The Stability of the Top Metre of the Sea Bed — Its Importance to Engineering and Navigational Projects

Consideration is given to the importance of knowledge about the stability of the top metre of the sea bed. In this context the results of a research programme which studied the movement of the crest of a sandwave in relation to tide and surface wave conditions are presented

Association between patient outcomes and key performance indicators of stroke care quality: A systematic review and meta-analysis

Purpose: Translating research evidence into clinical practice often uses key performance indicators to monitor quality of care. We conducted a systematic review to identify the stroke key performance indicators used in large registries, and to estimate their association with patient outcomes. Method: We sought publications of recent (January 2000–May 2017) national or regional stroke registers reporting the association of key performance indicators with patient outcome (adjusting for age and stroke severity). We searched Ovid Medline, EMBASE and PubMed and screened references from bibliographies. We used an inverse variance random effects meta-analysis to estimate associations (odds ratio; 95% confidence interval) with death or poor outcome (death or disability) at the end of follow-up. Findings: We identified 30 eligible studies (324,409 patients). The commonest key performance indicators were swallowing/nutritional assessment, stroke unit admission, antiplatelet use for ischaemic stroke, brain imaging and anticoagulant use for ischaemic stroke with atrial fibrillation, lipid management, deep vein thrombosis prophylaxis and early physiotherapy/mobilisation. Lower case fatality was associated with stroke unit admission (odds ratio 0.79; 0.72–0.87), swallow/nutritional assessment (odds ratio 0.78; 0.66–0.92) and antiplatelet use for ischaemic stroke (odds ratio 0.61; 0.50–0.74) or anticoagulant use for ischaemic stroke with atrial fibrillation (odds ratio 0.51; 0.43–0.64), lipid management (odds ratio 0.52; 0.38–0.71) and early physiotherapy or mobilisation (odds ratio 0.78; 0.67–0.91). Reduced poor outcome was associated with adherence to swallowing/nutritional assessment (odds ratio 0.58; 0.43–0.78) and stroke unit admission (odds ratio 0.83; 0.77–0.89). Adherence with several key performance indicators appeared to have an additive benefit. Discussion: Adherence with common key performance indicators was consistently associated with a lower risk of death or disability after stroke. Conclusion: Policy makers and health care professionals should implement and monitor those key performance indicators supported by good evidence

Stroke care in Africa: a systematic review of the literature

Background: Appropriate systems of stroke care are important to manage the increasing death and disability associated with stroke in Africa. Information on existing stroke services in African countries is limited. Aim: To describe the status of stroke care in Africa. Summary of review: We undertook a systematic search of the published literature to identify recent (1 January 2006–20 June 2017) publications that described stroke care in any African country. Our initial search yielded 838 potential papers, of which 38 publications were eligible representing 14/54 African countries. Across the publications included for our review, the proportion of stroke patients reported to arrive at hospital within 3 h from stroke onset varied between 10% and 43%. The median time interval between stroke onset and hospital admission was 31 h. Poor awareness of stroke signs and symptoms, shortages of medical transportation, health care personnel, and stroke units, and the high cost of brain imaging, thrombolysis, and outpatient physiotherapy rehabilitation services were reported as major barriers to providing best-practice stroke care in Africa. Conclusions: This review provides an overview of stroke care in Africa, and highlights the paucity of available data. Stroke care in Africa usually fell below the recommended standards with variations across countries and settings. Combined efforts from policy makers and health care professionals in Africa are needed to improve, and ensure access, to organized stroke care in as many settings as possible. Mechanisms to routinely monitor usual care (i.e., registries or audits) are also needed to inform policy and practice

