481 research outputs found
A national survey of services for the prevention and management of falls in the UK
Background: The National Health Service (NHS) was tasked in 2001 with developing service provision to prevent falls in older people. We carried out a national survey to provide a description of health and social care funded UK fallers services, and to benchmark progress against current
practice guidelines.
Methods: Cascade approach to sampling, followed by telephone survey with senior member of the fall service. Characteristics of the service were assessed using an internationally agreed taxonomy. Reported service provision was compared against benchmarks set by the National
Institute for Health and Clinical Excellence (NICE).
Results: We identified 303 clinics across the UK. 231 (76%) were willing to participate. The majority of services were based in acute or community hospitals, with only a few in primary care or emergency departments. Access to services was, in the majority of cases, by health professional
referral. Most services undertook a multi-factorial assessment. The content and quality of these assessments varied substantially. Services varied extensively in the way that interventions were delivered, and particular concern is raised about interventions for vision, home hazard modification, medication review and bone health.
Conclusion: The most common type of service provision was a multi-factorial assessment and intervention. There were a wide range of service models, but for a substantial number of services, delivery appears to fall below recommended NICE guidance
Progress in One-Loop QCD Computations
We review progress in calculating one-loop scattering amplitudes required for
next-to-leading-order corrections to QCD processes. The underlying technical
developments include the spinor helicity formalism, color decompositions,
supersymmetry, string theory, factorization and unitarity. We provide explicit
examples illustrating these techniques.Comment: To appear in Annual Reviews of Nuclear and Particle Science (1996
"Sometimes, it just stops me from doing anything": A qualitative exploration of epilepsy management in people with intellectual disabilities and their carers
: Epilepsy affects 1 in 5 people with an intellectual disability (ID), but little is known about their experiences of living with epilepsy. A qualitative study was conducted to investigate the impact and management of epilepsy in people with ID.
People with epilepsy and ID and their carers were invited to take part in semi-structured interviews. Eleven participants with ID and their carers were interviewed together, one participant with ID and their carer were interviewed separately, two interviews took place with the participant with ID only, and one interview took place with the carer only. The interviews were transcribed verbatim, coded, and analyzed thematically (dual independent coding for 30% of the transcripts).
Three themes emerged (participant characteristics, living with epilepsy, epilepsy management and information needs) which indicated the following: 1) diversity regarding health profiles, communication abilities, severity of epilepsy, perceived control of epilepsy, and support needs; 2) a reduction in severity and frequency of seizures for a sizeable proportion of participants through antiepileptic drugs; 3) the lifelong impact of epilepsy and related seizures on participants' activities and quality of life; 4) the perceived burden of epilepsy and difficulty managing the condition for a large proportion of participants; 5) high levels of satisfaction with epilepsy-related services and care; and 6) an overall lack of written accessible information about epilepsy.
This study has highlighted a significant impact of epilepsy and related seizures on the daily lives and quality of life of people with ID. Although a sizeable proportion of participants and their carers considered their epilepsy to be well controlled, the majority reported difficulties managing epilepsy and minimizing its impact on their wellbeing. Excluding care staff and the support provided by epilepsy clinics, the participants had not accessed any adapted self-management or information resources about epilepsy
Isokinetic muscle function comparison of lower limbs among elderly fallers and non-fallers
O objetivo deste estudo foi identificar se hĂĄ diferenças entre o desempenho muscular de tornozelo, joelho e quadril em idosos com e sem relato de queda nos Ășltimos seis meses. Foram incluĂdos 81 idosos com 65 anos ou mais: 56 negaram quedas (G1) e 25 relataram quedas (G2). Utilizou-se o questionĂĄrio perfil de atividade humana para medir o nĂvel de atividade fĂsica, e o dinamĂŽmetro isocinĂ©tico para mensurar os parĂąmetros fĂsicos da função muscular. Os grupos nĂŁo diferiram entre si em relação Ă idade (p=0,925), duração (p=0,065) e frequĂȘncia (p=0,302) da prĂĄtica do exercĂcio fĂsico, Ăndice de massa corpĂłrea (p=0,995) e nĂvel de atividade fĂsica (p=0,561). O G2 apresentou menor desempenho para as variĂĄveis pico de torque de flexĂŁo e extensĂŁo de joelho esquerdo (p=0,027 e p=0,030, respectivamente) e trabalho por peso corporal (p=0,040) de flexĂŁo de joelho esquerdo a 60°/s; pico de torque e trabalho por peso corporal de flexĂŁo e extensĂŁo de joelho a 180°/s bilateralmente (p<0,050); e potĂȘncia mĂ©dia