Analysis of Thermal Interconnectivity of Utilities in Rural Alaska

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCEThroughout the arctic there are two primary community utilities with dramatically contrary thermodynamic concerns. These are the intensely exothermic diesel electric power generation, and the strongly endothermic water and sewer utility. In this context exothermic processes must expel excess heat while endothermic process requires heat input. Failure of engineers, community planners, funding agencies, and interest groups to recognize the full social, economic, and environmental impact to the sustainability of utilities has come at tremendous cost. This is exemplified in many remote Alaskan communities such as Toksook Bay, Minto, Deering, and Kotlik

Improving the health of people with multimorbidity: the need for prospective cohort studies

The dramatic rise in long-term conditions (LTCs) represents a major challenge for individuals, families, and health care systems worldwide. Due to the scale of this rise, the management of patients with LTCs largely falls within the domain of primary rather than secondary care, at least in countries with well-developed primary care systems. For example, in the UK, which has a comprehensive primary care system based around general practice (trained family physicians working in multidisciplinary teams) and funded by the National Health Service (NHS), primary care contacts account for around 90% of the total activity of the NHS, and patients with LTCs account for 80% of general practice consultations. Effective primary care and community-based management of people with LTCs is thus a top priority

Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland

<b>Background</b> Patient 'enablement' is a term closely aligned with 'empowerment' and its measurement in a general practice consultation has been operationalised in the widely used patient enablement instrument (PEI), a patient-rated measure of consultation outcome. However, there is limited knowledge regarding the factors that influence enablement, particularly the effect of socio-economic deprivation. The aim of the study is to assess the factors influencing patient enablement in GP consultations in areas of high and low deprivation.<p></p> <b>Methods</b> A questionnaire study was carried out on 3,044 patients attending 26 GPs (16 in areas of high socio-economic deprivation and 10 in low deprivation areas, in the west of Scotland). Patient expectation (confidence that the doctor would be able to help) was recorded prior to the consultation. PEI, GP empathy (measured by the CARE Measure), and a range of other measures and variables were recorded after the consultation. Data analysis employed multi-level modelling and multivariate analyses with the PEI as the dependant variable.<p></p> <b>Results</b> Although numerous variables showed a univariate association with patient enablement, only four factors were independently predictive after multilevel multivariate analysis; patients with multimorbidity of 3 or more long-term conditions (reflecting poor chronic general health), and those consulting about a long-standing problem had reduced enablement scores in both affluent and deprived areas. In deprived areas, emotional distress (GHQ-caseness) had an additional negative effect on enablement. Perceived GP empathy had a positive effect on enablement in both affluent and deprived areas. Maximal patient enablement was never found with low empathy.<p></p> <b>Conclusions</b> Although other factors influence patient enablement, the patients' perceptions of the doctors' empathy is of key importance in patient enablement in general practice consultations in both high and low deprivation settings

Accentuate the negative

A survey of mean inequalities with real weights is given.Comment: 16 pages 3 figure

Development of an efficient procedure for calculating the aerodynamic effects of planform variation

Numerical procedures to compute gradients in aerodynamic loading due to planform shape changes using panel method codes were studied. Two procedures were investigated: one computed the aerodynamic perturbation directly; the other computed the aerodynamic loading on the perturbed planform and on the base planform and then differenced these values to obtain the perturbation in loading. It is indicated that computing the perturbed values directly can not be done satisfactorily without proper aerodynamic representation of the pressure singularity at the leading edge of a thin wing. For the alternative procedure, a technique was developed which saves most of the time-consuming computations from a panel method calculation for the base planform. Using this procedure the perturbed loading can be calculated in about one-tenth the time of that for the base solution

Investigation of effect of propulsion system installation and operation on aerodynamics of an airbreathing hypersonic airplane at Mach 0.3 to 1.2

Results from an investigation of the effects of the operation of a combined turbojet/scramjet propulsion system on the longitudinal aerodynamic characteristics of a 1/60-scale hypersonic airbreathing launch vehicle configuration are presented. Decomposition products of hydrogen peroxide were used for simulation of the propulsion system exhaust

Performance characteristics of an isolated coannular plug nozzle at transonic speeds

The Langley 16-Foot Transonic Tunnel was used to evaluate the performance characteristics of a coannular plug nozzle at static conditions (Mach number of 0) and at Mach numbers from 0.65 to 1.20. Jet total pressure ratio was varied from 1.0 (jet off) to 10.0. Thirty-seven configurations generated by the combination of three geometric variables - plug angle, shroud boattail length (fixed exit radius), and shroud extension length - were tested

Aerodynamic influence coefficient method using singularity splines

A numerical lifting surface formulation, including computed results for planar wing cases is presented. This formulation, referred to as the vortex spline scheme, combines the adaptability to complex shapes offered by paneling schemes with the smoothness and accuracy of loading function methods. The formulation employes a continuous distribution of singularity strength over a set of panels on a paneled wing. The basic distributions are independent, and each satisfied all the continuity conditions required of the final solution. These distributions are overlapped both spanwise and chordwise. Boundary conditions are satisfied in a least square error sense over the surface using a finite summing technique to approximate the integral. The current formulation uses the elementary horseshoe vortex as the basic singularity and is therefore restricted to linearized potential flow. As part of the study, a non planar development was considered, but the numerical evaluation of the lifting surface concept was restricted to planar configurations. Also, a second order sideslip analysis based on an asymptotic expansion was investigated using the singularity spline formulation

Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study

<b>Objective</b> To assess the nature and extent of physical-health comorbidities in people with schizophrenia and related psychoses compared with controls. <p></p> <b>Design </b>Cross-sectional study. <p></p> <b>Setting </b>314 primary care practices in Scotland. <p></p> <b>Participants </b>9677 people with a primary care record of schizophrenia or a related psychosis and 1 414 701 controls. Main outcome measures Primary care records of 32 common chronic physical-health conditions and combinations of one, two and three or more physical-health comorbidities adjusted for age, gender and deprivation status. <p></p> <b>Results</b> Compared with controls, people with schizophrenia were significantly more likely to have one physical-health comorbidity (OR 1.21, 95% CI 1.16 to 1.27), two physical-health comorbidities (OR 1.37, 95% CI 1.29 to 1.44) and three or more physical-health comorbidities (OR 1.19, 95% CI 1.12 to 1.27). Rates were highest for viral hepatitis (OR 3.98, 95% CI 2.81 to 5.64), constipation (OR 3.24, 95% CI 3.00 to 4.49) and Parkinson's disease (OR 3.07, 95% CI 2.42 to 3.88) but people with schizophrenia had lower recorded rates of cardiovascular disease, including atrial fibrillation (OR 0.62, 95% CI 0.51 to 0.73), hypertension (OR 0.71, 95% CI 0.67 to 0.76), coronary heart disease (OR 0.75, 95% CI 0.61 to 0.71) and peripheral vascular disease (OR 0.83, 95% CI 0.71 to 0.97).<p></p> <b>Conclusions </b>People with schizophrenia have a wide range of comorbid and multiple physical-health conditions but are less likely than people without schizophrenia to have a primary care record of cardiovascular disease. This suggests a systematic under-recognition and undertreatment of cardiovascular disease in people with schizophrenia, which might contribute to substantial premature mortality observed within this patient group. <p></p&gt