19,453 research outputs found
Innovative Stormwater Treatment Technologies: Best Management Practices Manual
Urban stormwater carries a number of pathogens, nutrients, heavy metals, sediment, and other contaminants as surface runoff flows over land. The increase in impervious or paved surfaces associated with development in urban areas reduces the natural infiltration of precipitation into the ground. With impervious cover, precipitation collects and carries contaminants before draining into nearby surface waters. Stormwater runoff from paved surfaces in developed areas can degrade downstream waters with both contaminants and increased volumes of water. This publication aims to make information on innovative stormwater treatment technologies more available to New Hampshireās urban planners, developers, and communities. Traditional runoff management techniques such as detention basins and infiltration swales may be preferable, but are not always practical for treating urban stormwater. Lack of space for natural solutions is often a problem in existing developed areas, making innovative treatment technologies an attractive alternative. Mostly designed for subsurface installation, urban āretrofitsā use less space than conventional methods to treat stormwater. This manual provides information on the innovative stormwater āretrofitā technologies currently available for use in developed areas in New Hampshire
Report for NMDGF Permit: 3293, 2016
Document from New Mexico Department of Game & Fish Scientific permit
A new Nomos offshore and bodies as their own signs
This paper begins with the paradoxes that accrue around the appearance of Robinson Crusoe and his āMan Fridayā within recent judgments relating to the Chagos Archipelago. These references are understood as revealing the complex of anxieties and limits that are the final legacy of these rulings. In particular, we trace the ways in which ā through Daniel Defoe's iconic characters ā these judgments enact a troubling retreat from review of executive action, and a fuller withdrawal of sensibility from situations of āothernessā that both bear and cannot bear analogy to that of Friday. The paper then more briefly considers a similar complex of anxieties and limits, retreats and withdrawals enacted by recent judgments relating to Australian territory in the Indian Ocean. This allows us to suggest that between these two series of highest court rulings, the Anglophone common law is currently constructing the Indian Ocean as an offshore: a site excised from judicial review, and a site in which certain figures ā peoples, individuals ā are not considerable in both senses of the word. But in fathoming this, we turn to Derrida's insights on sovereignty to argue that, far from being new, this construction of a common law of the Indian Ocean tells us about the affront of an archaic sovereignty that always already determines and is determined by law. Across the arguments of this paper, these perceptions of judgment, geography and sovereignty are enabled by literature, and specifically by reading the return of Crusoe and Friday in a recent novel form (by J. M. Coetzee) that also broaches the limits of judgment and recognition, but through a kind of vigilant silence ā an abstinence ā that craves an alternative commonality: and in this very longing, resists the silencing complicities of the UK and Australian judgments with the disembodiment of a littoral nomos, offshore
Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia
Acknowledging that the NDIS alone will not be able to solve the issues faced by young people in nursing homes, this review makes 12 recommendations including establishing a joint taskforce to ensure the recommendations are put in place.
LIST OF RECOMMENDATIONS
Recommendations to the Australian Government
Recommendation 1
6.7 The committee recommends that the Australian Government compile a database of all young people under the age of 65 years living in residential aged care facilities using the data held by the Aged Care Assessment Team (ACAT) program. This list should be provided in a regularly updated form to the National Disability Insurance Agency (NDIA) and to state and territory governments. This data should include the following information:
name;
age and age of entry to aged care;
diagnosis;
length of time spent in the aged care system; and
the factors that need to be addressed for the person to move out of the aged care facility.
Recommendation 2
6.8 The committee recommends that the Australian Bureau of Statistics (ABS) conduct a Longitudinal Survey of Disability, Ageing and Carers in addition to its triennial survey of Disability, Ageing and Carers.
Recommendation 3
6.10 The committee recommends that the Australian Government develop and implement a comprehensive assessment and placement tool or residential assessment instrument to assess the care and accommodation needs for all young people living in or at risk of entering residential care.
Recommendation 4
6.12 The committee recommends that supplementary assessment guidelines and tools are developed for the ACAT program to ensure that all young people being considered for an aged care placement are properly assessed. As part of this process, the committee recommends that:
all young people placed in aged care are intensively case managed; and
all ACAT placements for those aged under 65 are reviewed on an annual basis.
Recommendation 5
6.13 The committee recommends that the accreditation standards for residential aged care are amended to include standards relating to the clinical outcomes and lifestyle needs of young people. In order to assist with meeting these new accreditation standards, the committee recommends that the Australian Government:
ā¢ provide a supplementary payment to residential aged care facilities to ensure that these accreditation standards can be met; and
ā¢ invest in disability specific training for all staff involved in the care of young people living in aged care. This training should focus on building improved awareness of the needs of young people and those living with disability in order to provide better support. It should also lead to improved connectivity between the aged care sector and other service sectors including allied health and disability services.