de flexĂŁo de joelhos direito e esquerdo (p=0,030). A maioria das variĂĄveis do tornozelo e quadril nĂŁo apresentou diferenças entre os grupos. Apenas a variĂĄvel pico de torque de extensĂŁo de quadril esquerdo foi significativamente maior no G1 (p=0,035). Ă importante considerar a função muscular do joelho na avaliação clĂnica de idosos para direcionar a intervenção terapĂȘutica e a prevenção de quedas.The aim of this study was to identify whether there are differences between the performance of muscular groups of ankle, knee and hip among elderly people who didn't have falls and individuals who reported falls in the last six months. The study included 81 elderly aged 65 or older: 56 non-faller subjects (G1) and 25 faaller subjects (G2). To obtain the level of physical activity, the questionnaire Human Activity Profile was used, and the muscle function of the lower limbs was assessed using isokinetic dynamometer. The groups did not differ regarding age (p=0.925), duration (p=0.065) and frequency (p=0.302) of the practice of physical exercise, body mass index (BMI) (p=0.995) and level of physical activity (p=0.561). The G2 showed a lower performance of peak torque of left knee flexion and extension (p=0.027 and p=0.030, respectively) and work proportional to body weight (p=0.040) of left knee flexion at 60°/s; peak torque and work proportional to body weight of bilaterally knee flexion and extension at 180°/s (p<0.05) and average power of right and left knee extension (p=0.03). Most variables of ankle and hip joints did not differ between groups. Only peak torque of left hip extension was significantly higher in the non-faller group (p=0.035). It is important to consider knee muscle function in the clinical evaluation of elderly in order to make the intervention more assertive and thus to prevent falls
Electroweak Symmetry Breaking in the DSSM
We study the theoretical and phenomenological consequences of modifying the
Kahler potential of the MSSM two Higgs doublet sector. Such modifications
naturally arise when the Higgs sector mixes with a quasi-hidden conformal
sector, as in some F-theory GUT models. In the Delta-deformed Supersymmetric
Standard Model (DSSM), the Higgs fields are operators with non-trivial scaling
dimension 1 < Delta < 2. The Kahler metric is singular at the origin of field
space due to the presence of quasi-hidden sector states which get their mass
from the Higgs vevs. The presence of these extra states leads to the fact that
even as Delta approaches 1, the DSSM does not reduce to the MSSM. In
particular, the Higgs can naturally be heavier than the W- and Z-bosons.
Perturbative gauge coupling unification, a large top quark Yukawa, and
consistency with precision electroweak can all be maintained for Delta close to
unity. Moreover, such values of Delta can naturally be obtained in
string-motivated constructions. The quasi-hidden sector generically contains
states charged under SU(5)_GUT as well as gauge singlets, leading to a rich,
albeit model-dependent, collider phenomenology.Comment: v3: 40 pages, 3 figures, references added, typos correcte
A Systematic Review of Mosquito Coils and Passive Emanators: Defining Recommendations for Spatial Repellency Testing Methodologies.
Mosquito coils, vaporizer mats and emanators confer protection against mosquito bites through the spatial action of emanated vapor or airborne pyrethroid particles. These products dominate the pest control market; therefore, it is vital to characterize mosquito responses elicited by the chemical actives and their potential for disease prevention. The aim of this review was to determine effects of mosquito coils and emanators on mosquito responses that reduce human-vector contact and to propose scientific consensus on terminologies and methodologies used for evaluation of product formats that could contain spatial chemical actives, including indoor residual spraying (IRS), long lasting insecticide treated nets (LLINs) and insecticide treated materials (ITMs). PubMed, (National Centre for Biotechnology Information (NCBI), U.S. National Library of Medicine, NIH), MEDLINE, LILAC, Cochrane library, IBECS and Armed Forces Pest Management Board Literature Retrieval System search engines were used to identify studies of pyrethroid based coils and emanators with key-words "Mosquito coils" "Mosquito emanators" and "Spatial repellents". It was concluded that there is need to improve statistical reporting of studies, and reach consensus in the methodologies and terminologies used through standardized testing guidelines. Despite differing evaluation methodologies, data showed that coils and emanators induce mortality, deterrence, repellency as well as reduce the ability of mosquitoes to feed on humans. Available data on efficacy outdoors, dose-response relationships and effective distance of coils and emanators is inadequate for developing a target product profile (TPP), which will be required for such chemicals before optimized implementation can occur for maximum benefits in disease control
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
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
Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups
