Final evaluation of the saving gateway 2 pilot: main report

The Saving Gateway is a government initiative aimed at encouraging savings behaviour among people who do not usually save. Each pound placed into a Saving Gateway account is matched by the government at a certain rate and up to a monthly contribution limit. Matching provides a transparent and understandable incentive for eligible individuals to place funds in an account

Heart Rate Recovery Assessed by Cardiopulmonary Exercise Testing in Patients with Cardiovascular Disease: Relationship with Prognosis

Background: The use of exercise testing has expanded in recent decades and there is a wealth of information examining the prognostic significance of exercise variables, such as peak oxygen consumption or ventilatory measures whilst exercising. However, a paucity of research has investigated the use of recovery-derived parameters after exercise cessation. Heart rate recovery (HRR) has been considered a measure of the function of the autonomic nervous system and its dysfunction is associated with cardiovascular risk. Objectives: We aim to provide an overview of the literature surrounding HRR and its prognostic significance in patients with cardiovascular disease undertaking an exercise test. Data Sources: In December 2020, searches of PubMed, Scopus, and ScienceDirect were performed using key search terms and Boolean operators. Study Selection: Articles were manually screened and selected as per the inclusion criteria. Results: Nineteen articles met inclusion criteria and were reviewed. Disagreement exists in methodologies used for measuring and assessing HRR. However, HRR provides prognostic mortality information for use in clinical practice. Conclusions: HRR is a simple, non-invasive measure which independently predicts mortality in patients with heart failure and coronary artery disease; HRR should be routinely incorporated into clinical exercise testing

Cellulosic-crystals as a fumed-silica substitute in vacuum insulated panel technology used in building construction and retrofit applications

This article investigates impact of substituting fumed silica with a cellulosic-crystal innovation in a commercial Vacuum Insulated Panel (VIP) core. High building performance demands have attracted VIP technology investment to increase production capacity and reduce cost. In building retrofit VIPs resolve practical problems on space saving that conventional insulations are unsuitable for. Three challenges exists in fumed silica: cost, low sustainability properties, and manufacture technical maturity. Cellulosic nano-crystal (CNC) technology is in its infancy and was identified as a possible alternative due to a similar physical nano-structure, and biodegradability. The study aim was to determine a performance starting point and establish how this compares with the current benchmarks. Laboratory cellulosic-crystal samples were produced and supplied for incorporation into commercial VIP manufacture. A selection of cellulosic-panels with core densities ranging 127–170 kg/m3 were produced. Thermal conductivities were tested at a pressure of 1 Pa (0.01 mBar), with the results compared against a selection of fumed silica-VIPs with core densities ranging 144–180 kg/m3. Conductivity tests were then done on a cellulosic-VIP with 140 kg/m3 density, under variable pressures ranging 1–100,000 Pa (0.01–1000 mBar). This investigated panel lifespan performance, with comparisons made to a fumed silica-VIP of similar core density. Manufactured cellulosic-samples were found unsuitable as a commercial substitute, with performance below current standards. Areas for cellulosic nano-material technology development were identified that show large scope for improvement. Pursuit could create a new generation of insulation materials that resolve problems associated with current commercial versions. This is most applicable in building retrofit where large ranges of domestic and commercial cases are marginalised from their construction markets due to impracticalities and high upgrade costs. This being a problem in multiple economies globally

Preoperative aerobic fitness and perioperative outcomes in patients undergoing cystectomy before and after implementation of a national lockdown

Background: Lower fitness is a predictor of adverse outcomes after radical cystectomy. Lockdown measures during the COVID-19 pandemic affected daily physical activity. We hypothesised that lockdown during the pandemic was associated with a reduction in preoperative aerobic fitness and an increase in postoperative complications in patients undergoing radical cystectomy. Methods: We reviewed routine preoperative cardiopulmonary exercise testing (CPET) data collected prior to the pandemic (September 2018 to March 2020) and after lockdown (March 2020 to July 2021) in patients undergoing radical cystectomy. Differences in CPET variables, Postoperative Morbidity Survey (POMS) data, and length of hospital stay were compared. Results: We identified 267 patients (85 pre-lockdown and 83 during lockdown) who underwent CPET and radical cystectomy. Patients undergoing radical cystectomy throughout lockdown had lower ventilatory anaerobic threshold (9.0 [7.9–10.9] vs 10.3 [9.1–12.3] ml kg−1 min−1; P=0.0002), peak oxygen uptake (15.5 [12.9–19.1] vs 17.5 [14.4–21.0] ml kg−1 min−1; P=0.015), and higher ventilatory equivalents for carbon dioxide (34.7 [31.4–38.5] vs 33.4 [30.5–36.5]; P=0.030) compared with pre-lockdown. Changes were more pronounced in males and those aged >65 yr. Patients undergoing radical cystectomy throughout lockdown had a higher proportion of day 5 POMS-defined morbidity (89% vs 75%, odds ratio [OR] 2.698, 95% confidence interval [CI] 1.143–6.653; P=0.019), specifically related to pulmonary complications (30% vs 13%, OR 2.900, 95% CI 1.368–6.194; P=0.007) and pain (27% vs 9%, OR 3.471, 95% CI 1.427–7.960; P=0.004), compared with pre-lockdown on univariate analysis. Conclusions: Lockdown measures in response to the COVID-19 pandemic were associated with a reduction in fitness and an increase in postoperative morbidity among patients undergoing radical cystectomy

