Implications of heterogeneous fracture distribution on reservoir quality; an analogue from the Torridon Group sandstone, Moine Thrust Belt, NW Scotland

This research was funded by a NERC CASE studentship (NERC code NE/I018166/1) in partnership with Midland Valley. Midland Valley's Move software was used for cross section construction and strain modelling. 3D Field software is acknowledged for contour map creation. Mark Cooper is thanked for constructive comments. Steven Laubach and Bill Dunne are thanked overseeing the editorial process and Magdalena Ellis Curry, Bertrand Gauthier and Arthur Lavenu are thanked for constructive reviews.Peer reviewedPublisher PD

Influence of structural position on fracture networks in the Torridon Group, Achnashellach fold and thrust belt, NW Scotland

Acknowledgements This research is funded by a NERC CASE studentship (NERC code NE/I018166/1) in partnership with Midland Valley. The authors thank Midland Valley for use of FieldMove Clino software for fracture data collection, and Move software for cross section construction, and strain modelling. 3D Field software is acknowledged for contour map creation. We also thank Toru Takeshita for overseeing the editorial process, and Catherine Hanks and Ole Petter Wennberg for constructive reviews.Peer reviewedPublisher PD

Middle Ground: Market Demand and the Housing Supply Mismatch for Middle Housing in the United States

The purpose of this report is to analyze the market case in other words, the abundance of demand and lack of supply for middle scale, middle density housing. This category of housing used to be common in our cities but today is better known as the “missing middle,” due to demolition of the existing stock and a lack of new construction. The concept of missing middle housing has gained traction among urban planning circles in recent years, and even in the popular press. As the concept generates more buzz, it is important to step back and substantiate the degree to which middle housing is a bonafide market opportunity that satisfies unmet housing demand, rather than a fad. This established, stakeholders in the real estate development process can move forward to the more difficult task of addressing the many known regulatory and financial challenges associated with actually building middle housing today. This report surveys these challenges briefly but is more focused on emphasizing the market opportunity at stake more than laying out regulatory solutions, which is already well addressed in the literature. This report operates on the belief that what is needed today is not so much solutions as motivation to actually work toward those solutions

The Effect of Authigenic Clays on Fault Zone Permeability

Leverhulme Trust (GrantNumber(s): ECF-2020-560) Natural Environment Research Council (GrantNumber(s): NE/N003063/1) Open access via Wiley agreementPeer reviewedPublisher PD

Psychological effects of withdrawal of growth hormone therapy from adults with growth hormone deficiency.

Objective: Growth hormone (GH) is known to be required for physical well-being. Whilst it is also widely believed to be important for quality of life (QoL) and psychological health, there is less supportive evidence. The objective of this study was to investigate the psychological effects of discontinuation of GH replacement from adults with severe GH deficiency (GHD). Design: A double-blind, placebo-controlled trial in which GH replacement therapy was discontinued for 3 months from 12 of 21 GH-deficient adults, where 9 continued with GH replacement. Patients: GH-treated adults (10 men, 11 women), all with severe GHD (peak GH Measurements: Semi-structured interviews were given at baseline and end-point plus questionnaires that included a new hormone-deficiency specific, individualised, QoL questionnaire (HDQoL), the General Well-being Index (GWBI), the Well-being Questionnaire (W-BQ12), Short-Form 36 health status questionnaire (SF-36), the Nottingham Health Profile NHP) and the General Health Questionnaire (GHQ). Results: Three months after baseline the serum total IGF-I of placebo-treated patients fell from normal, age related levels (mean 26.6 ± 13.2 nmol/ L) to levels indicative of severe GHD (11.6 ± 6.6 nmol/ L) (P Conclusion: Withdrawal of GH-treatment from adults with severe GHD has detrimental psychological effects

Accuracy of energy and nutrient intake estimation versus observed intake using 4 technology-assisted dietary assessment methods: A randomized crossover feeding study

Background: Technology-assisted 24-h dietary recalls (24HRs) have been widely adopted in population nutrition surveillance. Evaluations of 24HRs inform improvements, but direct comparisons of 24HR methods for accuracy in reference to a measure of true intake are rarely undertaken in a single study population. Objectives: To compare the accuracy of energy and nutrient intake estimation of 4 technology-assisted dietary assessment methods relative to true intake across breakfast, lunch, and dinner. Methods: In a controlled feeding study with a crossover design, 152 participants [55% women; mean age 32 y, standard deviation (SD) 11; mean body mass index 26 kg/m2, SD 5] were randomized to 1 of 3 separate feeding days to consume breakfast, lunch, and dinner, with unobtrusive weighing of foods and beverages consumed. Participants undertook a 24HR the following day [Automated Self-Administered Dietary Assessment Tool-Australia (ASA24); Intake24-Australia; mobile Food Record-Trained Analyst (mFR-TA); or Image-Assisted Interviewer-Administered 24-hour recall (IA-24HR)]. When assigned to IA-24HR, participants referred to images captured of their meals using the mobile Food Record (mFR) app. True and estimated energy and nutrient intakes were compared, and differences among methods were assessed using linear mixed models. Results: The mean difference between true and estimated energy intake as a percentage of true intake was 5.4% (95% CI: 0.6, 10.2%) using ASA24, 1.7% (95% CI: −2.9, 6.3%) using Intake24, 1.3% (95% CI: −1.1, 3.8%) using mFR-TA, and 15.0% (95% CI: 11.6, 18.3%) using IA-24HR. The variances of estimated and true energy intakes were statistically significantly different for all methods (P \u3c 0.01) except Intake24 (P = 0.1). Differential accuracy in nutrient estimation was present among the methods. Conclusions: Under controlled conditions, Intake24, ASA24, and mFR-TA estimated average energy and nutrient intakes with reasonable validity, but intake distributions were estimated accurately by Intake24 only (energy and protein). This study may inform considerations regarding instruments of choice in future population surveillance. This trial was registered at Australian New Zealand Clinical Trials Registry as ACTRN12621000209897

