728 research outputs found

    Securing the well-being and engagement of construction workers: an initial appraisal of the evidence

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    Construction sites pose unique challenges for employers who are seeking to develop interventions to improve outcomes for workers. The contractors who constructed the infrastructure for the 2012 Olympic Games were encouraged by the client organisation to actively engage their workers and promote their well-being. This paper examines how scholarly research has approached well-being and engagement in the construction industry. A literature review identified a total of 21 papers that have examined either well-being or engagement in construction and only a single paper examined both subjects. There has been very limited research into this area. The existing papers highlight a number of gaps which could be filled through future research. The concept of well-being in construction is poorly defined and predominantly focuses on stress and work-life balance. There is a lack of clarity or certainty about whether and how some of the recommendations for improving wellbeing can be realistically implemented in construction, such as giving workers more flexible working arrangements. It is also unclear what specific benefits construction companies, and their clients, could expect to see from engagement or well-being strategies. Consequently, it is currently difficult to make a convincing business case or plan for the introduction of well-being or engagement strategies in construction. Nonetheless, there is evidence that engagement and well-being strategies can improve outcomes for individual construction workers and professionals, such as maintaining or improving health or promoting safety or skills development. Many of the practices that engage individuals also promote well-being: They do not need to be approached as completely separate issues. The extant research suggests that construction companies could usefully review; how they allocate and use resources on projects; the leadership and coaching skills of site managers; how workers can influence the planning of their work, and; their human resources procedures

    Modelling variable dropout in randomised controlled trials with longitudinal outcomes: application to the MAGNETIC study

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    Background Clinical trials with longitudinally measured outcomes are often plagued by missing data due to patients withdrawing or dropping out from the trial before completing the measurement schedule. The reasons for dropout are sometimes clearly known and recorded during the trial, but in many instances these reasons are unknown or unclear. Often such reasons for dropout are non-ignorable. However, the standard methods for analysing longitudinal outcome data assume that missingness is non-informative and ignore the reasons for dropout, which could result in a biased comparison between the treatment groups. Methods In this article, as a post hoc analysis, we explore the impact of informative dropout due to competing reasons on the evaluation of treatment effect in the MAGNETIC trial, the largest randomised placebo-controlled study to date comparing the addition of nebulised magnesium sulphate to standard treatment in acute severe asthma in children. We jointly model longitudinal outcome and informative dropout process to incorporate the information regarding the reasons for dropout by treatment group. Results The effect of nebulised magnesium sulphate compared with standard treatment is evaluated more accurately using a joint longitudinal-competing risk model by taking account of such complexities. The corresponding estimates indicate that the rate of dropout due to good prognosis is about twice as high in the magnesium group compared with standard treatment. Conclusions We emphasise the importance of identifying reasons for dropout and undertaking an appropriate statistical analysis accounting for such dropout. The joint modelling approach accounting for competing reasons for dropout is proposed as a general approach for evaluating the sensitivity of conclusions to assumptions regarding missing data in clinical trials with longitudinal outcomes

    Evaluation of a tumor microenvironment-based prognostic score in primary operable colorectal cancer

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    Purpose: The tumor microenvironment is recognized as an important determinant of progression and outcome in colorectal cancer. The aim of the present study was to evaluate a novel tumor microenvironment–based prognostic score, based on histopathologic assessment of the tumor inflammatory cell infiltrate and tumor stroma, in patients with primary operable colorectal cancer. Experimental Design: Using routine pathologic sections, the tumor inflammatory cell infiltrate and stroma were assessed using Klintrup–Mäkinen (KM) grade and tumor stroma percentage (TSP), respectively, in 307 patients who had undergone elective resection for stage I–III colorectal cancer. The clinical utility of a cumulative score based on these characteristics was examined. Results: On univariate analysis, both weak KM grade and high TSP were associated with reduced survival (HR, 2.42; P = 0.001 and HR, 2.05; P = 0.001, respectively). A cumulative score based on these characteristics, the Glasgow Microenvironment Score (GMS), was associated with survival (HR, 1.93; 95% confidence interval, 1.36–2.73; P < 0.001), independent of TNM stage and venous invasion (both P < 0.05). GMS stratified patients in to three prognostic groups: strong KM (GMS = 0), weak KM/low TSP (GMS = 1), and weak KM/high TSP (GMS = 2), with 5-year survival of 89%, 75%, and 51%, respectively (P < 0.001). Furthermore, GMS in combination with node involvement, venous invasion, and mismatch repair status further stratified 5-year survival (92% to 37%, 93% to 27%, and 100% to 37%, respectively). Conclusions: The present study further confirms the clinical utility of assessment of the tumor microenvironment in colorectal cancer and introduces a simple, routinely available prognostic score for the risk stratification of patients with primary operable colorectal cancer