Users’ experiences of lighting controls: a case-study

The aim of this paper is to elucidate how occupants perceive their lit environments in a university setting and how they interact with lighting controls using qualitative methods. Semi-structured interviews were carried out with academic teaching and research staff. Thematic analysis identified four main themes: control and choice, connection with the outdoors, concentration, and comfort. Participants were largely able to control and adapt their lighting using small power lighting in office spaces and they perceived this as beneficial to comfort and concentration. Participants expressed frustration with the light switches in classrooms, a lack of consistency in lighting controls across the university buildings was particularly notable. Installers should consider how piecemeal upgrades on large estates affect the perception of buildings where occupiers face multiple control systems. The management of the lighting in classroom spaces including the type and location of blinds, lack of regular window cleaning in some buildings and difficulty in minimising light on projection screens in upgraded classrooms were cited as areas for improvement. Wider implications for lighting control and management highlighted by this study include most notably that a lack of end users consultation has serious consequences on their perception of lighting upgrades and their willingness to employ “workarounds”

Cardiopulmonary exercise testing and cardiopulmonary morbidity in patients undergoing major head and neck surgery

Cardiopulmonary exercise testing (CPET) is used as a risk stratification tool for patients undergoing major surgery. In this study, we investigated the role of CPET in predicting day five cardiopulmonary morbidity in patients undergoing head and neck surgery. This observational cohort study included 230 adults. We recorded preoperative CPET variables and day five postoperative cardiopulmonary morbidity. Full data from 187 patients were analysed; 43 patients either had incomplete data sets or declined surgery/CPET. One hundred and nineteen patients (63.6%) developed cardiopulmonary morbidity at day five. Increased preoperative heart rate and duration of surgery were independently associated with day five cardiopulmonary morbidity. Those with such morbidity also had lower peak V̇O2 11.4 (IQR 8.4-18.0) vs 16.0 (IQR 14.0-19.7) ml.kg-1.min-1, P<0.0001 and V̇O2 at AT 10.6 (IQR 9.1-13.1) vs 11.5 (IQR 10.5-13.0) ml.kg-1.min-1, p=0.03. Logistic regression model containing peak V̇O2 and duration of surgery demonstrated that increased peak V̇O2 was associated with a reduction in the likelihood of cardiopulmonary complications OR 0.92 (95%CI 0.87 to 0.96), p=0.001. The area under the receiver operating characteristic curve for this model was 0.75(95%CI 0.68 to 0.82), p<0.0001, 64% sensitivity, 81% specificity. CPET can help to predict day five cardiopulmonary morbidity in the patients undergoing head and neck surgery. A model containing peak V̇O2 allowed identification of those with such complications

Vascular phenotype in angiogenic and non-angiogenic lung non-small cell carcinomas

We have previously described a group of non-small cell lung carcinomas without morphological evidence of neo-angiogenesis. In these tumours neoplastic cells fill up the alveoli and the only vessels present appear to belong to the trapped alveolar septa. In the present study we have characterised the phenotype of the vessels present in these non-angiogenic tumours, in normal lung and in angiogenic non-small cell lung carcinomas. The vessels, identified by the expression of CD31, were scored as mature when expressing the epitope LH39 in the basal membrane and as newly formed when expressing αVβ3 on the endothelial cells and/or lacking LH39 expression. In the nine putative non-angiogenic cases examined, the vascular phenotype of all the vessels was the same as that of alveolar vessels in normal lung: LH39 positive and αVβ3 variable or negative. Instead in 104 angiogenic tumours examined, only a minority of vessels (mean 13.1%; range 0–60%) expressed LH39, while αVβ3 (in 45 cases) was strongly expressed on many vessels (mean 55.5%; range 5–90%). We conclude that in putative non-angiogenic tumours the vascular phenotype is that of normal vessels and there is no neo-angiogenesis. This type of cancer may be resistant to some anti-angiogenic therapy and different strategies need to be developed

Evaluation of the Social Services and Well-being (Wales) Act 2014: Literature Review

The author list for the literature review is provided below: Evaluation of the Social Services and Well-being (Wales) Act 2014: Literature Review Chapter authors: Introduction and methods Verity, F., Wallace, S., Llewellyn, M., Anderson, P. and Lyttleton-Smith, J. Well-being Anderson, P., Lyttleton-Smith, J., Kosnes, L., Read, S., Blackmore, H. and Williams, Z. Prevention and early intervention Verity, F., Read, S. and Richards, J. Co-production Andrews, N., Calder, G., Blanluet, N., Tetlow, S. and Wallace, S. Multi-agency Wallace, C., Orrell, A., Garthwaite, T., Tetlow, S. and Wallace, S. Voice and control Llewellyn, M., Saltus, R., Blackmore, H., Tetlow, S., Williams, Z. and Wallace, S. Financial and economic Phillips, C., Prowle, M., Tetlow, S. and Williams, Z. Service user and carer experiences under the Act Wallace, S.This report is a summary of the extensive review of the literature to inform the evaluation of the Social Services and Well-being (Wales) Act 2014. This document is a summary of the extensive review of the literature undertaken to inform the evaluation of the Social Services and Well-being (Wales) Act 2014 (hereafter referred to as ‘the Act’).1 The Welsh Government has commissioned a partnership between academics across four universities in Wales and expert advisers to deliver the evaluation. The Act sets out a government vision to produce ‘transformative changes’ in social service public policy, regulations, and delivery arrangements across Wales. It has 11 parts and is informed by five principles that set out a vision to produce transformative changes in public policy, regulations, and service delivery. Aligned to it are structures, processes, and codes of practice. The Evaluation of the Act – a study called IMPACT – is organised around each of the five principles together with a focus on the financial and economic aspects of the Act’s implementation. The approach to undertaking this evaluation research is to structure the evaluation by using the fundamental principles of the Act as the scaffolding. These principles are: • Well-being • Prevention • Co-Production • Multi-agency working • Voice and control There is also a focus on the financial and economic considerations of the implementation of the Act and this area constitutes the sixth evaluation study theme