Living with persistent pain: experiences of older people receiving home care.

Background. Although the topic of pain among older people has received increasing interest, little is still known about how pain is experienced or handled by those who no longer manage independently but depend on professionals for help with daily living. Developing pain management for older people requires such knowledge. Aim. To explore sense of self, sense of pain, daily living with pain, sense of others and ways of handling pain in older people with persistent pain. Methods. Interviews with 90 older people receiving home care from nursing auxiliaries in their own homes or in sheltered accommodation were collected from January to June 2000. A typology of older people in persistent pain was developed. Activities for handling pain were examined using content analysis. Findings. Respondents' experiences of themselves and their pain varied. Two groups of older people, considered as 'competent and proud' and 'confident and serene', expressed satisfaction in spite of pain, while the groups 'misunderstood and disappointed' and 'resigned and sad' expressed dissatisfaction. The most common strategies used were medication, rest, mobility, distracting activities and talking about pain. Respondents chose strategies by balancing the advantages of the activities against the disadvantages these brought for their daily living. Conclusion. This study indicates that characteristics of the older people, such as their way of experiencing themselves, how pain affects their daily life and how they perceive effects and side-effects of pain management are areas that need to be identified when staff assess pain and plan pain management. Caring for older people in pain could be improved by listening to and believing their complaints, evaluating effects and side-effects from medications and nonpharmacological pain management and by emphasising the importance of common everyday activities such as mobility and distraction to relieve pain

Role of renin–angiotensin system antagonists on long-term mortality post-percutaneous coronary intervention in reduced and preserved ejection fraction

Aims: The use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II-receptor blockers (ARBs) post-myocardial infarction (MI) is supported by evidence based on trials performed in the thrombolysis era. This was prior to primary percutaneous coronary intervention (PCI) being routine practice, and with little direct evidence for the use of these medications in patients with preserved left ventricular (LV) function. This study sought to determine whether there is an association between ACEi/ARB use after PCI for acute coronary syndrome (ACS) and long-term all-cause mortality, with a particular focus on patients with preserved LV function. Methods: This multicentre, observational study evaluated prospectively collected data of 21,388 patients (> 18 years old) that underwent PCI for NSTEMI and STEMI between 2005 and 2018, and were alive at 30 day follow-up. Results: In total, 83.8% of patients were using ACEi/ARBs. Kaplan–Meier analysis demonstrated ACEi/ARB use was associated with a significantly lower mortality in the entire cohort (15.0 vs. 22.7%; p < 0.001) with a mean follow-up of 5.58 years; and independently associated with 24% lower mortality by Cox proportional hazards modelling (HR 0.76, CI 0.67–0.85, p < 0.001). ACEi/ARB therapy was also associated with significantly lower mortality in patients with reduced or preserved LV function, with greater survival benefit with worse LV dysfunction. Conclusion: ACEi/ARB therapy post-PCI is associated with significantly lower long-term mortality in patients with reduced and preserved LV function. These findings provide contemporary evidence for using these agents in the current era of routine primary PCI, including those with preserved EF. Graphical abstract: [Figure not available: see fulltext.

On design and optimization of curved composite beams

In curved beams of thin-walled construction secondary stresses such as crushing of the web and curling of the flanges occur due to the initial curvature of the beam. The presence of these stresses becomes more significant when advanced composite materials are used. Two parameters, accounting for material stiffness and geometric effects of the beam structure, characterize the flange stress redistribution. Using a simple `strength of materials'-based analytical solution for flange curling and web crushing, the design and optimization of curved composite I- and box beams under bending were examined. The ply orientations and stacking sequence of the flange have been found to drastically affect the nature of these stress redistributions and consequently the overall load carrying capability of the beam. Overall frame optimization was explored. To maximize load carrying capability, for a given amount of material, of a curved beam structure under bending in its own plane, the overall bending stiffness should be maximized and flange curling minimized. For composite beams, this is most effectively accomplished by minimizing web thickness and placing a large percentage of flange fibers perpendicular to the web. For the box beam, a low web bending stiffness seems beneficial in reducing flange curling moments. While web crushing needs to be considered, the curling of the flanges and its effect on the web is more critical

Assessment of BIOrefinery concepts and the implications for agricultural and forestry POLicy : Deliverable 7.6 : BIOPOL Final report

BIOPOL is a two-year research project funded by the European Commission since 2007 through the Sixth Framework Programme. The overall goal of BIOPOL is to assess the status (technical, social, environmental, political, and implementation) of innovative BIOrefinery concepts and the implications for agricultural and forestry POLicy. Biorefinery concepts are aimed at relevant market-competitive and environmental-friendly synthesis of bio-products (chemicals and/or materials) together with the production of secondary energy carriers (transportation fuels, power and/or CHP). BIOPOL was conceived to address the fact that the wider expectations for biorefineries have not yet yielded clear definitions for biorefinery concepts, or an understanding of the current status and prospective benefits of biorefining in Europe. Therefore the BIOPOL project was designed to assess the current status of biorefinery activities in Europe and explore future scenarios for development. By systematically accounting for potential technical, political, social and industrial impacts of such scenarios their outputs will be utilised to inform policy formulation in this area. By drawing from several complimentary research disciplines the insights gained will be able to inform EU policy-making and help frame future research directions both in Europe and elsewhere