Transport and Older People: Integrating Transport Planning Tools with User Needs

This study was funded through a pump-priming grant from the Strategic Promotion of Ageing Research Capacity (SPARC) programme. The purpose of the project was to bring together transport and public health research in order to demonstrate how the involvement of older people can help improve tools for transport planning. The study was unique in that it brought together public health and transport planning and engineering with older people to consider how services can be more responsive to older people’s transport needs. The project had five research objectives: 1. To investigate how accessibility problems impact on older people’s independence 2. To determine the extent to which currently available data sources and modelling tools reflect older people’s stated accessibility needs 3. To understand how the gap between expected and perceived accessibility problems varies across different categories of older people 4. To pilot techniques that could be applied to provide a more robust measure of accessibility for older people. 5. To build new research capacity across disciplines to develop a national focus on the interactions between ageing and transport planning. The methods were determined on the basis of ‘appropriate tools with maximum output’. Focus group interviews were selected as a useful tool for reaching a large number of older people within a limited time span, for providing an arena for discussion and debate about a topical subject and for generating ideas for improving transport planning. Following the interviews accompanied walks were undertaken with older people in a range of road environments and traffic situations. The purpose of these walks was to observe and explore the way older people interact with their environment. Data from the focus group interviews and the observations were compared with the outputs from an accessibility planning tool used by local authorities to plan accessible and acceptable transport routes (Accession™). The purpose of this exercise was to investigate whether or not such tools are able to take into account the varying needs of older people. The study was undertaken over eight months. Eighty one older people living in the Leeds district took part in the focus groups. They covered a broad range of mobility levels and used a variety of transport types, as such a reasonably rounded perspective on the issues concerned was offered. In addition six walks were undertaken with older people in their community

Thrombotic variables and risk of idiopathic venous thromboembolism in women aged 45-64 years - Relationships to hormone replacement therapy

Hormone replacement therapy (HRT) has been shown to increase the relative risk of idiopathic venous thromboembolism (VTE) about threefold in several observational studies and one randomised controlled trial. Whether or not this relative risk is higher in women with underlying thrombophilia phenotypes, such as activated protein C (APC) resistance, is unknown. We therefore restudied the participants in a case-control study of the relationship between the use of HRT and the occurrence of idiopathic VTE in women aged 45-64 years. After protocol exclusions, 66 of the cases in the original study and 163 of the controls were studied. Twenty haematological variables relevant to risk of VTE were analysed, including thrombotic states defined from the literature. The relative risk of VTE showed significant associations with APC resistance (OR 4.06; 95% CI 1.62, 10.21); low antithrombin (3.33; 1.15, 9.65) or protein C (2.93; 1.06, 8.14); and high coagulation factor IX (2.34: 1.26, 1.35), or fibrin D-dimer (3.84; 1.99, 7.32). HRT use increased the risk of VTE in women without any of these thrombotic static; (OR 4.09; 95% CI 1.26, 13.30). A similar effect of HRT use on the relative risk of VTE was also found in women with prothrombotic states. Thus for example, the combination of HRT use and APC resistance increased the risk of VTE about 13-fold compared with women of similar age without either APC resistance or HRT use (OR 13.27; 95%, CI 4.30, 40.97). We conclude that the combination of HRT use and thrombophilias (especially if multiple) increases the relative risk of VTE substantially; hence women known to have thrombophilias (especially if multiple) should be counselled about this increased risk prior to prescription of HRT. However. HRT increases the risk of VTE about fourfold even in women without any thrombotic abnormalities: possible causes are discussed

Effects of moderate weight loss on anginal symptoms and indices of coagulation and fibrinolysis in overweight patients with angina pectoris