Asthma diagnosis: a comparison of established diagnostic guidelines in adults with respiratory symptoms

BackgroundConsiderable variability exists between asthma diagnostic guidelines. We tested the performance characteristics of the European Respiratory Society (ERS), the National Institute for Health and Care Excellence (NICE) and the Global Initiative for Asthma (GINA) guidelines for the diagnosis of asthma in adults.MethodsIn this prospective observational study (ISRCTN—11676160, May 2019–June 2022), participants referred from primary care with clinician-suspected asthma underwent comprehensive investigation including: spirometry, bronchodilator reversibility, fractional exhaled nitric oxide, peak expiratory flow variability, bronchial challenge testing with methacholine and mannitol, and responsiveness to inhaled corticosteroid therapy. Results were reviewed by a panel of asthma specialists to determine asthma diagnosis (reference standard) and compared to each diagnostic test and the ERS, NICE and GINA diagnostic algorithms (index tests). The sensitivity, specificity, positive predictive and negative predictive values were calculated.FindingsOne hundred and forty adults were enrolled and 118 given a definitive diagnostic outcome [75 female; mean (SD) age 36 (12) years; 70 (59%) with asthma] and included in the analysis. Sensitivity of individual tests was poor (15–62%), but they provided good specificity at the most stringent thresholds (range: 88–100%). The sensitivity/specificity of ERS, NICE and GINA was 81/85%, 41/100% and 47/100%, respectively. Concordance between guidelines was only moderate (Cohen’s Kappa 0.45–0.51).InterpretationCurrent guidelines for the diagnosis of asthma in adults provide either excellent specificity but low sensitivity (GINA and NICE) or only reasonable sensitivity and specificity (ERS). All guidelines therefore have limitations with regards to their clinical application; new guidelines are needed but should be tested prospectively before roll out

CARer-ADministration of as-needed subcutaneous medication for breakthrough symptoms in homebased dying patients (CARiAD):study protocol for a UK-based open randomised pilot trial

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Carer administration of as-needed sub-cutaneous medication for breakthrough symptoms in people dying at home: the CARiAD feasibility RCT

Background Most people who are dying want to be cared for at home, but only half of them achieve this. The likelihood of a home death often depends on the availability of able and willing lay carers. When people who are dying are unable to take oral medication, injectable medication is used. When top-up medication is required, a health-care professional travels to the dying person’s home, which may delay symptom relief. The administration of subcutaneous medication by lay carers, although not widespread UK practice, has proven to be key in achieving better symptom control for those dying at home in other countries. Objectives To determine if carer administration of as-needed subcutaneous medication for common breakthrough symptoms in people dying at home is feasible and acceptable in the UK, and if it would be feasible to test this intervention in a future definitive randomised controlled trial. Design We conducted a two-arm, parallel-group, individually randomised, open pilot trial of the intervention versus usual care, with a 1 : 1 allocation ratio, using convergent mixed methods. Setting Home-based care without 24/7 paid care provision, in three UK sites. Participants Participants were dyads of adult patients and carers: patients in the last weeks of their life who wished to die at home and lay carers who were willing to be trained to give subcutaneous medication. Strict risk assessment criteria needed to be met before approach, including known history of substance abuse or carer ability to be trained to competency. Intervention Intervention-group carers received training by local nurses using a manualised training package. Main outcome measures Quantitative data were collected at baseline and 6–8 weeks post bereavement and via carer diaries. Interviews with carers and health-care professionals explored attitudes to, experiences of and preferences for giving subcutaneous medication and experience of trial processes. The main outcomes of interest were feasibility, acceptability, recruitment rates, attrition and selection of the most appropriate outcome measures. Results In total, 40 out of 101 eligible dyads were recruited (39.6%), which met the feasibility criterion of recruiting > 30% of eligible dyads. The expected recruitment target (≈50 dyads) was not reached, as fewer than expected participants were identified. Although the overall retention rate was 55% (22/40), this was substantially unbalanced [30% (6/20) usual care and 80% (16/20) intervention]. The feasibility criterion of > 40% retention was, therefore, considered not met. A total of 12 carers (intervention, n = 10; usual care, n = 2) and 20 health-care professionals were interviewed. The intervention was considered acceptable, feasible and safe in the small study population. The context of the feasibility study was not ideal, as district nurses were seriously overstretched and unfamiliar with research methods. A disparity in readiness to consider the intervention was demonstrated between carers and health-care professionals. Findings showed that there were methodological and ethics issues pertaining to researching last days of life care. Conclusion The success of a future definitive trial is uncertain because of equivocal results in the progression criteria, particularly poor recruitment overall and a low retention rate in the usual-care group. Future work regarding the intervention should include understanding the context of UK areas where this has been adopted, ascertaining wider public views and exploring health-care professional views on burden and risk in the NHS context. There should be consideration of the need for national policy and of the most appropriate quantitative outcome measures to use. This will help to ascertain if there are unanswered questions to be studied in a trial. Trial registration Current Controlled Trials ISRCTN11211024. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 25. See the NIHR Journals Library website for further project information