Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England

Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreak

The Flight Telerobotic Servicer (FTS) NASA's first operational robotic system

NASA has completed the preliminary definition phase of the Flight Telerobotic Servicer (FTS) and is now preparing to begin the detailed design and fabrication phase. The FTS will be designed and built by Martin Marietta Astronautics Group in Denver, CO, for the Goddard Space Flight Center, in support of the Space Station Freedom Program. The design concepts for the FTS are discussed, as well as operational scenarios for the assembly, maintenance, servicing and inspection tasks which are being considered for the FTS. The upcoming Development Test Flight (DTF-1) is the first of two shuttle test flights to test FTS operations in the environment of space and to demonstrate the FTS capabilities in performing tasks for Space Station Freedom. Operational planning for DTF-1 is discussed as well as development plans for the operational support of the FTS on the space station

Hydrological Investigations at Biafo Glacier, Karakoram Range, Himalaya; an Important Source of Water For the Indus River

Over 80% of the flow of the Upper Indus River is derived from less than 20% of its area: essentially from zones of heavy snowfall and glacierized basins above 3500 m elevation. The trans-Himalaya n contribution comes largely from an area of some 20000 km2 of glacierized basins, mostly along the axis of the Greater Karakoram range and especially from 20-30 of the largest glacier basins. Very few glaciological investigations have so far been undertaken in this the major glacierized region of Central Asia. Biafo Glacier, one of the largest of the Karakoram glaciers, drains south-eastwards from the central Karakoram crest. Its basin covers a total area of 853 km2 , 628 km2 of which are permanent snow and ice, with 68% of the glacier area forming the accumulation zone. This paper describes investigations of snow accumulation, ablation , glacier movement, and glacier depth undertaken in the period 1985-87 , set against a background of investigations carried out over the last 130 yea rs. Biafo Glacier differs from most of the other Karakoram glaciers in being nourished mainly by direct snowfall rather than by avalanching; this has the advantage of allowing extensive investigation of accumulation over a broad range of altitude. Snow-accumulation studies in the Biafo Glacier basin have indicated that annual accumulation varies from 0.9 to 1.9 m of water equivalent between 4650 and 5450 m a .. s.l. This suggests an annual moisture input above the equilibrium line of approximately 0.6 km3. Monopulse radar measurements indicate the presence of ice thickness as great as 1400 m at the equilibrium line, although these results may not be completely reliable . Mean surface velocity during the summer of 0.8 m d -I has been measured near to the equilibrium line. Calculations of annual ice flux through the vertical cross-profile at the equilibrium line indicate a throughput of 0.7 km3 a-I Estimates from stake ablation measurements also suggest that ice loss on Biafo Glacier is about 0.7 km3 a-I. The close agreement between these three sets of measurements is reassuring, indicating that the ablation zone of Biafo Glacier, whose area covers 0.09% of the whole Upper Indus basin, produces approximately 0.9% of the total run-off. However. it should be mentioned that this estimate does not include water originating from seasonal snow melt, e either above or below the equilibrium line, or from rainfall. Net annual ice losses due to wastage of the glacier since 1910 are probably of the order of 0.4-{).5 m a-I; this would represent between 12 and 15% of annual water yield from melting ice

Integrability and explicit solutions in some Bianchi cosmological dynamical systems

The Einstein field equations for several cosmological models reduce to polynomial systems of ordinary differential equations. In this paper we shall concentrate our attention to the spatially homogeneous diagonal G_2 cosmologies. By using Darboux's theory in order to study ordinary differential equations in the complex projective plane CP^2 we solve the Bianchi V models totally. Moreover, we carry out a study of Bianchi VI models and first integrals are given in particular cases

How reversible is sea ice loss?

