Cast metal cap splint use for immobilisation of mandibular fracture.

Use of cast metal cap splints in a patient with multiple fractures to sphenoid, zygoma, orbital floor and mandible unable to receive surgical treatment for reduction and fixation of fractured segments due to cervical spine fractures; technique considered in disuse by many

Ageing simulation of a hydraulic engine mount: a data informed finite element approach

Hydraulic engine mounts are key elements in an automotive vehicle suspension system that typically experience a change of their designed function during their working lifetime due to progressive material ageing, primarily from the elastomeric component. Ageing of the engine mount, resulting from severe and continuous mechanical and thermal loads, can have a detrimental impact on the ride and comfort and long-term customer satisfaction. This paper introduces a new practical methodology for simulating the ageing behaviour of engine mounts resulting from the change in properties of their elastomeric main spring component. To achieve this, a set of dynamic mechanical thermal analysis tests were conducted on elastomeric coupons taken from a set of engine mounts with different service and ageing conditions. These experimental results were used to characterise the change in mechanical response of the elastomer and to build up an empirical elastomer ageing model. Then a finite element model of the main spring was developed that used the elastomer ageing model so that the ageing behaviour of the engine mount could be simulated. The resulting ageing model was verified by using experimental results from a second batch of ex-service engine mounts. The results show an increasing trend of the vertical static stiffness of the engine mounts with distance travelled (or age) up to a certain distance (approximately 95,000 km). The trend is then reversed and a softening effect is observed. Moreover, the results reveal that both the maximum stiffness value and the distance travelled at the peak stiffness decrease as the temperature increases

School exclusion in children with psychiatric disorder or impairing psychopathology: a systematic review

This is an Accepted Manuscript of an article published by Taylor & Francis in Emotional and Behavioural Difficulties on 20 August 2014, available online: http://wwww.tandfonline.com/10.1080/13632752.2014.945741Childhood psychiatric disorders are associated with a wide range of adverse outcomes including poor academic attainment. For some children these difficulties are recognised through school Special Educational Need procedures (SEN) but many others may remain unidentified and/or unsupported. In Britain, government data suggests disproportionate representation of children with a SEN among children permanently excluded from school. This review asks whether school-aged children with impairing psychopathology were more likely to be excluded from school than those without. Databases covering education, social sciences, psychology and medicine were searched, experts were contacted and bibliographies of key papers were hand-searched. Studies were included if the population covered school-aged children, and if validated diagnostic measures had been used to assess psychopathology. Children with impairing psychopathology had greater odds of exclusion compared to the rest of the school-age population: odds ratios range from 1.13 (95% CI: 0.55–2.33) to 45.6 (95% CI: 3.8–21.3). These findings however need to be considered in light of the paucity of the literature and methodological weaknesses discussed.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula

Nonlinear Dynamics of Structures with Material Degradation

Structures usually experience deterioration during their working life. Oxidation, corrosion, UV exposure, and thermo-mechanical fatigue are some of the most well-known mechanisms that cause degradation. The phenomenon gradually changes structural properties and dynamic behaviour over their lifetime, and can be more problematic and challenging in the presence of nonlinearity. In this paper, we study how the dynamic behaviour of a nonlinear system changes as the thermal environment causes certain parameters to vary. To this end, a nonlinear lumped mass modal model is considered and defined under harmonic external force. Temperature dependent material functions, formulated from empirical test data, are added into the model. Using these functions, bifurcation parameters are defined and the corresponding nonlinear responses are observed by numerical continuation. A comparison between the results gives a preliminary insight into how temperature induced properties affects the dynamic response and highlights changes in stability conditions of the structure

Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis

BACKGROUND: Limited attention has been paid in the literature to multiple component fall prevention interventions that comprise two or more fixed combinations of fall prevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations. METHODS: Medline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013. RESULTS: Eighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio = 0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio = 0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I(2) =20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell. CONCLUSIONS: This systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option.National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) for the South West Peninsul

Patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review of patient reported outcomes and patient and clinician satisfaction

This is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: The cost to the NHS of missed or inappropriate hospital appointments is considerable. Alternative methods of appointment scheduling might be more flexible to patients' needs without jeopardising health and service quality. The objective was to systematically review evidence of patient initiated clinics in secondary care on patient reported outcomes among patients with chronic/recurrent conditions. METHODS: Seven databases were searched from inception to June 2013. Hand searching of included studies references was also conducted. Studies comparing the effects of patient initiated clinics with traditional consultant led clinics in secondary care for patients with long term chronic or recurrent diseases on health related quality of life and/or patient satisfaction were included. Data was extracted by one reviewer and checked by a second. Results were synthesised narratively. RESULTS: Seven studies were included in the review, these covered a total of 1,655 participants across three conditions: breast cancer, inflammatory bowel disease and rheumatoid arthritis. Quality of reporting was variable. Results showed no significant differences between the intervention and control groups for psychological and health related quality of life outcomes indicating no evidence of harm. Some patients reported significantly more satisfaction using patient-initiated clinics than usual care (p < 0.001). CONCLUSIONS: The results show potential for patient initiated clinics to result in greater patient and clinician satisfaction. The patient-consultant relationship appeared to play an important part in patient satisfaction and should be considered an important area of future research as should the presence or absence of a guidebook to aid self-management. Patient initiated clinics fit the models of care suggested by policy makers and so further research into long term outcomes for patients and service use in this area of practice is both relevant and timely.This systematic review was funded by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health

The clinical effectiveness of patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review

