UK with more than 300 languages, excluding dialects, spoken by children in London alone. However, there is dearth of data on the number of non-English speakers for planning effective interpreting services. The aim was to estimate the number of people requiring language support amongst the minority ethnic communities in England. Methods: Secondary analysis of national representative sample of subjects recruited to the Health Surveys for England 1999 and 2004. Results: 298,432 individuals from the four main minority ethnic communities (Indian, Pakistani, Bangladeshi and Chinese) who may be unable to communicate effectively with a health professional. This represents 2,520,885 general practice consultations per year where interpreting services might be required. Conclusion: Effective interpreting services are required to improve access and health outcomes of non-English speakers and thereby facilitate a reduction in health inequalities

NASA Propulsion Investments for Exploration and Science

The National Aeronautics and Space Administration (NASA) invests in chemical and electric propulsion systems to achieve future mission objectives for both human exploration and robotic science. Propulsion system requirements for human missions are derived from the exploration architecture being implemented in the Constellation Program. The Constellation Program first develops a system consisting of the Ares I launch vehicle and Orion spacecraft to access the Space Station, then builds on this initial system with the heavy-lift Ares V launch vehicle, Earth departure stage, and lunar module to enable missions to the lunar surface. A variety of chemical engines for all mission phases including primary propulsion, reaction control, abort, lunar ascent, and lunar descent are under development or are in early risk reduction to meet the specific requirements of the Ares I and V launch vehicles, Orion crew and service modules, and Altair lunar module. Exploration propulsion systems draw from Apollo, space shuttle, and commercial heritage and are applied across the Constellation architecture vehicles. Selection of these launch systems and engines is driven by numerous factors including development cost, existing infrastructure, operations cost, and reliability. Incorporation of green systems for sustained operations and extensibility into future systems is an additional consideration for system design. Science missions will directly benefit from the development of Constellation launch systems, and are making advancements in electric and chemical propulsion systems for challenging deep space, rendezvous, and sample return missions. Both Hall effect and ion electric propulsion systems are in development or qualification to address the range of NASA s Heliophysics, Planetary Science, and Astrophysics mission requirements. These address the spectrum of potential requirements from cost-capped missions to enabling challenging high delta-v, long-life missions. Additionally, a high specific impulse chemical engine is in development that will add additional capability to performance-demanding space science missions. In summary, the paper provides a survey of current NASA development and risk reduction propulsion investments for exploration and science

Liquid Oxygen/Liquid Methane Propulsion and Cryogenic Advanced Development

Exploration Systems Architecture Study conducted by NASA in 2005 identified the liquid oxygen (LOx)/liquid methane (LCH4) propellant combination as a prime candidate for the Crew Exploration Vehicle Service Module propulsion and for later use for ascent stage propulsion of the lunar lander. Both the Crew Exploration Vehicle and Lunar Lander were part the Constellation architecture, which had the objective to provide global sustained lunar human exploration capability. From late 2005 through the end of 2010, NASA and industry matured advanced development designs for many components that could be employed in relatively high thrust, high delta velocity, pressure fed propulsion systems for these two applications. The major investments were in main engines, reaction control engines, and the devices needed for cryogenic fluid management such as screens, propellant management devices, thermodynamic vents, and mass gauges. Engine and thruster developments also included advanced high reliability low mass igniters. Extensive tests were successfully conducted for all of these elements. For the thrusters and engines, testing included sea level and altitude conditions. This advanced development provides a mature technology base for future liquid oxygen/liquid methane pressure fed space propulsion systems. This paper documents the design and test efforts along with resulting hardware and test results

Prioritizing investments in innovations to protect women from the leading causes of maternal death

PATH, an international nonprofit organization, assessed nearly 40 technologies for their potential to reduce maternal mortality from postpartum hemorrhage and preeclampsia and eclampsia in low-resource settings. The evaluation used a new Excel-based prioritization tool covering 22 criteria developed by PATH, the Maternal and Neonatal Directed Assessment of Technology (MANDATE) model, and consultations with experts. It identified five innovations with especially high potential: technologies to improve use of oxytocin, a uterine balloon tamponade, simplified dosing of magnesium sulfate, an improved proteinuria test, and better blood pressure measurement devices. Investments are needed to realize the potential of these technologies to reduce mortality

How do combustion and non-combustion products used outdoors affect outdoor and indoor particulate matter levels? A field evaluation near the entrance of an italian university library