It is well accepted that increasing atmospheric CO<sub>2</sub> results in global warming, leading to a decline in polar sea ice area. Here, the specific question of whether there is a tipping point in the sea ice cover is investigated. The global climate model HadCM3 is used to map the trajectory of sea ice area under idealised scenarios. The atmospheric CO<sub>2</sub> is first ramped up to four times pre-industrial levels (4 × CO<sub>2</sub>), then ramped down to pre-industrial levels. We also examine the impact of stabilising climate at 4 × CO<sub>2</sub> prior to ramping CO<sub>2</sub> down to pre-industrial levels. Against global mean temperature, Arctic sea ice area is reversible, while the Antarctic sea ice shows some asymmetric behaviour – its rate of change slower, with falling temperatures, than its rate of change with rising temperatures. However, we show that the asymmetric behaviour is driven by hemispherical differences in temperature change between transient and stabilisation periods. We find no irreversible behaviour in the sea ice cover

What e-patients want from the doctor-patient relationship: content analysis of posts on discussion boards.

People with long-term conditions are encouraged to take control and ownership of managing their condition. Interactions between health care staff and patients become partnerships with sharing of expertise. This has changed the doctor-patient relationship and the division of roles and responsibilities that traditionally existed, but what each party expects from the other may not always be clear. Information that people with long-term conditions share on Internet discussion boards can provide useful insights into their expectations of health care staff. This paper reports on a small study about the expectations that people with a long-term condition (diabetes) have of their doctors using information gleaned from Internet discussion boards

Lithiation of InSb and Cu2_2Sb : A Theoretical Investigation

In this work the mechanism of Li insertion/intercalation in the anode materials InSb and Cu$_2$Sb is investigated by means of the first principles total energy calculations. The total charge densities for the lithiated products of the two compounds are presented. Based on these results the change in the bonding character on lithiation is discussed. Further, the isomer shift for InSb and Cu$_2$Sb and there various lithiated products is reported. The average insertion/intercalation voltage and volume expansion for transitions from InSb to Li$_2$InSb and Cu$_2$Sb to Li$_2$CuSb are calculated and found to be in good agreement with the experimental values. These findings help to resolve the controversy regarding the lithiation mechanism in InSb.Comment: 5 pages 3 figure

Information Costs and Reverse Payment Settlements: Bridging the Gap Between the Courts and the Antitrust Agencies

Reverse payment settlements have attracted increased scrutiny due to the controversial presence of a payment from a brand-name drug company to a generic company that is ostensibly preparing to infringe on the branded company’s patent. The antitrust agencies and the courts settled into an intergovernmental stalemate regarding the appropriate framework of analysis to apply when reviewing antitrust challenges to these settlements. The FTC and DOJ have viewed the deals skeptically as a vehicle for competitors to split monopoly profits, but the lower courts have generally been deferential to what they identified as an exercise of a patent holder’s lawful right to exclude. Much has been written about which side is correct, yet there has been relatively little exploration of the source of the persistent disagreement. Building off of Henry Smith’s property rights theory and the cognitive miser literature from Peter Lee, this Article explains that the long-standing disagreement stems from the judiciary’s application of information-cost-saving rules. Courts adopted a formalistic approach that would almost invariably uphold a reverse payment settlement because they tend to apply bright-line rules when dealing with property rights, and they are prone to adjudicate complex patent and patent-related cases in ways that economize on the costs of information processing. Although the Supreme Court resolved the disagreement by adopting a more information-demanding rule of reason approach in FTC v. Actavis, the cognitive miser phenomenon will continue to affect how courts adjudicate antitrust challenges to reverse-payment settlements

First Steps in Air Quality for Built Environment Practitioners

Air pollution is the biggest environmental risk to health. Globally, nine out of ten people live in a city that does not comply with WHO air quality standards. Within the UK, poor outdoor air quality is linked to 50,000 deaths each year. The most vulnerable are children, the elderly, or those with pre-existing medical conditions. The design of our urban infrastructure 13 including Green Infrastructure (GI) such as trees, parks, and green walls 13 determines where air pollution is produced, and how it disperses. Built environment professionals should consider air quality at all stages of urban design and development