Physical and chemical aspects of A10(_x)/PET gas barrier composites

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What evidence is there for the identification and management of frail older people in the emergency department? A systematic mapping review

Abstract Background Emergency departments (EDs) are facing unprecedented levels of demand. One of the causes of this increased demand is the ageing population. Older people represent a particular challenge to the ED as those older people who are frail will require management that considers their frailty alongside their presenting complaint. How to identify these older people as frail and how best to manage them in the ED is a major challenge for the health service to address. Objectives To systematically map interventions to identify frail and high-risk older people in the ED and interventions to manage older people in the ED and to map the outcomes of these interventions and examine whether or not there is any evidence of the impact of these interventions on patient and health service outcomes. Design A systematic mapping review. Setting Evidence from developed countries on interventions delivered in the ED. Participants Frail and high-risk older people and general populations of older people (aged > 65 years). Interventions Interventions to identify older people who are frail or who are at high risk of adverse outcomes and to manage (frail) older people within the ED. Main outcome measures Patient outcomes (direct and indirect) and health service outcomes. Data sources Evidence from 103 peer-reviewed articles and conference abstracts and 17 systematic reviews published from 2005 to 2016. Review methods A review protocol was drawn up and a systematic database search was undertaken for the years 2005–2016 (using MEDLINE, EMBASE, The Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium and PROSPERO). Studies were included according to predefined criteria. Following data extraction, evidence was classified into interventions relating to the identification of frail/high-risk older people in the ED and interventions relating to their management. A narrative synthesis of interventions/outcomes relating to these categories was undertaken. A quality assessment of individual studies was not undertaken; instead, an assessment of the overall evidence base in this area was made. Results Of the 90 included studies, 32 focused on a frail/high-risk population and 60 focused on an older population. These studies reported on interventions to identify (n = 57) and manage (n = 53) older people. The interventions to identify frail and at-risk older people, on admission and at discharge, utilised a number of different tools. There was extensive evidence on these question-based tools, but the evidence was inconclusive and contradictory. Service delivery innovations comprised changes to staffing, infrastructure and care delivery. There was a general trend towards improved outcomes in admissions avoidance, reduced ED reattendance and improved discharge outcomes. Limitations This review was a systematic mapping review. Some of the methods adopted differed from those used in a standard systematic review. Mapping the evidence base has led to the inclusion of a wide variety of evidence (in terms of study type and reporting quality). No recommendations on the effectiveness of specific interventions have been made as this was outside the scope of the review. Conclusions A substantial body of evidence on interventions for frail and high-risk older people was identified and mapped. Future work Future work in this area needs to determine why interventions work and whether or not they are feasible for the NHS and acceptable to patients. Study registration This study is registered as PROSPERO CRD42016043260. Funding The National Institute for Health Research Health Services and Delivery Research programme

Comparison of supplemented free choice corn silage rations with other forage rations for wintering dairy heifers

This publication is a report on Department of Dairy Husbandry research project 55, Diet and Growth--P. [2].Digitized 2007 AES.Includes bibliographical references (page 8)

Categories, stereotypes, and the linguistic perception of sexuality

This article examines how social stereotypes influence listeners’ perceptions of indexical language. Building on recent developments in linguistics and social psychology, I investigate the extent to which stereotypical attitudes and beliefs about categories of speakers serve to enable the association of linguistic features with particular social meanings while simultaneously blocking others. My arguments are based on an analysis of listener perceptions of the intersecting categories of gender, sexuality, and social class among men in the UK. Using a modified matched-guise paradigm to test three category-relevant variables (mean pitch, spectral characteristics of /s/, and TH-fronting), I demonstrate how the perception of social meaning is governed by a combination of both attitudinal and cognitive factors. This finding is important because it illustrates the listener-dependent nature of sociolinguistic perception. Moreover, it also provides further empirical support for an understanding of social meaning as an emergent property of language-in-use

Variance estimation for a low-income proportion

Proportions below a given fraction of a quantile of an income distribution are often estimated from survey data in poverty comparisons. We consider the estimation of the variance of such a proportion, estimated from Family Expenditure Survey data. We show how a linearization method of variance estimation may be applied to this proportion, allowing for the effects of both a complex sampling design and weighting by a raking method to population controls. We show that, for 1998-99 data, the estimated variances are always increased when allowance is made for the design and raking weights, the principal effect arising from the design. We also study the properties of a simplified variance estimator and discuss extensions to a wider class of poverty measures

The objectness of everyday life: disburdenment or engagement?

