Integrating Geriatrics in Primary Care: Progress and Prospects

Educational Objectives 1. Demonstrate the need for primary care redesign to better meet the needs of older patients. 2. Identify prospective redesign solutions. 3. Appreciate educational implication that redesign engenders

Rheology of Coating Adhesives

Many compounds, “flow modifiers”, have been used to change the flow properties of coating adhesives. Thiourea, ammonium thiocyanate, and urea were used in the work to find out what effect they would have on the coating adhesives, starch and alpha protein. It was found that they all lowered the viscosity a great deal. Also it was found that the resulting flow curve in most cases pseudoplastic

Skimming impacts and rebounds of smoothly shaped bodies on shallow liquid layers

Investigated in this paper is the coupled fluid–body motion of a thin solid body undergoing a skimming impact on a shallow-water layer. The underbody shape (the region that makes contact with the liquid layer) is described by a smooth polynomic curve for which the magnitude of underbody thickness is represented by the scale parameter C. The body undergoes an oblique impact (where the horizontal speed of the body is much greater than its vertical speed) onto a liquid layer with the underbody’s trailing edge making the initial contact. This downstream contact point of the wetted region is modelled as fixed (relative to the body) throughout the skimming motion with the liquid layer assumed to detach smoothly from this sharp trailing edge. There are two geometrical scenarios of interest: the concave case (C < 0 producing a hooked underbody) and the convex case (C < 0producing a rounded underbody). As C is varied the rebound dynamics of the motion are predicted. Analyses of small-time water entry and of water exit are presented and are shown to be broadly in agreement with the computational results of the shallow-water model. Reduced analysis and physical insights are also presented in each case alongside numerical investigations and comparisons as C is varied, indicating qualitative analytical/numerical agreement. Increased body thickness substantially changes the interaction structure and accentuates inertial forces in the fluid flow

False discovery rate regression: an application to neural synchrony detection in primary visual cortex

Many approaches for multiple testing begin with the assumption that all tests in a given study should be combined into a global false-discovery-rate analysis. But this may be inappropriate for many of today's large-scale screening problems, where auxiliary information about each test is often available, and where a combined analysis can lead to poorly calibrated error rates within different subsets of the experiment. To address this issue, we introduce an approach called false-discovery-rate regression that directly uses this auxiliary information to inform the outcome of each test. The method can be motivated by a two-groups model in which covariates are allowed to influence the local false discovery rate, or equivalently, the posterior probability that a given observation is a signal. This poses many subtle issues at the interface between inference and computation, and we investigate several variations of the overall approach. Simulation evidence suggests that: (1) when covariate effects are present, FDR regression improves power for a fixed false-discovery rate; and (2) when covariate effects are absent, the method is robust, in the sense that it does not lead to inflated error rates. We apply the method to neural recordings from primary visual cortex. The goal is to detect pairs of neurons that exhibit fine-time-scale interactions, in the sense that they fire together more often than expected due to chance. Our method detects roughly 50% more synchronous pairs versus a standard FDR-controlling analysis. The companion R package FDRreg implements all methods described in the paper

Hard x-ray polarimetry with the Ramaty High Energy Solar Spectroscopic Imager (RHESSI)

Although designed primarily as a hard X-ray imager and spectrometer, the Ramaty High Energy Solar Spectroscopic Imager (RHESSI) is also capable of measuring the polarization of hard X-rays (20-100 keV) from solar flares. This capability arises from the inclusion of a small unobstructed Be scattering element that is strategically located within the cryostat that houses the array of nine germanium detectors. The Ge detectors are segmented, with both a front and rear active volume. Low energy photons (below about 100 keV) can reach a rear segment of a Ge detector only indirectly, by scattering. Low energy photons from the Sun have a direct path to the Be and have a high probability of Compton scattering into a rear segment of a Ge detector. The azimuthal distribution of these scattered photons carries with it a signature of the linear polarization of the incident flux. Sensitivity estimates, based on simulations and in-flight background measurements, indicate that a 20-100 keV polarization sensitivity of less than a few percent can be achieved for X-class flares

