Therapeutic Strategies in Architecture for Senior Care and Rehabilition

My research is in developing a new building typology for the elderly retirement population. Retirement funds are often eaten up by poor planning and hasty decisions which can jeopardize their health. Hawaii has a large elderly population and I see a great need to address this problem now, as the largest demographic group is now retiring. Hypothesis: Retirement hangs as the preverbal carrot for most people in our rapidly paced society. The reward for life of hard work too often becomes a sedentary activity that encourages the degeneration of our physical body. Architecture for retirees often facilitates this and designs for a lethargic lifestyle. The consistent pattern for elderly is a ‘fall’, which then leads to a back-and-forth to the hospital. Most of the time, the fall occurs within a ‘designed’ space. The research goal is to develop design strategies, design components, and awareness of the problems. Just as ADA (American’s with Disabilities Act) is the product of awareness and energy to a neglected demographic, the elderly should have strong design influences. The desired outcome for the project is to prepare for a design that addresses the needs for this elderly age group . Gaining an understanding of the demographic, the needs, hazards, and opportunities will prepare me for the design process. Specific solutions ranging from therapeutic spaces to technical solutions for improved mobility and independence will be investigated. In urban or suburban places, our mobility is based on options presented to us. These are intentional designs and understanding how ‘designed circulation’ develops certain muscles while others are lost, helps me design spaces that become therapeutic and incorporate the muscles that are lost. Case studies will be investigated to gain parameters on cost, and design solutions. Emerging theories in senior health care incorporate more activity throughout the day compared to a periodic ‘exercise’ time. Architecture can facilitate this approach of a steady flow of stimulus and activity.My research is in developing a new building typology for the elderly retirement population. Retirement funds are often eaten up by poor planning and hasty decisions which can jeopardize their health. Hawaii has a large elderly population and I see a great need to address this problem now, as the largest demographic group is now retiring. Hypothesis: Retirement hangs as the preverbal carrot for most people in our rapidly paced society. The reward for life of hard work too often becomes a sedentary activity that encourages the degeneration of our physical body. Architecture for retirees often facilitates this and designs for a lethargic lifestyle. The consistent pattern for elderly is a ‘fall’, which then leads to a back-and-forth to the hospital. Most of the time, the fall occurs within a ‘designed’ space. The research goal is to develop design strategies, design components, and awareness of the problems. Just as ADA (American’s with Disabilities Act) is the product of awareness and energy to a neglected demographic, the elderly should have strong design influences. The desired outcome for the project is to prepare for a design that addresses the needs for this elderly age group . Gaining an understanding of the demographic, the needs, hazards, and opportunities will prepare me for the design process. Specific solutions ranging from therapeutic spaces to technical solutions for improved mobility and independence will be investigated. In urban or suburban places, our mobility is based on options presented to us. These are intentional designs and understanding how ‘designed circulation’ develops certain muscles while others are lost, helps me design spaces that become therapeutic and incorporate the muscles that are lost. Case studies will be investigated to gain parameters on cost, and design solutions. Emerging theories in senior health care incorporate more activity throughout the day compared to a periodic ‘exercise’ time. Architecture can facilitate this approach of a steady flow of stimulus and activity.My research is in developing a new building typology for the elderly retirement population. Retirement funds are often eaten up by poor planning and hasty decisions which can jeopardize their health. Hawaii has a large elderly population and I see a great need to address this problem now, as the largest demographic group is now retiring. Hypothesis: Retirement hangs as the preverbal carrot for most people in our rapidly paced society. The reward for life of hard work too often becomes a sedentary activity that encourages the degeneration of our physical body. Architecture for retirees often facilitates this and designs for a lethargic lifestyle. The consistent pattern for elderly is a ‘fall’, which then leads to a back-and-forth to the hospital. Most of the time, the fall occurs within a ‘designed’ space. The research goal is to develop design strategies, design components, and awareness of the problems. Just as ADA (American’s with Disabilities Act) is the product of awareness and energy to a neglected demographic, the elderly should have strong design influences. The desired outcome for the project is to prepare for a design that addresses the needs for this elderly age group . Gaining an understanding of the demographic, the needs, hazards, and opportunities will prepare me for the design process. Specific solutions ranging from therapeutic spaces to technical solutions for improved mobility and independence will be investigated. In urban or suburban places, our mobility is based on options presented to us. These are intentional designs and understanding how ‘designed circulation’ develops certain muscles while others are lost, helps me design spaces that become therapeutic and incorporate the muscles that are lost. Case studies will be investigated to gain parameters on cost, and design solutions. Emerging theories in senior health care incorporate more activity throughout the day compared to a periodic ‘exercise’ time. Architecture can facilitate this approach of a steady flow of stimulus and activity

