5,786 research outputs found
Streamlining pathways for minor injuries in emergency departments through radiographer-led discharge
This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.Diagnostic imaging services are essential to the diagnosis pathway for many patients arriving at hospital emergency departments with a suspected fracture. Commonly, these patients need to be seen again by a doctor or emergency nurse practitioner after an X-ray image has been taken in order to finalise the diagnosis and determine the next stage in the patientsâ pathway. Here, significant waiting times can accrue for these follow-up consultations after radiographic imaging although the vast majority of patients are discharged. Research evidence from pilot studies suggests that patients with minor appendicular injuries could be safely discharged by a suitably qualified radiographer directly after imaging thereby avoiding queues for repeated consultation. In this study, we model patient pathways through an emergency department (ED) at a hospital in the South West of England using process mapping, interviews with ED staff and discrete event simulation (DES). The DES model allowed us to compare the current practice at the hospital with scenarios using radiographer-led discharge of patients directly after imaging and assess the reduction in patientsâ length of stay in ED. We also quantified trade-offs between the provision of radiographer-led discharge and its effects, i.e. reduction in waiting times and ED workload. Finally, we discuss how this decision support tool can be used to support understanding for patients and members of staff.Part of this research, i.e. the work of Martin Pitt and Sebastian Rachuba, was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsula)
Salivary Biomarkers for Alzheimer's Disease and Related Disorders
The search for accessible and cost-effective biomarkers to complement current cerebrospinal fluid (CSF) and imaging biomarkers in the accurate detection of Alzheimer disease (AD) and other common neurodegenerative disorders remains a challenging task. The advances in ultra-sensitive detection methods has highlighted blood biomarkers (e.g. amyloid-ÎČ and neurofilament light) as a valuable and realistic tool in a diagnostic or screening process. Saliva, however, is also a rich source of potential biomarkers for disease detection and offers several practical advantages over biofluids that are currently examined for neurodegenerative disorders. However, while this may be true for the general population, challenges in collecting saliva from an elderly population should be seriously considered. In this review, we begin by discussing how saliva is produced and how age-related conditions can modify saliva production and composition. We then focus on the data available which support the concept of salivary amyloid-ÎČ, tau species and novel biomarkers in detecting AD and alpha-synuclein (α-syn) in Parkinsonâs disease (PD)
SYSTEMS-2: a randomised phase II study of radiotherapy dose escalation for pain control in malignant pleural mesothelioma
SYSTEMS-2 is a randomised study of radiotherapy dose escalation for pain control in 112 patients with malignant pleural mesothelioma (MPM). Standard palliative (20Gy/5#) or dose escalated treatment (36Gy/6#) will be delivered using advanced radiotherapy techniques and pain responses will be compared at week 5. Data will guide optimal palliative radiotherapy in MPM
Multistability of free spontaneously-curved anisotropic strips
Multistable structures are objects with more than one stable conformation,
exemplified by the simple switch. Continuum versions are often elastic
composite plates or shells, such as the common measuring tape or the slap
bracelet, both of which exhibit two stable configurations: rolled and unrolled.
