The SF36 as an outcome measure of services for end stage renal failure

OBJECTIVE: —To evaluate the use of the short form 36 (SF36) as a measure of health related quality of life of patients with end stage renal failure, document the results, and investigate factors, including mode of treatment, which may influence it. DESIGN: Cross sectional survey of patients with end stage renal failure, with the standard United Kingdom version of the SF36 supplemented by specific questions for end stage renal failure. SETTING: A teaching hospital renal unit. Subjects and methods—660 patients treated at the Sheffield Kidney Institute by haemodialysis, peritoneal dialysis, and transplantation. Internal consistency, percentage of maximal or minimal responses, SF36 scores, effect sizes, correlations between independent predictor variables and individual dimension scores of the SF36. Multiple regression analysis of the SF36 scores for the physical functioning, vitality, and mental health dimensions against treatment, age, risk (comorbidity) score, and other independent variables. RESULTS: A high response rate was achieved. Internal consistency was good. There were no floor or ceiling effects other than for the two “role” dimensions. Overall health related quality of life was poor compared with the general population. Having a functioning transplant was a significant predictor of higher score in the three dimensions (physical functioning, vitality, and mental health) for which multiple regression models were constructed. Age, sex, comorbidity, duration of treatment, level of social and emotional support, household numbers, and hospital dialysis were also (variably) significant predictors. CONCLUSIONS: The SF36 is a practical and consistent questionnaire in this context, and there is evidence to support its construct validity. Overall the health related quality of life of these patients is poor, although transplantation is associated with higher scores independently of the effect of age and comorbidity. Age, comorbidity, and sex are also predictive of the scores attained in the three dimensions studied. Further studies are required to ascertain whether altering those predictor variables which are under the influence of professional carers is associated with changes in health related quality of life, and thus confirm the value of this outcome as a measure of quality of care

Single-mode tunable erbium:ytterbium fibre Fabry-Perot laser

A compact tunable single-mode fiber laser is developed by using a novel combination of high-gain erbium: ytterbium (Er:Yb) phosphate fiber and fiber Fabry-Perot (FFP) cavity configurations. Experiments demonstrate the shortest Er:Yb phosphate FFP laser ever reported, which has a 100µm cavity length with a continuous wavelength tuning range over 4.52nm, as limited by the sharp fiber gain peak. In addition, an alternative 3-mirror laser design has also demonstrated single-mode lasing operation

The use of a cephalonium containing dry cow therapy and an internal teat sealant, both alone and in combination

AbstractThe dry period is a critical time in the lactation cycle, being the optimum time to cure existing intramammary infection (IMI) as well as encompassing the periods of highest susceptibility to new infection. Currently, IMI in the dry period is controlled with antibiotic dry cow therapy. The aim of this randomized control trial was to investigate different dry cow therapy regimens by stratifying cows by likely infection status at drying off in herds with low somatic cell count (SCC; bulk milk SCC <250,000 cells/mL) in southwest England. All quarters in 890 cows were recruited. The recruited cows were categorized as either infected or uninfected on the basis of SCC and clinical mastitis history. Ipsilateral quarters within each cow were randomly allocated to receive 1 of 4 different treatment regimens according to their infection category. Quarters in high-SCC infected cows were allocated to receive antibiotic dry cow therapy either alone or in combination with an internal teat sealant; quarters in low-SCC uninfected cows were allocated to receive teat sealant either alone or in combination with antibiotic dry cow therapy. All quarters were sampled for bacteriology at drying off and again within 10 d post-calving. Quarters were subsequently monitored for clinical mastitis for the first 100 d of lactation. The mass of residual sealant was assessed immediately post-calving to allow assessment of the association of sealant retention with treatment efficacy. Models were constructed to assess the efficacy of the different regimens in preventing IMI. Apparent cure rates of existing IMI with major pathogens were consistently >90% in quarters receiving antibiotic. Combination treatment of high-SCC infected cows resulted in an increased likelihood of being pathogen free post-calving (odds ratio=1.40; 95% credibility interval=1.03–1.90). The benefits of combination treatment of low-SCC uninfected cows were less clear. With respect to clinical mastitis, combination treatment of high-SCC infected cows resulted in a decreased likelihood of developing clinical mastitis in the first 100 d of the subsequent lactation (odds ratio=0.68; 95% credibility interval=0.48–0.98). The retention of the internal sealant was adversely affected by its use in combination with antibiotic dry cow therapy

A comparison of broad-spectrum and narrow-spectrum dry cow therapy used alone and in combination with a teat sealant

The dry period is a critical time in the lactation cycle, offering the optimum time for cure of existing intramammary infection (IMI), while also encompassing the periods of highest susceptibility to new intramammary infection. Until recent years, intramammary infection in the dry period has been controlled with the use of antibiotic dry cow therapy. The aim of this study was to investigate 3 different dry cow therapy regimens, in low-somatic cell count (SCC; bulk milk SCC < 250,000 cells/mL) herds in southwest England. A total of 489 cows was recruited to the study and randomly allocated to receive either the broad-spectrum antibiotic cefquinome, a combination treatment comprising the narrow-spectrum antibiotic cloxacillin and an internal teat sealant, or the narrow-spectrum antibiotic cloxacillin alone. All quarters were sampled for bacteriology at drying off and again in the week immediately postcalving; 2 quarters were also sampled 2 wk before the estimated calving date to allow an assessment of infection dynamics during the dry period. Quarters were subsequently monitored for clinical mastitis for the first 100 d of lactation. Conventional multilevel (random effects) models were constructed to assess the efficacy of products in preventing IMI. Survival analysis was used to examine factors that influenced the risk of clinical mastitis using conventional Cox proportional hazards models. No differences were identified between the treatment groups in terms of cure of IMI caused by the major pathogens. Quarters in both the combination and cefquinome-treated groups were more likely to be free of a major pathogen or enterobacterial pathogen postcalving. With respect to clinical mastitis, the cefquinome-treated group was less likely to develop clinical mastitis than was the cloxacillin treated group