Influential Article Review - Designing European Output and Demand Flows: The Trading Model Under Transtools3

This paper examines product development. We present insights from a highly influential paper. Here are the highlights from this paper: The paper presents a new model for trade flows in Europe that is integrated with a logistics model for transport chain choice through Logsum variables. Logsums measures accessibility across an entire multi-modal logistic chain and are calculated from a logistics model that has been estimated on disaggregated micro data and then used as an input variable in the trade model. Using Logsums in a trade model is new in applied large-scale freight models, where previous models have simply relied on the distance (e.g. crow-fly) between zones. This linkage of accessibility to the trade model makes it possible to evaluate how changes in policies on transport costs and changes in multi-modal networks will influence trade patterns. As an example, the paper presents outcomes for a European-wide truck tolling scenario, which showcases to which extent trade is influenced by such a policy. The paper discusses how such a complex model can be estimated and considers the choice of mathematical formulation and the link between the trade model and logistics model. In the outcomes for the tolling scenario, we decompose the total effects into effects from the trade model and effects from the logistics model. For our overseas readers, we then present the insights from this paper in Spanish, French, Portuguese, and German

Molecular Biomarker Expression in Window of Opportunity Studies for Oestrogen Receptor Positive Breast Cancer: A Systematic Review of the Literature

Window of opportunity (WoO) trials create the opportunity to demonstrate pharmacodynamic parameters of a drug in vivo and have increasing use in breast cancer research. Most breast cancer tumours are oestrogen receptor-positive (ER+), leading to the development of multiple treatment options tailored towards this particular tumour subtype. The aim of this literature review is to review WoO trials pertaining to the pharmacodynamic activity of drugs available for use in ER+ breast cancer in order to help guide treatment for patients receiving neoadjuvant and primary endocrine therapy. Five databases (EMBASE, Cochrane, MEDLINE, PubMed, Web of Science) were searched for eligible studies. Studies performed in treatment-naïve patients with histologically confirmed ER+ breast cancer were included if they acquired pre- and post-treatment biopsies, compared measurement of a proteomic biomarker between these two biopsies and delivered treatment for a maximum mean duration of 31 days. Fifteen studies were eligible for inclusion and covered six different drug classes: three endocrine therapies (ETs) including aromatase inhibitors (AIs), selective oestrogen receptor modulators (SERMs), selective oestrogen receptor degraders (SERDs) and three non-ETs including mTOR inhibitors, AKT inhibitors and synthetic oestrogens. Ki67 was the most frequently measured marker, appearing in all studies. Progesterone receptor (PR) and ER were the next most frequently measured markers, appearing five and four studies, respectively. All three of these markers were significantly downregulated in both AIs and SERDs; Ki67 alone was downregulated in SERMs. Less commonly assessed markers including pS6, pGSH3B, FSH and IGF1 were downregulated while CD34, pAKT and SHBG were significantly upregulated. There were no significant changes in the other biomarkers measured such as phosphate and tensin homolog (PTEN), Bax and Bcl-2.WoO studies have been widely utilised within the ER+ breast cancer subtype, demonstrating their worth in pharmacodynamic research. However, research remains focused upon routinely measured biomarkers such ER PR and Ki67, with an array of less common markers sporadically used

Terrace reconstruction and long profile projection: a case study from the Solent river system near Southampton, England

River terrace sequences are important frameworks for archaeological evidence and as such it is important to produce robust correlations between what are often fragmentary remnants of ancient terraces. This paper examines both conceptual and practical issues related to such correlations, using a case study from the eastern part of the former Solent River system near Southampton, England. In this region two recent terrace schemes have been constructed using different data to describe the terrace deposits: one based mainly on terrace surfaces; the other on gravel thicknesses, often not recording the terrace surface itself. The utility of each of these types of data in terrace correlation is discussed in relation to the complexity of the record, the probability of post-depositional alteration of surface sediments and comparison of straight-line projections with modern river long profiles. Correlation using age estimates is also discussed, in relation to optically-stimulated luminescence dating of sand lenses within terrace gravels in this region during the PASHCC project. It is concluded that the need for replication at single sites means that this approach has limited use for correlative purposes, although dating of sediments is important for understanding wider landscape evolution and patterns of human occupation

Phthalate side side-chain structures and hydrolysis metabolism associated with steroidogenic effects in MLTC-1 Leydig cells