Objective: To evaluate the effects of moderate weight loss, in overweight patients with angina, on plasma coagulation, fibrinolytic indicies and pain frequency. Design: Single- stranded 12-week dietary intervention, an individualised eating plan with quantitative advice delivered by a dietitian. Target weight loss of 0.5 kg per week. Setting: Outpatient research clinic. Subjects: Fifty-four volunteers with angina pectoris were recruited. Five subjects withdrew, so 27 males, 22 females, mean body mass index (BMI) 29.3 (s.d. 4.3) kg/m(2) and age 60.3 (s.d. 6.5) y completed the intervention. Measurements: Body weight and frequency of anginal pain. Plasma fibrinogen, red cell aggregation (RCA), viscosity, factor VII activity, plasminogen activator inhibitor (PAI) activity, tissue plasminogen activator antigen (t-PA), plasma cholesterol, triglyceride and insulin. Results: After the 12-week dietary intervention period, mean body weight fell by 3.5 (s.d. 2.6) kg or 4.3% (P = 0.0001), range -11.7 to +1.7 kg. Mean angina frequency fell by 1.8 (s.d. 3.6) from 3.2 to 1.4 episodes/week (P = 0.009) and plasma cholesterol by 0.4 (s.d. 0.7) from 6.3 to 5.9 mmol/1 (P = 0.0001). HDL cholesterol and triglyceride were unchanged. Of the coagulation and fibrinolytic factors, factor VII activity and RCA were significantly reduced by 5 (s.d. 20), IU/dl (P = 0.04) and 1.3 (s.d. 1.3) arbitrary units (P = 0.014), respectively. Conclusions: A conventional dietetic intervention, resulting in 4% weight loss, offers the potential to reduce atherosclerotic and thrombotic risk, and to reduce pain frequency, in angina patients. Given the importance of this result in a public health context, these results indicate that this may be a fruitful area for future nutrition research

Supervised exercise training and increased physical activity to reduce cardiovascular disease risk in women with polycystic ovary syndrome: Study protocol for a randomized controlled feasibility trial

Background: Polycystic ovary syndrome (PCOS) affects up to 20% of women and is characterised by higher amounts of visceral fat, obesity, insulin resistance, dyslipidemia and reproductive and cardiometabolic complications. Increased oxidised low-density lipoprotein (LDL) concentrations have been associated with an increased risk of cardiovascular disease (CVD)-related events. Oxidised LDL is rarely used as a marker for CVD risk in PCOS-related studies despite its widely accepted role in atherogenesis and the increased risk factors associated with PCOS. Additionally, prolonged periods of sedentary behaviour can negatively affect metabolic health. No studies have specifically examined the effects of reducing sedentary behaviour on CVD risk in PCOS with a lifestyle physical activity intervention. The aim of the current study is to measure the feasibility of a randomised controlled trial (RCT) examining the effects of supervised exercise and reducing sedentary behaviour in women with PCOS on CVD risk. Methods/design: A feasibility, exploratory RCT will be conducted. Fifty-one pre-menopausal females will be randomly allocated between an exercise group (EG), a lifestyle physical activity group (LPAG) and a control group. Participants in the EG will undertake a 12-week supervised aerobic exercise programme. The LPAG will aim to increase daily physical activity and reduce sedentary behaviour for 12 weeks. The control group will not take part in any intervention. Primary outcomes are feasibility and acceptability of the intervention and procedures. Secondary outcomes are oxidised LDL, aerobic fitness, blood lipid profile, fasting glucose and insulin, testosterone and inflammatory markers. Discussion: PCOS is associated with various increased risk factors for CVD, including hypertension, dyslipidemia, abdominal obesity, insulin resistance, and inflammation. Whether oxidised LDL has a role in this increased risk is not yet known. The present study aims to measure the feasibility of implementing structured exercise training and/or increased lifestyle physical activity in women with PCOS, so that a subsequent adequately powered RCT can be designed. The results from the study will be used to refine the interventions and determine the acceptability of the study design. A limitation is that some self-monitoring in the lifestyle physical activity group may not be reliable or replicable, for example inputting information about time spent cleaning/gardening

First Meeting of the joint IOC-ICES Study Group on Nutrient Standards (SGONS)