Particulate Matter (PM) is a well-known health risk factor and pollutes both outdoor and indoor air. Using PM as an air pollution indicator, the aims were to assess outdoor and indoor air pollution due to combustion and/or non-combustion products used outdoors and to compare the PM levels emitted by different products. PM with an aerodynamic diameter ≤10, 4, 2.5 and 1 µm (PM10, PM4, PM2.5, PM1) was simultaneously measured in two areas, respectively, indoors (with smoking ban) and outdoors (where people commonly smoke) of a university library during the morning and the afternoon of two weekdays. Both combustion and non-combustion products determined a relevant worsening of outdoor air quality, with the highest PM1 levels achieved when a single traditional cigarette (9920 µg m−3), a single e-cigarette (9810 µg m−3) and three simultaneous traditional cigarettes (8700 µg m−3) were smoked. An increase of indoor PM1 levels was found during outdoor smoking/vaping sessions, persisting also after the end of sessions. The results highlighted the need for a revision of smoke-free laws, especially for outdoor areas, to include non-combustion products. In addition, it is essential to make society aware of the dangers of smoking outdoors by implementing health promotion interventions

Giant Shapiro Resonances in a Flux Driven Josephson Junction Necklace

We present a detailed study of the dynamic response of a ring of $N$ equally spaced Josephson junctions to a time-periodic external flux, including screening current effects. The dynamics are described by the resistively shunted Josephson junction model, appropriate for proximity effect junctions, and we include Faraday's law for the flux. We find that the time-averaged $I-V$ characteristics show novel {\em subharmonic giant Shapiro voltage resonances}, which strongly depend on having phase slips or not, on $N$, on the inductance and on the external drive frequency. We include an estimate of the possible experimental parameters needed to observe these quantized voltage spikes.Comment: 8 pages RevTeX, 3 figures available upon reques

Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice

Flux Pinning and Phase Transitions in Model High-Temperature Superconductors with Columnar Defects

We calculate the degree of flux pinning by defects in model high-temperature superconductors (HTSC's). The HTSC is modeled as a three-dimensional network of resistively-shunted Josephson junctions in an external magnetic field, corresponding to a HTSC in the extreme Type-II limit. Disorder is introduced either by randomizing the coupling between grains (Model A disorder) or by removing grains (Model B disorder). Three types of defects are considered: point disorder, random line disorder, and periodic line disorder; but the emphasis is on random line disorder. Static and dynamic properties of the models are determined by Monte Carlo simulations and by solution of the analogous coupled overdamped Josephson equations in the presence of thermal noise. Random line defects considerably raise the superconducting transition temperature T$_c(B)$, and increase the apparent critical current density J$_c(B,T)$, in comparison to the defect-free crystal. They are more effective in these respects than a comparable volume density of point defects, in agreement with the experiments of Civale {\it et al}. Periodic line defects commensurate with the flux lattice are found to raise T$_c(B)$ even more than do random line defects. Random line defects are most effective when their density approximately equals the flux density. Near T$_c(B)$, our static and dynamic results appear consistent with the anisotropic Bose glass scaling hypotheses of Nelson and Vinokur, but with possibly different critical indices:Comment: 10 pages, LaTeX(REVTeX v3.0, twocolumn), 11 figures (not included

An auditory brainstem implant for treatment of unilateral tinnitus:protocol for an interventional pilot study

INTRODUCTION: Tinnitus may have a very severe impact on the quality of life. Unfortunately, for many patients, a satisfactory treatment modality is lacking. The auditory brainstem implant (ABI) was originally indicated for hearing restoration in patients with non-functional cochlear nerves, for example, in neurofibromatosis type II. In analogy to a cochlear implant (CI), it has been demonstrated that an ABI may reduce tinnitus as a beneficial side effect. For tinnitus treatment, an ABI may have an advantage over a CI, as cochlear implantation can harm inner ear structures due to its invasiveness, while an ABI is presumed to not damage anatomical structures. This is the first study to implant an ABI to investigate its effect on intractable tinnitus. METHODS AND ANALYSIS: In this pilot study, 10 adults having incapacitating unilateral intractable tinnitus and ipsilateral severe hearing loss will have an ABI implanted. The ABI is switched on 6 weeks after implantation, followed by several fitting sessions aimed at finding an optimal stimulation strategy. The primary outcome will be the change in Tinnitus Functioning Index. Secondary outcomes will be tinnitus burden and quality of life (using Tinnitus Handicap Inventory and Hospital Anxiety and Depression Scale questionnaires), tinnitus characteristics (using Visual Analogue Scale, a tinnitus analysis), safety, audiometric and vestibular function. The end point is set at 1 year after implantation. Follow-up will continue until 5 years after implantation. ETHICS AND DISSEMINATION: The protocol was reviewed and approved by the Institutional Review Board of the University Medical Centre Groningen, The Netherlands (METc 2015/479). The trial is registered at www.clinicialtrials.gov and will be updated if amendments are made. Results of this study will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER: NCT02630589. TRIAL STATUS: Inclusion of first patient in November 2017. Data collection is in progress. Trial is open for further inclusion. The trial ends at 5 years after inclusion of the last patient