The article grew out of a conference paper, ‘The objectness of everyday life: engagement and disburdenment’, Material Geographies, UCL, September 2002. An expanded version of the paper was included in a special themed section of an issue of Geoforum. The paper intervenes into contemporary philosophical scholarship on the nature of use-value, usability, design and ethics. The article has been directly engaged with in an academic journal; Christensen, Carleton B. (2005) ‘The Material Basis of Everyday Rationality: transformation by design or education?’, Design Philosophy Papers No.4,)

Integrated TiO2 resonators for visible photonics

We demonstrate waveguide-coupled titanium dioxide (TiO2) racetrack resonators with loaded quality factors of 2x10^4 for the visible wavelengths. The structures were fabricated in sputtered TiO2 thin films on oxidized silicon substrates using standard top-down nanofabrication techniques, and passively probed in transmission measurements using a tunable red laser. Devices based on this material could serve as integrated optical elements as well as passive platforms for coupling to visible quantum emitters.Comment: 4 pages, 3 figure

Automated quantification of mitral valve geometry on multi-slice computed tomography in patients with dilated cardiomyopathy: Implications for transcatheter mitral valve replacement

Objectives The primary aim of this study was to quantify the dimensions and geometry of the mitral valve complex in patients with dilated cardiomyopathy and significant mitral regurgitation. The secondary aim was to evaluate the validity of an automated segmentation algorithm for assessment of the mitral valve compared to manual assessment on computed tomography. Background Transcatheter mitral valve replacement (TMVR) is an evolving technique which relies heavily on the lengthy evaluation of cardiac computed tomography (CT) datasets. Limited data is available on the dimensions and geometry of the mitral valve in pathological states throughout the cardiac cycle, which may have implications for TMVR device design, screening of suitable candidates and annular sizing prior to TMVR. Methods A retrospective study of 15 of patients with dilated cardiomyopathy who had undergone full multiphase ECG gated cardiac CT. A comprehensive evaluation of mitral valve geometry was performed at 10 phases of the cardiac cycle using the recommended D-shaped mitral valve annulus (MA) segmentation model using manual and automated CT interpretation platforms. Mitral annular dimensions and geometries were compared between manual and automated methods. Results Mitral valve dimensions in patients with dilated cardiomyopathy were similar to previously reported values (MAarea Diastole: 12.22 ± 1.90 cm2), with dynamic changes in size and geometry between systole and diastole of up to 5%. The distance from the centre of the MA to the left ventricular apex demonstrated moderate agreement between automated and manual methods (ρc = 0.90) with other measurements demonstrating poor agreement between the two methods (ρc = 0.75–0.86). Conclusions Variability of mitral valve annulus measurements are small during the cardiac cycle. Novel automated algorithms to determine cardiac cycle variations in mitral valve geometry may offer improved segmentation accuracy as well as improved CT interpretation times

The climate adaptation frontier

Climate adaptation has emerged as a mainstream risk management strategy for assisting in maintaining socio-ecological systems within the boundaries of a safe operating space. Yet, there are limits to the ability of systems to adapt. Here, we introduce the concept of an “adaptation frontier”, which is defined as a socio-ecological system’s transitional adaptive operating space between safe and unsafe domains. A number of driving forces are responsible for determining the sustainability of systems on the frontier. These include path dependence, adaptation/development deficits, values conflicts and discounting of future loss and damage. The cumulative implications of these driving forces are highly uncertain. Nevertheless, the fact that a broad range of systems already persist at the edge of their frontiers suggests a high likelihood that some limits will eventually be exceeded. The resulting system transformation is likely to manifest as anticipatory modification of management objectives or loss and damage. These outcomes vary significantly with respect to their ethical implications. Successful navigation of the adaptation frontier will necessitate new paradigms of risk governance to elicit knowledge that encourages reflexive reevaluation of societal values that enable or constrain sustainability