Effects of augmented exercise therapy time after stroke: a meta-analysis

<p><b>Background and Purpose:</b> To present a systematic review of studies that addresses the effects of intensity of augmented exercise therapy time (AETT) on activities of daily living (ADL), walking, and dexterity in patients with stroke.</p> <p><b>Summary of Review:</b> A database of articles published from 1966 to November 2003 was compiled from MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, PEDro, DARE, and PiCarta using combinations of the following key words: stroke, cerebrovascular disorders, physical therapy, physiotherapy, occupational therapy, exercise therapy, rehabilitation, intensity, dose–response relationship, effectiveness, and randomized controlled trial. References presented in relevant publications were examined as well as abstracts in proceedings. Studies that satisfied the following selection criteria were included: (1) patients had a diagnosis of stroke; (2) effects of intensity of exercise training were investigated; and (3) design of the study was a randomized controlled trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for ADL, walking speed, and dexterity using fixed and random effect models. Correlation coefficients were calculated between observed individual effect sizes on ADL of each study, additional time spent on exercise training, and methodological quality. Cumulative meta-analyses (random effects model) adjusted for the difference in treatment intensity in each study was used for the trials evaluating the effects of AETT provided. Twenty of the 31 candidate studies, involving 2686 stroke patients, were included in the synthesis. The methodological quality ranged from 2 to 10 out of the maximum score of 14 points. The meta-analysis resulted in a small but statistically significant SES with regard to ADL measured at the end of the intervention phase. Further analysis showed a significant homogeneous SES for 17 studies that investigated effects of increased exercise intensity within the first 6 months after stroke. No significant SES was observed for the 3 studies conducted in the chronic phase. Cumulative meta-analysis strongly suggests that at least a 16-hour difference in treatment time between experimental and control groups provided in the first 6 months after stroke is needed to obtain significant differences in ADL. A significant SES supporting a higher intensity was also observed for instrumental ADL and walking speed, whereas no significant SES was found for dexterity.</p> <p><b>Conclusion:</b> The results of the present research synthesis support the hypothesis that augmented exercise therapy has a small but favorable effect on ADL, particularly if therapy input is augmented at least 16 hours within the first 6 months after stroke. This meta-analysis also suggests that clinically relevant treatment effects may be achieved on instrumental ADL and gait speed.</p&gt

The interaction between policy and education using stroke as an example

This paper discusses the interaction between healthcare policy at the European, UK and Scottish levels and the funding of education that underpins specific health policy priorities. Stroke is used throughout to illustrate the relationship between a designated European and UK health priority and the translation of that priority into clinical delivery. The necessity to build a responsive and sustainable culture to address the healthcare education that underpins changing healthcare policies is emphasized

Platelet ice, the Southern Ocean’s hidden ice: a review

Basal melt of ice shelves is not only an important part of Antarctica’s ice-sheet mass budget, but it is also the origin of one of the most peculiar types of sea ice found in the polar oceans: platelet ice. In many regions around coastal Antarctica, tiny ice crystals form and grow in supercooled plumes of Ice Shelf Water, releasing heat into the surrounding ocean. They usually rise towards the surface, eventually becoming trapped under an ice shelf as marine ice. Frequently, masses of those crystals are advected out of the ice-shelf cavity, and accumulate below a solid sea-ice cover to form a semiconsolidated layer. When the overlying sea ice grows into this so-called sub-ice platelet layer, the loose crystals are consolidated, adding additional thickness to the sea ice. These phenomena are generally referred to as platelet ice, although confusion about the terminology is widespread in the literature. The presence of platelet ice has a profound impact on sea-ice properties and processes in several regions of Antarctica, with numerous implications for the local polar marine biosphere. Most notably, sub-ice platelet layers provide a stable, sheltered, nutrient- and food-rich habitat which usually results in a highly productive and uniquely adapted ecosystem. It has also been hypothesised that platelet ice may be an indicator of the state of an ice shelf, although comprehensive time series are limited to the Ross Sea. This paper clears up the terminology by providing exact definitions of the relevant terms.We review platelet-ice formation, observational methods as well as geographical and seasonal occurrence. The physical properties and ecological implications are merged in a way understandable for physicists and biologists alike, to lay the foundation for the interdisciplinary research that is necessary to tackle the current knowledge gaps

Smelting conditions and smelting products: Experimental insights into the development of iron bloomery furnaces

The material record for bloomery furnaces in Iron Age and Roman Britain is fragmentary and, because of this paucity of evidence, the reconstruction of the ceramic structures used in iron production is difficult. Experiments have nevertheless been carried out to explore the working parameters and efficiency of iron smelting in bowl furnaces (small structures with little structure above ground level, interior measuring about 30 cm in height) (Craddock, 1995; Girbal, 2013) and shaft furnaces (height c.1m) (Smith, 2013; Crew, 2013; Doonan and Dungworth, 2013; Tylecote and Merkel, 1985; Tylecote and Wynne, 1958). These experiments aimed to clarify which furnace is more efficient for iron smelting and therefore what method was most likely used in Iron Age and Roman Britain. It is theorised that iron smelting furnaces developed from bowl structures to shaft structures over time, as smelters sought furnaces which could reach higher temperatures and create more reducing atmospheres (Dungworth 2013; Tylecote and Merkel, 1985; Tylecote and Wynne, 1958). These experiments suggest that the shaft furnace was used as it could meet these requirements. This study looks at the working conditions of a shaft furnace at an intermediary height - between that of a bowl furnace and of a shaft furnace - in order to understand its working parameters and to consequently better understand the progression from a bowl to a 1m high shaft structure