Time-to-death patterns in markers of age and dependency

Altres ajuts: HHS/R01-AG011552Altres ajuts: HHS/R01-AG04024Altres ajuts: UK/ESRC/ES/K004611/1We aim to determine the extent to which variables commonly used to describe health, wellbeing, and disability in old-age vary primarily as a function of years lived (chronological age), years left (thanatological age), or as a function of both. We analyze data from the US Health and Retirement Study to estimate chronological age and time-to-death patterns in 78 such variables. We describe results from the birth cohort born 1915-1919 in the nal 12 years of life. Our results show that most markers used to study well-being in old-age vary along both the age and time-to-death dimensions, but some markers are exclusively a function of either time to death or chronological age, and others display different patterns between the sexes

Stages of development and injury: an epidemiological survey of young children presenting to an emergency department

<p><b>Background:</b> The aim of our study was to use a local (Glasgow, west of Scotland) version of a Canadian injury surveillance programme (CHIRPP) to investigate the relationship between the developmental stage of young (pre-school) children, using age as a proxy, and the occurrence (incidence, nature, mechanism and location) of injuries presenting to a Scottish hospital emergency department, in an attempt to replicate the findings of a recent study in Kingston, Canada.</p> <p><b>Methods:</b> We used the Glasgow CHIRPP data to perform two types of analyses. First, we calculated injury rates for that part of the hospital catchment area for which reasonably accurate population denominators were available. Second, we examined detailed injury patterns, in terms of the circumstances, mechanisms, location and types of injury. We compared our findings with those of the Kingston researchers.</p> <p><b>Results:</b> A total of 17,793 injury records for children aged up to 7 years were identified over the period 1997–99. For 1997–2001, 6,188 were used to calculate rates in the west of the city only. Average annual age specific rates per 1000 children were highest in both males and females aged 12–35 months. Apart from the higher rates in Glasgow, the pattern of injuries, in terms of breakdown factors, mechanism, location, context, and nature of injury, were similar in Glasgow and Kingston.</p> <p><b>Conclusion:</b> We replicated in Glasgow, UK, the findings of a Canadian study demonstrating a correlation between the pattern of childhood injuries and developmental stage. Future research should take account of the need to enhance statistical power and explore the interaction between age and potential confounding variables such as socio-economic deprivation. Our findings highlight the importance of designing injury prevention interventions that are appropriate for specific stages of development in children.</p&gt

Restarting a prisoner's life onto a supportive path leading to RESETtlement in the community: The RESET Study

