Musculoskeletal pain is associated with a long-term increased risk of cancer and cardiovascular-related mortality

Objectives. To test the hypothesis that individuals with regional and widespread pain disorders have an increased risk of mortality

'Reaching the hard to reach' - lessons learned from the VCS (voluntary and community Sector). A qualitative study.

Background The notion 'hard to reach' is a contested and ambiguous term that is commonly used within the spheres of social care and health, especially in discourse around health and social inequalities. There is a need to address health inequalities and to engage in services the marginalized and socially excluded sectors of society. Methods This paper describes a pilot study involving interviews with representatives from eight Voluntary and Community Sector (VCS) organisations . The purpose of the study was to explore the notion of 'hard to reach' and perceptions of the barriers and facilitators to accessing services for 'hard to reach' groups from a voluntary and community sector perspective. Results The 'hard to reach' may include drug users, people living with HIV, people from sexual minority communities, asylum seekers, refugees, people from black and ethnic minority communities, and homeless people although defining the notion of the 'hard to reach' is not straight forward. It may be that certain groups resist engaging in treatment services and are deemed hard to reach by a particular service or from a societal stance. There are a number of potential barriers for people who may try and access services, including people having bad experiences in the past; location and opening times of services and how services are funded and managed. A number of areas of commonality are found in terms of how access to services for 'hard to reach' individuals and groups could be improved including: respectful treatment of service users, establishing trust with service users, offering service flexibility, partnership working with other organisations and harnessing service user involvement. Conclusions: If health services are to engage with groups that are deemed 'hard to reach' and marginalised from mainstream health services, the experiences and practices for engagement from within the VCS may serve as useful lessons for service improvement for statutory health services

Financing methods for small-scale hardwood plantations in Queensland, Australia

Under Vision 2020, a target was set in 1997 for trebling the plantation area in Australia by the year 2020. Government subsidies and extension for plantation establishment have largely disappeared, hence forestry expansion is highly dependent on access to private finance. In the state of Queensland, plantation expansion has occurred predominantly through managed investment schemes and the joint venture scheme managed by Forestry Plantations Queensland, a government-owned corporation. Most of these plantings are relatively small-scale hardwood plantations, which are designed to replace the hardwood timber from the native forests that will be protected from further logging after 2024 under the South-East Queensland Regional Forestry Agreement. Views on financing methods for forestry expansion in Queensland were investigated through by an email survey of 12 forestry and finance professionals, followed by in-depth personal interviews of the same group of key informants. Some of the issues identified include lack of transparent information, inequitable taxation system between Managed Investment Scheme (MIS) companies and small-scale forest operators, the need for further R&D on all aspects of the industry, the potential impacts of carbon credit schemes on the industry, and the design of a strategic model for forestry investors. Participants took the view that adoption of a strategic alliance model would encourage further investment in small-scale forestry, arguing that this model could protect the interest of all the stakeholders through reducing investment risk and creating competitive advantage. The potential introduction of a carbon trading scheme also attracted interest from investors, who look for recognisable structures that may alleviate the risk of investing in an industry with which they are unfamiliar. The participants considered that further R&D should be the main focus for government participation in small-scale forestry

Choice in the context of informal care-giving

Extending choice and control for social care service users is a central feature of current English policies. However, these have comparatively little to say about choice in relation to the informal carers of relatives, friends or older people who are disabled or sick. To explore the realities of choice as experienced by carers, the present paper reviews research published in English since 1985 about three situations in which carers are likely to face choices: receiving social services; the entry of an older person to long-term care; and combining paid work and care. Thirteen electronic databases were searched, covering both the health and social care fields. Databases included: ASSIA; IBSS; Social Care Online; ISI Web of Knowledge; Medline; HMIC Sociological Abstracts; INGENTA; ZETOC; and the National Research Register. The search strategy combined terms that: (1) identified individuals with care-giving responsibilities; (2) identified people receiving help and support; and (3) described the process of interest (e.g. choice, decision-making and self-determination). The search identified comparatively few relevant studies, and so was supplemented by the findings from another recent review of empirical research on carers' choices about combining work and care. The research evidence suggests that carers' choices are shaped by two sets of factors: one relates to the nature of the care-giving relationship; and the second consists of wider organisational factors. A number of reasons may explain the invisibility of choice for carers in current policy proposals for increasing choice. In particular, it is suggested that underpinning conceptual models of the relationship between carers and formal service providers shape the extent to which carers can be offered choice and control on similar terms to service users. In particular, the exercise of choice by carers is likely to be highly problematic if it involves relinquishing some unpaid care-giving activities

Evaluación funcional en ancianos intervenidos de fractura de cadera

Estudio observacional prospectivo en pacientes mayores de 65 años intervenidos de fractura de cadera. El objetivo fue conocer la evolución funcional de los pacientes a los tres meses del alta hospitalaria, identificar variables relacionadas con dicha recuperación funcional, describir la mortalidad e institucionalización asociadas al proceso. Se analizaron variables demográficas como edad, sexo, convivencia. Otros aspectos registrados fueron: comorbilidad, deterioro cognitivo, capacidad para caminar, nivel de dependencia según índice de Barthel, institucionalización y mortalidad. Se recogió la información al ingreso y a los 3 meses del alta. El 89,6% de la muestra, fueron mujeres, la edad media fue de 83,56 años. El 40% de los pacientes recuperaron la independencia previa registrándose una mortalidad del 16,7% así como una leve progresión hacia la institucionalización. La capacidad funcional y el deterioro cognitivo del paciente, previos a la fractura condicionan su recuperación funcional y dependencias posteriores