<p>Abstract</p> <p>Background</p> <p>Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients' assessment data and to evaluate their predictive performance (aim#1), and to identify high-risk subgroups from the data (aim#2).</p> <p>Methods</p> <p>A data set of n = 5,176 single in-patient episodes covering 1.5 years of admissions to a geriatric hospital were extracted from the hospital's data base and matched with fall incident reports (n = 493). A classification tree model was induced using the C4.5 algorithm as well as a logistic regression model, and their predictive performance was evaluated. Furthermore, high-risk subgroups were identified from extracted classification rules with a support of more than 100 instances.</p> <p>Results</p> <p>The classification tree model showed an overall classification accuracy of 66%, with a sensitivity of 55.4%, a specificity of 67.1%, positive and negative predictive values of 15% resp. 93.5%. Five high-risk groups were identified, defined by high age, low Barthel index, cognitive impairment, multi-medication and co-morbidity.</p> <p>Conclusions</p> <p>Our results show that a little more than half of the fallers may be identified correctly by our model, but the positive predictive value is too low to be applicable. Non-fallers, on the other hand, may be sorted out with the model quite well. The high-risk subgroups and the risk factors identified (age, low ADL score, cognitive impairment, institutionalization, polypharmacy and co-morbidity) reflect domain knowledge and may be used to screen certain subgroups of patients with a high risk of falling. Classification models derived from a large data set using data mining methods can compete with current dedicated fall risk screening tools, yet lack diagnostic precision. High-risk subgroups may be identified automatically from existing geriatric assessment data, especially when combined with domain knowledge in a hybrid classification model. Further work is necessary to validate our approach in a controlled prospective setting.</p
Cosmic Flows on 100 Mpc/h Scales: Standardized Minimum Variance Bulk Flow, Shear and Octupole Moments
The low order moments, such as the bulk flow and shear, of the large scale
peculiar velocity field are sensitive probes of the matter density fluctuations
on very large scales. In practice, however, peculiar velocity surveys are
usually sparse and noisy, which can lead to the aliasing of small scale power
into what is meant to be a probe of the largest scales. Previously, we
developed an optimal ``minimum variance'' (MV) weighting scheme, designed to
overcome this problem by minimizing the difference between the measured bulk
flow (BF) and that which would be measured by an ideal survey. Here we extend
this MV analysis to include the shear and octupole moments, which are designed
to have almost no correlations between them so that they are virtually
orthogonal. We apply this MV analysis to a compilation of all major peculiar
velocity surveys, consisting of 4536 measurements. Our estimate of the BF on
scales of ~ 100 Mpc/h has a magnitude of |v|= 416 +/- 78 km/s towards Galactic
l = 282 degree +/- 11 degree and b = 6 degree +/- 6 degree. This result is in
disagreement with LCDM with WMAP5 cosmological parameters at a high confidence
level, but is in good agreement with our previous MV result without an
orthogonality constraint, showing that the shear and octupole moments did not
contaminate the previous BF measurement. The shear and octupole moments are
consistent with WMAP5 power spectrum, although the measurement noise is larger
for these moments than for the BF. The relatively low shear moments suggest
that the sources responsible for the BF are at large distances.Comment: 13 Pages, 7 figures, 4 tables. Some changes to reflect the published
versio
Understanding the links between hearing impairment and dementia : development and validation of the social and emotional impact of hearing impairment (SEI-HI) questionnaire
Background
The links between hearing impairment (HI) and dementia have been well documented, but factors mediating this relationship remain unknown. Major consequences of HI are social and emotional dysfunction, and as the risk of dementia increases linearly with the severity of HI, it is plausible that socio-emotional difficulties may play a role in this association.
Objective
The aim of this study was to develop and validate a tool to analyse levels of hearing-related disability, to investigate ultimately whether subjective disability contributes to risk of cognitive impairment compared with hearing thresholds alone.
Methods
Development and validation of the questionnaire, the Social and Emotional Impact of Hearing Impairment (SEI-HI), was conducted in four phases: (1) content; (2) scoring and outcomes; (3) validation; (4) feasibility in a sample of people with cognitive impairment.
Results
Considerable evidence was found for the internal and external reliability of the tool with high construct validity, concurrent validity and test-retest values of the SEI-HI questionnaire. A feasibility check on 31 patients with mild cognitive impairment or dementia showed the SEI-HI questionnaire was easy to administer and well-received.
Conclusion
The SEI-HI questionnaire is a relevant instrument to assess hearing-related disability which can be used in people with cognitive decline to assess further impact on risk of developing dementia
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