This is the final version of the article. Available from Public Library of Science via the DOI in this record.BACKGROUND: Missed or inappropriate hospital appointments cost the UK National Health Service millions of pounds each year and delay treatment for other patients. Innovative methods of appointment scheduling that are more flexible to patient needs, may improve service quality and preserve resources. METHODS: A systematic review of the evidence for the clinical effectiveness of patient initiated clinics in managing long term care for people with chronic or recurrent conditions in secondary care. Seven databases were searched including MEDLINE, Embase and PsycINFO (using the OVID interface), the Cochrane Library of Systematic Reviews and CENTRAL, Science Citation Index Expanded, Social Sciences Citation Index, and Conference Proceedings Citation Index (via the Web of Science interface) from inception to June 2013. Studies comparing patient initiated clinics with traditional consultant-led clinics in secondary care for people with long term chronic or recurrent diseases were included. Included studies had to provide data on clinical or resource use outcomes. Data were extracted and checked by two reviewers using a piloted, standardised data extraction form. RESULTS: Eight studies (n = 1927 individuals) were included. All were conducted in the UK. There were few significant differences in clinical outcomes between the intervention and control groups. In some instances, using the patient initiated clinics model was associated with savings in time and resource use. The risk of harm from using the patient initiated clinic model of organising outpatient care is low. Studies with longer follow-up periods are needed to assess the long term costs and the ongoing risk of potential harms. CONCLUSIONS: The UK policy context is ripe for evidence-based, patient-centred services to be implemented, especially where the use of health care resources can be optimised without reducing the quality of care. Implementation of patient initiated clinics should remain cautious, with importance placed on ongoing evaluation of long term outcomes and costs.This systematic review was funded by the National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for the South West. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Containment: Logistics, Environmental Conflict, and the Legal Geography of Inland Ports

In 2020, as the COVID-19 pandemic disrupted the supply chain, people worldwide received a crash course in the importance of logistics when corporations like Amazon became a lifeline for many. Before this increased public attention, however, scholars in geography had shown logistics to be a highly political yet indispensable process in the operation of global capitalism. Much of this scholarship underscores how the logistics industry frequently operates at the expense of marginalized people, workers, and the environment. In this dissertation, I expand on this work by adding a legal geography and political ecology analysis—a legal political ecology approach—to examine the establishment of two logistics sites in inland North America: the Utah Inland Port, in Salt Lake City, as well as the CenterPoint and NorthPoint Intermodals outside of Chicago. Using interviews and participant observations collected at these sites, I argue that the logistics industry must enact various forms of containment—through legal enclosure, features in the built environment, and discourse—in order to assist in the movement of commodities. However, I also contend that these acts of containment ultimately fail as the adverse environmental impacts associated with the logistics industry inevitably spillover the logistical zones of containment. To make these arguments, I highlight how activist organizations scrutinize these forms of enclosure, and the paradoxical nature of containment in an industry that is reliant on the free flow of goods. Last, by illustrating the prominent role municipal and state law plays in the formation of logistics sites, I show how unpopular logistics projects get carried out against the will of frontline communities and the environmentalists, labor activists, and other groups who challenge the unfettered expansion of warehouses, distribution centers, and intermodal hubs

An investigation of the structurally induced acoustic field in a car passenger compartment

The causes and characteristics of structurally induced interior noise in cars in relation to the boom problem is discussed and the relevant theory developed. The work is concerned with structural excitation of the air within the passenger compartment associated with the second order component of the engine crankshaft out of balance forces. This limits the frequency range of interest to below 200 Hz. Firstly, the acoustic modes of a Rover Metro passenger compartment are predicted using the finite element method. A new method for the experimental acoustic modal analysis of cavities is introduced and verified for a rectangular rigid walled room. The method is then applied to the untrimmed passenger compartment of a Rover Metro to determine its acoustic modes and to study the interaction of the structural modes of the vehicle body and acoustic response of the cavity. The acoustics of a Rover Metro passenger compartment are modelled using the finite element method with experimental structural FRF data from the car body as a forcing function. This model is used to predict the noise spectra associated with the second order component of engine excitation experienced by occupants for the bare body. The acoustic effects of various items of trim are added to the model as acoustic absorption coefficients to show the Significance of trim in reducing low frequency boom in car passenger compcompartments. The necessary absorption coefficients were measured with an impedance tube

Fountains in a desert : place-making and collective action in Snake Valley, Great Basin against southern Nevada water authority's groundwater development project

This thesis explores how a diverse coalition of rural residents, ranchers, Native American tribes, and environmental activists -- many of them united under the grassroots organization known as the Great Basin Water Network (GBWN) -- have successfully created, used, and negotiated differing senses of place to resist the construction and implementation of a rural-to-urban inter-basin water transfer project. The Groundwater Development Project, first proposed in 1989 and later revived in 2004, is an effort by the Southern Nevada Water Authority (SNWA) to obtain water for the expanding Las Vegas metropolitan area. However, in the face of fierce resistance, led by the aforementioned coalition -- which is centered in Snake Valley on the Nevada/Utah border -- SNWA has yet to be granted the legal precedent to complete the multibillion dollar pipeline project. Drawing from the theoretical lenses of place-framing and relational place-making, this thesis shows that the social construction of place is a powerful tool in grassroots organizing and politics; a tool, in this case, that has been greatly enhanced through an existing network of people and places, originally formed in the early 1980s to resist the MX Missile Project, which has been effectively revived to engage in protest against SNWA's Groundwater Development Project