Improved spectral characteristics of a single-mode semiconductor laser using a fibre grating and a reduced laser diode length

Use of a reduced laser diode length with a fibre Bragg reflector leads to decreased mode-hopping and a factor of 3 improvement in temperature stability of the lasing wavelength over Δ T=22°C. Single frequency output power of 1.7 mW in the fibre with 45 dB side mode suppression was obtained

The use of an e-learning constructivist solution in workplace learning

We wished to investigate whether an e-learning approach which uses constructivist principles can be successfully applied to train employees in a highly specialised skill thought to require expert individuals and extensive prolonged training. The approach involved the development of an e-learning package which included simulations and interactivity, then experimental testing in a case study workplace environment with the collection of both quantitative and qualitative data to assess the effectiveness of the package. Our study shows that this e-learning strategy improved the skills of the inexperienced operator significantly. We therefore propose that such programmes could be used as a work based training aid and used as a model system for the training of employees in complex skilled tasks in the workplace. This research demonstrates that the e-learning can be applied outside the traditional learning environment to train unskilled employees to undertake complex practical tasks which traditionally would involve prohibitively expensive instruction. This work also illustrates that simulations and interactivity are powerful tools in the design of successful e-learning packages in preparing learners for real world practical situations. Finally this study shows that workplace learners can be better served by elearning environments rather than conventional training as they allow asynchronous learning and private study which are valued by employees who have other demands on their time and are more comfortable receiving tuition privately Relevance to industry: E-learning using constructivist principles, and incorporating simulations and interactivity can be used successfully in the training of highly specialised and skilled tasks required in the modern workplace

High-power erbium-doped-fibre amplifiers operating in the saturated regime

Highly saturated, erbium-doped fiber amplifiers can be employed as efficient power amplifiers. Differential pump-to-signal conversion efficiencies of 59% (quantum efficiency of 93%) can be obtained, resulting in 54 mW (+17.3 dBm) of amplified signal for only 100 mW of pump power at 978 nm. In addition, these amplifiers are shown to have virtually-flat spectral-gain characteristics with a 1 dB bandwidth in excess of 38 nm

Theoretical investigations of a highly mismatched interface: the case of SiC/Si(001)

Using first principles, classical potentials, and elasticity theory, we investigated the structure of a semiconductor/semiconductor interface with a high lattice mismatch, SiC/Si(001). Among several tested possible configurations, a heterostructure with (i) a misfit dislocation network pinned at the interface and (ii) reconstructed dislocation cores with a carbon substoichiometry is found to be the most stable one. The importance of the slab approximation in first-principles calculations is discussed and estimated by combining classical potential techniques and elasticity theory. For the most stable configuration, an estimate of the interface energy is given. Finally, the electronic structure is investigated and discussed in relation with the dislocation array structure. Interface states, localized in the heterostructure gap and located on dislocation cores, are identified

Randomized controlled field trial comparing quarter and cow level selective dry cow treatment using the California Mastitis Test

Selective use of antibiotic dry cow treatment can be implemented at the cow or quarter level, with the latter having the potential to further reduce antibiotic use. Our objective was to compare these 2 approaches in 6 herds in the United Kingdom in which environmental mastitis predominated. Eight hundred seven cows were enrolled and categorized as having a high cell count (n = 401) or low cell count (n = 406) in the last 3 mo of lactation and clinical mastitis history. All quarters of all enrolled cows received an internal teat sealant. Within each category, cows were randomly allocated to 1 of 3 groups; in one group antibiotic treatment was allocated at cow level (i.e., all 4 quarters received antibiotic), whereas in the 2 remaining groups antibiotic treatment was allocated at quarter level, based on California Mastitis Test (CMT) findings. Two different thresholds, score 1 and 2, were used to determine likely infection status. Quarter milk samples were collected at dry off and postcalving for bacteriological culture and somatic cell count (SCC). Cows were monitored for clinical mastitis from dry off until 100 d in milk. Cow level SCC and milk yield data were collated from farm records. Within each category, the 2 quarter level treatment groups were compared with cow level treatment at dry off. Leaving quarters untreated with intramammary antibiotic in cows in the high cell count group, with a CM

A diode-laser-pumped, Er³⁺-doped fibre laser operating at 1.57µm

Erbium-doped fibers show promise as stable narrow-linewidth laser sources and optical amplifiers operating in the third telecommunications window around 1.55µm Diode laser pumping is possible using the weak pump-band located at 807nm, although this band suffers severely from excited-state absorption (ESA), which reduces gain and pump efficiency. At the low pump power available from diode lasers the Er3+ behaves as a quasi four-level system. However, by codoping the core glass heavily with Yb3+, it is possible to excite the Er3+ ions indirectly using energy transfer. The Yb3+ provides an intense broad pump-band centered at 900nm, which reduces the effect of ESA. As a consequence of the resulting higher pump efficiency, the laser will oscillate at the required shorter wavelengths