    A cross-sectional survey of complementary and alternative medicine use by children and adolescents attending the University Hospital of Wales

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    BACKGROUND: A high prevalence of CAM use has been documented worldwide in children and adolescents with chronic illnesses. Only a small number of studies, however, have been conducted in the United Kingdom. The primary aim of this study was to examine the use of CAM by children and adolescents with a wide spectrum of acute and chronic medical problems in a tertiary children's hospital in Wales. METHODS: Structured personal interviews of 100 inpatients and 400 outpatients were conducted over a 2-month period in 2004. The yearly and monthly prevalence of CAM use were assessed and divided into medicinal and non-medicinal therapies. This use was correlated with socio-demographic factors. RESULTS: There were 580 patients approached to attain 500 completed questionnaires. The use of at least one type of CAM in the past year was 41% (95% CI 37–46%) and past month 26% (95% CI 23–30%). The yearly prevalence of medicinal CAM was 38% and non-medicinal 12%. The users were more likely to have parents that were tertiary educated (mother: OR = 2.3, 95%CI 1.6–3.3) and a higher family income (Pearson chi-square for trend = 14.3, p < 0.001). The most common medicinal types of CAM were non-prescribed vitamins and minerals (23%) and herbal therapies (10%). Aromatherapy (5%) and reflexology (3%) were the most prevalent non-medicinal CAMs. None of the inpatient medical records documented CAM use in the past month. Fifty-two percent of medicinal and 38% of non-medicinal CAM users felt their doctor did not need to know about CAM use. Sixty-six percent of CAM users did not disclose the fact to their doctor. Three percent of all participants were using herbs and prescription medicines concurrently. CONCLUSION: There is a high prevalence of CAM use in our study population. Paediatricians need to ensure that they ask parents and older children about their CAM usage and advise caution with regard to potential interactions. CAM is a rapidly expanding industry that requires further evidence-based research to provide more information on the effectiveness and safety of many CAM therapies. Statutory or self-regulation of the different segments of the industry is important. Integration of CAM with allopathic western medicine through education and better communication is slowly progressing

    Polymeric IgA and immune complex concentrations in IgA-related renal disease

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    Polymeric IgA and immune complex concentrations in IgA-related renal disease. Polymeric IgA (PIgA) and immune complex concentrations in IgA-related renal disease were measured in cross sectional and longitudinal studies to establish the relationship between these parameters and both mucosal infection and renal dysfunction. These studies were performed in 50 patients with IgA nephropathy (IgAN), 17 patients with Henoch Schönlein purpura nephritis (HSPN), 11 control patients with IgA negative, diffuse mesangial proliferative glomerulonephritis (DMPGN) and 50 healthy controls. Total PIgA (PIgAT) and PIgA subclass concentrations were measured using a secretory component binding enzyme immunoassay and isotype specific immune complex concentrations were measured using conglutinin (K) binding immunoassays. In cross sectional studies patients with IgAN were found to have increased concentrations of PIgAT, PIgA1, K-IgA1 and K-IgA2 compared to controls. In the longitudinal studies controls and patients had significant increases in PIgAT and PIgA1 concentrations during infection. However, in patients with IgAN, the increases were greater, persisted for longer, and PIgA2 concentrations were also increased. K-IgA1 and K-IgA2 concentrations increased significantly during episodes of infection in IgAN patients in contrast to controls. Patients with HSPN had results similar to those of IgAN patients. No significant correlation was found between PIgA or K-IgA concentrations, and either serum creatinine concentrations or the degree of hematuria. The results indicate that patients with IgA-related renal disease have abnormal regulation of PIgA and immune complexed IgA, and that these abnormalities are exaggerated during mucosal infection

    Association of asthma severity and educational attainment at age 6-7 years in a birth cohort : Population based record-linkage study

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    Acknowledgments: We are very grateful to David Fone for help in the concept of the study. SP received a Translational Health Research Platform Award from the National Institute for Social Care and Health Research (grant reference: TPR08- 15 006) for the development of WECC.JD was supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research: Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES-590-28-0005), Medical Research Council, the Welsh Government and the Wellcome Trust (WT087640MA), under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. SP was an applicant in the Centre for the Improvement of Population Health through E-records Research (CIPHER), one of four UK e-health Informatics Research Centres funded by a joint investment from: Arthritis Research UK, the British Heart Foundation, Cancer Research UK, the Chief Scientist Office (Scottish Government Health Directorates), the Economic and Social Research Council, the Engineering and Physical Sciences Research Council, the Medical Research Council,the National Institute for Health Research, the National Institute for Social Care and Health Research (Welsh Government) and the Wellcome Trust (Grant reference: 7 MR/K006525/1).Peer reviewe