Although it is well acknowledged that the anti-androgenic phthalate diesters can be readily hydrolysed into their monoester counterparts, their metabolites’ toxicology remains obscure. Herein, we tested the hypothesis that hydrolysis of one of the two ester bonds can mediate phthalate diesters’ potential endocrine effects in MLTC-1 Leydig cells, in line with their ability to disrupt androgen secretion in humans. Five diesters (DMP, DEP, DBP, DBzP and DEHP) and five monoesters (MMP, MEP, MBP, MBzP and MEHP) phthalates as mixtures or individually were applied to cell lines to investigate differences in phthalates’ hydrolysis associated with varying side-chain structures and steroidogenic effects. Short-chain diesters DMP, DEP and DBP are more readily hydrolysed compared to the long-chain DEHP, while aromatic alkyl chain DBzP cannot be metabolized completely in vitro. When the hydrolysis processes are interrupted, the diester phthalates’ steroidogenic effects can be influenced via regulating related steroidogenic pathway genes. With 10 to 100 μM treatment exposures, androgenic effects were observed only with DMP or DEP but not for MMP or MEP; while the phthalate diesters DBP, DBzP or DEHP generally exhibited more complex steroidogenic effects than their corresponding monoester counterparts (i.e., biphasic androgen and anti-androgen effects for diesters but monotonic androgen effects for monoesters were observed). DBP elicited hydrolysis-related steroidogenic modulation, in which the anti-androgenic effects of diester DBP reversed into the androgenic effects of monoester MBP at 100 μM. Phthalate metabolites appear to exert different effects at an endocrine level compared to parent compounds, and deeper insights into how the hydrolytic process is related to this alternating toxicity would improve our understanding of a risk assessment for these widespread contaminants in male reproduction

Marine Noise Budgets in Practice

Many countries have made statutory commitments to ensure that underwater noise pollution is at levels which do not harm marine ecosystems. Nevertheless, coordinated action to manage cumulative noise levels is lacking, despite broad recognition of the risks to ecosystem health. We attribute this impasse to a lack of quantitative management targets—or “noise budgets”—which regulatory decision-makers can work toward, and propose a framework of risk-based noise exposure indicators which make such targets possible. These indicators employ novel noise exposure curves to quantify the proportion of a population or habitat exposed, and the associated exposure duration. This methodology facilitates both place-based and ecosystem-based approaches, enabling the integration of noise management into marine spatial planning, risk assessment of population-level consequences, and cumulative effects assessment. Using data from the first international assessment of impulsive noise activity, we apply this approach to herring spawning and harbor porpoise in the North Sea

Value-based recruitment in midwifery: do the values align with what women say is important to them?

Aim: To discuss theoretical conceptualisation and definition of values and values-based recruitment in the context of women’s views about what they would like from their midwife. Background: Values-based recruitment received headline status in the UK government’s response to pervasive deficiencies in compassionate care identified in the health service. Core values which aim to inform service user’s experience are defined in the National Health Service Constitution but clarity about whether these encompass all that women say is important to them is needed. Design: Discussion paper Data Sources: A literature search included published papers written in English relating to values, VBR and women’s views of a ‘good’ midwife with no date limiters. Discussion: Definitions of values and values-based recruitment are examined. Congruence is explored between what women say is important to them and key government and professional regulatory documentation. The importance of a ‘sustainable emotional’ dimension in the midwife-mother relationship is suggested. Conclusion: Inconsistencies are identified between women’s views, government, professional documentation and what women say they want. An omission of any reference to emotions or emotionality in values-based recruitment policy, professional recruitment and selection guidance documentation is identified. Implications: A review of key professional documentation, in relation to selection for ‘values’, is proposed. We argue for clarity and revision so that values embedded in values-based recruitment are consistent with health service users’ views. An enhancement of the ‘values’ in the values-based recruitment framework is recommended to include the emotionality that women state is a fundamental part of their relationship with their midwife

The influence of light on nitrogen cycling and the primary nitrite maximum in a seasonally stratified sea