Optimizing accuracy and efficacy in data-driven materials discovery for the solar production of hydrogen

The production of hydrogen fuels, via water splitting, is of practical relevance for meeting global energy needs and mitigating the environmental consequences of fossil-fuel-based transportation. Water photoelectrolysis has been proposed as a viable approach for generating hydrogen, provided that stable and inexpensive photocatalysts with conversion efficiencies over 10% can be discovered, synthesized at scale, and successfully deployed (Pinaud et al., Energy Environ. Sci., 2013, 6, 1983). While a number of first-principles studies have focused on the data-driven discovery of photocatalysts, in the absence of systematic experimental validation, the success rate of these predictions may be limited. We address this problem by developing a screening procedure with co-validation between experiment and theory to expedite the synthesis, characterization, and testing of the computationally predicted, most desirable materials. Starting with 70 150 compounds in the Materials Project database, the proposed protocol yielded 71 candidate photocatalysts, 11 of which were synthesized as single-phase materials. Experiments confirmed hydrogen generation and favorable band alignment for 6 of the 11 compounds, with the most promising ones belonging to the families of alkali and alkaline-earth indates and orthoplumbates. This study shows the accuracy of a nonempirical, Hubbard-corrected density-functional theory method to predict band gaps and band offsets at a fraction of the computational cost of hybrid functionals, and outlines an effective strategy to identify photocatalysts for solar hydrogen generation

The development and application of a new tool to assess the adequacy of the content and timing of antenatal care

Abstract Background: Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care. Methods: The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from ‘Inadequate’ (both tools) to ‘Adequate plus’ (APNCU) or ‘Appropriate’ (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools. Results: According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as ‘Adequate’ or ‘Adequate plus’ by the APNCU were deemed ‘Inadequate’ by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care. Conclusions: The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as ‘Inappropriate’. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure

Phase changes of the Be/X-ray binary X Persei

We present high resolution optical spectroscopy and V band photometry obtained during the period 1987-2001 for the Be star X Persei/HD 24534, the counterpart to the X-ray pulsar 4U 0352+30. We find that throughout this interval X Per is highly active, with significant photometric and spectroscopic variability. We identify one episode of complete disc loss during this period (1988 May-1989 June), characterised by significant ΔV=0.6 mag optical fading and the presence of purely photospheric Hα and He I 6678 Å lines. Two further episodes of pronounced optical fading which did not result in the complete dispersal of the circumstellar disc were also identified (1994 October-1995 October and 1999 November-present). The emission line profiles of both Hα and He I 6678 Å also show significant variability. Cyclic changes in the strength of the peaks in both emission lines are observed, with periods ranging from 0.6-2 yrs - we attribute these to the presence of a one armed density wave in the inner circumstellar disc. Additional structure at large projected velocities is also present in the He I line - suggesting the presence of a significant density enhancement in the disc near the stellar surface (the "double disc'' of Tarasov & Roche). The evolution of the outer edge of the Hα emitting region of the circumstellar disc is followed during disc formation, and is found to increase rather slowly. This observation, combined with the presence of the one armed density wave and the rate of disc formation and loss all provide strong evidence for the hypothesis that the circumstellar disc of X Per is a viscous decretion disc, with angular momentum being supplied by an as yet unknown physical mechanism near the stellar surface

Medical Conditions of Nursing Home Admissions

<p>Abstract</p> <p>Background</p> <p>As long-term nursing home care is likely to increase with the aging of the population, identifying chronic medical conditions is of particular interest. Although need factors have a strong impact on nursing home (NH) admission, the diseases causing these functional disabilities are lacking or unclear in the residents' file. We investigated the medical reason (primary diagnosis) of a nursing home admission with respect to the underlying disease.</p> <p>Methods</p> <p>This study is based on two independent, descriptive and comparative studies in Belgium and was conducted at two time points (1993 and 2005) to explore the evolution over twelve years. Data from the subjects were extracted from the resident's file; additional information was requested from the general practitioner, nursing home physician or the head nurse in a face-to-face interview. In 1993 we examined 1332 residents from 19 institutions, and in 2005 691 residents from 7 institutions. The diseases at the time of admission were mapped by means of the International Classification of Diseases - 9th edition (ICD-9). Longitudinal changes were assessed and compared by a chi-square test.</p> <p>Results</p> <p>The main chronic medical conditions associated with NH admission were dementia and stroke. Mental disorders represent 48% of all admissions, somatic disorders 43% and social/emotional problems 8%. Of the somatic disorders most frequently are mentioned diseases of the circulatory system (35%) [2/3 sequels of stroke and 1/5 heart failure], followed by diseases of the nervous system (15%) [mainly Parkinson's disease] and the musculoskeletal system (14%) [mainly osteoarthritis]. The most striking evolution from 1993 to 2005 consisted in complicated diabetes mellitus (from 4.3 to 11.4%; p < 0.0001) especially with amputations and blindness. Symptoms (functional limitations without specific disease) like dizziness, impaired vision and frailty are of relevance as an indicator of admission.</p> <p>Conclusion</p> <p>Diseases like stroke, diabetes and mobility problems are only important for institutionalisation if they cause functional disability. Diabetes related complications as cause of admission increased almost three-fold between 1993 and 2005.</p