‘’It just happens’. Care home residents’ experiences and expectations of accessing GP care.

Background: Care homes provide personal care and support for older people who can no longer be supported in the community. As part of a larger study of integrated working between the NHS and care homes we asked older people how they accessed health care services. Our aim was to understand how older people resident in care homes access health services using the Andersen model of health care access. Methods: Case studies were conducted in six care homes with different socio-economic characteristics, size and ownership in three study sites. Residents in all care homes with capacity to participate were eligible for the study. Interviews explored how residents accessed NHS professionals. The Andersen model of health seeking behaviour was our analytic framework. Findings: Thirty-five participants were interviewed with an average of 4 different conditions. Expectations of their health and the effectiveness of services to mitigate their problems were low. Enabling factors were the use of intermediaries (usually staff, but also relatives) to seek access. Residents expected that care home staff would monitor changes in their health and seek appropriate help unprompted. Conclusions: Care home residents may normalise their health care needs and frame services as unable to remediate these which may combine to disincline older care home residents to seek care. Care access was enabled using intermediaries -either staff or relatives-and the expectation that staff would proactively seek care when they observed new/changed needs. Residents may over-estimate the health-related knowledge of care home staff and their ability to initiate referrals to NHS professionals.Peer reviewedFinal Accepted Versio

From catchment to national scale rainfall-runoff modelling: demonstration of a hydrological modelling framework

The increasing availability of digital databases (e.g. of climatology, topography, soils and land use) has enabled research into the generalisation of hydrological model parameter values from physical properties and the development of grid-based models. A hydrological modelling framework (HMF) is being developed to exploit this generalisation and provide a flexible gridded infrastructure, operational over regional, national or larger scales at a range of spatial and temporal resolutions. The capability of the framework is demonstrated through adaptation of an existing semi-distributed catchment-based rainfall-runoff model, CLASSIC, for which a generalised methodology exists to determine parameter values. The main change required was to ensure consistency of parameter values between the runoff procedure in CLASSIC and flow routing in the HMF. Assessment is by comparison of modelled and observed flow at grid points in Britain corresponding to gauging stations, both for catchments previously modelled and for new locations, for a range of catchment areas and physical properties and for four spatial resolutions (10, 5, 2.5 and 1 km). Good model performance is achieved for 90% of catchments tested, with a 5 km resolution proving adequate for catchments larger than 500 km2. Applications are outlined for which the framework could be used to test alternative modelling approaches or undertake consistent studies across the range of resolutions

A national-scale seasonal hydrological forecast system: development and evaluation over Britain

Skilful winter seasonal predictions for the North Atlantic circulation and northern Europe have now been demonstrated and the potential for seasonal hydrological forecasting in the UK is now being explored. One of the techniques being used combines seasonal rainfall forecasts provided by operational weather forecast systems with hydrological modelling tools to provide estimates of seasonal mean river flows up to a few months ahead. The work presented here shows how spatial information contained in a distributed hydrological model typically requiring high-resolution (daily or better) rainfall data can be used to provide an initial condition for a much simpler forecast model tailored to use low-resolution monthly rainfall forecasts. Rainfall forecasts (“hindcasts”) from the GloSea5 model (1996 to 2009) are used to provide the first assessment of skill in these national-scale flow forecasts. The skill in the combined modelling system is assessed for different seasons and regions of Britain, and compared to what might be achieved using other approaches such as use of an ensemble of historical rainfall in a hydrological model, or a simple flow persistence forecast. The analysis indicates that only limited forecast skill is achievable for Spring and Summer seasonal hydrological forecasts; however, Autumn and Winter flows can be reasonably well forecast using (ensemble mean) rainfall forecasts based on either GloSea5 forecasts or historical rainfall (the preferred type of forecast depends on the region). Flow forecasts using ensemble mean GloSea5 rainfall perform most consistently well across Britain, and provide the most skilful forecasts overall at the 3-month lead time. Much of the skill (64 %) in the 1-month ahead seasonal flow forecasts can be attributed to the hydrological initial condition (particularly in regions with a significant groundwater contribution to flows), whereas for the 3-month ahead lead time, GloSea5 forecasts account for  ∼ 70 % of the forecast skill (mostly in areas of high rainfall to the north and west) and only 30 % of the skill arises from hydrological memory (typically groundwater-dominated areas). Given the high spatial heterogeneity in typical patterns of UK rainfall and evaporation, future development of skilful spatially distributed seasonal forecasts could lead to substantial improvements in seasonal flow forecast capability, potentially benefitting practitioners interested in predicting hydrological extremes, not only in the UK but also across Europe

Unspoken playground rules discourage adolescent physical activity in school : a focus group study of constructs in the Prototype Willingness Model

The health benefits of exercise in school are recognised, yet physical activity continues to decline during early adolescence despite numerous interventions. In this study we investigated whether the Prototype Willingness Model, an account of adolescent decision-making that includes both reasoned behavioural choices and unplanned responses to social environments, might improve understanding of physical activity in school. We conducted focus groups with British pupils aged 12-13 and used deductive thematic analysis to search for themes relating to the model. Participants described reasoned decisions about physical activity outside school and unplanned choices to be inactive during break, in response to social contexts described as more ‘judgmental’ than in primary school. Social contexts appeared characterised by anxiety about competence, negative peer evaluation and inactive playground norms. The Prototype Willingness Model might more fully explain physical activity in school than reasoned behavioural models alone, indicating potential for interventions targeting anxieties about playground social environments

