Practitioners' views about equity within prenatal services

The British National Health Service (NHS) is based on principles of equal access, treatment and outcomes. This article reviews health professionals' aims to provide equitable prenatal services and their views on whether women could be equal in their access to services, understanding during choice-making, and satisfaction about their care. Inequalities which compromise equity, conflicting meanings of equity, and the contribution of in-hospital ethics seminars to ethical health services are considered. Qualitative research, combining sociological and philosophical methods, investigated the experiences of health care staff attempting to provide equitable services and their practical and ethical problems. A total of 70 staff at a teaching hospital and a district general hospital took part in semi-structured interviews, followed by 11 innovative in-hospital ethics seminars based on themes derived from the interviews. The 56 seminar participants usually began with clear statements of their equitable aims, but, encouraged by the health care ethicist, they went on to discuss their many concerns about obstacles which complicated the achievement of these aims. The sociological-ethics seminars provided unique opportunities for multi-disciplinary discussion of these inequalities and their impact on equitable intentions in health care. Analysis of the contradictions revealed during the seminars is guided by sociological theories that seek to explain the persistence of inequalities in health, and how NHS policies appear to perpetuate and increase them, despite practitioners' stated intentions to promote equality

The role of approach flow and blockage on local scour around circular cylinders with and without countermeasures

Local scour modelling has been established as an imperative tool in the understanding of local scour mechanisms and development of effective design methodologies for use in practice. However, there are limitations in physical scale modelling which must be fully understood in order to acquire useful experimental results to this end. In hydraulic modelling, facility constraints often result in dimensionless geometric parameters which are considerably altered from prototype conditions. Channel width b in a typical laboratory flume is limited, resulting in small values of channel aspect ratio AR (b/h, where h is flow depth). To further complicate matters, cylinder diameter D in local scour studies must be maximized to obtain a measurable scour pattern and maintain acceptably high relative coarseness D/d50 (where d50 is the median diameter of bed material). This results in cylinder sizes which pose a significant blockage to flow. While blockage effects have been explored for a cylinder mounted on a fixed bed, the effect of blockage ratio (D/b) for a cylinder in an erodible bed has only been explored through comparison of bed formations. In order to fully understand the effect of sidewall proximity on the flow field surrounding a cylinder under equilibrium of local scour, detailed velocity measurements are required. Furthermore, the effect of D/b on local scour must be isolated by holding all other scour-governing parameters constant. In order to achieve this, channel width b has been altered in the present investigation by movable flume sidewalls. In altering b, the channel aspect ratio AR is also affected. Particle Image Velocimetry (PIV) measurements have been undertaken in order to explore the effects of channel aspect ratio on open-channel flow over a porous bed. The effects of increasing vertical confinement(decreasing h) and horizontal confinement (decreasing b) are explored by comparison of vi mean and turbulence properties as well as third-order turbulent moments and quadrant analysis. The findings are then applied to an investigation of the role of D/b on the flow field mechanisms surrounding an emergent circular cylinder under equilibrium of clear-water scour. Changes in the distribution of time-averaged flow velocity, Reynolds shear stress and spanwise vorticity are presented and related to the bed formation. Increasing sidewall proximity is observed to confine the wake region and therefore influence the geometry of the dune downstream of the cylinder. The dune geometry subsequently affects the features in the surrounding flow field, and the streamwise velocity upstream of the cylinder is reduced as D/b increases. A primary objective of scour modelling is development of countermeasures for mitigation of the mechanisms which drive local scour. Lastly, an investigation of two types of scour countermeasures was carried out for flow around a submerged circular cylinder at equilibrium of clear-water scour. Based on fluid dynamic considerations, a vertical splitter plate and a horizontal base plate were chosen as potential flow-altering devices and the efficacy of these devices for scour mitigation are explored. PIV measurements also facilitate understanding of the methods by which each countermeasure affects the flow field mechanisms surrounding the cylinder, and the distribution of flow velocity and Reynolds shear stress are presented. The vertical splitter plate is found to affect the interaction between shear layers in the wake region, reducing the depth of scour downstream of the cylinder. The horizontal base plate is found to eliminate scour upstream of the cylinder altogether by protecting the bed around the sides of the cylinder where shear stress is maximized. Local scour modelling has been established as an imperative tool in the understanding of local scour mechanisms and development of effective design methodologies for use in practice. However, there are limitations in physical scale modelling which must be fully understood in order to acquire useful experimental results to this end. In hydraulic modelling, facility constraints often result in dimensionless geometric parameters which are considerably altered from prototype conditions. Channel width b in a typical laboratory flume is limited, resulting in small values of channel aspect ratio AR (b/h, where h is flow depth). To further complicate matters, cylinder diameter D in local scour studies must be maximized to obtain a measurable scour pattern and maintain acceptably high relative coarseness D/d50 (where d50 is the median diameter of bed material). This results in cylinder sizes which pose a significant blockage to flow. While blockage effects have been explored for a cylinder mounted on a fixed bed, the effect of blockage ratio (D/b) for a cylinder in an erodible bed has only been explored through comparison of bed formations. In order to fully understand the effect of sidewall proximity on the flow field surrounding a cylinder under equilibrium of local scour, detailed velocity measurements are required. Furthermore, the effect of D/b on local scour must be isolated by holding all other scour-governing parameters constant. In order to achieve this, channel width b has been altered in the present investigation by movable flume sidewalls. In altering b, the channel aspect ratio AR is also affected. Particle Image Velocimetry (PIV) measurements have been undertaken in order to explore the effects of channel aspect ratio on open-channel flow over a porous bed. The effects of increasing vertical confinement(decreasing h) and horizontal confinement (decreasing b) are explored by comparison of vi mean and turbulence properties as well as third-order turbulent moments and quadrant analysis. The findings are then applied to an investigation of the role of D/b on the flow field mechanisms surrounding an emergent circular cylinder under equilibrium of clear-water scour. Changes in the distribution of time-averaged flow velocity, Reynolds shear stress and spanwise vorticity are presented and related to the bed formation. Increasing sidewall proximity is observed to confine the wake region and therefore influence the geometry of the dune downstream of the cylinder. The dune geometry subsequently affects the features in the surrounding flow field, and the streamwise velocity upstream of the cylinder is reduced as D/b increases. A primary objective of scour modelling is development of countermeasures for mitigation of the mechanisms which drive local scour. Lastly, an investigation of two types of scour countermeasures was carried out for flow around a submerged circular cylinder at equilibrium of clear-water scour. Based on fluid dynamic considerations, a vertical splitter plate and a horizontal base plate were chosen as potential flow-altering devices and the efficacy of these devices for scour mitigation are explored. PIV measurements also facilitate understanding of the methods by which each countermeasure affects the flow field mechanisms surrounding the cylinder, and the distribution of flow velocity and Reynolds shear stress are presented. The vertical splitter plate is found to affect the interaction between shear layers in the wake region, reducing the depth of scour downstream of the cylinder. The horizontal base plate is found to eliminate scour upstream of the cylinder altogether by protecting the bed around the sides of the cylinder where shear stress is maximized