Executive Summary The potential of not having secure accommodation upon release from prison is a major problem for prisoners with mental health needs. This study focused on evaluating an intervention that supported prisoners upon their release from prison with the primary objective being to support them in finding accommodation release from prison service. In September, 2019 there were 83,518 prisoners detained in England and Wales (Her Majesty’s Prison and Probation Service, 2019). The period of transition from prison to the community has been acknowledged as a confusing and chaotic experience for many which is intensified by being homeless. A recent survey ascertained that 36% of people found rough sleeping had previously been in prison (CHAIN, 2018). Being homeless is viewed as a major factor in the likelihood of reoffending (Homeless Link, 2018) and not engaging with support services (health services, GP services, welfare benefits) (Williamson, 2007). It has been estimated that over 90% of prisoners have one or more psychiatric disorders (psychosis, neurosis, personality disorder, hazardous drinking and drug dependency). The period directly before and following release from prison is a highly stressful and isolating experience that exacerbates mental health problems (Theurer & Lovell, 2008; The Mental Welfare Commission for Scotland, 2017). Hopkins & Thornicroft (2014) have also reported that prisoners with mental health problems have twenty-nine times the rate of all-cause mortality during the first two weeks after release compared to the general population and are 8.3 times more likely to commit suicide in the twelve months following release from prison compared to the general population. Hancock et al (2018) has proposed that secure housing is the most important factor in ensuring a positive transition from prison to the community for people with mental health problems due to: • It is impossible to address mental health support and treatment before a person has stable accommodation • without housing they are lost to care. If someone does not have a fixed address, they are difficult to locate and connect with which makes it hard to provide support • housing helps break a cycle of returning to poor previous relationships and routines Providing support for prisoners with mental health needs upon their release has the potential to be an important factor in helping reintegrate this cohort into the community through helping to find secure accommodation, improving health and wellbeing, engaging with services, re-establishing contacts with family and friends and reducing reoffending. The Bradley Report (2009) noted if prisoners receive the support they need inside prisons, they were more likely to engage with services outside prison. The report added for the resettlement of prisoners with mental health needs into the community to be successful, it was important to ensure that the engagement that had started in prisons continued once prisoners leave the prison gate. However, the evidence for the effectiveness of existing services approaches is limited. Hopkin et al (2018) undertook a systematic review examining interventions for prisoners with diagnosed mental health conditions that targeted the transition period between prison and the community. Thirteen studies were found (with only two in the UK). The conclusions drawn were that there was some evidence that the interventions examined could improve contact between service users and mental health and other services. However, evidence that it reduced reoffending was equivocal and none on of the studies had examined whether the intervention improved access to secure accommodation. During the period of the study, the standard care package offered to prisoners upon their release was based on the government’s Transforming Rehabilitation strategy aimed to reduce reoffending and to provide a seamless transition between prison and the community by developing “Through the Gate” services (Ministry of Justice, 2013). The Through the Gate service was delivered by the newly commissioned local Community Rehabilitation Companies (CRCs) to help prisoners maintain or find accommodation; aid with finance, benefits and debt; and to support them to enter education, training and employment. It has been noted that prisoners with mental health needs present different challenges, have multiple and complex needs and require a more focused approach than the support provided by the CRCs. In addition, limitations in the amount of support and assistance offered to prisoners with mental health needs and, in particular, the lack of planning and arrangements for suitable accommodation were identified by Her Majesty’s Inspectorate of Probation reports (HMIP, 2019). To provide intensive support to those who had offended but also have identified mental health needs, Oxleas NHS Foundation Trust commissioned Clarion Housing (at the time known as Centra) and Nacro to provide a resettlement service for prisoners with mental health needs upon their release; the Supporting Prisoners upon Release Service (RESET) Intervention service. Clarion Housing worked from HMP Elmley, HMP Rochester and HMP Stamford Hill, while Nacro and Clarion Housing operated in London from HMP ISIS, HMP Belmarsh and HMP Thameside. The threshold for meeting the criteria for receiving support was that service users must have had limited community support in place, high rates of reoffending, and meet at least step 3 on the Oxleas stepped care model. The RESET service was based on the principles of the Critical Time Intervention (CTI) approach. CTI is a structured, time limited intervention developed in the USA in the 1990s to prevent recurrent homelessness in transient individuals with severe and mental illness moving from hospital care into the community. In CTI, case managers provided support for up to nine months to strengthen times with family, friends and service providers and to provide practical and emotional support during the transition in to the community. Studies had found significantly reduced number of homelessness for those users receiving CTI (Susser et al, 1997). The main elements of the RESET service were: • A short-term (12 week) support service to prisoners with an identified level of mental health need • The focus was in obtaining appropriate safe and secure accommodation, access to welfare benefits, re-engagement with health services and strengthening links with family and community support services • Referrals to the service were made through the Mental Health Inreach team at each prison • Work began before release to develop rapport with service user, to try to secure accommodation, and start to fill out necessary paperwork • On the day of release, the support co-ordinator would meet the service user at the gate • The main aim in first day is to ensure the individual has some form of housing • Any released prisoner would be escorted to all crucial appointments on the day, such as probation and local authority housing • Support was provided to ensure that the service users had all the essentials for the first few days i.e. correct medication, scripts and planned appointments • The support co-ordinator worked intensively during the first week of service users release and then gradually reduced their level of contact The overall aim of this study was to evaluate the impact of the RESET service. The specified objectives were to examine the: • Participants’ housing situation • Rate of reoffending • Number of hospital admissions • Number on maintained benefits • Number of contacts with mental health and GP services • Level of engagement with services • Number in employment or education • The service user’s views of the RESET servic

