Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]

Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes.  Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group). Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0).  The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600).  The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512). Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions

Outcomes of specialist discharge coordination and intermediate care schemes for patients who are homeless: analysis protocol for a population-based historical cohort

Introduction People who are homeless often experience poor hospital discharge arrangements, reflecting ongoing care and housing needs. Specialist integrated homeless health and care provision (SIHHC) schemes have been developed and implemented to facilitate the safe and timely discharge of homeless patients from hospital. Our study aims to investigate the health outcomes of patients who were homeless and seen by a selection of SIHHC services. Methods and analysis Our study will employ a historical population-based cohort in England. We will examine health outcomes among three groups of adults: (1) homeless patients seen by specialist discharge schemes during their hospital admission; (2) homeless patients not seen by a specialist scheme and (3)admitted patients who live in deprived neighbourhoods and were not recorded as being homeless. Primary outcomes will be: time from discharge to next hospital inpatient admission; time from discharge to next accident and emergency attendance and 28-day emergency readmission. Outcome data will be generated through linkage to hospital admissions data (Hospital Episode Statistics) and mortality data for November 2013 to November 2016. Multivariable regression will be used to model the relationship between the study comparison groups and each of the outcomes. Ethics and dissemination Approval has been obtained from the National Health Service (NHS) Confidentiality Advisory Group (reference 16/CAG/0021) to undertake this work using unconsented identifiable data. Health Research Authority Research Ethics approval (REC 16/EE/0018) has been obtained in addition to local research and development approvals for data collection at NHS sites. We will feedback the results of our study to our advisory group of people who have lived experience of homelessness and seek their suggestions on ways to improve or take this work further for their benefit. We will disseminate our findings to SIHHC schemes through a series of regional workshops

Dive, food and exercise effects on blood microparticles in Steller sea lions (Eumetopias jubatus) : exploring a biomarker for decompression sickness

Author Posting. © The Author(s), 2016. This is the author's version of the work. It is posted here by permission of American Physiological Society for personal use, not for redistribution. The definitive version was published in American Journal of Physiology - Regulatory, Integrative and Comparative Physiology 310 (2016): R596-R601, doi:10.1152/ajpregu.00512.2015.Recent studies of stranded marine mammals indicate that exposure to underwater military sonar may induce pathophysiological responses consistent with decompression sickness (DCS). However, DCS has been difficult to diagnose in marine mammals. We investigated whether blood microparticles (MPs, measured as number/μl plasma), which increase in response to decompression stress in terrestrial mammals, are a suitable biomarker for DCS in marine mammals. We obtained blood samples from trained Steller sea lions (Eumetopias jubatus, 4 adult females) wearing time-depth recorders that dove to predetermined depths (either 5 or 50 m). We hypothesized that MPs would be positively related to decompression stress (depth and duration underwater). We also tested the effect of feeding and exercise in isolation on MPs using the same blood sampling protocol. We found that feeding and exercise had no effect on blood MP levels, but that diving caused MPs to increase. However, blood MP levels did not correlate with diving depth, relative time underwater, and presumably decompression stress―possibly indicating acclimation following repeated exposure to depth.Funding for this project was provided by the Office of Naval Research to MM (ONR Award # N00014-12-10388) and SRT (ONR Award # N00014-13-10614). Additional support was provided by the National Oceanic and Atmospheric Administration through the North Pacific Marine Science Foundation and the North Pacific Universities Marine Mammal Research Consortium.2017-02-0

Manufacturing with light – micro-assembly of opto-electronic microstructures

Optical micromanipulation allows the movement and patterning of discrete micro-particles within a liquid environment. However, for manufacturing applications it is desirable to remove the liquid, leaving the patterned particles in place. In this work, we have demonstrated the use of optoelectronic tweezers (OET) to manipulate and accurately assemble Sn62Pb36Ag2 solder microspheres into tailored patterns. A technique based on freeze-drying technology was then developed that allows the assembled patterns to be well preserved and fixed in place after the liquid medium in the OET device is removed. After removing the liquid from the OET device and subsequently heating the assembled pattern and melting the solder microspheres, electrical connections between the microspheres were formed, creating a permanent conductive bridge between two isolated metal electrodes. Although this method is demonstrated with 40 µm diameter solder beads arranged with OET, it could be applied to a great range of discrete components from nanowires to optoelectronic devices, thus overcoming one of the basic hurdles in using optical micromanipulation techniques in a manufacturing micro-assembly setting

Parents and Teachers Make Different Contributions to a Shared Perspective on Hyperactive–Impulsive and Inattentive Symptoms: A Multivariate Analysis of Parent and Teacher Ratings on the Symptom Domains of ADHD

Attention deficit hyperactivity disorder (ADHD) is characterised by developmentally inappropriate and impairing levels of inattentive and hyperactive–impulsive behaviours. We aimed to investigate the differential effects of parent and teacher ratings on inattention and hyperactivity–impulsivity and the extent of genetic overlap between the two behavioural dimensions. Multivariate structural equation modelling was performed on DSM-IV based ADHD ratings by parents and teachers collected on a general population sample of 672 twin pairs, at ages 7–10 years. This study is the first to simultaneously use parent and teacher ratings in twin modelling to examine the effects of different raters on the two behavioural dimensions of ADHD. The findings indicated that hyperactivity–impulsivity and inattention load on to separate latent factors that represent a common behavioural view for both parents and teachers, although there are additional aspects to the observations of these behaviours that are unique to each type of rater. The findings further indicate some shared aetiology for hyperactivity–impulsivity and inattention as measured by both parent and teacher ratings, in agreement with previous findings on the aetiology of the two symptom dimensions of ADHD

Assessing the capacity of local ecosystems to meet industrial demand for ecosystem services

Despite the importance of ecosystems, engineering activities continue to ignore or greatly undervalue their role. Consequently, engineered systems often overshoot nature's capacity to support them, causing ecological degradation. Such systems tend to be inherently unsustainable, and they often fail to benefit from nature's ability to provide essential goods and services. This work explores the idea of including ecosystems in chemical processes, and assesses whether such a techno-ecological synergistic system can operate within ecological constraints. The demand for ecosystem services is quantified by emissions and resources used, while the supply is provided by ecosystems on the manufacturing site. Application to a biodiesel manufacturing site demonstrates that ecosystems can be economically and environmentally superior to conventional technologies for making progress toward zero emissions and net positive impact manufacturing. These results highlight the need for shifting the paradigm of engineering from that of dominating nature to embracing nature and respecting its limits

Simultaneous genetic analysis of means and covariance structure: Pearson-Lawley selection rules

The object of this paper is to indicate that the Pearson-Lawley selection rules form a plausible general theory for the simultaneous genetic analysis of means and covariance structure. Models are presented based on phenotypic selection and latent selection. Previously presented quantitative genetic models to decompose means and covariance structure simultaneously are reconsidered as instances of latent selection. The selection rules are very useful in the context of behavior genetic modeling because they lead to testable models and a conceptual framework for explaining variation between and within groups by the same genetic and environmental factors. © 1994 Plenum Publishing Corporation