Skimming impact of a thin heavy body on a shallow liquid layer

This study addresses the question of whether a thin, relatively heavy solid body with a smooth under-surface can skim on a shallow layer of liquid (for example water), i.e. impact on the layer and rebound from it. The body impacts obliquely onto the liquid layer with the trailing edge of the underbody making the initial contact. The wetted region then spreads along the underbody and eventually either retracts, generating a rebound, or continues to the leading edge of the body and possibly leads to the body sinking. The present inviscid study involves numerical investigations for increased mass ( M , in scaled terms) and moment of inertia ( I , proportional to the mass) together with an asymptotic analysis of the influential parameters and dynamics at different stages of the skimming motion. Comparisons between the asymptotic analysis and numerical results show close agreement as the body mass becomes large. A major finding is that, for a given impact angle of the underbody relative to the liquid surface, only a narrow band of initial conditions is found to allow the heavy-body skim to take place. This band includes reduced impact velocities of the body vertically and rotationally, both decreasing like M−2/3 , while the associated total time of the skim from entry to exit is found to increase like M1/3 typically. Increased mass thereby enhances the super-elastic behaviour of the skim

A body in nonlinear near-wall shear flow:impacts, analysis and comparisons

Interaction between body motion and fluid motion is considered inside a nonlinear viscous wall layer, with this unsteady two-way coupling leading to impact of the body on the wall. The present paper involves a reduced system analysis which is shown to be consistent with computational solutions from direct numerical simulations for a basic flat-plate shape presented in an allied paper (Palmer & Smith, J. Fluid Mech., 2020). The occurrence of impact depends mainly on fluid parameters and initial conditions. The body considered is translating upstream or downstream relative to the wall. Subsequent analysis focusses on the unusual nature of the impact at the leading edge. The impacting flow structure is found to have two nonlinear viscous–inviscid regions lying on either side of a small viscous region. The flow properties in the regions dictate the lift and torque which drive the body towards the wall. Pronounced flow separations are common as the impact then cuts off the mass flux in the gap between the body and the wall; here, a nonlinear similarity solution sheds extra light on the separations. Comparisons are made between results from direct simulations and asymptotics at increased flow rate

The role of body shape and mass in skimming on water

Over many years, there has been great practical interest in how solid bodies interact with and skim on liquid layers. In the present investigation, the focus is on the important role of body mass and shape in such skimming motions. Considering a thin two-dimensional solid body that impacts obliquely and then rebounds on a shallow inviscid water layer, we develop a mathematical model to predict quantitatively the duration and evolution of the body and fluid motions and indeed the success or failure of the whole skim. In the current setting, the shallow water layer thickness is small relative to the representative body length. The combined roles of increased mass and shape are found to be crucial, governed by a similarity solution. The relationship C ∼ M2/3 between scaled body curvature and mass is identified and highlighted. In particular, increased convex curvature of the underbody is found to alter the interactive pressure in such a way that it inhibits the occurrence of a super-elastic response in the exit vertical velocity and height of the body, and in effect enables a much heavier body to skim successfully provided the above relationship is maintained

Particle movement in a boundary layer

The study here is concerned with a thin solid body passing through a boundary layer or channel flow and interacting with the flow. Relevant new features from modelling, analysis and computation are presented along with comparisons. Three scenarios of such fluid-body interactive evolution in two-dimensional settings are considered in turn, namely a long body translating upstream or downstream, a long body with little or no translation and a short body with or without translation. The main progress and findings concern predictions of the time taken by the body to traverse the flow and impact upon the underlying wall, the delicate behaviour at the onset of impact, the dependence on parameters such as the initial conditions and the mass and shape of the body, and the influence of streamwise translation of the body in the surrounding fluid flow

A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: Study protocol

Background: Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory ('a systematic way of understanding events or situations') can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods: As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3-4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient's underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention's mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion: Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients' adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration: This study is registered at ISRCTN: https://doi.org/10.1186/ISRCTN7383153