    Effects of nebulised magnesium sulphate on inflammation and function of the guinea-pig airway

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    Magnesium sulphate is a potential treatment for acute severe asthma. However, the mechanisms and dose-response relationships are poorly understood. The first objective of this study was to examine whether inhaled magnesium sulphate exerts bronchodilator activity measured as bronchoprotection against histamine-induced bronchoconstriction in conscious guinea-pigs alone and combined with salbutamol. Secondly, we examined whether inhaled magnesium sulphate inhibits airways inflammation and function in models of neutrophilic and eosinophilic lung inflammation induced, respectively, by inhaled lipopolysaccharide or the inhaled antigen, ovalbumin (OVA). Airway function was measured in conscious guinea-pigs as specific airway conductance (sGaw) by whole-body plethysmography. Anti-inflammatory activity was measured against lung inflammatory cell influx induced by OVA inhalation in OVA-sensitised animals or by lipopolysaccharide (LPS) exposure of non-sensitised animals. Airway function (sGaw) was measured over 24 h after OVA exposure. Airway hyperresponsiveness to inhaled histamine and inflammatory cells in bronchoalveolar lavage fluid were recorded 24 h after OVA or LPS challenge. Histamine-induced bronchoconstriction was inhibited by inhaled magnesium sulphate or salbutamol alone and in combination, they produced synergistic bronchoprotection. LPS-induced neutrophil influx was inhibited by 6 days pretreatment with magnesium sulphate. Early and late asthmatic responses in OVA sensitised and challenged animals were attenuated by magnesium sulphate. Lung inflammatory cells were increased by OVA, macrophages being significantly reduced by magnesium sulphate. Nebulised magnesium sulphate protects against histamine-induced bronchoconstriction in conscious guinea-pigs and exerts anti-inflammatory activity against pulmonary inflammation induced by allergen (OVA) or LPS. These properties of magnesium sulphate explain its beneficial actions in acute asthma

    Displaced geostationary orbits using hybrid low-thrust propulsion

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    In this paper, displaced geostationary orbits using hybrid low-thrust propulsion, a complementary combination of Solar Electric Propulsion (SEP) and solar sailing, are investigated to increase the capacity of the geostationary ring that is starting to become congested. The SEP propellant consumption is minimized in order to maximize the mission lifetime by deriving semi-analytical formulae for the optimal steering laws for the SEP and solar sail accelerations. By considering the spacecraft mass budget, the performance is also expressed in terms of payload mass capacity. The analyses are performed both for the use of pure SEP and hybrid low-thrust propulsion to allow for a comparison. It is found that hybrid low-thrust control outperforms the pure SEP case both in terms of payload mass capacity and mission lifetime for all displacements considered. Hybrid low-thrust propulsion enables payloads of 255 to 487 kg to be maintained in a 35 km displaced orbit for 10 to 15 years. Adding the influence of the J2 and J22 terms of the Earth’s gravity field has a small effect on this lifetime, which becomes almost negligible for small values of the sail lightness number. Finally, two SEP transfers that allow for an improvement in the performance of hybrid low-thrust control are optimized for the propellant consumption by solving the accompanying optimal control problem using a direct pseudospectral method. The first type of transfer enables a transit between orbits displaced above and below the equatorial plane, while the second type of transfer enables customized service for which a spacecraft is transferred to a Keplerian parking orbit when geostationary coverage is not needed. While the latter requires a modest propellant budget, the first type of transfer comes at the cost of an almost negligible SEP propellant consumption

    Design of optimal Earth pole-sitter transfers using low thrust propulsion

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    Recent studies have shown the feasibility of an Earth pole-sitter mission using low-thrust propulsion. This mission concept involves a spacecraft following the Earth's polar axis to have a continuous, hemispherical view of one of the Earth's poles. Such a view will enhance future Earth observation and telecommunications for high latitude and polar regions. To assess the accessibility of the pole-sitter orbit, this paper investigates optimum Earth pole-sitter transfers employing low-thrust propulsion. A launch from low Earth orbit (LEO) by a Soyuz Fregat upper stage is assumed after which a solar-electric-propulsion thruster transfers the spacecraft to the pole-sitter orbit. The objective is to minimise the mass in LEO for a given spacecraft mass to be inserted into the pole-sitter orbit. The results are compared with a ballistic transfer that exploits the manifolds winding off the pole-sitter orbit. It is shown that, with respect to the ballistic case, low-thrust propulsion can achieve significant mass savings in excess of 200 kg for a pole-sitter spacecraft of 1000 kg upon insertion. To finally obtain a full low-thrust transfer from LEO up to the pole-sitter orbit, the Fregat launch is replaced by a low-thrust, minimum time spiral through an orbital averaging technique, which provides further mass savings, but at the cost of an increased time of flight
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