Recommendation 6
6.17 The committee recommends that the Department of Social Services\u27 current discussion paper on disability housing consider capital funding options for construction of specialised disability accommodation.
6.18 The committee recommends that the discussion paper is released as a matter of urgency.
6.19 The committee recommends that the Australian Government establish a supported disability accommodation fund similar to the Supported Accommodation Innovation Fund.
Recommendations to the Joint Standing Committee on the National Disability Insurance Scheme
Recommendation 7
6.21 The committee recommends that the Joint Standing Committee on the National Disability Insurance Scheme (NDIS) conduct an inquiry into the issue of disability housing after the release of the discussion paper on disability housing.
Recommendations to the Council of Australian Governments (COAG)
Recommendation 8
6.23 The committee recommends that the COAG develop and implement a national rehabilitation strategy including a framework for the delivery of slow stream rehabilitation in all jurisdictions.
Recommendation 9
6.28 The committee recommends that the NDIS, in all NDIS trial sites, and the relevant state or territory government in all other areas:
ā¢ assign an advocate to all young people living in residential care to provide information to a young person and their families about their options. If appropriate, the advocate can act on behalf of the young person;
ā¢ assign an advocate to all young people at risk of entering residential care to provide information to a young person and their families about their options. If appropriate, the advocate can act on behalf of the young person. The advocate should be made available as early as possible after diagnosis of an illness or disability and be assigned before any placement commences;
ā¢ extend the National Younger Onset Dementia Key Worker Program (YODKWP) to all young people identified as being at risk of placement in residential care to provide collaborative case management. The key worker should be assigned before any placement commences; and
ā¢ these programs should be proactively extended to young people living in residential care facilities under the age of 65 years by June 2017. Consideration of the mental health status of young people should be prioritised with appropriate support provided where necessary.
Recommendation 10
6.30 The committee recommends that the NDIS, in all NDIS trial sites, should consider how it supports those with Foetal Alcohol Spectrum Disorder (FASD).
6.31 The committee also recommends that the NDIS, in all NDIS trial sites, and the relevant state or territory government in all other areas work closely with community health services to provide the following for those with FASD
agreement on a standardised diagnostic tool; and
provision of early intervention services and other health services such as
speech pathology, physiotherapy and occupational therapy.
Recommendation 11
6.32 The committee recommends that the COAG establish a joint taskforce for young people living in residential care. This taskforce will:
ā¢ facilitate the development and implementation of integrated service pathways involving a range of portfolios at a state and federal level including housing, health, aged care, disability, and transport; and
ā¢ facilitate the collation and development of information packs outlining support, transition and placement options for young people. These packs should be made available to young people, their families, health practitioners and other relevant professionals in hospitals and aged care facilities. This process should collate all information and tools developed by the states during the Younger People with Disability in Residential Aged Care (YPIRAC) program and lead to the development of a standardised national information pack and make available to all state and territory governments for deployment.
6.33 The joint taskforce will also be responsible for oversight of the following for young people living in a Residential Aged Care Facility (RACF):
access to appropriate prescribed specialist services including speech pathology, physiotherapy, occupational therapy and other allied health services;
the national rehabilitation strategy;
the provision of advocates;
the expanded key worker program;
access to fully funded equipment as part of all state and territory Aids and Equipment schemes;
ā¢ a cross sector approach is adopted to explore options for the provision of short term respite services; and
ā¢ that all young people who indicate that they do not wish to live in residential care are transitioned into appropriate alternate accommodation by June 2018.
Recommendation 12
6.34 The committee recommends that the joint taskforce issues a half yearly report on the progress of Recommendation 11 to the COAG
A Bayesian approach to the analysis of time symmetry in light curves: Reconsidering Scorpius X-1 occultations
We present a new approach to the analysis of time symmetry in light curves,
such as those in the x-ray at the center of the Scorpius X-1 occultation
debate. Our method uses a new parameterization for such events (the bilogistic
event profile) and provides a clear, physically relevant characterization of
each event's key features. We also demonstrate a Markov Chain Monte Carlo
algorithm to carry out this analysis, including a novel independence chain
configuration for the estimation of each event's location in the light curve.
These tools are applied to the Scorpius X-1 light curves presented in Chang et
al. (2007), providing additional evidence based on the time series that the
events detected thus far are most likely not occultations by TNOs.Comment: 24 pages, 18 figures. Preprint typeset using LaTeX style emulateapj
v. 04/20/0
Clinically insignificant association between anterior knee pain and patellofemoral lesions which are found incidentally.