Characterisation of the Medipix3 detector for 60 and 80 keV electrons

In this paper we report quantitative measurements of the imaging performance for the current generation of hybrid pixel detector, Medipix3, used as a direct electron detector. We have measured the modulation transfer function and detective quantum efficiency at beam energies of 60 and 80 keV. In single pixel mode, energy threshold values can be chosen to maximize either the modulation transfer function or the detective quantum efficiency, obtaining values near to, or exceeding those for a theoretical detector with square pixels. The Medipix3 charge summing mode delivers simultaneous, high values of both modulation transfer function and detective quantum efficiency. We have also characterized the detector response to single electron events and describe an empirical model that predicts the detector modulation transfer function and detective quantum efficiency based on energy threshold. Exemplifying our findings we demonstrate the Medipix3 imaging performance recording a fully exposed electron diffraction pattern at 24-bit depth together with images in single pixel and charge summing modes. Our findings highlight that for transmission electron microscopy performed at low energies (energies <100 keV) thick hybrid pixel detectors provide an advantageous architecture for direct electron imaging

Medipix3 Demonstration and understanding of near ideal detector performance for 60 & 80 keV electrons

In our article we report first quantitative measurements of imaging performance for the current generation of hybrid pixel detector, Medipix3, as direct electron detector. Utilising beam energies of 60 & 80 keV, measurements of modulation transfer function (MTF) and detective quantum efficiency (DQE) have revealed that, in single pixel mode (SPM), energy threshold values can be chosen to maximize either the MTF or DQE, obtaining values near to, or even exceeding, those for an ideal detector. We have demonstrated that the Medipix3 charge summing mode (CSM) can deliver simultaneous, near ideal values of both MTF and DQE. To understand direct detection performance further we have characterized the detector response to single electron events, building an empirical model which can predict detector MTF and DQE performance based on energy threshold. Exemplifying our findings we demonstrate the Medipix3 imaging performance, recording a fully exposed electron diffraction pattern at 24-bit depth and images in SPM and CSM modes. Taken together our findings highlight that for transmission electron microscopy performed at low energies (energies <100 keV) thick hybrid pixel detectors provide an advantageous and alternative architecture for direct electron imagin

Thermal conductivity measurement of liquids in a microfluidic device

A new microfluidic-based approach to measuring liquid thermal conductivity is developed to address the requirement in many practical applications for measurements using small (microlitre) sample size and integration into a compact device. The approach also gives the possibility of high-throughput testing. A resistance heater and temperature sensor are incorporated into a glass microfluidic chip to allow transmission and detection of a planar thermal wave crossing a thin layer of the sample. The device is designed so that heat transfer is locally one-dimensional during a short initial time period. This allows the detected temperature transient to be separated into two distinct components: a short-time, purely one-dimensional part from which sample thermal conductivity can be determined and a remaining long-time part containing the effects of three-dimensionality and of the finite size of surrounding thermal reservoirs. Identification of the one-dimensional component yields a steady temperature difference from which sample thermal conductivity can be determined. Calibration is required to give correct representation of changing heater resistance, system layer thicknesses and solid material thermal conductivities with temperature. In this preliminary study, methanol/water mixtures are measured at atmospheric pressure over the temperature range 30–50°C. The results show that the device has produced a measurement accuracy of within 2.5% over the range of thermal conductivity and temperature of the tests. A relation between measurement uncertainty and the geometric and thermal properties of the system is derived and this is used to identify ways that error could be further reduced