Determining when a hospital admission of an older person can be avoided in a subacute setting: a systematic review and concept analysis

Objective To conduct a systematic review of the evidence for when a hospital admission for an older person can be avoided in subacute settings. We examined the definition of admission avoidance and the evidence for the factors that are required to avoid admission to hospital in this setting. Methods Using defined PICOD criteria, we conducted searches in three databases (Medline, Embase and Cinahl) from January 2006 to February 2018. References were screened by title and abstract followed by full paper screening by two reviewers. Additional studies were searched from the grey literature, experts in the field and forward and backward referencing. Data were narratively described, and concept analysis was used to investigate the definition of admission avoidance. Results A total of 17 studies were considered eligible for review; eight provided a definition of admission avoidance and 10 described admission avoidance criteria. We identified three factors which play a key role in admission avoidance in the subacute setting: (1) ambulatory care sensitive conditions and common medical scenarios for the older person, which included respiratory infections or pneumonia, urinary tract infections and catheter care, dehydration and associated symptoms, falls and behavioural management, and managing ongoing chronic conditions; (2) criteria/tools, referring to interventions that have used clinical expertise in conjunction with a range of general and geriatric triage tools; in condition-specific interventions, the decision whether to admit or not was based on level of risk determined by defined clinical tools; and (3) personnel and resources, referring to the need for experts to make the initial decision to avoid an admission. Supervision by nurses or physicians was still needed at subacute level, requiring resources such as short-stay beds, intravenous antibiotic treatment or fluids for rehydration and rapid access to laboratory tests. Conclusion<jats:p/> The review identified a set of criteria for ambulatory care sensitive conditions and common medical scenarios for the older person that can be treated in the subacute setting with appropriate tools and resources. This information can help commissioners and care providers to take on these important elements and deliver them in a locally designed way

Quantum Loop Subalgebra and Eigenvectors of the Superintegrable Chiral Potts Transfer Matrices

It has been shown in earlier works that for Q=0 and L a multiple of N, the ground state sector eigenspace of the superintegrable tau_2(t_q) model is highly degenerate and is generated by a quantum loop algebra L(sl_2). Furthermore, this loop algebra can be decomposed into r=(N-1)L/N simple sl_2 algebras. For Q not equal 0, we shall show here that the corresponding eigenspace of tau_2(t_q) is still highly degenerate, but splits into two spaces, each containing 2^{r-1} independent eigenvectors. The generators for the sl_2 subalgebras, and also for the quantum loop subalgebra, are given generalizing those in the Q=0 case. However, the Serre relations for the generators of the loop subalgebra are only proven for some states, tested on small systems and conjectured otherwise. Assuming their validity we construct the eigenvectors of the Q not equal 0 ground state sectors for the transfer matrix of the superintegrable chiral Potts model.Comment: LaTeX 2E document, using iopart.cls with iopams packages. 28 pages, uses eufb10 and eurm10 fonts. Typeset twice! Version 2: Details added, improvements and minor corrections made, erratum to paper 2 included. Version 3: Small paragraph added in introductio

How might climate change affect river flows across West Africa?

West Africa and its semi-arid Sahelian region are one of the world’s most vulnerable regions to climate change with a history of extreme climate variability. There is still considerable uncertainty as to how projected climate change will affect precipitation at local and regional scales and the consequent impact on river flows and water resources across West Africa. Here, we aim to address this uncertainty by configuring a regional-scale hydrological model to West Africa. The model (hydrological modelling framework for West Africa—HMF-WA) simulates spatially consistent river flows on a 0.1° × 0.1° grid (approximately 10 km × 10 km) continuously across the whole domain and includes estimates of anthropogenic water use, wetland inundation, and local hydrological features such as endorheic regions. Regional-scale hydrological simulations driven by observed weather data are assessed against observed flows before undertaking an analysis of the impact of projected future climate scenarios from the CMIP5 on river flows up to the end of the twenty-first century. The results indicate that projected future changes in river flows are highly spatially variable across West Africa, particularly across the Sahelian region where the predicted changes are more pronounced. The study shows that median peak flows are projected to decrease by 23% in the west (e.g. Senegal) and increase by 80% in the eastern region (e.g. Chad) by the 2050s. The projected reductions in river flows in western Sahel lead to future droughts and water shortages more likely, while in the eastern Sahel, projected increases lead to future frequent floods

150,000-year palaeoclimate record from northern Ethiopia supports early, multiple dispersals of modern humans from Africa

Climatic change is widely acknowledged to have played a role in the dispersal of modern humans out of Africa, but the timing is contentious. Dispersal is often linked to climatic change at ~60,000 years ago, despite increasing evidence for earlier presence of modern humans in Asia. Here we report a deep seismic and near-continuous core record of the last 150,000 years from Lake Tana in the Ethiopian highlands, close to the earliest modern human fossil sites and to postulated dispersal routes. The record shows varied climate at the end of the penultimate glacial, followed by an abrupt change to relatively stable moist climate during the last interglacial. These conditions would have favored population growth and range expansion, supporting models of early, multiple dispersals of modern humans from AfricapublishersversionPeer reviewe