Here we consider the energy landscape of a general class of multistable
anisotropic strips with spontaneous Gaussian curvature. We show that while
strips with non-zero Gaussian curvature can be bistable, strips with positive
spontaneous curvature are always bistable, independent of the elastic moduli,
strips of spontaneous negative curvature are bistable only in the presence of
spontaneous twist and when certain conditions on the relative stiffness of the
strip in tension and shear are satisfied. Furthermore, anisotropic strips can
become tristable when their bending rigidity is small. Our study complements
and extends the theory of multistability in anisotropic shells and suggests new
design criteria for these structures.Comment: 20 pages, 10 figure
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British research in accounting and finance (2001â2007): the 2008 research assessment exercise
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The Stories behind the Struggle: A Closer Look at First Experiences with Opioid Misuse
The opioid crisis is a national public health emergency. Over 47,000 people in the U.S. died of opioid overdoses in 2017. Improving our knowledge about how people first come to misuse opioids can help to inform prevention and treatment interventions. This research brief shows that opioid misuse most often begins before age 25, most people obtain the opioids they misuse from friends and family rather than a health care provider, and experimenting and coping with life stressors are the most common motivations for starting opioid misuse
Diffractive Contribution to the Elasticity and the Nucleonic Flux in the Atmosphere
We calculate the average elasticity considering non-diffractive and single
diffractive interactions and perform an analysis of the cosmic-ray flux by
means of an analytical solution for the nucleonic diffusion equation. We show
that the diffractive contribution is important for the adequate description of
the nucleonic and hadronic fluxes in the atmosphere.Comment: 10 pages, latex, 2 figures (uuencoded PostScript
The Stories behind the Struggle: A Closer Look at First Experiences with Opioid Misuse
The opioid crisis is a national public health emergency. Over 47,000 people in the U.S. died of opioid overdoses in 2017. Improving our knowledge about how people first come to misuse opioids can help to inform prevention and treatment interventions. This research brief shows that opioid misuse most often begins before age 25, most people obtain the opioids they misuse from friends and family rather than a health care provider, and experimenting and coping with life stressors are the most common motivations for starting opioid misuse
Effect of increased quadriceps tensile stiffness on peak anterior cruciate ligament strain during a simulated pivot landing
ACL injury prevention programs often involve strengthening the knee muscles. We posit that an unrecognized benefit of such training is the associated increase in the tensile stiffness of the hypertrophied muscle. We tested the hypothesis that an increased quadriceps tensile stiffness would reduce peak anteromedial bundle (AMâ)ACL relative strain in female knees. Twelve female cadaver knees were subjected to compound impulsive twoâtimes body weight loads in compression, flexion, and internal tibial torque beginning at 15° flexion. Knees were equipped with modifiable custom springs to represent the nonlinear rapid stretch behavior of a normal and increased stiffness female quadriceps (i.e., 33% greater stiffness). Peak AMâACL relative strain was measured using an in situ transducer while muscle forces and tibiofemoral kinematics and kinetics were recorded. A 3D ADAMSâą dynamic biomechanical knee model was used in silico to interpret the experimental results which were analyzed using a repeatedâmeasures Wilcoxon test. Female knees exhibited a 16% reduction in peak AMâACL relative strain and 21% reduction in change in flexion when quadriceps tensile stiffness was increased by 33% (mean (SD) difference: 0.97% (0.65%), p â=â0.003). We conclude that increased quadriceps tensile stiffness reduces peak ACL strain during a controlled study simulating a pivot landing. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:423â430, 2014.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102663/1/jor22531.pd
'I just want a job' : what do we really know about young people in jobs without training?
Over recent years, a central concern of policy has been to drive up post-16 participation rates in full-time education and address the needs of young people not in education, employment or training (NEET). As a result, young people who enter work which is classified as 'without training' at 16/17 have largely been ignored. However, the decision to Raise the Participation Age (RPA) for continuing in learning for all 17-year olds from 2013 and for all 18-year olds from 2015 in England, together with a growing unease about the impact of the current recession on youth unemployment rates, have revived interest in the 'jobs without training' (JWT) group. This paper draws on the findings from two studies: first, a qualitative study in two contrasting local labour markets, of young people in JWT, together with their employers and parents; and second, an evaluation of the Learning Agreement Pilots (LAP), which was the first policy initiative in England targeted at the JWT group. Both studies reveal a dearth of understanding about early labour market entrants and a lack of policy intervention and infrastructure to support the needs of the JWT group throughout the UK. From this, it is concluded that questionable assumptions have been made about the composition and the aspirations of young people in JWT, and their employers, on the basis of little or no evidence. As a consequence, a policy 'quick fix' to satisfy the RPA agenda will not easily be achieved. If the decision to raise the participation age is adopted also by the Welsh and Scottish parliaments, similar challenges may have to be faced
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