Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort study

Background. Hip fracture is common in the elderly. Previous studies suggest that psychiatric illness is common and predicts poor outcome, but have methodological weaknesses. Further studies are required to address this important issue. Methods. We prospectively recruited 731 elderly participants with hip fracture in two Leeds hospitals. Psychiatric diagnosis was made within 5 days of surgery using the Geriatric Mental State schedule and other standardized instruments, and data on confounding factors was collected. Main study outcomes were length of hospital stay, and mortality over 6 months after fracture. Results. Fifty-five per cent of participants had cognitive impairment (dementia in 40% and delirium in 15%), 13% had a depressive disorder, 2% had alcohol misuse and 2% had other psychiatric diagnoses. Participants were likely to remain in hospital longer if they suffered from dementia, delirium or depression. The relative risks of mortality over 6 months after hip fracture were increased in dementia and delirium, but not in depression. Conclusions. Psychiatric illness is common after hip fracture, and has significant effects on important outcomes. This suggests a need for randomized, controlled trials of psychiatric interventions in the elderly hip fracture population

Application and sensitivity investigation of Fourier transforms for microwave radiometric inversions

Existing microwave radiometer technology now provides a suitable method for remote determination of the ocean surface's absolute brightness temperature. To extract the brightness temperature of the water from the antenna temperature equation, an unstable Fredholm integral equation of the first kind was solved. Fast Fourier Transform techniques were used to invert the integral after it is placed into a cross-correlation form. Application and verification of the methods to a two-dimensional modeling of a laboratory wave tank system were included. The instability of the Fredholm equation was then demonstrated and a restoration procedure was included which smooths the resulting oscillations. With the recent availability and advances of Fast Fourier Transform techniques, the method presented becomes very attractive in the evaluation of large quantities of data. Actual radiometric measurements of sea water are inverted using the restoration method, incorporating the advantages of the Fast Fourier Transform algorithm for computations

Elastic and plastic analysis of pressure vessel weld lands with mismatch

Elastic and plastic analysis of pressure vessel weld lands with mismatc

Elastic and plastic stresses at weld sinkages and other discontinuities in pressure vessels

Mismatch and weld sinkage problems of pressure vessel geometric discontinuities studied in design graphs and test progra

A unified acquisition system for acoustic data

A multichannel, acoustic AM carrier system was developed for a wide variety of applications, particularly for aircraft noise and sonic boom measurements. Each data acquisition channel consists of a condenser microphone, an acoustic signal converter, and a Zero Drive amplifier, along with peripheral supporting equipment. A control network insures continuous optimal tuning of the converter and permits remote calibration of the condenser microphone. With a 12.70-mm (1/2-in.) condenser microphone, the converter/Zero Drive amplifier combination has a frequency response from 0 Hz to 20 kHz (-3 db), a dynamic range exceeding 70 db, and a minimum noise floor of 50 db ref. 20 micro Pa) in the band 22.4 Hz to 22.4 kHz. The system requires no external impedance matching networks and is insensitive to cable length, at least up to 900 m (3,000 ft). System gain varies only + or - 1 db over the temperature range 4 to 54 C (40 to 130 F). Adapters are available to accommodate 23.77-mm (1-in.) and 6.35-mm (1/4-in.) microphones and to provide 30-db attenuation. A field test to obtain the acoustical time history of a helicopter flyover proved successful

Competition and productivity: a review of evidence

Does competition spur productivity? And if so, how does it do so? These have long been regarded as central questions in economics. This essay reviews the literature that makes progress toward answering both questions.Competition ; Monopolies ; Productivity

Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review

Introduction The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation efforts should be focussed, and also how to build contingency at the strategic level for agile responses to macro-level environmental influences

Competition at work : railroads vs. monopoly in the U.S. shipping industry

This study primarily establishes two things: (1) that monopoly has been pervasive in the U.S. water transportation industry in both the 19th and 20th centuries and has led to prices above competitive levels and the adoption of inefficient technologies and (2) that the competition of railroads has greatly weakened this monopolistic tendency, leading to lower water transport prices and fewer inefficient technologies. The study establishes these points using standard economic theory and extensive historical U.S. data on the behavior of unions and shipping companies. These gains from competition have been ignored by researchers studying the contribution of railroads to U.S. economic growth. Researchers have assumed that if railroads had not been developed, the long-distance transportation industry would have been competitive. This study shows that it would not have been. The quantitative estimates of previous studies thus are likely to have significantly understated the gains from the development of railroads.Transportation ; Monopolies