Author Posting. © The Author(s), 2011. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Progress In Oceanography 91 (2011): 545–560, doi:10.1016/j.pocean.2011.09.001.In the seasonally stratified Gulf of Aqaba Red Sea, both NO2- release by phytoplankton and NH4+ oxidation by nitrifying microbes contributed to the formation of a primary nitrite maximum (PNM) over different seasons and depths in the water column. In the winter and during the days immediately following spring stratification, NO2- formation was strongly correlated (R2=0.99) with decreasing irradiance and chlorophyll, suggesting that incomplete NO3- reduction by light limited phytoplankton was a major source of NO2-. However, as stratification progressed, NO2- continued to be generated below the euphotic depth by microbial NH4+ oxidation, likely due to differential photoinhibition of NH4+ and NO2- oxidizing populations. Natural abundance stable nitrogen isotope analyses revealed a decoupling of the δ15N and δ18O in the combined NO3- and NO2- pool, suggesting that assimilation and nitrification were co-occurring in surface waters. As stratification progressed, the δ15N of particulate N below the euphotic depth increased from -5‰ to up to +20‰. N uptake rates were also influenced by light; based on 15N tracer experiments, assimilation of NO3-, NO2-, and urea was more rapid in the light (434±24, 94±17, and 1194±48 nmol N L-1 day-1 respectively) than in the dark (58±14, 29±14, and 476±31 nmol N L-1 day-1 respectively). Dark NH4+ assimilation was 314±31 nmol N L-1 day-1, while light NH4+ assimilation was much faster, resulting in complete consumption of the 15N spike in less than 7 hour from spike addition. The overall rate of coupled urea mineralization and NH¬4+ oxidation (14.1±7.6 nmol N L-1 day-1) was similar to that of NH¬4+ oxidation alone (16.4±8.1 nmol N L-1 day-1), suggesting that for labile dissolved organic N compounds like urea, mineralization was not a rate limiting step for nitrification. Our results suggest that assimilation and nitrification compete for NH4+ and that N transformation rates throughout the water column are influenced by light over diel and seasonal cycles, allowing phytoplankton and nitrifying microbes to contribute jointly to PNM formation. We identify important factors that influence the N cycle throughout the year, including light intensity, substrate availability, and microbial community structure. These processes could be relevant to other regions worldwide where seasonal variability in mixing depth and stratification influence the contributions of phytoplankton and non-photosynthetic microbes to the N cycle.This research was supported under the North Atlantic Treaty Organization (NATO) Science for Peace Grant SfP 982161 to AP and AFP, a grant from the Koret Foundation to AP, a National Science Foundation Biological Oceanography grant to AP, the Israel Science Foundation grant 135/05 to AFP, and research grant 8330-06 from the Geological Society of America to KRMM

Real-world incidence and prevalence of systemic lupus erythematosus in Alberta, Canada

Systemic lupus erythematosus (SLE) is rather uncommon than rare. The purpose of this study was to estimate the incidence and prevalence of SLE in the population of Alberta, Canada, using administrative health data. Multiple population-based data sources, including the Alberta Health Care Insurance Plan Central Stakeholder Registry (AHCIP CSR), Fee-For-Service, and Hospital Discharge Abstract Database were used. Age- and sex-specific incidence and prevalence rates, and 95% confidence intervals (CI), were computed using the AHCIP CSR mid-year population estimates as the denominator, for the period of 2000–2015. The overall incidence of SLE for all age groups was 4.43 (95% CI 3.65, 5.04) per 100,000 population. The overall incidence in male and female of all age groups was 1.26 (95% CI 0.72, 1.76) and 7.69 (95% CI 6.22, 8.81) per 100,000 population, respectively. A prevalence of 47.99 per 100,000 (male = 13.5, female = 83.2) of SLE was observed for the year 2000 and has increased to 90 (male = 25.5, female = 156.7) per 100,000 population in 2015. Over the 16-year period, the incidence of SLE in women was approximately six times higher than in men (odds ratio = 6.16). The highest and lowest incidence was recorded in 2001 and 2015, respectively. Despite the stable incidence of SLE, the findings of the study confirms that the prevalence of SLE has increased over the 16-year period. The increase in prevalence of SLE in Alberta will have an impact on health service utilizations. This finding can be used for planning and evaluating health services for this group of patients. Further studies are required to determine the economic burden of the condition

The ‘values journey’ of nursing and midwifery students selected using multiple mini interviews; Year One findings

Aim: to explore how adult, child and mental health nursing and midwifery students, selected using multiple mini interviews, describe their ‘values journey’ following exposure to the clinical practice environment. Background: Values based recruitment incorporates assessment of healthcare students’ personal values using approaches like multiple mini interviews. Students’ experience of adjustment to their values during their programme is conceptualised as a ‘values journey’. The impact of VBR in alleviating erosion of personal values is unclear. Design A cross-professional longitudinal cohort study was commenced at one university in England in 2016 with data collection points at the end of years one, two and three. Non-probability consecutive sampling resulted in 42 healthcare students (8 adult, 8 child and 9 mental health nursing and 17 midwifery students) taking part. Methods: Six semi-structured focus groups were conducted at the end of participants’ Year One (DC1). Data analysis incorporated inductive and deductive approaches in a hybrid synthesis. Findings: Participants described a ‘values journey’ where their values, particularly communication, courage and wanting to make a difference, were both challenged and retained. Participants personal journeys also acknowledged the: ‘courage it takes to use values’; ‘reality of values in practice’ and ‘need for self-reflection on values’. Conclusion: A ‘values journey’ may begin early in healthcare student’s education programme. This is important to recognise so that appropriate measures are implemented to support students across higher education and clinical practice. Consideration should also be given to the values incorporated in values based recruitment to ensure their fitness for purpose