Time-to-death patterns in markers of age and dependency

We aim to determine the extent to which variables commonly used to describe health, well-being, and disability in old age vary primarily as a function of years lived (chronological age), years left (thanatological age), or as a function of both. We analyze data from the U.S. Health and Retirement Study to estimate chronological age and time-to-death patterns in 78 such variables.We describe results for the birth cohort 1915–1919 in the final 12 years of life. Our results show that most of the markers used to study well-being in old age vary along both the age and the timeto- death dimensions, but that some markers are exclusively a function of either time to death or chronological age, while other markers display different patterns in men and women

The 2018 Otto Aufranc Award: How does genome-wide variation affect osteolysis risk after THA?

BACKGROUND: Periprosthetic osteolysis resulting in aseptic loosening is a leading cause of THA revision. Individuals vary in their susceptibility to osteolysis and heritable factors may contribute to this variation. However, the overall contribution that such variation makes to osteolysis risk is unknown. QUESTIONS/PURPOSES: We conducted two genome-wide association studies to (1) identify genetic risk loci associated with susceptibility to osteolysis; and (2) identify genetic risk loci associated with time to prosthesis revision for osteolysis. METHODS: The Norway cohort comprised 2624 patients after THA recruited from the Norwegian Arthroplasty Registry, of whom 779 had undergone revision surgery for osteolysis. The UK cohort included 890 patients previously recruited from hospitals in the north of England, 317 who either had radiographic evidence of and/or had undergone revision surgery for osteolysis. All participants had received a fully cemented or hybrid THA using a small-diameter metal or ceramic-on-conventional polyethylene bearing. Osteolysis susceptibility case-control analyses and quantitative trait analyses for time to prosthesis revision (a proxy measure of the speed of osteolysis onset) in those patients with osteolysis were undertaken in each cohort separately after genome-wide genotyping. Finally, a meta-analysis of the two independent cohort association analysis results was undertaken. RESULTS: Genome-wide association analysis identified four independent suggestive genetic signals for osteolysis case-control status in the Norwegian cohort and 11 in the UK cohort (p ≤ 5 x 10). After meta-analysis, five independent genetic signals showed a suggestive association with osteolysis case-control status at p ≤ 5 x 10 with the strongest comprising 18 correlated variants on chromosome 7 (lead signal rs850092, p = 1.13 x 10). Genome-wide quantitative trait analysis in cases only showed a total of five and nine independent genetic signals for time to revision at p ≤ 5 x 10, respectively. After meta-analysis, 11 independent genetic signals showed suggestive evidence of an association with time to revision at p ≤ 5 x 10 with the largest association block comprising 174 correlated variants in chromosome 15 (lead signal rs10507055, p = 1.40 x 10). CONCLUSIONS: We explored the heritable biology of osteolysis at the whole genome level and identify several genetic loci that associate with susceptibility to osteolysis or with premature revision surgery. However, further studies are required to determine a causal association between the identified signals and osteolysis and their functional role in the disease. CLINICAL RELEVANCE: The identification of novel genetic risk loci for osteolysis enables new investigative avenues for clinical biomarker discovery and therapeutic intervention in this disease

Finding apparent horizons and other two-surfaces of constant expansion

Apparent horizons are structures of spacelike hypersurfaces that can be determined locally in time. Closed surfaces of constant expansion (CE surfaces) are a generalisation of apparent horizons. I present an efficient method for locating CE surfaces. This method uses an explicit representation of the surface, allowing for arbitrary resolutions and, in principle, shapes. The CE surface equation is then solved as a nonlinear elliptic equation. It is reasonable to assume that CE surfaces foliate a spacelike hypersurface outside of some interior region, thus defining an invariant (but still slicing-dependent) radial coordinate. This can be used to determine gauge modes and to compare time evolutions with different gauge conditions. CE surfaces also provide an efficient way to find new apparent horizons as they appear e.g. in binary black hole simulations.Comment: 21 pages, 8 figures; two references adde