Patellofemoral chondral lesions are frequently identified incidentally during the arthroscopic treatment of other knee pathologies. A role has been described for arthroscopic debridement of such lesions when symptoms are known to originate from pathology of the patellofemoral joint. However, it remains unclear how to manage lesions which are found incidentally whilst tackling other pathologies. The purpose of this study was to establish the strength of association between anterior knee pain and patellofemoral lesions identified incidentally in a typical arthroscopic population. A consecutive series of patients undergoing arthroscopy for a range of standard indications formed the basis of this cross section study. We excluded those with patellofemoral conditions in order to identify patellofemoral lesions which were solely incidental. Pre-operative assessments were performed on 64 patients, where anterior knee pain was sought by three methods: an annotated photographic knee pain map (PKPM), patient indication with one finger and by palpated tenderness. A single surgeon, who was blinded to previous recordings, performed standard arthroscopies and recorded patellofemoral lesions. Statistical correlations were performed to identify the association magnitude. Associations were identified between incidental patellofemoral lesions and tenderness palpated on the medial patella (P=0.007, Ļ2=0.32) and the quadriceps tendon (P=0.029, Ļ2=0.26), but these associations were at best fair, which could be interpreted as clinically insignificant. In which case incidental patellofemoral lesions are not necessarily associated with anterior knee pain, we suggest that they could be left alone. This recommendation is only applicable to patellofemoral lesions which are found incidentally whilst addressing other pathology
An investigation into treatment administration and survival for people with small cell lung cancer
Background
Chemotherapy is the backbone of treatment for small cell lung cancer (SCLC) but this may change in the future with the emergence of immunotherapy. Current recommendations state performance status (PS) and comorbidity should be used as measures to decide whether chemotherapy is appropriate but in some circumstances this decision comes down to whether the patient is fit enough to withstand its toxicity. Thoracic radiotherapy and prophylactic cranial irradiation (PCI) are adjuncts to chemotherapy and can cause additional side effects, impacting quality of life. This is an important factor to consider as median survival is short. Furthermore, the efficacy of PCI has been questioned in extensive disease (ED-SCLC). In order to deliver effective treatment it is important that clinicians are aware of the short-term risks and long-term survival gains of these therapies so that a balanced, objective decision can be made before treatment is administered.
This thesis aims to improve the patient selection process by quantifying the factors that determine: receipt of treatment, early mortality and long term survival following chemotherapy. In addition, it sets survival benchmarks following the currently used treatments so that novel therapies can be compared in the future.
Methods
English national lung cancer audit data (NLCA) were linked with chemotherapy (SACT) and radiotherapy (RTDS) data to develop a multivariate logistic regression model in order to quantify the factors associated with receipt of treatment, early mortality and 1-year survival. A subsequent systematic review and meta-analysis of early and late survival following platinum chemotherapy was conducted. MEDLINE, EMBASE and online libraries from major lung cancer conferences were examined to identify studies from 1946 to 2017. Pooled survival estimates were calculated at 30 and 90 days, 1 year, 2 years and 5 years along with the median survival.
Results
Receipt of treatment
Approximately 60% of people diagnosed with SCLC received chemotherapy in the NLCA data. Receipt of treatment was independently associated with PS, age and the amount of comorbidities (P=<0.01 for all factors). There was significant variation in receipt of chemotherapy, radiotherapy and PCI by geographical location (P=<0.01 for all treatment modalities). There was no association between receiving chemotherapy and the stage of cancer.
Early survival
The 30-day mortality following chemotherapy for all stages of SCLC was approximately 7.8% in the NLCA data. This was associated with stage (ED-SCLC vs limited stage (LD-SCLC) adjusted OR 1.53 (95%CI 1.02-2.28)) and PS (PS2 vs PS0 adjusted OR 3.76 (95%CI 1.71-8.26)). After case-mix adjustment there was significant variation in 30-day mortality by geographical location (P=0.01). Thirty-day survival was considerably better in the meta-analysis of SCLC studies (all stages 98% (95% CI 98-99%, I266.2%, n=167)) and showed minimal variation by study factors. Neutropaenic sepsis and disease progression were the predominant causes of early death following chemotherapy. Overall ninety-day survival was 95% (95% CI 94-96%, I2=81.7%, n=166).
