1,735 research outputs found

    Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial

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    Background: Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS) software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services. Methods/Design: Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial. Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders. The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically. Discussion: Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services. In conclusion this complex emergency care trial will provide rigorous evidence on the clinical and cost effectiveness of CCDS for paramedics in the care of older people who have fallen

    Comparative life cycle assessment of LED lighting products

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    LED lighting products used in lighting applications and their subsequent environmental impact are growing rapidly. However, there are no in-depth updated studies that show how to assess and compare them for eco-design purposes. This research aims to add insights in this area to inform eco-design by assessing and comparing the environmental impact of a new LED eco-lighting product with an existing LED lighting product. A cradle to grave Life Cycle assessment (LCA) was conducted using ReCiPe Midpoint and Endpoint (H) life cycle impact assessment method with Simapro software. The system boundaries included all product life cycle stages, except the maintenance of the luminaires and the manufacturing of the packaging. A novel functional unit was defined for the assessment, which is more suitable for the LED lighting products. Six scenarios were considered, including three probable useful lives of the luminaires (1,000, 15,000 and 40,000 h) and two end of life options (domestic bin and recycling centre). The LCA results revealed that the new eco-lighting product has about 60% less environmental impact than the existing lighting product in all scenarios. The life cycle stages with the highest environmental impact are: 1) Use, 2) Manufacturing, 3) End of Life and 4) Transport. Based on the results obtained, recommendations for eco-design of LED lighting products were proposed, and challenges of application of LCA for the eco-design were discussed

    Attenuation of the Sensing Capabilities of PhoQ in Transition to Obligate Insect–Bacterial Association

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    Sodalis glossinidius, a maternally inherited endosymbiont of the tsetse fly, maintains genes encoding homologues of the PhoP-PhoQ two-component regulatory system. This two-component system has been extensively studied in facultative bacterial pathogens and is known to serve as an environmental magnesium sensor and a regulator of key virulence determinants. In the current study, we show that the inactivation of the response regulator, phoP, renders S. glossinidius sensitive to insect derived cationic antimicrobial peptides (AMPs). The resulting mutant strain displays reduced expression of genes involved in the structural modification of lipid A that facilitates resistance to AMPs. In addition, the inactivation of phoP alters the expression of type-III secretion system (TTSS) genes encoded within three distinct chromosomal regions, indicating that PhoP-PhoQ also serves as a master regulator of TTSS gene expression. In the absence of phoP, S. glossinidius is unable to superinfect either its natural tsetse fly host or a closely related hippoboscid louse fly. Furthermore, we show that the S. glossinidius PhoQ sensor kinase has undergone functional adaptations that result in a substantially diminished ability to sense ancestral signals. The loss of PhoQ's sensory capability is predicted to represent a novel adaptation to the static symbiotic lifestyle, allowing S. glossinidius to constitutively express genes that facilitate resistance to host derived AMPs

    The properties, origin and evolution of stellar clusters in galaxy simulations and observations

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    Published onlineWe investigate the properties and evolution of star particles in two simulations of isolated spiral galaxies, and two galaxies from cosmological simulations. Unlike previous numerical work, where typically each star particle represents one ‘cluster’, for the isolated galaxies we are able to model features we term ‘clusters’ with groups of particles. We compute the spatial distribution of stars with different ages, and cluster mass distributions, comparing our findings with observations including the recent LEGUS survey. We find that spiral structure tends to be present in older (100s Myr) stars and clusters in the simulations compared to the observations. This likely reflects differences in the numbers of stars or clusters, the strength of spiral arms, and whether the clusters are allowed to evolve. Where we model clusters with multiple particles, we are able to study their evolution. The evolution of simulated clusters tends to follow that of their natal gas clouds. Massive, dense, long-lived clouds host massive clusters, whilst short-lived clouds host smaller clusters which readily disperse. Most clusters appear to disperse fairly quickly, in basic agreement with observational findings. We note that embedded clusters may be less inclined to disperse in simulations in a galactic environment with continuous accretion of gas on to the clouds than isolated clouds and correspondingly, massive young clusters which are no longer associated with gas tend not to occur in the simulations. Caveats of our models include that the cluster densities are lower than realistic clusters, and the simplistic implementation of stellar feedback.We thank the referee for a useful report. The calculations for this paper were performed primarily on the DiRAC machine ‘Complexity’, as well as the supercomputer at Exeter, which is jointly funded by STFC, the Large Facilities Capital Fund of BIS, and the University of Exeter. We would like to thank Michele Fumagalli for work putting together the LEGUS cluster catalogues. CLD and CGF acknowledge funding from the European Research Council for the FP7 ERC starting grant project LOCALSTAR. CGF thanks Ben Thompson for performing data reduction. DG kindly acknowledges financial support by the German Research Foundation (DFG) through grant GO 1659/3-2. Figures in this paper were produced using splash (Price 2007)

    A novel isolator-based system promotes viability of human embryos during laboratory processing

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    In vitro fertilisation (IVF) and related technologies are arguably the most challenging of all cell culture applications. The starting material is a single cell from which one aims to produce an embryo capable of establishing a pregnancy eventually leading to a live birth. Laboratory processing during IVF treatment requires open manipulations of gametes and embryos, which typically involves exposure to ambient conditions. To reduce the risk of cellular stress, we have developed a totally enclosed system of interlinked isolator-based workstations designed to maintain oocytes and embryos in a physiological environment throughout the IVF process. Comparison of clinical and laboratory data before and after the introduction of the new system revealed that significantly more embryos developed to the blastocyst stage in the enclosed isolator-based system compared with conventional open-fronted laminar flow hoods. Moreover, blastocysts produced in the isolator-based system contained significantly more cells and their development was accelerated. Consistent with this, the introduction of the enclosed system was accompanied by a significant increase in the clinical pregnancy rate and in the proportion of embryos implanting following transfer to the uterus. The data indicate that protection from ambient conditions promotes improved development of human embryos. Importantly, we found that it was entirely feasible to conduct all IVF-related procedures in the isolator-based workstations

    DUST-CORRECTED STAR FORMATION RATES OF GALAXIES. I. COMBINATIONS OF H alpha AND INFRARED TRACERS

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    We combine Hα emission-line and infrared (IR) continuum measurements of two samples of nearby galaxies to derive dust attenuation-corrected star formation rates (SFRs). We use a simple energy balance based method that has been applied previously to H II regions in the Spitzer Infrared Nearby Galaxies Survey, and extend the methodology to integrated measurements of galaxies. We find that our composite Hα + IR based SFRs are in excellent agreement with attenuation-corrected SFRs derived from integrated spectrophotometry, over the full range of SFRs (0.01-80 M sun yr-1) and attenuations (0-2.5 mag) studied. We find that the combination of Hα and total IR luminosities provides the most robust SFR measurements, but combinations of Hα measurements with monochromatic luminosities at 24 μm and 8 μm perform nearly as well. The calibrations differ significantly from those obtained for H II regions, with the difference attributable to a more evolved population of stars heating the dust. Our results are consistent with a significant component of diffuse dust (the IR cirrus component) that is heated by a non-star-forming population. The same methodology can be applied to [O II]λ3727 emission-line measurements, and the radio continuum fluxes of galaxies can be applied in place of IR fluxes when the latter are not available. We assess the precision and systematic reliability of all of these composite methods
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