Clinical response to long-term propranolol therapy in hyperthyroidism

No Abstrac

Living with multiple losses: Insights from patients living with pressure injury

© 2017 Australian College of Nursing Ltd Background: Pressure injury is a common problem. Its prevention and treatment is predominantly focussed on views, perceptions and knowledge of healthcare staff rather than on patient experience, particularly those patients living in their own homes. Aim: This paper reports findings on patients experiences and perceptions of loss associated with PI. These findings are drawn from a larger study of pressure injury patients living and receiving care in the community. Methods: Qualitative interviews with 12 participants with pressure injury and five carers. Data was audio recorded and thematically analysed. The study is reported in accordance with the COREQ guidelines. Findings: Having a pressure injury negatively affected many aspects of life for our participants resulting in multiple losses. These losses included loss of mobility and independence, privacy and dignity, and social engagement and ability to engage in preferred activities. Discussion: Although the effects of a pressure injury may be similar for many people, the most important issues will differ from person-to-person thus treatment and prevention of pressure injury requires a multidisciplinary team having a holistic care approach. Some patients’ pressure injury will never heal and it is increasingly important to involve the patient to find out what matters most to them and how their wound is impacting on them, to jointly develop a holistic, person-centred plan. Conclusion: Policy and practice should recognise and reflect that patients living with a pressure injury at home have different challenges and needs to those in acute or long term care. Pragmatic solutions in the delivery of pressure injury care are needed to compliment the drive to move healthcare from the hospital-to-home

Optimum compressive strength of hardened Sandcrete building blocks with steel chips

The recycling of steel chips into an environmentally friendly, responsive, and profitable commodity in the manufacturing and construction industries is a huge and difficult challenge. Several strategies designed for the management and processing of this waste in developed countries have been largely unsuccessful in developing countries mainly due to its capital-intensive nature. To this end, this investigation attempts to provide an alternative solution to the recycling of this material by maximizing its utility value in the building construction industry. This is to establish their influence on the compressive strength of sandcrete hollow blocks and solid cubes with the aim of specifying the range percent of steel chips for the sandcrete optimum compressive strength value. This is particularly important for developing countries in sub-Saharan Africa, and even Latin America where most sandcrete blocks exhibit compressive strengths far below standard requirements. Percentages of steel chips relative to the weight of cement were varied and blended with the sand in an attempt to improve the sand grading parameters. The steel chips variations were one, two, three, four, five, ten and fifteen percent respectively. It was confirmed that the grading parameters were improved and there were significant increases in the compressive strength of the blocks and cube samples. The greatest improvement was noticed at four percent steel chips and sand combination. Using the plotted profile, the margin of steel chips additions for the optimum compressive strength was also established. It is recommended that steel chip sandcrete blocks are suitable for both internal load bearing, and non-load bearing walls, in areas where they are not subjected to moisture ingress. However, for external walls, and in areas where they are liable to moisture attack after laying, the surfaces should be well rendered. Below ground level, the surfaces should be coated with a water proofing agent like bitumen and cement containing waterproofing agents be used in the manufacture, laying, and rendering of steel chip sandcrete blocks

Behavioural compensation by drivers of a simulator when using a vision enhancement system

Technological progress is suggesting dramatic changes to the tasks of the driver, with the general aim of making driving environment safer. Before any of these technologies are implemented, empirical research is required to establish if these devices do, in fact, bring about the anticipated improvements. Initially, at least, simulated driving environments offer a means of conducting this research. The study reported here concentrates on the application of a vision enhancement (VE) system within the risk homeostasis paradigm. It was anticipated, in line with risk homeostasis theory, that drivers would compensate for the reduction in risk by increasing speed. The results support the hypothesis although, after a simulated failure of the VE system, drivers did reduce their speed due to reduced confidence in the reliability of the system

The impact of vibration time on compressive strength of hardened Sandcrete building blocks

The majority of the sandcrete blocks used in the Nigerian building industry fall short of the minimum specification standards. There is evidence to suggest a wide variation in compressive strength from one block manufacturer to another and also within block samples from a single source. This problem has been attributed to poor quality control and substandard constituent materials. Also very alarming is the ignorance surrounding the usage and engineering properties of some of the widely used fine aggregate deposits. As a way forward, this paper aims to re-establish the impact of vibration time in sandcrete block production using six fine aggregate deposits found within Benin City (Midwestern Nigeria) and their various pair combinations. Some of the basic properties like silt content, grading parameters—co-efficient of uniformity (Cu), curvature co-efficient (Cc) and the fineness modulus (Fm)—of these fine aggregates were established by laboratory means. In addition, the wet and dry compressive strength of these sandcrete blocks made from these sands were established. A total of 1,080 block samples produced under very controlled conditions were used in this investigation. It was revealed that the utility value of sand can be improved when the weaker and commonly used sands were combined with those that are better, more expensive and less frequently used at different vibration periods and ratios. Findings further revealed that sand types and the sand combination approach adopted were very significant to grading parameters and strength; at a much higher vibration time the compressive strength and durability properties were also considerably improved

Health service provision and the use of pressure-redistributing devices: mixed methods study of community dwelling individuals with pressure injuries

© 2017 Informa UK Limited, trading as Taylor & Francis Group. Background: Health care within the home setting is a vital and growing component of pressure injury (PI) prevention and management. Objectives: To describe the use of health services and pressure-redistributing devices in community dwelling patients with PI’s. Design: Mixed-methods collective case study of a defined, diverse geographic postcode area in the United Kingdom. Methods: Quantitative retrospective analysis of electronic and paper medical records of adult PI patients from 2015 district nursing reports. Qualitative semi-structured interviews of community dwelling adult patients receiving, or received, treatment for PI in 2016. Results: Mandatory reports (n = 103) revealed that 90 patients were supplied with a variety of pressure-redistributing devices but only one-third of patients used the equipment as recommended. Qualitative interviews (n = 12), reported to COREQ guidelines, revealed that patients felt reliant on community health services, and were concerned about the consistency of their care. Conclusions: Authentic patient involvement is required to provide care and interventions that are acceptable to PI patients and can be incorporated into self-care strategies and effectively monitored

Pain associated with pressure injury: A qualitative study of community-based, home-dwelling individuals

© 2017 John Wiley & Sons Ltd. Aims: The aim of this study was to provide deep insights into the pain associated with pressure injuries in home-dwelling individuals using narrative accounts. Background: Pressure injuries or pressure ulcers are burdensome and costly. Prevalence data, surveys and systematic reviews demonstrate that pain associated with pressure injury is widespread, but voices of home-dwelling patients have remained largely unheard. Design: Concurrent mixed methods case study of a UK community of approximately 50,000 adults. Methods: Qualitative interviews, conducted in 2016, of 12 home-dwelling adult participants with a current pressure injury (n = 10), or a recently healed pressure injury (n = 2). Findings: Pain had an adverse impact on activities of daily living, mobility and sleep. Participants described days that were clouded in pain; a pain they felt was poorly understood and often out of control. Thematic content analysis revealed two major themes; these are: Poorly controlled pain: “I just want the pain to go away”; and, Uncertainty for the future: “it almost seems insurmountable.”. Conclusion: Findings of our study support the need to develop an appropriate assessment tool for pressure injury patients in the community to enable healthcare professionals and patients to recognize and manage pressure injury-related pain effectively