A study of twenty adult cardiac cases at Rhode Island Hospital to show the factors which had bearing on the patients' following or not following the medical recommendations

Thesis (M.S.)--Boston Universit

Scale effects on design estimation of scour depths at piers

Due to the prevalence of bridge failures resulting from scour or scour-related complications, design of piers with respect to scour is prioritized by engineers. Current scour estimation methods typically over-predict scour depth, which results in uneconomical design. This tendency is partly due to the complexity of the scouring process, indicating that there are many aspects of scour which are still not well understood, and can also be attributed to scale effects in scour modelling. In this investigation, experimentation was completed in order to isolate the influences of governing non-dimensional parameters (relative coarseness and flow shallowness) on scour. Results from testing were then compared with results from previous investigations at the University of Windsor, and the influences of densimetric Froude number and separation velocity (representative of channel blockage) on scour were determined. A new scour estimation method based on these influences is presented and compared with methods used in current practice

Understanding the Socioeconomic Impact of Progressive Diseases in the Geriatric Population

The purpose of this to study is to discuss the economic repercussions that progressive diseases, such as Alzheimer’s and Parkinson’s, have on the geriatric population. This research brings to light the economic cost of these progressive diseases, as well as the importance of fostering positive social interactions within the geriatric population

Pilot community-based intervention to address the needs of elderly caregivers in the Eastern Cape Province, South Africa