Late survival
When the NLCA data were examined there was a considerable difference in 1-year survival between LD-SCLC and ED-SCLC (approximately 60.6% and 26.2 % respectively). For individuals with LD-SCLC this was associated with PS, chemotherapy, receipt of radiotherapy (total dose ā„40Gy) and PCI. Whereas in ED-SCLC sex, PS, comorbidity, receipt of radiotherapy (total dose ā„30Gy) and PCI were associated. The odds of 1-year survival for individuals who received 6 cycles of chemotherapy, instead of 4, were not significantly different (6 cycles vs 4 LD-SCLC adjusted OR 0.97 (95%CI 0.48-1.97) and ED-SCLC adjusted OR 1.34 (95%CI 0.81-2.22)). One-year survival did not vary considerably across England, with the exception of one hospital network. This network had better survival and tended to give more radiotherapy and PCI. The meta-analysis including all stages of SCLC revealed a pooled 1-year survival of 54% (95%CI 51-57%, I2=93.3%, n=189). The reporting of 2 and 5-year survival were almost exclusive to LD-SCLC cohorts (41% (95%CI 38-44%, I2=78.9%, n=85) and 23% (95%CI 20-25%, I2=72.3%, n=48) respectively).
The median survival for individuals who did not receive chemotherapy in the national audit data was 251 days (95% CI 201-284 days) for LD-SCLC and 32 days (95% CI 28-36 days) for ED-SCLC. The meta-analysis of studies that administered chemotherapy revealed a median survival of 18.0 months (95% CI 17.0-19.1 months, I2=77.3%, n=110) for LD-SCLC and 9.6 months (95%CI 8.9-10.3 months, I2=95.2%, n=103) for ED-SCLC. These figures varied substantially by the year of study, cohort ethnicity, PS, receipt of radiotherapy and PCI, with the latter two factors applying to LD-SCLC only.
Conclusions
This research provides robust survival benchmarks for the currently recommended treatments of SCLC. Age, PS and the number of comorbidities influenced whether a person received chemotherapy yet PS and stage were the central factors determining prognosis. These two factors, PS and stage, could be used to estimate the risk of early death following chemotherapy and guide treatment decision-making. In addition to assessing early mortality risk, thoracic radiotherapy and PCI should be encouraged in favour of prolonging chemotherapy beyond 4 cycles as this may yield better 1-year survival. Indeed, reducing the geographical inequalities in access to these treatments may also augment outcomes. Further survival advances can be achieved with the development of novel therapies, however, these will require approval by national commissioning bodies prior to use in clinical practice. The survival benchmarks identified within this thesis can be used in the appraisal process to ensure the survival gains of novel therapies are true and are worth their cost
Changes in initial COPD treatment choice over time and factors influencing prescribing decisions in UK primary care : a real-world study
Acknowledgements Samantha Holmes (CircleScience, an Ashfield Company, part of UDG Healthcare plc) and Paul Hutchin (contracted to CircleScience, an Ashfield Company, part of UDG Healthcare plc) provided medical writing assistance. Funding The study was funded by Novartis Pharma AG (Basel, Switzerland).Peer reviewedPublisher PD
Use of Coniothyrium minitans transformed with the hygromycin B resistance gene to study survival and infection of Sclerotinia sclerotiorum sclerotia in soil
A Coniothyrium minitans strain (T3) co-transformed with the genes for Ī²-glucuronidase (uidA) and hygromycin phosphotransferase (hph), the latter providing resistance to the antibiotic hygromycin B, was used to investigate the survival and infection of sclerotia of Sclerotinia sclerotiorum by C. minitans over time in four different soils. Infection of sclerotia was rapid in all cases, with the behaviour of transformant T3 and wild type parent A69 being similar. Differences were seen between the soils in the rate of infection of sclerotia by C. minitans and in their indigenous fungal populations. Amendment of agar with hygromycin B enabled the quantification of C. minitans in soil by dilution plating where there was a high background of other microorganisms. In Lincoln soil from New Zealand, which had a natural but low population of C. minitans the hygromycin B resistance marker allowed the umambiguous discrimination of the applied transformed isolate from the indigenous hygromycin B sensitive one. In this soil, although the indigenous C. minitans population was detected from sclerotia, none were recovered on the dilution plates, indicating the increased sensitivity of C. minitans detection from soil using sclerotial baiting. C. minitans was a very efficient parasite, being able to infect a large proportion of sclerotia within a relatively short time from an initially low soil population. The addition of hygromycin B to agar also allowed the detection of C. minitans from decaying sclerotia by inhibiting secondary fungal colonisers. This is the first report to show that fungi colonising sclerotia already infected by C. minitans mask the detection of C. minitans from sclerotia rather than displacing the original parasite
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