A meeting of the joint IOC-ICES Study Group on Nutrient Standards (SGONS) was held in Paris, France on 23-24 March 2010. It focused on the ongoing activities of the SGONS and plans for extended international collaborations to establish global comparability of the nutrient data from the world’s ocean. Thirty two scientists and experts from 11 countries and 2 delegates from IOC attended the meeting. The discussions followed the Terms of References of SGONS established in July 2009. Development of the reference materials for nutrients in seawater (RMNS) were also discussed in collaboration with the producers. The background and history of SGONS and an international nutrients scale system INSS and the progress with the production of RMNS materials and their current availability were reported. The production of RMNS and the latest status of the RMNS production facility, current status on the certification of RMNS for nitrate, nitrite, phosphate and silicate at the National Metrology Institute of Japan were also reported. The revised nutrients analysis manual which is being undertaken by the SGONS hopefully would be completed by 1 August 2010, and it will be published on line at the Go-Ship website. Results obtained with RMNS solutions used on the P6 reoccupation cruise in 2009-2010 by SIO (Scripps Institute of Oceanography, USA) showed that considerable improvement could be made in the internal comparability of the data by referencing it to the RMNS results and related good comparability with the previous P6 cruise in 2003 by JAMSTEC when RMNS were also used. The meeting strongly endorsed the idea of a ship board workshop in 2013/14 during which major groups would carry out a full inter-comparison of all procedures including analytical methods on board a research ship. The global stability test of RMNS by ten core laboratories of SGONS which started in 2009 will continue for more two years. It also was agreed to set up an international steering committee to plan the next inter-laboratory comparison study which will extend the study to about 70 laboratories working globally on deep sea hydrography. This will happen in early 2011. Future arrangements were considered for the collection of more batches of seawater for the preparation of RMNS waters suitable for use in all major water masses, and a list of candidate cruises in 2010/2011 was prepared. The related point of the extension of the use of RMNS for work in shelf sea water was also discussed, this followed on from discussions at the ICES Marine Chemistry Working Group (MCWG) meeting in 2010. The ICES MCWG considered that the use of suitable RMNS solutions would be valuable for improving the inter comparability of shelf sea data and be a valuable complement to work with the existing QUASIMEME proficiency testing scheme

The tail of the Jurassic fish Leedsichthys problematicus (Osteichthyes: Actinopterygii) collected by Alfred Nicholson Leeds - an example of the importance of historical records in palaeontology

The specimen of the tail of <i>Leedsichthys problematicus</i>, now in The Natural History Museum, London, was one of the most spectacular fossil vertebrates from the Oxford Clay Formation of Peterborough, but as an isolated find it shares no bones in common with the holotype of the genus and species. However, a letter from Alfred Nicholson Leeds and related documents cast valuable new light on the excavation of the tail, indicating that it was discovered with cranial bones, gill-rakers, and two pectoral fins, thereby including elements that can potentially be compared with those of the holotype. The documents also clearly indicate that The Natural History Museum's specimen is not part of the same individual as any other numbered specimen of <i>Leedsichthys</i> as had been speculated on other occasions. The maximum size of the animal represented by The Natural History Museum's specimen was possibly around 9 metres, considerably less than previous estimates of up to 27.6 metres for <i>Leedsichthys</i>. Historical documentary evidence should therefore be rigorously checked both when studying historical specimens in science, and in preparing text for museum display labels

Effectiveness of an inlet flow turbulence control device to simulate flight noise fan in an anechoic chamber

A hemispherical inlet flow control device was tested on a 50.8 cm. (20-inch) diameter fan stage in the NASA-Lewis anechoic chamber. The control device used honeycomb and wire mesh to reduce turbulence intensities entering the fan. Far field acoustic power level results show about a 5 db reduction in blade passing tone and about 10 dB reduction in multiple pure tone sound power at 90% design fan speed with the inlet device in place. Hot film cross probes were inserted in the inlet to obtain data for two components of the turbulence at 65 and 90% design fan speed. Without the flow control device, the axial intensities were below 1.0%, while the circumferential intensities were almost twice this value. The inflow control device significantly reduced the circumferential turbulence intensities and also reduced the axial length scale

Implementation of a Standardized Handoff System for a General Surgery Residency Program

Introduction: The I-PASS Handoff Bundle is an evidence based standardized set of educational materials designed to decrease handoff failures in patient care. Two of every three sentinel events , the most serious events reported to the Joint Commission, are due to failures of communication, including miscommunication during patient care handoffs. Implementation of the I-PASS method results in decreased medical errors and preventable adverse events There are few studies that evaluate this validated method in the context of a General Surgery resident program We aim to implement the I-PASS system into the transition of care process for General Surgery residents at our institution, and to analyze of the quality of the handoff process before and after the implementation.https://jdc.jefferson.edu/patientsafetyposters/1047/thumbnail.jp