The HIV epidemic in South Africa has placed a substantial burden on elderly caregivers, mainly women, who are often tasked with caring for their grandchildren who are orphaned and rendered vulnerable by the death or illness of their parents. The Medical Research Council (MRC), Age-in-Action, and the Horizons Program conducted formative research, as described in this research summary, to assess the needs of elderly caregivers in the Eastern Cape Province of South Africa in 2005. The investigations revealed that elderly caregivers faced a number of challenges including difficulty communicating with youth, fears and a sense of hopelessness around matters regarding youth, barriers to accessing health care, insufficient funds to cover basic needs, and difficulty accessing social service grants. Based on these findings, Horizons, MRC, and Age-in-Action developed an intervention study to explore and test whether a health education program would effectively lead to: 1) Improved care and support provided by elderly caregivers; 2) Improved psychosocial outcomes for the caregivers themselves; and 3) Increased capacity on the part of health service providers to enhance the care they provide to the elderly

Hypoxia Augments Outgrowth Endothelial Cell (OEC) Sprouting and Directed Migration in Response to Sphingosine-1-Phosphate (S1P)

Therapeutic angiogenesis provides a promising approach to treat ischemic cardiovascular diseases through the delivery of proangiogenic cells and/or molecules. Outgrowth endothelial cells (OECs) are vascular progenitor cells that are especially suited for therapeutic strategies given their ease of noninvasive isolation from umbilical cord or adult peripheral blood and their potent ability to enhance tissue neovascularization. These cells are recruited to sites of vascular injury or tissue ischemia and directly incorporate within native vascular endothelium to participate in neovessel formation. A better understanding of how OEC activity may be boosted under hypoxia with external stimulation by proangiogenic molecules remains a challenge to improving their therapeutic potential. While vascular endothelial growth factor (VEGF) is widely established as a critical factor for initiating angiogenesis, sphingosine-1-phosphate (S1P), a bioactive lysophospholipid, has recently gained great enthusiasm as a potential mediator in neovascularization strategies. This study tests the hypothesis that hypoxia and the presence of VEGF impact the angiogenic response of OECs to S1P stimulation in vitro. We found that hypoxia altered the dynamically regulated S1P receptor 1 (S1PR1) expression on OECs in the presence of S1P (1.0 mu M) and/or VEGF (1.3 nM). the combined stimuli of S1P and VEGF together promoted OEC angiogenic activity as assessed by proliferation, wound healing, 3D sprouting, and directed migration under both normoxia and hypoxia. Hypoxia substantially augmented the response to S1P alone, resulting in similar to 6.5-fold and similar to 25-fold increases in sprouting and directed migration, respectively. Overall, this report highlights the importance of establishing hypoxic conditions in vitro when studying ischemia-related angiogenic strategies employing vascular progenitor cells.University of California, DavisAmerican Heart Association (AHA)Univ Calif Davis, Dept Biomed Engn, Davis, CA 95616 USAUniversidade Federal de São Paulo, Dept Biophys, São Paulo, BrazilUniv Calif Davis, Dept Neurobiol Physiol & Behav, Davis, CA 95616 USAUniversidade Federal de São Paulo, Dept Biophys, São Paulo, BrazilAmerican Heart Association (AHA): 15PRE22930044Web of Scienc

Repeatability of quantitative pericoronary adipose tissue attenuation and coronary plaque burden from coronary CT angiography

BACKGROUND: High pericoronary adipose tissue (PCAT) attenuation and non-calcified plaque burden (NCP) measured from coronary CT angiography (CTA) have been implicated in future cardiac events. We aimed to evaluate the interobserver and intraobserver repeatability of PCAT attenuation and NCP burden measurement from CTA, in a sub-study of the prospective SCOT-HEART trial. METHODS: Fifty consecutive CTAs from participants of the CT arm of the prospective SCOT-HEART trial were included. Two experienced observers independently measured PCAT attenuation and plaque characteristics throughout the whole coronary tree from CTA using semi-automatic quantitative software. RESULTS: We analyzed proximal segments in 157 vessels. Intraobserver mean differences in PCAT attenuation and NCP plaque burden were −0.05HU and 0.92% with limits of agreement (LOA) of ±1.54 and ±5.97%. Intraobserver intraclass correlation coefficients (ICC) for PCAT attenuation and NCP burden were excellent (0.999 and 0.978). Interobserver mean differences in PCAT attenuation and NCP plaque burden were 0.13HU [LOA ±1.67HU] and −0.23% (LOA ±9.61%). Interobserver ICC values for PCAT attenuation and NCP burden were excellent (0.998 and 0.944). CONCLUSION: PCAT attenuation and NCP burden on CTA has high intraobserver and interobserver repeatability, suggesting they represent a repeatable and robust method of quantifying cardiovascular risk